surface anatomy 2013 final version
TRANSCRIPT
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Surface Anatomy
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SURFACE ANATOMYprovides knowledge of what lies under the skin
and what structures are perceptible to touch
in the living body.
requires a thorough understanding of the
anatomy of the structures beneath the surface
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the aim of this method is to visualize structuresthat give contour to the surface
SURFACE ANATOMY
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SURFACE ANATOMY
physical examination is the clinical application ofsurface anatomy
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
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SURFACE ANATOMY OF THE HEAD AND FACE
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Surface Anatomy of the Head and Face
Neurocranial Portion PARIETAL
OCCIPITAL
TEMPORAL
MASTOIDAURICULAR
FRONTAL
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Surface Anatomy of the Head and Face
FRONTAL REGION
region of the head
corresponding to the
outlines of the frontalbone
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Surface Anatomy of the Head and Face
PARIETAL REGION
surface region of the head
corresponding to the
outlines of the parietalbone
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TEMPORAL REGION
Surface Anatomy of the Head and Face
includes the lateral area
of the scalp and deeper
soft tissues overlying thetemporal fossa
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Surface Anatomy of the Head and Face
TEMPORAL REGION
bounded by: temporal lines,
frontal and zygomatic bones,
zygomatic arch, infratemporalcrest
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Surface Anatomy of the Head and Face
TEMPOROMANDIBULAR JOINT
modified hinge type of
synovial joint
allow the ff. movements:
close mouth
open mouth
protrude chinretrude chin
grinding and chewing
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AURICULAR REGION
Surface Anatomy of the Head and Face
includes the ear which
consists of the external,
middle and internal parts
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MASTOID REGIONconical prominence
projecting from the
undersurface of the
mastoid portion ofthe temporal bone
behind the external
acoustic meatus
lateral to the styloid
process
larger in the male
Surface Anatomy of the Head and Face
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Surface Anatomy of the Head and Face
OCCIPITAL REGION
includes the external
occipital protuberance
Note: protuberance means
a bulge beyond the adjacent
surface
posterior aspect of the
cranium
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Surface Anatomy of the Head and Face
Viscerocranial Portion
ORBITAL
PAROTID
ORAL
MENTAL
BUCCAL
ZYGOMATIC
INFRAORBITAL
NASAL
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Surface Anatomy of the Head and Face
ORBITAL REGION
area of the face overlying
the orbit and eyeball
ORBIT EYEBALL
ORBITAL
REGION
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Surface Anatomy of the Head and Face
ORBITAL REGIONEYEBROW
SUPRAORBITAL
MARGIN
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GLABELLA
Surface Anatomy of the Head and Face
ORBITAL REGION
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Surface Anatomy of the Head and Face
ORBITAL REGION
EYELIDmovable fold that covers
the eyeball
protects the eyeball from
injury and excessive light
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Surface Anatomy of the Head and Face
EPICANTHAL FOLDORBITAL REGION
fold of skin that covers the
medial angle of the eye
note: canthi means angle
MEDIAL CANTHI
LATERAL CANTHI
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Surface Anatomy of the Head and Face
SUPRAPALPEBRAL
SULCI
INFRAPALPEBRAL
SULCI
ORBITAL REGION
depressions superior and inferior to the eyelids
Note: sulcus means a shallow depression
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Surface Anatomy of the Head and Face
INFRAORBITAL REGION
located below the orbit and lateral to the nose on
each side
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Surface Anatomy of the Head and Face
ZYGOMATIC
BONE
ZYGOMATIC REGION
includes the zygomatic
bone
form the prominences
of the cheek
lie on the inferolateralsides of the orbits and
rests on the maxillae
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Surface Anatomy of the Head and Face
PAROTID REGION
includes the parotid gland
and duct, the masseter
muscle
located at the posterolateral
part of the facial region
bounded by: zygomatic arch,
external ear, mandible and
masseter
PAROTIDGLAND
MASSETERMUSCLE
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Surface Anatomy of the Head and Face
NASAL REGION
NASAL
REGION
includes the external nose
and nasal cavity
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Surface Anatomy of the Head and Face
ROOT OF NOSE
OR BRIDGE
DORSUM OF
NOSE
APEX
NARES
ALA
NASAL REGION
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Surface Anatomy of the Head and Face
ORAL REGION
ORAL
REGION
includes the oral cavity,
teeth, gingivae, tongue,
palate and palatinetonsils
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Surface Anatomy of the Head and Face
LABIALCOMMISURE
MENTOLABIAL
SULCUS
PHILTRUM
TUBERCLE OF
UPPER LIP
LOWER LIP
VERMILLION
BORDER
NASOLABIAL
SULCUS
ORAL
FISSURE
ORAL REGION
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Surface Anatomy of the Head and Face
BUCCAL REGION (CHEEKS)
CHEEK
bounded by: oral and mental
regions, zygomatic region,
parotid region and mandibleprincipal muscle include the
buccinators
BUCCINATOR
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Surface Anatomy of the Head and Face
MENTAL REGION
region of the chin
includes the mental protuberance
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Surface Anatomy of the Neck
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Surface Anatomy of the Neck
HYOID BONE
THYROID
CARTILAGE
CRICOID
CARTILAGE
THYROID
GLAND
LARYNGEAL
PROMINENCE
SUPRACLAVICULAR
FOSSA
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Surface Anatomy of the Neck
HYOID BONE
U Shaped
lies in the anterior part of
the neck
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Surface Anatomy of the Neck
LARYNGEAL PROMINENCE
produced by the meeting
of the laminae of the
thyroid cartilage in the
anterior midline
palpable and visible
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Surface Anatomy of the Neck
CRICOTHYROID LIGAMENT
inferior to the laryngeal
prominence
site for needle coniotomy
or cricothyrotomy
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Surface Anatomy of the Neck
CRICOID CARTILAGE
can be felt inferior to the
laryngeal prominence
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Surface Anatomy of the Neck
THYROID GLAND
apex of each lobe is at the
middle of the lamina of the
thyroid cartilage
Isthmus lies inferior to thecricoid cartilage
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Surface Anatomy of the Neck
THYROID GLAND
can be palpated anteriorly or posteriorly
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The neck is divided into 5 regions:
a. Sternocleidomastoid Region
b. Anterior Cervical Region
c. Lateral Cervical Region
d. Posterior Cervical Regione. Suboccipital Region
Surface Anatomy of the Neck
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1. Sternocleidomastoid Region
-the key landmark is the
Sternocleidomastoid muscle
-contents:Sternocleidomastoid muscle
Superior part of the external jugular
vein
Greater auricular nerve
Transverse cervical nerve
Surface Anatomy of the Neck
Sternocleidomastoid Region
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Surface Anatomy of the Neck
Sternocleidomastoid Region
Sternocleidomastoid Muscle
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2. Anterior Cervical Region or Anterior Triangle of Neck
-bounded by: Median line of the neck
Anterior border of Sternocleidomastoid m.
Inferior border of Mandible-divided into 4 smaller Triangles:
a. Submental Triangle
b. Submandibular Trianglec. Carotid Triangle
d. Muscular Triangle
Surface Anatomy of the Neck
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Surface Anatomy of the Neck
Anterior Cervical Region or Anterior Triangle of Neck
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A. Submental Triangle
-bounded by:
Rt. and Lt. anterior bellies of
Digastric muscle
Body of Hyoid bone
Mandibular Symphysis
-contents:
Submental lymph nodes
Small veins forming the ant.
Jugular vein
Surface Anatomy of the Neck
Submental Triangle
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Submental Triangle
Submental Lymph Nodes
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B. Submandibular Triangle
-bounded by:
Inferior border of the Mandible
Anterior and posterior bellies of
the Digastric muscle
-contents:
Submandibular gland
Submandibular lymph node
Hypoglossal and mylohyoid
nerve
Parts of the facial artery and
vein
Surface Anatomy of the Neck
Submandibular
Triangle
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Surface Anatomy of the Neck
Submandibular Triangle
Submandibular Gland
Submandibular Lymph
Nodes
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C. Carotid Triangle
-bounded by:
Superior belly of the Omohyoid m.
Posterior belly of the Digastric m.
Anterior border of the SCM
-contents:
Common carotid artery
External carotid artery
Internal jugular vein
Thyroid gld., larynx, pharynx
Surface Anatomy of the Neck
CarotidTriangle
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Surface Anatomy of the Neck
Carotid Triangle
Common Carotid Artery
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D. Muscular Triangle
-bounded by:
Superior belly of the Omohyoid m.
Anterior border of the SCM
Median plane of the neck
-contents:
Sternothyroid m.
Sternohyoid m.
Thyroid and Parathyroid Glands
Surface Anatomy of the Neck
Muscular
Triangle
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Muscular Triangle
Surface Anatomy of the Neck
Sternohyoid Muscle Sternothyroid Muscle
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3.Lateral Cervical Region or Posterior Triangle of theNeck
-bounded by: Posterior border of the SCM
Anterior border of the Trapezius
Middle third of the Clavicle
-divided into 2 Triangles:
a. Occipital Triangle
b. Omoclavicular Triangle
Surface Anatomy of the Neck
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Surface Anatomy of the Neck
Lateral Cervical Region or Posterior Triangle of the neck
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a. Occipital Triangle
-bounded by:
Posterior border of the SCM
Anterior border of the Trapezius
Inferior belly of the Omohyoid
-contents:
Part of the external jugular vein
Spinal accessory nerve
Trunks of the brachial plexus
Cervical lymph nodes
Surface Anatomy of the Neck
OccipitalTriangle
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Surface Anatomy of the Neck
Occipital Triangle
Trunks of Brachial Plexus
Spinal Accessory NerveCervical Lymph Nodes
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b. Omoclavicular Triangle
-also known as Supraclavicular or
Subclavian Triangle
-bounded by:
Posterior border of the SCM
Inferior belly of Omohyoid m.
Clavicle
-contents:
3rd part of the Subclavian artery
Suprascapular artery
Supraclavicular lymph nodes
Surface Anatomy of the Neck
Omoclavicular
Triangle
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Surface Anatomy of the Neck
Omoclavicular Triangle
Subclavian Artery
Suprascapular Artery
Supraclavicular Lymph Nodes
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4. Posterior Cervical Region-This region is posterior to
the anterior borders of the
Trapezius muscle.
-The Trapezius definesthis region
Surface Anatomy of the NeckPosterior
CervicalRegion
Trapezius
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Surface Anatomy of the Neck
5. Suboccipital Region
-Triangular area inferior to the
occipital region of the head
-bounded by:
Rectus capitis posterior major
Superior Oblique of head
Inferior Oblique of head
-contents:
Vertebral artery
Suboccipital nerve
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Surface Anatomy of the Thorax
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Surface Anatomy of the Thorax
Breastmost prominent surface
feature of the anterior
thoracic wall
overlies the pectoralis
major and serratus
anterior muscles
nipple lies in the 4th ICS
in men and young
nulliparous women
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Surface Anatomy of the Thorax
attaches to the clavicle and
sternum and superior 6 costal
cartilages
the lower border of the
pectoralis major muscle
forms the anterior axillary fold
Pectoralis Major Muscle
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Surface Anatomy of the Thorax
attaches to the lateral parts
of the 1st to 8th ribs
helps elevate the ribs to
expand the thoracic cavity
when inspiration is deep
and forceful
Serratus Anterior Muscle
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Surface Anatomy of the Thorax
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Surface Anatomy of the Thorax
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Surface Anatomy of the Thorax
Clavicle
collar bones
palpable bony ridges at
the junction of the thoraxand neck
demarcate the zones of
lymphatic drainage
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Surface Anatomy of the Thorax
Sternum
lies in the anterior
median line
palpable throughout
its length
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Surface Anatomy of the Thorax
Suprasternal or Jugular Notchlarge, visible dip where the
clavicles join the sternum
palpable between themedial ends of the clavicle
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Surface Anatomy of the Thorax
Suprasternal or Jugular Notch
lies opposite the inferior
border of the body of T2
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Surface Anatomy of the Thorax
Suprasternal or Jugular Notch
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Surface Anatomy of the Thorax
Manubrium
approximately 4 cm. long
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Surface Anatomy of the Thorax
Manubrium
lies at the level of the
bodies of T3 and T4
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Surface Anatomy of the Thorax
Manubrium
Left side
anterior to Arch of Aorta
Right side
overlies the merging
Brachiocephalic veins
that form the SuperiorVena Cava
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angle made between themanubrium and the bodyof sternum
also known as theManubriosternal Joint
or the Angle of Louis
Surface Anatomy of the Thorax
Sternal Angle
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Surface Anatomy of the Thorax
Sternal Angle
palpable and visible inyoung people
marks the level of the 2ndpair of costal cartilages
.
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Surface Anatomy of the Thorax
Sternal Angle
marks approximately thebeginning and end of theaortic arch and bifurcation of
the trachea into left and rightmain bronchi
lies at the level of T4-T5 IV disc
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approximately 10 cm. long
Intermammary cleft overlies it
Surface Anatomy of the Thorax
Body of the Sternum
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Surface Anatomy of the ThoraxBody of the Sternum
lies anterior to the right
border of the heart
lies anterior to T5-T9
vertebrae
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Surface Anatomy of the ThoraxXiphoid Process
lies in the epigastric
fossa
Xiphoid Process
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Surface Anatomy of the ThoraxXiphisternal Joint
palpable ridge at the
level of the inferior
border of T9 vertebra
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Surface Anatomy of the Thorax
Manubrium
Body of Sternum
Xiphoid Process
Intermammary Cleft
Subcostal Angle
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medial margin formed by
the costal cartilages of
the seventh rib to the
tenth rib
extend inferolaterally from
the xiphisternal joint
form the sides of theinfrasternal angle
Surface Anatomy of the Thorax
Costal Margin
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located at the inferior end
of the sternum
formed by the convergingcostal margins
used in cardiopulmonary
resuscitation
Surface Anatomy of the Thorax
Infrasternal or subcostal Angle
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provide a basis for
locating/describing the
position of structures or
sites of trauma
1st rib is not palpable,count starts with the
2nd rib
Surface Anatomy of the Thorax
Ribs and Intercostal Spaces
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Surface Anatomy of the Thorax
Ribs and Intercostal Spaces
to identify a particular rib,
always identify the 2nd
costal cartilage then countthe cartilages and ribs
downward
useful during auscultation of
heart sounds
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Surface Anatomy of the Thorax
Visible Landmarks
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Surface Anatomy of the Thorax
Site of Apex Beat of the Heart
Palpable Landmarks
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MIDSTERNAL
LINE
lies in the medianplane over the
sternum
Surface Anatomy of the Thorax
Lines of Orientation
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MIDCLAVICULA
RLINE
runs verticallydownward from the
midpoint of theclavicle
Surface Anatomy of the Thorax
Lines of Orientation
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ANTERIOR
AXILLARY LINE
runs vertically alongthe anterior axillary
fold
Surface Anatomy of the Thorax
Lines of Orientation
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Surface Anatomy of the Thorax
MID-AXILLARY
LINEfrom the apex of
axillary fossa,parallel to the AAL
LINES OF ORIENTATION
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POSTERIOR
AXILLARY LINE
runs along the posterioraxillary fold, parallel to
the AAL
Surface Anatomy of the ThoraxLINES OF ORIENTATION
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Surface Anatomy of the ThoraxLINES OF ORIENTATION
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Surface Anatomy of the Thorax
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Surface Anatomy of the Thorax
Borders of the Heart
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Surface Anatomy of the Thorax
Superior
Border
Right
Border
InferiorBorder
Left
Border
Borders of the Heart
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Surface Anatomy of the Thorax
THE FOUR BORDERS AND APEXSuperior Border is formed by the Roots of the Great Vessels
Right Border is formed by the Right Atrium
Left Border is formed by the Left Ventricle
Inferior Border is formed by the Right Ventricle and Apical part of the
Left Ventricle
Apex formed by the Left Ventricle, corresponds to the apex beat at the
5th left ICS
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Apex beat [Point of maximum impulse] =
4th or 5th ICS, Left MCL, 6-10 cm from AML
Surface Anatomy of the Thorax
Apex Beat of the Heart
S f f
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Tricuspid valve-lies
behind the right half of
the sternum, opposite
the 4th ICS;
Best heard: over the
right half of the lowerend of the body of the
sternum.
Surface Anatomy of the Thorax
The Heart Sounds
S f A f h Th
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Surface Anatomy of the Thorax
Mitral Valve- behind the
left half of the sternum,
opposite the 4th costalcartilage
Best heard: Apex Beat.
THE HEART SOUNDS
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Pulmonary Valve- lies
behind the medial end
of the 3rd left costalcartilage
Best heard: over the
medial end of the 2nd
left ICS.
Surface Anatomy of the Thorax
THE HEART SOUNDS
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Surface Anatomy of the Thorax
Aortic Valve- lies
behind the left half
of the sternum,
opposite the 3rd ICS
Best heard: over the
medial end of the
2nd right ICS
THE HEART SOUNDS
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Surface Anatomy of the Thorax
THE HEART SOUNDS
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Surface Anatomy of the Thorax
The Lungs
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QuickTime™ and a
decompressor are needed to see this picture.
Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
UMBILICUS
LINEA
SEMILUNARIS
RECTUS
ABDOMINIS
TENDINOUS INTERSECTIONS
OF THE RECTUS ABDOMINIS
EPIGASTRIC
FOSSA
EXTERNAL
OBLIQUE
MUSCLE
LINEA ALBA
INGUINAL
LIGAMENT
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Surface Anatomy of the Abdomen
ILIAC
CREST
ANTERIOR SUPERIOR
ILIAC SPINE
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Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
-LIVER: RIGHT LOBE
-GALLBLADDER
-STOMACH: PYLORUS
-DUODENUM: PARTS 1-3-PANCREAS: HEAD
-RIGHT SUPRARENAL GLAND
-RIGHT KIDNEY
-RIGHT COLIC FLEXURE
-ASCENDING COLON: SUPERIOR
PART
-TRANSVERSE COLON: RIGHT
HALF
RIGHT UPPER QUADRANT
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-LIVER: LEFT LOBE
-SPLEEN
-STOMACH
-JEJUNUM, PROXIMAL ILEUM-PANCREAS: BODY AND TAIL
-LEFT KIDNEY
-LEFT SUPRARENAL GLAND
-LEFT COLIC FLEXURE
-TRANSVERSE COLON: LEFT HALF-DESCENDING COLON: SUPERIOR
PART
LEFT UPPER QUADRANT
Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
-CECUM
-VERMIFORM APPENDIX
-MOST OF ILEUM
-ASCENDING COLON: INF. PART
-RIGHT OVARY-RIGHT UTERINE TUBE
-RIGHT URETER: ABDOMINAL
PART
-RIGHT SPERMATIC CORD:
ABDOMINAL PARTUTERUS (IF ENLARGED)
URINARY BLADDER ( IF VERY FULL)
RIGHT LOWER QUADRANT
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Surface Anatomy of the Abdomen
-SIGMOID COLON
-DESCENDING COLON:INF. PART
-LEFT OVARY
-LEFT UTERINE TUBE
-LEFT URETER: ABDOMINALPART
UTERUS (IF ENLARGED)
URINARY BLADDER (IF VERY FULL)
LEFT LOWER QUADRANT
S f A t f th Abd
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Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
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Surface Anatomy of the Abdomen
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QuickTime™ and a
decompressor are needed to see this picture.
Surface Anatomy of the Back
Surface Anatomy of the Back
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Surface Anatomy of the Back
S f A t f th B k
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Surface Anatomy of the Back
Surface Anatomy of the Back
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Surface Anatomy of the Back
Vertebral Column
S f A t f th B k
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C1 has no spinous process
C2 spinous process is the first
bony point that can be felt
Spinous processes of C3-C5
may be felt in the nuchal
groove but not easily palpable
Spinous process of C6 is easilyfelt
Surface Anatomy of the Back
Cervical Vertebrae
S f A t f th B k
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Cervical Vertebrae
seventh cervical
vertebra
most distinctivecharacteristic
existence of a long
and prominent spinous
process
palpable from the skin
surface
Surface Anatomy of the Back
S f A t f th B k
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C7 Spinous process is
usually evident
superficially and when
standing erect this is the
only spinous process
visible thus it is called
vertebra prominens.
Surface Anatomy of the Back
Vertebraprominens
Cervical Vertebrae
S f A t f th B k
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Surface Anatomy of the Back
Thoracic Vertebrae
spinous process of T1
may be more prominent
the short 12th rib can be
used to confirm the
identity of T12 spinous
process
Surface Anatomy of the Back
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when the trunk is
flexed it is easily seen
and palpated
the L2 spinous process
provides an estimate
on the position of the
inferior end of thespinal cord
Surface Anatomy of the Back
Spinous
Process
of Lumbar
Vertebrae
Lumbar Vertebrae
Surface Anatomy of the Back
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Surface Anatomy of the Back
horizontal line
joining the high
points of the iliac
crests passes thruthe L4 spinous
process and L4-L5
intervertebral discs
(useful for lumbar
puncture).
Horizontal line joining thehigh points of the iliac
crests
(SUPRACRISTAL PLANE)
Lumbar Vertebrae
Surface Anatomy of the Back
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Surface Anatomy of the Back
Lumbar Vertebrae
Surface Anatomy of the Back
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Surface Anatomy of the Back
Dimples
(Posterior Superior Iliac
Spine)
skin dimples are formed
by the attachment of
skin and fascia to the
posterior superior iliac
spines.
S2 spinous process lies
at the middle of these
dimples.
indicates the inferior
extent of the subarachnoid
space
Sacrum
Surface Anatomy of the Back
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Surface Anatomy of the Back
SACRAL
TRIANGLE
formed by the lines
joining the two posterior
superior iliac spines and
the superior part of theintergluteal cleft
the sacral triangle
outlines the sacrum
common area of pain
from low back sprains
Sacrum
Surface Anatomy of the Back
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Surface Anatomy of the Back
Sacrum
Surface Anatomy of the Back
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Surface Anatomy of the Back
Coccyx
can be palpated in the
intergluteal cleft
examined with a gloved
finger in the anal canal
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References:
1. Clinically Oriented Anatomy
by Keith Moore
2. Clinical Anatomy
by Richard Snell
3. The Wonderful World
Wide Web
by Dr. Google
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5x8 Index Card
Picture
Name
Cel no.
Pre med course
Pre med school
Transfer student/ Med school
back
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back• Lecture grades
• Module Score
1
2 3
4
Lab gradesModule Score
1
2 3
4