Thorax

Questions and Answers

 Surface anatomy

• 1. A 32-year-old patient who weighs 275 lb

comes to the doctor’s office. On the surface of
the chest, the physician is able to locate the
apex of the heart:
– (A) At the level of the sternal angle
– (B) In the left fourth intercostal space
– (C) In the left fifth intercostal space
– (D) In the right fifth intercostal space
– (E) At the level of the xiphoid process of the sternum
 Respiration

• 2. A 43-year-old female patient has been lying

down on the hospital bed for more than 4 months.
Her normal, quiet expiration is achieved by
contraction of which of the following structures?
– (A) Elastic tissue in the lungs and thoracic wall
– (B) Serratus posterior superior muscles
– (C) Pectoralis minor muscles
– (D) Serratus anterior muscles
– (E) Diaphragm
 respiration

• Normal, quiet expiration is achieved by contraction

of extensible tissue in the lungs and the thoracic wall.
• The serratus posterior superior muscles,
• diaphragm,
• pectoralis major,
• and serratus anterior are muscles of inspiration.
 Sympathetic system

• 3. A 23-year-old man received a gunshot wound, and

his greater splanchnic nerve was destroyed. Which of
the following nerve fibers would be injured?
– (A) General somatic afferent (GSA) and preganglionic
sympathetic fibers
– (B) General visceral afferent (GVA) and postganglionic
sympathetic fibers
– (C) GVA and preganglionic sympathetic fibers
– (D) General somatic efferent (GSE) and postganglionic
sympathetic fibers
– (E) GVA and GSE fibers
 Thoracic Splanchnic Nerves

• Contain sympathetic preganglionic GVE fibers with cell bodies located in the lateral horn
(intermediolateral cell column) of the spinal cord and GVA fibers with cell bodies located in
the dorsal root ganglia.
• Greater Splanchnic Nerve
– Arises usually from the fifth through ninth thoracic sympathetic ganglia
– perforates the crus of the diaphragm or occasionally passes through the aortic hiatus,
– and ends in the celiac ganglion.

• Lesser Splanchnic Nerve

– Is derived usually from the 10th and 11th thoracic ganglia,
– pierces the crus of the diaphragm,
– and ends in the aorticorenal ganglion.

• Least Splanchnic Nerve

– Is derived usually from the 12th thoracic ganglion,
– pierces the crus of the diaphragm,
– and ends in the ganglia of the renal plexus.
 Answer

• The greater splanchnic nerves contain general visceral afferent (GVA) and
preganglionic sympathetic general visceral efferent (GVE) fibers.

• The white rami communicantes contain preganglionic sympathetic GVE

fibers and GVA fibers whose cell bodies are located in the lateral horn of
the spinal cord and the dorsal root ganglia.

• The sympathetic chain ganglion contains cell bodies of the postganglionic

sympathetic nerve fibers.

• The anterior horn of the spinal cord contains cell bodies of the GSE fibers.
• The dorsal root ganglion contains cell bodies of GSA andGVA fibers.
 Heart

• 4. A 27-year-old cardiac patient with an irregular

heartbeat visits her doctor’s office for examination.
Where should the physician place the stethoscope to
listen to the sound of the mitral valve?

– (A) Over the medial end of the second left intercostal space
– (B) Over the medial end of the second right intercostal space
– (C) In the left fourth intercostal space at the midclavicular line
– (D) In the left fifth intercostal space at the midclavicular line
– (E) Over the right half of the lower end of the body of the
sternum
 lungs

• 5. A thoracic surgeon removed the right middle lobar

(secondary) bronchus along with lung tissue from a 57-
year-old heavy smoker with lung cancer. Which of the
following bronchopulmonary segments must contain
cancerous tissues?

– (A) Medial and lateral

– (B) Anterior and posterior
– (C) Anterior basal and medial basal
– (D) Anterior basal and posterior basal
– (E) Lateral basal and posterior basal
 Sternal Angle (Angle of Louis)

• Is the junction between the manubrium and the body of

the sternum.

• Is located at the level where:

– The second ribs articulate with the sternum.
– The aortic arch begins and ends.
– The trachea bifurcates into the right and left bronchi at the
carina.
– The inferior border of the superior mediastinum is demarcated.
– A transverse plane can pass through the intervertebral disk
between T4 and T5.