Академический Документы
Профессиональный Документы
Культура Документы
Blockage of which of the following arteries would lead to ischemia of the apex
of the heart?
Left circumflex
Right marginal
Right coronary
2. If the ductus arteriosus does not spontaneously close off soon after birth (to
become the ligamentum arteriosum), it may have to be surgically ligated.
When clamping or ligating it, what important structure immediately behind it
must be identified and saved?
Cardiac notch
Costomediastinal recess
Hilar reflection
aortic
pulmonary
mitral
tricuspid
5. Which valves would be open during ventricular systole?
Left atrium
Left ventricle
Right atrium
Right ventricle
7. A 3rd-year medical student was doing her first physical exam. In order to
properly place her stethoscope to listen to heart sounds, she palpated bony
landmarks. She began at the jugular notch, then slid her fingers down to the
sternal angle. At which rib (costal cartilage) level were her fingers?
4
8. A patient involved in an automobile accident presents with a sharp object
puncture of the middle of the sternum at about the level of the 4th or 5th costal
cartilage. If the object also penetrated pericardium and heart wall, which heart
chamber would most likely be damaged?
Left atrium
Left ventricle
Right atrium
Right ventricle
9. Which statement is true of the right atrioventricular valve?
it consists of 2 leaflets
10. A 23-year-old male injured in an industrial explosion was found to have
multiple small metal fragments in his thoracic cavity. Since the pericardium
was torn inferiorly, the surgeon began to explore for fragments in the
pericardial sac. Slipping her hand under the heart apex, she slid her fingers
upward and to the right within the sac until they were stopped by the cul-de-
sac formed by the pericardial reflection near the base of the heart. Her
fingertips were then in the:
Coronary sinus
Coronary sulcus
Costomediastinal recess
Oblique sinus
Transverse sinus
11. An elderly lady suffers a coronary occlusion and subsequently it is noted that
there is a complete heart block (that is, the right and left bundles of the
conduction system have been damaged). The artery most likely involved is
the:
circumflex branch
obtuse marginal
atrioventricular canal
coronary sinus
foramen ovale
sinus venosus
truncus arteriosis
13. The heart sound associated with the mitral valve is best heard:
Aortic
Pulmonary
Left atrioventricular
Right atrioventricular
15. In preparation for thoracic surgery, a median sternal splitting procedure was
carried out. But an improper depth setting on the saw blade resulted in a slight
nick on the underlying sternocostal surface of the heart. Which heart chamber
would most likely have been opened had the blade completely penetrated this
wall?
Left atrium
Left ventricle
Right atrium
Right ventricle
16. The sound associated with tricuspid stenosis (narrowing) in a 40-year-old male
would be best heard at which location on the anterior chest wall?
Circumflex
Left marginal
Posterior interventricular
Right coronary
Right marginal
18. Traumatic, acceleration/deceleration injuries to the aorta usually occur where
its mobile and fixed portions meet. This would be at the:
circumflex artery
coronary sinus
sympathetic trunk
ulnar nerve
vagus nerve
21. Which posterior mediastinal structure is most closely applied to the posterior
surface of the pericardial sac?
Aorta
Azygos vein
Esophagus
Thoracic duct
Trachea
22. In obstruction of the superior or inferior vena cava, venous blood is returned to
the heart by an alternate route via the azygos vein, which becomes dilated in
the process. Which of the following structures might it compress as a result?
trachea
phrenic nerve
thoracic duct
descending aorta
23. Elevated systolic blood pressure in the right ventricle suggests stenosis of
which valve?
Aortic
Mitral
Pulmonary
Tricuspid
24. During examination of a 62-year-old man, the senior resident tells you to put
your stethoscope on the left 5th intercostal space, slightly below the nipple,
and listen for a clearly audible murmur. You hear it distinctly and know it must
be associated with severe stenosis of which heart valve?
Aortic
Mitral
Pulmonary
Tricuspid
25. A 26-year-old male is brought into the emergency room after having been
kicked in the chest by a horse. After examination, it is concluded that the most
likely immediate danger is cardiac tamponade (bleeding into the pericardial
sac). You prepare to draw off some of the blood from the sac to relieve the
pressure on the heart. The safest site at which to insert the needle of the
syringe in order to miss the pleura would be:
Left atrium
Left ventricle
Right atrium
Right ventricle
27. While attempting to suture the distal end of a coronary bypass onto the
anterior interventricular artery, the surgeon accidentally passed the needle
through the adjacent vein. Which vein was damaged?
Aortic
Mitral
Pulmonary
Tricuspid
29. You are called to perform thoracentesis (remove fluid from the pleural cavity).
If you are to avoid injuring lung or neurovascular elements, where would you
insert the aspiration needle?
Anterior mediastinum
Costodiaphragmatic recess
Costomediastinal recess
Cupola
Pulmonary ligament
31. Which feature is found only in the left lung?
Cardiac notch
Horizontal fissure
Oblique fissure
Superior lobar bronchus
Three lobes
32. Which of the following nerves would be most vulnerable to irritation when the
tracheobronchial lymph nodes are enlarged due to a diseased situation?
Right phrenic
Left phrenic
Right vagus
33. Which part of the left lung might partially fill the costomediastinal recess in full
inspiration?
Apex
Cupola
Hilum
Lingula
Middle lobe
34. The oblique fissure of the right lung separates which structures?
Hilum
Inferior lobe
Lingula
Middle lobe
Superior lobe
36. A 4-year-old girl is brought in with coughing, and you are told by her mother
that she had been playing with some beads and had apparently aspirated one
(gotten it into her airway). Where would you expect it to most likely be?
its upper lobar bronchus lies behind and above the right pulmonary artery
it has the right phrenic nerve passing posterior to the lung root
38. During a surgical procedure in the vicinity of the descending aorta, a surgeon
accidentally cuts the first aortic intercostal arteries. Which of the following
structures might be deprived of its main source of blood supply?
left bronchus
right bronchus
fibrous pericardium
39. A sick person, lying supine in bed, aspirates (breathes in) some fluid into her
lungs while swallowing. It would most likely end up in which of the following
bronchopulmonary segments?
Cupola
Inferior lobe
Lingula
Middle lobe
Superior lobe
41. A 20-year-old man was stabbed in the back with a knife that just nicked his
right lung halfway between its apex and diaphragmatic surface. Which part of
the lung was most likely injured?
Middle lobe
Inferior lobe
Cardiac notch
Lingula
Superior lobe
42. A 10-year-old boy underwent a tonsillectomy under general anesthesia. At
home he lay supine in bed for two weeks and developed a fever and chest
pain with cough. He returned to the hospital and was diagnosed as having
right lung pneumonia due to aspiration of infectious material during the
tonsillectomy. In which bronchopulmonary segment of the lung would fluid
(pus) most likely have accumulated by the simple force of gravity?
Carina
Cricoid cartilage
Costal cartilage
Pulmonary ligament
Tracheal ring
44. The minor (horizontal) fissure separates:
the lower lobe from both the middle and upper lobes
Lingula
Lower lobe
Middle lobe
Left
Right
47. Which vessel courses across the mediastinum in an almost horizontal
fashion?
Azygos v.
Internal thoracic v.
Left brachiocephalic v.
Right brachiocephalic v.
49. An 8-year-old boy is found to have a mid-line tumor of the thymus gland that is
impinging posteriorly on a blood vessel. The affected vessel is most likely the:
brainstem
celiac ganglion
chain ganglion
spinal cord
aorta
heart
lung
sweat glands
trachea
53. In the midregion of the thorax the thoracic duct lies immediately posterior to
the:
aorta
azygos vein
esophagus
trachea
54. Lymph nodes can be found in which mediastinal compartment(s)?
Anterior
Middle
Posterior
ulnar nerve
vagus nerve
56. Which posterior mediastinal structure is most closely applied to the posterior
surface of the pericardial sac?
aorta
azygos vein
esophagus
thoracic duct
trachea
57. A tumor of the posterior mediastinum is most likely to compress which of the
following structures?
Esophagus
Pulmonary trunk
Trachea
58. The aorta is located in which mediastinal compartment(s)?
Anterior only
Middle only
Posterior only
59. While performing transesophageal echocardiography on a patient, the
posterior wall of the esophagus, immediately behind the left atrium, was
punctured from within. The patient subsequently developed an infection in the
space around the esophagus at this point, namely the:
Anterior mediastinum
Middle mediastinum
Posterior mediastinum
Superior mediastinum
60. Since the puncture in the previous question was through the posterior wall of
the esophagus, the doctors were also very concerned about possible damage
to a thin-walled vessel just behind the esophagus and between the azygos
vein and aorta, i.e., the:
Hemiazygos vein
Thoracic duct
61. During a surgical procedure, a patient's right sympathetic trunk was
accidentally severed just cranial to the level of spinal nerve T1. Which function
would be left intact in the affected region?
Sweat production
Sympathetic trunk
Phrenic nerve
Pulmonary plexus
Vagus nerve
64. An enlarging lymph node gradually constricts the flow of blood in the azygos
venous arch. Which vessel would enlarge as a result of collateral drainage?
Pleurisy
Chylothorax
Pyothorax
Hemothorax
Lymphedema
66. A cancerous growth from the body of the 9th thoracic vertebra exerts pressure
anterolaterally. Which structure lies in direct contact with this growth?
Vagus nerve
68. While viewing an exploratory surgery on a patient injured in an automobile
accident, you see the surgeon elevate the esophagus off the vertebral bodies
and look in the area between the azygos vein and descending aorta. What
structure was she most likely looking for?
Sympathetic trunk
Thoracic duct
69. The ductus arteriosus sometimes remains open after birth, requiring surgical
closure. When placing a clamp on the ductus, care must be taken to avoid
injury to what important structure immediately dorsal to it?
Thoracic duct
70. A frail, elderly man, suspected of having widespread cancer of the lungs and
bronchi, is brought in for bronchoscopic examination. The instrument is
inserted into the airway, where it accidentally punctures the thin, brittle
posterior wall of the diseased right main bronchus. A sudden gush of blood
immediately indicates that the instrument has also torn the wall of the blood
vessel immediately behind the right main bronchus, i.e., the:
Azygos vein
Pericardiacophrenic artery
costal margin
sternal angle
sternal notch
sternoclavicular joint
xiphoid process
72. The thoracic wall is innervated by:
Intercostal nerves
Thoracodorsal nerves
73. The sternocostal surface of the heart is formed primarily by the anterior wall of
which heart chamber?
Left atrium
Left ventricle
Right atrium
Right ventricle
74. A patient involved in an automobile accident presents with a sharp object
puncture of the middle of the sternum at about the level of the 4th or 5th costal
cartilage. If the object also penetrated pericardium and heart wall, which heart
chamber would most likely be damaged?
Left atrium
Left ventricle
Right atrium
Right ventricle
75. You are caring for a 68-year-old male who has copious amounts of fluid in the
left pleural cavity due to acute pleurisy. When you examine him as he sits up
in bed (trunk upright), where would the fluid tend to accumulate?
costodiaphragmatic recess
costomediastinal recess
cupola
hilar reflection
middle mediastinum
76. A 23-year-old male injured in an industrial explosion was found to have
multiple small metal fragments in his thoracic cavity. Since the pericardium
was torn inferiorly, the surgeon began to explore for fragments in the
pericardial sac. Slipping her hand under the heart apex, she slid her fingers
upward and to the right within the sac until they were stopped by the cul-de-
sac formed by the pericardial reflection near the base of the heart. Her
fingertips were then in the:
coronary sinus
coronary sulcus
costomediastinal recess
oblique sinus
transverse sinus
77. When inserting a chest tube, intercostal vessels and nerves are avoided by
placing the tube immediately:
Cardiac notch
Costomediastinal recess
Hilar reflection
Nipple
Sternal angle
Sternoclavicular joint
Xiphoid process
80. The portion of the parietal pleura that extends above the first rib is called the :
costodiaphragmatic recess
costomediastinal recess
costocervical recess
cupola
endothoracic fascia
81. You are attending an operation to remove a thymic tumor from the superior
mediastinum. The surgeon asks, "What important nerve lying on and partly
curving posteriorly around the arch of the aorta should we be careful of as we
remove this mass?" You quickly answer, "The--
left phrenic
left vagus
right phrenic
Cardiac notch
Coronary sinus
Coronary sulcus
Costodiaphragmatic recess
Costomediastinal recess
Cupola
Costodiaphragmatic recess
Costomediastinal recess
Cupola
Hilar reflection
Pulmonary ligament
86. The pleural cavity near the cardiac notch is known as the:
Costodiaphragmatic recess
Costomediastinal recess
Cupola
Hilum
Pulmonary ligament
87. The tubercle of the 7th rib articulates with which structure?
Body of vertebra T6
Body of vertebra T7
Body of vertebra T8
Transverse process of vertebra T6
Thoracic duct
89. A 16-year-old male suffered a stab wound in which a knife blade entered
immediately superior to the upper edge of the right clavicle near its head. He
was in extreme pain, which was interpreted by the ER physician as a likely
indicator of a collapsed lung following disruption of the pleura. If that was true,
what portion of the pleura was most likely cut or torn?
costal pleura
cupola
hilar reflection
mediastinal pleura
pulmonary ligament
90. During a lung transplant procedure, an observing 4th year attempted to pass
his index finger posteriorly inferior to the root of the left lung, but he found
passage of the finger blocked. Which structure would most likely be
responsible for this?
Costodiaphragmatic recess
Cupola
Pulmonary ligament
91. Which of the following layers provides a natural cleavage plane for surgical
separation of the costal pleura from the thoracic wall?
Deep fascia
Endothoracic fascia
Parietal pleura
Visceral pleura
costodiaphragmatic recess
costomediastinal recess
cupola
inferior mediastinum
pulmonary ligament
93. The sternal angle is a landmark for locating the level of the:
Costal margin
Jugular notch
Sternoclavicular joint
Xiphoid process
94. A 3rd-year medical student was doing her first physical exam. In order to
properly place her stethoscope to listen to heart sounds, she palpated bony
landmarks. She began at the jugular notch, then slid her fingers down to the
sternal angle. At which rib (costal cartilage) level were her fingers?
Can't be determined