PRIMES (Volume I)

COLUMNS OF CRANIAL NERVE NUCLEI

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 Anatomy (High-yield Points)

Efferent columns of cranial nerves

Type of columns Nuclei and destination
GSE (General ƒƒ Supplies muscles derived from head somites e.g. extraocular muscles, tongue muscles (nuclei are motor in
somatic efferent nature).
or Somatic motor ƒƒ Examples are:- [ Mnemonic: OTAH]
column) ○○ Oculomotor nucleus in midbrain at the level of superior colliculus → Extrinsic muscles of eye except LR & SO.
○○ Trochlear nucleus in midbrain at the level of inferior colliculus → SO of eye
○○ Abducent nucleus in lower pons → LR
○○ Hypoglossal nucleus in medulla → supplies 7 tongue muscles (through CN 12) except palatoglossus .

SVE (BE or ƒƒ Supplies muscles derived from branchial/pharyngeal arches (nuclei are branchio-motor in nature).
branchiomotor ƒƒ Examples are:-
column) ○○ Motor nucleus of trigeminal nerve (CN5) in upper pons,
○○ Nucleus of facial nerve (CN7) in lower pons,
○○ Nucleus ambiguus in medulla
GVE (General ƒƒ Supplies preganglionic parasympathetic fibres to glands & visceral smooth muscles (nuclei are mainly secreto-
visceral efferent motor in nature).
column) ƒƒ Examples are:-
○○ Edinger Westphal Nucleus (EWN) (for oculomotor nerve) in midbrain at the level of superior colliculus → to

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sphinctor pupillae & ciliaris
○○ Dorsal motor nucleus of vagus (CN 10) in medulla → Thoracic /abd viscera
○○

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Lacrimatory nucleus in lower pons → to lacrimal & nasal glands via pterygopalatine ganglion & greater
Vo
petrosal br of facial nerve.
○○ Superior salivatory nucleus in lower pons → to submandibular & sublingual salivary glands via chorda
tympani
○○ Inferior salivatory nucleus in lower pons → to parotid gland via otic ganglion (10th CN)
Es

Afferent columns of cranial nerves

GVA & ƒƒ Only nucleus is nucleus tractus solitarius (Solitary tract nucleus)
iM

SVA (BA) ○○ It receives general visceral sensations (GVA) through CN 10 & vagus
○○ It receives special visceral sensation (SVA or branchial afferent) of taste through CN 7 & 10
GSA (General ƒƒ There are 3 nuclei . All receive sensation through trigeminal nerve
PR

somatic afferent ○○ Superior or main sensory nucleus lies in upper pons.

column) ○○ Spinal nucleus descends through medulla & C1 C2 segment of spinal cord.
○○ Mesencephalic nucleus ascends up to midbrain. Only example of primary sensory neuron whose cell bodies
are within CNS.

SSA (Somatic ƒƒ Receive sensation through 8th (chochleo-vestibular ) nerve

somatic afferent ○○ Cochlear nuclei : (dorsal & ventral) at junction of medulla and pons.
column) ○○ Vestibular nuclei receive fibres from SCC, utricle,saccule through vestibular nerve.

GVE (General ƒƒ Supplies preganglionic parasympathetic fibres to glands & visceral smooth muscles.
visceral efferent ƒƒ Examples are:-
column) ○○ Edinger Westphal Nucleus (EWN) (for oculomotor nerve) in midbrain at the level of superior colliculus → to
sphinctor pupillae & ciliaris
○○ Dorsal motor nucleus of vagus (CN 10)in medulla → Thoracic /abd viscera
○○ Lacrimatory nucleus in lower pons → to lacrimal & nasal glands via pterygopalatine ganglion & greater
petrosal br of facial nerve.
○○ Superior salivatory nucleus in lower pons → to submandibular & sublingual salivary glands via chorda
tympani
○○ Inferior salivatory nucleus in lower pons → to parotid gland via otic ganglion (10th CN)

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 PRIMES (Volume I)

CRANIAL NERVES

T ROCHLEAR NERVE ‰‰

‰‰
Crossed CN
Only CN whose Fiber originate completely from
‰‰

‰‰
Longest intracranial course
Most slender CN
(CN-IV) contralateral nucleus ‰‰ Enters orbit through lateral part of superior orbital
‰‰ It supplies the C/L SO m/s fissure
‰‰ Emerges dorsally from brainstem

T RIGEMINAL
NERVE (CN-V)

Trigeminal nerve
nuclei and sensory
supply of V CN

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Trigeminal nerve Nuclei Sensory supply of face by V CN
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Divisions of Trigeminal Nerve (CN-V)

trigeminal nerve Ophthalmic divsion (V1) Maxillary division (V2) Mandibular division (V3)
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Supratrochlear nerve Infraorbital nerve Auriculotemporal nerve

Supraorbital nerve
Lacrimal nerve
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Mandibular
division of
trigeminal nerve

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 Anatomy (High-yield Points)

Maxillary
division (V2)
of trigeminal
nerve

Tests of Testing Trigeminal Nerve ‰‰ Reflexes

trigeminal •• Loss of sneezing reflex
‰‰ Sensory: By cotton wool test
nerve •• Loss of corneal reflex
‰‰ Motor
– Afferent → Nasociliary br of ophthalmic
•• Temporalis and masseter fail to become
division of V CN
prominent
── Efferent → Facial nerve
•• Jaw deviates towards normal side
‰‰ Great auricular n. supplies over angle of jaw and
over parotid gland.

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F ACIAL NERVE ‰‰ SVA: Carry taste from anterior 2/3rd of tongue ‰‰ GVE: Secretomotor to submandibular and
(CN-VII)
(except vallate papilla) and palate.
l. sublingual salivary glands lacrimal glands.
Vo
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Facial nerve branches

and lesions
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 PRIMES (Volume I)

V AGUS NERVE

Vagus nerve joins

cranial root of XI
nerve and passes b/w
IJV and carotid artery
in carotid sheath

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Branches of vagus
nerve
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‰‰ SVA/BE→ N. ambiguous: Palatoglossus (muscle of tongue)

•• M/s of soft palate exception tensor veli palatini
•• M/s of pharynx except stylopharyngeus (By Glossopharyngeal nerve)
‰‰ SVA: Taste from posterior part of tongue

Nerve Supply of Soft Palate

‰‰ Motor: All mls are supplied by pharyngeal plexus derived from cranial accessory n. through vagus.
(exception tensor veli palatini by V3)
‰‰ Sensory: V2 through pterygopalatine ganglion IX CN
‰‰ Taste: Chorda tympani branch of facial n
‰‰ All muscles of pharynx are supplied by pharyngeal plexus except stylopharyngeus (Glossopharyngeal n.)

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 Anatomy (High-yield Points)

C RANIAL AND Cranial and spinal accessory nerves

SPINAL ACCESSORY Spinal    Cranial
NERVE (CN-XI) 1. SCM 1. Pharyngeal muscles except stylopharyngeus
2. Trapezius 2. Sup/middle/inf. constrictors, palato/salpingo/cricopharyngeus
ƒƒ Injury leads to- 3. Soft palate except tensor veli palatini (Palatoglossus/
○○ Weakness of shrugging palatopharyngeus)
○○ Winging of scapula 4. Stylopharyngeus - 9th CN
5. Tensor veli - Nerve to pterygoid from mandibular nerve.

H YPOGLOSSAL
NERVE
(CN-XII)
AND ANSA
CERVICALIS

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OTHER IMPORTANT NERVES OF TRUNK AND LIMBS

P HRENIC NERVE
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‰‰ Right phrenic nerve shorter and more vertical than left (Remember: Right bronchus is also shorter, broader
and more vertical than left bronchus).
‰‰ Supply
•• Motor → Diaphragm
•• Sensory
── Pleura-diaphragmatic and mediastinal
── Pericardium-fibrous and parietal layer of serous pericardium
── Parietal peritoneum below central part of diaphragm (Visceral layer is supplied by vagus)
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 PRIMES (Volume I)

SYMPATHETIC/ ‰‰ Sympathetic ganglion trunk extends from base of

skull to coccyx
THORACO- ‰‰ Sympathetic outflow → T1 to L3/L4
LUMBER to face → T1 – L4
OUTFLOW ‰‰ Thoracic sympath Trunk
•• Across the neck of 1st rib
•• Heads of 2nd to 10th rib
•• Bodies of 11th and 12th rib
‰‰ Descents in front of posterior intercostal vessels
and IC nerves
‰‰ Passes deep to medial arcuate ligament.

MEDIAN
AND
ULNAR

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Median nerve Ulnar nerve

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 Anatomy (High-yield Points)

Nerve palsy Site M/S Affected CF

PIN (Posterior ƒƒ Below – ƒƒ Elbow, writs, IP joint extension and sensation are spared
interosseous br. of elbow ƒƒ Loss of MCP joint extension (Finger drop)
radial n.)
Median nerve ƒƒ Wrist ƒƒ AB PB ƒƒ Pen test in +ve
ƒƒ AB PB ƒƒ Ape thumb deformity
ƒƒ Opponens pollicis ƒƒ Loss of Opposition
ƒƒ Elbow ƒƒ PQ and PT ƒƒ Loss of Pronation \ Forearm is kept is supine position
ƒƒ Flexors except few and FDP ƒƒ Wrist flexion is weak and accompanied by adduction
ƒƒ FPB ƒƒ Flexion of terminal phalanx of thumb is lost
ƒƒ FDS and FDP (lat 1/2) ƒƒ Flexion of IP joint of index and middle finger is lost so there is
pointing index or +ve oschner clasp and Benediction test
Ulnar nerve – ƒƒ Palmer interossei ƒƒ +ve card (PAD)
[Mn: ABCDEF] – ƒƒ Adductor pollices ƒƒ +ve Book test/Froment sign (Pt holds book b/w thumb and index
finger by using Fph)
ƒƒ Dorsal interossei ƒƒ +ve Egawa’s test (side to side movement of middle finger is weak)
“DAB”
ƒƒ Loss of Abductn of fingers

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ƒƒ FCU ƒƒ Deviation of hand towards radial side when wrist is flexed
ƒƒ Lumbricals ƒƒ Loss/weakness of extension of middle and terminal phalanges of

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medial 2 fingers due to weakness of
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ƒƒ Ulnar claw hand
ƒƒ Atrophy of hypothenar area

R ADIAL NERVE
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 PRIMES (Volume I)

P UDENDAL
NERVE

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N EURAL
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PATHWAY OF
ERECTION
PR

C ELIAC PLEXUS

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 Anatomy (High-yield Points)

P ELVIC
SPLANCHNIC
NERVES
Functions
‰‰ Urination and defecation → Motor to sumj of

rectum anus and bladder wall but (–) to vesicle

sphinx
‰‰ Exection-due to VD

‰‰ VD to testes ovaries FT. uterus.

I MPORTANT

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Muscles Nerves Supply Muscles Nerves Supply
MUSCLE AND ƒƒ Supraspinatus ƒƒ Suprascapular nerve ƒƒ Brachialis ƒƒ Radial (and

THEIR NERVE ƒƒ Deltoid m/s ƒƒ Axillary nerve

l. musculocutaneous)
Vo
ƒƒ Gluteus maximus ƒƒ Inf. gluteal nerve
SUPPLY ƒƒ S. anterior ƒƒ Long thoracic nerve
Or nerve of bell ƒƒ G. medius ƒƒ Sup gluteal nerve
ƒƒ Trapezius ƒƒ Spinal part of ƒƒ G. minimus
ƒƒ Tensor fascia lata
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accessory nerve
ƒƒ Biceps Brachi ƒƒ Musculocut nerve ƒƒ Inf. gemellus ƒƒ Nerve to Q. femoris
ƒƒ Brachialis (IQ)
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ƒƒ Coracobrachialis ƒƒ Sup. gemellus ƒƒ Nerve to obturator

ƒƒ Brachioradialis ƒƒ Radial nerve internus (So)
PR

ƒƒ T. minor ƒƒ Axillary nerve ƒƒ Biceps femoris (short ƒƒ Common Peroneal

head) nerve (br. of sciatic
ƒƒ FDS ƒƒ Median nerve
nerve)
ƒƒ FDP ƒƒ Biceps femoris (long ƒƒ Tibial nerve (br. of
Radial half ƒƒ Median nerve
head) sciatic nerve)
Ulnar half ƒƒ Ulnar nerve
ƒƒ Obturator externus ƒƒ Obturator nerve

A XILLARY NERVE ƒƒ Injured in # of surgical neck humerus and Shoulder dislocation

ƒƒ Distribution of axillary nerve
(CIRCUMFLEX
HUMERAL) NERVE) Motor Sensory
↓ ↓
Deltoid, T. minor Upper lateral cutaneous nerve of arm
      ↓ (Palsy)       ↓ (Palsy)
Loss of rounded contour, Weakness of abduction Regiments batch anesthesia

M USCULOCUTE- Distribution of musculocuteneous nerves

NEOUS NERVE Muscular Cutaneous
ƒƒ Biceps ƒƒ Lateral cutaneous nerve of forearm
(C5C6C7)
○○ Supinates forearm
○○ Flexor in supine position
ƒƒ Brachialis (Supplied by Radial nerve also) 33
○○ Flexes forearm in all position
ƒƒ Coracobrachialis
 PRIMES (Volume I)

D ORSUM OF
FOOT AND
SOLE OF FOOT

Muscles of Leg in 4 Osteofacial Compartment

Compartments Anterior compartment Lateral compartment Posterior compartment
Nerve supply ƒƒ Deep peroneal nerve ƒƒ SF Peroneal nerve ƒƒ Tibial nerve
Muscle ƒƒ Tibialis anterior ƒƒ P. longus Superficial Deep
ƒƒ EHL ƒƒ P. brevis ƒƒ Gastroenemius ƒƒPopliteus
ƒƒ EDL ƒƒ Soleus ƒƒTibialis posterior

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ƒƒ Peroneus tertius ƒƒ Plantaris ƒƒFHL
ƒƒFDL
Action ƒƒ Dorsiflexion ƒƒ Eversion
l. ƒƒ Plantar flexion of foot ƒƒ Plantar flexion of foot and
Vo
phalanges
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Classification of Joints
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Fibrous (Immovable) Cartilagenous (Slightly movable) Synovial joint

ƒƒ Gomphosis → tooth socket ƒƒ 1°/synchondrosis ƒƒ 2° symphyses (slight)/ ƒƒ Hinge
PR

ƒƒ Syndesmosis → Inferior
Tibiofibular joint
ƒƒ Schindylesis → Vomer
and sphenoidal rostrum
junction
ƒƒ Sutures of skull
○○ Serrate – saggital
○○ Denticulate - Lamboid
(no or minimal
movement)/Hyaline
cart. joint
○○ Spheno-occipital
joint
○○ Growth plate
○○ Costochondral joint
○○ 1st chondro-sternal
joint
○○ Between ilium,
pubis, ischium
○○ Sacrum, coccyx
○○ Meant for growth of
joint
○○ Enchondreal
ossification
○○ Temporary joints
○○ Sternoxiphoid
Fibrocart joint
○○ All occurs in midline,
unpaired
○○ Symphysis menti
○○ Symphysis pubis
○○ Sacrococcygeal joint
○○ Intervertebral joint
between body of vertebrae
○○ Manubriosternal joint
○○ Ball and socket joint
 Incudostapedial joint
 Talocalcaneonavicular
joint (false)
○○ Elbow joint, ankle joint
○○ IP joint
ƒƒ Pivot
○○ Atlanto-axial joint
○○ Sup. Radioulnar joint
○○ Inf. Radioulnar joint
ƒƒ Bicondylar/condyloid joint
○○ Knee joint
○○ TMJ
ƒƒ Ellipsoid joint: Atlanto-occipital joint
○○ Wrist joint
○○ MCP joint, MTPJ
ƒƒ Saddle joint
○○ 1st carpometacarpal joint
○○ Sternoclavicular joint
○○ Pseudo-malleolar joint
ƒƒ Plane synovial joint
○○ Acromioclavicular joint
○○ Chondro-sternal joint
○○ Costo-transverse joint
○○ IVJ between post. art. facets

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 Anatomy (High-yield Points)

FUSION OF SUTURES & FONTANELLE

S UTURES ‰‰ Fusion of skull sutures

•• Metopic (frontal) sutures close at ~2 yrs (May Age Closure of suture Remark
persist in 5–10%). 2-3 years Metopic (frontal) May
•• Basiocciput fuses with basisphenoid at ~23 sutures persist in
yrs. 5-10%
•• Sagital suture closes between 25-30 years. 18 -23 Basi-occipital sutures -
•• Coronal sutures close at the age of 40 years. years with basisphenoid
•• Lambdoid sutures close at 50 years.
25-30 Saggital suture -
•• Temporo-parietal sutures remain open until
years
extreme old age.
•• In vault of skull, closure of sutures begins on
40 years Coronal sutures -
the inner side 5–10 yrs earlier than outer side. 50 years Lambdoid sutures
•• Sagittal, coronal and lambda sutures begins to Extreme Temporo-parietal Fuses at
close from inner side at the age of 25 yrs. of age last
•• Fusion occurs earlier in males than females.

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Fig.: Timing of fusion of sutures

F ONTANELLES ‰‰ Total number of fontanelles in human skull ‰‰ The condylar portion of occipital bone fuses with
at birth are 6. The anterior and posterior, two squama at 3rd year, and with basiocciput at the
mastoid, and two sphenoid. 5th year
‰‰ Lateral and occipital fontanelles usually close
within first 2 months.

Fontanel Location Shape & size Usual time of closure

Anterior ƒƒ At the junction of coronal ƒƒ Diamond shaped ƒƒ 18 months -2 yrs
& sagittal suture ƒƒ ~ 2 x 2 cm

Posterior ƒƒ Between occipital & ƒƒ Triangular ƒƒ 6-8 months.

parietal bone ƒƒ 1 finger tip size ƒƒ Persistence is seen
ƒƒ Non-palpable in first 6-8 in hydrocephalus &
weeks hypothyroidism.

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Fig.: Fontanelles in skull of infant (A) Lateral view (B) Superior view

TYPES OF MUSCLES

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Based on Muscle types Example
SHAPE Triangular Deltoid, Adductor longus, temporalis

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Quadrangular Quadratus femoris
Diamond shaped Rhomboid major
Rounded/Teres Teres major
Es

Worm like Lumbricals

Straight Rectus - abdominis
iM

FASCICULI Spiral (twisted Trapezius, pectoralis major, Latissimus dorsi, supinator

fasciculi)
PR

Cruciate muscles Sternocleidomastoid, masseter, adductor magnus

( Crossed fasciculi)
Strap muscles Sternohyoid & sartorius
(Parallel fasciculi)
Fusiform muscles Biceps brachii, digastric & sartorius
(Parallel fasciculi)
Oblique fasciculi Unipennate Flexor pollicis longus (FPL), Extensor digitorum longus (EDL)
/PENNATE Tibialis posterior, Peroneus tertius
(Feather like
muscles) Bipennate Rectus femoris, dorsal interossei, Flexor digitorum longus (FDL),
Multipennate Subscapularis, acromial/middle fibres of deltoid, Flexor hallucis longus (FHL)
Circumpennate Tibialis anterior
Composite/Hybrid Which have more than one set of fibers (and usually different nerve supply) but perform the
muscles same function. E.g.
Brachialis: Musculocutaneous nerve is motor and radial nerve is propioceptive,
Adductor magnus: Its adductor part by posterior division of obturator nerve and hamstring
part by tibial part of sciatic nerve.
Convergent Temporalis
Sphinctor Orbicularis occuli, Orbicularis oris
Parallel Fasciculi Infrahyoid, Sartorius, Rectus abdomins, Digastrics, Biceps, Thyrohyoid, Pronator quadratus

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 Anatomy (High-yield Points)

MISCELLANEOUS

1
S TRUCTURES Structures passing Minor orifices
PASSING THROUGH Superior epigastric vessels
l. Gap between sternal origin and costal origin (space of
Vo
MINOR ORIFICES Larry)
when this opening enlarged (foramen of morgagni)
Lower 5 intercostal vessels &nerves Between costal origin of diaphragm & transverses
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abdominus
Musculo phrenic artery Between 7th & 8th costal origins of diaphragm
Subcostal nerves & artery Behind lateral arcuate ligament
iM

Sympathetic trunk & least splanchnic nerve Behind medial arcuate ligament
Greater & lesser splanchnic nerve Piercing crus of diaphragm
PR

Inferior hemiazygous vein Pierce the left crus

Left phrenic nerve Pierces left cupola

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