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Anatomy: Surface Anatomy and CCA tips for Semester 2 Salman Zulfiqar Year 2 Medical StudentWhat this lecture will include - Summary of surface anatomy of the lungs and heart - Location of the different heart valves - Discuss the OSCE examination and tips to determining the intercostal spaces. - Brief summary of the anatomy of an X-ray - Brief summary over the high-yield Semester 2 Exam and OSCE related questions Rule of Two’s - The rule of Two’s helps work out the position of the right and left lung. - 1) 2 nd Costal Cartilage = The anterior borders of the lung meet in the midline th - 2) 4 Costal Cartilage = The anterior border of the left lung moves away from the midline. - 3) 6 Costal cartilage = The anterior border of the right lung moves away from the midline and the lower borders of both lungs cross the midclavicular line. - 4) 8 Costal cartilage = The lower borders of both lungs cross the midaxillary line - 5) 10 Costal Cartilage = The lower border of the posterior aspect of both lungs are level with the ribSurface anatomy of the lungs l Apex: - The apex projects into the neck approximately 2.5cm above the clavicle. Oblique Fissure: rd - The oblique fissure exteths from the level of 3 thoracic vertebra to the 6 costochondral junction. Horizontal Fissure: - The horizontathfissure extends from the oblique fissure to the 4 costal cartilage.Surface Anatomy of the lungs II Upper Lobe of left lung: - Left Posterior thorax at level of T2 Left midaxillary line between fourth and sixth ribs Upper Lobe of right lung: - Right midclavicular line between fourth and sixth ribs. Lower lobe of right lung: - Right posterior thorax between the seventh and tenth ribs Apex of lung: - Above the clavicle Surface anatomy of the heart Right Border: rd th - Extends from 3 to 6 Costal Cartilage, 1.3cm from edge of sternum Left Border: nd - Extends from 2 costal Cartilage, 1.3cm from edge of sternum to left 5 intercostal space 9cm from midline. Inferior Border: th - Extends from 6 Costal Cartilage, 1.3cm from edge of sternum to left 5 intercostal space 9cm from midline. Apex: - Projects to left, fifth intercostal space from midlineHeart Valve locations l Pulmonary Valve = Behind medial end of 3 Costal Cartilage and adjoining part of sternum. Aortic Valve = Behind left half of sternum opposite third intercostal space. Bicuspid = Behind left half of sternum opposite fourth costal cartilage. Tricuspid = Behind right half of sternum opposite fourth intercostal space. Auscultation sites for Heart Valves nd Pulmonary = Medial end of 2 Left intercostal space Aortic = Medial end of the second right intercostal space Bicuspid = Fifth intercostal space in the midclavicular line Tricuspid = Fourth intercostal space at the left or right sternal edgeCounting Ribs - Sternal angle is where the costal cartilage of second rib attaches. - Underneath it is the second intercostal spaceAnatomy of an X-ray 01 02 03 Need to know the Need to be able to Need to be able to different types of identify the understand simple an X-ray different pathologies of an anatomical X-ray (Air bubbles) rayuctures of an X-Anatomical structures in an X-ray AP vs PA X-ray - In PA view, the cardiac borders are smaller and more defined as the patient's chest is against the x-ray film with the beam entering posterior to anterior. - In a PA, the clavicle appears shorter and more horizontally orientatedOther High-yield OSCE/Sem2 Exam things to look over An ECG wave (Look at all the intervals and segments and what Spirometry graph they mean) Different types of white blood cells on histology slides and Vessels of the heart their characteristics ECG Graph 1.P wave: The P wave represents atrial depolarization 2.PR interval: It represents the time it takes for the electrical impulse to travel from the atria to the ventricles. 3.QRS complex: The QRS complex represents ventricular depolarization. 4.ST segment: It represents the early part of ventricular repolarization. 5.T wave: The T wave represents ventricular repolarization. 6.QT interval: It represents the total time for ventricular depolarization and repolarization. 7.RR interval: It represents the heart rate or the time between heartbeats. Spirometry •Tidal Volume (TV): the volume of air exchanged during normal inspiration or expiration. •Inspiratory Reserve Volume (IRV): the maximal volume that can be inspired in addition to a tidal inspiration. •Expiratory Reserve Volume (ERV): the maximal volume that can be expired in addition to a tidal expiration. •Residual Volume (RV): the volume remaining in the lungs at the end of a maximal expiration. Because it cannot be breathed out, it cannot be measured using an ordinary spirometer. •Vital (and Forced) Capacity (VC or FVC = ERV + TV + IRV): the maximal volume that can be expired following a maximal inspiration, that is, the largest possible breath you can make. This is a useful test of the ability to inflate and deflate the lungs. •Inspiratory Capacity (IC = TV + IRV): the maximal volume that can be inspired following a normal expiration. volume remaining in the lungs at the end of a normal expiration, that is, at the 'neutral' position, when all the muscles of breathing are relaxed. •Total Lung Capacity (TLC = RV + ERV + TV + IRV = FRC + IC): the volume in the lungs at the end of a maximal inspiration.Any Questions?