15.

All of the following pass through aortic hiatus EXCEPT

a) Aorta
b) Greater splanchnic nerve
c) Thoracic duct
d) Azygous vein

 Right lymphatic duct begins as a convergence of the right subclavian lymph trunk, right jugular lymph
trunk, and right bronchomediastinal lymph trunk and terminates at right jugulo-subclavian angle at the
base of the neck. It drains right upper quadrant (RUQ) of the body: right side of the head & neck, right
thoracic region (including medial and lateral quadrant of right breast, right lung) and the right upper
limb.
16. Kidney derives nerve supply from
a) Coeliac plexus
b) Lumbar plexus
c) Inferior mesenteric nerve
d) Nervi erigentes
17. In first stage of labour the referred pain from uterus is carried to the dermatome (AIIMS)
a) T-10, 11
b) T-12; L-1
c) L-1, 2
d) S-2, 3
 Pain during first stage of labour is initially confined to T11 – T12 dermatomes (latent phase), but
eventually labour enters active phase and much of the pain is due to dilatation of cervix and lower
uterine segment and pain passes through hypogastric plexus and aortic plexus before entering the
spinal cord at T10 – L1 nerve roots. Stretching and compression of the pelvic and perineal structures
involves pudendal nerve (S2-4), so pain during second stage of labour involves T10 – S4
dermatomes.
18. To provide pain relief during first stage of labour which sensory level should be blocked
a) T8 to L1
b) T9 to L2
c) T10 to L1
d) T11 to L2

 Spinal anesthesia up to spinal nerve T10 is necessary to block pain for vaginal Delivary and up to
spinal nerve T4 for cesarean section (due to the sympathetic fibre levels being at higher level than
motor or sensory blockade).
Questions: Abdomen- I
19. Hirschsprung’s disease is specifically known as
a) Congenital megacolon
b) Aganglionic megacolon
c) Congenital aganglionic megacolon
d) Congenital atretic aganglionic megacolon

 Hirschsprung disease occurs due to non-migration of neural crest cells into the distal part of the gut
tube colon/rectum. There is absence of myenteric (Auerbach’s) ganglia, which is a parasympathetic
component for faecal evacuation. The diseased segment gets narrowed down and the normal
proximal segment is dilated (maga-colon) due to faecal retention. Rectal biopsy is a-ganglionic. The
presenting complaint is chronic constipation and on per rectal examination, there occurs sudden gush
of the retained faeces.
20. An infant presents with an omphalocele at birth. Which of the following applies to this condition
a) It is also seen in patients with aganglionic megacolon
b) It results from herniation at the site of regression of the right umbilical vein
c) It is caused by a failure of recanalization of the midgut part of the duodenum
d) It is caused by failure of the midgut to return to the abdominal cavity after herniation into the
umbilical stalk
21. Which type of gut rotation is shown below

a) Normal
b) Non-rotation
c) Mixed rotation
d) Reverse rotation

22. All of the following contribute to celiac plexus EXCEPT

a) Vagus
b) Lesser splanchnic nerve
c) Ilio-hypogastric nerve
d) Phrenic nerve

23. Pain of distension in congenital hypertrophic pyloric stenosis is carried by

a) Vagus
b) Greater splanchnic nerve
c) Lesser splanchnic nerve
d) Sympathetic root value T-10

24. A 46-year-old woman complains of significant abdominal pain that her physician thinks is
localized to the epigastric region. Which of the following organs is most likely involved in this
problem
a) Duodenum
b) Ileum
c) Kidney
d) Transverse colon
25. A 23-year-old female in good health suddenly doubles over with pain in the area of the
umbilicus. She feels warm and uneasy and has no appetite. The pain seems to have moved to
the lower right abdominal region, which nerves, perceived in the area of the umbilicus, most
likely carried the painful sensations into CNS
a) Vagus nerves
b) Lesser splanchnic nerves
c) 10th Intercostal nerve
d) Greater splanchnic nerves

26. Double inferior vena cava is formed due to

a) Persistence of sacrocardinal vein
b) Persistence of supracardinal vein
c) Persistence of subcardinal vein
d) Persistence of posterior cardinal vein
Ans. b) Persistence of supracardinal vein > c). Persistence of subcardinal vein .
Explanation: Double inferior vena cava results from persistence of left supra-cardinal vein.
Inferior vena cava has contributions from multiple embryonic veins: 1. Right subcardinal veins forms
suprarenal IVC (left subcardinal vein regresses). 2. Right supracardinal vein forms infrarenal IVC (left
supracardinal vein regresses).3. Posterior cardinal vein form distal IVC i.e. iliac bifurcation.
 Additional Questions: Abdomen- I
27. A child complains of fluid coming out of umbilicus on straining. The diagnosis is
a) Patent vitello-intestinal duct
b) Gastroschisis
c) Umbilical hernia
d) Urachal fistula
Ans. d) Urachal fistula
Explanation: Non-obliteration of allantois (hindgut diverticulum) may result in patent allantoic (urachal)
fistula , which leads to leakage of urine from the urinary bladder towards the umbilicus, especially on
straining.
 Abdomen - II
Liver Segments
28. Liver is divided into anatomical segments by following all EXCEPT
a) Hepatic vein
b) Portal vein
c) Bile ducts
d) Hepatic artery
29. All of the following segment of liver which drains into right hepatic duct EXCEPT
a) I
b) III
c) V
d) VIII

Arteries - Duodenum
30. Superior pancreatico-duodenal artery is a branch of
a) Superior mesenteric artery
b) Gastroduodenal artery
c) Celiac trunk
d) Inferior mesenteric artery
 The gastroduodenal artery is prone to erosion by posterior perforation of duodenal ulcer. Splenic
artery may be eroded by penetrating ulcer of the posterior wall of the stomach into the lesser sac.
Left gastric artery may be subjected to erosion by a penetrating ulcer of the lesser curvature of the
stomach.

Peritoneal cavity
31. A 32 year old computer operator with history of heartburn, develops sever excruciating pain in
the epigastric region. She is taken for immediate surgical exploration, which reveals evidence
of ruptured gastric ulcer. Where will the surgeon find the stomach contents
a) Omental bursa
b) Hepatorenal pouch of Morrison
c) Paracolic gutter
d) Pouch of Douglas
32. In Pringle’s manoeuvre the structure ligated is
a) Portal pedicle
b) Hepatic vein
c) Inferior vena cava
d) Cystic duct
 In Pringle manoeuvre a large atraumatic haemostat is used to clamp the hepatoduodenal ligament
(free border of the lesser omentum) interrupting the flow of blood through the hepatic artery and the
portal vein and thus helping to control bleeding from the liver. If bleeding though continue, it is likely that
the inferior vena cava or the hepatic vein were also traumatised.
33. Following are the boundaries of epiploic foramen EXCEPT
a) Free margin of lesser omentum
b) Inferior vena cava
c) Quadrate lobe of liver
d) Right adrenal
Trans-Pyloric Plane
34. NOT present at the transpyloric plane
a) L-1 vertebra
b) Right suprarenal gland
c) Tip of ninth cartilage
d) Fundus of gallbladder

Anterior Abdominal Wall

35. Gubernaculum is attached to

a) Cranial pole of testis
b) Caudal pole of testis
c) Body of testis
d) Epididymis
36. Testes completely descend in the scrotum by the age of
a) End of 7th month of intrauterine life
b) End of 8 month of intrauterine life
c) End of 9 month of intrauterine life
d) After birth

37. Triangle of Doom bounded by all EXCEPT

a) Vas deferens
b) Testicular vessels
c) Cooper ligament
d) Reflected peritoneal fold

38. While performing an operation in the region of femoral canal, the surgeon reaches the femoral
ring. All of the following statements describe the structures forming its boundaries EXCEPT
a) Lacunar ligament
b) Inguinal ligament
c) Pectineal ligament of Cooper
d) Falx inguinalis
 The femoral triangle is bounded by the inguinal ligament, the sartorius, and the adductor longus. Its
floor is formed by the iliopsoas, pectineus and adductor longus (& not the sartorius), and the roof is
formed by the fascia lata and cribriform fascia and contains the femoral artery and vein in the femoral
sheath but the femoral nerve outside it.
39. Accessory obturator artery is a branch of
a) Inferior epigastric
b) External iliac
c) Internal iliac
d) Obturator
Abdomen - Relations
40. All of the following statements regarding relations of pancreas are true EXCEPT
a) Right renal vein is immediately posterior to the head
b) Superior mesenteric vein lies anterior to the uncinate process
c) First part of duodenum is posterior to the head
d) Superior mesenteric vein lies posterior to the neck

 The left renal vein may be compressed by an aneurysm of the superior mesenteric artery as the
vein crosses anterior to the aorta. Patients with compression of the left renal vein may result in renal
(and adrenal) hypertension on the left. A varicocele may also be found on the left side.

41. All are anterior relations of Right kidney EXCEPT

a) Adrenal gland
b) 4th part of duodenum
c) Liver
d) Hepatic flexure of colon
 Questions: Abdomen - II
42. Calot’s triangle is bounded by all EXCEPT
a) Inferior surface of liver
b) Common hepatic duct
c) Cystic duct
d) Cystic artery
 The cystic artery commonly arises from the right hepatic artery is the boundary for Calot’s triangle.
The triangle lies between three Cs - Common hepatic duct, Cystic duct, and Cystic artery. Inferior
surface of liver forms the boundary for the triangle of cholecystetctomy. In the angle between
Common hepatic duct and cystic duct lies the Callot’s lymph node of Lund, which gets inflammed in
cholecystitis.

43. Left renal vein crosses aorta

a) Posterior at the level of superior mesenteric artery
b) Anterior above the level of superior mesenteric artery
c) Anterior below the superior mesenteric artery
d) Anterior below the inferior mesenteric artery

44. Which of the following is present in the peritoneal reflection which forms one of the borders of
the paraduodenal fossa
a) Inferior mesenteric vein
b) Middle colic vein
c) Left colic vein
d) Splenic vein

45. Ascent of horse shoe shaped kidney is prevented by

a) Superior mesenteric artery
b) Inferior mesenteric artery
c) Superior mesenteric vein
d) Inferior mesenteric vein

46. Renal angle lies between

a) 12th rib and latissimus dorsi
b) 12th rib and quadratus lumborum
c) 12th rib and lateral border of sacrospinalis
d) Iliac crest and erector spinae

47. Appendices epiploicae are present in

a) Caecum
b) Appendix
c) Sigmoid colon
d) Rectum
 48. Appendix posses
a) Taenia coli
b) Appendices epiploicae
c) Sacculations
d) Mesentery
49. Spleen projects into the following space of peritoneal cavity
a) Greater sac
b) Left subhepatic space
c) Infracolic compartment
d) Paracolic gutter
50. NOT a content of spermatic cord
a) Ductus deferens
b) Testicular artery
c) Ilio-inguinal nerve
d) Genital branch of genitofemoral nerve

 The spermatic cord is surrounded by the external spermatic fascia, which is derived from the
aponeurosis of the external oblique abdominal muscle, the cremasteric fascia (cremaster muscle and
fascia) originating from the internal oblique abdominal muscle, and the internal spermatic fascia, which
is derived from the transversalis fascia.

Additional Questions
51. Liver is divided into two surgical halves by all EXCEPT
a) Cantlie’s line
b) Right hepatic vein
c) Portal vein at porta hepatis
d) Biliary duct at porta hepatis
Ans. b) Right hepatic vein.
Explanation: Liver is divided into two surgical halves by following middle hepatic vein (and not the right
hepatic vein)
 52. A Segmental resection was performed removing part of liver lying left of the falciform ligament.
The segments still retained in the left surgical liver are (AIIMS)
a) 2,3
b) 1,4
c) 2,4
d) 1,4,5
Ans. b) 1,4.
Explanation: During hepatic resection, segment 2 and 3 (lying left to the falciform ligament) have been
removed, and segment 1 and 4 are retained in the left surgical liver.
53. Regarding artery supply of pancreas, which of the following is/are correct (PGIC)
a) Both superior and inferior pancreatico-duodenal arteries are branches of gastro-duodenal artery
b) Posterior superior pancreatico-duodenal artery is a branch of superior mesenteric artery
c) Anterior inferior pancreatico-duodenal artery is a branch of superior mesenteric artery
d) Posterior inferior pancreatico-duodenal artery is a branch of gastro-duodenal artery
e) Body and tail are supplied by splenic artery
Ans. c) and e) .
Explanation: Gastroduodenal artery gives superior pancreatico-duodenal arteries (anterior and posterior
both). Superior mesenteric artery gives inferior pancreatico-duodenal arteries (anterior and posterior both).
Splenic artery runs on the superior border of pancreas and give multiple branches to body and tail of
pancreas.
54. Structures damaged while resecting the free edge of lesser omentum (PGIC)
a) Portal vein
b) Hepatic vein
c) Proper hepatic artery
d) Cystic duct
e) Common bile duct
Ans. a) Portal vein; c) Proper hepatic artery; e) Common bile duct.
Explanation: Free edge of lesser omentum contains the structures that enter the posrta hepatis (DAV). D –
Duct (Common bile), A- Artery (proper hepatic), V – Vein (portal).
55. A patient has a penetrating ulcer of the posterior wall of the first part of the duodenum. Which
blood vessel is subject to erosion
a) Common hepatic artery
b) Gastroduodenal artery
c) Proper hepatic artery
d) Anterior superior pancreatico-duodenal artery
Ans. b) Gastroduodenal artery.
Explanation: Gastroduodenal artery passes behind the first part of duodenum and is prone to bleeding in
posterior perforation of duodenal ulcer.
56. Wrong about ileum, as compared with jejunum is
a) Short club shaped villi
b) Long vasa recta
c) More lymphoid nodules
d) More fat in mesentery
Ans. b) Long vasa recta.
Explanation: Ileum has short vasa recta with relatively more arcades.
 57. Maximum mucosa associated lymphoid tissue is seen in
a) Stomach
b) Duodenum
c) Jejunum
d) Ileum
Ans. d) Ileum
Explanation: The amount of lymphoid tissue increases towards the ileum. Peyer patches are
aggregations of lymphoid tissue (MALT) seen in the terminal ileum.

58. Ovarian ligament and Round ligament of uterus are derivatives of

a) Peritoneum
b) Transversalis fascia
c) Processus vaginalis
d) Gubernaculum
Ans. d) Gubernaculum
Explanation: During development of uterus, gubernaculum becomes ovarian ligament and round ligament
of uterus

59. What is most medial in the femoral triangle

a) Lymphatics
b) Nerve
c) Vein
d) Artery
Ans. a) Lymphatics
Explanation: Deep inguinal lymph nodes (and lymphatics) is the medial most structure in the femoral
triangle.

60. WRONG statement concerning femoral region is

a) Medial boundary of femoral ring is lacunar ligament
b) Femoral hernia lies infero-lateral to the pubic tubercle
c) Femoral nerve lies inside the femoral sheath
d) Adductor longus forms the medial boundary of femoral triangle
Ans. c) Femoral nerve is inside the femoral sheath.
Explanation: Femoral nerve lies outside the femoral sheath.

61. All are boundaries of inguinal triangle EXCEPT

a) Inguinal ligament
b) Medial border of pyramidalis
c) Inferior epigastric vein
d) Lateral border of rectus abdominis
Ans. b) Medial border of pyramidalis.
Explanation: Hesselbach’s inguinal triangle is present on the anteroinferior abdominal wall bounded by
the rectus abdominis muscle, the inguinal ligament, and the inferior epigastric vessels.
Medial border: lateral margin of the rectus sheath (linea semilunaris); superolateral border: inferior
epigastric vessels; inferior border: inguinal ligament (Poupart's ligament).
It is the site in which a direct inguinal hernia begins.

62. Posterior wall of rectus sheath below the level of anterior superior iliac spine is formed by
a) Internal oblique
b) Transversus abdominis
c) Lacunar ligament
d) Fascia transversalis
Ans. d) Fascia transversalis.
Explanation: Rectus abdominis lies on the transversalis fascia below thr arcuate line.
 The rectus sheath is the fibrous condensation of the aponeurotic layers on the anterior aspect of the
abdominal wall investing the rectus abdominis muscle. It also encloses the epigastric vessels, the inferior
five intercostal and subcostal vessels and nerves, and occasionally pyramidalis.
 It is incomplete posteriorly at a level inferior to the arcuate line and superiorly above the costal margin.
 The anterior wall is formed from the external oblique aponeurosis and a superficial layer of the internal
oblique aponeurosis where it divides at the lateral edge of the rectus abdominis muscle.
 The posterior wall is formed from the aponeurosis of the transversus abdominis muscle where it joins the
deeper layer of the internal oblique aponeurosis. Together, both walls form the linea alba.
 Since the tendons of the Obliquus internus and Transversus only reach as high as the costal margin, it
follows that above this level the sheath of the Rectus is deficient behind, the muscle resting directly on the
cartilages of the ribs, and being covered merely by the tendon of the Obliquus externus.
 The Rectus, in the situation where its posterior sheath is deficient (below arcuate line), is separated from
the peritoneum only by the transversalis fascia, in contrast to the upper layers, where part of the internal
oblique also runs beneath the rectus. Because of the thinner layers below, this region is more susceptible
to herniation.
 High Yield Facts
 Umbilical cord contains two umbilical arteries and one umbilical vein. (‘Right’ umbilical vein ‘regresses’
and only ‘left is left’. At the sight of regressing right umbilical vein, there is a weak spot, which might result
in intestinal herniation (Gastroschisis).
 Aorta passes posterior to the diaphragm(and not through it), which is an osseo-aponeurotic opening in
front of T-12 vertebra and behind the median arcuate ligament.
 Oesophagus passes through the muscular opening in the right crus of diaphragm at T-10 vertebra level,
along with the two vagal nerves and branches of left gastric artery(and vein) which supply lower 1/3 of
oesophagus.
 Bochdalek hernia occurs through left postero-lateral opening in the diaphragm.
 The lienogastric (spleno-gastric) ligament contains the short gastric and left gastroepiploic vessels; the
lienorenal (splenorenal) ligament contains the splenic vessels and the tail of the pancreas; and the free
margin of the falciform ligament contains the ligamentum teres hepatis (fibrous remnant of the left
umbilical vein, and the paraumbilical vein.
 The renal fascia (the false capsule or Gerota fascia) is a discrete fascial layer that surrounds each
kidney. Paranephric fat outside this capsule and perinephric fat inside this fascial layer support the
kidney.
 Portal system is a system of vessels in which blood collected from one capillary network passes through
a large vessel and then a second capillary network before it returns to the systemic circulation. In hepatic
portal system blood from the intestinal capillary bed passes through the hepatic portal vein and then
hepatic capillaries (sinusoids) to the hepatic veins.
 Porto-systemic anastomosis

 Para-umbilical veins connects the left branch of the portal vein with the subcutaneous veins in the region
of the umbilicus.
 The median umbilical fold or ligament contains the fibrous remnant of the obliterated urachus, the medial
umbilical fold contains the fibrous remnant of the obliterated umbilical artery, and the lateral umbilical fold
contains the inferior epigastric vessels.
 A level of sensory blockade extending to the T 10 is desired in vaginal delivery (and T4 dermatome in
caesarean delivery). –William’s Obstetrics.
 The adrenal gland receives arteries from three sources: the superior suprarenal artery from the inferior
phrenic artery, the middle suprarenal from the abdominal aorta, and the inferior suprarenal artery from the
renal artery. It is drained via the suprarenal vein, which empties into the IVC on the right and the renal
vein on the left.
 The suprarenal and gonadal veins drain into the IVC on the right and the left renal vein. The azygos vein
is connected to the IVC, but the hemiazygos vein is connected to the left renal vein.
 An obstruction in the flow through the portal system (valveless) may cause reversal of blood flow and
portal hypertension. Blood flows in a retrograde direction and pass through porto-systemic
anastomosis to reach the caval system. Sites for these anastomoses include the esophageal veins and
rectal veins leading to varices and thoracoepigastric veins leading to caput medusae.
 Hepatic lobules are the small vascular units composing the substance of the liver, each of which is
polygonal, with a central vein at its center and portal canals peripherally at the corners. Portal lobule is a
triangular mass of liver tissue, larger than a liver acinus, containing portions of three adjacent hepatic
lobules, and having a portal vein at its center and a central vein peripherally at each corner.
 Liver acinus is a functional unit of the liver, smaller than a portal lobule, being a diamond-shaped mass
of liver parenchyma surrounding a portal tract. It consists of adjacent sectors of neighboring hexagonal
fields of classic lobules partially separated by distributing blood vessels. The zones, marked 1, 2, and 3,
are supplied with blood that is most oxygenated and richest in nutrients in zone 1 and least so in zone 3.
The terminal hepatic venules (central veins) in this interpretation are at the edges of the acinus instead of
in the center, as in the classic lobule. The vessels of the portal canals, namely, terminal branches of the
portal vein and hepatic artery that, along with the smallest bile ducts, make up the portal triad, are shown
at the corners of the hexagon that outlines the cross-sectioned profile of the classic lobule.
 Section 9. Pelvis and Perineum

Embryology
1. WRONG about genital system development is
a) Develop from mesoderm
b) Genital ridge forms at week 5
c) Testes develops earlier to ovary
d) External genitalia are fully differentiated at week 10

 Genotype of the embryo is established at fertilization, but male and female embryos are
phenotypically indistinguishable till weeks 6. Testis starts developing at week 7, whereas ovarian
development begins at week 10. Male and female characteristics of the external genitalia can be
recognized by week 12. Phenotypic differentiation is completed by week 20.
 Before the seventh week of gestation, the fetal gonads are not differentiated into either the male or
female genotype. Primordial germ cells migrate into the genital ridge (to form spermatocytes or
oocytes). The presence or absence of the Y chromosome (SRY gene - sex-determining region of the Y
chromosome) determine gonadal differentiation. All humans are destined to become females (default
mechanism) until interrupted by Y chromosome.
2. Trigone of urinary bladder develops from
a) Mesoderm
b) Ectoderm
c) Endoderm of urachus
d) Endoderm of urogenital sinus

 Genitourinary system develops from Intermediate mesoderm. It forms the Urogenital ridges on each
side of the aorta. Three pairs of kidneys develop in cranio-caudal sequence in the urogenital ridge of
intermediate mesoderm: pronephros, mesonephros, and metanephros.
 Pronephros regresses by the fifth week. Mesonephric duct (Mesonephros) at caudal end gives the
Ureteric bud (that later forms the ureter, renal pelvis, calyces, and collecting tubules).
 Ureteric bud penetrate and induces Metanephros to develop into the adult kidney. Kidney is formed
during the fifth week from the metanephric mass (develops into nephrons for urine formation) and the
ureteric bud (collecting system).
 Kidney develops in the pelvic cavity and ascends from sacral levels to lower thoracic levels later.
 Mesonephric duct also give Wolffian duct (which develops into the efferent ductules, epididymal duct,
ductus deferens, ejaculatory duct and seminal vesicles). In females it gives vestigeal remnants:
epoophoron, paroophoron and Gartner’s duct.
 Urogenital sinus forms the urinary bladder, urethra (and urethral and paraurethral glands, greater
vestibular glands) and lower vagina in females and urinary bladder, urethra (and prostate &
bulbourethral glands in males).
 Allantois is continuous with urinary bladder, later gets obliterated to form urachus (median umbilical
ligament).
 Paramesonephric (Müllerian) ducts develop on the sides of Mesonephric duct and form uterine tubes
and the uterus, cervix, and upper vagina in females and form the prostatic utricle (and appendix of
testes) in males.

3. All are derivatives of ureteric bud EXCEPT

a) Ureter
b) Renal pelvis
c) Minor calyx
d) Connecting tubule
 Prostate Gland
4. Urethral crest is due to
a) Opening of prostatic glands
b) Puboprostatic spread
c) Insertion of detrusor
d) Insertion of trigone
5. Which lobe of prostate gland raises uvula vesicae
a) Anterior lobe
b) Posterior lobe
c) Median lobe
d) Lateral lobe
There are four distinct glandular regions in prostate:
Fraction of
Name Description
gland
The sub-capsular portion of the posterior aspect of the prostate gland
Peripheral zone Up to 70% in
that surrounds the distal urethra. It is from this portion of the gland
(PZ) young men
that ~70–80% of prostatic cancers originate.
This zone surrounds the ejaculatory ducts. The central zone accounts
Central zone Approximately
for roughly 2.5% of prostate cancers although these cancers tend to
(CZ) 25% normally
be more aggressive and more likely to invade the seminal vesicles.
~10–20% of prostate cancers originate in this zone. The transition
Transition zone zone surrounds the proximal urethra and is the region of the prostate
5% at puberty
(TZ) gland that grows throughout life and is responsible for the disease
of benign prostatic enlargement.
Anterior fibro-
Approximately This zone is usually devoid of glandular components, and composed
muscular zone
5% only, as its name suggests, of muscle and fibrous tissue.
(or stroma)
6. Which of the following zones is prone to benign prostatic hypertrophy

a) Anterior muscular zone

b) Transitional zone
c) Peripheral zone
d) Central zone
Perineal Pouches
7. Contents of deep perineal pouch are all EXCEPT
a) Dorsal nerve of penis
b) Urethral sphincter
c) Root of penis
d) Bulbourethral gland
 Urogenital Diaphragm: It is a poorly defined structure, consists of the deep transverse perineal
muscle and the sphincter urethrae and is invested by superior and inferior fasciae. It stretches
between the two pubic rami and ischial rami but does not reach the pubic symphysis anteriorly. It is
pierced by the membranous urethra in the male and by the urethra and the vagina in the female.
Recently the existence of urogenital diaphragm has been challenged, suggesting it is not actually an
identifiable entity.
 The deep perineal space (pouch) lies between the superior and inferior fasciae of the urogenital
diaphragm. It contains the deep transverse perineal muscle and sphincter urethrae, the
membranous part of the urethra, the bulbourethral gland of Cowper in the male, and branches of the
internal pudendal vessels and pudendal nerve.
 The male external urethral sphincter is formed by two muscles: sphincter urethra and compressor
urethrae muscles, both in the deep perineal space. The female external urethral sphincter is formed by
three muscles: sphincter urethra, compressor urethrae, and urethrovaginalis muscles.
 Bulbourethral (Cowper’s) glands lie among the fibers of the deep transverse perineal muscle in the
deep perineal pouch in the male, on the posterolateral sides of the membranous urethra. Ducts pass
through the inferior fascia of the urogenital diaphragm (perineal membrane) to open into the bulbous
portion of the spongy urethra.
 The superficial perineal space (pouch) lies between the inferior fascia of the urogenital diaphragm
(perineal membrane) and the superficial perineal fascia (Colles’s fascia) and contains perineal
muscles, the crus of the penis or clitoris, the bulb of the penis or vestibule, the greater vestibular
glands of Bartholin in the female, branches of the internal pudendal vessels, and the pudendal nerve.
8. All is true about Bartholin gland EXCEPT
a) Homologous of male bulbo-urethral gland
b) Present in the superficial perineal pouch
c) Located at the junction of anterior 1/3 and middle 1/3 of labia majora
d) Opens into the vestibule between hymen and labia minora
 Bartholin duct opens in the postero-lateral wall of vagina (vestibule). In questions Lateral wall
> posterior wall.
 The epithelium of the Bartholin duct is cuboidal near the gland, but becomes transitional and
finally stratified squamous near the opening of the duct.
Urethra rupture and Extravasation of Urine
9. A patient exposed to bomb explosion injury presents with rupture of the fundus of urinary
bladder. The extravasated urine reaches
a) Space of Retzius
b) Deep perineal pouch
c) Superficial perineal pouch
d) Peritoneal cavity
 Rupture of the dome (superior wall) of the urinary bladder, leads to rupture of peritoneum and results in
an intraperitoneal extravasation of urine within the peritoneal cavity (ascites). It is caused by a
compressive force on a full bladder.

10. Injury to the male urethra above the perineal membrane due to a pelvic fracture, causes urine
to accumulate in all of the following EXCEPT
a) Space of Retzius
b) Deep perineal pouch
c) Superficial perineal pouch
d) Peritoneal cavity
 Rupture of membranous part of the urethra may lead to urine escaping into the space around the
prostate and bladder and extraperitoneal space. If the urogenital diaphragm is also disrupted urine
leaks into deep perineal space and into the superficial perineal space (as the perineal membrane
is also ruptured).
 The most common type of urethral injury is at the junction of posterior and anterior (bulbous) urethra.
Radiologists consider a type III urethral injury as a combined anterior/posterior urethral injury.

11. A 16-year-old boy presents to the emergency department with straddle injury and rupture of the
bulbous urethra. Extravasated urine from this injury can spread into which of the following
structures
a) Scrotum
b) Ischiorectal fossa
c) Deep perineal space
d) Thigh
 Extravasation of urine may result from rupture of the bulbous spongy urethra below the perineal
membrane; the urine may pass into the superficial perineal pouch and spread inferiorly into the
scrotum, anteriorly around the penis, and superiorly into the lower part of the abdominal wall. The
urine cannot spread laterally into the thigh because the perineal membrane and the superficial fascia of
the perineum are firmly attached to the ischiopubic rami and are connected with the deep fascia of the
thigh (fascia lata). It cannot spread posteriorly into the anal region (ischiorectal fossa) because the
perineal membrane and Colles’s fascia are continuous with each other around the superficial
transverse perineal muscles.
12. After fracture of the penis (injury to the tunica albuginea) with intact Buck’s fascia, there occurs
hematoma at
a) The penis and scrotum
b) At the perineum in a butterfly shape
c) Penis, scrotum, perineum and lower part of anterior abdominal wall
d) Shaft of the penis only
 If the Buck fascia is intact, penile ecchymosis is confined to the penile shaft. If the Buck fascia has
been violated, the swelling and ecchymosis are contained within the Colles’ fascia. In this instance, a
‘butterfly-pattern’ ecchymosis may be observed over the perineum, scrotum, and lower abdominal
wall.

Pelvis & Perineum: Nerves

13. FALSE statement regarding pudendal nerve is
a) Both sensory and motor
b) Derived from S2,3,4 spinal nerve roots
c) Leaves pelvis through the lesser sciatic foramen
d) Only somatic nerve to innervate the pelvic organs

 The pudendal nerve (S2–S4) passes through the greater sciatic foramen (below the piriformis
muscle) and enters the gluteal region. Then passes through the lesser sciatic along with the internal
pudendal vessels to enter the pudendal canal, gives rise to the inferior rectal and perineal nerves, and
terminates as the dorsal nerve of the penis (or clitoris).
 Pelvis & Perineum: Lymphatics

Questions: Pelvis & perineum

14. While a patient was being given an obstetric nerve block she gradually lost her voluntary control
over urination. The muscle which got anaesthetized is located in the
a) Trigone of the bladder
b) Urogenital diaphragm
c) Superficial perineal pouch
d) Pelvic diaphragm
15. All insert into perineal body EXCEPT
a) Superficial transverse perenei
b) Deep transverse perenei
c) Bulbo spongiosus
d) Ischio cavernosus

16. Levator ani muscle include all EXCEPT

a) Puborectalis
b) Pubococcygeus
c) Iliococcygeus
d) Ischiococcygeus

 Pelvic diaphragm: Forms the pelvic floor and supports all of the pelvic viscera. It is formed by the
levator ani (pubococcygeus and ilio-coccygeus) and coccygeus (ischio-coccygeus) muscles and
their fascial coverings. It lies posterior and deep to the urogenital diaphragm and medial and deep to
the ischiorectal fossa.
 17. All form anorectal ring EXCEPT
a) External sphincter
b) Internal sphincter
c) Puborectalis
d) Anococcygeal raphe
Ans. d) Ano-coccygeal raphe.
Explanation: Anorectal ring is a muscular present at the junction of rectum and anus.It is formed by
fusion of fibres of puborectalis, uppermost fibres of external anal sphincter and internal anal sphincter.
* Applied anatomy - Damage to the anorectal ring results in rectal incontinence.

18. Normal ano-rectal angle is

a) 70°
b) 90°
c) 120°
d) 150°

19. Uterine tube is supplied by

a) T: 6-8
b) T: 8-10
c) T: 10-12
d) L: 1-2
20. Urinary bladder is supplied by sympathetic root value
a) L1 & L2
b) L2 & L3
c) L3 & L4
d) L2,L3 & L4

21. Parasympathetic nerve innervation of urinary bladder has

a) Inhibitory control on detrusor contraction
b) Excitatory effect on detrusor
c) No effect on detrusor
d) Excitatory control over internal urethral sphincter
22. The narrowest lumen in ureter is at
a) 1
b) 3
c) 4
d) 5
23. All are branches of anterior division of internal iliac artery EXCEPT
a) Ovarian
b) Vesical
c) Middle rectal
d) Pudendal

24. All are branches of posterior division of internal iliac artery EXCEPT
a) Superior vesical
b) Superior gluteal
c) Lateral sacral
d) Ilio-lumbar
25. All the following pairs are correct concerning the lymphatics of uterus EXCEPT
a) Fundus: Para-aortic
b) Mid-uterus: External iliac
c) Cervix: Superficial inguinal lymph nodes
d) Cervix: Sacral
1. Fundus and upper part of the body: Pre- and para-aortic lymph nodes along the ovarian vessels (few
lymphatics from the lateral angles of the uterus travel along the round ligaments of the uterus and drain into
superficial inguinal lymph nodes .
2. Middle part of the body : External iliac nodes via broad ligament.
3. From cervix, on each side the lymph vessels drain in three directions:
Laterally: External iliac and obturator nodes.
Posterolaterally: Internal iliac nodes
Posteriorly: Sacral nodes

Additional Questions
26. Clitoris in females is embryologically derived from
a) Urogenital sinus
b) Genital swelling
c) Genital tubercle
d) Urogenital membrane
Ans. c) Genital tubercle.
Explanation: Glans penis and clitoris develop from the genital tubercle (phallus).

27. The transitional epithelium lining the urethra and the bladder is derived from
a) Mesoderm
b) Endoderm
c) Wall of the yolk sac
d) Paramesonephric duct
Ans. b) Endoderm.
Explanation: Epithelium of urinary bladder, urethra and vagina develop from endoderm of urogenital sinus.

28. Mullerian duct anomaly may include the absence of any of the following EXCEPT
a) Uterus
b) Vagina
c) Ovary
d) Uterine tube
Ans. c) Ovary.
Explanation: Ovaries develop from genital ridge.
 29. Organ of Rosenmüller (epoophoron) is derivative of
a) Mullerian duct
b) Wolffian duct
c) Urogenital sinus
d) Paramesonephric duct
Ans. b) Wolffian duct.
Explanation: Epoophoron is a vestigeal remnant of Wolffian duct in females.
30. UNTRUE about prostate is
a) Behind the urethra and between the two ejaculatory ducts lie the median lobe
b) Colliculus seminalis is an elevation on urethral crest showing three openings
c) Its urethra is convex anteriorly
d) Its urethra appears crescentic in transverse section
Ans. c) Its urethra is convex anteriorly.
Explanation: Male urethra is concave anteriorly.
31. Urogenital diaphragm is contributed by all EXCEPT
a) Sphincter urethra
b) Perineal body
c) Colles’ fascia
d) Perineal membrane
Ans. c) Colles’ fascia.
Explanation: Urogenital diaphragm has a floor of perineal membrane (not Colle’s fascia).
32. The deep perineal space
a) Is formed superiorly by the perineal membrane
b) Contains a segment of the dorsal nerve of the penis
c) Is formed inferiorly by Colles' fascia
d) Contains the greater vestibular glands
Ans. b) Contains a segment of the dorsal nerve of penis.
Explanation. Dorsal nerve of penis a content of both superficial and deep perinela poch. Other choices are
applicable to superficial perineal pouch.
33. All are content of sphincter of vagina EXCEPT
a) Pubovaginalis
b) External urethral sphincter
c) Internal urethral sphincter
d) Bulbospongiosus
Ans. c) Internal urethral sphincter.
Explanation: Internal urethral sphincter is present in males to prevent retrograde ejaculation of semen into
urinary bladder, it is absent in females.
34. Not a part of superficial perineal pouch
a) Posterior scrotal nerves
b) Sphincter urethrae
c) Ducts of bulbourethral glands
d) Bulbospongiosus muscle
Ans. b) Sphincter urethrae.
Explanation: Sphincter urethrae (part of external urethral sphincter) is present in the wall of membranous
urethra, in the deep perineal pouch. It also extends vertically, around the anterior aspect of the prostatic
urethra.
*Posterior scrotal nerves are the branches of pudendal nerve, and do pass the superficial perineal pouch.
*Cowper’s (bulbourethral) gland is present in the deep perineal pouch, but its duct pierces the perineal
membrane and opens into the bulbous urethra in the superficial perineal pouch.
*Bulbospongiosus muscle is a content of superficial perineal pouch, working as a vaginal sphincter in a
female; and for a male it help to empty the urethra of the urine/semen.
*The superficial perineal pouch is a fully enclosed compartment. Its inferior border is the perineal fascia
(Colles’ fascia). Its superior border is the perineal membrane.
- Contents:
1. Muscles
- Ischiocavernosus muscle
- Bulbospongiosus muscle
 - Superficial transverse perineal muscle
2. Others
- Crura of penis (males) / Crura of clitoris (females)
- Bulb of penis (males) / Vestibular bulbs (females)
- Greater vestibular glands (female)

35. Root value of inferior rectal nerve supplying external anal sphincter is
a) L– 3, 4, 5
b) L– 5; S-1
c) S– 2, 3 4
d) S– 4, 5
Ans. c) S – 2, 3, 4.
Explanation: External anal sphincter is upplied by inferior rectal nerve branch of pudendal nerve.
36. All of the following pairs about the boundaries of ischiorectal fossa are correct EXCEPT
a) Anterior: Perineal membrane
b) Posterior: Gluteus maximus
c) Medial: Levator ani
d) Lateral: Obturator externus
Ans. d) Obturator externus.
Explanation: Obturator internus is present at the lateral wall of ischiorectal fossa. It is covered by
obturator fascia, which has pudendal canal in it.

37. UNTRUE about ischiorectal fossa

a) Obturator fascia meets anal fascia at the apex
b) A communication is present between the two IRF in front of anal canal
c) Alcock's canal is located at the lateral wall
d) Inferior rectal nerve and vessels pass through it
Ans. b) A communication is present between the two IRF in front of anal canal
Explanation: A communication is present between the two IRF in behind the anal canal. The ischiorectal
fossa is separated from the pelvis by the levator ani and its fasciae and is bounded by the sphincter
urethrae and deep transverse perineal muscles (anteriorly), the gluteus maximus and the sacrotuberous
ligament (posteriorly), the sphincter ani externus and levator ani (superomedially), the obturator fascia
covering the obturator internus (laterally), and the skin (floor). Alcock’s pudendal canal is present in the
lateral wall of ischiorectal fossa and send inferior rectal nerve and vessels medially through the fossa
towards the anal canal.

38. UNTRUE about female pelvis is

a) Subpubic angle is wide (>80 degrees)
b) Obturator foramen in triangular
c) Greater sciatic notch is wide (~90 degrees)
d) Long and narrow sacrum
Ans. d) Long and narrow sacrum.
Explanation: Female pelvis has short and wide sacrum.
 39. Almost half of the females have which of the following type of pelvis
a) Anthropoid
b) Android
c) Platypelloid
d) Gynaecoid
Ans. d) Gynaecoid.
Explanation: The gynaecoid pelvis is the normal female type; its pelvic inlet typically has a rounded oval
shape and a wide transverse diameter. A platypelloid or markedly android (masculine or funnel-shaped)
pelvis in a woman may present with difficult vaginal delivery of a fetus.

 The obstetric conjugate is the least anteroposterior diameter of the pelvic inlet from the sacral
promontory to a point a few millimeters below the superior margin of the pubic symphysis.
40. Artery supply to ureter is by all EXCEPT
a) Gonadal artery
b) Common iliac artery
c) External iliac artery
d) Vesical artery
Ans. c). External iliac artery.
Explanation: Ureter has numerous arteries supplying as shown in the diagram (but not external iliac).

41. Lymphatic drainage of distal spongy urethra is towards the lymph nodes
a) Superficial inguinal
b) Deep inguinal
c) External iliac
d) Internal iliac
Ans. b) Deep inguinal.
Explanation: Distal spongy urethra and the glans penis drain into the deep inguinal lymph nodes of
Cloquest and Rosenmuller.
 42. Lymphatic drainage of uterine cervix is all EXCEPT
a) Obturator
b) Sacral
c) External iliac
d) Internal iliac
Ans. a) Obturator.
Explanation: Uterus drains into all the lymphatic destinations mentioned in the choices, hence this appears
to be a wrong question, though some standard textbooks do not mention obturator lymph nodes in the
lymphatic drainage.

43. Pelvic fascia between rectum and sacrum is

a) Denonvillier’s fascia
b) Colle’s fascia
c) Waldeyer’s fascia
d) Scarpa’s fascia
Ans. c) Waldeyer’s fascia.
Explanation: Waldeyer's fascia (presacral fascia) lines the anterior aspect of the sacrum, enclosing the
sacral vessels and nerves. It is limited postero-inferiorly, as it fuses with the mesorectal fascia, lying above
the levator ani muscle. Identification and preservation of the Waldeyer’s fascia is of fundamental
importance in preventing complications and reducing local recurrences of rectal cancer.
*Denonvillier’s fascia: A membranous partition separating the rectum from the prostate and urinary
bladder; this structure in the male corresponds to the fascia rectovaginalis in the female.

High Yield Facts

 Anal canal

 Rectum: Has a mucous membrane and a circular muscle layer that forms three permanent transverse
folds (Houston’s valves). Per rectal examination is performed for palpating for prostate, seminal vesicle,
ampulla of the ductus deferens, bladder, uterus, cervix, ovaries, perineal body etc.
 Cremasteric artery (external spermatic artery) is a branch of the Inferior epigastric artery which
accompanies the spermatic cord, and supplies the cremaster and other coverings of the cord,
anastomosing with the testicular artery. In the females the cremasteric artery accompanies the round
ligament and is very small.
 Corpora amylacea, are small hyaline masses (detected microscopically) found in the prostate gland,
neuroglia, and pulmonary alveoli. They are derived from degenerate cells or thickened secretions and
occur more frequently with advancing age.
 Parts of fallopian tube (medial to lateral): Interstitial part→ Isthmus→ Ampulla→ Infundibulum.
 Superior Hypogastric Plexus is the continuation of the aortic plexus below the aortic bifurcation and
receives the lower two lumbar splanchnic nerves. It bifurcates into the right and left hypogastric nerves in
front of the sacrum. It contains preganglionic and postganglionic sympathetic fibers, visceral afferent
fibers, and few, if any, parasympathetic fibers, which may run a recurrent course through the inferior
hypogastric plexus.
 Hypogastric Nerve is the lateral extension of the superior hypogastric plexus and lies in the extra-
peritoneal connective tissue lateral to the rectum. It provides branches to the sigmoid colon and the
descending colon and is joined by the pelvic splanchnic nerves to form the inferior hypogastric or pelvic
plexus.
 Inferior Hypogastric (Pelvic) Plexus is formed by the union of hypogastric, pelvic splanchnic, and sacral
splanchnic nerves and lies against the posterolateral pelvic wall, lateral to the rectum, vagina, and base of
 the bladder. it contains pelvic ganglia, in which both sympathetic and parasympathetic preganglionic
fibers synapse. It gives rise to rectal plexus, utero-vaginal plexus, vesical plexus, and prostatic plexus.
 Sacral Splanchnic Nerves consist of preganglionic sympathetic fibers that come off the sympathetic
chain and synapse in the inferior hypogastric (pelvic) plexus.
 Pelvic Splanchnic Nerves (Nervi Erigentes) arise from the sacral segment of the spinal cord (S2–S4)
and are the only splanchnic nerves that carry parasympathetic fibers. (All other splanchnic nerves are
sympathetic.) They contribute to the formation of the pelvic (or inferior hypogastric) plexus, and supply the
descending colon, sigmoid colon, and other viscera in the pelvis and perineum.
 Pelvic fascia condensations as the supports of uterus: (1) Lateral or transverse cervical (Cardinal or
Mackenrodt’s) ligaments of the uterus extending from the cervix and the vagina to the lateral pelvic walls,
running laterally below the base of the broad ligament. (2) Pubocervical ligaments are bands of connective
tissue that extend from the posterior surface of the pubis to the cervix of the uterus. (3) Sacrocervical
ligaments extend from the lower end of the sacrum to the cervix and the upper end of the vagina. (4)
Rectouterine (Sacrouterine) Ligaments hold the cervix back and upward and sometimes elevate a shelf-
like fold of peritoneum (rectouterine fold), which passes from the isthmus of the uterus to the posterior wall
of the pelvis lateral to the rectum. It corresponds to the sacrogenital (rectoprostatic) fold in the male.
 Section 10. Lower Limb

Embryology
1. Root value of sciatic nerve is (AIPG)
a) L-1,2,3,4,5
b) L-2,3,4,5;S-1
c) L-3,4,5;S-1,2
d) L-4,5;S-1,2,3

Dermatomes

 Lower limbs rotate medially by 90 degrees, the great toe becomes medial and little toe lateral. The
extensor compartment comes anterior and the flexor compartment becomes posterior.
 The dorsal and ventral axial lines both reach the ankle joint (ventral reaches the medial aspect).
Thigh Muscles
\
 Movements – Hip and Knee Joint
2. Rectus femoris is a part of quadriceps femoris causes
a) Hip flexion and knee extension
b) Hip and knee flexion
c) Hip and knee extension
d) Hip extension and knee flexion
3. Biceps femoris, a hamstring muscle causes
a) Hip flexion and knee extension
b) Hip and knee flexion
c) Hip and knee extension
d) Hip extension and knee flexion
 Superior gluteal nerve passes through the greater sciatic foramen (above the piriformis muscle) to
supply three muscles: gluteus medius, gluteus minimus and tensor fascia lata.
 Gluteus maximus is supplied by inferior gluteal nerve which passes through greater sciatic
foramen, along with sciatic and pudendal nerve (all pass below piriformis muscle).
4. In walking, gravity tends to tilt pelvis and trunk to the unsupported side, major factor in
preventing this unwanted movement is
a) Adductor muscles
b) Quadriceps
c) Gluteus maximus
d) Gluteus medius and minimus

Hybrid Muscles
5. Hybrid muscles are all EXCEPT
a) Pectineus
b) Adductor magnus
c) Tensor fascia lata
d) Biceps femoris
 Knee Joint

6. Physiological locking involves

a) Internal rotation of femur over stabilized tibia
b) Internal rotation of tibia over stabilized femur
c) External rotation of tibia over stabilized femur
d) External rotation of femur over stabilized tibia
7. A healthy young athlete sitting at table with knee at 90 degree flexion. What will happen when he
fully extends the knee
a) Movement of tibial tuberosity towards lateral border of patella
b) Movement of tibial tuberosity towards medial border of patella
c) Movement of tibial tuberosity towards centre of patella
d) No change in relationship

 Terrible triad (MOI): Foot fixed, knee flexed, twisting fall. Lachman test is carried out at 20-30° of knee
flexion and is less painful. It has high sensitivity and specificity as compared with the original
anterior drawer test.
 ACL and PCL are intracapsular but extrasynovial ligaments (lie inside the knee joint capsule but outside
the synovial cavity of the joint), still covered by synovial membrane.
 ACL: Arises from the anterior intercondylar area of the tibia and passes backward, upward, and
laterally (BUL) to insert into the medial surface of the lateral femoral condyle.The anterior cruciate
ligament prevents forward sliding of the tibia on the femur (or posterior displacement of the femur on the
tibia) and prevents hyperextension of the knee joint. It is taut during extension of the knee and is lax
during flexion. It may be injured in hyperextension injuries.
 Medial meniscus is also intracapsular but extrasynovial. It is C shaped (forms a semicircle) attaching
to the superior surface of tibia at intercondylar area, and is also attached to the medial collateral
ligament. It is more frequently torn in injuries than the lateral meniscus because of its strong attachment
to the tibial collateral ligament.
 Leg Muscles

Anterior leg muscles (Nerve: Deep peroneal nerve (L-5); Action: Foot extension/dorsiflexion
Muscle Additional Action
Tibialis anterior Foot inversion
Extensor digitorum longus Extends lateral 4 toes
Extensor hallucis longus Extends the great toe
Peroneus tertius Assists in foot eversion
Posterior leg muscles; Nerve: Tibial nerve (L-4,5; S-1,2); Action: Plantarflexion of foot & toes
Muscle Additional Action
Gastrocnemius (S1,2) Knee flexion; plantar flexion at ankle (in extended
leg)
Plantaris(S1,2) Works with gastrocnemius
Soleus(S1,2) Plantar flexion at ankle
Popliteus (L4,5;S1) Knee flexion; medial rotation of tibia in unplanted
leg (unlock the knee)
Tibialis posterior(L4,5) Ankle plantarflexion; foot inversion
Flexor digitorum longus(S2,3) Ankle plantarflexion; lateral 4 toes flexion
Flexor hallucis longus(S2,3) Ankle plantarflexion; great toe flexion

Lateral leg muscles (Nerve: Superficial peroneal nerve (L-5; S-1,2)

Muscle Action
Peroneus longus Foot eversion
Peroneus brevis Foot eversion
8. All are seen in Injury to neck of fibula EXCEPT
a) Common peroneal nerve injury
b) Loss of sensation over sole
c) Foot drop
d) Loss of dorsiflexion of toe
9. Medial aspect of great toe is supplied by
a) Saphenous nerve
b) Deep peroneal nerve
c) Superficial peroneal nerve
d) Sural nerve

LL - Nerve Injuries
 Ateries - Lower Limb
10. Head of femur is chiefly supplied by
a) Obturator artery
b) Medial circumflex femoral artery
c) Lateral circumflex femoral artery
d) Superior gluteal artery
 Questions: Lower Limb
11. Marked dermatome is

a) L-4
b) L-5
c) S-1
d) S-2
12. Posterior cutaneous nerve of thigh supplies skin overlying (PGIC)
a) Medial aspect of thigh
b) Posterior inferior aspect of buttock
c) Scrotum
d) Back of thigh
e) Popliteal fossa
 The root value of posterior cutaneous nerve of thigh is S – 1, 2, 3.
13. Abduction of the thigh is limited by
a) Tension in the adductors
b) Tension in the adductors and iliofemoral ligament
c) Tension in the adductors and pubofemoral ligament
d) Tension in the adductors and ischiofemoral ligament
 Pubofemoral ligament reinforces the fibrous capsule inferiorly, extends from the pubis bone to the
femoral neck, and limits abduction and extension.
14. Identify the marked muscle in the gluteal region

a) Obturator externus
b) Obturator internus
c) Quadratus femoris
d) Piriformis
15. Structures passing through lesser sciatic foramen (PGIC)
a) Internal pudendal vessels
b) Obturator internus muscle
c) Pudendal nerve
d) Nerve to obturator internus
e) Pyriformis muscle
 PIN (Pudendal nerve, Internal pudendal vessels and Nerve to obturator internus) structures come from
pelvic cavity, pass through the greater sciatic notch, hook behind the ischial spine (in gluteal region)
and move into the lesser sciatic notch. The tendon (and not muscle) of obturator internus passes
through the lesser sciatic notch.
16. All of the following pairs regarding adductor canal are true EXCEPT
a) Roof: Sartorius muscle
b) Contents: Femoral nerve
c) Floor: Adductor longus and magnus
d) Antero-lateral boundary: Vastus medialis
 Adductor canal (Sub-sartorial/Hunter’s canal): This passes from the apex of the femoral triangle to the
popliteal fossa.

17. Clergyman’s knee is an inflammation of

a) Anserine bursa
b) Pre-patellar bursa
c) Suprapatellar bursa
d) Infrapatellar bursa

18. All of the following pairs for boundaries of popliteal fossa are correct EXCEPT
a) Supero-medial boundary: semimembranosus
b) Supero-lateral boundary: Biceps femoris
c) Infero-lateral: Gastrocnemius and plantaris
d) Infero-medial: Gastrocnemius and soleus
 The popliteal fossa is the diamond-shaped space bounded superomedially by the semimembranosus
and semitendinosus, superolaterally by the biceps femoris, inferomedially by the medial head of the
gastrocnemius, and inferolaterally by the lateral head of the gastrocnemius and plantaris. It contains the
popliteal vessels, the common peroneal and tibial nerves, and the small saphenous vein.

19. In the following nutrient arteries to bones, choose the WRONG pair
a) Humerus : Profunda brachii
b) Radius: Anterior interosseous
c) Fibula: Peroneal
d) Tibia: Anterior tibial

20. Hunterian perforator is at

a) Upper thigh
b) Mid-thigh
c) Lower thigh
d) Knee

21. Deltoid ligament has all the following components EXCEPT

a) Anterior tibiotalar
b) Tibionavicular
c) Tibiocalcaneal
d) Calcaneonavicular
 Medial (Deltoid) Ligament of ankle joint is attached to the medial malleolus on tibia. It has four parts:
the tibionavicular, tibiocalcaneal, anterior tibiotalar, and posterior tibiotalar ligaments. It prevents
overeversion of the foot and helps maintain the medial longitudinal arch.
 Calcaneus bone has a shelf-like medial projection called the sustentaculum tali, which supports the
head of the talus (with the spring ligament) and has a groove on its inferior surface for the tendon of
flexor hallucis longus (which uses the sustentaculum tali as a pulley).
 The plantar calcaneonavicular (spring) ligament passes from the sustentaculum tali of the calcaneus
to the navicular bone. It supports the head of the talus and thereby maintains medial longitudinal
plantar arch. Laxity of this ligament results in fallen arches (flat feet).
 Avulsion or rupture of the Achilles tendon disables the triceps surae (gastrocnemius and soleus)
muscles; thus, the patient is unable to plantar flex the foot.

 Flexor retinaculum is a band of deep fascia , passes between the medial malleolus and the medial
surface of the calcaneus and forms the tarsal tunnel with tarsal bones for the tibial nerve, posterior
tibial vessels, and flexor tendons. It holds three tendons and blood vessels and a nerve in place
deep to it (from anterior to posterior): the tibialis posterior, flexor digitorum longus, posterior tibial artery
and vein, tibial nerve, and flexor hallucis longus (mnemonic: Tom, Dick ANd Harry).
 Tarsal tunnel syndrome is a complex symptom resulting from compression of the tibial nerve or its
medial and lateral plantar branches in the tarsal tunnel, with pain, numbness, and tingling sensations
on the ankle, heel, and sole of the foot. It may be caused by repetitive stress with activities, flat feet, or
excess weight.
 Extensor retinaculum: Bands of deep fascia , under which pass the tendons of the tibialis anterior,
extensor digitorum longus, extensor hallucis longus and the peroneus tertius. Inferior extensor
retinaculum is ‘Y’ shaped.
22. All of the following pairs concerning layers of sole muscles are correct EXCEPT
a) First layer: Adductor hallucis
b) Second layer: Lumbricals
c) Third layer: Flexor hallucis
d) Fourth layer: Interossei
I – Abductor Hallucis II - Lumbricals
III – Adductor and flexor hallucis IV – Interossei (Deepest)

 Lumbricals and interossei flex the MTP and extend the IP joints. Their paralysis might result in claw
foot.
 Adductor hallucis muscle is located in the third layerof foot and help in maintenance of transverse
plantar arch.
 Additional Questions
23. Hip flexion is done by all EXCEPT
a) Ilio-psoas
b) Pectineus
c) Sartorius
d) Semitendinosus
Ans. d) Semitendinosus.
Explanation: Hip flexion is chiefly carried out by ilio-psoas muscle and assisted by muscles like
pectineus, sartorius etc. Semitendinosus is a hamstring muscle for hip extension along with the gluteus
maximus.

24. Superior gluteal nerve acts at hip joint for

a) Abduction & lateral rotation
b) Abduction & medial rotation
c) Adduction & medial rotation
d) Adduction & lateral rotation
Ans. b) Abduction & medal rotation.
Explanation: Superior gluteal nerve supplies three muscles: gluteus medius, gluteus minimus and tensor
fascia lata, which act at the hip joint for abduction, medial rotation and pelvic rotation.

25. WRONG about Trendelenburg test is

a) Contraction of gluteus maximus is assessed
b) Positive in superior gluteal nerve damage
c) Right pelvis drops down in left superior gluteal nerve lesion
d) Bilateral damage results in Waddling gait
Ans. a) Contraction of gluteus maximus is assessed.
Explanation: Trendelenburg test is to check the gluteus medius and minimus muscle (not the gluteus
maximus). Superior gluteal nerve lesion paralyses gluteus medius and minimus, which leads to fall of
contralateral pelvis during swing phase of walking cycle. If the nerve injury is bilateral, it leads to bilateral
lurching (waddling gait).

26. INCORRECT statement regarding popliteus is

a) Intracapsular origin
b) Attaches to medial lemniscus
c) Supplied by tibial nerve
d) Causes flexion and medial rotation at knee joint
Ans. b) Attaches to medial meniscus.
Explanation: Popliteus muscle has intracapsular origin from the lateral condyle of femur, has attachment
with the lateral lemniscus (not medial) and inserts into the posterior surface of tibia (floor of popliteal fossa).
It is supplied by tibial nerve and unlocks the knee joint by medial rotation of tibia (in unplanted foot). It
also works with hamstring muscles for knee flexion.

27. Which of the following muscle has intracapsular origin

a) Anconeus
b) Coracobrachialis
c) Long head of biceps femoris
d) Popliteus
e) Peroneus longus
Ans. d) Popliteus.
Explanation: Long head of biceps brachii and the popliteus muscle has intra-capsular origin.

28. A boy playing football received a blow to the lateral aspect of the knee and suffered a twisting
fall. His medial meniscus is damaged, which other structure is most likely to be injured
a) Deltoid ligament
b) Posterior cruciate ligament
c) Anterior cruciate ligament
d) Patellar-ligament

Ans. c) Anterior cruciate ligament.

Explanation: This is a case of terrible (triple) triad and leads to damage of three ligaments: TCL (Tibial
Collateral Ligament), medial meniscus and ACL (Anterior Cruciate Ligament). Lachman test becomes
positive.

29. Following are the nerves and muscles of the leg. Choose the CORRECT pair
a) Superficial peroneal: Soleus
b) Deep peroneal: Peroneus brevis
c) Tibial nerve: Tibialis anterior
d) Common fibular nerve: Short head of biceps
Ans. d) Common fibular nerve: Short head of biceps..
Explanation: Short head of biceps is supplied by the common peroneal nerve. Soleus is calf muscle
suppled by posterior tibila nerve. Peroneus brevis is a lateral leg muscles innervated by superficial peroneal
nerve. Tibialis anterior is supplied by deep peronela nerve.

30. Postero-lateral herniation of nucleus pulposus at L5 – S1 vertebrae level will result in pain
located along the
a) Anterior aspect of the thigh
b) Medial aspect of the thigh
c) Antero-medial aspect of the leg
d) Lateral side of the foot
Ans. d) Lateral side of the foot.
Explanation: The nerve root involved is S-1, and the corresponding dermatome involved is the lateral side
of the foot and little toe.

31. Femoral pulsation can be best felt at

a) Below and medial to pubic tubercle
b) Near anterior superior iliac spine
c) Mid-point of inguinal ligament
d) Mid-inguinal point
Ans. d) Mid-inguinal point.
Explanation: Femoral artery pulsation can be felt against the head of femur at mid-inguinal point.

32. Middle genicular artery is a branch of

a) Femoral artery
b) Popliteal artery
c) Anterior tibial artery
d) Posterior tibial artery
Ans. b) Popliteal artery.
Explanation: Five genicular arteries are given by popliteal artery (including middle genicular artery) to
supply knee joint. There are two superior (medial & lateral) and two inferior (medial & lateral).

33. All are Valveless EXCEPT

a) Dural venous sinus
b) Hepatic veins
c) Inferior vena cava
d) Femoral vein
Ans. d) Femoral vein.
Explanation: Femoral veins contain between one and six valves, and popliteal veins contain between zero
and four valves. Deep vein valves are consistently located in the common femoral vein (within 5 cm of the
inguinal ligament), the femoral vein (within 3 cm of the deep femoral vein tributary) and in the popliteal vein
near the adductor hiatus.

34. The vessel at marker ‘D’ in the leg region is

a) Profunda femoris artery

b) Obturator artery
c) Posterior tibial artery
d) Peroneal artery
Ans. d) Peroneal artery.
Explanation: A: Politeal artery; B: Tibio-peroneal trunk; C: Anterior tibial artery; D: Fibular (peroneal) artery,
the shortest artery in the leg; E: Posterior tibial artery (Longest artery, which gives nutrient artery to tibia
and later gives plantar arteries in the foot).
 35. Tibialis posterior is inserted in all the tarsal bones EXCEPT
a) Calcaneus
b) Intermediate cuneiform
c) Cuboid
d) Talus
Ans. d) Talus.
Explanation: Tibialis posterior muscle has extensive attachments on the foot bones, but is not attached to
talus bone.Talus bone in the foot and Incus bone in the middle ear cavity has no has no muscle
attachments.
36. Which is NOT a part of medial longitudinal arch of foot
a) Third metatarsal
b) Cuboid
c) Calcaneum
d) Talus

Ans. b) Cuboid.
Explanation: Cuboid bone is present at the lateral aspect of the foot, articulates with calcaneum (CC joint
is saddle synovial) and both bones contributes to lateral longitudinal arch. Cuboid bone is the keystone
bone for the arch. Cuboid bone has a groove for the tendon of peroneus longus muscle.
 Lateral longitudinal arch is contributed by the calcaneus, the cuboid bone, and the lateral two
metatarsal bones. The keystone is the cuboid bone. It is supported by the peroneus longus tendon
and the long and short plantar ligaments.
 Medial longitudinal arch is contributed and maintained by the of the talus, calcaneus, navicular,
cuneiform, and three medial metatarsal bones. The keystone is the head of the talus, which is located
at the summit between the sustentaculum tali and the navicular bone. It is supported by the spring
ligament and the tendon of the flexor hallucis longus. Flat foot (pes planus or talipes planus) is a
condition of disappearance or collapse of the medial longitudinal arch with eversion and abduction of
the forefoot and leads to pain as a result of stretching of the plantar muscles and straining of the spring
ligament and the long and short plantar ligaments.
 Transverse arches: . 1. Proximal (metatarsal) arch is formed by the navicular bone, the three
cuneiform bones, the cuboid bone, and the bases of the five metatarsal bones of the foot. It is
supported by the tendon of the peroneus longus. 2. Distal arch is formed by the heads of five metatarsal
bones. It is maintained by the transverse head of the adductor hallucis.
37. Inversion & eversion mainly happen at which joint
a) Inferior tibio-fibular
b) Ankle
c) Subtalar
d) Calcaneo-cuboid
Ans. c) Sub-talar.
Explanation: Subtalar (Talocalcaneal) joint It is a plane synovial joint (part of the talocalcaneonavicular
joint), and is formed between talus and calcaneus bones. Inversion and eversion of the foot occurs at this
joint.

38. Which tendon passes below sustentacula tali

a) Tibialis anterior
b) Tibialis posterior
c) Flexor hallucis longus
d) Flexor digitorum longus
Ans. c) Flexor hallucis longus.
Explanation: The tendon of flexor hallucis longus (calf muscle) passes deep to flexor retinaculum on the
mediaial side of the ankle and then underneath the sustentaculum talus of calcaneus bone, to pull on the
great toe for flexion.

39. All of the following pass under the flexor retinaculum EXCEPT
a) Tibialis anterior
b) Tibialis posterior
c) Posterior tibial artery
d) Deep peroneal nerve
e) Anterior tibial nerve
Ans. A) Tibilais anterior; d) Deep peroneal nerve; e) Anterior tibial nerve
Explanation: Tibialis anterior and deep peroneal (anterior tibial) nerve pass under the anteriorly placed
extensor retinaculum.

40. In foot pronation, the axis of which two joints become parallel
a) Talo-calcaneal and talo- navicular
b) Talo-calcaneal and calcaneo -cuboid
c) Subtalar and Lisfranc
d) Talo-navicular and calcaneo-cuboid

Ans. d) Talo-navicular and calcaneo-cuboid.

Explanation: Transverse tarsal (Midtarsal) joint is a collective term for the talonavicular (TN) part of the
talocalcaneonavicular joint and the calcaneocuboid (CC) joint. The two joints are separated anatomically
but act together functionally. During supination of foot, the soles face each other and there occurs
inversion, whereas, in pronation, soles move outwards and is accompanied by eversion (TN and CC joint
become parallel).

High Yield Facts

 In lower limb, gracilis is the most common muscle used for surgical grafting.
 Sartorius muscle causes flexion at both hip and knee joint (Sartor – Tailor).
 Tibialis anterior is the muscle, which works in stance as well as swing phase of walking cycle.
 Lateral femoral cutaneous nerve arises from the lumbar plexus (L2–L3), passes under the inguinal
ligament near the anterior-superior iliac spine and supply skin on the anterolateral aspect of thigh. It
might get involved in meralgia paraesthetica.
 Saphenous Nerve is a branch of femoral nerve given in the femoral triangle and descends with the
femoral vessels through the femoral triangle and the adductor canal. Then it is accompanied by the
great saphenous vein to reach the medial margin of the foot. Innervates the skin on the medial side of
the leg and foot. It is vulnerable to injury during venesection at the medial malleolus.
 Pott’s (Dupuytren’s) fracture is caused by forced eversion of foot and involves the lower end of the
fibula, often accompanied by fracture of the medial malleolus (or rupture of the deltoid ligament).
 Most stable position for ankle joint is in dorsiflexion, when anterior wider part of talus(trochlear
surface) fits properly in tibio-fibular mortise.
 Obturator externus is supplied by lumbar plexus (obturator nerve).
 Tibio-femoral condyles are involved in weight transmission (pressure epiphysis) and are intracapsular.
Q. A man comes with aphasia, is unable to name things and repetition is poor. However
comprehension, fluency and articulation is unaffected. He is probably suffering from (AIIMS)
a) Anomic aphasia
b) Transcortical sensory aphasia
c) Conduction aphasia
d) Broca's aphasia
 The liver is divided into four portal sectors by the four main branches of the portal vein. These are right
lateral, right medial, left medial and left lateral (sometimes the term posterior is used in place of lateral
and anterior in place of medial).
 The three main hepatic veins lie between these sectors as intersectorial veins. These intersectoral planes
are also called portal fissures (scissures). The fissures containing portal pedicles are called hepatic
fissures. Each sector is sub-divided into segments (usually two) based on their supply by tertiary divisions
of the vascular biliary sheaths.
 Three major fissures, not visible on the surface, run through the liver parenchyma and harbour the three
main hepatic veins (main, left and right portal fissures). Three minor fissures are visible as physical
clefts of the liver surface (umbilical, venous and fissure of Gans).
 Segment I (anatomical caudate lobe) lies posterior (dorsal) to segment IV with its left half directly
posterior to segments II and II and its medial half surrounded by major vascular branches. This segment
is a boundary line structure and receives dual artery, vein and duct supply. The Glissonian sheaths to
segment I arise from both right and left main sheaths: the segment therefore receives vessels
independently from the left and right portal veins and hepatic arteries. Caudate lobe is peculiar in the
finding that it drains independently into the inferior vena cava by multiple small branches and not into
major hepatic veins.. The bile ducts draining the segment are closely related to the confluence of the right
and left hepatic ducts.
Q. All is true about functional divisions of liver EXCEPT (AIIMS)
a) Based upon portal vein & hepatic vein
b) Divided into 8 segments
c) Three major & three minor fissures
d) 4 sectors
 Liver is divided into eight (functional (surgical) segments according to Couinaud’s classification,
following hepatic veins and portal veins, and is further enhanced by following bile duct distribution.
Recently there was addition of a ninth segment, but most of the surgeons do not accept the new
addition for operative procedures.
 The Bismuth system, which is a modified version of the Couinaud system, is the most commonly used
anatomic nomenclature system. In the Bismuth system, each segment has an independent vascular
supply, including arterial, portal, and venous supplies, as well as independent lymphatic and biliary
drainage.
 Peri-conceptional intake of 400 µg of folic acid per day by the pregnant women (starting from 1 month prior
to 3 months after conception) can prevent 75% of all neural tube defects. Intake of 4000 µg /d is
recommended to prevent recurrences.
 Cancellous bone is metabolically more active than the cortical bone. Endosteum is metabolically more
active than periosteum.
 Reticular fibres/collagen type III is absent in thymus. Basement membrane has type – IV collagen.
 Jersey finger (Rugby finger or Sweater finger) is a type of injury due to avulsion of the flexor digitorum
profundus (FDP) at the base of the distal interphalangeal joint.
 Cranial nerves carrying GVE (General Visceral Efferent) fibres come under autonomic nervous system like
3, 7, 9 and 10 (parasympathetic system). Cranial nerve 1, 2 and 8 belong to SSA (Special Somatic Afferent)
column.
 Glomerulus is a derivative of metanephric blastema (and not mesonephric duct).
 Lower two part of sternum fused by age of 14 years.
 Nerve beneath the facial colliculus is facial nerve, while the nucleus deep to that is abducent nucleus.
 SIT (Supraspinatus, Infraspinatus, Teres minor) muscles sit on greater tubercle. Subscapularis muscle
attaches to lesser tubercle of humerus.
 First part of subclavian artery give VIT (Vertebral, Internal thoracic, Thyrocervical) branches. T
(Thyrocervical trunk) itself give SIT (Suprascapular, Inferior thyroid artery, Transverse cervical) branches.
 Card test is done to check palmar interossei.
 Microvilli are present in collecting ducts, but not as markedly developed as in PCT, Gall bladder,
Duodenum.
 Independent assortment of chromosomes occur during meiosis-I, when primary spermatocyte converts
into secondary spermatocyte.
 Cornea is supplied by nasociliary nerve (Trigeminal, ophthalmic division).
 Trochlear nerve injury leads to paralysis of superior oblique muscle (an intortor) and presents with affected
eye in extortion leading to vertical diplopia, especially while reading a book (adduction and depression),
and the patient attains a contralateral head tilt to correct it.
 At birth, ovaries contains primary oocyte arrested in diplotene stage of prophase – I, due to OMI (Oocyte
Maturation Inhibitor).
 Pelvic viscera (Uterus) are supported by Urogenital diaphragm, Pelvic diaphragm, Perineal body (but not
Rectovaginal septum).
 Mesorectum do not contain inferior rectal vein
 Intact comprehension and motor articulation but poor repetition is a feature of conduction aphasia.
 Brown adipose tissue is present around scapula, adrenals, blood vessels. White fat is subcutaneous (not
brown?).