Practice Quiz - Thoracic Wall, Pleura, & Pericardium
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  1. The second costal cartilage can be located by palpating the:
    costal margin
    sternal angle
    sternal notch
    sternoclavicular joint
    xiphoid process
  2. The thoracic wall is innervated by:
    Dorsal primary rami
    Intercostal nerves
    Lateral pectoral nerves
    Medial pectoral nerves
    Thoracodorsal nerves
  3. The sternocostal surface of the heart is formed primarily by the anterior wall of which heart chamber?
    Left atrium
    Left ventricle
    Right atrium
    Right ventricle
  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?
    Left atrium
    Left ventricle
    Right atrium
    Right ventricle
  5. You are caring for a 68-year-old male who has copious amounts of fluid in the left pleural cavity due to acute pleurisy. When you examine him as he sits up in bed (trunk upright), where would the fluid tend to accumulate?
    costodiaphragmatic recess
    costomediastinal recess
    cupola
    hilar reflection
    middle mediastinum
  6. A 23-year-old male injured in an industrial explosion was found to have multiple small metal fragments in his thoracic cavity. Since the pericardium was torn inferiorly, the surgeon began to explore for fragments in the pericardial sac. Slipping her hand under the heart apex, she slid her fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. Her fingertips were then in the:
    coronary sinus
    coronary sulcus
    costomediastinal recess
    oblique sinus
    transverse sinus
  7. When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately:
    above the margin of a rib
    below the margin of a rib
  8. A hand slipped behind the heart at its apex can be extended upwards until stopped by a line of pericardial reflection that forms the:
    Cardiac notch
    Costomediastinal recess
    Hilar reflection
    Oblique pericardial sinus
    Transverse pericardial sinus
  9. The first rib articulates with the sternum in close proximity to the:
    Nipple
    Root of the lung
    Sternal angle
    Sternoclavicular joint
    Xiphoid process
  10. The portion of the parietal pleura that extends above the first rib is called the :
    costodiaphragmatic recess
    costomediastinal recess
    costocervical recess
    cupola
    endothoracic fascia
  11. You are attending an operation to remove a thymic tumor from the superior mediastinum. The surgeon asks, "What important nerve lying on and partly curving posteriorly around the arch of the aorta should we be careful of as we remove this mass?" You quickly answer, "The--
    left phrenic
    left sympathetic trunk
    left vagus
    right phrenic
    right sympathetic trunk
  12. In cardiac surgery it is sometimes necessary to clamp off all arterial flow out of the heart. This could be done within the pericardial sac by inserting the index finger immediately behind the two great arteries and compressing them with the thumb of the same hand. The index finger would have to be inserted into which space?
    Cardiac notch
    Coronary sinus
    Oblique pericardial sinus
    Coronary sulcus
    Transverse pericardial sinus
  13. A needle inserted into the 9th intercostal space along the midaxillary line would enter which space?
    Cardiac notch
    Costodiaphragmatic recess
    Costomediastinal recess
    Cupola
    Oblique pericardial sinus
  14. During a heart transplant procedure, the surgeon inserted his left index finger through the transverse pericardial sinus, and then pulled forward on the two large vessels lying ventral to his finger. Which vessels were these?
    Pulmonary trunk and brachiocephalic trunk
    Pulmonary trunk and aorta
    Pulmonary trunk and superior vena cava
    Superior vena cava and aorta
    Superior vena cava and right pulmonary artery
  15. While observing in the OR, you see the resident insert a needle through the body wall just above the ninth rib in the mid-axillary line. She was obviously trying to enter the:
    Costodiaphragmatic recess
    Costomediastinal recess
    Cupola
    Hilar reflection
    Pulmonary ligament
  16. The pleural cavity near the cardiac notch is known as the:
    Costodiaphragmatic recess
    Costomediastinal recess
    Cupola
    Hilum
    Pulmonary ligament
  17. The tubercle of the 7th rib articulates with which structure?
    Body of vertebra T6
    Body of vertebra T7
    Body of vertebra T8
    Transverse process of vertebra T6
    Transverse process of vertebra T7
  18. The ductus arteriosus sometimes remains open after birth requiring surgical closure. When placing a clamp on the ductus, care must be taken to avoid injury to what important structure immediately dorsal to it?
    Accessory hemiazygos vein
    Left internal thoracic artery
    Left phrenic nerve
    Left recurrent laryngeal nerve
    Thoracic duct
  19. A 16-year-old male suffered a stab wound in which a knife blade entered immediately superior to the upper edge of the right clavicle near its head. He was in extreme pain, which was interpreted by the ER physician as a likely indicator of a collapsed lung following disruption of the pleura. If that was true, what portion of the pleura was most likely cut or torn?
    costal pleura
    cupola
    hilar reflection
    mediastinal pleura
    pulmonary ligament
  20. During a lung transplant procedure, an observing 4th year attempted to pass his index finger posteriorly inferior to the root of the left lung, but he found passage of the finger blocked. Which structure would most likely be responsible for this?
    Costodiaphragmatic recess
    Cupola
    Inferior vena cava
    Left pulmonary vein
    Pulmonary ligament
  21. Which of the following layers provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?
    Deep fascia
    Endothoracic fascia
    Parietal pleura
    Visceral pleura
    Transversus thoracis muscle fascia
  22. The lowest extent of the pleural cavity, into which lung tissue does not extend, is known as the:
    costodiaphragmatic recess
    costomediastinal recess
    cupola
    inferior mediastinum
    pulmonary ligament
  23. The sternal angle is a landmark for locating the level of the:
    Costal margin
    Jugular notch
    Second costal cartilage
    Sternoclavicular joint
    Xiphoid process
  24. 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?
    1
    2
    3
    4
    Can't be determined