Vertebral level of superior angle of scapula
T2
Vertebral level of spine of scapula - medial end
T3
Vertebral level of inferior angle of scapula
T7
Vertebral level of manubrium
T2/3-T4/5
Vertebral level of jugular notch
T2/3
Vertebral level of sternal angle
T4/5
Vertebral level of tracheal bifurcation
T4/5
Vertebral level of start and end of aortic arch
T4/5
Vertebral level of body of sternum
T5-8
Vertebral level of xiphisternum
T8/9
Vertebral level of transpyloric plane
L1
Vertebral level of subcostal plane
L2
How many places do you auscultate/percuss for each lobe
Upper 4 (front and back) Middle 2 Lower 2 (front and back)
What does stony percussion of lungs indicate
Pleural effusion
What does a hyper resonant percussion indicate
Pneumothorax
How does a pneumothorax percussion sound
hyperresonant
How does a pleural effusion percussion sound
Stony
Surface marking of upper/middle/lower lobes
- Upper lobes – from apex above clavicles to horizontal fissure in right lung (4th CC) or oblique fissure in left lung (6th CC)
- Middle lobe – between 4th and 6th CC in right lung
- Lower lobe found laterally between 6th and 7th CC
Describe & demonstrate the surface markings of the oblique and horizontal fissures of
right/left lung.
- Oblique – from T3/4 posteriorly to meet the 6th rib/CC anteriorly
- Horizontal – from 4th CC anteriorly to meet the oblique fissure in the mid-axillary line
Describe & demonstrate the surface marking of the inferior margin of parietal pleura of
right/left lung.
- Apex in the root of the neck above medial third of clavicle
- Just right of midline at level of 2nd CC
- Just right of midline at level of 6th CC
- MCL at level of 8th rib (just above costal margin)
- MAL at level of 10th rib (lowest point of costal margin)
- Scapular line crossing 12th rib
- Transverse process of T1 vertebrae
- Cardiac notch in left lung between 2nd and 6th CC
Describe & demonstrate the surface marking of inferior margin of the visceral pleura of
right/left lung.
- Apex in the root of the neck above medial third of clavicle
- Just right of midline at level of 2nd CC
- Just right of midline at level of 6th CC
- MCL at level of 6th rib
- MAL at level of 8th rib
- Scapular line at level of 10th rib posteriorly
Describe and demonstrate the triangle of safety for insertion of a chest drain
- Posterior - Latissimus dorsi - posterior axillary fold
- Anterior - Pectoralis major - anterior axillary fold
- Inferior - 4th/5th intercostal space at mid-axillary line
- Superior - below apex of axilla
- Lies over 2nd-5th ICS
Describe & demonstrate the surface marking of mediastinal pleura of right & left lung
on the anterior chest wall
- Sternal angle to T4
- At hilum, reflected on to vessels and bronchi
- Continuous with visceral pleura
Demonstrate the surface marking of upper/right/inferior/left borders of the heart.
- Just lateral to right sternal border at the 3rd CC
- Just lateral to the right sternal border at the 6th CC (at level of xiphisternal joint)
- At the position of apex beat, which is normally palpable just medial to the MCL in the 5th left ICS)
- Lateral (about 2.5 cm) to the left sternal border at the 2nd CC
