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Dentistry
Medicine
Basic Sciences
Surgery
Nursing
MBBS Curriculum
Pre-Clinical
Para Clinical
Two Semesters (1 st & 2 nd Anatomy, Physiology, Biochemistry
Clinical
Three Semesters (3 rd ,4 th & 5 th ) Community Medicine, Forensic Medicine, Pathology, Pharmacology, Microbiology, Clinical postings in wards, OPDs begin here
Four Semesters (6 th ,7 th ,8 th & 9 th )
Medicine & allied subjects - Psychiatry, Dermatology; Obst. Gynae.; Pediatrics; Surgery & allied subjects (Anesthesiology, E.N.T., Ophtha.,Ortho); Clinical postings
New Curriculum highlights:
• Early clinical exposure starting from the first year of the MBBS course. • Competency based learning. • Integration of ethics, attitudes and professionalism into all phases of learning.
Pre-Clinical - Anatomy
Anatomy is the science of the structure of the body and the relation of its parts.
Teaching hours are approximately 580
Prof Exam : Total – 200 marks
Theory – 100 marks
Practicals- 100 marks
Titles in Anatomy
Author
Title
Year
Price Target
Audience
AGUR
Grant’s Atlas of Anatomy, 13/e
2012 1595.00
UG's UG's
BRIJESH KUMAR
Histology: Text & Atlas
2013
495.00
EROSCHENKO difiore’s Atlas of Histology with Functional Correlations, 12/e
2012
795.00
UG's UG's UG's UG's UG's UG's UG's UG's PG's PG's PG's
MOORE
Clinical Oriented Anatomy 7/e
2013 2250.00
PAL
Illustrated Text Book of Neuroanatomy Langman’s Medical Embryology, 12/e
2013 2013
595.00 795.00
SADLER
SNELL SNELL
Clinical Anatomy by Regions 9/e
2012 2095.00 2009 1250.00
Clinical Neuroanatomy, 7/e
STEDMAN'S
Stedman’s Pocket Medical Dictionary
2009 2012 2010 2010 2009 2014 2013
365.00 650.00 695.00 695.00 695.00
TANK
Grant’s Dissector, 15/e
Dudek
BRS Embryology
Gartner
BRS Cell Biology and Histology
Dudek
BRS Genetics
Neuroanatomy, IE 9/e (Special Price) Tentative Price shown Barr's The Human Nervous System: An Anatomical Viewpoint 10/e Essential Clinical Anatomy, International Edition, 5/e Tentative Histology: A Text and Atlas, International Edition 6/e (Special Price)
$ 45.00T Reference $71.95 Reference
HAINES
KIERNAN
$ 35.00T) Reference $62.00 Reference
MOORE
2014 2010
ROSS
* Focus titles are highlighted
Grant’s Atlas of Anatomy 13/e
880 Pages ● 1600 illustrations ● 79 Tables ● Paperback ● Pub Year 2012 ● Rs. 1595.00
Anne M Agur B.Sc. (OT), M.Sc., PH.D, Professor, Division of Anatomy, Department of Surgery, Faculty of Medicine
Primary Market : MBBS Students (1 st Prof ) Secondary Market: Aspiring PG Students
USPs:
• Known for realistic dissection illustrations, detailed surface anatomy photos, clinical images and comments, and quick-reference muscle tables • Additional clinical images (CTs, MRIs (100)) help students apply the laboratory experience to clinical rotations • Color surface anatomy photographs combine with hallmark anatomical illustrations for the most complete atlas available
More Key features:
• A cornerstone of gross anatomy since 1943 •
Renowned for its accuracy, pedagogy, and clinical relevance, this classic atlas boasts significant enhancements, including updated artwork, new conceptual diagrams, and vibrantly re-colored illustrations • Updated/additional clinical comments now appear in blue text for quick identification (Page no. 4, 5) • Grant’s classic illustrations have been updated/replaced for feature enhanced colorization • Schematic and orientation drawings have been updated or replaced to better facilitate understanding of structures and relationships • Streamlined interior design and layout facilitate comprehension of complex, detailed information • Concise, interpretive legends present important observations and comments • Diagnostic images, with sections at the end of each chapter, feature clinically relevant MRIs, CT scans, and ultrasounds (Page no. 90, 91…) • Tables provide an overview of muscles, nerves, and arteries (Page no. 23…)
Resources: thePoint -
Interactive Question Bank,
- Interactive Atlas (Student Edition), and AclandAnatomy.com video Clips - Image Bank for Faculty - Powerpoint Slides with select dissection images - Interactive Atlas (Instructor Edition)
Adductor pollicis
1st dorsal interosseous
Dorsalis indicis artery
Perforating vein
Dorsalis pollicis artery
Subtendinous bursa of extensor carpi radialis brevis Extensor carpi radialis brevis Dorsal carpal branch Extensor pollicis longus Extensor carpi radialis longus
Radial artery in snuff box
Cephalic vein of forearm
Abductor pollicis longus
Extensor pollicis brevis
Tributaries of cephalic vein of forearm
Radial nerve, superficial branch
A
B
Lateral Views
Agur_Chap06.indd 592
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EPL
1st dorsal interosseous
EPB
Adductor pollicis (1)
Extensor (dorsal) expansion
1
Extensor digitorum (6)
2
1st metacarpal
1st dorsal interosseous (2)
Extensor pollicis brevis (5)
Radial artery
6
APL
Opponens pollicis
6
Abductor pollicis longus (4)
Extensor pollicis longus (3)
Joint capsule of 1st carpometacarpal joint
3
Midcarpal joint
5
Extensor carpi radialis brevis
Anatomical snuff box
Scaphoid bone
Wrist joint
Extensor carpi radialis longus
Styloid process of radius
6
Radial artery
4
Extensor digitorum (6)
D. Lateral View
Flexor carpi radialis
Distal Extents of:
EPL EPB APL
Extensor pollicis longus Extensor pollicis brevis Abductor pollicis longus
Brachioradialis
C. Lateral View
Agur_Chap06.indd 593
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Distal phalanx of 2nd digit
Extensor pollicis longus
1st dorsal interosseous
Adductor pollicis
Extensor pollicis brevis
Proximal phalanx of thumb
1st dorsal interosseous
1st metacarpal
1st metacarpal
Extensor carpi radialis longus
Trapezium Abductor pollicis longus
Thenar eminence
Hypothenar eminence
Trapezoid
Trapezium
Scaphoid
Scaphoid
Styloid process
Lunate
Grooves for:
Dorsal tubercle of radius
Abductor pollicis longus Extensor pollicis brevis
Groove for extensor pollicis longus
Extensor carpi radialis longus Extensor carpi radialis brevis
Radius
E
F
Lateral Views, Right Hand
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Frontal (metopic) suture
Frontal eminence
Frontal bone
Anterior fontanelle
Coronal suture
Key for B, E and F
A B C
Angle of mandible Body of mandible Coronal suture Frontal bone Lambdoid suture Mandibular symphysis Occipital bone Parietal eminence Sagittal suture Sphenoid Temporal bone Maxilla
Sagittal suture
F L M O
Parietal eminence
P S SP
Parietal bone
Mastoid process Zygomatic bone T X Y Z Arrowheads = Membranous outline of parietal bone
Posterior fontanelle
Lambdoid suture
D. Superior View
Occipital bone
C
F
P
L
SP
T
O
X
Z
X
Y
A
A
B
E. Lateral View
F. Lateral View
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Competition Matrix
Netters Atlas of Human Anatomy, 5/e
Atlas of Anatomy 2/e
Grant's Atlas of Anatomy 13/e
Author / Editor
Frank Netter, MD
Gilroy
Anne M. R. Agur
Product Data
960 Pages, Paperback, Elsevier, 2010
704 Pages, 2200 illustrations, 170 Tables, Paperback, Thieme, 2012 • New sectional anatomy spreads at the end of units build familiarity with 2D views of anatomic regions • Exquisite full-color illustrations with clear, thorough labeling and descriptive captions Even more clinical correlations help students make the connection between anatomy and medicine • Coverage of each region intuitively arranged to simplify learning: beginning with the skeletal framework, then adding muscles, organs, vasculature, and nerves, and concluding with topographic illustrations that put it all together • Innovative, user-friendly format in which each two-page spread is a self-contained guide to a topic • Surface anatomy spreads now include regions and reference lines or planes in addition to landmarks and palpable structures to develop physical exam skills Muscle Fact spreads ideal for memorization, reference, and review organize the essentials about muscles, including origin, insertion, innervation, and action
888 Pages, 1600 illust., 79 Tables, Paperback, WK, 2012
Contents
• Stronger clinical focus with new diafgnostic imaging examples - making it easier to correlate anatomy with practice. • Netter's has clearer pictures and better detail.
• Cornerstone of Gross Anatomy since 1943. • Renowed for its accuracy, pedagogy and clinical references • Additional clinical images (CTs, MRIs (100)) • Updated/additional clinical comments now appear in blue text for quick identification (Page no. 4, 5…) • Color surface anatomy photographs combine with hallmark anatomical illustrations for the most complete atlas available • Concise, interpretive legends present important observations and comments • Diagnostic images, with sections at the end of each chapter, feature clinically relevant MRIs, CT scans, and ultrasounds (Page no. 90, 91…) • Tables provide an overview of muscles, nerves, and arteries (Page no. 23…) • Quick reference muscle tables •Terminology conforms with Terminologica Anatomica, the standard for anatomical nomenclature
Resources
Student Consult online access includes supplementary learning resources
Access to WinkingSkull.com PLUS, with over 500 images from the book for labels-on and labels-off review and timed self-tests for exam preparation
For instructors: Image Bank, Powerpoint Slides + images, Interactive Atlas (Instructor Edition) For students: Figure Labeling Exercises, Flash cards, Interactive Question Bank, Interactive Atlas (Student Edition), and AclandAnatomy.com video clips
Price
Rs.1475.00
Rs.1495.00
Rs.1595.00
Clinically Oriented Anatomy 7/e 1248 Pages ● 1988 illustrations ● Paperback ● 2013 ● Price: Rs,2250
Keith L. Moore MSc PhD FIAC FRSM FAAA (American Association of Anatomy: Distinguish Educator Award 2007) (American Association of Clinical Anatomists: Honored Member Award 1994)
Primary Market: MBBS Students (1 st Prof) Secondary Market: Aspiring PG students
USPs: • The best-selling clinical anatomy textbook on the market •
CLINICAL BLUE BOXES, supported by photos and illustrations, help students understand the practical value of anatomy. Each clinical correlation is classified by the type of clinical information it contains: Anatomical Variation, Trauma, Surgical Procedure, Diagnostic Procedure, Life Cycle, and Pathology (659-661) • EXTENSIVE MEDICAL AND DIAGNOSTIC IMAGING reflects the increasing importance it plays in diagnosis and treatment(930-934) More Key features • NEW-AND-IMPROVED ART PROGRAM: All illustrations have been redrawn and updated for consistency in style and color as well as anatomical accuracy • ILLUSTRATED TABLES organize complex information about veins, arteries, nerves, and other structures • BOTTOM LINES summarize key study points for students • SURFACE ANATOMY photos clearly demonstrate anatomy’s relationship to physical examination and diagnosis
Resources Resource: thePoint -
Entire Content of the book fully searchable - Over 100 USMLE –style Questions with detailed explanation - 145 Interactive case studies - “Blue Box” Video Podcast
Also Available:
Essential Clinical Anatomy 5/e Master core anatomical concepts and prepare for course and board exams. Concise and easy-to-read, this bestselling text includes student-favorite Clinical Boxes, hundreds of striking illustrations, and up-to-date coverage of surface anatomy and medical imaging. Acclaimed for the relevance of its clinical correlations, the text emphasizes anatomy that is important in physical diagnosis for primary care, interpretation of diagnostic imaging, and understanding the anatomical basis of emergency medicine and general surgery. 9781451187496 ● Paperback ● 736 Pages ● $ 35.00 (T) ● 2013
Chapter 5 • Lower Limb
660
blood supply to the femoral head and in post-traumatic avascu- lar necrosis of the head of the femur. As a result, incongruity of the joint surfaces develops, and growth at the epiphysis is retarded. Such conditions, most common in children 3–9 years of age, produce hip pain that may radiate to the knee.
FIGURE B5.29.
Dislocation of Hip Joint
Congenital dislocation of the hip joint is common, occurring in approximately 1.5 per 1000 neonates; it is bilateral in approximately half the cases. Girls are affected at least eight times more often than boys (Salter, 1999). Dislocation occurs when the femoral head is not prop- erly located in the acetabulum. Inability to abduct the thigh is characteristic of congenital dislocation. In addition, the affected limb appears (and functions as if it is) shorter because the dislocated femoral head is more superior than on the normal side, resulting in a positive Trendelenburg sign (hip appears to drop on one side during walking). Approximately 25% of all cases of arthritis of the hip in adults are the direct result of residual defects from congenital dis- location of the hip. Acquired dislocation of the hip joint is uncommon because this articulation is so strong and stable. Nevertheless, disloca- tion may occur during an automobile accident when the hip is flexed, adducted, and medially rotated, the usual position of the lower limb when a person is riding in a car. Posterior dislocations of the hip joint are most common. A head-on collision that causes the knee to strike the dashboard
maintaining the femoral head; consequently, the fragment may undergo aseptic vascular necrosis (tissue death) .
Surgical Hip Replacement
Although the hip joint is strong and stable, it is sub- ject to severe traumatic injury and degenerative disease. Osteoarthritis of the hip joint, character- ized by pain, edema, limitation of motion, and erosion of articular cartilage, is a common cause of disability (Fig. B5.30A). During hip replacement, a metal prosthesis anchored to the person’s femur by bone cement replaces the femoral head and neck (Fig. B5.30B). A plastic socket cemented to the hip bone replaces the acetabulum.
Cartilage Hip bone
Cartilage
Femur
Normal hip
Osteophytes and eroded
articular cartilage
(A)
(B) Hip prosthesis
(A) Hip with moderate arthritis
FIGURE B5.30.
Head of femur is driven posteriorly, out of acetabulum
Necrosis of Femoral Head in Children In children, traumatic dislocations of the hip joint disrupt the artery to the head of the femur. Fractures that result in separation of the superior femoral epiphysis (the growth plate between the femoral head and neck) are also likely to result in an inadequate
(B)
Posterior dislocation of the right hip joint
FIGURE B5.31.
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Chapter 5 • Lower Limb
661
may dislocate the hip when the femoral head is forced out of the acetabulum (Fig. B5.31A). The joint capsule ruptures inferiorly and posteriorly, allowing the femoral head to pass through the tear in the capsule, and over the posterior mar- gin of the acetabulum onto the lateral surface of the ilium, shortening and medial rotating the limb (Fig. B5.31B). Because of the close relationship of the sciatic nerve to the hip joint (Fig. 5.80A), it may be injured (stretched and/or com- pressed) during posterior dislocations or fracture–dislocations of the hip joint. This kind of injury may result in paralysis of the hamstrings and muscles distal to the knee supplied by the sciatic nerve. Sensory changes may also occur in the skin over the posterolateral aspects of the leg and over much of the foot because of injury to sensory branches of the sciatic nerve. Anterior dislocation of the hip joint results from a violent injury that forces the hip into extension, abduction, and lateral rotation (e.g., catching a ski tip when snow skiing). In these cases, the femoral head is inferior to the acetabulum. Often, the acetabular margin fractures, producing a fracture–dislocation of the hip joint. When the femoral head dislocates, it usually carries the acetabular bone fragment and acetabular labrum with it. These injuries also occur with posterior dislocations. The femur is placed diagonally within the thigh, whereas the tibia is almost vertical within the leg, creating an angle at the knee between the long axes of the bones (Fig. B5.32A). The angle between the two bones, referred to clinically as the Q-angle, is assessed by drawing a line from the ASIS to the middle of the patella and extrap- olating a second (vertical) line passing through the middle of the patella and tibial tuberosity (Fig. 5.84). The Q-angle is typically greater in adult females, owing to their wider pelves. When normal, the angle of the femur within the thigh places Genu Valgum and Genu Varum
the middle of the knee joint directly inferior to the head of the femur when standing, centering the weight-bearing line in the intercondylar region of the knee (Fig. B5.32A). A medial angulation of the leg in relation to the thigh, in which the femur is abnormally vertical and the Q-angle is small, is a deformity called genu varum (bowleg) that causes unequal weight-bearing: The line of weight-bearing falls medial to the center of the knee (Fig. B5.32B). Excess pres- sure is placed on the medial aspect of the knee joint, which results in arthrosis (destruction of knee cartilages), and the fibular collateral ligament is overstressed (Fig. B.32D). A lateral angulation of the leg (large Q-angle, >17°) in relation to the thigh (exaggeration of the knee angle) is called genu valgum (knock-knee) (Fig. B5.32C). Because of the exagger- ated knee angle in genu valgum, the weight-bearing line falls lateral to the center of the knee. Consequently, the tibial col- lateral ligament is overstretched, and there is excess stress on the lateral meniscus and cartilages of the lateral femoral and tibial condyles. The patella, normally pulled laterally by the tendon of the vastus lateralis, is pulled even farther laterally when the leg is extended in the presence of genu valgum so that its articulation with the femur is abnormal. Children commonly appear bowlegged for 1–2 years after starting to walk, and knock-knees are frequently observed in children 2–4 years of age. Persistence of these abnormal knee angles in late childhood usually means congenital deformities exist that may require correction. Any irregularity of a joint eventually leads towear and tear (arthrosis) of the articular carti- lages and degenerative joint changes ( osteoarthritis [arthrosis] ).
Patellar Dislocation
When the patella is dislocated, it nearly always dis- locates laterally. Patellar dislocation is more com- mon in women, presumably because of their greater
ASIS
Line of gravity
Normal Q-angle
Q-angle
Q-angle
(A) Normal alignment
(B) Genu varum
(C) Genu valgum
(D) Osteoarthritis (arthrosis)
FIGURE B5.32.
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Chapter 7 • Head
930
Labial mucosa
Vestibular (mucolabial) fold
Alveolar mucosa
Labial frenulum
Superior labial gingiva
I1 I2
C
PM
M
Vermilion border of lip
(A)
M
PM
PM
I1 I2 C
Inferior labial gingiva (gingiva proper) Alveolar mucosa (unattached gingiva)
Vestibular (mucolabial) fold
Labial mucosa
(B)
FIGURE 7.78. Oral vestibule and gingivae. A. The vestibule and gingivae of the maxilla are shown. B. The vestibule and gingivae of the mandible are shown. As the alveolar mucosa approaches the necks of the teeth, it changes in texture and color to become the gingiva proper. (Courtesy of Dr. B. Liebgott, Professor, Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.)
pink, stippled, and keratinizing. The alveolar mucosa (unattached gingiva) is normally shiny red and non-keratin- izing. The nerves and vessels supplying the gingiva, underly- ing alveolar bone, and periodontium (which surrounds the root[s] of a tooth, anchoring it to the tooth socket), are pre- sented in Fig. 7.79A & C. Teeth The chief functions of teeth are to: • Incise (cut), reduce, and mix food material with saliva during mastication (chewing). • Help sustain themselves in the tooth sockets by assisting the development and protection of the tissues that sup- port them. • Participate in articulation (distinct connected speech). The teeth are set in the tooth sockets and are used in mastica- tion and in assisting in articulation. A tooth is identified and described on the basis of whether it is deciduous (primary)
The principal muscles of the cheeks are the buccinators (Figs. 7.76). Numerous small buccal glands lie between the mucous membrane and the buccinators (Fig. 7.74A). Super- ficial to the buccinators are encapsulated collections of fat; these buccal fat-pads are proportionately much larger in infants, presumably to reinforce the cheeks and keep them from collapsing during sucking. The cheeks are supplied by buccal branches of the maxillary artery and innervated by buccal branches of the mandibular nerve. GINGIVAE The gingivae (gums) are composed of fibrous tissue covered with mucous membrane. The gingiva proper (attached gin- giva) is firmly attached to the alveolar processes of the man- dible and maxilla and the necks of the teeth (Figs. 7.76 and 7.78). The gingiva proper adjacent to the tongue is the supe- rior and inferior lingual gingivae, and that adjacent to the lips and cheeks is the maxillary and mandibular labial or buccal gingiva, respectively. The gingiva proper is normally
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Chapter 7 • Head
931
Trigeminal nerve (CN V)
Maxillary nerve (CN V 2 )
Trigeminal ganglion
Infra-orbital nerve (CN V 2 )
Posterior Middle Anterior
Superior alveolar nerves (CN V 2 )
Mandibular nerve (CN V 3 )
Inferior alveolar nerve (CN V 3 ) Lingual nerve (CN V 3 )
Site of mandibular foramen
Buccal branch of CN V 3
Mental branch (CN V 3 )
Mandibular canal
Incisive branch of inferior alveolar nerve (CN V 3 )
Dental branches of inferior alveolar nerve (CN V 3 )
(A) Lateral view
Innervates right and left Teeth/tooth pulp Periodontal ligament Alveolar process
Occlusal surface
Innervates right and left vestibular (buccal, labial) gingiva
Contact surfaces
Innervates superior lingual gingiva
L ING U A L ( P AL AT A L )
Anterior superior alveolar and Infra-orbital
Anterior superior alveolar
D IST AL
8 7
9 10
6
11
N a s o p a l a t i n e
Infra-orbital and Middle superior alveolar
12
5
L ABIAL (V EST IBUL A R )
Middle superior alveolar
MESI AL
MAXILLARY, inferior view MANDIBULAR, superior view G r e a t e r p a l a t i n e G r e a t e r p a l a t i n e PALATE 13 14 4 3 2
CN V 2
Posterior superior alveolar
INCISOR TOOTH
Posterior superior alveolar
15
1
16
Occlusal surface
Contact surfaces
32
17
FLOOR OF MOUTH
Lingual
31
LI NG U AL ( P AL ATA L )
18
Buccal branch
DISTAL
30
Lingual 19
Dental branches of inferior alveolar
29
20
B U CCAL ( V EST IBU LAR )
CN V 3
21
28
MESIAL
27
Mental branch of inferior alveolar
26 2524 23 22
Incisive branch of inferior alveolar
MOLAR TOOTH
(B)
Floor of mouth and inferior lingual gingiva and anterior 2/3 of tongue (general sensory)
(C)
FIGURE 7.79. Innervation of teeth and gingiva. A. Superior and inferior alveolar nerves. B. Surfaces of an incisor and molar tooth. C. Innervation of the mouth and teeth.
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Chapter 7 • Head
932
in clinical (dental) practice, the mesial surface of a tooth is directed toward the median plane of the facial part of the cra- nium. The distal surface is directed away from this plane; both mesial and distal surfaces are contact surfaces —that is, surfaces that contact adjacent teeth. The masticatory surface is the occlusal surface. PARTS AND STRUCTURE OF TEETH A tooth has a crown, neck, and root (Fig. 7.82). The crown projects from the gingiva. The neck is between the crown and root. The root is fixed in the tooth socket by the peri- odontium (connective tissue surrounding roots) ; the number of roots varies. Most of the tooth is composed of dentine (L. dentinium ), which is covered by enamel over the crown
or permanent (secondary), the type of tooth, and its prox- imity to the midline or front of the mouth (e.g., medial and lateral incisors; the 1st molar is anterior to the 2nd). Children have 20 deciduous teeth; adults normally have 32 permanent teeth (Fig. 7.80A & C). The usual ages of the eruption (“cutting”) of these teeth are demonstrated in Figure 7.81 and listed in Table 7.13. Before eruption, the developing teeth reside in the alveolar arches as tooth buds (Fig. 7.80B). The types of teeth are identified by their characteristics: incisors, thin cutting edges; canines, single prominent cones; premolars (bicuspids), two cusps; and molars, three or more cusps (Fig. 7.80A & C). The vestibular surface (labial or buccal) of each tooth is directed outwardly, and the lingual surface is directed inwardly (Fig. 7.79B). As used
Maxillary alveolar process
PM
*
I
I
C
PM M1
M3
M2 M1 PM PM
I
C
I
M3
I
I
C
PM
M2
PM PM M1
PM
M2 M1
M3
M1 PM PMCI I
M2
M3
PM PM M1
Mandibular alveolar process
(A) Right anterolateral view
(B) Left anterolateral view
M3 M2 M1 PM PM C I I M3 M2 M1 PM PM C I I 1 2 3 4 5 6 7 8
16
9 10 11 12 13 14 15
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
(C) Panoramic view
FIGURE 7.80. Secondary dentition. A. The teeth are shown in occlusion. There is a supernumerary midline tooth (mesiodens) in this specimen (*). B. Maxillary and mandibular jaws of a child acquiring secondary dentition are shown. The alveolar processes are carved to reveal the roots of the teeth and tooth buds. C. A pantomographic radiograph of an adult mandible and maxilla is shown. The left lower 3rd molar is not present. I, incisor; C, canine; PM, premolar; M1, M2, and M3, 1st, 2nd, and 3rd molars. (Part C courtesy of M. J. Pharoah, Associate Professor of Dental Radiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.)
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Chapter 7 • Head
933
TABLE 7.13A. DECIDUOUS TEETH
Deciduous Teeth Central Incisor Lateral Incisor Canine 1st Molar 2nd Molar
Eruption (months) a
6–8
8–10
16–20 12–16
20–24
Shedding (years)
6–7
7–8
10–12 9–11
10–12
a In some normal infants, the first teeth (medial incisors) may not erupt until 12–13 months of age.
M1
M2
Interradicular septa of tooth socket
Socket for M1
C
Interalveolar septum
Central and lateral incisors
C
M1
M2
Molar M = Pm = Premolar
M1
Permanent teeth Deciduous teeth
M2
(A)
(B)
Primary dentition, < 2 years
M3 M2
M3 M2
M2
M1
M1
M1
Pm2 Pm1
M2
M2
M1
M1
Canine
Canine
Canine
Incisors
Incisor 1 Incisor 2
Central incisors Lateral incisors
Canine
Canine
Canine
M1
Pm2 Pm1
M1
M2
M2
M1
M1
M1
M2
M3 M2
M2
(E)
(C)
(D)
M3
Age: 6–7 years
Age: 12 years
Age: 8 years
FIGURE 7.81. Primary dentition (deciduous teeth) and eruption of permanent teeth.
TABLE 7.13B. PERMANENT TEETH
1st Premolar
2nd Premolar 1st Molar 2nd Molar 3rd Molar
Permanent Teeth Central Incisor Lateral Incisor Canine
Eruption (years)
7–8
8–9
10–12 10–11
11–12
6–7
12
13–25
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Chapter 7 • Head
934
variable amount of trabeculated bone. The labial wall of the socket is particularly thin over the incisor teeth; the reverse is true for the molars, where the lingual wall is thinner. Thus the labial surface commonly is broken to extract incisors and the lingual surface is broken to extract molars. The roots of the teeth are connected to the bone of the alve- olus by a springy suspension forming a special type of fibrous joint called a dento-alveolar syndesmosis or gomphosis. The periodontium (periodontal membrane) is composed of collagenous fibers that extend between the cement of the root and the periosteum of the alveolus. It is abundantly supplied with tactile, pressoreceptive nerve endings, lymph capillaries, and glomerular blood vessels that act as hydraulic cushioning to curb axial masticatory pressure. Pressoreceptive nerve end- ings are capable of receiving changes in pressure as stimuli. VASCULATURE OF TEETH The superior and inferior alveolar arteries, branches of the maxillary artery, supply the maxillary and mandibular teeth, respectively (Figs. 7.73 and 7.74A; Table 7.12). The alveolar veins have the same names and distribution accompany the arteries. Lymphatic vessels from the teeth and gingivae pass mainly to the submandibular lymph nodes (Fig. 7.77). INNERVATION OF TEETH The nerves supplying the teeth are illustrated in Figure 7.79A. The named branches of the superior (CN V 2 ) and inferior (CN V 3 ) alveolar nerves give rise to dental plexuses that supply the maxillary and mandibular teeth. Palate The palate forms the arched roof of the mouth and the floor of the nasal cavities (Fig. 7.83). It separates the oral cavity from the nasal cavities and the nasopharynx, the part of the pharynx superior to the soft palate. The superior (nasal) sur- face of the palate is covered with respiratory mucosa, and the inferior (oral) surface is covered with oral mucosa, densely packed with glands. The palate consists of two regions: the hard palate anteriorly and the soft palate posteriorly. HARD PALATE The hard palate is vaulted (concave); this space is mostly filled by the tongue when it is at rest. The anterior two thirds of the palate has a bony skeleton formed by the palatine processes of the maxillae and the horizontal plates of the palatine bones (Fig. 7.84A). The incisive fossa is a depression in the midline of the bony palate posterior to the central incisor teeth into which the incisive canals open. The nasopalatine nerves pass from the nose through a variable number of incisive canals and foramina that open into the incisive fossa (Fig. 7.87B). Medial to the 3rd molar tooth, the greater palatine fora- men pierces the lateral border of the bony palate (Fig. 7.84A). The greater palatine vessels and nerve emerge from this
Enamel
Crown
Crown
Dentine
Neck
Pulp cavity (tooth cavity)
Neck
Cement
Root
Root
Root canal
Apical foramen (root foramen)
Incisor tooth
Molar tooth
(A) Longitudinal section
5
1 1
2 2 3
4
7
8
7
6
(B) Lateral radiograph
1 Enamel 4 Root canal
2 Dentine 5 Buccal cusp
3 Pulp cavity 6 Root apex
7 Interalveolar septa (alveolar bone) 8 Interradicular septum (alveolar bone)
and cement (L. cementum ) over the root. The pulp cavity contains connective tissue, blood vessels, and nerves. The root canal (pulp canal) transmits the nerves and vessels to and from the pulp cavity through the apical foramen. The tooth sockets are in the alveolar processes of the maxillae and mandible (Fig. 7.80A); they are the skeletal features that display the greatest change during a lifetime (Fig. 7.81B). Adjacent sockets are separated by interalveo- lar septa; within the socket, the roots of teeth with more than one root are separated by interradicular septa (Figs. 7.81B and 7.82B). The bone of the socket has a thin cortex separated from the adjacent labial and lingual cortices by a FIGURE 7.82. Sections of teeth. A. An incisor and a molar are shown. In living people, the pulp cavity is a hollow space within the crown and neck of the tooth containing connective tissue, blood vessels, and nerves. The cavity narrows down to the root canal in a single-rooted tooth or to one canal per root of a multirooted tooth. The vessels and nerves enter or leave through the apical foramen. B. Bite-wing radiograph of maxillary premolar and molar teeth demonstrating features shown and described in part A.
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Competition Matrix
Netter's Clinical Anatomy: with Online Access, 2/e Clinically Oriented Anatomy 7/e
Hansen
Moore
Author / Editor
? Pages, Paperback, Elsevier, 2009
1248 Pages, 1988 illust., Paperback, WK, 2013
Product Data
• Presents nearly 6 beautifully colored illustrations which provide essential depictions of anatomy, embryology, and pathology to help you understand their clinical relevance. • Features Clinical Focus boxes throughout that present hundreds of well-illustrated clinical correlations which bridge anatomy to pathophysiology • Characteristics boxes that explain the relation between structure and function. • Includes Muscle/Ligament/Joint Tables that summarize attachment points, actions, and other key information related to each structure, providing a quick overview of the MSK system. • Offers short-answer review questions at the end of each chapter to help you gauge your mastery of the material and assess areas in need of further study.
• The best-selling clinical anatomy textbook on the market • NEW-AND-IMPROVED ART PROGRAM: All illustrations have been redrawn and updated for consistency in style and color as well as anatomical accuracy • CLINICAL BLUE BOXES, supported by photos and illustrations, help students understand the practical value of anatomy. Each clinical correlation is classified by the type of clinical information it contains: Anatomical Variation, Trauma, Surgical Procedure, Diagnostic Procedure, Life Cycle, and Pathology • ILLUSTRATED TABLES organize complex information about veins, arteries, nerves, and other structures • BOTTOM LINES summarize key study points for students • INTRODUCTION CHAPTER covers important systemic information and concepts basic to the understanding of the anatomy presented in the subsequent regional chapters • EXTENSIVE MEDICAL AND DIAGNOSTIC IMAGING reflects the increasing importance it plays in diagnosis and treatment • SURFACE ANATOMY photos clearly demonstrate anatomy’s relationship to physical examination and diagnosis • Online CASE STUDIES AND BOARD REVIEW-STYLE QUESTIONS provide interactive, convenient, and comprehensive self-testing and review to prepare for course and licensing exams • TERMINOLOGY fully adheres to the most current Terminologia Anatomica approved by the Federative International Committee on Anatomical Terminology
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Clinical Anatomy by Regions 9/e
9788184736588 ● 800 Pages ● 599 illustraƟons ● Paperback ● Pub Year 2012 ● Rs. 1995.00
Richard S. Snell MD, PhD , Emeritus Professor of Anatomy, George Washington University School of Medicine and Health Science, Washington, DC
Primary Market: MBBS Student (1 st and 3 rd Prof) Secondary Market: Aspiring PG student
Features:
• Widely praised for its clear and consistent organization, abundant illustrations, and emphasis on clinical applications. • Each chapter of Clinical anatomy is constructed in a similar manner. This gives students ready access to material and facilitates moving from one part of the book to another. Each chapter is divided into the following categories: - Clinical Examples - Chapter Objectives - Basic Clinical Anatomy - Surface Anatomy - Clinical Problem solving and Review questions (thePoint) • Updated design and layout allow for a shorter, more focused text. • Basic Clinical Anatomy sections provide essential information on gross anatomic structures of clinical significance. (Page No. 6) • Clinical Examples open each chapter and dramatize the relevance of anatomy in medicine. (Page no. 31) • Clinical Objectives sections in each chapter focus the student on material most important to their preparedness’ for the patient encounter. (Page No. 1) • Embryologic notes provide anatomical insights into developmental anatomy. (Page No. 33) • Full-color illustrations. • Numerous examples of clinical images support the text. (Page no. 69) • Surface Anatomy sections explain surface landmarks of important anatomic structures. (Page No. 50)
Resources for Student & Faculty thePoint
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Online eBook
- Interactive Question Bank for every chapter - Instructor Image Bank for every chapter (for faculty)
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158 CHAPTER 5 The Abdomen: Part II—The Abdominal Cavity
esophagus diaphragm
liver
stomach
gallbladder
left colic flexure
right colic flexure
duodenum transverse colon
descending colon
ascending colon
jejunum
ileocecal junction
cecum
ileum
appendix
sigmoid colon
rectum
anal canal
anus
FIGURE 5.1 General arrangement of abdominal viscera.
umbilical regions, and much of it lies under cover of the ribs. Its long axis passes downward and forward to the right and then backward and slightly upward. Small Intestine The small intestine is divided into three regions: duode- num, jejunum, and ileum. The duodenum is the first part of the small intestine, and most of it is deeply placed on the posterior abdominal wall. It is situated in the epigastric and umbilical regions. It is a C-shaped tube that extends from the stomach around the head of the pancreas to join the jejunum (Fig. 5.1). About halfway down its length, the small intestine receives the bile and the pancreatic ducts. The jejunum and ileum together measure about 20 ft (6 m) long; the upper two fifths of this length make up the jejunum. The jejunum begins at the duodenojeju- nal junction, and the ileum ends at the ileocecal junction (Fig. 5.1). The coils of jejunum occupy the upper left part of the abdominal cavity, whereas the ileum tends to occupy the lower right part of the abdominal cavity and the pelvic cavity (Fig. 5.3). Large Intestine The large intestine is divided into the cecum, appen- dix, ascending colon, transverse colon, descending colon,
sigmoid colon, rectum, and anal canal (Fig. 5.1). The large intestine arches around and encloses the coils of the small intestine (Fig. 5.3) and tends to be more fixed than the small intestine.
stomach
liver
gastroepiploic vessels
gallbladder falciform ligament
greater omentum
FIGURE 5.2 Abdominal organs in situ. Note that the greater omentum hangs down in front of the small and large intestines.
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Basic Anatomy 159
the right lower and upper quadrants (Figs. 5.1 and 5.3). On reaching the liver, it bends to the left, forming the right colic flexure. The transverse colon crosses the abdomen in the umbil- ical region from the right colic flexure to the left colic flex- ure (Figs. 5.1 and 5.3). It forms a wide U-shaped curve. In the erect position, the lower part of the Umay extend down into the pelvis. The transverse colon, on reaching the region of the spleen, bends downward, forming the left colic flex- ure to become the descending colon. The descending colon extends from the left colic flexure to the pelvis below (Figs. 5.1 and 5.3). It occupies the left upper and lower quadrants. The sigmoid colon begins at the pelvic inlet, where it is a continuation of the descending colon (Fig. 5.1). It hangs down into the pelvic cavity in the form of a loop. It joins the rectum in front of the sacrum. The rectum occupies the posterior part of the pelvic cavity (Fig. 5.1). It is continuous above with the sigmoid colon and descends in front of the sacrum to leave the pel- vis by piercing the pelvic floor. Here, it becomes continuous with the anal canal in the perineum. Pancreas The pancreas is a soft, lobulated organ that stretches obliquely across the posterior abdominal wall in the epi- gastric region (Fig. 5.4). It is situated behind the stomach and extends from the duodenum to the spleen. Spleen The spleen is a soft mass of lymphatic tissue that occupies the left upper part of the abdomen between the stomach
greater omentum
transverse colon
coils of jejunum
ascending colon
descending colon
appendix
coils of ileum cecum
The cecum is a blind-ended sac that projects down- ward in the right iliac region below the ileocecal junction (Figs. 5.1 and 5.3). The appendix is a worm-shaped tube that arises from its medial side (Fig. 5.1). The ascending colon extends upward from the cecum to the inferior surface of the right lobe of the liver, occupying FIGURE 5.3 Abdominal contents after the greater omentum has been reflected upward. Coils of small intestine occupy the central part of the abdominal cavity, whereas ascending, transverse, and descending parts of the colon are located at the periphery.
central tendon of diaphragm
phrenic artery
left suprarenal gland
inferior vena cava
spleen
right suprarenal gland
left kidney
portal vein
phrenicocolic ligament
right kidney
bile duct hepatic artery
splenic artery pancreas
gastroduodenal artery
descending colon
transverse colon
ascending colon
superior pancreaticoduodenal artery
FIGURE 5.4 Structures situated on the posterior abdominal wall behind the stomach.
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68 CHAPTER 3 The Thorax: Part II—The Thoracic Cavity
esophagus
trachea
right subclavian vein
right vagus
right internal jugular vein
rami communicantes
right brachiocephalic vein
sympathetic trunk
right phrenic nerve superior vena cava
azygos vein
right bronchi
ascending aorta
pulmonary arteries
right atrium covered by pericardium
pulmonary veins
pericardium
greater splanchnic nerve
diaphragm
lesser splanchnic nerve
inferior vena cava
A
thoracic duct
sympathetic trunk
left phrenic nerve left vagus nerve arch of aorta
left brachiocephalic vein
left recurrent laryngeal nerve ligamentum arteriosum
left pulmonary artery
left bronchi
left ventricle covered by pericardium
left pulmonary veins
descending aorta
pericardium
greater splanchnic nerve diaphragm
B
esophagus
FIGURE 3.15 A. Right side of the mediastinum. B. Left side of the mediastinum.
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Basic Anatomy 69
right subclavian vein
right clavicle
sympathetic trunk
right subclavius muscle
cut rib
internal thoracic artery
azygos vein
superior vena cava
intercostal nerve
ascending aorta
right bronchi
right phrenic nerve
pulmonary veins
right atrium
greater splanchnic nerve
right ventricle
cut costal cartilage
inferior vena cava
right cupola of diaphragm
ANTERIOR
cut costal cartilage
FIGURE 3.16 Dissection of the right side of the mediastinum; the right lung and the pericardium have been removed. The costal parietal pleura has also been removed.
sympathetic trunk left vagus nerve descending aorta left auricle
left subclavian artery
left common carotid artery
arch of aorta
pulmonary trunk
right ventricle
left phrenic nerve
ANTERIOR
left ventricle
left cupola of diaphragm
apex of heart
FIGURE 3.17 Dissection of the left side of the mediastinum; the left lung and the pericardium have been removed. The costal parietal pleura has also been removed.
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Competition Matrix
Gray's Anatomy for Students, 2/e IE
BD Chaurasia's Human Anatomy 6/e 3 Vol Set
Clinical Anatomy by Regions 9/e
Drake
Chaurasia
Snell
Author / Editor
1150 Pages, 350+ illust., Paperback, Elsevier, 2009 Vol 1-311 Pages, Vol 2-463 Pages,Vol 3-493 Pages,Paperback, CBS, 2013
800 Pages, 599 illust., Paperback, WK, 2012
Product Data
Emphasizes the practical applications of anatomy with clinical correlations throughout. • Discusses the relevance of surface anatomy to clinical procedures and physical examination techniques. • Relates regional anatomy to systemic function. • Features beautiful full-color anatomic illustrations as well as radiologic images. • Presents a review tool for course exams as well as the USMLE Step 1 that lets you study your way based on your own personal study habits.
• 1st published in 1979, now considered is the best selling book • Improved diagrams with better labelling and clarity •Illustrated clinical anatomy given at the end of each chapter to increase the book's utility during clinical years •Separate DVD given with each volume containing videos on osteology for better orientation of the bones and interactive section of questions—answers with diagrams for proper preparation for the examinations •Section on "Brain" has been revised with a chapter exclusively on cranial nerves. •Multiple choice questions have been increased and incorporated to test the knowledge and skills acquired •To make the volumes practical-oriented, steps of dissection are put in distinctive boxes, marked DISSECTION. The lines of skin incision are shown in figures. Figures have also been given for the dissection undertaken. The volumes impart both theoretical as well as practical knowledge to the students
• The best-selling clinical anatomy textbook on the market • South Asian Advisory Panel (12 from India and 3 from Pakistan) • NEW: Clinical Blue Boxes now have categorizations such as Health, Clinical Procedures, Physical Examination, and Development and are indexed at the front of the book for easy navigation. (Page no. 35) • BOTTOM LINE SECTIONS (in Yellow Boxes): Ensure that primary concepts do not become lost in the many details. (Page no. 36, 43, 56…) • CLINICAL CORRELATIONS: The popular BLUE BOXES are supported by photographs and/or dynamic color illustrations to help students understand the practical value of anatomy (Page no. 19, 23, 37…) also (Separate TOC for Clinical Blue boxes) • FUNCTIONAL ANATOMY: Includes a more realistic approach to the musculoskeletal system emphasizing the action and use of muscles and muscle groups in daily activities (Page 899. *Eye Lid) • INTRODUCTION CHAPTER: This thorough and unique chapter covers important systemic information and concepts basic to the understanding of the anatomy presented in the subsequent regional chapters (Page no. 1) professionals who need to be familiar with imaging (Page no. 456, 458…)
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DVD
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