NEET PG – 170 – BY Dr.

Shuvro Bhattacharya - Anatomy

Chapter 1: Muscles of Mastication

1. Overview
The muscles of mastication are a group of four paired muscles responsible for the movement of the
jaw, particularly during chewing. These muscles originate from the first pharyngeal (branchial) arch
and are innervated by the mandibular division of the trigeminal nerve (cranial nerve V3).
2. Muscles and Their Functions
1. Masseter
o Origin: Zygomatic arch
o Insertion: Lateral surface of the ramus and angle of the mandible
o Action: Elevates the mandible (closes the jaw)
2. Temporalis
o Origin: Temporal fossa
o Insertion: Coronoid process and anterior border of the mandibular ramus
o Action: Elevates and retracts the mandible
3. Medial Pterygoid
o Origin: Medial surface of the lateral pterygoid plate and maxillary tuberosity
o Insertion: Medial surface of the angle of the mandible
o Action: Elevates and protrudes the mandible; aids in side-to-side movements
4. Lateral Pterygoid
o Origin: Superior head: greater wing of sphenoid; Inferior head: lateral surface of
lateral pterygoid plate
o Insertion: Neck of mandible and articular disc of TMJ
o Action: Depresses and protrudes the mandible (opens the jaw); aids in side-to-side
movements
3. Developmental Aspects
• Originates from the first pharyngeal arch
• Innervated by the mandibular nerve (CN V3), the motor branch of the trigeminal nerve
4. Clinical Correlation
• Trismus (Lockjaw): Involuntary contraction of mastication muscles, often due to tetanus or
dental infections
• Pterygoid Muscle Dysfunction: Lateral deviation of the jaw towards the affected side
• Testing CN V3: Ask the patient to clench teeth (masseter/temporalis) or move jaw side to
side (pterygoids)
5. High-Yield Points
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

• All four muscles are innervated by CN V3

• Lateral pterygoid is the only muscle of mastication that opens the jaw
• Temporalis is the only muscle that retracts the mandible
6. MCQs
Q1: Which muscle of mastication is responsible for opening the mouth?
A. Temporalis
B. Masseter
C. Medial Pterygoid
D. Lateral Pterygoid
E. Buccinator
Answer: D. Lateral Pterygoid
Explanation: The lateral pterygoid is the only muscle that depresses the mandible, thereby opening
the mouth. Others primarily elevate the mandible.
Q2: All of the following muscles elevate the mandible EXCEPT:
A. Masseter
B. Temporalis
C. Medial Pterygoid
D. Lateral Pterygoid
E. None of the above
Answer: D. Lateral Pterygoid
Explanation: Lateral pterygoid depresses and protrudes the mandible, unlike the other muscles which
are involved in elevation.

Chapter 2: Muscles of Larynx

1. Overview
The intrinsic muscles of the larynx control the tension and position of the vocal cords and the size of
the rima glottidis. These muscles are key to phonation, breathing, and airway protection. All intrinsic
laryngeal muscles are innervated by the recurrent laryngeal nerve (branch of vagus nerve, CN X)
except for the cricothyroid, which is supplied by the external branch of the superior laryngeal nerve.
2. Muscles and Functions
1. Posterior Cricoarytenoid
o Action: Abducts vocal cords (opens glottis)
o Only abductor of vocal cords
2. Lateral Cricoarytenoid
o Action: Adducts vocal cords (closes glottis)
3. Transverse and Oblique Arytenoids
o Action: Adduct arytenoid cartilages, closing the posterior part of the rima glottidis
4. Thyroarytenoid
o Action: Relaxes vocal cords by shortening them
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

5. Vocalis (part of thyroarytenoid)

o Action: Fine tuning of vocal cord tension
6. Cricothyroid
o Action: Tenses vocal cords by lengthening them (raises pitch)
o Innervation: External branch of superior laryngeal nerve
3. Developmental Aspects
• Derived from mesoderm of the 4th and 6th pharyngeal arches
• Innervation reflects arch derivation:
o 4th arch: Cricothyroid (external laryngeal nerve)
o 6th arch: All other intrinsic muscles (recurrent laryngeal nerve)
4. Clinical Correlation
• Recurrent laryngeal nerve injury (e.g., thyroid surgery):
o Unilateral injury → hoarseness
o Bilateral injury → airway obstruction, stridor
• External laryngeal nerve injury → monotone voice due to cricothyroid paralysis
5. High-Yield Points
• Posterior cricoarytenoid is the only muscle that abducts vocal cords
• All muscles except cricothyroid are supplied by the recurrent laryngeal nerve
6. MCQs
Q1: Which muscle is the sole abductor of the vocal cords?
A. Cricothyroid
B. Lateral cricoarytenoid
C. Posterior cricoarytenoid
D. Thyroarytenoid
E. Vocalis
Answer: C. Posterior cricoarytenoid
Explanation: Posterior cricoarytenoid is the only muscle that opens the vocal cords.
Q2: Injury to the recurrent laryngeal nerve will affect all the following muscles EXCEPT:
A. Posterior cricoarytenoid
B. Thyroarytenoid
C. Vocalis
D. Cricothyroid
E. Transverse arytenoid
Answer: D. Cricothyroid
Explanation: Cricothyroid is supplied by the external branch of the superior laryngeal nerve, not the
recurrent laryngeal nerve.

Chapter 3: Great Auricular Nerve

NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

1. Overview
The great auricular nerve is a sensory branch of the cervical plexus. It arises from the ventral rami of
spinal nerves C2 and C3. This nerve ascends vertically across the sternocleidomastoid (SCM) muscle
to supply sensation to parts of the external ear and face.
2. Course and Distribution
• Arises from C2 and C3 spinal nerves of the cervical plexus
• Emerges at the posterior border of the SCM (Erb’s point)
• Crosses the SCM obliquely, running superiorly toward the parotid region
• Divides into:
o Anterior branch: Supplies skin over the parotid gland and angle of the mandible
o Posterior branch: Supplies the skin over the mastoid process and the posterior surface
of the auricle
3. Areas Supplied
• Skin over the parotid gland
• External ear (lower part)
• Mastoid region
• Angle of the mandible and adjacent face (important in differentiating trigeminal nerve
lesions)
4. Clinical Correlation
• Parotid Surgery: At risk of injury during superficial parotidectomy, leading to numbness of
the ear and jawline
• Erb’s Point Block: Used in regional anesthesia for neck and ear procedures
• Herpes Zoster Oticus (Ramsay Hunt Syndrome): Can involve great auricular distribution
5. High-Yield Points
• Sensory nerve from cervical plexus (C2–C3)
• Crosses sternocleidomastoid superficially
• Supplies skin over parotid gland, auricle, and angle of mandible
• Easily injured during parotid gland surgery
6. MCQs
Q1: The great auricular nerve is a branch of:
A. Mandibular nerve
B. Glossopharyngeal nerve
C. Cervical plexus (C2, C3)
D. Greater occipital nerve
E. Auriculotemporal nerve
Answer: C. Cervical plexus (C2, C3)
Explanation: The great auricular nerve arises from the ventral rami of C2 and C3 spinal nerves.
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

Q2: During parotidectomy, which nerve is most at risk of injury, resulting in numbness around the ear
and angle of mandible?
A. Facial nerve
B. Auriculotemporal nerve
C. Greater occipital nerve
D. Great auricular nerve
E. Lesser occipital nerve
Answer: D. Great auricular nerve
Explanation: The great auricular nerve crosses the parotid gland and is commonly injured during
surgery, leading to sensory loss.

Chapter 4: Brown-Séquard Syndrome

1. Overview
Brown-Séquard Syndrome (BSS) is a rare neurological condition resulting from hemisection (or
damage to one half) of the spinal cord. It presents with a characteristic pattern of motor and sensory
deficits due to the specific arrangement of spinal tracts.
2. Etiology
• Penetrating trauma (e.g., stab wounds)
• Spinal cord tumors
• Multiple sclerosis
• Disc herniation
• Epidural hematoma
• Ischemia
3. Tracts Involved
1. Corticospinal tract (lateral) – Motor
2. Dorsal columns (gracile and cuneate fasciculi) – Fine touch, proprioception, vibration
3. Spinothalamic tract (anterolateral system) – Pain and temperature
4. Classical Clinical Features
• Ipsilateral (same side as lesion):
o Upper motor neuron (UMN) signs (spastic paralysis) due to corticospinal tract
damage
o Loss of proprioception, fine touch, and vibration (dorsal column damage)
• Contralateral (opposite side):
o Loss of pain and temperature sensation 1–2 levels below lesion (spinothalamic tract
damage)
• Segmental signs at level of lesion:
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o LMN signs (flaccid paralysis) and sensory loss in the dermatomes at the level of
lesion
5. Example
A lesion at right T10 spinal cord:
• Right-sided spastic paralysis and loss of proprioception below T10
• Left-sided loss of pain and temperature below T12
• Flaccid paralysis and sensory loss at T10 dermatome level
6. Diagnostic Tools
• MRI: To identify the site and cause of spinal cord hemisection
• Neurological examination: To localize the lesion clinically
7. Management
• Address underlying cause (e.g., surgery for tumor or hematoma)
• Corticosteroids in traumatic cases
• Rehabilitation and physiotherapy
8. High-Yield Points
• BSS = Hemisection of spinal cord
• Ipsilateral loss: motor + vibration + proprioception
• Contralateral loss: pain and temperature (usually 1–2 levels below)
• Classic dissociation between motor and sensory deficits
9. MCQs
Q1: In Brown-Séquard syndrome due to right-sided spinal cord hemisection, which of the following
will be observed below the level of lesion?
A. Right-sided loss of pain and temperature
B. Left-sided spastic paralysis
C. Right-sided spastic paralysis
D. Left-sided loss of proprioception
E. Bilateral loss of crude touch
Answer: C. Right-sided spastic paralysis
Explanation: Corticospinal tract damage on the same side leads to spastic paralysis below the lesion.
Q2: The sensory loss in Brown-Séquard syndrome is best described as:
A. Bilateral loss of pain and temperature below lesion
B. Contralateral loss of pain and temperature, ipsilateral loss of proprioception
C. Ipsilateral loss of all sensations
D. Contralateral loss of all sensations
E. Loss of only vibration sense bilaterally
Answer: B. Contralateral loss of pain and temperature, ipsilateral loss of proprioception
Explanation: This dissociation occurs due to the specific arrangement of spinal tracts and their
decussation levels.
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

Chapter 5: Third Ventricle

1. Overview
The third ventricle is a narrow, slit-like midline cavity of the diencephalon, situated between the two
thalami. It is part of the ventricular system of the brain and contains cerebrospinal fluid (CSF).
2. Boundaries
• Lateral: Medial surfaces of the thalami and hypothalami
• Roof: Tela choroidea and body of the fornix
• Floor: Optic chiasm, infundibulum, tuber cinereum, mammillary bodies, and upper part of
the midbrain tegmentum
• Anterior wall: Lamina terminalis, anterior commissure, and columns of the fornix
• Posterior wall: Pineal body, posterior commissure, and cerebral aqueduct
3. Communications
• Anteriorly: With lateral ventricles via interventricular foramina (of Monro)
• Posteriorly: With fourth ventricle via the cerebral aqueduct (of Sylvius)
4. Recesses of the Third Ventricle
• Infundibular recess: Extends into the infundibulum (pituitary stalk)
• Optic recess: Located above the optic chiasm
• Suprapineal recess: Above the pineal gland
• Pineal recess: Into the pineal stalk
5. Applied Anatomy
• Hydrocephalus: Obstruction at the level of cerebral aqueduct or foramina of Monro can
cause dilatation of the third ventricle
• Tumors: Colloid cysts of the foramen of Monro can block CSF flow, leading to increased
intracranial pressure
• Endoscopic third ventriculostomy (ETV): A surgical procedure used to treat obstructive
hydrocephalus by creating an opening in the floor of the third ventricle
6. High-Yield Points
• Midline cavity of diencephalon
• Communicates with lateral and fourth ventricles
• Surrounded by thalamus and hypothalamus
• Important site for CSF circulation
• Key in pathologies like hydrocephalus and intraventricular tumors
7. MCQs
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

Q1: The third ventricle is located between which of the following structures?
A. Two cerebral hemispheres
B. Two cerebellar hemispheres
C. Two thalami
D. Two corpora quadrigemina
E. Two ventricles of the heart
Answer: C. Two thalami
Explanation: The third ventricle lies between the medial surfaces of the right and left thalamus.
Q2: Which structure connects the third ventricle with the fourth ventricle?
A. Foramen of Monro
B. Central canal
C. Cerebral aqueduct
D. Interventricular septum
E. Foramen of Luschka
Answer: C. Cerebral aqueduct
Explanation: The cerebral aqueduct connects the third ventricle posteriorly with the fourth ventricle.

Chapter 6: Thalamus
1. Overview
The thalamus is a large, ovoid mass of gray matter that forms the major part of the diencephalon. It
acts as the principal relay station for sensory information traveling to the cerebral cortex.
2. Location and Relations
• Situated bilaterally on either side of the third ventricle
• Superior: Body of the lateral ventricle
• Inferior: Hypothalamus
• Medial: Third ventricle
• Lateral: Posterior limb of internal capsule
3. Subdivisions
Thalamus is divided by a Y-shaped white matter band called the internal medullary lamina into:
• Anterior group
• Medial group
• Lateral group (further subdivided into dorsal and ventral tiers)
Important nuclei:
• Ventral posterolateral (VPL) – Somatic sensation from body
• Ventral posteromedial (VPM) – Somatic sensation from face
• Lateral geniculate body (LGB) – Visual pathway
• Medial geniculate body (MGB) – Auditory pathway
4. Functions
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

• Relay center for all sensory modalities except smell (olfaction)

• Pain perception
• Regulation of consciousness, sleep, and alertness
• Involved in motor function via connections with basal ganglia and cerebellum
5. Clinical Correlation
• Thalamic syndrome (Dejerine-Roussy syndrome):
o Caused by a vascular lesion in the posterior cerebral artery
o Characterized by contralateral hemianesthesia followed by spontaneous pain and
dysesthesia
• Hemiplegia and sensory loss: Due to internal capsule involvement
• Altered consciousness: Due to damage in intralaminar nuclei
6. High-Yield Points
• Major sensory relay station
• VPL: Body sensation; VPM: Face sensation
• LGB: Vision; MGB: Hearing
• Lesion can cause thalamic pain syndrome
7. MCQs
Q1: Which thalamic nucleus relays visual input to the cerebral cortex? A. Medial geniculate body
B. Ventral posteromedial nucleus
C. Ventral anterior nucleus
D. Lateral geniculate body
E. Ventral lateral nucleus
Answer: D. Lateral geniculate body
Explanation: The LGB receives input from the retina and sends visual signals to the primary visual
cortex.
Q2: Damage to the VPM nucleus of the thalamus will result in: A. Contralateral pain loss from the
body
B. Ipsilateral facial sensory loss
C. Contralateral facial sensory loss
D. Bilateral hearing loss
E. Visual field defect
Answer: C. Contralateral facial sensory loss
Explanation: VPM carries facial somatosensory information via the trigeminal pathway.
Chapter 7: Pharyngeal Arches
1. Overview
Pharyngeal arches, also known as branchial arches, are embryological structures that give rise to
various head and neck tissues. They appear during the 4th to 5th week of development.
Each arch contains:
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• A cartilaginous rod
• A muscular component
• A nerve (cranial nerve)
• An artery (aortic arch derivative)
2. List of Pharyngeal Arches and Their Derivatives

Skeletal
Arch Nerve Muscles Artery
Structures

Muscles of mastication,
mylohyoid, anterior belly of Malleus, incus,
1st Mandibular (CN V3) Maxillary artery
digastric, tensor tympani, tensor maxilla, mandible
veli palatini

Muscles of facial expression, Stapes, styloid

Stapedial artery
2nd Facial (CN VII) posterior belly of digastric, process, lesser
(regresses)
stylohyoid, stapedius horn of hyoid

Greater horn and Common carotid,

Glossopharyngeal
3rd Stylopharyngeus lower body of proximal internal
(CN IX)
hyoid carotid

Arch of aorta
Vagus (CN X - Cricothyroid, pharyngeal
4th Thyroid cartilage (left), subclavian
Superior laryngeal) constrictors, levator veli palatini
(right)

Pulmonary
Vagus (CN X - Intrinsic muscles of larynx (except
6th Cricoid cartilage arteries, ductus
Recurrent laryngeal) cricothyroid)
arteriosus (left)

Note: 5th arch is rudimentary or absent in humans.

3. Pharyngeal Clefts and Pouches
• Clefts (ectoderm):
o 1st cleft → External auditory meatus
o 2nd–4th clefts → Normally obliterated; persistent clefts can form branchial cysts
• Pouches (endoderm):
o 1st pouch → Middle ear, Eustachian tube
o 2nd pouch → Palatine tonsils
o 3rd pouch → Inferior parathyroid (dorsal), thymus (ventral)
o 4th pouch → Superior parathyroid (dorsal), ultimobranchial body (C cells of thyroid)
4. Clinical Correlations
• Treacher Collins syndrome: 1st arch neural crest dysfunction → mandibulofacial dysostosis
• Pierre Robin sequence: 1st arch defect → micrognathia, glossoptosis, cleft palate
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• DiGeorge syndrome: 3rd and 4th pouch failure → T-cell deficiency (thymic aplasia),
hypocalcemia (parathyroid hypoplasia)
5. High-Yield Points
• Arches form craniofacial muscles and skeleton
• Each arch is innervated by a specific cranial nerve
• Pouches (endodermal) and clefts (ectodermal) form key head and neck structures
• Defects in arches → syndromic craniofacial anomalies
6. MCQs
Q1: Which cranial nerve supplies the derivatives of the second pharyngeal arch? A. Trigeminal nerve
B. Facial nerve
C. Glossopharyngeal nerve
D. Vagus nerve (recurrent laryngeal)
E. Hypoglossal nerve
Answer: B. Facial nerve
Explanation: The second arch is innervated by the facial nerve (CN VII).
Q2: The stylopharyngeus muscle is derived from which pharyngeal arch? A. First
B. Second
C. Third
D. Fourth
E. Sixth
Answer: C. Third
Explanation: Stylopharyngeus is the only muscle derived from the third pharyngeal arch and is
innervated by the glossopharyngeal nerve (CN IX).
Chapter 8: Mesonephric and Paramesonephric Ducts
1. Overview
These are paired embryological ducts important in the development of the urogenital system.
• Mesonephric (Wolffian) ducts → Male reproductive tract
• Paramesonephric (Müllerian) ducts → Female reproductive tract
2. Development
• In early embryogenesis, both ducts are present in all embryos.
• Differentiation depends on the presence of:
o Testosterone (from Leydig cells)
o Müllerian Inhibiting Substance (MIS) from Sertoli cells
3. Derivatives

Structure Male (Mesonephric) Female (Paramesonephric)

Epididymis Develops Absent

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Vas deferens Develops Absent

Seminal vesicles Develops Absent

Ejaculatory duct Develops Absent

Uterus Absent Develops

Fallopian tubes Absent Develops

Upper vagina Absent Develops

Other remnants:
• Mesonephric duct remnants in females: Gartner's duct/cyst
• Paramesonephric duct remnants in males: Appendix testis
4. Clinical Relevance
• Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome): Failure of
paramesonephric duct development → Absent uterus and upper vagina
• Persistent Müllerian duct syndrome: Due to failure of MIS → Male child with uterus and
fallopian tubes
5. High-Yield Points
• Y chromosome → SRY gene → testes → MIS + testosterone
• Testosterone → Mesonephric duct derivatives
• MIS → Regression of Müllerian duct
• In females (no SRY): Mesonephric ducts regress, Müllerian ducts persist
6. MCQs
Q1: Which structure is derived from the paramesonephric duct? A. Epididymis
B. Vas deferens
C. Fallopian tube
D. Seminal vesicle
E. Prostate
Answer: C. Fallopian tube
Explanation: The paramesonephric ducts give rise to the female reproductive tract including
fallopian tubes.
Q2: Which hormone causes regression of the Müllerian ducts? A. Testosterone
B. Dihydrotestosterone
C. Estrogen
D. Müllerian Inhibiting Substance
E. Progesterone
Answer: D. Müllerian Inhibiting Substance
Explanation: MIS (also called Anti-Müllerian hormone) is secreted by Sertoli cells and causes
regression of the paramesonephric ducts in males.
Chapter 9: Development of Heart
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

1. Overview
Heart development begins in the third week of embryogenesis and continues through the eighth week.
It transforms from a simple tube into a complex, four-chambered organ.
2. Embryological Origin
• The heart develops from the mesodermal germ layer, specifically from the cardiogenic area in
the splanchnic mesoderm.
• Two endocardial tubes form and fuse to form the primitive heart tube.
3. Stages of Heart Development

Stage Description

Formation of Heart
Two endocardial tubes fuse to form the primitive heart tube around day 22-23
Tube

The heart tube elongates and loops rightward to establish the spatial
Heart Looping
arrangement of chambers

Formation of atrial and ventricular septa, division of the heart into four
Septation
chambers

Valve Formation Formation of atrioventricular and semilunar valves

Remodeling Maturation of vessels and chambers, formation of conduction system

4. Important Structures in Septation

• Atrial Septum Formation:
o Septum primum grows downward towards endocardial cushions.
o Foramen primum closes; foramen secundum forms in septum primum.
o Septum secundum forms to the right of septum primum, leaving the foramen ovale.
• Ventricular Septum Formation:
o Muscular ventricular septum grows upward.
o Membranous septum forms from endocardial cushions and neural crest cells.
• Atrioventricular Valves:
o Formed from endocardial cushions.
• Outflow Tract (Conotruncal) Septation:
o Neural crest cells divide truncus arteriosus into aorta and pulmonary trunk.
5. Clinical Correlations

Defect Description Cause

Atrial Septal Defect Deficient septum secundum

Failure of foramen ovale to close properly
(ASD) or primum
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Defect Description Cause

Ventricular Septal Failure of fusion of

Defect in membranous septum
Defect (VSD) endocardial cushions

Persistent Truncus Neural crest migration

Failure of conotruncal septation
Arteriosus defect

Transposition of Great Aorta and pulmonary artery connections Faulty conotruncal

Arteries reversed septation

Pulmonary stenosis, VSD, overriding aorta, Abnormal neural crest

Tetralogy of Fallot
right ventricular hypertrophy migration

6. High-Yield Points
• Heart development starts at week 3 and ends by week 8.
• Neural crest cells play a key role in outflow tract septation.
• Endocardial cushions are crucial for septation of atria, ventricles, and valves.
• Foramen ovale allows right-to-left shunting in fetal life.
7. MCQs
Q1: What structure separates the aorta and pulmonary artery during heart development?
A. Septum primum
B. Endocardial cushions
C. Neural crest cells
D. Septum secundum
E. Truncus arteriosus
Answer: C. Neural crest cells
Explanation: Neural crest cells contribute to the conotruncal septum that separates the aorta and
pulmonary artery.
Q2: Which septum forms the foramen ovale?
A. Septum primum
B. Septum secundum
C. Muscular ventricular septum
D. Membranous septum
E. Endocardial cushions
Answer: B. Septum secundum
Explanation: The septum secundum forms the flap of the foramen ovale in fetal heart.
Chapter 10: Openings of Diaphragm
1. Overview
The diaphragm is a musculotendinous structure separating the thoracic and abdominal cavities. It has
three major openings to allow passage of important structures between these cavities.
2. Major Openings of Diaphragm
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Opening Level (Vertebral) Contents Passing Through

Caval opening T8 Inferior vena cava (IVC), right phrenic nerve

Esophageal hiatus T10 Esophagus, vagus nerves (anterior and posterior trunks)

Aortic hiatus T12 Aorta, thoracic duct, azygos vein

3. Details of Each Opening

• Caval Opening (T8):
o Located in the central tendon.
o Transmits the inferior vena cava.
o Right phrenic nerve also passes through.
o This opening is the only one that dilates during inspiration to allow increased venous
return.
• Esophageal Hiatus (T10):
o Formed by muscular fibers of right crus of diaphragm.
o Transmits esophagus and vagal trunks.
o The esophageal hiatus constricts during inspiration to prevent reflux.
• Aortic Hiatus (T12):
o Located posterior to the diaphragm between the crura.
o Transmits the descending thoracic aorta, thoracic duct, and azygos vein.
o Does not pierce the diaphragm muscle, hence not affected by respiratory movements.
4. Accessory Openings
• Foramen for Superior Epigastric Vessels: Below the sternum.
• Openings for Sympathetic Chains: Posterior to the diaphragm.
• Lumbocostal Triangle: Weak spot where herniation can occur (Bochdalek hernia).
5. Clinical Correlations
• Hiatal Hernia: Protrusion of stomach through the esophageal hiatus causing reflux
symptoms.
• Bochdalek Hernia: Congenital diaphragmatic hernia through posterolateral lumbocostal
triangle, often left sided.
• Morgagni Hernia: Herniation through the parasternal space (foramen of Morgagni).
6. High-Yield Points
• Remember the vertebral levels: I 8 10 Eggs At 12
(IVC at T8, Esophagus at T10, Aorta at T12)
• Caval opening dilates during inspiration; esophageal hiatus constricts.
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• Aortic hiatus is posterior and does not move with respiration.

7. MCQs
Q1: Which structure passes through the aortic hiatus of the diaphragm?
A. Inferior vena cava
B. Esophagus
C. Thoracic duct
D. Right phrenic nerve
E. Vagus nerve
Answer: C. Thoracic duct
Explanation: The aortic hiatus transmits the aorta, thoracic duct, and azygos vein.
Q2: At which vertebral level does the esophagus pass through the diaphragm?
A. T8
B. T10
C. T12
D. T7
E. T9
Answer: B. T10
Explanation: The esophageal hiatus is located at the T10 vertebral level.
Chapter 11: Blood Supply of Heart
1. Overview
The heart receives blood primarily through the coronary arteries, which originate from the ascending
aorta. Venous blood from the myocardium is collected by cardiac veins and drains into the coronary
sinus.
2. Coronary Arteries

Artery Origin Course & Distribution Important Branches

SA nodal artery (in ~60%), right

Right Runs in right atrioventricular (AV)
Right Coronary marginal artery, AV nodal artery,
aortic groove; supplies right atrium, right
Artery (RCA) posterior descending artery (in
sinus ventricle, SA & AV nodes
~85%)

Left Passes between pulmonary trunk and

Left Coronary Left anterior descending (LAD),
aortic left auricle; divides into LAD and
Artery (LCA) Circumflex artery (LCx)
sinus Circumflex arteries

Left Anterior Runs in anterior interventricular

Branch Diagonal branches, septal
Descending groove; supplies anterior wall of left
of LCA branches
(LAD) ventricle and interventricular septum

Runs in left AV groove; supplies

Circumflex Branch
lateral and posterior wall of left Left marginal artery
Artery (LCx) of LCA
ventricle

3. Coronary Dominance
• Determined by which artery gives rise to the posterior descending artery (PDA).
• Right dominant (85%): PDA from RCA.
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• Left dominant (8%): PDA from LCx.

• Co-dominant (7%): PDA supplied by both.
4. Venous Drainage
• Most veins drain into the coronary sinus, which empties into the right atrium.
• Major cardiac veins:
o Great cardiac vein (runs with LAD)
o Middle cardiac vein (runs with PDA)
o Small cardiac vein (runs with RCA)
5. Clinical Correlations
• Myocardial infarction (MI): Commonly caused by occlusion of LAD ("widow maker"),
RCA, or LCx.
• Angina pectoris: Chest pain due to myocardial ischemia.
• Coronary artery bypass grafting (CABG): Bypass occluded arteries, often using internal
thoracic artery or saphenous vein grafts.
6. High-Yield Points
• LAD supplies anterior 2/3 of interventricular septum and anterior wall of left ventricle.
• RCA supplies SA and AV nodes in majority.
• Coronary arteries fill during diastole.
• Coronary dominance important in clinical presentation of MI.
7. MCQs
Q1: Which artery is commonly known as the "widow maker"?
A. Right coronary artery
B. Left circumflex artery
C. Left anterior descending artery
D. Posterior descending artery
E. Marginal artery
Answer: C. Left anterior descending artery
Explanation: LAD supplies a large portion of the left ventricle and interventricular septum; its
occlusion can cause fatal MI.
Q2: The coronary sinus drains into which cardiac chamber?
A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle
E. Pulmonary artery
Answer: B. Right atrium
Explanation: The coronary sinus empties venous blood from the myocardium into the right atrium.
Chapter 12: Segments of Liver
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1. Overview
The liver is divided into anatomical and functional segments based on vascular inflow, biliary
drainage, and venous outflow. Understanding liver segments is essential for surgeries like hepatic
resection and transplantation.
2. Couinaud’s Classification (Segmental Anatomy)
The liver is divided into 8 functional segments (I to VIII), each with its own vascular inflow, outflow,
and biliary drainage.

Segment Location Key Features

Posterior, near IVC; drains directly into

I Caudate lobe
IVC

II Left lateral superior segment Left lateral sector

III Left lateral inferior segment Left lateral sector

Left medial segment (IVa - superior, IVb -

IV Left medial sector
inferior)

V Right anterior inferior segment Right anterior sector

VI Right posterior inferior segment Right posterior sector

VII Right posterior superior segment Right posterior sector

VIII Right anterior superior segment Right anterior sector

3. Division of Liver
• Left and right lobes: Divided by the middle hepatic vein (Cantlie’s line), an imaginary line
from the gallbladder fossa to the IVC.
• Left lobe: Segments II, III, IV
• Right lobe: Segments V, VI, VII, VIII
• Caudate lobe (I): Functionally independent, drains directly into the IVC.
4. Blood Supply and Venous Drainage
• Each segment has its own branch of the portal vein and hepatic artery.
• Venous drainage is via hepatic veins: right, middle, and left hepatic veins.
5. Clinical Correlations
• Segmental anatomy guides hepatic resections and transplantation.
• Tumors or lesions localized to specific segments can be resected precisely.
• Caudate lobe involvement important in certain pathologies due to its unique drainage.
6. High-Yield Points
• The liver has 8 functional segments per Couinaud’s classification.
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

• Middle hepatic vein divides right and left lobes.

• Caudate lobe is segment I and drains directly into the IVC.
• Portal triad (portal vein, hepatic artery, bile duct) supplies each segment separately.
7. MCQs
Q1: Which hepatic segment corresponds to the caudate lobe?
A. Segment I
B. Segment II
C. Segment IV
D. Segment V
E. Segment VIII
Answer: A. Segment I
Explanation: The caudate lobe is segment I, unique for direct drainage into the IVC.
Q2: What structure divides the right and left functional lobes of the liver?
A. Left hepatic vein
B. Right hepatic vein
C. Middle hepatic vein
D. Ligamentum teres
E. Falciform ligament
Answer: C. Middle hepatic vein
Explanation: The middle hepatic vein runs in Cantlie’s line, dividing the liver into right and left
functional lobes.
Chapter 13: Median, Medial, and Lateral Umbilical Ligaments and Their Derivatives
1. Overview
The umbilical ligaments are fibrous remnants of fetal vessels and structures found on the inner
anterior abdominal wall. Understanding these ligaments is essential in embryology and anatomy,
especially during surgeries like laparoscopic procedures.
2. Types of Umbilical Ligaments

Ligament Embryological Origin Adult Structure / Location Clinical Relevance

Median Midline fibrous band from

Remnant of urachus Can form urachal cyst or
Umbilical apex of urinary bladder to
(allantois) sinus if patent
Ligament umbilicus

Paired structures on either

Medial Can be confused with
Remnants of umbilical side of median ligament,
Umbilical lymphadenopathy on
arteries running from internal iliac
Ligaments imaging
arteries to umbilicus

Lateral
Contain inferior Lateral to medial umbilical Important surgical
Umbilical
epigastric vessels (not ligaments, these folds cover landmarks during hernia
Ligaments
ligaments but folds) vessels repair
(folds)

3. Detailed Description
• Median Umbilical Ligament:
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o Single midline structure.

o Derived from the urachus, which connected the fetal bladder to the allantois during
development.
o Postnatally becomes a fibrous cord.
• Medial Umbilical Ligaments:
o Paired structures.
o Remnants of the fetal umbilical arteries which carried deoxygenated blood from the
fetus to the placenta.
o Run on the inner surface of the anterior abdominal wall, lateral to the median
ligament.
• Lateral Umbilical Folds:
o Not remnants but peritoneal folds covering the inferior epigastric vessels.
o Located lateral to the medial umbilical ligaments.
o Important in distinguishing direct and indirect inguinal hernias.
4. Surgical Significance
• During laparoscopic hernia repair, identification of these ligaments/folds is crucial to avoid
vessel injury.
• The space medial to the lateral umbilical fold is the site of a direct inguinal hernia.
• The space lateral to the lateral umbilical fold is the site of an indirect inguinal hernia.
5. Clinical Correlations
• Urachal anomalies: Patent urachus can cause urine leakage from the umbilicus.
• Urachal cysts and sinuses: Can cause infection or abscess formation.
• False lymphadenopathy: Medial umbilical ligaments can appear as masses on imaging.
6. High-Yield Points
• Median umbilical ligament = urachus remnant (midline).
• Medial umbilical ligaments = obliterated umbilical arteries (paired).
• Lateral umbilical folds = cover inferior epigastric vessels (vascular structures, not ligaments).
• Important landmarks in hernia surgery.
7. MCQs
Q1: The median umbilical ligament is a remnant of which fetal structure?
A. Umbilical artery
B. Urachus
C. Ductus arteriosus
D. Vitelline duct
E. Allantois
Answer: B. Urachus
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Explanation: The median umbilical ligament is the fibrous remnant of the urachus, connecting the
bladder to the umbilicus.
Q2: Which structure is covered by the lateral umbilical fold?
A. Umbilical artery
B. Urachus
C. Inferior epigastric vessels
D. Median umbilical ligament
E. Femoral artery
Answer: C. Inferior epigastric vessels
Explanation: The lateral umbilical fold is a peritoneal fold covering the inferior epigastric vessels.
Chapter 14: Sibson Fascia
1. Overview
Sibson fascia, also called the suprapleural membrane, is a thickening of connective tissue that
reinforces the thoracic inlet, playing a crucial role in protecting the apex of the lung and maintaining
the integrity of the thoracic cavity.
2. Anatomy and Location
• It is a fibrous extension of the endothoracic fascia.
• Extends from the transverse process of the C7 vertebra and the first rib to the inner
border of the first rib and costal cartilage.
• Covers the apex of the lung as it passes through the thoracic inlet into the neck.
3. Structure
• Made of dense connective tissue fibers.
• Continuous with the prevertebral fascia of the neck.
• Reinforces the thoracic inlet, providing a barrier against the herniation of lung tissue into the
neck.
4. Clinical Relevance
• Acts as a protective membrane preventing cervical extension of apical lung tumors (Pancoast
tumors).
• Important landmark in thoracic outlet syndrome, where structures like the subclavian artery
and brachial plexus may be compressed near the thoracic inlet.
• May be incised surgically to access the thoracic inlet or apex of the lung.
5. High-Yield Points
• Sibson fascia = suprapleural membrane, reinforcement at thoracic inlet.
• Attaches to transverse process of C7 and first rib.
• Protects the apex of the lung and supports structures entering/leaving the thorax.
• Continuity with prevertebral fascia.
6. MCQs
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Q1: The Sibson fascia is an extension of which fascia?

A. Endothoracic fascia
B. Pretracheal fascia
C. Superficial cervical fascia
D. Investing layer of deep cervical fascia
E. Buccopharyngeal fascia
Answer: A. Endothoracic fascia
Explanation: Sibson fascia is a thickening of the endothoracic fascia at the thoracic inlet.
Q2: The Sibson fascia is attached to which vertebral level?
A. C3
B. C5
C. C7
D. T1
E. T3
Answer: C. C7
Explanation: It attaches to the transverse process of the 7th cervical vertebra (C7).
Chapter 15: Inguinal Lymphatic Drainage
1. Overview
The inguinal lymph nodes are a group of lymph nodes located in the groin region that play a key role
in lymphatic drainage of the lower limb, lower abdominal wall, perineum, and external genitalia.
Knowledge of their anatomy is important for clinical assessment of infections, malignancies, and
surgeries.
2. Types of Inguinal Lymph Nodes
Inguinal lymph nodes are divided into two groups:

Number of
Group Location Drainage Area
Nodes

Drain skin of lower abdomen, perineum,

Just below the inguinal
Superficial buttocks, external genitalia, and lower
ligament, superficial to ~10 nodes
inguinal nodes limb (except lateral side of foot and
the fascia lata
posterolateral calf)

Medial to the femoral Drain deep structures of the lower limb 3–5 nodes
Deep inguinal
vein, deep to the fascia and receive efferents from superficial (including
nodes
lata (in femoral canal) nodes Cloquet’s node)

3. Lymphatic Drainage Patterns

• Superficial inguinal nodes receive lymph from:
o Skin of the lower abdomen (below the umbilicus)
o External genitalia (penis, scrotum, vulva)
o Perineum
o Buttocks
o Lower limb (except lateral foot and posterolateral leg)
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• Deep inguinal nodes receive lymph from:

o Deep lymphatics of the lower limb
o Efferent vessels from superficial nodes
• The Cloquet’s node is the highest deep inguinal node located in the femoral canal and is
clinically important as it may be the first node involved in malignancies.
• Efferents from the deep inguinal nodes drain into the external iliac nodes.
4. Clinical Significance
• Enlargement of superficial nodes can indicate infections or malignancies in the areas they
drain (e.g., sexually transmitted infections, skin infections, or penile cancer).
• Deep nodes may be involved in advanced malignancies of the lower limb or pelvis.
• Knowledge of drainage is important during lymphadenectomy and staging of cancers (e.g.,
melanoma, vulvar or penile carcinoma).
5. High-Yield Points
• Superficial inguinal nodes lie superficial to the fascia lata; deep nodes lie deep to fascia
lata.
• Drainage above the umbilicus goes to axillary nodes; below the umbilicus drains to inguinal
nodes.
• Cloquet’s node is the highest deep inguinal node in the femoral canal.
• Inguinal lymphadenopathy suggests local infections or malignancies in the perineal and lower
limb regions.
6. MCQs
Q1: Which area does NOT drain to the superficial inguinal lymph nodes?
A. Scrotum
B. Penis
C. Lateral side of foot
D. Lower abdominal wall below umbilicus
E. Vulva
Answer: C. Lateral side of foot
Explanation: Lymph from the lateral side of the foot drains to the popliteal nodes, not the superficial
inguinal nodes.
Q2: Cloquet’s node is located in which anatomical space?
A. Femoral triangle
B. Femoral canal
C. Popliteal fossa
D. Adductor canal
E. Inguinal canal
Answer: B. Femoral canal
Explanation: Cloquet’s node is the highest deep inguinal node, located in the femoral canal.
Chapter 16: Portosystemic Anastomosis
1. Overview
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Portosystemic anastomoses are vascular connections between the portal venous system and the
systemic venous system. These sites become clinically important when portal hypertension develops,
causing increased blood flow through these collateral channels leading to varices and other
complications.
2. Key Sites of Portosystemic Anastomosis

Systemic Vein
Site Portal Vein Tributary Clinical Manifestation
Tributary

Esophageal veins Esophageal varices,

Lower Esophagus Left gastric vein
(azygos system) hematemesis

Paraumbilical Paraumbilical veins (from Superficial epigastric Caput medusae (dilated

Region portal) veins veins around umbilicus)

Middle and inferior

Rectum Superior rectal vein (portal) Internal hemorrhoids
rectal veins (systemic)

Retroperitoneal Veins of colon, pancreas, Lumbar and iliac veins Collateral veins, less
Areas kidney (portal tributaries) (systemic) common clinically

3. Pathophysiology
• In portal hypertension, blood flow through the liver is obstructed.
• Blood is diverted through portosystemic anastomoses into systemic veins, which are not
designed to handle such high volume and pressure.
• This leads to dilatation of veins and formation of varices, which can rupture and bleed.
4. Clinical Importance
• Esophageal varices are a life-threatening cause of upper GI bleeding in cirrhosis.
• Caput medusae is a visible sign of portal hypertension around the umbilicus.
• Internal hemorrhoids due to rectal vein dilatation can cause bleeding and discomfort.
5. High-Yield Points
• Know the four major sites of portosystemic anastomoses: lower esophagus, paraumbilical
region, rectum, retroperitoneal veins.
• Esophageal varices cause hematemesis; internal hemorrhoids cause painless rectal bleeding.
• Caput medusae are dilated periumbilical veins visible on the abdominal wall.
6. MCQs
Q1: The left gastric vein forms an anastomosis with which systemic vein?
A. Azygos vein
B. Inferior vena cava
C. Superior mesenteric vein
D. Femoral vein
E. Renal vein
Answer: A. Azygos vein
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

Explanation: The left gastric vein (portal) anastomoses with esophageal veins draining into the
azygos vein (systemic).
Q2: Caput medusae is caused by dilatation of which veins?
A. Paraumbilical veins
B. Femoral veins
C. Superior rectal veins
D. Lumbar veins
E. Inferior epigastric veins
Answer: A. Paraumbilical veins
Explanation: Caput medusae results from dilated paraumbilical veins in portal hypertension.
Chapter 17: Inguinal Ring
1. Overview
The inguinal ring is an important anatomical structure forming the entrance and exit of the inguinal
canal, through which structures such as the spermatic cord (in males) and the round ligament (in
females) pass. It is clinically significant in the context of inguinal hernias.
2. Types of Inguinal Rings
There are two inguinal rings:

Structure
Inguinal Ring Location Function
Type

An opening in the transversalis fascia, Entrance of the inguinal

Deep (Internal) Oval-shaped
superior to the midpoint of the inguinal canal from the
Inguinal Ring defect
ligament abdominal cavity

Superficial Triangular opening in the aponeurosis of Exit of the inguinal

Triangular
(External) the external oblique muscle, just above canal to the superficial
opening
Inguinal Ring and lateral to the pubic tubercle fascia

3. Boundaries and Relations

• Deep inguinal ring:
o Location: About 1.25 cm above the midpoint of the inguinal ligament (midpoint
between ASIS and pubic tubercle)
o Lies lateral to the inferior epigastric vessels
o Contains the spermatic cord or round ligament
• Superficial inguinal ring:
o Location: Just above the pubic tubercle
o Formed by a split in the external oblique aponeurosis
o Bounded by the crura: medial crus (attached to pubic crest) and lateral crus (attached
to pubic tubercle)
4. Clinical Significance
• Inguinal hernias often pass through one or both of these rings.
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• Indirect inguinal hernia enters the deep inguinal ring lateral to the inferior epigastric vessels
and can pass through the entire canal to the superficial ring.
• Direct inguinal hernia protrudes through Hesselbach's triangle medial to the inferior
epigastric vessels and pushes through the abdominal wall near the superficial ring.
• Knowledge of ring anatomy is vital for diagnosis and surgical repair of hernias.
5. High-Yield Points
• Deep inguinal ring = entrance, lateral to inferior epigastric vessels.
• Superficial inguinal ring = exit, triangular opening in external oblique aponeurosis.
• Indirect hernia: through deep ring → canal → superficial ring.
• Direct hernia: through Hesselbach’s triangle, medial to inferior epigastric vessels.
6. MCQs
Q1: The deep inguinal ring is located lateral to which structure?
A. Inferior epigastric vessels
B. Superior epigastric vessels
C. Femoral vein
D. Pubic symphysis
E. Inguinal ligament
Answer: A. Inferior epigastric vessels
Explanation: The deep inguinal ring lies lateral to the inferior epigastric vessels.
Q2: Which structure passes through the superficial inguinal ring?
A. Femoral artery
B. Spermatic cord
C. Obturator nerve
D. Ilioinguinal nerve
E. Genitofemoral nerve
Answer: B. Spermatic cord
Explanation: The spermatic cord exits the abdominal cavity via the superficial inguinal ring.
Chapter 18: Brachial Plexus
1. Overview
The brachial plexus is a complex network of nerves that supplies motor and sensory innervation to the
upper limb. It arises from the anterior rami of the lower four cervical nerves (C5–C8) and the first
thoracic nerve (T1).
2. Anatomy of Brachial Plexus

Part Description Nerve Roots

Roots Anterior rami of C5, C6, C7, C8, T1 C5 to T1

Upper (C5-C6), Middle (C7), Lower (C8-

Trunks Formed by the union of roots
T1)

Each trunk divides into anterior and posterior

Divisions 6 divisions total
divisions
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

Part Description Nerve Roots

Cords Formed by recombination of divisions Lateral, Posterior, Medial cords

Musculocutaneous, Axillary, Radial,

Branches Terminal nerves from cords
Median, Ulnar

3. Roots
• Emerge between the anterior and middle scalene muscles.
• Carry both motor and sensory fibers.
4. Trunks
• Upper trunk: union of C5 and C6 roots
• Middle trunk: continuation of C7 root
• Lower trunk: union of C8 and T1 roots
5. Divisions
• Anterior divisions mainly supply flexor muscles (anterior compartments).
• Posterior divisions supply extensor muscles (posterior compartments).
6. Cords
• Named according to their relationship with the axillary artery.
• Lateral cord: anterior divisions of upper and middle trunks
• Posterior cord: all posterior divisions
• Medial cord: anterior division of lower trunk
7. Terminal Branches

Nerve Roots Motor Supply Sensory Supply

C5- Anterior compartment of arm Lateral forearm (lateral cutaneous nerve

Musculocutaneous
C7 (biceps, brachialis) of forearm)

C5- Skin over deltoid (regimental badge

Axillary Deltoid, teres minor
C6 area)

C5- Posterior compartments of arm Posterior arm, forearm, and hand

Radial
T1 and forearm (dorsal)

C5- Most anterior forearm muscles, Lateral palm and palmar fingers 1-3 and
Median
T1 thenar muscles half of 4

C8- Medial hand and 1.5 fingers (little finger

Ulnar Most intrinsic hand muscles
T1 and half of ring finger)

8. Important Branches from Roots and Cords

• Dorsal scapular nerve (C5): rhomboids and levator scapulae
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• Long thoracic nerve (C5-C7): serratus anterior

• Suprascapular nerve (C5-C6): supraspinatus and infraspinatus
• Lateral pectoral nerve (lateral cord): pectoralis major
• Medial pectoral nerve (medial cord): pectoralis major and minor
• Upper and lower subscapular nerves (posterior cord): subscapularis and teres major
9. Clinical Correlations
• Erb’s palsy: injury to upper trunk (C5-C6), results in “waiter’s tip” position.
• Klumpke’s palsy: injury to lower trunk (C8-T1), results in claw hand.
• Saturday night palsy: radial nerve injury causing wrist drop.
• Winged scapula: injury to long thoracic nerve.
10. High-Yield Points
• Roots → trunks → divisions → cords → branches (Randy Travis Drinks Cold Beer)
mnemonic.
• Upper trunk injury causes Erb’s palsy; lower trunk injury causes Klumpke’s palsy.
• Radial nerve injury → wrist drop; long thoracic nerve injury → winged scapula.
11. MCQs
Q1: Which nerve arises from the posterior cord of the brachial plexus?
A. Musculocutaneous nerve
B. Median nerve
C. Axillary nerve
D. Ulnar nerve
E. Lateral pectoral nerve
Answer: C. Axillary nerve
Explanation: The axillary nerve arises from the posterior cord.
Q2: The nerve supplying the serratus anterior muscle is derived from which roots?
A. C3-C5
B. C5-C7
C. C8-T1
D. C4-C6
E. C6-C8
Answer: B. C5-C7
Explanation: The long thoracic nerve (C5-C7) supplies serratus anterior.
Chapter 19: Nerves and Palsy
1. Overview
Nerve palsies occur when peripheral nerves are injured or compressed, leading to motor, sensory, or
mixed deficits. Understanding common nerve palsies is essential for diagnosis and management in
clinical practice.
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

2. Common Nerve Palsies

Root Sensory Clinical

Nerve Motor Deficits Common Causes
Level Deficits Features

Ape hand
Loss of wrist flexion, Supracondylar
Median Lateral palm deformity,
C5-T1 thumb opposition, finger fracture, carpal
nerve and fingers carpal tunnel
flexion (lateral 3.5 digits) tunnel
syndrome

Loss of finger Claw hand, Medial epicondyle

Ulnar Medial one and
C8-T1 abduction/adduction, sensory loss fracture, cubital
nerve a half fingers
flexion of medial 1.5 digits medial hand tunnel syndrome

Midshaft humerus
Radial Loss of wrist and finger Posterior arm
C5-T1 Wrist drop fracture, Saturday
nerve extension and forearm
night palsy

Loss of
sensation over Loss of Surgical neck
Axillary C5- Paralysis of deltoid and
deltoid shoulder fracture of
nerve C6 teres minor
(regimental abduction humerus
badge)

Foot drop, Posterior hip

Sciatic Weakness of hamstrings Posterior thigh,
L4-S3 sensory loss dislocation, pelvic
nerve and all muscles below knee leg, foot
below knee fractures

Pelvic fracture,
Femoral Anterior thigh Difficulty in
L2-L4 Weakness of quadriceps femoral sheath
nerve and medial leg knee extension
injury

Common
Foot dorsiflexion and Lateral leg and Fibular neck
peroneal L4-S2 Foot drop
eversion loss dorsum of foot fracture
nerve

3. Specific Nerve Palsy Details

Median Nerve Palsy
• Cause: Supracondylar fracture of humerus, carpal tunnel syndrome
• Motor: Loss of thumb opposition (thenar muscles), flexion of lateral fingers
• Sensory: Loss of sensation on lateral palm and first three and half fingers
• Sign: Ape hand deformity (thenar muscle atrophy)
Ulnar Nerve Palsy
• Cause: Fracture of medial epicondyle of humerus, cubital tunnel syndrome
• Motor: Claw hand deformity (hyperextension at MCP, flexion at IP joints)
• Sensory: Loss over medial one and a half fingers
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

• Sign: Froment’s sign (difficulty holding paper between thumb and index)
Radial Nerve Palsy
• Cause: Midshaft humerus fracture, prolonged compression (Saturday night palsy)
• Motor: Wrist drop (loss of wrist and finger extension)
• Sensory: Loss over posterior arm and dorsum of hand
• Sign: Inability to extend wrist and fingers
Axillary Nerve Palsy
• Cause: Fracture of surgical neck of humerus, anterior shoulder dislocation
• Motor: Weakness of deltoid (loss of abduction from 15 to 90 degrees)
• Sensory: Loss over regimental badge area on lateral shoulder

4. High-Yield Points
• Wrist drop → radial nerve palsy
• Claw hand → ulnar nerve palsy
• Ape hand → median nerve palsy
• Loss of shoulder abduction → axillary nerve palsy
• Foot drop → common peroneal nerve palsy

5. MCQs
Q1: Which nerve is most commonly injured in a midshaft humerus fracture?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Axillary nerve
E. Musculocutaneous nerve
Answer: C. Radial nerve
Explanation: The radial nerve runs in the radial groove on the posterior humerus shaft and is
vulnerable in midshaft fractures.
Q2: Claw hand deformity results from injury to which nerve?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Axillary nerve
E. Femoral nerve
Answer: B. Ulnar nerve
Explanation: Ulnar nerve palsy leads to claw hand due to paralysis of the intrinsic hand muscles.
Chapter 20: Stripping GSN Below Knee
1. Overview
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

The Great Saphenous Nerve (GSN) is a misnomer here; you likely mean the Great Saphenous Vein
(GSV), which is commonly involved in varicose vein surgeries including stripping procedures.
Stripping of the Great Saphenous Vein below the knee is a surgical technique performed to treat
varicose veins and chronic venous insufficiency.
2. Anatomy of Great Saphenous Vein (GSV)
• The GSV is the longest superficial vein of the lower limb.
• Originates from the dorsal venous arch of the foot, ascends anterior to the medial malleolus,
runs along the medial aspect of the leg and thigh.
• Terminates by draining into the femoral vein at the saphenofemoral junction (near the groin).
• Numerous tributaries including the anterior accessory saphenous vein and posterior accessory
saphenous vein.
3. Indications for GSV Stripping
• Symptomatic varicose veins
• Recurrent varicosities after previous treatment
• Chronic venous insufficiency with venous ulcers
4. Stripping Procedure
• Usually done under regional or general anesthesia.
• A small incision is made at the saphenofemoral junction to ligate and divide the GSV.
• Another incision is made below the knee (usually near the medial malleolus or mid-calf).
• A flexible stripper is inserted into the vein and passed proximally or distally to strip out the
vein segment.
• The procedure removes the incompetent vein segment to improve venous drainage.
5. Important Considerations
• Below knee stripping is preferred in some cases to reduce complications like injury to the
saphenous nerve.
• Avoids damage to the common peroneal nerve and saphenous nerve branches.
• Postoperative care includes compression stockings and early mobilization.
6. Complications
• Hematoma and bleeding
• Infection
• Nerve injury (especially saphenous nerve → numbness or dysesthesia on medial leg)
• Deep vein thrombosis (rare)
7. Anatomy Related to Nerve Injury
• The saphenous nerve, a sensory branch of the femoral nerve, accompanies the GSV in the
leg.
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

• It provides sensation to the medial leg and foot.

• During stripping below the knee, care must be taken to avoid saphenous nerve injury.
8. High-Yield Points
• GSV stripping is done to treat varicose veins.
• Incisions at groin and below knee (medial leg).
• Saphenous nerve injury is a common complication.
• Postoperative compression and ambulation reduce complications.

9. MCQs
Q1: The great saphenous vein drains into which deep vein?
A. Popliteal vein
B. Femoral vein
C. Posterior tibial vein
D. Small saphenous vein
E. Iliac vein
Answer: B. Femoral vein
Explanation: The GSV terminates at the saphenofemoral junction draining into the femoral vein.
Q2: Which nerve is at risk during stripping of the great saphenous vein below the knee?
A. Tibial nerve
B. Common peroneal nerve
C. Saphenous nerve
D. Femoral nerve
E. Superficial peroneal nerve
Answer: C. Saphenous nerve
Explanation: The saphenous nerve runs close to the GSV in the leg and can be injured during vein
stripping.
Chapter 21: Histology – Types of Epithelium and Basics
1. Overview
Epithelium is a tissue composed of tightly packed cells that cover body surfaces, line cavities, and
form glands. It functions as a protective barrier, absorptive surface, secretory tissue, and in sensation.

2. General Characteristics of Epithelium

• Cells closely packed with minimal extracellular matrix
• Avascular (no blood vessels), nourished by diffusion from underlying connective tissue
• Has a free (apical) surface and a basal surface attached to a basement membrane
• High mitotic rate for regeneration
• Polarized: apical, lateral, and basal surfaces differ in structure and function
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

3. Classification of Epithelium
A. Based on Number of Cell Layers:

Type Description Function Example

Absorption, Alveoli (simple squamous),

Simple epithelium Single cell layer
filtration intestines (simple columnar)

Skin (stratified squamous),

Stratified epithelium Multiple layers Protection
esophagus

Pseudostratified Single layer but appears Secretion,

Respiratory tract lining
epithelium multilayered movement of mucus

B. Based on Cell Shape:

Type Description Function Example

Squamous Flat, thin cells Diffusion, filtration Alveoli, glomerulus

Cuboidal Cube-shaped cells Secretion, absorption Kidney tubules, glands

Columnar Tall, column-like cells Absorption, secretion Intestine, stomach lining

Transitional Varying shape, stretchable Stretch and recoil Urinary bladder

4. Special Types of Epithelium

• Keratinized Stratified Squamous: Found in skin; surface cells are dead and keratinized for
waterproofing.
• Non-Keratinized Stratified Squamous: Lines moist surfaces like mouth, esophagus, vagina.
• Ciliated Epithelium: Has motile cilia for moving particles; e.g., respiratory tract.
• Goblet Cells: Mucus-secreting unicellular glands found in columnar epithelium.

5. Basement Membrane
• A thin extracellular layer separating epithelium from connective tissue.
• Composed of basal lamina (lamina lucida + lamina densa) and reticular lamina.
• Functions in support, filtration, and tissue repair.

6. Functions of Epithelium
• Protection: Barrier against mechanical injury, microbes
• Absorption: Nutrients, ions
• Secretion: Glandular epithelium
NEET PG – 170 – BY Dr. Shuvro Bhattacharya - Anatomy

• Sensation: Specialized epithelium in sensory organs

• Filtration: Renal corpuscles

7. High-Yield Points
• Epithelium is avascular, rests on basement membrane
• Simple epithelium suited for absorption and filtration
• Stratified epithelium protects against abrasion
• Transitional epithelium is specialized for stretching
• Goblet cells produce mucus to trap particles

8. MCQs
Q1: Which epithelium type is found lining the alveoli?
A. Simple cuboidal
B. Stratified squamous keratinized
C. Simple squamous
D. Pseudostratified columnar ciliated
E. Transitional
Answer: C. Simple squamous
Explanation: Simple squamous epithelium facilitates gas exchange in alveoli due to its thinness.
Q2: The epithelium that lines the urinary bladder is:
A. Simple squamous
B. Transitional epithelium
C. Stratified cuboidal
D. Pseudostratified columnar
E. Simple columnar
Answer: B. Transitional epithelium
Explanation: Transitional epithelium allows for stretching as the bladder fills.