Second year anatomy exam 6-2013

Tanta University second Year Final Anatomy Exam. (Egyptians) Faculty of Medicine Number of Questions: 6 Anatomy Department Time Allowed: 3 Hours24/6/2013 Total: 125 Marks

Very Important: each part of question must be written in a separate page

QUESTION (1) (Head)…………………………………….(22 MARKS) :

A- Enumerate the structures within the parotid gland from superficial to deep (diagram not needed). Mention surface anatomy of the parotid gland………………………………………………………….(5 marks)

B- Enumerate the branches of posterior division of mandibular nerve and discuss only one of them (diagram needed)……………………………………………………………………………………………...(5 marks)

C- Draw a diagram showing the relations of cavernous sinus. Mention its applied anatomy….(5 marks)

D- Discuss the roots of ciliary ganglion (diagram not needed)………………………………………(4 marks) E- Problem solving (3 marks):After a car accident, 40 years old man was admitted to the hospital with head trauma and loss of consciousness. X ray examination revealed fracture at the region between frontal, greater wing of sphenoid, parietal and squamous temporal bones of the skull.1- Name the site of fracture…………………………………………………………………………………...(1 mark)2- Which artery is suspected to be injured and what is its origin ……………………………………(1 mark)3- Through which foramen this artery enters the cranial cavity…………….…………………………(1 mark)_______________________________________________________________________________________

QUESTION (2) (Neck& Cavities)………..………………(21 MARKS):

A- Enumerate the tributaries of external jugular vein (diagram not needed). Mention its surface anatomy…………………………………………………………………………………………………………(4 marks)

B- Draw a diagram showing the deep relations of the mylohyoid muscle………………….……..(5 marks) C- Discuss the origin, course and branches of the superior thyroid artery (diagram not needed)………………………………………………………………………………………………………....(5 marks)

D- Describe the anterior and posterior walls of tympanic cavity (diagram needed)……..……….(4 marks)

E- Problem solving (3 marks):An 11 years old girl went to the hospital suffering from recurrent bleeding from her nose.1- What is the name of this condition?................................................................................................(1 mark)2- What is the common area of bleeding……………………………………………………………...……(1 mark)3- Name the arteries anastomose in this area…………………………………………………………….(1 mark)_______________________________________________________________________________________

QUESTION (3) (Neuroanatomy)………………………(22 MARKS) :

A- Discuss the origin, course and end of the corticospinal tracts (diagram not needed)……....(6 marks)

B- Write short notes about branchiomotor nuclei and nucleus solitarius in the brain stem (diagram not needed)………………………………………………………………………………………………………….(5 marks)

C- Describe the different thalamic nuclei (diagram needed)………………………………………….(6marks)

D- Define the insula and mention its sulci, gyri, contents and opercula (diagram needed) ……………………………………………………………………………………………………………………(5marks

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QUESTION (4) (Lower limb)…………..………………(22 MARKS) :

A- Discuss the perforating arteries and enumerate the arteries sharing in the cruciate anastomosis (diagram needed). Mention the surface anatomy of femoral artery………………………………….(5 marks)

B- Enumerate the lateral rotators of the thigh and mention their nerve supply (diagram not needed)………………………………………………………………………………………………………….(4 marks)

C- Discuss the origin, course and termination of the common peroneal (lateral popliteal) nerve (diagram not needed)…………………………………………………………………………………………(5marks)

D- Mention the site, attachments and structures deep to the inferior extensor retinaculum (diagram not needed)…………………………………………………………………………………….....................(5 marks)

E- Problem solving (3 marks):After an operation of hip joint replacement through the transgluteal approach (by cutting the gluteus medius), a 60 years old patient could not walk normally.1- Which nerve is suspected to be injured? ……..………...............................................................(0.5 mark)2- Enumerate the muscles supplied by it ………………………………………………………………(1.5 mark)3- What is the effect of injury of this nerve and the name of gate in unilateral and bilateral injury……………………………………………………………………………………………………………(1 mark)_______________________________________________________________________________________

QUESTION (5) (Special Embryology)..……………..(13 MARKS) :

A- Enumerate embryological origins of the diaphragm and its congenital anomalies………….(5 marks)

B- Mention the fate of bubus cordis, truncus arteriosus and ventral aortic sac………………….(4 marks)

C- Enumerate the derivatives of the hepato-biliary diverticulum (hepatic bud)…………………..(4 marks)_______________________________________________________________________________________

QUESTION (6): MCQ……………………………………(25 MARKS):

(25) Questions. Mark only the letter of chosen answer in the MCQ page of the answer paper

Oral Examination:

Tuesday 25/6/2013: At 8.5 o'clock From 1 to 225 At 10 o'clock From 226 to 450

Wednesday 26/6/2013: At 8.5 o'clock From 451- the end of list

With My Best Wishes

Chairman of Department: Prof. Dr. Mona Zoair

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QUESTION (6) MULTIPLE CHOICE QUESTIONS (25 MARKS)

Mark only the letter of the chosen answer (A or B or C or D ) of 25 questions in the MCQ page at the end of the answer paper.

Choose the correct answer:

1- Auricularis posterior muscle is supplied by:A) Temporal branch of facial nerve B) Posterior auricular branch of facial nerve C) Zygomatic branch of facial nerve D) Lesser occipital nerve

2- The action of orbital part of orbicularis occuli is:A) Compressing the contents of orbit B) BlinkingC) Direction of tears to lacrimal sac D) Supporting the lower eye lid against gravity

3- The following structure lies superficial to the medial ptreygoid muscle:A) Superior constrictor muscle B) Stylopharyngeus muscle C) Ascending palatine branch of facial artery D) Sphenomandibular ligament

4- Retraction of mandible is done by: A) Superficial fibres of masseter B) Medial pterygoid muscle C) Posterior fibres of temporalis D) Lateral pterygoid muscle

5- the following dural venous sinus lies in the lower concave border of falx cerebri:A) Straight sinus B) Inferior sagittal sinusC) Sphenoparietal sinus D) Occipital sinus

6- The lateral palbebral artery arises from:A) Lacrimal artery B) Ophthalmic arteryC) Supraorbital artery D) Supratrochlear artery

7- The following nerve lies between sternomastoid muscle and scalenus anterior muscle:A) Vagus nerve B) Spinal accessory nerveC) Phrenic nerve D) transverse cervical nerve

8- The following artery lies along the lower border of posterior belly of digastric muscle:A) Lingual artery B) Facial arteryC) Posterior auricular artery D) Occipital artery

9- The deep part of submandibular salivary gland is related medially to:A) Hyoglossus and styloglossus muscles B) Posterior belly of digastrics and stylohyoid musclesC) Lingual nerve D) Hypoglossal nerve

10- External carotid artery begins opposite:A) Disc between 2nd and 3rd cervical vertebrae B) Disc between 3rd and 4th cervical vertebraeC) Disc between 4th and 5th cervical vertebrae D) Disc between 5th and 6th cervical vertebrae

11- Glossopharyngeal nerve supplies the following muscle :A) Stylohyoid muscle B) Styloglossus muscleC) Stylopharyngeus muscle D) Palatopharyngeus muscle

12 -The following muscle of the palate is supplied by nerve to medial pterygoid:A) Musculus uvulae B) Tensor palatiC) Levator veli palatini D) Palatoglossus

13- The following structure lies between middle and inferior constrictors of pharynx:A) Auditory tube B) Glossopharyngeal nerveC) Internal laryngeal nerve D) Recurrent laryngeal nerve

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14- The dura mater of the spinal cord extends below to the level of:

A) 1st sacral vertebra B) 2nd sacral vertebraC) 3rd sacral vertebra D) 4th sacral vertebra

15- The following tract lies in the ventral column of the spinal cord:A) Tectospinal tract B) Rubro-spinal tract C) Lateral reticulo-spinal tract D) Lateral cortico-spinal tract 16- The Facial nerve does not have the following functional component:A) Special visceral efferent (SVE) B) General visceral efferent (GVE)C) General visceral afferent (GVA) D) Special visceral afferent (SVA)

17- Superior cerebellar peduncle contains the following fibres:A) Vestibulo-cerebellar fibres B) Olivo- cerebellar fibresC) Dorsal spino-cerebellar tract D) Ventral spino-cerebellar tract

18- Regarding the floor of fourth ventricle, the Inferior fovea overlies:A) Hypoglossal trigone B) Dorsal nucleus of vagusC) Upper vestibular area D) Lower vestibular area

19- The basal vein of the brain drains into:A) Anterior cerebral vein B) Deep middle cerebral veinC) Great cerebral vein D) Superior choroid vein

20- Antero- lateral wall of adductor canal is formed by:A) Vastus medialis muscle B) Adductor longus muscleC) Adductor magnus muscle D) Sartorius muscle

21- Semitendinosus muscle arises from:A) Upper lateral part of upper area of ischial tuberosity B) Lower medial part of upper area of ischial tuberosity C) Lateral part of lower area of ischial tuberosity D) Medial part of lower area of ischial tuberosity

22- In the middle 1/3 of the leg the anterior tibial artery lies between:A) Tibialis anterior medially and extensor digitorum longus laterallyB) Tibialis anterior medially and extensor hallucis longus laterallyC) Extensor hallucis longus medially and extensor digitorum longus laterallyD) Extensor digitorum longus medially and extensor hallucis longus laterally

23- The following structure is the most medial structure deep to the superior extensor retinaculum: A) Anterior tibial vessels B) Anterior tibial nerveC) Extensor hallucis longus D) Tibialis anterior

24- The action of peroneus tertius muscle is:A) Dorsiflexion and inversion B) Planter flexion and inversionC) Dorsilexion and eversion D) Planter flexion and eversion

25- The following muscle of the sole is supplied by lateral planter nerve:A) Flexor digitorum accessorius B) Flexor digitorum brevisC) Flexor hallucis brevis D) Abductor hallucis

END OF THE EXAM

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Answer Key For MCQ Questions

) Egyptian Anatomy Exam ( 1- B)

2- A)

3- D)

4- C)

5- B)

6- A)

7- C)

8- D)

9- A)

10- B)

11- C)

12- B)

13- C)

14- B)

15- A)

16- C)

17- D)

18- B)

19- C)

20- A)

21- B)

22- B)

23- D)

24- C)

25- A)

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ANATOMY DEPARTMENT:

MODEL ANSWER OF SECOND YEAR FINAL ANATOMY EXAMINATION (Egyptians) 24/6/2013

QUESTION (1) (HEAD)………(22 MARKS) :

1- A- The structures within the parotid gland from superficial to deep (diagram not needed). Mention its surface anatomy (5 marks):

The structures within the gland from superficial to deep:- Facial nerve- Posterior facial vein- External carotid artery

Surface anatomy of parotid gland:- It is marked by joining the following 4 points:1- a point on the upper part of mastoid process.2- a point at the head of the mandible.3- a point just above the center of masseter muscle.4- a point 2 cm below and behind the angle of mandible. - Anterior border is represented by a line joining points 2,3&4. - Concave upper border corresponds to a curved line between points 1,2.- Posterior border is indicated by a straight line between points 1,4. ____________________________________________________________________

1- B- The branches of posterior division of mandibular nerve and discussion of only one of them (diagram needed) (5 marks)

The branches of posterior division of mandibular nerve:- Auriculotemporal nerve- Lingual nerve- Inferior alveolar nerve

The discussion of only one of them (any one)

1- Auriculo-temporal nerve (sensory) : Arises by two roots that surround the middle meningeal artery. The nerve runs backward medial to the neck of the mandible . Then it ascends behind the temporomandibular joint and the superficial temporal vessels. It gives: * Sensory fibers to : - the skin of the external acoustic meatus, auricle and temple. - temporo-mandibular joint and parotid gland. * Postganglionic parasympathetic secretory fibers from the otic ganglion to the parotid gland.

12- Lingual nerve

- It appears at the lower border of the lateral pterygoid infront of the inferior alveolar nerve.

- It descends superficial to the medial pterygoid where it is joined by the chorda tympani , branch of the facial nerve , at an acute angle.

- It passes on the inner aspect of the mandible close to the medial side of the root of the 3rd molar tooth.

- Then, it reaches the floor of the mouth where it is related to the lateral surface of the hyoglossus muscle. Here : * The submandibular ganglion is suspended from the ligual nerve. * It receives a communication from the hypoglossal nerve.

- Near the anterior border of the hyoglossus it hooks around the submandibular duct to ascend medial to it.

- Both the nerve and duct then pass upwards between the genoglossus and sublingual gland to reach the tongue.

- It carries general sensations from the anterior 2/3 of the corresponding half of the tongue

- The chorda tympani fibres which are included with it carry: * Taste fibres from the anterior 2/3 of the tongue.

* Preganglionic secretomotor which relay in the submandibular ganglion to supply the submandibular and sublingual salivary glands.

3- Inferior alveolar nerve:- It appears at the lower border of the lateral pterygoid behind the lingual nerve.- It descends superficial to the medial pterygoid ,on the lateral surface of the

sphenomandibular ligament. - It then enters the mandibular canal through the mandibular foramen and runs forward

below the teeth.- It gives the following branches:- * Mylohyoid nerve:

- It pierces the sphenomandibular ligament, runs in the mylohyoid groove, lies superficial to the mylohyoid muscle and supplies :

a- Mylohyoid muscle & b- Anterior belly of digastric muscles.

* Branches to the teeth of the lower jaw and the associated gums. * Terminal branches: Below the second premolar tooth, it end by dividing into :

a- Mental nerve : Emerges through the mental foramen to supply the skin of the lower jaw Incisive branch: Supplies the lower incisors.

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1- C- A diagram showing the relations of cavernous sinus and its applied anatomy (5 marks)

Applied anatomy of cavernous sinusCavernous sinus thrombosis:Causes:

Spread of superficial infection from the lips and face via anterior facial and superior ophthalmic veins.

Suppurations in the orbit or nasal cavities and sinuses along ophthalmic veins. Spread of deep infection of the face through pterygoid venous plexus.

Symptoms and Sings: Oedema of conjunctiva and eyelids, exophthalmos, ophthalmoplegia, papilloedema and may spread to meninges.

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1- D- The roots of ciliary ganglion (diagram not needed) (4 marks) Sensory root: - Comes from the nasociliary nerve. - The fibers pass through the ganglion without relay- They carry sensation from the cornea, iris and choroid through the short ciliary nerves. Sympathetic root: - Comes from the plexus around the internal carotid artery.- It consists of postganglionic fibers from the superior cervical sympathetic ganglion.- They traverse the ganglion without relay and reach the eye through the short ciliary nerve to supply the dilator pupillae muscle and the blood vessels of eye. Parasympathetic root : - Runs with the nerve to inferior oblique.- It is formed from preganglionic parasympathetic fibers which originate from the Edinger-Westphal nucleus and pass through the oculomotor nerve.- They relay in the ciliary ganglion - The postganglionic fibers reach the eyeball through the short ciliary nerve to supply the sphincter pupillae and ciliary muscle.____________________________________________________________________

1- E- Problem solving (3 marks):

1- The region of fracture is pterion2- Middle meningeal artery arises from first part of maxillary artery.3- Through foramen spinosum.

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QUESTION (2) (NECK& CAVITIES)……(21 MARKS)

2- A- The tributaries of external jugular vein (diagram not needed) and its surface anatomy (4 marks)

Tributaries:- Posterior auricular vein.- Posterior division of the posterior facial vein- Posterior external jugular vein- Transverse cervical vein - Suprascapular vein

- - Anterior jugular veins.

Surface anatomy:- It is drawn by joining the following 2 points:1- A point a little below and behind the angle of the mandible.2- A point on the clavicle just lateral to the posterior border of the sternomastoid.____________________________________________________________________

2-B- A diagram showing the deep relations of the mylohyoid muscle (5 marks)

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2- C- The origin, course and branches of the superior thyroid artery (diagram

not needed)(5 marks)

Origin: Arises from the anterior aspect of the external carotid artery at a level below the greater cornu of hyoid Course: It curves downwards and forwards to reach the upper pole of thyroid gland.

It is accompanied by the external laryngeal nerveBranches: It gives the following branches: - Glandular branches *Anterior: On the medial border of thyroid and anastomose with that of opposite side *Posterior: On the back of thyroid and anastomose with the inferior thyroid artery.- Infrahyoid branch: Runs along the lower border of hyoid bone. - Superior laryngeal: Accompanies the internal laryngeal nerve and pierces the

thyrohyoid membrane- Cricothyroid: Runs on the cricothyroid membrane- Branch to sternomastoid muscle ____________________________________________________________________

2- D-The anterior and posterior walls of tympanic cavity (diagram needed) (4 marks)

Anterior wall - Its lower part is formed by a thin plate of bone which separates the tympanic cavity from the internal carotid artery

- Its upper part presents 2 openings for 2 canals: *The upper is the canal for the tensor tympani muscle *The lower is the opening for the auditory tube . Posterior wall

Above: - It shows a large irregular opening ; which is the aditus to the mastoid antrum Below:- - There is a small hollow conical projection ; called the pyramid - - From the apex of the pyramid emerges the tendon of stapedius muscle

____________________________________________________________________

2- E- Problem solving (3 marks): 1- The condition is called epistaxis.2- The common area of bleeding is the Little's area in the region of the vestibule.

- 3- The arteries that anastomose in this area are Anterior ethmoidal artery, septal

branch of superior labial artery of facial and sphenopalatine artery.

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QUESTION (3) (NEUROANATOMY)………………(22 MARKS) :

3- A- T h e origin, course and end of the corticospinal tracts (diagram not needed).(6 marks)origin: Motor area (area 4 or precentral area or pyramidal area) of the cerebralhemisphere.course: It descends as a thick motor tract through porta cerebri i.e. internal capsule to pass into the midbrain, the pons and open medulla oblongata. In open medulla, it bulges on the surface just medial to the olive. This bulge is called pyramid. On following the pyramidal tract downwards to the closed medulla, it decussates making motor decussation. Not all its fibers decussate but only 20% of the tract descends on the same side. However, at the spinal level these 20% fibers decussate to the opposite side.end : The 80% of the tract ends on the opposite somato-motor nuclei of the spinal cord._________________________________________________________________

3- B- Short notes about branchiomotor nuclei and nucleus solitarius in the brain stem (diagram not needed) (5 marks)

Branchiomotor nuclei:They are arranged along other vertical plane near the surface of the brain stem. These include, the 5th cranial (trigeminal), 7th cranial (facial) in the pons and 9th (glossopharygeal), 10th cranial (vagus) and 11th cranial (accessory) nerves in medulla. These cranial nerves supply muscles that originate from the branchial arches. Their functional components are SVE.

Nucleus Solitarius:This is sensory nucleus. It is located into the pons and medulla being medial to the spinal nucleus of trigeminal. It is divided into large lateral part and small medial part. The large lateral part receives taste sensations through the facial, glossopharyngeal and vagus nerves. This part of the solitary nucleus is special (taste) viscerosensory nucleus. Their afferents are SVA. The small medial part receives general sensations from the visceral structures i.e GVA.

73- C- The different thalamic nuclei (diagram needed).(6 marks)

1- Anterior group of nuclei: lies between the two short anterior limbs of Y shaped internal medullary lamina.2- Medial group of nuclei: lies medial to internal medullary lamina.3- Lateral group of nuclei (dorso-lateral nuclei): lies lateral to internal medullary lamina in dorsilateral part of thalamus.4- Posterior group of nuclei: lies in the pulvinar 5- Ventral group of nuclei: lies ventral to internal medullary lamina and divided into:

- Anterior group (ventro- anterior) - Intermediate group (ventro-lateral) - Posterior group subdivided into lateral part (ventro-postero-lateral VPL) And medial part (ventro-postero-medial VPM)

6- Other small nuclei:- Intra-laminar in the internal medullary lamina - Reticular nuclei in external medullary lamina - Midline nuclei on medial surface of thalamus.____________________________________________________________________

3- D- Definition, sulci, gyri, contents and opercula of the insula (diagram needed) (5 marks)

Definition: Is the part of the cerebral cortex buried in the floor of the lateral sulcus.It is pyramidal in shape and its apex is called limen insula.

Sulci and gyri: It is surrounded by a circular sulcus.It is divided by short and long sulci into 3 or 4 short gyri and one long gyrus.

Contents: The middle cerebral artery and the deep middle cerebral veins

Opercula: The edges of the lateral sulcus are termed the opercula of the insula.Parts of the opercula of the insula:1- Frontoparietal operculum; lies between the ascending ramus and the upturned end of the posterior ramus of the lateral sulcus.2- Frontal operculum; lies between the anterior and ascending rami of the lateral sulcus.3- Orbital operculum; is the part of the inferior frontal gyrus between the stem and anterior horizontal ramus of the lateral sulcus.4- Temporal operculum; lies inferior to the posterior ramus and is formed by the superior temporal gyrus.

8 QUESTION (4) (LOWER LIMB)…………(22 MARKS)

4- A-The perforating arteries and the arteries sharing in the cruciate anastomosis (diagram needed)& The surface anatomy of femoral artery (5 marks)

Perforating arteries :- There are 4 perforating arteries which perforate the adductor magnus to reach the

back of the thigh.- The 1st 3 perforators arise as branches from the profunda artery.-The 4th perforator is the termination of the profunda femoris artery itself.-On the back of the thigh they share in a longitudinal anastomotic channelArteries sharing in Cruciate anastomosis:

On the back of the thigh at the level of lesser trochanter between the following arteries: Transverse branch of lateral circumflex femoral artery. Transverse branch of medial circumflex femoral artery. Descending branch of the inferior gluteal artery. Ascending branch of 1st perforator artery.

____________________________________________________________________4- B- The lateral rotators of the thigh and their nerve supply (diagram not needed) (4 marks)- Piriformis muscle: supplied by ventral rami of 1st and 2nd sacral nerves.- Obturator internus: Supplied by nerve to obturator internus ventral rami of L5,S1,2- Superior gemellus: Supplied by nerve to obturator internus ventral rami of L5,S1,2- Inferior gemellus: Supplied by nerve to quadratus femoris (L. 4,5,S.1).- Quadratus femoris: Supplied by nerve to quadratus femoris (L. 4,5,S.1).- Obturator externus: Supplied by posterior division of obturator nerve (L.2,3&4).

_________________________________________________________________________________________

4- C-The origin, course, relations and termination of the common peroneal (lateral popliteal) nerve (diagram not needed) (5 marks)

Origin:It is the lateral and smaller of the 2 terminal branches of the sciatic nerve about the middle of the back of the thigh ( at the junction of middle 1/3 and lower 1/3 of the

thigh). Course and relations:

It enters the popliteal fossa through its upper angle lateral to the medial popliteal nerve.

It descends downwards and laterally along the medial border of biceps femoris muscle.

It leaves the fossa through its lateral angle It descends behind the head of fibula then curves forwards around its neck inside

the substance of peroneus longus muscle where it terminates. Termination:

At the lateral aspect of neck of fibula .It divides into : -Anterior tibial nerve (deep peroneal nerve).

-Musculocutaneous nerve (superficial peroneal nerve) .9

4- D- The site, attachments, structures deep to the inferior extensor retinaculum (diagram needed).(5 marks)

Site: In front of ankle joint below the superior retinaculum.

Attachments: It is Y- shaped band of deep fascia in front of the ankle joint - The stem of the Y is laterally placed . It is attached to the anterior part of the

upper surface of calcaneous.- - The upper band of Y is attached to the anterior margin of the medial malleolus.- - The lower band of Y is attached to the deep fascia of sole.

Deep structures: from medial to lateral- Tibialis anterior muscle- Extensor hallucis longus muscle- Dorsalis pedis artery- Anterior tibial nerve- Extensor digitorum longus muscle- Peroneus tertius muscle

____________________________________________________________________

4- E- Problem solving (3 marks): 1- The suspected nerve to be injured is superior gluteal nerve. (0.5 mark)2- It supplies gluteus medius, gluteus minimus and tensor fascia lata. (1.5 marks)3- The effect of its injury is drop pelvis of the opposite side so, the patient sways (waddles) on the paralysed side to clear the opposite foot off the ground. - The types of gate :-In unilateral injury this gait is called Lurching gait. - In bilateral injury this gait is called Waddling gait. (1 mark)

10QUESTION (5) (SPECIAL EMBRYOLOGY)..……… (13 MARKS):

5- A- Embryological origins of the diaphragm and its congenital anomalies (5 marks)

1- Septum transversum forms the muscle and central tendon. 2- Pleuro- peritoneal membranes forms the dorsi-lateral parts of the diaphragm. 3- Mesoderm of the thoracic wall forms the peripheral muscular part. 4- Mesentery of the oesophagus forms the crura of the diaphragm. Congenital anomalies: 1- Congenital diaphragmatic hernia. 2- Oesophageal hiatal hernia. 3- Parasternal hernia. _________________________________________________________________

5- B- The fate of bubus cordis, truncus arteriosus and ventral aortic sac (4 marks)

1 - Bulbus cordis: distal bulbar septum divides it longitudinally into -Smooth part of the right ventricle (Infundibulum).

-Smooth part of the left ventricle (Aortic vestibule) .

2 - Truncus arteriosus: spiral aortic-pulmonary septum divides it into -Proximal part of the pulmonary trunk (anterior half) -Proximal part of the ascending aorta (posterior half)

3 - Ventral aortic sac: is divided into left and right parts -The left part forms the proximal part of the arch of aorta and becomes continuous

with left 4th aortic arch. -The right part forms the innominate artery and becomes continuous with right 3rd and

4th arches.____________________________________________________________________

5- C- The derivatives of the hepato-biliary diverticulum (hepatic bud) (4 marks)

Hepatic bud divides into: - Cranial portion (pars hepatica) which divides into right and left branches

- Caudal portion (pars cystica)

Derivatives:1 -Right and left branches of pars hepatica forms columns of hepatic cords and right

and left hepatic ducts after canalization.2 -The stem of pars hepatica forms the common hepatic duct.

3 -The end of pars cystica forms the gall bladder.4 -The narrow stem of pars cystica forms the cystic duct.5 -The stem of hepatic bud forms the common bile duct

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Tanta University Second Year Final Anatomy Exam. (Malaysians) Faculty of Medicine Number of Questions: 6 Anatomy Department Time Allowed: 3 Hours24/6/2013 Total: 125 Marks

Very Important: each part of question must be written in a separate page

QUESTION (1) (Head)…………………………………….(22 MARKS) :

A- Enumerate the arterial supply of the face and their origin (diagram not needed). Mention the surface anatomy of facial artery…………………………………………………………………..(6 marks)

B- Draw a diagram showing the branches of maxillary nerve……………………………….(5 marks)

C- Discuss the attachments of tentorium cerebelli (diagram not needed). Enumerate the dural venous sinuses related to it………………………………………………………………………..(6 marks)

D- Enumerate The branches of nasociliary nerve and the areas supplied by them (diagram not needed)………………………………………………………………………………………………...(5 marks)______________________________________________________________________________

QUESTION (2) (Neck& Cavities)………..………………(21 MARKS):

A- Discuss the relations of the deep part of submandibular salivary gland (diagram needed)………………………………………………………………………………………………...(5 marks)

B- Draw a diagram showing the boundaries and contents of carotid triangle…………...(4 marks)

C- Enumerate the branches of external carotid artery (diagram not needed). Mention its surface anatomy………………………………………………………………………………………………..(5 marks)

D- Describe the medial wall of the tympanic cavity (diagram needed)…………………….(4 marks)

E- Problem solving (3 marks):After tonsillectomy operation (removal of palatine tonsil), a 10 years old girl was admitted to the hospital with bleeding and loss of sensation from the posterior 1/3 of the tongue.1- What is the source of bleeding…………………………………………………………………..(1 mark)2- What is the venous drainage of palatine tonsil……………………………………………….(1 mark)3- What was the cause of loss of sensation from posterior 1/3 of tongue………………… (1 mark)________________________________________________________________________________

QUESTION (3) (Neuroanatomy)………………………(22 MARKS) :

A- Enumerate the sensory and motor nuclei of spinal cord (diagram not needed)……..(5 marks)

B- Discuss the afferent fibers in the inferior cerebellar peduncle (diagram needed)…...(6 marks)

C- Mention the structures forming floor, anterior and posterior walls of the third ventricle (diagram needed)…………………………………………………………………………………….(6 marks)

D- Discuss the course and branches of the vertebral artery in the cranial cavity (diagram not needed)………………………………………………………………………………………………...(5 marks)

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QUESTION (4) (Lower limb)…………..………………(22 MARKS) :

A- Discuss origin, course and branches of the superior gluteal nerve (diagram not needed)………………………………………………………………………………………………...(4 marks)

B- Enumerate the boundaries and contents of the popliteal fossa (diagram needed)….(5 marks)

C- Discuss the branches of the anterior tibial artery (diagram not needed)……………...(5 marks)

D- Mention origin, insertion, nerve supply and action of peroneus longus muscle…….(4 marks)

E- Enumerate the site, attachments and structures deep to the flexor retinaculum (diagram needed)…………………………………………………………………………………………..........(4 marks)_________________________________________________________________________________

QUESTION (5) (Special Embryology)..……………..(13 MARKS) :

A- Discuss the congenital anomalies of the vertebral column………………………………(4 marks)

B- Mention the summary for the fate of sinus venosus……………………………………....(5 marks)

C- Discuss the congenital anomalies of the stomach………………………………………...(4 marks)_________________________________________________________________________________

QUESTION (6): MCQ……………………………………(25 MARKS):

(25) questions. Mark only the letter of chosen answer in the MCQ page of the answer paper

Oral Examination:

Wednesday 26/6/2013: At 10 o'clock From 1 to the end of the list

With My Best Wishes

Chairman of Department: Prof. Dr. Mona Zoair

2QUESTION (6) MULTIPLE CHOICE QUESTIONS (25 MARKS)

Mark only the letter of the chosen answer (A or B or C or D ) of 25 questions in the MCQ page at the end of the answer paper.

Choose the correct answer:

1- Auricularis Anterior muscle is supplied by:A) Temporal branch of facial nerve B) Posterior auricular branch of facial nerve C) Zygomatic branch of facial nerve D) Lesser occipital nerve

2- The action of palpebral part of orbicularis occuli is:A) Compressing the contents of orbit B) BlinkingC) Direction of tears to lacrimal sac D) Closure of the eye tightly to protect it from sudden injury

3- The following structure lies superficial to the lateral ptreygoid muscle:A) Mandibular nerve and its branches B) Middle meningeal artery C) Pterygoid venous plexus D) Sphenomandibular ligament

4- Depression of mandible is done by: A) Superficial fibres of masseter B) Medial pterygoid muscle C) Posterior fibres of temporalis D) Lateral pterygoid muscle

5- The following dural venous sinus occupies the upper covex border of falx cerebri:A) Superior sagittal sinus B) Inferior sagittal sinusC) Sphenoparietal sinus D) Straight sinus

6- The medial palbebral artery arises from:A) Lacrimal artery B) Ophthalmic arteryC) Supraorbital artery D) Supratrochlear artery

7- The following nerve lies deep to sternomastoid muscle and enclosed in the carotid sheath:A) Vagus nerve B) Spinal accessory nerveC) Phrenic nerve D) transverse cervical nerve

8- The following artery lies along the upper border of posterior belly of digastric muscle:A) Lingual artery B) Facial arteryC) Posterior auricular artery D) Occipital artery

9- The superficial part of submandibular salivary gland is related laterally to:A) Hyoglossus muscle B) Medial pterygoid muscleC) Lingual nerve D) Mylohyoid muscle

10- Superior cervical sympathetic ganglion lies opposite:A) Second and third cervical vertebrae B) Neck of 1st ribC) sixth cervical vertebra D) Third and fourth cervical vertebrae

11- Spinal root of accessory nerve supplies the following muscle :A) Sternomastoid muscle B) Styloglossus muscleC) Stylopharyngeus muscle D) Palatopharyngeus muscle

12 -The following muscle of the pharynx is supplied by glossopharyngeal nerve:A) Palatopharyngeus B) StylopharyngeusC) Salpingopharyngeus D) Superior constrictor

13- The following structure lies between superior and middle constrictors of pharynx:A) Auditory tube B) Internal laryngeal nerveC) Glossopharyngeal nerve D) Recurrent laryngeal nerve

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14- The arachnoid mater of the spinal cord extends below to the level of:

A) 1st sacral vertebra B) 2nd sacral vertebraC) 3rd sacral vertebra D) 4th sacral vertebra

15- The following tract lies in the lateral column of the spinal cord:A) Tectospinal tract B) Rubro-spinal tract C) Medial reticulo-spinal tract D) Ventral cortico-spinal tract 16- The trigeminal nerve does not have the following functional component:A) Special visceral efferent (SVE) B) General visceral afferent (GVA)C) General visceral efferent (GVE) D) General somatic afferent (GSA)

17- Posterior limb of the internal capsule has arterial supply from:A) Middle cerebral artery B) Posterior cerebral arteryC) Posterior communicating artery D) Anterior choroidal artery 18- The inter-peduncular fossa is bounded by:A) The optic chiasma anterolaterally B) The optic tract anteriorlyC) The crus cerebri posterolaterally D) The upper border of the medulla posteriorly 19- The superficial middle cerebral vein ends in:A) Basal vein B) Cavernous sinusC) Superior sagittal sinus D) Superior choroid vein

20- Antero- medial wall of adductor canal is formed by:A) Vastus medialis muscle B) Adductor longus muscleC) Adductor magnus muscle D) Fascia covered by Sartorius muscle

21- Semimembranosus muscle arises from:A) Upper lateral part of upper area of ischial tuberosity B) Lower medial part of upper area of ischial tuberosity C) Lateral part of lower area of ischial tuberosity D) Medial part of lower area of ischial tuberosity

22- In the upper 1/3 of the leg the anterior tibial artery lies between:A) Tibialis anterior medially and extensor digitorum longus laterallyB) Tibialis anterior medially and extensor hallucis longus laterallyC) Extensor hallucis longus medially and extensor digitorum longus laterallyD) Extensor digitorum longus medially and extensor hallucis longus laterally

23- The following structure is the most lateral structure deep to the superior extensor retinaculum: A) Anterior tibial vessels B) Extensor hallucis longusC) Peroneus tertius D) Tibialis anterior

24- The action of peroneus brevis muscle is:A) Inversion and dorsiflexion B) Inversion and planter flexion C) Eversion and dorsiflexion D) Eversion and planter flexion

25- The following muscle of the sole is supplied by medial planter nerve:A) Flexor digitorum accessorius B) Flexor digiti minimi brevisC) Flexor hallucis brevis D) Adductor hallucis

END OF THE EXAM

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Answer Key For MCQ Questions

) Malaysian Anatomy Exam ( 1- A)

2- B)

3- C)

4- D)

5- A)

6- B)

7- A)

8- C)

9- B)

10-A)

11-A)

12-B)

13-C)

14-B)

15-B)

16-C)

17-D)

18-C)

19-B)

20-D)

21-A)

22-A)

23-C)

24-D)

25-C)

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ANATOMY DEPARTMENT: MODEL ANSWER OF SECOND YEAR

FINAL ANATOMY EXAMINATION (Malaysians) 24/6/2013 QUESTION (1) (HEAD)………(22 MARKS) :

1- A- The arterial supply of the face and their origin& the surface anatomy of facial artery (6 marks) Arterial supply of face: 1- Facial artery arises from external carotid artery 2- Superficial temporal artery arises from external carotid artery 3- Supra-orbital & supratrochlear arteries : Arise from the ophthalmic artery. 4- Dorsal nasal artery : Branch of the ophthalmic artery. 5- Infra-orbital artery : Arises from the 3rd part of maxillary artery 6- Medial palpebral arteries: Branches of the ophthalmic artery and supply the medial parts of both eyelids.

7- Lateral palpebral arteries: Branches of the lacrimal artery and supply the lateral parts of both eyelids . 8- Buccal artery: Branch of the 2nd part of the maxillary artery 9- Mental artery: Branch of the inferior alveolar artery.10- Zygomatico-facial artery: arises from lacrimal artery

Surface anatomy of facial artery It is marked on the face as a tortuous line joining the following 3 points:

1- A point on the lower border of the mandible at the anterior border of the masseter. 2- A point half an inch lateral to the angle of the mouth. 3- A point at the medial angle of the eye. _____________________________________________________________________1- B- A diagram showing the branches of maxillary nerve (5 marks)

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1- C- The attachments of tentorium cerebelli (diagram not needed). Enumerate

the dural venous sinuses related to it (6 marks)

Attachments: It has 2 margins:* The attached peripheral margin : Attached to:- The posterior clinoid process- Upper border of the petrous part of temporal bone enclosing the superior petrosal sinuses. - The margins of the grooves for the transverse sinuses on the occipital bone. * The free central margin :Attached to :- The anterior clinoid process.

Dural venous sinuses related to tentorium cerebelli1- Superior petrosal sinus2- Transverse sinus3- Straight sinus_____________________________________________________________________

1- D- The branches of nasociliary nerve and the areas supplied by them (diagram needed (5 marks)

1- Sensory root to the ciliary ganglion which gives the short ciliary nerves.2- 2 or 3 long ciliary nerves which carry sensory fibers to the ciliary body, iris and cornea and sympathetic fibers which supply the dilator pupillae muscle. 3- Posterior ethmoidal nerve supplies the mucosa of sphenoidal and posterior ethmoidal sinuses.4- Terminal branches:a- Infratrochlear nerve supplies skin of the Upper ½ of the nose , the skin and conjunctiva of the medial part of the lower eye lid and the lacrimal caruncle and lacrimal sacb- Anterior ethmoidal nerve : - In the anterior cranial fossa, it supplies the dura and the mucosa of the anterior & middle ethmoidal sinuses

- In the nose, it divides into: -2 internal nasal nerves supply the anterior parts of the medial and lateral walls of nose. - External nasal nerve supply the Lower ½ of the nose as far as the tip.

2 QUESTION (2) (Neck& Cavities)………..………………(21 MARKS):

2- A- The relations of the deep part of submandibular salivary gland (diagram needed) (5 marks)

Medially: Hyoglossus muscle. Styloglossus muscle

Laterally: Mylohyoid muscle Superficial part of the gland

Superiorly: Lingual nerve.

Inferiorly: Hypoglossal nerve.

Anteriorly: Submandibular duct Sublingual salivary gland.

Posteriorly: Posterior belly of digastric Stylohyoid muscles.

_____________________________________________________________________2- B- A diagram showing the boundaries and contents of carotid triangle (4 marks)

32- C- The branches of external carotid artery (diagram not needed). Mention its surface anatomy (5 marks)

Branches:• From anterior aspect: 1. Superior thyroid artery2. Lingual artery3. Facial artery • From posterior aspect: 1. Occipital artery2. Posterior auricular artery • From medial aspect: • Ascending pharyngeal artery • Terminal branches: 1. Superficial temporal artery2. Maxillary artery

Surface anatomy:It is drawn as a broad line which is slightly convex forward in its lower half and slightly concave forward in its upper half. - This line joins the following 2 points: 1- A point on the anterior border of the sternomastoid at the level of upper border of thyroid cartilage. 2- A point on the posterior border of the neck of the mandible._____________________________________________________________________2- D- The medial wall of the tympanic cavity (diagram needed)(4 marks)The promontory is a rounded projection produced by the underlying 1st turn of the cochlea

The fenestra vestibuli is an oval window which lies above and behind the promontory and is

closed by the foot piece of the stapes

The fenestra cochlea lies below the posterior end of the promontory and is closed by the

secondary tympanic membrane

The prominence of the facial canal, is a rounded ridge passing above the promontory to reach

the posterior wall

________________________________________________________________________________

2- E- Problem solving (3 marks):

1- The source of bleeding is paratonsillar vein (1 mark)

2- Venous drainage of palatine tonsil: Pharyngeal plexus of veins receives most of the veins specially the paratonsillar vein which crosses the upper part of the tonsil. Some veins drain into the lingual vein. (1 mark) 3- Loss of sensation from the posterior 1/3 of the tongue was due to postoperative

oedema which may affect the 9th cranial (glossopharyngeal ) nerve which supply this

area. (1 mark)

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QUESTION (3) (Neuroanatomy)………………………(22 MARKS) :

3- A- The sensory and motor nuclei of the spinal cord (diagram not needed)

(5 marks)

Sensory nuclei:

- 1- Substantia gelatinosa of rolandi

- 2- Main sensory nucleus (nucleus proprius)

- 3- Nucleus dorsalis (Clark's column)

- Motor nuclei:

1- Ventromedial nucleus

2- Dorso-medial nucleus

3- Ventrolateral nucleus

4- Dorsolateral nucleus

5- Central nucleus

Motor nuclei to visceral structures (Autonomic)

1- Intermedio-medial nucleus

2- Intermedio-lateral nucleus

_____________________________________________________________________

3- B- The afferent fibers in the inferior cerebellar peduncle (diagram not needed) (6 marks)

1- Dorsal spino- cerebellar tract; arises from Clark's nucleus in the spinal cord and ends in the ipsilateral cerebellar hemisphere.2- Posterior external arcuate fibres (Cuneo- cerebellar tract); arise from the accessory cuneate nucleus in the medulla and end in the ipsilateral cerebellar hemisphere.3- Vestibulo- cerebellar fibres; arise from the vestibular nuclei (medial and inferior) and end in the ipsilateral cerebellar hemisphere.4- Reticulo- cerebellar tract; arises from the reticular formation of the medulla and end in the ipsilateral cerebellar hemisphere.5- Anterior external arcuate fibres; arise from the arcuate nuclei of both sides. Some fibres traverse the medulla and others run laterally to form the striae medullaris which end in the cerebellar hemisphere.6- Olivo- cerebellar fibres; reach the cerebellar hemisphere from the inferior olivary nucleus of the opposite side. Some para- olivo- cerebellar fibres arise from the accessory olivary nuclei and run with the olivo- cerebellar fibres.

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3- C- The structures forming floor, anterior and posterior walls of the third ventricle (diagram needed).(6 marks)

Floor: Is formed by (from before backwards):1. Optic chiasma and the supraoptic recess.2. Infundibulum and tuber cinerum.3. Mamillary bodies.4. Posterior perforated substance.5. Tegmentum of the midbrain and aqueduct.

Anterior wall: Is formed by:1. Lamina terminalis(a thin sheet of white matter).2. Two columns of the fornix which lie behind the lamina terminalis.3. Anterior commissure which a transverse cord-like band located between the

lamina terminalis and the 2 columns of the fornix.

Posterior wall: A short wall formed by:1. Stalk of the pineal body.2. Habenular (pineal) commissure.3. Posterior commissure

_____________________________________________________________________

3- D- The course and branches of the vertebral artery in the cranial cavity (diagram not needed) (5 marks)

Course:- It enters the cranial cavity through the foramen magnum.- Both arteries ascend on either side of the medulla oblongata and unite at the lower border of the ventral surface of pons to form the basilar artery

Branches:1-2- 1- Posterior spinal Artery:- Descends through the foramen magnum to reach the spinal cord, one on each side.-3- 2- Anterior Spinal Artery:

Joins its fellow of the opposite side, anterior to medulla oblongata, to form a single median artery.

4- 3- Posterior inferior cerebellar Artery:Arises from the lower part of the vertebral artery to supply the posterior part of the inferior surface of the cerebellum and forms the choroids plexus of the 4th ventricle.

5- 4- Medullary Branches: Small branches which supply the medulla oblongata.

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QUESTION (4) (Lower limb)…………..………………(22 MARKS) :

4- A- Origin, course and branches of the superior gluteal nerve (diagram not needed) (4 marks)

Origin: from posterior division of ventral rami of L4,5& S1 nerves of sacral plexusCourse:- It enters the gluteal region through the upper part of greater sciatic foramen, above the piriformis muscle with superior gluteal artery.

- Then, it passes forwards between the gluteus medius and minimus.Branches:- Upper branch: accompanied by upper division of deep branch of superior gluteal artery and supplies both glutei.- Lower branch: accompanied by lower division of deep branch of superior gluteal artery. At the middle of gluteus minimus, it gives branches to both glutei and ends in deep surface of tensor fasciae lata _____________________________________________________________________

4- B- The boundaries and contents of the popliteal fossa (diagram needed) (5 marks)

Boundaries - Upper lateral : Biceps femoris muscle- Upper medial : Semitendinosus and semimembranosus - Lower lateral :Lateral head of gastrocnemius & plantaris muscles - Lower medial: Medial head of gastrocnemius.

Contents: Vessels:

Popliteal artery.Popliteal vein.

Nerves:Lateral popliteal nerve (common peroneal nerve).Medial popliteal nerve (tibial nerve).Genicular branch of posterior division of obturator nerve.Popliteal lymph nodesPopliteal fat: in which all contents are embedded

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4- C- The branches of the anterior tibial artery (diagram not needed) (5 marks)

1- Posterior tibial Recurrent artery: Arises in the posterior compartment and ascends to share in the anastomosis around the knee with the inferior genicular branch of popliteal artery .

2- Anterior tibial recurrent artery:Arises in the anterior compartment and ascends to share in the anastomosis around the knee.

3- Anterior medial malleolar branch share in the anastomosis around the medial malleolus.

4- Anterior lateral malleolar branch share in the anastomosis around the lateral malleolus.

5- Muscular branches : To the muscles of the anterior compartment of leg._____________________________________________________________________

4- origin, insertion, nerve supply and action of peroneus longus muscle(4 marks)

Origin: from upper 2/3 of lateral surface of fibula

Insertion: into lateral side of base of 1st metatarsal bone and adjoining part of medial cuniform bone.

Nerve supply: by musculo-cutaneous nerve

Action: - Eversion and planter flexion of foot- Maintains thelongitudinal and transverse arches of foot_________________________________________________________________________________

4- E- The site, attachments and structures deep to the flexor retinaculum (diagram needed) (4 marks)

Site: Lies below and behind the medial malleolus.

Attachments: - Above ; to the posterior border of medial malleolus. - Below ; to the medial tubercle of calcaneous.

Structures passing deep to it: From medial to lateral

Tibialis posterior tendon Flexor Digitorum longus tendon Posterior Tibial Vessels Posterior Tibial Nerve Flexor Hallucis longus tendon

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QUESTION (5) (Special Embryology)..……………..(13 MARKS) :

5- A- The congenital anomalies of the vertebral column (4 marks)

- Klippel feil syndrome: Due to fusion and shortening of the cervical vertebrae so that the head appears to rest on the shoulders.

- Scoliosis: Is the result of a congenital hemivertebra and if it occurs in the thoracic region, it is often associated with abnormalities of the ribs. A hemivertebra is caused by failure in development of one of the two chondrification centers that appear in the centrum of each vertebra.

- Kyphosis: A prominent increased backward convexity of a part of the vertebral column is developed due to an error in the developing vertebral bodies.

- Spina bifida occulta: Resulting from imperfect fusion or non union of the vertebral arches with intact spinal cord.

____________________________________________________________________

5- B- The summary for fate of sinus venosus (5 marks)

1.Right horn will be incorporated into the right atrium to form the smooth part (sinus venarum).

2.Right common cardinal vein will form the lower part of superior vena cava.3.The opening of the right vitelline vein will form the opening of inferior vena cava.4.The right umbilical vein will disappear.5.The body and left horn will form the coronary sinus.6.The left common cardinal vein will form the oblique vein of left atrium (Marshal).7.The left umbilical and vitteline veins will lose communication with the sinus.8.The upper part of the right venous valve will form the crista terminalis.9.The lower part of right venous valve will form the valves of I.V.C and coronary sinus.

10.The left venous valve will be incorporated with the interatrial septum.____________________________________________________________________

C- The congenital anomalies of the stomach (4 marks) 1- Hypertrophic pyloric stenosis: Occurs when the muscle layer in the pyloric region hypertrophies causing a narrow pyloric lumen that obstructs food passage.

2- Thoracic stomach : This is the result of congenitally short oesophagus. The stomach may be partially or completely present in the thoracic cavity.

3- Hour-glass stomach: The stomach may show a local constriction which partly divides the stomach into two parts.

4- Transposition of the stomach: The stomach may be transposed into the right side of the abdomen.

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