Year Level III, OSI 205 THORAX

Examination Evaluation 1
College of Medicine, University of the Philippines
September 18, 2009

1. A 40-year old female patient accidentally ingested her 12. Which of the following statements is FALSE?
false denture. X-ray of the abdomen didn’t show any A. The surface of the right ventricle consist of
foreign body. The denture would most likely be lodged at small sternocostal and a large diaphragmatic
the area of the: surface of the heart.
A. Stomach B. The infundibulum of the right ventricle is also called
B. Gastroesophageal junction the conus arteriosus.
C. Cricopharyngeus C. The right ventricle is filled with irregular muscular
D. Carina elevation, the trabeculae carnae
D. Septomarginal trabeculae carry the right branch of
2. Which of these structures is the most superficial the atrioventricular bundle.
structure in the superior mediastinum?
A. Left brachiocephalic vein 13. Which of the following is true of the left atrium?
B. Innominate artery A. It is filled with pectinate muscles allowing mixing of
C. Phrenic nerve oxygenated and deoxygenated blood in the fetal
D. Thymus gland heart.
B. Foramen ovale closes with increases left atrial
3. As it courses through the thorax, which of the following pressure after birth, forcing the septum secundum
structures passes anterior to the root of the lung? over the foramen secundum
A. Phrenic nerve C. Left atrium fills up so much of the transverse
B. Vagus nerve pericardial sinus
C. Thoracic duct D. The left atrioventricular orifice is smaller than
D. Splanchnic nerve the right

4. The inferior limit of the anterior mediastinum is bound 14. Which of the following is true?
by which of the following structures? A. Foramen ovale is formed by the foramen primum of
A. T12 the septum secundum.
B. Manubriosternal joint B. The margin of the fossa ovale of the right atrium
C. Diaphragm consists of the septum primum.
D. Pericardium C. Right atrial pressure keeps the foramen ovale
open in the fetal heart.
5. Which of the following occupies a prevertebral location D. Foramen primum closes after birth.
in the posterior mediastinum?
A. Sympathetic trunk 15. Which of the following statements refer to the aortic
B. Vagus nerve valve?
C. Thoracic duct A. The sound generated by this valve is strongest at
D. Aorta the 2nd left intercostals space.
B. The valve is at the level of 4th thoracic vertebrae
6. The left recurrent laryngeal nerve takes off from the C. The valve has posterior, left and right cusps
vagus nerve and before it reaches the tracheoesophageal D. All of the above refer to the aortic valve
groove it goes around which of the following structures?
A. Subclavian artery 16. After the birth, which heart defect will most likely
B. Brachiocephalic vein manifest with cyanosis or presence of deoxygenated blood
C. Arch of the aorta in the arterial circulation?
D. Pulmonary artery A. Patent ductus arteriosus
B. Tetralogy of Fallot
7. At a level just before the esophagus descends though C. Persistent foramen ovale
the diaphragm, which of the following would be the most D. Persistent septum primum
anterior structure?
A. Esophagus 17. Which of the following statements is true?
B. Vagus nerve A. The right coronary artery usually supplies the right
C. Thoracic aorta atrium, right ventricle, interatrial septum, the SA and
D. Thoracic duct AV nodes but not the left atrium and left ventricle.
B. The right coronary artery takes off from the right
For question numbers 8-10, select the answer from the coronary sinus, and runs along the coronary groove
choices given below. between the right atrium and the right ventricle.
C. The branches of the right coronary include the
A. Anterior mediastinum right marginal branch, posterior interventricular
B. Superior mediastinum branch, atrioventricular (AV) nodal artery.
C. Posterior mediastinum D. The right coronary artery is side by side with the
D. Middle mediastinum great cardiac vein.
E. B and C
18. Which of the following structures drain directly to the
8. vagus nerve E right atrium?
9. Internal mammary vessels A A. Anterior cardiac vein
10. ascending aorta D B. Middle cardiac vein
C. Great cardiac vein
11. An 82 year old male presented with acute chest pain D. Marginal vein
and difficulty of breathing. Imaging studies showed
decreases perfusion of the left ventricle. Electro- 19. Which of the following regarding the sinoatrial node is
physiological studies suggest sick sinoatrial node. Which true?
of the following is the LEAST likely to be involved. A. The sinoatrial node is located at the superior end of
A. Right coronary artery sulcus terminalis.
B. Left coronary artery B. The sinoatrial node is supplied by the right
C. Left circumflex artery coronary artery.
D. Left anterior descending artery C. The depolarization of the sinoatrial node is
upregulated by vagus nerve.
D. The sinoatrial node is derived from the wall of
the sinus venosus.
20. Which of the following veins may carry blood to the
myocardium?
A. Venae cordis minimae or Thebesian veins
B. Anterior cardiac veins
C. Great cardiac vain
D. Oblique vein of the left atrium
21. The sound of the mitral valve closure will be heard
best at what part of the chest?
A. Sternum at the level of the 4th costal cartilage
B. Left 2nd intercostal space
C. Right 2nd intercostal space
D. Left midclavicular line, 4th costal cartilage
22. Which of the following structures connects the
pulmonary artery and the aorta in the fetal circulation?
A. Ductus venosus
B. Ligamentum arteriosum
C. Foramen ovale
D. None of the above
23. Which of the following structures connects the
pulmonary artery and the aorta in the fetal circulation?
A. Muscular ventricular septum
B. Spiral septum of the truncus arteriosus
C. Septum primum
D. None of the above
24. Which of the following heart defects does not require a
ventricular septal defect to be compatible with life?
A. Coarctation of the aorta
B. Transposition of great vessels
C. truncus arteriosus
D. Tetralogy of Fallot
25. Which of the following structures does not become
subdivided by a septum during fetal heart development?
A. Truncus arteriosus
B. Primitive atrium
C. Sinus venosus
D. Bulbus cordis
26. In the cadaver, which of the following is true of the
oblique fissure?
A. The oblique fissure is much lower than in life
B. The oblique fissure crosses the inferior border
2 inches from the median plane
C. The oblique fissure is much higher in sitting
position
D. The oblique fissure crosses the posterior border
3.5 inches below the apex
27. The horizontal fissure is described by which of the
following statements?
A. It is an incomplete fissure on the right side
B. It lies at the level of the 6th costal cartilage
C. It runs backward from the anterior border to
meet the oblique fissure in the midlateral line
D. It runs forward from the posterior border to meet
the cardiac notch on the midline
28. A 16 year old obese male was brought to the
emergency room after experiencing a choking fit. He had
been eating peanuts while lying on his back when the
episode occurred. The aspirated peanut is most likely to
be found in which of the following locations?
A. Superior bronchopulmonary segment of the
right lower lobe
B. Inferior bronchopulmonary segment of the right
lower lobe
C. Medial basal bronchopumonary segment of the left
lower lobe
D. Posterior basal bronchopulmonary segment of the
right lower lobe
29. The right pleural reflection diverges gradually from the
median line and leaves the sternum behind which costal
cartilage?
A. 4th costal cartilage
B. 5th costal cartilage
C. 6th costal cartilage
D. 7th costal cartilage
30. The inferior margin of the right pleural reflection is
behind the eight rib at which thoracic surface projection?
A. Midclavicular line
B. Axillary line
C. Midaxillary line
D. Scapular line
31. Which of the following is true of the aortic arch on the
living human?
A. The aortic arch falls 1 inch when assuming the
erect position
B. The aortic arch sinks below the superior
mediastinum
C. The aortic arch is at the level of the cupola
D. The aortic arch elevates 1 inch when assuming the
supine position
32. Which of the following statements accurately locate
the inferior border of the lungs?
A. It is at the same level whether in the living or in the
cadaver
B. It is lowest when the patient is in the prone position
C. it crosses the 3rd, 4th, 5th, and 6th ribs
D. It crosses the 9th, 10th, 11th, and 12th ribs
33. While taking a chest x-ray, a 10 year old boy was told
to take a deep and hold. The x-ray film would show his
tracheal bifurcation at which thoracic vertebral level?
A. T3-T4
B. T4-T5
C. T5-T6
D. T6-T7
34. Based on the lines of pleural reflection, the pleura is in
surgical danger on the following regions, EXCEPT:
A. Right xiphicostal angle
B. Left xiphicostal angle
C. Right costovertebral angle
D. Left costovertebral angle
35. Which of the following is devoid of lymphatic vessels?
A. Visceral pleura of the lungs
B. Surfaces of the lobes
C. Walls of the pulmonary alveoli
D. Bronchopulmonary segments
36. The sympathetic pre-ganglionic fibers that supply the
lungs arise from which of the following segments?
A. Upper 1-2 thoracic spinal cord segments
B. Upper 3-4 thoracic spinal cord segments
C. Cardiac plexus
D. T5-T6 Spinal cord segments
37. Which of the following is the correct orientation of hilar
structures?
A. Pulmonary vein ventral, bronchus dorsal,
pulmonary artery in between
B. Pulmonary artery ventral, pulmonary vein dorsal,
bronchus in between
C. Bronchus ventral, pulmonary artery dorsal,
pulmonary vein in between
D. Hilar structures orientation is not definite
38. Which of the following is true of the apex of the lungs?
A. It rises higher that the oblique plane of the first rib
B. It rises 2cm above the sterna end of the clavicle
C. It is lower by 1.5 cm – 2.5cm from the sterna end
of the clavicle
D. it is limited by the horizontal plane of the first rib
39. Which of the following accurately describes the right
bronchial artery, or arteries, as the case may be?
A. It is a single vessel arising from the first right
aortic intercostals artery
B. There are two in umber and they arise from the
superior bronchial artery on the right
C. It is a single vessel arising from the front of the
thoracic aorta
D. There are two in number and they arise just below
the left
40. Which of theses sets of lymph nodes are located in the 51. Which of the following statements id FALSE with
angle between the two bronchi? regards central chemoreceptors and the cerebrospinal
A. Tracheal or paratracheal fluid (CSF)?
B. Superior tracheobronchial A. Changes in the pH of the CSF affect ventilation by
C. Inferior tracheobronchial acting on these chemoreceptors
D. Bronchopulmonary B. The PCO2 in the CSF parallels the PaCO2
C. The blood-brain barrier is relatively
41. The normal radiologic image f the blood vessels in the impermeable to CO2
lungs are usually clearly seen out to within 1.5 cm of the D. Changes in the CSF bicarbonate concentration
pleural surfaces of the lungs except at the apices where occur over several hours
the distance may be up to ____ from the pleura.
A. 2cm 52. Based on neural transaction studies, apneustic
B. 3cm breathing will occur on which of the following
C. 4cm A. transection of the midbrain
D. 5cm B. transaction of the pons and the vagi
C. transaction of the medulla
42. Which of the following is NOT a bronchopulmonary D. cutting the vagi
segment of the right lobe?
A. Anterior segment of the upper lobe 53. Which of the following describe the ventilator response
B. Posterior segment of the upper lobe to hypercapnia?
C. Superior basal segment of the lower lobe A. It demonstrates an exponential curve in contrast to
D. Medial basal segment of the lower lobe response to hypoxemia
B. If acute, it is more pronounced than response
43. Which structure named below is NOT in the anterior to hypoxemia
mediastinum? C. During sleep, to shows a curve shifted to the left
A. Thymus D. It is due to a decrease in PaCO2
B. Trachea
C. Internal Mammary arteries and veins 54. With regards to breathing and the dorsal respiratory
D. Thyroid gland group (DRG) of neurons,
A. Inspiration begins with the abrupt removal of
44. The normal adult trachea bifurcates at which thoracic excitatory impulses to the DRG
vertebral level? B. There is a paradoxical increase in the activity of
A. T3 vertebral body DRG at the end of expiration
B. T4 vertebral body C. The inspiratory signal provides steady increase
C. T5 vertebral body in the lung volume during inspiration
D. T6 vertebral body D. The end of expiration is signaled by an “off” switch
event
45. Which of the following is NOT found in the posterior
mediastinum? 55. Which of the following refer to slowly adapting
A. Esophagus pulmonary stretch receptors?
B. Thoracic descending aorta A. They can be stimulated by noxious stimuli like
C. Thoracic duct cigarette smoke
D. Phrenic nerve B. They can cause more rapid breathing by
prolonging expiratory phase of respiration
46. The tracheal bifurcation in a child gradually descends C. They can contribute to periodic larger breaths
as he/she grows older. At what age does the tracheal (sighing)
bifurcation generally its adult level? D. They can respond when it senses chest wall
A. At 8 years old movement
B. At 9 years old
C. At 10 years old 56. Which of the following is a physiologic effect during a
D. At 11 years old breath-hold dive?
A. There is a decrease in pulmonary capillary
47. The breast generally lies on the chest wall between pressure
the clavicle and which ribs? B. There is a decrease in pAO2
A. 5th to 7th ribs C. There is a decrease in intrathoracic blood volume
B. 6th to 8th ribs D. There is a decrease in lung volume
C. 7th to 9th ribs
D. 8th to 10th ribs 57. Which of the following result in what is termed
‘shallow-water blackout’ that may occur in breath-hold
48. From a population perspective, at what age group of divers?
women will the mammogram appear radio-graphically A. The reversal of CO diffusion from alveoli to blood
denser? B. The increases in pN2
A. 20 years old C. The decreases in pAO2
B. 30 years old D. The undisturbed transfer of O2 from alveolus to
C. 40 years old tissue
D. 50 years old
58. At high altitude, the percentage of oxygen in
49. Which of the following structure has the least radio- atmospheric air
graphic density on an x-ray film? A. Increases
A. fat B. Decreases
B. lungs C. Remains unchanged
C. bone D. Varies with atmospheric pressure
D. soft tissue
59. Gigi plans to be member of the 2nd Philippine
50. Which of the following is NOT a bronchopulmonary Expedition to Mt. Everest and she asks you what is the
segment of the left lung? PIO2 at the summit. She tells you the BPM up there is
A. Posterior segment of the upper lobe around 250mmHg. You compute the PIO2 to be:
B. Superior lingular segment A. 42.63 mmHg
C. Anterior medial basal segment of the lower lobe B. 52.50 mmHg
D. Posterior basal segment of the lower lobe C. 69.93 mmHg
D. 149 mmHg
60. Gigi appears worried and you try to reassure her that 70. In the act of breathing, energy use is highest during
humans can adapt and acclimatize to high altitude most which phase?
importantly through: A. Start of inspiration
A. An increase in rate and depth of breathing B. Mid inspiration
B. An increase in the concentration of re cells in the C. The end of inspiration
blood to improve O2 carrying capacity D. Peak of expiration
C. Increasing heart rate to improve circulation to the
body tissues 71. Alveolar pores provide for an alternate route for air in
D. Having a higher brain activity case of any obstruction. Where are theses pores found?
A. Alveolar wall
61. When lung compliance is low (stiff lungs), normal B. Interalveolar septum
alveolar ventilation is achieved most efficiently with which C. Opening of the alveoli
breathing pattern? D. Junction of alveoli and bronchioles
A. Rapid, deep breathing
B. Rapid, shallow breathing 72. Defense mechanisms of respiratory system are based
C. Slow, deep breathing on all of the following EXCEPT:
D. Slow, shallow breathing A. Phagocytotic activity of type II pneumocytes
B. Nasal clearance of material
62. Which of the following is true regarding the magnitude C. Mucociliary action for tracheobronchial clearance
of surface tension lowering effect of surfactant on the D. Phagocyte action of alveolar macrophages
alveolar surfaces?
A. The effect is equal across alveoli of different sizes 73. At what point in the respiratory passages do the
B. The effect is different across alveoli of different segment where cartilages first disappear?
sizes A. Bronchus
C. The effect is highest in inflating alveoli B. Terminal bronchiole
D. The effect is highest in deflating alveoli C. Bronchiole
D. Respiratory bronchiole
63. Which of the following is best explained by the
“inverted funnel” model of the respiratory airways? 74. Which of the following does NOT describe the
A. The trachea contributes the least total airway olfactory epithelium?
resistance A. It has serous glands underneath the surface
B. Gas flow velocity is slowest at the trachea and epithelium
fastest in the bronchioles B. It is composed of pseudo-stratified columnar
C. Mass flow of gases continues up to alveolar level with goblet cells
D. Simple diffusion is needed to complete C. Pigment granules are present in supporting cells
intrapulmonary gas exchange D. It contains dendritic processes that serve as the
sensory surface
64. Which gas law governs the mechanical phenomenon
of breathing? 75. The smooth muscle layer is most prominent in which
A. Dalton’s law segment of the respiratory tract?
B. Henry’s law A. Respiratory bronchiole
C. Fick’s law B. Terminal bronchiole
D. Boyle’s law C. Alveolar duct
D. Alveoli
65. Which of the following generates the negative pleural
pressure at the resting state (end of expiration)? 76. Which of the following segment proximal to the
A. The lung elastic tendency to expand and the chest alveolar duct?
wall elastic tendency to collapse A. Bronchiole
B. The lung elastic tendency to collapse and the B. Alveoli
chest wall elastic tendency to expand C. Respiratory bronchiole
C. The combined elastic tendency of the lung and the D. Alveolar sac
chest wall to collapse
D. The combined elastic tendency of the lung and the 77. Which of the following lung cells is also known as
chest wall to expand “congestive heart failure” cells?
A. Type I pneumocyte
66. In the absence of surfactant, the Law of Laplace may B. Type II pneumocyte
be used to explain which of the following phenomenon? C. Macrophage
A. Larger alveoli should empty to smaller alveoli D.Erythrocytes
B. Alveoli of different sizes coexist
C. Smaller alveoli are easier to inflate 78. Which of the following explains respiratory distress
D. Smaller alveoli are likely to collapse syndrome in premature infants?
A. An incomplete endothelial lining
67. Which of the following is measured by spirometry? B. Insufficient development and maturation of
A. Lung compliance Type II pneumocytes
B. Airway resistance C. Lack of maturation of Type I pneumocytes
C. Air in the lungs at any given time D. Disrupted alveolar walls
D. Air that gets in and out of the lungs
79. Glands of Bowman are found in the lamina propia of
68. Which of the following results in a shift of the which structure?
oxyhemoglobin dissociation curve to the left? A. Trachea
A. Hypothermia B. Larynx
B. Hypercapnea C. Nose
C. Hypoxemia D. Pharynx
D. Acidosis
80. All of the following are part of the blood air barrier in
69. CO2 is “drawn inside” the RBC of venous blood the lungs EXCEPT:
because of the presence of… A. Basal lamina of endothelial cells
A. Carbamino hemoglobin B. Alveolar endothelial cells
B. Chloride shift C. Septal cells
C. Carbonic anhydrase D. Type I pneumocyte
D. Iron if the ferrous sulfate
81. When one has to auscultate the chest at the triangle of 89. The manubriosternal junction is a significant
auscultation, the patient is asked to cross his arms at the anatomical landmark. It guides us to these important areas
chest with his body bent. By doing so, this border f triangle of the thoracic wall. Which is NOT included?
is moved away. What makes up this border? A. It corresponds to the level of the carina of the
A. Latissimus dorsi trachea
B. Trapezius B. It divides the mediastinum into the superior and
C. Scapula, vertebral border inferior subdivisions
D. Levator Scapula C. it absolutely corresponds to the level of the second
costal cartilage
82. During inspiration, these events take place. Which of D. It marks the level of the 4th intevertebral disc
the following is NOT included? E. It corresponds to the location of the base of the
A. Forward movement of the sternum as a result of right side of the heart
the movement of the ribs
B. Contraction and subsequent upward pull on the 90. A mailman sustained a penetrating stab would to the
diaphragm anterior chest at the right nipple area, inflicted by an irate
C. Ribs are brought closer to each other customer. What would NOT be an expected finding in this
D. Upward and lateral displacement of the ribs patient?
E. Increases in the negative intrathoracic pressure A. Pneumothorax
B. Hemothorax
83. If you hear an abnormal heart sound that is loudest at C. Laceration of the lung
the area of left chest and at the 2nd intercostals space, D. Laceration in the liver
parasternal border, what heart valve would most probably E. Laceration of the intercostal neurovascular
be producing the abnormal sound? structures
A. Pulmonic valve
B. Aortic valve 91. Which of the following is the main venous drainage
C. Tricuspid valve channel of the breast?
D. Mitral valve A. Internal mammary vein
B. Axillary vein
84. During a radical mastectomy procedure where the C. Intercostal vein
pectoral muscles are removed together with the entire D. Lateral thoracic vein
breast, these structures can be injured. Which of the
following is NOT among them? 92. The elasticity of the thoracic cage is afforded mainly by
A. Intercostobrachial nerve which of the following?
B. Thoracodorsal nerve A. Intercostal muscles
C. Intercostal nerve B. Ribs
D. Long thoracic nerve C. Costal cartilages
E. Lateral pectoral nerve D. Endothoracic fascia

85. A dimpling of the skin of the breast if one of the signs 93. If you want to drain fluid from the pleural cavity by
of breast cancer. This skin change develops because of needing method, your entry to the cavity, in relation to the
the invasion by the cancer of which of the structures? rib, should be:
A. Subdermal lymph nodes A. Midway between the upper and lower ribs
B. Lactiferous ducts and sinuses B. At the inferior border of the rib
C. Glandular elements of the breast C. At the superior border of the rib
D. Deep fascial sheath of the breast and its adjacent D. A and C are correct choices
pectoral fascia E. AT any of the above three sites
E. Ligaments of Cooper
94. If you also want to drain fluid from the pericardial
86. A patient diagnosed to have breast cancer had a bone cavity, you would do it in this manner.
scan done. It revealed lesions involving the thoracic and A. Needle is inserted at the xiphisternal angle and
cervical vertebrae. Cancer cells found their way into these directed to left shoulder at an acute angulation from
bony areas through hematogenous spread via which one the horizontal plane
of the following? B. Needle is inserted at the costomediastinal recess
A. Internal thoracic vein and at the 30 degree angle from the horizontal plane
B. Axillary vein C. Needle is inserted at the xiphisternal angle and
C. Posterior intercostal vein directed to the left shoulder at a 30 degree angle
D. lateral thoracic vein from the horizontal plane
E. Pectoral veins D. Needle is inserted at the xiphisternal angle and
directed to the apex of the heart at a 30 degree angle
87. The glandular, ductal and other tissue elements of the from the horizontal plane
female breast are fully developed by what age?
A. 13 years 95. The xiphisternal junction is an important anatomical
B. 15 years landmark. It points to the following areas. Which of these
C. 18 years is NOT included?
D. 20 years A. Diaphragmatic surface of the liver
E. 25 years B. Inferior boundary of the superior mediastinum
C. Inferior border of the heart
D. Inferior limit of the thoracic cavity anteriorly
88. If you want to drain fluid from the pleural cavity and E. diaphragm
your entry point would be at the midaxillary line, the lowest
point of entry into the cavity can be made at what rib 96. The line of pleural reflection at the level of the
level? midaxillary line would be at the level of the:
A. 7th rib A. 8th rib
B. 8th rib B. 9th rib
C. 9th rib C. 10th rib
D. 10th rib D. 8th intercostal space
E. 11th rib E. 9th intercostal space
97. Which of the following is NOT a potential complication
following a subclavian vein catheterization?
A. Puncture of the cervical pleura
B. Laceration of the subclavian artery
C. Hemothorax
D. Atelectasis of the ipsilateral lung
E. Shifting of the mediastinal contents to the
ipsilateral side

98. Sometimes, the intercostal nerve can be injured during

thoracentesis and the patient will complain to you of
numbness in the area supplied by that intercostal nerve.
An intercostal nerve is found in between what muscles in
the intercostal space?
A. External and internal intercostal muscles
B. Internal intercostal and transverse thoracis
C. Internal and innermost intercostal muscles
D. The nerve is found between the innermost
intercostal and the endothoracic fascia
E. The nerve is found between the parietal pleura and
innermost intercostal muscle

99. When a patient is developing a tension pneumothorax,

the initial site where one can do a needling procedure to
relieve the pressure within the pleural cavity would be at
the:
A. Costomediastinal recess
B. 5th intercostal space, midclavicular line
C. 2nd intercostal space, midclavicular line
D. 9th intercostal space, posterior axillary line
E. 9th intercostal space, midaxillary line

100. When doing a block of the 7th intercostal nerve, the

needle is inserted at the:
A. Superior border of the 7th rib
B. Superior border of the 8th rib
C. Inferior border of the 7th rib
D. Inferior border of the 8th rib
E. Midpart of the 7th intercostal space