Chapter: Pharynx
Topic: Pharyngeal Muscles
Subtopic: Passavant's Ridge
Keyword Definitions:
Passavant's Ridge: A mucosal ridge on the posterior pharyngeal wall during swallowing.
Superior Constrictor: Muscle forming posterior pharyngeal wall, contributes to ridge formation.
Palatopharyngeus: Elevates pharynx and contributes fibers to ridge.
Palatoglossus: Muscle connecting tongue to palate, not involved in ridge.
Inferior Constrictor: Pharyngeal constrictor muscle, not part of ridge formation.
Soft Palate: Muscular fold that closes nasopharynx during swallowing.
Lead Question – 2012
Passavant ridge ?
a) Superior constrictor and palatopharyngeus
b) Inferior constrictor and palatopharyngeus
c) Superior constrictor and palatoglossus
d) Inferior constrictor and palatoglossus
Explanation: Passavant’s ridge is a mucosal prominence formed by contraction of the superior constrictor and palatopharyngeus during swallowing. It helps close the nasopharyngeal isthmus against the soft palate, preventing nasal regurgitation. Correct answer: a) Superior constrictor and palatopharyngeus.
Question 2. A patient presents with nasal regurgitation of liquids. Dysfunction of which structure is most likely?
a) Palatoglossus
b) Passavant’s ridge
c) Cricopharyngeus
d) Stylopharyngeus
Explanation: Failure of Passavant’s ridge to form properly prevents closure of nasopharynx, causing nasal regurgitation. This occurs with superior constrictor or palatopharyngeus weakness. Correct answer: b) Passavant’s ridge.
Question 3. Which muscle is primarily responsible for preventing food from entering the nasopharynx?
a) Tensor veli palatini
b) Levator veli palatini
c) Palatopharyngeus
d) Stylopharyngeus
Explanation: Levator veli palatini elevates the soft palate, sealing the nasopharynx against Passavant’s ridge. This prevents regurgitation during swallowing. Correct answer: b) Levator veli palatini.
Question 4. A lesion of glossopharyngeal nerve will most likely cause?
a) Absent gag reflex
b) Nasal regurgitation
c) Hoarseness
d) Shoulder droop
Explanation: Glossopharyngeal nerve supplies sensory input for gag reflex. Its lesion abolishes gag reflex while motor defects are due to vagus/accessory nerve. Correct answer: a) Absent gag reflex.
Question 5. Inadequate closure of the nasopharynx during swallowing is due to paralysis of?
a) Palatopharyngeus
b) Stylopharyngeus
c) Masseter
d) Cricopharyngeus
Explanation: Palatopharyngeus elevates pharynx and forms Passavant’s ridge. Its dysfunction leads to failure of nasopharyngeal closure. Correct answer: a) Palatopharyngeus.
Question 6. A child with cleft palate develops hypernasal speech. The main cause is?
a) Weak palatal closure
b) Weak tongue movement
c) Laryngeal stenosis
d) Weak jaw closure
Explanation: Hypernasality results from failure of palatal muscles and Passavant’s ridge to close the nasopharyngeal opening during speech. Correct answer: a) Weak palatal closure.
Question 7. Which nerve mediates motor supply to palatal muscles except tensor veli palatini?
a) Glossopharyngeal
b) Vagus via cranial accessory
c) Trigeminal mandibular
d) Hypoglossal
Explanation: All palatal muscles except tensor veli palatini are supplied by vagus through cranial part of accessory nerve. Correct answer: b) Vagus via cranial accessory.
Question 8. Which muscle is supplied by mandibular nerve among palatal muscles?
a) Levator veli palatini
b) Tensor veli palatini
c) Palatopharyngeus
d) Palatoglossus
Explanation: Tensor veli palatini is the only palatal muscle supplied by mandibular division of trigeminal nerve. Correct answer: b) Tensor veli palatini.
Question 9. A 40-year-old develops difficulty swallowing with nasal escape of food. Which nerve is most likely affected?
a) Vagus
b) Hypoglossal
c) Facial
d) Glossopharyngeal
Explanation: Vagus nerve supplies motor fibers to palatal muscles (via cranial accessory). Its lesion causes palatal paralysis and nasal regurgitation. Correct answer: a) Vagus.
Question 10. Which muscle contributes to Passavant’s ridge along with superior constrictor?
a) Palatopharyngeus
b) Palatoglossus
c) Stylopharyngeus
d) Tensor veli palatini
Explanation: Passavant’s ridge is formed by palatopharyngeus fibers joining superior constrictor contraction. Correct answer: a) Palatopharyngeus.
Question 11. A surgeon notes poor closure of nasopharynx after adenoidectomy. Which structure is compromised?
a) Passavant’s ridge
b) Cricopharyngeus
c) Stylopharyngeus
d) Tensor veli tympani
Explanation: If Passavant’s ridge or its contributing muscles are injured, nasopharyngeal closure fails, leading to regurgitation or hypernasal speech. Correct answer: a) Passavant’s ridge.
Chapter: Larynx
Topic: Cartilages of Larynx
Subtopic: Types of Laryngeal Cartilages
Keyword Definitions
Hyaline cartilage: Firm, translucent cartilage found in laryngeal cartilages like thyroid, cricoid, arytenoid. Can ossify with age.
Elastic cartilage: Flexible cartilage that retains shape, seen in epiglottis, corniculate, cuneiform.
Cricoid cartilage: Only complete ring of cartilage in airway, hyaline in nature.
Epiglottis: Leaf-shaped, elastic cartilage preventing aspiration.
Arytenoid cartilage: Paired hyaline cartilages with muscular and vocal processes.
Corniculate & cuneiform cartilages: Accessory elastic cartilages for laryngeal support.
Ossification of laryngeal cartilages: Hyaline cartilages ossify with age; elastic do not.
Lead Question – 2012
Which of the following laryngeal cartilage is hyaline?
a) Epiglottis
b) Corniculate
c) Cricoid
d) Cuneiform
Explanation: Cricoid cartilage is a hyaline cartilage forming the only complete ring of the airway. Unlike elastic cartilages such as epiglottis, corniculate, and cuneiform, hyaline cartilages like cricoid and thyroid tend to calcify with age. Correct answer is c) Cricoid.
Guessed Questions (NEET PG Style)
All of the following laryngeal cartilages are hyaline except
a) Thyroid
b) Arytenoid
c) Corniculate
d) Cricoid
Explanation: Except corniculate, all listed are hyaline cartilages. Corniculate is elastic cartilage, paired and small. Correct answer is c) Corniculate.
Which laryngeal cartilage ossifies earliest with age?
a) Epiglottis
b) Cricoid
c) Corniculate
d) Cuneiform
Explanation: Cricoid is the earliest to ossify among hyaline cartilages. Elastic cartilages such as epiglottis and corniculate remain flexible lifelong. Correct answer is b) Cricoid.
A patient with hoarseness due to arthritis of laryngeal joint most likely has involvement of
a) Cricoarytenoid joint
b) Cricothyroid joint
c) Atlanto-occipital joint
d) Temporomandibular joint
Explanation: Hoarseness occurs when cricoarytenoid joints (between arytenoid and cricoid, both hyaline) are involved in rheumatoid arthritis. Correct answer is a) Cricoarytenoid joint.
Which cartilage provides attachment for vocal cords?
a) Arytenoid
b) Corniculate
c) Epiglottis
d) Cuneiform
Explanation: Arytenoid cartilages (hyaline) provide vocal process where vocal cords attach. They are essential for phonation. Correct answer is a) Arytenoid.
Which laryngeal cartilage is leaf-shaped and elastic?
a) Cricoid
b) Epiglottis
c) Arytenoid
d) Thyroid
Explanation: Epiglottis is a flexible, elastic cartilage preventing aspiration during swallowing. Correct answer is b) Epiglottis.
All laryngeal cartilages ossify with age except
a) Thyroid
b) Cricoid
c) Arytenoid
d) Epiglottis
Explanation: Elastic cartilages like epiglottis, corniculate, and cuneiform do not ossify. Hyaline cartilages ossify with age. Correct answer is d) Epiglottis.
The only complete ring of cartilage in the airway is
a) Thyroid
b) Epiglottis
c) Cricoid
d) Arytenoid
Explanation: Cricoid cartilage forms a complete ring, unlike thyroid (open posteriorly). It supports airway and marks level of C6 vertebra. Correct answer is c) Cricoid.
In intubation, which cartilage is pressed for cricoid pressure (Sellick’s maneuver)?
a) Arytenoid
b) Thyroid
c) Cricoid
d) Epiglottis
Explanation: Cricoid cartilage is pressed to prevent aspiration by occluding esophagus during intubation. Correct answer is c) Cricoid.
Which muscle attaches to the muscular process of arytenoid cartilage?
a) Lateral cricoarytenoid
b) Cricothyroid
c) Posterior cricoarytenoid
d) Both a and c
Explanation: Muscular process of arytenoid gives attachment to posterior and lateral cricoarytenoid muscles controlling vocal cord movements. Correct answer is d) Both a and c.
Elastic cartilage of larynx includes all except
a) Epiglottis
b) Corniculate
c) Cuneiform
d) Arytenoid
Explanation: Arytenoid is hyaline cartilage, whereas epiglottis, corniculate, and cuneiform are elastic. Correct answer is d) Arytenoid.
During swallowing, which laryngeal cartilage protects airway by covering inlet?
a) Epiglottis
b) Corniculate
c) Cuneiform
d) Arytenoid
Explanation: Epiglottis (elastic cartilage) folds backward during swallowing, preventing aspiration. Correct answer is a) Epiglottis.
Chapter: Nose and Paranasal Sinuses
Topic: Nasal Septum
Subtopic: Little’s Area (Kiesselbach’s Plexus)
Keyword Definitions
Little’s area (Kiesselbach’s plexus): Anteroinferior nasal septum; common site of anterior epistaxis.
Epistaxis: Bleeding from the nose; anterior bleeds are usually from Little’s area.
Woodruff’s plexus: Venous plexus on posteroinferior lateral wall; source of posterior epistaxis.
Anterior ethmoidal artery: Ophthalmic branch contributing to Little’s area.
Sphenopalatine artery: Terminal maxillary branch; major supply of nasal cavity and Little’s area.
Greater palatine artery: Maxillary branch ascending via incisive canal to Little’s area.
Superior labial (septal) branch: Facial branch anastomosing in Little’s area.
Anterior nasal packing: Tamponade technique for uncontrolled anterior epistaxis.
Lead Question – 2012
Little's area is ?
a) Anteroinferior lateral wall
b) Anteroinferior nasal septum
c) Posteroinferior lateral wall
d) Posteroinferior nasal septum
Explanation: Little’s area (Kiesselbach’s plexus) lies on the anteroinferior nasal septum, where septal branches of anterior ethmoidal, sphenopalatine, greater palatine, and superior labial arteries anastomose. It is the commonest source of anterior epistaxis, especially in children and dry climates. Correct answer: b) Anteroinferior nasal septum.
Guessed Question 1
Most common site of epistaxis in children is:
a) Posterior choana
b) Little’s area
c) Middle meatus
d) Woodruff’s plexus
Explanation: Children typically bleed from the anterior septum due to trauma, crusting, or inflammation. Little’s area is highly vascular and exposed, making it the commonest source. Posterior bleeds (Woodruff’s plexus) are unusual in children. Correct answer: b) Little’s area.
Guessed Question 2
Posterior epistaxis commonly originates from:
a) Little’s area
b) Woodruff’s plexus
c) Anterior ethmoidal artery
d) Superior labial artery
Explanation: Severe posterior bleeds in adults usually arise from venous channels of Woodruff’s plexus on the posteroinferior lateral wall. They are profuse, difficult to control, and may require posterior packing or sphenopalatine artery ligation. Correct answer: b) Woodruff’s plexus.
Guessed Question 3
Which artery does not contribute to Little’s area?
a) Anterior ethmoidal
b) Greater palatine
c) Septal branch of superior labial
d) Posterior ethmoidal
Explanation: Little’s area receives from anterior ethmoidal (ophthalmic), sphenopalatine and greater palatine (maxillary), and superior labial septal (facial). Posterior ethmoidal does not typically form part of Kiesselbach’s plexus. Correct answer: d) Posterior ethmoidal.
Guessed Question 4
Initial first-aid step for active anterior epistaxis in clinic is:
a) Immediate artery ligation
b) Septoplasty
c) Firm nasal compression with topical vasoconstrictor
d) Posterior packing
Explanation: For anterior bleeds, seat the patient forward, apply topical vasoconstrictor (oxymetazoline/epinephrine on cotton), and pinch the soft nose for 10–15 minutes. This addresses Little’s area bleeding effectively in most cases. Correct answer: c) Firm nasal compression with topical vasoconstrictor.
Guessed Question 5
An adolescent with recurrent severe posterior epistaxis unresponsive to packing—next step?
a) Cautery of Little’s area
b) Endoscopic sphenopalatine artery ligation
c) External carotid ligation first
d) Oral antibiotics only
Explanation: Refractory posterior epistaxis is best treated with endoscopic sphenopalatine artery ligation, directly targeting the major arterial supply. External carotid ligation is less targeted and reserved for failures. Correct answer: b) Endoscopic sphenopalatine artery ligation.
Guessed Question 6
Little’s area is located at the junction of:
a) Quadrangular cartilage and vomer
b) Ethmoid labyrinth and inferior turbinate
c) Middle turbinate and lateral wall
d) Choana and nasopharynx
Explanation: Kiesselbach’s plexus lies on the anterior septum over the quadrangular cartilage near the junction with the vomera) Quadrangular cartilage and vomer
.
Guessed Question 7
Which clinical feature suggests posterior rather than anterior epistaxis?
a) Blood on anterior septum with visible point
b) Mild oozing controlled by compression
c) Blood flowing into oropharynx without clear anterior source
d) Bleeding after nose picking
Explanation: Posterior bleeds often lack an anterior point and present as blood trickling into the throat, with greater volume and hemodynamic impact. This pattern indicates a posterior source. Correct answer: c) Blood flowing into oropharynx without clear anterior source.
Guessed Question 8
Recurrent anterior epistaxis in a child—best preventive advice includes:
a) Daily aspirin
b) Humidification and saline ointment to septum
c) Posterior packing at home
d) Nose blowing frequently
Explanation: Dry mucosa exacerbates Little’s area bleeding. Regular room humidification and application of saline/soft paraffin to the anterior septum reduce crusting and trauma. Avoid aspirin unless indicated. Correct answer: b) Humidification and saline ointment to septum.
Guessed Question 9
Which vessel is a branch of the facial artery contributing to Little’s area?
a) Septal branch of superior labial artery
b) Anterior ethmoidal artery
c) Greater palatine artery
d) Sphenopalatine artery
Explanation: The septal branch of the superior labial artery (from the facial artery) ascends to Kiesselbach’s plexus and anastomoses with branches of the maxillary and ophthalmic systems. Correct answer: a) Septal branch of superior labial artery.
Guessed Question 10
Site of Woodruff’s plexus is best described as:
a) Anteroinferior nasal septum
b) Posteroinferior lateral wall
c) Superior nasal septum
d) Middle meatus anteriorly
Explanation: Woodruff’s plexus is a venous plexus on the posteroinferior lateral wall, commonly implicated in adult posterior epistaxis. It contrasts with Little’s area on the anteroinferior septum. Correct answer: b) Posteroinferior lateral wall.
Guessed Question 11
During silver nitrate cautery for anterior epistaxis, the recommended approach is to:
a) Cauterize both septal sides at once
b) Cauterize the identified bleeding point unilaterally
c) Avoid vasoconstrictor before cautery
d) Proceed directly to posterior packing
Explanation: Identify the bleeding point in Little’s area and cauterize unilaterally to avoid septal perforation. Pretreat with topical vasoconstrictor and anesthetic, then apply silver nitrate precisely. Correct answer: b) Cauterize the identified bleeding point unilaterally.
Chapter: Skull – Facial Bones
Topic: Maxilla
Subtopic: Articulations and Clinical Anatomy
Keyword Definitions
Maxilla: Paired facial bone forming upper jaw, hard palate anteriorly, orbital floor, and lateral nasal wall.
Articulation: Bony contact forming a suture or joint between two bones.
Frontal bone: Cranial bone articulating with maxilla at frontonasal–frontomaxillary region.
Ethmoid bone: Midline bone; maxilla meets its lateral mass via medial orbital wall.
Lacrimal bone: Small bone of medial orbital wall; articulates with maxilla around nasolacrimal groove.
Sphenoid bone: Midline cranial bone; the maxilla does not directly articulate with it.
Palatine bone: Posterior hard palate and part of nasal cavity; articulates with maxilla.
Zygomatic bone: Cheekbone; articulates with maxilla at zygomaticomaxillary suture.
Inferior nasal concha: Separate bone; articulates with maxilla along lateral nasal wall.
Vomer: Posteroinferior nasal septum; articulates with maxilla at incisive region.
Intermaxillary suture: Midline articulation between right and left maxillae.
Maxillary sinus: Largest paranasal sinus within maxilla opening into middle meatus.
Infraorbital nerve: Continuation of V2 traversing infraorbital canal/foramen of maxilla.
Canine fossa: Depression on anterior maxilla; common site for Caldwell–Luc access.
Ostiomeatal complex: Functional unit for sinus drainage in middle meatus region.
Pterygopalatine fossa: Space posterior to maxilla containing V2 and maxillary artery branches.
Alveolar process: Tooth-bearing part of maxilla housing maxillary teeth.
Le Fort fractures: Classic midface fracture patterns involving maxilla and buttresses.
Midfacial buttresses: Vertical load-bearing pillars (nasomaxillary, zygomaticomaxillary, pterygomaxillary).
Incisive canal: Canal transmitting nasopalatine nerve and greater palatine vessels to anterior palate.
Lead Question – 2012
Maxillary bone does not articulate with:
a) Ethmoid
b) Sphenoid
c) Frontal
d) Lacrimal
Explanation: The maxilla articulates with frontal, ethmoid, lacrimal, nasal, zygomatic, palatine, inferior nasal concha, vomer, and the opposite maxilla via the intermaxillary suture. It has no direct articulation with the sphenoid bone. Therefore, the correct answer is b) Sphenoid.
Guessed Question 1
Which of the following bones does articulate directly with the maxilla?
a) Temporal
b) Vomer
c) Parietal
d) Occipital
Explanation: The vomer forms the posteroinferior nasal septum and articulates anteriorly with the maxilla near the incisive region. Temporal, parietal, and occipital bones do not directly meet the maxilla. Correct answer: b) Vomer.
Guessed Question 2
Maxillary sinus drains into the nasal cavity primarily via the:
a) Inferior meatus
b) Sphenoethmoidal recess
c) Middle meatus (ostiomeatal complex)
d) Superior meatus
Explanation: The maxillary ostium opens into the middle meatus through the semilunar hiatus within the ostiomeatal complex. This pathway explains why edema of middle meatus mucosa predisposes to maxillary sinusitis. Correct answer: c) Middle meatus (ostiomeatal complex).
Guessed Question 3
The infraorbital nerve exits the maxilla through the:
a) Zygomaticofacial foramen
b) Infraorbital foramen
c) Greater palatine foramen
d) Incisive foramen
Explanation: V2 continues as the infraorbital nerve within the infraorbital groove and canal of the maxilla, emerging on the face via the infraorbital foramen to supply lower eyelid, cheek, and upper lip. Correct answer: b) Infraorbital foramen.
Guessed Question 4
Which wall forms the floor of the orbit and roof of the maxillary sinus?
a) Frontal bone
b) Maxilla
c) Ethmoid
d) Zygomatic (alone)
Explanation: The orbital floor is mainly the orbital surface of the maxilla, which simultaneously forms the roof of the maxillary sinus. Zygomatic contributes laterally but not alone. Correct answer: b) Maxilla.
Guessed Question 5
Caldwell–Luc approach enters the maxillary sinus through the:
a) Zygomatic buttress
b) Canine fossa
c) Infraorbital rim
d) Middle meatus
Explanation: The canine fossa is a thin area on the anterior wall of the maxilla above the canine tooth, commonly used for surgical entry (Caldwell–Luc). Correct answer: b) Canine fossa.
Guessed Question 6
In Le Fort I fracture, the fracture line passes:
a) Through nasofrontal suture and ethmoid
b) Across zygomatic arches and orbital floors
c) Above apices of maxillary teeth, separating alveolar process and hard palate
d) Through frontozygomatic suture and nasal bones
Explanation: Le Fort I is a horizontal maxillary fracture detaching the tooth-bearing segment and hard palate from the midface at the level above dental apices. Correct answer: c) Above apices of maxillary teeth, separating alveolar process and hard palate.
Guessed Question 7
Which vertical buttress is directly anchored to the maxilla and transmits masticatory forces?
a) Pterygomaxillary buttress
b) Nasomaxillary buttress
c) Frontozygomatic buttress
d) Parietomastoid buttress
Explanation: The nasomaxillary buttress runs from the canine fossa/upper alveolus to the frontal process and frontal bone, stabilizing the midface. Pterygomaxillary is posterior; frontozygomatic is lateral. Correct answer: b) Nasomaxillary buttress.
Guessed Question 8
The nasolacrimal duct is related to the maxilla at the:
a) Incisive canal
b) Lacrimal groove on medial orbital wall
c) Infraorbital groove
d) Greater palatine canal
Explanation: The lacrimal groove is formed by the maxilla and lacrimal bone, housing the nasolacrimal sac/duct which drains into the inferior meatus. Correct answer: b) Lacrimal groove on medial orbital wall.
Guessed Question 9
Which pair correctly matches the maxillary surface to its landmark?
a) Orbital surface – canine fossa
b) Anterior surface – canine fossa
c) Nasal surface – infraorbital groove
d) Infratemporal surface – incisive canal
Explanation: The canine fossa is a depression on the anterior surface of the maxilla. The infraorbital groove lies on the orbital surface; incisive canal belongs to the hard palate. Correct answer: b) Anterior surface – canine fossa.
Guessed Question 10
Which structure lies immediately posterior to the maxilla and communicates via the pterygomaxillary fissure?
a) Pterygopalatine fossa
b) Infratemporal fossa
c) Ethmoidal air cells
d) Sphenoidal sinus
Explanation: The pterygomaxillary fissure separates the posterior maxilla from the pterygoid process, opening laterally from the pterygopalatine fossa into the infratemporal fossa. The space immediately posterior that communicates through this fissure is the pterygopalatine fossa. Correct answer: a) Pterygopalatine fossa.
Guessed Question 11
Which artery most directly supplies the walls of the maxillary sinus?
a) Anterior ethmoidal artery
b) Sphenopalatine artery
c) Superior thyroid artery
d) Superficial temporal artery
Explanation: The maxillary sinus receives blood from branches of the maxillary artery, notably the sphenopalatine artery and infraorbital branches. Ethmoidal arteries primarily supply ethmoidal cells and superior nasal cavity. Correct answer: b) Sphenopalatine artery.
Chapter: Face & Oral Cavity
Topic: Palate Development & Clinical Anatomy
Subtopic: Primary and Secondary Palate
Keyword Definitions
Primary palate — anterior part of palate (premaxilla) that contains incisors; forms from medial nasal prominences.
Secondary palate — posterior bony and soft palate formed by palatine processes of maxilla and palatine bones.
Incisive foramen — midline opening in anterior hard palate marking junction of primary and secondary palates.
Alveolar arch — tooth-bearing ridge of maxilla; involved in dentoalveolar alignment and cleft classifications.
Canine teeth — erupt lateral to incisors; used as surgical and embryologic landmarks in clefting.
Greater palatine foramen — posterior lateral opening transmitting greater palatine vessels and nerve to hard palate.
Cleft lip & palate — congenital failure of fusion of facial/palatal processes; location relative to incisive foramen classifies primary vs secondary clefts.
Palatoglossus & palatopharyngeus — muscles of soft palate important for speech and swallowing; supplied by pharyngeal plexus (CN X).
Surgical repair — timing and technique differ for primary (lip) and secondary (palate) reconstructions to optimize feeding and speech outcomes.
Incisive canal — transmits nasopalatine nerve and vessels; located posterior to incisor roots at incisive foramen.
Lead Question - 2012
Primary and secondary palates are divided by
a) Greater palatine foramen
b) Canine teeth
c) Alveolar arch
d) Incisive foramen
Explanation: Embryologically the incisive foramen marks the transition between the primary (premaxillary) and secondary palates. Primary palate (anterior to the incisive foramen) forms the alveolus for incisors; secondary palate (posterior) forms the hard/soft palate. Clinically, clefts anterior to this are primary, posterior are secondary. Answer: d) Incisive foramen.
1. Cleft lip results from failure of fusion between which prominences?
a) Maxillary and lateral nasal
b) Medial nasal and maxillary
c) Mandibular and maxillary
d) Lateral nasal and mandibular
Explanation: Unilateral cleft lip arises from failed fusion of the medial nasal prominence with the maxillary prominence, producing a defect of the primary palate and lip. This affects the area anterior to the incisive foramen and may involve the alveolus. Answer: b) Medial nasal and maxillary.
2. Which nerve supplies sensation to the anterior hard palate (primary palate)?
a) Greater palatine nerve
b) Nasopalatine nerve
c) Lesser palatine nerve
d) Infraorbital nerve
Explanation: The nasopalatine nerve (branch of V2) traverses the incisive canal and supplies the anterior hard palate mucosa including the primary palate region. Greater palatine supplies posterior hard palate; infraorbital supplies skin and upper lip. Answer: b) Nasopalatine nerve.
3. Which artery primarily supplies the hard palate posterior to the incisive foramen?
a) Greater palatine artery
b) Sphenopalatine artery
c) Superior labial artery
d) Anterior ethmoidal artery
Explanation: The greater palatine artery (from descending palatine branch of maxillary artery) supplies the posterior hard palate and glands of the secondary palate. Anterior supply near incisive foramen comes from nasopalatine/superior labial branches. Answer: a) Greater palatine artery.
4. A cleft involving the secondary palate only is located posterior to which landmark?
a) Greater palatine foramen
b) Incisive foramen
c) Alveolar arch
d) Canine teeth
Explanation: Secondary palate defects are posterior to the incisive foramen and involve the hard and/or soft palate formed by palatine processes. Such clefts affect speech and middle ear function more than isolated primary palate clefts. Answer: b) Incisive foramen.
5. Which muscle forms the bulk of the soft palate and elevates it during swallowing?
a) Tensor veli palatini
b) Levator veli palatini
c) Palatoglossus
d) Palatopharyngeus
Explanation: Levator veli palatini elevates and retracts the soft palate during swallowing and phonation, contributing significantly to velopharyngeal closure. Tensor tenses and opens the auditory tube. Answer: b) Levator veli palatini.
6. Speech hypernasality after palatal repair suggests dysfunction of:
a) Palatoglossus only
b) Velopharyngeal closure mechanism
c) Jaw movement
d) Tongue base
Explanation: Hypernasal speech indicates inadequate velopharyngeal closure due to poor soft palate elevation or Passavant’s ridge dysfunction. This is a classic complication after palatal defects/repair requiring speech therapy or surgical revision. Answer: b) Velopharyngeal closure mechanism.
7. The incisive canal transmits which structure important for anterior palate sensation?
a) Nasopalatine nerve
b) Greater palatine nerve
c) Lesser palatine nerve
d) Inferior alveolar nerve
Explanation: The incisive canal carries the nasopalatine nerve and sphenopalatine vessels to the anterior palate. It exits at the incisive foramen, providing sensory innervation to mucosa anterior to the foramen. Answer: a) Nasopalatine nerve.
8. Primary palate repair is usually timed earlier than secondary palate repair to optimize?
a) Dentition eruption
b) Speech and feeding
c) Facial bone growth
d) Hearing
Explanation: Early repair of the primary palate (lip and anterior alveolus) improves feeding, aesthetics, and social bonding. Secondary palate repair timing prioritizes speech development. Both timing balance growth and functional outcomes. Answer: b) Speech and feeding.
9. In unilateral cleft lip and palate, the alveolar cleft typically lies between which teeth?
a) Incisors and canines
b) Canines and premolars
c) First and second molars
d) Lateral incisors and canines
Explanation: The alveolar cleft usually involves the area between lateral incisor and canine, affecting eruption/path of the canine and requiring secondary alveolar bone grafting for dental rehabilitation. Answer: d) Lateral incisors and canines.
10. Failure of palatal shelves to fuse in midline during embryogenesis causes:
a) Cleft lip only
b) Cleft palate
c) Microstomia
d) Macroglossia
Explanation: Non-fusion of palatal shelves yields a cleft palate of the secondary palate, leading to feeding, speech, and otologic problems. This occurs posterior to the incisive foramen. Management often requires palatoplasty. Answer: b) Cleft palate.
11. Which foramen is closest to the canine fossa used for Caldwell–Luc approach?
a) Incisive foramen
b) Greater palatine foramen
c) Infraorbital foramen
d) Foramen ovale
Explanation: The infraorbital foramen lies superior to the canine fossa on the anterior maxilla; the canine fossa is the thin anterior wall area accessed in Caldwell–Luc procedures to enter the maxillary sinus. Answer: c) Infraorbital foramen.
Chapter: Salivary Glands & Oral Cavity
Topic: Parotid Gland & Duct Anatomy
Subtopic: Stensen’s (Parotid) Duct — Relations and Clinical Significance
Keyword Definitions
Parotid (Stensen’s) duct — Duct of parotid gland that crosses masseter, pierces buccinator, and opens into oral vestibule opposite maxillary molars.
Buccinator — Facial muscle pierced by parotid duct; prevents cheek biting during mastication.
Masseter — Muscle over which parotid duct runs obliquely before turning medially.
Parotitis — Inflammation of parotid gland; duct obstruction may cause swelling and pain, worse on eating.
Sialography — Imaging of salivary ducts to detect stones or strictures.
Sialolithiasis — Stone formation in salivary ducts; less common in parotid than submandibular ducts.
Oral vestibule — Space between cheek/lips and teeth where parotid duct opens.
Maxillary second molar — Typical landmark opposite which Stensen’s duct papilla opens.
Salivary papilla — Small mucosal elevation marking duct opening on buccal mucosa.
Facial nerve branches — Motor to muscles around parotid; vulnerable in parotid surgery.
Lead Question - 2012
Parotid duct opens opposite to:
a) Upper 1st molar
b) Upper 2nd molar
c) Upper 2nd premolar
d) Upper 1st premolar
Explanation: The parotid (Stensen’s) duct typically opens into the oral vestibule at the parotid papilla opposite the crown of the maxillary second molar. Clinically this landmark is used during sialography, duct probing, and to locate the opening when evaluating parotid swelling or suspected ductal stones. (Answer: b) Upper 2nd molar.
1. The parotid duct pierces which structure to enter the mouth?
a) Buccinator muscle
b) Masseter muscle
c) Zygomatic arch
d) Orbicularis oris
Explanation: After running across the masseter, Stensen’s duct turns medially and pierces the buccinator muscle to open into the oral vestibule. Piercing the buccinator prevents salivary leakage into the cheek during chewing; this anatomical relation is critical during duct repair. (Answer: a) Buccinator muscle.)
2. A patient with parotid duct obstruction will most likely have:
a) Dry mouth and no swelling
b) Pain and swelling at meal times
c) Loss of taste on anterior tongue
d) Nasal obstruction
Explanation: Obstruction of the parotid duct (e.g., sialolithiasis) causes intermittent painful swelling of the gland, particularly during salivary stimulation with meals, and possible purulent discharge from the duct opening. This meal-related pain-swelling pattern is diagnostic. (Answer: b) Pain and swelling at meal times.)
3. Which imaging modality is best for detecting parotid duct stones?
a) Plain skull X-ray
b) Sialography
c) Chest X-ray
d) EEG
Explanation: Sialography (contrast study of salivary ducts) visualizes the ductal system and detects radiolucent or radiopaque stones, strictures, and dilatation. Ultrasound and CT are also useful, but sialography remains a specific diagnostic test for duct pathology. (Answer: b) Sialography.)
4. Which nerve carries secretomotor preganglionic fibers to parotid gland?
a) Glossopharyngeal via lesser petrosal nerve
b) Facial via chorda tympani
c) Trigeminal V1
d) Hypoglossal
Explanation: Preganglionic parasympathetic fibers to the otic ganglion arise from glossopharyngeal nerve and reach the parotid via the auriculotemporal nerve as postganglionic fibers; these stimulate watery salivary secretion. (Answer: a) Glossopharyngeal via lesser petrosal nerve.)
5. During parotidectomy, which structure must be preserved to maintain facial movement?
a) Facial nerve branches
b) Glossopharyngeal nerve
c) Hypoglossal nerve
d) Vagus nerve
Explanation: The facial nerve and its branches run through the parotid gland; injury during parotid surgery causes facial weakness or paralysis. Careful dissection to identify and preserve the facial nerve is essential in parotidectomy. (Answer: a) Facial nerve branches.)
6. The parotid duct crosses which muscle superficially?
a) Masseter
b) Lateral pterygoid
c) Medial pterygoid
d) Temporalis
Explanation: Stensen’s duct runs anteriorly over the lateral surface of the masseter muscle for a short distance before turning medially to pierce buccinator; this superficial course makes it vulnerable to trauma and visible palpation when swollen. (Answer: a) Masseter.)
7. A sialolith is most common in which salivary duct overall?
a) Submandibular (Wharton’s) duct
b) Parotid (Stensen’s) duct
c) Sublingual ducts
d) Minor salivary ducts
Explanation: Sialolithiasis occurs most often in the submandibular duct due to viscous saliva and uphill course; parotid stones are less common but can obstruct Stensen’s duct causing pain and swelling. (Answer: a) Submandibular (Wharton’s) duct.)
8. The mucosal papilla marking the parotid duct opening lies adjacent to which oral structure?
a) Maxillary second molar vestibule
b) Mandibular canine
c) Palatine tonsil
d) Uvula
Explanation: The parotid papilla is a small mucosal elevation in the buccal vestibule opposite the maxillary second molar; it helps clinicians locate the duct orifice during examination and duct cannulation. (Answer: a) Maxillary second molar vestibule.)
9. Therapeutic management for a symptomatic parotid duct stone includes all EXCEPT:
a) Sialogogues and massage
b) Surgical duct exploration and removal
c) Endoscopic stone retrieval (sialendoscopy)
d) Immediate radiotherapy
Explanation: Symptomatic ductal stones are managed conservatively with sialogogues, massage, or by minimally invasive sialendoscopy or surgical removal; radiotherapy is not a treatment and would harm gland function. (Answer: d) Immediate radiotherapy.)
10. Which artery runs in close relation to parotid gland and may be encountered in surgery?
a) External carotid artery and its terminal branches
b) Internal carotid artery
c) Vertebral artery
d) Superior thyroid artery only
Explanation: The external carotid artery and its branches (posterior auricular, superficial temporal, maxillary) run within or adjacent to the parotid region; surgeons must be aware to avoid major bleeding during parotid operations. (Answer: a) External carotid artery and its terminal branches.)
Chapter: Infectious Diseases / Dermatology
Topic: Chronic Subcutaneous Infections (Mycetoma & Osteomyelitis)
Subtopic: Mycetoma, Actinomycetoma & Differential Diagnosis
Keyword Definitions
Mycetoma — chronic granulomatous infection of skin, subcutis and bone with tumefaction, draining sinuses and granules; can be bacterial (actinomycetoma) or fungal (eumycetoma).
Actinomycetoma — caused by filamentous bacteria (eg. Nocardia, Streptomyces, Actinomadura); more sinuses and bone destruction, responds to antibiotics.
Eumycetoma — fungal mycetoma (eg. Madurella), often fewer granules, requires antifungals/surgery.
Sinus tract — draining channel from deeper infection to skin surface releasing pus and granules.
Granules — microcolonies seen in discharge; color/consistency suggests organism (black grains often fungal).
Osteomyelitis — bone infection that can complicate mycetoma causing chronic draining sinuses.
Culture & histology — essential to differentiate actinomycetoma (bacterial) from eumycetoma (fungal) for therapy choice.
Madura foot — eponym for mycetoma of the foot, common in tropical regions, plantar surface often affected.
Actinomyces vs Nocardia — both filamentous bacteria; Nocardia partially acid-fast and often pulmonary/skin involvement; Actinomyces not acid-fast.
Therapy — actinomycetoma treated with prolonged antibiotics (eg. co-trimoxazole, amikacin), eumycetoma often needs antifungals plus surgery.
Lead Question - 2012
Multiple sinuses from infection of great toe is mainly caused by:
a) Tuberculosis
b) Actinomycetes
c) Trichosporum
d) Histoplasmosis
Explanation: Multiple draining sinuses with granules from a chronic foot lesion (Madura foot) are classically due to mycetoma. The bacterial (actinomycetoma) form—caused by actinomycetes (eg. Nocardia, Actinomadura)—produces numerous sinuses and aggressive bone involvement and responds to prolonged antibiotics. Answer: b) Actinomycetes.
1. Common presentation of mycetoma includes:
a) Rapid generalized rash
b) Chronic swelling, draining sinuses with granules
c) Single painless ulcer with violaceous border
d) Lymphangitic streaking
Explanation: Mycetoma presents as chronic indolent swelling of foot with multiple sinuses that discharge granules. This triad (tumor, sinuses, granules) develops over months/years in endemic areas. It differs from cellulitis or plaque diseases. Management requires microbiology and prolonged targeted therapy. Answer: b) Chronic swelling, draining sinuses with granules.
2. Black granules in discharge from a mycetoma most likely indicate:
a) Actinomycetes
b) Eumycetoma (fungal) such as Madurella
c) Tuberculosis
d) Staphylococcus aureus
Explanation: Black or dark-colored granules are typical of some eumycetoma fungi (eg. Madurella mycetomatis). Fungal grains often differ in color/consistency from bacterial (actinomycetes) grains. Correct identification guides antifungal versus antibiotic therapy. Answer: b) Eumycetoma (fungal) such as Madurella.
3. Best initial diagnostic test to identify organisms in draining sinuses is:
a) Plain X-ray only
b) Culture of grains and histopathology
c) Viral PCR
d) Skin prick test
Explanation: Examination of granules, culture (aerobic/anaerobic/fungal) and histopathology (to see hyphae vs filaments) are essential to differentiate actinomycetoma from eumycetoma. Imaging complements to assess bone involvement. Empiric therapy without organism ID risks treatment failure. Answer: b) Culture of grains and histopathology.
4. Radiologic feature suggesting osteomyelitis in mycetoma is:
a) Soft tissue swelling only
b) Multiple irregular bone cavities and periosteal reaction
c) Pleural effusion
d) Demineralization of skull vault
Explanation: Chronic mycetoma can invade bone producing irregular lytic cavities, sequestra and periosteal reaction on X-ray or CT. This indicates osteomyelitis requiring combined medical and surgical management. Soft tissue disease alone suggests earlier stage amenable to conservative therapy. Answer: b) Multiple irregular bone cavities and periosteal reaction.
5. Which organism is partially acid-fast and may present as actinomycetoma-like disease?
a) Actinomyces israelii
b) Nocardia species
c) Madurella
d) Histoplasma capsulatum
Explanation: Nocardia species are filamentous bacteria that are weakly/partially acid-fast and can cause cutaneous mycetoma (actinomycetoma) with draining sinuses. They respond to sulfonamides and require prolonged therapy; distinguishing from Actinomyces is clinically important. Answer: b) Nocardia species.
6. First-line medical therapy for actinomycetoma typically includes:
a) Short course penicillin only
b) Prolonged combination antibiotics (eg. co-trimoxazole ± amikacin)
c) Topical antifungal creams
d) Immediate amputation without antibiotics
Explanation: Actinomycetoma requires prolonged combination antibiotic therapy (commonly co-trimoxazole, dapsone, streptomycin or amikacin regimens) often for months. Early medical therapy can avoid extensive surgery; treatment tailored to organism and response. Answer: b) Prolonged combination antibiotics (eg. co-trimoxazole ± amikacin).
7. Which clinical sign differentiates mycetoma from simple chronic osteomyelitis?
a) Fever and rigors
b) Presence of multiple draining sinuses with grains
c) Rapid resolution with antibiotics
d) Generalized lymphadenopathy
Explanation: The hallmark of mycetoma is multiple draining sinuses exuding characteristic granules (colored microcolonies). Simple chronic osteomyelitis may drain but lacks organized grains. Recognizing granules prompts specific culture and tailored treatment. Answer: b) Presence of multiple draining sinuses with grains.
8. When is surgical intervention indicated in mycetoma?
a) Never; medical therapy always sufficient
b) For localized disease not responding to medical therapy or to remove sequestra
c) Only for cosmetic reasons
d) Immediately upon diagnosis
Explanation: Surgery (debridement, excision, or even amputation) is indicated for localized lesions unresponsive to prolonged medical therapy, to remove necrotic bone/sequestra, or reduce fungal burden in eumycetoma. Choice depends on organism, extent, and response. Answer: b) For localized disease not responding to medical therapy or to remove sequestra.
9. A draining sinus with yellowish soft granules most likely represents:
a) Black-grain eumycetoma
b) White/yellow grain actinomycetoma
c) Viral wart
d) Primary tuberculosis only
Explanation: Yellowish or white granules often indicate actinomycetoma (bacterial grains), while black grains suggest certain fungi. Recognizing color and consistency aids early presumptive diagnosis pending culture. Answer: b) White/yellow grain actinomycetoma.
10. Public health prevention of mycetoma in endemic rural areas primarily focuses on:
a) Vaccination campaigns
b) Wearing protective footwear and early wound care
c) Quarantine of affected persons
d) Mass antibiotic distribution
Explanation: Mycetoma often follows traumatic inoculation (thorn/prick). Prevention emphasizes protective footwear, hygiene, prompt cleaning of wounds, and early medical evaluation to reduce chronicity and disability. No routine vaccine exists. Answer: b) Wearing protective footwear and early wound care.
Chapter: Head & Neck Anatomy
Topic: Facial Muscles
Subtopic: Risorius — anatomy, function, and clinical relevance
Keyword Definitions
Risorius — thin superficial facial muscle that retracts the angle of the mouth producing a smile or grimace.
Facial expression muscles — group of muscles innervated by the facial nerve (CN VII) that move the skin of the face.
Mastication muscles — muscles of chewing (masseter, temporalis, pterygoids) innervated by V3, not risorius.
Buccinator — deep cheek muscle that compresses the cheek and assists in mastication; distinct from risorius.
Facial nerve (CN VII) — motor nerve supplying muscles of facial expression including risorius; vulnerable in parotid surgery.
Parotid gland/plexus — risorius lies superficially near parotid region; surgical injury may affect branches of CN VII causing asymmetry.
Botulinum toxin — used cosmetically/therapeutically on facial muscles; improper injection into risorius can alter smile.
Deglutition — swallowing; risorius is not a primary deglutition muscle.
Orbicularis oris — sphincter muscle of the mouth working with risorius for lip movement.
Clinical sign — loss of risorius function causes inability to retract mouth corner, mild asymmetrical smile.
Lead Question - 2012
Risorius is a muscle of ?
a) Mastication
b) Deglutition
c) Facial expression
d) Eye movement
Explanation: Risorius is a superficial muscle of facial expression that retracts the angle of the mouth laterally, contributing to smiling or grimacing. It is innervated by branches of the facial nerve (CN VII) and not involved in mastication, swallowing, or eye movement. Answer: c) Facial expression.
1. Which nerve supplies the risorius muscle?
a) Mandibular division of trigeminal (V3)
b) Facial nerve (CN VII)
c) Hypoglossal nerve (XII)
d) Glossopharyngeal nerve (IX)
Explanation: The risorius receives motor innervation from the facial nerve (CN VII) via its buccal or zygomatic branches. Damage to these branches (eg. parotid surgery) produces weakness of mouth corner retraction and a flattened or asymmetrical smile. Answer: b) Facial nerve (CN VII).
2. Primary action of risorius is to:
a) Elevate mandible
b) Protrude tongue
c) Retract angle of mouth laterally
d) Close eyelids
Explanation: Risorius retracts the angle of the mouth laterally, creating a grin or stretched smile. It acts with levator and depressor muscles to modulate facial expression. It does not elevate the mandible, move the tongue, or close eyelids. Answer: c) Retract angle of mouth laterally.
3. Injury to the facial nerve branch supplying risorius produces which clinical sign?
a) Difficulty in chewing
b) Loss of forehead wrinkling
c) Asymmetrical smile with inability to retract mouth corner
d) Diplopia
Explanation: Paralysis of the branch to risorius causes inability to retract the mouth corner on the affected side, producing an asymmetrical smile. Chewing is mainly V3, forehead wrinkling involves temporal branch, and diplopia relates to ocular muscles. Answer: c) Asymmetrical smile with inability to retract mouth corner.
4. During parotid surgery, which precaution least helps preserve risorius function?
a) Identify and protect facial nerve branches
b) Minimize traction on superficial fascia
c) Avoid deep incisions through masseter
d) Only operate via transoral approach crossing buccinator
Explanation: Preserving facial nerve branches and superficial fascia protects risorius. A transoral approach through buccinator (d) risks injuring branches and the duct, making it least protective. Avoiding deep masseter incisions is sensible. Answer: d) Only operate via transoral approach crossing buccinator.
5. Which muscle lies deep to risorius and assists cheek flattening during mastication?
a) Buccinator
b) Masseter
c) Platysma
d) Levator labii superioris
Explanation: Buccinator lies deep to risorius and compresses the cheek to keep food between teeth, aiding mastication. Masseter is a primary masticator on lateral face. Risorius superficially retracts mouth corner and does not assist primary chewing. Answer: a) Buccinator.
6. Cosmetic injection of botulinum toxin into risorius is used to treat:
a) Jaw claudication
b) Gummy smile due to hyperactive smiling muscles
c) Orbital cellulitis
d) Vocal cord paralysis
Explanation: Botulinum toxin into risorius and adjacent smile muscles can reduce hyperactive lateral mouth retraction contributing to a gummy or asymmetrical smile. Careful dosing prevents excessive weakness and smile distortion. It is not used for orbital cellulitis or vocal cord issues. Answer: b) Gummy smile due to hyperactive smiling muscles.
7. Anatomical variation: risorius commonly inserts into:
a) Skin at angle of mouth
b) Mandibular ramus
c) Zygomatic arch
d) Hyoid bone
Explanation: Risorius inserts into the skin at the angle of mouth (modiolus area), pulling it laterally. It does not attach to bony structures like the mandible, zygoma, or hyoid. Variations in origin exist but insertion is cutaneous. Answer: a) Skin at angle of mouth.
8. Which clinical test assesses risorius function specifically?
a) Puff cheeks against closed lips
b) Ask patient to show teeth and retract mouth corners laterally
c) Test tongue protrusion
d) Assess shoulder shrug
Explanation: Asking the patient to smile broadly and retract mouth corners tests risorius among other smile muscles; inability to retract the affected corner suggests weakness. Puffing cheeks tests buccinator and orbicularis, tongue relates to XII, shoulder shrug to accessory nerve. Answer: b) Ask patient to show teeth and retract mouth corners laterally.
9. In facial nerve palsy localized to the buccal branches, which action is most compromised?
a) Eye closure
b) Nasolabial fold flattening and mouth corner retraction
c) Head rotation
d) Tongue movement
Explanation: Buccal branches supply muscles of the midface including risorius, buccinator, and orbicularis oris; palsy flattens nasolabial fold and impairs mouth corner retraction and labial competence. Eye closure is temporal/zygomatic, head rotation accessory. Answer: b) Nasolabial fold flattening and mouth corner retraction.
10. Which statement about risorius is FALSE?
a) It is a muscle of facial expression
b) It aids chewing by elevating mandible
c) It is innervated by CN VII
d) It inserts into skin at mouth angle
Explanation: Risorius does not aid mastication or elevate the mandible; that is the role of masseter and temporalis. Risorius retracts mouth angle, is innervated by facial nerve, and inserts into the skin at the angle of the mouth. Answer: b) It aids chewing by elevating mandible (FALSE).
Chapter: Lower Limb Anatomy
Topic: Hip Joint & Thigh Muscles
Subtopic: Hip Flexors — Actions and Clinical Relevance
Keyword Definitions
Psoas major — Primary hip flexor arising from lumbar vertebrae; strong hip flexion and trunk flexion contribution.
Iliacus — Joins psoas major to form iliopsoas, major hip flexor inserting on lesser trochanter.
Iliopsoas — Combined tendon of psoas major and iliacus; principal flexor of hip.
Biceps femoris — Hamstring muscle; knee flexor and hip extensor (long head) — not primary hip flexor.
Gluteus maximus — Principal hip extensor and external rotator; active in rising from sitting.
Tensor fasciae latae (TFL) — Assists hip flexion, abduction, and medial rotation; acts via IT band.
Hip flexion — Movement decreasing angle between thigh and trunk; important for walking, climbing stairs.
Femoral nerve — Supplies iliacus and provides motor to quadriceps; psoas major supplied by lumbar plexus.
Hip pathology — Iliopsoas bursitis or tendonitis causes anterior hip pain aggravated by flexion.
Clinical test — Straight leg raise and resisted hip flexion assess iliopsoas function.
Lead Question - 2012
Muscle causing flexion of hip ?
a) Biceps femoris
b) Psoas major
c) Gluteus maximus
d) TFL
Explanation: The psoas major, together with iliacus (forming iliopsoas), is the principal hip flexor producing powerful flexion at the hip and contributing to trunk flexion. Biceps femoris and gluteus maximus are extensors; TFL assists flexion but is not the primary flexor. Answer: b) Psoas major.
1. Primary nerve supply to psoas major is from:
a) Femoral nerve
b) Lumbar plexus (L1–L3)
c) Sciatic nerve
d) Superior gluteal nerve
Explanation: Psoas major receives direct branches from the anterior rami of lumbar spinal nerves (L1–L3) constituting part of the lumbar plexus. Femoral nerve supplies iliacus; sciatic and superior gluteal do not innervate psoas. Clinically lumbar radiculopathy affects hip flexion. Answer: b) Lumbar plexus (L1–L3).
2. Iliopsoas tendonitis typically causes pain at:
a) Posterior thigh
b) Anterior groin/hip
c) Lateral knee
d) Medial ankle
Explanation: Iliopsoas tendonitis presents with anterior groin or hip pain aggravated by hip flexion, resisted straight leg raise, and climbing stairs. It may mimic intra-articular hip pathology; ultrasound or MRI helps confirm tendon inflammation. Answer: b) Anterior groin/hip.
3. Which muscle is a synergist to psoas major in hip flexion?
a) Gluteus maximus
b) Rectus femoris
c) Adductor magnus
d) Piriformis
Explanation: Rectus femoris (part of quadriceps) crosses the hip and assists in hip flexion, acting as a synergist to iliopsoas during activities requiring powerful hip flexion like kicking. Gluteus maximus is an extensor. Answer: b) Rectus femoris.
4. A patient cannot flex hip against resistance but can on gravity-eliminated plane. This suggests:
a) Complete nerve transection
b) Pain inhibition or partial weakness
c) Intact motor function
d) Labral tear
Explanation: Inability to perform resisted hip flexion with preserved movement on gravity-eliminated testing suggests pain inhibition or partial weakness (Grade 3/5), not complete denervation. Further neuro exam and imaging are warranted. Answer: b) Pain inhibition or partial weakness.
5. InTrendelenburg gait is due to weakness of:
a) Hip flexors (psoas)
b) Hip abductors (gluteus medius/minimus)
c) Knee extensors (quadriceps)
d) Ankle dorsiflexors
Explanation: Trendelenburg gait arises from weak hip abductors (gluteus medius/minimus) causing pelvic drop on contralateral side during stance. Psoas weakness causes hip flexion issues but not Trendelenburg. Examination differentiates abductor from flexor pathology. Answer: b) Hip abductors (gluteus medius/minimus).
6. Which motion is produced when iliopsoas acts bilaterally on fixed femur?
a) Trunk extension
b) Trunk flexion (sit-up)
c) Lateral rotation of femur
d) Hip abduction
Explanation: With femur fixed, bilateral contraction of iliopsoas flexes the trunk at the hip (raises the torso), assisting in sit-up movements. It also stabilizes lumbar spine during posture. Dysfunction impairs rising from supine. Answer: b) Trunk flexion (sit-up).
7. Which muscle primarily extends the hip and opposes psoas major?
a) Iliacus
b) Gluteus maximus
c) Sartorius
d) Pectineus
Explanation: Gluteus maximus is the main hip extensor providing power for rising, climbing, and sprinting, functionally opposing the flexion produced by iliopsoas. Injury to gluteus maximus alters gait and seated-to-standing mechanics. Answer: b) Gluteus maximus.
8. Tight psoas major may cause which postural change?
a) Increased lumbar lordosis
b) Flattened lumbar curve
c) Thoracic kyphosis reduction
d) Knee hyperextension
Explanation: A tight psoas pulls lumbar spine into increased lordosis and anterior pelvic tilt, contributing to low back pain and altered gait mechanics. Stretching and posture correction are part of management. Answer: a) Increased lumbar lordosis.
9. Hip flexion power is most compromised by lesion of which structure?
a) Femoral nerve root (L2–L4)
b) Sciatic nerve
c) Obturator nerve
d) Superior gluteal nerve
Explanation: The femoral nerve innervates iliacus and rectus femoris; lesion reduces hip flexion strength. Psoas major is from lumbar plexus; combined lesions of L2–L4 significantly impair hip flexion. Sciatic/obturator/gluteal affect other functions. Answer: a) Femoral nerve root (L2–L4).
10. Clinical test for iliopsoas strength: patient performs?
a) Hip abduction against resistance
b) Resisted hip flexion in sitting or supine
c) Heel raise
d) Knee flexion
Explanation: Resisted hip flexion (patient attempts to lift thigh against resistance) assesses iliopsoas/rectus femoris. Positive pain or weakness suggests tendonitis, nerve lesion, or muscular tear and guides further imaging or EMG. Answer: b) Resisted hip flexion in sitting or supine.
Chapter: Neck Anatomy
Topic: Subclavian Artery & Its Branches
Subtopic: Thyrocervical Trunk — Origin and Branches
Keyword Definitions
Subclavian artery (parts): Divided into three parts in relation to anterior scalene: 1st (medial), 2nd (behind), 3rd (lateral).
Thyrocervical trunk: Short branch arising from the 1st part of subclavian; gives inferior thyroid, ascending cervical, transverse cervical, and suprascapular arteries.
Inferior thyroid artery: Branch supplying lower thyroid, parathyroids, and cervical branches; important in thyroid surgery.
Suprascapular artery: Supplies supraspinatus and infraspinatus regions; runs toward scapular notch.
Transverse cervical artery: Supplies trapezius and posterior neck; has superficial and deep branches.
Ascending cervical artery: Small vertical branch accompanying phrenic or vertebral levels.
Vertebral artery: Another branch of 1st part, ascends through transverse foramina to brainstem.
Clinical relevance: Knowledge of thyrocervical trunk anatomy is vital during central line placement, neck dissection, and thyroid surgery to avoid bleeding.
Lead Question - 2012
The thyrocervical trunk is a branch of which part of subclavian artery?
a) 1st
b) 2nd
c) 3rd
d) None
Explanation: The thyrocervical trunk arises from the first (medial) part of the subclavian artery, proximal to the anterior scalene muscle. It is a short, stout trunk giving inferior thyroid, ascending cervical, transverse cervical and suprascapular arteries. Surgeons must note this relation during neck and thyroid operations. Answer: a) 1st.
1. Which of the following is NOT a usual branch of the thyrocervical trunk?
a) Inferior thyroid artery
b) Transverse cervical artery
c) Suprascapular artery
d) Internal thoracic artery
Explanation: The internal thoracic artery is a branch of the subclavian but arises from the first part directly and not from the thyrocervical trunk. Thyrocervical trunk typically gives inferior thyroid, transverse cervical, suprascapular, and sometimes ascending cervical branches. Answer: d) Internal thoracic artery.
2. The inferior thyroid artery supplies all EXCEPT:
a) Lower pole of thyroid
b) Parathyroid glands
c) Larynx (via branches)
d) Supraorbital region
Explanation: Inferior thyroid artery supplies the lower thyroid, parathyroids and gives laryngeal branches but does not supply the supraorbital region which is served by branches of the ophthalmic artery. It is a branch of the thyrocervical trunk. Answer: d) Supraorbital region.
3. The transverse cervical artery commonly supplies which muscle?
a) Sternocleidomastoid
b) Trapezius (superficial branch)
c) Levator scapulae only
d) Diaphragm
Explanation: The superficial branch of the transverse cervical artery supplies the trapezius muscle and overlying skin. The deep branch (dorsal scapular) may supply levator scapulae and rhomboids. It arises from or near the thyrocervical trunk region. Answer: b) Trapezius (superficial branch).
4. During a thyroid lobectomy, which vessel must be carefully ligated to preserve laryngeal blood supply?
a) Superior thyroid artery
b) Inferior thyroid artery
c) Lingual artery
d) Facial artery
Explanation: Ligation of the inferior thyroid artery risks compromising inferior laryngeal branches; surgeons clip branches close to the thyroid capsule to preserve recurrent laryngeal artery supply. The inferior thyroid commonly arises from the thyrocervical trunk. Answer: b) Inferior thyroid artery.
5. The thyrocervical trunk most often arises medial to which muscle?
a) Anterior scalene
b) Middle scalene
c) Posterior scalene
d) Levator scapulae
Explanation: The first part of the subclavian and its branches, including the thyrocervical trunk and vertebral artery, lie medial to the anterior scalene muscle. This anatomical relation is crucial during central venous access and neck surgery. Answer: a) Anterior scalene.
6. A variant artery arising from thyrocervical trunk ascending along cervical vertebrae is called:
a) Ascending cervical artery
b) Superior thyroid artery
c) Deep cervical artery
d) Occipital artery
Explanation: The ascending cervical artery is a small upward branch often arising from the inferior thyroid or thyrocervical trunk, supplying neck muscles and vertebral bodies; it anastomoses with deep cervical branches. Answer: a) Ascending cervical artery.
7. Injury to the suprascapular artery may compromise blood supply to:
a) Supraspinatus and infraspinatus muscles
b) Levator scapulae primarily
c) Pectoralis major
d) Biceps brachii
Explanation: The suprascapular artery travels to the scapular region and supplies supraspinatus and infraspinatus muscles via scapular anastomoses; it commonly originates from the thyrocervical trunk. Damage affects shoulder girdle perfusion. Answer: a) Supraspinatus and infraspinatus muscles.
8. The vertebral artery arises from which part of the subclavian?
a) 1st part
b) 2nd part
c) 3rd part
d) It varies
Explanation: The vertebral artery classically arises from the first part of the subclavian artery and ascends through transverse foramina to supply posterior brain. Its proximity to thyrocervical trunk branches is important in cervical vascular anatomy. Answer: a) 1st part.
9. In posterior triangle bleeding from thyrocervical branches is best controlled by ligating which artery proximally?
a) Subclavian artery (first part)
b) External carotid artery
c) Vertebral artery
d) Internal thoracic artery
Explanation: Major control of bleeding from thyrocervical branches may require proximal control of the subclavian artery (first part) or selective ligation of offending branch at origin; external carotid ligation will not stop these branches. Answer: a) Subclavian artery (first part).
10. Which imaging modality best delineates small branches of thyrocervical trunk preoperatively?
a) Digital subtraction angiography (DSA)
b) Plain X-ray
c) Chest radiograph
d) EEG
Explanation: DSA provides high-resolution dynamic visualization of arterial branches, ideal for planning embolization or surgery involving the thyrocervical trunk and its branches. CT angiography is an alternative noninvasive option, but DSA remains gold standard for small branch delineation. Answer: a) Digital subtraction angiography (DSA).