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Question 1

Where do you auscultate right middle lobe and lung bases

Answer 1

Right middle lobe - place stethoscope between ribs 4 and 6 in mid-clavicular and mid-axillary lines
Lung bases - auscultate posteriorly, in the scapular line at T11 vertebral level

Question 2

Positions of the lung fissures

Answer 2

Horizontal fissure of right lung is at the level of rib 4.
Oblique fissures of left and right lungs are at the level of rib 6 anteriorly, rising to the level of T3 posteriorly.

Question 3

When does the larynx become the trachea

Answer 3

C6

Question 4

Bony landmarks of sternum

Answer 4

Jugular notch
Manubrium
Sternal angle
Sternum
Xiphoid process

Question 5

Arterial supply and venous drainage of the intercostal spaces

Answer 5

Anterior intercostal arteries – branch from internal thoracic artery.
Posterior intercostal arteries – branch from the thoracic aorta.
Anterior intercostal veins – drain into internal thoracic veins.
Posterior intercostal veins – drain into azygous vein

Question 6

Intercostal neurovascular bundles

Answer 6

From superior to inferior - vein, artery, nerve (VAN)
E.g. pin in most superior structure of NVB of 4th intercostal = 4th intercostal vein

Question 7

Openings of the diaphragm

Answer 7

I 8 10 EGGS AT 12
I 8= inferior vena cava pierce at T8
10 Eggs= Esophagus pierces at T10
At 12 = Aorta pierces at T12

Question 8

What type of muscle is the diaphragm

Answer 8

Skeletal muscle

Question 9

What is the phrenic nerve

Answer 9

Made up of the anterior rami of C3, 4 and 5

Question 10

What does the long thoracic nerve supply

Answer 10

Serratus anterior
Paralysis results in winged scapula

Question 11

Group of 3 blood vessels either side of the sternum

Answer 11

Internal thoracic artery (anterior intercostal arteries branch from this) and a pair of veins

Question 12

Most inferior part of the pleural cavity

Answer 12

The costodiaphragmatic recess, with the most inferior part of this recess being the costophrenic angle.
Fluid build-up in this will result in ‘blunting of angles’ and a fluid level being seen on x-ray

Question 13

Name of the tongue of the superior lobe of the left lung

Answer 13

Lingula

Question 14

Cephalic vein location

Answer 14

Delta-pectoral groove

Question 15

Trachea bifurcation level

Answer 15

Anywhere between the levels of the fourth and seventh thoracic vertebrae
Most commonly it is located at the level of the sternal angle (T4) and vertebra T5.

Question 16

Inguinal ligaments

Answer 16

Attach between ASIS (anterior superior iliac spine) and pubic tubercle

Question 17

Midpoint of the inguinal ligament

Answer 17

Deep ring

Question 18

Direct inguinal hernia

Answer 18

a bit of peritoneum is forced through the posterior wall of the inguinal canal, and DIRECTLY out of the SUPERFICIAL ring
Medial and a bit higher generally

Question 19

Indirect inguinal hernia

Answer 19

a bit of peritoneum is forced through the DEEP, into the inguinal canal, then out of the superficial ring
Lateral and a bit lower generally

Question 20

How to differentiate between a direct and indirect hernia

Answer 20

By reducing the hernia, occlude the deep ring with finger-tip, and ask patient to cough.
If it is a direct hernia, the lump will reappear as it does not need to pass through the deep ring to get out into the scrotum