Competency Based Questions And Answers In Anatomy For First Mbbs Professional Examination (Pb 2022) 9354661874, 9789354661877

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Competency Based Questions and Answers in

Anatomy for First MBBS Professional Examination Including • General Anatomy • Neuroanatomy

• Limbs, Thorax • Histology

• 103 Long Essays • 695 Short Essays • 630 Short Answers • 809 MCQs

• Head and Neck • Genetics

• Abdomen • Embryology and Ethics

Compiled and Designed as per CBME Guidelines|Competency Based Undergraduate Curriculum for the Indian Medical Graduate

Subscribe to Dr. Tejaswi's (Editor) YouTube Channel for Anatomy Videos https://www.youtube.com/c/learnanat Scan QR code to access the Channel

Competency Based Questions and Answers in

Anatomy for First MBBS Professional Examination Including • General Anatomy • Neuroanatomy

• Limbs, Thorax • Histology

• Head and Neck • Genetics

• Abdomen • Embryology and Ethics

Compiled and Designed as per CBME Guidelines|Competency Based Undergraduate Curriculum for the Indian Medical Graduate

• 103 Long Essays • 695 Short Essays • 630 Short Answers • 809 MCQs

Editor

Tejaswi HL MD (Anatomy) (FAIMER-PSGFRI 2019)

Associate Professor Department of Anatomy Coordinator, Medical Education Unit Adichunchanagiri Institute of Medical Sciences Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka

Sushrutha Academy Bengaluru

CBS Publishers & Distributors Pvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Lucknow • Mumbai Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand

Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The authors have tried their best in giving information available to them while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and the authors will not be held responsible for any inadvertent errors, omissions or inaccuracies. eISBN: xxxx Copyright © Authors and Publisher First eBook Edition: 2022 All rights reserved. No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the authors and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt. Ltd. Corporate Office: 204 FIE, Industrial Area, Patparganj, New Delhi-110092 Ph: +91-11-49344934; Fax: +91-11-49344935; Website: www.cbspd.com; www.eduport-global.com; E-mail: [email protected]; [email protected] Head Office: CBS PLAZA, 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi-110002, India. Ph: +91-11-23289259, 23266861, 23266867; Fax: 011-23243014; Website: www.cbspd.com; E-mail: [email protected]; [email protected].

Branches Bengaluru: Seema House 2975, 17th Cross, K.R. Road, Banasankari 2nd Stage, Bengaluru - 560070, Kamataka Ph: +91-80-26771678/79; Fax: +91-80-26771680; E-mail: [email protected] Chennai: No.7, Subbaraya Street Shenoy Nagar Chennai - 600030, Tamil Nadu Ph: +91-44-26680620, 26681266; E-mail: [email protected] Kochi: 36/14 Kalluvilakam, Lissie Hospital Road, Kochi - 682018, Kerala Ph: +91-484-4059061-65; Fax: +91-484-4059065; E-mail: [email protected] Mumbai: 83-C, 1st floor, Dr. E. Moses Road, Worli, Mumbai - 400018, Maharashtra Ph: +91-22-24902340 - 41; Fax: +91-22-24902342; E-mail: [email protected] Kolkata: No. 6/B, Ground Floor, Rameswar Shaw Road, Kolkata - 700014 Ph: +91-33-22891126 - 28; E-mail: [email protected]

Representatives Hyderabad Pune Nagpur Manipal Vijayawada Patna

to

MSR (M Shivaji Rao) Sir My Teacher and Mentor For inspiring me to achieve excellence in life and imparting the art of great teaching and My students For their unconditional love and appreciation for my teaching

Contributors Ajay Ningaiah MD Associate Professor Department of Anatomy Adichunchanagiri Institute of Medical Sciences Adichunchanagiri University BG Nagara, Nagamangala, Karnataka

Archana BJ MD

Associate Professor Department of Anatomy Sri Siddhartha Institute of Medical Sciences and Research Centre, T Begur, Nelamangala, Bengaluru Rural, Karnataka

Madhurima K Nayak MS, DNB

Consultant Ophthalmologist Yenepoya Specialty Hospital, Kodailbail, Mangaluru Karnataka

Revanth Mopuru PT, MPT

Board Certified Therapist in Geriatrics, Michigan, USA

Shwetha K MD

Senior Resident Department of Anatomy JSS Medical College JSS Academy of Higher Education and Research Mysuru, Karnataka

Sunitha R MD

Associate Professor Department of Anatomy Sambhram Institute of Medical Sciences and Research Kolar Gold Fields, Karnataka

Venkataraman Kini MD

Assistant Professor Department of Radiation Oncology AJ Hospital and Research Center Kuntikana, Mangaluru, Karnataka

Foreword “Assessment drives learning”

T

he purpose of assessment is not just to assess learning but also assist learning. The new CBME curriculum proposed by the Medical Council of India (MCI)/National Medical Commission (NMC) calls for an outcome-based teaching–learning approach and transition from just acquisition of knowledge to application and practice of knowledge. Assessments need to be designed to suit the newer teaching—learning methods and to assess if the required competency has been achieved or not. The main purpose of the editor in bringing out this book is to introduce the first MBBS students to the new format of questions that is most likely to be asked during the internal assessment and the University examination and equip them to face these examinations without fear. Students can use this book for selfassessment of learning, preparing for internal assessment and University examination. It is heartening to know that the book has been compiled by a group of passionate teachers who have undergone MCI recognized training in revised basic medical education technologies and advanced course in medical education. The questions in this book have been arranged according to competencies as listed in the MCI curriculum document. Various types of questions including structured long essays, short essays, short answers, multiple-choice questions and fill in the blanks type questions have been included. These questions have been framed according to the guidelines set by the MCI with appropriate use of verbs at each level of Bloom’s taxonomy of cognitive domain. The questions not only assess recall but also higher levels of learning. I congratulate the editor/contributors for their hard work and efforts in bringing out this much needed book and wish them all success with this venture. Happy reading to all learners.

Dr MG Shivaramu Principal, Adichunchanagiri Institute of Medical Sciences Dean, Health Sciences (Medical) Adichunchanagiri University Karnataka

Preface

M

ost of the first MBBS students feel that anatomy is the toughest among all the preclinical subjects. This is because of multiple reasons. One of the reasons being, unlike in physiology and biochemistry where there are a maximum of one or two textbooks to read, anatomy has separate books for general anatomy, gross anatomy, neuroanatomy, histology, and embryology. Reading multiple textbooks before exams is often stressful. The other reason being, it is challenging for the students to decide how much information is needed for examinations and how this must be presented while answering. There are three main purposes of bringing out this book. The first one is to include all aspects of anatomy—general anatomy, gross anatomy, neuroanatomy, histology, and embryology in one single book that can be used as a ready reckoner to revise everything just the day before examinations. The second reason is to make the student familiar with the new type of questions that are being asked in University examinations for the CBME batch. The third and the most important reason is helping the students in structuring their answers. The answers to questions have been framed in such a way that student will know how to present an answer effectively during the exam. Remember, the presentation of your answer in examinations is as important as the content in it. This book includes all types of questions asked in anatomy examinations of various universities across the country, like traditional/unstructured long essays, modified/structured long essays, case-based questions, short essays, short answers, multiple-choice questions of various types and also one-mark questions in the form of the fill in the blanks. Care has been taken not to exclude any important topic that can be asked frequently in university examinations. If a student can spend at least a couple of hours everyday, studying a minimum of ten pages from this book, the entire book can be revised thrice before appearing for the first professional examination. The editor/contributors also confidently feel/s that the contents in the book can be effectively and completely revised even the day before examinations because of the concise nature of the contents. Nothing can replace the luxury of having time to revise topics multiple times before examinations. We sincerely hope that this book will surely reduce the stress on first year students while facing any assessment in anatomy, including internal as well as university examinations. We would like to request the readers to provide their valuable feedback and suggestions through e-mail. We hereby wish the readers of the book all the best in their endeavors. Happy Reading!

Tejaswi HL Sushrutha Academy [email protected]

Acknowledgements

F

irst, I would like to extend my heartfelt gratitude to Sushrutha Academy without whom this book would not have been possible. I would like to express my gratitude to Dr MG Shivaramu, Principal, Adichunchanagiri Institute of Medical Sciences and Dean, Health Sciences (Medical), Adichunchanagiri University for his selfless support and encouragement for all my academic activities. My sincere thanks to Mr BK Umesh, Registrar, Adichunchanagiri Institute of Medical Sciences, and Chief Finance Officer, Adichunchanagiri University, for showing confidence in me, and helping me progress professionally. I greatly acknowledge the support offered by my wife Dr Shilpashree YD, mother Vidya PS, father Dr Lokanathan HG, daughter Aadhya, son Anshul, sister Dr Shilpashree HL and Mrs Vatsala YD, brother-inlaw Dr Raghava GS and Dr Srinivas AH, mother-in-law Mrs Lalitha YK and father-in-law Mr Dhanajaya YL in tolerating my self-absorption during the preparation of this book. Special thanks to my friend Dr Ajay N for his unconditional support in helping me with my departmental activities and responsibilities during the preparation of this book. I thank my departmental colleagues Dr Sharada B Menasinkai, Dr Asharani SK, and Dr Savitha V for their invaluable support, feedback, and suggestions in preparing this book. I am grateful to my teachers, Dr Dakshayani KR, Dr Seema Deepak, Dr Poornima GC, Dr Chandra Shekhar KT and Dr Parashuram R who kindled my interest in anatomy and inspired me during my post-graduation. I will always remain grateful to my past and present students who are and have been my real motivation to achieve excellence in teaching. Special mention of Sri Paruchuri Gopala Krishna—a predominant screenplay, story, dialogue writer, actor, director, playwright, and orator in Telugu cinema—from whom I have realized the importance of “11th hour”! I would like to acknowledge all the people who are involved in the preparation of this book, especially Mr SK Jain (Chairman and Managing Director), Mr Varun Jain (Director), Mr YN Arjuna (Sr. Vice President— Publishing, Editorial and Publicity), Mis Ritu Chawla (GM Production), Mr Neeraj Kumar Sharma (Copy Editor), Mr Parmod Kumar and Ms Jassi, and of CBSPD for their all-time support and bringing out this book in record short time. I hereby wish all the readers of the book all the best in their endeavors.

Tejaswi HL

Contents Contributors Foreword Preface

S. No.

Sections

vi vii ix

Competencies

Page number Qs and As

MCQs

1

General Anatomy

AN 1.1–7.8

1–53

817–825

2

Limbs

AN 8.1–20.10

54–207

825–842

3

Thorax

AN 21.1–25.9

208–297

842–849

4

Head and Neck

AN 26.1–43.9

298–474

850–874

5

Abdomen

AN 44.1–55.2

475–657

875–887

6

Neuroanatomy

AN 56.1–64.3

658–721

887–895

7

General Histology

AN 65.1–72.1

722–753

896–902

8

Genetics

AN 73.1–75.5

754–770

903–905

9

Embryology

AN 76.1–81.3

771–813

905–910

10

Ethics

AN 82.1

814 & 815

910

Fill in the blanks

911–920

Details of the Number of Questions and MCQs Included as per the Competency S. No.

Competency No.

Competency details

Long essays Short essays Short answers

MCQs

GENERAL ANATOMY 1. Anatomical Terminology 1

AN 1.1

2

AN 1.2

3 4 5 6

AN AN AN AN

7 8

AN 2.5 AN 2.6

Demonstrate normal anatomical position, various planes, relation, comparison, laterality and movement in our body Describe composition of bone and bone marrow

—

02

03

02

—

01

02

02

— — — —

08 — — 01

09 02 01 02

01 01 01 02

— —

03 —

05 01

02 02

— —

03 —

02 01

02 02

—

—

01

02

— — — — —

01 01 01 02 —

01 03 02 02 02

02 02 02 02 02

— —

01 01

02 —

—

04

05

— — — —

01 — 01 01

02 02 02 01

02 02 02 02 02 02 02 02 02 02

—

—

03

02

— — —

01 01 01

01 05 01

02 02 02

—

01

03

02

— — — — — — —

04 03 01 01 01 01 01

02 05 01 — — — —

02 02 02 02 02 02 02

2. General Features of Bones and Joints 2.1 2.2 2.3 2.4

Describe parts, blood and nerve supply of a long bone Enumerate laws of ossification Enumerate special features of a sesamoid bone Describe various types of cartilage with their structure and distribution in body Describe various joints with subtypes and examples Explain the concept of nerve supply of joints and Hilton’s law

3. General Features of Muscle 9 10

AN 3.1 AN 3.2

11

AN 3.3

Classify muscle tissue according to structure and action Enumerate parts of skeletal muscle and differentiate between tendons and aponeuroses with examples Explain shunt and spurt muscles

12 13 14 15 16

AN AN AN AN AN

Describe different types of skin and dermatomes in body Describe structure and function of skin with its appendages Describe superficial fascia along with fat distribution in body Describe modifications of deep fascia with its functions Explain principles of skin incisions

4. General Features of Skin and Fascia 4.1 4.2 4.3 4.4 4.5

5. General Features of the Cardiovascular System 69. Blood Vessels 17 18 19 20 21 22 23 24 25 26

AN AN AN AN AN AN AN AN AN AN

5.1 5.2 5.3 69.1 69.2 69.3 5.4 5.5 5.6 5.7

27

AN 5.8

Differentiate between blood vascular and lymphatic system Differentiate between pulmonary and systemic circulation List general differences between arteries and veins Identify elastic and muscular blood vessels, capillaries under the microscope Describe the various types ... vessel Describe the ultrastructure of blood vessels Explain functional difference between elastic, muscular arteries and arterioles Describe portal system giving examples Describe the concept of anastomoses and collateral circulation with significance of end-arteries Explain function of meta-arterioles, precapillary sphincters, arteriovenous anastomoses Define thrombosis, infarction and aneurysm

6. General Features of Lymphatic System 28 29 30

AN 6.1 AN 6.2 AN 6.3

List the components and functions of the lymphatic system Describe structure of lymph capillaries and mechanism of lymph circulation Explain the concept of lymphoedema and spread of tumors via lymphatics and venous system

7. Introduction to the Nervous System 31

AN 7.1

32 33 34 35 36 37 38

AN AN AN AN AN AN AN

7.2 7.3 7.4 7.5 7.6 7.7 7.8

Describe general plan of nervous system with components of central, peripheral and autonomic nervous systems List components of nervous tissue and their functions Describe parts of a neuron and classify them based on number of neurites, size and function Describe structure of a typical spinal nerve Describe principles of sensory and motor innervation of muscles Describe concept of loss of innervation of a muscle with its applied anatomy Describe various type of synapse Describe differences between sympathetic and spinal ganglia

xiv S. No.

Competency Based Qs and As in Anatomy Competency No.

Competency details

Long essays Short essays Short answers

MCQs

LIMBS 8. Features of Individual Bones (Upper Limb) 39 40 41 42 43

AN AN AN AN AN

8.1 8.2 8.4 8.3 8.5

44

AN 8.6

45 46

AN 9.1 AN 9.2

47

AN 9.3

Identify the given bone, its side, important features and keep it in anatomical position Identify and describe joints formed by the given bone Demonstrate important muscle attachment on the given bone Enumerate peculiarities of clavicle Identify and name various bones in the articulated hand, Specify the parts of metacarpals and phalanges and enumerate the peculiarities of pisiform Describe scaphoid fracture and explain the anatomical basis of avascular necrosis

—

01

15

— —

01 —

02 04

02 02 02 02 02

—

—

01

02

— 01

03 02

01 01

02 02

—

01

02

02

— 01

01 02

— 02

02 02

02

02

02

9. Pectoral Region Describe attachment, nerve supply and action of pectoralis major and pectoralis minor Breast: Describe the location, extent, deep relations, structure, age changes, blood supply, lymphatic drainage, microanatomy and applied anatomy of breast Describe development of breast

10. Axilla, Shoulder and Scapular Region 48 49

AN 10.1 AN 10.2

50

AN 10.3

51 52 53 54 55

AN AN AN AN AN

56

AN 10.9

57 58 59

AN 10.10 AN 10.11 AN 10.12

60

AN 10.13

61

AN 11.1

62

AN 11.2

63 64 65 66

AN AN AN AN

67

AN 12.1

68

AN 12.2

69 70 71

AN 12.3 AN 12.4 AN 12.5

72 73 74 75 76 77

AN AN AN AN AN AN

78

AN 12.12

79 80 81

AN 12.13 AN 12.14 AN12.15

10.5 10.6 10.4 10.7 10.8

Identify and describe boundaries and contents of axilla Identify, describe and demonstrate the origin, extent, course, parts, relations and branches of axillary artery and tributaries of vein Describe, identify and demonstrate formation, branches, relations, area of supply of branches, course and relations of terminal branches of brachial plexus Explain variations in formation of brachial plexus Explain the anatomical basis of clinical features of Erb’s palsy and Klumpke’s paralysis Describe the anatomical groups of axillary lymph nodes and specify their areas of drainage Explain anatomical basis of enlarged axillary lymph nodes Describe, identify and demonstrate the position, attachment, nerve supply and actions of trapezius and latissimus dorsi Describe the arterial anastomosis around the scapula and mention the boundaries of triangle of auscultation Describe and identify the deltoid and rotator cuff muscles Describe and demonstrate the attachment of serratus anterior with its action Describe and demonstrate shoulder joint for—type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements, muscles involved, blood supply, nerve supply and applied anatomy Explain anatomical basis of injury to axillary nerve during intramuscular injections

02

—

01

01

—

02

—

02 02 02 02 02

—

01

02

02

— — 01

08 01 01

02 — 01

02 02 02

—

01

—

02

—

05

01

02

—

05

02

02

— — — —

— 01 02 01

02 — — —

02 02 02 02

—

06

01

02

—

05

—

02

—

01

02

01

02

01

02 02 02

— 02 — — 01 —

01 04 01 04 — 03

01 — — — 02 01

02 01 02 02 02 02

—

01

—

02

— — —

— 01 01

01 — —

02 02 02

11. Arm and Cubital Fossa

11.3 11.4 11.5 11.6

Describe and demonstrate muscle groups of upper arm with emphasis on biceps and triceps brachii Identify and describe origin, course, relations, branches (or tributaries), termination of mportant nerves and vessels in the arm Describe the anatomical basis of venepuncture of cubital veins Describe the anatomical basis of saturday night paralysis Identify and describe boundaries and contents of cubital fossa Describe the anastomosis around the elbow joint

12. Forearm and Hand

12.6 12.7 12.8 12.9 12.10 12.11

Describe and demonstrate important muscle groups of ventral forearm with attachments, nerve supply and actions Identify and describe origin, course, relations, branches (or tributaries), termination of important nerves and vessels of forearm Identify and describe flexor retinaculum with its attachments Explain anatomical basis of carpal tunnel syndrome Identify and describe small muscles of hand. Also describe movements of thumb and muscles involved Describe and demonstrate movements of thumb and muscles involved Identify and describe course and branches of important blood vessels and nerves in hand Describe anatomical basis of clawhand Identify and describe fibrous flexor sheaths, ulnar bursa, radial bursa and digital synovial sheaths Explain infection of fascial spaces of palm ... Identify, describe and demonstrate important muscle groups of dorsal forearm with attachments, nerve supply and actions Identify and describe origin, course, relations, branches (or tributaries), termination of important nerves and vessels of back of forearm Describe the anatomical basis of wrist drop Identify and describe compartments deep to extensor retinaculum Identify and describe extensor expansion formation

Contents S. No.

Competency No.

Competency details

xv Long essays Short essays Short answers

MCQs

13. General Features: Joints, Radiographs and Surface Marking 82

AN 13.1

83 84

AN 13.2 AN 13.3

85

AN 13.4

86

AN 13.5

87

AN 13.6

88

AN 13.7

89

AN 13.8

Describe and explain fascia of upper limb and compartments, veins of upper limb and its lymphatic drainage Describe dermatomes of upper limb Identify and describe the type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements, blood and nerve supply of elbow joint, proximal and distal radio-ulnar joints, wrist joint and first carpometacarpal joint Describe sternoclavicular joint, acromioclavicular joint, carpometacarpal joints and metacarpophalangeal joint Identify the bones and joints of upper limb seen in anteroposterior and lateral view radiographs of shoulder region, arm, elbow, forearm and hand Identify and demonstrate important bony landmarks of upper limb: Jugular notch, sternal angle, acromial angle, spine of the scapula, vertebral level of the medial end, Inferior angle of the scapula Identify and demonstrate surface projection of: Cephalic and basilic vein, palpation of brachial artery, radial artery, testing of muscles: Trapezius, pectoralis major, serratus anterior, latissimus dorsi, deltoid, biceps brachii, brachioradialis Describe the development of upper limb

—

02

01

02

— 03

01 04

— —

02 02

—

01

02

02

—

—

—

02

—

—

—

02

—

—

—

02

—

01

02

02

— — — —

02 — — —

08 04 02 04

02 02 02 02

14. Features of Individual Bones (Lower Limb) 90 91 92 93

AN AN AN AN

14.1 14.2 14.3 14.4

Identify the given bone, its side, important features and keep it in anatomical position Identify and describe joints formed by the given bone Describe the importance of ossification of lower end of femur and upper end of tibia Identify and name various bones in the articulated foot with individual muscle attachment

15. Front and Medial Side of Thigh 94

AN 15.1

95 96 97 98

AN AN AN AN

99

AN 16.1

100 101 102

AN 16.2 AN 16.3 AN 16.4

103

AN 16.5

104

AN 16.6

105

AN 17.1

106 107

AN 17.2 AN 17.3

15.2 15.3 15.4 15.5

Describe and demonstrate origin, course, relations, branches (or tributaries), termination of important nerves and vessels of the anterior thigh Describe and demonstrate major muscles with their attachment, nerve supply and actions Describe and demonstrate boundaries, floor, roof and contents of femoral triangle Explain anatomical basis of psoas abscess and femoral hernia Describe and demonstrate adductor canal with its contents

04

03

04

02

01 01 — —

02 02 — 01

01 05 03 —

02 02 02 02

01

04

02

02

— — —

— — 04

01 01 02

02 02 02

01

04

—

02

01

02

02

02

01

01

01

02

— —

— —

02 02

02 02

—

04

—

02

—

03

—

02

— 01

— 03

01 01

02 02

— — —

01 — —

— 01 01

02 02 02

—

04

01

02

—

02

—

02

16. Gluteal Region and Back of Thigh Describe and demonstrate origin, course, relations, branches (or tributaries), termination of important nerves and vessels of gluteal region Describe anatomical basis of sciatic nerve injury during gluteal intramuscular injections Explain the anatomical basis of Trendelenburg sign Describe and demonstrate the hamstrings group of muscles with their attachment, nerve supply and actions Describe and demonstrate the origin, course, relations, branches (or tributaries), termination of important nerves and vessels on the back of thigh Describe and demonstrate the boundaries, roof, floor, contents and relations of popliteal fossa

17. Hip Joint Describe and demonstrate the type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements and muscles involved, blood and nerve supply, bursae around the hip joint Describe anatomical basis of complications of fracture of neck of femur Describe dislocation of hip joint and surgical hip replacements

18. Knee Joint, Anterolateral Compartment of Leg and Dorsum of Foot 108

AN 18.1

109

AN 18.2

110 111

AN 18.3 AN 18.4

112 113 114

AN 18.5 AN 18.6 AN 18.7

Describe and demonstrate major muscles of anterolateral compartment of leg with their attachment, nerve supply and actions Describe and demonstrate origin, course, relations, branches (or tributaries), termination of important nerves and vessels of anterior compartment of leg Explain the anatomical basis of footdrop Describe and demonstrate the type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements and muscles involved, blood and nerve supply, bursae around the knee joint Explain the anatomical basis of locking and unlocking of the knee joint Describe knee joint injuries with its applied anatomy Explain anatomical basis of osteoarthritis

19. Back of Leg and Sole 115

AN 19.1

116

AN 19.2

Describe and demonstrate the major muscles of back of leg with their attachment, nerve supply and actions Describe and demonstrate the origin, course, relations, branches (or tributaries), termination of important nerves and vessels of back of leg

xvi S. No.

Competency Based Qs and As in Anatomy Competency No.

117 118 119 120 121

AN AN AN AN AN

19.3 19.4 19.5 19.6 19.7

122

AN 20.1

123 124

AN 20.2 AN 20.3

125 126a 126b 127

AN 20.4 AN 20.5 AN 20.6 AN 20.7

128

AN 20.8

129

AN 20.9

130

AN 20.10

Competency details

Long essays Short essays Short answers

Explain the concept of “peripheral heart” Explain the anatomical basis of rupture of calcaneal tendon Describe factors maintaining important arches of the foot with their importance Explain the anatomical basis of flatfoot and clubfoot Explain the anatomical basis of metatarsalgia and plantar fasciitis

MCQs

— — 01 — —

01 — 01 01 —

— 01 — 02 03

02 02 02 02 02

01

01

01

02 02 02

20. General Features: Joints, Radiographs and Surface Marking Describe and demonstrate the type, articular surfaces, capsule, synovial membrane, ligaments, relations, movements and muscles involved, blood and nerve supply of tibiofibular and ankle joint Describe the subtalar and transverse tarsal joints Describe and demonstrate fascia lata, venous drainage, lymphatic drainage, retinacula and dermatomes of lower limb Explain anatomical basis of enlarged inguinal lymph nodes Explain anatomical basis of varicose veins and deep vein thrombosis Describe basic concept of development of lower limb Identify and demonstrate important bony landmarks of lower limb: Vertebral levels of highest point of iliac crest, posterior superior iliac spines, iliac tubercle, pubic tubercle, ischial tuberosity, adductor tubercle, -Tibial tuberosity, head of fibula, -Medial and lateral malleoli, condyles of femur and tibia, sustentaculum tali, tuberosity of fifth metatarsal, tuberosity of the navicular Identify and demonstrate palpation of femoral, popliteal, post-tibial, anti-tibial and dorsalis pedis blood vessels in a simulated environment Identify and demonstrate palpation of vessels (femoral, popliteal, dorsalis pedis, post-tibial), midinguinal point, surface projection of: Femoral nerve, saphenous opening, sciatic, tibial, common peroneal and deep peroneal nerve, great and small saphenous veins Describe basic concept of development of lower limb

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02 02 02 02

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02

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01

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THORAX 21. Thoracic Cage 131

AN 21.1

132

AN 21.2

133 134

AN 21.3 AN 21.8

135 136

AN 21.10 AN 21.4

137

AN 21.5

138

AN 21.6

139

AN 21.7

140 141

AN 21.9 AN 21.11

142

AN 22.1

143 144 145 146 147 148

AN AN AN AN AN AN

149

AN 23.1

150

AN 23.2

151 152

AN 23.7 AN 23.3

153 154 155

AN 23.4 AN 23.5 AN 23.6

156

AN 24.1

Identify and describe the salient features of the sternum, typical rib, 1st rib and typical thoracic vertebra Identify and describe the features of 2nd, 11th and 12th ribs, 1st, 11th and 12th thoracic vertebrae Describe and demonstrate the boundaries of thoracic inlet, cavity and outlet Describe and demonstrate type, articular surfaces and movements of manubriosternal, costovertebral, costotransverse and xiphisternal joints Describe costochondral and interchondral joints Describe and demonstrate extent, attachments, direction of fibres, nerve supply and actions of intercostal muscles Describe and demonstrate origin, course, relations and branches of a typical intercostal nerve Mention origin, course and branches/tributaries of: (1) Anterior and posterior intercostal vessels, (2) internal thoracic vessels Mention the origin, course, relations and branches of: (1) Atypical intercostal nerve, (2) superior intercostal artery, subcostal artery Describe and demonstrate mechanics and types of respiration Mention boundaries and contents of the superior, anterior, middle and posterior mediastinum

02 02 —

08

15

02 02 02 02 02

02

03

03

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01 04

01 02

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02 02 02

01

04

02

02

22. Heart and Pericardium

22.2 22.3 22.4 22.5 22.6 22.7

Describe and demonstrate subdivisions, sinuses in pericardium, blood supply and nerve supply of pericardium Describe and demonstrate external and internal features of each chamber of heart Describe and demonstrate origin, course and branches of coronary arteries Describe anatomical basis of ischemic heart disease Describe and demonstrate the formation, course, tributaries and termination of coronary sinus Describe the fibrous skeleton of heart in detail Mention the parts, position and arterial supply of the conducting system of heart

23. Mediastinum Describe and demonstrate the external appearance, relations, blood supply, nerve supply, lymphatic drainage and applied anatomy of esophagus Describe and demonstrate the extent, relations, tributaries of the thoracic duct and enumerate its applied anatomy Mention the extent, relations and applied anatomy of lymphatic duct Describe and demonstrate origin, course, relations, tributaries and termination of superior vena cava, azygos, hemiazygos and accessory hemiazygos veins Mention the extent, branches and relations of arch of aorta and descending thoracic aorta Identify and mention the location and extent of thoracic sympathetic chain Describe the splanchnic nerves

02 02 02

24. Lungs and Trachea Mention the blood supply, lymphatic drainage and nerve supply of pleura, the extent of pleura and describe the pleural recesses and their applied anatomy

Contents S. No.

Competency No.

157

AN 24.2

158 159 160 161

AN AN AN AN

24.5 24.3 24.4 24.6

Competency details

xvii Long essays Short essays Short answers

Identify side, external features and relations of structures which form root of lung and bronchial tree and their clinical correlate Mention the blood supply, lymphatic drainage and nerve supply of lungs Describe a bronchopulmonary segment Identify phrenic nerve and describe its formation and distribution Describe the extent, length, relations, blood supply, lymphatic drainage and nerve supply of trachea

02

04

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— 02 01

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03

MCQs 02 02 02 02 02

25. Thorax 162

AN 25.1

Identify, draw and label a slide of trachea and lung

163 164 165

AN 25.2 AN 25.3 AN 25.4

166

AN 25.5

167 168 169 170

AN AN AN AN

Describe development of pleura, lung and heart Describe fetal circulation and changes occurring at birth Describe embryological basis of: (1) Atrial septal defect, (2) ventricular septal defect, (3) Fallot’s tetralogy and (4) tracheo-oesophageal fistula Describe developmental basis of congenital anomalies, transposition of great vessels, dextrocardia, patent ductus arteriosus and coarctation of aorta Mention development of aortic arch arteries, SVC, IVC and coronary sinus Identify structures seen on a plain X-ray chest (PA view) Identify and describe in brief a barium swallow Demonstrate surface marking of lines of pleural reflection, lung borders and fissures, trachea, heart borders, apex beat and surface projection of valves of heart

25.6 25.7 25.8 25.9

01

14

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HEAD AND NECK 26. Skull Osteology 171 172 173 174 175 176 177 178

AN AN AN AN AN AN AN AN

26.1 26.2 26.3 30.2 26.4 26.5 26.6 26.7

Demonstrate anatomical position of skull, identify and locate individual skull bones in skull Describe the features of norma frontalis, verticalis, occipitalis, lateralis and basalis Describe cranial cavity, its subdivisions, foramina and structures passing through them Describe and identify major foramina with structures passing through them Describe morphological features of mandible Describe features of typical and atypical cervical vertebrae (atlas and axis) Explain the concept of bones that ossify in membrane Describe the features of the 7th cervical vertebra

179 180

AN 27.1 AN 27.2

Describe the layers of scalp, its blood supply, its nerve supply and surgical importance Describe emissary veins with their role in spread of infection from extracranial route to intracranial venous sinuses

181 182 183 184 185 186 187 188 189

AN AN AN AN AN AN AN AN AN

190

AN 28.10

Describe and demonstrate muscles of facial expression and their nerve supply Describe sensory innervation of the face Describe and demonstrate origin/formation, course, branches/tributaries of facial vessels Describe and demonstrate branches of facial nerve with distribution Describe cervical lymph nodes and lymphatic drainage of head, face and neck Identify superficial muscles of face, their nerve supply and actions Explain the anatomical basis of facial nerve palsy Explain surgical importance of deep facial vein Describe and demonstrate the parts, borders, surfaces, contents, relations and nerve supply of parotid gland with course of its duct and surgical importance Explain the anatomical basis of Frey’s syndrome

191

AN 29.1

192 193 194

AN 29.3 AN 29.2 AN 29.4

195 196 197 198

AN AN AN AN

199 200

AN 31.1 AN 31.5

27. Scalp

28. Face and Parotid Region 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9

29. Posterior Triangle of Neck Describe and demonstrate attachments, nerve supply, relations and actions of sternocleidomastoid Explain anatomical basis of wry neck Explain anatomical basis of Erb’s and Klumpke’s palsy Describe and demonstrate attachments of: (1) Inferior belly of omohyoid, (2) scalenus anterior, (3) scalenus medius and (4) levator scapulae

02

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30. Cranial Cavity 30.1 30.5 30.3 30.4

Describe the cranial fossae and identify related structures Explain effect of pituitary tumours on visual pathway Describe and identify dural folds and dural venous sinuses Describe clinical importance of dural venous sinuses

31. Orbit Describe and identify extraocular muscles of eyeball Explain the anatomical basis of oculomotor, trochlear and abducent nerve palsies along with strabismus

02 02

xviii S. No.

Competency Based Qs and As in Anatomy Competency No.

Competency details

Long essays Short essays Short answers

201 202 203

AN 31.2 AN 31.3 AN 31.4

Describe and demonstrate nerves and vessels in the orbit Describe anatomical basis of Horner’s syndrome Enumerate components of lacrimal apparatus

204 205

AN 32.1 AN 32.2

Describe boundaries and subdivisions of anterior triangle Describe and demonstrate boundaries and contents of muscular, carotid, digastric and submental triangles

206

AN 33.1

207

AN 33.2

208

AN 33.3

209 210

AN 33.4 AN 33.5

Describe and demonstrate extent, boundaries and contents of temporal and infratemporal fossae Describe and demonstrate attachments, direction of fibres, nerve supply and actions of muscles of mastication Describe and demonstrate articulating surface, type and movements of temporomandibular joint Explain the clinical significance of pterygoid venous plexus Describe the features of dislocation of temporomandibular joint

211

AN 34.1

212

AN 34.2

213 214 215

AN 35.1 AN 35.10 AN 35.2

216 217

AN 35.8 AN 35.3

218

AN 35.9

219

AN 35.4

220 221

AN 35.5 AN 35.6

222

AN 35.7

223

AN 36.1

224 225 226

AN 36.2 AN 36.3 AN 36.4

227

AN 36.5

MCQs

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32. Anterior Triangle

33. Temporal and Infratemporal Regions

34. Submandibular Region Describe and demonstrate the morphology, relations and nerve supply of submandibular salivary gland and submandibular ganglion Describe the basis of formation of submandibular stones

02 02

35. Deep Structures in the Neck Describe the parts, extent, attachments, modifications of deep cervical fascia Describe the fascial spaces of the neck Describe and demonstrate location, parts, borders, surfaces, relations and blood supply of thyroid gland Describe the anatomically relevant clinical features of thyroid swellings Demonstrate and describe the origin, parts, course and branches of subclavian artery Describe the clinical features of compression of subclavian artery and lower trunk of brachial plexus by cervical rib Describe and demonstrate origin, course, relations, tributaries and termination of internal jugular and brachiocephalic veins Describe and demonstrate extent, drainage and applied anatomy of cervical lymph nodes Describe and demonstrate the extent, formation, relation and branches of cervical sympathetic chain Describe the course and branches of IX, X, XI and XII nerve in the neck

01

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36. Mouth, Pharynx and Palate Describe the (1) morphology, relations, blood supply and applied anatomy of palatine tonsil, (2) composition of soft palate Describe the components and functions of Waldeyer’s lymphatic ring Describe the boundaries and clinical significance of pyriform fossa Describe the anatomical basis of tonsillitis, tonsillectomy, adenoids and peri-tonsillar abscess Describe the clinical significance of Killian’s dehiscence

37. Cavity of Nose 228

AN 37.1

229 230

AN 37.2 AN 37.3

Describe and demonstrate features of nasal septum, lateral wall of nose, their blood supply and nerve supply Describe location and functional anatomy of paranasal sinuses Describe anatomical basis of sinusitis and maxillary sinus tumours

38. Larynx 231

AN 38.1

232 233

AN 38.2 AN 38.3

234

AN 39.1

235

AN 39.2

Describe the morphology, identify structure of the wall, nerve supply, blood supply and actions of intrinsic and extrinsic muscles of the larynx Describe the anatomical aspects of laryngitis Describe anatomical basis of recurrent laryngeal nerve injury

39. Tongue Describe and demonstrate the morphology, nerve supply, embryological basis of nerve supply, blood supply, lymphatic drainage and actions of extrinsic and intrinsic muscles of tongue Explain the anatomical basis of hypoglossal nerve palsy

02 02

Contents S. No.

Competency No.

Competency details

xix Long essays Short essays Short answers

MCQs

40. Organs of Hearing and Equilibrium 236 237

AN 40.1 AN 40.2

238 239 240

AN 40.3 AN 40.4 AN 40.5

Describe and identify the parts, blood supply and nerve supply of external ear Describe and demonstrate the boundaries, contents, relations functional anatomy of middle ear and auditory tube Describe the features of internal ear Explain anatomical basis of otitis externa and otitis media Explain anatomical basis of myringotomy

241 242 243

AN 41.1 AN 41.2 AN 41.3

Describe and demonstrate parts and layers of eyeball Describe the anatomical aspects of cataract, glaucoma and central retinal artery occlusion Describe the position, nerve supply and actions of intraocular muscles

244 245 246

AN 42.1 AN 42.2 AN 42.3

Describe the contents of the vertebral canal Describe and demonstrate the boundaries and contents of suboccipital triangle Describe the position, direction of fibres, relations, nerve supply, actions of semispinalis capitis and splenius capitis

247

AN 43.1

248

AN 43.2

249

AN 70.1

250

AN 43.3

251

AN 43.4

252

AN 43.5

253

AN 43.6

254

AN 43.7

255 256

AN 43.8 AN 43.9

Describe and demonstrate the movements with muscles producing the movements of atlanto-occipital joint and atlantoaxial joint Identify, describe and draw the microanatomy of pituitary gland, thyroid, parathyroid gland, tongue, salivary glands, tonsil, epiglottis, cornea, retina Identify exocrine gland under the microscope and distinguish between serous, mucous and mixed acini Identify, describe and draw microanatomy of olfactory epithelium, eyelid, lip, sclero-corneal junction, optic nerve, cochlea: Organ of Corti, pineal gland Describe the development and developmental basis of congenital anomalies of face, palate, tongue, branchial apparatus, pituitary gland, thyroid gland and eye Demonstrate: (1) Testing of muscles of facial expression, extraocular muscles, muscles of mastication, (2) palpation of carotid arteries, facial artery, superficial temporal artery, (3) location of internal and external jugular veins, (4) location of hyoid bone, thyroid cartilage and cricoid cartilage with their vertebral levels Demonstrate surface projection of—thyroid gland, parotid gland and duct, pterion, common carotid artery, internal jugular vein, subclavian vein, external jugular vein, facial artery in the face and accessory nerve Identify the anatomical structures in: (1) plain X-ray skull, (2) AP view and lateral view (3) plain X-ray cervical spine-AP and lateral view (4) plain X-ray of paranasal sinuses Describe the anatomical route used for carotid angiogram and vertebral angiogram Identify anatomical structures in carotid angiogram and vertebral angiogram

—

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41. Eyeball —

02

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42. Back Region

43. Head and Neck Joints, Histology, Development, Radiography and Surface Marking

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ABDOMEN 44. Anterior Abdominal Wall 257

AN 44.1

258 259 260

AN 44.2 AN 44.3 AN 44.4

261 262 263

AN 44.5 AN 44.6 AN 44.7

Describe and demonstrate the planes (transpyloric, transtubercular, subcostal, lateral vertical, linea alba, linea semilunaris), regions and quadrants of abdomen Describe and identify the fascia, nerves abdominal wall Describe the formation of rectus sheath and its contents Describe and demonstrate extent, boundaries, contents of inguinal canal including Hesselbach’s triangle Explain the anatomical basis of inguinal hernia Describe and demonstrate attachments of muscles of anterior abdominal wall Enumerate common abdominal incisions

264 265 266 267

AN AN AN AN

Describe thoracolumbar fascia Describe and demonstrate lumbar plexus for its root value, formation and branches Describe important nerve plexuses of posterior abdominal wall Mention the major subgroups of back muscles, nerve supply and action

268

AN 46.1

269 270

AN 46.2 AN 46.3

271 272

AN 46.5 AN 46.4

45. Posterior Abdominal Wall 45.1 45.2 47.12 45.3

46. Male External Genitalia Describe and demonstrate coverings, internal structure, side determination, blood supply, nerve supply, lymphatic drainage and descent of testis with its applied anatomy Describe the parts of epididymis Describe penis under following headings: Parts, components, blood supply and lymphatic drainage Explain the anatomical basis of phimosis and circumcision Explain the anatomical basis of varicocoele

02 02

xx S. No.

Competency Based Qs and As in Anatomy Competency No.

Competency details

Long essays Short essays Short answers

MCQs

47. Abdominal Cavity 273 274 275 276

AN AN AN AN

47.1 47.2 47.3 47.4

Describe and identify boundaries and recesses of lesser and greater sac Name and identify various peritoneal folds and pouches with its explanation Explain anatomical basis of ascites and peritonitis Explain anatomical basis of subphrenic abscess

277

AN 47.5

278

AN 47.6

279 280

AN 47.7 AN 47.8

281 282 283

AN 47.10 AN 47.11 AN 47.9

284

AN 47.13

285

AN 47.14

286 287

AN 48.1 AN 48.2

288

AN 48.3

289 290

AN 48.4 AN 48.5

291 292 293

AN 48.6 AN 48.7 AN 48.8

Describe and identify the muscles of pelvic diaphragm Describe and demonstrate the (position, features, important peritoneal and other relations, blood supply, nerve supply, lymphatic drainage and clinical aspects of) important male and female pelvic viscera Describe and demonstrate the origin, course, important relations and branches of internal iliac artery Describe the branches of sacral plexus Explain the anatomical basis of suprapubic cystostomy, urinary obstruction in benign prostatic hypertrophy, retroverted uterus, prolapse uterus, internal and external haemorrhoids, anal fistula, vasectomy, tubal pregnancy and tubal ligation Describe the neurological basis of automatic bladder Mention the lobes involved in benign prostatic hypertrophy and prostatic cancer Mention the structures palpable during vaginal and rectal examination

294 295 296 297 298

AN AN AN AN AN

Describe and demonstrate the superficial and deep perineal pouch (boundaries and contents) Describe and identify perineal body Describe and demonstrate perineal membrane in male and female Describe and demonstrate boundaries, contents and applied anatomy of ischiorectal fossa Explain the anatomical basis of perineal tear, abscess and anal fissure

299 300 301

AN 50.1 AN 50.4 AN 50.2

302

AN 50.3

303 304

AN 51.1 AN 51.2

Describe and identify the cross-section at the level of T8, T10, and L1 (transpyloric plane) Describe and identify the midsagittal section of male and female pelvis

305

AN 52.1

306

AN 52.2

307

AN 52.3

308

AN 52.4

Describe and identify the microanatomical features of gastrointestinal system: Esophagus, fundus of stomach, pylorus of stomach, duodenum, jejunum, ileum, large intestine, appendix, liver, gallbladder, pancreas and suprarenal gland Describe and identify the microanatomical features of urinary system: Kidney, ureter and urinary bladder; male reproductive system: Testis, epididymis, prostate and penis; female reproductive system: Ovary, uterus, uterine tube, cervix, placenta and umbilical cord Describe and identify the microanatomical features of esophageal junction and corpus luteum Describe the development of anterior abdominal wall

Describe and demonstrate major viscera of abdomen under following headings: Anatomical position, external and internal features, important peritoneal and other relations, blood supply, nerve supply, lymphatic drainage and applied aspects Explain the anatomical basis of splenic notch, accessory spleens, Kehr’s sign, different types of vagotomy, liver biopsy (site of needle puncture), referred pain in cholecystitis, obstructive jaundice, referred pain around umbilicus, radiating pain of kidney to groin and lymphatic spread in carcinoma stomach Mention the clinical importance of Calot’s triangle Describe and identify the formation, course, relations and tributaries of portal vein, inferior vena cava and renal vein Enumerate the sites of portosystemic anastomosis Explain the anatomic basis of hematemesis and caput medusae in portal hypertension Describe and identify the origin, course, important relations and branches of abdominal aorta, coeliac trunk, superior mesenteric, inferior mesenteric and common iliac artery Describe and demonstrate the attachments, openings, nerve supply and action of the thoracoabdominal diaphragm Describe the abnormal openings of thoracoabdominal diaphragm and diaphragmatic hernia

01

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33

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48. Pelvic Wall and Viscera 01 06

02 17

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49. Perineum 49.1 49.2 49.3 49.4 49.5

50. Vertebral Column Describe the curvatures of the vertebral column Explain the anatomical basis of scoliosis, lordosis, prolapsed disc, spondylosis and spina bifida Describe and demonstrate the type, articular ends, ligaments and movements of intervertebral joints, sacroiliac joints and pubic symphysis Describe lumbar puncture (site, direction of the needle, structures pierced during the lumbar puncture)

51. Sectional Anatomy

52. Histology and Embryology

Contents S. No.

Competency No.

309 310 311 312

AN AN AN AN

52.5 52.6 52.7 52.8

313

AN 53.1

314

AN 53.2

315

AN 53.3

316

AN 53.4

317 318

AN 54.1 AN 54.2

319

AN 54.3

320

AN 55.1

321

AN 55.2

Competency details

xxi Long essays Short essays Short answers

Describe the development and congenital anomalies of diaphragm Describe the development and congenital anomalies of foregut, midgut and hindgut Describe the development of urinary system Describe the development of male and female reproductive system

MCQs

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01 10 07 06

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53. Osteology Identify and hold the bone in the anatomical position, describe the salient features, articulations and demonstrate the attachments of muscle groups Demonstrate the anatomical position of bony pelvis and show boundaries of pelvic inlet, pelvic cavity, pelvic outlet Define true pelvis and false pelvis and demonstrate sex determination in male and female bony pelvis Explain and demonstrate clinical importance of region (sacralization of lumbar vertebra, lumbarization of 1st sacral vertebra, types of bony pelvis and coccyx)

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54. Radiodiagnosis Describe and identify features of plain X-ray abdomen Describe and identify the special radiographs of abdominopelvic region (contrast X-ray barium swallow, barium meal, barium enema, cholecystography, intravenous pyelography and hysterosalpingography) Describe role of ERCP, CT abdomen, MRI, arteriography in radiodiagnosis of abdomen

55. Surface Marking Demonstrate the surface marking of regions and planes of abdomen, superficial inguinal ring, deep inguinal ring, McBurney’s point, renal angle and Murphy’s point Demonstrate the surface projections of: stomach, liver, fundus of gallbladder, spleen, duodenum, pancreas, ileocaecal junction, kidneys and root of mesentery

NEUROANATOMY 56. Meninges and CSF 322 323

AN 56.1 AN 56.2

Describe and identify various layers of meninges with its extent and modifications Describe circulation of CSF with its applied anatomy

324 325 326 327 328

AN AN AN AN AN

Identify external features of spinal cord Describe extent of spinal cord in child and adult with its clinical implication Draw and label transverse section of spinal cord at mid-cervical and mid-thoracic level Enumerate ascending and descending tracts at mid-thoracic level of spinal cord Describe anatomical basis of syringomyelia

329 330

AN 58.1 AN 58.2

331 332

AN 58.3 AN 58.4

Identify external features of medulla oblongata Describe transverse section of medulla oblongata at the level of (1) pyramidal decussation, (2) sensory decussation (3) ION Enumerate cranial nerve nuclei in medulla oblongata with their functional group Describe anatomical basis and effects of medial and lateral medullary syndrome

333 334 335

AN 59.1 AN 59.2 AN 59.3

Identify external features of pons Draw and label transverse section of pons at the upper and lower levels Enumerate cranial nerve nuclei in pons with their functional group

336 337 338

AN 60.1 AN 60.2 AN 60.3

Describe and demonstrate external and internal features of cerebellum Describe connections of cerebellar cortex and intracerebellar nuclei Describe anatomical basis of cerebellar dysfunction

339 340 341

AN 61.1 AN 61.2 AN 61.3

Identify external and internal features of midbrain Describe internal features of midbrain at the level of superior and inferior colliculus Describe anatomical basis and effects of Benedikt’s and Weber’s syndrome

342 343 344

AN 62.1 AN 62.2 AN 62.3

Enumerate cranial nerve nuclei with its functional components Describe and demonstrate surfaces, sulci, gyri, poles, and functional areas of cerebral hemisphere Describe the white matter of cerebrum

57. Spinal Cord 57.1 57.2 57.3 57.4 57.5

58. Medulla Oblongata

59. Pons

60. Cerebellum

61. Midbrain

62. Cranial Nerve Nuclei and Cerebral Hemispheres

xxii S. No.

Competency Based Qs and As in Anatomy Competency No.

Competency details

Long essays Short essays Short answers

345 346

AN 62.4 AN 62.5

347

AN 62.6

Enumerate parts and major connections of basal ganglia and limbic lobe Describe boundaries, parts, gross relations, major nuclei and connections of dorsal thalamus, hypothalamus, epithalamus, metathalamus and subthalamus Describe and identify formation, branches and major areas of distribution of circle of Willis

348 349

AN 63.1 AN 63.2

Describe and demonstrate parts, boundaries and features of IIIrd, IVth and lateral ventricle Describe anatomical basis of congenital hydrocephalus

MCQs

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63. Ventricular System

64. Histology and Embryology 350 351

AN 64.1 AN 64.2

352

AN 64.3

Describe and identify the microanatomical features of spinal cord, cerebellum and cerebrum Describe the development of neural tube, spinal cord, medulla oblongata, pons, midbrain, cerebral hemisphere and cerebellum Describe various types of open neural tube defects with its embryological basis

GENERAL HISTOLOGY 65. Epithelium Histology 353

AN 65.1

354

AN 65.2

Identify epithelium under the microscope and describe the various types that correlate to its function Describe the ultrastructure of epithelium

355 356

AN 66.1 AN 66.2

Describe and identify various types of connective tissue with functional correlation Describe the ultrastructure of connective tissue

357 358 359

AN 67.1 AN 67.2 AN 67.3

Describe and identify various types of muscle under the microscope Classify muscle and describe the structure–function correlation of the same Describe the ultrastructure of muscular tissue

360 361 362

AN 68.1 AN 68.2 AN 68.3

Describe and identify multipolar and unipolar neuron, ganglia, peripheral nerve Describe the structure–function correlation of neuron Describe the ultrastructure of nervous tissue

363

AN 70.1

364

AN 70.2

Identify exocrine gland under the microscope and distinguish between serous, mucous and mixed acini Identify the lymphoid tissue under the microscope and describe microanatomy of lymph node, spleen, thymus, tonsil and correlate the structure with function

66. Connective Tissue Histology

67. Muscle Histology

68. Nervous Tissue Histology

70. Glands and Lymphoid Tissue 02 —

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71. Bone and Cartilage 365

AN 71.1

366

AN 71.2

367

AN 72.1

Identify bone under the microscope; classify various types and describe the structure– function correlation of the same Identify cartilage under the microscope and describe various types and structure–function correlation of the same

72. Integumentary System Identify the skin and its appendages under the microscope and correlate the structure with function

GENETICS 73. Chromosomes 368 369 370

AN 73.1 AN 73.2 AN 73.3

Describe the structure of chromosomes with classification Describe technique of karyotyping with its applications Describe the Lyon’s hypothesis

371 372

AN 74.1 AN 74.2

373 374

AN 74.3 AN 74.4

Describe the various modes of inheritance with examples Draw pedigree charts for the various types of inheritance and give examples of diseases of each mode of inheritance Describe multifactorial inheritance with examples Describe the genetic basis and clinical features of achondroplasia, cystic fibrosis, vitamin D resistant rickets, haemophilia, Duchene’s muscular dystrophy and sickle cell anemia

74. Patterns of Inheritance 02 02 —

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75. Principle of Genetics, Chromosomal Aberrations and Clinical Genetics 375 376

AN 75.1 AN 75.2

Describe the structural and numerical chromosomal aberrations Explain the terms mosaics and chimeras with example

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Contents S. No.

Competency No.

377

AN 75.3

378 379

AN 75.4 AN 75.5

Competency details

xxiii Long essays Short essays Short answers

Describe the genetic basis and clinical features of Prader-Willi syndrome, Edward syndrome and Patau syndrome Describe genetic basis of variation: Polymorphism and mutation Describe the principles of genetic counselling

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Demonstrate respect and follow the correct procedure when handling cadavers and other biologic tissue

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103

695

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EMBRYOLOGY 76. Introduction to Embryology 380 381

AN 76.1 AN 76.2

Describe the stages of human life Explain the terms—phylogeny, ontogeny, trimester, viability

77. Gametogenesis and Fertilization 382 383 384 385 386 387

AN AN AN AN AN AN

77.1 77.2 77.3 77.4 77.5 77.6

Describe the uterine changes occurring during the menstrual cycle Describe the synchrony between the ovarian and menstrual cycles Describe spermatogenesis and oogenesis along with diagrams Describe the stages and consequences of fertilization Enumerate and describe the anatomical principles underlying contraception Describe teratogenic influences; fertility and sterility, surrogate motherhood, social significance of “sex-ratio”

78. Second Week of Development 388 389 390 391

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78.1 78.2 78.3 78.4

392

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393 394 395 396 397

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398

AN 79.6

399 400 401

AN 80.1 AN 80.2 AN 80.3

402 403 404 405

AN 80.4 AN80.5 AN 80.6 AN 80.7

Describe cleavage and formation of blastocyst Describe the development of trophoblast Describe the process of implantation and common abnormal sites of implantation Describe the formation of extra-embryonic mesoderm and coelom, bilaminar disc and prochordal plate Describe in brief abortion; decidual reaction, pregnancy test

79. 3rd to 8th Week of Development 79.1 79.2 79.3 79.4 79.5

Describe the formation and fate of the primitive streak Describe formation and fate of notochord Describe the process of neurulation Describe the development of somites and intraembryonic coelom Explain embryological basis of congenital malformations, nucleus pulposus, sacrococcygeal teratomas, neural tube defects Describe the diagnosis of pregnancy in first trimester and role of teratogens, alpha-fetoprotein

80. Fetal Membranes Describe formation, functions and fate of chorion: Amnion; yolk sac; allantois and decidua Describe formation and structure of umbilical cord Describe formation of placenta, its physiological functions, fetomaternal circulation and placental barrier Describe embryological basis of twinning in monozygotic and dizygotic twins Describe role of placental hormones in uterine growth and parturition Explain embryological basis of estimation of fetal age Describe various types of umbilical cord attachments

81. Prenatal Diagnosis 406 407 408

AN 81.1 AN 81.2 AN 81.3

Describe various methods of prenatal diagnosis Describe indications, process and disadvantages of amniocentesis Describe indications, process and disadvantages of chorion villus biopsy

ETHICS 82. Ethics in Anatomy 409

AN 82.1

Total Number of Fill in the Blanks: 318

1

Anatomical Terminology 1.1 DEMONSTRATE NORMAL ANATOMICAL POSITION, VARIOUS PLANES, RELATION, COMPARISON, LATERALITY AND MOVEMENT IN OUR BODY SHORT ESSAYS

2. Describe the terms of movement.

1. Describe the terms of relationship and comparison in human body. Term

Meaning

Superior Inferior Cranial Caudal Anterior Posterior Ventral Dorsal Rostral

Nearer to the vertex of the skull Nearer to the sole of the foot Nearer to the skull Nearer to the tail/feet Nearer to the front of the body Nearer to the back of the body Nearer to the belly/front Nearer to the back Nearer to the front (particularly used for describing structures in brain) Nearer to midline of the body Farther from the midline of the body Nearer to the skin In between superficial and deep Farther from the skin Outside of an organ/part of the body Inside of an organ/part of the body Nearer to the root of a structure or a limb Farther to the root of a structure or a limb

Medial Lateral Superficial Intermediate Deep External Internal Proximal Distal

Term

Meaning

Flexion

Movement that decreases in the angle between the anterior surface of two bones or bending Movement that increases in the angle between the anterior surface of two bones or straightening Movement that causes bending towards right or left side of the body (possible only with neck and trunk) Moving towards the median plane Moving away from the median plane A sequential movement involving flexion, abduction, extension, and adduction so that distal part of the structure moves in a circle Revolving of a part of the body around its own axis Raises a part upwards/superiorly Lowers a part downwards/inferiorly Movement that brings the anterior surface of a limb closer to the midline Movement that takes the anterior surface of the limb away from midline Forward movement (as in scapula and mandible)

Extension

Right/left lateral flexion Adduction Abduction Circumduction

Rotation Elevation Depression Medial rotation Lateral rotation Protrusion

1

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Competency Based Qs and As in Anatomy

Term

Meaning

Retrusion/ retraction Pronation

Forward movement (as in scapula and mandible) Occurs exclusively in forearm: Movement that causes palm to face posteriorly and dorsum of the hand to face anteriorly Occurs exclusively in forearm: Movement that causes palm to face anteriorly and dorsum of the hand to face posteriorly Movement that allows the tip of the thumb to touch tips of other fingers across the palm Movement that brings the tip of the thumb from opposition to normal position Occurs exclusively in foot: Movement that causes medial border of the sole to face upwards Occurs exclusively in forearm: Movement that causes lateral border of the sole to face upwards

Supination

Opposition

Reposition

Inversion

Eversion

Fig. 1.1.2: Anatomical position of the human body

SHORT ANSWERS 1. Describe the anatomical position of the human body. In the anatomical position, the human body is: • Standing straight with looking straightforward (Figs 1.1.1 and 1.1.2)

• Both the upper limbs by the bodyside with palms forward-facing • Feet approximated together with the toes pointing forwards 2. An Intern enters the casualty department, where a Consultant is looking at a CT scan of the head. The Consultant asks the Intern to describe the meaning of coronal, median, sagittal and transverse planes. Define all the above mentioned anatomical planes. Anatomical Planes (Fig. 1.1.3)

Fig. 1.1.1: Anatomical position of the human body

Fig. 1.1.3: Anatomical planes of the human body

Anatomical Terminology

1. Midsagittal plane or median plane • Passes through the center of the body • The body is divided into two equal halves— right and left 2. Sagittal plane: Any longitudinal plane which is parallel to the midsagittal plane 3. Coronal plane • This plane is perpendicular to the sagittal plane • The body is divided into two halves—anterior and posterior 4. Transverse plane • Perpendicular plane to the sagittal and coronal planes • The body is divided into two parts—upper and lower 3. Describe the use of anatomical planes in practice of medicine. Anatomical planes are used to describe sections:

3

1. Transverse/cross section: In this section, the slices of the body are cut in a plane perpendicular to the longitudinal axis of the body or parts of the body (as in a CT scan) 2. Longitudinal section: This section passes parallel to the longitudinal axis of the body or parts of the body 3. Oblique section: Refers to section of the body cut in planes/direction excluding the transverse and longitudinal sections 4. Describe the terms of laterality. Term

Meaning

Unilateral

Structures present on one side of the body only (E.g.: spleen, liver) Structures present on both sides of the body (E.g.: kidneys, lungs) Structures present on same side of the body (E.g.: right thumb and right toe) Structures present on different sides of the body (E.g.: right thumb and left thumb)

Bilateral Ipsilateral Contralateral

1.2 DESCRIBE COMPOSITION OF BONE AND BONE MARROW SHORT ESSAY 1. Describe the composition of bone. Bone is a highly vascularised, mineralized, living and specialized connective tissue made of cells embedded in an extracellular matrix. Composition of Bone A. Cells B. Extracellular matrix • Ground substance • Fibers

A. Cells: Five Types 1. Osteoprogenitor cells • These are the stem cells which can give rise to other types of cells • They are derived from mesenchymal stem cells • These are present on the external and internal surfaces of the bone 2. Osteoblasts • These are cells which produce the bone matrix

• Arise from the osteoprogenitor cells • These give rise to the osteocytes (only 10–20% of osteoblasts give rise to osteocytes) • Produces an unmineralized matrix known as osteoid • Produces osteocalcin, alkaline phosphatase, and matrix vesicles, which assist in mineralization of the osteoid 3. Osteocytes • Formed when an osteoblast is surrounded by matrix • Flattened cells with cytoplasmic processes which communicate with each other by gap junctions • Located in space called lacunae and canaliculi • The nutritive material diffuses through the canaliculi radiating from lacuna • Apart from maintaining bone, these also play a role in mechanotransduction (increased and decreased mechanical stimuli will lead to bone formation and bone loss, respectively)

4

Competency Based Qs and As in Anatomy

4. Osteoclasts • Derived from the fusion of uncommitted cells of red bone marrow • Large cells with many nuclei • Vital role in bone remodeling by resorbing the bone • Present in Howship’s lacunae—which are shallow depressions of the bone 5. Bone lining cells • Two types—periosteal and endosteal cells • Derived from the osteoblasts • Provide nutrition to osteocytes

B. Extracellular Matrix Ground substance • Proteoglycans—chondroitin sulfate, keratan sulfate • Glycoproteins—osteonectin, osteocalcin • Mineral component—hydroxyapatite, citrate ions, bicarbonate ions • Water—7% Fibers • Type I collagen fibers • Gives tensile strength

SHORT ANSWERS 1. Enumerate the bone cells and mention at least one function of each cell. Bone cells Osteoprogenitor cells Osteoblasts

Osteocytes Osteoclasts Bone lining cells

Functions • Give rise to osteoblasts and other bone cells • Produce osteoid—unmineralized matrix, made of proteoglycans, glycoproteins, type I collagen fibers • Produce osteocalcin, alkaline phosphatase cause the release of calcium and phosphate • Produce matrix vesicles—concentrate calcium and phosphate—vital for mineralization • Have balanced osteogenic and osteoclastic activity—maintain the bone • Alkaline phosphatase secreted—maintain calcification • Vital role in bone remodeling by resorbing the bone • Provide nutritional support to the osteocytes

2. Compare and contrast the features of compact/dense and cancellous/spongy bone. • The classification into compact and spongy bone depends on the amount of solid bony tissue present and the size and number of spaces present within bony tissue • Compact bone has more solid bony tissue, less and smaller spaces within and vice versa in case of cancellous bone Feature

Compact bone

Cancellous bone

Density Location Lamellae Haversian system Bone marrow Percentage in the body by weight

Dense Outer part of the bone Regular Present Absent 75%

Porous Inner part of the bone Irregular Absent Present 25%

2

General Features of Bones and Joints 2.1 DESCRIBE PARTS, BLOOD AND NERVE SUPPLY OF A LONG BONE SHORT ESSAYS 1. Classify bones according to shape. Give an example for each type. Type of bone

Feature

Example

Long bones (Fig. 2.1.1)

Length of the bone is greater than breadth and thickness Smaller in size, typical cuboid shaped Flat/plate-like bone, shallow Irregular shaped Develops in muscle tendons Irregular shaped, composed of air-filled cavity within Not present in the body usually

Typical long bone—femur, humerus Short/miniature long bone—phalanges Carpal bones Frontal bone, rib Vertebrae Patella Maxilla Sutural or wormian bones

Short bones (Fig. 2.1.2) Flat bones (Fig. 2.1.3) Irregular bones (Fig. 2.1.4) Sesamoid bones (Fig. 2.1.5) Pneumatic bones Accessory bones

Fig. 2.1.1: Frontal bone (flat bone)

Fig. 2.1.2: Carpals (short bone)

Fig. 2.1.3: Humerus (long bone) 5

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Competency Based Qs and As in Anatomy

Fig. 2.1.4: Vertebra (irregular bone)

Fig. 2.1.5: Patella (sesamoid bone)

2. Describe the parts of a growing long bone. Parts of growing long bone (Fig. 2.1.6) 1. Epiphysis • Refers to the ends of long bones ossifying from secondary centers • 4 types: 1. Pressure epiphysis – Covered by articular cartilage – Transmits body weight – E.g.—femoral head 2. Traction epiphysis – Caused by muscle pull – Non-articular – Provides attachment to the muscle – Ossification occurs after pressure epiphysis – E.g.—trochanters of femur 3. Atavistic epiphysis – Found as an independent bone in lower mammals

– Fuses to the nearby bone in humans, receiving the nutrition from it – E.g.— coracoid process of scapula 4. Aberrant epiphysis – Appears at unusual end of a short long bone – E.g.—Epiphysis at the head of the first metacarpal 2. Epiphyseal plate • Hyaline cartilage plate • Between the epiphysis and diaphysis of growing bone • It presents as long as the bone grows in length • Once bone growth is complete, the cartilage is replaced by bone • Nourished by epiphyseal and metaphyseal arteries 3. Metaphysis • The diaphyseal end towards epiphyseal cartilage • This is the most actively growing area of the long bone • Close to the metaphysis, capsule of the joint, ligaments and muscles are attached • Metaphysis has profuse blood supply. The nutrient arteries form hairpin-like bend here and

Fig. 2.1.6: Parts of a growing long bone

General Features of Bones and Joints

favour the settling of microorganisms. Hence metaphysis is the common site of infection in a growing bone 4. Diaphysis • It is the elongated part of the bone between the two metaphyseal ends • Develops from primary ossification center 3. Describe epiphysis. Mention the types with an example for each. Epiphysis • Ends of long bones ossifying from secondary centers • 4 types: 1. Pressure epiphysis (Fig. 2.1.7) – Covered by articular cartilage – Transmits body weight – E.g.—femoral head 2. Traction epiphysis (Fig. 2.1.7) – Caused by muscle pull – Non-articular – Provides attachment to the muscle – Ossification occurs after pressure epiphysis – E.g.—trochanters of femur 3. Atavistic epiphysis (Fig. 2.1.8) – Found as an independent bone in lower mammals – Fuses to the nearby bone in humans, receiving the nutrition from it – E.g.—coracoid process of scapula

4. Aberrant epiphysis (Fig. 2.1.9) – Appears at unusual end of a short long bone – E.g.—1st metacarpal bone head epiphysis 4. Describe the blood supply of the long bone. Supplied by 4 sets of arteries—nutrient, periosteal, metaphyseal, epiphyseal (Fig. 2.1.10) 1. Nutrient artery • Enters the shaft in the middle • Enters through the nutrient foramen • Has an oblique course in the cortex of the bone • In the medullary cavity, it divides into ascending and descending branches

Fig. 2.1.8: Atavistic epiphysis

Fig. 2.1.7: Pressure and traction epiphyses

7

Fig. 2.1.9: Aberrant epiphysis

8

Competency Based Qs and As in Anatomy

2. Periosteal arteries • They are numerous • Ramify below periosteum • Supply the outer third of the cortex by entering the Volkmann’s canals • More numerous below the ligamentous and muscular attachments 3. Metaphyseal/Juxtaepiphyseal arteries • Derived from anastomosis around the joint and enter the bone by piercing the joint capsule • Directly enters the metaphysis along joint capsule attachments 4. Epiphyseal arteries: Derived from circulus vasculosus, i.e., arterial anastomosis around the joint

There are Two Types of Epiphyseal Arteries Fig. 2.1.10: Blood supply of a growing long bone

• The branches subdivide into numerous smaller parallel vessels • These vessels form hairpin loops in the metaphysis • The loops anastomose with epiphyseal, juxtaepiphyseal, and periosteal arteries • Supplies the medullary cavity which contains the bone marrow and inner two-thirds of the outer shell of diaphysis and metaphysis

1. When articular cartilage and epiphyseal cartilage is a single continuous structure (as in head of femur), the epiphyseal artery pierces the epiphyseal cartilage before supplying epiphysis. These types of arteries when injured produce avascular necrosis 2. When articular cartilage and epiphyseal cartilage is not continuous, the epiphyseal artery enters without piercing the epiphyseal cartilage. Injury of such arteries does not result in avascular necrosis

5. Compare and contrast membranous and cartilaginous ossification. Step 1

Step 2 Step 3

Step 4 Step 5 Step 6

Membranous ossification

Cartilaginous ossification

Condensation of mesenchymal tissue to form membranous sheet model Osteoblasts are formed from the osteoprogenitor cells The site of appearance of osteoblasts is termed as ossification center Ground substance and collagen fibers are secreted by the osteoblasts into the intercellular spaces forming the osteoid tissue or bone matrix Osteoid tissue gets mineralized with calcium salts under the influence of alkaline phosphatase secreted by osteoblasts, leading to bone formation The osteoblasts trapped in mineralized matrix are called osteocytes

Chondroblasts of cartilaginous model enlarge and calcification of surrounding matrix occurs due to alkaline phosphatase secreted The death and disappearance of the chondroblasts leads to formation of empty spaces called primary areolae Osteoblasts are formed by differentiation of cells on the periosteal surface They enter at the ossification site (periosteal bud) along with blood vessels Majority of the calcified matrix is absorbed to form secondary areolae, which are large empty spaces A thin bar of calcified matrix is left behind Osteoid (new bone) is laid on the surface of calcified bar of matrix Mineralization of osteoid

General Features of Bones and Joints

6. Hyoid bone belongs to the axial skeleton of human skeletal system. Is this statement true? Classify human skeletal system with examples. Yes, hyoid bone is included as a part of the axial skeleton. Classification of Human Skeletal System with Examples Human skeletal system is classified into two parts • Axial skeleton: Includes bones that form the central axis of the body and is made up of: 1. Skull (28 bones) 2. Hyoid bone (1) 3. Vertebral column (7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 3–4 coccygeal vertebrae)

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4. Ribs (12 pairs) 5. Sternum (1) • Appendicular skeleton: Includes bones of the limbs a. Girdle bones 1. Upper limb: Clavicle (2) and scapula (2) 2. Lower limb: Hip bone (2) b. Bones of free limb 1. Upper limb: Humerus (2), radius (2), ulna (2), skeleton of hand (8 carpals, 5 metacarpals, 2 phalanges in thumb and 3 phalanges in rest of the fingers of each hand) 2. Lower limb: Femur (2), tibia (2), fibula (2), patella (2), skeleton of foot (7 tarsals, 5 metatarsals, 2 phalanges in great toe and 3 phalanges in rest of the toes of each foot)

7. Metacarpal bone is an example for a modified long bone. Is this statement true? Classify the bones based on their shape. • Yes, metacarpal bone is an example for modified long bone • Based on the shape, bones are classified as, Type of bone

Feature

Examples

Long bones

These are tubular bones with length more than width These bones have two ends (epiphysis) and a shaft (diaphysis)

Long bones of the limbs (humerus, radius, ulna, femur, tibia and fibula)

1b. Modified long bones

These bones have epiphysis at only one end and a shaft

Metacarpal

Short bones

These are short, cuboidal shaped bones with length almost equal to width

Carpal and tarsal bones

Flat bones

These are flat, plate like bones

Bones forming vault of the skull, ribs, sternum

Irregular bones

These bones do not have a characteristic shape

Vertebra and hip bone

Sesamoid bones

These bones develop within the tendons of the muscles

Patella, pisiform

Pneumatic bones

These bones are filled with air to make them lighter

Maxilla, ethmoidal, frontal and sphenoidal bone

Accessory bones

These bones are not always present

Wormian bones of the skull

1a. Typical long bones

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Competency Based Qs and As in Anatomy

8. Describe the structural classification of bones.

SHORT ANSWERS 1. Compare and contrast the features of a long bone with a miniature long bone. Long bone

Miniature long bone

Long, with length more than breadth and thickness

Shorter than typical long bone, but length more than breadth and thickness Has two epiphysis at the ends Has epiphysis at one end and an intervening diaphysis only E.g.—femur, humerus, radius E.g.—metacarpals, metatarsals, phalanges

Bones can be classified based on their macroscopic (gross) and microscopic appearance. 1. Macroscopic classification: Based on the structure as seen with naked eyes. i. Compact/dense bone: Refers to the outer part of the bone that is dense and compact, (e.g. cortex of the bone) ii. Spongy/cancellous bone: Refers to the sponge like meshwork found inside the bone forming the medullary cavity and filled with bone marrow 2. Microscopic classification: Based on the structure as seen with the help of a microscope. i. Immature/Woven bone • Also called bundle/non-lamellar bones • These bones are found in fetus during development • They do not have an organised/lamellated appearance • These contain more cells than per unit area than in mature bone • The cells are irregularly/randomly arranged • The matrix has more ground substance • The matrix stains with haematoxylin ii. Mature/Lamellar bone • Composed of units called osteons/Haversian systems • They have an organised/lamellated appearance • These contain less cells than per unit area than in mature bone • The cells are regularly arranged • The matrix has less ground substance • The matrix stains with eosin

2. What are pneumatic bones? What are their functional roles? Give one example. Pneumatic Bones • Type of irregular bone • Contains cavity filled with air and lined by mucous membrane • Mostly found in the face, around the nose Functional Role • Lighten the skull • Resonance added to the voice • Condition the inspired air Example Maxilla 3. What are accessory bones? How do they differ from heterotopic bones? Accessory/Supernumerary Bones • These bones are not found in the body usually. • These bones usually results because of appearance of extra center of ossification and failure of this center to fuse with the main bone • E.g.—sutural or wormian bones Heterotopic Bones • Formed pathologically in a muscle or soft tissue following trauma or surgery • Usually occurs due to the ossification of the clot that is produced as a result of trauma. 4. How bones are classified according to the process of development? Give example for each. • Membranous bones—bones of the cranial vault • Cartilaginous bones—vertebrae • Membrano-cartilagenous bones—mandible

General Features of Bones and Joints

5. What is periosteum? What is its functional significance? Periosteum • Thick fibromembranous external covering of the bone • It has two layers—outer fibrous and inner cellular Functional Significance • Protection and maintenance of bone shape • Nourishment of outer part of cortex • Ligaments, tendons, intermuscular septa attached to it • Helps in bone regeneration 6. Compare and contrast pressure epiphysis and traction epiphysis. Pressure epiphysis

Traction epiphysis

Found in the joints The bone is subjected to pressure Assist in weight transmission Ossify earlier

Not involved in the joints The bone is subjected to muscle pull Provide attachment to muscles Ossify after the pressure epiphysis E.g.—trochanters of femur

E.g.—head of femur

7. What is atavistic epiphysis and how does it differ from the aberrant epiphysis? Atavistic Epiphysis • Found as an independent bone in lower mammals • Fuses to the nearby bone in humans, receiving the nutrition from it • E.g.—coracoid process of scapula

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Aberrant Epiphysis • Appears at unusual end of a short long bone • E.g.—1st metacarpal bone head epiphysis 8. Metaphysis is a common site of osteomyelitis in children. Explain its anatomical basis. • Prior to epiphysis fusion, metaphysis has abundant blood supply by nutrient, metaphyseal, periosteal arteries • The nutrient arteries form a hairpin bend close to the metaphysis • The emboli or bacteria tend to get trapped at these bends leading to osteomyelitis in children • In adults, after epiphyseal fusion, the arteries communicate with epiphyseal arteries. Thus, it is a rare site for osteomyelitis in adults. 9. Classify the bones based on their development. Based on the development, bones are classified as: 1. Membranous bones • These bones develop by membranous ossification • Example—bones of the vault of skull 2. Cartilaginous bones • These bones develop by cartilaginous ossification • E.g.—long bones of the limbs (humerus, femur) 3. Membrano-cartilaginous bones • These bones develop by both membranous and cartilaginous ossification • E.g.—clavicle, mandible

2.2 ENUMERATE LAWS OF OSSIFICATION SHORT ANSWERS 1. Enumerate the laws of ossification. Laws of Ossification • Primary centers of ossification always appear before birth (exceptions are carpal bones, navicular bone and cuneiform which appear after birth) • Secondary centers of ossification always appear after birth [exceptions are the lower end of the femur and occasionally the upper end of the tibia for which secondary centers appear before birth] • As a rule, ossification centers which appear first fuses last and vice versa • Centers for pressure epiphysis fuse first compared to centers for traction epiphysis

• The foramen for the nutrient artery is always directed away from the growing end of the bone. (can be remembered as “to the elbow I go and from the knee, I flee”). 2. Describe the law of union of epiphysis. Law of the Union of Epiphysis • Ossification centers which appear first fuses last, and centers which appear last will fuse first • Exception: In fibula, the center for the lower end appears first and fuses first. This is because the upper end of the fibula is an example for traction epiphysis, whereas the lower end is a pressure epiphysis. As per the laws of ossification centers for pressure epiphysis fuses first.

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Competency Based Qs and As in Anatomy

2.3 ENUMERATE SPECIAL FEATURES OF A SESAMOID BONE SHORT ANSWER 1. Describe the features of a sesamoid bone. Sesamoid Bone (Fig. 2.1.5) Sesamoid bones are small seed-like bones which develops within the muscle tendons. Features • Lacks periosteum • Is avascular (derives the nutrition from the synovial fluid) • The rubbing surface is covered with articular cartilage

• Ossification occurs post-birth, commonly by multiple centers • No Haversian system Functions • Pulley for muscle contraction • Changes the direction of muscle pull • The friction of tendon against the bone is minimized Examples • Patella—in the tendon of quadriceps femoris • Pisiform—within the tendon of flexor carpi ulnaris

2.4 DESCRIBE VARIOUS TYPES OF CARTILAGE WITH THEIR STRUCTURE AND DISTRIBUTION IN BODY SHORT ESSAY 1. Compare and contrast the features of hyaline and elastic cartilage. Feature

Hyaline cartilage (Fig. 2.4.1)

Elastic cartilage (Fig. 2.4.2)

Location

Fetal life: All skeletal tissue Adults: Nasal cartilages, articular cartilages, thyroid, cricoid and part of the arytenoid cartilages Glossy bluish, translucent Present Abundant and present within the lacunae Arranged in group as isogenous cell nests Homogenous, basophilic, matrix with ground glass appearance arranged as—capsular, territorial and interterritorial matrix Type II collagen fibers—delicate and not visible, Common Flexible Forms the foundation for development of all cartilaginous bones Resists compression Forms the skeleton of the respiratory tract and provides structural support

External ear, epiglottis Auditory tube, apex of the arytenoid, corniculate and cuneiform cartilages Yellowish, opaque Present More numerous and bigger, packed more closely in the lacunae Eosinophilic matrix, rich in elastic fibers Type II collagen fibers are also present

Appearance Perichondrium Chondrocytes Matrix

Calcification tendency Elasticity Functions

Less common Most flexible Provides flexibility

General Features of Bones and Joints

13

Fig. 2.4.1: Hyaline cartilage

Fig. 2.4.2: Elastic cartilage

SHORT ANSWERS 1. What is perichondrium? What is its functional role? Perichondrium • Dense fibroconnective tissue layer covering the external surface of the cartilage • Has following two layers: – An outer fibrous layer – Inner cellular layer Functional Role • Protection from injury—especially in the growth and development phase • In children, it promotes cell regeneration thus reducing recovery time post-injury

• Reduces friction • Provides elasticity • Allows the blood flow to the cartilage 2. Describe the peculiar features of fibrocartilage. Fibrocartilage (Fig. 2.4.3) • Appearance and color—opaque, glistening white • Perichondrium—absent • Chondrocytes—few, scattered, arranged singly or in rows • Matrix—parallel running thick collagen fiber bundles within the matrix • Calcification—does not occur • Elasticity—firm, strongest type of cartilage

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Competency Based Qs and As in Anatomy

Fig. 2.4.3: Fibrocartilage

2.5 DESCRIBE VARIOUS JOINTS WITH SUBTYPES AND EXAMPLES SHORT ESSAYS 1. Classify the joints. Give an example for each. Joints’ Classification

Depending on the Amount of Movement Allowed and Structure of Joint A. Synarthroses/fibrous joints/immovable joints Here articular surfaces are connected by fibrous connective tissue. Subtypes include 1. Sutures (these are restricted to skull only) (Fig. 2.5.1) • Serrate suture—sagittal suture • Denticulate suture—lambdoid suture

Fig. 2.5.1: Sutures

• Squamous sutures—between squamous part of temporal bone and parietal bone • Plane suture—between palatine process of 2 maxillae • Wedge and groove (schindylesis)—between rostrum of sphenoid and upper part of vomer 2. Syndesmosis (bones are connected by a dense fibrous membrane or cord) (Fig. 2.5.2): Inferior tibio-fibular joint 3. Gomphosis (a peg and socket type of articulation) (Fig. 2.5.3): Roots of teeth

Fig. 2.5.2: Syndesmosis (e.g. middle radioulnar joint)

General Features of Bones and Joints

Fig. 2.5.3: Gomphosis

B. Amphiarthrosis 1. Synchondroses/primary cartilaginous joints (the centres of ossification are separated by hyaline cartilage): Junction between epiphysis and diaphysis 2. Symphyses/secondary cartilaginous joints (the articular surfaces are connected by fibrocartilage) (Fig. 2.5.4) • Intervertebral discs • Manubriosternal and xiphisternal joints • Pubic symphysis C. Diarthroses/synovial joint (these are freely movable joints) (Fig. 2.5.5) a. According to number of articulating joints 1. Simple joint: Two articular surfaces are involved in formation of a joint E.g.—interphalangeal joint 2. Compound joint: More than two articular surfaces are involved in formation of a joint E.g.—ankle joint

15

Fig. 2.5.5: Diarthroses

3. Complex joint: Here the joint cavity is divided into two distinct compartments E.g.—knee joint b. According to axis of movement/shape of articular surface 1. Uniaxial (movement is possible in only one axis/direction) • Hinge/ginglymus—elbow • Pivot/trochoid—atlanto-axial joint • Condylar joint—knee 2. Biaxial (movement is possible in two axis/ direction) • Ellipsoid joint—radiocarpal joint • Saddle joint—sternoclavicular joint 3. Polyaxial (movement is possible in multiple axis/direction) • Ball and socket/spheroidal joint—hip joint • Plane joint—intertarsal joint 2. Classify the synovial joints. Give an example for each type. Synovial Joints’ Classification

According to Number of Articulating Joints 1. Simple joint—interphalangeal joint 2. Compound joint—ankle joint 3. Complex joint—knee joint

Fig. 2.5.4: Symphyses

According to Axis of Movement/Shape of Articular Surface 1. Uniaxial • Hinge/ginglymus—elbow (Fig. 2.5.6) • Pivot/trochoid—atlanto-axial joint • Condylar joint—knee, TMJ

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Competency Based Qs and As in Anatomy

2. Biaxial • Ellipsoid joint—radiocarpal joint • Saddle joint—sternoclavicular joint (Fig. 2.5.7) 3. Polyaxial • Ball and socket/spheroidal joint—hip joint (Fig. 2.5.8) • Plane joint—intertarsal joint

3. Describe the components of a synovial joint. Mention functional significance of each. Synovial Joints’ Components (Fig. 2.5.9)

Fibrous Capsule • Completely covers and encloses the synovial cavity • Constitutes longitudinal and interlacing white connective tissue fiber bundles • It forms the articular capsule along with the synovial membrane Functions 1. Stabilizes the joint and prevents dislocation 2. Has numerous nerve endings, stimulation of which leads to contraction of the muscle such that the joint is brought to the position with maximum comfort.

Fig. 2.5.6: Uniaxial joint

Ligaments • Thickened collagen fiber bands • Two types—true and accessory 1. True ligament – Local thickenings of parallel fiber bundles of capsular ligament – Intrinsic ligaments—since they are not separate from the capsular ligament Function: Stabilizes the joint by permitting movement in one plane, and preventing in others 2. Accessory ligament – Separate from the capsule – Can be intracapsular or extracapsular Function: Gives reinforcement to the joint, limiting the range of movements

Fig. 2.5.7: Biaxial joint

Synovial Membrane A highly vascular, thin, connective tissue membrane which lines the inner aspect of the fibrous capsule Function: Produces synovial fluid which lubricates the joint

Articular Cartilage Made of hyaline cartilage. Function: Aids in smooth and frictionless joint movements and resist the compression forces

Fig. 2.5.8: Polyaxial joint

Meniscus or Articular Disc • Fibrocartilagenous pads in between the articular surfaces of some joints

General Features of Bones and Joints

17

Fig. 2.5.9: Synovial joint components

Function 1. Lubrication 2. Division of the joint into two components 3. Function as a ligament by modifying some movements 4. Provides cushioning to the articular cartilage and prevents its wear and tear

Bursae • Pouch-like sacs near some joints • Filled with synovial fluid Function 1. Cushioning the muscles 2. Aid in the movement of muscle or tendon over bone or ligamentous surfaces

Fat Pads (Haversian Glands) • Found between the fibrous capsule and synovial membrane or between the synovial membrane and bone • Function—accommodate to the changing conditions of the joint during movement

SHORT ANSWERS 1. Compare and contrast primar y secondary cartilaginous joints. Primary cartilaginous joints

and

Secondary cartilaginous joints

Also known as synchondroses Also known as symphyses Hyaline cartilage connects Hyaline cartilage covers the the bones bone, fibrocartilage connects the bones Movement not possible Minimal movement possible Temporary joint, replaced com- The fibrocartilage persists pletely by bone in later life throughout life Occurrence in midline is rare Always seen in midline

2. Describe syndesmosis. Give an example. Syndesmosis • Joint between 2 bones connected by greater amount of connective tissue • Connective tissue forms interosseous ligament and membrane • Permits slight movement at the joint

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Competency Based Qs and As in Anatomy

Example Interosseous radio–ulnar joints 3. List any three ball and sockets joints in the body 1. Hip joint 2. Shoulder joint 3. Incudostapedial joint 4. List the movements occurring at a ball and socket joint. 1. Flexion 2. Extension 3. Adduction

4. 5. 6. 7.

Abduction Medial rotation Lateral rotation Circumduction

5. Mention the factors maintaining the stability of a synovial joint. • Bones—fitting into each other • Ligaments—intracapsular and extracapsular ligaments • Muscles—strength and tone of various musclesmost important factor

2.6 EXPLAIN THE CONCEPT OF NERVE SUPPLY OF JOINTS AND HILTON'S LAW SHORT ANSWER 1. Define the Hilton’s law. Mention its functional significance. Hilton’s Law Nerve which supplies a joint will also innervate the muscles regulating the movements of that joint and the skin over the joint.

Functional Significance • When the joint is injured or damaged, the nerve supplying it will stimulate the muscle to contract in a way as to bring the joint to a position of maximum comfort, thus protecting the joint. • The joint pain is referred to the skin over the joint.

3

General Features of Muscle 3.1 CLASSIFY MUSCLE TISSUE ACCORDING TO STRUCTURE AND ACTION SHORT ESSAYS 1. Compare and contrast the features of skeletal and cardiac muscles. Feature

Skeletal muscle (Fig. 3.1.1)

Cardiac muscle (Fig. 3.1.2)

Synonyms

Striated muscle Somatic muscle Voluntary muscle Attached to skeleton Tongue Proximal and middle third of esophagus Three coverings, from outside inwards arranged as, epimysium, perimysium and endomysium Single elongated muscle cell

Myocardium

Location

Connective tissue

Structure of the muscle fiber Nucleus Ultrastructure Presence of cell junctions Type of innervation Response to exercise Response to injury

Multiple and peripherally situated T tubules arranged as triad (have two terminal cisternae) Absent Somatic Hypertrophy Regeneration is limited

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Heart and base of the great vessels of heart Presence of endomysium

Several cardiac muscle arranged as branching fibers Single and centrally situated T tubules arranged as diad (have one terminal cistern) Intercalated discs are present Autonomic/visceral Hypertrophy Regeneration is absent

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Competency Based Qs and As in Anatomy

Fig. 3.1.1: Skeletal muscle

Fig. 3.1.2: Cardiac muscle

General Features of Muscle

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2. Compare and contrast the features of skeletal and smooth muscles. Feature

Skeletal muscle (Fig. 3.1.1)

Smooth muscle (Fig. 3.1.3)

Synonyms

Striated muscle Somatic muscle Voluntary muscle Attached to skeleton Tongue Proximal and middle third of esophagus Three coverings, from outside inwards arranged as, epimysium, perimysium and endomysium Single elongated muscle cell Multiple and peripherally situated T tubules arranged as triad (have two terminal cisternae) Absent Somatic Hypertrophy Regeneration is limited

Involuntary

Location

Connective tissue

Structure of the muscle fiber Nucleus Ultrastructure Presence of cell junctions Type of innervation Response to exercise Response to injury

Tunica media of vessels Muscular layer of tubular organs in gastrointestinal tract and urinary tract Presence of endomysium

Short, spindle-shaped cell Single and centrally situated None Gap junctions are present Autonomic/visceral Hypertrophy and hyperplasia Regeneration is present

Fig. 3.1.3: Smooth muscle

3. Classify the muscles based on the arrangement of fibers. 1. Parallel fasciculi • Muscle fibers are parallel to the muscle pull • Have maximum range of movement • They may be: – Quadrilateral—thyrohyoid – Strake-like—sartorius – Strap-like—rectus abdominis – Fusiform—biceps 2. Convergent fasciculi • Muscle fibers are converging to the point of insertion • Powerful but with restricted range of movements

• Triangular—adductor longus • Fan-shaped—temporalis 3. Twisted or spiral fasciculi • Muscle fibers are arranged spirally • E.g.—trapezius 4. Cruciate fasciculi • Muscle fibers are arranged in two different planes and are arranged in the form of the letter ‘X’ • E.g.—sternocleidomastoid 5. Sphincteric fasciculi • Muscle fibers are arranged around an opening or orifice circumferentially • E.g.—orbicularis oculi, orbicularis oris

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Competency Based Qs and As in Anatomy

6. Pennate fasciculi • Muscle fibers resemble feather • They may be: – Unipennate: Muscle fibers are attached to one side of the tendon only. E.g. Flexor pollicis longus, extensor digitorum longus – Bipennate: Muscle fibers are attached to both sides of the tendon only. E.g. Rectus femoris, dorsal interossei muscles of hand and foot – Multipennate: Series of bipennate muscles attached together. E.g. middle fibers of deltoid – Circumpennate—muscle fibers are arranged as convergence of fibers from the walls of cylindrical space on to tendon. E.g. tibialis anterior

Fig. 3.1.4: Parallel and pennate muscle fibers

SHORT ANSWERS 1. Compare and contrast parallel and pennate muscle fibers. Parallel muscle fiber (Fig. 3.1.4)

Pennate muscle fiber (Fig. 3.1.4)

Arranged parallel to the muscle pull Has maximum range of movement Types—quadrilateral, strake-like, strap-like, fusiform E.g.—biceps

Arranged in the shape of feather Has lesser range of movement but stronger Types—unipennate, bipennate, multipennate, circumpennate E.g.—deltoid

2. Describe cruciate muscle. Mention an example. Cruciate Muscle • The muscle fibers are arranged in two planes— superficial and deep • Muscle fibers cross each other in the form of the letter ‘X’ Example Sternocleidomastoid, masseter, adductor magnus

3.2 ENUMERATE PARTS OF SKELETAL MUSCLE AND DIFFERENTIATE BETWEEN TENDONS AND APONEUROSES WITH EXAMPLES SHORT ANSWER 1. Compare the different modes of insertion of a skeletal muscles. Tendon

Aponeurosis

Rounded cord-like structure made up of connective tissue Attaches muscle to bone Allows proper contraction, provides support and strength, more endurance and stretching capacity

Thin, flattened sheath like structure Provides broader attachment for muscle to bone It bears extra pressure and tension since it is having property of recoiling, they act as shock absorber and allow to bear weight Provides strength and durability E.g.—bicipital aponeurosis

Provides flexibility and motility E.g.—tendon of biceps

General Features of Muscle

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3.3 EXPLAIN SHUNT AND SPURT MUSCLES SHORT ANSWER 1. Compare and contrast the features of spurt and shunt muscles. Spurt muscle (Fig. 3.3.1)

Shunt muscle (Fig. 3.3.1)

Produce force during a movement across the joint Origin is at a distance from the joint Inserts near the joint E.g.—brachialis

Stabilizes the joint during the movement Originates near the joint Insertion is away from the joint E.g.—brachioradialis

Fig. 3.3.1: Shunt and spurt muscles

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Competency Based Qs and As in Anatomy

4

General Features of Skin and Fascia 4.1 DESCRIBE DIFFERENT TYPES OF SKIN AND DERMATOMES IN BODY SHORT ESSAY 1. Compare and contrast the features of thick skin and thin skin. Feature

Thick skin (Fig. 4.1.1)

Thin skin (Fig. 4.1.2)

Synonyms

Non-hairy skin Glabrous skin Palms and soles Flexor surface of digits 400–600 m Epidermis Dermis Hypodermis Very prominent Present Well developed Absent Present Absent Absent

Hairy skin

Location Thickness Layers

Stratum corneum Stratum lucidum Stratum granulosum Hair follicles Sweat gland Sebaceous gland Arrector pilorum

SHORT ANSWER

Skin over almost all parts of the body except at palm and soles 75–150 m Epidermis Dermis Hypodermis Less prominent Absent Poorly developed Present Present Present Present

Areas of Dermatomal Discontinuity Observed in human beings at the level of the sternal angle. The area of the trunk above the level of the sternal angle is supplied by the C5 dermatome and the area immediately below is supplied by T1 dermatome. This is because the intervening dermatomes are ‘pulled’ to supply the upper limb.

1. Define dermatome. Mention the areas of dermatomal discontinuity in human body. Dermatome Dermatome is the area of the skin supplied by an individual/single spinal segment.

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General Features of Skin and Fascia

25

Fig 4.1.1: Thick skin

Fig 4.1.2: Thin skin

4.2 DESCRIBE STRUCTURE AND FUNCTION OF SKIN WITH ITS APPENDAGES SHORT ESSAY 1. Describe the structure of skin. Structure of Skin (Figs 4.2.1 and 4.2.2) Skin has 2 principal layers—epidermis and dermis 1. Epidermis • It is the superficial surface epithelium of skin • Made of stratified squamous keratinized epithelium • Avascular, derived from surface ectoderm • Thickness—0.007 to 0.12 mm

• Constitutes 4–5 layers, from deep to superficial they are: – Stratum basale o Also called stratum germinatum, basal layer, Malpighian layer o A single layer of columnar or cuboidal cells o Also contains melanocytes – Stratum spinosum o Also called spiny layer, prickle cell layer o Has several layer of polygonal cells o Desmosomes hold the cells together

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Competency Based Qs and As in Anatomy

Fig. 4.2.1: Thick skin

Fig. 4.2.2: Thin skin

– Stratum granulosum o Also called granular layer o 3–4 layers of flattened cells o Has pyknotic nuclei with signs of degeneration o Keratohyalin granules are seen in cytoplasm – Stratum lucidum o Also called clear layer o Seen in the thick skin over palms and soles o A thin homogenous glassy layer o Highly refractile

– Stratum corneum o Most superficial layer o Made of 25–30 layers of fully keratinized flattened scale like dead cells filled with keratin o Cornified 2. Dermis • Present beneath the epidermis and derived from mesoderm • Made of type I collagen and elastic fibers • Harbours glands, lymphatics, blood vessels, nerves

General Features of Skin and Fascia

27

2. Deep reticular layer o Mostly comprises of collagen fibers arranged in parallel bundles o Langer’s lines or cleavage lines—caused by direction of the bundles o Cleavage line—horizontal in trunk and neck, vertical in limbs

• Arrector pili—dermal muscle associated with hair follicles • Has 2 layers: 1. Superficial papillary layer o Constitutes one-fifth of dermal thickness o Dermal papillae—blunt conical projections into epidermis SHORT ANSWERS

1. Compare and contrast the features of eccrine and apocrine sweat glands. Feature

Eccrine sweat gland

Apocrine sweat gland

Location

Entire body except lips and parts of external

Axilla

genitalia

Nipple and areola External genitalia Skin around anus Simple tubular gland with large lumen Occasionally branched Associate with hair follicle

Type

Simple coiled tubular

Association with hair follicle

Independent structure Not associated with hair follicle Secretory segment Duct segment Narrow lumen and is made up of three types of cells Clear cells Dark cells Myoepithelial cells Lined by stratified cuboidal epithelium Lack myoepithelial cells Merocrine Resembles ultrafiltrate of blood Cholinergic Throughout life Temperature regulation

Component parts Secretory segment

Duct segment Mode of secretion Type of secretion Excitatory stimulus Age of functioning Function

2. Describe the structure and list the location of sebaceous gland. Structure • They are simple branched glands • Associated with hair follicles and each follicle has 1–6 glands • Secrete sebum, an oily material onto the hair shaft Location • They are present all over the body except palms and soles • They open directly onto the skin surface at the following sites:

– – – –

Secretory segment Duct segment Wider lumen but made up of only one type of cell

Lined by stratified cuboidal epithelium Lack myoepithelial cells Merocrine/apocrine/holocrine Protein and pheromone rich fluid Adrenergic Becomes active at puberty Regeneration is present

Nose Genital and perianal regions Areola of breast Eyelids

3. List the functions of skin. 1. Protection 2. Thermoregulation 3. Sensory reception 4. Hydroregulation 5. Absorption of lipid-soluble substances 6. Vitamin D synthesis 7. Excretion of waste material 8. Emotional communication

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Competency Based Qs and As in Anatomy

4.3 DESCRIBE SUPERFICIAL FASCIA ALONG WITH FAT DISTRIBUTION IN BODY SHORT ESSAY

SHORT ANSWERS

1. Describe the structure of superficial fascia. Structure of Superficial Fascia • It is the layer of loose areolar tissue found subcutaneously • Unites the dermis with the underlying deep fascia • It is abundant in fat • The fat content varies in various body parts • The fat in the superficial fascia is absent in – Eyelids – Pinna – Flexor creases of the fingers – Penis – Scrotum • The fat content is more in children and females • The fat deposition in particular sites in females leads to their secondary sexual characteristics – Breast – Anterior abdominal wall below umbilicus – Cervical thoracic region – Post-deltoid region – Gluteal and lumbar region – Anterior thigh • The blood vessels, lymphatics, and nerves travel in the superficial fascia before reaching dermis.

1. Define panniculus carnosus. List the muscles in human body which represent panniculus carnosus. Panniculus Carnosus Panniculus carnosus is a thin layer of muscle found in the superficial fascia in animals. Muscles which Represent Panniculus Carnosus 1. Muscles of facial expression 2. Platysma in the neck 3. Palmaris brevis 4. Corrugator cutis ani 5. Subareolar muscle in the breast 6. Dartos in the scrotal wall 2. List the functions of superficial fascia. 1. Forms an insulating layer beneath the skin 2. Leads to a smooth external contour, seen in children and females 3. Permits skin to move on the underlying structures 4. Let’s an easy passage to blood vessels, lymphatics nerves 5. Causes cushioning effect in certain sites

4.4 DESCRIBE MODIFICATIONS OF DEEP FASCIA WITH ITS FUNCTIONS SHORT ESSAYS 1. Describe the structure of deep fascia. Structure of Deep Fascia • A tough, inelastic membrane of fibrous tissue • Encloses the body deep to subcutaneous tissue • The soft tissues are held in place • The body shape is maintained • Prominent in neck and limbs • Neck has 3 layers: 1. General investing layer: Encloses the neck structure like collar 2. Pretracheal fascia: Present anterior to trachea 3. Prevertebral fascia: Anterior to cervical vertebrae

4. The neck is thus divided into visceral compartment and musculoskeletal compartment • Limbs 1. The deep fascia gives rise to intermuscular septa, which attach to the periosteum 2. The septa allow the muscle group to contract individually 3. Enables the muscles to slide freely over other groups 2. Describe the modifications of deep fascia. 1. Retinacula • Thickened band like, retaining the tendons of long muscles in place • Bowstringing during contraction of muscles is prevented

General Features of Skin and Fascia

2. Aponeurosis • A thick, wide sheet of fibrous tissue in palms and soles • Protects the underlying structures • Provided attachment to muscles 3. Fibrous sheaths • Deep fascia forms sheath around neurovascular bundles at certain sites • Carotid sheath—encloses the common carotid artery, vagus nerve, internal jugular vein • Axillary sheath—encloses axillary artery and vein 4. Fibrous capsule • Deep fascia splits to enclose certain glands by forming their capsule • E.g.—parotid gland capsule 5. Interosseous membrane: Connecting bones in forearm and leg 6. Intermuscular septa • The deep fascia gives rise to intermuscular septa in limbs, which attach to the periosteum • The septa allow the muscle group to contract individually • Enables the muscles to slide freely over other groups

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7. Fibrous flexor sheath • Formed around the flexor tendons of fingers and toes • Prevent the tendons from bowing out of position 8. Ligaments: Localized thickened bands of deep fascia 9. Fascial sheath: Sheath around certain muscles, like psoas sheath SHORT ANSWERS 1. Mention the sites in human body where deep fascia is absent. 1. Face 2. Breast 3. Anterior abdominal wall 4. Penis 5. Scrotum 6. Ischiorectal fossa 2. List the functions of deep fascia. 1. Keeps the underlying structures in position 2. Provides attachment to muscles 3. Facilitates venous and lymphatic drainage 4. Binding bones 5. Retains the tendons in position and prevents bowstringing

4.5 EXPLAIN PRINCIPLES OF SKIN INCISIONS SHORT ANSWERS 1. Define Langer's line. Describe its importance in planning surgical incisions. Langer’s line Langer’s lines are the topological lines on the body caused by the arrangement of the collagen fibers in the reticular layer of the dermis. Importance in Planning Surgical Incisions • Surgical incisions made parallel to these lines heal faster and leaves lesser scar. • Surgical incisions across these lines heals slower and leaves ugly scar.

2. Define dermatoglyphics. Mention its clinical application. Dermatoglyphics Dermatoglyphics is the study of the ridges of the skin or fingerprints. Clinical Application • Provides identity to an individual as it is unique to every individual • Medicolegal purpose to identify the criminal • In certain diseases, there is deviation from the normal pattern.

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Competency Based Qs and As in Anatomy

5

General Features of the Cardiovascular System 5.1 DIFFERENTIATE BETWEEN BLOOD VASCULAR AND LYMPHATIC SYSTEM SHORT ESSAY 1. Compare and contrast the features of blood vascular system and lymphatic system. Blood vascular system

Lymphatic system

Constitutes blood vessels Blood is the circulating fluid—reddish colour Transportation of blood through heart, blood vessels and platelets Contains plasma, erythrocytes, leukocytes and platelets Aids in transport of gases Carries digested food material, waste from cells Definite basal lamina and pericytes are present in blood capillaries

Constitutes lymph vessels Lymph is the circulating fluid—colourless Transportation of lymph through lymphatic vessels Contains lymphocytes Cannot transport gases Carries digested fat Basal lamina and pericytes are absent. Flap valves are present between endothelial cells in lymph capillaries Capillaries permeable to macromolecules of colloids and particulate matters Capillary wall is anchored to connective tissue, so the lumen remains patent

Capillaries are permeable to soluble crystalloids Capillaries collapse in increase tissue fluid pressure

SHORT ANSWERS

– Capillaries – Veins

1. List the components of cardiovascular system. • Blood – Blood cells o Erythrocytes o Leukocytes o Platelets • Plasma • Heart • Blood vessels – Arteries

2. List the functions of blood vascular system. 1. Transportation of nutrients to various body parts 2. Removal of waste products from various body parts 3. Gaseous exchange of oxygen and carbon dioxide 4. Carrying hormones and other regulatory molecules 5. Protection from infection

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General Features of the Cardiovascular System

31

5.2 DIFFERENTIATE BETWEEN PULMONARY AND SYSTEMIC CIRCULATION SHORT ESSAY 1. Compare and contrast the features of pulmonary and systemic circulation. Pulmonary circulation (Fig. 5.2.1)

Systemic circulation (Fig. 5.2.1)

Composed of pulmonary artery and pulmonary vein

Composed of superior and inferior vena cava, aorta and other small vessels Aorta carries the oxygenated blood from left ventricle of heart to the rest of the body The vena cava—superior and inferior, carry deoxygenated blood from different parts of body to right atrium Carries blood throughout body Provides nutrition and oxygen to metabolizing cells in the body

Pulmonary artery carries the deoxygenated blood from the right ventricle to the lungs Pulmonary veins carry oxygenated blood from lungs to the left atrium Carries blood to lungs Release carbon dioxide from blood and dissolve oxygen in blood

Fig. 5.2.1: Pulmonary and systemic circulations

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Competency Based Qs and As in Anatomy

5.3 LIST GENERAL DIFFERENCES BETWEEN ARTERIES AND VEINS 69.1 IDENTIFY ELASTIC AND MUSCULAR BLOOD VESSELS, CAPILLARIES UNDER THE MICROSCOPE 69.2 DESCRIBE THE VARIOUS TYPES AND STRUCTURE–FUNCTION CORRELATION OF BLOOD VESSEL 69.3 DESCRIBE THE ULTRASTRUCTURE OF BLOOD VESSELS SHORT ESSAYS 1. Classify blood vessels with examples. Blood Vessels Classification 1. Conducting vessels • Also called elastic arteries • Constitute the large arteries and their branches • E.g.—aorta 2. Distributing vessels • Also called muscular arteries • E.g.—renal artery 3. Resistance vessels • Arterioles • Diameter of less than 100 m • They are of 3 types: – Large arterioles – Terminal arterioles – Meta-arterioles

4. Exchange vessels • Capillaries • Sinusoids • Post-capillary venules 5. Capacitance or reservoir vessels • Veins • They are of 3 types: – Large veins—superior vena cava – Medium veins—splenic vein – Small veins o Post-capillary venules (exchange vessel) o Muscular venules 2. Describe the structure of a blood vessel. Structure of Artery (Fig. 5.3.1) Made of 3 layers—tunica intima, tunica media and tunica adventitia

Fig. 5.3.1: Schematic diagram of blood vessel

General Features of the Cardiovascular System

1. Tunica intima – Innermost layer – Consists of endothelium—flattened cells and basal lamina – Sub-endothelial loose connective tissue and internal elastic lamina support the endothelium externally – Internal elastic lamina is a fenestrated membrane of elastic tissue 2. Tunica media – Thickest layer of the arterial wall – Consists of alternate layer of elastic fibers and circularly arranged smooth muscle fibers – External elastic lamina o Fenestrated membrane of elastic tissue o Limits the tunica media externally

33

3. Tunica adventitia – Outermost layer – Thin, but strongest of the 3 layers – Consists of longitudinal connective tissue fibers and connective tissue cells – Connective tissue comprises of both elastic and collagen fibers – Merges with the perivascular sheath Structure of Capillary Made up of single cell layer of squamous epithelium, known as endothelium. Structure of Vein (Fig. 5.3.4) • Consists of the same 3 layers as artery • Differences are: – Tunica intima—internal elastic lamina is absent – Tunica media—poorly developed – Tunica adventitia—thickest of the 3 layers. Made of muscle, elastic and collagen fibers

3. Compare and contrast the microscopic features of large-sized artery and medium-sized artery. Microscopic feature

Large-sized artery (Fig. 5.3.2)

Medium-sized artery (Fig. 5.3.3)

Tunica adventitia Tunica media

Thin and has greater proportion of elastic fibers Consists mainly of elastic fibers arranged in fenestrated concentric membranes Consists of endothelium, subendothelial connective tissue, internal elastic lamina Subendothelial tissue has more elastic tissue Internal elastic lamina is not distinct

Thin layer of fibroelastic tissue Consists mainly of circular smooth muscles

Tunica intima

Fig. 5.3.2: Large-sized artery

Consists of endothelium, subendothelial connective tissue, internal elastic lamina Subendothelial tissue has lesser elastic tissue Internal elastic lamina is prominent

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Competency Based Qs and As in Anatomy

Fig. 5.3.3: Medium-sized artery

4. Describe the microscopic structure of largesized vein. Microscopic Structure of Large-sized Vein (Fig. 5.3.4) Made of 3 layers—tunica intima, tunica media, tunica adventitia • Tunica intima – Innermost layer – Consists of endothelium—flattened cells and basal lamina – Sub-endothelial loose connective tissue supports the endothelium externally

• Tunica media – Consists of collagen and elastic fibers and muscle – Has more collagen fibers and lesser elastic fibers and muscle • Tunica adventitia – Outermost layer – Thickest of the 3 layers – Elastic and muscle fibers—arranged longitudinally – Collagen fibers—form a meshwork, spiralling around the vessel

Fig. 5.3.4: Large-sized vein

General Features of the Cardiovascular System

35

SHORT ANSWERS 1. Compare and contrast the characteristic features of arteries and veins. Features

Arteries

Veins

Definition Layers (from inside out)

Vessels that deliver blood to capillaries Tunica intima Tunica media Tunica adventitia Large artery Medium-sized artery Small artery Arteriole Capillary Thick-walled Narrower Tunica media Absent

Vessels that collect blood from capillaries Tunica intima Tunica media Tunica adventitia Post-capillary venule Muscular venule Small vein Medium vein Large vein Thin-walled Wider Tunica adventitia Present

Absent

Present

Vascular tree

Thickness of the wall Lumen Thickest layer Presence of longitudinal smooth muscle in adventitia Valves within the lumen

2. Describe the blood supply of arteries. Blood Supply of Arteries • Vasa vasorum supplies tunica adventitia and outer two-thirds of tunica media by forming a dense plexus in tunica adventitia • Luminal blood supplies the tunica intima and inner third of tunica media via diffusion • Venous drainage is via the minute veins corresponding the arteries 3. List the common sites palpation of arterial pulse in human body. Common Sites Palpation of Arterial Pulse in Human Body Artery

Site of palpation

Carotid

At the level of cricoid cartilage, along anterior border of sternocleidomastoid Anterior aspect of elbow, medial to tendon of biceps At the wrist, on the radial aspect of forearm, lateral to flexor carpi radialis tendon Inferior to the inguinal ligament, between anterior superior iliac spine and pubic symphysis

Brachial Radial Femoral

Popliteal In the popliteal fossa Posterior tibial In the ankle, on the medial aspect, between the tendocalcaneus and medial malleolus Dorsalis pedis Dorsum of the foot, medial to extensor hallucis longus tendon

4. List the different types of capillaries with examples. Types of Capillaries 1. Continuous capillaries • The endothelial cells are continuous • Tight junctions hold the cells together • Selective transport of materials takes place through pinocytic vesicles • Found in skin, lungs, muscle and brain 2. Fenestrated capillaries • The endothelial cells have pores in between • Diaphragm, made of mucoprotein, closes the pores • Diffusion of materials takes place through the diaphragm • Found in intestinal villi, endocrine glands, etc

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Competency Based Qs and As in Anatomy

5. Compare and contrast the structure and function of capillary and sinusoid. Feature

Capillary

Sinusoid

Definition

Vessels that lie closet to the tissue that they supply

Large, irregular and expanded capillaries

Size

4–8 m in diameter

30–40 m in diameter

Continuity of endothelium

Can allow passage of single blood cell and that too with considerable deformity Endothelium is continuous. Adjacent cells are connected by tight junctions and act as true barrier (fenestrations are seen in fenestrated capillaries)

Endothelium exhibits true discontinuity

5.4 EXPLAIN FUNCTIONAL DIFFERENCE BETWEEN ELASTIC, MUSCULAR ARTERIES AND ARTERIOLES SHORT ESSAY 1. Classify arteries with examples. Compare and contrast the structures of elastic and muscular artery. Classification of Arteries 1. Conducting vessels • They measure more than 10 mm in diameter • Constitute the large arteries and their branches • E.g.—aorta

2. Distributing vessels • They measure 2–10 m in diameter • E.g.—renal artery 3. Resistance vessels • Arterioles • Their diameter varies between 10–100 microns • They are of 3 types: – Large arterioles – Terminal arterioles – Meta-arterioles

Elastic artery

Muscular artery

Also known as conducting vessel Large arteries Tunica media constitutes of elastic fibers

Also known as distributing vessel Medium-sized arteries Tunica media constitutes of muscular tissue (75%) mainly and elastic fibers Function is to supply blood to organs or limbs E.g.—renal artery

Function is to conduct blood from heart to the muscular artery E.g.—aorta

SHORT ANSWERS 1. Compare and contrast the structure of a muscular artery and an arteriole. Muscular artery

Arteriole

Also known as distributing vessel Diameter is 2–10 m Tunica media constitutes of muscular tissue (75%) mainly and elastic fibers Function is to supply blood to organs or limbs

Also known as resistance vessel Diameter is 10–100 m Tunica media is made up of smooth muscles

E.g.—renal artery

Function is to supply blood and also provide peripheral resistance to blood flow 3 types—large arterioles, terminal arterioles, meta-arterioles

2. Compare and contrast the structure of continuous and fenestrated capillaries. Continuous capillaries

Fenestrated capillaries

The endothelial cells are continuous Tight junctions hold the cells together Selective transport of materials takes place through pinocytic vesicles Found in skin, lungs, muscle and brain

The endothelial cells have pores in between Diaphragm, made of mucoprotein, closes the pores Diffusion of materials takes place through the diaphragm Found in intestinal villi, endocrine glands, etc.

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5.5 DESCRIBE PORTAL SYSTEM GIVING EXAMPLES SHORT ANSWERS 1. Define portal system. Give examples. Portal System • Portal system is a type of circulatory system which begins with capillaries and terminates with capillaries. • Hepatic portal system—venous blood of the gut, pancreas and spleen reach the liver via the portal

vein. In liver, secondary capillary bed is formed, known as hepatic sinusoids Examples • Hypothalamo-hypophyseal portal circulation— between the capillaries of hypothalamus and anterior pituitary • Renal portal circulation—efferent arterioles between the glomerular capillaries and capillary plexus around the proximal and distal convoluted tubules.

2. Compare and contrast systemic and portal circulation. Systemic circulation

Portal circulation

Blood is carried from left ventricle of the heart via arteries and then capillaries, veins carry the blood back to right atrium of the heart Main function is the oxygenation of various parts of the body

Portal vessel carries blood from a capillary network and than branches to form the terminating capillary network or sinusoids Function is to aid in absorption of nutrients, carrying hormones, reabsorption of salts and other constituents Present in hepatic portal system, hypothalamohypophyseal system, renal portal circulation

Present throughout the body

5.6 DESCRIBE THE CONCEPT OF ANASTOMOSES AND COLLATERAL CIRCULATION WITH SIGNIFICANCE OF END-ARTERIES SHORT ESSAY 1. Define anastomosis. Describe different types of anastomosis. Anastomosis Communication between the blood vessels is known as anastomosis. Types of Anastomosis 1. Arterial anastomosis • Communication between branches of two arteries forming anastomosis • Functions as collateral channel in case of blockage of one of the arteries • It may be actual or potential anastomosis i. Actual anastomosis – Can occur in the following way: o End-to-end anastomosis

o Ends of the arteries join to form anastomosis o E.g.—facial arteries – Convergent anastomosis o Convergence of two smaller arteries to form a larger artery o E.g.—anastomosis of vertebral arteries to form basilar artery ii. Potential anastomosis – Occurs between terminal arterioles – In case of sudden blockage of one of the arteries, a collateral circulation cannot be formed – But over a period, the arterioles can dilate to form a collateral circulation – E.g—coronary arteries 2. Arteriovenous anastomosis • Communication between an artery and a vein without the capillaries in between

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Competency Based Qs and As in Anatomy

• Also called arteriovenous shunts • The shunts are usually formed between a terminal arteriole and a venule • The wall of the shunt is thick, muscular, with rich vasomotor sympathetic nerve supply • They can act like a sphincter, and allow direct passage of blood, bypassing the capillaries • Sites of arteriovenous shunts – Skin over lips, nose and external ear – Tongue – Thyroid gland – Mucosal membrane of nose, alimentary canal – Erectile tissue of sex organs • Function—regulates temperature, blood pressure, and regional blood flow 3. Venous anastomosis • Communication between the tributaries of veins • E.g.—dorsal venous arch of hand and the foot

• Can be present normally to supply a particular region. E.g.—circle of Willis in brain

SHORT ANSWERS 1. Define collateral circulation. Describe its function.

Types 1. Anatomic or true end artery 2. Functional end artery

Collateral Circulation • Circulation that occurs through the anastomosis is referred to as the collateral circulation

Clinical Significance Blockage of the end arteries leads to ischemia and cell necrosis of the area supplied.

Function • Helps in maintaining blood supply in case of blockage of one of the arteries • Potential anastomosis is where the collateral circulation is formed by the arterioles if sufficient time is given. E.g.— coronary arteries 2. Define end arteries. Mention their types and clinical significance. End Arteries • Arteries with no pre-capillary anastomosis • They are found in – Central artery of retina – Arteries of spleen, kidney and liver – Arteries of metaphysis of long bone – Central branches of cerebral arteries

5.7 EXPLAIN FUNCTION OF META-ARTERIOLES, PRECAPILLARY SPHINCTERS, ARTERIOVENOUS ANASTOMOSES SHORT ESSAY 1. Define arteriovenous anastomosis. List the sites where these are present. Mention its functions. Arteriovenous Anastomosis (Fig. 5.7.1) • Direct connection between the smaller arteries and veins is referred to as arteriovenous anastomosis • Also called arteriovenous shunts • The wall of the shunt is thick, muscular with rich vasomotor sympathetic nerve supply • They can act like a sphincter, and allow direct passage of blood, bypassing the capillaries • The number of arteriovenous anastomosis is less at the extremes of age (newborns and old age), and

hence temperature regulation is less efficient in these age. Sites of Arteriovenous Shunts • Skin over lips, nose, external ear • Tongue • Thyroid gland • Mucosal membrane of nose and alimentary canal • Erectile tissue of sex organs Functions 1. Regulates temperature by regulating the flow of blood across the capillary bed 2. Regulates blood pressure in portal venous system 3. Regulates regional blood flow

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Fig. 5.7.1: Arteriovenous anastomosis

SHORT ANSWER 1. Compare and contrast structure and function of terminal and meta-arterioles. Terminal arteriole

Meta-arteriole

Larger diameter— 15–20 m Walls have smooth muscle Internal elastic lamina absent Pericytes absent

Smaller diameter—