Mcq_mini3 Superior Mediastinum And Lungs

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Mcq_mini3 Superior Mediastinum And Lungs - Quiz

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Questions and Answers
  • 1. 

    You are called to perform thoracentesis (remove fluid from the pleural cavity). If you are to avoid injuring lung or neurovascular elements, where would you insert the aspiration needle?

    • A.

      The top of interspace 8 in the midclavicular line

    • B.

      The bottom of interspace 8 in the midclavicular line

    • C.

      The top of interspace 9 in the midaxillary line

    • D.

      The bottom of interspace 9 in the midaxillary line

    • E.

      The top of interspace 11 in the scapular line

    Correct Answer
    D. The bottom of interspace 9 in the midaxillary line
    Explanation
    To avoid injuring the lung or neurovascular elements during thoracentesis, the aspiration needle should be inserted at the bottom of interspace 9 in the midaxillary line. This location ensures that the needle is inserted below the lung and away from any major blood vessels or nerves. The midaxillary line is a reliable landmark for this procedure, and the bottom of interspace 9 is the correct insertion point to safely remove fluid from the pleural cavity.

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  • 2. 

    The pleural space into which lung tissue just above the cardiac notch would tend to expand during deep inspiration is the:

    • A.

      Anterior mediastinum

    • B.

      Costodiaphragmatic recess

    • C.

      Costomediastinal recess

    • D.

      Cupola

    • E.

      Pulmonary ligament

    Correct Answer
    C. Costomediastinal recess
    Explanation
    During deep inspiration, the lung tissue just above the cardiac notch would tend to expand into the costomediastinal recess. The costomediastinal recess is a potential space located between the costal pleura and the mediastinal pleura. It is formed by the reflection of the parietal pleura at the level of the 4th or 5th costal cartilage. This recess allows for the expansion of the lung tissue during deep inspiration, allowing for increased lung capacity and improved oxygenation.

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  • 3. 

    Which feature is found only in the left lung?

    • A.

      Cardiac notch

    • B.

      Horizontal fissure

    • C.

      Oblique fissure

    • D.

      Superior lobar bronchus

    • E.

      Three lobes

    Correct Answer
    A. Cardiac notch
    Explanation
    The feature that is found only in the left lung is the cardiac notch. The cardiac notch is a concave impression on the medial surface of the left lung that accommodates the heart. This feature is not present in the right lung. The other options mentioned, such as the horizontal and oblique fissures, superior lobar bronchus, and three lobes, are all present in both the left and right lungs.

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  • 4. 

    Which of the following nerves would be most vuInerable to irritation when the tracheobronchial lymph nodes are enlarged due to a diseased situation?

    • A.

      Right phrenic

    • B.

      Left phrenic

    • C.

      Right recurrent laryngeal

    • D.

      Left recurrent laryngeal

    • E.

      Right vagus

    Correct Answer
    D. Left recurrent laryngeal
    Explanation
    When the tracheobronchial lymph nodes are enlarged due to a diseased situation, the left recurrent laryngeal nerve would be most vulnerable to irritation. The left recurrent laryngeal nerve loops around the aortic arch before ascending to supply the muscles of the larynx. Enlarged lymph nodes in this area can compress or irritate the nerve, leading to symptoms such as hoarseness of voice and difficulty swallowing. The other nerves listed in the options are not as closely related to the tracheobronchial lymph nodes and are less likely to be affected by their enlargement.

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  • 5. 

    Which part of the left lung might partially fill the costomediastinal recess in fuII inspiration?

    • A.

      Apex

    • B.

      Cupola

    • C.

      Hilum

    • D.

      Lingula

    • E.

      Middle lobe

    Correct Answer
    D. Lingula
    Explanation
    The lingula is a small, tongue-like projection of the left lung that extends from the anterior part of the upper lobe. During full inspiration, the lingula may partially fill the costomediastinal recess, which is a potential space between the lung and the mediastinum. This occurs because the lingula is located in close proximity to the mediastinum, allowing it to expand and fill the recess during deep inhalation.

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  • 6. 

    The oblique fissure of the right lung separates which structures?

    • A.

      Lower lobe from lingula

    • B.

      Lower lobe from upper lobe only

    • C.

      Lower lobe from both upper and middle lobes

    • D.

      Lower lobe from middle lobe only

    • E.

      Upper from middle lobe

    Correct Answer
    C. Lower lobe from both upper and middle lobes
    Explanation
    The oblique fissure of the right lung separates the lower lobe from both the upper and middle lobes.

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  • 7. 

    In a post-soccer match brawl, a 35-year-old man was stabbed in the back with a knife that Just nicked his left lung halfway between Its apex and diaphragmatic surface. Which part of the lung was most likely injured?

    • A.

      Hilum

    • B.

      Inferior lobe

    • C.

      Lingula

    • D.

      Middle lobe

    • E.

      Superior lobe

    Correct Answer
    B. Inferior lobe
    Explanation
    The question describes a stabbing injury to the back that just nicked the left lung. The lung is divided into lobes, and the inferior lobe is located at the bottom of the lung. Since the injury is described as being halfway between the apex (top) and diaphragmatic surface (bottom) of the lung, it is most likely to have affected the inferior lobe.

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  • 8. 

    A 4-year-old girl is brought in with coughing, and you are told by her mother that she had been playing with some beads and had apparently aspirated one (gotten It into her airway). Where would you expect it to most likely be?

    • A.

      Apicoposterior segmental bronchus of left lung

    • B.

      Left main bronchus

    • C.

      Lingular segment of left lung

    • D.

      Right main bronchus

    • E.

      Terminal bronchiole of right lung, lower lobe

    Correct Answer
    D. Right main bronchus
    Explanation
    When a foreign object is aspirated into the airway, it is most likely to get lodged in the bronchus of the lung on the same side as the hand used to manipulate the object. In this case, the girl had been playing with beads and had apparently aspirated one, so it is likely to be in the right main bronchus. As the right main bronchus is wider and more vertical than the left main bronchus, it is more prone to foreign body aspiration.

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  • 9. 

    Which statement is true about the right lung?

    • A.

      It is slightly smaller than the left lung

    • B.

      It has a lingular segmental bronchus

    • C.

      It occupies the rightmost portion of the mediastinum

    • D.

      Its upper lobar bronchus lies behind and above the right pulmonary artery

    • E.

      It has the rig ht phrenic nerve passing posterior to the lung root

    Correct Answer
    D. Its upper lobar bronchus lies behind and above the right pulmonary artery
    Explanation
    The correct answer is "its upper lobar bronchus lies behind and above the right pulmonary artery." This statement refers to the anatomical position of the upper lobar bronchus in the right lung, indicating its location relative to the right pulmonary artery.

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  • 10. 

    During a surgical procedure in the vicinity of the descending aorta, a surgeon accidentally cuts the first aortic intercostal arteries. Which of the following structures might be deprived of its main source of blood supply?

    • A.

      First posterior intercostal space

    • B.

      First anterior intercostal space

    • C.

      Left bronchus

    • D.

      Right bronchus

    • E.

      Fibrous pericardium

    Correct Answer
    D. Right bronchus
    Explanation
    If the surgeon accidentally cuts the first aortic intercostal arteries, the structure that might be deprived of its main source of blood supply is the right bronchus. The first aortic intercostal arteries are branches of the descending aorta that supply blood to the intercostal spaces and the bronchial arteries. Since the right bronchus is located in close proximity to the descending aorta, it is likely to be affected by the accidental cut.

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  • 11. 

    A sick person, Iying supine in bed, aspirates (breathes in) some fluid into her lungs while swallowing. It would most likely end up in which of the following bronchopulmonary segments?

    • A.

      Anterior segmental bronchus of right superior lobe

    • B.

      Medial segmental bronchus of right middle lobe

    • C.

      Superior segmentaI bronchus of right inferior Iobe

    • D.

      Medial basal segmental bronchus of left inferior lobe

    • E.

      Inferior segmental bronchus of Iingular lobe

    Correct Answer
    C. Superior segmentaI bronchus of right inferior Iobe
    Explanation
    When a person aspirates fluid while swallowing, it is most likely to end up in the bronchopulmonary segment that is closest to the location where the aspiration occurred. In this case, the fluid would most likely end up in the superior segmental bronchus of the right inferior lobe, as it is the closest to the location of aspiration.

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  • 12. 

    A 20-year-oId man was stabbed in the back with a knife that just nicked his right lung halfway between its apex and diaphragmatic surface. Which part of the lung was most likely injured?

    • A.

      Middle lobe

    • B.

      Inferior lobe

    • C.

      Cardiac notch

    • D.

      Ungula

    • E.

      Superior lobe

    Correct Answer
    B. Inferior lobe
    Explanation
    The correct answer is Inferior lobe. The question states that the knife just nicked the right lung halfway between its apex and diaphragmatic surface. The inferior lobe of the lung is located towards the bottom and is closer to the diaphragm. Therefore, it is most likely to be injured in this scenario.

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  • 13. 

    A 10-year-old boy underwent a tonsillectomy under general anesthesia. At home he lay supine in bed for two weeks and developed a fever and chest pain with cough. He returned to the hospital and was diagnosed as having right lung pneumonia due to aspiration of infectious material during the tonsillectomy. In which bronchopulmonary segment of the lung would fluid (pus) most likely have accumulated by the simple force of gravity?

    • A.

      Anterior basal segment--inferior lobe

    • B.

      Anterior segment--superior lobe

    • C.

      Lateral segment--middle lobe

    • D.

      Superior segment--inferior lobe

    • E.

      Superior ingual segment-IinguaI

    Correct Answer
    D. Superior segment--inferior lobe
    Explanation
    The fluid (pus) would most likely have accumulated in the superior segment of the inferior lobe due to gravity. When a person lies supine (flat on their back), the fluid will pool in the dependent areas of the lung, which are the lower lobes. In this case, the pneumonia is in the right lung, so the fluid would accumulate in the superior segment of the right lower lobe.

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  • 14. 

    You are observing a doctor perform a bronchoscopy. As he passes the bronchoscope down the trachea, a cartilagenous structure is observed separating the right and left main stem bronchi. He asks what it is called. You reply that it really does look like a ship's keel and that it is called the :

    • A.

      Carina

    • B.

      Cricoid cartilage

    • C.

      Costal cartilage

    • D.

      Pulmonary ligament

    • E.

      Tracheal ring

    Correct Answer
    A. Carina
    Explanation
    The correct answer is Carina. During a bronchoscopy, the doctor observed a cartilagenous structure separating the right and left main stem bronchi. This structure resembles a ship's keel and is called the carina.

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  • 15. 

    The minor (horizontaI) fissure separates

    • A.

      The lower lobe from the lingula

    • B.

      The upper lobe from the lingula

    • C.

      The lower lobe from both the middle and upper lobes

    • D.

      The lower lobe from the middle lobe

    • E.

      The middle lobe from the upper lobe

    Correct Answer
    E. The middle lobe from the upper lobe
    Explanation
    The minor (horizontal) fissure separates the middle lobe from the upper lobe.

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  • 16. 

    Your patient, an 86-year-old female who has been bed-ridden and lying supine for many weeks, has developed a right lung abscess that is draining by gravity into one particular region of the lung. Where is the most likely site of fluid accumulation?

    • A.

      Apical segment of upper lobe

    • B.

      Lingula

    • C.

      Lower lobe

    • D.

      Middle lobe

    • E.

      Superior segment of lower lobe

    Correct Answer
    E. Superior segment of lower lobe
    Explanation
    When a patient is bed-ridden and lying supine for a long period, gravity causes fluid to accumulate in the dependent areas of the lungs. The superior segment of the lower lobe is the most dependent area in the lungs when the patient is lying supine. Therefore, it is the most likely site of fluid accumulation in this case.

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  • 17. 

    Because of its angle with the trachea and size of the main bronchus, a bronchoscope would pass more readily into which lung?

    • A.

      Left

    • B.

      Right

    Correct Answer
    B. Right
    Explanation
    The bronchoscope would pass more readily into the right lung because of its angle with the trachea and size of the main bronchus.

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  • 18. 

    WhIch vessel courses across the mediastinum in an almost horizontal fashion?

    • A.

      Left subclavian artery

    • B.

      Left subclavian vein

    • C.

      Left brachiocephalic vein

    • D.

      Left internal jugular vein

    • E.

      Left common carotid artery

    Correct Answer
    C. Left brachiocephalic vein
    Explanation
    The left brachiocephalic vein courses across the mediastinum in an almost horizontal fashion. The mediastinum is the central compartment of the thoracic cavity, and the left brachiocephalic vein is one of the major veins located in this region. It receives blood from the left subclavian vein and the left internal jugular vein, and then joins with the right brachiocephalic vein to form the superior vena cava. The left subclavian artery, left subclavian vein, left internal jugular vein, and left common carotid artery are all located in the mediastinum, but they do not course across it in a horizontal fashion like the left brachiocephalic vein does.

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  • 19. 

    A 78-year-old female presented with edema of the left upper limb due to poor venous return . Examination revealed an aneurysm of the ascending aorta that was impinging on a large vein lying immediately anterosuperior to it, most likely the:

    • A.

      Azygos v

    • B.

      Internal thoracic v

    • C.

      Left brachtocephahc v.

    • D.

      Left superior intercosta! v.

    • E.

      Right brachiocephalic v.

    Correct Answer
    C. Left brachtocephahc v.
    Explanation
    The correct answer is Left brachiocephalic vein. The patient's edema of the left upper limb is likely due to poor venous return caused by compression of a large vein by the aneurysm of the ascending aorta. The left brachiocephalic vein is located immediately anterosuperior to the ascending aorta, making it the most likely vein to be impinged upon.

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  • 20. 

    An 8-year-old boy is found to have a mid-line tumor of the thymus gland that is impinging posteriorly on a blood vessel. The affected vessel is most likely the:

    • A.

      Left brachiocephalic vein

    • B.

      Left pulmonary vein

    • C.

      Left bronchial vein

    • D.

      Right pulmonary artery

    • E.

      Right superior intercostal vein

    Correct Answer
    A. Left brachiocephalic vein
    Explanation
    The thymus gland is located in the anterior mediastinum, behind the sternum. In this case, the tumor is impinging posteriorly on a blood vessel. The left brachiocephalic vein is a major blood vessel that drains blood from the upper body into the superior vena cava. It is located in close proximity to the thymus gland and could be affected by the tumor. The other options, such as the left pulmonary vein, left bronchial vein, right pulmonary artery, and right superior intercostal vein, are not as likely to be affected by a mid-line tumor of the thymus gland.

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  • 21. 

    A patient comes to you as a follow-up after removaI of his thymus to treat a thymoma. During surgeryf which artery did the surgeon ligate that supplies blood to the thymus?

    • A.

      Common carotid artery

    • B.

      Musculophrenic artery

    • C.

      Anterior intercostal artery

    • D.

      Posterior Intercostal artery

    • E.

      Superior Epigastric artery

    Correct Answer
    C. Anterior intercostal artery
    Explanation
    During the surgery to remove the thymus, the surgeon would have ligated the anterior intercostal artery that supplies blood to the thymus. The thymus is located in the anterior mediastinum, which is supplied by the anterior intercostal arteries. Ligation of this artery would effectively cut off the blood supply to the thymus, allowing for its removal.

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  • 22. 

    The phrenic gives nerve fibers (C3-5) that supply which of the following?

    • A.

      Diaphragm and Esophagus

    • B.

      Pericardium and Diaphragm

    • C.

      Pericardium and Internal Intercostal muscles

    • D.

      Esophagus and Mediastinal pleura

    • E.

      Pericardium and Esophagus

    Correct Answer
    B. Pericardium and Diaphragm
    Explanation
    The phrenic nerve originates from the cervical spinal nerves C3-C5 and supplies the pericardium and diaphragm. It is responsible for controlling the movement of the diaphragm, which is the main muscle involved in breathing. The pericardium is a protective sac around the heart, and the phrenic nerve provides sensory innervation to it. Therefore, the correct answer is Pericardium and Diaphragm.

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  • 23. 

    As the Vagus Nerves (CNX) descend through the superior mediastinum, they give off a recurrent laryngeal branch. On the left side of the mediastinum, which structure does this branch loop around?

    • A.

      Left venous angle

    • B.

      Left pulmonary veins

    • C.

      Ligamentum venosum

    • D.

      Ligamentum arteriosum

    • E.

      Subclavian artery

    Correct Answer
    D. Ligamentum arteriosum
    Explanation
    The recurrent laryngeal branch of the Vagus Nerve loops around the Ligamentum Arteriosum on the left side of the mediastinum. The Ligamentum Arteriosum is a remnant of the fetal ductus arteriosus, which connects the pulmonary trunk to the aorta in the developing fetus. As the Vagus Nerve descends through the superior mediastinum, it gives off this branch that wraps around the Ligamentum Arteriosum.

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  • Current Version
  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Nov 10, 2011
    Quiz Created by
    Chachelly
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