• Cardiac
o Apex beat: 5th intercostal space, midclavicular line (LV apex).
o Heart valves (best auscultated):
Aortic: 2nd right ICS, sternal edge.
Pulmonary: 2nd left ICS, sternal edge.
Tricuspid: lower left sternal edge.
Mitral: 5th ICS, midclavicular line.
• Lung borders
o Anterior: 6th rib midclavicular, 8th rib midaxillary, 10th rib paravertebral.
o Pleura extends 2 ribs lower than lungs.
• Major vessels
o Carotid bifurcation: ~C4 level.
o Abdominal aorta bifurcation: ~L4 level.
o Femoral artery: midway between ASIS and pubic symphysis.
o RA: receives from SVC, IVC, coronary sinus.
o RV: most anterior; forms most of anterior surface.
o LA: posterior; closely related to oesophagus (important in AF ablation).
o LV: forms apex and left border.
o Aortic valve: between LV and aorta.
o Mitral valve: between LA and LV.
o Pulmonary valve: between RV and pulmonary artery.
o Tricuspid valve: between RA and RV.
o RCA: supplies RA, RV, inferior wall; AV node (in ~85% right dominant hearts).
o LAD: anterior wall, septum, apex.
o LCx: lateral and posterior walls.
o Corticospinal tract: crosses in medullary pyramids → controls contralateral voluntary movement.
o Dorsal columns: vibration, proprioception; decussate in medulla.
o Spinothalamic: pain, temperature; cross at spinal cord level.
o CN III: eye movements, pupil constriction.
o CN VII: facial expression; upper face spared in UMN lesion.
o CN VIII: hearing, balance.
o CN X: swallowing, voice (recurrent laryngeal branch).
o Connects anterior and posterior circulations.
o Main contributors: ICA, basilar artery.
o ACA: medial frontal lobes, paracentral lobule (lower limb).
o MCA: lateral hemisphere, face/arm motor and sensory cortex, Broca/Wernicke areas.
o PCA: occipital lobe, visual cortex.
o Anterior spinal artery: anterior 2/3 (motor, pain/temp).
o Posterior spinal arteries: dorsal columns.
• Spleen
o Lies under ribs 9–11 on left side.
o Posterolateral, parallel to 10th rib.
• Liver
o Right upper quadrant, extends to left midclavicular line.
o Segmental anatomy important for surgery (Couinaud classification).
• Gallbladder
o Below liver; at intersection of right midclavicular line and costal margin (Murphy’s point).
• Kidneys
o T12–L3; right lower than left.
• Pancreas
o Head: in C of duodenum; body crosses aorta; tail contacts spleen.
Extra Revision Pearls
• Left atrium is closest to oesophagus → risk during TEE or AF ablation.
• Vertebral level of umbilicus: L3/L4 dermatome.
• Sensory decussation (medial lemniscus) in medulla explains crossed patterns in brainstem lesions.
• Surface marking for appendix: McBurney’s point (1/3 from ASIS to umbilicus).
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
