Applied Human Anatomy PDF

Applied Human Anatomy
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Applied Human Anatomy
Michael F. Nolan
John P. McNamara
Virginia Tech Carilion School of Medicine

in association with Virginia Tech Publishing
Blacksburg, VA
A free version of this book can be downloaded from:

https://doi.org/10.21061/applied-human-anatomy
Cover photos by Ryan Anderson, Virginia Tech Carilion School of Medicine
We wish to thank Ryan Anderson for the book cover photos, and VTCSOM Class of 2026 students Sydney
Dinn, Maedot Haymete, Lucy Honeycutt, Katherine Lee, Thisha Thiagarajan and Jessica Urbanczyk for per-
mission to use their photos for the book cover.
Copyright © 2022 by Michael F. Nolan and John P. McNamara
First published in 2022 by the Virginia Tech Carilion School of Medicine in association with Virginia Tech
Publishing
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Cataloging-in-Publication Data
Names: Nolan, Michael F., author | McNamara, John P., author.
Title: Applied Human Anatomy / Michael F. Nolan and John P. McNamara.
Description: Roanoke, VA : Virginia Tech Carilion School of Medicine in association with Virginia Tech Pub-
lishing, 2022. | Summary: “These practical exercises help students acquire a fundamental understanding of
anatomical structure and relationships as encountered in living persons.” – Preface.
Identifiers: ISBN: 978-1-957213-41-5 (PDF) | ISBN: 978-1-957213-95-8 (pbk) |
DOI: https://doi.org/10.21061/applied-human-anatomy
Subjects: HUMAN ANATOMY / Laboratory manuals. | HUMAN ANATOMY / Problems and Exercises.
Table of Contents
Preface vii
Introduction 1
How to Use the Manual 2
1 Back and Spine 3

Anatomy Review Questions 3
Application Exercises 7
2 Shoulder Girdle and Upper Limb 14
3 Hip Girdle and Lower Limb 38
4 Thorax 58
5 Lungs and Pleura 66
6 Heart 73
7 Abdomen 80
8 Head and Face 94
9 Neck 112
10 Mouth and Pharynx 123
11 Orbit and Eye 130
12 Ear 143
13 Answer Key 147
v
Preface
The ability to relieve discomfort and effectively treat injury, disease and disability requires
a clear understanding of the structural and functional bases of a variety of abnormal condi-
tions. Such knowledge of abnormal structure and function is most effectively acquired and
easily accessed when it is built upon a firm understanding of normal structure and function.
Thus, one of the first goals of students of the health care professions is to acquire an ade-
quate working knowledge of normal structure and function, including variations and ranges
in structure and function that are commonly understood to represent the normal condition.
The structure of the human body is usually considered in courses in gross anatomy. These
courses typically consist of lectures by the faculty, readings in assigned textbooks and
the study of photographs and illustrations in human anatomy atlases. Depending on the
resources of the educational program, students may also have access to skeletal material,
anatomical models, video tape presentations of cadaver prosections and other specialized
learning aids. Other computer-aided-instruction programs have been developed that com-
bine a number of self-directed learning and assessment strategies.
Some gross anatomy courses offer the opportunity to dissect and study human cadaveric
material, thereby providing students with a somewhat more realistic, three-dimensional per-
spective of individual tissues and organs and their anatomical relationship to one another.
The use of cadavers and cadaveric material is considered by many to be essential for stu-
dents requiring a thorough and complete knowledge of human structure.
However, as student’s progress through the curriculum and move into the more clinical or
practice oriented phases, many discover that the anatomical knowledge they actually need
is somewhat different from the kind they possess. What many encounter is difficulty in apply-
ing in the clinical setting, the facts and principles previously learned in the classroom and
dissection laboratory. This difficulty often becomes evident in clinical skills courses in which
students work with and learn from living persons, many of whom are patients. Student dif-
ficulty in making this transition points to a need which can be effectively addressed within
the context of most human anatomy courses. Namely, the need to acquire a fundamental
understanding of anatomical structure and relationships as encountered in living persons.
The practical exercises in this manual are intended to help meet that need.
Michael F. Nolan, Ph.D., P.T.

John P. McNamara, M.S., D.C.
vii
Introduction
The exercises in this manual are intended to bridge the gap between non-living and living
anatomy by helping students acquire a practical understanding of certain aspects of human
gross anatomy as can be appreciated in living human subjects. This manual is intended as
a companion text comprised of self-assessment questions and application exercises to be
used in conjunction with traditional materials in courses in human gross anatomy whether or
not such courses also provide opportunities to dissect and study cadaveric material. Individ-
ual exercises have been developed with an eye toward preparing students for subsequent
course work that may be dependent on a firm understanding of human gross anatomy. The
fill-in-the-blank questions are intended for use as a self-assessment tool and to provide
feedback with regard to a student’s progress in learning the material.
An important goal in preparing this manual was to better integrate material that is more often
than not treated separately in contemporary health care curricula. It is hoped that through
this integration students will develop a deeper and more lasting knowledge and understand-
ing of human anatomy as they are likely to need it in the evaluation and management of
patients.
1
How to Use the Manual
The exercises described in this manual are group activities, intended and designed for small
numbers of students working together. Each work group should ideally consist of four to six
students, preferably mixed with regard to body size, shape, age, gender and race. The intent
of building diversity within the work group is to permit students to gain familiarity with as
wide a variety of human anatomy as class enrollment will permit. Students should dress in
comfortable clothing that does not prohibit visualization or palpation of important anatomical
landmarks and structures.
Each student in the work group should take a turn as the subject for each exercise per-
formed by each of the other members of the group. Clearly, the greatest benefit is achieved
when each student performs each exercise on all other members of the group. In this way
variations in anatomical structure that exist within the group can be identified, compared
and discussed in relation to a student’s developing concept of normal human anatomy. The
short, written questions that accompany many of the exercises can be answered as one
progresses through the manual as a way of self-assessment and as a prompt for thought
and discussion about the anatomy being studied. Alternatively, they can be answered before
performing the exercises as a way of preparing for subsequent group work. Where there
is one line following a question, only one answer is sought. Where more than one line is
provided, an equivalent number of answers is sought.
Many of the exercises described in this manual involve palpation and learning through the
sense of touch. This approach to learning human anatomy, though overlooked in most tra-
ditional anatomy courses, is emphasized here in recognition of the fact that physicians and
other health care workers regularly use their hands as well as their eyes and ears to obtain
information about their patients. It is therefore important for students to become familiar with
human structure as it appears to the hands and fingertips. Not coincidentally, many of the
exercises and tasks outlined in this manual are similar or identical to those actually used
in the evaluation and treatment of patients. Please view these learning activities as serious
and necessary parts of your educational and professional development, and treat your work
group partners with the respect and sensitivity you would wish them to extend to you.
2
1 Back and Spine
Objectives
1. Describe and identify by palpation in a living subject the major curvatures of the
vertebral column.
2. Describe and identify by palpation in a living subject the major bony landmarks of
the back.
3. Identify and describe joints and ligaments of the vertebral column.
4. Describe and demonstrate using a living subject the movements both permitted
and restricted at each of the four regions of the vertebral column.
5. Define abnormal curvatures of the vertebral column and describe common

compensatory mechanisms that result from the abnormal curves.
Anatomy Review Questions
The vertebral column is stabilized and intervertebral movement is limited (restricted) by

ligaments that interconnect the vertebrae. Name the ligaments that course from:
1. vertebral body to vertebral body anteriorly
_________________________________________________________________
2. vertebral body to vertebral body posteriorly
_________________________________________________________________
3
3. lamina to lamina
_________________________________________________________________
4. transverse process to transverse process
_________________________________________________________________
5. spinous process to spinous process
_________________________________________________________________
6. tip of the spinous process to tip of the spinous process
_________________________________________________________________
7. Which vertebra presents the carotid tubercle?
_________________________________________________________________
8. Which vertebra presents the dens?
_________________________________________________________________
9. Is the dens positioned anterior or posterior to the vertebral canal?
_________________________________________________________________
10. Which spinal nerve is located in the C7 – T1 intervertebral foramina?
_________________________________________________________________
The muscles of the back can be conveniently divided into two groups; the superficially
located erector spinae and the more deeply located transversospinal group.
4
11. What muscles comprise the erector spinae?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
12. What muscles comprise the transversospinal group?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
13. What are the most superficial back muscles in the region of the cervical
spine?
a. __________________________________________________________
b. __________________________________________________________
14. The suboccipital muscles play a role in both stabilizing and moving the head on
the spine. What are the major suboccipital muscles?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
15. The greatest range of cervical motion in the transverse (axial) plane occurs
between what two vertebrae?
_________________________________________________________________
16. What is the name of the central, fluid-like component of the intervertebral
disc?
_________________________________________________________________
5
17. What is the name of the peripheral, fibrous component of the intervertebral
disc?
_________________________________________________________________
18. What structure is located in the transverse foramen?
_________________________________________________________________
19. Where is Batson’s plexus of veins located?
_________________________________________________________________
20. What segmental nerve emerges from within the suboccipital triangle?
_________________________________________________________________
21. What vascular structure passes through the posterior atlanto-occipital

membrane?
_________________________________________________________________
22. What three muscles form the triangle of auscultation?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
23. What three muscles form the lumbar (Petit’s) triangle?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
6
Application Exercises
A. Inspection and Palpation
With the subject standing comfortably and the back and shoulders exposed:
1. Inspect the midline of the back from the skull to the sacrum.
a. Is the vertebral column straight or are there curvatures in either the frontal
(coronal) or sagittal plane?
__________________________________________________________
b. Which segments of the vertebral column are concave posteriorly?
1) ________________________________________________________
2) ________________________________________________________
c. An increase in the curvature of either of these parts of the vertebral

column in the sagittal plane is referred to as
_________________________________________________________
d. Which segments of the vertebral column are convex posteriorly?
1) ________________________________________________________
2) ________________________________________________________
e. An increase in the curvature of the thoracic spine in the sagittal plane is

referred to as
__________________________________________________________
f. An increase in the curvature of the vertebral column in the coronal plane

is referred to as
__________________________________________________________
7
2. Palpate the external occipital protuberance and slide your fingers inferiorly in
the midline until you feel a prominent bony prominence.
a. What is the name of this bony prominence?
__________________________________________________________
b. What is the name of this part of the vertebra?
__________________________________________________________
c. Which vertebra is this palpable feature a part of?
__________________________________________________________
d. Were you able to feel the vertebral column in the region between the
external occipital protuberance and palpable bony feature?
__________________________________________________________
If not, indicate why.
__________________________________________________________
e. What is the name of the structure you palpated as you slid your
fingers inferiorly in the midline of the neck?
__________________________________________________________
3. Palpate the posterior cervical muscles bilaterally and compare the size and
contour of the muscles on each side of the neck.
a. What is the superior attachment of this group of muscles?
__________________________________________________________
8
4. Palpate the spinous process of C7 (vertebra prominens) and slide your fingers
inferiorly in the midline until you feel the sacrum.
a. Were you able to feel all the thoracic and lumbar spinous processes
throughout the length of the vertebral column?
__________________________________________________________
5. Palpate the thoracic and lumbar paraspinal muscles bilaterally and compare
the size and contour of the muscles on each side.
a. Are the two sides symmetrical?
__________________________________________________________
If not, describe the differences.
__________________________________________________________
6. Palpate the iliac crests together.
a. Are both at the same horizontal level with respect to the ground?
__________________________________________________________
If not, indicate which is higher (or lower)?
__________________________________________________________
b. Which vertebra would be crossed by a line drawn between the iliac

tubercle? (transtubercular line)
__________________________________________________________
9
7. While standing behind the subject, place your hands on the subject’s
shoulders (right hand on right shoulder and left hand on left shoulder).
a. Are the shoulders level (at the same level relative to the floor)?
__________________________________________________________
If not, indicate which is higher (or lower).
__________________________________________________________
8. With the subject standing comfortably, instruct the subject to bend forward at
the waist in attempt to touch the floor.
a. Is the subject able to touch the floor with both hands (or finger
tips)?
__________________________________________________________
If not, how far from the floor are the tips of the fingers:
right hand _____________________________________________
left hand _____________________________________________
b. Are the angles of the ribs level with the floor or is one side higher
than the other?
__________________________________________________________
If one side is higher, which side is higher?
__________________________________________________________
10
9. With the subject standing comfortably, instruct the subject to bend backward
at the waist as far as possible. (NOTE: Stand behind the subject to prevent a
fall.)
a. Was the subject able to bend backward and without leaning to one
side?
__________________________________________________________
b. Did the subject report any pain or discomfort with this movement?
__________________________________________________________
10. With the subject standing comfortably, instruct the subject to bend laterally at
the waist to the right as far as comfortable then to the left.
a. Was the subject able to bend the same amount in both directions?
__________________________________________________________
If not, approximate (or measure) in degrees the amount of lateral bending

achieved in each direction.
To the right _____________________________________________
To the left _____________________________________________
11. With the subject standing comfortably, instruct the subject to rotate the trunk,
first to the right then to the left.
a. Was the subject able to rotate equally in both directions?
__________________________________________________________
11
If not, approximate (or measure in degrees) the amount of rotation
achieved in each direction.
To the right _____________________________________________
To the left _____________________________________________
B. Movement (Muscles and Joints)
The vertebral column is stabilized and intervertebral movement is limited (restricted) by

ligaments that interconnect the vertebrae. Name the ligaments that course from:
1. vertebral body to vertebral body anteriorly
_________________________________________________________________
2. vertebral body to vertebral body posteriorly
_________________________________________________________________
3. lamina to lamina
_________________________________________________________________
4. transverse process to transverse process
_________________________________________________________________
5. spinous process to spinous process
_________________________________________________________________
6. tip of the spinous process to tip of the spinous process
_________________________________________________________________
12
The muscles of the back can be conveniently divided into two groups; the superficially
located erector spinae and the more deeply located transversospinal group.
7. What muscles comprise the erector spinae?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
8. What muscles comprise the transversospinal group?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
9. What are the most superficial back muscles in the region of the cervical
spine?
a. __________________________________________________________
b. __________________________________________________________
10. The suboccipital muscles play a role in both stabilizing and moving the head on
the spine. What are the major suboccipital muscles?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
13
2 Shoulder Girdle and Upper Limb
Objectives
1. Describe and identify by palpation in a living subject the major soft tissue and bony
landmarks of the upper limb.
2. List the action and innervation of the major muscle groups of the upper
limb.
3. List the major muscles responsible for movements permitted at each joint of the
upper limb.
4. Identify the major ligaments of the upper limb and describe the movements limited
or restricted by each.
5. Describe and identify by palpation in a living subject the major arterial pulses in the
upper limb.
6. Identify and outline on a living subject, the area of skin innervated by each of the
pre-plexus roots of the brachial plexus.
post plexus peripheral nerves of the brachial plexus.
8. Describe the movements that would be affected as a result of lesions affecting the
pre-plexus roots of the brachial plexus.
9. Describe the movements that would be affected as a result of lesions affecting

post plexus peripheral nerves of the brachial plexus.
14
1. What joint is located at the medial end of the clavicle?
_________________________________________________________________
2. What joint is located at the lateral end of the clavicle?
_________________________________________________________________
3. What two ligaments resist dislocation of the acromioclavicular joint?
a. _______________________________________________________________
b. _______________________________________________________________
4. What ligament of the shoulder region does NOT cross a movable joint?
_________________________________________________________________
5. What ligament helps to secure the head of the radius against the radial notch of
the ulna?
_________________________________________________________________
6. Describe the fiber direction of the interosseous membrane of the forearm.
_________________________________________________________________
7. What tendon passes superficial to the flexor retinaculum (transverse carpal

ligament)?
_________________________________________________________________
8. What anatomical landmark marks the point where the subclavian becomes the
axillary artery?
_________________________________________________________________
15
9. What anatomical landmark marks the point where the axillary artery becomes the
brachial artery?
_________________________________________________________________
10. What landmarks are used to divide the axillary artery into three (3) parts?
_________________________________________________________________
11. Name the major branches of the axillary artery:
first part _____________________________________________
second part _____________________________________________
_____________________________________________
third part _____________________________________________
_____________________________________________
_____________________________________________
12. What artery lies along the medial (vertebral) border of the scapula?
________________________________________________________________
13. What two arteries enter the hand by passing deep to the flexor retinaculum?
a. __________________________________________________________
b. __________________________________________________________
14. Name the bones that form the proximal row of carpal bones.
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
16
15. Name the bones that form the distal row of carpal bones.
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
16. What muscle forms the medial wall of the axilla?
_________________________________________________________________
17. What anatomical feature marks the lateral wall of the axilla?
_________________________________________________________________
18. Which spinal nerve roots contribute to the formation of the brachial plexus?
______________________________ to _______________________________
19. Which root(s) give rise to the:
a. upper trunk ______________________________________
b. middle trunk ______________________________________
c. lower trunk ______________________________________
20. Which division of the brachial plexus gives rise to the posterior cord?
_________________________________________________________________
21. Which trunk of the brachial plexus gives rise to the suprascapular nerve?
_________________________________________________________________
22. Which cord gives rise to the nerve that innervates the latissimus dorsi
muscle?
_________________________________________________________________
17
23. Which cord gives rise to the nerve that innervates the teres major muscle?
_________________________________________________________________
24. Which cord gives rise to the nerve that innervates the subscapularis muscle?
_________________________________________________________________
25. Which cord gives rise to the nerve that innervates the pectoralis minor muscle?
_________________________________________________________________
26. What are the two terminal branches of the posterior cord?
a. __________________________________________________________
b. __________________________________________________________
27. What nerve passes through the quadrangular space?
_________________________________________________________________
28. What nerve lies in the spiral groove?
_________________________________________________________________
29. What nerve lies posterior to the medial epicondyle?
_________________________________________________________________
30. What nerve passes deep to the flexor retinaculum?
_________________________________________________________________
31. What nerve passes through Guyon’s canal?
_________________________________________________________________
18
32. What is the average carrying angle in:
Women __________________________________________________________
Men __________________________________________________________
33. The median nerve crosses the cubital fossa and enters the forearm by passing
between the two heads of what muscle?
_________________________________________________________________
34. The ulnar nerve passes posterior to the medial epicondyle and enters the forearm
by passing between the two heads of what muscle?
_________________________________________________________________
35. The radial nerve passes into the cubital fossa anterior to the lateral epicondyle,
passing between what two muscles?
a. __________________________________________________________
b. __________________________________________________________
36. Axillary lymph nodes are distributed in several different “groups.” Name five of
these clusters of axillary lymph nodes.
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
e. __________________________________________________________
37. What tendons form the borders of the “anatomical snuff box”?
a. medial border _____________________________________________
b. lateral border _____________________________________________
19
38. The pulse of what artery can be palpated in the “anatomical snuff box”?
_________________________________________________________________
A. Inspection and Palpate
With the subject seated comfortably and the back, shoulders and upper limbs exposed:
1. Inspect and palpate the superior border of the trapezius.
a. Are the right and left sides visually symmetrical with regard to muscle
contour and bulk?
_________________________________________________________
________________________________________________________________
b. Are the right and left sides symmetrical to palpation?
_________________________________________________________
________________________________________________________________
2. Inspect and palpate the clavicle from the sternoclavicular joint to the
acromioclavicular joint.
a. What kind of movement is permitted at the sternoclavicular joint?

_________________________________________________________
20
b. What kind of movement is permitted at the acromioclavicular
joint?
_________________________________________________________
3. Inspect the deltoid muscle and palpate the anterior and posterior margins of
this muscle.
contour and bulk?
_________________________________________________________
________________________________________________________________
_________________________________________________________
________________________________________________________________
4. Palpate the spine of the scapula from its medial to lateral extent.
a. What is the name of the bony prominence at the lateral end of the spine of
the scapula?
_________________________________________________________
b. In a relaxed individual with both arms hanging comfortably at the sides,

which thoracic vertebral body would be crossed by a line interconnecting
the medial edge of the spines of the two scapulae?
_________________________________________________________
21
c. What muscle originates in the space superior to the spine of the
scapula?
________________________________________________________
d. What muscle originates in the space inferior to the spine of the

scapula?
________________________________________________________
5. Palpate the vertebral border, lateral border and inferior angle of the
scapula.
a. What is the average distance between the spinous processes of the

vertebral column and the vertebral border of the scapula?
________________________________________________________
b. What rib is covered by the superior angle of the scapula?
________________________________________________________
c. What rib is covered by the inferior angle of the scapula?
________________________________________________________
6. Palpate the anterior and posterior axillary folds.
a. What muscle forms the anterior axillary fold?
________________________________________________________

1) What two peripheral nerves provide motor innervation to this

muscle?
__________________________________________________
__________________________________________________
22
b. What two muscles form the posterior axillary fold?
________________________________________________________
________________________________________________________
1) What two peripheral nerves provide motor innervation to these

muscles?
__________________________________________________
__________________________________________________
7. Inspect and palpate the muscles of the anterior compartment of the arm.
a. What two muscles form the bulk of the anterior compartment of the
arm?
_________________________________________________________
_________________________________________________________
1) What peripheral nerve provides motor innervation to these

muscles?
_________________________________________________
b. Are the right and left sides visually symmetrical with regard to muscle
contour and bulk?
_________________________________________________________
_________________________________________________________
23
8. Inspect and palpate the muscles of the posterior compartment of the arm.
a. What muscle forms the bulk of the posterior compartment of the arm?
_______________________________________________________
1) What peripheral nerve provides motor innervation to this muscle?
_________________________________________________
b. Are the right and left sides visually symmetrical with regard to muscle
contour and bulk?
________________________________________________________
_______________________________________________________
9. Inspect and palpate the olecranon process of the ulna.
a. What muscle inserts on the olecranon process?
_______________________________________________________
b. What peripheral nerve lies immediately medial to the olecranon process?
_______________________________________________________
24
10. Inspect and palpate the medial supracondylar ridge and medial epicondyle of
the humerus.
a. What are the three major actions of the muscles that originate from the
medial supracondylar ridge and medial epicondyle?
1) _________________________________________________
2) _________________________________________________
3) _________________________________________________
11. Inspect and palpate the lateral supracondylar ridge and lateral epicondyle of
the humerus.
a. What are the three major actions of the muscles that originate from the
lateral supracondylar ridge and lateral epicondyle?
1) __________________________________________________
2) __________________________________________________
3) __________________________________________________
12. Inspect and palpate the medial and lateral margins of the cubital
fossa.
a. What muscle forms the inferomedial border of the cubital fossa?
_________________________________________________________
__________________________________________________
b. What muscle forms the inferolateral border of the cubital fossa?
_________________________________________________________
25
1) What peripheral nerve provides motor innervation to that muscle?
_________________________________________________
c. What artery lies on the floor of the cubital fossa?
_______________________________________________________
d. What vein lies superficial in the cubital fossa?
_______________________________________________________
e. The median nerve enters the forearm from the cubital fossa by passing
between the two heads of origin of what muscle?
_______________________________________________________
f. The ulnar nerve enters the forearm from behind the medial epicondyle of
the humerus by passing between the two heads of origin of what
muscle?
_______________________________________________________
13. Inspect and palpate the muscles of the posterior compartment of the
forearm.
bulk and contour?
_______________________________________________________
_______________________________________________________
_______________________________________________________
26
_______________________________________________________
c. What peripheral nerve provides motor innervation to these

muscles?
_______________________________________________________
14. Inspect and palpate the muscles of the anterior compartment of the
forearm.
bulk and contour?
_______________________________________________________
_______________________________________________________
______________________________________________________
c. What peripheral nerves provide motor innervation to these

muscles?
1) _________________________________________________
2) _________________________________________________
27
15. Palpate each of the following:
a. Head of the ulna
b. Pisiform bone
c. Styloid process of the radius
d. Dorsal (Lister’s) tubercle of the radius
1) What tendon lies along the ulnar side of Lister’s tubercle?
__________________________________________________
16. At the level of the proximal wrist crease, identify and palpate the tendons
of the
a. Flexor carpi radialis
b. Palmaris longus
c. Flexor carpi ulnaris
d. What artery lies on the radial side of the tendon of the flexor carpi
radialis?
_________________________________________________________
e. What artery lies on the radial side of the tendon of the flexor carpi
ulnaris?
_________________________________________________________
28
f. What nerve lies on the radial side of the tendon of the palmaris
longus?
_________________________________________________________
17. Identify and inspect the transverse and longitudinal flexion creases of the
palm.
18. Inspect and palpate the thenar and hypothenar eminences.
bulk and contour?
_________________________________________________________
_________________________________________________________
b. What three muscles form the bulk of the thenar eminence?
1) __________________________________________________
2) __________________________________________________
3) __________________________________________________
c. What peripheral nerve provides motor innervation to these

muscles?
_________________________________________________________
d. What three muscles form the bulk of the hypothenar eminence?
1) __________________________________________________
2) __________________________________________________
3) __________________________________________________
29
e. What peripheral nerve provides motor innervation to these
muscles?
_________________________________________________________
19. Identify and palpate the medial and lateral margins of the anatomical snuff
box.
a. What muscle forms the medial (ulnar) border of the anatomical snuff
box?
_________________________________________________________
b. What two muscles form the lateral (radial) border of the anatomical snuff
box?
1) __________________________________________________
2) __________________________________________________
c. What artery lies on the floor of the anatomical snuff box?
_________________________________________________________
20. Inspect and palpate the bellies of the dorsal interossei between adjacent
metacarpal bones.
bulk?
_________________________________________________________
_________________________________________________________
b. What is the action of the dorsal interossei?
_________________________________________________________
30
c. What nerve innervates the dorsal interossei?
_______________________________________________________
d. What is the action of the palmar interossei?
_______________________________________________________
e. What nerve innervates the palmar interossei?
_______________________________________________________
B. Movement
Instruct the subject to perform each of the following movements and to maintain the new
position while you attempt to move the body part to the starting position. Examine the
strength of both the right and left sides. Note the full range of motion permitted at each joint
and the strength needed by the subject to resist your efforts to reposition the body part. In
the spaces provided, list the main muscles responsible for each movement and indicate the
peripheral nerve that innervates each muscle. With the subject in the sitting position ask the
subject to:
MUSCLE NERVE
1. Elevate (shrug) the shoulders.
a. ___________________ ___________________
b. ___________________ ___________________
2. Retract the shoulders (adduct the scapulae).
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
31
MUSCLE NERVE
3. Flex the arm through the full range of motion.
a. ___________________ ___________________
4. Abduct the arm through the full range of motion.
a. ___________________ ___________________
b. ___________________ ___________________
5. Adduct the abducted arm.
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
d. ___________________ ___________________
6. Hyperextend the arm through the full range of motion.
a. ___________________ ___________________
b. ___________________ ___________________
7. Flex the forearm (elbow) with the forearm supinated.
a. ___________________ ___________________
b. ___________________ ___________________
8. Flex the forearm (elbow) with the forearm pronated.
a. ___________________ ___________________
b. ___________________ ___________________
9. Extend the forearm (elbow) from the fully flexed position.
a. ___________________ ___________________
32
MUSCLE NERVE
10. Pronate the supinated forearm.
a. ___________________ ___________________
b. ___________________ ___________________
11. Supinate the pronated forearm.
a. ___________________ ___________________
b. ___________________ ___________________
12. Extend the wrist.
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
13. Flex the wrist.
a. ___________________ ___________________
b. ___________________ ___________________
14. Deviate the wrist radialward.
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
15. Deviate the wrist ulnarward.
a. ___________________ ___________________
b. ___________________ ___________________
33
MUSCLE NERVE
16. Abduct the thumb.
a. ___________________ ___________________
b. ___________________ ___________________
17. Adduct the thumb.
a. ___________________ ___________________
18. Flex the thumb.
a. ___________________ ___________________
b. ___________________ ___________________
19. Extend the thumb.
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
20. Oppose the thumb and little finger.
a. ___________________ ___________________
b. ___________________ ___________________
21. Flex the metacarpophalangeal joints of the medial four fingers.
a. ___________________ ___________________
22. Extend the metacarpophalangeal joints of the medial four fingers.
a. ___________________ ___________________
34
MUSCLE NERVE
23. Abduct the fingers.
a. ___________________ ___________________
24. Adduct the fingers.
a. ___________________ ___________________
25. Flex the fingers at the proximal interphalangeal (PIP) joints.
a. ___________________ ___________________
26. Flex the fingers at the distal interphalangeal (DIP) joints.
a. ___________________ ___________________
27. Extend the fingers at the PIP and DIP joints.
a. ___________________ ___________________
C. Vasculature (Veins and Arteries)
1. With the aid of an elastic tourniquet wrapped around the arm near the axilla,
identify the following superficial veins throughout their course:
a. Basilic vein (in the arm and forearm)
b. Cephalic vein (in the arm and forearm)
c. Median cubital vein
d. Median antebrachial vein
35
2. Locate and palpate the following arterial pulses:
a. Brachial artery in the arm
b. Brachial artery in the cubital fossa
c. Radial artery at the wrist
d. Ulnar artery at the wrist
e. Radial artery in the anatomical snuff box
D. Nerves
1. On the right upper limb of a subject, outline the area of skin innervated by nerve
fibers comprising each of the following spinal dorsal roots:
a. C5
b. C6
c. C7
d. C8
e. T1
2. An autonomous zone is an area of skin generally understood to be innervated

exclusively by afferent (sensory) nerve fibers contained within a single
pre-plexus spinal nerve root or post-plexus peripheral nerve. On the right upper
limb, identify and mark the autonomous zone for each of the following spinal
dorsal roots:
a. C5
b. C6
c. C7
d. C8
e. T1
36
3. On the left upper limb of the same subject, outline the area of skin innervated by
nerve fibers comprising each of the following peripheral nerves:
a. Upper lateral brachial cutaneous nerve
b. Lower lateral brachial cutaneous nerve
c. Posterior brachial cutaneous nerve
d. Medial brachial cutaneous nerve
e. Lateral antebrachial cutaneous nerve
f. Posterior antebrachial cutaneous nerve
g. Medial antebrachial cutaneous nerve
h. Median nerve in the hand
i. Ulnar nerve in the hand
j. Radial nerve in the hand
4. On the left upper limb identify and mark the autonomous zone for each of the
following peripheral nerves:
a. Axillary nerve
b. Lateral antebrachial cutaneous nerve
c. Deep radial nerve
d. Median nerve
e. Ulnar nerve
f. Medial antebrachial cutaneous nerve
g. Medial brachial cutaneous nerve
5. The brachial plexus passes from the root of the neck into the axilla by coursing
over the top of the first rib between two muscles. These two muscles are:
a. _____________________________________________________
b. _____________________________________________________
37
3 Hip Girdle and Lower Limb
Objectives
1. Describe and identify by palpation in a living subject the major soft tissue and bony
landmarks of the lower limb.
2. List the action and innervation of the major muscle groups of the lower
limb.
3. List the major muscles responsible for movements permitted at each joint of the
lower limb.
4. Identify the major ligaments of the lower limb and describe the movements limited
or restricted by each.
5. Describe and identify by palpation in a living subject the major arterial pulses in the
lower limb.
pre-plexus roots of the lumbosacral plexus.
post-plexus peripheral nerves of the lumbosacral plexus.
pre-plexus roots of the lumbosacral plexus.
post-plexus peripheral nerves of the lumbosacral plexus.
38
1. What two bones form the pelvic girdle?
a. __________________________________________________________
b. __________________________________________________________
2. What three bones form the hip bone (os coxae or innominate bone)?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
3. What are the three ligaments that form the capsule of the hip joint?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
1) Do these ligaments become taught in hip flexion or hip

extension?
___________________________________________________
4. What are the two attachments of the inguinal ligament?
a. lateral attachment ______________________________________
b. medial attachment ______________________________________
5. What is the lateral attachment of the sacrotuberous ligament?
________________________________________________________________
6. What is the lateral attachment of the sacrospinous ligament?
________________________________________________________________
39
7. Describe the attachments and course of the anterior cruciate ligament.
________________________________________________________________
8. Describe the attachments and course of the posterior cruciate ligament.
________________________________________________________________
9. What ligament located on the medial side of the ankle resists pronation of the
foot?
________________________________________________________________
10. What vein receives venous blood from the great saphenous vein?
________________________________________________________________
11. What vein receives venous blood from the small saphenous vein?
________________________________________________________________
12. What vein receives venous blood from the femoral vein?
________________________________________________________________
13. What two structures are encased in the femoral sheath?
a. _________________________________________________________
b. _________________________________________________________
14. What structure is located in the femoral canal?
_______________________________________________________________
15. What structure marks the point where the external iliac artery becomes the
femoral artery?
_______________________________________________________________
40
16. At what point does the femoral artery become the popliteal artery?
________________________________________________________________
17. What are the two terminal branches of the popliteal artery?
a. __________________________________________________________
b. __________________________________________________________
18. What artery passes into the foot as the dorsal pedis artery?
________________________________________________________________
19. What spinal nerve roots contribute to the formation of the lumbar plexus?
___________________ to ___________________
20. What are the two (2) major nerves of the lower limb derived from the lumbar
plexus?
a. __________________________________________________________
b. __________________________________________________________
21. What spinal nerve roots contribute to the formation of the sacral plexus?
___________________ to ___________________
22. What are the two (2) major nerves of the lower limb derived from the sacral
plexus?
a. __________________________________________________________
b. __________________________________________________________
23 What nerve innervates the muscles of the posterior compartment of the

leg?
_________________________________________________________________
41
24. What nerve innervates the muscles of the anterior compartment of the
leg?
_________________________________________________________________
25. What nerve innervates the muscles of the lateral compartment of the leg?
_________________________________________________________________
26. What nerve passes deep to the extensor retinaculum to innervate muscles of the
foot?
_________________________________________________________________
27. What nerve passes posterior to the medial malleolus to innervate muscles of the
foot?
_________________________________________________________________
28. What nerve passes through the adductor hiatus?
_________________________________________________________________
29. What is the nerve that emerges from the adductor hiatus?
_________________________________________________________________
a. Is this nerve a motor nerve, sensory nerve or a mixed nerve?
__________________________________________________________
30. What are the structures that mark the borders of the femoral triangle?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
42
31. Define the angle of inclination.
_________________________________________________________________
a. What is the numerical value of the angle of inclination in the adult?
__________________________________________________________
32. Define the angle of declination.
_________________________________________________________________
a. What is the numerical value of the angle of declination?
__________________________________________________________
33. Define the “Q” angle.
_________________________________________________________________
a. What is the numerical value of the ”Q” angle?
__________________________________________________________
b. Is the “Q” angle greater or lesser in females than males?
__________________________________________________________
34. Which way does the tibia rotate on the femur during the last 150 of knee
extension?
________________________________________________________________
35. Indicate whether the line of gravity falls anterior or posterior to each of the
following joints.
a. hip joint ____________________________________________
b. knee joint ____________________________________________
c. ankle joint ____________________________________________
43
36. In full knee extension, is the medial collateral ligament of the knee tight or
slack?
________________________________________________________________
37. In full knee extension, is the lateral collateral ligament of the knee tight or
slack?
________________________________________________________________
38. What ligament of the foot is referred to as the “spring ligament”?
________________________________________________________________
With the subject resting comfortably in the supine position, perform the following:
1. Identify and palpate the greater trochanter.
2. Identify the location of the inguinal ligament by placing the tip of your long
finger on the pubic tubercle and the tip of your thumb on the anterior superior
iliac spine (Note: use your right hand when identifying the subject’s right
inguinal ligament and left hand when identifying the left inguinal
ligament.)
a. What artery courses deep to the inguinal ligament midway between the
anterior superior iliac spine and the pubic tubercle?
__________________________________________________________
b. What structure lies medial to the artery beneath the inguinal

ligament?
__________________________________________________________
44
c. What structure lies lateral to the artery passing deep to the inguinal
ligament?
__________________________________________________________
d. What muscles form the borders of the femoral triangle?
1) ___________________________________________________
2) ___________________________________________________
3. Inspect and palpate the quadriceps femoris muscle. Pay particular attention to
the distally located oblique fibers of the vastus medialis (VMO).
contour and bulk?
__________________________________________________________
__________________________________________________________
b. Which of the four heads of this muscle does NOT originate from the
femur?
__________________________________________________________
c. What is the origin of this part of the quadriceps femoris?
__________________________________________________________
45
4. Instruct the subject to contract the quadriceps (forcefully extend the knee)
while you palpate the distal part of the vastus medialis.
a. Are the two sides symmetrical to palpation?
__________________________________________________________
__________________________________________________________
b. What effect does the action of this part of the quadriceps have on the
patella?
__________________________________________________________
5. Inspect and palpate the patellar ligament.
a. What is the proximal attachment of this ligament?
__________________________________________________________
b. What is the distal attachment of this ligament?
__________________________________________________________
6. Inspect and palpate the fibular head.
a. What nerve lies along the posterior surface of the fibular head?
__________________________________________________________
b. What muscle originates on the fibular head?
__________________________________________________________
46
7. Inspect and palpate the tibial tubercle and anterior tibial crest.
a. What are the two (2) major actions of the muscles in the anterior
compartment of the leg?
1) ___________________________________________________
2) ___________________________________________________
b. What peripheral nerve lies within the anterior compartment of the

leg?
__________________________________________________________
c. What artery lies in the anterior compartment of the leg?
__________________________________________________________
8. Inspect and palpate the lateral malleolus and medial malleolus.
a. What two muscles have tendons that lie posterior to the lateral
malleolus?
1) ___________________________________________________
2) ___________________________________________________
9. Inspect the medial and lateral longitudinal arches of the foot.
a. What is the most important ligament supporting the medial longitudinal

arch?
__________________________________________________________
47
10. Inspect the toes.
a. Does the subject have hallux valgus? ________________
b. Does the subject have hammer toes? ________________
With the subject lying comfortably in the supine position, slide one foot toward the buttock
until the knee is flexed 90º. Keep the foot flat on the examination table.
11. Grasp the leg with both hands just below the knee and gently pull the tibia
away from the buttock while keeping the foot immobile.
a. What ligament prevents anterior displacement of the tibia on the

femur?
____________________________________________________
b. What is the tibial attachment of this ligament?
____________________________________________________
c. What is the femoral attachment of this ligament?
____________________________________________________
12. Grasp the leg with both hands just below the knee and gently push the tibia
toward the buttock while keeping the foot immobile.
a. What ligament prevents posterior displacement of the tibia on the

femur?
_____________________________________________________
b. What is the tibial attachment of this ligament?
_____________________________________________________
48
c. What is the femoral attachment of this ligament?
_____________________________________________________
With the subject lying comfortably in the prone position, perform the following:
13. Palpate the iliac crests.
a. Which vertebra would be crossed by a line interconnecting the superior

margins of the iliac crests?
___________________________________________________
14. Palpate the ischial tuberosity.
a. What ligament attaches to the ischial tuberosity?
____________________________________________________
b. What muscles originate from the ischial tuberosity?
1) ______________________________________________
2) ______________________________________________
3) ______________________________________________
4) ______________________________________________
49
15. The region of the “buttock” is commonly subdivided into four (4) regions:
superolateral, inferolateral, superomedial and inferomedial. Intramuscular
injections are administered in one of these regions. Indicate the region used
for intramuscular injections and provide a brief explanation for why this region
is preferred.
a. Region _______________________________________
b. Explanation _______________________________________
____________________________________________________
16. Inspect and palpate the posterior thigh (hamstring) muscles.
a. Are the right and left sides visually symmetrical with regard to bulk and
contour?
_______________
____________________________________________________
b. What is the major action of the posterior muscles of the thigh?
_____________________________________________________
17. Inspect and palpate the popliteal fossa.
a. What muscle forms the superolateral border of the popliteal

fossa?
_____________________________________________________
50
1) Which peripheral nerves provide motor innervation to this
muscle?
a) _________________________________________
b) _________________________________________
b. What muscles form the superomedial border of the popliteal

fossa?
1) _______________________________________________
2) _______________________________________________
3) What peripheral nerve provides motor innervation to these

muscles?
_______________________________________________
c. What muscle forms the inferomedial and inferolateral border of the

popliteal fossa?
_____________________________________________________
_______________________________________________
d. What artery lies on the floor of the popliteal fossa?
_____________________________________________________
e. What nerve lies in the popliteal fossa?
_____________________________________________________
f. What muscle forms the floor of the popliteal fossa?
_____________________________________________________
51
18. Inspect and palpate the posterior leg (crural) muscles.
a. Are the right and left sides visually symmetrical with regard to bulk and
contour?
______________
___________________________________________________
b. What are the major actions of the muscles of the posterior compartment of
the leg?
1) ______________________________________________
2) ______________________________________________
c. What three muscles have tendons that lie posterior to the medial
malleolus?
1) ______________________________________________
2) ______________________________________________
3) ______________________________________________
With the subject standing with the feet approximately 6–8 inches apart and the toes parallel
and directed forward:
19. Inspect the medial longitudinal arch of the foot.
a. Are the right and left arches symmetrical with regard to the height of the
arch?
_________________
____________________________________________________
52
b. What muscle of the leg helps support the medial longitudinal arch of the
foot?
_____________________________________________________
B. Movements
Instruct the subject to perform each of the following movements and to maintain the new
position while you attempt to move the body part to the starting position. Examine movement
and strength on both the right and left side. Note the full range of motion permitted at each
joint and the strength needed by the subject to resist your efforts to reposition the body part.
In the spaces provided, list the main muscles responsible for each movement and indicate
the peripheral nerve that innervates each muscle.
With the subject in the sitting position instruct the subject to:
MUSCLE NERVE
1. Flex the thigh (hip joint)
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
2. Extend the leg (knee joint)

a. ___________________ ___________________
3. Dorsiflex the foot (ankle joint)
a. ___________________ ___________________
4. Plantar flex the foot (ankle joint)
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
53
MUSCLE NERVE
5. Extend the toes
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
6. Flex the toes
a. ___________________ ___________________
b. ___________________ ___________________
With the subject lying in the prone position instruct the subject to:
7. Hyperextend the thigh (hip joint)
a. ___________________ ___________________
8. Flex the leg (knee joint)
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
With the subject lying in the supine position, instruct the subject to:
9. Adduct the abducted thigh (hip joint)
a. ___________________ ___________________
b. ___________________ ___________________
c. ___________________ ___________________
54
MUSCLE NERVE
10. Abduct the thigh (hip joint)
a. ___________________ ___________________
b. ___________________ ___________________
C. Vasculature (Veins and Arteries)
1. Identify the location of the following superficial veins:
a. great saphenous vein
b. small saphenous vein
c. popliteal vein
d. femoral vein
2. Palpate the following arterial pulses:
a. femoral artery at the level of the inguinal ligament
b. popliteal artery
c. anterior tibial artery at the ankle
d. posterior tibial artery at the talus
e. dorsal pedis artery in the foot
55
D. Nerves
1. On the right lower limb of a subject, outline the area of skin innervated by
sensory nerve fibers comprising each of the following spinal dorsal roots:
a. L2
b. L3
c. L4
d. L5
e. S1
f. S2
2. On the right lower limb identify and mark the autonomous zone for each of the
following spinal dorsal roots:
a. L2
b. L3
c. L4
d. L5
e. S1
3. On the left lower limb of the same subject, outline the area of skin innervated by
sensory nerve fibers comprising each of the following peripheral nerves:
a. lateral femoral cutaneous nerve
b. obturator nerve
c. saphenous nerve
d. superficial peroneal nerve
e. sural nerve
f. deep peroneal nerve
56
4. On the left lower limb identify and mark the autonomous zone for each of the
following peripheral nerves:
a. lateral femoral cutaneous nerve
b. obturator nerve
c. saphenous nerve
d. superficial peroneal nerve
e. sural nerve
f. deep peroneal nerve
57
4 Thorax
Objectives
1. Describe and identify by palpation in a living subject the major bony and soft tissue
landmarks of the thorax.
2. Describe and mark on a living subject the several “vertical lines” used to subdivide
the thorax into definable regions.
1. Name the three parts of the sternum.
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
2. What are the three structures that form the borders of the superior thoracic
aperture?
a. posterior border _____________________________________________
b. lateral border _____________________________________________
c. anterior border _____________________________________________
3. What are the four structures that form the borders of the inferior thoracic
aperture?
a. posterior border ______________________________________
b. posterolateral border ______________________________________
c. anterolateral border ______________________________________
d. anterior border ______________________________________
58
4. In the mid-axillary line, what is the fiber direction of the external intercostal
muscles?
________________________________________________________________
5. In the mid-axillary line, what is the fiber direction of the internal intercostal
muscles?
________________________________________________________________
6. Which rib serves as the insertion (inferior attachment) of each of the

following?
a. anterior scalene muscle _____________________________________
b. middle scalene muscle _____________________________________
c. posterior scalene muscle _____________________________________
7. What is the action of each of the muscles listed below?
a. serratus posterior superior ____________________________________
b. serratus posterior inferior ____________________________________
8. The external and internal intercostal muscles do fill the entire intercostal space
from the vertebral column to the sternum—each forms an attachment by way of an
intercostal membrane (i.e., external intercostal membrane and internal intercostal
membrane). Which of these membranes is located in the:
a. midclavicular line ______________________________________
b. mid scapular line ______________________________________
9. Describe the location of the neurovascular structures within the intercostal

space?
________________________________________________________________
59
10. What is the order (from superior to inferior) the three intercostal neurovascular
structures?
a. superior _____________________________________________
b. middle _____________________________________________
c. inferior _____________________________________________
11. What is the origin of the anterior intercostal artery?
_________________________________________________________________
12. What is the termination of the anterior intercostal vein?
_________________________________________________________________
13. What is the origin of the internal thoracic artery on the right side?
_________________________________________________________________
14. What is the origin of the internal thoracic artery of the left side?
_________________________________________________________________
15. What are the two terminal branches of the internal thoracic artery?
a. __________________________________________________________
b. __________________________________________________________
16. Into what vein do the internal thoracic veins drain into?
________________________________________________________________
17. What vessel does the azygos vein drain into?
________________________________________________________________
60
18. What vessel does the hemiazygos vein drain into?
________________________________________________________________
19. What vessel does the accessory hemiazygos vein drain into?
________________________________________________________________
20. In the region of the superior thoracic aperture (thoracic inlet), what muscle
separates the subclavian artery from the subclavian vein?
________________________________________________________________
With the subject seated comfortably facing toward you
1. Inspect the sternum
a. Is the body of the sternum flat or is it indented (pectus excavatum) or

protruded (pectus carinatum)?
_________________________________________________________
2. Palpate the suprasternal (jugular) notch and the sternoclavicular

joints.
a. What vertebral body would be crossed by a horizontal line extending

posteriorly from the suprasternal notch?
_________________________________________________________
61
3. Palpate the sternomanubrial joint (sternal angle or angle of Louis).

posteriorly from the sternomanubrial joint?
_________________________________________________________
b. What rib attaches to the sternum at the sternal angle?
_________________________________________________________
4. Palpate xiphoid process and xiphisternal joint.

posteriorly from the xiphisternal joint?
_________________________________________________________
b. Which ribs attach to the sternum by way of their own individual costal
cartilage (i.e., vertebrosternal ribs)?
_________________________________________________________
c. Which ribs attach to the sternum by way of a common costal cartilage

(i.e., vertebrochondral ribs)?
_________________________________________________________
5. Palpate the inferior margin of the costal cartilages starting at the xiphoid
process and moving laterally.
a. Which ribs attach only to the vertebral column (i.e., vertebral

ribs)?
_________________________________________________________
62
With the subject comfortably facing away from you
6. Inspect the vertebral column with respect to its position in the sagittal
plane.
a. Is the convexity of the thoracic spine directed anteriorly or

posteriorly?
_________________________________________________________
b. What term is used to refer to an increase in the curvature of the thoracic

spine in the sagittal plane?
_________________________________________________________
7. Inspect the vertebral column with respect to its position in the coronal
plane.
a. Is the thoracic spine straight or do you see a curvature?
_________________________________________________________
b. If you see a curvature, is the convexity directed toward the right or left
side?
_________________________________________________________
c. Is the lumbar spine straight or do you see a curvature?
_________________________________________________________
d. If you see a curvature, is the convexity directed toward the right or left
side?
_________________________________________________________
63
e. What term is used to refer to curvature of the spine in the coronal
plane?
_________________________________________________________
8. Palpate the spinous process of C7 (vertebra prominens). (NOTE: sometimes

the spinous process of T1 is prominent to palpation also.)
9. Palpate the supraspinous ligament from C7 to the sacrum, pressing hard

enough to identify the thoracic and lumbar spinous processes.
10. With the subject sitting upright and the hands resting lightly on the thighs,
palpate the vertebral border of the scapula from the superior angle to the
inferior angle.
a. What rib lies immediately deep to the superior angle of the

scapula?
__________________________________________________________
b. What rib lies immediately deep to the inferior angle of the

scapula?
__________________________________________________________
64
B. Landmarks
1. The location of clinically important structures within the thorax is frequently

described in relation to several vertical “lines” that subdivide the thoracic wall
into definable regions. With the subject sitting upright and comfortable, identify
and mark the following “lines” on the thorax:
a. midsternal line
b. midclavicular line
c. anterior axillary line
d. midaxillary line
e. posterior axillary line
f. midscapular line
g. midspinal line
2. Indicate the fiber direction of the external intercostal muscle in the 5th intercostal
space on the right side in the anterior axillary line.
______________________________________________________________
3. Indicate the fiber direction of the internal intercostal muscle in the 5th intercostal
space on the left side in the anterior axillary line.
_____________________________________________________________
4. What spinal (segmental) nerve provides sensory innervation to the skin of the
nipple and areola?
_____________________________________________________________
65
5 Lungs and Pleura
Objectives
1. Describe and identify by palpation in a living subject the location of the pleural
reflections on both sides.
2. Describe and identify by palpation in a living subject the location of the lung
margins on both sides.
3. Describe and identify by palpation in a living subject the location of the fissures of
each lung on both sides.
4. Describe and identify by palpation in a living subject the location of the landmarks
on the anterior and posterior that mark the level of the tracheal bifurcation.
1. What are the two divisions of the pleura?
a. __________________________________________________________
b. __________________________________________________________
2. What are the four parts of the parietal pleura?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
66
3. Name the bronchopulmonary segments of each lung
a. Right lung
1) superior lobe _______________________________________
_______________________________________
_______________________________________
2) middle lobe _______________________________________
_______________________________________
3) inferior lobe ________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
b. Left lung
1) superior lobe ______________________________________
______________________________________
______________________________________
______________________________________
2) inferior lobe ______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
4. Which lung is marked by a groove for the descending aorta?
_________________________________________________________________
67
5. Which lung is marked by a groove for the azygos vein?
_________________________________________________________________
6. The bifurcation of the trachea lies at a level marked by a horizontal line that
passes through the
a. ______________________________________ anteriorly
b. ______________________________________ posteriorly
7. Because of its more vertical orientation and slightly greater diameter, an object
aspirated into the trachea is more likely to pass into which main stem
bronchus.
_________________________________________________________________
8. Indicate the muscles that form the boundaries of the triangle of

auscultation.
a. superomedial boundary ______________________________________
b. superolateral boundary ______________________________________
c. inferior boundary ______________________________________
9. Which intercostal space forms the floor of the triangle of auscultation?
________________________________________________________________
10. Name the vertebra that marks the level of the following openings in the
respiratory diaphragm.
a. vena caval foramen ______________________________________
b. esophageal hiatus ______________________________________
c. aortic hiatus ______________________________________
68
11. List the structures that pass through the vena caval foramen.
______________________________________________________________
12. List the structures that pass through the esophageal hiatus.
a. _______________________________________________________
b. _______________________________________________________
13. List the structures that pass through the aortic hiatus.
a. _______________________________________________________
b. _______________________________________________________
c. _______________________________________________________
14. What nerve provides motor innervation to the respiratory diaphragm?
_____________________________________________________________
15. What spinal segments give rise to the nerve indicated in the above
question?
_____________________________________________________________
With the subject sitting comfortably with the hands resting lightly on the thighs:
1. Observe the movements of the chest during quiet breathing.
a. Which phase of the respiratory cycle is longer during quiet

breathing?
_______________________________________________________
69
b. What is the normal respiration rate?
_______________________________________________________
2. Place the palm and fingers of one hand over the subject’s xiphoid process
and the other hand over the spinous processes of the T8-T10 vertebrae. Note
the extent of chest expansion in the anterior-posterior direction during quiet
breathing. Ask the subject to inhale deeply and exhale fully several times
slowly and again note the extent of chest expansion in the anterior-posterior
direction.
3. Place your hands over the 8th-10th ribs bilaterally in the midaxillary line. Note
the extent of chest expansion in the transverse direction during quiet breath-
ing. Ask the subject to inhale deeply and exhale fully several times slowly and
again note the extent of chest expansion in the transverse direction.
B. Landmarks
With the subject sitting comfortably
1. Identify and mark the pleural reflections on the right and left sides of the
thorax.
2. Indicate the rib overlying the pleural reflection in the
a. midclavicular line ____________________________________
b. midaxillary line ____________________________________
c. midscapular line ____________________________________
3. Which costal cartilage marks the point where the pleural reflection moves
laterally beneath the body of the sternum on the right side?
____________________________________________________________
70
4. Which costal cartilage marks the point where the pleural reflection moves
laterally beneath the body of the sternum on the left side?
____________________________________________________________
5. Identify and mark the boundaries of the lungs on the right and left
sides.
6. What rib overlies the lung boundary in the
a. midclavicular line______________________________________
b. midaxillary line _______________________________________
c. midscapular line _______________________________________
7. Which costal cartilage marks the point where the medial edge of the right lung
moves laterally beneath the body of the sternum?
____________________________________________________________
8. Which costal cartilage marks the point where the medial edge of the left lung
moves laterally beneath the body of the sternum?
____________________________________________________________
9. Identify and mark the location of the oblique fissure of the right and left
lungs.
10. The oblique fissure lies parallel to a line interconnecting the
a. ___________________ spinous process posteriorly
b. ___________________ rib in the midaxillary line
c. ___________________ costal cartilage anteriorly
71
11. Identify and mark the location of the horizontal fissure of the right lung.
12. The horizontal fissure lies parallel to a line interconnecting the
a. ____________________ in the midaxillary line laterally
b. ____________________ costal cartilage anteriorly
72
6 Heart
Objectives
1. Describe and mark in a living subject the location of the borders of the heart of the
anterior chest wall.
2. Describe and mark in a living subject the location on the anterior chest wall of
each of the cardiac valves.
3. Describe and mark in a living subject the location on the anterior chest wall of the
best location for auscultating each of the cardiac valves.
4. Indicate the cardiac valves responsible for the S1 and S2 heart sounds.
1. The superior border of the middle mediastinum is marked by a line that extends
from the:
a. ___________________________________ anteriorly
b. ___________________________________ posteriorly
2. The inferior border of the middle mediastinum is marked by a line that extends
from the:
a. ___________________________________ anteriorly
b. ___________________________________ posteriorly
3. What are the two layers of the pericardium?
a. ______________________________________________________
b. ______________________________________________________
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4. What are the two layers of the serous pericardium?
a. __________________________________________________________
b. __________________________________________________________
5. Which layer of the heart is also referred to as the epicardium?
_________________________________________________________________
6. What are the two layers that enclose the pericardial cavity?
a. __________________________________________________________
b. __________________________________________________________
7. Through what cardiac valve does blood flow through to pass from the:
a. right ventricle to the pulmonary artery _________________________
b. left ventricle to the aorta _________________________
c. left atrium to the left ventricle _________________________
d. right atrium to the right ventricle _________________________
8. Which chambers of the heart are separated by the fossa ovalis?
a. __________________________________________________________
b. __________________________________________________________
9. In the fetus, in which direction does blood flow through the ductus
arteriosus?
________________________________________________________________
10. Into which chamber of the heart does the coronary sinus drain?
________________________________________________________________
74
11. In which chamber of the heart are pectinate muscles located?
________________________________________________________________
12. In which two (2) chambers of the heart are papillary muscles located?
a. _________________________________________________________
b. _________________________________________________________
13. What structures serve to attach papillary muscles to cardiac valve

leaflets?
_______________________________________________________________
14. What are the two (2) major named branches of the left coronary artery?
a. _________________________________________________________
b. _________________________________________________________
15. What are the two major named branches of the right coronary artery?
a. _________________________________________________________
b. _________________________________________________________
16. What are the five main veins that drain into the coronary sinus?
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
d. _________________________________________________________
e. _________________________________________________________
17. What coronary veins do NOT drain into the coronary sinus?
_______________________________________________________________
75
18. What is the location of the parasympathetic nerve cell bodies that innervate the
heart?
a. preganglionic cell ____________________________________
1) What is the neurotransmitter used by this cell?
__________________________________________
b. postganglionic cell ____________________________________
__________________________________________
19. What is the location of the sympathetic nerve cell bodies that innervate the
heart?
a. preganglionic cell ____________________________________
__________________________________________
b. postganglionic cell ____________________________________
___________________________________________
20. What are the three vessels (in order) that arise from the arch of the aorta?
a. ______________________________________________________
b. ______________________________________________________
c. ______________________________________________________
21. Which pulmonary vein passes under the arch of the aorta?
____________________________________________________________
76
A. Landmarks
With the subject sitting comfortably facing you
1. Identify and mark the borders of the heart on the anterior thorax
a. superior border – draw a line from the inferior margin of the 2nd costal
cartilage on the left to the inferior margin of the 2nd costal cartilage on the
right. The line should extend from the left sternal border to the right sternal
border.
b. right border – draw a line from the 2nd costal cartilage on the right to the
6th costal cartilage on the right. The line should have a slight convexity
toward the right as it courses inferiorly, approximately 1 cm lateral to the
lateral sternal border.
c. inferior border – draw a line from the 6th costal cartilage on the right side
beginning at the lateral sternal border to the 5th intercostal space on the
left side in the midclavicular line.
d. left border – draw a line from the 5th intercostal space on the left side
in the midclavicular line to the 2nd costal cartilage on the left along the
lateral sternal border.
2. Identify and mark the anatomical location of the valves of the heart.
a. pulmonary valve – lies posterior to the 3rd sternochondral junction on the

left side
b. aortic valve – lies in the midsternal line at the level of the 3rd intercostal
space
77
c. mitral valve – lies posterior to the 4th sternochondral junction on the left
side
d. tricuspid valve – lies in the midsternal line at the level of the 5th
sternochondral junction
3. Identify and mark on the anterior chest wall, sites for auscultating each of the
cardiac valves
a. aortic valve – 2nd intercostal space on the right side along the lateral
sternal border
b. pulmonary valve – 2nd intercostal space on the left side along the lateral
sternal border
c. tricuspid valve – 5th intercostal space on the left side along the lateral
sternal border
d. mitral valve – 5th intercostal space on the left side on or near the
midclavicular line
B. Inspection and Palpation
With the subject lying comfortably in the supine position with the head and upper thorax
slightly elevated
1. Observe the apical impulse
a. Describe the location of the apical impulse
______________________________________________________
78
2. While standing on the subject’s right side, use your right hand to palpate the
point of maximum impulse (PMI)
a. Describe the location of the PMI.
__________________________________________________________
b. What is the subject’s heart rate?
__________________________________________________________
C. Auscultation
The cardiac cycle consists of two phases: systole and diastole. During systole the left and
right ventricles contract, ejecting blood into the aorta and pulmonary artery, respectively.
The onset of systole is marked by closure of the mitral and tricuspid valves (atrioventricular
valves). Closure of these valves prevents reflux into the atria and gives rise to the 1st heart
sound (S1). The end of systole (or beginning of diastole) is marked by closure of the aortic
and pulmonary valves (semilunar valves). Closure of these valves prevents reflux into the
left and right ventricles respectively and gives rise to the second heart sound (S2).
With the subject lying comfortably in the supine position with the head and upper thorax
slightly elevated
1. Use your stethoscope to auscultate each of the heart valves individually.

Which heart sound is loudest or most clearly heard over each valve projection
area?
a. aortic area ______________________________________
b. tricuspid area ______________________________________
c. pulmonary area ______________________________________
d. mitral area ______________________________________
2. In your resting subject, which phase of the cardiac cycle is shorter?
_____________________________________________________________
79
7 Abdomen
Objectives
1. Describe and identify by palpation in a living subject the margins of the

abdominal wall.
2. Describe and mark in a living subject the lines used to divide the abdomen into
four (4) quadrants.
3. List the organs and other important anatomical structures commonly located in
each of the four quadrants.
4. Describe and mark in a living subject the lines used to divide the abdomen into
nine (9) regions.
5. List the organs and other important anatomical structures commonly located in
each of the nine regions.
1. Below the level of the umbilicus, what are the two layers of superficial
fascia?
a. __________________________________________________________
b. __________________________________________________________
2. What is the name of the layer of fascia that lies deep to the transversus
abdominus muscle?
_________________________________________________________________
80
3. The neurovascular structures of the abdominal wall lie between which two muscle
layers of the abdominal wall?
a. __________________________________________________________
b. __________________________________________________________
4. Above the level of the arcuate line, what structures form the:
a. anterior wall of the rectus sheath
__________________________________________________________
b. posterior wall of the rectus sheath
__________________________________________________________
5. Below the level of the arcuate line, what structures form the:
a. anterior wall of the rectus sheath
__________________________________________________________
b. posterior wall of the rectus sheath
__________________________________________________________
The lower part of the anterior abdominal wall receives arterial blood supply from both the
distal part of the external iliac artery and the proximal part of the femoral artery.
6. What are the two branches of the external iliac artery that supply the anterior
abdominal wall?
a. __________________________________________________________
b. __________________________________________________________
7. What are the two branches of the femoral artery that supply the anterior abdominal
wall?
a. __________________________________________________________
b. __________________________________________________________
81
8. What structure gives rise to the:
a. median umbilical fold ______________________________________
b. medial umbilical fold ______________________________________
c. lateral umbilical fold ______________________________________
9. What structure invaginates to form the deep (internal) inguinal ring?
_________________________________________________________________
10. What structure splits to form the superficial (external) inguinal ring?
_________________________________________________________________
11. Which abdominal muscle gives rise to the cremaster muscle?
________________________________________________________________
12. What structure (layer) of the abdominal wall gives rise to the:
a. external spermatic fascia ________________________________
b. internal spermatic fascia ________________________________
c. tunica vaginalis ________________________________
13. What part of the stomach lies between the body of the stomach and the distal
esophagus?
_________________________________________________________________
14. What part of the stomach lies between the body of the stomach and the
duodenum?
_________________________________________________________________
82
15. What are the three major branches of the celiac trunk?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
16. What two arteries anastomose on the lesser curvature of the stomach?
a. __________________________________________________________
b. __________________________________________________________
17. What two arteries anastomose on the greater curvature of the stomach?
a. __________________________________________________________
b. __________________________________________________________
18. What artery is the origin of the short gastric arteries?
________________________________________________________________
19. What artery is the usual origin of the cystic artery?
_________________________________________________________________
20. What two vessels form the portal vein?
a. __________________________________________________________
b. __________________________________________________________
21. Into what vein does the inferior mesenteric vein drain?
________________________________________________________________
83
22. What are the four parts of the duodenum? (List in order from proximal to
distal.)
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
23. What two structures commonly merge and drain into the duodenum by way of the
major duodenal papilla?
a. __________________________________________________________
b. __________________________________________________________
24. Into what part of the duodenum does the major duodenal papilla drain?
_________________________________________________________________
25. Where and what is the “sphincter of Oddi”?
_________________________________________________________________
26. Where and what is the “ampulla of Vater”?
_________________________________________________________________
27. Which of the four parts of the duodenum is supported by the suspensory ligament
of the duodenum (ligament of Treitz)?
_________________________________________________________________
28. The superior mesenteric artery passes superficial to which part of the duodenum
in order to supply the structures of the foregut?
_________________________________________________________________
84
29. What part of the large intestine (colon) serves as the attachment for the
appendix?
________________________________________________________________
30. Which three parts of the colon are typically supplied by branches of the superior
mesenteric artery?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
31. Which two parts of the colon are typically supplied by branches of the inferior
mesenteric artery?
a. __________________________________________________________
b. __________________________________________________________
32. What two structures fuse to form the bile duct?
a. __________________________________________________________
b. __________________________________________________________
33. What three structures comprise the portal triad?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
85
34. Indicate the vertebral level of each of the following:
a. bifurcation of the aorta ___________________
b. pyloric valve of the stomach ___________________
c. the inferior vena cava ___________________
d. origin of the inferior mesenteric artery ___________________
e. origin of the renal arteries ___________________
f. superior mesenteric artery ___________________
35. Which renal vein is the longer of the two?
_________________________________________________________________
36. Which renal vein is crossed by the superior mesenteric artery?
_________________________________________________________________
37. What structure is the origin of the thoracic duct?
_________________________________________________________________
38. What vascular structure does the thoracic duct drain into?
_________________________________________________________________
39. Describe the location of McBurney’s point.
_________________________________________________________________
A. Inspection
With the subject lying comfortably in the supine position:
86
1. Inspect the anterior abdominal wall
a. Is it flat or distended? __________________________
b. Are there scars or bruises? __________________________
If so, describe the location, size, length, direction and apparent

age.
__________________________________________________________
__________________________________________________________
c. Are there dilated veins visible? _________________________
If so, describe their location and orientation.
__________________________________________________________
__________________________________________________________
2. Inspect the umbilicus.
a. Is the umbilicus in the midline? ___________________
b. Is the umbilicus inverted or everted? ___________________
3. Inspect the skin overlying the rectus abdominis muscle. Ask the subject to
cross the arms over the chest and attempt to lift the shoulders off the
table.
a. Can you see the lateral borders of the rectus abdominis?
__________________________________________________________
87
b. Are the tendinous intersections above or below the umbilicus?
__________________________________________________________
B. Palpation and Landmarks
1. Palpate and mark the xiphoid process.
2. Palpate the inferior margin of the costal cartilages of ribs 6-10. Begin medially at
the xiphoid process and move laterally along the costochondral margin until you
feel the anterior end of the 11th rib. Mark this border of the anterior abdominal
wall on both sides with a line extending from the xiphoid process to the inferior
margin of the 11th rib in the midaxillary line.
3. Palpate the iliac crests on both sides. Begin laterally in the midaxillary line and
move anteriorly until you reach the anterior superior iliac spine (ASIS). Mark this
border of the ilium with a line extending from the iliac crest in the midaxillary
line to the anterior superior iliac spine on both sides.
4. Palpate the inguinal ligament from its superolateral attachment on the anterior
superior iliac spine to its inferomedial attachment on the pubic tubercle. Mark
this inferior border of the anterior abdominal wall with a line extending from the
anterior superior iliac spine (ASIS) to the pubic tubercle.
5. Using proper technique, palpate the free edge of the liver.
a. Describe the location on the anterior abdominal wall where you would
palpate the free margin of the liver.
_____________________________________________________
88
The anterior abdominal wall can be divided into four regions or nine regions by a series
of vertical and horizontal lines that intersect identifiable anatomical landmarks. Anatomical
landmarks associated with both systems will be identified below.
The Four Region System
6. Mark a vertical line from the xiphoid process to the pubic symphysis that passes
through the umbilicus.
7. Mark a horizontal line that passes through the umbilicus (transumbilical line).
These two lines define four quadrants identified as the right upper quadrant
(RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ) and left lower
quadrant (LLQ).
a. In a thin subject, what vertebra would be intersected by a horizontal line

that extends posteriorly from the umbilicus?
____________________________________________________________
8. List the organs or other important anatomical structures commonly located in

each quadrant. (Fill in one structure for each line provided.)
a. RUQ: _____________________ ___________________
___________________ __________________
___________________ __________________
___________________ __________________
___________________ __________________
89
b. LUQ: _____________________ ____________________
___________________ __________________
___________________ __________________
___________________ __________________
___________________ __________________
c. RLQ: _____________________ ___________________
___________________ __________________
___________________ __________________
___________________ __________________
___________________ __________________
d. LLQ: _____________________ ___________________
___________________ __________________
___________________ __________________
___________________ __________________
90
The Nine Region System
9. Mark vertical lines on both sides of the abdomen from the costal cartilage to the
inguinal ligament in the midclavicular line.
10. Mark a horizontal line that passes between the lowest extent of the costal
cartilages on each side (subcostal line).
a. What vertebrae would be intersected by a horizontal line extending posteriorly

from the subcostal line?
_____________________________________________________________
b. Name the three regions of the anterior abdominal wall that lie above the
subcostal line.
1) __________________________________________________________
2) __________________________________________________________
3) __________________________________________________________
11. Mark a horizontal line that passes between the iliac tubercles (transtubercular
line).
a. What vertebrae would be intersected by a horizontal line extending

posteriorly from the transtubercular line?
_____________________________________________________________
b. Name the three regions of the anterior abdominal wall that lie above the
transtubercular line and below the subcostal line.
1) __________________________________________________________
2) __________________________________________________________
3) __________________________________________________________
91
c. Name the three regions of the anterior abdominal wall that lie below the
transtubercular line.
1) __________________________________________________________
2) __________________________________________________________
3) __________________________________________________________
12. Mark a line from the umbilicus to the right anterior superior iliac spine (ASIS).
McBurney’s point lies on this line, two thirds the distance from the umbilicus to the
ASIS.
13. What spinal (segmental) nerve provides sensory innervation to the skin of the
umbilicus?
________________________________________________________________
14. On the right side of the anterior abdominal wall indicate the fiber direction of the
external oblique muscle.
________________________________________________________________
15. On the left side of the anterior abdominal wall indicate the fiber direction of the
internal oblique muscle.
________________________________________________________________
92
C. Auscultation
With the subject lying comfortably in the supine position, perform the following:
1. Use your stethoscope to auscultate each of the four quadrants of the

anterior abdominal wall. Listen for approximately three minutes in each
quadrant.
a. Did you hear something in each quadrant?
______________________________________________________
b. Describe the sounds you heard.
______________________________________________________
______________________________________________________
c. What is borborygmy?
______________________________________________________
2. Place your stethoscope on the abdomen in the places where you would best
hear bruits of the following vessels and describe that location.
a. aorta
____________________________________________________
b. renal artery
___________________________________________________
c. common iliac artery
____________________________________________________
93
8 Head and Face
Objectives
1. Describe the anatomical features of the face commonly inspected when evaluating
the face.
2. Describe the major movements of the face used when testing the motor function of
the facial nerve. Indicate the muscles producing each movement.
3. Describe and identify by palpation in a living subject the area of skin innervated by
each major branch of the trigeminal nerve.
4. Demonstrate in a living subject the major palpable arterial pulses of the

face.
5. Describe the anatomical organization of autonomic innervation to smooth muscle

and glandular structures of the face.
1. What bones are joined to form the lambda?
a. __________________________________________________________
b. __________________________________________________________
2. What bones are joined to form the bregma?
a. __________________________________________________________
b. __________________________________________________________
94
3. What two bones contribute to the zygomatic arch?
a. __________________________________________________________
b. __________________________________________________________
4. What four bones contribute to the formation of the pterion?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
5. At approximately what age does the anterior fontanelle become no longer

palpable?
________________________________________________________________
6. What structure divides the intracranial compartment into right and left
halves?
________________________________________________________________
7. What structure divides the intracranial compartment into supratentorial and

infratentorial compartments?
_________________________________________________________________
8. What are the five layers of the scalp?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
e. __________________________________________________________
95
9. What branch of the external carotid artery:
a. is palpable along the inferior border of the mandible?
_____________________________________________________________
b. supplies the structure of the tongue?
_____________________________________________________________
c. is palpable in the temporal fossa?
_____________________________________________________________
d. supplies part of the thyroid gland?
_____________________________________________________________
e. enters the pterygopalatine fossa?
_____________________________________________________________
10. What artery anastomoses from the front with the intraorbital branches of the
ophthalmic artery?
_________________________________________________________________
11. What dural venous sinus:
a. lies in the superior margin of the falx cerebri?
_____________________________________________________________
b. lies in the inferior margin of the falx cerebri?
_____________________________________________________________
96
c. lies along the petrous ridge?
_____________________________________________________________
d. lies immediately lateral to the sella turcica?
_____________________________________________________________
12. Which two dural venous sinuses drain directly into the jugular vein?
a. __________________________________________________________
b. __________________________________________________________
13. What artery enters the cranial cavity by passing through the foramen
magnum?
_________________________________________________________________
14. What artery enters the cranial cavity by passing through the foramen
spinosum?
_________________________________________________________________
15. What two arteries are connected by way of the anterior communication
artery?
a. __________________________________________________________
b. __________________________________________________________
16. What two arteries are connected by way of the posterior communication
artery?
a. __________________________________________________________
b. ___________________________________________________________
97
17. What are the five major intracranial branches of the internal carotid artery?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
e. __________________________________________________________
18. What cranial nerve passes through the parotid gland?
_________________________________________________________________
19. What are the four muscles of mastication?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
20. What cranial nerve mediates sensation from the
a. forehead over the eyebrows?
_____________________________________________________________
b. skin over the maxilla?
_____________________________________________________________
c. skin over the mental tubercle?
_____________________________________________________________
98
21. What cranial nerve provides parasympathetic innervation to the parotid
gland?
_________________________________________________________________
a. What is the location of the postganglionic cell body?
_____________________________________________________________
22. What cranial nerve provides parasympathetic innervation to the submandibular

and submaxillary glands?
_________________________________________________________________
_____________________________________________________________
23. What cranial nerve provides parasympathetic innervation to the lacrimal

gland?
________________________________________________________________
_____________________________________________________________
24. What cranial nerve provides motor innervation to the muscles of facial
expression?
_________________________________________________________________
25. What cranial nerve provides motor innervation to the muscles of

mastication?
_________________________________________________________________
99
26. What cranial nerve provides sensory innervation to the face?
________________________________________________________________
a. What branch of this nerve innervates the skin over the eyebrow?
_____________________________________________________________
1) Which opening in the middle cranial fossa contains the axons of this nerve
branch?
__________________________________________________________
b. What branch of this nerve innervates the skin over the maxilla?
_____________________________________________________________
branch?
__________________________________________________________
c. What branch of this nerve innervates the skin over the mental
protuberance?
_____________________________________________________________
branch?
__________________________________________________________
27. What foramen transmits the axons of the glossopharyngeal nerve?
_________________________________________________________________
100
28. What striated (skeletal) muscle is innervated by the glossopharyngeal
nerve?
_________________________________________________________________
29. What special sensory functions are mediated by the glossopharyngeal

nerve?
a. __________________________________________________________
b. __________________________________________________________
30. What foramen transmits the axons of the vagus nerve?
_________________________________________________________________
31. What striated muscles are innervated by the vagus nerve?
a. __________________________________________________________
b. __________________________________________________________
32. What is the effect of the vagus nerve on heart rate?
_________________________________________________________________
33. What is the effect of the vagus nerve on gastric and intestinal motility?
_________________________________________________________________
34. What special sensory functions are mediated by the vagus nerve?
a. __________________________________________________________
b. __________________________________________________________
35. What two foramina transmit the axons of the spinal accessory nerve?
a. ___________________________________________________________
b. ___________________________________________________________
101
36. What muscles are innervated by the spinal accessory nerve?
a. ___________________________________________________
b. ___________________________________________________
37. What foramen transmits the axons of the hypoglossal nerve?
_________________________________________________________________
38. What muscle innervated by the hypoglossal nerve is primarily involved in

protrusion of the tongue?
_________________________________________________________________
39. What cranial nerve exits the skull via the stylomastoid foramen?
_________________________________________________________________
40. Through what foramen does the facial nerve enter the skull (exit the posterior
cranial fossa)?
_________________________________________________________________
41. Through what foramen does the facial nerve exit the skull?
_________________________________________________________________
42. What are the five terminal branches of the facial nerve that emerge from the
substance of the parotid gland?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
e. __________________________________________________________
102
43. What two nerves form the nerve of the pterygoid canal (Vidian nerve)?
a. ___________________________________________________________
b. ___________________________________________________________
44. What cranial nerve gives rise to the chorda tympani?
_________________________________________________________________
45. What cranial nerve gives rise to the greater superficial petrosal nerve?
_________________________________________________________________
46. What cranial nerve gives rise to the tympanic nerve?
_________________________________________________________________
With the subject seated comfortably facing you:
1. Inspect the position of the head with respect to the neck.
a. Is the head in the midline? ___________________________
If not, is it tilted forward or backward, to the right or left, or rotated (face
turned) to the right or left? ________________________
Describe.
__________________________________________________________
__________________________________________________________
103
b. Is the head held steady or do you see movement?
__________________________________________________________
If you see movement, please describe.
__________________________________________________________
2. Palpate the external occipital protuberance.
a. What dural venous sinus lies deep to the external occipital

protuberance?
__________________________________________________________
3. Palpate each of the following bony landmarks.
a. glabella
b. nasion
c. zygomatic arch
d. mental protuberance and tubercles
e. angle of the mandible
f. mastoid process
Instruct the subject to relax the face and gaze forward.
4. Inspect the skin of the forehead.
a. Do you see wrinkles?
__________________________________________________________
If so, on which side or both?
__________________________________________________________
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5. Inspect the eyebrows.
a. Are they at the same level?
__________________________________________________________
If not, which side is higher?
__________________________________________________________
6. Inspect and measure the height of both palpebral fissures.
a. Are they the same height on both sides?
__________________________________________________________
If not:
What is the height on the right side?
__________________________________________________________
What is the height on the left side?
__________________________________________________________
b. What muscle elevates the upper eyelid?
__________________________________________________________
1) What cranial nerve innervates this muscle?
___________________________________________________
c. Does the upper lid on either side cover the pupil?
__________________________________________________________
105
__________________________________________________________
d. Does the upper lid on either side cover the iris?
__________________________________________________________
__________________________________________________________
e. Does the lower lid on either side cover the iris?
__________________________________________________________
__________________________________________________________
f. Do you see more sclera below the iris on one side or the other?
__________________________________________________________
If so, on which side do you see more sclera?
__________________________________________________________
g. Is the edge of the lower lid touching the eye?
__________________________________________________________
If not, is the lower lid everted (ectropion) or inverted (entropion)?
__________________________________________________________
1) Weakness of what muscle causes ectropion?
___________________________________________________
106
2) What cranial nerve innervates this muscle?
___________________________________________________
7. Inspect the pupils in ambient room light.
a. Are they identical in diameter?
__________________________________________________________
If not, what are their diameters?
right pupil ____________________________________
left pupil ____________________________________
8. Inspect the conjunctiva of the upper and lower eyelids. Describe its
color.
_____________________________________________________________
9. Inspect the nasolabial folds on each side.
a. Do they appear symmetrical in terms of shape and depth?
__________________________________________________________
If not, describe the difference between the two sides.
__________________________________________________________
10. Inspect the upper and lower lips.
a. Are the right and left sides symmetrical?
__________________________________________________________
107
If not, describe the difference.
__________________________________________________________
11. Inspect the corners of the mouth.
__________________________________________________________
__________________________________________________________
12. Inspect the color of the face.
a. Is one side redder (hyperemic) than the other?
__________________________________________________________
If so, which side?
__________________________________________________________
13. With aid of a pen light, inspect the nasal cavity
a. Is the septum in the midline?
__________________________________________________________
If not, describe its position.
__________________________________________________________
B. Movement
1. Ask the subject to “Raise your eyebrows” or “Look up to the ceiling.”
108
a. What muscle is used to raise the eyebrows?
_____________________________________________________________
b. What cranial nerve innervates this muscle?
_____________________________________________________________
c. Do symmetrical wrinkles appear on both sides the forehead?
_____________________________________________________________
_____________________________________________________________
2. Ask the subject to “Close both eyes tightly.”
a. What muscle is used to close the eyes tightly?
_____________________________________________________________
_____________________________________________________________
c. Do both eyes close symmetrically?
_____________________________________________________________
d. Describe Bell’s phenomenon.
_____________________________________________________________
_____________________________________________________________
109
3. Ask the subject to “Smile to a friend” or “Show me your teeth.”
a. What muscle is used to retract the corners of the mouth?
_____________________________________________________________
_____________________________________________________________
c. Do both corners of the mouth move symmetrically to the sides?
_____________________________________________________________
_____________________________________________________________
4. Ask the subject to “Purse the lips as if to whistle or kiss someone.”
a. What muscle is used to purse the lips?
_____________________________________________________________
_____________________________________________________________
5. Place your fingers immediately anterior to the tragus on both sides and palpate the
movement of the condyle of the mandible as the subject opens and closes
the mouth.
a. Is the movement smooth and symmetrical?
_____________________________________________________________
If not, describe what you feel.
_____________________________________________________________
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6. Ask the subject to alternately clench the teeth and relax the bite while you palpate
the temporalis and then masseter muscles.
a. What two muscles are used to clench the teeth?
1) ___________________________________________________________
2) ___________________________________________________________
b. What cranial nerve innervates these muscles?
_____________________________________________________________
C. Vasculature
1. Palpate pulsations of the superficial temporal artery immediately anterior to the

tragus on each side.
a. Is the superficial temporal artery a branch of the internal or external carotid

artery?
_____________________________________________________________
2. Palpate pulsations of the superficial temporal artery in the temporal fossa between
the top of the ear and the lateral margin of the eyebrow.
3. Palpate pulsations of the facial artery over the body of the mandible between the
angle and the mental tubercle.
a. Is the facial artery a branch of the internal or external carotid artery?
_____________________________________________________________
111
9 Neck
Objectives
1. Describe and identify by palpation in a living subject the major anatomical

structure of the anterior and lateral neck.
2. Identify and mark in a living subject the borders and margins of the anterior and
posterior triangles of the neck, including the smaller triangles within each.
3. Identify and describe the anatomical structures commonly located within each of
the triangles of the neck.
1. What are the four parts of the deep cervical fascia?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
2. What two muscles are ensheathed by the investing layers of the deep cervical
fascia?
a. __________________________________________________________
b. __________________________________________________________
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3. What four structures are enclosed within the pretracheal layer of deep cervical
fascia?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
4. What are the three main structures enclosed within the carotid sheath?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
5. What are the boundaries of the anterior triangle of the neck?
a. ___________________________________________________________
b. ___________________________________________________________
c. ___________________________________________________________
6. What are the boundaries of the carotid triangle?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
7. What are the boundaries of the submandibular triangle?
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
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8. What are the boundaries of the submental triangle?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
9. What muscles are boundaries of the muscular triangle?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
10. What are the boundaries of the posterior triangle of the neck?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
11. What muscles comprise the infrahyoid muscles of the neck?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
12. What muscles comprise the suprahyoid muscles of the neck?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
114
13. What muscle abducts the vocal folds?
________________________________________________________________
14. What nerve provides motor innervation to this muscle?
________________________________________________________________
15. What two muscles adduct the vocal folds?
a. __________________________________________________________
b. __________________________________________________________
16. What nerve provides motor innervation to these muscles?
_________________________________________________________________
17. What laryngeal muscle lies on the external surface of the larynx?
_________________________________________________________________
18. What nerve provides motor innervation to this muscle?
_________________________________________________________________
19. What nerve provides sensory innervation to the mucosal lining the internal surface
of the larynx?
_________________________________________________________________
20. The roots of the brachial plexus course through the root of the neck by passing
between which two of the scalene muscles?
a. __________________________________________________________
b. __________________________________________________________
115
21. The subclavian artery courses through the root of the neck by passing
___________________________ to the anterior scalene muscle
22. The subclavian vein courses through the root of the neck by passing
___________________________ to the anterior scalene muscle
23. What is the anatomical landmark that marks the point where the subclavian artery
becomes the axillary artery?
________________________________________________________________
24. What are the four branches of the subclavian artery?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
d. __________________________________________________________
25. What artery is the origin of the superior thyroid artery?
_________________________________________________________________
26. What artery is the origin of the inferior thyroid artery?
_________________________________________________________________
27. What veins merge to form the retromandibular vein?
a. __________________________________________________________
b. __________________________________________________________
116
28. What veins merge to form the external jugular vein?
a. __________________________________________________________
b. __________________________________________________________
29. What veins merge to form the brachiocephalic vein?
a. __________________________________________________________
b. __________________________________________________________
30. What spinal segments give rise to the phrenic nerve?
_________________________________________________________________
31. What spinal segments give rise to the ansa cervicalis?
_________________________________________________________________
32. At what vertebral level does the common carotid artery bifurcate to form the
internal and external carotid arteries?
_________________________________________________________________
33. Sympathetic chain ganglia from what segmental levels fuse to form the superior
cervical ganglion?
_________________________________________________________________
34. Sympathetic chain ganglia from what segmental levels fuse to form the middle
cervical ganglion?
_________________________________________________________________
35. Sympathetic chain ganglia from what segmental levels fuse to form the inferior
cervical ganglion?
_________________________________________________________________
117
1. Inspect neck from the mastoid process and body of the mandible above to the
clavicle and suprasternal notch below.
a. Are the two sides visually symmetrical?
__________________________________________________________
If not, describe.
__________________________________________________________
b. Do you see any masses, swelling or pulsations?
__________________________________________________________
If so, describe.
__________________________________________________________
2. Palpate the anterior edge of the sternocleidomastoid muscle from its superior
attachment on the mastoid process to its inferior attachment on the clavicle
and manubrium. Identify the anterior triangle of the neck.
a. List the borders of the anterior triangle of the neck.
1) _______________________________________________
2) _______________________________________________
3) _______________________________________________
118
With the subject seated comfortably facing away from you:
3. Palpate the angle of the mandible. Move your fingers anteriorly along
the inferior margin of the body of the mandible toward the mental
protuberance.
4. Slide your fingers inferiorly from the body of the mandible and gently palpate
the body and greater horns of the hyoid bone.
a. What is the vertebral level of the hyoid bone?
______________________________________________________
5. Slide your fingers inferiorly in the anterior midline below the hyoid bone and
gently palpate the thyroid notch, laryngeal prominence and intervening
thyrohyoid membrane.
a. What is the vertebral level of the thyroid notch?
______________________________________________________
6. With your fingers on the laryngeal prominence, ask the subject to

swallow.
a. Which direction does the thyroid cartilage move?
______________________________________________________
7. Slide your fingers inferiorly in the anterior midline below the thyroid cartilage
and gently palpate the cricoid cartilage and intervening cricothyroid
membrane.
a. What is the vertebral level of the cricoid cartilage?
______________________________________________________
119
8. Slide your fingers inferiorly in the anterior midline below the cricoid cartilage
and gently palpate the trachea in the space above the suprasternal (jugular)
notch. Can you feel the isthmus of the thyroid gland where it lies over the 2–4
tracheal rings? If not, ask the subject to swallow, causing the trachea and
overlying thyroid isthmus to move upward beneath your fingertips.
a. List the four infrahyoid muscles:
1) ____________________________________________________
2) ____________________________________________________
3) ____________________________________________________
4) ____________________________________________________
9. Palpate the neck along the anterior margin of the sternocleidomastoid

muscle from the manubrium to the mastoid process and along the posterior
and inferior margins of the mandible from the auricle to the mental
protuberance.
a. Do you feel any swollen lymph nodes?
______________________________________________________
If so, are they tender to palpation?
______________________________________________________
10. Palpate the external occipital protuberance. Then slide your fingers inferiorly
along the ligamentum nuchae toward vertebra prominens.
a. Vertebra prominens in the spinous process of which vertebra?
______________________________________________________
120
11. Palpate the anterior border of the trapezius and the posterior border of the
sternocleidomastoid from their superior attachments on the skull to their inferior
attachments on the clavicle.
a. List and mark the three boundaries of the posterior triangle of the
neck.
1) ___________________________________________________
2) ___________________________________________________
3) ___________________________________________________
b. Mark the course of the spinal accessory nerve as it courses toward the
trapezius across the floor of the posterior triangle.
c. What four muscles form the floor of the posterior triangle of the
neck?
1) ___________________________________________________
2) ___________________________________________________
3) ___________________________________________________
4) ___________________________________________________
d. What is the action of the sternocleidomastoid muscle on the

head?
_________________________________________________________
12. Palpate the neck along the posterior margin of the sternocleidomastoid muscle
from clavicle to the occipital bone.
a. Do you feel any swollen lymph nodes?
_____________________________________________________________
121
If so, are they tender to palpation?
______________________________________________________
B. Vasculature
With the subject sitting comfortably facing you:
1. Palpate pulsations of the common carotid artery in the space between the thyroid
cartilage and the sternocleidomastoid muscle.
a. At what vertebral level does the common carotid artery bifurcate?
_____________________________________________________________
2. Palpate pulsations of the internal carotid artery immediately deep to the angle of
the mandible.
a. What nerve lies within the carotid sheath along with the carotid artery?
_____________________________________________________________
b. What other structure lies within the carotid sheath?
_____________________________________________________________
3. Palpate pulsations of the common carotid in the space between the cricoid
cartilage and the sternocleidomastoid muscle.
a. What bony structure lies immediately posterior to the common carotid artery
at this level?
_____________________________________________________________
b. What is the heart rate of your subject?
_____________________________________________________________
122
10 Mouth and Pharynx
Objectives
1. Identify and describe by inspection in a living subject the major structures and
anatomical landmarks of the oral cavity and oropharynx.
2. Indicate the nervous innervation of the various structures and regions of the oral
cavity and oropharynx.
3. Describe the sensory and motor innervation of the tongue and the tonsillar
fossa.
1. What are the two main muscles used to close the mouth?
a. __________________________________________________________
b. __________________________________________________________
2. What muscle forms the floor of the oral cavity?
_________________________________________________________________
3. What muscle forms the palatoglossal arch?
_________________________________________________________________
a. What nerve provides motor innervation to this muscle?
_____________________________________________________________
4. What muscle forms the palatopharyngeal arch?
_________________________________________________________________
123
_____________________________________________________________
5. What muscle forms the anterior pillar of the tonsillar fossa?
_________________________________________________________________
6. What muscle forms the posterior pillar of the tonsillar fossa?
_________________________________________________________________
7. What nerve provides sensory innervation to the mucosal lining of the tonsillar
fossa?
_________________________________________________________________
8. What two muscles act on the soft palate?
a. __________________________________________________________
b. __________________________________________________________
9. What nerve provides motor innervation to the superior, middle and inferior
pharyngeal constrictor muscles?
_________________________________________________________________
10. What nerve provides motor innervation to the intrinsic muscles of the
tongue?
_________________________________________________________________
11. What nerve provides motor innervation to MOST of the extrinsic muscles of the
tongue?
_________________________________________________________________
124
12. Which of the extrinsic muscles of the tongue is NOT innervated like the
others?
_________________________________________________________________
_____________________________________________________________
13. What nerve innervates mechanical and thermal receptors on the anterior 2/3 of the
tongue?
_________________________________________________________________
14. What nerve innervates mechanical and thermal receptors on the posterior 1/3 of
the tongue?
_________________________________________________________________
15. What nerve innervates taste buds on the anterior 2/3 of the tongue?
_________________________________________________________________
16. What nerve innervates taste buds on the posterior 1/3 of the tongue?
_________________________________________________________________
17. What cranial nerve provides motor innervation to the submandibular salivary
glands?
_________________________________________________________________
18. What cranial nerve provides motor innervation to the parotid salivary
glands?
_________________________________________________________________
125
19. What nerve provides sensory innervation to the gingiva of the maxillary
teeth?
_________________________________________________________________
20. What nerve provides sensory innervation to the gingiva of the mandibular
teeth?
_________________________________________________________________
21. What nerve provides sensory innervation to the mucosa overlying the hard
palate?
_________________________________________________________________
22. What nerve provides sensory innervation to the mucosa overlying the soft
palate?
_________________________________________________________________
1. Instruct the subject to open and close the mouth while you palpate the
temporomandibular joints bilaterally.
a. Are the two sides symmetrical to palpation? __________________
If not, describe what you feel:
_____________________________________________________________
126
2. Instruct the subject to clench the teeth together while you palpate the mandible
immediately anterior and superior to the angle.
a. What muscle do you feel contract beneath your fingers?
_____________________________________________________________
b. What cranial nerve provides motor innervation to this muscle?
_____________________________________________________________
3. Instruct the subject to open the mouth widely. With the aid of a pen light inspect
the position of the uvula.
a. Is the uvula resting in the midline? ________________________
If not, describe its position.
_____________________________________________________________
4. Inspect the lateral walls of the posterior part of the oropharynx.
a. Are the palatine tonsils present in the tonsillar fossa?
_____________________________________________________________
b. What cranial nerve provides sensory innervation to the posterior part of

the oropharynx?
_____________________________________________________________
5. Inspect the tongue in the relaxed state lying on the floor of the mouth.
a. Are the two sides visually symmetrical with regard to muscle bulk?
_____________________________________________________________
127
_____________________________________________________________
B. Movements
1. With the tongue lying relaxed in the floor of the mouth, instruct the subject to say
“AAHH.”
a. Describe the movement of the uvula.
_____________________________________________________________
b. What muscle acts to move the uvula during phonation?
_____________________________________________________________
c. What cranial nerve provides motor innervation to this muscle?
_____________________________________________________________
2. Instruct the subject to protrude the tongue.
a. Does the tongue protrude in the midline?
_____________________________________________________________
If not, describe the deviation.
_____________________________________________________________
b. What muscle acts to protrude the tongue?
_____________________________________________________________
c. What cranial nerve provides motor innervation to this muscle?
_____________________________________________________________
128
d. What cranial nerve provides general sensory (cutaneous) innervation to
the anterior part of the tongue?
_____________________________________________________________
e. What cranial nerve provides special sensory (taste) innervation to the anterior
part of the tongue?
_____________________________________________________________
129
11 Orbit and Eye
Objectives
1. Describe the normal relationship between the eye and the eyelids.
2. Demonstrate and describe in a living subject the action(s) of each of the

extraocular muscles.
3. Describe and demonstrate in a living subject a method for evaluating the function
of ocular motor function.
4. Describe the effect on the position of the resting eye resulting from destructive
lesions affecting each of the extraocular nerves.
5. Describe the autonomic innervation of the iris.
6. Describe and demonstrate in a living subject a method for evaluating the pupillary
light reflex and the accommodation reflex.
7. Describe the bony structure of the orbit and identify the contents.
Orbit
1. What are the three openings located in the posterior part of the orbit?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
130
2. What are the two main structures that pass through the optic canal?
a. __________________________________________________________
b. __________________________________________________________
3. What are the main structures that pass through the superior and inferior orbital
fissures?
a. _____________________________________________ nerve
b. _____________________________________________ nerve
c. _____________________________________________ nerve
d. _____________________________________________ nerve
e. _____________________________________________ nerve
f. _____________________________________________ nerve
g. _____________________________________________ vein
h. _____________________________________________ vein
4. What are the main structures that pass through the common tendinous
ring?
a. _____________________________________________ nerve
b. _____________________________________________ nerve
c. _____________________________________________ nerve
d. _____________________________________________ nerve
5. What is the name of the thin membrane that lines the surface of the cornea and
deep surface of the upper and lower eye lids (palpebrae)?
_________________________________________________________________
131
6. What two muscles play a role in the elevation of the upper eyelid?
a. __________________________________________________________
b. __________________________________________________________
7. What are the two main types of glands in the upper eyelid?
a. __________________________________________________________
b. __________________________________________________________
8. Describe the location of the lacrimal gland in the orbit.
_________________________________________________________________
9. Where does the nasolacrimal duct drain?
_________________________________________________________________
10. What cranial nerve provides motor innervation to the lacrimal gland?
_________________________________________________________________
11. Which extraocular muscle does NOT originate from the common tendinous
ring?
_________________________________________________________________
12. What nerve provides motor innervation to the levator palpebrae superioris
muscle?
_________________________________________________________________
13. Where are the nerve cell bodies that provide motor innervation to Mueller’s
muscle?
_________________________________________________________________
132
Eye
1. What are the three layers of the eye? (List layers from superficial to deep.)
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
2. What nerve provides sensory innervation to the cornea?
_________________________________________________________________
3. What structure separates the anterior chamber from the posterior chamber of the
eye?
_________________________________________________________________
4. What fluid is found in the anterior chamber of the eye?
_________________________________________________________________
5. What fluid is found in the posterior chamber of the eye?
_________________________________________________________________
6. What two muscles are located in the iris AND what division of the autonomic
nervous system provides motor innervation to each?
Muscle Autonomic Division
a. __________________________ _____________________________
b. __________________________ _____________________________
7. What structure connects the lens to the ciliary muscle?
_________________________________________________________________
133
8. What is the effect of contraction of the ciliary muscle?
_________________________________________________________________
9. Where are the nerve cell bodies that provide motor innervation to the ciliary
muscle?
Preganglionic cell Postganglionic cell
____________________________ ____________________________
10. Where are the cell bodies that provide motor innervation to the pupillary
constrictors?
____________________________ ____________________________
11. Where are the cell bodies that provide motor innervation to the pupillary
dilators?
____________________________ ____________________________
12. What structure produces aqueous humor?
_________________________________________________________________
13. Through what opening does aqueous humor normally pass to exit the
eye?
_________________________________________________________________
14. Where is this opening located?
_________________________________________________________________
134
15. What is the optic disc?
_________________________________________________________________
16. What is the physiologic cup?
_________________________________________________________________
17. What is the macula lutea?
_________________________________________________________________
18. What is the fovea centralis?
_________________________________________________________________
19. What retinal structure is associated with the “blind spot” in the visual field?
_________________________________________________________________
20. What are the two types of photoreceptor cells?
a. __________________________________________________________
b. __________________________________________________________
21. Which photoreceptor cell is heavily concentrated in the fovea centralis?
_________________________________________________________________
22. What vessel is the origin of the central artery of the retina?
_________________________________________________________________
135
23. The superior and inferior ophthalmic veins receive venous blood from intra-orbital
structures. Blood in these vessels can drain out of the orbit by passing posteriorly,
anteriorly or inferiorly, depending on intravenous pressure. What are the three (3)
vascular structures that receive venous blood from the ophthalmic veins?
a. _______________________________ posteriorly
b. _______________________________ inferiorly
c. _______________________________ anteriorly
24. What are the three branches of the ophthalmic nerve in the orbit?
a. __________________________________________________________
b. __________________________________________________________
c. __________________________________________________________
A. Inspection
Instruct the subject to look straight ahead and focus on some non-moving object at a
distance of 20 feet or more.
1. Inspect the sclera in both eyes.
a. What color is the sclera?
_____________________________________________________________
b. Are the scleral blood vessels engorged or dilated?
_____________________________________________________________
136
2. Inspect the iris in both eyes.
a. What color is the iris?
_____________________________________________________________
b. Are the irides free of defects?
_____________________________________________________________
If not, describe the defect.
_____________________________________________________________
c. Are the pupils round in both eyes?
_____________________________________________________________
If not, describe their shape.
_____________________________________________________________
d. Are the pupils stable in size or do they fluctuate in diameter?
_____________________________________________________________
3. What is the diameter of the RIGHT pupil?
_________________________________________________________________
4. What is the diameter of the LEFT pupil?
_________________________________________________________________
a. What word is used to describe pupillary asymmetry of greater than

1 mm?
_____________________________________________________________
137
5. Using a pen light in a room in which the lights have been dimmed, quickly
illuminate the RIGHT eye, taking care to avoid illuminating the left eye.
a. What effect did you observe in the illuminated right eye?
_____________________________________________________________
Repeat the procedure described in number 5 above.
b. What effect did you observe in the non-illuminated left eye?
_____________________________________________________________
c. What reflex did you observe in the illuminated right eye?
_____________________________________________________________
d. What reflex did you observe in the non-illuminated left eye?
_____________________________________________________________
6. Now, quickly illuminate the LEFT eye, taking care to avoid illuminating the right
eye.
a. What effect did you observe in the illuminated left eye?
_____________________________________________________________
Repeat the procedure described in number 6 above.
b. What effect did you observe in the non-illuminated right eye?
_____________________________________________________________
7. Inspect the position of the eyes in the orbits.
_________________________________________________________________
138
a. Are the visual axes of both eyes parallel?
_____________________________________________________________
If not, describe the malalignment.
_____________________________________________________________
b. What term is used to refer to misalignment of the visual axes of the two
eyes?
_____________________________________________________________
c. Are the eyes held steady in the orbits?
_____________________________________________________________
If not, describe the movements you see.
_____________________________________________________________
d. What term is used to describe involuntary, oscillating movements of the

eyes?
_____________________________________________________________
139
B. Movements
1. Indicate the primary and secondary actions of each of the extraocular muscles
(assume the eye to be in the position of primary gaze and that the muscle in
question is the only muscle acting on the globe)
Muscle Primary Action Secondary Actions
a. lateral rectus ____________
b. medial rectus ____________
c. superior rectus ____________ ____________
d. inferior rectus ____________ ____________
e. superior oblique ____________ ____________
f. inferior oblique ____________ ____________
2. Indicate the cranial nerve that innervates each extraocular muscle.
Muscle Nerve
a. lateral rectus ___________________
b. medial rectus ___________________
c. superior rectus ___________________
d. inferior rectus ___________________
e. superior oblique ___________________
f. inferior oblique ___________________
140
3. In the position of primary gaze in the normal situation, the eyes are directed
straight ahead and the visual axes of the two eyes are parallel. Keep in mind that
in this position all six, extraocular muscles in each eye are tonically active and that
the position of the eye in the orbit reflects the combined, balanced actions of all six
extraocular muscles contracting simultaneously. Any loss in the contractile force
(weakness or paralysis) of a single extraocular muscle will result in movement of
the eye about one or more axes produced by the relatively unopposed action of
the remaining muscles. Indicate the effects on the eye resulting from paralysis of
each of the extraocular muscles.
Muscle Primary Effect Secondary Effect
a. lateral rectus ____________
b. medial rectus ____________
c. superior rectus ____________ ____________ ____________
d. inferior rectus ____________ ____________ ____________
e. superior oblique ____________ ____________ ____________
f. inferior oblique ____________ ____________ ____________
4. Extraocular muscle function can be evaluated by observing eye movement

produced by each muscle when its action is exerted perpendicular to a single axis
of rotation. Indicate the muscle being evaluated by each of the following
movements.
a. abduction of the eye _________________________
b. elevation of the abducted eye _________________________
c. depression of the abducted eye _________________________
d. adduction of the eye _________________________
e. elevation of the adducted eye _________________________
f. depression of the adducted eye _________________________
141
5. Ocular malalignment (strabismus) can occur as a result of damage to the ocular
motor nerves. Indicate the effects on the eye resulting from damage to each
ocular motor nerve.
Nerve Resulting Eye Position
a. abducens nerve _________
b. trochlear nerve _________ _________ _________
c. oculomotor nerve _________ _________ _________
6. Which cranial nerve, if damaged, will affect pupillary size?
________________________________________________________________
a. Will the pupil on the affected side be larger or smaller than the pupil on the
uninvolved side?
_______________________________________________________
7. Which cranial nerve, if damaged, will result in ptosis?
________________________________________________________________
8. Which cranial nerve passes through the cavernous sinus, and as a result, can be
damaged by intracavernous carotid artery aneurysms?
________________________________________________________________
9. Which cranial nerve emerges from the dorsal surface of the brainstem?
________________________________________________________________
142
12 Ear
Objectives
1. Name the different parts of the external ear.
2. Describe the features observable with the otoscope.
3. Describe the attachments and organization of the ossicles of the ear.
4. Identify the muscles that attach to the ossicles of the ear and indicate the nervous
innervations of each.
1. What two peripheral nerves provide sensory innervation to the auricle?
a. __________________________________________________________
b. __________________________________________________________
2. Which branchial arch is the origin of each of the following ossicles?
Auditory Ossicle Branchial Arch
Malleus _____________________________
Incus _____________________________
Stapes _____________________________
3. Which of the ossicles is attached to the internal surface of the tympanic mem-
brane?
________________________________________________________________
143
4. Which of the ossicles is attached to the oval window?
________________________________________________________________
5. What muscle attaches to the malleus?
________________________________________________________________
a. What cranial nerve innervates this muscle?
_____________________________________________________________
6. What muscle attaches to the stapes?
________________________________________________________________
a. What cranial nerve innervates this muscle?
_____________________________________________________________
7. What cranial nerve transmits auditory impulses to the brainstem?
________________________________________________________________
8. What foramen of the skull transmits the axons of the vestibulocochlear

nerve?
________________________________________________________________
9. What vestibular system receptor structure is responsive to rotatory (angular)

acceleration and deceleration of the head?
________________________________________________________________
10. What vestibular system receptor structure is responsive to linear acceleration and
deceleration of the head?
________________________________________________________________
144
11. What fluid substance is found in the scala tympani?
________________________________________________________________
12. What fluid substance is found in the scala vestibuli?
________________________________________________________________
13. What fluid substance is found in the scala media?
________________________________________________________________
14. What fluid substance is found in the semicircular canals?
________________________________________________________________
15. Which vestibular receptor structures are associated with otoconia?
________________________________________________________________
16. Where are the cell bodies of the afferent nerve fibers of the cochlear
nerve?
________________________________________________________________
17. Where are the cell bodies of the afferent nerve fibers of the vestibular
nerve?
________________________________________________________________
145
A. Inspection
With the subject seated comfortably
1. Inspect the auricles, identifying the helix, antihelix, tragus, antitragus and
concha.
_____________________________________________________________
_____________________________________________________________
2. Inspect the external acoustic meatus.
3. Using an otoscope, carefully examine the tympanic membrane.
a. What direction does the “cone of light” extend from the umbo?
_____________________________________________________________
b. What cranial nerves provide sensory innervation to the external surface of

the tympanic membrane?
1) __________________________________________________________
2) __________________________________________________________
146
13 Answer Key
Spine and Back
1. anterior longitudinal lig

2. posterior longitudinal lig
3. ligamentum flavum
4. intertransverse lig
5. Interspinous lig
6. ligamentum nuchae (supraspinous lig)
7. C6
8. C2
9. anterior
10. C8
11. a. iliocostalis
b. longissimus
c. spinalis
12. a. semispinalis
b. multifidus
c. rotatores
13. a. levator scapulae
b. trapezius
14. a. oblique capitus superior
b. oblique capitus inferior
c. rectus capitus posterior major
d. rectus capitus posterior minor
15. C1 and C2
16. nucleus pulposus
17. annulus fibrosus
18. vertebral artery
19. spinal epidural space
20. suboccipital nerve
22. a. rhomboid major
b. latissimus dorsi
c. trapezius
147
23. a. latissimus dorsi
b. external oblique
c. iliac crest
A. 1. a. there are curvatures in the sagittal plane

b. 1) cervical
2) lumbar
c. lordosis
d. 1) thoracic
2) sacral
e. kyphosis
f. scoliosis
2. a. vertebra prominens
b. spinous process
c. C7
d. no – thick Supraspinous lig (ligamentum nuchae
e. ligamentum nuchae
3. superior and inferior nuchal lines of occipital bone
4. yes
5.
6. a.
b. L5
7. a.
8. a.
b.
9. a.
b.
10. a.
11.
B.
1. anterior longitudinal ligament
2. posterior longitudinal ligament
3. ligamentum flavum
4. intertransverse ligament
5. interspinous ligament
6. supraspinous
7. a. iliocostalis
b. longissimus
c. spinalis
148
8. a. semispinalis
b. multifidus
c. rotatores
9. a. splenius capitis
b. splenius cervicis
10. a. obliquus capitis superior
b. obliquus capitis inferior
c. rectus capitis posterior major
d. rectus capitis posterior minor
Shoulder Girdle and Upper Limb

1. sternoclavicular joint
2. acromioclavicular joint
3. a. acromioclavicular lig
b. coracoclavicular lig
4. coraco-acromial lig
5. annular lig
6. inferolateral or superomedial
7. palmaris longus
8. lateral border of first rib
9. inferior border of teres major
10. pectoralis minor
11. first part – superior thoracic
second part – thoracoacromial and lateral thoracic
third part – subscapular, art. humeral circumflex and post. humeral circumflex
12. dorsal scapular art.
13. a. radial art
b. ulnar art
14. a. scaphoid (navicular)
b. lunate
c. triquetrum
d. pisiform
15. a. trapezium (greater multangular)
b. trapezoid (lesser multangular)
c. capitate
d. hamate
16. serratus anterior
17. intertubercular groove of humerus
149
18. C5 – T1
19. a. C5 and C6
b. C7
c. C8 and T1
20. posterior divisions
21. superior
22. posterior
23. posterior
24. posterior
25. medial
26. a. radial
b. axillary
27. axillary
28. radial
29. ulnar
30. median
31. ulnar
32. Women – 15 (>15)
Men – 12 (10 – 15)
33. pronator teres
34. flexor carpi ulnaris
35. a. brachialis
b. brachioradialis
36. a. apical
b. humeral
c. central
d. pectoral
e. subscapular
37. a. extensor pollicis longus
b. abductor pollicis longus and extensor pollicis brevis
38. radial
A 1. a.
b.
2. a. gliding
b. gliding
3. a.
b.
4. a. acromion process
b. T3
150
c. supraspinatus
d. infraspinatus
5. a. 5 CM
b. 2nd rib
c. 7th rib
6. a. pectoralis major
1) medial pectoral nerve
2) lateral pectoral nerve
b. latissimus dorsi and teres major
1) thoracodorsal and lower subscapular nerves
7. a. 1) biceps brachii and brachialis
2) brachialis
3) musculocutaneous nerve
b.
8. a. triceps brachii
1) radial nerve
b.
9. a. triceps brachii
b. ulnar nerve
10. a. 1) forearm pronation
2) wrist flexion
3) finger flexion
11. a. 1) forearm supination
2) wrist extension
3) finger extension
12. a. pronator teres
1) median nerve
b. brachioradialis
1) radial nerve
c. brachial artery
d. median cubital vein
e. pronator teres
f. flexorcarpiulnaris
13. a.
b.
c. radial nerve
14. a.
b.
c. 1) median nerve
2) ulnar nerve
15. a.
151
b.
c.
d. 1) extensor pollicis longus
16. a.
b.
c.
d. radial artery
e. ulnar artery
f. median nerve
17.
18. a.
b. 1) abductor pollicis brevis
2) flexor pollicis brevis
3) opponens pollicis
c. median nerve
d. 1) abductor digiti minimi
2) flexor digiti minimi
3) opponens digiti minimi
e. ulnar nerve
19. a. extensor pollicis longus
b. 1) abductor pollicis longus
2) extensor pollicis brevis
c. radial artery
20. a.
b. finger abduction
c. ulnar nerve
d. finger adduction
e. ulnar nerve
B 1. a. trapezius spinal accessory
b. levator scapulae dorsal scapular
2. a. rhomboid major dorsal scapular
b. rhomboid minor spinal accessory
c. trapezius dorsal scapular
3. a. deltoid (ant) axillary
4. a. deltoid axillary
b. supraspinatus suprascapular
5. a. teres major lower subscapular
b. teres minor axillary
c. pectoralis major pectoral (med. and lat.)
d. latissimus dorsi thoracodorsal
6. a. deltoid (post) axillary
152
b. latissimus dorsi thoracodorsal
7. a. biceps brachii musculocutaneous
b. brachialis musculocutaneous
8. a. brachioradialis radial
b. brachialis musculocutaneous
9. a triceps brachii radial
10. a. pronator teres median
b. pronator quadratus median
11. a. supinator radial
b. biceps brachii musculocutaneous
12. a. extensor carpi radialis longus radial
b. extensor carpi radialis brevis radial
c. extensor carpi ulnaris radial
13. a. flexor carpi radialis median
b. flexor carpi ulnaris ulnar
14. a. extensor carpi radialis longus radial
b. extensor carpi radialis brevis radial
c. flexor carpi radialis median
15. a. extensor carpi ulnaris radial
b. flexor carpi ulnaris ulnar
16. a. abductor pollicis longus radial
b. abductor pollicis brevis median
17. a. adductor pollicis ulnar
18. a. flexor pollicis longus median
b. flexor pollicis brevis median
19. a. extensor pollicis longus radial
b. extensor pollicis brevis radial
c. abductor pollicis longus radial
20. a. opponens pollicis median
b. opponens digiti minimi ulnar
21. a. lumbricales median/ulnar
22. a. extensor digitorum communis radial
23. a. dorsal interossei ulnar
24. a. palmar interossei ulnar
25. a. flexor digitorum superficialis median
26. a. flexor digitorum profundus median/ulnar
27. a. extensor digitorum communis radial
C 1.
2.
153
D1.
2.
3.
4.
5. a. anterior scalene
b. middle scalene
Hip Girdle and Lower Limb
1. a. innominate (hip) bone

b. sacrum
2. a. ilium
b. ischium
c. pubis
3. a. iliofemoral
b. ischiofemoral
c. pubofemoral
d. hip extension
4. a. anterior superior iliac spine
b. pubic tubercle
5. ischial tuberosity
6. ischial spine
7. ant intercondylar tibia to post part, medial surface of lat femoral condyle
8. post intercondylar tibia to ant part, lateral surface of med femoral condyle
9. deltoid lig
10. femoral vein
11. popliteal vein
12. external iliac vein
13. a. femoral art.
b. femoral vein
14. loose connective tissue and lymphatics
15. inguinal lig.
16. adductor hiatus
17. a. anterior tibial art
b. posterior tibial art
18. anterior tibial art
19. L2 – S2
20. a. femoral nerve
154
b. obturator nerve
21. L4 – S2 (S3)
22. a. common fibular (common peroneal) nerve
b. tibial nerve
23. posterior tibial nerve
24. deep fibular (anterior tibial) nerve
25. Superficial fibular (superficial peroneal) nerve
26. deep fibular nerve
27. posterior tibial nerve
28. femoral nerve
29. saphenous nerve
30. a. inguinal lig
b. adductor longus
c. Sartorius
31. 126 degrees (range 115 – 140)
32. angle subtended by trans plane of fem condyles and axis of head/neck of femur
a. 7 degrees – males and 12 degrees – females
33. angle subtended by line of gravity and line between ASIS and center of patella
a. appox. 8 degrees
b. females
34. externally (laterally)
35. a. posterior
b. anterior
c. anterior
36. tight
37. tight
38. plantar calcaneonavicular lig
A 1.
2. a. femoral artery
b. femoral vein
c. femoral nerve
d. 1) sartorius
2) adductor longus
3. a.
b. rectus femoris
c. anterior inferior iliac spine
4. a.
b. prevents lateral displacement of the patella during knee extension
155
5. a. apex of patella
b. tibial tubercle
6. a. common fibular (peroneal) nerve
b. soleus
7. a. 1) ankle dorsiflexion
2) toe extension
b. deep peroneal nerve
c. anterior tibial artery
8. a. 1) peroneus longus
2) peroneus brevis
9. a. plantar calcaneonavicular ligament
10. a.
b.
11. a. anterior cruciate ligament
b. anterior part of intercondylar eminence
c. posteromedial surface of lateral femoral condyle
12. a. posterior cruciate ligament
b. posterior part of intercondylar fossa
c. anterolateral surface of medial femoral condyle
13. a. L4
14. a. sacrotuberous ligament
b. 1) semitendinosus
2) semimembranosus
3) biceps femoris (long head)
4) adductor magnus
15. a. superolateral (“upper outer quadrant”)
b. to avoid injury to the sciatic nerve
16. a.
b. knee flexion
17. a. biceps femoris
1) a tibial nerve (long head)
b common peroneal nerve (short head)
b. 1) semitendinosus
2) semimembranosus
3) tibial nerve
c. gastrocnemius
1) tibial nerve
d. popliteal artery
e. tibial nerve
f. popliteus
18. a.
156
b. 1) plantar flexion
2) toe flexion
c. 1) tibialis posterior
2) flexor digitorum longus
3) flexor hallucis longus
19. a.
b. tibialis posterior
B 1. a. psoas major lumbar nerves
b. iliacus femoral
c. rectus femoris femoral
2. a. quadriceps femoris femoral
3. a. tibialis anterior deep peroneal
4. a. gastrocnemius tibial
b. soleus tibial
c. tibialis posterior tibial
5. a. extensor hallucis longus deep peroneal
b. extensor digitorum longus deep peroneal
c. extensor digitorum brevis deep peroneal
6. a. flexor hallucis longus tibial
b. flexor digitorum longus tibial
7. a. gluteus maximus inferior gluteal
8. a. biceps femoris tibial/common peroneal
b. semitendinosus tibial
c. semimembranosus tibial
9. a. adductor magnus obturator/tibial
b. adductor longus obturator
c. adductor brevis obturator
10. a. gluteus medius superior gluteal
b. gluteus minimus superior gluteal
C 1.
2.
D 1.
2.
3.
4.
Thorax

1. a. manubrium
157
b. body
c. xiphoid process
2. a. 1st thoracic vertebra
b. 1st rib
c. manubrium (sternal notch)
3. a. 12th thoracic vertebra
b. 12th and 11th ribs
c. costal cartilages
d. xiphoid process
4. anterior-inferior or superior-posterior
5. posterior-inferior or superior-anterior
6. a. 1st rib
b. 1st rib
c. 2nd rib
7. a. elevates the upper ribs
b. depresses the lower ribs
8. a. external intercostal membrane
b. internal intercostal membrane
9. on the inferior margin of the rib above
10. a. vein
b. artery
c. nerve
11. internal thoracic artery
12. internal thoracic vein
13. subclavian artery (1st part)
14. subclavian artery (1st part)
15. a. superior epigastric artery
b. musculophrenic artery
16. brachiocephalic veins
17. superior vena cava
18. azygos vein or left renal vein
19. azygos vein
20. anterior scalene
A1. a.
2. a. T2
3. a. T4
b. 2nd rib
4. a. T9
158
b. ribs 1-7
c. ribs 8-10
5. a. ribs 11 and 12
6. a. posteriorly
b. kyphosis
7. a.
b.
c.
d.
e. scoliosis
8.
9.
10. a. rib 2
b. rib 7
B 1.
2. anteriorly and inferiorly
3. posteriorly and inferiorly
4. T4
Lungs and Pleura

1. a. visceral pleura
b. parietal pleura
2. a. costal
b. mediastinal
c. diaphragmatic
d. cervical
3. a. 1) apical
1) posterior
1) anterior
2) medial
2) lateral
3) superior
3) anterior basal
3) lateral basal
3) posterior basal
3) medial basal
b. 1) apico-posterior
159
1) anterior
1) superior (lingual)
1) inferior (lingual)
2) superior
2) anterior basal
2) lateral basal
2) posterior basal
2) medial basal
4. left lung
5. right lung
6. a. sternal angle
b. T4 – T5 intervertebral disc
7. right
8. a. trapezius
b. rhomboid major (or medial border of inferior angle of the scapula)
c. latissimus dorsi
9. 6th
10. a. T8
b. T10
c. T12
11. inferior vena cava
12. a. esophagus
b. anterior and posterior vagal trunks
13. a. aorta
b. azygos vein
c. thoracic duct
14. phrenic nerve
15. C3, C4, C5
A 1. a. expiration
b. 12-18
2.
3.
B 1.
2. a. 8th rib
b. 10th rib
c. 12th rib
3. 6th costal cartilage
160
5.
6. a. 6th rib
b. 8th rib
c. 10th rib
9.
10. a. T3
b. 5th
c. 6th
11.
12. a. 5th rib
b. 4th
Heart
1. a. sternal angle
b. T4 – T5 intervertebral disc
2. a. xiphisternal joint
b. T9 vertebra
3. a. fibrous layer
b. serous layer
4. a. parietal layer
b. visceral layer
5. visceral pericardium
6. a. parietal layer of serous pericardium
b. visceral layer of serous pericardium
7. a. pulmonary valve
b. aortic valve
c. mitral valve
d. tricuspid valve
8. a. right atrium
b. left atrium
9. from pulmonary artery to aorta
10. right atrium
11. right atrium
12. a. right ventricle
b. left ventricle
161
13. chordae tendinae
14. a. anterior interventricular
b. circumflex
15. a. right marginal
b. posterior interventricular
16. a. great cardiac vein
b. middle cardiac vein
c. small cardiac vein
d. left posterior interventricular vein
e. left marginal vein
17. anterior cardiac veins
18. a. dorsal motor nucleus of X
1) acetylcholine
b. cardiac plexus
1) acetyl choline
19. a. intermediolateral nucleus
1) acetylcholine
b. superior, middle and inferior cervical ganglia
1) norepinephrine
20. a. brachiocephalic trunk
b. left common carotid artery
c. left subclavian vein
21. right pulmonary vein
A 1. a.
b.
c.
d.
2. a.
b.
c.
d.
3. a.
b.
c.
d.
B 1. a.
2. a.
162
b.
C 1. a. S2
b. S1
c. S2
d. S1
2. systole
Abdomen
1. a. superficial fatty layer (Camper’s fascia)

b. deep membranous layer (Scarpa’s layer)
2. transversalis fascia
3. a. internal oblique
b. transversus abdominus
4. a. aponeurosis of the external oblique and anterior ½ of internal oblique
b. aponeurosis of the transversus abdominus and posterior ½ of internal
oblique
5. a. aponeurosis of all three abdominal muscles
b. transversalis fascia
6. a. inferior epigastric artery
b. deep circumflex iliac artery
7. a. superficial epigastric artery
b. superficial circumflex iliac artery
8. a. uracus
b. umbilical artery
c. inferior epigastric vessels
9. transversalis fascia
10. external oblique aponeurosis
11. internal oblique
12. a. external oblique aponeurosis
b. transversalis fascia
c. peritoneum
13. cardia
14. pyloric antrum
15. a. left gastric artery
b. splenic artery
c. hepatic (common) artery
16. a. right gastric artery
163
b. left gastric artery
17. a. right gastroepiploic (gastro-omental) artery
b. left gastroepiploic (gasttro-omental) artery
18. splenic artery
19. proper hepatic artery
20. a. superior mesenteric vein
b. splenic vein
21. splenic vein
22. a. superior
b. descending
c. inferior (horizontal)
d. ascending
23. a. bile duct
b. pancreatic duct
24. descending
25. sphincter of the major duodenal papilla
26. dilated duct receiving bile and pancreatic duct – drains into descending duodenum
27. ascending
28. inferior (horizontal)
29. cecum
30. a. cecum
b. ascending
c. transverse (proximal half)
31. a. descending
b. sigmoid
32. a. cystic duct
b. common hepatic duct
33. a. hepatic artery
b. portal vein
c. bile duct
34. a. L4
b. L1
c. L5
d. L3
e. L2
f. L2
35. right
36. left
37. cisterna chili
38. junction left internal jugular and left subclavian (“venous angle”)
39. ½ the distance from the ASIS to the umbilicus
164
A 1. a.
b.
c.
2. a.
b.
3. a.
b. above
B1.
2.
3.
4.
5. a. approximately 3 cm below the right costal margin in the midaxillary
line
6.
7. a. L4
8. a. 1) liver (right lobe)
2) gall bladder
3) duodenum (parts 1 and 3)
4) pancreas (head)
5) right kidney
6) hepatic flexure
7) right adrenal gland
8) superior part of ascending colon
9) transverse colon – right half
10) pylorus
b. 1) stomach
2) spleen
3) liver (left lobe)
4) pancreas (body and tail)
5) left kidney
6) left adrenal gland
7) splenic flexure
8) descending colon (upper part)
9) jejunum
c. 1) appendix
2) cecum
3) ileum (most)
4) right ovary
5) right ureter
165
6) ascending colon (inferior part)
7) right uterine tube
8) urinary bladder (enlarged)
9) right spermatic cord
10) uterus (enlarged)
d. 1) left ovary
2) left ureter
3) descending colon (inferior part)
4) sigmoid colon
5) left uterine tube
6) left spermatic cord
7) uterus (enlarged)
8) urinary bladder (enlarged)
9.
10. a. L3
b. 1) right hypochondriac
2) epigastric
3) left hypochondriac
11. a. L5
b. 1) right lumbar
2) umbilical
3) left lumbar
c. 1) right inguinal (iliac)
2) hypogastric (pubic)
3) left inguinal (iliac)
12.
13. T10
14. anteriorly and inferiorly
15. posteriorly and inferiorly
C 1. a. yes
b.
c. long, prolonged “gurgles” of hyperperistalsis “stomach growling”
2. a. midline just below the xiphoid process
b. along the semilunar line at the level of the 10 costal cartilage
th
c. along the semilunar line at the level of the iliac crest
Head and Face
1. a. occipital
166
b. parietal
2. a. frontal
b. parietal
3. a. zygomatic bone
b. temporal bone
4. a. frontal
b. parietal
c. temporal
d. sphenoid
5. approximately 18 months
6. falx cerebri
7. tentorium cerebelli
8. a. skin
b. dense connective tissue
c. epicranial aponeurosis
d. loose connective tissue
e. periosteum (pericranuim)
9. a. facial artery
b. lingual artery
c. superficial temporal artery
d. superior thyroid artery
e. maxillary artery
10. facial artery
11. a. superior sagittal sinus
b. inferior sagittal sinus
c. superior petrosal sinus
d. cavernous sinus
12. a. inferior petrosal sinus
b. sigmoid sinus
14. middle meningeal artery
15. a. right anterior cerebral artery
b. left anterior cerebral artery
16. a. middle cerebral artery
b. posterior cerebral artery
17. a. ophthalmic artery
b. anterior choroidal artery
c. posterior communicating artery
d. middle cerebral artery
e. anterior cerebral artery
18. facial nerve
167
19. a. temporalis
b. masseter
c. lateral pterygoid
d. medial pterygoid
20. a. ophthalmic nerve
b. maxillary nerve
c. mandibular nerve
21. glossopharyngeal nerve
a. otic ganglion
22. facial nerve
a. submandibular ganglion
23. facial nerve
a. pterygopalatine ganglion
24. facial nerve
25. trigeminal nerve
a. ophthalmic nerve
1) superior orbital fissure
b. maxillary nerve
1) foramen rotundum
c. mandibular nerve
1) foramen ovale
27. jugular foramen
28. stylopharyngeus
29. a. taste from posterior 1/3 of tongue
b. arterial pressure measured at the carotid sinus
30. jugular foramen
31. a. laryngeal muscles
b. upper third of the pharyngeal constrictors
32. slowing of heart rate
33. increased motility
34. a. blood gas monitoring at carotid body
b. taste perception from the epiglottis
35. a. foramen magnum
b. jugular foramen
36. a sternocleidomastoid
b. trapezius
37. hypoglossal canal
38. genioglossus
39. facial nerve
40. internal auditory (acoustic) meatus
168
41. stylomastoid foramen
42. a. temporal
b. zygomatic
c. buccal
d. marginal mandibular
e. cervical
43. a. greater superficial petrosal nerve
b. deep petrosal nerve
44. facial nerve (nervus intermedius)
45. facial nerve (nervus intermedius)
A 1. a.
b.
2. a. confluence of sinuses
3. a.
b.
c.
d.
e.
4. a.
5. a.
6. a.
b. levator palpebrae superioris
1) oculomotor nerve
c.
d.
e.
f.
g. 1) orbicularis oculi
2) facial nerve
7. a.
8. a.
9. a.
10. a.
11. a.
12. a.
13. a.
B 1. a. frontalis
169
b. facial
c.
2. a. orbicularis oculi
b. facial
c.
d. supraduction of the eye in conjunction with forceful eye closure
3. a. risorius
b. facial nerve
c.
4. a. orbicularis oris
b. facial nerve
5.
6. a masseter
b.. temporalis
c. trigeminal nerve
C 1. a. external carotid artery
2.
3. a. external carotid artery
Neck
1. a. investing fascia
b. pretracheal fascia
c. prevertebral fascia
d. carotid sheath
2. a. sternocleidomastoid
b. trapezius
3. a. infrahyoid muscles
b. thyroid gland
c. trachea
d. esophagus
4. a. carotid arteries
b. internal jugular vein
c. vagus nerve
5. a. midline of neck
b. anterior border of sternocleidomastoid
c. inferior border of mandible
6. a. anterior border of sternocleidomastoid
170
b. posterior belly of digastric
c. superior belly of omohyoid
7. a. posterior belly of digastric
b. anterior belly of digastric
c. inferior border of mandible
8. a. anterior belly of digastric
b. hyoid bone
c. midline beneath mandible
9. a. superior belly of omohyoid
b. anterior border of sternocleidomastoid
c. sternohyoid
10. a. anterior border of trapezius
b. posterior border of sternocleidomastoid
c. superior border of clavicle
11. a. sternohyoid
b. thyrohyoid
c. sternothyroid
d. omohyoid
12. a. digastric
b. stylohyoid
c. mylohyoid
d. geniohyoid
13. posterior cricoarytenoid
14. internal laryngeal nerve (branch of superior laryngeal)
15. a. lateral cricoarytenoid
b. transverse arytenoid
16. internal laryngeal nerve
17. cricothyroid
18. external laryngeal nerve
19. internal laryngeal nerve
20. a. anterior scalene
b. middle scalene
21. posterior
22. anterior
23. lateral border of first rib
24. a. vertebral artery
b. thyrocervical trunk (artery)
c. internal thoracic artery
d. costocervical trunk (artery)
25. external carotid artery
26. common carotid artery
171
27. a. superficial temporal vein
b. maxillary vein
28. a. retromandibular vein
b. posterior auricular vein
29. a. internal jugular vein
b. subclavian vein
30. C3, C4, C5
31. C1, C2, C3
32. C4
33. C1 - C4
34. C5 and C6
35. C7, C8, (T1)
A 1. a.
b.
2. a. 1) midline of neck
2) anterior border of sternocleidomastoid
3) inferior border of mandible
3.
4. a. C3
5. a. C5
6. a. up
7. a. C6
8. a. 1) sternothyroid
2) thyrohyoid
3) sternohyoid
4) omohyoid
9. a.
10. a. C7
11. a. 1) anterior border of trapezius
2) posterior border of sternocleidomastoid
3) superior border of clavicle
b.
c. 1) splenius capitis
2) levator scapulae
3) posterior scalene
4) middle scalene
d. rotation to the contralateral side
12. a.
172
B 1. a. C4
2. a. vagus nerve
b. internal jugular vein
3. a. carotid tubercle
b.
Mouth and Pharynx
1. a. masseter
b. temporalis
2. mylohyoid
3. palatoglossus
a. vagus nerve
4. palatopharyngeus
a. vagus nerve
5. palatoglossus
6. palatopharyngeus
8. a. levator veli palatine
b. tensor veli palatine
9. vagus nerve
10. hypoglossal nerve
11. hypoglossal nerve
12. palatoglossus
a. vagus nerve
17. facial nerve
19. maxillary nerve (trigeminal V2)
20. mandibular nerve (trigeminal V3)
21. greater palatine nerve
22. lesser palatine nerve
A 1. a.
173
2. a. masseter
b. trigeminal
3. a.
4. a.
b. glossopharyngeal
5. a.
B 1. a.
b. levator veli palatini
c. vagus
2. a.
b. genioglossus
c. hypoglossal
d. trigeminal
e. facial
Eye
Orbit
1. a. optic canal
b. superior orbital fissure
c. inferior orbital fissure
2. a. optic nerve
b. ophthalmic artery
3. a. frontal nerve
b. lacrimal nerve
c. nasociliary nerve
d. oculomotor nerve
e. trochlear nerve
f. abducens nerve
g. superior ophthalmic vein
h. inferior ophthalmic vein
4. a. oculomotor nerve (superior branch)
b. oculomotor nerve (inferior branch)
c. nasociliary nerve
d. abducens nerve
5. conjunctiva
6. a. levator palpebrae superioris
b. superior tarsal muscle (Mueller’s muscle)
174
7. a. tarsal glands
b. ciliary glands
8. anterior in the supero-lateral margin
9. below the inferior nasal concha
10. facial nerve
11. inferior oblique
12. oculomotor
13. superior cervical ganglion
Eye
1. a. sclera (fibrous)
b. choroid (vascular)
c. retina (neural)
2. long ciliary > nasociliary > trigeminal
3. iris
4. aqueous humor
5. aqueous humor
6. a. pupillary constrictor parasympathetic
b. pupillary dilator sympathetic
7. suspensory ligament of the lens (zonular fibers of Zinn)
8. accommodation of the lens
9. Edinger-Westphal nucleus ciliary ganglion
10. Edinger-Westphal nucleus ciliary ganglion
11. intermediolateral nucleus superior cervical ganglion
12. ciliary body
13. canal of Schlemm (scleral venous sinus)
14. lateral margin of the anterior chamber
15. point of exit of retinal ganglion cell axons from the retina
16. center of the optic disc
17. retinal region of high visual acuity
18. center of macula lutea – area of highest visual acuity
19. optic disc
20. a. rods
b. cones
21. cone
22. ophthalmic artery
23. a. cavernous sinus (posteriorly)
b. pterygoid sinus (inferiorly)
c. angular vein (anteriorly)
24. a. frontal nerve
b. nasociliary nerve
175
c. lacrimal nerve
A 1. a. white
b.
2. a.
b.
c.
d.
3.
4. a. anisocoria
5. a. pupillary constriction
b. pupillary constriction
c. direct light reflex
d. indirect (consensual) light reflex
6. a. pupillary constriction
b. pupillary constriction
7. a.
b. heterotropia (tropia) or strabismus
c.
d. nystagmus
B 1. a. abduction
b. adduction
c. supraduction intorsion adduction
d. subduction extorsion adduction
e. intorsion subduction abduction
f. extorsion supraduction abduction
2. a. abducens
b. oculomotor
c. oculomotor
d. oculomotor
e. trochlear
f. oculomotor
3. a. adducted
b. abducted
c. subducted extorted abducted
d. supraducted intorted abducted
e. extorted supraducted adducted
f. intorted subducted adducted
4. a. lateral rectus
176
b. superior rectus
c. inferior rectus
d. medial rectus
e. inferior oblique
f. superior oblique
5. a. adducted
b. extorted supraducted adducted
c. subducted abducted intorted
6. oculomotor
a. larger
7. oculomotor
8. abducens
9. trochlear
Ear
1. a. great auricular nerve

b. auriculotemporal nerve
2. malleus 1st arch
incus 2nd arch
stapes 3rd arch
3. malleus
4. stapes
5. tensor tympani
a. trigeminal
6. stapedius
a. facial
7. cochlear (auditory)
8. internal auditory meatus
9. semicircular canals
10. utricle and saccule (otolithic organs)
11. perilymph
12. perilymph
13. endolymph
14. endolymph
15. utricle and saccule (otolithic organs)
16. spiral ganglion
17. vestibular (Scarpa’s) ganglion
177
A1. a.
2.
3. a. anteriorly and inferiorly
b. 1) trigeminal
2) vagus
178
179
About the Authors
Michael F. Nolan is professor of Basic Science Education at the Virginia Tech Carilion
School of Medicine in Roanoke. He received his Physical Therapy training at Marquette
University and his PhD in Human Anatomy from the Medical College of Wisconsin. Nolan
spent the first 34 years of his career teaching gross anatomy and neuroanatomy to medical
students and resident physicians at the University of South Florida. He has received more
than 20 awards for excellence in teaching including the Master Teacher Award in 2014 from
the International Association of Medical Science Educators and the John M. Thompson Out-
standing Teacher Award in Neurosurgery in 2006. He has published over 40 peer-reviewed
articles and book chapters as well as four textbooks in human gross anatomy and neuro-
anatomy.
John P. McNamara is the Director of Anatomy and Assistant Professor of Basic Science
Education at the Virginia Tech Carilion School of Medicine in Roanoke. His doctoral training
is in chiropractic from Life University (Marietta, GA) with undergraduate (Lock Haven Univer-
sity of Pennsylvania) and graduate (Shippensburg University of Pennsylvania) degrees. He
is also ABD from Virginia Tech in Educational Leadership and Policy Studies. For nearly the
past 30 years, McNamara has maintained a private practice in Salem, VA, and taught full-
time anatomy and physiology, gross anatomy, neuroanatomy, and pathophysiology at the
College of Health Sciences (Jefferson College) in Roanoke. From 2013 to 2017 he taught
the gross anatomy course for the Doctor of Physical Therapy program at Radford University
in Roanoke. He is licensed to practice as a Doctor of Chiropractic in both Virginia and Penn-
sylvania, and he is certified as an Emergency Medical Technician in Virginia.
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Applied Human Anatomy

About this Book

Virginia Tech Carilion School of Medicine

A free version of this book can be downloaded from:

Copyright © 2022 by Michael F. Nolan and John P. McNamara

Virginia Tech Carilion School of Medicine

Virginia Tech Publishing

How to Use the Manual 2

1 Back and Spine 3

13 Answer Key 147

Michael F. Nolan, Ph.D., P.T.

3. Identify and describe joints and ligaments of the vertebral column.

5. Define abnormal curvatures of the vertebral column and describe common

Anatomy Review Questions

The vertebral column is stabilized and intervertebral movement is limited (restricted) by

1. vertebral body to vertebral body anteriorly

2. vertebral body to vertebral body posteriorly

4. transverse process to transverse process

5. spinous process to spinous process

6. tip of the spinous process to tip of the spinous process

7. Which vertebra presents the carotid tubercle?

8. Which vertebra presents the dens?

9. Is the dens positioned anterior or posterior to the vertebral canal?

10. Which spinal nerve is located in the C7 – T1 intervertebral foramina?

12. What muscles comprise the transversospinal group?

18. What structure is located in the transverse foramen?

19. Where is Batson’s plexus of veins located?

21. What vascular structure passes through the posterior atlanto-occipital

22. What three muscles form the triangle of auscultation?

23. What three muscles form the lumbar (Petit’s) triangle?

A. Inspection and Palpation

b. Which segments of the vertebral column are concave posteriorly?

c. An increase in the curvature of either of these parts of the vertebral

d. Which segments of the vertebral column are convex posteriorly?

e. An increase in the curvature of the thoracic spine in the sagittal plane is

f. An increase in the curvature of the vertebral column in the coronal plane

a. What is the name of this bony prominence?

b. What is the name of this part of the vertebra?

c. Which vertebra is this palpable feature a part of?

If not, indicate why.

a. What is the superior attachment of this group of muscles?

a. Are the two sides symmetrical?

If not, describe the differences.

6. Palpate the iliac crests together.

If not, indicate which is higher (or lower)?

b. Which vertebra would be crossed by a line drawn between the iliac

If not, indicate which is higher (or lower).

right hand _____________________________________________

left hand _____________________________________________

If one side is higher, which side is higher?

If not, approximate (or measure) in degrees the amount of lateral bending

To the right _____________________________________________

To the left _____________________________________________

a. Was the subject able to rotate equally in both directions?

To the right _____________________________________________

To the left _____________________________________________

B. Movement (Muscles and Joints)

The vertebral column is stabilized and intervertebral movement is limited (restricted) by

1. vertebral body to vertebral body anteriorly