ESA 3 - Respiratory - Session 1 - Anatomy

Question 1

Which statement regarding the INTERCOSTAL nerves is FALSE?

1. They are the anterior rami of the thoracic spinal nerves
2. They contain both motor and sensory fibres
3. They supply the visceral as well as parietal pleura
4. They supply the intercostal muscles of each space, the parietal pleura and overlying skin
5. They carry pain fibres

Answer 1

3. They supply the visceral as well as parietal pleura
   - FALSE, they only supply the parietal pleura. The visceral pleura is supplied by bronchial arteries
4. They supply the intercostal muscles of each space, the parietal pleura and overlying skin
   TRUE - This is why pain arising from the parietal pleura is well localised to the overlying chest wall

Question 2

Which statement regarding movement of ribs during respiration is FALSE?

1. Rib movement takes place at the two costo –vertebral joints on each side
2. The external intercostal muscles elevate the ribs
3. Elevation of the ribs can only change the lateral diameter of the chest
4. The internal intercostal muscles act on the ribs to reduce thoracic volume

Answer 2

3. Elevation of the ribs can only change the lateral diameter of the chest

FALSE - elevation of the upper ribs increases the AP diameter of the chest in a “pump handle” type movement

Question 3

Involvement which structure will cause paralysis of the left hemi-diaphragm?

[2018 Session 1 quiz - same order as Exemplify - question 2]

1. A
2. B
3. C
4. D

Answer 3

4. D

A - This is the left vagus nerve
B - This is the sympathetic chain
C - arrow is pointing to origin of the Left recurrent laryngeal nerve (a branch of vagus)
D - This is the phrenic nerve which supplies the diaphragm. It lies in front of the hilum

Question 4

Which statement regarding the vasculature of the Lungs and chest wall is FALSE?

1. The Lung has a dual blood supply
2. The lung receives mixed venous blood via the pulmonary arteries
3. The bronchial arteries supply the visceral pleura
4. The posterior intercostal veins on the right side drain to the azygous vein
5. The azygous vein drains into the IVC

Answer 4

5. The azygous vein drains into the IVC

FALSE - it drains into the SVC

Question 5

Which statement regarding the INTERCOSTAL arteries is FALSE?

1. Each intercostal space has an anterior and posterior intercostal artery which anastomose
2. They lie between internal and innermost intercostal muscles
3. They run in the costal groove of the rib -
4. Damage during pleural fluid aspiration can be avoided by inserting the needle above the rib
5. They supply the parietal as well as visceral pleura

Answer 5

5. They supply the parietal as well as visceral pleura

FALSE - visceral pleura is supplied by the bronchial arteries

Question 6

Which statement regarding the surface markings of the lungs and the pleura is FALSE?

1. The horizontal fissure follows the 6th rib
2. The oblique fissure corresponds to the medial border of the scapula when the arm is abducted
3. The pleural reflection crosses the mid-axillary line at the 10th rib
4. The pleural reflection lies at the level of the 12th rib posteriorly
5. The lower border of the lung lies two ribs above the pleural reflection posteriorly

Answer 6

1. The horizontal fissure follows the 6th rib

FALSE - it follows the 4th rib

Question 7

Which statement regarding the trachea is FALSE?

1. Commences at the lower border of the cricoid cartilage
2. Terminates at the carina
3. Has complete cartilage rings
4. Is lined by pseudostratified columnar ciliated epithelium
5. Lies anterior to the oesophagus

Answer 7

3. Has complete cartilage rings

FALSE - It has incomplete C-shaped rings

Question 8

At which vertebral level does the opening in the diaphragm for the oesophagus lie?

1. T 8
2. T 9
3. T 10
4. T 11
5. T12

Answer 8

3. T 10

Question 9

Which of the following statements about the diaphragm is FALSE?

1. Accounts for 70% of chest expansion in inspiration
2. It is supplied by the phrenic nerve
3. It is supplied by C6/7/8/ nerve roots
4. Its central tendon is fused with the fibrous pericardium
5. The upper border of the right hemi-diaphragm lies at the level of the 5th rib

Answer 9

3. It is supplied by C6/7/8/ nerve roots

FALSE - it is supplied by C3/C4/C5 nerve roots

Question 10

Which costal cartilage articulates with the sternum at the sternal angle?

1. 1st rib
2. 2nd rib
3. 3rd rib
4. 4th rib

Answer 10

2. 2nd rib

TRUE - the sternal angle is used to identify the 2nd rib; the first step in counting the ribs