Practice Quiz - Lungs and Mediastina
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  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
    Cupola
    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?
    Apex
    Cupola
    Hilum
    Lingula
    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?
    Hilum
    Inferior lobe
    Lingula
    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?
    Cupola
    Inferior lobe
    Lingula
    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
    Lingula
    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:
    Carina
    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
    Lingula
    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?
    Left
    Right
  19. Which vessel courses across the mediastinum in an almost horizontal fashion?
    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 the:
    left brachiocephalic vein
    left pulmonary vein
    left bronchial vein
    right pulmonary artery
    right superior intercostal vein
  22. Sympathetic fibers in the greater thoracic splanchnic nerve arise from neuron cell bodies found in the:
    brainstem
    celiac ganglion
    chain ganglion
    spinal cord
    superior mesenteric ganglion
  23. Which nerve fiber would have its cell body in the lateral horn of the spinal cord at segmental level T1?
    Afferent fiber from cutaneous blood vessels of the nose
    Afferent fiber from skin around the nipple
    Efferent fibers to sweat glands in the lumbar region
    Efferent fibers to skin of the forehead
    Parasympathetic fibers to the heart
  24. Gray rami communicantes contain postganglionic sympathetic fibers that innervate which of the following structures in the thoracic region?
    aorta
    heart
    lung
    sweat glands
    trachea
  25. In the midregion of the thorax the thoracic duct lies immediately posterior to the:
    aorta
    azygos vein
    esophagus
    superior vena cava
    trachea
  26. Lymph nodes can be found in which mediastinal compartment(s)?
    Anterior
    Middle
    Posterior
    All of the above
    None of the above
  27. Which structure contains postganglionic sympathetic fibers?
    greater thoracic splanchnic nerve
    recurrent larygneal nerve
    white ramus communicans
    ulnar nerve
    vagus nerve
  28. Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac?
    aorta
    azygos vein
    esophagus
    thoracic duct
    trachea
  29. A tumor of the posterior mediastinum is most likely to compress which of the following structures?
    Arch of the aorta
    Esophagus
    Inferior vena cava
    Pulmonary trunk
    Trachea
  30. The aorta is located in which mediastinal compartment(s)?
    Anterior only
    Anterior and middle
    Middle only
    Middle and posterior
    Posterior only
  31. While performing transesophageal echocardiography on a patient, the posterior wall of the esophagus, immediately behind the left atrium, was punctured from within. The patient subsequently developed an infection in the space around the esophagus at this point, namely the:
    Anterior mediastinum
    Middle mediastinum
    Posterior mediastinum
    Superior mediastinum
  32. Since the puncture in the previous question was through the posterior wall of the esophagus, the doctors were also very concerned about possible damage to a thin-walled vessel just behind the esophagus and between the azygos vein and aorta, i.e., the:
    Hemiazygos vein
    Left bronchial vein
    Left pulmonary vein
    Superior vena cava
    Thoracic duct
  33. During a surgical procedure, a patient's right sympathetic trunk was accidentally severed just cranial to the level of spinal nerve T1. Which function would be left intact in the affected region?
    Arrector pili muscle activity
    Dilation/constriction of blood vessels
    Sweat production
    Visceral reflex activity
    Voluntary muscle activity
  34. Most of the drainage of the thoracic body wall reaches the superior vena cava via the azygos vein. A notable exception is the left superior intercostal vein, which normally drains into the:
    Left brachiocephalic vein
    Left bronchial vein
    Left pulmonary vein
    Left subclavian vein
    Superior vena cava
  35. You are observing a physician perform a thoracoscopic procedure. She pushes the deflated lung anteroinferiorly and points out a nervous structure lying across the heads of the ribs. You identify this structure as the
    Greater thoracic splanchnic nerve
    Sympathetic trunk
    Phrenic nerve
    Pulmonary plexus
    Vagus nerve
  36. An enlarging lymph node gradually constricts the flow of blood in the azygos venous arch. Which vessel would enlarge as a result of collateral drainage?
    Superior vena cava
    Inferior vena cava
    Internal thoracic vein
    Right brachiocephalic vein
    Superior epigastric vein
  37. During a procedure to harvest lymph nodes in the posterior mediastinum, the thoracic duct is accidentally cut. The resulting accumulation of lymph in the pleural cavity is referred to as:
    Pleurisy
    Chylothorax
    Pyothorax
    Hemothorax
    Lymphedema
  38. A cancerous growth from the body of the 9th thoracic vertebra exerts pressure anterolaterally. Which structure lies in direct contact with this growth?
    Right vagus nerve
    Right phrenic nerve
    Right sympathetic trunk
    Right greater thoracic splanchnic nerve
    Right 9th intercostal nerve
  39. A 45-year-old female patient complains of excessive sweating on the right side of the face and neck and in the right armpit region, where it leaves her clothing constantly stained with moisture. It is now such a terrible social embarrassment that she has become withdrawn and self-conscious. Since no medical treatment has proven effective, she is considering surgical denervation of the sweat glands in the affected areas. Which structure(s) might be removed or cut in order to alleviate her condition?
    Cervicothoracic (stellate) ganglion
    Dorsal roots of cervical nerves
    Greater thoracic splanchnic nerve
    Lumbar sympathetic trunk
    Vagus nerve
  40. While viewing an exploratory surgery on a patient injured in an automobile accident, you see the surgeon elevate the esophagus off the vertebral bodies and look in the area between the azygos vein and descending aorta. What structure was she most likely looking for?
    Greater thoracic splanchnic nerve
    Left recurrent laryngeal nerve
    Right pulmonary artery
    Sympathetic trunk
    Thoracic duct
  41. 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
  42. A frail, elderly man, suspected of having widespread cancer of the lungs and bronchi, is brought in for bronchoscopic examination. The instrument is inserted into the airway, where it accidentally punctures the thin, brittle posterior wall of the diseased right main bronchus. A sudden gush of blood immediately indicates that the instrument has also torn the wall of the blood vessel immediately behind the right main bronchus, i.e., the:
    Azygos vein
    Left brachiocephalic artery
    Pericardiacophrenic artery
    Right pulmonary vein
    Superior vena cava