Tanta University second Year Final Anatomy Exam. (Egyptians) Faculty of Medicine Number of Questions: 6 Anatomy Department Time Allowed: 3 Hours9/8/2014 Total: 125 Marks

Very Important: each part of question must be written in a separate pageQUESTION (1) (Head)…………………………………….(22 MARKS) :

A- Mention the course and enumerate the branches of the facial artery in the face (diagram needed). Mention its surface anatomy …………………………………………………………………………………(6 marks)

B- Draw a diagram showing the branches of the maxillary nerve……………………………………..(4 marks)

C- Enumerate single and paired dural venous sinuses (diagram not needed)……………………...(4 marks)

D- Mention the roots of the ciliary ganglion (diagram not needed)…………………………………...(5 marks) E- Problem solving (3 marks):A 45 years old woman came to the clinic suffering from sudden severe pain in the right side of her face which affected the lower part of the face, part of auricle , lower lip and lower teeth. After examination, the diagnosis was trigeminal neuralgia.1- Which branch of the trigeminal nerve is affected?....………………….……………………………..(0.5 mark) a- Ophthalmic nerve b- Maxillary nerve c- Mandibular nerve2- Enumerate its branches in the face………………………………..…………………………………..(1.5 marks)3- Mention the nerves supplying the lateral surface of the auricle……………………………………..(1 mark) ________________________________________________________________________________________

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

A- Mention the origin, insertion, nerve supply and action of the mylohyoid muscle (diagram not needed)………………………………………………………………………………………………………......(4 marks)

B- Describe the course of the lingual nerve in the submandibular region (diagram needed). Mention its applied anatomy…………………………………………………………………………………………..…….(5 marks) C- Draw a diagram showing the branches of the subclavian artery…….………………….…………(4 marks)

D- Enumerate the blood and nerve supply of the palate (diagram not needed)…………………….(5 marks)

E- Problem solving (3 marks):A 40 years old man went to the clinic complaining of tense swelling below the body of the mandible which became large during meals and was reduced in size or absent between meals. After examination the diagnosis was stone in the submandibular duct. 1- Mention the length and site of opening of the submandibular duct………………………….....(1.5 marks)2- Mention the cranial nerve carries the parasympathetic supply of the submandibular salivary gland ……………………………………………………………………………………………………………………..(0.5 mark)3- Mention the blood supply of the submandibular salivary gland……………………………………..(1 mark)________________________________________________________________________________________

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

A- Describe the course of the lateral cortico-spinal tract (diagram not needed)……………..........(6 marks)

B-Mention the afferent and efferent fibres in the inferior cerebellar peduncle (diagram not needed)……............................................................................................................................................(6 marks)

C- Mention the relations and parts of the lentiform nucleus (diagram needed) ……………………(5 marks)

D- Enumerate the branches of the basilar artery (diagram needed) …………………………………(5 marks)

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

A- Enumerate the branches of the profunda femoris artery…………………………………………...(4 marks)

B- Mention origin, insertion, nerve supply and action of adductor longus muscle (diagram not needed)…………………………………………………………………………………………………………..(4 marks)

C- Enumerate the branches of the lateral popliteal (common peroneal) nerve (diagram not needed). Mention its applied anatomy………………………………………………………………………………...(6 marks)

D- Draw a diagram showing the anastomosis around the ankle joint………………………………..(5 marks)

E- Problem solving (3 marks):A 50 years old woman came to the hospital after noticing a swelling in the upper part of her left thigh. After physical examination, there was enlarged superficial inguinal lymph nodes. 1- Enumerate areas of drainage of upper medial group of superficial inguinal lymph nodes…(1.5 marks)2- Mention the causes of enlargement of theses nodes ……………………………………………..(1.5 marks)________________________________________________________________________________________

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

A- Discuss the development of the urethra in male and female……………………………………….(4 marks)

B- Mention the components of the two atria………………………………………..……………………..(5 marks)

C- Enumerate 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

االثنين- يوم الطالب لجميع والعملي الشفوي االمتحانصباحا 11/8/2014 الثامنة الساعة

أثناء- األبيض البالطو بارتداء االلتزام الطالب جميع على. المحدد الموعد في والحضور والعملية الشفوية االمتحانات

االمتحانات- أثناء المحمول التليفون اصطحاب باتا منعا ممنوعغش ذلك يعتبر طالب أي مع وجوده ثبوت حالة وفى العملية

. االمتحان حضور من ويحرم

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- The nerve root of greater occipital nerve is:A) Ventral ramus of 2nd cervical nerve B) Dorsal ramus of 2nd cervical nerve C) Ventral ramus of 3rd cervical nerve D) Dorsal ramus of 3rd cervical nerve

2- The followings are branches of ophthalmic nerve in the face EXCEPT:A) Supraorbital nerve B) Supratrochlear nerveC) Infraorbital nerve D) External nasal nerve

3- The upper head of the lateral pterygoid muscle arises from:A) Infratemporal surface of greater wing of sphenoidB) Lateral surface of lateral pterygoid plateC) Medial surface of lateral pterygoid plateD) Tuberosity of maxilla

4- The following structure lies anterior to the mandibular nerve trunk: A) Lateral pterygoid muscle B) Medial pterygoid muscle C) Tensor palate muscle D) Middle meningeal artery

5- The following structure lies medial to the cavernous sinus:A) Internal carotid artery B) Temporal lobe of the brainC) Pituitary gland D) Trigeminal ganglion

6- The lacrimal artery gives the following branches EXCEPT:A) Muscular branches B) Zygomatic branchC) Recurrent meningeal branch D) Medial palpebral branches

7- The following muscle does not share in the floor of the posterior triangle:A) Splenius capitis B) Semispinalis capitisC) Scalenus medius D) Scalenus posterior

8- The followings are branches of the superior thyroid artery EXCEPT:A) Suprahyoid artery B) Glandular branchesC) Superior laryngeal artery D) Cricothyroid artery

9- The followings are tributaries of internal jugular vein EXCEPT:A) Common facial vein B) Lingual veinC) Superior thyroid vein D) Transverse cervical vein

10- The isthmus of the thyroid gland is related posteriorly to:A) 1st, 2nd, 3rd tracheal rings B) 2nd, 3rd, 4th tracheal rings C) 3rd, 4th ,5th tracheal rings D) 4th ,5th, 6th tracheal rings

11- Costocervical trunk gives the following branch :A) Transverse cervical artery B) Deep cervical arteryC) Suprascapular artery D) Inferior thyroid artery

12 -The following structure lie between superior constrictor and middle constrictor:A) Levator palati muscle B) Superior laryngeal arteryC) Stylopharyngeus muscle D) Recurrent laryngeal nerve

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13- The anterior superior quadrant of the lateral nasal wall is supplied by the following artery:A) Facial artery B) Sphenopalatine arteryC) Greater palatine artery D) Anterior ethmoidal artery

14- The following structures form the posterior wall of the third ventricle EXCEPT:A) Tegmentum of midbrain B) Habenular commissureC) Pineal stalk D) Posterior commissure

15- Regarding the radicular arteries of the spinal cord, one is Wrong: A) They arise from ascending cervical or vertebral arteries B) They enter the vertebral canal through the intervertebral foramina C) They supply spinal nerve roots D) They supply the posterior white columns of the spinal cord

16- Anterior perforated substance is bounded medially by: A) Optic chiasma and tract B) Uncus C) Diverging olfactory stria D) Stem of lateral sulcus

17- The followings are branches of the internal carotid artery EXCEPT:A) Anterior cerebral artery B) Middle cerebral arteryC) Posterior cerebral artery D) Anterior choroidal artery

18- The following commissure connects the superior colliculi of both sides: A) Anterior commissure B) Posterior commissureC) Corpus callosum D) Habenular commissure

19- Regarding the caudate nucleus all are true EXCEPT:A) It is formed of head, body and tail B) Head lies in the floor of anterior horn of lateral ventricle

C) Head is the lateral boundary of the anterior limb of internal capsule D) Body Lies in the floor of the central part of the lateral ventricle 20- The nerve supply of the adductor longus muscle is:A) Femoral nerve B) Anterior division of obturator nerveC) Posterior division of obturator nerve D) Sciatic nerve

21- The superior gluteal nerve supplies the following muscles EXCEPT:A) Gluteus Maximus B) Gluteus medius C) Gluteus minimus D) Tensor fascia lata

22- The lateral popliteal nerve gives the following articular branch to the knee joint:A) Superior medial genicular nerve B) Inferior medial genicular nerve C) Middle genicular nerve D) Recurrent genicular nerve

23- Gastrocnemius muscle is supplied by the following nerve:A) Lateral popliteal nerve B) Medial popliteal nerveC) Anterior tibial nerve. D) Musculo-cutaneous nerve

24- The following is a branch of anterior tibial artery:A) Anterior medial malleolar artery B) Medial tarsal artery C) Arcuate artery D) Lateral tarsal artery

25- The following artery gives nutrient branch to the fibula:A) Anterior tibial artery B) Posterior tibial arteryC) Peroneal artery D) Dirsalis pedis artery

END OF THE EXAM4

Answer Key For MCQ Questions) Egyptian Anatomy Exam (

1- B)

2- C)

3- A)

4- B)

5- C)

6- D)

7- D)

8- A)

9- D)

10- B)

11- B)

12- C)

13- D)

14- A)

15- D)

16- A)

17- C)

18- B)

19- C)

20- B)

21- A)

22- D)

23- B)

24- A)

25- C)

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ANATOMY DEPARTMENT: MODEL ANSWER OF SECOND YEAR

FINAL ANATOMY EXAMINATION (Egyptians) 9/8/2014 QUESTION (1) (Head)……(22 MARKS) :

1- A- Mention the course and enumerate the branches of the facial artery in the face (diagram needed). Mention its surface anatomy (6 marks)Course: It enters the face by curving round the lower border of the mandible . It ascends in the face close to the antero-inferior angle of the masseter. It passes upwards and medially in a wavy course superficial to the buccinator muscle towards

the angle of the mouth. It ascends in the naso-labial furrow to end close to the medial angle of the eye as the angular

artery. It ends by anastomosing with the dorsal nasal artery ( a branch of ophthalmic artery ).

Branches:1- Submental artery2- Inferior labial artery3- Superior labial artery4- Lateral nasal artery5- Angular artery

Surface anatomy: 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- Draw a diagram showing the branches of the maxillary nerve.(4 marks)

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1- C- Enumerate single and paired dural venous sinuses (diagram not needed) (4 marks)

Single sinuses1- Superior sagittal sinus2- Inferior sagittal sinus3- Straight sinus.4- Anterior and posterior intercavernous sinuses.5- Occipital sinus6- Basilar plexus of sinuses.

Paired sinuses1- Sphenoparietal sinus.2- Cavernous sinus.3- Superior petrosal sinus.4- Inferior petrosal sinus.5- Transverse sinus.6- Sigmoid sinus.

_____________________________________________________________________

1- D- Mention the roots of the ciliary ganglion (diagram not needed) (5 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- Which branch of the trigeminal nerve is affected?. (0.5 mark) c- Mandibular nerve2- Enumerate its branches in the face… (1.5 marks)- Auriculotemporal nerve- Buccal nerve- Mental nerve

3- Mention the nerves supplying the lateral surface of the auricle.(1 mark)- Upper part by auriculotemporal nerve- Lower part by great auricular nerve

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

2- A- Mention the origin, insertion, nerve supply and action of the mylohyoid muscle (diagram not needed).(4 marks)

Origin:

Mylohyoid line on the inner surface of the mandible.

The fibres run downwards and medially

Insertion:

- Posterior fibres are inserted into the body of the hyoid.

- The rest of fibres are inserted into the median raphe

Nerve supply:

- Nerve to mylohyoid.

Action:

Elevates the hyoid or depresses the mandible_________________________________________________________________________________

2- B- Describe the course of the lingual nerve in the submandibular region (diagram needed). Mention its applied anatomy...(5 marks)

Course: It passes on the inner aspect of the mandible grooving the alveolar margin 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 it *It receives a communication from the hypoglossal nerve Near the anterior border of the hyoglossus it hooks around the submandibular duct coming

from its lateral aspect then below and ascend medial to it. Both the nerve and duct then pass upwards under cover the sublingual gland on the

genioglossus muscle. It ends by dividing into its terminal branches

Applied anatomy of lingual nerve:- It is at a great risk during surgical removal of impacted lower third molars. After such operations up to 105 of patients may have symptoms of temporary nerve damage.- The nerve is also at risk during operations to remove the submandibular salivary gland, during which the duct must be dissected carefully from the lingual nerve.

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2- C- Draw a diagram showing the branches of the subclavian artery (4 marks)

_____________________________________________________________________

2- D- Enumerate the blood and nerve supply of the palate (diagram not needed) (5 marks)Blood Supply of the palate:Arteries:• Greater palatine, lesser palatine and sphenopalatine arteries (from maxillary)• Ascending palatine artery (from facial)• Ascending pharyngeal artery

Veins: Drains into:1. Pharyngeal venous plexus2. Pterygoid venous plexus

Nerve Supply of the palate:Sensory:

• Glossopharyngeal nerve• Greater palatine nerve• Middle palatine nerve• Lesser palatine nerve• Sphenopalatine nerve

Motor:• All the muscles of the palate are supplied by cranial part of accessory nerve through

pharyngeal plexus • EXCEPT tensor palati which is supplied by mandibular nerve through nerve to medial pterygoid

muscle4

2- E- Problem solving (3 marks):

1- Mention the length and site of opening of the submandibular duct (1.5 marks)Length: 5 cmSite of opening: open on the floor of the mouth at the sides of the frenulum linguae on the summit of the sublingual papilla.

2- Mention the cranial nerve carries the parasympathetic supply of the submandibular salivary gland.(0.5 mark)Facial nerve

3- Mention the blood supply of the submandibular salivary gland (1 mark) Branches from facial and lingual arteries

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

3- A- Describe the course of the lateral cortico-spinal tract (diagram not needed). (6 marks) First neurons : (Upper Motor Neuron) 1- Are the large pyramidal cells (Betz cells) in the motor and premotor areas of the cerebral cortex. 2- Course of the axons:

The fibers first descend in the white matter of the cerebral hemisphere forming the corona radiata, then run in the posterior limb of the internal capsule.

The fibers pass through the middle three fifths of the crus cerebri of the midbrain, then in the basis pontis and at last form the pyramid of medulla.

In the lower medulla most of the fibers decussate (about 80%) and cross to the opposite side (in the motor or pyramidal decussation) to descend in the lateral white column of the spinal cord forming the crossed pyramidal tract (Lateral corticospinal tract).

Some fibers (about 20%) remain uncrossed and descend in the ventral white column of the same side forming the uncrossed or direct pyramidal tract (ventral or anterior corticospinal tract). The fibers of this last tract gradually cross to the opposite grey matter and are only present in the upper half of the spinal cord.

3- Termination of Lateral corticospinal tracts: its crossed fibres relay on the anterior horn cells of the opposits side of the spinal cord. Ventral corticospinal tract; its uncrossed fibres gradually and successively cross at each spinal segment to relay on the anterior horn cells of the opposite side.Therefore each cerebral hemisphere will control the movements of the opposite side of the body.

Second neurons: (Lower Motor Neuron) Is the anterior horn cells of the spinal cord. Their axons running in the ventral root and rami of the spinal nerves to form the motor

innervations of the voluntary muscles.________________________________________________________________________________

3- B- Mention the afferent and efferent fibres in the inferior cerebellar peduncle (diagram not needed).(6 marks)Afferent fibres: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.

Efferent fibres:These fibres leave the cerebellum to:1- Vestibular nuclei; (cerebello- vestibular fibres)2- Reticular nuclei of the medulla; (cerebello- reticular)

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3- C- Mention the relations and parts of the lentiform nucleus (diagram needed) …(5 marks)

Relations of lentiform nucleus: It has two ends (anterior and posterior)

i. Anterior end ; continuous with the head of caudate .ii. Posterior end ; is related to the optic radiation in the retrolenticular part of the internal capsule

- It has three surfaces ( lateral, medial and inferior )i. Lateral surface; is convex and separated from the claustrum by the fibres of the external

capsule .ii. Medial surface ; is more convex and separated from the head of the caudate nucleus

anteriorly by the anterior limb of the internal capsule and from the thalamus posteriorly by the posterior limb of the internal capsule .

iii. Inferior surface ; is related to the auditory radiation in the sublenticular part of internal capsule

Parts of lentiform nucleus :- It is subdivided by the medullary lamina into two parts : i. Putamen :

It is larger, darker and situated laterallyii. Globus pallidus :

It is smaller, paler and situated medially__________________________________________________________________________________

3- D- Enumerate the branches of the basilar artery (diagram needed) (5 marks) 1- Pontine Branches :

Long and short branches which pierce the ventral aspect of the pons.2- Labyrinthine Artery (internal acoustic):

Runs laterally in company with the 7th and 8th cranial nerves to enter the internal auditory meatus to supply the labyrinth.

3- Anterior Inferior Cerebellar Artery: Arises from the lower part of the artery and runs laterally below the 6th , 7th and 8th , cranial

nerves to reach the anterior part of the inferior surface of the cerebellum.

4- Superior Cerebellar Artery: Arises from the upper part of the artery and runs backwards to supply the superior surface

of the cerebellum.

5- Posterior Cerebral Artery: Is the terminal branch of the basilar artery. It runs backwards on the lateral aspect of the

midbrain and is separated from the superior cerebellar artery by the 3rd and 4th cranial nerves.

It reaches the under and medial surfaces of the occipital lobe where it ends by dividing into 2 terminal divisions; the parieo-occipital and calcarine arteries which run in the corresponding sulci.

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

4- A- Enumerate the branches of the profunda femoris artery (4 marks)

1- Lateral circumflex femoral artery which gives: - Ascending branch - Transverse branch - Descending branch

2- Medial circumflex femoral artery which gives: - Ascending branch - Transverse branch

- Acetabular branch

3- 4 perforating branches________________________________________________________________________________

4- B- Mention origin, insertion, nerve supply and action of adductor longus muscle (diagram not needed).(4 marks)

Origin:

- Arises by a strong rounded tendon from the front of the body of the pubis just below the pubic

tubercle .

- The muscle fibers run downwards, backwards & laterally, and spread out to form a broad fleshy

belly.

Insertion:

Into the middle 1/3 of the linea aspera below pectineal insertion.

Nerve supply:

Obturator nerve (anterior division L.2,3)

Action:

Adduction and medial rotation of the thigh

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4- C- Enumerate the branches of the lateral popliteal (common peroneal) nerve (diagram not needed). Mention its applied anatomy (6 marks)Branches: No muscular branches are given in the fossa. The nerve supplies the short head of biceps femoris in the back

of the thigh . 2 Cutaneous branches :Sural communicating nerve:

Runs downwards on the lateral head of gastrocnemius to join the sural nerve.Lateral cutaneous nerve of the calf:

Arises near the lateral angle of the popliteal fossa and supplies the skin of the upper lateral aspect of the leg.3 Articular (genicular) branches:Superior lateral genicular nerve. Inferior lateral genicular nerve.

Both accompany the corresponding arteries. Recurrent genicular nerve: Arises near the end of lateral popliteal nerve

Applied anatomy:Causes of its injury:- The commonest cause is fracture neck fibula.- It may be compressed by tight plaster cast or from bandage with a resultant foot drop.Effects: - Paralysis of extensors of foot (supplied by deep peroneal).- Paralysis of evertors of foot (supplied by superficial peroneal).- Loss of sensation from: 1- Anterolateral aspect of the upper part of leg (supplied by lateral cutaneous nerve of the calf). 2-Lower part of the front of leg (supplied by superficial peroneal). 3-Dorsum of foot and toes (supplied by superficial and deep peroneal).Resulting deformity: Talipus equino varus: foot drop& inversion of foot. _______________________________________________________________________________________

4- D- Draw a diagram showing the anastomosis around the ankle joint.(5 marks)

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4- E- Problem solving (3 marks):

1- Enumerate areas of drainage of upper medial group of superficial inguinal lymph nodes…(1.5 marks) -Anterior abdominal wall below umbilicus.

- Perineum.

- Lower part of the anal canal

- External genitalia.( but NOT the testis or ovary)

2- Mention the causes of enlargement of theses nodes (1.5 marks)

1- General causes: - Elephantiasis: lymphatic obstruction by filarial parasite results in hypertrophy of the skin and subcutaneous tissue to unusual proportions.- Diseases of the lymphatic tissue as Hodgkin's and non Hodgkin's lymphoma.2- Local causes: -Occurs secondary to infections in the draining areas. This requires examinations of all these areas even the clefts between the toes.

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

5- A- Discuss the development of the urethra in male and female… (4 marks)

In male:Upper part of prostatic urethra develops from vesico-urethral canalLower part of prostatic urethra and membranous urethra develop from pelvic part of definitive urogenital sinusPenile urethra develops from phalic part of definitive urogenital sinus

In female: The female urethra develops from vesicourethral canal

The surrounding connective tissue and smooth muscle tissue is derived from the splanchnic mesoderm_________________________________________________________________________________

5- B- Mention the components of the two atria….(5 marks)

-The right atrium develops from:

1-Rt. Half of primitive atrium (rough auricular part)

2- Rt. Horn of sinus venosus (posterior smooth part)

3- upper part of Rt. atrioventricular canal

-The left atrium develops from:

1-Lt. Half of primitive atrium (rough auricular part)

2-Absorbed pulmonary veins (posterior part)

3- upper part of Lt. atrioventricular canal

________________________________________________________________________________

3- C- Enumerate the congenital anomalies of the stomach….(4 marks)

1- Hypertrophic pyloric stenosis: Due to hypertrophy of muscle layer of pylorus causing narrow lumen

2- Thoracic stomach: Due to congenital short oesophagus 3- Hour-glass stomach: A local constriction which partially divides stomach into two parts

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

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Tanta University Second Year Final Anatomy Exam. (Malaysians) Faculty of Medicine Number of Questions: 6 Anatomy Department Time Allowed: 3 Hours9/8/2014 Total: 125 Marks

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

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

A- Mention the origin, insertion, nerve supply and action of the buccinator muscle (diagram not needed)……..……………………………………………………………………………………..(6 marks)

B- Discuss the branches of the anterior division of the mandibular nerve (diagram not needed)………………………………………………………………………………………………...(5 marks)

C- Draw a diagram showing the communications of the cavernous sinus. Mention its applied anatomy …………………………………………….…………………………………………………(6 marks)

D- Enumerate the structures of the lacrimal apparatus (diagram not needed)…………..(5 marks)________________________________________________________________________________

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

A- Discuss the course and the branches of lingual artery (diagram needed)…………….(4 marks)

B- Enumerate the structures between the external and internal carotid arteries (diagram not needed). Mention the surface anatomy of the external carotid artery……........................(5 marks)

C- Mention the arterial supply and venous drainage of the thyroid gland (diagram not needed)………………………………………………………………………………………………...(5 marks)

D- Draw a diagram showing the structures in the lateral wall of the nasopharynx……...(4 marks)

E- Problem solving (3 marks):A 65- years old man had right- sided heart failure. On neck examination, the physician noticed engorged vein obliquely crossing the sternomastoid muscle.1- Which is the engorged vein………………………………………………………………….(0.5 mark)a- Anterior jugular vein b- External jugular vein c-Internal jugular vein2- Mention the beginning of this vein……………………………………………………………...(1 mark)3- Mention the course and end of this vein…………………..……………….………………(1.5 marks)________________________________________________________________________________

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

A- Enumerate the arteries supplying the spinal cord and discuss one of them (diagram not needed)………………………………………………………………………………………………...(6 marks)

B- Mention the afferent and efferent fibres in the superior cerebellar peduncle (diagram not needed)………………………………………………………………………………………………...(5 marks)

C- Discuss the boundaries of the body of the lateral ventricle (diagram needed)……...(5 marks)

D- Enumerate the association fibres of the cerebral hemisphere (diagram needed)……(6 marks)1

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

A- Mention the boundaries of the adductor canal (diagram needed)……………………..(4 marks)

B- Mention the common features of the hamstring muscles (diagram not needed)……(6 marks)

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

D- Mention the branches of the plantar arch (diagram needed)…………………………….(5 marks)

E- Mention the surface anatomy of the great saphenous vein………………………………(2 marks)_________________________________________________________________________________

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

A- Mention the congenital anomalies of the urinary bladder…….………………………….(5 marks)

B- Mention the components of the two ventricles……………………..………………………(4 marks)

C- Enumerate in table the fate of the pharyngeal pouches…………………………………..(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 & Practical examination:

To all the students On Monday 11/8/2014 at 10 o'clock

NB: -All students should attend oral and practical examinations with white coat -All the students should not carry mobile phone during practical examination

With My Best Wishes

Chairman of Department: Prof. Dr. Mona Zoair

2

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- The nerve root of greater occipital nerve is:A) Ventral ramus of 2nd cervical nerve B) Dorsal ramus of 2nd cervical nerve C) Ventral ramus of 3rd cervical nerve D) Dorsal ramus of 3rd cervical nerve

2- The followings are branches of ophthalmic nerve in the face EXCEPT:A) Supraorbital nerve B) Supratrochlear nerveC) Infraorbital nerve D) External nasal nerve

3- The upper head of the lateral pterygoid muscle arises from:A) Infratemporal surface of greater wing of sphenoidB) Lateral surface of lateral pterygoid plateC) Medial surface of lateral pterygoid plateD) Tuberosity of maxilla

4- The following structure lies anterior to the mandibular nerve trunk: A) Lateral pterygoid muscle B) Medial pterygoid muscle C) Tensor palate muscle D) Middle meningeal artery

5- The following structure lies medial to the cavernous sinus:A) Internal carotid artery B) Temporal lobe of the brainC) Pituitary gland D) Trigeminal ganglion

6- The lacrimal artery gives the following branches EXCEPT:A) Muscular branches B) Zygomatic branchC) Recurrent meningeal branch D) Medial palpebral branches

7- The following muscle does not share in the floor of the posterior triangle:A) Splenius capitis B) Semispinalis capitisC) Scalenus medius D) Scalenus posterior

8- The followings are branches of the superior thyroid artery EXCEPT:A) Suprahyoid artery B) Glandular branchesC) Superior laryngeal artery D) Cricothyroid artery

9- The followings are tributaries of internal jugular vein EXCEPT:A) Common facial vein B) Lingual veinC) Superior thyroid vein D) Transverse cervical vein

10- The isthmus of the thyroid gland is related posteriorly to:A) 1st, 2nd, 3rd tracheal rings B) 2nd, 3rd, 4th tracheal rings C) 3rd, 4th ,5th tracheal rings D) 4th ,5th, 6th tracheal rings

11- Costocervical trunk gives the following branch :A) Transverse cervical artery B) Deep cervical arteryC) Suprascapular artery D) Inferior thyroid artery

12 -The following structure lie between superior constrictor and middle constrictor:A) Levator palati muscle B) Superior laryngeal arteryC) Stylopharyngeus muscle D) Recurrent laryngeal nerve

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13- The anterior superior quadrant of the lateral nasal wall is supplied by the following artery:A) Facial artery B) Sphenopalatine arteryC) Greater palatine artery D) Anterior ethmoidal artery

14- The following structures form the posterior wall of the third ventricle EXCEPT:A) Tegmentum of midbrain B) Habenular commissureC) Pineal stalk D) Posterior commissure

15- Regarding the radicular arteries of the spinal cord, one is Wrong: A) They arise from ascending cervical or vertebral arteries B) They enter the vertebral canal through the intervertebral foramina C) They supply spinal nerve roots D) They supply the posterior white columns of the spinal cord

16- Anterior perforated substance is bounded medially by: A) Optic chiasma and tract B) Uncus C) Diverging olfactory stria D) Stem of lateral sulcus

17- The followings are branches of the internal carotid artery EXCEPT:A) Anterior cerebral artery B) Middle cerebral arteryC) Posterior cerebral artery D) Anterior choroidal artery

18- The following commissure connects the superior colliculi of both sides: A) Anterior commissure B) Posterior commissureC) Corpus callosum D) Habenular commissure

19- Regarding the caudate nucleus all are true EXCEPT:A) It is formed of head, body and tail B) Head lies in the floor of anterior horn of lateral ventricle

C) Head is the lateral boundary of the anterior limb of internal capsule D) Body Lies in the floor of the central part of the lateral ventricle 20- The nerve supply of the adductor longus muscle is:A) Femoral nerve B) Anterior division of obturator nerveC) Posterior division of obturator nerve D) Sciatic nerve

21- The superior gluteal nerve supplies the following muscles EXCEPT:A) Gluteus Maximus B) Gluteus medius C) Gluteus minimus D) Tensor fascia lata

22- The lateral popliteal nerve gives the following articular branch to the knee joint:A) Superior medial genicular nerve B) Inferior medial genicular nerve C) Middle genicular nerve D) Recurrent genicular nerve

23- Gastrocnemius muscle is supplied by the following nerve:A) Lateral popliteal nerve B) Medial popliteal nerveC) Anterior tibial nerve. D) Musculo-cutaneous nerve

24- The following is a branch of anterior tibial artery:A) Anterior medial malleolar artery B) Medial tarsal artery C) Arcuate artery D) Lateral tarsal artery

25- The following artery gives nutrient branch to the fibula:A) Anterior tibial artery B) Posterior tibial arteryC) Peroneal artery D) Dirsalis pedis artery

END OF THE EXAM4

Answer Key For MCQ Questions) Malaysian Anatomy Exam (

1- B)

2- C)

3- A)

4- B)

5- C)

6- D)

7- D)

8- A)

9- D)

10- B)

11- B)

12- C)

13- D)

14- A)

15- D)

16- A)

17- C)

18- B)

19- C)

20- B)

21- A)

22- D)

23- B)

24- A)

25- C)

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ANATOMY DEPARTMENT: MODEL ANSWER OF SECOND YEAR

FINAL ANATOMY EXAMINATION (Malaysians) 9/8/2014

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

1-A- Mention the origin, insertion, nerve supply and action of the buccinator muscle (diagram not needed) (6 marks)

Origin: Above : From the outer surface of the alveolar processes of the maxilla opposite the 3 molar teeth.Below : From the alveolar processes of the mandible , close to the oblique line , opposite the 3 molar teeth Inbetween : From the pterygomandibular raphe, which extends from the pterygoid hamulus to the posterior end of the Mylohyoid line.Insertion: - The fibers converge towards the angle of mouth and enter the upper and lower lips where they are arranged as follows : * The upper fibers pass to the upper lip. * The lower fibers pass to the lower lip. * The middle fibers decussate where those from below enter the upper lip and those from above enter the lower lip.Nerve supply : Buccal branch of the facial nerve.Action: - It compresses the cheek and lips against the teeth , so the food is kept under immediate action of teeth .- It helps in whistling and blowing.________________________________________________________________________________

1- B- Discuss the branches of the anterior division of the mandibular nerve (diagram not needed).(5 marks)

All are motor except the buccal nerve Masseteric nerve (motor)

- Passes with the corresponding artery through the mandibular notch to the deep surface of masseter.

Two deep temporal nerves (motor)- Run upward and emerge above the upper border of the lateral pterygoid and enter the

deep surface of the temporalis muscle.

Nerve to the lateral pterygoid (motor) Enters the deep surface of the muscle

The buccal nerve (sensory)- Runs forward between the two heads of the lateral pterygoid.- It emerges beneath the anterior border of the masseter and supplies the skin over the

cheek and the mucous membrane lining it.

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1- C- Draw a diagram showing the communications of the cavernous sinus. Mention its applied anatomy (6 marks)

Cavernous 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.

Arteriovenous communication: may be established between cavernous sinus and internal carotid artery within it leading to pulsating exophthalmos.________________________________________________________________________________

1- D- Enumerate the structures of the lacrimal apparatus (diagram not needed) (5 marks)

The lacrimal apparatus consists of:

1-Lacrimal gland and its ducts.

2- Conjunctiva.

3- Lacrimal canaliculi and puncta.

4-Lacrimal sac.

5- Nasolacrimal duct.

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

2-A- Discuss the course and the branches of lingual artery (diagram needed)… (4 marks) Arises from the external carotid artery opposite the tip of greater cornu of hyoid bone. It runs forwards :Above the hyoid bone Deep to the hyoglossus muscle. It then passes upwards along the anterior border of the hyoglossus to the tip of the tongue. This

part of the artery is called the deep lingual or profunda artery.Branches: Suprahyoid artery: Runs along the upper border of hyoid bone. Dorsal lingual branches: Ascend to the dorsum of the tongue. Sublingual artery: Ascends upwards and forwards on the genioglossus deep to mylohyoid to supply the sublingual gland ._________________________________________________________________________________

2- B- Enumerate the structures between the external and internal carotid arteries (diagram not needed). Mention the surface anatomy of the external carotid artery (5 marks)

Structures between the internal and external carotid arteries: - - Styloid process. - - Styloglossus. - - Stylopharyngeus.- - Glossopharyngeal nerve. - - Pharyngeal branch of vagus.- - A part of the parotid gland

Surface anatomy of the external carotid artery :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.

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2- C- Mention the arterial supply and venous drainage of the thyroid gland (diagram not needed).(5 marks)

Arterial supply:Superior thyroid artery:

- A branch of external carotid. - Descends to the upper pole of each lobe.

Inferior thyroid artery: - It is a branch of the thyrocervical trunk. - It ascends behind the gland to the level of the cricoid - It then turns medially and downwards to reach the posterior border of the gland.

Thyroida-ima artery: if present- Arises from the arch of aorta or the innominate artery- It ascends infront of the trachea to the isthmus.

Venous drainage:Superior thyroid vein

- Drains into the internal jugular vein.Middle thyroid vein

- Drains into the internal jugular vein. Inferior thyroid vein

- Drains into the left innominate vein._________________________________________________________________________________

2- D- Draw a diagram showing the structures in the lateral wall of the nasopharynx….(4 marks)

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3- E- Problem solving (3 marks)

1- Which is the engorged vein… (0.5 mark)b- External jugular vein 2- Mention the beginning of this vein…..(1 mark)It begins behind the angle of mandible by the union of posterior auricular vein and posterior division of posterior facial vein.

3- Mention the course and end of this vein (1.5 mark)-It descends obliquely backwards across the sternomastoid muscle accompanied by the great auricular nerve and crossing the transverse cervical nerve -About 1 inch above the middle of the clavicle it pierces the deep fascia to end in the subclavian vein .

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

3- A- Enumerate the arteries supplying the spinal cord and discuss one of them (diagram not needed)...(6 marks)The spinal cord is supplied by the following arteries : any one of them 1- Anterior spinal artery :

At first there are two arteries which arise from the 4th part of the vertebral arteries, one for each side.

The two arteries unite to form one anterior spinal artery which descends in the anterior median fissure of the cord and may continue on the filum terminale.

It gives sulcal (central) branches which run through the anterior median sulcus to supply the right and left half of the cord.

It supplies anterior and lateral horns of grey matter and also the bases of its posterior horns. It also supplies the anterior and lateral white columns (anterior 2/3 of spinal cord).

2- Posterior spinal arteries : Are two arteries, one for each side. They arise from the 4th part of the vertebral artery. Each artery divides into two branches. The branches descend on the sides of spinal cord medial and lateral to the posterior (dorsal)

roots of the spinal nerves. They supply the posterior white columns and the posterior horns of grey matter (posterior 1/3

of spinal cord). At the conus medullaris , the anterior & posterior spinal arteries form anastmotic loops with

each other which give cauda equina arteries .

3- Radicular arteries : Are numerous fine branches. They arise on each side from vertebral, ascending cervical,

deep cervical, posterior intercostals, lumbar and lateral sacral arteries. They enter the vertebral canal through the intervertebral foramina, each artery divides into

anterior and posterior branches which follow the anterior and posterior roots of the spinal nerve respectively.

They supply spinal nerve roots, posterior root ganglion and anastomose with branches from anterior and posterior spinal arteries making a plexus of arteries supplying the superficial surface of the spinal cord called the pial plexus.

________________________________________________________________________________________

3- B- Mention the afferent and efferent fibres in the superior cerebellar peduncle (diagram not needed).(5 marks)

Afferent fibres:1- Ventral spino- cerebellar; these fibres cross in the spinal cord but recross in the cerebellum via cerebello- ponto- cerebellar fibres.

2- Tecto-cerebellar; from the tectum of midbrain to the cerebellum.Efferent fibres:Arise from the dentate nucleus then, reach the midbrain and cross the opposite side in the decussation of the superior cerebellar peduncle and are distributed to:

1- Olivary nucleus in medulla (cerebello- olivary).1- Red nucleus (cerebello- rubral) then to spinal cord.2- Reticular nuclei of brain stem ( cerebello- reticular)3- Superior colliculus (cerebello-tectal)4- Intermediate ventral nucleus of the thalamus(cerebello- thalamic) then to the cerebral cortex.

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3- C- Discuss the boundaries of the body of the lateral ventricle (diagram needed)….(5 marks)

It is triangular in cross section.

Its boundaries are:

Roof: Trunk of corpus callosum.

Medial wall : Septum pellucidum and body of fornix.

Floor : From lateral to medial the following structures are present: Body of caudate nucleus, stria

terminalis and thalamostriate vein (lie in the groove between caudate nucleus and thalamus),a

strip of the superior surface of the thalamus, internal cerebral vein, choroids plexus of the lateral

ventricle and body of the fornix.

________________________________________________________________________________

3- D- Mention the association fibres of the cerebral hemisphere (diagram needed) (6 marks)

1- SHORT ASSOCIATION FIBRES : They lie immediately beneath the cortex and connect the adjacent gyri together.

2- LONG ASSOCIATION FIBRES :A-Uncinate fasciculus (Bundle):Connects the Broca's area and the gyri on the orbital surface of the frontal lobe with the cortex of the temporal pole. They hook across the stem of the lateral sulcus.

B-Cingulum Fasciculus: Is a C- shaped long curved bundle . It connects all parts of the medial surface of the hemisphere. It lies within the gyrus cinguli. It begins from below the rostrum of the corpus callosum and follow the curve of the gyrus cinguli to the parahippocampal gyrus to end in the uncus.C- Superior Longitudinal Fasciculus (Bundle): Is the largest of all fasciculi, connects all parts of the superolateral surface of the hemisphere together. It begins in the frontal pole and arches backwards above the insular area to the occipital cortex, then curves downwards and forwards into the temporal lobe where it ends in the temporal lobe.D- Inferior Longitudinal Fasciculus (Bundle): It lies near the inferior surface. It extends from the occipital pole posteriorly to the temporal pole

anteriorly. E- Prependicular Fasciculus:- Connects the posterior parts of the parietal and occipital lobes.

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

4- A- Mention the boundaries of the adductor canal (diagram needed).(4 marks)It has 3 walls:

Antero-lateral wall:

Formed by vastus medialis muscle

Posterior wall (floor):

Formed by:

- Adductor longus in the upper part.

- Adductor magnus in the lower part.

Antero-medial wall (roof):

- Formed by a strong sheet of fascia stretched between vastus medialis and adductor magnus.

- On this fibrous roof lies the sartorius muscle, separated from it by the subsartorial plexus of nerves.

________________________________________________________________________________________

4- B- Mention the common features of the hamstring muscles (diagram not needed)(6 marks)

. Origin:

- All arise from the ischial tuberosity except the short head of biceps which arises from the linea

aspra.

. Insertion:

- In the upper end of the tibia or fibula (not the femur).

- Their tendons form cords (strings) in the ham region (popliteal fossa & back of thigh).

. Nerve supply:

- All are supplied by the tibial division of the sciatic nerve except the short head of biceps : by the

common peroneal.

. Blood supply:

- Mainly the perforating branches of profunda femoris artery.

. Action:

- All have a common action of extending the hip & flexing knee.

- The muscles which are inserted into the lateral bone of leg (biceps) rotates the leg laterally

- The muscles which are inserted in the medial bone (the semi-muscles) rotate the leg medially.

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4- C- Enumerate the branches of the anterior tibial nerve (diagram not needed) (5 marks) Terminal branches :

It ends just distal to the inferior extensor retinaculum by dividing into 2 terminal branches; - Lateral terminal branch:

- Supplies the extensor digitorum brevis - Ends deep to this muscle in a ganglioform

expansion (pseudo ganglion) . - Medial terminal branch:

is divided into 2 digital branches that supply the adjacent side of the 1st & 2nd toes. Muscular:

To muscles of anterior compartment of leg & dorsum of foot. Articular:

To the ankle joint, inter-tarsal and tarso-metatarsal joints. Cutaneous:

To small area of skin in the cleft between the 1st & 2nd toes._________________________________________________________________________________

4- D- Mention the branches of the plantar arch (diagram needed)….(5 marks) 4 plantar metatarsal arteries - They pass forward to the clefts between the toes.- Each one gives rise to the following branches:

* 2 plantar digital arteries supplying the adjacent sides of the toes.* Anterior perforating arteries which pass upwards through the distal ends of

intemetatarsal spaces to join the dorsal metatarsal arteries. - The 1st plantar metatarsal artery may arises from the dorsalis pedis artery in the sole.

Posterior perforating arteries:They pass upwards through the proximal ends of intermetatarsal spaces to join the dorsal

metatarsal arteries.

Plantar digital artery for the lateral side of little toe._________________________________________________________________________________

4- E- Mention the surface anatomy of the great saphenous vein…(2 marks) It can be represented by a line joining the following 4 points:1st : A point on the anterior surface of the medial malleolus.2nd : A point on the medial border of tibia at the junction of the upper 2/3 and lower 1/3 of the leg.3rd : A point at the adductor tubercle.4th : A point just below the center of saphenous opening.

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

5- A- Mention the congenital anomalies of the urinary bladder (5 marks)1) Urachal fistula: - The allantois fails to become obliterated and the urine passes out of the patent urachus to the

umbilicus.

2) Urachal cyst: - Occurs when a localized area of the allantois persists. - The secretory activity of the lining epithelium results in a cystic dilatation.

3) Urachal sinus: -The proximal part of the urachus is obliterated and fibrosed, while its distal part remains patent. - This leads to the formation of a sinus with discharge of serous fluid through the umbilicus.

4) Ectopia vesica: - Occurs when the posterior wall of the urinary bladder is exposed to the exterior.

- It is caused by the failure of the anterior abdominal wall and anterior wall of the bladder to develop.

- This defect is due to inability of the mesoderm of the primitive streak to migrate around the cloacal membrane.

_________________________________________________________________________________

5- B- Mention the components of the two ventricles (4 marks)

Right ventricle develops from:1.Right part of the primitive ventricle forms the rough trabeculated part.2.Infundibulum from the right part of the bulbus cordis forms the smooth part. Left ventricle develops from:1. Left part of the primitive ventricle forms the rough trabeculated part.2. Vestibule from the left part of the bulbus cordis forms the smooth part

________________________________________________________________________________

5- C- Enumerate in table the fate of the pharyngeal pouches (4 marks)

Pouch No.Derivatives

1Middle ear cavity

Eustachian tube of middle earTympanic membrane

2Palatine tonsillar fossa

3Dorsal : Inferior parathyroidVentral : primordium of thymus

4Dorsal : Superior parathyroidVentral: - Ultimobranchial body incorporated into the thyroid for a while, but eventually is completely degenerates - rudimentary thymus (soon disappears)

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