Surface Anatomy of Thorax Flashcards
How do you assess surface anatomy of the thorax during a physical exam?
-Observe symmetrical breathing patterns
-Identify correct landmarks for stethoscope placement
What are the bony landmarks on the anterior view of the thorax?
-jugular (sternal) notch (JN)
-sternal angle (SA)
-2nd rib
-intercostal spaces 2-6 (ICS)
-costal margin (CM)
What is the jugular (sternal) notch (JN)? How would you describe it anatomically?
Top notch of the manubrium, easy to identify, good starting point for palpation
What is the sternal angle (SA)? How would you describe it anatomically?
Raised bump in between body of sternum and manubrium
-Behind it, trachea does it’s first split/bifurcated into left and right primary bronchi
-Location where the aortic arch is going up and over (beginning and end of aortic arch)
-Palpation of the SA helps you find the second rib
What is the 2nd rib? How would you describe it anatomically?
Found on side of the sternal angle,
Good place to start finding the intercostal spaces!
What are the intercostal spaces (ICS)? How would you describe them anatomically?
Spaces in between ribs
-if you can find the second, you can find the others and use them for auscultation points/procedures
What is the costal margin (CM)? How would you describe it anatomically?
The costal cartilage along the bottom of the anterior ribs (there are two of them, right and left)
What is the subcostal angle (SCA)? How would you describe it anatomically?
Angle formed by the two costal margins on the anterior ribs
What are the bony landmarks on the posterior view of the thorax?
-costovertebral angle (CVA)
-spinous processes of thoracic vertebrae 1-12
What is the costovertebral angle (CVA)? How would you describe it anatomically?
Junction formed by the 12th rib and vertebral column
-good place to assess symmetry of ribs when breathing
-kidneys located deep to CVA on each side, if pathology is going on there will be tenderness in the CVA (kidney punch test to assess for tenderness)
How do you describe the inferior borders of the lungs from a POSTERIOR view?
Lungs do not go down to the 12th rib, located along the horizontal line of the 10th rib (T10)
Count up from T12 to T10 spinous processes for a ballpark starting point to find base of the lungs for auscultation
How do you describe the inferior borders of the lungs from a LATERAL view?
Inferior border will start at 10th rib and span along to about the 8th rib (as the ribs wrap around at a diagonal level)
How do you describe the inferior borders of the lungs from an ANTERIOR view?
Inferior border will start at 8th rib and span along to costal cartilage of the 6th rib
How does blood flow through the heart (brief overview)?
-into right atrium from body
-moves into right ventricle
-pushed into pulmonary arteries where it becomes oxygenated
-travels back to heart through pulmonary veins
-enters the left atrium of the heart
-moves into the left ventricle and into the body tissues through the aorta
Where are the four chambers of the heart located on an anterior view?
-Right atrium
-Right ventricle
-Left atrium
-Left ventricle
What are the anterior landmarks of the heart?
-aortic valve
-pulmonary valve
-Erb’s point
-tricuspid valve
-mitral valve
Where is the aortic valve (anterior landmark of the heart) located? Where should it be auscultated?
Located at the junction of the left ventricle and beginning of aorta
Auscultate: RIGHT 2nd intercostal space
Where is the pulmonary valve (anterior landmark of the heart) located? Where should it be auscultated?
Located at the junction of the right ventricle as it enters the pulmonary trunk
Auscultate: LEFT 2nd intercostal space
Where should Erb’s point (anterior landmark of the heart) be auscultated?
Auscultate: LEFT 3rd intercostal space
Nice generic one stop point to pick up any abnormal sounds in the heart
Where is the tricuspid valve (anterior landmark of the heart) located? Where should it be auscultated?
Located between the right atrium and right ventricle
Auscultate: LEFT 4th/5th intercostal spaces at the left sternal border (where sternum meets rib) **right around where right ventricle is (problem from the tricuspid valve will be picked up from sounds in the right ventricle)
Where is the mitral valve (anterior landmark of the heart) located? Where should it be auscultated?
Located between the left atrium and the left ventricle
Auscultate: LEFT 5th intercostal space along the midclavicular line (lined up with the middle of the left clavicle)
**right around where left ventricle is (problem from the mitral valve will be picked up from sounds in the left ventricle)
What is the anterior median (midsternal) line of the thorax?
Reference vertical line that descends from mid sternum (divides body into right and left)
What are the midclavicular lines (MCL) of the thorax?
Reference vertical line that descends from middle of each of the clavicles
What is the posterior median (midspinal/midvertebral) line of the thorax?
Reference vertical line that descends through spinous processes of vertebrae (spine) and separates body into right and left
What are the posterior scapular lines of the thorax?
Reference vertical line that descends through the inferior angles of the right and left scapula
What is the anterior axillary line of the thorax?
Reference vertical line that descends through the anterior border of the armpit
What is the mid axillary line of the thorax?
Reference vertical line that descends through the middle of the armpit (dividing armpit into right and left equal parts)
What is the posterior axillary line of the thorax?
Reference vertical line that descends through the posterior border of the armpit
What are the significant landmarks of the male breast?
Nipples
Where are nipples located on the thorax in men?
4th intercostal spaces just lateral to midclavicular line
What part of the heart is located just inferior/medial to the left nipple on a male thorax?
Apex of the heart (located in 5th intercostal space)
*can use the male nipple as a reference point for finding the 5th intercostal space/listen to the mitral valve/left ventricle
What are the significant landmarks of the female breast?
-circular base (starts from mid-sternum and extends laterally)
-axillary tail (aka axillary process) *this is the part of the breast that extends to the mid-axillary line
What are the two methods of clinical documentation of the female breast?
-quadrants
-“clock” positions
Used to document findings like cysts, tumors, etc.
How would you describe the quadrant documentation method for the female breast?
Breast separated into 4 quadrants (vertical and horizontal lines across the middle of the breast form these quadrants)
Quadrants are:
-Upper inner/medial quadrant
-Lower inner/medial quadrant
-Upper outer/lateral quadrant
-Lower outer/lateral quadrant
How would you describe the “clock” positions documentation method for the female breast?
Using a vertical and horizontal line through the middle of the breast, the numbers on a clock are used for reference of a position
-Top of vertical line: 12 o’clock
-Right end of horizontal line: 3 o’clock
-Bottom of vertical line: 6 o’clock
-Left end of horizontal line: 9 o’clock
What is important to consider when using the “clock” position documentation method for the female breast?
Whether it is the left or right breast
For example,
3 o’clock on the right breast would be considered medial
BUT
3 o’clock on the left breast would be considered lateral
75% of lymphatic vessels in the breast drain into which nodes?
Axillary (armpit) lymph nodes
Where do the rest of the lymph vessels in the breast drain (the ones that don’t drain into the axillary nodes)?
Drain medially through the parasternal lymph nodes
Why is it important to palpate the axillary region?
To assess for enlargement of lymph nodes (cancer cells may have drained from the breast tissue and into axillary lymph nodes)
-If not addressed, could enter the venous system and spread even further
What is post-surgical lymphedema?
-Surgery may damage the lymph vessels in the axilla, or if lymph vessels here are removed due to pathology, drainage of lymph from the arm would be blocked/edema would result from a backup of the lymph drainage pathway
