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 Three

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Question 1
In the anatomical position, which dermatome is most likely affected by a complete, articulating cervical rib?
A
Lateral aspect of arm
B
Medial aspect of arm
C
Lateral aspect of forearm
D
Medial aspect of forearm
E
Dorsal palmar surface
Question 1 Explanation: 
The lower roots of the brachial plexus (T1>C8) are more likely affected. Revise dermatome mapping.
Question 2
Which of the following is not true of costal cartilage?
A
Formed of hyaline cartilage
B
Is translucent in appearance
C
Adds resilience to the thoracic cage
D
Risks increased likelihood of blunt fracture
E
Directly enables ribs 1-7 to articulate with the sternum
Question 3
The manubrium does not articulate with
A
First rib
B
Second rib
C
Acromial head of the clavicle
D
Sternal body
E
Costal cartilage
Question 4
Which structure is not related to the superior boundaries of the manubrium?
A
Left brachiocephalic artery
B
Aortic arch
C
Left brachiocephalic vein
D
Left common carotid artery
E
Left subclavian artery
Question 4 Explanation: 
The aortic arch is related to the lower border of the manubrium
Question 5
A patient requires a sternal puncture for biopsy. Which of the following structures is least relevant to be aware of for their surface anatomy?
A
Right pleura
B
Left pleura
C
Right mediastinal lung parenchyma
D
Pericardium
E
Right anterior lung parenchyma
Question 6

Stem 1 of 4

A 42YOM presents with dyspnoea, orthopnoea,  dysphagia. His wife notes during collateral history that he sounds "hoarse" when speaking, and has increasingly sounded this way over a course of months.  On examination, there is an unexpected dullness noted over palpation of the sternal body.  The patient is otherwise asymptomatic.
Based on the information, which is the best matched diagnosis?
A
Left ventricular heart failure
B
Heart failure with preserved ejection fraction
C
Retrosternal goitre
D
Pleurisy
E
Aorticopulmonary space-occupying lesion
Question 7

Stem 2 of 4

A sternotomy is performed to ablate the hypertrophic tissue.  Which of the following described organs is not accessed in a similar manner?
A
The secretor of ANP
B
The secretor of ACE
C
The site of T cell maturation
D
The site of PT hormone release
Question 7 Explanation: 
Heart, retrosternal goitre of thyroid parenchyma, the thymus and ectopic parathyroid glands can be surgically accessed via Sternotomy - though the heart remains the only one commonly occurring in this manner, it is still core knowledge of the MRCS Part A.
Question 8

Stem 3 of 4

A patient has recently been successfully trying to lose weight and presents to their GP asymptomatic with a superior epigastrium mass. Which is the most appropriate diagnosis below?
A
Gastrinoma
B
Bowel perforation
C
Compaction of the small intestine
D
IBD
E
Normal xiphoid process
Question 8 Explanation: 
Older persons, or those recently losing weight, can sometimes report feeling "a new lump" in the epigastrium. This is often just the xiphoid process, recently calcified or uncovered from anteriorly located subcutaneous fat.
Question 9

Stem 4 of 4

From superior to inferior, which is the middle-most structure within a neuro-vascular bundle of a costal groove?
A
Anterior intercostal vein
B
Posterior intercostal vein
C
Posterior intercostal artery
D
Intercostal nerve
E
Intercostal lymphatics
Question 10
Which of the following best matches the course of muscle fibres immediately superficial to the neuro-vascular bundle of the costal groove?
A
Inferomedial
B
Superolateral
C
Transverse
D
Inferosuperior
E
Superoinferior
Question 10 Explanation: 
This is describing the direction of travel of muscle fibres of the internal intercostal muscle.
Question 11
The correct approach for aspiration of the pleural cavity must take into account
A
The haemorrhagic potential of the internal intercostal muscle
B
The dorsal rami of the thoracic spinal nerves
C
The superior costal groove
D
The insertion through the superior aspect of the rib surface
E
The superficial risk of visceral pleural rupture to cause a haemopneumothorax
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