Surface Anatomy

By Az and Izzy

Plan for this session

We’ll run through this presentation, that (hopefully) will tell you everything you need to know

We’ll have a little play about

If you’re anything like us – you’ll forget some/all of it

Use this slide show for revision (later)

LUNGS!

Before thinking about the lungs...

It’s worth being familiar with the markers people like to use:

Levels of superiority / inferiority are almost always described by a rib (or costal cartilage)

The lateral landmarks we care about are:Anterior MidlineMid ClavicularMid AxilliaryScapularPosterior midline (spinous process)

Lungs – Where are they?

Apex

Joins Midline

Lower Sternal level

Mid Clavicular

Mid Axillary

2-3 cm above middle of the clavicle

Sternal Angle / 2nd CC / T4

6th Costal Cartilage

6th Rib

8th Rib

Scapular / back midline

10th Rib10th Spinous Process

There’s a little kink at 4th CC in the left lung

What about the Pleura?

Apex

Joins Midline

Lower Sternal level

Mid Clavicular

Mid Axilliary

2-3 cm above middle of the clavicle

Sternal Angle

6th Costal Cartilage

6th Rib

8th Rib

Scapular / back midline

10th Rib10th Spinous Process

Sternal Angle

6th Costal Cartilage

8th Rib

10th Rib

12th Rib12th Spinous Process

Where are the fissures?

Right Left

Oblique Fissure 2nd SP -> 6th rib MCL 2nd SP -> 6th rib MCL

Cheeky approximation?

Hand on head, follow the inf edge of scapula

Hand on head, follow the inf edge of scapula

Horizontal Fissure 5th rib MAL -> 4th CC

HEART!

Borders of the Heart

Upper Right corner Right 3rd CC – 1cm right of sternum

Upper Left Corner Left 2nd CC – 1cm left of sternum

Lower Left Corner (Apex) Left 5th intercostal space – Mid Clavicular Line

Lower Right Corner Right 6th/7th CC (sterno-costal margin)

Listen to your Heart

All Prostitutes Take Money

Special moves

Mitral Stenosis – Lean left, Exhale - BELL

Aortic regurgitation – Sit forwards, Exhale - DIAPHRAGM

Carotids – With your bell

ECG Leads

V1 – 4th IC , right parasternal boarder;

V2 – 4th IC left parasternal boarder;

V4 – apex beat (mid clav);

V3 – half way between V2 and V4;

V6 – horizontal line from V4 in the axillary line;

V5 – midway between V4 and 6

Plus each limb

Other stuff they can ask you

Systolic and Diastolic Murmurs

As Mr Ar Ms

• Aortic stenosis• Mitral

regurgitation• Aortic

regurgitation• Mitral stenosis

Where would you put a chest drain in?

Triangle of safety

Anterior axilliary fold (Pec maj) Posterior axilliary fold (Lat Dorsi)Horisontal Line just above Nipple

Where do you listen to the lungs?

Apex, Each lobe ant + post, axilla, lung bases

Where is the hilum of each lung?

3rd -4th CC / T5/T7

Important Message

If you’re looking at this presentation before your OSCEs…

GOOD LUCK!!!Remember:

Practise makes perfect

There is A LOT of room for error

What song is the lyric from?

“I hear the ticking of the clock, I’m lying here the room’s pitch dark…”

Heart – Alone(US #1 1987)

What song is the lyric from?

“Cos you know, questions are never that easy, and never the same, You have the answer believe me, if you have the faith

Phil Collins –Find a way to my heartReleased in 1989

What song is the lyric from?

“This is a gift, it comes with a price, who is the lamb and who is the knife?”

Florence and the Machine - Rabbit Heart

Released in 2009