Thorax

A 65-year-old man presents with a swollen neck, marked edema in both upper limbs, and engorged and prominent intercostal veins. Subsequent examination reveals a tumor in his right lung. The tumor is likely compressing structures in which of the following regions? (A) Anterior mediastinum (B) Posterior mediastinum (C) Superior mediastinum (D) Hilum of the lung (E) Vena caval foramen of the diaphragm

(C) Superior mediastinum

A 58-year-old woman presents with acute abdominal pain, which radiates superior to the right shoulder region. The given CT reveals a large hepatic abscess. Which of the follow- ing nerves conveys the visceral sensory fibers involved with the pain specific to the right shoulder region? (A) Greater splanchnic nerve (B) Lesser splanchnic nerve (C) Least splanchnic nerve (D) Phrenic nerve (E) Vagus nerve

(D) Phrenic nerve

A 62-year-old patient with pericardial effusion comes to a local hospital for aspiration of pericardial fluid by pericardiocentesis. The needle is inserted into the pericardial cavity through which of the following intercostal spaces adjacent to the sternum?

Left 5th intercostal space

A 65-year-old woman is diagnosed as having an extensive, invasive abscess in the lower posterior wall of the thoracic cavity on the right, accompanied by resultant lesions of multiple intercostal nerves. Which of the following is the most likely outcome?

Loss of motor control of intercostal muscles.

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?

Lungs

A 25-year-old man is brought to the emergency room after suffering a deep stab wound directly through the right 5th intercostal space in the midclavicular line. Which of the following structures is most likely pierced?

Middle lobe of the lung

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?

Muscles of the abdominal wall

Disruption of parasympathetic input to the thorax may be related to damage to which of the following structures?

Vagus nerves

A 23-year-old man attending a cocktail party suddenly began to choke. A friend performed the Heimlich maneuver. Although he seemed to be somewhat better, it was not long before he began to cough again. When asked what he had been eating when he started to choke, he said, "peanuts." Bronchoscopy revealed a large object in a bronchus. In which one of the following places would the foreign object most likely be located?

Right main bronchus

A 44-year-old man was stabbed in the right side of his neck, about 2 cm superior to the middle of the clavicle. After a paramedic controlled the bleeding, the man began breathing rapidly and was given oxygen. A chest radiograph in the ER showed a mediastinal shift to the right and a denser (whiter) right lung. Which of the following injuries would most likely produce these signs?

Stab wound of the pleura and apex of the right lung

A 44-year-old man was stabbed in the right side of his neck, about four centimeters superior to the middle of the clavicle. After a paramedic controlled the bleeding, the man began breathing rapidly and was given oxygen. A physical examination by an ER physician revealed a significant shift to the left of the apex beat of the heart and poor breath sounds on the right side of his thorax. Which of the following injuries would most likely produce these signs

Stab wound of the pleura and apex of the right lung

A chest X-ray reveals lobar pneumonia located over the horizontal fissure of the lung. Which of the following lobes of the lung would be inflamed and full of fluid?

Superior lobe of right lung

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 most likely blocked?

Terminal bronchioles

Which of the following is not correct pertaining to the anatomy of the lungs?

The apex of each lung is in contact with the diaphragm

During a routine physical examination, a physician asks her 41-year-old female patient to breathe normally while she assesses the patient's respiration. Which of the following is true of the mechanics of inspiration during normal quiet respiration?

The diaphragm descends.

A 65-year-old woman visits her doctor complaining of a severe cough that elicits intense pain in her chest and that extends into the anterior abdominal wall. Thorough examination leads to a diagnosis of lobar pneumonia with pleurisy. Which of the following is true of the parietal pleura?

The parietal pleura is innervated by the intercostal nerves.

A 14-year-old girl was taken to the family physician because she had a hacking cough and was bringing up blood-tinged sputum, and she had pain in her chest. After receiving laboratory and radiology reports, the physician diagnosed her illness as pleurisy (pleuritis) caused by pneumococcal pneumonitis. Which of the following statements is correct about pleural pain?

The parietal pleura, particularly its costal part, is very sensitive to pain

A thoracic surgeon is dissecting the right side bronchopulmonary lymph nodes near the hilum of the lung in his patient suffering bronchogenic carcinoma. The surgeon must be aware of which of the following relations of the root of the right lung?

The right pulmonary artery lies anterior to the right main (principal) bronchus.

A medical resident is reviewing the case history of a 45-year-old man suffering thoracic outlet syndrome. In a clinical context, which of the following is the correct definition of the thoracic outlet?

The upper opening in the thoracic cage.

Which of the following is true pertaining to the ribs?

An intercostal space is numbered based on the superior rib

A patient complains to you of pain in a limited strip on one side of his chest and back. Upon examination, you notice that the skin associated with the T3 dermatome of that side is red with vesicular eruptions. Which of the following is your most reasonable conclusion about your patient's illness?

He has shingles (herpes zoster)

A 31-year-old man was involved in a severe automobile accident and suffered laceration of the left primary bronchus. The damaged primary bronchus:

Is longer than the right primary bronchus

A 41-year-old female is admitted to the emer- gency department with a complaint of severe, sharp, but poorly localized pain on the chest wall. Radio- graphic examination gives evidence of pleural effusion. What is the location of the neuronal cell bodies respon- sible for the nerve fibers that carry this pain to the central nervous system (CNS)? A. Dorsal root ganglia B. Sympathetic chain ganglia C. Dorsal horn of the spinal cord D. Lateral horn of the spinal cord E. Ventral horn of the spinal cord

A. Dorsal root ganglia

A 27-year-old comatose anorexic woman is admitted to the emergency department. A nasogastric tube is inserted and passed into her esophagus. What will be the last resistance point felt by the physician as the tube passes from the nose into the stomach? A. Esophageal hiatus of the diaphragm B. Level of the superior thoracic aperture C. Posteriortotheaorticarch D. Posterior to the left atrium E. Posterior to the left main bronchus

A. Esophageal hiatus of the diaphragm

A 45-year-old female is admitted to the hospital with difficulty breathing. Radiographic examination reveals a tumor invading the lung surface anterior to the hilum. Which nerve is most likely compressed by the tumor to result in dyspnea? A. Phrenic B. Vagus C. Intercostal D. Recurrent laryngeal E. Cardiopulmonary

A. Phrenic

A robbery victim receives a stab injury to the thoracic wall in the area of the right fourth costal cartilage. Which of the following pul- monary structures is present at the site of this injury? A. Apex of the lung B. Horizontal fissure of the lung C. Lingula D. Oblique fissure of the lung E. Pulmonary ligament

B. Horizontal fissure of the lung

A 39-year-old male is admitted to the hospital with a complaint of severe retrosternal pain that radi- ates to the left shoulder. The pain is relieved by lean- ing forward. Auscultation reveals a pericardial fric- tion rub, leading to a diagnosis of pericarditis. Which of the following nerves is responsible for the radiat- ing pain? A. Intercostobrachial B. Phrenic C. Long thoracic D. Greater thoracic splanchnic E. Cardiopulmonary

B. Phrenic

A 54-year-old female is admitted to the hospital with a stab wound of the thoracic wall in the area of the right fourth costal cartilage. Which of the following pulmonary structures is present at this site? A. The horizontal fissure of the left lung B. The horizontal fissure of the right lung C. The oblique fissure of the left lung D. The apex of the right lung E. The root of the left lung

B. The horizontal fissure of the right lung

As you make a surgical incision in the thorax at the midaxillary line, where would you expect to find the 7th spinal nerve?

Between the internal intercostal and innermost intercostal muscles

A patient has a small but solid tumor in the mediastinum, which is confined at the level of the sternal angle. Which of the following structures would most likely be found at this level?

Bifurcation of the trachea

A 72-year-old male is admitted to the hospital with complaints of severe chest pain radiating to his left arm. ECG examination provides evidence of signifi- cant myocardial infarction of the posterior wall of the left ventricle. Which of the following nerves is respon- sible for the radiation of pain to the arm during myo- cardial infarction? A. Phrenic B. Vagus C. Intercostobrachial D. Greater splanchnic E. Suprascapular

C. Intercostobrachial

During a surgery rotation, a 3rd year medical student is asked by a cardiovascular surgeon to explain what "left coronary dominance" means in relation to the left coronary artery. Which of the following explanations should be given by an astute student?

It gives rise to the posterior interventricular artery

Which of the following is correct based on the above image, which was taken during inspiration?

It shows a patient who likely has a paralyzed right phrenic nerve

During open-heart surgery, the pericardial sac is cut open by a longitudinal incision. If a horizontal incision is used, which of the following structures might be transected? A. Azygos vein B. Inferior vena cava C. Internal thoracic artery D. Phrenic nerves E. Vagus nerves

D. Phrenic nerves

The sternal angle (of Louis) is an important clinical surface landmark on the anterior chest wall, dividing the thorax into the superior and inferior mediastinum. Which of the following features also is found at the level of the sternal angle? A. Articulation of first rib B. Azygos vein C. Descending aorta D. Sinuatrial node E. Tracheal bifurcation

E. Tracheal bifurcation

It is common to explain the relationships between the lung and surrounding structures by using the analogy of a fist inserted into a balloon. Accordingly, which of the following group of associations would be accurate?

Fist—lung; space between inner and outer balloon layers—pleural cavity; outer layer of balloon—parietal pleura