Atlas of Anatomy

Appendix

Answers to Surface Anatomy Questions

Index

Answers to Surface Anatomy Questions

Back (pp. 4041)

Q1: The superior boundaries of Michaelis' rhomboid run from the spinous process of L4 to the posterior superior iliac spines. The rhomboid then follows the curve of the iliac crest to the anal cleft.

Q2: The inferior angle of the scapula is at the level of the T7 spinous process. The iliac crest is at the level of the L4 spinous process. See p. 40 for palpable bony landmarks.

Thorax (pp. 120121)

Q1: After careful inspection, undertake a systematic palpation of each breast. Palpate the tissue of each breast by quadrant in the following sequence: inferior lateral, inferior medial, superior medial, and superior lateral. Palpate the axilla to examine the axillary tail of breast tissue. The majority of lymph drainage from the breast is to the axillary lymph nodes. The parasternal lymph nodes, which run along the internal thoracic vessels, drain the medial portions of the breast. See p. 64 for the axillary lymph nodes.

Q2: The aortic and pulmonary valves are best auscultated at the 2nd right and left intercostal spaces, respectively. Locate the 2nd intercostal spaces by finding the usually palpable sternal angle (the junction between the manubrium and body of the sternum). The 2nd ribs attach to the sternum at the sternal angle. The tricuspid (right atrioventricular) and bicuspid (left atrioventricular) valves are best auscultated at the left 5th intercostal space. If the ribs are visible/palpable, the 5th rib can be found by counting up from below (the lowest rib at the midclavicular line is the 10th rib). See p. 87 for auscultation sites; see p. 120 for reference lines in the thorax.

Abdomen & Pelvis (pp. 248249)

Q1: Use a vertical and a horizontal line through the umbilicus (at approximately the level of L4) to divide the abdomen and pelvis into right and left upper and lower quadrants (see p. 142).

LUQ

Liver, stomach, transverse colon, small intestine, spleen, pancreas, duodenum, descending colon, left kidney and suprarenal gland, left ureter.

RUQ

Liver, stomach, transverse colon, small intestine, gallbladder, pancreas, duodenum, ascending colon, right kidney and suprarenal gland, right ureter.

LLQ

Small intestine, descending colon, left ureter, urinary bladder, reproductive organs.

RLQ

Small intestine, ascending colon (with cecum and vermiform appendix), right ureter, urinary bladder, reproductive organs.

Q2: Direct inguinal hernias are most common in middle-aged or older males and are believed to be caused by “wear and tear.” They typically occupy the medial portion of the inguinal canal (having exited the abdomen through the inguinal triangle). They may also exit via the superficial inguinal ring. Rarely, they enter the scrotum. Indirect hernias are seen in male children and young adults and are believed to have a congenital basis. They generally exit via the deep inguinal ring and thus may occupy the entire length of the inguinal canal. They may also exit via the superficial inguinal ring, and occasionally enter the scrotum. See p. 135 for inguinal hernias.

Upper Limb (pp. 350353)

Q1: The medial and lateral antebrachial cutaneous nerves are both vulnerable during intravenous punctures in the cubital fossa. The medial nerve is a direct branch from the medial cord of the brachial plexus; the lateral nerve is the cutaneous component of the musculatocutaneous nerve (lateral cord). See p. 339 for the cubital region.

Q2: With the elbow joint in flexion, the ulnar collateral ligament can be palpated using the olecranon, the medial and lateral epicondyles, and the coronoid process. The radial collateral ligament can be palpated using the lateral epicondyle. See p. 284 for the collateral ligaments of the elbow.

Q3: In the wrist, the flexor carpi ulnaris tendon runs laterally to the ulnar artery and nerve until the ulnar tunnel. The median nerve is located between the palpable tendons of palmaris longus and flexor carpi radialis. The radial artery is slightly lateral to the flexor carpi radialis tendon. See p. 342 for the topography of the carpal region.

Q4: Tenderness at the base of the anatomic snuffbox suggests a fracture of the scaphoid. See p. 347 for the anatomic snuffbox; see p. 299 for scaphoid fractures.

Lower Limb (pp. 450451)

Q1: The head of the femur is located directly behind the femoral artery. The femoral artery emerges below the midpoint of the inguinal ligament. See p. 436 for the inguinal region.

Q2: The sciatic nerve can be located as it exits the greater sciatic foramen by identifying the midpoint between the posterior superior iliac spine and the ischial tuberosity. In the gluteal region (see pp. 438439), the sciatic nerve passes just medial to the midpoint of a line connecting the greater trochanter of the femur and the ischial tuberosity. The common fibular nerve can be palpated on the lateral border of the popliteal fossa as it courses along the medial border of the biceps femoris tendon (see p. 442). At the ankle, the tibial nerve is located midway between the palpable medial malleolus and the calcaneal (Achilles') tendons (see p. 442).

Head & Neck (pp. 588589)

Q1: A bolus of anesthetic injected approximately two thirds of the way up the posterior border of the sternocleidomastoid would serve as a nerve block for the cervical plexus.

Q2: The confluence of the sinuses is found deep to the external occipital protuberance. See p. 608 for the dural sinuses.

Q3: The lateral cervical (posterior) triangle is bounded by the sternocleidomastoid and trapezius muscles and the clavicle. It contains the (spinal) accessory nerve (CN XI) and the brachial plexus. See p. 576for the triangles of the neck. See p. 582 for the contents of the lateral cervical triangle.

Q4: The carotid triangle is bounded by the sternohyoid, posterior belly of the digastric, and sternocleidomastoid. It contains the vagus nerve (CN X). See p. 576 for the triangles of the neck. See p. 580 for the contents of the carotid triangle.

Q5: The thyroid cartilage (see p. 570) is commonly referred to as the “Adam's apple.”