Anatomy Image Bank Edition 2 Updated Upto NEET PG 21

Anatomy
Image Bank
Index
Sl.No. Chapter Pg.No.
1. Embryology 09
2. Upper Limb 26
3. General Anatomy 49
4. Histology 52
5. Lower Limb 61
6. Thorax 69
7. Abdomen And Pelvis 82
8. Head And Neck 96
9
Embryology
GAMETOGENESIS
Formation of gamete from primordial germ cells.
Primordial germ cell Derived from epiblast
Endodermal wall of yolk sac (4th week)
Gonads (5th week)
Spermatogenesis - 74 days
Spermatogenesis begins at puberty
I Meiosis occurs in adult ovary and seminiferous tubules
Spermatid is derived from secondary spermatocyte
Fertilization is complete when 2nd polar body is formed.
Q. Meiosis occurs in:

'
NEET 20
Reference: Textbook of Clinical Embryology,Vishram Singh, pg22

10
Fertilization
Fertilization occurs at the ampulla of Fallopian tube.

Acrosome reaction —> Cortical reaction —> Zona reaction
Sperm remains fertile for 24- 48 hrs in female genital tract.
'
NEET 13
Q. Sperm remains fertile for how many
hours in female genital tract?
Reference: Textbook of Clinical Embryology,Vishram Singh, pg 34

11
FETAL CIRCULATION
PLACENTA
LEFT UMBILICAL VEIN UMBILICAL ARTERIES
FETUS RIGHT AN LEFT

INTERNAL ILIAC ARTERIES
DUCTUS VENOSUS
RIGHT AND LEFT
COMMON ILIAC ARTERIES
INFERIOR VENACAVA
MIXES WITH VENOUS RETURN FROM AORTA
LOWER EXTREMITIES
RIGHT ATRIUM LEFT ATRIUM

FORAMEN OVALE
RIGHT VENTRICLE
PULMONARY ARTERY DUCTUS ARTERIOSIS

12
'
MEET 21
Q. Anatomical closure of Foramen
Q. Deoxygenated blood is returned to
'
MEET 20
ovale occurs at what age ? the placenta from the fetus through ?
UMBILICAL CORD
Develops from extraembryonic mesoderm
Q. Contents of Umbilical cord?
1. Two umbilical arteries

2. One umbilical vein (left)
3. Wharton’s jelly
4. Remains of allantoic diverticulum
5. Remains of vitellointestinal
duct (remnant ofyolk sac)
Umbilical arteries carry deoxygenated blood
from fetus to the placenta
Umbilical vein carries oxygenated blood from
the placenta to the fetus.
CORD PROLAPSE COMPRESSION FETAL HYPOXIA

13
ANOMALIES
OMPHALOCELE
Failure of the small intestine to return into
abdominal cavity from their physiological herniation
into extraembryonic celom during
sixth to tenth week of IUL.
Covered by peritoneum, Wharton’s jelly, and amnion
Associated with cardiac and neural tube defects
Has genetic basis
Has bad prognosis (mortality rate 25%)
'
NEET /9 Q. What is the basis for the formation of Omphalocele?
Gastroschisis
Linear defect in anterior abdominal wall
through which abdominal contents herniate out
Occurs lateral to the umbilicus, usually on to the right.
Due to failure of lateral folds of embryo to fuse with
each other around connecting stalk.
Absence of membraneous sac
Q. What is the basis of formation of Gastroschisis?
Congenital umbilical hernia

Herniation of abdominal viscera through the
weak umbilical opening (poorly closed umbilicus)
Covered with peritoneum,
subcutaneous tissue, and skin.
The congenital umbilical hernia gets reduced
on its own within 2–3 years of life
Q. What is the basis of formation of Congenital umbilical hernia?

14
PHARYNGEAL ARCHES
Surface elevations that appear in the lateral wall
of primitive pharynx caudal to stomodeum
Fourth week of intrauterine development
I–IV: pharyngeal arches

1–4: pharyngeal pouches (inside)
pharyngeal grooves (outside)
a: Tuberculum laterale
b: Tuberculum impar
c: Foramen cecum
d: Ductus thyreoglossus
e: Sinus cervicalis
'
NEET 19
'
NEET 18
'
NEET 20
Q. First pharyngeal arch gives rise to?
Q. The nerve of second brachial arch?
Q. Reason for long left recurrent

laryngeal nerve is due to
persistence of which arch artery ?

15
PHARYNGEAL POUCHES
Evaginations of endoderm, lining the interior to primitive pharynx between the two arches.
Derivatives of pharyngeal clefts and

pharyngeal membranes

16
DiGeorge syndrome
Occurs when the third and fourth pharyngeal pouches fail to
differentiate into thymus and parathyroid glands.
Caused by the deletion of long arm of chromosome 22. Hence it
is also called 22q deletion syndrome.
Features:
1) Cardiac abnormality( aortic arch, TOF,Truncus arteriosus)
2) Abnormal facies (Fish mouth deformity (shortened philtrum)
Low set notched ear; Increased susceptibility to infection.)
3) Thymic aphasia
MNEUMONIC - CATCH 22 4) Cleft palate
5) Hypocalcemia, HypoPTH
'
AIIMS 17
Q. Defective development of which pouch presents
with hypoparathyroidism, absent thymus and tetany?
FIRST ARCH SYNDROMES
Treacher Collins syndrome

Autosomal dominant trait.
Clinically it presents as:
1. Malar hypoplasia (due to underdevelopment of zygomatic bones)
2. Mandibular hypoplasia
3. Down slanting palpebral fissures
4. Deformed external ears.
Q. Identify the first arch syndromes?
Pierre Robin syndrome

Autosomal recessive disorder.
Clinically presents as triad of anomalies:
1. Micrognathia (small mandible),
2. Cleft palate
3. Glossoptosis (posteriorly placed tongue).

17
NOTOCHORD
1. Develops from the primitive knot
2. Induces the formation of neural tube from the ectoderm.
3. Disappears later but its remnants are seen in the form of
nucleus pulposus of the intervertebral discs and apical ligament
of dens of second cervical vertebra.
Q. Nucleus pulposus is derived from?
'
AIIMS MAY 17
FORMATION OF NOTOCHORD
1. Cells of primitive knot proliferate to
form prenotochordal cells that
invaginates to produce a central
depression called blastopore.The
prenotochordal cells migrate forward in
midline of the bilaminar germ disc to
form notochordal process.
2. The notochordal process gets canalized
to form notochordal canal.
3. The floor of notochordal canal fuses
with the endoderm.
4. Breakdown of fused parts of floor of
notochordal process and endoderm.
amniotic cavity and the yolk sac are in
communication with each other.
5. Walls of the canal become flattened to

form a flattened plate called
notochordal plate.
6. The notochordal plate becomes curved to
form a tube
7. Proliferation of cells of the tube form
definitive notochord. Notochord is
completely separated from the endoderm.

18
Chordoma
1. Tumor arising from the remnants of notochord.
2. Formed either in the cranial region
or in the sacral region.
3. Commonly occurs in men over 50 years of age.
4. 30% are malignant.
Q. Tumor arising from remnants of notochord?
Development of heart
Heart starts to beat at the 4th week of intrauterine period

Mesodermal in origin
Develops from primitive heart tube, which forms from
mesenchyme in the cardiogenic area of the embryo.
Starts functioning at the end of the third week of
intrauterine life on day 22
NEET 18
'
Q. The heart starts to beat in which week of development?

19
'
AIIMS MAY 20
Q. Infundibulum develops from which part of embryonic dilatation?
BULBUS CORDIS
PROXIMAL 1/3 TRABECULATED PART OF RT VENTRICLE
MIDDLE 1/3 ( CONUS CORDIS) INFUNDIBULUM
DISTAL 13 (TRUNCUS ARTERIOSUS) AORTA AND PULMONARY ARTERY
Formation of Atrioventricular Septum

The AV septum is formed by the fusion of AV cushions
Endocardial cushions appear on the dorsal and ventral
walls of AV canal by proliferation of subendocardial
mesenchymal cells around right and left AV canals.
They fuse and form the septum intermedium.
Take part in the formation of interatrial and
interventricular septum ( NEET 19)

20
Formation of Intraventricular septum
Bulbar
part
Right and left bulbar ridges
Muscular
part
Floor of primitive ventricle
Membranous Bulbar ridge

part
AV cushions.
Ventricular septal defect (VSD)

Failure of fusion of right and left bulbar
ridges with the AV cushions.
left-to-right shunting of blood
tetralogy of Fallot (TOF)

(a) pulmonary stenosis,
(b) overriding aorta
(c) IV septal defect
(d) hypertrophy of the right ventricle.
right-to-left shunting of blood
Commonest congenital cyanotic heart disease.
The membranous part of IV septum is derived from

Right bulbar ridge,
Left bulbar ridge,
Endocardial cushions. '
NEET 19
Q. Membraneous part of Intraventicular septum is derived from?

21
DEVELOPMENT OF KIDNEY
intermediate mesoderm
urogenital ridge
medial parT lateral part
genital ridge nephrogenic

cord.
pronephros
mesonephros
metanephros
URETERIC BUD
-Ureteric bud arises from mesonephric duct
-Ureteric bud induces the metanephric
tissue to form metanephric blastema.
-Renal agenesis occurs when ureteric bud
fails to develop
Q. Ureteric bud develops from?

'
NEET 18

22
Potter syndrome
Potter Facies
FAILURE OF URETERIC BUD TO DEVELOPE Low set ears
Beaked nose
BILATERAL RENAL AGENESIS Prominent epicanthic fold
Downward slant eyes
REDUCED FETAL URINE EXCRETION
Pulmonary hypoplasia
OLIGOHYDRAMINOS
Limb deformities
FETAL COMPRESSION
Development of skin
Q. Dermis is derived from?

'
NEET /9
Dermis is derived from Mesoderm

(a) Paraxial mesoderm,
(b) Somatopleuric layer of
lateral plate mesoderm
(c) Neural crest cells.
Dermis differentiates into two layers:
1. Superficial papillary layer
-contains capillary plexus and
sensory nerve end organ
2. Deeper reticular layer.
-contains large amount of fatty
tissue.
Epidermis develops from surface ectoderm
The appendages of skin (sebaceous and
sweat glands, hair, and nails) are
derived from the epidermis.
Q. Dendritic cell is derived from?

23
FONTANELLES OF SKULL
Soft membranous areas in the vault of newborn skull. anterior
Six fontanelles at birth median
fontanelles Posterior fontanelle
anterolateral (sphenoid)
two paired lateral
fontanelles
posterolateral (mastoid)
All fontanelles except anterior fontanelle are closed within three or four months after birth.
Anterior fontanelle is closed between second and third year of age.
Functions of fontanelles
1. Moulding of skull during parturition to facilitate the baby birth.
2. Permit postnatal growth of skull bones
3. Allows postnatal development of the brain. NEET 18
'
Sunken fontanelle - Dehydration Q. Which is the last fontanelle to close?

Bulging fontanelle - Increased intracranial pressure.

24
Langman's medical embryology

25
Langman's medical embryology

26
Upper limb
Scapula
Coracoid process
Attachment to three muscles:- Short head of biceps brachii,
Coracobrachialis
Pectoralis minor AIIMS
'
/7
Attachment to three ligaments:- Coracoacromial,

Q. The structure of scapula palpable
Coracoclavicular in infraclavicular fossa?
Coracohumeral.
The tip of the coracoid process of the scapula lies 2-3 cm below the clavicle, overlapped by the
anterior fibres of the deltoid.
It can be felt on deep palpation just lateral to the infraclavicular fossa.
Reference:Textbook of Anatomy,Vishram Singh, pg15

27
Lymphatic drainage of breast
The superficial lymphatics drain the skin over the breast except
for the nipple and areola.
The deep lymphatics drain the parenchyma of the breast.
They also drain the nipple and areola
Cancer cells may infiltrate the suspensory ligaments. The breast
then becomes fixed. Contraction of the ligaments can cause
retraction or puckering of the skin
Infiltration of lactiferous ducts and their consequent fibrosis
can cause retraction of the nipple.
Obstruction of superficial lymph vessels by cancer cells may
produce oedema of the skin giving rise to an appearance like
that of the skin of an orange (peau d'orange appearance)
Most conspicuous sign of breast cancer.
'
AIIMS NOV 17
Q. Most conspicuous sign of breast cancer?

28
brachial plexus
Plexus of nerves formed by the anterior (ventral) rami of lower four cervical and the first thoracic
spinal nerves (C5, C6, C7, C8, and T1).
Dorsal scapular n. C4
Lateral pectoral n. Suprascapular n.
Musculocutaneous
nerve C5
Subclavius
nerve
Phrenic n.
Axillary n.
C6
Median n. C7
Lower
subscapular
nerve
Thoracodorsal n.
Radial n. Upper subscapular n. C8
Ulnar n. T1
Medial antebrachial cutaneous n.
Medial brachial cutaneous n. 1st intercostal n.
Medial pectoral n. Long thoracic n.
NERVES Cords NERVEROOT

Musculocutneous LATERAL CORD C5,c6,c7
nerve
Axillary nerve Posterior cord C5,c6
Median nerve LATERAL CORD C5,c6,c7

Medial cord C8,T1
Radial nerve Posterior cord C5,c6,c7,C8,t1
Ulnar nerve Medial cord C8, T1

Lateral root of
median nerve C7
'
INICET 20
NEET '2Q
Q. Nerveroot of Axillary nerve?

Dorsal scapular nerve supplies levator scapulae
29
AIIMS NOV ' 17
Q. Structure of brachial
plexus that do not give rise
to branches?
Divisions of brachial plexus

do not give rise to branches
Parts Branches
Dorsal scapular nerve(C5)
Roots Long thoracic nERVE (C5,C6,C7)
Suprascapular nERVE (C5,C6)

Upper trunk
NERVE TO Subclavius (C5,C6)
Lateral cord Lateral pectoral nERVE (C5,C6,C7)

Musculocutaneous NERVE (C5,C6,C7)
LML Lateral root of median nerve (C5,C6,C7)
Medial pectoral NERVE (C8,T1)
Medial cord Medial brachial cutaneous nERVE (C8,T1)
Medial antebrachial cutaneous nERVE (C8,T1)
MUM
Ulnar nerve (C8,T1)
medial root of median nerve (C8,T1)
Upper subscapular nERVE (C5,C6)

Posterior cord Thoracodorsal nERVE (C6,C7,C8)
STARS Axillary nerve (C5,C6)
Radial nerve (C5,C6,C7,C8,T1)
lower subscapular nerve (C5,C6)

30
UPPER SUBSCAP.nl .
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corf;¥É
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RADIAL N
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f ?⃝ LATERAL CORD
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MEDIAL CORD
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N.to LATM POSTERIOR CORD
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-
DELTOID MUSCLE
Origin: Anterior head- Lateral 1/3 of clavicle
Lateral head- Acromion of scapula
Posterior head- Spine of scapula
Insertion: Deltoid tuberosity of humerus
Innervation: Axillary nerve (C5,C6)
Action: Anterior head- Flexes & internally rotates arm
Middle head- Abducts arm
Posterior head- Extends & laterally rotates arm
'
INICET 20
Q. Muscles involved in overhead abduction of arm?

Abduction of arm
The muscles which helps in the abduction of arm are :-
390
ANGLE MUSCLES
0 - 15 Supraspinatus
15 - 90 Lateral fibers of Deltoid 15-90
> 90
(Overhead Abduction) Trapezius & Serratus anterior
¥
Reference:Chaurasia’s human anatomy, pg67

31
ROTATOR CUFF MUSCLES
Musculotendinous cuff
Fibrous sheath formed by the four
flattened tendons which blend with
the capsule of the shoulder joint and
strengthen it.
1.Supraspinatus
2.Infraspinatus
3.Teres minor
4. Subscapulris
Rotator cuff gives strength to the capsule of the shoulder joint all around except inferiorly
- dislocations of the humerus occur most commonly in a downward direction.
DELTOID
- DELTOID BRANCH OF THORACO ABDOMINAL ARTERY

PELTOPECTORAL
\
GROOVE
→
PECTORALIS MAJOR
CEPHALIC VEIN -
Pectoralis major
Origin: Clavicular head-Medial third of Clavicle
Sternocostal head- Anterior aspect of sternum
Upper 6 costal cartilage
Insertion: Lateral lip of bicipital groove of the humerus
Innervation: Lateral pectoral nerve C5,C6,C7
Medial pectoral nerve C8,T1
Function Adduction & Medial rotation of shoulder joint
Clavicular head flexes shoulder joint
Strenocostal head extends the flexed arm

32
Trapezius muscle
Flat triangular muscle '
AIIMS NOV 17
Q. Shape of trapezius muscle?
Origin
1. Medial third of superior nuchal line
2. External occipital protuberance
3. Ligamentum nuchae
4. Spine of 7th cervical vertebra
5. Spines of all thoracic vertebrae
Insertion
1. Superior fibres runs downwards and laterally
-lateral third of the clavicle
2. The middle fibres proceed horizontally
-the acromion and spine of the scapula
3. The lower fibres pass upward and laterally
-deltoid tubercle
Nerve supply
1. Spinal part of the accessory nerve
-motor supply
2. Ventral rami of C3 & C4
-proprioceptive sensations
Actions
1. Upper fibres of trapezius along with levator scapulae
-elevate the scapula (shrugging the shoulder)
2. Middle fibres of trapezius along with rhomboids
- retract the scapula (bracing back the shoulder)
3. Lower fibres of trapezius
-depress the medial part of the spine of the scapula.
4. Acting with serratus anterior
- rotates the scapula forward
Trapezius is a shrugging muscle supplied by spinal root of XI nerve.

Trapezius with serratus anterior causes 90'-180' of abduction at shoulder joints.

33
Anterior compartment of arm
Popeye SIGN
Rupture of tendon long head of biceps usually occurs from
wear and tear of an inflamed tendon as it moves back and
forth in the bicipital groove of the humerus.
It may also result from forceful flexion of arm against
excessive resistance as during weight lifting.
Usually occurs in individuals above 35 years of age.
The deformity is due to detached belly of the biceps muscle
'
NEET 20
Q. Identify the sign and the reason for the deformity?

34
musculocutaneous nerve
The musculocutaneous nerve is the main nerve of the front of the arm, and continues below
the elbow as the lateral cutaneous nerve of the forearm
It is a branch of the lateral cord of the brachial plexus, arising at the lower border of the
pectoralis minor in the axilla
Root value : ventral rami of C5-C7
segments of spinal cord.
ORigin, Course ond Termination
Musculocutaneous nerve arises from the lateral
cord of brachial plexus in the lower part of the
axilla.
It accompanies the third part of the axillary
artery.
It then enters the front of arm, where it
pierces coracobrachialis muscle.
Then it runs downwards and laterally between
biceps brachii and brachialis muscles to reach
the lateral side of the tendon of biceps brachii.
It terminates by continuing as the lateral
cutaneous nerve of forearm 2 cm above the
bend of the elbow
Branches and distribution
Muscular: It supplies the following muscles of the front of the arm. NIEETÉI
i. Coracobrachialis Q. A small boy with multiple humerus fractures following which there
ii. Biceps brachii,long and short heads is loss of sensation over lateral side of forearm, difficulty in Flexion of
elbow and supination of forearm. Which nerve is involved?
iii. Brachialis
Cutaneous: Through the lateral cutaneous nerve of the forearm it supplies the skin of the
lateral side of the forearm from the elbow to the wrist including the ball of the thumb
Articular branches:
i. The elbow joint through its branch to the brachialis.
ii. The shoulder joint through a separate branch which enters the humerus along with its
nutrient artery.
Communicating branches : The musculocutaneous nerve through lateral cutaneous nerve of
forearm communicates with the neighbouring nerve, namely the superficial branch of the radial
nerve, the posterior cutaneous nerve of the forearm, and the palmar cutaneous branch of the
median nerve.
35
Cubical fossa
Boundaries
Lateral: Medial border of brachioradialis muscle.
Medial: Lateral border of pronator teres muscle.
Base: Imaginary horizontal line, joining the front of two epicondyles of the humerus.
Apex: Meeting point of the lateral and medial boundaries.
Floor: Brachialis in the upper part and Supinator in the lower part
Roof:1. Skin
2. Superficial fascia:- Median cubital vein (connects cephalic and basilic vein)
Medial and lateral cutaneous nerves of forearm
3. Deep fascia:- Bicipital aponeurosis
MEDIAL, LATERAL, APEX , BASE Roof Floor
CONTENTS
median nerve
Leaves the fossa by passing between the two
heads of pronator teres
brachial artery
Termination of the brachial artery, and the
beginning of the radial and ulnar arteries.
tendon of the biceps brachi
radial nerVe
Superficial branch -Continues in forearm
Deep branch
-Leaves the fossa by piercing
the supinator muscle
MNEUMONIC - MBBS

36
Basilic vein
Cephalic vein
Median cubital vein
Tendon of biceps
Median nerve
Brachial artery
Ulnar artery
Radial artery
Q. Identify the boundaries
and contents of cubital fossa?
AIIMS NOV 19 Q. Cutaneous supply of Median nerve?
'
AIIMS Nov 19
Q. Injury to radial nerve causes?

37
RADIAL NERVE ULNAR NERVE MEDIAN NERVE
WRIST DROP CLAW HAND APE THUMB
BACK OF FOREARM
•a Man
µ,
38
Maggot
SUPERFICIAL MUSCLES
'
NEET 19
Q. Identification of superficial muscles of back of forearm?

39
'
NEET 19
Extensor retinaculum
Deep fascia on the back of the

wrist is thickened to form an
oblique fibrous band.
Divided into 6 compartments.
Directed downwards and laterally
Medial end attached to:
-Styloid process of ulna,
-Triquetral
-Pisiform
Lateral end attached to:
-Anterior border of the radius
40
De Quervain syndrome
Tenosynovitis of the extensor tendons of the
first compartment of extensor retinaculum.
ABDUCTOR POLLICIS LONGUS
EXTENSOR POLLICIS BREVIS
Finkelstein's test
Pain increases when the wrist is bent inwards while
a person is grabbing their thumb within a fist.
'
NEET 19
Q. Tendons affected in De Quervain syndrome?
Reference:Textbook of Anatomy,Vishram Singh, p123

41
ANATOMICAL SNUFF BOX
Also known as Radial fossa

Triangular depression in the lateral aspect of dorsum of hand.
Seen best when the thumb is extended
Extensor pollicis longus tendon

Radial artery
Extensor pollicis brevis tendon
'
NEET 20
Abductor pollicis longus
Boundaries
Ulnar border( Medial): Tendon of Extensor pollicis longus
Radial border: Tendon of Extensor pollicis brevis
(lateral) Tendon of Abductor pollicis longus
Floor: Scaphoid & Trapezium
Proximal: Radial styloid process
Distal: Base of 1st metacarpal
Contents
1. Cephalic vein Mnemonic- CARTs
2. Artery- Radial
3. Radial nerve- Superficial branch
4. Tendons of Extensor carpi radial is longus & brevis
CLINICAL significance
Tenderness in this area signifies Scaphoid
fracture
Risk of Avascular necrosis
'
Q. Lateral boundary of anatomical snuff box?

NEET 20
42
Cutaneous nerve supply of upper limb
'
NEET 19
Q. Identify the area of hand supplied by radial nerve?

43
Intrinsic muscles of hand

Thenar eminence
MUSCLES ORIGIN INSERTION INNERVATION ACTION
Abductor Scaphoid & Base of 1st Proximal Median nerve Abduction of MCP
pollicis Brevis Trapezium Phalanx(Radial side) (C8 - T1) Flexion of IP
Flexor Trapezium & Base of 1st Ulnar nerve
pollicis Brevis Flexor Retinaculam Proximal Phalanx (C8 - T1) Flexion at MCP
Opponens Trapezium & Radial side of1st Median nerve Opposition &
pollicis Flexor Retinaculam metacarpal bone (C8 - T1) Adduction
'
INICET 20
HYPOTHENAR EMINENCE Q. Identification & insertion of Opponens pollicis?
Opponens Digiti Hook of hamate & Medial side of

I
Ulnar nerve Opposition of
minimi Flexor retinaculum 5th metacarpal (C8 - T1) 5th metacarpal
Abductor Digiti Pisiform & tendon Base of 5th Ulnar nerve Abduction of
minimi of flexor carpi ulnaris proximal phalanx (C8 - T1) little finger
Flexor Digiti Hook of hamate & Base of 5th Ulnar nerve Flexion of
minimi Flexor retinaculum proximal phalanx (C8 - T1) MCP joint
Adductor of thumb \
ADDUCTOR Transverse head: 3rd MC Base of 1st Proximal Ulnar nerve Adduction at
POLLICIS Oblique: Trapezoid&Capitate Phalanx(medial side) (C8 - T1) CMC
Thenar muscles
Abductor pollicis Brevis

Flexor pollicis Brevis
Opponens pollicis
Hypothenar muscles
Opponens Digiti Minimi

Abductor Digiti Minimi
Flexor Digiti Minimi Brevis
44
÷÷÷÷÷:
•
FPB
•
OP
BqaaqB%
Lumbrical Muscles Origin

1. Lumbricals 1 and 2:
From lateral side of lateral two tendons of the
flexor digitorum profundus.
2. Lumbricals 3 and 4:
From adjacent sides of medial three tendons of the
flexor digitorum profundus.
Insertion
The tendons cross radial side of metacarpophalangeal
joints & insert into the lateral side of dorsal digital
Nerve supply expansion of the corresponding digit from 2nd to 5th.
1st & 2nd: Median nerve (C8,T1)
3rd & 4th: Ulnar nerve (C8,T1)
'
NEET 19
Q. Nerve supply of second lumbirical?

ACTION
Flexion of Metacarpophalangeal joints (MP) Q. Action of lumbirical muscle?
Extension of Proximal & Distal interphalangeal joints (PIP & DIP) NEET 20
'
'
NEET 18

45
÷Y 1- ÷
MoMA
Palmar & Dorsal interossei

46
Nerve supply AIIMS MAY ' 19

Q. Finger having 2 dorsal Interossei?
Deep branch of ulnar nerve
Palmar interossei : ADduction Dorsal interossei : ABDUCTION

PAD DAP
Dorsal Digital Expansion
Small triangular aponeurosis covering the dorsum
of the proximal phalanx.
The muscles inserted into the dorsal digital expansions of:
Index finger:
First dorsal interosseous, Second palmar interosseous,
First lumbrical, Extensor digitorum slip, Extensor indicis.
Middle finger:
Second and third dorsal interossei,
Second lumbrical, Extensor digitorum slip.
Ring finger:
Fourth dorsal interosseous, Third palmar interosseous,
Third lumbrical and Extensor digitorum slip.
Little finger:
Fourth palmar interosseous, fourth lumbrical,
Extensor digitorum slip and Extensor digiti minimi.
'
AIIMS NOV 19
Q. Identify and muscles inserted in dorsal digital expansion of middle finger?

47
ayr_gpEBpoo-fg@E-
Palmar interossei i3-_BfoBS&
Dorsal interossei
Fifi
B-
PALMAR ARCH AIIMS NOV 17
Q. Identify the
structure marked?

48
Ulnar tunnel/Guyon’s canal
Osseofibrous tunnel formed by the pisohamate
ligament bridging the concavity between pisiform bone
and hook of hamate.
Guyon’s tunnel syndrome:
Compression of the ulnar nerve in Guyon’s canal at
wrist.
Clinical symptoms
1. Hypoesthesia in medial 1 1⁄2 fingers
2. Weakness of intrinsic muscles of hand
Q. Identify the nerve involved in Guyon’s tunnel syndrome?
Bazaar
µ

49
General Anatomy
Structural Classification of Joints
Fibrous Cartilaginious Synovial

- Connected by Dense connective -Connected by fibrocartilage -Articulating bones are separated
tissue mainly collagen or hyaline cartilage by fluid filled Joint capsule
- Immovable -Slightly movable -Freely movable
Primary/
Sutures Synchondroses Hinge
i. Plane i. Connected by Hyaline i. Elbow joint,
ii. Ankle joint,
ii. Squamous cartilage iii. Knee joint
iii. Serrate
eg:- Diaphysis & Saddle
iv. Dentate
Epiphysis of long bones i. Carpometacarpal joints
v. Schindylesis
Gomphosis Plane
Secondary/ i. Acromioclavicular joint
i. Peg & Socket Symphyses ii. Subtalar joint
eg:- Tooth in alveolar processes i. Connected by
Syndesmosis fibrocartilage Pivot
i. middle & distal tibiofibular, i. Atlantoaxial joint,
ii. middle radioulnar joint eg:- Pubic Symphysis, ii. Proximal & distal
-Joints between radioulnar joint
-vertebral bodies
Condyloid/ Ellipsoid
i. Wrist joint,
ii. Metacarpophalangeal joint
iii. Metatarsophalangeal joint
Ball & Socket
i. Hip joint
ii. Shoulder joint
iii. Talocalcaneonaccular
joint
Syndesmosis
'
'
INICET 20 AIIMS 17
Q. Type of middle radioulnar joint? Q. Type of Talocalcaneonaccular joint?

50
Talocalcaneonaccular joint
ball and socket type of
synovial joint
The articular surface on the rounded
head of the talus fits into the socket
formed by the calcaneum, navicular, and
spring ligament.
Atlantoaxial Joints
Joints present:
1. Median atlantoaxial joint.
2. Two lateral atlantoaxial joints.
Movements
Rotatory movements of atlas with head
(NO MOVEMENT)
Pivot joint
Articular surfaces comprise a central bony pivot
surrounded by an osteoligamentous ring.
Movements are permitted in one plane around a
'
NEET 19
Q. Movements of atlantoaxial joint?

vertical axis.
Wrist joint
Synovial joint of ellipsoid variety

Proximal articular surface
-Lower end of radius
-Triangular articular disc of inferior radio-ulnar joint.
Distal articular surface
- proximal surfaces of scaphoid, triquetral, and lunate
AIIMS NOV 19
Q. Bones forming wrist joint?

51
DERMATOME
'
Area of skin supplied by a single segment of spinal cord.

NEET 19
Q. Identify dermatome T10?
Reference:Textbook of Anatomy,Vishram Singh

52
Histology
Cartilage
Connective tissue composed of cells (chondrocytes) and fibres (collagen or yellow elastic)
embedded in a firm, gel-like matrix which is rich in a mucopolysaccharide.
It is much more elastic than bone.
Q. Identify elastic cartilage?

'
NEET 20
Reference:Human histology, IB Singh , p93

53
Collagen
Most abundant protein in the human body
Type Location Deficiency
Collagen Bone, LIGAMENT, TENDON, APONEUROSIS Osteogenesis
type 1 Bone imperfecta type 1
Collagen HYALINE & ELASTIC Cartilage

-
type 2 Car2lage
Collagen Blood vessels , reticular issue Vascular type of
type 3 3 layers, re3cular Ehler-danlos
Collagen Basement membrane Alport

type 4 syndrome
Floor
AIIMS MAY 18
Q. Type 2 collagen is found in ?
Reticular Fibers
Consist mainly of collagen type III, which forms
an extensive network (reticulum) of thin fibers.
Seen in
bone marrow,
spleen
lymph nodes.
LYMPH NODE
Mantle zone of a lymphatic nodule is

an outer ring of small lymphocytes
surrounding a germinal center.
Composed mainly of B cells
Paracortex is composed of T cells
'
AIIMS 17
Q. Identify mantle zone ?

54
Thymus contains a network of interconnected epithelial cells unlike other lymphoid structures, that has
chiefly collagenous reticular tissue.
THYMUS
Primary lymphoid organ
Encapsulated, soft & bilobed
Site - Superior Mediastinum
Site of mature T cell production
Histology
CORTEX MEDULLA
Mainly composed of Thymocytes The lymphoid cells are relatively fewer in number
and epithelial cells. Network of reticular cells is coarser
Supported by network of finely
branched epithelial reticular Hassall’s corpuscles are present
cells Fewer vessels
Rich capillary plexus
Hassall’s Corpuscles
Also known as Thymic corpuscles

formed by aggregation of medullary epithelial cells
Concentric, layered whorls of epithelial cells
Increase in number throughout life
Remains of epithelial tubules, which grow out from third
pharyngeal pouch
'
INICET 20
Q. Reticular fibers are not found in?

55
Cilia
Minute hair-like projections from the free surfaces of some epithelial cells.
Microtubules in cilia are bound with proteins (dynein and nexin).
- Nexin holds the microtubules together.
- Dyenin molecules are responsible for bending of tubules.
Bronchi - Pseudo-stratified Ciliated columnar epithelium
The epithelial lining of bronchi is mainly pseudostratified

ciliated columnar cells with a few goblet cells.
Responsible in clearing debris and mucus by moving it
upward along the bronchial tree and trachea.
In the larger bronchioles, the epithelium is ciliated
pseudostratified columnar, but this decreases in height and
complexity to become ciliated simple columnar or simple cuboidal
epithelium in the smallest terminal bronchioles
Ependyma - Ciliated cuboidal to columnar epithelium

Ependymal cells are epithelial-like cells
that form a single layer lining the fluid
filled ventricles and central canal of the
CNS.
Cilia helps in movement of cerebrospinal
fluid
Oviduct - Ciliated columnar epithelium
Oviduct mucosa is highly folded in the ampulla

region and lined by a simple columnar
epithelium of ciliated cells and secretory cells
producing nutritive mucus that bathes the
sperm and zygote.
Responsible for moving the developing embryo to
the uterus.

56
Vasdefernens
Also known as Ductus Deferens
Derived from Mesonephric or Wolffian duct
Connects the epididymis to the urethra
Has pseudo-stratified Ciliated columnar epithelium with long
microvilli - Stereocilia
Sterocilia
Non-motile apical modifications
Increases the luminal surface area and has absorptive function
Also found in i. Epididymis
ii. Sensory cells of the inner ear (sensory transducers)
'
INICET 20
Q. Identify cilia and the structures having cilia?
glands

57
endocrine gland exocrine gland
Ductless glands May have or may have not ducts

Secreting substance:hormone Enzyme,sweats,saliva &milk
Transport process:Through bloodstream Transport process:Through ducts or tube
Control long term activity of target organ Control short term activity
Eg-thyroid,pituitary,adrenal,testes Eg-gastric,salivary,sweat gland

Funcions- metabolism,growth,development,water & Functions-Regulation of body temp by
electrolyte balance producing sweat
Mechanisms of exocrine gland secretion
MEROCRINE & APOCRINE GLANDS HOLOCRINE - SEBACEOUS GLAND

'
AIIMS 17
Q. Identify Holocrine gland?
58
Parotid gland
Pancreas exocrine
Absence of Striated duct in Exocrine pancreas differentiates it from parotid gland.

AIIMS MAY 20
Q. Feature differentiating exocrine

pancreas from parotid gland?
SENSORY RECEPTORS of skin
unencapsulated receptors
Merkel cells - Tonic receptors for sustained light touch and for sensing an object’s texture.
Free nerve - Respond primarily to high and low temperatures, pain, and itching.
endings - Present in the papillary dermis.
Root hair
plexuses - Detects movements of the hairs. Present in bases of hair follicles
encapsulated receptors
Meissner - Initiate impulses when light touch or low frequency stimuli against skin
corpuscles temporarily deform their shape. Present in the dermal papillae.
Lamellated - Specialized for sensing coarse touch, pressure (sustained touch),

(pacinian) and vibrations, Present deep in the reticular dermis and hypodermis.
corpuscles
Krause end bulbs - Sense low frequency vibrations.
Ruffini corpuscles - Stimulated by stretch (tension) or twisting (torque) in the skin.

59
Lamellated (pacinian)
Meissner '
corpuscles
AIIMS NOV 18
corpuscles
Q. Meissner corpuscles are present in?
ORAL CAVITY
The oral cavity is lined primarily by mucosa with nonkeratinized stratified squamous epithelium, with
keratinized stratified squamous epithelium on the hard palate and gingiva.
lingual papillae OF TONGUE
- Elevations of the mucous membrane that assume various forms and functions.
filiform papillae - Provide friction to help move food during chewing.
foliate papillae - Present on the sides of the tongue are best developed in young children.
Fungiform papillae - Mushroom-shaped with well-vascularized and innervated cores of
lamina propria.
Vallate (circumvallate) - Continuously flush the cleft, renewing the fluid in contact
papillae
with the taste buds.
'
NEET 18
Q. Epithelium of
Hard palate?
NEET '21
Q. Identify the
papillae?
Fungiform papillae filiform papillae circumvallate papillae

60
cerebellar cortex
1. Thick molecular layer has much neuropil

and scattered neuronal cell bodies. Contains
Basket cells and Stellate cells.
2. Thin middle layer of large neurons called
Purkinje cells. Their dendrites extend
throughout the molecular layer as a
branching basket of nerve fibers
3. Thick inner granular layer contains various
very small, densely packed neurons. Contains
Golgi cell and Granule cell.
Purkinje neurons
Characterize the cortex of the cerebellum, and layers of small pyramidal neurons form the
cerebral cortex.
The cell bodies of these neurons are large and flask- shaped.
It contains only one layer of neurons.
The cells are evenly spaced
Serve as the initial processing sites for synaptic signals
They inhibit deep nuclei of cerebellum
Neurotransmitter - GABA
Purkinje neurons (P)

silver staining dendrites from
granular layer (GL) containing axons
each large Purkinje cell (P)
molecular layer (ML) containing dendrites
'
NEET 20
Q. Identify Purkinje cells?
'
AIIMS 17
Q. What does Purkinje cells inhibit?

61
Lower Limb
Femur
Marked area: GLUTEAL TUBEROSITY

Muscle attached: Gluteus Maximus
Action: Extension, External Rotation & Abduction
Innervation: Inferior gluteal nerve ( L5, S1, S2)
Blood supply: Superior & Inferior gluteal arteries
Posterior view of femur identified by

inter trochanteric crest & prominent lesser trochanter.
Muscle insertion Action Nerve supply Blood Supply

Insertion of Extension & Innervated by Gluteal Supplied by
Gluteus Medius lateral Rotation nerve Superior gluteaL
Greater
Trochanter (Post Fibers) (L4 L5 S1 nerve root) artery
(Posterior
Innervated by Gluteal Supplied by
part) Insertion of Abduction &
nerve Superior gluteaL
Gluteus Minimus Medial Rotation
(L4 L5 S1 nerve root) artery
Innervated by Supplied by Medial

Lesser Iliopsoas Flexion and femoral circumflex
Trochanter
Muscle Medial rotation Femoral nerve
(Posterior
(L1 - L3) artery & Iliolumbar
part)
artery
Extension, Inferior gluteal nerve Superior & Inferior
Gluteal
Gluteus Maximus External Rotation
Tuberosity
& Abduction ( L5, S1, S2) gluteal arteries
Inter
trochanteric
Quadratics Lateral Rotation & Nerve to Quadratus Medial circumflex
crest femoris Adduction of thigh femoris (L4 - S1) femoral artery
'
INICET 20
Q. Identify Gluteal tuberosity.

Action of muscle attached to gluteal tuberosity?
'
AIIMS MAY 19
Q. Identify Greater trochanter.
Action of muscles attached to that area?
62
( in
Contents of
greater
sciatic notch
-q☒
BE
63
Compartments of leg
lateral compartment
anterior compartment
Primarily dorsiflexors of the ankle and

Plantarflex and evert the foot.
extensors of the toes.
Tibialis anterior Peroneus longus
Extensor hallucis longus Peroneus brevis
Extensor digitorum longus '
ALIM NOV 19
Q. Action of peroneus longus?

Peroneus tertius
posterior compartment
Divided into superficial and deep compartment by transoerse fascial septa.
superficial compartment Deep COMPARTMENT
They act on calcaneus to plantarflex the foot.

Flex the toes and plantarflex the ankle.
Gastrocnemius, and Soleus, which together
Popliteus
form the triceps surae which is inserted by a
Flexor digitorum longus
long thick tendon (tendoachillis) into calcaneus
Flexor hallucis longus
Plantaris
Tibialis posterior.
Reference:Textbook of Anatomy,Vishram Singh

64
Anterior compartment
Posterior compartment
BB
BB
Posterior compartment
( Musa
☐
65
NERVE SUPPLY OF LEG
Compartments NERVE SUPPLY

anterior compartment deep peroneal nerve
lateral compartment superficial peroneal

nerve
posterior superficial
compartment -
posterior DEEP Tibial nerve
compartment
superficial peroneal nerve
COMMON PERONEAL NERVE

deep peroneal nerve
SCIATIC NERVE
LATERAL PLANTAR NERVE
Tibial nerve MUSCLES
OF SOLE
MEDIAL PLANTAR NERVE
'
AIIMS MAY 19
Q. Compartment of leg lacking neurovascular bundle?

66
Footdrop
Injury to the common peroneal nerve
Paralysis of muscles of the anterior compartment
of the leg (dorsiflexors of the foot).
Unopposed pull of the muscles in the posterior leg
produce permanent plantarflexion
Foot drop
'
NEET 19
Q. Injury to which nerve causes foot drop?
ADDUCTOR CANAL
SUBSARTORIAL CANAL/ HUNTER’S CANAL
Contents
1. Femoral artery.
2. Femoral vein.
3. Saphenous nerve.
4. Nerve to vastus medialis.
Boundaries
Anterolateral wall: vastus medialis
Posterior (floor): adductor longus
Medial (roof ): strong fibrous membrane
overlapped by the sartorius muscle.
"
NEET 21
Q. A patient underwent CABG for which saphenous

vein graft taken and during surgery GSV removed.
B-
The complication that can occur is ?
A. Saphenous nerve

67
Clinical significance
Femoral artery is exposed and ligated in the adductor canal during surgery for
aneurysm of the popliteal artery
POPLITEAL FOSSA
CONTENTS
1. Popliteal artery and its branches.
2. Popliteal vein and its tributaries.
3. Tibial nerve and its branches.
4. Common peroneal nerve and its branches.
5. Popliteal lymph nodes.
6. Popliteal pad of fat.
Bro
-Bq•←
68
FLEXOR RETINACULUM
Thick broad band of the deep fascia (2.5 cm broad) on the medial side of
the ankle, behind and below the medial malleolus
zappy

69
Thorax
Sibson’s fascia
Diaphragm of superior thoracic aperture.
apex - Tip of transverse process of C7 vertebra

base - Inner border of first rib and its costal cartilage
Functions
1. Protects the underlying cervical pleura and apex of the lung beneath.
2. Resists the intrathoracic pressure during respiration.
NEET 18
'
Q. Attachment of sibson’s fascia?
intervertebral joints
JOINTS BETWEEN THE BODIES OF THE VERTEBRAE
Secondary cartilaginous joint
Ligaments
1. Anterior longitudinal ligaments
2. Posterior longitudinal ligaments
JOINTS BETWEEN THE ARTICULAR PROCESSES
Plane type of synovial joints
Permit gliding movements
Ligaments
1. Ligaments flava
2. Supraspinous
3. Infraspinous am
4. Intertransverse ligaments.
The ligamentam flavum connect the laminae of adjacent vertebrae.
They are made up mainly of elastic tissue. '
AIIMS NOV 18
Q. Ligamentam flavum is made of?

70
ABNORMALITIES OF THE VERTEBRAL CURVATURES

1. Scoliosis (crookedness)
Abnormal lateral curvature of vertebral column.
Most common in thoracic region.
Caused by poliomyelitis, short leg or hip disease.
2. Kyphosis (hunchback)
Exaggeration of posterior convexity of thoracic curvature.
Occur due to osteoporosis or disc degeneration
3. Lordosis (swayback)
Exaggeration of anterior convexity of lumbar curve.
'
AIIMS NOV / 8
Occur due to pregnancy or pot belly Q. Abnormality of lumbar spine?
joints of thorax
'
NEET 20
1. Costovertebral Q. Identify costotransverse joint and what is

2. Costotransverse the type of joint?
3. Costochondral '
NEET 18
4. Interchondral Q. Joint between 8th and 9th rib to 7th rib ?

5. Manubriosternal
6. Intervertebral

71
Costovertebral joints
Plane type of synovial joint
Articulation of head of ribs and costal facets
on the bodies of thoracic vertebrae
LIGAMENTS
Intra-articular ligament
Capsular ligament
Triradiate ligament
Costotransverse JOINTS
Plane type of synovial joint
Tubercle of a typical rib articulates with the
transverse process of the corresponding vertebra.
LIGAMENTS
Capsular ligament
Costotransverse ligament
- Superior, Inferior, Lateral
Costochondral
Each rib is continuous anteriorly with
its cartilage
Primary cartilaginous joint.
Interchondral
7th-9th costal cartilage articulate
with each other by small synovial joints.
9th - 10th costal cartilage is
ligamentous.
Manubriosternal
Lower end of manubrium sterni and
upper end of body of sternum
Secondary cartilaginous joint

72
Azygous system
T4
T8
AZYGOS VEIN
On the right side in the upper part of the posterior abdominal wall and the posterior
mediastinum.
Connects the inferior vena cava with the superior vena cava
Drains venous blood from the thoracic wall and upper lumbar region
Leaves the abdomen by passing through the aortic opening of the diaphragm and
enters the posterior mediastinum
HEMIAZYGOS VEIN
Left side only and corresponds to the lower part of the azygos vein
At T8 vertebra it turns to the right and crosses in front of the vertebral
column posterior to the aorta, esophagus and thoracic duct to terminate in
the azygos vein.
ACCESSORY HEMIAZYGOS VEIN

On the left side only and corresponds to the upper part of the azygos vein
At the level of T8 vertebra, it turns to the right passes in front of the vertebral column
posterior to the aorta, esophagus and thoracic duct to terminate in the azygos vein.

73
Postreior intercostal veins
'
AIIMS NOV 18 Q. Left superior intercostal vein drains into which vein?
Q. Right superior intercostal vein drains into?
openings of the diaphragm

74
'
MEET 18
Q. Structures passing through aortic opening?

AIIMS 17
Q. Structure passing through central tendon?

Paradoxical respiration
During inspiration the diaphragm moves down
expanding the lungs.
During exhalation the diaphragm moves up.
Reversal of this pattern is paradoxical respiration.
It is seen in :- i. Chest trauma
ii. Paralysis of Diaphragm
iii. Flail chest
Diaphragm is innervated by phrenic nerve (C3-C5).
In the image given the nerve anterior to Serratus
anterior muscle is phrenic nerve.
Serratus Anterior
'
INKET 20
A- Phrenic nerve Q. Identify phrenic nerve?

B- Vagus nerve
C- Sympathetic chain Q. Injury to phrenic nerve causes?
D- Recurrent laryngeal nerve
75
Pulmonary Pleurae
Serous membrane surrounding the lung
'
INICET 20
Visceral pleura
Covers the outer surface of lungs Q. During deep inspiration the lower border of
and extend into the interlobar fissures lung reaches the which part of liver?
Parietal pleura
Covers the internal surface of thoracic cavity
Divided into- i. Mediastinal pleura
ii. Cervical pleura
iii. Costal pleura
iv. Diaphragmatic pleura
Visceral pleura
Parietal pleura
During inspiration visceral pleura of lung reaches till the upper 1/3rd of liver.
Pleural recess
Costodiaphragmatic recess- located between costal pleura and diaphragmatic pleura
Costomediastinal recess- located between costal pleura and mediastinal pleura
Clinical significance: In pleural effusion, fluid gets collected in the costodiaphragmatic recess
also known as costophrenic recess causing widening of the costodiaphragmatic angle which
can be diagnosed in chest X-ray.
T3-T4 LEVEL
Brachiocephalic trunk
Left common carotid
artery
Left subclavian artery
Superior venacava
Oseophagus ARCH OF AORTA
Trachea
INFERIOR VIEW FROM T3-T4 LEVEL

'
INICET 20
Q. Identify the level of the above section?

76
T3-T4
The section will be from the level of Arch of aorta
The opening of the branches of arch of aorta can be seen
1. Brachiocephalic trunk
2. Left common Carotid artery
3. Left subclavian artery
T4-T5
The section will be at the level of Manubrium Sterni
The beginning and ending of arch or aorta will be visible
BRANCHES OF AORTIC ARCH
Right External Left External

Carotid A. Carotid A.
Right internal Left internal
carotid a. carotid a.
Basiliar a. Basiliar a.
Right vertebral a. Left vertebral a.
Right Left
Axillary a. Axillary a.
77
SUBCLAVIAN ARTERY
Left subclavian artery

arise from the aortic arch directly.
Right subclavian artery
arise from brachiocephalic artery.
Brachiocephalic artery
branch of aortic arch
divides into right common carotid artery
and right subclavian artery.
Subclavian artery is divided into 3 parts

by the Serratus anterior muscle
First part:- orgin to medial border of Serratus anterior
3rd 2nd 1st Second part:- posterior to Serratus anterior
Third part:- lateral border of Serratus anterior to
outer border of first rib.
Subclavian artery Mnemonic- vitamin c& d
1st part 2nd part 3rd part
Vertebral artery Costocervical trunck Dorsal scapular artery
Internal thoracic artery Deep cervical artery

Thyrocervical trunk Superior intercostal artery
Suprascapular artery
MNEUMONIC AIIMS MAY 98
VIT-SIT Inferior thyroid artery Q. Inferior thyroid artery is a branch of?

Deep branch of Transverse
cervical artery Q. Branches of subclavian artery?
78
BLOOD SUPPLY OF HEART
RIGHT CORONARY ARTERY

Arises from the anterior aortic sinus of the ascending aorta, immediately above the aortic valve.
Course
Runs forwards and descends in right anterior coronary
sulcus up to the inferior borders of the heart.
It turns posteriorly and runs in the right posterior

coronary sulcus up to the posterior interventricular groove
Anastamose with left coronary artery

79
Branches
1. Right conus artery
- First branch, supplies infundibulum of right ventricle
2. Atrial branches
- Sinuatrial nodal artery supplies SA node
3. Anterior ventricular branches
- Supplies anterior surface of right ventricle, Marginal branch - largest
4. Posterior ventricular branch
- Supply diaphragmatic surface of right ventricle
5. Posterior interventricular artery
- Supplies posterior IV septum, AV node, right and left ventricles
Left coronary artery

Arises from the left posterior aortic sinus of the ascending aorta, immediately above the aortic valve.
Course Runs forwards and divides into
left anterior descending circumflex
artery (LAD) artery
Runs downward in anterior Winds around the left

interventricular groove to the apex margin of heart
Passes posteriorly in posterior Continues in left posterior

interventricular groove coronary sulcus
Anastamose with posterior Anstamose with

interventricular artery, branch of RCA right coronary artery
Branches
1. Left anterior descending artery
- Supplies anterior part of IV septum, Left and right ventricle, left bundle branch
2. Circumflex artery
- Left marginal artery supplies left margin of left ventricle up to apex
3. Diagonal artery
- May arise directly from trunk of LCA
4. Conus artery
- Supplies pulmonary conus
5. Atrial branches
- Supply left atrium.

80
'
NEET 19
Q. Branches of right
coronary artery?
'
AIIMS NOV 19
Q. Blood supply of
right ventricle?
Surface marking of heart
upper border
A point at the lower border of the second left
costal cartilage about 1.3 cm from the sternal
margin.
A point at the upper border of the third right
costal cartilage 0.8 cm from the sternal margin
lower border
A point at the lower border of the sixth right
costal cartilage 2 cm from the sternal margin.
A point at the apex of the heart in the left fifth
intercostal space 9 cm from the midsternal line
'
AIIMS MAY 19
Right and left borders are formed

by joint upper and lower border. Q. Surface marking of right
border of heart?
Atrioventricular groove
Marked by a line drawn from the sternal end of left
3rd costal cartilage to the sternal end of right sixth Q. Surface marking of
atrioventricular groove?
costal cartilage.
81
CUT SECTION OF HEART
Musculi
pectinate
'
AIIMS MAY 19
Q. Identify the structures highlighted in the cut

section of heart?

82
Abdomen and Pelvis

ANTERIOR ABDOMINAL WALL
EXTERNAL OBLIQUE
Fibres run downward, forward, and

medially
Structures derived
Inguinal ligament
Lacunar ligament
Pectineal ligament
INTERNAL OBLIQUE
Fibres run upward, forward, and

medially
Structures derived
conjoint tendon
arcuateline or
linea semicirculnris
TRANSVERSUS ABDOMINIS
Direction of most of its fibres is

horizontal/transverse
Lowest fibres of the muscle fuse

with the lowest fibres of the
internal oblique to form the
conjoint tendon

83
RECTUS ABDOMINIS
Vertical muscle
Enclosed in a sheath formed mainly

by the aponeuroses of the three flat
muscles of the abdominal wall
- Rectus sheath
'
NEET 19
Q. Structures derived from aponeurosis
of external oblique muscle?

84
Conjoint tendon
Formed by the fusion of lower
aponeurotic fibres of internal oblique and
transversus abdominis muscles which
arches over the spermatic cord and is
attached on to the pubic crest and
medial part of the pectineal line.
The conjoint tendon strengthens the

abdominal wall at the site where it is
weakened by the superficial inguinal ring
FASCIA TRANSVERSALIS
Thin layer of fascia that lines the inner surface of the transversus abdominis muscle
Presents deep inguinal ring- passage to the spermatic cord in male and round ligament
of the uterus in female.
Forms:- 1) Internal spermatic fascia
2) femoral sheath
3) Iliopubic tract
iliopubic tract
Thickened inferior margin of the fascia transversalis in the inguinal region.
Posterior to the inguinal ligament.
'
NEET 18
Q. Features of iliopubic tract?

85
inguinal canal
Oblique intermuscular passage about 4 cm long lying above the medial half of the inguinal ligament.
Extends from deep inguinal ring to the superficial inguinal ring.
It is directed downward, forward, and medially.

86
Psoas Major
This is a fusiform muscle placed on the side of the lumbar spine and along the brim of the
pelvis. The psoas and the iliacus are together known as the iliopsoas, due to their common
inseftion and actions
Origin
a. From anterior surfaces and lower borders of transverse process of all lumbar vertebrae
b. By 5 slips, one each from the bodies of two adjacent vertebrae and their intervertebral
discs, from vertebrae, T12 to L5
c. From 4 tendinous arches extending across the constricted parts of the bodies of lumbar
vertebrae, between the preceding slips. The origin is a continuous one from the lower border of
T12 to upper border of L5
Insertion
The muscle passes behind the inguinal ligament and in front of the hip joint to
enter the thigh.
It ends in a tendon which receives the fibres of the iliacus on its lateral side.
It is then inserted into the tip and medial part of the anterior surface of the
lesser trochanter of the femur
Nerve supply
Branches from the roots of spinal nerve L2, L3 and sometimes L4.
Actions
1. With the iliacus, it acts as a powerful flexor of the hip, joint as in raising the trunk from
recumbent to sitting posture
2. Helps in maintaining stability at the hip. Balances the trunk while sitting
3. When the muscle of one side acts alone, it brings about lateral flexion of the trunk on
that side
4. lt is a weak medial rotator of the hip. After fracture of the neck of the femur, the limb
rotates laterally
Clinical anatomy
The psoas is enclosed in the psoas sheath, a parl of the lumbar fascia. Pus from tubercular
infection of the thoracic and lumbar vertebrae may track down through the sheath into
the thigh, producing a soft swelling in the femoral triangle.
The typical posture of a laterally rotated lower limb following fracture of the neck of the
femur is produced by contraction of the psoas muscle.
Q. A child was brought to the hospital by his father with complaint of fever, low backache
and persistent Flexion of the hip joint. He had history of spine TB in the past. On
NEET'2I examination child has inguinal swelling. Identify the muscle responsible to be involved.
87
Liver & HEPATOBILIARY APPARATUS

Foramen Epiploicum (Foramen of Winslow)
Vertical slit through which lesser sac of peritoneum communicates with the greater
sac of peritoneum.
At the level of T12 vertebra.
Boundaries
Anterior Right free border of the lesser omentum
containing bile duct, vertical part of the
hepatic artery, and portal vein.
Posterior Inferior vena cava and right suprarenal gland.
Inferior First part of the duodenum and horizontal

part of the hepatic artery.
Superior Caudate process of the caudate lobe of the liver.
NEETPG 2020
'
AIIMS MAY 17
Q. During cholecystectomy, which structure is injured when superior

border of epiploic foramen is accidentally injured?

88
Couinaud’s segments
a. Right anterior (V and VIIi)

b. Right posterior (VI and VII)
c. Left lateral (II and III)
d. Left medial (I and IV)
The structure that divides the liver is
PORTAL VEIN
Segment I to IV Left branch of hepatic artery '

AIIMS MAY 19
Left branch of portal vein Q. Liver is divided in couinaud’s

Drained by left hepatic duct segment by which structure?
Segments V to VIII Right hepatic artery
Right branch of portal vein
Drained by right hepatic duct
Cantlie line
'
MEET 19
Cholecystokinin-vena caval line
Q. Cantlie line separates?
Separates right and left lobe of liver
Contains middle hepatic vein
Posteroinferior surface- Passes through the fossa for gallbladder to the groove for IVC
Anterosuperior surface - Passes from the IVC to the cystic notch

89
Hepatic stellate cells
perisinusoidal cells or Ito cells
Found in the space of Disse
(Perisinusoidal space of the liver between the sinusoids and hepatocytes)
Involved in liver fibrosis in response to liver damage
Fat storage cell- VIT A '
AIIMS MAY 20
Q. Location of ITO cells?
CYSTOHEPATIC TRIANGLE OF CALOT
'
NEET 19
Q. Boundaries of
calot’s triangle?
BOUNDARIES contents
Right side:- Cystic duct 1. Right hepatic artery
Left side:- Common hepatic duct 2. Cystic artery
Above:- Inferior surface of the liver 3. Cystic lymph node of Lund
CLINICAL SIGNIFICANCE
To locate the pedicle of gallbladder and its ligation in cholecystectomy.
During gallbladder surgery right hepatic artery in this triangle presents a
caterpillar- like loop called Moynihan’s hump which may be ligated along with
cystic pedicle, and cut leading to profuse bleeding.

90
Pancreas
1. Head (with one process—uncinate process)
2. Neck
3. Body (with one process—tuber omentale)
4. Tail
Uncinate process :- Hook like process from the lower and left part of the head.
It extends toward the left behind the superior mesenteric vessels.
Uncinate process
'
NEET 20
Q. Tumor of uncinate process of pancreas

affects which vessel?
stomach
Blood supply
1. Left gastric artery - Direct branch from the coeliac trunk
2. Right gastric artery- Branch of the common hepatic artery
3. Left gastroepiploic artery - Branch of the splenic artery
4. Right gastroepiploic artery - Branch of the gastroduodenal artery
5. Short gastric arteries - Branches of the splenic artery
'
NEET 20
Q. Ligation of common hepatic artery will

cause impairment of blood supply in?

91
Anal Canal
'
NEET 20
Enlarged inguinal lymph nodes

is seen in Anal cancer.

92
pudendal canal (Alcock’s canal)

Fascial canal present in the lateral wall of the ischiorectal fossa about 2.5 cm
above the ischial tuberosity
Contents
1. Pudendal nerve which divides into dorsal nerve of penis and perineal nerve.
2. Internal pudendal vessels '
AIIMS NOV 19
Q. Identify ischial spine and what is

the structure related?
Pudendal Nerve
arises from ventral
rami of S2, S3, S4
greater sciatic foramen

below the piriformis muscle
crosses the dorsum of

ischial spine
lesser sciatic foramen
pudendal canal
(Alcock’s canal)
Pudendal nerve block
Pudendal nerve is infiltrated with a

local anaesthetic where it crosses the
ischial spine.
Bilateral pudendal block causes:-
- Loss of anal reflex
- Relaxation of pelvic floor muscles
- Loss of sensation to vulva and lower
1/3rd of vagina

93
PELVIC DIAPHRAGM
Muscular partition between the true pelvis and the perineum
Formed by the levator ani and coccygeus muscles.
FUNCTION
- Provides principal support to the pelvic viscera
- Sphincteric action on the rectum and vagina
OPENINGS
1. Hiatus urogenitalis:
- Triangular gap between the anterior fibres of the two levator ani muscles.
- Transmits the urethra in male, and urethra and vagina in female.
- Closed from below by the urogenital diaphragm.
2. Hiatus rectalis:
- Round opening between the perineal body and the anococcygeal raphe.
- Provides passage to the anorectal junction.
Q. Muscles forming pelvic diaphragm?

'
AIIMS 17
Q. Identify pelvic diaphragm? Q. Openings of pelvic diaphragm?

94
LEVATOR ANI COCCYGEUS

(ISCHIOCOCCYGEUS)
body of pubis,
tendinous arch of obturator 1. Apex of ischial spine
Origin fascia 2. Sacrospinous ligament
pelvic surface of the
ischial spine
Iliococcygeus:-
anococcygeal raphe & coccyx
Puborectalis:- LAST PIECE OF sacrum
Insertion upper two pieces of coccyx
anococcygeal raphe
Sphincter vaginae/
Levator prostatae:-
perineal body
perineal branch of S4
Nerve perineal branch of the ventral rami of S4, S5
Supply pudendal nerve (S2, S3)
1. support the pelvic viscera

1. support the pelvic viscera
2. resist the intra-abdominal 2. minor movements of the
Actions pressure coccyx
3. sphincteric action
'
AIIMS MAY 19
Q. Attachments of levator ani?

95
Peritoneal relations of spleen
The spleen is surrounded by peritoneum, and is. suspended by following ligaments.

The gastrosplenic ligament extends from the hilum of the spleen to the greater curvature
of the stomach. It contains the short gastric vessels and associated lymphatics and
sympathetic nerves
The lienorenal ligament extends from the hilum of the spleen to the anterior surface of
the left kidney. It contains the tail of the pancreas, the splenic vessels, and associated
pancreaticosplenic lymph nodes, lymphatics and sympathetic nerves.
The phrenicocolic ligament is not attached to the spleen, but supports its anterior end. It
is a horizontal fold of peritoneum extending from the splenic flexure of colon to the
diaphragm opposite the 11th rib in the midaxillary line. It limits the upper end of the left
paracolic gutter.
NEET 121
Q. A patient of splenomegaly
reaching 15 cm costal margin.
Which structure prevents spleen
from vertically going down?
Peritoneal ligaments
attached to the spleen,
and common sites of
accessory spleen
Hepatic flexure Splenic flexure
Placed anteriorly on right side Placed posteriorly on left side

Right angle Acute angle
Lies on right kidney Lies on spleen
Supplied by right colic aftery Supplied by left colic artery
No ligament is attached Phrenicocolic ligament is attached
Lies at level of L2 vertebra Lies at level of T12 vertebra
96
Head & Neck

Pterion
The junction between 4 bones:- i. Greater wing of Sphenoid bone
ii. Squamous portion of Temporal bone
iii. Frontal bone
iv. Parietal bone
Site of Anterolateral Fontanelle which closes 3 months after birth.
Landmark:- Overlies Anterior branch of Middle Meningeal Artery and Lateral fissure
of Cerebral hemisphere.
Clinical Significance:- Weakest part of skull. Traumatic blow can rupture middle meningeal
artery and cause epidural haemorrhage .
sphenoid bone
Pterion
Pterion
Interior View
Lesser wing of Sphenoid

'
INICET 20
AIIMS MAY '20
Q. Identify pterion and the bony

Q. Identify pterion and the related artery? structure beneath it?

97
the Foramens
FORAMEN ROTUNDUM Pterygoid /Vidian’s canal

Contents passing through Contents passing through
Maxillary Nerve, branch of trigeminal nerve Nerve of Pterygoid canal - Vidian nerve
Artery of the foramen rotundum Artery of Pterygoid canal - Vidian artery
Emissary Vein Vein of Pterygoid canal - Vidian vein
Lesser wing of
Sphenoid Superior Orbital Fissure
Greater wing of
Sphenoid Foramen Rotundun
Body Pterygoid canal
(Vidian’s canal)
Vidian nerve is formed by the junction of greater '
IN / CET 20
petrosal nerve (branch of facial nerve) and deep Q. Identify foramen rotundum?
petrosal nerve.
98
Cranial Cranial
Foramen Structures Conducted
Fossa Bone
Cribriform Olfactory nerve (CN I) Anterior

Ethmoid
foramina in Anterior ethmoidal cranial
bone
cribriform plate nerves fossa
Middle
Optic nerve (CN II) Sphenoid
Optic canal cranial
Ophthalmic artery bone
fossa
Lacrimal nerve
Frontal nerve- branch of
ophthalmic nerve of
trigeminal nerve (CN V)
Superior ophthalmic vein
Trochlear nerve (CN IV)
Superior division of the
Middle
Superior oculomotor nerve (CN III) Sphenoid
cranial
orbital fissure Nasociliary nerve- bone
fossa
branch of ophthalmic
nerve (CN V1)
Inferior division of the
oculomotor nerve (CN III)
Abducens nerve (CN VI)
A branch of the Inferior
ophthalmic vein
Middle
Foramen Maxillary branch of Sphenoid
cranial
rotundum trigeminal nerve (CN V) bone
fossa
Middle
Mandibular branch of Sphenoid
Foramen ovale cranial
trigeminal nerve (CN V) bone
fossa
Middle meningeal artery

Middle
Foramen Middle meningeal vein Sphenoid
cranial
spinosum Meningeal branch of CN bone
fossa
V3
Facial nerve (CN VII)

Internal Vestibulocochlear nerve Middle Petrous part
acoustic (CN VIII) cranial of temporal
meatus Vestibular ganglion fossa bone
Labyrinthine artery
Anterior
Glossopharyngeal nerve aspect:
(CN IX) Petrous
Vagus nerve (CN X) Posterior portion of
Jugular
Accessory nerve (CN XI) cranial the temporal
foramen
Jugular bulb fossa Posterior
Inferior petrosal and aspect: '
sigmoid sinuses Occipital AIIMS 17
bone
Q. Identify foramen ovale
Posterior
Hypoglossal Hypoglossal nerve (CN
cranial
Occipital and structure passing
canal XII) bone
fossa
through?
Vertebral arteries
Medulla and meninges
Posterior
Foramen CN XI (spinal division)
cranial
Occipital Q. Foramens of middle
magnum Dural veins bone
Anterior and posterior
fossa
cranial fossa?
spinal arteries
Reference:www.teachmeanatomy.com
99
Superior Orbital Fissure

This fissure is divided into three parts by means of the
common tendinous ring of Zinn.
1. Structures passing through the part present within the common tendinous ring:
Superior and inferior divisions of the oculomotor nerve
Nasociliary nerve
'
AIIMS NOV IF
Abducent nerve Q. Identify the fissure through

Sympathetic root of the ciliary ganglion which Abducent nerve passes?
2. Structures passing through the part present above and lateral to the common tendinous ring:
Trochlear nerve
Frontal nerve
Lacrimal nerve
AIIMS NOV 18
'
Lacrimal artery Q. Identify the fissure through which

Superior ophthalmic vein oculomotor nerve passes?
Recurrent meningeal branch of lacrimal artery
3. Structures passing through the part present below and medial to the common tendinous ring:
Inferior ophthalmic vein
Foramen ovale
Mandibular nerve
Accessory meningeal artery
Lesser petrosal nerve
Emissary vein MNEMONIC Q. Branch of Trigeminal nerve which
AIIMS MAY 17 MALE passes through foramen ovale?

100
Jugular foramen
1. Anterior part:
Inferior petrosal sinus.
2. Middle part:
Glossopharyngeal nerve.
Vagus nerve.
Accessory nerve.
3. Posterior part:
Sigmoid sinus.
Q. Structures passing through jugular foramen?
CRANIAL NERVES
Obey • µm*←µodaÉ.•. MA
__EEgg_@-I→-
. -
' '
AIIMS NOV 18 NEET 20
Nerves involved in olfaction:- Q. Identify facial nerve?

Olfactory nerve
Glossophayrngeal nerve
Q. Identify branches of Trigeminal nerve?
Vagus nerve
Reference:www.teachmeanatomy.com
101
Dura Mater
Nerve Supply
Q. Nerve supply of duramater
Supratentorial dura ophthalmic nerve
in middle cranial fossa?
Infratentorial dura
anterior cranial anterior and posterior
fossa ethmoidal nerves
anterior part meningeal branch of the

middle cranial maxillary nerve
fossa
posterior part meningeal branch of the
mandibular nerve
posterior meningeal branches of the
cranial fossa vagus and hypoglossal nerves
Blood Supply
anterior cranial Meningeal branches of ophthalmic, anterior, and posterior ethmoidal arteries,
fossa A branch of the middle meningeal artery
middle cranial Middle and accessory meningeal arteries
fossa Meningeal branches of internal carotid and ascending pharyngeal arteries
posterior
cranial fossa Meningeal branches of the vertebral and occipital arteries

102
cavernous sinuses
Large venous space situated in the middle cranial fossa
On either side of the body of the sphenoid bone.
Relations
Superiorly Optic tract, Optic chiasma, Olfactory tract
Internal carotid artery and Anterior perforated substance
INFERIORLY Foramen lacerum and
Junction of body and greater wing of the sphenoid bone
Medially Hypophysis cerebri and Sphenoidal air sinus
Laterally Temporal lobe with uncus

Mandibular nerve below
Anteriorly Superior orbital fissure and the apex ofthe orbit
Posteriorly Apex of the petrous temporal and the crus cerebri of the midbrain
Structures Present in the Structures Passing Through

Lateral Wall of the Sinus Cavernous Sinus
1. Oculomotor nerve. 1. Internal carotid artery surrounded
2. Trochlear nerve. by the sympathetic plexus of nerves.
3. Ophthalmic nerve. 2. Abducent nerve
4. Maxillary nerve.

103
Tributaries of the Cavernous Sinus

From orbit
1. Superior ophthalmic vein.
2. Inferior ophthalmic vein. Q. Tributaries of cavernous sinus from orbit?
3. Central vein of retina
From meninges From brain
1. Sphenoparietal sinus. 1. Superficial middle cerebral vein.
2. Anterior trunk of the middle meningeal vein. 2. Inferior cerebral veins
Communications of Cavernous Sinus
1. Transverse sinus via superior petrosal sinus.
2. Internal jugular vein via inferior petrosal sinus.
3. Pterygoid venous plexus via emissary veins which pass through
- Foramen ovale,
- Foramen lacerum,
- Emissary sphenoidal foramen.
4. Facial vein via
Superior ophthalmic vein → angular vein → facial vein
Emissary veins → pterygoid venous plexus → deep facial vein → facial vein
5. Opposite cavernous sinuses via anterior and posterior intercavernous sinuses.
6. Superior sagittal sinus via superficial middle cerebral vein and superior anastomotic vein.
7. Internal vertebral venous plexus, via basilar venous plexus.

104
Orbital muscles
Orbital Muscles
Intraocular Extraocular
Ciliary Muscle
Sphincter pupillae INVoluntary voluntary
Dilated pupillae Levator Palpabrae Superialis
Superior Tarsal
Inferior Tarsal Superior Rectus
Inferior Rectus
Orbitalis Medial Rectus
Lateral Rectus
Superior Oblique
Inferior Oblique
AIIMS NOV49
Q. Nerve supply of superior oblique ?
Nerve Supply Origin of Muscles

i. LPS- Sphenoid Bone
Oculomotor(III) Abducent (VI) Troclear (IV) ii. SR- Annulus of Zinn
iii. IR- Annulus of Zinn
SR,IR,MR LR SO iv. MR- Annulus of Zinn
IO,LPS v. LR- Annulus of Zinn
vi. SO- Annulus of Zinn via trochlear
vii. IO- Maxillary bone
MNEMONIC -SO4 LR6
Blood supply
Ophthalmic Artery
Medial Muscular artery Lateral Muscular artery

Medial Rectus Lateral Rectus
Inferior Rectus Superior Rectus
Inferior Oblique Superior Oblique
Levator palpabrae Superialis

105
ACTION OF EXTRAOCULAR MUSCLES
' '
AIIMS NOV 19 INKET 20
Q. Muscles supplied by oculomotor nerve? Q. Nerve supply of extraocular muscle?
Mandibular foramen
Located a little above the centre of ramus and leads into mandibular canal which runs
downwards and forwards into the body to open on its external surface as mental foramen.
It provides passage to:
Inferior alveolar nerve: a branch of the posterior division of the mandibular nerve.
Inferior alveolar artery: a branch from the 1st part of the maxillary artery.
Inferior alveolar vein
NEET '19
Q. Identify the foramen and the

Bagg nerve passing through?

106
LARYNX
LARNGEAL CARTILAGES
Unpaired Paired
Arytenoid Cartilage
Thyroid Cartilage(largest)
Corniculate Cartilage of Santorini
Cricoid Cartilage
Cuneiform Cartilage of Wrisberg
Epiglottis
'
INICET 20
Q. Cartilages of larynx?
- Thyroid, Cricoid and Arytenoid Cartilages are Hyaline cartilages.(undergo ossification)

- Epiglottis, Corniculate and Cuneiform are Elastic fibrocartilage
Laryngeal Membranes
EXTRINSIC INTRINSIC
Thyrohyoid membrane Cricovocal membrane

Cricotracheal membrane Quardrangular membrane
Hyoepiglottic ligament Cricothyroid ligament
Thyroepiglottic ligament
107
Muscles of larynx
/
NEET 18
Q. Tensor of vocal cord?

108
Greater auricular nerve
ventral rami of 2nd and 3rd

cervical nerves
Greater auricular nerve
NEET '18
Travels along
sternocleidomastoid muscle Q. Identify greater auricular nerve?
Sensory innervation to skin over parotid gland,

mastoid process and both surface of outer ear.
Frey’s syndrome
Auriculotemporal nerve syndrome
Due to damage auriculotemporal and great auricular nerves
Clinical features Gustatory sweating Q. Nerves involved in
Cutaneous hyperesthesia in front of the ear Frey’s syndrome?

109
muscles of the mastication
'
AIIMS NOV 18
Q. Identify temporalis
and its action?
'
AIIMS NOV 18
Q. Identify lateral
pterygoid and its action?
pterygopalatine fossa
contents
1. Maxillary nerve.
2. Pterygopalatine ganglion.
3. Third part of the maxillary artery.
Q. Contents of pterygopalatine fossa?

¥4111"

110
DEEP CERVICAL FASCIA (FASCIA COLLI)

The deep fascia of the neck is condensed to form the following layers:
Investing layer of deep cervical fascia. -

IIMS MAY '2O
Deep to the platysma, and surrounds the neck like a collar. Q. Structures enclosed by
Forms the roof of the posterior triangle of the neck. Pretracheal layer?
Pretracheal fascia
Encloses and suspends the thyroid gland and forms its false capsule
Posterior layer of the thyroid capsule is thick and forms a suspensory ligament for
the thyroid gland known as ligament of Berry.
Prevertebral fascia
Lies in front of the prevertebral muscles.
Forms the floor of the posterior triangle of the neck
Carotid sheath
Condensation of the fibroareolar tissue
around the main vessels of the neck.
Formed on anterior aspect by pretracheal fascia
and on posterior aspect by prevertebral fascia.
Contents: Common or Intenal carotid arteries
Internal jugular vein
Vagus nerve
'
AIIMS MAY 20
Q. Contents of carotid sheath?

111
Buccopharyngeal fascia
Covers the superior constrictor muscle externally
Extends on to the superficial aspect of the buccinator muscle.
Pharyngobasilar fascia
Thickened between the upper border of superior constrictor muscle and the base of the skull.
It lies deep to the pharyngeal muscles
Thyroid gland
'
NEET 20
The upward extension of the thyroid is prevented by

attachment of stereo thyroid to thyroid cartilage.
Ligament of berry extends from cricoid cartilage to thyroid

and prevents downward sinking of thyroid

112
Levels of lymph node
Hyoid bone
am
Mnm
Cricoid cartilage
'
AIIMS NOV 18
Q. Level of lymph node between hyoid and

cricoid cartilage?
113
FORNIX
Large bundle of projection fibres, which connects the hippocampus with the mammillary body.
It constitutes the sole efferent system of the hippocampus
'
NEET 19
Q. Identify fornix?
Hippocamus AIIMS NOV 19
Q. Blood supply of fornix?

'
ALUMS NOV 18
Q. Identify hippocampus?

114
É Éµ
¥
] ÉÉÉ
HABENULAR
§¥ÉÉ
" " ^^ "" "
• ¥
§É-=
n
,
FLOOR
of HI
i
ventricle
LATERAL ANALL Of 111 VENTRICLE
•
•
Thalamus
Hypothalamus
Hypothalamic sulcus
• BOB
115
hippocampus
(Arise from the pyramidal cells)
alveus
(Form a thin layer of white fibres on
its ventricular surface)
fimbria
(Form a narrow strip of white matter on
the medial margin of hippocampus)
(over the dentate gyrus)
crus of fornix
(Arches upwards, medially and forwards
underneath the splenium of corpus callosum)
body of fornix
(Two crura, one of each hemisphere, curving over the thalamus, converge
and unite in the midline beneath the trunk of corpus callosum)
columns of fornix
(Anteriorly, the body of fornix divides into two columns
Arches downwards towards the anterior commissure)
mammillary body
(Curves posteriorly through the
hypothalamus to end here)
Postcommissural fornix precommissural fornix

(Fibres being located posterior to (Fibres in front of
anterior commissure) anterior commissure)
/
AIIMS MAY 19 AHMSMAY -18
Fornix is supplied by anterior cerebral artery. Q. Fornix arise from?

116
AUDITORY PATHWAY
Auditory cortex
superior temporal gyrus
(Brodmann’s area 41)
Medial geniculate
body
Inferior colliculus
lateral lemniscus
Superior olivary
complex
(Decussition of left and right
impulses)
Cochlear
nuclei
Cochlear division of
mnemonic viii (eight) cranial
nerve
E.COLI-MA
'
AIIMS MAY 18
Q. Identify Broca’s area?
'
NEET 18
Broca’s area is located in

inferior frontal gyrus.
Q. Location of primary
auditory area?
117
TYPES OF FIBRES IN WHITE MATTER
Association Fibres Projection Fibres

Interconnect the different regions of the cerebral Connect the cerebral cortex to the
cortex in the same hemisphere (intrahemispheric subcortical centres (such as the corpus
fibres). striatum, thalamus, brainstem) and spinal
1. Short association fibres cord 1. Internal capsule
2. Long association fibres 2. Fornix
Commissural Fibres
Interconnect the identical cortical areas of the two
cerebral hemispheres (interhemispheric fibres). '
NEET 19
1. Corpus callosum. Q. Identify internal capsule and

2. Anterior commissure. mention the fibers?
3. Posterior commissure.
4. Hippocampal commissure.
5. Habenular commissure.

118
Internal capsule
Compact bundle of projection fibres

between the thalamus and caudate
nucleus medially and the lentiform
nucleus laterally.
Afferent (sensory) fibres pass up
from thalamus to the cerebral
cortex.
Efferent (motor) fibres pass down
from the cerebral cortex to the
cerebral peduncle of the midbrain.
Responsible for the sensory and
motor innervation of the opposite
half of the body

119
Lower Higher
BBB
BULBOFPOSTERIORHORNIZFF.is?o-.:nlPTr1
LATERAL VENTRICLE
#
Bog
120
Corpus callosum
largest commissure of the brain
Parts
1. Genu
2. Rostrum
3. Trunk
4. Splenium
The fibres of the splenium connect the parietal (posterior parts), temporal,
and occipital lobes of the two hemispheres.
The corpus callosum is largely responsible for '
NOV 17
AIIMS
interhemispheric transfer of information which is Q. Identify the part of corpus callosum

essential for bilateral responses and learning associated with striate cortex?
processes.
midbrain
Connects the pons to the diencephalon and cerebrum.
Cerebral aqueduct (aqueduct of Sylvius) connects the 3rd ventricle with the 4th ventricle.
Posterior part is called tectum
Anterior part is divided into two equal right and left halves cerebral peduncles
cerebral peduncles (a) Tegmentum,
(b) Substantia nigra
(c) Crus cerebri
substantia nigra
Crescent shaped pigmented band of grey matter
situated between tegmentum and crus cerebri.
Made up of deeply pigmented nerve cells which
contain melanin (a polymerized form of
dopamine) and iron.
Neurotransmitter - DOPAMINE

121
Transverse section of the midbrain

at the level of the inferior colliculi
Grey Matter
Trochlear nerve nucleus
Mesencephalic nucleus of trigeminal nerve
Nucleus of inferior colliculus
White Matter
Decussation of the superior cerebellar peduncles
lemnisci:- Medial lemniscus
Trigeminal lemniscus
Spinal lemniscus
Lateral lemniscus
at the Level of Superior Colliculi

Grey Matter
Central grey matter:- Oculomotor nerve nucleus
Mesencephalic nucleus
Nucleus of superior colliculus
Pretectal nucleus
Red nucleus
White Matter
Decussation of fibres (tectospinal and
tectobulbar tracts) arising from
superior colliculi forming dorsal
tegmental decussation (of Meynert).
Decussation of fibres (rubrospinal tracts)
arising from red nuclei forming ventral
tegmental decussation (of Forel).
Medial, trigeminal, and spinal lemnisci

Emerging fibres of the oculomotor nerve.
'
AIIMS MAY 20
Q. Decussation of superior cerebellar peduncle occurs at which level?

122
Lateral medullary syndrome of Wallenberg

Thrombosis the of posterior inferior cerebellar artery
– Contralateral loss of pain and temperature sensation in the trunk and limbs
due to involvement of spinothalamic tract.
– Ipsilateral loss of pain and temperature sensation over the face
due to involvement of spinal nucleus and tract of trigeminal nerve.
– Ipsilateral paralysis of muscles of palate, pharynx, and larynx
due to involvement of nucleus ambiguus.
– Ipsilateral ataxia,
due to involvement of inferior cerebellar peduncle and cerebellum.
– Giddiness,
due to involvement of vestibular nuclei
'
NEET 20
Q. Clinical features of lateral

pontine syndrome?
Medial medullary syndrome

Due to damage to penetrating branches of the anterior spinal branch of the vertebral artery
– Contralateral hemiplegia/paralysis of arm and leg, due to damage of pyramid.
– Ipsilateral paralysis and atrophy of the half of the tongue, due to damage of hypoglossal nerve.
– Contralateral loss of position and vibration sense due to damage of medial lemniscus.
Weber’s syndrome
Due to occlusion of a branch of the posterior cerebral artery.
– Ipsilateral lateral squint, due to involvement of the 3rd cranial nerve.
–Contralateral hemiplegia, due to involvement of corticospinal tract in the crus cerebri.
Benedikt’s syndrome
Due to the vascular ischemia of the tegmentum of the midbrain, involving medial lemniscus,
spinal lemniscus, red nucleus, superior cerebellar peduncle, and fibres of the oculomotor nerve.

123
TRACTS OF THE SPINAL CORD
dorsal column—medial lemniscus pathway
dorsal root ganglia of the spinal nerves

first-order sensory neurons
fasciculus gracilis and fasciculus cuneatus
Terminate in nucleus gracilis
and nucleus cuneatus
Undergo decussation
medial lemniscus
Terminate in the ventral posterolateral

nucleus (VPL) of the thalamus
Third-order sensory neurons from thalamus project

into the cerebral cortex of the cerebral hemisphere
Reference:Textbook of Anatomy,Vishram Singh, pg 308

124
Pyramidal Tract
qq.oz-q.AM
'
MS 17
Q. Identify pyramid and the lesion there causes?

Lateral corticospinal tracts
Cross to the opposite side at the pyramidal
decussation of the medulla
Anterior corticospinal tracts
Uncrossed fibres
Cross to the opposite side in the anterior
white commissure of the spinal cord at the
level of their termination
Origin
Pyramidal cells (of Betz) of the motor
area of the cerebral cortex.
Mediate voluntary motor activities
Because of decussation of corticospinal fibres in
the medulla (medullary decussation), the
cerebral cortex of one side controls the muscles
of the opposite half of the body.
Lesion causes - contralateral hemiplegia

125
Circle of Willis (Circulus Arteriosus)
MEET 121
'
NEET 20
'
NEET 20
Q. A patient is having visual disturbances. On investigating Q. Cerebellar lesion is due to
a vessel developed aneurysm on base of brain which was
thrombosis of which artery?
compressing optic chiasma. Involved vessel is?
MEET 121
By
PERFORATES
÷
gives LABYRINTHINE
ARTERY
POSTERIOR INFERIOR
CEREBELLAR ARTERY
( Most TORTOUS ARTERY )

126
sensory fibres of cranial nerves
/
NEET 18
Q. Trochlear nerve nucleus is a type of?
'
AIIMS NOV 18
Q. Sensation perceived by spinal

nucleus of Trigeminal nerve?

127
Lumbar puncture
Lumbar puncture in adult:
Patient is lying on side with maximally flexed
spine.
A line is taken between highest points of iliac
spine at L4 level.
Skin locally anaesthetized, and lumbar puncture
needle with trocar inserted carefully between L3
and L4 spines.
Lumbar puncture in infant, children:
During 2nd month of life, spinal cord usually
reaches L3 level. Lumbar puncture needle is
introduced in flexed spine between L4 and L5.
The Lumbar Puncture needle pierces in order:
Skin,
I
Subcutaneous tissue,
Supraspinous ligament,
Interspinous ligament,
Ligamentum flavum,
Epidural space containing the internal

vertebral venous plexus,
Dura, Sagittal section of lumbar vertebrae illustrating the course of the lumbar
puncture needle through skin (1), subcutaneous tissue (2), supraspinous
Arachnoid ligament (3), interspinous ligament (5) between the spinous processes
(4), ligamentum flavum (6), dura mater (8), into the subarachnoid space
and between the nerve roots of the cauda equina (7). Lumbar vertebral
Subarachnoid space.
bodies (9), intervertebral disc (10), and lumbar puncture needle (11).
CSF
Q. Last structure encountered during
lumbar puncture?
NEETKI
128
129

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Anatomy

Endodermal wall of yolk sac (4th week)

Gonads (5th week)

Q. Meiosis occurs in:

Reference: Textbook of Clinical Embryology,Vishram Singh, pg22

Fertilization occurs at the ampulla of Fallopian tube.

Reference: Textbook of Clinical Embryology,Vishram Singh, pg 34

FETUS RIGHT AN LEFT

RIGHT ATRIUM LEFT ATRIUM

PULMONARY ARTERY DUCTUS ARTERIOSIS

Reference: Textbook of Clinical Embryology,Vishram Singh, pg228

1. Two umbilical arteries

Reference: Textbook of Clinical Embryology,Vishram Singh, pg70

NEET /9 Q. What is the basis for the formation of Omphalocele?

Q. What is the basis of formation of Gastroschisis?

Congenital umbilical hernia

Q. What is the basis of formation of Congenital umbilical hernia?

Reference: Textbook of Clinical Embryology,Vishram Singh, pg 150

I–IV: pharyngeal arches

Q. First pharyngeal arch gives rise to?

Q. The nerve of second brachial arch?

Q. Reason for long left recurrent

Reference: Textbook of Clinical Embryology,Vishram Singh, pg 110

Derivatives of pharyngeal clefts and

Reference: Textbook of Clinical Embryology,Vishram Singh, pg117

FIRST ARCH SYNDROMES

Treacher Collins syndrome

Q. Identify the first arch syndromes?

Pierre Robin syndrome

Reference: Textbook of Clinical Embryology,Vishram Singh, pg 119

5. Walls of the canal become flattened to

Reference: Textbook of Clinical Embryology,Vishram Singh, pg 47

Heart starts to beat at the 4th week of intrauterine period

Reference: Textbook of Clinical Embryology,Vishram Singh, pg197

Q. Infundibulum develops from which part of embryonic dilatation?

Formation of Atrioventricular Septum

Reference: Textbook of Clinical Embryology,Vishram Singh, pg197

Membranous Bulbar ridge

Ventricular septal defect (VSD)

tetralogy of Fallot (TOF)

The membranous part of IV septum is derived from

Q. Membraneous part of Intraventicular septum is derived from?

Reference: Textbook of Clinical Embryology,Vishram Singh, pg 204

medial parT lateral part

genital ridge nephrogenic

Q. Ureteric bud develops from?

Reference: Textbook of Clinical Embryology,Vishram Singh, pg237

Q. Dermis is derived from?

Dermis is derived from Mesoderm

Q. Dendritic cell is derived from?

Reference: Textbook of Clinical Embryology,Vishram Singh, pg76

Sunken fontanelle - Dehydration Q. Which is the last fontanelle to close?

Reference: Textbook of Clinical Embryology,Vishram Singh, pg95

Langman's medical embryology

Langman's medical embryology

Attachment to three ligaments:- Coracoacromial,

Reference:Textbook of Anatomy,Vishram Singh, pg15

Lymphatic drainage of breast

Reference:Textbook of Anatomy,Vishram Singh, pg43

NERVES Cords NERVEROOT

Median nerve LATERAL CORD C5,c6,c7

Ulnar nerve Medial cord C8, T1

Q. Nerveroot of Axillary nerve?