1.

A 45 years old nulliparous woman

reported to the OPD with complaints of
small palpable nodules in left axilla.
She was admitted, investigated and
taken up for mastectomy (left)in the
same week. With your knowledge of
anatomy answer the following
questions:
A• What could be the probable
diagnosis?
B• What could be the nodule in the
axilla and why?
C• Describe the blood supply and
lymphatic drainage of the breast.
D• Mention the development and
developmental anomalies of the breast
2. A 55-year-old female presented to the
general surgery outpatient department
with pain in left axilla and swelling of
left upper limb. On clinical
examination the surgeon noted the
presence of a few enlarged swellings
in her left axilla and a swelling in the
upper lateral quadrant of her left
breast. With your knowledge in
anatomy, answer the following
questions.
a) Which group of axillary lymph
nodes could be enlarged in this
patient.
b) Describe the anatomical groups of
axillary lymph nodes and specify their
areas of drainage.
c) Describe the lymphatic drainage of
mammary gland
d) Enumerate the boundaries and
contents of axilla.
3. Assisted delivery was required during
the birth of a baby at term. The
maneuver involved an unusually wide
stretching at the neck shoulder angle.
The
neonate on examination by a
neurologist showed upper brachial
plexus injury.
Answer the following
• Describe formation and branches of
brachial plexus
•Explain the anatomical basis of the
above lesion
4. Describe the brachial plexus under
following headings.
• Formation
• Relations
• Branches
• Applied anatomy.
5. A football player dislocated his right
shoulder while
playing. After one month of treatment,
he noticed the right shoulder was less
prominent than the left and there was
difficulty to abduct.
• Mention the anatomical features
making the shoulder joint more prone
for dislocation
• What is the cause for flattening of
shoulder in this case and difficulty to
abduct?
• Name the movements occurring at
the shoulder joint and muscles
producing these movements
• State the reason, why head of the
humerus is often displaced
downwards?
6. A football player fell heavily and
dislocated his right shoulder joint
while playing. A collar and cuff
support was given, after reducing the
dislocation. Subsequently
an orthopedic surgeon noticed that his
right shoulder was less prominent
than the left. The player was finding it
difficult to abduct the arm to the
horizontal
level. Based on your anatomical
knowledge answer the following
questions:
• What anatomical features make the
shoulder joint particularly prone to
dislocation
• Briefly describe the most stabilizing
structure of the
joint and why the head of the humerus
is often displaced downwards.
•In this case, what is the cause of
subsequent flattening of the right
shoulder and the difficulty in
abducting the arm to a horizontal level.
• Briefly mention the ligaments and the
muscles acting at the shoulder joint.
7. Describe cubital fossa under following
headings.
•Boundaries
•Contents
•Clinical importance
8. A 35-year-old rowdy sheeter involved
in a fight received a deep cut in the
middle of the back of his right arm. He
was bleeding profusely and was
rushed to the hospital
1. Which nerve and artery at this site
are in danger of injury.
2. What is the origin and termination of
this artery.
3. How will you assess the functional
integrity of the nerve in this case.
4. Which part of the brachial plexus
gives origin to this nerve and which
other nerves arise from this part.
5. Give the motor distribution and
cutaneous branches of this nerve.
9. A 50 year old lady complains of severe
pains & needles sensation in the palm
of her hand and lateral fingers. On
examination there is loss of
sensations on lateral 3½ fingers, and
weakness of thenar muscles.
Sensations over thenar eminence
appear normal.
•Name the clinical syndrome and the
nerve affected mentioning its root
value.
•Give the attachments of the flexor
retinaculum of hand, enumerating the
structures passing superficial and
deep to it.
•Describe the distribution of the
affected nerve in the hand.
•Why are the sensations over the
thenar eminence spared?
(2+7+4+2)
10. A 45 year old man was brought to the
hospital with a fracture of the shaft of
the humerus. On examinations, he had
impairment of extension of the wrist.
There was also loss of cutaneous
sensation on the dorsum of the
forearm and lateral aspect of dorsum
of hand & lateral digits With your
knowledge of anatomy answer the
following questions.
•Name the clinical condition and the
structure involved in this scenario.
•Mention its origin, course and
branches at different levels of
distribution.
•Mention the reason for loss of
cutaneous sensations in the
mentioned.
•Name the accompanying blood
vessels at the site of fracture.
•What is the reason behind the
patient's inability to extend wrist joint
& also the joints of hand
•Name the other nerves that are
closely related to the humerus, giving
its appropriate sites and effect of
injury
•Describe the anastomosis around
elbow joint.
•What is wrist drop.
(1+5+2+1+2+1+2+1)
11. A 35-year-old female came to the OPD
with complaints of tingling sensation
along the lateral three and half digits
of her right hand. On examination she
had Ape thumb deformity.
When the patient was asked to make a
fist, there was extension of index
finger and thumb,
and Benediction sign was positive.
Based on your knowledge in anatomy,
answer the following:
•Name the anatomical structure
affected in the given scenario.
•What is the origin and root value of
the affected structure?
•Describe the entire course and
important relations of the structure in
the upper limbs from origin to
termination.
•Describe its branches and distribution
in the upper limb.
•Explain the anatomical reasons for
Ape thumb deformity and Benediction
sign.
•Name a clinical test to determine the
integrity of the affected structure.
•Describe the boundaries of the carpal
tunnel & enumerate its contents
(1+2+1+6+2+1+2)
12. A 36-year-old patient is examined by a
physician. The patient has weakness
of pronation and flexion at the index
and middle fingers at the distal
interphalangeal joints and inability to
form letter "O” by touching the tip of
thumb to index finger. There is no
sensory deficit.
•Which nerve has been injured?
•Mention its nerve of origin and root
value of the parent nerve.
•Describe the course of the parent
nerve in hand.
•Mention the area of supply
•Briefly describe pronation and
supination
•Explain Tinel sign and Phalen test
(1+3+4+2+3+2= 15)
13. A 25 yr old male brought to the
casualty with swelling in the right
elbow joint. The swelling developed
after he met with an accident. On
examination, movement was restricted
and the right ring and little finger was
hyper extended at the
metacarpophalangeal joint and flexed
at the interphalangeal joints. Physical
examination showed wasting of
hypothenar eminence. He could not
hold a card between ring & little finger
or thumb & index finger. X ray showed
fracture of medial epicondyle of
Humerus. With your knowledge in
Anatomy answer the following
questions
•What is the nerve likely to be injured?
•Explain the reason for the attitude of
the medial two fingers of the right
hand?
•Describe the origin, course, branches
and distribution of the nerve involved
in this condition.
•Give the anatomical reasons for
wasting of hypothenar eminence and
inability to hold the card between
fingers
•Explain anatomical basis of Carpal
tunnel syndrome.
(1+2+7+2+3)