2 TARGET JIPMER

2. Which of the following is the site of cerebellar input?

JIPMER–MAY 2017 (a)

(b)
(c)
Inferior olivary nuclei
Vestibular nuclei
Globose and emboliform nuclei
(d) Dentate nucleus
Explanation:
The Afferent Cerebellar Pathways
ANATOMY Pathway Function Origin Destination
Corticopontocerebellar Conveys control from Frontal, parietal, temporal, Via pontine nuclei and mossy
cerebral cortex and occipital lobes (cerebral fibers to cerebellar cortex
1. Fate of 6th aortic arch:
cortex)
(a) Arch of aorta in between left common carotid artery and left subclavian artery Cerebro-olivocerebellar Conveys control from Frontal, parietal, temporal, Via inferior olivary nuclei
(b) Ductus arteriosus cerebral cortex and occipital lobes (cerebral and climbing fibers to cere-
(c) Right brachiocephalic cortex) bellar cortex
(d) Left subclavian artery Cerebroreticulocerebellar Conveys control from Sensorimotor areas (cere- Via reticular formation
cerebral cortex bral cortex)
Explanation:
Anterior spinocerebellar Conveys information Muscle spindles, tendon Via mossy fibers to cerebellar
Aortic arch Develops into from muscles and joints organs, and joint receptors cortex
1st Aortic arch Maxillary artery* Posterior spinocerebellar Conveys information Muscle spindles, tendon Via mossy fibers to cerebellar
2nd Aortic arch Hyoid artery* from muscles and joints organs, and joint receptors cortex

PREVIEW
Stapedial artery* Cuneocerebellar Conveys information Muscle spindles, tendon Via mossy fibers to cerebellar
from muscles and joints organs, and joint receptors cortex
3rd Aortic arch Common carotid artery*
of upper limb (from upper limb)
Proximal part of internal carotid and external carotid artery
Vestibular nerve Conveys information Utricle, saccule, and semi- Via mossy fibers to cerebellar
4th Aortic arch Left side: Arch of aorta in between left common carotid artery and left subclavian artery of head position and circular canals flocculonodular lobe
Right side: Right subclavian artery movement
5th Aortic arch Disappear completely Other afferents Conveys information Red nucleus, tectum Cerebellar cortex
6th Aortic arch Proximal part – Pulmonary artery* from midbrain
Distal part disappear on the right side but persist on the left side as ductus arteriosus*
The Efferent Cerebellar Pathways
Pathway Function Origin Destination
Globose- Influences Globose and emboli- To contralateral red nucleus, then via crossed rubro-
emboliform- ipsilateral motor form nuclei spinal tract to ipsilateral motor neurons in spinal cord
rubral activity
Dentothalamic Influences Dentate nucleus To contralateral ventrolateral nucleus of thalamus,
ipsilateral motor then to contralateral motor cerebral cortex; cortico-
activity spinal tract crosses midline and controls ipsilateral
motor neurons in spinal cord
Fastigial vesti- Influences ipsi-- Fastigial nucleus Mainly to ipsilateral and to contralateral lateral vesti-
bular lateral extensor bular nuclei; vestibulospinal tract to ipsilateral motor
muscle tone neurons in spinal cord
Fastigial reti- Influences ipsi- Fastigial nucleus To neurons of reticular formation; reticulospinal tract
cular lateral muscle to ipsilateral motor neurons to spinal cord
tone
Note: Each cerebellar hemisphere influences the voluntary muscle tone on the same side of the body

Ans: (a) Inferior olivary nuclei

Ref: Clinical Neuroanatomy, Richard S. Snell, 7th Edition, 2010, Page 237–243
Fig: Development of aortic arches
3. Gross dissected specimen of hand is shown. Identify this structure in Black circle.
Ans: (b) Ductus arteriosus (a) Deep palmar arch (b) Superficial palmar arch
Ref: Langman’s Medical Embryology, 9th Edition, Page 255–259 (c) Radial artery (d) Ulnar artery
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Explanation:
Explanation: l In this image based question, the circle is marked on the median nerve just distal to the origin of recurrent
l In this image based question, the circle was marked on the ulnar artery just distal to the flexor reticulam. branch
So it is Superficial branch of the ulnar artery not the superficial palmar arch. Superficial ulnar artery not More details about median nerve in the hand:
in the option, so ulnar artery is the correct answer.
l Median nerve enters the palm of hand by passing deep to the flexor retinaculam (carpel tunnel)
More details about ulnar artery in the hand: l Branches of median nerve in the hand:
l Ulnar artery enters the palm of hand by passing superficial to the flexor retinaculum or passing through
Recurrent branch (Motor) Supply the thenar muscles*

PREVIEW
Guyon’s canal [fibers of the flexor retinaculum split to form a tunnel to the passage of ulnar nerve and artery]
l Flexor pollicis brevis
accompanied by the ulnar artery
l Abductor pollicis brevis
l In front of the flexor retinacuclum and lateral to the pisiform the ulnar artery continues as superficial ulnar l Opponens pollicis
artery after giving deep branch
Palmar digital branches l Supply the First and second lumbricals
l Superficial branch of ulnar artery anastomose with superficial palmar branch of the radial artery or
(Motor and sensory) l Innervates the skin of lateral 3½ fingers of palmar aspect of hand
arteria radialis indicis or arteria princeps pollicis and forms superficial palmar arch.
l Branches of superficial palmar arch: l After giving the recurrent branch the median nerve divides into 2 proper palmar digital nerves and 2
o Three common palmar digital arteries - aries from the convexity of the superficial palmar arch. Common palmar digital nerves The 2 proper palmar digital nerves runs along the ulnar side of thumb
o Each common palmar digital artery divides into two proper palmar digital arteries and supplies the and radial side of index finger respectively.
contiguous sides of medial four fingers. l Each common palmar digital nerves divides into 2 proper palmar digital nerves which supplies the
l Deep branch of the ulnar artery (accompanies with deep branch of ulnar nerve) joins the radial artery adjacent sides of index, middle finger and ring finger respectively.
to complete the deep palmar arch. l Palmar digital nerves also gives vasomotor (blood vessels) and sudomotor (sweat glands) branches
l Branches of deep palmar arch: to lateral 3½ fingers of hand.
o Three palmar metacarpal arteries - which join the common palmar digital arteries from the superficial
Ans: (d) Median nerve
palmar arch
o Three perforating branches–which pass posteriorly between the heads of origin of the dorsal interossei Ref: Gray’s Anatomy, The Anatomical Basis of Clinical Practice, 41st Edition, 2016, Page 891
to anastomose with the dorsal metacarpal arteries from the dorsal carpel arch. 5. Sixth pharyngeal arch gives rise to:
EXTRA EDGE: (a) Sternohyoid (b) Cricothyroid
Look for thumb or little finger in the shape. (c) Cricoarytenoid (d) Stylopharyngeus
l Along the side of thumb: Explanation:
o Nerve-Median nerve*
Mesodermal derivatives of the pharyngeal arches and their innervation
o Artery-Radial artery* of its branches.
l Along the side of little finger Pharyngeal Nerve Artery Muscles Skeleton
o Nerve-Ulnar nerva Arch
o Artery-Ulnar artery 1 arch V. Trigeminal: Maxillary Mastication (tempo- Premaxilla, maxilla, zygo-
[mandibular] (maxillary and ral, Masseter, medial matic bone, part of tempo-
Ans: (d) Ulnar artery and lateral pterygoids), ral bone, Meckel’s carti-
(maxillary and mandibular
Ref: Gray’s Anatomy, The Anatomical Basis of Clinical Practice, 41st Edition, 2016, Page 889 and 890 mandibular divisions) mylohyoid, anterior lage, Mandible, malleus,
processes) belly of digastric, ten- incus, anterior ligament of
4. Gross dissected specimen of forearm and hand is shown. Identify the structure in Black circle. sor veli palatinii and malleus and sphenoman-
(a) Digital branch of radial nerve (b) Anterior introsseous nerve tensor tympani dibular ligament
c) Digital branch of ulnar nerve (d) Median nerve Contd.
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Contd. l To reach the second pharyngeal arch mesoderm the main trunk of facial nerve courses through the
2 arch VII. Facial Hyoid and stapedial Facial expression Stapes, styloid process, middle ear.
[Hyloid] (buccinators, Auricularis, stylohyoid ligament,
lesser horn and upper Surgical landmark of facial nerve during middle ear and mastoid surgery
Frontalis, Platysma, or-
bicularis oris, orbicularis portion of body of
Processes cochleariformis It demarcates the geniculate ganglion
oculi), posterior belly K\RLGERQH
Cog It is a bony spur, projecting from the tegmen anterior to the head of malleus. It is the
of digastric,
landmark for geniculate ganglion
stylohyoid and
stapedius Oval window Facial nerve lies above the oval window niche
3 arch IX. Glossopharyn- Common carotid artery, Stylopharyngeus Greater horn and lower Lateral semicircular canal Facial nerve lies below the lateral semicircular canal
geal proximal (1st part) of internal portion of body of Short process of incus Facial nerve lies medial to the short process of incus at the level of aditus
carotid artery amd External hyoid bone Pyramid Facial nerve runs behind the pyramid and post tympanic sulcus
carotid artery
Tympanomastoid suture Vertical or the mastoid segment facial nerve runs behind this suture
4 arch X. Vagus Left side: Arch of aorta Cricothyroid, levator Thyroid cartilage, epi- Digastric ridge Facial nerve leaves the mastoid at the anterior end of this ridge
Superior laryngeal Right side: Right subclavian veli palatinii and glottis and cuneiform
Stylomastoid foramen Facial nerve exits through this foramen
branch artery constrictors muscles cartilage
of pharynx
Surgical landmark of facial nerve during parotid surgery
5 arch Disappears
6 arch X. Vagus Right and left pulmonary All intrinsic muscles Cricoid, arytenoid, Tragal point Facial nerve located 1 cm deep and inferior to this point
Recurrent laryngeal artery of larynx except crico- corniculate, and tracheal Tympanomastoid suture Facial nerve lies 6-8 mm deep to this suture
branch Left side: Distal part persist thyroid cartilages Styloid process Facial nerve crosses lateral to styloid process
as ductus arteriosus Posterior belly of digastric muscle Facial nerve is situated between digastric groove and styloid process

PREVIEW
Retromandibular vein Facial nerve passes Superficial to it

Ans: (c) Processes cochleariformis

Ref: Snapshots in Ear, Nose and Throat, Head and Neck Surgery,
Santosh Kumar Swain, 1st Edition, 2016, Page 195 and 196
7. A patient presented with pustule over the dorsum of nose and upper lip. Which is the most direct route
of spread of this infection to cavernous sinus?
(a) Angular vein to ophthalmic vein to cavernous sinus
(b) Dorsal nasal vein to maxillary vein to cavernous sinus
(c) Facial vein to pterygoid plexus to cavernous sinus
(d) Palatine vein to ophthalmic vein to cavernous sinus
Explanation:
l Dorsum of nose and upper lip is dangerous area of face; this area is drained by facial vein and its
tributaries.

Fig: Mesodermal derivatives of the pharyngeal arches

Ans: (c) Cricoarytenoid

Ref: Langman’s Medical Embryology, 9th Edition, Page 366-372
6. During surgery, which of the following anatomical landmark is closely associated with geniculate
ganglion?
(a) Pyramid (b) Short process of incus
(c) Processes cochleariformis (d) Oval window
Explanation:
l The complex course of facial nerve through the middle ear is due to its development from facioacoustic
primordium which gives rise to VII and VIII nerves*. Fig: Communications of facial vein with the cavernous sinus
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Redistribution of blood flow in the body

PHYSIOLOGY l Tremendous increases in skeletal muscle flow is made possible by redistribution of blood flow
l Sympathetic, nor adrenergic vasoconstriction occurs in two important vascular beds:
1. Deglutitive inhibition: o Renal circulation*.
o Splenic blood flow*
(a) Wave of inhibition preceding peristalsis l Vasoconstriction in Renal and Splanchnic system diverts their blood to the exercising muscle.
(b) Inhibition occurs simultaneously with peristalsis l Cutaneous blood flow increases during sustained activities to dissipate the heat generated during
(c) Inhibition occurs after peristalsis exercise.
(d) Wave of stimulation preceding peristalsis l coronary blood flow increases by more than four times than normal*.
l Cerebral blood flow remains largely unchanged.
Explanation:
Ans: (a) 3 mm Hg
Deglutitive inhibition
Ref: West Respiratory Physiology, 9th Edition, Page 91
l Definition: A second swallow, initiated while an earlier peristaltic contraction is still progressing in
the striated muscles of esophagus, causing rapid and complete inhibition of the contraction induced by 3. A man weighing 70 kg has a hematocrit of 45%. What would be his approximate plasma volume?
the first swallow. (a) 2310 ml (b) 2695 ml (c) 2890 ml (d) 3080 ml
l It happens secondary to hyperpolarization of the circular smooth muscle
Explanation:
l It is mediated through nonadrenergic, noncholinergic neurons in the myenteric plexusLQ*,WUDFW
l Average blood volume account for 8% of body weight.
Deglutition l So, here for 70 Kg man, Blood volume is 5.6 Litres (70 × 8/100).
l It is the process of swallowing l Blood Volume = Plasma volume/1-Hematocrit.
l It refers to the passage of food from the oral cavity in to the stomach. l So, Plasma volume = Blood volume × (1-hematocrit).
It comprises three stages namely: l Here, plasma volume = 5.6* (1-0.45) = 3080 ml.

PREVIEW
l
1. Oral phase - voluntary.
Total Body Water (60% of body weight), 42 liters
2. Pharyngeal phase - involuntary.
3. Esophageal phase - involuntary. Intracellular fluid Extracellular fluid
2/3rd of TBW,LH 40% body 1/3rd of TBW,LH 20% body weight (14 liters)
Motility events in the esophagus weight (28 liters) Interstitial Fluid Plasma
l During the esophageal phase, food bolus is pushed from esophagus to the stomach by peristalsis.
75% or 3/4th of ECF or 15% of body 25% or 1/4th of ECF Or 5% of body weight
l Two types of sphincters are seen in esophagus namely: weight (10.5 liters) (3.5 liters)
o Upper esophageal sphincter:
n Formed by the cricopharyngeal muscle Ans: (d) 3080 ml
n It is normally contracted tonically and opens only during swallowing Ref: Ganong Review of Medical Physiology, 21st Edition, Page 2
o Upper esophageal sphincter:
4. A patient who underwent extensive bowel resection is on total parenteral nutrition (TPN) for 1 month.
n Also called as cardiac sphincter
Endoscopy done after one month reveals defuse gastric mucosal atrophy. Which enzyme deficiencies
n Its main function is to prevent regurgitation of gastric contents into esophagus.
are most likely responsible for gastric mucosal atrophy in this patient?
Ans: (b) Inhibition occurs simultaneously with peristalsis (a) Gastrin and Ghrelin (b) Secretin and CCK
Ref: Yamada’s Textbook of Gastroenterology, 5th Edition, Page 194 (c) Gastrin and CCK (d) Gastrin and Secretin
2. PO2 (in mm Hg) in skeletal muscle during exercise: Explanation:
(a) 3 (b) 10 (c) 20 (d) 30 Gastrin
Explanation: l Produced by G cells in the antral portion of the gastric mucosa
l Three forms – G 34, G 17 and G 14 gastrins
l PO2(in mm Hg) in skeletal muscle during exercise can be as low as 1 to 3 mm Hg*.
l G 17 is the principal form*
l This is mainly due to the compression of blood vessels supplying the muscle during muscle contrac-
l Acts via CCK-B receptor*.
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l Stimuli that increase gastrin secretion:
l Fortunately, myoglobin in the muscle acts as a reservoir for O2 and enhances its diffusion during exercise. o Peptides*.
Skeletal muscle blood flow during exercise: o Amino acids(Phenylalanine, tryptophan)
o Gastric distension
l All rest, skeletal muscle receives blood flow of 2-4mL/100g/min. But during exercise the value increase
o Gastrin releasing peptide*.
by more than 20 times – 80 mL/100 g/min.
o Calcium.
l This increase is mainly because of: o Epinephrine.
o Accumulation of local metabolites that causes vasodilation l Stimuli that decrease gastrin secretion:
o Opening up of new capillaries during exercise o Acid
14 TARGET JIPMER JIPMER–May 2017 15
o Somatostatin*. Contd.
o Secretin*. Medial geniculate body • Thalamic nuclei for hearing
o GIP.
• Project to auditory cortex
o VIP.
o Glucagon. Auditory cortex • Location – Superior temporal gyrus of the temporal lobe
o Calcitonin • Also called as Heschl gyrus
l Actions: • Tonotopic organization – Low tones are represented anterolaterally and high tones postero-
o Stimulation of gastric acid and pepsin secretion. medially
o Stimulation of the growth of the mucosa of GI tract (Trophic action*). • Planum temporale – Part of auditory cortex involved in language related auditory process-
ing. It is larger in the left hemisphere.
Cholecystokinin
Ans: (d) Inferior colliculus
l Secreted by I cells in the mucosa of the upper small intestine*.
Ref: Kandel, Principle of Neural Sciences, 5th Edition, Page 697
l Also found in nerves in the distal ileum, colon and brain.
l Acts via CCK-A receptor*. 6. A 60-year-old patient, known case of Hypertension for the past 25 years underwent renal artery dop-
l Functions of CCK: pler which showed narrowing and turbulence in right renal artery. If the diameter of lumen is reduced
o Gut-stimulation of pancreatic enzyme secretion. by 50%, how much blood flow will be reduced?
o Contraction of the gallbladder*.
(a) 1/4th (b) 1/8th (c) 1/16th (d) 1/32nd
o Relaxation of the sphincter of Oddi.
o Brain-regulation of food intake. Explanation:
o Production of anxiety and analgesia.
Blood flow (F)
l Other actions:
o Augments the action of secretin. • Blood flow (F) inside vessel depends on:
o Inhibits gastric emptying. o Pressure difference (PA - PB) - Directly related*

PREVIEW
o Exerts a trophic effect on the pancreas. o Viscosity of the fluid (η) - Inversely related*
o Increases the synthesis of enterokinase. n Viscosity is a measure of fluid’s resistance to flow.
l Releasing factors that activate CCK secretion: n A fluid with low viscosity flows easily such fluids are called Newtonian fluid. Example is water*.
o CCK - releasing peptide (intestinal mucosa). n A fluid with high viscosity flows resist motion. Such fluids are called:
o Monitor peptide (Pancreas) Non-Newtonian fluid Example is blood*.
l Stimuli that increase CCK secretion: n Fahraeus-Lindqvist effect– This effect is seen mainly in capillaries where RBCs flow in the
o Peptides and amino acids. center which leaves cell free plasma near the vessel wall. So, the viscosity change per unit change
o Fatty acids (more than 10 carbon atoms). in hematocrit is much less in capillaries.
4
Ans: (c) Gastrin and CCK o Radius of the vessel (r ) - directly related
Ref: Yamada’s Textbook of Gastroenterology, 5th Edition, Page 284 o Length of the vessel (L) - inversley related
• Inter-relation of these factors are expressed in Poiseuille-Hagen formula which is:
5. Direction of sound is differentiated by:
(a) Auditory cortex (b) Medial geniculate body F = (PA – PB) *πr4/8ηL)
(c) Lateral geniculate body (d) Inferior colliculus
• According to the above formula, blood flow is directly proportional to the fourth power of radius*.
Explanation: •
4
So, if the radius is halved, then blood flow decreases by 2 times which is 16 times*.
Central auditory pathway Ans: (c) 1/16th
l Auditory pathway can be easily remembered with the help of a very familiar mnemonic “E COLI MA”. Ref: Ganong, 25th Edition, Page 573
Structure Characteristics 7. PCO2 at alveoli and expired air is 40 and 30 mm Hg respectively. Calculate dead space to tidal volume
Eighth nerve l Carries the afferent auditory information ratio.
Cochlear nuclei l 95% of fibres in cochlear nuclei are myelinated fibres that receives input from inner hair cells DEFG
l Small number (5%) of unmyelinated fibres receives input from outer hair cells Explanation:
Superior Olivary nucleus l Receives information from both the ears (bilateral)
• Dead space to tidal volume ratio is calculated by PCO2 of alveolar air – PCO2 of expired air/PCO2 of
l Helps in localization of sound and the direction from which the sound comes alveolar air. This equation is called Bohr’s equation.
l Also send efferent to outer hair cells in the form of olivocochlear bundle modulates the
sensitivity of these hair cells and blocks background noise
PCO2 of alveolar air - PCO2 of expired air
Lateral lemniscus l Project auditory information to inferior colliculus Dead space to tidal volume ratio =
PCO 2
of alveolar air
Inferior colliculus l All auditory pathways ascending through the brainstem converge in inferior colliculi
l Helps in localization of sound and the direction from which the sound comes
Contd.
• So, Here it is 40 – 30/40, that comes around 0.25.
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