Surface anatomy

Question 1

Where can the sternal angle be found?

Answer 1

• The junction between the manubrium and the body of the sternum (manubriosternal joint)
• A ridge/protrusion can be felt here
• In line with 2nd costal cartilage

Question 2

Where is the jugular notch found?

Answer 2

Superior extent of the manubrium

Question 3

What lies in line with the T IV/V plane?

Answer 3

• Sternal angle (border of inferior and superior mediastinum)
• Costal cartilage II
• Ascending aorta ends and aortic arch begins
• Aortic arch ends and thoracic aorta begins
• Trachea bifurcates

Question 4

Where do the internal jugular vein and the subclavian vein join to form the brachiocephalic vein?

Answer 4

At the sternal ends of the clavicle (posterior to the clavicle)

Question 5

What are the surface landmarks of the heart?

Answer 5

Superiorly - 3rd CC on the R and 2nd CC on the L
Right - from the 3rd to the 6th CC
Left - from 2nd ICS to the 5th ICS at mid-clavicular line (apex)
Inferiorly - sternal end of R 6th CC to 5th ICS at mid-clavicular line (apex)

Question 6

Where should you place the stethoscope to heart the tricuspid valve?

Answer 6

Left of the sternum at the 5th intercostal space.

Question 7

Where should you place the stethoscope to heart the mitral valve?

Answer 7

Apex of the heart (5th ICS at midclavicular line)

Question 8

Where should you place the stethoscope to heart the pulmonary valve?

Answer 8

Medial end of the left 2nd ICS.

Question 9

Where should you place the stethoscope to heart the aortic valve?

Answer 9

Medial ends of the right 2nd ICS.

Question 10

What are the posterior landmarks of the oblique fissures of the lungs?

Answer 10

• Originate at T4
• Move laterally and inferiorly, crossing the 4th and 5th `ics
• Ends at 6th rib

Question 11

What are the surface landmarks of the pleura?

Answer 11

Superiorly - just superior to the 1st CC
Anteriorly - approaches midline posterior to the sternum on the R, does not come as medial on the left due to cardiac impression
Inferiorly - just above the costal margin

Question 12

Do the lungs fill the pleural cavity?

Answer 12

Not entirely, especially not inferiorly or anteriorly.

Question 13

Where does the horizontal fissure extend from in the right lung (level) ?

Answer 13

Begins at the level of the 5th rib and ends at the level fo the 4th rib towards the midline.

Question 14

Explain the innervation of the oesophagus.

Answer 14

Innervated via the oesophageal plexus, which is formed from parasympathetic vagal trunks and sympathetic trunks from the cervical and thoracic trunks.

Question 15

Describe the pathway of excitation through the heart?

Answer 15

1) SA node
2) Atrial intermodal tracts
3) Right and left atria
4) AV node
5) Bundle of His
6) Purkinje system
7) Ventricles

Question 16

Explain the phenomenon of referred pain to the chest wall and thoracic viscera from T1-5.

Answer 16

• Percieves pain from the heart
• Dermatomes of that region have neuronal cell bodes in the same dorsal root ganglia and synapse in the same second order neurones
• General cardiac visceral pain fibres follow the sympathetic fibres back to the cell bodies which are located in the thoracic dorsal root ganglia (1-4/5)