امتحان الدور التانى لعام 2013

1. Tanta University Second Year Final Anatomy Exam. (Egyptians)
Faculty of Medicine Number of Questions: 6
Anatomy Department Time Allowed: 3 Hours
30/9/2013 Total: 125 Marks
( ‫أغسطس‬ ‫دور‬ ‫الثانية‬ ‫الفرقة‬ ‫امتحان‬ ‫عن‬ ‫المتخلفين‬ ‫للطالب‬2013 )
Very Important: each part of question must be written in a separate page

 QUESTION (1) (Head)…………………………………….(22 MARKS):
A- Enumerate the nerve supply and relations of buccinator muscle (diagram not needed)…….…(5 marks)
B- Draw a diagram showing the branches of the maxillary artery……………………………………..(5 marks)
C- Mention the attachments and borders of falx cerebri and enumerate the venous sinuses enclosed in it
(diagram not needed)…………………………………………………………...............................................(5 marks)
D- Enumerate the nerves supplying the extraocular muscles (diagram not needed)……................(4 marks)
E- Problem solving (3 marks):
A 10 years old boy suffered from a painful swelling anterior to the lobule of the ear and diagnosed as
inflammation of the parotid gland.
1- Why is the case painful?................................………………………………………………………………..(1mark)
2- Mention the site of opening of the parotid duct………………….……………………………………….(1 mark)
3- Mention the arterial supply and venous drainage of parotid gland……………………………………(1 mark)
__________________________________________________________________________________
 QUESTION (2) (Neck& Cavities)………..………………(21 MARKS):
A- Discuss the cutaneous nerves of anterolateral aspect of the neck (diagram needed)...............(5 marks)
B- Mention origin, insertion, nerve supplyand action of mylohyoid muscle (diagram needed).....(4 marks)
C- Enumerate the structures between external and internal carotid arteries (diagram not needed).Mention
the surface anatomy of the internal carotid artery.........…………………………………………………..(5 marks)
D- Discuss the blood supply and lymphatic drainage of palatine tonsil (diagram not needed)......(4 marks)
E- Problem solving (3 marks):
A 40 years old man suffered from thyroid tumour and a subtotal thyroidectomy (removal of thyroid
gland) was performed to him. After the operation the patient suffered from weak voice (hoarseness)
1- Which is the nerve liable to be injured? Is the injury unilateral or bilateral? Explain...................(2 marks)
2- Enumerate the arteries supplying of the thyroid gland…………………………………………………(1 mark)
__________________________________________________________________________________

 QUESTION (3) (Neuroanatomy)………………………(22 MARKS):
A- Write a short note about origin, end and function of tectospinal and rubrospinal tracts (diagram not
needed)………………………………………………………………………………........................................ (6 marks)
B- Draw a diagram showing the anterior surface of the brain stem………………………………….. (5 marks)
C- Enumerate the structures forming anterior and posterior walls of the third ventricle (diagram needed)
………………………………………………………………………………………………………………………(5 marks)
D- Discuss the long association fibres (diagram needed)………………………………………………(6 marks)
1

2. 
 QUESTION (4) (Lower limb)…………..………………(22 MARKS):
A- Enumerate the boundaries and contents of the femoral triangle (diagram needed)……………..(5 marks)
B- Enumerate the branches of sciatic nerve (diagram not needed) Mention its surface
anatomy…………………………………………………………………………………………………………...(5 marks)
C- Discuss origin, insertion, nerve supply and action of tibialis anterior muscle (diagram not needed)
………………………………………………………………………………………………………………………(4 marks)
D- Discuss the branches of the planter arch (diagram needed). ………………………………….........(5 marks)
E- Problem solving (3 marks):
During a football game, a football player fell on the ground with severe pain in his left knee joint after
making a sudden rotatory movement.
1- What is the most affected structure and why? …………………………….…………………………….(1 mark)
2- Define unlocking of the knee joint………………………………………………………..………...............(1 mark)
3- Which muscle produces unlocking of knee joint………………………………….……………………..(1 mark)
a- Gastrocnemius b- Plantaris c- Popletius
__________________________________________________________________________________

 QUESTION (5) (Special Embryology)..……………..(13 MARKS):
A- Enumerate the derivatives of mesonephros in male and female……………………………………(4 marks)
B- Mention the embryological components of the two atria……………….……………………….........(4 marks)
C- Enumerate the congenital anomalies of the rectum and anal canal…………………………………(5marks)
__________________________________________________________________________________

 QUESTION (6): MCQ……………………………………(25 MARKS):
(25) Questions. Mark only the letter of chosen answer in the MCQ page of the answer paper
Oral and Practical Examination:
Tuesday 1/10/2013: At 8.5 o'clock oral examination
At 10 o'clock practical examination
With My Best Wishes
Chairman of Department: Prof. Dr. Mona Zoair
2

3. QUESTION (6) MULTIPLE CHOICE QUESTIONS (25 MARKS)
 Mark only the letter of the chosen answer (A or B or C or D) of
25 questions in the MCQ page at the end of the answer paper.
Choose the correct answer:
1- The motor nerve supply of the scalp behind the auricle is :
A) Posterior auricular branch of facial nerve B) Lesser occipital nerve
C) Great auricular nerve D) Greater occipital nerve
2- The central part of the face drains into the following lymph nodes:
A) Buccal lymph nodes B) Submandibular lymph nodes
C) Preauricular (parotid) lymph nodes D) Submental lymph nodes.
3- The sensory nerve supplyto the parenchyma of the parotid gland is by the following nerve:
A) Great auricular nerve B) Auriculotemporal nerve
C) Greater occipital nerve D) Zygomaticotemporal nerve
4- The following artery passes upwards through the foramen ovale:
A) Deep auricular artery B) Anterior tympanic artery
C) Accessory meningeal artery D) Middle meningeal artery
5- The following nerve pierces the dura at the point of crossing of free margin over attached margin of
tentorium cerebelli:
A) Occulomotor nerve B) Trochlear nerve
C) Abducent nerve D) Ophthalmic nerve
6- The following extra-ocular muscle is supplied by abducent nerve:
A) Superior rectus muscle B) Superior oblique muscle
C) Inferior rectus muscle D) Lateral rectus muscle
7- One of the following muscles does not share in the floor of carotid triangle:
A) Superior constrictor muscle B) Hyoglossus muscle
C) Middle constrictor muscle D) Thyrohyoid muscle
8- The following structure lies deep to the anterior belly of digastric muscle:
A) Parotid gland B) Submandibular salivary gland
C) Mylohyoid muscle D) Hyoglossus muscle
9- The following muscle is supplied by ansa cervicalis:
A) Sternohyoid B) Geniohyoid
C) Genioglossus D) Thyrohyoid
10- Posterior inferior quadrant of lateral nasal wall is supplied by the following artery:
A) Posterior ethmoidal artery B) Facial artery
C) Sphenopalatine artery D) Greater palatine artery
11- Vagus nerve leaves the skull through the following foramen:
A) Jugular foramen B) Anterior condylar canal
C) Stylomastoid foramen D) Carotid canal
12- The nerve supplyof the larynx below the level of vocal cords is by:
A) Superior laryngeal nerve B) Internal laryngeal nerve
C) Recurrent laryngeal nerve D) External laryngeal nerve
13- The roof of mastoid antrum is formed by :
A) Tegmen tympani B) Tympanic cavity
C) Posterior semicircular canal D) Suprameatal triangle of skull
3

4. 14- The origin of corticospinal tract is:
A) Motor area B) Red nucleus in the midbrain
C) Superior colliculus of the opposite side D) Lateral vestibular nucleus
15- The middle 3/5 of the crus cerebri of the midbrain is formed by the following nerve fibres:
A) Cortico-spinal & cortico- bulbar fibres B) Fronto-pontine fibres
C) Tempro-pontine fibres D) Parieto-pontine fibres
16- The inferior surface of posterior end of the thalamus is related to:
A) Caudate nucleus B) Posterior limb of the internal capsule
C) Medial and lateral geniculate bodies D) 3rd
ventricle
17- The lateral wall of inferior horn of lateral ventricle is formed by:
A) Septum pellucidum B) Tapetum of corpus callosum
C) Rostrum of corpus callosum D) Head of cudate nucleus
18- The lower part of the roof of fourth ventricle is formed by:
A) Superior medullary velum B) White core of cerebellum
C) Inferior medullary velum D) Tela choroidea of 4th
ventricle
19- The following artery is not a branch of the basilar artery:
A) Superior cerebellar artery B) Posterior cerebral artery
C) Posterior inferior cerebellar artery D) Anterior inferior cerebellar artery
20- The most lateral muscle of the floor of femoral triangle is:
A) Pectineus muscle B) Adductor longus muscle
C) Psoas major muscle D) Iliacus muscle
21- Long head of biceps femoris muscle arises from:
A) Upper lateral part of upper area of ischial tuberosity
B) Lower medial part of upper area of ischial tuberosity
C) Lateral part of lower area of ischial tuberosity
D) Medial part of lower area of ischial tuberosity
22- The skin of the medial side of the dorsum of the foot is supplied by:
A) Sural nerve B) Saphenous nerve
C) Superficial peroneal nerve D) Anterior tibial nerve
23- The medial planter nerve supplies the following muscle:
A) Second lumbrical B) Flexor digitorum brevis
C) Abductor digiti minimi brevis D) Flexor Digitorum Accessorius
24- The action of peroneus brevis muscle is:
A) Dorsiflexion and inversion B) Planter flexion and inversion
C) Dorsilexion and eversion D) Planter flexion and eversion
25- The abduction of the hip joint is done by the following muscle:
A) Iliopsoas B) Gluteus medius
C) Sartorius D) Gluteus maximus
END OF THE EXAM
4

5. Answer Key For MCQ Questions
/2013)9/30-(Egyptian Anatomy Exam
1- A)
2- D)
3- B)
4- C)
5- B)
6- D)
7- A)
8- C)
9- A)
10- D)
11- A)
12- C)
13- A)
14- A)
15- A)
16- C)
17- B)
18- C)
19- C)
20- D)
21- B)
22- B)
23- B)
24- D)
25- B)
10

6. ANATOMY DEPARTMENT:
MODEL ANSWER OF SECOND YEAR
FINAL ANATOMY EXAMINATION (Egyptians) 30/9/2013
 QUESTION (1) (HEAD)………(22 MARKS):
1-A- The nerve supply and relations of buccinator muscle (diagram not needed).
(5 marks)
Nerve supply: Buccal branch of the facial nerve.
Relations:
* The muscle is covered by:
- Buccal pad of fat.
- Buccopharyngeal fascia.
- Buccal lymph nodes (1-2) on the bucco-pharyngeal fascia
- Buccal salivary glands (4-5) small which lie on the buccopharyngeal fascia around the parotid duct
.
* The muscle is crossed by:
- Parotid duct
- Buccal branches of the facial nerve.
- Facial artery and vein
* The muscle is pierced by:
- The parotid duct which opens in the vestibule of mouth
* The origin of the muscle from the pterygomandibular raphe,
is in line with that of the superior constrictor muscle.
______________________________________________________________________________
1- B- A diagram showing the branches of the maxillary artery(5 marks)
1

7. 1- C- The attachments and borders of falx cerebri and the venous sinuses
enclosed in it (diagram not needed) (5 marks)
Attachment and borders:
 Its anterior narrow margin (apex) is attached to the crista galli of the ethmoid bone
 Its posterior broad margin is attached to the upper surface of the tentorium cerebelli in the midline .
Its upper convex margin is attached to the inner surface of the skull from the foramen caecum to the
internal occipital protuberance.
 Its lower concave border is free
Venous sinuses enclosed:
1- The superior border encloses the superior sagittal sinus
2- The inferior border encloses the inferior sagittal sinus
3- Between posterior margin and upper surface of tentorium cerebella lies the straight sinus
__________________________________________________________________________________
1- D- The course of abducent nerve in the cranial cavity and orbit(diagram not
needed).(4 marks)
In the cranial cavity:
 It pierces the dura at the clivus midway between the foramen magnum and posterior clinoid process
 It crosses the apex of the petrous bone .
 Then, it passes in the floor of the cavernous sinus below and lateral to the internal carotid artery
 Finally it enters the superior orbital fissure to reach the orbit
In the orbit:
 It enters the orbit through the superior orbital fissure inside the common tendinous ring.
 It passes between the two heads of the lateral rectus and supplies it only through its deep surface.
__________________________________________________________________________________
1- E- Problem solving(3 marks):
1- The case is painful because the gland swells within its tight fibrous capsule.(1 mark)
2- The site of opening of the parotid duct (1 mark) It opens in the vestibule of the mouth upon a
small papilla opposite the 2nd upper molar tooth.
3- arterial supply and venous drainage of parotid gland(1 mark):
- Arterial by branches from external carotid artery
- Venous drainage into external jugular vein
__________________________________________________________________________________
2

8.  QUESTION (2) (Neck& Cavities)………..………………(21 MARKS):
2- A- The cutaneous nerves of anterolateral aspect of the neck (diagram
needed)(5 marks)
 Lesser occipital ( C2 ) :
-Ascends along the posterior border of the sternomastoid .
-Supplies the skin over :
- Upper 2/3 of the medial surface of the auricle
- Lateral part of the occipital region the scalp.
 Great auricular ( C 2 & 3 ) :
- Ascends obliquely across the sternomastoid muscle
- Supplies the skin over :
- Angle of the mandible and parotid gland
- Lower 1/3 of both sides of the auricle
 Transverse cervical ( C2 & 3 ) :
 - Passes transversely forwards across the middle of the sternomastoid muscle
 - Supplies the skin over the front of the neck.
 Supraclavicular ( C3 & 4 ) :
- These are 3 branches, medial, intermediate and lateral
 -They descend in front of the clavicle to the anterior thoracic wall
- Supplies the skin over:
- Shoulder region
- Anterior thoracic wall down to the level of the 2nd rib.
- ________________________________________________________________________________
2- B- Origin, insertion, nerve supply and action of mylohyoid muscle (diagram
needed).(4 marks)
 Origin:
Mylohyoid line on the inner surface of the mandible.
The fibres run downwards and medially
 Insertion:
Posterior fibres are inserted into the body of the hyoid.
The rest of fibres are inserted into the median raphe
 Nerve supply:
- Nerve to mylohyoid.
 Action:
Elevates the hyoid or depresses the mandible.
3

9. 2- C-The structures between external and internal carotid arteries (diagram not
needed).And the surface anatomy of the internal carotid artery (4 marks)
Structures between ECA& ICA:
- Styloid process.
- Styloglossus.
- Stylopharyngeus.
- Glossopharyngeal nerve.
- Pharyngeal branch of vagus.
- A part of the parotid gland
Surface anatomy of ICA
- It is drawn as a broad line by joining the following 2 points:
1- A point on the anterior border of the sternomastoid at the level of upper border of thyroid cartilage.
2- A point on the posterior border of the condyle of the mandible.
________________________________________________________________________________
2- D- The blood supply and lymphatic drainage of the palatine tonsil(diagram not
need).(5 marks)
 Blood supply of the tonsil:
Arteries:
 To the upper pole
- Tonsillar branches of descending palatine artery .
 To the lower pole
- Tonsillar branch of the facial artery .
- Tonsillar branches of ascending palatine artery .
- Tonsillar branches of dorsal lingual artery .
Veins:
- Pharyngeal plexus of veins receives most of the veins specially the paratonsillar vein which crosses the
upper part of the tonsil.
- Some veins drain into the lingual vein
 Lymphatic drainage of the tonsil:
The lymphatics drain into :
 -The deep cervical lymph nodes (jugulo-digastric nodes) which lie behind the angle of the mandible.
- Submandibular lymph nodes.
- Superficial cervical lymph nodes.
_______________________________________________________________________________
2- E- Problem solving(3 marks):
1- The nerve which is liable to be injured is the recurrent laryngeal nerve. The injury is unilateral
because phonation is possible but the voice is weak (hoarseness) but if the injury is bilateral this results
in dyspnea, stridor and loss of voice. ................................................................................(2 marks)
2- The arteries supplying of the thyroid gland (1 mark):
- Superior thyroid artery
- Inferior thyroid artery
- Thyroida ima artery
4

10. 
 QUESTION (3) (Neuroanatomy)………………………(22 MARKS):
3 A- A short note about origin, end and function of tectospinal and rubrospinal
tracts (diagram not needed)(6 marks)
Tecto spinal tract
origin: Superior colliculus of the opposite side
site: Deeply in the ventral column of the spinal cord
course: It passes from its origin downwards and medially to decussate with its
fellow and then descends into the ventral column to its end
end: Into the spinal motor nuclei of the cervical segments of opposite side an also to some cranial
motor nuclei of opposite side which are related to visual reflex. This is the tectobullar tract.
function: It moves the head towards the side of stimulation during spinovisual reflex (see the function
of the spinotectal tract)
Rubrospinal tract
origin: Red nucleus in the midbrain
site: Deeply in the lateral column just in front of the lateral corticospinal tract
course: It descends from the red nucleus where it soon decussates with its fellow. The crossed tract
travels down into the lateral column to reach its end
end: Motor nuclei of the spinal cord. In its way some fibers end into cranial motor nuclei and nuclei of
reticular formation in pons and medulla
function: It transmits impulses coming to the red nucleus from the cerebrum (frontal lobe) and the
cerebellum (dentate nucleus).
_______________________________________________________________________________
3- B- A diagram showing the anterior surface of the brain stem (6 marks)
5

11. 3- C- The structures forming anterior and posterior walls of the third ventricle
(diagram needed) (5 marks)
Anterior wall: Is formed by:
1. Lamina terminalis(a thin sheet of white matter).
2. Two columns of the fornix which lie behind the lamina terminalis.
3. Anterior commissure which a transverse cord-like band located between the lamina terminalis and the
2 columns of the fornix.
Posterior wall: A short wall formed by:
1. Stalk of the pineal body.
2. Habenular (pineal) commissure.
3. Posterior commissure
_______________________________________________________________________________
3- D- The long association fibres (diagram needed) (6 marks)
A-Uncinate fasciculus (Bundle):
- Connects the Broca's area and the gyri on the orbital surface of the frontal lobe with the cortex of the
temporal pole.
- The fibres hook across the stem of the lateral sulcus.
B-Cingulum Fasciculus:
- Is a C- shaped long curved bundle .
- It connects all parts of the medial surface of the hemisphere.
- It lies within the gyrus cinguli.
- It begins from below the rostrum of the corpus callosum and follow the curve of the gyrus cinguli to
the parahippocampal gyrus to end in the uncus.
C- Superior Longitudinal Fasciculus (Bundle):
- Is the largest of all fasciculi, connects all parts of the superolateral surface of the hemisphere together.
- It begins in the frontal pole and arches backwards above the insular area to the occipital cortex, then curves
downwards and forwards into the temporal lobe where it ends in the temporal lobe.
D- Inferior Longitudinal Fasciculus (Bundle):
- It lies near the inferior surface.
-It extends from the occipital pole posteriorly to the temporal pole anteriorly.
E- Prependicular Fasciculus:
- Connects the posterior parts of the parietal and occipital lobes.
6

12.  QUESTION (4) (Lower limb)…………..………………(22 MARKS):
4- A- The boundaries and contents of the femoral triangle (diagram needed
(5 marks)
Boundaries:
 Laterally: Medial border of sartorius muscle.
 Medially: Medial border of adductor longus muscle.
 Base: It is formed by the inguinal ligament extending between the anterior superior iliac spine & the
pubic tubercle
Contents of the femoral triangle:
 Femoral sheath
 Vessels:
- Femoral artery and its branches.
- Femoral vein and its tributaries.
 Nerves:
- Femoral nerve :
Lies in the groove between the iliacus & psoas major
- Femoral branch of genitofemoral nerve :
Along the antero-lateral aspect of femoral artery.
- Lateral cutaneous nerve of thigh :
- In the upper lateral angle.
 Deep group of inguinal lymph nodes
 A pad of fat collection
________________________________________________________________________________
4- B- The branches of sciatic nerve (diagram not needed). And its surface
anatomy.(5 marks)
Branches:
A. Muscular branches:
 From its medial popliteal part it gives branches to the following muscles :
- Long head of biceps.
- Semitendinosus.
- Semimembranosus.
- Ischial part of adductor magnus
 From its lateral popliteal part it gives a branch to the following muscle:
- Short head of biceps.
B. Articular branches: To the hip joint.
C. Terminal branches:
- Medial popliteal nerve (tibial nerve)
- Lateral popliteal nerve( common peroneal nerve)
Surface anatomy:
- It can be represented by a line joining the following 3 points:
1st: A point 1 inch lateral to the midpoint between the posterior superior iliac spine and ischial
tuberosity.
2nd: A point just medial to the midpoint between ischial tuberosity and greater trochanter.
3rd: A point on the middle line on the back of the thigh at the junction between its upper 2/3 and the
lower 1/3.
7

13. 4- C- Origin,insertion,nervesupply and action of tibialis anterior muscle (diagram
not needed) .(4 marks)
 Origin:
 Upper 1/2 of lateral surface of tibia.
 Adjoining part of the interosseous membrane.
 Insertion:
 The medial side of the medial cuneiform bone.
 Base of 1st metatarsal bone.
 Nerve Supply:
 Anterior tibial nerve.
 Action:
- Dorsiflexion of the foot ( at ankle joint ).
- Inversion of the foot ( at the subtalar joint )
- Helps to maintain the medial longitudinal arch of the Foot.
_______________________________________________________________________________
4- D- The branches of the planter arch (diagram needed)(5 marks)
 4 plantar metatarsal arteries
- They pass forward to the clefts between the toes.
- Each one gives rise to the following branches:
* 2 plantar digital arteries supplying the adjacent
sides of the toes.
* Anterior perforating arteries which pass upwards through the distal ends of
intemetatarsal spaces to join the dorsal metatarsal arteries.
- The 1st plantar metatarsal artery may arises from the dorsalis pedis artery in the sole.
 Posterior perforating arteries:
They pass upwards through the proximal ends of intermetatarsal spaces to join the dorsal
metatarsal arteries.
 Plantar digital artery for the lateral side of little toe.
______________________________________________________________________
4- E- Problem solving(3 marks):
1- The most affected structure is the medial meniscus of the knee joint because it is more fixed
and cannot adapt itself to sudden rotatory movement of the lower end of the femur over the tibia.
(1 mark)
2- Unlocking of the knee joint is lateral rotation of the femur on the tibia during initial stages of
flexion of the knee when feet are off the ground. .(1 mark)
3- c- Popletius muscle (1 mark)
8

14.  QUESTION (5) (Special Embryology)..……………..(13 MARKS):
5-A- The derivatives of mesonephros in male and female (4 marks)
Parts of
mesonephros
In male In female
Upper tubules Appendix of epididymis epoophoron
Middle tubules Vasa efferentia degenerate
Lower tubules
paradidymis paroophoron
Mesonephric duct 1-vas deferens, epididymis,
seminal vesicle,
ejaculatory duct,
2- Trigone of the urinary
bladder,
upper part of the posterior wall
of the prostatic urethra
3- Ureteric bud and its
derivatives
1-Trigone of the
urinary bladder
2-Ureteric bud
and its derivatives
3- Gartner's duct
__________________________________________________________________________________
5- B- The embryologicalcomponents of the two atria(4 marks)
-The right atrium develops from:
1-Rt. Half of primitive atrium (rough auricular part)
2- Rt. Horn of sinus venosus (posterior smooth part)
3- upper part of Rt. atrioventricular canal
-The left atrium develops from:
1-Lt. Half of primitive atrium (rough auricular part)
2-Absorbed pulmonary veins (posterior part)
3- upper part of Lt. atrioventricular canal
______________________________________________________________________
5- C- The congenitalanomaliesof the rectum and anal canal(5 marks)
Imperforate anus :
- The anal membrane fails to perforate.
Anal agenesis
- The anal canal ends as a blind sac below the puborectails muscle due to abnormal formation
of the urorectal septum.
 Anorectal agenesis
- The rectum ends as a blind sac above the puborectalis muscle due to abnormal formation of the
urorectal septum.
Rectal atresia
- Both the rectum and anal canal are present but remain unconnected due to abnormal
recanalization
 Agenesis & atresia is usually associated with abnormal communication between:
- rectum and bladder: Rectovesical fistula
- rectum & urethra: Rectouretheral fistula
- rectum & vagina: Rectovaginal fistula.
9