Topic: Axilla and Axillary Artery
Subtopic: Divisions of Axillary Artery
Keyword Definitions:
Axillary artery: Continuation of the subclavian artery, supplying the upper limb.
Pectoralis minor: A muscle that divides axillary artery into three parts.
Clavicle: Collar bone, superior boundary of axilla.
Teres minor: Muscle of rotator cuff, posterior boundary near axilla.
1st rib: Marks transition from subclavian to axillary artery.
Quadrangular space: Anatomical interval transmitting axillary nerve and posterior circumflex humeral artery.
Spiral groove: Groove on humerus for radial nerve and profunda brachii artery.
Bicipital aponeurosis: Fibrous extension of biceps tendon protecting underlying neurovascular structures.
Lead Question - 2014
Axillary artery is divided into three parts by?
a) 1st rib
b) Clavicle
c) Pectoralis minor muscle
d) Teres minor muscle
Explanation: The pectoralis minor divides the axillary artery into three parts: first part proximal, second part posterior, and third part distal to the muscle. Other structures like 1st rib and clavicle mark transition of vessels but do not divide axillary artery into parts. Correct answer is c) Pectoralis minor muscle.
1) Branch of the first part of axillary artery?
a) Superior thoracic artery
b) Lateral thoracic artery
d) Thoracoacromial artery
Explanation: The first part of the axillary artery gives only one branch: the superior thoracic artery. The other branches arise from second and third parts. Knowledge of these branches is essential for surgical interventions in axilla. Correct answer is a) Superior thoracic artery.
2) A patient with humeral neck fracture injures the artery closely related to quadrangular space. Which is it?
a) Subscapular artery
b) Posterior circumflex humeral artery
c) Lateral thoracic artery
d) Profunda brachii artery
Explanation: The posterior circumflex humeral artery runs through the quadrangular space with the axillary nerve. It is often injured in surgical neck fractures of humerus. This leads to bleeding and compromised deltoid perfusion. Correct answer is b) Posterior circumflex humeral artery.
3) Which artery accompanies radial nerve in spiral groove?
a) Subscapular artery
b) Profunda brachii artery
c) Circumflex scapular artery
d) Lateral thoracic artery
Explanation: The profunda brachii artery accompanies radial nerve in spiral groove. Both are vulnerable in midshaft humeral fractures, leading to wrist drop and bleeding. Correct answer is b) Profunda brachii artery.
4) Which structure lies superficial to bicipital aponeurosis in cubital fossa?
a) Median nerve
b) Radial nerve
c) Median cubital vein
d) Brachial artery
Explanation: The median cubital vein lies superficial to bicipital aponeurosis, making it accessible for venipuncture. The aponeurosis protects deeper structures like brachial artery and median nerve. Correct answer is c) Median cubital vein.
5) Which branch arises from the second part of axillary artery?
a) Superior thoracic artery
b) Subscapular artery
c) Thoracoacromial artery
d) Posterior circumflex humeral artery
Explanation: The thoracoacromial artery and lateral thoracic artery arise from the second part of axillary artery. The thoracoacromial artery further divides into four branches supplying pectoral and deltoid regions. Correct answer is c) Thoracoacromial artery.
6) A patient with axillary lymph node dissection has bleeding from the largest branch of axillary artery. Which is it?
a) Superior thoracic artery
b) Subscapular artery
c) Thoracoacromial artery
d) Posterior circumflex humeral artery
Explanation: The subscapular artery is the largest branch of the axillary artery. It supplies latissimus dorsi via thoracodorsal artery and scapular region via circumflex scapular branch. Correct answer is b) Subscapular artery.
7) Which muscle divides the axilla into anterior and posterior folds?
a) Teres major
b) Latissimus dorsi
c) Pectoralis major
d) Deltoid
Explanation: The pectoralis major forms the anterior axillary fold, and the latissimus dorsi with teres major form the posterior axillary fold. These landmarks are important clinically for axillary palpation. Correct answer is c) Pectoralis major.
8) A stab wound injures the third part of axillary artery. Which branch is most likely affected?
a) Lateral thoracic artery
b) Subscapular artery
c) Superior thoracic artery
d) Thoracoacromial artery
Explanation: The third part of axillary artery gives rise to subscapular, anterior and posterior circumflex humeral arteries. Subscapular is the largest and most clinically significant. Correct answer is b) Subscapular artery.
9) Which nerve is closely related to the second part of axillary artery?
a) Ulnar nerve
b) Median nerve
c) Cord of brachial plexus
d) Musculocutaneous nerve
Explanation: The cords of brachial plexus are named according to their relation to the second part of axillary artery: lateral, medial, and posterior cords. This relation is important in axillary blocks. Correct answer is c) Cord of brachial plexus.
10) Which artery participates in scapular anastomosis?
a) Subscapular artery
b) Brachial artery
c) Radial artery
d) Ulnar artery
Explanation: The subscapular artery, through its circumflex scapular branch, forms an important part of scapular anastomosis with suprascapular and dorsal scapular arteries. This collateral circulation is crucial if axillary artery is obstructed. Correct answer is a) Subscapular artery.
Copic: Axilla
Subtopic: Walls of Axilla
Keyword Definitions:
Axilla: Pyramidal space between upper limb and thorax, important for neurovascular passage.
Subscapularis: Muscle forming part of posterior wall of axilla.
Pectoralis major: Muscle forming anterior wall of axilla.
Latissimus dorsi: Muscle forming posterior axillary fold.
Teres major: Muscle forming part of posterior wall with subscapularis and latissimus dorsi.
Axillary artery: Main blood supply of axilla and upper limb.
Quadrangular space: Interval transmitting axillary nerve and posterior circumflex humeral artery.
Brachial plexus cords: Nerve bundles named in relation to axillary artery.
Lead Question - 2014
Posterior wall of axilla is formed by
a) Pectoralis major
b) Pectoralis minor
c) Subscapularis
d) Intercostal muscles
Explanation: The posterior wall of axilla is formed mainly by subscapularis in its upper part, and teres major with latissimus dorsi in the lower part. The anterior wall is by pectoralis muscles. Thus, correct answer is c) Subscapularis.
1) Which muscle forms the anterior wall of axilla?
a) Pectoralis major and minor
b) Subscapularis
c) Latissimus dorsi
d) Teres major
Explanation: The anterior wall of axilla is formed by pectoralis major and pectoralis minor muscles. These muscles form the anterior axillary fold and cover the neurovascular bundle. Correct answer is a) Pectoralis major and minor.
2) A surgeon retracts the posterior wall of axilla during lymph node dissection. Which major nerve is endangered?
a) Axillary nerve
b) Thoracodorsal nerve
c) Median nerve
d) Ulnar nerve
Explanation: The thoracodorsal nerve runs along the posterior wall supplying latissimus dorsi. It can be injured during axillary lymph node dissection, affecting arm adduction and internal rotation. Correct answer is b) Thoracodorsal nerve.
3) The lateral wall of axilla is formed by?
a) Intertubercular sulcus of humerus
b) Clavicle
c) Subscapularis
d) Pectoralis major
Explanation: The lateral wall of axilla is the narrowest and is formed by the intertubercular sulcus of humerus, which serves as the site for long head of biceps tendon. Correct answer is a) Intertubercular sulcus of humerus.
4) A patient with surgical neck fracture of humerus risks damage to structures passing through quadrangular space. Which artery is involved?
a) Posterior circumflex humeral artery
b) Profunda brachii artery
c) Subscapular artery
d) Superior thoracic artery
Explanation: The posterior circumflex humeral artery passes through the quadrangular space along with axillary nerve. It is vulnerable in surgical neck fractures of humerus. Correct answer is a) Posterior circumflex humeral artery.
5) Which nerve is closely related to the medial wall of axilla?
a) Long thoracic nerve
b) Radial nerve
c) Axillary nerve
d) Musculocutaneous nerve
Explanation: The long thoracic nerve runs along the medial wall of axilla, supplying serratus anterior. Injury causes winging of scapula. Correct answer is a) Long thoracic nerve.
6) A breast cancer patient undergoes radical mastectomy. Which nerve injury during axillary clearance leads to "winged scapula"?
a) Long thoracic nerve
b) Axillary nerve
c) Thoracodorsal nerve
d) Median nerve
Explanation: Injury to the long thoracic nerve during axillary clearance leads to paralysis of serratus anterior, producing winging of scapula. Correct answer is a) Long thoracic nerve.
7) Which structure forms the floor of axilla?
a) Skin, subcutaneous tissue, axillary fascia
b) Pectoralis major
c) Subscapularis
d) Clavicle
Explanation: The floor of axilla is formed by skin, subcutaneous tissue, and axillary fascia stretching between anterior and posterior folds. Correct answer is a) Skin, subcutaneous tissue, axillary fascia.
8) Which lymph nodes are located along the posterior wall of axilla?
a) Subscapular group
b) Pectoral group
c) Central group
d) Apical group
Explanation: The subscapular group of axillary lymph nodes lie along the posterior wall, accompanying subscapular vessels. They drain posterior thoracic wall and scapular region. Correct answer is a) Subscapular group.
9) A knife wound in posterior axilla injures latissimus dorsi. Which nerve is affected?
a) Thoracodorsal nerve
b) Long thoracic nerve
c) Axillary nerve
d) Median nerve
Explanation: The thoracodorsal nerve supplies latissimus dorsi and is located in the posterior wall of axilla. Injury weakens arm adduction and internal rotation. Correct answer is a) Thoracodorsal nerve.
10) Which muscle contributes to both posterior wall and posterior axillary fold?
a) Latissimus dorsi
b) Pectoralis major
c) Serratus anterior
d) Intercostal muscles
Explanation: The latissimus dorsi contributes to the posterior wall and forms the posterior axillary fold along with teres major. Correct answer is a) Latissimus dorsi.
Topic: Axilla
Subtopic: Axillary Folds
Keyword Definitions:
Axilla: Pyramidal space between arm and thorax transmitting major neurovascular structures.
Anterior axillary fold: Fold formed by lower border of pectoralis major.
Posterior axillary fold: Formed by latissimus dorsi and teres major.
Pectoralis major: Large anterior chest muscle forming anterior wall of axilla.
Pectoralis minor: Deeper chest muscle related to axillary vessels.
Subscapularis: Posterior axilla muscle, part of rotator cuff.
Teres major: Muscle forming part of posterior wall and fold.
Axillary folds: Landmark ridges important for surface anatomy and surgical orientation.
Lead Question - 2014
Anterior axillary fold is due to which muscle?
a) Pectoralis major
b) Pectoralis minor
c) Subscapularis
d) Teres major
Explanation: The anterior axillary fold is formed by the lower border of the pectoralis major muscle. Pectoralis minor lies deep but does not contribute. Subscapularis and teres major form posterior folds. Thus, the correct answer is a) Pectoralis major.
1) Which muscle forms the posterior axillary fold?
a) Pectoralis major
b) Latissimus dorsi and teres major
d) Pectoralis minor
Explanation: The posterior axillary fold is formed by latissimus dorsi and teres major muscles. These together create the posterior ridge visible at the axilla. Correct answer is b) Latissimus dorsi and teres major.
2) A surgeon palpates anterior axillary fold for clinical exam. Which nerve supplies its forming muscle?
a) Lateral and medial pectoral nerves
b) Thoracodorsal nerve
c) Long thoracic nerve
d) Axillary nerve
Explanation: The anterior axillary fold is formed by pectoralis major, supplied by both lateral and medial pectoral nerves. Correct answer is a) Lateral and medial pectoral nerves.
3) Which nerve injury affects posterior axillary fold?
a) Thoracodorsal nerve
b) Median nerve
c) Long thoracic nerve
d) Radial nerve
Explanation: The posterior axillary fold is mainly from latissimus dorsi, supplied by thoracodorsal nerve. Injury leads to weakened adduction and medial rotation. Correct answer is a) Thoracodorsal nerve.
4) Which structure forms the medial wall of axilla?
a) Serratus anterior
b) Subscapularis
c) Pectoralis minor
d) Latissimus dorsi
Explanation: The medial wall of axilla is formed by serratus anterior covering thoracic wall and supplied by long thoracic nerve. Correct answer is a) Serratus anterior.
5) A radical mastectomy may injure nerve causing "winged scapula". Which is it?
a) Long thoracic nerve
b) Axillary nerve
c) Thoracodorsal nerve
d) Median nerve
Explanation: Winging of scapula occurs after injury to the long thoracic nerve, paralyzing serratus anterior. Correct answer is a) Long thoracic nerve.
6) Which artery is most related to anterior wall of axilla?
a) Thoracoacromial artery
b) Profunda brachii artery
c) Posterior circumflex humeral artery
d) Subscapular artery
Explanation: The thoracoacromial artery pierces the clavipectoral fascia near pectoralis minor in the anterior wall of axilla. Correct answer is a) Thoracoacromial artery.
7) Floor of axilla consists of?
a) Skin, subcutaneous tissue, axillary fascia
b) Pectoralis major
c) Subscapularis
d) Teres major
Explanation: The floor is made by skin, subcutaneous tissue, and axillary fascia spanning between folds. Correct answer is a) Skin, subcutaneous tissue, axillary fascia.
8) Which lymph nodes are located along anterior axillary fold?
a) Pectoral nodes
b) Subscapular nodes
c) Apical nodes
d) Central nodes
Explanation: The pectoral (anterior) nodes lie along lateral thoracic vessels near anterior fold, draining breast and anterior thoracic wall. Correct answer is a) Pectoral nodes.
9) A patient with axillary abscess needs incision near anterior fold. Which vein is at risk?
a) Cephalic vein
b) Basilic vein
c) Median cubital vein
d) Brachial vein
Explanation: The cephalic vein ascends in the deltopectoral groove and pierces clavipectoral fascia near anterior fold. Correct answer is a) Cephalic vein.
10) Which muscle is deep to pectoralis major forming part of anterior wall?
a) Pectoralis minor
b) Subscapularis
c) Serratus anterior
d) Latissimus dorsi
Explanation: Pectoralis minor lies deep to pectoralis major and contributes to anterior wall of axilla. Correct answer is a) Pectoralis minor.
Topic: Shoulder Joint
Subtopic: Intracapsular but Extrasynovial Structures
Keyword Definitions:
Intracapsular: Located within the fibrous capsule of a joint.
Extrasynovial: Outside the synovial membrane but still within the joint capsule.
Shoulder joint: A synovial ball-and-socket joint formed between the humerus and scapula.
Biceps tendon: The long head passes through the shoulder joint capsule but remains extrasynovial.
Triceps tendon: Attaches posteriorly, not intracapsular.
Lead Question - 2014
Intracapsular but extrasynovial is ?
a) Long head of triceps
b) Long head of biceps
c) Short head of biceps
d) Medial head of biceps
Explanation: The long head of biceps tendon lies within the capsule of the shoulder joint but remains outside the synovial cavity, making it intracapsular but extrasynovial. This feature protects the tendon while maintaining joint mobility. Correct answer is Long head of biceps.
Guessed Questions:
1) Which tendon passes through the intertubercular sulcus of the humerus?
a) Short head of biceps
b) Long head of biceps
c) Coracobrachialis
d) Teres major
Explanation: The long head of biceps tendon passes through the intertubercular sulcus and is held in place by the transverse humeral ligament. This orientation stabilizes the tendon during shoulder movement. Correct answer is Long head of biceps.
2) Which structure prevents dislocation of the long head of biceps tendon?
a) Glenoid labrum
b) Transverse humeral ligament
c) Rotator cuff
d) Deltoid muscle
Explanation: The transverse humeral ligament bridges across the intertubercular sulcus, preventing displacement of the long head of biceps tendon during arm movements. Correct answer is Transverse humeral ligament.
3) A 30-year-old man presents with shoulder pain. MRI reveals inflammation of the tendon passing through the intertubercular sulcus. Which tendon is affected?
a) Subscapularis
b) Long head of biceps
c) Supraspinatus
d) Coracobrachialis
Explanation: Bicipital tendinitis occurs due to inflammation of the long head of biceps tendon within the intertubercular sulcus. It often presents as anterior shoulder pain aggravated by flexion. Correct answer is Long head of biceps.
4) Which part of the glenoid labrum is attached to the long head of biceps tendon?
a) Inferior
b) Superior
c) Anterior
d) Posterior
Explanation: The long head of biceps tendon originates from the supraglenoid tubercle and the superior part of the glenoid labrum, helping stabilize the shoulder joint. Correct answer is Superior.
5) Intracapsular but extrasynovial tendon in the knee joint is?
a) Posterior cruciate ligament
b) Anterior cruciate ligament
c) Patellar ligament
d) Medial collateral ligament
Explanation: The cruciate ligaments (ACL and PCL) are located within the joint capsule but remain extrasynovial. This anatomical arrangement protects them from direct synovial exposure. Correct answer is Anterior cruciate ligament.
6) A patient develops rupture of intracapsular but extrasynovial tendon in the shoulder joint. Which movement will be most affected?
a) Shoulder abduction
b) Shoulder extension
c) Shoulder flexion
d) Shoulder adduction
Explanation: The long head of biceps assists in flexion of the shoulder joint. Rupture of this tendon leads to weakness of flexion and supination, particularly affecting overhead movements. Correct answer is Shoulder flexion.
7) The tendon of long head of biceps is enclosed in a synovial sheath. True or False?
a) True
b) False
Explanation: The long head of biceps tendon has a tubular synovial sheath, facilitating smooth gliding within the intertubercular sulcus during arm movements. Correct answer is True.
8) Which tendon rupture causes “Popeye deformity” in the arm?
a) Short head of biceps
b) Long head of biceps
c) Brachialis
d) Coracobrachialis
Explanation: Rupture of the long head of biceps tendon leads to distal bunching of the muscle belly, producing the “Popeye deformity.” It usually occurs in older adults or athletes. Correct answer is Long head of biceps.
9) Which tendon runs intracapsular in shoulder joint but remains extrasynovial?
a) Long head of triceps
b) Long head of biceps
c) Supraspinatus
d) Teres minor
Explanation: The long head of biceps tendon is the only tendon that lies intracapsular but remains extrasynovial in the shoulder joint. Correct answer is Long head of biceps.
10) Which structure keeps the tendon of long head of biceps in place during shoulder motion?
a) Coracohumeral ligament
b) Transverse humeral ligament
c) Glenohumeral ligament
d) Rotator cuff tendons
Explanation: The transverse humeral ligament stabilizes the long head of biceps tendon in the intertubercular sulcus, preventing its displacement during shoulder movements. Correct answer is Transverse humeral ligament.
Topic: Nipple and Areola
Subtopic: Lactiferous Ducts
Keyword Definitions:
Lactiferous ducts: Channels that carry milk from mammary glands to the nipple.
Nipple: The conical projection in the center of the areola where ducts open externally.
Areola: Pigmented circular skin around the nipple containing sebaceous glands.
Mammary gland: Modified sweat gland specialized in milk secretion.
Lobules: Functional units of breast, drained by lactiferous ducts.
Lead Question - 2014
How many lactiferous ducts open in nipple ?
a) 0 -10
b) 15 -20
c) 25 -50
d) 50 -75
Explanation: Each breast usually has 15 to 20 lactiferous ducts, each draining a separate lobe. These ducts converge and open independently on the nipple surface to deliver milk during lactation. Thus, the correct answer is 15–20.
Guessed Questions:
1) Which structure surrounds the openings of lactiferous ducts?
a) Areola
b) Sebaceous glands
c) Montgomery’s tubercles
d) Nipple
Explanation: The nipple contains the terminal openings of lactiferous ducts. It is surrounded by the areola, which houses sebaceous glands (Montgomery’s glands) that lubricate and protect during breastfeeding. Correct answer is Nipple.
2) A lactating mother presents with blockage of a single duct causing localized swelling. Which structure is obstructed?
a) Alveolus
b) Lactiferous sinus
c) Lactiferous duct
d) Areolar gland
Explanation: Obstruction of a lactiferous duct prevents drainage of milk from the corresponding lobe, producing localized swelling and pain. This condition can lead to mastitis if untreated. Correct answer is Lactiferous duct.
3) Which hormone primarily stimulates milk secretion from breast lobules?
a) Estrogen
b) Progesterone
c) Prolactin
d) Oxytocin
Explanation: Prolactin secreted from the anterior pituitary promotes milk synthesis in alveolar cells of breast lobules, while oxytocin causes milk ejection through ducts. Correct answer is Prolactin.
4) Which hormone is responsible for milk ejection reflex during suckling?
a) Estrogen
b) Prolactin
c) Oxytocin
d) Progesterone
Explanation: Oxytocin from the posterior pituitary causes contraction of myoepithelial cells around alveoli and ducts, resulting in milk letdown reflex during suckling. Correct answer is Oxytocin.
5) A 25-year-old lactating woman presents with cracked nipple and mastitis. Infection spreads most likely through?
a) Areolar glands
b) Lactiferous ducts
c) Lymphatic vessels
d) Intercostal nerves
Explanation: Infection of the breast often enters through cracks in the nipple and spreads via lactiferous ducts into glandular tissue, leading to mastitis. Correct answer is Lactiferous ducts.
6) Which type of gland is the mammary gland?
a) Apocrine gland
b) Holocrine gland
c) Merocrine gland
d) Modified sweat gland
Explanation: Mammary gland is a modified sweat gland of apocrine type, functioning in milk production under hormonal regulation. Correct answer is Modified sweat gland.
7) A newborn fails to suckle effectively. Which structure in the mother provides direct milk entry to the infant?
a) Areola
b) Lactiferous ducts
c) Nipple
d) Lobules
Explanation: The nipple is the direct structure delivering milk from lactiferous ducts to the infant’s mouth. Ineffective suckling prevents proper milk ejection. Correct answer is Nipple.
8) Which artery mainly supplies blood to the lactating breast?
a) Internal thoracic artery
b) Radial artery
c) Brachial artery
d) Axillary artery
Explanation: The breast receives blood supply mainly from perforating branches of internal thoracic artery, lateral thoracic artery, and intercostal arteries. Correct answer is Internal thoracic artery.
9) A 40-year-old woman presents with retracted nipple. This is commonly due to?
a) Obstruction of ducts
b) Fibrosis of lactiferous ducts
c) Blockage of lymphatics
d) Muscular spasm
Explanation: Carcinoma of the breast causes fibrosis and retraction of lactiferous ducts, leading to nipple retraction. Correct answer is Fibrosis of lactiferous ducts.
10) Which lymph nodes primarily drain the nipple and areola?
a) Parasternal nodes
b) Supraclavicular nodes
c) Axillary nodes
d) Infraclavicular nodes
Explanation: The axillary lymph nodes, especially anterior (pectoral) group, are the primary drainage site for nipple and areola, making them crucial in breast cancer staging. Correct answer is Axillary nodes.
Topic: Pectoral Region
Subtopic: Deltopectoral Groove
Keyword Definitions:
Deltopectoral groove: Depression between deltoid and pectoralis major, an important landmark in the pectoral region.
Cephalic vein: A superficial vein of upper limb draining into axillary vein, running in deltopectoral groove.
Axillary artery: Main artery of upper limb continuation of subclavian artery.
Basilic vein: Superficial vein draining medial forearm and arm into axillary vein.
Radial nerve: Major branch of brachial plexus supplying extensor compartment of arm and forearm.
Lead Question - 2014
Structure related to deltopectoral groove ?
a) Axillary artery
b) Cephalic vein
c) Baselic vein
d) Radial nerve
Explanation: The cephalic vein runs through the deltopectoral groove, lying between deltoid and pectoralis major. It pierces the clavipectoral fascia to join axillary vein. Other listed structures do not lie in this groove. Hence, the correct answer is Cephalic vein.
Guessed Questions:
1) Deltopectoral groove is situated between?
a) Deltoid and trapezius
b) Pectoralis major and trapezius
c) Deltoid and pectoralis major
d) Deltoid and subscapularis
Explanation: The deltopectoral groove is formed between deltoid laterally and pectoralis major medially. It is an anatomical landmark for venous access via cephalic vein. Correct answer is Deltoid and pectoralis major.
2) Which structure pierces the clavipectoral fascia in the deltopectoral triangle?
a) Basilic vein
b) Cephalic vein
c) Radial nerve
d) Thoracodorsal artery
Explanation: The cephalic vein passes through the deltopectoral triangle and pierces clavipectoral fascia to drain into axillary vein. This region is used surgically for catheter placement. Correct answer is Cephalic vein.
3) A surgeon inserting a pacemaker uses which anatomical landmark for venous access?
a) Cubital fossa
b) Deltopectoral groove
c) Axillary fold
d) Radial groove
Explanation: For pacemaker insertion, the cephalic vein in the deltopectoral groove is commonly accessed, providing a safe superficial route to axillary vein and superior vena cava. Correct answer is Deltopectoral groove.
4) Which muscle forms the lateral boundary of the deltopectoral groove?
a) Deltoid
b) Trapezius
c) Pectoralis major
d) Latissimus dorsi
Explanation: The deltoid muscle forms the lateral boundary of the deltopectoral groove, with pectoralis major on the medial side. Correct answer is Deltoid.
5) A patient undergoing surgery near the deltopectoral groove risks injury to which superficial vein?
a) Basilic vein
b) Cephalic vein
c) Median cubital vein
d) Great saphenous vein
Explanation: Surgical approaches near deltopectoral groove risk injury to the cephalic vein, which lies in this groove and drains into axillary vein. Correct answer is Cephalic vein.
6) The deltopectoral triangle is bounded superiorly by?
a) Clavicle
b) Scapula
c) Sternum
d) First rib
Explanation: The deltopectoral triangle is bounded by clavicle superiorly, deltoid laterally, and pectoralis major medially. Correct answer is Clavicle.
7) Which artery accompanies the cephalic vein in the deltopectoral groove?
a) Thoracoacromial artery
b) Axillary artery
c) Radial artery
d) Subclavian artery
Explanation: The deltoid branch of thoracoacromial artery accompanies the cephalic vein in deltopectoral groove. Correct answer is Thoracoacromial artery.
8) A catheter introduced through the cephalic vein in deltopectoral groove ultimately drains into?
a) Subclavian vein
b) Superior vena cava
c) Axillary vein
d) Internal jugular vein
Explanation: The cephalic vein drains into axillary vein after piercing clavipectoral fascia in deltopectoral triangle, hence catheters placed here ultimately reach superior vena cava. Correct answer is Axillary vein.
9) Which clinical procedure often utilizes the deltopectoral approach for exposure?
a) Rotator cuff repair
b) Pacemaker insertion
c) Coronary bypass
d) Appendectomy
Explanation: The deltopectoral approach provides surgical access to shoulder joint and proximal humerus, frequently used in fracture fixation and prosthesis insertion. Correct answer is Pacemaker insertion (via cephalic vein) and shoulder surgeries.
10) Deltopectoral groove serves as an anatomical landmark for which type of block?
a) Axillary block
b) Brachial plexus block
c) Interscalene block
d) Caudal block
Explanation: Deltopectoral groove is important for surgical access but not commonly used in anesthesia blocks. The axillary block targets brachial plexus, often guided by anatomical landmarks. Among given options, the closest association is with Axillary block.
Topic: Arteries of Forearm
Subtopic: Common Interosseous Artery
Keyword Definitions:
Brachial artery: Main artery of arm, continuation of axillary artery.
Radial artery: Lateral terminal branch of brachial artery.
Ulnar artery: Medial terminal branch of brachial artery, supplies forearm.
Common interosseous artery: Short branch of ulnar artery, dividing into anterior and posterior interosseous arteries.
Profunda brachii artery: Deep artery of arm, runs with radial nerve.
Lead Question - 2014
Common interosseous artery is a branch of -
a) Brachial artery
b) Radial artery
c) Ulnar artery
d) Profunda brachii artery
Explanation: The common interosseous artery is a short thick branch arising from the ulnar artery just below the cubital fossa. It quickly divides into anterior and posterior interosseous arteries. These supply the deep flexor and extensor compartments. Hence, the correct answer is Ulnar artery.
1) Which artery accompanies the median nerve in forearm?
a) Radial
b) Ulnar
d) Posterior interosseous
Explanation: The anterior interosseous artery, branch of common interosseous, accompanies the anterior interosseous nerve, a branch of the median nerve, in forearm. It supplies deep flexor muscles. The correct answer is Anterior interosseous.
2) Posterior interosseous artery passes through which structure?
a) Carpal tunnel
b) Interosseous membrane
c) Cubital tunnel
d) Supinator arch
Explanation: The posterior interosseous artery arises from the common interosseous and passes through an opening in the interosseous membrane to reach posterior compartment of forearm. It supplies extensor muscles. The correct answer is Interosseous membrane.
3) Anterior interosseous artery supplies all except?
a) Flexor digitorum profundus
b) Flexor pollicis longus
c) Pronator quadratus
d) Extensor carpi ulnaris
Explanation: The anterior interosseous artery supplies deep flexor muscles like FDP, FPL, pronator quadratus. Extensor carpi ulnaris is located in posterior compartment, supplied by posterior interosseous artery. Hence, the correct answer is Extensor carpi ulnaris.
4) A patient with posterior compartment forearm ischemia likely has obstruction of?
a) Anterior interosseous artery
b) Posterior interosseous artery
c) Radial recurrent artery
d) Profunda brachii artery
Explanation: Ischemia of extensor compartment indicates loss of posterior interosseous artery flow. This artery supplies most extensors and arises from the common interosseous. Thus, the correct answer is Posterior interosseous artery.
5) Which artery contributes to dorsal carpal arch?
a) Anterior interosseous
b) Posterior interosseous
c) Radial
d) Ulnar
Explanation: The posterior interosseous artery anastomoses with branches of radial and ulnar arteries to form the dorsal carpal arch supplying dorsal hand. Therefore, the correct answer is Posterior interosseous.
6) In Volkmann ischemic contracture, compromised artery is?
a) Ulnar
b) Radial
c) Brachial
d) Anterior interosseous
Explanation: Volkmann ischemic contracture results from brachial artery obstruction, reducing blood flow to forearm including interosseous branches. This leads to muscle ischemia and fibrosis. The correct answer is Brachial artery.
7) The nutrient artery to radius is derived from?
a) Anterior interosseous
b) Posterior interosseous
c) Radial
d) Ulnar
Explanation: The anterior interosseous artery gives nutrient branches to radius and ulna. Hence, the nutrient artery to radius comes from Anterior interosseous artery.
8) Injury to posterior interosseous artery during fracture of proximal radius leads to?
a) Loss of flexion
b) Loss of pronation
c) Loss of extension
d) Loss of supination
Explanation: Posterior interosseous artery supplies extensors. Injury leads to extensor weakness or loss. Therefore, correct answer is Loss of extension.
9) Which branch of common interosseous artery participates in palmar carpal arch?
a) Anterior interosseous
b) Posterior interosseous
c) Radial recurrent
d) Deep radial branch
Explanation: The anterior interosseous artery contributes to palmar carpal arch by anastomosing with branches of radial and ulnar arteries. The correct answer is Anterior interosseous.
10) Patient with compartment syndrome of deep anterior forearm – which artery is primarily affected?
a) Radial
b) Ulnar
c) Anterior interosseous
d) Posterior interosseous
Explanation: Deep anterior compartment of forearm is mainly supplied by anterior interosseous artery. Compartment syndrome compromises its blood flow, affecting deep flexors. Thus, the correct answer is Anterior interosseous artery.
Topic: Wrist and Hand Vasculature
Subtopic: Scaphoid Blood Supply
Keyword Definitions:
Scaphoid: Carpal bone located on radial side of wrist, prone to fracture.
Radial artery: Main arterial supply to scaphoid, particularly dorsal branch.
Ulnar artery: Supplies medial side of hand, not major source for scaphoid.
Dorsal branch: Provides retrograde blood flow to proximal scaphoid.
Avascular necrosis: Bone death due to inadequate blood supply, common in proximal scaphoid fractures.
Lead Question - 2014
True about blood supply of scaphoid?
a) Mainly through ulnar artery
b) Major supply from ventral surface
c) Major supply from dorsal surface
d) Proximal supply in antegrade fashion
Explanation: The scaphoid receives its blood supply predominantly from the dorsal branch of the radial artery. This supply enters distally and runs retrograde to the proximal pole, making the proximal part vulnerable to avascular necrosis. Hence, the correct answer is Major supply from dorsal surface.
1) Which carpal bone is most commonly fractured?
a) Scaphoid
b) Lunate
c) Triquetrum
d) Pisiform
Explanation: Among carpal bones, the scaphoid is most frequently fractured, especially after falls on an outstretched hand. Due to retrograde blood flow, its proximal fragment is at high risk of avascular necrosis. The correct answer is Scaphoid.
2) A patient presents with tenderness in the anatomical snuffbox. Which bone is likely fractured?
a) Scaphoid
b) Lunate
c) Hamate
d) Capitate
Explanation: Anatomical snuffbox tenderness is highly suggestive of scaphoid fracture. Clinical suspicion requires imaging since fracture may be radiologically occult initially. The correct answer is Scaphoid.
3) Main arterial supply to lunate bone is from?
a) Radial artery
b) Ulnar artery
c) Interosseous artery
d) Both radial and ulnar arteries
Explanation: The lunate receives dual supply from both radial and ulnar arteries. Despite this, it may still undergo avascular necrosis in Kienbock’s disease. Correct answer is Both radial and ulnar arteries.
4) In scaphoid fracture, which part is more prone to avascular necrosis?
a) Distal pole
b) Waist
c) Proximal pole
d) Tubercle
Explanation: The proximal pole of scaphoid has retrograde blood supply from the distal entry of radial artery branches. Hence, fracture often compromises proximal circulation leading to avascular necrosis. Correct answer is Proximal pole.
5) Which artery enters scaphoid through its dorsal ridge?
a) Ulnar artery
b) Radial artery
c) Anterior interosseous artery
d) Posterior interosseous artery
Explanation: The dorsal branch of radial artery enters scaphoid through its dorsal ridge and supplies most of the proximal part. Correct answer is Radial artery.
6) Patient with delayed healing of scaphoid fracture – what complication is likely?
a) Osteoarthritis
b) Avascular necrosis
c) Osteomyelitis
d) Carpal tunnel syndrome
Explanation: Due to retrograde blood flow, proximal scaphoid is prone to ischemia after fracture, leading to avascular necrosis. Hence, the major complication of scaphoid fracture is Avascular necrosis.
7) Which carpal bone dislocates most frequently?
a) Scaphoid
b) Lunate
c) Capitate
d) Hamate
Explanation: The lunate, located centrally in the proximal row of carpals, is the most frequently dislocated carpal bone. Correct answer is Lunate.
8) Which nerve may be compressed in lunate dislocation?
a) Ulnar nerve
b) Radial nerve
c) Median nerve
d) Musculocutaneous nerve
Explanation: Lunate dislocation pushes into the carpal tunnel, compressing the median nerve. This leads to sensory and motor symptoms in hand. Correct answer is Median nerve.
9) Which ligament stabilizes the scaphoid and lunate together?
a) Scapholunate ligament
b) Radiocarpal ligament
c) Intercarpal ligament
d) Palmar carpal ligament
Explanation: The scapholunate ligament holds scaphoid and lunate in close articulation. Its rupture leads to carpal instability and may mimic scaphoid fracture symptoms. Correct answer is Scapholunate ligament.
10) Pain in anatomical snuffbox after fall but normal X-ray – best next step?
a) Ignore
b) Cast immobilization
c) Immediate surgery
d) Nerve conduction test
Explanation: Scaphoid fracture may be radiologically occult initially. If clinical suspicion exists, immobilization in thumb spica cast is done, and repeat imaging after 10–14 days confirms fracture. Correct answer is Cast immobilization.
Topic: Nerve Supply of Foot Muscles
Subtopic: Lumbricals of Foot
Keyword Definitions:
Lumbricals (foot): Four small intrinsic muscles of the foot, flex metatarsophalangeal joints and extend interphalangeal joints.
Medial plantar nerve: Branch of tibial nerve, supplies abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and 1st lumbrical.
Lateral plantar nerve: Branch of tibial nerve, supplies most intrinsic muscles of the foot including 2nd–4th lumbricals.
Tibial nerve: Main posterior leg nerve, parent of medial and lateral plantar nerves.
Peroneal nerve: Supplies anterior and lateral compartments of leg, not lumbricals.
Lead Question - 2014
3rd and 4th lumbrical (lateral two lumbricals) of foot are supplied by?
a) Medial plantar nerve
b) Lateral plantar nerve
c) Peroneal nerve
d) None of the above
Explanation: The 1st lumbrical of the foot is supplied by the medial plantar nerve. The 2nd, 3rd, and 4th lumbricals are supplied by the lateral plantar nerve. Thus, the 3rd and 4th lumbricals specifically receive innervation from the lateral plantar nerve. Correct answer: Lateral plantar nerve.
1) Which lumbrical of the foot is supplied by medial plantar nerve?
a) 1st
b) 2nd
c) 3rd
d) 4th
Explanation: Only the first lumbrical of the foot is supplied by the medial plantar nerve. The remaining lumbricals (2nd to 4th) are supplied by the lateral plantar nerve. Correct answer is 1st.
2) A patient presents with weakness in toe flexion at metatarsophalangeal joints. Which muscles are primarily involved?
a) Lumbricals
b) Interossei
c) Extensors
d) Plantar aponeurosis
Explanation: Lumbricals flex the metatarsophalangeal joints and extend the interphalangeal joints. Weakness in these movements is indicative of lumbrical muscle dysfunction. Correct answer is Lumbricals.
3) Which nerve injury leads to loss of function of lateral three lumbricals of foot?
a) Medial plantar nerve
b) Lateral plantar nerve
c) Deep peroneal nerve
d) Superficial peroneal nerve
Explanation: The lateral plantar nerve supplies the 2nd, 3rd, and 4th lumbricals. Injury to this nerve results in loss of function of the lateral three lumbricals. Correct answer is Lateral plantar nerve.
4) Which compartment of foot contains lumbricals?
a) Medial
b) Lateral
c) Central
d) Interosseous
Explanation: The lumbricals are located in the central compartment of the foot, along with flexor digitorum brevis and tendons of flexor digitorum longus. Correct answer is Central.
5) Lumbricals of the foot act on which joints?
a) Only ankle
b) Only knee
c) Metatarsophalangeal and interphalangeal joints
d) Tarsal joints
Explanation: Lumbricals flex the metatarsophalangeal joints and extend interphalangeal joints, thus balancing flexors and extensors during walking. Correct answer is Metatarsophalangeal and interphalangeal joints.
6) A football player has tibial nerve injury at ankle. Which lumbrical remains functional?
a) 1st
b) 2nd
c) 3rd
d) None
Explanation: Both medial and lateral plantar nerves are branches of tibial nerve. Injury at ankle compromises all lumbricals. Hence, no lumbrical remains functional. Correct answer is None.
7) Which intrinsic foot muscles are supplied by medial plantar nerve along with 1st lumbrical?
a) Flexor hallucis brevis, abductor hallucis, flexor digitorum brevis
b) Interossei
c) Adductor hallucis
d) Lateral two lumbricals
Explanation: Medial plantar nerve supplies abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and 1st lumbrical. The rest are supplied by the lateral plantar nerve. Correct answer is Flexor hallucis brevis, abductor hallucis, flexor digitorum brevis.
8) In clawing of toes due to lumbrical paralysis, what happens?
a) Hyperextension of MTP, flexion of IP
b) Flexion of MTP, extension of IP
c) Both extended
d) Both flexed
Explanation: Lumbricals normally flex the MTP joints and extend the IP joints. Paralysis leads to opposite deformity: hyperextension at MTP and flexion at IP joints, causing claw toe deformity. Correct answer is Hyperextension of MTP, flexion of IP.
9) Which tendon gives origin to lumbricals of foot?
a) Flexor digitorum longus
b) Flexor digitorum brevis
c) Extensor digitorum longus
d) Extensor digitorum brevis
Explanation: All four lumbricals of the foot arise from tendons of flexor digitorum longus. Correct answer is Flexor digitorum longus.
10) A patient with lateral plantar nerve injury is most likely to lose which movement?
a) Flexion of great toe
b) Extension of toes
c) Flexion at MTP and extension at IP of lateral toes
d) Inversion of foot
Explanation: Lateral plantar nerve supplies lateral three lumbricals. Their paralysis causes inability to flex MTP and extend IP joints of lateral toes. Correct answer is Flexion at MTP and extension at IP of lateral toes.
Topic: Superficial Veins of Lower Limb
Subtopic: Short Saphenous Vein
Keyword Definitions:
Short saphenous vein: Superficial vein of the leg, begins behind the lateral malleolus, drains into popliteal vein.
Long saphenous vein: Largest superficial vein of the leg, runs medially from foot to femoral vein.
Lateral malleolus: Bony prominence of distal fibula, landmark for short saphenous vein course.
Sural nerve: Cutaneous nerve of posterior leg, often runs with short saphenous vein.
Achilles tendon: Tendon of gastrocnemius and soleus, medial to short saphenous vein at ankle level.
Lead Question - 2014
All are true about short saphenous vein except?
a) Runs behind lateral malleolus
b) Runs on lateral side of leg
c) Accompanied by sural nerve
d) Achillis tendon is medial to vein
Explanation: The short saphenous vein runs behind the lateral malleolus, courses along the posterior aspect of the leg, is accompanied by the sural nerve, and lies lateral to the Achilles tendon. Therefore, the incorrect statement is that Achilles tendon is medial to vein. Correct answer: Achilles tendon is medial to vein.
1) The short saphenous vein drains into?
a) Femoral vein
b) Popliteal vein
c) External iliac vein
d) Posterior tibial vein
Explanation: The short saphenous vein ascends along the posterior leg and pierces deep fascia at popliteal fossa to drain into the popliteal vein. This makes the popliteal vein the correct answer.
2) Varicosity of short saphenous vein most commonly presents at?
a) Groin
b) Popliteal fossa
c) Medial malleolus
d) Lateral thigh
Explanation: Varicosities of short saphenous vein usually present in the posterior calf and popliteal region, as the vein terminates into the popliteal vein there. Correct answer: Popliteal fossa.
3) Which nerve accompanies the short saphenous vein?
a) Tibial nerve
b) Sural nerve
c) Superficial peroneal nerve
d) Deep peroneal nerve
Explanation: The sural nerve, a sensory branch formed by tibial and common peroneal nerves, accompanies the short saphenous vein along the posterior leg. Correct answer: Sural nerve.
4) During surgery for varicose veins, short saphenous vein is ligated at?
a) Groin
b) Lateral malleolus
c) Popliteal fossa
d) Medial thigh
Explanation: The short saphenous vein drains into the popliteal vein at the popliteal fossa. Therefore, surgical ligation is performed at the popliteal fossa. Correct answer: Popliteal fossa.
5) Short saphenous vein originates from?
a) Medial marginal vein
b) Lateral marginal vein
c) Dorsal venous arch
d) Femoral vein
Explanation: The short saphenous vein begins from the lateral end of dorsal venous arch of foot, via the lateral marginal vein. Correct answer: Lateral marginal vein.
6) A patient with sural nerve injury may show sensory loss in which region?
a) Medial leg
b) Anterior leg
c) Posterolateral leg and lateral foot
d) Medial thigh
Explanation: The sural nerve supplies sensation to posterolateral part of leg and lateral border of foot. Injury results in sensory loss over this distribution. Correct answer: Posterolateral leg and lateral foot.
7) Which is true about communication of short saphenous vein?
a) Communicates with long saphenous via perforators
b) Has no communication
c) Drains directly into femoral vein
d) Communicates only with deep femoral vein
Explanation: The short saphenous vein communicates with the long saphenous vein through perforating veins, allowing collateral venous return. Correct answer: Communicates with long saphenous via perforators.
8) Short saphenous vein lies in relation to Achilles tendon as?
a) Medial
b) Lateral
c) Posterior
d) Deep
Explanation: The short saphenous vein lies lateral to the Achilles tendon as it passes upwards behind the lateral malleolus. Correct answer: Lateral.
9) Short saphenous vein pierces deep fascia at?
a) Groin
b) Popliteal fossa
c) Ankle
d) Medial thigh
Explanation: The short saphenous vein ascends along posterior calf and pierces the popliteal fossa to drain into popliteal vein. Correct answer: Popliteal fossa.
10) Clinical significance of short saphenous vein in DVT diagnosis?
a) Used for arterial cannulation
b) Assessed for varicosities
c) Doppler used to trace flow into popliteal vein
d) Used for dialysis access
Explanation: In suspected DVT, Doppler ultrasound assesses venous flow of short saphenous vein into popliteal vein. Its patency and reflux are clinically significant for diagnosis. Correct answer: Doppler used to trace flow into popliteal vein.