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					1. A 46-year-old woman complains to her physician of progressive muscular weakness. Her physician suspects
     myasthenia gravis. Laboratory blood tests confirm the presence of antibodies for the neuromuscular receptor.
     Computed tomographic (CT) scanning of the chest finds a tissue mass in the left anterior mediastinum, adjacent
     to the main pulmonary artery and left main pulmonary artery and contiguous with the pericardium. Which of
     the following could produce a tumor in the anterior mediastinum consistent with these findings?

     A.   Bronchial lymph nodes
     B.   Conus elasticus
     C.   Pericardium
     D.   Thymus
     E.   Vallecula

2. A 52-year-old woman had a thyroidectomy. During ligation of the superior thyroid artery, a nerve was
     inadvertently cut. Which of the following laryngeal muscles is most likely paralyzed as a result of this injury?

     A. Cricothyroid
     B. Lateral cricoarytenoid
     C. Posterior cricoarytenoid
     D. Thyroartenoid
     E. Transverse arytenoid
3. A 23-year-old woman is stabbed with an ice pick in the right third intercostal space immediately lateral to the
     sternum. The ice pick passed in an anterior to posterior direction. The most likely structure penetrated by this
     injury was which of the following?

     A.   Aortic arch
     B.   Inferior vena cava
     C.   Pulmonary trunk
     D.   Right atrium
     E.   Right brachiocephalic vein

4. A 48-year-old man has complains of difficulty in swallowing solids. An upper GI series shows indentation and
                                                           nd
     posterior displacement of the esophagus within the 2 intercostal space. Enlargement of which of the following
     structures is the most likely cause of his problem?

     A. Superior vena cava
     B. Right middle lobe of the lung
     C. Right atrium
     D. Left inferior lobe of the lung
     E. Left atrium
                                      nd
5. A projectile penetrates the right 2 intercostal space at an angle such that it transects the right external laryngeal
     nerve. Which of the following muscles would most likely develop right hemiparalysis?

     A.   Cricothyroid
     B.   Lateral cricoarytenoid
     C.   Oblique arytenoid
     D.   Thyroepiglottis
     E.   Transvese arytenoid
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6. While examining a patient you feel the point of maximum impulse (PMI) along the left mid-clavicular line at the 5
    left intercostal space. Which anatomical structure is most probably being felt?

     A. Apex of the left ventricle
     B. Base of the heart
     C. Left atrium
     D. Aortic arch
     E. Left musculophrenic artery
7. The pericardial cavity passage from the left to the right side of the pericardial sac, passing between the great
     arteries and the great veins is called the:
       A.   coronary sinus
       B.   oblique sinus
       C.   sinus of Valsalva (aortic sinus)
       D.   transverse sinus

8. The sympathetic nervous supply to the heart include:

       A.   cardiac nerves from only the superior, middle, and inferior cervical ganglia
       B.   cardiac nerves from only the upper four or five thoracic ganglia
       C.   cardiac nerves from the superior, middle, and inferior cervical ganglia and the upper four or five thoracic
            ganglia.
       D.   nerve fibers from only the left vagus nerve.
       E.   nerve fibers from the right and left vagus nerves.




                                               A

                                                                  D

   B




                                                                  C




Please match the appropriate letter to the following coronary blood vessels:
9. Sinuatrial nodal artery A
10. Left circumflex artery D
11. Right coronary artery B
12. Great cardiac vein C

13. The triangle of Koch:

       A.   Describes the location of the atrioventricular node.
       B.   Describes the location of the sinuatrial node.
       C.   Is found in the coronary sinus.
       D.   Is superior to the sinuatrial node.
       E.   Marks the location of the left bundle branch of the His-Purkinje system.
13.



       1.   In the X-ray of the chest, the arrow points to the:
                 A. Arch of the azygos vein.
                 B. Arch of the aorta.
                 C. Left atrium.
                 D. Left ventricle.
                 E. Pulmonary trunk.
2.   A 78 yo male has fluid in the left pleural cavity due to acute pleurisy. When he stands the fluid accumulates
     in the:
          A. Costodiaphragmatic recess
          B. Costomediastinal recess
          C. Cupola
          D. Hilar reflection
          E. Middle mediastinum

3.   A tumor of the thymus is being excised from the superior mediastinum. What nerve lying on and partly
     curving posteriorly around the arch of the aorta must be avoided during this procedure?
          A. Left phrenic
          B. Left sympathetic trunk
          C. Left vagus
          D. Right phrenic
          E. Right sympathetic trunk

4.   The pleural cavity near the cardiac notch is known as the:
          A. Costodiaphragmatic recess
          B. Costomediastinal recess
          C. Cupola
          D. Hilum
                                                                                                       th
5.   A patient arrives at the ER after being shot in the chest just to the left of the sternum at the 4 intercostal
     space. He is cyanotic with jugular vein distention on inspiration. You suspect cardiac tamponade and
     prepare for pericardiocentesis. What is the final layer that the needle must transverse in order to drain the
     accumulating blood?
          A. Epicardium
          B. Fibrous pericardium
          C. Mediastinal pleura
          D. Parietal pericardium
          E. Visceral pericardium

6.  A patient involved in an agricultural accident presents with a 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?
           A. Left atrium
           B. Left ventricle
           C. Right atrium
           D. Right ventricle
7. Which of the following layers provides a natural cleavage plane for surgical separation of the costal pleura
    from the thoracic wall?
           A. Deep fascia
           B. Endothoracic fascia
           C. Parietal pleura
           D. Visceral pleura
           E. Transversus thoracis muscle fascia
 8. During a surgical procedure in the vicinity of the descending aorta, a surgeon must temporarily ligate the
      first posterior intercostal artery. Which of the following structures might be deprived of its main source of
      blood supply?
           A. First posterior intercostal space
           B. First anterior intercostal space
           C. Left bronchus
           D. Right bronchus
           E. Fibrous pericardium
9.   During bronchoscopy a pulmonologist passes the bronchoscope down the trachea. A cartilaginous
     structure is observed separating the right and left main (primary) bronchi. This structure is the:
         A. Carina
         B. Costal cartilage
         C. Cricoid cartilage
         D. First tracheal ring
         E. Pulmonary ligament

10. A 73 yo female eroded the posterior wall of the esophagus, immediately behind the left atrium. The
    patient subsequently developed an infection in the space around the esophagus. The most likely location
    for this abscess is at the:
        A. Costodiaphragmatic recess
        B. Costomediastinal recess
        C. Middle mediastinum
        D. Posterior mediastinum
        E. Superior mediastinum
                                 th
11. A cancerous growth of the 9 thoracic vertebra exerts pressure anterolaterally. Which of the following
    structure lies in direct contact with this growth?
              th
        A. 9 intercostal nerve
        B. Greater thoracic splanchnic nerve
        C. Phrenic nerve
        D. Sympathetic trunk
        E. Vagus nerve


12. Which of the following statements about the inferior thoracic aperture is true?
      A. It is bordered by the inferior border of the manubrium anteriorly
      B. It is bounded by T1 and 1st ribs and costal cartilages laterally
      C. The inferior is formed by the hiatus of the cavae
      D. The inferior thoracic aperture is bounded by T6 posteriorly
      E. Through a hiatus passes the esophagus

13. Costoclavicular syndrome causing pallor and coldness of upper limbs and diminished brachial and radial
    pulses is caused by:
        A. Brachiocephalic venous compression
        B. Compression of C3-C5 nerve roots
        C. Compression of C8, T1 nerve roots and inferior trunk of brachial plexus
        D. Compression of the vagus nerves between T1 and T11
        E. Subclavian arterial compression

14. The pleural cavity contains which of the following?
       A. Bronchi
       B. Paratracheal lymph nodes
       C. Pulmonary arteries and veins
       D. Serous pleural fluid
       E. Vagus nerves

15. Which of the following structured is located in the middle mediastinum?
       A. Azygos vein
       B. Esophagus
       C. Heart
       D. Lungs
       E. Thoracic duct
16. The azygos vein receives blood from which of the following?
       A. Anterior intercostal veins
       B. Anterior jugular vein
        C.   Lateral thoracic vein
        D.   Left internal jugular vein
        E.   Posterior intercostal veins

17. The internal thoracic artery is found:
        A. At the costal attachment of the diaphragm at the tenth rib
        B. Bilaterally at the midaxillary line
        C. Immediately lateral to the posterior intercostal artery
        D. Immediately beneath parietal pleurae adjacent to the sternum
        E. Within the diaphragmatic hiatus
18. A 47 yo man is diagnosed with bronchogenic carcinoma (malignant lung tumors arising from respiratory
    epithelia) of the upper lobe of the left lung. X-ray films show paralysis of the diaphragm on the ipsilateral
    side. Damage to which of the following nervous structures is the most likely cause of this paralysis?
        A. Sympathetic trunk
        B. Inferior cervical ganglion
        C. Recurrent laryngeal nerve
        D. Phrenic nerve
        E. Medial cord of the brachial plexus

19. A central venous line is being placed in a 32yo woman. During the procedure, a significant amount of air
    enters unnoticed. Which of the following parts of the body is at greatest risk for complications from this
    event?
        A. Brain
        B. Hand
        C. Heart
        D. Lungs
        E. Upper limb
20. A 63 yo female former smoker has had difficulty swallowing solids for the past several months. She has a
    7-year history of cardiovascular disease. X-ray films of the esophagus with barium contrast show
    indentation and posterior displacement of the esophagus. Enlargement of which of the following
    structures is the most likely cause of her problem?
        A. Left atrium
        B. Left lung
        C. Right atrium
        D. Right lung
        E. Superior vena cava
21. A 46 yo woman is seen in clinic complaining of a “pounding of the heart” that comes on without warning.
    Doppler echocardiography demonstrates mitral valve prolapse. The mitral valve:
        A. Has cusps attached to pectinate muscles
        B. Have three cusps
        C. Is located between the left atrium and ventricle
        D. Is located between the right atrium and ventricle
                                                                     nd
        E. Is located posterior to the sternum at the level of the 2 costal cartilage

22. The “bare area” within the thorax refers to:
        A. A deviation in the left sternal reflection of the pleural that facilitates needle puncture of the
              pericardial cavity without penetration of the left lung or pleural cavity.
        B. A deviation in the right costal reflection of the pleural that facilitates needle puncture of the liver
              without penetration of the right lung or pleural cavity.
        C. A deviation in the right sternal reflection of the pleural that facilitates needle puncture of the
              pericardial cavity without penetration of the right lung or pleural cavity.
        D. An area of continuity between both pleural cavities and the heart.
        E. The area of the heart that is in direct contact with the sternum.
23. During an electrophysiological study an alert monitor technician advised the cardiologist that the pacing
    catheter introduced into the right heart has “captured” the atrioventricular (AV) node. That is, the pacing
    tip of catheter is at the location of the AV node. The catheter tip is most likely:
        A. At the crista terminalis
        B. At the interventricular septum
         C. At the moderator band.
         D. Within the coronary sinus.
         E. Within the triangle of Koch
Please the next two answer questions using the following case.

A 64 yo woman is admitted to the hospital with shortness of breath and difficulty swallowing. She coughs up
blood during the examination and speaks with a hoarse voice. Diagnosis is made of an esophageal carcinoma at a
site of constriction of the esophagus where it is indented by the left main bronchus.

1.    The patient’s hoarse voice in the preceding question may have been caused by the mass impinging on:
           A. Cardiopulmonary splanchnic nerves
           B. The left phrenic nerve
           C. The left recurrent laryngeal
           D. The left vagus nerve
           E. The sympathetic trunk on the left

 2.    If the esophageal mass expands anteriorly into the middle mediastinum, what structure might initially
       become compressed?
            A. Left atrium
            B. Left ventricle
            C. Right atrium
            D. Right ventricle

 24. Inferiorly, the pericardium is attached to the central tendon of the diaphragm by the___.
         A. Epicardial ligament
         B. Pericardiacophrenic ligament
         C. Sternopericardial ligament
         D. Transverse pericardial ligament

25. Is the retropharyngeal space anterior to or posterior to the esophagus?
          A. Anterior
          B. Posterior
                                              th        th
2. A 28 year old female fractured her right 9 and 10 ribs. There are no lung sounds at the right inferior
    costal margin. Lung sounds were normal on the left. A chest x ray showed the mediastinum to be deviated
    to the left. MRI showed fluid collected in the right costodiaphragmatic recess. A right thoracotomy at the
            th
    right 6 intercostal space and right anterior axillary line was performed. A large tear was found in a vessel
    penetrating the central tendon of the right hemidiaphragm and repaired. The vessel repaired was the:
          A. Inferior vena cava
          B. Right internal thoracic artery
          C. Right musculophrenic artery
          D. Right pericardiacophrenic artery
          E. Thoracic aorta

3.    A 21 year old man complaining of shortness of breath was admitted. Chest X- ray showed that his right lung
      was partially collapsed . At what location would a chest tube be typically placed?
           A. At the costal angle directed left.
                                                       th        th
           B. Left anterior axillary space at the 7 or 8 left intercostal space
                                                 th       th
           C. Left mid axillary space at the 5 or 6 left intercostal space
                                                    th        th
           D. Right mid axillary space at the 5 or 6 right intercostal space
                                                           th       th
           E. Right posterior axillary space at the 5 or 6 right intercostal space
4.    Suzi Cheamcheese is a 24 year old female who fractured her left clavicle when she lost control of her Ducati
      1098S motorycle. The clavicle was reapproximated and immobilized. Follow up showed a well healed
      clavicle with no reduction in range of motion or sensation in the left arm. She returned to clinic 3 mo after
      her initial follow up visit complaining of pain, tingling and weakness in her left arm. Physical examination
      showed pallor and coldness of the left arm with diminished brachial, ulnar, and radial pulses. A mid
      clavicular mass was palpated. MRI noted a large callus (thickening of the bone associated with the healed
      fracture). The callus was surgically reduced with a good result and the patient was free of all symptoms on
      discharge. The cause of her more resent complaint was:
              A.   Compression of left C5-T1 anterior rami, brachiocephalic vessels between the clavicle and C5
                   vertebra.
              B.   Compression of left C5-T1 posterior rami, subclavian artery between the clavicle and C5 vertebra.
                                                                                                       st
              C.   Left brachial plexus and subclavian vessel compression between the clavicle and 1 rib.
                                                                                        st         nd
              D.   Left brachial plexus and subclavian vessel compression between the 1 rib and 2 rib.

    5.   67-year-old man is seen in clinic. He complains of left-sided lateral thoracic pain, and left-sided neck and
         shoulder pain. He is diagnosed with inflammation of the parietal pleura (pleurisy). What combination of
         nerves, responsible for innervating the parietal pleura, is responsible for the distribution of pain reported by
         the patient?
              A. Greater splanchnics
              B. Intercostal and phrenic
              C. Parasympathetic and sympathetic
              D. Phrenic and vagus
              E. Vagus and intercostal

    6.   An 87-year-old woman complains of not feeling anything on a portion of her chest wall. An examination
         determines that she has complete loss of sensory and motor function in a small portion of her anterior
         thoracic wall. Which of the following nervous structures is most likely responsible for this patient's deficit?
              A. Anterior ramus of a spinal nerve
              B. Anterior roots of a spinal nerve
              C. Spinal ganglion
              D. Sympathetic trunk
              E. White rami communicantes

    7.   A 72-year-old cigarette smoker is diagnosed with cancer of the right lung and the right lung must be
         removed. During this surgical procedure, which of the following structures, passing posterior to the root of
         the lung, could be injured?
              A. Aorta
              B. Hemiazygos vein
              C. Inferior vena cava
              D. Right phrenic nerve
              E. Right vagus nerve

    8.   A 42-year-old man has trouble swallowing. After numerous tests he is diagnosed with cancer involving the
         lower end of the thoracic portion of the esophagus and the entire abdominal esophagus. The neoplasm is
         large and has filled the esophageal hiatus of the diaphragm. In this position it is compressing all of the
         structures passing through this opening. Which of the following structures is being compressed?
              A. Anterior vagal trunk
              B. Azygos vein
              C. Greater splanchnic nerve
              D. Right phrenic nerve
              E. Thoracic duct

    9.   A 63-year-old man has had pain in the lateral side of his left chest for the past 60 days. On auscultation of
         the left posterior thorax, a loud sound similar to leather surfaces creaking over one another is heard during
         inspiration and expiration. Which of the following nerves most likely carries the pain sensation from the
         affected side?
              A. An intercostal
              B. Greater splanchnic
              C. Phrenic
              D. Postganglionic parasympathetic
              E. Vagus

19. During a surgical repair of a ruptured disc between thoracic vertebrae 7 and 8 the thoracic duct is nicked. What
part of the mediastinum would fill with lymphatic fluid?
     A. Anterior.
     B. Middle.
     C.   Posterior.
     D.   Superior.

20. Which of the following statements regarding the intercostal space is true. **Thrown out**
              A. Intercostal nerves travel anteriorly in a virtual space between the external interostal and internal
                   intercostal muscles.
              B. The anterior intercostal arteries drain directly into the azygos vein.
              C. The anterior intercostal arteries of the first six intercostal spaces are branches of the superior
                   intercostal artery.
              D. The anterior intercostal arteries of the upper six intercostal spaces arise from the thoracic aorta,
              E. The intercostal blood vessels are positioned with in the subcostal groove from superior to inferior
                   as nerve, artery, vein.

21. Dissecting infections spreading from the parapharyngeal and paratonsillar regions of the upper airway are most
     likely to reach the superior mediastinum through which of the following?
                 A. carotid sheath
                 B. pterygoid venous plexus
                 C. retropharyngeal space
                 D. suprasternal space
                 E. superficial cervical fascia
23. While placing a central line placement into the right subclavian vein which of the following is most likely at risk of
     being punctured?
                 A. superior thyroid artery
                 B. pleural cavity
                 C. vagus nerve
                 D. sympathetic trunk
                 E. azygos vein
The triangle of Koch:
                 F. Describes the location of the atrioventricular node.
                 G. Describes the location of the sinuatrial node.
                 H. Is found in the coronary sinus.
                 I. Is superior to the sinuatrial node.
                 J. Marks the location of the left bundle branch of the His-Purkinje system.
Which of the following layers provides a natural cleavage plane for surgical separation of the costal pleura from the
thoracic wall?
                 K. Deep fascia
                 L. Endothoracic fascia
                 M. Parietal pleura
                 N. Visceral pleura
                 O. Transversus thoracis muscle fascia




The arrow points to what structure?
              P. Arch of the azygos vein
              Q. Arch of the aorta
              R. Left atrium
              S. Left ventricle
              T. Pulmonary trunk
Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac?
    A. Aorta
    B. Azygos vein
    C. Esophagus
    D. Thoracic duct
    E. Trachea

46. Most of the drainage of the thoracic body wall reaches the superior vena cava via the azygos vein. A notable
exception is the left superior intercostal vein, which normally drains into the: **Thrown out??**
     A. Left brachiocephalic vein???
     B. Left bronchial vein
     C. Left pulmonary vein
     D. Left subclavian vein
     E. Superior vena cava
Azygos vein:
     A. Originates from the left ascending lumbar and subcostal veins
     B. Drains in to the inferior vena cava
     C. Communicates with the accessory hemiazygos vein at the level of T12
     D. Communicates with the hemiazygos vein at the level of T10
     E. Crosses the root of the right lung




. A 28 year old male is brought to the emergency department after being injured during a
suicide bombing. An entry wound is seen medially 2 cm below the umbilicus and no exit
would is found. A PA radiograph of the thorax shows a foreign object (arrow). This
foreign object is located at:
     A. the stomach.
     B. the dome of the right hemidiaphragm.
     C. the 12th rib.
     D. the lower margin of the left lung.
     E. the lower margin of the right lung.

The inferior laryngeal artery is a branch of the__________ artery.
     A. superior thoracic
     B. superior laryngeal
     C. inferior thoracic
     D. cricothyroid
     E. external carotid
2. Which of the following is true of the right vagus nerve?
     A. It gives a branch to the cardiac plexus.
     B. It gives rise to a branch that supplies sensory innervation to the diaphragm.
     C. It gives rise to the right superior phrenic nerve.
     D. It passes anterior to the root of the right lung.
     E. It passes posterior to the right subclavian artery.
3.   Which of the following is correct pertaining to the azygos venous system?
     A. It drains blood from the anterior walls of the thorax and abdomen.
     B. It forms an alternate route for venous blood to return to the heart when the inferior vena cava is blocked.
     C. The azygos vein arches inferior to the root of the right lung.
     D. The hemiazygos vein arches superior to the root of the left lung.
     E. The hemiazygos vein receives tributaries from the right anterior intercostal veins.


4.   Which of the following is correct pertaining to the thoracic sympathetic trunk?
     A. It gives rise to only the greater splanchnic nerve.
     B. It has only white rami at each level.
     C. It is in continuity with the cervical and lumbar sympathetic trunks.
     D. It lies against the costal angle of the ribs in the superior part of the thorax.
     E. It supplies only postganglionic sympathetic fibers to thoracic viscera.

5.    A 21-year-old man, in shock and bleeding profusely after being stabbed in the chest, is brought to the
                                                                               st
     emergency department. Examination shows a knife wound to the right 1 intercostal space, immediately lateral
     to the manubrium. The knife entered parallel to the ground and penetrated to a depth of 6.5 cm. Which of the
     following structures is most likely injured?
     A. Ascending aorta
     B. Left common carotid artery
     C. Right subclavian artery
     D. Right ventricle
     E. Superior vena cava
                                                                                                                      th
6.   During a routine physical examination, the examiner notices the point of maximum impulse (PMI) is at the left 6
     intercostal space at the midaxillary line. These findings suggests The patient has:
     A. A hypoplastic heart.
     B. A normal heart.
     C. An enlarged heart.
     D. Dextrocardia.
     E. Pulmonary hypertension.
7.   Traumatic, acceleration/deceleration injuries to the aorta usually occur where its mobile and fixed portions
     meet. This would be at the:
     A. ligamentum arteriosum
     B. junction of aortic arch with the descending portion
     C. junction of the ascending aorta with the heart
     D. origin of the brachiocephalic artery
     E. where the descending aorta passes through the diaphragm
8.   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. You prepare to draw
     off some of the blood 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:
           th
     A. 4 left intercostal space in the midaxillary line
     B. just below the nipple on the left
     C. just to the left of the xiphisternal junction
     D. near the sternal angle
     E. through the jugular notch

9.   A 22-year-old male involved in an automobile accident presents with symptoms suggestive of myocardial
     contusion due to blunt trauma, specifically compression of the sternocostal surface of the heart by the sternum
     when his chest hit the steering wheel. Which heart chamber was most likely damaged?
     A. left atrium
     B. left ventricle
     C. right atrium
     D. right ventricle
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 penetrated both pericardium and heart wall, which
heart chamber would most likely be damaged?
     A. Left atrium
     B. Left ventricle
     C. Right atrium
     D. Right ventricle

20. A 23-year-old male injured by an explosive device was found to have multiple small metal fragments in his
thoracic cavity and a lacerated pericardium, torn inferiorly. The surgeon explored for fragments in the pericardial sac.
Slipping her hand under the heart apex, she slid her fingers downward and to the right within the sac until they were
stopped by a large vessel near the posterior margin of the heart. Her fingertips were:
     A. In the coronary sinus.
     B. In the costomediastinal recess.
     C. In the transverse sinus.
     D. Touching the inferior vena cava.
     E. Touching the pulmonary veins.


. A 62-year-old man consults his physician about difficulty in breathing. Upon physical examination, the physician
palpates the man's trachea in the jugular notch. During cardiac systole, the physician feels the trachea move abnormally
(tugging). Aortic angiography demonstrates an aneurysm of the aortic arch. What structures may be compressed by the
aneurysm?
      A. Left phrenic nerve
      B. Superior and inferior vena cavae
      C. Superior bronchial lymphatics
      D. Trachea and esophagus


24. The pulmonary ligament:
      A. Extends as the phrenicopleural fascia connecting diaphragmatic pleura to diaphragmatic muscle fibers.
      B. Extends between the lung and the mediastinum, immediately anterior to the esophagus.
      C. Extends superiorly to the hilum of the lung to anchor the primary bronchi to the sternum.
      D. Forms the fibrous component of the central tendon of the diaphragm.
The internal thoracic artery is found:
                                                                th
      E. at the costal attachment of the diaphragm at the 10 rib..
      F. bilaterally at the midaxillary line.
      G. inferior and lateral to the sternum.
      H. lateral to the posterior intercostal artery.
      I. within the diaphragmatic hiatus.
Mr. Lumpphart, against the advice of his physician, declines repair of his inferior thoracic aortic aneurysm and discharges
himself from hospital. Two weeks later he returns to the hospital complaining of swelling in his legs, inguinal region, and
testicles. Physical exam reveals a bruit and other physical finding are consistent with the aortic aneurysm. Compression of
which of the following structures is most likely responsible for this physical finding.
      A. Carinal (inferior tracheobronchial) lymph nodes.
      B. Iliac vein
      C. Internal vertebral artery
      D. Thoracic duct

59. A patient complains of dysphagia and is seen in clinic. An esophageal mass is found. If the esophageal mass
expands anteriorly into the middle mediastinum, what structure might initially become compressed?
     A. Left ventricle
     B. Right ventricle
     C. Right atrium
     D. Left atrium
     E. Pretracheal lymph nodes

10. Which of the following structures is located in the posterior mediastinum?
    A. Lungs
    B. Heart
    C. Azygos vein
    D. Superior vena cava
    E. Right coronary artery
11. An 18-year-old man, in shock and bleeding profusely, is brought to the emergency department after being
    stabbed in the chest. Examination shows a knife wound to the right first intercostal space, immediately lateral
    to the manubrium. The knife entered parallel to the ground and penetrated to a depth of 6.5 cm. Which of the
    following structures is most likely injured?
    A. Left common carotid artery
    B. Ascending aorta
    C. Superior vena cava
    D. Right ventricle
    E. Right subclavian artery

 31. Which of the following is NOT contained in the anterior mediastinum?
   A. Fat
   B. Sternopericardial ligaments
   C. Branches of internal thoracic vessels
   D. Lymphatic vessels
   E. Heart
 32. The accessory hemiazygos vein parallel the vertebral column along which vertebral levels?
   A. T1-12
   B. T2-6
   C. T5-8
   D. C8-12
   E. L1-4

 33. Which of the following is most likely to compress the esophagus?
   A. Aortic arch
   B. Right main bronchus
   C. Left vagus Right brachiocephalic vein
   D. Brachiocephalic trunk

 34. They azygos vein receives blood from which of the following?
   A. Posterior intercostals veins
   B. Anterior intercostals veins
   C. Left internal jugular vein
   D. Anterior jugular vein
   E. Lateral thoracic vein

 35. The outermost layer of the three layers of heart tissue is also known as which layer of pericardium?
   A. fibrous pericardium
   B. parietal pericardium
   C. visceral pericardium
   D. none of the above; the epicardium is separate from the pericardium

  A thin 26 year old man is an avid skin-diver. During a diving trip, he surfaces complaining of difficulty breathing and
  chest pain. There are no indications of a surface wound of the chest. A diagnosis of spontaneous pneumothorax is
  made the ER. The pain experienced by the patient resulted from irritation of pain fibers that innervate the costal
  pleura. The __________ nerves carry pain from the costal pleura.
     F. vagus
     G. greater splanchnic
     H. intercostal
     I. phrenic nerves
     J. cardiopulmonary splanchnic
  A 42-year-old male requires a bone marrow biopsy, the needle is pushed too deeply through the midline of the
  lower half of the manubrium and blood is obtained. The needle has most likely entered which of the following
  structures?
     K. Aortic arch
     L. Left ventricle
     M. Pulmonary trunk
     N. Superior vena cava




  34. Lipsinger Mudphart Jr. is diagnosed with an aortic aneurysm 6 cm in diameter extending 2 cm superiorly to 2 cm
  inferiorly as the aorta transverses the aortic hiatus. Which of the following venous structures would most likely be
  compressed?
     O. Azygos vein
     P. Inferior vena cava
     Q. Internal thoracic artery.
     R. Sympathetic nervous trunk

36 – 39 Matching
Please MATCH the appropriate (numbered) thoracic structures with their representations in the drawing to your
right (A-D):
                                                   A


                                               B

                                   C
                           E

                                                           D



       Number                       Thoracic Structure
      36               Superior mediastinum A
      37               Anterior mediastinum C
      38               Costomediastinal recess E
      39               Costodiaphragmatic recess D

40.
    Which of the following is a neural structure that carries visceral pain fibers from the heart that results in
    referred pain over the T1-5 dermatomes?
   A. ventral roots of the T1-5 spinal nerves
   B. dorsal roots of the T-5 spinal nerves
   C. greater splanchnic nerves
   D. gray rami communicated of the T1-5 spinal nerves
   E. dorsal rami of the T1-5 spinal nerves
41. The carotid sheath blends with the deep fascia and contains of the following?
   A. Internal and common carotid arteries, internal jugular v., vagus n., and deep cervical nodes
   B. Internal carotid, external jugular v., phrenic and deep cervical nodes
   C. Carotid arteries, external jugular v., vagus n., and superficial and deep nodes

				
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