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  • Question 1 - A 27-year old lady is shot in the chest. The bullet enters superior...

    Correct

    • A 27-year old lady is shot in the chest. The bullet enters superior to the upper edge of the clavicle. She had difficulty in breathing which is interpreted by the A&E physician as a likely indicator of a collapsed lung. If that is the case, what portion of the pleura is most likely to have been punctured?

      Your Answer: Cupola

      Explanation:

      The cupola is part of the pleura that extends above the first rib into the root of the lung. Most likely to injured in a stab above the level of the clavicle.

      Costodiaphragmatic recess: the lowest extent of the pleural sac.

      Pulmonary ligament: is a fold of pleura located below the root of the lung.

      Mediastinal pleura: part of the pleura that lines the mediastinal cavity.

      Hilar reflection is the part of the pleura where the visceral pleura of the lung reflects to become continuous with the parietal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      6.3
      Seconds

  • Question 2 - A 26-year old man is brought to the A&E with a stab wound...

    Correct

    • A 26-year old man is brought to the A&E with a stab wound to the chest. The wound is in a part of the left lung that might partially fill the costomediastinal recess in full respiration. Where did the weapon strike this man?

      Your Answer: Lingula

      Explanation:

      During full inspiration, the lingual-of the left lung partially fills the costomediastinal recess. If the apex of the lung is fully filled with air, it would occupy the copula (the part of the pleura that extends above the first rib). The hilum is part of the lung where the neurovascular structures that form the root of the lung enter and leave the lung and doesn’t expand on inspiration. The middle lobe can expand to fill the costomediastinal recess, however, the middle lobe is on the right lung. The inferior lobe, during full inspiration, might fill the costodiaphragmatic recess.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      11
      Seconds

  • Question 3 - You are asked to help a junior medical student studying anatomy to identify...

    Correct

    • You are asked to help a junior medical student studying anatomy to identify the left lung. Which of the following features found only in the left lung will you use the identify it?

      Your Answer: Cardiac notch

      Explanation:

      Oblique fissure: is found on both the left and the right lungs. It separates the upper from the lower lobes in both lungs and the middle lobe from the lower lobe in the right lung(which has three lobes.)

      The superior lobar bronchus is found in both lungs.

      Cardiac notch: found only on the left lung.

      Horizontal fissure: a deep groove separating the middle lobe from the upper lobe of the right lung is absent on the left lung.

      Diaphragmatic surface: refers to the part of the lung, both the left and the right, that is in contact with the diaphragm.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      7
      Seconds

  • Question 4 - During thymectomy the surgeon accidentally nicks a vein that lies just posterior to...

    Correct

    • During thymectomy the surgeon accidentally nicks a vein that lies just posterior to the thymus. Which of the following vessels is likely to be injured?

      Your Answer: Left brachiocephalic vein

      Explanation:

      The thymus is located superficially in the anterior mediastinum. The left brachiocephalic vein courses through the mediastinum to join the right brachiocephalic vein and form the superior vena cava on the right side of the thorax. The left brachiocephalic vein, being superficial, courses just deep to the thymus so that it may be susceptible to compression by an adjacent tumour. The left pulmonary vein, left bronchial vein and right pulmonary artery are deep, and enter and exit the lung at its root, thus are not near the thymus. The right superior intercostal vein drains the 2nd to the 4th intercostal spaces and drains into the arch of the azygos vein. It is not, therefore, closely related with the thymus.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      10.2
      Seconds

  • Question 5 - An operation to remove a segment of the oesophagus through a right thoracotomy...

    Correct

    • An operation to remove a segment of the oesophagus through a right thoracotomy is complicated when a tear develops in a large venous structure in the posterior mediastinum that empties into the superior vena cava. Which of the following structures is likely to be injured?

      Your Answer: Azygos vein

      Explanation:

      The azygos vein is formed by the union of the right subcostal veins and the ascending lumbar veins at the level of the 12th thoracic vertebra. It enters the thorax through the aortic hiatus to ascend in the posterior mediastinum and arching over the right main bronchus posteriorly at the root of the right lung to join the superior vena cava before it pierces the pericardium.

      The basilic vein is a vein on the medial aspect of the arm that ascends to become the axillary vein.

      The cephalic vein is also a vein of the arm.

      The external jugular and brachiocephalic vein are not in the posterior mediastinum.

      The median cubital vein is found in the cubital fossa of the arm.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      942.2
      Seconds

  • Question 6 - A 20-year old cyclist falls off a speeding bike and fractures a structure...

    Correct

    • A 20-year old cyclist falls off a speeding bike and fractures a structure that articulates with the tubercle of the 7th rib. Which structure is fractured?

      Your Answer: Transverse process of vertebra T7

      Explanation:

      A rib tubercle is a projection that is postero-inferior and lateral to the neck of a rib which articulates with the transverse process of the corresponding vertebra i.e. of the same number. Therefore, the tubercle of rib 7 articulates with the transverse process of T7 vertebra. The head of the rib 7, on the other hand, articulates with the 6th vertebra superiorly and the 7th vertebra inferiorly.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      41.8
      Seconds

  • Question 7 - Which among the following vertebrae marks the lowest extent of the superior mediastinum?...

    Correct

    • Which among the following vertebrae marks the lowest extent of the superior mediastinum?

      Your Answer: Fourth thoracic

      Explanation:

      The superior mediastinum lies between the manubrium anteriorly and the upper vertebrae of the thorax posteriorly. Below, it is bound by a slightly oblique plane that passes backward from the sternal angle to the lower part of the body of T4 and laterally by the pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      6.4
      Seconds

  • Question 8 - Following a posterolateral thoracotomy, a surgeon may wish to infiltrate local anaesthetic above...

    Correct

    • Following a posterolateral thoracotomy, a surgeon may wish to infiltrate local anaesthetic above and below the incision to block the nerves supplying the thoracic wall. This wall is innervated by?

      Your Answer: Intercostal nerves

      Explanation:

      Intercostal nerves are the ventral primary rami of spinal nerves T1–T11. They give branches which supply the thoracic wall.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      24.6
      Seconds

  • Question 9 - A patient is brought to the accident and emergency department. He is said...

    Incorrect

    • A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:

      Your Answer: Transverse sinus

      Correct Answer: Oblique pericardial sinus

      Explanation:

      Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.

      Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this sinus.

      Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.

      Coronary sulcus: groove on the heart demarcating the atria from the ventricles.

      Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.

      Sulcus terminalis: a groove between the right atrium and the vena cava.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      81.6
      Seconds

  • Question 10 - A 60 year-old patient being treated for hypertension presents to the ED with...

    Correct

    • A 60 year-old patient being treated for hypertension presents to the ED with swelling of the left upper limb due to poor venous return. On examination, it is found that an aneurysm of the ascending aorta is impinging on a large vein lying immediately anterosuperior to it. Which vein is it likely to be?

      Your Answer: Left brachiocephalic

      Explanation:

      Among the veins listed, only the left brachiocephalic vein is anterosuperior to the ascending aorta. The right brachiocephalic vein being on the right side would not be affected by the aortic aneurysm.

      The azygos vein lies deep in the chest on the right side.

      The internal thoracic vein lies interior to the anterior wall of the chest.

      The left superior intercostal vein is close to the aortic arch, crossing it laterally. This vein drains the 2nd to 4th interspaces on the left side.

      The Right internal jugular vein joins the right brachiocephalic vein which would not be affected by the aneurysm.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      8.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (9/10) 90%
Thorax (9/10) 90%
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