🥵 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.
Reviewed by: awaiting review
Thorax Anatomy - Part One
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Question 1 |
The following questions relate to cardiac embryology. Which are false?
The heart tube is formed of endothelium in the pericardial cavity | |
The sinus venosus is incorported into the ventricular outflow | |
The bulbus cordis is incorporated into the ventricular outflow | |
The endocardial cushions proliferate ventrodorsally | |
The endocardial cushion proliferation divides the common atrioventricular orifice |
Question 1 Explanation:
The sinus venosus is incorporated into the dorsal atrial walls, forming a smoothened inflow to reduce turbulence of flow within the system.
Question 2 |
The cardiac septum containing the right bundle branch originates
At the dorsolateral surface of the heart | |
From the right heart border | |
From the sinoatrial (SAN) node | |
From the apex of the heart | |
From the common atrioventricular orifice to the apex of the heart |
Question 2 Explanation:
The IVS (interventricular septum) commences proliferation at the heart apex.
Question 3 |
A patient with a patent foramen ovale (PFO) has an aperture defect in which structure?
Interventricular septum | |
Septal cusp of the tricuspid valve | |
Septum secundum | |
Endocardial cushion of the atrioventricular orifice | |
Septum primum |
Question 3 Explanation:
As the septum primum descends toward the endocardial cushions from the atrial superior surface, shear stress (t) applied to the wall causes apoptosis to be triggered, forming a foramen. This is the foramen patent in PFO.
Question 4 |
The structure that later septates into the pulmonary trunk and aorta gives off six arches. Which recede ordinarily in the human?
Sixth | |
Fourth | |
Third | |
Fifth | |
Seventh |
Question 4 Explanation:
The fifth arch is said to disappear. In brief, the first and second arches obliterate, the third remains as the common carotid artery, the fourth becomes the R. subclavian artery and the aortic arch, the fifth arch disappears, the sixth arch becomes the pulmonary arteries and some dorsal aorta.
Question 5 |
The right recurrent branch of the vagus nerve recurs about which structure most-caudally?
The brachiocephalic trunk | |
The arch of the aorta | |
The pulmonary trunk | |
The common carotid artery | |
The subclavian artery |
Question 6 |
Of fetal circulation: what is the origin of the arteries carrying deoxygenated blood to the placenta?
External iliac artery | |
Inferior epigastric artery | |
Inferior vena cava | |
Umbilical vein | |
Internal iliac artery |
Question 6 Explanation:
The answer is internal iliac arteries. Note the question asks for the direct origin of the arteries (umbilical) carrying the blood. This second order questions requires multiple layers of thought, so ensure you are slowing down and adequately processing the question before answering.
Question 7 |
Use the following vignettes to match the pathophysiology to the correct diagnosis:
A post-partum ostium secundum defect without con-concomitant interventricular septal defect
ASD | |
VSD | |
PDA | |
Eisenmenger's syndrome | |
Coarctation |
Question 8 |
Use the following vignettes to match the pathophysiology to the correct diagnosis:
Pulmonary hypertension and increased load on the left side of the heart as a consequence of a shunt.
PDA | |
ASD | |
VSD | |
Coarctation | |
Fallot's tetralogy |
Question 9 |
Use the following vignettes to match the pathophysiology to the correct diagnosis:
Hypertrophic right ventricle with ventricular septal defect. There is also a reduction in the lumen of the outflow of the right ventricle and a widened aorta which is "overriding" the ventricles.
Eisenmenger's syndrome | |
Coarctation of the aorta | |
Fallot's tetralogy | |
VSD | |
Valvular defection |
Question 10 |
In a patient with characteristic rib "notching" sign on plain thoracic radiograph, which pulse would you expect to be notably weakened in general examination?
Posterior tibial artery | |
Common carotid artery | |
Radial artery | |
Medial cubital vein | |
Brachial artery |
Question 10 Explanation:
Coarctation of the aorta causes extensive anastomotic rerouting of blood, enlargement of the intercostal arteries and therefore notching sign on radiograph. Notably, despite the anastomosis formed, lower limb blood flow - and therefore prominence of pulsation - will be reduced
Question 11 |
A Morgagni herniation has occurred
Into the posteolateral diaphragmatic foramen | |
Causing gastric reflux on account of herniation through the oesophageal aperture | |
Lying between xiphoid and costal margins | |
And is a significant diaphragmatic herniation through the major central tendon | |
Through the femoral canal causing a hernia that is reducible |
Question 11 Explanation:
The canal of Morgagni is an eponymous term for that space anterior to the diaphragm between the xiphoid and costal origins.
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