NEET-PG 2012 — Anatomy

Q: A patient is found to have a melanoma originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. Which axillary nodes would not be removed?

Apical lymph nodes. ***Apical lymph nodes*** - The **apical lymph nodes** are located **medial** to the **medial border of the pectoralis minor muscle**, at the apex of the axilla (Level III) [2]. - Since the removal was restricted to nodes **lateral** to the medial edge of the pectoralis minor, the apical nodes would **not be removed**. - These nodes receive lymph from all other axillary node groups and drain into the subclavian lymphatic trunk. *Central lymph nodes* - **Central lymph nodes** are located **posterior to (deep to)** the pectoralis minor muscle, within the axillary fat (Level II) [1]. - They lie between the medial and lateral borders of the pectoralis minor and are generally considered to be **lateral** to the medial edge of the pectoralis minor, so they would be removed in this dissection. *Lateral lymph nodes* - **Lateral (humeral) lymph nodes** are found along the **lateral border** of the axilla, following the axillary vein (Level I) [1]. - These nodes drain the majority of the upper limb and are clearly **lateral** to the pectoralis minor muscle, so hese would be included in the dissection. *Pectoral lymph nodes* - **Pectoral (anterior) lymph nodes** lie along the **lower border** of the pectoralis minor muscle and the lateral thoracic vessels (Level I). - They receive lymph from the anterior and lateral thoracic walls and much of the breast. - These nodes are located **lateral** to the medial edge of the pectoralis minor and would be removed as part of the surgical procedure. [Practice more Anatomy PYQs on OnCourse]

Q: Deltoid ligament is attached to all, except which structure?

Medial cuneiform. ***Medial cuneiform*** - The **deltoid ligament** is located on the **medial side of the ankle** and primarily connects the **tibia** to several tarsal bones. It does not attach to the medial cuneiform. - The **medial cuneiform** is a midfoot bone primarily involved in the **tarsometatarsal joint** and is not a direct attachment site for the deltoid ligament. *Medial malleolus* - The **medial malleolus**, the distal end of the **tibia**, serves as the **proximal attachment point** for all four parts of the deltoid ligament. - This strong connection is crucial for **stabilizing the ankle joint** medially. *Navicular bone* - The **tibionavicular part** of the deltoid ligament attaches to the **tuberosity of the navicular bone**. - This attachment helps **limit excessive abduction** and **eversion** of the foot. *Sustentaculum tali* - The **tibiocalcaneal part** of the deltoid ligament attaches to the **sustentaculum tali** on the calcaneus. - This attachment provides significant stability to the **subtalar joint**. [Practice more Anatomy PYQs on OnCourse]

Q: Which is the primary segment of the liver drained by the right hepatic vein?

VII. ***VII*** - The **right hepatic vein** drains the **posterior segment** of the right lobe, which includes segments **VI and VII**. Segment VII is particularly well-drained by this vein. [3] - Understanding hepatic venous drainage is crucial for **surgical planning** and interpreting imaging studies of the liver. [4] *I* - Segment I, the **caudate lobe**, is unique in its venous drainage, often by small veins directly into the **inferior vena cava (IVC)** or occasionally into the left and middle hepatic veins. [1] - It has a separate blood supply and drainage which differentiates it from other segments. [4] *II* - Segment II is part of the **left lateral segment** and is primarily drained by the **left hepatic vein**. - The left hepatic vein typically drains segments II and III. [2] *IV* - Segment IV, or the **quadrate lobe**, is primarily drained by the **middle hepatic vein**. - The middle hepatic vein also drains segment VIII and the anterior aspect of segment V. [Practice more Anatomy PYQs on OnCourse]

Q: Corpora arenacea is seen in?

Pineal. ***Pineal*** - **Corpora arenacea**, also known as **brain sand**, are calcium deposits found in the pineal gland. - Their presence is a normal, age-related finding and increases with age, though their exact physiological role is not fully understood. *Prostate* - The prostate gland contains **corpora amylacea**, which are concentric calcifications found within the glandular acini. - While similar in appearance to corpora arenacea, they are distinct structures specific to the prostate. *Seminal vesicle* - The seminal vesicles produce a fluid component of semen, and while they may occasionally show calcifications, these are typically due to stones or chronic inflammation, not the characteristic "brain sand" seen in the pineal gland. - They do not contain corpora arenacea as a normal physiological feature. *Breast* - Calcifications in the breast are common and can be either benign (e.g., **fibrocystic changes**, vascular calcifications) or malignant (e.g., **ductal carcinoma in situ**). - These calcifications are generally not referred to as corpora arenacea and have different clinical implications and microscopic appearances. [Practice more Anatomy PYQs on OnCourse]

Q: Which of the following is a tributary of the coronary sinus?

Great cardiac vein. ***Great cardiac vein*** - The **great cardiac vein** is a major tributary that drains into the **coronary sinus**, carrying deoxygenated blood from the anterior and left ventricular walls [1]. - It travels alongside the **anterior interventricular artery** (LAD) and then wraps around the left side of the heart to join the coronary sinus [1]. *Anterior cardiac vein* - The **anterior cardiac veins** typically collect blood directly into the **right atrium**, bypassing the coronary sinus [1]. - They primarily drain the anterior wall of the right ventricle. *Thebesian vein* - **Thebesian veins** (or venae cordis minimae) are small veins that drain blood from the **myocardium directly into the heart chambers**, predominantly the atria [1]. - They represent a direct communication between the myocardial capillaries and the heart chambers, not tributaries of the coronary sinus. *Smallest cardiac vein* - The term "smallest cardiac vein" is often used synonymously with **Thebesian veins** [1]. - These veins empty directly into the **heart chambers**, serving as an ancillary drainage system, rather than converging into the coronary sinus. [Practice more Anatomy PYQs on OnCourse]

98 Previous Year Questions with Answers & Explanations

Questions

A patient is found to have a melanoma originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. Which axillary nodes would not be removed?

Deltoid ligament is attached to all, except which structure?

Which is the primary segment of the liver drained by the right hepatic vein?

Corpora arenacea is seen in?

Which of the following is a tributary of the coronary sinus?

Waldeyer's fascia lies?

Which of the following is not a boundary of Koch's triangle?

Skeletal derivative of 2nd pharyngeal arch -

Which of the following is derived from endoderm?

Q10

What is the outer layer of the blastocyst called?

NEET-PG 2012 - Anatomy NEET-PG Practice Questions and MCQs

Question 1: A patient is found to have a melanoma originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. Which axillary nodes would not be removed?

A. Central lymph nodes
B. Lateral lymph nodes
C. Pectoral lymph nodes
D. Apical lymph nodes (Correct Answer)

Explanation: ***Apical lymph nodes*** - The **apical lymph nodes** are located **medial** to the **medial border of the pectoralis minor muscle**, at the apex of the axilla (Level III) [2]. - Since the removal was restricted to nodes **lateral** to the medial edge of the pectoralis minor, the apical nodes would **not be removed**. - These nodes receive lymph from all other axillary node groups and drain into the subclavian lymphatic trunk. *Central lymph nodes* - **Central lymph nodes** are located **posterior to (deep to)** the pectoralis minor muscle, within the axillary fat (Level II) [1]. - They lie between the medial and lateral borders of the pectoralis minor and are generally considered to be **lateral** to the medial edge of the pectoralis minor, so they would be removed in this dissection. *Lateral lymph nodes* - **Lateral (humeral) lymph nodes** are found along the **lateral border** of the axilla, following the axillary vein (Level I) [1]. - These nodes drain the majority of the upper limb and are clearly **lateral** to the pectoralis minor muscle, so hese would be included in the dissection. *Pectoral lymph nodes* - **Pectoral (anterior) lymph nodes** lie along the **lower border** of the pectoralis minor muscle and the lateral thoracic vessels (Level I). - They receive lymph from the anterior and lateral thoracic walls and much of the breast. - These nodes are located **lateral** to the medial edge of the pectoralis minor and would be removed as part of the surgical procedure.

Question 2: Deltoid ligament is attached to all, except which structure?

A. Sustentaculum tali
B. Medial cuneiform (Correct Answer)
C. Navicular bone
D. Medial malleolus

Explanation: ***Medial cuneiform*** - The **deltoid ligament** is located on the **medial side of the ankle** and primarily connects the **tibia** to several tarsal bones. It does not attach to the medial cuneiform. - The **medial cuneiform** is a midfoot bone primarily involved in the **tarsometatarsal joint** and is not a direct attachment site for the deltoid ligament. *Medial malleolus* - The **medial malleolus**, the distal end of the **tibia**, serves as the **proximal attachment point** for all four parts of the deltoid ligament. - This strong connection is crucial for **stabilizing the ankle joint** medially. *Navicular bone* - The **tibionavicular part** of the deltoid ligament attaches to the **tuberosity of the navicular bone**. - This attachment helps **limit excessive abduction** and **eversion** of the foot. *Sustentaculum tali* - The **tibiocalcaneal part** of the deltoid ligament attaches to the **sustentaculum tali** on the calcaneus. - This attachment provides significant stability to the **subtalar joint**.

Question 3: Which is the primary segment of the liver drained by the right hepatic vein?

A. I
B. II
C. IV
D. VII (Correct Answer)

Explanation: ***VII*** - The **right hepatic vein** drains the **posterior segment** of the right lobe, which includes segments **VI and VII**. Segment VII is particularly well-drained by this vein. [3] - Understanding hepatic venous drainage is crucial for **surgical planning** and interpreting imaging studies of the liver. [4] *I* - Segment I, the **caudate lobe**, is unique in its venous drainage, often by small veins directly into the **inferior vena cava (IVC)** or occasionally into the left and middle hepatic veins. [1] - It has a separate blood supply and drainage which differentiates it from other segments. [4] *II* - Segment II is part of the **left lateral segment** and is primarily drained by the **left hepatic vein**. - The left hepatic vein typically drains segments II and III. [2] *IV* - Segment IV, or the **quadrate lobe**, is primarily drained by the **middle hepatic vein**. - The middle hepatic vein also drains segment VIII and the anterior aspect of segment V.

Question 4: Corpora arenacea is seen in?

A. Pineal (Correct Answer)
B. Seminal vesicle
C. Breast
D. Prostate

Explanation: ***Pineal*** - **Corpora arenacea**, also known as **brain sand**, are calcium deposits found in the pineal gland. - Their presence is a normal, age-related finding and increases with age, though their exact physiological role is not fully understood. *Prostate* - The prostate gland contains **corpora amylacea**, which are concentric calcifications found within the glandular acini. - While similar in appearance to corpora arenacea, they are distinct structures specific to the prostate. *Seminal vesicle* - The seminal vesicles produce a fluid component of semen, and while they may occasionally show calcifications, these are typically due to stones or chronic inflammation, not the characteristic "brain sand" seen in the pineal gland. - They do not contain corpora arenacea as a normal physiological feature. *Breast* - Calcifications in the breast are common and can be either benign (e.g., **fibrocystic changes**, vascular calcifications) or malignant (e.g., **ductal carcinoma in situ**). - These calcifications are generally not referred to as corpora arenacea and have different clinical implications and microscopic appearances.

Question 5: Which of the following is a tributary of the coronary sinus?

A. Anterior cardiac vein
B. Smallest cardiac vein
C. Thebesian vein
D. Great cardiac vein (Correct Answer)

Explanation: ***Great cardiac vein*** - The **great cardiac vein** is a major tributary that drains into the **coronary sinus**, carrying deoxygenated blood from the anterior and left ventricular walls [1]. - It travels alongside the **anterior interventricular artery** (LAD) and then wraps around the left side of the heart to join the coronary sinus [1]. *Anterior cardiac vein* - The **anterior cardiac veins** typically collect blood directly into the **right atrium**, bypassing the coronary sinus [1]. - They primarily drain the anterior wall of the right ventricle. *Thebesian vein* - **Thebesian veins** (or venae cordis minimae) are small veins that drain blood from the **myocardium directly into the heart chambers**, predominantly the atria [1]. - They represent a direct communication between the myocardial capillaries and the heart chambers, not tributaries of the coronary sinus. *Smallest cardiac vein* - The term "smallest cardiac vein" is often used synonymously with **Thebesian veins** [1]. - These veins empty directly into the **heart chambers**, serving as an ancillary drainage system, rather than converging into the coronary sinus.

Question 6: Waldeyer's fascia lies?

A. In front of the bladder.
B. Behind the rectum. (Correct Answer)
C. Between the bladder and uterus.
D. Between the uterus and rectum.

Explanation: ***Behind the rectum*** - **Waldeyer’s fascia**, also known as the **sacrorectal fascia**, is a retrorectal connective tissue sheet located between the **rectum** and the **sacrum**. - It plays a crucial role in supporting the rectum and forms part of the posterior rectosacral space, separating the rectum from the sacral bone and nerves. *In front of the bladder* - The space in front of the bladder is typically referred to as the **retropubic space of Retzius**, containing loose connective tissue and fat. - No specific fascial layer named Waldeyer's fascia is located in this anterior position relative to the bladder. *Between the bladder and uterus* - This space, known as the **vesicouterine pouch** or **anterior cul-de-sac**, is a peritoneal reflection between the bladder and the uterus [1]. - It does not contain a structure known as Waldeyer's fascia. *Between the uterus and rectum* - This space is the **rectouterine pouch** or **Pouch of Douglas**, which is the deepest part of the peritoneal cavity in females [2]. - While important surgically, it does not correspond to the location of Waldeyer's fascia.

Question 7: Which of the following is not a boundary of Koch's triangle?

A. Limbus fossa ovalis (Correct Answer)
B. Tricuspid valve ring
C. Coronary sinus
D. Tendon of Todaro

Explanation: ***Limbus fossa ovalis*** - The **limbus fossa ovalis** is a prominent oval ridge on the **interatrial septum** that surrounds the fossa ovalis. - It is **not involved** in forming the boundaries of Koch's triangle, which is located in the **right atrium** near the AV node [1]. *Tricuspid valve ring* - The **tricuspid valve ring** (or annulus) forms one of the key anatomical boundaries of **Koch's triangle**, specifically its base [1]. - This **fibrous ring** anchors the tricuspid valve leaflets and marks the inferior aspect of the triangle [1]. *Coronary sinus* - The **coronary sinus ostium** (opening) forms another crucial boundary of **Koch's triangle** [1]. - It is located at the **inferior-posterior aspect** of the interatrial septum, opening into the right atrium [1]. *Tendon of todaro* - The **Tendon of Todaro** is a fibrous structure that forms the superior boundary of **Koch's triangle** [1]. - It extends from the **Eustachian valve** (of the inferior vena cava) towards the central fibrous body, playing a role in **AV nodal localization** [1].

Question 8: Skeletal derivative of 2nd pharyngeal arch -

A. Malleus
B. Incus
C. Stapes (Correct Answer)
D. Maxilla

Explanation: ***Stapes*** - The **2nd pharyngeal arch** (also known as the hyoid arch) gives rise to several structures, including Reichert's cartilage, which forms the **stapes** bone, the styloid process, the lesser horn of the hyoid, and the upper part of the hyoid body. - Its muscles include the **stapedius**, stylohyoid, posterior belly of the digastric, and muscles of facial expression. *Malleus* - The **malleus** is derived from the **1st pharyngeal arch** (Meckel's cartilage), along with the incus. - The 1st pharyngeal arch is also responsible for forming the malleus, incus, and mandible. *Incus* - Similar to the malleus, the **incus** also originates from the **1st pharyngeal arch** (Meckel's cartilage). - Both the malleus and incus are crucial components of the middle ear ossicles but are structurally distinct from the stapes. *Maxilla* - The **maxilla** development is primarily from the **maxillary prominence** of the first pharyngeal arch, which is a subdivision of the first arch but does not originate from the 2nd arch. - It forms a significant portion of the midface and upper jaw, contributing to the nasal cavity and orbital floor.

Question 9: Which of the following is derived from endoderm?

A. Gall bladder (Correct Answer)
B. Lens
C. Spleen
D. Lymph nodes

Explanation: ***Gall bladder*** - The **gallbladder**, along with other organs of the **gastrointestinal tract** such as the liver, pancreas, and epithelial lining of the digestive and respiratory systems, originates from the **endoderm** [1]. - The endoderm forms the primitive gut tube, from which these accessory digestive organs bud off. *Lens* - The **lens of the eye** is derived from the **surface ectoderm**, which invaginates to form the lens vesicle. - This contrasts with the neural ectoderm, which forms the neural tube and retina. *Spleen* - The **spleen** is derived from the **mesoderm**, specifically from mesenchymal cells in the dorsal mesentery of the stomach. - It is involved in blood filtration and immune responses, making it a lymphoid organ. *Lymph nodes* - **Lymph nodes** are primarily derived from the **mesoderm**, specifically from specialized mesenchymal cells that form their connective tissue capsule and stroma. - The immune cells within the lymph nodes, such as lymphocytes, originate from hematopoietic stem cells that migrate into these developing structures.

Question 10: What is the outer layer of the blastocyst called?

A. Embryo proper
B. Trophoblast (Correct Answer)
C. Primitive streak
D. Yolk sac

Explanation: ***Trophoblast*** - The **trophoblast** is the outer layer of cells of the blastocyst, which goes on to form the **placenta** and other extraembryonic tissues [1]. - It plays a crucial role in the **implantation** of the blastocyst into the uterine wall and in producing hormones [1]. *Primitive streak* - The **primitive streak** is a structure that forms during **gastrulation**, much later than the initial blastocyst stage. - It establishes the **anterior-posterior axis** and initiates the formation of the three germ layers. *Yolk sac* - The **yolk sac** is an extraembryonic membrane that forms within the blastocyst cavity, but it is not the outermost layer of the entire structure. - It is involved in early **nutrient transfer** and **blood cell formation** before the placenta is fully functional. *Embryo proper* - The **embryo proper**, derived from the **inner cell mass (ICM)**, is the part of the blastocyst that will develop into the actual embryo [2]. - It is located *inside* the trophoblast layer, not forming the outer boundary of the blastocyst [2].