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Cardiac and Pulmonary Pre Block Anatomy Quiz Questions

Blockage of which of the following arteries would lead to ischemia of the apex of the

a. Anterior interventricular (descending)

b. Left circumflex

c. Posterior interventricular (descending)

d. Right marginal

e. Right coronary

A stethoscope placed over the left second intercostal space just lateral to the
sternum would be best positioned to detect sounds associated with which heart

a. aortic

b. pulmonary

c. mitral

d. tricuspid

Which valves would be open during ventricular systole?

a. Aortic and pulmonary

b. Aortic and tricuspid

c. Mitral and aortic

d. Tricuspid and mitral

e. Tricuspid and pulmonary

Which chamber's anterior wall forms most of the sternocostal surface of the heart?

a. Left atrium

b. Left ventricle

c. Right atrium

d. Right ventricle
A 3rd-year medical student was doing her first physical exam. In order to properly
place her stethoscope to listen to heart sounds, she palpated bony landmarks. She
began at the jugular notch, then slid her fingers down to the sternal angle. At which
rib (costal cartilage) level were her fingers?

a. 1

b. 2

c. 3

d. 4

A patient involved in an automobile accident presents with a sharp object puncture

of the middle of the sternum at about the level of the 4th or 5th costal cartilage. If
the object also penetrated pericardium and heart wall, which heart chamber would
most likely be damaged?

a. Left atrium

b. Left ventricle

c. Right atrium

d. Right ventricle

Which statement is true of the right atrioventricular valve?

a. it is also called the mitral valve

b. it is open during ventricular diastole

c. it transmits oxygenated blood

d. it is opened by the pull of chordae tendineae

e. it consists of 2 leaflets

An elderly lady suffers a coronary occlusion and subsequently it is noted that there
is a complete heart block (that is, the right and left bundles of the conduction
system have been damaged). The artery most likely involved is the:
a. acute marginal branch

b. circumflex branch

c. anterior interventricular (Left anterior descending)

d. obtuse marginal

e. posterior interventricular (posterior descending)

During fetal life and sometimes persisting into the adult there is an opening
between the right and left atria; this opening is called the:

a. atrioventricular canal

b. coronary sinus

c. foramen ovale

d. sinus venosus

e. truncus arteriosis

The heart sound associated with the mitral valve is best heard:

a. In the jugular notch

b. In the second left intercostal space

c. In the second right intercostal space

d. In the fifth left intercostal space

e. To the right of the xiphoid process

Which heart valve has leaflets described as "anterior, left and right"?

a. Aortic

b. Pulmonary

c. Left atrioventricular

d. Right atrioventricular

The sound associated with tricuspid stenosis (narrowing) in a 40-year-old male

would be best heard at which location on the anterior chest wall?

a. Below the left nipple

b. In the right 2nd intercostal space near the sternum

c. Over the apex of the heart

d. Over the sternal angle

e. Xiphoid area, just off the sternum

Blockage of blood flow in the proximal part of the anterior interventricular artery
could deprive a large area of heart tissue of blood supply, unless a substantial
retrograde flow into this artery develops via an important anastomosis with which
other artery?

a. Circumflex

b. Left marginal

c. Posterior interventricular

d. Right coronary

e. Right marginal

Traumatic, acceleration/deceleration injuries to the aorta usually occur where its

mobile and fixed portions meet. This would be at the:

a. at the ligamentum arteriosum

b. junction of aortic arch with the descending portion

c. junction of the ascending aorta with the heart

d. origin of the brachiocephalic artery on the arch

e. point where the descending aorta passes through the diaphragm

Elevated systolic blood pressure in the right ventricle suggests stenosis of which

a. Aortic

b. Mitral

c. Pulmonary

d. Tricuspid
During examination of a 62-year-old man, the senior resident tells you to put your
stethoscope on the left 5th intercostal space, slightly below the nipple, and listen
for a clearly audible murmur. You hear it distinctly and know it must be associated
with severe stenosis of which heart valve?

a. Aortic

b. Mitral

c. Pulmonary

d. Tricuspid

A 26-year-old male is brought into the emergency room after having been kicked in
the chest by a horse. After examination, it is concluded that the most likely
immediate danger is cardiac tamponade (bleeding into the pericardial sac). You
prepare to draw off some of the blood from the sac to relieve the pressure on the
heart. The safest site at which to insert the needle of the syringe in order to miss
the pleura would be:

a. Just below the nipple on the left

b. Just to the left of the xiphisternal junction

c. Near the sternal angle

d. Through the jugular notch

e. 4th left intercostal space in the midaxillary line

1. You are called to perform thoracentesis (remove fluid from the pleural
cavity). If you are to avoid injuring lung or neurovascular elements, where
would you insert the aspiration needle?

the top of interspace 8 in the midclavicular line

the bottom of interspace 8 in the midclavicular line

the top of interspace 9 in the midaxillary line

the bottom of interspace 9 in the midaxillary line

the top of interspace 11 in the scapular line

2. The pleural space into which lung tissue just above the cardiac notch would
tend to expand during deep inspiration is the:

Anterior mediastinum

Costodiaphragmatic recess

Costomediastinal recess


Pulmonary ligament

3. Which feature is found only in the left lung?

Cardiac notch

Horizontal fissure

Oblique fissure

Superior lobar bronchus

Three lobes

4. Which of the following nerves would be most vulnerable to irritation when the
tracheobronchial lymph nodes are enlarged due to a diseased situation?

Right phrenic

Left phrenic

Right recurrent laryngeal

Left recurrent laryngeal

Right vagus

5. Which part of the left lung might partially fill the costomediastinal recess in
full inspiration?




Middle lobe

6. The oblique fissure of the right lung separates which structures?

Lower lobe from lingula

Lower lobe from upper lobe only

Lower lobe from both upper and middle lobes

Lower lobe from middle lobe only

Upper from middle lobe

7. In a post-soccer match brawl, a 35-year-old man was stabbed in the back

with a knife that just nicked his left lung halfway between its apex and
diaphragmatic surface. Which part of the lung was most likely injured?


Inferior lobe


Middle lobe

Superior lobe

8. A 4-year-old girl is brought in with coughing, and you are told by her mother
that she had been playing with some beads and had apparently aspirated
one (gotten it into her airway). Where would you expect it to most likely be?

Apicoposterior segmental bronchus of left lung

Left main bronchus

Lingular segment of left lung

Right main bronchus

Terminal bronchiole of right lung, lower lobe

9. Which statement is true about the right lung?

it is slightly smaller than the left lung

it has a lingular segmental bronchus

it occupies the rightmost portion of the mediastinum

its upper lobar bronchus lies behind and above the right pulmonary artery

it has the right phrenic nerve passing posterior to the lung root

10.During a surgical procedure in the vicinity of the descending aorta, a surgeon

accidentally cuts the first aortic intercostal arteries. Which of the following
structures might be deprived of its main source of blood supply?

first posterior intercostal space

first anterior intercostal space

left bronchus

right bronchus

fibrous pericardium

11.A sick person, lying supine in bed, aspirates (breathes in) some fluid into her
lungs while swallowing. It would most likely end up in which of the following
bronchopulmonary segments?

anterior segmental bronchus of right superior lobe

medial segmental bronchus of right middle lobe

superior segmental bronchus of right inferior lobe

medial basal segmental bronchus of left inferior lobe

inferior segmental bronchus of lingular lobe

12.A 22-year-old male involved in a bar-room brawl suffered a stab wound
through the posterior thoracic wall that entered the posterior surface of the
right lung half way between its apex and diaphragmatic surface. Which part
of the lung did the knife first enter?


Inferior lobe


Middle lobe

Superior lobe

13.A 20-year-old man was stabbed in the back with a knife that just nicked his
right lung halfway between its apex and diaphragmatic surface. Which part of
the lung was most likely injured?

Middle lobe

Inferior lobe

Cardiac notch


Superior lobe

14.A 10-year-old boy underwent a tonsillectomy under general anesthesia. At

home he lay supine in bed for two weeks and developed a fever and chest
pain with cough. He returned to the hospital and was diagnosed as having
right lung pneumonia due to aspiration of infectious material during the
tonsillectomy. In which bronchopulmonary segment of the lung would fluid
(pus) most likely have accumulated by the simple force of gravity?

Anterior basal segment--inferior lobe

Anterior segment--superior lobe

Lateral segment--middle lobe

Superior segment--inferior lobe

Superior lingual segment--lingula

15.You are observing a doctor perform a bronchoscopy. As he passes the
bronchoscope down the trachea, a cartilagenous structure is observed
separating the right and left main stem bronchi. He asks what it is called. You
reply that it really does look like a ship's keel and that it is called the:


Cricoid cartilage

Costal cartilage

Pulmonary ligament

Tracheal ring

16.The minor (horizontal) fissure separates:

the lower lobe from the lingula

the upper lobe from the lingula

the lower lobe from both the middle and upper lobes

the lower lobe from the middle lobe

the middle lobe from the upper lobe

17.Your patient, an 86-year-old female who has been bed-ridden and lying
supine for many weeks, has developed a right lung abscess that is draining
by gravity into one particular region of the lung. Where is the most likely site
of fluid accumulation?

Apical segment of upper lobe


Lower lobe

Middle lobe

Superior segment of lower lobe

18.Because of its angle with the trachea and size of the main bronchus, a
bronchoscope would pass more readily into which lung?


19.Which vessel courses across the mediastinum in an almost horizontal


Left subclavian artery

Left subclavian vein

Left brachiocephalic vein

Left internal jugular vein

Left common carotid artery

20.A 78-year-old female presented with edema of the left upper limb due to poor
venous return. Examination revealed an aneurysm of the ascending aorta
that was impinging on a large vein lying immediately anterosuperior to it,
most likely the:

Azygos v.

Internal thoracic v.

Left brachiocephalic v.

Left superior intercostal v.

Right brachiocephalic v.

21.An 8-year-old boy is found to have a mid-line tumor of the thymus gland that
is impinging posteriorly on a blood vessel. The affected vessel is most likely

left brachiocephalic vein

left pulmonary vein

left bronchial vein

right pulmonary artery

right superior intercostal vein