2011 GARQ Simulator

Describe the vertebral column. The vertebral column is comprised of how many vertebrae? What are the terms used to designate “regions” of the vertebral column? How many vertebrae are there in each region? Diagram and label a ”typical vertebra” (body, vertebral arch [vertebral arch = 2 pedicles, 2 laminae], spinous process, transverse processes, vertebral canal). How many vertebrae are individual bones? Are any vertebrae fused? (If so, which ones?) What is an intervertebral disc and how many are there?

Define/describe the sternal angle (of Louis). Palpating the sternal angle involves palpating what three structures? What is the plane of the sternal angle and what is the posterior bony landmark involved? Indicate the plane of the sternal angle on the diagram of a sagittal section through the thoracic cage. What is the significance of this anatomical landmark? Name three intrathoracic “landmarks” that can be reliably found at the level of the sternal angle.

What is the axial skeleton, and how does it differ from the appendicular skeleton? What bones comprise the axial skeleton? Describe the pectoral girdle. Describe the pelvic girdle. List two ways in which the pectoral and pelvic girdles are alike. List two ways in which they differ.

Describe the anatomical position. Define the directional terms that are essential for describing, and understanding descriptions of, human anatomy. Describe the conventional planes of section of the human body. Identify (name and location) twenty bony prominences/protrusions that can be palpated and that guide your understanding of the bony anatomy of the human body.

Define the terms auscultation, palpation, and percussion. Use a line to indicate the position of the diaphragm on this illustration of the anterior thoracic wall. Draw an outline of the heart as it is projected onto the anterior thoracic wall. Name, and indicate the position of, each of the four valves of the heart. Also indicate the position for auscultation for each valve. Define, and explain, PMI

Draw the lateral surfaces of the right and left lungs. Indicate apex and base and anterior border. Identify the lobes and fissures of each lung. As the oblique fissure projects onto the lateral and anterior thoracic wall, its course follows which rib? Where on the chest wall (anterior or posterior) would you listen for lung sounds from the superior lobe of the left lung, and why? Where on the chest wall (anterior or posterior) would you listen for lung sounds from the inferior lobe of the left lung, and why?

Name each “segment” of the digestive tract, in order, beginning with the esophagus and ending with the rectum. For each, state its location (thorax or abdominal quadrant) and one distinctive/descriptive feature.

Identify the bones of the appendicular skeleton of the upper extremity. (The bones of the hand may be grouped into the categories “carpal bones”, “metacarpal bones”, and “phalanges”.) For the bones of the arm and forearm, list two special anatomical features of each. Use diagrams, even “stick figures” if you wish, to assist you in your descriptions. Be sure to indicate which drawings are anterior views and which are posterior, and to identify medial and lateral directions. Also employ the terms anterior/posterior, medial/lateral, and proximal/distal, where necessary, in your written descriptions. Identify the bones of the appendicular skeleton of the lower extremity. (The bones of the foot may be grouped into the categories “tarsal bones”, “metatarsal bones”, and “phalanges”.) For the bones of the thigh and leg, list two special anatomical features of each. Again, use diagrams to assist you in your descriptions. Be sure to label any drawings clearly.

Describe the course taken by a drop of blood that enters the heart from the systemic circulation via the superior vena cava and, finally, leaves the heart to re-enter the systemic circulation. Your description should include all structures, e.g., heart chamber, valve, vessel, etc., through which the drop of blood travels

You may remember that the L2, L3, and L4 spinal cord segments provide innervation for, among other structures, the quadriceps femoris muscle and the L2, L3, and L4 dermatomes. In this empty diagram of the third lumbar spinal cord segment, insert a neuron that innervates the skin of the L3 dermatome on the anterior thigh. Insert a second neuron that innervates a muscle spindle in the quadriceps muscle. Insert a third neuron that innervates the skeletal muscle fibers of the quadriceps muscle. For each neuron (1) place its cell body in the correct place; (2) correctly label it; and (3) correctly illustrate the course of its axon. Label the dorsal root, dorsal root ganglion, ventral root, dorsal primary ramus, ventral primary ramus

Differentiate between the adjectives / terms “somatic” and “visceral”. What is the meaning of the term "trilaminar embryo”? Name at least 2 derivatives of each of the three embryonic germ layers. Define the term "somite," identify each of its three subdivisions, and provide one example of a derivative from each segment.

Define/describe the autonomic nervous system (ANS). What are the two divisions of the ANS? What are 2 structural differences between the two divisions of the ANS?

Define “dermatome”. Consider BOTH meanings of the word (i.e., what is a dermatome “embryologically” and what is a dermatome “neurologically”?) Why is a dermatome important? Are dermatomes related to spinal nerves? Are they related to spinal cord segments? How many dermatomes are there? Is there a spinal nerve/spinal cord segment that has no dermatome?

Which spinal nerves exit the vertebral column via the intervertebral foramen ABOVE the body of the vertebra to which they correspond? Which spinal nerves exit the vertebral canal via the intervertebral foramen BELOW the body of the vertebra to which they correspond? Which spinal nerve does not correspond to a vertebra of the same number? Describe the contents of the vertebral canal at lumbar and sacral vertebral levels, including (1) consideration of relevant vertebral levels, and (2) a definition/description of each of the following: conus medullaris, filum terminale, cauda equina
dura mater, arachnoid mater, pia mater, subarachnoid space

Define “arterial pulse”; why do arterial pulses exist? What information does an arterial pulse give the examiner? Identify five pulse points in the body; for each state the name of the artery involved, the general location of the artery, and at least one related structure that can be palpated for guidance in finding the pulse.

Diagram the aorta in its entirety. Use the provided drawing of an anterior view of the vertebral column to make your diagram, superimposing your illustration on it. Ensure that (1) the ascending aorta begins just below the level of the sternal angle; (2) the arch of the aorta begins and ends at the level of the sternal angle; and (3) the abdominal aorta terminates at the level of the 4th lumbar vertebra, by dividing into the common iliac arteries. Include and label the following: Ascending aorta, and its branches – right and left coronary arteries, Arch of aorta, and its branches – brachiocephalic trunk, left common carotid artery, and left subclavian artery, Thoracic portion of descending aorta, and several posterior intercostal arteries, Abdominal portion of descending aorta (sometimes called “abdominal aorta”), and these branches (in order, from superior to inferior): celiac trunk, superior mesenteric artery, renal arteries, inferior mesenteric artery

Use the provided drawing of an anterior view of the vertebral column to make your diagrams of the vessels below (A. and B., below), superimposing your illustrations on it. A. Diagram the superior vena cava (SVC), which drains the venous blood from the body above the diaphragm and empties into the right atrium at the level of the sternal angle. Include and label the following:
 Right and left brachiocephalic veins
 Right internal jugular and subclavian veins Left internal jugular and subclavian veins
 Azygos vein, which drains the walls of the thorax, and empties into the SVC just as the SVC empties into the right atrium
B. Diagram the inferior vena cava (IVC), which begins at the level of L5 and drains the venous blood from the body below the diaphragm, emptying into the right atrium at the level of the T8 vertebra.
Include and label the following:
 Common iliac veins
 Renal veins
 Hepatic veins

Label and briefly define each of the following on the illustration provided. Dorsal root ganglion
 Dorsal horn of gray matter
 Ventral horn of gray matter
 Ventral primary ramus
 Dorsal primary ramus
 Dorsal root
 Ventral root
 Spinal nerve

Illustrate a reflex arc in this empty drawing of a spinal cord segment. Describe the five structures and/or functions necessary to complete the reflex arc that you have illustrated.

On this diagram of the T4 spinal cord segment, insert the preganglionic and postganglionic sympathetic neurons that innervate a sweat gland in the skin of the thorax (mid-axillary line). Label all involved structures. Explain how a cervical spinal nerve can distribute the axons of vasomotor, sudomotor, and pilomotor neurons to the neck or to the upper extremity.
Explain how a sacral spinal nerve can distribute the axons of vasomotor, sudomotor, and pilomotor neurons to the foot.