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Xpress AIIMS PG November 2014

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 Xpress
AIIMS PG
November 2014
With Explanatory Answers

Ranjith A R
Junior Resident
Dept. of Pathology
JIPMER, Pondicherry

KALAM BOOKS
Xpress AIIMS PG November 2014
© Author 2015

January 2014

ISBN 978 81 89477 26 4

All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted, in any form or by any means, electronic, mechanical,
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no expressed or implied warranty of any kind and assume no responsibility for errors
or omissions. No liability is assumed for incidental or consequential damages with or
arising out of the use of the information contained herein.

Published by
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Printed at SAP Print Solutions Pvt. Ltd., Mumbai

Reviewed by
Dr.Praveen. P.V, Junior Resident, Anaesthesia, JJMMC, Davangare
Dr. Remya Rajan, Junior Resident, Paediatrics, LHMC, Delhi
Dr. S. Ashok, Junior Resident, Orthopaedics, Thanjavur Medical
College, Tamilnadu
Dr. A. Durairaj, Junior Resident, Medicine IGGGH & PGI, Puducherry
Dr. Sathish. K, Junior resident, Radiodiagnosis. JIPMER
Dr. S.Manikandan, Junior Resident, Community medicine, JIPMER
Dr. Perumal. M, Junior Resident, Dermatology, JIPMER
Contents
Anatomy 1 – 12
Physiology 13 – 28
Biochemistry 29 – 32
Pathology 33 – 52
Microbiology 53 – 61
Forensic Medicine 62 – 69
Pharmacology 70 – 90
ENT 91 – 103
Ophthalmology 104 – 122
PSM 123 – 143
Medicine 144 – 184
Surgery 185 – 195
OBG 196 – 205
Paediatrics 206 – 224
Anaesthesia 225 – 229
Orthopaedics 230 – 238
Psychiatry 239 – 244
Radiology 245 – 250
Dermatology 251 – 257
 ANATOMY

1. Turkish saddle shaped structure is

a. Amygdala
b. Hypothalamus
c. Pituitary
d. Basal ganglia

Ref. Gray’s anatomy 40th edition. Pg. 527.

The sella turcica (Turkish Chair) is a saddle-shaped depression in
the body of the sphenoid bone.
The seat of the saddle is known as the hypophyseal fossa, which
holds the pituitary gland. The hypophyseal fossa is located in a
depression in the body of the sphenoid bone. Located anteriorly
to the hypophyseal fossa is the tuberculum sellae
Extra Edge (PGI)
 A J-shaped sella is a variant configuration of the sella turcica,
where the tuberculum sellae is flattened, thus forming the
straight edge of the “J”. The dorsum sellae remains rounded
and forms the loop of the “J”.
Mneumonic: CONMAN
Chronic hydrocephalus
Optic glioma, Osteogenesis imperfecta
Neurofibromatosis
Mucopolysaccharidosis
Achondroplasia
Normal variant

Answer: (C) Pituitary. (to be perfect the option must have been Sella
Turcica).
 | Xpress AIIMS PG November 2014

2. Dense regular collagen is not seen in which among the

following
a. Tendon
b. Ligament
c. Aponeurosis
d. Periosteum

Ref. Gray’s anatomy 40th edition. Pg. 112

Connective tissue is made up of cells and extracellular matrix.
 The extracellular matrix is made up of fibres in a protein
and polysaccharide matrix, secreted and organised by cells
in the extracellular matrix. Variations in the composition of
the extracellular matrix, determines the properties of the
connective tissue.
 The cells sit in a matrix made up of glycoprotein, fibrous
proteins and GAG, which have been secreted by the fibroblasts,
and the major component of the matrix, is in fact, water.
Classification
Connective tissue proper 
 Loose irregular connective tissue
 Dense irregular connective tissue - joint capsules & dermis of
skin
Specialised connective tissues
 Dense regular connective tissue which is found in tendons and
ligaments and aponeurosis
 Cartilage
 Adipose tissue
Dense Regular Connective Tissue
 In this type of tissue, the collagen fibres are densely packed,
and arranged in parallel. This type of tissue is found in
ligaments (which link bone to bone at joints) and tendons
(connections between bones or cartilage and muscle). These
are powerfully resistant to axially loaded tension forces, but
allow some stretch
Answer: (D) Periosteum.
 Anatomy | 

3. Panniculus adiposus is seen in?

a. Scrotum
b. Penis
c. Eyelid
d. Orbit

Ref. Cunningham’s textbook of anatomy. Pg.364. Gray’s anatomy 40th

edition. Pg 457
“Fascia superficialis is closely adherent to the cutis vera and is
sometime called as panniculus adiposus, from the fact that
except beneath the skin of eyelids, penis and scrotum its
usually impregnated with fat elsewhere”
 The panniculus adiposus is the fatty layer of the subcutaneous
tissues, superficial to a deeper vestigial layer of muscle, the
panniculus carnosus.
 Examples: Fascia of Camper, the superficial cervical fascia
The Panniculus carnosus is a part of the subcutaneous tissues
in the study of animal anatomy. It is a layer of striated muscle
deep to the panniculus adiposus.
In humans structures derived from PC are.
 The platysma muscle of the neck,
 Palmaris brevis in the hand, and the
 Dartos muscle in the Muscles of facial expression in the head

Answer: (D) Orbit.

 | Xpress AIIMS PG November 2014

4. Regarding Sphincter urethrae, all are true except

a. Located at neck of bladder
b. Arises from ischiopubic rami
c. Supplied by Pudendal nerve
d. Under voluntary control

Ref. Gray’s anatomy.40th editon Pg. 1094 & Victor adams’s Neurology.
Pg.1233
The urethral sphincter refers to one of the following muscles
1. the internal urethral sphincter (IUS), which consists of smooth
muscle and is continuous with the detrusor muscle and under
involuntary control,
2. the external urethral sphincter (EUS), which is made up of
striated muscle and is under voluntary control.
The external urethral sphincter originates at the ischio-pubic
ramus and inserts into the intermeshing muscle fibers from the
other side. It is controlled by the deep perineal branch of the
pudendal nerve. Activity in the nerve fibers constricts the urethra.
The external sphincter muscle of urethra (sphincter urethrae):
located at the bladder’s inferior end in females and inferior to the
prostate (at the level of the membranous urethra) in males.
The internal sphincter muscle of urethra: located at the
bladder’s inferior end and the urethra’s proximal end at the
junction of the urethra with the urinary bladder.

Answer: (A) Neck of bladder.

 Anatomy | 

5. Membrana tectoria is
a. Posterior longitudinal ligament
b. Anterior longitudinal ligament
c. Anterior atlantooccipital membrane
d. Posterior atlantooccipital membrane

Ref. Gray’s anatomy 40th edition. Pg 734

Ligaments Connecting the Axis with the Occipital Bone

 The Membrana Tectoria
 Two Alar &
 The apical odontoid
The Membrana Tectoria (occipitoaxial ligament) - The
membrana tectoria is situated within the vertebral canal. It is
a broad, strong bands which covers the odontoid process and
its ligaments, and appears to be a prolongation upward of the
posterior longitudinal ligament of the vertebral column.
The Alar Ligaments (ligamenta alaria; odontoid ligaments,
check ligaments) - The alar ligaments are strong, rounded
cords, which arise one on either side of the upper part of the
odontoid process.
In the triangular interval between these ligaments is another
fibrous cord, the apical odontoid ligament, which extends
from the tip of the odontoid process to the anterior margin of the
foramen magnum

Answer: (A) Post longitudinal ligament.

 | Xpress AIIMS PG November 2014

6. Regarding Cavernous sinus thrombosis all are true except

a. Infection spread through inferior opthalmic vein
b. Ethmoidal sinusitis is a cause
c. Loss of orbital sensation
d. Loss of jaw jerk

Ref. Gray’s anatomy 40th edition. Pg 430, 492

Cavernous sinus thrombosis (CST) is the formation of a blood
clot within the cavernous sinus.
 Abrupt onset of unilateral periorbital edema, headache,
photophobia, and bulging of the eye (proptosis).
 Ptosis, chemosis, cranial nerve palsies (III, IV, V, VI).
 Sixth nerve palsy is the most common.
 Sensory deficits of the ophthalmic and maxillary branch of the
fifth nerve are common. Periorbital sensory loss and impaired
corneal reflex may be noted.
 Papilledema, retinal hemorrhages, and decreased visual acuity
and blindness may occur from venous congestion within the
retina.
“CST most commonly results from contiguous spread of infection
from dangerous area of face that includes a nasal furuncle (50%),
sphenoidal or ethmoidal sinuses (30%) and dental infections
(10%)”
Mandibular branch of trigeminal nerve which is responsible
for jaw jerk is not affected in cavernous sinus thrombosis.
Each cavernous sinus (one for each hemisphere of the brain)
contains the following:
Lateral wall of sinus - vertically, from superior to inferior
 oculomotor nerve (CN III)
 trochlear nerve (CN IV)
 ophthalmic nerve, the V1 branch of the trigeminal nerve 
(CN V)
 maxillary nerve, the V2 branch of CN V
GRAY’S ANATOMY STATES “The abducens nerve (CN VI)
does not run within the lateral wall of the cavernous sinus; rather,
it runs through the middle of the sinus within a dural tunnel
(Dorello’s canalQ) alongside the internal carotid artery.”
 Anatomy | 

Tributaries:
 Superior and inferior ophthalmic veins
 Sphenoparietal sinus
 Superficial middle cerebral veins
 Rarely central retinal vein and frontal tributary of middle
meningeal veinQ

Answer: (D) loss of Jaw jerk.

 | Xpress AIIMS PG November 2014

7. Which of the cranial nerve nucleus is deep to facial

colliculus?
a. Abducent
b. Occulomotor
c. Trigeminal
d. Facial

Ref. Gray’s clinical neuroanatomy.Pg 85. Gray’s anatomy 40th edition.

Pg. 240
The facial colliculus is not formed by the facial nerve nucleus,
but by the fibres of the facial nerve arching backwards around
the abducens nerve (CN VI) nucleus before turning forwards
once more.
The colliculus is an elevation on the floor of the fourth
ventricle.
A lesion involving the facial colliculus is therefore likely to result
in facialcolliculus syndrome by involving:
 abducent nerve (CN VI) nucleus
 facial nerve (CN VII) fibres at the genu
 medial longitudinal fasciculus

Answer: (A) Abducent.

 Anatomy | 

8. All of the following pass through the foramen shown in the

picture except.

a. Maxillary nerve b. Meningeal artery

c. Lesser petrosal nerve d. Emissary vein.

Ref. Gray’s anatomy 40th edition. Pg. 527–529

The foramen shown in the picture is foramen ovale. Even if you
don’t know the picture you can narrow it down based on the
options.
Mnemonic:
 O: otic ganglion (inferior)
 V: V3 cranial nerve (mandibular division of trigeminal nerve)
 A: accessory meningeal artery
 L: lesser petrosal nerve
 E: emissary veins
The foramen rotundum: located in the middle cranial fossa and
joins the middle cranial fossa with the pterygopalatine fossa.
The foramen spinosum : located in the posteromedial part of
greater wing of sphenoid (posterolateral to foramen ovale) and
connects the middle cranial fossa with the infratemporal fossa.
It transmits the middle meningeal artery, middle meningeal vein
and meningeal branch of mandibular nerve. Rarely, the middle
meningeal artery originates directly from the ophthalmic artery,
as a result foramen spinosum is either absent or small.
The foramen lacerum: located in the middle cranial fossa
anterior to the petrous apex. It transmits the small meningeal
branches of the ascending pharyngeal artery and emissary veins
from the cavernous sinus. The internal carotid artery passes along
its superior surface but does not traverse it.
10 | Xpress AIIMS PG November 2014

The foramen caecum: located in the anterior cranial fossa, anterior

to cribriform plate of ethmoid bone and posterior to the frontal bone.
The foramen caecum is frequently found in infants, uncommonly in
children and rarely in adults where <1.5% of foraminae are open. It
rarely transmits emissary venous connections (intra- or extra-cranial)
to the nasal cavity.

Answer: (A) Maxillary nerve.

 Anatomy | 11

9. Most common site of MALT tissue

a. Stomach
b. Ileum
c. Duodenum
d. Jejunum

Ref. Gray’s anatomy 40th edition. Ref. 72, 1135

If the question is on MALToma the answer is STOMACH. If it’s
just MALT – answer is ileum.
Mucosa-associated lymphoid tissue (MALT) is scattered along
mucosal linings in the human body & constitutes the most
extensive component of human lymphoid tissue.
The components of MALT are sometimes subdivided into the
following:
 GALT (gut-associated lymphoid tissue. Peyer’s patches are
a component of GALT found in the lining of the small
intestines.)
 BALT (bronchus-associated lymphoid tissue)
 NALT (nasal-associated lymphoid tissue)
 CALT (conjunctival-associated lymphoid tissue)
 O-MALT (organized mucosa-associated lymphatic tissue);
specifically, the tonsils of Waldeyer’s tonsillar ring are O-
MALT
 D-MALT (diffuse mucosa-associated lymphatic tissue);
MALT that is not organized as a separately macroscopically
anatomically identifiable mass, tissue or organ (such as the
aforementioned O-MALT) is diffuse MALT
 LALT (larynx-associated lymphoid tissue)
 SALT (skin-associated lymphoid tissue)

Answer: (B) Ileum.

12 | Xpress AIIMS PG November 2014

10. Pronation of foot angles parallel—

a. Calcaneocuboid & talonavicular joints
b. Spring ligament
c. Talo calcaneal
d. Mid tarsal joints

Ref. Ankle stability movements J. Orthop Sports. Gray’s anatomy 40th

edition. Pg. 1446
Pronation or eversion is the inward roll of the foot. There are
three main types of pronation in human gait;
Neutral pronation,
Overpronation,
Underpronation or supination.
 While both overpronation and supination occur while walking
and standing, they are usually more pronounced and the
effects amplified while running
 Motion at the sub-talar joint resulting in eversion, abduction
and dorsi-flexion of the foot.
 The major axes of the Calcaneo-cuboid joint (longitudinal)
and talo-navicular joint (oblique) are in parallel when the sub-
talar joint is everted. As the sub-talar joint inverts, the axes of
these joints are convergent.

Answer: (A) calcaneocuboid & talonavicular joints.

 PHYSIOLOGY

11. Dorsal column carries all the folllowing sensations except

a. Pain
b. Proprioception
c. Vibration
d. Touch

Ref. Ganong. Pg.173- 175

The below picture explains it all.

Answer: (A) Pain.

14 | Xpress AIIMS PG November 2014

12. All of the following is involved in counter current mechanism

except?
a. Vasarecta
b. Thick limb of loop of henle
c. Thin limb of loop of henle
d. Collecting duct

Ref. Ganong.23rd e. Ch 38
The Countercurrent Mechanism
The concentrating mechanism depends upon the maintenance
of a gradient of increasing osmolality along the medullary
pyramids.
The loops of Henle as countercurrent multipliers
The vasa recta as countercurrent exchangers
 Physiology | 15

Answer: (D) Collecting duct.

16 | Xpress AIIMS PG November 2014

13. A brief high frequency stimulation of perforant pathway of

hippocampus with 5 Hz causes?
a. Long term potentiation
b. Post tetanic potentiation
c. Habituation
d. Long term depression

Ref. Ganong. 23rd 291

SYNAPTIC PLASTICITY & LEARNING

Short- and long-term changes in synaptic function can occur as
a result of the history of discharge at a synapse; that is, synaptic
conduction can be strengthened or weakened on the basis of past
experience(learning and memory)
Post tetanic potentiation
 Enhanced postsynaptic potentials in response to stimulation
- lasts up to 60
 Due to accumulation of Ca 2+ in presynaptic neuron to
such a degree that the intracellular binding sites that keep
cytoplasmic Ca2+ low are overwhelmed.
Habituation
 Neutral stimulus is repeated many times. The first time it is
applied it is novel and evokes a reaction eventually, the subject
becomes habituated to the stimulus and ignores it.
 Decreased release of neurotransmitter from the presynaptic
terminal
 Because of decreased intracellular Ca2+ .
Sensitization
 Opposite of habituation.
 Augmented postsynaptic responses after a stimulus to which
one has become habituated is paired once or several times
with a noxious stimulus.
 Due to presynaptic facilitation.
 The short-term prolongation of sensitization is due to a
Ca2+-mediated change in adenylyl cyclase that leads to a
greater production of cAMP.
 Physiology | 17

 The long-term potentiation also involves protein synthesis and

growth of the presynaptic and postsynaptic neurons and their
connections.
Long-term potentiation (LTP)
 Rapidly developing persistent enhancement of the postsynaptic
potential response to presynaptic stimulation after a brief
period of rapidly repeated stimulation of the presynaptic
neuron.
 There are two forms in the hippocampus:
– Mossy fiber LTP, which is presynaptic and independent of
N-methyl-D-aspartate(NMDA) receptors;
– Schaffer collateral LTP, which is postsynaptic and NMDA
receptor-dependent.
Long-term depression (LTD)
 It is produced by slower stimulation of presynaptic neurons
and is associated with a smaller rise in intracellular Ca2 than
occurs in LTP.
 In the cerebellum, its occurrence appears to require the
phosphorylation of the GluR2 subunit of AMPA receptors.

Answer: (A) Long Term Potentiation.

18 | Xpress AIIMS PG November 2014

14. Sleep spindles and k complex are seen in

a. REM
b. Stage 2 NREM
c. Stage 3 NREM
d. Stage 4 NREM

Ref. Ganong. 23rd Pg.234

Sleep:
 Rapid eye movement (REM) sleep and
 Non-REM (NREM) Or slow-wave sleep.
Sleep Disorders:
 Narcolepsy is characterized by a sudden onset of REM sleep.
 OSA experience a much greater time in stage 1 NREM sleep
(from an average of 10% of total sleep to 30–50%)and a
marked reduction in slow-wave sleep (stages 3 and 4NREM
sleep)
 Periodic limb movement disorder (PLMD) The duration
of stage 1 NREM sleep may be increased and that of stages 3
and 4 may be decreased
Stage CI/signs EEG waves(Beurger
waves)
0 (awake state) Eye open Beta
Eye closed Alpha
1 – NREM Dozing a interspersed with
q waves (bursts of rolling)
II – NREM Equivocal sleep q waves
(40-50% of Sleep spindles
time) k-complex
a-like bursts
III-NREM Deep/slow Q, d synchronisation
wave sleep
IV – NREM Slowest wave Δ (eyes fixed)
sleep/cerebral
sleep
 Physiology | 19

REM Active Mixed frequency

(paradoxical dreaming/ Darting movements
sleep) night mares Low voltage (q, a>b),
Pontogeniculo-occipital
(PGO) spikes.

Answer: (B) Stage 2 NREM.

20 | Xpress AIIMS PG November 2014

15. The structure responsible for Knee Jerk (patellar reflex) is

a. Dynamic intrafusal fibres
b. Golgi tendon
c. Static nuclear bag
d. Both golgi tendon and muscle spindles

Ref. Ganong. 23rd. Pg. 158

Intrafusal Fibers – Two types of intrafusal fibers
 Nuclear bag fiber – Subtypes (dynamic and static):
– Transmits both dynamic and steady state information of
muscle length via group la (dynamic response) and group II
(static response) afferents
 Nuclear chain fiber:
Transmits only steady state information of muscle length via
group II afferents Ia afferents are very sensitive to the velocity
of the change in muscle length during a stretch (dynamic
response).
Knee Jerk:
The knee jerk reflex is an example of a deep tendon reflex (DTR)
in a neurological exam and is graded on the following scale:
0 (absent)
1+ (hypoactive)
2+ (brisk, normal)
3+ (hyperactive without clonus)
4+ (hyperactive with mild clonus)
5+ (hyperactive with sustained clonus).
 Absence of the knee jerk can signify an abnormality anywhere
within the reflex arc, including the muscle spindle, the Ia
afferent nerve fibers, or the motor neurons to the quadriceps
muscle. The most common cause is a peripheral neuropathy
from such things as diabetes, alcoholism, and toxins.
 A hyperactive reflex can signify an interruption of
corticospinal and other descending pathways that influence
the reflex arc.

Answer: (A) Dynamic intra fusal fibres.

 Physiology | 21

16. Attention and concentration is function of ?

a. Frontal lobe
b. Basal Ganglia
c. Hypothalamus
d. Parietal lobe

Ref. Harrison 18th e. Ch 26

Frontal lobe - Networks
Perisylvian network
Parietofrontal network
Occipitotemporal network
Limbic network
Prefrontal network
Function
Language
Spatial cognition
Face and object recognition
Retentive memory
Attention and behavior

Temporal Lobe Controls: Behaviour (aggressive), Short-term

memory, Language comprehension, Musical awareness
Parietal Lobe controls: Academic skills, Awareness of body
parts, Eye-hand coordination, Tactile perception (touch), Spatial
orientation, Right/left organisation, Visual attention
Occipital Lobe Controls: Reading (the perception and recognition
of printed words), Visual perception & Visual processing

Answer: (A) Frontal lobe.

22 | Xpress AIIMS PG November 2014

17. Nerve endings sensitive to noxious substance is present in

a. Intestine
b. Spleen
c. Liver
d. Mesentry

Ref. Ganong 23rde Visceral pain and nociceptors. Pg. 170

 Visceral pain is transmitted by C fibers that are found in
muscle, periosteum, mesentery, peritoneum, and viscera.
Abdominal visceral nociceptors respond to mechanical and
chemical stimuli
 The principal mechanical signal to which visceral nociceptors
are sensitive is stretch; cutting, tearing, or crushing of viscera
does not result in pain.
 Visceral stretch receptors are located in the muscular layers of
the hollow viscera, between the muscularis mucosa and sub-
mucosa, in the serosa of solid organs, and in the mesentery
(especially adjacent to large vessels)
 Abdominal visceral nociceptors also respond to various
chemical stimuli. Chemical nociceptors are contained mainly
in the mucosa and sub-mucosa of the hollow viscera.
 There are nerve ending sensitive to noxious stimuli in
mesentery, pancreas and capsule of liver. (PGI)

Answer: (D) Mesentry.

 Physiology | 23

18. Hypertension, bradycardia and irregular respiration is seen

in
a. Bain bridge reflex
b. Bezhold Jarisch reflex
c. Herring Breuer reflex
d. Cushings reflex

Ref. Ganong Pg.562.

 When intracranial pressure is increased, the blood supply to
RVLM neurons is compromised, and the local hypoxia and
hypercapnia increase their discharge.
 The resultant rise in systemic arterial pressure (Cushing
reflex) tends to restore the blood flow to the medulla and over
a considerable range, the blood pressure rise is proportional to
the increase in intracranial pressure.
 The rise in blood pressure causes a reflex decrease in heart
rate via the arterial baroreceptors. This is why bradycardia
rather than tachycardia is characteristically seen in patients
with increased intracranial pressure.
 A rise in arterial P CO2 stimulates the RVLM. Moderate
hyperventilation, which significantly lowers the CO2 tension
of the blood, causes cutaneous and cerebral vasoconstriction
in humans, but there is little change in blood pressure.
Extra Edge:
Mayer waves, which are waves in arterial blood pressure that can
be seen in an electrocardiograph (ECG) register or blood pressure
traces, are a symptom of a physiological response to falling blood
flow. This often results in an increase in blood pressure.

Answer: (D) Cushings reflex.

 24 | Xpress AIIMS PG November 2014

19. H reflex is common in

a. S1 radiculopathy
b. L1 radiculopathy
c. L2 radiculopathy
d. L4 radiculopathy

Ref. Ganong. 23rd pg. 116. VictorAdam neurology. 9th e. Pg. 1240.
Information about the conduction of impulses through the
proximal segments of a nerve is provided by the study of the H
reflex and the F wave
The H-reflex (or Hoffmann’s reflex) is a reflectory reaction of
muscles after electrical stimulation of sensory fibers (Ia
afferents stemming from muscle spindles) in their innervating
nerves (for example, those located behind the knee)
H-reflex is analogous to the mechanically induced spinal stretch
reflex
H reflex:
 Submaximal stimulation of mixed motor–sensory nerves,
insufficient to produce a direct motor response, nonetheless
induces a muscle contraction (H wave) after a latency that is
far longer than that of the direct motor response
 Activation of afferent fibers from muscle spindles (the same
axons that conduct the afferent volley of the tendon reflex),
 Long delay reflects the cumulative time required for the
impulses to reach the spinal cord via the sensory fibers, synapse
with anterior horn cells, and to be transmitted along motor
fibers to the muscle
The H reflex is particularly helpful in the diagnosis of S1
radiculopathy and of polyradiculopathies
F Response (Wave)
 Supramaximal stimulus of a mixed motor–sensory nerve.
 After a latency that is longer than for the direct motor
response, a second small muscle action potential is recorded.
 Impulses that travel antidromically in motor fibers to the
anterior horn cells, a small number of which are activated and
produce an orthodromic response that is recorded in a distal
muscle.

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