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Question 1
Correct
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Which of the following occurs primarily to produce passive expiration:
Your Answer: Relaxation of diaphragm and external intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Correct
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A 40 year old man from Japan was diagnosed with cancer of the oesophagus. He is to undergo esophagectomy. While mobilizing the oesophagus in the neck, for resection and anastomosis with the stomach tube on the left side, the surgeon must be cautious not to injure a vital structure. Which of the following is it?
Your Answer: Thoracic duct
Explanation:The oesophagus is divided into 3 portions: cervical (part that is in the neck), thoracic portion and the abdominal portion. The cervical part is bordered by the trachea anteriorly and the prevertebral fascia covering the bodies of the 6,7 and 8th vertebra posteriorly. The thoracic duct lies on the left side at the level of the sixth cervical vertebra. The carotid sheath with its contents and lower poles of the lateral lobes of thyroid gland are lateral. The thoracic duct is the structure most likely to be injured.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 3
Incorrect
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All of the following typically occurs as part of normal inspiration except:
Your Answer: Contraction of the diaphragm
Correct Answer: Contraction of the internal intercostal muscles
Explanation:Passive inspiration is a result of contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, several movements occur. These are: 1. elevation of the sternal ends of the ribs (‘pump handle’ movement), 2. elevation of the lateral shafts of the ribs (‘bucket handle’ movement) 3. depression of the diaphragm. These result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. There is an increased intrathoracic volume and decreased intrathoracic pressure and air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 4
Correct
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Which of the following anatomical structures is most likely the cause of oedema and erythema of the arm in a patient who underwent modified radical mastectomy and radiotherapy?
Your Answer: Axillary lymph nodes
Explanation:Arm oedema is one of the sequelae after breast cancer surgery and radiation therapy. Arm oedema in the breast cancer patient is caused by interruption of the axillary lymphatic system by surgery or radiation therapy, which results in the accumulation of fluid in subcutaneous tissue in the arm, with decreased distensibility of tissue around the joints and increased weight of the extremity. Chronic inflammatory changes result in both subcutaneous and lymph vessel fibrosis.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 6
Incorrect
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Which muscle separates the subclavian artery and the subclavian vein?
Your Answer: Sternocleidomastoid
Correct Answer: Scalenus anterior
Explanation:The subclavian artery and vein have a similar path throughout their course, with the subclavian vein running anterior to the subclavian artery. The artery and vein are separated by the insertion of the scalenus anterior muscle. There are three scalene muscles, found on each side of the neck: 1. Anterior scalene 2. Middle scalene 3. Posterior scalene The scalenus anterior muscle is the anterior most of the three scalene muscles. It originates from the transverse processes of vertebrae C3-C6 and is inserted in the first rib.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 7
Incorrect
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During work up for a 29 year-old lady who complained of chest pain, a computed tomography showed a large mass in the posterior mediastinum. Which among the following structures could be involved?
Your Answer: Inferior vena cava
Correct Answer: Lymph glands
Explanation:Boundaries of the posterior mediastinum include: Superior: a plane through the sternal angle and T4/5Inferior: the diaphragmAnterior: the middle mediastinal structuresPosterior 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. In this case, the lymph nodes is the correct answer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Incorrect
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A 60-year old woman who has a left sided post-pneumonic effusion, was to have some pleural fluid aspirated for culture and sensitivity. If the medical intern in charge of the procedure decided to aspirate while the patient is sitting up on her bed, where in the pleural cavity would the fluid tend to accumulate?
Your Answer: Cupola
Correct Answer: Costodiaphragmatic recess
Explanation:The lowest part of the pleural cavity is the costodiaphragmatic recess and it the space in which the pleural fluid will accumulate when the patient sits up. The cupola is part of the pleural cavity that extends into the root of the neck above the first rib. The costomediastinal recess is the junction at which the costal pleura becomes the mediastinal pleura. The middle mediastinum is the part of the mediastinum that is occupied by the heart. The hilar reflection is the point where the mediastinal pleura is reflected to continue on as the visceral pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Correct
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When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?
Your Answer: Costodiaphragmatic recess
Explanation:The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 10
Incorrect
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A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from the steering wheel of his car after falling asleep while driving headlong into an oncoming HGV lorry. Bruising around his sternum was observed, which appears to be the central point of impact. Which of the following structures is most likely injured by the blunt force trauma?
Your Answer: Right atrium
Correct Answer: Right ventricle
Explanation:In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart: Anterior (or sternocostal) – Right ventricle Posterior (or base) – Left atrium Inferior (or diaphragmatic) – Left and right ventricles Right pulmonary – Right atrium Left pulmonary – Left ventricle
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 11
Correct
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Which of the following statements is true about percutaneous needle aspiration?
Your Answer: The needle should be inserted just above the upper border of the chosen rib
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration. In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 12
Incorrect
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Contraction of the diaphragm results in which of the following effects:
Your Answer: Decreased intra-abdominal pressure
Correct Answer: Increased vertical dimension of the thorax
Explanation:Contraction of the diaphragm (as in inspiration) results in flattening (depression) of the diaphragm with an increase in vertical dimension of the thorax. This results in decreased intrathoracic pressure and increased intra-abdominal pressure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Incorrect
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Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?
Your Answer: Left circumflex artery
Correct Answer: Left anterior descending artery
Explanation:Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results. Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern. The following ECG leads determine the location and vessels involved in myocardial infarction: ECG Leads Location Vessel involved V1-V2 Septal wall Left anterior descending V3-V4 Anterior wall Left anterior descending V5-V6 Lateral wall Left circumflex artery II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%) I, aVL High lateral wall Left circumflex artery V1, V4R Right ventricle Right coronary artery V7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 14
Incorrect
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The 'pump handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The internal intercostal muscles elevating the ribs
Correct Answer: The anterior ends of the ribs moving upwards and forwards
Explanation:Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, the anterior end moves upwards and forwards, moving the sternum upwards and forwards in turn. This ‘pump handle’ upwards and forwards movement changes the anteroposterior (AP) dimension of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 15
Correct
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How many unpaired branches leave the abdominal aorta to supply the abdominal viscera?
Your Answer: Three
Explanation:The abdominal arteries are divided into 3 branches;- 3 main unpaired trunks (celiac trunk, superior mesenteric, inferior mesenteric arteries)- 6 paired branches- unpaired median sacral artery.We can group the abdominal aorta as follows;-Ventral which includes: Coeliac trunk, superior mesenteric and inferior mesenteric arteries-Lateral: Inferior phrenic, middle suprarenal, renal and gonadal arteries-Dorsal: Lumbar and median sacral arteries-Terminal : Right and left common iliac arteriesThe celiac trunk (L1) takes blood the foregut and its found posterior to the stomach. The unpaired superior mesenteric artery supplies blood to the mid-gut. The paired renal arteries form the inferior suprarenal arteries. The renal arteries arise around L1/L2 and takes blood to either side of the kidneys. The median sacral artery supplies blood to the lumbar vertebrae the L4 and L5.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 16
Incorrect
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Which of the following muscles are primarily involved in passive inspiration:
Your Answer: Diaphragm and internal intercostal muscles
Correct Answer: Diaphragm and external intercostal muscles
Explanation:Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 17
Incorrect
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The spinal cord tracts that transmits the sensations of pain, crude temperature, and light touch is?
Your Answer: Corticospinal
Correct Answer: Spinothalamic
Explanation:Dorsal column (ascending tract) – Proprioception, vibration, discriminative Spinocerebellar (ascending tract) – Subconscious muscle position and tone Corticospinal (descending tract) – Voluntary muscle Rubrospinal (descending tract) – Flexor muscle tone Vestibulospinal (descending tract) – Reflexes and muscle tone Reticulospinal(descending tract) – Voluntary movements, head position.- Autonomic – Descending tract.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 18
Incorrect
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Which coronary artery is mostly likely affected if an ECG shows ST segment elevation in leads II, III and aVF, and ST segment depression in V1-V3?
Your Answer: Left marginal artery
Correct Answer: Right coronary artery
Explanation:A posterior wall MI occurs when posterior myocardial tissue (now termed inferobasilar), usually supplied by the posterior descending artery — a branch of the right coronary artery in 80% of individuals — acutely loses blood supply due to intracoronary thrombosis in that vessel. This frequently coincides with an inferior wall MI due to the shared blood supply. The ECG findings of an acute posterior wall MI include the following: 1. ST segment depression (not elevation) in the septal and anterior precordial leads (V1-V4). This occurs because these ECG leads will see the MI backwards; the leads are placed anteriorly, but the myocardial injury is posterior. 2. A R/S wave ratio greater than 1 in leads V1 or V2. 3. ST elevation in the posterior leads of a posterior ECG (leads V7-V9). Suspicion for a posterior MI must remain high, especially if inferior ST segment elevation is also present. 4. ST segment elevation in the inferior leads (II, III and aVF) if an inferior MI is also present. The following ECG leads determine the location and vessels involved in myocardial infarction: ECG Leads Location Vessel involved V1-V2 Septal wall Left anterior descending V3-V4 Anterior wall Left anterior descending V5-V6 Lateral wall Left circumflex artery II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%) I, aVL High lateral wall Left circumflex artery V1, V4R Right ventricle Right coronary artery V7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 19
Correct
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In order to arrest sudden bleeding during pericardiectomy that started after accidental injury to a major vasculature in the pericardium; the surgeon inserted his left index finger through the transverse pericardial sinus, pulled forward on the two large vessels lying ventral to his finger, and compressed these vessels with his thumb to control the bleeding. Which vessels were these?
Your Answer: Pulmonary trunk and aorta
Explanation:Transverse pericardial sinus: located behind two great vessels (aorta and pulmonary trunk) and in front of the superior vena cava and is accessed from above as in this case. The brachiocephalic trunk is located above the pericardium and the right pulmonary artery is above the pericardial reflections.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Correct
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Which of the following statements about a cervical rib is correct?
Your Answer: It originates from the 7th cervical vertebra
Explanation:The costal elements of the seventh cervical vertebrae form projections known as cervical ribs, which are present in approximately 0.5% – 1 % individuals. A cervical rib commonly comprises of a head, neck and tubercle. The body of the rib varies from person to person. It extends into the posterior triangle of the neck, where it is either free anteriorly, or attached to the first rib / sternum. Patients with a cervical rib mostly are asymptomatic and it is usually diagnosed as an incidental finding on chest x-ray. However, in some cases, the subclavian artery and the lower trunk of the brachial plexus are compressed where they pass over the cervical rib. This leads to a condition known as ”neurovascular compression syndrome,” in which these neurovascular structures are compressed between the cervical rib and scalenus anterior. The most common cause of neurogenic symptoms in approximately 80% of the patients with cervical rib is neck trauma. In most cases, the tingling, numbness and impaired circulation to the upper limb appears only after puberty. This is because the neck elongates, and the shoulders droop slightly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 21
Correct
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During a procedure in the mediastinum, the surgeon accidentally injured a key structure that lies immediately anterior to the thoracic duct. Which structure is likely to be injured?
Your Answer: Oesophagus
Explanation:In the mid-thorax, the azygos vein, thoracic duct and aorta (in this order from right to the left) are all located posterior to the oesophagus. The superior vena cava, left internal jugular vein and trachea are not found in the mid thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 22
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 23
Incorrect
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Which of the following muscles is least likely to be involved in forceful expiration:
Your Answer: Transversus thoracis
Correct Answer: External intercostal muscles
Explanation:Forceful expiration is primarily produced by the deeper thoracic muscles (internal and innermost intercostal muscles, subcostals and transversus thoracis) aided by contraction of the abdominal wall muscles which increase intra-abdominal pressure thus further reducing the volume of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 24
Incorrect
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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: Costomediastinal recess
Correct 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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 25
Incorrect
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During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:
Your Answer: Begins at the spinous process of T6, crosses the fifth intercostal space laterally and follows the contour of rib 7 anteriorly.
Correct Answer: Begins at the spinous process of T4, crosses the fifth intercostal space laterally and follows the contour of rib 6 anteriorly.
Explanation:During quiet respiration, the approximate position of the right oblique fissure can be marked by a line on the thoracic wall that begins at the spinous process of vertebra T4, crosses the fifth intercostal space laterally and then follows the contour of rib 6 anteriorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 26
Incorrect
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A 40-year-old woman presents with retrosternal central chest pain that she has been complaining about for the past two days. Upon deep inspiration and while lying flat, the pain worsens but relieved by sitting forwards. The pain radiates to both of her shoulders. The result of her ECG shows widespread concave ST-elevation and PR depression. A diagnosis of pericarditis is suspected. Which of the following nerves is responsible for the pattern of her pain?
Your Answer: Vagus nerve
Correct Answer: Phrenic nerve
Explanation:Pericarditis is inflammation of the pericardial sac and is the most common pathologic process involving the pericardium. Frequently, pericardial inflammation can be accompanied by increased fluid accumulation within the pericardial sac forming a pericardial effusion, which may be serous, hemorrhagic or purulent depending on aetiology. The classic presentation is with chest pain that is central, severe, pleuritic (worse on deep inspiration) and positional (improved by sitting up and leaning forward). The pain may also be radiating and may involve the ridges of the trapezius muscle if the phrenic nerve is inflamed as it traverses the pericardium.
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This question is part of the following fields:
- Anatomy
- Thorax
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SESSION STATS - PERFORMANCE PER SPECIALTY
