SFA 271 - Advanced Surgical Anatomy

1. Demonstrate understanding of the cardiorespiratory system.
   1. Describe the layers of muscles of the thoracic wall.
   2. Identify the anatomical considerations during an intercostal thoracotomy incision and closure (i.e., location of nervous and vascular structure.
   3. Compare the sternocostal projections of the pleurae and lungs, and explain the clinical significance of the pleural recesses/sinuses not filled by lung.
   4. Describe the anatomical structure of the mediastinum.
   5. Explain where one would expect to find most aspirated foreign bodies and why. 
   6. Compare the size and structure of the right and left lungs, and compare the relationships of vascular, bronchial, and nervous elements at their hila.
   7. Describe the changes that occur in the lining epithelium from the trachea to the lung alveoli.
   8. Explain why the arterial element is clamped first during anatomic lung resections.
   9. List the different types of bronchogenic carcinomas.
   10. Discuss metastasis to the lung.
   11. Describe the anatomical, histological, vascular, and neurological structures of the heart.
   12. Describe the conduction system of the heart.
   13. List the risk factors for coronary artery disease (CAD) and define "unstable" angina.
   14. Describe the changes that occur in the histologic and gross appearance of the heart after MI, and relate these to common complications of MI.
   15. Differentiate the signs and symptoms of right and left congestive heart failure.
   16. Explain the difference between valvular stenosis and valvular insufficiency/regurgitation.
   17. Discuss the embryologic origin, location, and potential complications of congenital cardiac anomalies.
   18. Explain the clinical significance of the esophageal veins during liver disease, such as cirrhosis.
   19. Describe the Azygos vein system.
   20. Describe the location and significance of the thoracic duct.
   21. Describe the location of the openings in the diaphragm and describe the structures and function of those structure passes.
2. Relate the anatomical structures of the abdomen to common surgical procedures.
   1. Describe the gross anatomy, vasculature, embryology, histology, and neurology of the GI system
   2. Relate the two layers of the subcutaneous connective tissue below the umbilicus to the placement of sutures.
   3. Name an incision that may encounter the Pyramidalis muscle.
   4. Explain how the "peritoneal cavity" differs from the "abdominal cavity."
   5. Name the structures that form the median, medial, and lateral umbilical folds and identify the surgical procedure during which they are most apt to be seen.
   6. Discuss the possible results of traumatic injury to the pancreas.
   7. Discuss the histologic and gross characteristics and the common clinical manifestations of cirrhosis.
   8. Discuss the most common cause of malignancy in the liver.
   9. Explain how the pattern of blood supply to the jejunoileum affects vascular occlusions and surgical resections of the small bowel.
   10. Discuss intussusception, Crohn's disease, ulcerative colitis, Irritable Bowel Syndrome, polyps, and diverticulosis.
   11. Differentiate between “external hemorrhoids” and “internal hemorrhoids” and identify which are painful and why.
3. Demonstrate understanding of the anatomical features of the post abdominal wall and kidneys in relation to common surgical procedures.
   1. Describe the gross anatomy of the posterior abdominal wall, including the vasculature.
   2. Differentiate a “true” aneurysm, a “false” aneurysm, and a “dissecting” aneurysm or “dissection.”
   3. Describe the changing relationships between the Inferior Vena Cava and the Aorta in their courses through the abdomen, and how the tributary pattern of the Inferior Vena Cava differs from the arterial pattern of the Aorta.
   4. Discuss the indications for inserting an intracaval filtering device.
   5. Describe the gross anatomy, physiology, histology, neurology, embryology, and vasculature of the kidney and ureter.
   6. Discuss the etiologies of glomerulonephritis and pyelonephritis, and differentiate acute and chronic renal failure.
   7. Define “shock kidney.”
   8. Describe the anatomical structures that must be protected during the usual surgical approach for nephrectomy.
   9. Identify the most common cause of kidney trauma and the most common cause of ureteral injury.
   10. Compare the various methods of “angio-access.”
4. Demonstrate understanding of the anatomical features of the male and female pelvis in relation to surgical procedures.
   1. Describe the relationship between the pelvic inlet and the pelvic outlet.
   2. List the structures that define the diamond-shaped boundaries and the floor of the perineum.
   3. Define the internal and external female pelvis: gross anatomy, histology, neurology, vasculature, all organs, and their functions.
   4. Define the internal and external male pelvis: gross anatomy, histology, neurology, vasculature, all organs, and their functions.
   5. Describe the process of micturition and the autonomic influences.
   6. State the danger inherent in an ascending URI.
   7. Compare the female perineum with that of the male.
   8. Explain the location of referred pain from the ovary and during pregnancy.
   9. Compare cervical and uterine cancers.
5. Demonstrate understanding of anatomical features of the lower extremity in relation to common surgical interventions.
   1. Describe the normal gross osteology, arthrology, neurology, and vasculature of the anterior, medial, lateral, and posterior thigh.
   2. Describe the “cruciate anastomosis” of blood vessels on the lateral side of the greater trochanter.
   3. Identify the structures that compensate for the inherent instability of the knee joint.
   4. Describe the mechanism for “locking” the knee in extension and “unlocking” it for flexion.
   5. Explain why tibial fractures can be problematic.
   6. Define “intermittent claudication” and explain why it occurs.
   7. List the muscles of the anterior/posterior compartment of the leg, their actions, innervation, and blood supply.
   8. Compare the Greater and Lesser Saphenous veins, including origin, drainage, and companion structures.
   9. Discuss the causes, possible complications, and indications for surgical treatment of varicosed veins of the leg.
   10. Explain why the Common Peroneal nerve is easily injured and discuss the possible results of injury.
   11. List the structures contained in the four compartments beneath the flexor retinaculum at the medial malleolus.
   12. Identify the bones and ligaments of the ankle and the foot and their functions; discuss where most ankle sprains occur and why, and explain why surgery may be indicated and what the procedure does.
   13. Compare the long tendons and intrinsic muscles of the foot to those of the hand.
   14. Compare the arterial supply and nerve distribution of the foot to that of the hand.
   15. Define Pott’s fracture, “clubfoot”, Morton’s neuroma, and “flat feet.”
6. Discuss the significance of structural components of the skull and brain in intracranial pathologies.
   1. Name the cranial and facial bones and the main suture lines of the calvarium.
   2. List and explain different types of congenital cranial deformities.
   3. Relate a craniotomy approach and closure to the layers of the scalp and the special character of skull bone.
   4. Describe the brain’s meningeal coverings, dural duplications and cranial venous sinuses.
   5. Explain the relationship of the ventricular system to diagnostic imaging, hydrocephalus and shunting surgery.
   6. Locate the major areas and features of the brain and describe the function(s) associated with each.
   7. List the general principles concerning the organization of cranial nerve nuclei in the brainstem.
   8. Be able to sketch the major vascular structures that comprise the Circle of Willis and explain why the anastomosing system among the four major contributing arteries is important.
   9. Explain how the knowledge of brain functions is used to diagnose and locate brain tumors.
   10. Define types of skull fractures.
   11. Differentiate the character of the bleeding of an epidural vs. a subdural hematoma, and describe how different types of hemorrhages or hematomas are treated.
   12. Relate foramina of the skull to the structure(s) passing through them.
   13. List the functions of cerebrospinal fluid.
   14. Describe the pathway of CSF from its production to its drainage.
   15. Differentiate the causes of “communicating’ vs. ‘non-communicating’ hydrocephalus, and discuss types of shunting procedures and their potential long term complications.
   16. Define the Glasgow Coma Scale and discuss methods for assessing levels of consciousness.
7. Discuss anatomical considerations relevant to surgery of the face, eye, ear, nose, neck and throat.
   1. Name the components of the bony orbit and identify its anatomical relationships.
   2. List the innervation and function(s) of each of the extra ocular eye muscles, and explain how eye movements are used to test the integrity of cranial nerves.
   3. List the functions of each of the cranial nerves around the eye and explain the significance of the ciliary ganglion to eye surgery performed under Local anesthesia.
   4. Describe the circulation pathway of aqueous humor and relate it to the treatment options for glaucoma.
   5. Describe the features of the retina, define retinal detachment, and explain why a retinal detachment that is approaching the macula requires immediate surgery.
   6. Explain how the optic disk can reflect increased intracranial pressure.
   7. Describe what happens to the distribution of optic nerve fibers at the optic chiasma and explain how various lesions along the optic pathway affect vision.
   8. Describe the temporomandibular joint (TMJ) and its actions.
   9. Describe the course, functions, and anatomical relationships of the branches of the Trigeminal (facial) Nerve.
   10. Trace the course of the Facial Artery and explain the significance of the system of anastomoses near the medial canthus/angle of the eye
   11. Describe the veins/arteries of the neck.
   12. List the suprahyoid and infrahyoid muscles, name their innervations, and explain how their functions relate to each other.
   13. List the nerves responsible for general sensation, taste, and motor function in the tongue.
   14. Describe the arterial supply, venous drainage and other anatomic relationships of the thyroid gland.
   15. Identify the major sources of blood supply to the palatine tonsils.
   16. Describe the muscular coats of the pharynx and the functions of the pharyngeal plexus.
   17. List the major cartilages of the larynx and the innervations of the muscles of the larynx.
   18. Explain the clinical significance of the fascial compartments of the neck.
8. Relate structures of the chest wall and superficial back to pathology and surgery of the chest wall, breast and axilla.
   1. Demonstrate the movements of the humerus and the scapula.
   2. List the superficial back muscles and anterior chest wall muscles, and describe their functions.
   3. Describe the gross and histologic architecture of the normal breast, identify where most breast cancers occur, and explain what alterations occur with benign and malignant changes.
   4. List the major structures contained in the axilla.
   5. Draw and label the components of the Brachial Plexus.
9. Relate anatomical considerations to orthopedic pathology and surgery of the upper limb.
   1. Differentiate between a “shoulder separation” and a shoulder dislocation.
   2. List intracapsular structures that might be seen during a shoulder arthroscopy.
   3. List the muscles, nerves, and arteries of the arm and forearm, along with their functions.
   4. Describe common injuries to nervous and vascular structures in the arm and forearm and their resulting limitations (i.e. clinical manifestations).
   5. Describe the fascial features of the wrist and how the forearm tendons are organized.
   6. Describe osteology, arthrology, musculature, vasculature, and neurology of the wrist and hand.
   7. Discuss the relevance of the extensor “hood”, vincula, and fascial features of a digit to hand injuries.
   8. Describe what happens to the hand with rheumatoid arthritis.
10. Discuss pathologies of and surgical approaches to the vertebral column and spinal cord.
    1. Define the characteristics that differentiate cervical, thoracic, and lumbar vertebrae.
    2. Relate the vertebral ligaments to a laminectomy approach.
    3. Describe the contents of the vertebral canal, including the blood vessels.
    4. State where a spinal anesthetic is injected and explain why.
    5. List and describe the various meningeal specializations around the spinal cord.
    6. Describe the arterial supply to the spinal cord.
    7. Describe a ruptured lumbar disc.
    8. Identify aspects of the spinal cord in cross-section and discuss their functions.