1. Thorax Thoracic Wall and Diaphragm 1. Intercostal nerves A.

are the ventral rami of thoracic

spinal nerves B. lie deep to the internal intercostal muscles C. supply the parietal pleura D.
lie above the intercostal vessels in the costal groove E. cross in front of the internal thoracic
artery near the sternum 2. Regarding intercostal nerves A. The anterior primary ramus of the
twelfth thoracic nerve is the subcostal nerve B. The 7th intercostal nerve is a typical spinal
nerve C. They lie in the subcostal groove D. The 4th intercostal nerve supplies only the
thoracic wall E. The 2nd has a supply to the skin of the axilla 3. Regarding intercostal
arteries A. All posterior intercostal arteries arise from the descending aorta B. They lie
superior to the vein and nerve in the costal groove C. All anterior intercostal arteries arise
from the internal thoracic artery D. Posterior intercostal arteries supply the spinal cord 1
2. 10. E. The right third posterior intercostal artery gives off the right bronchial artery 4. External
intercostal muscle A. is innervated by the posterior ramus of the thoracic spinal nerve B. is
derived from the paraxial mesoderm C. extends as far forwards as the costochondral
junction D. has an attachment to the neck of the respective rib E. has fibres directed
downwards and backwards 5. Internal thoracic artery A. arises from the first part of the
subclavian artery B. supplies the upper six intercostal spaces C. supplies the thymus D.
gives off the superior epigastric artery E. terminates in the 5th intercostal space 6. Regarding
intercostal spaces A. External intercostal muscle has fibres directed downwards and
forwards B. Neurovascular bundle runs between the internal and innermost intercostal
muscle layers
3. 11. C. Each intercostal space is supplied by two anterior intercostal arteries D. Posterior
intercostal arteries supplying the first two spaces arise from the descending aorta E. All
anterior intercostal veins drain into the internal thoracic vein 7. The first rib A. Its head
articulates with the body of first thoracic vertebra B. Its neck is related to the sympathetic
trunk C. The inner border gives attachment to the suprapleural membrane D. Has a groove
for the subclavian vein on its inferior surface E. Articulates with the manubriosternal angle 8.
Branches of the internal thoracic artery are A. pericardiacophrenic artery B. posterior
intercostal artery C. superior epigastric artery D. musculophrenic artery E. superior
intercostal artery 9. Primary cartilaginous joints are
4. 12. A. manubriosternal joint B. sternoclavicular joint C. costochondral joint D. first
sternocostal joint E. costotransverse joint 10. Regarding thoracic vertebrae A. The first
thoracic vertebra has a complete facet for the 1st rib B. They have thick bifid spines C.
Transverse process articulates with the neck of the corresponding rib D. The articulation
between two vertebral bodies is synovial E. An inferior costal facet is absent on T9 vertebra
11. Regarding the inlet of the thorax A. The lateral boundary is formed by the inner surface
of the first rib and its costal cartilage B. Manubrium sterni forms the anterior boundary C.
Posterior boundary is formed by the lower border of T4 vertebra D. Brachiocephalic artery
passes through it E. Vertebral artery passes through it 12. The aortic opening in the
diaphragm A. lies anterior to the body of tenth thoracic vertebra
5. 13. B. lies between the crura of the diaphragm C. transmits the sympathetic trunk D.
transmits the vagus nerve E. transmits the azygos vein 13. The thoracic sympathetic trunk A.
is present in the posterior mediastinum B. has ganglia most of which lie anterior to the heads
of ribs C. passes into the abdomen behind the lateral arcuate ligament D. sends
postganglionic fibres to the cardiac plexus E. sends preganglionic fibres to the greater
splanchnic nerve 14. The diaphragm is developed from the A. ventral mesentery of
oesophagus B. dorsal mesentery of oesophagus C. pleuroperitoneal membrane D.
pleuropericardial membrane E. septum transversum 15. Derivatives of the septum
transversum include A. lesser omentum
6. 14. B. Kupffer cells C. ligamentum teres D. falciform ligament E. central tendon of the
diaphragm 16. The oesophageal opening in the diaphragm A. is at the tenth thoracic
vertebral level B. is surrounded by a sling of fibres from right crus C. lies in the central
tendon of the diaphragm D. transmits branches of the right gastric artery E. transmits the
right phrenic nerve 17. Regarding the diaphragm A. The level of the diaphragm is higher in
 the supine position than in the standing position B. The right dome reaches the upper border
of the 5th rib C. The central tendon lies at the level of the xiphisternal joint D. The
hemiazygos vein passes through the right crus
7. 15. E. The sympathetic trunk passes behind the medial arcuate ligament 18. Regarding the
arcuate ligaments of the diaphragm A. The medial arcuate ligament is a thickening of lumbar
fascia B. The medial arcuate ligament has an attachment to the body of first lumbar vertebra
C. The lateral arcuate ligament is the thickening of the fascia of quadratus lumborum muscle
D. The lateral arcuate ligament extends from transverse process of L1 vertebra to the 12th
rib E. Crura develops from the dorsal mesentery of the oesophagus The Thoracic Cavity
Superior Mediastinum 19. The superior vena cava A. is formed by the right anterior cardinal
and right common cardinal veins B. is formed behind the manubrium sterni C. opens into the
right atrium behind the 3rd costal cartilage D. receives the hemi azygos vein E. lies in the
superior mediastinum
8. 16. 20. Regarding the superior mediastinum A. Its anterior boundary is formed by the body of
the sternum B. The arch of the aorta lies within it C. The prevertebral fascial layer is present
within it D. It is separated from the inferior mediastinum by a plane passing through the third
costal cartilage E. It contains the thymus 21. The thoracic duct A. commences at twelfth
thoracic vertebral level B. passes through the aortic opening of the diaphragm C. lies along
the left margin of the oesophagus in the superior mediastinum D. crosses from right to left
side at the fourth thoracic vertebral level E. drains lymph from the right upper limb 22.
Regarding the arch of the aorta A. It commences at the level of the sternal angle B. It is
developed from the third left aortic arch C. Left vagus nerve lies anterior to it D. It forms the
cervical constriction of the oesophagus
9. 17. E. A cardinal sign in the coarctation of aorta is diminished femoral pulse 23. The
ascending aorta A. is an elastic artery B. is developed from the fourth left aortic arch C. lies
posterior to the root of the pulmonary trunk D. is covered by the fibrous pericardium at its
commencement E. is stenosed in tetralogy of Fallot 24. The trachea A. commences at the
inferior border of the cricoid cartilage B. contains incomplete rings of hyaline cartilage C. is
lined by a simple columnar epithelium D. bifurcates at the level of sternal angle E. lies in the
posterior mediastinum 25. Structures present in a cross section of the thorax at the upper
border of the fourth thoracic vertebra include A. arch of aorta
10. 18. B. superior vena cava C. left atrium D. left vagus nerve E. right atrium 26. The trachea A.
is about 10 cm in length B. lies in the midline through out its course C. is supplied by the
inferior thyroid arteries D. has an epithelium derived from the endoderm of the foregut E. is
supplied by the recurrent laryngeal nerves 27. The pulmonary trunk A. lies within the
pericardial sac B. divides at the fourth thoracic vertebral level C. lies posterior to the
transverse sinus D. is stenosed in Fallot’s tetralogy E. is developed from the truncus
arteriosus
11. 19. 28. The left principal (main) bronchus A. is wider than the right principal bronchus B. is
longer than the right principal bronchus C. is developed from the tracheo-bronchial
diverticulum D. divides into two lobar bronchi E. has the root of the pulmonary trunk anterior
to it 29. At the sternal angle A. the first rib articulates with sternum B. the aortic arch ends C.
the trachea bifurcates D. the azygos vein enters the superior vena cava E. the inferior
boundary of the superior medisatinum is demarcated 30. Regarding the development of the
venous system A. Azygos vein is developed from the right supracardinal vein B. Left
brachiocephalic vein is developed from the left supracardinal vein C. The inferior vena cava
has a part developed from the right subcardinal vein D. Right renal vein is developed from
the subcardinal anastomosis
12. 20. E. Common iliac vein is developed from the sacrocardinal anastomosis 31. Veins
draining into the right brachiocephalic vein include A. vertebral B. inferior thyroid C. middle
thyroid D. external jugular E. internal thoracic 32. Structures found in both superior and
posterior mediastina are A. oesophagus B. trachea C. thoracic aorta D. phrenic nerves E.
vagi Anterior mediastinum
13. 21. 33. The thymus A. lies in the anterior mediastinum B. is developed from the 3rd branchial
pouch C. has lymphoid follicles D. involutes after puberty E. is supplied by the inferior thyroid
artery 34. The thymus A. is the only structure lying in the anterior mediastinum B. has a
blood supply from the internal thoracic artery C. regresses soon after birth D. contains
Hassall’s corpuscles E. lies in front of the left brachiocephalic vein Middle mediastinum 35. In
the foetal circulation mixing of oxygenated and deoxygenated blood occurs in the A. left
atrium B. left ventricle C. right atrium D. right ventricle
14. 22. E. liver 36. Embryonic structures that contribute to the inter-atrial septum include A.
septum primum B. septum spurium C. septum secondum D. left valve of sinus venosus E.
right valve of sinus venosus 37. Ligaments that have foetal vessels of origin include A.
median umbilical ligament B. ligamentum teres C. ligamentum venosum D. medial umbilical
ligaments E. gastrosplenic ligament 38. The right atrium A. forms the right border of the heart
B. has a smooth part derived from the right horn of sinus venosus
15. 23. C. has the sinuatrial node in its wall D. has the crista terminalis separating the smooth
and rough parts E. receives the coronary sinus 39. The ductus arteriosus A. represents the
distal portion of the left sixth aortic arch B. is functionally closed shortly after birth C.
connects the pulmonary vein to the aortic arch D. is present as the ligamentum arteriosum at
birth E. shunts blood from the pulmonary trunk to the aorta before birth 40. The right
coronary artery A. arises from the anterior aortic sinus B. supplies blood to the sinu-atrial
node C. is accompanied by the great cardiac vein D. causes an infarction at the apex of the
heart if occluded E. gives off the circumflex branch 41. The left atrium A. forms the major part
of the left border of the heart
16. 24. B. lies behind the right atrium C. has the oblique sinus posterior to it D. lies anterior to the
oesophagus E. receives the four pulmonary veins 42. Regarding the development of the
heart A. The secondary septum completely divides the atrium B. The septum spurium
contributes to the formation of the interatrial septum C. The pulmonary arteries develop from
the right horn of sinus venosus D. The right valve of sinus venosus gives rise to the valve of
the inferior vena cava E. The smooth part of the right atrium is developed from the left horn
of sinus venosus Posterior Mediastinum 43. The descending thoracic aorta A. begins at the
level of the lower border of the fourth thoracic vertebra B. lies in the posterior mediastinum
17. 25. C. gives off the pericardiacophrenic artery D. passes through the diaphragm at the tenth
thoracic vertebral level E. gives off branches to supply the middle third of the oesophagus
44. The azygos vein A. is formed by the union of right subcostal and right ascending lumbar
veins B. passes through the oesophageal opening C. arches over the root of the right lung D.
receives the superior intercostal vein E. drains directly into the right atrium 45. Branches
arising from the descending thoracic aorta are A. third right posterior intercostal artery B.
musculophrenic artery C. superior phrenic artery D. superior intercostal artery E. bronchial
arteries 46. Regarding the thoracic part of the oesophagus A. It lies posterior to the left
bronchus B. It lies anterior to the thoracic duct
18. 26. C. Its wall is composed of smooth muscle along its entire length D. Venous blood from
the thoracic part drains into azygos vein E. The right pulmonary artery is anterior to it 47. The
oesophagus A. is lined by the stratified squamous non keratininsed epithelium B. is
constricted by the right bronchus C. lies posterior to the pericardium and the left atrium D.
passes through both superior and posterior mediastina E. has an arterial supply from the left
gastric artery 48. The right phrenic nerve A. lies in the superior mediastinum B. has the
superior vena cava on its medial side C. is posterior to the thoracic duct D. passes through
the caval opening in the diaphragm E. supplies the fibrous pericardium Lungs and Pleurae
49. The right lung
19. 27. A. has its inferior lobe below and behind the oblique fissure B. has four structures in the
hilum C. has five bronchopulmonary segments in its lower lobe D. has the arch of the aorta
related to its mediastinal surface E. is supplied by two bronchial arteries 50. The parietal
pleura A. extends superiorly up to the neck of the first rib B. is attached to the mediastinal
surface of the fibous pericardium C. is developed from the splanchnic mesoderm D. forms
 the pulmonary ligament E. forms the costo diaphragmatic recess 51. Regarding the
bronchopulmonary segments A. There are eight bronchopulmonary segments in each lung
B. Each segment is pyramidal in shape with the base towards the hilum C. Each segment is
supplied by a lobar bronchus D. It is the smallest part of the lung that could be removed
surgically E. They are supplied by end arteries
20. 28. 52. Regarding the pleura A. The cervical pleura extends above the clavicle B. The
parietal layer is separated from the thoracic wall by the endothoracic fascia C. The parietal
and visceral pleurae are continuous around the root of the lung D. The visceral pleura
extends into the depths of the interlobar fissures of the lung E. The visceral pleura is
sensitive to pain Thorax : Answers and Explanations Thoracic wall and diaphragm 1.
21. 29. A. True – The intercostal nerves are the ventral rami of T1 – T11 spinal nerves B. True -
In the intercostal space the nerve lies in the subcostal groove between the internal
intercostal muscle and innermost intercostal muscles C. True – The collateral branch arising
near the angle of the rib supplies the muscles of that space. It also supplies the parietal
pleura and the parietal peritoneum in the case of the lower nerves D. False – In the costal
groove the nerve lies below the intercostal vessels. The order from above downwards is
vein, artery and nerve E. True 2. A. True B. False – The 3rd to 6th intercostal nerves supply
only the thoracic wall and are called typical nerves. The 7th to 11th nerves supply the
abdominal wall in addition to the intercostal spaces C. True D. True – It is a typical
intercostal nerve E. True – The lateral cutaneous branch of the 2nd intercostal nerve crosses
the axilla to the medial side of the arm as the intercostobrachial nerve and supplies the skin
of the axilla . Not infrequently the lateral cutaneous nerve of the 3rd intercostal nerve also
supplies the skin of the axilla
22. 30. 3. A. False – The 3rd -11th arteries arise from the descending aorta. The 1st and 2nd
arise from the superior intercostal artery which is a branch of the costocervical trunk B. False
– In the costal groove the artery is accompanied by the vein and nerve. The relationship from
above downwards being vein-artery- nerve C. False - The upper six arise from the internal
thoracic artery and the 7th to 9th arise from the musculophrenic artery D. True – The dorsal
branch which supplies the muscles and skin at the back gives off a spinal branch which
supplies the spinal cord and vertebrae. E. True 4. A. False – The intercostal muscles are
innervated by the corresponding intercostal nerve. The intercostal nerves are the anterior
rami of first 11 thoracic spinal nerves. The anterior ramus of the twelfth thoracic nerve lies in
the abdomen and runs forward in the
23. 31. abdominal wall as the subcostal nerve B. True – Although the ribs develop from
sclerotome the intercostal muscles develop from the somatic mesoderm (body wall muscles)
C. True – The muscle extends as far forwards as the costochondral junction and continues
as the anterior intercostal membrane D. False – It is attached to the tubercle of the rib E.
False – The fibres of the external intercostal muscle are directed downwards and forwards.
The fibres of the internal intercostal muscle are directed downwards and backwards 5. A.
True – It is the second branch that arises from the inferior aspect of the first part of the
subclavian artery B. True - It gives off two anterior intercostals to each of the upper six
intercostal spaces C. True - It supplies the thymus via mediastinal branches D. True – The
artery terminates in the 6th intercostal space by dividing into superior epigastric and
musculophrenic artery E. False
24. 32. 6. A. True - The fibres of the external intercostal muscle are directed downwards and
forwards. The fibres of the internal intercostal muscle are directed downwards and
backwards B. False - The intercostal nerves and vessels (neurovascular bundle) run
between the intermediate and innermost layers of muscles C. True - Each intercostal space
contains a large single posterior intercostal artery (branches of the descending thoracic
aorta) and two small anterior intercostal arteries (branches of the internal thoracic artery) D.
False –They arise from the superior intercostal artery. Others arise from the descending
aorta E. False - The upper six drain into the internal thoracic vein and the 7th - 9th spaces
drain into the musculophrenic vein 7. A. True B. True – Anteriorly the neck is related from
 medial to lateral to the sympathetic chain, the first posterior intercostal vein, the superior
intercostal artery and the first thoracic nerve C. True D. False –The groove for the subclavian
vein is on its superior surface anterior to the scalene tubercle. The groove behind the
25. 33. tubercle lodges the subclavian artery E. False – It articulates with the manubrium sterni.
The 2nd rib articulates at the manubriosternal angle 8. A. True – Branches of the internal
thoracic artery include : two anterior intercostal arteries to each space, pericardiacophrenic
artery, mediastinal branches, perforating branches, superior epigastric artery,
musculophrenic artery B. False – Posterior intercostal arteries are 11 in number. 1-2 arise
from the superior intercostal artery and 3-11 arise from the descending aorta. C. True D.
True E. False - The superior intercostal artery is a branch of the costocervical trunk which
comes off from the second part of the subclavian artery. The first and second posterior
intercostal arteries arise from it 9. A. False – The manubriosternal joint is a symphyseal joint.
The joint between the body of the sternum and the xiphoid process (xiphisternal joint) is
another symphysis. B. False – It is a synovial joint C. True – The anterior end of each rib
makes a a primary cartilaginous joint with its costal cartilage (costochondral joint)
26. 34. D. True – The first costal cartilage articulates with the sternum at a primary cartilaginous
joint. The other six costal cartilages (2nd to 7th ) articulate with the sternum at synovial joints
E. False – It is a synovial joint 10. A. True – Except the first, tenth, eleventh and twelfth
vertebrae all others have demi facets to articulate with the respective ribs B. False – This is
not a feature of thoracic vertebrae. Bifid spines are found in some of the cervical vertebrae
(2nd to 6th) C. True D. False – The articulation between two vertebral bodies (the
27. 35. intervertebral disc), is a symphyseal or secondary cartilaginous E. True – The tenth,
eleventh and twelfth vertebrae have only single facets on each side of their bodies for
articulation with the numerically corresponding ribs. The tenth rib has only a single facet on
the head for articulation with the body of the tenth thoracic vertebra. It has no articulation
with the vertebra above. Hence T9 vertebra has no inferior costal facet. 11. A. True B. True
C. False – The posterior boundary is formed by the superior surface of the body of the first
thoracic vertebra D. True E. False – The vertebral artery (right and left) arise from the first
part of the subclavian artery. The vertebral artery enters the foramen transversarium of the
sixth cervical vertebra. It does not pass through the inlet of the thorax 12. A. False – The
aortic opening lies anterior to the body of the twelfth thoracic vertebra B. True - It lies
between the left and right crura which form the
28. 36. median arcuate ligamnet C. True – The sympathetic trunk passes behind the medial
arcuate ligament D. False - It transmits the aorta with azygos vein to the right and the
thoracic duct between them E. True 13. A. False – The thoracic sympathetic trunk lies
posterior to the costovertebral pleura. Hence it is not a content of the posterior mediastinum
B. True – It has about 12 ganglia, most of which lie anterior to the heads of ribs. The stellate
ganglion (the fused first thoracic ganglion and the inferior cervical ganglion) lies anterior to
the neck of the first rib while the lowest three ganglia lie lateral to the corresponding vertebral
bodies C. False – It passes into the abdomen behind the medial arcuate ligament which is
the thickening of the psoas fascia. The subcostal nerve and vessels pass behind the lateral
arcuate ligament which is the thickening of the quadratus lumborum fascia D. True –
Postganglionic sympathetic fibres pass to the cardiac and
29. 37. pulmonary plexuses, trachea, oesophagus, thoracic aorta and its branches, and to each
thoracic spinal nerves E. True – Preganglionic sympathetic fibres are present in the greater
spanchnic nerve which receives branches from the fifth to ninth thoracic sympathetic ganglia
14. A. False – The diaphragm is developed from four embryonic structures namely, the
septum transversum, left and right pleuroperitoneal membranes, dorsal mesentery of the
oesophagus and left and right lateral body wall muscles originating from the lower six
intercostal region B. True C. True D. False E. True 15. A. True – Derivatives of the septum
transversum include the central tendon of the diaphragm, falciform ligament, lesser
omentum,
30. 38. coronary ligaments of the liver, connective tissue and Kupffer cells of the liver and
connective tissue of the gall bladder B. True C. False D. True E. True 16. A. True B. True –
lies within a sling of muscle fibres originating from the right crus C. False – It lies in the
muscular part of the diaphragm. The inferior vena cava passes through the central tendon D.
False – It transmits the oesophageal branches of the left gastric artery E. False – It transmits
the oesophagus, right and left vagus nerves, oesophageal branches of left gastric artery and
lymphatics from the lower part of the oesophagus 17. A. True
31. 39. B. True – The right dome reaches as high as the upper border of the fifth rib whereas the
left reaches the lower border of the fifth rib C. True D. False – The hemiazygos vein passes
through the left crus E. True – The sympathetic trunk passes behind the medial arcuate
ligament which is the thickening of the psoas fascia. The subcostal nerve and vessels pass
through the lateral arcuate ligament which is the thickening of the fascia of the quadratus
lumborum muscle 18. A. False – The medial arcuate ligament is the thickened upper margin
of the fascia covering the anterior surface of the psoas muscle The lateral arcuate ligament
is the thickened upper margin of the fascia covering the anterior surface of the quadratus
lumborum muscle B. False – The medial arcuate ligament extends from the body of the
second lumbar vertebra to the transverse process of first lumbar vertebra C. True D. True
32. 40. E. True The Thoracic Cavity Superior Mediastinum 19. A. True B. False – It is formed
behind the right first costal cartilage by the union of right and left brachiocephalic veins C.
True D. False - Its tributaries are azygos vein, mediastinal and pericardial veins E. True – Its
upper part lies in the superior mediastinum. The lower part lies in the anterior mediastinum
20. A. False – The anterior boundary is formed by the manubrium as the lower boundary of
the superior mediastinum is at T4 level (manubriosternal joint)
33. 41. B. True – The commencement and the termination of the arch of the aorta is at the T4
level (manubriosternal junction). Therefore the arch of the aorta is above this level lying in
the superior mediastinum C. True - The prevertebral fascial layer passes in front of the
vertebral bodies into the superior mediastinum and is attached to the body of the fourth
thoracic vertebra D. False – It is separated from the inferior mediastinum by an imaginary
plane passing through the sternal angle anteriorly and the lower border of the body of the
fourth thoracic vertebra posteriorly E. True – Contents of the superior mediastinum include
the thymus, large veins, large arteries, trachea, oesophagus, thoracic duct and sympathetic
trunks 21. A. True – The thoracic duct commences as a continuation of cisterna chili at the
lower border of the twelfth thoracic vertebra B. True – It passes through the aortic opening of
the diaphragm between the right crus of diaphragm and abdominal aorta C. True – In the
posterior mediastinum the thoracic duct passes upwards in front of T12 to T5 vertebrae and
lies between the
34. 42. azygos vein and descending aorta. It crosses from right to left side behind the
oesophagus at T5 vertebral level. Next it passes in the superior mediastinum along the left
margin of the oesophagus to the neck D. False – It crosses from right to left side at the fifth
thoracic vertebral level E. False – It drains right and left lower limbs, viscera and walls of the
abdomen and pelvis, left half of the thorax, left half of the head and neck and left upper limb.
The right lymphatic duct drains the right upper limb 22. A. True – The arch of the aorta
commences at the level of the sternal angle (T4 level). It passes upwards and backwards
forming an arch in the superior mediastinum. It then passes downwards to the left of the
midline to reach the level of the fourth thoracic vertebra and continues as the descending
aorta B. False - The third left aortic arch gives rise to the left internal carotid artery. The arch
of the aorta is developed from the fourth left aortic arch
35. 43. C. True – Both the left vagus and left phrenic nerves lie anterior to the arch of the aorta
D. False - There are four constrictions in the oesophagus. The first is at the cricopharyngeal
sphincter (ie. 6 inches (15cm) away from incisor teeth). This is called the cervical
constriction. The second is at the crossing of the arch of the aorta (ie 9 inches (22.5 cm) from
the incisor teeth). The third is at where it is crossed by the left bronchus (ie. 11 inches (27.5
cm) from the incisor teeth). The fourth is at where is passes through the diaphragm ( 16
 inches (40 cm) from the incisor teeth) E. True – The pulsation in the femoral arteries of both
lower limbs can be absent or diminished in coarctation of aorta. A collateral circulation helps
to compensate the diminished blood flow
36. 44. 23. A. True – Arteries close to the heart are elastic arteries B. False – The ascending
aorta is developed from the truncus arteriosus. A spiral septum forms within the truncus
arteriosus which separates the truncus into the pulmonary trunk and ascending aorta. The
fourth left aortic arch gives rise to the arch of the aorta C. True D. True – The fibrous
pericardium invests the commencement of great vessels E. False – The abnormalities
present in tetralogy of Fallot are , high ventricular septal defect, an overriding aorta,
pulmonary stenosis and right ventricular hypertrophy 24.
37. 45. A. True – The trachea is the continuation of the larynx and it commences in the neck
below the cricoid cartilage at the level of the sixth cervical vertebra B. True – Its wall contains
16-20 incomplete rings of hyaline cartilage C. False – It is lined by a pseudostratified
columnar ciliated epithelium with goblet cells which is the respiratory epithelium D. True – It
bifurcates into the two main bronchi at the level of the sternal angle (T4-T5 vertebral level) E.
False – It lies in the superior mediastinum and bifurcates at the level of the lower border of
the fourth thoracic vertebra which is the lower boundary of the superior mediastinum 25. A.
True – Structures present in a cross section of the thorax at the upper border of T4 vertebral
level include the arch of the aorta, left and right lungs and pleura, superior vena cava,
trachea,
38. 46. oesophagus, azygos vein, left superior intercostal vein, vagi and right and left phrenic
nerves B. True C. False D. True E. False 26. A. True B. False – It lies in the midline over
most of its length but near the lower end it deviates slightly to the right C. True – Branches
from the inferior thyroid and bronchial arteries form an anastomotic network in the tracheal
wall D. True – Apart from the epithelium, the other structures (cartilage, muscle etc) are
derived from the splanchnic mesoderm E. True – It receives a parasympathetic supply
through vagi and recurrent laryngeal nerves, and sympathetic fibres from the upper ganglia
of the sympathetic trunk to smooth muscles and blood vessels
39. 47. 27. A. True – The fibrous pericardium blends with the wall of the pulmonary trunk up to
its division and thus it lies in the pericardial sac B. False – The pulmonary trunk divides at the
fifth thoracic vertebral level C. False – The pulmonary trunk lies anterior to the transverse
sinus D. True – The abnormalities present in the tetralogy of Fallot are high ventricular septal
defect, an overriding aorta, pulmonary stenosis and right ventricular hypertrophy E. True –
The truncus arteriosus is divided into the pulmonary artery and ascending aorta by the
formation of a spiral septum within it.
40. 48. 28. A. False – The left principal bronchus is narrower, longer and more horizontal than
the right principal bronchus B. True C. True – The lung develops as an outgrowth
(diverticulum) from the ventral aspect of the foregut which gives rise to all parts of the
bronchial tree ie. the trachea, principal bronchi, tertiary bronchi, bronchioles and alveoli. This
diverticulum is called the tracheo-bronchial diverticulum D. True – The left principal bronchus
divides into two lobar bronchi and the right principal bronchus into three lobar bronchi E.
True – The immediate relation of the left principal bronchus is the pulmonary trunk. The arch
of the aorta lies superior to the left principal bronchus. 29. A. False – The sternal angle is the
junction of the manubrium and the
41. 49. body of the sternum. It is located at the level where the second costal cartilage
articulates with the sternum. At this level lies the bifurcation of the trachea, origin and
termination of the aortic arch and the opening of the azygos vein into the superior vena cava.
It marks the end of the arch of the aorta and the beginning of the descending aorta. It
demarcates the inferior boundary of the superior mediastinum B. True C. True D. True E.
True 30. A. True - The azygos system of veins develop from the left and right supra cardinal
veins and supra cardinal anastomosis. Left supra cardinal vein and supra cardinal
anastomosis give rise to the hemiazygos vein and the right supracardinal vein gives rise to
 the azygos vein B. False – The left brachiocephalic vein develops from the left anterior
cardinal vein and anterior cardinal anastomosis
42. 50. C. True – The inferior vana cava develops from several embryonic veins. From above
downwards it develops from the right vitelline vein (later becomes the right hapatocardiac
channel), right subcardinal vein, right sacrocardinal vein and sacrocardinal anastomosis D.
False – The right renal vein has no embryonic vein of origin. The subcardinal anastomosis
gives rise to the left renal vein. E. True 31. A. True – Both right and left brachiocephalic veins
receive vertebral, inferior thyroid and internal thoracic veins (tributaries corresponding to the
branches of the first part of the subclavian artery). In addition the left brachiocephalic vein
receives the superior intercostal vein B. True C. False – The middle thyroid vein drains into
the internal jugular vein D. False – The external jugular vein drains into the subclavian vein
43. 51. E. True 32. A. True – The superior mediastinum contains the thymic remnants, internal
thoracic arteries and veins, brachiocephalic veins, upper half of the superior vena cava, the
aortic arch, the braciocephalic artery, left common carotid artery, subclavian arteries, the left
superior intercostal vein, the vagus, cardiac, phrenic, and left recurrent laryngeal nerves, the
trachea, oesophagus, the superficial part of the cardiac plexus and thoracic duct. The
posterior mediastinum contains the oesophagus, thoracic aorta, azygos, hemiazygos and
accessory azygos veins, the vagus and splanchnic nerves, thoracic duct and the posterior
mediastinal lymph nodes. Hence the structures contained in both mediastina are the
oesophagus, vagi and thoracic duct B. False – The trachea ends and bifurcates into left and
right bronchi at the sternal angle – the lower limit of the superior mediastinum C. False – The
thoracic aorta which is the continuation of the arch of the aorta begins at the level of the
sternal angle and is located in the posterior mediastinum D. False – The phrenic nerves pass
through the superior mediastinum
44. 52. and the middle mediastinum only E. True Anterior mediastinum 33. A. True – The thymus
lies in both the superior and anterior mediastina. B. True – It develops from the ventral wing
of the third branchial pouch C. False – The thymus consists of lymphoid cells arranged in
lobes and lobules D. True– It is large and active during infancy and childhood and remains
active up to puberty after which it involutes E. True – The inferior thyroid artery and branches
of the internal thoracic artery supply the thymus 34. A. False – The anterior mediastinum
contains the thymus (or its remnants), a few lymph nodes and branches of the internal
thoracic vessels B. True - The inferior thyroid artery and branches of the internal thoracic
artery supply the thymus
45. 53. C. False – It is largest in the early part of life up to adolescence, although its activity
continues into old age D. True – Some of the epithelial cells become thymic (Hassall’s)
corpuscles and the others form an epithelial network E. False – The thymus lies in front of
the upper pericardium and great vessels Middle mediastinum 35. A. True – Mixing of
oxygenated blood from the inferior vena cava via the foramen ovale and deoxygenated blood
from the pulmonary veins occur in the left atrium B. False – Left ventricle receives
oxygenated blood from the left atrium and no deoxygenated blood enters into it
46. 54. C. True – Mixing of oxygenated blood from the inferior vena cava and deoxygenated
blood from the superior vena cava occurs in the right atrium D. False - The right ventricle
receives deoxygenated blood from the superior vena cava (via the right atrium) and no
oxygenated blood enters into it E. True – Oxygenated blood entering the liver via the left
umbilical vein (from the placenta) mixes with the deoxygenated blood from the portal vein 36.
A. True – The interatrial septum is developed from the septum primum, septum secundum,
septum spurium and the left valve of sinus venosus. The right valve of sinus venosus gives
rise to the crista terminalis and valves of the coronary sinus and inferior vena cava B. True
C. True D. True
47. 55. E. False 37. A. False – The median umbilical ligament is the urachus (a derivative of
distal urogenital sinus) which is not a foetal vessel B. True – The ligamentum teres is the
obliterated left umbilical vein which carries oxygenated blood from the placenta to the foetus
during foetal life C. True – The ligamentum venosum is the obliterated ductus venosus which
 shunts oxygenated blood from the left umbilical vein to the right hepatocardiac channel
which will be the post hepatic part of the inferior vena cava D. True – The left and right
umbilical arteries which carry deoxygenated blood from the foetus to the placenta form the
medial umbilical ligaments (distal part) and the superior vescical arteries (proximal part)
48. 56. E. False – The gastrosplenic ligament is a derivative of the dorsal mesentery of the
stomach and hence is not a foetal vessel 38.
49. 57. A. True - The right border of the heart is formed by the right atrium, the left border by the
left atrium and left ventricle. The lower border or base is formed by the left and right
ventricles. The upper border is related to the ascending aorta, pulmonary trunk and superior
vena cava B. True - The right atrium has a smooth part and a rough part separated by the
crista. The smooth part is derivedfrom the absorbed right horn of the sinus venosus and
sinus venosus. The rough part is the right side of the primitive common atrium from the right
horn of the sinus venosus C. True – Both the sinuatrial and atrioventricular nodes are
located in the wall of the right atrium D. False – The crista terminalis is developed from the
upper part of the right valve of sinus venosus and separates the smooth and rough parts of
the right atrium E. True – The right atrium receives the superior vena cava, inferior vena
cava and the coronary sinus
50. 58. 39. A. True – It represents the distal portion of the of the left sixth aortic arch and
connects the left pulmonary artery to the aortic arch closer to the commencement of the
descending aorta B. True – It is functionally closed shortly after birth; however, its structural
closure takes place after several months C. False – It connects the pulmonary artery to the
aortic arch D. True – At birth, with the pulmonary circulation, the release of Bradykinin leads
to the contraction of ductus arteriosus. It gradually becomes a ligament E. True – It shunts
blood from the pulmonary trunk to the aortic arch before birth, by passing the pulmonary
circulation 40. A. True – Arising from the anterior aortic sinus on the right side of the
pulmonary trunk the artery passes between the right auricle and the pulmonary trunk and
descends in the anterior atrioventricular groove
51. 59. B. True – The artery to the SA node supplies the SA node and right and left
atrioventricular bundles C. False – It accompanies the small cardiac vein in the anterior
interventricular groove and accompanies the coronary sinus in the right posterior coronary
sulcus. The great cardiac vein passes in the anterior interventricular groove along with the
anterior interventricular artery, a branch of the left coronary artery D. False – The apex of the
heart receives blood from the anterior interventricular branch of the left coronary artery and
not by a branch of the right coronary artery E. False – The branches arising from the right
coronary artery are conus artery, SA nodal artery, marginal artery, AV nodal artery and
posterior interventricular branch. The circumflex artery is a branch of the left coronary artery
52. 60. 41. A. False – The left border of the heart is formed mostly (4/5ths) by the left ventricle,
with the auricle of the left atrium forming the uppermost part (1/5th ). B. True - The left atrium
forms the posterior surface (base) of the heart and lies behind the right atrium C. True – The
oblique sinus lies posterior to the left atrium and the transverse sinus lies anterior to the left
atrium D. True – Its posterior relations are the oesophagus and descending thoracic aorta E.
True – The four pulmonary veins, two on each side on its posterior wall open in to the left
atrium. These veins do not have valves 42. A. False - The common atrium is separated by
the interatrial septum which in developed from four embryonic parts. They are the septum
primum, septum secondum, septum spurium and the left value of sinus venosus. B. True C.
False - The pulmonary arteries develop from the proximal part of the sixth aortic arches on
left and right sides. The right horn
53. 61. of sinus venosus along with the sinus venosus gets absorbed into the right side of the
common atrium giving rise to the smooth part of the right atrium. D. True - Upper half of the
right valve of sinus venosus gives rise to the crista terminals and from the lower half
develops the valves of the coronary sinus and inferior vena cava. E. False- Smooth part of
the right atrium is developed from the sinus venosus and its right horn. The coronary sinus
develops from the left horn of sinus venosus. Posterior Mediastinum 43. A. True – The
 descending thoracic aorta is the continuation of the arch of the aorta. The arch ends at the
fourth thoracic vertebral level and the descending aorta begins at this level B. True C. False
–The pericardiacophrenic artery arises from the internal thoracic artery D. False – It passes
through the diaphragm at T12 vertebral level E. True – The upper part of the oesophagus
(the cervical part) is supplied by branches of the inferior thyroid arteries. The middle part (the
thoracic part) is supplied by oesophageal
54. 62. branches of the descending thoracic aorta and bronchial arteries. The lower part is
supplied by the oesophageal branches of the left gastric artery 44. A. True B. False – It
enters the thorax by passing through the aortic opening of the diaphragm C. True - It
ascends upto the 4th thoracic vertebral level and arches forwards over the root of the right
lung and ends by opening into the superior vena cava D. True – Its tributaries are superior
intercostal vein formed by 2nd, 3rd, 4th posterior intercostal veins, 5th 11th posterior
intercostal veins, hemiazygos and accessory hemiazygos, oesophageal, pericardial and
mediastinal veins, and the right bronchial vein. E. False – The azygos vein drains into the
superior vena cava. The right atrium receives the superior vena cava, inferior vena cava and
the coronary sinus. 45. A. True – The descending aorta gives off nine pairs of posterior
55. 63. intercostal arteries (for 3rd -11th spaces), a pair of subcostal arteries, bronchial arteries,
oesophageal vessels, pericardial branches and superior phrenic arteries B. False – The
musculophrenic artery is a terminal branch of the internal thoracic artery C. True D. False –
The superior intercostal artery is a descending branch of the costocervical trunk which
comes off from the second part of the subclavian artery E. True 46. A. True – The anterior
relations of the thoracic part of the oesophagus from above downwards are: the trachea and
the left recurrent laryngeal nerve; the left principal bronchus and the right pulmonary artery;
and the pericardium which separates it from the left atrium B. True – The thoracic part of the
oesophagus lies anterior to the bodies of the thoracic vertebrae, thoracic duct, azygos vein,
right
56. 64. posterior intercostal arteries and at the lower end the descending thoracic aorta C. False
– The muscularis externa of the oesophagus in the upper third is composed of skeletal
muscle; the middle third is composed of both skeletal and smooth muscle; and the lower
third is composed of smooth muscle D. True – The veins from the upper third drain into the
inferior thyroid veins, from the middle third into the azygos veins and from the lower third into
the left gastric vein, a tributary of the portal vein E. True – Just below the bifurcation of the
trachea in the posterior mediastinum the oesophagus is crossed anteriorly by the left main
bronchus and the right pulmonary artery 47. A. True B. False – The oesophagus has three
anatomic constrictions. The first is pharyngo-oesophageal junction, the second is where
aortic arch and left bronchus cross its anterior surface, and third occurs where the
oesophagus passes through the diaphragm
57. 65. C. True – It lies posterior to the trachea and the left recurrent laryngeal nerve; the left
principal bronchus and the right pulmonary artery; and the pericardium which separates it
from the left atrium D. True E. True – The upper third of the oesophagus is supplied by the
inferior thyroid artery, the middle third by branches from the descending thoracic aorta, and
the lower third by branches from the left gastric artery 48. A. True – Nerves lying in the
superior mediastinum are : phrenic, vagus and cardiac nerves, and left recurrent laryngeal
nerve B. True – The right brachiocephalic vein, superior vena cava, the pericardium over the
right atrium and the inferior cava lie on its medial side C. False – The right phrenic is not
related to the thoracic duct D. True – Its terminal branches pass through the caval opening in
the central tendon to supply the undersurface of the diaphragm
58. 66. E. True – The phrenic nerve supplies the mediastinal pleura, fibrous pericardium, parietal
layer of the serous pericardium Lungs and Pleurae 49. A. True – The right lung has three
lobes. The inferior lobe is below and behind the oblique fissure. The part of right lung in front
and above the oblique fissure is subdivided in to the superior lobe and middle lobe by the
horizontal fissure. The left lung has two lobes, superior and inferior, sparated by the oblique
fissure B. False – The right lung has five structure in the hilum, namely the two pulmonary
 veins, one pulmonary artery, upper lobar bronchus and right principal bronchus. The left has
four structures in the hilum, namely the two pulmonary veins, one pulmonary artery and the
left principal bronchus
59. 67. C. True – It has three, two and five bronchopulmonary segements in the upper, middle
and lower lobes respectively D. False – The arch of the aorta is related to the mediastinal
surface of the left lung. The azygos vein is related to the mediastinal surface of the right lung
E. False – It is supplied by a single bronchial artery 50. A. True – The parietal pleura is
attached to the inferior surface of the suprapeural membrane and extends up to the neck of
the first rib B. True
60. 68. C. False – The parietal pleura is developed from the somatic mesoderm and the visceral
pleura from the visceral (splanchnic) mesoderm D. True – From the mediastinal layer of the
parietal a cuff of membrane surrounds the hilum of the lung (the root of lung) which forms the
pulmonary ligament inferiorly and continues with the visceral pleura. E. True – The parietal
pleura lines the inner surface of the thoracic wall (rib cage, vertebrae and diaphragm). The
recess formed by the parietal pleura inferiorly between the ribs and the diaphragm is the
costo diaphragmatic recess. 51. A. False – There are ten bronchpulmonary segments in
each lung and each of the ten bronchopulmonary segments have ten segmental bronchi B.
False – Each bronchopulmonary segment is pyramidal in shape with the base towards the
lung surface and apex towards the
61. 69. hilum C. False – Each segment is supplied by a segmental brochuus. Lobar bronchi
supply the lobes of the lung (two lobar bronchi in the left lung and three lobar bronchi in the
right lung) D. True – It is the smallest part of the lung that could be surgically removed with
minimal bleeding and damage E. True – This is important because if this artery gets blocked
that part will become an infarct 52. A. True – The cervical pleura extends up into the neck
above the clavicle up to the level of the neck of the first rib, lining the undersurface of
suprapleural membrane. It reaches a level 1- 1.5 inches (2.5 – 4 cm) above the medial third
of the clavicle B. True – The parietal layer of pleura lines the thoracic wall. Loose areolar
tissue separates it from the endothoracic fascia which is an extrapleural sheet of fascia that
lines the thoracic wall C. True – The two layers are continuous with one another by means of
62. 70. a cuff of pleura that surrounds the structures entering and leaving the lung at the hilum of
each lung. This pleura extends for a distance below the hilum froming a double layered fold
called the pulmonary ligament D. True E. False – It is sensitive to stretch, but is insensitive to
common sensations such as pain and touch. The parietal pleura is sensitive to pain,
temperature and pressure 2