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1

What is the thin fold of pleural membrane that projects inferiorly from the root of the lung and also extends form the hilum to mediastinum?

A. Pulmonary ligament
B. Interlobular septum
C. Lacunal ligament
D. Bronchomediastinal fold

A. Pulmonary ligament

2

As it travels superiorly, the thoracic duct remains posterior to which blood vessel?

A. Descending aorta
B. SVC
C. Azygous vein
D. IVC

A. Descending aorta

3

How many bronchopulmonary segments are usually present in the right lungs?

A. 7
B. 8
C. 9
D. 10

D. 10

RIGHT LUNG = 10 bronchopulmonary segments
- 3 in superior lobe
- 2 in middle lobe
- 5 in inferior lobe
LEFT LUNG = 8 segments
- 4 in upper lobe
- 4 in lower lobe)

Layer of connective tissue separates each segment from the next.

4

The oblique fissure on a lung extends from the 3rd thoracic vertebra posteriorly to which rib anteriorly?

A. 4th rib
B. 6th rib
C. 10th rib
D. 12th rib

B. 6th rib

5

In the sequence of air movement inside the lungs, what comes next after a respiratory bronchiole?

A. Alveolar sac
B. Alveolar duct
C. Terminal bronchiole
D. Interlobular bronchiole

B. Alveolar duct

Order is: Bronchioles --> Terminal bronchioles --> Respiratory bronchioles --> Alveolar ducts --> Alveolar sacs

6

At what level is the oesophageal hiatus?

A. 2nd lumber vertebra
B. 5th thoracic vertebra
C. 8th thoracic vertebra
D. 10th thoracic vertebra

D. 10th thoracic vertebra

Oesophageal hiatus = Opening in the diaphragm through which the oesophagus and the vagus nerve pass.

7

Looking at the thoracic vertebrae, what points posteriorly and inferiorly?

A. Transverse processes
B. Spinous processes
C. Vertebral body
D. Superior articular processes

B. Spinous processes

8

True or false: about the pleura surrounding the lungs

A. There are two layers, the visceral and the parietal
B. The two layers are continuous at the lung hila
C. The right pleural cavity is smaller
D. There is an inferior deflection from each hilum, marking the attachment of the pulmonary ligament

A: True
B: True
C: False
D: True

9

True or false: about lung fissures

A. The right lung has both horizontal and oblique fissures
B. The oblique fissure runs at an angle from T3 posteriorly to the hilum at the level of the 6th cc anteriorly
C. All fissures are always complete in all lungs
D. The horizontal fissure runs from the 4th costal cartilage anteriorly to meet the oblique fissure, resulting in a wedge-shaped middle lobe

A: True
B: True
C: False
D: True

10

The bronchial veins can drain into multiple places, which of the following is incorrect?

A. Directly into the right atrium
B. The pulmonary veins
C. The azygous vein on the right, or the hemizygous vein on the left
D. The carotid sinus

D. The carotid sinus

11

The following are all direct branches of the aortic arch:

A. Left common carotid artery
B. Right common carotid artery
C. Brachiocephalic trunk
D. Left subclavian

B. Right common carotid artery

The right common carotid comes from the brachiocephalic trunk, not directly from the aortic arch.

12

The phrenic nerves:

A. Lie only in the superior mediastinum
B. Arise from the lower lumbar vertebrae
C. Originate from C3-5
D. Have recurrent laryngeal branches

C. Originate from C3-5

C3, 4, 5 keeps the diaphragm alive

13

The coronary veins mainly drain into:

A. The aortic sinuses
B. The carotid sinus
C. The coronary sulcus
D. The posterior cardiac vein

B. The carotid sinus

14

Which of the following ligaments is most likely to be torn in the head of a rib and its articulation with the vertebra are compromised?

A. Anterior longitudinal
B. Interarticular
C. Intertransverse
D. Posterior longitudinal
E. Radiate

E. Radiate

15

Which of the following muscles will actively assist in expiration during COPD (e.g emphysema)?

A. Diaphragm
B. External abdominal obliques
C. Pectoralis major
D. Scalenes
E. Sternocleidomastoid

B. External abdominal obliques

16

Intercostal arteries form an important anastomosis with which of the following arteries?

A. Axillary
B. Brachiocephalic
C. Internal thoracic
D. Subclavian
E. Superior epigastric

C. Internal thoracic

17

Which of the following muscles lie deep (posterior) to the internal thoracic vessels?

A. External intercostals
B. Innermost intercostals
C. Internal intercostals
D. Scalenes
E. Transversus thoracic

E. Transversus thoracic

18

Which of the following nerves for a plexus on the oesophagus?

A. Greater splanchnic nerves
B. Intercostal berves
C. Least splanchnic nerves
D. Lesser splanchnic nerves
E. Vagus nerves

E. Vagus nerves

19

Which of the following is the major blood supply to the lungs?

A. Bronchial
B. Internal thoracis
C. Mediastinal
D. Pericardiocophrenic
E. Pulmonary

A. Bronchial

20

Which of the following structures lies just posteriorly to the left atrium and can be compressed if the atrium is enlarged?

A. Ascending aorta
B. Azygos vein
C. Descending aorta
D. Oesophagus
E. Thoracic duct

D. Oesophagus

21

The collection of blood in the pericardial sac can compromise the force of contraction of the heart’s chambers and is termed “cardiac…”:

A. Infarct
B. Insufficiency
C. Ischaemia
D. Rebound
E. Tamponade

E. Tamponade

22

The pain associated with MI (angina pectoris) is conveyed along visceral afferent nerve fibres that enter which of the following spinal cord levels?

A. C3-5
B. T1-4
C. T10-12
D. L1-2
E. L2-4

B. T1-4

23

Which of the following sets of lymph nodes is a major site of metastasis of cancer cells from the breast?

A. Axillary
B. Infraclavicular
C. Parasternal
D. Pulmonary
E. Supraclavicular

A. Axillary

24

Although the azygos vein is important in portocaval anastomoses, it normally drains into which of the following veins?

A. Hemiazygos
B. IVC
C. Left gastric
D. Right brachiocephalic
E. SVC

E. SVC

25

Which of the following features of the right atrium separates the pectinate muscle from the sinus venarum (smooth portion of the inner atrial wall)?

A. Crista terminalis
B. Fossa ovalis
C. Opening of the coronary sinus
D. Right auricle
E. Tricuspid valce

A. Crista terminalis

26

Which of the following muscles helps depress the ribs during expiration?

A. Anterior scalene
B. External intercostals
C. Levator scapulae
D. Lower internal intercostals
E. Pecoralis minor

D. Lower internal intercostals

27

Which of the following muscles assists in elevating the ribs during deep inspiration?

A. Diaphragm
B. External intercostal
C. Pectoralis major
D. Rectus abdominus
E. Sternohyoid

B. External intercostal

28

Which of the following coronary vessels supplies blood to most of the interventricular septum?

A. Circumflex
B. Left anterior descending
C. Left marginal
D. Posterior descending
E. Right marginal

B. Left anterior descending

29

The parietal serous pericardium lines which of the following structures?

A. Epicardium
B. Fibrous pericardium
C. Mediastinal pleura
D. Proximal aorta
E. Proximal pulmonary trunk

B. Fibrous pericardium

30

Why might the right ventricle become hypertrophied in a heart with a ventricular septal defect?

A. Absence of the septomarginal trabecula
B. Increased blood volume from the left side
C. Obstruction of the mitral valve
D. Prolapse of tricuspid valve
E. Reduced ventricular filling

B. Increased blood volume from the left side

31

When introducing a needle into the thoracic cavity, why is the needle inserted superior to a rib rather than just inferior to the rib margin?

A. To avoid piercing the inferior lobe of the lung
B. To avoid piercing the intercostal neurovascular bundle
C. To avoid piercing the internal thoracic artery
D. To avoid piercing the parietal pleura
E. To avoid piercing the transversus thoracic muscle

B. To avoid piercing the intercostal neurovascular bundle

32

Following surgery to the breast, the patient presented with a unilateral ‘winging’ of the scapula. Which of the following nerves were likely damaged?

A. Lateral pectoral
B. Long thoracic
C. Lower subscapular
D. Suprascapular
E. Thoracodorsal

B. Long thoracic

33

Why might ischaemia to the interventricular septum disrupt the rhythmicity of the heart?

A. It may affect the subendocardial conduction system
B. It may block the AV node conduction
C. It may block SA node conduction
D. It may decrease venous return
E. It may inhibit the vagus nerve

A. It may affect the subendocardial conduction system

34

When the pleura lining the inner aspect of the anterior thoracic wall becomes inflamed and painful, which of the following portions of the pleura is most likely to be involved in this inflammatory process?

A. Costal pleura
B. Diaphragmatic pleura
C. Mediastinal pleura
D. Pulmonary ligament
E. Visceral

A. Costal pleura

35

Which of the following structures is responsible for the first heart sound?

A. Closure of the aortic valve
B. Closure of the mitral valve
C. Contraction of the right ventricle
D. Prolapse of the tricuspid valve
E. Relaxation of the right atrium

B. Closure of the mitral valve

36

A tumour in the left lung displaces the left main bronchus. Which of the following structures is most likely compressed by the displaced bronchus?

A. Aortic arch
B. Azygos vein
C. Oesophagus
D. Thoracic duct
E. Thymus gland

C. Oesophagus

37

If a surgeon’s finger is in the transverse pericardial sinus, what is the relationship of his/her finger to the SVC?

A. Anterior
B. Inferior
C. Posterior
D. Lateral
E. Superior

A. Anterior

38

A surgeon wished to clamp the pulmonary artery at the hilum of the right lung. Where would he/she look for this artery?

A. Anteroinferiorly
B. Inferiorly
C. Posteriorly
D. Posteroinferiorly
E. Superiorly

E. Superiorly

39

Which of the following ribs is least likely to be fractured?

A. 2nd
B. 5th
C. 6th
D. 10th
E. 11th

E. 11th

Fractures of the middle ribs are most common.

40

True or false: the angle of Louis

A. Marks a secondary cartilaginous joint
B. Lies medial to the 3rd intercostal spaces on either side of the chest
C. Is at the level of T2
D. Lies anterior to the aortic bifurcation
E. Is the point of insertion of the pectoralis minor

A. Marks a secondary cartilaginous joint.
TRUE

B. Lies medial to the 3rd intercostal spaces on either side of the chest.
FALSE - Medial to the 2nd rib

C. Is at the level of T2.
FALSE - T4

D. Lies anterior to the aortic bifurcation.
FALSE: L4

E. Is the point of insertion of the pectoralis minor.
FALSE - It inserts at the corticoid process of the scapula

41

True or false: the right lung
A. Has two oblique fissures
B. Has a root consisting of the right main bronchus, a pulmonary artery and a pulmonary vein
C. Has a superior and inferior lobe only
D. Has an anterior extension known as the linguila
E. Border crosses the 8th rib in the mid-axillary line

A. Has two oblique fissures.
FALSE - Oblique fissure and horizontal fissure

B. Has a root consisting of the right main bronchus, a pulmonary artery and a pulmonary vein.
FALSE - TWO pulmonary veins

C. Has a superior and inferior lobe only.
FALSE - 3 lobes

D. Has an anterior extension known as the linguila.
FALSE - Linguila is on the left side

E. Border crosses the 8th rib in the mid-axillary line.
TRUE - Crosses 6th rib in mid-clavicular, 8th in mid-axillary and 10th rib at the vertebral column

42

True or false: the thoracic duct

A. Begins above the diaphragm at the cisternal chyli
B. Crosses from the left to the right between T7 and T4
C. Drains into the SVC
D. Drains blood from the lower limbs, abdomen and left thoracic wall
E. Is found in the posterior mediastinum

A. Begins above the diaphragm at the cisterna chyli. FALSE - Begins BELOW the diaphragm (between the aorta and oesophagus)

B. Crosses from the left to the right between T7 and T4. FALSE - Right --> Left

C. Drains into the SVC.
FALSE - Drains into the left brachiocephalic vein

D. Drains blood from the lower limbs, abdomen and left thoracic wall.
FALSE - Drains lymph, not blood

E. Found in the posterior mediastinum. TRUE

43

True or false: the tricuspid valve

A. Has 3 semilunar cusps – anterior, posterior and septal
B. Is also known as the right atrioventricular valve
C. Has an opening for the right coronary artery in the right cusp
D. Lies between the left atrium and ventricle
E. Closes at the 2nd heart sound in the cardiac cycle

Has three semilunar cusps - anterior, posterior and septal. FALSE - Not a semilunar value but has three leaflets (names as above)

B. Is also known as the right atrioventricular valve.
TRUE

C. Has an opening for the right coronary artery in the right cusp.
FALSE - The aortic valve does

D. Lies between the left atrium and ventricle.
FALSE - Tricuspid valve = right, mitral valve = left

E. Closes at the second heart sound in the cardiac cycle - FALSE - At the first heart sound

44

True or false: the left coronary artery

A. Is commonly the predominant supply to the sinoatrial node
B. Divides into two branches, the circumflex and left marginal artery
C. Forms the posterior interventricular branch of the coronary circulation in a left-dominant coronary circulation
D. Does not supply the AV bundle
E. Arises from the pulmonary artery

A. Is commonly the predominant supply to the sinoatrial node.
FALSE - The right CA usually is

B. Divides into two branches, the circumflex and left marginal artery.
FALSE - It divides into the circumflex and left anterior descending; the circumflex branch gives rise to the left marginal artery

C. Forms the posterior interventricular branch of the coronary circulation in a left dominant coronary circulation.
TRUE

D. Does not supply to AV bundle
FALSE - It does

E. Arises from the pulmonary artery
FALSE - It arises directly from the aorta

45

The most inferior structures in the hilum of the lung is A.. The bronchus
B. The pulmonary veins
C. The pulmonary artery
D. The pulmonary ligament

D. The pulmonary ligament

46

The following structures pass through the diaphragm at the given levels:

A. IVC = T8, Aorta = T10, Oesophagus = T12
B. Oesophagus = T8, IVC = T10, Aorta = T12
C. Aorta = T8, Oesophagus = T10, IVC = T12
D. IVC = T8, Oesophagus = T10, Aorta = T12

D. IVC = T8, Oesophagus = T10, Aorta = T12

47

The short left coronary artery is also sometimes referred to as the

A. LAD
B. Left main stem vessel
C. Innominate artery
D. Right coronary artery

B. Left main stem vessel