Surface and Radiological Anatomy

Surface and Radiological Anatomy Indian Medical PG Question 1: Choose the best method of diagnosis for the clinical sign represented in the image.

• A. Serum copper
• B. Serum ceruloplasmin (Correct Answer)
• C. Karyotyping
• D. PCR

Surface and Radiological Anatomy Explanation: ***Serum ceruloplasmin*** - The image shows a **Kayser-Fleischer ring**, a greenish-brown discoloration in the periphery of the cornea, which is pathognomonic for **Wilson's disease**. - **Wilson's disease** is a genetic disorder of copper metabolism characterized by **low serum ceruloplasmin** levels (the primary copper-carrying protein in the blood) and increased copper deposition in various tissues. *Serum copper* - While Wilson's disease involves copper accumulation, **total serum copper** can be normal or even elevated due to widespread tissue damage releasing copper into the circulation, making it an unreliable diagnostic marker on its own. - A low serum copper level can be seen, but it is not as specific as low ceruloplasmin, as much of the copper in serum is bound to ceruloplasmin. *Karyotyping* - **Karyotyping** is used to analyze the number and structure of chromosomes and is primarily indicated for diagnosing chromosomal abnormalities, such as Down syndrome or Turner syndrome. - It is not relevant for diagnosing metabolic disorders like Wilson's disease, which is caused by a mutation in a single gene (ATP7B), not a chromosomal aberration. *PCR* - **PCR (Polymerase Chain Reaction)** is a technique used to amplify DNA sequences and can be used for genetic testing to identify specific mutations. - While genetic testing for the **ATP7B gene** mutation is a confirmatory test for Wilson's disease, it is not the primary or best method for initial diagnosis, especially when classic clinical signs and biochemical markers (like low ceruloplasmin) are present.

Surface and Radiological Anatomy Indian Medical PG Question 2: Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:

• A. 1 and 2 only
• B. 1, 2, 3 and 4 (Correct Answer)
• C. 3 and 4 only
• D. 1, 2 and 3 only

Surface and Radiological Anatomy Explanation: ***1, 2, 3 and 4*** - All four statements are correct regarding lymphoedema. Patients often experience **constant dull ache and severe pain** due to the swelling and tissue changes. - **Manual lymphatic drainage (MLD)** is a key component of complete decongestive therapy for lymphoedema, aiming to reduce swelling and improve lymphatic flow. **Primary lymphoedema** is indeed caused by **congenital lymphatic dysplasia**, which refers to abnormalities in lymphatic system development from birth. **Milroy's disease** (also known as Nonne-Milroy disease) is a specific type of primary lymphoedema characterized by early-onset lymphatic dysfunction. *1 and 2 only* - This option is incomplete as statements 3 and 4 are also correct. - It correctly identifies the role of manual lymphatic drainage and the presence of pain in lymphoedema but omits other accurate facts. *3 and 4 only* - This option is incomplete as statements 1 and 2 are also correct. - While correctly identifying the nature of primary lymphoedema and Milroy's disease, it misses other important aspects of lymphoedema. *1, 2, and 3 only* - This option is incomplete because statement 4, concerning Milroy's disease as a type of primary lymphoedema, is also correct. - It provides correct information about pain, MLD, and the cause of primary lymphoedema but omits a specific example of primary lymphoedema.

Surface and Radiological Anatomy Indian Medical PG Question 3: A 50-year-old male presents with sharp, localized chest pain, worse with deep breaths and relieved by sitting up. ECG is normal. What is the most likely diagnosis?

• A. Pneumothorax
• B. Myocardial infarction
• C. Pleuritis
• D. Pericarditis (Correct Answer)

Surface and Radiological Anatomy Explanation: ***Pericarditis*** - The classic presentation of **sharp, localized chest pain** that is **worse with deep breaths** and **relieved by sitting up and leaning forward** is highly characteristic of pericarditis [2]. - A **normal ECG** makes other cardiac causes less likely, supporting the diagnosis of pericarditis, which can have diffuse ST elevation or PR depression as ECG findings, but a normal ECG doesn't rule it out, especially early on [2]. *Pneumothorax* - While pneumothorax can cause **sharp chest pain** and be **respiratory variation**, it is typically associated with **dyspnea** and **diminished breath sounds** on examination, which are not mentioned here. - The pain relief with sitting up is not characteristic of pneumothorax. *Myocardial infarction* - **Myocardial infarction** pain is typically described as a **heavy, pressure-like sensation**, often radiating to the arm, jaw, or back, and is usually not relieved by position changes [1]. - A **normal ECG** makes acute myocardial infarction less likely, though it does not entirely rule out non-ST elevation myocardial infarction (NSTEMI). *Pleuritis* - **Pleuritis** also causes **sharp, pleuritic chest pain** that worsens with deep inspiration or coughing. - However, the classic relief with **sitting up and leaning forward** is more specific to pericarditis than pleuritis.

Surface and Radiological Anatomy Indian Medical PG Question 4: All cartilage is covered by perichondrium, except

• A. Hyaline
• B. Elastic
• C. Fibrocartilage (Correct Answer)
• D. All types of cartilage are covered by perichondrium.

Surface and Radiological Anatomy Explanation: ***Fibrocartilage*** - **Fibrocartilage** completely lacks a perichondrium as a defining characteristic of this cartilage type. - This type of cartilage is found in structures like **intervertebral discs**, **pubic symphysis**, and **menisci**, where it provides strong support and shock absorption. - It merges imperceptibly with surrounding dense connective tissue without a distinct perichondrial covering. - Among all cartilage types, **fibrocartilage is the only type that NEVER has perichondrium**. *Hyaline* - Most **hyaline cartilage** (such as in the **trachea, bronchi, nose, larynx, and ribs**) is covered by a **perichondrium** that provides growth and nutrition. - **Important exception:** **Articular cartilage** (covering joint surfaces) lacks perichondrium because it receives nutrition from synovial fluid, but this is a specific exception within the hyaline category [1]. - Since hyaline cartilage CAN have perichondrium in most locations, it is not the best answer to this "except" question. *Elastic* - **Elastic cartilage**, found in structures such as the **external ear (auricle)** and **epiglottis**, is always surrounded by a **perichondrium**. - The perichondrium supports growth, provides nutrition, and aids in repair after injury. *All types of cartilage are covered by perichondrium* - This statement is **incorrect** because fibrocartilage never has a perichondrium. - Additionally, articular hyaline cartilage also lacks perichondrium, making this statement doubly false [1].

Surface and Radiological Anatomy Indian Medical PG Question 5: Highest point of iliac crest is seen at?

• A. L3
• B. L4 (Correct Answer)
• C. S2
• D. S1

Surface and Radiological Anatomy Explanation: ***L4*** - The **highest point of the iliac crest** typically corresponds to the level of the **L4 vertebral body**. - This anatomical landmark is crucial for procedures like **lumbar punctures** and determining the location for **epidural anesthesia**. *L3* - The L3 vertebral level is generally located slightly **above the highest point of the iliac crest**. - While close, it is not the most consistent anatomical correlation for the highest point. *S2* - The **S2 vertebral level** is significantly **below the iliac crests**, marking the approximate midpoint of the sacroiliac joint. - This level is used as a landmark for the **dermatome of the posterior thigh**. *S1* - The **S1 vertebral level** is also located **below the iliac crests**, forming the most superior segment of the sacrum. - It is used as a landmark for the **dermatome of the lateral foot and posterior leg**, and corresponds to the ankle jerk reflex.

Surface and Radiological Anatomy Indian Medical PG Question 6: Which artery passes through the anatomical snuffbox?

• A. Radial artery (Correct Answer)
• B. Brachial artery
• C. Ulnar artery
• D. Interosseus artery

Surface and Radiological Anatomy Explanation: ***Radial artery*** - The **radial artery** is palpable within the **anatomical snuffbox**, as it courses over the scaphoid and trapezium bones towards the deep palmar arch. - This location is clinically significant for feeling the pulse and is vulnerable to injury, especially during **scaphoid fractures**. *Brachial artery* - The **brachial artery** is found in the **arm**, typically running in the cubital fossa, well proximal to the anatomical snuffbox. - It bifurcates into the radial and ulnar arteries at the level of the elbow, not within the wrist structures. *Ulnar artery* - The **ulnar artery** typically lies on the **medial side of the forearm** and wrist, contributing to the superficial palmar arch. - It does not pass through the anatomical snuffbox, which is located on the lateral aspect of the wrist. *Interosseus artery* - The **interosseus arteries** (anterior and posterior) run between the radius and ulna in the forearm, supplying muscles and bones. - These arteries are deep within the forearm compartments and do not traverse the superficial anatomical snuffbox at the wrist.

Surface and Radiological Anatomy Indian Medical PG Question 7: All are true about the triangle marked green except:

• A. Localised pain in this area after fall on outstretched hand indicates fracture of scaphoid
• B. Cephalic vein in this area is used to make Ciminobrescia fistula in hemodialysis
• C. Medial border is formed by tendon of abductor pollicis longus and extensor pollicis brevis (Correct Answer)
• D. Superficial branch of radial nerve runs to provide innervation to 3.5 digits

Surface and Radiological Anatomy Explanation: ***Medial border is formed by tendon of abductor pollicis longus and extensor pollicis brevis*** - This statement is incorrect because the **medial border of the anatomical snuffbox** is formed by the tendon of the **extensor pollicis longus**. - The **lateral border** of the anatomical snuffbox is formed by the tendons of the **abductor pollicis longus** and **extensor pollicis brevis**. *Localised pain in this area after fall on outstretched hand indicates fracture of scaphoid* - The anatomical snuffbox is a crucial site for palpating the **scaphoid bone**, which is frequently fractured in falls on an **outstretched hand**. - **Tenderness in the anatomical snuffbox** following such an injury is a strong clinical indicator of a scaphoid fracture, even if initial X-rays are negative. *Cephalic vein in this area is used to make Ciminobrescia fistula in hemodialysis* - The anatomical snuffbox region provides access to the **cephalic vein**, which is a common site for creating an **arteriovenous fistula (AV fistula)**, also known as a Cimino-Brescia fistula. - An AV fistula connects the radial artery to the cephalic vein, providing robust venous access for **hemodialysis**. *Superficial branch of radial nerve runs to provide innervation to 31/2 digits* - The **superficial branch of the radial nerve** traverses the anatomical snuffbox region to provide **sensory innervation** to the dorsal aspect of the lateral 3.5 digits (thumb, index finger, middle finger, and radial half of the ring finger) as well as the associated dorsal hand. - This nerve is susceptible to injury in this area due to its superficial location.

Surface and Radiological Anatomy Indian Medical PG Question 8: Name the muscles being used in climbing a tree as shown in the figure.

• A. Latissimus dorsi and pectoralis major (Correct Answer)
• B. Teres major and pectoralis major
• C. Teres minor and pectoralis minor
• D. External oblique and pectoralis major

Surface and Radiological Anatomy Explanation: ***Latissimus dorsi and pectoralis major*** - The **latissimus dorsi** is a large, powerful muscle responsible for adduction, extension, and internal rotation of the arm, all crucial for pulling the body upward during climbing. - The **pectoralis major** is a large, fan-shaped muscle that helps with adduction, flexion, and internal rotation of the humerus, also vital for pulling oneself up against gravity. *Teres major and pectoralis major* - While the **pectoralis major** is involved, the **teres major** is a smaller muscle that primarily assists the latissimus dorsi in extension, adduction, and internal rotation of the humerus, but is not as dominant in the main pulling action as the latissimus dorsi. - The primary pulling force comes from larger muscles, making the teres major a less significant contributor to the overall climbing action. *Teres minor and pectoralis minor* - The **teres minor** is part of the rotator cuff and primarily functions in external rotation of the humerus, which is not a primary movement for pulling oneself up. - The **pectoralis minor** is a small, thin muscle that stabilizes the scapula and depresses the shoulder; it does not directly contribute to the powerful pulling action needed for climbing. *External oblique and pectoralis major* - The **external oblique** is an abdominal muscle involved in trunk rotation and flexion, providing core stability but not directly contributing to the primary upper body pulling motion for climbing. - While the **pectoralis major** is correctly identified, the external oblique is not a primary muscle used for the upward pulling motion in climbing.

Surface and Radiological Anatomy Indian Medical PG Question 9: While performing drainage of fluid from the pleural cavity, the needle is introduced through all of the following structures except which one?

• A. Thoracic fascia
• B. Skin
• C. Pulmonary pleura (Correct Answer)
• D. Intercostal muscles

Surface and Radiological Anatomy Explanation: ***Pulmonary pleura*** - The needle for pleural fluid drainage, or thoracentesis, passes through the **parietal pleura** [1] but not the **pulmonary (visceral) pleura**. - Puncturing the pulmonary pleura would indicate the needle has entered the lung parenchyma, which is an avoidable complication. *Skin* - The **skin** is the outermost layer and the first structure the needle penetrates during a thoracentesis. - It must be sterilized prior to the procedure. *Thoracic fascia* - The needle passes through the **superficial fascia** and then the **deep fascia** covering the intercostal muscles. - These fascial layers provide structural support and enclose the musculature of the thoracic wall. *Intercostal muscles* - The needle traverses the **external**, **internal**, and **innermost intercostal muscles** as it moves deeper into the thoracic cavity. - The neurovascular bundle runs between the internal and innermost intercostals, hence the needle is typically inserted over the superior border of the rib to avoid it [1].

Surface and Radiological Anatomy Indian Medical PG Question 10: Which of the following muscles is not in the pectoral region?

• A. Pectoralis major
• B. Infraspinatus (Correct Answer)
• C. Pectoralis minor
• D. Subclavius

Surface and Radiological Anatomy Explanation: ***Infraspinatus*** - The **infraspinatus** muscle is located in the **posterior scapular region**, specifically on the posterior aspect of the scapula, filling the infraspinous fossa. - Its primary function is **external rotation** of the humerus, and it is a key component of the **rotator cuff**. *Pectoralis major* - The **pectoralis major** is a large, superficial muscle located in the **anterior chest wall**, forming the bulk of the chest. [1] - It plays a significant role in **adduction**, **flexion**, and **medial rotation** of the humerus. *Pectoralis minor* - The **pectoralis minor** is a smaller, triangular muscle situated beneath the pectoralis major in the **anterior thoracic wall**. [1] - Its functions include **stabilizing the scapula** by pulling it inferiorly and anteriorly, and assisting in forced inspiration. [1] *Subclavius* - The **subclavius** is a small, triangular muscle located inferior to the clavicle in the **pectoral region**. - Its primary role is to **depress and stabilize the clavicle**, protecting the underlying neurovascular structures.

Surface and Radiological Anatomy Flashcard 1 of 10

Question: The optimum site for performing the patch test is the back or the _____ side of the arm

Answer: lateral

Surface and Radiological Anatomy Flashcard 2 of 10

Question: Where does the great cardiac vein lie on the surface of the heart?_____

Answer: Anterior interventricular sulcus.

Surface and Radiological Anatomy Flashcard 3 of 10

Question: Facial nerve main trunk lies _____ cm deep to the Triangular inferior portion of the tragus

Answer: 1

Surface and Radiological Anatomy Flashcard 4 of 10

Question: mid arm circumference is measured between _____

Answer: olecranon process and acromion process

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Surface and Radiological Anatomy Flashcard 5 of 10

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Answer:

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Surface and Radiological Anatomy Flashcard 6 of 10

Question: d4f504e7accc43959ee4fe5ea41ccd3b-ao-1

Answer:

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Surface and Radiological Anatomy Flashcard 7 of 10

Question: 10f93b3f6707442e87ec0271b17dfa60-ao-5

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Surface and Radiological Anatomy Flashcard 8 of 10

Question: An imaginary plane drawn, extending between _____ of eye and the angle of mandible, is known as Ohngren's line

Answer: medial canthus

Surface and Radiological Anatomy Flashcard 9 of 10

Question: The neoaortic area is beside the sternum at the _____ third intercostal space

Answer: left

Surface and Radiological Anatomy Flashcard 10 of 10

Question: On an abdominal CT scan, the pancreas can be identified by:- its head in close association with the _____ part of the duodenum- its body overlying the abdominal aorta

Answer: 2nd