Q.

Vaginal epithelium is derived from

a. Endoderm of genital ridgeb. Endoderm of urogenital sinusc. Mesoderm of
genital ridge d. Mesoderm of urogenital sinus
Ans. b. Endoderm of urogenital sinus > 3. Mesoderm of genital ridge

Q. Trophoblast differentiation occurs at which day ?

Q. Trophoblast differentiates into cyto and syncytio trophoblast at post
fertilization day
a. 6-8
b. 8-12
c. 12-14
d. 16-18
Ans. a. 6-8
Explanation: Trophoblast differentiates into cyto and syncytio trophoblast at 6 8th day post ovulation/fertilization.
Q. Which of the following lies lateral to sheath of femoral hernia
a. Femoral artery
b. Femoral vein
c. Femoral nerve
d. Lateral cutaneous nerve of thigh

Ans. b. Femoral vein

Explanation:
*Femoral hernia passes through the femoral ring into the femoral canal,
and femoral vein lies lateral to it.

*Femoral hernias occur just below the inguinal ligament, when abdominal
contents pass through a naturally occurring weakness called the femoral canal.

*The femoral canal is located below the inguinal ligament on the lateral aspect
of the pubic tubercle.
- The hernia must pass the femoral ring to enter the femoral canal.
- The ring is bounded by the inguinal ligament anteriorly,pectineal
ligament posteriorly, lacunar ligamentmedially, and the femoral vein laterally.
- The femoral canal normally contains a few lymphatics, loose areolar tissue and
occasionally a lymph node called Cloquet's node.

*Femoral triangle: It is present in the anterior thigh and is bounded by

- Superiorly: inguinal ligament
- Medially: Medial border of the adductor longus muscle
- Laterally: Medial border of the sartorius muscle

*Contents (lateral to medial):

1) Terminal part of the femoral nerve and its branches; the femoral branch of
genitofemoral nerve; and theLateral cutaneous nerve of thigh.

2) The three compartments of the femoral sheath (From lateral to medial):

- Femoral artery and its branches
- Femoral vein and its tributaries
- Femoral canal, which contains lymphatic vessels and deep inguinal lymph
nodes.

Q. Anatomical closure of ductus arteriosus usually occurs at

a) Birth
b) 3 - 4 Day
c) 10 Day
d) 60 Day

Ans. a) 60 day

Explanation:
*Physiological closure of ductus arteriosus occurs within 1 4 days of birth.
Often a small shunt of blood stays for 24-48 hours in a normal full term infant.
At the end of 24 hours (1 day), 20 % ducts are functionally close, 82 % by 48
hours and 100% at 96 hours (4 days).
*Anatomical closure of ductus arteriosus occurs within 2 12 postnatal weeks
(1 month to 3 months).
Note: Ductus arteriosus is a vascular communication between the systemic and
pulmonary vasculature, usually between the isthmus of the aortic arch and the
origin of the left pulmonary artery.

*Anatomical closure: PDA is closed by 8 weeks in 88% of children with a

normal cardiovascular system. Authorities consider the patent ductus to be
abnormal only after 3 months (12 weeks) of age.

*Additional Points:
1. Ductus arteriosus develops from the dorsal portion of the left sixth arch.
Pulmonary arteries develop from sixth pharyngeal arch arteries (ventral part).

2. Left recurrent laryngeal nerve branches off the vagus and encircles (hooks)
the inferomedial wall of the duct before ascending behind the aortic arch into
the tracheoesophageal groove.

Q. Radially arranged muscle on the iris is supplied by

a. Oculomotor nerve
b. Sympathetic supply from cervical plexus nerve from cervical
sympathetic chain
c. Parasympathetic supply
d. Short ciliary nerve

Ans. b. Sympathetic supply from cervical plexus nerve from cervical

sympathetic chain

Explanation:
*Dilator pupillae has the radially arranged fibres on iris and is supplied by
the T-1 sympathetic fibres, which start from the lateral horn cells of the spinal
cord.
- These fibres synapse in superior cervical ganglionon
the cervical sympathetic chain.

- The post-ganglionic fibres pass through around the branches of internal

carotid arteries to reach the eyeball muscles like dilator pupillae via long
ciliary nerves.
- It is innervated by the sympathetic system, which acts by releasing
noradrenaline, which acts on 1-receptors.
-Threatening stimuli that activates the fight-or-flightresponse, this innervation
contracts the muscle and dilates the iris, thus temporarily letting more
light/information reach the retina.

*Structure - Dilator pupillae is a smooth muscle, withradial arrangement of

fibres in the iris, whereas, sphincter pupillae has concentric fibres.

*Sphincter pupillae is also present in the iris, and is supplied by

the cholinergic fibres of parasympatheticnervous system,
via oculomotor nerve.

*Embryology Iris muscles (Sphincter & dilator pupillae) are derived from
the neural plate ectoderm.

Q. NOT a part of superficial perineal pouch

a. Posterior scrotal nerves
b. Sphincter urethrae
c. Ducts of bulbourethral glands
d. Bulbospongiosus muscle

Ans. b. Sphincter urethrae

Explanation:
*Sphincter urethrae (external urethral sphincter) is present in the wall of
membranous urethra, in the deep perineal pouch.

- Sphincter urethrae also extends vertically, around the anterior aspect of the
prostatic urethra.

*Posterior scrotal nerves are the branches ofpudendal nerve, and do pass
the superficial perineal pouch.

*Cowpers bulbourethral gland is present in the deep perineal pouch, but

its duct pierces the perineal membrane and opens into the bulbous urethra in
thesuperficial perineal pouch.

*Bulbospongiosus muscle is a content of superficial perineal pouch, working

as a vaginal sphincter in a female; and for a male it help to empty the urethra
of the urine/semen.

*The superficial perineal pouch is a fully enclosedcompartment:

- Its inferior border is the perineal fascia (Colles fascia)
- Its superior border is the perineal membrane

- Contents:
1. Muscles
- Ischiocavernosus muscle
- Bulbospongiosus muscle
- Superficial transverse perineal muscle

2. Others
- Crura of penis (males) / Crura of clitoris (females)
- Bulb of penis (males) / Vestibular bulbs (females)
- Greater vestibular glands (female)

Q. All of the following are present in the liver capsular plate EXCEPT
a. Ductal plate
b. Hilar plate
c. Umbilical plate
d. Cystic plate

Ans. a. Ductal plate

Explanation:
*Liver plate has 3 parts, which does not include ductal plate.

*Cystic plate separates the gall bladder from the liver.

*Hilar plate is at the confluence of the hepatic ducts at the hilum.

*Umbilical plate lodges the left portal triad, starting from the hilum of liver
(porta hepatis).

*The plate system consists of bile ducts and blood vessels surrounded by a
sheath that is continuous with Glissons capsule, intrahepatically, and the
hepatoduodenal ligament, extrahepatically.
- This system also contains a large number of lymphatics, nerves, and a small
vascular network.
- Couinaud classification states that the bile ducts and hepatic artery are located
within the plate system, but that the portal vein is covered with a separate sheath
of loose connective tissue, and that is why the plate containing the extrahepatic
bile duct and hepatic artery can be easily separated from the portal vein.

AIIMS May - 2015: High Yield Facts

By God's grace, it is heartening to find that quite a significant number of
questions were asked from the topics, discussed in the class and distributed as
class notes.
Some High Yield Facts :

Peri-conceptional intake of 400 g of folic acid per day by the pregnant

women (starting from 1 month prior to 3 months after conception) can prevent
75% of all neural tube defects. Intake of 4000 g /d is recommended to
prevent recurrences.

Cancellous bone is metabolically more active than the cortical

bone. Endosteum is metabolically more active than periosteum.

Liver is divided into eight (functional (surgical) segments according

to Couinauds classification, following hepatic veins and portal veins, and is
further enhanced by following bile duct distribution. Recently there was
addition of a ninth segment, but most of the surgeons do not accept the new
addition for operative procedures.

Reticular fibres/collagen type III is absent in thymus. Basement

membrane has type IV collagen.

Jersey finger (Rugby finger or Sweater finger) is a type of injury due to

avulsion of the flexor digitorum profundus (FDP) at the base of the distal
interphalangeal joint.

Cranial nerves carrying GVE (General Visceral Efferent) fibres come

under autonomic nervous system like 3, 7, 9 and 10 (parasympathetic system).
Cranial nerve 1, 2 and 8 belong to SSA (Special Somatic Afferent) column.

Glomerulus is a derivative of metanephric blastema (and not

mesonephric duct).

Lower two part of sternum fused by age of 14 years.

Nerve beneath the facial colliculus is facial nerve, while the nucleus
deep to that is abducent nucleus.

SIT (Supraspinatus, Infraspinatus, Teres minor) muscles sit on greater

tubercle. Subscapularismuscle attaches to lesser tubercle of humerus.

First part of subclavian artery give VIT (Vertebral, Internal thoracic,

Thyrocervical) branches. T (Thyrocervical trunk) itself give SIT (Suprascapular,
Inferior thyroid artery, Transverse cervical) branches.

Card test is done to check palmar interossei.

Microvilli are present in collecting ducts, but not as markedly developed

as in PCT, Gall bladder, Duodenum.

Independent assortment of chromosomes occur during meiosis-I, when

primary spermatocyte converts into secondary spermatocyte.

Cornea is supplied by nasociliary nerve(Trigeminal, ophthalmic

division).

Trochlear nerve injury leads to paralysis of superior oblique muscle (an

intortor) and presents with affected eye in extortion leading to vertical diplopia,
especially while reading a book (adduction and depression), and the patient
attains a contralateralhead tilt to correct it.

At birth, ovaries contains primary oocyte arrested in diplotene stage of

prophase I, due to OMI (Oocyte Maturation Inhibitor).

Pelvic viscera (Uterus) are supported by Urogenital diaphragm, Pelvic

diaphragm, Perineal body (but notRectovaginal septum).

Mesorectum do not contain inferior rectal vein.

Intact comprehension and motor articulation butpoor repetition is a

feature of conduction aphasia.

Brown adipose tissue is present around scapula, adrenals, blood vessels.

White fat is subcutaneous (not brown?).
Note: I understand, some of the answers arecontroversial and will attract some
discussion. Please do come forth, I am open to any corrections.

Q1. Mesonephric derivatives are all EXCEPT

a) Glomerulus
b) Para-oophoron
c) Vas deferens
d) Epididymis

Ans. a) Glomerulus.
Explanation: Glomerulus (excretory sytem) is derived from 'metanehric'
blastema (and not mesonephros).
*Mesonephric duct gives ureteric bud to form the collecting system of kidney
(and not excretory system).

*Wolffian system (developing from Mesonephric duct) gives male reproductive

tubes (and becomes vestigial in females).
*Wolffian system in males forms: Epididymis, Vas deferens, Seminal vesicle,
Common ejaculatory ducts etc.

*Vestigial remnant of Wolffian (mesonephric) system in females are: Epioophoron, Para-oophoron, Gartener's duct.

Q4. All is true about functional divisions of liver EXCEPT

a) Based upon portal vein & hepatic vein
b) Divided into 8 segments
c) Three major & three minor fissures
d) 4 sectors

Ans. b) Divided into eight segments.

Explanation: Few AIIMS questions are typically beyond the scope of normal
standard textbooks and are controversial. This is among one of them.
*Though there has been addition of an extra segment in the liver, but it's a
subject of debate and is not fully accepted by Entire Surgeon's community.

*Caudate lobe is anatomically divided into 3 parts: Spiegel's lobe (Couinaud's

segment I), paracaval portion (Couinaud's segment IX), and the caudate
process. Segment IX is a recent subdivision of segment I, and describes the
paracaval part that lies posterior to segment VIII.

*Liver is divided into four portal sectors by the four main branches of the
portal vein. These are right lateral, right medial, left medial and left lateral
(sometimes the term posterior is used in place of lateral and anterior in place of
medial).
*The three main hepatic veins lie between these sectors as intersectorial veins.
These intersectoral planes are also called portal fissures (scissures). The fissures
containing portal pedicles are called hepatic fissures. Each sector is sub-divided
into segments (usually two) based on their supply by tertiary divisions of the
vascular biliary sheaths.
*Three major fissures, not visible on the surface, run through the liver
parenchyma and harbour the three main hepatic veins (main, left and right
portal fissures).Three minor fissures are visible as physical clefts of the liver
surface (umbilical, venous and fissure of Gans).

*Segment I (anatomical caudate lobe) lies posterior (dorsal) to segment IV with

its left half directly posterior to segments II and II and its medial half
surrounded by major vascular branches. This segment is a boundary line
structure and receives dual artery, vein and duct supply. The Glissonian sheaths
to segment I arise from both right and left main sheaths: the segment therefore
receives vessels independently from the left and right portal veins and hepatic
arteries. Caudate lobe is peculiar in the finding that it drains independently into
the inferior vena cava by multiple small branches and not into major hepatic
veins.. The bile ducts draining the segment are closely related to the confluence
of the right and left hepatic ducts.

Q2. Independent Assortment of Chromosome occurs at which level

a) Primordial Germ cells to Spermatogonia
b) Spermatogonia to Primary spermatocyte
c) Primary spermatocyte to secondary spermatocyte
d) Secondary Spermatocyte to Spermatids

Ans. c) Primary spermatocyte to secondary spermatocyte

Explanation: Maternal and paternal chromosomes separate during Meiosis - I
and by independent assortment.

*During meiosis, the pairs of homologous chromosome are divided in half to

form haploid cells, and this separation, or assortment, of homologous
chromosomes is 'random'.

*This means that all of the maternal chromosomes will not be separated into
one cell, while the all paternal chromosomes are separated into another.
*Instead, after meiosis occurs, each haploid cell contains a 'mixture' of genes
from the organism's mother and father.

Q. All of the following muscles undergo paralysis after injury to the C5-C6
roots of brachial plexus EXCEPT

a. Biceps
b. Coracobrachialis
c. Brachialis
d. Brachioradialis

Ans. b. Coracobrachialis.

Explanation: Coracobrachialis is supplied equally by all the three root values

(C-5,6,7), and may not be paralysed (due to the sparing of C-7 root value).
*Brachio-radialis is supplied by root value C-5 & 6, and hence is paralysed.

*Biceps brachii: C-5,6

*Brachialis: C-5,6,7 (But the dominant vale is C-6)

Q. All is true about scalenus anterior muscle EXCEPT

a. It is attached to tubercle of second rib
b. It is pierced by phrenic nerve
c. It separates subclavian vein from subclavian artery
d. It is anterior to transverse cervical artery

Ans. a. It is attached to the tubercle of second rib.

Explanation: Scalenus anterior (and scalenus medius) both attach to first rib
(and 'not' second).

*The phrenic descends anterior of the muscle from the lateral to the medial side
(but nerve fibres may pierce the muscle occasionally).
*Scalenus anterior muscle is sandwiched between subclavian artery from
subclavian vein, and separates the two vessels. (But as a variation, the muscle
may be present posterior to the artery sometime).
*Transverse cervical artery passes anterior to the scalenus anterior muscle (may
be found running posterior as a variation)

*The conventional description of scalene triangle anatomy probably occurs in

no more than a third of individuals, with variations in the soft tissue structure of
this region being very common.
These variations may lead to increased incidence of anatomic compression of
neurovascular structures TOCS - (Thoracic outlet compression syndrome).

Meta-Carpo-Phalangeal joint is Ellipsoid or Condylar ?!

Q. Isthmus of thyroid is at the level of tracheal rings

1. 1st and 2nd
2. 2nd and 3rd
3. 3rd and 4th
4. 5th and 6th
Ans. 2. 2nd and 3rd

- Gray's Anatomy (Ed. 40)

Q. Tracheal bifurcation is at vertebra level

1. T4
2. T5
3. T6
4. T7
Ans. 2. T5
*Trachea bifurcates at upper border of T5 vertebrae.
*In deep inspiration, as diaphragm descends, trachea is pulled down to T6
vertebra level
- Gray's Anatomy - Ed 40

*Tracheal bifurcation is found at T4 in cadavers.

- Vishram Singh
- Harold

Foot plate of stapes - Development

June 24, 2014 at 12:18am
Q. Foot plate of stapes derived from
1. Meckel's cartilage
2. Otic capsule
3. Reichart's cartilage
4. Hyoid arch
Ans. 3. Reichert's cartilage > Otic capsule.Explanation: Footplate of stapes has
dual origin from the Reichert's cartilage and otic capsule. If Reichert's cartilage
fails to form, the otic capsule part does not develop.*Reichert's cartilage is the
second arch cartilage (derived from the neural crest cells) and form bones like
stapes, styloid process, lesser cornu and upper body of hyoid.
Q. Thumb and index finger dermatome is
1. C6,6
2. C6,7
3. C7,7
4. C7,8
Ans. 2. C6,7
Q. Which of the following is not a part of ethmoid bone
1. Agger nasi
2. Uncinate process
3. Crista galli

4. Inferior turbinate
Ans. 4. Inferior turbinate
Explanation: Inferior turbinate (concha) is a separate bone.
Follow the given diagrams.

Q. The palatine tonsil receives its arterial supply from all of the following
except
1. Facial
2. Ascending palatine
3. Sphenopalatine
4. Dorsal lingual
Ans. 3. Sphenopalatine

Explanation: Sphenopalatine artery(3) is a branch of maxillary artery and

doesnt give branches to the tonsil. It mainly supplies the nasal septum, lateral
wall of nose and the paranasal sinuses.

Tonsil is mainly supplied by the tonsillar branches of facial(1) artery.

Lingual artery is a branch of external carotid artery which gives dorsal

lingual(4) branches to the tonsil.

Ascending palatine artery (2) is a branch of facial artery, which also

supplies the tonsil.

The upper pole of the tonsil also receives branches from the ascending
pharyngeal artery, which enter the tonsil posteriorly, and from the descending
palatine artery and its branches, the greater and lesser palatine arteries.

Palatine tonsil - artery supply

Q. Major artery supply to stomach is by which branch of celiac trunk

1. Left gastric artery
2. Short gastric artery
3. Right gastro-epiploic artery
4. Left gastro-epiploic artery

Ans. 1. Left gastric artery

Explanation: According to the surgery books by Sabiston and Schwartz,
the largest artery to the stomach is left gastric artery (1).

According to Shoukat N Kazi (Anatomy), left gastric artery is

the principal artery of the stomach supplying upper 2/3 of the organ.

Though personally, I am not convinced by the details in the

aforementioned books. No such details are found in Bailey & Love surgery,
Grays anatomy, Moore clinical anatomy or other standard textbooks.

Following diagram illustrates, the main five arteries supplying stomach.

. Cardiac jelly around heart tube during early development, contributes to

formation of
A. Pericardium
B. Mesocardium
C. Myocardium

D. Endocrdium

Ans. Endocardium

Explanation: Cardiac jelly is secreted by the cardiac myocytes and forms the
connective tissue of the endocardium.
*Cardiac myocytes (derived from the lateral plate mesoderm) form the
myocardium.
1)Nerve supply to platysma is
1. Ansa cervicalis
2. Cervical branch of facial nerve
3. Marginal mandibular branch of facial nerve
4. Mandibular nerve
Ans. Cervical branch of facial nerve
Explanation: Platysma develops in second pharyngeal arch and is supplied by
facial nerve (cervical branch)
Q. Vaginal sphincter is formed by all EXCEPT
A.Internal urethral sphincter
B.External urethral sphincter
C.Pubovaginalis
D.Bulbospongiosis

Ans. A. Internal urethral sphincter

Explanation: Internal urethral sphincter is present onlyin males.

Q. Blood testis barrier lies between

1. Leydig - sertoli
2. Sertoli - spermatid
3. Sertoli - myoid
4. Sertoli - sertoli
Ans. 4. Sertoli - sertoli
Explanation: Blood testis barrier - the adjacent cytoplasm of Sertoli cells are
joined by occluding tight junctions, producing a bloodtestis barrier that
subdivides each seminiferous tubule into a basal compartment and an adluminal
compartment.

Blood testis barrier

This important barrier segregates the spermatogonia from all successive

stages of spermatogenesis in the adlumi-nal compartment and excludes plasma
proteins and bloodborne antibodies from the lumen of seminiferous tubules. The

more advanced spermatogenic cells can be recognized by the body as foreign

and cause an immune response.

The bloodtestis barrier protects developing cells from the immune

system by restricting the passage of membrane antigens from developing sperm
into the bloodstream. Thus, the bloodtestis barrier prevents an autoimmune
response to the individuals own sperm, antibody formation, and eventual
destruction of spermatogenesis and induction of sterility.

The bloodtestis barrier also keeps harmful substances in the blood from
entering the developing germinal epithelium.
Q. Which part of the uterine tube acts as anatomical sphincter
1. Intramural part
2. Isthmus
3. Ampulla
4. Infundibulum
Ans. 2. Isthmus > 1. Intramural part
Explanation: The arrangement of the muscles at theisthmus is such that it can
work like a sphincter, preventing the oocyte from entring the uterine cavity.

Some autorities mention the location of sphincter at the junction of uterus

and uterine tube (intramural part).