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Thorax
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Thorax
1. 1. A 32-year-old patient who weighs 275 pounds
comes to the doctor's office. On the surface of the Description
chest, the physician is able to locate the apex of the Thorax
heart:
Updated
12/21/2010, 10:48:22 AM
(A) At the level of the sternal angle
(B) In the left fourth intercostal space Show Answers
(C) In the left fifth intercostal space
(D) In the right fifth intercostal space
(E) At the level of the xiphoid process of the sternum

(C) In the left fifth intercostal space

2. 2. A 43-year-old female patient has been lying down

on the hospital bed for more than 4 months. Her
normal quiet expiration is achieved by contraction of
which of the following structures?

(A) Elastic tissue in the lungs and thoracic wall

(B) Serratus posterior superior muscles
(C) Pectoralis minor muscles
(D) Serratus anterior muscles
(E) Diaphragm
(A) Elastic tissue in the lungs and thoracic wall

3. 3. A 23-year-old man received a gunshot wound, and

his greater splanchnic nerve was destroyed. Which of
the following nerve fibers would be injured?

(A) General somatic afferent (GSA) and preganglionic

sympathetic fibers
(B) General visceral afferent (GVA) and postganglionic
sympathetic fibers
(C) GVA and preganglionic sympathetic fibers
(D) General somatic efferent (GSE) and
postganglionic sympathetic fibers
(E) GVA and GSE fibers
(C) GVA and preganglionic sympathetic fibers

4. 4. A 17-year-old boy was involved in a gang fight, and

a stab wound severed the white rami communicantes
at the level of his sixth thoracic vertebra. This injury
would result in degeneration of nerve cell bodies in
which of the following structures?

(A) Dorsal root ganglion and anterior horn of the spinal

cord
(B) Sympathetic chain ganglion and dorsal root
ganglion
(C) Sympathetic chain ganglion and posterior horn of
the spinal cord
(D) Dorsal root ganglion and lateral horn of the spinal
cord
(E) Anterior and lateral horns of the spinal cord
 (D) Dorsal root ganglion and lateral horn of the spinal cord

5. 5. A 27-year-old cardiac patient with an irregular

heartbeat visits her doctor's office for examination.
Where should the 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
(D) In the left fifth intercostal space at the midclavicular line

6. 6. A 19-year-old man came to the emergency

department, and his angiogram exhibited that he was
bleeding from the vein that is accompanied by the
posterior interventricular artery. Which of the following
veins is most likely to be ruptured?

(A) Great cardiac vein

(B) Middle cardiac vein
(C) Anterior cardiac vein
(D) Small cardiac vein
(E) Oblique veins of the left atrium
(B) Middle cardiac vein

7. 7. A 37-year-old patient with palpitation was examined

by her physician, and one of the diagnostic records
included a posterior-anterior chest x-ray film. Which of
the following comprises the largest portion of the
sternocostal surface of the heart seen on the
radiograph?

(A) Left atrium

(B) Right atrium
(C) Left ventricle
(D) Right ventricle
(E) Base of the heart
(D) Right ventricle

8. 8. A 7-year-old boy has a damaged interventricular

septum. Which of the following valves is most likely
defective?

(A) Pulmonary valve

(B) Mitral valve
(C) Valve of coronary sinus
(D) Tricuspid valve
(E) Aortic valve
(D) Tricuspid valve

9. 9.A 54-year-old patient is implanted with an artificial

cardiac pacemaker. Which of the following conductive
tissues of the heart had a defective function that
required the pacemaker?
 (A) Atrioventricular (AV) bundle
(B) AV node
(C) Sinoatrial (SA) node
(D) Purkinje fiber
(E) Moderator band
(C) Sinoatrial (SA) node

10. 10. A thoracic surgeon removed the right middle lobar

(secondary) bronchus along with lung tissue from a
57-year-old heavy smoker with lung cancer. Which of
the following bronchopulmonary segments must
contain cancerous tissues?

(A) Medial and lateral

(B) Anterior and posterior
(C) Anterior basal and medial basal
(D) Anterior basal and posterior basal
(E) Lateral basal and posterior basal
(A) Medial and lateral

11. 11. The bronchogram of a 45-year-old female smoker

shows the presence of a tumor in the eparterial
bronchus. Which airway is most likely blocked?

(A) Left superior bronchus

(B) Left inferior bronchus
(C) Right superior bronchus
(D) Right middle bronchus
(E) Right inferior bronchus
(C) Right superior bronchus

12. 12. An 83-year-old man with a typical coronary

circulation has been suffering from an embolism of the
circumflex branch of the left coronary artery. This
condition would result in ischemia of which of the
following areas of the heart?

(A) Anterior part of the left ventricle

(B) Anterior interventricular region
(C) Posterior interventricular region
(D) Posterior part of the left ventricle
(E) Anterior part of the right ventricle
(D) Posterior part of the left ventricle

13. 13.
A 44-year-old man with a stab wound was brought to
the emergency department, and a physician found
that the patient was suffering from a laceration of his
right phrenic nerve. Which of the following conditions
has likely occurred?

(A) Injury to only general somatic efferent fibers

(B) Difficulty in expiration
(C) Loss of sensation in the fibrous pericardium and
mediastinal pleura
(D) Normal function of the diaphragm
(E) Loss of sensation in the costal part of the
diaphragm
(C) Loss of sensation in the fibrous pericardium and
mediastinal pleura
14. 14. An 8-year-old boy with atrial septal defect presents
to a pediatrician.This congenital heart defect shunts
blood from the left atrium to the right atrium and
causes hypertrophy of the right atrium, right
ventricle, and pulmonary trunk. Which of the following
veins opens into the hypertrophied atrium?

(A) Middle cardiac vein

(B) Small cardiac vein
(C) Oblique cardiac vein
(D) Anterior cardiac vein
(E) Right pulmonary vein
(D) Anterior cardiac vein

15. 15.
A 37-year-old patient with severe chest pain,
shortness of breath, and congestive heart failure was
admitted to a local hospital. His coronary angiograms
reveal a thrombosis in the circumflex branch of the left
coronary artery. Which of the following conditions
could result from the blockage of blood flow in the
circumflex branch?

(A) Tricuspid valve insufficiency

(B) Mitral valve insufficiency
(C) Ischemia of atrioventricular (AV) node
(D) Paralysis of pectinate muscle
(E) Necrosis of septomarginal trabecula
(B) Mitral valve insufficiency

16. 16.
A 75-year-old patient has been suffering from lung
cancer located near the cardiac notch, a deep
indentation on the lung. Which of the following lobes is
most likely to be excised?

(A) Superior lobe of the right lung

(B) Middle lobe of the right lung
(C) Inferior lobe of the right lung
(D) Superior lobe of the left lung
(E) Inferior lobe of the left lung
(D) Superior lobe of the left lung

17. 17.
A thoracentesis is performed to aspirate an abnormal
accumulation of fluid in a 37-year-old patient with
pleural effusion. A needle should be inserted at the
midaxillary line between which of the following two
ribs so as to avoid puncturing the lung?

(A) Ribs 1 and 3

(B) Ribs 3 and 5
(C) Ribs 5 and 7
(D) Ribs 7 and 9
(E) Ribs 9 and 11
(D) Ribs 7 and 9

18. 18.
A 6-year-old boy with tetralogy of Fallot shows
pulmonary stenosis and right ventricular hypertrophy
in addition to other symptoms.Which of the following
 structures is likely to be found in the hypertrophied
heart chamber?

(A) Sinus venarum

(B) Crista terminalis
(C) Pectinate muscles
(D) Septomarginal trabecula
(E) Valve of the coronary sinus
(D) Septomarginal trabecula

19. 19.
A 33-year-old patient is suffering from a sudden
occlusion at the origin of the descending (thoracic)
aorta. This condition 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
(E) Lower nine posterior

20. 20.
A 56-year-old patient recently suffered a myocardial
infarction in the area of the apex of the heart. The
occlusion by atherosclerosis is in which of the
following arteries?

(A) Marginal artery

(B) Right coronary artery at its origin
(C) Anterior interventricular artery
(D) Posterior interventricular artery
(E) Circumflex branch of the left coronary artery
(C) Anterior interventricular artery

21. 21.
A 75-year-old woman was admitted to a local hospital,
and bronchograms and radiographs revealed a lung
carcinoma in her left lung. Which of the following
structures or characteristics does the cancerous lung
contain?

(A) Horizontal fissure

(B) Groove for superior vena cava
(C) Middle lobe
(D) Lingula
(E) Larger capacity than the right
(D) Lingula

22. 22.
An 18-year-old girl is thrust into the steering wheel
while driving and experiences difficulty in expiration.
Which of the following muscles is most likely
damaged?

(A) Levator costarum

(B) Innermost intercostal muscle
(C) External intercostal muscle
(D) Diaphragm
(E) Muscles of the abdominal wall
 (E) Muscles of the abdominal wall

23. 23.
A 78-year-old patient presents with an advanced
cancer in the posterior mediastinum. The surgeons
are in a dilemma as to how to manage the condition.
Which of the following structures is most likely
damaged?

(A) Brachiocephalic veins

(B) Trachea
(C) Arch of the azygos vein
(D) Arch of the aorta
(E) Hemiazygos vein
(E) Hemiazygos vein

24. 24.
A 46-year-old patient comes to his doctor's office and
complains of chest pain and headache. His computed
tomography (CT) scan reveals a tumor located just
superior to the root of the right lung. Blood flow in
which of the following veins is most likely blocked by
this tumor?

(A) Hemiazygos vein

(B) Arch of the azygos vein
(C) Right subclavian vein
(D) Right brachiocephalic vein
(E) Accessory hemiazygos vein
(B) Arch of the azygos vein

25. 25.
A 21-year-old patient with a stab wound reveals a
laceration of the right vagus nerve proximal to the
origin of the recurrent laryngeal nerve.Which of the
following conditions would most likely result from this
lesion?

(A) Contraction of bronchial muscle

(B) Stimulation of bronchial gland secretion
(C) Dilation of the bronchial lumen
(D) Decrease in cardiac rate
(E) Constriction of coronary artery
(C) Dilation of the bronchial lumen

26. 26.
A 5-year-old boy with breathing difficulty chest pain,
and cough was admitted to a local hospital. The
pediatrician who examined the boy, along with
laboratory results, diagnosed the child as having
cystic
fibrosis. Which of the following structures is most likely
blocked?

(A) Trachea
(B) Primary bronchus
(C) Secondary or lobar bronchi
(D) Terminal bronchioles
(E) Alveolar duct
(D) Terminal bronchioles
27. 27.
A 12-year-old boy was admitted to a local hospital with
a known history of heart problems. His left ventricular
hypertrophy could result from which of the following
conditions?

(A) A constricted pulmonary trunk

(B) An abnormally small left atrioventricular (AV)
opening
(C) Improper closing of the pulmonary valves
(D) An abnormally large right AV opening
(E) Stenosis of the aorta
(E) Stenosis of the aorta

28. 28.A 31-year-old man was involved in a severe

automobile accident and suffered laceration of the left
primary bronchus. The damaged primary bronchus:

(A) Has a larger diameter than the right primary

bronchus
(B) Often receives more foreign bodies 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
(D) Is longer than the right primary bronchus

29. 29. A 62-year-old woman who is a heavy smoker has

an advanced lung cancer that spread into her right
third intercostal space posterior to the midaxillary line.
If cancer cells are carried in the venous drainage, they
would travel first to which of the following veins?

(A) Superior vena cava

(B) Right superior intercostal vein
(C) Right brachiocephalic vein
(D) Azygos vein
(E) Hemiazygos vein
(B) Right superior intercostal vein

30. 30. A radiologist examines posterior-anterior chest

radiographs of a 27-year-old victim of a car accident.
Which of the following structures forms the right
border of the cardiovascular silhouette?

(A) Arch of the aorta

(B) Pulmonary trunk
(C) Superior vena cava
(D) Ascending aorta
(E) Left ventricle
(C) Superior vena cava

31. 31.A 37-year-old man is brought to the emergency

room complaining of severe chest pain. His angiogram
reveals thromboses of both brachiocephalic veins.This
condition would most likely cause a dilation of which of
the following veins?

(A) Azygos
(B) Hemiazygos
(C) Right superior intercostal
 (D) Left superior intercostal
(E) Internal thoracic
(D) Left superior intercostal

32. 32.A cardiologist is on clinical rounds with her medical

students. She asks them, “During the cardiac cycle,
which of the following events occurs?”

(A) Atrioventricular (AV) valves close during diastole

(B) Aortic valve closes during systole
(C) Pulmonary valve opens during diastole
(D) Blood flow in coronary arteries is maximal during
diastole
(E) Aortic valve closes at the same time as AV valve
(D) Blood flow in coronary arteries is maximal during
diastole

33. 33. Coronary angiographs of a 44-year-old male

patient reveal an occlusion of the circumflex branch of
the left coronary artery. This patient has been suffering
from myocardial infarction in which of the following
areas?

(A) Right and left ventricles

(B) Right and left atria
(C) Interventricular septum
(D) Apex of the heart
(E) Left atrium and ventricle
(E) Left atrium and ventricle

34. 34.A patient has a small but solid tumor in the

mediastinum, which is confined at the level of the
sternal angle. Which of the following structures would
most likely be found at this level?

(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
(A) Bifurcation of the trachea

35. 35.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 would
most likely be damaged?

(A) Manubrium of the sternum

(B) Body of the second thoracic vertebra
(C) Spinous process of the third thoracic vertebra
(D) Body of the fourth thoracic vertebra
(E) Transverse process of the second thoracic
vertebra
(B) Body of the second thoracic vertebra

36. 36.A 45-year-old woman presents with a tumor

confined to the posterior mediastinum. This could
result in compression of which of the following
structures?

(A) Trachea
 (B) Descending aorta
(C) Arch of the aorta
(D) Arch of the azygos vein
(E) Phrenic nerve
(B) Descending aorta

37. 37.A 62-year-old patient with pericardial effusion

comes to a local hospital for aspiration of pericardial
fluid by pericardiocentesis. The needle is inserted into
the pericardial cavity through which of the following
intercostal spaces adjacent to the sternum?

(A) Right fourth intercostal space

(B) Left fourth intercostal space
(C) Right fifth intercostal space
(D) Left fifth intercostal space
(E) Right sixth intercostal space
(D) Left fifth intercostal space

38. 38.The attending faculty in the coronary intensive care

unit (ICU) demonstrates to his students a normal heart
examination. The first heart sound is produced by
near-simultaneous closure of which of the following
valves?

(A) Aortic and tricuspid

(B) Aortic and pulmonary
(C) Tricuspid and mitral
(D) Mitral and pulmonary
(E) Tricuspid and pulmonary
(C) Tricuspid and mitral

39. 39.A 27-year-old patient with Marfan's syndrome 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

40. 40.A 47-year-old man with a known atrial fibrillation

returns to see his cardiologist for follow-up of his
cardiac health. The right atrium is important in this
case because it:

(A) Receives blood from the oblique cardiac vein

(B) Is associated with the apex of the heart
(C) Contains the sinoatrial node
(D) Receives the right pulmonary vein
(E) Is hypertrophied by pulmonary stenosis
(C) Contains the sinoatrial node

41. 41.A 57-year-old patient has a heart murmur resulting

from the inability to maintain constant tension on the
cusps of the atrioventricular (AV) valve. Which of the
following structures is most likely damaged?

(A) Crista terminalis

 (B) Septomarginal trabecula
(C) Chordae tendineae
(D) Pectinate muscle
(E) Anulus fibrosus
(C) Chordae tendineae

42. 42.A 52-year-old patient with a history of myocardial

infarction exhibits a right coronary artery that is
blocked by a fat globule after giving off the right
marginal artery. Which of the following structures may
have oxygen deficiency?

(A) Right atrium

(B) Sinoatrial (SA) node
(C) Atrioventricular (AV) node
(D) Apex of the heart
(E) Anterior interventricular septum
(C) Atrioventricular (AV) node

43. 43.A surgical resident inadvertently ligates the phrenic

nerve instead of the accompanying artery descending
between the mediastinal pleura and the pericardium
without causing any particular harm. Which of the
following arteries did he intend to ligate?

(A) Internal thoracic

(B) Musculophrenic
(C) Pericardiacophrenic
(D) Right coronary
(E) Superior (supreme) thoracic
(C) Pericardiacophrenic

44. 44.A pulmonary fellow at a university hospital is asked

to consult on a patient in respiratory failure. When the
diaphragm contracts, which of the following conditions
should normally occur?

(A) Decreased thoracic volume

(B) Increased abdominal volume
(C) Increased lung volume
(D) Air flow out of the bronchi
(E) Increased thoracic pressure
(C) Increased lung volume

45. 45.
A 32-year-old patient has a tension pneumothorax that
can be treated with needle aspiration. To avoid an
injury of the intercostal neurovascular bundle, the
needle may be inserted in which of the following
locations?

(A) Above the upper border of the ribs

(B) Deep to the upper border of the ribs
(C) Beneath the lower border of the ribs
(D) Between the external and internal inter-costals
(E) Through the transversus thoracis muscle
(A) Above the upper border of the ribs

46. 46.
A 57-year-old man made a long airplane trip to
Boston, returned home last night, and came to the
 clinic with a chief complaint of sudden left-sided
weakness and garbled speech. After physical
examination and reviewing his echocardiograms, his
physician diagnosed him as having an ischemic
stroke.Which of the following conditions most likely
caused the stroke?

(A) Pulmonary stenosis

(B) Mitral valve prolapse
(C) Atrial septal defect
(D) Dextroposition of the aorta
(E) Coronary atherosclerosis
(C) Atrial septal defect

47. 47.
A 7-day-old baby is diagnosed as having congenital
neonatal emphysema, which is caused by collapsed
bronchi because of failure of bronchial cartilage
development. Bronchial cartilages are derived from
which of the following derivations?

(A) Ectoderm
(B) Mesoderm
(C) Endoderm
(D) Proctodeum
(E) Neuroectoderm
(B) Mesoderm

48. 48. Stenosis of which structure may produce left

ventricular hypertrophy?
LOOK AT GRAPH

The answer is C. Stenosis of the ascending aorta results in

left ventricular hypertrophy.

49. 49. Which structure 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? LOOK AT GRAPH

The answer is B.
During surgical treatment for cancer in the apex of
the right lung by a lobectomy, the right superior
secondary (eparterial) bronchus should be removed.

50. 50. Which structure branches into the bronchial

arteries? LOOK AT GRAPH
 The answer is E. The right and left bronchial arteries arise
from the descending (thoracic) aorta.

51. 51. Into which structure does the azygos vein drain
venous blood?

The answer is A. The azygos vein drains venous blood into

the superior vena cava.

52. 52. The left coronary artery arises from which

structure?

The answer is C. The right and left coronary arteries arise

from the ascending aorta.

53. 53. Which structure is crossed superiorly by the aortic

arch and left pulmonary artery?

The answer is D. The left primary bronchus is crossed

superiorly by the arch of the aorta and the pulmonary artery.

54. 54. Can be removed in a surgical resection of a lobe

to remove lung cancer on the diaphragmatic surface?

The answer is B.
The right inferior lobar bronchus may be removed in
a surgical resection of the inferior lobe of the right
lung that is in contact with the diaphragm.
55. 55. Becomes hypertrophied as result of the pulmonary

stenosis?

The answer is C. Pulmonary stenosis results in right

ventricular hypertrophy.

56. 56. Receives oxygenated blood via pulmonary veins?

The answer is E. The left atrium receives oxygenated blood

from the lung by way of the pulmonary veins.

57. 57. Lies on the right side of the aortic arch and
ascending aorta?

The answer is A. The superior vena cava lies on the right

side of the ascending aorta and the arch of the aorta.

58. 58. Contains the septomarginal trabecula?

The answer is C. The right ventricle contains the

septomarginal trabecula.

59. 59. Takes its origin from the left ventricle and ends at
the sternal angle?

The answer is D.
The ascending aorta takes its origin from the left
ventricle and ends at the level of the sternal angle by
becoming the arch of the aorta.
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