Clinical-Based Anatomy Questions (CBME Pattern)
Upper Limb
LAQ: A young man falls on his outstretched hand and sustains a fracture at the surgical neck of humerus.
Discuss the clinical anatomy, nerve injured, its course, branches and applied aspects.
Answer: Axillary nerve injury (C5–C6). Winds around surgical neck. Supplies deltoid and teres minor. Injury →
loss of abduction beyond 15°, shoulder flattening, sensory loss over regimental badge.
LAQ: A patient presents with inability to supinate forearm and weakness in flexion of elbow. Which nerve is
involved? Explain its course and applied anatomy.
Answer: Musculocutaneous nerve (C5–C7). Pierces coracobrachialis, supplies biceps and brachialis. Injury →
weak elbow flexion, loss of supination, sensory loss on lateral forearm.
SAQ: Winging of scapula—explain nerve involved and its course.
Answer: Long thoracic nerve (C5–C7). Runs on medial wall of axilla, supplies serratus anterior. Injury → winging
of scapula.
SAQ: Explain anatomical basis of Erb’s palsy.
Answer: Upper trunk lesion (C5–C6). Causes paralysis of deltoid, biceps, brachialis, supraspinatus. Limb hangs
medially rotated, pronated (waiter’s tip).
SAQ: Carpal tunnel syndrome—name nerve involved and clinical features.
Answer: Median nerve. Compression under flexor retinaculum. Symptoms → tingling, thenar wasting, loss of
thumb opposition.
BAQ: Claw hand is due to injury of?
Answer: Ulnar nerve.
BAQ: Foot drop of upper limb equivalent?
Answer: Wrist drop (radial nerve injury).
BAQ: Which artery accompanies radial nerve in arm?
Answer: Profunda brachii artery.
Lower Limb
LAQ: A football player sustains injury at the neck of fibula. Describe anatomical course, branches and
clinical features of common peroneal nerve injury.
Answer: Common peroneal nerve winds around fibular neck. Divides into superficial (eversion) and deep
(dorsiflexion) branches. Injury → foot drop, steppage gait, sensory loss over dorsum of foot.
LAQ: A patient develops weakness of knee extension following pelvic surgery. Which nerve is likely injured?
Discuss its course and functions.
Answer: Femoral nerve (L2–L4). Passes under inguinal ligament, supplies quadriceps. Injury → loss of knee
extension, absent knee jerk.
SAQ: Trendelenburg gait—explain nerve and muscle basis.
Answer: Superior gluteal nerve supplies gluteus medius and minimus. Weakness → pelvis drops on opposite side.
SAQ: Explain anatomical basis of sciatica.
Answer: Compression of sciatic nerve (L4–S3) → radiating pain down posterior thigh and leg.
SAQ: Posterior dislocation of hip—name structures endangered.
Answer: Sciatic nerve, inferior gluteal nerve and vessels.
BAQ: Nerve injured in anterior dislocation of hip?
Answer: Obturator nerve.
BAQ: Main blood supply to head of femur in adults?
Answer: Medial circumflex femoral artery.
BAQ: Cutaneous innervation of sole of foot?
Answer: Tibial nerve via medial and lateral plantar branches.
Thorax
LAQ: Explain anatomical basis of referred cardiac pain.
Answer: Pain fibers from heart travel with sympathetic nerves (T1–T4). Brain misinterprets as somatic pain → left
arm, chest.
LAQ: Describe anatomical basis and clinical importance of pericardiocentesis.
Answer: Done in left 5th or 6th intercostal space near sternum. Needle passes through chest wall → pericardial
sac. Avoids pleura and coronary arteries.
SAQ: A penetrating injury to the thoracic wall injures internal thoracic artery. Name its branches and applied
importance.
Answer: Gives anterior intercostal arteries, pericardiophrenic, musculophrenic. Used in CABG.
SAQ: Why is right main bronchus more prone to foreign body aspiration?
Answer: Wider, shorter, more vertical than left.
SAQ: Anatomical basis of cyanosis in Fallot’s tetralogy?
Answer: VSD, overriding aorta, pulmonary stenosis, RV hypertrophy → right-to-left shunt → cyanosis.
BAQ: Nerve supply of diaphragm?
Answer: Phrenic nerve (C3–C5).
BAQ: Thoracocentesis is done in which intercostal space?
Answer: 8th or 9th intercostal space, mid-axillary line.
BAQ: Which rib corresponds to oblique fissure of lung posteriorly?
Answer: 6th rib.
Abdomen & Pelvis
LAQ: Explain anatomical basis of obstructive jaundice in carcinoma head of pancreas.
Answer: Head of pancreas compresses common bile duct → obstruction → jaundice, clay-colored stools.
LAQ: Describe descent of testes and applied anatomy of undescended testis.
Answer: Testis develops in abdomen, descends via inguinal canal guided by gubernaculum. Arrest →
cryptorchidism → infertility, malignancy risk.
SAQ: Anatomical basis of indirect inguinal hernia.
Answer: Protrusion through deep inguinal ring, lateral to inferior epigastric vessels. Due to patent processus
vaginalis.
SAQ: What is Meckel’s diverticulum?
Answer: Remnant of vitellointestinal duct. 2 feet from ileocecal junction, 2 inches long, 2% population. May mimic
appendicitis.
SAQ: Explain portocaval anastomosis and its clinical importance.
Answer: Communication between portal and systemic veins (esophageal, rectal, paraumbilical). Dilatation →
varices, hemorrhoids, caput medusae.
BAQ: Ligament of Treitz is formed by?
Answer: Suspensory muscle of duodenum.
BAQ: Which structure forms median umbilical ligament?
Answer: Urachus remnant.
BAQ: Blood supply of appendix?
Answer: Appendicular artery (branch of ileocolic).
Head & Neck
LAQ: A patient presents with facial asymmetry and inability to close eye after parotid surgery. Discuss
anatomy of facial nerve.
Answer: Facial nerve passes through parotid gland, divides into 5 branches. Supplies muscles of facial
expression. Injury → Bell’s palsy: drooping mouth, ectropion.
LAQ: Explain anatomical basis of Horner’s syndrome.
Answer: Sympathetic pathway interruption → ptosis, miosis, anhidrosis, enophthalmos.
SAQ: Hoarseness of voice after thyroidectomy—explain nerve injured.
Answer: Recurrent laryngeal nerve (branch of vagus). Supplies intrinsic laryngeal muscles except cricothyroid.
SAQ: Why is middle meningeal artery clinically important?
Answer: Lies under pterion. Injury → extradural hematoma.
SAQ: Clinical importance of Kiesselbach’s plexus.
Answer: Site of epistaxis. Anastomosis of anterior ethmoidal, sphenopalatine, greater palatine, superior labial
arteries.
BAQ: Dangerous area of face drains into?
Answer: Cavernous sinus via facial → angular → ophthalmic veins.
BAQ: Artery palpated at angle of mandible?
Answer: Facial artery.
BAQ: Nerve supply of tongue taste anterior 2/3?
Answer: Chorda tympani (CN VII).
Neuroanatomy
LAQ: A patient with stroke develops contralateral hemiplegia and aphasia. Which artery is occluded?
Answer: Middle cerebral artery. Supplies lateral hemisphere, Broca’s, Wernicke’s areas. Occlusion →
contralateral weakness, aphasia.
LAQ: A patient develops quadriplegia due to cervical cord injury. Explain anatomy of corticospinal tract.
Answer: Originates in motor cortex, descends via internal capsule, crosses in medulla. Lesion above decussation
→ contralateral paralysis.
SAQ: Explain anatomical basis of Parkinsonism.
Answer: Degeneration of substantia nigra → dopamine deficiency → rigidity, tremor, bradykinesia.
SAQ: Why does cerebellar lesion cause ipsilateral signs?
Answer: Double crossing of pathways. Lesion → ipsilateral ataxia, intention tremor.
SAQ: Explain features of Brown-Séquard syndrome.
Answer: Hemisection of spinal cord → ipsilateral paralysis, proprioception loss; contralateral pain and temperature
loss.
BAQ: Artery supplying internal capsule?
Answer: Lenticulostriate branches of MCA.
BAQ: CSF is absorbed mainly through?
Answer: Arachnoid villi into dural venous sinuses.
BAQ: Nerve involved in lateral rectus palsy?
Answer: Abducent nerve (CN VI).