Chapter: Anatomy
Topic: Respiratory System
Subtopic: Surface Anatomy of Lungs
Keywords:
Lower border of lung: Inferior margin of lung seen in surface anatomy, varies with line of reference (midclavicular, midaxillary, paravertebral).
Midaxillary line: Imaginary vertical line through the apex of axilla, useful in thoracic surface markings.
Pleura: Membranous covering of lungs; parietal pleura extends beyond lung border.
LEAD QUESTION - 2012
Q1. Level of lower border of lung at midaxillary line is
a) 6th rib
b) 8th rib
c) 10th rib
d) 12th rib
Explanation: The lower border of the lung at the midaxillary line lies at the 8th rib. In surface anatomy, lung margins end at the 6th rib (midclavicular), 8th rib (midaxillary), and 10th rib (paravertebral). The pleura extends two ribs lower. Hence, correct answer: 8th rib (b).
Q2. The lower border of the pleura at the midaxillary line corresponds to which rib level?
a) 8th rib
b) 10th rib
c) 12th rib
d) 6th rib
Explanation: The pleura extends two ribs below the lung margin. At the midaxillary line, the lung ends at the 8th rib, and the pleura extends till the 10th rib. This difference is clinically important in pleural tap. Answer: 10th rib (b).
Q3. A pleural tap done at midaxillary line should be inserted at which intercostal space to avoid lung injury?
a) 6th intercostal space
b) 8th intercostal space
c) 9th intercostal space
d) 10th intercostal space
Explanation: To avoid puncturing lung tissue, pleural tap is performed below the lung margin but above pleural reflection, usually in the 9th intercostal space at midaxillary line. This ensures fluid aspiration without injuring lung. Correct answer: 9th intercostal space (c).
Q4. At the midclavicular line, the lower border of the lung is at which rib?
a) 4th rib
b) 6th rib
c) 8th rib
d) 10th rib
Explanation: Surface anatomy shows the lung reaches the 6th rib at the midclavicular line. This landmark is important in clinical percussion and auscultation. Correct answer: 6th rib (b).
Q5. At the paravertebral line, the lower border of the lung is located at which rib?
a) 8th rib
b) 10th rib
c) 12th rib
d) 6th rib
Explanation: Posteriorly, the lung border lies at the 10th rib in the paravertebral line. This corresponds to the lower extent of lung tissue seen in imaging and clinical percussion. Answer: 10th rib (b).
Q6. Which rib level does the pleura reach at paravertebral line?
a) 8th rib
b) 10th rib
c) 12th rib
d) 11th rib
Explanation: The pleura extends two ribs below the lung border. Since the lung ends at the 10th rib paravertebrally, the pleura goes down till the 12th rib in the same line. Correct answer: 12th rib (c).
Q7. A patient with pleural effusion requires aspiration at midaxillary line. The safe level is:
a) 6th intercostal space
b) 8th intercostal space
c) 9th intercostal space
d) 11th intercostal space
Explanation: In pleural effusion aspiration, the 9th intercostal space in the midaxillary line is chosen. It lies below the lung but avoids injury to abdominal organs. Correct answer: 9th intercostal space (c).
Q8. Which structure crosses the midaxillary line at the level of the 8th rib?
a) Lower lung border
b) Pleural reflection
c) Diaphragm dome
d) Cardiac notch
Explanation: The lower lung border crosses the 8th rib in the midaxillary line. Pleura is two ribs lower, diaphragm dome is higher, and cardiac notch lies anteriorly. Correct answer: Lower lung border (a).
Q9. During quiet respiration, costodiaphragmatic recess at midaxillary line extends up to:
a) 6th rib
b) 8th rib
c) 10th rib
d) 12th rib
Explanation: The costodiaphragmatic recess is the potential space between lung and pleura. At midaxillary line, lung ends at 8th rib, pleura at 10th rib, so recess lies between them. Correct answer: 10th rib (c).
Q10. A stab wound at the right midaxillary line at the level of the 9th rib during expiration is most likely to injure:
a) Lung parenchyma
b) Pleural cavity
c) Diaphragm
d) Liver
Explanation: At 9th rib midaxillary line, lung ends higher (8th rib), pleura extends till 10th rib. A stab wound at 9th rib pierces pleural cavity without lung injury, potentially involving diaphragm or liver on right side. Correct answer: Pleural cavity (b).
Chapter: Anatomy
Topic: Cardiovascular System
Subtopic: Coronary Circulation – Coronary Sinus Tributaries
Keywords:
Coronary sinus: Large venous channel in the posterior atrioventricular groove, drains most venous blood of heart into right atrium.
Great cardiac vein: Major tributary of coronary sinus accompanying LAD artery.
Small cardiac vein: Runs with right marginal artery, drains into coronary sinus.
Middle cardiac vein: Runs in posterior interventricular groove, joins coronary sinus.
Anterior cardiac veins: Drain directly into right atrium, not via coronary sinus.
Thebesian veins: Minute veins draining directly into heart chambers, not into coronary sinus.
Lead Question – 2012
Q1. Tributary of coronary sinus?
a) Anterior cardiac vein
b) Thebesian vein
c) Smallest cardiac vein
d) Great cardiac vein
[Explanation – Light Yellow]
Explanation: The great cardiac vein is the principal tributary of the coronary sinus. The coronary sinus receives blood from great cardiac, middle cardiac, small cardiac, oblique vein of left atrium, and posterior vein of left ventricle. The anterior cardiac and Thebesian veins drain directly into right atrium, not via coronary sinus. Correct answer: d) Great cardiac vein.
Q2. Which of the following veins drains directly into the right atrium, bypassing the coronary sinus?
a) Middle cardiac vein
b) Great cardiac vein
c) Anterior cardiac vein
d) Small cardiac vein
Explanation: The anterior cardiac veins drain the anterior surface of the right ventricle and empty directly into the right atrium, unlike the great, middle, and small cardiac veins that join the coronary sinus. This direct drainage is clinically significant during venous cannulation. Correct answer: c) Anterior cardiac vein.
Q3. The Thebesian veins are characterized by which feature?
a) Drain into coronary sinus
b) Drain directly into heart chambers
c) Always accompany coronary arteries
d) Present only in ventricles
Explanation: Thebesian veins, also known as venae cordis minimae, are minute veins that drain directly into the cardiac chambers, mainly right atrium and ventricles. They do not join the coronary sinus. Their presence allows minimal collateral venous drainage. Correct answer: b) Drain directly into heart chambers.
Q4. Which of the following is the largest tributary of the coronary sinus?
a) Middle cardiac vein
b) Great cardiac vein
c) Small cardiac vein
d) Posterior vein of left ventricle
Explanation: The great cardiac vein is the largest tributary, accompanying the left anterior descending (LAD) artery along the anterior interventricular groove. It drains into the coronary sinus at the left end. This vein is critical in retrograde cardioplegia procedures in cardiac surgery. Correct answer: b) Great cardiac vein.
Q5. Which vein accompanies the posterior interventricular artery and drains into the coronary sinus?
a) Great cardiac vein
b) Middle cardiac vein
c) Small cardiac vein
d) Oblique vein of left atrium
Explanation: The middle cardiac vein runs in the posterior interventricular groove along with the posterior interventricular artery and drains into the coronary sinus. This is an important landmark during posterior heart dissections. Correct answer: b) Middle cardiac vein.
Q6. The oblique vein of left atrium is a remnant of which embryological structure?
a) Left anterior cardinal vein
b) Left superior vena cava
c) Left posterior cardinal vein
d) Right sinus horn
Explanation: The oblique vein of left atrium (Marshall’s vein) is a remnant of the left superior vena cava. It courses obliquely over the left atrium to join the coronary sinus. Its recognition is important during electrophysiological ablation procedures. Correct answer: b) Left superior vena cava.
Q7. A patient undergoing retrograde cardioplegia has a catheter placed in which venous structure?
a) Superior vena cava
b) Coronary sinus
c) Anterior cardiac vein
d) Thebesian veins
Explanation: In retrograde cardioplegia, the cardioplegic solution is delivered via the coronary sinus to perfuse the coronary venous system and myocardium. This method is used when coronary arteries are obstructed. Correct answer: b) Coronary sinus.
Q8. Which vein is most closely related to the right marginal artery and drains into the coronary sinus?
a) Great cardiac vein
b) Small cardiac vein
c) Middle cardiac vein
d) Thebesian vein
Explanation: The small cardiac vein accompanies the right marginal artery along the inferior border of the heart and drains into the coronary sinus near its termination. This association is an important anatomical correlation. Correct answer: b) Small cardiac vein.
Q9. During cardiac catheterization, the opening of the coronary sinus is found in which chamber?
a) Right atrium
b) Left atrium
c) Right ventricle
d) Left ventricle
Explanation: The coronary sinus opens into the right atrium between the orifice of the inferior vena cava and the tricuspid valve. It is guarded by the Thebesian valve. Recognition is important during invasive procedures. Correct answer: a) Right atrium.
Q10. In a stab injury to the posterior atrioventricular groove, which venous structure is most likely to be injured?
a) Great cardiac vein
b) Coronary sinus
c) Anterior cardiac vein
d) Thebesian vein
Explanation: The coronary sinus lies in the posterior part of the atrioventricular groove. Trauma to this region can damage the coronary sinus leading to retroperitoneal cardiac tamponade. Correct answer: b) Coronary sinus.
Chapter: Cardiovascular System
Topic: Right Atrium Anatomy
Subtopic: Koch’s Triangle
Keyword Definitions
Koch’s Triangle – Anatomical landmark in right atrium used to locate AV node.
Tricuspid valve ring – Fibrous annulus surrounding tricuspid valve, forms part of Koch’s triangle.
Coronary sinus orifice – Opening of coronary sinus into right atrium, key boundary of Koch’s triangle.
Tendon of Todaro – Fibrous extension from Eustachian valve to central fibrous body, part of Koch’s triangle.
Limbus fossa ovalis – Prominent ridge at margin of fossa ovalis, not part of Koch’s triangle.
AV node – Specialized cardiac tissue located within Koch’s triangle, responsible for conduction between atria and ventricles.
Bundle of His – Continuation of AV node, conducting pathway to ventricles.
Eustachian valve – Ridge at IVC opening, gives rise to tendon of Todaro.
Right atrium – Chamber of heart receiving systemic venous blood, site of Koch’s triangle.
Catheter ablation – Clinical procedure often targeting arrhythmias using Koch’s triangle as a landmark.
Lead Question (2012 NEET PG):
Boundary of the Koch's triangle is not formed by?
a) Tricuspid valve ring
b) Coronary sinus
c) Tendon of Todaro
d) Limbus fossa ovalis
Answer & Explanation:
The limbus fossa ovalis is not a boundary of Koch’s triangle. Koch’s triangle is bounded by the tricuspid valve annulus (anteriorly), coronary sinus orifice (posteriorly), and tendon of Todaro (superiorly). Inside this triangle lies the AV node, crucial for conduction. The limbus fossa ovalis is unrelated to this area, hence the correct answer is d).
Q1. The apex of Koch’s triangle corresponds to which structure?
a) AV node
b) SA node
c) Bundle of His
d) Crista terminalis
Answer & Explanation:
The apex of Koch’s triangle corresponds to the AV node, which is the key conduction relay between atria and ventricles. SA node lies near the SVC opening, not in Koch’s triangle. Bundle of His is distal continuation of AV node, and crista terminalis is a ridge in RA. Answer – a).
Q2. During catheter ablation for AV nodal reentry tachycardia, the interventional cardiologist targets which landmark near Koch’s triangle?
a) Near coronary sinus ostium
b) Near SA node
c) Near fossa ovalis
d) Near pulmonary veins
Answer & Explanation:
In AVNRT ablation, the catheter is positioned near the coronary sinus ostium at the posterior boundary of Koch’s triangle. This area provides safe access to slow pathway modification without damaging the compact AV node. Pulmonary veins relate to atrial fibrillation ablation, not AVNRT. Correct answer – a).
Q3. Which of the following is true regarding the tendon of Todaro?
a) Derived from the Thebesian valve
b) Extends from IVC valve to central fibrous body
c) Forms inferior vena cava orifice
d) Lies in left atrium
Answer & Explanation:
The tendon of Todaro is a fibrous band formed by the continuation of the Eustachian valve (valve of IVC) that extends to the central fibrous body. It is an essential boundary of Koch’s triangle. It does not arise from Thebesian valve, nor is it in left atrium. Answer – b).
Q4. The AV node is supplied mainly by which artery in Koch’s triangle?
a) Left coronary artery
b) Right coronary artery
c) Left anterior descending artery
d) Circumflex artery
Answer & Explanation:
The AV nodal artery, usually a branch of the right coronary artery, runs in the region of Koch’s triangle to supply the AV node. In some individuals with left dominant circulation, it arises from the circumflex artery. However, most commonly it is RCA. Correct answer – b).
Q5. Which clinical arrhythmia is classically associated with Koch’s triangle anatomy?
a) AV nodal reentrant tachycardia (AVNRT)
b) Wolff-Parkinson-White syndrome
c) Ventricular fibrillation
d) Atrial flutter
Answer & Explanation:
AVNRT arises due to dual AV nodal pathways located within Koch’s triangle. The slow and fast pathways allow reentrant circuits. WPW involves accessory pathways (Bundle of Kent). Atrial flutter relates to cavotricuspid isthmus. Ventricular fibrillation originates in ventricles. Correct answer – a).
Q6. Which structure forms the posterior boundary of Koch’s triangle?
a) Coronary sinus ostium
b) Tricuspid valve annulus
c) Eustachian ridge
d) Fossa ovalis
Answer & Explanation:
The posterior boundary of Koch’s triangle is formed by the orifice of the coronary sinus. Tricuspid valve annulus is anterior boundary, tendon of Todaro superior boundary. Fossa ovalis is not part of the triangle. Correct answer – a).
Q7. In right atrial dissection, damage to Koch’s triangle risks injury to which conduction structure?
a) SA node
b) AV node
c) Bundle branches
d) Purkinje fibers
Answer & Explanation:
Koch’s triangle houses the AV node, and any surgical or dissection injury here can result in complete heart block. SA node is at SVC-RA junction, not in this region. Bundle branches and Purkinje fibers are distal conduction tissues in ventricles. Correct answer – b).
Q8. In echocardiography, Koch’s triangle is used as a landmark for:
a) Estimating pulmonary artery pressure
b) Localizing the AV node
c) Measuring left atrial size
d) Assessing mitral valve prolapse
Answer & Explanation:
Koch’s triangle serves as an echocardiographic landmark to locate the AV node during procedures and for guiding device placement. It is not used for pulmonary artery pressure, left atrial size, or mitral valve prolapse assessment. Correct answer – b).
Q9. In which chamber of the heart is Koch’s triangle located?
a) Left atrium
b) Right atrium
c) Left ventricle
d) Right ventricle
Answer & Explanation:
Koch’s triangle is an anatomical area within the right atrium, bounded by tricuspid valve annulus, coronary sinus ostium, and tendon of Todaro. Left atrium is relevant for pulmonary veins and mitral valve. Correct answer – b).
Q10. A surgeon operating near Koch’s triangle must avoid injuring which structure to prevent complete heart block?
a) AV node
b) SA node
c) Right bundle branch
d) Moderator band
Answer & Explanation:
The AV node, lying at the apex of Koch’s triangle, is highly vulnerable to injury during surgery or catheterization. Damage can result in AV block requiring pacemaker implantation. SA node is in high right atrium, not this area. Correct answer – a).
Q11. Which surface landmark corresponds to the location of Koch’s triangle?
a) Near septal leaflet of tricuspid valve
b) Near lateral leaflet of tricuspid valve
c) Near anterior mitral valve leaflet
d) Near pulmonary valve annulus
Answer & Explanation:
Koch’s triangle lies adjacent to the septal leaflet of the tricuspid valve inside the right atrium. This relationship is crucial for electrophysiologists to navigate during ablation procedures. It is not related to mitral valve or pulmonary valve areas. Correct answer – a).
Chapter: Thorax
Topic: Venous System of Thorax
Subtopic: Azygos Vein
Keywords
• Azygos vein – unpaired vein draining thoracic wall into SVC
• Superior vena cava – major vein returning blood from upper body
• Hemiazygos vein – tributary of azygos system on left side
• Bronchial veins – drain blood from bronchi
• Mediastinum – central thoracic compartment
• Esophageal veins – tributaries of azygos system
Q1. (2012 – Lead Question)
Azygos vein drains into:
a) Left brachiocephalic vein
b) Inferior vena cava
c) Superior vena cava
d) Right brachiocephalic vein
Answer & Explanation:
Correct answer: c) Superior vena cava.
The azygos vein is a key collateral pathway between the superior and inferior vena cava. It arches over the right main bronchus at the root of the right lung and opens into the superior vena cava. This pathway ensures venous return even when the IVC is obstructed.
Q2.
Which of the following is a tributary of the azygos vein?
a) Right superior intercostal vein
b) Left brachiocephalic vein
c) Inferior thyroid vein
d) External jugular vein
Answer & Explanation:
Correct answer: a) Right superior intercostal vein.
The azygos vein collects venous return from the posterior intercostal veins, right superior intercostal vein, hemiazygos, and accessory hemiazygos veins. These tributaries help drain thoracic walls and act as important venous channels, especially in cases of caval obstruction.
Q3.
The azygos vein arches over which structure before entering the superior vena cava?
a) Right pulmonary artery
b) Right main bronchus
c) Esophagus
d) Thoracic duct
Answer & Explanation:
Correct answer: b) Right main bronchus.
Before draining into the SVC, the azygos vein forms an arch over the root of the right lung, passing above the right main bronchus. This arch is an important radiological landmark on chest X-rays and CT scans.
Q4. Clinical Scenario
A 50-year-old man with obstruction of the inferior vena cava is able to maintain venous return through collateral channels. Which vein plays the most important role?
a) Azygos vein
b) Internal jugular vein
c) Basilic vein
d) Median cubital vein
Answer & Explanation:
Correct answer: a) Azygos vein.
The azygos system forms an alternative pathway connecting SVC and IVC. In IVC obstruction, azygos and hemiazygos veins enlarge and ensure drainage of lower body blood into the superior vena cava. Clinically, this reduces venous congestion.
Q5.
The hemiazygos vein usually drains into the azygos vein at which level?
a) T6
b) T8
c) T9
d) T12
Answer & Explanation:
Correct answer: c) T9.
The hemiazygos vein ascends on the left side of the vertebral column and usually crosses to join the azygos vein around the T9 vertebral level. This anatomical connection allows venous communication between left and right thoracic walls.
Q6. Clinical
On CT chest, a dilated azygos vein is noticed. Which of the following conditions may cause it?
a) Portal hypertension
b) Pulmonary embolism
c) Bronchial asthma
d) Pleural effusion
Answer & Explanation:
Correct answer: a) Portal hypertension.
In portal hypertension, collateral circulation develops via portosystemic anastomosis. One such pathway is the esophageal veins → azygos vein → SVC. This can cause dilatation of the azygos vein and visible varices on imaging.
Q7.
The azygos vein develops embryologically from which structure?
a) Posterior cardinal vein
b) Subcardinal vein
c) Supracardinal vein
d) Vitelline vein
Answer & Explanation:
Correct answer: c) Supracardinal vein.
The azygos system, including azygos, hemiazygos, and accessory hemiazygos, develops from the supracardinal veins. This embryological origin explains their paravertebral location and connection to intercostal veins.
Q8.
Which structure lies anterior to the arch of azygos vein?
a) Right vagus nerve
b) Right phrenic nerve
c) Trachea
d) Esophagus
Answer & Explanation:
Correct answer: c) Trachea.
The azygos arch lies posterior to the superior vena cava and arches over the right main bronchus. The trachea is anterior to it, forming a useful landmark in thoracic imaging.
Q9. Clinical
A patient with carcinoma esophagus develops esophageal varices. Which venous system is primarily involved?
a) Azygos vein
b) Portal vein
c) Inferior thyroid vein
d) Subclavian vein
Answer & Explanation:
Correct answer: a) Azygos vein.
Esophageal varices result from portosystemic anastomosis between left gastric vein (portal system) and esophageal veins draining into azygos (systemic). Enlargement of these collaterals leads to varices and risk of life-threatening bleeding.
Q10.
Accessory hemiazygos vein drains into azygos vein at which level?
a) T5–T6
b) T7–T8
c) T9–T10
d) T11–T12
Answer & Explanation:
Correct answer: a) T5–T6.
The accessory hemiazygos vein descends on the left side, draining mid-thoracic intercostal spaces and typically crosses to join azygos around T5–T6 vertebrae. This provides an alternate channel for thoracic venous return.
Chapter: Anatomy
Topic: Anal Canal
Subtopic: Anal Valve
Keyword Definitions:
Anal Canal: Terminal part of the large intestine extending from rectum to anus.
Anal Valve: Mucosal folds joining bases of anal columns.
Anal Columns: Longitudinal mucosal ridges containing branches of rectal veins.
Pectinate Line: Junction between upper 2/3rd and lower 1/3rd of anal canal.
Hemorrhoids: Dilated veins of anal canal.
Internal Anal Sphincter: Involuntary muscle surrounding upper anal canal.
External Anal Sphincter: Voluntary muscle surrounding lower anal canal.
Pecten (Anal Pectin): Zone below pectinate line, lined by non-keratinized stratified squamous epithelium.
Anoderm: Lower anal canal lining, sensitive to pain, touch, and temperature.
Anal Sinuses: Recesses between anal columns above anal valves.
Lead Question – 2012
Anal valve is found in which part of anal canal?
a) Upper
b) Middle
c) Lower
d) At anus
Explanation:
Anal valves are small mucosal folds connecting the lower ends of adjacent anal columns. Together with anal columns, they form anal sinuses above them. They are located at the junction of the upper and middle parts of the anal canal, specifically at the level of the pectinate line. The correct answer is b) Middle. This area is clinically significant since internal hemorrhoids occur above this line and are painless, while lesions below are painful due to somatic innervation.
Guessed Questions (NEET PG style)
The pectinate line of the anal canal corresponds embryologically to:
a) Hindgut endoderm and ectoderm junction
b) Cloaca and allantois junction
c) Mesodermal anal plate
d) Neural crest migration zone
Explanation:
The pectinate line marks the junction of the hindgut endoderm (upper anal canal) and ectoderm of the proctodeum (lower anal canal). This embryological boundary explains differences in epithelium, nerve supply, lymphatic drainage, and venous return. Thus, the correct answer is a) Hindgut endoderm and ectoderm junction.
Which nerve mediates pain sensation in external hemorrhoids?
a) Pelvic splanchnic nerve
b) Inferior rectal nerve
c) Pudendal plexus
d) Superior rectal nerve
Explanation:
Pain from external hemorrhoids is due to rich somatic innervation below the pectinate line. The inferior rectal nerve (branch of pudendal nerve) supplies the anoderm and external sphincter, making external hemorrhoids painful. In contrast, internal hemorrhoids are painless because they are above the pectinate line, supplied by autonomic nerves. Correct answer: b) Inferior rectal nerve.
A 40-year-old man presents with painless rectal bleeding. On examination, dilated veins are found above the pectinate line. What is the likely diagnosis?
a) Anal fissure
b) Internal hemorrhoids
c) External hemorrhoids
d) Rectal varices
Explanation:
Painless bleeding from dilated veins above the pectinate line is diagnostic of internal hemorrhoids. These are covered by mucosa, lack somatic sensory supply, and hence are painless. External hemorrhoids occur below the line and are painful. Rectal varices occur in portal hypertension. Correct answer: b) Internal hemorrhoids.
The anal pecten is lined by which type of epithelium?
a) Columnar
b) Transitional
c) Non-keratinized stratified squamous
d) Keratinized stratified squamous
Explanation:
The anal pecten is the region immediately below the pectinate line. It is lined by non-keratinized stratified squamous epithelium, unlike the lower anoderm which is keratinized. This distinction is important clinically because fissures are common in the anoderm due to trauma. Correct answer: c) Non-keratinized stratified squamous.
Lymphatic drainage below the pectinate line goes to:
a) Internal iliac nodes
b) External iliac nodes
c) Superficial inguinal nodes
d) Para-aortic nodes
Explanation:
Above the pectinate line, lymph drains into internal iliac nodes. Below it, lymph flows to the superficial inguinal nodes. This explains why anal carcinoma below the line often spreads to inguinal lymph nodes. Correct answer: c) Superficial inguinal nodes.
Which artery supplies the middle part of the anal canal near the anal valves?
a) Superior rectal artery
b) Middle rectal artery
c) Inferior rectal artery
d) Internal iliac artery
Explanation:
The anal canal receives a rich blood supply. The superior rectal artery (branch of inferior mesenteric) supplies the area above the pectinate line, including anal valves. The middle rectal artery contributes collaterals, while the inferior rectal artery supplies below the line. Correct answer: a) Superior rectal artery.
Which feature differentiates upper and lower anal canal?
a) Sphincter type
b) Blood supply
c) Nerve supply
d) All of the above
Explanation:
The anal canal is divided by the pectinate line. Upper anal canal: autonomic nerve supply, superior rectal vessels, internal iliac lymphatics. Lower anal canal: somatic nerve supply (inferior rectal), inferior rectal vessels, superficial inguinal nodes. Thus, all of the above features differ. Correct answer: d) All of the above.
A patient develops an abscess in the anal crypts near anal valves. This condition is called:
a) Hemorrhoids
b) Anal fissure
c) Cryptitis
d) Perianal fistula
Explanation:
The anal valves form recesses called anal sinuses or crypts. Infections here lead to cryptitis, which can progress to abscess and fistula-in-ano. Hence, the correct answer is c) Cryptitis. Clinically, cryptitis is painful due to irritation of sensory nerves below the pectinate line.
Venous drainage above the pectinate line ultimately drains into:
a) Inferior vena cava
b) Hepatic portal vein
c) Common iliac vein
d) External iliac vein
Explanation:
Above the pectinate line, venous return is to the superior rectal vein → inferior mesenteric vein → portal vein, hence portal system. Below the line, drainage is systemic via inferior rectal vein → internal pudendal → IVC. Correct answer: b) Hepatic portal vein.
A patient complains of severe pain during defecation. Fissure is found below the pectinate line. Which nerve carries this pain?
a) Pelvic splanchnic
b) Inferior rectal
c) Hypogastric plexus
d) Superior rectal
Explanation:
Pain below the pectinate line is mediated by somatic nerves. The inferior rectal nerve, branch of pudendal, supplies the anoderm and conveys severe localized pain during fissure-in-ano. This contrasts with lesions above the line, which are insensitive to sharp pain. Correct answer: b) Inferior rectal.
Topic: Uterine Support
Subtopic: Ligamentous Support of Uterus
Keyword Definitions:
Cardinal Ligament: Primary ligament providing lateral support to the uterus, extends from cervix to lateral pelvic wall.
Broad Ligament: Double fold of peritoneum attaching uterus to lateral pelvic walls, contains vessels and nerves.
Round Ligament: Connects uterine horns to labia majora via inguinal canal, maintains anteverted position.
Pubocervical Ligament: Connects cervix to pubic symphysis, contributes to anterior support.
Uterosacral Ligament: Extends from cervix to sacrum, provides posterior support.
Pelvic Floor Muscles: Muscular layer supporting pelvic organs, including levator ani.
Prolapse: Descent of uterus or vaginal walls due to ligament or muscle weakness.
Parametrium: Connective tissue surrounding cervix, includes cardinal ligaments.
Anteverted Uterus: Normal position of uterus inclined forward over bladder.
Pelvic Organ Support: Combination of ligaments and muscles maintaining organ position.
Lead Question – 2012
Main support of uterus is from – ligament :
a) Cardinal
b) Broad
c) Round
d) Pubocervical
Explanation: The cardinal ligament provides primary lateral support to the uterus by anchoring the cervix and upper vagina to the lateral pelvic wall. It contains uterine vessels and connective tissue. Weakness or injury can lead to uterine prolapse. Therefore, the correct answer is a) Cardinal. Other ligaments contribute but are secondary.
1. Which ligament helps maintain the anteverted position of the uterus?
a) Cardinal
b) Broad
c) Round
d) Uterosacral
Explanation: The round ligament extends from uterine horns to labia majora via the inguinal canal, maintaining anteverted position. Weakness can allow retroversion. Correct answer: c) Round.
2. Uterosacral ligaments provide which type of uterine support?
a) Anterior
b) Lateral
c) Posterior
d) Inferior
Explanation: The uterosacral ligaments extend from cervix to sacrum and provide posterior support, preventing backward displacement. They are clinically important in uterine prolapse surgeries. Correct answer: c) Posterior.
3. Broad ligament contains which of the following structures?
a) Uterine vessels
b) Ovarian vessels
c) Nerves and lymphatics
d) All of the above
Explanation: The broad ligament is a double layer of peritoneum attaching uterus to lateral pelvic walls. It contains uterine and ovarian vessels, nerves, and lymphatics. Correct answer: d) All of the above.
4. A 50-year-old woman presents with uterovaginal prolapse. Weakness of which ligament is most likely responsible?
a) Round ligament
b) Cardinal ligament
c) Broad ligament
d) Pubocervical ligament
Explanation: Uterovaginal prolapse is most commonly caused by weakness of cardinal ligaments. These ligaments provide primary lateral support. Damage occurs due to childbirth trauma or aging. Correct answer: b) Cardinal ligament.
5. Which ligament connects cervix to pubic symphysis?
a) Pubocervical ligament
b) Cardinal ligament
c) Round ligament
d) Uterosacral ligament
Explanation: The pubocervical ligament connects cervix and upper vagina to pubic symphysis, providing anterior support. Weakening contributes to anterior vaginal wall prolapse (cystocele). Correct answer: a) Pubocervical ligament.
6. During hysterectomy, which ligament must be carefully ligated to control uterine vessels?
a) Broad ligament
b) Cardinal ligament
c) Round ligament
d) Uterosacral ligament
Explanation: The cardinal ligament contains uterine vessels, which must be ligated during hysterectomy to prevent hemorrhage. Correct answer: b) Cardinal ligament.
7. Which ligament is most likely to be stretched during pregnancy to maintain uterine position?
a) Broad ligament
b) Round ligament
c) Cardinal ligament
d) Uterosacral ligament
Explanation: During pregnancy, the round ligament stretches as the uterus enlarges to maintain anteverted position. Stretching can cause ligamentous pain in lower abdomen. Correct answer: b) Round ligament.
8. Which structure is part of the parametrium?
a) Cardinal ligament
b) Broad ligament
c) Uterosacral ligament
d) Round ligament
Explanation: The parametrium is connective tissue surrounding cervix. The cardinal ligament is a major component, providing lateral support and containing uterine vessels. Correct answer: a) Cardinal ligament.
9. Damage to which ligament may result in retroversion of the uterus postpartum?
a) Round ligament
b) Cardinal ligament
c) Uterosacral ligament
d) Pubocervical ligament
Explanation: The round ligament maintains anteversion. Weakening postpartum or after surgery may lead to retroverted uterus, often asymptomatic. Cardinal ligament damage leads to prolapse, not retroversion. Correct answer: a) Round ligament.
10. Which ligament is primarily responsible for posterior support preventing uterine descent?
a) Cardinal ligament
b) Broad ligament
c) Uterosacral ligament
d) Round ligament
Explanation: The uterosacral ligament extends from cervix to sacrum and prevents posterior displacement and uterine descent. It is especially important in posterior vaginal wall prolapse. Correct answer: c) Uterosacral ligament.
Topic: Abdominal Arteries
Subtopic: Coeliac Trunk and Its Branches
Keyword Definitions:
Coeliac Trunk: First major branch of the abdominal aorta supplying stomach, spleen, liver, and pancreas.
Left Gastric Artery: Branch of coeliac trunk supplying lesser curvature of the stomach.
Right Gastric Artery: Usually arises from the proper hepatic artery, not coeliac trunk directly.
Splenic Artery: Branch of coeliac trunk supplying spleen, pancreas, and fundus of stomach.
Common Hepatic Artery: Branch of coeliac trunk giving proper hepatic artery to liver and right gastric artery.
Abdominal Aorta: Major artery from heart supplying abdominal organs.
Branches: Major arteries originating from a main trunk.
Gastroepiploic Arteries: Branches supplying stomach greater curvature.
Portal Circulation: System of veins and arteries related to liver blood supply.
Collateral Circulation: Alternative pathways for blood flow if primary arteries are blocked.
Lead Question – 2012
All of the following arteries are the branches of coeliac trunk, EXCEPT?
a) Left gastric artery
b) Right gastric artery
c) Splenic artery
d) Hepatic artery
Explanation: The coeliac trunk has three primary branches: left gastric artery, splenic artery, and common hepatic artery. The right gastric artery usually arises from the proper hepatic artery, not directly from coeliac trunk. Therefore, the correct answer is b) Right gastric artery. Understanding these branches is clinically important in surgeries and liver-stomach blood supply.
1. The common hepatic artery gives rise to which of the following?
a) Left gastric artery
b) Right gastric artery
c) Splenic artery
d) Superior mesenteric artery
Explanation: The common hepatic artery arises from the coeliac trunk and gives off the proper hepatic artery, gastroduodenal artery, and right gastric artery. This is important in liver and stomach surgeries. Correct answer: b) Right gastric artery.
2. Splenic artery branches to which organ?
a) Stomach fundus
b) Spleen
c) Pancreas
d) All of the above
Explanation: The splenic artery supplies the spleen primarily, with branches to the pancreas and short gastric arteries supplying the fundus. This collateral supply is critical during splenectomy. Correct answer: d) All of the above.
3. Which artery arises directly from coeliac trunk and supplies lesser curvature of stomach?
a) Right gastric artery
b) Left gastric artery
c) Gastroduodenal artery
d) Superior mesenteric artery
Explanation: The left gastric artery arises directly from the coeliac trunk and supplies the lesser curvature of the stomach. It anastomoses with the right gastric artery, forming collateral circulation. Correct answer: b) Left gastric artery.
4. Gastroduodenal artery is a branch of:
a) Coeliac trunk directly
b) Common hepatic artery
c) Splenic artery
d) Superior mesenteric artery
Explanation: The gastroduodenal artery arises from the common hepatic artery (branch of coeliac trunk), supplying the pylorus, duodenum, and pancreas. Awareness is important for managing upper GI bleeding. Correct answer: b) Common hepatic artery.
5. Which of the following is NOT a primary branch of coeliac trunk?
a) Left gastric artery
b) Splenic artery
c) Common hepatic artery
d) Superior mesenteric artery
Explanation: The superior mesenteric artery arises from the abdominal aorta below the coeliac trunk, not from it. Coeliac trunk branches are left gastric, splenic, and common hepatic arteries. Correct answer: d) Superior mesenteric artery.
6. The right gastric artery anastomoses with:
a) Left gastric artery
b) Splenic artery
c) Gastroduodenal artery
d) Inferior mesenteric artery
Explanation: The right gastric artery, arising from proper hepatic artery, anastomoses with the left gastric artery along the lesser curvature of the stomach, providing important collateral blood flow. Correct answer: a) Left gastric artery.
7. Clinical importance of splenic artery ligation includes:
a) Control of splenic hemorrhage
b) Pancreatic tumor surgery
c) Gastric fundus surgery
d) All of the above
Explanation: The splenic artery supplies spleen, pancreas, and gastric fundus. Ligating it is necessary in splenectomy, pancreatic surgeries, or upper gastric operations to control bleeding. Correct answer: d) All of the above.
8. Hepatic artery proper arises from:
a) Left gastric artery
b) Common hepatic artery
c) Splenic artery
d) Coeliac trunk directly
Explanation: The hepatic artery proper is a continuation of the common hepatic artery (branch of coeliac trunk), giving off right gastric and cystic arteries. Correct answer: b) Common hepatic artery.
9. Short gastric arteries are branches of:
a) Splenic artery
b) Left gastric artery
c) Right gastric artery
d) Common hepatic artery
Explanation: Short gastric arteries arise from the terminal splenic artery branches to supply the fundus of the stomach. Correct answer: a) Splenic artery.
10. During upper GI bleed, which artery is most commonly involved?
a) Right gastric artery
b) Left gastric artery
c) Splenic artery
d) Superior mesenteric artery
Explanation: The left gastric artery is most commonly implicated in upper GI bleeding, especially along lesser curvature ulcers. Its anastomosis with right gastric artery can also provide collateral circulation. Correct answer: b) Left gastric artery.
Topic: Cavernous Sinus
Subtopic: Structures within the Cavernous Sinus
Keyword Definitions:
Cavernous Sinus: A venous sinus located on either side of the pituitary fossa, containing cranial nerves and the internal carotid artery.
Internal Carotid Artery: Artery passing through cavernous sinus, giving off ophthalmic artery and sympathetic plexus.
Oculomotor Nerve (CN III): Passes through lateral wall of cavernous sinus, controls most extraocular muscles.
Trochlear Nerve (CN IV): Lies in lateral wall, innervates superior oblique muscle.
Ophthalmic Nerve (V1): Branch of trigeminal nerve in lateral wall, sensory to upper face and cornea.
Maxillary Nerve (V2): Passes in lateral wall, sensory to midface, upper teeth.
Mandibular Nerve (V3): Does not pass through cavernous sinus; exits skull via foramen ovale.
Abducens Nerve (CN VI): Runs through sinus near ICA, controls lateral rectus muscle.
Facial Nerve (CN VII): Not present in cavernous sinus; exits via stylomastoid foramen.
Clinical Relevance: Cavernous sinus thrombosis affects cranial nerves III, IV, V1, V2, VI and internal carotid artery.
Lead Question – 2012
Which of the following structures seen in the cavernous sinus?
a) Maxillary division of V nerve
b) Mandibular division of V nerve
c) Internal carotid artery
d) Facial nerve
Explanation: The internal carotid artery courses through the cavernous sinus along with cranial nerves III, IV, V1, V2 (maxillary), and VI. The mandibular nerve (V3) and facial nerve (CN VII) are not present. Therefore, the correct answer is c) Internal carotid artery. Understanding anatomy is critical in cavernous sinus thrombosis and aneurysms.
1. Which cranial nerve passes through the lateral wall of the cavernous sinus?
a) Abducens (CN VI)
b) Oculomotor (CN III)
c) Mandibular (V3)
d) Facial (CN VII)
Explanation: Cranial nerves III, IV, V1, and V2 pass in the lateral wall of the cavernous sinus. CN VI runs centrally near ICA. Mandibular (V3) and facial nerve do not traverse the sinus. Correct answer: b) Oculomotor (CN III).
2. Abducens nerve (CN VI) is located:
a) In lateral wall
b) Medial to ICA
c) Outside sinus
d) With facial nerve
Explanation: The abducens nerve (CN VI) runs adjacent to the internal carotid artery within the sinus. It is most vulnerable in cavernous sinus thrombosis. Correct answer: b) Medial to ICA.
3. Which trigeminal branch passes through cavernous sinus?
a) Ophthalmic (V1)
b) Maxillary (V2)
c) Mandibular (V3)
d) Both a and b
Explanation: V1 (ophthalmic) and V2 (maxillary) traverse the lateral wall of cavernous sinus, providing sensory innervation to face. V3 exits via foramen ovale, outside sinus. Correct answer: d) Both a and b.
4. Facial nerve (CN VII) exits skull through:
a) Foramen ovale
b) Jugular foramen
c) Stylomastoid foramen
d) Superior orbital fissure
Explanation: The facial nerve (CN VII) exits via stylomastoid foramen, not through cavernous sinus. Lesions in sinus do not affect CN VII. Correct answer: c) Stylomastoid foramen.
5. Cavernous sinus thrombosis can affect all EXCEPT:
a) CN III
b) CN IV
c) CN VII
d) CN VI
Explanation: Thrombosis of cavernous sinus involves CN III, IV, V1, V2, and VI. CN VII (facial nerve) is not affected because it is outside the sinus. Correct answer: c) CN VII.
6. Internal carotid artery in cavernous sinus gives off:
a) Ophthalmic artery
b) Maxillary artery
c) Middle cerebral artery
d) Vertebral artery
Explanation: The internal carotid artery within cavernous sinus gives rise to ophthalmic artery and branches to carotid sympathetic plexus. Middle cerebral and vertebral arteries arise more proximally. Correct answer: a) Ophthalmic artery.
7. Superior orbital fissure transmits which structures in relation to cavernous sinus?
a) CN III, IV, V1, VI
b) V2 and V3
c) CN VII and VIII
d) ICA only
Explanation: Cranial nerves III, IV, V1, VI leave the cavernous sinus to enter orbit through superior orbital fissure. This pathway explains clinical ophthalmoplegia in cavernous sinus lesions. Correct answer: a) CN III, IV, V1, VI.
8. Maxillary nerve (V2) exits skull via:
a) Foramen rotundum
b) Foramen ovale
c) Superior orbital fissure
d) Jugular foramen
Explanation: Maxillary nerve (V2) passes through lateral wall of cavernous sinus and exits via foramen rotundum to reach pterygopalatine fossa. Correct answer: a) Foramen rotundum.
9. Mandibular nerve (V3) is located:
a) Within cavernous sinus
b) Exits via foramen ovale
c) Lateral wall of sinus
d) With CN VI
Explanation: The mandibular nerve (V3) does not traverse the cavernous sinus. It exits skull via foramen ovale to supply lower face and muscles of mastication. Correct answer: b) Exits via foramen ovale.
10. Cavernous sinus is clinically important in:
a) Spread of facial infections
b) Thrombosis causing cranial nerve palsies
c) ICA aneurysms
d) All of the above
Explanation: The cavernous sinus is prone to thrombosis from facial infections (danger triangle), can compress CN III, IV, V1, V2, VI, and ICA aneurysms can occur. Clinical knowledge is crucial. Correct answer: d) All of the above.
Topic: Retroperitoneal Organs
Subtopic: Relations of the Kidney
Keyword Definitions:
Right Kidney: Retroperitoneal organ located at T12-L3 vertebral level, partially protected by ribs 11–12.
Anterior Relations: Structures lying in front of the kidney, including liver, duodenum, and colon.
Posterior Relations: Muscles and ribs behind the kidney such as diaphragm, psoas major, quadratus lumborum.
Hepatic Flexure: The right colic flexure of the colon, near the liver.
Duodenum: C-shaped loop of small intestine; 2nd part lies anterior to right kidney.
Adrenal Gland: Endocrine organ on superior pole of kidney, usually considered superior relation, not anterior.
Retroperitoneal: Behind peritoneum; kidneys are retroperitoneal organs.
Clinical Importance: Knowledge of kidney relations is crucial in surgeries and radiology.
Renal Fascia: Connective tissue enclosing kidney and adrenal gland.
Peritoneum: Serous membrane covering abdominal organs.
Lead Question – 2012
Anterior relations of the right kidney are all except?
a) Liver
b) 4th part of duodenum
c) Hepatic flexure
d) Adrenal gland
Explanation: The right kidney lies posterior to liver, 2nd part of duodenum, and hepatic flexure. The adrenal gland lies on the superior pole, considered a superior relation, not anterior. Therefore, the correct answer is d) Adrenal gland. Understanding relations is important for nephrectomy and imaging interpretation.
1. Posterior relation of the right kidney includes:
a) Psoas major
b) Quadratus lumborum
c) Diaphragm
d) All of the above
Explanation: The posterior relations of the right kidney include psoas major, quadratus lumborum, transversus abdominis, and diaphragm. These structures are important in flank surgery and imaging. Correct answer: d) All of the above.
2. Superior relation of the right kidney is:
a) Liver
b) Adrenal gland
c) Duodenum
d) Hepatic flexure
Explanation: The adrenal gland lies on the superior pole of the kidney, separated by perirenal fat. Knowledge is crucial in adrenalectomy and renal surgeries. Correct answer: b) Adrenal gland.
3. Which part of duodenum lies anterior to right kidney?
a) 1st
b) 2nd
c) 3rd
d) 4th
Explanation: The 2nd part of the duodenum lies medial and anterior to the right kidney, forming part of the anterior relations. 4th part is more left-sided. Correct answer: b) 2nd.
4. Anterior relation of the right kidney involving large intestine:
a) Splenic flexure
b) Hepatic flexure
c) Cecum
d) Transverse colon
Explanation: The hepatic flexure of the colon lies anterior and lateral to the right kidney. This relation is important in right nephrectomy and colon surgeries. Correct answer: b) Hepatic flexure.
5. Which of the following is NOT an anterior relation of the right kidney?
a) Liver
b) Adrenal gland
c) Hepatic flexure
d) 2nd part of duodenum
Explanation: The adrenal gland is on the superior pole, not anterior. All other structures (liver, duodenum, hepatic flexure) lie anteriorly. Correct answer: b) Adrenal gland.
6. Retroperitoneal organs include:
a) Stomach
b) Liver
c) Kidneys
d) Spleen
Explanation: The kidneys are retroperitoneal, lying behind the peritoneum. Liver, stomach, and spleen are intraperitoneal. Correct knowledge is crucial for surgical approaches. Correct answer: c) Kidneys.
7. Which structure lies between right kidney and liver?
a) Peritoneum
b) Right adrenal gland
c) Gallbladder
d) Duodenum
Explanation: The peritoneum covers the anterior surface of the kidney and separates it from liver. Gallbladder and duodenum are anterior but partially overlapping; adrenal lies superior. Correct answer: a) Peritoneum.
8. Clinical importance of hepatic flexure relation to right kidney:
a) Risk during nephrectomy
b) Imaging landmark
c) Colon injury during surgery
d) All of the above
Explanation: The hepatic flexure lies anterior-lateral to right kidney. During nephrectomy or trauma, careful dissection avoids colon injury. Radiologists use it as a landmark in CT/MRI. Correct answer: d) All of the above.
9. Which of the following structures is closest to right kidney superior pole?
a) Right adrenal gland
b) Liver
c) Duodenum
d) Hepatic flexure
Explanation: The right adrenal gland sits on the superior pole, closely related to kidney. Liver lies more anterior, duodenum and hepatic flexure lateral-anterior. Correct answer: a) Right adrenal gland.
10. Fourth part of duodenum is related to:
a) Right kidney
b) Left kidney
c) Liver
d) Gallbladder
Explanation: The 4th part of duodenum passes medially, anterior to left kidney at L2-L3 level. Right kidney lies lateral to duodenum 2nd and 3rd parts. Correct answer: b) Left kidney.
Topic: Pancreas
Subtopic: Developmental Anomalies
Keyword Definitions:
Pancreas Divisum: Congenital anomaly where dorsal and ventral pancreatic buds fail to fuse, resulting in separate drainage of pancreatic ducts.
Dorsal Pancreatic Bud: Forms the superior part of head, body, and tail of pancreas.
Ventral Pancreatic Bud: Forms inferior part of head and uncinate process.
Pancreatic Ducts: Duct of Wirsung (main), duct of Santorini (accessory).
Fusion Failure: Leads to two separate ducts opening into duodenum.
Clinical Relevance: May cause recurrent pancreatitis due to inadequate drainage.
Duplication of Pancreas: Rare anomaly where two separate pancreatic glands exist, different from divisum.
Embryology: Pancreas develops from foregut endodermal buds in 5th week of gestation.
Symptoms: Often asymptomatic; can present with abdominal pain or pancreatitis.
Imaging: MRCP or ERCP can show separate dorsal and ventral ducts.
Lead Question – 2012
Pancreas divisum indicates which of the following ?
a) Duplication of the pancreas
b) Failure of fusion of dorsal & ventral pancreatic buds
c) Formation of more than two pancreatic buds
d) Formation of only one pancreatic bud
Explanation: Pancreas divisum occurs when the dorsal and ventral pancreatic buds fail to fuse during embryogenesis, resulting in separate dorsal and ventral ducts. This is not a duplication or formation of extra buds. Clinically, it can lead to recurrent pancreatitis due to impaired pancreatic juice drainage. Correct answer: b) Failure of fusion of dorsal & ventral pancreatic buds.
1. The main duct of dorsal pancreas is called:
a) Duct of Wirsung
b) Duct of Santorini
c) Common bile duct
d) Accessory hepatic duct
Explanation: The duct of Santorini is the main duct of the dorsal pancreatic bud. In pancreas divisum, it drains separately into minor duodenal papilla. Wirsung is mainly from ventral bud. Correct answer: b) Duct of Santorini.
2. Ventral pancreatic bud forms:
a) Body and tail
b) Superior head
c) Inferior head and uncinate process
d) Dorsal duct
Explanation: The ventral pancreatic bud rotates and fuses with dorsal bud to form the inferior head and uncinate process. Fusion failure leads to pancreas divisum. Correct answer: c) Inferior head and uncinate process.
3. Most common clinical presentation of pancreas divisum:
a) Jaundice
b) Recurrent pancreatitis
c) Diabetes mellitus
d) Vomiting
Explanation: Patients with pancreas divisum are often asymptomatic but can present with recurrent pancreatitis due to impaired drainage through minor papilla. Correct answer: b) Recurrent pancreatitis.
4. Imaging of choice to diagnose pancreas divisum:
a) Ultrasound
b) MRCP
c) X-ray abdomen
d) CT scan without contrast
Explanation: MRCP (Magnetic Resonance Cholangiopancreatography) is non-invasive and shows separate dorsal and ventral ducts characteristic of pancreas divisum. ERCP is also diagnostic but invasive. Correct answer: b) MRCP.
5. Dorsal pancreatic bud contributes to:
a) Inferior head
b) Body and tail
c) Uncinate process
d) Ventral duct only
Explanation: The dorsal pancreatic bud forms the body, tail, superior head, and accessory duct (Santorini). Fusion failure results in divisum. Correct answer: b) Body and tail.
6. Duplication of pancreas refers to:
a) Two separate pancreatic glands
b) Unfused buds
c) Extra duct only
d) Pancreatic cysts
Explanation: Duplication is a rare anomaly with two separate pancreatic glands, distinct from pancreas divisum which is a failure of fusion of ducts. Correct answer: a) Two separate pancreatic glands.
7. Minor duodenal papilla drains:
a) Duct of Wirsung
b) Duct of Santorini
c) Common bile duct
d) Major pancreatic duct
Explanation: In pancreas divisum, the duct of Santorini drains through the minor duodenal papilla, while ventral duct drains through major papilla. Correct answer: b) Duct of Santorini.
8. Ventral and dorsal pancreatic buds fuse normally at:
a) 5th week
b) 7th week
c) 8th week
d) 12th week
Explanation: Normal fusion of dorsal and ventral buds occurs around 7th week of gestation. Failure leads to pancreas divisum. Correct answer: b) 7th week.
9. Pancreas divisum increases risk of:
a) Pancreatic carcinoma
b) Recurrent pancreatitis
c) Diabetes
d) Gastric ulcers
Explanation: Due to inadequate drainage of pancreatic juice via minor papilla, pancreas divisum can cause recurrent pancreatitis. Correct answer: b) Recurrent pancreatitis.
10. Embryological origin of pancreas:
a) Midgut
b) Hindgut
c) Foregut
d) Neural crest
Explanation: The pancreas develops from endodermal buds of the foregut in 5th week of gestation. Dorsal and ventral buds rotate and fuse to form the adult pancreas. Failure of fusion causes divisum. Correct answer: c) Foregut.