ANATOMY 1STMODULE TEST

RD
43 MBBS
Q-2
A 16 year old boy complaining of pain in right lower part of anterior
abdominal wall was seen by a doctor. On examination he was having
temperature of 101 ⁰F. He had a furred tongue and was extremely tender
in n right lower quadrant. He told that initially the pain started around
umbilicus and later shifted to right lower abdomen. The abdominal
muscle in the area were firm (rigid) on palpation and became more
spastic when increased pressure was applied (guarding).

a. What is the most likely diagnosis? Give the anatomical basis of its
02Marks
referred pain?

b. What is Macburney’s point? Give its significance. 02Marks

03Marks
c. Enlist three common positions where appendix can be found.
a. What is the most likely diagnosis? Give the anatomical basis
of its referred pain? 2 marks

• Appendicitis (1 marks)
• Anatomical basis (1 mark)
b. What is Macburney’s point? Give its significance. 2
marks
• It is a point on an imaginary line joining umbilicus and right anterior
superior iliac spine. It is present at the junction of medial two third
and lateral one third of this line.
(1 mk)

• Base of appendix in present at this point. Surgeons give incision at

this point during surgery to remove inflamed appendix. (1 mk)
c. Enlist three common positions where appendix can
be found. 3 marks

• In order of priority the a & b are most common, then

c.-------------------2.5 marks
• Diagram-------------------------------0.5 mark
QUESTION NO 3
3. A 30 year old male presents in surgery OPD with dull pain and swelling in left
scrotum for last 4 years. It started in lower part of scrotum and is slowly increasing in
size. There is no pain abdomen or urinary urinary complaints. On palpation of
scrotum, a bag of worms is felt in left testis. There is no expansile pulse on cough.
The size of left testis is smaller than the right one. Abdomen examination is normal.
A diagnosis of “vericocele” is made.

a. Give blood supply of testis? Why vericocele is more common on left? 04

b. The lymphatic drainage from scrotum and testis occurs in which lymph nodes? 02
c. How would you comment on anatomical basis of vericocele and hydrocele. 02
a. Give blood supply of testis? Why vericocele is more common on left? 04
• Arterial Supply: Testicular artery, a branch of the abdominal aorta (at the level of
the second lumbar vertebra), descends on the posterior abdominal wall. It traverses
the inguinal canal and supplies the testis and the epididymis. 01
• Venous Drainage: An extensive venous plexus, the pampiniform plexus, leaves the
posterior border of the testis . As the plexus ascends, it becomes reduced in size so that
at about the level of the deep inguinal ring, a single testicular vein is formed.
• It drains into the left renal vein on the left side and into the inferior vena cava on the
right side. 01
• Vericocele is more common on left
• Because the right testicular vein joins the low-pressure inferior vena cava, whereas the
left vein joins the left renal vein, in which the venous pressure is higher.
• Left testicular vein is longer than the right. 02
b. The lymphatic drainage from scrotum and testis occurs in which lymph nodes? 02
• Scrotum: Lymph from the skin and fascia, including the tunica vaginalis, drains into
the superficial inguinal lymph nodes. 01
• Testis: The testicular lymph vessels ascend through the inguinal canal and pass up
over the posterior abdominal wall to reach the lumbar (para-aortic) lymph nodes on
the side of the aorta at the level of the first lumbar vertebra. 01

c. How would you comment on anatomical basis of vericocele and hydrocele. 02

• Varicocoele: is produced by dilatation of the pampiniform plexus on veins. 01
• Hydrocele: is a condition in which fluid accumulates in the processus vaginalis. 01
• The testes develop in relation to the developing mesonephros, at the level of segments
T10 to T12. Subsequently, they descend to reach the scrotum. An extension of
peritoneal cavity called the processes vaginalis precedes the descent of testis into the
scrotum, into which the testis invaginates.
• The processes vaginalis closes above the testis. Normally, the upper part becomes
obliterated just before birth and the lower part remains as the tunica vaginalis.
• The processus is subject to the following common congenital anomalies:
• It may persist partially or in its entirety as a preformed hernial sac for an
indirect inguinal hernia.
• Congenital, when the entire processus vaginalis is patent and communicates
with the peritoneal cavity.
• Encysted, when the middle part of the processus is patent.

Reference: Richard S. Snell ,8th Edition

Q. 4Formation of portal vein (1)
• The portal vein is formed behind the neck of the pancreas by the
union of the superior mesenteric and splenic veins.
Tributaries of the Portal Vein (3 marks)

The tributaries of the portal vein are the splenic vein, superior mesenteric
vein, left gastric vein, right gastric vein, and cystic veins.
1. Splenic vein: It receives the short gastric, left gastroepiploic, inferior
mesenteric, and pancreatic veins.
2. Inferior mesenteric vein: It receives the superior rectal veins, the
sigmoid veins, and the left colic vein.
3. Superior mesenteric vein: It receives the jejunal, ileal, ileocolic, right
colic, middle colic, inferior pancreaticoduodenal, and right gastroepiploic
veins.
4. Left gastric vein: It opens directly into the portal vein
5. Right gastric vein: It drains directly into the portal vein
6. Cystic veins:
(b) Identify the sites of portal systemic
anastomoses. Give their clinical importance
(3,1)
[Link] the lower third of the esophagus, the esophageal branches of
the left gastric vein (portal tributary) anastomose with the
esophageal veins draining the middle third of the esophagus into
the azygos veins (systemic tributary). (Oesophageal varices)

[Link] down the anal canal, the superior rectal veins (portal
tributary) draining the upper half of the anal canal anastomose
with the middle and inferior rectal veins (systemic tributaries),
which are tributaries of the internal iliac and internal pudendal
veins. (Rectal varices/ Haemorroids)
[Link] paraumbilical veins connect the left branch of the portal vein with
the superficial veins of the anterior abdominal wall (systemic
tributaries). (Caput medusae)

[Link] veins of the ascending colon, descending colon, duodenum,

pancreas, and liver (portal tributary) anastomose with the renal, lumbar,
and phrenic veins (systemic tributaries).

5. Bare area of the liver

Clinical importance:
• Eosophageal varices
• Internal haemorroids
• Caput medusae
• Ascites
• Splenomegaly
Question No. 5
a. What are the anatomical structures forming walls of inguinal canal. 4
Marks
• The inguinal canal is an oblique passage through the lower part of the anterior
abdominal wall. In males, it transmits spermatic cord and in females it allows
round ligament of uterus to pass through.

Walls of the Inguinal Canal

• Anterior wall: External oblique aponeurosis, reinforced laterally by the origin of
the internal oblique from the inguinal ligament. This wall is therefore strongest
opposite the deep inguinal ring. 1
• Posterior wall: Conjoint tendon medially, fascia transversalis laterally. This wall is
strongest opposite the superficial inguinal ring. 1
• Roof or superior wall: Arching lowest fibers of the internal oblique and
transversus abdominis muscles. 1
• Floor or inferior wall: inguinal ligament and the lacunar ligament. 1
b. Give “mechanics” of inguinal canal. 3 Marks

• The inguinal canal in the lower part of the anterior abdominal wall is a site of
potential weakness in both sexes. The following factors help to lessen this
weakness. Except in the newborn infant, the canal is an oblique passage with the
weakest areas, namely, the superficial and deep rings, lying some distance apart.
0.5
• The anterior wall of the canal is reinforced by the fibers of the internal oblique
muscle immediately in front of the deep ring. 0.5
• The posterior wall of the canal is reinforced by the strong conjoint tendon
immediately behind the superficial ring. 0.5
• On coughing and straining, as in micturition, defecation, and parturition, the
arching lowest fibers of the internal oblique and transversus abdominis muscles
contract, flattening out the arched roof so that it is lowered toward the floor. 0.5
• The roof may actually compress the contents of the canal against the floor so that
the canal is virtually closed. 0.5
• When great straining efforts may be necessary, as in defecation and parturition,
the person naturally tends to assume the squatting position; the hip joints are
flexed, and the anterior surfaces of the thighs are brought up against the anterior
abdominal wall. By this means, the lower part of the anterior abdominal wall is
protected by the thighs. 0.5
Question No. 6
a. Name the coverings of spermatic cord. 3 Marks
• The coverings of the spermatic cord are three concentric layers of fascia
derived from the layers of the anterior abdominal wall.
1. External spermatic fascia derived from the external oblique aponeurosis
and attached to the margins of the superficial inguinal ring 1
2. Cremasteric fascia derived from the internal oblique muscle 1
3. Internal spermatic fascia derived from the fascia transversalis and
attached to the margins of the deep inguinal ring 1
b. Discuss how these coverings are derived from anterior abdominal
wall. 4 Marks

• A peritoneal diverticulum called the processus vaginalis is formed before

the descent of the testis and the ovary from their site of origin, on the
posterior abdominal wall at the level of L1 vertebrae.
• The processus vaginalis passes through the layers of the lower part of the
anterior abdominal wall and, acquires a tubular covering from each layer. 1
• It traverses the fascia transversalis at the deep inguinal ring and acquires a
tubular covering, the internal spermatic fascia. 1
• As it passes through the lower part of the internal oblique muscle, it takes
with it some of its lowest fibers, which form the cremaster muscle.
• The muscle fibers are embedded in fascia, and thus the second tubular sheath is
known as the cremasteric fascia. 1
• The processus vaginalis passes under the arching fibers of the transversus
abdominis muscle and therefore does not acquire a covering from the abdominal
layer of the transversus abdominis.
• On reaching the aponeurosis of the external oblique, it evaginates this to form
the superficial inguinal ring and acquires a third tubular fascial coat, the external
spermatic fascia. 1
 Q7
a) Contents of superficial & deep perineal pouches in
female (4 marks)
➢ Superficial pouch (02 marks) ½ for each

• Bulb of vestibule & bulbospongiosus

• Crura of clitoris & ischiocavernosus

• Superficial transverse perineal muscle

• perineal nerve & vessels

• greater vestibular glands

22
a) Contents of superficial & deep perineal pouches in
female (4 marks)

➢ Deep pouch (02 marks) ½ for each

• Part of urethra & vagina

• External urethral sphincter

• Pudendal nerve

• Branches of internal pudendal vessels

23
 b) Renal fascia and its significance (3marks)

➢ Description of renal fascia (02 marks)

➢ What it is made up of & where it is ( ½ mark)

• Connective tissue condensation

• Outside perirenal fat & covered by pararenal fat

• Encloses kidney & suprarenal glands

➢ Extension or attachment ( 1½)

24
 b) Renal fascia and its significance (3marks)

➢ Importance of renal fascia (01 marks)

➢ Maintain the position of kidney

➢ Determine the extension path of abscess or blood in case of

trauma

25
Question no 8
a. Illustrate the microscopic structure of liver 4 marks
b. Draw and label the histological section of ureter 3 marks
Q9(a)Histological features in the cross section of
esophagus in the abdomen? (03)

• DIAGRAM = 0.5

• MUCOSA:
• Stratified squamous epithelium

• Lamina Propria (excretory ducts ) and (esophageal cardiac glands)

• SUBMUCOSA:
• Esophageal gland proper

• Blood vessels
• MUSCULARIS MUCOSA:
• In esophagus it is usually a single layer of longitudinal smooth muscle

• In stomach a second layer of smooth is added called inner circular layer

• MUSCULARIS EXTERNA

• SEROSA
Q9(b)Development of pancreas? (3)
Annular pancreas? (1)
• Pancreas develop from two buds dorsal & ventral originating from
endodermal lining of duodenum.

• When the duodenum rotates to the right & becomes C-shaped the
ventral pancreatic bud moves dorsally in a manner similar to the
shifting of the entrance of the bile duct

• Ventral bud comes to lie immediately below & behind the dorsal bud
• The ventral bud forms the uncinate process and inferior part of the
head of pancreas

• Remaining part is derived from dorsal bud

• Main pancreatic duct is formed by the distal part of the dorsal

pancreatic duct and the entire ventral pancreatic duct

• Proximal part of the dorsal pancreatic duct either is obliterated or

persists as a small channel the accessory pancreatic duct
• The main pancreatic duct, together with the bile duct enters the
duodenum at the site of the major papilla (site of entrance of
accessory duct when present)

• In 3rd month ,pancreatic islets of Langerhan’s develop from the

parenchymatous pancreatic tissue & scatter throughout the pancreas

• Insulin secretion starts at approximately 5th month

• Visceral mesoderm surrounding the pancreatic buds forms the

pancreatic connective tissue
• ANNULAR PANCREAS:
• It results from the growth of a bifid ventral pancreatic bud around
the duodenum which fuses with the dorsal pancreatic bud to form
a ring of pancreatic [Link] this anomaly the second part of
duodenum is surrounded by a thin,flat band of pancreatic tissue
• QUESTION 10
• What is the differentiation of cloaca? (3marks)
• How does the excretory system of kidney develop? (3marks)
• What is pelvic kidney (1 mark)
•
 ANSWER a)
The cloaca is an endoderm lined cavity covered at its ventral boundary by surface ectoderm. Two things enter in it
1. The terminal portion of hindgut in the posterior region of cloaca, the primitive anorectal canal
2. The allantois in the anterior region, the primitive urogenital sinus (0.5 mark for naming the two parts)
A layer of mesoderm, uro-rectal septum separates these two regions. (0.5 mark)

Anal part: As the embryo grows and caudal folding continues, tip of urorectal septum comes to lie close to
cloacal membrane. At the end of 7th week, the membrane ruptures, creating anal opening for hindgut and ventral
opening for uro-genital sinus. (0.5mark)

Urogenital part: Three portions

1. Upper part: Forms urinary bladder in both males and females (0.5 mark)
2. Pelvic part (second part which is narrow): In males, it forms membranous and prostatic parts of urethra. In
females, urethra and sinovaginal bulbs (structures that eventually form inferior 2/3rd of vagina). (0.5 mark)
3. Phallic part (last part): In males, it forms penile urethra. In females, it forms urethra and vestibule of vagina.
(0.5 mark)
 ANSWER b)
The excretory system of kidney comprise of tubules of the kidney which form nephron, together with
glomeruli. (0.5 mark)
They develop from metanephric mesoderm. (0.5 mark)
• Each newly formed collecting tubule is covered at its distal end by a metanephric tissue cap. (0.5 mark)
• Under the inductive influence of the tubule, cells of the tubule form vesicles, the renal vesicles. (0.5 mark)
• Vesicles give rise to S-shaped tubules. Capillaries grow into pocket at one end of the S and differentiate
into glomeruli. The proximal end of each nephron forms Bowman’s capsule. (0.5 mark)
• The distal end forms an open connection with one of the collecting tubules, establishing a passageway
from Bowman’s capsule to collecting unit. Continuous lengthening of the excretory tubule results in
formation of proximal convoluted tubule, loop of Henle and distal convoluted tubule. (0.5 mark)
 ANSWER c)
Normally, the ascent of kidneys is caused by diminution or lengthening of body
curvature and by growth of the body in lumbar and sacral regions. (0.5 mark)
During their ascent, kidneys pass through arterial fork formed by the umbilical
arteries but occasionally one of them fails to do so and remain in the pelvis, close
to common iliac artery. It is called pelvic kidney. (0.5 mark)