EXAMPLE QUESTIONS FOR THE THORAX - DR.

HISLEY'S MATERIALS
80 QUESTIONS WITHOUT ANSWERS
- updated 09252018 -
THE ANS, THORAX, RIBCAGE, PLEURAL CAVITIES/PLEURA, LUNGS, MEDIASTINUM
(MIDDLE: HEART), MEDIASTINUM(ANTERIOR), MEDIASTINUM (SUPERIOR),
MEDIASTINUM (POSTERIOR)

--------------------------ANS---------------------
1. Which one of the following neural information modalities represents
motor innervation of somatic muscle?

A. GVA
B GVE
C. GSA
D. GSE
E. SVE

2. Which one of the following answers correctly characterizes an effect on

the heart by cardiac branches of the vagus nerve?

A. stimulates a sympathetic action

B causes constriction of the coronary arteries
C. increases the rate of contraction
D. decreases the rate of contraction
E. increase the strength of contractility

3. Which one of the following autonomic outflow systems has components

in both the cranial nerves AND the spinal cord?

A. parasympathetic system
B sympathetic system
C. enteric nervous system
D. somatic nervous system - PNS
E. somatic nervous system – CNS
4. Peripheral nerves, in terms of the information transmission type(s) they
carry, would be most probably which one of the following?

A. somatic motor
B somatic sensory
C. mixed combinations of motor, sensory and autonomics
D. visceral motor
E. visceral sensory

5. Which one of the following answers names the location of the only
parasympathetic component emerging from the spinal cord?

A. cervical cord
B thoracic cord
C. lumbar cord
D. sacral cord
E. coccygeal cord

6. A fiber in the lesser thoracic splanchnic nerves coursing inferiorly would

be characterized by which one of the following?

A. pre-ganglionic parasympathetic
B post-ganglionic parasympathetic
C. pre-ganglionic sympathetic
D. post-ganglionic sympathetic
E. pre-ganglionic lumbar

7. Parasympathetic fibers entering the lungs via the pulmonary plexuses

would have which one of the following total effects?

A. bronchial constriction
B decreases pulmonary secretions
C. bronchial dilation
D. increases pulmonary secretions
E. A and D
-----------THORACIC WALL / RIBCAGE---------------------

8. How many TRUE ribs does the human adult ribcage usually have?

A. 7
B 5
C. 2
D. 3
E. 6

9. Which one of the following joint types represents the joint between the
first rib and the manubrium of the sternum?

A. synovial
B symphysis
C. synchondrosis
D. fibrous
E. sutural

10. Which one of the following posterior rib-vertebral joint geometries is

optimal for the “pump handle” mechanism of ribcage movement during
inspiration?

A. cylindrical (8th to 10th ribs)

B cylindrical (1st to 7th ribs)
C. planar (8th to 10th ribs)
D. planar (1st to 7th ribs)
E. fused (8th to 10th ribs)

11. Anterior intercostal arteries are supplied with fresh blood by which one
of the following structures??

A. descending thoracic aorta

B musculophrenic arteries
C. superior epigastric arteries
D. internal thoracic arteries
E. bronchial arteries
12. Which one of the following structures causes depression of the ribcage
during expiration by acting on the posterior ribs?

A. internal intercostal muscles

B external intercostal muscles
C. subcostal muscles
D. transversus thoracic muscles
E. anterior scalene muscle

13. Venous blood from the posterior intercostal spaces on the right side
drains directly into which one of the following before entering the superior
vena cava?

A. hemiazygos vein
B accessory hemiazygos vein
C. lumbar veins
D. azygous vein
E. right brachiocephalic vein

14. Which one of the following is the final conduit of lymph drainage from
the ribcage, the thoracic walls and subcostal pleura (parietal) ON THE LEFT
SIDE?

A. right lymphatic duct

B intercostal nodes
C. parasternal nodes
D. bronchomediastinal nodes
E. thoracic duct

15. Which one of the following sites is preferred for the clinical drainage of
a hemothorax with a trocar?

A. 2nd-3rd intercostal space on the midclavicular line

B 9th intercostal space on the midaxillary line
C. 2nd-3rd parasternal intercostal spaces
D. apical aspect above the first rib
E. posterior paravertebral site
-----------PLEURAL CAVITIES - PLEURA--------------------

16. Which of the following 3D locations does visceral pleura become

parietal pleura and vice versa?

A. hilum of the lung

B root of the lung
C. costodiaphragmatic pleura
D. mediastinal pleura
E. apical pleura

17. Which one of the following types of parietal pleura covers the apex of
the lungs?

A. hilum of the lung

B root of the lung
C. costodiaphragmatic pleura
D. mediastinal pleura
E. cupola pleura

--------------------------LUNGS / AIRWAY---------------------
18. Regarding the gross biomechanics of breathing, the bucket-handle
model explains which one of the following:

A. increase in the anterior-posterior dimension of the ribcage

B increase in the left-right dimension of the ribcage
C. the increase in the depth of the costodiaphragmatic recess
D. the degree of depression of the diaphragm
E. the movement of the sternum
19. Regarding the structures contained within the hilum of the left lung,
which one of the following structures is usually found most inferior:

A. pulmonary trunk
B left pulmonary veins
C. left main bronchus
D. left pulmonary arteries
E. hilar lymph nodes

20. Which of the following structures represents a segment of the

conducting portion of the bronchial tree?

A. alveolar ducts
B respiratory bronchioles
C. terminal bronchioles
D. alveolar sac cluster
E. single alveolar sac

21. Which one of the following arteries supplies oxygenated blood to the
visceral pleura, lung root, bronchial tree down to, but not including, the
respiratory bronchiole?

A. pulmonary arteries
B bronchial arteries
C. lobar veins
D. pulmonary veins
E. bronchial veins

22. Which one of the following arteries supplies blood-based O2 to the

majority of parenchymal lung tissue?

A. pulmonary arteries
B bronchial arteries
C. lobar veins
D. pulmonary veins
E. bronchial veins
23. If trauma to the ribcage results in an opening into the parietal pleura
through the thoracic wall at T6, atelectasis would occur- thus - which one of
the following would be most likely to occur?

A. lung over inflation

B lung not affected
C. collapse of the lung
D. herniation of the lung through the thoracic wall
E. herniation of the lung through the diaphragm

24. A single blood clot that straddles both pulmonary arteries is called:

A. pulmonary infarct
B simple pulmonary embolus
C. saddle pulmonary embolus
D. bronchial clot
E. deep venous thrombosis

25. Surgically removing a bronchopulmonary segment from the lung is

referred to specifically as:

A. pneumonectomy
B lobectomy
C. bronchioectomy
D. segmentectomy
E. interlobarectomy

26. On the right side, which one of the following refers to the fissure
defining the middle lobe on the right side:

A. oblique
B horizontal
C. lingular
D. apical
E. intra-lobar
 27. In the bronchial tree, which one of the following branching points
defines a segmental” bronchi?

A. primary
B secondary
C. tertiary
D. quaternary
E. 5th branching point

---------MEDIASTINUM, INCLUDING HEART---------------

28. The thoracic inlet allows the passage of the following structures EXCEPT
for which one of the following:

A. right brachiocephalic vein

B left brachiocephalic vein
C. trachea
D. inferior vena cava
E. esophagus

29. The thoracic outlet (not the floor) consists of which one of the
following:

A. aortic hiatus
B esophageal hiatus
C. opening described by ribs 8-12
D. complex muscular surface extending from the 4th rib to the 12th ribs on
both sides of the body as viewed anteriorly
E. central tendon

30. Which type of pleura is the mediastinal pleura directly adjacent to

laterally?
A. diaphragmatic pleura
B. costal pleura
C. apical pleura
D. costodiaphragmatic pleura
E. sub-diaphragmatic pleura
31. The superior mediastinum extends from the thoracic inlet to which of
the following:

A. sternal angle
B Angle of Louis
C. xiphosternal joint
D. the 12th rib
E. A and B

32. The inferior mediastinum extends from the sternal angle to:

A. thoracic inlet
B costodiaphragmatic recess
C. diaphragm (central tendon)
D. diaphragm (right dome)
E. diaphragm (left dome)

33. The posterior mediastinum extends from the thoracic inlet to:

A. costodiaphragmatic recess
B T12 (vertebral body)
C. T10 (anterior false rib)
D. mediastinal recess
E. diaphragm (central tendon)

34. Which of the following structures is indicated from the surface by the
sternal angle?

A. the disk between T4 and T5

B the carina (trachea)
C. pulmonary veins
D. primary bronchi
E. A and B
35. Which of the following structures is NOT located in the posterior
mediastinum:

A. sympathetic chain
B esophagus
C. thymus
D. vagus nerve
E. esophageal plexus

36. Which of the following structures is located in the posterior

mediastinum and uses it as a thoroughfare through the thorax to the
abdomen:

A. trachea
B esophagus
C. aorta
D. heart
E. B and C

37. Which one of the following structures represents the location where
parietal pleura becomes visceral pleura?

A. pleural root of the lung

B costodiaphragmatic recess
C. mediastinal recess (anterior)
D. mediastinal recess (posterior)
E. cupola of lung

38. Which one of the following structures represents the location where
costal pleura (lateral wall) becomes diaphragmatic pleura?

A. pleural root of the lung

B costodiaphragmatic recess
C. mediastinal recess (anterior)
D. mediastinal recess (posterior)
E. cupola of lung
39. Which one of the following structures is in the ANTERIOR mediastinum?

A. ascending aorta
B esophagus
C. carina (trachea)
D. pulmonary trunk
E. thymus

40. Which one of the following structures is NOT in the middle

mediastinum?

A. ascending aorta
B pulmonary trunk
C. right atrium of the heart
D. heart
E. rami communicantes
(between the sympathetic ganglion and posterior intercostal nerve)

41. The root of the lungs provide a landmark point for two nerves, one
coursing inferiorly ANTERIOR TO the root of the lung and one coursing
inferiorly POSTERIOR TO the root of the lung. Select the best answer from
the following in [anterior, posterior] order

A. vagus (cardiac plexus), phrenic nerve

B vagus (recurrent laryngeal nerve), phrenic nerve
C. phrenic nerve, vagus nerve
D. phrenic nerve, vagus (recurrent laryngeal nerve)
E. phrenic nerve, rami communicantes

42. Regarding the named layers of the walls of the pericardium AND heart,
the outermost and the innermost layers are:
A. fibrous pericardium, serous pericardium
B fibrous pericardium, pericardial sac
C. fibrous pericardium, endocardium
D. serous pericardium, epicardium
E. pericardial sac, epicardium
43. If one removes the posterior wall of the pericardium posterior to the
heart, one would most likely find which one of the following structures:
A. thoracic duct
B descending aorta
C. esophagus
D. anterior intercostal arteries
E. A, B and C

44. The heart is really two pumps: the right side and the left side.
Which cardiovascular circulations does each function within?

A. pulmonary circulation, upper extremities

B pulmonary circulation, lower extremities
C. neck circulation, systemic circulation
D. abdominal circulation, systemic circulation
E. pulmonary circulation, systemic circulation

45. If a saddle embolus blocks both pulmonary arteries, the immediate

clinical result would most likely be:

A. cardiac tamponade
B congestive heart failure
C. myocardial infarction
D. aortic valve insufficiency
E. patent foramen ovale

46. During early systole, which of the following valves would be open?
A. aortic valve
B pulmonary valve
C. tricuspid valve
D. mitral valve
E. A and B
47. The fibrous skeleton that holds the heart valves within a semi-rigid
framework that electrically insulates the atria from the ventricles is located:

A. in the interventricular septum

B in the interatrial septum
C. in the plane of the coronary sulcus
D. in the plane of the interventricular sulcus
E. in the coronary sinus

48. During early diastole, which of the following valves would be open?

A. aortic valve
B pulmonary valve
C. tricuspid valve
D. mitral valve
E. C and D

49. A drop of blood BEGINNING AT THE LEFT CUSP OF THE AORTIC VALVE
would take the following route to the anterior 2/3’s of the interventricular
septum?

A. left coronary artery LAD  circumflex artery posterior septum

B left coronary artery LAD  anterior septum
C. left coronary artery LAD  right marginal branch posterior septum
D. right coronary artery LAD  circumflex artery anterior septum
E. right coronary artery posterior interventricular artery posterior
septum

50. A drop of blood BEGINNING AT THE RIGHT CUSP OF THE AORTIC VALVE
would take the following route to the posterior 1/3 of the interventricular
septum?

A. left coronary artery LAD  circumflex artery posterior septum

B left coronary artery LAD  anterior septum
C. left coronary artery LAD  right marginal branch posterior septum
D. right coronary artery LAD  circumflex artery anterior septum
E. right coronary artery posterior interventricular artery posterior
septum
51. A drop of blood BEGINNING AT THE ANTERIOR SURFACE OF THE HEART
AT THE APEX traveling within the great cardiac vein would return to the right
atrium by which route?

A. great cardiac veincoronary sinus right atrium

B anterior cardiac veinscoronary sinus right atrium
C. small cardiac vein coronary sinus right atrium
D. left posterior ventricular vein coronary sinus right atrium
E. A and B

52. Which of the following structures is NOT found in the right atrium?

A. pectinate muscles
B cristae terminalis
C. tricuspid valve
D. right auricle
E. trabecula carnae

53. Which of the following structures is NOT found in the right ventricle?

A. pectinate muscles
B interventricular septum (membranous part)
C. interventricular septum (muscular part)
D. papillary muscles
E. trabecula carnae

54. Which of the following structures is NOT found in the left ventricle?

A. chordae tendineae
B moderator band
C. interventricular septum (muscular part)
D. papillary muscles
E. trabecula carnae
55. Which of the following structure(s) working as a unit prevents
atrioventricular valve prolapse in either ventricle?

A. chordae tendineae
B moderator band
C. interventricular septum (muscular part)
D. papillary muscles
E. A and D

56. Which one of the following structures is located on the interatrial

septum within the sinus venarum?

A. fossa ovalis
B valve of the inferior vena cava
D. left auricle
E. valve of the coronary sinus

57. Which one of the following structures is NOT a component of the

cardiac conduction system?

A. sinoatrial (SA) node

B atrioventricular (AV) node
C. bundle branches (right and left)
D. moderator band
E. chordae tendineae

58. Which one of the following structures is a part of both the superior and
posterior mediastinum?

A. aorta (ascending, arch, descending)

B esophagus
C. trachea
D. heart
E. thoracic splanchnic nerves
59. Which one of the following structures connects the sympathetic nervous
system (chain ganglion) to the somatic nervous system (VPR)?
A. posterior intercostal nerve
B dorsal root ganglion
C. rami communicantes (white)
D. rami communicantes (grey)
E. C and D

60. A drop of blood returning to the heart from the neck on the opposite
side of the body from the right atrium would most probably follow this
course:

A. right IJV right brachiocephalic vein superior vena cava right atrium
B left IJV right brachiocephalic vein superior vena cava right atrium
C. left IJV left brachiocephalic vein superior vena cava right atrium
D. left IJV left brachiocephalic vein superior vena cava left atrium
E. right IJV right brachiocephalic vein superior vena cava left atrium

61. A drop of blood returning to the heart from the hemiazygos vein would
follow this course:

A. hemiazygos vein azygous vein SVC

B. hemiazygos vein accessory hemiazygos vein azygous vein SVC
C. hemiazygos vein azygous vein accessory hemiazygos vein SVC
D. hemiazygos vein SVCazygous vein accessory hemiazygos vein
E. right lumbar veins hemiazygos vein azygous vein SVC

62. A drop of blood returning to the heart from the accessory hemiazygos
vein could follow this course(s):

A. accessory hemiazygos vein azygous vein SVC

B. accessory hemiazygos vein hemiazygos vein azygous vein SVC
C. hemiazygos vein azygous vein accessory hemiazygos vein SVC
D. hemiazygos vein SVCazygous vein accessory hemiazygos vein
E. A and B
63. A drop of blood returning to the heart from the intercostal vein in the
first intercostal space on the right side would follow this course:

A. right posterior intercostal vein accessory hemiazygos vein SVC

B right posterior intercostal vein hemiazygos vein SVC
C. right posterior intercostal vein azygous vein SVC
D. left superior intercostal vein azygous vein SVC
E. right superior intercostal vein azygous vein SVC

64. Which of the following statements is NOT true about the phrenic nerve?

A. it spinal roots are C3-C5

B it runs on the anterior surface of the anterior scalene muscle
C. in the thorax it courses anterior to the lung root
D. on the pericardium it runs parallel to the pericardiophrenic vessels
E. it provides ONLY motor innervation to the diaphragm

65. In adulthood, the ligamentum arteriosum is the normally non-patent

remnant of the embryological ___________________.

A. ductus venosus
B ductus arteriosus
C. umbilical vein
D. umbilical artery
E. dorsal aorta

66. The right vagus nerve entering the superior thoracic aperture gives off
the recurrent laryngeal nerve which then courses back and around which one
of the following structures to ascend to the larynx.

A. aortic arch
B right brachiocephalic vein
C. right primary bronchi
D. right subclavian artery
E. left subclavian artery
67. In the prenatal fetus, the forerunner of the ligamentum arteriosum
allows the maternal circulation to bypass the __________________.

A. hepatic system
B the GI system
C. the pulmonary system
D. the renal system
E. the nervous system

68. Which of the following structures rests against the anterior surface of
the carina in the superior mediastinum?

A. ascending aorta
B pulmonary trunk
C. left pulmonary artery
D. right pulmonary artery
E. azygos vein

69. Lymph drainage from the superior lobe of the left lung normally takes
the following course:

A. hilar LNs superior/inferior tracheobronchial LNs paratracheal LNs 

the thoracic duct left IJV
B hilar LNs paratracheal LNs superior/inferior tracheobronchial LNs
the thoracic duct left IJV
C. hilar LNs superior/inferior tracheobronchial LNs posterior mediastinal
nodes  the thoracic duct left IJV
D. hilar LNs superior/inferior tracheobronchial LNs superior phrenic LNs
 the thoracic duct left IJV
E. hilar LNs celiac LNs superior phrenic LNs 
the thoracic duct left IJV
70. Which of the following nerves are NOT found in the posterior
mediastinum?

A. vagus nerve
B esophageal plexus
C. thoracic sympathetic chain
D. posterior intercostal nerves
E. phrenic nerve

71. Which of the following nerves supply PRE-GANGLIONIC fibers from the
thoracic sympathetic ganglia from T10-T11 to the abdominal viscera?

A. sympathetic cardiac plexus

B sympathetic pulmonary plexus
C. greater thoracic splanchnic nerves
D. lesser thoracic splanchnic nerves
E. least thoracic splanchnic nerves

72. The term cardiac tamponade refers to an abnormal condition where a

abnormal blood fills the following anatomical structure restraining the heart:
A. fibrous pericardium
B epicardium
C. pericardial sac
D. left venticle
E. right ventricle

73. Referred cardiac pain describes a condition where ________ pain

afferents travel to spinal cord segments in the _________spinal cord
and are interpreted by the brain as somatic pain radiating down the left arm.

A. sympathetic, thoracic
B parasympathetic, thoracic
C. sympathetic, cervical
D. parasympathetic, cervical
E. sympathetic, lumbar
74. The most common myocardial infarcts (40-50%) occur in the anterior
surface of the heart in the perfusion field supplied by which one of the
following coronary arteries?

A. circumflex artery
B right coronary artery
C. posterior interventricular artery
D. anterior interventricular artery (LAD)
E. left marginal artery

75. Where would usually be the optimal location to auscultate the

TRICUSPID valve?

A. right anterior 2nd intercostal space

B left anterior 2nd intercostal space
C. left parasternal 6th rib/sternum interface
D. right parasternal 6th intercostal space
E. left anterior first intercostal space

76. Which valvular condition would lead to left ventricular overload and
hypertrophy?

A. aortic stenosis
B aortic regurgitation
C. mitral stenosis
D. mitral regurgitation
E. patent foramen ovale

77. Which valvular condition would lead to stroke volume blood ejected
during systole from the left ventricle, then returning to that chamber?

A. aortic stenosis
B aortic regurgitation
C. mitral stenosis
D. mitral regurgitation
E. patent foramen ovale
 78. Which valvular condition would lead to left atrial dilatation?

A. aortic stenosis
B aortic regurgitation
C. mitral stenosis
D. mitral regurgitation
E. patent foramen ovale

79. Which valvular condition would lead to left ventricular blood

returning to the left atrium during diastole?

A. aortic stenosis
B aortic regurgitation
C. mitral stenosis
D. mitral regurgitation
E. patent foramen ovale

80. Which one of the following pathologies contained within the middle
mediastinum might logically cause the compression of the anterior wall of the
esophagus?

A. pericardial cyst on the base of the heart (bronchogenic cyst)

B thymoma
C. Schwann cell tumor
D. neurofibroma
E. patent foramen ovale

81. Which of the following heart abnormalities is most like a patent

foramen ovale?

A. atrial septal defect

B ventricular septal defect
C. left ventricular hypertrophy
D. right atrial hypertrophy
E. left atrial hypertrophy
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