Review Questions Flashcards
What structure exists in the superior and anterior mediastinum of children, but regresses by adulthood?
The thymus
Name the two innermost intercostal muscles. What do they aid in?
Transversus thoracis and subcostalis muscles. They aid in expiration.
What drains into the right venous angle?
What drains into the left venous angle?
Right: right lymphatic duct
Left: thoracic duct
Which lung lobes are drained by the thoracic duct?
Which heart chambers are drained by the thoracic duct?
Which quadrants of the thorax are drained by the thoracic duct?
Upper left lobe of lung (lower lobes send lymph to the right side)
Right atrium, right ventricle
Upper Left, Lower Left, Lower Right quadrants
Ductus arteriosus involves a shunt from which vessel to which vessel?
a) Aorta Arch => Left pulmonary artery
b) Left pulmonary artery => Aorta Arch
c) Left Atrium => Right Atrium
d) Right Atrium => Left Atrium
b) LEFT pulmonary artery to the aortic arch
A 27 year old patient has an aneurysm of the aortic arch. This may compress which of the following structures?
a) right vagus nerve
b) left phrenic nerve
c) right sympathetic trunk
d) left recurrent laryngeal nerve
e) left greater splanchnic nerve
d) left recurrent laryngeal nerve
Where is the left recurrent laryngeal nerve in relation to the ligamentum arteriosum?
The nerve loops under the aortic arch POSTERIOR to the ligamentum arteriosum.
What does the right recurrent laryngeal nerve recurve around?
a) Right subclavian a.
b) Right common carotid a.
c) Right internal jugular v.
d) Brachiocephalic trunk
a) right subclavian artery
Which structure lies just posterior to the left atrium?
a) Aorta
b) Azygous v.
c) Esophagus
d) Sympathetic Trunk
e) Trachea
c) esophagus (remember transesophogeal cardiography)
At what spinal levels do the following structures pass through the diaphragm?
Inferior vena cava
Esophagus
Aorta
IVC: T8
Esophagus: T10
Aorta: T12 (this is where its name changes from the thoracic aorta to the abdominal aorta)
Which vagus nerve passes anterior to the esophagus?
The left.
Remember LARP
Patient has difficulty swallowing (dysphagia). Compression and constriction at which vertebra level may be the cause?
a) C4
b) T8
c) T10
d) T12
c) T10 (at the esophogeal hiatus - the diaphragmatic constriction)
Which ganglionic nerve fibers are long? There are two answers.
a) Preganglionic Sympathetic
b) Postganglionic Sympathetic
c) Preganglionic Parasympathetic
d) Postganglionic Parasympathetic
b) postganglionic sympathetic
c) preganglionic parasympathetic
Cardiac plexus contain which nerve fibers? There might be more than one answer.
a) CN X
b) CN XI
c) Cardiopulmonary Splanchnic
d) Greater Splanchnic
e) Thoracic Splanchnic
a) CN X is the vagus nerve (parasympathetic)
c) Cardiopulmonary splanchnic (T1-T4 sympathetic)
Which of the following does NOT insert onto the linea alba?
a) External oblique
b) Internal oblique
c) Transverse abdominal
d) Rectus abdominis
e) Pyramidalis
d) Rectus abdominis (runs parallel to the linea alba and inserts on costal cartilages and the inferior xyphoid process)
Name four things that happen at the linea semilunaris.
- Lateral border of the rectus abdominis.
- Border of the aponeurosis of the anterior abdominal muscles.
- Medial border of Hasselbach’s triangle (inside the abdomen).
- Spigelian hernias happen here
Name all the layers (fascia and muscles) of the abdomen from superficial to deep.
Camper's fascia Scarpa's fascia External oblique Internal oblique Transversalis abdominis Transversalis fascia Extra-peritoneal CT Parietal peritoneum
Do the external intercostal muscles exist in the condral portion of the ribs?
Do the internal intercostal muscles continue posterior to the angles of the ribs?
No, no
Herpes zoster virus can cause painful blisters in a dermatomal pattern via infection of the cell bodies of…?
a) Dorsal root ganglia
b) Ventral horn
c) Dorsal primary rami
d) Ventral primary rami
a) dorsal root ganglia (sensory nerves)
Patient presents with severe shoulder pain. Tests rule out upper brachial plexus abnormality or damage to the axillary n. You suspect pain originating from the pleura space. Which nerve and which specific region of the pleura is the likely culprit?
Phrenic nerve (C3-C5)
Diaphragmatic and mediastinal parietal pleura (intercostal nerves innervate the costal pleura)
Patient’s chest x-ray reveals a “water-bottle” silhouette and presents with three pathognomonic symptoms.
1) What does this patient have?
2) What are the symptoms?
3) What is the Treatment?
Acute pericardial effusion with cardiac tamponade.
Beck’s triad:
- Muffled heart sounds
- Low BP
- Internal jugular vein distension
Tx is pericardiocentesis
A senior resident asks you to retrieve the cardiac muscle biopsy of a patient’s right atrium. At the lab, you grab the sample labeled:
a) Chordae tendinae
b) Pectinate
c) Septomarginal trabeculae
d) Sinus venarum
e) Trabeculae carnae
b) pectinate - muscle of the right atrium
the other things are:
Septomarginal trabeculae – moderator band
Sinus venarum – smooth tissue of atrium
Trabeculae carnae – cardiac m. of ventricle
A 25 year old woman sustained a chest injury with the steering wheel during a car crash. An X-ray revealed a fracture of the manubrium at the sternomanubrial joint. Which of the following ribs would also most likely be involved in such an injury?
a) First
b) Second
c) Third
d) Fourth
e) Fifth
b) second
A 37-year-old house painter fell from a ladder and fractured his left third rib and the structures with which it articulated. Which of the following structures might also be damaged?
A. Manubrium of the sternum
B. Spinous process of the third thoracic vertebra
C. Body of the second thoracic vertebra
D. Body of the fourth thoracic vertebra
E. Transverse process of the second thoracic vertebra
C. Body of the second thoracic vertebra
- A 29 year old man is involved in a motor vehicle accident in which his spinal cord is crushed and severed between C8 and T1. How would such an injury affect his respiration?
- Which other motor, sensory or autonomic functions might be lost in the thorax or abdomen?
- Intercostal muscles, which are used in respiration and, supplied by intercostal nerves T1 – T12, would be paralyzed.
- Sensation from thoracic wall and anterior abdominal wall are also supplied by intercostal nerves.
Sympathetic nerves, T1 – L2, parasympathetic nerves from S2 – S3.
You are preparing to insert a needle in the midaxillary line of your patient in order to relieve a tension pneumothorax. Which of the following structures will be avoided by the needle piercing the chest wall?
A. Internal intercostal muscle B. Serratus anterior muscle C. Transversus thoracis muscle D. Parietal pleurae E. Innermost intercostal muscle
C. Transversus thoracis muscle (its located on the anterior chest wall)
During a routine physical examination, a physician asks her 62-year-old male patient to breathe normally while she assesses the patient's respiration. Which of the following is TRUE of the mechanics of inspiration during normal quiet respiration? A. The diaphragm descends B. The sternum moves inferiorly C. The ribs spread apart from each other D. The abdominal wall muscles contract E. The scalene muscles contract
A. the diaphragm descends
A twenty-three year old female presents to your clinic with complaints of being easily tired, pain in her lower extremities with weakness and cold feet, frequent headaches, and epistaxis (nosebleed). On physical exam you find: cool lower extremities with an absence of distal pulses and diminished femoral pulses, the blood pressure in the upper extremities is elevated while the blood pressure in the lower extremities is low.
An X-ray of this patient’s chest shows significant “notching of the ribs”.
What type of pathology do these findings indicate?
Coarctation of the aorta – intercostal vessels carry more blood than usual in order to bypass coarctated aorta.
Can you explain why a postductal (inferior) lesion in the fetus is more compatible with long term survival versus a preductal lesion?
A postductal lesion forces good collateral circulation to develop from proximal to distal portions of the aorta via the anterior intercostals from internal thoracic artery anastomosing with posterior intercostal branches of descending aorta. A preductal lesion presents a life threatening situation early in infancy. The distal aorta is initially filled via a patent ductus arteriosus, but as the ductus closes blood flow to the distal aorta diminishes, and the infant’s survival may be threatened.
Enlargement of which lymph nodes can lead to a flattening and widening of the carina?
The inferior tracheobronchial nodes.
- While removing a lung tumor during surgery, you notice that it has caused inflammation of the visceral pleura on the posterior aspect of the lung. Would your patient feel somatic pain from this inflammation?
- What if the inflammation had spread to the parietal pleura in this location? What nerves do pain fibers from the parietal pleura travel in?
- No, visceral pleurae are not sensitive to somatic pain – temperature,touch, pressure.
- Parietal pleurae are sensitive to somatic pain which is carried by intercostal (costal pleurae) and phrenic nerves (diaphragmatic and mediastinal pleurae).
- Your patient has fluid in her pleural cavity. Where should you insert the needle to perform a thoracocentesis, but avoid injuring the lung and main neurovascular structures?
- If you wanted to perform a pericardiocentesis where would you insert the needle?
- Below the 8th rib and above the lower rib in the intercostal space to avoid the main neurovascular bundle – in the middle to avoid the collateral bundle.
- 5th intercostal space just to left of sternum to pass needle through “bare area” and avoid the parietal pleura.
A 23-year old male is rushed to the ER in a state of respiratory distress after being shot in the left chest. He has absent breath sounds on the left side and very rapid heart rate, with cyanosis in his face and upper limb. An X-ray shows his mediastinum has been shifted to the right.
What is the problem with this patient and why is it a life-threatening emergency?
Most likely a tension pneumothorax – can lead to obstruction of great vessels, reduced cardiac output and death.
A twelve-year old boy suffers from shortness of breath, wheezing and chest pain, particularly after playing outdoors. Your diagnosis is chronic asthma, an inflammatory disease characterized by airway obstruction and bronchospasm. Your plan of treatment is to prescribe a breath inhaler which delivers a albuterol, a sympathomemetic substance to dilate his airways. Explain why this can be an effective treatment for asthma.
The sympathetic nervous system will relax smooth muscle within the bronchi and inhibit production of mucous, reducing the obstruction of the airways in diseases such as asthma.
A 42 year old male was admitted to the hospital after a head-on vehicular collision in which he received severe blunt trauma to his sternum from the steering wheel. Which part of the heart would be most likely to be injured by the impact?
a) Right ventricle
b) Left ventricle
c) Left atrium
d) Right atrium
e) Apex of the left ventricle
a) right ventricle
During an aortic valve replacement procedure, the surgeon explores the oblique pericardial sinus. Where is this area and which structures can be palpated there?
This is an area located inside the pericardial sac and between the pulmonary veins. The esophagus lies posterior to it, the left atrium lies anterior.
The transverse pericardial sinus is located behind the ascending aorta and pulmonary trunk, and in front of the SVC.
Enlargement of the left atrium can impinge on which structure that lies posterior to it?
The esophagus
