PAH DEM PRIMARY EXAM PREPARATION PROGRAM ANATOMY PROGRAM

Transcription

1 PAH DEM PRIMARY EXAM PREPARATION PROGRAM ANATOMY PROGRAM The Exam: MCQ Paper 60 questions, 90 minutes o Choose best response from 4 options o Must obtain scaled score of 10 or greater out of 20 to pass o Must pass all subject MCQs to be eligible to sit the viva Integrated viva o 4 integrated vivas 4 questions in each viva - one question from each subject o Scaled score of 5 or greater out of 10 in at least two of the four vivas and have a total score of 20 or greater out of 40 to pass Expectations as per the ACEM Training and Examination Handbook: There will be an emphasis on applied anatomy in both MCQ and viva sections. Candidates are expected to have a detailed knowledge of the upper and lower limbs, with a special emphasis on anatomy important to the practice of emergency medicine. Candidates must be familiar with anatomy essential for the interpretation of diagnostic imaging used by emergency physicians. The candidate is expected to be familiar with common X-rays and with cross-sectional anatomy necessary for the interpretation of CT scans. CT scans may be included in the exam and candidates will be expected to show knowledge of gross features and relationships. These will be single slices only, with knowledge appropriate to the practice of emergency medicine. Detailed radiology knowledge is not expected. CT levels are most likely to demonstrate important anatomical levels, e.g. level of transpyloric plane, aortic arch. Detailed neuro-anatomy is not expected, but candidates should be able to describe lobes, ventricles and other gross structures. Histology and embryology will not be examined; however, knowledge of clinically relevant paediatric anatomy is expected. It should be stressed that detailed knowledge of the techniques of clinical procedures is not expected, but that the knowledge of areas in which these procedures are performed are obviously of key importance to emergency physicians. LOA 1 - Candidates should demonstrate a detailed knowledge of the anatomical structures relationships, nerve and blood supply as they pertain to the topic. Candidates should be able to explain the clinical significance of the anatomy as applied to the practice of emergency medicine. 1

2 LOA 2 - Candidates should demonstrate a general knowledge of the anatomical structures, relationships, nerve and blood supply where relevant to the practice of emergency medicine. LOA 3 - Candidates should demonstrate a basic knowledge of the anatomical structures and relationships as they pertain to the topic without the need for fine detail. Imaging (CT and X-ray) o Imaging of regions important to emergency medicine will be examinable as LOA 2 with the aim of demonstrating normal anatomical structures and relationships. o Sectional imaging via CT will be examined in relation to brain, thorax and abdomen. o Plain X-ray imaging will be examined in relation to head, neck, thorax, abdomen, pelvis, spine, lower limb and upper limb. Recommended Texts & Models: In theory, anatomy texts should show little variation, however the reality is that there can be a large amount of variation from text to text. Remember that the exam is set from and referenced to the set texts. Clinically Oriented Anatomy Moore & Dalley (Lippincott Williams & Wilkins) ensure you have the most recent edition McMinn s Clinical Atlas of Human Anatomy Mosby - ensure you have the most recent edition Somso CS 2 Eyeball with part of Orbit (new model may be used in conjunction with F 13 (see below) ) GS 4 Larynx with Tongue FS 5 Nasal Cavity, Oral Cavity and Pharyngeal Cavity including Larynx (old model may be used in conjunction with GS 4) HS 1 Heart NS 9 Muscles of the Foot NS 10 Muscles of the Let with Base of Pelvis NS 13 Muscles of the Hand with Base of Forearm NS 15 Muscles of the Arm with Shoulder Girdle NS 50 Functional Model of the Knee Joint NS 52 Functional Model of the Elbow Joint NS 53 Functional Model of the Shoulder Joint NS 54 Functional Model of the Ankle Joint QS 23 Skeleton of the foot QS 54 Case with collection vertebrae and spinal cord 3B Scientific Product F 13 Eye (older model may be used in conjunction with CS 2 (see above) ) Half Skeleton, Disarticulated both left and right These models are available in the department. 2

3 Other Resources: Trainee Room contains MCQs, previous viva exams and previous candidate s notes. ACEM website has many useful resources: o In Training Program Information Primary Exam there are exam dates, application forms, past viva papers, MCQ on-line practice and links to the Training and Examination Handbook. o In Trainees Home Resources Non-ACEM Resources Primary Exam there are practice MCQs from the NZ Primary Course Talk to trainees that have recently undertaken the exam they will have acquired numerous useful resources that they would be happy to share. Multiple Choice Matrix: The more important the topic the more questions: Tissues & Structures 4 Upper limb 15 Lower limb 15 Head & Neck 7 Nervous System 4 Central nervous system 4 Thorax 5 Abdomen & Pelvis 6 Please note that the matrix provides weighting with respect to the MCQ component of the exam; it does not necessarily reflect the composition of the oral exam. 3

4 ANATOMY CURRICULUM Please note that the ACEM Primary Examination Handbook allocates Level of Assessment (LOA) ratings to each curriculum topic. LOA 1 is designated expert ; LOA 2 important ; LOA 3 general. This should help guide you as to the level of detail you will need to know on each topic. Please check with the ACEM Primary Examination Handbook to ensure currency of the syllabus and LOA noted below. 1. Approaches to studying Anatomy 1.1 Regional anatomy Systemic anatomy Clinical anatomy 3 2. Anatomicomedical Terminology 2.1 Anatomical position Anatomical planes Terms of relationship and comparison Terms of laterality Terms of movement 1 3. Anatomical Variations 3 4. Integumentary System 3 5. Fascial Compartments, Bursae & Potential Spaces 1 6. Fascias 3 7. Skeletal System 7.1 Cartilage and bones Bone markings and formations Joints 1 8. Muscle Tissue and the Muscular System 8.1 Types of muscle (muscle tissue) Skeletal muscles Cardiac striated muscle Smooth muscle 2 9. Cardiovascular System 9.1 Vascular circuits Blood vessels Lymphoid System Nervous System 11.1 Central nervous system 1 4

5 11.2 Peripheral nervous system Somatic nervous system Autonomic nervous system Medical Imaging Techniques Overview of Thorax Thoracic Wall 14.1 Skeleton of thoracic wall Thoracic apertures Joints of thoracic wall Movements of thoracic wall Muscles of thoracic wall Fascia of thoracic wall Nerves of thoracic wall Vasculature of thoracic wall Breasts Surface anatomy of thoracic wall Viscera of Thoracic Cavity 15.1 Pleurae, lungs & tracheobronchial tree Overview of mediastinum Pericardium Heart Superior mediastinum and great vessels Posterior mediastinum Anterior mediastinum Surface anatomy of heart and mediastinal viscera Abdomen Overview: Walls, Cavities, Regions & Planes Anterolateral Abdominal Wall 17.1 Fascia of the anterolateral abdominal wall Muscles of anterolateral abdominal wall Neurovasculature of anterolateral abdominal wall Internal surface of anterolateral abdominal wall Inguinal region Spermatic cord, scrotum, and testis Surface anatomy of anterolateral abdominal wall Peritoneum & Peritoneal Cavity 18.1 Subdivisions of the peritoneal cavity 3 5

6 19. Abdominal Viscera 19.1 Overview of abdominal viscera and digestive tract Oesophagus 19.3 Stomach Small intestine Spleen Pancreas Liver Biliary tracts and gall bladder Kidneys, ureters, and suprarenal glands Summary of intervention of abdominal viscera Diaphragm 20.1 Vessels and nerves of diaphragm Diaphragmatic apertures Actions of diaphragm Posterior Abdominal Wall 21.1 Fascia of posterior abdominal wall Muscles of posterior abdominal wall Nerves of posterior abdominal wall Vessels of posterior abdominal wall Introduction to Pelvis & Perineum Pelvic Girdle 23.1 Bones and features of pelvic girdle Orientation of pelvic girdle Joints and ligaments of pelvic girdle Pelvic Cavity 24.1 Walls and floor of pelvic cavity Peritoneum and peritoneal cavity of pelvis Pelvic fascia Neurovascular Structures of Pelvis 25.1 Pelvic arteries Pelvic veins Lymph nodes of pelvis Pelvic nerves Pelvic Viscera 26.1 Urinary organs Rectum Male internal genital organs 3 6

7 26.4 Female internal genital organs Lymphatic drainage of pelvic viscera Perineum 27.1 Fasciae and pouches of urogenital triangle Features of anal triangle Male urogenital triangle Female urogenital triangle Overview of Back & Vertebral Column Vertebrae 29.1 Structure and function of vertebrae Regional characteristics of vertebrae Vertebral Column 30.1 Joints of vertebral column Movements of vertebral column Curvatures of vertebral column Vasculature of vertebral column Nerves of vertebral column Muscles of Back 31.1 Extrinsic back muscles Intrinsic back muscles Surface anatomy of back muscles Suboccipital and deep neck muscles Contents of Vertebral Canal 32.1 Spinal cord Spinal nerve roots Spinal meninges and cerebrospinal fluid (CSF) Vasculature of spinal cord and spinal nerve roots Overview of Lower Limb Development of Lower Limb Bones of Lower Limb 35.1 Arrangement of lower limb bones Hip bone Femur Tibia and fibula Bones of foot Surface anatomy of bones of foot 1 7

8 36. Fascia, Veins, Lymphatics, Efferent Vessels & Cutaneous Nerves of Lower Limb 36.1 Subcutaneous tissue and fascia Venous drainage of lower limb Lymphatic drainage of lower limb Cutaneous innervation of lower limb Motor innervation of lower limb Posture and Gait 37.1 Standing at ease walking: the gait cycle Anterior & Medial Regions of Thigh 38.1 Organization of proximal lower limb Anterior thigh muscles Medial thigh muscles Neurovascular structures and relationships in anteromedial thigh Surface anatomy of anterior and medial regions of thigh Gluteal & Posterior Thigh Regions 39.1 Gluteal region: buttocks and hip region Muscles of gluteal region Posterior thigh region Neurovascular structures of gluteal and posterior thigh regions Surface anatomy of gluteal and posterior thigh regions Popliteal Fossa & Leg 40.1 Popliteal region Anterior compartment of leg Lateral compartment of leg Posterior compartment of leg Surface anatomy of leg Foot 41.1 Skin and fascia of foot Muscles of foot Neurovascular structures and relationships in foot Surface anatomy of ankle region and foot Joints of Lower Limb 42.1 Hip joint Knee joint Tibiofibular joints Ankle joint Foot joints 1 8

9 42.6 Surface anatomy of joints of knee, ankle, and foot Overview of Upper Limb Bones of Upper Limb 44.1 Clavicle Scapula Humerus Bones of forearm Bones of hand Surface anatomy of upper limb bones Fascia, Efferent Vessels, Cutaneous Innervation & Myotomes of Upper Limb 45.1 Fascia of upper limb Venous drainage of upper limb Lymphatic drainage of upper limb Cutaneous innervation of upper limb Motor innervation (myotomes) of upper limb Pectoral & Scapular Regions 46.1 Anterior axioappendicular muscles Posterior axioappendicular and scapulohumeral muscles Scapulohumeral (intrinsic shoulder) muscles Surface anatomy of pectoral, scapular, and deltoid regions Axilla 47.1 Axillary artery Axillary vein Axillary lymph nodes Brachial plexus Arm 48.1 Muscles of arm Brachial artery Veins of arm Nerves of arm Cubital fossa Surface anatomy of arm and cubital fossa Forearm 49.1 Compartments of forearm Muscles of forearm Arteries of forearm Veins of forearm Nerves of forearm 1 9

10 49.6 Surface anatomy of forearm Hand 50.1 Fascia and compartments of palm Muscles of hand Long flexor tendons and tendon sheaths in hand Arteries of hand Veins of hand Nerves of hand Surface anatomy of hand Joints of Upper Limb 51.1 Sternoclavicular joint Acromioclavicular joint Glenohumeral joint 51.4 Elbow joint Proximal radioulnar joint Distal radio-ulnar joint Wrist joint Intercarpal joints Carpometacarpal and intermetacarpal joints Metacarpophalangeal and interphalangeal joints Overview Head Cranium 53.1 Facial aspect of cranium Lateral aspect of cranium Occipital aspect of cranium Superior aspect of cranium External surface of cranial base Internal surface of cranial base Walls of cranial cavity Regions of head Face & Scalp 54.1 Face Scalp Muscles of face and scalp Nerves of face and scalp Superficial vasculature of face and scalp Surface anatomy of face Cranial Meninges 55.1 Dura mater 3 10

11 55.2 Arachnoid mater and pia mater Meningeal spaces Brain 56.1 Parts of brain Ventricular system of brain Arterial blood supply of brain Venous drainage of brain Eye, Orbit, Orbital Region & Eyeball 57.1 Orbits Eyelids and lacrimal apparatus Eyeball Extraocular muscles of orbit Nerves of orbit Vasculature of orbit Surface anatomy of eye and lacrimal apparatus Parotoid & Temporal Regions, Infratemporal Fossa & Temporomandibular Joint 58.1 Parotid region Temporal region Infratemporal fossa Oral Region 59.1 Oral cavity Lips, cheeks, and gingivae Teeth Palate Tongue Salivary glands Pterygopalatine Fossa 60.1 Pterygopalatine part of maxillary artery Maxillary nerve Nose 61.1 External nose Nasal cavities Vasculature and innervation of nose Paranasal sinuses Ear 62.1 External ear Middle ear 2 11

12 62.3 Internal ear Overview Neck Bones of Neck 64.1 Cervical vertebrae Hyoid bone Fascia of Neck 65.1 Cervical subcutaneous tissue and platysma Deep cervical fascia Superficial Structures of Neck: Cervical Regions 66.1 Sternocleidomastoid region Posterior cervical region Lateral cervical region Anterior cervical region Surface anatomy of cervical regions and triangles of neck Deep Structures of Neck 67.1 Prevertebral muscles Root of neck Viscera of Neck 68.1 Endocrine layer of cervical viscera Respiratory layer of cervical viscera Alimentary layer of cervical viscera Surface anatomy of endocrine and respiratory layers of cervical viscera Lymphatics of the Neck Summary of Cranial Nerves 71. Overview Summary of Cranial Nerves Olfactory Nerve (CN I) Optic Nerve (CN II) Oculomotor Nerve (CN III) Trochlear Nerve (CN IV) Trigeminal Nerve (CN V) Ophthalmic nerve (CN V1) Maxillary nerve (CN V2) Mandibular nerve (CN V3) Abducent Nerve (CN VI) 1 12

13 78. Facial Nerve (CN VII) Vestibulocochlear Nerve (CN VIII) Glossopharyngeal Nerve (CN IX) Vagus Nerve (CN X) Spinal Accessory Nerve (CN XI) Hypoglossal Nerve (CN XII) 3 13

14 STUDY AID (Based on a 22 week preparation) Make sure you pick and stick. With respect to sitting this exam, make a commitment and stick to it. Avoid taking a toe in the water approach, where you just see how your study goes for a few months before deciding whether to sit or not. If you go in half-hearted you will be wasting your time. Once you have made your decision to sit, you can set about planning your intensive preparation. This study aid suggests that you undertake to study the more important topics first (i.e. those from which many of the exam questions come from). In the following, I have not reproduced the curriculum in its entirety but tried to limit it to the most important topics. I have also applied my own ranking system to define which topics should be understood in the most detail. ### - Understand in detail. Many questions are likely to come from this topic and the knowledge expected will be high. ## - Understand well. # - Understand in general. The suggested time frames are suggestions only. It does start with generous time frames to cover the initial topics in the belief you may take a little time to warm to the task. Feel free to cover more territory at a faster rate. Regardless you should have completed your run through of the curriculum by weeks; thus allowing 6-7 weeks revision and focused exam practice. As you study each topic have an understanding of how this topic is examined. Practice MCQ questions on the topic as you go, to check and consolidate knowledge. Similarly, look to work in a study group and test each other with viva questions as you complete a section. I have also added to the curriculum topics exam questions from vivas from the last few years. Use these as prompts to test your understanding of a topic. At the end of the day, you must be able to not only acquire knowledge but to organise it in a way that allows you to reproduce it in a format that is tailored to the exam. Depending on what other subjects you are studying simultaneously, look to study like with like (i.e. anatomy of the heart with CVS pathology; renal physiology with renal system pathology etc). Study from the prescribed text(s) as this where the MCQs are referenced from and from where the oral exam questions are developed. Also note that the pictures / figures / tables are just important as the text. Often questions are based straight from what is displayed in these adjuncts. 14

15 Week 1: Tissues and Structures Skin Subcutaneous tissue Deep fascia Ligaments Cartilage Muscles Tendons Bone joints Mucous membranes Serous membranes Blood vessels Lymphatics. Past Questions: Nil Week 2-5: The Upper Limb Osteology Pectoral Girdle Breast and Axilla Scapular Region Arm Forearm Hand Joints Vessels Nerves Radiology Past Questions: Wrist Dorsum Boundaries of the snuff box What makes up the floor of the snuff box Tendons under the extensor retinaculum Median nerve in forearm Demonstrate the course Motor supply in forearm Innervation of the arm Course of the radial nerve in upper limb Major branches of radial nerve in the arm Upper limb sensation Demonstrate the dermatomes Describe the cutaneous innervation of the hand 15

16 Cutaneous innervation of the rest of the UL Brachial Plexus What is the brachial plexus and how is it formed Humerus and scapula Bony features of the proximal humerus Stability of the glenohumeral joint Wrist & Hand Bones of the carpus Attachments of the flexor retinaculum What nerves pass superficial to the carpal tunnel Cubital fossa Boundaries Contents Median nerve (photo) Identify Course of the median nerve Structures supplied by the median nerve Elbow XR Boney features Demonstrate common extensor origin and name the muscles Dermatome of upper limb Demonstrate on own arm Peripheral nerve supply to the skin of the hand Cubital fossa Boundaries Contents Course of the brachial artery through the arm Hand Describe the palmar fascial spaces Contents of the central fascial compartment of the palm Boundaries of the central fascial compartment of the palm Clavicle (bone) Is this right or left Muscular attachments Anatomical relations of the medial third Course of the subclavian vein Lymphatics Drainage of the superficial lymphatics of the upper limb Drainage of the deep lymphatics of the upper limb How do the right and left subclavian lymphatic trunks drain Wrist (photo) Identify structures bounded by the extensor retinaculum Motor supply of these muscles Sensory supply of the dorsum of the hand Humerus Identify and main features Factors stabilising the shoulder joint 16

17 Attachments of the rotator cuff on the humerus Wrist XR Identify bones Movements at the wrist photo brachial plexus Identify the components of the brachial plexus Identify the muscles visible in this photo model elbow Demonstrate the bony features of the elbow joint Demonstrate the capsular attachments of the elbow Describe the collateral ligaments of the elbow Describe the movements of the elbow joint photo upper limb Describe the superficial venous drainage of the upper limb Model hand Identify muscular structures in the hand Demonstrate actions produced by the lumbricals and the interossei and describe their innervation Demonstrate the origins and insertions of the short muscles of the hand model thumb Identify muscles thenar eminence and demonstrate their origins and insertions Demonstrate the movements produced by the thenar muscles and innervation L wrist and hand photo Identify median n and adjacent structures Demonstrate where sensation changes may occur if median nerve is injured in the forearm Demonstrate these changes if median n compressed in carpal tunnel syndrome photo cubital fossa Identify contents of cubital fossa Demonstrate course and branches of radial n and name structures they supply Which veins are usually accessed during venepuncture and what are common variations to these vessels model elbow Demonstrate and describe on the model the movements of supination and pronation What muscles are involved in supination and pronation? What nerves are involved in supination and pronation? discussion Describe the muscles of the thenar eminence and their function What is their innervation Xray hand/wrist Identify the bones of the carpus on this Xray Identify the bones of the carpus on the lateral bone ulna 17

18 Describe the main features of the proximal end of this bone (ulna) How does this bone articulate with the other bones of the elbow? What else contributes to the stability of the elbow joint? photo axilla/brachial plexus Please identify the muscles in this photo of the axilla Identify the components of the brachial plexus. What are the terminal branches of medial cord? discussion hand Please describe the sensory innervations of the hand. What dermatomes are represented on the hand What are the landmarks of the median nerve at the wrist? photo axilla Please describe the boundaries of the axilla What are the contents of the axilla? photo upper limb Identify the ulnar nerve in this photo and adjacent structures Demonstrate where sensation changes may occur if the ulnar nerve is injured in the forearm photo upper limb (rotator cuff) Identify the rotator cuff muscles in this image What are the actions of the rotator cuff muscles? What are their innervations? bone elbow joint Demonstrate the bony features that form the elbow joint articulation Describe the ligaments of the elbow joint and demonstrate their attachments photo cubital fossa Describe the boundaries of the cubital fossa Identify its contents in this photo Xray elbow Identify the bony features on this Xray What factors determine the stability of the elbow joint photo hand What structures can you identify in this image What are the attachments of the flexor retinaculum and what does the carpal tunnel contain Describe the median n supply in the hand discussion Describe the origins and insertions of the muscles in the thenar eminence Demonstrate the movements produced by these muscles What nerves innervate these muscles discussion Demonstrate the dermatomes of the upper limb On your own hand demonstrate which nerves supply sensation to which parts of the hand photo hand Describe the vascular supply of the hand What other major structures can you identify 18

19 Week 6-9: The Lower Limb Osteology Front of the Thigh Adductor Compartment Gluteal Region Hamstring Compartment Popliteal Fossa Front of the leg Dorsum of the foot Peroneal Compartment Calf Sole Joints Vessels Nerves Radiology Past Questions: Sciatic Nerve Structures in buttock dissection Course of the sciatic nerve in the buttock Describe its motor distribution in the thigh Lower limb Dermatomes Cutaneous nerves of lower limb Ankle and foot Identify bones Neurovascular relations of the medial malleolus How much skin is blocked with a posterior tibial block behind medial malleolus Femur Name & describe its proximal features Factors contributing to stability of the hip joint Ankle Attachments of the inferior extensor retinaculum Structures passing through the IER Function of the IER Ankle Structures passing behind the medial malleolus Cutaneous innervation of the tibial nerve Femoral Triangle (photo) Boundaries and contents Branches and course of the femoral artery Foot Bones of the tarsus Attachments of the medial collateral ligament (deltoid ligament) 19

20 Structures immediately posterior to the medial melleolus Knee XR Bony features Cruciate ligaments Factors contributing to the stability of the knee joint Tibia Features of the proximal ends Tibia and Fibula Tibiofibular joint What can be damaged by direct trauma to region of prox fibula Consequences of common peroneal nerve injury Popliteal fossa (photo dissection) Superficial boundaries Demonstrate the contents Distribution / supply of the common fibular nerve Knee (model) Major ligaments and attachments Actions of ligaments Attachments of menisci Foot Name the bones of the foot Which bones contribute to the medial longitudinal arch Major factors contributing to the stability of the bony arches of the foot Function of the longitudinal arches of the foot Leg Identify and describe the fibularis muscles What nerves supply these muscles Actions of the fibular muscles What joints are involved in the inversion and eversion of the foot Lateral ankle XR Identify bones Movements at ankle joint Femoral Triangle (model) Boundaries of the femoral triangle Contents What does the femoral nerve supply discussion Describe the superficial venous drainage of the lower limb discussion Outline the course of the common fibular n and its main branches What does it supply bone femur Identify this bone and the significant bony landmarks of the proximal portion What is the blood supply of the neck and head of the femur How does the capsule of the hip joint attach on this bone photo gluteal area Identify structures 20

21 Describe course of sciatic n and muscles it supplies bone femur Identify landmarks Demonstrate attachments of adductor muscles of the hip model ankle Identify ankle dorsiflexors What is their n supply Identify the insertions bone ankle joint Identify bony landmarks of ankle Name structures passing behind medial malleolus Xray ankle Please demonstrate the ligamentous attachments of the ankle joint What is the most common injury of the ankle joint? knee model Identify the ligaments of the knee joint and their attachments that you can see in this model Describe the main movements of the knee joint and the muscles that are involved Describe the locking and unlocking process that occurs with the weightbearing knee as we extend and flex the joint whilst walking foot Describe the peripheral nerves which supply sensation to the foot? Describe the dermatomes of the dorsum of the foot model leg Identify the muscles of the anterior compartment of the leg, describe their attachments Actions? What nerves supply the muscles of the anterior compartment of the leg? model leg Identify the fibularis muscles, describe their attachments. Actions? What nerves supply the fibularis muscles model leg Identify the muscles of the posterior compartment of the leg (calf). Describe the proximal attachments of the muscles of the superficial compartment Describe the actions of the muscles of the deep compartment bone ankle Demonstrate the bony features of the ankle joint Demonstrate the ligaments that stabilise the ankle joint (name and describe / show attachments) model lower limb Identify the muscles of the lateral compartment of the leg and describe their origins and insertions What is their nerve supply? What are their actions? 21

22 bone hip joint Demonstrate the bony features of the hip joint Describe the ligaments that stabilise the hip joint and demonstrate their attachments model leg On this model demonstrate the muscles of the posterior compartment of the leg. Demonstrate the origins and insertions of the superficial group What is their Nerve Supply? Describe their action model thigh Demonstrate the quadriceps muscles on this model What are their actions? What is their nerve supply? bone foot Identify the bones of the tarsus and foot What are the major dorsiflexors of the foot and where do they attach model posterior compartment of leg Identify the muscles of the posterior compartment of the leg What is the nerve supply of these muscles Using the model, describe the course of this nerve in the leg Xray knee Identify the bony structures that are shown on this Xray What factors stabilize the knee joint Describe the attachments of the cruciate ligaments model buttock The gluteus maximus has been removed. Identify the main structures seen here Demonstrate the course of the sciatic n and name the muscles that it supplies in the thigh Xray ankle Identify the bony features on this Xray Please describe the ligamentous attachments of the ankle joint photo femoral artery Describe the course and relationships of the femoral artery Describe the branches of the femoral artery bone femur Identify the important features of this bone Describe the blood supply to the head of the femur What is the clinical significance of this bone tibia Identify this bone and its main features Describe the articulations between this bone and the fibula Xray foot Identify the bones in this Xray What are the movements that occur in the foot and the joints where those movements occur 22

23 Weeks 10 11: The Central Nervous System; The Nervous System Brain o Mid Brain o Brain Stem o Cerebellum Spinal Cord Radiology CT head Nerve supply of body wall and limbs o Dermatomes o Myotomes Nerve supply of head and neck Autonomic nervous system o Sympathetic nervous system o Parasympathetic nervous system o Cranial autonomic ganglia Past Questions: CT brain Name the visible intracranial structures on this CT Demonstrate areas supplied by the MCA and outline the function of there ares CT brain Name the visible intracranial structures on this CT What structures does the CSF pass through to reach the base of the brain CSF Describe circulation of CSF Functions of the CSF Circle of Willis Draw the circle of Willis What area of the brain does each branch supply CT head Intracranial structures Describe the posterior circulation What areas of the brain do the main arteries of the posterior circulation supply CT head Identify the non bony features on this CT scan. Which bony sinuses are shown? What is the blood supply of the cerebellum? CT brain Identify anatomical features of the brain shown in this CT scan Describe the territories that the cerebral arteries supply CT brain Identify the anatomical features of the brain shown on this CT Describe the circulation of CSF in the brain 23

24 Weeks 12 13: The Head and Neck Skull and Cranial Cavity Face Mouth, Pharynx, Larynx Ear Neck Vessels Cranial Nerves Vertebral Column and Spinal Canal Eye Radiology face & neck; plain films and CT Past Questions: Thoracic vertebra Identify the major features Ligamentous attachments Lumbar vertebra Identify the major features Factors responsible for stability What layers are passed through in LP Neck Boundaries of the anterior triangle Identify major blood vessels (model with SCM removed) Identify structures (Submandibular gland, Parotid, Facial nerve, Masseter, Omohyoid, Digastric, Mandible, Hyoid) XR lateral neck Identify structures (bones, soft tissues) Boundaries of the spinal canal on this XR EOM & innervation Demonstrate the EOM (model) What is the nerve supply to these muscles Action of the inferior oblique C1 & C2 Features of C2 What ligaments stabilise the atlantoaxial joint What movement occur at C1/ Lateral C-spine Demonstrate the boney features of C1/2 on XR Components of the soft tissue shadow anterior to the upper cervical vertebrae Muscles of vocalistation, Nerve supply (Model) Identify structures of the larynx and upper airway Muscles of vocalisation Describe the nerve supply to the intrinsic laryngeal mm (mm of vocalisation) 24

25 Tongue muscles and nerve supply (model) Structures that make up the floor of the mouth Innervation of the tongue Mandible, TMJ, Muscles of mastication Features of the mandible Features of the TMJ Mandibular attachments of the muscles of mastication Larynx (model) Main features Innervation of the muscles of the larynx Neck (photo) Borders of posterior triangle Borders of anterior triangle Identify and branches of common carotid Skull (model) Bones that make up the orbit Identify superior and inferior orbital fissures Structures passing through superior orbital fissure Course of the infra orbial nerve and its distribution Facial XR Bones Sinuses Identify infra orbial foramen, what structure pass through it and what does it supply Vertebrae (lumbar and cervical) Features of lumbar vertebra What region is this from (cervical vertebra) Differences cervical v lumbar Movements between cervical vertebra and neighbours Neck (photo dissection) Identify major vascular structures Course of R subclavian Branches of subclavian Thoracic vertebra Features of this bone / where is it from How does it differ from other regions Anterior triangle of the neck Boundaries Surface markings of the carotid sheath Contents of the carotid sheath Location of the thyroid gland in the neck EOM (model) Identify the EOM and describe their function Nerve supply of EOM Effects of an occulomotor nerve palsy 25

26 C2 Identify this bone Anatomical features Major ligamentous attachments Xray face Demonstrate the walls of the orbit on this Xray and name the bones that form them Demonstrate the position of the infra-orbital n on this Xray What structures does the infra-orbital n innervate Xray lateral C-spine Identify the major bony features of the cervical spine in the Xray Describe the ligaments which maintain alignment of the C-spine model larynx Identify the structures that make up the larynx Describe the nerve supply of the larynx discussion Draw or describe the circle of Willis Which part of the brain is supplied by each of the major arteries discussion What is the motor supply of the muscles of facial expression? Discuss the non motor component of the facial nerve photo anterior triangle neck Define the boundaries of the anterior triangle of the neck. The internal jugular vein has been removed. Name some structures in the anterior triangle Name the branches of the external carotid bone skull Show me which bones make up the orbital rim? Describe the course of the infra-orbital nerve? What does the infra-orbital nerve supply? Xray Peg Demonstrate the bony features of the upper cervical vertebrae on this x- ray What ligaments stabilise these bones lateral neck Identify the major regions or triangles of the neck Identify the carotid triangle and its boundaries Identify the structures within the carotid triangle lateral C-spine XRay Demonstrate the bony features of the Atlas and Axis. Describe the movements of the head on the neck discuss CN 5 What are the main branches of the trigeminal nerve Describe the motor and sensory distribution of the trigeminal nerve Which nerve branch would you anaesthetize before repairing a lower lip laceration bone C1/C2 Name these bones. 26

27 Demonstrate their features and describe the structures stabilising the atlantoaxial joint. Describe the articular surfaces and the movements that occur at the Atlanto-axial joint? discussion CN What is the nerve supply to the extra-ocular muscles? What other structures are supplied by the III CN? What is the effect of a complete III N lesion? discussion face What is the sensory supply of the face? What is the motor supply to facial muscles photo face Name the branches of the facial n and indicate their position in the photo What is its main function What else does it supply model eye Identify the muscles responsible for eye movement and describe their function What is the nerve supply to these muscles What are the effects of an oculomotor nerve palsy bone C1/C2 C2 identify the features of this bone Describe the joints between C1 and C2 Which ligaments stabilize these joints discussion Draw a diagram depicting the Circle of Willis Which arteries supply which parts of the brain 27

28 Week 14: The Thorax Chest Wall and Diaphragm Mediastinum Heart and Great Vessels Airways and Lungs Radiology the CXR Past Questions: Q1 The heart Demonstrate the 4 chambers of the heart What is this (SVC) What are these valves (Ao, Pul) Demonstrate the coronary arteries and their branches Q2 CXR Mediastinal contours Diaphragm attachements Openings in the diaphragm First rib What is this? What are its features Neurovascular relations Layers when performing a needle thoracostomy through a lateral IC space Thorax (Photo) Identify the major vascular structures Branches of the descending thoracic aorta Chest wall Intercostals muscles Pattern of distribution of neurovascular structures in the thoracic wall Arterial supply of the intercostals spaces Cardiac chambers Chambers of the heart and their borders Arterial supply to the heart Venous drainage of the heart Heart (model) Chambers of the heart (model closed) Valves (model open) Conducting structures CXR Mediastinal borders Surface anatomy of the heart Diaphragm What are the different parts of the diaphragm What are their attachments Nerve supply of the diaphragm How does contraction of the diaphragm result in ventilation of the lungs Thoracic inlet (photo) Vascular structures Branches of the subclavian artery 28

29 Posterior relations of the thyroid gland Surface anatomy of the pleura Describe the surface anatomy of the parietal pleura Compare surface anatomy of the lung to the that of the pleura model heart Describe the arterial supply of the heart What does the right coronary artery supply Demonstrate the venous drainage of the heart bone first rib What bone is this What are the bony landmarks What muscles attach to this bone CXR Demonstrate the borders of the mediastinum on this Xray In the supine position, which mediastinal structures are located at the same level as the sternal angle surface anatomy Describe the surface anatomy of the parietal pleura. What is the clinical significance of the attachment of the pleura? Model heart Identify the chambers of the heart on this model Demonstrate where the major components of the conducting system would be found on this model photo thoracic inlet Identify the veins involved in drainage of the head and upper limb on the left side of this specimen The Right IJV has been removed (demonstrate this) identify the structures that lie adjacent to the Right IJV bone thoracic vertebrae Identify this bone, and demonstrate its bony features. What movements are possible at thoracic vertebrae? Demonstrate the ligaments Xray chest Outline the structures that make up the right and left cardiomediastinal borders on this X-Ray Which corresponding part of the lungs lie adjacent to the right and left cardiomediastinum Which part of the heart lies immediately behind the sternum (Prompt : What forms the anterior surface of the heart bone thoracic vertebra Identify this bone, and demonstrate its bony features. What movements are possible at thoracic vertebrae? Demonstrate the ligaments CXR Identify the structures that make up the mediastinal contours on this CXR Describe the lobes of the lungs and their fissures discussion heart Describe the arterial blood supply of the myocardium. 29

30 What is the blood supply of the conducting system? Describe the venous drainage of the heart discussion superior mediastinum Describe the vascular structures which lie in the superior mediastinum Can you name the other structures which lie in the superior mediastinum bone scapula Identify the anatomical landmarks of this bone Demonstrate the muscular attachments on the posterior surface What are the muscles involved in Abduction of the shoulder joint bone clavicle Identify and describe the features of this bone What structures stabilise the acromioclavicular joint discussion lungs Can you describe the surface anatomy of the lungs and pleura What are the anatomical structures to consider when inserting a lateral chest tube photo lung Longitudinal section through hilum of left lung What structures can you identify What are the branches of the aortic arch photo thoracic inlet Identify the vascular structures in this photo What is the anatomical relationship of the internal jugular vein to the carotid artery Describe the surface marking of the internal jugular vein model heart Describe the arterial supply of the heart Identify the chambers and valves of the heart Identify the components of the tricuspid valve 30

31 Week 15: The Abdomen Abdominal Wall and Peritoneum Gut, Liver, Spleen, Pancreas, Kidneys and Ureters, Bladder and Urethra. Reproductive Organs Joints of Pelvis Vessels Nerves Radiology Past Questions: AXR / Male genitals Outline the course of the ureters on XR Outline the expected course of the aorta What is the lymphatic drainage of the male genitalia Abdo photo Left Kidney Vascular structures adjacent Ureter identify, narrow points Abdo (photo) What are the unpaired visceral branches of the abdominal aorta Branches of the coeliac trunk Venous structures in abdo Pelvis (soft tissue photo) Structures in this photo Potential spaces for fluid to collect Pelvis XR Major boney features Boney attachments of thigh flexors Posterior abdo wall (photo) All major structures Course of ureter from kidney to bladder Common sites of ureteric narrowing Pelvis XR Major boney features Attachments of the ligaments of the hip joint Blood supply of the gut Branches of the abdominal aorta that supply the gut Arterial supply of the stomach Arterial supply of the colon Pelvis (photo of dissection) Major anatomical structures Describe the innervation of the bladder Identify structures that innervate the bladder CT Abdo (upper) Identify structures on contrast scan Which are retroperitoneal Potential spaces for fluid collection when supine Posterior abdominal wall (photo) 31

32 What can you identify Course of the ureters and narrow points Arterial supply of the ureter CT upper abdo Identify intra-abdo structures Relations of the pancreas\ Male urethra Parts of the male urethra and the course of each part Where is it narrowest In a case of ruptured spongy urethra, where does the urine extravasate Pelvis, major vessels, ureter (photo) Identify the ureters Course of the ureter and narrow points Vascular structures in this photo bone pelvis What bones make up this structure and what are their major features? What are the lateral rotations of the femur and and where do they originate photo female pelvis Midline sagittal section name the major anatomical structures Describe the boundaries and relations of the Pouch of Douglas CT abdomen Identify the intra-abdominal structures visible in this CT scan Describe the relations of the right kidney bone sacrum Identify the features of this bone Xray pelvis Identify the bony features of this x-ray Describe the anatomy of the iliopsoas muscle discussion Describe the transpyloric plane. What are the anatomical structures transected at the transpyloric plane? discussion Name the branches of the abdominal aorta Describe the anatomy of the superior mesenteric artery bone lumbar vertebra Identify this bone, and demonstrate its bony features. What movements occur in the lumbar spine? What structures are traversed when you perform a lumbar puncture? photo abdomen What structures can you identify on this photograph? Describe the course of the ureters, and identify the narrow points What is the arterial blood supply of the ureter? Xray abdomen On this Xray, please demonstrate the transpyloric plane Please outline the course of the ureters Outline the expected course of abdominal aorta 32

33 discussion Describe the portal-systemic anastamoses. When do these become clinically significant? abdo Xray Describe the path of the ureter in this Xray Where does the ureter narrow in the pelvis anatomically Give a clinical example of why this may be important discussion Describe the course and branches of the abdominal aorta What is the relationship of the IVC to the aorta model female pelvis Identify the major anatomical structures in this model Name the potential spaces where free fluid can accumulate in the pelvis and demonstrate their boundaries CT abdomen Identify the structures visible on this CT What are the branches of the abdominal aorta model male pelvis Identify the structures that form the male genitourinary system in this model What are the contents of the spermatic cord Indicate the location of the named parts of the urethra Weeks 16 22: Revision and exam practice 33