Respiratory Anatomy: BRS/Michigan Questions
A 26-year-old singer visits her physician—an ear, nose, and throat (ENT) surgeon—and complains of changes in her voice. A laryngoscopic examination demon- strates a lesion of the superior laryngeal nerve, causing weakness of which of the following muscles? (A) Inferior pharyngeal constrictor (B) Middle pharyngeal constrictor (C) Superior pharyngeal constrictor (D) Thyroarytenoid (E) Thyrohyoid
A
A 45 year old woman is suffering numbness over the tip of her nose. Which of the following nerves is most likely to be damaged? (A) Ophthalmic division of the trigeminal nerve (B) Maxillary division of the trigeminal nerve (C) Mandibular division of the trigeminal nerve (D) Facial nerve (E) Auriculotemporal nerve
A
A patient has a small but solid tumor in the mediastinum, which is confi ned at the level of the sternal angle. Which of the fol- lowing 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
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 is called the: A. carina B. cricoid cartilage C. costal cartilage D. pulmonary ligament E. tracheal ring
A carina is keel-shaped cartilage lying at the tracheal bifurcation separating the right main stem bronchus from the left main stem bronchus
Most of the drainage of the thoracic body wall reaches the superior vena cava via the azygos vein. A notable exception is the left superior intercostal vein, which normally drains into the: a. left brachiocephalic vein b. left bronchial vein c. left pulmonary vein d. left subclavian vein e. superior vena cava
A left superior intercostal vein drains intercostal spaces 2-4 and then drains into Left BC vein
Infections may spread from the nasal cavity to the meninges along the olfactory nerves, as its fibers pass from the mucosa of the nasal cavity to the olfactory bulb via the: a. cribiform plate of the ethmoid b. crista galli c. foramen caecum d. superior orbital fissure
A the olfactory nerve exits the skull through the cribiform plate of the ethmoid bone -- an infection in the nasal cavity may be carried to the olfactory bulb by the nerves that are passing through the cribiform plate
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
A thymus is very superfificial structure found in anterior mediastinum. The left brachiocephalic vein courses through the mediastinum to join the right brachiocephalic vein to form the SCV on the right side of the thorax, since the left vein is fairly superficial it travels just deep to the thymus and might be compressed by a tumor
A 76-year-old man with swallowing dif- fi culties undergoes imaging for a possible mass. The CT scan image at the level of the cricothyroid ligament in his neck should show which of the following structures? (A) Inferior laryngeal nerves (B) External carotid arteries (C) Inferior thyroid veins (D) Thyrocervical trunks (E) Internal laryngeal nerves
A inferior laryngeal nerves are the terminal portion of the recurrent laryngeal nerves above lower border of cricoid cartilage
a tumor of the posterior mediastinum is most likely to compress which of the following structures? a. arch of aorta b. esophagus c. IVC d. pulmonary trunk e. trachea
B esophagus is the only structure on this list that is in the posterior mediastinum
Which feature is found only in the left lung? A. Cardiac notch B. horizontal fissue C. Oblique fissue D. superior lobar bronchus E. 3 lobes
A.
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. the right middle lobar bronchus leads to the medial and lateral bronchopulmonary segments, the right superior lobar bronchus divides into superior/ posterior and anterior segmental bronchi, the right inferior lobar bronchus has an anterior, lateral, posterior and anterior segmental bronchi
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. normal, quiet expiration is achieved by contraction of extensible tissue in the lungs and the thoracic wall. the other muscles listed are muscles of inspiration
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
B
which structure lies immediately anterior to the right anterior scalene muscle at its costal attachment? a. subclavian a. b. subclavian v. c. thoracic duct d. thyrocervical trunk e. vagus nerve
B
A 7-year-old girl has diffi culty breathing through her nose and is brought to her pedi- atrician. On examination, she is diagnosed with adenoids. Which of the following tonsils is enlarged? (A) Palatine tonsil (B) Pharyngeal tonsil (C) Tubal tonsil (D) Lingual tonsil (E) Eustachian tonsil
B adenoid obstructs passage of air from nasal cavities through the choanae into the nasopharynx --? difficulty in nasal breathing and phonation
The thoracic wall is innervated by: a. dorsal primary rami b. intercostal nerves c. lateral pectoral nerves d. medial pectoral nerves e. thoracodorsal nerves
B intercostal nerves = the ventral primary rami of spinal nerves T1-T11 providing motor innervation to intercostal muscles, abdominal wall muscles and muscles of forearm and hand.
A young homeless child presents to the emergency department with high fever and low blood pressure. He had strep throat 2 weeks ago when seen in the free clinic; however, his parents could not afford antibi- otic medication, and he did not take any. He now has an abscess in the auditory tube that is blocking communication between the nasopharynx and which of the following structures? (A) Vestibule of the inner ear (B) Middle ear (C) Semicircular canals (D) External ear (E) Inner ear
B middle ear eustachian tube connects the nasopharynx with the middle ear cavity
A first year resident attempts to insert a central venous catheter into the heart by a subclavicular approach to the subclavian vein. following the attempt, it is noted that the patient has difficulty breathing. what nervous structure lying immediately deep to the subclavian vein, as it crosses the anterior scalene muscle, may have been injured? a. external branch of superior laryngeal nerve b. phrenic nerve c. recurrent laryngeal nerve d. sympathetic trunk e. vagus nerve
B phrenic nerve formed from contributions from C3,C4,C5 ventral primary rami. it innervates the diaphragm and since the patient has difficulty breathing this fits the injury .
A 46-year-old patient comes to his doc- tor'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 the azygous vein arches over the root of the right lung and empties into the SVC, other veins do not pass over the root of the right lung
A 27 year old woman with a goiter comes to the hospital for surgical treatment. The surgeon must ligate the superior laryngeal artery before surgically resecting the goiter, so care must be taken to avoid injury to which of the following nerves? a. external laryngeal nerve b. internal laryngeal nerve c. superior laryngeal nerve d. hypoglossal nerve e. vagus nerve
B the internal laryngeal nerve accompanies the superior laryngeal artery external laryngeal nerve accompanies the superior thyroid artery
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 long was most likely injured? A. hilum b. inferior lobe c. lingula d. middle lobe e. superior lobe
B the posterior surface is almost entirely comprised of the inferior lobe because of the sharp angle of the oblique fissure
A 45-year-old woman presents with a tumor confined to the posterior mediasti- num. 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.
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 fi rst to which of the following veins? (A) SVC (B) Right superior intercostal vein (C) Right brachiocephalic vein (D) Azygos vein (E) Hemiazygos vein
B.
A 22-year old male involved in a bar-room brawl suffered a stab wound through the posterior thoracic wall that entered the posterior surface of the right lung halfway between its apex and diaphragmatic surface. Which part of the lung did the knife first enter? a. cupola b. inferior lobe c. lingula d. middle lobe e. superior lobe
B. because of the sharp angle of the oblique fissures, the posterior surfaces of both the right and left lungs are almost entirely comprised of the inferior lobe. The middle lobe of the right lung is not part of the posterior surface of the lung.
A 53-year old man with a known history of emphysema is examined in the emergency department. Laboratory findings along with examination indicate that the patient is unable to exchange oxygen in the air and carbon dioxide in the blood. This exchange occurs in which portion of the respiratory system? a. bronchi b. alveolar sac c. nasal cavity d. larynx e. trachea
B. the respiratory portion of the lung contains alveolar sacs/alveoli which are surrounded by networks of pulmonary capillaries. Oxygen and carbon dioxide exchange occurs across thin walls of the alveoli and blood capillaries with the aid of the diaphragm and thoracic cage
A 53-year-old man has diffi culty with breathing through his nose. On examination, his physician fi nds that he has swelling of the mucous membranes of the superior nasal meatus. Which opening of the parana- sal sinuses is most likely plugged? (A) Middle ethmoidal sinus (B) Maxillary sinus (C) Posterior ethmoidal sinus (D) Anterior ethmoidal sinus (E) Frontal sinus
C
In the midregion of the thorax the thoracic duct lies immediately posterior to the a. aorta b. azygous vein c. esophagus d. SVC e. trachea
C
The oblique fissure of the right lung separates which structures? A. aower 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 lobe from middle lob
C
Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac? a. aorta b. axygos vein c. esophagus d. thoracic duct e. trachea
C
A six year old child, whose medical history includes a rather difficult birth has a permanently tilted head posture, with the right ear near the right shoulder and the face turned upward and to the left. Which of the following muscles was very likely damaged during birth? a. anterior scalene b. omohyoid c. sternoclediomastoid d. trapezius e. platysma
C SCM damaged at birth --> becomes shorted --> patient might have muscular torticollis with a neck appearing twisted and the chin appearing elevated because SCM too short on one side.
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
a
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. azygous vein b. internal thoracic vein c. left brachiocephalic vein d. left superior intercostal vein e. right brachiocephalic vein
C left brachicephalic vei nis the only vein listed that is anterosuperior to the ascending part of the aorta
A 56-year-old man with a one pack/day history of cigarette smoking is found to have a malignant squamous cell carcinoma located in the superior sulcus of Pancoast (superior apex of the lung). Shortly after the diagnosis is known, the patient develops symptoms that consist of shoulder pain along with ptosis, miosis, enophthalmos, and anhidrosis. Which of the following nerves is most likely compressed by the tumor mass? (A) Phrenic nerve (B) Vagus nerve (C) Cervical sympathetic trunk (D) Ansa cervicalis (E) Recurrent laryngeal nerve
C lung cancer in the apex of the lung compresses the cervical cympathetic trunk
During a gang fi ght, a 17-year-old boy is punched, and his nasal septum is broken. Which of the following structures would be damaged? (A) Septal cartilage and nasal bone (B) Inferior concha and vomer (C) Vomer and perpendicular plate of ethmoid (D) Septal cartilage and middle concha (E) Cribriform plate and frontal bone
C nasal septum formed primarily by vomer, the perpendicular plate of the ethmoid bone and the septal cartilage. the superior/middle/inferior conchae form lateral wall of nasal cavity. ethmoid/cribiform plate, nasal, frontal and sphenoid bones form the roof floor is formed by palatine process of maxilla and horizontal plate of palatine bone
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 the parasympathetic nerve fibers in the vagus nerve constrict the bronchial lumen ??
A 17-year-old boy is involved in a group fi ght, and a stab wound lacerates a ventral root of his thoracic spinal nerve. Cell bodies of the injured nerve fi bers are located in which of the following nervous structures? (A) Dorsal root ganglia and sympathetic trunk (B) Lateral horn of spinal cord and dorsal root ganglia (C) Anterior horn and lateral horn of spinal cord (D) Sympathetic trunk and lateral horn of spinal cord (E) Anterior horn of spinal cord and sympa- thetic trunk
C ventral root of thoracic spinal nerve contains sympathetic preganglionic fibers with cell bodies located in lateral horn of gray matter of spinal cord and general somatic efferent fibers with cell bodies located in anteiror horn of gray matter of spinal cord
A 34-year-old singer has been diagnosed with thyroid cancer and consequently has a thyroidectomy. He has been hoarse ever since the surgery 8 weeks ago. It has been suspected that a nerve was injured during the operation. Which of the following nerves is most likely damaged? (A) External laryngeal nerve (B) Internal laryngeal nerve (C) Recurrent laryngeal nerve (D) Hypoglossal nerve (E) Glossopharyngeal nerve
C recurrent laryngeal nerve runs behind the thyroid gland in a groove between trachea and esophagus and is vulnerable to injury during thyroidectomy
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
C the left brachiocephalic vein joins wit hthe right brachiocephalic vein to form the SVC on the right side of the body so it has to course across the mediastinum to reach its destination the left subclavian artery and vein are lateral to the mediastinum
18. After having a tonsillectomy, a 57-year-old man with a long history of chewing tobacco use is unable to detect taste on the posterior one-third of his tongue. Which of the following nerves has most likely been injured? (A) Internal laryngeal nerve (B) Lingual nerve (C) Glossopharyngeal nerve (D) Greater palatine nerve (E) Chorda tympani
C.
A 21-year-old woman presents to her physician with a swelling on her neck. On examination, she is diagnosed with an infec- tion within the carotid sheath. Which of the following structures would be damaged? (A) Vagus nerve and middle cervical ganglion (B) Internal carotid artery and recurrent laryngeal nerve (C) Internal jugular vein and vagus nerve (D) Sympathetic trunk and common carotid artery (E) External carotid artery and ansa cervicalis
C. carotid sheath contains internal jugular vein, vagus nerve and common/internal carotid arteries externa
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
C. left vagus because it gives the left recurrent laryngeal nerve that loops around the aortic arch and innervates the muscles of the left larynx
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 GSE 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. phrenic nerve supplies the pericardium, mediastinal and diaphragmatic pleura, and the diaphragm. it contains GSE GSA and GVE fibers
A 35 year old woman with a history of cholecystectomy arrives in the emergency department with intractable hiccups most likely caused by an abdominal abcess secondary to surgical infection. Which of the following nerves carries pain sensation caused by irritation of the peritoneum on the central portion of the inferior surface of the diaphragm? a. vagus n. b. lower intercostal n. c.phrenic n. d. greater splanchnic n. e. subcostal n.
C. the diaphragm receives somatic motor fibers solely from the phrenic nerves, however the peritoneum on the central part of the diaphragm recieves sensory fibers from phrenic and peripheral part receives sensory fibers from lower intercostal n.
A 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 c. cupola e. pulmonary ligament
C. Costomediastinal recess is an area right next to the cardiac notch- an indentation in the superior lobe of the lft lung. This is where the medial area of the superior lobe of the left lung would tend to expand if it became very inflated.
A 38 year old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid artery is damaged during the surgery. This injury could result in a sever impairment of function of which of the following? a. relaxing the vocal cords b. rotating the arytenoid cartilages c. tensing the vocal cords d. widening the rima glottidis e. abducting the vocal cords
C. external laryngeal nerve innervates the cricothyroid muscle [ major tensor] which tenses the vocal cord.
A sick person, lying 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 segmental bronchus of right inferior lobe d. medial basal segmental bronchus of left inferior lobe e. inferior segmental bronchus of lingular lobe
C. inhaled material goes into the right bronchus most of the time because it is bigger and more vertical, the superior segmental bronchus branches posteriorly off of the intermediate bronchus/inferior lobe bronchus so it is most likely to receive the foreign bodies that enter the right bronchus
A 63 year old man comes to the emergency department with back pain, weakness and shortness of breath. On examination, he has an anueurysm of the abdominal aorta at the aortic hiatus of the diaphragm. Which of the following pairs of structures would most likely be compressed? a. vagus nerve and azygos vein b. esophagus and vagus nerve c. azygos vein and thoracic duct d. thoracic duct and vagus neve e. inferior vena cava and phrenic nerve
C. the aortic hiatus of the diaphragm transmits the azygos vein and the thoracic duct vagus nerve passes through the esophageal hiatus and right phrenic nerve may run through caval hiatus
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 b. left inferior c. right superior d. right middle e. right inferior
C. the eparterial bronchus is the right superior lobar bronchus, all the other options are hyparterial bronchi
23. A young singer at the local music theater visits her physician and complains of vocal diffi culties. On examination, she is unable to abduct the vocal cords during quiet breath- ing. Which of the following muscles is most likely paralyzed? (A) Vocalis muscle (B) Cricothyroid muscle (C) Oblique arytenoid muscle (D) Posterior cricoarytenoid muscle (E) Thyroarytenoid muscle
D
A 12-year-old boy has diffi culty in breathing because he is choking on food. A school nurse performs the Valsalva maneu- ver to expel air from his lungs and thus dis- lodge the food. When that fails, she performs a needle cricothyrotomy, which would open into which of the following regions? (A) Rima glottidis (B) Laryngeal vestibule (C) Laryngeal ventricle (D) Infraglottic cavity (E) Piriform recess
D
A 62-year-old patient with pericardial effusion comes to a local hospital for aspira- tion of pericardial fl uid by pericardiocente- sis. The needle is inserted into the pericar- dial cavity through which of the following intercostal spaces adjacent to the sternum? (A) Right fourth intercostal space (B) Left fourth intercostal space (C) Right fi fth intercostal space (D) Left fi fth intercostal space (E) Right sixth intercostal space
D
During a carotid endarterectomy of a 57-year-old man who suffered a stroke, the carotid sinus is damaged. A third-year medi- cal student in surgical rotation notices that the injured structure: (A) Is located at the origin of the external carotid artery (B) Is innervated by the facial nerve (C) Functions as a chemoreceptor (D) Is stimulated by changes in blood pressure (E) Communicates freely with the cavernous sinus
D
Which nerve fiber would have its cell body in the lateral horn of the spinal cord at segmental level T1 a. afferent fiber from cutaneous blood vessels of the nose b. afferent fiber from skin around the nipples c. efferent fibers to sweat glands in the lumbar region c. efferent fibers to the skin of the forehead e. parasympathetic fibers to the heart D
D afferent fibers have their cell bodies in DRG not the lateral horn
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. cardiac notch is a deep indentation of the anterior border of the superior lobe of the left lung
A 4 year old girl is brought in with coughing, and you are told by her mother that she has been play8ing 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
D The carina [bifurcation of trachea] is set a little more towards the left so there is a direct path for objects to fall to the right. Also the right bronchus is shorter, wider and more verticle than the left bronchus.
A stab wound penetrates the posterior thoracic wall near vertebra of a 24-year-old man. Examination at the emergency depart- ment indicates a lesion of gray rami commu- nicantes. Which of the following nerve fi bers would most likely be damaged? (A) General somatic afferent (GSA) fi bers (B) Postganglionic parasympathetic fi bers (C) Preganglionic sympathetic fi bers (D) Postganglionic sympathetic fi bers (E) General visceral afferent (GVA) fi bers
D gray rami communicantes contain posgtganglionic sympathetic nerve fibers but no other nerve fibers
You are called on to do a venous catheterization to measure central venous pressure in the heart. Which muscle of the neck would provide the best area of approach to the internal jugular vein? a. anterior scalene b. digastric c. omohyoid d. sternocleidomastoid e. sternohyoid
D internal jugular vein is found in the carotid triangle, bounded medially by omohyoid, laterally by SCM and superiorly by posterior belly of digastric. SCM is the easiest landmark to find on the neck, and the most practical to find when looking for the carotid triangle and internal jugular vein.
A stab wound just above the left clavicle, lateral to the sternocleidomastoid muscle, may be life-threatening because of the possibility of injury to the: a. brachial plexus b. internal jugular vein c. axillary artery d. subclavian artery e. thoracic duct
D subclavian artery crosses between anterior and middle scalene muscles, and is posterior to SCM muscle life threatening --> know its an artery
During a palatine tonsillectomy, a sur- geon must ligate arteries to avoid bleeding within the surgical fi eld. Which of the follow- ing arteries can be spared? (A) Lesser palatine artery (B) Facial artery (C) Lingual artery (D) Superior thyroid artery (E) Ascending pharyngeal artery
D superior thyroid artery doesn't supply the palatine tonsil palatine tonsil receives blood from lesser palatine branch of maxillary artery
During surgery on a 56 year old man for a squamous cell carcinoma of the neck, a surgeon notices profuse bleeding from the deep cervical artery. Which of the following arteries must be ligated immediately to stop bleeding? a. inferior thyroid artery b. transverse cervical artery c. thyrocervical trunk d. costocervical trunk e. ascending cervical artery
D surgeon should ligate costocervical trunk because it divides into deep cervical and superior intercostal arteries
A 26-year-old woman with the fl u comes to an outpatient clinic. On examination, a physician diagnoses her with sinus and pal- ate infection, and her uvula deviates to the left side on phonation. Which of the follow- ing nerves is injured? (A) Left hypoglossal nerve (B) Right hypoglossal nerve (C) Left vagus nerve (D) Right vagus nerve (E) Left trigeminal nerve
D uvula innervated by vagus nerve, lesion of vagus nerve results in deviation of uvula to opposite side of injury
A 35-year-old man is suffering from an infected mediastinum (mediastinitis) after neck and chest injuries resulting from a head-on automobile collision. He has been intubated since the accident and on broad- spectrum intravenous antibiotics since admission; however, the infection continues to progress throughout the mediastinum. Which of the following structures is free from infection? a. thymus gland b. esophagus c. trachea d. lungs e. heart
D the mediastinum doesn't contain the lungs; it contains the thymus esophagus, trachea and heart
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.
A thoracentesis is performed to aspirate an abnormal accumulation of fl uid 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. below fluid level but not below the ninth intercostal space
A 19 year old woman complains of numbness of the nasopharynx after surgical removal of the adenoid. A lesion of which of the following nerves would be expected? a. maxillary nerve b. superior cervical ganglion c. external laryngeal nerve d. glossopharyngeal nerve e. vagus nerve
D. glossopharyngeal nerve supplies sensory innervation to the mucosa of the upper pharynx while the vagus nerve supplies sensory innervation to the lower pharynx and larynx maxillary nerve gives sensory innervation to face below level of eye and above level of upper lip + palate + nasal mucosa
A 75-year-old woman was admitted to a local hospital, and bronchograms and radio- graphs 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 SVC c. middle lobe d. lingula e. larger capacity than the right
D. lingula because all other things are true for the right lung
A 10-year old boy underwent a tonsillectomy under general anesthesia. At home he lay supine in bed for 2 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 lingual segment -lingula
D. superior segmental bronchus of the inferior lobe branches posteriorly off the intermediate bronchus/inferior lobe bronchus so it is most likely to receive foreign bodies or fluids that enter the right bronchus
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 needles? 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 II in the scapular line
D. for thoracentesis the needle needs to be inserted below the level of the lungs, in the costodiaphragmatic recess. The midaxillary line is between 8 and 10 and the neurovascular bundle runs through the costal groove at the top of the interspace
A 17 year old boy receives an injury to the phrenic nerve by a knife wound in the neck. The damaged nerve passes by which of the following structures in the neck? a.anterior to subclavian vein b. posterior to subclavian artery c. deep to brachial plexus d. medial to common carotid artery e. superficial to anterior scalene muscle
E
While viewing an exploratory surgery on a patient injured in an automobile accident, you see the surgeon elevate the esophagus off the vertebral bodies and look in the area between the azygos vein and descending aorta. What structure was she most likely looking for? a. greater thoracic splanchnic nerve b. left recurrent laryngeal nerve c. right pulmonary artery d. sympathetic trunk e. thoracic duct
E thoracic duct lies in posterior mediastinum between aorta and azygous vein. they are all posterior to the esophagus
During a surgical procedure, a patient's right sympathetic trunk was accidentally severed just cranial to the level of spinal nerve T1. Which function would be left intact in the affected region? a. arrector pili muscle activity b. dilation/constriction of blood vessels c. sweat production d. visceral reflex activity e. voluntary muscle activity
E SNS is not responsible for voluntary muscle activity. these neurouns originate from the ventral horn of the spinal cord.
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
E superior segmental bronchus to the lower lobe of the right lung branches posteriorly off of the intermediate bronchus or inferior lobe bronchus, so it is the segmental bronchus most likely to receive fluid or foreign bodies that enter the right main bronchus. even more likely when the patient is supine
The horizontal 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
E the horizontal fissure cuts across the right lung in such a way as to separate the middle lobe from the upper lobe. the oblique fissure separates the lower lobe from both the middle and upper lobes
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. hemiazygous vein is located in posterior mediastinum
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
E. tubercle of rib is a projection of the rib located posteroinferior and lateral to the neck of the rib, it articulates with the transverse process of the vertebra of the same number.
20. The nerve accompanying the superior thyroid artery may be damaged during an operation on the thyroid gland. Which of the following functional defects may result from this injury? (A) Loss of sensation above the vocal cord (B) Loss of lateral rotation of the arytenoid cartilages (C) Paralysis of vocalis muscle (D) Lack of abduction of the vocal cord (E) Decreased tension of the vocal cord
E. superior thyroid artery is accompanied by external laryngeal nerve which innervates cricothyroid muscle. paralysis of this muscle decreases tension in the vocal cord
Tears drain through the nasolacrimal duct into the space below which structure?
Inferior nasal meatus below the inferior concha
Which structure lies lateral to the lateral wall of the nasal cavity and inferior to the floor of the orbit?
Maxillary sinus
A 27-year old man who is a professional weight lifter comes to his physician complaining of recent weakness in his left arm and frequent tingling in his hand and fingers during exercise sessions which subsides with rest. He is diagnosed as having vascular insufficiency due to scalenus anticus syndrome and as a remedy it is decided to transect the anterior scalene muscle where it inserts on the first rib. during surgery, which structure in contact with the anterior surface of the muscle must the surgeon be careful of sparing? a. inferior trunk of brachial plexus b. long thoracic nerve c. phrenic nerve d. sympathetic trunk e. vagus nerve
c phrenic nerve is formed from C3,C4,C5 ventral primary rami and lies on the anterior scalene muscle
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
d
A young man presents to your clinic with a 3-month history of an enlarging mass in his right neck. He undergoes a CT scan that reveals a fl uid-fi lled mass where the com- mon carotid artery bifurcates. Which of the following is another structure that would be located at this level? (A) Thyroid isthmus (B) Cricoid cartilage (C) Sternal angle (D) Superior border of the thyroid cartilage (E) Jugular notch
d level of superior border of thryoid cartilage
A muscular patient who regularly lifts weights presents with pain and weakness in his right upper limb that has been slowly developing over time. His limb is cool and there is an obvious vascular insufficiency in his upper extremity. Subsequent tests show that a large vessel passing between the anterior and middle scalene muscles is being occluded by hypertrophy [enlargement[ of the muscles due to exercise. the artery involved is the: a. axillary b. brachial c. brachiocephalic d. subclavian e. suprascapular
d. subclavian artery runs between anterior and middle scalene muscles
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 blocked? a. trachea b. primary bronchus c. secondary bronchi d. terminal bronchioles e. alveolar duct
d. CF affects the respiratory system by causing an excess production of viscous mucus by the bronchial glands, followed by mucous plugging and obstruction of the respiratory airway
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. abdominal muscles are major muscles of expiration all others deal with inspiration
Which structure would spread infection into the anterior part of the middle nasal meatus through the frontonasal duct/infadinbulum
frontal sinus drains into the anterior part of the middle nasal meatus via the frontonasal duct/infandibulum
What is formed primarily by the perpendicular plate of the thmoid bone, vomer and septal cartilage?
nasal septum
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
right
