1. Surface Anatomy By Az and Izzy

2. 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)

3. LUNGS!

4. 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 Midline Mid Clavicular Mid Axilliary Scapular Posterior midline (spinous process)

5. Lungs – Where are they? Apex Joins Midline Lower Sternal level Mid Clavicular Mid Axillary 2-3 cm above middle of the clavicle Sternal Angle / 2 nd CC / T4 6 th Costal Cartilage 6 th Rib 8 th Rib Scapular / back midline 10 th Rib 10 th Spinous Process There’s a little kink at 4 th CC in the left lung

6. What about the Pleura? Apex Joins Midline Lower Sternal level Mid Clavicular Mid Axilliary 2-3 cm above middle of the clavicle Sternal Angle 6 th Costal Cartilage 6 th Rib 8 th Rib Scapular / back midline 10 th Rib 10 th Spinous Process Sternal Angle 6 th Costal Cartilage 8 th Rib 10 th Rib 12 th Rib 12 th Spinous Process

7. Where are the fissures? RightLeft Oblique Fissure2 nd SP -> 6 th rib MCL Cheeky approximation? Hand on head, follow the inf edge of scapula Horizontal Fissure5 th rib MAL -> 4 th CC

8. HEART!

9. Borders of the Heart Upper Right cornerRight 3 rd CC – 1cm right of sternum Upper Left CornerLeft 2 nd CC – 1cm left of sternum Lower Left Corner (Apex)Left 5 th intercostal space – Mid Clavicular Line Lower Right CornerRight 6 th /7 th CC (sterno-costal margin)

10. Listen to your Heart All Prostitutes Take Money

11. Special moves Mitral Stenosis – Lean left, Exhale - BELL Aortic regurgitation – Sit forwards, Exhale - DIAPHRAGM Carotids – With your bell

12. ECG Leads V1 – 4 th IC, right parasternal boarder; V2 – 4 th 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

13. Other stuff they can ask you

14. Systolic and Diastolic Murmurs As Mr Ar Ms Aortic stenosis Mitral regurgitation Aortic regurgitation Mitral stenosis

15. 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

16. Where do you listen to the lungs? Apex, Each lobe ant + post, axilla, lung bases

17. Where is the hilum of each lung? 3 rd -4 th CC / T5/T7

18. Important Message If you’re looking at this presentation before your OSCEs… Remember: Practise makes perfect There is A LOT of room for error

19. 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)

20. 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 heart Released in 1989

21. 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