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Surgical Anatomy

ST 230

Surgical Anatomy

ST 230

Course Description

Prerequisites: Prerequisites: Admission to the Surgical Technology program and concurrent enrollment in ST 207, ST 210, ST 220, and ST 240.

Presents comprehensive regional study of human anatomy as encountered during surgery. Provides the basis for studies of surgical pathology, operative procedures and practical skills of surgical patient care. Credit may be earned in ST 130 or ST 230 but not in both. (45- 45)

Outcomes and Objectives

Demonstrate progress in communication and language skills, critical thinking, interpersonal/collaborative skills, and information literacy.

Objectives:

  • Communicate in acceptable English and use medical terminology accurately and appropriately.
  • Analyze data and discipline-based knowledge to formulate logical conclusions.
  • Work constructively within a group, demonstrating respect and consideration for others.
  • Demonstrate the ability to access, analyze, and use information appropriate to the discipline.

Demonstrate knowledge of the anatomy of the abdominal wall and of the inguinal and femoral regions.

Objectives:

  • Define "Linea Alba", "Linea Semilunaris", "Scarpas Fascia", and "Camper's Fascia".
  • Explain the surgical significance of the pattern of segmental nerves and superficial arteries of the anterior abdominal wall.
  • Name and locate the muscles of the anterior abdominal wall, and identify the origin and insertion, fiber direction, innervation and actions of each.
  • Explain the differences in the composition of the Rectus Sheath above and below the Arcuate Line.
  • Explain the Lateral, Medial and Median Umbilical Folds on the internal surface of peritoneum.
  • Name and locate the muscles of the posterior abdominal wall, and identify their origin and insertion, innervation, actions, and relationship to the diaphragm and the Lumbar Plexus.
  • Explain the specializations of each of the anterior abdominal wall muscles and fasciae in the inguinal region.
  • Describe the cutaneous innervation of the suprapubic region, inguinal region, scrotum or labia, and medial thigh, and the innervation of the Cremaster muscle.
  • Define the Inguinal Canal (including its boundaries), and the Deep/Internal and Superficial/ External Inguinal Rings, and list the contents of the Inguinal Canal in the male and female.
  • Describe the descent of the testis.
  • Identify the boundaries of Hesselbach's Triangle and compare its relationship to direct and indirect inguinal hernias.
  • Define the Femoral Triangle, including its boundaries and neuro-vascular compartments.
  • Explain the clinical significance of the Saphenous Opening.
  • List the surgical uses of access to the Femoral Artery and Vein.

Demonstrate knowledge of the anatomy and physiology of the abdominal viscera.

Objectives:

  • Differentiate the peritoneal cavity from the abdominopelvic cavity.
  • Discuss the anatomic variability of the biliary system.
  • Name and locate the folds/duplications of visceral peritoneum that suspend abdominal organs, and compare the movement capabilities of those structures.
  • List the major components and the primary functions of bile.
  • Explain the contributions to the process of digestion made by each portion of the alimentary tract and by each of its accessory organs.
  • Trace the path of bile from its formation in the liver to its flow into the duodenum.
  • Identify the four layers of the wall of the stomach and intestines.
  • Identify the component segments of the large intestine and their anatomic relationships.
  • Differentiate the mucosal features and histology along the alimentary tract.
  • List the distinguishing external features of the colon.
  • Identify and discuss the role of valves and sphincters along the alimentary tract.
  • Describe the arterial arcade along the large intestine.
  • Explain the role of the lymphatic system in transporting products of digestion and identify the major lymphatic vessels.
  • Discuss the pattern of lymphatics associated with the colon.
  • Describe the change in position of the Vagus Nerves between the chest and the esophago-gastric junction, and trace Vagal branches along the stomach.
  • Trace the arterial supply and venous drainage of the rectum and anal canal.
  • Describe the shape, location, subdivisions and anatomic relationships of the stomach.
  • Explain the composition and the function of the Pelvic Diaphragm.
  • Differentiate Greater and Lesser Omentum, and list the components of the Greater Omentum.
  • Differentiate the Internal and External Anal Sphincters.
  • Define the entrance and boundaries of the lesser peritoneal sac (omental bursa).
  • Describe the location and contents of the Ischiorectal/Ischioanal Fossa.
  • Discuss the shape, subdivisions, location and anatomic relationships of the duodenum.
  • Describe the mucosal features of the rectum and the anal canal.
  • Describe the arterial supply of the stomach, duodenum and pancreas.
  • Explain the anatomic differences above and below the Pectinate/Dentate Line of the anal canal.
  • Define the Ligament of Treitz and explain its surgical significance.
  • Compare the effects of Parasympathetic and Sympathetic stimulation on the digestive organs.
  • Discuss the length of the jejunoileum, its differentiating features (surgical landmarks), blood supply, and the attachment and characteristics of its mesentery.
  • Summarize the distributions of the Celiac Trunk/Axis, the Superior Mesenteric Artery, and the Inferior Mesenteric Artery, and relate this to embryologic development.
  • Describe the appendix and its blood supply, and explain the variations in its location.
  • Describe the location and regions of the pancreas, its duct system, anatomic relationships, blood supply, histology, and functions.
  • Describe the location, vasculature, innervation, anatomic relationships, histology, and functions of the spleen.
  • Define "accessory spleen".
  • Describe the location, divisions, blood supply, ligaments, anatomic relationships, histology, and functions of the liver.
  • Define the "Hepatic/Portal Triad" and trace it from the Porta Hepatis to lobular divisions.
  • Trace Portal circulation from its origins to its termination, and cite collateral anastomotic pathways.
  • Discuss the relationship between the liver and the Inferior Vena Cava and why this is significant during trauma surgery.
  • Discuss the functions of the gallbladder and identify the stimuli for its empyting.
  • Identify the parts of the gallbladder and describe its blood supply and anatomic relationships.
  • Describe the boundaries and contents of the Triangle of Calot.

Demonstrate knowledge of the anatomy of the retroperitoneum.

Objectives:

  • Discuss the location, surroundings (fat and fasciae) and anatomic relationships of the kidneys.
  • Describe the hilar structures and vascular segmentation of the kidney.
  • Label a diagram of the gross morphology of the kidney in coronal section.
  • Draw and/or label the parts of a nephron unit and relate each part to the process of urine formation and to the maintenance of fluid, electrolyte and acid-base balances.
  • Discuss hormonal and pharmacologic influences on renal function.
  • List other functions of the kidney and explain the effects of their loss during renal failure.
  • Describe the fascial relationships among the suprarenal/adrenal gland, kidney and ureter.
  • Discuss the location, blood supply, divisions and functions of the suprarenal/adrenal gland.
  • Describe the course of the abdominal and pelvic portions of the ureter and explain how the blood supply changes.
  • Explain the functional significance of the oblique entrance of the ureters into the bladder.
  • Describe the changing relationships between the Aorta and the Inferior Vena Cava in their courses between the diaphragm and the pelvis.
  • Draw and/or label the branches that come off the Abdominal Aorta and identify the vertebral level of each.
  • Compare the tributaries of the Inferior Vena Cava to Aortic branches.
  • Diagram and/or label the general scheme of Sympathetic and Parasympathetic innervation to abdominal and pelvic structures.
  • Locate and name the major autonomic ganglia, plexuses and nerves, differentiating pre-ganglionic and post-ganglionic fibers.
  • Describe the general pattern of abdominal lymphatics and identify the major groups of nodes.
  • Describe the location and formation of the Lumbar Plexus and identify the function of each of the emerging nerves, and trace the course of those nerves that exit the pelvis.

Demonstrate knowledge of the anatomy of pelvic structures, the perineum, and the external genitalia.

Objectives:

  • Identify the bony features of the pelvis and the major ligaments of the joints of the pelvis.
  • Explain the changes in blood flow to the uterus during pregnancy.
  • Define the relationships among the pelvic inlet, the pelvic outlet, the Perineal Membrane (Urogenital Diaphragm) and the Pelvic Diaphragm.
  • Describe the anatomic relationships of the cervix to vascular structures, the ureters, and the vaginal walls.
  • Describe the perineum, the principal structures of the Urogenital and Anal triangles, the superficial and deep perineal muscles, and the Central Tendinous Point/Perineal Body.
  • Relate the cellular lining of the cervical canal to the diagnostic use of Pap smears.
  • Discuss the innervation and function of the perineal muscles.
  • Describe the anatomic relationships of the vagina.
  • Trace the course of the Common Iliac, External Iliac and Internal Iliac Arteries and name the branches coming off from the Internal Iliac.
  • Discuss the patterns of lymphatic drainage of pelvic and perineal structures.
  • Describe the location, blood supply, innervation and anatomic relationships of the urinary bladder.
  • Identify the major branches of the Sacral Plexus.
  • State the normal capacity of the urinary bladder and describe what happens when this is exceeded.
  • Trace the course of the Sciatic Nerve and discuss its functions.
  • Explain the clinical significance of the retropublic space.
  • Describe the muscle layering, mucosal features, and sphincters of the urinary bladder.
  • Compare the anatomic features and relationships of the urethra in the male and the female.
  • Explain the clinical significance of the continuity in mucosal lining from the urethra to the renal pelvis.
  • Explain the clinical significance of the relationship between the bladder fundus and urethra and the vagina in the female.
  • Explain the function of the scrotum, and describe the internal morphology and functions of the testis.
  • Trace the pathway of sperm from the Seminiferous Tubules to the Prostatic Urethra.
  • Compare the functions of the seminal vesicles and the prostate gland.
  • Discuss the location, lobes and anatomic relationships of the prostate gland.
  • Compare the cavernous bodies and related musculature of the male and female perineum.
  • Identify the structures in a cross-sectional view of the penis, and relate the role of each and of related perineal structures in penile erection.
  • Describe the autonomic influences on male sexual function.
  • Trace the courses of the Pudendal Nerve and the Internal Pudendal Artery.
  • Describe the external genital structures of the female.
  • Describe the location of the ovary and fallopian tube, their blood supplies and their anatomic relationships.
  • List and locate the ligaments related to the uterus and adnexa.
  • Identify the descriptive parts of the uterus.
  • Differentiate "anteflexion" and "anteversion".
  • Describe the sources of blood supply to the uterine fundus, corpus, and cervix and to the vagina.

Demonstrate knowledge of the anatomy of the gluteal region and lower limb.

Objectives:

  • Explain what happens to pre-axial and post-axial muscle groups as the hip, knee and ankle rotate from the amphibian/reptilian to the mammalian quadrupedal to the human bipedal position.
  • Compare the superficial venous systems of the upper and lower limbs, including their associations to the deep veins of the limb.
  • Describe the fascial continuities and fascial compartments, superficial veins and cutaneous nerves of the thigh and leg.
  • Describe the Calcaneal/Achilles Tendon and explain its importance in walking, running, and jumping.
  • Explain the function of the Fascia Lata and Iliotibial Tract in hip and knee movement.
  • List the structures contained in the four compartments beneath the Flexor Retinaculum at the medial malleolus, and list the structures that pass behind the lateral malleolus.
  • Identify and explain the bony features of the pelvis and proximal femur.
  • Describe the ankle joint, including the bones that comprise it, and differentiate the movements of the ankle joint vs. movements that occur within the foot.
  • Review the muscles of the posterior abdominal wall and relate them to the hip region.
  • Identify and compare the ligaments that provide stability at the ankle and within the foot.
  • Name and locate the muscles of the anterior, medial, and posterior thigh muscle groups,, and identify the origin and insertion, innervation, and action(s) of each.
  • Compare the positions of maximum stability at the hip, knee, and ankle joints.
  • Describe the boundaries and contents of the Adductor/Hunter's Canal.
  • Contrast the skeletal makeup of the ankle and foot with that of the wrist and hand.
  • Name and locate the gluteal and subgluteal muscles, and identify the origin and insertion, blood supply, innervation, and action(s) of each.
  • Compare the long tendons and intrinsic muscles of the foot to those of the hand.
  • Name the muscle that is an important landmark in the subgluteal region and identify its relationships.
  • Define the relation of the Plantar Aponeurosis to muscular compartments of the foot, and compare it to the Palmar Aponeurosis of the hand.`
  • List all the muscles that insert on the Greater Trochanter of the femur.
  • Explain the importance of ligaments and tendons in maintaining the arches of the foot.
  • Compare the features, movement, and stability of the hip joint with those of the shoulder joint.
  • Compare and contrast the arterial distribution patterns and the pattern of nerves in the foot with those of the hand.
  • Describe the ligaments that reinforce the hip joint capsule and discuss the clinical significance of the capsules non-distensibility.
  • Summarize what happens during each of the phases of a walking gait.
  • Relate the actions of the various muscles during hip movement.
  • Explain the function of the patella as a sesamoid bone, and discuss how the patella is stabilized.
  • Describe the boundaries and contents of the Popliteal Fossa.
  • Trace the courses of the Superficial and Deep (Profunda) Femoral Arteries and the Popliteal Artery.
  • Describe the collateral circulation around the hip and knee and explain the clinical significance of the sources of blood supply to those joints.
  • Identify and explain the bony features of the distal femur, proximal tibia, and proximal fibula.
  • Identify and discuss the knee joint capsule, synovium, extent of the joint space, and related bursae and fat pads.
  • Discuss the functions of the Collateral Ligaments of the knee.
  • discuss the functions of the Medial and Lateral menisci, comparing their shapes, extent of attachment and movement, and gender differences in susceptibility to injury.
  • Discuss the functions and actions of the Anterior and Posterior Cruciate Ligaments, and explain how they can be intra-articular but extracapsular.
  • List the movements of the knee joint and explain how each is accomplished+ and how the knee is stabilized in erect posture.
  • Name and locate the muscles of the anterior, lateral, superficial posterior, and deep posterior compartments of the leg, and identify the origin and insertion, innervation, and action(s) of each.
  • Trace arterial and nervous structures from the Popliteal Fossa to the ankle.
  • Locate the Dorsalis Pedis Artery and explain its clinical significance.

Define and appropriately use anatomical terminology.

Objectives:

  • Utilize correct spelling, pronunciation, and formation of plurals.
  • Define anatomical planes of the body or an organ.
  • Define and demonstrate action terms and terms pertaining to anatomical relationships.

Relate events in embryological development to normal and anomalous post-birth anatomy.

Objectives:

  • Compare and contrast spermatogenesis and oogenesis.
  • Describe ovarian and endometrial events during the menstrual cycle.
  • Describe the process of fertilization and list the events that happen when fertilization occurs.
  • Define: zygote, cleavage, morula, blastula/blastocyst and gastrulation.
  • Describe implantation and the development of the placenta.
  • Summarize the major events that occur during the second, third and fourth embryonic weeks.
  • List adult organs and tissues derived from each of the three embryonic germ layers, and identify embryonic cells that persist in adult organs.
  • Describe the development of the brain and spinal cord (including motor and sensory nerve cells) and of the ventricular system.
  • Describe the formation of the eye, ear, face and palate.
  • Discuss the major events in the development of the heart and major blood vessels.
  • Trace the course of fetal circulation and explain the changes that occur at birth.
  • Discuss the major events in the development of the respiratory system and the diaphragm.
  • Describe the formation of pharyngeal/bronchial arches, pouches and clefts, and identify the associated nerve and/or derivatives of each.
  • Explain the development of the abdominopelvic cavity, the fate of the yolk sac and vitelline duct, the formation of the regions of the gut tube (including vascular supply), and the derivatives of dorsal and ventral mesenteries.
  • Describe the formation and development of the gastrointestinal tract and accessory organs.
  • Explain the difference between primarily and secondarily retroperitoneal structures.
  • Discuss the formation of the genitourinary system and compare the migrations of the kidney, testis, and ovary from the urogenital ridge.
  • Trace the differentiation of the male and female reproductive tracts and genitalia and identify homologous structures.
  • Describe the development of a limb bud, including the derivatives of dermatomes, myotomes, and lateral plate mesoderm.
  • Differentiate the terms "embryo" and "fetus."
  • Discuss teratogenesis.
  • Define the "age of viability" and differentiate it from "prematurity."
  • Explain the three major categories of stem cells and differentiate embryonic vs. adult stem cells.
  • Discuss the medical applications of stem cell research, and differentiate therapeutic vs. reproductive cloning.

Demonstrate knowledge about the anatomy of the scalp, skull and brain.

Objectives:

  • List the layers of the scalp and discuss the clinical significance of the special characteristics of each layer.
  • Name and locate the muscles and aponeurosis of the scalp.
  • Explain the character of skull bone and its clinical significance.
  • Name and locate the special features of the cranial and facial bones.
  • Define the limits and contents of the three cranial fossae.
  • Identify and locate foramina involved in transmission of cranial nerves and blood vessels.
  • Locate and describe the meningeal layers, spaces, and intracranial dural duplications.
  • Identify the principal artery of the cranial dura and explain the clinical significance of its course.
  • Locate and discuss the major cranial venous sinuses.
  • Name and locate the components parts and connections within the ventricular system.
  • Describe the function, formation, circulation and drainage of cerebrospinal fluid.
  • Draw and/or label the major components of the arterial supply of the brain and explain the clinical significance of the Circle of Willis.
  • Explain the function of each of the cellular components of the Central Nervous System.
  • Differentiate "gray matter" vs. "white matter."
  • Describe the surface features of the brain and identify the major sulci and gyri.
  • Locate and describe the major function(s) of the following brain components: each of the cerebral lobes, thalamus, hypothalamus, basal ganglia/nuclei, brainstem (including reticular formation), and cerebellum.
  • Relate the location of various brain lesions to their clinical manifestations.
  • Compare the pathways and functions of the Pyramidal (Corticospinal) and extrapyramidal tracts.
  • Trace the path of the Spinothalamic Tract from the spinal cord to its cortical radiations.
  • Identify the twelve pairs of Cranial Nerves by name and number, locate each on the inferior surface of the brain, and indicate the major function(s) of each one.

Demonstrate knowledge about neck and face anatomy.

Objectives:

  • Locate and name the muscles of facial expression, and describe their actions and innervation.
  • Describe the cutaneous/sensory innervation, arterial supply, and venous drainage of the face.
  • Describe the structure, function, and anatomic relationships of the salivary glands.
  • Describe the lymphatic drainage and lymph nodes of the head and neck.
  • Describe the landmark triangles of the neck and explain how they are used clinically.
  • Identify all the fascial layers of the neck, and discuss the clinical significance of the fascial compartments of the neck.
  • Locate the prevertebral muscles in the neck and list their innervations and actions.
  • Identify the superficial veins in the neck and explain their patterns of drainage.
  • Identify the contents of the Carotid Sheath and describe its anatomic relationships.
  • Explain how the Internal Carotid Artery can be distinguished from the External Carotid Artery in the neck.
  • Locate and differentiate the Carotid Sinus vs. the Carotid Body, and explain the surgical significance of the Carotid Sinus.
  • Name and locate the branches of the External Carotid Artery.
  • Describe the Cervical Plexus, including its anatomic relationships and its major branches.
  • Identify the origin and insertion, innervation and actions of each of the suprahyoid and infrahoid (strap) muscles, and discuss the functional relationships between the two groups.
  • Describe the structure of the thyroid gland, its arterial and venous pathways, and its relationship to adjacent structures.
  • Discuss the functions of the thyroid and parathyroid glands.

Demonstrate knowledge about the anatomy of the nose, deep face, ear, eye, oral cavity, palate and throat.

Objectives:

  • Identify the bones that contribute to the orbit, discuss the relationship of the orbit to adjacent structures, and locate the foramina associated with the orbit.
  • Describe the nervous and arterial supplies of the nasal cavity.
  • Discuss the composition of the eyelids and describe the conjunctiva, bulbar fascia, periorbita, and the components of the lacrimal apparatus.
  • Identify and locate each of the paranasal air sinuses and explain the clinical significance of their drainage pathways and their mucous membrane continuities with other structures.
  • Compare the courses of the arterial and nervous structures within the orbit, and explain the surgical significance of the Ciliary Ganglion.
  • Describe the musculature and motor and sensory nerves of the pharynx.
  • Name and locate each of the extraocular muscles, and describe the innervation and actions of each.
  • Relate the actions of the muscles of the lips, cheeks, mastication, tongue, palate, and pharynx in chewing and swallowing.
  • List the components of the three tunics of the globe (eyeball).
  • Define Waldeyer's lymphatic ring.
  • Describe the intrinsic eye muscles, their innervations and actions.
  • Describe the location, anatomic relationships, and arterial supply of the palatine tonsil.
  • Differentiate the location and character of aqueous humor and vitreous humor.
  • List the paired and unpaired cartilages of the larynx, locate and describe the various mucosal elements of the larynx, and describe the attachments, innervation, and actions of laryngeal muscles.
  • Describe the formation, circulation, and drainage mechanism of aqueous humor.
  • Name the divisions of the Trigeminal Nerve, and identify the names and distributions of branches from each division.
  • Discuss the composition of the lens and how its shape is modified.
  • Trace the course of the Facial Nerve and its branches and explain the function(s) of each branch.
  • Compare the refractive powers of the cornea, aqueous humor, and the lens.
  • Describe the distribution and functions of the Glossopharyngeal Nerve, the Vagus Nerve, the (Spinal) Accessory Nerve, and the Hypoglossal Nerve.
  • Describe the retina and define "macula", "fovea centralis", and "optic disc".
  • Review the sources and pathways of Sympathetic innervation of the head and neck.
  • Draw and/or label depictions of the visual pathways from the retina to the occipital cortex.
  • Discuss the pupillary light reflex and contrast this with Sympathetic responses.
  • Identify the features of the auricle (pinna), and describe the composition and features of the tympanic membrane (eardrum).
  • Describe the boundaries, features, contents, and function of the middle ear (tympanum), and discuss the function of the Eustachian Tube.
  • Explain the clinical significance of the relationships among the middle ear, mastoid air cells, pharynx, and palate.
  • Identify the components of the inner ear, including the bony and membranous labyrinths and their respective fluids, and differentiate the vestibular vs. cochlear apparatus.
  • Describe the boundaries and contents of the temporal and infratemporal fossae.
  • Describe the origin and insertion, innervation, and actions of the muscles of mastication.
  • Describe the structure and movements of the temporomandibular joint (TMJ).
  • Locate and name the branches of the Maxillary Artery.
  • Explain the contents and foramina of the Pterygopalatine Fossa.
  • Describe the hard and soft palate, including the related muscles and their innervation and actions, and the sensory and vascular supplies.
  • Describe the attachments, innervation, and actions of the extrinsic and intrinsic tongue muscles.
  • Differentiate the nerves responsible for taste and for general sensation from the tongue.
  • Identify the nasal cartilages and the components of the nasal septum and lateral nasal wall.

Demonstrate knowledge of the anatomy of the superficial back, pectoral region and upper limb.

Objectives:

  • Name and locate the muscles of the pectoral region, and identify the origin and insertion, innervation, and action(s) of each.
  • Describe the dorsal and palmar arterial arches and trace arterial branches within the hand and digits.
  • Describe the internal structure of the mammary gland and the nipple-areolar complex.
  • Describe the sensory/cutaneous and motor distribution in the hand and digits, and explain how nerve integrity can be assessed.
  • Explain the clinical significance of the arterial supply and lymphatic drainage of the breast.
  • Draw and/or label the Brachial Plexus and describe its anatomic relationships.
  • Describe the origin, branches, termination, and anatomic relationships of the Subclavian Artery and the Axillary Artery.
  • Explain the boundaries, fasciae, and contents of the axilla, identifying arterial branches and nerves that must be protected during axillary dissection.
  • Demonstrate the movements of the humerus/shoulder and the movements of the scapula.
  • Identify and explain the bony features of the scapula, clavicle, and proximal humerus.
  • Name and locate the superficial back muscles and scapular muscles and identify the origin and insertion, innervation, and action(s) of each.
  • Identify the anatomic landmarks commonly used for incisional approaches to the shoulder.
  • List the components of the "rotator cuff" and relate the actions of all the various muscles during shoulder movements.
  • Compare the sternoclavicular, acromioclavicular, and glenohumeral joints.
  • Describe the fascial continuities and compartments, superficial veins, and cutaneous nerves of the arm and forearm.
  • Name and locate the pre-axial and post-axial muscles of the arm, and identify the origin and insertion, innervation, and action(s) of each.
  • Describe the collateral circulation around the shoulder and elbow joints.
  • Explain the anatomic relationships among superficial veins, tendons, major arteries, and nerves in the antecubital fossa.
  • Identify and explain the bony features of the middle and distal humerus, radius, and ulna.
  • Describe the ligaments of the elbow joint, and relate the actions of the various muscles on elbow and forearm movements.
  • Name and locate the pre-axial and post-axial muscles of the forearm, and identify the origin and insertion, innervation, and action(s) of each.
  • Describe the course of the major nerves through the arm and forearm, and relate the effect of injuries at various levels to functional losses.
  • Explain the clinical relevance of the "anatomical snuff box", the retinacula at the wrist, the "carpal tunnel", and the palmar aponeurosis.
  • Name and locate the bones of the wrist and hand, and compare and contrast the articulations and ligaments associated with carpals, meta-carpals, and phalanges.
  • Describe the synovial/tendon sheaths in the wrist and hand and the fascial features of the digits; discuss their functions and explain their clinical relevance.
  • Describe the "M-P hood" (extensor expansion) and the relationship between the superficial and deep flexor tendons at their insertions.
  • Name and locate the thenar and hypothenar muscles and the other intrinsic hand muscles, and identify the origin and insertion, innervation, and action(s) of each.
  • Relate the actions of the various muscles during wrist and hand movements.

Demonstrate knowledge of the anatomy of the deep back, vertebral column and spinal cord.

Objectives:

  • Describe the components, origins and insertions, and actions of the Erector Spinae and other deep back and suboccipital muscles.
  • List the regions of the vertebral column, indicate the number of vertebrae in each region, and identify the characteristic features of each type of vertebra.
  • Describe the special features of the Atlas and Axis.
  • Identify the major ligaments of the vertebral column and explain their functions.
  • Describe the components, characteristics and functions of intervertebral discs.
  • Describe the meningeal coverings of the spinal cord, including their specializations.
  • Explain the clinical significance of the level of the Conus Medullaris and how the Cauda Equina is formed.
  • Describe the contents of the vertebral canal, including the vascular structures.
  • Describe the arterial supply of the spinal cord.
  • Identify major features of the gray matter and major tracts of the white matter on a cross-sectional depiction of the spinal cord and discuss their functions.
  • Define functional terms relating to the Peripheral Nervous System: general vs. special, somatic vs. visceral, afferent vs. efferent.
  • Draw and/or label a cross-sectional depiction of a typical segmental spinal nerve, including its motor and sensory distribution and relationship to a paravertebral ganglion.
  • Compare the origins and anatomic pathways of the Sympathetic and Parasympathetic nervous systems, differentiating the characteristics of pre- and post-ganglionic fibers and the neurotransmitters of each.

Demonstrate knowledge of the anatomy of the chest wall and thoracic cavity.

Objectives:

  • List the muscles of the thorax and the accessory muscles of respiration, and explain the changes in dimension/configuration of the bony thorax during respiratory movements.
  • Describe the structures contained in the Posterior Mediastinum.
  • Identify the bony features of a typical rib and relate these to articulations and/or muscle attachments.
  • Describe the Azygos System of veins.
  • Differentiate "true", "false" and "floating" ribs.
  • Trace the course of the Thoracic Duct from its origin to its termination.
  • Locate the jugular notch and the sternal angle and discuss how these can be used as clinical landmarks.
  • Describe the composition, innervation and blood supply of the diaphragm.
  • Describe the patterns of the intercostal musculature and associated membranes.
  • Name the openings in the diaphragm, identify their vertebral levels, and list the structures that pass through each.
  • Describe the relationship in an intercostal space of the intercostal vessels and nerve to each other and to the rib margins.
  • Locate the Internal Thoracic/Mammary artery and explain its surgical importance.
  • Define parietal and visceral pleurae, compare the limits of the pleural sac/cavity with the excursions of the lung, and explain the clinical significance of pleural recesses/sinuses.
  • Describe the contents of the Anterior and Superior Mediastina.
  • Describe the anatomic relationships of the trachea, esophagus, bronchi, pulmonary vessels, and bronchial vessels.
  • Discuss the relationships among the structures found at the root/hilum of the lungs, and identify the impressions on the mediastinal surfaces of the right and left lungs.
  • Compare and contrast the fissures, lobes and bronchopulmonary segments of the right and left lungs.
  • Trace the bronchial tree from the tracheal bifurcation to an alveolus.
  • Discuss the clinical significance of the lymph nodes around the trachea and bronchi.
  • Locate the course of the Phrenic and Vagus Nerves and the origin of the Left Recurrent Laryngeal Nerve.
  • Compare the extent of the fibrous pericardium with that of the pericardial sac/cavity.
  • Externally locate the apex of the heart.
  • Name and locate the Coronary Arteries and each of their main branches.
  • Relate each Coronary artery to the area of myocardium to which it supplies blood.
  • Describe the venous drainage of the heart.
  • Trace the path of blood flow from the venae cavae to the aorta, including heart chambers, valves and pulmonary vessels.
  • Compare the features of the various valves of the heart.
  • Explain the origin of the features of the atrial and ventricular septa.
  • Draw and/or label the conductile pathway of the heart, and explain the significance of the "cardiac skeleton".
  • Relate the Vagal and Sympathetic Trunks to the Pulmonary and Cardiac Plexuses, and explain the effects of Sympathetic and Parasympathetic stimulation on respiratory and cardiac activities.
  • Describe the course and branches coming from the Aorta between the heart and the diaphragm.