Anatomy Practicals Notes

Department Of Anatomy, OMC
EMBRYOLOGY MODELS
DEPARTMENT OF ANATOMY
OSMANIA MEDICAL COLLEGE
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MENSTURAL CYCLE
At puberty, secretion of FSH and LH begins
from pituitary. Under the influence of these
hormones, a 28-day menstrual cycle begins
in a female (menarche); henceforth, every
month, this cycle gets repeated. Cessation of
the menstrual cycle occurs at the end of the
reproductive period and is known as
menopause.
• The regular 28-day cycle has three phases:
proliferative, secretory, and menstrual.
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1. Proliferative Phase
• The proliferative phase begins after menstruation, from the 4th or 5th day to the 14th day of the menstrual cycle.
• The main hormones responsible for these changes are FSH and LH.
 Changes in Ovarian Follicles
Under the influence of FSH and LH, ovarian follicles undergo a series of changes.
 Primary Follicle
• The flat follicular cells of the primordial follicle become cuboidal. The follicle is now called primary follicle.
• A layer of glycoprotein called zona pellucida begins to develop between oocyte and follicular cells.
• Follicular cells divide and become multi-layered around the oocyte while the cells of connective tissue surrounding the ovarian
follicle get differentiated to form a layer, known as theca follicle.
• The theca follicle gets further differentiated into two layers: inner theca interna and outer theca externa.
 Secondary (or Antral) Follicle

• The follicular cells begin to secrete fluid, liquor folliculi, which gets accumulated in small cavities in between the follicular
cells.
• Theca interna becomes more vascular and begins to secrete oestrogen.
 Graafian Follicle
• During each menstrual cycle, one follicle grows more than the others and becomes a mature (dominant) follicle, called the
Graafian follicle. Other developing follicles undergo atrophy.
• The cavities in between the follicular cells coalesce to form a single, large antrum. 3
• The oocyte is displaced to one side of the follicle. Department Of Anatomy, OMC
• Few layers of follicular cells that immediately surround the oocyte are called corona radiata.
• Some of the follicular cells concentrate at one point, projecting into the antrum. These cells together are called cumulus
oophorous.
 Changes in the Uterine Endometrium

• Changes in the uterine endometrium occur under the influence of the hormone oestrogen, which is secreted from the
developing follicles in the ovary. The stratum functionale of uterine endometrium, which was shed during the menstrual
phase, regenerates from stratu1n basale. The thickness of stratum functionale increases.
• The glands are straight and they increase in length.
 Ovulation
• Ovulation occurs on the 14th day of the 28-day menstrual cycle.
• Secretion of LH fro1n anterior pituitary peaks few hours before ovulation. It is this LH surge which induces ovulation.
• Just before the ovulation, the oocyte completes its first meiotic division giving rise to one secondary oocyte and the first
polar body.
• The secondary oocyte enters the second meiotic division and gets arrested in metaphase until fertilization takes place.
• The first polar body lies inside the zona pellucida.
• The maturing follicle migrates toward the surface of the ovary and produces a bulge on it. The tip of this bulge, which is
avascular, is referred to as stigma.
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• During ovulation, corona radiata containing secondary oocyte get detached from cumulus oophorous Department Of Anatomy,
and stigma OMC
ruptures.
The secondary oocyte with zona pellucida and corona radiata along with antral fluid is expelled into the peritoneal cavity.
If fertilization occurs, then the second meiotic division is completed. Otherwise, ovum undergoes degeneration.
2. Secretory Phase
• The secretory phase lasts from day 14 to day 28.
 Formation of Corpus Luteum
• After ovulation, the Graafian follicle forms a temporary endocrine gland called corpus luteum.
• Immediately after ovulation, the wall of the Graafian follicle collapses. Granulosa cells and theca interna cells undergo
changes and corpus luteum is formed.
• The granulosa cells increase in size to form granulosa luteal cells which secrete progesterone.
• The theca interna cells also increase in size to form theca lutein cells which secrete oestrogen.
• If fertilization does not occur, then corpus luteu1n is called corpus luteum of menstruation. It degenerates after 14 days.
• If fertilization occurs, then it is called corpus luteum of pregnancy. It is maintained till the second to third month of
pregnancy and after that it degenerates.
 Changes in the Uterine Endometrium

• Changes take place under the influence of progesterone secreted by the corpus luteum.
• The thickness of the endometrium increases further. It almost doubles from what it was in the previous phase.
• Glands enlarge and become highly coiled. Their lumens are filled with secretions.
• The spiral arteries become more coiled. They grow in length and extend into the superficial region of stratum functionale.
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3. Menstrual Phase
• The menstrual phase lasts from day 1 to day 4 or 5 of the menstrual cycle.
• The events occurring in this phase are due to a decline in the progesterone level, which is due to degeneration
of corpus luteum. Intermittent contractions occur in the spiral arteries; as a result, the stratum functionale is
subjected to ischemia and undergoes degeneration.
• The entire stratum functionale is shed. The menstrual fluid containing the necrotic tissue of stratum functionale
and blood is discharged through vagina.
• The straight arteries of stratun1 basale do not undergo constriction during this phase; hence, no ischemic
changes occur in stratum basale and it is not shed.
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DEVELOPMENT OF THE EMBRYO
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 CHANGES IN EMBRYOBLASTS (FORMATION OF A GERM DISK) Department Of Anatomy, OMC
• The embryoblasts differentiate into columnar and cuboidal cells and they get organized into a bilayered germ or embryonic disk.
• A single layer of columnar cells which are called epiblasts forms the upper layer of the germ disk.
• A single layer of cuboidal cells which are called hypoblasts forms the lower layer of the germ disk.
• A basement membrane is formed in between the two layers of the disk to which epiblasts and hypoblasts are attached.
 FORMATION OF THE AMNIOTIC CAVITY

• The cells of epiblasts differentiate and form a layer between epiblasts and trophoblasts. This layer is known as amnion.
• A small cavity is forn1ed between epiblasts and amnion. This cavity is known as amniotic cavity and it gets filled by a fluid known as
amniotic fluid.
 FORMATION OF THE YOLK SAC, EXTRAEMBRYONIC MESODERM,

 CHORIONIC CAVITY, AND CHORION
• Cells of hypoblasts give rise to flat cells which migrate and line the inner aspect of cytotrophoblasts. This layer of cells is called
exocoelomic membrane or Heuser's membrane.
• The cavity lined by the exocoelomic membrane and hypoblasts is known as primary yolk sac or primary umbilical vesicle or exocoelomic
cavity.
• The exocoelomic membrane gives rise to another layer known as extraembryonic mesoderm which lies between the exocoelomic
membrane and the cytotrophoblasts. The cells of extraembryonic mesoderm migrate between cytotrophoblasts and amnion; hence, both the
amniotic cavity and the primary yolk get surrounded by the extraembryonic mesoderm.
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• Small cavities appear in the extraembryonic mesoderm which later coalesce to form a single, large cavity known as extraembryonic
coelom or chorionic cavity.
• With formation of the chorionic cavity, the extraembryonic mesoderm splits into two layers.
The inner layer surrounds the amniotic cavity, secondary yolk sac, and it is known as the splanchnic layer of extraembryonic
mesoderm. The outer layer lines the inner aspect of cytotrophoblasts and this layer is known as the somatic layer of extraembryonic
mesoderm. At the embryonic disk, the extraembryonic mesoderm does not split and it forms the connecting stalk, which connects the
embryonic disk with cytotrophoblasts.
• With formation of the chorionic cavity, a part of the primary yolk sac is pinched off in the splanchnic layer of the extraembryonic
mesoderm; hence, the size of the primary yolk sac is reduced and it is now known as secondary or definitive yolk sac.
• The somatic layers of the extraembryonic mesoderm, cytotrophoblasts and syncytiotrophoblasts, together constitute the chorion.
 FORMATION OF PRIMARY CHORIONIC VILLI

• As the syncytiotrophoblast grows, small intercommunicating spaces appear in it. These spaces are called lacunae. The adjacent
lacunae communicate with each other around the strands of syncytiotrophoblast.
• As the syncytiotrophoblast erodes the endometrium, it also erodes the blood vessels present in it. As a result, the lacunae get filled
with maternal blood which comes from the eroded blood vessel.
• Soon, the underlying cytotrophoblasts invade the strands of syncytiotrophoblast. Now, these strands of syncytiotrophoblast that have
cytotrophoblasts in their core are known as primary chorionic villi and lacunae are called intervillus spaces.
• The nutrients from maternal blood present in intervillus spaces diffuse to embryo through the primary chorionic villi.
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EMBRYO SOMITES Department Of Anatomy, OMC
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Somites Department Of Anatomy, OMC
• As mentioned earlier, somites are segmentally organized paraxial mesoderm. They are transient structures.
• At the beginning of the third week, the entire paraxial mesoderm undergoes segmentation. Each segment is called
somitomere.
• Formation of somitomere begins from the cephalic region as bilateral pairs. Subsequently, more pairs of somitomeres are
formed craniocaudally in the trunk region of the embryo.
• In somitomeres of the trunk region, the cells undergo further segmentation to form somites.
• Somites appear in pairs (one on each paraxial mesoderm). The first pair of somites is formed on the 20th day in the occipital
region of the embryo. Subsequently, more pairs of somites are formed craniocaudally (occipital, cervical, thoracic, lumbar,
sacral, and coccygeal). Around three to four pairs of somites are formed every day. By the end of the fifth week, around 42-
44 pairs of somites are formed.
• Since the timing of the appearance of somites is so specific and regular, the age of an embryo can be determined by counting
the number of somites.
• Somites give rise to axial skeleton and the associated muscles and dermis of skin.
• The paraxial mesoderm of the cephalic region is different from the trunk region. In this region, somitomeres do not form
somites. These somitomeres give rise to skeletal muscles of the cephalic region.
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PLACENTA Department Of Anatomy, OMC
The placenta consists of two components: foetal

and maternal. The foetal component is chorionic
frondosum and the maternal component is
decidua (endometrium).
Structure of Mature Placenta

• Mature placenta is a disk-shaped organ with a
diameter of 18-20 cm. IL has two surfaces:
foetal and maternal.
• The foetal surface is smooth and shiny. It is
covered by amnion. The umbilical cord is
attached to this surface. Radiating branches and
tributaries of umbilical arteries and vein are
visible underneath the transparent amnion.
• The maternal surface is irregular due to the
presence of cotyledons. The adjacent cotyledons
are separated from each other by placental septa.
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SEPTUM TRANSVERSUM
 Septum Transversum
• A mesodermal structure appears cranial to the
cardiogenic area, at the beginning of the fourth week,
which is known as septum transversum.
• After the folding of the embryo, it is present as a
horizontal septum, extending from the ventral body wall
toward the dorsal body wall, in the transverse plane of the
embryo. It separates the developing pericardium from the
developing liver. It does not extend till the dorsal body
wall; hence, it partially separates the pleural and peritoneal
cavity as well as the thoracic and abdominal cavity.
• Pleuroperitoneal canals lie dorsal to the free margin of
septum transversum.
• Septum transversum contributes to the central tendon of
the diaphragm, ventral mesentery, and stroma of the liver.
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DEVELOPMENT OF HEART & RIGHT ATRIUM
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DEVELOPMENT OF HEART & RIGHT ATRIUM
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Development of interatrial septum
• The sinus venosus is taken up in the primitive atrium separated by sinus venosus valve
which is having right and left valves, and these valves fuse to form septum spurium. The
primitive atrial chamber is communicating with the primitive ventricle by atrio-ventricular
orifice. The A.V. orifice is divided by means of dorsal and ventral endocardial cushions.
These cushions fuse together to give rise septum inter-medium. From the dorso –cranial
aspect of primitive atrium ( to the left of septum spurium), septum primum (sickle shaped)
arises. The dorsal and ventral ends of the septum primum fuse with the dorsal and ventral
ends of the endo-cardial cushions respectively, having a foramen-ostium primum between
septum inter medium and septum primum. As the ostium primum is closed foramen appears
in the cranial part of septum primum by means of apoptosis (programmed cell death). This
is known as ostium secondum. Another septum ( septum secondum ) appears in between
the septum spurium and the septum primum, grows towards the septum inter medium. The
margin of septum secondum overlaps ostium secondum and oblique passage is established
known as the foramen ovale. After birth, the septum primum comes in contact with the
septum secondum. The septum primum represents the fossa ovalis and septum secondum
gives rise to limbus fossa ovalis in adult.
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DEVELOPMENT OF HEART TUBES
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Tubular Heart
• The Two endothelial heart tubes develop in the cardiogenic area (splanchnic
mesoderm of pericardial sac).
• As they fuse they show dilatations and are named cranio – caudally as
bulbous cordis, primitive ventricle, primitive atrium and sinus venosus with
right and left horns. The right and left horns of sinus venosus receives
common cardinal veins formed by fusion of anterior and posterior cardinal
veins on either side. The floor of the sinus venosus receives umbilical vein
laterally and vitelline vein medially.
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DEVELOPMENT OF CARDIAC LOOPS
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 Cardiac loop formation

The heart tube developed in the cardio genic area, invaginates in to the
pericardial sac from dorsal aspect(after head fold). The bulbous cordis and
primitive ventricle enter the sac ventro caudally. The atrium with sinus
venosus occupy dorso-cranial part of the sac. Thus the cardiac loop is
formed. The bulbous cordis and the ventricle are separated by bulbo-
ventricular ridge, which disappears and common bulbo ventricular chamber
is formed.
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FETAL CIRCULATION
1- SUPERIOR VENA CAVA
2- PULMONARY VEIN
3- CRISTA DIVIDENS
4- OVAL FORAMEN
5, 7- INFERIOR VENA CAVA
6- DUCTUS VENOSUS
8- UMBILICAL VEIN
9- PORTAL VEIN
10- UMBILICAL ARTERIES
11- DESCENDING AORTA
12- PULMONARY ARTERY
13- PULMONARY VEINS
14- DUCTUS ARTERIOSUS
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AORTIC ARCHES
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Aortic arches
• There are six aortic arches in the lateral wall of the pharynx and extend from the ventral to dorsal aortae.
• First aortic arch almost completely disappears except a part-for the maxillary artery. Second aortic arch mostly regresses
except its dorsal part forms the stapedial artery.
• Ventral part of third arch forms the common carotid artery, and its dorsal part together with dorsal aorta persists as internal
carotid artery. External carotid artery sprouts head wards as a new vessel from the third aortic arch.
• Right fourth aortic arch, part of right dorsal aorta, and right seventh inter segmental artery forms together right subclavian
artery.
• Left limb of aortic sac, left fourth aortic arch, left dorsal aorta form together the arch of aorta.
• Fifth aortic arch disappears completely on both sides.
• Ventral part of each sixth aortic arch forms the corresponding pulmonary artery. Dorsal part of right sixth arch disappears.
Dorsal part of the left sixth arch forms the ductus arteriosus in foetal life, and ligamentum arteriosum after birth.
Aortic arches and relation of recurrent laryngeal nerve

• Each recurrent laryngeal nerve recurs upwards winding the caudal surface of the sixth aortic arch. The degeneration of the
dorsal part of the right sixth aortic arch and associated elongation of the neck allow the right recurrent laryngeal nerve to
hook around the caudal surface of the right fourth aortic arch, which forms the proximal part of the right subclavian artery
(fifth aortic arches disappear at an early stage on both sides). Dorsal part of the left sixth aortic arch persists as the ductus
arteriosus, and left fourth arch forms a part of arch of aorta.
• So the right recurrent laryngeal nerve winds round the caudal surface of the right subclavian artery. The left recurrent
laryngeal nerve winds round the caudal surface of the arch of aorta dorsal to the ligamentum arteriosum.
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ROTATION OF THE GUT
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 ROTATION OF GUT
• The pre arterial and post arterial segments forms a u shaped loop ventrally.
• It rotates 90 degrees so that the pre arterial segment comes to the left and post arterial
segment to the right side (anti clock wise rotation) the pre arterial segment grows faster and
enters into the extra embryonic coelom causing physiological hernia.
• From the post arterial segment caecal bud arises. The pre arterial segment enters into the
abdominal cavity passing behind the superior mesenteric artery regulated by caecal bud. As
the pre arterial segment enters the abdominal cavity there is further anti clockwise rotation
• Finally the post arterial segment enters the abdominal cavity infront of the midgut artery. The
caecum lies nearer to the sub hepatic region on the right side. Because of the enlargement of
the abdominal cavity, the caecal bud descends into the right iliac fossa and ascending colon
is formed. As this is progressing, the peritoneum of ascending colon and descending colon
disappears on posterior aspect by means of zygosis. The peritoneum of transverse colon,
sigmoid colon persists.
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DEVELOPMENT OF PANCREAS
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Pancreas
• Pancreas develops from two pancreatic buds: ventral and dorsal. Both buds arise from the
terminal part of the foregut and grow into their respective mesenteries. The dorsal bud is
larger than the ventral bud, in size.
• The ventral pancreatic bud arises close to hepatic diverticulum. With clockwise rotation of
duodenum, it moves from ventral to dorsal position and eventually fuses with the dorsal
pancreatic bud.
• The ventral pancreatic bud contributes to the uncinated process and part of head of
pancreas. The remaining of pancreas, i.e., part of head, neck, body, and tail, is derived from
the dorsal pancreatic bud.
• As the two pancreatic buds fuse with each other, their ducts also anastomose. The duct of
ventral bud fuses with the distal portion of the duct of dorsal bud and gives rise to the main
pancreatic duct. The main pancreatic duct and common bile duct have a common opening at
the major duodenal papilla in duodenum. The proximal portion of the duct of the dorsal bud
usually regresses; if persists, it is known as accessory pancreatic duct and it opens into the
minor duodenal papilla in duodenum.
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DEVELOPMENT OF THE PORTAL VEIN
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DEVELOPMENT OF THE PORTAL VEIN

•It is developed from the infra hepatic part of the right and left vitelline veins which are interconnected to each
other by three transverse anastomoses and encircle the primitive duodenum in a figure of ‘8’ fashion
•The trunk of portal vein formed by the middle dorsal anastomosis together with a part of the right vitelline
vein between the middle and the cephalic anastomosis. The splenic and the superior mesenteric veins join with
the left end of the middle anastomosis
•The right branch of the portal vein is derived from the right vitelline vein proximal to the cephalic
anastomosis, the left branch developed from the cephalic anastomosis and part of the left vitelline vein
proximal to the transverse anastomosis.
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DEVELOPMENT OF IVC;SVC;AZYGOS VEIN
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 Development of Inferior vena cava Department Of Anatomy, OMC
•Persistent caudal part of the right posterior cardinal vein

•The right supra-cardinal vein – this part receives 3rd and 4th pairs of the lumbar veins
•The anastomosis between the right supra-cardinal and right sub-cardinal veins- this part receives the right gonadal (testicular / ovarian ) vein.
•Upper part of the right sub-cardinal vein- this part receives both the renal veins and the right supra renal vein
•A new vessel grows dorsal to the liver and communicates the right sub-cardinal vein with the common hepatic vein
•Common hepatic vein- it is developed from the supra-hepatic part of the right vitelline vein.
 Superior vena cava.

•It is developed from 2 sources:
•Extra pericardial part is developed from the caudal part of the right anterior cardinal vein below the oblique anastomotic channel of the two
anterior cardinal veins.
•Intra cardiac part owes its development from the right common cardinal vein (right duct of Cuvier)
 Azygos vein
•It is developed from 2 sources
•Vertical part from the right azygos venous line
•Arch of azygos vein from the persistent cephalic part of the right posterior cardinal vein
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DEVELOPMENT OF PALATE
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 Palate
• The intermaxillary process is formed by the fusion of medial nasal processes. One of the structures formed by the
intermaxillary process is the primary palate.
The primary palate lies in between the two maxillary processes, separating the nasal and oral cavities. The anterior part of
the primary palate possesses four incisor teeth.
• Meanwhile, a shelf-like projection, known as palatine shelf, is formed as a medial extension from each maxillary
process. Both these processes grow medially and eventually fuse with each other and form the secondary palate. A
definitive palate is formed by the fusion of primary and secondary palates. The incisive foramen of the definitive palate is
the central point of the fusion of primary and palatine shelves.
• The anterior portion of the secondary palate undergoes intramembranous ossification and gives rise to the hard palate
whereas the posterior portion forms the soft palate.
• The developing nasal septum (frontonasal process) grows toward the palate and eventually fuses with it.
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DEVELOPMENT OF TONGUE
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The development of the tongue can be studied under three headings-Mucous membrane, muscles, fibro areolar stroma Mucous
membrane development is divided into ventral two third and dorsal one third.
A pair of lingual swellings at the ventral ends of first arch and an unpaired median elevation, tuberculum impar, between the
first and second arches appear. These elevations appear by the proliferation of underlying mesenchyme. The lingual swellings grow
forwards fuse with each other across the mid line, and subsequently join with the tuberculum impar, the combined mass persists as ventral
two third of the tongue.
Dorsal to the tuberculum impar, another median endodermal elevation, the hypobranchial eminence, appears in the floor of the
pharynx. This elevation is contributed by ventral ends of third arch. A transverse sulcus divides the eminence into dorsal and ventral parts.
This ventral part forms the dorsal one third of the tongue.
Along the front and sides of the rudimentary tongue, develops an endodermal alveo lingual sulcus which separates the tongue
from the floor of the mouth. Just behind the tuberculum impar a median thyroid diverticulum extends caudally through the substance of
the tongue as thyroglossal duct. Later the duct mostly disappears but its primitive commencement is represented by foramen caecum of the
tongue.
• Development of tongue muscles.
They are derived from the occipital myotomes
• Development of fibroalveolar stroma.
It is derived from the mesenchyme of the branchial arches
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DEVELOPMENT OF THE FACE
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DEVELOPMENT OF THE FACE Department Of Anatomy, OMC
The face developed from five processes around the stomodeum. The stomodeum is bounded
cranially by fore brain vesicle and caudally by pericardial cavity.
The fronto – nasal process is divided into a median nasal process and two lateral nasal
processes by the ingrowth of a pair of olfactory pits.
The medial nasal process forms the nasal septum, philtrum of the upper lip, and the primitive
palate.
A pair of maxillary processes are derived from the mandibular arches and contribute to the
formation of the lateral parts of the upper lip, upper jaw, and cheek. The angles of the oral
fissure are formed by fusion of maxillary process and mandibular arch.
A pair of mandibular arches form the lower lip, lower jaw, and the integument covering the
mandible.
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NEURAL CREST DERIVATIVES
Neural Crest Cells
• As the formation of neural tube takes place, at the lateral
margin of the neural plate, the cells differentiate from the
ectoderm and form the neural crest.
• They get separated from the ectoderm and migrate into
mesoderm on the dorsolateral aspect of the neural tube.
• These neural crest cells further undergo proliferation and
differentiation and migrate to different regions of the body and
contribute to several structures.
Neural Crest Cells of the Trunk Region
• Some migrate dorsally toward the surface ectoderm and form
melanocytes.
• Other neural crest cells migrate ventrally and form the cells of
dorsal root ganglion and sympathetic chain ganglion, Schwann
cells, Merkel cells, parasympathetic ganglion of gut, preaortic
sympathetic ganglion, and adrenal medulla.
Neural Crest Cells of the Head Region
• They form several bones of the skull; connective tissue of the
region; sensory ganglion of cranial nerves V, VII, VIII, IX, and
X; glial cells; conotruncal (aorticopulmonary) septum;
melanocytes; and parafollicular cells of the thyroid gland.
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DEVELOPMENT OF HYPOPHYSIS CEREBRI
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Pituitary Gland or Hypophysis
• The pituitary gland develops from two sources: upward growth from the roof of oral cavity
and downward growth of diencephalon.
• A downward growth develops from diencephalon known as infundibulum. It gives rise to
pituitary stalk and posterior pituitary (or neurohypophysis).
• In the roof of the oral cavity, an ectoderm outgrowth develops which is known as Rathke's
pouch. It grows upward, toward the infundibulum, and eventually fuses with it. Rathke's
pouch forms pars tuberalis, anterior lobe of pituitary, and pars intermedia of the pituitary
gland.
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THYROID DEVELOPMENT & THYROGLOSSAL CYST
• During the fourth week, the thyroid primorcliun1 develops
as endodermal proliferation, in the median plane, between
the first and the second arches (in the ventral wall of the
primordial pharynx). Soon, it becomes a diverticulum and
begins to descend through the neck it descends down in
front of the primordial pharynx, crosses the hyoid bone and
thyroid cartilage, and reaches its permanent position. It
gives rise to two lobes and isthmus of the gland.
• During the descent, the thyroid gland remains connected
to its point of origin (which now lies at the junction of the
anterior two-third and the posterior one-third of the tongue)
through a duct known as the thyroglossal duct. This duct
degenerates later.
• The location of the primordial thyroid gland is represented
on the dorsum of the tongue as a shallow depression known
as foramen cecum, in the median plane at the junction of
the anterior two-third and the posterior one-third of the
tongue.
• The ultimo branchial bodies which are a derivative of the
fourth pharyngeal pouch give rise to parafollicular cells (or
C cells) of the thyroid gland.
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LARYNX Department Of Anatomy, OMC
• The opening of the respiratory diverticulum becomes the

laryngeal inlet. It is bounded by the fourth and sixth
pharyngeal arches.
• The mesenchyme of the sixth pharyngeal arch
proliferates around the laryngeal inlet and gives rise to a
pair of arytenoid swellings. Meanwhile, the caudal part of
hypobranchial eminence enlarges to form epiglottal
swelling. The opening of the respiratory diverticulum now
becomes a "T" -shaped laryngeal inlet, bounded in front by
epiglottal swelling and on sides and behind by arytenoid
swellings.
• Epiglottal swelling gives rise to epiglottis. Other
laryngeal cartilages (cricoid, thyroid, and arytenoid) are
derived from the mesenchyme of the fourth and sixth
arches.
• The endoderm of the developing pharynx gives rise to the
lining epithelium of larynx and glands. Similar to the
epithelium of gut, laryngeal epithelium proliferates and
occludes the lumen, which later gets recanalized. During
the process of recanalization, ventricles of larynx, bounded
by vocal and vestibular folds, are formed.
• Laryngeal muscles are derived from the mesenchyme of
the fourth and sixth pharyngeal arches.
They are innervated by the vagus nerve.
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DEVELOPMENT OF LUNGS & PLEURA
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 Lungs Department Of Anatomy, OMC
• Various components of the lung tissue are contributed by endoderm and mesoderm.
• The lining epithelium and glands of the respiratory tree are derived from endoderm.
• Connective tissue, smooth muscles, cartilage, and visceral pleura are derivatives of splanchnic mesoderm which is present around the
developing airway.
 Stages of the Development of Lungs
Based on the histological appearance of the lung, development of the lungs has been subdivided into the following five stages.
 Embryonic Stage (4- 5 Weeks)
• Formation of respiratory diverticulum.
 Pseudoglandular Stage (6-16 Weeks)
• The bronchial tree divides and increases in length. Formation of principal bronchi, lobar bronchi, bronchopulmonary segments, bronchioles,
and terminal bronchioles takes place.
• The airway is lined by simple columnar epithelium.
• Lung tissues appear similar to exocrine glands; hence, this stage has been named as pseudoglandular stage.
 Canalicular Stage (17-25 Weeks)
• This phase is characterized by the formation of respiratory bronchioles.
• Terminal bronchioles fanned during the pseudoglandular stage divide and form respiratory bronchioles.
• Newly formed airways have a lining epithelium of simple cuboidal epithelium.
• The capillary network develops in the surrounding mesoderm in this stage.
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DEVELOPMENT OF THE KIDNEY
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 KIDNEY. Department Of Anatomy, OMC
 Metanephros
• Metanephros gives rise to a permanent set of kidneys.
• Formation of metanephros begins in the 5th week and it becomes functional in the 10th week.
• Metanephros consists of two components: collecting part and excretory part. Both these components develop from two different sources. The
collecting part develops from the ureteric bud and the excretory part develops from the metanephric blastema or metanephric mesoderm.
 Development of the Collecting Part

• The entire collecting part which includes ureter, renal pelvis, major and minor calyces, collecting ducts, and collecting tubules develops from
the ureteric bud.
• The ureteric bud develops as a small diverticulum at the caudal end of the mesonephric duct, just before it joins the cloaca.
• The ureteric bud grows into the metanephric blastema. The cranial end of the ureteric bud divides repeatedly and gives rise to major and
minor calyces, collecting ducts, and collecting tubules. The caudal part of the ureteric bud remains undivided and gives rise to the ureter.
• Part of the ureteric bud just before it penetrates the mesonephric blastema dilates. This part of the ureteric bud becomes the renal pelvis.
 Development of the Excretory Part

• Nephrons constitute the excretory part of the kidneys.
• Under the inductive influence of the collecting tubules, the mesodermal cells of metanephric blastema adjacent to the distal end of the
collecting tubules differentiate to form vesicles known as metanephric vesicles.
• The metanephric vesicles elongate and form metanephric tubules. These metanephric tubules form different parts of the nephron, Bowman's
capsule, proximal convoluted tubules, loops of Henle, and distal convoluted tubules.
• The proximal end of the metanephric tubules (which becomes Bowman's capsule) is invaginated by a tuft of capillaries, the glomerulus. The
distal end of the metanephric tubules (which gives rise to the distal convoluted tubule) fuses with the collecting ducts.
46
DERIVATIVES OF MESONEPHRIC DUCTS
Derivatives
• Mesonephric duct forms the following structures:
In male
– Trigone of urinary bladder (in both sexes)
– Efferent ducts of testis, epididymis
– Vas deferens
– Posterior wall of prostatic urethra, appendix of epididymis.
– Seminal vesicles, ejaculatory ducts.
In female
– Trigone of urinary bladder
– Epoöphoron
– Paraoöphoron
– Gartner’s duct or cyst
– Skene’s glands
Ureteric bud arises from Wolffian duct and it gives rise to ureter,
renal pelvis, major and minor calyces, ampulla and 1–3 million
collecting tubules.
47
 Terminal Sac (or Saccular) Stage (26 Weeks to Birth)
• In this stage, respiratory bronchioles divide to form terminal sacs. These sacs will mature into alveoli in the next phase.
• The lining epithelium of terminal sacs consists of type I and II pneumocytes. Type I pneumocytes are squamous cells.
These cells along with the endothelium of capillaries form the blood- air barrier. Type II pneumocytes are cuboidal cells.
They secrete a surfactant in this stage. The surfactant spreads over the inner surface of alveoli. It reduces the surface
tension and prevents alveoli from collapsing.
 Alveolar Stage (Birth to 8 Years of Age)
• This phase is characterized by the formation of millions of alveoli in the terminal sacs. More and more alveoli are formed
as partitioning of terminal sacs and alveoli takes place due to the formation of connective tissue septae.
 Pleura
• The developing lungs expand into pericardioperitoneal canals.
• Pleuropericardial folds arise from the lateral aspect of the body wall and separates the pericardioperitoneal canals into
pericardial and pleural cavities. The pleural cavities get separated from the peritoneal cavity with development of
diaphragm.
• The expanding lungs are closely invested by the visceral layer of pleura, and the parietal layer of pleura is in contact with
the body wall. The visceral layer is derived from splanchnic mesoderm whereas the parietal layer is derived from the
somatic layer of mesoderm.
48
ENDODERMAL CLOACA
Post allantoic part of the hindgut is dilated to form the
endodermal cloaca. The ventral wall of the cloaca is formed
by bilaminar cloacal membrane.
The endodermal cloaca is divided by the urorectal septum
into ventral part, primitive urogenital sinus and dorsal part,
primitive rectum.
Urorectal septum extends caudally towards the cloacal
membrane.
The line of fusion between the urorectal septum and cloacal
membrane forms the perineal body. Endodermal cloaca
gives rise to development of rectum, upper part of anal
canal, most of mucous membrane of urinary bladder and
urethra.
49
VESICO-URETHRAL PORTION OF ENDODERMAL CLOACA
 Stages of Urinary Bladder Development
1. Cloacal division:
• Cloaca is divided by urorectal septum into ventral urogenital
sinus and dorsal primitive rectum.
• Urorectal septum establishes contact with cloacal membrane to
divide it into ventral urogenital membrane and dorsal anal
membrane.
• Urorectal septum forms perineal body.
• Urorectal septum contains four ducts, a pair of mesonephric
ducts and a pair of paramesonephric ducts.
• In the 5th week, mesonephric ducts open into the urogenital
sinus.
• The opening of mesonephric duct divides the urogenital sinus in
cranial vesicourethral canal and caudal definitive urogenital
sinus.
• Definitive urogenital sinus is subdivided into cranial pelvic part
and caudal phallic part.
50
2. Absorption of mesonephric ducts into vesicourethral canal

• Initially, ureteric bud (future ureters) and mesonephric ducts have a common opening in the vesicourethral
canal.
• Slow absorption (incorporation) of mesonephric duct in dorsal wall of vesicourethral canal separates openings
of mesonephric ducts from ureteric buds.
• Gradually absorption continues, and openings of ureteric buds move laterally and cranially.
• Incorporated mesonephric ducts form a triangular zone on the dorsal wall of vesicourethral canal. This
triangular part (trigone of urinary bladder) lies between the openings of ureters (ureteric bud) and mesonephric
ducts.
• Note: Terminal part of mesonephric ducts disappears in female and in male they form ejaculatory ducts.
3. Development of muscular and connective tissue coats

• Muscular and connective tissue coats (serous) of urinary bladder are derived from a splanchnopleuric layer of
intraembryonic mesoderm that surrounds vesicourethral canal.
51
DEVELOPMENT OF ARTERIES OF UPPER LIMB

Upper Limb
• The axis artery joins with the developing
subclavian artery.
• The persistent part of the axis artery forms the
brachial artery, interosseous artery, and deep
palmer arch. Other arteries of the upper limb
sprout from the axis artery.
• The persistent part of the marginal sinus forms
basilic and cephalic veins.
52
DEVELOPMENT OF ARTERIES OF LOWER LIMB
Lower Limb
• The axis artery joins with the umbilical
artery.
• Most of the axis artery regress; the persistent
part of the axis artery forms the sciatic artery
(artery supplying the sciatic nerve) and
peroneal artery.
• The external iliac artery forms the femoral
artery, which joins the axial artery. Most of the
arteries of the lower limb sprout from it.
53
FORMATION OF UTERUS & VAGINA
54
Uterus:- Uterus and cephalic part of the utero vaginal canal develop by fusion of the
caudal vertical parts of both paramesonephric ducts. The fundus of the uterus is formed by
the incorporation of a segment of horizontal parts of paramesonephric ducts.
Vagina :- Upper four fifth, above the hymen – the mucous membrane is derived from the
endoderm of the canalized sinovaginal bulbs . The musculature is developed from the
mesoderm of the united lower vertical parts of the two paramesonephric ducts. Lower one
fifth, below the hymen- developed from the endoderm of the urogenital sinus. External
vaginal orifice- it is derived from the ectoderm of the genital folds after the rupture of the
urogenital membrane.
55
DESCENT OF THE TESTIS
 Testis
• In the abdomen, the cranial pole of testes is held by the
cranial suspensory ligament which extends from testis to
diaphragm. Later, this ligament degenerates and descent of
testis begins. From the lower poles of the testis, a cord of
fibrous tissue known as gubernaculum extends from the testis
to scrotum. Once the testis reaches the scrotum, only small part
of gubernaculum persists, connecting the lower pole of testis
with the scrotum.
• The testis descends along the posterior abdominal wall,
behind the peritoneum, and reaches the inguinal canal by the
third month. It stays in this region till the seventh month and
then passes through the inguinal canal to reach the scrotum just
before full-term delivery.
• As the testis descends, its blood vessels, vas deferens, and an
extension of peritoneum known as processus vaginalis
accompanies it. As the descent is complete, most of the
processus vaginalis get obliterated and a small sac persists at its
distal end which is known as tunica vaginalis. It is present in
front and sides of the testis.
56
GENETICS CHARTS
1
NORMAL HUMAN KARYOTYPE (MALE/FEMALE)
Normal
Human
Karyotype
4 5
7 8 9 10 11 12
16 17 18
13 14 15
19 20 21 22
Autosomes
XX (female ) XY (male)
U.S.Natonal Library of Medicine Sex Chromosomes
The normal human karyotypes contain 22 pairs of autosomal chromosomes

and one pair of sex chromosomes. Normal karyotypes for females contain
two X chromosomes and are denoted 46,XX and males have both an X
and a Y chromosome denoted 46,XY.
2
NORMAL MALE
XxK 3
1 1 R
17
13 14 15
3R 21 22 Y
The ormal human karyotypes contain 22 pairs

of autosomal chromosomes and one pair of sex chromosomes.
Males have both an X and a Y chromosome. Normal karyotypes
for males are denoted as 46,XY.
3
NORMAL FEMALE
4
1 2 3
88 12
9 10 11
6 8
16 17 18
13 14 15
19 20 21 22 X
.The normal human karyotypes contain 22 pairs

of autosomal chromosomes and one pair of sex chromosomes.
.Normal karyotypes for females contain two X chromosomes and are

denoted as 46,XX.
4
SEX CHROMATIN or BARR BODY
5
SEX CHROMATIN AND LYON’S HYPOTHESIS
Sex Chromatin
In human being sex can be determined by observing interphase (resting) nucleus. The female
interphase nucleus shows a dark stained chromatin mass attached on one side to nuclear
membrane. This is known as sex chromatin or Barr body. Barr body is observed only in
females and is absent in males.
Identification of sex chromatin is an easy and quick method to determine the sex. Most of the
body cells in females show the presence of sex chromatin (skin, oral, vaginal or urethral
epithelium and blood cells). However, buccal mucosa is most commonly used for examination
of Barr body. The scrapping from check is taken on a slide and evenly spread. The slide is
then fixed in alcohol and stained with any of the basic dyes. The slide is observed under high
magnification for presence or absence of sex chromatin (Barr-body). If the cells are chromatin
positive the sex is identified as female.
Similar to Barr body the nucleus of human female polymorph presents a small drumstick like
structure. This drumstick is absent in males. The determination of sex by Barr body is not a
very satisfactory method. Karyotyping determines sex accurately.
Why Barr body or drumstick is present in females only but absent in male?
Ohano, Kaplan and Kinosita in 1959, worked out the relationship between sex chromatin and
sex chromosomes. They observed that sex chromatin is derived only from one of two X
chromosomes. Out of two X chromosomes one becomes condensed and inactive; the other X-
chromosome is euchromatic and active in cellular metabolism. As males have only one X-
chromosome it remains active hence, Barr body is not formed.
Lyon's hypothesis
Mary F. Lyon demonstrated in 1962 that during early embryogenesis (15th or 16th day of
development) one of two X chromosomes in females become condensed and inactive and
form Barr body. The process of X inactivation is often referred to as Lyonization.
Following are the features of the Lyonization:

• Out of the two chromosomes any one becomes inactive.
• Inactivation occurs early in embryonic life (at about 5000 cell stage, 15th or 16th day of
gestation).
6
KLINEFELTER SYNDROME
K
10 1 12
13
19 2
KCinfeter Synoma
Genotype
Karyotypeis 47, XXY; Mosaicism-46 XY/ 47, XXY.
.These individuals show Barr body.
Clinical features:
Affected individual is normally appearing tall male.
H e has small testis, but normal penis and scrotum.
.Puberty fails to occur normally and secondary sexual characters

doesn't develop fully. Pubic and facial hair are scanty.
.Gynaecomastiais seen.
7
Klinefelter syndrome
There is no for Klinefelter syndrome. However its
cure
symptoms may be treated as follows:

Testosterone replacement therapy to induce puberty and the
associated body changes
Surgery to remove excess breast tissue.
Physical and speech therapy for muscle weakness and

language improvement.
Fertility treatment to increase sperm count and quantity
Psychological counseling to deal with the emotional and

social problems
8
TURNER SYNDROME
Short staure
Charseterign
fhres
LOwhairline Folt of s
Congireto
3hieit shaped ota
nOr Poor breas
Wiufely spad dveleprment
Npples
bo
Shortened eforrrity
netacarpal y
nal Rinentary
ingernaiis vafos
orneiai streak
(urerrkvlnpnet
pradal
structures)
Bown spots (nevt)
No menstruation
Genotype.
Karyotype of Turner syndrome is 45, XO
Monosomy is the most frequent cause
Mosaicism 45 XO/ 46, XX
Isochromosome 46. X, i (Xq)
Ring chromosome 46 X, r (X)
Sex chromatin is always negative
9
Turners syndrome
Profound Severe short stature (height)
Infer tility (inability to become pregnant without medical
intervention such as in vir tro fer tilization)
Wide or web-like neck
High, narrow roof of the mouth (palate)
Low-set ears (ears low onthe neck)
.Low hairline at the back of the head
Drooping evelids
Broad chest with widely spaced nipples
Short fingers and toes
Arms that turn outward at the elbows (cubitus valgus)
Fingernails turned upward
10
CRI DU CHAT SYNDROME
10 11 12
7 8
15 16 17 18
13 14
21 22 X Y
19 20
Cri du chat syndrome

Arare syndrome (1 in 50,000 live births) caused bya
deletion on the short arm of chromosome 5.
.French for "cry of the cat," referring to the distinctive cry
of children with this disorder.
Cryis caused by abnormal larynx development, which
becomes normal within a few weeks of birth.
Infants have low birth weight and may have respiratory
problems.
.Some have a shortened lifespan, but most have a normal
life expectancy.
In 80% of the cases, the chromosome carrying the
deletion comes from the father's sperm.
11
TRISOMY 13: PATAU'S SYNDROME
Karyohpe From aFemae Wth Patau opodrnme (07041)

typotelonsm
X
broad,
fat nose
ceft ip
and palate
eas
1 2
15 16 17 18
postasial
pohydartyy
19 21 2 XY
Genotype:E
Karyotype of Patau's syndrome is 47, XX+ 13.
Trisomy of chromosome 13.
Mosaicism &Robertsoniantranslocation are also observed in rare
cases.
Incidence
Amonglive birth is 1 in 5000. Most affected die within a month.
Most of these trisomies lead to spontaneous abortion.
12
TRISOMY 18: EDWARD'S SYNDROME
kaw set -
hypertelonsm
-upturned
nose
mall jaw
9 12
13 |4 clenched fist
with digits 2 and 5
Overtapping 3 and 4
19 21 N rocker-bottom
feet
Genotype
Karyotype of Edward's syndrome is 47, XX + 18.
.Trisomy of chromosome 18.
Incidence
Among live birth is 1 in 6500. Most affected die before 6 months of
age
.Most ofthis trisomy result into spontaneous abortion.
13
DOWN'S SYNDROME
Growth failure Broad flat face

Mental retardaton Slanting eyes
Epicanthic eyetold
Flat back of head Short nose
Abnormal ears Short and
broad hands
Many "loops
on finger tips Small and
Palm crease arched palate
Big. wnnkled
Special skin tongue
ridge patterns Dental anomalies
10 I12 Unilateral or bilateral
absence of one rib
Congenital heart
Intestinalblockage disease
Enlarged colon
13 14 16 17 18 Umbilical hermia
Abnormal pevis
Big toes widely
Diminished musde tone spaced
19 2 22
(a)
Genotype:
Karyotype of Down's syndrome is 47, XY + 21.
Trisomy of chromosome 21
Mosaicism &Robertsoniantranslocation are also observed.
Incidence
1 in 700 live birth. Males are more affected than females.
Life span:
.Mean age is 16 though it varies from few weeks to decades.
14
RING CHROMOSOME
g Chromosome
Deleted Genetic
Material
.
alcs in
mosome Fusion
Deleted Genetic
Material
I t is a abnormality where chromosome forms a closed circle(ring).

I t results because of breaks near tips on each arm
These broken sticky ends subsequently fuse with each

other.
The two distal fragments are lost.
Individuals with ring chromosomes are usually mosaics.
15
NON-DISJUNCTION
PROCESS: NONDISJUNCTION n+1
n+1
n-1
2n4
n-2
1. Meloslsl starts normally. 2. Nondisjunction. 3. Melosis I occurs normally. 4. Aneuploidy results,
211 PeencnEouc anon
Non-disjunction is seen during gametogenesis (meiosis) as well as in
developing zygote where cells divide mitotically. As a result two or more
cell lines are observed. This phenomenon is known as mosaicism.
Causes
1. Advance maternal age.
2. Radiation.
3. Delayed fertilization after ovulation.
4. Chemicals: Smoking, alcohol consumption, oral contraceptive,
pesticides etc.
5. Non disjunction may also be under genetic control.
16
INVERSION
chromosome which breaks at

This abnormality involves only a single
two points.
.The broken segment rearranges itselfby inverting its position
.A chromosome with inversion gives rise to abnormal gametes

is formation of unbalanced
because during meiosis I there
abortion or
This leads to spontaneous
recombinant chromosomes.
abnormal offsprings.
17
TRANSLOCATIONS
Translocations
Mixed up pieces
These are called translocations, and involve pieces of non-
homologous chromosomes swapping locations. They are the most
common chromosomal abnormalities in humans-I in 500 people
have a translocation.
Robertsonian translocationsinvolve
the acrocentric(chromosomes with the centromeres very near to
the end) chromosomes (13, 14, 15, 21, and 22), and involves the
entire chromosomes fusing together so that you are down one
chromosome
Philadelphia Chromosome:A translocation from chromosome
22 to the long arm of chromosome 9. This can lead to cancer and
the abl gene is mutated
9 9qt
Short arm (P
22 Ph
Centromere
Translocation
Long arm (q)
18
Insertion
An insertion of genetic material from chromosome
9 into chromosome 6. The
sample tested was peripheral
blood froma 1-year-old boy. Banded metaphase (left) and
spectral karyotype (right) are shown. The insertion was
confirmed by FISH using painting probes specific for
chromosomes 6 and 9 (not shown).
19
Karyotyping (preparation of chromosomes).

Karyotyping is a procedure to obtain karyotype of an individual. In this procedure the metaphase
chromosomes of a somatic cell are obtained and photographed. From this photograph individual
chromosomes are cut and arranged according to standard classification.
•For preparation of chromosomes rapidly dividing cells are used which can be obtained from
following sources:
1.Lymphocytes from peripheral blood
2.Fibroblasts from skin
3.Bone marrow cells
4.Chorionic villi
5.Amniotic fluid cells
•Most commonly used cells are lymphocytes from peripheral blood. Following steps are involved in
chromosome preparation from blood.
a.Approximately 5 ml. of venous blood is collected under sterile conditions and is mixed with heparin
to avoid clotting.
b.The lymphocytes are separated off from red cells.
c.The white cell suspension is then put in culture vial. This vial contains culture media and fetal calf
serum that help to nourish the lymphocytes. The vial also contains phytohaemagglutinin that stimulates the
cell division in lymphocytes. Antibiotics arc also added to prevent infection of culture.
d.The culture vial is then put in an incubator for three days at 37°C. During this incubation period
lymphocytes divide rapidly.
e.At the end of third day (approximately after 72 hours) colchicine is added to the culture vial.
Colchicine has the property of preventing formation of spindles and thus arrests cell division during
metaphase. At metaphase chromosomes are maximally condensed and can be easily visible.
f.After two hours of addition of colchicine dividing lymphocytes are separated off with the help of
centrifuge.
g.These cells are treated with hypotonic saline. This causes cells to swell and chromosomes to
separate.
h.Cells are then fixed by adding a mixture of glacial acetic acid and methanol.
i.Cells suspended in fixative are then dropped on chilled slides from a height. This helps to rupture the
cell wall so that chromosomes can spread in large area. This is referred to as metaphase spread.
j.These slides are then stained and micro-photographed.
k.From the photograph individual chromosome is cut and arranged. Thus a karyotype of an individual
is obtained.
20
CLASSIFICATION OF CHROMOSOMES
For identification of chromosomes following classifications are used.
a. Classification based on position of centromere
•Metacentric - In this type of chromosomes the centromere is located near the

centre and two arms are almost equal in length.
•Sub metacentric - Here the centromere is slightly away from the centre so
that two arms are of unequal length.
•Acrocentric -If the position of centromere is very close to one end so that
one arm is very short and other is long.
•Telocentric - These chromosomes have centromere at one end and thus have
only one arm.
b. Standard classification (Denver classification)
In this classification the chromosomes are classified in seven groups as per their
descending length. These groups are designated as A to G. Female sex chromosome
(X) is included in group C and male chromosome (Y) in group G.
c. Paris nomenclature
After the invention of banding techniques (vide infra) more accurate methods for
identification of chromosomes came into existence. According to this method the
long and short arms of a chromosome are divided into 1, 2, and 3 regions starting
from centromere. These regions are further subdivided into bands. With the help of
banding not only individual chromosome is identified accurately but also a location
within the chromosome can be identified precisely. This method has helped to
detect minor structural abnormalities within a chromosome.
Denver Classification
21
Objective Structured Practical

Examination (OSPE)
Department of Anatomy
OsmaniaMedical College
1
QUESTIONS
1. What does the red arrow indicate?
2. Which cranial nerve is involved?
3. What is the first sign of this
condition?
4. What happens due to compression of
crus cerebri?
5. What is Cushing’s triad?
ANSWERS:
1. Uncal herniation
2. 3rd oculomotor nerve
3. Loss of accommodation
4. Hemiparesis.
5. Hypertension, bradycardia and
irregular respiration or apnea
2
QUESTIONS
1. What is the area injured here?
2. What bones are involved in the
formation?
3. What is the structure runs
underneath?
4. What is the effect of the injury
5. Name the foramen the structure
passes through.
ANSWERS:
1. Pterion
2. Frontal, temporal, parietal and
sphenoid.
3. Frontal branch of middle
meningeal artery
4. Epidural haematoma
5. Foramen spinosum
3
QUESTIONS Department Of Anatomy, OMC
1. Which layer of the scalp is injured here?

2. Why is the gaping of the wound seen?
3. Name the layers of scalp.
4. What is the dangerous area of the scalp
and why?
5. Name any 3 nerves supplying the scalp
ANSWERS:
1. Galea aponeurotica
2. Due to transverse cut and the pull of
frontal and occipital bellies of
occipitofrontalis muscle
3. Skin, connective tissue, aponeurosis,
losse connective tissue, periosteum
4. 4th layer because infection can
potentially spread from scalp through
emissary veins into the cranial cavity
5. Supra orbital, supra trochlear,
zygomatico temporal,
auriculotemporal, greater occipital
lesser occipital. 4
1. What is this clinical condition?

2. What is the other name for
this?
3. What is the etiology?
4. Are these swellings mobile?
Why?
5. What is a pilosebaceous unit?
ANSWERS:
1. Sebaceous cysts
2. Wens
3. If the gland or the duct is
blocked due to trauma to that
area.
4. Yes
5. Hair, hair follicle, arrector
pilorum muscle, and sebaceous
gland is an epidermal
invagination called
pilosebaceous cyst. 5
QUESTIONS
2. Clinical features are
3. Position of the eye is .
4 . Peripheral parasympathetic ganglion
associated here is
5. Nucleus associated with GVE fibres
ANSWERS:
1. Oculomotor nerve palsy
2. Loss of accommodation,
Extorsion, depression, ptosis,
mydriasis
3. Down and Out.
4. Ciliary ganglion.
5. Edinger westphal nucleus
6
QUESTIONS
1. Name the clinical condition.
2. Where and why is the swelling present
here?
3. Nerve supply of Sternocleidomastod
muscle is .
4. Name symptoms of this condition
5. Name 2 Nerves related to
sternocleidomastod in posterior triangle
ANSWERS:
1. Bezold’s abscess
2.Deep to posterior border of
sternicleidomastod. tracking of pus from
mastoid process due to mastoiditis.
3. Spinal Accessory nerve
4. Pain in premastoid region, dysphagia,
nuchal rigidity, fever
5. Supraclavicular, great auricular, lesser
occipital.
7
1. What is the clinical condition?

2. What is the other name for this syndrome?
3. What are the nerves involved here?
4. Which peripheral parasympathetic ganglion supplies parotid gland?
5. What are the clinical signs and symptoms?
ANSWERS:
1. Frey’s syndrome
2. Baillarger’s syndrome
3. Aberrant reinnervation of postganglionic parasympathetic fibres to nearby denervated sweat
glands and cutaneous blood vessels after parodidectomy.
4. Otic ganglion
5. Sweating and flushing in pre-auricular area in response to mastication or salivary stimulus.
8
QUESTIONS
2. What are the glands affected?
3. Is it a contagious disease?
4. What are the complications of of this
condition?
5. Signs and symptoms are
ANSWERS:
1. Mumps
2. Parotid gland.
3. Yes
4. Orchitis, pancreatitis,
meningitis, encephalitis
5. Dysphagia, difficulty in
chewing.
9
QUESTIONS
1. What is the clinical condition

shown?
2. Name few causes of this palsy.
3. Name the clinical signs ?
4. Tongue muscles are derived from
.
5. Where is the hypoglossal nerve
nucleus situated?
ANSWERS:
1. Unilateral hypoglossal nerve
palsy
2. Intracranial space occupying
lesions , trauma, stroke
3. Deviation of the tongue to the
affected side and atrophy of the
muscles
4. Occipital myotomes
5. Medulla oblongata
10
QUESTIONS
1. Name the clinical condition seen.
2. What is the cause for this condition?
3. What are the clinical signs due to?
4. Name any 3 branches of subclavian
artery.
5. How is the subclavian artery related to the
recurrent laryngeal nerve?
ANSWERS:
1. Subclavian steal syndrome
2. Due to stenosis of subclavian artery there
is retrograde blood flow through the
vertebral arteries
3. Arterial insufficiency afflicting the
brain, the upper extremity.
4. Vertebral artery, thyrocervical trunk, internal
thoracic artery, Costocervical trunk, Dorsal
scapular artery
5. Right recurrent laryngeal nerve loops round
the right subclavian artery whereas the left
one loops round the arch of aorta
11
1. Identify the clinical condition

2. What is the etiology?
3. Describe the clinical features.
4. Name the palsy associated with this syndrome.
5. What is stellate ganglion?
ANSWERS:
1. Horner’s syndrome
2. Interruption of sympathetic fibres.
3. Ptosis, anhidrosis, miosis, facial flushing, headaches, loss of ciliospinal reflex.
4. Klumpke’s palsy.
5. Stellate ganglion is formed by the fusion of inferior cervical sympathetic ganglion and first thoracic
sympathetic ganglion.
12
QUESTIONS
1. What is the picture indicating?

2. Indications
3. Site
4. Lining epithelium of trachea
5. Which membrane is pierced
during the procedure
ANSWERS:
1. Tracheostomy
2. Emergency airway access .
Birth defects of airway.
Airway obstruction.
Decreased clearance of
tracheobronchial secretions and
inefficient oxygen delivery.
3. 3rd and 4th tracheal rings.
4. Lining epithelium is
pseudostratified ciliated columnar
epithelium
5. Cricothyroid membrane.
13

2. What is the cause?
3. What are the signs of increased intracranial
pressure?
4. Name structures draining CSF into dural
venous sinuses.
5. Treatment
ANSWERS:
1. Hydrocephalus
2. Abnormal accumulation of cerebrospinal
fluid (CSF) in the ventricles of the brain.
3. Persistent vomiting, frontal bossing,
dilated scalp veins, and sun set eye sign.
4. Arachnoid granulations.
5. Ventriculo-peritoneal shunt.
14
1. What is the picture depicting?

2. Name the numbered structures.
3. Classify the lymphoid organs
4. Site of structure at no.3
5. What is the embryological 1
remnant in no.3
ANSWERS:
1. Waldeyer’s ring 2
2. 1) adenoids 2) tubal tonsils 3) 3
platine tonsils 4) lingual tonsils
3. Primary – thymus , bone marrow
and secondary - lymphnode, palatine
tonsil, MALT, Spleen.
4. Between palatoglossal and
palatopharyngeal arches.
5. Intratonsillar cleft from second pouch
4
15
QUESTIONS
2. Etiology is
3. The nerves involved are
4. Muscles paralysed here are
5. What’s the typical position of this palsy and the
other name for this position?
ANSWERS:
1. Erb’s palsy
2. Injury to erb’s point I.e., the
upper trunk of brachial plexus
3. C5, C6 roots, anterior posterior divisions of
upper trunk, nerve to subclavius and
suprascapular.
4. Deltoid, supraspinatus, infraspinatus, biceps,
brachialis, brachiradialis
5. Arms hanging by the side, medically rotated
with forearm extended and pronated, flexed
wrist. Porter’s tip hand.
16
QUESTIONS
2. Nerve trunk involved are .
3. Muscles paralyzed here are .
4. Clinical signs shown are .
5. What is cervical rib?
ANSWERS:
1. Klumpke’s palsy
2. Lower trunk of brachial plexus.
3. Intrinsic muscles of hand, flexors
of digits
4. Claw hand, anaesthesia along
inner side of forearm, hand and
little finger
5. It is an extra rib in the neck region
which causes compression of lower
trunk of brachial plexus against
scalenus anterior muscle.
17
QUESTIONS

2. What is the muscle involved?
3. What is the other name for this
condition?
4. Characteristics of this disorder are
.
5. Nerve involved in this condition.
ANSWERS:
1. Torticollis
2. Sternocleidomastoid.
3. Wry neck
4. Extended and tilting neck on the
affected side with chin pointing
towards the normal.
5. Spinal accessory nerve.
18
QUESTIONS
1. What does the picture
indicate?
2. Which ganglion is
involved?
3. Location of the ganglion.
4. What glands are
stimulated in hayfever?
5. Name the nucleus
concerned.
ANSWERS:
1. Hay fever
2. Pterygopalatine ganglion
3. Pterygopalatine fossa.
4. Lacrimal, nasal, palatine and
pharyngeal
5. Lacrimatory and superior
salivatory
19
QUESTIONS
1. Name the clinical condition.
2. Position of the eye.
3. What muscle is involved?
4. Peculiarity related to this
nerve?
5. Attempt look down results in
.
ANSWERS:
1. 4th nerve palsy.

2. Up and In.
3. Superior oblique muscle
4. Only cranial nerve emerging
through the dorsal aspect of brain
stem. Complete decussation
occurs with the nerve of opposite
side before emerging from the
brain stem.
5. Vertical diplopia with loss of
balance.
20
QUESTIONS
2. Define the condition?
3. Etiology
4. What is cauda equina syndrome ?
5. What is the site of lumbar puncture
ANSWERS:
1. Lordosis
2. Unusually large inward arch
in the lumbar region.
3. Spondylolisthesis,
achondroplasia,
osteoporosis.
4. It occurs due to injury to the
lower part of the cauda
equina which is the
extension of the lumbar( L4
and L5) and sacral and
coccygeal nerves beyond the
lower end of the spinal cord
5. Between L3 and L4 vertebrae
21
QUESTIONS

2. Etiology is
3. Which vertebra are affected?
ANSWERS:
1. Kyphosis
2. Degenerative diseases such as
arthritis, developmental issues,
scheuermann’s disease
3. Thoracic and sacral
22
QUESTIONS

3. Is it permanent deformity?
4. Which layer id involved?
5. Mention arterial supply of the scalp
ANSWERS:
1. Capital succedaneum
2. Interference of venous return while
passing through birth canal.
3. No. Subsides on itself in few days.
4. Loose connective tissue.
5. Supra trochlear, supraorbital,
superficial temporal, posterior
auticular, occipital arteries.
23
QUESTIONS
2. What is the extent of the swelling?
4. Which skull bone is commonly
related?
5. Name the parts of a flat bone.
ANSWERS:
1. Cephalohydrocele/ cephalohematoma.
2. Restrict to the skull bones
3. Fracture of the skull results in intracranial
hemorrhage which enters the subaponeurotic
space through the fracture lineduring forceps
delivery.
4. Parietal.
5. Outer and inner tables with intervening
diploe tissue.
24
QUESTIONS
1. Name the clinical condition .

2. Location of the structure
involved.
3. Embryological origin of the
structure
4. Mention the arterial supply of the
structure.
5. Mention its embryological
remnant
ANSWERS:
1. Tonsillitis
2. Between palatoglossal and
palatopharyngeal arches.
3. 2nd pharyngeal pouch
4. Tonsillar branches from facial artery,
lingual artery, ascending pharyngeal
5. Intra-tonsillar cleft.
25
QUESTIONS
2. What are the signs and
symptoms?
3. Is it familial?
4. Etiology?
5. What are the hormones secreted
by the gland?
ANSWERS:
1. Thyrotoxicosis
2. Goitre, exosphthalmos,
weightloss, nervousness.
3. Yes , majority of the patients have
a family history.
4. Graves disease, Thyroiditis
5. T3, T4, calcotonin
26
QUESTIONS
1. What is the clinical
condition?
2. Clinical features of this
condition are
3. Where from the thyroid
gland develops?
4. Parafollicular cells develop
from.
5. Mention the parts of thyroid
gland.
ANSWER
1. Hypothyroidism
showing goitre
2. Dry skin, hoarse voice, dry
and coarse hair, puffy face
etc.
3. Thyroglossal duct
4. Ultimobranchial body
5. Two lateral lobes connected
by isthmus.
27
a. Identify the picture?

b. Mention the nerve involved in it?
c. Mention the movements possible at wrist
joint?
d. Name the muscles producing extension of
wrist joint?
e. Enumerate the muscles supplied by the
involved nerve in hand?
ANSWER
a. Wrist drop
b. Radial nerve
c. Flexion, extension & Adduction, abduction
d. Extensor carpi radialis & extensor carpi
ulnaris
e. NIL.
28
QUESTIONS ANSWERS
a. Identify the condition shown in the a. Ulnar claw hand
picture? b. Extension at metacarpophalangeal
b. Describe its position? joint and flexion at
c. Name the nerve involved in it? Interphalangeal joint
d. Which group of intrinsic muscles are c. Ulnar nerve
primarily involved in this condition? d. Lumbricals & Interosseii
e. Which extrinsic muscle produces e. Extensor digitorum muscle
extension at metacarpo-phalangeal
joint?
29
QUESTION
a) Identify the condition shown in the
picture?
b) Name the nerves involved?
c) Describe the position of the hand?
d) Mention the nerve supply of lumbrical
muscles?
e) Mention the action of lumbrical
muscle?
ANSWER
a) Total claw hand
b) Median & ulnar nerves
c) Extension at the metacorphalngeal
joint & flexion at the interphalangeal
joint
d) Ist & IInd by median nerve IIIrd & IVth
ulnar nerve
e) Flexion at the metacarpophalangeal
joint & Extension at the
interphalangeal joint
30
QUESTIONS
a) Identify the condition shown in the marked
area?
b) Paralysis of which muscle leads to this?
c) Mention the attachment of that muscle?
d) What is the nerve supply of the paralyzed
muscle?
e) From which level of the brachial plexus does
that nerve arise?
ANSWER
a) Winging of scapula
b) Serratus anterior muscle
c) Origin – upper eight ribs
Insertion – medial border of costal
surface of scapula
d) Long thoracic nerve of Bell.
e) Root level
31
a) Identify the condition?

b) Mention any two professions lead to this condition?
c) Name the perforators related to this vein?
d) What are the complications?
e) Name the tests performed to determine the
incompetency of the sapheno – femoral valve &
communicating veins respectively?
ANSWER
a) Varicose veins
b) Teacher & conductor
c) Ankle perforator
Below knee perforator
Mid thigh perforator
d) Pain
Varicose venous ulcer
Pigmentation & itching of the skin
e) To determine the
Incompetency of sapheno – femoral
valve…..Trendelenburg test
Incompetency of communicating
vein…….Tourniquet test
32
QUESTIONS
a) Identify the picture?
b) Mention the nerve involved in it?
c) Fracture of which bone may lead to injury
of that nerve?
d) What are the movements possible at ankle
joint?
e) At which joint the inversion & eversion
movements occur?
ANSWER
a) Foot drop
b) Common peroneal nerve
c) Fracture neck of Fibula
d) Dorsiflexion & Plantar flexion
e) Subtalar joint
33
QUESTIONS
a. Identify the defect of vertebral column?
b. Define the condition?
c. Mention the other congenital anomalies
related to the vertebral column?
d. Mention any two acquired conditions of
vertebral column?
e. Name the structure mainly responsible for
primary and secondary vertebral
curvature
ANSWER
a. Kyphosis
b. Excessive posterior curvature of thoracic
spine
c. Scoliosis, kyphoscoliosis & lordosis
d. Fracture vertebra, disc prolapse and
vertebral abscess
e. Primary curvature – I.V.disc
Secondary curvature – Body of vertebra
34
QUESTIONS
a. Identify the condition?
b. What are the other conditions related to the
vertebral column?
c. Mention the normal curvatures of the vertebral
column?
d. Which part of the vertebral column is usually
e. At what age it may occur?
ANSWER
a) Scoliosis
b) Kyphosis, kyphosoliosis, lordosis
c) Primary and Secondary
- Thoracic - Cervical
- Sacrococcygeal - Lumbar
d) Thoracic part
e) Mostly occur during growth spruts before puberty
35
a. Identify the x-ray?

b. Name the contrast substance used for it?
c. Mention the level of constrictions of the
organ shown?
d. Which cardiac chamber enlargement
causes dysphagia?
e. What is the procedure used to visualize the
interior of the organ shown in the x-ray?
ANSWER
a) Barium swallow x -ray
b) Barium sulphate
c) i. Pharyngo esophageal junction
ii. where it is crossed by arch of aorta
iii. where it is crossed by left bronchus
iv. where it pierces the diaphragm
d) Left atrium enlargement
e) Esophagoscopy
36
QUESTIONS
a. Identify the condition shown in the marked area?
b. Mention its types?
c. Mention any two cause for it?
d. Clinically how do you diagnose?
e. What is the remedy?
ANSWER
a) Pneumothorax
b) Open, Closed & Tension Pneumothorax
c) Fracture ribs & injury to pleura, Rupture of the
emphysematous bulla
d) Short breath with pain
Resonant note on percussion of the chest wall
e) Removal of air from pleural cavity
37
QUESTIONS ANSWER
a. Identify the condition shown in the picture? a. Pleural effusion/ hydrothorax
b. Name the recesses obliterated by this condition? b. Costophrenic & Cardiophrenic recesses
c. Mention any two common symptoms of it? c. Breathlessness & chest pain
d. Mention the investigations done to diagnose this d. Plain x-ray chest / MRI scan
condition? e. Drainage of fluid, Suitable antibiotics after
e. What is the remedy? culture & sensitivity test
38
QUESTIONS
b. How does the coronary artery differ from other
arteries?
c. Through which artery of lower limb the catheter
is passed for this procedure?
d. What is the indication?
ANSWER
a) Coronary angiogram
b) Coronary arteries are filled during diastole
whereas other arteries are filled during systole
c) Femoral artery
d) Coronary vessel block, Ischemia
e) Ischemia – coronary vasodilators
Block – coronary bypass surgery
39
QUESTIONS
a. Identify the sign shown in the marked
area?
b. Mention the portal & systemic veins
anastomose at this site?
c. Name the condition producing this sign?
d. Name the liver disease causing this
condition?
e. What is this the commonest drug
responsible for it?
ANSWER
a. Caput medusae
b. Paraumbilical veins (portal ) & veins
of anterior abdominal wall (systemic)
c. Portal hypertension
d. Cirrhosis of liver
e. Alcohol
40
QUESTIONS
b. Mention its types?
c. Which clinical test is performed to
differentiate the main types?
d. Mention the treatment?
e. How do you prevent it?
ANSWER
a. Inguinal hernia
b. Direct and indirect inguinal hernia
c. Ring occlusion test
d. Surgical treatment-----Herniotomy,
Hernioraphy, Hernioplasty
e. Avoid stress and strain and
physical activity which increases
the intra abdominal pressure.
41
QUESTIONS ANSWER
a. Identify the X– ray? a. Intra – venous pyelogram
b. Name the dye used for it? b. Conray – 420
c. What are the structures can be studied by c. Calyces, pelvis, ureter, and urinary bladder
this X– ray? d. Urinary stones & stricture
d. What are the indications? e. Renal failure
e. What are the contraindications?
42
a. Identify the X–ray?

b. Name the substance used for it?
c. Name the parts of G-I tract visible?
d. Mention any two conditions associated with
colon?
e. Which of its gross feature can be identified
radiologically?
ANSWER
a. Barium meal X – ray (late picture)
b. Barium sulphate
c. Terminal part of small intestine, ascending,
transverse, descending colon & rectum
d. Tumour & stricture
e. Haustrations / sacculations
43
QUESTIONS ANSWER
a. Identify the X–ray? a. Barium meal X- ray
b. Name the contrast medium used in it? b. Barium sulphate
c. Why do you prefer that contrast substance? c. Non toxic & Radio opaque
d. What are the indications for this investigation? d. To study – Ulcers & tumors & diverticulum of
e. How do you identify the small &large intestine G.I tract
by this X – ray? e. Small intestine – feathery appearance
Large intestine – sacculations
44
QUESTIONS ANSWER
a. Identify the procedure shown in the picture? a. Episiotomy
b. Mention its types? b. Median episiotomy & mediolateral episiotom
c. Which anesthesia is given for it? c. Pudental block
d. Mention the complications avoided by this d. Perineal body rupture & recto vaginal fistula
procedure? e. In primiparous woman
e. For whom it is done routinely?
45
QUESTIONS
b. Which position of the uterus prevents this
condition?
c. Which position of the uterus promotes this
condition?
d. Mention the Ligamentous support of the organ?
e. How do you treat this condition?
ANSWER
a. Prolapse of uterus
b. Anteversion & Anteflexion
c. Retroversion & Retroflexion
d. Round ligament, Mackenrodt’s ligament,
Pubocervical and utero sacral ligaments
e. Surgical – Hysterectomy /
Hysterosalphingectomy
46
QUESTIONS ANSWER
a. Identify the X – ray? a. Hysterosalphingogram
b. What contrast medium is used for this b. Lipiodol
procedure? c. Colposcope
c. Name the instrument used to dilate the vagina? d. Bicornis bicolis / bicornis unicolis / unicornis
d. Mention any two congenital anomalies of the unicolis, septate uterus, arcuate uterus
organ concerned? e. Sterility ( to confirm the luminal patency )
e. What is the indication for this X- ray?
47
QUESTIONS ANSWER
a. Identify the picture? a. Phymosis
b. Name the other condition related to the prepuce? b. Paraphymosis
c. What are the complications of this condition? c. Urinary tract infection,Smegma collection, P
d. What is the remedy? cancerous lesion
e. In which religion the prepuce is removed as a d. Circumcision
social custom? e. Muslims
48
QUESTIONS
a. Identify the condition shown in
the picture?
b. Name the condition opposite to
this?
c. Mention its complications?
d. What is circumcision?
e. Which disease is uncommon in
circumcised penis?
ANSWER
a. Paraphymosis
b. Phymosis
c. Pain, oedema and infection
d. Removal of prepuce around the
glans penis
e. Cancer penis
49
QUESTIONS
a. Identify the marked area in the
picture?
b. When does it close?
c. What do you suspect in delayed
closure?
d. What does it indicate the bulging
& depression of marked area?
e. Which dural venous sinus and
ventricle can be approached
through that area?
ANSWER
a. Anterior fontanelle
b. 1 ½ - 2 years
c.Vitamin – D deficiency
d. Bulging – raised intracranial
pressure
Depression – dehydration
e. Superior Sagittal sinus
Lateral ventricle 50

b. Name the nerve involved
in it?
c. Mention the type of lesion?
d. Mention its features?
e. What is the cause of
Ramsay hunt syndrome?
ANSWER
a. Bell’s palsy
b. Facial nerve
c. LMN (lower motor neuron) type of lesion
d.
1. Absence of wrinkles in the fore head
2. Inability to close the eye tightly
3. Absence of nasolabial fold on the paralyzed side
4. Drooling of saliva & collection of food
5. Inability of hold the air in the mouth cavity.
e. It is due to involvement of geniculate ganglion of facial nerve in the Herpes Zoster Infection.
51
a. Identify the defect shown in the marked area of the

picture?
b. Name the structures forming the septum?
c. Mention the blood supply & nerve supply of the septum?
d. What are the symptoms of the above condition in severe
cases?
e. What is the surgical intervention?
ANSWER
a. Deviated nasal septum

b. (i) perpendicular plate of ethmoid bone
(ii) vomer
(iii) septal cartilage
c. Blood supply Nerve supply

- ethmoidal arteries - Anterior ethmoidal nerve
-Sphenopalatine artery - Nasopalatine nerve
-Greater palatine artery
- Superior palatine artery
d. Difficulty in breathing, sinusitis, headache, excessive snoring.
e. Corrected by sub mucous resection (SMR) or Septoplasty.
52
QUESTIONS
a. Identify the symptom shown in the picture?
b. From which area of the nasal septum this
bleeding occurs?
c. Name the arteries anastomosing at this site?
d. What is the clinical term for the
anastomosis at this site?
e. Mention the commonest cause for this
symptom in children & adult?
ANSWER
a. Epistaxis
b. Antero inferior part of nasal septum /
Little’s area.
c. Ethmoidal, palatine and septal arteries
d. Kiesselbachs’s plexus.
e. In children - nose picking
In adult – hypertension
53
QUESTIONS
a. Identify the gland related to the marked area?
b. Where does its duct open?
c. Which nerve may be injured during its surgical
procedure?
d. Mention any two conditions related to this
gland?
e. What is the importance of Patey’s faciovenous
plane?
ANSWER
a. Parotid gland
b. Vestibule of the mouth opposite to the upper
second molar tooth.
c. Facial nerve
d. Parotiditis, parotid abscess, mumps, parotid
tumours , Frey’s syndrome
e. Patey’s faciovenous plane helps the surgeon to
remove the parotid tumor without damaging the
facial nerve.
54
QUESTIONS
b. Mention its alternate nomenclature?
c. Which layer of the scalp injury lead to this?
d. What is the special name given to that layer?
e. Mention the attachment of frontal belly of
occipitofrontal.
ANSWER
a. Black eye
b. Periorbital Echymosis
c. Loose areolar tissue layer
d. Dangerous layer of scalp
e. No bony attachment, attached with skin & fascia
of forehead
55
a. Identify the eye defect shown in the

marked side?
b. Paralysis of which muscle leads to this
condition?
c. Name the extra ocular muscles?
d. What is their nerve supply?
e. What is the origin and insertion of the
involved muscle(s)
ANSWER
a. Lateral squint / lateral
strabismus
b. Medial rectus
c. Four recti muscles and Two oblique
muscles
d. All are supplied by oculomotor nerve
(3rd nerve) Except Lateral rectus (6th
nerve) & Superior oblique (4th nerve)
e. Origin – common tendinous ring
Insertion – into the sclera, 5mm
posterior to the limbus (cornea-scleral junction)
56
QUESTIONS
a. Identify the defect in the marked eye?
b. Which muscle paralysis leads to this?
c. What is the nerve supply of the
paralyzed muscle?
d. Name the muscle responsible for closure
& opening of eye lids?
e. What is the location of the nucleus of the
involved nerve?
ANSWER
a. Medial squint / strabismus
b. Lateral rectus
c. Abducent nerve (6th cranial nerve)
d. Closure of eyelid – Orbicularis occuli
Opening of eyelid – Levator palpebrae
superiors
e. Caudal part of the pons, medial to sulcus
limitans.
57
QUESTIONS
a. Identify the condition shown in the picture?
b. How do you confirm it?
c. How does it develop?
d. What other condition closely related to it?
e. How do you differentiate it from branchial cyst?
ANSWER
a. Thyroglossal cyst
b. Location(mid line swelling) & Moves with
deglutition
c. Non obliteration of thyroglossal duct
d. Thyroglossal fistula
e. Branchial cyst is a lateral swelling related to the
anterior border of sternocleidomastoid muscle.
58
QUESTIONS ANSWER
a. Identify the position of the vocal cords in the a. Adduction and Abduction of vocal
Picture 1 & 2 ? cords
b. Which membrane of larynx forms the vocal
b. Cricovocal membrane
cord?
c. Posterior cricoarytenoid muscle
c. Which muscle produces abduction of vocal
d. Vocal cord palsy, Singer’s nodule
cord?
e. Fissure between the vocal cords
d. Name any two conditions related to the vocal
cord?
e. What is Rima glottidis?
1 2
59
QUESTIONS
a. Identify the marked area in the picture ?
b. Mention it complications?
c. Which vessel damage leads to this
condition ?
d. Name the meningeal spaces?
e. What are the contents of the spinal
epidural space?
ANSWER
a. Extra dural hematoma
b. Middle meningeal vessels
c. Extradural, subdural and
subarachnoid spaces
d. Vertebral venous plexus & Pad of
fat
e. Compression & lesion of the
underlying area
60
QUESTIONS
a. Identify the condition shown the picture?
b. Name the commonest sex and joint involved?
c. Describe its position?
d. What are its complications?
ANSWER
a. Club foot / Talipus equinovarus
b. Sex -male
joint -subtalar joint
c. Ankle -plantar flexed
Foot -inverted
Fore foot -adducted
d. Shortness of limb
Tightness of muscles, Tendon and ligaments with
painful walking
e. Surgical correction 61
QUESTIONS ANSWER Department Of Anatomy, OMC
a. Identify the condition shown in the picture a. Undescended testis / Cryptorchidism

b. From which germinal layer the gonads develop b. Intermediate mesoderm
c. Gubernaculum,Foetal testosterone, Intra
c. Mention any two factors that help in the descent abdominal pressure & High intra abdominal
of testis temperature
d. What are the complications of undescended testis d. Sterility& Tumours
e. Trans abdominal phase
e. What are the stages of descent of testis
Inguino-scrotal phase
62
QUESTIONS
b. Name the fetal membrane
covering the contents?
c. What is physiological
umbilical hernia?
d. When does physiological
hernia disappear?
e. How do you differentiate this
condition from acquired
umbilical hernia?
ANSWER
a. Omphalocele / Exomphalos / Congenital umbilical hernia
b. Amnion
c. Temporary protrusion of the abdominal contents outside the abdominal cavity.
d. After tenth week of intra uterine life.
e. Acquired umbilical hernia --- appears after birth, contents are covered by skin.
63
QUESTIONS
a. Identify the anomaly in the picture?
b. Name the processes forming the upper lip?
c. What will be the associated defect with this
condition?
d. Mention the complication of this condition?
e. What is the treatment?
ANSWER
a. Cleft upper lip
b. Maxillary process & fronto nasal process
c. Cleft plate
d. Difficulty in deglutition & speech
e. Surgical correction
64
QUESTIONS ANSWER
a. Identify the picture? a. Meningocele
b. What does it contain? b. C.S.F
c. Mention the vertebral defect associated with it?
c. Spina bifida
d. Name the other condition related to it?
e. Mention its complications? d. Meningomyelocele
e. Injuries to meninges and spinal cord
65
QUESTIONS
a. Identify the anomaly shown the picture?
b. How does it occur?
c. Mention its features?
d. How do you diagnose antenatally?
e. How do you prevent it?
ANSWER
a. Anencephaly / exencephaly
b. Non closure of anterior neuropore
c. Absence of cranial vault
Exposed & malformed brain
Absence of swallowing reflex
d. Hydramnios & Estimation of alpha fetoprotein
e. Antenatal administration of folic acid tablets
66
QUESTIONS
b. Mention its chromosomal anomaly?
c. What is the predisposing factor?
d. Mention its features?
e. What are the prenatal diagnostic tests?
ANSWER
a. DOWN’S SYNDROME
b. 47 chromosomes ( Trisomy 21)
c. Non - disjunction of 21st pair of chromosome
d. Mental retardation
• Short stature
• Constantly open mouth with protruded tongue
• Simian crease
• Cardiac defects (V.S.D)
e. Amniocentesis
Chorionic villus biopsy
non-invasive prenatal testing
67

b. Mention its chromosomal complement?
c. What is the reason for the above chromosomal
defect?
d. What is the phenotype?
e. Mention any four of its manifestions?
ANSWER
a) Klinefelter syndrome
b) 47 – xxy
c) Male
d) Non disjunction of chromosomes during meiosis.
e) – Tall stature with disproportionately long lower
limbs
a. Gynaecomastia
b. Scanty growth of hair
c. Underdeveloped male secondary sexual
characters
f) Infertility
Increased risk of type 2 diabetes mellitus, metabolic
syndrome, Increased risk of breast cancer.
68
1 Department of Anatomy OMC
RADIOLOGICAL
ANATOMY
STANDARD VIEWS OF A RADIOGRAPH

Skiagrams are taken in different positions of the subject in relation to the source of
X- Rays and the photographic film. Some of the common positions used are :
1. Antero-posterior view (A.P.)

It is taken with the X-Ray tube anterior to the subject and the film posteriorly
placed. Posterior structures are better visualised in this view.
2. Postero-anterior view (P.A.)

It is taken with the X-ray tube posterior to the subject and the film anterior,
the rays thus passing postero-anteriorly through the subject. Anteriorly
placed structures are more clearly visible in this view. The more commonly
taken X-ray of the chest is a P.A. View.
3. Lateral views
These are used to assess the depth of the structures and can be:-
(i) Right lateral view : When the film is in contact with the right side of the
subject.
(ii)Left lateral view : When the film is kept against the left side of the subject.
STANDARD VIEWS OF A RADIOGRAPH

4. Oblique views
These are used for special study of a particular structure. In the case of chest
X-rays these could be
(i) Right anterior oblique view (R.A.O)
(ii) Left anterior oblique view (L.A.O)
The subject stands in front of upright film cassette holder and is then turned 450
oblique (left or right).
The orientation of a radiograph is marked by incorporating a lead letter into the
cassette before exposing a film e.g. the right side with an ‘R’, and left side with an ‘L’
TYPES OF RADIOGRAPHS
1. Plain radiographs
When X-rays are allowed to pass through the subject without the use of any
medium the translucent portions appear black on the developed x-ray plate,
whereas the dense areas absorb the x-rays in varying degree resulting in
different shades of white.
2. Contrast radiographs
When X-rays are taken after filling a cavity or space with a contrast medium in
order to visualise the lumen of the viscus or extent of the cavity.
The contrast media are of two types:-

(a) Opaque e.g., barium sulphate for the gastro-intestinal tract, and iodine
compounds for the urinary tract.
(b) Translucent e.g. air or oxygen for ventricles of brain.
X-RAY APPEARANCES OF NORMAL

SKELETON
• Structure of mature bone
Because of their high calcium content, the bones of the skeleton are clearly
defined and contrasted with the soft parts. The long bones show a dense white
homogenous outer layer, the cortex, which encloses a less dense inner portion, the
cancellous bone, which is represented by a series of fine white lines that
correspond to the thin sheets of bone known as the trabeculae or lamellae. These
lamellae are arranged mainly in the direction of the predominant stress, but are
joined to each other by cross bracing lamellar. Lamellae placed on the lines of
pressure are seen particularly clearly, in the neck of the femur (calcar-femorale)
and in the calcaneum, because they are subjected to great stress. In the long bones
of the limbs generaly they tend to run vertically, but the number of cross bracing
obscures the pattern. Study of the trabecular architecture and the distribution of
the cortical and cancellous layers in each bone is useful because alterations occur
in many pathological conditons.
In the shafts of the long bones the cancellous bone is absent and is replaced by a
space, the medullary (marrow) cavity, which can be seen in a skiagram through its
limits are not clearly demarcated.
X-RAY APPEARANCES OF NORMAL

SKELETON
• Structure of immature bone
At birth considerable portions of the skeleton are formed of
cartilage, the radiographic density of which is much the same and
that of the overlying skin and muscles. These portions are therefore
not normally distinguished in a skiagram e.g. the cartilaginous
carpal elements in the wrist and the ends of certain long bones of the
extremities.
Shoulder-AP view
Elbow-Lateral view
Wrist & Hand-AP view

Hip-AP view
Knee-AP view
Knee-Lateral view
Ankle-AP view
Foot-Dorsoplantar view
Ankle and foot-lateral view

THORAX
Chest
X-ray examination of the chest is Important in diseases of the lungs

and heart. The ordinary standard x-ray film of chest is a postero-
anterior view (P.A.) that is to say one taken with the film against the
front of the patient’s chest and the x-ray tube two metres behind the
patient. With the subject sitting or standing the hands are placed on
the waist and the elbows are pointed antero-laterally. This moves the
scapulae from the lung fields. The skiagram is taken the breathing is
momentarily stopped after taking a deep inspiration.
Thorax-Postero-anterior view
Thorax-lateral view
Thorax-Right anterior oblique view

Oesophageogram-Left anterior-oblique view

Skull-Antero-Posterior view
Skull-Caldwell view
Skull-Lateral view
Cervical spine-AP view
Cervical spine-Lateral view
ABDOMEN AND PELVIS

• PLAIN X-RAY ABDOMEN
A plain rediograph of the abdomen is extremely valuable in
(i) Excluding biliary and renal calculi,
(ii) In urgent surgery for diagnosing:
• acute intestinal obstruction.
• paralytic ileus and
• rupture of a hollow viscus.
It is taken after preparing the patient in the following manner to eliminate excessive faecal, air and gas shadows from the
intestine.
•Purgative should be given 36 or 24 hours before x-ray is taken. Half to one ounce of castor oil is effective in clearing the
colon with most patients, but it tends to encourage gas distension after the initial irritation. Milder purgatives such as
Senna may also be used. Colon wash-outs may also be given.
• Patient should be up and about before examination to dispel gases when this is
possible.
•Pitressin (1.5 ml) can also be given subcutaneously to cause the colon to empty, provided the patient is not pregnant or
suffering from high blood pressure. Afteer the injection, the patient is instructed to retire to the lavatory and pass flatus.
The radiographs are taken after wards.
Abdomen-Plain X-Ray (KUB)
CONTRAST RADIOGRAPHY
GASTROINTESTINAL TRACT
The alimentary tract is examined with the aid of a contrast medium.
Their common value depends on their outlining the internal shape
of hollow organs. The most commonly employed medium in present
day radiography of the gastrointestinal tract is barium sulphate in
water suspension. 125 gm of barium sulfate powder to 180 ml of
water is adequate in most patients. If the small intestines are to be
examined and additional 120 to 180 ml of the mixture should be
given routinely.
BARIUM MEAL
Barium meal is flavoured with vanilla and sweetend with white saccharin. It has a
creamy consistency. Before giving barium meal, the patient is prepared in the
following manner.
• He should have nothing to eat or drink for six hours prior to the barium meal
and should not smoke, chew gum or take medicines during this period.
•No purgative should be given the night before the examination as they tend to
cause misleading motor phenomena.
•Medicines containing elements of high atomic weight such as bismuth, calcium
or magnesium should be discontinued at least three days prior to the test as they
may adhere to colon wall in the region of splenic fiexure and cast a confusiing
shadow.
The meal is best given at about 9 a.m. The patient drinks 0.5 to 1 pint (10 to
15 ozs.) of barium emulsion so that stomach is filled up. The barium emulsion is
then smeared over the interior of the stomach by gentle pressure on the abdominal
wall. The patient is radio-graphed immediately after the meal and then at ½ hr., 1
hr. and 1 ½ hours intervals. The stomach starts emptying its contents within a few
minutes of their reaching it. A half pint of barium suspension will usually have
left the stomach in two hours.
BARIUM ENEMA
The large intestine can be examined either after a barium enema or a barium meal.
A barium enema is used in preference for most purposes. A necessary preliminary
is to cleanse the bowel thoroughly, and for this purpose the following procedure is
adopted.
• A suitable purgative (castor oil 1-2 oz or Dulcolax tablets) is given 48 hours
before the examination to remove gross faecal masses.
• A clear liquid diet is given for a perior of 24 hours prior to X-ray.
•A high colonic wash-out is given just prior to the examination. Three pints of
plain water or normal saline are run into the rectum from douche can, at a
pressure of about one foot of water. No soap should be used for colonic lavage.
After the patient has been thus prepared, the whole colon is easily outlined by
slowly running in two to three pints of a simple barium sulphate suspension
through the anus. 300 gms of barium sulfate powder are added to each 1000 ml of
tap-water. Various drugs are sometimes added e.g. Clysotrast to help colonic
peristalsis and precipitate mucus which might otherwise cling to the mucosa.
The result is an improved post evacuation study.
Stomach (J-shaped) immediately after barium
Stomach and duodenum-15 minutes after barium meal
Urinary Tract
In a plain skiagram of abdomen (K.U.B. film) the kidney outlines can be cleary
seen. To outline the calyces, ureter and bladder, certain organic compounds
containing iodine in their molecule, have to be introduced either intravenously or
through a catheter to make the urinary tract radio-opaque. Such an x-ray in which
the urinary tract is visualised by a radio-opaque medium is called a pyelogram.
Plain radiographs of the abdomen should be taken first, before pyelography, as
these will show whether the kidneys are normal in size, shape and position, and
whether there are any abnormal opacities in the renal tract, which may require
localisation by pyelography. Occasionally, they may reveal non-renal conditions
which make pyelography unnecessary.
Urinary Tract
 Descending Pyelogram
The preparation and technique is as follows:
Conray 420 (compound containing iodine) is the preparation of choice.
• A mild vegetable aperient on two consecutive evenings preceding examination.
• A light supper on the preceding evening.
• For twelve hours before the injection the intake of fluids is limited and diuretic
drugs are excluded.
• No food or fluid is given on the morning of the test.
• Urinary bladder should be empty when the injection is given.
• If possible the patient should be up and about to expel gases.
• Test for iodine sensitivity is done.
• Warm 20-40 ml of the solution to body temperature. Inject slowly taking care
that there is no leakage out of the vein.
Urinary Tract
The first radiograph of the abdomen is taken five minutes after the injection. A
second radiograph ten minuts after the injection may suffice but more may be
taken if considered necessary.
Excretion urography or descending or intravenous pyelography (I.V.P.) is not only
performed to obtain an anatomic evaluation of the urinary tracts, nut is also done
to determine the functional status of the kidneys and so constitutes one of the
renal function tests.
 Ascending Pyelogram
If delineation of the calyces, pelvis or ureters is unsatisfactory on one or both sides
after intravenous pyelography, a retrograde pyelogram may be necessary. An
intravenous pyelogram is safe, but a retrograde pyelogram must be undertaken
with caution. The preparation and technique is as follous:
• Nothing by mouth after a light meal in the evening.
• Cleansing enema in the morning.
•A cystoscope is passed through the urethra into the bladder. A cystoscope is an
instrument of such a size that it can be passed up the urethra. The inner end carries
a small electric light and a mirror, the outer end a telescope, a system of lenses
focussed on the mirror. The light from the lamp luminates a part of the bladder
wall. Its image is reflected by the mirror along the tube into the eye piece. Special
channels are incorporated in the instrument through which fine flexible catheters
can be passed and guided into the orifices and then up the ureters.
• A ureteric catheter is manipulated through the cystoscope into

the bladder then under direct vision is guided into the ureter.
• Hypaque (45 per cent) is injected by the catheter into the ureter
in a fully conscious patient.
• The injection of the opaque medium is continued until the
patient feels discomfort in the loin, or until 10 ml have been
introduced.
• The radiograph is taken.
• The fluid is aspirated from the renal pelvis and the catheter
is removed.
Descending pyelogram
FEMALE GENITAL TRACT

Hysterosalpingography
It is particularly useful in cases of sterility and to prove or disprove the patency of the
uterine tubes. It also outlines the uterine cavity, shows the length, shape and position of the
Fallopian tubes. The most common contrast medium used is Lipiodol. A suitable cannula,
which at the same time obstructs the cervical canal, is inserted into the cervical canal of the
uterus. Approximately 6 ml of the opaque medium is injected and an antero-posterior film
is obtained. When iodized oil is used, another film is obtained in twenty-four hours to
detect the extent of the overflow into the pelvis through the uterine tubes.
Uterus-Hystero Salpingogram

Anatomy Practicals Notes

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Department Of Anatomy, OMC

 Secondary (or Antral) Follicle

 Changes in the Uterine Endometrium

 Changes in the Uterine Endometrium

 FORMATION OF THE AMNIOTIC CAVITY

 FORMATION OF THE YOLK SAC, EXTRAEMBRYONIC MESODERM,

 FORMATION OF PRIMARY CHORIONIC VILLI

The placenta consists of two components: foetal

Structure of Mature Placenta

 Cardiac loop formation

Aortic arches and relation of recurrent laryngeal nerve

DEVELOPMENT OF THE PORTAL VEIN

•Persistent caudal part of the right posterior cardinal vein

 Superior vena cava.

• The opening of the respiratory diverticulum becomes the

 Development of the Collecting Part

 Development of the Excretory Part

2. Absorption of mesonephric ducts into vesicourethral canal

3. Development of muscular and connective tissue coats

DEVELOPMENT OF ARTERIES OF UPPER LIMB

NORMAL HUMAN KARYOTYPE (MALE/FEMALE)

U.S.Natonal Library of Medicine Sex Chromosomes

The normal human karyotypes contain 22 pairs of autosomal chromosomes

The ormal human karyotypes contain 22 pairs

Males have both an X and a Y chromosome. Normal karyotypes

for males are denoted as 46,XY.

.The normal human karyotypes contain 22 pairs

.Normal karyotypes for females contain two X chromosomes and are

SEX CHROMATIN or BARR BODY

SEX CHROMATIN AND LYON’S HYPOTHESIS

Following are the features of the Lyonization:

.Puberty fails to occur normally and secondary sexual characters

symptoms may be treated as follows:

Physical and speech therapy for muscle weakness and

Psychological counseling to deal with the emotional and

Monosomy is the most frequent cause

Mosaicism 45 XO/ 46, XX

Isochromosome 46. X, i (Xq)

Ring chromosome 46 X, r (X)

Sex chromatin is always negative

CRI DU CHAT SYNDROME

Cri du chat syndrome

TRISOMY 13: PATAU'S SYNDROME

Karyohpe From aFemae Wth Patau opodrnme (07041)

TRISOMY 18: EDWARD'S SYNDROME

Growth failure Broad flat face

I t is a abnormality where chromosome forms a closed circle(ring).

These broken sticky ends subsequently fuse with each

PROCESS: NONDISJUNCTION n+1

1. Meloslsl starts normally. 2. Nondisjunction. 3. Melosis I occurs normally. 4. Aneuploidy results,

211 PeencnEouc anon

Non-disjunction is seen during gametogenesis (meiosis) as well as in

developing zygote where cells divide mitotically. As a result two or more

cell lines are observed. This phenomenon is known as mosaicism.

chromosome which breaks at

.The broken segment rearranges itselfby inverting its position

.A chromosome with inversion gives rise to abnormal gametes

Long arm (q)

Karyotyping (preparation of chromosomes).

For identification of chromosomes following classifications are used.

a. Classification based on position of centromere

•Metacentric - In this type of chromosomes the centromere is located near the

b. Standard classification (Denver classification)

Objective Structured Practical