Surface Anatomy - Thorax

Question 1

What does the clavicle articulate with anteriorly?

Answer 1

Manubrium of sternum

Question 2

What structure lies between the medial ends of the two clavicles?

Answer 2

Jugular notch of the manubrium

Question 3

What is the small ridge felt by moving your fingers down from the jugular notch? What is this notch?

Answer 3

Sternal angle (of Louis)
Manubriosternal joint

Question 4

What bones articulate at the sternal angle?

Answer 4

Manubrium
Body of sternum
Rib 2

Question 5

What type of joint is the manubriosternal joint?

Answer 5

Secondary cartilaginous (symphysis)

Question 6

What type of joint does rib 2 have with the sternal angle?

Answer 6

Synovial plane joint

Question 7

If you palpate the sternal angle and palpate laterally, what bony structure do you palpate?

Answer 7

Rib 2

Question 8

As you count down the ribs and intercostal spaces, what can help as you descend? Why?

Answer 8

Moving fingers laterally along thoracic wall with every rib

As costal cartilages of lower ribs (7-10) unite

Question 9

Where can ribs 11 and 12 be palpated?

Answer 9

Posterior aspect of thoracic wall

Question 10

Can rib 1 be palpated?

Answer 10

No

Question 11

What is the pleural cavity?

Answer 11

The space between the parietal pleura lining the inside of the thoracic cage and the visceral pleura passing over the surface of each lung

Question 12

Where does each pleural cavity extend above?

Answer 12

2-3cm above middle of medial third of the clavicle

Question 13

Where does the anterior border of the pleural cavity reach?

Answer 13

Midline at the 6th costal cartilage

Question 14

Where does the parietal pleura pass laterally away from the midline on the right?

Answer 14

6th costal cartilage

Question 15

Where does the parietal pleura pass laterally away from the midline on the left?

Answer 15

4th costal cartilage:

- To accommodate heart

Question 16

Where does the parietal pleura cross the following lines:

• Midclavicular line
• Midaxillary line

Answer 16

Midclavicular line = 8th costal cartilage

Midaxillary line = 10th costal cartilage

Question 17

What line does the parietal pleura following horizontally along the posterior body wall?

Answer 17

Line of the 12th rib

Question 18

Where do the domes of each hemidiaphragm reach?

Answer 18

5th costal cartilage on left

4th costal cartilage on right

Question 19

What are the levels of the visceral pleura at:

• Midclavicular line
• Midaxillary line
• Posterior thoracic wall

Answer 19

Midclavicular line = 6th costal cartilage
Midaxillary line = 8th costal cartilage
Posterior thoracic wall = 10th costal cartilage

Question 20

Does the visceral pleura pass into the costodiaphragmatic recess?

Answer 20

No

Question 21

Where do the oblique fissures run?

Answer 21

T3 posteriorly

6th costochondral junction anteriorly

Question 22

How can the level of the superior part of the oblique fissure be found?

Answer 22

Palpate C7 spinous process (vertebra prominens)

Count down to T3 spinous process

Question 23

Where does the horizontal fissure run?

Answer 23

From the right oblique fissure posteriorly to the 4th costal cartilage anteriorly on the right

Question 24

What do the oblique fissures do?

Answer 24

Separate superior and inferior lobes of lungs

Question 25

What does the middle fissure do?

Answer 25

Divides the right superior and right middle lung lobes

Question 26

What organs can be detected when percussing the text (except the lungs)? How?

Answer 26

Liver and heart borders: | - More dense than lungs so produce a duller sound

Question 27

If we percuss the right side of the chest from the clavicle towards the 6th intercostal space, where will a change in resonance be heard and why?

Answer 27

Around 4th intercostal space: | - Nears upper border of liver

Question 28

If you percuss from the left midaxillary line and move towards anterior midline, what will cause a change in percussion to a duller sound?

Answer 28

Left border of heart

Question 29

Where can we auscultate the superior lung lobes?

Answer 29

Anterosuperiorly on the chest wall: | - Above the nipple

Question 30

Where can we auscultate the right middle lobe?

Answer 30

Right mid axillary line (anterolaterally)

Question 31

Where can the inferior lung lobes be auscultated?

Answer 31

Posteroinferiorly

Question 32

Where does the apex of the heart lie?

Answer 32

Left midclavicular line in the 5th intercostal space

Question 33

Where does the inferior border of the heart lie?

Answer 33

From apex in a horizontal line just to the right of the sternum

Question 34

Where does the right heart border lie?

Answer 34

A bulge slightly beyond (1-2cm) the right border of the sternum

Question 35

Where does the left heart border lie?

Answer 35

Extends from apex superiorly and medially to sternal end of the 2nd intercostal space

Question 36

What chamber of the heart makes up each heart border?

Answer 36

Left border = Left ventricle (mainly) Right border = Right atrium Inferior border = Right ventricle Superior border = Both atria and their auricles

Question 37

Why is it not possible to place a stethoscope directly over the heart valves?

Answer 37

They lie underneath the sternum

Question 38

Where can the mitral valve be auscultated?

Answer 38

Apex of heart: - Midclavicular line - 5th intercostal space

Question 39

Where can the tricuspid valve be auscultated?

Answer 39

Left of sternum at 4th costal cartilage

Question 40

Where can the pulmonary valve be auscultated?

Answer 40

2nd intercostal space, just to the left of the sternum

Question 41

Where can the aortic valve be auscultated?

Answer 41

2nd intercostal space, just to the right of the sternum

Question 42

What creates the "lub" (S1) heart sound?

Answer 42

Closure of the atrioventricular valves (tricuspid and mitral)

Question 43

What creates the "dub" (S2) heart sound?

Answer 43

Closure of the semilunar valves (pulmonary and aortic)

Question 44

What can be accessed in a median sternotomy?

Answer 44

Usually used for full mediastinal access | Allows access to entire thoracic cavity

Question 45

What can be accessed in anterolateral thoracotomy incisions?

Answer 45

Lungs (both sides) Heart (left side) Oesophagus

Question 46

Where does an anterolateral thoracotomy incision run?

Answer 46

From sternum to midaxillary line in the 4th or 5th intercostal space

Question 47

Where is a pacemaker incision made? How long is the incision?

Answer 47

Left infraclavicular region | 4-5cm long

Question 48

Describe a posterolateral thoracic incision?

Answer 48

Starts between the scapula and the midline of the spine and extends to the anterior axillary line

Question 49

What is a posterolateral thoracic incision used for?

Answer 49

Gold standard for thoracic procedures: - Great access to lungs for pneumonectomy, lobectomy - Chest wall excisions - Oesophageal procedures

Question 50

Where would a cannula be inserted to emergently relieve a tension or a large pneumothorax?

Answer 50

2nd/3rd intercostal space in the midclavicular line

Question 51

Where is a chest tube inserted?

Answer 51

5th intercostal space in mid-axillary line: - Guide superiorly for pneumothorax - Guide inferiorly for haemothorax

Question 52

When is a chest tube used?

Answer 52

Once a tension or large pneumothorax has been reduced by emergency thoracocentesis OR Haemothorax

Question 53

Where is a needle insertion for pericardiocentesis?

Answer 53

0.5cm below and to the left of the xiphoid process 45 degrees to skin Aim at left shoulder or nipple