Skeletal System

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).

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: Thorax & Mediastinum; Topic: Sternum & Xiphoid Process; Subtopic: Ossification and Fusion of Xiphoid

Keyword Definitions:

• Xiphoid process: Small inferior cartilaginous/ossified part of the sternum, variable in shape and fusion time.

• Sternum: Midline anterior thoracic bone formed by manubrium, body, and xiphoid process.

• Ossification: Process of cartilage turning into bone during growth and maturation.

• Fusion: The bony union of xiphoid with sternal body, completes skeletal continuity.

• Epigastrium: Region overlying xiphoid; clinical landmark for subxiphoid procedures.

Lead Question - 2014

Xiphoid fuses with sternum by what age ?

a) 30 years
b) 35 years
c) 40 years
d) 45 years

Explanation: The xiphoid process usually ossifies and fuses with the sternal body in middle adulthood; most commonly fusion is complete by around forty years of age. Clinically this is relevant for subxiphoid landmarks and variations; correct answer: c) 40 years.

Guessed Questions for NEET PG (1–10)

1) The xiphoid process is derived from which embryologic tissue?
a) Neural crest
b) Paraxial mesoderm (somites)
c) Lateral plate mesoderm (somatic layer)
d) Endoderm

Explanation: The sternum, including the xiphoid, arises from paired sternal bars derived from the somatic (lateral plate) mesoderm that fuse in the midline during embryogenesis. This explains congenital sternal defects. Correct answer: c) Lateral plate mesoderm (somatic layer).

2) Which structure lies immediately posterior to the xiphoid process in the epigastrium?
a) Right lobe of liver
b) Left lobe of liver
c) Stomach
d) Transverse colon

Explanation: The xiphoid process overlies the superior surface of the left lobe of the liver and the epigastric region; care is required for subxiphoid approaches. In trauma, xiphoid fractures risk liver injury. Correct answer: b) Left lobe of liver.

3) Clinical: A patient has a sharp midline inferior sternal pain after CPR with lower sternal tenderness. Likely injury is to the:
a) Manubrium
b) Sternal body
c) Xiphoid process
d) Costal cartilage

Explanation: Forceful chest compressions can fracture or displace the xiphoid process, causing localized inferior sternal pain and tenderness; this may also injure underlying liver. Clinical suspicion after CPR should include xiphoid injury. Correct answer: c) Xiphoid process.

4) Which of the following muscles attaches to the xiphoid process?
a) Rectus abdominis
b) Transversus thoracis
c) Diaphragm
d) All of the above

Explanation: Multiple muscles anchor to the xiphoid: rectus abdominis fibers attach inferiorly, the diaphragm has a central tendon near it, and transversus thoracis attaches to lower sternum. These attachments explain pain referral patterns. Correct answer: d) All of the above.

5) Straight anatomy: The sternal angle (Angle of Louis) is at the junction of which parts?
a) Manubrium and body of sternum
b) Body and xiphoid process
c) Manubrium and clavicle
d) Xiphoid and costal cartilage

Explanation: The sternal angle is the junction between the manubrium and the body of the sternum and corresponds to the level of the second costal cartilage and the T4/T5 vertebral level—important surface landmark. Correct answer: a) Manubrium and body of sternum.

6) Clinical: During subxiphoid pericardial window, the surgeon should avoid which structure immediately deep to the xiphoid?
a) Pericardium and right ventricle
b) Stomach body
c) Inferior vena cava
d) Splenic flexure

Explanation: A subxiphoid approach reaches the pericardium lying deep and slightly posterior to xiphoid; care avoids injuring the right ventricle and pericardial sac. Knowledge of xiphoid anatomy reduces cardiac injury risk. Correct answer: a) Pericardium and right ventricle.

7) Which ossification pattern is common for the xiphoid in adults?
a) Remains cartilaginous throughout life
b) Ossifies and fuses variably, sometimes bifid or perforated
c) Always fuses by puberty
d) Is absent congenitally in all cases

Explanation: The xiphoid shows variable ossification: it may remain cartilaginous for years, ossify and fuse in middle age, or present anatomical variants like bifid or foraminal xiphoid. These variants can mimic epigastric masses on exam. Correct answer: b) Ossifies and fuses variably, sometimes bifid or perforated.

8) Straight anatomy: Which costal cartilages articulate directly with the body of the sternum (not xiphoid)?
a) 1st and 2nd
b) 2nd to 7th
c) 7th only
d) 8th to 10th

Explanation: The body of the sternum articulates with the 2nd to 7th costal cartilages. The 1st joins the manubrium, and 8th–10th fuse with each other indirectly to the sternum via the 7th. Correct answer: b) 2nd to 7th.

9) Clinical: A palpable bony projection below the sternum is found; xiphoid is angled anteriorly causing discomfort when pressed. This condition is called:
a) Xiphoidalgia
b) Costochondritis
c) Sternal cleft
d) Pectus excavatum

Explanation: Painful anterior projection or tenderness of xiphoid is termed xiphoidalgia (xiphoid syndrome). It may follow trauma, heavy lifting, or be positional; treatment is conservative or local steroid if persistent. Correct answer: a) Xiphoidalgia.

10) Straight anatomy: Fusion of xiphoid to sternal body is complete by which decade in most adults?
a) Second decade
b) Third decade
c) Fourth decade
d) Sixth decade

Explanation: While variable, most textbooks note xiphoid ossification and fusion to the sternal body occurs by the fourth decade of life. This is clinically relevant for forensic age estimation and surgical landmarks. Correct answer: c) Fourth decade (≈ 40 years).

Topic: First Rib Relations
Subtopic: Structures Related to First Rib

Keyword Definitions:

• First rib: The uppermost rib, short and curved, articulating with T1 vertebra.

• Sympathetic chain: Nerve chain running along vertebral bodies.

• Scalenus anterior: Muscle inserting onto scalene tubercle of first rib.

• Suprapleural membrane: Fibrous layer covering lung apex and attaching to first rib.

• T2 nerve: Intercostal nerve arising from second thoracic segment.

Lead Question - 2014
First rib is not related to ?
a) Sympathetic chain
b) Scalenus anterior
c) Suprapleural membrane
d) T2 Nerve

Explanation: The first rib is related to scalenus anterior, suprapleural membrane, and sympathetic chain, but not to the T2 nerve. The T2 nerve is associated with the second intercostal space. Hence, the correct answer is d) T2 Nerve. Relations of first rib are key for surgical anatomy. (50 words)

1. Which structure passes anterior to scalenus anterior on the first rib?
a) Subclavian vein
b) Subclavian artery
c) Brachial plexus
d) Thoracic duct

Explanation: The subclavian vein passes anterior to scalenus anterior at the level of the first rib. Subclavian artery and brachial plexus pass posterior to scalenus anterior. Thoracic duct drains into venous angle but not directly related to first rib anteriorly. Correct answer: a) Subclavian vein. (50 words)

2. Groove for subclavian artery on first rib is located:
a) Anterior to scalene tubercle
b) Posterior to scalene tubercle
c) On superior surface lateral to tubercle
d) On inferior surface

Explanation: On the first rib, the scalene tubercle separates two grooves. Subclavian vein lies anterior to scalene tubercle, while subclavian artery lies posterior to it. This anatomical landmark is important during thoracic outlet surgery. Correct answer: b) Posterior to scalene tubercle. These relations are constant and clinically significant. (50 words)

3. A patient with cervical rib compressing the lower trunk of brachial plexus presents with:
a) Erb’s palsy
b) Klumpke’s palsy
c) Carpal tunnel syndrome
d) Winged scapula

Explanation: Cervical rib compresses lower trunk (C8-T1) of brachial plexus. This produces weakness in intrinsic hand muscles with sensory loss over medial forearm and hand, known as Klumpke’s palsy. Erb’s palsy affects upper trunk, not lower. Correct answer: b) Klumpke’s palsy. This is a classic thoracic outlet syndrome presentation. (50 words)

4. Which muscle is not attached to first rib?
a) Serratus anterior
b) Scalenus anterior
c) Scalenus medius
d) Subclavius

Explanation: First rib provides attachment to scalenus anterior and medius, and also subclavius muscle. Serratus anterior attaches to upper eight ribs, but not to first rib directly. Correct answer is a) Serratus anterior. Understanding rib muscle attachments is critical for thoracic surgery and interpreting radiological landmarks. (50 words)

5. In thoracic outlet syndrome, which structure is commonly compressed between first rib and clavicle?
a) Subclavian vein
b) Subclavian artery
c) Brachial plexus
d) All of the above

Explanation: Thoracic outlet syndrome involves compression of neurovascular bundle between clavicle and first rib. Subclavian artery, subclavian vein, and brachial plexus may all be compressed leading to pain, paresthesia, or vascular compromise. Correct answer is d) All of the above. Clinical diagnosis depends on symptoms and imaging. (50 words)

6. Groove for subclavian vein is located:
a) Posterior to scalene tubercle
b) Anterior to scalene tubercle
c) Inferior surface
d) Medial border

Explanation: The groove for subclavian vein lies anterior to scalene tubercle on the superior surface of first rib. This is a key relation during central venous catheterization. Correct answer is b) Anterior to scalene tubercle. The close relationship explains potential complications during subclavian vein puncture procedures. (50 words)

7. A patient develops swelling above clavicle due to apical lung tumor. Which structure related to first rib is involved?
a) Subclavian vein
b) Suprapleural membrane
c) Sympathetic chain
d) Scalenus anterior

Explanation: Apical lung tumors (Pancoast tumors) invade suprapleural membrane (Sibson’s fascia) attached to first rib. This leads to compression of nearby neurovascular structures including sympathetic chain. Correct answer is b) Suprapleural membrane. Such cases may also cause Horner’s syndrome due to sympathetic chain involvement. (50 words)

8. Which artery runs posterior to anterior scalene and superior to first rib?
a) Subclavian artery
b) Subclavian vein
c) Internal thoracic artery
d) Superior intercostal artery

Explanation: Subclavian artery passes posterior to scalenus anterior and lies in the groove on the superior surface of the first rib. Subclavian vein passes anterior to scalenus anterior. Correct answer is a) Subclavian artery. This relationship is surgically important during vascular procedures and thoracic outlet decompression. (50 words)

9. Which nerve crosses anterior to scalenus anterior muscle over the first rib?
a) Phrenic nerve
b) Long thoracic nerve
c) Dorsal scapular nerve
d) Suprascapular nerve

Explanation: The phrenic nerve crosses anterior to scalenus anterior muscle and descends into thorax. Over the first rib, it runs vertically downwards. Long thoracic and dorsal scapular nerves pass behind scalene muscles. Correct answer is a) Phrenic nerve. This relation is clinically relevant in neck surgeries. (50 words)

10. In subclavian vein cannulation, first rib serves as:
a) Direct puncture site
b) Bony landmark for guidance
c) Arterial compression site
d) Nerve compression site

Explanation: During subclavian vein catheterization, first rib serves as a bony landmark guiding the needle under the clavicle. The vein runs anterior to scalene tubercle along the first rib. Correct answer is b) Bony landmark for guidance. This helps avoid complications like pneumothorax and arterial puncture. (50 words)

Topic: Pelvis and Vertebral Column
Subtopic: Sacroiliac Joint

Keyword Definitions:

• Sacroiliac joint: Synovial joint between auricular surface of sacrum and ilium, transmitting body weight to pelvis.

• Sacrum: A triangular bone formed by fusion of five sacral vertebrae, articulating with ilium, coccyx, and L5 vertebra.

• Auricular surface: Ear-shaped surface of sacrum that articulates with ilium to form sacroiliac joint.

• Vertebral level: A reference point using vertebrae to locate anatomical structures.

• Pelvic stability: Strength provided by joints, ligaments, and muscles to support body weight and locomotion.

Lead Question - 2014

Lower limit of sacroiliac joint lies upto which level in females?

a) 1 to 1½
b) 2 to 2½
c) 3 to 3½
d) 4 to 4½

Explanation: In females, the sacroiliac joint extends from the auricular surface of sacrum, usually from the upper part of S1 to about the middle of S3. Thus, its lower limit corresponds to approximately the level of 3 to 3½ vertebrae. Correct answer: c) 3 to 3½.

1. The sacroiliac joint is classified as?
a) Fibrous joint
b) Primary cartilaginous
c) Synovial plane
d) Symphysis
Explanation: The sacroiliac joint is a synovial plane joint, stabilized by strong ligaments, allowing limited movement but providing stability for weight transmission. Correct answer: c) Synovial plane.

2. Which ligament is strongest in stabilizing the sacroiliac joint?
a) Anterior sacroiliac
b) Posterior sacroiliac
c) Interosseous sacroiliac
d) Iliolumbar
Explanation: The interosseous sacroiliac ligament is the strongest stabilizer, lying deep between sacrum and ilium, transmitting weight and limiting joint mobility. Correct answer: c) Interosseous sacroiliac.

3. A 30-year-old woman presents with low back pain, tenderness over sacroiliac joint, worsened by standing. Which pathology is likely?
a) Osteoarthritis
b) Sacroiliitis
c) Disc prolapse
d) Hip arthritis
Explanation: Sacroiliitis is inflammation of the sacroiliac joint, presenting with localized pain and tenderness, common in autoimmune diseases like ankylosing spondylitis. Correct answer: b) Sacroiliitis.

4. Which gender has a shorter sacroiliac joint surface?
a) Male
b) Female
c) Both equal
d) None
Explanation: Females have a shorter but wider sacroiliac joint surface compared to males, allowing greater pelvic flexibility for childbirth. Correct answer: b) Female.

5. The sacral promontory is part of?
a) Ilium
b) Coccyx
c) First sacral vertebra
d) Pubis
Explanation: The sacral promontory is the anterior projecting margin of the body of the first sacral vertebra, forming part of the pelvic brim. Correct answer: c) First sacral vertebra.

6. A woman with pelvic instability after delivery may have injury to?
a) Pubic symphysis
b) Sacroiliac joint
c) Acetabulum
d) Iliolumbar ligament
Explanation: During childbirth, the sacroiliac joint can be strained due to relaxation of ligaments under hormonal influence, leading to instability and back pain. Correct answer: b) Sacroiliac joint.

7. Which muscle inserts near the auricular surface of sacrum?
a) Piriformis
b) Gluteus maximus
c) Iliacus
d) Quadratus lumborum
Explanation: The piriformis arises from the anterior sacrum, near the auricular surface, and exits via greater sciatic foramen to attach on femur. Correct answer: a) Piriformis.

8. Which imaging is best for diagnosing sacroiliitis?
a) X-ray
b) Ultrasound
c) MRI
d) CT
Explanation: MRI is the most sensitive imaging for early detection of sacroiliitis, as it identifies marrow edema and inflammation before radiographic changes. Correct answer: c) MRI.

9. Which joint transmits body weight from spine to pelvis?
a) Pubic symphysis
b) Hip joint
c) Sacroiliac joint
d) Sacrococcygeal joint
Explanation: The sacroiliac joint connects the sacrum with ilium, transmitting weight from axial skeleton to pelvis and lower limbs. Correct answer: c) Sacroiliac joint.

10. A patient with ankylosing spondylitis develops fusion of which joint earliest?
a) Hip
b) Knee
c) Sacroiliac
d) Lumbar
Explanation: In ankylosing spondylitis, the sacroiliac joint is first affected, progressing to spinal joints and causing “bamboo spine.” Correct answer: c) Sacroiliac.

11. Which structure forms the posterior boundary of sacroiliac joint?
a) Iliac crest
b) Sacral canal
c) Posterior sacroiliac ligament
d) Sacral promontory
Explanation: The posterior sacroiliac ligament lies behind the sacroiliac joint, forming its posterior boundary and reinforcing its stability. Correct answer: c) Posterior sacroiliac ligament.

Topic: Vertebral Column
Subtopic: Sacrum Articular Surface

Keyword Definitions:

• Sacrum: A large triangular bone at the base of the spine formed by fusion of five sacral vertebrae.

• Articular surface: The surface of a bone that forms a joint with another bone.

• Ilium: The broad upper part of the hip bone that articulates with the sacrum.

• Sacroiliac joint: A synovial joint between sacrum and ilium providing stability to pelvis.

• Vertebrae: Series of small bones forming the spinal column, classified into cervical, thoracic, lumbar, sacral, and coccygeal regions.

Lead Question - 2014

Articular surface of the sacrum extends upto how many vertebrae in males?

a) 1 to 1½
b) 2 to 2½
c) 3 to 3½
d) 4 to 4½

Explanation: The auricular (articular) surface of the sacrum articulates with the ilium forming the sacroiliac joint. In males, this surface typically extends from the level of the first sacral vertebra down to the middle of the third sacral vertebra, i.e., about 3 to 3½ vertebrae. Correct answer: c).

1. Which type of joint is formed between sacrum and ilium?
a) Synovial joint
b) Fibrous joint
d) Symphysis
Explanation: The sacroiliac joint is a synovial joint between the auricular surface of sacrum and ilium, providing stability and transmitting body weight. Correct answer: a) Synovial joint.

2. The sacrum is formed by fusion of how many vertebrae?
a) 3
b) 4
c) 5
d) 6
Explanation: The sacrum is a triangular bone formed by fusion of five sacral vertebrae, usually completed by adulthood. It contributes to the posterior wall of pelvis. Correct answer: c) 5.

3. A patient presents with pain localized to the sacroiliac joint after trauma. Which surface of sacrum is involved?
a) Auricular surface
b) Sacral canal
c) Spinous tubercles
d) Median crest
Explanation: The auricular surface of sacrum articulates with the ilium at the sacroiliac joint. Trauma here causes joint pain and instability. Correct answer: a) Auricular surface.

4. Which vertebral level corresponds to the sacral promontory?
a) L3
b) L4
c) S1
d) S2
Explanation: The sacral promontory is the anterior projecting edge of the first sacral vertebra (S1), important in pelvic measurements. Correct answer: c) S1.

5. A fracture involving the alae of sacrum will affect articulation with?
a) Coccyx
b) Lumbar vertebrae
c) Ilium
d) Pubis
Explanation: The lateral alae of the sacrum form articulation with the ilium at the sacroiliac joint. Injury disrupts pelvic stability. Correct answer: c) Ilium.

6. Which structure passes through the anterior sacral foramina?
a) Spinal cord
b) Sacral spinal nerves
c) Vertebral artery
d) Iliolumbar artery
Explanation: The anterior sacral foramina transmit anterior divisions of sacral spinal nerves and blood vessels. Correct answer: b) Sacral spinal nerves.

7. A patient with ankylosing spondylitis shows fusion at which joint first?
a) Pubic symphysis
b) Sacroiliac joint
c) Intervertebral joint
d) Hip joint
Explanation: Ankylosing spondylitis initially affects the sacroiliac joints, leading to pain and eventual fusion, then progresses to spine. Correct answer: b) Sacroiliac joint.

8. Which ligament strengthens the sacroiliac joint?
a) Anterior sacroiliac ligament
b) Interosseous sacroiliac ligament
c) Posterior sacroiliac ligament
d) All of the above
Explanation: The sacroiliac joint is stabilized by anterior, posterior, and interosseous sacroiliac ligaments. Correct answer: d) All of the above.

9. Which structure forms the continuation of the sacral canal?
a) Vertebral canal
b) Coccygeal canal
c) Neural tube
d) Intervertebral foramen
Explanation: The sacral canal is the continuation of the vertebral canal, ending at the sacral hiatus and transmitting sacral nerves. Correct answer: a) Vertebral canal.

10. In caudal epidural anesthesia, the needle is inserted at which landmark?
a) Sacral hiatus
b) Sacral promontory
c) Auricular surface
d) Sacral crest
Explanation: The sacral hiatus at the lower end of sacrum allows access for caudal epidural anesthesia. It is bounded by sacral cornua. Correct answer: a) Sacral hiatus.

11. A patient has compression of S1 nerve root. Which symptom is expected?
a) Loss of ankle jerk
b) Loss of knee jerk
c) Weak elbow extension
d) Weak shoulder abduction
Explanation: S1 nerve root compression leads to absent ankle jerk, weakness of plantar flexion, and pain radiating down posterior leg. Correct answer: a) Loss of ankle jerk.

Topic: Foot Joints and Ligaments
Subtopic: Support of Talus

Keyword Definitions:

• Talus: A tarsal bone of the ankle articulating with tibia, fibula, calcaneus, and navicular for weight transfer.

• Spring ligament: Plantar calcaneonavicular ligament supporting head of talus and medial longitudinal arch.

• Deltoid ligament: Strong medial ankle ligament preventing talar eversion, arising from medial malleolus.

• Lateral collateral ligament (LCL): Group of three ligaments supporting lateral ankle joint, preventing inversion injuries.

• Cervical ligament: Connects calcaneus and talus, stabilizing subtalar joint during inversion and eversion.

Lead Question - 2014

Ligament supporting the talus is ?
a) Spring ligament
b) Deltoid ligament
c) LCL
d) Cervical ligament

Explanation: The spring ligament (plantar calcaneonavicular ligament) forms a sling under the talus, supporting its head and maintaining the medial longitudinal arch of the foot. It is essential for weight transmission and stability. Thus, the correct answer is a) Spring ligament, with clinical importance in flatfoot deformity if weakened.

Guessed Questions for NEET PG

1) Which ligament prevents talar eversion?
a) Deltoid ligament
b) Spring ligament
c) LCL
d) Cervical ligament
Explanation: The deltoid ligament on the medial side prevents excessive talar eversion and stabilizes the ankle joint. Correct answer: a) Deltoid ligament.

2) Ligament most often injured in ankle inversion sprain?
a) Anterior talofibular
b) Deltoid
c) Cervical
d) Spring
Explanation: The anterior talofibular ligament, part of the lateral collateral ligament complex, is most commonly injured in inversion sprains. Correct answer: a) Anterior talofibular.

3) Ligament maintaining medial longitudinal arch?
a) Deltoid
b) Spring
c) Cervical
d) Plantar aponeurosis
Explanation: The spring ligament is key in maintaining the medial longitudinal arch by supporting the head of talus. Correct answer: b) Spring.

4) Which ligament connects calcaneus to talus in subtalar joint?
a) Spring
b) Cervical
c) Deltoid
d) LCL
Explanation: The cervical ligament lies between talus and calcaneus, stabilizing subtalar joint during inversion and eversion. Correct answer: b) Cervical.

5) Injury of spring ligament leads to?
a) High arch foot
b) Flatfoot
c) Clubfoot
d) In-toeing
Explanation: Weakening of spring ligament causes collapse of medial longitudinal arch, resulting in flatfoot deformity. Correct answer: b) Flatfoot.

6) A child presents with painful flatfoot and medial foot collapse. Likely structure involved?
a) Spring ligament
b) Deltoid ligament
c) Cervical ligament
d) LCL
Explanation: Pediatric flatfoot with medial arch collapse is most commonly due to weakened spring ligament support. Correct answer: a) Spring ligament.

7) The deltoid ligament arises from?
a) Lateral malleolus
b) Medial malleolus
c) Talus head
d) Navicular tuberosity
Explanation: The deltoid ligament originates from medial malleolus and spreads to talus, calcaneus, and navicular. Correct answer: b) Medial malleolus.

8) Which ligament supports talus during walking?
a) Cervical ligament
b) Spring ligament
c) LCL
d) Interosseous ligament
Explanation: The spring ligament forms a sling for the head of talus, supporting weight during walking. Correct answer: b) Spring ligament.

9) Ligament stabilizing lateral ankle against inversion?
a) Spring ligament
b) Lateral collateral ligament
c) Deltoid ligament
d) Cervical ligament
Explanation: Lateral collateral ligament complex stabilizes the ankle against inversion forces. Correct answer: b) Lateral collateral ligament.

10) A football player develops medial ankle swelling after forced eversion. Injured ligament?
a) Deltoid
b) Spring
c) Cervical
d) ATFL
Explanation: Forced eversion injuries stretch or tear the deltoid ligament on the medial ankle. Correct answer: a) Deltoid.

Topic: Knee Joint Anatomy
Subtopic: Oblique Popliteal Ligament and Related Arteries

Keyword Definitions:

• Oblique Popliteal Ligament: Broad ligament at the posterior knee, reinforcing the joint capsule.

• Middle Genicular Artery: Branch of popliteal artery, supplies cruciate ligaments and synovium.

• Genicular Arteries: Vascular branches forming an anastomosis around the knee joint.

• Popliteal Artery: Continuation of femoral artery through the popliteal fossa.

Lead Question - 2014
Artery piercing the oblique popliteal ligament of knee -

a) Superior genicular
b) Inferior genicular
c) Middle genicular
d) Popliteal

Explanation: The middle genicular artery, a branch of the popliteal artery, pierces the oblique popliteal ligament to supply cruciate ligaments and synovium. Other genicular arteries form periarticular anastomoses but do not pierce the ligament. Thus, the correct answer is option (c) Middle genicular artery.

1) The popliteal artery is a direct continuation of which artery?
a) Anterior tibial
b) Posterior tibial
c) Femoral
d) Peroneal
Explanation: The popliteal artery is a continuation of the femoral artery after it passes through the adductor hiatus. It supplies the knee joint and leg branches. Options anterior tibial and posterior tibial are its terminal branches, not its origin. Correct answer: (c) Femoral artery.

2) A patient sustains injury to the popliteal artery. Which structure is most at risk due to its proximity?
a) Tibial nerve
b) Sciatic nerve
c) Saphenous vein
d) Common peroneal nerve
Explanation: The tibial nerve lies posterior and superficial to the popliteal artery, making it most vulnerable in popliteal injuries. Sciatic nerve terminates proximal to popliteal fossa, while saphenous vein and peroneal nerve lie more laterally. Correct answer: (a) Tibial nerve.

3) Which artery is most important in supplying cruciate ligaments of the knee?
a) Middle genicular
b) Superior genicular
c) Inferior genicular
d) Descending genicular
Explanation: The middle genicular artery directly pierces the posterior knee capsule and oblique popliteal ligament to supply cruciate ligaments. Superior, inferior, and descending genicular arteries mainly contribute to periarticular anastomoses. Thus, the correct answer is (a) Middle genicular artery.

4) During posterior knee surgery, which vessel pierces the posterior capsule and must be preserved?
a) Middle genicular
b) Anterior tibial
c) Femoral
d) Inferior gluteal
Explanation: The middle genicular artery pierces the posterior capsule through the oblique popliteal ligament and supplies intra-articular structures. Injury can cause intra-articular bleeding and compromise cruciate ligament nutrition. Correct answer: (a) Middle genicular artery.

5) Which branch of the popliteal artery does NOT contribute significantly to the knee joint anastomosis?
a) Superior genicular
b) Middle genicular
c) Inferior genicular
d) Descending genicular
Explanation: The middle genicular artery does not participate in periarticular anastomosis. Instead, it directly supplies cruciate ligaments and synovial membrane. Superior, inferior, and descending genicular arteries form the vascular ring around the knee joint. Correct answer: (b) Middle genicular artery.

6) A 30-year-old man with posterior knee trauma develops hemarthrosis. Which artery is most likely damaged?
a) Superior genicular
b) Middle genicular
c) Inferior genicular
d) Popliteal
Explanation: Posterior capsule trauma often injures the middle genicular artery, as it pierces the oblique popliteal ligament to enter the joint. This leads to bleeding into the joint cavity (hemarthrosis). Correct answer: (b) Middle genicular artery.

7) Which ligament is reinforced by expansion from the semimembranosus tendon?
a) Anterior cruciate ligament
b) Oblique popliteal ligament
c) Posterior cruciate ligament
d) Lateral collateral ligament
Explanation: The oblique popliteal ligament is formed partly by an expansion of the semimembranosus tendon. This structure strengthens the posterior knee capsule. Correct answer: (b) Oblique popliteal ligament.

8) A patient with PCL injury undergoes reconstruction. Which artery provides major vascular supply to the PCL?
a) Middle genicular
b) Superior genicular
c) Inferior genicular
d) Descending genicular
Explanation: The middle genicular artery supplies both cruciate ligaments (ACL and PCL). Its preservation during surgery is vital for graft healing and ligament nutrition. Correct answer: (a) Middle genicular artery.

9) Which of the following arteries passes anterior to the interosseous membrane into the anterior compartment?
a) Middle genicular
b) Anterior tibial
c) Posterior tibial
d) Popliteal
Explanation: The anterior tibial artery arises from the popliteal artery, pierces the interosseous membrane, and supplies the anterior compartment of the leg. Middle genicular is intra-articular, not related to anterior compartment. Correct answer: (b) Anterior tibial artery.

10) A 40-year-old athlete has persistent posterior knee pain after ligament injury. Which small artery damage may compromise ligament healing?
a) Popliteal artery
b) Middle genicular artery
c) Inferior genicular artery
d) Anterior tibial artery
Explanation: Damage to the middle genicular artery compromises blood supply to cruciate ligaments, delaying healing. Popliteal is main trunk, while inferior genicular and anterior tibial supply periarticular structures. Correct answer: (b) Middle genicular artery.

Topic: Shoulder Girdle
Subtopic: Clavicle

Keyword Definitions:

• Clavicle: S-shaped long bone connecting sternum to scapula, forming part of shoulder girdle.

• Endochondral ossification: Bone formation from a cartilage template, typical of long bones.

• Medullary cavity: Central hollow space of long bones containing bone marrow.

• Fracture: Break in bone continuity.

• Vertical orientation: Alignment of bone along long axis.

Lead Question - 2014

True about clavicle?

a) Endochondral ossification
b) Vertical
c) No medullary cavity
d) Rarely fractures

Explanation: The clavicle is unique as it undergoes intramembranous ossification predominantly, has a horizontal S-shaped orientation, possesses a medullary cavity, and is commonly fractured, especially at the middle third. Therefore, options a, b, c, and d are incorrect; correct features are intramembranous ossification, horizontal, medullary cavity present, and frequently fractures.

Guessed Questions

1. Middle third of clavicle is fractured commonly due to?
a) Direct trauma
b) Indirect trauma
c) Stress fracture
d) Pathological fracture

Explanation: The middle third of clavicle is the thinnest and lacks ligamentous support, making it most susceptible to fractures from direct trauma, especially falls on shoulder. Stress and pathological fractures are rare. Correct answer is Direct trauma.

2. Primary ossification of clavicle occurs at?
a) Lateral end
b) Medial end
c) Middle third
d) Both ends simultaneously

Explanation: Clavicle is the first bone to ossify in embryo, mainly by intramembranous ossification from two primary centers: medial and lateral ends. Ossification starts at medial end around 5th-6th week and lateral later. Correct answer is Medial end.

3. Which ossification type is predominant in clavicle?
a) Endochondral
b) Intramembranous
c) Mixed
d) Periosteal only

Explanation: The clavicle is unique as it is primarily formed by intramembranous ossification, although lateral end may have some endochondral component. Most long bones form via endochondral ossification. Correct answer is Intramembranous.

4. Clavicle articulates medially with?
a) Scapula
b) Sternum
c) Acromion
d) Humerus

Explanation: Medially, the clavicle articulates with the manubrium of sternum forming sternoclavicular joint. Laterally, it articulates with acromion of scapula. Humerus articulates with glenoid cavity. Correct answer is Sternum.

5. Lateral end of clavicle articulates with?
a) Sternum
b) Acromion
c) Coracoid process
d) Humeral head

Explanation: The lateral end of clavicle articulates with acromion process of scapula forming acromioclavicular joint, stabilized by coracoclavicular ligaments. Sternum and humerus are not lateral articulations. Correct answer is Acromion.

6. Clavicle lacks which typical long bone feature?
a) Medullary cavity
b) Epiphyses
c) Diaphysis
d) Periosteum

Explanation: Clavicle has medullary cavity, diaphysis, and periosteum like other long bones. It has two epiphyses—sternal and acromial ends—so it does not lack epiphyses. Correct answer is None of these if present; otherwise all typical features exist.

7. Fracture of lateral clavicle can injure?
a) Subclavian artery
b) Axillary nerve
c) Brachial plexus
d) Subclavian vein

Explanation: Fracture of lateral third clavicle rarely injures subclavian vessels due to lateral position; medial third fractures may injure subclavian artery/vein. Axillary nerve injury is uncommon. Correct answer is Subclavian vein for medial involvement; lateral fractures are safer.

8. Clavicle is palpable along its length except?
a) Medial end
b) Middle third
c) Lateral end
d) None

Explanation: The clavicle is subcutaneous along entire length, making it easily palpable. Middle third is most prominent, medial end near sternum less so, lateral end near acromion is palpable. Correct answer is None, as all parts are palpable.

9. Which ligament stabilizes lateral clavicle?
a) Coracoclavicular ligament
b) Sternoclavicular ligament
c) Interclavicular ligament
d) Costoclavicular ligament

Explanation: The coracoclavicular ligament stabilizes lateral clavicle, connecting it to coracoid process. Sternoclavicular ligament stabilizes medial end, interclavicular across manubrium, costoclavicular to first rib. Correct answer is Coracoclavicular ligament.

10. Ossification of clavicle is complete by?
a) Birth
b) 5 years
c) 25 years
d) 15 years

Explanation: Clavicle is first bone to ossify and last to complete ossification. Lateral epiphysis fuses by 18–25 years. Thus, ossification is complete around 25 years.

Topic: Upper Limb Bones
Subtopic: Ulna and its Processes

Keyword Definitions:

• Olecranon process: The prominent proximal projection of the ulna forming the point of the elbow and insertion site for triceps tendon.

• Trochlear notch: A large articular depression on ulna formed by olecranon and coronoid processes, articulating with humeral trochlea.

• Radial notch: Small depression on ulna’s lateral side for articulation with the head of radius.

• Olecranon fossa: A depression on the posterior distal humerus accommodating olecranon during extension.

• Coronoid fossa: Depression on anterior distal humerus receiving coronoid process during flexion.

Lead Question - 2014

Olecranon process of ulna helps in formation of?

a) Radial notch
b) Trochlear notch
c) Olecranon fossa
d) Coronoid fossa

Explanation: The olecranon process along with the coronoid process forms the trochlear notch of ulna, articulating with the trochlea of humerus. This articulation allows hinge-like flexion and extension at the elbow. Therefore, the correct answer is Trochlear notch, not radial notch or humeral fossae.

Guessed Questions

1. The olecranon process provides insertion for?
a) Biceps brachii
b) Brachialis
c) Triceps brachii
d) Anconeus

Explanation: The olecranon process forms the posterior projection of ulna and serves as the insertion site for the tendon of triceps brachii. This allows elbow extension. Biceps inserts on radial tuberosity, brachialis on coronoid process, and anconeus on olecranon lateral aspect. Correct answer is Triceps brachii.

2. Fracture of olecranon process mainly impairs?
a) Elbow flexion
b) Elbow extension
c) Supination
d) Pronation

Explanation: Since the olecranon process is the insertion of triceps brachii, its fracture impairs the power of elbow extension. Flexion, supination, and pronation involve different muscles. Thus, the correct answer is Elbow extension.

3. The coronoid process is located -
a) Proximal ulna anteriorly
b) Proximal ulna posteriorly
c) Distal ulna
d) Radial head

Explanation: The coronoid process is a triangular anterior projection at proximal ulna below the trochlear notch. It serves as attachment for brachialis and helps stabilize elbow joint. Thus, correct answer is Proximal ulna anteriorly.

4. The radial notch of ulna articulates with?
a) Trochlea of humerus
b) Capitulum of humerus
c) Head of radius
d) Head of ulna

Explanation: The radial notch is a shallow concavity on the lateral proximal ulna that articulates with the head of radius, forming the proximal radioulnar joint. This articulation is stabilized by annular ligament. Correct answer is Head of radius.

5. A patient with olecranon fracture will have difficulty in -
a) Making a fist
b) Extending elbow
c) Flexing wrist
d) Supinating forearm

Explanation: The olecranon fracture disrupts triceps insertion, thus impairing elbow extension. Wrist and hand movements are unaffected. Hence, the clinical problem is inability to extend elbow.

6. Which joint is formed by trochlear notch of ulna?
a) Proximal radioulnar joint
b) Elbow joint (humeroulnar part)
c) Distal radioulnar joint
d) Wrist joint

Explanation: The trochlear notch of ulna articulates with trochlea of humerus, forming the humeroulnar part of the elbow joint. This is responsible for hinge-like flexion and extension. Correct answer is Elbow joint (humeroulnar part).

7. The posterior surface of olecranon is attachment for?
a) Triceps tendon
b) Anconeus
c) Brachialis
d) Supinator

Explanation: The posterior surface of olecranon provides attachment for anconeus muscle in addition to triceps insertion. Brachialis inserts on coronoid process, supinator attaches near proximal radius. Correct answer is Anconeus.

8. A child falls and fractures proximal ulna near olecranon. Which nerve is most at risk?
a) Radial nerve
b) Median nerve
c) Ulnar nerve
d) Axillary nerve

Explanation: The ulnar nerve runs posterior to medial epicondyle and can be injured with proximal ulna fractures near olecranon. This produces sensory loss in medial fingers and intrinsic hand weakness. Correct answer is Ulnar nerve.

9. The coronoid process provides attachment to?
a) Triceps
b) Biceps
c) Brachialis
d) Supinator

Explanation: The coronoid process gives insertion to brachialis muscle, which is the chief flexor of the elbow. Biceps inserts on radial tuberosity, triceps on olecranon, supinator on proximal radius. Correct answer is Brachialis.

10. A 45-year-old male with posterior elbow trauma has inability to extend elbow and swelling over olecranon. Likely diagnosis?
a) Radial head fracture
b) Olecranon process fracture
c) Capitulum fracture
d) Coronoid process fracture

Explanation: Direct trauma to posterior elbow with loss of extension indicates olecranon process fracture, as it disrupts triceps tendon insertion. Other options present differently. Correct diagnosis is Olecranon process fracture.

Chapter: Anatomy

Topic: Skull Foramina

Subtopic: Jugular Foramen Contents

Keywords:

• Jugular Foramen: An opening in the base of the skull transmitting several important structures.

• Emissary Vein: Veins that connect intracranial venous sinuses with veins outside the skull, allowing blood drainage.

• Vagus Nerve (CN X): A cranial nerve controlling autonomic functions and motor control of the larynx, heart, and viscera.

• Mandibular Nerve (V3): The third branch of the trigeminal nerve, providing sensory and motor innervation to the lower face.

• Internal Jugular Vein: Drains blood from the brain, face, and neck, exiting the skull through the jugular foramen.

Lead Question - 2013:

All pass through jugular foramen except:

a) Emissary vein
b) Vagus nerve
c) Mandibular nerve
d) Internal jugular vein

Answer & Explanation:
Correct answer: c) Mandibular nerve.
Explanation: The jugular foramen transmits the glossopharyngeal, vagus, accessory nerves, internal jugular vein, and emissary veins. The mandibular nerve (V3), part of the trigeminal nerve, passes through the foramen ovale, not the jugular foramen. This distinction is crucial in understanding cranial nerve pathways and related pathologies.

MCQ 1 :

Which cranial nerve exits through the jugular foramen?

a) Optic nerve
b) Facial nerve
c) Vagus nerve
d) Olfactory nerve

Answer & Explanation:
Correct answer: c) Vagus nerve.
Explanation: The vagus nerve (CN X) exits the skull through the jugular foramen, playing a pivotal role in autonomic control of thoracic and abdominal viscera. Clinically, injury at this site can cause voice changes and autonomic dysfunction, making its identification critical in surgery.

MCQ 2:

The emissary vein connects which two venous systems?

a) Systemic veins and arterial system
b) Intracranial venous sinuses and extracranial veins
c) Jugular vein and carotid artery
d) Cerebral veins and heart chambers

Answer & Explanation:
Correct answer: b) Intracranial venous sinuses and extracranial veins.
Explanation: Emissary veins connect the intracranial venous sinuses with veins outside the skull, providing alternate venous drainage routes. They are clinically significant as they may facilitate the spread of infections from superficial to intracranial structures, potentially leading to conditions like meningitis.

MCQ 3 :

Which nerve is not associated with the jugular foramen?

a) Glossopharyngeal nerve
b) Accessory nerve
c) Hypoglossal nerve
d) Vagus nerve

Answer & Explanation:
Correct answer: c) Hypoglossal nerve.
Explanation: The hypoglossal nerve exits the skull through the hypoglossal canal, not the jugular foramen. In contrast, the glossopharyngeal, vagus, and accessory nerves all pass through the jugular foramen. Recognizing this anatomical detail is important for surgical planning and diagnosing cranial nerve injuries.

MCQ 4 (Clinical):

A patient shows dysphagia and hoarseness after skull base fracture. Which nerve is likely injured?

a) Optic nerve
b) Mandibular nerve
c) Vagus nerve
d) Facial nerve

Answer & Explanation:
Correct answer: c) Vagus nerve.
Explanation: Dysphagia and hoarseness are typical symptoms of vagus nerve injury, which exits via the jugular foramen. Damage during skull base fractures can affect laryngeal muscle control, impairing voice and swallowing functions. Early diagnosis is essential for rehabilitation and preventing aspiration pneumonia.

MCQ 5:

Which structure is NOT transmitted by the jugular foramen?

a) Internal jugular vein
b) Glossopharyngeal nerve
c) Facial nerve
d) Accessory nerve

Answer & Explanation:
Correct answer: c) Facial nerve.
Explanation: The facial nerve exits through the stylomastoid foramen, not the jugular foramen. The jugular foramen primarily transmits the internal jugular vein, glossopharyngeal, vagus, and accessory nerves. Knowledge of these pathways helps prevent nerve injury during otologic and skull base surgeries.

MCQ 6(Clinical):

A patient has jugular foramen syndrome. Which of the following is least likely?

a) Hoarseness
b) Shoulder weakness
c) Loss of taste in anterior two-thirds of tongue
d) Dysphagia

Answer & Explanation:
Correct answer: c) Loss of taste in anterior two-thirds of tongue.
Explanation: Loss of taste in the anterior two-thirds of the tongue is mediated by the facial nerve (chorda tympani), not involved in the jugular foramen. Jugular foramen syndrome affects the glossopharyngeal, vagus, and accessory nerves, leading to hoarseness, dysphagia, and shoulder weakness.

MCQ 7:

The mandibular nerve exits the skull through which foramen?

a) Jugular foramen
b) Foramen ovale
c) Hypoglossal canal
d) Foramen magnum

Answer & Explanation:
Correct answer: b) Foramen ovale.
Explanation: The mandibular nerve (V3) exits the skull through the foramen ovale. This nerve carries both sensory and motor fibers, supplying the lower face. Distinguishing its exit point from the jugular foramen is important for diagnosing nerve entrapments and surgical interventions.

MCQ 8 (Clinical):

Following trauma, a patient shows unilateral vocal cord paralysis. Which nerve is likely affected?

a) Hypoglossal nerve
b) Vagus nerve
c) Mandibular nerve
d) Accessory nerve

Answer & Explanation:
Correct answer: b) Vagus nerve.
Explanation: The vagus nerve innervates the intrinsic laryngeal muscles. Trauma affecting the jugular foramen may impair this nerve, causing unilateral vocal cord paralysis. This leads to hoarseness and aspiration risk. Proper assessment of vocal function helps in identifying vagus nerve injuries post trauma.

MCQ 9:

Which is a function of the glossopharyngeal nerve passing through the jugular foramen?

a) Motor supply to cricothyroid
b) Sensory to external ear and oropharynx
c) Motor to tongue muscles
d) Vision processing

Answer & Explanation:
Correct answer: b) Sensory to external ear and oropharynx.
Explanation: The glossopharyngeal nerve (CN IX) carries sensory information from the external ear and oropharynx and provides taste from the posterior third of the tongue. Its passage through the jugular foramen is clinically significant, as injury may cause impaired gag reflex and taste sensation.

MCQ 10 (Clinical):

A patient has absent gag reflex but intact shoulder movement. Which structure is likely involved?

a) Accessory nerve
b) Hypoglossal nerve
c) Glossopharyngeal nerve
d) Mandibular nerve

Answer & Explanation:
Correct answer: c) Glossopharyngeal nerve.
Explanation: The glossopharyngeal nerve mediates the afferent limb of the gag reflex. Damage leads to its absence, while the accessory nerve (responsible for shoulder movement) remains intact. Understanding this helps localize cranial nerve injuries during neurological examinations.

Chapter: Anatomy

Topic: Lower Limb

Subtopic: Femur and its Landmarks

Keyword Definitions:

• Linea Aspera: A prominent longitudinal ridge on the posterior surface of femur giving attachment to muscles and intermuscular septa.

• Gluteal Tuberosity: A roughened area lateral to linea aspera for gluteus maximus insertion.

• Adductor Tubercle: Projection on medial epicondyle of femur for adductor magnus insertion.

• Popliteal Surface: Smooth triangular area above femoral condyles posteriorly.

• Clinical Relevance: Fractures near linea aspera may affect attachment of thigh muscles causing displacement.

Lead Question - 2013

True about linea aspera?

a) Forms lateral border of femur
b) Forms medial border of femur
c) Continues as gluteal tuberosity
d) None of the above

Explanation: Linea aspera is a vertical ridge on the posterior surface of femur, not on its medial or lateral border. Superiorly, it diverges into the gluteal tuberosity laterally and pectineal line medially. Thus, the correct answer is c) Continues as gluteal tuberosity.

Guessed Question 2

Linea aspera provides attachment to which major thigh muscles?

a) Vastus lateralis and vastus medialis
b) Gluteus minimus and sartorius
c) Biceps femoris and adductor magnus
d) Tensor fascia lata and rectus femoris

Explanation: Linea aspera serves as an important attachment site for thigh muscles like adductor magnus, adductor longus, and short head of biceps femoris. It also anchors intermuscular septa. The correct answer is c) Biceps femoris and adductor magnus.

Guessed Question 3

Which clinical consequence is likely if a femoral shaft fracture involves the linea aspera?

a) Loss of hip abduction
b) Loss of knee extension
c) Muscle displacement due to adductors and hamstrings
d) Loss of ankle dorsiflexion

Explanation: Fractures involving the linea aspera can cause displacement due to strong pull of attached muscles like adductors and hamstrings. This alters alignment of the femur. The correct answer is c) Muscle displacement due to adductors and hamstrings.

Guessed Question 4

Which structure is found between the medial and lateral lips of the linea aspera?

a) Nutrient foramen
b) Trochlear groove
c) Adductor tubercle
d) Intercondylar notch

Explanation: The nutrient foramen of the femur is commonly located near or on the linea aspera between its medial and lateral lips, providing vascular entry to the femoral shaft. The correct answer is a) Nutrient foramen.

Guessed Question 5

The upper lateral prolongation of linea aspera forms which structure?

a) Gluteal tuberosity
b) Pectineal line
c) Supracondylar ridge
d) Greater trochanter

Explanation: The linea aspera continues superiorly as the gluteal tuberosity laterally and as the pectineal line medially. These provide important muscular attachments. The correct answer is a) Gluteal tuberosity.

Guessed Question 6

The lower end of linea aspera diverges into which structures?

a) Medial and lateral supracondylar lines
b) Intercondylar fossa
c) Patellar surface
d) Popliteal surface

Explanation: Inferiorly, the linea aspera splits into medial and lateral supracondylar lines, which border the triangular popliteal surface of the femur. The correct answer is a) Medial and lateral supracondylar lines.

Guessed Question 7

Which artery passes near linea aspera and may be injured in fractures?

a) Profunda femoris artery
b) Popliteal artery
c) Obturator artery
d) Medial circumflex femoral artery

Explanation: The profunda femoris artery and its perforating branches run close to the linea aspera. They can be damaged in femoral shaft fractures, leading to hemorrhage. The correct answer is a) Profunda femoris artery.

Guessed Question 8

Which intermuscular septum is attached to the linea aspera?

a) Lateral and medial intermuscular septa
b) Posterior intermuscular septum
c) Anterior intermuscular septum
d) Obturator membrane

Explanation: The medial and lateral intermuscular septa of thigh are attached to linea aspera. They separate the anterior, medial, and posterior thigh compartments. The correct answer is a) Lateral and medial intermuscular septa.

Guessed Question 9

In radiographs, which feature helps identify the posterior aspect of the femur?

a) Patellar surface
b) Linea aspera
c) Greater trochanter
d) Lesser trochanter

Explanation: Linea aspera is a posterior landmark of femur and helps differentiate anterior from posterior surfaces on radiographs. The correct answer is b) Linea aspera.

Guessed Question 10

Which muscle inserts along the gluteal tuberosity, a continuation of the linea aspera?

a) Gluteus maximus
b) Vastus lateralis
c) Sartorius
d) Pectineus

Explanation: The gluteus maximus muscle inserts partly into the gluteal tuberosity, which is a lateral continuation of the linea aspera. This is a key insertion site for powerful hip extension. The correct answer is a) Gluteus maximus.

Guessed Question 11

Popliteal surface of femur lies just below the bifurcation of linea aspera into?

a) Medial and lateral supracondylar lines
b) Intercondylar fossa
c) Greater trochanter
d) Adductor tubercle

Explanation: The popliteal surface lies inferior to the bifurcation of linea aspera into medial and lateral supracondylar lines, forming a triangular area above condyles. The correct answer is a) Medial and lateral supracondylar lines.

Keyword Definitions

• Bursa – Fluid-filled sac reducing friction between tendon and bone.

• Synovial sheath – Tubular bursa surrounding a tendon for smooth gliding.

• Radial bursa – Synovial sheath enclosing flexor pollicis longus tendon.

• Ulnar bursa – Common flexor sheath for FDP and FDS tendons.

• Flexor pollicis longus (FPL) – Muscle flexing thumb distal phalanx.

• Flexor digitorum profundus (FDP) – Muscle flexing distal phalanges of fingers.

• Flexor digitorum superficialis (FDS) – Muscle flexing middle phalanges.

• Flexor carpi radialis (FCR) – Wrist flexor inserting into 2nd metacarpal.

• Thenar space – Potential space in palm communicating with radial bursa.

• Midpalmar space – Potential space in palm communicating with ulnar bursa.

• Clinical relevance – Infections of synovial sheaths may spread rapidly to palm and forearm.

Chapter: Anatomy / Upper Limb

Topic: Hand and Forearm Structures

Subtopic: Synovial Sheaths and Bursae of Hand

Lead Question – 2013

Radial bursa is the synovial sheath covering the tendon of ?

a) FDS

b) FDP

c) FPL

d) FCR

Explanation: The radial bursa is the synovial sheath of flexor pollicis longus (FPL) tendon. It extends from wrist into the thumb. Correct answer: FPL. Clinical: infection here (tenosynovitis) may spread into the forearm and cause “horseshoe abscess” by communicating with the ulnar bursa.

Guessed Questions for NEET PG

1) Ulnar bursa covers tendons of:

a) FPL

b) FDP and FDS

c) FCR

d) EPL

Explanation: Ulnar bursa is the common flexor sheath enclosing tendons of FDP and FDS to fingers. Correct answer: FDP and FDS. Clinical: infections here can spread into midpalmar space, causing swelling and impaired finger movements.

2) Horseshoe abscess occurs due to communication between:

a) Radial and ulnar bursa

b) Ulnar bursa and carpal tunnel

c) Radial bursa and midpalmar space

d) Thenar and hypothenar spaces

Explanation: Radial bursa of thumb communicates with ulnar bursa of little finger, producing a characteristic “horseshoe-shaped abscess.” Correct answer: Radial and ulnar bursa. Clinical: requires early drainage to prevent spread to forearm.

3) Infection of thumb flexor tendon sheath may spread into:

a) Thenar space

b) Midpalmar space

c) Parona’s space

d) Dorsum of hand

Explanation: FPL tendon sheath infection spreads through radial bursa into Parona’s space (forearm). Correct answer: Parona’s space. Clinical: severe swelling of forearm seen in advanced tenosynovitis.

4) Which tendon passes separately in its own sheath within carpal tunnel?

a) FPL

b) FDP

c) FDS

d) Palmaris longus

Explanation: FPL passes in its own synovial sheath (radial bursa) through the carpal tunnel. Correct answer: FPL. Clinical: inflammation here may cause isolated thumb pain in carpal tunnel syndrome.

5) Parona’s space is located:

a) Between palmar aponeurosis and flexor tendons

b) Between pronator quadratus and flexor tendons

c) In dorsal hand

d) In thenar eminence

Explanation: Parona’s space is between pronator quadratus and flexor tendons in distal forearm. Correct answer: Between pronator quadratus and flexor tendons. Clinical: serves as pathway for spread of infection from radial or ulnar bursa.

6) Which of the following muscles inserts into the distal phalanx of thumb?

a) FPL

b) FDS

c) FDP

d) EPL

Explanation: Flexor pollicis longus (FPL) inserts into the base of distal phalanx of thumb, flexing IP joint. Correct answer: FPL. Clinical: important in pinch grip strength, loss indicates anterior interosseous nerve palsy.

7) Ulnar bursa commonly extends up to which finger?

a) Index

b) Middle

c) Ring

d) Little

Explanation: The ulnar bursa extends into the little finger flexor sheath. Correct answer: Little finger. Clinical: explains why infections of little finger flexor sheath can spread to common flexor sheath and palm.

8) Which structure is enclosed within both radial bursa and carpal tunnel?

a) FCR

b) FPL

c) EPL

d) Lumbricals

Explanation: FPL tendon passes through carpal tunnel inside its radial bursa sheath. Correct answer: FPL. Clinical: tenosynovitis here may mimic carpal tunnel syndrome with isolated thumb symptoms.

9) A 25-year-old presents with swelling of thumb and little finger tendon sheaths with forearm spread. Most likely condition?

a) Thenar abscess

b) Midpalmar abscess

c) Horseshoe abscess

d) Carpal tunnel syndrome

Explanation: Simultaneous infection of radial and ulnar bursae produces characteristic horseshoe abscess. Correct answer: Horseshoe abscess. Clinical: requires surgical drainage through palmar incisions.

10) Which flexor tendon does not pass through the carpal tunnel?

a) FCR

b) FDP

c) FDS

d) FPL

Explanation: Flexor carpi radialis (FCR) passes in its own canal, not inside carpal tunnel. Correct answer: FCR. Clinical: helps distinguish isolated FCR tenosynovitis from carpal tunnel pathologies.

Keyword Definitions

• Humerus – Long bone of upper limb extending from shoulder to elbow.

• Ossification center – Site where bone formation begins during development.

• Primary center – First ossification site, usually diaphysis of long bone.

• Secondary center – Ossification sites in epiphysis, appear later.

• Distal humerus – Lower end of humerus forming part of elbow joint.

• Capitulum – Lateral articular surface of distal humerus, articulates with radius.

• Trochlea – Medial articular surface of distal humerus, articulates with ulna.

• Epicondyle – Bony prominence above condyles for muscle attachment.

• Epiphysis – End part of long bone formed from secondary centers.

• Physis – Growth plate between diaphysis and epiphysis.

• Clinical relevance – Helps in diagnosing pediatric fractures and growth disturbances.

Chapter: Anatomy / Upper Limb

Topic: Osteology of Humerus

Subtopic: Ossification Centers of Distal Humerus

Lead Question – 2013

Distal end of humerus develops from how many centres ?

a) 2

b) 5

c) 3

d) 4

Explanation: The distal end of humerus has multiple secondary ossification centers – capitulum, trochlea, lateral epicondyle, medial epicondyle. Together, there are 4 centers. Correct answer: 4. Clinical: knowledge of ossification sequence (CRITOE rule) is important in interpreting pediatric elbow X-rays.

Guessed Questions for NEET PG

1) First ossification center to appear at distal humerus?

a) Capitulum

b) Trochlea

c) Medial epicondyle

d) Lateral epicondyle

Explanation: The capitulum is the first secondary ossification center to appear, around 1 year of age. Others follow in a predictable CRITOE sequence. Correct answer: Capitulum. Clinical: helps differentiate normal ossification centers from fracture fragments in pediatric radiographs.

2) Medial epicondyle ossification center appears at which age?

a) 2 years

b) 5 years

c) 7 years

d) 9 years

Explanation: The medial epicondyle ossification center appears around 5 years of age and fuses late, around puberty. Correct answer: 5 years. Clinical: it is the most common site of avulsion fracture in children due to throwing injuries.

3) Which ossification center fuses last in distal humerus?

a) Capitulum

b) Trochlea

c) Medial epicondyle

d) Lateral epicondyle

Explanation: Medial epicondyle is the last to fuse, around 18–20 years. Correct answer: Medial epicondyle. Clinical: helps identify skeletal maturity and growth potential in radiographs.

4) Sequence of ossification centers in elbow joint is remembered by acronym:

a) CRITOE

b) SALTER

c) ABCDEF

d) PRISME

Explanation: CRITOE – Capitulum, Radial head, Internal epicondyle (medial), Trochlea, Olecranon, External epicondyle (lateral). Correct answer: CRITOE. Clinical: used to read pediatric elbow X-rays and prevent misdiagnosis of normal centers as fractures.

5) At what age does trochlea ossification center appear?

a) 2 years

b) 7 years

c) 9 years

d) 12 years

Explanation: Trochlea ossification center appears around 9 years. Correct answer: 9 years. Clinical: irregular ossification pattern here can mimic fracture in children, so proper sequence knowledge is vital.

6) Failure of medial epicondyle fusion leads to:

a) Cubitus varus

b) Cubitus valgus

c) Recurvatum

d) Radial head dislocation

Explanation: Nonunion of medial epicondyle can cause valgus deformity due to loss of medial support. Correct answer: Cubitus valgus. Clinical: may lead to tardy ulnar nerve palsy in adults.

7) Which nerve is most endangered in medial epicondyle fractures?

a) Radial

b) Median

c) Ulnar

d) Musculocutaneous

Explanation: Ulnar nerve runs in groove behind medial epicondyle, making it vulnerable in avulsion fractures. Correct answer: Ulnar nerve. Clinical: may present with tingling in medial 1½ fingers.

8) In children, supracondylar fracture of humerus occurs commonly due to:

a) Direct trauma

b) Fall on flexed elbow

c) Fall on outstretched hand

d) Rotational injury

Explanation: Supracondylar fractures are common pediatric injuries due to fall on outstretched hand, leading to distal humerus fracture above condyles. Correct answer: Fall on outstretched hand. Clinical: may damage brachial artery and median nerve.

9) Which structure is at risk in supracondylar fracture of humerus?

a) Ulnar nerve

b) Radial artery

c) Brachial artery

d) Axillary nerve

Explanation: The brachial artery is closely related anteriorly and is most commonly injured in supracondylar fractures. Correct answer: Brachial artery. Clinical: leads to Volkmann’s ischemic contracture if untreated.

10) A 7-year-old presents with elbow swelling. X-ray shows separate ossification center at medial side. Most likely structure?

a) Capitulum

b) Trochlea

c) Medial epicondyle

d) Olecranon

Explanation: At 7 years, medial epicondyle ossification center is visible. Correct answer: Medial epicondyle. Clinical: distinguishing this from fracture fragment is crucial in pediatric practice.

Keyword Definitions

• Clavipectoral fascia – A strong sheet of connective tissue deep to pectoralis major, enclosing subclavius and pectoralis minor.

• Costocoracoid ligament – Thickened portion of clavipectoral fascia between coracoid process and first rib; origin of fascia.

• Coracoacromial ligament – Connects coracoid process to acromion, prevents superior displacement of humeral head.

• Coracoclavicular ligament – Strong stabilizer between clavicle and coracoid process; prevents clavicle dislocation.

• Costoclavicular ligament – Connects first rib to clavicle, stabilizes sternoclavicular joint.

• Pectoralis minor – Muscle enclosed by clavipectoral fascia, important surgical landmark.

• Subclavius – Small muscle beneath clavicle, enclosed by clavipectoral fascia.

• Axilla – Space under shoulder joint, bounded anteriorly by clavipectoral fascia, important for neurovascular structures.

• Clinical relevance – Thickening or fibrosis of clavipectoral fascia can compress neurovascular bundle in thoracic outlet syndrome.

• Fascia – Connective tissue layers enveloping muscles, vessels, and nerves.

Chapter: Anatomy / Thorax

Topic: Pectoral Region

Subtopic: Clavipectoral Fascia and Ligament Derivation

Lead Question – 2013

Clavipectoral fascia is derived from which ligament?

a) Coracoacromial

b) Coracoclavicular

c) Costoclavicular

d) Costocoracoid

Explanation: Clavipectoral fascia originates from the costocoracoid ligament, extending between the coracoid process and first rib. Correct answer: Costocoracoid ligament. This fascia encloses subclavius and pectoralis minor, forming an important surgical plane. Clinical: In axillary surgeries, the fascia acts as a guide for neurovascular structures, preventing accidental injuries.

Guessed Questions for NEET PG

1) Clavipectoral fascia encloses:

a) Pectoralis major

b) Subclavius and pectoralis minor

c) Serratus anterior

d) Latissimus dorsi

Explanation: The fascia encloses subclavius and pectoralis minor, not pectoralis major. Correct answer: Subclavius and pectoralis minor. Clinical: important in surgical dissection of axilla.

2) Costoclavicular ligament connects:

a) Clavicle to sternum

b) Clavicle to coracoid

c) Clavicle to first rib

d) Coracoid to acromion

Explanation: Costoclavicular ligament stabilizes sternoclavicular joint by attaching clavicle to first rib. Correct answer: Clavicle to first rib. Clinical: damage leads to sternoclavicular instability.

3) Coracoacromial ligament prevents:

a) Inferior displacement of humerus

b) Superior displacement of humeral head

c) Lateral displacement of scapula

d) Medial rotation of clavicle

Explanation: It forms an arch preventing superior displacement of humeral head. Correct answer: Superior displacement of humeral head. Clinical: impingement syndrome occurs beneath this arch.

4) Clavipectoral fascia pierces to transmit:

a) Cephalic vein

b) Axillary vein

c) Subclavian artery

d) Long thoracic nerve

Explanation: Cephalic vein pierces the clavipectoral fascia near deltopectoral groove. Correct answer: Cephalic vein. Clinical: serves as an important venous access site.

5) Axillary sheath is continuous with:

a) Pretracheal fascia

b) Prevertebral fascia

c) Carotid sheath

d) Endothoracic fascia

Explanation: Axillary sheath is extension of prevertebral fascia enclosing axillary vessels and brachial plexus. Correct answer: Prevertebral fascia. Clinical: important in brachial plexus block anesthesia.

6) Subclavius muscle is innervated by:

a) Nerve to subclavius

b) Lateral pectoral nerve

c) Medial pectoral nerve

d) Long thoracic nerve

Explanation: Subclavius is innervated by nerve to subclavius (C5–C6). Correct answer: Nerve to subclavius. Clinical: weakness may cause instability of clavicle in trauma.

7) Pectoralis minor inserts into:

a) Acromion

b) Coracoid process

c) Clavicle

d) Glenoid cavity

Explanation: Pectoralis minor attaches to coracoid process of scapula. Correct answer: Coracoid process. Clinical: hypertrophy or contracture compresses brachial plexus in thoracic outlet syndrome.

8) Which structure lies deep to clavipectoral fascia?

a) Axillary vein

b) Axillary artery

c) Brachial plexus cords

d) All of the above

Explanation: Clavipectoral fascia overlies axillary vessels and brachial plexus cords. Correct answer: All of the above. Clinical: careful dissection required to avoid vascular/nerve injury.

9) Surgical importance of clavipectoral fascia?

a) Defines axillary surgical plane

b) Stabilizes clavicle

c) Prevents scapular rotation

d) Guides deltoid function

Explanation: Clavipectoral fascia acts as an anatomical landmark for axillary surgeries. Correct answer: Defines axillary surgical plane. Clinical: helps surgeons avoid injury to axillary neurovascular structures.

10) Coracoclavicular ligament function is:

a) Stabilize acromioclavicular joint

b) Stabilize sternoclavicular joint

c) Prevent humeral displacement

d) Reinforce shoulder capsule

Explanation: Coracoclavicular ligament is the major stabilizer of acromioclavicular joint. Correct answer: Stabilize acromioclavicular joint. Clinical: rupture causes “shoulder separation” injury.

Keyword Definitions

• Pubic symphysis – Midline cartilaginous joint between left and right pubic bones; allows limited movement.

• Joint types – Fibrous (immovable), cartilaginous (primary/secondary), synovial (freely movable).

• Fibrous joint – Bones united by dense connective tissue; minimal or no movement.

• Primary cartilaginous (synchondrosis) – Bones joined by hyaline cartilage; temporary in growth plates.

• Secondary cartilaginous (symphysis) – Bones joined by fibrocartilage; allows limited movement; found in pubic symphysis and intervertebral discs.

• Fibrocartilage – Dense cartilage with type I collagen; provides strength and shock absorption.

• Pelvic mobility – During childbirth, pubic symphysis slightly widens to facilitate delivery.

• Clinical relevance – Pubic symphysis injury or separation causes pain and gait disturbance; osteitis pubis is inflammation of this joint.

• Embryology – Forms from mesenchyme between pubic bones; fibrocartilaginous disc develops in early childhood.

• Anatomy – Located anteriorly in pelvis; superior and inferior pubic ligaments reinforce it.

Chapter: Anatomy / Osteology

Topic: Pelvic Girdle

Subtopic: Pubic Symphysis and Joint Types

Lead Question – 2013

Pubic symphysis is which type of joint?

a) Gomphosis

b) Fibrous joint

c) Primary cartilaginous

d) Secondary cartilaginous

Explanation: Pubic symphysis is a secondary cartilaginous joint (symphysis), consisting of fibrocartilage between the pubic bones, allowing limited movement. Correct answer: Secondary cartilaginous. Fibrous joints like gomphoses are immobile; primary cartilaginous joints are temporary (growth plates). Clinically, separation or inflammation affects gait and childbirth.

Guessed Questions for NEET PG

1) Intervertebral discs are examples of:

a) Secondary cartilaginous joints

b) Primary cartilaginous joints

c) Synovial joints

d) Fibrous joints

Explanation: Intervertebral discs are secondary cartilaginous joints (symphyses) with fibrocartilage, allowing slight movement. Correct answer: Secondary cartilaginous joints. Clinical: disc degeneration leads to back pain.

2) Epiphyseal plates are:

a) Primary cartilaginous joints

b) Secondary cartilaginous joints

c) Fibrous joints

d) Synovial joints

Explanation: Epiphyseal plates are primary cartilaginous joints (hyaline cartilage) temporarily present during growth. Correct answer: Primary cartilaginous. Clinical: fractures through growth plates affect bone length.

3) Sutures of skull are examples of:

a) Fibrous joints

b) Cartilaginous joints

c) Synovial joints

d) Symphyses

Explanation: Skull sutures are fibrous joints (immovable) united by dense connective tissue. Correct answer: Fibrous joints. Clinical: premature fusion (craniosynostosis) affects skull shape.

4) Gomphosis is a type of:

a) Fibrous joint

b) Cartilaginous joint

c) Synovial joint

d) Symphysis

Explanation: Gomphosis is a peg-and-socket fibrous joint, e.g., tooth in alveolar socket. Correct answer: Fibrous joint. Clinical: periodontal disease affects this joint.

5) Superior and inferior pubic ligaments reinforce:

a) Pubic symphysis

b) Sacroiliac joint

c) Hip joint

d) Knee joint

Explanation: Superior and inferior ligaments strengthen pubic symphysis. Correct answer: Pubic symphysis. Clinical: ligament injury can cause pelvic instability.

6) Fibrocartilage in pubic symphysis contains:

a) Type I collagen

b) Type II collagen

c) Elastic fibers only

d) Hyaline cartilage only

Explanation: Fibrocartilage in secondary cartilaginous joints contains type I collagen for tensile strength. Correct answer: Type I collagen. Clinical: degeneration causes pain and reduced mobility.

7) During childbirth, pubic symphysis:

a) Widens slightly

b) Becomes rigid

c) Fuses permanently

d) Fractures routinely

Explanation: Pubic symphysis widens slightly due to relaxin hormone, facilitating vaginal delivery. Correct answer: Widens slightly. Clinical: excessive separation causes symphyseal diastasis.

8) Osteitis pubis is inflammation of:

a) Pubic symphysis

b) Hip joint

c) Sacroiliac joint

d) Knee joint

Explanation: Osteitis pubis is inflammation of pubic symphysis, often post-surgery or in athletes. Correct answer: Pubic symphysis. Clinical: presents as pain in groin and pubic region.

9) Fibrocartilaginous disc of pubic symphysis functions to:

a) Absorb shock and allow slight movement

b) Produce synovial fluid

c) Form growth plate

d) Connect ligaments only

Explanation: Fibrocartilaginous disc absorbs mechanical stress and allows limited movement. Correct answer: Absorb shock and allow slight movement. Clinical: disc injury impairs pelvic stability.

10) Separation of pubic symphysis may occur due to:

a) Trauma or childbirth

b) Osteoporosis only

c) Infection of hip joint

d) Vertebral fracture

Explanation: Pubic symphysis separation can occur during traumatic injury or childbirth. Correct answer: Trauma or childbirth. Clinical: causes pain, difficulty walking, and may require surgical stabilization.

Keyword Definitions

• Hyoid bone – U-shaped bone in anterior neck; supports tongue and serves as attachment for muscles of swallowing and speech.

• Cervical vertebrae – Seven vertebrae in neck region, labeled C1–C7; provide support and mobility for head and neck.

• C3 – Third cervical vertebra; anterior to it lies the body of hyoid bone.

• Suprahyoid muscles – Muscles above hyoid, elevate it during swallowing; include digastric, stylohyoid, mylohyoid, geniohyoid.

• Infrahyoid muscles – Muscles below hyoid, depress it; include sternohyoid, omohyoid, thyrohyoid, sternothyroid.

• Thyroid cartilage – Cartilage inferior to hyoid; forms Adam’s apple; attachment for laryngeal muscles.

• Clinical relevance – Hyoid fractures suggest strangulation; landmarks for neck surgery and radiology; level of airway structures.

• Embryology – Hyoid develops from second and third pharyngeal arches; lesser horn from 2nd, greater horn from 3rd.

• Laryngeal inlet – Located inferior to hyoid; opens into pharynx; important in intubation.

• Anatomical landmarks – Hyoid at C3; thyroid cartilage at C4–C5; cricoid cartilage at C6.

Chapter: Anatomy / Osteology

Topic: Cervical Region

Subtopic: Hyoid Bone and Neck Landmarks

Lead Question – 2013

Hyoid lies at the level of?

a) C3

b) C5

c) C7

d) T2

Explanation: The hyoid bone is positioned at the level of the third cervical vertebra (C3) in the neck. It is U-shaped, supports the tongue, and serves as an attachment for suprahyoid and infrahyoid muscles. Correct answer: C3. Clinical relevance includes neck surgery landmarks, airway management, and forensic assessment of strangulation.

Guessed Questions for NEET PG

1) Thyroid cartilage lies at the level of:

a) C3–C4

b) C4–C5

c) C5–C6

d) C6–C7

Explanation: Thyroid cartilage, forming the Adam’s apple, is located at C4–C5. Correct answer: C4–C5. Clinical: important landmark for cricothyrotomy and neck surgery.

2) Cricoid cartilage lies at the level of:

a) C4

b) C6

c) C7

d) T1

Explanation: Cricoid cartilage is complete ring below thyroid cartilage at C6. Correct answer: C6. Clinical: landmark for tracheostomy and endotracheal tube placement.

3) Greater horn of hyoid arises from:

a) 2nd pharyngeal arch

b) 3rd pharyngeal arch

c) 1st pharyngeal arch

d) 4th pharyngeal arch

Explanation: The greater horn of hyoid develops from the 3rd pharyngeal arch. Correct answer: 3rd pharyngeal arch. Clinical: anomalies may affect swallowing or neck mobility.

4) Lesser horn of hyoid arises from:

a) 2nd pharyngeal arch

b) 3rd pharyngeal arch

c) 1st pharyngeal arch

d) 4th pharyngeal arch

Explanation: Lesser horn of hyoid develops from the 2nd pharyngeal arch. Correct answer: 2nd pharyngeal arch. Clinical: variations may be seen on imaging.

5) Suprahyoid muscles function to:

a) Elevate hyoid

b) Depress hyoid

c) Rotate hyoid

d) Stabilize vertebrae

Explanation: Suprahyoid muscles elevate the hyoid during swallowing and speech. Correct answer: Elevate hyoid. Clinical: paralysis affects swallowing.

6) Infrahyoid muscles function to:

a) Depress hyoid

b) Elevate hyoid

c) Flex cervical spine

d) Extend cervical spine

Explanation: Infrahyoid muscles depress the hyoid and larynx. Correct answer: Depress hyoid. Clinical: injury may affect voice and swallowing.

7) Fracture of hyoid bone suggests:

a) Strangulation

b) Fall from height

c) Sports injury

d) Osteoporosis

Explanation: Hyoid fractures commonly indicate manual strangulation. Correct answer: Strangulation. Clinical: forensic marker in neck trauma cases.

8) Hyoid is U-shaped and located:

a) Anterior neck

b) Posterior neck

c) Lateral neck

d) Mediastinum

Explanation: Hyoid bone is U-shaped in anterior neck at C3, supporting tongue and neck muscles. Correct answer: Anterior neck. Clinical: important landmark for airway and neck surgery.

9) The hyoid does not articulate with any other bone:

a) True

b) False

Explanation: Hyoid is a floating bone, not articulating with other bones; it is anchored by muscles and ligaments. Correct answer: True. Clinical: allows mobility for swallowing and speech.

10) Hyoid bone serves as attachment for:

a) Suprahyoid and infrahyoid muscles

b) Only neck flexors

c) Only tongue muscles

d) Sternocleidomastoid only

Explanation: Hyoid provides attachment for both suprahyoid and infrahyoid muscles, facilitating swallowing and speech. Correct answer: Suprahyoid and infrahyoid muscles. Clinical: fractures impair these functions and may indicate trauma.

Chapter: Upper Limb Anatomy

Topic: Bones of the Hand

Subtopic: Ossification of Carpal Bones

Keyword Definitions

• Carpal bones: Eight small bones forming the wrist (carpus).

• Ossification: The process of bone formation from cartilage or fibrous tissue.

• Capitate: One of the carpal bones, centrally located in the distal carpal row.

• Lunate: A crescent-shaped carpal bone in the proximal row, beside the scaphoid.

• Pisiform: A small, pea-shaped carpal bone on the ulnar side of the wrist.

• Trapezium: A carpal bone at the base of the thumb, distal row.

• Clinical: Relating to the observation and treatment of patients.

• Radiograph: An image produced on sensitive plate or film by X-rays.

• Developmental anatomy: Study of the structural changes of organisms as they grow.

• Epiphysis: The end part of a long bone, initially growing separately from the shaft.

• NEET PG: National Eligibility cum Entrance Test for Postgraduate medical courses in India.

Lead Question – 2013

First carpal bone to appear is?

a) Trapezium

b) Capitate

c) Pisiform

d) Lunate

Explanation: The **capitate** is the first carpal bone to ossify, usually around the 2nd month after birth. This knowledge is essential in pediatric radiology and helps assess bone age.

Guessed MCQs for NEET PG

1. Which carpal bone is last to ossify?

a) Trapezium

b) Capitate

c) Pisiform

d) Lunate

Explanation: Pisiform is the last carpal bone to ossify, appearing around 9–12 years, important for assessing delayed skeletal development in children.

2. Order of appearance of carpal bones in ossification usually is:

a) Capitate, Hamate, Triquetrum

b) Capitate, Trapezium, Pisiform

c) Lunate, Scaphoid, Hamate

d) Scaphoid, Capitate, Pisiform

Explanation: Capitate appears first, followed by Hamate and then Triquetrum, helping in the assessment of normal growth on X-rays.

3. A 3-year-old child’s wrist X-ray lacks ossified pisiform. This is:

a) Normal finding

b) Suggestive of delayed bone age

c) Indicates rickets

d) Indicates infection

Explanation: Absence of pisiform at 3 years is normal; pisiform ossifies around 9–12 years, so this is not a sign of pathology.

4. Which carpal bone lies most medial in anatomical position?

a) Scaphoid

b) Pisiform

c) Hamate

d) Lunate

Explanation: Pisiform is the most medial carpal bone when the palm faces up, a key landmark in wrist anatomy.

5. The bone forming the floor of the anatomical snuffbox is:

a) Lunate

b) Hamate

c) Trapezium

d) Scaphoid

Explanation: The scaphoid forms the floor of the anatomical snuffbox, relevant to wrist trauma assessment.

6. Which carpal bone articulates with the first metacarpal?

a) Capitate

b) Scaphoid

c) Trapezium

d) Trapezoid

Explanation: Trapezium articulates with the first metacarpal and is crucial for thumb movement, especially in clinical settings like Bennett's fracture.

7. A fall on outstretched hand may most likely fracture:

a) Capitate

b) Scaphoid

c) Pisiform

d) Lunate

Explanation: Scaphoid is most commonly fractured due to its anatomical position and vascular supply, important for recognizing complications like avascular necrosis.

8. In carpal tunnel syndrome, which bone forms the floor of the tunnel?

a) Pisiform

b) Hamate

c) Lunate

d) Capitate

Explanation: The floor of the carpal tunnel is formed by the carpal bones, including the **capitate**, important for understanding clinical symptoms and management.

9. An eight-year-old’s wrist X-ray shows ossified capitate and hamate only. Bone age is approximately:

a) 1 year

b) 3 years

c) 5 years

d) 8 years

Explanation: Capitate and hamate ossify by age 1; absence of other carpal bones suggests bone age is around 1 year, valuable for pediatric growth assessment.

10. The capitate bone is located in which row of the carpus?

a) Proximal row

b) Distal row

c) Both rows

d) Middle row

Explanation: The capitate is centrally located in the distal row of carpal bones, a crucial point in wrist biomechanics. 

Chapter: Radiology
Topic: Skull Base Imaging
Subtopic: Craniovertebral Junction (CVJ) Lines

Keywords:

• Chamberlain’s line: Radiological line from hard palate to posterior margin of foramen magnum.

• McGregor’s line: Line from hard palate to lowest point of occiput, used to assess basilar invagination.

• Basilar invagination: Upward displacement of vertebral elements into foramen magnum.

• Craniovertebral junction (CVJ): Region between skull base and cervical spine including atlas and axis.

• Clinical relevance: Radiological lines are essential for diagnosing CVJ anomalies like atlantoaxial dislocation.

Lead Question - 2012

Chamberlain’s line is ?

a) Palate to occiput
b) Palate to temporal
c) Palate to foramen magnum
d) Palate to parietal

Explanation: Chamberlain’s line is drawn from the posterior edge of the hard palate to the posterior margin of the foramen magnum (opisthion). It is used to assess basilar invagination. The tip of the odontoid should not project more than 3 mm above this line. Correct answer is Palate to foramen magnum.

Guessed Question 1

McGregor’s line is drawn from hard palate to which landmark?

a) Posterior margin of foramen magnum
b) Inferior occiput
c) External occipital protuberance
d) Clivus

Explanation: McGregor’s line runs from the posterior edge of the hard palate to the lowest point of the occipital bone. Odontoid projecting >4.5 mm above this line indicates basilar invagination. Correct answer is Inferior occiput.

Guessed Question 2

In Chamberlain’s line, how much odontoid process protrusion above the line is considered abnormal?

a) 2 mm
b) 3 mm
c) 5 mm
d) 6 mm

Explanation: Normally, the tip of the dens should not lie more than 3 mm above Chamberlain’s line. If it projects beyond this, basilar invagination should be suspected. Correct answer is 3 mm.

Guessed Question 3

Which pathology is best assessed using Chamberlain’s line?

a) Chiari malformation
b) Basilar invagination
c) Hydrocephalus
d) Pituitary adenoma

Explanation: Chamberlain’s line is used in radiology to evaluate basilar invagination, where the odontoid process migrates upward into the foramen magnum. Correct answer is Basilar invagination.

Guessed Question 4

McGregor’s line is considered more reliable than Chamberlain’s line because?

a) Includes clivus
b) Uses occipital bone landmark
c) Uses odontoid directly
d) Longer reference line

Explanation: McGregor’s line is preferred because the inferior occiput is more easily visible on X-rays than opisthion. Hence, it is considered more practical. Correct answer is Uses occipital bone landmark.

Guessed Question 5

Which radiological line connects nasion to tuberculum sellae?

a) Chamberlain’s line
b) McGregor’s line
c) Twining’s line
d) McRae’s line

Explanation: Twining’s line runs from the nasion to tuberculum sellae and is useful in skull radiology. Chamberlain and McGregor relate to craniovertebral junction. Correct answer is Twining’s line.

Guessed Question 6

McRae’s line is drawn across which structure?

a) Foramen magnum
b) Hard palate
c) Occipital condyles
d) Clivus

Explanation: McRae’s line extends from basion to opisthion across the foramen magnum. The odontoid tip should lie below this line in normal anatomy. Correct answer is Foramen magnum.

Guessed Question 7

Which radiological line is most useful in detecting atlantoaxial dislocation?

a) Chamberlain’s line
b) McGregor’s line
c) McRae’s line
d) All of the above

Explanation: Atlantoaxial dislocation and basilar invagination require combined use of Chamberlain, McGregor, and McRae’s lines. Each provides complementary assessment. Correct answer is All of the above.

Guessed Question 8

Odontoid lying more than 4.5 mm above McGregor’s line suggests?

a) Chiari malformation
b) Basilar invagination
c) Syringomyelia
d) Hydrocephalus

Explanation: Protrusion of dens >4.5 mm above McGregor’s line is pathological and diagnostic of basilar invagination. Correct answer is Basilar invagination.

Guessed Question 9

McRae’s line is abnormal if?

a) Odontoid tip lies above line
b) Odontoid tip lies below line
c) Occiput overlaps clivus
d) Clivus angle decreases

Explanation: McRae’s line should always lie above the dens tip. If the odontoid projects above this line, it suggests basilar invagination. Correct answer is Odontoid tip lies above line.

Guessed Question 10

Which condition is commonly associated with basilar invagination?

a) Rheumatoid arthritis
b) Diabetes mellitus
c) Hypertension
d) COPD

Explanation: Basilar invagination is frequently associated with rheumatoid arthritis, congenital anomalies, and Paget’s disease due to weakening of craniovertebral junction structures. Correct answer is Rheumatoid arthritis.

Chapter: Skull – Facial Bones
Topic: Maxilla
Subtopic: Articulations and Clinical Anatomy

Keyword Definitions

• Maxilla: Paired facial bone forming upper jaw, hard palate anteriorly, orbital floor, and lateral nasal wall.

• Articulation: Bony contact forming a suture or joint between two bones.

• Frontal bone: Cranial bone articulating with maxilla at frontonasal–frontomaxillary region.

• Ethmoid bone: Midline bone; maxilla meets its lateral mass via medial orbital wall.

• Lacrimal bone: Small bone of medial orbital wall; articulates with maxilla around nasolacrimal groove.

• Sphenoid bone: Midline cranial bone; the maxilla does not directly articulate with it.

• Palatine bone: Posterior hard palate and part of nasal cavity; articulates with maxilla.

• Zygomatic bone: Cheekbone; articulates with maxilla at zygomaticomaxillary suture.

• Inferior nasal concha: Separate bone; articulates with maxilla along lateral nasal wall.

• Vomer: Posteroinferior nasal septum; articulates with maxilla at incisive region.

• Intermaxillary suture: Midline articulation between right and left maxillae.

• Maxillary sinus: Largest paranasal sinus within maxilla opening into middle meatus.

• Infraorbital nerve: Continuation of V2 traversing infraorbital canal/foramen of maxilla.

• Canine fossa: Depression on anterior maxilla; common site for Caldwell–Luc access.

• Ostiomeatal complex: Functional unit for sinus drainage in middle meatus region.

• Pterygopalatine fossa: Space posterior to maxilla containing V2 and maxillary artery branches.

• Alveolar process: Tooth-bearing part of maxilla housing maxillary teeth.

• Le Fort fractures: Classic midface fracture patterns involving maxilla and buttresses.

• Midfacial buttresses: Vertical load-bearing pillars (nasomaxillary, zygomaticomaxillary, pterygomaxillary).

• Incisive canal: Canal transmitting nasopalatine nerve and greater palatine vessels to anterior palate.

Lead Question – 2012

Maxillary bone does not articulate with:

• a) Ethmoid

• b) Sphenoid

• c) Frontal

• d) Lacrimal

Explanation: The maxilla articulates with frontal, ethmoid, lacrimal, nasal, zygomatic, palatine, inferior nasal concha, vomer, and the opposite maxilla via the intermaxillary suture. It has no direct articulation with the sphenoid bone. Therefore, the correct answer is b) Sphenoid.

Guessed Question 1

Which of the following bones does articulate directly with the maxilla?

• a) Temporal

• b) Vomer

• c) Parietal

• d) Occipital

Explanation: The vomer forms the posteroinferior nasal septum and articulates anteriorly with the maxilla near the incisive region. Temporal, parietal, and occipital bones do not directly meet the maxilla. Correct answer: b) Vomer.

Guessed Question 2

Maxillary sinus drains into the nasal cavity primarily via the:

• a) Inferior meatus

• b) Sphenoethmoidal recess

• c) Middle meatus (ostiomeatal complex)

• d) Superior meatus

Explanation: The maxillary ostium opens into the middle meatus through the semilunar hiatus within the ostiomeatal complex. This pathway explains why edema of middle meatus mucosa predisposes to maxillary sinusitis. Correct answer: c) Middle meatus (ostiomeatal complex).

Guessed Question 3

The infraorbital nerve exits the maxilla through the:

• a) Zygomaticofacial foramen

• b) Infraorbital foramen

• c) Greater palatine foramen

• d) Incisive foramen

Explanation: V2 continues as the infraorbital nerve within the infraorbital groove and canal of the maxilla, emerging on the face via the infraorbital foramen to supply lower eyelid, cheek, and upper lip. Correct answer: b) Infraorbital foramen.

Guessed Question 4

Which wall forms the floor of the orbit and roof of the maxillary sinus?

• a) Frontal bone

• b) Maxilla

• c) Ethmoid

• d) Zygomatic (alone)

Explanation: The orbital floor is mainly the orbital surface of the maxilla, which simultaneously forms the roof of the maxillary sinus. Zygomatic contributes laterally but not alone. Correct answer: b) Maxilla.

Guessed Question 5

Caldwell–Luc approach enters the maxillary sinus through the:

• a) Zygomatic buttress

• b) Canine fossa

• c) Infraorbital rim

• d) Middle meatus

Explanation: The canine fossa is a thin area on the anterior wall of the maxilla above the canine tooth, commonly used for surgical entry (Caldwell–Luc). Correct answer: b) Canine fossa.

Guessed Question 6

In Le Fort I fracture, the fracture line passes:

• a) Through nasofrontal suture and ethmoid

• b) Across zygomatic arches and orbital floors

• c) Above apices of maxillary teeth, separating alveolar process and hard palate

• d) Through frontozygomatic suture and nasal bones

Explanation: Le Fort I is a horizontal maxillary fracture detaching the tooth-bearing segment and hard palate from the midface at the level above dental apices. Correct answer: c) Above apices of maxillary teeth, separating alveolar process and hard palate.

Guessed Question 7

Which vertical buttress is directly anchored to the maxilla and transmits masticatory forces?

• a) Pterygomaxillary buttress

• b) Nasomaxillary buttress

• c) Frontozygomatic buttress

• d) Parietomastoid buttress

Explanation: The nasomaxillary buttress runs from the canine fossa/upper alveolus to the frontal process and frontal bone, stabilizing the midface. Pterygomaxillary is posterior; frontozygomatic is lateral. Correct answer: b) Nasomaxillary buttress.

Guessed Question 8

The nasolacrimal duct is related to the maxilla at the:

• a) Incisive canal

• b) Lacrimal groove on medial orbital wall

• c) Infraorbital groove

• d) Greater palatine canal

Explanation: The lacrimal groove is formed by the maxilla and lacrimal bone, housing the nasolacrimal sac/duct which drains into the inferior meatus. Correct answer: b) Lacrimal groove on medial orbital wall.

Guessed Question 9

Which pair correctly matches the maxillary surface to its landmark?

• a) Orbital surface – canine fossa

• b) Anterior surface – canine fossa

• c) Nasal surface – infraorbital groove

• d) Infratemporal surface – incisive canal

Explanation: The canine fossa is a depression on the anterior surface of the maxilla. The infraorbital groove lies on the orbital surface; incisive canal belongs to the hard palate. Correct answer: b) Anterior surface – canine fossa.

Guessed Question 10

Which structure lies immediately posterior to the maxilla and communicates via the pterygomaxillary fissure?

• a) Pterygopalatine fossa

• b) Infratemporal fossa

• c) Ethmoidal air cells

• d) Sphenoidal sinus

Explanation: The pterygomaxillary fissure separates the posterior maxilla from the pterygoid process, opening laterally from the pterygopalatine fossa into the infratemporal fossa. The space immediately posterior that communicates through this fissure is the pterygopalatine fossa. Correct answer: a) Pterygopalatine fossa.

Guessed Question 11

Which artery most directly supplies the walls of the maxillary sinus?

• a) Anterior ethmoidal artery

• b) Sphenopalatine artery

• c) Superior thyroid artery

• d) Superficial temporal artery

Explanation: The maxillary sinus receives blood from branches of the maxillary artery, notably the sphenopalatine artery and infraorbital branches. Ethmoidal arteries primarily supply ethmoidal cells and superior nasal cavity. Correct answer: b) Sphenopalatine artery.

Chapter: Larynx
Topic: Cartilages of Larynx
Subtopic: Types of Laryngeal Cartilages

Keyword Definitions

• Hyaline cartilage: Firm, translucent cartilage found in laryngeal cartilages like thyroid, cricoid, arytenoid. Can ossify with age.

• Elastic cartilage: Flexible cartilage that retains shape, seen in epiglottis, corniculate, cuneiform.

• Cricoid cartilage: Only complete ring of cartilage in airway, hyaline in nature.

• Epiglottis: Leaf-shaped, elastic cartilage preventing aspiration.

• Arytenoid cartilage: Paired hyaline cartilages with muscular and vocal processes.

• Corniculate & cuneiform cartilages: Accessory elastic cartilages for laryngeal support.

• Ossification of laryngeal cartilages: Hyaline cartilages ossify with age; elastic do not.

Lead Question – 2012

Which of the following laryngeal cartilage is hyaline?
a) Epiglottis
b) Corniculate
c) Cricoid
d) Cuneiform

Explanation: Cricoid cartilage is a hyaline cartilage forming the only complete ring of the airway. Unlike elastic cartilages such as epiglottis, corniculate, and cuneiform, hyaline cartilages like cricoid and thyroid tend to calcify with age. Correct answer is c) Cricoid.

Guessed Questions (NEET PG Style)

1. All of the following laryngeal cartilages are hyaline except
   a) Thyroid
   b) Arytenoid
   c) Corniculate
   d) Cricoid

Explanation: Except corniculate, all listed are hyaline cartilages. Corniculate is elastic cartilage, paired and small. Correct answer is c) Corniculate.

2. Which laryngeal cartilage ossifies earliest with age?
   a) Epiglottis
   b) Cricoid
   c) Corniculate
   d) Cuneiform

Explanation: Cricoid is the earliest to ossify among hyaline cartilages. Elastic cartilages such as epiglottis and corniculate remain flexible lifelong. Correct answer is b) Cricoid.

3. A patient with hoarseness due to arthritis of laryngeal joint most likely has involvement of
   a) Cricoarytenoid joint
   b) Cricothyroid joint
   c) Atlanto-occipital joint
   d) Temporomandibular joint

Explanation: Hoarseness occurs when cricoarytenoid joints (between arytenoid and cricoid, both hyaline) are involved in rheumatoid arthritis. Correct answer is a) Cricoarytenoid joint.

4. Which cartilage provides attachment for vocal cords?
   a) Arytenoid
   b) Corniculate
   c) Epiglottis
   d) Cuneiform

Explanation: Arytenoid cartilages (hyaline) provide vocal process where vocal cords attach. They are essential for phonation. Correct answer is a) Arytenoid.

5. Which laryngeal cartilage is leaf-shaped and elastic?
   a) Cricoid
   b) Epiglottis
   c) Arytenoid
   d) Thyroid

Explanation: Epiglottis is a flexible, elastic cartilage preventing aspiration during swallowing. Correct answer is b) Epiglottis.

6. All laryngeal cartilages ossify with age except
   a) Thyroid
   b) Cricoid
   c) Arytenoid
   d) Epiglottis

Explanation: Elastic cartilages like epiglottis, corniculate, and cuneiform do not ossify. Hyaline cartilages ossify with age. Correct answer is d) Epiglottis.

7. The only complete ring of cartilage in the airway is
   a) Thyroid
   b) Epiglottis
   c) Cricoid
   d) Arytenoid

Explanation: Cricoid cartilage forms a complete ring, unlike thyroid (open posteriorly). It supports airway and marks level of C6 vertebra. Correct answer is c) Cricoid.

8. In intubation, which cartilage is pressed for cricoid pressure (Sellick’s maneuver)?
   a) Arytenoid
   b) Thyroid
   c) Cricoid
   d) Epiglottis

Explanation: Cricoid cartilage is pressed to prevent aspiration by occluding esophagus during intubation. Correct answer is c) Cricoid.

9. Which muscle attaches to the muscular process of arytenoid cartilage?
   a) Lateral cricoarytenoid
   b) Cricothyroid
   c) Posterior cricoarytenoid
   d) Both a and c

Explanation: Muscular process of arytenoid gives attachment to posterior and lateral cricoarytenoid muscles controlling vocal cord movements. Correct answer is d) Both a and c.

10. Elastic cartilage of larynx includes all except
    a) Epiglottis
    b) Corniculate
    c) Cuneiform
    d) Arytenoid

Explanation: Arytenoid is hyaline cartilage, whereas epiglottis, corniculate, and cuneiform are elastic. Correct answer is d) Arytenoid.

11. During swallowing, which laryngeal cartilage protects airway by covering inlet?
    a) Epiglottis
    b) Corniculate
    c) Cuneiform
    d) Arytenoid

Explanation: Epiglottis (elastic cartilage) folds backward during swallowing, preventing aspiration. Correct answer is a) Epiglottis.

Chapter: Head & Neck Anatomy

Topic: Skull Bones

Subtopic: Ethmoid Bone and its parts

Keyword definitions

• Ethmoid bone — An unpaired midline bone between the orbits forming part of the nasal cavity and orbit.

• Agger nasi — Small prominence anterior to the middle turbinate, part of ethmoid labyrinth.

• Crista galli — Superior midline projection of ethmoid giving attachment to falx cerebri.

• Uncinate process — Thin bony process of ethmoid forming part of osteomeatal complex.

• Inferior turbinate — A separate facial bone, not a part of ethmoid.

• Olfactory foramina — Perforations in cribriform plate of ethmoid transmitting olfactory nerves.

• Cribriform plate — Horizontal plate of ethmoid separating nasal cavity and anterior cranial fossa.

• Ethmoidal air cells — Small paranasal sinuses within the ethmoid labyrinth.

• Perpendicular plate — Part of ethmoid forming superior nasal septum.

• Orbital plate — Part of ethmoid contributing to medial wall of orbit.

Lead Question - 2012

Which of the following is not the part of ethmoid bone?

a) Agger nasi
b) Crista galli
c) Uncinate process
d) Inferior turbinate

Explanation (50 words): Ethmoid bone contributes to nasal septum, orbit, and ethmoidal labyrinth. Agger nasi, crista galli, and uncinate process are all parts of the ethmoid. However, the inferior turbinate (concha) is a separate bone of the facial skeleton. Answer: d) Inferior turbinate.

1. Which structure of the ethmoid bone contributes to the formation of the nasal septum?
a) Cribriform plate
b) Crista galli
c) Perpendicular plate
d) Orbital plate

Explanation (50 words): The perpendicular plate of the ethmoid descends from the cribriform plate and forms the superior portion of the nasal septum. It articulates with the vomer and septal cartilage. Answer: c) Perpendicular plate.

2. A patient with anosmia following trauma most likely has fracture through which part of ethmoid?
a) Crista galli
b) Cribriform plate
c) Orbital plate
d) Perpendicular plate

Explanation (50 words): Olfactory nerves pass through the foramina of the cribriform plate. Fracture of this thin plate can shear the nerves, leading to anosmia and CSF rhinorrhea. Answer: b) Cribriform plate.

3. Which part of ethmoid bone gives attachment to falx cerebri?
a) Crista galli
b) Cribriform plate
c) Orbital plate
d) Uncinate process

Explanation (50 words): The crista galli is a vertical projection superiorly from the ethmoid bone. It provides anterior attachment for the falx cerebri, helping stabilize the brain within the cranial cavity. Answer: a) Crista galli.

4. Ethmoidal labyrinth contains:
a) Ethmoidal air cells
b) Sphenoidal sinus
c) Maxillary sinus
d) Frontal sinus

Explanation (50 words): The ethmoid labyrinth is composed of multiple thin-walled ethmoidal air cells, which open into the nasal cavity. They are classified as anterior, middle, and posterior groups. Answer: a) Ethmoidal air cells.

5. The medial wall of the orbit is formed partly by:
a) Orbital plate of ethmoid
b) Inferior turbinate
c) Perpendicular plate
d) Maxilla

Explanation (50 words): The lamina papyracea (orbital plate of ethmoid) forms a thin part of the medial orbital wall, making it prone to fractures and spread of sinus infection to the orbit. Answer: a) Orbital plate of ethmoid.

6. Which paranasal sinus lies within the ethmoid bone?
a) Ethmoidal sinus
b) Sphenoid sinus
c) Frontal sinus
d) Maxillary sinus

Explanation (50 words): The ethmoid bone contains the ethmoidal air cells, collectively referred to as ethmoidal sinuses. These are numerous small cavities within the ethmoid labyrinth. Answer: a) Ethmoidal sinus.

7. Agger nasi is related to which of the following?
a) Anterior ethmoidal cells
b) Sphenoethmoidal recess
c) Middle turbinate
d) Inferior turbinate

Explanation (50 words): The agger nasi is an anterior ethmoidal air cell lying just anterior to the attachment of the middle turbinate. It is an important landmark for endoscopic sinus surgery. Answer: a) Anterior ethmoidal cells.

8. A child with orbital cellulitis following sinusitis most likely has infection spread from:
a) Maxillary sinus
b) Ethmoidal sinus
c) Sphenoid sinus
d) Frontal sinus

Explanation (50 words): The lamina papyracea of the ethmoid forms a very thin medial wall of the orbit, allowing direct spread of infection from ethmoidal sinuses into the orbit. Answer: b) Ethmoidal sinus.

9. The structure passing through the anterior ethmoidal foramen is:
a) Anterior ethmoidal artery
b) Posterior ethmoidal nerve
c) Optic nerve
d) Nasociliary nerve

Explanation (50 words): The anterior ethmoidal artery, vein, and nerve pass through the anterior ethmoidal foramen to enter the nasal cavity and anterior cranial fossa. Answer: a) Anterior ethmoidal artery.

10. Which bone articulates with the ethmoid to form the nasal septum?
a) Vomer
b) Inferior turbinate
c) Zygoma
d) Palatine

Explanation (50 words): The vomer articulates inferiorly with the perpendicular plate of the ethmoid to form the bony part of the nasal septum. Answer: a) Vomer.

Keywords

- Vertebrae — Individual bones forming the vertebral column; regions: cervical, thoracic, lumbar, sacral, coccygeal.

- Cervical (C) — Typically seven vertebrae (C1–C7); most constant region in humans; atlas and axis are specialized C1–C2.

- Thoracic (T) — Usually twelve vertebrae (T1–T12) bearing ribs and forming thoracic cage; variations may occur.

- Lumbar (L) — Generally five vertebrae (L1–L5) providing lumbar lordosis and load-bearing; transitional anomalies (lumbarization/sacralization) possible.

- Sacral (S) — Five fused vertebrae forming the sacrum; sacralization of L5 or lumbarization of S1 are common variants.

- Transitional vertebra — Vertebra at junction showing characteristics of adjacent region (e.g., lumbosacral transitional vertebra).

- Lumbarization — S1 partially unfuses appearing as an extra lumbar vertebra.

- Sacralization — L5 fuses to sacrum reducing mobile lumbar count.

- Congenital variation — Developmental changes in vertebral count/shape, asymptomatic or syndromic.

- Spinal level localization — Essential for surgery, anesthesia, and imaging accuracy.

Chapter: Spine — Topic: Vertebral Column — Subtopic: Vertebral Number, Variants & Clinical Implications

Lead Question - 2012

1. Number of vertebrae is usually constant in

a) Cervical

b) Thoracic

c) Lumbar

d) Sacral

Explanation & answer: The cervical region is the most constant in humans with seven vertebrae (C1–C7) across almost all individuals; thoracic and lumbar counts can show variation due to transitional anomalies and sacral segments may be variable by fusion. Correct answer: (a) Cervical. 

2. A patient has low back pain and imaging shows L5 fused to the sacrum. This is called:

a) Lumbarization

b) Sacralization

c) Spina bifida occulta

d) Transitional scoliosis

Explanation & answer: Fusion of L5 to the sacrum is sacralization, a lumbosacral transitional anomaly changing biomechanics and possibly causing back pain or radiculopathy. This reduces mobile lumbar count and may complicate surgical level numbering. Correct answer: (b) Sacralization. 

3. Which vertebral level is most appropriate landmark for locating the conus medullaris in adults?

a) L1 vertebral level (approximately)

b) C7 vertebral level

c) T12 vertebral level

d) S2 vertebral level

Explanation & answer: In adults the conus medullaris usually terminates around the L1 vertebral level (range T12–L3). This is relevant for lumbar puncture and epidural planning. Variations exist with congenital vertebral count differences. Correct answer: (a) L1 vertebral level (approximately). 

4. Which region most frequently shows variation in number due to lumbarization or sacralization?

a) Lumbosacral junction

b) Cervicothoracic junction

c) Thoracolumbar junction only

d) Craniovertebral junction

Explanation & answer: The lumbosacral junction commonly shows transitional anomalies: lumbarization of S1 or sacralization of L5, altering lumbar count and biomechanics and contributing to back pain and diagnostic confusion. Cervical and craniovertebral variability are far less common. Correct answer: (a) Lumbosacral junction. 

5. A neonate has 13 thoracic vertebrae on X-ray. This finding most likely represents:

a) Transitional or supernumerary thoracic vertebra (variation)

b) Normal cervical variation

c) Immediate indication for surgery

d) Pathognomonic spina bifida

Explanation & answer: Presence of 13 thoracic vertebrae is a congenital variation—supernumerary or transitional rib-bearing segment. It may be asymptomatic but can affect spinal mechanics. It does not automatically mandate surgery; clinical correlation required. Correct answer: (a) Transitional or supernumerary thoracic vertebra (variation). 

6. Which statement is TRUE regarding human cervical vertebrae count?

a) Cervical vertebrae number (7) is highly conserved and usually constant

b) Cervical vertebrae commonly vary between individuals (4–10)

c) Cervical count changes with posture acutely

d) Cervical vertebrae fuse normally in adults to form one bone

Explanation & answer: Humans almost always have seven cervical vertebrae; this number is evolutionarily conserved and extremely constant compared with other regions. Large deviations are rare and usually pathological. Correct answer: (a) Cervical vertebrae number (7) is highly conserved and usually constant. 

7. For epidural anesthesia, counting vertebral levels from which landmark is common and why might vertebral number variation matter?

a) Iliac crest (L4 level) — variations can mislead level identification causing high/low block

b) Mastoid process — unrelated to lumbar levels

c) Xiphoid — accurate for L4 always

d) Clavicle — used for lumbar counting

Explanation & answer: The iliac crest commonly approximates the L4 vertebral level for lumbar puncture/epidural; however, transitional vertebrae can mislead counting and result in incorrect level placement and unintended high or low block. Correct answer: (a) Iliac crest (L4 level) — variations can mislead level identification causing high/low block. 

8. Which congenital condition involves failure of vertebral segmentation and may affect vertebral count/shape?

a) Klippel–Feil syndrome (cervical fusion)

b) Osteoarthritis only

c) Spinal epidural abscess

d) Degenerative disc disease only

Explanation & answer: Klippel–Feil syndrome is congenital fusion of cervical vertebrae altering normal cervical anatomy and potentially counts or function; it can cause a short neck and limited motion. It is a segmentation defect rather than degenerative disease. Correct answer: (a) Klippel–Feil syndrome (cervical fusion). 

9. A surgeon planning lumbar discectomy must avoid counting errors caused by which of the following?

a) Lumbosacral transitional vertebra (LSTV)

b) Normal cervical count

c) Clavicular anomalies

d) Mandibular asymmetry

Explanation & answer: Lumbosacral transitional vertebrae (lumbarization/sacralization) may shift numbering so that the intended operated disc level is misidentified. Preoperative imaging and careful vertebral numbering from thoracic landmarks reduce wrong-level surgery risk. Correct answer: (a) Lumbosacral transitional vertebra (LSTV). 

10. Which imaging modality best documents vertebral segmentation and number before spine surgery?

a) Whole-spine X-ray or CT with clear vertebral counting from C2 down

b) Plain skull radiograph only

c) Abdominal ultrasound

d) ECG

Explanation & answer: Whole-spine radiographs or CT allowing numbering from a reliable upper landmark (C2 or the skull base) down to sacrum accurately document vertebral counts and anomalies, preventing surgical errors. Abdominal ultrasound or ECG are irrelevant. Correct answer: (a) Whole-spine X-ray or CT with clear vertebral counting from C2 down. 

11. A patient with chronic low back pain and a transitional L5–S1 vertebra undergoes targeted steroid injection. Why must the clinician recognize the variant?

a) To ensure correct level targeting and avoid ineffective treatment

b) Because variants prevent injections entirely

c) Because transitional vertebrae are immune to steroids

d) Because injections are only done at cervical levels

Explanation & answer: Recognizing a transitional vertebra is essential to correctly target the symptomatic level for epidural or facet injections; misidentification can lead to ineffective treatment or complications. Variants do not preclude injections but mandate accurate imaging-guided localization. Correct answer: (a) To ensure correct level targeting and avoid ineffective treatment. 

Keywords

- Maxillary (bone) — Paired facial bone forming maxillary sinus walls and a major portion of the orbital floor.

- Zygomatic — Cheekbone contributing to lateral orbital rim and zygomaticomaxillary complex.

- Sphenoid — Central skull base bone; lesser wing forms part of the posterior orbit.

- Palatine — Small paired bone contributing posteriorly to the orbital floor and lateral nasal wall.

- Orbital floor — Thin bony partition separating the orbit from maxillary sinus; commonly fractures in blunt trauma.

- Blowout fracture — Orbital floor fracture causing diplopia, enophthalmos, and entrapment of orbital contents.

- Infraorbital rim — Bony landmark at anterior orbital floor; important in reconstruction and fixation.

- Enophthalmos — Posterior displacement of the globe due to increased orbital volume or wall loss.

- Orbital reconstruction — Surgical repair (mesh, titanium, porous polyethylene) to restore orbital volume and function.

- Entrapment — Herniation or incarceration of extraocular muscle or fat causing restricted eye movements and diplopia.

Chapter: Head & Neck — Topic: Orbit — Subtopic: Orbital Floor Anatomy & Fractures

Lead Question - 2012

Maximum contribution to the floor of orbit is by:

a) Maxillary

b) Zygomatic

c) Sphenoid

d) Palatine

Explanation & Answer: The maxillary bone forms the largest portion of the orbital floor anteriorly and centrally, abutting the infraorbital rim and separating the orbit from the maxillary sinus. Therefore the maxillary bone contributes most to the orbital floor — Answer: a) Maxillary. (50 words)

1. A 22-year-old male with blunt facial trauma has diplopia on upward gaze and infraorbital anesthesia. Which fracture is most likely?

a) Zygomatic arch fracture

b) Orbital roof fracture

c) Orbital floor (blowout) fracture

d) Frontal sinus fracture

Explanation & Answer: Diplopia on upward gaze with infraorbital numbness indicates orbital floor fracture causing inferior rectus entrapment and infraorbital nerve involvement. These signs are classic for blowout fractures of the orbital floor. Correct choice: c) Orbital floor (blowout) fracture. (50 words)

2. Which structure passes through the infraorbital foramen supplying sensation to the midface?

a) Maxillary nerve (V2) infraorbital branch

b) Zygomaticofacial nerve

c) Anterior ethmoidal nerve

d) Frontal nerve

Explanation & Answer: The infraorbital nerve, a continuation of the maxillary nerve (V2), exits via the infraorbital foramen to provide sensation to the lower eyelid, upper lip, and cheek. Infraorbital anesthesia follows orbital floor injury. Correct answer: a) Maxillary nerve (V2) infraorbital branch. (50 words)

3. In reconstruction of a large orbital floor defect with persistent enophthalmos, the best immediate implant choice is:

a) Autologous fat grafting

b) Porous polyethylene sheet or titanium mesh

c) Simple soft-tissue closure

d) External beam radiotherapy

Explanation & Answer: Large orbital floor defects require rigid implants to restore orbital volume and support the globe. Porous polyethylene or titanium mesh are standard. Fat grafting is inadequate. Correct answer: b) Porous polyethylene sheet or titanium mesh. (50 words)

4. A patient with an isolated orbital floor fracture has entrapment of the inferior rectus causing oculocardiac reflex symptoms. Immediate management should include:

a) Observation only

b) Urgent surgical release of entrapped muscle

c) High-dose steroids only

d) Enucleation

Explanation & Answer: Entrapment causing oculocardiac reflex (bradycardia, nausea) mandates urgent surgical release to free the inferior rectus and prevent ischemia and diplopia. Answer: b) Urgent surgical release of entrapped muscle. (50 words)

5. Which bone forms the posteromedial portion of the orbital floor and may be involved in posteriorly extensive fractures?

a) Maxilla

b) Palatine bone

c) Nasal bone

d) Zygomatic bone

Explanation & Answer: The palatine bone contributes a small posteromedial portion of the orbital floor; in posteriorly extensive fractures, palatine involvement is possible. Answer: b) Palatine bone. (50 words)

6. Which clinical sign quantifies enophthalmos and helps decide need for reconstruction?

a) Hertel exophthalmometry

b) Snellen visual acuity

c) Pupillary light reflex

d) Perimetry

Explanation & Answer: Hertel exophthalmometer measures globe position relative to orbital rims and quantifies enophthalmos. A difference >2 mm or progressive change indicates reconstruction. Answer: a) Hertel exophthalmometry. (50 words)

7. Which artery supplies the orbital floor periosteum and may cause bleeding during floor exposure?

a) Infraorbital artery

b) Anterior ethmoidal artery

c) Ophthalmic artery

d) Posterior superior alveolar artery

Explanation & Answer: The infraorbital artery, branch of maxillary artery, runs in the infraorbital canal supplying the orbital floor. It may bleed during surgical exposure. Answer: a) Infraorbital artery. (50 words)

8. CT scan finding most diagnostic for an orbital floor blowout fracture is:

a) Malar fracture without sinus change

b) Orbital fat herniation into maxillary sinus and discontinuity of the floor

c) Isolated orbital emphysema only

d) Isolated frontal sinus fluid

Explanation & Answer: CT showing orbital floor discontinuity with herniation of orbital fat or muscle into maxillary sinus confirms blowout fracture. Answer: b) Orbital fat herniation into maxillary sinus and discontinuity of the floor. (50 words)

9. In a clinical exam, limited elevation of the eye with normal pupil and vision suggests involvement of which muscle in floor fractures?

a) Superior rectus

b) Inferior rectus

c) Medial rectus

d) Lateral rectus

Explanation & Answer: Limitation of elevation suggests inferior rectus entrapment in orbital floor fracture. Pupillary and vision function may be intact. Correct choice: b) Inferior rectus. (50 words)

10. A 45-year-old with chronic post-traumatic enophthalmos 6 months after injury seeks correction. Best management is:

a) Late orbital reconstruction with implant

b) Continued observation

c) Systemic steroids

d) Radiotherapy

Explanation & Answer: Chronic enophthalmos from unrepaired floor defect is corrected with delayed orbital reconstruction using implants. Observation or steroids cannot restore bone support. Answer: a) Late orbital reconstruction with implant. (50 words)

Keyword Definitions

• Locking of Knee Joint – A condition where the knee becomes stuck in one position due to mechanical obstruction, usually caused by meniscus injury or loose bodies.

• Osgood Schlatter Disease – An overuse injury causing pain and swelling at the tibial tuberosity, common in adolescents.

• Loose Body in Knee – Small fragments of bone or cartilage floating inside the joint, often causing locking or catching.

• Tuberculosis of Knee – A chronic infection of the knee joint caused by Mycobacterium tuberculosis, leading to pain, swelling, and restricted movement.

• Meniscal Tear – Injury to the cartilage in the knee, a common cause of locking.

• Patellofemoral Pain Syndrome – Pain in the front of the knee, often from overuse or malalignment, not typically causing locking.

• Anterior Cruciate Ligament (ACL) Injury – Damage to the ACL causing instability, swelling, and reduced movement.

• Synovial Chondromatosis – A joint disorder where cartilage nodules form in the synovium, which may break off and cause loose bodies.

Chapter: Orthopaedics

Topic: Knee Joint Disorders

Sub-topic: Mechanical Locking of the Knee

Q1 (Lead Question – 2012): Locking of knee joint can be caused by:

a) Osgood Schlatter

b) Loose body in knee joint

c) Tuberculosis of knee

d) a and b both

Explanation: The correct answer is b) Loose body in knee joint. Knee locking occurs when something physically obstructs joint movement, most often due to meniscus tears or loose bodies (osteochondral fragments). Osgood Schlatter disease affects the tibial tuberosity in growing adolescents and does not cause locking. Tuberculosis of the knee leads to chronic swelling and stiffness, but locking is uncommon.

Q2: A 22-year-old athlete reports sudden locking of the knee after a twisting injury. Which structure is most likely injured?

a) ACL

b) Medial meniscus

c) Lateral collateral ligament

d) Patellar tendon

Explanation: Correct answer: b) Medial meniscus. Meniscal tears, especially bucket-handle tears, can mechanically block knee extension, leading to locking. The medial meniscus is more frequently injured due to its firm attachment to the tibia and medial collateral ligament, making it less mobile.

Q3: Which imaging modality is best for detecting a meniscal tear?

a) X-ray

b) MRI

c) CT scan

d) Ultrasound

Explanation: Correct answer: b) MRI. MRI provides detailed images of soft tissue, making it the investigation of choice for diagnosing meniscal injuries. X-rays can detect bony pathology but not cartilage tears. CT is less sensitive for soft tissue, and ultrasound is rarely used for intra-articular injuries.

Q4: In knee tuberculosis, the most common X-ray finding is:

a) Sunburst appearance

b) Phemister’s triad

c) Onion-skin periosteal reaction

d) Ground-glass opacity

Explanation: Correct answer: b) Phemister’s triad – periarticular osteoporosis, marginal erosions, and gradual joint space narrowing. TB of the knee is a slowly progressive monoarthritis that rarely causes acute locking.

Q5: Which of the following can present with intermittent locking due to cartilage nodules?

a) Synovial chondromatosis

b) Gout

c) Rheumatoid arthritis

d) Osteoporosis

Explanation: Correct answer: a) Synovial chondromatosis. This rare condition produces loose cartilage nodules in the synovial membrane, which may detach and cause locking or catching sensations in the joint.

Q6: The most common site of Osgood Schlatter disease is:

a) Tibial tuberosity

b) Patella

c) Femoral condyle

d) Fibular head

Explanation: Correct answer: a) Tibial tuberosity. Osgood Schlatter is an apophysitis caused by repetitive strain from the patellar tendon, especially in adolescents during sports activities.

Q7: The “bucket handle” tear is associated with:

a) Cruciate ligament rupture

b) Meniscal tear

c) Patellar fracture

d) Quadriceps tendon rupture

Explanation: Correct answer: b) Meniscal tear. In this injury, a portion of the torn meniscus flips into the joint, causing mechanical blockage and locking.

Q8: A patient with a locked knee cannot perform which movement?

a) Flexion

b) Extension

c) Abduction

d) Internal rotation

Explanation: Correct answer: b) Extension. Locking typically prevents full extension, as the obstructing structure (like a torn meniscus) blocks the femoral condyle from gliding forward.

Q9: Which treatment is preferred for a young patient with symptomatic loose body in the knee?

a) Arthroscopic removal

b) Plaster cast immobilization

c) Long-term NSAIDs

d) Heat therapy

Explanation: Correct answer: a) Arthroscopic removal. Surgery removes the mechanical obstruction, restoring movement and preventing further cartilage damage.

Q10: Meniscal tears heal poorly because:

a) Meniscus has no nerve supply

b) Meniscus has limited blood supply

c) Meniscus is made of bone

d) Meniscus is too thick

Explanation: Correct answer: b) Meniscus has limited blood supply. The inner two-thirds of the meniscus is avascular, limiting healing potential. Only peripheral tears in the vascular zone may heal with conservative treatment.

Chapter: Anatomy – Lower Limb

Topic: Ankle Joint & Ligaments

Sub-topic: Medial (Deltoid) Ligament of Ankle

Keyword Definitions:

• Deltoid Ligament: Strong triangular ligament on the medial side of the ankle, preventing eversion.

• Medial Malleolus: Bony prominence on inner side of ankle, part of tibia.

• Medial Cuneiform: Tarsal bone in midfoot, articulates with first metatarsal.

• Spring Ligament: Plantar calcaneonavicular ligament supporting medial arch.

• Sustentaculum Tali: Medial projection of calcaneus supporting talus.

• Plantar Ligaments: Support arches of foot, prevent excessive dorsiflexion.

• Ankle Joint: Synovial hinge joint between tibia, fibula, and talus.

• Foot Arches: Medial and lateral longitudinal arches, transverse arch.

• Tibialis Posterior: Muscle supporting medial arch and inverting foot.

• Eversion Injury: Outward twisting of foot, commonly involving deltoid ligament injury.

Q1 (2012 NEET PG): Deltoid ligament is attached to all except:

1. Medial malleolus

2. Medial cuneiform

3. Spring ligament

4. Sustentaculum tali

Explanation: The deltoid ligament originates from the medial malleolus and fans out to attach to the talus, sustentaculum tali, and navicular via the spring ligament. It is not directly attached to the medial cuneiform. Therefore, the correct answer is Medial cuneiform. Its function is to resist eversion and maintain medial ankle stability.

Q2: Which component of the deltoid ligament attaches to the navicular bone?

1. Tibiocalcaneal

2. Tibionavicular

3. Tibiotalar anterior

4. Tibiotalar posterior

Explanation: The tibionavicular part of the deltoid ligament extends from the medial malleolus to the navicular bone. It helps support the medial longitudinal arch by linking with the spring ligament and prevents excessive eversion.

Q3: In an eversion ankle injury, which ligament is most likely torn first?

1. Anterior talofibular ligament

2. Calcaneofibular ligament

3. Deltoid ligament

4. Bifurcate ligament

Explanation: Eversion injuries stress the medial side of the ankle. The deltoid ligament is often injured first due to its strong attachment to the medial malleolus and tarsal bones. Severe force may cause medial malleolar fracture instead of ligament rupture.

Q4: Which tarsal bone does not receive direct attachment from the deltoid ligament?

1. Talus

2. Calcaneus

3. Navicular

4. Cuboid

Explanation: The deltoid ligament attaches to talus, calcaneus, and navicular but not to the cuboid. The cuboid is located laterally, away from the ligament’s medial orientation.

Q5: The spring ligament connects the sustentaculum tali to which bone?

1. Talus

2. Navicular

3. Medial cuneiform

4. First metatarsal

Explanation: The plantar calcaneonavicular ligament (spring ligament) runs from the sustentaculum tali of the calcaneus to the navicular. It supports the head of the talus and the medial arch.

Q6: A patient with posterior tibial tendon dysfunction is likely to have attenuation of which ligament?

1. Spring ligament

2. Long plantar ligament

3. Deltoid ligament

4. Interosseous talocalcaneal ligament

Explanation: Posterior tibial tendon dysfunction leads to collapse of the medial arch and stretching of the spring ligament. This reduces ankle stability and causes flatfoot deformity.

Q7: Which part of the deltoid ligament attaches to the sustentaculum tali?

1. Tibionavicular

2. Tibiocalcaneal

3. Tibiotalar anterior

4. Tibiotalar posterior

Explanation: The tibiocalcaneal portion of the deltoid ligament connects the medial malleolus to the sustentaculum tali of the calcaneus, resisting valgus tilt of the ankle.

Q8: In a trimalleolar fracture, which ligament is most often associated with medial injury?

1. Anterior talofibular ligament

2. Deltoid ligament

3. Bifurcate ligament

4. Long plantar ligament

Explanation: In a trimalleolar fracture (medial, lateral, and posterior malleoli), the deltoid ligament is commonly damaged on the medial side, contributing to ankle instability.

Q9: Which ligament is important for preventing abduction of the foot at the ankle?

1. Deltoid ligament

2. Calcaneofibular ligament

3. Interosseous ligament

4. Bifurcate ligament

Explanation: The deltoid ligament is the primary restraint to abduction (eversion) of the foot at the ankle joint. Its medial location counteracts outward tilting.

Q10: Which is the strongest medial ankle ligament?

1. Spring ligament

2. Deltoid ligament

3. Long plantar ligament

4. Bifurcate ligament

Explanation: The deltoid ligament is the strongest medial ligament of the ankle, made of superficial and deep fibers, providing strong stability against eversion and rotational forces.

Q11: Which ligament maintains the head of the talus in position?

1. Spring ligament

2. Deltoid ligament

3. Long plantar ligament

4. Bifurcate ligament

Explanation: The spring ligament supports the head of the talus, preventing it from dropping and maintaining the medial longitudinal arch of the foot.

Chapter: General Anatomy | Topic: Joints | Subtopic: Synovial Joints

Keyword Definitions:

• Synovial Joint - A freely movable joint with a synovial cavity, lined by synovial membrane and filled with synovial fluid.

• Hyaline Cartilage - Smooth, glass-like cartilage covering articular surfaces in most synovial joints, providing low-friction movement.

• Mobility - The range of motion a joint can perform.

• Stability - The resistance of a joint to displacement.

• Hinge Joint - A uniaxial synovial joint allowing flexion and extension.

• Pivot Joint - A uniaxial joint allowing rotation around a single axis.

• Saddle Joint - A biaxial joint allowing movement in two planes, like the 1st carpometacarpal joint.

• Articular Disc - Fibrocartilage dividing some synovial joints into two cavities (e.g., temporomandibular joint).

• Metacarpophalangeal Joint - A condyloid synovial joint allowing flexion, extension, abduction, and adduction.

• Synovial Fluid - Lubricating fluid produced by synovial membrane, nourishing cartilage.

Lead Question (2012): Which is true about synovial joint?

1. Stability is inversely proportional to mobility

2. Hyaline cartilage covers articular surface of all synovial joints

3. Metacarpo-phalangeal joint is a hinge joint

4. Cartilage usually divides the joint into two cavities

Explanation: The correct answer is (a) Stability is inversely proportional to mobility. Synovial joints with high mobility (like the shoulder) are less stable, while more stable joints (like the hip) have less mobility. Hyaline cartilage covers most articular surfaces, but exceptions exist. Metacarpophalangeal joints are condyloid, not hinge. Cartilage dividing a joint is rare, seen only in specific joints like TMJ.

Q2. Which synovial joint type is the shoulder joint?

1. Hinge

2. Pivot

3. Ball and Socket

4. Saddle

Explanation: The shoulder joint is a ball and socket synovial joint. It allows movement in multiple axes—flexion, extension, abduction, adduction, rotation, and circumduction—making it highly mobile but inherently less stable compared to other joints due to its shallow glenoid cavity.

Q3. Hyaline cartilage is absent in which synovial joint?

1. Hip

2. Knee

3. Sternoclavicular

4. Temporomandibular

Explanation: The temporomandibular joint has fibrocartilage instead of hyaline cartilage on its articular surfaces. This adaptation helps withstand compressive and shear forces during chewing. Most other synovial joints have hyaline cartilage on articulating surfaces.

Q4. Which synovial joint is uniaxial?

1. Hip

2. Elbow

3. Wrist

4. Shoulder

Explanation: The elbow joint is a classic example of a hinge joint, which is uniaxial and allows movement in one plane—flexion and extension. The hip and shoulder are multiaxial, while the wrist (radiocarpal) is biaxial.

Q5. In synovial joints, synovial fluid is secreted by?

1. Hyaline cartilage

2. Fibroblasts

3. Synovial membrane

4. Ligaments

Explanation: The synovial membrane produces synovial fluid, which lubricates the joint, reduces friction, and nourishes the avascular articular cartilage. Hyaline cartilage is non-vascular and non-secretory.

Q6. Which joint contains an articular disc?

1. Knee

2. Shoulder

3. Temporomandibular

4. Hip

Explanation: The temporomandibular joint contains an articular disc made of fibrocartilage, dividing the joint cavity into upper and lower compartments. This helps in complex chewing and speaking movements.

Q7. Which joint type is found at the atlantoaxial articulation?

1. Hinge

2. Pivot

3. Saddle

4. Plane

Explanation: The atlantoaxial joint is a pivot joint, allowing rotation of the atlas (C1) around the dens of the axis (C2), enabling head rotation as in “no” movement.

Q8. Which movement is not possible in a saddle joint?

1. Flexion

2. Extension

3. Rotation

4. Abduction

Explanation: Saddle joints, like the first carpometacarpal joint of the thumb, allow flexion, extension, abduction, adduction, and circumduction, but not axial rotation.

Q9. A 25-year-old suffers ACL injury. Which joint is affected?

1. Elbow

2. Knee

3. Hip

4. Ankle

Explanation: The anterior cruciate ligament (ACL) is located in the knee joint, a modified hinge joint. ACL injuries often occur in sports involving sudden stops and changes in direction.

Q10. Which joint shows the greatest range of motion?

1. Shoulder

2. Hip

3. Wrist

4. Ankle

Explanation: The shoulder joint is the most mobile joint in the body due to its shallow glenoid cavity and loose capsule. However, this also makes it prone to dislocations.

Q11. Which factor increases stability of synovial joints?

1. Shallow articular surface

2. Strong ligaments

3. Loose capsule

4. Weak muscles

Explanation: Strong ligaments enhance joint stability by limiting excessive movement. Deep sockets, tight capsules, and strong surrounding muscles also contribute to stability, as in the hip joint.

Chapter: Locomotion and Movement | Topic: Gait Cycle | Subtopic: Heel Touch Phase & Calf Compartment Pressure

Keywords:

• Heel Touch Phase - Initial phase of gait cycle when the heel makes contact with the ground.

• Calf Compartment - Posterior compartment of the leg containing gastrocnemius, soleus, and other muscles, enclosed by fascia.

• Resting Pressure - The baseline pressure within a closed anatomical compartment at rest.

• Compartment Pressure - Pressure within an enclosed myofascial compartment, influenced by muscle activity and blood flow.

• Gait Cycle - Sequence of movements during walking, from heel strike to the next heel strike of the same foot.

• Muscle Pump - The action of muscles in aiding venous return to the heart.

Q1 (Lead - NEET PG 2012): During heel touch phase of walking, pressure in calf compartment is?

a) More than resting pressure

b) Less than resting pressure

c) No change in pressure

d) First rises and then falls

Explanation: The heel touch phase activates the gastrocnemius and soleus muscles to control foot placement and initiate push-off preparation. This contraction compresses the posterior compartment, briefly elevating intracompartmental pressure above resting level. The pressure rise aids venous return. Thus, the correct answer is a) More than resting pressure. Clinically, this principle explains why dynamic muscle use prevents venous stasis.

Q2: Which phase of the gait cycle involves maximum activity of the tibialis anterior muscle?

a) Heel strike

b) Toe-off

c) Mid-stance

d) Swing phase

Explanation: The tibialis anterior is most active during heel strike and swing phase, preventing foot slap and aiding dorsiflexion clearance. However, EMG studies show peak activation at a) Heel strike to control plantar flexion. Dysfunction may cause foot drop, requiring orthotic support.

Q3: In compartment syndrome, which parameter is most important for deciding fasciotomy?

a) Duration of symptoms

b) Pressure exceeding 30 mmHg

c) Presence of pain on passive stretch

d) Sensory loss

Explanation: While clinical signs are critical, the gold standard decision criterion is b) Pressure exceeding 30 mmHg or within 30 mmHg of diastolic BP. Persistent ischemia beyond 6 hours risks irreversible muscle and nerve damage.

Q4: Which muscle group forms the superficial layer of the posterior calf compartment?

a) Soleus and gastrocnemius

b) Tibialis posterior

c) Flexor hallucis longus

d) Peroneus longus

Explanation: The superficial posterior calf compartment includes gastrocnemius, soleus, and plantaris. The correct answer is a) Soleus and gastrocnemius. These muscles share the Achilles tendon and function mainly in plantar flexion.

Q5: A 45-year-old runner develops pain and swelling in the calf after prolonged exercise. Which is the most likely cause?

a) Acute arterial occlusion

b) Chronic exertional compartment syndrome

c) Deep vein thrombosis

d) Muscle strain

Explanation: Chronic exertional compartment syndrome (CECS) causes reversible intracompartmental pressure rise during activity, leading to pain and swelling. The hallmark is resolution with rest. Thus, b) Chronic exertional compartment syndrome fits the presentation better than DVT or strain.

Q6: The pressure in calf compartment is lowest during which gait phase?

a) Heel strike

b) Toe-off

c) Swing

d) Mid-stance

Explanation: During swing phase, calf muscles relax, reducing intracompartmental pressure below resting levels. This recovery allows reperfusion of muscles. Correct answer: c) Swing.

Q7: The primary artery supplying the posterior calf compartment is?

a) Anterior tibial artery

b) Fibular artery

c) Posterior tibial artery

d) Popliteal artery

Explanation: The posterior tibial artery supplies most of the posterior compartment, branching into medial and lateral plantar arteries in the foot. Hence, answer: c) Posterior tibial artery.

Q8: Which condition results from unrelieved acute compartment syndrome?

a) Volkmann's ischemic contracture

b) Sudeck’s atrophy

c) Osgood-Schlatter disease

d) Shin splints

Explanation: Prolonged compartment syndrome leads to ischemic necrosis and fibrosis of muscles, resulting in permanent flexion deformity known as Volkmann's ischemic contracture. Timely fasciotomy prevents this outcome.

Q9: Which nerve is most at risk in posterior calf compartment syndrome?

a) Tibial nerve

b) Superficial peroneal nerve

c) Deep peroneal nerve

d) Sural nerve

Explanation: The tibial nerve passes through the posterior compartment with posterior tibial vessels, making it most susceptible to compression in elevated pressures. Hence, a) Tibial nerve is correct.

Q10: A patient with calf pain has resting compartment pressure of 12 mmHg and post-exercise pressure of 40 mmHg. Diagnosis?

a) Acute compartment syndrome

b) Chronic exertional compartment syndrome

c) DVT

d) Muscle tear

Explanation: Resting pressure <15 mmHg is normal, but post-exercise >30-35 mmHg confirms CECS. The pattern here matches b) Chronic exertional compartment syndrome.

Q11: Which maneuver increases venous return from the calf during walking?

a) Plantar flexion

b) Dorsiflexion

c) Both plantar and dorsiflexion

d) None

Explanation: The calf muscle pump works during both plantar flexion (push-off) and dorsiflexion (relaxation), propelling blood towards the heart and preventing stasis. Correct: c) Both plantar and dorsiflexion.

Chapter: Skeletal System

Topic: Bone Growth and Development

Subtopic: Types of Epiphyses

Keywords & Definitions:

• Traction epiphysis: An epiphysis subjected to tensile forces by muscles or tendons rather than weight-bearing.

• Pressure epiphysis: Epiphysis subjected to compressive forces and weight-bearing.

• Epiphysis: The end part of a long bone, initially growing separately from the shaft.

• Apophysis: A secondary ossification center that serves as a site of tendon or ligament attachment.

• Ossification: The process of bone formation.

• Growth plate (physis): Cartilaginous zone allowing longitudinal bone growth.

• Trochanter: A large, blunt projection on a bone for muscle attachment.

• Coracoid process: A hook-like bony projection from the scapula for muscle attachment.

• Femur: The thigh bone, longest bone in the body.

• Tibial condyles: Rounded prominences at the top of tibia involved in knee joint articulation.

Lead Question - 2012:

Which of the following is a traction epiphysis?

a) Tibial condyles

b) Trochanter of femur

c) Coracoid process of scapula

d) Head of femur

Explanation & Answer:

The correct answer is b) Trochanter of femur. Traction epiphyses are sites where tendons or muscles pull on bones, causing tensile stress; the trochanter of the femur is a classic example. Other options like tibial condyles and head of femur are pressure epiphyses subjected to compressive forces, and the coracoid process is an apophysis but not classically classified as traction epiphysis.

Q2. Pressure epiphysis primarily undergoes growth by?

a) Longitudinal growth at physis

b) Appositional growth only

c) Ossification of periosteum

d) Remodeling by osteoclasts

Explanation & Answer:

Pressure epiphyses grow primarily by longitudinal growth at the physis (growth plate), responding to compressive forces from weight-bearing.

Q3. Which of the following is NOT a traction epiphysis?

a) Tibial tuberosity

b) Greater trochanter

c) Calcaneal tuberosity

d) Femoral head

Explanation & Answer:

The femoral head (option d) is a pressure epiphysis, not a traction epiphysis, as it bears weight and articulates with the acetabulum.

Q4. The ossification center of a traction epiphysis is usually classified as?

a) Primary ossification center

b) Secondary ossification center

c) Apophysis

d) Sesamoid bone

Explanation & Answer:

Traction epiphyses typically correspond to apophyses (option c), which are secondary ossification centers at sites of tendon attachment.

Q5 (Clinical). Osgood-Schlatter disease affects which traction epiphysis?

a) Tibial tuberosity

b) Calcaneus

c) Trochanter

d) Coracoid process

Explanation & Answer:

Osgood-Schlatter disease (option a) is inflammation of the tibial tuberosity, a traction epiphysis where the patellar tendon attaches, common in adolescents during growth spurts.

Q6. Which bone feature is an example of a sesamoid bone rather than a traction epiphysis?

a) Patella

b) Greater trochanter

c) Coracoid process

d) Tibial tuberosity

Explanation & Answer:

The patella (option a) is a sesamoid bone embedded in the tendon of quadriceps muscle, different from traction epiphyses which are ossification centers at tendon insertions.

Q7. Which of the following statements about traction epiphyses is true?

a) They are sites of weight-bearing

b) They develop ossification centers due to tensile forces

c) They fuse early during childhood

d) They are involved in joint articulation

Explanation & Answer:

Traction epiphyses (option b) develop ossification centers where tendons exert pulling forces; they are not primarily weight-bearing or articular surfaces.

Q8. Which epiphysis typically fuses last during skeletal maturity?

a) Pressure epiphysis

b) Traction epiphysis

c) Apophysis

d) Primary ossification center

Explanation & Answer:

Traction epiphyses (option b) often fuse later than pressure epiphyses, as they correspond to sites under tensile forces and tendon attachments.

Q9 (Clinical). Avulsion fractures of traction epiphyses occur due to?

a) Excessive tensile forces

b) Compressive forces

c) Direct trauma only

d) Osteoporosis

Explanation & Answer:

Avulsion fractures (option a) of traction epiphyses happen when excessive tensile forces from muscle contraction pull the ossification center away from the bone.

Q10. Which of the following is a characteristic feature of traction epiphyses?

a) Subjected mainly to compressive stress

b) Serve as tendon attachment sites

c) Participate in joint surface formation

d) Do not undergo endochondral ossification

Explanation & Answer:

Traction epiphyses (option b) serve as attachment sites for tendons and muscles, experiencing tensile rather than compressive forces, and undergo endochondral ossification like other epiphyses.

Chapter: Anatomy

Topic: Bone Vasculature

Subtopic: Nutrient Artery

Keywords & Definitions:

• Nutrient artery: The main artery that enters the diaphysis of long bones through the nutrient foramen supplying the bone marrow and inner two-thirds of the cortex.

• Metaphysis: The neck portion of a long bone between the epiphysis and diaphysis, rich in blood supply for bone growth.

• Epiphysis: The rounded end of a long bone, initially separated from the diaphysis by the growth plate.

• Diaphysis: The shaft or central part of a long bone.

• Bone vasculature: The network of blood vessels supplying bones, critical for nutrition and repair.

• Foramen: An opening or hole in bone for passage of vessels and nerves.

• Clinical relevance: Knowledge of nutrient artery direction is vital during orthopedic surgeries to avoid ischemia.

• Growth plate: Also called the epiphyseal plate, site of longitudinal bone growth.

• Blood supply: Nutrient arteries supply inner compact bone and marrow, while periosteal arteries supply outer bone.

• Long bones: Bones longer than they are wide, such as femur, tibia, humerus.

Lead Question - 2012:

Nutrient artery runs?

a) Towards metaphysis

b) Away from metaphysis

c) Away from epiphysis

d) None

Explanation & Answer:

The correct answer is b) Away from metaphysis. Nutrient arteries enter the diaphysis and typically run away from the metaphysis towards the epiphysis. This ensures the metaphysis, which has a rich blood supply from other sources, is not primarily dependent on the nutrient artery. This is crucial in fracture healing and orthopedic interventions.

Q2. Which part of the bone does the nutrient artery primarily supply?

a) Outer periosteum

b) Inner two-thirds of cortex and marrow

c) Epiphyseal cartilage

d) Articular cartilage

Explanation & Answer:

The nutrient artery mainly supplies the inner two-thirds of the cortex and the bone marrow (option b). The outer one-third of the cortex is supplied by periosteal arteries.

Q3. The nutrient foramen is usually located on which surface of long bones?

a) Posterior

b) Anterior

c) Lateral

d) Variable but often on the shaft's anterior surface

Explanation & Answer:

The nutrient foramen is variable but most commonly located on the anterior surface of the shaft (option d). Its position is important during surgical approaches to avoid damaging vessels.

Q4. Which artery supplements the blood supply to the epiphysis?

a) Nutrient artery

b) Metaphyseal artery

c) Periosteal artery

d) Epiphyseal artery

Explanation & Answer:

The epiphyseal artery (option d) supplies the epiphysis, which is separate from the nutrient artery that mainly supplies the diaphysis and medullary cavity.

Q5 (Clinical). Damage to the nutrient artery during fracture fixation can result in?

a) Delayed union or nonunion

b) Increased bone growth

c) Immediate bone healing

d) No clinical significance

Explanation & Answer:

Injury to the nutrient artery can cause delayed union or nonunion (option a) due to compromised blood supply essential for bone healing.

Q6. Which embryological layer forms the periosteum that carries periosteal arteries?

a) Endoderm

b) Mesoderm

c) Ectoderm

d) Neural crest

Explanation & Answer:

The periosteum, containing periosteal arteries, is derived from the mesoderm (option b), which also forms most skeletal components.

Q7. Which of the following is NOT a source of blood supply to long bones?

a) Nutrient artery

b) Periosteal arteries

c) Metaphyseal and epiphyseal arteries

d) Pulmonary arteries

Explanation & Answer:

Pulmonary arteries (option d) do not supply bones; they are part of the lung circulation. Bones receive blood from nutrient, periosteal, metaphyseal, and epiphyseal arteries.

Q8. The nutrient artery enters the bone via?

a) Epiphyseal plate

b) Nutrient foramen

c) Metaphyseal artery

d) Periosteum

Explanation & Answer:

The nutrient artery enters the bone through the nutrient foramen (option b), a small opening in the diaphyseal cortex.

Q9 (Clinical). Nutrient artery injury is most critical in which type of bone fracture?

a) Greenstick fracture

b) Comminuted fracture

c) Spiral fracture

d) Transverse fracture of diaphysis

Explanation & Answer:

Transverse diaphyseal fractures (option d) can disrupt the nutrient artery, risking compromised blood supply and delayed healing.

Q10. The nutrient artery usually arises from which blood vessel?

a) Periosteal arteries

b) Major systemic arteries near the bone

c) Venous system

d) Lymphatic vessels

Explanation & Answer:

The nutrient artery typically arises from major systemic arteries near the bone (option b), such as the femoral artery for the femur