The answer is D: Epidermis, dermis, superfi cial fascia, deep
fascia, epimysium. The epidermis is the superfi cial cellular
layer of the skin. The dermis is the deeper, dense connective
tissue layer of the skin. The superfi cial fascia (subcutaneous
tissue) is the fatty loose connective tissue layer that underlies
the skin. The deep fascia is the relatively dense, fat-free connective tissue layer that lies deep to the skin and superficial fascia. The epimysium is a deep extension of the deep fascia that tightly invests the surface of individual muscles. Choice A (Epidermis, dermis, superfi cial fascia, epimysium, deep fascia) is incorrect. In this sequence, the epimysium incorrectly overlies the deep fascia. Choice B (Dermis, epidermis, superfi cial
fascia, deep fascia, epimysium) is incorrect. Here, the dermis is
incorrectly superfi cial to the epidermis. Choice C (Dermis, epidermis, superfi cial fascia, epimysium, deep fascia) is incorrect. Again, the dermis is incorrectly listed as the most superficial layer. Also, the epimysium incorrectly overlies the deep fascia. Choice E (Epidermis, superfi cial fascia, dermis, deep fascia, epimysium) is incorrect. In this sequence, the superfi cial fascia is incorrectly interposed between the epidermis and the
dermis.

2) The caecum is found to be placed below the stomach and in
midline. Which of the following abnormalities would have
taken place in the rotation of gut?

In mixed rotation the intestine doesn’t rotate as it re-enters the abdomen after physiological hernia leading to caecum located just
inferior to the pylorus of the stomach in the midline.

Brown Sequard syndrome presents with contralateral loss of crude touch sensations, since anterior spinothalamic tract carrying
these sensations, crosses the midline and runs on the opposite half of spinal cord.

4) During a thyroid operation, a nerve coursing along with the superior thyroid artery is injured. What can be the possible consequence(s)?

4) The nerve coursing along with the superior thyroid artery is external laryngeal nerve (branch of superior laryngeal nerve, vagus)
which supplies cricothyroid muscle.
• All the muscles of larynx are supplied by recurrent laryngeal nerve except the cricothyroid muscle.
• Sensory supply to laryngeal mucosa above vocal cords is by internal laryngeal nerve and below the vocal cords by recurrent
laryngeal nerve

5)The anterior abdominal wall of a 21-year-old woman impacts the steering wheel during a head-on car collision. The blunt trauma resulted in a lacerated pancreas with
digestive enzyme spilling anterior. Which of the following locations would initially receive the contents of the lacerated
pancreas?

The answer is D: Omental bursa. The omental bursa (or
lesser peritoneal sac) is an isolated part of the peritoneal
cavity, which lies posterior to the stomach and anterior to
the pancreas. Because of its location, the omental bursa
would receive digestive enzymes emanating from the lacerated section of the anterior pancreas. The only connection
between the omental bursa and the remaining aspects of the
peritoneal cavity is through the epiploic (omental) foramen.
Choice A (Supracolic part of greater peritoneal sac) is
incorrect. The supracolic part of greater peritoneal sac is
located above the transverse mesocolon. Digestive enzymes
emanating from a lacerated pancreas would only reach this
space if the fl uids traveled through the epiploic foramen.
Remember, these fluids initially spill into the omental bursa. Choice B (Infracolic part of greater peritoneal sac) is incorrect. The infracolic part of greater peritoneal sac is
located below the transverse mesocolon. Digestive enzymes
emanating from a lacerated pancreas could only reach this
space if the fluids traveled inferiorly via the right paracolic
gutter to reach this lower aspect of the peritoneal cavity.
However, these pancreatic enzymes would initially spill into the omental bursa. Choice C (Subhepatic space) is incorrect. The subhepatic space is a recess in the supracolic part of the greater peritoneal sac located between the visceral surface of the liver and the transverse colon. Digestive enzymes emanating from the anterior pancreas initially
spill into the omental bursa. Choice E (Subphrenic space)
is incorrect. The subphrenic space is a recess located in the
anterior part of the liver and the diaphragm. Therefore, it is
a component of the supracolic part of the greater peritoneal
sac. Due to the superior location of the damaged organ, the
subphrenic space is not a likely location to fi nd the emitted
pancreatic enzymes.

6) All of the following pairs for Brodmann area are correct
EXCEPT:
a. Superior temporal gyrus: Auditory cortex (41,42)
b. Superior temporal gyrus: Wernicke’s sensory speech area (22)
c. Inferior frontal gyrus: Broca’s motor speech area (44)
d. Superior frontal gyrus: Frontal eye field (8)

d. Superior frontal gyrus: Frontal eye field (8)
• Frontal eye field (8) is located at the middle frontal gyrus.

7) A physician orders a lumbar puncture (spinal tap) for his
43-year-old female patient in order to obtain a sample of cerebrospinal fl uid (CSF). He explains to her that this procedure will be done in the lower back, between the spinous processes of the L3 and L4 vertebrae. What is the best reason for performing the lumbar puncture at this location?

(A) The medullary cone ends at or above the L3 level
(B) The subarachnoid space ends at the L3 level
(C) The intervertebral foramina at L3-4 are large and easy to penetrate
(D) No vertebral venous plexuses exist below the L3 level
(E) The ligamenta fl ava are absent below the L3 level

The objective of a lumbar puncture is to enter (tap) the subarachnoid space and access the CSF. This procedure is performed using a long spinal needle. For several reasons, this procedure is best performed in the low lumbar region, between the spinous processes of the L3 and L4 (sometimes L4 and L5) vertebrae. The medullary cone (or conus medullaris) is the
tapered terminal end of the spinal cord. In adults, the medullary cone is normally located within the T12-L3 vertebral levels. Thus, penetrating the vertebral canal and subarachnoid
space below L3 is the “safe” place to go, in that the spinal needle
should not penetrate the spinal cord. Choice B (The subarachnoid space ends at the L3 level) is incorrect. The subarachnoid
space is the CSF-fi lled space between the arachnoid and pia
mater layers of the meninges. The dura-arachnoid layers line
the vertebral canal and end at the S2 level. The pia mater lines
the exterior surface of the neural tube and continues distally
to envelope the spinal nerve rootlets and roots. Because the
spinal cord ends at approximately the L1 level, there is a large
separation between the dura and arachnoid mater layers of the
meninges and the pia mater below L1. Thus, the subarachnoid
space is quite large below the medullary cone (conus medullaris), providing a signifi cant pool (the lumbar cistern) of CSF.
Choice C (The intervertebral foramina at L3-4 are large and
easy to penetrate) is incorrect. The intervertebral foramina in
the lumbar region are large openings; however, the lumbar
puncture does not occur at these locations. During a spinal tap, the spinal needle is inserted through an interlaminar space, on the posterior side of the vertebral column. These spaces are largest in the low lumbar spine, thus affording a relatively open path to the vertebral canal. Before a spinal tap
is administered, the patient is often bent forward into the fetal position by fl exing the spine, which expands the interlaminar spaces during the lumbar puncture. Choice D (No vertebral venous plexuses exist below the L3 level) is incorrect. The vertebral venous plexuses are an extensive network of valveless,
interconnecting vessels running the entire length of the vertebral column. The external vertebral venous plexus lies on the
anterior aspect of the vertebral column and the posterior side
of the vertebral arch. The internal vertebral venous plexus is
a major constituent of the epidural space within the vertebral
canal. A lumbar puncture must traverse both the external and
internal plexuses to reach the subarachnoid space. Choice E
(The ligamenta fl ava are absent below the L3 level) is incorrect. The ligamenta fl ava are short ligaments that connect the anterior sides of adjacent vertebral laminae along the entire length of the vertebral column. The spinal needle must pierce a ligamentum fl avum in order to enter the vertebral canal.

*Ans. B. Transverse process of lumbar vertebra and body of T12 vertebra*

The psoas major muscle is a muscle of the posterior abdominal wall. It has two slips of origin that enclose the lumbar plexus within it.

• *Option: A*. Greater trochanter of the femur gives origin to the vastus lateralis. Hence, it is the wrong answer.

• *Option: B*. Psoas major muscle superficial and deep origin sites owing to the presence of branches of the lumbar plexus embedded within it. The superficial part overlies the lumbar plexus and originates from the sides of the T12 and L1-L4 vertebrae along with the intervening intervertebral discs. The deep part originates from the transverse process of L1-L5. Hence, it is the correct answer.

• *Option: C*. The transverse process of the thoracic vertebra and body of the L1 vertebra doesn’t give rise to a specific muscle that has the lumbar plexus embedded within it. Hence, it is the wrong answer.

• *Option: D.* the lesser trochanter is the site of the insertion of the psoas major muscle. Hence, it is the wrong answer.