Arteries of the UE (anatomical arm and forearm only)

Axillary Artery

The axillary artery extends from the outer border of the first rib to the inferior border of the teres major muscle, where it then becomes the brachial artery. The axillary artery is bordered on its medial side by the axillary vein.

One more time.

The axillary artery extends from the first rib to the inferior border of the teres major muscle, where it then becomes the brachial artery. The axillary artery is bordered on its medial side by the axillary vein.

Brachial Artery

The brachial artery extends from the inferior border of the teres major muscle to its bifurcation in the center of the cubital fossa. It then provides muscular branches and terminates by dividing into the radial artery and the ulnar artery at the level of the  neck of the radius, slightly below the elbow, in the fossa. It is accompanied by the basilic vein in the middle of the arm.

The brachial artery extends from the inferior border of the teres major muscle to its bifurcation in the center of the cubital fossa. It then sends muscular branches and terminates when it splits into the radial artery and the ulnar artery at the level of the neck of the radius, slightly below the elbow, in the fossa. It is accompanied by the basilic vein in the middle of the arm.

Profunda Brachii (Deep Brachial) Artery (Comes from the Brachial Artery)

The profunda brachii (Deep brachial) artery descends posteriorly with the radial nerve.

The profunda brachii (deep brachial) artery divides into the middle collateral artery and the radial collateral artery. The middle collateral artery anastomoses with the common interosseous artery. The radial collateral artery follows the radial nerve through the lateral intermuscular septum and ends in front of the lateral epicondyle (of the humerus) by anastomosing with the radial recurrent artery of the radial artery.

Let’s try it again.

The profunda brachii (deep brachial artery) descends posteriorly with the radial nerve.

The profunda brachii (Deep brachial artery) divides into the middle collateral artery and the radial collateral artery. The middle collateral artery anastomoses with the common interosseous artery. The radial collateral artery follows the radial nerve through the intermuscular septum and ends in front of the lateral epicondyle (of the humerus) by anastomosing with the radial recurrent artery of the radial artery.

Superior Ulnar Collateral Artery (Comes off of the Brachial Artery)

The superior Ulnar Collateral Artery pierces the medial intermuscular septum and follows the ulnar nerves behind the septum and medial epicondyle (of the humerus), where it then anastomoses with the posterior ulnar recurrent artery of the ulnar artery.

One more time.

The Superior Ulnar Collateral Artery pierces the medial intermuscular septum and follows the ulnar nerve behind the septum and the medial epicondyle (of the humerus), where it then anastomoses with the posterior ulnar recurrent artery of the ulnar artery.

 

Inferior Ulnar Collateral Artery (Comes from the Brachial Artery)

The Inferior Ulnar Collateral Artery arises from the brachial artery just above the elbow and descends in front of the medial epicondyle of the humerus, where it anastomoses with the anterior ulnar recurrent artery of the ulnar artery.

Again.

The Inferior Ulnar Collateral Artery arises from the brachial artery just above the elbow and descends in front of the medial epicondyle of the humerus, where it then anastomoses with the anterior ulnar recurrent artery of the ulnar artery.

Radial Artery

The radial artery arises as the smaller lateral branch of the brachial artery in the cubital fossa and descends laterally under the cover of the brachioradialis muscle, with the superficial radial nerve on its lateral side, on the supinator muscle and the flexor pollicis longus muscle.

Try it again.

The radial artery arises as the smaller lateral branch of the brachial artery in the cubital fossa, descends laterally under the cover of the brachioradialis muscle, with the superficial radial nerve on its lateral side, on the supinator muscle and the flexor pollicis longus muscle.

Wow, that’s wordy. No new picture here because the radial artery was introduced in the first picture.

Radial Recurrent Artery (comes off of the radial artery)

The radial recurrent artery arises from the radial artery just below its origin and ascends on the supinator and then between the brachioradialis and the brachialis muscle. The radial recurrent artery then anastomoses with the radial collateral branch of the profunda brachii (deep brachial) artery.

Wasn’t paying attention. Try again.

The Radial Recurrent Artery arises from the radial artery just below its origin and ascends on the supinator and then between the brachioradilis and the brachialis muscle. The radial recurrent artery than anastomoses with the radial collateral branch of the profunda brachii (deep brachial) artery.

No additional drawing needed here because it was demonstrated in the second figure.

Ulnar Artery

The ulnar artery is the larger medial branch of the brachial artery in the cubital fossa. It descends behind the ulnar head of the teres muscle and lies between the flexor digitorum superficialis and the profundus muscles. The ulnar artery gives rise to three other branches: the anterior ulnar recurrent artery, the posterior ulnar recurrent artery, and the common interosseous artery.

Getting close. Try again.

The ulnar artery is the larger medial branch of the brachial artery in the cubital fossa. It descends behind the ulnar head of the posterior teres muscle and lies between the flexor digitorum superficialis and profundus muscles. The ulnar artery gives rise to three branches: the anterior ulnar recurrent artery, the posterior ulnar recurrent artery, and the common interosseous artery.

Again, these structures have already been demonstrated in previous figures.

Anterior Ulnar Recurrent Artery (branches off the Ulnar Artery)

The anterior ulnar recurrent artery anastomoses with the inferior ulnar collateral artery.

Previous figure demonstrates this.

Posterior Ulnar Recurrent Artery (branches off the Ulnar Artery)

The posterior ulnar recurrent artery anastomoses with the superior ulnar collateral artery.

This has been demonstrated already.

Common Interosseous Artery (branches off the Ulnar Artery)

The common interosseous artery arises form the lateral side of the ulnar artery and divides into two branches: the anterior interosseous artery and the posterior interosseous artery.

Anterior Interosseous Artery

The anterior interosseous artery is a branch of the common interosseous artery and descends with the anterior interosseous nerve in front of the interosseous membrane, where it is located between the flexor digitorum profundus and the flexor pollicis longus muscles. The anterior interosseous artery then perforates the interosseous membrane and anastomoses with the posterior interosseous artery to join the dorsal venous network.

That was long and wordy. Try again.

The anterior interosseous artery is a branch of the common interosseous artery and descends with the anterior interosseous nerve in front of the interosseous membrane, where it is located between the flexor digitorum profundus and the flexor pollicis longus muscles. The anterior interosseous artery then perforates the interosseous membrane and anastomoses with the posterior interosseous artery to join in the dorsal venous network.

See the figure above.

Posterior Interosseous Artery

The posterior interosseous artery descends behind the interosseous membrane in company with the posterior interosseous nerve where it then anastomoses with the anterior interosseous artery.

So there you have it. Ther arteries of the upper extremity (anatomical arm and forearm only).

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Thoughts on Happiness

I’ve just completed the fourth day of medical school courses (first year) and it has been a rush. I had planned on studying by talking about what I was learning (among other methods of course) but that won’t be happening. Seriously, the sheer volume of information we have to master is unbelievable!

I’m thrilled. I am so, so, so thankful that I have been given the opportunity to be what I want to be, to do what I want to do. It really is all about attitude, especially from the first waking moment. Every morning I smile because I know that I am one of the fortunate few who have to wake up super early just to go to class. It’s med school class!!

Having a small laptop is a blessing also. I wouldn’t be able to capture the information the professors present to us if I were writing it down by hand. Luckily for me, I type like a fiend so I can type almost as fast as they talk 🙂

About the quote in the last post:

I put that up as a reminder to not let myself be sucked in by all the negative and tense energy being given off by other students around me. Since Monday, I’ve heard things like the following more times than I can count on both my hands and feet:

“I’m so tired!”

“Ugh, I hate studying!”

“Seriously, I have to go into anatomy lab again?!?”

“Lecture is so boring.”

…. and on and on and on.

I ask myself, Why do they have to take on that attitude? Why? To the people thinking about going into the medical profession (or any job for that matter). Know what you are getting into. Talk to people! Spend time in the area as a volunteer if you can. Understand that challenges arise with almost every situation there is to think of and then accept those facts! You will be SO much happier. Really.

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Happiness

“Happiness is different from pleasure. Happiness has something to do with struggling and enduring and accomplishing.”

So true.

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Back in the saddle after a 3-yr hiatus

You know what? I give myself credit! I’ll tell you why in a minute.

This last week I got back on the bicycle (after being off it since 2006). I have a guaranteed 5-mile/day ride since I bike to and from school. This means that I will get at least 25 miles a week in.

I’ve also had the luck of finding another classmate who also has an interest in recreational cycling. We decided to go for a ride today and ended up taking (and finishing!) a 15-mile route. It took us about an hour and we went at an average speed of ~ 13-15mph. So why do I give myself credit? Because my classmate is a seasoned athlete, holds a black belt in martial arts, and I was still never further than a minute behind. AND I finished the ride. THAT’S why I give myself credit.

The goal now is (a) to do a long ride at least once a week and (b) to find additional classmates who share this interest.

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Here’s a good quote I believe in…

Never regret. If it’s good, it’s wonderful. If it’s bad, it’s experience.

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Mildred

We decided to name her. We decided to name her because in the next year, she would become so personal to us. She is our first official patient. It is she that will teach us a great majority of information. We are greatful for the gift which she has given us, which is to explore her body and to learn from her. So, we decided to name her Mildred.

(Consequently, Mildred means, “gentle counselor.”)

Mildred was an elderly woman in her late 80’s or early 90’s when she passed away. Our card said that she passed due to “pneumonia, renal failure, and stroke.”

I will say that the squeamish stop reading now.

If you are still reading, you are not squeamish.

Our first anatomical experience was to skin the upper portion of her body. And it was a marvelous sight to behold. It was beautiful. It was a gift and a true honor.

I really am here…

Well anyhow, this day has been incredibly sobering for me. It has mentally exhausted me, but I really wanted to write about this day before it faded. I leave you with two images of my first time in med-school scrubs and about to head into the anatomy lab.

Good night.

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Last day of medical school orientation

Best summation? This day ended with much to think about and a long drive to sort (most of) it all out.  

The day began with the Dean of our medical school speaking to us about professionalism, or about learning how to be a physician. I jotted down a lot of what he said, and following are some of the comments which made an impression on me for one reason or another:

• You want to matter. You can make a difference if you choose to approach situations in a positive manner.
• As of today, the focus is on your future patients. You are making the transformatoin from students to professionals, which is a long journey taken in many little steps. Do what is best for the patient, not what is best for you. This is not easy – it takes time.
• There are a hundred and twenty-five of you here. Each and every one of you deserves to be here. You are the 1% of the population of the world that has made it to the top of the “intellect pyramid.”  This means that in a worst case scenario, one of you will be the one with the lowest or even failing score. This does not mean that you are bad or dumb. This simply means that you must refocus and that you have not yet mastered material well enough to move on. (I cannot stress this enough).
• This profession is unique in that in three years, the material that you’ll have learned this first year will be obsolete. Science and medicine changes by the second. You must commit to being a lifelong learner.

He also continue by asking if any of us had had a negative experience with a physician before. About two-thirds of the class raised their hands.

Don’t be the south end of a northbound horse!

My thoughts exactly. “You must,” he stated, “make a decision as to what kind of doctor you will be. But the secret in this is that you must make this decision multiple times a day, not just during an epiphany.” Great point.

One thing that he focused on helped to further reinforce (to myself) that I truly do deserve to be here. “The MCAT is commonly thought of as an indicator for how well you’ll do in medical school.” I held my breath as he drew a chart with a curve that increased positively and then leveled out midway. “A high score (such as 15) in the Verbal Reasoning subject (which is incidentally the most important) will not predict that you’ll be a better doctor than a person who scored a lower score (such as 8). Why? It levels out. ADCOMs (admissions committees) spend much time going through your portfolios and making sure that you deserve to be here. YOU ARE HERE FOR A REASON.”

Yes. That knowledge was much appreciated.

Also, for those who are thinking about the medical profession because of job security and the supposed promise of big-time-money – don’t even touch it with a 10-ft pole. If you are in this for the money, GET OUT. You will find a better job with better hours, pay, and happiness. To be a doctor, you must so fierecely believe in what you’re doing that you will always be willing to spend the time needed with your patients and their families. Do physicians live comfortably? Yes. Are they well off? Absolutely not.

Believe it or not, there was a even a brief discussion about what our personal lives would be like and how they would benefit and suffer.

“For those that happened to already be married or get married early on/during medical school, the roles may be such that the non-med school spouse is the supporting player in terms of bringing home the bacon and taking care of the home. But when the med-school spouse is set loose on the world, the roles tend to reverse. The med-school spouse is prepared for the role, but it is usually the case that the non-med spouse is not. This is why there is such a high level of divorce rate among physicians. Be sure to be with someone who truly understands all aspects of your career choice and be sure that both of you are comfortable with the roles that are chosen. Moreover, be with someone who truly understands your passion and who can maybe even match your passion. Take the time to explore yourself completely.”

That’s a lot to think about. A lot.

Following that talk, we had a panel of local community physicians come in and hold a Q&A for us. One of them said this,

This is the best time and place to learn your basic science material. Don’t do this alone.

More and more I am realizing just how important teamwork and cooperation will be playing a role in my life for forever. We really need each other in order to provide the best possible healthcare. Wow.

He also said,

The fact that patients come to see you is a gift. The minute you start seeing this as work, it steals your joy. Don’t let it.

Amen to that.

An aside…. Note to self: Interests lay in LMSA, AMSA, HeRMES, and Peds Interest.

Three individuals who share in the kind of passion I do (Shoot.. forgot his name!, Bernadette, Nicholas, Me)

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Locker 239

I didn’t take a picture of it (yet), but I now have a medical school locker. This locker is located on the 3rd floor, which seems to be a most sacred level. Why is that?

The 3rd floor houses the anatomy lab, which houses our first patient – the cadaver. Think about it this way… The cadaver was once an animate human. It lived. It had a life, likely also a family. Who knows? I may have once briefly crossed paths with the cadaver I will be working on tomorrow. This once-was-alive-person will be the first to teach me critial knowledge about the human body. He/She will be a gift and, in my opinion, will be one of the most memorable patients I will ever come across. I haven’t met this person yet, but ahead of time, thank you for your last gift.

(Anyhow… outside people aside from medical school faculty/personnel/students are not permitted in the 3rd level).

Our day started out with a motivational speech from a local phyisician and medical faculty member. His essential message was,

Be passionate about the field you are going into because if you are not, I can tell you right now that it will not be worth it.

He went on to explain his hierarchy of things that are most important in the life of a physician.

1. Family. Be it the first steps of your child or spending more time with your parents before they pass, be with your family and treasure them as much as possible. Time is a theif and you’ll wish you had done so when you are no longer able to.
2. Mentor. Your life will be filled with ups and downs. All happiness all the time would make it a boring life. Have someone available to you whom will be non-biased and non-judgemental towards you, someone who will help you realign yourself, someone who will help you move forward in this world.
3. Passion. If you don’t have it, it’s not worth it. It simply isn’t. Have an unconditional love for everything involved in medicine. What follows passion is, then, compassion.
4. Communication. This follows compassion. Have a dialogue with yourself, the people around you, with your patients. Voice the good and the bad.
5. Touch Therapy. So often, physicians never look up from the medical chart and see the patient themselves. Don’t be afraid to hold their hand.
6. Teamwork. If you are not a team player, medicine is not for you. Here’s a particularily striking thought: Wellness begins with the word, “We.” Illness begins with the word, “I.”
7. Leadership. In an emergent setting, everyone will want to do something. Someone will want to tend to wounds, someone will want to ventilate, and so on and so forth. When you can, be the person in the background who runs the show. (Great leaders are hardly ever known).
8. Don’t Aim Low. It is important to have a purpose in life. Succeed. Do well. Work towards something. There is something more out there than to you just breathing and “going through the motions.” Find it. Have a purpose. Don’t aim low.

He gave us (well, me, at least) quite a bit to think about. I thank him for sharing his experiences.

After that, there was more talk about student health insurance options. What I essentially have to remember is this: In April, sign up for summer coverage!

Safety issues were discussed. It was suggested that we sign up to receive texts or emails from the emergency alert system on our campus.

Learning resources were discussed. I plan to make use of the counseling center, specifically for guidance in dealing with extreme test anxiety.

A learning system overview was presented to us. We were told,

You are now part of the medical fraternity. Welcome.

I’m telling you… everytime someone mentions that I am a part of this world, I glow with joy. This is real.

For those who want to know a bit about the academic intensity in medical school, read this:

The nine courses you will be taking this semester are equivalent to thirty-four (34) undergraduate credits.

Holy expletive.

Nonetheless, the medical school expects that we, as students, experience a sincere thrill for learning about the awesome, volumonous information that we will have the privilage to learn. We must also not present behavior unbefitting of a medical student. We are now professionals. Forever more, we are students who will be expected to continually prove ourself, to certify and re-certify. Science and health is ever expansive, and we must do what we can to stay current.

Later on, study techniques were discussed, as were topics in complementary, alternative, and integrative medicine. I am pleased to find out that our medical institution is taking these avenues of medicine seriously.

Soon thereafter, cultural competency was discussed by a phyician I would like to contact in the near future. He is a neonatologist, which is (in all likelihood) the field that I would love to pursue. He spoke our need to learn how to interact effectively with people of different cultures.

Remember. By the time that you are full-fledged, practicing physicians, we will have been trained in the Western form of medical thinking and beliefs. We will have a clear outline. But the majority of patients won’t. Be open to learning from them. So long as they do not put themselves in danger, do not discredity their believes and concerns. Truly speak with them, and collaborate.

This topic, of all in the day, truly touched upon the work I had been doing in the last two years at the children’s hospital. I hope that we will continue to have more exposure to this topic throughout the school year.

Finally, a student panel was held and we discuessed things about the coming courses.

I now leave you with images of the day….

A great lunch was provided by the school. A great majority of us sat outside and ate together.

A quick view of the speakers of the day:

And finally, a view of the student panel (ranging from M2’s to M4’s to MD/PhD students):

 

 

 

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We plowed through the morning…

… literally.

This morning was jam-packed with information that seemed neverending. Granted, it was the stuff we’d been wanting to hear more about like what courses we would be taking, how exams were going to work, where to go for lab, etc etc. First a quick overview and then a word on certain subjects:

• We were first introduced to the curriculum and to the concept of basic skills examinations and certifications
• We were introduced to the rules of the labratory and the idea of skills examinations
• (Out of order now, since we were running late on time)…
• All main course coordinators (professors) were introduced to us at this time.
• We were supposed to get a break, but that didn’t happen. Curtis, an upperclassman, said, “Welcome to school. Get used to it!”
• Our Health Center faculty introduced themselves to us and let us know about the services offered.
• Financial aid personnel dropped by to scare the living daylights out of us. (Ohmygod…student loans, the bane of our existance!)
• Lunch took place on our own
• Then we stood in long lines waiting for our turns to be counseled in finanical aid, to be finger-printed for the crinminal background check (CBC), and to take photos for the class composite. (The photos were a horrible experience…yikes!)

Sorry if the post seems a little broken. Today was a VERY long day and I am trying to write down at least a few notes (otherwise, this post will never take place).

Had the pleasure of meeting Dianne (a fellow Hopkins graduate), Ashley, and Huayi.

We were told about the graduation competencies. There are six concepts which I’ll quickly list but not (at this moment) go further into detail: Integrity. Tolerance. Interpersonal Relationships. Initiative. Dependability. Attitudes. Function under stress. Appearance. Okay, I lied. Eight concepts 🙂

Next, we were told about our classes and how to read the exam schedule. Quick run up…

We have three types of courses this year: Year long (6 courses), Semester long (five courses), and one-and-a-half-semester-long (one course). Here’s info…

• Anatomy, Histology, Immunobiology/Microbiology, Physiology, Introduction to Human Disease (IHD) are year long courses. There is one final grade in May, but in December we know “where we stand.”
• The fall semester-long courses are Medical Statistics, Medical Genetics, and Embryology. We receive final grades for these in December.
• The spring semester-long courses are Neuroscience and Behavioral Science. We receive final grades for these in May.
• Biochemistry is a 1.5 semester long course. We receive a final grade in March.

All exams are administered via school-provided-laptops. A computer program randomizes our names to two sections.. either the day exam time or the afternoon exam time. We have no control over this… so get used to it!

Use the exam schedule to make plans accordingly. Know where your emphasis is (but don’t ignore the rest!). Study smartly!

And the part that sucks… when a specific section of the test finishes, you CANNOT go back to change an answer. Bummer!!

It is strongly recommended that we STAY ORGANIZED before, during, and after classes. This is ESSENTIAL. Review all new material within 24 hours to stay up-to-date (even if it is only skimming).

We will now be learning how to learn from cadavers.

By the way, make sure to care for yourself!

My info… I’m lab # 77. This Friday I will be in group #7N, but am week #3. (Yes, this is cryptic on purpose).

Aside from housekeeping…

Today we also took pictures for the class composite. We’re supposed to look like we’re wearing our white coats, except that none of the white coats provided fit me. Firstly, they were all men’s sizes and either WAY too small or WAY too large. And my face looked puffy. And pale. Too pale. *sigh* Oh well. Nothing I can do about it!

Had a great lunch with some of the girls.

Had an AMAZING time at the med school social sponsored by the school. Took tons of candid shots and got to know a group of students much better. (Nicholas, Amara, Nikunj, Bryan, Jean, among others). Played darts for the first time. Am now known as class photographer 🙂

Also, found a cycling partner for the longer rides on weekends!

Things couldn’t be better 🙂

Now, for photos:

Welcome to Orientation!

Sly shot of the professors ^_^

Ate with great groups of people

Hung out with and played games with others

And now, a good night to you all 🙂

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Tidbits from the M1 Orientation

Ooooo, part of me was so irritated this morning! Orientation (according to an email received in July) was supposed to begin at 8AM today. Great, I think, I’ll just get up at 6AM so that I can have an hour to get ready calmly, eat breakfast, and then bike to campus (a 2.2 mile ride each way).  Imagine my displeasure (and the surprise of about 15 other people) when we were handed our information and noted that check-in time was from 8:15AM-9:15AM.

Can I get a collective groan from everyone here?

The shock wore off… eventually.

I had the pleasure of meeting yet another student, Kelly, that morning and, of course, whining with her about the lost hour of sleep we would never get back. Misery does love company! 🙂

This is where orientation took place (and this is also where most of our medical lectures will take place):

 

Orientation began and we were introduced to two more Deans and to the administrative staff of the Student Affairs and Academic Affairs. I have to say that I was so impressed by the level of energy that each of these people radiated out to the crowd! I’d like to say that maybe its because its the start of the year, but I doubt that. Why? It’s also the start of a new application cycle, which means LOTS of work and LOTS of stress for them. Yet, here they were, in bright pink shirts (guys included) cheering everyone on.

These people are approachable! Each and every person continues to stress the importance of working together towards a common goal. They tell us,

“You are here. Know that we chose you for a reason and do not doubt that.”

(By the way, I love that one of the deans has her hair dyed a green color… probably remnants of some party. :] )

The remainder of the morning lent way to hashing out multiple types of policies. A lot of “housekeeping” was done and then we were “encouraged” to meet a person we had not yet met and spend the next 10 minutes getting to know each other. I turned to my right and met Taylor, but we didn’t have too much to say. There are a few awkward moments like that with people, but it shouldn’t deter you from “meeting them again” a day or two later.

(Mental note/reminder: Buy some scrubs by Friday. You will need them for anatomy lab.)

During break time, I was introduced to a few MSPers (those are the MD/Phd students). I am sure that I will be seeking plenty of advice from Kijrsten, Jen, Johnathan, and Nicholas.

Orientation is sometimes very boring. There is so much information being thrown at you that, eventually, all the information begins to poor back out the other ear. Why listen? I can just ask a person later if I need help. It’s a possibility, yes, but still keep your ears/eyes open for that potentially remarkable information. Here’s an example.

In the past, this has all been about you. You have needed to do well, get good grades, good jobs. You. You. You. Now? Now you have a greater obligation to your future patients.

Did she just say, “you have a greater obligation to your future patients? Yes. And it was a sobering thought. Everything we do, everything that we learn, everything that we experience from here on out… it’s for our future patients.

Wow. It’s really beginning to hit home, to become solid reality. I am a medical student. I am training for the medical profession. I. Am. Here.

So now, time for pictures from our lunch together.

 

And here I had the pleasure of meeting (counterclockwise): Me, Scott, Francisca, Lisa, Neil, Claudia, Bernadette, and Kelly.

 

And now I leave you with a thought/question…. What kind of a spider is this????? *deep shudder*

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