Thorax Flashcards
How do you record chest movement?
Place hands firmly on subject’s anterior chest wall (just below 5th or 6th ribs) with fingers extended around the sides of the chest. The thumbs should just meet in anterior midline, resting lightly on chest wall to allow its movement during respiration (below breasts in women)
Ask patient to take deep breath and observe how far tips of examiner’s thumbs move apart (at least 5 cm). Repeat on posterior chest wall with thus meeting in posterior midline T10 (T7 is inferior angle of scapula)
Where is the vertebral prominence?
C7
At what level is the superior angle of the scapula?
T2
Where is the spine of the scapula?
Medial end is T3
Where is the inferior angle of the scapula?
T7
At what level is manubrium?
T2/3-T4/5
Where is the jugular notch?
T2/3
Where is the sternal angle?
T4/5 and 2nd costal cartilage
Where is the body of the sternum?
T5-8
Where is the xiphersternum?
T8/9
At what level is the subcostal plane?
Rib 10/ L2?
Where is the apex of the pleura?
In the root of the neck above the medial 1/3 of the clavicle
How is the left parietal pleura different from the right?
The pleura defects sharply to allow for cardiac notch
When you auscultate the lungs, where do you listen to?
Apex, super, middle and inferior lobe of both lungs and over the trachea
on front and same on back but hilum instead of trachea
Where is the lung hilum found?
Mid point of scapular and posterior medial line opposite the spines of T4-T6
What are chest drain used for?
Pneumothorax
Pleural effusion
Haemothorax
Post-operative
What is the safe triangle used in chest drains?
Posterior- latissimus dorsi- posterior axillary fold
Anterior- pectoralis major- anterior axillary fold
Inferior- 4th intercostal space- level of male nipple
Superior- below apex of axilla
Where do you place the chest leads in an ECG?
V1- Right 4th intercostal space next to sternum
V2- Left 4th intercostal space next to the sternum
V3- Left 5th intercostal space between V2 and V4
V4- Left 5th intercostal space at mid clavicular line
V5- Left 5th intercostal space at anterior axillary line
V6- left 5th intercostal space at mid-axillary line
Where are the 4 corners of the heart?
Just lateral to right sternal border at 3rd CC
Just lateral to right sternal border at 6th CC (xiphisternal joint level)
At position of apex beat which is normally palpable just medial to MCL in the 5th ICS
Lateral (about 2.5 cm) to the left sternal border at 2nd CC
How would you palpate the apex beat?
Stand facing subject on right side
Palpate with palm and middle three fingers on right hand, aligning the middle finger in the left 5th ICS and other two fingers in ICSs above and below. Start palpating from lateral side (MAL) and move anteriorly towards MCL. If it is difficult, facilitated by brisk jogging to increase rate and strength of heartbeat
At what level is the male nipple?
4th ICS lateral to MCL
Where is the aortic arch?
The beginning of the arch from ascending aorta is at level of right 2nd CC
End of arch becomes thoracic aorta at level of left 2nd CC
Top of the arch midway between jugular notch and sternal angle
How would you draw the brachiocephalic trunk?
Draw a line representing brachiocephalic trunk from the aortic arch, superolaterally to the right stenoclavicular joint. It then divides into right subclavian and right common carotid behind sternoclavicular joint
How would you draw right subclavian artery?
Draw a line laterally (representing RS artery) from right sternoclavicular joint arching over first rib
Palpate the subclavian pulse over the first rib in the supraclavicular fossa just behind medial end of clavicle
How does the right common carotid ascend into the neck?
It ascends on right side of trachea under cover of right sternocleidomastoid muscle
How will you draw the right common carotid?
Subject should turn their head to left side so right SCM muscle will become prominent and visible. Then draw a line from right sternoclavicular joint to the lobe of the right ear
How would you draw the left common carotid artery?
Subject should turn their head to right side. Draw a line from aortic arch towards the left sternoclavicular joint. This line ascends into the neck along the left side of the trachea and continues upwards along the anterior border of left SCM muscle towards the left ear lobe
How would you draw the left subclavian artery?
Draw a line laterally from left sternoclavicular joint arching over left first rib
How would you draw right and left internal jugular veins?
Draw lines just lateral to the common carotid arteries to reach the sternoclavicular joints
How would you draw the right and left subclavian veins?
Draw lines parallel to the subclavian arteries to meet the internal jugular veins just behind the sternoclavicular joints.
The subclavian vein and internal jugular veins unite to form the brachiocephalic veins
How would you draw the right brachiocephalic vein?
Draw a line from right sternoclavicular joint to the inferior border of the right 1st costal cartilage
How would you draw the left brachiocephalic vein?
Draw a line from left sternoclavicular joint to inferior border of right 1st costal cartilage, which runs behind the manubrium from left to right
Right and left brachiocephalic veins unite behind the right 1st costal cartilage to form superior vena cava
How would you draw the superior vena cava?
Draw a line from right 1st costal cartilage to right 3rd costal cartilage, running behind the right side of manubrium and sternum to join right atrium
Where do you listen for aortic valve sounds?
Right 2nd intercostal space near sternum
Where do you listen for pulmonary valve sounds?
Left 2nd or 3rd intercostal space near sternum
Where do you listen for tricuspid valve sounds?
Left 5th intercostal space near sternum
Where do you listen for mitral valve sounds?
Left 5th intercostal space at mid-clavicular line (apex beat)
What does palpitation of an arterial pulse normally reveal?
Pulse rate Rhythm Character Volume Any delays between major arteries
Where do you palpate the common carotid artery?
In the neck between the lateral side of thyroid cartilage and medial border of sternocleidomastoid muscle
Where do you palpate the superficial temporal artery?
Palpate in front of the triages of the ear- terminal branch of external carotid artery
Where do you palpate the subclavian artery?
Palpate in the supraclavicular region, at the angle between clavicle and sternocleidomastoid muscle. At this site you can compress and occlude the artery completely
Where do you palpate the axillary artery?
Palpate on yourself on the medial side of the humerus posterior to the tendon of short head of biceps
Where do you palpate the brachial artery (mid arm)?
Palpate along the middle third of humerus in the medial bicipital groove behind the medial border of the biceps)
Where do you palpate the brachial artery pulse in cubital fossa?
On medial side of tendon of biceps on a fully extended elbow
Where do you palpate the radial artery?
In the wrist over distal end of radius
Where do you palpate femoral artery?
In mid-inguinal point. You can compress and occlude artery completely at this point
How do you palpate the popliteal artery?
In the popliteal fossa against the posterior surface of the tibia. The pulse is slightly difficult
How do you palpate the posterior tibial artery?
Palpate behind medial malleolus
How do you palpate dorsalis pedis artery?
Palpate dorsum of the foot, lateral to extensor hallucis longus tendon
