Case -1

A baby with a history of forceps delivery was brought to the pediatrician after four weeks for a routine
checkup. On examination, it was observed that the baby’s left arm was medially rotated and adducted
and the left forearm was pronated and extended.

Questions
1. Name the position of the upper limb seen in this baby.
2. Lesion at which site in the brachial plexus causes this position of the upper limb?
3. What are the causes of injury in this condition?
4. Which spinal segments are involved in this case?
5. Which muscles are affected in this condition?
6. Explain anatomical basis of above deformity.
7. Which reflexes are lost in this condition?
8. Which are other sites of brachial plexus injury?
9. Enumerate the branches of brachial plexus.
10. What is Horner’s syndrome?

Case -2
A 55-year-old woman came to the surgeon with complaint of hard, painless lump in the upper outer
quadrant of the right breast. On Examination, the doctor found that skin of breast was puckered and
gave appearance of skin of an orange and the nipple was retracted. On palpation he found that the
breast was fixed and enlarged axillary lymph nodes on the right side.

Questions
1. What is the probable diagnosis?
2. Name the three muscles related to the base of the breast.
3. Give the anatomical basis of puckering of skin.
4. Give anatomical basis for the orange like appearance of the skin.
5. Give anatomical basis for retraction of the nipple.
6. Why was the breast fixed?
7. How carcinoma of the one breast can spread to the opposite breast?
8. Explain the anatomical basis of metastasis of carcinoma breast to other sites.
9. Which radiological procedure is recommended for early detection of breast carcinoma?
10. Which test is employed for confirmation of diagnosis of breast carcinoma?
11. Explain surgical treatment of carcinoma breast.
 Case – 3
A 35 year old lady operated for breast cancer last week, came to the hospital for check up. She also
complaint about bony swelling on the left side of the back and difficulty in overhead abduction .On
examination, the doctor found prominent medial border of left scapula .On asking her to push the
wall against resistance, the swelling became more prominent.

Questions
1. Identify the clinical condition.
2. Which nerve is likely to be injured in this condition?
3. Give the root value of affected nerve.
4. Name the muscle supplied by it.
5. Describe the origin and insertion of affected muscle.
6. Name the movements produced by the affected muscle.
7. Explain the anatomical basis of the above condition.
8. How do you test this muscle clinically?
9. What is disability in this case?
10. Affected muscle is also known as………………

Case – 4
A 50-year-old female computer operator came to the doctor with complaints of sensation of ‘pins and
needle’ affecting the first 31/2 digits of her right hand. Initially the symptoms occurred at night but then
they were present throughout the day. On examination, the doctor noticed flattening of thenar
eminence. Pain was aggravated on flexing the wrist.

Questions
1. What is this condition called?
2. Compression of which structure is responsible for the above mentioned condition?
3. Give anatomical basis for tingling and numbness over the affected digits.
4. Why there is flattening of the thenar eminence?
5. What are the other causes leading to this condition?
6. What is Tinel’s Sign?
7. What is Phalen’s sign?
8. Name the muscles of the hand supplied by affected nerve and explain the various tests for
confirmation of motor loss.
9. Name the structures passing above and below to Flexor Retinaculum.
10. Which structure is surgically cut to relieve the symptoms?
 Case-5
Mr. Ram, 45 year old man visited Orthopaedic OPD with change in the shape of right shoulder region
and difficulty in moving his right arm outwards. On asking, he said that he had taken intramuscular
injection for TT. Doctor noticed loss of rounded shoulder contour and on physical examination, he
found loss of abduction from 150 to 900 as well as loss of sensation over upper half of the deltoid
muscle.

Questions
1. Which structure is likely to be affected in this case?
2. Explain origin and root value of the nerve.
3. Name the muscles supplied by the nerve.
4. Describe course, relations and branches of the affected nerve.
5. Explain the anatomical basis of the given condition.
6. What is the relationship of affected structure with humerus? Which are the other causes of
injury to affected structure?
7. What is regimental badge sign?
8. What is Hilton’s law?
9. Which muscles are producing abduction of shoulder joint?
10. Explain boundaries and contents of Quadrangular space.

Case- 6
Mrs Ganga, an elderly lady from the tribal area, with the known case of Hansen’s disease( Leprosy),
came to skin OPD for routine follow up, During the physical examination, The Doctor palpated the
structure present behind her both medial epicondyles.

Questions
1. Identify the structure palpated by the doctor during the physical examination. Explain its origin.
2. Enumerate all the muscles supplied by the structure. Explain their actions.
3. Name the area (of the hand) from which the structure carries sensations.
4. Which nerve is termed a musician’s nerve? And why?
5. Explain the anatomical basis of precise actions of the intrinsic muscles of the hand.
6. Mention the functional importance of the lumbricals.
7. What do you understand by claw hand? How does an ulnar claw hand differ from a complete
claw hand?
8. Name the sites where the ulnar nerve is commonly injured.
9. What do you know about cubital tunnel syndrome? What is guyon’s canal?
10. What do you understand by the ulnar paradox?
11. Explain the various tests for muscles supplied by affected structure.
 Case -1
A 50-year-old policeman with a history of chronic dull ache in both legs came to the hospital, when he
noticed dilated and tortuous veins on the medial side of his both legs. The skin on the medial malleolus
was found to be discolored, dry and scaly.

Questions
1. Name the clinical condition & mention the vein involved.
2. Name the factors helping the venous return of lower limb.
3. Explain the anatomical basis of above condition.
4. Name the closely related nerve with involved vein and which area of skin is supplied by it?
5. Describe the veins that connect involved vein to the deep veins of lower limb. Enlist their sites.
6. What is the direction of flow of blood in the connecting veins?
7. Name the tributaries of involved vein.
8. What is Trendelenberg’s test?
9. What is Perthes’s test?
10. Explain the clinical importance of involved vein.

Case – 2
A 50-year-old woman came to the hospital, when she noticed a lemon-sized swelling in the right upper
thigh. On examination, the swelling was found to be inferior and lateral to the pubic tubercle and it was
seen to push into the saphenous opening.

Questions
1. What is probable diagnosis? Explain it.
2. Name the passage through which the hernia enters the thigh. Which are the contents of this
passage?
3. Why this hernia is common in females?
4. Give the name and the boundaries of the upper opening of the passage.
5. What is the Course of the hernia? Write its importance.
6. What are the coverings of this hernia?
7. What are the likely complications of the hernia?
8. How strangulation of this hernia is treated?
9. Which are the content of the femoral sheath? Why the femoral nerve is not the content of the
femoral sheath?
10. Mention other abnormal swellings that occur in femoral triangle.
 Case -3
A candidate for recruitment in the army was rejected because he was found to have pes planus (flat
foot) in the medical checkup.

Questions
1. Define pes planus. What are the consequences of the flat foot?
2. Explain the anatomical factors that are responsible for maintaining arches of foot.
3. Name the bones forming the medial longitudinal arch of foot.
4. Which bone is the keystone of medial longitudinal arch?
5. Name the bones forming the Lateral longitudinal arch of foot.
6. Explain the functions of arches of foot.
7. Define inversion and eversion.
8. Name the joints where these movements take place.
9. Name the muscles producing these movements.
10. Mention the other anomalies of arches of foot.

Case - 4

A few days following the removal of plaster cast for fracture of the upper end of left fibula, the
patient complained of loss of sensation on the dorsum of foot except the lateral side of little toe. On
examination, it was noticed that the patient was unable to dorsiflex and evert the left foot.

Questions
1. Name the structure injured in this patient.
2. Give the root value of involved structure.
3. Name the site where this nerve is palpated.
4. Which deformity will occur in this patient?
5. Explain anatomical basis of given condition.
6. Describe the course and distribution of involve nerve.
7. Give anatomical basis for loss of sensations on the dorsum of the foot.
8. Describe the muscles that are the chief evertors of foot.
9. What is pseudoganglion? Which nerve bears pseudoganglion in lower limb?
10. Describe cutaneous nerve supply of dorsum of foot.
 Case – 5
A 27 years old male sustained a bullet shot injury in his right buttock. He was admitted in the hospital
and fully recovered. He was discharged from the hospital but he developed a characteristic limp during
walking. There was a sagging of the left hip while taking step on the right foot. On examination, the
Trendelenburg’s sign was positive.

Questions
1. Name the involved nerve and its root value.
2. Enumerate the muscles supplied by the injured nerve.
3. What is Trendelenburg’s sign? Write its anatomical basis.
4. Name the characteristic gait in unilateral injury and in bilateral injury.
5. What is abductor mechanism of hip joint?
6. Name the structures undercover the gluteus maximus muscle.
7. Write the nerve supply and action of gluteus maximus muscle.
8. Name the structures passing through greater & lesser sciatic foramina.
9. Which quadrant of gluteus region is used for giving intramuscular injection & why?
10.Name the movements permitted by hip joint with muscles producing them.

Case – 6

A football player, while playing football received a blow on the lateral side of his right knee and fell on
the ground. He felt sharp pain on the medial aspect of right knee and was not able to extend the leg on
the same side. On examination, doctor found that his right knee was swollen especially above the
patella. Drawer’s sign was negative. X-ray of knee joint does not reveal fracture of any bone. Diagnosis
is medial meniscus tear of knee joint.

Questions
1. Enumerate the ligaments of knee joint.
2. Name the structures which maintain the stability of the joint.
3. Name the structures attached to the intercondylar area of tibia.
4. Name the structures which are intra-articular and extrasynovial.
5. Why the injury of medial meniscus is more common than that of a lateral meniscus?
6. Explain locking and unlocking of knee joint.
7. Name the movements permitted by knee joint with muscles producing them.
8. Enumerate bursa around knee joint with clinical aspects.
9. What is drawer’s sign and how it is performed?
10. What is the unhappy triad of the knee joint?
 Case - 1
A 48 years old man visited the doctor with complaint of pain on the right side of chest, difficulty in
breathing, fever and dry cough for the last seven days. On further inquiry, he also told that pain radiates
to anterior abdominal wall and right shoulder. Palpation revealed tenderness and decreased tactile
vocal fremitus. On percussion of chest, dull note along the 7th to 10th intercostal spaces on the right
side. Auscultation revealed absence of breath sounds and decreased vocal resonance over the lower
lobe of his right lung. Chest X-ray showed obliteration of costo-diaphragmatic angle on the right side.

1. What is the probable diagnosis?

2. Name the recesses of pleura.
3. Give anatomical basis for pain radiating to the anterior abdominal wall.
4. Give anatomical basis for pain radiating to the right shoulder tip.
5. Why there is decreased tactile vocal fremitus and vocal resonance?
6. Why dry pleurisy is more painful than wet pleurisy?
7. What is the name of the procedure for draining this fluid?
8. In which space, the doctor will insert the needle to drain the fluid?
9. Which layers of chest wall are pierced by the needle during pleural tapping?
10. Name the types of fluids that can accumulate in the pleural cavity.

Case - 2

A 55 years old man who is chronic smoker visited the doctor with complaints of difficulty in breathing,
swallowing and hoarseness of the voice. Physical examination revealed engorgement of veins of upper
limb and neck. Radiographic examination revealed a well-circumscribed radio-opaque shadow in the
hilar region of right lung with erosion of vertebral bodies. The doctor diagnosed the condition as
bronchogenic carcinoma.

1. What is bronchogenic carcinoma? Q. Why bronchogenic carcinoma is more common in right

lung?
2. What is mediastinal syndrome?
3. Give anatomical basis for difficulty in breathing and difficulty in swallowing in this condition.
4. Give anatomical basis for hoarseness of voice and engorgement of veins in this condition.
5. Why there is erosion of vertebral bodies?
6. Trace the venous pathway through which metastasis of bronchogenic carcinoma occurs to the
brain.
7. Trace the arterial pathway through which metastasis of bronchogenic carcinoma occurs to the
brain.
8. What is mediastinal shadow?
9. What is mediastinal shift?
10. What is the importance of tracheal shadow in deciding mediastinal shift in X-ray chest PA view?
 Case - 3
Mr. Rajendra Kumar, a 37-year-old male, chain smoker, was brought to emergency OPD by his family
members with complaints of a sensation of pressure and burning in the chest that lasted longer than 30
minutes, precordial pain radiating to the left arm, forearm and jaw. Before appearing these symptoms,
the patient was asleep. Suddenly, he developed profuse sweating with shortness of breath and
increased heart rate. He had an episode of vomiting. Coronary angiogram demonstrated marked
narrowing of anterior interventricular artery. A diagnosis of myocardial infarction was made by the
doctor.

1. State the anatomical basis of myocardial infarction. How does myocardial infarction differ from
angina pectoris?
2. Name the artery most commonly affected in this condition.
3. Why cardiac pain is radiated to the precordial skin, neck, jaw, left arm and forearm? Explain its
anatomical basis.
4. What do you understand by coronary predominance? Explain its clinical significance.
5. Name the clinical procedure used to diagnose ischaemic heart disease.
6. Coronary disease in old age is less fatal than in young/middle age. Justify it.
7. Acute oesophagitis can mimic the pain of myocardial infarction. Why?
8. What are the treatment modalities in ischaemic heart disease?
9. What is coronary bypass surgery?
10. Which vessels are used for coronary artery bypass surgery?

Case - 4
A 45 years old man is admitted to the hospital for sharp stabbing retrosternal pain that radiates to left
shoulder. He also complained of fatigue and dyspnoea. On auscultation, the doctor heard the
pericardial rub over the left sternal border and upper ribs. Radiograph showed collection of fluid in the
pericardial cavity.

1. What is pericarditis?
2. What is pericardial effusion? What is pericardial tamponade?
3. Why is the pain referred to the shoulder?
4. What is pericardial friction rub?
5. What are the signs of pericardial tamponade or cardiac temponade?
6. What sign of pericardial effusion is seen in X-ray PA view?
7. Which is the site where paracentesis can be done to remove the pericardial fluid?
8. Which structures will be traversed by the needle at above mentioned site during paracentesis?
9. Explain boundaries of transverse sinus. Explain its clinical importance.
10. Explain boundaries of oblique sinus. Explain its clinical importance.
 Case - 5
A 60 years old female was operated by laparotomy under general anaesthesia for intestinal obstruction.
The surgery was successful and obstruction was relieved. A few days after the surgery the patient
developed fever and cough. Radiographic investigation revealed lung abscess involving the right lung.

1. Which segments of the lungs are affected with lung abscess due to aspiration?
2. Why lung abscess mostly occurs in right lung?
3. Why this type of patient is advised to lie in prone position?
4. Detailed knowledge of bronchial tree is useful in which procedures?
5. What is Mendelson's syndrome?
6. Why apical regions of the lungs are frequent site of tuberculosis?
7. How many segments present in lung?
8. Which bronchus aerates each segment?
9. Which structures each segment has?
Which structure guides the surgeon to resect particular segment?

Case 1

34-year-old male patient was brought by his family members to primary health center (PHC) with
complaints of vomiting and severe pain in the abdomen. On examination, the doctor found tenderness
and guarding of the abdominal wall, distended abdomen and absent bowel sounds. An emergency X-ray
abdomen was taken which demonstrated free gas under the right dome of the diaphragm The X-ray and
blood reports confirmed the diagnosis of acute peritonitis secondary to perforation of the organ.

Questions
1. Define peritoneum.
2. Write functions of the peritoneum.
3. What do you understand by peritonitis? Write its anatomical basis.
4. Parietal peritoneum is sensitive to pain, but the visceral peritoneum is insensitive. Write its
embryological basis.
5. Peritoneum is a site of choice for dialysis. Explain its anatomical basis.
6. Explain the anatomical basis of cardboard rigidity (guarding) and rebound tenderness.
7. Write the anatomical basis of X-ray findings in this case?
8. Which are the most dependents parts of peritoneal cavity?
9. In which peritoneal space fluid will be collected in case of perforation of posterior wall of stomach
10. Classify abdominal organs in view of relation to the peritoneum.
 CASE 2
80-year-old male patient, a known case of chronic constipation, presents with dragging pain in his right
groin region. Physical examination revealed small globular swelling in his right groin above the right
pubic tubercle which expands on coughing. A diagnosis of inguinal hernia was made.

Questions
1. What is the inguinal canal? Mention its functional and clinical significance.
2. Define hernia. What are the parts of a hernia?
3. Enlist Various types abdominal hernia.
4. What do you understand by an inguinal hernia?
5. Explain the anatomical basis of inguinal hernia.
6. What are the types of inguinal hernia? Enlist the difference between them
7. Explain the mechanisms which prevent inguinal hernia.
8. What do you know about the inguinal triangle? Write its clinical importance.
9. What are the common complications of the hernia?
10. How will you differentiate inguinal from femoral hernia

CASE 3
A male child was delivered by the caesarean section in the maternity ward. The pediatric doctor was
examining the newborn. During the physical examination, he found the right side of the scrotum empty.
Then he started palpating the surrounding area. He found a small swelling in the inguinal region on the
same side.

Questions
1. Identify the clinical condition.
2. What do you understand by the descent of testis? Name the factors responsible for it.
3. What is the normal schedule of testicular descent?
4. Name the factors interfering with the descent of the testis.
5. What are the common complications of this condition?
6. What is the difference between undescended and ectopic testis? Name the sites occupied by both of
them
7. Name the coverings and constituents of the spermatic cord
8. Name the coverings of Testis.
9. Enlist the congenital anomalies of the testis.
10. Differential diagnosis of various swellings in upper part of thigh and inguinal region of thigh.
 CASE 4
A middle-aged man, chronic alcoholic, visits a general physician with complaints of pain in the
abdomen, yellowish discolouration of skin and eyeball, and repeated episodes of vomiting of blood for 2
weeks. Before palpating the right hypochondriac region of the abdomen, the doctor asks him to inhale
deeply. After that, he starts palpating the right iliac fossa and the palpation ends in the left
hypochondriac region. He was diagnosed with liver cirrhosis with hepatomegaly and splenomegaly.

Questions
1. Define the terms: Hepatomegaly and Splenomegaly.
2. The doctor asks the patient to inhale deeply during the examination. Why?
3. What do you understand by liver cirrhosis?
4. Explain the anatomical basis of the yellowish discolouration of skin and sclera.
5. Mention the blood supply of the liver.
6. How the portal vein is formed? What are the peculiarities of the portal vein
7 Name the tributaries of the portal vein.
8. Name the sites of Portocaval anastomosis.
9. What is the functional importance and clinical significance of Portocaval Anastomosis.
10. Give other examples of portal circulation with details.

CASE 5
25-year-old male, came to the hospital with history of acute pain around the umbilicus, fever and
vomiting a day before and now pain moved into the region of the right iliac fossa. On physical
examination, the surgeon found the area of maximum tenderness at Mc Burney's point. The psoas test
was positive. He was diagnosed with a case of acute appendicitis.

Questions
1. Mention the functional importance of the appendix.
2. Explain the anatomical basis of acute appendicitis.
3. The patient experiences initially dull pain in the umbilical region, as it shifts to the right iliac fossa, it
becomes more severe and precise. Why?
4. What is Mc Burney's point? Write its clinical significance.
5. Enlist the various positions of the appendix.
6. What do you understand by the psoas test?
7. How will you confirm the pelvic position of the appendix on physical examination?
8. Gangrene of an inflamed appendix is common. Why?
9. What are the likely complications of appendicitis?
10. What is the reliable anatomical structure which helps in localizing the appendix during
appendicectomy?
11. Name the nerve commonly affected during appendicectomy.
 Case. 1
A 56-year-old woman, complained that for the past 3 months, she had frequently passed blood-stained
stools, and recently she noticed that one rounded mass protrudes out from her anus during straining at
stool. After defaecation, she can push it back inside the anus. She had a family history of piles. The
proctoscopic examination revealed three pink-coloured swellings located at 3, 7 and 11 o'clock
positions in the lithotomy position. A diagnosis of an 'internal haemorrhoid (piles)' was made.

Questions
1. What do you understand by haemorrhoids?
2. Explain the anatomical basis of piles.
3. What do you mean by primary and secondary internal haemorrhoids?
4. Which are the types of internal haemorrhoids according to degree of prolapse?
5. Describe the venous drainage of Anal Canal.
6. How do internal piles differ from external piles?
7. Define the pectinate line. Write its clinical importance.
8. Sometimes pregnant lady presents with haemorrhoids in the third trimester of pregnancy. Explain.
9. What is Proctoscopic Examination? Which are the structures seen through Proctoscope?
10. Mention the various sites of Portosystemic Anastomosis with their clinical importance

Case. 2
A 32-year-old man, presented to the emergency department and complained of chills with fever and
severe abdominal pain. Before coming to the hospital, he had passed red colour urine. The patient
described the pain as colicky and started in his back region and radiated towards the inner side of the
right thigh. The CT scan demonstrated a stone at the vesico-ureteral junction.

Questions
1. What is Ureteric colic?
2. Explain the anatomical basis of pain radiating from the back to the thigh.
3. What are the constrictions of the ureter? State their clinical importance.
4. What do you understand by the KUB film?
5. How will you localize a ureteric stone on the plain radiograph of the abdomen?
6. What is Pyelography? Describe its types.
7. How does the presentation of bladder stone differ from ureteric stone?
8. What is Hydronephrosis?
9. What is the renal angle? What is its clinical importance?
10. Mention important surgical relations in male and female.
 Case. 3
A 72-year-old man, presented with difficulty in passing urine, a weak stream (flow), increased frequency
of urination and a feeling of incomplete bladder emptying. Per rectal examination confirmed a smooth,
rubbery and non-nodular prostate swelling.

Questions
1. Identify the clinical condition. Write its anatomical basis.
2. Explain the anatomical basis of urinary obstruction in this case.
3. What is post-prostatic pouch of stagnant urine?
4. How will you treat this condition surgically?
5. What precautions will you take while removing the prostate from the body?
6. What is the most common complication of prostatectomy?
7. Name the lobes of the prostate. Write their clinical significance.
8. Hypertrophy of the prostate gland is common in old age. Justify the statement.
9. What will be the clinical presentation of a patient with prostatic carcinoma?
10. Mention the functions of the prostate

Case-4
A 60-year-old multiparous female, attended obstetrics and gynaecology OPD with complaints of leakage
of urine and feeling of heaviness in her perineal region. On asking, she informed that 'something coming
down into the vagina'. On Per vaginal examination, the gynaecologist found the descent of the cervix
into the vagina with the bladder. She was diagnosed as a case of uterine prolapse.

Questions
1. Mention the functional importance of the uterus.
2. What do you understand by uterine prolapse?
3. Explain the anatomical basis of the clinical condition.
4. What is the normal position of the uterus?
5. Explain the anatomical basis of the retroverted uterus.
6. Classify the supports of the uterus. Describe muscular and visceral supports.
7. Describe the Fibro-muscular and secondary supports of uterus.
8. Enlist the contents of the broad ligament of the uterus.
9. Which structures are palpable during per vaginal examination?
10. What is prolapse of vagina, cystocele, rectocele?
 CASE - 1
A 24 year male attended surgery OPD and complained of swelling around his left eye. He had history of
trauma. The doctor examined his left eye; he found the eye normal. There was slight tenderness,
oedema around the eye and blackish discolouration of the skin. The doctor made a diagnosis of black
eye.

Questions:
1. Explain the anatomical basis of black eye.
2. Describe the layers of scalp in detail.
3. Describe the blood supply and nerve supply of scalp.
4. Explain the anatomical basis of why scalp wound bleed profusely.
5. Swellings of the second layer of the scalp are small in size but painful. Explain the reason.
6. Deep wounds of the scalp tend to gape. Explain the anatomical basis.
7. Which layer of scalp is known as the dangerous layer of the scalp and Why?
8. Explain the anatomical basis of generalized and painless swelling of the fourth layer of the scalp.
9. Explain the anatomical basis of 4th layer of scalp as safety valve haematoma.
10. Explain the terms: caput succedaneum and cephalohematoma

CASE - 2
A 3 year old male baby was brought by his parents to orthopaedic OPD. The child had a tilted posture
with the right ear near the right shoulder and chin turned upward and to the left. The parents told the
doctor about his difficult birth process.

Questions:
1. What is the most probable diagnosis?
2. Which anatomical structure is likely to be injured in this condition?
3. Explain the nerve supply of affected structure.
4. Explain the anatomical basis of the condition.
5. What are the types of the above conditions?
6. Describe the action of affected structure.
7. How will you test the involved structure?
8. Enumerate the triangles of the neck and their contents related to the affected structure.
9. Which are the important relations of the affected structure?
10. What is the nerve point of the posterior triangle of neck?
 CASE - 3
A 41 year old patient presented with inability to close his mouth since 2 days. He was a known case of
hypertension. His physical examination revealed facial asymmetry, dribbling of saliva and loss of
nasolabial furrow on the right side of the face. On asking him to raise his eyebrows, the doctor could
see wrinkles on his forehead.

Questions:
1. What is the most probable diagnosis?
2. Explain the anatomical basis of presenting features and fibres of which side are involved in this
case?
3. What is the anatomical basis of the presence of wrinkles on his forehead?
4. Describe the origin & course of facial nerve.
5. Enumerate the functional components of the facial nerve with their nuclei.
6. Enumerate the branches of the facial nerve. Name the structures supplied by them with their
functions.
7. How will you test the facial nerve clinically?
8. What is Bell's phenomenon?
9. Which are the types of facial palsy and how do they differ from each other?
10. What is crocodile tear syndrome?
11. Which gland is related to the facial nerve? Describe its clinical significance in detail.
12. Describe the sensory nerve supply of face.
13. Describe the peculiarities of facial muscles.

CASE - 4
A 30 year old male brought to the emergency department by his friends with history of trauma. On
examination, the doctor noticed no major injury over the body except the bleeding wound on the right
side of the neck superficial to the sternocleidomastoid muscle.

Questions:
1. Which vessel is likely to be injured in this condition resulting into bleeding?
2. Mention the branches / tributaries and the termination of affected vessel.
3. Enumerate the veins present in the superficial fascia of the neck.
4. What is the most common complication of this injury? How will you prevent it?
5. Explain anatomical reason of continuous bleeding in this case.
6. Name the important veins located in the neck region with their clinical significance.
7. Name the layers of deep cervical fascia.
8. Name the structures enclosed by investing layer of the deep cervical fascia.
9. Mention the clinical importance of the investing layer of deep cervical fascia.
10. Mention the clinical importance of the pretracheal layer of deep cervical fascia.
11. Mention the clinical importance of the prevertebral layer of deep cervical fascia
12. Mention the clinical importance of the spaces of the neck.
 CASE 1
Miss Zoya, a 21-year-old young girl residing in the hilly area, visited her family physician with complaints
of swelling in the neck, a feeling of tightness in the throat area, increased sensitivity to heat and
hoarseness of voice. On examination, swellings moved up and down during swallowing. She was
diagnosed as a case of simple goitre.

Questions
1. What are the normal dimensions of the thyroid gland?
2. What is the extent of the thyroid gland?
3. Define goitre.
4. Name the physiological conditions in which the thyroid gland is enlarged.
5. Explain the anatomical basis of pressure symptoms produced by goitre.
6. Name the coverings of the gland. Write their clinical significance.
7. Thyroid swellings can grow backward and downwards but not upwards. Why?
8. Why do thyroid swellings move up and down during swallowing?
9. Write the blood supply of the thyroid gland.
10. What precautions one should take during thyroidectomy?
11. How does the thyroid gland develop?

CASE- 2
Chirag, a 12-year-old boy, was brought to the ENT hospital by his parents with chief complaints of high-
grade fever, sore throat and difficulty in swallowing for 3 days. He also reported pain in his ears. On
examination of the oral cavity, the surgeon found that both tonsils were enlarged. The doctor also
palpated lymph nodes in the neck region which were enlarged.

Questions
1. Identify the clinical condition.
2. Mention the functional importance of the palatine tonsil.
3. Mention the relations of palatine tonsil. Write clinical significance. (Name the structures forming
the tonsillar bed.)
4. Name the arteries supplying palatine tonsil.
5. Which lymph node is called the lymph node of the tonsil?
6. What is the cause of earache?
7. Explain the anatomical basis of loss of taste sensation in the tongue after
tonsillectomy.
8. Formation of a blood clot is prevented after tonsillectomy. Explain the
reason.
9. What do you know about quinsy?
10. How does the palatine tonsil develop?
 Case- 3
Mr. Satish, an elderly man, a teacher by profession visits an ENT surgeon with complaints of a change in
voice quality past 2 months. A laryngoscopic examination of the patient reveals the presence of pinhead
size reddish bilateral nodules on the vocal cord. Based on physical examination and illness history, the
surgeon makes a diagnosis of the singer's (vocal) nodules.

Questions
1. What do you know about the cavity of the larynx?
2. Explain the anatomical basis of the singer's nodule.
3. Enlist the difference between vocal and vestibular folds.
4. What is rima glottidis?
5. Mucous membrane covering the vocal cord is devoid of mucosal glands and
sub-mucosa. Why?
6. What is the saccule of the larynx? Write its functional and clinical importance.
7. Explain the clinical significance of the lymphatic drainage of the larynx.
8. What do you know about laryngoscopy? Write its clinical importance.
9. Males usually have low-pitched but louder voices than females. Justify it.
10. In neonates, breathing and suckling occur at the same time. Explain its
anatomical basis.

Case- 4
A 25 years old female visited his physician with complaint of very painful swelling on the face in
retromandibular region on the left side. On examination, the doctor found that there is weakness in
facial muscles and left ear lobule was lifted by the swelling.

Questions
1. Which structure is affected?
2. Why was the swelling painful?
3. Name the important structures passing through the affected structure?
4. Why there was weakness of facial muscles?
5. How is the abscess drained from affected structure?
6. Why pain of affected structure increases during eating but in relieved after the meal?
7. Write secretomotor nerve supply of the affected structure.
8. What is Frey’s syndrome?
9. What is sialography?
10. Which viral infection has special affinity for the affected structure?
 Case- 5
A 10 years old boy is admitted to the hospital for severe pain in the eye and forehead area. Physical
examination revealed marked oedema of the eyelids, cornea and root of the nose and weakness in
movements of ipsilateral eyeball. The doctor also noticed that the boy suffers from severe acne
involving in the area between the upper lip, and nose and on adjoining part of cheek. Radiographic
examination revealed thrombosis of cavernous sinus.

Questions
1. What is the most likely cause of cavernous sinus thrombosis in this case?
2. What is dangerous area of face?
3. What is possible route of the spread of infection from face to cavernous sinus?
4. What are nervous symptoms of cavernous sinus thrombosis?
5. How thrombosis of one cavernous sinus may pass to opposite side?
6. Which nerves lie in relation to the cavernous sinus?
7. Infection from mastoid air cells may spread to which sinus?
8. Enumerate dural venous sinuses.
9. Describe Tributaries & communications of cavernous sinus.
10. What is emissary vein & its importance.

CASE 1:
A 61 years old man was admitted to the emergency department with complaints sudden onset of
headache, giddiness and slurred speech. Physical examination revealed loss of pain sensations on the
left side of body and right side of face. Patient also had difficulty in standing in upright position. There
was drooping of right upper eyelid and constriction of right pupil. MRI showed infarction of wedged-
shaped area on the dorsolateral aspect of medulla oblongata on right side.

Questions
1. What is this condition called?
2. Which artery is involved in this condition?
3. Explain anatomical basis of giddiness.
4. Explain anatomical basis of slurred speech
5. Explain anatomical basis of loss of pain sensation.
6. Why the patient had difficulty in standing upright position?
7. Explain anatomical basis of drooping of eyelid and constriction of pupil.
8. Name the cranial nerves attached to medulla oblongata.
9. Name the cranial nerve nuclei in the medulla oblongata with their functional components and
structures supplied by it.
10. Explain the arterial supply of medulla oblongata.
 Case 2:
A 60 years old man was admitted to the hospital for vertigo, vomiting and then unconsciousness. MRI of
the brain revealed infarction of right cerebellar hemispheric region. When the patient regained
consciousness and became aware to time and place. Physical examination was done. Patient exhibited
difficulty in touching his nose with finger, intentional tremors, adiadochokinesis, dysarthria, and
hypotonia and rebound phenomenon on right side.

Questions
1. Which cerebellar syndrome is seen in this condition?
2. Why the symptoms were present on right side?
3. Why patient had difficulty in touching his nose with finger?
4. What is intentional tremor?
5. What is adiadochokinesis?
6. What is dysarthria?
7. What is rebound phenomenon?
8. What are the functions of cerebellum?
9. What are the morphological subdivisions of cerebellum? Write their functions.
10. Name the various nuclei of the cerebellum with their connections.

Case 3:
68 years old was admitted to the hospital with complaints of sudden development of paralysis on left
side of body. His blood pressure was 210/120 mm HG. MRI of the brain revealed intracerebral
haemorrhage involving posterior limb of the internal capsule on right side.

Questions
1. Describe parts of internal capsule.
2. Explain the anatomical basis of symptoms on left side of body.
3. Describe blood supply of internal capsule.
4. Which artery is commonly involved in haemorrhage involving posterior limb of internal capsule?
5. What is cerebro vascular stroke?
6. Why a small lesion of internal capsule produces widespread effect?
7. Which type of paralysis will occur in the given condition (UMN/LMN)? Which are the differences
between these two types of paralysis?
8. Name the various fibers passing through the internal capsule.
9. Write different types of white fibers of cerebrum with example.
10. What is Babinski’s sign? Why this sign is present up to 2 years of life?
 Case 4:
A 58 years old male found that his hands have started shaking uncontrollably over the past few days.
His relatives found his face non-expressive. He was taken to the doctor and after examination he was
diagnosed with Parkinsonism.

Questions
1. What is the cause of Parkinsonism?
2. What are the signs and symptoms of Parkinsonism?
3. Where the Dopamine is synthesized? What is the action of Dopamine?
4. What is the treatment of Parkinsonism?
5. Which are the components of basal nuclei?
6. Which are the functions of basal nuclei?
7. Which are the afferent & efferent connections of corpus striatum?
8. Which are the Huntington’s chorea & Sydenham’s chorea?
9. What are Athetosis and ballismus?
10. What are the differences in the lesion of basal nuclei and cerebellum?

Case 5:
A 4 months old infant was brought to the doctor for abnormal large size of his head. Physical
examination revealed differently looking eyes and large and tense anterior fontanelle.

Questions
1. What is the probable diagnosis?
2. What are the causes of given condition?
3. What are the types of this condition?
4. Explain CSF circulation.
5. Enumerate other clinical features of given condition.
6. Define CSF rhinorrhea & CSF otorrhea.
7. Enumerate the structures forming the blood –CSF barrier.
8. What are the functions of CSF?
9. What is Lumbar puncture? Which is preferred site for it?
10. Enumerate the structures pierced by lumbar puncture needle in lumbar puncture.
11. What is cistern? Enumerate different cisterns.