Practice Thorax Questions

These are a sample of questions that are

similar to those you will see on your written
exam. Answers and commentary are given in
notes section of each slide
1. Which of the following structures carries
preganglionic sympathetic fibers?

A. Dorsal root of T1
B. Dorsal ramus of T4
C. Gray ramus communicans of T1
D. Ventral root of C5
E. Ventral root of T2
2. While performing a pleural tap, you ask your
patient to exhale, then insert a needle just
inferior to the right ninth rib in the midaxillary
line. Which structure is at greatest risk of injury?

A. Diaphragm
B. Inferior lobe of the right lung
C. Intercostal neurovascular bundle
D. Pericardial sac
E. Spleen
3. A patient is brought into the Emergency
Department in respiratory distress. Based on this
chest radiograph, what condition is causing this
patient’s distress?

A. Cardiac tamponade
B. Left hemothorax
C. Left tension pneumothorax
D. Right hemothorax
E. Right tension pneumothorax
4. A 60-year-old man presents to the ER with pain that
radiates down the medial side of his left arm. Coupled
with additional tests, he is diagnosed with acute
myocardial infarction. The neuronal cell bodies whose
axons are transmitting this pain sensation from the
affected region of the myocardium are located in the

A. celiac ganglion.
B. T1-L2 sympathetic chain ganglia.
C. cardiac nerves.
D. left greater thoracic splanchnic nerve.
E. T1-T4 dorsal root ganglia.
5. Auscultation of the mitral valve is best
accomplished

A. in the left fifth intercostal space 3.5 cm lateral to

the sternum.
B. in the right second intercostal space adjacent to the
sternum.
C. inferior to the right third costal cartilage.
D. in the left second intercostal space adjacent to the
sternum.
E. in the costodiaphragmatic recess.
6. Which of the following pathways could be
involved in collateral circulation around a
coarctated aorta?

A. Internal thoracic artery - anterior intercostal artery

B. Internal thoracic artery - supreme intercostal artery
C. Vertebral artery - anterior intercostal artery
D. Pulmonary artery - internal thoracic artery
E. Posterior intercostal artery - subclavian artery
7. Somatic sensation, resulting from adhesion
between the visceral and mediastinal parietal
pleura (pleurisy), would travel on which nerve?

A. Phrenic nerve
B. Second intercostal nerve
C. Sympathetic bronchial nerves
D. Third intercostal nerve
E. Vagus nerve
8. A lesion on the moderator band may
interrupt

A. Impulses generated by the sinoatrial node.

B. Impulses traveling on the cardiac plexus.
C. Impulses traveling on the left atrioventricular
bundle.
D. The neural connections between the sinoatrial and
atrioventricular nodes.
E. Purkinje fibers that supply the anterior papillary
muscle.
9. A patient is seen in the emergency department
with a myocardial infarction. An
electrocardiogram and clinical examination reveals
occlusion of the anterior interventricular branch
of the left coronary artery. Which of the following
areas is most likely to be involved?
A. posterior surface of the left ventricle.
B. anterior part of the ventricular septum and anterior
papillary muscle of the left ventricle.
C. posterior wall of the right atrium.
D. atrioventricular bundle.
E. right auricle.
10. A small aortic aneurysm which interferes
with normal speech is also likely to

A. compress the right bronchus.

B. compress the azygos vein.
C. cause pressure on the greater splanchnic nerve.
D. compress the hemiazygos vein.
E. cause pressure on the left vagus nerve.
11. If the wall of the arch of the aorta is split,
blood would be released into the

A. left pleural cavity.

B. right pleural cavity.
C. mediastinum.
D. pericardial cavity.
 12. The arrow
in this picture
points to

A. an aortic coarctation.
B. the adventitia of the
thoracic aorta.
C. the hemiazygos vein.
D. the intimal flap of a
dissecting aortic aneurysm.
E. the wall of the esophagus.
13. A lesion on the thoracodorsal nerve will
cause weakness in which of the following
motions?

A. Elevation of the scapula

B. Extension of the humerus
C. Flexion of the humerus
D. Retraction (adduction) of the scapula
E. Rotation of the scapula
14. What movement does the “bucket handle”
motion during respiration describe?

A. Abnormal movements of sternal flail

B. Depression of the diaphragm
C. Lateral rotation of the floating ribs
D. Lateral rotation of the ribs around an
anterior-posterior axis
E. Sternal movements to increase the anterio-
posterior dimension of the thorax
15. Which of the following muscles is innervated
by motor neurons traveling on dorsal rami of
spinal nerves?

A. Innermost intercostals
B. Levator scapulae
C. Longissimus
D. Pectoralis major
E. Serratus posterior inferior
 Anatomy Review Session
• Referred Pain
– Ex: Phrenic nerve joins with neck/shoulder dermatome
• Knife through left ventricle:
– Skin, external, internal, innermost, costalparietal pleura, visceral pleura, lung, visceral pleura,
mediastinal parietal pleura, fibrous/parietal/viceral layers of the serous pericardium
• Midaxillary thoracenesis
– 9/10th IC Space
• Mediastinal Flutter vs Tension Pneumothorax
– Wavering mediastinum vs full push
• Paradoxical Breathing
– Flail Inspiration/Expiration: less negative pressure area causes wrong way movement
• Carina: right branch is higher (receptacle for foreign objects)
• Lumbar Puncture
– L3,4,5
– With Children: L4 or below
• Intervertebral Disc
– Annulus Firbosus surrounds nucleus pulposus
– LX/Y disc ruptures disrupts lower nerve level

• Spinal Stenosis
– Laminectomy for treatment
– Narroving of spinal column around spinal nerve

• Esophageal Varices
– Portal Hypertension: backs up azygos vein
– Pushes into esphageal wall

• Hiatal Hernias
– Sliding or paraesophageal

• Patent Ductus Arteriosus

– USE DUCT/OCLUDER TO CLOSE
– Causes coarctation of Aorta  collateral pathways  bigger internal thoracic artery
• Purulent Pericaditis
– Fibrous/Parietal/Visceral
– Cardiac Tampanade: heart unable to move within pericardium
• Purulent Pericaditis
– Fibrous/Parietal/Visceral
– Cardiac Tampanade: heart unable to move within pericardium
– Pericardiocentesis to resolve via ECG Monitor
• Aortic Aneurysm
– Prevents blood flow out of major branch arteries
• Aortic Dissection: creation of false lumen
– Pinches off descending arteries
• Tips
– Imaging
– Learning objectives
– THE LIST
– Fascia, planes, structures – physical relationships to one another
– Fiber type, nerves/distribution
– Exceptions to the rule
– Multi-stage questions
– Helpful resources: Umich website