Anatomy Exam Guide 1.pdf

The exam is split into 50 questions. Mostly multiple choice with a few true and false and one select all that apply. You will have 75 minutes to complete the exam. Some of the questions will reference attached photos. There are a couple scenario questions that are a part of the test. These are used...

The exam is split into 50 questions. Mostly multiple choice with a few true and false and one select all that apply. You will have 75 minutes to complete the exam. Some of the questions will reference attached photos. There are a couple scenario questions that are a part of the test. These are used to help connect anatomy to real life scenarios. 1. Review of anatomical terms What is regional anatomy? ○ Method of studying the body’s structure by focusing attention on a specific part ○ Examining the arrangement and relationships of systemic structures (muscles, nerves, bones, vasculature) within each part ○ Regions: Head, Neck, Back, Thorax, Upper Limbs, Abdomen, Pelvis and Perineum, Lower Limbs Regional Anatomy: Study of Layers ○ Regional anatomy focuses on the body’s organization by layers: Skin, subcutaneous tissue, deep fascia, muscles, skeleton, cavities containing viscera (organs) “Base Human Model” “You cannot fix it unless you know how it works” Surface Anatomy ○ Studying structures that are visible and palpable below the skin on living individuals Anatomical landmarks ○ Physical exam on patients (palpation, deep palpation, auscultation, observation) is a clinical application of surface anatomy Example Finding and palpating the radial artery for a pulse Finding and auscultating the right middle lobe of the lung Anatomical Position ○ One consistent and standardized position so that all anatomical descriptions are the same ○ Allows you to relate any part of the body precisely to any other part of the body ○ Head, eyes, and toes directed anteriorly (forward) ○ Arms adjacent to the sides with palms facing ○ anteriorly (forward) ○ Lower limbs close together with feet parallel 2. Review of anatomical planes Based on 3 cardinal plane ○ Median Plane (Median or Midsagittal Plane) ○ Frontal (coronal) ○ Transverse (axial) Median Plane (Median or Mid- Sagittal Plane) ○ Vertical plane that passes longitudinally through the midlines of the head, neck, and trunk ○ Divides the body into left and right halves Sagittal Plane (Parasagittal) ○ Vertical planes that pass through the body parallel to the median plane (on either side) ○ Divide body into unequal halves Frontal (Coronal) Plane ○ Vertical plane that passes through the body at right angle to median plane ○ Divides body into anterior (front) and posterior (back) sections Transverse Plane (Axial Plane) ○ Horizontal plane that passes through body at right angles to medial and frontal planes ○ Divides body into superior (upper) and inferior (lower) parts Anatomical Sections ○ Longitudinal Sections made from median, sagittal, and frontal planes Run lengthwise/parallel to long axis of body ○ Transverse Cross-sections Slices cut at right angles to longitudinal axis of body Sections made from transverse/axial plane ○ Oblique Slices of the body not cut along any of the anatomical planes.  Anatomy Directional Terms 3. Review the structure and purpose of bones, cartilage Basic parts of the bone (Diaphysis, Epiphysis, Metaphysis, Articular Surface, periosteum) ○ Diaphysis (shaft) Long central portion of bone ○ Epiphysis (proximal and distal) Enlargement of bone that caps the diaphysis (on both ends) ○ Metaphysis (proximal and distal) Locations within long bones where growth plates are found ○ Articular surface Ends of epiphysis on both ends that are lined by hyaline cartilage ○ Periosteum fibrous sheath that covers bones. It contains the blood vessels and nerves that provide nourishment and sensation to the bone. Bone ○ Highly specialized, living tissue ○ Hard form of connective tissue ○ Makes up most of the skeleton  ○ Provides: Support for the body and its vital cavities (chief supporting tissue of body) Protection for vital structures Mechanical basis for movement Storage for salts (calcium) Continuous supply of new blood cells (produced in bone marrow) Types of Bone (2 types of bone: Spongy and Compact) ○ Distinguished by the amount of solid matter and the number/size of the spaces they contain ○ All bones have superficial thin layer of compact bone that surround a central mass of spongy bone ○ Compact Bone Compact bone provides strength for weight bearing and stores calcium ○ Spongy Bone house the bone marrow, allow for RBCs formation or erythropoiesis, and allow bones to be less dense and more light. Spongy bone also allows for flexibility. some have medullary cavity (marrow) with yellow (fatty) marrow and red (blood cell and platelet forming) marrow, less dense Different types of cartilage and the areas they are located (3 types: Hyaline, Elastic, Fibro) ○ Cartilage function Resilient, semi-rigid form of connective tissue Forms parts of skeleton where flexibility is needed There is no blood supply (avascular), receives oxygen and nutrients through diffusion Proportion of bone to cartilage changes as person ages (young have more cartilage, old more bone) ○ Hyaline Cartilage flexible cartilage Costal cartilage (where ribs meet sternum) protects the anterior aspect of thoracic walls, lines end of bones of articulating surfaces, end of nose, larynx and trachea, precursor for bone.  ○ Elastic cartilage more flexible and most limited throughout the body Articular cartilage in ears, epiglottis ○ Fibrocartilage more dense, less flexible than hyaline structural/supportive role Intervertebral discs, ligaments, public symphysis, joint capsules, cartilaginous Cartilaginous pads (menisci) between bones of knee shock absorbers 4. Review of terms for movements Flexion ○ bending or decreasing angle between joints/ parts of the body. ○ Joints above the knee → flexion is a movement in anterior direction Extension ○ straightening or increasing the angle between the bones or parts of the body ○ Generally occurs in a posterior direction Hyperextension Extension of a limb beyond the normal limit. Over-extension can cause injury. Example: Whiplash Dorsiflexion ○ flexion at the ankle joint. Example: lifting the toes off the ground Plantar Flexion ○ Bends the foot and toes toward the ground. Example: thinking “planting” your foot on the ground. Protraction ○ anterolateral movement of the scapula (shoulder blade) causing shoulder to move anteriorly Retraction ○ Posteromedial movement of the scapula causing the shoulder to move posteriorly Supination ○ rotates radius laterally returning pronated forearm to anatomical position Pronation ○ rotates radius (lateral long bone of the forearm) medially so that palm of hand faces posteriorly and dorsum of hand faces anteriorly Medial Rotation (Internal Rotation)  ○ Brings anterior surface of a limb closer to the median plane Lateral Rotation (External Rotation) ○ Brings anterior surface away from the median plane Abduction ○ moving away from the median plane ○ Example: moving an upper limb laterally away from the side of the body ○ Abduction of the digits (fingers and toes) → spreading them apart Adduction ○ Moving towards the median plane ○ Example: moving an upper limb medially towards the side of the body ○ Adduction of the digits (fingers and toes) → bringing spread toes/fingers closer together 5. Types of Joints Synovial: most abundant in body - free movement with capsules containing synovial fluid (limbs, knee joints etc) ○ Plane: gliding and sliding (AC joint) ○ Hinge: flexion and extension only (elbow) ○ Saddle: more circumduction (thumb) ○ Condyloid: limited circumduction (knuckles) ○ Ball in socket: very mobile (hips and shoulders) ○ Pivot: rotation around central axis (vertebrae) Fibrous joint: connects together with fibrous tissue ○ Syndesmosis: partial movement ○ Dento-alveolar syndesmosis: tooth in jaw Cartilaginous: articulating joints united by hyaline and fibrous cartilage ○ Primary cartilaginous joints (synchondroses): hyaline and bendable ○ Secondary cartilaginous joints (symphyses): fibrocartilage and less bendable 6. Review role of Lymphatics Purpose: Immune system + carry interstitial fluid to circulatory system ○ plays a role in immune response but its not the only function Can tell progression of cancer ○ Clinical correlations → Radical Lymphadectomy in the upper extremity will have what type of precautions? Radical lymphadenectomy touches on a clinical procedure often related to cancer treatment, where lymph nodes are surgically removed. After a radical lymphadenectomy in the upper extremity, precautions are typically put in place to manage complications like lymphedema (swelling) due to lymphatic drainage from removal of nodes. 7. Bones of the upper extremity Humerus ○ Largest bone of the upper limb ○ Articulates with scapula at glenohumeral joint ○ Articulates with radius and ulna at the elbow joint ○ Medial/lateral epicondyles: sites of muscle attachment ○ Lesser tubercle: anterior ○ Greater tubercle: better seen in posterior, lateral margin Radius ○ lateral, short bone ○ Short head: articulates with capitulum of humerus during flexion/extension ○ Styloid process of radius: styloid process of radius ○ Important point to palpate to assess fractures Ulna ○ stabilizing bone of forearm, longer, medial, articulates with humerus, allows for flexion/extension ○ Olecranon: articulates with humerus, lever for extension of elbow ○ Coronoid process: articulates with humerus, projects anteriorly ○ Ulnar styloid process: shorter than radial styloid process, visible/palpable through skin Scapula ○ Overlines 2nd -7th ribs ○ Spine of scapula - can palpate ○ Acromion - articulates with acromial end of clavicle - forming acromioclavicular joint ○ Coracoid process - beak like anterior project, provides stability to shoulder ○ Glenoid cavity: articulates with head of humerus - forms glenohumeral joint Clavicle ○ Connects upper limb to trunk ○ Long bone (no medullary cavity) ○ Sternal end: articulates with manubrium of sternum ○ Shaft ○ Acromial end: articulates with acromion of scapula - forms acromioclavicular joint How the digits are numbered ○ Thumb is 1, pinky is 5 The difference of DIP and PIP ○ Distal interphalangeal point → (tip of finger) ○ Proximal interphalangeal point → (closest to palm)  Movements of the shoulder girdle ○ Elevation: Raising the shoulder upwards, as in shrugging. The scapula moves superiorly. ○ Depression: Lowering the shoulder downward. The scapula moves inferiorly. ○ Protraction (Abduction): Moving the shoulder blade away from the spine, as in reaching forward. ○ Retraction (Adduction): Pulling the shoulder blade toward the spine, as in pinching the shoulder blades together. ○ Upward Rotation: When the arm is raised overhead, the scapula rotates so its lower part moves upward and away from the spine. ○ Downward Rotation: Returning the arm from an elevated position, the scapula rotates so its lower part moves downward toward the spine. ○ How it articulates with the axial skeleton (formed by scapula, clavicle and manubrium of sternum) The clavicle is the only bony connection between the upper limb and the axial skeleton. It articulates with: Manubrium of the sternum at the sternoclavicular joint. The acromion of the scapula at the acromioclavicular joint The scapula does not directly articulate with the axial skeleton; it "floats" and is connected via muscles that allow its movement over the thoracic cage. ○ Role of important structures The muscles of the shoulder girdle act as active ligaments, supporting the articulation of the head of the humerus in the glenoid cavity. They include the supraspinatus, subscapularis, teres minor, infraspinatus and long head of the biceps. The first four of these muscles constitute the rotator cuff. Sternoclavicular Joint: The only joint connecting the shoulder girdle to the axial skeleton, allowing movement of the clavicle in three planes. Acromioclavicular Joint: A gliding joint that allows the scapula to move relative to the clavicle. Glenohumeral Joint: The shoulder joint proper, where the head of the humerus articulates with the glenoid cavity of the scapula. It’s a ball-and-socket joint that allows a wide range of motion. Coracoclavicular Ligament: Connects the coracoid process of the scapula to the clavicle, providing stability between the clavicle and scapula.  Basic types of fractures (complete, compound, greenstick, spiral, Comminuted) ○ Compound Open fracture (compound fracture): The bone pokes through the skin and can be seen. ○ Greenstick This is an incomplete break. A part of the bone is broken, causing the other side to bend. (common in kids) ○ Spiral The break spirals around the bone. This is common in a twisting injury. ○ Comminuted The bone has broken into 3 or more pieces (shattering). Fragments are present at the fracture site. Often from high impact trauma ○ Oblique A diagonal fracture across the bone, often from an angled blow. 8. Muscles of the upper extremity Different types of contraction (concentric, eccentric, and isometric) Skeletal muscle contraction ○ shorten and then relax to normal length Reflexive contractions: Involuntary ex: respiratory movements of diaphragm Tonic contraction or muscle tone: Slight contraction Does not produce movement or active resistance Gives muscle firmness - assists in stability of joint/maintenance of posture Occurs when unconscious Isotonic Muscle Contraction ○ muscle changes length to produce movement Concentric: muscle shortens Muscle length decreases Eccentric muscle relaxes and lengthens, muscle length increases Isometric Contraction ○ muscle tension increases, but length stays the same = no movement ○ Force (muscle tension) is increased  What major muscles cause what movements Muscle(s) Movement Anterior shoulder girdle Horizontal adduction and protraction Pectoralis Major Clavicular attachment (works to flex humerus) Shoulder flexion Sternal attachment Together: horizontal adduction + internal rotation of the arm Pectoralis Minor ○ Shoulder depression ○ Protract and depress scapula ○ Elevate ribs for deep inspiration Serratus Anterior ○ Shoulder abduction above 90 degrees ○ Protract scapula ○ Rotates scapula Posterior Shoulder Girdle Attach the superior appendicular skeleton to axial skeleton Trapezius (superficial) ○ Elevate scapula ○ Depress scapula ○ Retract scapula ○ (EDRS) Latissimus Dorsi ○ Extends shoulder ○ Adduct humerus ○ Raises trunk to arm (chin-ups) Levator Scapulae ○ Lateral flexion of the neck ○ With upper trapezius elevate scapula *in chronic neck pain, muscle ○ With trapezius, extends neck shortens Rhomboids ○ Retract and downward rotation of the scapula ○ depressing glenoid cavity Deltoid (pulls arm up) ○ stabilize glenohumeral joint and hold head Anterior of humerus in the glenoid cavity during Middle movements of upper limb posterior ○ All 3 parts: Abduct arm ○ Anterior and posterior parts used to swing limbs when walking ○ Anterior with pec major in flexing arm ○ Middle helps with horizontal abduction ○ Posterior with latissimus dorsi in extending arm Teres Major Adducts and medially/internally rotates arm Rotator Cuff Muscles (SITS) ○ Rotate the humerus (Except supraspinatus) ○ Protects joint and gives stability Supraspinatus ○ Force couple (works in conjunction with another muscle to achieve one goal): initiates and assists the deltoid in the first 15 degrees abduction of the arm ○ Abduct and stabilizes arm at glenohumeral joint **lies on supraspinous fossa Infraspinatus Externally rotate humerus **lies on infraspinous fossa Teres Minor Externally rotate arm and assist in adduction Subscapularis Internally rotate arm and adduct arm Muscles of the Arm Biceps Brachii ○ Supinates forearm ○ Flexes forearm ○ Long head resists dislocation of shoulder Brachialis Main flexor of forearm (flexes in all directions) Coracobrachialis ○ Forward flexion and adduct arm ○ Resists dislocation of shoulder Triceps Brachii ○ Main extensor of the forearm/ elbow *supply by the radial nerve extensors ○ Resists dislocation of shoulder Muscles of anterior compartment of ○ Flexors and pronators of the forearm the forearm ○ Served by median nerve Muscles of posterior ○ Extensors and supinator of the forearm compartment of the forearm ○ Served my radial nerve What innervates the forearm muscle? (Radial, Median, Ulnar) ○ The muscles of the forearm are primarily innervated by the median nerve, ulnar nerve, and radial nerve. ○ Median nerve innervates most of the anterior forearm muscles responsible for flexion and pronation, such as the flexor carpi radialis and flexor digitorum superficialis. ○ Ulnar nerve innervates some anterior muscles, including the flexor carpi ulnaris and the medial half of the flexor digitorum profundus. ○ Radial nerve innervates all the posterior forearm muscles, which are responsible for extension and supination, like the extensor carpi radialis and extensor digitorum. These nerves work together to control movements of the forearm. What is a force couple and where is it found  ○ A force couple is when two or more muscles work together to produce movement in different directions, but their combined action results in a rotational movement of a body part. Each muscle in a force couple generates force in opposite directions, but the overall effect is to produce rotation or stability of a joint. ○ Example: When supraspinatus initiates and assists deltoid in the first 15 degrees of abduction of the arm What muscles are agonists/antagonists of each other ○ Agonist and antagonist muscles work in pairs to control movement. ○ The agonist is the primary muscle responsible for the movement, while the antagonist opposes the action to provide balance and control. ○ Common agonist/antagonist pairs: Biceps brachii (agonist) / Triceps brachii (antagonist): Biceps flex the elbow, triceps extend it. Pectoralis major (agonist) / Latissimus dorsi (antagonist): Pectoralis major adducts and flexes the arm, latissimus dorsi extends and abducts the arm. Deltoid (anterior fibers) (agonist) / Latissimus dorsi (antagonist): Anterior deltoid flexes the shoulder, latissimus dorsi extends the shoulder. Trapezius (upper fibers) (agonist) / Pectoralis minor (antagonist): Trapezius elevates the scapula, pectoralis minor depresses it. What muscles involved form the rotator cuff? ○ Referred to as the SITS muscle, with reference to the first letter of their names (Supraspinatus, Infraspinatus,Teres minor, and Subscapularis). ○ The muscles arise from the scapula and connect to the head of the humerus, forming a cuff around the glenohumeral (GH) joint. 9. Vasculature of the upper extremity The arterial blood flow to the hand ○ Subclavian → axillary → brachial artery → ulnar (supplies most of hand) & radial artery (supplies some of hand) ○ Ulnar Artery → supplies most of hand (medial aspect, pinky side) ○ Radial Artery → supplies elbow joint and some of hand (lateral aspect, thumb side) Major venous blood return to the body from the hand ○ Subclavian Vein, Cephalic Vein, Axillary Vein, Brachial Vein, Basilic Vein, Median Cubital Vein, Radial & Ulnar Vein, there are also perforating veins Palpation points for pulse (radial and brachial) ○ Radial artery: anterior surface on distal end of radius  ○ Brachial artery: for blood pressure 10. Main nerves of the upper extremity Musculocutaneous, ulna, radial, and median nerves: what muscle is affected by nerves? ○ Median nerve flexors and pronators of the forearm (principle nerve for anterior component) ○ Radial nerve extensors and supinators of the forearm, arm, triceps ○ Ulnar 1 ½ muscles of the forearm ○ Musculocutaneous nerve coracobrachialis, biceps, brachialis ○ Symptoms weak flexion, paralysis, numbness/ tingling ○ Main innervations of these nerves and the purpose they serve. ○ Symptoms associated with damage to these nerves 11. Anatomical landmarks/ Surface landmarks of the Upper extremity Anatomical snuff box ○ The Radial Styloid Process is palpated in the triangular depression on the dorsal side of the wrist. ○ anatomical landmark over the scaphoid bone Spine of the scapula ○ A thick projecting ridge of bone on the posterior surface of the scapula. It divides the scapula into supraspinous and infraspinous fossa ○ Supraspinous fossa - above the spine of the scapula ○ Infraspinous fossa - below the spine of scapula ○ Subscapular fossa- concave, coastal surface of scapula ○ Inferior angle of the scapula: bottom of scapula AC joint (acromioclavicular) ○ The superior surface or end of the acromion can be traced medially to the AC joint  SC joint ○ The Sternoclavicular Joint (SC joint) is formed from the articulation of the medial aspect of the clavicle and the manubrium of the sternum. The sternoclavicular (SC) joint is the link between the clavicle (collarbone) and the sternum (breastbone). ○ The SC joint supports the shoulder and is the only joint that connects the arm to the body. ○ The SC joint is covered with a smooth, slippery substance called articular cartilage. Sternoclavicular joint is the only connecting thing to axial skeleton 12. Brief overview of imaging modalities X-ray vs. CT scan vs. MRI vs. Nuclear imaging/PET scan Basic principles of x-rays and CT scan. What looks like what. X-Ray: conventional radiology → shows tissues of differing densities of mass ○ Dense tissue: lighter ○ less dense: darker ○ Radiation CT (also CAT scan) scan: computerized tomography → always viewed from bottom up when patient in supine position - measures amount of radiation that passes through the body ○ Best for bones and harder structures MRI: magnetic resonance imaging → better for tissue differentiation (downfall = strong magnet) ○ Sends magnetic wave through patient, realigns protons, re-creates image Nuclear imaging/PET scan: best for cancer → shows aerobic glycolysis (using warburg effect to identify aerobic glycolysis) ○ Radiation ○ metabolized by cells at different rates ○ Can show if cells are alive and how active they are Ultrasound (echolocation): ultrasonography → records pulses of ultrasonic waves reflecting off tissues ○ Cheaper, more portable, shows flow of blood vessels, no radiation, movement of structures (safe for pregnancy) Which is best for blood flow: ultrasound Which is best for soft tissue: MRI Which is best for metastatic disease and cellular metabolism → PET, nuclear imaging 13.Bones of the lower extremity Femur, Tibia, fibula, tarsals, metatarsals, phalanges 14. Joints of the lower extremity Femoroacetabular, knee, talocrural ○ Talocrural - joint formed between the distal tibia-fibula and the talus bone; plantarflexion and dorsiflexion ○ Femoroacetabular - ball and socket joint formed between the femur and the pelvic bone; large range of motion ○ Knee joint - articulation of tibiofemoral and patellofemoral; hinge movements 15. Muscles of the lower extremity Hip flexors  hip extensors Adductors Abductors knee extensors and flexors plantar flexors dorsiflexors 16. Clinical correlations for the lower extremity Compartment syndrome ○ Excessive pressure builds up in an enclosed muscle space due to either blood, fluid, or edema. Caused by crush injury, wrapping a bandage too tight, burns, extremely vigorous exercise Symptoms: persistent deep ache, numbness (pins & needles) Swelling, tightness, and bruising Treatment: Fasciotomy Sprains and strains → tip for strain. There’s a T in Strain so it relates to the tendons! ○ A sprain occurs when you overextend or tear a ligament while severely stressing a joint. A sprain is an injury to the ligaments and capsule of a joint in the body. ○ A strain occurs when tendons (bands at the end of muscles that connect muscles to bones) get stretched or pulled away from the bone. A strain is an injury to muscles or tendons 17. Main arteries and veins of the lower extremity - PAD vs PVD Peripheral Arterial Disease (PAD): narrowing of arteries reducing blood flow to limbs ○ Symptoms: claudication (leg pain during exercise), weak pulses ○ Management: lifestyle changes, medications, surgery Peripheral Venous Disease (PVD): problems with veins that interfere with returning blood to the heart ○ Symptoms: swelling, varicose veins, ulcers ○ Management: compression therapy, medications, surgery