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Thorax
1．On the surface of the chest ,a physician is able to locate the apex
of the heart
(A)
(B)
(C)
(D)
(E)
at
in
in
in
at
the
the
the
the
the
level of the sternal angle
left fourth intercostal space
left fifth intercostal space
right fifth intercostal space
level of the xiphoid process of the sternum
2.Normal quiet expiration is achieved by contraction of the
(A)
(B)
(C)
(D)
(E)
elastic tissue in the thoracic wall and lungs
serratus posterior superior muscles
pectoralis minor muscles
serratus anterior muscles
diaphragm
3.Which of the following nerve fibers would be injured if the greater
splanchnic nerve were severed?
(A)
(B)
(C)
(D)
(E)
General somatic afferent (GSA)and preganglionic sympathetic fibers
General visceral afferent (GVA)and postganglionic sympathetic fibers
General visceral afferent (GVA)and preganglionic sympathetic fibers
General somatic efferent(GSE)and postganglionic sympathetic fibers
GVA and GSE fibers
4.A stab wound that severed the white rami communicantrs at the level of
the six thoracic vertebra would result in degeneration of nerve cell
bodies in which of the following structures?
(A)
(B)
(C)
(D)
(E)
Dorsal root ganglion and anterior horn of the spinal cord
Sympathetic chain ganglion and dorsal root ganglion
Sympathetic chain ganglion and posterior horn of the spinal cord
Dorsal root ganglion and lateral horn of the spinal cord
Anterior and lateral horn of the spinal cord
5.Where should a physician place the stethoscope to listen to the sound
of the mitral valve?
(A) Over the medial end of the second left intercostal space
(B) Over the medial end of the second right intercostal space
(C) In the left fourth intercostal space at the midclavicular line
(D) In the left fifth intercostal space at the midclavicular line
(E) Over the right half of the lower end of the body of the sternum
6.Bleeding comes from the vein that is accompanied by the posterior
interventricular artery .which of the following veins is most likely to
be ruptured?
(A)
(B)
(C)
(D)
(E)
Great cardiac vein
Middle cardiac vein
Anterior cardiac vein
Small cardiac vein
Oblique veins of the left atrium
7.The largest portion of the sternocostal surface of the heart seen on
a posterior-anterior chest radiograph is composed of the
(A)
(B)
(C)
(D)
(E)
left atrium
right atrium
left ventricle
right ventricle
base of the heart
8.If the interventricular septum is damaged , which of the following
valves is most likely defective?
(A)
(B)
(C)
(D)
(E)
Pulmonary valve
Mitral valve
Valve of coronary sinus
Tricuspid valve
Aortic valve
9.An artificial cardiac pacemaker is implanted in a 54-year-old patient
Which of the following conductive tissues of the heart has a defective
function?
(A)
(B)
(C)
(D)
(E)
Atrioventricular(AV) bundle
Atrioventricular(AV) node
Sinoatrial(SA) node
Purkinje fiber
Moderator band
10. Which of the following bronchopulmonary segments must contain
cancerous tissues if a thoracic surgeon has to remove the right middle
lobar (secondary) bronchus along with lung tissue?
(A)
(B)
(C)
(D)
(E)
Medial and lateral
Anterior and posterior
Anterior basal and medial basal
Anterior basal and posterior basal
Lateral basal and posterior basal
11.A pulmonary physician finds a small mass of tumor in the eparterial
bronchus . Which of the following airways is most likely blocked?
(A)
(B)
(C)
(D)
(E)
Left superior bronchus
Left inferior bronchus
Right superior bronchus
Right middle bronchus
Right inferior bronchus
12.If a blood clot blocks the circumflex branch of the left coronary artery
in a patient with a typical coronary circulation,which area of the heart
Musculature is most likely to be ischemic?
(A)
(B)
(C)
(D)
(E)
Anterior part of the left ventricle
Anterior interventricular region
Posterior interventricular region
Posterior part of the left ventricle
Anterior part of the right ventricle
13. Which of the following would most likely occur if the phrenic nerve
is severed?
(A)
(B)
(C)
(D)
(E)
Injury to only general somatic efferent(GSE) fibers
Difficulty in expiration
Loss of sensation in the pericardium and mediastinal pleura
Normal function of the diaphragm
Loss of sensation in the costal part of the diaphragm
14. Which of the following conditions could injure the left recurrent
laryngeal nerve?
(A)
(B)
(C)
(D)
(E)
A pericardial incision medial to the ligamentum arteriosum
Scar tissue in front of the subclavian artery
A tumor in the posterior mediastinum
An aneurysm in the aortic arch
A knife wound on the arch of the azygos vein
15. Which of the following conditions could result from
infarction limited to the interventricular septum ?
(A)
(B)
(C)
(D)
(E)
a myocardial
Tricuspid valve insufficiency
Pulmonary valve insufficiency
Inferior vena caval valve insufficiency
Mitral valve insufficiency
Aortic valve insufficiency
16.Lung cancer is located in the vicinity of the cardiac notch ,a deep
indentation on the lung. Which of the following lobes is most likely to
be excised ?
(A)
(B)
(C)
(D)
(E)
Superior lobe of the right lung
Middle lobe of the right lung
Inferior lobe of the right lung
Superior lobe of the left lung
Inferior lobe of the left lung
17. Which of the following conditions reprsents the normal changes that
occur in the circulation at or soon after birth ?
(A)
(B)
(C)
(D)
(E)
Decreased blood flow through the lungs
Anatomical closure of the ductus arteriosus
Increased left atrial pressure
Anatomical closure of the foramen ovale
Functional closure of the right umbilical vein
18.Destructive changes in the right atrium could damage which of the
following structures ?
(A)
(B)
(C)
(D)
(E)
Papillary muscles
Chordae tendineae
Septomarginal trabecula
Pectinate muscles
Trabeculae carneae cordis
19.A sudden occlusion at the origin of the descending(thoracic) aorta
would most likely decrease blood flow in which of the following
intercostal arteries?
(A) Upper six anterior
(B) All of the posterior
(C) Upper two posterior
(D) Lower anterior
(E) Lower nine posterior
20.The right coronary artery
(A)
(B)
(C)
(D)
is shorter in length than the left one
supplies blood to the sinoatrial(SA) node
causes myocardial infarction in the apex of the heart if it is occluded
provides maximal blood flow during systole and minimal during
diastole
(E) arises from the aortic arch
21. Which of the following describes a characteristic of the left lung?
(A)
(B)
(C)
(D)
(E)
Horizontal fissure
A groove for the superior vena cava
Three lobar (secondary)bronchi
Lingula of lung
A larger capacity than the right lung
22.A victim of an automobile accident experiences difficulty in
expiration . Which of the following muscles is most likely injured?
(A)
(B)
(C)
(D)
(E)
Levator costarum
Innermost intercostal muscles
External intercostal muscles
Diaphragm
Muscles of the abdominal wall
23. In a 78-year-old patient with an advanced cancer in the superior
mediastinum , Which of the following structures may be spared ?
(A)
(B)
(C)
(D)
(E)
Brachiocephalic veins
Trachea
Lower portion of the left common carotid artery
Arch of the aorta
Hemiazygos vein
24.A tumor located just superior to the root of the right lung may block
blood flow in which of the following veins?
(A) Hemiazygos vein
(B) Azygos vein
(C) Right subclavian vein
(D) Right brachiocephalic vein
(E) Accessory hemiazygos vein
25.A lesion of the right vagus nerve near the trachea in the superior
mediastinum could cause which of the following condition?
(A) Loss of sensation carried by the recurrent laryngeal
(B) Lack of parasympathetic fibers in the anterior esophageal plexus
(C) Functional injury to the anterior vagal trunk at the lower part of
the esophagus
(D) Reduction in cardiac rate
(E) Injury to parasympathetic preganglionic fibers
26.The ductus arteriosus has which of the following properties?
(A)
(B)
(C)
(D)
(E)
Anatomical closure right after birth
Carrying highly oxygenated blood during prenatal life
Functional closure several weeks after birth
Connection of the right pulmonary vein to the aorta
Shunt of blood from the pulmonary trunk to the aorta before birth ,by
passing the pulmonary circulation
27.Left ventricular hypertrophy could result from which of the following
condition?
(A)
(B)
(C)
(D)
(E)
A constricted pulmonary trunk
An abnormally small left atrioventricular (AV) opening
Improper closing of the pulmonary valves
An abnormally large right AV opening
Stenosis of the aorta
28.The left primary bronchus
(A) has a larger diameter than the right primary bronchus
(B) often receives more foreign bodies via the trachea than the right
primary bronchus
(C) gives rise to the eparterial bronchus
(D) is longer than the right primary bronchus
(E) runs under the arch of the azygos vein
29.The hemiazygos vein
(A) receives the left superior intercostal vein
(B) receives the lower left posterior intercostal vein
(C) empties into the superior vena cava
(D) is connected to the inferior vena cava
(E) enter the thorax through the esophageal opening
30.On posterior-anterior chest radiographs which of the following
structures forms the right border of the cardivascular silhouette?
(A)
(B)
(C)
(D)
(E)
Arch of the aorta
Pulmonary trunk
Superior vena cava
Ascending aorta
Left ventricle
31.Which of the following veins typically drains into the right or left
brachiocephalic vein?
(A)
(B)
(C)
(D)
(E)
Azygos
Hemiazygos
Right superior intercostal
Left superior intercostal
Internal thoracic
32.During the cardiac cycle,which of the following events occurs?
(A)
(B)
(C)
(D)
(E)
Atrioventricular(AV) valves close during diastole
Aortic valve closes during systole
Pulmonary valve opens during diastole
Blood flow in coronary arteries maximal during diastole
Aortic valve closes at the same time as AV valve
33.Which of the following condition may occur at or soon after birth ?
(A)
(B)
(C)
(D)
(E)
Anatomical closure of the ductus venosus
Anatomical closure of the foramen ovale
Anatomical closure of the ductus arteriosus
Obiliteration of the left umbilical vein
Obiliteration of the right umbilical vein
34. Which of the following anatomic features would most likely be found
at the level of the sternal angle?
(A) Bifurcation of the trachea
(B) Beginning of the ascending aorta
(C) Middle of the aortic arch
(D) Articulation of the third rib with the sternum
(E) Superior border of the superior mediastinum
35. Which of the following structures would most likely articulate with
the third rib ?
(A)
(B)
(C)
(D)
(E)
Manubrium of the aternum
Body of the second thoracic vertebra
Spinous process of the third thoracic vertebra
Body of the fouth thoracic vertebra
Transverse process of the second thoracic vertebra
36.A large tumor confined in the posterior mediastinum may compress which
of the following structures?
(A)
(B)
(C)
(D)
(E)
Ascending aorta
Trachea
Descending aorta
Arch of the aorta
Arch of the azygos vein
37. Which of the following structures is correctly paired with its nerve
supply?
(A)
(B)
(C)
(D)
(E)
Mediastinal pleura-intercostal nerves
Peripheral part of the diaphragmatic pleura-phrenic nerves
Visceral pleura-general visceral afferent (GVA) pain fibers
Gland in the bronchial tree-parsympathetic fibers
Smooth muscle in the pulmonary artery- parsympathetic fibers
38.The near-simultaneous closure of which of the following valves
produces the fist heart sound ?
(A)
(B)
(C)
(D)
(E)
Aortic and tricuspid
Aortic and pulmonary
Tricuspid and mitral
Mitral and pulmonary
Tricuspid and pulmonary
39. Which of the following structures loops around the arch of the aorta
near the ligamentum arteriosum?
(A) Left vagus nerve
(B) Left phrenic nerve
(C) Left sympathetic trunk
(D) Left recurrent laryngeal nerve
(E) Left greater splanchnic nerve
40.The right atrium
(A)
(B)
(C)
(D)
(E)
receives blood from the oblique cardiac veins
associated with the apex of the heart
contains the sinoatrial(SA) node
enlarges briefly in response to coarctation of the aorta
is hypertrophied by pulmonry stenosis
41. Which of the following structures maintains constant tension on the
cusps of the atrioventric-ular(AV) valves?
(A)
(B)
(C)
(D)
(E)
Crista terminalis
Septomarginal trabecula
Chordae tendineae
Pectinate muscle
Anulus fibrosus
42.If the right coronary artery is blocked by a fat globule after giving
off the right marginal artery,which of the following structures may have
oxygen deficiency?
(A)
(B)
(C)
(D)
(E)
Right atrium
Sinoatrial(SA) node
Atrioventricular(AV) node
Apex of the heart
Root of the pulmonary trunk
43.A surgical resident ligates the phrenic nerve instead of the
accompanying artery descending between the mediastinal pleura and the
pericar-dium . Which of the following arteries did he intend to ligate?
(A)
(B)
(C)
(D)
(E)
Internal thoracic
Musculophrenic
Pericardiacophrenic
Right coronary artery
Superior(supreme) thoracic
44.When the diaphragm contracts , which of the following conditions most
likely occurs?
(A)
(B)
(C)
(D)
(E)
Decreased thoracic volume
Increased abdominal volume
Increased lung volume
Air flow out of the bronchi
Increased thoracic pressure
45.During a pleural tap,a needle may injure the intercostal neurovascular
bundle because it is located
(A)
(B)
(C)
(D)
(E)
above the upper border of the ribs
deep to the upper border of the ribs
beneath the lower border of the ribs
between the external and internal intercostals
between the transverse thoracis and subcostalis
Match each of the following descriptions with the appropriate lettered
structure in this computed tomography(CT) scan of the heart from a
42-year-old man who complains of chest pain and breathing problems.His
electrocardiogram(ECG)shows left ventricular hypertrophy.
46.Stenosis of this structure may produce left ventricular hypertrophy
47.Structure that is most likely to be removed by a pulmonary surgeon in
a surgical resection of a lobe(lobectomy) to remove lung cancer in the
apex of the right lung .
48. Structure that branches into the bronchial arteries
49. Structure into which the azygos vein drains venous blood
50. Structure from which the left coronary artery arises
Match each of the following description with approprriate lettered
structure in the superior cross-sectional view of the heart
51.Runs toward the apex of the heart and supplies atrial blood to the
anterior right ventricle
52.Supplies arterial blood to the sinoatrial (SA) node
53.Arises from the left aortic sinus
54.Gives rise to the anterior interventricular artery
55.Has a sound that is best heard through a stethoscope at the fifth
intercostal space at the midclavicular line