last minute hodgepodge

Question 1

Through which intercostal space along the midaxillary line is it appropriate to insert a needle to drain a pleural effusion (ie perform a thoracocentesis)

Answer 1

Want to go into the diaphragmatic recess and avoid injuring the visceral pleura.

To do this insert needle in the 8th intercostal space aka below the 8th rib. (along the midaxillary line)

(e syllabus says to insert needle between ribs 7 and 9)

As always make sure to avoid the van structures running in the inferior costal groove and the collateral bundle running directly superior to the rib below

Question 2

Along what rib level does the horizontal fissure of the right lung run?

Answer 2

The horizontal fissure roughly corresponds to the level of the 4th rib

Question 3

The transverse thoracic plane (T4/T5) [also called the sternal angle) is a useful landmark for myriad structures:

Answer 3

• bifurcation of trachea (carina)
• second rib
• boundary between superior/inferior mediastinum
• bifurcation of L and R pulmonary arteries
• inferior border of aortic arch
• left recurrent laryngeal nerve
• ligamentum arteriosum

Question 4

what is the landmark for the IVC hiatus

Answer 4

T8 (hiatus meaning where the IVC passes through the diaphragm)

Question 5

what is the landmark for the esophageal hiatus

Answer 5

T10

Question 6

what is the landmark for the aortic hiatus?

Answer 6

T12

Question 7

What is Virchow’s node. Why is it famous enough that it was worth naming?

Answer 7

it is a left supraclavicular lymph node.

If it is enlarged can be the first sign of gastric/other abdominal cancers

Question 8

Right side of the heart drains into:

Answer 8

the left venous angle via the thoracic duct

Question 9

left side of the heart drains into

Answer 9

right venous angle via the r thoracic duct

Question 10

Where does the thoracic duct begin?

Answer 10

At the cisterna chyli (L1-L3)

Question 11

When does the thoracic duct traverse from right to left?

Answer 11

At T4

Question 12

between what structures does the thoracic duct ascend?

Answer 12

Between the aorta and the azygos vein behind the esophagus

Question 13

where does the oblique fissure of the right lung run?

Answer 13

Roughly along the 6th rib

Question 14

Where do you put the bell of a stethoscope to auscultate the middle lobe of the right lung?

Answer 14

Lateral between ribs 4 and 6

Question 15

How do you auscultate the upper lobe of the lung?

Answer 15

listen on the back superior to T3