ABDOMEN

🦴Anterior & Posterior Abdominal Wall

1. Anterior Abdominal Wall:

𝙌1 Show drainage areas of different groups of lymph nodes.

• Superficial Inguinal Nodes:

Location: Located in the groin region.

Drainage: Skin of the lower abdomen, perineum, buttocks, and external genitalia.

• Deep Inguinal Nodes:

Location: Deeper within the inguinal region.

Drainage: Receive lymph from the superficial inguinal nodes and also drain the deeper structures of the lower limb (e.g., muscles, bones).

• External Iliac Nodes:

Location: Along the external iliac vessels.

Drainage: Receive lymph from the deep inguinal nodes and drain the lower limb, external genitalia, and lower part of the abdominal wall.

• Common Iliac Nodes:

Location: Along the common iliac vessels.

Drainage: Receive lymph from the external iliac nodes and drain the corresponding half of the pelvis and lower limb.

• Para-aortic Nodes:

Location: Along the aorta.

Drainage: Receive lymph from the common iliac nodes and drain a wide area, including the kidneys, ureters, gonads, and abdominal viscera.

𝙌2 Inguinal Hernia: Define and Explain the basis / Define the condition & explain why it is common in male.

• Definition: An inguinal hernia is the protrusion of a part of the intestine or other abdominal contents through a weakness in the abdominal wall in the inguinal region.

• Basis:

Weakness in the abdominal wall: The inguinal region is an area of inherent weakness due to the passage of the spermatic cord in males and the round ligament of the uterus in females.

Increased intra-abdominal pressure: Conditions like chronic cough, constipation, and heavy lifting can increase pressure within the abdomen, pushing abdominal contents through the weakened area.

• More common in males:

Larger inguinal canal: The inguinal canal in males is larger to accommodate the passage of the spermatic cord, making it more susceptible to herniation.

Descent of the testes: The passage of the testes through the inguinal canal during fetal development creates a potential weakness.

𝙌3 Direct Inguinal Hernia: Explain anatomical basis of formation.

• Direct Inguinal Hernias: Protrude directly through the transversalis fascia, medial to the inferior epigastric vessels.

Anatomical Basis: Weakening of the transversalis fascia, often due to age-related changes or increased intra-abdominal pressure.

𝙌4 Inguinal Lymph Node: Describe drainage area of different groups of lymph nodes.

See the answer to question 1.

𝙌5. Caput Medusae: Define the condition and explain the anatomical basis of formation.

• Definition: Caput Medusae is a condition characterized by a network of prominent, dilated veins radiating from the umbilicus (belly button).

• Anatomical Basis:

Portal Hypertension: Increased pressure within the portal vein (which carries blood from the intestines to the liver) due to conditions like cirrhosis, liver fibrosis, or portal vein thrombosis.

Collateral Circulation: When blood flow through the liver is obstructed, it seeks alternative routes. The veins around the umbilicus (paraumbilical veins) establish connections between the portal system and systemic veins, leading to their dilation and the characteristic appearance of Caput Medusae.

𝙌6. Posterior Abdominal Wall in torso model: Show locations where different groups of lymph nodes lie & describe lymphatic drainage in different groups. Mention areas of drainage of pre-aortic group of lymph nodes.

• Locations of Lymph Nodes:

Para-aortic Nodes: Located along the aorta.

Lumbar Nodes: Located along the lumbar arteries.

Renal Nodes: Located around the renal hilum.

• Lymphatic Drainage:

Para-aortic Nodes: Drain a wide area, including the kidneys, ureters, gonads, and abdominal viscera.

Lumbar Nodes: Drain the lumbar region and associated muscles.

Renal Nodes: Drain the kidneys.

𝙌7. Regional Dissection of anterior abdominal wall: procedure

Skin Incision: Make a midline incision or a paramedian incision (parallel to the midline).
Superficial Fascia: Incise and reflect the superficial fascia (Camper's and Scarpa's fascia).
External Oblique Muscle: Identify and incise the external oblique aponeurosis, following the direction of its fibers.
Internal Oblique Muscle: Identify and incise the internal oblique aponeurosis, following the direction of its fibers.
Transversus Abdominis Muscle: Identify and incise the transversus abdominis aponeurosis.
Transversalis Fascia: Identify and incise the transversalis fascia.
Identify structures:

Inguinal Canal: Identify the deep inguinal ring, superficial inguinal ring, and contents of the inguinal canal (spermatic cord in males, round ligament in females).

Rectus Abdominis Muscle: Identify the rectus sheath and the linea alba.

Blood vessels and nerves: Identify the epigastric vessels, circumflex iliac vessels, and the ilioinguinal and iliohypogastric nerves.

𝙌8. Inguinal Hernia: Define the condition & Explain why it is more common in males.

• See the answer to question 2.

𝙌9. Direct Inguinal Hernia: Explain anatomical basis of formation.

• See the answer to question 3.

𝙌10. Paracentesis: Describe its procedure.

• Paracentesis is a medical procedure used to remove fluid that has accumulated in the abdomen (ascites).

• Procedure:

~The patient typically lies on their back.

~The abdomen is cleaned with antiseptic solution.

~Local anesthesia is administered to the area where the needle will be inserted.

~A small incision is made in the abdomen.

~A thin needle or catheter is inserted into the abdomen, guided by ultrasound or other imaging techniques.

~Fluid is drained from the abdomen into a sterile container.

~The puncture site is then cleaned and bandaged.

𝙌11. Systemic Embryology and related anomalies

• Embryological Development: The abdominal wall develops from the lateral and ventral body walls of the embryo.

• Related Anomalies:

Gastroschisis: A congenital defect where the abdominal wall fails to close completely, resulting in the intestines protruding outside the body.

Omphalocele: A congenital defect where the intestines and other abdominal organs remain within the umbilical cord.

Diaphragmatic hernia: A congenital defect where a portion of the abdominal organs herniates into the chest cavity through a defect in the diaphragm.

𝙌12. Veins of abdomen: Read the figure & Explain what special understanding it offers.

• General Understanding:

Portal Circulation: The figure would likely depict the portal vein and its tributaries (e.g., splenic vein, superior mesenteric vein). Understanding these veins is crucial for understanding portal circulation and its role in liver function.

Collateral Circulation: The figure might also show potential collateral pathways for blood flow in cases of portal hypertension, such as the esophageal veins, rectal veins, and paraumbilical veins.

Inferior Vena Cava: The figure would likely show the inferior vena cava and its tributaries, providing an understanding of how blood is returned from the lower limbs and abdomen to the heart.

Alimentary System Stomach

𝙌1. Stomach in relation to Torso

• Points in Favor:

Location: Primarily in the left hypochondrium and epigastric regions of the abdomen.

Anterior Relations:

▪ Diaphragm

▪ Liver

▪ Anterior abdominal wall

Posterior Relations:

▪ Pancreas

▪ Spleen

▪ Left kidney

▪ Left adrenal gland

• Parts:

Cardia: Entrance of the esophagus.

Fundus: Dome-shaped portion above the esophageal opening.

Body: Main central portion.

Pyloric Antrum: Funnel-shaped region leading to the pylorus.

Pyloric Canal: Narrowed outlet of the stomach.

Pylorus: Muscular sphincter controlling passage into the duodenum.

• Surfaces:

~Anterior Surface

~Posterior Surface

• Borders:

~Lesser Curvature: Short, concave border on the right side.

~Greater Curvature: Long, convex border on the left side.

Cross-Questions:

𝙌• Why is the fundus typically filled with gas?

Ans: - Due to swallowed air.

𝙌• What is the clinical significance of the lesser curvature?

Ans: -Site of frequent peptic ulcer formation.

𝙌2. Stomach in relation to Skeleton

• Points in Favor:

~Lies deep to the ribs and costal cartilages of the left side of the thorax.

~Related to the diaphragm superiorly.

• Stomach Bed:

~Formed by the left lobe of the liver, left kidney, spleen, pancreas, and left suprarenal gland.

• Gastric Canal:

~A narrow channel along the lesser curvature.

~Directs food towards the pylorus.

Cross-Questions:

𝙌• How does the diaphragm affect stomach position during respiration?

~The diaphragm pushes down during inspiration, slightly displacing the stomach.

𝙌3. Stomach: Arterial Supply Parts of the Stomach and their Arterial Supply:

• Cardia: Supplied by the left gastric artery (from the celiac trunk).

• Fundus: Supplied by the short gastric arteries (from the splenic artery) and the left gastric artery.

• Body: Supplied by the left gastric artery and short gastric arteries.

• Pyloric Antrum: Supplied by the right gastric artery (from the common hepatic artery) and the right gastroepiploic artery (from the gastroduodenal artery).

• Pylorus: Supplied by the right gastric artery and the right gastroepiploic artery.

Mode of Arterial Supply:

• Anastomoses: The stomach receives blood supply from multiple branches that form extensive anastomoses (connections) along the lesser and greater curvatures. This provides a rich and redundant blood supply to the organ.

Sources of Arterial Supply:

• Celiac Trunk: The primary source of blood supply to the stomach. It gives rise to:

~Left gastric artery: Supplies the lesser curvature.

~Splenic artery: Gives rise to the short gastric arteries and the left gastroepiploic artery.

• Common Hepatic Artery:

~Gives rise to the right gastric artery which supplies the lesser curvature.

~Gives rise to the gastroduodenal artery which in turn gives rise to the right gastroepiploic artery that supplies the greater curvature.

𝙌4. Stomach: Lymph Nodes

• Gastric lymph nodes: Located along the lesser and greater curvatures.

• Celiac lymph nodes: Receive lymph from the gastric nodes.

𝙌5. Stomach: Venous Drainage

• Left gastric vein: Drains into the portal vein.

• Right gastric vein: Drains into the portal vein or the hepatic vein.

• Left gastroepiploic vein: Drains into the splenic vein.

𝙌6. Development of Stomach with Rotation

• Right gastroepiploic vein: Drains into the superior mesenteric vein.

• Rotation: The stomach undergoes a 90-degree clockwise rotation around its longitudinal axis.

• Significance: This rotation explains the final positions of the greater and lesser curvatures and the nerves.

𝙌7. Stomach: Nervous System

• Sympathetic:

~Inhibits gastric secretion and motility.

~From the celiac and splanchnic nerves.

• Parasympathetic (Vagas nerve):

~Stimulates gastric secretion and motility.

~Anterior and posterior vagal trunks.

𝙌8. Stomach: Nerve Supply

Vagas nerve: Provides parasympathetic innervation.

Sympathetic nerves: From the celiac and splanchnic nerves.

𝙌9. Peptic Ulcer Disease

• Definition: Erosion of the mucosal lining of the stomach or duodenum.

• Anatomical Basis:

~Helicobacter pylori infection: Weakens the mucosal barrier.

~Excessive acid secretion: Due to increased gastric acid production or decreased mucosal protection.

~Use of NSAIDs: Can damage the mucosal lining.

𝙌10. Structure-Function Relationship of Stomach Muscles

• Oblique layer: Allows for churning and mixing of food.

• Circular layer: Controls the movement of food through the stomach.

• Longitudinal layer: Shortens the stomach during peristalsis.

Duodenum, Pancreas, Spleen

1. Spleen: Show & Describe course & termination of venous drainage. / Mode of venous drainage.

Course:

▪ Blood from the spleen is drained by the splenic vein.

▪ The splenic vein runs along the posterior border of the pancreas.

Termination:

▪ The splenic vein joins the superior mesenteric vein behind the neck of the pancreas to form the portal vein.

Mode of Venous Drainage:

▪ The splenic vein drains blood from the spleen and contributes to the portal venous system, which carries blood from the digestive tract to the liver for processing.

𝙌2. Spleen: Show origin, course & mode of artery supply.

Origin: The splenic artery arises from the celiac trunk.

Course: It runs along the upper border of the pancreas, tortuous in its course.

Mode of Artery Supply:

▪ The splenic artery branches extensively within the spleen, supplying its various compartments.

▪ It exhibits a unique pattern of branching, with some branches ending in capillaries (open circulation) and others supplying sinuses (closed circulation).

𝙌3. Spleen: Show different parts & Mention open & close circulation

Parts:

▪ Hilum: The concave medial surface where vessels and nerves enter and exit.

▪ Diaphragmatic surface: Smooth and convex, related to the diaphragm.

▪ Visceral surface: Related to the stomach, kidney, and pancreas.

Open Circulation: Blood filters through the splenic cords (red pulp), allowing for removal of aged red blood cells and immune surveillance.

Closed Circulation: Blood flows through the splenic sinuses (red pulp).

𝙌4. Spleen in relation to skeleton: Hold viscus in relation to skeleton & Give points in favor. Show axis, surfaces, borders. (With cross questions)

Points in Favor:

▪ Lies in the left hypochondrium, deep to the 9th-11th ribs.

▪ Related to the diaphragm superiorly, left kidney posteriorly, and stomach anteriorly.

Axis: Long axis directed Antero posteriorly.

Surfaces:

▪ Diaphragmatic surface: Smooth and convex, related to the diaphragm.

▪ Visceral surface: Related to the stomach, kidney, and pancreas.

Borders:

▪ Anterior border: Thin and sharp.

▪ Posterior border: Blunt.

Cross-Questions:

𝙌• Why is the spleen vulnerable to injury from blunt trauma to the left upper quadrant?

Ans: -Due to its proximity to the ribs and its relatively fragile nature.

𝙌• What are the potential consequences of splenic rupture?

Ans: -Significant bleeding into the abdominal cavity.

𝙌5. Spleen in relation to skeleton: Hold viscus in anatomical position in relation to skeleton & Give points in favor. Show relations of both surface in torso model. (With cross questions)

Points in Favor:

▪ As mentioned above.

Diaphragmatic Surface:

▪ Related to the diaphragm and 9th-11th ribs.

Visceral Surface:

▪ Related to the stomach (gastric impression), kidney (renal impression), and pancreas (pancreatic impression).

Cross-Questions:

𝙌What is the clinical significance of the splenic hilum?

Ans: -It is the site of entry and exit for the splenic artery, vein, and nerves.

𝙌6. Spleen in relation to skeleton: Hold viscus in anatomical position in relation to skeleton & Give points in favor. Show & Describe gross features, & Mention its functions. (With cross questions)

Points in Favor:

▪ As mentioned above.

Gross Features:

▪ Purple-colored organ, soft in consistency.

▪ Hilum on the medial surface.

▪ Trabeculae within the spleen provide structural support.

Functions:

▪ Immune function:

▪ Filters blood, removes aged red blood cells, and removes pathogens.

▪ Produces lymphocytes and antibodies.

▪ Blood storage:

▪ Can store a reserve of blood.

Cross-Questions:

𝙌• What are the potential consequences of splenectomy?

Ans: -Increased susceptibility to infections, especially encapsulated bacteria.

𝙌7. Portal Vein: Show site of formation & Identify formative tributaries. / Identify formative veins, describe course and termination.

• Site of Formation:

~Formed by the union of the splenic vein and the superior mesenteric vein behind the neck of the pancreas.

• Formative Tributaries:

~Splenic vein

~Superior mesenteric vein

• Course:

~Ascends along the right side of the pancreas.

• Termination:

~Enters the liver through the porta hepatis.

𝙌8. Porto-caval Anastomoses: Mention sites with corresponding portal and systemic veins with Clinical importance.

• Sites:

Esophageal veins:

▪ Portal system: Left gastric vein.

▪ Systemic system: Azygos vein.

Rectal veins:

▪ Portal system: Superior rectal vein (from inferior mesenteric vein).

▪ Systemic system: Middle and inferior rectal veins.

Umbilical veins:

▪ Portal system: Paraumbilical veins.

▪ Systemic system: Epigastric veins.

Retroperitoneal veins:

▪ Portal system: Retroperitoneal veins draining into the portal vein.

▪ Systemic system: Lumbar veins and others.

• Clinical Importance:

~In cases of portal hypertension (e.g., cirrhosis), blood flow through the liver is obstructed.

~This can lead to increased pressure in the portal vein, forcing blood to seek alternative routes through these anastomoses.

~This can result in varices (dilated veins) at these sites, which can rupture and cause life-threatening bleeding.

𝙌9. Development of pancreas: Explain why annular pancreas develops.

• Development: The pancreas develops from two buds:

Ventral bud: Arises from the hepatic diverticulum.

Dorsal bud: Arises from the dorsal wall of the duodenum.

• Annular Pancreas:

~Occurs when the ventral and dorsal pancreatic buds encircle the duodenum during development.

~This can lead to partial or complete obstruction of the duodenum, resulting in vomiting and abdominal distension.

𝙌10. Pancreas in relation to skeleton: Hold viscus in anatomical position in relation to skeleton & Give points in favor. Describe gross features. (With cross questions)

• Points in Favor:

~Lies retroperitoneally, extending from the duodenum to the spleen.

~Related to the posterior abdominal wall.

• Gross Features:

~Head: Broadest part, lies within the C-shaped curve of the duodenum.

~Neck: Connects the head to the body.

~Body: Elongated portion, passes posterior to the stomach.

~Tail: Extends to the left, reaching the hilum of the spleen.

Cross-Questions:

𝙌• What is the clinical significance of the close relationship between the pancreas and the duodenum?

~Pancreatitis can lead to duodenal ulcers.

~Gallstones can obstruct the common bile duct, leading to pancreatitis.

𝙌11. Pancreas in relation to skeleton: Hold viscus in anatomical position in relation to skeleton & Give points in favor. Show & Describe gross features, & Mention its functions. (With cross questions)

• Points in Favor:

As mentioned above.

• Gross Features:

See the description above. Has both endocrine and exocrine functions.

• Functions:

Endocrine: Produces hormones (insulin, glucagon) that regulate blood sugar levels.

Exocrine: Produces digestive enzymes (e.g., amylase, lipase, trypsin) that are secreted into the duodenum.

Cross-Questions:

𝙌• What are the potential consequences of chronic pancreatitis?

Ans: -Malabsorption, diabetes, and pancreatic insufficiency.

𝙌12. Pancreas: Describe artery supply.

• Arterial Supply:

Pancreaticoduodenal arteries:

▪ Superior pancreaticoduodenal artery: From the gastroduodenal artery (branch of the common hepatic artery).

▪ Inferior pancreaticoduodenal artery: From the superior mesenteric artery.

Splenic artery: Supplies the tail of the pancreas.

𝙌13. Pancreas: Mention its sources of development & derivatives of ventral & dorsal pancreatic buds.

• Sources of Development:

The pancreas arises from two embryonic buds:

▪ Ventral bud: Arises from the hepatic diverticulum.

▪ Dorsal bud: Arises from the dorsal wall of the duodenum.

• Derivatives:

Ventral bud: Gives rise to the uncinate process of the pancreas and part of the head.

Dorsal bud: Gives rise to the majority of the pancreas, including the body, tail, and the remaining portion of the head.

𝙌14. Duodenum in relation to torso: Hold viscus in anatomical position in relation to torso model & Give points in favor. Show different parts with their directions, lenths, gross feature. (With cross questions)

• Points in Favor:

~The duodenum is the first part of the small intestine.

~It has a characteristic C-shaped curve that encircles the head of the pancreas.

~It is primarily retroperitoneal (behind the peritoneum).

• Different Parts:

First Part (Superior Part):

▪ Shortest part.

▪ Lies anterior to the portal vein and common bile duct.

▪ Superiorly related to the liver.

Second Part (Descending Part):

▪ Descends along the right side of the vertebral column.

▪ Contains the major duodenal papilla (where the common bile duct and pancreatic duct enter).

Third Part (Horizontal Part):

▪ Crosses the vertebral column anteriorly.

▪ Lies anterior to the inferior vena cava and aorta.

Fourth Part (Ascending Part):

▪ Ascends to the left to join the jejunum.

• Lengths: Approximately 25-30 centimeters long.

• Gross Features: Relatively wide and fixed in position due to its retroperitoneal attachment.

Cross-Questions:

𝙌• What is the significance of the major duodenal papilla?

Ans: -It is the site where bile from the liver and gallbladder and pancreatic enzymes enter the duodenum for digestion.

𝙌• Why is the second part of the duodenum susceptible to duodenal ulcers?

Ans: -It is exposed to the corrosive effects of gastric acid and pepsin.

• Interior of the Second Part: Major duodenal papilla:

𝙌15. Duodenum in relation to torso: Hold viscus/model in anatomical position in relation to torso model & Show different parts with their direction. Describe interior of 2nd part. (With cross questions)

• Different Parts and Directions:

o See the description above (in question 14).

▪ A raised, nipple-like projection where the common bile duct and the main pancreatic duct join and open into the duodenum.

Minor duodenal papilla:

▪ A smaller opening above the major duodenal papilla, present in some individuals.

▪ May be the opening of an accessory pancreatic duct.

Cross-Questions:

𝙌. What are the potential consequences of obstruction of the major duodenal papilla?

Ans: -Impaired digestion and absorption of nutrients, leading to malnutrition.

𝙌16. Duodenum: Show parts of duodenum mentioning artery supply.

• Parts:

o See the description above (in question 14).

• Arterial Supply:

Superior pancreaticoduodenal artery:

▪ Branches from the gastroduodenal artery (from the common hepatic artery).

▪ Supplies the superior part of the duodenum.

Inferior pancreaticoduodenal artery:

▪ Branches from the superior mesenteric artery.

▪ Supplies the inferior part of the duodenum.

𝙌17. Duodenum: Mention the source of development & Explain why it has dual artery supply

• Source of Development: The duodenum develops from both the foregut and midgut.

• Dual Artery Supply:

~The foregut portion is supplied by the celiac trunk (via the gastroduodenal artery and superior pancreaticoduodenal artery).

~The midgut portion is supplied by the superior mesenteric artery (via the inferior pancreaticoduodenal artery).

~This dual arterial supply reflects the embryological origin of the duodenum from two different parts of the primitive gut.

𝙌18. Duodenum, pancreas & spleen in relation to torso: Hold (conjoined) viscera in relation to torso model, Give points in favor & Show different parts. Show relations of posterior surface of head & neck of pancreas.

• Points in Favor:

~These organs are closely related and form a crucial part of the digestive system.

~They have important anatomical and functional interrelationships.

• Different Parts:

~Duodenum: Four parts (see question 14).

~Pancreas: Head, neck, body, tail.

~Spleen: Diaphragmatic surface, visceral surface, hilum.

• Relations of Posterior Surface of Head & Neck of Pancreas:

~Head:

▪ Right kidney

▪ Right colic flexure

▪ Common bile duct

▪ Superior mesenteric vessels

~Neck:

▪ Superior mesenteric vessels

▪ Portal vein

▪ Uncinate process of the pancreas

Cross-Questions:

𝙌• What is the significance of the C-shaped curve of the duodenum?

Ans: -It accommodates the head of the pancreas.

𝙌• What structures pass through the head of the pancreas?

Ans: - Common bile duct , Gastroduodenal artery

𝙌• What is the clinical significance of the close relationship between the pancreas and the duodenum?

o Pancreatitis can lead to duodenal ulcers.

o Gallstones can obstruct the common bile duct, leading to pancreatitis.

Liver & Gall bladder :

1. Liver in relation to Skeleton:

• Points in Favor:

o Largest abdominal organ, situated in the right upper quadrant of

the abdomen.

o Extends from the right hypochondrium to the epigastric and left

hypochondriac regions.

o Protected by the lower ribs and diaphragm superiorly.

• Anatomical and Physiological Lobes:

o Right lobe (larger): Extends to the right midclavicular line.

o **Left lobe (smaller): Extends to the left median line and houses

the falciform ligament.

o Functional lobes: Divided into eight functional segments based on

portal venous supply, bile drainage, and blood flow.

• Surfaces:

o Diaphragmatic surface (superior): Smooth and convex, related to

the diaphragm and pericardium.

o Visceral surface (inferior): Irregular and concave, related to the

stomach, duodenum, right kidney, right adrenal gland, and omental

attachments.

• Borders:

o Anterior border: Sharp and thin, separates the right and left lobes.

o Posterior border: Blunt and thick, contains the hilum (gateway for

vessels, nerves, and bile ducts).

o Right border: Thick and separates the right lobe from the kidney

and adrenal gland.

o Left border: Thin and separates the left lobe from the stomach.

• Functions:

o Essential metabolic functions: Carbohydrate metabolism, protein

synthesis, lipid metabolism, detoxification, and bile production.

o Storage: Stores glucose (glycogen), vitamins, minerals, and iron.

o Hematopoiesis (in fetus): Produces red blood cells.

2. Relations of Right Lateral Surface:

• Related to the diaphragm, ribs, and pleura superiorly.

• In contact with the lateral abdominal wall muscles inferiorly.

• Right kidney and right suprarenal gland posteriorly.

Ligaments of the Liver:

• Falciform ligament: Attaches the liver to the anterior abdominal wall and

diaphragm.

• Coronary ligament: Suspends the liver from the diaphragm.

• Lesser omentum: Connects the liver to the stomach and duodenum

(includes the hepatoduodenal ligament and the hepatogastric ligament).

3. Relations of Inferior Surface:

• Related to the following structures:

o Stomach (fundus)

o Duodenum (first part)

o Right colic flexure

o Omental bursa

o Right kidney

o Right adrenal gland

4. Portocaval Anastomoses:

• Bare Area:

o A small triangular area on the inferior surface not covered by

peritoneum.

o Boundaries:

▪ Anterior: Falciform ligament

▪ Left: Left triangular ligament

▪ Right: Right triangular ligament

• Three sites of portosystemic anastomoses (connections between portal

and systemic circulation):

o Esophageal veins: Connect the portal system (left gastric vein) to

the systemic system (azygos vein).

o Rectal veins: Connect the portal system (superior rectal vein) to the

systemic system (middle and inferior rectal veins).

o Paraumbilical veins: Connect the portal system (paraumbilical

veins) to the systemic system (epigastric veins).

5. Portal Circulation:

• A unique circulatory system delivering blood from the digestive organs to

the liver for processing.

• Pathway:

o Blood from the intestines, spleen, and stomach flows through the

splenic vein and superior mesenteric vein.

o These veins unite to form the portal vein, which enters the liver.

o Within the liver, the portal vein branches into smaller vessels and

sinusoids.

o Liver cells (hepatocytes) take up nutrients and process blood.

o Processed blood exits the liver through hepatic veins and joins the

inferior vena cava.

6. Arterial Supply:

• Dual blood supply:

o Portal vein (80%): Carries blood rich in nutrients from the digestive

organs.

o Hepatic artery (20%): Supplies oxygenated blood from the aorta.

7. Venous Drainage:

• Hepatic veins collect processed blood from the liver lobules.

8. Explanatory Figure:

• These veins unite to form larger hepatic veins that drain into the inferior

vena cava.

I can't directly show figures, but refer to anatomical atlases or online resources

for detailed liver illustrations.

9. 3D Schematic Diagram of Hepatic Sinusoid and Lobule:

3D Schematic Diagram of Hepatic Sinusoid

• Shape: Imagine a highly irregular, interconnected network of spaces

between the plates of hepatocytes.

• Components:

o Sinusoidal Endothelial Cells: These cells line the sinusoids. They

have large pores (fenestrations) that allow for free exchange of

substances between the blood and hepatocytes.

o Kupffer Cells: These are specialized macrophages that reside within

the sinusoids. They play a crucial role in removing bacteria, debris,

and old red blood cells from the bloodstream.

o Hepatocytes: These liver cells form plates that surround the

sinusoids. They are responsible for most of the liver's metabolic

functions.

o Space of Disse: This is the narrow space between the sinusoidal

endothelial cells and the hepatocytes. It allows for the exchange of

substances between the blood and hepatocytes.

o Stellate Cells (Ito Cells): These cells are located in the Space of

Disse. They play a role in vitamin A storage and in the development

of liver fibrosis.

Key Features:

• High permeability: The fenestrations in the endothelial cells allow for

rapid exchange of substances between the blood and hepatocytes.

• Slow blood flow: This allows for ample time for the exchange of

substances between the blood and hepatocytes.

In Summary:

Note:

• Unique cell population: The presence of Kupffer cells and stellate cells

within the sinusoids contributes to the liver's important immune and

metabolic functions.

The hepatic sinusoid is a highly specialized and complex structure that plays a

critical role in liver function. Its unique architecture and cellular composition

facilitate the liver's diverse metabolic and immune functions.

• This is a simplified description. The actual structure of the hepatic sinusoid

is more intricate.

Visualizing this in 3D is crucial for understanding the complex interactions

between the different cell types and the flow of blood and other substances

within the liver.

10. 3D Schematic Diagram of Hepatic Lobule, Portal Lobule and Portal

Acinus/Three models of liver organization

• Hepatic Lobule:

o The classic model, considered the structural unit of the liver.

o Hexagonal-shaped, with a central vein at its center.

o Portal triads (portal vein branch, hepatic artery branch, and bile

duct) are located at the corners.

o Hepatocytes radiate outward from the central vein towards the

periphery.

• Portal Lobule:

o Defined by a portal triad at its center.

o Hepatocytes radiate outward from the portal triad.

• Portal Acinus:

o A triangular region defined by three adjacent central veins.

o Reflects the pattern of blood flow within the liver.

o Zones of the acinus are defined based on their proximity to the

terminal branches of the portal vein and hepatic artery.

11. Blood & Biliary Flow in Liver

• Blood Flow:

o Oxygenated blood from the hepatic artery and nutrient-rich blood

from the portal vein enter the liver lobules.

o Blood mixes within the hepatic sinusoids.

o Hepatocytes process the blood, removing toxins and storing

nutrients.

o Blood then flows into the central vein, which drains into the hepatic

veins and ultimately into the inferior vena cava.

• Biliary Flow:

o Bile is produced by hepatocytes.

o It flows through bile canaliculi (small channels between

hepatocytes) towards the periphery of the lobule.

o Bile then enters bile ducts within the portal triads.

o Bile ducts merge to form larger ducts, eventually forming the right

and left hepatic ducts, which unite to form the common hepatic

duct.

12. TS through stomach, liver, spleen: Read the figure & Explain what special

understanding it offers.

• Special Understanding:

o A transverse section would provide an excellent view of the spatial

relationships between these organs.

o You would see the stomach lying anteriorly, the liver superiorly, and

the spleen posteriorly.

o The section would demonstrate the curvature of the stomach and

the dome-shaped configuration of the diaphragm.

o It would also reveal the close proximity of the spleen to the tail of

the pancreas.

13. Special Figure:

• This likely refers to a specific diagram or image related to liver anatomy

or function. Without the specific figure, it's difficult to provide an

explanation.

14. Clinical Anatomy:

• This is a broad area encompassing the application of anatomical

knowledge to clinical practice.

• Examples include:

o Understanding the spread of liver tumors or infections.

o Interpreting imaging studies (e.g., ultrasound, CT scan) of the liver.

o Performing liver biopsies and other procedures.

15. Acute Cholecystitis: Explain why pain is felt at tip of shoulder in this

condition.

• Acute Cholecystitis: Inflammation of the gallbladder.

• Referred Pain:

o The gallbladder is innervated by the phrenic nerve (C3-C5).

o The phrenic nerve also innervates the diaphragm.

o Pain signals from the gallbladder can be misinterpreted by the brain

as originating from the diaphragm, leading to referred pain in the

right shoulder tip.

16. Liver Biopsy: Mention site & Explain why this site is chosen.

• Site: Usually performed through the right intercostal space (between the

7th and 9th ribs) under ultrasound or CT guidance.

• Reason for Choice:

o This approach provides relatively easy access to the right lobe of

the liver, which is the largest lobe.

17. Systemic Embryology and related anomalies

• Development: The liver develops from the hepatic diverticulum, an

outgrowth of the foregut endoderm.

• Anomalies:

o Biliary atresia: Congenital obstruction of the bile ducts, leading to

jaundice and liver damage.

o Liver cysts: Fluid-filled sacs within the liver.

o Polycystic liver disease: Multiple cysts within the liver.

18. Liver: Mention source of development of different types of cells.

• Hepatocytes: Derived from the endoderm of the hepatic diverticulum.

• Kupffer cells (macrophages): Derived from blood stem cells.

• Bile duct epithelial cells: Derived from the endoderm of the hepatic

diverticulum.

Small Intestine and the Mesentery

• The small intestine is the longest part of the digestive tract, responsible

for most of the digestion and absorption of nutrients.

• It consists of three parts:

o Duodenum: The first and shortest part.

o Jejunum: The middle portion.

o Ileum: The longest portion.

• Mesentery:

o A double layer of peritoneum that suspends the jejunum and ileum

from the posterior abdominal wall.

o Provides support, blood supply, lymphatic drainage, and nerve

innervation to the small intestine.

19. Show arterial arcades & Describe mode of artery supply.

• Arterial Supply:

o The small intestine is primarily supplied by the superior mesenteric

artery.

o It branches into numerous smaller arteries that form arterial

arcades within the mesentery.

o These arcades provide a rich and redundant blood supply to the

small intestine.

20. Development of the small intestine with rotation.

• During embryonic development, the midgut undergoes rapid growth and

herniates into the umbilical cord.

• It then undergoes a counterclockwise rotation around the superior

mesenteric artery.

• This rotation brings the small intestine back into the abdomen and

determines its final position.

21. Hold viscus in relation to torso model & Give points in favor. Show different

parts, internal modifications, gross features & mention function(s).

• Points in Favor:

o Occupies most of the central and lower abdomen.

o Highly convoluted and coiled to increase surface area for digestion

and absorption.

• Different Parts:

o Duodenum, jejunum, and ileum.

• Internal Modifications:

o Plicae circulares: Circular folds of the mucosa that increase surface

area.

o Villi: Finger-like projections of the mucosa that further increase

surface area.

o Microvilli: Microscopic projections on the surface of the epithelial

cells that maximize surface area for absorption.

• Gross Features:

o Long, convoluted tube.

o Jejunum has larger diameter, thicker walls, and more plicae

circulares compared to the ileum.

• Functions:

o Digestion and absorption of nutrients.

22. Small Intestine: Show parts in viscus & mode of artery supply in figure

• Parts:

o Duodenum, jejunum, and ileum.

• Mode of Artery Supply:

o Primarily by the superior mesenteric artery through a series of

arterial arcades.

Large Intestine

• The large intestine extends from the ileocecal valve to the anus.

• It consists of:

o Cecum

o Appendix

o Colon (ascending, transverse, descending, sigmoid)

o Rectum

o Anal canal

Large intestine:

23. Describe the venous drainage.

• Blood from the large intestine is drained by the superior mesenteric vein

and the inferior mesenteric vein.

• The superior mesenteric vein drains the cecum, ascending colon, and part

of the transverse colon.

• The inferior mesenteric vein drains the descending colon, sigmoid colon,

and rectum.

• These veins ultimately drain into the portal vein.

24. Show origin, arteries supplying it & Describe mode of supply of jejunum

and ileum.

• Origin:

o The jejunum and ileum arise from the midgut during embryonic

development.

• Arteries:

o Primarily supplied by the superior mesenteric artery.

o The superior mesenteric artery branches into numerous smaller

arteries that form arterial arcades within the mesentery.

o These arcades provide a rich and redundant blood supply to the

jejunum and ileum.

25. Large Intestine/The mesentery with jejunum & ileum in relation to torso:

Hold viscus in relation to torso model & Give points in favor.

• Points in Favor:

o The large intestine frames the small intestine within the abdomen.

o The mesentery provides support and attachment for the jejunum

and ileum.

26. Show different parts & cardinal features.

• Parts:

o Cecum, appendix, ascending colon, transverse colon, descending

colon, sigmoid colon, rectum, and anal canal.

• Cardinal Features:

o Haustra: Pouches formed by sacculations of the colon wall.

o Teniae coli: Three longitudinal bands of smooth muscle.

o Omental appendices: Small, fatty projections hanging from the

surface of the colon.

Rectum and Anal Canal

• The rectum is the final part of the large intestine, located in the pelvis.

• The anal canal is the terminal portion of the rectum, passing

Rectum and Anal Canal:

27. Rectum & anal canal in relation to torso: Hold viscus in relation to torso

model & Give points in favor. Show & Describe gross features.

• Points in Favor:

o The rectum is the final part of the large intestine, located in the

pelvis.

o The anal canal is the terminal part of the rectum, passing through

the pelvic floor.

• Gross Features:

o Rectum:

▪ S-shaped curve.

▪ Three lateral folds (Houston's valves) in its lumen.

▪ Ampulla: Dilated portion that stores feces before defecation.

o Anal Canal:

▪ Short, muscular tube.

▪ Lined with specialized epithelium.

▪ Contains internal and external anal sphincters.

28. Name arteries supplying it & Describe mode of supply.

• Arterial Supply:

o Superior rectal artery: Branch of the inferior mesenteric artery.

o Middle rectal artery: Branch of the internal iliac artery.

o Inferior rectal artery: Branch of the internal pudendal artery.

o Mode of Supply:

▪ The rectum receives blood supply from a combination of

these arteries, creating anastomoses for collateral

circulation.

29. Show mode of venous drainage in the torso.

• Venous Drainage:

o Superior rectal vein: Drains into the inferior mesenteric vein (which

joins the splenic vein to form the portal vein).

o Middle and inferior rectal veins: Drain into the internal iliac veins

and ultimately into the inferior vena cava.

30. Explain why internal hemorrhoids are pain insensitive while external

hemorrhoids are pain sensitive.

• Internal Hemorrhoids:

o Located above the pectinate line.

o Innervated by the autonomic nervous system (sympathetic and

parasympathetic).

o Lack pain sensation.

• External Hemorrhoids:

o Located below the pectinate line.

o Innervated by the somatic nervous system (pudendal nerve).

o Painful due to the presence of somatic sensory nerves.

31. Describe lymphatic drainage.

• Lymph from the rectum drains into the internal iliac lymph nodes and

para-aortic lymph nodes.

32. Show drainage areas of different groups of lymph nodes.

• Internal iliac lymph nodes: Receive lymph from the rectum, anus, and

pelvic organs.

• Para-aortic lymph nodes: Receive lymph from the internal iliac nodes and

drain a wider area, including the kidneys, ureters, and gonads.

VESSELS

1. Porto-caval Anastomoses: Show THREE sites in torso model & Name

participating veins.

• Esophageal Veins:

o Portal System: Left gastric vein

o Systemic System: Azygos vein

• Rectal Veins:

o Portal System: Superior rectal vein

o Systemic System: Middle and inferior rectal veins

• Paraumbilical Veins:

o Portal System: Paraumbilical veins

o Systemic System: Epigastric veins

2. Mention their clinical importance.

• Portal Hypertension: When blood flow through the liver is obstructed

(e.g., cirrhosis), pressure in the portal vein increases.

• Collateral Circulation: Blood seeks alternative pathways through these

anastomoses to bypass the obstructed liver.

• Clinical Consequences:

o Esophageal varices: Can rupture and cause life-threatening

bleeding.

o Rectal varices (hemorrhoids): Can cause bleeding and discomfort.

o Caput Medusae: Dilated veins around the umbilicus due to

increased blood flow through paraumbilical veins.

3. Cisterna chyli: State the location, drainage area & tributaries.

• Location: Located in the abdomen, anterior to the second lumbar

vertebra.

• Drainage Area: Receives lymph from the lower limbs, pelvis, abdomen,

and left side of the thorax.

• Tributaries:

o Right and left lumbar trunks

o Intestinal trunk

4. Caput Medusae: Explain why it occurs.

• Caput Medusae: A condition characterized by dilated veins around the

umbilicus.

• Occurrence:

o Occurs due to portal hypertension.

o When blood flow through the liver is obstructed, pressure in the

portal vein increases.

o Blood seeks alternative pathways, including through the

paraumbilical veins, leading to their dilation and the characteristic

appearance of "head of Medusa."

5. Hemorrhoids: Explain why external hemorrhoids are painful while internal

hemorrhoids are pain insensitive.

• Internal Hemorrhoids:

o Located above the pectinate line.

o Innervated by the autonomic nervous system (sympathetic and

parasympathetic).

o Lack pain sensation.

• External Hemorrhoids:

o Located below the pectinate line.

o Innervated by the somatic nervous system (pudendal nerve).

o Painful due to the presence of somatic sensory nerves.

6. Portal vein: Show site of formation & Identify formative tributaries

• Site of Formation:

o Behind the neck of the pancreas.

• Formative Tributaries:

o Splenic vein

o Superior mesenteric vein

7. Right lymphatic duct: Mention area of drainage & termination.

• Drainage Area:

o Drains lymph from the right upper limb, right side of the head and

neck, and right thorax.

• Termination:

o Empties into the right subclavian vein.

8. Portal vein in torso: Identify formative veins. Describe its course &

termination.

• Formative Veins:

o Splenic vein

o Superior mesenteric vein

• Course:

o Ascends along the right side of the pancreas.

• Termination:

o Enters the liver through the porta hepatis.

9. Anterior Abdominal Wall: Show drainage areas of different groups of lymph

nodes.

• Superficial Inguinal Nodes: Drain the skin of the lower abdomen,

perineum, buttocks, and external genitalia.

• Deep Inguinal Nodes: Receive lymph from the superficial inguinal nodes

and also drain the deeper structures of the lower limb.

• External Iliac Nodes: Receive lymph from the deep inguinal nodes and

drain the lower limb, external genitalia, and lower part of the abdominal

wall.

• Common Iliac Nodes: Receive lymph from the external iliac nodes and

drain the corresponding half of the pelvis and lower limb.

• Para-aortic Nodes: Receive lymph from the common iliac nodes and drain

a wide area, including the kidneys, ureters, and gonads.

10. Abdominal aorta: Show its extension in torso model & Identify ventral

branches & Describe their area of supply.

• Extension: Descends from the thoracic aorta through the aortic hiatus of

the diaphragm.

• Ventral Branches:

o Celiac trunk: Supplies the stomach, liver, spleen, pancreas, and

duodenum.

o Superior mesenteric artery: Supplies the small intestine andmost

of the large intestine.

o Inferior mesenteric artery: Supplies the descending colon, sigmoid

colon, and part of the rectum.

11. Inferior vena cava: Show its extension in torso model & Identify tributaries

& Describe their area of drainage.

• Extension: Ascends along the right side of the vertebral column.

• Tributaries:

o Renal veins: Drain the kidneys.

o Hepatic veins: Drain the liver.

o Lumbar veins: Drain the lumbar region.

o Common iliac veins: Drain the lower limbs and pelvis.

12. Porto-caval anastomoses: Mention sites with corresponding portal and

systemic veins.

• See response to question 1.

13. Veins of abdomen: Read the figure & Explain what special understanding

it offers.

• A figure of the veins of the abdomen would provide a visual

understanding of:

o The portal venous system and its tributaries.

o The drainage of blood from the abdominal organs into the inferior

vena cava.

o The location and significance of portocaval anastomoses.

o The relationship between the portal and systemic circulations.

Posterior Abdominal Wall

1. Locations of Lymph Nodes on the Posterior Abdominal Wall:

• Para-aortic Nodes: Located along the sides of the abdominal aorta.

• Lumbar Nodes: Located along the lumbar arteries.

• Renal Nodes: Located around the renal hilum.

Drainage Areas of Pre-aortic Group of Lymph Nodes:

• The pre-aortic group of lymph nodes (which includes the celiac, superior

mesenteric, and aorticorenal nodes) drain a vast area of the abdomen,

including:

o Stomach

o Small intestine

o Large intestine (except for the distal part of the rectum)

o Liver

o Spleen

o Pancreas

o Kidneys

o Ureters

o Adrenal glands

Kidney & Ureter

1. Kidney: Show mode of artery supply. Model/figure (5)

• Arterial Supply:

o The kidneys receive their blood supply from the renal arteries,

which arise directly from the abdominal aorta.

o Each renal artery divides into several segmental arteries within the

renal sinus.

o Segmental arteries further branch into interlobar arteries, which

pass between the renal pyramids.

o Interlobar arteries give rise to arcuate arteries that arch over the

bases of the renal pyramids.

o Arcuate arteries branch into interlobular arteries that run between

the renal tubules.

o Finally, afferent arterioles arise from the interlobular arteries and

supply blood to the glomeruli.

2. Development of a metanephric excretory unit: Read the figure & Explain

what special understanding it offers.(7)

• Metanephric Excretory Unit: Consists of a renal corpuscle (glomerulus

and Bowman's capsule) and a renal tubule.

• Development:

o Begins with an interaction between the metanephric mesoderm

(forms the nephrons) and the ureteric bud (an outgrowth of the

mesonephric duct).

o The ureteric bud branches repeatedly, forming the collecting ducts,

minor calyces, major calyces, and finally the renal pelvis.

o Simultaneously, metanephric mesoderm forms renal vesicles that

differentiate into renal tubules.

o The renal tubules become intimately associated with the

developing collecting ducts.

• Special Understanding:

o The figure would illustrate the intricate interplay between the

ureteric bud and the metanephric mesoderm, demonstrating how

these two structures interact to form the complex architecture of

the kidney.

o It would highlight the key steps in nephrogenesis, including the

formation of the glomerulus, Bowman's capsule, proximal tubule,

loop of Henle, and distal tubule.

3. Kidney: Show mode of venous drainage. Figure (5) / describe from model (5)

• Venous Drainage:

o Blood from the kidneys is drained by the renal veins.

o The right renal vein is shorter and drains directly into the inferior

vena cava.

o The left renal vein is longer and passes anterior to the aorta,

receiving the left testicular (or ovarian) vein before draining into

the inferior vena cava.

4. Kidney in relation to skeleton: Hold viscus in anatomical position in relation

to skeleton & Give Points in favor. Show & Describe gross features.(With cross

questions) (10)

• Points in Favor:

o Retroperitoneal organs (lie behind the peritoneum).

o Located on either side of the vertebral column, between the 12th

thoracic and 3rd lumbar vertebrae.

o Protected by the ribs and the posterior abdominal wall.

• Gross Features:

o Bean-shaped:

o Hilum: A concave medial border where the renal artery and vein,

ureter, and nerves enter and exit.

o Renal cortex: Outermost layer, appears granular due to the

presence of renal corpuscles.

o Renal medulla: Inner region, consists of renal pyramids.

o Renal pelvis: Funnel-shaped structure that collects urine from the

renal pyramids.

Cross-Questions:

• Why are the kidneys well-protected within the body?

o To protect these vital organs from external trauma.

• What is the significance of the renal hilum?

o It serves as the gateway for the entry and exit of blood vessels,

nerves, and the ureter.

5. Read a figure- Photomicrograph of adult human kidney(7)

• Key Features in a Photomicrograph of the Kidney:

o Renal corpuscles: Glomeruli appear as spherical structures.

o Renal tubules: Visible as convoluted or straight structures.

o Collecting ducts: Larger tubules that collect urine from multiple

nephrons.

o Blood vessels: Arteries, veins, and capillaries can be observed.

o Interstitial tissue: Connective tissue that surrounds the nephrons

and other structures.

6. show macroscopic features in the longitudinally sectioned kidney model.

(With cross questions)(4+3)

• Macroscopic Features:

o Renal Cortex: Outer granular layer.

o Renal Medulla: Inner region, composed of renal pyramids.

o Renal Columns: Extensions of cortical tissue that dip between the

renal pyramids.

o Renal Pelvis: Funnel-shaped structure that collects urine from the

renal pyramids.

Cross-Questions:

• What is the functional unit of the kidney?

o The nephron.

• What structures are found within the renal pyramids?

o Loops of Henle and collecting ducts.

7. kidney:show external features & structures passing through the hilum.

• External Features:

o Bean-shaped organ.

o Hilum: Indentation on the medial border.

o Anterior and posterior surfaces.

o Upper and lower poles.

• Structures Passing Through the Hilum:

o Renal artery: Supplies blood to the kidney.

o Renal vein: Drains blood from the kidney.

o Ureter: Carries urine from the kidney to the urinary bladder.

o Nerves: Sympathetic and parasympathetic nerves innervate the

kidney.

8. Read figure: Renal corpuscles

• A figure of renal corpuscles would show:

o Glomerulus: A network of capillaries enclosed within Bowman's

capsule.

o Bowman's capsule: A double-layered cup-shaped structure that

surrounds the glomerulus.

o Afferent arteriole: Brings blood to the glomerulus.

o Efferent arteriole: Carries blood away from the glomerulus.

9. Renal agenesis: Explain why it causes oligohydramnios.(6)

• Renal Agenesis:

o The absence of one or both kidneys during development.

• Oligohydramnios:

o Abnormally low levels of amniotic fluid.

• Explanation:

o The kidneys play a crucial role in producing urine, which contributes

to the amniotic fluid volume.

o In renal agenesis, the lack of urine production leads to a significant

decrease in amniotic fluid volume, resulting in oligohydramnios.

10. Diagrams & photomicrograph of an adult human kidney(7)

• Diagrams: Would provide a visual representation of the overall structure

of the kidney, including its external features, internal anatomy (cortex,

medulla, pyramids, etc.), and blood supply.

• Photomicrograph:

o Would allow for a detailed examination of the microscopic

structures within the kidney, such as nephrons, tubules, and blood

vessels.

11. Kidney: Show origin, course & mode of artery supply. Model-Torso (5)

• Origin:

o The renal arteries arise directly from the abdominal aorta.

• Course:

o The right renal artery is typically shorter than the left.

o They enter the hilum of each kidney.

• Mode of Supply:

o See the description of arterial supply in question 1.

12. Development of collecting part of kidney: Read The figure & Explain what

special understanding it offers.(7)

• Development:

o The collecting part of the kidney develops from the ureteric bud, an

outgrowth of the mesonephric duct.

o The ureteric bud undergoes repeated branching to form the

collecting ducts, minor calyces, major calyces, and renal pelvis.

• Special Understanding:

o The figure would illustrate the process of branching morphogenesis

and how the ureteric bud gives rise to the complex branching

pattern of the collecting ducts within the kidney.

13. Show relations of anterior & posterior surface in torso model.(3)

• Anterior Surface:

o Related to the liver (right kidney)

o Related to the stomach, spleen, and pancreas (left kidney)

• Posterior Surface:

o Related to the diaphragm, quadratus lumborum muscle, psoas

major muscle, and 12th rib.

14. Ureter: Show constrictions & Mention artery supply.(5)

• Constrictions:

o Ureteropelvic junction: Where the ureter leaves the renal pelvis.

o Pelvic brim: As the ureter crosses the pelvic brim.

o Ureterovesical junction: Where the ureter enters the urinary

bladder.

• Artery Supply:

o The ureters receive blood supply from the renal arteries,

testicular/ovarian arteries, and branches of the aorta and iliac

arteries.

Urinary Bladder

15. Urinary bladder: Describe nerve supply.(5) / from figure

• Nerve Supply:

o Sympathetic innervation:

▪ From the hypogastric plexus.

▪ Causes relaxation of the detrusor muscle (bladder wall) and

contraction of the internal urethral sphincter.

o Parasympathetic innervation:

▪ From the pelvic splanchnic nerves (S2-S4).

▪ Causes contraction of the detrusor muscle and relaxation of

the internal urethral sphincter.

o Somatic innervation:

▪ Pudendal nerve innervates the external urethral sphincter

(voluntary control).

16. BPH: Explain how difficulty in micturition occurs.(7)

• BPH (Benign Prostatic Hyperplasia): Enlargement of the prostate gland.

• Difficulty in Micturition:

o Obstruction: The enlarged prostate gland compresses the urethra,

obstructing the flow of urine.

o Weak Stream: Reduced force of urine flow due to the narrowing of

the urethra.

o Hesitancy: Difficulty initiating urination.

o Frequency: Frequent and urgent need to urinate.

o Nocturia: Frequent urination at night.

o Incomplete emptying: Feeling of incomplete bladder emptying.

o Straining: Increased effort needed to initiate and maintain

urination.

17. Atonic bladder: Define & Explain anatomical basis.(7)

• Atonic Bladder: A condition characterized by loss of bladder muscle tone,

resulting in urinary retention.

• Anatomical Basis:

o Damage to the nerves:

▪ Lesions of the spinal cord (e.g., spinal cord injury) can disrupt

the nerve supply to the bladder, leading to loss of bladder

control and atony.

o Neurological disorders:

▪ Diseases like multiple sclerosis or diabetes can also affect

nerve function and contribute to atonic bladder.

o Medications:

▪ Certain medications can cause side effects that affect

bladder function.

18. Urinary bladder: Describe effects of autonomic stimulation.(5)

• Sympathetic Stimulation:

o Relaxation of the detrusor muscle.

o Contraction of the internal urethral sphincter.

o Inhibits urination.

• Parasympathetic Stimulation:

o Contraction of the detrusor muscle.

o Relaxation of the internal urethral sphincter.

o Promotes urination.

19. Urinary bladder in relation to skeleton: Hold viscus in anatomical position

in relation to skeleton & Give points in favor. Show parts & peritoneal

reflections in hemisectioned model of male pelvis. (With cross questions) (10)

• Points in Favor:

o Located in the pelvic cavity, posterior to the pubic symphysis.

o Lies on the pelvic floor.

o Related to the pelvic bones (pubis, ischium).

• Parts:

o Apex: Directed anteriorly towards the pubic symphysis.

o Body: Main portion of the bladder.

o Neck: Narrowed lower portion.

o Trigone: Triangular area on the internal surface, defined by the two

ureteric orifices and the internal urethral orifice.

• Peritoneal Reflections:

o In males, the bladder is covered by peritoneum only on its superior

surface.

Cross-Questions:

• Why is the male bladder more closely related to the rectum than the

female bladder?

o Due to the presence of the prostate gland in males.

• What is the clinical significance of the trigone?

o It is a relatively fixed area, making it less susceptible to distension.

20. Outline trigone inside viscus & Mention its importance.(4)

• Outline:

o Triangular area on the internal surface of the bladder.

o Defined by the two ureteric orifices (where the ureters enter the

bladder) and the internal urethral orifice (where the urethra exits

the bladder).

• Importance:

o Relatively fixed area, less susceptible to distension.

o Important landmark for surgical procedures.

21. Show relations of superior surfaces in torso model.(3)

• Superior Surface:

o Related to the peritoneum.

o In males, related to the coils of the ileum.

o In females, related to the uterus and vagina.

Male Reproductive system

1. Derivatives of Mesonephric and Paramesonephric Ducts

• Mesonephric Ducts:

o Male: Develop into the vas deferens, seminal vesicle, and

ejaculatory duct.

o Female: Mostly regress, but remnants form the epoophoron,

paroophoron, and Gartner's duct.

• Paramesonephric Ducts:

o Male: Form vestigial structures like the appendix testis and

paradidymis.

o Female: Develop into the fallopian tubes, uterus, cervix, and upper

portion of the vagina.

2. Testis in Relation to the Torso

• Position: Located in the scrotum, suspended by the spermatic cord.

• Points in Favor:

o Lies inferior to the pubic symphysis.

o Protected by the bony pelvis and muscles of the abdominal wall.

• Gross Features:

o Oval-shaped organs.

o Tunica albuginea: Tough white capsule covering the testis.

o Septula testis: Divides the testis into lobules.

o Lobules: Each lobule contains seminiferous tubules where sperm

are produced.

o Epididymis: Coiled structure on the posterior surface of the testis,

stores and matures sperm.

3. Development of the Testis

• Begins in the embryo as the indifferent gonads.

• Under the influence of SRY gene on the Y chromosome, the indifferent

gonads develop into testes.

• Primordial germ cells migrate from the yolk sac and colonize the

developing testes.

• These germ cells differentiate into spermatogonia, which give rise to

mature sperm.

4. Descent of the Testis

• The testes descend from the abdomen into the scrotum during fetal

development.

• This descent is guided by the gubernaculum testis, a ligament that

connects the developing testis to the scrotum.

• The descent creates an environment with a lower temperature, which is

necessary for sperm production.

5. Testis in Relation to the Skeleton

• Located posterior to the pubic symphysis, resting on the diaphragm and

iliacus muscle.

• Borders:

o Superior: Attached to the spermatic cord.

o Inferior: Rounded.

o Medial: Faces its counterpart.

o Lateral: Convex.

• Surfaces:

o Anterior: Covered by peritoneum.

o Posterior: Related to the intestines and iliac vessels.

• Coverings:

o Skin of the scrotum.

o Superficial fascia of the scrotum.

o Dartos fascia: Provides a contractile layer for temperature

regulation.

o Spermatic fascia: Derived from transversalis fascia.

o Infundibule fascia: Extension of the transversalis fascia.

o Tunica vaginalis: Serous membrane surrounding the testis and

epididymis.

6. Male External Genitalia

• Position: Located in the perineum, inferior to the scrotum.

• Points in Favor:

o Includes the penis and scrotum.

o Essential for sexual function and urinary elimination.

• Parts of the Penis:

o Root: Attached to the perineum.

o Body: Contains the corpora cavernosa and corpus spongiosum.

o Glans penis: Expanded tip, covered by prepuce (foreskin).

o Urethra: Carries urine and semen.

• Scrotum:

o Pouch of skin containing the testes.

o Layers:

▪ Skin.

▪ Dartos muscle.

▪ Spermatic fascia.

▪ Cremaster muscle.

▪ Colles' fascia.

7. Undescended Testis

• A condition where one or both testes fail to descend into the scrotum.

• Can lead to infertility due to the higher temperature in the abdomen,

which impairs sperm production.

8. Genital Ducts

A figure showing the development of genital ducts can illustrate the following:

9. Hypospadias

• The origin of the vas deferens, epididymis, ejaculatory duct, seminal

vesicles, uterus, fallopian tubes, cervix, and upper vagina.

• How the mesonephric and paramesonephric ducts differentiate into

these structures in males and females.

• A developmental defect where the urethral opening is located on the

underside of the penis instead of the tip.

• Can be caused by abnormal development of the urogenital system.

10. Testis Lymphatic Drainage

A figure depicting the lymphatic drainage of the testis can show:

The lymphatic drainage of the testes is unique. Here's a breakdown:

• Lymph vessels: Originate within the testicular parenchyma (the functional

tissue of the testis).

• Path:

o These vessels travel within the spermatic cord, alongside the

testicular artery and vein.

o They ascend through the inguinal canal into the abdomen.

• Destination:

o Primarily drain into the para-aortic lymph nodes. These nodes are

located along the abdominal aorta, specifically in the lumbar

region.

Key Points:

• Contrast with Scrotum:

o The scrotum, unlike the testes, drains to the superficial inguinal

lymph nodes.

• Clinical Significance:

o This drainage pattern is crucial for the spread of testicular cancer.

Cancer cells can travel through the lymphatic system to the para

aortic lymph nodes and potentially to other parts of the body.

11. Vasectomy: Describe procedure & Mention preferable site.

• Procedure:

o A surgical procedure for male sterilization.

o Involves making small incisions in the scrotum.

o The vas deferens (duct that carries sperm) is located and a small

segment is removed.

o The cut ends of the vas deferens are then sealed or cauterized to

prevent the passage of sperm.

• Preferable Site:

o Typically performed in a doctor's office or outpatient surgical

center.

12. Circumcision: Describe procedure & Mention indication.

• Procedure:

o Surgical removal of the foreskin (prepuce) of the penis.

o Can be performed for religious, cultural, or medical reasons.

• Indications:

o Religious or cultural practices.

o Prevention of penile infections.

o Treatment of recurrent balanitis (inflammation of the glans penis).

o Treatment of phimosis (inability to retract the foreskin).

13. Testis: Describe artery supply. ( Tool - figure )

• Arterial Supply:

o Primarily supplied by the testicular arteries, which arise directly

from the abdominal aorta.

o The testicular arteries descend into the scrotum within the

spermatic cord.

o Other smaller arteries also contribute to the blood supply.

14. Testis: Describe mode of venous drainage. ( Tool - figure )

• Venous Drainage:

o Blood from the testis is drained by the pampiniform plexus of

veins.

o The pampiniform plexus forms a complex network of veins within

the spermatic cord.

o These veins converge to form the testicular vein.

o The right testicular vein drains directly into the inferior vena cava.

o The left testicular vein drains into the left renal vein.

15. Testis: Show & Describe venous drainage. ( Tool - model / torso )

• On a model or torso:

o Identify the spermatic cord.

o Trace the path of the pampiniform plexus of veins ascending within

the spermatic cord.

o Observe the right testicular vein draining into the inferior vena cava

and the left testicular vein draining into the left renal vein.

16. Penis: Show & Describe artery supply. ( Tool - figure )

• Arterial Supply:

o Primarily supplied by the deep penile artery, a branch of the

internal pudendal artery.

o The deep penile artery runs within the corpus cavernosum and

branches extensively to supply the erectile tissue.

o Other arteries contributing to the blood supply include the dorsal

artery of the penis and the urethral artery.

17. Testis with spermatic cord in relation to skeleton: Hold viscera on correct

side in relation to skeleton & Give points in favor. Show & Describe gross

features. (With cross questions)

• Points in Favor:

o Located within the scrotum, which hangs inferior to the pubic

symphysis.

o Suspended by the spermatic cord.

• Gross Features:

o Testis: Oval-shaped, covered by the tunica albuginea.

o Spermatic Cord:

▪ Contains:

▪ Testicular artery and vein

▪ Vas deferens

▪ Lymphatic vessels

▪ Nerves (genitofemoral nerve, sympathetic nerves)

▪ Cremaster muscle

Cross-Questions:

• Why is the scrotum located outside the body cavity?

o To maintain a lower temperature, which is essential for sperm

production.

• What is the function of the cremaster muscle?

o To regulate testicular temperature by raising or lowering the testes.

18. Male external genitalia in relation to skeleton: Hold viscus/model in

relation to torso & Give Points in favor. Show & Describe gross features (with

cross questions)

• Points in Favor:

o Located in the perineum, inferior to the pubic symphysis.

o Related to the pubic bones and the ischiopubic rami.

• Gross Features:

o Penis:

▪ Root, body, glans penis, urethra.

o Scrotum:

▪ Pouch of skin containing the testes.

▪ Rugae (wrinkles) on the scrotal surface.

Cross-Questions:

• What is the function of the corpus cavernosum and corpus spongiosum?

o They are erectile tissues that fill with blood during sexual arousal,

causing erection.

• What is the clinical significance of the perineum?

o It is an important anatomical landmark for surgical procedures and

childbirth.

19. Undescended Testis: Define the condition and explain it on anatomical

basis

• Definition: A condition where one or both testes fail to descend from the

abdomen into the scrotum during fetal development.

• Anatomical Basis:

o Can be due to abnormalities in the development of the

gubernaculum testis, the structure that guides testicular descent.

o Hormonal imbalances can also contribute to the condition.

20. Prostate: Show parts & Describe venous drainage. ( Tool - viscus )

• Parts:

o Apex: Points towards the urogenital diaphragm.

o Base: Lies against the bladder neck.

o Lateral lobes: Two main lobes on either side of the urethra.

o Median lobe: Located between the lateral lobes.

• Venous Drainage:

o Primarily by the prostatic venous plexus, which drains into the

internal iliac veins.

21. Testis: Show parts in viscus & Describe venous drainage in figure

• Parts:

o Tunica albuginea, lobules, seminiferous tubules, epididymis.

• Venous Drainage:

o As described in question 14: Primarily by the pampiniform plexus

of veins, which converge to form the testicular vein.

22. Testis: Mention sources of development of different types of cells. Define

hypospadias & epispadias.

• Sources of Development:

o Germ cells: Originate from the yolk sac and migrate to the

developing gonads.

o Sertoli cells: Derived from the surface epithelium of the testis.

o Leydig cells: Also derived from the surface epithelium of the testis.

• Hypospadias:

o A congenital condition where the urethral opening is located on the

underside of the penis instead of the tip.

• Epispadias:

o A congenital condition where the urethral opening is located on the

upper surface of the penis.

23. Study of a figure: Development of gonads showing cortical & medullary

cords- Read the figure & Explain what special understanding it offers.

• Special Understanding:

o The figure would illustrate the differentiation of the indifferent

gonad into either a testis or an ovary.

o In males, the medullary cords develop into seminiferous tubules,

while the cortex regresses.

o In females, the cortical cords develop into follicles, while the

medulla regresses.

24. Study of a figure: Development of ovary - Read the figure & Explain what

special understanding it offers.

• Special Understanding:

o The figure would illustrate the development of ovarian follicles

from primordial germ cells.

o It would show the stages of follicular development, from primordial

follicles to Graafian follicles.

o It would also depict the process of oogenesis, the formation of

mature ova.

25. Male internal genital organs: Show different parts & Describe lymphatic

drainage. (model / figure )

• Parts:

o Testes

o Epididymis

o Vas deferens

o Seminal vesicles

o Ejaculatory ducts

o Prostate gland

• Lymphatic Drainage:

o Lymph from the testes drains primarily to the lumbar lymph nodes.

o Lymph from the other male genital organs drains to the internal

iliac lymph nodes.

26. Testis with spermatic cord in relation to skeleton: Hold viscera in

anatomical position in relation to skeleton & Describe macroscopic structures.

Mention factors helping in descent of testis. (With cross questions)

• Macroscopic Structures:

o See the description in question 7.

• Factors Helping in Descent of Testis:

o Gubernaculum testis: A fibrous band that connects the testis to the

scrotum.

o Hormonal influences: Testosterone plays a crucial role in testicular

descent.

o Intra-abdominal pressure: Changes in intra-abdominal pressure

may assist in the descent of the testes.

Cross-Questions:

• Why is the descent of the testes important?

o To provide an optimal temperature for sperm production.

• What are the potential consequences of undescended testes?

o Infertility, testicular cancer, and psychological impact.

27. Male external genital organs in relation to torso: Hold viscera in anatomical

position in relation to skeleton & Give points in favor. Identify parts & Describe

structure of penis.

Male External Genitalia in Relation to Torso

• Points in Favor:

o Located in the perineum, inferior to the pubic symphysis.

o Protected by the pubic bones and the ischiopubic rami.

• Parts:

o Penis:

▪ Root: Attached to the perineum.

▪ Body (Shaft):

▪ Contains three cylindrical masses of erectile tissue:

▪ Corpora cavernosa: Two dorsolateral cylinders.

▪ Corpus

spongiosum:

surrounding the urethra.

Ventral

cylinder

▪ Glans penis:

▪ Distal, enlarged portion of the penis.

▪ Covered by the prepuce (foreskin).

o Scrotum:

▪ Pouch of skin containing the testes.

▪ Rugae (wrinkles) on the scrotal surface.

Structure of the Penis:

• Erectile Tissue:

o The corpora cavernosa and corpus spongiosum are composed of a

network of interconnected spaces filled with blood sinuses.

o During sexual arousal, these spaces fill with blood, causing the

penis to become erect.

• Urethra:

o Passes through the center of the corpus spongiosum.

o Carries both urine and semen.

• Skin:

o Loosely covers the penis.

o Contains sensory nerves.

• Prepuce (foreskin):

o A fold of skin that covers the glans penis.

28. Reading of figure Schematic diagram of Sertoli & spermatogenic cell

• A figure depicting Sertoli cells and spermatogenic cells would show:

o Sertoli cells:

▪ Tall, columnar cells that extend from the basement

membrane to the lumen of the seminiferous tubule.

▪ Provide structural and nutritional support to developing

sperm cells.

▪ Form the blood-testis barrier, which isolates developing

sperm from the immune system.

o Spermatogenic cells:

▪ Located within the seminiferous tubules.

▪ Undergo a series of mitotic and meiotic divisions to produce

mature sperm cells.

▪ Include spermatogonia, primary spermatocytes, secondary

spermatocytes, spermatids, and spermatozoa.

29. Sertoli cell & its relationship to adjacent spermatogenic cell

• Relationship:

o Sertoli cells provide a supportive environment for

spermatogenesis.

o They form tight junctions that create the blood-testis barrier,

isolating developing sperm cells from the immune system.

o They provide nutrients and growth factors to the developing sperm

cells.

o They phagocytose excess cytoplasm during spermatogenesis.

Female Reproductive System

GENITALIA

30. Female internal genitalia in relation to skeleton: Hold Viscera in anatomical

position in relation to pelvis of skeleton, Give points in favor & Show parts of

uterus & fallopian tube. Mention normal positions & supports of uterus. (With

cross questions)

• Points in Favor:

o Located within the pelvic cavity.

o Supported by ligaments and pelvic floor muscles.

• Parts of Uterus:

o Fundus: Upper, rounded portion.

o Body: Main portion.

o Isthmus: Narrow region connecting the body to the cervix.

o Cervix: Lower, narrow portion that projects into the vagina.

• Parts of Fallopian Tube:

o Infundibulum: Funnel-shaped distal end with fimbriae.

o Ampulla: Widest part, where fertilization usually occurs.

o Isthmus: Narrow portion.

o Intramural part: Passes through the uterine wall.

• Normal Positions and Supports:

o Anteversion: The uterus is tilted forward so that the fundus is bent

anteriorly towards the bladder.

o Anteflexion: The body of the uterus is bent anteriorly at the level

of the isthmus.

o Supports:

▪ Ligaments (broad ligament, round ligament, uterosacral

ligaments, cardinal ligaments)

▪ Pelvic floor muscles

Cross-Questions:

• Why is the uterus anteverted and anteflexed?

o This position allows for optimal space within the pelvis and

facilitates childbirth.

• What is the significance of the broad ligament?

o It provides broad support to the uterus and contains the fallopian

tubes, ovaries, and round ligaments.

31. Female internal genitalia: Describe lymphatic drainage

• Uterus: Drains to the internal iliac lymph nodes and para-aortic lymph

nodes.

• Fallopian tubes: Drain to the para-aortic lymph nodes.

• Ovaries: Drain to the para-aortic lymph nodes and lumbar lymph nodes.

• Cervix: Drains to the internal iliac lymph nodes and inguinal lymph nodes.

• Vagina: Drains to the internal iliac lymph nodes and inguinal lymph nodes.

32. Female external genitalia in relation to skeleton: Hold viscus in anatomical

position in relation to skeleton & Give points in favor. Show different parts &

Identify gynecological perineum. With cross questions

• Points in Favor:

o Located in the perineum, inferior to the pubic symphysis.

o Protected by the pubic bones and the ischiopubic rami.

• Parts:

o Mons pubis: Rounded eminence over the pubic symphysis.

o Labia majora: Two folds of skin enclosing the vulva.

o Labia minora: Two smaller folds of skin within the labia majora.

o Clitoris: Small erectile organ located at the anterior junction of the

labia minora.

o Vestibule: Space between the labia minora, containing the urethral

and vaginal openings.

• Gynecological Perineum: The area between the vaginal opening and the

anus.

Cross-Questions:

• What is the function of the labia majora?

o To protect the more delicate structures within the vulva.

• What is the clinical significance of the perineum?

o It is an important landmark for childbirth and surgical procedures.

33. Female external genitalia: Name different parts & their sources of

development

• Mons pubis: Develops from the same embryonic tissue as the labia

majora.

• Labia majora: Develop from the same embryonic tissue as the scrotum in

males.

• Labia minora: Develop from the same embryonic tissue as the urethral

folds in males.

• Clitoris: Develops from the same embryonic tissue as the penis in males.

UTERUS

34. Uterus in relation to skeleton: Hold viscus in anatomical position in relation

to skeleton & Give points in favor. Show different parts of uterus & fallopian

tube.

• Parts of Uterus:

o See the description in question 30.

• Points in Favor:

o Located in the pelvic cavity, anterior to the rectum and posterior to

the bladder.

o Supported by ligaments and the pelvic floor.

• Parts of Fallopian Tube:

o See the description in question 30.

35. Uterus: Explain how bicornuate uterus develops

• Bicornuate Uterus:

o A congenital anomaly where the uterus has two separate horns,

each with its own fallopian tube.

• Development:

o Occurs when the paramesonephric ducts fail to fuse completely

during embryonic development.

36. Uterus in relation to skeleton: Hold viscus in anatomical position in relation

to skeleton & Give points in favor. Show parts & peritoneal relations in

hemisection model of female pelvis. (With cross question )

• Points in Favor:

o See the description in question 30.

• Peritoneal Relations:

o Anterior: Covered by peritoneum except for a small area on the

posterior surface of the cervix.

o Posterior: Related to the rectum (separated by the rectouterine

pouch - Pouch of Douglas).

o Lateral: Related to the broad ligament.

Cross-Question:

• Why is the Pouch of Douglas clinically important?

o It is the most dependent part of the peritoneal cavity, allowing the

accumulation of fluid (e.g., blood, pus) in cases of pelvic infections.

37. Uterus in relation to skeleton: Hold viscus in anatomical position in relation

to pelvis of skeleton & Give points in favor. Show parts & peritoneal reflections

on viscus & State importance of Pouch of Douglas. (With cross questions)

• See the answers to questions 30, 34, and 36.

38. Show & Describe gross features of uterus. (With cross questions)

Cross-Questions:

• Gross Features:

o Pear-shaped organ.

o Muscular walls (myometrium).

o Endometrium: Inner lining that undergoes cyclic changes during the

menstrual cycle.

o Cervix: Lower, narrow portion that projects into the vagina.

• What is the function of the myometrium?

o To contract during childbirth to expel the fetus.

• What are the functions of the endometrium?

o To provide a receptive environment for implantation of a fertilized

egg.

o To undergo cyclic changes during the menstrual cycle.

39. Uterus in torso: Mention parts of uterus & drainage areas of different

groups of lymph nodes

• Parts of Uterus: See the description in question 30.

• Lymphatic Drainage:

o See the description in question 31.

40. Uterus: Describe lymphatic drainage

• See the description in question 31.

41. Uterus in torso: Mention parts of uterus & drainage areas of different

groups of lymph nodes

• Parts of Uterus:

o Fundus

o Body

o Isthmus

o Cervix

• Drainage Areas of Different Groups of Lymph Nodes: * Uterus (body and

fundus): Primarily drain to the para-aortic lymph nodes. * Cervix: Drains

to the internal iliac lymph nodes and some to the para-aortic lymph

nodes.

42. Uterus: Describe lymphatic drainage

• See the response to question 41.

43. Uterus in torso: Mention parts of uterus & drainage areas of different

groups of lymph nodes

• Parts of Uterus:

o See the description in question 30.

• Drainage Areas of Different Groups of Lymph Nodes:

o See the response to question 41.

44. Uterus: Mention nerve supply

• Nerve Supply:

o Sympathetic innervation: From the hypogastric plexus.

o Parasympathetic innervation: From the pelvic splanchnic nerves

(S2-S4).

45. Uterus: Describe mode of artery supply

• Arterial Supply:

o Primarily by the uterine arteries, which arise from the internal iliac

arteries.

o The uterine arteries ascend along the sides of the uterus, giving off

numerous branches.

o The ovarian arteries also contribute to the blood supply to the

upper part of the uterus and the fallopian tubes.

46. Uterus: Show course of uterine artery in relation to uterus. Show mode of

artery supply

• Course of Uterine Artery:

o The uterine artery ascends along the lateral margin of the uterus.

o It gives off numerous branches that penetrate the myometrium.

o The arcuate arteries arise from the uterine artery and encircle the

uterus.

o Radial arteries branch from the arcuate arteries and supply the

endometrium.

• Mode of Artery Supply:

o See the description in question 45.

47. Reading of figure uterus

• A figure of the uterus would show:

o The different parts of the uterus (fundus, body, cervix).

o The relationship of the uterus to the vagina, fallopian tubes, and

ovaries.

o The internal structure of the uterus, including the endometrium

and myometrium.

48. Clinical Anatomy (Procedure / Disorder Utero-vaginal prolapse: Define the

condition & Explain the anatomical basis

• Utero-vaginal Prolapse:

o A condition where the uterus descends from its normal position in

the pelvis and prolapses into the vagina.

• Anatomical Basis:

o Weakening of the pelvic floor muscles and ligaments that support

the uterus.

o Factors such as childbirth, aging, and chronic cough can contribute

to this weakening.

49. Clinical Anatomy (Procedure / Disorder) - Ectopic pregnancy: Define &

Mention its sites

• Ectopic Pregnancy:

o A pregnancy that occurs outside the uterus, typically in the

fallopian tube.

• Sites:

o Tubal pregnancy: Most common, occurs in the fallopian tube.

o Ovarian pregnancy: Occurs in the ovary.

o Abdominal pregnancy: Occurs in the peritoneal cavity.

50. Clinical Anatomy (Procedure / Disorder) - Prolapse of uterus: Mention

causes & Explain features

• Causes:

o Weakening of the pelvic floor muscles and ligaments.

o Childbirth (especially vaginal deliveries with large babies).

o Chronic cough or straining.

o Aging.

o Hormonal changes (e.g., menopause).

• Features:

o Descent of the uterus into the vagina.

o Symptoms may include pelvic pressure, back pain, urinary or bowel

problems, and vaginal bleeding.

51. rectovaginal fistula: Read the figure & Explain what special understanding

it offers.

• Rectovaginal Fistula:

o An abnormal connection between the rectum and the vagina.

• A figure depicting a rectovaginal fistula would show:

o The abnormal opening between the rectum and the vagina.

o The potential for fecal matter to pass from the rectum into the

vagina.

• Special Understanding:

o The figure would help to visualize the anatomical basis of this

condition and its potential complications.

52. Transverse section of the ovary, showing degeneration of the primitive

(medullary) sex cords and formation of the cortical cords: Read the figure &

Explain what special understanding it offers.

• Special Understanding:

o The figure would illustrate the early stages of ovarian development.

o It would show the regression of the medullary cords and the

proliferation of the cortex, which will ultimately give rise to the

ovarian follicles.

53. Development of ovary: Read the figure & Explain what special

understanding it offers

• Special Understanding:

o The figure would depict the various stages of ovarian development,

from the indifferent gonad to the mature ovary.

o It would illustrate the formation of ovarian follicles, including

primordial follicles, primary follicles, secondary follicles, and

Graafian follicles.

54. Follicle development & changes within the ovary

• Follicle Development:

o Primordial follicle: Contains a single oocyte surrounded by a single

layer of flat granulosa cells.

o Primary follicle: Oocyte grows larger, and granulosa cells become

cuboidal.

o Secondary follicle: Multiple layers of granulosa cells form, and a

fluid-filled antrum begins to develop.

o Graafian follicle: Mature follicle with a large antrum and a

prominent cumulus oophorus.

• Changes within the Ovary:

o Follicle growth and maturation.

o Ovulation: Release of the mature oocyte from the Graafian follicle.

o Formation of the corpus luteum after ovulation.

55. Maturation of ovarian follicle: Read the figure & Explain what special

understanding it offers.

• Special Understanding:

o The figure would illustrate the stages of follicular development,

from the primordial follicle to the Graafian follicle.

o It would show the changes in the oocyte and the surrounding

granulosa cells during this process.

o It would also depict the formation of the antrum and the cumulus

oophorus.

56. Reading of figure Follicle development & changes within ovary

• See the responses to questions 54 and 55.

57. Study of a figure: Development of gonads showing cortical & medullary

cords- Read the figure & Explain what special understanding it offers.

• See the response to question 23.

58. Study of a figure: Development of ovary - Read the figure & Explain what

special understanding it offers.

• See the response to question 53.

59. Genital ducts: Name derivatives of mesonephric and paramesonephric

ducts.

• See the response to question 1.

60. Genital ducts: Read the figure & Explain what special understanding it

offers

• Special Understanding:

o The figure would illustrate the development of the male and female

reproductive tracts from the indifferent gonads and their ducts.

o It would show how the mesonephric and paramesonephric ducts

differentiate in males and females to form the various structures of

the reproductive system.

61. Fallopian tube: Show parts & Mention artery supply

• Parts:

o Infundibulum

o Ampulla

o Isthmus

o Intramural part

• Artery Supply:

o Primarily supplied by the uterine artery and the ovarian artery.

PELVIS

1. Pelvis in skeleton: Show boundaries of different pelvic diameters. Identify

joints formed & Mention their types. (With cross questions)

• Pelvic Diameters:

o True (Obstetric) Conjugate:

▪ Distance between the sacral promontory and the symphysis

pubis.

▪ Most important diameter for childbirth.

o Diagonal Conjugate:

▪ Distance between the sacral promontory and the inferior

margin of the symphysis pubis.

▪ Can be measured clinically.

o Obstetrical Conjugate:

▪ True conjugate minus 1-2 cm to account for the thickness of

the symphysis pubis.

o Transverse Diameter:

▪ Widest diameter of the pelvic inlet.

o Oblique Diameters:

• Joints Formed:

o Sacroiliac joints:

▪ Two oblique diameters, extend from one sacroiliac joint to

the opposite iliopubic eminence.

▪ Between the sacrum and the ilium.

▪ Synovial joints, but with limited movement.

o Pubic symphysis:

▪ Between the two pubic bones.

▪ Cartilaginous joint (symphysis).

Cross-Questions:

• Why are pelvic diameters important in obstetrics?

o They determine the size and shape of the pelvic inlet and outlet,

which are crucial for the passage of the fetus during childbirth.

• What is the significance of the sacroiliac joints?

o They transmit weight from the upper body to the lower limbs and

play a role in stabilizing the pelvis.

2. Articulated pelvis in skeleton: Identify joints formed. Trace the pelvic inlet

& outlet. (With cross questions)

• Joints:

o Sacroiliac joints

o Pubic symphysis

• Pelvic Inlet:

o Bounded anteriorly by the pubic symphysis, laterally by the

iliopectineal lines, and posteriorly by the sacral promontory.

• Pelvic Outlet:

o Bounded anteriorly by the pubic arch, laterally by the ischial

tuberosities, and posteriorly by the tip of the coccyx.

Cross-Questions:

• What is the clinical significance of the pelvic inlet and outlet?

o They determine the passageway for the fetus during childbirth.

• How does the shape of the pelvis differ between males and females?

o The female pelvis is generally wider, shallower, and more oval

shaped compared to the male pelvis.

• Location:

o Between the two pubic bones.

3. Symphysis pubis in skeleton: Show & identify joint. Mention its type &

structure. (With cross questions)

• Joint Type:

o Cartilaginous joint (symphysis).

• Structure:

o Connected by a fibrocartilaginous disc.

o Allows for slight movement, especially during pregnancy to

accommodate the passage of the fetus.

Cross-Questions:

• How does the pubic symphysis change during pregnancy?

o The fibrocartilaginous disc becomes more relaxed and allows for

slight widening of the pelvis, which aids in childbirth.

• What are the potential complications associated with pubic symphysis

dysfunction?

o Pain in the pubic area, difficulty walking, and back pain.

4. Pelvis in skeleton: Show formation of pelvic inlet & Show FOUR points that

determine its sex. (With cross questions)

• Formation of Pelvic Inlet:

o Formed by the pubic symphysis anteriorly, the iliopectineal lines

laterally, and the sacral promontory posteriorly.

• Four Points that Determine Sex:

o Shape of the pelvic inlet:

▪ Female: More oval-shaped.

▪ Male: More heart-shaped.

o Subpubic angle:

▪ Female: Wider (greater than 90 degrees).

▪ Male: Narrower (less than 90 degrees).

o Sacrum:

▪ Female: Shorter, wider, and more curved.

▪ Male: Longer, narrower, and less curved.

o Ischial spines:

▪ Female: Shorter and farther apart.

▪ Male: Longer and closer together.

Cross-Questions:

• Why are these differences in pelvic shape important?

o They are crucial for childbirth. The female pelvis is adapted for the

passage of the fetus.

• How can these differences be assessed clinically?

o Through pelvic examinations and imaging studies.

5. Articulated pelvis in skeleton: Show & Describe gross features in articulated

pelvis. Identify foramina & Name structures passing through them. (With cross

questions)

• Gross Features:

o Pelvic inlet:

▪ Bounded by the pubic symphysis, iliopectineal lines, and

sacral promontory.

o Pelvic outlet:

▪ Bounded by the pubic arch, ischial tuberosities, and the tip

of the coccyx.

o Pelvic cavity:

▪ Space enclosed by the pelvic bones.

• Foramina:

o Obturator foramen:

▪ Located in the hip bone.

▪ Allows passage of the obturator nerve and vessels.

o Greater sciatic foramen:

▪ Located above the ischial spine.

▪ Allows passage of the sciatic nerve, pudendal nerve, and

gluteal nerves and vessels.

o Lesser sciatic foramen:

▪ Located below the ischial spine.

▪ Allows passage of the pudendal nerve, internal pudendal

vessels, and the obturator internus muscle.

Cross-Questions:

• Why are the foramina in the pelvis important?

o They allow for the passage of nerves, blood vessels, and muscles

that supply the lower limbs and pelvic organs.

(With cross questions).

• What is the clinical significance of the sciatic foramen?

o It is a potential site of nerve compression, which can lead to

sciatica.

6. Articulated pelvis in skeleton: Show location of sacral plexus & how sciatic

nerve leaves pelvis. Hold a ribbon from origin(s) to insertion(s) of “sartorius”.

• Location of Sacral Plexus:

o Located within the pelvis, anterior to the sacrum and piriformis

muscle.

• Sciatic Nerve:

o Leaves the pelvis through the greater sciatic foramen.

o Located deep to the gluteus maximus muscle.

• Sartorius Muscle:

o Origin: Anterior superior iliac spine.

o Insertion: Medial side of the tibia.

o A ribbon can be placed along the course of the muscle,

demonstrating its long, strap-like shape and its action in flexing,

abducting, and laterally rotating the hip joint.

Cross-Questions:

• What are the major branches of the sacral plexus?

o Sciatic nerve, pudendal nerve, and posterior cutaneous nerve of the

thigh.

• What is the function of the sartorius muscle?

o It is the "tailor's muscle," used for crossing the legs.

7. Lumbar plexus: Describe formation, supply of motor branches.

• Formation:

o Formed by the anterior rami of the first four lumbar nerves (L1-L4).

• Motor Supply:

o Femoral nerve: Innervates the quadriceps femoris muscle,

sartorius muscle, and pectineus muscle.

o Obturator nerve: Innervates the adductor muscles of the thigh.

8. Pelvic splanchnic nerve: Explain action on urethral sphincter.

• Pelvic Splanchnic Nerves:

o Parasympathetic nerves that arise from the sacral spinal cord (S2

S4).

o They innervate the pelvic organs, including the bladder and rectum.

• Action on Urethral Sphincter:

o Cause relaxation of the internal urethral sphincter, which is

important for urination.

9. Lumbar plexus: Describe its formation & Mention branches.

• Formation:

o Formed by the anterior rami of the first four lumbar nerves (L1-L4).

• Branches:

o Femoral nerve

o Obturator nerve

o Lumbosacral trunk (contributes to the formation of the sciatic

nerve)

o Iliohypogastric nerve

o Ilioinguinal nerve

o Genitofemoral nerve

o Lateral femoral cutaneous nerve

10. Sciatic nerve: Mention the area supplied by it.

• Area Supplied:

o Supplies the muscles of the posterior compartment of the thigh

(hamstrings).

o Also provides sensory innervation to the skin of the posterior thigh

and leg, and part of the foot.

11. Sacral plexus: Show formation of plexus & branches.

• Formation:

o Formed by the anterior rami of the L4-S4 spinal nerves.

o Located within the pelvis, anterior to the sacrum and piriformis

muscle.

• Branches:

o Sciatic nerve:

▪ Largest nerve in the body.

▪ Divides into the tibial nerve and common fibular nerve.

o Pudendal nerve:

12. Enteric nervous system: Show locations & functions.

▪ Supplies the external genitalia, perineum, and external anal

sphincter.

o Posterior cutaneous nerve of the thigh:

▪ Supplies sensory innervation to the skin of the posterior

thigh.

• Locations:

o Found within the walls of the digestive tract, from the esophagus

to the anus.

o Includes the myenteric plexus (Auerbach's plexus) and the

submucosal plexus (Meissner's plexus).

• Functions:

o Controls the motility and secretion of the gastrointestinal tract

independently of the central nervous system.

o Regulates digestion, absorption, and gut motility.

13. Sciatica- Define the condition and Explain it on an anatomical basis.

• Sciatica:

o Pain that radiates along the course of the sciatic nerve, typically

from the lower back down the back of the leg.

• Anatomical Basis:

o Often caused by compression of the sciatic nerve as it exits the

pelvis through the greater sciatic foramen.

o Common causes include:

▪ Herniated disc: Protrusion of the intervertebral disc can

compress the nerve roots that form the sciatic nerve.

▪ Piriformis syndrome: Compression of the sciatic nerve by the

piriformis muscle.

▪ Spinal stenosis: Narrowing of the spinal canal can compress

the nerve roots.

14. Sciatic nerve: Show its formation, Mention branches & their motor supply.

• Formation:

o Formed by the union of the tibial nerve and the common fibular

nerve within the pelvis.

• Branches:

o Tibial Nerve:

▪ Supplies the muscles of the posterior compartment of the leg

(hamstrings, gastrocnemius, soleus).

o Common Fibular Nerve:

▪ Divides into the superficial fibular nerve and the deep fibular

nerve.

▪ Superficial Fibular Nerve: Supplies the muscles that evert

the foot.

▪ Deep Fibular Nerve: Supplies the muscles that dorsiflex the

foot and extend the toes.

PERINEUM

Female External Genitalia in Relation to Skeleton

• Points in Favor:

o Located in the perineum, inferior to the pubic symphysis.

o Protected by the bony pelvis (pubic bones, ischiopubic rami).

• Different Parts:

o Mons Pubis:

▪ Rounded eminence over the pubic symphysis.

▪ Covered with pubic hair after puberty.

o Labia Majora:

▪ Two prominent folds of skin that enclose and protect the

other external genitalia.

o Labia Minora:

▪ Two smaller folds of skin within the labia majora.

▪ Highly vascular and sensitive.

o Clitoris:

▪ Contains erectile tissue.

o Vestibule:

Cross-Questions:

▪ Small, erectile organ located at the anterior junction of the

labia minora.

▪ Space between the labia minora.

▪ Contains the urethral opening and the vaginal opening.

• Gynecological Perineum:

o The area between the vaginal opening and the anus.

• Why is the location of the external genitalia important?

o Protects the delicate structures within from external trauma.

• What is the function of the labia majora?

o To protect the more delicate structures within the vulva.

1. Hip Joint in Skeleton:

• Articular Parts:

o Head of the femur.

o Acetabulum of the hip bone.

• Movements:

o Flexion:

▪ Bringing the thigh towards the abdomen.

▪ Example: Lifting your leg to touch your chest.

▪ Muscle: Iliopsoas muscle (origin: iliac fossa and lumbar

vertebrae; insertion: lesser trochanter of femur)

o Extension:

▪ Moving the thigh backwards.

▪ Example: Swinging your leg backwards.

▪ Muscle: Gluteus maximus muscle (origin: posterior surface

of ilium, sacrum, and coccyx; insertion: iliotibial tract)

Cross-Questions:

• What type of joint is the hip joint?

o Ball-and-socket joint.

• What is the significance of the labrum in the hip joint?

o It deepens the acetabulum, increasing stability.

2. Sacrum in skeleton: Show & Describe gross features. Mention structures

passing through sacral foramina. (With cross questions)

• Gross Features:

o Triangular bone formed by the fusion of five sacral vertebrae.

o Base articulates with the fifth lumbar vertebra.

o Apex articulates with the coccyx.

o Anterior surface is concave.

o Posterior surface is rough and convex.

• Structures Passing Through Sacral Foramina:

o Sacral foramina:

▪ Four pairs of anterior sacral foramina and four pairs of

posterior sacral foramina.

▪ Allow passage of spinal nerves, blood vessels, and veins.

Cross-Questions:

• Why is the sacrum considered a fused bone?

o The five sacral vertebrae fuse together during adulthood.

• What is the clinical significance of the sacral foramina?

o They allow for the exit of the spinal nerves that innervate the lower

limbs and pelvic organs.

3. Hip joint in skeleton: Show the articular parts in the skeleton, Mention

movements, and Demonstrate them on your body. Hold a ribbon from

origin(s) to insertion(s) of ONE muscle that causes ONE of those movements.

(With cross questions)

• See the explanation in question 1 for articular parts and movements.

• Muscle:

o Iliopsoas muscle:

▪ Hold a ribbon from its origin (iliac fossa and lumbar

vertebrae) to its insertion (lesser trochanter of femur).

▪ Demonstrate flexion of the hip joint.

Cross-Questions:

• What other muscles are involved in hip flexion?

o Rectus femoris, pectineus, tensor fasciae latae.

• What is the importance of the iliopsoas muscle?

o It is a powerful hip flexor and plays a crucial role in walking, running,

and climbing.

4. Movement of vertebral column: Read the figure & Explain what special

understanding it offers.

• A figure depicting movements of the vertebral column would show:

o Flexion: Bending forward.

o Extension: Bending backward.

o Lateral flexion: Bending to the side.

o Rotation: Twisting of the vertebral column.

• Special Understanding:

o The figure would help to visualize the range of motion possible at

each vertebral level.

o It would also highlight the importance of the intervertebral discs

and facet joints in allowing these movements.

5. 5th lumbar vertebra in skeleton: Show & Describe gross features. Identify

foramina in skeleton & bone, & Name structures passing through them. (With

cross questions)

• Gross Features:

o Largest and most massive lumbar vertebra.

o Thick, robust body.

o Transverse processes are long and well-developed.

o Spinous process is short and blunt.

• Foramina:

o Vertebral foramen: Allows passage of the spinal cord.

o Intervertebral foramina:

▪ Formed between adjacent vertebrae.

▪ Allow passage of spinal nerves and blood vessels.

Cross-Questions:

• Why is the 5th lumbar vertebra particularly susceptible to injury?

o It bears the most weight of the upper body and is subjected to

significant stress during activities such as lifting and twisting.

• What is the clinical significance of the intervertebral foramina?

o Compression of the spinal nerves within these foramina can lead to

pain, numbness, and weakness.

6. Articulated pelvis in skeleton: Show & Describe gross features in articulated

pelvis. Identify foramina & Name structures passing through them. (With cross

questions)

• See the response to question 2.

7. Bone: Justify- the body of a vertebra is a modified long bone.

• The body of a vertebra can be considered a modified long bone because:

o It has a central, cylindrical shaft (the vertebral body itself).

o It is primarily composed of cancellous bone (spongy bone)

surrounded by a thin layer of compact bone.

o It is involved in weight-bearing, similar to the diaphysis of a long

bone.

8. Articulated pelvis in skeleton: Identify different joints present here &

Mention their type. Show boundaries of pelvic inlet & Name structures cross

it. (With cross questions)

• See the response to question 2.

9. Typical lumbar vertebra: Identify in skeleton & Show gross feature in bone.

Hold a ribbon from origin(s) to insertion(s) of “psoas major” muscle. (With

cross questions)

• Gross Features:

o Large, kidney-shaped body.

o Long, transverse processes.

o Short, blunt spinous process.

o Vertebral foramen.

o Intervertebral foramina.

o Facet joints for articulation with adjacent vertebrae.

• Psoas Major Muscle:

o Origin: Transverse processes and bodies of lumbar vertebrae.

o Insertion: Lesser trochanter of the femur.

o Hold a ribbon from the lumbar vertebrae to the lesser trochanter

to visualize the course of the muscle.

Cross-Questions:

• What is the primary function of the lumbar vertebrae?

o To support the weight of the upper body and provide flexibility to

the spine.

• What is the function of the psoas major muscle?

o Hip flexion, lateral flexion of the spine, and external rotation of the

hip.

10. Hip bone in skeleton: Show & Describe gross features of different parts of

the bone. Hold a ribbon from origin(s) to insertion(s) of muscle that are

attached to iliac fossa & anterior superior iliac spine. (With cross questions)

• Parts of the Hip Bone:

o Ilium:

▪ Largest part, forms the wing of the hip bone.

▪ Contains the iliac crest, iliac fossa, and greater sciatic notch.

o Ischium:

▪ Lower, posterior part of the hip bone.

▪ Contains the ischial tuberosity.

o Pubis:

▪ Anterior part of the hip bone.

▪ Forms the pubic symphysis.

• Muscles Attached to Iliac Fossa and Anterior Superior Iliac Spine:

o Iliacus muscle:

▪ Origin: Iliac fossa.

▪ Insertion: Lesser trochanter of the femur.

▪ Hold a ribbon from the iliac fossa to the lesser trochanter.

• Muscles Attached to Anterior Superior Iliac Spine:

o Sartorius muscle:

▪ Origin: Anterior superior iliac spine.

▪ Insertion: Medial side of the tibia.

▪ Hold a ribbon from the anterior superior iliac spine to the

medial side of the tibia.

Cross-Questions:

• What is the function of the iliacus muscle?

o Hip flexion, lateral flexion of the spine, and external rotation of the

hip.

• What is the function of the sartorius muscle?

o Flexion, abduction, and lateral rotation of the hip.

Clavicle

1. Clavicle in skeleton: Show & Describe gross features. -3

o S-shaped bone.

o Medial (sternal) end: Rounded and articulates with the manubrium

of the sternum.

o Lateral (acromial) end: Flattened and articulates with the acromion

process of the scapula.

2. Explain why junction between medial 2/3rds & lateral 1/3rd is prone to

fracture.-

o The junction between the medial two-thirds and lateral one-third

of the clavicle is the weakest point of the bone.

o It is subjected to significant forces during falls, often resulting in a

fracture at this location.

3. Hold a ribbon from origin(s) to insertion(s) of ONE muscle that are

attached from clavicle to upper limb. -4

o Muscle: Deltoid muscle

▪ Origin: Clavicle, acromion, and spine of the scapula.

▪ Insertion: Deltoid tuberosity of the humerus.

4. Hold a ribbon from origin(s) to insertion(s) of ONE muscle that is

attached to shaft of clavicle. -4 (With cross questions) -3

o Muscle: Pectoralis major muscle

▪ Origin: Clavicle, sternum, and costal cartilages.

▪ Insertion: Lateral lip of the intertubercular groove of the

humerus.

o Cross-questions:

▪ What is the action of the pectoralis major muscle?

▪ Adduction, medial rotation, and flexion of the

humerus.

5. Clavicle: Explain why it is a modified long bone.

o The clavicle is considered a modified long bone because it has a

central shaft (like a typical long bone), but it is not cylindrical like

other long bones. It has a unique S-shape and lacks a medullary

cavity.

Scapula

1. Scapula in skeleton : Show & Describe gross features. -3

o Triangular bone located on the posterior aspect of the thorax.

o Three borders: Superior, medial (vertebral), and lateral (axillary).

o Three angles: Superior, inferior, and lateral.

o Features:

▪ Glenoid cavity: Shallow socket that articulates with the head

of the humerus.

▪ Acromion process: Projects laterally to form the highest

point of the shoulder.

▪ Coracoid process: Projects anteriorly and laterally.

▪ Spine: Prominent ridge on the posterior surface.

2. Hold a ribbon from origin(s) to insertion(s) of TWO muscles that are

attached to dorsal surface of scapula. -4

o Muscle 1: Trapezius muscle

▪ Origin: Occipital bone, ligamentum nuchae, and spinous

processes of C7-T12.

▪ Insertion: Lateral third of the clavicle, acromion, and spine of

the scapula.

o Muscle 2: Deltoid muscle

▪ Origin: Clavicle, acromion, and spine of the scapula.

▪ Insertion: Deltoid tuberosity of the humerus.

3. Hold a ribbon from origin(s) to insertion(s) of TWO muscles that are

attached to ventral surface of scapula.-4

o Muscle 1: Subscapularis muscle

▪ Origin: Subscapular fossa of the scapula.

▪ Insertion: Lesser tubercle of the humerus.

o Muscle 2: Serratus anterior muscle

▪ Origin: Lateral aspects of the upper 8-9 ribs.

▪ Insertion: Anterior surface of the medial border of the

scapula.

4. Identify different types of joints formed by the bone & Mention

movements occurring at them. -4

o Acromioclavicular joint:

▪ Type: Plane (gliding) joint.

▪ Movements: Gliding movements between the acromion and

the clavicle.

o Glenohumeral joint:

▪ Type: Ball-and-socket joint.

▪ Movements: Flexion, extension, abduction, adduction,

rotation (medial and lateral), circumduction.

5. Mention position of glenoid cavity. Hold a ribbon from origin(s) to

insertion(s) of any ONE muscle that attached to spinous process.-4 (With

cross questions) -3

o Position of glenoid cavity:

▪ Located on the lateral angle of the scapula.

o Muscle:

▪ Trapezius muscle (see answer to question 2)

o Cross-questions:

▪ What is the clinical significance of the glenoid cavity?

▪ It is a shallow socket that provides limited stability to

the shoulder joint, making it prone to dislocation.

Humerus

1. Humerus in skeleton: Show & Describe gross features of upper end.-3

o Head: Rounded, articulates with the glenoid cavity of the scapula.

o Greater tubercle: Prominent lateral projection.

o Lesser tubercle: Smaller projection anterior and medial to the

greater tubercle.

o Intertubercular groove (bicipital groove): Separates the greater

and lesser tubercles, and accommodates the tendon of the long

head of the biceps brachii.

2. Hold a ribbon from origin(s) to insertion(s) of Biceps brachii muscle.-4

o Origin:

▪ Long head: Supraglenoid tubercle of the scapula.

▪ Short head: Coracoid process of the scapula.

o Insertion:

▪ Tuberosity of the radius.

3. Hold a ribbon from origin(s) to insertion(s) of chief flexor muscle of

elbow joint.-4

o Muscle: Brachialis muscle

▪ Origin: Anterior surface of the humerus below the deltoid

tuberosity.

▪ Insertion: Coronoid process of the ulna.

4. Hold a ribbon from origin(s) to insertion(s) of triceps brachii.-4

o Origin:

▪ Long head: Infraglenoid tubercle of the scapula.

▪ Lateral head: Posterior surface of the humerus.

▪ Medial head: Posterior surface of the humerus.

o Insertion:

▪ Olecranon process of the ulna.

5. Show & Describe gross features. -3

o Shaft:

▪ Long and cylindrical.

▪ Contains a prominent deltoid tuberosity laterally.

▪ Contains a groove for the radial nerve.

6. Hold a ribbon from origin(s) to insertion(s) of TWO muscles that arises

from humerus.-4

o Muscle 1: Brachialis muscle (see answer to question 3)

o Muscle 2: Brachioradialis muscle

▪ Origin: Lateral supracondylar ridge of the humerus.

▪ Insertion: Lateral side of the distal radius.

7. Show & Describe gross features of upper end & Hold a ribbon from

origin(s) to insertion(s) of biceps brachii muscle. -4

o See the descriptions in questions 1 and 2.

8. Mention nerves related to upper end & Hold a ribbon from origin(s) to

insertion(s) of biceps brachii muscle. -4

o Nerves: Axillary nerve, musculocutaneous nerve

o Muscle: Biceps brachii muscle (see answer to question 2)

9. Identify different types of joints formed by the bone & Mention

movements occurring at them.-4

o Glenohumeral joint:

▪ Type: Ball-and-socket joint.

▪ Type: Hinge joint.

▪ Movements: Flexion, extension, abduction, adduction,

rotation (medial and lateral), circumduction.

o Humeroulnar joint:

▪ Movements: Flexion and extension.

o Humeroradial joint:

▪ Type: Gliding joint.

▪ Movements: Contribute to flexion and extension.

10. Show & Describe gross features of lower end.-3

• Medial condyle: Large, rounded prominence.

• Lateral condyle: Smaller than the medial condyle.

• Trochlea: Pulley-shaped articular surface for the ulna.

• Capitulum: Rounded articular surface for the radius.

11. Show & Describe gross features of shaft & lower ends.-3

• Shaft: Long and cylindrical, with a slight anterior curvature.

• Lower end:

o Medial and lateral condyles.

o Trochlea and capitulum.

12. Identify different types of joints formed by the bone & Mention

movements occurring at them. -4

• See the description in question 9.

13. Hold a ribbon from origin(s) to insertion(s) of brachialis muscle.-4(With

cross questions)-3

• Muscle: Brachialis muscle

o Origin: Anterior surface of the humerus below the deltoid

tuberosity.

o Insertion: Coronoid process of the ulna.

• Cross-questions:

o What is the primary action of the brachialis muscle?

▪ Flexion of the elbow joint.

o Why is it considered the "workhorse" of elbow flexion?

Radius

▪ It is the strongest flexor of the elbow joint, contributing

significantly to elbow flexion even when other muscles are

weak or paralyzed.

1. Radius in skeleton: Show & Describe gross features. -3

o Long bone located on the lateral side of the forearm.

o Head: Disc-shaped, articulates with the capitulum of the humerus.

o Neck: Narrowed region below the head.

o Radial tuberosity: Prominent projection on the medial side of the

proximal shaft.

o Styloid process: Prominent projection on the lateral side of the

distal end.

2. Hold a ribbon from origin(s) to insertion(s) of brachialis muscle. -4

o Muscle: Brachialis muscle (see answer to question 3 under

Humerus)

3. Show & Describe gross features of upper end.-3

o Head: Disc-shaped, articulates with the capitulum of the humerus.

o Radial tuberosity: Prominent projection on the medial side of the

proximal shaft.

4. Hold a ribbon from origin(s) to insertion(s) of a muscle that is attached

with it. -4

o Muscle: Biceps brachii muscle

▪ Origin:

▪ Long head: Supraglenoid tubercle of the scapula.

▪ Short head: Coracoid process of the scapula.

▪ Insertion: Radial tuberosity of the radius.

5. Show & Describe gross features of upper & lower ends. -3

o Upper end:

▪ Head, neck, radial tuberosity.

o Lower end:

▪ Styloid process.

▪ Ulnar notch: Articulates with the ulna.

6. Identify different types of joints formed by the bone & Mention

movements occurring at them. -4

o Humeroradial joint:

▪ Type: Gliding joint.

▪ Movements: Contribute to flexion and extension.

o Radioulnar joints:

▪ Proximal radioulnar joint:

▪ Type: Pivot joint.

▪ Distal radioulnar joint:

▪ Type: Pivot joint.

▪ Movements: Pronation and supination.

7. Identify different types of joints formed by the bone & Mention

movements occurring at them. -4

o See the answer to question 6.

8. Upper end of radius in skeleton: Show gross features & Identify joints

formed by it. -3

o Gross Features:

▪ Head, neck, radial tuberosity.

o Joints:

▪ Humeroradial joint: Articulation with the capitulum of the

humerus.

▪ Proximal radioulnar joint: Articulation with the radial notch

of the ulna.

9. Hold a ribbon from origin(s) to insertion(s) of biceps brachii muscle.-4

o Muscle: Biceps brachii muscle (see answer to question 2)

Ulna

2. Ulna in skeleton: Show & Describe gross features. -3

o Longer than the radius.

o Proximal end:

▪ Olecranon process: Forms the bony prominence of the

elbow.

▪ Trochlear notch: Articulates with the trochlea of the

humerus.

▪ Coronoid process: Projects anteriorly.

o Shaft:

▪ Triangular in cross-section.

o Distal end:

▪ Head: Articulates with the ulnar notch of the radius.

▪ Styloid process: Projects posteriorly.

3. Hold a ribbon from origin(s) to insertion(s) of muscles that helps in

supination movement.-4

o Muscle: Supinator muscle

▪ Origin: Lateral epicondyle of the humerus and annular

ligament.

▪ Insertion: Lateral surface of the radius.

4. Show & Describe gross features of upper end. Hold a ribbon from

origin(s) to insertion(s) of a muscle that is attached with ulna. (With

cross question)(3+4+3)

o Gross Features:

▪ Olecranon process: Forms the bony prominence of the

elbow.

▪ Trochlear notch: Articulates with the trochlea of the

humerus.

▪ Coronoid process: Projects anteriorly.

o Muscle:

▪ Brachialis muscle

▪ Origin: Anterior surface of the humerus below the

deltoid tuberosity.

▪ Insertion: Coronoid process of the ulna.

o Cross-question:

▪ What is the function of the olecranon process?

▪ Provides a strong attachment point for the triceps

brachii muscle.

5. Ulna in skeleton: Show & Describe gross features of upper end. Outline

the articular surfaces & Mention ossification of it. (With cross

questions)(3+4+3)

o Gross Features:

▪ See the description in question 3.

o Articular Surfaces:

▪ Trochlear notch: Articulates with the trochlea of the

humerus.

▪ Radial notch: Articulates with the head of the radius.

o Ossification:

▪ The ulna develops from a single ossification center.

o Cross-questions:

▪ What is the significance of the trochlear notch?

▪ What is the function of the radial notch?

▪ It allows for the hinge-like movement at the elbow

joint.

▪ It allows for the rotation of the radius on the ulna

during pronation and supination.

6. Show & Describe gross features of upper & lower ends. Identify different

types of joints formed by the bone & Mention movements occurring at

them. (With cross questions)(3+4+3)

o Upper end: See the description in question 3 and 4.

o Lower end:

▪ Head: Articulates with the ulnar notch of the radius.

▪ Styloid process: Projects posteriorly.

o Joints:

▪ Humeroulnar joint:

▪ Type: Hinge joint.

▪ Movements: Flexion and extension.

▪ Proximal radioulnar joint:

▪ Type: Pivot joint.

▪ Movements: Pronation and supination.

▪ Distal radioulnar joint:

▪ Type: Pivot joint.

100

▪ Movements: Pronation and supination.

o Cross-questions:

▪ What is the difference between pronation and supination?

▪ Pronation: Turning the palm of the hand downwards.

▪ Supination: Turning the palm of the hand upwards.

7. Show & Describe gross features of upper end & shaft. Hold a ribbon from

origin(s) to insertion(s) of ONE muscle that is attached to upper end.

(With cross questions)(3+4+3)

o Upper end: See the description in question 3 and 4.

o Shaft:

▪ Triangular in cross-section.

▪ Provides attachment sites for muscles.

o Muscle:

▪ Triceps brachii muscle

▪ Origin:

▪ Long head: Infraglenoid tubercle of the scapula.

▪ Lateral head: Posterior surface of the humerus.

▪ Medial head: Posterior surface of the humerus.

▪ Insertion: Olecranon process of the ulna.

o Cross-questions:

▪ What is the primary action of the triceps brachii muscle?

▪ Extension of the elbow joint.

▪ Why is the olecranon process an important landmark?

▪ It provides a strong attachment point for the triceps

brachii muscle, which is crucial for elbow extension.

101

Articulated Hand

1. Articulated hand in skeleton: Show bones forming articulated hand.-3

o Carpal bones:

▪ Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid,

capitate, hamate.

o Metacarpal bones: Five bones, one for each finger.

o Phalanges:

▪ Proximal, middle, and distal phalanges (except for the

thumb, which has only two phalanges).

2. Identify FOUR types of joints present & Show movements of wrist joint

in your own body.

o Plane joints:

▪ Intercarpal joints (between carpal bones)

▪ Carpometacarpal joints (except for the first carpometacarpal

joint)

o Saddle joint:

▪ Metacarpophalangeal joints

▪ Proximal interphalangeal joints

▪ Distal interphalangeal joints

o Wrist joint movements:

▪ First carpometacarpal joint (between trapezium and base of

the first metacarpal)

o Hinge joints:

▪ Flexion: Bending the wrist towards the anterior surface of

the forearm.

▪ Extension: Bending the wrist towards the posterior surface

of the forearm.

▪ Radial deviation: Moving the hand towards the radial side

(thumb side).

▪ Ulnar deviation: Moving the hand towards the ulnar side

(little finger side).

3. Show bones forming it & Mention morphological types of bones with

explanation.-4

o Carpal bones: Short bones (cube-shaped).

o Metacarpal bones: Long bones (with a shaft and two ends).

o Phalanges: Long bones.

4. First carpometacarpal joint in skeleton: Identify joint in skeleton &

Demonstrate movements in your own body. (With cross

questions)(3+4+3)

102

o Joint: Saddle joint between the trapezium and the base of the first

metacarpal bone (thumb).

o Movements:

▪ Flexion/extension

▪ Abduction/adduction

▪ Opposition (bringing the thumb to touch the other fingers)

o Cross-questions:

▪ Why is the first carpometacarpal joint unique?

▪ It is a saddle joint, allowing for a wide range of motion,

including opposition.

▪ What is the significance of opposition?

▪ It allows for precise manipulation of objects.

5. Articulated hand in skeleton: Show different types of joints formed by

its different parts. Demonstrate movements at any TWO of them in your

own body & Mention muscles responsible for each movement. (With

cross questions)(3+4+3)

o See the list of joint types in question 2.

o Example 1: Metacarpophalangeal joint (MCP joint) of the index

finger

▪ Movement: Flexion

▪ Muscle: Flexor digitorum superficialis (inserts on the middle

phalanx)

o Example 2: Wrist joint

▪ Movement: Flexion

▪ Muscle: Flexor carpi radialis

o Cross-questions:

▪ What are the other muscles that contribute to wrist flexion?

▪ Flexor carpi ulnaris, palmaris longus.

▪ What is the importance of the MCP joints?

▪ They allow for bending and straightening of the

fingers.

6. Show different joints & Mention their types. Demonstrate any TWO

movements of wrist joint in your body with mentioning responsible

muscles. With cross questions)(3+4+3)

o Joints:

▪ Radiocarpal joint:

▪ Type: Ellipsoid joint (condyloid joint).

▪ Intercarpal joints:

▪ Type: Plane (gliding) joints.

o Wrist Movements:

103

▪ Flexion: Bending the wrist towards the anterior surface of

the forearm.

▪ Muscle: Flexor carpi radialis

▪ Extension: Bending the wrist towards the posterior surface

of the forearm.

▪ Muscle: Extensor carpi radialis longus

o Cross-questions:

▪ What other muscles contribute to wrist extension?

▪ Extensor carpi radialis brevis, extensor carpi ulnaris.

▪ What is the importance of wrist movements?

▪ Essential for activities such as grasping, manipulating

objects, and waving.

7. Articulated hand: Identify bones & Mention their morphological type.

Show different joints formed by the bones mentioning their types. (With

cross questions)(3+4+3)

o Bones:

▪ Carpal bones: Short bones.

▪ Metacarpal bones: Long bones.

▪ Phalanges: Long bones.

o Joints:

▪ See the list of joint types in question 2.

o Cross-questions:

▪ Why is the classification of bone morphology important?

▪ It helps to understand the function and biomechanics

of the bone.

▪ What are the other morphological types of bones?

▪ Long bones, short bones, flat bones, irregular bones,

sesamoid bones.

8. Articulated hand in skeleton: Show different joints present here with

their type. Hold a ribbon from origin to insertion of any ONE muscle that

is inserted in a phalanx. (With cross questions)(3+4+3)

o Joints:

▪ See the list of joint types in question 2.

o Muscle:

▪ Flexor digitorum superficialis

▪ Origin:

▪ Anterior surface of the radius and ulna.

▪ Insertion:

▪ Middle phalanx of each finger (except the

thumb).

104

o Cross-questions:

▪ What is the function of the flexor digitorum superficialis?

▪ Flexion of the proximal interphalangeal joints.

▪ What other muscles contribute to finger flexion?

▪ Flexor digitorum profundus, lumbricals, interossei.

Shoulder joint

1. Shoulder joint in skeleton: Show articular parts in skeleton &

Demonstrate movements in your own body. (With cross

questions)(3+4+3)

o Articular Parts:

▪ Head of the humerus.

▪ Glenoid cavity of the scapula.

o Movements:

▪ Flexion: Lifting the arm forward.

▪ Extension: Moving the arm backward.

▪ Abduction: Raising the arm to the side.

▪ Medial rotation: Turning the arm inward.

▪ Adduction: Lowering the arm from an abducted position.

▪ Lateral rotation: Turning the arm outward.

▪ Circumduction: A combination of flexion, extension,

abduction, and adduction.

o Cross-questions:

▪ What type of joint is the shoulder joint?

▪ Ball-and-socket joint.

▪ Why is the shoulder joint the most mobile joint in the body?

▪ Due to its shallow socket and loose ligaments, allowing

for a wide range of motion.

2. Shoulder joint in skeleton: Show the articular parts in the skeleton,

Mention movements, and Demonstrate them on your body. Hold a

ribbon from origin(s) to insertion(s) of ONE muscle that causes ONE of

those movements. (With cross questions)(3+4+3)

o Articular Parts:

▪ See answer to question 1.

o Movement:

▪ Abduction: Raising the arm to the side.

o Muscle:

▪ Deltoid muscle

▪ Origin: Clavicle, acromion, and spine of the scapula.

105

▪ Insertion: Deltoid tuberosity of the humerus.

o Cross-questions:

▪ What other muscles contribute to shoulder abduction?

▪ Supraspinatus muscle.

▪ What is the role of the rotator cuff muscles in shoulder

stability?

▪ They help to center the head of the humerus within

the glenoid cavity.

3. Shoulder Joint in skeleton: Show the articular parts in the skeleton,

Mention movements, and Demonstrate them on your body. Hold a

ribbon from origin(s) to insertion(s) of ONE muscle that causes ONE of

those movements. (With cross questions)(3+4+3)

o See the answer to question 2.

4. Outline articular surfaces in skeleton. Hold a ribbon from origin(s) to

insertion(s) of ONE flexor & ONE extensor. (With cross

questions)(3+4+3)

o Articular Surfaces:

▪ Head of the humerus.

▪ Glenoid cavity of the scapula.

o Flexor:

▪ Pectoralis major muscle

Shoulder joint (continued)

▪ Origin: Clavicle, sternum, and costal cartilages.

▪ Insertion: Lateral lip of the intertubercular

4. Outline articular surfaces in skeleton. Hold a ribbon from origin(s) to

insertion(s) of ONE flexor & ONE extensor. (With cross

questions)(3+4+3)

o Articular Surfaces:

▪ Head of the humerus.

▪ Glenoid cavity of the scapula.

o Flexor:

▪ Pectoralis major muscle

▪ Origin: Clavicle, sternum, and costal cartilages.

▪ Insertion: Lateral lip of the intertubercular groove of

the humerus.

o Extensor:

▪ Latissimus dorsi muscle

106

▪ Origin: Spinous processes of T7-L5, iliac crest, and ribs

10-12.

▪ Insertion: Medial lip of the intertubercular groove of

the humerus.

o Cross-questions:

▪ What other muscles contribute to shoulder flexion?

▪ Anterior deltoid, coracobrachialis.

▪ What other muscles contribute to shoulder extension?

▪ Posterior deltoid, teres major.

5. Show articular parts in skeleton & any TWO movements in your body

with mentioning responsible muscles. Name factors providing stability

to shoulder joint. (With cross questions)(3+4+3)

o Articular Parts:

▪ Head of the humerus.

▪ Glenoid cavity of the scapula.

o Movements:

▪ Flexion:

▪ Muscle: Pectoralis major

▪ Abduction:

▪ Muscle: Deltoid

o Factors providing stability:

▪ Glenoid labrum: Deepens the glenoid cavity.

▪ Rotator cuff muscles: (Supraspinatus, infraspinatus, teres

minor, subscapularis)

▪ Joint capsule and ligaments:

▪ Glenohumeral ligaments, coracohumeral ligament,

transverse humeral ligament.

o Cross-questions:

▪ Why is the shoulder joint prone to dislocation?

▪ Because of its shallow socket and reliance on soft

tissue structures for stability.

▪ What is the role of the rotator cuff muscles in shoulder

stability?

▪ They help to center the head of the humerus within

the glenoid cavity and prevent dislocation.

Radioulnar joint

1. Radio-ulnar joints in skeleton: Show types & Demonstrate movements

in your own body. -7

107

o Types:

▪ Proximal Radioulnar Joint: Pivot joint.

▪ Distal Radioulnar Joint: Pivot joint.

o Movements:

▪ Pronation: Turning the palm of the hand downwards (e.g.,

placing your hand palm down on a table).

▪ Supination: Turning the palm of the hand upwards (e.g.,

holding a bowl of soup).

2. Show the articular parts in the skeleton, Mention movements, and

Demonstrate them on your body. Hold a ribbon from origin(s) to

insertion(s) of ONE muscle that causes ONE of those movements. (With

cross questions)(3+4+3)

o Articular Parts:

▪ Proximal Radioulnar Joint:

▪ Head of the radius.

▪ Radial notch of the ulna.

▪ Distal Radioulnar Joint:

▪ Head of the ulna.

▪ Ulnar notch of the radius.

o Movement:

▪ Supination:

▪ Muscle: Supinator muscle

▪ Origin: Lateral epicondyle of the humerus and

annular ligament.

▪ Insertion: Lateral surface of the radius.

o Cross-questions:

▪ What other muscles contribute to supination?

▪ Biceps brachii.

▪ Why is the proximal radioulnar joint a pivot joint?

▪ It allows for rotation of the radius around the ulna.

3. Show & Describe their formation & Mention type(s). Demonstrate TWO

movements in your own body mentioning their responsible muscles.

(With cross questions)(3+4+3)

o Formation:

▪ Proximal Radioulnar Joint: Formed by the articulation of the

head of the radius with the radial notch of the ulna.

▪ Distal Radioulnar Joint: Formed by the articulation of the

head of the ulna with the ulnar notch of the radius.

o Type:

▪ Both are pivot joints.

108

o Movements:

▪ Pronation:

▪ Muscle: Pronator teres, pronator quadratus.

▪ Supination:

▪ Muscle: Supinator, biceps brachii.

o Cross-questions:

▪ What is the difference between pronation and supination?

▪ Pronation: Turning the palm of the hand downwards.

▪ Supination: Turning the palm of the hand upwards.

▪ Why are the radioulnar joints important?

▪ They allow for the rotational movements of the

forearm, which are essential for many daily activities.

Elbow joint

1. Elbow joint in skeleton: Show articular parts in skeleton & Demonstrate

movements in your own body. -7

o Articular Parts:

▪ Humeroulnar joint: Trochlea of the humerus and trochlear

notch of the ulna.

▪ Humeroradial joint: Capitulum of the humerus and head of

the radius.

o Movements:

▪ Flexion: Bending the forearm towards the upper arm.

▪ Extension: Straightening the forearm.

2. Show articular parts in skeleton & Demonstrate movements in your own

body. (With cross questions)(3+4+3)

o Articular Parts:

▪ See answer to question 1.

o Movements:

▪ Flexion, extension.

o Cross-questions:

▪ What is the primary function of the elbow joint?

▪ To allow for flexion and extension of the forearm.

▪ What are the other accessory movements at the elbow

joint?

▪ Slight rotation.

3. Elbow joint in skeleton: Show articular surfaces in skeleton.

Demonstrate movements in your own body. (With cross

questions).(3+4+3)

109

o Articular Surfaces:

▪ Humeroulnar joint: Trochlea of the humerus and trochlear

notch of the ulna.

▪ Humeroradial joint: Capitulum of the humerus and head of

the radius.

o Movements:

▪ Flexion, extension.

o Cross-questions:

▪ Why is the trochlea of the humerus shaped like a pulley?

▪ To guide the ulna during flexion and extension.

4. Elbow joint in skeleton: Show the articular parts in the skeleton,

Mention movements, and Demonstrate them on your body. Hold a

ribbon from origin(s) to insertion(s) of ONE muscle that causes ONE of

those movements. (With cross questions)(3+4+3)

o Articular Parts:

▪ See answer to question 1.

o Movement:

▪ Flexion:

▪ Muscle: Brachialis muscle

▪ Origin: Anterior surface of the humerus.

▪ Insertion: Coronoid process of the ulna.

o Cross-questions:

▪ What is the primary action of the brachialis muscle?

▪ Flexion of the elbow joint.

▪ Why is the brachialis considered the "workhorse" of elbow

flexion?

▪ It is the strongest flexor of the elbow joint,

contributing significantly to elbow flexion even when

other muscles are weak or paralyzed.

5. Elbow joint in skeleton: Show the articular parts in the skeleton,

Mention movements, and Demonstrate them on your body. Hold a

ribbon from origin(s) to insertion(s) of ONE muscle that causes ONE of

those movements. (With cross questions)(3+4+3)

o See the answer to question 4.

6. Show articular parts in skeleton. Demonstrate movements in your own

body & Name muscles responsible for movements. (With cross

questions)(4+3)

o Articular Parts:

▪ See answer to question 1.

o Movements:

110

▪ Flexion:

▪ Muscles: Brachialis, biceps brachii.

▪ Extension:

▪ Muscle: Triceps brachii.

o Cross-questions:

▪ What other muscles contribute to elbow flexion?

▪ Biceps brachii, brachioradialis.

▪ **What

111

7. Show & Describe its formation & Mention type. Demonstrate

movements at this joint in your own body & Name muscles producing

those movements. (With cross questions)(3+4+3)

• Formation:

o Formed by the articulation of the trochlea of the humerus with the

trochlear notch of the ulna.

• Type:

o Hinge joint.

• Movements:

o Flexion:

▪ Muscles: Brachialis, biceps brachii.

o Extension:

▪ Muscle: Triceps brachii.

• Cross-questions:

o Why is the elbow joint classified as a hinge joint?

▪ Because it allows for movement in only one plane (flexion

and extension), similar to the hinge of a door.

o What is the role of the ulnar collateral ligament in the elbow joint?

Wrist joint

▪ It provides stability to the medial side of the elbow joint.

1. Wrist joint in skeleton: Show articular parts in skeleton & Demonstrate

movements in your own body. (With cross questions)(3+4+3)

o Articular Parts:

▪ Radiocarpal joint:

▪ Distal radius and ulnar bones.

▪ Scaphoid, lunate, and triquetrum bones of the wrist.

o Movements:

▪ Flexion, extension, radial deviation, ulnar deviation,

circumduction.

o Cross-questions:

▪ What type of joint is the radiocarpal joint?

▪ Ellipsoid joint (condyloid joint).

▪ Why is the wrist joint capable of a wide range of motion?

▪ Due to its ellipsoid shape, allowing for movement in

two planes.

2. Show the articular parts in the skeleton, Mention movements, and

Demonstrate them on your body. Hold a ribbon from origin(s) to

112

insertion(s) of ONE muscle that causes ONE of those movements. (With

cross questions)(3+4+3)

o Articular Parts:

▪ See answer to question 1.

o Movement:

▪ Flexion:

▪ Muscle: Flexor carpi radialis

▪ Origin: Lateral epicondyle of the humerus.

▪ Insertion: Base of the second metacarpal bone.

o Cross-questions:

▪ What other muscles contribute to wrist flexion?

▪ Flexor carpi ulnaris, palmaris longus.

▪ Why is the flexor carpi radialis important for wrist flexion?

▪ It is a strong wrist flexor and also contributes to radial

deviation.

3. Wrist joint in skeleton: Show articular parts in skeleton & Demonstrate

movements in your own body. Hold a ribbon from origin(s) to

insertion(s) of ONE muscle that causes ONE of those movements. (With

cross questions)(3+4+3)

o Articular Parts:

▪ See answer to question 1.

o Movement:

▪ Flexion:

▪ Muscle: Flexor carpi radialis (see answer to question

o Cross-questions:

▪ See the cross-questions from question 2.

4. Wrist joint in skeleton: Show articular parts in skeleton & Demonstrate

movements in your body. Hold a ribbon from origin(s) to insertion(s) of

ONE muscle that crosses joint in front. (With cross questions)(3+4+3)

o Articular Parts:

▪ See answer to question 1.

o Movement:

▪ Flexion:

▪ Muscle: Flexor carpi radialis

▪ Origin: Lateral epicondyle of the humerus.

▪ Insertion: Base of the second metacarpal bone.

o Cross-questions:

▪ Why is it important to identify muscles that cross a joint?

113

▪ Because muscles that cross a joint are typically the

primary movers of that joint.

▪ What other muscles cross the wrist joint anteriorly?

▪ Flexor carpi ulnaris, palmaris longus.

Arm and Forearm

● Arm: Show different compartments & Mention nerve supply with their root

values and cords from where they come. 5

* **Anterior Compartment:**

* **Nerve Supply:** Musculocutaneous nerve (C5-C7)

* Origin: Lateral cord of the brachial plexus.

* **Posterior Compartment:**

* **Nerve Supply:** Radial nerve (C5-T1)

* Origin: Posterior cord of the brachial plexus.

* **Medial Compartment:**

* **Nerve Supply:** Ulnar nerve (C8-T1)

* Origin: Medial cord of the brachial plexus.

● Muscular compartments of forearm: Name the nerves supplying different

compartments & Show the cords from which they come. 5

* **Anterior Compartment:**

* **Nerve Supply:** Median nerve (C5-T1)

* Origin: Lateral and medial cords of the brachial plexus.

* **Posterior Compartment:**

* **Nerve Supply:** Radial nerve (C5-T1)

* Origin: Posterior cord of the brachial plexus.

* **Lateral Compartment:**

* **Nerve Supply:** Radial nerve (C5-T1)

* Origin: Posterior cord of the brachial plexus.

Mammary

● Mammary gland: Explain how krukenberg tumor develops. 7

* **Krukenberg tumor:** A rare type of metastatic cancer that typically

originates in the stomach or ovaries and spreads to the breasts.

* **Development:**

114

115

* Cancer cells from the primary tumor (stomach or ovary) travel through the

bloodstream or lymphatic system and reach the breast tissue.

* These cells then infiltrate and grow within the breast, often presenting as

bilateral, firm, and often rubbery masses.

● Mammary gland: Show and Explain importance of drainage of different

quadrants. 5

* **Importance of Drainage:**

* The lymphatic drainage pattern of the breast is crucial for the spread of

breast cancer.

* Cancer cells can travel through the lymphatic vessels to regional lymph

nodes.

* **Quadrantal drainage:**

* **Upper inner quadrant:** Drains primarily to the internal mammary

lymph nodes.

* **Upper outer quadrant:** Drains primarily to the axillary lymph nodes.

* **Lower inner quadrant:** Drains primarily to the internal mammary

lymph nodes.

* **Lower outer quadrant:** Drains primarily to the axillary lymph nodes.

* **Clinical Significance:**

* Understanding the drainage patterns helps in determining the extent of

cancer spread and guiding treatment decisions (e.g., lymph node dissection).

Vessels

● Upper limb: Describe the venous drainage. 5

* **Superficial Veins:**

* **Cephalic vein:**

* Begins on the radial side of the dorsum of the hand.

* Ascends along the lateral side of the arm.

* Joins the axillary vein.

* **Basilic vein:**

* Begins on the ulnar side of the dorsum of the hand.

* Ascends along the medial side of the arm.

* Joins the brachial veins to form the axillary vein.

* **Deep Veins:**

* **Brachial veins:**

* Formed by the deep veins of the forearm.

* Accompany the brachial artery.

* **Axillary vein:**

* Formed by the union of the brachial veins and the basilic vein.

● Cephalic vein: Mention formation, course & termination. 5

* **Formation:** Begins on the radial side of the dorsum of the hand.

* **Course:** Ascends along the lateral side of the forearm and arm.

* **Termination:** Joins the axillary vein.

● Basilic vein: Mention formation, course and termination. 5

* **Formation:** Begins on the ulnar side of the dorsum of the hand.

* **Course:** Ascends along the medial side of the forearm and arm.

* **Termination:** Joins the brachial veins to form the axillary vein.

● Superficial veins of upper limb: Show formations, courses & terminations. 5

* **Cephalic vein:**

* See description above.

* **Basilic vein:**

* See description above.

* **Median cubital vein:**

* Connects the cephalic and basilic veins in the cubital fossa.

● Elbow joint: Show & Describe anastomosis around elbow joint. 5

* **Anastomosis:** The communication between the cephalic and basilic veins

occurs at the elbow joint via the median cubital vein.

* **Significance:**

* Provides alternative pathways for blood flow if one of the

116

Vessels (continued)

• Elbow joint: Show & Describe anastomosis around elbow joint. 5

o Anastomosis: The communication between the cephalic and basilic

veins occurs at the elbow joint via the median cubital vein.

o Significance:

▪ Provides alternative pathways for blood flow if one of the

veins is obstructed.

▪ This is a common site for venipuncture (blood drawing).

• Palmar arch: Show & Describe its location & formation. 5

o Location:

▪ Located deep within the palm of the hand.

o Formation:

▪ Formed by the deep palmar branch of the ulnar artery and

the superficial palmar branch of the radial artery.

Nerves

• Ulnar nerve: Describe sensory supply to hand/ by root

values/dermatome. 5

o Sensory Supply:

▪ Supplies the medial one and a half fingers (little finger and

medial half of the ring finger) on both the palmar and dorsal

surfaces.

o Root Values: C8-T1

o Dermatome: C8-T1 dermatomes.

• Ulnar nerve: Mention origin, termination & distribution. 5

o Origin:

▪ Medial cord of the brachial plexus.

o Termination:

▪ Divides into superficial and deep branches in the hand.

o Distribution:

▪ Motor: Supplies the intrinsic hand muscles (except those

supplied by the median nerve), flexor carpi ulnaris, and flexor

digitorum profundus to the fourth and fifth fingers.

▪ Sensory: Supplies the medial one and a half fingers.

• Ulnar nerve: Show course, Mention its root values & one muscle that it

innervates. 5

o Course:

▪ Descends along the medial side of the arm and forearm.

117

▪ Passes posterior to the medial epicondyle of the humerus

(cubital tunnel).

▪ Enters the hand through the Guyon's canal.

o Root Values: C8-T1

o Muscle:

▪ Flexor carpi ulnaris

• Radial nerve: Describe sensory supply to dorsum of hand. 5

o Sensory Supply: Supplies the posterior surface of the hand

(dorsum), except for the medial one and a half fingers.

• Radial nerve: Mention area supplied by it. 5

o Area Supplied:

▪ Motor: Supplies the posterior compartment of the arm

(triceps brachii) and the posterior compartment of the

forearm (extensors of the wrist and fingers).

▪ Sensory: Supplies the posterior surface of the arm and

forearm, and the posterior surface of the hand (except for

the medial one and a half fingers).

• Median nerve: Mention sensory nerve supply to hand. 5

o Sensory Supply:

• Median nerve: Mention origin & distribution. 5

o Origin:

▪ Supplies the lateral three and a half fingers on the palmar

surface.

▪ Lateral and medial cords of the brachial plexus.

o Distribution:

▪ Motor: Supplies the anterior compartment of the forearm

(most flexor muscles), thenar muscles.

▪ Sensory: Supplies the lateral three and a half fingers on the

palmar surface.

• Axillary nerve: Show course, Mention its root values & one muscle that

it innervates. 5

o Course:

▪ Passes through the quadrangular space.

o Root Values: C5-C6

o Muscle:

▪ Deltoid muscle

• Brachial plexus: Mention its formation & branches. 5

o Formation:

▪ Formed by the anterior rami of spinal nerves C5-T1.

o Branches:

118

▪ Musculocutaneous nerve, axillary nerve, radial nerve,

median nerve, ulnar nerve.

• Upper limb: Show dermatomes of upper limb. 5

o Dermatomes are areas of skin innervated by a single spinal nerve

root.

o The dermatomes of the upper limb correspond to the spinal nerves

that contribute to the brachial plexus (C5-T1).

Clinical

• Smith’s fracture: Mention site and Explain features. 7

o Site: Fracture of the distal radius with palmar displacement of the

distal fragment.

o Features:

▪ Often occurs due to a fall on an outstretched hand.

▪ Characterized by a "dinner fork" deformity.

• Subluxation or pulled elbow: Explain features, anatomical basis &

Mention which age group is usually affected. 7

o Features:

▪ Often occurs in children.

o Anatomical basis:

▪ Sudden onset of pain and refusal to use the affected arm.

▪ Subluxation of the radial head from the annular ligament.

o Age group:

▪ Most common in children between 1 and 4 years old.

• Cubital tunnel syndrome: Mention site and Explain features, why it

mostly occurs inferiorly. 7

o Site:

▪ Compression of the ulnar nerve at the cubital tunnel (the

space behind the medial epicondyle of the humerus).

o Features:

▪ Numbness and tingling in the medial one and a half fingers.

▪ Weakness of the hand muscles innervated by the ulnar

nerve.

o Why it occurs inferiorly:

▪ The ulnar nerve is more susceptible to compression at the

cubital tunnel due to its superficial location and the relatively

tight confines of the tunnel.

• Carpal tunnel syndrome: Mention cause & Explain the features. 7

o Cause:

119

▪ Compression of the median nerve as it passes through the

carpal tunnel (a narrow passageway in the wrist).

▪ Can be caused by repetitive use, injury, or underlying

conditions like diabetes or rheumatoid arthritis.

o Features:

▪ Numbness, tingling, and weakness in the thumb, index

finger, middle finger, and sometimes the ring finger.

▪ Pain that may radiate up the arm.

• Venepuncture: Mention most preferable vein & Explain anatomical

basis of choosing this vein. 7

o Most preferable vein:

▪ Median cubital vein.

o Anatomical basis:

▪ It is large, easily accessible, and relatively superficial.

▪ It is well-anchored and less likely to roll compared to other

superficial veins.

• Claw hand: Explain anatomical basis of formation, How medial

Epicondyle fracture can lead to this. 7

o Anatomical basis:

▪ Caused by damage to the ulnar nerve.

▪ Results in weakness or paralysis of the intrinsic hand muscles

innervated by the ulnar nerve.

o Medial Epicondyle Fracture:

▪ A fracture of the medial epicondyle of the humerus can injure

the ulnar nerve as it passes behind the epicondyle.

▪ This can lead to ulnar nerve palsy and subsequent claw hand

deformity.

• Saturday night palsy: Explain how it occurs. 7

o Occurs due to compression of the radial nerve.

▪ Often caused by prolonged pressure on the lateral aspect of

the arm, such as sleeping with the arm hanging over the edge

of a chair (hence the name "Saturday night palsy").

▪ Results in wrist drop (inability to extend the wrist).

• Frozen shoulder- Mention the site and explain the features. 7

o Site:

▪ Adhesive capsulitis of the shoulder joint.

o Features:

▪ Severe pain and stiffness in the shoulder joint.

▪ Limited range of motion in all directions.

▪ Often develops gradually.

120

• Shoulder joint dislocation: Explain why it most commonly occurs

inferiorly. 7

o Reason:

▪ The inferior portion of the glenoid cavity is shallower,

providing less bony support to the head of the humerus.

▪ The capsule and ligaments are weaker inferiorly.

▪ Forces that cause the arm to be abducted and externally

rotated are more likely to dislocate the shoulder inferiorly.

• Fracture shaft of humerus: Explain why this fracture can lead to wrist

drop. 7

o Reason:

▪ The radial nerve winds around the spiral groove of the

humerus.

▪ A fracture in this region can injure the radial nerve, leading

to paralysis of the muscles that extend the wrist and fingers

(wrist drop).

• Dupuytren’s contracture: Explain how it occurs, anatomical basis. 7

o Occurs due to:

▪ Thickening and shortening of the palmar fascia in the hand.

o Anatomical basis:

▪ Leads to the formation of cords of fibrous tissue that can pull

the fingers into a flexed position.

• Winging of scapula: Define the condition & Explain it on an anatomical

basis. 7

o Definition:

▪ Medial border of the scapula protrudes away

• Winging of scapula: Define the condition & Explain it on an anatomical

basis. 7

o Definition:

▪ A condition where the medial border of the scapula

protrudes away from the chest wall, giving the appearance

of "wings."

o Anatomical basis:

▪ Primarily caused by weakness or paralysis of the serratus

anterior muscle.

▪ The serratus anterior muscle is crucial for stabilizing the

scapula against the chest wall during arm movements.

121

▪ When this muscle is weakened or paralyzed, the scapula

loses its normal attachment to the thorax, leading to the

characteristic "winged" appearance.

• Wrist drop: Explain why fracture shaft of humerus at the level of spiral

groove may lead to it. 7

o Reason:

▪ The radial nerve winds around the spiral groove of the

humerus.

▪ A fracture in this region can injure the radial nerve, leading

to paralysis of the muscles that extend the wrist and fingers

(wrist drop).

• Intramuscular injection in upper & lower limb: Mention the most

preferred sites and Explain the anatomical basis for choosing these sites.

o Upper Limb:

▪ Deltoid muscle:

▪ Preferred site:

▪ Anatomical basis:

▪ The lateral aspect of the deltoid muscle,

approximately 2-3 fingerbreadths below the

acromion process.

▪ This site provides access to a large muscle mass

with few major nerves and blood vessels in the

immediate vicinity.

▪ Brachialis muscle:

▪ Preferred site:

▪ The middle of the anterior aspect of the arm.

▪ Anatomical basis:

▪ Provides a large muscle mass for injection.

o Lower Limb:

▪ Gluteus medius muscle:

▪ Preferred site:

▪ The upper outer quadrant of the buttock, below

the iliac crest.

▪ Anatomical basis:

▪ This site avoids major nerves and blood vessels,

such as the sciatic nerve and the gluteal arteries.

▪ Vastus lateralis muscle:

▪ Preferred site:

▪ The anterolateral aspect of the thigh.

122

▪ Anatomical basis:

▪ A large, easily accessible muscle with few major

nerves and blood vessels in the immediate

vicinity.

Development

• Upper limb: Describe the process of development. 5

o The upper limb develops from a limb bud, which appears as an

outgrowth from the lateral body wall of the embryo.

o This limb bud undergoes a process of cell proliferation and

differentiation, eventually forming the various bones, muscles,

nerves, and blood vessels of the upper limb.

o Key stages include:

▪ Formation of the limb bud.

▪ Apical ectodermal ridge (AER) signaling, which regulates limb

outgrowth.

▪ Development of muscles and nerves.

▪ Formation of the limb skeleton through endochondral

ossification.

• Development of upper & lower limb: Differentiate by TWO points. 6

o Rotation:

▪ Upper limb: Rotates laterally (externally) so that the thumb

points laterally.

▪ Lower limb: Rotates medially (internally) so that the big toe

points medially.

o Innervation:

▪ Upper limb: Primarily innervated by the brachial plexus (C5

T1).

▪ Lower limb: Primarily innervated by the lumbosacral plexus

(L1-S4).

• Developing muscle cells move into the limb: Read the figure & Explain

what special understanding it offers. 7

o Special Understanding:

▪ The figure would likely show the migration of myoblasts

(developing muscle cells) from their origin in the somites to

their final destinations within the developing limb.

▪ This would help to understand how muscles are formed and

positioned within the limb.

123

• Development of limb: Read the figure & Explain what special

understanding it offers. 7

o Special Understanding:

▪ The figure would likely depict the stages of limb

development, from the initial formation of the limb bud to

the development of the mature limb.

▪ It would illustrate key processes such as limb outgrowth,

patterning, and differentiation of tissues.

Lymphatics

• Axillary lymph node: Show drainage areas of different groups of lymph

nodes. 5

o Drainage areas:

▪ Lateral group: Receive lymph from the lateral wall of the

chest and the upper limb.

▪ Anterior group: Receive lymph from the anterior chest wall

and breast.

▪ Posterior group: Receive lymph from the posterior chest wall

and back.

▪ Central group: Receive lymph from the other axillary groups.

▪ Apical group: Receive lymph from the other axillary groups

and drain into the subclavian vein.

• Axillary lymph nodes: Mention locations & drainage areas of different

groups. 5

o See the answer to the previous question.

• Upper limb: Describe lymphatic drainage. 5

o Lymph from the upper limb drains primarily into the axillary lymph

nodes.

o Superficial lymphatic vessels follow the superficial veins (cephalic

and basilic veins).

o Deep lymphatic vessels accompany the deep arteries.

o From the axillary lymph nodes, lymph drains into the subclavian

veins.

124

Articulated Foot

1. Articulated foot in skeleton: Identify joints formed by them.

Demonstrate movements of subtalar joint in your own body (With cross

questions) 3+4+3=10

o Joints:

▪ Talocrural joint (ankle joint): Between the tibia, fibula, and

talus.

▪ Subtalar joint: Between the talus and calcaneus.

▪ Transverse tarsal joint (Chopart's joint): Between the talus,

calcaneus, navicular, and cuboid bones.

▪ Tarsometatarsal joints: Between the tarsal bones and the

metatarsal bones.

▪ Intermetatarsal joints: Between the metatarsal bones.

▪ Metatarsophalangeal joints: Between the metatarsal bones

and the proximal phalanges.

▪ Interphalangeal joints: Between the phalanges.

o Subtalar joint movement:

▪ Inversion: Turning the sole of the foot inwards (towards the

midline of the body).

o Cross-questions:

▪ What other movements occur at the subtalar joint?

▪ Eversion (turning the sole of the foot outwards).

▪ Why is the subtalar joint important for walking?

▪ It allows for the foot to adapt to uneven surfaces and

provides stability during walking.

2. Articulated foot in skeleton: Show sets of bones & Mention their

morphological type. Mention their morphological types & Identify

arches. (With cross questions) 3+4+3=10

o Sets of Bones:

▪ Tarsal bones:

▪ Talus, calcaneus, navicular, cuboid, cuneiforms

(medial, intermediate, lateral).

▪ Mostly short bones.

▪ Metatarsal bones:

▪ Long bones.

▪ Phalanges:

▪ Long bones.

o Arches:

▪ Medial longitudinal arch:

125

▪ Extends from the heel to the ball of the foot.

▪ Lateral longitudinal arch:

▪ Less prominent than the medial arch.

▪ Transverse arch:

▪ Runs across the foot, perpendicular to the longitudinal

arches.

o Cross-questions:

▪ What is the function of the arches of the foot?

▪ To distribute body weight, absorb shock, and provide

flexibility during walking.

▪ What are the consequences of a collapsed arch (flatfoot)?

▪ Pain, discomfort, and altered gait.

3. Articulated foot in skeleton: Identify joints & Show inversion movement

in your own body. Hold a ribbon from origin(s) to insertion(s) of tibialis

anterior muscle. (With cross questions) 3+4+3=10

o Joints:

▪ See the list of joints in question 1.

o Inversion:

▪ Turning the sole of the foot inwards.

o Muscle:

▪ Tibialis anterior

▪ Origin: Lateral condyle and proximal two-thirds of the

lateral surface of the tibia.

▪ Insertion: Medial cuneiform and first metatarsal bone.

o Cross-questions:

▪ What other muscles contribute to inversion?

▪ Tibialis posterior.

▪ What is the action of the tibialis anterior?

▪ Dorsiflexion and inversion of the foot.

4. Articulated foot in skeleton: Identify joints & Demonstrate inversion,

eversion movements in your own body. Hold a ribbon from origin(s) to

insertion(s) of muscles responsible for eversion movement. (With cross

questions) 3+4+3=10

o Joints:

▪ See the list of joints in question 1.

o Inversion:

▪ Turning the sole of the foot inwards.

o Eversion:

▪ Turning the sole of the foot outwards.

o Muscles for Eversion:

126

▪ Peroneus longus

▪ Origin: Lateral surface of the fibula.

▪ Insertion: Medial cuneiform and first metatarsal bone.

▪ Peroneus brevis

▪ Origin: Distal two-thirds of the lateral surface of the

fibula.

▪ Insertion: Base of the fifth metatarsal bone.

o Cross-questions:

▪ What is the difference between inversion and eversion?

▪ Inversion: Turning the sole of the foot inwards.

▪ Eversion: Turning the sole of the foot outwards.

▪ What is the role of the peroneal muscles?

▪ To evert the foot and assist in plantarflexion.

5. Articulated foot: Show different types of joints / One important joint of

walking. Demonstrate movements at any TWO of them in your own

body & Mention muscles responsible for each movement. (With cross

questions) 3+4+3=10

o Joints:

▪ See the list of joint types in question 1.

▪ Important joint for walking: Subtalar joint.

o Movements:

▪ Subtalar joint:

▪ Inversion:

▪ Muscle: Tibialis posterior

▪ Eversion:

▪ Muscle: Peroneus longus

o Cross-questions:

▪ What is the role of the subtalar joint in walking?

▪ To adapt the foot to uneven surfaces and provide

stability during the gait cycle.

▪ What are the other important joints in the foot for walking?

▪ Talocrural joint (ankle joint), metatarsophalangeal

joints.

Hip joint

6. Hip joint in skeleton: Show articular parts in skeleton. Demonstrate

flexion and extension movements in your own body & Name muscles

responsible / Hold a ribbon from origin(s) to insertion(s) of ONE muscle/

127

Flexor/ Extensor that causes ONE of those movements. (With cross

questions) 3+4+3=10

o Articular Parts:

▪ Head of the femur.

▪ Acetabulum of the hip bone.

o Movements:

▪ Flexion: Lifting the thigh towards the abdomen.

▪ Extension: Moving the thigh backwards.

o Muscle:

▪ Flexor: Iliopsoas muscle

▪ Origin: Iliac fossa and lumbar vertebrae.

▪ Insertion: Lesser trochanter of the femur.

o Cross-questions:

▪ What other muscles contribute to hip flexion?

▪ Rectus femoris, pectineus, tensor fasciae latae.

▪ What is the significance of the iliopsoas muscle?

▪ It is a powerful hip flexor and plays a crucial role in

walking, running, and climbing.

7. Ankle joint in skeleton: Show bones forming ankle joint/ mention its

type. Demonstrate movements of it in your own body. (With cross

questions) 3+4+3=10

o Bones:

▪ Tibia, fibula, and talus.

o Type:

▪ Hinge joint.

o Movements:

▪ Dorsiflexion:

▪ Moving the foot upwards (towards the shin).

▪ Plantarflexion:

▪ Moving the foot downwards (pointing the toes).

o Cross-questions:

▪ What other movements occur at the ankle joint?

▪ Slight inversion and eversion.

▪ Why is the ankle joint classified as a hinge joint?

▪ Because it primarily allows for movement in one plane

(dorsiflexion and plantarflexion).

8. Ankle Joint in skeleton: Show the articular parts in the skeleton,

Mention movements, and Demonstrate them on your body. Hold a

ribbon from origin(s) to insertion(s) of ONE dorsi-flexor & ONE plantar

flexor. (With cross questions) 3+4+3=10

128

o Articular Parts:

▪ Tibia, fibula, and talus.

o Movements:

▪ Dorsiflexion:

▪ Muscle: Tibialis anterior

▪ Origin: Lateral condyle and proximal two-thirds

of the lateral surface of the tibia.

▪ Insertion: Medial cuneiform and first metatarsal

bone.

▪ Plantarflexion:

▪ Muscle: Gastrocnemius

▪ Origin: Medial and lateral condyles of the

femur.

▪ Insertion: Calcaneus (via the Achilles tendon).

o Cross-questions:

▪ What other muscles contribute to dorsiflexion?

Knee joint

▪ Extensor digitorum longus, extensor hallucis longus

9. Knee joint in skeleton: Show articular parts in skeleton. Name

movements & Demonstrate any TWO of them in your own body / Hold

a ribbon from origin(s) to insertion(s) of ONE muscle that causes ONE of

those movements. (With cross questions) 3+4+3=10

• Articular Parts:

o Femorotibial joint: Between the medial and lateral condyles of the

femur and the tibial plateau.

o Patellofemoral joint: Between the patella and the patellar groove

of the femur.

• Movements:

o Flexion: Bending the knee.

o Extension: Straightening the knee.

• Muscle:

o Quadriceps femoris muscle (specifically, the rectus femoris)

▪ Origin: Anterior inferior iliac spine.

▪ Insertion: Tibial tuberosity via the patellar tendon.

• Cross-questions:

o What other muscles contribute to knee extension?

▪ Vastus lateralis, vastus medialis, vastus intermedius.

129

o What is the role of the menisci in the knee joint?

▪ To deepen the articular surfaces and provide shock

absorption.

10. Knee joint in skeleton: Show articular parts. Describe gross features of

upper end. (With cross questions) 3+4+3=10

• Articular Parts:

o See answer to question 9.

• Gross Features of the Upper End of the Femur:

o Head: Rounded, articulates with the acetabulum of the hip bone.

o Neck: Connects the head to the shaft.

o Greater trochanter: Prominent lateral projection.

o Lesser trochanter: Smaller projection on the medial aspect.

o Intertrochanteric crest: Ridge between the greater and lesser

trochanters.

• Cross-questions:

o What is the angle of inclination of the femoral neck?

▪ The angle between the shaft of the femur and the femoral

neck.

▪ It influences the stability and range of motion of the hip joint.

o What is the significance of the greater trochanter?

▪ Provides attachment sites for muscles that rotate the hip.

11. Knee joint in skeleton: Show articular parts. Demonstrate movements in

your own body & Name muscles responsible. (With cross

questions) 3+4+3=10

• Articular Parts:

o See answer to question 9.

• Movements:

o Flexion:

▪ Muscles: Hamstrings (biceps femoris, semitendinosus,

semimembranosus), gastrocnemius, popliteus.

o Extension:

▪ Muscles: Quadriceps femoris (rectus femoris, vastus

lateralis, vastus medialis, vastus intermedius).

• Cross-questions:

o What is the role of the menisci in knee joint stability?

130

▪ They deepen the articular surfaces and provide shock

absorption.

o What is the function of the cruciate ligaments in the knee joint?

▪ To provide stability and prevent excessive anterior and

posterior movement of the tibia on the femur.

12. Talocalcaneonavicular joint in skeleton: Show & Describe formation &

Mention type. Demonstrate TWO movements in your own body

mentioning their responsible muscles. (With cross questions) 3+4+3=10

• Formation:

o Formed by the articulation between the talus, calcaneus, and

navicular bones.

• Type:

o Ball-and-socket joint (although its range of motion is limited).

• Movements:

o Inversion:

▪ Muscle: Tibialis posterior

o Eversion:

▪ Muscle: Peroneus longus

• Cross-questions:

o What is the significance of the talocalcaneonavicular joint?

▪ It plays a crucial role in adapting the foot to uneven surfaces

during walking.

▪ It contributes to the flexibility and shock-absorbing

properties of the foot.

13. Hip bone in skeleton: Show & Describe gross features of different parts

of the bone. Hold a ribbon from origin(s) to insertion(s) of muscle that

are attached to iliac fossa & anterior superior iliac spine. (With cross

questions) 3+4+3=10

• Parts of the Hip Bone:

o Ilium:

▪ Largest part, forms the wing of the hip bone.

▪ Contains the iliac crest, iliac fossa, and greater sciatic notch.

o Ischium:

▪ Lower, posterior part of the hip bone.

▪ Contains the ischial tuberosity.

o Pubis:

131

▪ Anterior part of the hip bone.

▪ Forms the pubic symphysis.

• Muscles Attached to Iliac Fossa and Anterior Superior Iliac Spine:

o Iliacus muscle:

▪ Origin: Iliac fossa.

▪ Insertion: Lesser trochanter of the femur.

o Sartorius muscle:

▪ Origin: Anterior superior iliac spine.

▪ Insertion: Medial side of the tibia.

• Cross-questions:

o What is the function of the iliacus muscle?

▪ Hip flexion, lateral flexion of the spine, and external rotation

of the hip.

o What is the function of the sartorius muscle?

▪ Flexion, abduction, and lateral rotation of the hip.

14. Femur in skeleton: Show & Describe gross features of shaft. Hold a

ribbon from origin(s) to insertion(s) of rectus femoris muscle. 3+4+3=10

• Muscle:

o Rectus femoris muscle

• Gross Features of the Shaft:

o Long and cylindrical.

o Slightly curved to accommodate the weight-bearing function.

o Contains a linea aspera (a longitudinal ridge) on its posterior

surface.

▪ Origin: Anterior inferior iliac spine.

▪ Insertion: Tibial tuberosity via the patellar tendon.

15. Femur in skeleton: Show & Describe gross features of upper end. Hold a

ribbon from origin(s) to insertion(s) of TWO vastus / hamstring /

Quadriceps Femoris muscles. (With cross questions) (With cross

questions)

3+4+3=10

• Gross Features of the Upper End:

o Head: Rounded, articulates with the acetabulum of the hip bone.

o Neck: Connects the head to the shaft.

o Greater trochanter: Prominent lateral projection.

o Lesser trochanter: Smaller projection on the medial aspect.

132

o Intertrochanteric crest: Ridge between the greater and lesser

trochanters.

• Muscles:

o Vastus lateralis:

▪ Origin: Lateral lip of the greater trochanter and lateral

surface of the femur.

▪ Insertion: Tibial tuberosity via the patellar tendon.

o Vastus medialis:

▪ Origin: Medial lip of the linea aspera and medial surface of

the femur.

▪ Insertion: Tibial tuberosity via the patellar tendon.

• Cross-questions:

o What is the function of the quadriceps femoris muscle group?

▪ Extension of the knee joint.

o Why is the quadriceps femoris muscle group important?

▪ Essential for walking, running, jumping, and other activities

that involve extending the knee.

16. Femur in skeleton: Show & Describe gross features of lower end. Hold a

ribbon from origin(s) to insertion(s) of TWO muscles that are attached

to upper end of femur. (With cross questions) 3+4+3=10

• Gross Features of the Lower End:

o Medial condyle: Large, rounded prominence.

o Lateral condyle: Smaller than the medial condyle.

o Trochlea: Pulley-shaped articular surface for the tibia.

o Capitulum: Rounded articular surface for the fibula.

• Muscles:

o Adductor magnus:

▪ Origin: Ischium and pubis.

▪ Insertion: Medial lip of the linea aspera and adductor

tubercle of the femur.

o Adductor longus:

▪ Origin: Pubis.

▪ Insertion: Medial lip of the linea aspera.

• Cross-questions:

o What is the function of the adductor muscles?

▪ Adduction of the hip joint.

o What is the significance of the condyles of the femur?

▪ They articulate with

133

Femur in skeleton: Show & Describe gross features of lower end. Hold a ribbon

from origin(s) to insertion(s) of TWO muscles that are attached to upper end

of femur. (With cross questions) 3+4+3=10

• Gross Features of the Lower End:

o Medial condyle: Large, rounded prominence.

o Lateral condyle: Smaller than the medial condyle.

o Trochlea: Pulley-shaped articular surface for the tibia.

o Capitulum: Rounded articular surface for the fibula.

• Muscles:

o Adductor magnus:

▪ Origin: Ischium and pubis.

▪ Insertion: Medial lip of the linea aspera and adductor

tubercle of the femur.

o Adductor longus:

▪ Origin: Pubis.

▪ Insertion: Medial lip of the linea aspera.

• Cross-questions:

o What is the function of the adductor muscles?

▪ Adduction of the hip joint.

o What is the significance of the condyles of the femur?

▪ They articulate with the tibial plateau to form the knee joint.

17. Lower end of femur in skeleton: Show & Describe gross features. Hold a

ribbon from origin(s) to insertion(s) of THREE vastus muscles. (With

cross questions) 3+4+3=10

• Gross Features:

o Medial condyle: Large, rounded prominence.

o Lateral condyle: Smaller than the medial condyle.

o Trochlea: Pulley-shaped articular surface for the tibia.

o Capitulum: Rounded articular surface for the fibula.

• Muscles:

o Vastus lateralis:

▪ Origin: Lateral lip of the greater trochanter and lateral

surface of the femur.

▪ Insertion: Tibial tuberosity via the patellar tendon.

o Vastus medialis:

▪ Origin: Medial lip of the linea aspera and medial surface of

the femur.

134

▪ Insertion: Tibial tuberosity via the patellar tendon.

o Vastus intermedius:

▪ Origin: Anterior and lateral surfaces of the femur.

▪ Insertion: Tibial tuberosity via the patellar tendon.

• Cross-questions:

o What is the collective function of the vastus muscles?

▪ Extension of the knee joint.

o Why is the vastus medialis important for knee joint stability?

▪ It helps to track the patella correctly within the

patellofemoral groove, preventing patellofemoral pain

syndrome.

18. Tibia in skeleton: Show & Describe gross features of upper end. Hold a

ribbon from origin(s) to insertion(s) of ONE/TWO muscle that arises

from tibia/upper end of tibia. / Tibialis Anterior/ “Guy Ropes”/

Peroneus Longus and Brevis, mentioning their action. (With cross

questions)

3+4+3=10

• Gross Features of the Upper End:

o Tibial plateau:

• Muscle:

o Tibialis Anterior

▪ Broad, flat surface that articulates with the condyles of the

femur.

▪ Divided into medial and lateral condyles.

o Tibial tuberosity:

▪ Prominent projection on the anterior surface for the

attachment of the patellar tendon.

▪ Origin: Lateral condyle and proximal two-thirds of the lateral

surface of the tibia.

▪ Insertion: Medial cuneiform and first metatarsal bone.

▪ Action: Dorsiflexion and inversion of the foot.

• Cross-questions:

o What are the "guy ropes" of the knee joint?

▪ The ligaments that provide stability to the knee joint, such as

the cruciate ligaments and collateral ligaments.

o What is the function of the tibialis anterior muscle?

▪ Dorsiflexion and inversion of the foot.

135

19. Tibia in skeleton: Show & Describe gross features of upper end. Identify

different types of joints formed by the bone & Mention movements

occurring at them. (With cross questions) 3+4+3=10

• Gross Features of the Upper End:

o See answer to question 18.

• Joints:

o Tibiofemoral joint:

▪ Type: Hinge joint.

▪ Movements: Flexion and extension of the knee.

o Proximal tibiofibular joint:

▪ Type: Plane joint.

▪ Movements: Slight gliding movements.

• Cross-questions:

o Why is the tibiofemoral joint a hinge joint?

▪ Because it allows for movement primarily in one plane

(flexion and extension).

o What is the significance of the tibial plateau?

• Gross Features:

o Upper End:

▪ It forms the main articulation surface for the knee joint.

20. Fibula in skeleton: Show & Describe gross features of upper & lower

ends. Hold a ribbon from origin(s) to insertion(s) of Peroneus longus &

Peroneus brevis muscles. (With cross questions) 3+4+3=10

▪ Head: Articulates with the lateral condyle of the tibia.

o Lower End:

▪ Lateral malleolus: Prominent projection that forms the

lateral side of the ankle joint.

• Muscles:

o Peroneus longus:

▪ Origin: Lateral surface of the fibula.

▪ Insertion: Medial cuneiform and first metatarsal bone.

o Peroneus brevis:

▪ Origin: Distal two-thirds of the lateral surface of the fibula.

▪ Insertion: Base of the fifth metatarsal bone.

• Cross-questions:

o What is the function of the peroneal muscles?

▪ Eversion of the foot.

136

o What is the role of the fibula in weight-bearing?

▪ It provides lateral stability to the ankle joint and contributes

to the attachment of muscles.

21. Neck of fibula: Show & Explain why fracture at this site may lead to foot

drop. 7

• Fracture at the neck of the fibula can injure the common peroneal nerve,

which winds around the neck of the fibula.

• Foot drop occurs when the muscles that dorsiflex the foot (e.g., tibialis

anterior) are paralyzed due to damage to the common peroneal nerve.

• This results in difficulty lifting the foot during walking, leading to a "foot

drop" gait.

Muscle

• Intramuscular injection in upper & lower limb: Mention the most

preferred sites and Explain the anatomical basis for choosing these sites.

o Upper Limb:

▪ Deltoid muscle:

▪ Preferred site:

▪ The lateral aspect of the deltoid muscle,

approximately 2-3 fingerbreadths below the

acromion process.

▪ Anatomical basis:

▪ This site provides access to a large muscle mass

with few major nerves and blood vessels in the

immediate vicinity.

▪ Brachialis muscle:

▪ Preferred site:

▪ The middle of the anterior aspect of the arm.

▪ Anatomical basis:

▪ Provides a large muscle mass for injection.

o Lower Limb:

▪ Gluteus medius muscle:

▪ Preferred site:

▪ The upper outer quadrant of the buttock, below

the iliac crest.

▪ Anatomical basis:

137

▪ This site avoids major nerves and blood vessels,

such as the sciatic nerve and the gluteal arteries.

▪ Vastus lateralis muscle:

▪ Preferred site:

▪ The anterolateral aspect of the thigh.

▪ Anatomical basis:

▪ A large, easily accessible muscle with few major

nerves and blood vessels in the immediate

vicinity.

Development

• Development of upper & lower limb: Differentiate by TWO points. 6

o Rotation:

▪ Upper limb: Rotates laterally (externally) so that the thumb

points laterally.

▪ Lower limb: Rotates medially (internally) so that the big toe

points medially.

o Innervation:

Development (continued)

▪ Upper limb: Primarily innervated by the brachial plexus (C5

T1).

▪ Lower limb: Primarily innervated by the lumbosacral plexus

(L1-S4).

• Developing muscle cells move into the limb: Read the figure & Explain

what special understanding it offers. 7

o Special Understanding:

▪ The figure would

• Developing muscle cells move into the limb: Read the figure & Explain

what special understanding it offers. 7

o Special Understanding:

▪ The figure would likely show the migration of myoblasts

(developing muscle cells) from their origin in the somites to

their final destinations within the developing limb.

▪ This would help to understand how muscles are formed and

positioned within the limb.

• Development of limb: Read the figure & Explain what special

understanding it offers. 7

138

o Special Understanding:

▪ The figure would likely depict the stages of limb

development, from the initial formation of the limb bud to

the development of the mature limb.

▪ It would illustrate key processes such as limb outgrowth,

patterning, and differentiation of tissues.

Clinical

• Trendelenburg sign: Define the condition & Explain it on an anatomical

basis. 7

o Definition:

▪ A clinical sign characterized by a noticeable drop of the pelvis

on the side opposite to a weak or paralyzed hip abductor

muscle (typically the gluteus medius).

o Anatomical basis:

▪ During single-leg stance, the gluteus medius muscle on the

stance leg is crucial for stabilizing the pelvis.

▪ Weakness of the gluteus medius on one side results in the

pelvis dropping on the opposite side when standing on the

affected leg.

• Club foot: Define the condition & Explain how it develops. 7

o Definition:

▪ A congenital deformity of the foot characterized by a

combination of abnormalities, including:

▪ Foot pointing downwards (plantarflexion).

▪ Foot turned inwards (inversion).

▪ Foot turned downwards and inwards (equinovarus).

o Development:

▪ The exact cause is unknown, but it is believed to involve a

combination of genetic and environmental factors.

▪ Abnormal positioning of the foot in the uterus may play a

role.

• Flat foot: Explain the clinical disorder & its underlying cause. 7

o Clinical Disorder:

▪ A condition characterized by a loss of the normal arch of the

foot.

o Underlying Causes:

▪ Weakening of the muscles and ligaments that support the

arch.

139

▪ Injury or trauma to the foot.

▪ Congenital abnormalities.

▪ Obesity.

▪ Aging.

• Foot drop: Explain causes of its features. 7

o Causes:

▪ Damage to the common peroneal nerve (e.g., due to injury,

compression, or nerve disorders).

▪ Damage to the nerves that supply the muscles that dorsiflex

the foot (e.g., tibialis anterior).

▪ Certain neurological conditions.

o Features:

▪ Difficulty lifting the front part of the foot.

▪ Foot dragging or slapping on the ground during walking.

▪ High-stepping gait to avoid tripping.

• Genu vara & valga: Define & Explain the anomalies. 7

o Genu vara (bowleg):

▪ A condition where the knees are angled inwards, causing the

legs to bow outward.

o Genu valga (knock-knee):

▪ A condition where the knees are angled inwards, causing the

legs to bow inward.

• Coxa vara & valga: Define & Explain the anomalies. 7

o Coxa vara:

▪ A condition where the angle between the femoral neck and

the femoral shaft is decreased.

▪ Can lead to increased stress on the hip joint.

o Coxa valga:

▪ A condition where the angle between the femoral neck and

the femoral shaft is increased.

▪ Can also affect hip joint biomechanics.

Vessels

• Knee joint: Describe anastomosis around knee joint. 5

o Anastomosis:

▪ The popliteal artery gives off several branches that form a

network of anastomoses around the knee joint.

▪ This provides collateral circulation, ensuring blood supply to

the lower leg even if one of the main arteries is blocked.

140

• Varicose veins: Explain basis of formation. 7

o Formation:

▪ Caused by weakened or damaged valves in the veins.

▪ Normally, veins have valves that prevent blood from flowing

backwards.

▪ In varicose veins, these valves malfunction, allowing blood to

pool in the veins, causing them to become dilated, tortuous,

and visible.

• Deep vein thrombosis: Define the condition & Explain how it develops.

o Definition:

▪ The formation of a blood clot (thrombus) within a deep vein,

usually in the legs.

o Development:

▪ Can occur due to:

▪ Prolonged sitting or immobility (e.g., during long

travel).

▪ Injury or surgery.

▪ Obesity.

▪ Certain medical conditions (e.g., pregnancy, blood

clotting disorders).

• Vascular grafting: Mention the preferred vessel & anatomical basis of

choice. 7

o Preferred Vessel:

▪ Great saphenous vein.

o Anatomical basis:

▪ It is a long, relatively large vein that can be easily harvested.

▪ It has a similar diameter to many arteries, making it suitable

for grafting.

▪ It has a good blood supply, which helps to maintain its

viability after transplantation.

• Great saphenous vein: Mention formation, course and termination. 5

o Formation:

▪ Begins on the medial side of the foot.

o Course:

▪ Ascends along the medial side of the leg and thigh.

o Termination:

▪ Joins the femoral vein.

• Lower limb: Show & Describe venous drainage. 5

o Superficial veins:

141

▪ Great saphenous vein.

▪ Small saphenous vein.

o Deep veins:

▪ Femoral vein.

▪ Popliteal vein.

▪ Tibial veins (anterior and posterior).

▪ Fibular vein.

Nerves

• Femoral nerve: Explain which compartment of thigh is supplied. 5

o Compartment:

▪ Anterior compartment of the thigh.

• Femoral nerve: Describe the formation, structures supplied by it & effect

of lesion. 5

o Formation:

▪ Lumbar plexus (L2-L4).

o Structures supplied:

▪ Motor:

▪ Sartorius muscle.

▪ Sensory:

▪ Quadriceps femoris muscle (responsible for knee

extension).

▪ Anterior thigh and medial aspect of the leg.

o Effect of lesion:

▪ Weakness or paralysis of the quadriceps muscles, resulting in

difficulty extending the knee.

▪ Loss of sensation in the anterior thigh and medial aspect of

the leg.

• Sciatic nerve: Show, Mention the area supplied by it by root values. 5

o Area supplied:

▪ Motor:

▪ Posterior compartment of the thigh (hamstrings).

▪ Muscles of the leg and foot.

▪ Sensory:

▪ Posterior thigh, leg, and foot.

o Root values:

▪ L4-S3

• Sciatic nerve: Show its formation, Mention branches & their motor

supply. 5

142

o Formation:

▪ Formed by the union of the tibial and common peroneal

nerves.

o Branches:

▪ Tibial nerve:

▪ Supplies the posterior compartment of the thigh

(hamstrings) and muscles in the posterior

compartment of the leg.

▪ Common peroneal nerve:

▪ Supplies the anterior and lateral compartments of the

leg.

• Common peroneal nerve: Mention origin, termination & area supplied.

/ effect of injury at neck of Fibula 5

o Origin:

▪ Sciatic nerve.

o Termination:

▪ Divides into the superficial and deep peroneal nerves.

o Area supplied:

▪ Motor:

▪ Sensory:

▪ Foot drop:

▪ Anterior and lateral compartments of the leg (muscles

involved in dorsiflexion and eversion of the foot).

▪ Lateral aspect of the leg and dorsum of the foot.

o Effect of injury at neck of fibula:

▪ Inability to dorsiflex the foot due to paralysis of the

muscles that dorsiflex the foot (e.g., tibialis anterior).

• Lower limb: Define dermatome & Show dermatomes of lower limb. 5

o Dermatome:

▪ An area of skin innervated by a single spinal nerve root.

o Dermatomes of the Lower Limb:

▪ L1-S5 dermatomes cover the lower limb, with each spinal

nerve root contributing to a specific area of skin.

Nerves (continued)

• Lumber plexus: Mention its formation & branches. 5

o Formation:

▪ Formed by the anterior rami of spinal nerves L1-L4.

143

o Branches:

▪ Femoral nerve, obturator nerve, lateral femoral cutaneous

nerve.

• Sacral plexus: Show formation of plexus & branches. 5

o Formation:

▪ Formed by the anterior rami of spinal nerves L4-S4.

o Branches:

▪ Sciatic nerve (largest branch), pudendal nerve.

• Sciatica- Define the condition and Explain it on an anatomical basis. 7

o Definition:

▪ Pain that radiates along the path of the sciatic nerve, typically

from the lower back down the back of the leg and into the

foot.

o Anatomical basis:

▪ Usually caused by compression or irritation of the sciatic

nerve, often due to:

▪ Herniated disc in the lumbar spine.

▪ Spinal stenosis.

Lymphatics

▪ Piriformis syndrome (compression of the sciatic nerve

by the piriformis muscle).

• Superficial & deep inguinal lymph nodes: Describe their site & drainage.

o Superficial inguinal lymph nodes:

▪ Site: Located in the groin region.

▪ Drainage:

▪ Superficial structures of the lower limb, external

genitalia, and lower abdomen.

o Deep inguinal lymph nodes:

▪ Site: Located deeper in the groin region.

▪ Drainage:

▪ Deep structures of the lower limb.

• Lower limb: Describe lymphatic drainage. 5

o Lymph from the lower limb drains primarily into the superficial and

deep inguinal lymph nodes.

o Superficial lymphatic vessels follow the superficial veins.

o Deep lymphatic vessels accompany the deep arteries.

144

o From the inguinal lymph nodes, lymph drains into the lumbar

lymph nodes and eventually into the thoracic duct.

• Lymphatic drainage of lower limb: Show drainage areas of different

groups of lymph nodes. 5

o Superficial inguinal lymph nodes:

▪ Drain the skin and subcutaneous tissues of the lower limb,

external genitalia, and lower abdomen.

o Deep inguinal lymph nodes:

▪ Drain the deep structures of the lower limb, including

muscles, bones, and joints.

Explanatory Figures

• Innervation of axial skeletal muscle 7

o Special Understanding:

▪ The figure would illustrate the distribution of spinal nerves

and their branches to the muscles of the axial skeleton

(muscles of the head, neck, trunk, and back).

▪ This would help to understand the segmental innervation of

the axial musculature and the relationship between spinal

cord segments and muscle function.

145

General Anatomy: Musculoskeletal system

1. Periosteum: Mention its layers and functions. 5

• Layers:

o Outer fibrous layer: Dense, fibrous connective tissue.

o Inner cellular layer: Contains osteoblasts (bone-forming cells) and

osteoclasts (bone-resorbing cells).

• Functions:

o Provides nutrient and oxygen supply to the underlying bone.

o Serves as attachment sites for tendons and ligaments.

o Plays a crucial role in bone growth, repair, and remodeling.

2. Primary and secondary cartilaginous joints: Differentiate by TWO points. 6

• Primary Cartilaginous Joints:

• Secondary Cartilaginous Joints:

o United by hyaline cartilage.

o Allow for very limited movement.

o Examples: Epiphyseal plates (growth plates), synchondroses (e.g.,

between first rib and sternum).

o United by fibrocartilage.

o Allow for slight movement.

o Examples: Intervertebral discs, pubic symphysis.

3. Growing end: Mention the parts of a growing long bone. Explain why

metaphysis is called the site of bone formation. 6

• Parts of a Growing Long Bone:

o Diaphysis (shaft)

o Epiphysis (ends)

o Metaphysis (region between diaphysis and epiphysis)

o Epiphyseal plate (cartilaginous growth plate)

• Metaphysis as the Site of Bone Formation:

o The metaphysis contains the epiphyseal plate, a layer of hyaline

cartilage that undergoes continuous growth and ossification.

o Endochondral ossification occurs here, where cartilage is gradually

replaced by bone tissue, allowing the long bone to grow in length.

146

4. Joints: Justify- all synovial joints require a cavity. 7

• Synovial joints are characterized by the presence of a joint cavity filled

with synovial fluid.

• This cavity allows for a wide range of motion.

• The synovial fluid within the cavity provides:

o Lubrication: Reduces friction during movement.

o Nutrition: Nourishes the articular cartilage.

o Shock absorption: Cushions the impact of joint loading.

5. Spongy bone: Justify arrangements of different bony spicules in different

directions in spongy bones. 7

• The arrangement of trabeculae (bony spicules) in spongy bone is not

random.

• It is highly organized and follows the lines of stress that the bone

experiences.

• This arrangement provides maximum strength and support with minimal

weight.

• The trabeculae are oriented to resist forces from various directions,

ensuring optimal load-bearing capacity.

6. Strap muscle: Explain structure-function relationship between strap muscles

and its wide range of movement. 7

• Strap muscles are long, thin muscles with parallel fibers.

• This arrangement allows for a large range of motion due to the long

distance the muscle fibers can shorten.

• Examples include the sartorius (longest muscle in the body) and the rectus

abdominis.

7. Schematic drawing of cells associated with bone: Read the figure & Explain

what special understanding it offers. 7

• Special Understanding:

o The figure would likely depict:

▪ Osteoblasts: Bone-forming cells.

▪ Osteocytes: Mature bone cells embedded within the bone

matrix.

▪ Osteoclasts: Bone-resorbing cells.

147

o This would help to understand the dynamic nature of bone tissue,

where bone is constantly being remodeled through the

coordinated actions of these cells.

8. Unipennate Muscle: Explain structure-function relationship between

unipennate muscles and force of contraction. 7

• Unipennate muscles have fibers that run obliquely from a tendon on one

side only.

• This arrangement allows for a greater number of muscle fibers to be

packed into a given space, resulting in a higher force of contraction

compared to parallel-fibered muscles of similar size.

• However, the range of motion may be slightly limited.

9. Stages of bone healing process: Read the figure & Explain what special

understanding it offers. 7

• Special Understanding:

o The figure would likely illustrate the stages of bone healing:

▪ Hematoma formation: Blood clot formation at the fracture

site.

▪ Fibrocartilaginous callus formation: Formation of a soft

callus composed of cartilage and fibrous tissue.

▪ Bony callus formation: Replacement of the

fibrocartilaginous callus with bony tissue.

▪ Bone remodeling: Remodeling of the bone to restore its

original shape and strength.

o This helps to understand the dynamic process of bone repair and

the factors that influence healing time.

10. Bursa: Explain the structure-function relationship of bursa. 7

• Bursa:

o Fluid-filled sacs located between bones, tendons, and ligaments.

• Structure-Function Relationship:

o Reduce friction: Bursa act as cushions, reducing friction between

moving structures, such as tendons gliding over bone.

o Facilitate movement: They allow for smoother and more efficient

joint movement.

148

11. Muscle contraction: Justify functional importance of ‘eccentric contraction’

of muscles. 7

• Eccentric contraction occurs when a muscle lengthens while generating

force.

• Functional Importance:

o Control movement: Essential for controlled movements that

involve slowing down or resisting a force.

▪ Examples:

▪ Lowering a heavy weight.

▪ Controlling the speed of descent during a squat.

o Shock absorption: Helps to absorb impact forces during activities

like running or jumping.

o Injury prevention:

▪ Helps to protect joints and muscles from excessive stress.

12. Movement of vertebral column: Read the figure & Explain what special

understanding it offers. 7

• Special Understanding:

o The figure would likely illustrate the different planes of movement

in the vertebral column:

▪ Flexion/extension: Forward and backward bending.

▪ Lateral flexion: Bending to the side.

▪ Rotation: Twisting of the spine.

o This would help to understand the range of motion possible at each

vertebral level and the contributions of different spinal segments

to overall spinal mobility.

13. Bone matrix: Explain structure-function relationship of bone matrix in

providing mechanical support. 7

• Bone matrix is composed of organic (collagen) and inorganic

(hydroxyapatite) components.

• Collagen fibers provide tensile strength, resisting stretching and pulling

forces.

• Hydroxyapatite crystals provide compressive strength, resisting forces

that try to compress the bone.

• The combination of these components gives bone its unique properties of

strength, rigidity, and resilience.

149

14. Muscle: Evaluate importance of “muscle nomenclature” in understanding

muscle action. 7

• Muscle nomenclature (the system of naming muscles) provides valuable

information about the muscle's:

o Location:

▪ E.g., pectoralis major (chest muscle).

o Shape:

▪ E.g., trapezius (trapezoid-shaped).

o Size:

▪ E.g., gluteus maximus (largest gluteal muscle).

o Action:

▪ E.g., flexor carpi radialis (flexes the wrist and radially deviates

the hand).

o Origin and insertion:

▪ E.g., sternocleidomastoid (originates from the sternum and

clavicle, inserts on the mastoid process).

• They may:

o Stabilize joints:

• This information helps to predict the muscle's function and understand its

role in movement.

15. Muscle action: Justify- a synergist muscle helps a prime mover in its action

(with TWO examples). 7

• Synergist muscles assist the prime mover in performing a specific

movement.

▪ Example:

▪ When flexing the elbow, the muscles that stabilize the

shoulder joint (e.g., rotator cuff muscles) act as

synergists to allow the biceps brachii to effectively flex

the elbow.

o Neutralize unwanted actions:

▪ Example:

▪ When flexing the fingers, the flexor carpi radialis also

tends to radially deviate the wrist. Synergistic muscles,

such as the flexor carpi ulnaris, help to counteract this

radial deviation and maintain a neutral wrist position.

16. Antagonist: Explain role of antagonist during movement. 6

150

• Antagonist muscles have actions opposite to the prime mover.

• They play a crucial role in:

o Controlling movement:

▪ Antagonists provide smooth and controlled movements by

resisting the action of the prime mover.

▪ For example, during elbow flexion, the triceps brachii

(antagonist) helps to control the speed and prevent

excessive flexion.

o Maintaining joint stability:

▪ By providing a counterforce, antagonists help to stabilize the

joint and prevent excessive movement.

17. Primary and secondary cartilaginous joints: Differentiate by TWO

structural points. 6

• Primary Cartilaginous Joints:

o United by hyaline cartilage.

o Usually temporary joints that eventually ossify.

• Secondary Cartilaginous Joints:

o United by fibrocartilage.

o More durable and allow for slight movement.

(with TWO examples of each). 7

• Primary Cartilaginous Joints:

18. Ossification: Justify the terms, ‘primary’ & ‘secondary’ cartilaginous joints

o Justified by:

▪ They are involved in endochondral ossification, where bone

replaces hyaline cartilage during development.

o Examples:

▪ Epiphyseal plates (growth plates)

▪ First rib-sternum joint

• Secondary Cartilaginous Joints:

o Justified by:

▪ They are formed by the replacement of embryonic

connective tissue with fibrocartilage.

o Examples:

▪ Intervertebral discs

▪ Pubic symphysis

151

19. Joint movement: Justify with TWO examples- one relatively ‘fixed’ & one

‘mobile’ bone together determine a joint movement. 7

• Examples:

o Relatively Fixed Bone:

▪ Glenoid cavity of the scapula in the shoulder joint.

▪ The relatively stable glenoid cavity allows for a wide range of

motion of the humerus, which is the more mobile bone.

o Relatively Mobile Bone:

▪ Radius in the radioulnar joint.

▪ The radius rotates around the relatively fixed ulna, allowing

for pronation and supination.

• Justification:

o The stability of one bone provides a stable base for the movement

of the other bone, determining the range and type of motion

possible at the joint.

• Osteocytes:

20. Bones: Explain structure-function relationship between the osteocyte and

nutrition of bone. 7

o Mature bone cells embedded within the bone matrix.

o They maintain the bone matrix and play a crucial role in bone

remodeling.

• Structure-Function Relationship:

o Canaliculi:

▪ Osteocytes are connected to each other and to the bone

surface by a network of tiny canals called canaliculi.

▪ These canaliculi allow for the passage of nutrients, oxygen,

and waste products between the blood vessels in the bone

and the osteocytes.

▪ This ensures the proper nutrition and functioning of the bone

cells, maintaining bone health.

21. Joint: Evaluate the importance of knowing ‘plane’ of a joint movement for

understanding the function of that movement. 7

152

• Importance of Knowing the Plane of Joint Movement:

o Understanding Muscle Function:

▪ Knowing the plane of movement helps to identify the

muscles that are responsible for producing that movement.

▪ For example, if a joint primarily moves in the sagittal plane

(flexion/extension), the muscles involved will likely have

their fibers oriented in that plane.

o Assessing Joint Range of Motion:

▪ Knowing the normal planes of movement for a joint allows

for accurate assessment of joint range of motion during

physical examinations.

o Designing Exercise Programs:

▪ This knowledge is crucial for designing effective exercise

programs that target specific muscles and movements.

22. Long bone: Mention the features of typical & atypical long bone. 5

• Typical Long Bone:

• Atypical Long Bone:

o Cylindrical shape with a shaft (diaphysis) and two expanded ends

(epiphyses).

o Examples: Femur, humerus.

o May have a more complex shape or deviate from the typical

cylindrical structure.

o Examples: Clavicle, fibula.

23. Muscle action: Justify intercalated discs of cardiac muscles determine its

functions. 7

• Intercalated discs:

o Specialized junctions between adjacent cardiac muscle cells.

o Contain gap junctions that allow for rapid electrical conduction

between cells.

• Functional Significance:

o Rapid and Coordinated Contraction:

▪ Gap junctions enable the rapid spread of electrical impulses

throughout the heart.

▪ This ensures that the heart muscle contracts as a single unit

(syncytium), allowing for efficient pumping of blood.

153

24. Volkmann’s canal: Explain structure-function relationship of Volkmann’s

canal in cortical bones. 7

• Volkmann's canals:

o Transverse or oblique channels that connect the Haversian canals

to each other and to the periosteum and endosteum.

• Structure-Function Relationship:

o Provide a pathway for blood vessels, nerves, and lymphatic

vessels to enter and exit the Haversian system.

o This ensures adequate nutrient and oxygen supply to the

osteocytes within the bone matrix and allows for the removal of

waste products.

25. Cartilage: Mention type & examples of each. 5

• Hyaline cartilage:

o Most common type.

o Smooth and translucent.

o Found in articular surfaces of bones, respiratory tract, and

developing fetal skeleton.

• Fibrocartilage:

o Tough and durable.

o Contains a high proportion of collagen fibers.

o Found in intervertebral discs, menisci of the knee, and pubic

symphysis.

• Elastic cartilage:

o Contains elastic fibers in addition to collagen.

o Provides flexibility and support.

o Found in the external ear and epiglottis.

26. Bone: Mention the composition of bone. 5

• Organic component:

o Primarily collagen fibers, providing tensile strength and flexibility.

• Inorganic component:

o Primarily hydroxyapatite crystals, providing hardness and

compressive strength.

27. Skeletal muscle: Evaluate importance of muscle fiber direction in bone

movement. 7

154

• Muscle fiber direction plays a crucial role in determining the direction and

effectiveness of muscle contraction.

• For example:

o Parallel-fibered muscles (e.g., sartorius) have a greater range of

motion but may generate less force.

o Pennate muscles (e.g., deltoid) have a greater number of muscle

fibers packed into a given space, allowing for greater force

production but a smaller range of motion.

• Understanding muscle fiber direction helps to predict the muscle's

primary action and its contribution to joint movement.

28. Sesamoid bone: Explain why it is called so. 6

• Sesamoid bones are small, round bones embedded within tendons.

• They are called "sesamoid" because they resemble sesame seeds in shape

and size.

29. Muscle: Explain structure-function relationship of actin-myosin in skeletal

muscle contraction. 7

• Actin: Thin filaments.

• Myosin: Thick filaments.

• Actin and myosin are the contractile proteins within skeletal muscle

fibers.

• Sliding Filament Theory:

o During muscle contraction, myosin heads bind to actin filaments

and pull them towards the center of the sarcomere, shortening the

muscle fiber.

o This interaction between actin and myosin is the basis of muscle

contraction.

30. Muscle contraction: Justify functional importance of ‘concentric

contraction’ of muscles. 7

• Concentric contraction occurs when a muscle shortens while generating

force.

• Functional Importance:

o Overcoming resistance:

▪ Essential for activities like lifting weights, climbing stairs, and

jumping.

155

o Producing movement:

▪ Drives the majority of everyday movements, such as walking,

running, and reaching.

31. Compact & spongy bone: Differentiate by THREE points. 6

• Compact bone:

o Dense and solid.

o Forms the outer layer of most bones.

o Contains Haversian systems (osteons).

• Spongy bone:

o Porous and trabecular.

o Found within the interior of most bones.

o Contains a network of interconnected bony spicules (trabeculae).

32. Parallel muscle: Explain structure-function relationship between biceps

brachii and its function as parallel muscle. 7

• Biceps brachii is a classic example of a parallel-fibered muscle.

• Its fibers run parallel to each other along the length of the muscle.

• This arrangement allows for a large range of motion during elbow flexion.

• However, the force generated may be relatively lower compared to

pennate muscles of similar size.

33. Osteoblast: Explain structure-function relationship between bone

formation and osteoblast. 7

• Osteoblasts are bone-forming cells.

• They synthesize and secrete the organic matrix of bone (collagen) and

initiate the process of mineralization (deposition of calcium salts).

• They play a crucial role in:

o Bone growth: During development and throughout life.

o Bone repair: After fractures.

o Bone remodeling: Continuous process of bone formation and

resorption.

34. Muscle: Explain how sarcomere helps in muscle contraction. 6

• Sarcomere:

o The basic contractile unit of a skeletal muscle fiber.

156

o Bounded by two Z-lines.

o Contains overlapping actin (thin) and myosin (thick) filaments.

• Muscle Contraction:

o During contraction, the actin and myosin filaments slide past each

other, shortening the sarcomere.

o This shortening of individual sarcomeres leads to the overall

shortening of the muscle fiber and subsequent muscle contraction.

35. Bone: Explain why bone contain abundant collagen fiber. 6

• Collagen fibers provide tensile strength to the bone matrix, resisting

stretching and pulling forces.

• Without collagen, bone would be brittle and easily fracture under stress.

• The combination of collagen fibers and the mineral component

(hydroxyapatite) gives bone its unique combination of strength, rigidity,

and flexibility.

36. Spiral muscle: Explain structure-function relationship between of biceps

brachii muscle as supinator. 7

• Biceps brachii has a spiral course of its fibers.

• In addition to its primary function of elbow flexion, this spiral

arrangement allows it to also participate in supination of the forearm.

• As the biceps brachii contracts, it not only flexes the elbow but also

rotates the forearm laterally (supination).

37. Muscle contraction: Describe how calcium plays an important role in

muscle contraction. 5

• Calcium ions trigger muscle contraction.

• When a nerve impulse reaches the muscle fiber, it triggers the release of

calcium ions from the sarcoplasmic reticulum.

• Calcium ions bind to troponin, which then moves tropomyosin away from

the myosin-binding sites on actin.

• This allows myosin heads to bind to actin and initiate the cross-bridge

cycle, leading to muscle contraction.

38. Synovial joint: Explain structure-function relationship between

morphology of hinge type of synovial joint and its movement. 7

157

• Hinge joints are characterized by a convex surface of one bone

articulating with a concave surface of another bone.

• This morphology restricts movement to a single plane, typically flexion

and extension.

• Examples: Elbow joint, knee joint.

• This restricted range of motion provides stability and allows for strong,

powerful movements in a specific direction.

39. Pennate muscle: Explain structure-function relationship between pennate

muscles and force of contraction. 7

• Pennate muscles have fibers that run obliquely to the tendon, like the

barbs of a feather.

• This arrangement allows for a greater number of muscle fibers to be

packed into a given space compared to parallel-fibered muscles.

• As a result, pennate muscles can generate higher forces but may have a

slightly smaller range of motion.

40. Diad & Triad: Differentiate by TWO points. 6

• Diad:

• Triad:

o Found in smooth muscle.

o Consists of a single transverse tubule and a single cisterna of the

sarcoplasmic reticulum.

o Found in skeletal muscle.

o Consists of a transverse tubule sandwiched between two cisternae

of the sarcoplasmic reticulum.

41. Organization of a skeletal muscle fiber: Read the figure & Explain what

special understanding it offers. 7

• Special Understanding:

o The figure would likely illustrate the hierarchical organization of a

skeletal muscle fiber:

▪ Muscle → Muscle fascicle → Muscle fiber (muscle cell) →

Myofibrils → Sarcomeres.

o This helps to understand how the structural components of a

muscle fiber contribute to its contractile function.

158

42. Secondary cartilaginous joint: Explain structure- function relationship of

secondary cartilaginous type of joint in pubic symphysis. 7

• Pubic symphysis:

o A secondary cartilaginous joint that unites the two pubic bones.

o Consists of a disc of fibrocartilage.

• Structure-Function Relationship:

o Fibrocartilage:

▪ Provides a strong and slightly compressible connection

between the pubic bones.

▪ Allows for a small degree of movement, which is important

during pregnancy and childbirth.

43. Unipennate muscle & Bipennate muscle: Differentiate by TWO points. 6

• Unipennate:

o Fibers run obliquely from one side of the tendon only.

o Example: Extensor digitorum longus.

• Bipennate:

o Fibers run obliquely from both sides of a central tendon.

o Example: Rectus femoris.

44. Skeletal muscle: Classify according to direction of fiber. 5

• Parallel: Fibers run parallel to the long axis of the muscle (e.g., sartorius).

• Pennate: Fibers run obliquely to the tendon (e.g., deltoid, rectus femoris).

o Unipennate

o Bipennate

o Multipennate

45. Ossification: Justify the terms, ‘primary’ & ‘secondary’ ossification centers.

• Primary Ossification Center:

o The first site of bone formation within a developing bone.

o Typically appears in the diaphysis (shaft) of long bones during fetal

development.

• Secondary Ossification Center:

159

o Appear later in development, usually after birth.

o Located in the epiphyses (ends) of long bones.

o Responsible for the growth in length of long bones.

46. Parallel fiber muscles: Explain structure-function relationship between the

direction of muscle fibers in strap muscle and its range of movement. 7

• Strap muscles have parallel fibers that run the entire length of the muscle.

• This arrangement allows for a large range of motion due to the long

distance the muscle fibers can shorten.

• Examples: Sartorius, sternocleidomastoid.

47. Muscle: Mention the types of muscles based on their color. 5

• Red muscle fibers:

o High in myoglobin content (gives them a reddish color).

o Rich in mitochondria.

o Specialized for slow, sustained contractions (e.g., postural

muscles).

• White muscle fibers:

• Hinge joints

o Low in myoglobin content (appear pale).

o Fewer mitochondria.

o Specialized for rapid, powerful contractions (e.g., muscles involved

in sprinting).

48. Hinge variety of synovial joint: Explain structure-function relationship

between the morphology of elbow joint and movement at this joint. 7

o Have a convex surface of one bone articulating with a concave

surface of another bone.

o This morphology restricts movement to a single plane (flexion and

extension).

• Elbow Joint:

o The trochlea of the humerus (convex) articulates with the trochlear

notch of the ulna (concave).

o This hinge-like configuration allows for smooth and efficient flexion

and extension of the forearm.

160

49. Skeletal muscle: Evaluate importance of antagonist muscles. 7

• Antagonist muscles play crucial roles in:

o Controlling movement:

▪ They provide smooth and controlled movements by resisting

the action of the prime mover.

o Maintaining joint stability:

▪ They help to stabilize the joint and prevent excessive

movement.

o Protecting joints:

▪ They help to prevent excessive stress and injury to the joints.

50. Periosteum: Describe structure & Mention functions. 5

• Structure:

o A tough, fibrous connective tissue membrane that covers the outer

surface of bones (except at articular surfaces).

o Consists of an outer fibrous layer and an inner cellular layer.

• Functions:

o Provides nutrient and oxygen supply to the underlying bone.

o Serves as attachment sites for tendons and ligaments.

o Plays a crucial role in bone growth, repair, and remodeling.

51. Bone: Justify presence of both ‘compact’ & ‘spongy’ parts in long bones. 7

• Long bones require a combination of strength, rigidity, and lightness.

• Compact bone provides the necessary strength and rigidity to withstand

weight-bearing forces. It forms the outer shell of the bone, providing a

solid, protective layer.

• Spongy bone within the interior of the bone contributes to strength and

reduces weight.

• The trabeculae of spongy bone are arranged along lines of stress,

providing maximum strength with minimal weight.

• This combination of compact and spongy bone allows long bones to be

both strong and lightweight, which is essential for efficient movement and

locomotion.

52. Cruciate ligaments of knee joint: Explain structure-function relationship of

attachment of cruciate ligament in knee joint. 7

161

• Cruciate ligaments are crucial for the stability of the knee joint.

• Anterior Cruciate Ligament (ACL):

o Attachment:

▪ Anterior intercondylar area of the tibia to the medial side of

the medial femoral condyle.

o Function:

▪ Prevents anterior displacement of the tibia on the femur.

• Posterior Cruciate Ligament (PCL):

o Attachment:

▪ Posterior intercondylar area of the tibia to the lateral side of

the lateral femoral condyle.

o Function:

▪ Prevents posterior displacement of the tibia on the femur.

• Structure-Function Relationship:

o The specific attachments of the cruciate ligaments within the knee

joint are crucial for their function in preventing excessive anterior

and posterior translation of the tibia relative to the femur.

53. Ossification: Justify- synostosis is common in primary cartilaginous joints

(with TWO examples). 7

• Synostosis is the fusion of two bones that were previously separated by a

joint.

• Primary cartilaginous joints are initially united by hyaline cartilage.

• In many cases, these joints undergo ossification later in life, resulting in

synostosis.

• Examples:

o Epiphyseal plates:

▪ In adulthood, the epiphyseal plate ossifies, fusing the

diaphysis and epiphysis of long bones.

o First rib-sternum joint:

▪ This primary cartilaginous joint often ossifies in adulthood.

54. Movement of vertebral column: Read the figure & Explain what special

understanding it offers. 7

162

• Special Understanding:

o The figure would likely illustrate the different planes of movement

in the vertebral column:

▪ Flexion/extension: Forward and backward bending.

▪ Lateral flexion: Bending to the side.

▪ Rotation: Twisting of the spine.

o This would help to understand the range of motion possible at each

vertebral level and the contributions of different spinal segments

to overall spinal mobility.

55. Skeletal muscle: Mention different types of muscles based on direction of

their fibers, providing examples. 5

• Parallel: Fibers run parallel to the long axis of the muscle (e.g., sartorius,

rectus abdominis).

• Pennate: Fibers run obliquely to the tendon.

o Unipennate: Fibers run obliquely from one side of the tendon only

(e.g., extensor digitorum longus).

o Bipennate: Fibers run obliquely from both sides of a central tendon

(e.g., rectus femoris).

o Multipennate: Fibers run obliquely from several tendons (e.g.,

deltoid).

56. Bone: Describe Haversian system of compact bone. 5

• Haversian system (osteon):

o The basic structural unit of compact bone.

o Consists of concentric lamellae (rings) of bone matrix surrounding

a central Haversian canal.

o Haversian canals contain blood vessels, nerves, and lymphatic

vessels.

o Osteocytes are embedded within the lamellae and connected to

each other and to the central canal by canaliculi.

57. Skeletal muscle: Differentiate between Red fiber & white fiber of skeletal

muscle by THREE structural points. 6

• Red fibers (slow-twitch):

o High myoglobin content.

o Many mitochondria.

163

o Rich in blood supply.

• White fibers (fast-twitch):

o Low myoglobin content.

o Fewer mitochondria.

o Less extensive blood supply.

58. Synovial fluid: Justify the presence of synovial fluid in both synovial cavity

& bursa. 7

• Synovial fluid is essential for the proper function of both synovial joints

and bursae.

• In synovial joints:

o It provides lubrication, reducing friction during movement.

o It nourishes the articular cartilage.

o It acts as a shock absorber.

• In bursae:

• Parts of a Growing Long Bone:

o It reduces friction between moving structures, such as tendons and

bones.

o It facilitates smooth and efficient movement.

59. Bone: Show parts of a growing long bone & Define growing end with

examples. 5

o Diaphysis (shaft)

o Epiphysis (ends)

o Metaphysis (region between diaphysis and epiphysis)

o Epiphyseal plate (cartilaginous growth plate)

• Growing End:

o The epiphyseal plate is the growing end of a long bone.

o It is a layer of hyaline cartilage that allows for longitudinal growth

of the bone.

60. Bone: Explain why the knowledge of the growing end is important. 6

• Importance of the Growing End:

o Growth and Development:

164

▪ The epiphyseal plate is crucial for the longitudinal growth of

long bones during childhood and adolescence.

o Clinical Significance:

▪ Injuries or diseases that affect the epiphyseal plate can

disrupt bone growth and lead to deformities.

▪ Monitoring the status of the epiphyseal plate is important in

assessing bone growth and development in children.

61. Skeletal muscle: Explain structure-function relationship of T- tubules in

skeletal muscles. 7

• T-tubules (transverse tubules):

o Invaginations of the sarcolemma (muscle cell membrane) that

penetrate deep into the muscle fiber.

• Structure-Function Relationship:

o Rapid conduction of action potentials:

• Bone:

▪ T-tubules rapidly transmit the nerve impulse from the

surface of the muscle fiber to the interior, reaching the

sarcoplasmic reticulum.

o Triggering calcium release:

▪ The arrival of the action potential at the T-tubules triggers

the release of calcium ions from the sarcoplasmic reticulum,

initiating muscle contraction.

62. Bone & cartilage: Differentiate by THREE points. 6

o Rigid and mineralized.

o Contains a matrix of collagen fibers and hydroxyapatite crystals.

o Highly vascularized.

• Cartilage:

o Flexible and avascular.

o Contains a matrix of collagen fibers and proteoglycans.

o Receives nutrients by diffusion from surrounding tissues.

63. Pennate muscle: Explain structure-function relationship between deltoid

muscle (middle fiber) and force of contraction. 7

• Deltoid muscle:

165

o A multipennate muscle with fibers running obliquely from multiple

tendons.

o The middle fibers of the deltoid are arranged in a bipennate

fashion.

• Structure-Function Relationship:

o This arrangement allows for a high number of muscle fibers to be

packed into a relatively small space.

o This results in the middle fibers of the deltoid generating a high

force during shoulder abduction.

64. Skeletal muscle: Explain how sarcomere length changes during muscle

contraction. 6

• During muscle contraction:

o The sarcomere shortens due to the sliding of actin and myosin

filaments over each other.

o The Z-lines, which mark the boundaries of the sarcomere, move

closer together.

o The H-zone (region containing only myosin filaments) and the I

band (region containing only actin filaments) narrow.

o The A-band (region containing both actin and myosin filaments)

remains relatively constant in length.

65. Skeletal muscle: Explain why myofilaments are considered as the ultimate

contractile element. 6

• Myofilaments (actin and myosin) are the fundamental units of muscle

contraction.

• The interaction between actin and myosin, specifically the sliding filament

mechanism, is the basis of muscle contraction.

• Therefore, myofilaments are considered the ultimate contractile

elements within a muscle fiber.

66. Synovial joint: Mention the different types of synovial joints based on the

direction of their axis, providing examples. 5

• Uniaxial:

o Movement occurs around a single axis.

▪ Hinge joint: Elbow, knee (flexion/extension)

166

▪ Pivot joint: Radioulnar joint (pronation/supination)

• Biaxial:

o Movement occurs around two axes.

▪ Condyloid

joint:

Metacarpophalangeal

(flexion/extension, abduction/adduction)

joints

▪ Saddle joint: Carpometacarpal joint of the thumb

(flexion/extension, abduction/adduction, opposition)

• Triaxial:

o Movement occurs around three axes.

▪ Ball-and-socket

joint:

Hip

joint,

shoulder

(flexion/extension, abduction/adduction, rotation)

67. Prime mover: Evaluate the importance of iliopsoas as the prime mover

compared to other flexors of thigh. 7

• Iliopsoas is a powerful hip flexor.

• Syndesmosis:

joint

• Importance as Prime Mover:

o Strongest hip flexor: It generates the most force during hip flexion

compared to other hip flexors like rectus femoris and pectineus.

o Crucial for many activities: Essential for activities such as walking,

running, climbing stairs, and rising from a seated position.

o Postural significance: Contributes to maintaining an upright

posture by resisting hip extension.

68. Fibrous joint: Explain necessity of syndesmosis type of fibrous joint in our

body. 6

o A type of fibrous joint where bones are connected by a sheet of

dense fibrous connective tissue (interosseous membrane).

• Necessity:

o Provides stability:

▪ Example: The syndesmosis between the tibia and fibula

provides stability to the ankle joint.

o Allows for slight movement:

▪ While providing stability, it allows for some degree of

movement, which is important for the proper functioning of

the joint.

167

69. Pennate muscles: Mention the different types based on the arrangement

of their fibers, and provide examples. 5

• Unipennate:

o Fibers run obliquely from one side of the tendon only.

o Example: Extensor digitorum longus.

• Bipennate:

o Fibers run obliquely from both sides of a central tendon.

o Example: Rectus femoris.

• Multipennate:

o Fibers run obliquely from several tendons.

o Example: Deltoid muscle.

70. Muscle contraction: Explain structure-function relationship between actin

myosin and muscle contraction. 7

• Actin and myosin are the contractile proteins within skeletal muscle

fibers.

• Actin: Thin filaments.

• Myosin: Thick filaments.

• Sliding Filament Theory:

o During muscle contraction, myosin heads bind to actin filaments

and pull them towards the center of the sarcomere.

o This interaction between actin and myosin shortens the sarcomere,

resulting in muscle contraction.

71. Bone: Mention its organic & inorganic composition & Describe functions of

osteoblast. 5

• Organic Component:

o Primarily collagen fibers.

• Inorganic Component:

o Primarily hydroxyapatite crystals (calcium and phosphate).

• Functions of Osteoblasts:

o Synthesize and secrete the organic matrix of bone (collagen).

o Initiate the process of mineralization (deposition of calcium salts).

168

o Play a crucial role in bone growth, repair, and remodeling.

72. Red muscles: Explain structure-function relationship of red muscles as

antigravity muscles. 7

• Red muscle fibers are specialized for slow, sustained contractions.

• They have a high content of myoglobin, mitochondria, and blood vessels,

which enable them to maintain aerobic metabolism.

• As antigravity muscles:

o They are responsible for maintaining posture and resisting the

effects of gravity.

o Examples:

▪ Muscles of the back and neck.

▪ Soleus muscle in the calf.

73. Muscle: Justify why if a muscle crosses multiple joints, it would cause

movements in all those joints. 7

• Muscle Action and Joint Movement:

o A muscle's action is primarily determined by its attachment points

(origin and insertion).

o If a muscle crosses multiple joints, its contraction will tend to

produce movement at all of those joints.

o Example:

▪ The biceps brachii crosses both the shoulder and elbow

joints.

▪ Contraction of the biceps brachii can cause both shoulder

flexion and elbow flexion.

74. Bone: Classify according to morphology. 5

• Long bones:

o Longer than they are wide.

o Examples: Femur, humerus.

• Short bones:

o Cube-shaped.

o Examples: Carpal bones, tarsal bones.

• Flat bones:

o Thin, flat, and often curved.

169

o Examples: Skull bones, ribs, sternum.

• Irregular bones:

o Complex shapes.

o Examples: Vertebrae, facial bones.

• Sesamoid bones:

o Small, round bones embedded within tendons.

o Examples: Patella.

75. Cardiac muscle: Explain structure-function relationship between Cardiac

muscle & functional syncytium. 7

• Cardiac muscle is composed of interconnected cells that form a

functional syncytium.

• Intercalated discs:

o Specialized junctions between adjacent cardiac muscle cells.

o Contain gap junctions that allow for rapid electrical conduction

between cells.

• Functional Syncytium:

examples. 7

• Gravity:

o The interconnected network of cardiac muscle cells allows the

heart to contract as a single unit, ensuring efficient pumping of

blood.

76. Joint: Evaluate ‘importance of gravity’ in joint movement with TWO

o Plays a significant role in influencing joint movement.

• Examples:

o Standing:

▪ Gravity exerts a constant downward force on the body,

requiring the muscles of the legs and back to work against

gravity to maintain an upright posture.

o Walking:

▪ Gravity assists with the downward phase of the gait cycle,

but muscles must work against gravity to lift the leg during

the swing phase.

170

77. Synovial joint: Mention THREE important structural features. 5

• Articular cartilage:

o Smooth, hyaline cartilage that covers the articulating surfaces of

the bones.

• Joint capsule:

o A fibrous connective tissue capsule that encloses the joint.

• Synovial membrane:

o Lines the inner surface of the joint capsule and secretes synovial

fluid.

78. Skeletal muscle: Evaluate importance of antagonist muscles. 7

• Antagonist muscles play crucial roles in:

o Controlling movement:

▪ They provide smooth and controlled movements by resisting

the action of the prime mover.

o Maintaining joint stability:

• Skeletal Muscle:

▪ They help to stabilize the joint and prevent excessive

movement.

o Protecting joints:

▪ They help to prevent excessive stress and injury to the joints.

79. Skeletal & smooth muscles: Differentiate by THREE structural points. 6

o Striated appearance.

o Voluntary control.

o Multinucleated cells.

• Smooth Muscle:

o Non-striated appearance.

o Involuntary control.

o Single nucleus per cell.

80. Developing long bone: Select the most vascular part of a developing long

bone, & give reason(s) for selection. 7

• Most Vascular Part:

o Metaphysis

o Reasons:

171

▪ The metaphysis contains the epiphyseal plate, which is the

site of active bone growth.

▪ Extensive vascularization is necessary to deliver nutrients

and oxygen to the rapidly growing cartilage and newly

formed bone tissue.

▪ Blood vessels also play a crucial role in the removal of waste

products from the growing bone.

81. Movement of vertebral column: Read the figure & Explain what special

understanding it offers. 7

• Special Understanding:

o The figure would likely illustrate the different planes of movement

in the vertebral column:

▪ Flexion/extension: Forward and backward bending.

▪ Lateral flexion: Bending to the side.

▪ Rotation: Twisting of the spine.

o This would help to understand the range of motion possible at each

vertebral level and the contributions of different spinal segments

to overall spinal mobility.

82. Bone: Describe Haversian system of compact bone. 5

• Haversian system (osteon):

o The basic structural unit of compact bone.

o Consists of concentric lamellae (rings) of bone matrix surrounding

a central Haversian canal.

o Haversian canals contain blood vessels, nerves, and lymphatic

vessels.

o Osteocytes are embedded within the lamellae and connected to

each other and to the central canal by canaliculi.

83. Cardiac muscle: Explain structure-function relationship between gap

junction in cardiac muscle and muscle contraction. 7

• Gap junctions are specialized intercellular connections that allow for the

direct passage of ions and small molecules between adjacent cells.

• In cardiac muscle:

o Gap junctions are abundant in intercalated discs.

172

o They enable the rapid spread of electrical impulses (action

potentials) from one cardiac muscle cell to another.

• Structure-Function Relationship:

o This rapid electrical conduction allows the heart to contract as a

single unit (functional syncytium), ensuring coordinated and

efficient pumping of blood.

84. Skeletal muscle: Differentiate between Red fiber & white fiber of skeletal

muscle by THREE structural points. 6

• Red fibers (slow-twitch):

o High myoglobin content.

o Many mitochondria.

o Rich in blood supply.

• White fibers (fast-twitch):

o Low myoglobin content.

o Fewer mitochondria.

o Less extensive blood supply.

85. Bone: Justify- the body of a vertebra is a modified long bone. 7

• The body of a vertebra shares some features with long bones, despite its

irregular shape:

o Central marrow cavity: Similar to the medullary cavity in long

bones.

o Cortical bone:

▪ A dense outer layer similar to the diaphysis of long bones.

o Trabecular bone:

▪ Spongy bone within the interior, similar to the arrangement

in long bones.

• Justification:

o These structural similarities suggest that the vertebral body may

have evolved from a long bone-like structure, adapted to its specific

function of weight-bearing and providing support for the spinal

column.

86. Muscle fiber: Explain structure-function relationship of rectus abdominis

as strap muscle. 7

173

• Rectus abdominis:

o A strap muscle with long, parallel fibers running vertically along the

anterior abdominal wall.

• Structure-Function Relationship:

o This arrangement allows for a large range of motion during trunk

flexion (forward bending).

o The long fibers can shorten significantly, allowing for substantial

trunk flexion.

87. Parallel Muscle: Explain structure-function relationship between parallel

muscles and range of movement. 7

• Parallel muscles have fibers that run parallel to the long axis of the

muscle.

• This arrangement allows for a large range of motion due to the long

distance the muscle fibers can shorten.

• Examples: Sartorius, sternocleidomastoid.

88. Cardiac & smooth muscles: Differentiate by THREE structural points. 6

• Cardiac Muscle:

o Striated appearance.

o Branched fibers.

o Intercalated discs.

• Smooth Muscle:

o Non-striated appearance.

o Spindle-shaped cells.

o Lack of striations.

89. White muscle: Explain structure-function relationship between white

muscles and its rapid, less sustained contraction. 7

• White muscle fibers are specialized for fast, powerful contractions.

• They have:

o Fewer mitochondria: Rely primarily on anaerobic metabolism for

energy production.

o Lower myoglobin content: Reduced oxygen storage capacity.

o Less extensive blood supply.

174

• Structure-Function Relationship:

o These structural features allow for rapid bursts of activity, but they

also limit their endurance.

o White muscle fibers are well-suited for activities that require short

bursts of high-intensity effort, such as sprinting.

90. Diad & triad: Differentiate by THREE points. 6

• Diad:

o Found in smooth muscle.

o Consists of a single transverse tubule and a single cisterna of the

sarcoplasmic reticulum.

• Triad:

o Found in skeletal muscle.

o Consists of a transverse tubule sandwiched between two cisternae

of the sarcoplasmic reticulum.

91. Periosteum: Explain how it takes part in repair of bone Fracture. 7

• Periosteum:

o Plays a vital role in bone fracture repair.

• Role in Fracture Repair:

o Source of cells: Contains osteoblasts that differentiate and migrate

to the fracture site to form new bone.

o Provides a scaffold:

▪ The periosteum acts as a scaffold for the ingrowth of blood

vessels and the formation of new bone tissue.

o Provides nutrients:

▪ Supplies nutrients and oxygen to the healing bone.

92. Primary & secondary cartilaginous joints: Differentiate by THREE points. 6

• Primary Cartilaginous Joints:

o United by hyaline cartilage.

o Usually temporary joints that eventually ossify.

o Examples: Epiphyseal plates, first rib-sternum joint.

• Secondary Cartilaginous Joints:

o United by fibrocartilage.

175

o More durable and allow for slight movement.

o Examples: Intervertebral discs, pubic symphysis.

93. Muscle: Justify why if a muscle crosses multiple joints, it would cause

movements in all those joints. 7

• Muscle Action and Joint Movement:

o A muscle's action is primarily determined by its attachment points

(origin and insertion).

o If a muscle crosses multiple joints, its contraction will tend to

produce movement at all of those joints.

o Example:

▪ The biceps brachii crosses both the shoulder and elbow

joints.

▪ Contraction of the biceps brachii can cause both shoulder

flexion and elbow flexion.

94. Multipennate muscle: Explain structure-function relationship between

multipennate muscle and force of contraction. 7

• Multipennate muscles have fibers that run obliquely from several

tendons.

• This arrangement allows for a very high number of muscle fibers to be

packed into a given space.

• As a result, multipennate muscles can generate extremely high forces.

• Example:

o Deltoid muscle (especially the anterior and posterior portions).

95. Study of a figure: Haversian system- Read the figure & Explain what special

understanding it offers. 7

• Special Understanding:

o The figure would likely depict the detailed structure of a Haversian

system, including:

▪ Concentric lamellae.

▪ Central Haversian canal.

▪ Lacunae (spaces containing osteocytes).

▪ Canaliculi (microscopic channels connecting lacunae).

176

o This would help to understand how the Haversian system provides

structural support and facilitates nutrient and waste exchange

within compact bone.

96. Cartilaginous & membranous ossifications: Differentiate by THREE points.

• Intramembranous Ossification:

o Bone develops directly from mesenchymal tissue.

o Occurs in flat bones (e.g., skull bones).

o No cartilage intermediate.

• Endochondral Ossification:

o Bone develops by replacing a pre-existing cartilage model.

o Occurs in most bones of the body, especially long bones.

o Involves the formation of a cartilage model that is subsequently

replaced by bone.

97. Joint: Explain movements at biaxial joints with ONE example. 6

• Biaxial joints allow for movement around two axes.

• Example:

o Condyloid joint:

▪ Found at the metacarpophalangeal joints (knuckles).

▪ Allows for flexion/extension and abduction/adduction.

98. Bone: Functionally justify presence of 'cartilaginous epiphyseal plates' in

some developing bones. 7

• Cartilaginous Epiphyseal Plates:

o Essential for the longitudinal growth of long bones.

o Allow for the continuous production of new bone tissue, enabling

the bone to increase in length.

• Functional Justification:

o Growth and Development:

▪ The epiphyseal plates are crucial for normal skeletal

development and achieving adult height.

o Clinical Significance:

▪ Injury or disease affecting the epiphyseal plates can disrupt

bone growth and lead to deformities.

177

99. Red & white muscles: Differentiate by THREE points. 6

• Red fibers (slow-twitch):

o High myoglobin content.

o Many mitochondria.

o Rich in blood supply.

• White fibers (fast-twitch):

o Low myoglobin content.

o Fewer mitochondria.

o Less

99. Red & white muscles: Differentiate by THREE points. 6

• Red fibers (slow-twitch):

o High myoglobin content.

o Many mitochondria.

o Rich in blood supply.

• White fibers (fast-twitch):

o Low myoglobin content.

o Fewer mitochondria.

o Less extensive blood supply.

100. Bipennate muscle: Explain structure-function relationship between

bipennate muscle and force of contraction. 7

• Bipennate muscles have fibers that run obliquely from both sides of a

central tendon.

• This arrangement allows for a high number of muscle fibers to be packed

into a given space.

• As a result, bipennate muscles can generate high forces but may have a

slightly smaller range of motion compared to parallel-fibered muscles.

• Example:

o Rectus femoris.

Labels

Sunday, June 7, 2026

BMDC new curriculum Anatomy VIVA board-II Answer | Best for VIVA Question Topic Wise Solution | Anatomy viva question |

ABDOMEN

🦴Anterior & Posterior Abdominal Wall

Alimentary System Stomach

Duodenum, Pancreas, Spleen

Thank you see you again

Best of luck

BMDC new curriculum Anatomy VIVA board-II Answer | Best for VIVA Question Topic Wise Solution | Anatomy viva question |

Report Abuse

About Me