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Anatomy of the Individual > Surface Anatomy - Thorax > Flashcards

Surface Anatomy - Thorax Flashcards

1
Q

What does the clavicle articulate with anteriorly?

A

Manubrium of sternum

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2
Q

What structure lies between the medial ends of the two clavicles?

A

Jugular notch of the manubrium

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3
Q

What is the small ridge felt by moving your fingers down from the jugular notch? What is this notch?

A 
Sternal angle (of Louis)
Manubriosternal joint
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4
Q

What bones articulate at the sternal angle?

A

Manubrium
Body of sternum
Rib 2

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5
Q

What type of joint is the manubriosternal joint?

A

Secondary cartilaginous (symphysis)

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6
Q

What type of joint does rib 2 have with the sternal angle?

A

Synovial plane joint

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7
Q

If you palpate the sternal angle and palpate laterally, what bony structure do you palpate?

A

Rib 2

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8
Q

As you count down the ribs and intercostal spaces, what can help as you descend? Why?

A

Moving fingers laterally along thoracic wall with every rib

As costal cartilages of lower ribs (7-10) unite

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9
Q

Where can ribs 11 and 12 be palpated?

A

Posterior aspect of thoracic wall

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10
Q

Can rib 1 be palpated?

A

No

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11
Q

What is the pleural cavity?

A

The space between the parietal pleura lining the inside of the thoracic cage and the visceral pleura passing over the surface of each lung

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12
Q

Where does each pleural cavity extend above?

A

2-3cm above middle of medial third of the clavicle

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13
Q

Where does the anterior border of the pleural cavity reach?

A

Midline at the 6th costal cartilage

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14
Q

Where does the parietal pleura pass laterally away from the midline on the right?

A

6th costal cartilage

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15
Q

Where does the parietal pleura pass laterally away from the midline on the left?

A

4th costal cartilage:

- To accommodate heart

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16
Q

Where does the parietal pleura cross the following lines:

  • Midclavicular line
  • Midaxillary line
A

Midclavicular line = 8th costal cartilage

Midaxillary line = 10th costal cartilage

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17
Q

What line does the parietal pleura following horizontally along the posterior body wall?

A

Line of the 12th rib

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18
Q

Where do the domes of each hemidiaphragm reach?

A

5th costal cartilage on left

4th costal cartilage on right

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19
Q

What are the levels of the visceral pleura at:

  • Midclavicular line
  • Midaxillary line
  • Posterior thoracic wall
A

Midclavicular line = 6th costal cartilage
Midaxillary line = 8th costal cartilage
Posterior thoracic wall = 10th costal cartilage

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20
Q

Does the visceral pleura pass into the costodiaphragmatic recess?

A

No

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21
Q

Where do the oblique fissures run?

A

T3 posteriorly

6th costochondral junction anteriorly

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22
Q

How can the level of the superior part of the oblique fissure be found?

A

Palpate C7 spinous process (vertebra prominens)

Count down to T3 spinous process

23
Q

Where does the horizontal fissure run?

A

From the right oblique fissure posteriorly to the 4th costal cartilage anteriorly on the right

24
Q

What do the oblique fissures do?

A

Separate superior and inferior lobes of lungs

25
Q

What does the middle fissure do?

A

Divides the right superior and right middle lung lobes

26
Q

What organs can be detected when percussing the text (except the lungs)? How?

A

Liver and heart borders:

- More dense than lungs so produce a duller sound

27
Q

If we percuss the right side of the chest from the clavicle towards the 6th intercostal space, where will a change in resonance be heard and why?

A

Around 4th intercostal space:

- Nears upper border of liver

28
Q

If you percuss from the left midaxillary line and move towards anterior midline, what will cause a change in percussion to a duller sound?

A

Left border of heart

29
Q

Where can we auscultate the superior lung lobes?

A

Anterosuperiorly on the chest wall:

- Above the nipple

30
Q

Where can we auscultate the right middle lobe?

A

Right mid axillary line (anterolaterally)

31
Q

Where can the inferior lung lobes be auscultated?

A

Posteroinferiorly

32
Q

Where does the apex of the heart lie?

A

Left midclavicular line in the 5th intercostal space

33
Q

Where does the inferior border of the heart lie?

A

From apex in a horizontal line just to the right of the sternum

34
Q

Where does the right heart border lie?

A

A bulge slightly beyond (1-2cm) the right border of the sternum

35
Q

Where does the left heart border lie?

A

Extends from apex superiorly and medially to sternal end of the 2nd intercostal space

36
Q

What chamber of the heart makes up each heart border?

A

Left border = Left ventricle (mainly)
Right border = Right atrium
Inferior border = Right ventricle
Superior border = Both atria and their auricles

37
Q

Why is it not possible to place a stethoscope directly over the heart valves?

A

They lie underneath the sternum

38
Q

Where can the mitral valve be auscultated?

A

Apex of heart:

  • Midclavicular line
  • 5th intercostal space
39
Q

Where can the tricuspid valve be auscultated?

A

Left of sternum at 4th costal cartilage

40
Q

Where can the pulmonary valve be auscultated?

A

2nd intercostal space, just to the left of the sternum

41
Q

Where can the aortic valve be auscultated?

A

2nd intercostal space, just to the right of the sternum

42
Q

What creates the “lub” (S1) heart sound?

A

Closure of the atrioventricular valves (tricuspid and mitral)

43
Q

What creates the “dub” (S2) heart sound?

A

Closure of the semilunar valves (pulmonary and aortic)

44
Q

What can be accessed in a median sternotomy?

A

Usually used for full mediastinal access

Allows access to entire thoracic cavity

45
Q

What can be accessed in anterolateral thoracotomy incisions?

A

Lungs (both sides)
Heart (left side)
Oesophagus

46
Q

Where does an anterolateral thoracotomy incision run?

A

From sternum to midaxillary line in the 4th or 5th intercostal space

47
Q

Where is a pacemaker incision made? How long is the incision?

A

Left infraclavicular region

4-5cm long

48
Q

Describe a posterolateral thoracic incision?

A

Starts between the scapula and the midline of the spine and extends to the anterior axillary line

49
Q

What is a posterolateral thoracic incision used for?

A

Gold standard for thoracic procedures:

  • Great access to lungs for pneumonectomy, lobectomy
  • Chest wall excisions
  • Oesophageal procedures
50
Q

Where would a cannula be inserted to emergently relieve a tension or a large pneumothorax?

A

2nd/3rd intercostal space in the midclavicular line

51
Q

Where is a chest tube inserted?

A

5th intercostal space in mid-axillary line:

  • Guide superiorly for pneumothorax
  • Guide inferiorly for haemothorax
52
Q

When is a chest tube used?

A

Once a tension or large pneumothorax has been reduced by emergency thoracocentesis
OR
Haemothorax

53
Q

Where is a needle insertion for pericardiocentesis?

A

0.5cm below and to the left of the xiphoid process
45 degrees to skin
Aim at left shoulder or nipple

Anatomy of the Individual (10 decks)

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