Living Anatomy of the Thorax

Question 1

Describe how to count ribs.

Answer 1

• Palpate the jugular notch, and feel the sternal angle
• This is in line with rib 2, as well as at vertebral level T4
• Count down from rib 2

Question 2

List what happens at the T4/5 spinal level

Answer 2

• Rib 2 articulates with the sternum
• Superior medistinum separated from inferior mediastinum
• Ascending aorta ends and arch of the aorta begin
• Thoracic aorta begins
• Trachea bifurcates - carina

Question 3

What happens behind the clavicle and mediastinum?

Answer 3

• Internal jugular and subclavian veins join to form brachiostephalic veins near the sternoclavicular joints
• Left brachiocephalic vein from left to right behind the manubrium
• Brachiocephalic veins form superior vena cava
• Aorta ends at sternal angle, arch may reach as high as the midlevel of the manubrium

Question 4

Where are the margins of the heart?

Answer 4

• Upper limit 3rd CC on the right of the sternum, and 2nd IC space on the left of the sternum
• Right margin from right 3rd CC to right 6th CC
• Left margin from 2nd IC space to apex at the midclavicular line in the 5th IC space
• Lower margin from sternal end of the right 6th CC to apex in the 5th IC space near the midclavicular line

Question 5

Where do you listen to hear the tricuspid valve?

Answer 5

Left of the lower part of the sternum near the 5th IC space

Question 6

Where do you listen to hear the mitral valve?

Answer 6

Over the apex of the heart in the left 5th ICs at the midclavicular ling

Question 7

Where do you listen for the pulmonary valve?

Answer 7

Over the medial end of the left 2nd IC space

Question 8

Where do you listen for the aortic valve?

Answer 8

Medial end of the right second IC space

Question 9

Describe the outline of the visceral pleura/lung in quiet respiration.

Answer 9

• Extends as high as 3cm above clavicle

- Base from sternum at level rib 6 to rib 8 midaxillary line to vertebra T10 posteriorly

Question 10

Describe the outline of the parietal pleura

Answer 10

Inferiorly, rib 8 midclavicular line, rib 10 in the midaxillary line, vertebra T12 posteriorly

Question 11

What is the costomediastinal recess?

Answer 11

Occurs anteriorly, on the left side in relationship to the heart bulge

Question 12

What is the costodiaphragmatic recess?

Answer 12

Occurs inferiorly between the lower lung margin and the lower margin of the pleural cavity

Question 13

Where is the oblique fissure on both sides of the lung?

Answer 13

• Posteriorly, at the level of spine T3
• Anteriorly, 6th costal cartilage lower border of the lung
• Connect these two dots with a smooth line
• Also follows the medial border of the scapular when the arm is raised above the head

Question 14

Where is the horizontal fissure?

Answer 14

• Right side of the lung

- Follows the contour of rib 4 and its costal cartilage until it meets the oblique fissure at the mid-axillary line

Question 15

Where do you have to listen to lung sounds in the right lung?

Answer 15

• Apex of lung (3cm over clavicle)
• Superior lobe (2nd IC space)
• Inferior lobe (right lung - 6th IC space, midaxillary line)
• Middle lobe of right lung (midclavicular line 4th IC space)

Question 16

Where do you have to listen to the lung sounds posteriorly in the left lung?

Answer 16

• Apex in level with T1 (shoulder)
• Superior lobe 2nd IC space
• Inferior lobe 7th IC space

Question 17

How can you distinguish between PA and AP x ray?

Answer 17

In AP, the heart will be less clear and distorted - smaller