GROSS ANATOMY

SELF-EVALUATION EXAM - THORAX

by O.W. Henson, Jr., Ph.D.

University of North Carolina, Chapel Hill

Answer each question True (T) or False (F)

Straight in, penetrating wounds of the anterior chest wall and the anterior or sternocostal surface of the heart could damage:

_____ 1. the right ventricle since this forms a large part of the anterior surface of the heart.

_____ 2. the left ventricle since this chamber forms part of the anterior surface of the heart.

_____ 3. the left atrium which lies anteriorly along the lower border of the body of the sternum.

_____ 4. the vessels in the anterior interventricular sulcus which lie lateral to the left

margin of the body of the sternum.

The structures within or partially within the pericardial sac include:

_____ 5. the superior vena cava.

_____ 6. the azygos vein.
_____ 7. the ascending aorta.
_____ 8. the entire pulmonary trunk.

Which of the following procedures would be expected to accomplish the stated goals:

_____ 9. crushing or sectioning the phrenic nerves to relieve spasms of the diaphragm or chronic hiccups.

_____ 10.sectioning the sympathetic trunk to cause vasodilation of the skin.

_____ 11.sectioning the dorsal root of a spinal nerve to relieve pain distributed along

the course of the nerve.

_____ l2. sectioning the ventral root of a spinal nerve to interrupt the motor supply to striated (voluntary) muscle fibers.

The thoracic part of the sympathetic nervous system includes:

_____ 13.a series of ganglia which correspond approximately in number to that of the thoracic spinal nerves.

_____ 14.rami communicantes which connect each ganglion with a splanchnic nerve.

_____ 15.postganglionic fibers which are distributed to the thoracic & abdominal walls via the intercostal nerves.

_____ 16.white rami communicantes whose efferent fibers synapse in either the sympathetic chain ganglia or ganglion cells within the walls of the thoracic and abdominal viscera.

Sectioning a typical thoracic spinal nerve at the intervertebral foramen would result in:

_____ 17. loss of some sensory fibers to the skin on both the anterior (ventral) and posterior (dorsal) surfaces of the body.

_____ 18. loss of some preganglionic sympathetic nerve fibers.

_____ 19. loss of some preganglionc parasympathetic nerve fibers.

_____ 20. denervation of some skeletal muscle fibers.

The fibrous pericardium:

_____ 2l. is a dense layer of connective tissue that is continuous superiorly with the external coats of the great vessels.

_____ 22. is adherent inferiorly to the diaphragm.

_____ 23. is continuous with the fibrous layer of the mediastinal pleura.

_____ 24. is confined to the middle mediastinum.

The serous pericardium:

_____ 25. lines the inner surface of the fibrous pericardium and covers the outer surface of the heart.

_____ 26. encloses the ascending aorta and pulmonary trunk.

_____ 27. covers only the heart & is synonymous with epicardium.

_____ 28. is separated from the fibrous pericardium by a thin film of fluid.

The coronary sulcus:

_____ 29. is deficient in front where it is crossed by the root of the pulmonary trunk.

_____ 30. contains the right and left coronary arteries and the coronary sinus.

_____ 31. contains portions of the great and small cardiac veins.

_____ 32. is synonymous with the interventricular groove.

Paracentesis of the pericardium (the draining of fluid from the pericardial cavity) may be performed by inserting a hollow needle through the 5th or 6th intercostal space near the left margin of the sternum. With this procedure one would expect that:

_____ 33. care would have to be taken to avoid the internal thoracic vessels.

_____ 34. the needle would penetrate the muscle fibers of the external intercostal muscle.

_____ 35. the needle would penetrate the fibrous layer of the pericardium.

_____ 36. the anterior interventricular artery might be damaged.

In PA radiographs of the chest, the shadow of the left border of the mediastinum is formed by:

_____ 37. a portion of the arch of the aorta.

_____ 38. the pulmonary trunk and left pulmonary artery which lies just below the arch of the aorta.

_____ 39. the left auricle which lies just below the pulmonary trunk.

_____ 40. the left ventricle.

A patient was known to have a sudden effusion of blood into the pericardial sac. On the basis of normal anatomy, you would expect:

_____ 4l. little dilation of the sac due to the presence of the dense fibrous layer of the pericardium.

_____ 42. compression of the relatively thin-walled veins (superior and inferior venae cavae) which lie partially within the pericardial sac.

_____ 43. the blood to collect in the oblique pericardial sinus when the patient is supine.

_____ 44. some leakage of blood into the pleural cavities through the pleuro-pericardial canals.

The pectoralis major muscle:

_____ 45. receives blood from branches of the thoracoacromial artery.

_____ 46. is pierced by lymphatics from the breast which drain into the axillary lymph nodes.

_____ 47. forms the substance of the anterior axillary fold.

_____ 48. is partly innervated by the medial pectoral nerve which also innervates the pectoralis minor muscle.

The intercostobrachial nerve usually:

_____ 49. emerges from the third intercostal space.

_____ 50. supplies sensory and autonomic innervation to the axilla and the medial side of the arm.

_____ 51. contains parasympathetic fibers.

_____ 52. is accompanied by the intercostobrachial artery.

During respiration:

_____ 53. the transverse diameter of the thoracic cage is changed largely by movements of the lower ribs.

_____ 54. the anteroposterior diameter of the thoracic cage is changed largely by movements of the upper ribs.

_____ 55. the lungs can follow the excursion of the thoracic cage largely because of the in-rush of air on inspiration.

_____ 56. the diaphragm contracts and the dome moves downward during expiration.

The tela subcutanea:

_____ 57. is also known as superficial fascia.

_____ 58. conveys the blood vessels and nerves that supply skin.

_____ 59. may contain striated muscle fibers.

_____ 60. contains lymphatic vessels.

On the surface of the body one can often palpate or see the position of the:

_____ 6l. sternal angle.

_____ 62. coracoid process.
_____ 63. xiphisternal junction.
_____ 64. tip of the xiphoid process.

In PA radiographs of the chest, the shadow of the right mediastinal border is formed by or marks the position of:

_____ 65. the line of reflection where the right costal pleura reflects onto the mediastinum.

_____ 66. the right atrium.
_____ 67. the aorta.
_____ 68. the pulmonary trunk.

The cephalic vein is often used for inserting catheters or the electrodes of cardiac pacemakers. This vein:

_____ 69. lies in the interval between the deltoid and pectoralis major muscles.

_____ 70.is accompanied through part of its course by the deltoid branch of the thoracoacromial artery.

_____ 71. is accompanied by the cephalic nerve.

_____ 72. perforates the costocoracoid membrane and empties into the axillary vein.

With regard to topographic relations in the thorax the:

_____ 73. jugular notch marks the upper border of the manubrium of the sternum and lies at the level of the first thoracic vertebra.

_____ 74. pulmonary valve lies approximately at the level of the third costal cartilage.

_____ 75. coracoid process lies deep to the deltopectoral triangle and is the insertion point of the pectoralis major muscle.

_____ 76. middle four thoracic vertebrae correspond approximately to the position of the body of the sternum.

In lateral radiographs, the radiolucent area behind the shadow of the heart and in front of the vertebral bodies is called the retrocardiac space. This space:

_____ 77. is occupied by the esophagus.

_____ 78. contains the thoracic duct.

_____ 79. contains the fibers of the vagus nerves.

_____ 80. contains the phrenic nerves.

With regard to the lungs and bronchial tree:

_____ 8l. the lymphatic vessels lie between the visceral pleura and parietal pleura.

_____ 82. the lymphatic vessels are a pathway for removal of fine particulate matter inhaled into the lungs.

_____ 83. the trachea and mainstem bronchi are the only parts of the respiratory tree within the mediastinum.

_____ 84. the trachea lies against the vertebral column throughout the superior mediastinum.

The skeleton of the heart:

_____ 85. is composed of connective tissue which completely separates the atrial and ventricular muscle fibers with the result that depolarization of the atria does not spread directly to the ventricular muscle fibers.

_____ 86. would be expected to show up on radiographs if it were to become calcified.

_____ 87. has fibrous rings which surround the valves of the heart and which lie approximately in a plane which parallels the base of the heart.

_____ 88. extends to the apex within the interventricular septum.

With regard to the heart:

_____ 89. the bicuspid valve is synonymous with the left atrioventricular valve.

_____ 90. the auricles have no major coronary arteries on their surface and could be incised without interrupting any named branches of the coronary arteries.

_____ 91. the AV valves open widely during the time that the aortic and pulmonary valves are tightly shut.

_____ 92. the sinoatrial node may be supplied by branches of either the left or the right coronary artery.

The azygos vein:

_____ 93. passes directly over the hilus of the right lung where it is closely associated with the right upper lobe bronchus.

_____ 94. usually occurs on the right.

_____ 95. is primarily concerned with the drainage of blood from the intercostal spaces.

_____ 96. could, along with the hemiazygos vein, be compressed by tumors or anything else which increased the pressure in the posterior mediastinum.

The right atrium characteristically:

_____ 97. has openings for the coronary sinus, anterior cardiac veins, superior vena cava, and inferior vena cava.

_____ 98. has an interatrial wall formed by two septa which originally functioned as a valve allowing oxygenated blood in the fetus to bypass the lungs.

_____ 99. contains valves of the superior and inferior vena cava which function to prevent the backflow of blood into the systemic veins during atrial contractions.

____100. contains a valve of the coronary sinus which functions to prevent the regurgitation of blood into the cardiac veins during atrial contraction.

Within the thorax, the left vagus nerve:

_____ 101. contains both afferent and efferent fibers.

_____ 102. innervates the esophagus.

_____ 103. sends fibers to the diaphragm.

_____ 104. is accompanied by the pericardiacophrenic vessels.

The timing cycle of the heart may be affected by the:

_____ 105. atrioventricular bundle.

_____ 106. parasympathetic nervous system.

_____ 107. sinoatrial node.

_____ 108. vagus nerve.

The mediastinum:

_____ 109. is the space between the right and left pleural cavities and it is bounded on each of these sides by mediastinal pleura.

_____ 110.would be expected to appear narrower and more elongated during inspiration than expiration.

_____ 111.is limited inferiorly by the diaphragm.

_____ 112.is limited superiorly by a horizontal line at the level of the jugular notch.

Each of the thoracic spinal nerves:

_____ 113. has a number designated by the number of the thoracic vertebra below which it emerges.

_____ 114. has a dorsal (posterior) root composed of afferent and efferent nerve fibers.

_____ 115. has a ventral (anterior) root containing motor fibers to skeletal muscles & preganglionic sympathetic fibers.

_____ 116. is connected to the sympathetic trunk by white and gray rami communicantes.

The right lung:

_____ 117. has the widest and shortest of the two main bronchi.

_____ 118. at its hilus (root) has the pulmonary artery above and behind the main bronchus.

_____ 119. usually presents superior & inferior pulmonary veins.

_____ 120. at its hilus (root) has the arch of the azygos vein as an inferior relationship.

The intercostal arteries:

_____ 121. end to parallel the intercostal nerves and veins.

_____ 122. lie for most of their route immediately deep to the external intercostal muscles.

_____ 123. arise from the internal thoracic artery.

_____ 124. arise from the aorta.

True (T) or False (F):

_____ 125. The aortic sinuses are three small dilations at the level of the cusps of the aortic valve.

_____ 126. The right and left coronary arteries arise from the aorta just beneath the aortic valves.

_____ 127. The posterior interventricular artery may be a branch of either the right or left coronary artery.

_____ 128. The interventricular septum is usually supplied by branches of the right and left coronary artery.

_____ 129. Most, but not all, of the blood delivered to the walls of the heart is returned to the right atrium.

_____ 130. The septomarginal trabecula is a bundle of tissue in the right ventricle that passes from the interventricular septum to the anterior papillary muscle.

_____ 131. The left atriventricular valve has anterior, posterior and septal cusps, but only two papillary muscles.

_____ 132. The right lung has three lobes and three segmental bronchi (apical, posterior and anterior) branching from the upper lobe bronchus.

_____ 133. The bronchial arteries arise from the pulmonary artery and supply unoxygenated blood to the bronchial tree.

_____ 134. The inferior lobe of the right lung normally extends as high as the fifth thoracic vertebra posteriorly.

_____ 135. The main structure filling the anterior mediastinum is the thymus or its remnants.

_____ 136. All of the lymphatic vessels of the breast pass to the axillary lymph nodes.

_____ 137. The internal thoracic artery ends at about the level of the sixth costal cartilage by dividing into musculophrenic and superior epigastric arteries.

_____ 138. Each posterior intercostal artery typically lies in an intercostal groove with the intercostal nerve above and the intercostal vein below.

_____ 139. The costal pleura normally does not extend below the level of the tenth rib posteriorly.

_____ 140. The thoracic duct lies posterior to the esophagus in the posterior mediastinum.

_____ 141. The apex of the lung lies above the level of the clavicle.

_____ 142. Every rib bears a costal cartilage.

_____ 143. The base of the heart rests on the diaphragm

ANSWER SHEET

The following answers are True (T) :

1 37. 74. 111
2. 38. 76. 113.
4 39 77 115.
5. 40. 78. 116.
7. 41. 79. 117.
8. 42. 82. 119.
9. 43. 83. 121.
10. 45. 85. 123.
11 46. 86. 124.
12. 47. 87. 125.
13. 48. 89. 127.
15. 50. 90. 128.
17. 53. 91. 129.
18. 54. 92. 130.
20. 57. 93. 132.
21. 58. 94. 134.
22. 59. 95. 135.
24. 60. 96. 137.
25. 61. 97. 140.
26. 62. 98. 141.
29. 63. 101. 142.
30. 64. 102.
31. 66. 105.
106.

33. 69 107.
108.

35. 70. 109.
36. 72. 110.