Table Of Content

ANATOMY MEDICAL COURSE AND STEP 1 REVIEW FIRST EDITION Accompanies online videos taught by Rhett Thomson & Michael Christensen physeo.com Copyright © 2019 by Physeo All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of Physeo, except in the case of personal study purposes. TABLE OF CONTENTS CARDIOVASCULAR ANATOMY ............................................................................................3 Section I - Arteries of the Upper Body ................................................................................................................................................3 Section II - Veins of the Upper Body ...................................................................................................................................................7 Section III - Arteries of the Lower Body ...........................................................................................................................................10 Section VI - Veins of the Lower Body ...............................................................................................................................................12 Section V - Gastrointestinal Arteries .................................................................................................................................................16 Section VI - Gastrointestinal Veins and the Portal System ................................................................................................................19 Section VII - Ovarian and Testicular Vasculature ..............................................................................................................................22 Section VIII - Cardiovascular Anatomy on Imaging .........................................................................................................................25 RESPIRATORY ANATOMY ....................................................................................................28 Section I - Overview of Respiratory Anatomy ..................................................................................................................................28 RENAL ANATOMY ..................................................................................................................31 Section I - Overview of Renal Anatomy ............................................................................................................................................31 GASTROINTESTINAL ANATOMY .......................................................................................34 Section I - Mesentery and Peritoneum ...............................................................................................................................................34 Section I.1 - Retroperitoneal Organs..................................................................................................................................................40 Section II - Inguinal Canal .................................................................................................................................................................42 Section III - Pectinate Line ................................................................................................................................................................47 Section IV - Layers of the Intestinal Wall ..........................................................................................................................................51 ENDOCRINE ANATOMY ........................................................................................................56 Section I - Overview of Endocrine Anatomy .....................................................................................................................................56 REPRODUCTIVE ANATOMY ................................................................................................57 Section I - Female Reproductive Organs ...........................................................................................................................................57 Section II - Female Ligaments and Local Structures .........................................................................................................................61 Section III - Pelvic Floor ....................................................................................................................................................................66 Section IV - Male Reproductive Organs ............................................................................................................................................69 NEUROANATOMY ..................................................................................................................72 Section I - Neuroanatomy Overview .................................................................................................................................................72 MUSCULOSKELETAL ANATOMY .......................................................................................73 Section I - Upper Trunk, Axillary, Musculocutaneous, Suprascapular Nerves .................................................................................73 Section II - Lower Trunk and the Median and Ulnar Nerves ............................................................................................................82 Section III - Radial and Long Thoracic Nerves .................................................................................................................................88 Section IV - Shoulder .........................................................................................................................................................................92 Section V - Elbow and Wrist ..............................................................................................................................................................99 Section VI - Lumbosacral Plexus.....................................................................................................................................................105 Section VII - Hip ..............................................................................................................................................................................109 Section VIII - Lumbar Radiculopathy .............................................................................................................................................113 Section IX - Knee Ligaments and Menisci ......................................................................................................................................117 Section X - Other Knee and Leg Conditions ...................................................................................................................................121 Section XI - Ankle and Foot ............................................................................................................................................................125 3 We would like to extend a special thanks to the following individual who has spent many hours tutoring, guiding and consulting this work, making Physeo Anatomy possible. Julie Anne Jahp MD Candidate, Class of 2022 University of Utah School of Medicine 4 CARDIOVASCULAR ANATOMY Section I - Arteries of the Upper Body I. There are seven arteries of the upper body that are important to know for board examinations. (See Table 3.1.1 - Upper body arteries) Vessel Anatomy Notes • From aortic arch (left side) • Subclavian steal (proximal stenosis → Subclavian artery • From brachiocephalic artery (right side) retrograde vertebral artery flow) • Anterior arteries arise from subclavian Intercostal arteries • Rib notching in aortic coarctation • Posterior arteries arise from aorta Internal carotid • Supplies brain • Involved in strokes artery • Involved in face, neck or nose pathology External carotid • Supplies face, neck and nose (mostly via • Epistaxis (especially medial nose) artery maxillary artery) • Epidural hematoma (middle meningeal artery) • Damaged in distal humeral fractures with median nerve Brachial artery • From axillary artery • Memory hook: “Brake before you hit the median, or you will be in deep red blood” • Damaged in mid-humeral fractures with radial nerve Deep brachial • From brachial artery • Memory hook: “Brake before you hit artery the median, or you will be in deep red blood” • From brachial artery • Scaphoid fractures can result in Radial artery • Branches into dorsal scaphoid branch proximal scaphoid bone necrosis Table 3.1.1 - Upper body arteries 5 Figure 3.1.1 - Upper body arteries 6 Figure 3.1.2 - Neurovasculature diagram 7 II. Subclavian Steal Syndrome 2. Anterior intercostal arteries supply the posterior intercostals -Posterior intercostals A. Proximal subclavian artery stenosis → increased engorge and damage inferior ribs over time pressure (decreased flow) in the vertebral (rib notching) artery on the same side as the obstruction → retrograde blood flow down the vertebral artery on the opposite side of the obstruction IV. Proximal scaphoid bone necrosis A. The dorsal scaphoid branch from the radial artery provides blood to the distal portion of the scaphoid bone before traveling more proximally to supply the proximal scaphoid bone. B. Fractures to the scaphoid bone can leave the distal portion well perfused, but the proximal portion without adequate oxygenation → necrosis III. Aortic Coarctation A. A narrowing of the descending aorta 1. Decreased flow to posterior intercostal arteries 8 REVIEW QUESTIONS ? 1. A 30-year-old male presents to the emergency 3. A 15-year-old boy is involved in a car accident department following trauma to the nose and presents to the emergency department during a snowboarding accident. Physical exam with profuse bleeding from his left arm. He is reveals profuse nasal bleeding. The damaged also unable to extend his wrist. A radiograph arteries resulting in this presentation originate of the injured arm is obtained. Which artery from what vessel? is more likely damaged, the brachial, deep brachial or radial artery? What nerve is likely A) Internal carotid artery damaged? B) External carotid artery C) Vertebral artery D) Middle meningeal artery E) Distal subclavian artery • Answer: Arteries in the face, neck and nose come from the maxillary artery, which is a branch of the external carotid artery. • Most of the bleeding seen in this patient is likely from the medial nose, the nasal sep- tum, where the vascular density is greatest 2. An elderly patient is found to have vertebrobasilar insufficiency, resulting in frequent syncopal episodes. Extensive diagnostic evaluation reveals retrograde blood By Bill Rhodes from Asheville (mid-shaft humeral compound comminuted fx lat) [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons flow through the right vertebral artery directly • This image demonstrates a humerus with into a major vessel. This major vessel arises a midshaft fracture, which places the deep directly from what artery? brachial artery in jeopardy. The deep brachial artery branches off the brachial artery • Because this patient has retrograde blood and crosses the mid humerus in this mid- flow through the right vertebral artery, shaft region. we know this patient has subclavian steal • The nerve often damaged with deep bra- syndrome. chial artery injury is the radial nerve. • The “major vessel” receiving the blood from • Remember the memory hook: Brake before the right vertebral artery is the right subcla- you hit the median, or you will be deep in vian artery, which arises directly from the red blood. brachiocephalic artery. • Meaning that when you damage the deep brachial artery, you are also likely to damage the radial nerve at the same time. • Or you could suspect radial nerve damage from the physical exam. We are told he cannot extend his wrist, which may tell you right there that he has radial nerve damage 9 Section II - Veins of the Upper Body I. There are primarily two major groups of veins that are important to know for board examinations. (See Table 3.1.2 - Upper body veins) Vessel Anatomy Notes • Drain subclavian and internal jugular • Obstruction causes unilateral swelling of Brachiocephalic veins (IJV) tissues drained by EJV and subclavian veins • External jugular vein (EJV) drains into • EJV drains the face and neck subclavian • IJV drains the brain • Drains right and left brachiocephalic • Obstruction causes bilateral swelling Superior vena cava veins (SVC syndrome) of tissues drained by EJV (SVC) • Returns blood to the right atrium and subclavian Table 3.1.2 - Upper body veins Figure 3.1.3 - Upper body veins