UPPER LIMB

1. Muscles attached to the coracoid process of the scapula are short head of biceps brachii,
coracobrachialis, pectoralis minor.
2. Atavistic epiphysis – coracoid process of scapula, posterior tubercle of talus
3. 6 peculiarities of clavicle:
i. Only long bone to lie horizontally
ii. No medullary cavity
iii. Present subcutaneously
iv. First bone to start ossification
v. Last bone to complete ossification
vi. Two primary ossification centers
4. Claviculardystosis is the failure of fusion of the medial and lateral parts of the clavicle
due to the non-fusion of the two primary ossification centers.
5. Cleidocranaialdystosis is the partial/complete absence of the clavicle due to defective
ossification of the skull bones.
6. Sprengel’s deformity/Congenital high scapula refers to the failure of descent of scapula
from neck position to the adult position. It may be attached to cervical vertebra or
omovertebral body. It’s surgical correction may injure the brachial plexus.
7. The nerves directly related to the humerus are:
i. Axillary nerve (around the surgical neck)
ii. Radial nerve (radial/spiral groove)
iii. Ulnar nerve (behind medial epicondyle)
8. Volkmann’s ischemic contracture refers to the injury of the brachial artery (maybe due to
supracondylar fracture of the humerus), thereby causing ischemia of the forearm muscles,
leading to claw-like deformity of hand.
9. Colle’s fracture is when the distal broken end of the radius is pointed upward and
backward.
Smith’s fracture is when the distal broken end of the radius is pointed downward and
forward.
10. Chauffeur’s fracture refers to the fracture of the styloid process of the radius.
11. Madelung deformity is a congenital deformity of the radius bones due to the abnormal
extension of the distal epiphysis. This is clinically presented as:
i. Anterior bowing of the radius
ii. Dislocation of ulnar bone
iii. Occurs 10-14 years of age
12. Monteggia fracture refers to the fracture of the upper third of shaft of ulna and the
dislocation of the radial head of the superior radio-ulnar joint.
Galezzi fracture dislocation refers to the fracture of the lower third of shaft of ulna and
the dislocation of the inferior radio-ulnar joint.
13. Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
14. Largest carpal – Capitate
Crescent shape – Lunate
Commonly fractured – Scaphoid
Commonly dislocated – Lunate
15. Median nerve is most commonly injured in the supracondylar fracture of humerus.
16. Bennet’s fracture refers to the fracture of the base of the 1st metacarpal along with the
dislocation of the metacarpal.
Boxer’s fracture refers to the fracture of the neck of usually the 5th metacarpal.
17. Peculiarities of the sesamoid bones:
i. No periosteum
ii. No haversian system
iii. Develops in the tendons of muscles
iv. Ossifies after birth with multiple ossification centers.
18. Around 7-8 sesamoid bones are present in the following areas:
i. Patella – tendon of the quadriceps femoris
ii. Fabella – behind knee joint; lateral head of gastrocnemius
iii. Pisiform – tendon of flexor carpi ulnaris
iv. 2 bones – tendon of flexor hallucis brevis
v. 1 bone – tendon of peroneus longus
vi. 1 bone – tendon of adductor pollicis
vii. Sometimes 1 bone – tendon of flexor pollicis brevis
19. Key muscle of the pectoral region: pectoralis minor, subclavian m.
20. The pectoralis major and minor are supplied by all the five segments of brachial plexus.
21. Serratus anterior is called the ‘Boxer’s muscle’ as it causes the protraction of scapula
which leads to the pulling and pushing movements required for boxing.
22. Paralysis of the serratus anterior m. due to the injury to long thoracic nerve by stab injury
or removal of breast tumor that causes the prominence of the inferior angle and medial
border of the scapula, especially when the hands are pushing against the walls is called
the winging of scapula.
23. Vertically: from the clavicle to the axillary fascia
Medially: first rib and blends with the external intercostal muscles of the upper 2
intercostal spaces
Laterally: coracoid process
24. Structures piercing into the clavipectoral fascia are:
i. Lateral pectoral nerve
ii. Thoraco-abdominal artery
iii. Cephalic vein
iv. Lymphatics from breast draining into the apical axillary lymph nodes
25. The axillary tail of Spence is an extension of the beast tissue that extends into the axilla
through the deep fascia.
The foramen of Langer is the aperture in the deep fascia that allows the passing of the
axillary tail of Spence.
26. The retromammary space refers to a space filled with loose areolar tissue that separates
the breast tissue from the pectoral fascia.
27. Suspensory ligaments of Cooper are radially arranged fibrous strands that are formed by
the condensation of the connective tissue. It maintains the protuberance of the breast.
28. Montgomery’s tubercles are enlarged areolar sebaceous glands that appear as small
nodular elevation during pregnancy. They help in lubricating the nipples.
29. 15-20 lobes in parenchyma are arranged in radial fashion.
30. Via venous route: Cancer cells from breast -> Posterior intercostal veins -> vertebral
venous plexus -> dural venous sinuses -> brain
31. Lymphatics drainig the breast are:
 i. Axillary nodes
ii. Internal mammary nodes
iii. Posterior intercostal nodes
iv. Cephalic nodes
v. Supraclavicular nodes.
32. Breast cancer is adenocarcinoma arising from the epithelial cells of the lactiferous ducts,
which may metastasize via lymphatics.
33. Obstruction of the superficial lymphatics during breast cancer leads to the appearance of
the skin like that of the skin of orange is called ‘peau de orange’ appearance.
34. Secondary tumors from the metastasis of the cancer cells of breast through the sub-
peritoneal lymph nodes to the ovary is called the Krukenberg tumor.
35. Radical mastectomy refers to the removal of the entire breast along with the axillary
lymph nodes, the pectoralis major and minor muscles.
36. Subareolar plexus of Sappey refers to a plexus of lymph nodes present deep to the areola.
It drains into the anterior group of axillar lymph nodes.
37. Lateral thoracic artery
38. The apex of the axillar is also called the ‘cervico-axillary canal’ as the axillary artery and
the brachial plexus enters the axilla through this gap.
39. Extent: Outer border of first rib as continuation of subclavian artery --- Lower border of
teres minor as brachial artery.
Branches: The artery is divided into 3 parts by the pectoralis minor muscle.
 1st part – Superior thoracic artery
 2nd part – Thoraco-acromion artery, Lateral Thoracic Artery
 3rd part – Subscapular artery, Anterior Circumflex Humeral Artery, Posterior
Circumflex Humeral Artery
40. Largest branch – Subscapular artery
41. Main – first part of subclavian artery and third part of axillary artery
Around the body of scapula:
 Suprascapular artery – thyrocervical trunk from subclavian artery
 Circumflex scapular artery - Subscapular artery from Axillary artery
  Deep branch of Transverse Cervical Artery – thyrocervical trunk from subclavian
artery

Around the acromion process of scapula:

 Acromial branch of thoraco-acromion artery – second part of axillary artery

 Acromial branch of suprascapular artery – subclavian artery
 Acromial branch of posterior circumflex humeral artery – third part of axillary
artery
42. Extent: Runs upward medial to the axillary artery and ends at the outer border of the first
rib by continuing as the subclavian vein
Tributaries:
 Venae comitantes of the Axillary artery (lateral thoracic vein, subscapular vein)
 Basilic vein
43. There are 20-30 lymph nodes present in the axillary region, which are differentiated into 5
groups.
44. Axillary abscess is the collection of pus in the axilla due to an infection in the axillary
lymph nodes. It may travel to the neck if it breaks through the clavipectoral fascia. Can be
removed by an incision in the floor of axilla.
45. The lower trunk of brachial plexus does not give any branches.
46. Prefixed brachial plexus has a domination of supply from C4 spinal nerve and absent from
T2 spinal nerve.
Postfixed brachial plexus has a domination of supply from T2 spinal nerve and absent
from C4 spinal nerve.
47. From roots:
 Long thoracic nerve/Nerve to serratus anterior (C5-C7)
 Dorsal Scapular artery (C5)

From trunks: (only upper trunk gives branches)

 Nerve to subclavius
 Suprascapular nerve
48. Posterior cord (ULNAR)
  Upper subscapular nerve
 Lower subscapular nerve
 Nerve to latissimus dorsi/Thoracodorsal nerve
 Axillary nerve
 Radial nerve
49. Lateral pectoral nerve – C5-C7
Thoraco-dorsal nerve – C6-C8
Ulnar nerve – C7,C8,T1
50. The radial nerve and the median nerve constitute all spinal segments from the brachial
plexus.
51. The naming of the cords of the brachial plexus are done based of its relation the the
axillary artery.
52. Erb’s point is the region in the upper trunk where six nerves meet. The six nerves are C5
and C6 forming the trunk, giving off the suprascapular nerve and the nerve to subclavius
and then divides into the anterior and posterior division.
53. Upper trunk injury is called Erb’s paralysis and is characterized by policeman tip arm. The
C5 and C6 spinal nerves are affected, and sensory loss may occur on the outer aspect of
the arm.
Lower trunk injury is called Klumpke’s paralysis and is characterized by claw hand and
Horner’s syndrome may be present. The C8 and T1 spinal nerves are affected. Sensory
loss may occur along the medial border of the arm.
54. When T1 sympathetic fibres that supply the head and neck are affected, such as in
Klumpke’s palsy, manifestations may be seen in the eye as:
 Partial ptosis
 Miosis (excessive constriction of the pupil)
 Anhydrosis
 Enopthalmos
55. Common complications of the brachial plexus block is injury to the subclavian artery and
injury to the posterior cord of brachial plexus itself.
Supraclavicular blocks are the safest.
56. Shrugging muscle – Trapezius (elevation of scapula)
 Climbing muscle – Latissimus dorsi (pulling up of trunk)
57. When latissimus dorsi is conditioned by exposed to pulsated electrical activity, it begins to
function like cardiac tissues, by becoming non-fatigable and using oxygen at a steady
pace. Although a pacemaker is used to provide rhythmic contractions, latissimus dorsi can
be used as an auto-transplant to repair surgically removed portion of heart by wrapping it
around the heart.
58. Boundaries: Superior horizontal border of the latissimus dorsi, Medial border of scapula
and Inferolateral border of the trapezius
Clinical significance: When trunk is flexed and the arm is folded across the chest, this
triangle enlarges and becomes more subcutaneous. The auscultation of the lower lobe of
the corresponding lung can be done without muffled sounds.
59. Parts of deltoid m.: Anterior unipennate, Posterior unipennate and Middle multipennate
Strongest part is the middle multipennate part due to the multipennate arrangement.
60. Site – Deltoid m. : lower half to prevent injury to the axillary nerve
[in actual clinical practice, it is given in the upper and outer quadrant]
The deltoid muscle is preferred as it is easily felt and easily palpable.
61. Initiation of abduction of shoulder joint is done by the Supraspinatus m.
62. Rotator cuff muscles/Musculo-tendinous cuff – Supraspinatus, Infraspinatus, Teres minor
and Subscapularis
63. i. Quadrangular space
Contents: Axillary nerve
Posterior circumflex humeral artery and vein
ii. Upper triangular space
Contents: Circumflex scapular artery
iii. Lower triangular space
Contents: Radial nerve
Profunda brachii artery and vein
64. Injury of axillary nerve are presented with the following features:
a. Impaired abduction of shoulder – due to paralysis of the deltoid and teres minor
b. Regimental badge area sign/loss of sensation in the lower half of deltoid –
involvement of upper lateral cutaneous nerve of arm
 c. Loss of shoulder contour with prominence of greater tubercle of humerus – due to
wasting of deltoid
65. Glenohumeral joint is a ball-and-socket type of synovial joint.
66. Flexion of shoulder – Pectoral m. (clavicular part) + Deltoid m. (anterior fibers)
Extension of shoulder – Latissimus dorsi + Deltoid m. (posterior fibers)
Adduction of shoulder – Pectoral m. (sternocostal part) + Latissimus dorsi
Abduction of shoulder – Deltoid m (middle fibers) + Supraspinatus
Medial rotation – Subscapularis
Lateral rotation – Deltoid m. (posterior fibers)
67. Septic arthritis is when the epiphyseal part of proximal humerus is present inside the
capsule/intracapsular. It may occur following metaphyseal osteomyelitis.
68. All bursae: Subscapular bursa, Subacromial/Subdeltoid bursa, Infraspinatus bursa
Subacromial bursa is the largest synovial bursa.
69. Factors providing stability:
i. Rotator cuffs
ii. Coraco-acromial arch
iii. Long head of biceps brachii
iv. Glenoid labrum
70. The coracoacromial arch is called as the secondary socket of the glenohumeral joint.
71. The scapula-humeral rhythm refers to the rhythm between the simultaneous movements of
scapula and humerus for the smooth movement at the shoulder. In abduction, there is a 10
lateral rotation of scapula for 20 movement of the scapula-humeral joint.
72. Dislocation of shoulder joint commonly occurs in the antero-inferior aspect due to the lack
of proper support in this region. This often injures the axillary nerve, due to tis close
relation with the region.
73. Adhesive capsulitis, aka Frozen shoulder, is the presentation of pain and uniform
limitation of all movements of the shoulder joint despite no radiological change. It is
caused due to the shrinkage of the joint capsule.
74. Dawbarn’s sign is when subacromial bursitis pain cannot be elicited by application of
pressure in the deltoid m. just below the acromion process as the bursa slides underneath
the acromion process.
75. Yes, the clavicle moves upward during overhead abduction.
76. The coraco-clavicular ligament is the strongest ligament of the upper limb.
77. Weight in the upper limb is transmitted from the scapula to the clavicle via the
coracoclavicular ligament, then from the clavicle to the sternum via the sternoclavicular
ligament. Some of the weight may also be transmitted to the first rib via the
costoclavicular ligament.
78. (axial – w/ reference to the axis of the body)
Preaxial vein – Cephalic vein
Postaxial vein – Basilic vein
79. The cephalic vein crosses the roof of the anatomical snuff box.
80. Median cubital vein is preferred for IV injections and for withdrawing blood from donors
as it is the most superficial vein in the body and is supported by bicipital aponeurosis.
81. Cephalic vein is preferred for hemodialysis and removal of waste products in patients with
chronic renal failure as its cut-down in the deltopectoral groove is helpful when infusion
of superior vena cava is necessary.
82. The basilic vein is preferred for cardiac catheterization for two major reasons:
i. The diameter of the vein increases as it ascends from the cubital fossa to the
axillary vein.
ii. It is in direct line with the axillary vein, so it passes like: basilic vein -> axillary
vein -> subclavian vein -> brachiocephalic vein -> superior vena cava -: right
atrium of the heart.
83. The cephalic vein is not used for cardiac catheterization as:
i. Its diameter does not increase as it ascends.
ii. It joins the axillary vein at a right angle, thus making the maneuvering of the
catheter difficult around the cephalon-axillary angle.
iii. It divides into smaller branches in the deltopectoral groove, few of which join the
external jugular vein.
84. Lymphangitis refers to the inflammation of the lymph vessels following trivial injuries,
such as pin pricks.
Lymphedema refers to the obstruction of the lymph vessels that cause swelling due to the
accumulation of the tissue fluid.
85. Hybrid muscles of the arm: Brachialis
Hybrid muscles of the forearm: Flexor digitorum profundus
86. Biceps brachii is a strong supinator of the forearm.
87. Muscles that arise from the coracoid process of the scapula are:
i. Short head of biceps brachii
ii. Coracobrachialis
iii. Pectoralis minor
88. The third head of the coracobrachialis has disappeared in human beings, but sometimes it
persists as a fibrous band called the ligament of Struthers. The median nerve and the
brachial artery pass deep to this ligament and may get compressed.
89. The anatomical events occurring at the level of insertion of coracobrachialis are:
i. Circular shaft of humerus becomes triangular below this level
ii. Basilic vein and medial cutaneous nerve of arm and forearm pierce the deep fascia
iii. Ulnar nerve enters the posterior compartment by piercing the intermuscular septum
iv. Radial nerve enters the anterior compartment from the posterior compartment by
piercing the intermuscular septum
v. Brachial artery passes from the medial aspect to the anterior aspect
vi. Median nerve crosses in front of brachial artery to pass from lateral aspect to the
medial side
vii. Nutrient artery pierces the humerus
90. Brachialis is called the ‘work-horse of the elbow joint’ due to its untiring strong flexion of
the elbow.
91. Branches of the brachial artery:
i. Muscular branches to the muscles of the anterior compartment of the arm
ii. Profunda brachii artery
iii. Nutrient artery to the humerus
iv. Superior ulnar collateral artery
v. Inferior ulnar collateral artery
vi. Radial artery and Ulnar artery (terminal branches)
- The largest branch – Profunda brachii artery
92. Brachial pulse can be auscultated using a stethoscope medial to the biceps brachii tendon
in the cubital fossa. It can be easily recorded if the elbow is flexed.
93. Clinical significance of Brachial artery:
i. Auscultation of the brachial pulse
ii. To stop hemorrhages in the upper limb, the brachial artery can be effectively
compressed against the shaft of the humerus
iii. Volkman’s ischemic contracture may take place in supracondylar fracture of the
humerus that injures the brachial artery, thereby leading to lack of proper blood
supply.
94. Nerve of the posterior compartment of arm is the Radial nerve.
95. Popliteal fossa
96. Median nerve, Brachial artery, Tendon of Biceps brachii, Superficial branch of the Radial
nerve
97. Work-horse muscle of forearm flexion – Brachialis
Work-horse muscle of forearm extension – Medial head of triceps brachii
98. Superficial muscles of the front of forearm:
i. Pronator teres
ii. Flexor carpi radialis
iii. Palmaris longus
iv. Flexor digitorum superficialis
v. Flexor carpi ulnaris

Deep muscles of the front of forearm:

i. Flexor pollicis longus

ii. Flexor digitorum profundus
iii. Pronator quadratus
99. Medial attachment of the flexor retinaculum: Pisiform, Hamate
Lateral attachment of the flexor retinaculum: Trapezium, Scaphoid
100. Structures passing superficial to flexor retinaculum: (medial to lateral)
i. Ulnar nerve
ii. Ulnar artery
 iii. Palmar cutaneous branch of ulnar nerve
iv. Tendon of Palmaris longus
v. Palmar cutaneous branch of median nerve
vi. Palmar cutaneous branch of radial artery

Structures passing deep to flexor retinaculum:

i. Tendon of Flexor digitorum profundus

ii. Tendon of Flexor digitorum superficialis
iii. Tendon of Flexor pollicis longus
iv. Median nerve
101. Median nerve passes through the two heads of pronator teres.
Ulnar artery passes deep to the deep head of pronator teres.
102. Palmar aponeurosis represents the degenerated tendons of the palmaris longus muscle.
103. The tendon of palmaris longus is used for tendon grafting by surgeons.
104. The ulnar nerve passes in between the flexor carpi ulnaris and the flexor digitorum
profundus.
105. Aberrant ulnar artery refers to when the ulnar artery develops higher in the arm and
passes superficial to the flexor muscles in about 3% of individuals. This should be kept in
mind before the withdrawal of blood and before the injection of an irritating drug.
106. Clinical significance of radial artery is the examination of the radial pulse, which can be
palpated on the styloid process, where the artery runs medial to the tendon of flexor carpi
radialis and the tendon of brachioradialis.
Another significance – Volkmann’s ischemic contracture (injury to brachial artery affects
the radial artery too)
107. The ulnar artery forms the superficial palmar arch, and it terminates as the radial artery.
108. The radial artery forms the deep palmar arch and terminates by anastomosing with the
deep palmar branch of the ulnar artery.
109. The following nerves end in a pseudoganglion:
i. Posterior interosseous nerve of Radial nerve
ii. Deep peroneal nerve of sciatic nerve
110. The lateral side of the forearm is considered to be the ‘surgical safe side of the forearm’
as the main nerve of the front of forearm, the median nerve is mostly directed medially,
and only the sensory branch of radial nerve runs deep to brachioradialis on the lateral
aspect. Therefore, vulnerability to damage or injury is less.
111. Abductor pollicis longus, Extensor pollicis brevis and the Extensor pollicis longus are
called out cropping muscles as they ‘crop out’ through the lateral side of forearm in order
to gain insertion into the three short long bones of the thumb.
112. 4th compartment: Extensor digitorum
Extensor indicis
Anterior interosseous nerve
Posterior interosseous nerve
6th compartment: Extensor carpi ulnaris
113. Elbow is a hinge type synovial joint.
114. Factors providing stability to the elbow joint:
i. Strong radial and ulnar collateral ligaments
ii. Pulley-shaped trochlea of humerus fits perfectly into jaw-shaped trochlear notch of
the ulna
115. Flexion: Brachialis
Biceps brachii
Brachioradialis (most effective in mid-prone position)
Extension: Triceps brachii
Anconeus
116. Carrying angle refers to the deviation in the angle between the long axis of the arm and
the long axis of the forearm and usually measure about 10-150.
It is more pronounced in females as the forearm is more deviated laterally to prevent
rubbing with the wider female pelvis while carrying load.
(long axis of arm is pointed downwards and medially, long axis of forearm is pointed
downwards and laterally)
117. Posterior dislocation of the elbow is more common, and it is commonly associated with
the fracture of the coronoid process of the ulna.
118. Nursemaid’s elbow/Pulled elbow occurs when the head of the radius is pulled out of the
annular ligament by pulling of forearm in pronated position. Occurs in kids of 1-3 years.
119. Tennis elbow/lateral epicondylitis refers to severe pain and tenderness over the lateral
epicondyle of the humerus, with pain during abrupt pronation.
120. Golfer’s elbow/medial epicondylitis refers to severe pain and tenderness over the medial
epicondyle of the humerus.
121. Student’s elbow/Miner’s elbow refers to a round fluctuating painful swelling over the
olecranon. This occurs due to inflammation of the subcutaneous olecranon bursa.
122. Both the superior and inferior radio-ulnar joint are examples of pivot type synovial joint.
123. Middle radio-ulnar joint is a syndesmosis type of fibrous joint.
124. The oblique cord represents the degenerated part of the flexor pollicis longus muscle.
125. Supination: Supinator
Biceps brachii (when elbow is flexed)
Brachioradialis (from pronated forearm to mid-prone position)
Pronation: Pronator teres
Pronator quadratus
Brachioradialis (from supinated forearm to mid-prone position)
126. Dupuytren’s contracture is the progressive fibrosis of the medial aspect of the palmar
aponeurosis, causing progressive thickening to form permanent contracture and the flexion
deformity of the little and ring fingers. (ring finger is commonly affected)
127. Trigger finger refers to the clinical condition where one finger is completely flexed, and
extension occurs only with excessive voluntary effort or with the other hand’s help. When
extension begins, it occurs suddenly with a click sound. It is caused by the localized
thickening of a long flexor tendon, thus preventing its free movement.
128. Tenosynovitis of the synovial sheath of flexor tendons refers to the infection and
inflammation of the synovial sheaths of long flexor tendons which occur commonly due to
small penetrating wounds such as pin pricks.
129. Thenar group: Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor of thumb: Adductor pollicis
 Hypothenar group: Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
Lumbricals: Lumbrical 1 (unipennate)
Lumbrical 2 (unipennate)
Lumbrical 3 (bipennate)
Lumbrical 4 (bipennate)
Interossei: 4 palmar interossei (PAD – adduction)
4 dorsal interossei (DAB – abduction)
130. Thenar muscles of the hand: Abductor pollicis brevis, Flexor pollicis brevis, Opponens
pollicis
131. Flexor pollicis brevis is the hybrid muscle of the hand (superficial head – median nerve,
deep head – ulnar nerve)
132. Lumbricals action is the flexion of metacarpal joints and the extension of proximal
interphalangeal joints and the distal interphalangeal joints.
133. Palmar interossei helps in adduction of digits and the dorsal interossei helps in the
abduction of digits. (PAD DAB)
134. Ulnar nerve is called the musician’s nerve as it supplies almost all the intrinsic muscles
of hand (except lateral 2 lumbricals and the thenar muscles). These muscles are required
for the fine movements of a musician.
135. The ulnar tunnel/Guyon tunnel syndrome is caused by the compression of the ulnar nerve
and its branches. This causes weakness of the intrinsic muscles of the hand and the
hypoaesthesia (numbness) of the medial 1 ½ fingers.
136. The spaces of the hand are:
 Palmar spaces:
i. Midpalmar space
ii. Thenar space
iii. Pulp space of digits
 Dorsal spaces:
i. Subcutaneous space
ii. Subaponeurotic space
  Space of Parona/ Forearm space (fascial interval underneath the flexor tendons)
137. Boundaries of the anatomical snuff box:
Anterolaterally: Tendon of extensor pollicis brevis
Tendon of abductor pollicis brevis
Posteromedial: Tendon of extensor pollicis longus
Floor: Scaphoid and Trapezium
Roof: Skin and superficial fascia
Contents: Radial artery
Structures passing superficial to roof: Cephalic vein, terminal branches of the Superficial
Radial nerve
138. Mallet finger/ Baseball finger/ Cricket finger is when the insertion of extensor tendon
into the tip of the digit can be torn by a forceful blow to the tip of the finger. This causes a
sudden and strong flexion of the phalanx, that looks like swan neck. Voluntary extension is
impossible.
139. Clinical significance of the anatomical snuff box:
i. Pulsations of the radial artery can be felt here
ii. Superficially located cephalic vein is used for intravenous injections
iii. The terminal branches of the superficial radial nerve can roll over the tendon of the
extensor pollicis longus
iv. Tenderness of the anatomical snuff box can indicate fracture of the scaphoid.
140. The median nerve is called the eye of the hand/peripheral eye as it provides sensory
supply to the pulp of the thumb and the index finger which helps in seeing the texture and
thinness of materials and performing fine movements like buttoning a coat.
141. The wrist joint is an ellipsoid type synovial joint.
142. Motor supply of axillary nerve – Deltoid m. and teres minor m.
Sensory supply of axillary nerve – Shoulder join and skin over the lower lateral part of
the shoulder
143. The musculocutaneous nerve pierces the coracobrachialis m.
144. Motor supply (all extensor compartment): Triceps brachii, anconeus, lat. part of
brachialis, brachioradialis, supinator, extensor carpi radialis longus, extensor carpi radialis
 brevis, extensor digitorum, extensor digiti minimi, extensor pollicis longus, extensor
pollicis brevis, abductor pollicis longus.
Sensory supply: Posterior surface of arm and forearm, Dorsum of lateral 2/3rd of hand.
145. The paralysis of the extensor carpi radialis longus (ECRL) causes wrist drop due to the
PIN entanglement.
146. Crutch palsy is the injury to the radial nerve in the axilla due to the pressure applied by
the upper end of the crutch. Overall damage to the actions of radial nerve is seen. Wrist
drop is also seen due to the overcompensating action of the flexors.
147. Saturday night palsy refers to the injury to the radial nerve in the spiral groove by the
application of direct pressure over the radial nerve by a drunkard inadvertently falling
asleep with his one arm over the back of a chair. Clinical features seen are loss of
extension of wrist and fingers, and wrist drop.
148. Muscles supplies by median nerve:
i. Pronator teres
ii. Pronator quadratus
iii. Palmaris longus
iv. Flexor carpi radialis
v. Flexor digitorum superficialis
vi. Flexor digitorum profundus (lat. part)
vii. Flexor pollicis longus
viii. Abductor pollicis brevis
ix. Opponens pollicis
x. Flexor pollicis brevis
xi. 1st lumbrical
xii. 2nd lumbrical

Muscles supplied by the ulnar nerve:

i. Flexor carpi ulnaris

ii. Flexor digitorim profundus (medial half)
iii. Palmaris brevis
iv. Wrist joint
v. Medial 1 ½ digits palmar aspect
vi. Adductor pollicis
vii. Abductor digiti minimi
viii. Flexor digiti minimi
ix. Opponens digiti minimi
x. 3 palmar interossei
xi. 4 dorsal interossei
xii. 2 medial lumbricals
149. Carpal tunnel syndrome is the injury to the median nerve due to its compression inside
the carpal tunnel.
150. Complete claw hand is a medical condition in which combined lesions of the median
nerve and the ulnar nerve causes a true/complete claw hand deformity. Clinical features
are hyperextension of wrist joint and metacarpophalangeal joints and flexion at
interphalangeal joints.
151. Ape thumb deformity is seen in carpal tunnel syndrome due to the overcompensating
action of the adductor pollicis and paralysis of the thenar muscles.
152. Tinel’s sign (tingling feeling upon hitting the flexor retinaculum) and Phalen’s sign
(dorsal aspects of hand is kept opposing each other and numbness is felt in affected hand)
is seen in carpal tunnel syndrome.
153. Foment’s sign is positive in the injury of ulnar nerve at elbow and wrist.

LOWER LIMB

1. Dorsalis pedis artery is a direct continuation of the anterior tibial artery.

2. The triceps surae muscle refers to the two heads of gastrocnemius and soleus.
3. Vein used for aortocoronary grafting is a segment of the Great Saphenous vein to bypass
an arterial constriction. The great saphenous vein has valves and hence should be reverse
so as to not obstruct the blood flow.
4. The sciatic nerve is the thickest nerve in the body.
5. The tendon of soleus and the tendon of both the bellies of gastrocnemius join to form the
tendocalcaneus/tendoachilles, which is inserted into the middle of the posterior surface of
the calcaneum.
6. The posterior part of the iliac crest is used for bone marrow aspiration.
7. The ischial spine is crossed by three PIN structures from lateral to medial:
i. Pudendal nerve
ii. Internal Pudendal vessels
iii. Nerve to obturator internus
8. Muscles attached to linea aspera:
i. Vastus medialis
ii. Vastus lateralis
iii. Vastus intermedialis
iv. Short head of Biceps femoris
v. Adductor brevis
vi. Adductor longus
vii. Adductor magnus
9. Talus is the only bones of the foot that is devoid of any muscular attachments.
10. Jone’s fracture refers to the fracture of the styloid process of the fifth metatarsal caused
by pulling of the styloid process by the tendon of peroneus brevis during forced
inversion.
March fracture refers to the fracture of the shaft or neck of the second or third
metatarsal due to aggressive prolonged march past by soldiers.
11. Meralgia paresthetica refers to the pain and paresthesia caused in the lateral aspect of
thigh due to the compression of the lateral cutaneous nerve when it passes through the
inguinal canal.
12. The Holden’s line is a modification of the Scarpa’s and Colle’s fascia and it prevents the
movement of extravasated (fluid that is let/forced out of the vessel that naturally contains
it) urine into the thigh.
13. Major tributaries are: medial end of the dorsal venous arch of foot and the medial
marginal vein of foot.
Other tributaries are: Anterolateral vein, posteromedial vein, communicating veins
between short saphenous vein and deep veins, perforating veins, anterior veins of leg,
deep external pudendal vein, superficial epigastric vein, superficial circumflex iliac vein,
superficial external pudendal vein.
14. Two modifications of the deep fascia of the thigh are:
i. Iliotibial tract
ii. Saphenous opening
15. Attachments of the iliotibial tract -
Superficial lamina – tubercle of iliac crest
Deep lamina – capsule of hip joint
Inferior attachment – anterior surface of lateral condyle of tibia.
16. Quadriceps femoris is formed by: rectus femoris, vastus medialis, vastus lateralis, vastus
intermedius. It is supplied by the femoral nerve.
17. Anterior compartment of thigh – Femoral nerve
Medial compartment of thigh – Obturator nerve
Posterior compartment of thigh – Sciatic nerve
18. The muscles that cross two joints are:
i. Sartorius
ii. Semitendinosus
iii. Semimembranosus
iv. Long head of biceps femoris
19. Kicking muscle – Rectus femoris
Tailor’s muscle – Sartorius
20. Clinical significance of femoral triangle: Easy access to femoral artery, femoral hernia
21. The intraabdominal fascia tranversalis and fascia iliaca join to form a fascial tube called
the femoral sheath around the femoral vessels that enters the triangle.
22. Boundaries:
Lateral – femoral vein
Anterior – inguinal ligament
Posterior – pecten pubis
Medial – lacunar ligament
Content:
i. Lymph nodes of Cloquet/Rosenmuller
ii. Lymphatics
23. Contents:
i. Femoral artery
ii. Femoral vein
iii. Saphenous nerve
iv. Nerve to vastus medialis
v. Obturator nerve occasionally
vi. Descending genicular artery

Significance: The femoral artery is exposed and ligated here during surgery for aneurysm
of the popliteal artery as the artery here is healthy and won’t tear off.

24. Superficial branches – Superficial epigastric artery, superficial external pudendal artery,
superficial circumflex iliac artery.
Deep branches – Deep external pudendal artery, Muscular branches, Profunda femoris
artery
Descending genicular artery
25. Great saphenous vein, Medial and lateral circumflex femoral veins, Profunda femoris
vein, Direct muscular branches, Deep external pudendal vein.
26. Obturator nerve
27. Two hybrid/composite muscles of the adductor canal are:
i. Pectineus - obturator nerve and femoral nerve
ii. Adductor magnus - obturator nerve and tibial part of sciatic nerve.
28. Rider’s bone is when the rounded tendon of the adductor longus muscle gets calcified due
to friction with the horseback in horse riders.
29. The adductor muscles of the thigh, especially the gracilis m. is called the custodian of
virginity (custodes virginitatis) as they cause the adduction of the thigh.
30. Criteria for hamstring muscles:
i. All should arise from the ischial tuberosity
ii. All should insert into a bone of the leg
iii. All should be supplied by the tibial part of the sciatic nerve
iv. All should be flexors of the knee and extensors of the hip
31. Adductor magnus is the pseudo-hamstring muscle as it fulfils the criteria for hamstrings
partially. Only a part of the muscle arises from the ischial tuberosity and is supplied by
the tibial part of the sciatic nerve.
32. Structures passing through the greater sciatic foramen:
i. Piriformis m.
ii. Superior gluteal n. and vessels
iii. Inferior gluteal n. and vessels
iv. Nerve to quadratus femoris
v. Posterior cutaneous nerve of thigh
vi. Pudendal nerve
vii. Internal Pudendal artery
viii. Nerve to obturator internus

Structures passing through the lesser sciatic foramen:

i. Tendon of obturator internus

ii. Nerve to obturator internus
iii. Internal pudendal vessels
iv. Pudendal nerve
33. Lurching gait is due to the paralysis of the gluteus medius and gluteus minimus of the
other side causing the drop/sag on the healthy side when foot is off ground. This is called
the Trendelenburg’s sign.
34. Upper and outer region of the gluteus medius muscle is the preferred site for
intramuscular injection so as to not damage the sciatic nerve.
35. The key muscle of the gluteal region is the piriformis.
36. Oblique popliteal ligament is a remnant of the tendon of semimembranosus muscle.
37. Tibial/Medial collateral ligament resembles the degenerated tendon of the insertion of the
ischial head of the adductor magnus.
38. Sciatic bed is made of:
i. Body of ischium
ii. Obturator internus
iii. Quadratus femoris
iv. Adductor magnus
39. The side lateral to sciatic nerve is the safe side of the upper part of thigh.
The side medial to sciatic nerve is the safe side of the lower part of thigh.
40. All muscular branches of the tibial nerve arise from the lateral side of the sciatic nerve
except the nerve to gastrocnemius.
41. Sural nerve is the cutaneous branch of the tibial part of sciatic nerve.
42. Popliteal aneurysm refers to the aneurysm in the popliteal artery, as this artery is prone to
aneurysm than other arteries due to difference in wall composition, repetitive knee joint
usage or idiopathic.
Baker’s cyst is a cystic swelling in the popliteal fossa due to inflammation of the synovial
bursa.
43. Iliofemoral ligament/Bigelow’s ligament is the strongest ligament of both the hip joint
and the body. It prevents the trunk from falling backwards in the standing position.
44. Iliofemoral ligament/Bigelow’s ligament is an inverted Y-shaped ligament.
45. Factors that help in stabilizing the hip joint:
i. Depth of acetabulum and its narrowing towards the acetabular labrum.
ii. Three strong ligaments (iliofemoral, ischiofemoral and pubofemoral)
iii. Surrounding strong muscles
iv. Length and obliquity of the head of femur
46. Weaver’s bottom is the inflammation and enlarged subgluteal bursa (present between the
gluteus maximus and ischial tuberosity) in people whose profession includes sitting for
long periods, such as weavers.
47. The short rotators of the hip joint are:
i. Piriformis
 ii. Obturator externus
iii. Obturator internus
iv. Associated gemelli
v. Quadratus femoris
48. Most common acquired dislocation of the hip bone is posterior dislocation. But
congenital dislocation is more common in hip joint due to lose joint capsule at birth.
49. Coxa vara is the reduction in neck-shaft angle of the femur, such as in fracture of neck of
femur and Perthe’s disease.
Coxa valga is the increase in neck-shaft angle of the femur, such as in congenital
dislocation of the hip joint.
50. Perthe’s disease/Pseudocoxalgia refers to the destruction and flattening of the head of
femur along with an increased joint space.
51. Shenton’s line refers to a continuous curved line from the upper border of the obturator
foramen to the lower margin of the neck of the femur.
In case of fracture of neck of femur or dislocation of the hip joint, the curve is
disrupted.
Shoemaker’s line refers to a straight line that extends from the tip of the greater
trochanter to the anterior superior iliac spine and continues upward through the anterior
abdominal wall into the umbilicus.
In case of elevation of greater trochanter, such as in fracture of neck of femur, the
line passes below the umbilicus.
52. The tendon of soleus joins with the tendon of the two bellies of gastrocnemius to form the
tendocalcaneum that inserts into the posterior aspect of calcaneum bone.
53. The chief dorsiflexor of the foot is the tibialis anterior m. (the only m. of the anterior
compartment of foot that does not arise from the fibula)
54. Shin splits/Anterior Tibial Compartment Syndrome/Fresher’s syndrome is caused by the
overexertion of the muscles of the anterior compartment of the leg. The muscles swell up
within the tight compartment which may impede venous return and apply pressure on the
anterior tibial artery causing ischemia and pain.
55. The deep peroneal nerve is called the nervus hesitans as the nerve hesitates to cross from
the lateral to medial side of the anterior tibial artery in the middle 1/3 rd of the nerve. So, it
goes back to the lateral side of the artery.
Therefore, its final path looks like: the nerve lies lateral to the anterior tibial artery in the
upper 1/3rd and lower 1/3rd of the nerve and lies anterior to the artery in the middle 1/3rd.
56. Deep peroneal nerve ends in a pseudoganglion deep to the extensor digitorum brevis.
57. The dorsalis pedis artery is the chief artery for the dorsum of the foot.
58. The dorsalis pedis pulse can be felt between the tendon of the extensor hallucis longus
and the tendon of extensor digitorum longus.
59. Peroneus longus is the chief evertor of foot.
60. Talipes varus is the over inversion of foot due to injury to the superficial peroneal nerve
that causes the paralysis of the peroneus muscles, thereby allowing the overcompensation
of the invertor muscles.
Talipes valgus is the over extension of the foot due to the paralysis of the anterior tibial
muscles/invertors of foot, thereby allowing for the overcompensation of the evertor
muscles/peroneal muscles.
61. Although the muscles arise from various parts of the hip bone, the lower ends of the
sartorius, gracilis and semitendinosus attached at one point, the upper part of the medial
surface of the tibia. Therefore, they act as guy ropes, providing stability to the bony
pelvis on the femur.
62. Anserine bursitis refers to the inflammation of the anserine bursa due to repeated trauma
to the upper aspect of the medial surface of the tibia, thereby causing pain and swelling in
the region.
63. Structures passing deep to the flexor retinaculum: [The Doctors Are Not Here]
i. Tendon of tibialis posterior
ii. Tendon of flexor digitorum longus
iii. Posterior tibial artery and its branches
iv. Posterior tibial nerve and its terminal branches
v. Tendon of flexor hallucis longus
64. Tarsal tunnel syndrome refers to the compression of the tibial nerve deep to the flexor
retinaculum which is clinically presented as tingling, burning and pain in the sole of the
foot.
65. The soleus muscle is the peripheral heart as the muscles contains large venous sinuses
called soleal sinuses which communicated with superficial veins by perforating veins and
with deep veins directly, thus it can propel blood into deep veins directly.
NOTE: NOT TO BE CONFUSED BY CALF MUSCLE PUMP WHICH IS
GASTROCNEMIUS + SOLEUS TO FACILITATE VENOUS RETURN FROM THE
LOWER LIMB.
66. Tennis leg refers to a painful calf injury due to tear/strain of the medial head of
gastrocnemius at its musculo-tendinous junction due to overstretching, such as when a
tennis player overstretches during a difficult serve.
67. Work-horse of plantar flexion is soleus m.
68. 7-8 sesamoid bones are present in the following locations:
i. Patella – tendon of quadriceps femoris
ii. Fabella – behind knee joint; lateral head of gastrocnemius
iii. Pisiform – tendon of flexor carpi ulnaris
iv. 2 bones – tendon of flexor hallucis brevis
v. 1 bone – tendon of adductor pollicis
vi. 1 bone – tendon of peroneus longus
vii. Sometimes, 1 bone – tendon of flexor pollicis brevis
69. The long and slender tendon of plantaris m. is often mistaken for a nerve by first year
medical students. Thus, it is called freshman’s nerve.
70. Locking of knee is the medial rotation of the femur on the tibia during the terminal
phase of extension. It is brought about by the quadriceps femoris. The knee joint is
rigid, and all the ligaments are taut.
Unlocking of knee is the lateral rotation of the femur on the tibia during the initial
phase of flexion. It is brought about by the plantaris muscle. The knee joint can be
further flexed, and all the ligaments are relaxed.
71. The plantar aponeurosis represents the degenerated tendon of the plantaris muscle, which
was separated by the enlarging heel during evolution.
72. The plantar aponeurosis is stretched in standing position. Therefore, any profession that
involves a lot of walking or standing, the tearing or inflammation of the plantar
aponeurosis occurs, thereby causing pain and tenderness in the sole of the foot. This is
called plantar fasciitis.
- Repeated attacks of plantar fasciitis lead to calcification of the posterior
attachment of aponeurosis, leading to calcaneal spur.
73. The medial plantar nerve is called the preaxial nerve of foot and the lateral plantar nerve
is called the postaxial nerve of foot.
The median nerve is the preaxial nerve of palm and the ulnar nerve is the postaxial nerve
of palm.
74. Jogger’s foot/Medial plantar nerve entrapment is the compression of the medial plantar
nerve either deep to the flexor retinaculum, or deep to the abductor pollicis due to
repeated eversion of the foot. It is clinically presented as tingling, burning and numbness
on the medial aspect of the sole of the foot.
75. All structures, such as the main neurovascular bundle and tendons of long flexors enter
the sole of foot through the porta pedis except the tendon of peroneus longus, which
enters through a groove beneath the cuboid.
76. All interossei of sole are supplied by the lateral plantar nerve except those in the 4 th
intermetatarsal space, which are supplied by the superficial branch of the lateral plantar
nerve.
77. Keystone of the medial longitudinal arch is the talus as it lies at the summit of the arch.
78. Joints of medial longitudinal arch are: tendocalcaneonavicular joint and subtalar joints.
79. The main joint of the lateral longitudinal arch is the calcaneocuboid joint.
80. Intersegmental ties are both long and short plantar ligaments.
81. The flexor hallucis longus is the strongest and bulkiest muscle that supports the medial
longitudinal arch by supporting the calcaneum and talus and stretching the arch like a
string of a bow.
82. The cuboid is the keystone of the longitudinal arch.
83. Pes planus/Flat foot is the collapse/flattening of the medial longitudinal arch. Due to the
stretching of the plantar aponeurosis and spring ligament, the head of talus is lost and
pushed between calcaneum and navicular.
 Pes cavus/High arched foot is the exaggeration of the longitudinal arch of the foot usually
caused by a contracture of the transverse tarsal joint.
84. Club foot is a congenital or acquired clinical condition where the foot is twisted out of
shape or position. There are five types:
a. Talipes equinus (horse-like) – patient walks on toes with heel raised and foot is
plantar flexed
b. Talipes calcaneus – patient walks on heel with forefoot raised
c. Talipes varus – patient walks on outer border of foot, foot is inverted and
adducted
d. Talipes valgus - patient walk on inner border of foot, foot is everted and
abducted
e. Talipes equinovarus - foot is inverted, adducted and plantar flexed
85. Hammer toe is a deformity of the toe where the metatarsophalangeal joint and the distal
interphalangeal joint is hyper-extended, but the proximal interphalangeal joint is flexed.
This usually affects the 2nd and 3rd toes.
86. Rocker bottom foot is when the plantar concavity is replaced by plantar convexity. This
occurs in trisomy of 18 or Edward syndrome.
87. Knee joint is a modified hinge variety of synovial joints. It is modified as it undergoes
some degree of rotation during the flexion and extension of knee.
88. Factors conferring stability to the knee joint are:
a. The surrounding muscles and tendons are strong.
b. The lateral (fibular) and medial (tibial) collateral ligaments maintain side to side
stability
c. The cruciate ligaments maintain antero-posterior stability
d. The iliotibial tract help stability is partly flexed knee position
89. The ligamentum patellae is an extension of the tendon of the quadriceps femoris.
90. Fibular collateral ligament is a representation of the degenerated tendon of peroneus
longus.
91. The cruciate ligaments provide the antero-posterior stability to the knee joint. It prevents
the dislocation of the femur on the tibia or vice versa.
92. The anterior meniscofemoral ligament is called the ligament of Humphrey and the
posterior meniscofemoral ligament is called the ligament of Wrisberg.
93. Bucket handle tear refers to the longitudinal tearing of the menisci.
94. Housemaid’s knee is the inflammation of the prepatellar bursa, caused by friction of the
bursa on the patella when in contact with ground.
Clergyman’s knee is the inflammation of the subcutaneous infrapatellar bursa, caused by
the fiction of the bursa against the tibia, such as when kneeling down.
95. Unhappy triad of knee refers to the combination injury of the:
A. Tibial/medial collateral ligament
B. Anterior cruciate ligament
C. Medial meniscus
96. The anterior talofibular ligament is commonly torn in the ankle joint.
97. Pott’s fracture refers to the fracture dislocation of the ankle joint due to forced eversion.
A. Oblique fracture of the lateral malleolus of fibular – first grade
B. Longitudinal fracture of the medial malleolus – second grade
C. Fracture of posterior margin of lower end of tibia – third grade (trimalleolar
fracture)
98. Factors helping the venous drainage of lower limb:
a. Calf pump/peripheral heart squeezes the blood in the upward direction
b. Transmitted pulsations of adjacent arteries
c. Presence of valves in perforating veins to prevent backflow into superficial veins
d. Presence of valves in deep veins to only allow unidirectional upward flow of blood
e. Suction action of diaphragm during vis-a-tergo
f. Negative intrathoracic pressure, which becomes more negative on yawning and
inspiration
99. The great saphenous vein is the pre-axial vein of the lower limb.
100. The named perforators are:
A. Hunterian perforator – present in the Hunter’s canal/Adductor’s canal
B. Boyd’s perforator – present in the knee
C. Three medial ankle perforators of Cockett
D. One lateral ankle perforator
101. The incompetency of the valves is the basis for the dilatation and tortuosity of the
veins/ varicose veins. This commonly occurs in the superficial veins.
The incompetency of the perforating veins’ valves leaks high amount of pressure from
deep veins to the superficial veins, causing dilatation. Incompetency of the valves of the
superficial veins also increases pressure and therefore causes dilatation.
102. Elephantiasis refers to the massive oedema of the lower limb caused by the
blockage of the lymph vessels by microfilarial parasites.
103. Sciatica refers to a shooting pain along the distribution of the sciatic nerve
(buttocks, posterior thigh, lateral leg, dorsal foot) due to compression and irritation of
L4-S3 spinal nerve roots by herniated intervertebral discs.
Piriformis syndrome refers to if the sciatic nerve passes through the piriformis
muscle, it can cause compression of the nerve. It is clinically presented as pain in the
buttocks.
104. Morton’s metatarsalgia refers to the formation of a neuroma/nerve tumor of the
plantar digital nerves just before bifurcation at toe cleft. It is clinically presented as an
intermittent pain on the plantar aspect of foot.
105. Foot drop occurs due to injury to the common peroneal nerve that causes the
paralysis of the muscles of the anterior compartment of leg, i.e., the dorsiflexors of the
foot.
106. Buerger’s syndrome refers to the obliterative disorder of the lower limb arteries
distal to the knee, usually occurring in young male smokers. It is clinically presented as
intermittent claudication (muscle pain due to lack of oxygen), ischemia of digits and loss
of ankle pulses. It may be treated by stopping smoking and sympathectomy.
107. Lateral cutaneous nerve of thigh is the thickest cutaneous nerve in the body.
108. Flexor hallucis brevis
109. Middle genicular artery is a branch of the popliteal artery.
110. Root values of:
A. Sciatic nerve – L4 to S3
B. Femoral nerve – L2 to L4
C. Obturator nerve – L2 to L4
111. The saphenous nerve is the innervation of the first interdigital cleft.
112. Structures passing deep to extensor retinaculum:
A. Extensor hallucis longus
B. Extensor digitorum longus
C. Anterior tibial artery
D. Deep peroneal nerve
E. Peroneus tertius

ABDOMEN
1. McBurney’s point refers to the point at the junction of the medial 2/3rd and lateral
1/3rd of an imaginary line that extends from the umbilicus to the anterior superior iliac
spine. The base of appendix lies deep to this point, and thus pain during acute
appendicitis is felt at this point.
2. Events occurring at the transpyloric plane:
i. Pylorus of the stomach
ii. Fundus of the gall bladder
iii. Hila of both kidneys
iv. Origin of superior mesenteric artery
v. Lower end of spinal cord
3. Median umbilical ligament is a remnant of the urachus.
4. Ligamentum teres is a remnant of the left umbilical vein.
5. The two medial umbilical ligaments are remnants of the two umbilical arteries.
6. The umbilicus is called the hot bed of embryology because it is the ‘meeting point of
four embryological folds’.
7. The Holden’s line is the site of attachment of the Scarpa’s fascia, and this prevents the
collection of urine in the thigh in the event of deep injury to the urethra at the
perineum.
8. In portocaval obstruction, backflow of blood from liver may occur through the
paraumbilical veins of Sappey, thereby causing their gross distention and tortuosity.
This radiates out of the umbilicus in a spoke-like fashion called the caput medusae.
9. Cremasteric reflex is when the upper medial aspect of thigh is stroked/stimulated, the
cremaster muscle contracts reflexively, thereby causing an elevation of the testis.
10. Contents of the rectus sheath:
i. Two muscles - rectus abdominis, pyramidalis
ii. Two arteries – superior epigastric and inferior epigastric
iii. Two veins - superior epigastric and inferior epigastric
iv. Six nerves - lower 6 thoracic nerves (lower 5 intercostal nerves + subcostal
nerve) accompanied by the posterior intercostal vessels
11. Divarication of recti is the separation of the rectus muscles in elder multiparous
women with weak abdominal muscles due to the excessive stretching of the
aponeurosis forming the rectus sheath. When intraabdominal pressure increases (eg.
cough), wider separation occurs and hernial sac protrudes.
12. Anterior wall of femoral sheath is formed by downward prolongation of the fascial
transversalis, and the posterior wall of femoral sheath is formed by the downward
prolongation of the fascia iliaca.
13. Lateral compartment, Intermediate compartment and Medial compartment/Femoral
canal are the compartments of the femoral sheath.
14. Femoral hernia is more common is women because the femoral ring is larger due to
greater width of the female pelvis.
Also, pregnancy causes abdominal distension, which further weakens the femoral
ring.
15. Contents of the inguinal canal are:
Male - spermatic cord, ilioinguinal nerve
Female - round ligament of the uterus, ilioinguinal nerve
16. The ilioinguinal nerve is called the partial content of inguinal canal, as it does not
enter the canal via the deep inguinal ring. It enters through a slit between the external
and internal oblique muscles.
17. Coverings of spermatic cord:
i. Internal spermatic fascia
ii. Cremasteric fascia
iii. External spermatic fascia
 Contents of spermatic cord:

i. Vas deferens
ii. Artery to vas deferens
iii. Cremasteric artery
iv. Testicular artery
v. Pampiniform plexus of veins
vi. Lymphatics
vii. Genital branch of genitofemoral nerve
viii. Remains of processus vaginalis.
18. Indirect hernia is if the hernial sac enters through the deep inguinal ring. It can be
classified as congenital or acquired. It is more common in young adults, predisposed
if there is a partial patency of the processes vaginalis.
Direct hernia is if the hernial sac pushes through the posterior wall of the inguinal
canal instead of entering via the deep inguinal ring. It is more common in the elderly
due to weak abdominal muscles.
19. Canal of nuck refers to the persistence of processus vaginalis in the female inguinal
canal.
20. Coverings of the scrotum:
i. Skin
ii. Dartos muscle (replaces superficial fascia)
iii. External spermatic fascia
iv. Cremasteric muscle and fascia
v. Internal spermatic fascia

Coverings of the testis:

i. Tunica vaginalis
ii. Tunica albuginea
iii. Tunica vasculosa
21.

LAYER OF SKIN LAYER OF SCROTUM

SKIN SKIN
 SUPERFICIAL FASCIA DARTOS MUSCLE
EXTERNAL OBLIQUE MUSCLE EXTERNAL SPERMATIC FASCIA
INTERNAL OBLIQUE MUSCLE CREMASTERIC M. AND FASCIA
FASCIA TRANSVERSALIS INTERNAL SPERMATIC FASCIA
22. In hydrocele, fluid collection is seen in the tunica vaginalis layer of testis.
23. Varicocele may mostly occur on the left side due to:
i. Left testicular vein drains at a right angle in the left renal vein => high venous
pressure
ii. Left testicular artery compression due to the loaded constipated sigmoid colon
iii. Entry of left testicular vein may be blocked by the malignant growth of the
left kidney
24. Factors affecting the descent of testis:
i. Differential growth of the body wall
ii. Increased intraabdominal pressure and temperature
iii. Contraction of the gubernaculum (fibromuscular band extending from testis to
scrotum)
iv. Male sex hormones
v. Calcitonin gene-related peptide (CGRP)
25. Cryptorchidism refers to the incomplete descent of testis, where although it follows
the normal path, it doesn’t not reach the base of the scrotum.
Complications:
i. May undergo a malignant change
ii. May not produce spermatozoa
26. If a baby is diagnosed unilateral undescended testis, I would suggest for a surgical
procedure to bring the testis down into the scrotum before puberty.
27. The nine regions of the abdomen are:
i. Right hypochondrium (liver, gall bladder)
ii. Epigastric (stomach, pancreas, duodenum)
iii. Left hypochondrium (spleen, left colic flexure)
iv. Right lumbar (right kidney, right ureter, ascending colon)
 v. Umbilicus (Loops of small intestine, aorta, inferior vena cava)
vi. Left lumbar (left kidney, left ureter, descending colon)
vii. Right iliac fossa (caecum, appendix)
viii. Hypogastric (coils of small intestine, distended urinary bladder, enlarged
uterus)
ix. Left iliac fossa (sigmoid colon)
28. Primary retroperitoneal organs:
i. Kidney
ii. Suprarenal glands
iii. Ureters

Secondary retroperitoneal organs/mesentery lost during development:

i. Pancreas (except tail)

ii. Duodenum (except first 2cm)
iii. Ascending colon
iv. Descending colon
v. Caecum
vi. Upper 2/3rd Rectum
29. Derivatives of foregut:
i. Esophagus
ii. Stomach
iii. Upper half of duodenum

Derivatives of midgut:

i. Lower half of duodenum

ii. Jejunum
iii. Ileum
iv. Appendix
v. Caecum
vi. Ascending colon
vii. Right 2/3rd of transverse colon
 Derivatives of hindgut:

i. Left 1/3rd of transverse colon

ii. Descending colon
iii. Sigmoid colon
iv. Rectum
v. Upper part of the anal canal
30. The root of mesentery is attached to an oblique line on the posterior abdominal wall
extending from the duodeno-jejunal flexure to the ileo-caecal junction.
31. The hepatorenal pouch of Morison is the most dependent part of the peritoneal cavity
in supine position above the pelvic brim. Therefore, any fluid from various locations
tend to accumulate here.
32. The hepatorenal pouch of Morrison is the dependent pouch in supine position.
33. The stomach bed structures are:
i. Diaphragm
ii. Left kidney
iii. Left suprarenal gland
iv. Pancreas
v. Transverse mesocolon
vi. Spleen
vii. Splenic artery
viii. Left colic flexure
34. All stomach bed structures are separated from the stomach by lesser sac, except
spleen, which is separated by the greater sac of peritoneum.
35. Boundaries of foramen epiploicum:
i. Superior - caudate process of the caudate lobe of liver
ii. Inferior – First part of duodenum, horizontal part of hepatic artery
iii. Anterior – free border of lesser omentum containing bile duct, vertical part of
hepatic artery and portal vein
iv. Posterior – Inferior vena cava, Right suprarenal gland
36. The rectouterine pouch of Douglas is the most dependent part of the peritoneal cavity
in upright position and that of the pelvic cavity in the supine position. Thus, pus tends
 to collect here and form pelvic abscess. The pus can be drained either via rectum or
through the posterior fornix of vagina.
37. Due to neuromuscular incoordination of the myenteric plexus, the lower esophageal
sphincter fails to open, thereby causing the dilatation of the esophagus and thus,
dysphagia. This is called achalasia cardia.
38. If upon percussion, the Traube’s space appears dull, it indicates splenomegaly.
[Traube’s space is the space overlying the fundus of the stomach, which gives
tympanic sounds upon percussion.]
39. Gastric triangle refers to a triangular region of the stomach that is in contact with the
anterior abdominal wall. In complete esophageal obstruction, gastrostomy is
performed to feed the patient in this region.
40. The gastric canal of Magenstrasse allows for a rapid passage of swallowed liquid
along the lesser curvature of the stomach before it spreads to other parts of the
stomach. Therefore, the lesser curvature is more exposed to spicy food and irritable
liquids like alcohol, which makes it vulnerable to ulceration.
41. Gastric cancer is the malignant growth commonly occurring in the pyloric region
along the greater curvature of the stomach. These cancer cells usually spread through
the lymph nodes to the left supraclavicular nodes, which appears enlarged and
palpable. This is called the Virchow’s node, which may be the first sign of gastric
cancer called the Troisier’s sign.
42. Vagotomy refers to the surgical and selective removal of the vagus nerve in the
stomach to cure chronic gastric ulcers.
43. The Harris’ dictum of odd number 1,3,5,7,9,11 summarizes few spleen statistics like
the following:
i. Thickness – 1 inch
ii. Breadth – 3 inches
iii. Length – 5 inches
iv. Weight – 7 oz
v. Lies deep to – 9,10,11 ribs
44. The phrenicocolic ligament is called the easy chair of spleen as the spleen is held up
by this that prevents the downward extension during splenomegaly.
45. Gastrosplenic ligament and the lienorenal ligament
46. Contents of greater omentum:
i. Adipose tissue
ii. Milky spots of dense macrophage aggregation
iii. Right and left gastroepiploic artery
iv. Gastrosplenic ligament

Contents of lesser omentum:

i. Right and left gastric vessels

ii. Gastric lymph nodes
iii. Portal vein
iv. Bile duct
v. Hepatic artery
vi. Hepatogastric ligament
47. Splenomegaly is the enlargement of the spleen in a number of diseases such as
malaria, kala-azar, cirrhosis of liver.
Splenectomy is the surgical removal of spleen when either the spleen is ruptured,
accidentally nicked in surgery, or in certain blood diseases.
48.

SPLENOMEGALY HEPATOMEGALY
Left hypochondrium to right iliac fossa Right hypochondrium to right iliac fossa
Superior border has a notch that can be No notch is present
palpated – used for difference
No downward extension due to the Downward extension is present as no
presence of phrenicocolic ligament specific ligament is there

49. The spleen is mostly frequently ruptured organ in the abdomen and its pain is to the
left shoulder due to irritation of the left dome of diaphragm by splenic blood, which
is called the ‘Kehr’s sign’.
50. The bare area of liver is the triangular area located on the posterosuperior side, right
to the Inferior vena cava between the two layers of coronary and right triangular
ligaments. It is in direct contact with the diaphragm.
51. Couinaud’s segments refers to the special nomenclature in which the hepatic
segments are number I to VIII, where I to IV is in the liver hemiliver and V to VIII is
in the right hemiliver. Segment I correspond to the caudate lobe and the segment IV
corresponds to the quadrate lobe.
52. True ligaments:
i. Ligamentum teres hepatis
ii. Ligamentum venosum

False ligaments:

i. Falciform ligament
ii. Coronary ligament
iii. Right triangular ligament
iv. Left triangular ligament
v. Lesser omentum
53. The areas other than the bare areas of liver, caudate lobe, lesser sac, are covered by
peritoneum.
54. Ligamentum teres hepatis is the remnant of the obliterated left umbilical vein.
55. Ligamentum venosum is the remnant of the obliterated ductus venosum.
56. Structures entering the porta hepatis: hepatic artery, portal vein
Structures leaving the porta hepatis: hepatic ducts
[PORTA HEPATIS : VAD STRUCTURES]
57. For taking a biopsy of the liver, the needle is inserted in the midaxillary line in the 9th
or 10th intercostal space to avoid injuring the lung.
58. There are two surgical importance to the bare area of the liver:
i. Portocaval anastomoses of venous capillaries is present in the region of the
bare area of liver between the liver and the diaphragm, which become
functional under portal hypertension.
 ii. The bare area of the liver encloses the right extraperitoneal subphrenic space
which might be a site for pus collection leading to subphrenic abscess.
59. Factors that keep the liver in position:
i. Hepatic veins by connecting the liver to the inferior vena cava
ii. Intraabdominal pressure by the tone of the abdominal muscles
iii. Peritoneal ligaments that connect the liver to the posterior abdominal wall
60. The hepatocytes of the liver when undergoes necrosis, are often replaced by fibrous
tissue by the proliferation of peri-lobular connective tissue. This resulting hepatic
fibrosis is called the cirrhosis of liver.
Characterized by:
a. Jaundice due to obstruction of bile flow
b. Resistance to blood flow increases pressure inside the portal vein due to the
lack of the valves which causes portal hypertension
61. Components of the extrahepatic biliary apparatus are:
i. Right and left hepatic ducts
ii. Common hepatic duct
iii. Gall Bladder
iv. Cystic Duct
v. Bile Duct/Common bile duct
62. Contents of the cystohepatic triangle of Calot are:
i. Right hepatic artery
ii. Cystic artery
iii. Cystic lymph node of Lund
63. Cholecystitis refers to the inflammation of the gall bladder.
64. Cholelithiasis refers to the formation of stones in the gall bladder, usually due to
chronic cholecystitis.
Both usually occurs in 5Fs: fat, fertile, flatulous (accumulation of gas in the
alimentary canal) female of forty
65. Courvoisier’s law states the obstructive jaundice with distended and palpable gall
bladder is probably caused by an extrinsic constriction to the common bile duct, such
 as the carcinoma of the head of pancreas. [i.e., it is unlikely to be caused by gall
stones] and the vice versa is applicable.
66. Jaundice is the clinical condition where there is yellowish discoloration of the skin,
sclera and mucous membrane due to excessive bilirubin in the blood. It can of pre-
hepatic/hemolytic, hepatic/hepatocellular or post-hepatic/obstructive types.
67. Endoscopic retrograde cholangiopancreatography refers to the technique for
visualizing the hepatic and pancreatic ducts by the insertion of a catheter into the
hepatopancreatic ampulla and thereby the injection of the radiopaque contrast
medium under direct vision using fibre-optic endoscope.
68. Ligament of Treitz/Suspensory muscle of duodenum is a fibromuscular band that
suspends the duodeno-jejunal flexure from the right crus of the diaphragm, thereby
preventing its dragging down by the weight of the loops of the small intestine.
69. The common hepatopancreatic duct and the accessory pancreatic duct opens into the
second part of the duodenum.
70. The duodenal recesses are superior duodenal recess, inferior duodenal recess,
paraduodenal recess and retroduodenal recess.
71. Duodenal ulcer refers to the inflammatory erosion of the mucosa of the duodenum.
The first part of duodenum is often affected due to the end arteries supply and the
receival of acidic chyme from the stomach.
72. The duodenal cap refers to a triangular shadow on the first part of duodenum with a
well-demarcated base and a less distinct apex. This appears to be deformed if ulcer is
present in the first part under barium meal X-Ray.
73. Nutcracker’s syndrome is the compression of left renal vein due to small aortico-
mesenteric angle (<15 degree), which is clinically presented with hypertension due to
imbalance in RAAS mechanism, left side varicocele, and homeostatic imbalances.
74. Annular pancreas is a developmental anomaly in which a ring of pancreatic tissue
encircles the second part of duodenum.
75. The tail of pancreas contains the maximum number of islets of Langerhans per unit of
tissue.
76. The duct of Santorini is the accessory pancreatic duct that opens into the minor
duodenal papilla in the second part of the duodenum.
 The duct of Wirsung is the main pancreatic duct that opens into the major duodenal
papilla in the second part of the duodenum by forming the hepatopancreatic ampulla
of Vater.
77. Fusion of the dorsal and ventral bud of the pancreas and thereby the anastomoses of
their ducts form the main pancreatic duct. The ventral bud forms the proximal part
and the dorsal bud forms the distal part of the main pancreatic duct.
78. Carcinoma of the head of the pancreas refers to an abnormal growth that compresses
the bile duct leading to persistent obstructive jaundice, distention of the gall bladder
and compression of the portal vein.
79. The portal vein is formed by the union of the superior mesenteric vein and the splenic
vein behind the neck of pancreas, at the level of L2 vertebra.
80. The tributaries of the portal vein are:
i. Splenic vein
ii. Superior mesenteric vein
iii. Superior pancreaticoduodenal vein
iv. Left and right gastric veins
v. Cystic vein
vi. Paraumbilical veins
81. Sites of portocaval anastomoses are:
i. Umbilicus
ii. Lower end of Esophagus
iii. Anal canal
iv. Bare area of liver
v. Extraperitoneal surfaces of retroperitoneal organs
82. Portal hypertension refers to the obstruction of the portal vein or its branches that
increases the venous pressure. This causes the enlargement of the collateral channels.
83. The first part of the duodenum is the most vulnerable to duodenal ulcer due to the
entry of acidic chyme, and due its blood supply being of end arteries.
84. The third part of duodenum is most vulnerable to external injury because it gets
crushed between the vertebral column and the anterior abdominal wall.
85.
 JEJUNUM ILEUM
Long vasa recta Short vasa recta
2-3 arterial arcades 4-5 arterial arcades
Lesser fat => translucent More fat => opaque
Tongue like villi Finger like villi
Thicker diameter due to circular folds of Presence of lymph nodes called ‘Peyer’s
mucous membrane patches’

86. Peyer’s patches refer to the patches of aggregations of lymphoid follicles present in
the jejunum and ileum supervising the intestinal bacterial population and checking the
growth of pathogenic bacteria in the intestine.
87. Typhoid ulcers refer to the oval shaped ulceration of the Peyer’s patches in the
typhoid fever, which may perforate, but do not cause intestinal obstruction on healing.
Tubercular ulcers refer to circular ulceration of the Peyer’s patches that do cause
intestinal obstruction on healing due to fibrosis.
88. If the root of mesentery fails to attach to the posterior abdominal wall over its full
length, it allows the formation of an intraparietal pouch/sac called the mesenteric
parietal hernia of Waldeyer.
89. Meckel’s diverticulum refers to the persistent proximal part of the vitello-intestinal
duct, whose inflammation brings about symptoms similar to that of acute
appendicitis.
90. The peculiarities of the large intestine are:
i. Taenia coli – three ribbon-like bands of the longitudinal muscle coat of the
colon and caecum.
ii. Appendices epiploicae – small bags of visceral peritoneum that are filled with
fat and attached to the taenia coli.
iii. Sacculations/Haustration – dilatations in the wall of the colon and caecum.
91. The types of caecum are:
i. Conical shape/foetal type – conical in shape
ii. Quadrate shape – infantile
iii. Normal type – right saccule is larger than the left saccule
 iv. Exaggerated type – the right saccule is extremely big with an absent left
saccule
92. The commonest position of the vermiform appendix is retroceacal/retrocolic 12 ‘o’
clock position.
The most dangerous position of the vermiform appendix is pre-ileal splenic 2 ‘o’
clock as infection from the appendix spreads into the general peritoneal cavity.
93. Appendicitis refers to the inflammation of the vermiform appendix, commonly
occurring due to its lumen obstruction by fecaliths or oedema.
94. Psoas test – when the appendix is in the retrocecal position, upon its inflammation, it
can irritate the right psoas major m. The psoas test is when the right leg is forcefully
extension, the right iliac fossa aches.
Obturator test – when the appendix is pelvic in position, upon its inflammation, it can
irritate the obturator internus m. The obturator test is when the right thigh is flexed
and medially rotated, the lower abdomen aches.
95. The point of origin of the last sigmoidal branch of the inferior mesenteric artery is
called the critical point of Sudeck.
96. Hirschsprung disease, aka congenital megacolon, occurs due to failure of the neural
crest cells to migrate and form the myenteric plexus in the sigmoid colon and rectum
during embryonic development. This causes the absence of peristalsis, thereby
causing the dilatation of the proximal part of the colon due to fecal retention.
97. Volvulus refers to the rotation of the gut either clockwise or anticlockwise on the axis
of the mesentery. The sigmoid colon is very susceptible to this due to the extreme
mobility of its mesentery.
Intussusception refers to the clinical condition in which the proximal part of the
bowel invaginates into the lumen of an adjoining distal part of the colon.
98. Diverticulosis refers to the clinical condition in which herniation of the lining
mucosa occurs through the circular muscle between the taenia coli. It most
commonly occurs in the sigmoid colon. It occurs where the circular muscle is the
weakest, i.e., where the blood vessels pierce.
99. The splenic flexure is the most vulnerable site to ischemia due to its limited collateral
network.
100. The sigmoid colon is the most common site for intestinal diverticulosis.
101. The most common site for intussusception is ileocolic.
102. The renal hilar structures from before backwards are:
i. Renal vein
ii. Renal artery
iii. Renal pelvis
103. There are 4 capsules/coverings to the kidney:
i. True capsule/Fibrous capsule
ii. Perinephric/perirenal capsule
iii. False capsule/Renal fascia
iv. Paranephric/pararenal capsule
104. A functional avascular junction between the areas supplied by the anterior
division and posterior division of the renal artery is called the Brodel’s line. It lies on
the posterior aspect of the kidney, at the junction of the medial 2/3rd and lateral 1/3rd.
It is a suitable site for surgical incision during nephrolithotomy (removal of renal
stones).
105. The excreting part, consisting of nephrons, develops from the metanephros.
The collecting part, consisting of collecting tubules, collecting duct, minor and major
calyces, renal pelvis, and the ureter, develops from the ureteric bud.
106. The most common abdominal malignancy in children above 1 year is
nephroblastoma/Wilm’s tumor which arises from the embryonic nephrogenic tissue.
107. If the continuity of the lumens of the nephron and the collecting part has failed to
establish, congenital polycystic kidneys occur. This is due to the fact that the
glomeruli continue to excrete urine, which has no outlet, hence accumulating in the
tubules, thereby forming cystic enlargements.
108. Horseshoe kidney is a congenital anomaly created due to the fusion of both the
lower poles of the kidneys.
109. Transplantation of kidney is done is 5 steps:
i. Placing the donor kidney retroperitoneally in the iliac fossa of the
recipient
 ii. The hilum of the donor kidney is placed parallel to the external iliac
vessels
iii. Renal artery of the donor kidney is anastomosed end to end with the
external iliac artery
iv. Renal vein of the donor kidney is anastomosed end to end with the
external iliac vein
v. Ureter is implanted into the urinary bladder in a process called
ureterocystostomy.
110. The morris parallelogram refers to the quadrilateral drawn around the kidney to
identify the surface markings of it on the back.
It vertically extends from T11 to L3 vertebrae, horizontally, from 2.5cm away from
the posteromedian plane to 9cm away from the posteromedian plane, such that the
hilum of each kidney lies approximately at the lower border of L1 vertebra.
111. Nutcracker’s syndrome is the compression of the left renal vein due to very small
aortico-mesenteric angle (<15 angle), which is clinically presented as hypertension
due to interference in RAAS mechanism, homeostatic imbalances, and left side
varicocele.
112. The three anatomical constrictions of ureter are:
i. At the pelvo-ureteric junction
ii. At the pelvic brim where it crosses the common iliac artery
iii. At the uretero-vesical junction

There are two more surgical constrictions:

i. At the juxtaposition of the vas deferens/broad ligament

ii. At the ureteric opening/orifice
113. Blood supply to the suprarenal gland:
i. Superior suprarenal artery, br. of inferior phrenic artery
ii. Middle suprarenal artery, br. of abdominal aorta
iii. Inferior suprarenal artery, br. of renal artery
114. Addison’s disease is the hyposecretion of glucocorticoids. It is clinically
presented as hypotension, hyperpigmentation, anorexia, hypoglycemia.
 Cushing’s syndrome is the hypersecretion of glucocorticoids. It is clinically
presented as obesity, moon face, reddish-purple striae in the abdomen, hypertension.
Pheochromocytoma refers to the tumor of the adrenal medulla. It is clinically
presented with headache, chronic hypertension, palpitation, and excessive sweating.
115. Ureteric calculus refers to the presence of a stone in the lumen of the ureters. It
produces violent muscular contractions, that causes severe spasmodic pain called
renal colic.
116. Tubercular infection of the vertebrae of the thoracolumbar region leads to the
destruction of the bodies, leading to the formation of an abscess. This abscess cannot
spread anteriorly due to the presence of anterior longitudinal ligament. Therefore,
this abscess moves laterally into the psoas sheath, thus forming the psoas abscess.
This abscess may continue to move along the psoas muscles under the inguinal
ligament into the femoral triangle, causing a small swelling in the region.
117. Aortic aneurysm refers to the localized dilatation of the aorta most commonly due
to atherosclerosis, which weakens the arterial wall.
It is clinically presented as a pulsatile and expansile abdominal mass superior and
left to the umbilicus.
118. There are two openings in the pelvic diaphragm, which are:
i. Hiatus urogenitalis – triangular gap between the anterior fibers of the two
levator ani m. Transmits the urethra in male, urethra and vagina in female.
ii. Hiatus rectalis – round gap between the perineal body and the
anococcygeal raphae. Transmits the anorectal junction.
119. Superficial perineal pouch contains:
i. Root of penis and clitoris
ii. Urethra
iii. Bulbospongiosus m. covering of the bulb of penis + bulbospongiosus m.
covering of vestibule in female
iv. Ischiocavernous muscle on each side for covering of the crura of penis and
clitoris
v. Ducts of bulbourethral glands in male, and that of Bartholin’s glands in
female
 vi. Superficial transverse perineal muscles
vii. Branches of internal pudendal artery
viii. Branches of the pudendal nerve

Deep perineal pouch contains:

i. Sphincter urethrae
ii. Deep transverse perineal muscles
iii. In males, two bulbourethral glands of Cowper
iv. In female, the urethra and vagina
v. Branches of the internal pudendal artery (art. to penis and clitoris)
vi. Branches of the pudendal nerve (dorsal nerve of penis and dorsal nerve of
clitoris)
120. The 10 muscles that converge into the perineal body are:
i. Two superficial transverse perineal muscles
ii. Two deep transverse perineal muscles
iii. Two levator ani muscles
iv. One sphincter ani muscle
v. Two bulbospongiosus muscles
vi. One longitudinal muscular coat of anal canal
121. The contents of the pudendal canal/Alcock’s canal are:
i. Pudendal nerve, and it divides within the canal into the dorsal nerve of penis
and the perineal nerve
ii. Internal pudendal vessels
122. Supports of the urinary bladder are the true ligaments, which are:
i. Two posterior ligaments
ii. Median umbilical ligament (remnant of the urachus)
iii. Two lateral ligaments
iv. 4 Puboprostatic ligaments (medial 2 and lateral 2)

False ligaments are simply peritoneal folds and have no supportive functions:

i. Two false posterior ligaments

ii. Two false lateral ligaments
 iii. Two medial umbilical folds
iv. One median umbilical fold
123. The true posterior ligaments contain the vesical venous plexus.
124. The superior boundary of the trigone of bladder is formed by the inter-ureteric
ridge/Bars of Mercier, which connects the two ureteric orifices.
The lateral boundaries of the trigone of bladder is formed by the uretero-urethral
ridges/Bell’s bars, which connects the ureteric orifices to the urethral opening.
125. The vesical venous plexus drains into the internal iliac veins by communicating
this way:
a. In males, it communicates with the prostatic venous plexus
b. In females, it communicates with the veins present at the base of the broad
ligament
126. The parts and their shapes of the male urethra are as follows:
i. Prostatic part – fusiform in shape
ii. Membranous part – star-shaped
iii. Spongy/penile part – trapezoid shape in bulb, transverse lit in the body and
vertical slit at the external urethral orifice.
127. The prostatic urethra is the widest and the most dilatable part of the male urethra.
128. The membranous urethra is the narrowest and least dilatable part of the male
urethra with the exception of the external urethral orifice.
129. Urinary tract infections are more common in females due to the shorter urethra
whose orifice is present very close to the vaginal and anal orifice.
130. The posterior lobe of the prostate gland is more common for carcinoma, and the
median lobe of the prostate gland is more common for hypertrophy.
131. The prostatic venous plexus lies in between the true and false capsule, therefore
the enucleation of the prostate lies deep to the capsules, unlike the thyroid gland.
132. Supports of the prostate gland are as follows:
i. Urogenital diaphragm
ii. Two pairs of puboprostatic ligaments
iii. Rectovesical fascia of Denonvilliers – fascial septum between the prostate
gland and ampulla of the rectum
133. The structures present within the prostate gland are:
i. Prostatic urethra
ii. Ejaculatory ducts
iii. Prostatic utricle (remnants of the Mullerian ducts)
134. TURP, aka trans urethral resection of the prostate, refers to the surgical removal
of the prostate gland due to median lobe hypertrophy/enlargement. It is done when
the following symptoms are presented:
i. Incomplete voiding sensation
ii. Difficulty in micturition
iii. Frequent voiding
135. The ovarian ligaments are:
i. Ovarian ligaments – attaches the lower end of ovaries with the uterus
ii. Suspensory ligament of the Ovary – attached the superior end of the ovaries
with the lateral abdominal wall. It contains the ovarian vessels, nerves, and
lymphatic vessels.
136. Ovarian torsion refers to the twist of the ovary on its supportive muscles most
commonly due to long mesovarium and suspensory ligaments of ovary.
Ovarian cysts refer to fluid filles sacs in or on the ovary. Small cysts are usually
formed due to the developmental arrest of follicles. Large cysts are formed by corpus
luteum of pregnancy.
137. Parts of the uterine/fallopian tube are:
i. Infundibulum – funnel shaped lateral most part containing fimbriae
ii. Ampulla – site of fertilization and is the longest and widest part
iii. Isthmus – narrowest part
iv. Intramural/Interstitial part – part of the fallopian tube that traverses the uterine
wall at the junction of the fundus with the body
138. Ectopic pregnancy refers to the implantation of the fetus outside the uterus. It is
commonest in the uterine tube and is associated with intraperitoneal hemorrhage that
occurs due to rupture of the tubes due to enlarging conceptus.
139. Salpingitis refers to the inflammation of the uterine tube/salpinx. It is one of the
commonest cause of tubal block and may cause secondary sterility in females.
140. Anteversion refers to the position of the long axis of cervix that is bent forward
on the long axis of vagina at around 900.
Anteflexion refers to the position of the long axis of uterus that is bent forward
on the long axis of cervix at an angle of 1700.
141. Parts of the broad ligaments of uterus:
i. Mesosalpinx – between the fallopian tube and the ovary
ii. Mesometrium
iii. Mesovarium
iv. Suspensory ligament of Ovary/Infundibulopelvic ligament

Contents of the broad ligaments of uterus:

i. One tube
- Fallopian tube
ii. Two arteries
- Uterine artery
- Ovarian artery
iii. Two ligaments
- Ovarian ligament
- Round ligament of Uterus
iv. Two nerve plexus
- Uterovaginal plexus
- Ovarian plexus
v. Three embryological remnants:
- Epoophoron/Gartner’s duct
- Paraoophoron
- Vesicular appendices
vi. Other structures
- Lymph vessels and nodes
- Fibroareolar tissue
142. True ligaments of the uterus:
i. Transverse cervical ligament (Mackenrodt’s ligament)
 ii. Pubocervical ligament
iii. Uterosacral ligament
iv. Round ligament of Uterus (Ligamentum teres uteri)
False ligaments of the uterus:
iv. Broad ligaments of the uterus
v. Rectovaginal fold/posterior ligaments
vi. Uterovesical fold/anterior ligaments
vii. Rectouterine fold
143. Primary support of the uterus:
i. Muscular
- Pelvic diaphragm
- Perineal body
- Urogenital diaphragm
ii. Visceral
- Urinary bladder
- Vagina
- Uterine axis
iii. Fibromuscular/true ligaments
- Round ligament of the uterus
- Pubocervical ligament
- Uterosacral ligament
- Transverse cervical ligament

Secondary support of the uterus/False ligaments

i. Broad ligaments of the uterus

ii. Anterior ligament/Uterovesical fold
iii. Posterior ligament/Rectovaginal fold
144. Cervical carcinoma is the cancer of the cervix. It is the most common cancer in
females. It spreads directly to adjacent structures and metastasizes via lymphatics to
the pelvic lymph nodes, then to pre-aortic and para-aortic lymph nodes.
 145. Weak muscular support such as pelvic diaphragm, perineal body and urogenital
diaphragm and broad ligament may lead to the prolapse of uterus.
Tightening of the Mackenrodt’s/Transverse cervical ligament is done to treat
prolapsed uterus.
146. Vaginitis refers to the infection of the vagina which is uncommon is healthy adult
females as vagina is self-sterilizing due to its 4.5/acidic pH. This may occur in kids as
the mechanism has not evolved.
147. Culdocentesis refers to the clinical procedure in which a needle is inserted
through the posterior fornix of the vagina into the rectouterine pouch of Douglas to
drain the pus or excess fluid accumulated here in conditions such as pelvic
inflammatory diseases, bleeding due to fallopian tube damage, etc. It is now used to
collect oocytes for IVF.
148. The rectum begins as a continuation of the sigmoid colon at the level of S3 and
terminates into the anal canal a little below the tip of coccyx.
149. There are two anteroposterior curvatures and three lateral curvatures. They are as
follows:
A. Anteroposterior curvatures:
i. Sacral curvature – concavity on the anterior surface due to the concavity between the
sacrum and the coccyx
ii. Perineal curvature – forward bend at the anorectal junction which is maintained by
the levator ani’s puborectal sling
B. Lateral curvatures:
i. Upper lateral curvature – convexity to the right side
ii. Middle lateral curvature – convexity to the left side
iii. Lower lateral curvature – convexity to the right side
150. Houston’s valves/Permanent folds are semilunar transverse folds of the mucous
membrane against the concavities of the lateral curvatures of the rectum.
They are always present and become more prominent on distension. They are four in
number.
151. The third valve of Houston is called the Nelaton’s valve.
152. The superior rectal artery is the chief artery of the rectum.
153. The third valve of Houston/Nelaton’s valve projects from the anterior and the
right wall causes a hinderance for the passing of an instrument from the anus.
Therefore, the cannula for rectal washing is passed in the left lateral position of
patient to prevent injury to the third valve and cause unnecessary discomfort to the
patient.
154. The supports of the rectum are:
i. Pelvic diaphragm
ii. Lateral ligaments of the rectum
iii. Fascia of Waldeyer - connective tissue behind the rectum
iv. Rectovesical Fascia of Denonvilliers
v. Reflection of the pelvic fascia
155. The prolapse of rectum refers to the protrusion of the rectum through the anus. It
might either be incomplete, where only the mucous membrane of the rectum
prolapses due to imperfect support of the rectal mucosa by the submucosa, or it may
be complete where the entire thickness of the rectum prolapses due to the inadequate
fixation of rectum or the laxity of the pelvic diaphragm.
156. The anal canal beings at the anorectal junction and moves downwards and
backward and ends at the anal orifice which is in front of the tip of the coccyx.
157. The external anal sphincter has three parts which cover the entire length of the
anal canal. The three parts are: i. Deep ii. Superficial iii. Subcutaneous
158. The pectinate line is the line that divides the anal canal into its upper and lower
parts.
It represents the embryological site of attachment of the anal membrane.
159. The dentate line/wavy pectinate line is called the ‘watershed line of anal canal’ as
it separates the upper part of the anal canal that drains into the internal iliac lymph
nodes and the lower part of the anal canal that drains into the superficial inguinal
lymph nodes.
160. External hemorrhoids are painful than internal hemorrhoids as the mucous
membrane/skin covering the external piles is supplied by somatic nerves but the
mucous membrane covering internal piles is supplied by the autonomic nervous
 system. [Somatic nerves carry pain sensation, sympathetic & parasympathetic/ANS
do not carry those]
161. Fistula in the anorectal canal is caused due to the rupture of an abscess around the
canal.
162. Fissure in the anorectal canal is caused due to the rupture of one of the anal valves
of Morgagni by the passage of hard fecal matter. It is very painful due to the somatic
innervation of the lower mucous membrane.
163. Primary piles are located in the left lateral [3 ‘o’ clock], right posterior [7 ‘o’
clock] and right anterior [11 ‘o’ clock] aspects of the anal columns.

HEAD AND NECK

1. The superficial temporal artery’s pulsations can be clearly felt in front of the tragus of
the ear, thereby providing help to anesthetist’s as radial pulse may not be available. It is
also called Anesthetist’s artery.
2. Boundaries of the McEwen’s triangle:
i. Above by supramastoid crest
ii. In front by posterosuperior margin of external auditory meatus
iii. Behind by a vertical tangent to the posterior margin of the external auditory
meatus

Contents:

i. Mastoid antrum lies 2.5cm deep (air space communicating with the temporal
bone)
ii. Supremeatal spine of Henle may be present
3. The anterior division of the middle meningeal artery lies deep to the pterion, which may
rupture following a blow/fracture to the pterion. This causes an extradural hematoma
(clot formation between the brain and the dura mater) and if the clot is big, it may even
compress the brain.
4. Nerves related to the spine of sphenoid are:
i. Auriculotemporal nerve on the lateral side
 ii. Chorda tympani on the medial side
5. Foramen lacerum
i. Internal carotid Artery
ii. Emissary veins
iii. Greater petrosal nerve
iv. Meningeal branch of ascending pharyngeal artery

Foramen magnum

i. Medulla oblongata along with its meninges

ii. Two posterior spinal arteries
iii. Anterior spinal artery
iv. Two vertebral arteries
v. Spinal roots of two accessory nerves

Foramen ovale [MALE]

i. Mandibular nerve
ii. Accessory middle meningeal artery
iii. Lesser petrosal nerve
iv. Emissary veins

Foramen spinosum

i. Middle meningeal artery

ii. Nervus spinosus

Incisive foramen

i. Nasopalatine nerve
ii. Sphenopalatine artery

Greater palatine foramen

i. Greater palatine nerve

ii. Greater palatine vessels

Stylomastoid foramen
 i. Seventh cranial/Facial nerve
ii. Stylomastoid artery

Hypoglossal canal

i. Twelfth cranial/Hypoglossal nerve

ii. Meningeal branch of Ascending meningeal artery

Arnold’s canal/Mastoid canaliculus

i. Auricular branch of Vagus nerve (Alderman’s nerve/Arnold’s nerve)

Carotid canal

i. Internal carotid artery

ii. Internal jugular vein
iii. Internal carotid venous plexus
iv. Emissary vein

Superior Orbital Fissure

i. Oculomotor nerve
ii. Trochlear nerve
iii. Ophthalmic nerve
iv. Abducens nerve
v. Ophthalmic veins
vi. Sympathetic fibres from cavernous plexus
vii. Lacrimal artery

Incisive foramen

i. Nasopalatine nerve
ii. Sphenopalatine artery
6. Anterior fontanelle allows access to the superior sagittal sinus. An abnormal depression
of the membrane/fontanelle indicates dehydration.
7. Layers of the scalp are:
i. Skin
 ii. Connective Tissue (superficial fascia)
iii. Aponeurotic layer (occipitofrontalis muscle and its aponeurosis)
iv. Loose areolar tissue
v. Pericranium
8. The first three layers of the scalp are inseparable and therefore are called the surgical
layers of the scalp.
9. The layer of loose areolar tissue is called the dangerous layer of the scalp and blood and
pus tends to easily collect here. They might travel via the emissary veins into the
intracranial dural venous sinuses, thereby causing its thrombosis. This can be fatal.
10. Safety valve hematoma refers to the collection of blood in the fourth layer of scalp,
and only when this subaponeurotic space is fully filled with blood, signs of cerebral
compression, as in the cases fracture of cranium, develop.
Cephalhematoma refers to the subperiosteal collection of blood. As the periosteum is
loosely bound to the skull bones, except at the sutures, the hematoma takes the shape of
the skull bones and is bounded by the sutural lines, therefore, making it well-defined.
Cephalhydrocele refers to the subaponeurotic collection of cerebrospinal fluid.
Caput succedaneum refers to the subcutaneous edema at the presenting part of the
head during vaginal delivery. It occurs due to the interference of the venous return,
making the affected parts feel soft.
11. The temporal fascia is used as a graft by ENT surgeons for
tympanoplasty/myringoplasty (i.e., repair of the tympanic membrane). The temporal
fascia is the thickest fascia in the body.
12. Contraction of the orbicularis oculi m. causes the pulling of the skin of forehead, temple
and cheek towards the lateral aspect of the eye, forming radiating skin folds from the eye
that resemble the feet of crows. This is called crow’s feet.
13. The muscles forming the modiolus are:
i. Levator anguli oris
ii. Zygomaticus major
iii. Risorius
iv. Buccinator
v. Depressor anguli oris
14. Grinning muscle – Risorius
Bowing/whistling muscle – Buccinator
15. Pes anserinus refers to the goose-foot shape distribution of the five terminal branches of
the facial nerve, which are; Temporal, Zygomatic, Buccal, Mandibular and Cervical.
16. Bell’s palsy refers to the lower motor neuron paralysis of the facial muscles due to the
compression of the facial nerve in the facial canal near the stylomastoid foramen.
Clinically characterized by loss of forehead wrinkles, accumulation of food in the
vestibule of mouth, drooling from lateral angle of mouth, epiphora.
17. Tic douloureux refers to trigeminal neuralgia, where paroxysmal (sudden increase in
symptoms) of lancinating (sharp, stabbing) pain over the regions supplied by the
trigeminal nerve.
18. The retromandibular vein is formed by the joining superficial temporal vein and
maxillary vein.
The anterior division of the retromandibular vein joins with the facial vein to form the
internal jugular vein.
The posterior division of the retromandibular vein joins with the posterior auricular vein
to form the external jugular vein.
19. The dangerous area of face refers to the lower part of nose, upper lip and adjoining
cheek.
If a septic emboli is located in this region, it may spread in retrograde direction by the
movements of the facial muscles and finally reach the cavernous sinus via the pterygoid
venous plexus. This may cause meningitis or cavernous sinus thrombosis.
This can easily occur as the facial vein does not have valves and it lies directly on the
facial muscles.
20. The parasympathetic/secretomotor supply of lacrimal gland is as follows:
A. Preganglionic fibers – Lacrimatory nucleus in pons -> Nervus intermedius ->
Geniculate ganglion -> Greater petrosal nerve -> Pterygopalatine ganglion.
B. Postganglionic fibers – Pterygopalatine ganglion -> Zygomatic nerve ->
Zygomaticotemporal nerve -> Lacrimal nerve -> Lacrimal gland.
21. Platysma represents panniculus carnosus of animals.
 22. Nerve point of the neck refers to the junction of the upper third and middle third of the
posterior border of the sternocleidomastoid where four cutaneous nerves, namely lesser
occipital, great auricular, transverse cervical and supraclavicular, and spinal
accessory nerve emerges.
23. The intermediate supraclavicular nerve pierces the clavicle through and through.
24. The external jugular vein is adherent to the deep fascia and pierces through the investing
layer of deep cervical fascia. This means that if the external jugular vein is cut at this
level, its walls cannot collapse.
During inspiration, due to negative intrathoracic pressure, air enters into its lumen,
causing venous air embolism, it may cause death subsequently.
25. The right external jugular vein is often used for central venous cannulation as it is in
direct line with the superior vena cava. The manipulation of cannula might be difficult
due to the presence of valves and the variable size of the lower end of the vein.
26. The investing layer of the deep cervical fascia is called as the layer of two’s because it
presents everything in 2s. For example,
i. The fascia covers 2 muscles – trapezius and sternocleidomastoid
ii. The fascia splits to enclose 2 glands – submandibular and parotid
iii. The fascia encloses 2 spaces – suprasternal space of Burns and supraclavicular
iv. The fascia roofs 2 triangles – anterior and posterior triangle
27. The parotido-masseteric fascia is a modification of the investing layer of the deep
cervical fascia and covers the superficial surface of the parotid gland.
28. The modifications of the deep cervical fascia are as follows:
i. Parotido-masseteric fascia
ii. Stylomandibular ligament

The modifications of the prevertebral fascia are as follows:

i. Axillary sheath
ii. Fascial carpet of posterior triangle

The modifications of the pre-tracheal fascia are:

i. Suspensory ligament of Berry

29. The ligament of Berry is a modification of the pretracheal fascia. (it connects the thyroid
cartilage to the cricoid cartilage)
30. Contents of the carotid sheath are:
i. Common carotid artery and internal carotid artery
ii. Internal jugular vein
iii. Vagus nerve
31. Wry neck/Torti collis is the clinical condition of the spasm of the sternocleidomastoid
and the trapezius which are supplied by the spinal accessory nerve. This causes the head
to bend one way and the chin to point to the opposite side.
i. Spasmodic torti collis – pains repeated spasms of the muscles due to exposure to
cold or maladjustment of pillow during sleep
ii. Reflex torti collis – irritation of the spinal accessory nerve
iii. Congenital torti collis – due to birth trauma
32. Superficial relations to the sternocleidomastoid are:
i. Skin
ii. Platysma
iii. Cutaneous nerves:

Great auricular

Lesser occipital

Medial supraclavicular

Transverse cervical

iv. External jugular vein

v. Superficial cervical lymph nodes
vi. Parotid gland
33. The fascial carpet of the floor of the posterior triangle is formed by the prevertebral
layer of the deep cervical fascia, which covers the muscular floor of the posterior
triangle.
34. The posterior triangle is divided into two by the inferior belly of the omohyoid.
35. The brachial plexus can be blocked by injecting local anesthetics between the first rib
and the skin above the clavicle to perform surgeries on the upper limb.
[The brachial plexus is located in the region from the posterior border of the
sternocleidomastoid at the level of cricoid cartilage to the midpoint of the superior aspect
of the clavicle.]
36. Structures present on the anterior median region of the neck:
i. Symphysis menti
ii. Fibrous raphae
iii. Hyoid bone
iv. Median thyrohyoid ligament
v. Upper border of thyroid cartilage
vi. Angle of the thyroid cartilage/laryngeal prominence/Adam’s apple in men
vii. Median cricothyroid ligament
viii. Cricoid cartilage
ix. First tracheal ring
x. Isthmus of the thyroid gland
xi. Inferior thyroid veins
xii. Thyroidea ima artery
xiii. Jugular venous arch
xiv. Suprasternal notch
37. The anterior triangle is divided by the digastric muscle and the superior belly of the
omohyoid m. These are:
i. Submental triangle
ii. Digastric triangle
iii. Carotid triangle
iv. Muscular triangle
38. The strap muscles of the neck are the infrahyoid muscles of the neck. They are 4 paired
muscles:
i. Sternothyroid
ii. Sternohyoid
iii. Thyrohyoid
iv. Omohyoid
39. Cisternal puncture refers to the insertion of needle onto the midline of the spine of the
axis vertebra to take out CSF sample when lumbar puncture fails. The needle pierces 2
inches into the posterior atlanto-occipital membrane, but utmost care should be taken as
the medulla lies just 1 inch anterior to this.
40. Hangman’s fracture is a severe extension injury of the neck which is characterized by
the fracture of the pedicles of the axis vertebra. It is called so, because during
execution/death by hanging, the knot of the Hangman’s rope causes sudden severe
extension injury to the neck.
NOTE: The vertebral canal enlarges in this case as the body of axis is displaced forward,
therefore the spinal cord is rarely compressed.
41. Structures present within the parotid gland are:
i. Facial nerve
ii. Retromandibular vein
iii. External carotid artery
42. Pleomorphic adenoma refers to the mixed parotid tumor, which is a slow-growing
lobulated pain-less tumor of the large superficial part of the parotid gland.
43. Structures pierced by the parotid duct are:
i. Buccal pad of fat
ii. Buccopharyngeal fascia
iii. Buccinator m.
iv. Buccopharyngeal membrane
Opening of the parotid duct is: opens into the vestibule of mouth opposite to the crown of
the upper 2nd molar tooth.
44. The secretomotor/parasympathetic pathway of parotid secretion is as follows:
A. Preganglionic fibers – Inferior salivatory nucleus in the medulla ->
Glossopharyngeal nerve -> Jacobson’s nerve/tympanic branch of the
glossopharyngeal nerve -> Tympanic plexus -> Otic ganglion
B. Postganglionic fibers – Otic ganglion -> Auriculotemporal nerve -> Parotid
gland
45. Frey’s syndrome/Auriculotemporal nerve syndrome – penetrating wounds of the parotid
gland can damage the auriculotemporal and greater auricular nerves. They contain
sympathetic, parasympathetic and secretomotor nerves. During regeneration of these
nerves, the secretomotor nerves start supplying the cutaneous pain, touch and
temperature, and the sympathetic nerves start supplying sweat glands and blood
vessels. Therefore, when a stimulus intended for salivation occurs, there is
cutaneous hyperesthesia, pain, redness, sweating and flushing.
46.

ANTERIOR BELLY OF DIGASTRIC POSTERIOR BELLY OF DIGASTRIC

M. M.
Unipennate Bipennate
Developed from the 1st pharyngeal arch Developed from the 2nd pharyngeal arch
Supplied by mylohyoid n., br. of Supplied by facial n.
mandibular n.
47. Key muscle of the submandibular region is the hyoglossus.
48. The mylohyoid m. divides the submandibular gland into two parts.
49. The secretomotor/parasympathetic pathway for submandibular gland is as follows:
A. Preganglionic fibers – Superior salivatory nucleus in the pons -> Facial nerve
-> Chorda tympani n. -> Lingual nerve -> Submandibular/Langley’s ganglion.
B. Postganglionic fibers – Submandibular ganglion -> directly into the
submandibular gland
50. Langley’s ganglion/Submandibular ganglion that acts as a relay station for the
secretomotor fibers supplying the submandibular and sublingual glands.
51. Boundaries of the infratemporal fossa are as follows:
i. Roof – infratemporal surface of the greater wing of sphenoid
ii. Floor – open and extends till base of mandible
iii. Medial wall – lateral pterygoid plate of sphenoid bone
iv. Lateral wall – ramus of mandible
v. Anterior wall – infratemporal surface of maxilla
vi. Posterior wall – styloid process of temporal bone
52. The peculiarities of the lateral pterygoid muscle are:
 i. Only depressor of the temporo-mandibular joint
ii. Peripheral heart containing the pterygoid venous plexus
iii. Divides the maxillary artery into 3 branches
iv. Its remnant forms the articular disc of TMJ
v. Inserted into the pterygoid fovea.
53. First part of maxillary artery – 5 branches
i. Deep auricular artery
ii. Anterior tympanic artery
iii. Middle meningeal artery
iv. Accessory meningeal artery
v. Inferior alveolar artery

Second part of maxillary artery – 4 branches

i. Deep temporal arteries (usually 2 in number)

ii. Pterygoid branches
iii. Masseteric artery
iv. Buccal branch (buccinator m.)

Third part of maxillary artery – 6 branches

i. Posterior superior alveolar artery

ii. Infraorbital artery
- Middle superior alveolar artery
- Anterior superior alveolar artery
iii. Greater palatine artery
iv. Sphenopalatine artery
v. Pharyngeal artery
vi. Artery to pterygoid canal
54. The pterygoid venous plexus is called the peripheral heart because during yawning, the
mouth is widely open due to the contraction of the lateral pterygoid muscle, which
causes the stagnant venous blood to move into the cavernous sinus and maxillary vein.
55. The IA block/Inferior alveolar nerve block is the most common nerve block performed
in dentistry to operate on mandibular teeth. The anesthetic is injected slightly superior to
the entry of the inferior alveolar nerve into the mandibular foramen.
56. The temporomandibular joint is a condylar type of synovial joint.
57. The only depressor of the TMJ is the lateral pterygoid muscle.
58. The temporomandibular joint syndrome is a collection of symptoms due to spasmatic
contractions of the muscles of mastication. It is often associated with clicking sound and
pain during chewing.
Clinically presented with: Diffuse facial pain due to spasm of masseter
Headache due to spasm of temporalis
Jaw pain due to spasm of lateral pterygoid
Occurs due to detachment of posterior attachments of disc.
59. Contents of the pterygopalatine artery:
i. Maxillary nerve
ii. Pterygopalatine ganglion
iii. Third part of maxillary artery
60. Ganglion of hay fever is the pterygopalatine ganglion as allergic reactions irritate the
ganglion which causes congestion of the glands in the nose, palate, and lacrimal gland.
As a result, the person suffers from running nose and eyes.
61. Anterior dislocation of the TMJ is the most common dislocation.
62. The largest and the mixed division of the trigeminal nerve is the mandibular nerve.
63. The dense venous plexus in the thyroid gland lies deep to the true capsule, so to prevent
hemorrhage, the gland along with the capsule is removed during thyroidectomy.
Whereas, in prostate gland, the dense venous plexus lies in between the true and false
capsule, so during the enucleation of the gland, both the capsules are left behind.
64. Medial relations of the thyroid gland are:
Two tubes: trachea and esophagus
Two muscles: inferior constrictor and cricothyroid
Two cartilages: cricoid and thyroid
65. Levator glandulae thyroideae is a remnant of the connection between the pyramidal lobe
with the body of the hyoid bone.
66. Three features of enlargement of thyroid gland/goitre are: (NOTE: thyroid gland can
only move backward or downwards due to fascial sheath and sternothyroid muscle on
top)
i. Dyspnea – difficulty in breathing due to pressure on trachea
ii. Dysphagia – difficulty in swallowing due to pressure on esophagus
iii. Dysphonia – hoarseness of voice due to pressure on recurrent laryngeal nerve
67. The superior thyroid artery and the external laryngeal nerve diverge near the apex of the
gland, hence ligation should be done close to the apex to prevent damage to the external
laryngeal nerve.
The inferior thyroid artery and the internal laryngeal nerve converge near the base of the
gland, hence ligation should be done as far away from the base as possible to prevent
injury to the internal laryngeal nerve.
68. Ectopic thyroid is when the thyroid gland can be located anywhere abnormal along the
thyroglossal duct, anywhere on the tongue as Lingual thyroid or above, behind, below
the hyoid bone called Suprahyoid thyroid, retrohyoid thyroid, infrahyoid thyroid
respectively.
69. Persistence of thyroglossal duct can lead to the formation of a thyroid cyst or a thyroid
fistula.
70. Key muscle of the root of neck is the scalenus anterior.
71. Stellate ganglion/cervicothoracic ganglion is formed by the joining of the inferior
cervical ganglion and the 1st thoracic ganglion.
72. Features of the Horner’s syndrome:
i. Miosis – constriction of pupil due to paralysis of dilator muscle
ii. Anhydrosis – loss of sweating on that side of face due to vasoconstrictor
denervation
iii. Enophthalmos – reason is not confirmed
iv. Partial ptosis – due to paralysis of the levator palpebrae superioris
v. Loss of ciliospinal reflex – pinching of back of the neck does not lead to dilation
of pupil
73. Largest papillae – circumvallate papillae
Papillae with no taste buds – filiform papillae
 Most numerous papillae – filiform papillae
74. Genioglossus is the safety muscle of tongue as it prevents the back fall of the tongue
which will block the respiratory tract.
75. Tongue tie is a clinical condition where the frenulum extends excessively till the tip of
tongue. It interferes with the movements of tongue and normal speech, which can be
corrected by surgically cutting the frenulum linguae.
76. The internal laryngeal nerve is called the Beer-drinkers nerve as the taste of beer is
appreciated well in the posterior most part of tongue.
77. The muscles of tongue are developed from the occipital myotomes.
78. The principal lymph node of the tongue is the jugulo-omohyoid lymph node.
79. Enlargement of the nasopharyngeal tonsils due to infection is called adenoids. It blocks
the posterior nares, thereby making mouth breathing obligatory.
80. Passavant’s ridge refers to the U-shaped muscle loop formed by the palatopharyngeus
and superior constrictor muscle that is pulled forward while swallowing.
81. The sinus of Morgagni is the gap in the pharyngeal wall between the base of the skull
and the upper concavity of the superior constrictor muscle. The structures passing
through this are:
i. Auditory tube
ii. Levator palati muscle
iii. Ascending palatine artery
iv. Palatine branch of ascending pharyngeal artery
82. Foreign bodies such as fish bones get lodged into the piriform fossa and its removal may
damage the internal laryngeal nerve, whose paralysis will result in the loss of protective
cough reflex.
Any growth of malignant tumor may grow in the space of piriform fossa with no
symptoms until the patient presents with malignant lymphadenopathy.
83. Waldeyer’s ring refers to the aggregation of lymphoid tissue/tonsils underneath the
epithelial lining of the pharynx surrounding the commencements of the food and sir
passages. It is hypothesized to prevent the entry of pathogens into the respiratory and
alimentary canals.
84. Within outwards structures of tonsillar bed are:
 i. Pharyngobasilar fascia
ii. Superior constrictor muscle
iii. Buccopharyngeal fascia
85. Kilian’s dehiscence/Pharyngeal dimple refers to a potential gap between the
thyropharyngeus and cricopharyngeus muscle, through which the mucosa and sub-
mucosa of the pharynx may bulge due to the weak area. This bulging is called Zenker’s
diverticulum/Pharyngeal pouch.
86. All muscles of the pharynx are supplied by the cranial root of accessory nerve except
the stylopharyngeus which is supplied by the glossopharyngeal nerve.
87. The pharyngeal plexus of nerves is located over the middle constrictor underneath the
buccopharyngeal fascia and is made up of:
i. Pharyngeal branch of the vagus nerve that carries fibers of the cranial root of
accessory nerve
ii. Pharyngeal branch of the glossopharyngeal nerve
iii. Pharyngeal branch of the superior cervical sympathetic ganglion
88. Gag reflex is a protective reflex associated with gagging and retching when the mucous
membrane of the oropharynx is stimulated by unknown objects.
Afferent limb: glossopharyngeal nerve
Efferent limb: vagus nerve
89. Most common source of bleeding after tonsillectomy is due to the damage of the
paratonsillar vein.
90. Principal artery of the tonsils is the tonsillar branch of the facial artery. It pierces the
superior constrictor.
91. The alvelo-lingual/linguo-tonsillar sulcus is called the coffin corner of the mouth as it is
a common site for cancer but often neglected by surgeons. [It separates the tonsils from
the tongue]
92. The unpaired cartilages of the larynx are:
i. Thyroid cartilage
ii. Cricoid cartilage
iii. Epiglottis

The paired cartilages of the larynx are:

 i. Arytenoid cartilage
ii. Corniculate cartilage of Santorini
iii. Cuneiform cartilage of Wrisberg
93. The cricoid cartilage is called the foundation stone of the larynx as it completely
encircles the lumen of the larynx.
94. The life-saving muscle is the posterior cricoarytenoid as if they are paralyzed, the
adductor muscles of the vocal cords dominate and therefore the person might die due to
the lack of air.
95. The cricothyroid muscle is the tensor of the larynx.
96. The cricothyroid muscle is the tuning fork of the larynx as it tenses the vocal cord when
sound is about to be produced and makes it ready to vibrate like a tuning fork.
97. All intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except
the cricothyroid, which is supplied by the external laryngeal nerve.
98. The cadaveric position of the vocal cords/rima glottidis is caused due to the paralysis of
both external laryngeal nerve and the recurrent laryngeal nerve which causes the vocal
cords to abduct more and get fixed due to the paralysis of all the intrinsic muscles of
the larynx.
99. Laryngeal obstruction is called the café coronary phenomenon as if the foreign body is
not dislodged and expelled immediately by the Heimlich manoeuvre, the person will die
within minutes, almost certainly before he/she is taken to the hospital.
100. Basis of laryngocele – Increase of air pressure in the laryngeal sinus such as in
trumpet players, causes dilatation of saccule leading to an air-filled cyst called
laryngocele.
Basis of singer’s nodule - Singer’s nodules are inflammatory nodules on the vocal cords
at the junction of the anterior 1/3rd and the posterior 2/3rd as that is subjected to
maximum friction during vibration. In early stages, it is edematous.
101. The two terminal branches of the internal thoracic artery are:
i. Musculophrenic artery
ii. Superior epigastric artery
102. The branches of the external carotid artery are: [Sister Lucy’s Powdered Face
Often Attracts Medical Students]
 i. Superior thyroid artery
ii. Lingual artery
iii. Posterior auricular artery
iv. Facial artery
v. Occipital artery
vi. Ascending pharyngeal artery
vii. Maxillary artery (terminal branch)
viii. Superficial temporal artery (terminal branch)
103. Superficial temporal artery is also called the anesthetist’s artery as its pulse can
easily be felt against the tragus of the ear. Thus, when the radial pulse is not accessible to
the anesthetist, this pulse can be utilized.
104. Structures passing between the external carotid artery and the internal carotid
artery are:
i. Deep part of the parotid gland
ii. Styloid process
iii. Styloglossus
iv. Stylopharyngeus
v. Glossopharyngeal nerve
vi. Pharyngeal branch of vagus nerve
105. Chief/principal vein of the head and neck is the internal jugular vein.
106. Inferior petrosal vein is the first tributary of the internal jugular vein.
107. The styloid apparatus refers to the styloid process along with the structures
attached to it, which are:
i. Three muscles: Stylohyoid, styloglossus, stylopharyngeus
ii. Two ligaments: Stylohyoid and stylomandibular
108. Eagle’s syndrome/stylalgia refers to either the elongation of the styloid process or
the calcification of the stylohyoid ligament which causes recurrent neck pain in the
region of tonsillar fossa and upper neck which radiates to the ipsilateral ear and is
aggravated on swallowing.
109. Deviated nasal septum/DNS is the sideway displacement of the medial wall of the
nose which causes nasal obstruction.
110. The nasal septum is an osseocartilaginous structure formed by:
A. Bony part
i. Posterosuperior part – perpendicular plate of the ethmoidal bone
ii. Posteroinferior part – vomer
B. Cartilaginous part
i. Major anterior part – septal cartilage
The lateral wall is also an osseocartilaginous structure formed by:
A. Bony part
i. Nasal
ii. Lacrimal
iii. Frontal process of maxilla
iv. Conchae of ethmoid bone
v. Inferior nasal conchae
vi. Perpendicular plate of palatine
vii. Medial pterygoid plate of sphenoid
B. Cartilaginous part
i. Lateral nasal cartilage/Upper nasal cartilage
ii. Major alar cartilage/Lower nasal cartilage
iii. 3-4 minor alar cartilages
111. The inferior concha is an independent bone.
112. Openings of the lateral nasal wall are as follows:

Sphenoethmoidal recess Sphenoidal air sinus

Superior meatus Posterior ethmoidal air sinus
Middle meatus Frontal air sinus
Anterior ethmoidal air sinus
Middle ethmoidal air sinus
Maxillary air sinus
Inferior meatus Nasolacrimal duct
113. Kiesselbach’s plexus is formed by the anastomoses of the septal branches of
anterior ethmoidal artery, sphenopalatine artery, greater palatine artery and
superior labial artery.
114. The septal branch of the sphenopalatine artery is called the artery of epistaxis as it
is most commonly involved.
115. Vidian’s nerve is the nerve to pterygoid canal.
116. Rhinitis is the inflammation of the mucosal membrane of the nose and is
clinically presented as nasal blockage, sneezing and water leakage from nose/rhinorrhea.
117. The antrum of Highmore refers to the maxillary air sinus which opens into the
middle meatus of the lateral wall of nose.
118. Caldwell-Luc operation refers to a method of drainage of the maxillary sinus as it
is opening on the upper aspect of the lateral wall which is not easily accessible. This is
done through the fenestration of the antrum through the canine fossa in the gingivolabial
sulcus.
119. The septal branch of the sphenopalatine artery is called the rhinologist’s artery.
120. Woodruff’s area is the vascular area located under the inferior nasal concha, and it
is a site of posterior epistaxis.
121. The largest paranasal air sinus is the maxillary air sinus.
122. The maxillary air sinus is the most commonly infected air sinus as infected nose,
carious upper premolar and molar teeth can send infection into the sinus. It is also the
most dependent part and acts as a reservoir for pus.
123. The auditory tube/pharyngotympanic tube connects the nasopharynx with the
middle ear cavity.
124. Ramsay Hunt syndrome refers to the infection caused by the herpes-zoster virus,
which leads to the infection of the few fibers of facial nerve that accompany the
auricular branch of the vagus nerve and supply the concha of the external ear. This
causes the irritation and swelling of the nerve leading to the clinical presentation with
vesicles in the conchal regions.
125. Walls of middle ear cavity:
i. Anterior: Carotid wall
ii. Posterior: Mastoid wall
iii. Superior: Tegmen tympani
iv. Inferior: Jugular wall
v. Lateral: Tympanic wall
 vi. Medial: Labyrinthine wall
126. Incudomalleolar joint is a saddle type of synovial joint.
127. Incudostapedial joint is a ball-and-socket type of synovial joint.
128. Otosclerosis refers to the abnormal ossification of the annular ligament that
attaches the footplate of stapes to the oval window. This impedes movement and causes
conductive deafness.
129. Otitis media is the infection of the middle ear where the infective agents reach the
middle ear from the upper respiratory tract via the pharyngotympanic/auditory tube. It is
clinically presented with ear discharge and perforation of the tympanic membrane.
130. Jacobson’s nerve is the tympanic branch of the glossopharyngeal nerve.
131.

Tensor tympani Mandibular Inserted into Tenses the tympanic

nerve Malleus membrane
Stapedius Facial nerve Inserted into Draws the stapes laterally thus
Stapes tilting its footplate on the oval
window

132. The Muller’s muscle is the superior tarsal muscle, which is an involuntary
extraocular muscle.
133. The lateral rectus muscle arises by two heads.
134. The inferior oblique muscle does not originate from the tendinous ring of Zinn.
[The tendinous ring of Zinn is a ring of fibrous tissue that surrounds the optic nerve at its
entrance at the apex of orbit]
135. Contents of the superior orbital fissure:
i. Oculomotor nerve
ii. Trochlear nerve
iii. Abducent nerve
iv. Ophthalmic nerves branches:
a. Lacrimal
b. Frontal
c. Nasociliary branch
viii. Inferior ophthalmic vein
136. There are 4 recti muscles and 2 oblique muscles.
137. Lateral rectus is supplied by the 6th cranial nerve, abducent nerve.
Superior oblique is supplied by the 4th cranial nerve, trochlear nerve.
138. Complete ptosis refers to the paralysis of the Levator palpebrae superioris due to
involvement of the oculomotor nerve, thereby causing the complete drooping of the
eyelids.
Partial ptosis refers to the damage to the cervical sympathetic ganglion, such as
in Horner’s syndrome, that causes the paralysis of only the smooth muscles of Levator
palpebrae superioris, thereby causing only partial drooping of the eyelids.
139. Squint/Strabismus is the deviation of the eye to the opposite side.

TYPE MUSCLE NERVE

Medial squint Lateral rectus Abducent nerve
Lateral squint Medial rectus Oculomotor nerve
140. The suspensory ligament of Lockwood/suspensory ligament of eye is the
hammock-like support to the eye by the blending of the fascial sleeve of the inferior
rectus with the inferior oblique along with the medial and lateral check ligaments.
141. The lacrimal gland is supplied by the lacrimal branch of the ophthalmic nerve.
142. The phrenic nerve lies on the scalenus anterior m. which is why it is an important
surgical landmark. [Subclavian artery is deep to it, brachial plexus is present on its
lateral border]
143. The terminal branches of the external carotid artery are:
i. Maxillary artery
ii. Superficial temporal artery
144. Contents of the infratemporal fossa:
i. Muscles: Lateral pterygoid, medial pterygoid, tendon of temporalis
ii. Blood vessels: Maxillary artery, maxillary vein, pterygoid venous plexus
iii. Nerve: Mandibular nerve, chorda tympani nerve, otic ganglion
145. Internal laryngeal nerve pierces the thyrohyoid membrane.
146. The branches of the ophthalmic nerve are: lacrimal branch, frontal branch,
nasociliary branch.
147. Toynbee’s muscle is the tensor tympani.
 148. The narrowest part of the larynx is the rima glottidis, which is the space between
the right and left vocal cords.
149. The lingual nerve loops/winds around the submandibular duct.
150. The nerve to pterygoid canal is also called the Vidian’s nerve.
151. The pterygopalatine ganglion is the largest peripheral parasympathetic ganglion.
152. The eustachian tube/auditory tube/pharyngotympanic tube is 36 mm long in
adults.
153. Contents of infratemporal fossa:
Muscles: Lateral pterygoid, medial pterygoid, tendon of temporalis
Blood vessels: Maxillary artery, maxillary vein and pterygoid venous plexus
Nerve: Mandibular nerve, chorda tympani, otic ganglion
154. The first branch of the internal carotid artery is caroticotympanic artery that arises
from the petrous part of the artery.
155. The pterygoid venous plexus is a collection of small veins located around and
within the lateral pterygoid muscle.
156. Articular disc is a remnant of lateral pterygoid muscle.
157. Cricothyroid is supplied by the external laryngeal nerve.
158. Palatopharyngeus forms the palatine aponeurosis.
159. The thyroid angle is prominent in males which causes the prominence on the front
of the neck called the Adam’s apple.

NEUROANATOMY
1. The modifications of the pia mater are as follows:
i. Filum terminale
ii. Ligamentum denticulata
iii. Linea splendens
iv. Subarachnoid septum
2. Subarachnoid cisterns are as follows:
i. Cerebello-medullary cisterns/Cisterna magna
ii. Pontine cistern
iii. Interpeduncular cistern
 iv. Cisterna ambiens
3. The spinal cord begins at the foramen magnum as a continuation of the medulla oblongata
and terminates at the level of L1-L2.
4. Blood supply of the spinal cord:
i. Anterior spinal artery
ii. Posterior spinal artery
iii. Segmental arteries
5. The lower end of the spinal cord is called conus medullaris.
6. The cauda equina is made up of the lumbar nerves (except L1), sacral and coccygeal nerves.
7. The lumbar puncture is usually performed between the L3 and L4 vertebrae.
8. The brainstem is a stalk-like structure that connects the forebrain to the spinal cord. It
contains the midbrain, pons and medulla oblongata from up downwards.
9. The rootlets of the 12th CN – Hypoglossal n emerges from in between the olive and pyramid.
10. The cranial nerves emerging from the medulla from in between the olive and the inferior
cerebellar peduncle are: 9th CN – Glossopharyngeal n, 10th CN – Vagus n, 11th CN –
Accessory Nerve
11. From the cerebellopontine angle, the 6th CN – Abducent n, 7th CN – Facial n and 8th CN –
Vestibulocochlear n emerges.
12. The 4th CN – Trochlear n. emerges from the midbrain.
13. Only the trochlear n. emerges from the dorsal side of the brain.
14. The structure underlying the pyramid is the corticospinal/pyramidal tract fibers.
15. The structure underlying the olive is the inferior cerebellar peduncle.
16. Clinical conditions related to medulla:
i. Lateral medullary syndrome of Wallenberg/Posterior inferior cerebellar artery
syndrome: thrombosis of the posterior inferior cerebellar artery causing:-
- Contralateral loss of pain and temperature sense in limbs due to spinothalamic
tract involvement
- Ipsilateral loss of pain and temperature in the face die to involvement of the
trigeminal nerve
- Ipsilateral paralysis of muscles of palate, pharynx and larynx
- Giddiness
 ii. Medial medullary syndrome: damage to the penetrating branches of the anterior
inferior cerebellar artery causing:-
- Contralateral paralysis of limbs due to damage to pyramid
- Ipsilateral paralysis and atrophy of half of tongue due to damage to the
hypoglossal nerve
- Contralateral loss of sense of position and vibration due to involvement of
medial lemniscus.
17. The clinical condition associated with pons is the Millard-Gubler syndrome which is the
lesion of the pons in such a way that it affects the pyramidal tract and the emerging fibers of
the abducent nerve and facial nerve. This causes:
- Contralateral hemiplegia due to pyramidal tract
- Ipsilateral medial squint due to abducent nerve
- Ipsilateral facial palsy
18. Clinical conditions related to the midbrain:
1. Weber’s syndrome – vascular lesion in the basal region of the cerebellar peduncles due to
the occlusion of a branch of the posterior cerebral artery that includes the crus cerebri and
the oculomotor nerve. This causes:
- Ipsilateral lateral squint due to the involvement of oculomotor n.
- Contralateral hemiplegia due to damage to spinothalamic tract via the crus
cerebri
2. Benedikt’s syndrome – vascular ischemia of the tegmentum of midbrain which affects the
medial lemniscus, spinal lemniscus, red nucleus, oculomotor nerve, etc. This causes:
- Contralateral loss of sense of vibration due to medial lemniscus
- Ipsilateral lateral squint and ptosis due to oculomotor nerve
- Contralateral tremors and involuntary movements due to the involvement of the
red nucleus
3. Perinaud’s syndrome – lesion of the superior colliculi due to the compression of this area
but tumors of the pineal gland. It causes a loss of upward gaze without affecting other
movements of the eye.
19. Four features of the floor of fourth ventricle are:
 i. The entire floor is divided into a right and left symmetrical half by the median
sulcus.
ii. The medial sulcus causes two eminences called the medial eminence.
iii. The medial eminence is bounded laterally by the sulcus limitans.
iv. The widest part of the floor is transversely crossed by white fibers of the arcuate
nucleus called stria terminalis.
20. The apertures of the fourth ventricle are:
i. Median aperture/foramen of Magendie
ii. Lateral aperture/Foramen of Lushka
21. The facial colliculus is related to the facial nerve and the abducent nucleus.
22. Deep nuclei of cerebellum are:
- Dentate
- Emboliform
- Globose
- Fastigial
23. Blood supply to the cerebellum:
i. Superior cerebellar artery
ii. Anterior Inferior Cerebellar artery
iii. Posterior Inferior Cerebellar artery
24. The superior cerebellar peduncle connects the cerebellum to the midbrain. It mainly consists
of the efferent fibers from the dentate nucleus to the red nucleus, thalamus and cerebral
cortex of the opposite side.
The middle cerebellar peduncle connects the cerebellum to the pons. It only consists of the
afferent fibers arising from the pontine nuclei of the opposite side.
The inferior cerebellar peduncle connects the cerebellum to the medulla oblongata. It mainly
consists of afferent fibers from the spinal cord, the olivary nucleus, vestibular nuclei, etc., to
the cerebellum.
25. Motor Area
No. – Brodmann area 4
Function – Movements of the body [uppermost part controls lower limb and lowermost parts
controls upper limb]
 Clinical anatomy – Lesion in the primary motor area on one side leads to contralateral
hemiplegia.
Pharyngeal, masticatory, upper facial and extraocular muscle are spared due to bilateral
representation.
Somatosensory Area
No. – Brodmann area 3,1,2
Function – Perception of exteroceptive stimulus (pain, touch and temperature) and
proprioceptive stimulus (vibration, muscle and joint sense) of opposite half of body.
Clinical anatomy – Lesion to this area causes the loss of exteroceptive and proprioceptive
stimulus of the opposite half of the body.
Motor Speech Area of Broca
No. – Brodmann area 44 and 45
Function – Planning of the process of speech by coordinating with the temporal cortex for
processing of sensory information and with the motor cortex for the movements of the
mouth.
Clinical anatomy – Lesion to this area causes the loss of proper speech called expressive
aphasia/motor aphasia, where the patient is able to understand what one is saying but cannot
say the right words.
Sensory Speech Area of Wernicke
No. – Brodmann area 39 and 40
Function – To interpret/understand the speech by using visual and auditory cues
Clinical anatomy – Lesion to this area in the dominant hemisphere causes receptive aphasia,
where the patient is not able to understand the spoken language and written speech.
26. Contents of the lateral sulcus are:
i. Superficial middle cerebral vein
ii. Deep cerebral vein
iii. Middle cerebral artery
27. The paracentral lobule is the highest center for the voluntary control of micturition and
defecation. It is bounded below by the cingulate sulcus and is invaded by the upper end of
the central sulcus/
28. The central sulcus divides the primary motor area in the frontal lobe and the primary sensory
area in the parietal lobe.
29. The lobes of the cerebrum are: frontal, parietal, temporal and occipital. The insula/island of
Reil/Central lobe is also considered to be a separate lobe which is submerged due to the
development of the surrounding cortical areas.
30. The parts of the corpus callosum are: Rostrum, Genu, Body/Trunk, Splenium.
31. Two examples of projection fibers are: Internal capsule and Fornix.
NOTE: Fornix connects the hippocampus to then mammillary body
32. The parts of the internal capsule are: Anterior part, Posterior part, Genu, Retro-lentiform part
and Sub-lentiform part.
33. Blood supply of the internal capsule are:
i. The anterior limb is supplied by the lateral striate branches of the anterior cerebral
artery and the medial striate branches of the middle cerebral artery.
ii. The genu is supplied by the recurrent artery of Huebner or the direct branches from
the internal carotid artery.
iii. The posterior limb is supplied by the lateral striate branches of the middle cerebral
artery (Charcot’s artery) and branches of the anterior choroidal artery.
34. The five important commissural fibers are:
i. Corpus callosum
ii. Anterior commissure
iii. Posterior commissure
iv. Hippocampal commissure
v. Habenular commissure (superior lamina of stalk of pineal gland)
35. The main functional components of the basal nuclei are corpus striatum, globus pallidus,
substantia nigra, red nucleus and subthalamic nucleus.
36. The functions of the basal nuclei are as follows:
i. Control the planning and programming of voluntary movements
ii. Determine how rapid and large a movement should be
iii. Decrease muscle tone and inhibit unwanted movements
iv. Regulate muscle tone
v. Control reflex muscular activity
 vi. Regulate automatic associated movements (swaying of arms while walking)
vii. Control group of movements for emotional expression
37. The formation of the Circle of Willis is as follows:
- Anteriorly formed by the anterior communicating arteries and the anterior
cerebral artery
- Posteriorly formed by the basilar artery dividing into posterior cerebral arteries
- Laterally by the posterior communicating arteries connected the internal carotid
artery with the posterior cerebral artery
38. The central branches of the circle of Willis are end arteries that arise from the region of the
arterial circle of Willis and are arranged into the anteromedial group, anterolateral group,
posteromedial group, and posterolateral group.
39. Arteries supplying the:
i. Superolateral surface – mostly Middle cerebral artery (2/3rd), then anterior cerebral
artery and then posterior cerebral artery
ii. Medial surface – mostly Anterior cerebral artery (2/3rd), then middle cerebral artery
and then posterior cerebral artery
iii. Inferior surface – everywhere except temporal pole is by Posterior cerebral artery,
then middle cerebral artery and then anterior cerebral artery.
40. Parts of the lateral ventricle are:
i. Central part
ii. Anterior horn
iii. Posterior horn
iv. Inferior horn
41. Each lateral ventricle communicates with the 3rd ventricle by the interventricular foramen of
Monroe.
42. The 3rd ventricle anteriorly communicates with the lateral ventricles through the foramen of
Monroe, and it communicates posteriorly with the 4th ventricle via the cerebral aqueduct of
Sylvius.
43. The ventricles of the brain are mainly the lateral ventricles, the 3 rd ventricle, and the 4th
ventricle.
The ventricles are important as they produce and store CSF.
 [The choroid plexus in lateral ventricles mainly produce the CSF which travels via the
foramen of Monroe to the 3rd ventricle and then via the cerebral aqueduct of Sylvius to the 4th
ventricle, from where it reaches the cerebellomedullary and pontine cisterns via the foramen
of Magendie and the foramen of Luschka respectively. From here, the CSF moves into the
subarachnoid space of the brain and the spinal cord to provide a protective covering.
44. The functions of the thalamus are as follows:
i. Sensory integration and relay station for all senses except that of the olfactory
pathway (olfaction projects directly to the cerebral cortex)
ii. Poor recognizer of pain, thermal and tactile sensations
45. The contents of the interpeduncular fossa are as follows:
i. Oculomotor nerve
ii. Mamillary bodies
iii. Tuber cinereum (gray matter lying anterior to the mamillary bodies)
iv. Posterior perforated substance (layer of gray matter pierced by the posterior cerebral
arteries)
v. Infundibulum (narrow stalk that connects the hypophysis cerebri with the tuber
cinereum)
46. Effect of injury to Broca’s area causes expressive/motor aphasia where the patient is able to
understand speech but cannot speak the right words to express.
Effect of injury to Wernicke’s area causes receptive aphasia where the patient is not able to
understand speech or written speech but can talk sensical words.

THORAX
1. The sternal angle/angle of Louis is a transverse ridge present on the sternum about 5cm
below the suprasternal notch. It is an important anatomical landmark as the following
events occur at this level:
i. Second costal cartilage articulates here, thus used for counting ribs
ii. Level of T3-T4 intervertebral disc
iii. Ascending aorta ends
iv. Arch of aorta begins and ends
v. Descending thoracic aorta begins
vi. Separates superior mediastinum from inferior mediastinum
vii. Azygos vein arches over the root of lung and enters SVC
 viii. Trachea bifurcates into the left and right principal bronchi
ix. Pulmonary trunk bifurcates into right and left pulmonary arteries
2. In males, the nipples lie at the level of the 4th intercostal space about 4 inches from the
mid-sternal line. In females, this levels varies.
3. Sibson’s fascia/Diaphragm of superior thoracic inlet/Suprapleural membrane refers to the
fascial sheet covering a part of the thoracic inlet on either side.
It protects the cervical pleura below which the apex of the lung lies. It also resists the
intrathoracic pressure from entering the root of neck.
4. The important structures passing through the thoracic inlet are:
i. Sternohyoid m.
ii. Sternothyroid m.
iii. Longus colli m.
iv. Brachiocephalic trunk
v. Left common carotid artery
vi. Left subclavian artery
vii. Brachiocephalic veins
viii. Inferior thyroid veins
ix. Right and left vagus nerves
x. Left recurrent laryngeal nerve
xi. Right and left phrenic nerves
xii. Thoracic duct
xiii. Esophagus
xiv. Trachea
xv. Apices of the lungs
5. Thoracic inlet syndrome/Scalenus anterior syndrome/Cervical rib syndrome refers to the
stretching or pushing up of the subclavian artery or the lower trunk of the brachial plexus
due to congenital hypertrophy of scalenus anterior or cervical rib. This may present as:
i. Numbness/tingling feeling in upper limb and wasting of small muscles of hand
due to damage to brachial plexus
ii. Ischemic symptoms such as pallor or coldness of upper limb with weak radial
pulse due to damage to subclavian artery.
6. The major openings of the diaphragm are:
i. Vana caval opening at the level of T8
ii. Oesophageal opening at the level of T10
iii. Aortic opening at the level of T12
7. Hiccups are a result of the spasmodic contractions of the diaphragm accompanied by the
closure of glottis.
Physiologically, this occurs due to gastric irritation.
Pathologically, this may occur due to diaphragmatic or phrenic nerve irritation.
8. Manubrium sterni is the preferred site for bone marrow aspiration as it is subcutaneous
and easily accessible.
9. Pectus carinatum/Pigeon chest is an abnormal shape of the thoracic cage in which the
cage is compressed from side to side and the sternum projects forward, similar to the
chest of a pigeon.
10. Pectus excavatum/Funnel chest is an abnormal shape of the thoracic cage where the cage
is compressed antero-posteriorly, and the sternum is pushed backward due to the
overgrowth of the ribs. This shape of the cage may compress the heart.
11. Vertebrosternal ribs are the 1st-7th ribs which attach posteriorly to the vertebrae and attach
anteriorly to the sternum.
Vertebrochondral ribs are the 8th-10th ribs which attach posteriorly to the vertebrae and
their cartilages attaches to the cartilage of the higher rib.
Vertebral/floating ribs are the 11th and 12th ribs which are attached posteriorly to the
vertebrae and are free anteriorly but attached to small pieces of hyaline cartilage.
12. The costal element of the C7 vertebra may elongate to form a cervical rib either
unilaterally or bilaterally. It may compress the subclavian artery and the lower trunk of
the brachial plexus, causing cervical rib syndrome. It may clinically be presented with:
i. Numbness/tingling feeling/pain in the upper limb with wasting of small muscles
of the hand due to damage of brachial plexus.
ii. Ischemic symptoms like pallor and coldness of upper limb and weak pulsation of
radial pulse due to the damage of subclavian artery.
13. Lumbar/Gorilla rib refers to the elongation of the costal element of the L1 vertebra. It
usually does not cause any symptoms, therefore it goes undiagnosed.
14. Flail chest occurs when fracture of ribs occurs at 2 sites causing paradoxical respiration,
as in the flail segments of the ribs move in during inspiration and move out during
expiration.
15. The manubrium is the thickest and the strongest part of the sternum.
16. The 8th rib projects more laterally.
17. Since the size of the body increases as we descend, the T1/T3 vertebra has the smallest
body.
18. The spinous process of T8 is the longest.
19. Contents of a typical intercostal space are:
i. Three intercostal muscles
- External intercostal
- Internal intercostal
- Intercostalis intima
ii. Intercostal nerves
iii. Intercostal arteries
iv. Intercostal veins
v. Intercostal lymph vessels and lymphatics
20. The neurovascular bundle consisting of the intercostal nerve and vessels lie in between
the layer of the internal intercostal muscles and the intercostalis intima and arranged as
intercostal nerve, intercostal arteries, and intercostal veins from above downwards.
21. The atypical intercostal nerves are 1, 2, 7, 8, 9, 10 and 11.
22. The 7th-11th intercostal nerves are called the thoraco-abdominal nerves as they leave the
corresponding intercostal space to enter into the abdomen. They also supply the muscles
of the anterior abdominal wall and the skin and peritoneum of the abdomen.
23. Coarctation of the aorta refers to the congenital narrowing of the arch of the aorta just
proximal or just distal to the entrance of ductus arteriosus. Therefore, collateral
circulation occurs between the anterior and posterior intercostal arteries, thus the
posterior intercostal arteries are markedly enlarged and cause notching of the ribs.
24. The internal mammary artery graft is preferred over other grafts as it lasts longer, and its
histological peculiarity of containing only elastic tissues makes it less vulnerable to
develop atherosclerosis.
25. Pump handle movement refers to the up-and-down movement of the sternum during
respiration as the elevation of the ribs carry the sternum along with their anterior ends
move upward and forward. This is to increase the antero-posterior diameter of the
thoracic cage.
Bucket handle movement refers to the outward movement of the shaft of ribs during their
elevation to increase the transverse diameter of the thoracic cage.
26. The diaphragm is the muscle of weight-lifting as it supports the vertebral column without
allowing its flexion when deep inspiration is taken.
27. Deep inspiration muscles:
i. External intercostal m.
ii. Scalene muscles
iii. Sternocleidomastoid
iv. Diaphragm
Forced inspiration
i. Trapezius
ii. Serratus anterior
iii. External intercostal
iv. Scalene muscles
v. Sternocleidomastoid
vi. Diaphragm
Forced expiration
i. Quadratus lumborum
ii. Internal intercostal m.
28. The parts of the parietal pleura are:
i. Cervical pleura
ii. Costal pleura
iii. Mediastinal pleura
iv. Diaphragmatic pleura
29. The pulmonary ligament provides dead space for the expansion of the pulmonary veins
during increased venous return, such as during exercise.
 It also allows the descent of the root of lung during inspiration, thereby giving more
space for the expansion of the apex into this empty space.
30. The recesses of the pleura allow space for the lung expansion during forced/deep
inspiration. The recesses of the pleura are:
i. Costo-diaphragmatic recess
ii. Costo-mediastinal recess
31.
PARIETAL PLEURA VISCERAL PLEURA
Outer layer of the pleura Inner layer of the pleura
Covers the pulmonary cavity Firmly adherent to the lung except at the
hilum
Thicker than visceral pleura Thinner than parietal pleura
Divided into 4 types based on the Not subdivided
structures enclosed
32. The thoracocentesis needle is inserted into the sixth intercostal space along the mid-
axillary line.
33. Pancoast syndrome is the involvement of the structures posterior to the apex of the lung
due to cancer of the apex of the lung. It can clinically be presented as:
i. Pain along the medial side of the forearm and hand, and wasting of small muscles
of the hand due to involvement of the ventral ramus of T1.
ii. Horner’s syndrome due to the involvement of the sympathetic chain.
iii. Erosion of the first rib.
34.
Mediastinal relations of the right lung Mediastinal relations of the left lung
Right atrium Left ventricle
SVC, IVC Ascending aorta
Azygos vein (it enters SVC) Arch of Aorta, Descending thoracic aorta
Right brachiocephalic vein Left subclavian and Left common carotid
arteries
Esophagus and trachea Esophagus and thoracic duct
3 nerves: 4 nerves:
- Right phrenic nerve - Left phrenic nerve
- Right vagus nerve - Left vagus nerve
- Right sympathetic chain - Left recurrent laryngeal
nerve
- Left sympathetic chain
35. Sometimes, the medial part of the superior lobe is separated by a fissure of variable
length which contains the terminal part of the azygos vein. This is called the accessory
lobe of the azygos vein.
36. Structures in the hilum of the right lung:
i. Epiarterial bronchus
ii. Pulmonary artery
iii. Hypoarterial bronchus
 iv. Superior pulmonary vein
v. Inferior pulmonary vein
Structures in the hilum of the left lung:
i. Pulmonary artery
ii. Principal bronchus
iii. Superior pulmonary vein
iv. Inferior pulmonary vein
37.
RIGHT PRINCIPAL BRONCHUS LEFT PRINCIPAL BRONCHUS
Shorter and wider Longer and narrower
More vertical More horizontal
In line with the trachea Not in line with the trachea
38. Each pulmonary unit contains:
i. Alveolar ducts
ii. Air saccules
iii. Alveoli
iv. Atria
[Each respiratory bronchiole aerates a pulmonary unit that is concerned with
gaseous exchange]
39. The most common site for lung abscess is the right lower lobe as the trachea is directly
opening here.
40. The commonest site of pulmonary tuberculosis is the apex of lung. [apparently due to
high oxygen tension and slow lymphatic drainage]
41. Contents of the superior mediastinum:
Arteries:
i. Arch of aorta
ii. Brachiocephalic artery
iii. Left common carotid artery
iv. Left subclavian artery
Veins:
i. Upper half of SVC
ii. Right and left brachiocephalic veins
iii. Left superior intercostal vein
Nerves:
i. Right and left phrenic nerve
ii. Right and left vagus nerve
iii. Left recurrent laryngeal nerve
iv. Sympathetic trunks and cardiac nerves
Lymphatics and lymphoid organs:
 i. Thymus
ii. Thoracic duct
iii. Lymph nodes
Tubes:
i. Esophagus
ii. Trachea
Muscles:
i. Sternohyoid
ii. Sternothyroid
iii. Longus colli
Contents of the middle mediastinum:
- Heart
- Pericardium
- Arteries:
i. Ascending Aorta
ii. Pulmonary trunk dividing into the right and left pulmonary arteries
iii. Pericardiophrenic artery
- Veins:
i. Lower half of SVC
ii. Lower half of Azygos vein
iii. Pulmonary veins
- Lymphatics:
i. Tracheobronchial lymph nodes
- Nerves:
i. Phrenic nerves
ii. Deep cardiac plexus
- Tubes:
i. Bifurcation of trachea
ii. Right and left principal bronchi
Contents of the posterior mediastinum:
i. Esophagus
ii. Thoracic duct
iii. Descending Thoracic Aorta and its branches
iv. Vagus nerve
v. Sympathetic trunks
vi. Posterior mediastinal lymph nodes
42.
VISCERAL/SEROUS PERICARDIUM PARIETAL PERICARDIUM
 Adherent to the myocardium of the heart Adherent to the visceral pericardium
Developed by somatopleuric mesoderm Developed from splanchnopleuric
mesoderm
Innervated by somatic nerve fibers Innervated by autonomic nerve fibers
Sensitive to pain Insensitive to pain
43. There are two sinuses of the pericardium:
i. Transverse sinus – the horizontal recess behind the ascending aorta and the
pulmonary trunk for the ligation of the arteries during open-heart surgery.
ii. Oblique sinus – the recess of the serious/visceral pericardium behind the base of
the left atrium to allow for the distension and thereby proper contraction of the
left atrium during the return of oxygenated blood from the lungs.
44. The openings in the interior of right atrium are:
i. Opening for the SVC – upper part of the right atrium
ii. Opening for the IVC – lower part of the right atrium
45. The triangle of Koch is a triangular region in the heart that is located behind the tricuspid
valve and in front of the coronary sinus, it contains the AV node.
46. The moderator band/septo-marginal tuberculum refers to a thick muscular ridge
extending from the ventricular septum to the base of the anterior papillary muscle. It
conveys the right branch of the AV bundle of His, part of the conducting system of the
heart.
47. The functional significance of the fibrous skeleton of heart is that:
- It allows the cardiac muscle to contract against the rigid skeleton
- It prevents the valves from stretching and becoming incompetent and supports
the base of the cusps of the valves
48. The third coronary artery is the right conus artery.
49. In the right coronary dominance, the posterior interventricular artery arises from the right
coronary artery, and this occurs in 90% of the individuals.
In the left coronary dominance, the posterior interventricular artery arises from the
circumflex branch of the left coronary artery.
50. The anterior interventricular artery/Left Anterior descending artery is called the ‘widow
maker’s artery’ as 100% blockage of it can cause a massive heart attack.
51. The great saphenous vein is used for coronary artery bypass graft (CABG) for the
following reasons:
i. It is easily dissected
ii. Its diameter is almost the same as that of the coronary artery
iii. Minimum occurrence of valves
52. The superficial cardiac plexus is located below the arch of aorta, in front of the
bifurcation of the pulmonary trunk.
The deep cardiac plexus is located behind the arch of aorta and in front of the bifurcation
of the trachea.
53. The tributaries of the coronary sinus are as follows:
i. Great cardiac vein
ii. Middle cardiac vein
 iii. Small cardiac vein
iv. Posterior vein of the left ventricle
v. Oblique vein of Marshall
vi. Right marginal vein
vii. Left marginal vein
54. Kugel’s artery is an atrial branch of the circumflex artery that anastomoses with a similar
atrial branch of the right coronary artery.
55. Annulus of Vieussens refers to the circular anastomotic channel between the right and left
conus arteries around the infundibulum.
56. Tributaries of the SVC are:
i. Left and right brachiocephalic veins
ii. Azygos vein
iii. Mediastinal and pericardial veins
Tributaries of the IVC are:
i. Right and left common iliac veins + Median sacral vein [formative]
ii. Right suprarenal vein
iii. Renal veins
iv. Right gonadal vein (testicular/ovarian)
v. Right, middle and left hepatic vein
vi. Inferior phrenic veins
vii. 3rd and 4th lumbar veins
57. Non-obliterated ducts arteriosus is called patent ductus arteriosus, this allows for the
mixture of the oxygenated blood with deoxygenated blood, thereby bringing down the
efficiency of the circulation of blood.
58. Branches of the descending thoracic aorta are:
i. Parietal
- 3rd-11th posterior intercostal arteries
- Subcostal arteries
- Superior phrenic artery
ii. Visceral
- Pericardial arteries for posterior pericardium
- Mediastinal arteries for the posterior mediastinum
- Two left bronchial arteries
- Esophageal branches
59. Esophageal constrictions are:
i. At pharyngo-esophageal junction – Cervical constriction (C6)
ii. At crossing arch of aorta – Aortic constriction (T4)
iii. At crossing the left principal bronchus – Bronchial constriction (T6)
iv. At the diaphragmatic opening – Diaphragmatic constriction (T10)
60. The curvatures of the esophagus are as follows:
- 2 side-to-side curvatures, both towards the left
i. At the root of the neck, before entering the thoracic inlet
 ii. At the level of T7, before passing in front of the descending thoracic
aorta
- 2 antero-posterior curvatures
i. First one corresponding to the curvature of the cervical spine
ii. Second one corresponding to the curvature of the thoracic spine
61. The most common anomaly of the esophagus is tracheo-esophageal fistula which refers
to the abnormal connection between the trachea and the esophagus due to failure of
separation of the lumen of esophagus and tracheal tube by a laryngotracheal septum.
It may be clinically presented as:
i. hydramnios as fetus cannot swallow amniotic fluid
ii. stomach distended with air
iii. all food spit up
iv. baby may cough up bile
It needs to be corrected surgically.
62. Tributaries of the azygos vein:
i. Right superior intercostal vein [2nd,3rd,4th posterior intercostal veins]
ii. 5th-11th right posterior intercostal veins
iii. Right Subcostal vein
iv. Hemiazygos vein
v. Accessory hemiazygos vein
vi. Right ascending lumbar vein
vii. Esophageal branches
viii. Right bronchial veins
ix. Pericardial veins
x. Mediastinal veins
Tributaries of the hemiazygos vein:
i. 9th-11th left posterior intercostal veins
ii. Left subcostal vein
iii. Left ascending lumbar vein
iv. Small esophageal branches and mediastinal branches
Tributaries of the accessory hemiazygos vein:
i. 5th-8th left posterior intercostal veins
ii. Left bronchial veins (sometimes)
63. Irritation of the diaphragm secondary to peritonitis causes pain due to the stimulation of
the phrenic nerve (root value C3, C4 and C5), and this pain is referred to the
corresponding tip of shoulder which is supplied by the supraclavicular nerve (also root
value C3, C4 and C5).
64. The lowest splanchnic nerve that arises from the 12th thoracic ganglion and terminates in
the renal plexus is called the ‘renal nerve’.
65.