How anatomy is examined
According to the FACEM Training Handbook, the Primary Written Examination is two three-hour papers, each of 180 select-choice questions, across anatomy, pathology, physiology and pharmacology. It can be attempted at any time in Training Stage 1, and the pass standard is a pre-defined level of performance. Once it is passed, the Primary Integrated Viva is four 10-minute stations, each scored across anatomy, pathology, physiology, pharmacology and clinical building blocks. Check the ACEM website for the current format and dates.
Anatomy questions tend to test what matters at the bedside: the nerve at risk with a fracture, the layers a needle passes through, the landmark for a procedure, or the deficit that follows a lesion.
High-yield regions
| Region | What to know | Emergency link |
|---|---|---|
| Airway and larynx | Laryngeal cartilages, cricothyroid membrane, recurrent laryngeal nerve, epiglottis | Intubation and front-of-neck access |
| Neck | Triangles, carotid sheath, internal jugular relations, brachial plexus roots | Central lines and penetrating neck injury |
| Thorax | Intercostal neurovascular bundle, pleural reflections, mediastinum | Chest drain in the safe triangle |
| Upper limb | Brachial plexus, median, ulnar and radial nerves, carpal bones | Fractures, dislocations, regional blocks |
| Lower limb | Femoral triangle, sciatic nerve, compartments of the leg, ankle ligaments | Fascia iliaca block, compartment syndrome |
| Abdomen and pelvis | Peritoneal relations, retroperitoneal organs, inguinal canal | Trauma, hernias, FAST windows |
| Neuroanatomy | Cranial nerves, spinal cord tracts, vascular territories | Stroke and spinal cord syndromes |
Peripheral nerve injuries
| Injury | Nerve at risk | Deficit |
|---|---|---|
| Midshaft humerus fracture | Radial nerve | Wrist drop, sensory loss over first dorsal web space |
| Anterior shoulder dislocation | Axillary nerve | Deltoid weakness, regimental badge sensory loss |
| Supracondylar fracture in a child | Anterior interosseous (median) nerve | Weak pinch (OK sign) |
| Medial epicondyle injury | Ulnar nerve | Intrinsic hand weakness, clawing of ring and little fingers |
| Fibular neck fracture | Common fibular nerve | Foot drop, sensory loss over dorsum of foot |
| Posterior hip dislocation | Sciatic nerve | Weakness below the knee |
Procedural anatomy
- Chest drain: safe triangle bordered by the lateral edge of pectoralis major, the anterior border of latissimus dorsi and the fifth intercostal space; insert just above the rib to avoid the neurovascular bundle.
- Cricothyroidotomy: the cricothyroid membrane lies between the thyroid and cricoid cartilages.
- Femoral line: from lateral to medial, nerve, artery, vein (NAVY) below the inguinal ligament.
- Fascia iliaca block: deposits local anaesthetic deep to the fascia iliaca to reach the femoral and lateral femoral cutaneous nerves.
- Lumbar puncture: below the end of the spinal cord (usually L1 to L2 in adults), at L3 to L4 or L4 to L5, using the intercristal line.
Worked questions
Worked SCQ 1 · Upper limb
A 34-year-old has a midshaft humeral fracture after a fall. Which deficit is most likely?
- A Loss of shoulder abduction
- B Wrist drop
- C Clawing of the ring finger
- D Weak thumb opposition
- E Loss of elbow flexion
Show the reasoning
Answer B. The radial nerve runs in the spiral groove of the humerus and is at risk in midshaft fractures, causing wrist and finger extensor weakness with sensory loss over the first dorsal web space.
Worked SCQ 2 · Thorax
Why is a chest drain inserted just above the upper border of a rib?
- A The parietal pleura is thinnest at that level
- B To avoid the intercostal neurovascular bundle
- C To enter the lung directly
- D To avoid the internal thoracic artery and its branches
- E Because the rib protects the diaphragm
Show the reasoning
Answer B. The intercostal vein, artery and nerve run in the costal groove along the inferior border of each rib, so insertion above the rib below avoids them.
A 6-week anatomy plan alongside clinical work
| Week | Focus |
|---|---|
| 1 | Upper limb: brachial plexus and nerve injuries |
| 2 | Lower limb and pelvis |
| 3 | Thorax and procedures |
| 4 | Head, neck and airway |
| 5 | Abdomen and neuroanatomy |
| 6 | Mixed timed sets and error log review |
Do 20 to 30 timed questions on most days and keep an error log: write the concept you missed in one line, then revisit it at the end of the week.
Common anatomy traps
- Learning lists without linking them to injuries and procedures.
- Confusing median nerve branches.
- Forgetting variations in the femoral triangle.
- Neglecting neuroanatomy and vascular territories.
- Not doing timed sets: 360 questions over six hours rewards speed.
Free sample anatomy questions
Questions from our Emergency (ACEM) bank. Choose your answer, then open the explanation.
During a can't intubate, can't oxygenate emergency, a scalpel cricothyroidotomy is performed. Which structure lies immediately above the cricothyroid membrane?
- AIsthmus of the thyroid gland overlying rings two to four
- BFirst tracheal ring
- CCricoid cartilage
- DThyroid cartilage
- EHyoid bone
Show answer and explanation
Answer D. The cricothyroid membrane lies between the thyroid cartilage above and the cricoid cartilage below. It is relatively avascular in the midline, making it the site for emergency front-of-neck access.
Learning point: Cricothyroid membrane: between thyroid cartilage (above) and cricoid (below).
After a knee dislocation, which artery must be assessed urgently?
- ASaphenous artery
- BFemoral artery in the groin
- CPopliteal artery
- DDorsalis pedis only
- EAnterior tibial vein
Show answer and explanation
Answer C. The popliteal artery is tethered above and below the knee and is injured in up to a third of knee dislocations. Assess pulses and ankle-brachial index; CT angiography if abnormal.
Learning point: Knee dislocation: popliteal artery injury; check ABI.
A glass laceration at the wrist causes loss of thumb opposition. Which nerve?
- AUlnar nerve
- BMedian nerve
- CRadial nerve superficial branch
- DMusculocutaneous nerve
- EPosterior interosseous nerve
Show answer and explanation
Answer B. The recurrent motor branch of the median nerve supplies the thenar muscles (LOAF: lateral lumbricals, opponens, abductor and flexor pollicis brevis). Injury causes loss of opposition.
Learning point: Median nerve: LOAF muscles and thumb opposition.
Practise more anatomy questions free
Every anatomy subtopic in our bank
The bank holds 35 anatomy questions across 35 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Abdominal aorta branches1
- Achilles rupture1
- Anatomical snuffbox1
- Axillary nerve and shoulder dislocation1
- Brachial plexus lower trunk1
- Brachial plexus roots1
- Carotid sheath1
- Circle of Willis territories1
- Common fibular nerve1
- Compartments of the leg1
- Coronary sinus and veins1
- Cricothyroid membrane1
- Diaphragm openings1
- Epidural haematoma1
- Facial artery and nerve landmarks1
- Facial nerve1
- Femoral nerve block1
- Inguinal canal1
- Intercostal drain site1
- Knee dislocation1
- Larynx innervation1
- Lumbar disc herniation1
- Median nerve at wrist1
- Neurovascular bundle1
- Popliteal artery1
- Recurrent laryngeal nerve1
- Retroperitoneal organs1
- Rotator cuff tear test1
- Scalp layers1
- Scaphoid blood supply1
- Spinal cord level1
- Supracondylar fracture1
- Thoracic outlet and subclavian1
- Ulnar nerve at elbow1
- Vertebral level landmarks1
Common questions
How many questions are in the ACEM Primary written exam?
The FACEM Training Handbook describes two three-hour papers, each of 180 select-choice questions. Check ACEM for the current format.
Is anatomy in the Primary viva?
Yes. Each Integrated Viva station is scored across anatomy, pathology, physiology, pharmacology and clinical building blocks.
Which anatomy resources do trainees use?
An applied anatomy textbook, an atlas and procedure-focused learning, together with timed questions.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.