Thorax

1. A 32-year-old patient who weighs 275 pounds comes to the doctor's office. On the surface of the chest, the physician is able to locate the apex of the heart:

(A) At the level of the sternal angle
(B) In the left fourth intercostal space
(C) In the left fifth intercostal space
(D) In the right fifth intercostal space
(E) At the level of the xiphoid process of the sternum

2. 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

3. A 23-year-old man received a gunshot wound, and his greater splanchnic nerve was destroyed. Which of the following nerve fibers would be injured?

(A) General somatic afferent (GSA) and preganglionic sympathetic fibers
(B) General visceral afferent (GVA) and postganglionic sympathetic fibers
(C) GVA and preganglionic sympathetic fibers
(D) General somatic efferent (GSE) and postganglionic sympathetic fibers
(E) GVA and GSE fibers

4. A 17-year-old boy was involved in a gang fight, and a stab wound severed the white rami communicantes at the level of his sixth thoracic vertebra. This injury would result in degeneration of nerve cell bodies in which of the following structures?

(A) Dorsal root ganglion and anterior horn of the spinal cord
(B) Sympathetic chain ganglion and dorsal root ganglion
(C) Sympathetic chain ganglion and posterior horn of the spinal cord
(D) Dorsal root ganglion and lateral horn of the spinal cord
(E) Anterior and lateral horns of the spinal cord

5. A 27-year-old cardiac patient with an irregular heartbeat visits her doctor's office for examination. Where should the physician place the stethoscope to listen to the sound of the mitral valve?

(A) Over the medial end of the second left intercostal space
(B) Over the medial end of the second right intercostal space
(C) In the left fourth intercostal space at the midclavicular line
(D) In the left fifth intercostal space at the midclavicular line
(E) Over the right half of the lower end of the body of the sternum

6. A 19-year-old man came to the emergency department, and his angiogram exhibited that he was bleeding from the vein that is accompanied by the posterior interventricular artery. Which of the following veins is most likely to be ruptured?

(A) Great cardiac vein
(B) Middle cardiac vein
(C) Anterior cardiac vein
(D) Small cardiac vein
(E) Oblique veins of the left atrium

7. A 37-year-old patient with palpitation was examined by her physician, and one of the diagnostic records included a posterior-anterior chest x-ray film. Which of the following comprises the largest portion of the sternocostal surface of the heart seen on the radiograph?

(A) Left atrium
(B) Right atrium
(C) Left ventricle
(D) Right ventricle
(E) Base of the heart

8. A 7-year-old boy has a damaged interventricular septum. Which of the following valves is most likely defective?

(A) Pulmonary valve
(B) Mitral valve
(C) Valve of coronary sinus
(D) Tricuspid valve
(E) Aortic valve

9.A 54-year-old patient is implanted with an artificial cardiac pacemaker. Which of the following conductive tissues of the heart had a defective function that required the pacemaker?

(A) Atrioventricular (AV) bundle
(B) AV node
(C) Sinoatrial (SA) node
(D) Purkinje fiber
(E) Moderator band

10. 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

11. 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 bronchus
(B) Left inferior bronchus
(C) Right superior bronchus
(D) Right middle bronchus
(E) Right inferior bronchus

12. An 83-year-old man with a typical coronary circulation has been suffering from an embolism of the circumflex branch of the left coronary artery. This condition would result in ischemia of which of the
following areas of the heart?

(A) Anterior part of the left ventricle
(B) Anterior interventricular region
(C) Posterior interventricular region
(D) Posterior part of the left ventricle
(E) Anterior part of the right ventricle

13.
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 general somatic efferent 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

14. An 8-year-old boy with atrial septal defect presents to a pediatrician.This congenital heart defect shunts blood from the left atrium to the right atrium and causes hypertrophy of the right atrium, right
ventricle, and pulmonary trunk. Which of the following veins opens into the hypertrophied atrium?

(A) Middle cardiac vein
(B) Small cardiac vein
(C) Oblique cardiac vein
(D) Anterior cardiac vein
(E) Right pulmonary vein

15.
A 37-year-old patient with severe chest pain, shortness of breath, and congestive heart failure was admitted to a local hospital. His coronary angiograms reveal a thrombosis in the circumflex branch of the left coronary artery. Which of the following conditions could result from the blockage of blood flow in the circumflex branch?

(A) Tricuspid valve insufficiency
(B) Mitral valve insufficiency
(C) Ischemia of atrioventricular (AV) node
(D) Paralysis of pectinate muscle
(E) Necrosis of septomarginal trabecula

16.
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

17.
A thoracentesis is performed to aspirate an abnormal accumulation of fluid 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

18.
A 6-year-old boy with tetralogy of Fallot shows pulmonary stenosis and right ventricular hypertrophy in addition to other symptoms.Which of the following structures is likely to be found in the hypertrophied heart chamber?

(A) Sinus venarum
(B) Crista terminalis
(C) Pectinate muscles
(D) Septomarginal trabecula
(E) Valve of the coronary sinus

19.
A 33-year-old patient is suffering from a sudden occlusion at the origin of the descending (thoracic) aorta. This condition would most likely decrease blood flow in which of the following intercostal
arteries?

(A) Upper six anterior
(B) All of the posterior
(C) Upper two posterior
(D) Lower anterior
(E) Lower nine posterior

20.
A 56-year-old patient recently suffered a myocardial infarction in the area of the apex of the heart. The occlusion by atherosclerosis is in which of the following arteries?

(A) Marginal artery
(B) Right coronary artery at its origin
(C) Anterior interventricular artery
(D) Posterior interventricular artery
(E) Circumflex branch of the left coronary artery

21.
A 75-year-old woman was admitted to a local hospital, and bronchograms and radiographs 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 superior vena cava
(C) Middle lobe
(D) Lingula
(E) Larger capacity than the right

22.
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

23.
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

24.
A 46-year-old patient comes to his doctor'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

25.
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

26.
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?

(A) Trachea
(B) Primary bronchus
(C) Secondary or lobar bronchi
(D) Terminal bronchioles
(E) Alveolar duct

27.
A 12-year-old boy was admitted to a local hospital with a known history of heart problems. His left ventricular hypertrophy could result from which of the following conditions?

(A) A constricted pulmonary trunk
(B) An abnormally small left atrioventricular (AV) opening
(C) Improper closing of the pulmonary valves
(D) An abnormally large right AV opening
(E) Stenosis of the aorta

28.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

29. 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 first to which of the following veins?

(A) Superior vena cava
(B) Right superior intercostal vein
(C) Right brachiocephalic vein
(D) Azygos vein
(E) Hemiazygos vein

30. A radiologist examines posterior-anterior chest radiographs of a 27-year-old victim of a car accident. Which of the following structures forms the right border of the cardiovascular silhouette?

(A) Arch of the aorta
(B) Pulmonary trunk
(C) Superior vena cava
(D) Ascending aorta
(E) Left ventricle

31.A 37-year-old man is brought to the emergency room complaining of severe chest pain. His angiogram reveals thromboses of both brachiocephalic veins.This condition would most likely cause a dilation of which of the following veins?

(A) Azygos
(B) Hemiazygos
(C) Right superior intercostal
(D) Left superior intercostal
(E) Internal thoracic

32.A cardiologist is on clinical rounds with her medical students. She asks them, “During the cardiac cycle, which of the following events occurs?”

(A) Atrioventricular (AV) valves close during diastole
(B) Aortic valve closes during systole
(C) Pulmonary valve opens during diastole
(D) Blood flow in coronary arteries is maximal during diastole
(E) Aortic valve closes at the same time as AV valve

33. Coronary angiographs of a 44-year-old male patient reveal an occlusion of the circumflex branch of the left coronary artery. This patient has been suffering from myocardial infarction in which of the following
areas?

(A) Right and left ventricles
(B) Right and left atria
(C) Interventricular septum
(D) Apex of the heart
(E) Left atrium and ventricle

34.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?

(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

35.A 37-year-old house painter fell from a ladder and fractured his left third rib and the structures with which it articulated. Which of the following structures would most likely be damaged?

(A) Manubrium of the sternum
(B) Body of the second thoracic vertebra
(C) Spinous process of the third thoracic vertebra
(D) Body of the fourth thoracic vertebra
(E) Transverse process of the second thoracic vertebra

36.A 45-year-old woman presents with a tumor confined to the posterior mediastinum. 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

37.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?

(A) Right fourth intercostal space
(B) Left fourth intercostal space
(C) Right fifth intercostal space
(D) Left fifth intercostal space
(E) Right sixth intercostal space

38.The attending faculty in the coronary intensive care unit (ICU) demonstrates to his students a normal heart examination. The first heart sound is produced by near-simultaneous closure of which of the following valves?

(A) Aortic and tricuspid
(B) Aortic and pulmonary
(C) Tricuspid and mitral
(D) Mitral and pulmonary
(E) Tricuspid and pulmonary

39.A 27-year-old patient with Marfan's syndrome has an aneurysm of the aortic arch. This may compress which of the following structures?

(A) Right vagus nerve
(B) Left phrenic nerve
(C) Right sympathetic trunk
(D) Left recurrent laryngeal nerve
(E) Left greater splanchnic nerve

40.A 47-year-old man with a known atrial fibrillation returns to see his cardiologist for follow-up of his cardiac health. The right atrium is important in this case because it:

(A) Receives blood from the oblique cardiac vein
(B) Is associated with the apex of the heart
(C) Contains the sinoatrial node
(D) Receives the right pulmonary vein
(E) Is hypertrophied by pulmonary stenosis

41.A 57-year-old patient has a heart murmur resulting from the inability to maintain constant tension on the cusps of the atrioventricular (AV) valve. Which of the following structures is most likely damaged?

(A) Crista terminalis
(B) Septomarginal trabecula
(C) Chordae tendineae
(D) Pectinate muscle
(E) Anulus fibrosus

42.A 52-year-old patient with a history of myocardial infarction exhibits a right coronary artery that is blocked by a fat globule after giving off the right marginal artery. Which of the following structures may have oxygen deficiency?

(A) Right atrium
(B) Sinoatrial (SA) node
(C) Atrioventricular (AV) node
(D) Apex of the heart
(E) Anterior interventricular septum

43.A surgical resident inadvertently ligates the phrenic nerve instead of the accompanying artery descending between the mediastinal pleura and the pericardium without causing any particular harm. Which of the
following arteries did he intend to ligate?

(A) Internal thoracic
(B) Musculophrenic
(C) Pericardiacophrenic
(D) Right coronary
(E) Superior (supreme) thoracic

44.A pulmonary fellow at a university hospital is asked to consult on a patient in respiratory failure. When the diaphragm contracts, which of the following conditions should normally occur?

(A) Decreased thoracic volume
(B) Increased abdominal volume
(C) Increased lung volume
(D) Air flow out of the bronchi
(E) Increased thoracic pressure

45.
A 32-year-old patient has a tension pneumothorax that can be treated with needle aspiration. To avoid an injury of the intercostal neurovascular bundle, the needle may be inserted in which of the following locations?

(A) Above the upper border of the ribs
(B) Deep to the upper border of the ribs
(C) Beneath the lower border of the ribs
(D) Between the external and internal inter-costals
(E) Through the transversus thoracis muscle

46.
A 57-year-old man made a long airplane trip to Boston, returned home last night, and came to the clinic with a chief complaint of sudden left-sided weakness and garbled speech. After physical examination and reviewing his echocardiograms, his physician diagnosed him as having an ischemic stroke.Which of the following conditions most likely caused the stroke?

(A) Pulmonary stenosis
(B) Mitral valve prolapse
(C) Atrial septal defect
(D) Dextroposition of the aorta
(E) Coronary atherosclerosis

47.
A 7-day-old baby is diagnosed as having congenital neonatal emphysema, which is caused by collapsed bronchi because of failure of bronchial cartilage development. Bronchial cartilages are derived from which of the following derivations?

(A) Ectoderm
(B) Mesoderm
(C) Endoderm
(D) Proctodeum
(E) Neuroectoderm

48. Stenosis of which structure may produce left ventricular hypertrophy?
LOOK AT GRAPH

49. Which structure is most likely to be removed by a pulmonary surgeon in a surgical resection of a lobe
(lobectomy) to remove lung cancer in the apex of the right lung? LOOK AT GRAPH

50. Which structure branches into the bronchial arteries? LOOK AT GRAPH

51. Into which structure does the azygos vein drain venous blood?

52. The left coronary artery arises from which structure?

53. Which structure is crossed superiorly by the aortic arch and left pulmonary artery?

54. Can be removed in a surgical resection of a lobe to remove lung cancer on the diaphragmatic surface?

55. Becomes hypertrophied as result of the pulmonary stenosis?

56. Receives oxygenated blood via pulmonary veins?

57. Lies on the right side of the aortic arch and ascending aorta?

58. Contains the septomarginal trabecula?

59. Takes its origin from the left ventricle and ends at the sternal angle?