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  • Question 1 - 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
      2.7
      Seconds

  • Question 2 - What is the correct order of structures a needle must pass before it...

    Correct

    • What is the correct order of structures a needle must pass before it enters the pleural cavity?

      Your Answer: External intercostals – internal intercostals – innermost intercostals – parietal pleura

      Explanation:

      The correct order of structures from superficial to deep are: the skin and subcutaneous tissue, the external intercostals followed by internal intercostals, innermost intercostals and finally parietal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      3.8
      Seconds

  • Question 3 - 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
      7.2
      Seconds

  • Question 4 - An infant, 5 weeks and 6 days old born with a large sub-aortic...

    Correct

    • An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?

      Your Answer: Transverse pericardial sinus

      Explanation:

      Cardiac notch: is an indentation on the left lung of the heart.

      Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart.

      Coronary sulcus: a groove on the heart between the atria and ventricles.

      Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava.

      Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.

      Horizontal pericardial sinus: this is a made-up term.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      4.8
      Seconds

  • Question 5 - An 80 year-old lady presents to the out patient clinic complaining of chest...

    Correct

    • An 80 year-old lady presents to the out patient clinic complaining of chest pain of 2 months' duration with a normal electrocardiogram and cardiac enzymes. A computed tomographic scan is done which reveals a mass lesion involving a structure in the middle mediastinum. Which among the following structures could be involved?

      Your Answer: Ascending aorta

      Explanation:

      The middle mediastinum is the broadest part of the mediastinal cavity containing the heart enclosed in the pericardium, ascending aorta, lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery with its branches, pulmonary veins, phrenic nerves and bronchial lymph nodes. The most likely structure involved is the ascending aorta, perhaps with an aneurysm.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      7.6
      Seconds

  • Question 6 - A patient in the recovery ward after cardiac surgery is noticed to have...

    Correct

    • A patient in the recovery ward after cardiac surgery is noticed to have a small effusion in the lowest extent of the pleural cavity, into which no lung tissue extends. What is the name of this part of the pleural cavity?

      Your Answer: Costodiaphragmatic recess

      Explanation:

      The costodiaphragmatic recess is the part of the pleural cavity where the costal pleura is in continuity with the diaphragmatic pleura. It forms the lowest extent of the pleural cavity.

      Costomediastinal recess: a tiny recess that is anteriorly located, where the costal pleura becomes continuous with the mediastinal pleura.

      The cupola is the pleural cavity that extends above the first rib.

      The inferior mediastinum refers to the posterior, middle and anterior mediastinal divisions together.

      The pulmonary ligament on the other hand, is a pleural fold that is situated beneath the root of the lung on the medial aspect of the lung.

      Oblique pericardial sinus is not part of the pleural cavity.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      4.4
      Seconds

  • Question 7 - When inserting a chest drain anteriorly into the second intercostal space, one must...

    Correct

    • When inserting a chest drain anteriorly into the second intercostal space, one must identify the second costal cartilage by palpating which landmark?

      Your Answer: Sternal angle

      Explanation:

      The sternal angle is the site for identification of the second rib as the second rib is attached to the sternum at this point.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      6
      Seconds

  • Question 8 - A surgeon trainee is assisting in an operation to ligate the ductus arteriosus....

    Correct

    • A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?

      Your Answer: Left recurrent laryngeal nerve

      Explanation:

      The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.

      Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.

      The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.

      Left phrenic nerve is lateral to the vagus nerve.

      Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.

      Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      10.1
      Seconds

  • Question 9 - 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
      3.9
      Seconds

  • Question 10 - A tumour growing in the posterior mediastinum is found in a 40-year-old man...

    Incorrect

    • A tumour growing in the posterior mediastinum is found in a 40-year-old man who presented to the out patient clinic with chest pain. Such a tumour is likely to compress the following structure:

      Your Answer: Inferior vena cava

      Correct Answer: Oesophagus

      Explanation:

      The boundaries of the posterior mediastinum are: the superiorly through the sternal angle and T4/5, inferiorly, the diaphragm, anteriorly, by the middle mediastinal structures and posteriorly by the spinal cord. Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. The oesophagus is the only structure in the posterior mediastinum among the choices.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      5.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

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