Gross Anatomy

178 Pages·1992·14.909 MB·English

by  William J. L. Felts Ph.D. (auth.), William J. L. Felts Ph.D. (eds.)

Basic-Sciences Review for Medical Licensure
Developed at
The University of Oklahoma, College of Medicine
Suitable Reviews for:
United States Medical Licensing Examination
(USMLE), Step 1
Federation Licensing Examination (FLEX)
Gross Anatomy
Second Edition
William J.L. Felts
Springer-Verlag
New York Berlin Heidelberg London Paris
Tokyo Hong Kong Barcelona Budapest
William J.L. Felts, Ph.D.
Department of Anatomical Sciences
College of Medicine Health Sciences Center
The University of Oklahoma
Oklahoma City, OK 73190
USA
Library of Congress Cataloging-in-Publication Data
Felts, William J.L. (William Joseph Lawrence), 1924-
Gross anatomy j William J.L. Felts.-2nd ed.
p. cm.-(Oklahoma notes)
1. Human anatomy-Outlines, syllabi, etc. 2. Human
anatomy-Examinations, questions, etc. I. Title. II. Series.
[DNLM: 1. Anatomy. QS 4 F328gj QM31.F45 1992
611-dc20
DNLMjDLC
for Library of Congress 92-2144
Printed on acid-free paper.
© 1992, 1987 Springer-Verlag New York, Inc.
Softcover reprint ofthe hardcover 2nd edition 1992
All rights reserved. This work may not be translated or copied in whole or in part without
the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Ave
nue, New York, New York 10010, USA), except for brief excerpts in connection with
reviews or scholarly analysis. Use in connection with any form of information storage
and retrieval, electronic adaptation, computer software, or by similar or dissimilar meth
odology now known or hereafter developed is forbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publication,
even if the former are not especially identified, is not to be taken as a sign that such
names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly
be used freely by anyone.
While the advice and information in this book is believed to be true and accurate at the
date of going to press, neither the authors nor the editors nor the publisher can accept
any legal responsibility for any errors or omissions that may be made. The publisher makes
no warranty, express or implied, with respect to the material contained herein.
Production managed by Christin R. Ciresi; Manufacturing supervised by Jacqui Ashri.
Camera-ready copy prepared by the author.
9 8 7 6 5 4 321
ISBN-13: 978-0-387-97295-4 e-ISBN-13: 978-1-4612-2758-8
DOl: 10.1007/978-1-4612-2758-8
Preface to the
t)~~
In 1973, the University of Oklahoma College of Medicine instituted a require
ment for passage of the Part 1 National Boards for promotion to the third year.
To assist students in preparation for this examination, a two-week review of the
basic sciences was added to the curriculum in 1975. Ten review texts were writ
ten by the faculty: four in anatomical sciences and one each in the other six
basic sciences. Self-instructional quizzes were also developed by each discipline
and administered during the review period.
The first year the course was instituted the Total Score performance on Na
tional Boards Part I increased 60 points, with the relative standing of the school
changing from 56th to 9th in the nation. The performance of the class since then
has remained near the national candidate mean (500) with a range of 467 to 537.
This improvement in our own students' performance has been documented (Hyde
et al: Performance on NBME Part I examination in relation to policies regarding
use of test. J. Med. Educ. 60:439-443, 1985).
A questionnaire was administered to one of the classes after they had com
pleted the Boards; 82% rated the review books as the most beneficial part of the
course. These texts were subsequently rewritten and made available for use by
all students of medicine who were preparing for comprehensive examinations
in the Basic Medical Sciences. Since their introduction in 1987, over a quarter
of a million copies have been sold. Assuming that 60,000 students have been
first-time takers in the intervening five years, this equates to an average of four
books per examinee.
Obviously these texts have proven to be of value. The main reason is that they
present a concise overview of each discipline, emphasizing the content and con
cepts most appropriate to the task at hand, i.e., passage of a comprehensive ex
amination over the Basic Medical Sciences.
The recent changes in the licensure examination structure that have been made
to create a Step l/Step 2 process have necessitated a complete revision of the
Oklahoma Notes. This task was begun in the summer of 1991; the book you are
now holding is a product of that revision. Besides bringing each book up to date,
the authors have made every effort to make the texts and review questions con
form to the new format of the National Board of Medical Examiners tests.
I hope you will find these review books valuable in your preparation for the
licensure exams. Good Luck!
Richard M. Hyde, Ph.D.
Executive Editor
Preface
This is not a textbook. Instead, it contains what the author judges necessary to
cope with questions relating to Gross Anatomy in board and licensure exami
nations. Although material that has appeared recently on (Part I) National Board
Examinations is covered, simply listing and answering such questions certainly
would not prepare you for the myriad possible alternatives. Because of your suc
cessful background in anatomy, the approaches used in a first-year course are
not necessary here. Recall, review and synthesis are the goals. Please examine
the entire book now, to understand its organization and content, and how they
may serve your needs.
Throughout, text is kept to a minimum. The style, size and boldness of type
were chosen to aid the quick recognition of import items. The illustrations, es
sentially adaptations from blackboard drawings used by the author in reviews,
support the text in certain areas. However, the number of illustrations sufficient
to make this an independent resource would defeat our purpose. I assume you
will consult your favorite atlas as you review, and that you are experienced enough
now to relate your reading to your own body. A general table of contents follows
this preface; detailed tables of content precede individual chapters.
The extremity chapters each emphasize systems and function. Material is ar
ranged for review from lists or for more detailed study. Overviews introducing
each muscle group or compartment may be sufficient, but concise descriptions
of individual muscles are included. In these chapters-indeed, throughout the
manual-tracing of vessels, often with parallel nerves, is a means of reviewing
critical relationships.
The chapter on the trunk is a departure from tradition, for it contains topics
usually studied in separate thoracic and abdominopelvic blocks. You may wish
to review its musculoskeletal aspects with later chapters. However, I strongly
recommend that you review central lymphatics and the autonomic nervous sys
tem here, as entities.
The thorax and abdomen and pelvis chapters share certain emphases: dis
positions of serous membranes, major vascular patterns and then viscera. In the
abdomen and pelvis, tracing of individual vessels after presentations of viscera
reinforces knowledge of the peritoneum, an essential point in understanding the
region.
The complex detail in head and neck anatomy is always a problem. This chap
ter presents general information and traditional anatomical subregions. The tri
geminal nerve is emphasized relative to other nerves and to blood vessels. Cer
tain topics (e.g., CN X) are not reviewed as entities. It was determined they are
better treated in pieces, in overlapping packets of information on viscera or an
atomical subregions.
The final chapter contains questions and answers of the types used in board
and licensure examinations. They are, however, anatomical, not problem-solv-
viii Preface
ing. Placing questions at the end of the manual avoids interruption of the text.
The questions are learning devices, placing a premium on thoughtful reading.
Please consider why each alternative is correct or incorrect; this in itself is an
excellent method of review.
I wish you a productive review!
William Felts
Contents
Preface to the Oklahoma Notes ..................................... v
Preface ........................................................... vii
Figures........................................................... xi
Upper Extremity .................................................. 1
Joints and Movements ........................................... 1
Musculature .................................................... 5
Vasculature ..................................................... 15
Some Important Relationships .................................... 22
Lower Extremity .................................................. 24
Joints and Movements ........................................... 24
Musculature .................................................... 30
Vasculature ..................................................... 38
Some Important Relationships .................................... 45
The Trunk ........................................................ 48
Skeleton ........................................................ 48
Musculature .................................................... 51
Lymphatics ..................................................... 59
Autonomic Nervous System...................................... 62
Thorax........................................................... 66
Thoracic Cavity ................................................. 66
Pleura.......................................................... 66
Blood Vessels and Nerves in Thoracic Wall ....................... 68
Trachea and Lungs .............................................. 71
Heart ..................................... ,..................... 73
Contents of Mediastina .......................................... 77
Abdomen and Pelvis .............................................. 79
Abdominopelvic Cavity. .. . . . . . . . .. . .. . . . . . . .. .. . . . . .. . . ... . . .. . . 80
Peritoneum ..................................................... 81
Abdominal Aorta and Inferior Vena Cava ......................... 84
Gastrointestinal Tract ............................................ 86
Celiac and Mesenteric Arteries and Portal Vein .. " . . . . .. . . . . . . . . . . 92
Urinary System ................................................. 96
Male Reproductive System ....................................... 100
Female Reproductive System ................. , . . . . . . . . . . . . . .. . . . . 103
Distribution of Iliac Arteries and Veins ........................... 106
Lumbar and Sacral Plexuses ....... " ........... " . .. . .. . . . . . ... . . 108
x Contents
Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Functional Components of Cranial Nerves ........ " . .. .. . . . . . . . .. . 112
Head-Neck Muscles and Innervations ............................. 113
Vasculature ..................................................... 114
Lymphatics ..................................................... 117
Autonomies in the Head ......................................... 119
Cranial Cavity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Orbit........................................................... 129
CN V2 in Maxilla and Nasal Cavity ............................... 132
Infratemporal Fossa, Muscles of Mastication and eN v3 •••••••••••• 136
Tongue and Suprahyoid Region .................................. 139
Oral and Nasal Cavities and Adjacent Parts of Pharynx ............ 142
Pharnyx ........................................................ 144
Larynx and Thyroid Gland ....................................... 145
Cervical Triangles and Cervical Plexus ............................ 149
Parotid Region .................................................. 150
Questions and Answers. . .. . . . . . . . . . . . . . . . ... . . . . .. .. . .. . . . . . . . . . . . 152
Upper Extremity Questions ...................................... 152
Lower Extremity Questions ...................................... 155
Thorax Questions ............................................... 157
Abdomen and Pelvis Questions. . . . . . . . . ... . . . . . . . .. . .. . . . . . . . . . . . 160
Head and Neck Questions ........................................ 164
Figures
Upper Extremity
p. 2 Important Features of Major Joints in the Upper Extremity
p. 6 Brachial Plexus: Roots, Trunks and Divisions, Cords and Nerves
p. 7 Motor Innervation in Arm, Forearm and Hand
p. 11 Schematic of Muscles of the Forearm
p. 16 Axillary, Brachial, Radial and Ulnar Arteries
p. 17 Arteries in the Hand
p. 21 Nerve and Artery Relationships in Arm and at Wrist
Lower Extremity
p. 26 Important Features of Major Joints in the Lower Extremity
p. 28 Relationships in Arches of the Foot
p. 31 Motor Innervation in the Lower Extremity
p. 39 Femoral and Popliteal Arteries
p. 42 Arteries of the Foot
p. 46 Nerve and Artery Relationships in the Leg and at the Ankle
Trunk
p. 56 Inguinal Region: Rings and Coverings of the Spermatic Cord
p. 58 Male Urogenital Diaphragm
p.60 Central Lymphatics in Thorax and Abdomen
p.63 Schematic of the Sympathetic Division of the ANS
p.64 Schematic of the Parasympathetic Division of the ANS
Thorax
p. 67 Mediastina
p.69 Veins of the Thoracic Wall
p.72 Topography of the Lungs
p.74 Projection of the Heart in situ
p.75 Coronary Arteries and Cardiac Veins
Abdomen and Pelvis
p. 82 Bare Areas and Mesenteries
p. 85 Abdominal Aorta and Inferior Vena Cava
p. 89 Inferior Surface of the Liver
p. 93 Celiac Artery
p. 94 Superior and Inferior Mesenteric Arteries
p. 95 Portal Venous System
p. 97 Anterior Relationships of the Kidneys
p. 104 Components and Contents of the Broad Ligament
p. 107 Internal Iliac Artery
xii Figures
Head and Neck
p. 115 External Carotid Artery
p. 120 Parasympathetic Ganglia in the Head
p. 121 Parasympathetic Ganglia in the Head (cont.)
p. 123 Cranial Base
p. 126 Dural Septa
p. 127 Schematic of the Dural Sinuses
p. 131 Ophthalmic Artery and Ophthalmic Division of CN V
p. 133 Maxillary Division of CN V
p. 134 Maxillary Division of CN V (cont.)
p. 138 Mandibular Division of CN V
p. 140 Suprahyoid Region
p. 146 Larynx
p. 147 Blood Vessels and Nerves of the Thyroid and Larynx