Anatomy - Thoracic Wall, Pleura, Pericardium

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  • 1/25 Questions

    The thoracic wall is innervated by

    • Dorsal primary rami
    • Intercostal nerves
    • Lateral pectoral nerves
    • Medial pectoral nerves
    • Thoracodorsal nerves
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About This Quiz

This quiz focuses on the anatomy of the thoracic wall, pleura, and pericardium, assessing knowledge of structures like the sternum, costal cartilages, and heart chambers. It is designed for learners in medical fields, enhancing understanding of critical anatomical relationships and clinical scenarios.

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  • 2. 

    The thoracic wall is innervated by:

    • Dorsal primary rami

    • Intercostal nerves

    • Lateral pectoral nerves

    • Medial pectoral nerves

    • Thoracodorsal nerves

    Correct Answer
    A. Intercostal nerves
    Explanation
    The thoracic wall is innervated by the intercostal nerves. These nerves originate from the ventral rami of the thoracic spinal nerves and run between the ribs, supplying sensory innervation to the skin, muscles, and other structures of the thoracic wall. The intercostal nerves also provide motor innervation to the intercostal muscles, which are involved in respiration. Therefore, the intercostal nerves play a crucial role in the sensory and motor functions of the thoracic wall.

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  • 3. 

    While observing in the OR, you see the resident insert a needle through the body wall just above the ninth rib in the mid-axillary line. She was obviously trying to enter the:

    • Costodiaphragmatic recess

    • Costomediastinal recess

    • Cupola

    • Hilar reflection

    • Pulmonary ligament

    Correct Answer
    A. Costodiaphragmatic recess
    Explanation
    The correct answer is the Costodiaphragmatic recess. The Costodiaphragmatic recess is a potential space located between the diaphragm and the costal pleura. It is formed when the diaphragm is at its lowest position during inspiration, causing the costal pleura to descend further than the lungs. By inserting the needle just above the ninth rib in the mid-axillary line, the resident was aiming to enter this recess.

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  • 4. 

    A 3rd-year medical student was doing her first physical exam. In order to properly place her stethoscope to listen to heart sounds, she palpated bony landmarks. She began at the jugular notch, then slid her fingers down to the sternal angle. At which rib (costal cartilage) level were her fingers?

    • 1

    • 2

    • 3

    • 4

    • Can't be determined

    Correct Answer
    A. 2
    Explanation
    The sternal angle is located at the level of the second rib. Therefore, when the medical student slid her fingers down to the sternal angle, her fingers were at the level of the second rib.

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  • 5. 

    The sternal angle is a landmark for locating the level of the:

    • Costal margin

    • Jugular notch

    • Second costal cartilage

    • Sternoclavicular joint

    • Xiphoid process

    Correct Answer
    A. Second costal cartilage
    Explanation
    The sternal angle, also known as the angle of Louis, is a bony landmark located at the level of the second costal cartilage. This angle is formed by the articulation of the manubrium (upper part of the sternum) and the body of the sternum (middle part of the sternum). It is an important anatomical reference point used in clinical examinations, such as identifying the level of the second rib and the second intercostal space.

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  • 6. 

    The second costal cartilage can be located by palpating the:

    • Costal margin

    • Sternal angle

    • Sternal notch

    • Sternoclavicular joint

    • Xiphoid process

    Correct Answer
    A. Sternal angle
    Explanation
    The sternal angle is the correct answer because it is the point where the manubrium and body of the sternum articulate. It can be easily palpated as a bony prominence in the midline of the chest, making it a reliable landmark for locating the second costal cartilage. The costal margin refers to the lower border of the ribcage, the sternal notch is a depression at the superior end of the sternum, the sternoclavicular joint is where the clavicle and sternum meet, and the xiphoid process is a small cartilaginous extension at the lower end of the sternum.

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  • 7. 

    You are caring for a 68-year-old male who has copious amounts of fluid in the left pleural cavity due to acute pleurisy. When you examine him as he sits up in bed (trunk upright), where would the fluid tend to accumulate?

    • Costodiaphragmatic recess

    • Costomediastinal recess

    • Cupola

    • Hilar reflection

    • Middle mediastinum

    Correct Answer
    A. Costodiaphragmatic recess
    Explanation
    When a person sits up in bed with their trunk upright, the fluid in the left pleural cavity would tend to accumulate in the costodiaphragmatic recess. This is because the costodiaphragmatic recess is the lowest part of the pleural cavity when the person is in an upright position. Gravity causes the fluid to settle in this area, which is the space between the diaphragm and the lower ribs.

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  • 8. 

    When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately:

    • Above the margin of a rib

    • Below the margin of a rib

    Correct Answer
    A. Above the margin of a rib
    Explanation
    When inserting a chest tube, it is important to avoid damaging the intercostal vessels and nerves. Placing the tube immediately above the margin of a rib helps to ensure that these structures are not punctured or injured during the procedure. This location allows for safe and effective drainage of air or fluid from the pleural space without causing additional harm to the patient. Placing the tube below the margin of a rib could increase the risk of damaging these vital structures and potentially lead to complications.

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  • 9. 

    The first rib articulates with the sternum in close proximity to the:

    • Nipple

    • Root of the lung

    • Sternal angle

    • Sternoclavicular joint

    • Xiphoid process

    Correct Answer
    A. Sternoclavicular joint
    Explanation
    The first rib articulates with the sternum in close proximity to the sternoclavicular joint. The sternoclavicular joint is the joint between the clavicle and the sternum, located at the base of the neck. This joint allows for movement of the clavicle and is important for shoulder function. The first rib connects to the sternum at this joint, providing stability and support to the upper body.

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  • 10. 

    A needle inserted into the 9th intercostal space along the midaxillary line would enter which space?

    • Cardiac notch

    • Costodiaphragmatic recess

    • Costomediastinal recess

    • Cupola

    • Oblique pericardial sinus

    Correct Answer
    A. Costodiaphragmatic recess
    Explanation
    A needle inserted into the 9th intercostal space along the midaxillary line would enter the costodiaphragmatic recess. The costodiaphragmatic recess is a potential space located between the diaphragm and the lower border of the lung. It is the lowest part of the pleural cavity and is formed by the reflection of the parietal pleura from the thoracic wall onto the diaphragm. This space is important for the movement of the diaphragm during respiration and can be accessed for procedures such as thoracentesis or chest tube insertion.

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  • 11. 

    The lowest extent of the pleural cavity, into which lung tissue does not extend, is known as the:

    • Costodiaphragmatic recess

    • Costomediastinal recess

    • Cupola

    • Inferior mediastinum

    • Pulmonary ligament

    Correct Answer
    A. Costodiaphragmatic recess
    Explanation
    The lowest extent of the pleural cavity, into which lung tissue does not extend, is known as the costodiaphragmatic recess. This recess is located at the bottom of the pleural cavity, between the diaphragm and the lower border of the lungs. It is a potential space that allows for the movement of the diaphragm during respiration. The costodiaphragmatic recess is important for maintaining the integrity and function of the lungs, as it allows for their expansion and contraction without causing damage to surrounding structures.

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  • 12. 

    During a heart transplant procedure, the surgeon inserted his left index finger through the transverse pericardial sinus, and then pulled forward on the two large vessels lying ventral to his finger. Which vessels were these?

    • Pulmonary trunk and brachiocephalic trunk

    • Pulmonary trunk and aorta

    • Pulmonary trunk and superior vena cava

    • Superior vena cava and aorta

    • Superior vena cava and right pulmonary artery

    Correct Answer
    A. Pulmonary trunk and aorta
    Explanation
    The surgeon inserted his left index finger through the transverse pericardial sinus and pulled forward on the two large vessels lying ventral to his finger. The vessels that were pulled forward were the pulmonary trunk and the aorta.

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  • 13. 

    The pleural cavity near the cardiac notch is known as the:

    • Costodiaphragmatic recess

    • Costomediastinal recess

    • Cupola

    • Hilum

    • Pulmonary ligament

    Correct Answer
    A. Costomediastinal recess
    Explanation
    The pleural cavity near the cardiac notch is known as the costomediastinal recess. This is a small space between the mediastinal surface of the lung and the costal surface of the mediastinum. It is formed by the reflection of the pleura from the mediastinum onto the lung. The costomediastinal recess is important because it allows for expansion of the lung during inspiration, as the lung can move into this recess and increase its volume.

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  • 14. 

    A 16-year-old male suffered a stab wound in which a knife blade entered immediately superior to the upper edge of the right clavicle near its head. He was in extreme pain, which was interpreted by the ER physician as a likely indicator of a collapsed lung following disruption of the pleura. If that was true, what portion of the pleura was most likely cut or torn?

    • Costal pleura

    • Cupola

    • Hilar reflection

    • Mediastinal pleura

    • Pulmonary ligament

    Correct Answer
    A. Cupola
    Explanation
    The cupola of the pleura is the dome-shaped uppermost part of the pleural cavity, extending above the level of the first rib. In this case, the knife blade entered immediately superior to the upper edge of the right clavicle near its head, indicating that it likely cut or tore the cupola of the pleura. This would cause extreme pain and could result in a collapsed lung, as the cupola is in close proximity to the apex of the lung.

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  • 15. 

    You are attending an operation to remove a thymic tumor from the superior mediastinum. The surgeon asks, "What important nerve lying on and partly curving posteriorly around the arch of the aorta should we be careful of as we remove this mass?" You quickly answer, "The--

    • Left phrenic

    • Left sympathetic trunk

    • Left vagus

    • Right phrenic

    • Right sympathetic trunk

    Correct Answer
    A. Left vagus
    Explanation
    During the removal of a thymic tumor from the superior mediastinum, it is important to be careful of the left vagus nerve. The left vagus nerve lies on and partly curves posteriorly around the arch of the aorta. It is important to avoid damaging this nerve during the operation to prevent potential complications such as vocal cord paralysis or gastrointestinal dysfunction.

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  • 16. 

    A hand slipped behind the heart at its apex can be extended upwards until stopped by a line of pericardial reflection that forms the:

    • Cardiac notch

    • Costomediastinal recess

    • Hilar reflection

    • Oblique pericardial sinus

    • Transverse pericardial sinus

    Correct Answer
    A. Oblique pericardial sinus
    Explanation
    When a hand is slipped behind the heart at its apex and extended upwards, it will be stopped by a line of pericardial reflection. This line forms the oblique pericardial sinus. The oblique pericardial sinus is a potential space located between the left atrium and the posterior surface of the heart. It is formed by the reflection of the pericardium onto the pulmonary veins and the inferior vena cava.

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  • 17. 

    A patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of the 4th or 5th costal cartilage. If the object also penetrated pericardium and heart wall, which heart chamber would most likely be damaged?

    • Left atrium

    • Left ventricle

    • Right atrium

    • Right ventricle

    Correct Answer
    A. Right ventricle
    Explanation
    If the object penetrated the pericardium and heart wall at the level of the 4th or 5th costal cartilage, the heart chamber most likely to be damaged would be the right ventricle. The right ventricle is located in the lower part of the heart and is closer to the sternum compared to the left ventricle. Therefore, it is more susceptible to injury in this scenario.

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  • 18. 

    Which of the following layers provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?

    • Deep fascia

    • Endothoracic fascia

    • Parietal pleura

    • Visceral pleura

    • Transversus thoracis muscle fascia

    Correct Answer
    A. Endothoracic fascia
    Explanation
    The endothoracic fascia provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall. This layer is located between the parietal pleura and the innermost intercostal muscles. It is a thin layer of connective tissue that helps to separate the pleura from the thoracic wall, allowing for easier surgical access and manipulation.

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  • 19. 

    The sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber?

    • Left atrium

    • Left ventricle

    • Right atrium

    • Right ventricle

    Correct Answer
    A. Right ventricle
    Explanation
    The sternocostal surface of the heart is formed primarily by the anterior wall of the right ventricle. This means that when looking at the heart from the front, the right ventricle is the chamber that is most visible and in contact with the sternum and ribs. The left atrium, left ventricle, and right atrium are not primarily responsible for forming the sternocostal surface of the heart.

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  • 20. 

    The tubercle of the 7th rib articulates with which structure?

    • Body of vertebra T6

    • Body of vertebra T7

    • Body of vertebra T8

    • Transverse process of vertebra T6

    • Transverse process of vertebra T7

    Correct Answer
    A. Transverse process of vertebra T7
    Explanation
    The tubercle of the 7th rib articulates with the transverse process of vertebra T7.

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  • 21. 

    The ductus arteriosus sometimes remains open after birth requiring surgical closure. When placing a clamp on the ductus, care must be taken to avoid injury to what important structure immediately dorsal to it?

    • Accessory hemiazygos vein

    • Left internal thoracic artery

    • Left phrenic nerve

    • Left recurrent laryngeal nerve

    • Thoracic duct

    Correct Answer
    A. Left recurrent laryngeal nerve
    Explanation
    The left recurrent laryngeal nerve is located immediately dorsal to the ductus arteriosus. During surgical closure of the ductus, care must be taken to avoid injuring this important structure. Damage to the left recurrent laryngeal nerve can result in vocal cord paralysis, leading to hoarseness and difficulty speaking. Therefore, surgeons must be cautious and precise when placing a clamp on the ductus arteriosus to prevent any harm to the left recurrent laryngeal nerve.

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  • 22. 

    In cardiac surgery it is sometimes necessary to clamp off all arterial flow out of the heart. This could be done within the pericardial sac by inserting the index finger immediately behind the two great arteries and compressing them with the thumb of the same hand. The index finger would have to be inserted into which space?

    • Cardiac notch

    • Coronary sinus

    • Oblique pericardial sinus

    • Coronary sulcus

    • Transverse pericardial sinus

    Correct Answer
    A. Transverse pericardial sinus
    Explanation
    The question asks for the space into which the index finger would have to be inserted in order to clamp off all arterial flow out of the heart within the pericardial sac. The correct answer is the transverse pericardial sinus. The transverse pericardial sinus is a space located behind the great arteries and in front of the superior vena cava and right atrium. By inserting the index finger into this space and compressing the great arteries, arterial flow out of the heart can be clamped off.

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  • 23. 

    During a lung transplant procedure, an observing 4th year attempted to pass his index finger posteriorly inferior to the root of the left lung, but he found passage of the finger blocked. Which structure would most likely be responsible for this?

    • Costodiaphragmatic recess

    • Cupola

    • Inferior vena cava

    • Left pulmonary vein

    • Pulmonary ligament

    Correct Answer
    A. Pulmonary ligament
    Explanation
    During a lung transplant procedure, the pulmonary ligament is the most likely structure responsible for blocking the passage of the observer's finger. The pulmonary ligament is a fold of pleura that extends from the inferior part of the root of the lung to the diaphragm. It helps to anchor the lung in place and allows for the movement of the lung during respiration. Therefore, when the observer attempted to pass his finger posteriorly inferior to the root of the left lung, the pulmonary ligament would have prevented the finger from passing through.

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  • 24. 

    The portion of the parietal pleura that extends above the first rib is called the

    • Costodiaphragmatic recess

    • Costomediastinal recess

    • Costocervical recess

    • Cupola

    • Endothoracic fascia

    Correct Answer
    A. Cupola
    Explanation
    The cupola is the portion of the parietal pleura that extends above the first rib. It is a dome-shaped structure that covers the apex of the lung. The cupola is important because it allows for movement of the lung during respiration and provides protection to the surrounding structures in the thoracic cavity.

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  • 25. 

    A 23-year-old male injured in an industrial explosion was found to have multiple small metal fragments in his thoracic cavity. Since the pericardium was torn inferiorly, the surgeon began to explore for fragments in the pericardial sac. Slipping her hand under the heart apex, she slid her fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. Her fingertips were then in the:

    • Coronary sinus

    • Coronary sulcus

    • Costomediastinal recess

    • Oblique sinus

    • Transverse sinus

    Correct Answer
    A. Oblique sinus
    Explanation
    The surgeon's fingertips were in the oblique sinus. The oblique sinus is a recess formed by the pericardial reflection near the base of the heart. It is located between the posterior surface of the heart and the posterior wall of the pericardial sac. By sliding her fingers upward and to the right within the sac, the surgeon reached this cul-de-sac, indicating that her fingertips were in the oblique sinus.

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  • Current Version
  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Nov 05, 2011
    Quiz Created by
    Chachelly
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