Chapter: Anatomy; Topic: Anterior Abdominal Wall; Subtopic: Muscles and Ligamentous Structures of Abdominal Wall
Keyword Definitions:
• External Oblique: The outermost flat muscle of the anterior abdominal wall, involved in trunk rotation and flexion.
• Lacunar Ligament: Crescent-shaped ligament formed by fibers of the external oblique tendon attaching to the pubic bone.
• Pectineal Ligament: Ligament along the pectineal line of the pubic bone, contributing to the inguinal canal structure.
• Conjoint Tendon: Tendinous fusion of internal oblique and transversus abdominis, not external oblique.
• Inguinal Ligament: Formed by the lower border of external oblique aponeurosis from ASIS to pubic tubercle.
Lead Question – 2014
External oblique forms all except?
a) Lacunar ligament
b) Pectineal ligament
c) Conjoint tendon
d) Inguinal ligament
Explanation:
The conjoint tendon is not formed by the external oblique; it is formed by the fusion of the internal oblique and transversus abdominis aponeuroses. External oblique contributes to the inguinal ligament, lacunar ligament, and pectineal ligament. Understanding the origins of these structures is critical for hernia surgery and abdominal wall reconstruction. Hence, the answer is conjoint tendon.
1. Which ligament is formed by fibers of the external oblique attaching to pubic bone?
a) Lacunar ligament
b) Pectineal ligament
c) Conjoint tendon
d) Inguinal ligament
2. The inguinal ligament extends from:
a) Pubic symphysis to ASIS
b) ASIS to pubic tubercle
c) Pubic tubercle to iliac crest
d) Iliac crest to ASIS
3. Conjoint tendon is formed by which muscles?
a) External oblique only
b) Internal oblique and transversus abdominis
c) Rectus abdominis and external oblique
d) Transversus abdominis only
4. Pectineal ligament is associated with which part of abdominal wall?
a) Iliac crest
b) Pectineal line of pubic bone
c) ASIS
d) Pubic symphysis
5. Which structure forms the roof of the superficial inguinal ring?
a) External oblique aponeurosis
b) Internal oblique
c) Conjoint tendon
d) Lacunar ligament
6. A patient has direct inguinal hernia. Which ligament is most relevant surgically?
a) Lacunar ligament
b) Pectineal ligament
c) Conjoint tendon
d) Inguinal ligament
7. Which abdominal wall muscle contributes to the inguinal canal formation?
a) External oblique
b) Transversus abdominis
c) Rectus abdominis
d) Pyramidalis
8. Lacunar ligament is clinically important in:
a) Femoral hernia repair
b) Umbilical hernia repair
c) Diaphragmatic hernia
d) Hiatal hernia
9. In repair of a direct inguinal hernia, which structure is reinforced?
a) Conjoint tendon
b) External oblique
c) Inguinal ligament
d) Lacunar ligament
10. Which aponeurosis forms the superficial inguinal ring?
a) External oblique
b) Internal oblique
c) Transversus abdominis
d) Conjoint tendon
11. During abdominal wall reconstruction, avoiding damage to which tendon is crucial for conjoint action?
a) Conjoint tendon
b) Lacunar ligament
c) Inguinal ligament
d) Pectineal ligament
Explanation:
The external oblique contributes to the inguinal ligament, lacunar ligament, and pectineal ligament but not the conjoint tendon, which arises from the internal oblique and transversus abdominis aponeuroses. Proper knowledge of these anatomical relationships is essential for hernia surgery, abdominal wall reconstruction, and understanding the mechanics of the inguinal canal. Therefore, the correct answer is conjoint tendon.
Chapter: Neuroanatomy; Topic: Cranial Nerve Pathways; Subtopic: Trigeminal Ganglion and Meckel’s Cave
Keyword Definitions:
• Meckel’s Cave: A dural pouch in the middle cranial fossa housing the trigeminal ganglion.
• Trigeminal Ganglion: Sensory ganglion of cranial nerve V located within Meckel’s cave.
• Otic Ganglion: A small parasympathetic ganglion located below the foramen ovale, linked to the glossopharyngeal nerve.
• Pterygopalatine Ganglion: Parasympathetic ganglion in the pterygopalatine fossa associated with facial nerve fibers.
• Submandibular Ganglion: Parasympathetic ganglion associated with chorda tympani and lingual nerve supplying submandibular glands.
Lead Question – 2014
Meckel's cave is related to?
a) Submandibular ganglion
b) Trigeminal ganglion
c) Otic ganglion
d) Pterygopalatine ganglion
Explanation:
Meckel’s cave is a dural recess in the middle cranial fossa that contains the trigeminal ganglion (Gasserian ganglion). It provides cushioning and protection to the ganglion and its divisions. The space is filled with cerebrospinal fluid and communicates with the subarachnoid space. Therefore, the correct answer is trigeminal ganglion.
1. Meckel’s cave is located in which cranial fossa?
a) Anterior
b) Middle
c) Posterior
d) None
2. The trigeminal ganglion lies within:
a) Cavernous sinus
b) Meckel’s cave
c) Foramen ovale
d) Internal auditory meatus
3. Trigeminal ganglion gives rise to how many main divisions?
a) One
b) Two
c) Three
d) Four
4. Which structure passes through the foramen rotundum?
a) Maxillary nerve
b) Mandibular nerve
c) Ophthalmic nerve
d) Facial nerve
5. Which cranial nerve is most likely affected if there is lesion in Meckel’s cave?
a) CN IV
b) CN V
c) CN VI
d) CN VII
6. A patient presents with loss of corneal reflex and facial pain. The lesion most likely involves:
a) Otic ganglion
b) Trigeminal ganglion
c) Geniculate ganglion
d) Pterygopalatine ganglion
7. The dural covering of Meckel’s cave is derived from:
a) Pia mater
b) Arachnoid mater
c) Dura mater
d) Endosteum
8. A tumor compressing Meckel’s cave may lead to which symptom?
a) Anosmia
b) Trigeminal neuralgia
c) Vertigo
d) Diplopia
9. Pterygopalatine ganglion is associated with which cranial nerve?
a) Facial nerve
b) Glossopharyngeal nerve
c) Trigeminal nerve
d) Vagus nerve
10. Otic ganglion is related to which nerve fiber type?
a) Sensory fibers of trigeminal nerve
b) Parasympathetic fibers from glossopharyngeal nerve
c) Sympathetic fibers from carotid plexus
d) Somatic motor fibers
11. During skull base surgery, damage to Meckel’s cave may result in loss of sensation from:
a) Ear and scalp
b) Cornea and face
c) Tongue and palate
d) Jaw and larynx
Explanation:
Meckel’s cave houses the trigeminal ganglion and is an important structure in skull base anatomy. Compression of this space can lead to trigeminal neuralgia, facial pain, or sensory loss in the face. It is located in the middle cranial fossa, posterior to the cavernous sinus, lined by dura mater. Thus, the correct answer is trigeminal ganglion.
Topic: Vertebral Column; Subtopic: Cervical Vertebrae and Spinous Processes
Keyword Definitions:
• Spinous Process: The posterior bony projection from a vertebra where muscles and ligaments attach.
• Cervical Vertebrae: The seven vertebrae of the neck (C1–C7).
• Vertebra Prominens: The seventh cervical vertebra with a long non-bifid spinous process palpable at the base of the neck.
• Atlas (C1): The first cervical vertebra, supporting the skull.
• Axis (C2): The second cervical vertebra, having the odontoid process (dens).
Lead Question – 2014
Longest spinous process is seen in?
a) C2
b) C4
c) C5
d) C7
Explanation:
The seventh cervical vertebra (C7), also called the vertebra prominens, has the longest spinous process in the cervical region. It is easily palpable at the back of the neck, serving as a landmark for counting vertebrae. Its spine is thick, prominent, and non-bifid, differentiating it from upper cervical spines.
1. Vertebra prominens refers to which vertebra?
a) C1
b) C3
c) C7
d) T1
2. The spinous process of C7 is typically:
a) Bifid
b) Long and non-bifid
c) Absent
d) Fused with T1
3. The transverse foramina of C7 usually transmit:
a) Vertebral artery
b) Vertebral vein only
c) Both artery and vein
d) Sympathetic trunk
4. The most prominent spine palpable in the back of neck when head is flexed belongs to:
a) C6
b) C7
c) T1
d) C5
5. Which cervical vertebra contains the dens (odontoid process)?
a) Atlas
b) Axis
c) C3
d) C7
6. A 30-year-old man with neck trauma shows fracture at vertebra prominens. Which spinal level is affected?
a) C2
b) C6
c) C7
d) T1
7. Which vertebra has the longest spinous process in the thoracic region?
a) T1
b) T5
c) T7
d) T12
8. A surgeon palpates a prominent spine at the base of the neck before incision. This corresponds to:
a) C6
b) C7
c) T1
d) T2
9. Which cervical vertebra has the smallest body and large vertebral foramen?
a) C1
b) C2
c) C3
d) C4
10. A fracture at vertebra prominens can endanger which nearby structure?
a) Brachial plexus
b) Vertebral artery
c) Sympathetic chain
d) Phrenic nerve
11. A patient reports pain at the base of the neck and X-ray shows fracture at vertebra with longest spinous process. Identify the vertebra.
a) C2
b) C5
c) C7
d) T1
Explanation:
The C7 vertebra, or vertebra prominens, is distinct for its long, palpable, non-bifid spinous process. It serves as a key anatomical landmark for locating cervical and thoracic vertebrae. Clinically, it aids in surface anatomy and surgical localization. Therefore, the correct answer is C7.
Chapter: Anatomy of Eye; Topic: Glands of Eyelid; Subtopic: Sweat and Sebaceous Glands near Eyelid Margin
Keyword Definitions:
Moll’s gland: Modified apocrine sweat glands located near eyelash follicles at the eyelid margin.
Zeis gland: Sebaceous glands associated with eyelash follicles.
Meibomian gland: Large sebaceous glands in the tarsal plate secreting oily film to prevent tear evaporation.
Krause gland: Accessory lacrimal gland contributing to tear secretion.
Lead Question (2014):
Sweat gland near the lid margins
a) Moll
b) Zeis
c) Meibomian
d) Krause
Explanation:
The sweat glands near the eyelid margin are Moll’s glands, which are modified apocrine sweat glands associated with the eyelashes. They help lubricate the eyelid margin and maintain ocular hygiene. Infections of these glands cause stye-like conditions. Answer: Moll’s gland. Understanding their anatomy aids in diagnosing eyelid pathologies such as hordeolum and blepharitis.
1) Blockage of Moll’s gland leads to which condition?
a) Chalazion
b) External hordeolum
c) Internal hordeolum
d) Dacryocystitis
Explanation:
Blockage or infection of Moll’s gland results in external hordeolum (stye), presenting as a painful, red swelling at the eyelid margin. It differs from chalazion, which involves Meibomian glands. Proper eyelid hygiene and warm compresses are preventive. Answer: External hordeolum. It reflects inflammation of apocrine glands near lashes.
2) Which gland is responsible for the lipid layer of tear film?
a) Krause
b) Moll
c) Meibomian
d) Zeis
Explanation:
The Meibomian glands secrete an oily (lipid) layer that prevents evaporation of tears. Dysfunction of these glands causes dry eye syndrome and ocular irritation. Their ducts open at the eyelid margin posterior to the lashes. Answer: Meibomian gland. Proper function maintains ocular surface stability and comfort during blinking.
3) Sebaceous glands associated with eyelash follicles are called:
a) Moll
b) Zeis
c) Krause
d) Wolfring
Explanation:
The Zeis glands are sebaceous glands connected to eyelash follicles, producing oily secretions that lubricate lashes. Infection leads to external hordeolum as well. They differ from Meibomian glands, which are embedded in the tarsal plate. Answer: Zeis gland. Their role is vital for lash protection and smooth movement of eyelids.
4) Accessory lacrimal glands of Krause are located in:
a) Conjunctival fornix
b) Eyelid margin
c) Tarsal plate
d) Caruncle
Explanation:
The glands of Krause are small accessory lacrimal glands found in the conjunctival fornix. They supplement tear secretion along with glands of Wolfring. Their secretions maintain ocular surface moisture and corneal transparency. Answer: Conjunctival fornix. Damage can lead to dry eye due to reduced tear volume.
5) A 35-year-old woman presents with a painful, red swelling at the eyelid margin near an eyelash follicle. Most likely involved gland is:
a) Meibomian
b) Krause
c) Moll
d) Wolfring
Explanation:
A Moll’s gland infection causes external hordeolum, presenting as a painful, red nodule near the eyelash base. It is bacterial, commonly due to Staphylococcus aureus. Warm compresses help drain infection. Answer: Moll’s gland. Clinically, location and tenderness distinguish it from internal hordeolum or chalazion.
6) Blockage of Meibomian gland results in:
a) Chalazion
b) Stye
c) Blepharitis
d) Dacryoadenitis
Explanation:
Obstruction of a Meibomian gland leads to a chalazion, a chronic, non-infective, granulomatous swelling within the tarsal plate. It appears firm and painless, unlike stye, which is acute and tender. Answer: Chalazion. Surgical drainage or steroid injection may be required if persistent, though small lesions may resolve spontaneously.
7) Glands of Wolfring are situated near:
a) Tarsal border
b) Conjunctival fornix
c) Caruncle
d) Limbus
Explanation:
The glands of Wolfring are accessory lacrimal glands located near the tarsal border. They provide continuous tear secretion to keep the cornea moist. Along with Krause glands, they supplement the main lacrimal gland. Answer: Tarsal border. Their dysfunction contributes to chronic dryness or irritation in ocular surface diseases.
8) A patient with chronic blepharitis develops recurrent chalazia. Which gland dysfunction is most likely?
a) Zeis
b) Meibomian
c) Krause
d) Moll
Explanation:
Chronic blepharitis causing recurrent chalazia is linked to Meibomian gland dysfunction. Blocked ducts lead to stagnation and lipogranulomatous inflammation. Long-standing inflammation alters tear composition. Answer: Meibomian gland. Regular lid hygiene and warm compresses are key to management. Antibiotics may be needed if secondary infection occurs.
9) Which gland opens near the base of eyelashes and secretes oily material?
a) Moll
b) Krause
c) Zeis
d) Meibomian
Explanation:
The Zeis glands open at the base of eyelashes and secrete oily material to lubricate lash follicles. Their blockage can cause external hordeolum. Answer: Zeis gland. Proper lubrication from these glands prevents eyelash brittleness and maintains smooth eyelid motion during blinking and protection from dust.
10) A 50-year-old diabetic presents with a firm, painless swelling in the tarsal plate lasting weeks. Diagnosis?
a) Internal hordeolum
b) Chalazion
c) External hordeolum
d) Dacryoadenitis
Explanation:
A chronic, firm, painless swelling in the tarsal plate indicates chalazion, due to Meibomian gland blockage. It is non-suppurative and commonly seen in diabetics and patients with seborrheic dermatitis. Answer: Chalazion. Histologically, it represents lipogranulomatous inflammation. Excision or intralesional corticosteroids may be needed for persistent cases.
Chapter: Head and Neck Anatomy; Topic: Lymphatic Drainage of Nose; Subtopic: Anterior and Posterior Nasal Lymphatics
Keyword Definitions:
Lymphatic drainage: Pathway by which lymph fluid from tissues drains into lymph nodes for immune filtration.
Submandibular lymph nodes: Nodes located beneath the mandible, draining the anterior nasal cavity, cheek, and lips.
Pretracheal nodes: Small lymph nodes in front of the trachea, draining thyroid and laryngeal regions.
Superficial cervical nodes: Nodes along the external jugular vein, receiving lymph from the scalp and face.
Lead Question (2014):
Anterior lymphatics from the nose drain into?
a) Pretracheal nodes
b) Submandibular nodes
c) Sublingual nodes
d) Superficial cervical nodes
Explanation:
The anterior lymphatics of the nose, particularly from the anterior nasal cavity and vestibule, drain into the submandibular lymph nodes. Posterior nasal regions drain into retropharyngeal and upper deep cervical nodes. Understanding these pathways is important in diagnosing nasal and facial infections. Answer: Submandibular nodes. These nodes play a vital role in filtering lymph from anterior facial structures.
1) Posterior nasal cavity lymphatics primarily drain into:
a) Submandibular nodes
b) Retropharyngeal nodes
c) Pretracheal nodes
d) Submental nodes
Explanation:
Lymph from the posterior nasal cavity drains into retropharyngeal nodes, located behind the pharynx. These nodes later communicate with upper deep cervical nodes. Infections in posterior nasal structures, such as adenoids or nasopharyngeal carcinoma, often spread here first. Answer: Retropharyngeal nodes. Their deep location makes clinical detection difficult unless significantly enlarged.
2) Which lymph nodes drain the tip of the nose?
a) Submandibular nodes
b) Submental nodes
c) Superficial parotid nodes
d) Deep cervical nodes
Explanation:
The tip of the nose and adjacent alae drain primarily into the submandibular nodes. However, some lymph from the midline of the lower lip and chin may reach submental nodes. Answer: Submandibular nodes. This pattern is clinically important because infections at the nasal vestibule or furuncles can cause tender swelling beneath the jawline.
3) A patient with a nasal vestibular abscess will most likely have tenderness over which lymph nodes?
a) Pretracheal
b) Submandibular
c) Deep cervical
d) Retropharyngeal
Explanation:
A nasal vestibular abscess drains anteriorly into the submandibular lymph nodes, leading to tenderness and swelling under the mandible. These nodes filter lymph from the anterior nose, cheek, and upper lip. Answer: Submandibular nodes. Clinically, enlarged submandibular nodes help localize infections to anterior facial regions or vestibular furuncles.
4) Posterior nasal lymphatics ultimately reach which group of deep cervical nodes?
a) Jugulodigastric
b) Jugulo-omohyoid
c) Supraclavicular
d) Pretracheal
Explanation:
Posterior nasal lymphatics drain via retropharyngeal nodes into the jugulodigastric nodes, one of the key deep cervical lymph nodes. These receive lymph from nasopharynx, tonsils, and posterior scalp. Answer: Jugulodigastric nodes. Their enlargement may indicate infections like tonsillitis or malignancy in posterior nasal or pharyngeal regions.
5) Which lymph nodes receive drainage from both the nose and upper lip?
a) Submandibular
b) Submental
c) Retropharyngeal
d) Superficial cervical
Explanation:
Both the nose and upper lip drain into the submandibular lymph nodes. This overlap explains why infections around the mouth and nose can spread rapidly, even causing cavernous sinus thrombosis in severe cases. Answer: Submandibular nodes. These nodes are palpable below the jawline and are clinically relevant in facial cellulitis evaluation.
6) A carcinoma in the nasal septum anteriorly will first spread to:
a) Retropharyngeal nodes
b) Submandibular nodes
c) Deep cervical nodes
d) Prelaryngeal nodes
Explanation:
Cancer in the anterior nasal septum first metastasizes to submandibular lymph nodes. The anterior lymphatic drainage pattern directs lymph flow toward these superficial nodes before reaching deeper cervical nodes. Answer: Submandibular nodes. Palpation of submandibular nodes is vital in head and neck oncology to detect early regional spread.
7) The posterior nasal cavity and nasopharynx share lymphatic drainage with which structure?
a) Palatine tonsil
b) Parotid gland
c) Tongue tip
d) Lower lip
Explanation:
Both the posterior nasal cavity and palatine tonsil drain into retropharyngeal and upper deep cervical (jugulodigastric) nodes. This shared drainage explains why nasopharyngeal carcinoma may spread to tonsillar lymphatic pathways. Answer: Palatine tonsil. Awareness of these connections helps clinicians assess metastasis patterns in head and neck malignancies.
8) Inflammation over the bridge of the nose drains to which lymph node group?
a) Preauricular
b) Submandibular
c) Retropharyngeal
d) Occipital
Explanation:
The bridge of the nose drains into submandibular lymph nodes, while lateral aspects may communicate with preauricular nodes. In infections like cellulitis or furuncles, submandibular tenderness is a key sign. Answer: Submandibular nodes. Prompt management is crucial as facial veins lack valves, increasing risk of cavernous sinus spread.
9) Deep cervical lymph nodes receive indirect drainage from nasal structures via which group?
a) Retropharyngeal
b) Pretracheal
c) Submental
d) Submandibular
Explanation:
The deep cervical lymph nodes collect lymph from the nose indirectly through retropharyngeal and submandibular nodes. These act as intermediary stations before lymph enters the jugular trunk. Answer: Retropharyngeal nodes. The sequence reflects the structured lymphatic hierarchy in the head and neck drainage network.
10) A patient with posterior nasal carcinoma has enlarged deep cervical nodes. The spread occurred through which intermediate group?
a) Submandibular
b) Retropharyngeal
c) Pretracheal
d) Parotid
Explanation:
Posterior nasal or nasopharyngeal carcinomas first spread to the retropharyngeal nodes, then to the deep cervical (jugulodigastric) group. Answer: Retropharyngeal nodes. These nodes are often the first indicator of malignancy in this region. Their involvement provides essential clues in imaging and surgical planning for head and neck cancers.
Chapter: Head and Neck Anatomy; Topic: Pharynx; Subtopic: Killian’s Dehiscence and Pharyngoesophageal Junction
Keyword Definitions:
Killian’s dehiscence: A weak area between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor muscle of the pharynx.
Cricopharyngeus muscle: The lower part of the inferior constrictor muscle, functioning as the upper esophageal sphincter.
Zenker’s diverticulum: A pharyngoesophageal pouch that protrudes through Killian’s dehiscence.
Pharyngoesophageal junction: The region between the pharynx and esophagus, significant for swallowing mechanics and pathology.
Lead Question (2014):
Killian's dehiscence is seen in?
a) Oropharynx
b) Nasopharynx
c) Cricopharynx
d) Vocal cords
Explanation:
Killian’s dehiscence is a triangular gap located between the oblique fibers of the thyropharyngeus and the transverse fibers of the cricopharyngeus, parts of the inferior constrictor muscle. It is a potential site of herniation leading to Zenker’s diverticulum. This weak area is anatomically part of the cricopharyngeal region. Answer: Cricopharynx. It is clinically important in dysphagia and diverticular formation.
1) Killian’s dehiscence lies between which muscle fibers?
a) Thyropharyngeus and cricopharyngeus
b) Stylopharyngeus and cricopharyngeus
c) Palatopharyngeus and stylopharyngeus
d) Superior and middle constrictor muscles
Explanation:
The Killian’s dehiscence is a weak gap between the oblique fibers of the thyropharyngeus and the transverse fibers of the cricopharyngeus muscle. Both belong to the inferior constrictor group. Answer: Thyropharyngeus and cricopharyngeus. This anatomical weakness predisposes individuals to Zenker’s diverticulum, which manifests as dysphagia and regurgitation of undigested food.
2) Zenker’s diverticulum arises through?
a) Laimer’s triangle
b) Killian’s dehiscence
c) Triangle of Petit
d) Pirogov’s triangle
Explanation:
Zenker’s diverticulum is a pulsion diverticulum that arises through Killian’s dehiscence, the weak area between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor. It commonly presents with dysphagia, halitosis, and regurgitation. Answer: Killian’s dehiscence. It typically occurs in elderly patients and may require surgical correction through diverticulectomy.
3) The upper esophageal sphincter is formed by which muscle?
a) Thyropharyngeus
b) Cricopharyngeus
c) Stylopharyngeus
d) Palatopharyngeus
Explanation:
The upper esophageal sphincter (UES) is primarily formed by the cricopharyngeus muscle, the lower part of the inferior constrictor. It prevents regurgitation of esophageal contents and air entry during respiration. Answer: Cricopharyngeus. Dysfunction of this muscle may lead to Zenker’s diverticulum and swallowing difficulties in elderly patients.
4) Laimer’s triangle lies:
a) Above the cricopharyngeus
b) Below the cricopharyngeus
c) Between the middle and inferior constrictors
d) Between palatopharyngeus and stylopharyngeus
Explanation:
Laimer’s triangle is located just below the cricopharyngeus muscle. It represents another weak area through which rare esophageal diverticula may form. Answer: Below the cricopharyngeus. This triangle lies between longitudinal muscle fibers and the cricopharyngeus, but herniation here is much less common than through Killian’s dehiscence.
5) A patient with regurgitation of undigested food and gurgling in the neck is likely to have?
a) Achalasia cardia
b) Zenker’s diverticulum
c) Laryngocele
d) Cricopharyngeal spasm
Explanation:
Zenker’s diverticulum causes regurgitation of undigested food, gurgling sounds, halitosis, and possible aspiration. It arises through Killian’s dehiscence due to cricopharyngeal dysfunction. Answer: Zenker’s diverticulum. Barium swallow shows a posterior pouch at the pharyngoesophageal junction, and treatment is surgical myotomy or diverticulectomy.
6) Killian’s dehiscence is related to which part of the pharynx?
a) Nasopharynx
b) Oropharynx
c) Laryngopharynx
d) Hypopharynx
Explanation:
Killian’s dehiscence lies in the posterior wall of the laryngopharynx (hypopharynx), between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor. Answer: Laryngopharynx. This area is clinically relevant because of its association with pharyngoesophageal diverticula formation, which may cause dysphagia and aspiration symptoms in elderly individuals.
7) Which nerve supplies the cricopharyngeus muscle?
a) Glossopharyngeal nerve
b) Pharyngeal plexus
c) Recurrent laryngeal nerve
d) Superior laryngeal nerve
Explanation:
The cricopharyngeus muscle receives its motor supply mainly from the recurrent laryngeal nerve (branch of the vagus), while the rest of the inferior constrictor is supplied by the pharyngeal plexus. Answer: Recurrent laryngeal nerve. Damage to this nerve can cause dysfunction of the upper esophageal sphincter, leading to swallowing difficulties and aspiration risk.
8) Which imaging technique best demonstrates Zenker’s diverticulum?
a) CT neck
b) Barium swallow
c) MRI
d) Ultrasound
Explanation:
A barium swallow radiograph is the diagnostic tool of choice for Zenker’s diverticulum. It demonstrates a posterior outpouching at the pharyngoesophageal junction, arising through Killian’s dehiscence. Answer: Barium swallow. CT or MRI may be used for complications, but barium swallow remains the most specific and sensitive method for identifying the diverticular sac.
9) Killian-Jamieson diverticulum differs from Zenker’s by arising:
a) Above cricopharyngeus
b) Below cricopharyngeus
c) Through Laimer’s triangle
d) In the thoracic esophagus
Explanation:
Killian-Jamieson diverticulum arises below the cricopharyngeus, unlike Zenker’s which occurs above it. It projects anterolaterally, whereas Zenker’s projects posteriorly. Answer: Below cricopharyngeus. The difference in anatomical site and direction of protrusion helps radiologists distinguish these diverticula during barium studies and avoid surgical misidentification.
10) In Zenker’s diverticulum, the most likely symptom due to compression of surrounding structures is:
a) Hoarseness
b) Dysphagia
c) Stridor
d) Dysphonia
Explanation:
Dysphagia is the most characteristic symptom of Zenker’s diverticulum. The pouch compresses the esophagus and retains food, causing regurgitation, halitosis, and aspiration. Answer: Dysphagia. Large diverticula may also cause neck swelling and gurgling. Surgical cricopharyngeal myotomy often resolves symptoms by eliminating the pressure gradient responsible for the outpouching.
Topic: Pelvic Spaces and Fascia
Subtopic: Cave of Retzius
Keyword Definitions:
Cave of Retzius: Also known as the retropubic space, it lies between the pubic symphysis and urinary bladder.
Pelvic Fascia: Connective tissue covering pelvic organs, providing support and passage for vessels.
Urinary Bladder: A hollow muscular organ for urine storage, located in the lesser pelvis.
Rectovesical Space: The peritoneal space between bladder and rectum in males.
Pubic Symphysis: Midline cartilaginous joint uniting the left and right pubic bones.
Lead Question – 2014
Where is the Cave of Retzius present?
a) Between urinary bladder and rectum
b) Between urinary bladder and cervix
c) In front of the bladder
d) Between the cervix and the rectum
Explanation: The Cave of Retzius, or retropubic space, is located anterior to the urinary bladder and posterior to the pubic symphysis, not in contact with the peritoneum. It contains loose connective tissue and the venous plexus, aiding in surgical access to the bladder. Hence, the correct answer is c) In front of the bladder.
1. The retropubic space of Retzius is bounded anteriorly by:
a) Rectum
b) Pubic symphysis
c) Urethra
d) Peritoneum
Explanation: The retropubic space (Cave of Retzius) lies between the pubic symphysis anteriorly and the urinary bladder posteriorly. This space is clinically important in bladder surgery and pelvic trauma. It contains the retropubic venous plexus. The correct answer is b) Pubic symphysis.
2. The space of Retzius is filled with:
a) Loose areolar tissue
b) Fat
c) Fibrous tissue
d) Muscular tissue
Explanation: The space of Retzius is a potential space filled with loose areolar connective tissue, allowing bladder distension and movement. It acts as a cushion and supports surrounding structures. Therefore, the correct answer is a) Loose areolar tissue.
3. The clinical importance of the space of Retzius is:
a) Site for hernia repair
b) Approach for retropubic prostatectomy
c) Passage of fallopian tubes
d) Site for peritoneal dialysis
Explanation: The space of Retzius provides a surgical approach to the prostate and bladder without breaching the peritoneum. Retropubic prostatectomy and bladder neck procedures utilize this route safely. Hence, the correct answer is b) Approach for retropubic prostatectomy.
4. Which structure is located posterior to the Cave of Retzius?
a) Pubic symphysis
b) Rectum
c) Urinary bladder
d) Peritoneum
Explanation: Posterior to the Cave of Retzius lies the urinary bladder, separated by fascia and connective tissue. The space serves as a buffer during bladder filling and emptying. Thus, the correct answer is c) Urinary bladder.
5. In females, the space of Retzius lies between:
a) Pubic symphysis and uterus
b) Pubic symphysis and urinary bladder
c) Urinary bladder and cervix
d) Rectum and vagina
Explanation: In females, the space of Retzius occupies the area between the pubic symphysis and the urinary bladder, similar to males. It helps in gynecological surgeries like Burch colposuspension. Therefore, the answer is b) Pubic symphysis and urinary bladder.
6. (Clinical) A 60-year-old male undergoing prostatectomy develops venous bleeding from the retropubic area. The source is likely from:
a) External iliac vein
b) Retropubic venous plexus
c) Superior vesical artery
d) Inferior epigastric vein
Explanation: During retropubic surgeries, injury to the retropubic venous plexus within the Cave of Retzius can cause severe bleeding. This plexus drains the prostate and bladder. Therefore, the correct answer is b) Retropubic venous plexus.
7. (Clinical) During bladder surgery, why is the retropubic space entered carefully?
a) It contains the ureters
b) It contains a venous plexus prone to bleeding
c) It contains peritoneum
d) It contains nerves to bladder wall
Explanation: The retropubic space holds a dense venous plexus (Santorini’s plexus), which, if injured, can lead to major bleeding. This makes careful dissection essential during urological procedures. Hence, the correct answer is b) It contains a venous plexus prone to bleeding.
8. (Clinical) A cystocele repair often involves dissection through which space?
a) Rectovaginal space
b) Space of Retzius
c) Ischiorectal fossa
d) Vesicouterine pouch
Explanation: During cystocele repair, the surgeon enters the space of Retzius to reposition the bladder and reinforce pelvic fascia. It provides access to the anterior vaginal wall without entering the peritoneal cavity. Hence, the answer is b) Space of Retzius.
9. (Clinical) A patient with pelvic trauma has urine extravasation in front of the bladder but not into the peritoneum. The space involved is:
a) Retropubic space (Cave of Retzius)
b) Rectovesical pouch
c) Ischiorectal fossa
d) Paravesical space
Explanation: Extraperitoneal urine extravasation occurs in the retropubic space (Cave of Retzius) after bladder rupture anteriorly. This distinguishes it from intraperitoneal rupture involving peritoneal spaces. Hence, the correct answer is a) Retropubic space (Cave of Retzius).
10. (Clinical) During laparoscopic surgery, which landmark helps identify the space of Retzius?
a) Cooper’s ligament
b) Ischial spine
c) Arcus tendineus fascia pelvis
d) Round ligament
Explanation: Cooper’s ligament (pectineal ligament) marks the lateral boundary of the space of Retzius during laparoscopic or open pelvic surgeries. It guides dissection in hernia repairs and bladder surgeries. Hence, the correct answer is a) Cooper’s ligament.
Chapter: Respiratory System Anatomy; Topic: Larynx; Subtopic: Cartilages of Larynx
Keyword Definitions:
Larynx: A cartilaginous structure located in the neck that houses the vocal cords and is involved in breathing, sound production, and airway protection.
Unpaired cartilage: Cartilages that occur singly in the larynx such as thyroid, cricoid, and epiglottis.
Paired cartilage: Cartilages that occur in pairs, including arytenoid, corniculate, and cuneiform.
Epiglottis: A leaf-shaped unpaired cartilage that covers the glottis during swallowing, preventing aspiration.
Arytenoid cartilage: Paired cartilages involved in vocal cord movement and phonation.
Lead Question – 2014
Unpaired laryngeal cartilage ?
a) Arytenoid
b) Corniculate
c) Cuneiform
d) Epiglottis
Explanation:
The larynx consists of three unpaired (thyroid, cricoid, epiglottis) and three paired cartilages (arytenoid, corniculate, cuneiform). The epiglottis is a leaf-shaped unpaired cartilage that prevents food from entering the trachea during swallowing. It plays a crucial role in protecting the airway and facilitating speech. Hence, the correct answer is epiglottis (d).
1) Which cartilage forms a complete ring in the larynx?
a) Thyroid
b) Cricoid
c) Arytenoid
d) Corniculate
Explanation: The cricoid cartilage forms a complete ring around the larynx and is the only cartilage with such structure. It provides structural support and connects the larynx to the trachea. The correct answer is cricoid (b).
2) The vocal cords are attached posteriorly to which cartilage?
a) Thyroid
b) Cricoid
c) Arytenoid
d) Epiglottis
Explanation: The vocal cords are attached posteriorly to the arytenoid cartilages and anteriorly to the thyroid cartilage. Arytenoids control tension and position of vocal cords for phonation. The correct answer is arytenoid (c).
3) Which nerve supplies the cricothyroid muscle?
a) Recurrent laryngeal nerve
b) External branch of superior laryngeal nerve
c) Glossopharyngeal nerve
d) Internal laryngeal nerve
Explanation: The cricothyroid muscle is supplied by the external branch of the superior laryngeal nerve. It tenses the vocal cords and modulates pitch. The correct answer is external branch of superior laryngeal nerve (b).
4) A patient with hoarseness after thyroid surgery has likely injured which nerve?
a) Recurrent laryngeal
b) Phrenic
c) Glossopharyngeal
d) Accessory
Explanation: The recurrent laryngeal nerve innervates most intrinsic laryngeal muscles responsible for voice production. Injury during thyroid surgery leads to hoarseness or voice loss. The correct answer is recurrent laryngeal nerve (a).
5) Which muscle abducts the vocal cords?
a) Lateral cricoarytenoid
b) Posterior cricoarytenoid
c) Thyroarytenoid
d) Cricothyroid
Explanation: The posterior cricoarytenoid is the only abductor of the vocal cords, opening the rima glottidis during inspiration. Paralysis causes airway obstruction. The correct answer is posterior cricoarytenoid (b).
6) A child presents with high-pitched breathing after choking. The likely site of obstruction is?
a) Trachea
b) Larynx
c) Nasopharynx
d) Bronchi
Explanation: Stridor, a high-pitched sound, indicates laryngeal obstruction. The larynx’s narrow lumen in children predisposes them to airway compromise. The correct answer is larynx (b).
7) Which cartilage provides attachment for the vocal cords anteriorly?
a) Thyroid
b) Cricoid
c) Arytenoid
d) Epiglottis
Explanation: The anterior ends of the vocal cords attach to the thyroid cartilage at the laryngeal prominence. It provides anchoring for sound modulation. The correct answer is thyroid (a).
8) The laryngeal inlet is guarded by which structure during swallowing?
a) Epiglottis
b) Aryepiglottic fold
c) Vocal cords
d) Cricoid cartilage
Explanation: During swallowing, the epiglottis folds down to cover the laryngeal inlet, preventing food from entering the trachea. The correct answer is epiglottis (a).
9) Which of the following is a paired laryngeal cartilage?
a) Epiglottis
b) Thyroid
c) Corniculate
d) Cricoid
Explanation: The corniculate cartilages are small paired nodules situated on the apices of arytenoid cartilages, assisting in voice production and airway control. The correct answer is corniculate (c).
10) During intubation, which cartilage is felt as the "Adam’s apple"?
a) Cricoid
b) Thyroid
c) Epiglottis
d) Arytenoid
Explanation: The thyroid cartilage projects anteriorly to form the Adam’s apple, most prominent in males. It protects the vocal cords and serves as an important landmark for cricothyrotomy. The correct answer is thyroid (b).
Chapter: Neuroanatomy; Topic: Cranial Nerves; Subtopic: Trochlear Nerve and its Unique Features
Keyword Definitions:
Cranial nerves: Twelve pairs of nerves that arise directly from the brain and brainstem, responsible for sensory and motor innervation to the head and neck.
Brainstem: The central part of the brain consisting of the midbrain, pons, and medulla oblongata, controlling vital reflexes.
Trochlear nerve (CN IV): The only cranial nerve emerging dorsally from the brainstem and the smallest in size. It supplies the superior oblique muscle of the eye.
Dorsal exit: Refers to a nerve emerging from the posterior (back) aspect of the brainstem.
Superior oblique muscle: Muscle responsible for intorsion and depression of the eyeball, controlled by CN IV.
Lead Question – 2014
Which is the only nerve which exits the brainstem on dorsal side?
a) Facial
b) Trigeminal
c) Trochlear
d) Abducent
Explanation:
The trochlear nerve (CN IV) is unique as it exits from the dorsal aspect of the brainstem, just below the inferior colliculus. It also decussates before emerging, supplying the contralateral superior oblique muscle. This dorsal emergence distinguishes it from all other cranial nerves, which exit ventrally or laterally. Hence, the correct answer is Trochlear (c).
1) The trochlear nerve supplies which muscle?
a) Superior rectus
b) Superior oblique
c) Inferior oblique
d) Lateral rectus
Explanation: The trochlear nerve supplies the superior oblique muscle, responsible for intorsion and depression of the eyeball. It helps move the eye downward and inward. Its lesion leads to vertical diplopia, especially when looking downward, such as reading or descending stairs.
2) Which cranial nerve has the longest intracranial course?
a) Trochlear
b) Abducent
c) Trigeminal
d) Facial
Explanation: The trochlear nerve has the longest intracranial course and is most prone to injury during head trauma. It travels around the midbrain before entering the orbit through the superior orbital fissure. The correct answer is Trochlear (a).
3) Which cranial nerve nucleus lies in the midbrain at the level of the inferior colliculus?
a) Oculomotor
b) Trochlear
c) Abducent
d) Facial
Explanation: The trochlear nucleus lies in the midbrain at the level of the inferior colliculus. The nerve fibers decussate before emerging dorsally. This unique crossing explains contralateral superior oblique muscle innervation. The correct answer is Trochlear (b).
4) A patient presents with vertical diplopia, worsened when looking down. Which nerve is likely affected?
a) Oculomotor
b) Trochlear
c) Abducent
d) Optic
Explanation: Lesion of the trochlear nerve causes vertical diplopia due to paralysis of the superior oblique muscle. The patient tilts the head away from the affected side to compensate. The correct answer is Trochlear (b).
5) Which cranial nerve decussates before emerging from the brainstem?
a) Optic
b) Trochlear
c) Abducent
d) Facial
Explanation: The trochlear nerve is the only cranial nerve to fully cross (decussate) within the brainstem before exiting dorsally. Each nucleus thus controls the contralateral superior oblique muscle. The correct answer is Trochlear (b).
6) During head trauma, which cranial nerve is most likely injured due to its long intracranial course?
a) Oculomotor
b) Trochlear
c) Abducent
d) Facial
Explanation: Because the trochlear nerve travels the longest intracranial path, it is highly susceptible to shearing forces in head injury. Patients experience difficulty looking down, particularly when reading. The correct answer is Trochlear (b).
7) The trochlear nerve exits the brainstem from which structure?
a) Medulla
b) Pons
c) Midbrain
d) Cerebellum
Explanation: The trochlear nerve arises from the dorsal aspect of the midbrain at the level of the inferior colliculus. It then wraps around the brainstem anteriorly to enter the cavernous sinus. The correct answer is Midbrain (c).
8) A patient cannot look down when walking downstairs. Which muscle is weak?
a) Superior rectus
b) Superior oblique
c) Inferior rectus
d) Lateral rectus
Explanation: Weakness of the superior oblique muscle due to trochlear nerve palsy causes inability to look downward when the eye is adducted. This results in vertical diplopia. The correct answer is Superior oblique (b).
9) Which cranial nerve controls the downward gaze of the eyeball?
a) Oculomotor
b) Trochlear
c) Abducent
d) Optic
Explanation: The trochlear nerve controls the superior oblique muscle, which assists in downward gaze, especially when the eye is adducted. Lesion leads to upward deviation and diplopia. The correct answer is Trochlear (b).
10) A patient presents with head tilt to the right and vertical diplopia. Which nerve is likely affected?
a) Right oculomotor
b) Left trochlear
c) Right trochlear
d) Left abducent
Explanation: A lesion of the right trochlear nerve causes the right eye to deviate upward due to superior oblique paralysis. The patient tilts the head to the left to compensate for diplopia. The correct answer is Right trochlear (c).
Chapter: Neuroanatomy; Topic: Cerebral Circulation; Subtopic: Blood Supply of Basal Ganglia
Keyword Definitions:
Basal ganglia: A group of subcortical nuclei involved in motor control, emotion, and learning, including caudate nucleus, putamen, and globus pallidus.
Putamen: The lateral part of the lentiform nucleus, involved in regulating voluntary motor movements and learning.
Lenticulostriate arteries: Small penetrating branches from the middle cerebral artery that supply the putamen and internal capsule.
Anterior choroidal artery: A branch of the internal carotid artery supplying the optic tract, internal capsule, and hippocampus.
Posterior communicating artery: Connects the internal carotid and posterior cerebral arteries, forming part of the Circle of Willis.
Lead Question – 2014
Blood supply of putamen includes all except?
a) Medial striate arteries
b) Lateral striate arteries
c) Anterior choroidal artery
d) Posterior communicating artery
Explanation:
The putamen receives its major blood supply from the lateral striate arteries (branches of the middle cerebral artery) and medial striate arteries (from the anterior cerebral artery). The anterior choroidal artery contributes to its posterior part. The posterior communicating artery does not supply the putamen. Hence, the correct answer is d) Posterior communicating artery. The putamen is highly vascular and susceptible to infarction in MCA occlusion.
1) The lateral striate arteries are branches of which main artery?
a) Anterior cerebral artery
b) Middle cerebral artery
c) Posterior cerebral artery
d) Basilar artery
Explanation: The lateral striate arteries originate from the middle cerebral artery and supply deep structures like the putamen, caudate nucleus, and internal capsule. These arteries are often termed “arteries of stroke” because they are prone to rupture due to hypertension. The correct answer is b) Middle cerebral artery.
2) The anterior choroidal artery is a branch of which vessel?
a) Middle cerebral artery
b) Internal carotid artery
c) Posterior cerebral artery
d) Vertebral artery
Explanation: The anterior choroidal artery arises from the internal carotid artery just before it bifurcates. It supplies the optic tract, posterior limb of the internal capsule, and choroid plexus of the lateral ventricle. Infarction can cause contralateral hemiplegia and hemianopia. The correct answer is b) Internal carotid artery.
3) A hypertensive patient develops hemiplegia due to rupture of lenticulostriate arteries. Which structure is most affected?
a) Thalamus
b) Putamen
c) Cerebellum
d) Corpus callosum
Explanation: The lenticulostriate arteries supply the putamen and internal capsule. Hypertension may cause rupture, leading to intracerebral hemorrhage and contralateral hemiplegia. This clinical condition is known as “stroke in the internal capsule.” The correct answer is b) Putamen.
4) The posterior communicating artery connects which two major arteries?
a) Internal carotid and middle cerebral
b) Internal carotid and posterior cerebral
c) Anterior cerebral and basilar
d) Vertebral and posterior inferior cerebellar
Explanation: The posterior communicating artery forms a link between the internal carotid artery and posterior cerebral artery, completing the Circle of Willis. It mainly supplies the hypothalamus and optic chiasma regions but does not contribute to the putamen supply. Hence, correct answer is b) Internal carotid and posterior cerebral.
5) Which artery is most frequently involved in lacunar infarcts affecting the putamen?
a) Posterior cerebral artery
b) Middle cerebral artery
c) Anterior cerebral artery
d) Basilar artery
Explanation: The middle cerebral artery and its deep branches (lateral striate arteries) are the most common sources of lacunar infarcts in the putamen. These small vessel occlusions result in pure motor strokes or dysarthria. Hence, the correct answer is b) Middle cerebral artery.
6) A 65-year-old man presents with contralateral weakness and hemianopia. MRI shows infarction in the region supplied by the anterior choroidal artery. Which structure is involved?
a) Pons
b) Internal capsule
c) Cerebellum
d) Thalamus
Explanation: The anterior choroidal artery supplies the posterior limb of the internal capsule, optic tract, and choroid plexus. Infarction results in contralateral hemiplegia and homonymous hemianopia. Hence, the correct answer is b) Internal capsule. This artery plays an essential role in deep cerebral circulation.
7) Which part of the Circle of Willis directly contributes to the putamen blood supply?
a) Anterior cerebral artery
b) Middle cerebral artery
c) Posterior communicating artery
d) Vertebral artery
Explanation: The middle cerebral artery and anterior cerebral artery contribute through their striate branches to the putamen. The posterior communicating artery does not supply this structure. Hence, the correct answer is b) Middle cerebral artery.
8) A 52-year-old male with chronic hypertension presents with sudden hemiplegia and CT shows bleed in the lentiform nucleus. Which artery rupture is most likely?
a) Lateral striate artery
b) Posterior inferior cerebellar artery
c) Basilar artery
d) Vertebral artery
Explanation: The lateral striate arteries (MCA branches) supply the putamen and internal capsule. Their rupture causes hemorrhage in the lentiform nucleus, leading to contralateral paralysis. The correct answer is a) Lateral striate artery.
9) Which structure does the anterior choroidal artery not supply?
a) Optic tract
b) Hippocampus
c) Putamen
d) Choroid plexus
Explanation: The anterior choroidal artery supplies the optic tract, posterior limb of the internal capsule, hippocampus, and choroid plexus of the lateral ventricle. It does not significantly supply the putamen, which mainly receives blood from the lenticulostriate arteries. Hence, the correct answer is c) Putamen.
10) A patient with occlusion of the lateral striate arteries will most likely show which symptom?
a) Ipsilateral paralysis
b) Contralateral paralysis
c) Cerebellar ataxia
d) Facial nerve palsy
Explanation: Occlusion of lateral striate arteries damages the internal capsule and putamen, producing contralateral hemiplegia and sensory loss. These arteries are commonly involved in hypertensive hemorrhages. Hence, the correct answer is b) Contralateral paralysis.