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GSSE > Thorax > Flashcards

Thorax Flashcards

1
Q

19462 – In the superior mediastinum
A. the left superior intercostal vein passes forward across the arch of the aorta deep to the vagus nerve
B. the left superior intercostal vein passes forward across the arch of the aorta superficial to the phrenic nerve
C. the aortic bodies subserve respiratory reflexes via vagal fibres
D. the left subclavian artery gives its internal thoracic branch
E. the ligamentum arteriosum passes from the right pulmonary artery to the aortic arch

A

C
Last 10th ed. Page: 177; 183

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2
Q

19108 – The superior mediastinum contains the
A. left phrenic nerve passing medial to the left vagus nerve, just above the arch of the aorta
B. left superior intercostal vein
C. whole of the superior vena cava
D. oesophagus held to the left of the midline by the aorta
E. origin of the right recurrent laryngeal nerve

A

B
Last 10th ed. PAGE: 183
C - upper
D - midline
E - left recurrent laryngeal n

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3
Q

23584 – The serous pericardium
1: has the phrenic nerve supplying sensation to its pareital layer
2: encloses the aorta and pulmonary trunk in separate sheaths of its visceral layer
3: has an oblique sinus behind the left atrium
4: has a transverse sinus directly behind both atria

A

TFTF
Last 9th p. 261
4 - transverse sinus posterior to aorta and pulmonary trunk, anterior to superior vena cava

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4
Q

19354 – The fibrous pericardium
A. has visceral and parietal layers
B. has no attachments to the sternum
C. encloses a part only of the superior vena cava
D. is inferiorly related to the diaphragmatic pleura
E. has none of the above properties

A

Answers: C
Last 9th ed p 261
fused with fibrous area of diaphragm posterior aspect, attached to posterior surface of sternum by sternopericardial ligaments.
continuous with outer adventitial layer of neighbouring great blood vessels

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5
Q

23079 – The fibrous pericardium
1: is attached to the sternum
2: is separated from the central tendon of diaphragm
3: is derived from the septum transversum
4: fuses with the root of the IVC

A

Answers: TFTF
Last 9th p261

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6
Q

21015 – S . The inferior vena cava in the thorax has no serous pericardial
covering BECAUSE R. the right atrium is directly attached to a part of the
fibrous pericardium

A

both S and R and false
Last 9th p261
The IVC enters the pericardium through the central tendon of the diaphragm and recieves no covering from the fibrous laye

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7
Q

18940 – The right atrium
A. lies anterior to the left atrium
B. receives blood from all the venae cordis minimae
C. has its left wall formed by the interventricular septum
D. has the coronary sinus opening to the right of the fossa ovalis
E. has a valve for the superior vena cava

A

A
Last 9th p265
D - near the conjunction of posterior interventricular sulcus and coronary sulcus - between IVC and tricuspid valve.

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8
Q

19114 – The right atrium
A. has the atrioventricular node in the upper part of the crista terminalis
B. continues above as the auricular appendage
C. has the coronary sinus opening in the fossa ovalis
D. has the inter-atrial septum forming the left wall of the atrium
E. recovers blood from all the vena cordis minimae

A

Answer: B
Last 9th p265
A - near the coronary sinus on interatrial sptum .

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9
Q

22539 – Within the right atrium
1: the crista terminalis separates the true auricular appendage from the part of the atrium derived
from the sinus venosus
2: the opening of the coronary sinus lies to the left of the valve of the inferior vena cava
3: the fossa ovalis lies in the inferior part of the interatrial septum
4: the AV node is in the interatrial septum above and to the left of the opening of the coronary sinus

A

TTTT
Last 9th p265
1 - crista terminalis is a ridge extending along posteriolateral wall of right atrium between orifice of SVC and IVC

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10
Q

14977 – The atrioventricular node
1: lies subendocardially within the interatrial septum
2: lies above the opening of the coronary sinus
3: is supplied with blood from the left coronary artery in 60% of individuals
4: lies above the anterior cusp of the tricuspid valve

A

Answers: TTFF
Refer to Last 9th p272
3.- supplied by RCA in Right heart individuals (80% of population)

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11
Q

19995 – The AV node receives blood from the
A. conus arteriosus
B. interventricular branch of the left coronary artery
C. right marginal artery
D. left marginal artery
E. by a terminal branch of the right coronary artery

A

E
Last 9th p272

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12
Q

19360 – In valves of the heart
A. the mitral valve has 3 cusps
B. the aortic sound is best heard at the apex
C. the interatrial and interventricular septa lie at about 45 degrees to the saggital plane
D. the tricuspid valve has 2 large papillary muscles
E. the right coronary artery arises from the right posterior aortic sinus

A

C
Last 10th ed. PAGE: 195.
E - anterior aortic sinus

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13
Q

21618 – Heart valves are characterized by
1: many elastic fibres in fibrous tissue covered with vascular endothelium
2: the aortic valve having left, right and anterior cusps
3: the aortic and pulmonary valves having thick cusps with a central fibrous nodule in the free edge
4: the pulmonary valve having a posterior papillary muscle and chordae tendineae

A

TFTF
Last 10th ed. PAGE: 195

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14
Q

22814 – The aortic valve
1: has 2 cusps, whereas the pulmonary valve has 3 cusps
2: has an anterior cusp adjacent to which the left coronary artery arises
3: has a surface marking at the medial end of the left 3rd costal cartilage behind the sternal border
4: is best auscultated in the second right interspace

A

Answers: FFTT
Last 10th ed. PAGE: 194.
Aortic valve has three cusps:
- anterior (origin of right coronary)
- left posterior (origin of left posteiror)
- right posterior

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15
Q

22008 – The left atrio-ventricular valve (mitral valve)
1: has an anterior (septal) cusp with a larger atrioventricular ring attachment than the posterior cusp
2: can be a tricuspid valve
3: has a small posterior cusp
4: has thicker cusps than the right atrioventricular valve

A

FTFT
Last 10th ed. PAGE: 194

mitral valve (lasts)
anterior
- attached to 1/3 of av ring
- thicker and more ridgid
- lies between mitral and aortic orifices between inflow and outflow tracts of the LV

posterior
- attached to 2/3 of av ring

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16
Q

21613 – The fibrous skeleton of the heart
1: is traversed by muscle bundles
2: is traversed by specialized conducting tissue
3: lies in the coronal plane
4: gives attachment to the membranous part of the interventricular septum

A

FTFT
Last 10th ed. PAGE: 190
3 - saggital?

its between the atria and the ventricles

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17
Q

20241 – S. The posterior wall of the right atrium is smooth
internally BECAUSE R. the posterior wall of the right atrium develops from
the right horn of the sinus venosus

A

Answer: S is true, R is true and a valid explanation of S
Last 10th ed. PAGE: 199, 193, 29

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18
Q

23824 – The diaphragmatic surface of the heart consists of parts of
1: (R) atrium
2: atrioventricular groove
3: (R) ventricle
4: (L) ventricle

A

TTTT
Last 10th ed. PAGE: 191

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19
Q

14153 – In the surface projection of the normal heart
1: the tricuspid valve lies beneath the fourth right costal cartilage
2: the upper border of the heart lies below and behind the manubriosternal joint
3: the ‘apex beat’ lies just medial to the midclavicular line
4: the pulmonary valve lies on the left border of the sternum opposite the third left costal cartilage

A

Answers: FTTT
Last’s 9th Ed., p266.
1 - all the valves of the heart lie behind the sternum

heard the best:
- tricuspid right sternal border 5th intercostal
- mitral at apex beat - just medial to mid clavicular line, 5th intercostal space
- aortic - near ascending aorta, right sternal margin 2nd space
- pulmonary left sternal margin 2nd intercostal space over pulmonary trunk

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20
Q

13439 – S:The size of hypertrophied cardiac muscle fibres cannot exceed a
certain maximum because R:increase in the size of cardiac muscle cells is
not accompanied by an increase in the number of capillaries supplying
each muscle fibre and is limited by mitochondrial oxidative capacity

A

S is true, R is true and a valid explanation of S
It is believed that each heart muscle fibre is supplied by only one capillary. When the heart muscle fibre undergoes hypertrophy there is no increase in the vascular supply of the fibre (R true). The extent to which the muscle fibre can enlarge is thus limited by the blood supply (S true and R is a
valid explanation S).

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21
Q

23314 – The right coronary artery
1: arises from the right posterior aortic sinus
2: does not have a corresponding draining vein
3: supplies the sino-atrial node in less than 10% of cases
4: gives off an anterior interventricular branch

A

FTFF
Last 10th ed. PAGE: 197; 198.
1 - arises from anterior
branches of RCA
- rright posterior descneding,
- acute marginal artery
also SA node branch, AV node branch, Right ventricular branch,

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22
Q

22819 – The right coronary artery
1: arises from the right aortic sinus
2: usually supplies the sino-atrial node
3: gives off a posterior interventricular branch
4: provides the main blood supply of the conus arteriosus(infundibulum)

A

TTTT
Last 10th ed. PAGE: 197

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23
Q

19989 – Which of the following statements about the right coronary artery
is NOT true? It supplies
A. most of the right ventricle
B. part of the diaphragmatic surface of the left ventricle
C. about half of the interventricular septum
D. the lower part of the interatrial septum
E. the atrioventricular node in a minority of cases

A

E
Last 10th ed. PAGE: 197

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24
Q

19366 – The left coronary artery
A. arises from the posterior aortic sinus
B. supplies the sinuatrial node in only 10% of cases
C. gives off the anterior interventricular artery
D. usually gives off the posterior interventricular artery
E. supplies no part of the right ventricle

A

C
Last 10th ed. PAGE: 197
a- left posterior

branches of LCA
- LCx, LAD, diagonal branch, left marginal,

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25
Q

21943 – The left pulmonary artery
1: is connected to the arch of the aorta by a fibrous ligament
2: is shorter than the right pulmonary artery
3: passes in front of the left main bronchus
4: lies above the left recurrent laryngeal nerve

A

TTTF
Last 10th ed. PAGE: 207

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26
Q

22484 – The arch of the aorta
1: is crossed anteriorly and to the left by the left supreme intercostal vein
2: has the left brachiocephalic vein above it
3: usually causes an impression on the left side of the oesophagus
4: is crossed anteriorly and to the left by the left phrenic nerve

A

Answers: FTTT
Last 10th ed. PAGE: 186.

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27
Q

21633 – The ascending aorta
1: gives origin to the right coronary artery from its anterior sinus
2: is a posterior relation of the left auricle
3: is encased in a common pericardial sheath with the pulmonary trunk
4: is an anterior relation of the right atrium

A

Answers: TFTF
Last 10th ed. PAGE:190, 197
RCA comes from anterior aortic sinus,
LCA from left posterior aortic sinus

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28
Q

27150 – Type A dissection of the aorta
A. arises proximal to the left subclavian artery
B. may produce neurological signs
C. causes pain which differs from typical myocardial ischaemic pain
D. has a very high mortality when untreated
E. all of the above responses concerning Type A dissection are correct

A

Answer: E
Type A dissection arises just distal to the aortic valve, and is most frequent in patients with
hypertension or a pre-existing aneurysm. Compression of the vessels arising from the arch of the aorta may cause cerebral ischaemic symptoms and signs. Pain often radiates to the back, which is uncommon in myocardial ischaemia. The mortality of untreated type A dissection approaches 90% at
four weeks. Thus, all options are correct, answer E.

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29
Q

22224 – The thoracic part of the left subclavian artery
1: arises from the aortic arch at the level of the disc between the 3rd and 4th thoracic vertebrae
2: is separated by the left vagus nerve, the cardiac nerves and the phrenic nerves from the left
brachio-cephalic vein
3: lies posteriorly on the oesophagus, thoracic duct and longus colli muscles
4: is related medially to the trachea and the left recurrent laryngeal nerve

A

Answers: TTTT
Last 10th ed. Page: 191.

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30
Q

7769 – The pulmonary trunk
1: arises at a slightly higher level than the aortic orifice
2: is at first anterior, then to the left of the ascending aorta
3: is bounded on either side by the appropriate auricle and coronary artery
4: is enclosed with the aorta in a common tube of serous pericardium

A

Answers: TTTT
Last 10th ed, Ch 4

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31
Q

24054 – The right pulmonary artery
1: is shorter and smaller than the left pulmonary artery
2: is an anterior relation of the azygos vein
3: divides at the root of the right lung into two branches
4: is a posterior relation of the thoracic duct

A

Answers: FFTF
Last 10th, pgs 185 (Fig 4.11) & 265. The azygos is in superior relation

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32
Q

21598 – The internal thoracic artery
1: supplies the anterior body wall from clavicle to umbilicus
2: at its origin is closely related to the phrenic nerve
3: supplies the pleura and fibrous pericardium
4: passes into the rectus sheath between rectus abdominis and the anterior sheath

A

Answers: TTTF
Last 10th ed. PAGE: 177

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33
Q

21628 – Coronary venous blood returns directly to the right atrium via
1: the coronary sinus
2: the venae cordis minimae
3: the anterior cardiac veins
4: the oblique vein (of Marshall)

A

Answers: TTTF
Last p274

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34
Q

24269 – The superior vena cava
1: has the right phrenic nerve on its lateral side
2: receives the azygos vein
3: lies anterior to the right pulmonary artery
4: lies to the left of the transverse sinus of the pericardium

A

TTTF

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35
Q

21643 – The superior vena cava
1: fuses with the fibrous pericardium
2: is formed by union of the brachio-cephalic veins
3: receives the azygos vein opposite the second right costal cartilage
4: represents the persistence of part of the right anterior cardinal vein

A

TTTT
Last p259

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36
Q

22914 – The inferior vena cava
1: enters the right atrium to the right of the fossa ovalis
2: enters a deep groove on the bare area of the liver, to the right of the caudate lobe
3: commences at level of L4
4: is posterior to the medial part of the right suprarenal gland

A

Answers: TTFF
Last (8) PAGE: 363.

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37
Q

19120 – The left brachio-cephalic vein
A. lies posterior to the lower half of the manubrium when the neck is extended
B. receives the left superior intercostal vein
C. crosses in front of the aortic arch
D. joins the right brachio-cephalic vein below the second costal cartilage
E. represents the left anterior cardinal vein

A

B
Last’s 9th Ed., p45. The left anterior cardinal vein disappears. The cross channel between L + R AC
vein persists.

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38
Q

20001 – The right brachio-cephalic vein
A. lies anterior to the thymus gland
B. projects above the jugular notch in infants
C. receives the superior intercostal vein
D. crosses the right vagus nerve sub-pleurally
E. occasionally receives the right supreme intercostal vein

A

E
Last 10th ed. PAGE: 187, 185v

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39
Q

19330 – The azygos vein
A. joins the right brachiocephalic vein
B. passes in front of the right lung root
C. is joined by the right superior intercostal vein
D. is crossed anteriorly by right posterior intercostal arteries
E. commences by the union of the lower posterior inter-costal veins

A

C
Last 10th ed. PAGE: 204

40
Q

19977 – Tributaries of the vena azygos include
A. the right superior intercostal vein
B. some oesophageal veins from the middle third of the oesophagus
C. the right fifth to eleventh posterior intercostal veins
D. the right ascending lumbar vein
E. all of the above

A

E
Last 10th ed. PAGE: 204

41
Q

21653 – The left vagus in the thorax
1: is held off the trachea by the great arteries
2: is crossed by the left phrenic nerve just above the arch of the aorta
3: is crossed by the left superior intercostal vein on the arch of the aorta
4: runs posterior to the root of the left lung

A

TTTT
Last 10th ed. PAGE: 189

42
Q

18934 – In relation to the vagus nerves in the thorax
A. pre-ganglionic contributions are made to the oesophageal plexus
B. the left vagus nerve passes medial to the aortic arch
C. the right vagus nerve passes anterior to the right lung root
D. entry into the abdomen is achieved by piercing the crura of the diaphragm
E. recurrent laryngeal nerves are given off by both vagi in the superior mediastinum

A

A
Last 10th ed. PAGE: 204; 189

43
Q

18994 – The left recurrent laryngeal nerve
A. hooks round the arch of the aorta anterior to the attachment of the ligamentum arteriosum
B. may supply a branch to the inferior constrictor muscle before entering the larynx
C. supplies the left cricothyroid muscle
D. supplies sensation to the whole of the laryngeal mucosa
E. contains motor fibres derived from the spinal root of the accessory nerve

A

B
Last 8th Edition PAGE: 404, 488

C - RLN supplies all of the intrinsic muscles of the larynx except for cricothyroid.
D - sensation to the larynx below the level of the vocal cords

44
Q

22239 – The right phrenic nerve
1: runs subpleurally, lateral to the right brachio-cephalic vein
2: runs anterior to the root of the right lung
3: runs over the fibrous pericardium covering the right atrium
4: penetrates the diaphragm through or just lateral to the opening for the inferior vena cava

A

TTTT
Last 10th ed. PAGE: 188

45
Q

14581 – The phrenic nerve
1: descends on the anterior surface of scalenus anterior muscle from medial to lateral
2: may contain C5 fibres which pass anterior to the subclavian vein
3: lies anterior to the prevertebral fascia
4: lies lateral to the ascending cervical artery

A

FTFT
Last p427.

46
Q

22804 – The anterior primary rami of the spinal nerves in the thorax
1: give a collateral branch near the angle of the ribs
2: have some fibres of the first three thoracic nerves going to the upper limb
3: are at first anterior to the internal intercostal muscles
4: end as the intercostal nerves, lying above the artery and vein in the intercostal space

A

TTTF
Last’s 10th Ed., p176.

47
Q

19468 – The cardiac plexus
A. is formed by postganglionic fibres from the vagi
B. is formed by preganglionic sympathetic fibres from T1-4 ganglia
C. lies anterior to the left bronchus at the bifurcation of the pulmonary trunk
D. has a component from the left phrenic nerve
E. innervates the pleura over the pericardium

A

C
Last p259

48
Q

27156 – Innervation of the lung includes
A. sensory supply to the tracheobronchial tree
B. parasympathetic innervation inhibiting secretion of mucus
C. sympathetic innervation mediating vasoconstriction
D. sympathetic innervation constricting bronchial smooth muscle
E. sensory supply to the visceral pleura

A

A
Mechanical stimulation or chemical irritation of the epithelium of the airways evokes the cough reflex (Option A is correct). There is a modest parasympathetic innervation, which is secretomotor, through muscarinic receptors, blocked by atropine and related drugs - hence the use of ipratropium in asthma. The sympathetic supply to the lung - only modest in density - releases noradrenaline, which acts on
beta-2-receptors to dilate bronchioles. There is virtually no effect on the vasculature, which in the lung has little autonomic regulation. Its major vasoconstrictor stimulus is hypoxia, which helps match perfusion to ventilation. The pulmonary beta-receptors respond mainly to circulating adrenaline (and asthma drugs). The lung parenchyma and visceral pleura have no sensation; hence the observation that a localised inflammatory process produces no symptoms until it impinges on the parietal pleura
giving pleuritic pain.

49
Q

19402 – The sympathetic trunk in the thorax has
1: a stellate ganglion lying medial to the first posterior intercostal vein
2: a distribution to the heart via the first 4 thoracic ganglia
3: motor fibres to the eye, causing dilation of the pupil
4: a distribution to the upper limb via the subscapular vessels
5: a distribution to the abdomen, via the splanchnic nerves, under the medial arcuate ligaments

A

FTTFF
Last 10th ed. Page: 204.

50
Q

21858 – The thoracic trachea
1: is directly related to the right lung and pleura
2: lies immediately posterior to the brachio-cephalic artery
3: does not contact the left lung and pleura directly
4: has the bifurcation of the pulmonary trunk directly anterior

A

TTTF
Last 10th ed. PAGE: 187

pulmonary trunk bifuracation is over the left main bronchus.
trachea is higher up

51
Q

23089 – In the left lung
1: the main bronchus is longer than on the right
2: the lingular bronchopulmonary segment is equivalent to the apical bronchopulmonary segment of the lower lobe on the right
3: the left pulmonary artery is longer than the right
4: the pleural reflection crosses the midaxillary line at the eighth rib

A

TFFF
Last 10th ed. Page: 206-207

left main bronchus is longer but right pulmonary artery is longer as pulmonary trunk bifurcates over the left main bronchus and the trachea bifurcates slightly to the right of midline (so left main bronchus is longer)

52
Q

7774 – The left lung root
1: contains the pulmonary ligament, whose layers separate on inspiration
2: contains the pulmonary ligament, that maintains lung compliance
3: has the pulmonary artery above and anterior to the bronchus
4: has the upper lobe bronchus leave the main bronchus outside the lung

A

TFTF
Last 10th ed, Ch 4

53
Q

20163 – S. The pulmonary ligament and femoral canal serve a similar function BECAUSE R. each provides space for increased venous distention

A

Answer: S is true, R is true and a valid explanation of S
Last 10th ed. PAGE: 206

54
Q

7688 – S:The lingula of the left lung corresponds to the middle lobe of the
right lung because R:the lingula of the left lung is separated from the lower
lobe by the oblique fissure

A

Answer: S is true, R is true but not a valid explanation of S
Last 10th ed, Ch 4

55
Q

15408 – The diaphragm
1: develops, in part, from the septum transversum
2: has part of the right crus that lies to the left of the oesophagus supplied by the right phrenic nerve
3: has a caval opening lying behind the right 8th costal cartilage
4: has the right phrenic nerve supplying the muscle from its superior surface

A

TFFF
Refer to Last, 10th Ed, Ch 4, page 178-181

56
Q

19983 – The diaphragm
A. has motor innervation from the phrenic nerve, to all its parts except the crura
B. has sensory innervation from the vagus nerves
C. has a blood supply mostly from the pericardiacophrenic arteries
D. has lymph nodes that drain into the tracheobronchial group
E. moves in respiration under central control of cell groups in the region of the nucleus of the tractus
solitarius

A

E
Last 9th ed. PAGE: 251, 279, 253

57
Q

21828 – In the diaphragm
1: the sympathetic trunk passes behind the medial arcuate ligament
2: the subcostal nerve and vessels pass behind the lateral arcuate ligament
3: the greater and lesser splanchnic nerves pierce each crus
4: the neurovascular bundles of the seventh to eleventh inter-costal spaces pass between the
digitations of the diaphragm and transversus abdominis into the neurovascular plane of abdominal
wall

A

TTTT
Last 10th ed. Page: 178; 180

58
Q

13469, 21608 – The central tendon of the diaphragm
1: gives passage to the right phrenic nerve
2: is fused with the fibrous pericardium
3: is attached to the falciform ligament
4: is attached to the phreno-oesophageal ligament

A

TTTF
Last 10th ed. PAGE: 178; 318.
The central tendon of the diaphragm is trefoil and is inseparable from the fibrous pericardium with which it is embryologically identica. Near the junction of central and right leaves it is pierced by an opening for the inferior vena cava. The wall of the inferior vena cava is attached to the foramen, which is at the level of T8, just behind the right sixth costal cartilage.
The right phrenic nerve pierces the central tendon alongside the inferior vena cava (A true). The falciform ligament of the liver is attached to the liver’s upper surface somewhat to the right of the
midline, and its diaphragmatic attachment is to the central tendon near the base of the fibrous pericardium and runs forwards and to the left to reach the xiphisternum and thence down along the linea alba to the umbilicus (C true). The phreno-oesophageal ligaments are thickenings of the
infradiaphragmatic fascia around the oesophageal opening, which is in the right crus at the level of T10 to the left of the midline (D false).

59
Q

638 – In relation to the diaphragm
1: the vagus nerves pass through its oesophageal opening.
2: the sympathetic trunks pass behind the medial arcuate ligaments.
3: the major motor nerve supply comes from C4.
4: the right phrenic nerve passes through the central tendon.

A

TTTT
The major openings in the diaphragm are at T8 in the dome, where the central tendon is pierced by inferior vena cava and right phrenic nerve (which supplies the diaphragm from its lower surface)
the oesophageal opening at T10 vertebral level transmitting the oesophagus and its associated left (anterior) and right (posterior) vagal nerves;
and the opening for the aorta between the right and left crura opposite T12 vertebra, transmitting aorta and azygos vein and thoracic duct. The left phrenic nerve pierces the muscle of the left diaphragmatic dome.
The splanchnic nerves pierce each crus, and the sympathetic trunks run on psoas behind the medial arcuate ligaments. Each half of the diaphragm is supplied by its own phrenic nerve, originating from C3, 4 & 5 but predominantly from C4. The motor supply is solely from the phrenic. Sensation is supplied by both the phrenic nerve centrally and the lower intercostal nerves peripherally. The oesophageal opening is within the left crus but fibres from the right crus encircle it and contribute to oesophago-gastric competence. Those muscle fibres to the right of the oesophageal opening are supplied by the right phrenic nerve and fibres to the left of the opening are supplied by the left phrenic nerve.

60
Q

23649 – In relation to the diaphragm
1: the vagus nerves pass through its oesophageal opening
2: the splanchnic nerves pass behind the medial arcuate ligament
3: the major nerve supply comes from C4
4: the right phrenic nerve passes through the central tendon

A

TFTT
Last PAGE: 217

61
Q

19348 – Structures penetrating the diaphragm include
A. the oesophagus at the level of T8
B. the aorta at the level of T10
C. the splanchnic nerves, through the crura
D. the right phrenic nerve through the muscle of the right dome
E. the left phrenic nerve through the central tendon

A

C
Last 8th ed. PAGE: 249-251

62
Q

18922 – Structure(s) closely related to the neck of the first rib are
A. the sympathetic trunk and the stellate ganglion
B. the superior intercostal vein
C. internal thoracic artery
D. the intercosto-brachial nerve
E. the sympathetic outflow to the upper limb

A

A
Last 10th ed. PAGE: 212

63
Q

19695 – The arterial supply of the posterior part of the first intercostal
space arises from
A. the arch of the aorta
B. the descending aorta
C. the suprascapular artery
D. the costocervical trunk
E. the transverse cervical artery

A

D
Last 10th ed. PAGE: 177

64
Q

24309 – At the level of the 2nd costal cartilage
1: the superior vena cava receives the azygos vein
2: the oesophagus is a midline structure
3: the left main bronchus arises
4: the right recurrent laryngeal nerve hooks around the arch of the aorta

A

TTTF
Last 10th Ed PAGE: 186.

65
Q

22013 – The 12th rib is characterised by
1: a complete articular facet on the head
2: many muscular attachments
3: a relationship to pleura, medially
4: the absence of a subcostal groove

A

TTTT
Last 10th ed. PAGE: 212

66
Q

21493 – The lower five intercostal nerves
1: cross anterior to the costal margin
2: run deep to the internal intercostal muscles
3: supply parietal and visceral peritoneum
4: supply the rectus abdominis muscle

A

FTFT
Last (8) PAGE: 247

67
Q

21648 – The anterior primary ramus of the 12th thoracic spinal nerve
1: emerges beneath the lateral arcuate ligament of the diaphragm
2: lies behind the kidney
3: has a lateral branch which crosses the iliac crest to reach the buttock
4: supplies the pyramidalis muscle

A

TTTT
Last 10th. ed. PAGE: 272

The antertior primary ramus/anterior division of the 12th thoracic nerve IS the subcostal nerve.
runs along the lower border of the twelfth rib, in front of QL, then internal oblique
communicating branch to the first lumbar nerve which passes laterally under the lumbocostal arch
communicates with ilihypogastric nerve and ilioinguinal nerve of lumbar plexus. gives a branch to pyramidalis and QL.
also lat cutanoeus branch supplying skin over the hip

68
Q

19971 – The intercostal spaces have the
A. collateral branches located superior to the main nerve in the neurovascular plane
B. neurovascular bundles between the external and internal intercostal muscles
C. internal intercostal muscle as the main muscle of respiration
D. levator costae muscles innervated by the anterior primary rami of the spinal nerves
E. intercostal nerves related inferior to the vein and arteries

A

E
Last 10th ed. PAGE: 176-77

69
Q

19689 – The arterial supply to the intercostal spaces are
A. anteriorly, directly from the subclavian artery
B. anteriorly, from the superior epigastric artery
C. posteriorly, from the vertebral artery
D. posteriorly, from the superior intercostal branch of the costocervical trunk, to spaces 1 and 2
E. posteriorly, from the inferior phrenic arteries

A

D
Last 10th. ed. PAGE: 177

70
Q

20871 – S. The internal intercostal muscles are purely inspiratory
muscles BECAUSE R. the fibres of the internal intercostal muscles run
downwards and backwards from one rib to the next below

A

S is false and R is true
Last 10th Ed PAGE: 175; 176; 181

71
Q

18952 – The serratus posterior superior muscle is characterized by
A. glistening tendinous fibres
B. lying immediately adjacent the serratus posterior inferior muscle
C. being a muscle of expiration
D. being superficial to the dorsal scapular nerve and descending scapular vessels
E. being inserted into the posterior angle of the upper four ribs

A

A
Last p244
rises from the spinous processes of the lowest two cervical and the upper two thoracic vertebrae and from the intervening
supraspinous ligaments. The flat sheet of muscle slopes downwards on the surface of splenius and is inserted just lateral to the angles of ribs 2-5. Many tendinous fibres in the sheet of muscle give it a characteristic glistening appearance which provides a useful landmark in exposures of this region. The dorsal scapular nerve and vessels run down on the muscle, which is covered by levator scapulae and the rhomboids

72
Q

20733 – S. Movement can occur at the manubriosternal joint BECAUSE R. the manubriosternal joint is a synovial joint

A

S is true and R is false
Last p244
is a synarthrosis - fibrous connection

73
Q

20319 – S. The sternocostal joint at the manubriosternal angle has two synovial joints BECAUSE R. the manubrium and body do not usually fuse as the other sternebrae do

A

S is true, R is true and a valid explanation of S
Last p244

74
Q

20259 – S. Two separate synovial joints persist at the costal articulation
with the manubrio-sternal junction BECAUSE R. fusion does not normally
occur between the body of the sternum and the manubrium

A

S is true, R is true and a valid explanation of S
Last p244

75
Q

19803 – The body of the sternum
A. gives attachment to the external intercostal muscles laterally
B. has the internal thoracic artery on its posterior surface
C. gives attachment to the pectoralis major and minor anteriorly
D. has a manubrium and body connected by a secondary cartilaginous joint
E. is related directly to the trachea

A

D
Last 10th ed PAGE: 211, 175

76
Q

15345 – The lower part of the body of the sternum
1: forms a secondary cartilaginous joint with the xiphoid process
2: articulates via synovial joints, with the 5th, 6th and 7th costal cartilages
3: is attached to the xiphoid process at the level of the 8th thoracic vertebra
4: has the superior epigastric vessels related posteromedially

A

TTTF
Last p.243

77
Q

19965 – Relations of thoracic vertebrae body include
A. anteriorly, the descending aorta supplying a segmental intercostal artery to all intercostal spaces
B. antero-laterally the sympathetic trunk lying against the vertebral bodies
C. the thoracic duct ascending behind the right intercostal arteries to cross the midline behind the oesophagus at the T4 level
D. the accessory hemi-azygos vein crossing from left to right behind the oesophagus and aorta at the level of T4
E. posteriorly the spinal canal containing extra-dural fat and the internal vertebral venous plexus

A

E
Last 10th ed. PAGE: 425, 203-204.

78
Q

23614 – The lines of pleural reflection
1: lie posterior to the kidneys
2: are adjacent from the angle of Louis to the level of the 4th costal cartilage
3: cross the mid-clavicular line at the tenth costal cartilage
4: project above the neck of the first rib

A

TTFF
Last 10th ed. PAGE: 205.

The lines of pleural reflection outline where parietal pleura abruptly changes direction as it passes from one wall of the pleural cavity to another.
R and L asymmetric
visceral pleura remains roughly two ribs higher than the lines of pleural reflection

3 - MCL at 8th costal cartilage
4 - 1 inch above the midpoint of the medial third of the clavicle

79
Q

7096, 19372 – Which of the following statements about the surface marking of the line of pleural reflection on the left is NOT true?
A. it lies behind the sternoclavicular joint
B. it lies in the midline behind the angle of Louis
C. it lies at the level of the sixth rib in the midclavicular line
D. it crosses the midaxillary line at the level of the tenth rib
E. it crosses the twelfth rib at the lateral border of sacrospinalis muscle

A

C
Last 10th. ed. PAGE: 205. The level of pleural reflection on the left lies at the level of the eighth rib
(not the sixth rib) in the midclavicular line. The response is the only false one and C is thus the correct
answer.

80
Q

8530 – The left pleural reflection
1: is in contact anteriorly with the right pleura from the sternal angle to the level of the 4th costal cartilage
2: crosses the 10th rib in the midclavicular line
3: runs lateral to the body of the sternum from the 4th to the 6th costal cartilages on the left
4: is related to the spleen and left kidney posteriorly

A

TFTF
Last 10th ed, Ch 4.

81
Q

23839 – The apex of the pleura (dome) on either side
1: is related to the subclavian artery
2: is a posterior relation of the lateral third of the clavicle
3: is covered by a layer of fascia attached to the seventh cervical transverse process
4: medially reaches 2.5 cm above the neck of the first rib

A

TFTF
Last 10th ed. PAGE: 205

82
Q

23924 – The classical posterolateral thoracotomy in the 5th interspace
1: will divide levator scapulae
2: follows roughly the oblique fissure on both sides
3: encounters the horizontal fissure on the left side at the midaxillary line
4: causes skin pain mediated in part by the T\b5 posterior ramus

A

FTFT
Last 10th ed. Page: 210

83
Q

22809 – The classical posterolateral thoracotomy incision in the fifth interspace, individual muscles divided include
1: transversus thoracis
2: latissimus dorsi
3: external intercostal
4: serratus anterior

A

FTTT
Last 10th ed. Page: 210; 182

84
Q

623 – In full expiration, a stab wound passing horizontally through the left 9th intercostal space in the mid-axillary line and in the coronal plane, is likely to penetrate the
1: spleen.
2: lung.
3: pleura.
4: kidney.

A

TFTF
The lowest part of the pleural cavity is the costo-diaphragmatic recess. The line of its reflection from diaphragm to parietal pleura lining the ribs runs from the lateral sternal edge on the right, at the level of the sixth costal cartilage (on the left the reflection arches out between fourth and sixth costal cartilages about half way to the apex of the heart). The reflection then runs just above the costal margin anteriorly, crossing the eighth rib at the midclavicular line, and the tenth rib at the mid axillary
line. From this point it runs horizontally around the back, crossing the obliquely running twelfth rib at the lateral border of the erector spinae. It continues horizontally to the lower border of the twelfth thoracic vertebra. The lower margin of the pleura thus overlies posteriorly the upper pole of the kidney. The lower margins of the lungs lie usually about two rib levels above the line of the pleura and its costo-diaphragmatic recess; so that stab wounds can traverse the pleura while missing the lower border of the lung, especially in full expiration.
The dome of the diaphragm reaches as high as the level of the eighth thoracic vertebra, which is approximately at the nipple line level. Stab wounds between the nipple line and the costal margin can thus potentially injure first pleura and lung; and after penetration of the diaphragm, a variety of intraabdominal organs.
The spleen in its surface anatomy lies above the costal margin posterolaterally, with its long axis centred along the line of the tenth rib and extending over an area about as large as a closed fist immediately under the diaphragm, and extending as far forward as the mid axillary line. A stab wound passing horizontally from the left intercostal space in the mid axillary line and running in the coronal plane can therefore pierce the parietal and diaphragmatic pleura, the diaphragm, and the underlining spleen (1 and 3 true). It will be too far forward and too high for kidney, and too low to injure lung (2 and 4 false).

85
Q

15230 – The thoracic duct
A. enters the thorax anterior to the aorta between the crura of the diaphragm
B. crosses anterior to the oesophagus from right to left as it ascends
C. at its termination arches laterally and lies posterior to the vagus nerve
D. crosses the dome of pleura inferior to the subclavian artery
E. contains a valve at its termination

A

C
Refer to Last p279 ; Ch 6, page 403.

86
Q

22149 – The thoracic duct
1: reaches the left side of the oesophagus in the superior mediastinum
2: drains the right posterior intercostal nodes
3: has numerous valves similar to that of the venous system
4: lies anterior to the intercostal branches of the aorta

A

TFTT
Last p279

87
Q

19390 – The thoracic duct
A. enters the chest anterior to the aorta, between the crura of the diaphragm
B. crosses the oesophagus anteriorly from right to left
C. arches forward lateral to the vagus nerve but medial to the phrenic nerve in the neck
D. crosses the dome of the pleura deep to the subclavian artery
E. contains effective valves at its termination

A

C
Last p279
Ascends between thoracic aorta on the left and azygos vein on the right,
- crosses over to the left side between 4th and 6th thoracic vertebrae.
- descends behind the aortic arch and left subclavian artery, anterior to anterior scalene and left phrenic nerve,
- crosses behind recurrent largyneal nerve?
- crosses lateral to vagas with vagas above, but medial to phrenic

88
Q

13197, 19396 – The thoracic duct contains lymph from all of the following
EXCEPT
A. the large intestine
B. the adrenal glands
C. the right arm
D. the left arm
E. the left side of the head and neck

A

C
Last p279
The thoracic duct in the neck contains all lymph draining the lower half of
the body (A and B false), the left half of the thorax, and, through the left jugular and subclavian lymph trunks, the lymph from the left arm (D false) and head and neck (E false). Lymph from the right arm enters the right lymph trunk which drains into the great veins on the right side of the neck (C true).

89
Q

23084 – In the trunk
1: the surface area of the anterior chest and abdomen is 18%of total body surface area
2: relaxed skin tension lines are at right angles to the underlying ribs
3: posterior rami have cutaneous distribution almost to the posterior axillary lines
4: nerves are predominantly above the accompanying arteries and veins

A

TFTF
Last 10th ed. Page: 2, 3
Order: vein artery nerve above down from the above rib

90
Q

24379 – In the trunk
1: the surface area of the anterior and posterior chest and abdomen is 36% of total body surface area
2: posterior rami have no cutaneous distribution
3: relaxed skin tension lines generally follow the direction of ribs
4: the platysma muscle is histologically equivalent to the subareolar muscle of the nipple and dartos muscle

A

TFTF
Last 10th ed. Page: 3; 11

91
Q

19240, 19378 – The oesophagus is closely related to the vertebral bodies
from the
A. cricoid cartilage to the median arcuate ligament
B. cricoid cartilage to the oesophageal hiatus in the diaphragm
C. cricoid cartilage to the lower limit of the superior mediastinum
D. thoracic inlet to the oesophageal hiatus of the diaphragm
E. thoracic inlet to the lower limit of the superior mediastinum

A

C
Last (8) PAGE: 238, 290, 369 277, 434. Last 10th ed. PAGE: 201

92
Q

22179 – The oesophagus is closely related to the
1: pericardium
2: left phrenic nerve
3: left main bronchus
4: right sympathetic trunk

A

TFTF
Last (8) PAGE: 277

starts at C6 behind cricoid cartilage.
from the bifurcation of the trachea downwards the oesophagus passes behind the right pulmonary artery, left main bronchus, and left atrium.
lower oesophagus lies behind the heart and curves in front of the thoracic aorta.

Thoracic duct passes behind the oesophagus, curving from lying behind the esophagus on the right in the lower part to lying behind on the left at the upper oesophagus.
also lies in front of part of the hemiazygous veins and intercostal veins on the right side.

the vagus nerve divides and covers the oesophagus in a plexus

it is crossed by the aortic arch in the superior mediastinum

93
Q

649 – The oesophagus
1: Is encircled by fibres of the left crus as it passes through the diaphragm.
2: has a coat containing non-striated muscle fibres in its lower two-thirds.
3: is in contact with the right mediastinal pleura in the posterior mediastinum.
4: pierces the diaphragm at the level of the tenth thoracic vertebra

A

FTTT
The oesophagus as it passes through the diaphragm at T10 level, is encircled by the fibres of the right crus (1 false, 4 true). The muscle wall of the oesophagus has an inner circular and outer longitudinal layer. This muscle is striated skeletal muscle in approximately the upper third and smooth non-striated visceral muscle in the lower two-thirds (2 true). There is no sharp line of demarcation between the two areas and there is some overlap of the two muscle types. The surface epithelium is stratified squamous epithelium throughout in the normal osophagus. The relations of the oesophagus in the posterior mediastinum below the bifurcation of the trachea include the mediastinal pleura on both sides (especially the right) (3 true). Spontaneous rupture of the oesophagus, provoked by vomiting against a closed upper sphincter, occurs in its unsupported lower third, and can cause accumulation of fluid in either the left or right pleural spaces.

94
Q

20169 – S. Swallowed material may be held up at the level of the fifth thoracic vertebra BECAUSE R. the oesophagus may be indented by the left main bronchus

A

is true, R is true and a valid explanation of S
Last 10th ed. PAGE: 20

95
Q

22519 – The mammary gland
1: contains myoepithelial cells between glandular epithelium and basal lamina
2: has lactiferous sinuses beneath the areola
3: has large branched apocrine glands
4: has lymphatics which drain to the lateral group of axillary lymph node

A

Answers: TTTF
Wheater & Last PAGE: Wheater (pp.75, 305) Last (p.67)
Rotters nodes (interpectoal between min and maj drain into apical axillary and pectoral group
deltopectoral nodes
and parasternal (internal mammary nodes) that travel along the internal thoracic artery

96
Q

20349 – S. Lymphatic spread of carcinoma of the breast can pass intraabdominally BECAUSE R. lymph may pass from the breast through the diaphragm or rectus sheath

A

S is true, R is true and a valid explanation of S
Last 10th. ed. Page: 54

97
Q

23144 – The blood supply of the breast is derived from
1: the lateral thoracic artery
2: the internal thoracic artery
3: the thoraco-acromial artery
4: the superior thoracic artery

A

TTTF
Last 10th Edition, page 54

blood supply from axillary artery via several branches
- superior thoracic
- thoracoacromial
- latearl thoracic and subscapular
- internal thoracic via medial mammary arteries
- perforating branches of second third and fourth intercostal arteries.

venous drainage
- axillary
- internal thoracic
- second to fourth intercostal veins

  • innervation
  • anterior and lateral cutaneous branches of the 2nd to 6th intercostal nerves. fourth intercostal nerve = nipple

GSSE (11 decks)

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