Severson Lung Vignettes

Question 1

Radiographic examinations of a 38-year-old male complaining of difficulty in breathing revealed a tumor invading the lung surface anterior to the hilum.  Which nerve is MOST LIKELY being compressed by the tumor resulting in dyspnea?
A. Greater splanchnic
B. Intercostal
C. Phrenic
D. Recurrent laryngeal
E. Vagus

Answer 1

C. phrenic

Question 2

A 47-year-old female comes to the walk-in clinic with a complaint of severe, sharp, but poorly localized pain on the chest wall.  Radiographic examination revealed evidence of pleural effusion.  What is the location of the neuronal cell bodies responsible for the nerve fibers that carry this pain to the central nervous system?
A. Dorsal horn of the spinal cord
B. Dorsal root ganglia
C. Lateral horn of the spinal cord
D. Sympathetic chain ganglia
E. Ventral horn of the spinal cord

Answer 2

B. DRG

Question 3

A 15-year-old girl is admitted to the hospital with severe dyspnea following an asthma attack, with associated bronchospasms.  What nerves are responsible for innervation of the bronchial smooth muscle cells?
A. Greater thoracic splanchnic
B. Intercostal
C. Lesser thoracic splanchnic
D. Phrenic
E. Vagus

Answer 3

E. Vagus

Question 4

A 45-year-old male visits the walk-in clinic with a complaint of sharp localized pain over the thoracic wall.  A diagnosis of pleural effusion is made.  Which intercostal space along the midaxillary line is MOST appropriate to insert a chest tube to drain the pleural effusion fluid?
A. Fourth
B. Sixth
C. Eighth
D. Tenth
E. Twelfth

Answer 4

C. 8th

Question 5

A 56-year-old male with severe oropharyngeal dysphagia develops right lower lobe pneumonia after an episode of vomiting. Which of the following is the BEST reason that this type of aspiration pneumonia most commonly affects the right lower lung lobe?
A. Pulmonary vascular resistance is higher in the right lung than the left lung
B. The right main bronchus is straighter than the left main bronchus
C. The right main bronchus is narrower than the main bronchus
D. The right main bronchus is longer that the left main bronchus
E. The right lower lung lobe has poorer venous drainage than the other lobes

Answer 5

B. right main bronchus is straighter than the left main bronchus

Question 6

A 22-year-old female is brought to the emergency department after a severe fall when riding her bicycle. Radiographs reveal that her right lung is collapsed and the left lung is compressed by the great volume of air in her right pleural cavity. Physical examination revealed no signs of external injuries. Which of the following conditions MOST LIKELY describes this case?
A. Chylothorax
B. Emphysema
C. Flail chest with paradoxical respiration
D. Hemothorax
E. Tension pneumothorax

Answer 6

E. tension pneumo

Question 7

A 20-year-old woman comes to the walk-in clinic with dyspnea and fever. Radiographic examination reveals lobar pneumonia in one of the lobes of the right lung. When examined with the stethoscope at the level of the sixth intercostal space at the midaxillary line, crackles (or roles) are heard and dull sounds are produced during percussion. Which of the following lobes is (are) MOST LIKELY to be involved by pneumonia?
A. Upper lobe of the right lung
B. Middle lobe of the right lung
C. Lower lobe of the right lung
D. Lower lobes of the right and left lungs
E. Upper lobes of the right and left lungs

Answer 7

B. right middle

Question 8

A 16-year-old boy is brought to the emergency room with cough and severe dyspnea.  Physical examination reveals expiratory wheezes, and a diagnosis is made of acute asthma.  The expiratory wheezes are characteristic signs of smooth muscle bronchospasm of the bronchial airways.  Which of the following nerves could be blocked to result in relaxation of the smooth muscle?
A. Intercostal
B. Phrenic
C. Recurrent laryngeal
D. T1 to T4 sympathetic fibers
E. Vagus

Answer 8

E. Vagus

Question 9

A 16-year-old cross-country runner is brought to the emergency department with severe dyspnea because of an acute asthma attack.  A bronchodilating drug is administered.  Which component of the peripheral nervous system must be inhibited by the drug to achieve relaxation of the smooth muscle of the tracheobronchial tree? 
A. Postganglionic parasympathetic fibers
B. Postganglionic sympathetic fibers
C. Preganglionic sympathetic fibers
D. Somatic efferent fibers
E. Visceral efferent fibers

Answer 9

A. postgalgnilic parasympathetic fibers

Question 10

A 12-year-old boy fell from a tree and fractured a rib in the midaxillary line.  He was brought to the emergency department because of difficulty breathing.  Radiographic and physical examination revealed atelectasis because of accumulation of blood in his left pleural space producing a hemothorax.  What is the MOST LIKELY source of bleeding to cause the hemothorax?
A. Intercostal vessels
B. Internal thoracic vessels
C. Left common carotid artery
D. Left subclavian artery
E. Pulmonary arteries
F. Pulmonary veins

Answer 10

A. intercostal vessels