Lippincott® Illustrated Reviews: Anatomy Lippincott® Illustrated Reviews: Anatomy Kelly M. Harrell, PhD, MPT Assistant Professor Department of Anatomy and Cell Biology Brody School of Medicine at East Carolina University Greenville, North Carolina Ronald Dudek, PhD Professor Emeritus Department of Anatomy & Cell Biology Brody School of Medicine at East Carolina University Greenville, North Carolina Wolters Kluwer ® Philadelphia • Baltimore • New York• London Buenos Aires • Hong Kong• Sydney • Tokyo Acquisitions Editor: Crystal Taylor Product Development Editor: Kelly Horvath/Andrea Vosburgh Editorial Coordinator: Jeremiah Kiely Editorial Assistant: Brooks Phelps Marketing Manager: Phyllis Hitner Production Project Manager: Marian Bellus Design Coordinator: Steve Druding Manufacturing Coordinator: Margie Orzech Prepress Vendor: S4Carlisle Publishing Services Copyright © 2019 Wolters Kluwer. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via e-mail at permissions@lww. com, or via our website at shop.lww.com (products and services). 987654321 Printed in China (or the United States of America) Library of Congress Cataloging-in-Publication Data Names: Harrell, Kelly, author. I Dudek, Ronald W., 1950-author. Title: Anatomy / Kelly Harrell, Ronald Dudek. Other titles: Lippincott's illustrated reviews. Description: Philadelphia: Wolters Kluwer, [2019] I Series: Lippincott illustrated reviews I Includes bibliographical references. Identifiers: LCCN 2018042670 I ISBN 9781496317902 Subjects: I MESH: Anatomy I Outlines Classification: LCC QP34.5 I NLM QS 18.2 I DDC 612-dc23 LC record available at https://lccn.loc.gov/2018042670 This work is provided "as is," and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based on health care professionals' exami nation of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance, and this work is merely a reference tool. Health care professionals, and not the publisher, are solely responsible for the use of this work, including all medical judgments, and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made, and health care professionals should consult a variety of sources. When prescribing medication, health care professionals are advised to consult the product information sheet (the manufacturer's package insert) accompanying each drug to verify, among other things, conditions of use, warnings, and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com Dedication To my Fox and Flower-Knox and Lily, who inspire me every day to be the best version of myself. I am forever grateful for the love and laughter you bring to my life. - Kelly M. Harrell Acknowledgments When opportunity comes knocking, you open the door and let it in. Over 4 years ago, I was asked to come on board to what would be one of the richest learning experiences of my professional life. At the time, the LIR series was missing a vital component-anatomic sciences-that needed to be filled to complete the set. The LIR team reached out to veteran author Ron Dudek to spearhead the task of putting together an integrated embryology, gross anatomy, and histology text. A few days later, I, a lowly assistant professor of anatomy, opened an email from Dr. Dudek that invited me to join as a coauthor. This gracious offer was quickly met with excitement as I formulated my response. With little thought of the time and energy it may require, I said "yes," eager to put my stamp on something of significance in anatomy education. During the early planning phases, I quickly learned that I would need to rely on my colleagues and students for contributions, whether in the form of radiologic images, consulting, or time spent assisting in dissection. We were assembling a team, and without that team, UR Anatomy would not exist in such a well-rounded, aesthetically pleasing form. First and foremost, Ron and I would like to acknowledge the anatomic donors and their families for the generous bequeathal of their own or their loved ones' remains. We recog nize and honor the ultimate gift, that is, donating one's body for the purposes of educating future health care providers. We are eternally grateful. Without the leadership of a dedicated and patient development team, UR Anatomy may have faded into the sunset. Crystal Taylor, thank you for trusting Ron and me to create an educational product that upholds the quality of the LIR name. I applaud and appreciate your ability to remain flexible yet firm in your leadership role as Senior Acquisitions Editor, allowing UR Anatomy to come to fruition organically over the past 4 years. I also want to thank you for choosing Kelly Horvath as the freelance Development Editor on this project. I knew, when I signed on, that I would gain a publication, but I never imagined that I would also gain a lifelong colleague and friend in Kelly. Kelly, thank you for your honesty, hard work, countless phone meetings, vivid storytelling, constant support, and friendship. You kept me sane and confident through the past 2 years, and I am so very grateful to be on this team with you. I also thank the other members of the Wolters Kluwer team who worked behind the scenes to help turn this project into a book. They include Andrea Vosburgh, Internal Development Editor; Jeremiah Kiely, Editorial Coordinator; and Marian Bellus, Production Project Man ager. A special thank-you must go to Art Director Jen Clements, who worked miracles to turn our artistic vision into reality. She went above and beyond, putting lots of long hours as well as diligence and care into the art program. vi Acknowledgments I would like to recognize the clinicians and educators who provided valuable radiologic images and consulting to ensure that the clinical application text and figures were accu rate and informative-specifically, interventional and diagnostic radiologists Dr. Michael Berry, Dr. Gregory Lewis, and Dr. Douglas Shusterman (Eastern Radiology, Greenville, NC) and Dr. Michael Meuse (Carolina HealthCare System, Charlotte, NC). Your conscientious contributions to the radiologic components of UR Anatomy are very much appreciated. I would also like to thank Dr. Robert Hartman, Clinical Assitant Professor of Pediatrics at the Brody School of Medicine for providing the beautiful ultrasound images of pediatric heart defects. Thank you to the medical and allied health students who took pride and time in preparing clean, complete dissections (Chapters 4 and 7) and were actively involved in developing practice questions (Chapters 8 and 9). Across multiple disciplines, I'd like to thank a small group of students, many of whom have now graduated and moved on to their professional careers. Thank you Dr. Jinal Desai and Dr. Dan-Thanh Nguyen (MD) for your creative and engaging clinical vignette-style practice questions. For assistance with dissections, I'd like to thank my friend and colleague, Dr. Emily Askew; Dr. Amalia Kondyles, Dr. Brandon Kovash, and Dr. Marisa Lee (DPT); Richard Khang; Dr. Samantha Sellers (PhD); and Dr. Asem Rahman (MD). I would also like to acknowledge and thank future-doctor Gabrielle Kattan, for lending her hand modeling skills to Chapter 7. We also recognize and thank the Brody School of Medicine and the University of California San Francisco School of Medicine for permission to use histology light micrographs from each institution's slide collections. To Dr. M. Alex Meredith (Medical College of Virginia, Richmond, VA), thank you for sharing your artistic depiction of an area so many learners (and teachers) struggle to imagine and explain-the pterygopalatine fossa. Your willingness to contribute your art and vision of this space has better informed not only UR Anatomy but also countless learners who have passed through our classrooms and laboratories. Thank you to my parents for their love and encouragement through this process and life in general. You raised me in a nurturing environment, where I was taught to seize my moment, and that approach to life continues to serve me well. Thank you for instilling in me confi dence, work ethic, and a love for learning. Those traits have turned this vision into a reality. Finally, I would like to acknowledge the unyielding support of my husband, Danny. Over the course of coauthoring and designing UR Anatomy, we grew our family from just the two of us to a family of four. Danny, without your encouragement and love, the idea of writing a book while working full time and raising two small children would have seemed impossible. You helped me believe it was possible, and I am forever grateful for your role in the whole process. Preface In all living forms, structure dictates function. Take the human skeleton, for example-a bony core that serves as a mobile, yet protective scaffold onto which our tissues are succes sively layered, producing our adaptable, fluid bodies. In each unique tissue, intricate cells and fibers flow together to fill a role-movement, transport, protection, stability, nutrition, procreation, storage, intelligence, sensation, life, and, ultimately, death. From a young age, I was in awe of the way these structures coexist and function together within a single vessel. Even in light of variation or anomaly, the human body almost always finds a way to grow, evolve, and accommodate within its own environment. It is truly a marvel to be studied and celebrated. The study of anatomy is a journey across the microscopic landscape of cells and tissues into the macroscopic topography of organ systems. Much like the estuaries of eastern North Carolina, anatomy comprises small structures merging to form larger structures and functioning within a physiologic ebb and flow. Just as small creeks fill grooves carved into earth and merge to form tributaries and rivers, histologic examination of human tissue shows how cells and microscopic structures merge and coordinate as larger organs. Just as rivers expand into sounds and eventually flow out to sea, human organs integrate as body systems. The estuary represents the place where the river meets the sea, an intersection seen in the study of the human body where histology meets gross anatomy. This intersection of histology and gross anatomy is underpinned by embryology. These three streams of anatomic science converge in a novel way in the first edition of UR Anatomy to better elucidate the structural and functional details of the human body. So unique in its layout, UR Anatomy regionally integrates embryology, gross anatomy, and histology together in a single source to highlight the important relationships that exist across these topics. Purpose: Since its inception, UR Anatomy has been designed to precipitate those "ah ha" moments that occur when learners follow related topics along a continuum of time and space. As the puzzle begins to come together, learners build on their understanding in a more integrative fashion. Studies show that thoughtful integration of topics leads to deeper learning and retention. This theory underpins the shift of many medical schools from traditional to integrated curricula. UR Anatomy augments this approach to learning with writing that is engaging, well-organized, and informative. Audience: UR Anatomy is written as a detailed review text with medical students in mind. From day 1 of medical school, students must integrate basic science topics and organ ize them to promote learning and retention. In the short term, medical students are most concerned with performance on licensing exams. The integration of all three anatomic sci ence topics-embryology, gross anatomy, and histology-provides learners with a valuable resource for immediate exam preparation and future clinical reference. Although succinct enough for review purposes, UR Anatomy is comprehensive in its treat ment of the anatomic science triumvirate, making it an appropriate primary text in allied health programs that incorporate these topics. Art: UR Anatomy art brings the text to life with interactive figures that walk the reader through processes and concepts in a systematic, comprehensible manner. Images are further invigorated with strategically placed tips and mnemonics in the series' signature viii Preface dialogue bubbles. Figures also include directional labels to assist readers in orientation to structures on a two-dimensional page. Clear, crisp histologic images display unique tissue characteristics across systems, while color-coded schematic embryologic figures take readers through the step-wise process of human development. The hallmark of UR Anatomy art is its cadaveric specimens, which were carefully dissected just for this book, photographed, and then digitally enhanced to present realistic yet ideal ized views of the inside of the human body. Coloring, labeling, and "narration" highlight the arrangement of gross anatomic structures in a more three-dimensional format. Format: UR Anatomy is designed to be both narrative and concise. The outline-format chapters are organized by anatomic region and further subdivided into easy-to-digest sections. Each chapter follows a similar progression, with embryology presented up front, followed by gross anatomy and histology. This approach allows readers to integrate top ics, while continuing to support the traditional, regional method common to the study of anatomic sciences. This two-pronged system allows for easy adoption across different curricular models. Features: UR Anatomy incorporates a variety of features to facilitate integrative learning within a clinical context. • Clinical applications (blue boxes}: Learning anatomy out of context is like fishing with out a lure-you aren't going to catch anything! Each chapter provides high-yield clinical anatomy applications in blue boxes that give readers insight into the utility of the content in practice. Additionally, clinical applications illustrate how important a solid foundational knowledge in the anatomic sciences is in the diagnosis of common pathologies and injuries. • Knowledge morsels (green boxes}: Whether it is a helpful mnemonic or a stand-out structural or functional detail, green boxes are incorporated in each chapter to augment learning. These tidbits of information reinforce and supplement both the main text and the adjacent figures. • Dialogue bubbles: Dialogue bubbles have been added to figures to remind readers of important relationships, further integrate topics, highlight clinically significant information, and provide learners with helpful study tips. As readers process the figures, they can imagine the authors taking a moment to interject and engage in a discussion. Readers should use these memorable dialogues as prompts for further thought and discussion in each chapter. • Study questions: Board-style practice questions on high-yield topics are included at the end of each chapter for self-assessment. These questions are written to address the first three levels of Bloom's taxonomy-knowledge, understanding, and applica tion. Many questions are presented in clinical-vignette style to provide opportunity for learners to practice applying knowledge in a low-stakes environment before sitting for licensing exams. -Kelly M. Harrell, PhD, MPT