Thorax

Question 1

Vertebral level of superior angle of scapula

Answer 1

T2

Question 2

Vertebral level of spine of scapula - medial end

Answer 2

T3

Question 3

Vertebral level of inferior angle of scapula

Answer 3

T7

Question 4

Vertebral level of manubrium

Answer 4

T2/3-T4/5

Question 5

Vertebral level of jugular notch

Answer 5

T2/3

Question 6

Vertebral level of sternal angle

Answer 6

T4/5

Question 7

Vertebral level of tracheal bifurcation

Answer 7

T4/5

Question 8

Vertebral level of start and end of aortic arch

Answer 8

T4/5

Question 9

Vertebral level of body of sternum

Answer 9

T5-8

Question 10

Vertebral level of xiphisternum

Answer 10

T8/9

Question 11

Vertebral level of transpyloric plane

Answer 11

L1

Question 12

Vertebral level of subcostal plane

Answer 12

L2

Question 13

How many places do you auscultate/percuss for each lobe

Answer 13

Upper 4 (front and back)
Middle 2
Lower 2 (front and back)

Question 14

What does stony percussion of lungs indicate

Answer 14

Pleural effusion

Question 15

What does a hyper resonant percussion indicate

Answer 15

Pneumothorax

Question 16

How does a pneumothorax percussion sound

Answer 16

hyperresonant

Question 17

How does a pleural effusion percussion sound

Answer 17

Stony

Question 18

Surface marking of upper/middle/lower lobes

Answer 18

• Upper lobes – from apex above clavicles to horizontal fissure in right lung (4th CC) or oblique fissure in left lung (6th CC)
• Middle lobe – between 4th and 6th CC in right lung
• Lower lobe found laterally between 6th and 7th CC

Question 19

Describe & demonstrate the surface markings of the oblique and horizontal fissures of
right/left lung.

Answer 19

• Oblique – from T3/4 posteriorly to meet the 6th rib/CC anteriorly
• Horizontal – from 4th CC anteriorly to meet the oblique fissure in the mid-axillary line

Question 20

Describe & demonstrate the surface marking of the inferior margin of parietal pleura of
right/left lung.

Answer 20

• Apex in the root of the neck above medial third of clavicle
• Just right of midline at level of 2nd CC
• Just right of midline at level of 6th CC
• MCL at level of 8th rib (just above costal margin)
• MAL at level of 10th rib (lowest point of costal margin)
• Scapular line crossing 12th rib
• Transverse process of T1 vertebrae
• Cardiac notch in left lung between 2nd and 6th CC

Question 21

Describe & demonstrate the surface marking of inferior margin of the visceral pleura of
right/left lung.

Answer 21

• Apex in the root of the neck above medial third of clavicle
• Just right of midline at level of 2nd CC
• Just right of midline at level of 6th CC
• MCL at level of 6th rib
• MAL at level of 8th rib
• Scapular line at level of 10th rib posteriorly

Question 22

Describe and demonstrate the triangle of safety for insertion of a chest drain

Answer 22

• Posterior - Latissimus dorsi - posterior axillary fold
• Anterior - Pectoralis major - anterior axillary fold
• Inferior - 4th/5th intercostal space at mid-axillary line
• Superior - below apex of axilla
• Lies over 2nd-5th ICS

Question 23

Describe & demonstrate the surface marking of mediastinal pleura of right & left lung
on the anterior chest wall

Answer 23

• Sternal angle to T4
• At hilum, reflected on to vessels and bronchi
• Continuous with visceral pleura

Question 24

Demonstrate the surface marking of upper/right/inferior/left borders of the heart.

Answer 24

• Just lateral to right sternal border at the 3rd CC
• Just lateral to the right sternal border at the 6th CC (at level of xiphisternal joint)
• At the position of apex beat, which is normally palpable just medial to the MCL in the 5th left ICS)
• Lateral (about 2.5 cm) to the left sternal border at the 2nd CC

Question 25

Demonstrate where you would auscultate for aortic/pulmonary/mitral/tricuspid valves using a stethoscope.

Answer 25

* Aortic – right 2nd ICS near sternum * Pulmonary – left 2nd ICS near sternum * Mitral – left 5th ICS at mid-clavicular line (apex beat) * Tricuspid – left 5th ICS near sternum

Question 26

Describe the surface marking of the apex beat of the heart and demonstrate palpation

Answer 26

• 5th left ICS just medial to MCL

Question 27

Demonstrate the sites of routine venepuncture

Answer 27

• Antebrachial vein in the cubital fossa

Question 28

Describe and demonstrate the surface marking of the arch of the aorta

Answer 28

* Beginning of arch (from ascending aorta) at level of right 2nd CC * Top of the arch midway between jugular notch and sternal angle * End of arch (becoming thoracic aorta) at level of left 2nd CC

Question 29

Describe and demonstrate the surface markings of the internal jugular vein & common carotid artery.

Answer 29

* Common carotid artery from the right SCJ to the lobe of the ear * Internal jugular vein lateral to the common carotid artery to the SCJ

Question 30

Which ribs are the cardiac notch inbetween

Answer 30

4-6