Transcript Introduction to Clinical Anatomy

Anatomy
Introduction to
Clinically Oriented Anatomy
Associate Professor
Dr. Alexey Podcheko
Spring 2015
Approaches to Studying Anatomy
Anatomy is the study of the structure of the human body.
 Regional
anatomy considers the body as organized into
segments or parts;
 systemic anatomy sees the body as organized into organ
systems.
 Surface anatomy provides information about structures that
may be observed or palpated beneath the skin,
 radiographic anatomy allows appreciation of structures in the
living, as they are affected by muscle tone, body fluids and
pressures, and gravity.
 Clinical
anatomy emphasizes application
knowledge to the practice of medicine.
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of
anatomical
ADMINISTRATION
Course Director:
Dr. Alexey Podcheko MD, Ph.D,
Associate Professor
Email: [email protected]
Course Instructor:
Dr. Ermanul Huq Ph.D;
Assistant Professor
Email: [email protected]
My background
 1989-1995 – MD (General Practitioner) from Smolensk
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State School of Medicine, Russia
1995-1998 – Residency at Departments of Pathology and
Clinical Endocrinology of Smolensk State Medical School
1998-2000- Assistant Professor at Department of Clinical
Endocrinology
2000-2005 - Ph.D. in Molecular Biology at Nagasaki
University, School of Medicine, (Japan)
2005-2010 – Postdoctoral Research Associate at
Department of Laboratory Medicine and Pathobiology,
University of Toronto, School of Medicine
2010- Associate Professor at Department of Basic
Sciences SJSM
Research Projects:
Ionizing Radiation and Thyroid
Cancer
-To clarify the mechanisms of radiationinduced thyroid carcinogenesis
-To develop novel diagnostic techniques
and gene/molecular-targeted therapy for
thyroid cancer
-To analyze genomic instability in multistep process of radiation carcinogenesis
-To analyze radiation-induced cellular and
molecular response
-To identify the molecular mechanisms of
cellular senescence and stress response
-To clarify the mechanisms of UV or
ionizing radiation-induced DNA damage
repair
May the tree thrive.
My research in Diabetes area
•Role of immunomodulators
(thymic extracts) on protection
against experimental Type I
Diabetes
•Identification of novel genes
involved in beta-cell growth and
survival
•Cloning and characterization of
novel positive regulator of betacell growth - Plekstrin Homology
Interacting Protein 1 (PHIP1)
My research/publications:
TEXTBOOKS You will need for the
course:
 Clinically Oriented Anatomy
by Keith L. Moore et al.,
Lippincott Williams & Wilkins,
2010
 BRS Gross Anatomy, 6 or 7th
edition by Kyung W. Chung.
Published by Lippincott
Williams & Wilkins,
 Atlas of Human Anatomy, 4th
edition by Frank H. Netter.
Published by Saunders, 2006
or an equivalent atlas will be
acceptable
Other resources:
 Acland’s Video Atlas of Human Anatomy
http://aclandanatomy.com/index.aspx
 Anatomyzone
http://anatomyzone.com/
 Anatomy Mnemonics
http://www.medicalmnemonics.com/cgibin/browse.cfm
https://itunes.apple.com/us/app/anatomymnemonicsmusculoskeletal/id863837276?mt=8
Dissection Lab manual needed for the
course:
 Gray's Dissection Guide
for Human Anatomy:
With STUDENT
CONSULT Online Access,
2e
Or
 Grant's Dissector (Tank,
Grant's Dissector)
ON LINE RESOURCES
 http://www.visiblebody.com/
 http://www.med.umich.edu/lrc/coursepages/
m1/anatomy2010/html/index.html
 http://www.wesnorman.com (Georgetown
University’s anatomist, Wes Norman, has his
own site with images, information and
quizzes)
 AnatomyOne http://www.anatomyone.com/
 http://medicalppt.blogspot.com/search/label
/ANATOMY
Question Banks
 BRS Gross Anatomy, 7th edition
by Kyung W. Chung. Published
by Lippincott Williams & Wilkins
 Appleton & Lange Review of
Anatomy, Sixth Edition, Royce
Lee Montgomery, PhD
 USMLE Easy (sjsm.org/library)
Other important qBanks:
 USMLE WORLD
 USMLE-RX
ATTENDANCE POLICY
 Students must attend at least 80% of
lectures.
Attendance will be monitored through Moodle or by a
roll call
 Any student falling short of 80% attendance please
refer to the Attendance policy of SJSM Anguilla
campus
Organization of Course
 ~12 weeks
 ~ 60 Lectures (5 times/week)
 Laboratory Classes 2 times per week starting from next week
Major Topics:
-Introduction to the Anatomy course
-Back
-Thorax
-Upper Limb
-Abdomen
-Pelvis
-Lower Limb
-Head and Neck
Student must
read/review
appropriate
textbook chapter
before the lecture
EVALUATIONS
 The course is divided on 4 blocks
 Every block (app. 3 weeks of classes) you will be evaluated in the
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2.
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following ways:
Attendance for lectures and lab classes : if you missed >20% of
lectures or labs for first time without providing approved Leave
of Absence/doctor/legal note, 20 points will deducted from your
final block score (second time you did it – will get 0 for the
block).
1 written 25 MCQs quiz per block (dates of quizzes are in the
syllabus) will provide up to 10 bonus points to final block score
1 written 50 MCQs block exam – will provide 80% of your block
score
1 practical exam (identification of specific structures on
cadavers, bones, X-Ray films, etc) – will provide 20% of your final
score
Final course score and grade will be calculated based on the
following formula:
Final course score=(B1+B2+B3+B4)/4; B1-4=Block 1-4 scores
EVALUATIONS
 Example of score calculation for student A:
 Student A attended 100% of all classes
 Student A answered 60% of Quiz questions correctly –
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received 6 points
Student A on the Written exam answered 70% of
questions correctly – received 70*0.8=56 points
Student A on the Practical exam answered 80% of
questions correctly – received 0.2*80=16 points
Final score of the student for Block 1 is : 6+56+16=78
(C)
All grades will be posted on Moodle within 1 week after
quiz/exam
EVALUATIONS
 Curving: Curving will be done only for 50 questions
MCQ exam in case if average of the group is below
70. The aim of the curving is to bring average score
of the group to the range of 70 by using the following
formula:
 Curved Score=100-A(100-You Raw Score);
A could be between 0-1.
Laboratory Classes
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SJSM ANATOMY Lab Policies posted on the
Moodle
No photos/video in the lab due to ethical issues
Cadavers should be appropriately draped at all
times.
Shorts, short skirts, sandals, and open-toe and
heel shoes are not allowed: this lab employs
chemical and biological agents
Wear lab coats and scrubs. After the end of each
session, leave them in the lab or take home in a
plastic bag for laundry.
Students not in compliance with the lab dress code
or other safety regulations will not enter the lab
Laboratory Classes
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You are only allowed to dissect the cadaver you have
been assigned to.
The cadavers MUST be kept moist. Every time you
open a cadaver bag, spray it generously with the
wetting fluid before closing the bag.
INTENDED LEARNING OUTCOMES
FOR ANATOMY COURSE
 Knowledge and understanding of the principles of
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Evidence Based Medicine.
Knowledge and understanding of normal structure
and function of the body and each of its major organ
systems.
The ability to perform routine technical dissection
procedures specic to the medical speciality. Perform
practical exercises that entail accurate observation
of biomedical phenomenon and critical analyses of
data.
The ability to apply Evidence Based Medicine
principles to clinical decision making
The ability to seek help, when needed, to deal with
academic, personal, or interpersonal problems.
Clinical vignettes and Anatomy
Why do we need them?
 A 47-year-old man is brought to the
emergency department after being
involved in a motor vehicle accident. He
was a restrained driver and rear-ended
a slowly moving car on a highway. He
complains of chest pain, abdominal pain,
and shortness of breath. His other
medical problems include hypertension,
asthma, and type 2 diabetes mellitus.
His initial blood pressure is 90/54 mm
Hg and pulse is 121/min. He becomes
unresponsive and loses his pulse 30
minutes after arriving at the hospital.
His EKG monitoring demonstrates sinus
tachycardia. The patent dies despite
resuscitation efforts. Which of the
following identifiers from the figure
indicates the site most likely to have an
aortic injury on autopsy?
 A. A B. B C. C D. D
Explanation
 This patient presents after trauma with signs/symptoms
consistent with likely aortic rupture, which is most commonly
caused by motor vehicle accidents.
 A motor vehicle accident with sudden deceleration can cause
different rates of deceleration between the heart (in a
fixed position) and the aorta .
 The most common site of injury is the aortic isthmus (site
C on the figure), which is the connection between the
ascending and descending aorta distal to where the left
subclavian artery branches off the aorta
 Patients typically present with chest pain, back pain, or
shortness of breath. However, there can be significant
rupture, causing instant death after the trauma Patients
who survive the initial rupture may have a widened
mediastinum on chest x-ray.
Approaches to Studying Anatomy
1. Regional Anatomy
 Regional anatomy
(topographical anatomy)
considers the
Thorax
organization of the
human body as segments
or major parts based on Abdomen
form and mass
Upper Limb
 a main body, consisting of
 the head, neck,
Pelvis/Perineum
 trunk (subdivided into
thorax, abdomen, back, Lower Limb
and pelvis/perineum),
 paired upper limbs and
lower limbs.
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Head
Neck
Back
Approaches to Studying Anatomy
2. Systemic Anatomy
 Systemic anatomy recognizes the organization of the body's
organs into systems or collective apparatuses that work
together to carry out complex functions
 The
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integumentary system (dermatology) consists of the skin (L.
integumentum, a covering) and its appendages hair, nails, and sweat glands
The skeletal system (osteology) consists of bones and cartilage
The articular system (arthrology) consists of joints and their associated
ligaments
The muscular system (myology)
The nervous system (neurology) consists of the central nervous system
(brain and spinal cord) and the peripheral nervous system
The circulatory system (angiology) consists of the cardiovascular and
lymphatic systems
The digestive or alimentary system (gastroenterology)
The respiratory system (pulmonology)
The urinary system (urology) consists of the kidneys, ureters, urinary
bladder, and urethra
The reproductive or genital system (gynecology for females; andrology for
males) consists of the gonads (ovaries and testes)
The endocrine system (endocrinology)
Approaches to Studying Anatomy
3. Clinical Anatomy
 Clinical
(applied) anatomy emphasizes aspects of bodily
structure and function important in the practice of medicine,
dentistry, and the allied health sciences.
 It incorporates the regional and systemic approaches to
studying anatomy and stresses clinical application.
 Clinical anatomy often involves inverting or reversing the
thought process typically followed when studying regional or
systemic anatomy. For example,
 The action of this muscle is …?
 clinical anatomy asks, How would the absence of this muscle's activity
be manifest?
 The nerve provides innervation to this area of skin,
 clinical anatomy asks, Numbness in this area indicates a lesion of
which nerve?
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Anatomical Position
 The anatomical position refers to the
body position as if the person were
standing upright, regardless of the
actual posture or position, with the:
1.
2.
3.
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Head, gaze (eyes), and toes
anteriorly (forward).
Arms adjacent to the sides
palms facing anteriorly.
Lower limbs close together
feet parallel and the toes
anteriorly.
directed
with the
with the
directed
Anatomical Planes
Anatomical descriptions are based on four imaginary planes (median, sagittal,
frontal, and transverse) that intersect the body in the anatomical position
1.
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The median plane, the vertical plane
passing longitudinally through the
body, divides the body into right and
left halves. The plane intersects the
midlines of the anterior and
posterior surfaces of the body
Anatomical Planes
2. Sagittal planes are vertical planes passing
through the body parallel to the median plane.
 It is helpful to give a point of reference by
naming a structure intersected by the plane
you are referring to, such as a sagittal plane
through the midpoint of the clavicle.
 The term midsagittal plane is a superfluous
term for the median plane
 Parasagittal,
commonly
used
by
neuroanatomists and neurologists, is also
unnecessary because any plane parallel and to
either side of the median plane is sagittal by
definition.
 However, a plane parallel and near to the
median plane may be referred to as a
paramedian plane.
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Anatomical Planes
3. Frontal (coronal) planes are vertical
planes passing through the body at
right angles to the median plane,
dividing the body into anterior (front)
and posterior (back) parts.
 Again,
a point of reference is
necessary to indicate the position of
the plane (e.g., a frontal plane
through the heads of the mandible).
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Anatomical Planes
4. Transverse planes are planes
passing through the body at right
angles to the median and frontal
planes, dividing the body into
superior (upper) and inferior
(lower) parts.
 It is helpful to give a reference
point to identify the level of the
plane, such as a transverse plane
through the umbilicus or through a
specific vertebra.
 Radiologists refer to transverse
planes as transaxial,
commonly shortened
planes.
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which is
to axial
Anatomical Planes
The number of sagittal, frontal, and transverse planes is unlimited.
The main use of anatomical planes is to describe sections.
Sections provide views of the body as if cut or sectioned along particular
planes.
 Longitudinal sections run lengthwise
or parallel to the long axis of the
body or of any of its parts, and the
term applies regardless of the
position of the body.
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Anatomical Planes
 Transverse sections, or cross sections,
are slices of the body or its parts that
are cut at right angles to the longitudinal
axis of the body or of any of its parts;
Q: Transverse Section of the foot lies in
Frontal
____________
Plane.
Note: the long axis of the foot runs
horizontally, a transverse section of the
foot lies in the frontal plane .
 Oblique sections are slices of the
body or any of its parts that are not
cut along one of the previously
mentioned anatomical planes.
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Terms of Relationship and Comparison
 Superficial,
intermediate,
and
deep
describe the position of structures relative
to the surface of the body or the
relationship of one structure to another
underlying or overlying structure.
 Superficial: Toward the surface
Example: The muscles of the arm are
superficial to its bone (Humerus)
 Intermediate: Between
Deep structure
a Superficial and
 Example:
The biceps muscle is
intermediate between the skin and the
humerous
 Deep: Away from the surface of the body
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
Example: The humerus is deep to the arm muscles
Terms of Relationship and Comparison
 Superior refers to a structure that
is nearer the vertex, the topmost
point of the cranium. Cranial relates
to the cranium (skull) and is a useful
directional term, meaning toward
the head.
 Example: The Heart is Superior to
the stomach
 Inferior refers to a structure that is
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situated nearer the sole of the foot.
Caudal (L. cauda, tail) is a useful
directional term that means toward the
tail region, represented in humans by the
coccyx, the small bone at the inferior
(caudal) end of the vertebral column.
The term caudal is used in embryology
 The stomach is inferior to the heart
Terms of Relationship and Comparison
Posterior
(dorsal)
denotes the back
surface of the body
or nearer to the
back.
Example:
The
heal is posterior
to the toes
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Anterior
(ventral) denotes
the front surface
of
the
body.
Rostral is often
used instead of
anterior
when
describing parts
of the brain; it
means toward the
rostrum (beak)
Example: The
toes
are
anterior
to
the ankle
Terms of Relationship and Comparison
Proximal and distal are used when
contrasting positions nearer to or
farther from the attachment of a limb
or the central aspect of a linear
structure, respectively.
Proximal : Nearer to trunk or point of
origin
Example: The elbow is proximal to
the wrist
Distal: Farther from trunk or point of
origin
Example: The Wrist is distal to the
elbow
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Terms of Relationship and Comparison
 Medial is used to indicate that (in
the
anatomical
position)
a
structure, such as the 5th digit of
the hand (little finger), is nearer to
the median plane of the body than
the other digits.
 lateral stipulates that a structure,
such as the 1st digit of the hand
(thumb), is farther away from the
median plane.
 *NOTE: Lateral and medial are not
synonymous
with
the
terms
external (outer) and internal
(inner). External and internal mean
farther from and nearer to the
center of an organ or cavity,
respectively,
regardless
of
direction.
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Median
Plane
Terms of Movement
Flexion indicates bending or decreasing the angle between the bones or parts of
the body. ( Blue Arrows)
For most joints (e.g., elbow), flexion generally involves movement in an
anterior direction;
however, flexion at the knee joint involves posterior movement.
 Dorsiflexion describes flexion at the ankle
joint, as occurs when walking uphill or lifting
the toes off the ground.
 Plantarflexion turns the foot or toes toward
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the plantar surface (e.g., when standing on your
toes).
Terms of Movement
Extension indicates straightening or increasing the angle between the bones or
parts of the body. (green Arrows)
• Extension usually occurs in a posterior direction (saggital plain)
•but extension of the knee joint occurs in an anterior direction.
 Extension of a limb or part beyond the normal
limit hyperextension (overextension) can cause
injury, such as whiplash (i.e., hyperextension of
the neck during a rear-end automobile collision).
 !!! For the thumb, from the anatomical position,
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flexion and extension are movements in the
frontal plane
Terms of Movement
Abduction : moving away from the median plane in
the frontal plane (e.g., when moving an upper limb
away from the side of the body).
 In abduction of the digits (fingers or toes), the
term means spreading them apart moving the
other fingers away from the neutrally positioned
3rd (middle) finger or moving the other toes
away from the neutrally positioned 2nd toe.
 The 3rd finger and 2nd toe medially or laterally
abduct away from the neutral position.
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Right and left lateral flexion (lateral bending)
are special forms of abduction for only the neck
and trunk.
Terms of Movement
 Adduction means moving toward the
median plane in a frontal plane (e.g.,
when moving an upper limb toward the
side of the body).
 In adduction of the digits, the term
means reapproximating the spread
fingers or toes or moving the other
digits toward the neutral position of
the 3rd finger or 2nd toe
 The medially or laterally abducted
3rd finger or 2nd toe adducts back to
the neutral position
 Note:* The thumb is rotated 90°
relative to other structure. Thumb
flexes and extends in the frontal
plane, and abducts and adducts in
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Terms of Movement
 Circumduction is a circular movement that
is a combination of flexion, extension,
abduction, and adduction occurring in such
a way that the distal end of the part
moves in a circle. Circumduction can occur
at any joint at which all the abovementioned movements are possible (e.g.,
the hip joint).
 Rotation involves turning or revolving a part
of the body around its longitudinal axis, such
as turning one's head to face sideways.

Medial rotation (internal rotation) brings the anterior
surface of a limb closer to the median plane,
 Lateral rotation (external rotation) takes the
anterior surface away from the median plane.
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Terms of Movement
 Pronation is the rotational movement of
the forearm and hand that swings the
radius (the lateral long bone of the
forearm) medially around its longitudinal
axis so that the palm of the hand faces
posteriorly and its dorsum faces
anteriorly.
 When the elbow joint is flexed, pronation
moves the hand so that the palm faces
inferiorly (e.g., placing the palms flat on a
table).
When applied to the foot, pronation
refers to a movement that results in
lowering of the medial margin of the
foot. (The feet of an individual with
flat feet are pronated.)
Terms of Movement
 Supination is the rotational movement
of the forearm and hand that swings
the radius laterally around its
longitudinal axis so that the dorsum of
the hand faces posteriorly and the
palm faces anteriorly (i.e., moving them
into the anatomical position).
 When the elbow joint is flexed,
supination moves the hand so that the
palm faces superiorly.
 When
applied to the foot, supination
generally implies movements resulting in
raising the medial margin of the foot.
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Mnemonics:
 "SOUPination": Supination is to turn your arm
palm up, as if you are holding a bowl of soup.
"POUR-nation": Pronation is to turn your arm
with the palm down, as if you are pouring out
whatever is your bowl.
 Think: "Supinate to the Sun and Pronate to
the Plants"
 Supination: palm towards the Sun
 Pronation: palm towards the Plants
Terms of Movement
 Inversion moves the sole of the foot
toward the median plane (facing the sole
medially, aka supination). When the foot
is fully inverted it is also plantarflexed.
 Eversion moves the sole of the foot away
from the median plane (turning the sole
laterally, aka pronation). When the foot is
fully everted it is also dorsiflexed
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Eversion
Terms of Movement
 Opposition is the movement by which the pad of the 1st
digit (thumb) is brought to another digit pad. This
movement is used to pinch, button a shirt, and lift a
teacup by the handle. Reposition describes the
movement of the 1st digit from the position of
opposition back to its anatomical position.
 Protrusion is a movement anteriorly (forward) as in
protruding the mandible (chin), lips, or tongue. Retrusion
is a movement posteriorly (backward), as in retruding
the mandible, lips, or tongue.
The similar terms protraction and
retraction are used most commonly for
anterior and posterior movements of the
shoulder.
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Terms of Movement
 Elevation
raises or moves a part
superiorly, as in elevating the shoulders
when shrugging, the upper lid when
opening the eye, or the tongue when
pushing it up against the palate.
 Depression
lowers or moves a part
inferiorly, as in depressing the
shoulders when standing at ease, the
upper lid when closing the eye, or pulling
the tongue away from the palate.
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Structure of Terms
Anatomy is a descriptive science and necessarily
requires names for the many structures and
processes of the body.
 The terminology fully adheres to Terminologia Anatomica (1998),
approved by the International Federation of Associations of
Anatomists (IFAA)
Anatomical terms provide information about a
 structure's shape,
 size,
 location,
 or function
 or about the resemblance of one structure to
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another.
Structure of Terms
 EXAMPLES:
 the deltoid muscle, like the symbol for delta, the fourth

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
letter of the Greek alphabet. The suffix -oid means like
therefore, deltoid means like delta.
Biceps means two-headed and triceps means threeheaded.
Some muscles are named according to their shape the
piriformis muscle, for example, is pear shaped (L. pirum,
pear + L. forma, shape or form).
Other muscles are named according to their location. The
temporal muscle is in the temporal region (temple) of the
cranium (skull).
In some cases, actions are used to describe muscles for
example, the levator scapulae elevates the scapula (L.
shoulder blade).
Eponyms
 An eponym is a person (real or fictitious)
from whom something is said to take its
name
 Very common in medicine and Anatomy, pay
attention as you will see them on board
exams
Examples:
Sternal angle – angle of Louis
Major pancreatic duct -duct of Wirsung
Thank You
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