A new biotech company is interested in developing a new

mechanical heart with a superficial implantable and

rechargeable battery for easy access. During the design phase,
the physician hired from the local academic hospital is asked
about which structure carries or comes in contact with
oxygenated blood. Which of the following answers is correct?
Pulmonary veins

A 47-year-old man with a known atrial fibrillation returns to
see his cardiologist for follow-up of his cardiac health. The
right atrium is important in this case because it:
Contains the SA node

In beginning a coronary bypass procedure, a thoracic surgeon
opens his patient's chest and pericardial sac, exposing the
anterior surface of the heart. The anterior (sternocostal)
surface of the heart is formed mainly by which of the
following?
Right Ventricle

What is the name of the keel-like septum at the bifurcation of
the trachea?
Carina

Coronary angiographs of a 44-year-old male patient reveal an
occlusion of the circumflex branch of the left coronary artery.
This patient has been suffering from myocardial infarction in
which of the following areas?
Left atrium and ventricle

Which of the following is found in the posterior mediastinum?
Thoracic duct

A radiologist is examining a series of contrast-enhanced CT
scans of a patient's thorax in evaluating findings of a
hypertrophied right heart. Which of the following structures
is located in the pathologically enlarged right atrium?
Opening of the coronary sinus

A 75-year-old woman was admitted to a local hospital, and
bronchograms and radiographs revealed a lung carcinoma in
her left lung. Which of the following structures or
characteristics does the cancerous lung contain?
Lingul

A 23-year-old man attending a cocktail party suddenly began
to choke. A friend performed the Heimlich maneuver.
Although he seemed to be somewhat better, it was not long
before he began to cough again. When asked what he had
been eating when he started to choke, he said, "peanuts."
Bronchoscopy revealed a large object in a bronchus. In which
one of the following places would the foreign object most
likely be located?
Right main bronchus

A 47-year-old woman has had a lumpectomy and axillary
dissection to check for metastasis. She has come in for her
follow-up appointment, and her physician notices on her
physical examination that the medial part of her scapula
protrudes from her back and that she is not able to raise her
arm above the horizontal level. Which of the following nerves
has been damaged during her surgery?
Long thoracic nerve

A 5-year-old girl is brought to the emergency department
because of difficulty breathing (dyspnea), palpitations, and
shortness of breath. Doppler study of the heart reveals an
atrial septal defect (ASD). This malformation usually results
from incomplete closure of which of the following embryonic
structures?
Foramen ovale

A newborn baby is readmitted to the hospital with hypoxia
and upon testing is found to have pulmonary stenosis,
transposition of the aorta, interventricular septal defect, and
hypertrophy of the right ventricle. Which of the following is
best described by these symptoms?
Tetralogy of Fallot

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During a newborn examination, a pediatrician is unable to
detect a pulse in the groin or legs of an infant and notes the
lower extremities are cold to the touch. The pulse and blood
pressure of the upper limbs are significantly elevated from
normal. A pediatric cardiologist performs an echocardiogram
and other imaging. The given sagittal MRI verifies the
presence of what specific anomaly, as indicated by the white
arrowhead?
Coarctation of the aorta

Which of the labeled structures in the given PA radiograph of
the chest indicates the right atrium?
B

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?
In the left fifth intercostal space at the midclavicular line

A thoracic surgeon prepares to insert a chest tube (tube
thoracostomy) in the 5th left intercostal space at the anterior
axillary line in his 60-year-old male patient. In evaluating the
chest wall for this procedure, the surgeon must be aware that
which of the following is a correct relation?
The intercostal blood vessels and nerves are positioned in the
order of vein, artery, and nerve from superior to inferior in a
subcostal groove

During a routine physical examination, a physician asks her
41-year-old female patient to breathe normally while she
assesses the patient's respiration. Which of the following is
true of the mechanics of inspiration during normal quiet
respiration?
The diaphragm descends.

The anterior border of the heart is formed mainly by the
__________ .
right ventricle.

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Which of the labeled structures in the given CT scan of the
thorax indicates the left main bronchus?
C

A 20-year-old man was stabbed in the chest with a jackknife
(pocket knife) with a blade five centimeters long. The stab
wound in the left fourth intercostal space was approximately
two centimeters lateral to the body of the sternum. What part
of the heart would likely be injured?
Right ventricle

A chest X-ray reveals lobar pneumonia located over the
horizontal fissure of the lung. Which of the following lobes of
the lung would be inflamed and full of fluid?
Superior lobe of right lung

A 65-year-old woman is diagnosed as having an extensive,
invasive abscess in the lower posterior wall of the thoracic
cavity on the right, accompanied by resultant lesions of
multiple intercostal nerves. Which of the following is the most
likely outcome?
Loss of motor control of intercostal muscles.

A 7-day-old newborn with a diagnosis of patent ductus
arteriosus undergoes surgery to ligate the ductus arteriosus.
During the repair, the surgeon takes special care to avoid
injury to a closely related nerve. The surgeon is protecting
which of the following nerves?
Left recurrent laryngea

A 60-year-old woman receives a coronary angiogram
following a myocardial infarction in order to evaluate the
condition of her coronary circulation. Most blood from the
heart wall will return to the heart at which of the following
locations?
Coronary sinus

A 58-year-old stockbroker is brought to the cardiac
catheterization laboratory emergently after evaluation in the
emergency department has determined that he is suffering
from an acute myocardial infarction. During the
catheterization, he is found to have inadequate blood flow in
the artery that runs aside the great cardiac vein in the anterior
interventricular sulcus of the heart. This is most likely an
acute occlusion of the _____________ .
Left coronary artery.

A 19-year-old man came to the emergency department, and
his angiogram exhibited that he was bleeding from the vein
that is accompanied by the posterior interventricular artery.
Which of the following veins is most likely to be ruptured?
Middle cardiac vein

A 55-year-old man presents with pain radiating down the
medial side of his right forearm and hand, and wasting of the
small muscles in the right hand. A comprehensive physical
examination leads to a diagnosis of thoracic outlet syndrome.
Which of the following is true of the thoracic outlet?
On each side, the lower trunk of the brachial plexus is closely
related to the outlet and passes laterally over the upper surface
of the first rib.

A physician conducts a breast examination of a 24-year-old
woman. Which of the following features constitutes a normal
condition?
The breast overlies the 2nd to the 6th ribs.

A race car driver is brought to the city trauma center after a
high-speed crash in which his car spun out of control and
struck the concrete embankment. He has blunt trauma to his
chest and undergoes extensive vascular studies to determine
which blood vessels are still intact. The interventional
radiologist recalls that one of the following veins drains
directly into the superior vena cava. Which vein would this
be?
Azygos vein

A 23-year-old man is stabbed in a bar fight. The blade of the
knife enters his chest in the left 5th intercostal space, just
lateral to the sternum, and pierces to a depth of
approximately 4 cm. What structure is most likely damaged?
Pericardium

A 22-year-old man who was thrown from his motorcycle
complained of severe pain in the lower left side of his chest.
He held his hand over his lower left ribs near the midaxillary
line. A radiograph of his thorax revealed fractures of the
eighth and ninth ribs. What internal organ would most likely
be injured?
Spleen

A 37-year-old patient with palpitation was examined by her
physician, and one of the diagnostic records included a
posterior-anterior chest radiograph. Which of the following
comprises the largest portion of the sternocostal surface of the
heart seen on the radiograph?
Right ventricle

The given coronary artery angiogram is from a 68-year-old
man with recurrent angina. It reveals 90% stenosis of the left
anterior descending (LAD) artery, indicated by the white
arrow. Based upon this finding, which portion of the heart is
most likely susceptible to ischemic damage?
Anterior two thirds of interventricular septum

An 81-year-old woman complained to her physician about
shortness of breath (dyspnea). Physical examination in the
sitting position revealed percussive dullness inferior to the
fifth rib in the right midaxillary line. The diagnosis was an
accumulation of fluid in the right pleural cavity. Thoracentesis
(thoracocentesis) was performed to remove the pleural fluid.
Where would the physician insert the needle into the pleural
cavity to avoid injuring the intercostal neurovascular bundle?
Superior to the rib in the eighth or seventh intercostal spaces in
the midaxillary line.

Deep venous thrombosis is a common complication from
sitting in one position for a prolonged duration, such as
during a long car trip or a long plane flight. The first vascular
channels likely to be obstructed or occluded by an embolus
from the deep veins of a lower limb are the _____________
.
Branches of the pulmonary arteries.

Choose the appropriate lettered site or structure in this CT
scan (see figure) of the thorax from a 42-year-old man who
complains of chest pain and breathing problems. His
electrocardiogram shows left ventricular hypertrophy. Into
which structure does the azygos vein drain venous blood?
A

A 44-year-old man was stabbed in the right side of his neck,
about four centimeters superior to the middle of the clavicle.
After a paramedic controlled the bleeding, the man began
breathing rapidly and was given oxygen. A physical
examination by an ER physician revealed a significant shift to
the left of the apex beat of the heart and poor breath sounds
on the right side of his thorax. Which of the following injuries
would most likely produce these signs
Stab wound of the pleura and apex of the right lung

A 35-year-old man is suffering from an infected mediastinum
(mediastinitis) after neck and chest injuries resulting from a
head-on automobile collision. He has been intubated since
the accident and on broad-spectrum intravenous antibiotics
since admission; however, the infection continues to progress
throughout the mediastinum. Which of the following
structures is free from infection?
Lungs


Atropine is a drug that acts to block stimulation of the
receptors targeted by postsynaptic parasympathetic neurons.
When it takes effect, atropine acts to do which of the following
Increase heart rate



A 78-year-old patient presents with an advanced cancer in the
posterior mediastinum. The surgeons are in a dilemma as to
how to manage the condition. Which of the following
structures is most likely damaged?
Hemiazygos vein

An 83-year-old man with a typical coronary circulation has
been suffering from an embolism of the circumflex branch of
the left coronary artery. This condition would result in
ischemia of which of the following areas of the heart?
Posterior part of the left ventricle

A 24-year-old man who has been overweight and sedentary
most of his life experiences shortness of breath and cyanosis
on exertion when he attempts to start an exercise program for
the first time. A thorough physical examination by his
physician reveals an aortic valve defect and an aortic murmur.
This murmur is best detected with the stethoscope placed
over which of the indicated sites?
A

A 56-year-old patient recently suffered a myocardial
infarction in the area of the apex of the heart. The occlusion
by atherosclerosis is in which of the following arteries?
Anterior interventricular artery

A 39-year-old man in seemingly good health experiences
recurring angina pectoris during practices for an adult
recreational basketball league. A thorough cardiac evaluation
reveals left coronary artery dominance, a 90% narrowing of
the anterior interventricular artery and a 60% narrowing of
the circumflex artery. The patient's cardiologist strongly
recommends a cardiac bypass procedure plus stenting to
relieve the blood flow condition. Which of the following is
true of this man's coronary circulation?
The circumflex artery gives rise to the posterior interventricular
artery.

Your 26-year-old patient has thoracic outlet syndrome, which
is a condition associated with impingement on structures that
pass through the superior thoracic aperture. Accordingly,
what is this syndrome is associated with?
A cervical (supernumerary) rib

You see a 30-year-old hockey player who "caught" a high
velocity puck in his mid-sternum. Radiography clearly shows
a sternal fracture. What next study (or studies) might you
order?
Echocardiography and ECG to see if there is a pericardial
effusion or other sign of cardiac injury

Which of the following is correct of the endothoracic fascia?
It provides a surgical cleavage plane between the thoracic wall
and the costal parietal pleura

A patient complains to you of pain in a limited strip on one
side of his chest and back. Upon examination, you notice that
the skin associated with the T3 dermatome of that side is red
with vesicular eruptions. Which of the following is your most
reasonable conclusion about your patient's illness?
He has shingles (herpes zoster)

It is common to explain the relationships between the lung
and surrounding structures by using the analogy of a fist
inserted into a balloon. Accordingly, which of the following
group of associations would be accurate?
Fistlung; space between inner and outer balloon layers
pleural cavity; outer layer of balloonparietal pleura

Which of the following is not correct pertaining to the
anatomy of the lungs?
The apex of each lung is in contact with the diaphragm

Which of the following is correct about your patient based on
the above radiograph (note white arrow)?
The patient is a child who aspirated a foreign object that is now
in the right main bronchus

Your 56-year-old patient has cardiac tamponade. Which of
the following is therefore correct?
He has excess fluid in the pericardial cavity
During esophagectomy for esophageal cancer, the surgical field began to fill with a
clear to milky fluid. Which of the following most likely had occurred?
The surgeon had lacerated the thoracic duct