THIS DOCUMENT IS BASED ON THE BASIC SCIENCE CURRICULUM OF THE COLLEGE OF EMERGENCY MEDICINE. AVAILABLE HERE.

IT DOES NOT REPRESENT AN OFFICIAL DOCUMENT OF RCEM IN ANY WAY.

SECTIONS (CLICK TO JUMP TO SECTION)

1 - UPPER LIMB

2 - LOWER LIMB

3 - THORAX

4 - ABDOMEN

5 - HEAD AND NECK

6 - CENTRAL NERVOUS SYSTEM

7 - CRANIAL NERVE LESIONS

SECTION 1: UPPER LIMB

PECTORAL REGION

An appreciation of their role in producing pectoral movement and the fact that their stability rests upon ligaments. The role of the ACJ in force transmission following a fall.

AXILLA

BREAST

SHOULDER

Muscles and movements

Actions and innervation of:

Knowledge of origins and insertions NOT required

Knowledge of the muscles which exert group effects (eg abduction) at the shoulder joint and the means of

clinical testing:

Shoulder joint

THE ANTERIOR ARM

Note: the arm is divided anatomically to facilitate learning. Question stems

may involve knowledge from several of these subsections

Muscles and movements

Knowledge of origins & insertions is NOT required but an appreciation of the surface topography is required,

for example in relation to the palpation of brachial pulsation in relation to biceps at the elbow

Brachial artery

Median nerve

Musculocutaneous nerve

Ulnar nerve

Other nerves of the compartment

Lymph nodes

THE POSTERIOR ARM

Muscles and movements

Radial nerve

Elbow joint

pathological increase of the carrying angle

THE ANTERIOR FOREARM

Muscles

Actions & innervation of:

Detail in relation to attachments and relations is NOT required but the surface topography in relation to

injuries at any given point should be appreciated in order to predict possible muscular damage and

functional disability

Vessels of the compartment:

supply

Vessels of the compartment:

Nerves of the flexor compartment

Radioulnar joints

Movement: muscles exerting and allowing flexion, extension and rotation (see also individual muscle names)

POSTERIOR COMPARTMENT OF THE FOREARM

Muscles and movements

Actions & innervations of:

Note – although detailed knowledge of attachments and relations is not required, particular focus should be

given to the clinical effects of injury or division of any of these muscles or their tendons

Anatomical snuffbox

Extensor retinaculum

WRIST AND HAND

Note: The anatomy of this region represents key knowledge for Emergency

Medicine. Although questions will focus on functional effects of injury, only by

a thorough grasp of the arrangement of the structures listed can

competence be gained. You are strongly advised to equip yourself with as

detailed knowledge of the hand as possible.

Palmar aponeurosis

Flexor retinaculum

Carpal tunnel

Thenar eminence

Hypothenar eminence

Palmar arches

Digital nerves

Ulnar & median nerves:

Surface anatomy of the digital nerves as they enter and supply each digit in relation to injury and anaesthetic field blockade

Lumbricals and interossei

Interossei:

The flexor sheaths

THE DIGITAL ATTACHMENTS OF THE LONG TENDONS

This section warrants a separate heading. A detailed knowledge is expected of the anatomy of the attachments of both the flexor and extensor tendons, particularly to allow understanding of the clinical effects of division or injury at any given level of the finger.

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OTHER ASPECTS OF UPPER LIMB ANATOMY

Innervation

Injuries to nerves:

Radial nerve

Ulnar nerve

Median nerve

UPPER LIMB BONY ANATOMY AND RADIOLOGY

Knowledge of osteology need extend only to an appreciation of the key attachment points for soft tissues specifically mentioned above.

Topographical anatomy of individual bones is NOT required

Radiological anatomy is not explicitly assessed by MCQ but the other components of the examination will test knowledge of the key and common radiological landmarks in relation to clinical injury. These do not fall within the

scope of this document.

SECTION 2: LOWER LIMB

General introduction

Required anatomy knowledge for lower limb follows the same principles as upper limb: emphasis is placed on those key structures which are of high clinical importance by virtue of their location, relations or actions. In learning the required content, approach the material from the viewpoint of shopfloor clinical practice. The MCEM exam will assess your grasp of the lower limb anatomy detailed below.

You can assume that, where a given structure is not specifically listed, then details of it will not be required. The limb is divided to facilitate learning but questions may contain material from several regions in one stem.

ANTERIOR THIGH

Superficial innervation

Superficial arteries

Superficial veins

Lymph nodes

Muscles and movements

 

Actions and innervation of:

The group actions of these muscles as knee extensors

Attachments not required

Femoral sheath

The femoral canal and femoral ring.

Femoral artery

Femoral vein

Femoral nerve

Patellar region

Patellar ligament and the patellar bone as a sesamoid bone

The bony, ligamentous and muscular factors preventing lateral patellar draw

MEDIAL THIGH

Muscles and movements

Arteries and nerves

Obturator nerve: Territory of supply

HIP JOINT & GLUTEAL REGION

Cutaneous innervation

Muscles and movements

Sciatic nerve

Hip joint

 

POSTERIOR THIGH COMPARTMENT

Muscles and movements

Sciatic nerve

POPLITEAL FOSSA AND KNEE

The knee joint is complex and clinically highly relevant for Emergency Medicine. Your knowledge of the arrangement of the structures of the knee will facilitate a clearer understanding of the clinical symptoms and signs generated by anatomical injury.

Although detailed knowledge of the contents of the popliteal fossa is not required, pay attention to the highlighted material below which is of particular relevance and which may be assessed in MCEM.

Muscles and movements

Knee joint

Although a detailed knowledge of the attachments and relations of these ligaments is not required, you should be aware of the principal actions and roles of each

Bursae: Names and communications

Movements of the knee

ANTERIOR LEG

Muscles

DORSUM OF THE FOOT

Innervation

Vessels

Knowledge of its branches not required

LATERAL LEG

Muscles

 

POSTERIOR LEG (CALF)

Knowledge of calf anatomy assists in understanding the basis of deep vein thrombosis and compartment syndrome

Appreciation that the calf muscles fall into two groups

An understanding of the arrangement of the muscles and vessels of the calf in cross-section:

Muscles and movements

Vessels

Named branches NOT required

Nerves

SOLE OF THE FOOT

Appreciation that the sole is layered and that plantar arteries and nerves lie between the first and second layers.

This has implications for the structures likely to be compromised when the sole is injured.

The four layers

Individual muscles

Knowledge of the sites of insertions of these to the bones of the feet

 

ANKLE AND FOOT JOINTS ; JOINT DYNAMICS

Ankle joint

Ankle movements

Tarsal joints

Spring ligament:

Foot movements

 

LOWER LIMB INNERVATION

Candidates should possess sufficient anatomical knowledge to be able to predict the clinical effects of damage to:

LOWER LIMB OSTEOLOGY

The normal x-ray appearances of the bones of the lower limb and foot should be known together with the names of all bones

Common variants of normal will not be required in detail

You should be aware of the typical radiological appearances of fractures of the femur, tibia, fibula, malleoli and foot

SECTION 3: THORAX

Introduction

The level of knowledge required is stated below. Throughout, items with particular clinical significance are highlighted. Where structures are mentioned, the detail required is clarified.

THORACIC WALL

Thoracic body wall:

The dermatomal innervation map of the thoracic body wall 

Appreciation of the structure of the body wall:

Arrangement of muscles of the thoracic wall into three layers:

Thoracic movements:

The main muscular actions effecting a cycle of respiration

Intercostal structures:

The cross-sectional anatomy of an intercostal space.

 

DIAPHRAGM

Appreciation of its essential respiratory role

The surface markings of the diaphragm

Openings and landmarks:

The three main openings

Innervation:

Innervation from the phrenic nerve;

Actions:

Appreciation of the ways in which the diaphragmatic movements contribute to inspiration and straining

Herniations:

Congenital and acquired: outline details only

SURGICAL APPROACH TO THE THORAX

Knowledge of the key structures implicated in anterolateral or posterolateral thoracotomy or median sternotomy

Candidates will be expected to know the anatomical disposition of structures routinely divided during thoracotomy and the nearby structures which are also at risk

THORACIC INLET

The key aspect of knowledge here is an appreciation of the arrangement of structures at the inlet to allow understanding of the consequences of trauma or disease within this important region

Anatomy of the inlet:

Relations of the key structures to each other at the thoracic inlet:

A detailed knowledge of the anatomical course of the individual major structures is not required. The branches of the aortic arch should be appreciated but their anatomical course is not required. Likewise, apart from appreciation of the relations at the inlet, knowledge of the formation of the brachiocephalic veins and superior vena cava is not required

TRACHEA

Appreciation of its primary functions and the adaptations it possesses for these functions:

The anatomical landmarks defining its upper and lower extremities.

Appreciation of those structures which lie in close proximity to the trachea in the thorax (oesophagus, veins, arteries, lung) in relation to potential for injury or involvement in local disease processes. Detailed knowledge of the anatomical relations not required

See also head and neck section

THYMUS

Anatomical location and implications for injury or local pathology

Natural history of regression after puberty

HEART AND PERICARDIUM

General notes:

Knowledge of cardiac anatomy and the structures surrounding the heart is vital for competent assessment of normal and abnormal function:

auscultation and potentially life-saving interventions such as pericardiocentesis are both equally reliant on this knowledge

Throughout this section, remember that knowledge of the following is not required:

Focus your learning on those aspects of cardiac and perocardiac anatomy with relevance to clinical assessment, injury and disease

Pericardium:

The fibrous and serous layers and their roles

Nerve supply of the fibrous perocardium and its role in the pain of pericarditis vs ACS

Heart:

Great vessels:

Origins and relations of the ascending aorta and pulmonary trunk to each other as they emerge from their orifices

Conducting system:

Overview of the nature of the pathway; anatomical location of the SA and AV nodes and the nature of impulse transmission via left and right bundles

Cardiac blood supply:

Origin of the coronary arteries from the aortic root

The two named principal branches of each coronary artery and the

territory they supply;

Anatomy of the cardiac veins is not required

Procedural anatomy:

Candidates will be expected to know the procedural steps for pericardial aspiration and be able to relate this to relevant anatomical landmarks

OESOPHAGUS

Anatomical extent (C6-T10)

Position of the oesophagus in relation to the vertebral bodies, left bronchus, thoracic aorta and pericardium en route to the diaphragm and the surface marking of the point where it pierces the diaphragm

The points of constriction

Oesophageal nerve supply in relation to referred pain

PLEURA AND LUNGS

General note

As with cardiac anatomy, knowledge here is focussed upon clinical relevance. Items which are NOT required knowledge are:

Pleura:

Parietal & visceral pleura: functions.

Nerve supply

Surface markings and implications for aspiration & drainage

Lungs:

Appreciation of the numbers of lobes in each lung; the overall structural arrangement of bronchi, pulmonary arteries and veins and the principles of subdivision within the lung substance

The lung roots as key structures connecting lung with mediastinum and the contents of each root

Fissures: the oblique fissures as key functional anatomy in normal respiratory excursion of the lung substance

Surface markings of the hila, lungs and fissures

Lymph drainage via hilar, tracheobronchial and mediastinal groups/trunks

Nerve supply - autonomic (and implications for bronchial stimulation and pain perception) and appreciation of central control of respiration

OSTEOLOGY

Ribs: typical arrangement. The costal groove and its clinical implication

Knowledge of the functional anatomy of the bony thorax to allow understanding of the way in which the typical and atypical ribs and sternum work as a functional unit in respiration.

The clinical consequences of injury to the bony cage: flail chest

SECTION 4: ABDOMEN

Knowledge requirements

- focus on the applied anatomy of the abdominal wall and key internal structures. The detailed anatomy of individual organs is not required but aspects of importance are highlighted below for specific

study.

- Knowledge of the development of the gut (growth, movement, rotation) is not explicitly assessed, but having overview knowledge of the topic facilitates understanding of the arterial supply and lymph drainage of the gut which

may aid your learning.

- Bear in mind that knowledge of the cross-sectional anatomy of the abdomen as revealed by CT is highly important in determining the extent of injury or disease. You should make every effort to familiarise yourself with normal and

common abnormal cross-sectional CT films of the abdomen.

ABDOMINAL WALL

The standard regions of the abdomen and their lines of definition (e.g. epigastric, unbilical)

External oblique:

Internal oblique:

Transversus:

Rectus abdominis:

The derivation of the aponeurosis between the two recti

Nerve supply of anterior abdominal wall muscles

Rectus sheath:

o Posterior intercostal nerves

o Superior epigastric artery

o Inferior epigastric artery

Actions of the abdominal muscles:

INGUINAL REGION

Knowledge of the inguinal region enables understanding of the basis of hernias as well as the procedural anatomy of line placement and regional nerve blockade

Inguinal canal:

o Position

o Roof, walls and floor

o Origin of the superficial inguinal ring

o Origin of the deep inguinal ring

o Anatomical relations of the nerves, arteries & veins in the inguinal region and the position of psoas

TESTIS, EPIDIDYMIS AND SPERMATIC CORD

Components of the spermatic cord:

Appreciation of the gross anatomy of the testis: structure not required

Blood supply as being derived from aorta via testicular artery in the cord

Lymph drainage: differentiation from scrotal drainage pattern

Descent pathway: derivation of undescended testis & indirect inguinal hernias in infants

Vas (ductus) deferens:

o As being derived from epididymal canal

o As a component of spermatic cord

o Its course through to prostatic urethra

Nerve supply of testis and epididymis

TOPOGRAPHY OF THE ABDOMINAL CAVITY

Note: Knowledge requirements for this section relate to the anatomical implications of injury to the cavity

Appreciation of those abdominal organs possessing free mesenteries and those bound to the posterior abdominal wall

Retroperitoneal vs intraperitoneal structures

A detailed knowledge of the sacs, compartments and peritoneal folds of the abdomen is NOT required

PERITONEUM

Note: Knowledge of the compartments, ligaments and sacs is of direct relevance in relation to abdominal ultrasonography. Assessment at MCEM level will not assume any experience of the technique.

Parietal and visceral peritoneum as a serous membrane; functional differences of the two

Knowledge of the peritoneal folds and the greater and lesser sacs is not required

Concept of the supracolic, infracolic and pelvic compartments

Infracolic compartment

Primary components of the right and left infracolic compartments

The small intestinal mesentery: anatomical attachments (root) and role of encapsulated mechanoreceptors

The sigmoid mesocolon: anatomical attachments

Supracolic compartment

Greater omentum:

Knowledge of the lesser sac is NOT required

GASTROINTESTINAL TRACT

Abdominal oesophagus

Its anatomical landmarks (eg diaphragmatic opening at level of 7th costal cartilage) at both its diaphragmatic and gastric limits and the factors guarding against gastric reflux

Anatomical relations in terms of the consequences of oesophageal rupture or penetration

Stomach

The anatomical distinctions of fundus, body & pylorus: role of the pylorus in the digestive process

Relations of the stomach:

Implications for local spread of disease

Arterial supply as being derived from the 3 branches of the coeliac trunk.

Detailed knowledge of the arterial supply not required, but see

below for note regarding vasculature of the alimentary tract

Nerve supply:

Small intestine 1: duodenum

Detailed relations of each section are NOT required

Blood supply from the pancreaticoduodenal arteries

Small intestine 2: jejunum, ileum

Large intestine 1: Caecum

Large intestine 2: colon

LIVER AND BILIARY TREE

Surfaces, relations and features of the liver

Surface marking

The liver lobule as an architectural building block: function of the lobule, vessels, sinusoids

The shape of the liver: presence of visceral & diaphragmatic surfaces

Principal relations of the diaphragmatic surface (eg diaphragm, lungs, pleura). Position of vena cava and other key structures (eg porta hepatis) in relation to the gross structure of the liver.

Gall Bladder

Biliary ducts

Portal vein

Pancreas

SPLEEN

POSTERIOR ABDOMINAL WALL: MUSCLES, VESSELS AND NERVES

General note

Required knowledge in this section focuses on those aspects of anatomy relevant to injury or disease in the emergency setting. A detailed knowledge of the course and many named branches of the abdominal aorta is NOT

required, neither is knowledge of the course and relations of the IVC nor details of the umbilical, vitelline or cardinal veins.

Knowledge of the nerves of this region centres upon appreciation of the spinal nerve roots implicated in injury and disease. The detailed course of the individual named nerves (e.g. subcostal, ilioinguinal) is NOT required.

However, the prime importance of the femoral nerve mandates knowledge of its origin, position in the region and relations to psoas and iliacus.

Muscles

Psoas major:

Quadratus lumborum:

Iliacus:

Appreciation that each of these 3 muscles possesses strong fascial coverings. Detailed local anatomy NOT required

Vessels

Surface markings of abdominal aorta and inferior vena cava

The abdominal aorta as having 3 groups of branches in this region (single ventral gut arteries, paired visceral arteries, paired wall arteries)

Details of the named arterial branches (e.g. inferior phrenic) not required

Inferior vena cava: primary tributaries (external iliac, lumbar, gonadal, renal, hepatic) and the areas drained by each

Nerves

Branches of the lumbar plexus and the structures supplied by each of L1 - L4 (anterior & posterior divisions where applicable)

Overview only of the arrangement of the sympathetic & parasympathetic supply to the abdomen. Anatomical knowledge of the lumbar sympathetic trunk, lumbar ganglia & coeliac plexus not required

Lymph nodes

Arrangement of nodes into pre- and para-aortic groups.

Structures draining to each

KIDNEYS, URETERS AND BLADDER

Note: anatomy of the suprarenals NOT required.

Kidney

Ureters

Urinary bladder

THE PELVIC CAVITY

As before, knowledge requirements focus on the anatomical principles for the emergency management of injury & disease

You should examine and revise the bony components of the pelvis and know each bone's name, articulations with its neighbours and position on radiographs of the normal pelvis

Obturator internus & piriformis: requirements stated in gluteal section above

Appreciation of the pelvic floor as a muscular sheet: details of the muscles not required

Understanding of the actions of the pelvic floor in postural and contractile tonus

Knowledge of the pelvic fascia NOT required

Rectum & anus

Innervation:

The anal canal as the last 4cm of the adult alimentary tract: overview of the mechanism of defecation & its nervous control

Detailed knowledge of the external & internal sphincters, ischiorectal fossa, perineal body, anococcygeal body and anal mucous membrane structure not required

Lymph drainage:

Cutaneous innervation of the anal skin: utilisation of anal reflex in neurological assessment

Male internal genitalia: prostate

Size of normal adult prostate & immediate anatomical relations. Its penetration by the proximal urethra

Knowledge of the lobular structure sufficient to appreciate the anatomical basis of prostatic hypertrophy (benign or potentially malignant)

Lymph drainage of the prostate: potential drainage to external iliacs and clinical implications if palpably enlarged

Developmental details NOT required

Anatomy of the vas (ductus) deferns & seminal vesicles NOT required

Female reproductive system

Size and immediate prime anatomical relations (bladder, rectouterine pouch, ovary, intestine, ureter) of the adult uterus 

Division of the structure into fundus, body, cervix: detailed knowledge not required

Uterine tubes: length, division into

Locations of ectopic pregnancy

Blood supply:

Innervation of the uterus and tubes (not motor)

Knowledge of the internal uterine structure and its musculoligamentous

supports NOT required

Ovary

Vagina

Male urogenital region

Urethra

Appreciation of the cross-sectional anatomy of the penis: relative positions of corpora, blood vessels and urethra

Penile innervation (S2)

Stability of the pelvis: joints and ligaments

Lumbar and sacral plexuses

Where appropriate, mention has been made of key knowledge requirements in relation to the lumbar plexus. A detailed knowledge of the courses of the derived nerves is not required. Likewise, although it is important to know the six branches which arise from the sacral segments (eg pudendal S2, 3, 4), the anatomy of these branches is not required.

Specific named nerves which are required knowledge are:

SECTION 5: HEAD AND NECK

Introductory comments

Key knowledge for the head and neck region relates to safe management of common injuries of the region, in particular the face. Appreciation of the anatomy of the neck facilitates an understanding of the causes of airway obstruction and the rationale for management of cervical spine injuries. There are several aspects of the anatomy of this region which are important to know in some detail, and some which are not required. These are highlighted

throughout.

General topography: muscles, spaces & fascia

Appreciation of the topography in terms of:

Specific requirements:

[Knowledge of the anatomy of each fascial component not required]

Tissue spaces of the neck:

Their locations

The common pathways by which infection may spread from each

Anatomical basis of Ludwig's angina

Triangles of the neck: sternomastoid

Triangles of the neck: anterior and posterior triangles

Knowledge of the boundaries and contents of the triangles is not required as a stand-alone item of knowledge, though an appreciation of the topography of the anterior triangle will benefit understanding of the specific structures within it which are highlighted below.

Suprahyoid and infrahyoid muscles

Thyroid

Trachea

(See also earlier sections)

Oesophagus

(See also earlier sections)

Carotid sheath

Neck

Cervical sympathetic trunk

Root of the neck

Subclavian vein:

Subclavian artery: surface marking in the neck

Knowledge of the detailed relations of scalenus anterior in the root of the neck is not required except in reference to the specific points highlighted above. Likewise, knowledge of scalenus medius and posterior is not required.

Face

Overview

Eyelids

Levaror palpebrae superioris & occipitofrontalis: see below

Lips & cheeks

Orbicularis oris:

Buccinator:

Actions & innervation

Modiolus:

Detail of the lip dilators (eg mentalis, risorius) not required

Facial nerve in the facial region

Sensory supply of the face

Arterial supply of the face

Venous drainage

Facial lymph drainage

Scalp

Occipitofrontalis:

Arterial supply:

Venous drainage:

Innervation:

Temporal fossa:

Temporalis: attachments, innervation & actions

Parotid region

Parotid gland

artery,

vein

Infratemporal fossa

Overview only of the location of this region beneath the skull basebetween pharynx & mandible

Appreciation of the key contents of this region:

Pterygoids

Maxillary artery

Pterygoid venous plexus

Knowledge of sphenomandibular ligament & mylohyoid nerve not required

Mandibular nerve

Carotid sheath

Glossopharyngeal nerve

Vagus nerve

Accessory nerve

Hypoglossal nerve

Maxillary nerve

Pterygopalatine fossa

Nose and paranasal region

External nose

Nasal cavity

Position & function of nasolacrimal duct

Appreciation (anatomy not required) of the ostia from the maxillary sinus & ethmoidal air cells

Paranasal sinuses

Mouth and hard palate

Mucous membrane and gingivae

Teeth

Oral cavity

Tongue

Floor of the mouth

Muscular pharynx

Muscles

Interior of pharynx

The valleculae: location

Laryngeal region of pharynx

This region is especially important as it contains the laryngeal inlet & piriform fossae. Candidates will be assumed to possess sufficient anatomical knowledge to be able to identify the key structures of this pharyngeal part as viewed via direct laryngoscopy

Gag reflex

Larynx

Laryngeal muscles

Intrinsic muscles

Intrinsic laryngeal movements

Extrinsic muscles

Orbit and eye

o Superior rectus

o Medial rectus

o Inferior rectus

o Lateral rectus

o Superior oblique

o Inferior oblique

A detailed knowledge of the anatomical course of the many other nerves with a presence in the orbit (eg lacrimal, nasociliary) is NOT required.

Ear

Temporomandibular joint

Its composition: synovial joint between mandibular head & squamous temporal bone

Vertebral column: bones, joints, muscles

A working knowledge of the anatomy of the vertebral column is essential for the correct interpretation of clinical symptoms & signs. Candidates are advised to revise the anatomy of this region by reference to an articulated vertebral column or at least a virtual computer-based model.

Note that knowledge of the blood supply of the vertebral column is not required

Structural overview:

 

Vertebral column (see also muscles below)

Atlas & axis

Muscles of the column

Detailed knowledge is not required. However, an overview of the mechanics of vertebral movement is required as listed below:

Vertebral canal

SECTION 6: CENTRAL NERVOUS SYSTEM

Overview

Detail in relation to Central Nervous System (CNS) anatomy is limited to those aspects highlighted below. You should be aware, however, of the general structural arrangement of the brain and spinal cord.

The cerebral hemispheres essentially constitute the developed forebrain. The midbrain contains an aqueduct and acts as a connection to the hindbrain (pons, medulla oblongata and cerebellum).

The cavity of the hindbrain is the fourth ventricle. The brainstem comprises the midbrain, pons and medulla. The medulla passes via the skull’s foramen magnum to form the spinal cord, from which cervical nerve roots emerge. CSF forms within ventricular choroid plexuses and exits via the foramina in the roof of the fourth ventricle.

Cerebral hemispheres

o Frontal lobe – anterior to central sulcus and above the lateral sulcus

o Parietal lobe – behind central sulcus and above lateral sulcus

o Temporal lobe – below lateral sulcus

o Occipital lobe – below parieto-occipital sulcus

Specific knowledge requirements are listed below

 

Cortical areas

Appreciation of the key areas within which bodily function is determined is a fundamental part of the rationale for knowledge of CNS anatomy. The effects of traumatic and atraumatic brain lesions can be predicted based upon a working knowledge of the likely clinical signs, and this works in reverse such that typical neurological presentations infer typical areas of central damage.

The following specific examples are required knowledge. You should be aware of their anatomical site and functions:

o Broca’s area

o Wernicke’s area

o Auditory area

o Visual area (see also below)

Visual fields and pathways

A competent knowledge of the anatomical basis of vision is important.

Knowledge is expected of the key components of the visual axis and the role of each in the generation of normal vision.

Note that there is a separate section on key cranial lesions at the end of this section.

Olfactory pathways

Knowledge NOT required

Limbic system

Knowledge NOT required

Ventricles

A working knowledge of the anatomy and function of the ventricular system is key to understanding the clinical effects of pathology within  the cranial cavity

Key required knowledge is listed below:

the divisions of the cavity into a body, anterior, inferior and posterior horns

rd

Thalamus

rd

Cerebral blood supply

Internal carotid artery

Middle cerebral artery

Anterior cerebral artery

Posterior cerebral artery

Cerebral venous drainage

Brainstem

General comments

This area comprises the midbrain, pons and medulla. It extends from the tentorial aperture to the level of C1. The medulla passes out via the foramen magnum and becomes the spinal cord as C1 roots emerge

Anatomy I: nuclei

These are listed below:

o Oclulomotor

o Trochlear

o Trigeminal

o Abducent

o Facial

o Vestibulocochlear

o Glossopharyngeal

o Vagus

o Accessory

o Hypoglossal

Anatomy II: midbrain

Anatomy III: pons

Anatomy IV: medulla oblongata

Cerebrospinal fluid

Cerebellum

o Posterior inferior cerebellar

o Anterior inferior cerebellar

o Superior cerebellar

Spinal cord anatomy

Knowledge of the key anatomical elements of the cord is fundamental in clinical practice

Extent

o Cervical (for brachial plexus) and lumbosacral (for lumbar & sacral plexuses). These sit at the vertebral levels of C3-T1 (cervical) and T9 to L1 (lumbosacral) Spinal nerve roots

o Rootlets emerge from the cord in the subarachnoid space and amalgamate shortly afterwards into roots

o Anterior & posterior roots then emerge from their individual intervertebral foramina. After invaginating the dura they combine into mixed spinal nerves which then go off to their respective destinations

o The cord is shorter than the space available to it: below L1 level, the roots pass down near-vertically to form the cauda equina

o The lower a nerve root, therefore, the more steeply it slopes down before gaining its intervertebral foramen: this is an important anatomical fact when interpreting potential clinical signs in spinal trauma

Internal anatomy

o The cross-sectional anatomy of the main features of the cord should be known and understood as listed below

o Disposition of the cord into grey and white matter

o Grey matter as cell body collections; white matter as fibres 

The locations of the important white matter tracts

The anatomical basis for clinical effects of division of the cord

Cord blood supply

SECTION 7: CRANIAL NERVE LESIONS

Knowledge of the anatomical basis for the clinical effects of lesions of the cranial nerves reinforces the need to know key anatomy in everyday practice. For each of the following nerves, an appreciation of likely causes of

disease or injury, the common clinical effects, and the anatomical rationale for these, is required. In particular, knowledge of the effects of interruption of the optic nerve along its course from retina to radiation is required: