usmle step1 booksothersmk_high-yield grossanatomy

1、457565837High-YieldGross AFOUR TH EDITION457565837High-YieldGross AnatomyFOUR TH EDITION457565837Ronald W. Dudek, PhDProfessorBrody School of Medicine East Carolina UniversityDepartment of Anatomy and Cell Biology Greenville, North CarolinaThomas M. Louis, PhDP

2、rofessorBrody School of Medicine East Carolina UniversityDepartment of Anatomy and Cell Biology Greenville, North CarolinaAcquisitions Editor: Crystal Taylor Product Manager: Sirkka E. Howes Manufacturing Coordinator: Margie Orzech Vendor Manager: Bridgett Dougherty Designer: Teresa MallonCompositor

3、: Aptara, Inc.Fourth EditionCopyright 2011, 2008, 2002, 1997 Lippincott Williams & Wilkins, a Wolters Kluwer business.351 West Camden Street Baltimore, MD 21201530 Walnut StreetPhiladelphia, PA19106Printed in CAll rights reserved. This book is protected by copyright. No part of th

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5、 articles and reviews. Materials appearing in this book prepared by in- dividuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Torequest permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadel- phia, P

6、A 19106, via email at , or via website at (products and services).9 8 7 6 5 4 3 2 1Library of Congress Cataloging-in-Publication DataDudek, Ronald W., 1950-High-yield gross anatomy / Ronald W. Dudek, Thomas M. Louis. 4th ed.p. ; cm. Includes index.ISBN 978-1-60547-763-31. Hu

7、man anatomyOutlines, syllabi, etc. 2. Anatomy, Surgical and topographicalOutlines, syllabi, etc. I. Louis, Thomas. II. Title.DNLM: 1. AnatomyOutlines. QS 18.2 D845h 2011QM31.D83 2011 612.00202dc222009047422DISCLAIMERCare has been taken to confirm the accuracy of the information present and to descri

8、be generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of th

9、e contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations.The authors, editors, and publisher hav

10、e exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of informa- tion relating

11、to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly impor- tant when the recommended agent is a new or infrequently employed drug.Some drugs and medical

12、 devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to as- certain the FDA status of each drug or device planned for use in their clinical practice.To purchase a

13、dditional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300.Visit Lippincott Williams & Wilkins on the Internet: . Lippincott Williams & Wilkins customer service representat

14、ives are available from 8:30 am to 6:00 pm, EST.PrefaceHigh-Yield Gross Anatomy addresses many of the recurring clinical themes of the USMLE Step 1. The information presented in this text prepares you to handle not only the clinical vignettes found on the USMLE Step 1, but also the questions concern

15、ing basic gross anatomy concepts.Like the USMLE Step 1, the discussions are comprehensively illustrated with a combination of drawings, MRIs, CT scans, radiographs, and cross-sectional anatomy. In addition, High-Yield Gross Anatomy directly addresses clinical issues and common clinical techniques (e

16、.g., liver biopsy, tra- cheostomy, and lumbar puncture) that require knowledge of basic gross anatomy to deduce the correct answer.For High-Yield Gross Anatomy, Fourth Edition, Dr. Thomas Louis has again contributed his con- siderable gross anatomy teaching experience to improve and narrow the focus

17、 of the book. Dr. Louis has taught gross anatomy for about 30 years in both cadaver-dissection and computer-assisted distance-learning gross anatomy courses. He has been a leader in developing computer-assisted distance learning at the Brody School of Medicine and has received national recognition f

18、or his efforts.Dr. Louis used High-Yield Gross Anatomy in his physician assistant gross anatomy course for 4 years with excellent success and supplemented the clinical anatomy presented in the book with critical basic anatomy figures and diagrams to assist students in learning the gross anatomy rela

19、- tionships of these clinically relevant areas. Dr. Louis and I have added some of these figures and diagrams to further enhance your understanding. In addition, Dr. Louis has compiled a plethora of clinical vignettes, many of which are included in this edition.I would like to thank Dr. Edward A. Mo

20、naco, III, for his suggestions and contributions to many of the chapters (especially the chapters on the Lymphatic System and Eye). Dr. Monaco has a PhD in Neuroscience from SUNY Upstate Medical University and is currently completing his medical studies at Columbia University College of Physicians a

21、nd Surgeons in New York City.I would appreciate your comments or suggestions about this book, especially after you have taken the USMLE Step 1, so that future editions can be improved and made more relevant to the test. You may contact me at .Ronald W. Dudek, PhDvContentsPrefacevVertebr

22、al Column1I. The Vertebral Column11II. Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2III. Joints2IV. Vasculature of the Vertebral Column4V. Clinical Considerations4VI. Normal Radiology102Spinal Cord and Spinal Nerves13I. Com

23、ponents of the Spinal Cord13II. Meninges and Spaces13III. Arterial Supply of the Spinal Cord14IV. Components of a Spinal Nerve15V. Dermatomes17VI. Clinical Procedures18VII. Clinical Considerations193Autonomic Nervous System22I. General Features of the Nervous System22II. Sympathetic Division of the

24、ANS (Thoracolumbar)22III. Parasympathetic Division of the ANS (Craniosacral)26IV. Summary Table of Sympathetic and Parasympathetic Motor Actions304Lymphatic System31I. Central Lymphatic Drainage31II. Summary Diagram of Specific Lymphatic Drainage325Chest Wall34I. General Features of the Thorax34II.

25、Bones of the Thorax34III. Muscles of the Thorax35IV. Movement of the Thoracic Wall36V. Arteries of the Thorax36VI. Veins of the Thorax37viiviiiCONTENTSVII. VIII. IX.X.XI. XII.Nerves of the Thorax37Breast37Anterior Chest Wall40Lateral Chest Wall43Posterior Chest Wall44Mediastinum44XIII. Radiology46Pl

26、eura, Tracheobronchial Tree, and Lungs50I. Pleura50II. Tracheobronchial Tree52III. Lungs54IV. Clinical Considerations56V. Cross-sectional Anatomy616Heart697I.II. III. IV.V.VI. VII. VIII. IX.X.XI. XII.The Pericardium69Heart Surfaces70Heart Borders71Fibrous Skeleton of the Heart72Valves and Auscultati

27、on Sites72Arterial Supply of the Heart73Venous Drainage of the Heart75The Conduction System75Innervation of the Heart76Gross Anatomy of the Heart77Clinical Considerations79Radiology83Abdominal Wall89I. Abdominal Regions89II. Clinical Procedure90III. Inguinal Region90IV. The Scrotum928Peritoneal Cavi

28、ty94I. Peritoneal Cavity94II. Omentum94III. Intraperitoneal and Extraperitoneal Viscera969IV.Clinical Considerations96Abdominal Vasculature97I. Abdominal Aorta97II. Venous Drainage of the Abdomen99III. Hepatic Portal System10010ixCONTENTSAbdominal Viscera10311I.II. III. IV.V.VI. VII. VIII. IX.X.XI.

29、XII. XIII. XIV. XV.Esophagus103Stomach106Duodenum110Jejunum111Ileum112Innervation of the Small Intestine112Large Intestine112Innervation of the Large Intestine115Appendix116Gallbladder116Extrahepatic Biliary Ducts117Liver120Pancreas122Cross-sectional Anatomy124Radiology127Sigmoid Colon, Rectum, and

30、Anal Canal130I. Sigmoid Colon130II. Rectum13212III. IV.V.Anal Canal132Defecation Reflex134Radiology135Spleen136I. General Features136II. Arterial Supply137III. Venous Drainage13713IV.V.Clinical Considerations137Radiology138Kidney, Ureter, Bladder, and Urethra13914I.II. III. IV.V.VI. VII. VIII. IX.X.

31、XI.General Features139Kidney Surface Projections140Internal Macroscopic Anatomy ofthe Kidney140Arterial Supply141Venous Drainage142Innervation143Clinical Considerations of the Kidney143Ureter144Urinary Bladder147Urethra152Radiology153Suprarenal (Adrenal) Glands158I. General Features158II. Arterial S

32、upply15815xCONTENTSIII. IV.V.VI. VII.Venous Drainage158Innervation159Adrenal Cortex159Adrenal Medulla161Laboratory Findings Used to Diagnose Suprarenal Gland Disorders16216 FemaleReproductive System163I.II. III. IV.V.VI. VII.Ovaries163Uterine Tubes163Uterus165Cervix168Ectocervix168Vagina169External

33、Genitalia170VIII. Innervation of the Female Reproductive System17117 MaleReproductive System172I.II. III. IV.V.VI. VII. VIII. IX.X.XI.Testes172Epididymis175Ductus Deferens176Contents of the Spermatic Cord176Ejaculatory Duct176Seminal Vesicles176Bulbourethral (BU) Glands of Cowper177Prostate Gland177

34、Penis179Innervation of the Male Reproductive System181Erection, Secretion, Emission, and Ejaculation18118 Pelvis182I.II. III. IV.V.VI. VII. VIII. IX.X.XI. XII.Bones of the Pelvis182Greater and Lesser Sciatic Foramina184Pelvic Inlet (Pelvic Brim)184Pelvic Outlet184Comparison of the Female and Male Pe

35、lvis186Muscles of the Pelvis186Arterial Supply186Venous Drainage188Nerves188Support of the Pelvic Organs190Clinical Considerations191Radiology19319 Perineum194I.II. III. IV.Perineum194Urogenital (UG) Triangle195Anal Triangle196Muscles of the Male and Female Perineum197xiCONTENTSUpper Limb19820I.II.

36、III. IV.V.VI. VII. VIII. IX.X.XI.Bones198Muscles198Arterial Supply198Venous Drainage202Cutaneous Nerves of the Upper Limb203Brachial Plexus204Nerve Lesions.206Shoulder Region208Elbow Region211Wrist and Hand Region214Cross-sectional Anatomy of Right Arm and Right Forearm218Lower Limb22021I.II. III. I

37、V.V.VI. VII. VIII. IX.X.XI.Bones220Muscles220Arterial Supply220Venous Drainage224Cutaneous Nerves of the Lower Limb225Lumbosacral Plexus226Nerve Lesions228Hip and Gluteal Region229Knee Region232Ankle and Foot Region233Cross-sectional Anatomy of Right Thigh and Right Leg237Head24122I.II. III. IV.V.VI

38、. VII. VIII. IX.Skull241Scalp244Meninges244Muscles of the Head246Arterial Supply246Venous Drainage249Clinical Consideration251Lymph Drainage of the Head and Neck Region251Cranial Nerves254NeckI.II. III. IV.V.VI. VII.23. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39、. . . . . . . . . . . . . . . . . . . . . .258Muscles of the Neck258Cervical Plexus258Cervical Triangles of the Neck259Larynx262Thyroid Gland265Parathyroid Gland265Parotid Gland266xiiCONTENTSEye267I. Bony Orbit267II. Eyelids and Lacrimal Apparatus268III. The Globe or Eyeball269IV. Extraocular Muscul

40、ature272V. Arterial Supply of the Orbit273VI. Venous Drainage of the Orbit274VII. Clinical Considerations27424Ear277I. General Features277II. External Ear277III. Middle Ear279IV. Inner Ear280V. Clinical Considerations28225Appendix 1: Muscles of the Arm283Appendix 2: Muscles of the Leg286Credits289In

41、dex293Chapter 1Vertebral ColumnThe Vertebral Column (Figure 1-1)IA.The vertebral column consists of 33 vertebrae (cervical C17, thoracic T112, lumbar L15, sacral S15 sacrum, and coccygeal Co14 coccyx).Dens of C2Atlas (C1)Axis (C2)Atlas (C1)C1C2 C3 C4 C5 C6 C7T1 T2T3 T4 T5 T6 T7T8Axis (C2)7 CervicalV

42、ertebrae12 ThoracicSpinous process overlapping inferior vertebraT9T10 T11T12 L1L2 L3 L4L55 LumbarS1 S2 S3S4S5Sacrum (5 segments)Coccyx(4 segments) 2A13Curvatures:Cervical (2)Thoracic (1)Lumbar (2)Sacral (1)Normal Kyphosis12Lordosis3NormalScoliosis44 yearsNewbornFetusAdultBC Figure 1-1 A: Vertebral c

43、olumn: (1) anterior view; (2) right lateral view; (3) posterior view with vertebral ends of the ribs. B: Curvatures of the vertebral column from fetus to adult. C: Curvatures of the vertebral column: (1) normal;(2) kyphosis; (3) lordosis; (4) scoliosis. (continued)12CHAPTER 1VERTEBRAL LEVELS FOR REF

44、ERENCEAnatomic StructureVertebral LevelHyoid bone, bifurcation of common carotid artery Thyroid cartilage, carotid pulse palpatedCricoid cartilage, start of trachea, start of esophagus Sternal notch, arch of aortaSternal angle, junction of superior and inferior mediastinum, bifurcation of trachea Pu

45、lmonary hilumInferior vena cava hiatus Xiphisternal joint Esophageal hiatus Upper pole of left kidney Aortic hiatusDuodenumCeliac artery, upper pole of right kidneySuperior mesenteric artery, end of spinal cord in adult (conus medullaris and pia mater)Renal arteryEnd of spinal cord in newborn, infer

46、ior mesenteric artery, umbilicus Iliac crest, bifurcation of aortaSacral promontory, start of sigmoid colonEnd of dural sac, dura, arachnoid, subarachnoid space, and cerebrospinal fluid End of sigmoid colonC4 C5 C6 T2 T4 T57 T8 T9 T10 T11 T12T12L1 T12 L1L2 L3 L4 S1 S2 S3D Figure 1-1 Continued D: Ver

47、tebral levels. Vertebral levels are used to reference the location of important anatomic structures. Knowledge of these vertebral levels will assist in deciphering clinical vignette questions. For example, a clini- cal vignette question may describe a pulsatile swelling located at vertebral level T2

48、. Knowledge that the arch of the aorta is found at T2 will allow you deduce an aortic arch aneurysm.B. The vertebral canal contains the spinal cord, dorsal rootlets, ventral rootlets, dorsal nerve root, ventral nerve root, and meninges.C. The spinal nerve is located outside the vertebral canal by ex

49、iting through the interver- tebral foramen.Curves (Figure 1-1)IIA.PRIMARY CURVES are the thoracic and sacral curvatures, which form during the fetal period.SECONDARY CURVES arethe cervical andlumbar curvatures, which form afterbirth as a result of lifting the head and walking, respectively.KYPHOSIS

50、is an exaggeration of the thoracic curvature, which may occur in the aged due to osteoporosis or disc degeneration.LORDOSIS is an exaggeration of the lumbar curvature, which may occur as a result of pregnancy, spondylolisthesis, or “pot belly.”SCOLIOSIS is a complex lateral deviation/torsion, which

51、may occur due to po- liomyelitis, a short leg, or hip disease.B.C.D.E.JointsA. ATLANTO-OCCIPITAL JOINTS (FIGURE 1-2)1. Atlanto-occipital joints are the articulations between the superior articular surfaces of the atlas (C1) and the occipital condyles.III3VERTEBRAL COLUMN2.The action of nodding the h

52、ead (as in indicating “yes”) and sideways tilting of the head occurs at these joints.These are synovial joints and have no intervertebral disc.The anterior and posterior atlanto-occipital membranes limit excessive move- ment at this joint.3.4.B.ATLANTOAXIAL JOINTS (FIGURE 1-2)1. Atlantoaxial joints

53、are the articulations between the atlas (C1) and axis (C2) that include two lateral atlantoaxial joints between the inferior facets of C1 and supe- rior facets of C2, and one median atlantoaxial joint between theanterior arch of C1 and the dens of C2.2. Theaction of turning the head side to side (as

54、 in indicating “no”) occurs atthese joints.3. These are synovial joints and have no intervertebral disc.4. The alar ligaments, which extend from the sides of the dens to the lateral margins of the foramen magnum, limit excessive movement at this joint.CLINICAL CONSIDERATION: ATLANTOAXIAL DISLOCATION

55、 (SUBLUXATION)C.1.Atlantoaxial dislocation (subluxation) is caused by the rupture of the transverse ligament of the atlas due to trauma (e.g., Jefferson fracture) or rheumatoid arthri- tis. This allows mobility of the dens (part of C2) within the vertebral canal, which placesatriskthecervicalspinalcord(leadingtoquadriplegia) and/ormedulla(res- piratory paralysis leading to sudden death).The dens is secured in its position by the:2.a.Transverse ligament of the atlas, which together with the superior longitudi- nal band and inferior longitudinal band form th