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THE GOOFY ANATOMIST’S THORAX Quiz Answers Contents BONES AND BOUNDARIES ......................................................................... 1 MUSCLES ..................................................................................................... 3 PLEURAE ...................................................................................................... 7 ARTERIES & VEINS ...................................................................................... 9 NERVES ...................................................................................................... 12 HEART & MEDIASTINUM (1) ...................................................................... 16 HEART & MEDIASTINUM (2) ...................................................................... 20 ADDITIONAL HEART QUESTIONS............................................................. 24 LUNGS ........................................................................................................ 25 BREAST ...................................................................................................... 29 Quiz Answers BONES AND BOUNDARIES Q1. Which of the following are true ribs? A. Ribs 1, 2, 11 and 12. B. Ribs 1, 3, 5, 7, 9, 11. C. Ribs 1, 2, 3, 4, 5, 6, 7, 8. D. Ribs 1, 2, 3, 4, 5, 6, 7. Ribs 1 – 7 are true, Ribs 8 – 10 are false, Ribs 11 and 12 are floating. Q2. Which of the following statements concerning the bones of the thorax is true? A. The aortic arch lies immediately posterior to the xiphoid process. B. Rib 5 articulates with the bodies of the T5 and T6 vertebrae. C. The manubriosternal joint is classified as a symphysis joint. D. The neck of rib 7 articulates with the transverse process of the T7 vertebrae. It can’t be A, because the aortic arch lies posterior to the manubrium. Can’t be B, because rib 5 articulates with T4 and T5. Can’t be D, because tubercle of rib articulate with transverse process of T7. Q3. Which of the following statements concerning the bones of the thorax is true? A. Expansion of the thoracic cavity is greatly facilitated by the chondrosternal joints. B. Expansion of the thoracic cavity is greatly facilitated by the costochondral joints. C. The ribs move downwards and outwards during inspiration. D. None of the answers provided. Can’t be B, because costochondral joints provide have very little movement. Can’t be C, because the ribs move upwards and outwards during inspiration. Q4. Which of the following statements is false? A. The fifth rib articulates with the transverse process of T5. B. The eighth rib articulates with the vertebral bodies of T7 and T8. C. The third rib articulates with the vertebral bodies of T4 and T3. E. The seventh rib articulates with the vertebral bodies of T7 and T6. C is incorrect – the third rib actually articulates with T3 and T2. Q5. Identify the only correct statement below. A. Rib 1 articulates with the sternal body. B. Rib 3 articulates with the sternal body. C. The costal cartilage of rib 1 articulates with the sternal body. D. The costal cartilage of rib 3 articulates with the sternal body. Can’t be A, because the costal cartilage of rib 1 articulates with the manubrium. Can’t be B, because the costal cartilage of rib 3 articulates with the sternal body. Can’t be C, because the costal cartilage of rib 1 articulates with the manubrium. Q6. Which of the following ribs are ‘typical’ ribs? A. Ribs 1, 2, 11 and 12. B. Ribs 3 – 10. C. Ribs 1 – 10. D. Ribs 8 – 12. Ribs 3 – 10 are typical, and ribs 1, 2, 11 and 12 are atypical. Q7. Where is the jugular notch found? A. On the manubrium. B. On the sternal body. C. On the xiphoid process. D. On the first – seventh costal cartilages. The jugular notch is the u-shaped dip in the manubrium of the sternum. Q8. How many articulations (when counting demi-facets as individual articulations) are present on the posterior part of a typical rib? A. 1. B. 2. C. 3. D. 4. There are 3 – a demi-articulation on the superior part of the head of the rib; a demiarticulation on the inferior part of the head of the rib; an articulation on the tubercle of the rib. MUSCLES Q1. Fill in the blank: the fibres of the external intercostal muscles travel in a/an _________________ direction. A. Inferomedial. B. Inferolateral. C. Superolateral. D. Superomedial. External IC muscles are directed in an inferomedial direction. Internal IC muscles are directed in a superomedial direction. Innermost IC muscles proper are directed in a superomedial direction too. Q2. Regarding the intercostal muscles, which statement is true? A. The internal intercostal membrane extends from the sternum to the costochondral junction. B. The external intercostal membrane extends from the sternum to the costochondral junction. C. The internal intercostal muscles are complete (not deficient) from the thoracic vertebrae to the sternum. D. The external intercostal muscles are complete (not deficient) from the thoracic vertebrae to the sternum. Remember that the external IC muscles are deficient anteriorly, and internal IC muscles are deficient posteriorly. Q3. Which of the following structures lies deepest in the thorax region? A. Internal intercostal muscles. B. Innermost intercostal muscle proper. C. Intercostal vein. D. Internal intercostal membrane. From superficial to deep, the structures are: external IC muscles and membrane, internal IC muscles and membrane, intercostal vein, artery, nerve, innermost IC muscles proper. Q4. Where does the subcostalis muscle lie? A. Anteriorly, with an origin on the sternum. B. Laterally, with an origin on ribs 3 – 6. C. Posteriorly, with an origin on ribs 6 – 10. D. Posteriorly, with an origin on ribs 3 – 6. Q5. Where exactly do the intercostal vessels and nerves lie? A. Between the external intercostal and internal intercostal muscles. B. Between the external intercostal and subcostalis muscles. C. Between the internal intercostal and subcostalis muscles. D. Between the internal intercostal muscle and innermost intercostal muscle proper. They lie in answer D, in the costal groove of the rib. Q6. Which of the following statements is true regarding the intercostal vessels and nerves? A. The intercostal artery always lies inferior to the intercostal vein. B. The intercostal vein always lies inferior to the intercostal nerve. C. The intercostal nerve always lies superior to the intercostal vein. D. None of the answers provided. The intercostal vessels and nerves are arranged, from top-to-bottom, in the following order: VEIN, ARTERY, NERVE. Q7. Which of the following statements is incorrect? A. The diaphragm flattens during inspiration. B. The left dome of the diaphragm normally lies at a lower level compared to the right dome. C. The diaphragm is a bony sheet with an aponeurotic cover. D. The diaphragm is a muscular sheet with a central tendon. The diaphragm is a muscular sheet with a central tendon – it has no bone and it has no aponeurosis. Q8. Which of the following statements is true? A. The thoracic aorta passes through the central tendon of the diaphragm at the level of T12. B. The inferior vena cava passes behind the diaphragm at the level of T12. C. The oesophagus pierces the central tendon of the diaphragm at the level of T10. D. The oesophagus passes between the ligamentous layers of the left crus and right crus of the diaphragm at T10. Can’t be A, because the thoracic aorta passes behind the diaphragm at T12. Can’t be B, because the IVC pierces the diaphragm at T8. Can’t be C, because the oesophagus passes between the ligamentous layers of the cru at T10. Q9. Which of the following statements is true concerning the thoracic aorta? A. The thoracic aorta is continuous with the abdominal aorta. B. The thoracic aorta pierces the diaphragm at the level of T8. C. The thoracic aorta runs immediately lateral to the superior vena cava. D. The thoracic aorta is carrying deoxygenated blood to the tissues of the body. Can’t be B, because the thoracic aorta passé behind the diaphragm at T12. Can’t be C, because the superior vena cava and thoracic aorta run on different sides of the vertebral column. Can’t be D, because the thoracic aorta is an artery that carries oxygenated blood to the body’s tissues. Q10. Which of the following structures is mainly responsible for increasing the vertical diameter of the thoracic cavity? A. The diaphragm. B. The external and innermost intercostal muscles, by pulling on the ribs. C. The transversus thoracis muscles, by pulling on the sternum. D. The external intercostal muscles, by pulling the upper six ribs moving laterally. The diaphragm flattens during inspiration, thereby increasing the vertical diameter of the thoracic cavity. Q11. What is the first step in the process of inspiration? A. The diaphragm becomes dome-shaped. B. Signals travel to the diaphragm from the medullary respiratory centres to the diaphragm. C. The external intercostal muscles contract. D. The diaphragm flattens. The nerve impulse from the medulla is the initiator of ventilation. This is followed by the diaphragm contracting and flattening, and in cases of forced inspiration, the external intercostal muscles will also be used too. Q12. Where does the muscle pectoralis major insert? A. Humerus (in the arm). B. Clavicle, sternum and upper six costal cartilages. C. Sternum only. D. Clavicle only. Pec major has two origins (heads): the sternocostal and clavicle. It forms a large ‘fanshape’ that spreads over the upper thorax, then narrows to insert into the intertubercular groove of the humerus (in the upper arm). Remember that this question is asking about the insertion of the muscle, not the origin. Q13. Which of the following statements regarding inspiration is true? A. Inspiration is a passive process. B. Subclavius is a major bilateral muscle that assists in forced inspiration. C. During normal quiet breathing, the external intercostal muscles are the main effectors of inspiration. D. Serratus anterior is used in forced inspiration. Can’t be A, because inspiration is active – the diaphragm has to contract! Expiration can be largely passive. Can’t be B, because subclavius is a small muscle that has a very limited role in inspiration. Can’t be C, because during normal quiet breathing, the diaphragm is the main effector of inspiration – the external IC muscles are only used in forced inspiration. PLEURAE Q1. The parietal pleura… A. Extends anteriorly to rib 8, laterally to rib 10 and posteriorly to the T12 vertebra. B. Extends anteriorly to rib 6, laterally to rib 8 and posteriorly to the T10 vertebra. C. Extends anteriorly to rib 6, laterally to rib 10 and posteriorly to the T8 vertebra. D. Extends anteriorly to rib 8, laterally to rib 8 and posteriorly to the T10 vertebra. The parietal pleura extends anteriorly to rib 8, laterally to rib 10 and posteriorly to the T12 vertebra. The visceral pleura extends anteriorly to rib 6, laterally to rib 8 and posteriorly to the T10 vertebra. Q2. Which of the following statements concerning the parietal pleural layers is most accurate? A. The cervical pleura runs inferior to the first rib and clavicle. B. The costal pleura is located only on the anterior aspect of the lungs. C. The mediastinal pleura runs more medially than the costal pleura. D. The costal pleura is the most superior of the parietal pleural layers. Can’t be A, because the cervical pleura extends above the first rib and medial third of the clavicle. Can’t be B, because the costal pleura is located on the anterior, lateral and posterior aspects of the ribcage – technically it is not adhered to the lungs at all. Can’t be D, because the cervical pleura lies much more superiorly than the costal pleura. Q3. What is the nerve supply of the visceral pleura? A. General visceral sensory nerves from the pulmonary plexus. B. The intercostal nerves T1 – T11. C. The sensory component of the phrenic nerve. D. General visceral motor nerves from the pulmonary plexus. The visceral pleura is always less sensitive than the parietal pleura, and is only associated with sensory nerves. Also…Can’t be B, because the intercostal nerves supply the costal and peripheral diaphragmatic pleurae and the intercostal muscles. Can’t be C, because the phrenic nerve supplies the mediastinal and diaphragmatic pleurae and the muscular diaphragm. Can’t be D, because the visceral pleura has no motor function at all. Q4. Concerning embryonic development of the thoracic cavity… A. The visceral and parietal pleura arise from different sources. B. The laryngotracheal tube arises from a hollowed-out area of the thoracic aorta. C. The lung buds invaginate the intraembryonic coelomic cavity. D. The lungs end up lying within the pleural cavity after pushing the intraembryonic coelom flat against the thoracic walls. Can’t be A, because the visceral and parietal pleural layers both arise from the compression of the walls of the intraembryonic coelom. Can’t be B, because the laryngotracheal tube arises from an out-pouching of the pharynx. Can’t be D, because the lungs do not end up lying in the pleural cavity – the lungs are surrounded by both pleural layers but they are said to lie in the thoracic cavity only. Q5. A chest drain is best inserted… A. Directly into the lung tissue to remove excess air. B. Through the bony ribs to avoid damaging respiratory muscles. C. Through the intercostal space but close to the superior border of the rib below. D. Through the intercostal space but close to the inferior border of the rib above. By inserting the drain close to the superior border of the rib below, you are avoiding damaging the intercostal vessels and nerves (which are running in the costal groove of the rib above. Q6. The parietal pleura… A. Is adhered to the internal aspect of the ribs and the innermost intercostal muscles proper. B. Is adhered to the substance of the lung. C. Is sensitive to stretch only. D. Has no sensory nerve supply. Can’t be B, because the visceral pleura, not the parietal pleura, is adhered to the substance of the lung. Can’t be C, because it is the visceral pleura, not the parietal pleura, that is sensitive to stretch only. Can’t be D, because the parietal pleura receives a sensory nerve supply from both the phrenic nerve and intercostal nerves. ARTERIES & VEINS Q1. Which of the following statements is true? A. The brachiocephalic trunk divides into the right subclavian artery and right common carotid artery. B. The brachiocephalic trunk divides into the right subclavian artery and the left common carotid artery. C. The brachiocephalic trunk divides into the left subclavian artery and the right common carotid artery. D. The brachiocephalic trunk divides into the left subclavian artery and the left common carotid artery. Remember that the three branches off the aortic arch are the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The brachiocephalic trunk gives rise to the right common carotid artery and right subclavian artery. Q2. What structures do the common carotid arteries supply? A. Root of the neck, clavicular region and sternal region. B. Scalp, face and brain. C. Arms. D. Posterior thoracic wall. The common carotid travels superiorly and divides to become the internal carotid (supplies the brain) and the external carotid (supplies superficial head and neck). Q3. Identify the first four branches off the left subclavian artery. A. Left vertebral, left common carotid, left axillary, left thyrocervical. B. Left vertebral, right common carotid, left axillary, left costocervical. C. Left common carotid, left thyrocervical, left axillary, left internal thoracic. D. Left vertebral, left internal thoracic, left thyrocervical, left costocervical. Q4. The descending aorta… A. Gives rise to the anterior intercostal arteries. B. Gives rise to the posterior intercostal arteries. C. Gives rise to the internal thoracic arteries. D. Gives rise to the coronary arteries. Can’t be A, because the anterior intercostal arteries arise from the internal thoracic arteries. Can’t be C, for the same reason. Can’t be D, because the coronary arteries arise from the ascending aorta. Q5. Name the three arteries that branch off the aortic arch. A. Brachiocephalic trunk, right common carotid, left subclavian. B. Left brachiocephalic artery, left common carotid, left subclavian. C. Right subclavian, right common carotid, left common carotid. D. Brachiocephalic trunk, left common carotid, left subclavian Q6. Where do the internal thoracic vessels run? A. Inferiorly, down the posterior abdominal wall. B. Posterolateral to the sternum, behind the costal cartilages. C. In the costal groove of each rib. D. Under the length of the clavicle. Q7. Which of the following statements is true? A. The costocervical trunk gives off a branch that supplies the first and second intercostal spaces. B. The thyrocervical trunk gives off two branches that travel inferiorly to supply the first, second and third intercostal spaces. C. The vertebral artery runs inferiorly alongside the spinal cord. D. The axillary artery is a continuation of the vertebral artery. Can’t be B, because the ‘-thyro’’-cervical’ trunk supplies the thyroid gland and the neck. Can’t be C, because the vertebral artery runs superiorly to supply the brain. Can’t be D, because the axillary artery is a continuation of the subclavian artery. Q8. Where do the 3rd – 12th posterior intercostal arteries arise? A. From the costocervical trunk. B. From the ascending aorta. C. From the internal thoracic artery. D. From the descending aorta. Posterior IC arteries arise from the descending aorta, and the anterior IC arteries arise from the internal thoracic arteries (and the musculophrenic arteries). Q9. Where do the anterior intercostal arteries arise? A. From the descending aorta. B. From the internal thoracic artery and the musculophrenic artery. C. From the superior epigastric artery. D. From the descending aorta. Q10. Which of the following statements regarding venous drainage is true? A. The right brachiocephalic vein drains the upper six posterior intercostal veins. B. The left brachiocephalic vein drains the superior hemiazygous vein. C. The second, third and fourth posterior intercostal veins on both sides are drained by the superior intercostal vein. D. The two subclavian veins unite to form the superior vena cava. Can’t be A, because the right brachiocephalic vein is ultimately draining the head and neck – it is continuous with the right subclavian vein. Can’t be B, because the left brachiocephalic vein is draining the head and neck (and the superior intercostal vein too). Q11. The azygous vein… A. Runs on the right anterolateral aspect of the vertebral column. B. Drains the superior vena cava. C. Drains the inferior vena cava. D. Drains 90% of the head and neck. The azygous vein is on the right side of the thorax, the hemiazygous veins are on the left side. Q12. Which of the following statements is false? A. The superior/accessory hemiazygous vein drains the left 5th – 8th posterior intercostal veins. B. The inferior hemiazygous vein drains the left 9th – 11th posterior intercostal veins and the subcostal vein. C. The azygous vein drains the right 5th – 11th posterior intercostal veins and the subcostal vein. D. The superior/accessory hemiazygous vein drains into the azygous vein. The superior hemiazygous vein crosses the vertebral column (at approx T8) and drains into azygous vein. NERVES Q1. Which of the following classifications of the nervous systems is correct? A. The autonomic nervous system is composed of the brain, cranial nerves and spinal nerves. B. The peripheral nervous system includes all cranial and spinal nerves. C. The somatic nervous system is purely sensory. D. The somatic nervous system is purely motor. Can’t be A, because the ANS is made up of general and special motor and sensory nerves (mainly in the sympathetic and parasympathetic divisions). Can’t be C or D, because the SNS is sensory and motor (think about the sensory receptors on the skin and the motor nerves innervating the skeletal muscles of the legs). Q2. The spinal cord… A. Receives sensory information via the dorsal root. B. Receives motor information via the dorsal root. C. Is composed of white matter only. D. Is composed of grey matter only. Spinal cord receives sensory information via the dorsal root and sends out motor information via the ventral root. The spinal cord contains both grey and white matter (grey matter lies in the centre of the spinal cord, white matter lies in the periphery of the spinal cord. Q3. What is the root value of the phrenic nerve? A. Cranial nerve 10. B. T1 – T12. C. T1 – T11. D. C3, C4 and C5. C3, 4 5…keeps the diaphragm alive. Q4. A spinal nerve contains… A. Purely sensory fibres. B. Purely motor fibres. C. Sensor, motor and autonomic fibres. D. Autonomic fibres only. Some autonomic fibres will be mixed into the spinal nerves, which mainly consist of somatic sensory and motor fibres. Q5. The 8th intercostal nerve… A. Supplies the muscles of the 7th intercostal space only. B. Supplies the muscles of the 7th intercostal space and some abdominal muscles. C. Supplies the muscles of the 8th intercostal space only. D. Supplies the muscles of the 8th intercostal space and some abdominal muscles. No trick question here – the 8th intercostal nerve supplies the muscles of the 8th intercostal space, and some of the abdominal muscles (e.g. rectus abdominis) too. Remember that the 7th – 11th intercostal nerves also supply some of the abdominal muscles. Q6. What is the sympathetic division of the autonomic nervous system responsible for? A. The “rest and digest” response, e.g. slowing the heart and facilitating digestion. B. The “fight or flight” response, e.g. increasing the heart rate and delivering more oxygen to skeletal muscles. C. The contraction of skeletal muscles. D. The dilation of peripheral blood vessels. Q7. What is the parasympathetic division of the autonomic nervous system responsible for? A. The “rest and digest” response, e.g. slowing the heart and facilitating digestion. B. The “fight or flight” response, e.g. increasing the heart rate and delivering more oxygen to skeletal muscles. C. The contraction of skeletal muscles. D. The constriction of peripheral blood vessels. Q8. At what spinal levels do sympathetic fibres leave the spinal cord? A. C1 – Co1. B. C1 – C7. C. T1 – L2/L3. D. L1 – S2/S3. Sympathetic division of the ANS, also called thoracolumbar outflow. Q9. Where do parasympathetic fibres leave the central nervous system? A. Via all of the cranial nerves. B. Via cranial nerves 3, 7, 9 and 10, as well as sacral spinal nerves S2 – S4. C. Via cranial nerves 1, 2, 3, 4 and 5 and all thoracic spinal nerves. D. None of the above. Parasympathetic division of the ANS, also called craniosacral outflow. Q10. Which of the following thoracic sympathetic ganglia nerves will give rise to postganglionic fibres that will innervate the heart and oesophagus? A. Stellate, T2, T3, and T4. B. T5, T6, T7, T8, T9. C. T10. T11. D. T12. Remember that T5 – T9 form the greater thoracic splanchnic nerve, T10 – 11 form the lesser thoracic splanchnic nerve, T12 forms the least thoracic splanchnic nerve. If you research this online, you will find considerable variation in the composition of each of these thoracic splanchnic nerves. Q11. Fill in the blanks: sympathetic nerve fibres enter the sympathetic trunk by the _____ And some fibres leave by the __________. A. White rami communicantes, grey rami communicantes. B. Grey rami communicantes, white rami communicantes. C. White rami communicantes, white and grey rami communicantes. D. Grey rami communicantes, white and grey rami communicantes. Sympathetic nerve fibres enter the sympathetic trunk by the white rami communicantes, and leave by the grey rami communicantes. Q12. The left vagus nerve… A. Runs posterior to the hilum of the left lung. B. Runs anterior to the hilum of the left lung. C. Will stimulate the SA node to increase the heart rate. D. Gives off the left recurrent laryngeal at the level of the left subclavian artery. Can’t be B, because the vagus nerve runs posterior to the lung hilum (remember: phrenic in front, vagus behind). Can’t be C, because the vagus is a parasympathetic nerve which slows the heart rate. Can’t be D, because the left vagus gives off the left recurrent laryngeal nerve at the level of the aortic arch. The right recurrent laryngeal branches off at the level of the right subclavian artery. Q13. The right vagus nerve… A. Gives off the right recurrent laryngeal nerve at the level of the right subclavian artery. B. Originates at the SA node of the heart. C. Runs inferiorly on the anterior aspect of the heart. D. Will stimulate the SA node to increase the heart rate. Can’t be B, because the vagus nerve originates in the brainstem. Can’t be C, because the right vagus nerve runs in an inferior direction on the posterior aspect (or base) of the heart. Can’t be D, because the vagus nerve is parasympathetic and would slow the heart rate. Q14. The cardiac plexus… A. Is only superficial. B. Is only deep. C. Lies on the posterior aspect of the carina of the trachea. D. Has both sympathetic and parasympathetic components. The cardiac plexus has superficial and deep parts and these contain cardiac branches (from the parasympathetic vagus nerve) and sympathetic nerves from the sympathetic trunk (stellate and T2 – T4 ganglia). HEART & MEDIASTINUM (1) Q1. Which of the following lie in the posterior mediastinum? A. Thymus, brachiocephalic veins, trachea. B. Oesophagus, descending aorta, thoracic duct. C. Heart, thymus, sternopericardial ligaments. D. Superior vena cava, aortic arch and trachea. The key to answering this question correctly is checking to see if all three structures in each answer are in the same mediastinal subdivision. For example, C is wrong because the heart and sternopericardial ligaments lie in the middle mediastinum, while the thymus lies in the anterior mediastinum. Q2. The sternal plane extends between… A. The sternal symphysis and the IVD of T4/T5. B. The sternal symphysis and the IVD of T3/T4. C. The sternal symphysis and the IVD of T5/T6. D. The sternal symphysis and the IVD of T2/T3. Q3. Blood from the right ventricle… A. Drains from the left atrium. B. Leaves via the aorta. C. Leaves via the pulmonary trunk. D. is the chamber of the heart that receives the coronary sinus. Right ventricle pulmonary trunk pulmonary arteries lungs. Q4. ‘Myogenic’ means… A. The heart depends on the medulla for generating its action potentials. B. The lungs generate their own rhythm of ventilation. C. The atrioventricular node is the main rhythm generator of the heart. D. The sinoatrial node generates the action potentials of the heart. Can’t be A, because the heart generates its own action potential – the medulla only influences the activity of the heart. Can’t be B, because the lungs are not myogenic – the medulla initiates their movement by generating nerve impulses in the respiratory centre. Can’t be C, because the SA node lies in the right atrium and is responsible for generating the action potential – the AV node delays and conducts the action potential. Q5. The pulmonary arteries… A. Travel from the heart to the lungs. B. Travel from the lungs to the heart. C. Travel from the lungs to the peripheral tissues. D. Travel from the peripheral tissues to the lungs. Arteries travel Away from the heart, Veins Veer back. Q6. Which structures form the right border of the heart? A. The right atrium, right ventricle and left ventricle. B. The right ventricle mainly. C. The right atrium mainly. D. The left atrium mainly. Remember the angle at which the heart lies…the right atrium mainly forms the right border, and the right ventricle mainly forms the inferior border. Q7. The apex of the heart is found… A. At the inferior tip of the left ventricle. B. At the superior tip of the left ventricle. C. At the inferior tip of the right atrium. D. At the superior tip of the right atrium. Q8. The pericardiophrenic ligament stretches between which structures? A. The pericardium and the sternum. B. The pericardium and the heart. C. The pericardium and the diaphragm. D. The pericardium and the anterior thoracic wall. Easy to guess – remember that ‘phrenic’ generally refers to the diaphragm. Q9. Where is the pericardial cavity located? A. Between the visceral pericardium and the epicardium. B. Between the visceral pericardium and the parietal pericardium. C. Between the visceral pericardium and the fibrous pericardium. D. Between the fibrous pericardium and serous pericardium. As with the pleural cavity…the pericardial cavity is found between the visceral and parietal layers and contains a little fluid. Q10. The parietal pericardium… A. Receives a somatic sensory nerve supply via the phrenic nerve, so it can detect temperature and pain. B. Receives a somatic sensory nerve supply via the vagus nerve, so it can detect temperature and pain. C. Receives a visceral sensory nerve supply via the phrenic nerve, so it can detect only stretch. D. Receives a visceral sensory nerve supply via the vagus nerve, so it can detect only stretch. Remember that the fibrous and parietal pericardial layers have somatic sensory innervation from the phrenic nerve. Somatic sensory innervation means they can detect temperature, pain and pressure. The visceral pericardial layer receives autonomic sensory fibres (e.g. from vagus nerve), so it can only detect stretch. Q11. Which of the following is not a ‘great vessel’? A. Pulmonary trunk. B. Superior vena cava. C. Inferior vena cava. D. Brachiocephalic trunk. The ascending aorta is a great vessel, but the brachiocephalic trunk is a branch of the aortic arch, so is not considered a great vessel. Q12. Which of the following vessel(s) lie(s) most anteriorly in the thoracic cavity? A. Pulmonary trunk. B. Descending aorta. C. Pulmonary veins. D. Superior vena cava. At the point where these vessels enter/leave the heart, the pulmonary trunk is the most anteriorly located. Q13. The transverse pericardial sinus lies… A. Posterior to the ascending aorta and pulmonary trunk. B. Posterior to the superior vena cava and inferior vena cava. C. Posterior to the pulmonary veins. D. Anterior to the ascending aorta but posterior to the pulmonary trunk. The transverse sinus lies posterior to the ascending aorta and pulmonary trunk, but anterior to the superior vena cava. Q14. Which coronary artery branch(es) supplies the sinoatrial node in most people? A. Right conus artery. B. Right marginal artery. C. Posterior interventricular artery. D. Atrial branches. The sinoatrial node is in the right atrium, so this is the correct answer. Q15. Which coronary artery branch (es) supplies the atrioventricular node? A. Posterior interventricular artery. B. Left marginal artery. C. Left atrial branch. D. Right marginal artery. This artery runs in a fairly central position, so you would expect it to supply the AV node, which lies in the interatrial septum. Knowledge is important here too though, because the left atrial branch is the incorrect answer. HEART & MEDIASTINUM (2) Q1. Which of the following vessels run in the coronary sulcus? A. Right coronary artery, right marginal branch, posterior interventricular artery. B. Left conus artery, left marginal artery. C. Right coronary artery, left coronary artery, left circumflex artery. D. Anterior interventricular artery, posterior interventricular artery, right circumflex artery. Q2. Which of the following statements is true? A. The coronary sinus drains all of the veins of the heart. B. The small cardiac vein drains into the middle cardiac vein, which drains into the great cardiac vein. C. The coronary sinus drains into the left atrium. D. The coronary sinus drains into the right atrium. Remember that the right atrium is receving all of the deoxygenated blood from the body’s tissues, so even if you can’t remember the answer in an exam, the right atrium is a good guess. Q3. Regarding the following structures is not present in the right atrium? A. Right auricle. B. Infundibulum. C. Fossa ovalis. D. Sinus venarum. The infundibulum is found in the right ventricle. Q4. What is the name of the roughened muscle fibres present in the part of the atrial wall are given what name? A. Papillary muscles. B. Musculi pectinati. C. Fossa ovalis. D. Trabeculae carneae. In the atrium, these are the musculi pectinati. In the ventricle, the roughened muscular fibres are more pronounced and are called the trabeculae carneae. Q5. Which of the following vessels do not drain into the right atrium? A. Superior vena cava. B. Inferior vena cava. C. Coronary sinus. D. Pulmonary veins. These drain into the left atrium. Q6. What is the fossa ovalis? A. The fingerprint-like indent in the atrial walls that is formed from the closure of the foramen ovale. B. The opening of the coronary sinus into the right atrium. C. The gap in the atrial wall that will become the foramen ovale upon closure. D. The finger-print like indent in the atrial wall that houses the sinoatrial node. The foramen ovale essentially becomes the fossa ovalis. Q7. Which os the following statements is false regarding the valves of the heart? A. The bicuspid valve is present on the right side of the heart. B. The tricuspid valve is present on the right side of the heart. C. There are three cusps making up the aortic valve. D. There are three cusps making up the pulmonary valve. TRicuspid is on the Right. Q8. The right ventricle is divided from the right atrium by the… A. Bicuspid valve. B. Tricuspid valve. C. Aortic valve. D. Pulmonary valve. Q9. What is the function of the anterior papillary muscle on the right? A. Close the anterior cusp of the bicuspid valve. B. Close the anterior cusp of the pulmonary valve. C. Prevent backflow into the pulmonary trunk. D. Prevent the inversion of the anterior cusp of the tricuspid valve. Q10. What is the function of the moderator band in the right ventricle? A. Conduct the cardiac action potential to the posterior papillary muscle. B. Conduct the cardiac action potential to the anterior papillary muscle. C. Conduct the cardiac action potential to the septal papillary muscle. D. Conduct the cardiac action potential through the interventricular septum. Q11. What is the name of the strands that connect the papillary muscles and valve cusps in the ventricles? A. Chordae tendineae. B. Trabeculae carneae. C. Musculi pectinati. D. Cusp bands. Q12. Which of the following statements is true concerning the left ventricle? A. It ejects its blood into the pulmonary trunk. B. It has a thicker muscular wall to pump blood through the systemic circulation. C. Has the tricuspid valve protecting the left atrioventricular orifice. D. Has underdeveloped trabeculae carneae. The left ventricle is pumping blood into the aorta, which will distribute oxygenated blood to all of the body’s peripheral tissues. Q13. The four valves of the heart… A. Are supported by left and right fibrous trigones. B. Are forcefully closed shut by the action of the papillary muscles. C. All have three cusps. D. Are supported by a bony skeleton embedded deep in the myocardium. The answer is not B because when the papillary muscles contract, they are NOT forcefully closing the cusps of the valves. The cusps are actually closed by the increase in ventricular pressure. The papillary muscles are actually preventing inversion of the cusps when blood is pushed against them during ventricular systole. Q14. The apex of the heart has what surface landmark? A. 2nd left costal cartilage. B. 3rd right costal cartilage. C. 6th right costal cartilage. D. 5th left intercostal space. Q15. In transposition of the great arteries… A. The pulmonary veins and pulmonary arteries leave from the incorrect ventricles. B. The ascending aorta and pulmonary trunk leave from the incorrect ventricles. C. The coronary arteries supply the incorrect sides of the heart. D. The ascending aorta travels to the lungs, while the pulmonary trunk travels to the peripheral tissues. TGA is simply the wrong (opposite) vessel coming out of each ventricle. ADDITIONAL HEART QUESTIONS Q1. What are the three layers of the heart? A. Epicardium, myocardium and endocardium. B. Ectocardium, myocardium and endocardium. C. Epicardium, Ectocardium and endocardium. D. Ectocardium, myocardium, epicardium. Q2. The correct order for the electrical conduction of the heart is… A. SA node, AV node, moderator band, AV bundle. B. SA node, AV node, AV bundle, bundle branches, Purkinje fires. C. AV node, SA node, AV bundle, moderator band, Purkinje fibres. D. AV node, SA node, Purkinje fibres, AV bundle, bundle branches. Q3. What is a myocardial infarction? A. Death of the myocardium due to a blood clot in a coronary artery. B. A blood clot that arises in the pulmonary arteries that travels to the lungs. C. A build-up of blood in the pericardial cavity. D. Chest pain on exercise only. Can’t be B, because this is more like a pulmonary embolism. Can’t be C, because this is cardiac tamponade. Can’t be D, because this is angina pectoris. LUNGS Q1. Fill in the blanks: the _______ lung has ________ lobes and ________ fissures. A. Right, three, two. B. Right, two, one. C. Left, three, two. D. Left, two, three. The right lung has 3 lobes and 2 fissures. The left lung has 2 lobes and 1 fissure. Q2. The base of the lung faces... A. An inferior direction. B. A superior direction. C. A posterior direction. D. An anterior direction. Q3. The left lung… A. Has an indent called the cardiac notch, where the heart lies. B. Has a superior tip called ‘the base’ of the lung. C. Has a superior, middle and inferior lobe. D. Has two clear fissures: an oblique fissure and a transverse fissure. Q4. The hila of the lungs don’t contain which of the following vessels? A. The azygous vein. B. The pulmonary arteries. C. The pulmonary veins. D. The primary bronchi. The azygous vein runs up the right anterolateral aspect of the vertebral column, and it does not directly remove blood from the lungs (this is largely the job of the pulmonary veins). Q5. The carina… A. Lies at the level of T6. B. Is the anatomical landmark for an emergency airway. C. Is present at the bifurcation of the primary bronchi on each side. D. Is made of hyaline cartilage. Can’t be A, because the carina lies at the level of the sternal plane. Can’t be B, because the major anatomical landmark for an emergency ‘cricothyroidotomy’ airway is the cricothyroid ligament in the neck. Can’t be C, because the carina is present at the bifurcation of the trachea, NOT at the bifurcation of the primary bronchi. Q6. A tertiary bronchus could also be called a… A. Segmental bronchus. B. Main bronchus. C. Lobar bronchus. D. Principal bronchus. Each tertiary bronchus supplies a bronchopulmonary segment. Q7. Which of the following statements concerning the trachea is true? A. It is deficient of cartilage anteriorly, although the trachealis muscle is present here. B. It is deficient of cartilage posteriorly, although the trachealis muscle is present here. C. The trachea bifurcates at T6. D. The trachea lies posterior to the oesophagus. Q8. The left bronchial arteries… A. Arise from the descending aorta. B. Arise from the pulmonary arteries. C. Arise from the descending vertebral arteries. D. Arise from the intercostal arteries. The two left bronchial arteries arise directly from the descending aorta. The single right bronchial artery arises from the 5th or 6th posterior intercostal artery. Q9. The superficial bronchial vein on the left… A. Drains into the superior hemiazygous vein. B. Drains into the inferior hemiazygous vein. C. Drains into the azygous vein. D. Drains into the pulmonary veins. The superficial bronchial vein on the left drains into the superior hemiazygous vein. The superficial bronchial vein on the right drains into the azygous vein. Q10. Where does the right bronchial artery arise from? A. The descending aorta. B. The right fifth or sixth posterior intercostal artery. C. The right fifth or sixth anterior intercostal artery. D. The right internal thoracic artery. Q11. Which of the following statements regarding the bronchopulmonary segments is true? A. There are lingular segments on the right lung. B. There are more segments of the left lung than on the right lung. C. The superior lobe of the right lung is made up of three segments: the apical, posterior and anterior segments. D. The inferior lobe of the left lung is made up of two segments: the anterior basal and posterior basal segments. Q12. Which of the following tertiary bronchial arrangements is incorrect? A. Middle lobe of right lung: supplied by medial and lateral tertiary bronchi. B. Inferior lobe of right lung: supplied by anterior basal, posterior basal, lateral basal, medial basal and superior tertiary bronchi. C. Superior lobe of left lung: supplied by apico-posterior, anterior, superior lingular and inferior lingular tertiary bronchi. D. Inferior lobe of left lung: supplied by anterior basal, lateral basal and posterior basal tertiary bronchi. The inferior lobe of the left lung is supplied by: superior, anteromedial basal, lateral basal, posterior basal bronchi. Q13. The respiratory airways… A. Are composed of the trachea and primary bronchi. B. Are composed of the alveoli, alveolar ducts and respiratory bronchioles. C. Are composed of the primary, secondary and tertiary bronchi. D. Make up most of the respiratory system (but not the lungs). B is the correct answer for ‘respiratory airways’. The ‘conducting airways’ are made up of the trachea, primary, secondary and tertiary bronchi and terminal bronchioles. Q14. At the alveoli… A. Carbon dioxide diffuses into the pulmonary capillaries, down its concentration gradient. B. Carbon dioxide diffuses into the alveolar sac (air space), down its concentration gradient. C. Massive dilation occurs during exercise. D. Cartilage plates ensure the alveoli do not collapse under ventilatory pressures. Q15. Which of the following statements concerning a tension pneumothorax is true? A. It can be defined as a build-up of air between the pleural cavity and thoracic cavity. B. Involves the mediastinum shifting to the opposite side of the injury. C. Involves serious damage to the elastin fibres in the alveolar walls. D. Involves the mediastinum shifting towards the side of the injury. The pleural cavity fills with atmospheric air and pushes the mediastinum to the opposite side. BREAST Q1. Which of the following statements concerning the breast is true? A. The inferomedial region of the breast contains the anterior axillary nodes. B. The breast can be subdivided into six regions for clinical purposes. C. Lies within the superficial fascia of the thorax. D. The breast lies at the level of T1- T3. Q2. Which hormones maintain milk secretion in the lactating woman? A. Oestrogen. B. Prolactin and growth hormone (GH). C. Progesterone. D. Follicle-stimulating hormone (FSH). Pro-‘lactin’ is the giveaway for milk secretion. Q3. What is the name of the milk-producing parts of the breast? A. Areola. B. Lactiferous ducts. C. Lobes, lobules and bulbs. D. Lactiferous sinuses. Can’t be A, because this is a coloured area of skin with a limited number of lubricantsecreting glands. Can’t be B, because they transport, not produce, the milk. Can’t be D, because recent evidence suggests that the lactiferous sinuses do not even exist. Q4. Which of the following statements is true regarding the breast? A. The suspensory ligaments of Cooper act as fibrous tissue that help maintain the shape and strength of the breast. B. The breast lies within the deep fascia of the pectoralis major muscle. C. The nipple is the centre point of attachment for the suspensory ligaments of Cooper. D. The areola is lighter and pinker in women who have borne a child. Q5. Where are the tubercles of Montgomery found? A. Areola. B. Nipple. C, Lobes. D. Lactiferous ducts. Q6. Which of the following group of lymph nodes doesn’t drain lymph from the breast? A. Central group. B. Anterior axillary group. C. Internal thoracic group. D. Mid-sternal group. Q7. Which of the following arteries supply the breast? A. Branches of the internal thoracic, anterior intercostal and axillary arteries. B. Branches of the posterior intercostal arteries. C. Branches of the subclavian artery only. D. Branches direct from the descending aorta. Q8. The thoracic duct drains… A. Venous blood from the right intercostal spaces and axilla. B. Lymph fluid from the cisterna chyli and left side of the thorax. C. Arterial blood from the abdomen, pelvis and lower limbs. D. Lymph fluid into both brachiocephalic veins. Q9. What is gynaecomastia? A. Extra/supernumary breasts. B. Extra/supernumary nipples. C. Hypertrophy of the male breast after puberty. D. Atrophy of the female breast after puberty. Q10. What is a DCIS? A. A breast cancer that develops in the epithelial lining of the lactiferous ducts. B. A breast cancer that develops in the areola and/or nipple. C. A specific type of lymphoma. D. A carcinogen that often leads to the development of breast cancer. Q11. Which of the following structures is not drained by the right lymphatic duct. A. The right axilla. B. The right iliac region. C. The right side of the face. D. The right lower arm.
