Table Of ContentFirst FRCR Anatomy
Questions and Answers
UsmanShaikh
InterventionalRadiologyFellow,RoyalLiverpool
UniversityHospital,Liverpool,UK
JohnCurtis
ConsultantRadiologist,UniversityHospitalAintree,
Liverpool,UK
RebeccaHanlon
ConsultantRadiologist,
UniversityHospitalAintree,Liverpool,UK
DavidWhite
ConsultantRadiologist,
UniversityHospitalAintree,Liverpool,UK
AndrewDunn
ConsultantRadiologist,
RoyalLiverpoolUniversityHospital,Liverpool,UK
AndrewHealey
ConsultantPaediatricInterventionalRadiologist,
AlderHeyChildren’sHospital,Liverpool,UK
JaneBelfield
ConsultantRadiologist,RoyalLiverpoolUniversityHospital,Liverpool,UK
ElizabethKneale
RadiologyRegistrar,
UniversityHospitalAintree,Liverpool,UK
PeterDangerfield
UniversityofLiverpool,
Liverpool,UK
HilaryFewins
ConsultantRadiologist,
LiverpoolHeartandChestHospital,Liverpool,UK
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FirstFRCRanatomy:questionsandanswers/JohnCurtis...[etal.].
p.;cm.
Includesindex.
ISBN978-1-107-67949-8(Paperback)
I. Curtis,John,1963–
[DNLM: 1. Anatomy–CaseReports. 2. Anatomy–ExaminationQuestions.
3. Radiology–CaseReports. 4. Radiology–ExaminationQuestions. QS18.2]
616.07057076–dc23
2011034134
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Contents
Foreword pagevii
Preface ix
Introduction 1
Examination 1: Questions 3
Examination 1: Answers 23
Examination 2: Questions 31
Examination 2: Answers 51
Examination 3: Questions 58
Examination 3: Answers 78
Examination 4: Questions 85
Examination 4: Answers 105
Examination 5: Questions 113
Examination 5: Answers 133
Examination 6: Questions 141
Examination 6: Answers 161
Examination 7: Questions 167
Examination 7: Answers 187
Examination 8: Questions 193
Examination 8: Answers 213
v
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Foreword
Knowledge and understanding of human anatomy is a key element of medical
training,whetheritisatanundergraduateoratapostgraduatelevel.Thisisparticu-
larlysoininterpretingradiologicalimages.Agoodradiologistrequiresmanydiffer-
ent skills and competences, but right up there at the top of the list is a detailed
knowledgeofanatomyrelevanttoradiology.Overrecentyearsithasbecomeappar-
entthattheknowledgeofanatomyacquiredatmedicalschoolandinspecialtiesprior
to entry to radiology training is variable and the Royal College of Radiologists
hasmadeitoneofitsprioritiestosetthestandardofradiologicalanatomicalknow-
ledge that all radiologists should achieve. Theoretically, knowledge of anatomy
should be possible to acquire as a radiology trainee passes through the modular
training, but many involved in training have realized that this on its own is not
sufficient.Acurriculumandanappropriateformofassessmentarerequiredtoensure
consistency,andthereisgoodevidencethattheneedtopassanexamdriveslearning.
The recently introduced anatomy curriculum and the First Part FRCR anatomy
examinationareintendedtoachievethisend.
Radiologicalimages,particularlycross-sectionalimages,arealsoanexcellentway
of teaching anatomy to medical students, and more and more medical schools are
taking advantage of this facility, as are specialties where anatomy is essential for
practicewithinthatparticularareaofmedicine.Theexcitingdevelopmentsinmolecu-
lar and functional imaging mean that it is now even more important to be able to
localize a particular function to a particular anatomical structure, and this is only
possiblewithanexcellentunderstandingandknowledgeofanatomy.
A key element of a modern curriculum is that students should undertake regular
formativeassessmenttoallowthemtoevaluatetheirownprogressandidentifytheir
trainingneedsandthatpartofthisshouldbeself-assessment.Thereareanumberof
resourcesavailabletoachievethisandamongstthemarebooksproducedspecifically
forthispurpose,web-basedmaterialandtheradiology–integratedtraininginitiative
(R-ITI)e-learningdatabase(e-LD).
DrDavidRMLindsellFRCR
vii
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Preface
The reintroduction of an anatomy section heralded a welcome return to the part 1
FRCR examination. Anatomy is the main cornerstone on which radiology rests and
without a good grounding, being an effective radiologist is impossible. Clinicians
oftencalluponradiologiststoguidethemwithanatomyinadditiontosteeringthem
towardsbetterdiagnosisandmanagementoftheirpatients.
Our aim with this book was much more than a simple pre-examination self-
assessment text. From its inception, we wanted to write a text that would prove
equally as useful after the part 1 FRCR examination and therefore endeavoured to
include radiological ‘pearls’ that would serve the radiologist well throughout his or
her career. Similarly a non-radiologist reading the text would derive significant
benefitin theirparticular field. The authors havechosen theseclinical ‘pearls’,from
withintheir own susbspecialties, rather than purelydidacticinformation thatmight
beobtainedinotherstandardtextbooks.
The cases in this book very closely match the standard type of cases likely to be
encounteredintheactualanatomysectionoftheexamination.
Self-assessment gives immediate feedback to the reader which is often lacking in
larger texts. Furthermore it gives a framework for further reading in the various
subspecialties. We also believe that this text will be invaluable to medical students,
foundationdoctorsandspecialisttraineesinsurgeryandmedicine.
We would like to thank all of the contributing authors for their hard work in
diligentlyputtingquestionstogetherandfortheirsharedwisdom.
UsmanShaikh
JohnCurtis
June2011
ix
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Introduction
Atthetimeofwriting,theanatomysectionofthepart1FRCRexaminationconsistsof
00
20digitalimages presented on acomputer witha19 monitor.Eachimagehasfive
questionsattached,labelleda–e.Youwill have75minutes toanswer atotalof one-
hundredquestions.
TheimagespresentedareDICOMimages,whichhavebeenconvertedintoj-pegs
or tiffs in order to allow annotated symbols to be applied. These images are then
convertedbackintoDICOManduploadedontoanOsiriXdatabase.Itisabsolutely
essentialtofamiliarizeyourselfwiththissoftwarepriortotheexamination.Itshould
be noted that the OsiriX software is only available for Apple Macs and not on IBM
PCs.Thereishoweveropportunitypriortothestartoftheexaminationtomanipulate
sampleimages.Theanswersaretobewrittenintoabooklet.
There is further information regarding the examination available on the Royal
CollegeofRadiologistswebsitewww.rcr.ac.ukwhichshouldbepartofyouressential
revision.Therearealsosamplequestionsandanswerstoaccess.
Thebasicsaretrueforanyexaminationbutneedtobereiteratedhere.
This is not an examination to be taken lightly. The anatomy learned at medical
school may be far removed from radiological anatomy in the workplace. However,
more and more medical schools are using radiological anatomy to educate their
undergraduates.Anatomyhasbeen‘broughttolife’intheworkplacebyradiologists.
AgoodwayoflearninganatomyistositatyourPACSworkstation.Ononescreen
put up a patient's chest radiograph with a CT scan of the thorax on the adjacent
screen.ScrollingthroughtheCTstudyallowseasierexplanationoftheproductionof
interfacesseenonthechestradiograph.Thisappliesequallyaswellwiththeabdom-
inal radiograph and CT of the abdomen and pelvis. The anatomy tested in the
examination is not beyond the scope of most of the basic radiology atlases and
thereforearegularconsistentapproachtorevisionisadvised.
Theexaminationisnotnegativelymarkedandthereforetheremustbeananswerin
everybox.
An easy way to lose marks is not stating the side of the labelled structure, for
instance,rightlateralventricle.Forthepurposesofthisbook,iftherecanonlybeone
side(e.g.imageofarightknee)thenforeaseofreadingthesidehasnotbeenincluded
intheanswer.
Eachpersonhasadifferentapproachtorevisionandifyoupreferonlinelearning
then there are a number of websites providing radiological e-learning options.
AlthoughanumberofthesewebsitesareAmerican,andthereforenotgearedtowards
the part 1 FRCR examination, there is a degree of overlap and these sites are well
worth a visit. The Radiology – Integrated Training Initiative (R-ITI) should not be
overlookedasitcontainsusefulinformationandiswrittenbylike-mindedpeopleto
whowouldsettheanatomyexamination.Otherwebsitesthatourtraineeshavefound
usefulinclude:
http://www.radiologyanatomy.com/index.php
http://www.info-radiologie.ch/index-english.php
http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/x_sec/mainx_sec.
htm
http://radiologytutorials.com/
1
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n http://web.mac.com/rlivingston/Eycleshymer/Welcome.html
o
ti http://www.rad.washington.edu/academics/academic-sections/msk/teaching-
uc materials/radiology-anatomy-teaching-modules/
d
o
r There are a number of anatomy courses now run as preparation prior to sitting the
t
n examination.Similartomocktestsinbookstheytutoryouinkeyanatomywithtipsto
I
avoid simple mistakes. Their one-day format provide focussed revision and they
serveasausefuladjunct.
2
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Examination 1: Questions
Case 1.1
A
B
C
D
QUESTION WRITEYOURANSWERHERE
(a) Namethestructure
labelledA.
(b) Namethestructure
labelledB.
(c) Namethestructure
labelledC.
(d) Namethestructure
labelledD.
(e) Whichnormal
variantispresent
onthisimage?
3
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