THORAX

Question 1

Spinal level for : jugular notch, sternal angle, xiphoid process

Answer 1

T2/3, T4/5, T9/10

Question 2

Scapula angles

Answer 2

T2 (superior), T3 (medial) and T7 (inferior)

Question 3

Borders of heart

Answer 3

UL: 2nd ICS, 2.5cm left from sternal edge
UR: 3rd CC, 1cm right from sternal edge
LL: 5th ICS, MC line
LR: 6th CC, 1cm right from sternal edge

Question 4

Auscultate valves

Answer 4

Aortic: 2nd ICS, right sternal border
Pulmonary: 2nd ICS, left sternal border
Tricuspid: 5th costosternal border, left.
Mitral: apex- 5th ICS, left.

Question 5

Would you auscultate at the location of the valves?

Answer 5

no. the sound flows with the bloodstream

Question 6

Where can you detect rate, rhythm, character and volume of blood flow?

Answer 6

rate and rhythm- central and peripheral

character and volume- central only eg. carotid

Question 7

venepuncture from

Answer 7

median cubital vein or ante brachial vein if this isn’t possible.
or Cephalic vein adjacent to the anatomical snuffbox, Basilic vein on dorsum of arm, Dorsal metacarpal veins

Question 8

surface mark (SM) aortic arch

Answer 8

beginning: right 2nd cc
top: between jugular notch and sternal angle
end: left 2nd cc

Question 9

common carotid SM

when does it become the ICA

Answer 9

sternoclavicular joint along anterior border of sternocleidomastoid
becomes ICA after upper border of thyroid cartilage

Question 10

internal jugular SM

Answer 10

lateral to CCA

Question 11

Inflation (ant and post)

Answer 11

anterior: hands below breast for woman and just below nipple for men (5/6th rib).
posterior: T10, bit below scapula
thumbs meet at mid sternal line/back midline. thumbs up, off chest and towards you. see chest move 5cm

Question 12

What would cause reduced or asymmetrical lung expansion?

Answer 12

reduced: asthma, COPD, NM disease
asymmetrical: pneumothorax, pleural effusion, collapsed lung

Question 13

what helps lungs expand passively ?

Answer 13

expand:
diaphragm (motor, phrenic, C3,4,5)
external intercostals (motor, T1-11)

Question 14

what helps lungs expand and deflate forcefully?

Answer 14

expand: SCM, scalene
deflate: abd muslces (rectus abdominus and external oblique), internal intercostals (motor, T1-11)

Question 15

breathing rate

Answer 15

12-20 (16) = normal

regular? deep/shallow?

Question 16

describe vesicular breathing

Answer 16

over thorax, soft, inspiration > expiration, no pause, lower.

Question 17

describe bronchial breathing

Answer 17

over trachea, higher and louder pitch, inspiration= expiration, pause.

Question 18

give some examples of abnormal breath sounds

Answer 18

crackling- pneumonia, pulmonary oedema (2ndary to CHF)
wheeze- asthma, COPD (expiratory)
stridor- upper resp tract obstructions (inspiratory)

Question 19

what does it mean if the lungs are hyper-resonant or dull?

Answer 19

hyper- pneumothorax

dull- pleural, fluid, solid effusion; pneumonia; or collapsed lung

Question 20

where is it normal to be hyper resonant/dull?

Answer 20

dull- left upper lung (heart) and right lower lung (liver)

hyper-resonant: left lower (stomach)

Question 21

chest drain

Answer 21

ant of lat dorsi
lateral of pec major
apex below axilla
sup of line of nipple- rib number?
inserted just above rib

Question 22

AP

Answer 22

heart is magnified (can’t see cardiomegaly)

scapula projects over more of the lungs, clearly seen

Question 23

is the corresponding rib above or below the vertebral body?

Answer 23

above

Question 24

superior or inferior costal facet is bigger?

Answer 24

superior