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CRRAB 1 Week 3 > Severson Mediastinum Vignette Questions > Flashcards

Severson Mediastinum Vignette Questions Flashcards

1
Q 
A 72-year-old male patient during a yearly physical exam expresses concern that his voice has changed over the preceding months.  An MRI of the neck and thorax reveals a growth located within the aortic arch, adjacent to the left pulmonary artery.  What nervous system structure is MOST LIKELY being compressed to cause the changes in the patient’s voice?
A. Cardiopulmonary plexus
B. Left phrenic nerve
C. Left recurrent laryngeal nerve
D. Left sympathetic trunk
E. Left vagus nerve
A

C

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2
Q 
A 56-year old patient is admitted to the hospital following a sudden occurring, tearing pain radiating to his back.  A CT examination reveals the patient has an aortic aneurysm.  Which of the following nerves is MOST LIKELY responsible for tearing sensation radiating to the back?
A. Parasympathetic afferents
B. Somatic afferents
C. Sympathetic post ganglionics
D. Sympathetic preganglionics
E. Thoracic visceral afferents
A

E

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3
Q

A nasogastric tube is inserted into a 32-year-old female who is in a comatose state and suffers from anorexia nervosa. What is the last site at which resistance would be expected as the tube passes from the nose to the stomach?
A. Esophageal hiatus of the diaphragm
B. Level of the superior thoracic aperture
C. Pharyngoesophageal junction
D. Posterior to the aortic arch
E. Posterior to the left main bronchus

A

A

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4
Q

A 62-year-old man is admitted to the hospital for surgery after a CT scan reveals a dissecting aneurysm of the thoracic aorta. Post operatively, the patient suffers from paraplegia. Which of the following arteries was MOST LIKELY injured during surgery to result in the paralysis?
A. Esophageal arteries
B. Great radicular artery (of Adamkiewicz)
C. Left common carotid artery
D. Right coronary artery
E. Right subclavian artery

A

B

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5
Q

A 47-year-old unconscious male is brought to the emergency department. Because his blood pressure is 85/45 mm Hg, a central venous line is placed. A subsequent radiographic examination reveals a chylothorax. Which of the following structures was MOST LIKELY accidently damaged during the placement of the central venous line?
A. Left external jugular vein
B. Origin of the left brachiocephalic vein
C. Proximal part of the right brachiocephalic vein
D. Right external jugular vein
E. Right subclavian vein

A

b

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6
Q 
A 67-year-old male comes to the emergency department with severe dyspnea and complaining of pain over the left shoulder.  Radiographic examination reveals an aneurysm of the aortic arch.  Which nerve is MOST LIKELY affected by the aneurysm?
A. Cardiopulmonary
B. Intercostal
C. Phrenic
D. Thoracic splanchnic
E. Vagus
A

c

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7
Q 
A 50-year-old woman is seen by her family physician with severe dyspnea.  A chest x-ray confirms the presence of a Pancoast tumor in the apical region of the left lung.  Physical examination reveals that the patient has miosis of the pupil, partial ptosis of the eyelid, and anhydrosis of the face.  Involvement of which of the following structures accounts for the clinical signs?
A. Aortic arch
B. Cardiopulmonary plexus
C. Phrenic nerve
D. Sympathetic chain
E. Vagus nerve
A

D

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8
Q 
A 45-year-old farmer is seen at the family physicians office because of severe dysphagia.  A CT scan reveals carcinoma of the middle segment of the esophagus.  Which of the following structures will MOST LIKELY be affected if the carcinoma increases in size?
A. Inferior vena cava
B. Left atrium
C. Left ventricle
D. Pulmonary artery
E. Vertebral body
A

B

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9
Q 
A 63-year-old male who underwent mitral valve replacement demonstrated significant cardiac hypertrophy postoperatively.  Which of the following structures would MOST LIKELY be compressed by the enlarged heart?
A. Inferior vena cava
B. Esophagus
C. Pulmonary trunk
D. Superior vena cava
E. Trachea
A

B

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10
Q
  1. Which of the following sites is NOT an anatomic constriction of the esophagus?
    A. At its origin (cricopharyngeus muscle)
    B. Where it lies adjacent to the right atrium
    C. At its passage through the diaphragm
    D. Where the left primary bronchus crosses it
    E. Where the aortic arch crosses its anterior surface
A

B

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11
Q
  1. Which of the following would NOT be transversed by a five-inch deep penetrating wound of the chest along the right midclavicular line just below the level of the fifth rib?
    A. Intercostal muscles
    B. Liver
    C. Middle lobe of the right lung
    D. Pleural cavity
    E. Secondary and tertiary pulmonary bronchi
A

B

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12
Q 
3.	Which of the following structures is located in the anterior mediastinum?
A. Heart
B. Pericardial sac
C. Thymus
D. Thyroid gland
E. Trachea
A

C

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13
Q
  1. Which of the following statements regarding the ribs is INCORRECT?
    A. The first seven ribs have direct cartilaginous attachments to the sternum.
    B. The lower ribs (7-12) protect both thoracic and abdominal structures.
    C. A typical rib has two articulations with the vertebral column.
    D. The anterior intercostal arteries (spaces 1-6) are branches of the internal thoracic artery.
    E. The major vascular and nerve supply of each intercostal space courses immediately superior to ribs 2-12.
A

E

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14
Q 
5.	Which of the following structures is NOT contained in the mediastinum?
A. Heart
B. Lungs
C. Pericardium
D. Thymus
E. Trachea
A

B

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15
Q 
6.	Which of the following structures is NOT present in the root of the lung?
A. Bronchial arteries
B. Lymph vessels and nodes
C. Phrenic nerve
D. Pulmonary arteries
E. Pulmonary veins
A

C

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16
Q 
7.	Which of the following nerves is involved with referred pain from the diaphragm to over the right shoulder?
A. Intercostobrachial nerve
B. Musculocutaneous nerve
C. Right vagus (X) nerve
D. Right phrenic nerve
E. Right sympathetic chain
A

D

17
Q 
8.	How many pairs of ribs articulate directly with the sternum through their costal cartilages?
A. Six
B. Seven
C. Eight
D. Nine
E. Ten
A

B

18
Q
  1. Which of the following statement regarding the pleural cavity is INCORRECT?
    A. It is a large cavity when the lung is deflated.
    B. Air moves freely in and out of it during respiration
    C. It is a potential space between the layers of pleura.
    D. It normally contains a capillary layer of fluid.
    E. The right and left pleural cavities are separated and closed.
A

B

19
Q
  1. Which of the following statements about the azygos vein is INCORRECT?
    A. It empties into the superior vena cava.
    B. It has connections with the vertebral venous plexus of veins.
    C. It is commonly formed by the junction of the right subcostal and the right ascending lumbar veins.
    D. It enters the thorax through the esophageal hiatus of the diaphragm.
    E. It receives blood from right posterior intercostal veins and the hemiazygos vein.
A

D

20
Q
  1. Which of the following statements BEST illustrates or describes the original position of the developing diaphragm in the adult?
    A. Compound origin
    B. Innervation by the phrenic nerve
    C. Lack of smooth muscle
    D. Perforation by the esophagus and the great vessels
    E. Relation to the common cardinal veins
A

B

21
Q 
12.	What structures does the left recurrent laryngeal nerve recur around?
A. Left subclavian artery
B. Left subclavian vein
C. Ligamentum arteriosum
D. Pulmonary artery
E. Root of the left lung
A

C

22
Q
  1. Which of the following statements does NOT accurately describe the vertebral venous system?
    A. The veins in these plexuses are valveless.
    B. Cells from abdominal or pelvic tumors can pass to the brain through this system.
    C. Regional changes in venous pressure (e.g., coughing) can cause reversal of flow within parts of the system.
    D. The azygos system of veins communicates with this system.
    E. The veins are found between the arachnoid membrane and the pia mater.
A

E

23
Q 
14.	A 3-year-old boy was playing with some coins that he found on the floor.  He put a five-cent piece into his mouth and accidentally swallowed it.  He suddenly began to cough, drool, and choke.  The boy was rushed to Children's Hospital.  A lateral radiograph of the neck revealed that the coin was lodged in his esophagus.  Where would the coin most likely lodge?
A. Aortic arch constriction
B. Diaphragmatic constriction
C. Left primary bronchus constriction
D. Pharyngoesophageal junction
E. Piriform recess
A

D

24
Q 
15.	What structure does the left recurrent laryngeal nerve, adjacent to the ligamentus arteriosum, recur around?
A. Aortic arch
B. Left subclavian artery
C. Left subclavian vein
D. Left pulmonary artery
E. Root of the left lung
A

A

25
Q 
16.	What nerves supply the primary somatic sensory supply to the central portion of the diaphragm?
A. Greater splanchnic nerves
B. Phrenic nerves
C. Seventh through 12th thoracic nerves
D. Supraclavicular nerves
E. Vagus nerves
A

B

26
Q
  1. With respect to the usual pathway for foreign objects to take in the airway, which of the following statements regarding the primary bronchi is CORRECT?
    A. The left is longer and of larger diameter than the right.
    B. The right is longer and of smaller diameter than the left.
    C. The left is shorter and of larger diameter than the right.
    D. The right is of larger diameter and more vertical than the left
    E. The right and left primary bronchi do not differ.
A

D

27
Q
  1. Which of the following statements is CORRECT regarding a tension or valvular pneumothorax of the right side?
    A. Both lungs would be collapsed.
    B. The left lung would be shifted to the right.
    C. The right lung and heart would be shifted to the left.
    D. The right lung would be collapsed and the heart and left lung shifted to the left.
    E. The right lung would be collapsed and the heart and left lung shifted to the right.
A

D

28
Q
  1. Which of the following statements regarding the visceral pleura is CORRECT?
    A. Covers the different parts of the thoracic wall
    B. Forms the costodiaphragmatic recesses
    C. Is supplied by intercostal arteries
    D. Receives no nerves of general somatic sensation
    E. Receives visceral afferents traveling in the greater thoracic splanchnic nerves
A

D

29
Q
  1. Which of the following statements is CORRECT regarding a left-sided tension pneumothorax?
    A. Left lung will shift toward the left
    B. Left lung will be collapsed and the heart will be in normal position
    C. Left lung will be collapsed and the heart will be shifted to the left
    D. Left lung will be collapsed and the heart will be shifted to the right
    E. Right lung will shift toward the left
A

D

CRRAB 1 Week 3 (7 decks)

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