🥵 HARD

Below is a stretch-and-challenge MCQ of clinically applied thoracic anatomy addressing learning outcomes of both the Anatomical Society of Great Britain and Northern Ireland’s “Anatomical Society core regional anatomy syllabus for undergraduate medicine” and the MRCS Part A Basic Science syllabus.  Best of luck!

Reference: Smith, C et al. (2015). The Anatomical Society core regional anatomy syllabus for undergraduate medicine.  Journal of Anatomy.Available here when last accessed 7th Oct 2019.

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Thorax Anatomy - Part Four

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Question 1
Which of the following is not true of the trachea?
A
Trachealis muscle for the anterolateral wall of the trachea
B
Extends from C6 superiorly
C
Extends to T4-5 inferiorly
D
Is lined by columnar ciliated epithelium
E
The superior most trachea is at the level of the inferior-most cricoid cartilage.
Question 2
The patient has an anterior mass occluding the trachea and causing a stridor. Which of the following structures is likely to be compressing the trachea in the specific manner described?
A
Carotid sheath haemorrhage
B
Lobes of the thyroid cartilage
C
Oesophagus dilatation
D
Recurrent laryngeal nerve demyelination
E
Brachiocephalic artery aneurysm
Question 2 Explanation: 
This artery crosses the anterior aspect of the trachea in the thorax adn is a key relation alongside the left common carotid artery, isthmus of the thyroid and left brachiocephalic vein. Also note the thymus before pubescent atrophy.
Question 3
In relation to the trachea, the arching accessory vein which unifies both caval circulations, lies
A
Superior
B
Right lateral
C
Left lateral
D
Anterior
E
Posterior
Question 3 Explanation: 
This is a description of the relation of the trachea to the azygos vein.
Question 4
A patient has aspirated into his conducting airway. Given your knowledge of the most likely course of the inhaled particulate, which of the following are false of the bronchus it is most-likely placed?
A
It is narrower than its counterpart
B
It is longer than its counterpart
C
It is more vertical than its counterpart
D
It contains columnar epithelium
E
The inferior vena cava receives an arching vein over its root into the hilum of the lung
Question 5
A patient with notable stridor and sign present on median thoracic radiograph is noted to have a delay between radial-femoral pulses.  Which of the following structures is most likely causing the above signs?
A
Thyroid ima carcinoma
B
Oesophageal varices
C
Aortic arch aneurysm
D
Recurrent laryngeal nerve resection
E
Laryngal cartilage disturbance
Question 6
A patient involved in a road traffic accident who wasn't wearing his seatbelt is admitted.  His chest expansion is not bilateral, apex beat has shifted medially and trachea is deviated. Which of the following is the most apt diagnosis?
A
Aortic aneurysm rupture
B
Spontaneous pneumothorax
C
Traumatic chylothorax
D
Spontaneous haemopneumothorax
E
Tension pneumothorax
Question 7
During routine bronchoscopy, patient is found to have distortion of the carinal division between major bronchi. Which lymphadenopathy is most likely to result in this sign?
A
Hilar
B
Internal pulmonary
C
Subpleural
D
Bronchomediastinal
E
Trachobronchial
Question 8
A left stab wound parasternally, left side will cause which sign?
A
Tension pneumothorax
B
Haemothorax
C
Chylothorax
D
Haemopericardium
E
None of the above
Question 8 Explanation: 
It is most likely, given this surface anatomy, that the pleural cavity would be altogether missed in this patient. The pericardium, and possibly myocardial mass, would instead be penetrated.
Question 9
The right lung's two fissures intersect at which surface anatomy point?
A
3rd costal cartilage
B
4th costal cartilage
C
5th costal cartilage
D
6th costal cartilage
E
7th costal cartilage
Question 10
Which of the following regions would it be most possible to obtain a penetrating wound and not directly penetrate lung parenchyma?
A
Supraclavicular, midclavicular line
B
Sixth rib, left side, midclavicular line
C
Fourth rib, right side, parasternally
D
Eighth rib in midaxillary line
E
11th rib at lateral erector spinae border
Question 10 Explanation: 
The lung will only descend to the 10th rib at this level above.
Question 11
The discreet blood supply of the airway passages derive from
A
Ascending thoracic aorta
B
Descending thoracic aorta
C
Internal mammary arteries
D
Pulmonary arteries
E
Pulmonary veins
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