GRAY’S Anatomy Review This page intentionally left blank GRAY’S Anatomy Review Marios Loukas, MD, PhD Associate Professor Department of Anatomical Sciences St. George’s University School of Medicine Grenada, West Indies Gene L. Colborn, PhD Professor Emeritus of Anatomy and Surgery The Medical College of Georgia Augusta, Georgia Peter Abrahams, MBBS, FRCS(ED), FRCR, DO(Hon) Professor of Clinical Anatomy Medical Teaching Centre Institute of Clinical Education Warwick Medical School University of Warwick United Kingdom Stephen W. Carmichael, PhD, DSc Department of Anatomy Mayo Clinic Rochester, Minnesota With illustrations from Abrahams P, Boon J, Spratt J: McMinn’s Clinical Atlas of Human Anatomy, 6th edition. St. Louis: Elsevier, 2008 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 GRAY’S ANATOMY REVIEW ISBN: 978-0-443-06938-3 International ISBN: 978-0-8089-2403-6 Copyright © 2010 by Churchill Livingstone, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: ((cid:2)1) 215 239 3804 (US) or ((cid:2)44) 1865 843830 (UK); fax: ((cid:2)44) 1865 853333; e-mail: h [email protected] . You may also complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions . Notice Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recom- mended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher Library of Congress Cataloging-in-Publication Data Loukas, Marios. Gray’s anatomy review / Marios Loukas, Stephen Carmichael, Gene L. Colborn. p. ; cm. Questions in this review are correlated with the textbook Gray’s anatomy for students and with Gray’s atlas of anatomy. ISBN 978-0-443-06938-3 1. Human anatomy--Examinations, questions, etc. I. Carmichael, Stephen W. II. Colborn, Gene L. III. Gray’s anatomy for students. IV. Gray’s atlas of anatomy. V. Title. [DNLM: 1. Anatomy--Examination Questions. QS 18.2 L888g 2009] QM32.L68 2010 611.0076--dc22 2008046824 Acquisitions Editor: William Schmitt Developmental Editor: Andrew Hall Design Direction: E llen Zanolle Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 To my daughter, Nicole, and my wife, Joanna, for their continuous support and love Marios Loukas To my wife and friend, Sarah Gene Colborn To “Lucy in the Sky with Diamonds,” who puts up with my early mornings and late nights Peter Abrahams To Susan Stoddard and Allen Carmichael Stephen Carmichael This page intentionally left blank PREFACE Rote memorization of anatomic facts has been the car- 3. The multiple-choice, single-best-answer format of dinal feature of exhaustive, and exhausting, courses in the questions is designed to facilitate student review human anatomy for many generations of students in in preparation for the USMLE and similar testing medicine, dentistry, and other allied health science methods. programs. Often, little distinction was made between 4. The explanations of the answers emphasize the crit- the wheat and the chaff, and little attention was given ical importance of understanding normal and dys- to the practical, clinical application of the data. In the functional human anatomy. face of the modern explosion of information and tech- 5. Student understanding is further enhanced by criti- nical advances in the medical sciences, Gray’s Anatomy cal examination of alternative, incorrect answers for Students was conceived and written as a clinically that students might be tempted to choose. oriented, student-friendly textbook of human anatomy. 6. Finally, the review provides a succinct distillation of The authors, Richard L. Drake, Wayne Vogl, and Adam the plethora of facts in clinical anatomy, assisting W. M. Mitchell, have provided a sound base for student the student’s learning and understanding of impor- learning and understanding of both normal and altered tant concepts in the practice of medicine, irrespec- human anatomy in the clinical setting. tive of the student’s career choice. This book, the G ray’s Anatomy Review , was de- The questions in this review are correlated with signed for use by students after they have read the Gray’s Anatomy for Students and with G ray’s Atlas of textbook and is in keeping with course objectives. The Anatomy by Richard L. Drake, Wayne Vogl, Adam W. M. questions, answers, and explanations in this book are Mitchell, Richard M. Tibbitts, and Paul E. Richardson. intended to serve multiple purposes for students in Each answer is referenced to pages in the anatomy text various programs: (GAS) and in the atlas (GA). We have incorporated or 1. T his review provides a thought-provoking source for adapted many drawings, full-color illustrations, and ra- study by students in preparation for examinations in diologic images in an attempt to accelerate the learning various programs of gross anatomy. process and to enhance understanding of both the anat- 2. To avoid pointless memorization by the student, all omy and the clinical applications. The primary sources the questions are framed within clinical vignettes upon which we have drawn for illustrative material are that guide the student toward practical applications from the 6th edition of McMinn’s Clinical Atlas of Hu- of the textual material. man Anatomy by Peter H. Abrahams, Joahannes M. Boon, and Jonathan D. Spratt. vii This page intentionally left blank ACKNOWLEDGMENTS A clinical review book is the work not only of the au- The authors thank the following individuals and thors but also of numerous scientifi c and clinical their institutions for kindly supplying various clinical, friends and colleagues who have been so generous operative, endoscopic, and imaging photographs: with their knowledge and given signifi cant feedback and help. This book would not have been possible Dr. Ray Armstrong, Rheumatologist, Southampton Gen- were it not for the contributions of the colleagues and eral Hospital, Southampton, and Arthritis Research friends listed below. Campaign A very special group of medical students, members Professor Paul Boulos, Surgeon, Institute of Surgical of the Student Clinical Research Society at the Depart- Studies, University College London Medical School, ment of Anatomical Sciences at St. Georges’ University, London helped enormously with the completion of this project Professor Norman Browse, Emeritus Professor of Sur- through their comments and criticism. gery, and Hodder Arnold Publishers, for permission to use illustrations from Symptoms and Signs of Sur- Steven Andrade Elizabeth Lax gical Disease, 4th edition, 2005 Esther Bilinsky Gopi Maharaja Mr. John Craven, formerly Consultant Surgeon, York Samuel Bilinsky Nadine Mirzayan District Hospital, York Julie Ferrauiola Michelle Shirak Professor Michael Hobsley, formerly Head of the De- Chris Groat Ashley Steinberg partment of Surgical Studies, The Middlesex Hospi- Michael Hill Darius Strike tal Medical School, London Rajkamal Khangura Ashley Sullivan Mr. Ralph Hutchings, photographer for Imagingbody Alexis Lanteri .com The following Professors from the Department of Mr. Umraz Khan, Plastic Surgeon, Charing Cross Hos- Anatomical Sciences at St. Georges’ University have pital, London also been very helpful with their comments and Professor John Lumley, Director, Vascular Surgery Unit, criticism. St. Bartholomew’s and Great Ormond Street Hospi- tals, London Feisal Brahim, Ph.D. Dr. J. Spratt, Consultant Radiologist, University Hospi- Danny Burns, MD., Ph.D. tal of North Durham Brian Curry, Ph.D. Dr. William Torreggiani, Radiologist, The Adelaide and Robert Hage, MD., Ph.D. Meath Hospital, Tallaght, Dublin Robert Jordan, Ph.D. Miss Gilli Vafi dis, Ophthalmologist, Central Middlesex Vid Persaud, MD., Ph.D. Hospital, London Vish Rao, Ph.D. Mr. Theo Welch, Surgeon, Fellow Commoner Queens’ Dr. R. Shane Tubbs, Ph.D., Associate Professor at College, Cambridge the University of Alabama, Birmingham, has always Professor Jamie Weir, Department of Clinical Radiol- been a great friend and colleague. His continuous sup- ogy, Grampian University Hospitals Trust, Aberdeen, port, comments, criticism, and enthusiasm have con- Scotland, and editor of Imaging Atlas of Human tributed enormously to the completion of this project. Anatomy, 3rd edition, Elsevier 2003. ix