1. _____ The brachiocephalic artery

A. is a branch of the ascending aorta.

B. divides into right common carotid and right subclavian arteries at the level of the sternal angle.

C. is derived from the aortic sac.

D. is located lateral to the right phrenic nerve.

E. Both B and D

2. _____ The left phrenic nerve

A. passes anterior to the fibrous pericardium.

B. is composed of fibers from the dorsal (posterior) rami of spinal nerves C3,4, and 5.

C. is located anterior to the left vagus n. at the arch of the aorta.

D. provides sensory innervation to the peripheral part of diaphrag matic pleura.

E. descends from the root of the neck into the superior mediastinum posterior to the left subclavian artery.

3. _____ Which of the following events does not occur at the sternal angle of Louis?

A. Trachea bifurcates into main bronchi

B. Azygous vein enters superior vena cava

C. coronary arteries originate from the aorta

D. Superior border of fibrous pericardium

E. border between superior and inferior mediastina

4. _____ The thoracic duct

A. usually drains lymph into the beginning of the right brachiocephalic vein.

B. passes through the diaphragm at the level of T10.

C. receives lymph from all structures inferior to the diaphragm, left side of head, and left upper extremity.

D. is located at the right border of the esophagus in the superior mediastinum.

E. Both C and D.

5. _____ The thoracic (descending) aorta

A. has 11 pairs of posterior intercostal arteries.

B. has three bronchial arteries to the right lung.

C. is located lateral (left) to vertebra T12.

D. is located posterior to the esophagus at the level of the esophageal hiatus of the diaphragm.

E. has 2 subcostal branches to the superior surface of the diaphragm.

6. _____ Which of the following statements about the esophagus are FALSE?

A. is supplied by arteries derived from the vitelline arteries of the embryonic aorta.

B. is "constricted" on its left side by the aortic arch.

C. is located anterior to thoracic vertebrae 1-4 in the superior mediastinum.

D. is located posterior to the right atrium.

E. has an inner epithelial lining derived from endoderm.

7. _____V The right vagus nerve

A. lies at the lateral (right) border of the trachea in the superior mediastinum.

B. descends posterior to the right subclavian artery to enter the superior mediastinum.

C. passes anterior to the root of the right lung to which it supplies pulmonary preganglionic parasympathetic fibers.

D. has a recurrent laryngeal branch, which passes posterior to the derivative of the embryonic right 6th aortic arch.

E. forms a plexus on the anterior side of the esophagus.

8. _____ The left border of the heart

A. is formed by the left ventricle as well as the left auricle of the left atrium.

B. extends from the level of the left 3rd costal cartilage to a point 3.5" from the midline in the left 5th intercostal space.

C. extends from the left 2nd intercostal space to a point 3.5" from the midline in the left 6th intercostal space.

D. is formed by the left ventricle only.

E. Both A and B

9. _____ The left coronary artery

A. has a circumflex branch, which is located in the posterior interventricular sulcus.

B. has an anterior interventricular branch (LAD), which supplies both ventricles.

C. can anastomose with the marginal branch of the rt. coronary art.

D. originates from the aortic sinus of the posterior cusp.

E. is located superficial to the visceral pericardium.

10. _____ The atrio-ventricular bundles

A. originate from the A-V node located in the crista terminalis.

B. spread the waves of impulses directly from the pacemaker.

C. reach the anterior wall of the rt. ventricle via the posterior papillary muscle.

D. are mostly located in the interventricular septum.

E. innervate the musculi pectinati.

11. _____ The best site to auscultate the tricuspid valve is in the

A. left 5th intercostal space at apex of heart.

B. left 5th intercostal space at the border of the sternum.

C. left 6th intercostal space adjacent to the sternum.

D. right 5th intercostal space adjacent to the sternum.

E. left 2nd intercostal space adjacent to the sternum.

12. _____ The coronary veins include

A. the middle cardiac v., which is located in the posterior part of the coronary sulcus.

B. the anterior cardiac v., which drains into the coronary sinus.

C. the great cardiac v., which is only found in the anterior interventricular sulcus.

D. the coronary sinus, which drains into an opening in the smooth- walled portion of the right atrium.

E. the small cardiac v., which drains directly into the rt. atrium.

13. _____ The aortic vestibule

A. contains trabeculae carnae.

B. is located inferior to the mitral valve.

C. contains the openings for the coronary arteries.

D. is located inferior to the pulmonary trunk.

E. is derived embryologically from the bulbus cordis.

14. _____ The left atrium

A. is smooth walled except for the left auricle.

B. receives two pulmonary veins only (right and left).

C. is located posterior to the right atrium.

D. Both A and C.

E. A, B, and C.

15. _____ The tricuspid valve

A. has 3 cusps, which are attached to a ring of tissue at the rt. atrio-ventricular orifice called the limbus.

B. has an anterior cusp, which is attached in part to the posterior papillary muscle via the chordae tendinae.

C. has a septal cusp, which is attached to a single septal papillary muscle via the chordae tendinae.

D. is closed during ventricular relaxation (diastole).

E. None of the above.

16. _____ The right atrium

A. forms most of the inferior border of the heart.

B. receives the superior and inferior vena cava at openings located in the tissue derived from the embryonic primitive atrium.

C. has a smooth walled auricle.

D. is demarcated from the left atrium by the coronary sulcus.

E. has surface markings that extend from the 3rd rt. costal cartilage to the 6th rt. costal cartilage.

17. _____ The contents of the middle mediastinum include the

A. phrenic nerve

B. hemiazygous vein

C. ascending aorta

D. thoracic duct

E. Both A and C

18. _____ Pericardial paracentesis can be safely performed with a cannula inserted

A. into the left 4th intercostal space.

B. into the left 5th intercostal space in the midaxillary line.

C. into the left 5th intercostal space 3.5" lateral to the midline of the sternum.

D. into the right 5th intercostal space parasternally.

E. into the left 5th intercostal space parasternally.

19. _____ The oblique pericardial sinus

A. separates the superior vena cava from the ascending aorta and pulmonary trunk.

B. is part of the pericardial cavity between the right atrium and the posterior wall of the pericardial sac.

C. is formed in part by the reflection of serous pericardium from the right atrium to the superior vena cava.

D. is part of the pericardial cavity between the left atrium and the posterior wall of the pericardial sac.

E. Both C and D.

20. _____ If a foramen of Morgagni is present, herniation of abdominalcontents into the anterior mediastinum occurs through the

A. sternocostal hiatus

B. aortic hiatus in diaphragm

C. esophageal hiatus in diaphragm

D. inferior vena caval foramen

E. none of the above

21. _____ The embryonic structure which does not form the diaphragm is

A. paraxial mesoderm of somites C3-5.

B. somatic mesoderm of the body wall.

C. pleuroperitoneal membrane.

D. septum transversum.

E. dorsal mesentery of midgut.

22. _____ The intercostal nerve of the 7th intercostal space in the midaxillary line contains

A. preganglionic sympathetic fibers.

B. somatic sensory fibers.

C. preganglionic parasympathetic fibers.

D. postganglionic parasympathetic fibers.

E. Both B and D.

23. _____ Parasympathetic preganglionic fibers are

A. myelinated.

B. found in the white ramus communicans.

C. shorter than the parasympathetic postganglionic fibers.

D. found in the ventral root of S3 (sacral) spinal nerve.

E. Both A and D.

24. _____ Postganglionic sympathetic fibers from the pre-aortic ganglia

A. form named nerves (e.g. splanchnic), which innervate abdominal viscera.

B. travel with branches of the aorta to reach the abdominal viscera.

C. synapse on sympathetic chain ganglia.

D. join the gray rami communicans of lumbar spinal nerves.

E. None of the above.

25._____ The sympathetic trunk

A. contains postganglionic fibers that ascend or descend to different spinal levels.

B. has chain ganglia only at levels T1-L2.

C. is located paravertebrally, from C1 to the coccyx.

D. is found within the posterior mediastinum.

E. is located lateral to the parietal pleura at upper thoracic levels.

26. _____ Splanchnic nerves

A. synapse on sympathetic chain ganglia.

B. contain preganglionic fibers that synapse on mural ganglia of the stomach.

C. hitch a ride on branches of the aorta to reach organs.

D. contain preganglionic sympathetic fibers.

E. Both B and C.

27. _____ The dorsal root of a spinal nerve

A. contains visceral and somatic sensory fibers.

B. contains somatic motor fibers that innervate intrinsic back muscles.

C. joins the ventral root to form a spinal nerve.

D. courses lateral to the intervertebral foramen to form the spinal nerve.

E. Both A and C.

28. _____ Vagal fibers

A. are found in cranial nerve 9.

B. innervate the sweat glands of the skin of the thorax.

C. synapse on mural ganglia in the small intestine.

D. are postganglionic fibers.

E. are found in the white ramus communicans.

29. _____ In the midclavicular line, visceral pleurae extends as far inferiorly as rib

A. five

B. four

C. eight

D. ten

E. six

30. _____ Which of the following statements is FALSE in regard to the development of the lung?

A. Epithelial lining of bronchi are derived from endoderm.

B. Laryngotracheal tube forms as an outgrowth of the ventral floor of the foregut.

C. Lung buds invaginate pleural sacs.

D. Splanchnic mesoderm forms cartilaginous rings of trachea.

E. None of the above.

31. _____ The costodiaphragmatic recess

A. normally contains air.

B. is part of the pleural cavity between the inferior border of the lung and the diaphragm.

C. is formed by the reflection of costal pleura to mediastinal pleura.

D. is found only on the left side due to the presence of the heart.

E. Both A and D.

32. _____ Each bronchopulmonary segment

A. is supplied by a single segmental bronchus.

B. can not be removed without causing a pneumothorax .

C. is supplied by a single tributary to a pulmonary vein.

D. is rectangular in shape.

E. is supplied by several branches of the pulmonary artery.

33. _____ The left bronchomediastinal lymph trunk

A. drains into the thoracic duct.

B. receives lymph directly from the pulmonary nodes.

C. drains into the beginning of the left brachiocephalic vein.

D. drains into the right lymphatic duct.

E. Both A and C.

34. _____ The horizontal fissure of the right lung

A. separates the middle lobe from the inferior lobe.

B. lies at the level of the 6th costal cartilage.

C. intersects the oblique fissure at the midaxillary line.

D. intersects the oblique fissure near the spine of T3 vertebra.

E. lies at the level of the 5th costal cartilage.

35. _____ The eparterial bronchus is

A. the main bronchus to the right lobe.

B. located directly superior to the pulmonary veins in the root of the right lung.

C. the bronchus to the middle lobe of the rt. lung.

D. the bronchus to the upper lobe of the rt. lung.

E. found in both lungs.

36. _____ Aortic arch III contributes to the definitive

A. common carotid artery

B. arch of the aorta

C. right subclavian artery

D. brachiocephalic trunk

E. left subclavian artery

37. _____ The complete separation of left and right atria of the heart depends upon fusion of the septum secundum with the

A. endocardial cushions.

B. superior (dorsal) part of septum primum.

C. bulbar ridges.

D. inferior (ventral) part of septum primum.

E. Both A and B.

38. _____ The conus arteriosus (infundibulum) is derived from the

A. primitive atrium

B. primitive ventricle

C. sinus venosus

D. bulbus cordis

E. truncus arteriosus

39. _____ In the development of the heart, the structure that divides the common atrioventricular canal into a right and left atrioventric- ular canals is the

A. septum primum

B. septum secundum

C. endocardial cushions

D. bulbar ridges

E. truncal ridges

40. _____ Which of the following embryonic aortic arches gives rise to the ductus arteriosus?

A. left third

B. left fourth

C. left sixth

D. right fourth

E. right sixth

41. _____ The walls of the left atrium are mostly formed by the

A. right horn of the sinus venosus.

B. primitive atrium.

C. left horn of the sinus venosus.

D. walls of the embryonic pulmonary vein.

E. Both B and C

42. _____ Postnatally, the right umbilical artery forms the definitive

A. proximal part of right internal iliac artery.

B. right common iliac artery.

C. right medial umbilical ligament.

D. ligamentum teres hepatis.

E. Both A and C

43. _____ The bronchial arteries are derived from the embryonic

A. aortic arch VI

B. vitelline arteries

C. intersegmental arteries

D. lateral splanchnic arteries

E. dorsal aorta

44. _____ The event which triggers the completion of meiotic divisions of the developing ovum is

A. ovulation

B. fertilization

C. rapid increase in estrogen

D. breakdown of zona pellucida

E. none of the above

45. _____ Cleavage of the zygote

A. is initiated by fertilization.

B. results in an increase in total volume of the incipient embryo.

C. occurs within the zona pellucida.

D. results in the direct formation of the blastocyst.

E. Both A and C.

46. _____ Neural crest ectoderm gives rise to all of the following EXCEPT

A. sensory neurons.

B. somatic motor neurons.

C. adrenal (suprarenal) medulla.

D. melanocytes of the skin.

E. sympathetic chain ganglia.

47. _____ The amniotic cavity develops

A. during week 1

B. within the inner cell mass

C. in extraembryonic mesoderm

D. between the inner cell mass and the trophoblast

E. none of the above

48. _____ The allantois

A. forms the definitive medial umbilical ligament.

B. is a diverticulum of the hindgut (caudal yolk sac).

C. completely degenerates postnatally.

D. is an outpouching of the coelom into the connecting stalk.

E. is not found in the umbilical cord at any time.

49. _____ Which of the following statements are TRUE in relation to the anatomical "events" that result from head folding of the embryonic disc?

A. The septum transversum is now located rostral to the heart.

B. The heart is located dorsal to the pericardial coelom.

C. Myoblasts from the paraxial mesoderm of somites C3-C6 migrate into the septum transversum.

D. The rostral part of the yolk sac is incorporated into the embryo to form the foregut.

E. Both B and D.

50. _____ Which of the following statements is TRUE in regards to gastrulation?

A. begins during week 4 of development.

B. epiblast cells migrate into the primitive groove to form the neural tube.

C. primitive streak extends caudally from the oropharyngeal membrane to the primitive knot.

D. cloacal membrane contains 3 germ layers.

E. None of the above.

51. _____ Intraembryonic somatic mesoderm from the lateral plate forms the

A. epidermis of the skin.

B. smooth muscle of the wall of the esophagus.

C. pectoralis minor muscle.

D. intercostal muscles.

E. dermis of the skin.

52. _____ Prior to birth, primary oocytes

A. contain the haploid number of chromosomes.

B. are surrounded by the zona pellucida.

C. are found with the 1st polar body within a follicle.

D. begin meiosis I but stopped until 48 hours prior to ovulation.

E. Both C and D.

53. _____ The chorionic cavity (extra-embryonic coelom)

A. is lined by extra-embryonic mesoderm.

B. is obliterated by the expansion of the placenta.

C. is formed initially during postnatal week 3.

D. is located between the cytotrophoblast and syncytiotrophoblast.

E. None of the above.

54. _____ Each of the following arteries is a branch of the internal thoracic EXCEPT the

A. pericardiacophrenic

B. superior phrenic

C. musculophrenic

D. superior epigastric

E. anterior intercostals

55. _____ The dermatome at the nipple of the mammary gland is innervated by

A. ventral ramus of T4 spinal nerve.

B. ventral ramus of T5 spinal nerve.

C. 3rd intercostal nerve.

D. postganglionic parasympathetic fibers.

E. dorsal ramus of 4th intercostal nerve.

56. _____ The pectoralis minor muscle

A. inserts onto the acromion process.

B. is invested by pectoral fascia.

C. originates from ribs 3,4,and 5.

D. receives blood from the thoracoacromial artery.

E. Both C and D.

57. _____ The intercostal arteries in the 8th intercostal space can provide a direct anastomotic channel between the

A. aorta and superior epigastric a.

B. aorta and musculophrenic a.

C. aorta and internal thoracic a.

D. internal thoracic and musculophrenic a.

E. internal thoracic a. and costocervical trunk

58. _____ Immediately posterior to a typical intercostal nerve (in the inter- costal space adjacent to the sternum ), one should find the

A. internal intercostal muscle fibers.

B. intercostal artery.

C. intercostal vein.

D. transversus thoracis muscle fibers.

E. costal cartilage.

59. _____ Which of the following costal cartilages does NOT form the costal margin?

A. rib 6

B. rib 8

C. rib 10

D. rib 11

E. Both A and D

60. _____ Which of the following structures is NOT found at the level of the 2nd rib?

A. junction of body and manubrium of sternum.

B. beginning and end of arch of the aorta

C. intervertebral disc between T4 and T5 vertebrae

D. thoracic duct deviates from right to left posterior to the esophagus.

E. formation of superior vena cava from brachiocephalic veins.

A=1, 2, and 3

B= 1 and 3

C= 2 and 4

D= 4 only

E=all

61. _____ Which of the following statements are true concerning endothoracic fascia?

1. It is located between innermost intercostal muscles and the ribs

2. Provides a surgical plane for separating parietal pleura from the rest of the thoracic wall.

3. Derived from ectoderm.

4. It is located between innermost intercostal muscles and the parietal pleura.

62. _____ The pectoralis major muscle

1. originates in part from the clavicle and sternum.

2. is invested by deep fascia.

3. inserts on the lateral lip of the bicipital groove of the humerus.

4. adducts the arm

63. _____ The intercostal spaces receive blood from direct branches of the:

1. internal thoracic artery

2. musculophrenic artery

3 thoracic aorta

4. thoracoacromial artery

64. _____ The arch of the aorta is formed from

1. left dorsal aorta

2. left fourth aortic arch

3. aortic sac

4. left 7th intersegmental artery

65. _____ Tetralogy of Fallot is composed of the following defects:

1. pulmonary valve stenosis

2. narrow aorta over-riding ventricular septal defect

3. ventricular septal defect

4. left ventricular hypertrophy

66. _____ The truncus arteriosus contributes to the formation of the

1. aortic vestibule

2. pulmonary trunk

3. infundibulum

4. ascending aorta

A=1, 2,and 3

B=1 and 3

C=2 and 4

D=4 only

E= all.

67. _____ Which of the following statements about the oblique fissure of the left lung are TRUE?

1. surface landmark is spine of vertebra T3 posteriorly

2. separates superior from inferior lobe, which can be best auscultated on the ant. thoracic wall.

3. surface landmark is costochondral junction of left rib six anteriorly.

4. is lined by parietal pleura.

68. _____ Structures found within the root of the lung include the

1. main bronchus

2. parasympathetic and sympathetic fibers

3. two pulmonary veins

4. lymphatic vessels.

69. _____ The dorsal ramus of spinal nerve L1 contains

1. cutaneous sensory fibers from the back

2. postganglionic sympathetic fibers

3. motor fibers to the intrinsic back muscles

4. motor fibers to intercostal muscles of the posterior thoracic wall.

70. _____ The sacral component of the parasympathetic nervous system

1. has postganglionic fibers which innervate structures derived embryologically from the hindgut (e.g., rectum ).

2. has preganglionic neuronal cell bodies located in the intermediolateral cell column.

3. has preganglionic fibers that enter the ventral ramus of a sacral spinal nerve.

4. has preganglionic fibers contained within white rami communicans of sacral spinal nerves.

71. _____ The fibrous pericardium

1. is located medial to the mediastinal pleura.

2. is attached to the outer layer of the ascending aorta.

3. is lined internally by the parietal pericardium.

4. is formed from the pleuropericardial membrane.

72. _____ Which of the following form the membranous interventricular septum of the heart?

1. muscular interventricular septum

2. fused bulbar ridges

3. septum primum (ventral part)

4. endocardial cushions

A= 1, 2, and 3

B=1 and 3

C=2 and 4

D=4 only

E=all.

73. _____ In a fetus, oxygenated blood is transported from the placenta to the fetus via the

1. right umbilical artery

2. right umbilical vein

3. left umbilical artery

4. left umbilical vein

74. _____ The auscultation sites of the heart valves

1. Tricuspid valve- right 6th costal cartilage.

2. Pulmonary valve- left 2nd intercostal space.

3. Aortic valve- right 3rd costal cartilage.

4. Mitral valve- left 5th intercostal space 3.5" from the midline.

75. _____ The "dupp" sound of the heart beat is due to the

1. closure of the mitral valve.

2. contraction of the ventricles.

3. closure of the tricuspid valve.

4. closure of the aortic valve.

76. _____ The posterior mediastinum contains the

1. inferior vena cava

2. left vagus nerve

3. pulmonary vein

4. thoracic aorta

77. _____ Which of the following structures contribute to the inferior boundary of the inferior mediastinum?

1. xiphoid process

2. T10 vertebra

3. diaphragm

4. pericardium

78. _____ The brachiocephalic trunk (artery)

1. receives the right lymphatic duct.

2. ascends anterior to the trachea throughout its course.

3. contains smooth muscle which is innervated directly by preganglionic sympathetic fibers.

4. is crossed anteriorly by the left brachiocephalic v.

79. _____ The azygous vein

1. is a superior continuation of the right ascending lumbar vein

2. receives posterior intercostal venous blood from the left side via the hemiazygous veins

3. is located directly anterior to the bodies of thoracic vertebrae

4. receives tributaries from esophageal and bronchial veins.

80. _____ The left pulmonary artery

1. is located superior to the left pulmonary veins in the root of the lung

2. is found partly within the posterior mediastinum

3. is located inferior to the arch of the aorta.

4. can constrict the esophagus

81. _____ Fluid in the left costodiaphragmatic recess should be tapped by a cannula placed in the midaxillary line at left intercostal space 10 to avoid damaging the spleen under the diaphragm.

82. _____ The zona pellucida doesn't break down until the blastula has implanted into the endometrium of the uterus.

83. _____ An intercostal nerve can be composed of fibers from more than one thoracic spinal nerve.

84. _____ The right phrenic nerve lies on the lateral surface of the trachea in the superior mediastinum.

85. _____ The left vagus nerve descends posterior to the root of the lung.

86. _____ The left main bronchus is smaller in diameter than the right main bronchus but it is more vertically oriented.

87. _____ Spinal nerve C7 exits the spinal canal between the last cervical and the first thoracic vertebrae.

88. _____ The lingula of the right lung enters the costomediastinal recess during normal inspiration.

89. _____ Left and right visceral pleurae are in contact with each other at the sternal angle of Louis.

90. _____ It is possible for cancer of the breast to metastasize to lymph nodes along the internal thoracic artery.

91. _____ The inferior vena cava passes through the diaphragm at the level of vertebra T8.

92. _____ The clavipectoral fascia is pierced by the thoracoacromial art., cephalic v., and lateral thoracic artery.

93. _____ The notochord induces the overlying ectoderm to transform into the neural plate.

94. _____ Lateral folding of the embryo results in the formation of lateral and ventral body walls during week 4.

95. _____ The right recurrent laryngeal nerve hooks around an artery that is formed in part from the right dorsal aorta and rt. 7th inter- segmental artery.

96. _____ The thymus is located anterior to the left brachiocephalic v. in the superior mediastinum.

97. _____ A patient who experiences pain at the shoulder may actually have an inflammed costal pleura. This is a result of referred pain from the phrenic nerve.

98. _____ The right brachiocephalic vein is formed from the right internal jugular and subclavian veins posterior to the 2nd costal cartilage.

99. _____ The posterior cusp of the mitral valve is attached to chordae tendinae of the septal and posterior papillary muscles.

100. _____ The parietal pleurae are derived embryologically from the lateral plate mesoderm.

THE END