University of Balamand Faculty of Medicine & Medical Sciences

In Association with St. George University Medical Center

Human Gross Anatomy (HGAN 457) Syllabus Fall 2013-2014

COURSE OBJECTIVES: Anatomy is concerned with the structure and function of the body. In this course, we approach anatomy from gross structural perspective. The students will use this knowledge to recognize normal variations and clinically relevant abnormalities during their medical careers. The major educational objectives of the course are to

learn correct anatomical vocabulary so that the student can communicate effectively with medical colleagues learn the gross morphology of the body, particularly the structural relationships which permit understanding of anatomical variation, clinical radiology and the spread of disease learn and appreciate that the various structures of the human body form an integrated whole, without which proper function is impossible understand anatomy in three-dimensions and use this knowledge to analyze medical images such as CT scans, MR images, ultrasound and 3D images.

This course consists of eight modules most of which are integrated with embryology, histology and physiology of the indicated body systems. Great emphasis is on learning normal structural and functional relationships. To accomplish these goals, students acquire information through lectures, cadaver dissections, organ models, video tapes, anatomical websites, and interactive software. Clinical presentations and problem sets emphasize the clinical relevance of learning anatomical structure and its relation to function.

In addition to learning the structure, function and context of anatomy, the gross anatomy experience provides students an opportunity to acquire and hone many of the professional skills needed throughout their medical careers. In particular, this course will allow you to

strengthen your sense of compassion and respect for the patient (cadaver), especially under difficult circumstances strengthen your commitment to and respect for colleagues strengthen and refine the skills necessary to work effectively with others in solving problems and achieving goals reinforce the value and necessity of arriving to all professional meetings and situations on time and fully prepared

By the end of this course, the student will have learned to function as a cooperative participant of a medical team and have acquired a life-long basic understanding of the dynamic gross structure of the human body based on the factual and conceptual information covered in the course.

Textbooks:
Required texts: (latest edition) Name of Books
1- Essential Clinical Anatomy 2- Grants Atlas of Anatomy 3- Grants Dissector 4- Medical Dictionary

Author
Moore, Agur & Dalley Agur & Dalley Tank Stedmans or Dorlands

Publisher
Lippincott Williams & Wilkins Williams & Wilkins

RECOMMENDED TEXTS: (latest edition) Name of Books

1- Clinically Oriented Anatomy

Author
Moore, Dalley & Agur

Publisher
Lippincott

2- Cunninghams Textbook of Anatomy 3- Clinical Anatomy for Medical Students 4- Color Atlas of Anatomy

Romanes Snell Rohen & Yokochi

Oxford Little, Brown Igaku-Shoin Medical publisher Urban & Schwarzenberg Geigy Corporation Mosby Elsevier Churchil Livingstone

5- Anatomy: A Regional Atlas of the Human body 6- Atlas of Human Anatomy 7- Imaging Atlas of Human Anatomy 8- Grays Anatomy for Students

C.D. Clemente

Netter Ciba Weir & Abrahams Drake, Vogl & Mitchell

FACULTY
Course Director E-mail Cell Phone Anatomy Lab Teaching Team : Jihad HAWI : jihad.hawi@balamand.edu.lb : 03-601558 Jamil Halabi, M.D., General Surgery Youssef Douaihy, M.D., General Surgery Ghassan Nabbut, M.D., General Surgery

Clinical Lecturers
Ghassan Nabbut, M.D., General Surgery Alexander Nehme, M.D., Orthopedic Surgery Chawki Cortbawi, M.D., Orthopedic Surgery Hanna Ghazi, M.D., Otolaryngology Ibrahim Dunia, M.D., Ophthalmology Bassam Abou Khalil, M.D., Cardiothoracic Surgery Jamil Halabi, M.D., General Surgery Ghassan Nabbut, M.D., General Surgery Michel Daher, M.D., General Surgery George Ghazal, M.D., Urology George Kehdy, M.D., Obstetrics and Gynecology Mitri Achram, M.D. Rami Chemali, M.D. Raja Achou, M.D Carmen Adem, M.D.

Clinical Topics
Axilla & Breast Upper Limb & Back Lower Limb Face, Nasal Cavities & Neck Orbit Thorax Abdominal Hernias Liver & Gall Bladder Proctology Male Pelvis & Perineum Female Pelvis & Perineum Radiology Radiology Radiology Radiology

Lecture Reading Assignments

Textbook: Essential Clinical Anatomy Moore, Agur & Dalley (4th Edition)

Topic
Introduction to Clinical Anatomy Breast; Axilla Upper Limb Back Head -Cranium -Face -Scalp -Cranial Meninges -Brain Eye, Orbit, Orbital Region and Eyeball Neck Summary of Cranial Nerves Parotid, Temporal Regions, & Infratemporal Fossa Oral Region Palate, Tongue and Salivary Glands Nose Thorax Abdomen - Anterolateral Abdominal Wall - Inguinal Region - Peritoneum & Abdominal Viscera Kidneys, Ureters & Suprarenal Glands Diaphragm Posterior Abdominal Wall Male/Female Pelves & Perineum Lower Limb

Page #
1-46 53-55, 427-433 405-428, 436-492 274-314

496-502 519-526 502 503-511 512, 517-519 529-549 593-641 643-673 526, 549-554 557 560-570 573-578 47-114

116-126 127-135 135-174 174-183 183-192 199-204 204-271 316-404

Lab Reading Assignments

Textbook: Grants Dissector, 15th Edition Module 1 (30/10/2013 4/12/2013)
Introduction; Pectoral Region; Breast and Axilla 1-4 21-22; 26-30; 30-34; 63-64 21-26 34-39 40-47 46-52 53-55 38-39

Superficial Veins and Cutaneous Nerves Arm ( Anterior Compartment) and Cubital Fossa Flexor Region of Forearm Palm of Hand Extensor Region of Forearm and Dorsum of Hand Arm (Posterior Compartment)

Module 2 (5/12/2013 24/1/2014)

Anterolateral Abdominal Wall Back Vertebral Canal; Spinal Cord and Meninges Skull and Face Scalp Interior of skull Posterior Triangle of Neck Orbit Anterior Triangle of Neck Root of Neck Parotid, Temporal, and Infratemporal Regions Bisection of the Head Pharynx Nose & Nasal Cavity Hard Palate and Soft Palate Oral Region Larynx

89-98 05-14 15-19 219-226 228-229 235-245 205-209 245-252 209-216 216-218 226-232 257 255-259 259-263 263-268 268-271 271-274 63-67 72-82; 82-84

Module 3 (10/3/2014 24/3/2014)

Intercostal Space and Muscles Superior and Middle Mediastinum and Heart

Module 4 (24/3/2014 2/4/2014) Module 5 (2/4/2014 14/4/2014) Module 6 (14/4/2014 28/4/2014) Module 7 (28/4/2014 12/5/2014)

Pleural Cavities and Lungs Posterior Mediastinum Peritoneum and Peritoneal Cavity Abdominal Organs and Arteries Posterior Abdominal Wall and Diaphragm Male External Genitalia and Perineum (Scrotum, Spermatic Cord, Testis) Male Pelvic Cavity in Hemisection Female Pelvic Cavity in Hemisection Male Urogenital Triangle Female Urogenital Triangle

68-72 84-87

99-102 102-116
121-124 125-137

137-140 152-156 132-137 148-152

Module 8 (12/5/2014 30/5/2014)

Anterior and Medial Compartments of Thigh Gluteal Region Posterior Compartment of Thigh and Popliteal Fossa The Leg and Foot as a Functional Unit The Knee Joint

165-176 176-180 181-184

184-198 200-202

GROSS ANATOMY SURVIVAL GUIDE

In medical school, you need to use your time wisely. In this course particularly, where the cadaver is your primary instructor, you need to take time in the laboratory in learning the material. If you do not come to anatomy class prepared, you will find yourself just completing the assigned list of tasks. Here are the keys to success in anatomy:

Complete the PRE-LABORATORY OBJECTIVES before each class. This will provide the background information you need in order to learn from the dissection. Note: The textbook contains many details that you do not need to learn (more in some areas than in others). Some students say they benefit from repetition, especially since a lot of the language is new. Read the dissection instructions before class and become familiar with the new vocabulary, the structures for dissection, and the dissection approach. Consult these images as you read through the exercise. Take full advantage of all scheduled meetings. Pre-labs will give you a heads-up on what to expect in lab. Post-labs are designed to insure that you understand what you saw in dissection, and to provide you with an opportunity to ask any questions related to the anatomy or clinical applications. You will benefit from these discussions even if you are not the one asking the questions. Do not hesitate to ask questions at any time. We want you to understand the material, and we will be happy to answer as many questions as necessary. Nobody was born knowing this material, and despite our best efforts, we do not imagine that the cadaver, the lab manual and the textbook are perfect. Use your scheduled time in lab wisely. During the dissection, you will generally work in pairs on one side of the body. One individual in the group should be a reader - a person who reads the steps in the dissection manual and finds the appropriate atlas pages - while the others are dissecting. It is a good idea to switch roles frequently, both to avoid getting tired and because most people find that, they remember things better if they dissect them. If you are dissecting an area that does not have sides, e.g. the heart, those of you not dissecting should spend the time discussing the objectives with your lab partners, studying other material (bone specimens, articulated skeletons, cross-sections, models and prosections) or reviewing there is always plenty to do. You can then switch with your dissection partners later in the lab.

Do not rush, and do not let your lab partners rush you. .Dissecting the cadaver is a unique opportunity, one that most of you will never have again, so you should take full advantage of it. Take a few minutes at the end of the period to review the dissection. Help each other. You are not competing with your classmates. Your learning experience will be more collegial and much more efficient if you work together. Group learning is very effective in anatomy. You can use the first few minutes of lab to quiz your partners on the previous dissection(s), for example pointing to structures with a probe and asking group members to identify them. This will make a big difference in your practical exam scores, with a minimal amount of time and effort. If something is confusing to you, ask your lab partners. One person in the group may understand a particular concept and can explain it to the others. Most importantly, discussing the material tells you what you know: If you can explain the material to someone else, you own it. If you cannot, you know what you need to study. Most students find a study partner or two that they work with regularly. You should spend at least a few hours each week together reviewing the dissections, quizzing each other on dissections, discussing lecture material, integrating material over the whole unit, discussing clinical cases, etc. Study other cadavers. There is a tremendous amount of variation between cadavers (and patients!) in many of the structures you will dissect. Trading tours of the dissection with other groups regularly will make you much more adapt at identifying structures by their relations, not by their visual appearance in your cadaver. This will benefit everyone, not least on the practical exam. This can also be a good way to take a break from dissection and do a little review if you get tired (see below). N.B. You may not dissect any cadaver other than your own, but you do have access to all of the cadavers for study. You should arrange in advance with other groups to examine their cadavers at a time that will not interfere with their work. Keep up with the material. We expect you to behave professionally and treat the opportunity to dissect a cadaver with the respect it deserves by showing up prepared. You should expect to spend about 1 hour of quality time studying for every scheduled hour of class/lab time. You should spend at least one of those hours before lab, completing the pre-lab objectives and reading the dissector, and as much time as necessary before the following meeting to complete the post-lab objectives. Add in a little time each week for review post-lab objectives are a great place to start. The pace and content being what they are, you will not be able to cram for anatomy. DO NOT get behind, you will not be able to catch up (ask the second years if you doubt this). Have Fun!

THE CADAVER
The following rules of conduct are mainly a matter of common sense, but they are below as a reminder: 1. 2. 3. 4. Approach each dissection as a professional (i.e., be prepared and focused). Work at developing your skills as dissectors. Dissection is NOT mutilation. Take pride in your work and always respect your "silent teacher." The dissection room does not have to be a morbid place to work and study. Instead, the constant thrill of discovery permeates its atmosphere. Animated conversation should be an inevitable consequence. Do not invite guests to the lab. There will be no photographs in the Laboratory. Inappropriate comments or actions made with reference to the cadaver are intolerable. This is grounds for dismissal. Do not take any anatomical material outside of the laboratory. This constitutes a criminal offense. Remember -- this is your lab and you are responsible for its proper operation and maintenance. Lighten up and be happy! You are about to learn more in a shorter period than you ever have before. That is exciting.

5. 6. 7. 8. 9. 10.

When the bodies are prepared by an anatomical embalmer they will last for a millennium with routine maintenance. These solutions will kill every known pathogen including the AIDS virus. NOTE: Formaldehyde and phenol are known carcinogens but the concentration of these two compounds within the total fixative solution is low and well within safety limits. Phenol is also a powerful anesthetic and can cause numbness of the fingers. Latex gloves of surgical quality are therefore available in the Lab.

LABORATORY POLICY
1. Each student should wear a long lab coat while working in the laboratory. Students are responsible for keeping their lab coats clean in accordance with standards of professional conduct. 2. When handling cadaveric material, make sure you wear Latex surgical gloves. 3. Caps or similar headwear is unacceptable attire. This applies to the lecture hall as well as the laboratory. Medical schools prohibit such disrespectful informality. 4. There will be No eating, drinking or smoking in the laboratories. Such activities may be hazardous to your health. 5. The dissecting table and its environs are in a neat and orderly fashion pursuant to professional standards of cleanliness. DO NOT allow paper towels, cadaver remains, and fluids to accumulate on the table or floor. DISCARD small cadaver scraps in the bucket provided to each dissection table. Paper waste goes in the receptacle next to the sinks. DISCARD sharp instruments, such as scalpel blades, in the containers on each sink marked for such instruments. You must NEVER mix these items. Sharp instruments in the waste paper receptacle pose a serious health hazard. 6. DO NOT remove skeletons, models, instruments, etc. from the laboratory! DO NOT disarticulate skeletons! DO NOT disassemble models. Clean the instruments and return it to their proper storage after use. 7. DO NOT remove any body parts, tissues, or prosthetic appliances found in the cadavers from the laboratory. Violation of this rule is punishable by failure of the course. 8. Write down your names on the lab coat. 9. Do not block open the laboratory doors. If you are cold, put on more clothing! The lab is kept as cool as possible to reduce the volatility of the fluids and to retard microbial growth and corrosion.

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ABOUT DISSECTION
1. How to Dissect: Before the first day of actual dissection carefully read pages 1-4 of your dissector. 2. Equipment: Professional dissections require professional instruments. It is only necessary to have two sets of instruments per tank table, one set per side. The instruments are available in the lab. 3. Safety Tips: Ordinarily the gross anatomy lab is a safe environment. However, there are some hazards to avoid: A. Never use a dull scalpel blade. Always put on a new blade when cutting becomes difficult. B. Never remove a scalpel blade from its handle with your fingers; always use forceps. The same advice applies to putting on a new scalpel blade. C. If you can, remove soft, gas-permeable contact lenses before entering lab. The lenses absorb and concentrate the noxious vapors emanating from the cadaver, leading to irritated eyes. D. Some people are very sensitive to the preservative fumes, to the extent that they get headaches, feel faint, or even pass out. This is a very rare event. E. If you cut or puncture yourself with an instrument, seek first aid from an instructor or TA. F. If a small piece of tissue flies into your eye, go over to a sink and flush it out. G. Watch out for jagged edges of bone (e.g., cut ends of ribs). When using a saw, try to cut the bone clean through. Try to trim off jagged edges with a bone cutter so that the risk of a cut or puncture minimizes. H. Pregnant women may wish to speak to their physicians about possible hazards presented by the preservatives. As far as is known, none of the preservatives is mutagens.

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HOW ANATOMY IS STUDIED?

The most frequently asked question in gross anatomy courses is -- "How can I possibly learn all this stuff?" However, the answer is disappointingly simple -- by daily study! The subject matter of anatomy is not particularly difficult, but there is a lot of it and students cannot afford to get behind. It is not possible to cram for anatomy exams. Moreover, contrary to popular belief anatomy cannot be mastered by rote memorization. Anatomy is one of the most logical of sciences and therefore must be "thought through". Facts quickly memorized are as quickly forgotten. Facts understood will stay with you. While there are at least 1,786 different methods of studying (and learning!) anatomy the following 8-step method has been thoroughly tested and time proven to be a very successful approach. Try it - and if you do not like it, see one of your instructors early in the course so we can get you on the right track. Remember -- you cannot afford to get behind. 1. BEFORE each lecture read or at least PREVIEW the suggested text and SYLLABUS/CLASS NOTES pages. 2. Focus on the study questions! Try to answer them before coming to class. They are the crux of the course. We will try to answer as many as time permits during the lecture but even if we miss a few you are still responsible for all of them. That is why God invented books! 3. PREVIEW the next day's topics. Preview, THINK, and Review. Get the idea! 4. The same approach applies equally, if not more so, to the lab. BEFORE each lab read or at least preview the day's dissection in your dissection manual by referring to the designated plates in your atlas. In short, perform the dissection mentally.... 5. . . . before you perform it physically. Follow each day's instructions carefully and professionally. Never leave the lab before you have identified all of the designated structures. Your lab instructors will be delighted to check you out. 6. During each evenings study session, REVIEW the day's dissection (and all preceding ones!) For the lab, your atlas is your very best friend. Get used to living with it. Moreover sleep with it under your pillow (it will also ward off evil demons!).

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Grade Computation
Examinations: Written: Eight exams = 70% Exam 1: 10% Exam 2: 15% Exam 3: 5% Exam 4: 5% Exam 5: 10% Exam 6: 5% Exam 7: 10% Exam 8: 10%

Practical (hands-on): 30% Dissection effort and cleanliness: 5% Performance on Lab quizzes: 25%

Exam attendance is mandatory. If for any reason, the student were not able to attend the exam, he or she must justify the absence to the course director and to the Dean before a make-up exam may be assigned. Make-up exams are graded by Pass or Fail. One make-up exam will be allowed in the course upon validation of the circumstance that prevented the student from attending the scheduled exam.

Attendance: Lectures:

Attendance is MANDATORY to all lectures sessions. Attendance policy is in accordance with the Faculty of Medicine Rules and Regulations.

Labs:
Attendance is MANDATORY to all lab sessions. If you come to the lab unprepared, you will be dismissed If you are dismissed for two lab sessions, you will take an INCOMPLETE grade for that given Part

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