Surface Anatomy - All

Question 1

Locate the apex beat

• where would it move to if the beat is moved
• what is the significance of this

Answer 1

5ICS MCL

Beat moved LATERALLY => cardiomegaly

Question 2

Locate the pubic symphysis

Answer 2

Midline cartilaginous joint connecting the SUPERIOR RAMI of the left and right PUBIC bones

Question 3

Locate the angle of the jaw

Answer 3

Posterior border at the junction of the ramus of the mandible

Question 4

Locate McBurney’s point

-clinical significance

Answer 4

2/3ds of the way between the UMBILICUS and ASIS
-closer to ASIS

Base of appendix here
-tender => acute appendicitis

Question 5

Locate the mastoid process

-clinical significance in trauma

Answer 5

Behind the earlobe

Battle sign
-bruising of the mastoid from basal skull trauma

Question 6

Locate the jugular notch

-contents of the JN

Answer 6

Between the clavicles and above the sternum

Common carotid artery
Trachea
Internal jugular vein

Question 7

Locate the carotid pulse

-how would you palpate it

Answer 7

Between trachea and sternocleidomastoid

Tell patient to turn head to one side and place finger anterior to SCM

Question 8

Anatomical snuffbox

• borders
• contents
• describe the clinical significance of the anatomical snuffbox

Answer 8

Borders

• EPL, EPB, APL
• base - scaphoid

Contents

• radial artery
• branch of radial nerve
• cephalic vein

Scaphoid fracture => localised pain in anatomical snuffbox
If untreated, AVN

Question 9

Locate the posterior tibial pulse

Answer 9

Behind the medial malleolus

Question 10

Location of

• the heart valves
• auscultation spots

Answer 10

Aortic - L 3ICS => R 2ICS
Pulmonary - L 3CC => L 2ICS
Tricuspid - R 4ICS => L 4ICS
Mitral - L 4CC => L 5ICS MCL

Question 11

Location of the thyroid cartilage

Answer 11

C4 - Adam’s apple

Question 12

Location of the cricothyroid membrane

-clinical significance

Answer 12

Below thyroid cartilage

Site of cricothyrotomy

Question 13

Location of the

• mid inguinal point
• mid point of the inguinal ligament

What is the clinical significance

Answer 13

Mid inguinal point - between ASIS and pubic symphysis
-femoral pulse here

Mid point of the inguinal ligament - between ASIS and pubic tubercle
-deep inguinal ring and femoral nerve here

Question 14

Location of the transpyloric plane

What is the vertebral level

Answer 14

Halfway between the jugular notch and pubic symphysis

L1 - cuts through pylorus

Question 15

Location of the subcostal plane

What is the vertebral level

Answer 15

Line between lower parts of costal margin

L3

Question 16

Where is the Angle of Louis

-what structures are found at the Angle of Louis

Answer 16

2nd rib

RATPLANT
Rib 2
Aortic arch
Tracheal bifurcation
Pulmonary bifurcation
Left recurrent laryngeal
Azygos system => IVC
Nerves - cardiac plexus
Thoracic duct => L subclavian

Question 17

Where would you insert a chest drain

Answer 17

5ICS MAL

Question 18

Where would you do a liver biopsy

-how would you angle the needle

Answer 18

9ICS MAL via costodiaphragmatic recess

-insert needle downwards to avoid lungs

Question 19

Aspirating a tension pneumothorax

Answer 19

5ICS MAL

Question 20

Where would you do a lumbar puncture

• why is this important
• when would you do a lumbar puncture

Answer 20

Between
L3-4
L4-5
L5-S1

Avoid piercing SC, ends at L1-2

Diagnosis of CNS infection
-GBS, MS
-CNS vasculitis
-CT negative SAH
Therapeutics
-relieve benign raised ICP

Question 21

Function of the
-biceps brachii
How to test

Answer 21

Elbow flexion, supination

Keep elbow at 90deg with forearm in supination
Hold elbow and forearm and tell them to pull against resistance

Question 22

Function of the
-soleus
How to test

Answer 22

Plantarflexion

Tell patient to push the sole of their foot against resistance

Question 23

Function of the
-masseter
How to test

Answer 23

Elevation, protrusion and ipsilateral mv

Tell patient to open and close mouth

Question 24

Function of the
-sternocleidomastoid unilaterally
How to test

Answer 24

Contralateral rotation
Ipsilateral lateral flexion

Tell patient to rotate head

Question 25

Function of the -sternocleidomastoid bilaterally How to test

Answer 25

Cervical flexion Tell patient to put neck towards sternum

Question 26

Function of the -iliopsoas How to test

Answer 26

Hip flexion Tell patient to lay flat and raise whole leg against resistance

Question 27

Function of the -brachioradialis How to test

Answer 27

Elbow flexion when forearm is partially pronated Tell patient to keep forearm partially pronated Ask them to flex elbow against resistance

Question 28

Function of the -rectus femoris How to test

Answer 28

Hip flexion Leg extension Tell patient to sit on couch with legs over edge Tell patient to lift leg whilst leg with knee flexed

Question 29

Function of the -deltoid How to test

Answer 29

Shoulder abduction, flexion, extension Ask patient to hold arms laterally Ask them to resist you pushing up and down, forwards and back

Question 30

Function of the -temporalis How to test

Answer 30

Closes jaw Ask patient to clench jaw to palpate muscle

Question 31

Function of the -supraspinatus How to test

Answer 31

Abduction of the arm at the shoulder Empty can test -ask patient to put arm out infront, horizontally abduct slightly and have arms internally rotated => thurmbs down like they're emptying a can Ask patient to lift arm against resistance

Question 32

What organs can you palpate in a healthy person

Answer 32

Lower pole of right kidney Cecum Sigmoid colon

Question 33

What are the -boundaries -contents of the carpal tunnel How to test for carpal tunnel

Answer 33

Boundaries - deep carpal arch - scaphoid, trapezium, hamate, pisiform - flexor retinaculum Contents - median nerve - FPL - 4 tendons of FDP - 4 tendons of FDS Tinel - tap median nerve to elicit pain Phalen - inverse prayer hands for 60s to elicit pain

Question 34

Contents of the -axilla Clinical significance of the axilla

Answer 34

Axillary vein, artery, lymph nodes Biceps brachii Brachial plexus Key region for LN biopsy 75% of lymph drains into axilla breast LN so must be removed in breast cancer Risk of damage to long thoracic nerve => winging of the scapula