Anatomy - Thoracic Wall, Pleura, Pericardium

25 Questions | By Chachelly | Last updated: Mar 22, 2022 | Total Attempts: 533

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1.

The second costal cartilage can be located by palpating the:
- A.
  
  Costal margin
- B.
  
  Sternal angle
- C.
  
  Sternal notch
- D.
  
  Sternoclavicular joint
- E.
  
  Xiphoid process
2.

The thoracic wall is innervated by:
- A.
  
  Dorsal primary rami
- B.
  
  Intercostal nerves
- C.
  
  Lateral pectoral nerves
- D.
  
  Medial pectoral nerves
- E.
  
  Thoracodorsal nerves
3.

The sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber?
- A.
  
  Left atrium
- B.
  
  Left ventricle
- C.
  
  Right atrium
- D.
  
  Right ventricle
4.

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?
- A.
  
  Left atrium
- B.
  
  Left ventricle
- C.
  
  Right atrium
- D.
  
  Right ventricle
5.

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?
- A.
  
  Costodiaphragmatic recess
- B.
  
  Costomediastinal recess
- C.
  
  Cupola
- D.
  
  Hilar reflection
- E.
  
  Middle mediastinum
6.

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:
- A.
  
  Coronary sinus
- B.
  
  Coronary sulcus
- C.
  
  Costomediastinal recess
- D.
  
  Oblique sinus
- E.
  
  Transverse sinus
7.

When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately:
- A.
  
  Above the margin of a rib
- B.
  
  Below the margin of a rib
8.

A hand slipped behind the heart at its apex can be extended upwards until stopped by a line of pericardial reflection that forms the:
- A.
  
  Cardiac notch
- B.
  
  Costomediastinal recess
- C.
  
  Hilar reflection
- D.
  
  Oblique pericardial sinus
- E.
  
  Transverse pericardial sinus
9.

The first rib articulates with the sternum in close proximity to the:
- A.
  
  Nipple
- B.
  
  Root of the lung
- C.
  
  Sternal angle
- D.
  
  Sternoclavicular joint
- E.
  
  Xiphoid process
10.

The portion of the parietal pleura that extends above the first rib is called the
- A.
  
  Costodiaphragmatic recess
- B.
  
  Costomediastinal recess
- C.
  
  Costocervical recess
- D.
  
  Cupola
- E.
  
  Endothoracic fascia
11.

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--
- A.
  
  Left phrenic
- B.
  
  Left sympathetic trunk
- C.
  
  Left vagus
- D.
  
  Right phrenic
- E.
  
  Right sympathetic trunk
12.

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?
- A.
  
  Cardiac notch
- B.
  
  Coronary sinus
- C.
  
  Oblique pericardial sinus
- D.
  
  Coronary sulcus
- E.
  
  Transverse pericardial sinus
13.

A needle inserted into the 9th intercostal space along the midaxillary line would enter which space?
- A.
  
  Cardiac notch
- B.
  
  Costodiaphragmatic recess
- C.
  
  Costomediastinal recess
- D.
  
  Cupola
- E.
  
  Oblique pericardial sinus
14.

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?
- A.
  
  Pulmonary trunk and brachiocephalic trunk
- B.
  
  Pulmonary trunk and aorta
- C.
  
  Pulmonary trunk and superior vena cava
- D.
  
  Superior vena cava and aorta
- E.
  
  Superior vena cava and right pulmonary artery
15.

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:
- A.
  
  Costodiaphragmatic recess
- B.
  
  Costomediastinal recess
- C.
  
  Cupola
- D.
  
  Hilar reflection
- E.
  
  Pulmonary ligament
16.

The pleural cavity near the cardiac notch is known as the:
- A.
  
  Costodiaphragmatic recess
- B.
  
  Costomediastinal recess
- C.
  
  Cupola
- D.
  
  Hilum
- E.
  
  Pulmonary ligament
17.

The tubercle of the 7th rib articulates with which structure?
- A.
  
  Body of vertebra T6
- B.
  
  Body of vertebra T7
- C.
  
  Body of vertebra T8
- D.
  
  Transverse process of vertebra T6
- E.
  
  Transverse process of vertebra T7
18.

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?
- A.
  
  Accessory hemiazygos vein
- B.
  
  Left internal thoracic artery
- C.
  
  Left phrenic nerve
- D.
  
  Left recurrent laryngeal nerve
- E.
  
  Thoracic duct
19.

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?
- A.
  
  Costal pleura
- B.
  
  Cupola
- C.
  
  Hilar reflection
- D.
  
  Mediastinal pleura
- E.
  
  Pulmonary ligament
20.

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?
- A.
  
  Costodiaphragmatic recess
- B.
  
  Cupola
- C.
  
  Inferior vena cava
- D.
  
  Left pulmonary vein
- E.
  
  Pulmonary ligament
21.

Which of the following layers provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?
- A.
  
  Deep fascia
- B.
  
  Endothoracic fascia
- C.
  
  Parietal pleura
- D.
  
  Visceral pleura
- E.
  
  Transversus thoracis muscle fascia
22.

The lowest extent of the pleural cavity, into which lung tissue does not extend, is known as the:
- A.
  
  Costodiaphragmatic recess
- B.
  
  Costomediastinal recess
- C.
  
  Cupola
- D.
  
  Inferior mediastinum
- E.
  
  Pulmonary ligament
23.

The sternal angle is a landmark for locating the level of the:
- A.
  
  Costal margin
- B.
  
  Jugular notch
- C.
  
  Second costal cartilage
- D.
  
  Sternoclavicular joint
- E.
  
  Xiphoid process
24.

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?
- A.
  
  1
- B.
  
  2
- C.
  
  3
- D.
  
  4
- E.
  
  Can't be determined
25.

The thoracic wall is innervated by
- A.
  
  Dorsal primary rami
- B.
  
  Intercostal nerves
- C.
  
  Lateral pectoral nerves
- D.
  
  Medial pectoral nerves
- E.
  
  Thoracodorsal nerves