AIIMS 2010: Questions with Authentic Answers & Ref.

Discussion in 'AIIMS Nov 2013' started by Guest, May 15, 2010.

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    Q1. All cause retraction of scapula except?
    a. Rhomboides major
    b. rhomboides minor
    c. trapezius
    d. levator scapula

    Ans levator scapula
    Gray’s 40 th ed 837

    The levator scapulae and the rhomboids assist other scapular muscles in controlling the position and movement of the scapula. Acting with trapezius, rhomboids retract the scapula, bracing back the shoulder; with levator scapulae and pectoralis minor they rotate the scapula, depressing the point of the shoulder. With the cervical vertebral column fixed, levator scapulae acts with trapezius to elevate the scapula or to sustain a weight carried on the shoulder; with the shoulder fixed, the muscle inclines the neck to the same side.

    Q2. ANTERIOR ETHMOIDAL NERVE SUPPLIES ALL EXCEPT :
    A) DURA MATER IN ANTerior cranial FOSSA
    B) NASAL CAVITY INTERNAL
    C)ETHMOIDAL CELLS
    D)MAXILLARY SINUS LINING

    Ans dura mater of anterior cranial fossa
    Gray’s 40th ed 699

    • The nasociliary nerve is intermediate in size between the frontal and lacrimal nerves, and is more deeply placed in the orbit, which it enters through the common tendinous ring, lying between the two rami of the oculomotor nerve.
    • It crosses the optic nerve with the ophthalmic artery and runs obliquely below superior rectus and superior oblique to reach the medial orbital wall.
    • Here, as the anterior ethmoidal nerve, it passes through the anterior ethmoidal foramen and canal and enters the cranial cavity.
    • It runs forwards in a groove on the upper surface of the cribriform plate beneath the dura mater and descends through a slit lateral to the crista galli into the nasal cavity, where it occupies a groove on the internal surface of the nasal bone and gives off two internal nasal branches
    • The medial internal nasal nerve supplies the anterior septal mucosa, and the lateral internal nasal nerve supplies the anterior part of the lateral nasal wall.
    • The anterior ethmoidal nerve emerges, as the external nasal nerve , at the lower border of the nasal bone, and descends under the transverse part of nasalis to supply the skin of the nasal ala, apex and vestibule.
    • The nasociliary nerve has connections with the ciliary ganglion and has long ciliary, infratrochlear and posterior ethmoidal branches.

    • The ramus communicans to the ciliary ganglion usually branches from the nerve as it enters the orbit lateral to the optic nerve.
    • It is sometimes joined by a filament from the internal carotid sympathetic plexus or from the superior ramus of the oculomotor nerve as it enters the posterosuperior angle of the ganglion.
    • Two or three long ciliary nerves branch from the nasociliary nerve as it crosses the optic nerve .
    • They accompany the short ciliary nerves and pierce the sclera near the attachment of the optic nerve.
    • Running forwards between sclera and choroid, they supply the ciliary body, iris and cornea and are said to contain postganglionic sympathetic fibres for the dilator pupillae from neurones in the superior cervical ganglion.
    • An alternative pathway for the supply of the dilator pupillae is via the sympathetic root associated with the ciliary ganglion.
    • The posterior ethmoidal nerve leaves the orbit by the posterior ethmoidal foramen and supplies the ethmoidal and sphenoidal sinuses.

    Q3. APPENDICES EPIPLOICAE are present in
    a. caecum
    b. appendix
    c. sigmoid colon
    d. rectum

    Ans rectum
    Gray’s 40 1178

    • The haustrations of the colon are often absent in the caecum proximal to the origin of the ascending colon and are often relatively sparse in the ascending and proximal transverse colon.
    • In these regions the taeniae coli are usually thin and occupy only a small percentage of the circumference of the colon.
    • There are few if any appendices epiploicae on the serosal surface of the caecum, and only a limited number on the surface of the ascending colon.
    • The haustrations become more pronounced from the middle of the transverse colon to the distal portion of the descending colon: the sigmoid colon is often characterized by marked sacculation.
    • The width of the taeniae coli remains fairly constant throughout the length of colon but the number of appendices usually increases, becoming most numerous in the sigmoid colon where they can be fairly large in the obese individual.
    • The taeniae are located in fairly constant positions beneath the serosal surface of the colon except in the transverse colon.
    • They are oriented anteriorly, opposite the midline of the mesenteric attachment on the anti-mesenteric aspect of the colon (taenia libera), posterolaterally (taenia omentalis) and posteromedially (taenia mesocolica) midway between the taenia libera and the mesentery.
    • In the caecum and descending colon, which are partly retroperitoneal structures, the posterolateral taenia is often obscured from view by the peritoneal reflection onto the colonic wall.
    • In the transverse colon, the taeniae are rotated through 90° - anterior being inferior, posteromedial being posterior and posterolateral being superior - as a consequence of the mobility and dependent position of this part of the colon.
    • The taeniae coli broaden to occupy more of the circumference of the sigmoid colon in its distal portion and by the level of the rectosigmoid junction have widened to form distinct anterior and posterior bands, which unite to form a complete longitudinal muscle covering for the rectum.
    • The rectum therefore has no external sacculation and no serosal appendices epiploicae.

    Q4. Coeliac plexus is present
    a. Ant lat and around the aorta
    b. post medial and around the aorta
    c. ant medial to lumbar symp chain
    d. post lat to lumbar symp chain

    Ans a. Ant lat and around the aorta
    GRAY’S ANATOMY 40TH 1045

    COELIAC PLEXUS
    • THE COELIAC PLEXUS IS THE LARGEST MAJOR AUTONOMIC PLEXUS, SITED AT THE LEVEL OF THE TWELFTH THORACIC AND FIRST LUMBAR VERTEBRAE.
    • IT IS A DENSE NETWORK UNITING TWO LARGE COELIAC GANGLIA AND SURROUNDS THE COELIAC ARTERY AND THE ROOT OF THE SUPERIOR MESENTERIC ARTERY .
    • IT IS POSTERIOR TO THE STOMACH AND LESSER SAC, ANTERIOR TO THE CRURA OF THE DIAPHRAGM AND THE COMMENCEMENT OF THE ABDOMINAL AORTA, AND LIES BETWEEN THE SUPRARENAL GLANDS.
    • THE PLEXUS AND GANGLIA ARE JOINED BY GREATER AND LESSER SPLANCHNIC NERVES AND BRANCHES FROM THE VAGUS AND PHRENIC NERVES.
    • THE PLEXUS EXTENDS AS NUMEROUS SECONDARY PLEXUSES ALONG ADJACENT ARTERIES.

    • THE COELIAC GANGLIA ARE IRREGULAR MASSES ON EACH SIDE OF THE COELIAC TRUNK ADJACENT TO THE SUPRARENAL GLANDS.
    • THEY LIE ANTERIOR TO THE CRURA OF THE DIAPHRAGM.
    • THE RIGHT GANGLION IS POSTERIOR TO THE INFERIOR VENA CAVA, THE LEFT GANGLION POSTERIOR TO THE ORIGIN OF THE SPLENIC ARTERY.
    • THE IPSILATERAL GREATER SPLANCHNIC NERVE JOINS THE UPPER PART OF EACH GANGLION.
    • THE LOWER PART OF EACH GANGLION FORMS A DISTINCT SUBDIVISION USUALLY TERMED THE AORTICORENAL GANGLION.
    • THIS RECEIVES THE IPSILATERAL LESSER SPLANCHNIC NERVE AND GIVES ORIGIN TO THE MAJORITY OF THE RENAL PLEXUS.
    • IT MOST COMMONLY LIES ANTERIOR TO THE ORIGIN OF THE RENAL ARTERY.
    • THE COELIAC PLEXUS IS CONNECTED TO OR GIVES RISE TO THE PHRENIC, SPLENIC, HEPATIC, SUPERIOR MESENTERIC, SUPRARENAL, RENAL AND GONADAL PLEXUSES.

    Q5. About Prostatic urethra all are true except:-
    TRAPEZOID IN CROSS SECTION
    VERUMOMENTUM IS PRESENT IN POSTERIOR WALL
    OPENING OF PROSTATIC DUCTS LIES IN POSTERIOR WALL
    RELATION OF URETHRAL CREST IN POSTERIOR WALL

    ANS TRAPEZOID IN CROSS SECTION
    GRAY’S 40TH ED 1295

    • The male urethra is18-20 cm long and extends from the internal orifice in the urinary bladder to the external opening, or meatus, at the end of the penis. It may be considered in two parts .
    • The relatively long anterior urethra (16 cm long) lies within the perineum (proximally) and the penis (distally) surrounded by the corpus spongiosum and is functionally a conduit. The relatively short posterior urethra (4 cm) lies in the pelvis proximal to the corpus spongiosum and is acted upon by the urogenital sphincter mechanisms and also acts as a conduit.

    • The anterior urethra is subdivided into a proximal component, the bulbar urethra, which is surrounded by the bulbospongiosus and is entirely within the perineum, and a pendulous or penile component, which continues on to the tip of the penis.
    • The posterior urethra is divided into preprostatic, prostatic, and membranous segments.
    • In the flaccid penis, the urethra as a whole presents a double curve .
    • Except during the passage of fluid along it, the urethral canal is a mere slit: in transverse section, the slit is transversely arched in the prostatic part, in the preprostatic and membranous portions it is stellate, in the bulbar and penile portions it is transverse, while at the external orifice it is sagittal

    MEMBRANOUS PART

    • The membranous part of the urethra is the shortest (c.1.5 cm), least dilatable and, with the exception of the external orifice, the narrowest, section of the urethra.
    • It descends with a slight ventral concavity from the prostate to the bulb of the penis , passing through the perineal membrane, c.2.5 cm posteroinferior to the pubic symphysis.
    • The wall of the membranous urethra consists of a muscle coat, separated from the epithelial lining by a narrow layer of fibroelastic connective tissue.
    • The muscle coat consists of a relatively thin layer of bundles of smooth muscle, which are continuous proximally with those of the prostatic urethra, and a prominent outer layer of circularly orientated striated muscle fibres, which form the external urethral sphincter, as it is commonly known.
    • The bladder neck is sometimes called the proximal sphincter mechanism, to distinguish it from the distal sphincter mechanism.
    • This latter term has considerable value because it recognizes that the sphincter-active membranous urethra consists of several components, namely, urethral smooth muscle; urethral striated muscle (rhabdosphincter), which is the most important component; and the periurethral part of levator ani, which is important to resist surges of intra-abdominal pressure (e.g. on coughing or exercise).
    • The external sphincter represents the point of highest intraurethral pressure in the normal, contracted state. The intrinsic striated muscle component is devoid of muscle spindles.
    • The striated muscle fibres themselves are unusually small in cross-section (15-20 μm diameter), and are physiologically of the slow twitch type, unlike the pelvic floor musculature, which is a heterogeneous mixture of slow and fast twitch fibres of larger diameter.
    • The slow twitch fibres of the external sphincter are capable of sustained contraction over relatively long periods of time and actively contribute to the tone, which closes the urethra and maintains urinary continence.

    PREPROSTATIC PART

    • The preprostatic urethra is c.1-1.5 cm in length, extending almost vertically from the bladder neck to the superior aspect of the verumontanum.
    • In addition to the smooth muscle bundles which run in continuity from the bladder neck down to the prostatic urethra, and distinct from the smooth muscle within the prostate, smooth muscle bundles surround the bladder neck and preprostatic urethra: they are arranged as a distinct circular collar which has its own distinct adrenergic innervation.
    • The bundles which form this 'preprostatic sphincter' are small in size compared with the muscle bundles of the detrusor and are separated by a relatively larger connective tissue component rich in elastic fibres.
    • Unlike the detrusor and the rest of the urethral smooth muscle (common to both sexes), the preprostatic sphincter is almost totally devoid of parasympathetic cholinergic nerves but is richly supplied with sympathetic noradrenergic nerves.
    • Contraction of the preprostatic sphincter serves to prevent the retrograde flow of ejaculate through the proximal urethra into the bladder, and can maintain continence when the external sphincter has been damaged.
    • It is extensively disrupted in the vast majority of men undergoing bladder neck surgery, e.g. transurethral resection of the prostate, which results in retrograde ejaculation.

    PROSTATIC PART

    • The prostatic urethra is c.3-4 cm in length and tunnels through the substance of the prostate closer to the anterior than the posterior surface of the gland.
    • It is continuous above with the preprostatic part and emerges from the prostate slightly anterior to its apex (the most inferior point of the prostate).
    • The urethra turns anteriorly as it passes through the prostate making an angle of 35.
    • Throughout most of its length the posterior wall possesses a midline ridge, the urethral crest, which projects into the lumen causing it to appear crescentic in transverse section.
    • On each side of the crest there is a shallow depression, termed the prostatic sinus, the floor of which is perforated by the orifices of c.15-20 prostatic ducts.
    • An elevation, the verumontanum (colliculus seminalis), at about the middle of the length of the urethral crest, contains the slit-like orifice of the prostatic utricle.
    • On both sides of, or just within, this orifice are the two small openings of the ejaculatory ducts.
    • The prostatic utricle is a cul-de-sac c.6 mm long, which runs upwards and backwards in the substance of the prostate behind its median lobe.
    • Its walls are composed of fibrous tissue, muscular fibres and mucous membrane; the latter is pitted by the openings of numerous small glands.
    • The prostatic utricle develops from the paramesonephric ducts or urogenital sinus, and is thought to be homologous with the vagina of the female .
    • It is sometimes called the 'vagina masculina', but the more usual view is that it is a uterine homologue and hence the term 'utricle'.
    • The lowermost part of the prostatic urethra is fixed by the puboprostatic ligaments and is therefore immobile

    Q6. Middle superior alveolar nerve is a branch of :
    a) palatine branch of maxillary
    b) nasal branch of maxillary
    c) infraorbital nerve
    d)mandibular nerve

    Ans c) infraorbital nerve
    Gray’s 40th 699

    MAXILLARY NERVE

    • The maxillary nerve is a sensory division of the trigeminal nerve.
    • Most of the branches from the maxillary nerve arise in the pterygopalatine fossa.
    • It gives rise to the zygomatic and infraorbital nerves that pass into the orbit through the inferior orbital fissure and two others that pass through the pterygopalatine ganglion without synapsing and are distributed to the nose, palate and pharynx.

    Zygomatic nerve

    • The zygomatic nerve is located close to the base of the lateral wall of the orbit. It soon divides into two branches, the zygomaticotemporal and the zygomaticofacial nerves, which run for only a short distance in the orbit before passing onto the face through the lateral wall of the orbit.
    • They may either enter separate canals within the zygomatic bone or the zygomatic nerve itself may enter the bone before dividing.

    • The zygomaticotemporal nerve exits the zygomatic bone on its medial surface, and pierces the temporal fascia to supply the skin over the temple.
    • It also gives a branch to the lacrimal nerve which may carry parasympathetic fibres to the lacrimal gland .

    • The zygomaticofacial nerve leaves the zygomatic bone on its lateral surface to supply skin overlying the prominence of the cheek.

    Infraorbital nerve

    • The infraorbital nerve initially lies in the infraorbital groove on the floor of the orbit.
    • As it approaches the rim of the orbit it runs into the infraorbital canal through which it passes to emerge onto the face at the infraorbital foramen.
    • The infraorbital nerve supplies the skin of the lower eyelid, possibly the conjunctiva, and skin over the upper jaw, and also provides the middle and anterior superior alveolar nerves.

    Q7. Ovarian pathology referred to
    a) Gluteal region.
    b) Ant thigh
    c) Medial part of thigh.
    d) back of thigh

    Ans medial part of thigh
    Gray’s anatomy 40th ed

    • The ovarian plexuses consist of postganglionic sympathetic, parasympathetic and visceral afferent fibres.
    • The efferent sympathetic fibres are derived from the tenth and eleventh thoracic spinal segments and are probably vasoconstrictor, whereas the parasympathetic fibres, from the inferior hypogastric plexuses, are probably vasodilator.
    • The nerves accompany the ovarian artery to the ovary and uterine tube.
    • The upper part of the ovarian plexus is formed from branches of the renal and aortic plexuses, and the lower part is reinforced from the superior and inferior hypogastric plexuses.
    • Autonomic fibres do not reach the ovarian follicles and are not required for ovulation.

    REFERRED PAIN

    • Sensory fibres accompany the sympathetic nerves, and so ovarian pain can be periumbilical.
    • It is often perceived in the right or left iliac fossa due to local inflammation.
    • Ovarian pain can also be perceived on the medial side of the thigh in the cutaneous distribution of the obturator nerve, presumably because the ovary lies close to the obturator nerve in the ovarian fossa, and so any inflammation of the ovary or peritoneum in the ovarian fossa may affect the obturator nerve.

    Q8. All are External laryngeal membrane except
    cricothyroid
    thyrohyoid
    cricotracheal
    hyoepiglotic
    Ans cricothyroid

    Gray’s antomy 40th 636
    EXTRINSIC LIGAMENTS AND MEMBRANES

    Thyrohyoid membrane

    • The thyrohyoid membrane is a broad, fibroelastic layer, attached below to the superior border of the thyroid cartilage lamina and the front of its superior cornua, and above to the superior margin of the body and greater cornua of the hyoid.
    • It thus ascends behind the concave posterior surface of the hyoid, separated from its body by a bursa which facilitates the ascent of the larynx during swallowing. Its thicker part is the median thyrohyoid ligament.
    • The more lateral, thinner, parts are pierced by the superior laryngeal vessels and internal laryngeal nerves.
    • Externally it is in contact with thyrohyoid and omohyoid and the body of the hyoid bone. Its inner surface is related to the epiglottis and the piriform fossae of the pharynx. The round, cord-like, elastic lateral thyrohyoid ligaments form the posterior borders of the thyrohyoid membrane, and connect the tips of the superior thyroid cornua to the posterior ends of the greater hyoid cornua .

    Hyo- and thyroepiglottic ligaments

    • The epiglottis is attached to the hyoid bone and thyroid cartilage by the extrinsic hyoepiglottic and intrinsic thyroepiglottic ligaments respectively.

    Cricotracheal ligament

    The cricotracheal ligament unites the lower cricoid border to the first tracheal cartilage, and is thus continuous with the perichondrium of the trachea

    INTRINSIC LIGAMENTS AND MEMBRANES

    • The fibroelastic membrane of the larynx lies within the cartilaginous skeleton of the larynx, beneath the laryngeal mucosa.
    • It is interrupted on both sides of the larynx by a horizontal cleft between the vestibular and vocal ligaments.
    • Its upper part, the quadrangular membrane, extends between the arytenoid cartilages and the sides of the epiglottis.
    • Its lower part forms the cricovocal membrane, which connects the thyroid, cricoid and arytenoid cartilages.

    Quadrangular membrane

    • Each quadrangular membrane passes from the lateral margin of the epiglottis to the arytenoid cartilage on its own side.
    • It is often poorly defined. The upper and lower borders of the membrane are free.
    • The upper border slopes posteriorly to form the aryepiglottic ligament, which constitutes the central component of the aryepiglottic fold.
    • It is less defined in its upper portion.
    • Posteriorly it passes through the fascial plane of the oesophageal suspensory ligament, and helps to form a median corniculopharyngeal ligament which extends into the submucosa adjacent to the cricoid cartilage.
    • This ligament may exert vertical traction. The lower border forms the vestibular fold. The cuneiform cartilages lie within the aryepiglottic folds.

    Cricothyroid ligament and cricovocal membrane
    • The cricothyroid ligament is composed mainly of elastic tissue. It consists of two parts: an anterior part, the anterior (median) cricothyroid ligament, and a lateral part, the cricovocal membrane.

    Cricothyroid membrane and anterior (median) cricothyroid ligament

    • The cricothyroid membrane passes upwards from the upper border of the cricoid cartilage to the lower border of the thyroid cartilage. Anteriorly, it is thickened to form the anterior (median) cricothyroid ligament, which is broader below and narrower above.

    Cricovocal membrane

    • This membrane is sometimes called the conus elasticus or the lateral cricothyroid ligament; such terminology ignores the fact that the cricovocal membrane is attached to the arytenoid cartilage as well as to the thyroid cartilage, and that it shows a thickened ligament only where it becomes the vocal ligament.
    • The cricovocal membrane is thinner than the anterior cricothyroid ligament.
    • It arises beneath the cricothyroid membrane from the inner surface of the cricoid cartilage, near its lower margin.
    • It passes upwards beneath the lower border of the thyroid cartilage and is attached anteriorly to the inner surface of the angle of the thyroid cartilage (just below its midpoint) and posteriorly to the tip of the vocal process of the arytenoid cartilage.
    • Between these attachments, the upper edge of the cricovocal membrane is free, horizontally aligned and thickened to form the vocal ligament, which underlines the mucosa-covered vocal cord.
    • The cricovocal membrane is covered internally by mucosa and externally by lateral cricoarytenoid and thyroarytenoid

    Q9. Nerve without parasympathetic outflow
    troclear,
    facial,
    oculomotor,
    glossopharyngeal

    ans trochlear
    ganong

    • The parasympathetic nervous system is sometimes called the craniosacral division of the ANS because of the location of its preganglionic neurons .
    • The parasympathetic nerves supply the visceral structures in the head via the oculomotor, facial, and glossopharyngeal nerves, and those in the thorax and upper abdomen via the vagus nerves.
    • The sacral outflow supplies the pelvic viscera via branches of the second to fourth sacral spinal nerves.
    • Parasympathetic preganglionic fibers synapse on ganglia cells clustered within the walls of visceral organs; thus these parasympathetic postganglionic fibers are very short.

    Q10. Which is not supplied by pelvic splanchnic nerve?
    A. Appendix
    B. Rectum
    C uterus
    D. Urinary Bladder

    Ans appendix
    Gray’s 40th ed 238

    • Pelvic splanchnic nerves to the pelvic viscera travel in anterior rami of the second, third and fourth sacral spinal nerves.
    • These nerves unite with branches of the sympathetic pelvic plexuses. Minute ganglia occur at the points of union and in the visceral walls, and sacral preganglionic parasympathetic fibres relay synaptically in these ganglia.
    • The pelvic splanchnic nerves are motor to the muscle of the rectum and bladder wall but inhibitory to the vesical sphincter.
    • They supply vasodilator fibres to the erectile tissue of the penis and clitoris and are probably also vasodilator to the testes, ovaries, uterine tubes and uterus.
    • Filaments from the pelvic splanchnic nerves ascend in the hypogastric plexus and are visceromotor to the sigmoid and descending colon, the left colic flexure and terminal transverse colon.

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