Thorax Questions! Ultimate Trivia Quiz

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Thorax Questions! Ultimate Trivia Quiz - Quiz

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Questions and Answers
  • 1. 

    A 35‑year‑old man is stabbed through the 9th right intercostal space in the mid‑axillary line during mid‑inspiration. Which structures are likely to have been pierced?

    • A.

      Skin, intercostal muscles, parietal pleura, visceral pleura

    • B.

      Skin, intercostal muscles, parietal pleura

    • C.

      Skin, parietal pleura, visceral pleural, lung

    • D.

      Intercostal muscles, parietal pleura, lung

    • E.

      Skin, intercostal muscles, visceral pleura

    Correct Answer
    B. Skin, intercostal muscles, parietal pleura
    Explanation
    The 9th right intercostal space in the mid-axillary line corresponds to the location between the 9th and 10th ribs on the right side of the body. During mid-inspiration, the intercostal muscles are contracted and the ribs are elevated, making them more susceptible to injury. Therefore, it is likely that the skin, intercostal muscles, and parietal pleura (the outer layer of the pleura) have been pierced. The visceral pleura (the inner layer of the pleura) and lung are not likely to have been pierced in this scenario.

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  • 2. 

    A 5‑year‑old boy inhales a small marble. In which segment is it MOST LIKELY to lodge?

    • A.

      Left superior lingual

    • B.

      Right apical

    • C.

      Right medial basal

    • D.

      Left apical

    • E.

      Left medial basal

    Correct Answer
    C. Right medial basal
    Explanation
    The right medial basal segment is the most likely segment for the small marble to lodge in a 5-year-old boy. This is because the right medial basal segment is located in the lower lobe of the right lung, which is closer to the trachea and bronchi. Since the boy inhaled the marble, it is more likely to travel down the bronchi and get lodged in the lower part of the right lung.

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  • 3. 

    Which of the following statements concerning the thoracic duct is INCORRECT?

    • A.

      Ascends through the aortic opening of the diaphragm

    • B.

      Its enlarged lower end is called the cisterna chyli

    • C.

      It drains all lymphatics below the diaphragm

    • D.

      Normally drains into the origin of the left brachiocephalic vein

    • E.

      Lies in front of the esophagus

    Correct Answer
    E. Lies in front of the esophagus
    Explanation
    The thoracic duct is a major lymphatic vessel that drains lymph from the lower body and left side of the upper body. It ascends through the aortic opening of the diaphragm and its enlarged lower end is called the cisterna chyli. It drains all lymphatics below the diaphragm and normally drains into the origin of the left brachiocephalic vein. Therefore, the statement that the thoracic duct lies in front of the esophagus is incorrect. The thoracic duct actually lies behind the esophagus.

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  • 4. 

    In the examination and investigation of a patient with long­standing mitral stenosis, which of the following statements is CORRECT?

    • A.

      The mitral valve is best heard at the level of 5th left intercostal space, at the midclavicular line

    • B.

      The mitral valve is found between the right atrium and right ventricle

    • C.

      The left ventricle will hypertrophy

    • D.

      A barium swallow will show anterior displacement of the esophagus

    • E.

      The mitral valve has 3 cusps

    Correct Answer
    A. The mitral valve is best heard at the level of 5th left intercostal space, at the midclavicular line
    Explanation
    The correct answer is that the mitral valve is best heard at the level of the 5th left intercostal space, at the midclavicular line. This is because the mitral valve is located between the left atrium and left ventricle, and its sound can be best heard in this specific location during examination and investigation.

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  • 5. 

    Which of the following statements is INCORRECT regarding the sternal angle of Louis?

    • A.

      It is where the 3rd pair of costal cartilages attach to the sternum

    • B.

      It is used to indicate where the trachea bifurcates

    • C.

      It is located at the vertebral level of T4/T5

    • D.

      It is used to indicate where the arch of the aorta begins

    • E.

      It is used to indicate where the arch of the aorta ends

    Correct Answer
    A. It is where the 3rd pair of costal cartilages attach to the sternum
    Explanation
    The sternal angle of Louis is not where the 3rd pair of costal cartilages attach to the sternum. The sternal angle is actually the joint between the manubrium and the body of the sternum, and it is used to indicate where the trachea bifurcates, where the arch of the aorta begins, and where the arch of the aorta ends. The sternal angle is located at the vertebral level of T4/T5.

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  • 6. 

    Which of the following statements is INCORRECT?

    • A.

      Involvement of level one axillary lymph node carries the worst prognosis

    • B.

      Polythelia is a condition in which there are accessory nipples

    • C.

      The majority of lymph from the breast goes to the axillary lymph nodes

    • D.

      The pectoralis minor muscles is used to divide axillary lymph nodes into 3 levels

    • E.

      Skin dimpling is a sign of breast cancer

    Correct Answer
    A. Involvement of level one axillary lymph node carries the worst prognosis
    Explanation
    The statement "Involvement of level one axillary lymph node carries the worst prognosis" is incorrect because in breast cancer, involvement of level one axillary lymph nodes is associated with a better prognosis compared to involvement of higher level lymph nodes. Higher level lymph node involvement indicates a more advanced stage of cancer and carries a worse prognosis.

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  • 7. 

    Internal bleeding can be a complication if the subluxed bone fragment tears a vessel and punctures the pleura. Which of the following vascular structures is particularly vulnerable in a clavicular fracture?

    • A.

      Subclavian artery

    • B.

      Axillary artery

    • C.

      Brachiocephalic artery

    • D.

      Lateral thoracic artery

    • E.

      Thoracoacromial trunk

    Correct Answer
    A. Subclavian artery
    Explanation
    The subclavian artery is particularly vulnerable in a clavicular fracture because it runs just below the clavicle. If the bone fragment tears a vessel, it can easily damage the subclavian artery, leading to internal bleeding. This is a significant complication because the subclavian artery supplies blood to the upper extremities, head, and neck.

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  • 8. 

    Which of the following is NOT characteristic of the right atrium or right auricle?

    • A.

      Trabeculae carneae

    • B.

      Ostia (openings) for the anterior cardiac veins

    • C.

      Crista terminalis

    • D.

      Ostium of the coronary venous sinus

    • E.

      Valve of the inferior vena cava

    Correct Answer
    A. Trabeculae carneae
    Explanation
    Trabeculae carneae are characteristic of the right atrium and right auricle. They are muscular ridges and columns that help to strengthen the walls of the heart and prevent them from collapsing during contraction. The other options listed, such as ostia for the anterior cardiac veins, crista terminalis, ostium of the coronary venous sinus, and valve of the inferior vena cava, are all characteristic features of the right atrium or right auricle.

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  • 9. 

    The MOST IMPORTANT factor in increase of intrathoracic volume in quiet inspiration is

    • A.

      The "buckethandle movement" of the ribs

    • B.

      Contraction of the diaphragm

    • C.

      The "pumphandle movement" of the ribs

    • D.

      The contraction of intercostal muscle

    • E.

      The ascent of the sternum by contraction of the sternocleidomastoid

    Correct Answer
    B. Contraction of the diaphragm
    Explanation
    The contraction of the diaphragm is the most important factor in increasing intrathoracic volume during quiet inspiration. The diaphragm is a dome-shaped muscle that separates the thoracic and abdominal cavities. When it contracts, it flattens and moves downward, increasing the vertical dimension of the thoracic cavity. This action creates a negative pressure within the thoracic cavity, causing air to be drawn into the lungs. The other options mentioned, such as the buckethandle movement of the ribs, the pumphandle movement of the ribs, the contraction of intercostal muscles, and the ascent of the sternum by contraction of the sternocleidomastoid, also contribute to some extent in increasing intrathoracic volume, but the diaphragm is the most important muscle involved in quiet inspiration.

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  • 10. 

    Occlusion (blockage) of the left coronary artery is MOST LIKELY to stop blood from flowing into the:

    • A.

      Right marginal artery

    • B.

      Posterior interventricular artery

    • C.

      Anterior interventricular artery

    • D.

      Right coronary artery

    • E.

      S.A. nodal artery

    Correct Answer
    C. Anterior interventricular artery
    Explanation
    When the left coronary artery is occluded, it is most likely to block blood flow into the anterior interventricular artery. The left coronary artery is responsible for supplying blood to the left side of the heart, including the left ventricle. The anterior interventricular artery, also known as the left anterior descending artery, is a major branch of the left coronary artery that supplies blood to the anterior (front) part of the interventricular septum and the anterior walls of the left and right ventricles. Therefore, if the left coronary artery is blocked, it would result in a lack of blood flow to the anterior interventricular artery.

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  • 11. 

    A 47‑year‑old male patient is scheduled to have a coronary arterial bypass because of chronic anginal pains. Coronary arteriography reveals nearly the total blockage of the LAD artery. In exposing this artery to perform the bypass procedure, what accompanying vessel must be protected from injury?

    • A.

      Middle cardiac vein

    • B.

      Great cardiac vein

    • C.

      Small cardiac vein

    • D.

      Anterior cardiac vein

    • E.

      Coronary venous sinus

    Correct Answer
    B. Great cardiac vein
    Explanation
    During a coronary arterial bypass procedure, the LAD artery is being bypassed due to its total blockage. In order to perform this procedure, the surgeon needs to expose the LAD artery. The Great cardiac vein runs alongside the LAD artery and can be easily injured during the process. Therefore, it is important to protect the Great cardiac vein from injury during the procedure.

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  • 12. 

    The 47‑year‑old female patient's right breast exhibited peau d’ orange characteristics. This condition is primarily a result of

    • A.

      Blockage of cutaneous lymphatic vessels.

    • B.

      Shortening of the suspensory ligaments by cancer in the axillary tail of the breast.

    • C.

      Contraction of the retinacula cutis of the areola and nipple.

    • D.

      Invasion of the pectoralis major by metastatic cancer.

    • E.

      Ipsilateral (same side as the disease) inversion of the nipple from cancer of the duct system of the breast.

    Correct Answer
    A. Blockage of cutaneous lymphatic vessels.
    Explanation
    The peau d'orange characteristics observed in the patient's right breast are primarily a result of the blockage of cutaneous lymphatic vessels. This condition refers to the dimpled or orange peel-like appearance of the skin, which occurs when the lymphatic drainage becomes obstructed. The blockage prevents the normal flow of lymph fluid, leading to the accumulation of fluid in the interstitial spaces and subsequent swelling of the skin. This is a common manifestation of breast cancer, as cancer cells can block the lymphatic vessels, causing lymphedema and the characteristic skin changes.

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  • 13. 

    The patient's chest had obviously suffered severe blunt trauma from impact with the steering wheel of the automobile when the auto hit the tree. Electrocardiographic data indicated that the heart had been injured by contact with the sternum. The MOST LIKELY part of the heart to be bruised by the force of impact with the sternum would be the ...

    • A.

      Conus region

    • B.

      Apex of left ventricle

    • C.

      Dextral margin of the right ventricle

    • D.

      Obtuse margin of the left ventricle

    • E.

      Anterior margin of the left atrium

    Correct Answer
    C. Dextral margin of the right ventricle
    Explanation
    The dextral margin of the right ventricle is the most likely part of the heart to be bruised by the force of impact with the sternum because it is located closest to the sternum. The impact with the steering wheel would cause the sternum to push against the chest, potentially causing damage to the adjacent structures, including the right ventricle.

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  • 14. 

    The 27‑year‑old male had received a small-caliber bullet wound to the chest in the region of the third intercostal space, several centimeters to the left of the sternum. After a reception in the Emergency Department in the large Miami hospital, a preliminary notation of "Beck's triad" was entered on the patient's chart. This comment referred to the fact that among other possibilities of the injury that ...

    • A.

      There is injury to the left pulmonary artery, left primary bronchus and esophagus.

    • B.

      The patient has bleeding into the pleural cavity, a collapsed lung and mediastinal shift to the right.

    • C.

      The patient has a small, quiet heart, decreased pulse pressure and increased central venous pressure.

    • D.

      The young man is suffering from marked Diastolic emptying, Dyspnea, and Dilation of the aortic arch.

    • E.

      The left lung has collapsed, there is paradoxical respiration, and there is a mediastinal shift of the heart and trachea to the left.

    Correct Answer
    C. The patient has a small, quiet heart, decreased pulse pressure and increased central venous pressure.
    Explanation
    The correct answer suggests that the patient is experiencing Beck's triad, which is a set of clinical signs indicating cardiac tamponade, a life-threatening condition. This includes a small, quiet heart, decreased pulse pressure (the difference between systolic and diastolic blood pressure), and increased central venous pressure (pressure in the veins near the heart). These signs are indicative of the heart being compressed by fluid or blood in the pericardial sac, leading to decreased cardiac output.

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  • 15. 

    The condition of aortic coarctation distal to the ductus arteriosus 

    • A.

      Results in diversion of aortic blood such that arterial pressure in the lower limbs is higher than that in the upper limbs.

    • B.

      Is usually accompanied by a reduction of flow into the subclavian arteries.

    • C.

      Can result in "notching" of the ribs as seen on X ray.

    • D.

      Is one of the features of the "Tetralogy of Fallot”

    • E.

      Leads to death at birth if the ductus arteriosus fails to close.

    Correct Answer
    C. Can result in "notching" of the ribs as seen on X ray.
    Explanation
    The condition of aortic coarctation distal to the ductus arteriosus can result in "notching" of the ribs as seen on X-ray. This occurs because the narrowing of the aorta causes increased pressure in the collateral blood vessels that supply blood to the lower limbs. These vessels, known as intercostal arteries, can erode the undersurface of the ribs, leading to notching. This finding is a characteristic sign of aortic coarctation and can help in the diagnosis of the condition.

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  • 16. 

    In a ventricular septal defect of the heart

    • A.

      There is failure of closure of the septum primum

    • B.

      The endocardial cushions fuse with the aorticopulmonary septum.

    • C.

      There is a shunting of blood from the right ventricle to the left ventricle

    • D.

      There is always a resulting stenosis of the pulmonary trunk.

    • E.

      Hypertrophy of the right ventricle occurs.

    Correct Answer
    E. Hypertrophy of the right ventricle occurs.
    Explanation
    In a ventricular septal defect of the heart, there is an abnormal opening in the septum that separates the ventricles. This allows blood to flow from the left ventricle to the right ventricle, causing an increased volume of blood in the right side of the heart. As a result, the right ventricle has to work harder to pump this extra blood, leading to hypertrophy or thickening of the right ventricular wall.

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  • 17. 

    The 35‑year‑old patient has a hard nodule about 1 cm in diameter slightly above and lateral to her right areola. A specific dye is injected into the tissue around the tumor, and an incision is made to expose the lymphatic vessels draining the area, for the lymphatic vessels take up the dye - which is visible. The vessels can be then traced to expose the lymph nodes receiving the lymph from the lesion. Usually, one should expect that the first nodes encountered would be the 

    • A.

      Anterior axillary (anterior pectoral) nodes.

    • B.

      Rotter's nodes.

    • C.

      Parasternal nodes alongside the internal thoracic artery and vein, just lateral to, and deep to the area of the sternum.

    • D.

      Central axillary nodes.

    • E.

      The apical, or infraclavicular nodes.

    Correct Answer
    A. Anterior axillary (anterior pectoral) nodes.
    Explanation
    The explanation for the correct answer is that the lymphatic vessels draining the area around the tumor would first lead to the anterior axillary (anterior pectoral) nodes. These nodes are located in the anterior part of the axilla (armpit) and are the first set of lymph nodes encountered when tracing the lymphatic vessels from the lesion.

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  • 18. 

    When the mother heard her four-year-old son choking and coughing, and then found him in the kitchen struggling to breathe, she quickly observed the open bag of peanuts on the kitchen table. Because she could observe his frightened efforts at breathing she knew, as a former student at Ross Medical School, that his airway was not completely blocked. She quickly found transport to the Emergency Department in the hospital where she was performing her clinical rotations. She, correctly, informed the Attending Physician that her son had aspirated a peanut, and that it would be MOST LIKELY found within the

    • A.

      Right primary bronchus

    • B.

      Left primary bronchus

    • C.

      Trachea

    • D.

      Oral cavity

    • E.

      Lower part of the esophagus

    Correct Answer
    A. Right primary bronchus
    Explanation
    The mother correctly informed the Attending Physician that her son had aspirated a peanut. Based on her observation of his struggling breathing and her medical knowledge, she knew that his airway was not completely blocked. The peanut would most likely be found within the right primary bronchus, which is one of the two main branches of the trachea that leads to the lungs. This is because the right primary bronchus is more vertical and wider than the left primary bronchus, making it easier for an object to become lodged in that area.

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  • 19. 

    The patient had been diagnosed earlier in the week with Guillain‑Barre disease. He was now in extreme respiratory distress. His thoracic wall contracted and relaxed violently, but there was little movement of his abdominal wall. The degenerative disease had obviously affected the muscle that is most responsible for increasing the longitudinal dimensions of the thoracic cavity (and pleural cavities). It should be obvious, therefore, that he was suffering from ...

    • A.

      Paralysis of his intercostal muscles, and loss of the "bucket handle movement" of his ribs.

    • B.

      Generalized intercostal nerve paralysis that caused the loss of the "pumphandle movment" of his ribs.

    • C.

      Paralysis of his medial and lateral pectoral nerves, interrupting the function of his pectoralis major muscles, important accessory respiratory muscles.

    • D.

      Paralysis of the sternocleidomastoid muscles.

    • E.

      Degeneration of the myelin of his phrenic nerves.

    Correct Answer
    E. Degeneration of the myelin of his phrenic nerves.
    Explanation
    The patient's extreme respiratory distress and lack of movement in the abdominal wall suggest a problem with the muscles responsible for increasing the longitudinal dimensions of the thoracic cavity. The phrenic nerves play a crucial role in controlling the diaphragm, the main muscle involved in breathing. Degeneration of the myelin, the protective covering of the phrenic nerves, would result in paralysis of the diaphragm and severe respiratory difficulties. Therefore, the patient's symptoms indicate degeneration of the myelin of his phrenic nerves.

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  • 20. 

    Two days after the patient's breathing had become assisted by mechanical ventilation, the patient with Guillain‑Barre began experiencing severe cardiac arrhythmia, with perilously slow cardiac contractions, resulting in reduced cardiac output. This MOST LIKELY resulted from interruption of the contractile stimulus carried by the ...

    • A.

      Left vagus nerve

    • B.

      Right phrenic nerve

    • C.

      Preganglionic sympathetic fibers in upper thoracic spinal nerves.

    • D.

      Cardiac pain fibers carried by upper thoracic spinal nerves.

    • E.

      Ventral horn neurons of spinal cord levels T1 - T4.

    Correct Answer
    C. Preganglionic sympathetic fibers in upper thoracic spinal nerves.
    Explanation
    The patient with Guillain-Barre syndrome experienced severe cardiac arrhythmia and reduced cardiac output two days after being put on mechanical ventilation. This is most likely due to the interruption of the contractile stimulus carried by the preganglionic sympathetic fibers in the upper thoracic spinal nerves. These fibers are responsible for transmitting signals that regulate heart rate and contraction. The interruption of these fibers may have led to the cardiac abnormalities observed in the patient.

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  • 21. 

    It is medieval Transylvania and the peasants have finally revolted against the rule of the evil and tyrannical Count Vlad (the Impaler). Driving a wooden stake into the sleeping count's chest at the sternal angle (of Louis), they hope to pierce the left ventricle of his heart. They miss. Why?

    • A.

      They were at the right level but their stake must have veered off at an angle

    • B.

      The stake missed the heart to the left

    • C.

      The stake missed the heart to the right

    • D.

      The stake pierced the arch of the aorta

    • E.

      The stake pierced the right subclavian artery

    Correct Answer
    D. The stake pierced the arch of the aorta
    Explanation
    The stake pierced the arch of the aorta because it is located above the heart and slightly to the left. The peasants aimed for the sternal angle (of Louis), which is the level where the second rib attaches to the sternum. However, the stake must have veered off at an angle, causing it to miss the heart and instead pierce the arch of the aorta.

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  • 22. 

    The patient, Harry, was 58 years of age and obviously very overweight. He was admitted to the hospital complaining of severe, crushing, retrosternal pain which he said began while he was jogging in his neighborhood. The pain has not gone away after taking three nitroglycerine tablets, and the pain has lasted longer than when he had last experienced an anginal attack. His skin is clammy and unusually cool, his heart rate is 120 per minute. Laboratory results show that his mitral valve is not functioning properly because of ischemia of the posterior aspect of his left ventricle and his left posterior papillary muscle. From your previous knowledge of the patient's coronary arterial pattern as being "left coronary dominant," you make the correct guess that 

    • A.

      The left coronary circumflex artery is blocked by disease(fatty and calcified atherosclerotic plaque).

    • B.

      The right coronary artery supplies the posterior one third of the IVS.

    • C.

      The LAD is almost completely closed, probably just beyond the origin of the first major branch to the IVS.

    • D.

      The conus artery is totally occluded.

    • E.

      The moderator band of the left ventricle has become ischemic.

    Correct Answer
    A. The left coronary circumflex artery is blocked by disease(fatty and calcified atherosclerotic plaque).
    Explanation
    Based on the information provided, the patient is experiencing severe chest pain that has not been relieved by nitroglycerine tablets. The patient's symptoms, such as clammy skin, coolness, and an elevated heart rate, suggest a myocardial infarction (heart attack). The laboratory results indicate that the posterior aspect of the left ventricle and the left posterior papillary muscle are ischemic, meaning they are not receiving enough blood supply. Given the patient's "left coronary dominant" arterial pattern, it can be inferred that the left coronary circumflex artery, which supplies blood to the posterior aspect of the left ventricle, is blocked by atherosclerotic plaque. Therefore, the correct answer is that the left coronary circumflex artery is blocked by disease.

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Nov 22, 2011
    Quiz Created by
    Chachelly
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