1

Anatomy and Genetics / 1

Anatomy and
Genetics
1. Which of the following bones do not contribute to
the nasal septum?
A. Sphenoid
B. Lacrimal
C. Palatine bone
D. Ethmoid
Reference: Grays Anatomy 38th Edition Page 574
QTDF: All Books
Quality: Reader
Discussion
The medial wall or nasal septum, between the roof and
floor, is a thin sheet of bone with a wide anterior deficiency
occupied by septal cartilage; its bony part is largely vomer
and perpendicular plate of the ethmoid. The vomer
extends from the sphenoidal body to the bony palate,
forming the posteroinferior region, including the posterior
border; it is furrowed by vessels and nerves. The
perpendicular plate of the ethmoid forms the septums
anterosuperior part, continuous above with cribriform
plate.
At the upper and lower limits of the medial wall other
bones make minor contributions to the septum:
anterosuperior are the nasal bones and frontals nasal
spine, posterosuperior are the sphenoids rostrum and
crest, and inferiorly, the maxillary and palatine nasal
crests. The vomer is grooved by the nasopalatine nerves
and vessels.
Explanation
Self explanatory
Comments
The cartilage of the septum (or septal cartilage, or
quadrangular cartilage) is somewhat quadrilateral in form,
thicker at its margins than at its center, and completes the
separation between the nasal cavities in front.
Its anterior margin, thickest above, is connected with
the nasal bones, and is continuous with the anterior

2 / AIPG January 2008

margins of the lateral cartilages; below, it is connected to
the medial crura of the greater alar cartilages by fibrous
tissue.
Its posterior margin is connected with the perpendicular plate of the ethmoid; its inferior margin with the
vomer and the palatine processes of the maxillae.
Tips
The septum is often deviated, most commonly at the
vomero-ethmoidal suture.

Answer: (B) Lacrimal

Anatomy and Genetics / 3

2.
A.
B.
C.
D.

Coronary ligament of knee joint is between:

Menisci at anterior ends
Menisci at posterior ends
Menisci and tibial condyle
Menisci and femoral condyle

Reference: Grays Anatomy 38th Edition Page 698

Quality: Reader
QTDF: Gray
Discussion
Internally the capsule is attached to the meniscal rims,
connecting them to the tibia by short coronary ligaments.
Explanation
Self explanatory
Comments
There is another coronary ligament in the Liver. This name
is given to the reflexion of peritoneum from the diaphragm
to the superior and posterior surfaces of the right lobe of
the liver, forming the perimeter of the approximately
triangular but rather variable bare area of the liver, i.e.
that part of its surface which is apposed to the diaphragm
without intervening peritoneum.
Tips
The coronary ligament of the liver is sometimes reflected
on to the upper part of the right kidneys anterior surface
(so forming the hepatorenal ligament).

Answer: (C) Menisci and tibial condyle

4 / AIPG January 2008

3.
A.
B.
C.
D.

Blood supply of the Anterior Cruciate ligament is by:

Middle genicular artery
Descending genicular artery
Anterior synovial artery
Circumflex fibular A

Reference: Grays Anatomy 38th Edition Page 1570

QTDF: Gray
Quality: Reader
Discussion
Arteries supplying the joint are the descending genicular
branches of the femoral; superior, middle and inferior
genicular branches of the popliteal; anterior and posterior
recurrent branches of anterior tibial; the circumflex fibular
artery and the descending branch of the lateral circumflex
femoral.
Explanation
Middle Genicular Artery is a small artery which arises from
the popliteal artery near the posterior centre of the knee
joint; it pierces the oblique popliteal ligament to supply
the cruciate ligaments and synovial membrane.
Comments
Genicular Anastomosis: Around the patella and femoral
and tibial condyles an intricate anastomosis exists. A
superficial network spreads between the fascia and skin
around the patella and in the fat deep to the ligamentum
patellae. A deep network lies on the femur and tibia near
the adjoining articular surfaces, supplying the bone and
marrow, the articular capsule and synovial membrane. The
vessels involved are the medial and lateral genicular,
descending genicular, the descending branch of the lateral
circumflex femoral, circumflex fibular and the anterior and
posterior tibial recurrent arteries.
Tips
Nerve Supply of the knee joint are the obturator, femoral,
tibial and common peroneal nerves

Answer: (A) Middle genicular artery

Anatomy and Genetics / 5

4.
A.
B.
C.
D.

All are composite muscles except:

Pectineus
Rectus femoris
Adductor magnus
Biceps femoris

Reference: Grays Anatomy 38th Edition Pages 873, 874,

875, 879,
Quality: Thinker
Status: New
Discussion
A muscle is called as a composite muscle when it is
innervated by two nerves. Some books also call a muscle
as a composite muscle when it is derived from two
embryological compartments (Eg Flexor and Extensor)
Explanation
A. Pectineus is innervated by the Femoral nerve, L2 and
3; and accessory obturator, L3, when present.
B. Rectus Femoris is supplied by the femoral nerve, L2,
3 and 4.
C. Adductor magnus is composite and is doubly
innervated by the obturator nerve and the tibial
division of the sciatic nerve (L2, 3 and 4); the latter
nerve supplies the ischiocondylar part. Both nerves are
derived from anterior divisions in the lumbrosacral
plexus, indicating a primitive flexor origin for both
parts of the muscle.
D. Biceps Femoris is innervated by the Sciatic nerve, L5,
S1 and 2, (the long head through the tibial division
and the short head through the common peroneal
division, reflecting the composite derivation from
flexor and extensor musculature.)
Comments
The composite character of the tongue is indicated by its
innervation.
Diaphragm has a composite origin from many different
mesenchyme sources.
Tips: Another Classification that is often asked
It is possible to attempt a classification of muscles based
on their general shape and the predominant orientation
of their fibres relative to the direction of pull
Muscles with fibres that are largely parallel to the line
of pull vary in form from flat, short and quadrilateral
(e.g. thyrohyoid) to long and straplike (e.g.
sternohyoid, sartorius).

6 / AIPG January 2008

In such muscles, individual fibres may run for the

entire length of the muscle, or over shorter segments when there are transverse, tendinous
intersections at intervals (e.g. rectus abdominis).
In a fusiform muscle, the fibres may be close to
parallel in the belly, but converge to a tendon at
one or both ends.
Where fibres are oblique to the line of pull, muscles
may be
Triangular (e.g. temporalis, adductor longus)
Pennate ( = feather-like) in construction.
Unipennate (e.g. flexor pollicis longus),
Bipennate (e.g. rectus femoris, dorsal interossei)
Multipennate (e.g. deltoid).
In some muscles the fibres pass obliquely
between deep and superficial aponeuroses, in
a kind of unipennate form (e.g. soleus).
In other sites muscle fibres start from the walls
of osteofascial compartments, and converge
obliquely on a central tendon in circumpennate
fashion (e.g. tibialis anterior).
Some muscles have a spiral or twisted arrangement
(e.g. sternocostal fibres of pectoralis major and
latissimus dorsi, which undergo a 180 twist between
their median and lateral attachments).
Some muscles spiral around a bone (e.g. supinator,
which winds obliquely around the proximal radial
shaft).
Another type of spiral arrangement is shown by
muscles, sometimes referred to as cruciate, that have
two or more planes of fibres arranged in differing
directions; sternocleidomastoid, masseter and adductor
magnus are all partially spiral and cruciate.
Many muscles have more than one of these major types
of arrangement, and show regional variations that
correspond to contrasting, and in some cases independent,
actions.

Answer: (B) Rectus femoris

Anatomy and Genetics / 7

5.
A.
B.
C.
D.

All of the following are Digastric muscles except:

Muscle fibres in the ligament of Treitz
Omohyoid
Occipitofrontalis
Sternocleidomastoid

Reference: Gray 38th Edition Pages 805, 806, 807, 1763,

1764
QTDF: Gray
Quality: Thinker
Status: New
Discussion
The digastricus (digastric muscle) consists of two fleshy
bellies united by an intermediate rounded tendon. The two
bellies of the digastric muscle may have different embryological origins, and are supplied by different nerves.
Explanations
A. The terminal part and the duodenojejunal flexure are
said to be positioned by the suspensory muscle of the
duodenum (suspensory muscle, or ligament, of Treitz),
often described as being in two parts:
a slip of skeletal muscle derived from the
diaphragm near its oesophageal opening, ending
in connective tissue near the coeliac artery
a fibromuscular band of smooth muscle, passing
from the duodenum (third and fourth partsand
duodenojejunal flexure) to blend with the same
pericoeliac connective tissue.
B. Omohyoid consists of two bellies united at an angle
by an intermediate tendon. Superior belly: branches
from the ramus superior of the ansa cervicalis (C1).
Inferior belly: the ansa cervicalis itself (C2, 3).
C. Occipitofrontalis covers the dome of the skull from the
highest nuchal lines to the eyebrows. The occipital part
is supplied by the posterior auricular branch, and the
frontal part by the temporal branches of the facial nerve.
D. Sternocleidomastoid (7.63) descends obliquely across
the side of the neck and forms a prominent surface
landmark (7.62), especially when contracted. It is thick
and narrow centrally, and broader and thinner at each
end.
Comments
Tretz described both entities, naming the former der
Hilfsmuskel (the accessory muscle). Subsequent authorities
regarded them as a digastric muscle, naming the whole

8 / AIPG January 2008

the suspensory muscle of Treitz, a misnomer perpetuated
in most textbooks. Confusion was increased by Haley and
Peden, who derived the suspensory muscle from the right
crus, and by Argme et al, who described an intermediate
tendon but regarded this as part of a false digastric muscle.
Jit has persistently repeated the dual nature of the original
description by Tretz, supporting it by embryological
and histological evidence. The diaphragmatic slip
(Hilfsmuskel) has no satisfactory official name.
Tips
It is supplied, according to Jit, by myelinated nerve fibres
probably from the phrenic nerve and is sometimes
considered an aberrant part of iliocostalis thoracis. The
suspensory muscle proper (smooth muscle) is supplied by
autonomic fibres from the coeliac and superior mesenteric
plexuses. Descriptions of the duodenal attachments of the
muscle vary; none of these accounts contain a convincing
view of its function, the usual suggestion being that it
augments duodenojejunal flexure, acting like a
valve.Muscle fibres in the ligament of Treitz

Answer: (D) Sternocleidomastoid

Anatomy and Genetics / 9

6. Which of the following statements about Diploic
Veins is not true:
A. They are seen in Cranial Bones:
B. They arelined by single layer endothelium supported
by elastic tissue
C. They do not have valvesc. valveless
D. They develop at 8th Week of Intrauterine Life
Reference: Grays Anatomy 38th Edition Page 1581
QTDF: Gray
Quality: Reader
Status: New
Discussion
Diploic veins occupy channels in the diplo of some cranial
bones and are devoid of valves. They are large, with
dilatations at irregular intervals; their thin walls are
merely endothelium supported by elastic tissue .
Radiographically they may appear as relatively transparent
bands 3 or 4 mm wide. Absent at birth, they begin to
develop with the diplo at about 2 years.
Explanation
Self explanatory
Comments
The diploic veins communicate with meningeal veins,
dural sinuses and pericranial veins. Recognizably regular
channels are:
Frontal diploic vein, emerging from bone in the
supraorbital foramen to join the supraorbital vein
Anterior temporal (parietal) diploic vein, confined
chiefly to the frontal bone, which pierces the greater
wing of the sphenoid to end in the sphenoparietal sinus
or anterior deep temporal vein
Posterior temporal (parietal) diploic vein, in the parietal
bones, descending to the parietal mastoid angle to join
the transverse sinus through a foramen at the angle
or mastoid foramen
Occipital diploic vein, the largest, confined to the
occipital bone, opening into occipital veins or the
transverse sinus near the confluence of sinuses or into
an occipital emissary vein.
Tips
In the cranial bones, the layers of compact tissue are
familiarly known as the tables of the skull; the outer one

10 / AIPG January 2008

is thick and tough; the inner is thin, dense, and brittle, and
hence is termed the vitreous table. The intervening
cancellous tissue is called the diplo, and this, in certain
regions of the skull, becomes absorbed so as to leave spaces
filled with air (air-sinuses) between the two tables.

Answer: They develop at 8th Week of Intrauterine Life

Anatomy and Genetics / 11

7.
A.
B.
C.
D.

In the lungs, bronchial arteries supply:

Till tertiary bronchi
Till segmental bronchi
Till respiratory bronchioles
Till alveolar sacs

Reference: Grays Anatomy 38th Edition Page 1674

QTDF: Gray
Quality: Spotter
Status: New Question from repeated topic
Discussion
Bronchial arteries supply oxygenated blood to maintain
the pulmonary tissues.
They are derived from the descending thoracic aorta
directly or indirectly;
the right is usually a branch of the third posterior
intercostal artery, whilst
there are normally two left bronchial arteries (upper
and lower) which branch separately from the
thoracic aorta.
The bronchial arteries accompany the bronchial tree
and supply bronchial glands and the walls of the
bronchial tubes and larger pulmonary vessels.
The bronchial branches form, in the muscular tunic of
the air passages, a capillary plexus supporting a second,
mucosal plexus which communicates with branches
of the pulmonary artery and drains into the pulmonary
veins. Other arterial branches ramify in interlobular
loose connective tissue and end partly in deep and
partly in superficial, bronchial veins. Some also ramify
on the surface of the lung, forming subpleural capillary
plexuses.
Explanation
Bronchial arteries supply the bronchial wall as far as the
respiratory bronchioles.
Comments
They anastomose with branches of the pulmonary arteries
in the walls of the smaller bronchi and in the visceral pleura.
Such bronchopulmonary anastomoses may be more
numerous in the newborn, and then later obliterated to
a marked degree.
Tips
In addition to the main bronchial arteries, smaller bronchial
branches arise from the descending thoracic aorta; one of
these may lie in the pulmonary ligament and may cause
bleeding during inferior lobectomy.
Answer: (C) Till Respiratory Bronchioles

12 / AIPG January 2008

8. Which of the following is not a tributary of cavernous
sinus:
A. Superficial middle cerebral vein
B. Deep middle cerebral vein
C. Superior petrosal sinus
D. Inferior petrosal sinus
E. Not a tributary of Cavernous sinus
Reference: Gray 38th Edition Pages 1585, 1587
QTDF: ???
Quality: Confusa
Status: Repeat
Discussion
Tributaries of Cavernous Sinus
Superior ophthalmic vein,
A branch from the inferior ophthalmic vein (or the
whole vessel),
Superficial middle cerebral vein,
Inferior cerebral veins
Sphenoparietal sinus;
Central retinal vein
Frontal tributary of the middle meningeal
sometimes drain to it.
The sinus drains
to the transverse sinus via the superior petrosal
sinus,
to the internal jugular via the inferior petrosal sinus
and a plexus of veins on the internal carotid,
to the pterygoid plexus by veins traversing the
emissary sphenoidal foramen, foramen ovale and
foramen lacerum and
to the facial vein via the superior ophthalmic.
The two sinuses are connected by anterior and posterior
intercavernous sinuses and the basilar plexus. All
connections are valveless; the direction of flow in them
is reversible.
Explanation
If the question had been Which is a tributary then
the answer is superficial middle cerebral vein
If the question had been Which is not a connection
the answer is Deep Middle Cerebral Vein
Comments
Inferior Petrosal Sinuses drain the cavernous sinuses to
the internal jugular veins. Each begins postero-inferiorly
at its cavernous sinus and runs back in a groove between

Anatomy and Genetics / 13

the petrous temporal and basilar occipital bones.
Traversing the anterior part of the jugular foramen it ends
in the superior jugular bulb. It receives labyrinthine veins
via the cochlear canaliculus and the vestibular aqueduct
and tributaries from the medulla oblongata, pons and
inferior cerebellar surface. According to Browder and
Kaplan the sinus is more often a plexus and sometimes
drains by a vein in the hypoglossal canal to the suboccipital
vertebral plexus.
Tips
Propulsion of blood in the sinus is partly due to pulsation
of the internal carotid artery. It is also influenced by gravity
and hence by the position of the head.

Answer: ??

14 / AIPG January 2008

9. The vein that is found in relation to the Paraduodenal
fossa is:
A. Inferior mesenteric vein
B. Middle colic vein
C. Left colic vein
D. Splenic vein
Reference: Grays Anatomy 38th Edition Page 1603
BDC 3rd Edition II Volume Page 204
Quality: Spotter
Status: Repeated from AIPG 2003
QTDF: Grays Anatomy
Discussion
Inferior Mesenteric Vein drains the rectum, and sigmoid
and descending parts of the colon. It begins as the superior
rectal vein, from the rectal plexus, through which it
connects with middle and inferior rectal veins. The superior
rectal vein leaves the pelvis and crosses the left common
iliac vessels medial to the left ureter with the superior rectal
artery, continuing up as the inferior mesenteric vein. This
is left of its artery, ascending behind the peritoneum
anterior to the left psoas major; it may cross the testicular
or ovarian vessels or be medial to them and then passes
above, or behind, the duodenojejunal flexure, opening into
the splenic vein posterior to the body of the pancreas;
sometimes it ends at the union of the splenic and superior
mesenteric veins.
Explanation
If a duodenal or paraduodenal fossa exists, the vein is
usually in its anterior wall.
Comments
Its tributaries are sigmoid veins from the sigmoid colon
and the left colic vein from the descending colon and the
left colic flexure.
Tips
Go through the various fossae, Recesses and the Triangles.
Of late questions are being asked from these

Answer: (A) Inferior mesenteric vein

Anatomy and Genetics / 15

10. The skin overlying the region where a cut-down
is made to access the Great saphenous vein is supplied
by:
A. Femoral nerve
B. Sural nerve
C. Tibial nerve
D. Superf. peroneal nerve
Reference: Grays Anatomy 38th Edition Page 1281, 1564
QTDF: All Book
Quality: Thinker
Status: New Stem
Discussion
The posterior division of the femoral nerve supplies
the saphenous nerve and branches to the quadriceps
femoris and the knee joint
Saphenous Nerve is the largest femoral cutaneous
branch and this descends lateral to the femoral artery
into the adductor canal, where it crosses anteriorly to
become medial to the artery. At the distal end of the
canal it leaves the artery, emerging through the
aponeurotic covering with the saphenous branch of the
descending genicular artery. It proceeds vertically
along the medial side of the knee behind the sartorius,
pierces the fascia lata between the tendons of the
sartorius and gracilis and becomes subcutaneous.
Thence it descends the medial side of the leg with the
long saphenous vein along the medial tibial border and
divides distally into a branch continuing along the tibia
to the ankle and into another passing anterior to the
ankle to supply the skin on the medial side of the
foot, often as far as the hallucial metatarsophalangeal
joint; it connects with the medial branch of the
superficial peroneal nerve.
Explanation
The nerve which supplies the medial malleolar region is
Saphenous Nerve. But it is not given as one of the choices.
However Femoral nerve is given. So we opt for that
Comments
Near midthigh the saphenous nerve gives a branch to the
subsartorial plexus. As it leaves the adductor canal an
infrapatellar branch pierces the sartorius and fascia lata
to supply the prepatellar skin; proximal to the knee it
connects with medial and intermediate femoral cutaneous
nerves; distal to it, it connects with other branches of the

16 / AIPG January 2008

saphenous nerve; laterally it connects with the lateral
cutaneous femoral nerve, forming a patellar plexus.
Tips
Saphenous Nerve is also called as the long or internal
saphenous nerve.
It is the largest cutaneous branch of the femoral nerve.

Answer: (A) Femoral nerve

Anatomy and Genetics / 17

11.
A.
B.
C.
D.

Which is not involved in Low Radial Nerve Palsy:

Brachoradialis
Loss of Nerve Supply to Extensor Carpi Radialis Brevis
Loss of Nerve Extensor pollicis brevis.
Loss of Sensation over first dorsal web spave

Reference: Snells, 6th, Pg-493, AK Dutta, Pg-66, BDC Vol

1 Page 90, Grays Anatomy 38th Edition Page 1274
Quality: Reader
Status: Repeat
QTDF: All books
Discussion
BDC describe the branches of Radial Nerve only under
the following headings:
Before Spiral Groove
Long Head of Triceps
Medial Head of Triceps
In Spiral Groove
Long Head of Triceps
Lateral Head of Triceps
Medial Head of Triceps
Ancomeus
After Spiral Groove
Brachialis
Brachoradialis
Extensor Carpi Radialis
Gray describes the muscular branches as below:
These supply the triceps, anconeus, brachioradialis,
extensor carpi radialis longus and brachialis in medial,
posterior and lateral groups.
Medial muscular branches
Arise from the radial nerve on the medial side of
the arm.
They supply the
Medial head of Triceps -the branch to the
medial being a long, slender filament which,
lying close to the ulnar nerve as far as the distal
third of the arm, is often termed the ulnar
collateral nerve.
Long heads of the triceps,
A large posterior muscular branch
Arises from the nerve as it lies in the humeral groove.
It divides to supply the
Medial and
Lateral heads of the triceps and the

18 / AIPG January 2008

Anconeus, that for the latter being a long nerve

which descends in the medial head of the
triceps and partially supplies it; it is
accompanied by the middle collateral branch
of the arteria profunda brachii and passes
behind the elbow joint to end in the anconeus.
Lateral muscular branches
Arise in front of the lateral intermuscular septum;
Supply the
Lateral part of the brachialis,
Brachioradialis and
Extensor carpi radialis longus.

Explanation
Lesions of Radial Nerve
At axilla
Loss of Elbow Extension
Loss of Sensation in the lateral and posterior Part of Arm
Loss of Wrist Extension - Wrist Drop
Loss of Thumb Extension - Thumb drop
Loss of Finger Extension - Finger drop
Loss of Sensation in the first dorsal web space
At the lower end of Spiral Groove
Loss of Wrist Extension - Wrist Drop
Loss of Thumb Extension - Thumb drop
Loss of Finger Extension - Finger drop
Loss of Sensation in the first dorsal web space
After Spiral Groove Before Piercing the Supinator and before
the origin of sensory branch
Diminished Wrist Extension - Wrist Deviates radially when
extended
Loss of Thumb Extension - Thumb drop
Loss of Finger Extension - Finger drop
Loss of Sensation in the first dorsal web space
After Piercing the Supinator (Posterior Interosseus Nerve)
Loss of Thumb Extension - Thumb drop
Loss of Finger Extension - Finger drop
Superficial Branch
It lies superficially and relatively unprotected overlying the lateral
aspect of the radius, where it is easily compressed by tight
bracelets, watch straps and handcuffs, Called as Cheralgia
Paraesthetica (compare with Meralgia Paraesthetica)
Loss of Sensation in the first dorsal web space
If the lesion is proximal in this nerve, sensation may be
impaired over a variable area of skin over the lateral side
of the dorsum of the hand.

Anatomy and Genetics / 19

Comments
Radial Nerve Extends, Flexes (by supplying Bracho
Radialis, which is morphologically a extensor and
functionally a flexor and Brachialis which has a dual nerve
Supply along with Musculocutaneous Nerve) and also
Supinatesbut it does not supply pronation
Tips
Other nerve Injuries
zLesions of the Median Nerve
Median nerve lesions occur at two sites,
In the forearm (Pronator Syndrome) and
At the wrist. (Carpal Tunnel Syndrome)
Pronator Syndrome
This is an uncommon entrapment neuropathy of the
median nerve
Sites
The nerve may be involved at any of these sites.
1. As it passes alongside the fibrous band connecting the
biceps tendon to the forearm fascia,
2. As it passes down between the two heads of pronator
teres
3. As it passes through a fibrous arch formed by flexor
digitorum superficialis.
Symtoms and Signs
Motor
There is weakness of all the muscles innervated by the
median nerve, including abductor pollicis brevis and the
long finger flexors.
Sensory
There is also sensory impairment on the palm of the
hand(spared in the carpal tunnel syndrome because the
palmar cutaneous branch of the median nerve arises above
the carpal tunnel and lies superficial to it.)
Anterior interosseous nerve palsy
The anterior interosseous nerve usually arises from the
median nerve proximal to the site of compression in the
pronator syndrome; it may be affected with the median
nerve or by itself.
Causes
1. Due to external pressure(a form of Saturday night
palsy),
2. Sometimes by tight grip in association with pronation
without obvious cause.

20 / AIPG January 2008

3. May be a manifestation of neuralgic amyotrophy and
tends to resolve spontaneously over several months.
Motor:
An anterior interosseous nerve palsy causes weakness of
pinch grip due to involvement of flexor pollicis longus and
flexor digitorum profundus to the index finger.
Please note that
Innervation of flexor digitorum profundus to the middle finger
is rather variable,(also by Ulnar Nerve) therefore this muscle
may or may not be weak.
The branches to these three muscles (FDP,FPL,PQ)may
arise separately from the median nerve, so that isolated
weakness of the terminal phalanx to the thumb or index
finger may occur. The pronator quadratus is also involved
but is not clinically significant.
Carpal Tunnel Syndrome
This is the most common entrapment mononeuropathy
caused by the compression of the median nerve as it passes
through the fibro-osseous tunnel beneath the flexor
retinaculum.
Causes
The carpal tunnel may be narrowed by
1. Arthritic changes in the wrist joint, particularly
rheumatoid arthritis;
2. Soft tissue thickening as may occur in myxoedema and
acromegaly;
3. Edema and obesity including pregnancy.
Pathology
Normally the nerve slides smoothly in and out of the carpal
tunnel with flexion and extension of the wrist; when the
nerve is compressed there is an additional damage to the
nerve with flexion and extension.
The dominant hand is usually affected first, probably
because this hand is used more frequently and more
vigorously.
Motor
There is wasting and weakness of abductor pollicis brevis
Sensory
Impairment of sensation in the
1. Thumb,
2. Index Finger,
3. Middle Finger and
4. Median side of the Ring finger,
(the palmar branch of the median nerve is spared since
it does not pass through the carpal tunnel.)

Anatomy and Genetics / 21

Lesions of the Ulnar Nerve
Ulnar nerve lesions occur at four sites,
Behind the medial epicondyle,
In the cubital tunnel,
At the wrist and
In the hand.
At the Elbow
The ulnar nerve is in a vulnerable position as it lies between
the median epicondyle and the olecranon: it lies on bone
covered only by a thin layer of skin.
It is easily damaged if the ulnar groove is shallow and
the nerve may become more prominent than the medial
epicondyle or the olecranon when the elbow is fully flexed.
Sometimes the nerve may override the medial
epicondyle in full flexion. Loss of the ulnar groove may
be associated with arthritis of the elbow joint, often due
to an old fracture, in which case there may be incomplete
extension of the elbow with a wide carrying angle.
The nerve is easily palpable and is often thickened.
Motor
There is usually weakness of flexor digitorum profundus
to the ring and little fingers, and if these muscles are
involved the lesion must be at the elbow.
zSensory
Sensation Impaired in
Palmar Aspect
Medial palmar skin,
Medial side of the little finger,
Adjoining sides of little and ring fingers
Dorsum
Medial side of the little finger,
Adjacent sides of the little and ring,
Adjoining sides of the ring and middle finger
Cubital Tunnel Syndrome
This is an entrapment neuropathy of the ulnar nerve in
the tunnel formed by the tendinous arch connecting the
two heads of flexor carpi ulnaris at their humeral and ulnar
attachments. The clinical features are precisely the same
as a lesion in the ulnar groove and again, involvement of
flexor digitorum profundus to the ring and little fingers
is variable.
Lesions at these two sites cannot be reliably
distinguished neurophysiologically, but in the cubital
tunnel syndrome the elbow joint is usually normal: elbow
movements are full with a normal carrying angle; the ulnar

22 / AIPG January 2008

nerve feels normal in the ulnar groove; it does not sublux;
nor does it become superficial on elbow flexion.
At the Wrist
Site
The ulnar nerve may be compressed in Guyons canal by
a ganglion.
Motor
All the small hand muscles innervated by the ulnar nerve
are involved.
Preservation of flexor digitorum profundus to the ring
and little fingers
The dorsal cutaneous branch and the palmar branch
of the ulnar nerve are both spared since the lesion is distal
to their origin from the main trunk of the ulnar nerve in
midforearm.
In the Hand
The deep motor branch of the ulnar nerve may be
compressed against the pisiform and hamate bones when
the hand is used as a mallet, or if a vibrating tool or
motorcycle handlebar is held in such a way that the
hypothenar eminence is off the edge of the handle. The
sensory branches are always spared and involvement of
the hypothenar muscles is variable depending on the level
at which branches to these muscles arise.

Answer: (A) Brachoradialis

Anatomy and Genetics / 23

12.
A.
B.
C.
D.

What is the type of joints between the ossicles of ear:

Fibrous Joints
Primary cartilaginous
Secondary Cartilaginous Joints
Synovial Joints

Reference: Gray 38th Edition Page 1375

QTDF: Gray
Quality: Reader
Status: Repeat
Discussion
The articulations between ear ossicles are typical synovial
joints.
Explanation
Self Explanatory
Comments
The incudomalleolar joint is saddle-shaped, the
incudostapedial is a ball and socket articulation. Their
articular surfaces are covered with articular cartilage and
each joint is enveloped by a capsule containing much elastic
tissue and lined by synovial membrane.
Tips
Joints are classified as follows
I. SYNARTHROSES bonesolid connective tissue
bone
1. FIBROUS JOINTS (Articulationes fibrosae)
a. Sutures: bonecollagenous sutural ligament
bone
b. Syndesmoses: bonecollagenous interosseous
ligament, membrane or cordbone(elastic
fibrous tissue is occasionally prominent)
c. Gomphoses: bonecomplex collagenous
periodontiumdental cement
2. CARTILAGINOUS JOINTS (Articulationes
cartilagineae)
a. Synchondroses: bonehyaline cartilage
bone (Primary cartilaginous joints)
b. Symphyses: bonehyaline cartilagefibrocartilaginous dischyaline cartilagebone
(Secondary cartilaginous joints)
SYNOSTOSES: Rigid bony union; after growth has ceased
this is the normal fate of synchondroses, ultimately most
sutures, and some symphyses

24 / AIPG January 2008

II. DIARTHROSES bonecavitated connective tissue
bone
SYNOVIAL JOINTS bonearticular cartilagesynovial
fluid in cavityarticular cartilagebone (Articulationes
synoviales) Bond: surrounding sleeve of collagenous fibrous
capsule lined by synovial membrane; extrinsic and intrinsic
ligaments and presence of occasional intracapsular
ligaments, tendons, fat pads, fibrocartilaginous discs or
menisci.

Answer: (D) Synovial Joints

Anatomy and Genetics / 25

13. Facial Nucleus / Facial Colliculus seen in:
A. Midbrain
B. Pons
C. Medulla
D. Interpeduncular fossa
Reference: Gray 38th Edition 1243
QTDF: All Books
Qualtiy: Spotter
Status: Repeat
Discussion
The nucleus from which most facial motor fibres are
derived lies deep in the reticular formation of the caudal
part of the pons, posterior to the dorsal trapezoid nucleus
and ventromedial to the spinal tract nucleus of the
trigeminal nerve. It represents the branchial efferent
column but lies deeper in the pons than might be expected
and its efferent fibres have a most unusual course. Both
these features have been explained by invoking
neurobiotaxis.
Explanation
Self Explanatory
Comments
The nucleus receives fibres from both corticonuclear tracts
in the lower pons and is reputedly supplied by aberrant
pyramidal fibres which descend in the medial lemniscus.
The facial motor nucleus is a complex consisting of lateral,
intermediate and medial subnuclei The lateral subnucleus
is said to innervate the buccal musculature, the intermediate sends axons into the temporal, orbital and
zygomatic facial branches and the medial group into the
posterior auricular and cervical rami and probably the
stapedial nerve. Nuclear lesions have produced a roughly
similar but more detailed schema
Tips
Sensory Nucleus is the rostral end of the nucleus solitarius
in the medulla oblongata. It receives gustatory and possibly
other afferents from the sensory root and sends fibres to
the contralateral ventral lateral thalamic nuclei. As they
ascend in the midbrain and subthalamic regions, these
fibres pass near the midline.
The sensory root also contains efferent preganglionic
parasympathetic fibres for the submandibular and sublingual salivary glands, lacrimal gland, and pharyngeal,
nasal and palatine glands.
Answer: (B) Pons

26 / AIPG January 2008

14. All of the following are Somatic Efferent except:
A. Facial nerve
B. III Nerve
C. IV Nerve
D. VI Nerve
Reference: Grays Anatomy 38th Edition Pages 238, 241
QTDF: Gray / Neuroanatomy Books
Quality: Thinker
Status: New
Discussion
General somatic efferent neurons exit ventrally in a similar
manner to those of the spinal cord, comprising the
oculomotor, trochlear, abducens and hypoglossal nerves.
Thus nerves III, IV, VI and XII parallel the organization
of the somatic motor neurons in the spinal cord.
Explanation
Self Explanatory
Comments
The second motor component, special branchial
efferent, comprises the accessory nerve and the motor
parts of the trigeminal, facial, glossopharyngeal and
vagus nerves, whose nerve exit points lie more dorsally
than the somatic motor system.
The cranial nerves also contain a third class of efferent
neurons, the general visceral efferent neurons
(parasympathetic preganglionic) travelling in nerves
III, VII, IX and X, which leave the hindbrain via the
same exit points as the special branchial efferent fibres.
The most rostral sensory ganglion, the trigeminal (V)
comprises both neural crest and placode-derived
neurons that mediate general somatic afferent
functions. In the case of more caudal cranial nerves
(VII, IX and X) the same applies, but the two cell
populations form separate ganglia in the case of each
nerve. Analogous with the trigeminal, the proximal
series of ganglia is neural crest derived (forming the
proximal ganglion of VII, the superior ganglion of IX
and the jugular ganglion of X) while the distal series
derives from placodal cells (forming the geniculate
ganglion of VII, the petrosal ganglion of IX and the
nodose ganglion of X). These ganglia contain neurons
that mediate special, general visceral and somatic
afferent functions. The VIIth nerve has a vestibular
ganglion containing both crest and placodal cells and
an acoustic ganglion from placodal neurons only; it
conveys special somatic afferents.

Anatomy and Genetics / 27

Both neurons and supporting cells of the cranial

autonomic ganglia in the head and the trunk originate
from neural crest cells

Tips
Types of functional components in a nerve
Fibres and Sensation Carried Nucleus
Sensory or
Afferent

Visceral

Somatic

Motor of
Efferent

Visceral

Somatic

General

General Visceral Afferent

Dorsal Nucleus of
Vagus
Pain arising from Viscera

Special

Special Visceral Afferent

Taste

Nucleus Tractus
Solitarius
Nucleus of Dorsal
Visceral Gray

General

General Somatic Afferent

Exteroceptive impulses
cutaneous sensations
of pan, touch and
temperature Proprioceptive impulses
arising in muscles,
tendon and joints
conveying information
regarding movement
and position of joint

Chief Sensory
Nucleus (Tactile)
Nucleus of Spinal
Tract of Trigeminal
Nerve (Pain Temp)
Nucleus of
Mesencephalic Tract
of Spinal Nerve
(Proprioception)

Special

Special Somatic Afferent

Vision
Hearing
Equilibrium

Nucleus of the
Vestibulocochlear
nerver

General

General Visceral Efferent

General visceral efferent
neurons
Parasympathetic
preganglionic (III, VII,
IX and X)
innervate glands of the
head,
the sphincter pupillae
and ciliary muscles,
and the thoracic and
abdominal viscera.
Smooth muscle
Cardiac Muscle
Glands

Dorsal Vagal Nucleus

Superior Salivatory
Nucleus
Inf Salivatory Nucleus
Lacrimatory Nucleus
Edinger Westpal
Nucleus

Special

Nucleus Ambigus
Special Visceral Efferent
(accessory nerve and the
motor parts of the V,
VII, IX, X nerves)
Also called as Branchial
Efferent.
Striated muscles
developing within the
pharyngeal (branchial)
arches
Mucles of Mastication,
face, larynx

General

General Somatic Efferent

Answer: (A) Facial nerve

Oculomotor Nucleus
(III)
Supply striated muscle
Trochlear Nucleus
now known to be
(IV)
derived from the cranial
Abducent Nucleus
(occipital) somites and
(VI)
prechordal mesenchyme.
Hypoglossal
Muscles of Body wall
Nucleus (XII.
and Limbs
Eye and Tongue

28 / AIPG January 2008

15. Which is the Nucleus of Masseteric Reflex:
A. Chief Sensory Nucleus
B. Nucleus of Spinal Tract of Trigeminal Nerve
C. Nucleus of Mesencephalic Tract of Spinal Nerve
D. Dorsal Vagal Nucleus
Reference: Grays Anatomy 38th Edition Page 1237
QTDF: Gray
Quality: Thinker
Status: New
Discussion
The trigeminal, the largest cranial nerve, is the sensory
supply to the face, the greater part of the scalp, the teeth, the
oral and nasal cavities, the dura mater and the cerebral blood
vessels. It gives the motor supply to the masticatory muscles,
and the anterior belly of digastric and mylohyoid, and
contains proprioceptive nerve fibres from the masticatory
and probably the extraocular and facial muscles
Expanation
A. Chief Sensory Nucleus is concerned with Tactile
sensation.
B. Nucleus of Spinal Tract of Trigeminal Nerve is
concerned with Pain and Temperature Sensation.
C. Nucleus of Mesencephalic Tract of Spinal Nerve is
concerned with proprioception
D. Dorsal Vagal Nucleus is a General Visceral Efferent
Nucleus which innervates glands of the head, the
sphincter pupillae and ciliary muscles, and the thoracic
and abdominal viscera.
Comments
Masseter is supplied by a branch of the anterior trunk of
the mandibular nerve.
Tips
Other ascending fibres enter the mesencephalic nucleus,
a column of unipolar cells, whose peripheral branches may
convey proprioceptive impulses from the masticatory
muscles; it is also stated that similar impulses reach it from
the teeth and from the facial and ocular muscles. Its neurons
are unique in being the only primary sensory neurons with
somata in the CNS. It is the relay for the only supraspinal
monosynaptic reflex, namely the jaw-jerk. If, however,
the primary proprioceptive neurons of extraocular muscles
are in fact situated in their motor nerves or in the trigeminal
ganglion, some mesencephalic trigeminal neurons may be
secondary in status. Small multipolar cells, possibly
interneurons, occur near the unipolar neurons.
Answer: (C) Nucleus of mesencephalic tract of spinal nerve

Anatomy and Genetics / 29

16.
A.
B.
C.
D.

Biondi ring tangles found in:

Choroidal plexus cells
Golgi type II cells
Basket cells
??

QTDF: ??
Status: New
Quality: Super-specialty
Reference, Discussion, Explanation:
http://www.springerlink.com/content/
rp13274551870703/
Biondi bodies in the choroid plexus epithelium of the
human brain
Journal
Cell and Tissue Research
Publisher
Springer Berlin / Heidelberg
ISSN
0302-766X (Print) 1432-0878 (Online)
Issue
Volume 244, Number 1/April, 1986
Category
Short Communications
DOI
10.1007/BF00218405
Pages
239-240. (1986;244(1):239-40.
Subject Collection Biomedical and Life Sciences
SpringerLink Date Monday, November 29, 2004
A. I. Kiktenko1
1. All-Union Research Center of Mental Health, Academy
of Medical Sciences of the USSR, Moscow, USSR
2. All-Union Research Center of Mental Health, Academy
of Medical Sciences of the USSR, Zagorodnoje shosse
2, korp 2, 113152 Moscow, USSR
Accepted: 9 December 1985
Summary
Scanning electron microscopy (SEM) was used to examine
choroid plexuses in the brain of two human adults aged
44 and 46, respectively, and 12 older subjects from 67 to
98 years of age. It was possible to obtain a threedimensional view of the ring-like structures (Biondi bodies)
located in the cytoplasm of choroid plexus epithelial cells
in the older-age group. The filaments forming the rings
were clearly visible. No such structures were found
between epithelial cells. The intracellular location of the
Biondi bodies and their state of preservation compared to
other cytoplasmic elements suggest that they may have
a destructive effect on epithelial cells of choroid plexuses.
The same material was examined by transmission electron
microscopy (TEM); the results obtained were in full
agreement with the evidence obtained with SEM.

30 / AIPG January 2008

Comments
No Comments !!!
Tips
Dont waste your time reading such questions again and
again

Answer: (A) Choroid Plexus

Anatomy and Genetics / 31

17. A surgeon excises a portion of liver to the left of the
attachment of the faliciform ligament. The segments that
have been resected at:
A. 1 a and 4
B. 1 and 4b
C. 2 and 3
D. 1 and 3
Reference: Gray Page 38th Edition 1797, Sabiston Surgery
QTDF: ??
Quality: Thinker
Status: New Question from Repeated Topic
Discussion
Although much of the surface is smoothly continuous, the
liver is customarily apportioned by anatomists into a larger
right and a much smaller left lobe according to some surface
markings and peritoneal attachments, namely the line of
attachment of the falciform ligament anteriorly, and the
fissure for the ligamentum teres and ligamentum venosum
on the livers inferior surface. To the right of this groove
are two prominences, the quadrate lobe in front, and the
caudate lobe behind, separated from each other by the
porta hepatis. The gallbladder lies (usually) in a shallow
fossa to the right of the quadrate lobe.
Explanation
The above statement (from Gray) clearly says that Caudate
Lobe and Quadrate lobe are to the right of the attachment
of the falciform ligament. So in this case, based on the
diagram given below we can safely assume that these two
lobes were not resected. (Do note that Segment 1 is Caudate
Lobe)

32 / AIPG January 2008

Comments: Segmental anatomy as defined by Couinaud
(the French system).
According to Couinauds description, the three main
hepatic veins divide the liver into four sectors.
He terms the planes through which the veins course
the portal scissurae.
The right, main, and left portal scissurae define the four
sectors, each of which receives a portal pedicle.
The main portal scissura divides the liver into right
and left sectors. The right portal scissura divides the
right and left livers into sectors.
It also divides the right liver into anterior and posterior
sectors, each of which sectors contains two segments:
the anterior sector has segment V inferiorly and
segment VIII superiorly, and
the posterior sector has segment VI inferiorly and
segment VII superiorly.
The left portal scissura divides the left liver into
superior and inferior sectors.
The umbilical fissure divides the anterior sector into
two segments:
segment IV medially and segment III laterally.
The posterior sector has only one segment, segment
II, which forms the posterior part of the left lobe.
The caudate lobe comprises segment I.
The portal veins and hepatic arteriole branches
correspond to the segmental anatomy. Likewise, the
bile ducts provide segmental drainage.
Tips
I.
II.
III.
IVa.
IVb.
V.
VI.
VII.
VIII.

Caudate/Spigel lobe
Left posterolateral segment
Left anterolateral segment
Left superomedial segment
Left inferomedial segment
Right anteroinferior segment
Right posteroinferior segment
Right posterosuperior segment
Right anterosuperior segment

Answer: (C) 2 and 3

Anatomy and Genetics / 33

18. Which of the following is the correct order for
Pathway a sperm:
A. Straight tubules Rete testis Efferent tubules
B. Rete Tubules Efferent Tubules Straight Tubule
C. Efferent Tubule Rete Testis Straight Tubules
D. Straight Tubule Efferent Tubules Rete Tubules
Reference: Grays Anatomy 38th Edition Page 1849.
Diagram 14.2
QTDF: Gray
Quality: Thinker
Status: New
Discussion

Explanation
The actual path is seminiferous tubules Straight tubules
Rete Testis Efferent ductile Tail of epididymis
Deferent duct
Comments
As Highly coiled parts of the seminiferous tubules
reach the lobular apices they are less convoluted,
assume an almost straight course and unite into
2030 larger but short straight ducts (tubuli recti), about
0.5 mm in diameter.

34 / AIPG January 2008

Straight seminiferous tubules enter the fibrous tissue

of the mediastinum testis, ascending backwards as a
close network (the rete testis) of anastomosing tubes
lined by a flat epithelium.
At the upper pole of the mediastinum, 1220 efferent
ductules (ductuli efferentes) perforate the tunica
albuginea to pass from the testis to the epididymis.
They are at first straight, becoming enlarged and very
convoluted and forming conical lobules of the
epididymis, which make up its head (caput).
Each epididymal lobule is a convoluted duct, 1520
cm in length. Opposite the lobular bases the ducts open
into a single duct of the epididymis, whose coils form
the epididymal body (corpus) and tail (cauda). With
the coils unravelled the tube measures more than 6
metres, increasing in thickness as it approaches the
epididymal tail, where it becomes the deferent duct.
The coils are held together by bands of fibrous
connective tissue. The epididymal body and tail are
thus a single tube.

Tips
Efferent ductules are lined by two types of epithelial
cell: tall columnar ciliated cells, their cilia beating
towards the epididymis, and shorter non-ciliated cells
containing conspicuous lysosomes and shown to be
actively endocytic. External to the epithelium, the
ductules are surrounded by a thin circular coat of
smooth muscle.

Answer: (A) Straight tubules Rete testis Efferent

tubules

Anatomy and Genetics / 35

19.
A.
B.
C.
D.

The artery to the ductus deferens is a branch of:

Inferior epigastric artery
Superior Epigastric Artery
Superior Vesical Artery
Cremasteric Artery

Reference: Grays Anatomy 38th Edition Page 1559

QTDF: Most Books
Quality: Reader
Status: Repeat
Discussion
Each internal iliac artery, about 4 cm long, begins at the
common iliac bifurcation, level with the lumbosacral
intervertebral disc and anterior to the sacro-iliac joint; it
descends posteriorly to the superior margin of the greater
sciatic foramen, dividing here into: an anterior trunk, which
continues in the same line towards the ischial spine; and
a posterior trunk, passing back to the foramen.
Explanation
Superior Vesical Artery supplies many branches to the
vesical fundus; from one the artery to the ductus
deferens occasionally starts and accompanies the
ductus to the testis, anastomosing with the testicular
artery. Others supply the ureter. The beginning of the
superior vesical artery is the proximal, patent section
of the fetal umbilical artery.
Often arising with the middle rectal, Inferior Vesical
Artery supplies the vesical fundus, prostate, seminal
vesicles and lower ureter. Prostatic branches
communicate across the midline. The inferior vesical
may sometimes provide the artery to the ductus
deferens.
Comments
In the fetus the internal iliac artery is twice the size of the
external and is the direct continuation of the common iliac.
It ascends on the anterior abdominal wall to the umbilicus,
converging on its fellow. Having traversed the opening,
the two arteries, now umbilical, enter the umbilical cord,
coil round the umbilical vein and ultimately ramify in the
placenta. At birth, when placental circulation ceases, only
the pelvic segment remains patent as the internal iliac
artery and part of the superior vesical, the remainder
becoming a fibrous medial umbilical ligament raising the
peritoneal medial umbilical fold from the pelvis to the
umbilicus. In males, the patent part usually gives off an
artery to the ductus deferens.

36 / AIPG January 2008

Tips
The remnant of the fetal left umbilical vein is the
ligamentum teres of the liver; the obliterated umbilical
arteries form the medial umbilical ligaments, enclosed in
peritoneal folds of the same name; and the partially
obliterated remains of the urachus persist as the median
umbilical ligament.

Answer: (C) Superior Vesical Artery