CHAPTER 3

The Thorax
Questions

DIRECTIONS (Questions 1 through 75): Each of the (C) venous drainage

numbered items or incomplete statements in this (D) poor imaging techniques
section is followed by answers or by completions of (E) complex lymphatic drainage
the statement. Select the ONE lettered answer or
completion that is BEST in each case. 5. Which of the following statements correctly
apply to the internal thoracic artery?
1. The articular part of a rib tubercle articulates
with which of the following structures? (A) It runs posterior to the transversus tho-
racis muscle.
(A) body of the vertebra
(B) It ends in the 6th intercostal space.
(B) costal cartilage
(C) It divides into the superior and inferior
(C) adjacent rib epigastric arteries.
(D) sternum (D) It runs posterior to the superior six ribs.
(E) transverse process (E) It gives rise to the posterior intercostal
arteries.
2. Where is the groove for the subclavian artery
located? 6. Which of the following statements concerning
(A) posterior to the scalene tubercle the sternal angle is correct?
(B) on the clavicle (A) It lies at the level of the intervertebral disk
(C) on the manubrium between T4/T5.
(D) at the sternal angle (B) It is flanked by the costal cartilage of the
(E) at the angle of the 1st rib 3rd pair of costal cartilages.
(C) It is crossed by the superior epigastric
3. The retromammary space is located between artery.
which of the following structures? (D) It lies in the epigastric fossa.
(A) skin and the areola (E) It is located 3 mm superior to the jugular
(B) pectoralis major and minor notch.
(C) breast and deep pectoral fascia
7. The pleural cavity contains which of the fol-
(D) suspensory ligament and the skin lowing?
(E) lactiferous sinus and the nipple
(A) lungs
4. The high death rate associated with breast can- (B) bronchi
cer is related to which of the following? (C) serous pleural fluid
(A) nerve supply (D) lymph nodes
(B) blood supply (E) pulmonary arteries and veins

31
32 3: The Thorax

8. The parietal pleura consists of all of the follow- (D) heart

ing parts EXCEPT (E) azygos vein
(A) costal
13. All of the following statements correctly apply
(B) pericardial
to the right atrium EXCEPT
(C) mediastinal
(D) diaphragmatic (A) It receives blood from the superior and
inferior vena cava and coronary sinus.
(E) cervical
(B) It forms the right side of the heart.
9. All of the following statements correctly apply (C) It contains the crista terminalis.
to the right lung EXCEPT (D) It contains the limbus fossae ovalis.
(A) The superior and oblique fissures divide it (E) It contains trabeculae carneae.
into three lobes.
14. The interventricular septum contains which of
(B) It is larger and heavier than the left lung.
the following structures?
(C) It is shorter and wider than the left lung.
(D) It contains a thin, tonguelike process (A) anterior papillary muscle
called the lingula. (B) fossa ovalis
(E) It has three surfaces. (C) sinus venarum
(D) sinoatrial node
10. All of the following statements correctly apply (E) conus arteriosus
to the left main bronchus EXCEPT
(A) It is wider, shorter, and runs more verti- 15. All of the following statements correctly apply
cally than the right main bronchus. to the right coronary artery EXCEPT
(B) It passes anterior to the esophagus. (A) Typically supplies the SA node in approx-
(C) It passes anterior to the thoracic aorta. imately 60% of people.
(D) It contains c-shaped rings of hyaline (B) Typically supplies the AV node in
cartilage. approximately 80% of people.
(E) It arises at the level of the sternal angle. (C) Arises from the arch of the aorta.
(D) Runs in the coronary sulcus.
11. All of the following statements correctly apply (E) Dominance is typical.
to a bronchopulmonary segment EXCEPT
(A) It is separated from adjacent segments by 16. Which of the following is the basic structural
connective tissue septa. unit for gas exchange in the lung?
(B) It is the largest subdivision of a lobe. (A) terminal bronchioles
(C) It is not resectable. (B) respiratory bronchioles
(D) It is named according to the segmental (C) alveolar ducts
bronchus supplying it. (D) alveoli
(E) It is a pyramid-shaped segment of the (E) bronchi
lung, with its apex facing the lung root
and its base at the pleural surface. 17. Which of the following structures carry highly
oxygenated blood from the lungs to the heart?
12. Which of the following structures is located in
the middle mediastinum? (A) pulmonary arteries
(B) pulmonary veins
(A) thoracic duct
(C) coronary arteries
(B) lungs
(D) cardiac veins
(C) esophagus
(E) ascending aorta
 Questions: 8–26 33

18. Which of the following structures is located in 22. All of the following veins drain into the coro-
the posterior mediastinum? nary sinus EXCEPT
(A) lungs (A) anterior cardiac
(B) heart (B) small cardiac
(C) azygos vein (C) middle cardiac
(D) superior vena cava (D) great cardiac
(E) right coronary artery (E) oblique vein of the left atrium

19. All of the following statements concerning spinal 23. All of the following statements concerning the
nerves are correct EXCEPT sinoatrial node are correct EXCEPT
(A) The dorsal and ventral rami are both (A) It is located near the superior end of the
motor and sensory. sulcus terminalis.
(B) The cutaneous branches include anterior, (B) It is located at the junction of the superior
lateral, and posterior branches. vena cava and the right atrium.
(C) The dorsal root is both sensory and motor. (C) It is known as the pacemaker of the heart.
(D) The ventral root is pure motor. (D) It is specialized cardiac muscle fiber.
(E) They supply a bandlike skin area known (E) It is avascular.
as a dermatome.
24. Which of the following structures is located in
20. Which of the following statements correctly the left ventricle?
applies to the tricuspid valve?
(A) fossa ovalis
(A) It guards the left atrioventricular orifice. (B) crista terminalis
(B)It guards the conus arteriosus. (C) opening of the coronary sinus
(C) It is also known as the mitral valve. (D) conus arteriosus
(D) Chordae tendineae attach to the free (E) posterior papillary muscle
edges of the cusps.
(E) The apex of each cusp attaches to the 25. Which of the following structures is located in
fibrous ring around the orifice. the left atrium?
(A) pectinate muscle
21. All of the following statements concerning the
pericardium are correct EXCEPT (B) pulmonary semilunar valves
(C) septomarginal trabeculae
(A) The external layer of the sac is fibrous.
(D) septal papillary muscle
(B) The internal layer is reflected onto the
(E) atrioventricular node
heart as the visceral serous layer (epi-
cardium).
26. Which of the following is NOT part of the chest?
(C) The internal layer of the fibrous sac is the
partietal serous layer. (A) 12 pairs of ribs
(D) The pericardial cavity is the potential (B) sternum
space between the parietal and visceral (C) costal cartilages
serous layers. (D) 12 thoracic vertebrae
(E) The fibrous pericardium is attached to (E) clavicle
the sternum by the pericardiacophrenic
ligament.
34 3: The Thorax

27. Which of the following is NOT likely to con- (C) internal intercostals
tribute to chest pain? (D) subcostals
(A) cardiac disease (E) serratus posterior inferior
(B) pulmonary disease
33. Which of the following do NOT elevate the
(C) thyroid disorders
ribs?
(D) gallbladder disorders
(E) intestinal disorders (A) serratus posterior superior
(B) serratus posterior inferior
28. Which of the following is a special feature of a (C) external intercostals
thoracic vertebra? (D) levatores costarum
(A) foramen for vertebral artery (E) subcostals
(B) dens for rotation
34. With which of the following does the intercos-
(C) short spinous processes
tobrachial nerve communicate?
(D) costal facets on bodies
(E) costal facets on spinous processes (A) medial brachial cutaneous nerve
(B) thoracodorsal nerve
29. Which of the following is a saddle-type synovial (C) long thoracic nerve
joint? (D) first intercostal nerve
(A) sternoclavicular joint (E) sympathetic trunk
(B) manubriosternal joint
35. The musculophrenic arteries give rise to which
(C) interchondral joint
of the following?
(D) intervertebral joint
(E) costochondral joint (A) anterior intercostal arteries for intercostal
spaces 7–9
30. The mammary glands are modified versions of (B) posterior intercostals arteries for inter-
which type of gland? costal spaces 3–11
(C) subcostal artery
(A) sebaceous gland
(D) inferior phrenic artery
(B) lymph gland
(E) lumbar arteries
(C) sweat gland
(D) tonsillar tissue 36. Anterior and posterior intercostals arteries pass
(E) endocrine gland between which two layers?

31. Which of the following does NOT supply the (A) skin and external intercostal muscles
breast with blood? (B) external and internal intercostal muscles
(C) internal and innermost intercostals
(A) lateral thoracic artery
muscles
(B) thoracoacromial artery
(D) innermost intercostal muscles and trans-
(C) posterior intercostals arteries versalis fascia
(D) internal thoracic artery (E) transversalis fascia and peritoneum
(E) costoclavicular artery
37. Of the bronchopulmonary segments in the supe-
32. Which of the following are innervated by dor- rior lobe of the left lung, which two are com-
sal rami? bined to form the lingula?
(A) levatores costarum (A) apical and posterior
(B) external intercostals (B) posterior and anterior
 Questions: 27–46 35

(C) anterior and superior 42. Which of the following is NOT a branch of the
(D) superior and inferior right coronary artery?
(E) apical and inferior (A) SA nodal
(B) right marginal
38. Which of the following areas do NOT receive
(C) posterior interventricular
visceral afferent fibers?
(D) AV nodal
(A) bronchial mucosa (E) circumflex
(B) bronchial muscles
(C) interalveolar connective tissue 43. Which of the following is NOT contained in the
(D) pulmonary arteries and veins superior mediastinum?
(E) diaphragm (A) thymus
(B) great vessels and their branches
39. Sympathetic nerves do NOT contribute to which
(C) azygos and hemiazygos veins
of the following?
(D) trachea
(A) diaphragm (E) esophagus
(B) bronchial muscle
(C) pulmonary vessels 44. The thymus is supplied by which of the fol-
(D) alveolar glands of the bronchial tree lowing?
(E) sweat glands of the chest (A) anterior intercostal branches of the inter-
nal thoracic artery
40. Which of the following is correct? (B) brachiocephalic artery
(A) While a person is supine, the arch of the (C) posterior intercostal arteries
aorta lies superior to the transverse tho- (D) left common carotid artery
racic plane. (E) pericardiacophrenic arteries
(B) While a person is supine, the bifurcation
of the trachea lies at the level of the 45. Which of the following is NOT a branch of the
xiphisternal junction and T9. aorta in the thorax?
(C) While a person is supine, the central ten-
(A) posterior intercostal arteries
don of the diaphragm is transected by the
transverse thoracic plane. (B) inferior phrenic artery
(D) While a person is standing, the arch of the (C) bronchial arteries
aorta lies inferior to the transverse tho- (D) esophageal arteries
racic plane. (E) superior phrenic arteries
(E) While a person is standing, the tracheal
bifurcation is transected by the transverse 46. The posterior mediastinum does NOT include
thoracic plane. which of the following?
(A) prevertebral muscles
41. The pericardium does NOT receive blood sup-
(B) thoracic aorta
ply from which of the following?
(C) thoracic duct
(A) pericardiacophrenic artery (D) thoracic sympathetic trunks
(B) musculophrenic artery (E) thoracic splanchnic nerves
(C) bronchial arteries
(D) esophageal arteries
(E) pectoral arteries
36 3: The Thorax

47. Which of the following may compress the (C) ganglion impar
esophagus? (D) superior cervical ganglia
(A) aortic arch (E) inferior cervical ganglia
(B) right main bronchus
53. Which of the following does NOT contain syn-
(C) left vagus
apses for the sympathetic nervous system?
(D) right brachiocephalic vein
(E) brachiocephalic trunk (A) prevertebral ganglia
(B) collateral ganglia
48. The azygos vein receives blood from which of (C) aortic plexus
the following? (D) celiac ganglia
(A) posterior intercostal veins (E) cardiac plexus
(B) anterior intercostal veins
54. Which of the following does NOT occur in the
(C) left internal jugular vein
sympathetic trunk?
(D) anterior jugular vein
(E) lateral thoracic vein (A) Presynaptic neurons synapse with post-
synaptic neurons immediately.
49. The hemiazygos vein does NOT receive blood (B) Fibers ascend and synapse.
from which of the following? (C) Fibers descend and synapse.
(A) left subcostal vein (D) Presynaptic fibers innervate immediately
surrounding blood vessels.
(B) ascending lumbar veins
(E) Fibers pass, without synapsing, into a
(C) inferior three posterior intercostal veins
splanchnic nerve.
(D) superior phrenic veins
(E) small mediastinal veins 55. Parasympathetic fibers stimulate secretion by
all glands except which of the following?
50. The accessory hemiazygos vein parallels the
vertebral column along which vertebral levels? (A) sweat glands
(B) lacrimal glands
(A) T1–4
(C) salivary glands
(B) T2–6
(D) nasal glands
(C) T5–8
(E) palatine glands
(D) T8–12
(E) L1–4 56. Vasoconstriction is sympathetically stimulated
with the exception of which arteries?
51. Which of the following is NOT contained in the
anterior mediastinum? (A) bronchial arteries
(B) coronary arteries
(A) fat
(C) esophageal arteries
(B) sternopericardial ligaments
(D) adrenal arteries
(C) branches of internal thoracic vessels
(E) renal arteries
(D) lymphatic vessels
(E) heart 57. Which of the following is a result of sympathetic
stimulation in the heart?
52. Which of the following is NOT part of the sym-
pathetic trunks? (A) decrease in the rate and strength of con-
traction
(A) prevertebral ganglia
(B) paravertebral ganglia
 Questions: 47–66 37

(B) inhibition of the effect of parasympathetic (A) cervical splanchnic nerves

system on coronary arteries, allowing (B) upper thoracic splanchnic nerves
them to dilate (C) lower thoracic splanchnic nerves
(C) production of atrial natriuretic factor (D) lumbar splanchnic nerves
(D) opening and closing of mitral valve (E) pelvic splanchnic nerves
(E) glandular secretion
63. The greater splanchnic nerve originates from
58. Which of the following is NOT a result of sym- which vertebral levels?
pathetic stimulation in the lungs?
(A) T1–4
(A) inhibition of parasympathetic system (B) T5–9
(B) bronchodilation (C) T10–11
(C) reduced secretion (D) T12
(D) maximum air exchange (E) L1–4
(E) surfactant production
64. The fibers of the greater splanchnic nerve syn-
59. Sympathetic fibers of the heart are accompanied apse in which ganglion?
by visceral afferent fibers that convey which type
of sensation? (A) celiac ganglion
(B) inferior mesenteric ganglion
(A) reflex
(C) paravertebral ganglia
(B) pain
(D) pulmonary plexus
(C) rate information
(E) adrenal cortex
(D) contraction feedback
(E) pressure sensation 65. The level of the domes of the diaphragm varies
according to various situations. Which of the fol-
60. The pulmonary plexus contains which of the lowing does NOT affect the level of the domes of
following? the diaphragm?
(A) cell bodies of visceral afferent fibers (A) phase of respiration
(B) cell bodies of postsynaptic sympathetic (B) posture
fibers (C) size of distention of abdominal viscera
(C) cell bodies of postsynaptic parasympa- (D) degree of distention of abdominal viscera
thetic fibers
(E) heart contractions
(D) somatic efferent fibers passing on to
diaphragm 66. Which of the following passes through the
(E) somatic afferent fibers from diaphragm caval opening of the diaphragm?

61. Visceral afferent fibers of the tenth cranial nerve (A) terminal branches of the right phrenic
are NOT distributed to which of the following? nerve
(B) thoracic duct
(A) bronchial mucosa
(C) greater thoracic splanchnic nerve
(B) bronchial muscles
(D) sympathetic trunk
(C) interalveolar connective tissue
(E) vagus
(D) pulmonary arteries and veins
(E) diaphragm

62. The greater, lesser, and least splanchnic nerves

are examples of what type of splanchnic nerves?
38 3: The Thorax

67. Which of the following does NOT pass through (C) mesoderm
the esophageal hiatus of the diaphragm? (D) ectoderm
(A) esophagus (E) notochord invagination
(B) branches of the left gastric vessels
73. Which of the following is NOT derived from
(C) lymphatic vessels
the original aortic arch system?
(D) vagal trunks
(E) lesser thoracic splanchnic nerve (A) carotid arteries
(B) arch of the aorta
68. Which of the following passes through the aortic (C) pulmonary artery
hiatus of the diaphragm? (D) right subclavian artery
(A) least thoracic splanchnic nerve (E) coronary arteries
(B) thoracic duct
74. The respiratory system is an outgrowth of what?
(C) branches of right gastric vessels
(D) sympathetic trunks (A) middle mediastinum
(E) terminal branches of the left phrenic nerve (B) ventral wall of foregut
(C) anterior abdominal wall
69. Ribs are formed from which of the following? (D) aortic arches
(A) sclerotome portion of paraxial mesoderm (E) pharyngeal arches
(B) lateral plate mesoderm
75. Which of the following correctly describes the
(C) ectodermal invagination
development of the lungs, in order?
(D) endodermal migration
(E) neural crest cell transitory development (A) pseudoglandular period, canalicular
period, terminal sac period, alveolar
70. The pleuropericardial membranes develop into period
what structures of the adult? (B) canalicular period, pseudoglandular
period, terminal sac period, alveolar
(A) fibrous pericardium period
(B) diaphragm (C) alveolar period, pseudoglandular period,
(C) parietal pleura canalicular period, terminal sac period
(D) visceral pleura (D) pseudoglandular period, terminal sac
(E) the membranes degenerate completely period, alveolar period, canalicular period
(E) terminal sac period, alveolar period,
71. The diaphragm is NOT derived from which of pseudoglandular period, canalicular
the following? period
(A) septum transversum
(B) pleuroperitoneal membranes
(C) muscular components from lateral and
dorsal body walls
(D) mesentery of esophagus
(E) anterior thoracic fascia

72. The entire cardiovascular system is derived from

which of the following?
(A) neural crest cells
(B) endoderm