Previous year question on foramen based on neet pg, usmle, plab and fmge or mci screening exams

22-year-old Suma, with a history of epilepsy is undergoing the pre-anaesthetic review. The use of which inhalational agent is contraindicated in this patient?

A: HalothaneB: EnfluraneC: SevofluraneD: Isoflurane

Correct Ans:BExplanation

Enflurane can precipitate generalized tonic clonic seizure in epileptics. It is however safer than halothane, causes less myocardiac depression and less hypotension.

Sample Previous Year Question on Epilepsy based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

A patient presented with short lasting episodic behavioural changes which include agitation and dream like state with thrashing movements of his limbs. He does not recall these episodes and has no apparent precipitating factor. Which of the following is the most likely diagnosis?

A: Panic episodesB: SchizophreniaC: Temporal lobe epilepsyD: Dissociative disorder

Correct Ans:CExplanation

The patient in the question has most likely suffered an attack of temporal lobe epilepsy. The loss of consciousness need not always be present but it is associated with loss of memory for the episode. In temporal lobe seizure, the patient usually experiences auras or warning signs, epigastric discomfort, olfactory hallucination, sensation of deja vu. A dream like state is often a feature of TLE. There may be loss of consciousness abnormal movement of mouth, and rarely abnormal movement of body. Frontal lobe epilepsy is also associated with episodes of agitation known as ‘intermittent explosive disorder’.

Ref: Clinical Neuroanatomy By Stephen G. Waxman, 26th Edition, Chapter 19


Gustatory hallucinations are most commonly associated with:

A: Temporal lobe epilepsyB: Grand mal epilepsy

C: Anxiety disordersD: Tobacco dependenceCorrect Ans:AExplanation

Gustatory hallucinations are most commonly associated with temporal lobe lesions, especially uncinate gyrus seizures. Patients report experiencing bitter, sweet, salty, tobacco-like, metallic or indescribable strange tastes. They are found in 4% of seizure patients with temporal lobe foci.

Ref: Clinical neuropsychology 4th Ed By Kenneth M.Heilman, Page 488.


A 27 year old man with epilepsy presents with complaints of persistent lethargy and occasional feelings of intoxication, although he does not consume alcohol. The patient is currently taking phenobarbital for the long-term management of tonic-clonic seizures. In addition, he was recently started on a medication for the treatment of gastroesophageal reflux disease. Which of the following agents was he most likely prescribed?

A: CimetidineB: FamotidineC: LansoprazoleD: Ranitidine

Correct Ans:AExplanationCimetidine is an H2-receptor antagonist indicated for the short-term and maintenance treatment of duodenal and gastric ulceration, as well as gastroesophageal reflux disease. One of the primary disadvantages of using this agent, with respect to other H2-receptor antagonists famotidine and ranitidine, is that it is a relatively potent hepatic enzyme inhibitor. Therefore, this medication is likely to decrease the metabolism of other hepatically metabolized medications, such as phenobarbital. When the metabolism of a medication is decreased, the blood levels will increase, leading to an extension of the

therapeutic effect and/or toxicity. Phenobarbital is a barbiturate indicated for the treatment of tonic-clonic seizures and status epilepticus. When the blood concentration of this medication increases, lethargy and feelings of intoxication may occur.Lansoprazole is a gastric acid proton-pump inhibitor indicated for the short-term and maintenance treatment of duodenal and gastric ulceration, as well as gastroesophageal reflux disease. This agent does not affect hepatic enzymes.

Ref: McQuaid K.R. (2012). Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds),Basic & Clinical Pharmacology, 12e.


At autopsy, a body is found to have copious fine leathery froth in mouth and nostrils which increased on pressure over chest. Which of the following was the most likely cause of death?

A: EpilepsyB: Hanging

C: DrowningD: Opium poisoningCorrect Ans:CExplanation

Presence of fine, white, leathery froth seen at the mouth and nostrils is one of the most characteristic external signs of drowning. It is white or rarely blood stained, lather-like, abundant and increase in amount with compression of chest. Even after wiping it gradually reappears, especially if pressure is applied to the chest.

Froth is also seen in strangulation, acute pulmonary edema, electric shock, during epileptic fit, in opium poisoning and putrefaction. But in all these cases the quantity of froth is not as large as in drowning, and the bubbles are also much smaller.

Ref: Parikh’s Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 6th Edition, Pages 3.66-3.67 ; Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 325-6


Corpus callosotomy is useful in treatment of:

A: EpilepsyB: StrokeC: Alzheimer’s diseaseD: none of the above

Correct Ans:AExplanationPatients with generalized seizures, atonic seizures associated with drop attacks, or absence seizures, who are found to have bilaterally coordinated pathologic cortical discharges on EEG and who fail AED therapy, may be candidates for corpus callosotomy. The corpus callosum is a large white matter tract that connects the cerebral hemispheres.

Loss of consciousness requires simultaneous seizure activity in both hemispheres. Focal or partial seizures may spread via the corpus callosum to the contralateral hemisphere, causing generalization and loss of consciousness. Division of the corpus callosum can interrupt this spread.

Ref: Schwartz’s principle of surgery 9th edition, chapter 42.


Which of the following methods of contraception should be avoided in women with epilepsy?

A: Oral contraceptive pillsB: IUCD

C: CondomsD: DiaphragmCorrect Ans:AExplanationAll the antileptics (except for sodium valproate and clonazepam) have the property to induce the enzyme complex which metabolizes the oral contraceptives. Hence it is better avoided in patients with a history of epilepsy on medications. The other three methods of contraception mentioned in the question have no such contraindication.

Ref: Dutta textbook of Obstetrics, 6th Edition, Page 545; Textbook of Gynaecology By Rao, Page 183-184


Which of the following drugs is not used in Juvenile Myoclonic Epilepsy (JME)?

A: TopiramateB: ZonisamideC: CarbamezapineD: Valproate

Correct Ans:CExplanationCarbamezipine, Phenytoin, Oxcarbazepine are few drugs which are capable of aggravating Juvenile Myoclonic Epilepsy.

Ref: Epileptic Syndromes in Infancy, Childhood and Adolescence By Joseph Roger, Michelle Bureau, Charlotte Dravet, Pierre Genton, Page 382


All of the following factors are associated with a substantially greater risk of developing epilepsy after febrile seizures, except:

A: Complex Febrile seizuresB: Early age of onset

C: Developmental abnormalitiesD: Positive family History of EpilepsyCorrect Ans:BExplanationFactors increasing risk of epilepsy after febrile seizures include family history of epilepsy, a typical seizures/complex nature of seizures and presence of a neurodevelopmental abnormality.

Early age on onset increases the risk of recurrence of febrile convulsions.

Ref: Febrile Seizures By Tallie Z. Baram, Shlomo Shinnar, Page 63; Essential of Pediatrics By O P Ghai, 6th Edition, Page 509


An adolescent is brought to the emergency department following an episode of myoclonic jerks at morning after waking up. His consciousness was not impaired. His EEG shows generalized 3-4 Hz spike and slow wave complexes. Most probable diagnosis is?

A: Generalized tonic clonic seizureB: Absent seizure

C: Temporal lobe epilepsyD: Juvenile myoclonic epilepsyCorrect Ans:DExplanation

Juvenile myoclonic epilepsy is a subtype of idiopathic generalized epilepsy with onset usually between 8 and 20 years of age. Myoclonic jerks, especially in the morning, are of variable intensity ranging from simple twitching (“flying saucer syndrome”) to falls; consciousness is not impaired in it. It is precipitated by alcohol and sleep deprivation. Patients will have normal intelligence. The typical interictal EEG abnormality consists of a generalized 4- to 6-Hz spike or polyspike and slow-wave discharges lasting 1-20 seconds. Usually, 1-3 spikes precede each slow wave.

Also know:

In Generalized tonic clonic seizure EEG shows a normal background with generalized epileptiform discharges such as spike or polyspike wave complexes at 2.5 to 4 Hz.

During absence seizures there is an abrupt onset of bilaterally synchronous and symmetrical 3 Hz spike-wave discharge, irrespective of whether typical absences are simple or complex.

Ictal recordings from patients with typical temporal lobe epilepsy usually exhibit 5-7 Hz, rhythmic, sharp theta activity, maximal in the sphenoidal and the basal temporal electrodes on the side of seizure origin.

Ref: A-Z of Neurological Practice: A Guide to Clinical Neurology By Andrew J. Larner, Alasdair J Coles, Neil J. Scolding, Roger A Barker, 2011, Page 368 ; Clinical Electroencephalography by Misra,2005, Page 188


Which one of the following is the characteristic feature of juvenile myoclonic epilepsy?

A: Myoclonic seizures frequently occur in morningB: Complete remission is common

C: Response to anticonvulsants is poorD: Associated absence seizures are present in majority of patientsCorrect Ans:AExplanation

Juvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescence and is usually characterized by bilateral myoclonic jerks that may be single or repetitive. The myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivation. Consciousness is preserved unless the myoclonus is especially severe. Many patients also experience generalized tonic-clonic seizures, and up to one-third have absence seizures.

Although complete remission is relatively uncommon, the seizures respond well to appropriate anticonvulsant medication. There is often a family history of epilepsy, and genetic linkage studies suggest a polygenic cause.

Ref: Lowenstein D.H. (2012). Chapter 369. Seizures and Epilepsy. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.


Which of the following statements is incorrect in relation to pregnant women with epilepsy?

A: The rate of congenital malformation is increased in the offspring of women with epilepsy

B:Seizure frequency increases in approximately 70% of women

C: Breast feeding is safe with most anticonvulsantsD: Folic acid supplementation may reduce the risk of neural tube defectCorrect Ans:BExplanation

Frequency of convulsions is unchanged in majority.

Ref:Textbook of Gynecology By D C Dutta, 6th Edition, Page 298; Harrison’s Principles of Internal Medicine, 16th Edition, Page 2371


Vitamin deficient is most commonly seen in a pregnant mother who is on phenytoin therapy for epilepsy?

A: Vitamin B6B: Vitamin B12C: Vitamin AD: Folic acid

Correct Ans:DExplanation

Phenytoin interferes with metabolism of folate and patients taking phenytoin may become deficient in folic acid. Phenytoin decreases absorption of folic acid and increases its excretion.

Ref: Advanced Therapy in Epilepsy By Wheless, James W. Wheless, James Willmore, Roger A. Brumback, 2009, Page 259.


Triad of Tuberous Sclerosis includes all, except:

A: Epilepsy

B: Low intelligenceC: HydrocephalusD: Adenoma sebaceumCorrect Ans:CExplanation

Diagnostic triad of Tuberous sclerosis includes epilepsy, mental retardation and adenoma sebaceum (facial angiofibroma).

Tuberous sclerosis (TS) is an autosomal dominant disorder which result from mutations in either the TSC1 gene encoding hamartin or the TSC2 gene encoding tuberin. Hamartin and tubulin form a complex which negatively regulate cell growth and proliferation through inhibition of mTOR.

Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 284; The 5-Minute Neurology Consult By D. Joanne Lynn, Page 430; Tuberous Sclerosis Complex: Genes, Clinical Features and Therapeutics By David J. Kwiatkowsk, Page 221


In pediatric patients, the risk of developing post-traumatic epilepsy is significantly increased by:

A: Brief loss of consciousnessB: Acute intracranial hemorrhageC: Retrograde amnesiaD: Post-traumatic vomitingCorrect Ans:BExplanationLate post-traumatic epilepsy is diagnosed when a seizure occurs for the first time more than one week after a head injury. Factors that correlate with an increased risk of developing post-traumatic epilepsy include presence of a depressed skull fracture, acute intracranial hemorrhage, cerebral contusion, or unconsciousness lasting more than 24 hours. Because the risk of a subsequent seizure is approximately 75%, acute and chronic treatment with anticonvulsants is indicated.

Loss of consciousness, retrograde amnesia, and vomiting are relatively common immediate consequences of head trauma. They are usually transient and are not highly correlated with a risk of subsequent post-traumatic seizures.

Ref: Smith W.S., English J.D., Johnston S.C. (2012). Chapter 370. Cerebrovascular Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.


All of the following structures pass through optic foramen, EXCEPT:

A: Optic nerveB: Ophthalmic arteryC: Ophthalmic nerveD: Dural mater

Correct Ans:CExplanationThe optic foramen lies at the orbital apex and transmits the optic nerve and ophthalmic artery. Superior orbital fissure transmits the ophthalmic nerve.

Optic foramen: Is a oval opening at the apex of the orbit. It lies between the two roots of the lesser wings of the sphenoid bone.

It transmits

Optic nerve Ophthalmic branch of internal carotid artery Branches of sympathetic carotid plexus Prolongation of optic nerve sheaths

Superior orbital fissure: The superior orbital fissure is bounded by the lesser and greater wings of the sphenoid.

Contents:

Superior ophthalmic vein Oculomotor nerve (III) Trochlear nerve (IV) Lacrimal, frontal and nasociliary branches of Ophthalmic nerve (V1) Abducent nerve (VI) Orbital branch of middle meningeal artery Recurrent branch of lacrimal artery Superior orbital vein Superior ophthalmic vein

Inferior orbital fissure: The greater wing of the sphenoid, the maxilla, and the palatine bones of the orbit form the boundaries of the inferior orbital fissure.

The fissure transmits the Maxillary nerve and its zygomatic branch, Infraorbital vessels, Ascending branches from the sphenopalatine ganglion and a vein which

connects the inferior ophthalmic vein with the pterygoid venous plexus.

Ref: Comprehensive Manual of Ophthalmology, By Ahmed E, Page 4

Sample Previous Year Question on Foramen Part II based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

Which of the following opening in the base of the skull transmits the third branch of trigeminal nerve?

A: Foramen ovaleB: Foramen lacerumC: Foramen magnumD: Foramen spinosumCorrect Ans:AExplanationForamen ovale is an opening at the base of the lateral pterygoid plate. It transmits the third branch of the trigeminal nerve, the accessory meningeal artery, and occasionally the superficial petrosal nerve.

Foramen lacerum transmits the internal carotid artery.Foramen magnum transmits the medulla and its membranes, the spinal accessory nerves, the vertebral arteries, and the anterior and posterior spinal arteries.

Ref: Waxman S.G. (2010). Chapter 11. Ventricles and Coverings of the Brain. In S.G. Waxman (Ed), Clinical Neuroanatomy, 26e.


Which of the following cranial nerve travels through the jugular foramen in the base of the skull?

A: 3rd branch of trigeminal nerveB: Abducens nerve

C: Facial nerveD: Glossopharyngeal nerve

Correct Ans:DExplanationGlossopharyngeal nerve travel through the middle compartment of the jugular foramen. Jugular foramen is formed by the petrous portion of the temporal and occipital bones. It is divided into 3 compartments. The intermediate compartment contains the glossopharyngeal, vagus, and spinal accessory nerves. The anterior compartment contains the inferior petrosal sinus and the posterior compartment contains the sigmoid sinus and meningeal branches from the occipital and ascending pharyngeal arteries.



Middle meningeal artery courses along which of the following opening in the base of the skull?

A: Foramen ovaleB: Foramen lacerumC: Foramen spinosumD: Foramen rotundumCorrect Ans:CExplanationMiddle meningeal artery and vein travels through foramen spinosum.

Structures passing through openings in the skull base are:

Foramen Structures

Cribriform plate of ethmoid Olfactory nerves

Optic foramen Optic nerve, ophthalmic artery, meninges

Superior orbital fissure Oculomotor, trochlear, and abducens nerves; ophthalmic division of trigeminal nerve; superior ophthalmic vein

Foramen rotundum Maxillary division of trigeminal nerve, small artery and vein

Foramen ovale Mandibular division of trigeminal nerve, vein

Foramen lacerum Internal carotid artery, sympathetic plexus

Foramen spinosum Middle meningeal artery and vein

Internal acoustic meatus Facial and vestibulocochlear nerves, internal auditory artery

Jugular foramen Glossopharyngeal, vagus, and spinal accessory nerves; sigmoid sinus

Hypoglossal canal Hypoglossal nerve

Foramen magnum Medulla and meninges, spinal accessory nerve, vertebral arteries, anterior and posterior spinal arteries



Which of the following structure is passing through foramen rotundum?

A: Maxillary arteryB: Maxillary nerveC: Middle meningeal arteryD: Spinal accessory nerve

Correct Ans:BExplanationForamen rotundum located posterior to the medial end of the superior orbital fissure. The foramen rotundum transmits the maxillary nerve (CN V-2) en route to the pterygopalatine fossa. CN V-2 supplies the skin, teeth, and mucosa associated with the maxillary bone.

Ref: Morton D.A., Foreman K.B., Albertine K.H. (2011). Chapter 15. Scalp, Skull, and Meninges. In D.A. Morton, K.B. Foreman, K.H. Albertine (Eds), The Big Picture: Gross Anatomy.


Herniation through Foramen of Morgagni is seen in children. Foramen of Morgagni refers to an opening in:

A: The brainB: The lesser omentumC: The skullD: The diaphragm

Correct Ans:DExplanationThe foramen of Morgagni occurs at the junction of the septum transversum and the anterior thoracic wall. This anterior, central diaphragmatic defect accounts for only 2% of diaphragmatic hernias. It may be parasternal, retrosternal, or bilateral.

The defect is closed by suturing the posterior rim of diaphragm to the posterior rectus sheath, since there is no anterior diaphragm.

Ref: Albanese C.T., Sylvester K.G. (2010). Chapter 43. Pediatric Surgery. In G.M. Doherty (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.


Which of the following circulatory changes normally take place in the newborn within 5 minutes after birth?

A: Closure of the ductus arteriosusB: Closure of the foramen ovaleC: Increase in pulmonary artery resistanceD: All of the above

Correct Ans:BExplanationWith the first breath of life, pulmonary arterial resistance drops dramatically. This is due to the oxygenation of the lungs causing vasodilatation of the pulmonary vessels. Clamping of the umbilical cord doubles peripheral resistance and causes an increase in arterial blood pressure. As soon as right atrial, pressure drops below left atrial pressure, the foramen ovale will close (valve-like mechanism), establishing the adult-type blood circulation.

The rising systemic and falling pulmonary artery pressure causes a flow reversal through the ductus arteriosus from right to left to left to right within minutes of birth. Complete closure of the ductus arteriosus appears to be due to a decline of local prostacyclin levels and usually occurs within 24 to 48 hours after birth.

Ref: Morton D.A., Foreman K.B., Albertine K.H. (2011). Chapter 4. Heart. In D.A. Morton, K.B. Foreman, K.H. Albertine (Eds), The Big Picture: Gross Anatomy.


Foramen of Morgagni refers to an opening in:

A: The brainB: The lesser omentumC: The skullD: The diaphragmCorrect Ans:DExplanation

Foramen of morgagni is a small triangular diaphragmatic cleft bounded medially by muscle fibers originating from the sternum and laterally by the seventh costal cartilages. It occurs due to lack of fusion or muscularization of the pleuroperitoneal membrane anteriorly leading to a defect in the costosternal trigones.

Diaphragmatic hernia can occur anteriorly at the foramen of morgagni and posterolaterally through the Bochdalek foramen or at the esophageal hiatus.Bochdalek foramen refers to the gap between the lumbar and costal elements.

Openings in the diaphragm:

The caval foramen is located on the right at the level of T8 within the central tendon.

Esophageal foramen lies at T10 level. The aortic opening lies behind the diaphragm at its lowest point opposite

to the T12 vertebrae.

Ref: Teaching Atlas of Chest Imaging By Mark Parker page 757, Upper Gastrointestinal Surgery edited by John W. L. Fielding, page 118.


All of the following statements are true regarding the pudendal nerve, except:

A: It is both sensory and motorB: It is derived from S2,3,4

C: It leaves the pelvis through the lesser sciatic foramenD: It leaves through lesser sciatic foramen and enter pudendal canalCorrect Ans:C

Explanation

Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower part of the greater sciatic foramen. Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum.

Ref: Clinical anatomy for Medical Students By Richard S Snell, 6th Edition, Pages 362-3 ;

B.D.Chaurasia’s Human Anatomy, 5th Edition, Volume 2, Page 365


The boundaries of the interconnection between greater sac and lesser sac of peritoneum known as 'Foramen of Winslow' are all, EXCEPT:

A: Caudate lobe of liverB: Inferior vena cavaC: Free border of lesser omentumD: 4th part of Duodenum


Interconnection between greater sac and lesser sac of peritoneum is known as Foramen of Winslow. It has the following boundaries:

Superior boundary: Caudate lobe of liver

Anterior boundary: Free edge of lesser omentum containing common bile duct, hepatic artery andportal vein.

Inferior boundary: First part of duodenum

Posterior boundary: Inferior vena cava and abdominal aorta


Structures passing through lesser sciatic foramen are all, except:

A: Pudendal nerve

B: Internal pudendal arteryC: Nerve to obturator externusD: Tendon of obturator internusCorrect Ans:CExplanation

Structures passing through lesser sciatic foramen are tendon of obturator internus muscle, nerve to obturator internus, pudendal nerve, internal pudendal artery and vein.

Structures passing through greater sciatic foramen are:

Piriformis Sciatic nerve Posterior cutaneous nerve of thigh Superior and inferior gluteal nerve Nerve to obturator internus and quadratus femoris Pudendal nerve Superior and inferior gluteal nerves and arteries Internal pudendal artery and vein


Which of the following structures form the superior border of Epiploic foramen ?

A: Quadrate lobe of liverB: Caudate process of caudate lobe of liverC: Porta hepatisD: First part of the duodenumCorrect Ans:BExplanation

In human anatomy, the omental foramen (Epiploic foramen, foramen of Winslow, or uncommonly aditus) is the passage of communication or foramen, between the greater sac (general cavity of the abdomen) and the lesser sac.

Borders of Epiploic foramen:It has the following boundaries:

Anteriorly : free border of lesser omentum, bile duct, hepatic artery and portal vein.

Posteriorly : Inferior vena cava, right suprarenal gland and T12 vertebrae Superiorly : Caudate process of caudate lobe of liver

Inferiorly : First part of the duodenum and horizontal part of hepatic artery


Which of the following structure forms the superior border of Epiploic foramen?

A: Head of pancreasB: Caudate lobe of liverC: Lesser omentumD: IVC


Caudate process of caudate lobe of the liver forms the superior border of epiploic foramen.

The right margin of the lesser sac opens into the greater sac through the opening of the lesser sac called Epiploic foramen.

Boundaries of epiploic foramen are formed by:

Anteriorly: Free border of the lesser omentum, bile duct, hepatic artery and portal vein.Posteriorly: Inferior vena cavaSuperiorly: Caudate process of caudate lobe of the liverInferiorly: First part of the duodenum.

Ref: Clinical Anatomy by Regions By Richard S. Snell, 8th edn, page 208


All of the following structures forms the boundries of epiploic foramen, EXCEPT:

A: Caudate process of liverB: Inferior vena cava

C: 4th part duodenum

D: Free border of lesser omentumCorrect Ans:CExplanation

Epiploic foramen also known as foramen of winslow is a vertical slit like opening, through which the lesser sac communicates with the greater sac.

Boundaries of the epiploic formen:

Anteriorly: by lesser omentum containing portal vein, hepatic artery and bile duct.

Posteriorly: suprarenal gland inferior vena cava and T12 vertebra. Superiorly: caudate lobe of liver. Inferiorly: 1st part of duodenum and hepatic artery.

Ref: Cunningham's textbook of anatomy, By Daniel John Cunningham, Page 1239


Structure that DOES NOT pass through lesser sciatic foramen:

A: Pudendal nerveB: Internal pudendal vesselsC: Tendon to obturator internusD: Tendon to obturator externusCorrect Ans:DExplanation

Lesser sciatic foramen is formed by the lesser sciatic notch and the sacrotuberous and sacrospinous ligaments. Structures that pass through the foramen are:

Tendon to obturatur internus Nerve to obturatur internus Pudendal nerve and Internal pudendal artery and vein

Ref: Snell's, Clinical Anatomy, 7th Edition, Page 602.


A 47 year old woman presents to the emergency department with cramping/colicky abdominal pain. The current episode of pain began several hours ago, following a fatty meal. The pain began slowly, and rose in intensity to a plateau over the course of several hours. The patient reports that she had had several other episodes of similar pain during the past several months, with long intervening periods of freedom from pain. On physical examination, she is noted to have tenderness to deep palpation in the right upper quadrant of the abdomen near the rib cage. The patient also reports that she is experiencing shoulder/back pain at a site she identifies near the right lower scapula, but no tenderness can be elicited during the back and shoulder examination. Following appropriate diagnostic studies, the patient is taken to the surgical suite. During the surgery, the surgeon inserts his fingers from right to left behind the hepatoduodenal ligament. As he does so, his fingers enter which of the following?

A: Ampulla of VaterB: Common bile ductC: Epiploic foramenD: Greater peritoneal sacCorrect Ans:CExplanation

The space behind the stomach, hepatoduodenal ligament, and hepatogastric ligament is the omental bursa. This space can be entered by passing through the epiploic foramen of Winslow, as described in the question stem.

Good to know:

The common bile duct enters the duodenum through the ampulla of Vater. The hepatoduodenal ligament contains the common bile duct, the portal

vein and the hepatic artery. The greater peritoneal sac lies anterior to the stomach and

hepatoduodenal ligament.

Ref: Morton D.A., Foreman K.B., Albertine K.H. (2011). Chapter 8. Serous Membranes of the Abdominal Cavity. In D.A. Morton, K.B. Foreman, K.H. Albertine (Eds), The Big Picture: Gross Anatomy.


Epiploic foramen provides communication between greater and lesser sacs. The length of the epiploic foramen is:

A: 5 cmB: 6 cm

C: 4 cmD: 3 cmCorrect Ans:DExplanation The greater and lesser sacs communicate with each other through the epiploic foramen (of Winslow). The foramen is about 3 cm in size and situated opposite the 12th thoracic vertebra.



Where is the ‘Foramen of Winslow’ located anatomically?

A: Between greater and lesser sacB: At hilum of liverC: Transverse cervical ligament of uterusD: Pouch of Douglas

Correct Ans:AExplanation

The lesser omentum attaches between the liver, stomach, and proximal portion of the duodenum. It forms a sac known as the omental bursa, which forms a subdivision of the peritoneal cavity known as the lesser sac. The greater sac is the remaining part of the peritoneal cavity.

The greater and lesser sacs communicate with each other through the epiploic foramen (of Winslow).



Which of the following is the anatomical location of foramen of winslow?



The lesser omentum forms a sac known as the omental bursa, which forms a subdivision of the peritoneal cavity known as the lesser sac. The greater sac is the remaining part of the peritoneal cavity. The greater and lesser sacs communicate with each other through the epiploic foramen (of Winslow).

Also know:

The omentum refers to modified mesenteries associated with the stomach and liver.

Greater omentum. An apron-like fold of mesentery that attaches between the transverse colon to the greater curvature of the stomach.

Lesser omentum. Mesentery that attaches between the liver, stomach,

and proximal portion of the duodenum. As a result, the lesser omentum is also referred to as thehepatogastric ligament and hepatoduodenal ligament.



Where is the anatomical location of Foramen of Winslow?


Correct Ans:A

Explanation

The lesser omentum forms a sac known as the omental bursa, which forms a subdivision of the peritoneal cavity known as the lesser sac. The greater sac is the remaining part of the peritoneal cavity. The greater and lesser sacs communicate with each other through the epiploic foramen (of Winslow).

Boundaries of epiploic foramen:

Anteriorly: The free border of the lesser omentum, containing the bile duct, the hepatic artery, and the portal vein

Posteriorly: Inferior vena cava Superiorly: The caudate process of the caudate lobe of the liver Inferiorly: The first part of the duodenum



The posterior relation of epiploic foramen is:

A: Hepatic arteryB: Inferior vena cavaC: Common bile ductD: Portal vein

Correct Ans:BExplanationEpiploic foramen or aditus to lesser sac communicates lesser sac to greater sac. It is bounded posteriorly by inferior vena cava, suprarenal gland and T12 vertebra.

Epiploic foramen: also known as foramen of winslow is a vertical slit like opening, through which the lesser sac communicates with the greater sac. It is situated at the upper wall of lesser sac at the level of T12.

Boundaries of the epiploic foramen:

Anteriorly: right free margin of lesser omentum containing portal vein, hepatic artery and bile duct

Posteriorly: suprarenal gland, inferior vena cava and T12 vertebra Superiorly: caudate lobe of liver Inferiorly: 1st part of duodenum and hepatic artery

Ref: Cunningham's textbook of anatomy, By Daniel John Cunningham, Page 1239

Sample Previous Year Question on Foramen Part III based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

All the following structures form boundaries of Epiploic foramen, EXCEPT:

A: Portal veinB: Inferior vena cavaC: Quadrate lobe of liverD: First part of duodenumCorrect Ans:CExplanation

The right margin of the lesser sac opens into the greater sac through the epiploic foramen. The superior boundary of the foramen is foramen by caudate lobe of the liver.

Structures forming boundaries of the epiploic foramen are:Anteriorly: free border of lesser omentum, bile duct, hepatic artery and portal vein.Posteriorly: Inferior vena cavaSuperiorly: Caudate process of caudate lobe of liverInferiorly: First part of duodenum

Ref: Clinical Anatomy by Regions By Richard S. Snell page 208.


All of the following structures pass through the greater sciatic foramen, EXCEPT:

A: Piriformis muscleB: Pudendal nerve

C: Inferior gluteal vesselD: Internal pudendal vesselCorrect Ans:BExplanationPudendal nerve courses through the lesser sciatic foramen.

Structures passing through the lesser sciatic foramen are:

Pudendal nerve Internal pudendal vessels Obturator internus tendon

Structures passing through the greater sciatic foramen are:

Sciatic nerve Piriformis muscle Internal pudendal and inferior gluteal vessels Other branches of the sacral nerve plexus

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 38. Anatomy.


Which of the following is TRUE about ‘Foramen of Winslow’?

A: It is seen between greater and lesser sacB: Anteriorly bound by 2nd part of duodenumC: Seen in transverse cervical ligament of uterusD: Posteriorly bound by pouch of Douglas

Correct Ans:AExplanationThe epiploic foramen of Winslow or the aditus to the lesser sac is the only communication between greater and lesser sac. It is bounded,

Anteriorly by hepatoduodenal ligament Posteriorly by inferior venacava Superiorly by caudate lobe of liver Inferiorly by first part of duodenum

Ref: Last's Anatomy: Regional and Applied By Chummy S. Sinnatamby, 2011, Chapter 5.


All of the following passing through lesser sciatic foramen, except:

A: Pudendal nerve

B: Internal pudendal vesselsC: Nerve to obturator internusD: Inferior gluteal vessels


The lesser sciatic foramen is formed by the lesser sciatic notch of the pelvic bone, the ischial,the sacrospinous ligament and the sacrotuberous ligament.

It transmits the following structures:

The tendon of the Obturator internus Internal pudendal vessels Pudendal nerve Nerve to the obturator internus

Ref: Morton D.A., Foreman K.B., Albertine K.H. (2011). Chapter 12. Pelvis and Perineum. In D.A. Morton, K.B. Foreman, K.H. Albertine (Eds), The Big Picture: Gross Anatomy.


All of the following structures passes through lesser sciatic foramen, EXCEPT:

A: Inferior gluteal vesselsB: Internal pudendal vesselsC: Pudendal nerveD: Nerve to obturator internusCorrect Ans:AExplanationStructures passing through the lesser sciatic foramen are tendon of obturator internus, internal pudendal vessels and pudendal nerve.

Structures passing through greater sciatic foramen are:

Piriformis muscle Superior and inferior gluteal vessel Internal pudendal vessel Pudendal nerve Sciatic nerve Posterior femoral cutaneous nerve

Nerve to obturator internus Quadratus femoris

Structures passing through both greater and lesser sciatic foramen:

Pudendal nerve Internal pudendal vessels Nerve to obturator internus

Ref: BRS Gross Anatomy By Kyung Won Chung, page 97


The middle meningeal artery enters the cranium through the:

A: Foramen spinosumB: Foramen rotundumC: Foramen magnumD: Foramen ovale


The middle meningeal artery is the largest of the arteries supplying the dura mater. It is a branch of the maxillary artery and enters the cranium through the foramen spinosum.

Ref: Gray's Basic Anatomy International Ed, page 429


Which of the following foramen is responsible for the drainage of CSF from lateral to third ventricle?

A: Foramen of MonroB: Foramen of LuschkaC: Foramen of MagendieD: Cerebral aqueduct


The two interventricular foramens, or foramens of Monro, are apertures between the column of the fornix and the anterior end of the thalamus. The two lateral ventricles communicate with the third ventricle through these foramens and drainage of CSF occurs.

The lateral aperture (foramen of Luschka) is the opening of the lateral recess into the subarachnoid space near the flocculus of the cerebellum. A tuft of choroid plexus is commonly present in the aperture and partly obstructs the flow of CSF from the fourth ventricle to the subarachnoid space.

The medial aperture (foramen of Magendie) is an opening in the caudal portion of the roof of the ventricle. Most of the outflow of CSF from the fourth ventricle passes through this aperture.

The cerebral aqueduct is a narrow, curved channel running from the posterior third ventricle into the fourth.



A 17-year-old male is examined by a physician, who notes a mass at the back of the young man's tongue. The physician biopsies the mass, and the pathology report comes back with a diagnosis of normal thyroid tissue. The occasional presence of such tissue at the back of the tongue is related to the embryonic origin of the thyroid near which of the following structures?

A: First pharyngeal pouchB: Foramen cecum

C: Nasolacrimal ductD: Second pharyngeal archCorrect Ans:BExplanation

The thyroid gland originates as a mass of endodermal tissue near the foramen cecum, which is near the tuberculum impar (which becomes the central part of the tongue). During development, the thyroid descends in front of the pharynx, maintaining a connection to the tongue via the thyroglossal duct.

Usually, the thyroglossal duct disappears. Uncommonly, residual ectopic thyroid tissue can be left anywhere along the path, including at the back of the tongue. (In rare patients, all of the thyroid tissue remains at this site, forming a mass that should not be excised, for obvious reasons!).

The first pharyngeal pouch develops into the middle ear and eustachian tube. The

nasolacrimal ducts connect the eyes to the mouth. The second pharyngeal arch develops into many muscles of the face and styloid process of the temporal bone.


A 17-year-old male is examined by a physician, who notes a mass at the back of the young man's tongue. The physician biopsies the mass, and the pathology report comes back with a diagnosis of normal thyroid tissue. The occasional presence of such tissue at the back of the tongue is related to the embryonic origin of the thyroid near which of the following structures?

A: First pharyngeal pouchB: Foramen cecum

C: Nasolacrimal ductD: Second pharyngeal archCorrect Ans:BExplanation

The thyroid gland originates as a mass of endodermal tissue near the foramen cecum, which is near the tuberculum impar (which becomes the central part of the tongue). During development, the thyroid descends in front of the pharynx, maintaining a connection to the tongue via the thyroglossal duct.

Usually, the thyroglossal duct disappears. Uncommonly, residual ectopic thyroid tissue can be left anywhere along the path, including at the back of the tongue. (In rare patients, all of the thyroid tissue remains at this site, forming a mass that should not be excised, for obvious reasons!).

The first pharyngeal pouch develops into the middle ear and eustachian tube. The nasolacrimal ducts connect the eyes to the mouth. The second pharyngeal arch develops into many muscles of the face and styloid process of the temporal bone.


Which gland is derived from foramen caecum?

A: PituitaryB: Thyroid

C: Thymus

D: ParathyroidCorrect Ans:BExplanation

The site of origin of the thyroglossal duct is the foramen caecum. It grows down in the midline into the neck. Its tip soon bifurcates. Proliferation of the cells of this bifid end gives rise to the two lobes of the thyroid.

Ref: Textbook of Human Embryology, 6th Ed Page 119.


All of the following characteristics differentiate a typical cervical vertebrae from a thoracic vertebrae except

A: Mas a triangular vertebral canalB: Has foramen transversariumC: Superior articular facet is directed backwards & upwards.D: Has a large vertebral body


The transverse process of cervical vertebrae is pierced by a foramen called the foramen transversarium.The laminae of cervical vertebrae are long(transversely)and narrow (vertically).The spinous processes are short and bifid in a typical cervical vertebra.

The vertebral bodies progressively increase in size from above downwards.They are therefore smallest in the cervical vertebrae and largest in the lumbar vertebrae.

Ref: Textbook of Anatomy with Colour Atlas by Inderbir Singh By Inderbir Singh Page 85


Cervical vertebrae can be differentiated from thoracic vertebrae on the basis of which of the following features?

A: Triangular bodyB: Presence of foramen transversariumC: Superior articular facet which is directed backwards and sidewardsD: Presence of a large vertebral body


Foramen transversarium is a characteristic feature of cervical vertebrae. Foramen transversarium of transverse process of cervical vertebrae transmits:

Vertebral artery, Vertebral veins, Branch from the inferior cervical sympathetic ganglion.

Thoracic vertebrae is chracterised by the presence of costal facets in the body.

Lumbar vertebrae has:

Kidney shaped body Long thin transverse process Spine which is short, quadrilateral and horizontal Presence of mamillary body and accessary mamillary process Absence of foramen transvorsorium and costal facets.


All of the following characteristics differentiate a typical cervical vertebrae from a thoracic vertebrae, EXCEPT:

A: Has a triangular vertebral canalB: Has foramen transversariumC: Superior articular facet is directed backwards and upwardsD: Has a large vertebral body


Cervical vertebrae has a small body. Its transverse diameter is greater than the anteroposterior length. Outline of thoracic vertebral body when viewed from above is heart shaped.

Features of a typical cervical vertebrae:

Each transverse process has foramen transversarium. The spines are short and bifid. Vertebral foramen is large and triangular.

Features of thoracic vertebrae:

Presence of costal facets on each side of the body for articulation with ribs.

Their spinous process are long, slender, and directed downwards. Vertebral foramina is circular.

Ref: TEXTBOOK of ANATOMY and PHYSIOLOGY for NURSES ASHALATA By Jaypee Brothers, page 72.


Which of the following is the location of the mental foramen?

A: Between the premolar of mandibleB: First molar of mandibleC: Canine of mandibleD: Canine of maxilla

Correct Ans:AExplanationThe mental foramen lies below the interval between the premolar teeth. The mental nerve exits the mandible through the mental foramen and supplies the lower lip and chin. The mental nerve is palpable and sometimes visible through the oral mucosa adjacent to the roots of the premolar tooth.

Ref: Gray's Basic Anatomy By Richard Drake, A. Wayne Vogl, Adam W. M. Mitchell, 2012, Page 504.


Health & Medicine

Previous year question on foramen based on neet pg, usmle, plab and fmge or mci screening exams