Basic medicine mcqs, Uncategorized

Basic MCQs for Thorax, Lung, Heart, Mediastinum

I will be posting basic mcqs regarding the following subjects over the next few days. The answers will be shown April 23rd…so keep checking back!


– Proof that ANYTHING is possible (loved the ending…)

– also check the bottom of the page…these are great basic mcqs I found on the net….more to come in the next few days.


1. Thorax

The first rib articulates with?
sternoclavicular joint
– sternal angle
– body of sternum
– histogram

The second rib articulates with?
– sternoclavicular joint
sternal angle
– body of sternum
– histogram

How many floating ribs are there?
– 8
2 – 11,12
– 12
– 7

How many false ribs are there?
– 8
3 (8,9,10)
– 12
– 7

At what age do the ribs start to harden?
about 40
– about 15
– about 50

What nerve would you see behind the sternal notch?
phrenic nerve
– jugular nerve

Where is the sternal notch?
– at the middle of the sternum
– at the 10th rib
at the top of the manubrium

Where is the sternal angle?
– top of the manubrium
at position of 2nd rib
– above xyphoid process

Where would you find the anterior longitudinal ligament?
– behind the first thoracic vertebra
transversing intervertebral disks and bodies on anterior surface of spine
– opposite the ligament of simonium

Which are the vertebrocostal (true) ribs?
– 1st-8th
– 2nd -12th
1st -7th

Which are the false (vertebrochondral) ribs?
– 7th, 8th, 9th
– 8th, 9th, 10th, 11th
8th, 9th, 10th

Which ribs are atypical?
– none (they are all typical)
1st, 2nd, 10th-12th
– 7th – 12th

What makes the 1st rib atypical?
– it is not atypical
– has a single facet on head for articulation with T1 vertebra
two transversely directed grooves crossing its superior surface for the subclavian vessels

– both 2nd and 3rd choice
What makes the 2nd rib atypical?
– it is not atypical
its main atypical feature is a rough area on its upper surface, the tuberosity for serratus anterior
– it has two facets, and no tubercle
What makes 10th-12th ribs atypical?
– They are not atypical
They have only one facet on their heads, same as first rib
– They have no rough borders at the facet of moji
Why are the 11th and 12th ribs atypical?
– They are long and have no necks or tubercles
– They are short and have no necks or tubercles
– They are made of plastic
What is the name of the bilateral costal facets on the thoracic vertibrae?
– semifacets
– demiglace
– plexiglass
What is the purpose of the demifacets on thoracic vertebrae?
– articulate with spinous processes
to articulate with heads of ribs
– to artculate well under pressure

Costal facets on the transverse processes are for
 articulation with the tubercles of ribs, except for the inferior two
or three thoracic vertebrae

Name the three parts of the sternum
– Sternal notch, Body of Manubrium, Costal notch
Manubrium, Body, Xiphoid process
– This question is too easy

At what level does the manubrium lie?
– Just below the sternal notch
at level of T3, T4 vertebrae
– at level of T4, T5 vertebrae

The sternal angle is palpable and opposite what?
– 3rd pair of costal cartilages at cartilages at the level of the IV disc between the T4 and T5 vertebrae

2nd pair of costal cartilages at the level of the IV disc between the T4 and T5 vertebrae

The body of the sternum lies at what vertebral level?
T5-T9 vertebral level
– T4-T9 vertebral level

The xiphoid process is the midline marker for:
superior level of liver, the central tendon of diaphragm, and the inferior border of heart

– superior level of the diaphragm, and the inferior border of liver
– superior level of liver, the central tendon of the great sinus of king arthur
How many thoracic apertures are there? Names?
2, superior and inferior
– 3 superior and inferior and medial
Matching (it doesn’t get any easier than this!): ALL CORRECT
Vertebrae                                              (intervertebral joints)
Ribs and vertebrae                                 (costavertebral joints)
Sternum and costal cartilages                  (sternocostal joints)
Sternum and clavicle                               (sternoclavicular joints)
Ribs and costal cartilages                        (costochondral joints)
Costal cartilages                                      (interchondral joints)
Parts of sternum                                      (manubriosternal and xiphisternal joints)
What happens when there is a disturbance with any of the above joints that reduces mobility?
interferes with respiration
– interferes with forward movement 
What upper limb muscles attach to the thoracic cage?
– Pectoralis major, pectoralis minor, serratus posterior, latissimus dorsi
Pectoralis major, pectoralis minor, serratus anterior, latissimus dorsi
– Pectoralis major, pectoralis minor, serratus anterior, tony dorsi
What is the name of the muscle in the thoracic wall that is continuous with the transverse abdominal?
– Transverse intercostal
Transverse thoracic
– Diaphragmatic transverse abdominis snowman

Name the three layers of the intercostal spaces:
External- superficial, Internal- middle, Innermost- internal

– External- superficial, Lateral- side, Innermost- internal
How many pairs of thoracic nerves are there?
– 10
– 12
– 8
– 3

Which rami of  T1-T11 comprise the intercostal nerves that run
the extent of the intercostal spaces (in a costal grove)?
Anterior rami
– Posterior rami

Where do the posterior rami pass?
– inferiority immediately lateral to the transverse processes of the vertebrae to supply
bones, deep back muscles
– posteriorly immediately lateral to the articular processes of the vertebrae to supply
bones, deep back muscles

What is the order of veins, nerves and arteries in the costal groove?
superiorly to inferiorly – VAN
– Inferioly to superiorly – ANV

Which nerve innervates the serratus anterior (runs EXTERNALLY)?
– the short thoracic nerve
the long thoracic nerve
– the nerve of auntie ramus

What nerve trunk would you expect to see lateral to the intercostal nerves?
the sympathetic ganglia
– the parasympathetic ganglia
– the great ganglionic wall of ramus (not related to auntie ramus)

The external abdominal oblique layer runs diagonally from above downward in the same direction as the external intercostal muscles. If you place your hands in the pockets of a short jacket with your fingers extended, the fingers will point in that direction.

What would you find posterior to the abdominal aorta?
– esophagus
– trachea
vertebral column

What would you find lateral to the aorta and proximal to the vertebral column?
posterior ramus
– ventral ramus
– radiate ligament

What are the contents of the entire mediastinum?
– Heart, lungs, thoracic parts of the great vessels, thoracic part of the trachea, esophagus,
thymus, and other structures (lymph)
Heart, thoracic parts of the great vessels, thoracic part of the trachea, esophagus,
thymus, and other structures (lymph)

2. Lung

You would you find all of the following in the pulmonary cavity EXCEPT:
– Lungs
– Mediastinal pleura
– Cervical pleura
– Parietal pleura
– Diaphragmatic pleura
– Costal pleura
– Visceral pleura
– Endothoracic facia
Pericardiacophrenic vein

What is pleurisy?
–  A build-up of fluid from as a result of inflammation of the pleura, often caused
caused by a virus
–  Friction as a result of inflammation of the pleura, often caused
caused by a virus

Friction at the level of the lung or heart is often caused by:
rheumatoid arthritis
– osteoarthritis
– a runny nose

What are the four parts of the parietal pleura (Lines cavity, adheres to thoracic wall)?
– costal, mediastinal, diaphragmatic, visceral
– costal, mediastinal, diaphragmatic, cervical

The visceral and parietal pleura are CONTINUOUS AT THE HILUM
of the lung where structures enter and leave the lung (bronchus, pulmonary
vessels, bronchial vessels, lymphatics)

The potential space between the visceral and parietal layers of pleura is known as:
The pleural cavity
– The visceral hang out place
– The parietoplural plaza

The pleural cavity Contains serous pleural fluid, which lubricates the
pleural surfaces and allows the layers of pleura to slide smoothly over
each other during respiration.

T/F? NO…they do not…
The lungs completely occupy the pleural cavities during expiration

What are the costodiaphragmatic recesses?
– The pleural-lined “gutters” that surround the upward convexity
of the diaphram inside the thoracic wall
– A kind of time-out in between classes taken by costodiaphagmatic
– Spaces in between the cardiac notch and the pleural lingula

How many sections does the right lung have? What are the names for
the lobes?
3, oblique fissure (between middle and inferior lobe),
horizontal fissure (between superior and middle lobe)
– 3, transverse fissure (between middle and inferior lobe),
horizontal fissure (between superior and middle lobe)
– The human body does not contain lungs, it has gills
(unless you are the Man from Atlantis, in which case you have both – I think)

“Inhale a bite, goes down the right”:
Inhaled objects more likely to lodge in right bronchus,
since it is the one that is more oblique. NO VERTICAL!!!

The APEX of the lung is the blunt superior end of the lung ascending
above the 1st rib into root of neck, and is covered by the:
cervical pleura
– mediastinal pleura
– visceral pleura

Like other parts of the lung, the LINGULA is quite likely to get affected by lung
diseases and infections, including:
– diaphragmatic palsey
– lingualosis

What is atelectasis?
– Atelectasis is a condition in which the entire lung or a
specific lobe in the lung gets deflated and does not expand properly.
– A dive bar in Greenwich Village
– “water on the lung”
– synonymous with a pleural effusion

The lungs bifurcate at which level?
– The 10th rib
The sternal angle
– The xiphoid process

Which is more lateral?
phrenic nerve
– left vagus nerve

The groove for the aorta would be found in the:
left lung
– right lung
– vastus lateralis

The groove for the superior vena cava would be found in the:
right lung
– left lung
– naughtiness maximus

The grove for the subclavian artery would be found in:
– right lung
left lung
– both
– neither

The root of the lung is found a little above the middle of the mediastinal
surface of each lung, and nearer its posterior than its anterior border,
by which the lung is connected to the heart and the trachea.

What is enclosed within the area of continuity between the parietal and
visceral layers of pleura-the pleural sleeve, and connects the lung with
the heart and trachea?
– the inferior border of the pulmonary trunk
the root of the lung

What lies at the MEDIAL surface of the lungs, and is the place
where pulmonary vessels, bronchial vessels, lymphatic vessels,
and nerves, enters and leave the lung?
The hilum
– The hilium
– The Milum

In the root arrangement of the lungs, where would
you find the pulmonary artery?
– superiormost on the left (the superior lobar
bronchus may be superiormost on the right)
– inferiormost on the left (the superior lobar
bronchus may be inferiormost on the right)

The contents of the lung roots contain all of the
following except:
– pulmonary artery (superiormost on left, right)
– superior and inferior pulmonary veins (anteriormost and inferiormost)
– bronchus (against and approximately in the middle of the posterior boundary,
with the bronchial vessels immediately surrounding)
pulmonary plexus (superiorly facing the wall of simonomoji)

Left lung is wider, shorter and more vertical – and has three lobes RIGHT LUNG!

The arch of the aorta runs behind the esophagus and in front of the vertebral
column. in front of the esophagus!!

The superior vena cava runs in front of the trachea

Left main bronchus –
•Passes inferiolaterally, INFERIOR to the arch of the aorta and
ANTERIOR to the esophagus and thoracic aorta

The left and right brachiocephalic veins (or innominate veins) in the upper
chest are formed by the union of each corresponding internal jugular vein 
and subclavian vein. This is at the level of the sternoclavicular joint.[1]
The left brachiocephalic vein is usually longer than the right. These great
vessels merge to form the superior vena cava behind the junction of the first
costal cartilage with the manubrium sternum. The brachiocephalic veins are
the major veins returning blood to the superior vena cava.

In human anatomy, the internal thoracic artery (ITA), previously known as
the internal mammary artery (a name still common among surgeons), is an
artery that supplies the anterior chest wall and the breasts. It is a paired
artery, with one running along each side of the sternum, to continue
after its bifurcation as the superior epigastric and musculophrenic arteries.

3. Heart 

The pericardial sac is made up of all of the following except:
– the outermost fibrous pericardium and
– the inner serous pericardium.
the innermost pericardium

The fibrous pericardium is tough, external, and
continuous with the central tendon of the diaphraphm

The serous pericardium, in turn, is divided into two layers,
1. the PARIETAL pericardium, which is fused to and inseparable from the
fibrous pericardium, and
2. the VISCERAL pericardium, which is part of the epicardium.

The epicardium is the layer immediately 
outside of the heart muscle proper (the myocardium).

The pericardial cavity is the POTENTIAL SPACE between the opposing 
layers of the parietal and visceral layers of the serous pericardium

The PERICARDIAPHRENIC artery supplies the pericaridum. Which large
artery gives rise to it (it branches of this artery).
– the subclavian artery
– the internal thoracic artery
– the musculophrenenic artery

What would correctly describe the position of the phrenic nerve
in realtion to the vagus nerve?
The vagus nerve is medial to the phrenic nerve
– The phrenic nerve is medial to the vagus nerve
– The vagus and phrenic nerve are connected

What veins drain the pericardium?
– the right and left pericardium veins
the pericardiacophrenic veins
– the phrenocardiadrano veins

The brachiocephalic veins are  chest are formed by the union of each corresponding 
internal jugular vein and subclavian vein

The phrenic nerves also supply the pericardium

What may cause pericarditis – all except?
– a virus
– after an MI
after a V8

Cardiac tamponade is a type of fizzy drink.

or – is it a condition where the pericardium in chronically inflamed
and effusion squezes the heart? yes!

Cardiomegaly is a condition wherein the heart is enlarged. May happen as a result of the heart constantly beating with HTN, or COPD.

The nervous supply to the pericadium contains all of the following
– Phrenic nerves (C3-C5)-sensory fibers (Pain sensations conveyed by these
nerves are commonly referred to the skin (C3-C5 dermatomes) of the top of
the shoulder of the same side)
-Vagus nerve (CN X)
The phreaky nerve
– Sympathetic trunks-vasomotor

Apex normally lies in the left 6th intercostal
space just medial of midclavicular line    no the 5th

Base of the  heart  is the posterior surface, formed mainly by left atrium

–Anterior surface is mainly right ventricle

–Inferior surface is mainly left ventricle

In the heart, the sinus venarum and auricle (artial appendage)
are separated by:
the crista terminalis
– terminalis crista
– none of the above

Fossa ovalis is in interatrial septum

What is the fossa ovalis (right atrium)?
– depression in the RA, remnant of a thin fibrous sheet that
covered the foramen ovale during fetal development
– same as above, but in the LA

The right ventricle has 2 papillary muscles which attach to valve cusps by
chordae tendineae NO THE LEFT!!!!!!!
–Septomarginal (moderator) band
–Conus arteriosus

The septomarginal trabecula (also known as moderator band) is a muscular band of heart tissue found in the right ventricle. 

This septomarginal trabecula is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle. This shortcut across the chamber of the ventricle seems to facilitate conduction time, allowing coordinated contraction of the anterior papillary muscle; (see electrical conduction system of the heart).

From its attachments it was thought to prevent overdistension of the ventricle, and was named the “moderator band”. It is well-marked in sheep and some other animals, and frequently extends from the base of the anterior papillary muscle to the ventricular septum.
The moderator band is often used by radiologists and obstetricians to more easily identify the right ventricle in prenatal ultrasound.

The conus arteriosus is a conical pouch formed from the upper and left angle of the right ventricle in the chordate heart, from which the pulmonary trunk arises.

Left atrium
–Receives blood from 2 pulmonary veins NO 4 VEINS!!

Left ventricle
–Mitral valve
4 papillary muscles attach to cusps by chordae tendineae NO TWO PAPLLARY MUSCLES

T/F? (ok, I’ll tell’s true!)

Right coronary artery
•Typically, the RCA supplies:
–The right atrium.
–Most of right ventricle.
–Part of the left ventricle (the diaphragmatic surface).
–Part of the IV septum, usually the posterior third.
–The SA node (in approximately 60% of people).
–The AV node (in approximately 80% of people).
Gives off marginal branch (supplies right border of heart)

T/F? (yup, this is true also…)

Left coronary artery
•Typically, the LCA supplies:
–The left atrium.
–Most of the left ventricle.
–Part of the right ventricle.
–Most of the IVS (usually its anterior two thirds), including the AV bundle
of the conducting system of the heart, through its perforating IV septal branches.
–The SA node (in approximately 40% of people).
Anterior interventricular artery (left anterior descending=LAD)
•Circumflex artery

Things to remember about the RCA:

Things to remember about the LCA:

Things to remember about the Cardiac veins:
GREAT CARDIAC VEIN Accompanies anterior interventricular artery, and continues as coronary sinus
YUP – runs right next to the LAD!!!!
ANTERIOR CARDIAC VEINS Drains directly into right atrium

These are the correct order of serious heart
conditions concerning coronary vessels:
1. M.I. due to L.A.D. of L. coronary artery (widow maker b/c covers most of LV)
2. RCA b/c RA and RV
3. Circumflex branch coming off LCA

4. Left coronary artery (before circumflex branching)
5. Posterior interventricular branch
6. Marginal artery

Clinical correlate:
CABG (coronary bybass graft)
– blocked coronary artery MI, can bypass it by 
adding a graft (e.g., leg vessel).
– also used for seriois angina (from ischemia?)
– links proximal and distal portions (a detour)

MI: ischemia of muscle myocardiaum are which has undergone necrosis
LAD, RC, etc, why do they clog? Plaques…coronary atherosclerosis


Tricuspid (right atrioventricular) valve
Inferior middle sternum
Over inferior middle sternum
Bicuspid (left atrioventricular) valve
Fourth costal cartilage and 4th intercostal space
Over apex of heart (5th intercostal space at midclavicular line)
Pulmonary valve
Third left costal cartilage
Second left intercostal space, just lateral to sternum
Aortic valve
Fourth left costal cartilage
Second right intercostal space, just lateral to sternum

4. Mediastinum 

Contents of the mediastinum contain all except:
– the heart,
– the great vessels of the heart,
– the esophagus,
– the trachea,
– the phrenic nerve,
– the cardiac nerve,
– the thoracic duct,
– the thymus,
– the lymph nodes of the central chest.
the kitchen sink

Parts of the mediastinum:

UPPER PORTION – SUPERIOR MEDIASTINUM (above the upper level of the pericardium)

superior limit- at the superior thoracic aperture
inferior limit – at the plane from the sternal angle to the disc of T4-T5
(Plane of Ludwig at Angle of Louis);

LOWER PORTION (below the upper level of the pericardium)

This lower portion is subdivided into three parts, viz.:
ANTERIOR MEDIASTINUM that in front of the pericardium, the anterior mediastinum;
MIDDLE MEDIASTINUM (containing the pericardium and its contents)
POSTERIOR MEDIASTINUM (behind the pericardium)

Hey! Know the contents of these too!!!!

The superior mediastinum is superior to the transverse thoracic plane
which is at the sternal angle (T4 is just above this)

The inferior mediastinum is below the transverse thoracic plane (along sternal angle)

As a review…T/F?
Divisions of the mediastinum:
–Anterior (Heart, roots of great vessels) NO!!! middle

The anterior mediastinum contains all of the following EXCEPT:
– Remnants of thymus
– Lymph nodes
– Fat
Brachiocephalic trunk
– Connective tissue

The superior mediastinum is located superior to the:
– oblique thoracic plane
transverse thoracic plane
– medial thoracic plane

The location of the superior mediastinum passes through the:
– sternal angle and the junction (V disk) of vertabrae T5 and T6
– sternal angle and the junction (IV disk) of vertabrae T4 and T5

What nerve passes anteriorly to the trachea in the superior mediastinum?
the recurrent laryngeal nerve
– the rerun laryngeal nerve
– the nerve of that guy!

What nerve passes closet to the trachea?
– phrenic
– superphrenic
– superphreaky

The AZYGUS VEIN is a vein running up the thoracic
vertebral column. It can also provide an alternative path for blood
to the right atrium by allowing the blood to flow between the
venae cavae when one vena cava is blocked.
Which side does it run up?
the right side
– the left side (pleeeese don’t choose this one!!)

Brachicephalic veins form (posterior/inferior) to the sternoclavicularjoints
by the union of the (external/internal) jugular and subclavianveins

Right phenic nerve lies between the SVC and the mediastinal peura

Arch of the aorta ascends anterior/posterior to the right pulmonary
artery and the bifurcation of the trachea

Does the subclavian vein join the brachiocephalic vein?
– no
– abstain

As the arch of the aorta decends, via the body of the T$ vertebra and ends
by becoming the ___________, posterior to the 2nd left sternocostal joint.
– vena cava
thoracic aorta
– thoracic arteriole
– Baltimore Orioles
– Oreo cookie

Ligamentum arteriosum
•Remnant of the fetal ductus arteriosus, passes from the root of the
left pulmonary artery to the inferior surface of the arch of the aorta
Left recurrent layngeal nerve (AKA the giant nerve loop of SIMON)
hooks beneath the arch immediately
lateral to the ligamentum arteriosum and ascends BETWEEN the
trachea and esophagus

Arch of the Aorta

Branches are all EXCEPT:
–Brachiocephalic trunk
–Left common carotid artery
–Left subclavian artery
Left tarsal artery

The brachiocephalic artery (or brachiocephalic trunk or 
innominate artery) is an artery of the mediastinum that supplies 
blood to the RIGHT ARM and the head and neck.

The brachiocephalic artery of the arch of the aorta splits into

separate arteries

Review T/F?
The sternal angle is at about L5 (the transverse thoracic plane), or between
T4 and T5..about the level of the first rib.

The AORTIC ARCH starts anterior to the trachea, then goes behind
all until reaching the vertebral column.

The brachiocephalic trunk branches off into the RCCA and the:
– left subclavian artery
right subclavian artery
– the sub claviocobrachial plexus 🙂

What is the sole motor supply to the diaphragm? Hey! Some are sensory!!
– the vagus nerve
the phrenic nerve
– the super phreaky phrenic nerve

What branch of the VAGUS nerve (CNX) supplies the all the intrinsic
muscles of the larynx AT THE LEVEL OF THE AORTIC ARCH – they travel up the
side of the trachea to the larynx? (with the exception of the cricothyroid
muscles?) (the left nerve loops under the arch)
– the great nerve of sim
recurrent laryngeal nerves
– the late show with david letterman

The trachea stems from C6 down into the:
– middle mediastinum
superior mediastinum
– super medial miastinum

The trachea lies ANTERIOR to the AORTIC ARCH

The trachea bifurcates into bronchi at the sternal angle

The SCALENE MUSCLES are a group three pairs of muscles in the
lateral neck. The PHRENIC NERVES run:
anterior to the scalene muscles
– posterior to the scalene muscles

The ligamentum arteriosum is a remnant of the fetal ductus arterioisus

The ligamentum arteriosum (or arterial ligament) is a small ligament attached to the superior surface of the left pulmonary artery and the proximal descending aorta.[1] It is a nonfunctional vestige of the ductus arteriosus, and is formed within three weeks of birth.The ligamentum arteriosum is closely related to the left recurrent laryngeal nerve, a branch of the left vagus nerve. After splitting from the left vagus nerve, the left recurrent laryngeal loops around the aortic arch posterior to the ligamentum arteriosum, after which it ascends to the larynx. This ligament also plays a role in major trauma; it fixes the aorta in place during rapid decelerations recoil, consequently potentially resulting in ruptured aorta.

The three branches of the arch of the aorta are all except:
– the brachiocephalic artery
– left common carotid Artery
– left subclavian Artery
thoracic aorta

The left and right EXTERNAL JUGULAR VEINS first drain into the:
subclavian veins
– superior vena cava

The INTERNAL JUGULAR VEINS join with the subclavian veins more
medially to form the:
brachiocephalic veins
– abdominal aorta (I know, ridiculous!)

anterior to T5-T12, posterior to the pericardium and
diaphragm, and between the parietal pleura of the 2 lungs

The POSTERIOR MEDIASTINUM contains all of the following
– Thoracic aorta
– Thoracic duct
– Azygos and hemiazygos veins
– Esophagus and plexus
– Sympathetic trunks
– Splanchnic nerves
cabbage patch kids

The HEMIZYGOS VEIN and the ACCESSORY hemiazygos vein, 
when taken together, essentially serve as the left-sided 
equivalent of the azygos vein. That is, the azygos vein serves 
to drain most of the posterior intercostal veins on the right side 
of the body, and the hemiazygos vein and the accessory hemiazygos 
vein drain most of the posterior intercostal veins on the left side of 
the body

The SPLANCHNIC NERVES are paired nerves that contribute to 
the innervation of the viscera, carrying fibers of the autonomic 
nervous system (visceral efferent fibers)

 in the diaphragm and changes its name to:
abdominal aorta
– thoracic aortic plexus
– Inspector clouseau

What also descend on the right side of the thoracic aorta and accompany
it through the hiatus?
thoracic duct and azygos vein
– Peaches and Herb

– The HIATUS is a hole in the diaphragm –

What side does the thoracic aorta begin (T4 – descends to T5-T12)?
left side
– right side

What nerves would you find on the thoracic aorta?
– Thoracic aortic plexus-autonomic nerves
– cranial nerve number 1
– yellow ones

Remember: The recurrent laryngeal nerves emerge from the vagus nerve 
at the level of the arch of aorta, and then travel up the side of the trachea to 
the larynx. 

The phrenic nerve causes hiccups

Branches of thoracic aorta are all of the following EXCEPT:
– Bronchial
– Pericardial
– Posterior intercostals
– Superior phrenic
– Esophageal
– Mediastinal
– Subcostal
tummy button

The esophagus runs from THE PHARNYX at C6 to
CARDIAC ORIFICE of the stomach
–Passes through esophageal hiatus in the diaphragm at the T10 vertebrae

There are 3 constrictions in thorax which show after barium is swallowed
•As it crosses posterior arch if aorta
•As it crosses left main bronchus
•As it passes through the esophageal hiatus

Aneurysm of the ascending aorta
–Distal part of the ascending aorta
–Localized dilation
–Patients usually complain of chest pain that radiated to the back
–May exert pressure on the trachea, esophagus, and recurrent laryngeal
nerve – SO EXPECT VOICE CHANGES (hoarse)
•Injury to recurrent laryngeal nerve

The trachea is first behind the esophagus until it bifurcates 
at the  aortic arch


The location of the heart is correctly described as
A) lateral to the lungs.
B) medial to the sternum.
C) superior to the diaphragm.
D) posterior to the spinal column.
Feedback: The heart is medial to the lungs, posterior to the sternum, and anterior to the spinal column.

The location of the heart is correctly described as
A) lateral to the lungs.
B) medial to the sternum.
C) superior to the diaphragm.
D) posterior to the spinal column.
Feedback: Correct Answer
The apex of the heart
A) is part of the left ventricle wall.
B) points inferiorly and laterally.
C) is at the approximate level of the 5th intercostal space.
D) All of the above are correct concerning the apex of the heart.
Feedback: The apex of the heart is the pointed “bottom” of the heart.
The heart would NOT appear on this kind of thoracic section.
A) midsagittal section
B) transverse section at the level of the 4th rib
C) transverse section at the level of the 8th rib
D) frontal (coronal) section that also includes the pulmonary trunk

The apex of the heart is located at the 5th intercostal space. A true transverse section at the 8th rib would include the upper abdomen.
In normal individuals, about 2/3 of the total mass of the heart is located
A) above the aortic arch
B) on the right side of the thoracic cavity
C) on the left side of the thoracic cavity
D) in the right ventricle
Feedback: Correct Answer
The heart is located
A) inside the pericardial cavity.
B) in the mediastinum, which is located in the pericardial cavity.
C) in the mediastinum, which is located in the thoracic cavity.
D) in the thoracic cavity, which is located in the mediastinum.
Feedback: The mediastinum is the subdivision of the thoracic cavity between the left and right pleural cavities. The pericardial cavity is between the visceral pericardium and the parietal pericardium, and contains only serous fluid.
A needle being inserted into the heart would travel through the layers of the heart wall and coverings in which order, beginning on the outside?
A) fibrous pericardium, parietal pericardium, visceral pericardium, myocardium, endocardium
B) parietal pericardium, fibrous pericardium, visceral pericardium, myocardium, endocardium
C) endocardium, myocardium, fibrous pericardium, parietal pericardium, visceral pericardium
D) visceral pericardium, parietal pericardium, fibrous pericardium, endocardium, myocardium
Feedback: Correct Answer

Which layer of the heart is correctly matched with the tissue of which it is composed?
A) endocardium – cardiac muscle tissue
B) fibrous pericardium – stratified squamous epithelium
C) myocardium – dense irregular connective tissue
D) visceral pericardium – a thin layer of epithelium and loose connective tissue
Feedback: The visceral pericardium is the serous membrane on the outer surface of the myocardium. It is composed of simple squamous epithelium and areolar tissue.
What is located in the pericardial cavity?
A) the heart
B) the fibrous pericardium
C) the mediastinum
D) a small amount of serous fluid
Feedback: Correct Answer
The pericardial cavity is between the
A) fibrous pericardium and parietal pericardium
B) left atrium and left ventricle
C) visceral pericardium and parietal pericardium
D) endocardium and myocardium
Feedback: Correct Answer

The function of the pericardial fluid is to
A) reduce friction between the pericardial membranes.
B) lubricate the heart valves.
C) replace any blood that is lost.
D) provide oxygen and nutrients to the endocardium.
Feedback: Correct Answer
The visceral pericardium is also called the
A) endocardium.
B) epicardium.
C) myocardium.
D) mediastinum.
Feedback: Correct Answer
The coronary sulcus is a groove on the outside of the heart that marks the division between the
A) left and right atria
B) left and right ventricles
C) atria and ventricles
D) aorta and pulmonary trunk
Feedback: Correct Answer

The anterior and posterior interventricular sulci mark the position of which internal heart structure?
A) bicuspid and tricuspid valves
B) semilunar valves
C) fossa ovalis
D) interventricular septum
Feedback: Correct Answer
The chordae tendineae
A) attach the semilunar valves directly to the heart wall
B) prevent the atrioventricular valve cusps from prolapsing into the atria during ventricular systole
C) open the atrioventricular valves during ventricular systole
D) attach the heart to the pericardium
Feedback: The chords attach the valve cusps to the papillary muscles of the ventricle. They pull the valves open during ventricular diastole, and provide tension on the cusps during ventricular systole, preventing them from prolapsing in the atria.

The heart valves
A) contract to pump blood through the heart.
B) separate the left and right sides of the heart.
C) prevent blood from flowing backward through the heart.
D) cause the heart sound when they open.
Feedback: Correct Answer
Which of the following vessels is a branch of the left coronary artery?
A) left posterior ascending artery
B) circumflex artery
C) posterior interventricular artery
D) left subclavian artery
Feedback: Correct Answer

A blood clot in the circumflex artery would cause a myocardial infarction in part of the
A) walls of the left atrium and posterior left ventricle.
B) anterior walls of the left and right ventricles, and the interventricular septum.
C) posterior walls of the left and right ventricles.
D) lateral walls of the right atrium and right ventricle.
Feedback: Correct Answer

All cardiac veins empty into the ______, which then empties into the ______.
A) coronary sinus; left atrium
B) coronary sinus; right atrium
C) great cardiac vein; right atrium
D) great cardiac vein; left atrium
Feedback: Correct Answer

The right ventricle of the heart acts as a pump for the
A) pulmonary circulation.
B) systemic circulation.
C) coronary circulation.
D) hepatic portal circulation.
Feedback: The right ventricle pumps blood through the pulmonary trunk and pulmonary arteries to the lungs.
The aorta and pulmonary trunk extend from the heart at its
A) apex.
B) base.
C) interventricular sulcus.
D) atrioventricular sulcus.
Feedback: The apex is at the lower left corner of the heart. A sulcus is a shallow depression on the exterior surface of an organ.
Which two layers are the most similar in tissue structure?
A) fibrous pericardium and visceral pericardium
B) fibrous pericardium and endocardium
C) visceral pericardium and parietal pericardium
D) myocardium and endocardium
Feedback: They are most similar because they are continuous with each other and are composed of the same kinds of tissues.
An auricle is
A) a valve located in a blood vessel
B) an extension of the atrial wall
C) part of a heart valve
D) a blood vessel that carries blood away from the heart
Feedback: “Auricle” means ear-like, and refers to flap-like appearance of the atrium when not filled with blood.
The coronary sinus is a(n) ______ located in the ________.
A) vein; posterior atrioventricular sulcus
B) vein; posterior interventricular sulcus
C) artery; anterior atrioventricular sulcus
D) artery; interatrial septum
Feedback: Correct Answer

Which of the following is not associated with atrioventricular valves?
A) chordae tendineae
B) cusps
C) papillary muscles
D) arteries
Feedback: Correct Answer
A point where two arteries connect and combine their blood flow is called a(n)
A) anastomosis.
B) infarction.
C) divergence.
D) aneurysm.
Feedback: Correct Answer
The presence of arterial anastomoses in the heart
A) increases the chance of a myocardial infarction by providing more places for blood clots to lodge.
B) reduces the chance of a myocardial infarction by providing alternate sources of blood flow to the myocardium.
C) increases the time it takes for blood to flow through the coronary circulation.
D) is a sign of cardiovascular disease.
Feedback: If one vessel is blocked by a blood clot, blood coming through another vessel that joins the first one can make up for the lack of flow in the blocked vessel.
Which chamber of the heart has to work the hardest (pump against the highest pressure)?
A) right atrium
B) left atrium
C) right ventricle
D) left ventricle
Feedback: Correct Answer
Which statement is correct concening pulmonary circulation?
A) Oxygen rich blood returns from the lungs to the heart through the pulmonary arteries.
B) Oxygen poor blood leaves the heart and goes to the lungs through the pulmonary veins.
C) Oxygen poor blood returns from the body to the heart through the vena cavae.
D) Oxygen rich blood leaves the heart and goes to the body through the vena cavae.
Feedback: Correct Answer

Which of the following heart chambers is correctly associated with the blood vessel that enters or leaves it?
A) right atrium – pulmonary veins
B) left atrium – aorta
C) right ventricle – pulmonary trunk
D) left ventricle – superior and inferior vena cavae
Feedback: Correct Answer
Blood leaving the left ventricle goes through which of the following valves?
A) biscuspid
B) tricuspid
C) aortic semilunar
D) pulmonary semilunar
Feedback: Correct Answer
Blood from the pulmonary veins enters which heart chamber?
A) right atrium
B) left atrium
C) right ventricle
D) left ventricle
Feedback: Correct Answer
An obstruction in the pulmonary trunk would prevent blood from
A) being distributed to the systemic circulation
B) picking up oxygen in the lungs
C) getting into the right atrium
D) leaving the left ventricle
Feedback: Correct Answer
The Purkinje fibers are found in which layer of the heart wall?
A) endocardium
B) epicardium
C) fibrous pericardium
D) myocardium
Feedback: The Purkinje fibers are modified cardiac muscle cells that carry impulses as part of the cardiac conducting system.
The “skeleton” of the heart
A) provides attachment for the heart valves and cardiac muscle
B) is made of fibrocartilage
C) provides internal support for the cardiac chambers
D) is also called the fibrous pericardium
Feedback: The fibrous skeleton of the heart is composed of collagen fibers. It electrically isolates the atria from the ventricles, and serves as the attachment site of the valves and muscle.

The atria are electrically isolated from the ventricles by the
A) fibrous skeleton
B) AV bundle
C) visceral pericardium
D) Purkinje fibers
Feedback: The fibrous skeleton of the heart is composed of collagen fibers. It electrically isolates the atria from the ventricles, and serves as the attachment site of the valves and muscle.
Intercalated discs include these structures:
A) gap junctions, desmosomes, interdigitating folds
B) gap junctions, tight junctions, t-tubules
C) gap junctions, desmosomes, t-tubules
D) sarcoplasmic reticulum, interdigitating folds
Feedback: Everything at an intercalated disc involves holding two myocardial cells together or allowing them to communicate. T-tubules and sarcoplasmic reticula are located within muscle cells, not between them.
The repair process that occurs in cardiac muscle following injury consists of the replacement of dead myocardial cells by
A) mitosis of existing cardiac muscle cells
B) scar tissue
C) the migration of immature cardiocytes into the damaged area
D) the growth of epithelial cells into the damaged tissue
Feedback: Correct Answer
Which of the following parts of the cardiac conduction system is correctly matched with its location?
A) AV bundle (bundle of His) – upper part of interatrial septum
B) AV node – left atrium in the inferior interventricular septum
C) Purkinje fibers – epicardium of the ventricles
D) SA node – right atrium near the opening of the superior vena cava
Feedback: Correct Answer

In which choice are the components of the cardiac conduction system listed in the correct sequence?
A) SA node, AV bundle, AV node, Purkinje fibers
B) SA node, AV node, AV bundle, Purkinje fibers
C) AV node, AV bundle, SA node, Purkinje fibers
D) AV node, SA node, Purkinje fibers, AV bundle
Feedback: Correct Answer

Damage to cells of the AV bundle would prevent the cardiac impulse from reaching the
A) SA node
B) atria
C) AV node
D) ventricles
Feedback: Correct Answer
Conduction of the cardiac impulse is slowed as it passes through the AV node. This allows time for the
A) ventricles to start contracting before the atria finish contracting.
B) atria to contract completely before the ventricles start to contract.
C) SA node to catch up.
D) last ventricular contraction to finish.
Feedback: Correct Answer
Because of the distribution of the cardiac impulse by the conduction system, ventricular contraction begins
A) in the semilunar valves and then pushes blood toward the interventricular septum
B) in the papillary muscles and causes the atrioventricular valves to open
C) in the superior part of the ventricles and pushes blood toward the apex
D) at the apex of the heart and pushes blood toward the semilunar valves
Feedback: Contraction of the superior aspects of the ventricles would push blood toward the apex, making it harder for the ventricles to force the blood up and out through the semilunar valves.
In the cardiac conduction system, junctional fibers connect the
A) atrial syncytium to the AV node.
B) AV node to the AV bundle.
C) SA node to the Purkinje fibers.
D) AV bundle branches to the Purkinje fibers.
Feedback: Correct Answer
Which structure is present in the cardiac muscle tissue but not skeletal muscle tissue?
A) striations
B) nuclei
C) intercalated disks
D) t-tubules
Feedback: Correct Answer
Energy for contraction of myocardial cells comes primarily from
A) aerobic respiration in the mitochondria.
B) anaerobic respiration in the cytosol.
C) glycolysis in the cytosol.
D) ATP that is stored while the heart is not contracting.
Feedback: The energy demands of the myocardium are very high, therefore cardiac cells require the full ATP production provided by aerobic respiration.
Which component of a myocardial cell allows it to electrically stimulate adjoining cells?
A) gap junctions
B) t-tubules
C) desmosomes
D) sarcoplasmic reticulum
Feedback: Correct Answer
The sinus rhythm of a normal adult heart would be about
A) less than 40 beats per minute.
B) 40 – 50 beats per minute.
C) 70 – 80 beats per minute.
D) 10 to 120 beats per minute.
Feedback: Correct Answer
The cells of the heart’s normal pacemaker
A) spontaneously generate electrical signals about 70 to 80 times per minute.
B) are located in the interventricular septum.
C) generate electrical signals only when stimulated by sympathetic fibers.
D) are not in contact with other cells of the heart.
Feedback: The SA node has the fastest depolarization/repolarization rate, and is called the pacemaker because it originates the cardiac impulse.
An electrocardiogram actually records
A) the contraction and relaxation of the myocardium
B) electrical changes that occur in the myocardial cells.
C) blood flow through the heart.
D) changes in pressure in the left ventricle.
Feedback: Correct Answer
Which of the following components of an ECG is not correctly matched with the corresponding event occurring in the heart?
A) P wave – atrial depolarization
B) PR interval – AV node conduction
C) QRS complex – ventricular depolarization
D) T wave – atrial repolarization
Feedback: Correct Answer

If the SA node is damaged, which part of the heart is most likely to take over as a pacemaker?
A) atrial myocardial cells
B) AV nodal cells
C) Purkinje fibers
D) ventricular myocardial cells
Feedback: Correct Answer
The normal rate of spontaneous depolarization of the AV node is
A) 20 – 40 per minute
B) 40 – 60 per minute
C) 70 – 80 per minute
D) over 100 per minute
Feedback: The AV node has a depolarization rate of 40 – 60 per minute – a bit slower than the SA node.
In which choice are the components of the heart placed in correct order of decreasing intrinsic rhythm?
A) SA node, AV node, Purkinje cells
B) SA node, Purkinje cells, AV node
C) AV node, SA node, Purkinje cells
D) Purkinje cells, AV node, SA node
Feedback: Correct Answer
The cardiac pacemaker potential is caused by cyclic changes in membrane potential that occur in which of the following sequences?
A) slow inflow of Na; rapid K+ inflow; slow K+ outflow
B) slow inflow of Ca2+ ; rapid Na+ inflow; rapid K+ outflow
C) slow inflow of Kwithout Naoutflow; rapid Na+ inflow; rapid K+ outflow
D) slow inflow of Na+ without Koutflow; rapid Ca2+ inflow; rapid K+ outflow

The ion channels in cardiac muscle cells operate differently than those of neurons or skeletal muscle cells. The slow inflow of Na+ gradually depolarizes the cell to threshold without requiring a nerve impulse.
The plateau phase of the cardiac myocardial cell potential
A) normally keeps the heart from beating faster than 70 – 80 times per minute
B) allows the cell to depolarize spontaneously instead of having to be stimulated by nerve fibers
C) prevents tetanus, which would cease pumping action of the heart
D) allows the myocardial cells time to rest during the contraction
Feedback: The plateau phase lengthens the absolute refractory period, preventing a second impulse from forming before the contraction caused by the first has relaxed.
What do skeletal muscle cells, cardiac autorhythmic cells, and cardiac contractile cells have in common?
A) In all three, depolarization to threshold is caused primarily by Koutflow
B) In all three, depolarization between threshold and peak membrane potential is caused entirely by Na+ inflow
C) In all three, repolarization is caused by K+ outflow
D) In all three, the depolarization phase is longer than the repolarization phase

Ca2+ is involved in cardiac muscle cell potentials, but not in skeletal muscle cell potentials.
If lines were drawn on a typical ECG recording showing where atrial and ventricular systole begin and end, then the ventricular systole would be seen as beginning during a ____ and ending during the next ____.
A) P wave; QRS complex
B) PR segment; T wave
C) QRS complex; T wave
D) T wave; P wave
Feedback: The ECG tracing is a picture of an impulse passing through the cardiac conduction system. Each wave indicates the electrical depolarization or repolarization of a different area. The mechanical contraction of myocardial cells occurs just after the depolarization of the adjacent area of the cardiac conduction system.

In an ECG taken from a person who has no SA node activity, which component will not appear?
A) P wave
B) QRS complex
C) ST segment
D) T wave
Feedback: Correct Answer
Calcium is needed for contraction in both skeletal muscle and cardiac muscle. However there are some differences in where it comes from and what it does. Which of these choices correctly describes how calcium works in cardiac muscle cells?
A) Extracellular Ca2+ diffuses into the cardiac muscle cells, binds to Ca2+ channels in the sarcoplasmic reticulum and causes Ca2+ release into the cytosol.
B) Extracellular Ca2+ diffuses into the cardiac muscle cells, binds to troponin and initiates contraction.
C) Ca2+ from the sarcoplasmic reticulum diffuses out of the cell, causing the plateau phase of the action potential.
D) Ca2+ from the sarcoplasmic reticulum diffuses out of the cell, causing repolarization.

In cardiac muscle cells, extracellular Ca2+ has a different job than the Ca2+ from the sarcoplasmic reticulum. The extracellular Ca2+ ions are involved in action potential formation. The ions from the sarcoplasmic reticulum are involved in the contraction mechanism.
The plateau phase of the cardiac contractile cell action potential is caused by
A) Ca2+ inflow
B) Cl inflow
C) K+ outflow
D) Na+ outflow
Feedback: The plateau phase slows repolarization by increasing the number of positive ions in the cell.
Contraction of a ventricular chamber is called
A) diastole.
B) diastasis.
C) hypertrophy.
D) systole.
Feedback: Correct Answer
The atrioventricular valves open when pressure in the
A) atria is greater than pressure in the ventricles.
B) ventricles is greater than pressure in the arteries.
C) arteries is greater than pressure in the ventricles.
D) ventricles is greater than pressure in the atria.
Feedback: Correct Answer
When the right atrium contracts, it pushes blood into the
A) superior and inferior vena cavae.
B) left atrium.
C) right ventricle.
D) aorta.
Feedback: Correct Answer

The alternate contraction and relaxation of the atria and ventricles are referred to as the
A) cardiac output
B) coronary circulation
C) cardiac conduction system
D) cardiac cycle
Feedback: The cardiac conduction system carries the impulse that stimulates the mechanical contraction of the heart chambers. The cardiac cycle refers to the heart’s mechanical rhythm.
While the atria of the heart are in systole
A) the ventricles are also in systole.
B) the atrioventricular valves are closed.
C) blood is being pumped into the aorta and pulmonary trunk.
D) blood is being pumped into the ventricles.
Feedback: Correct Answer
Of the amount of blood entering the ventricles before they contract
A) about 70% comes in during atrial contraction.
B) about 70% comes in before atrial contraction.
C) 100% comes in during atrial contraction.
D) 30% comes in during atrial contraction and 70% comes in during ventricular contraction.
Feedback: Passive filling occurs during the atrial and ventricular diastole between beats.
During ventricular diastole
A) pressure in the atria exceeds pressure in the ventricles and the atrioventricular valves open
B) pressure in the ventricles eventually exceeds pressure in the arteries and the semilunar valves open.
C) the atria contract and pump blood into the ventricles
D) no blood enters the arteries
Feedback: The function of ventricular systole is to pump blood into the arteries.

Pressure in the ventricles would be highest during
A) atrial diastole
B) atrial systole
C) ventricular diastole
D) ventricular systole
Feedback: Correct Answer
In which choice must the first event occur before the second event for normal cardiac activity during one cardiac cycle?
A) Purkinje cells depolarize; atrial myocardial cells contract
B) ventricular cells contract; atrial cells contract
C) atrioventricular valves close; semilunar valves open
D) AV node depolarizes; SA node depolarizes
Feedback: If the AV valves don’t close before the semilunar valves open, blood flows backward through the chambers.
During the isovolumetric phase of the cardiac cycle
A) the atria contract and pump blood into the ventricles
B) the ventricles contract and pump blood into the blood vessels
C) both atria and ventricles are relaxed
D) the ventricles contract but ventricular pressure is lower than arterial pressure
Feedback: The isovolumetric phase occurs immediately after the T wave ends. The ventricles relax, but for a short period all the valves in the heart are closed, and no ventricular filling offers. Because the ventricular volume is not changing, this time is said to be isovolumetric (meaning “same volume”).

The semilunar valves close at the beginning of
A) atrial systole
B) atrial diastole
C) ventricular systole
D) ventricular diastole
Feedback: The reduction of ventricular pressure below arterial pressure allows the force of arterial blood “falling back” toward the ventricles to close the semilunar valves.
Which part of the cardiac cycle occurs between the time the AV valves close and the semilunar valves open?
A) atrial systole
B) atrial diastole
C) isovolumetric phase of ventricular systole
D) ejection phase of ventricular systole
Feedback: While all the valves are closed, no blood moves. The volumes don’t change, so the phase is called isovolumetric (meaning “same volume”)
The action of acetylcholine after binding to muscarinic receptors on the SA node is to
A) open K+ channels, causing hyperpolarization and a decreased rate of spontaneous depolarization
B) close K+ channels, causing depolarization and and increased rate of spontaneous depolarization
C) open Ca2+ channels, causing increased Ca2+ entry and a stronger contraction
D) close Ca2+ channels, causing decreased Ca2+ entry and a faster rate of spontaneous depolarization
Feedback: Acetylcholine is released by parasympathetic fibers, and acts to slow the heart rate.
What is the effect of norepinephrine on the heart?
A) It decreases the rate and strength of contraction.
B) It increases the rate and strength of contraction.
C) It decreases the amount of blood pumped per minute.
D) It has no effect on the heart.
Feedback: Correct Answer
The amount of blood in the ventricles just before they contract is called the
A) end diastolic volume
B) end systolic volume
C) stroke volume
D) cardiac output
Feedback: Correct Answer

If the heart rate is 70 beats per minute and stroke volume is 70 ml, then
A) ESV is 140 ml
B) ESV is 1 ml
C) CO = 4900 ml/min
D) CO = 140 ml/min
Feedback: Correct Answer
The amount of blood ejected from the heart in one minute is called the
A) cardiac output
B) end diastolic volume
C) end systolic volume
D) stroke volume
Feedback: The difference between EDV and ESV is the stroke volume. Cardiac output is defined as SV times beats per minute.
Which choice would not increase cardiac output?
A) increase heart rate, increase stroke volume
B) increase heart rate, no change in stroke volume
C) no change in heart rate, increase stroke volume
D) decrease heart rate, no change in stroke volume
Feedback: Correct Answer
Cardiac output from the left ventricle is
A) normally greater than that of the right ventricle
B) probably lower than the right ventricle if the person has systemic edema
C) probably lower than the right ventricle if the person has pulmonary edema
D) probably higher than the right ventricle if the person has pulmonary edema
Feedback: Edema occurs when one ventricle cannot keep up with the other. The blood “backs up” on one side of circulation, increasing the hydrostatic pressure in the vessels. The increased pressure causes more fluid to enter the tissues, causing the edema.
Joe’s cardiac output at rest is 5 L/min. When he is exercising strenuously it is 20 L/min. What is Joe’s cardiac reserve?
A) 4 L/min
B) 15 L/min
C) 25 L/min
D) 100 L/min
Feedback: Cardiac reserve equals CO during exertion minus CO at rest. The higher the cardiac reserve, the more easily one tolerates strenuous exercise.
Based on the information given below, which individual has the greatest tolerance for strenuous exercise? Assume they are similar in terms of size and muscular fitness.
A) Ann, cardiac reserve = 8 L/min
B) Betsy, cardiac reserve = 15 L/min
C) Carla, cardiac reserve = 18 L/min
D) Donna, cardiac reserve = 25 L/min
Feedback: Correct Answer
Any factor that alters heart rate is called
A) a chemotrope
B) a chronotrope
C) an inotrope
D) an isotope
Feedback: Correct Answer
Which of the following is not a positive chronotrope?
A) acetylcholine
B) epinephrine
C) thyroid hormone
D) caffeine
Feedback: Correct Answer
Any factor that causes a change in heart contractility is called
A) a chemotrope
B) a chronotrope
C) an inotrope
D) an isotope
Feedback: Correct Answer
At a heart rate above 180 beats per minute, all of these decrease except
A) cardiac output
B) filling time
C) stroke volume
D) end systolic volume
Feedback: The ESV is affected by contraction force, and not by heart rate. The others are all factors dependent on heart rate.
The higher the _____, the greater the cardiac output.
A) extracellular K+ concentration
B) blood pressure in the aorta
C) venous return
D) level of acetylcholine released at the SA node
Feedback: To increase cardiac output, either heart rate or contractile force or both must be increased. An increase in venous return would stretch the walls of the ventricle, increasing the preload and therefore the strength of contraction.
With respect to the effect on cardiac output, the term preload refers to
A) the force developed by the myocardial cells during ventricular systole
B) the blood pressure in the aorta and pulmonary trunk during ventricular systole
C) the amount of tension developed in the myocardium before it contracts
D) anything that decreases stroke volume
Feedback: Correct Answer
Phophodiesterase is the enzyme that degrades cAMP. A drug that inhibits phosphodiesterase would have what effect on the heart?
A) It would decrease cardiac contractility by causing increased removal of Ca2+ from the cell.
B) It would increase heart rate but have no effect on contractility.
C) It would have no effect, because cAMP is not involved in altering cardiac contractility
D) It would increase cardiac contractility by prolonging Ca2+ availability inside the cell.

Cyclic AMP increases the permeability of the plasma membrane to Ca2+, primarily by opening calcium slow channels in the plasma membrane. Inhibiting the phosphodiesterase would allow prolonged action of cAMP, increasing the Ca2+ concentration of the cell.
Slowing the heart while holding the rate of venous return (ml/min) constant would cause
A) decreased cardiac output
B) increased cardiac output
C) no change in cardiac output, because heart rate is not increased
D) no change in cardiac output, because stroke volume is not increased
Feedback: Correct Answer
Stroke volume times heart rate equals
A) blood pressure
B) afterload
C) end systolic volume
D) cardiac output
Feedback: Correct Answer
Which of the following would not increase stroke volume?
A) increased venous return
B) increased sympathetic stimulation of the myocardium
C) increased end diastolic volume
D) increased arterial blood pressure
Feedback: An increase in arterial blood pressure would make it harder for the ventricle to open the semilunar valves to eject blood. As a consequence, the end systolic volume would be higher, leading to a lower stroke volume.
The Frank-Starling law of the heart says that the higher the end diastolic volume, the
A) lower the cardiac output
B) higher the end systolic volume
C) lower the blood pressure
D) higher the stroke volume
Feedback: Correct Answer
In response to exercise, the heart would be called upon to _____ the amount of blood pumped, and this would be initiated by signals from ______ fibers.
A) increase; sympathetic
B) increase; parasympathetic
C) decrease; sympathetic
D) decrease; parasympathetic
Feedback: Correct Answer
Which of the following would be an effect of cutting the vagus nerve?
A) reduced heart rate
B) increased heart rate
C) reduced strength of contraction
D) increased secretion of acetylcholine
Feedback: Correct Answer
Inhibition of the SA node by the parasympathetic division of the ANS is called
A) cardioacceleration
B) inotropia
C) bradycardia
D) vagal tone
Feedback: Vagal tone refers to the action of the parasympathetic fibers in the vagus nerve on the heart. These fibers reduce the rate of SA node depolarization from 100 per minute to 70 – 80 per minute.
In response to an elevation in blood pressure, the cardiac control center would attempt to restore homeostasis primarily through
A) sympthetic stimuli to the ventricular myocardium
B) sympathetic stimuli to the SA node
C) parasympathetic stimuli to the SA node
D) parasympathetic stimuli to the ventricular myocardium
Feedback: Correct Answer
The ANS is the main extrinsic control for cardiac activity, acting through both sympathetic and parasympathetic fibers innervating the heart. This control system is not symmetric–one part of the ANS has less control over the heart. Which of the following statements is NOT correct?
A) The sympathetic division has significant control of heart rate through its action at the SA node.
B) The sympathetic division has significant control of contractility through its action on the ventricular myocardium.
C) The parasympathetic division has significant control of heart rate through its action at the SA node.
D) The parasympathetic division has significant control of contractility through its action on the ventricular myocardium.
Feedback: Correct Answer
Which ionic imbalance would decrease the strength of cardiac muscle contraction?
A) hypocalcemia
B) hypercalcemia
C) hypokalemia
D) hyponatremia
Feedback: Calcium ions are needed for both cardiac action potential formation and for the mechanical events of cardiac muscle contraction.
Damage to which of the following parts of the brain would cause the body to have less control over cardiac activity?
A) cerebral cortex
B) thalamus
C) basal nuclei
D) medulla oblongata
Feedback: Correct Answer
Increased input from the baroreceptors to the cardiac control center would cause which of the following to occur?
A) increased sympathetic stimulation and decreased parasympathetic stimulation
B) increased sympathetic stimulation and increased parasympathetic stimulation
C) decreased sympathetic stimulation and increased parasympathetic stimulation
D) decreased sympathetic stimulation and decreased parasympathetic stimulation
Feedback: The baroreceptors are stimulated by high blood pressures. By decreasing the rate and force of contraction, the ANS can reduce the blood pressure.
Which of the following commonly increases with age?
A) size of the left ventricle
B) size of the right ventricle
C) heart rate
D) flexibility of heart valves
Feedback: Correct Answer
Which of the following commonly decreases with age?
A) the size of the left ventricle
B) size of the right ventricle
C) heart rate
D) oxygen consumption by the myocardium

The gradual decrease in heart rate seen in aging may be due to changes in ability to carry out aerobic respiration, decrease Ca2+ transport, or decreased sensitivity to sympathetic hormones and neurotransmitters.

More MCQs (because I love them…)

Lung mcqs

3. Which of the following is NOT an effector of respiration?
A. Heart
B. diaphragm
C. intercostals
D. Trapezius

4. Which of the following is the first branching of the bronchial tree that has gas exchanging capabilities?
A. Terminal bronchioles.
B. Respiratory bronchioles.
C. Alveoli
D. segmental bronchi
E. alveolar ducts.

5. Which of the following could NOT be part of an acinus?
A. alveolar sacs
B. Alveolar ducts
C. Terminal bronchioles
D. Respiratory bronchiole

6. If you increased the left atrial pressure from 5 mmHg to 15 mmHg, what effect would that have on pulmonary circulation?
A. It would force blood the opposite direction.
B. It would increase the speed at which blood moves through the pulmonary circulation.
C. No change.
D. Blood flow would almost or completely stop.

8. Which of the following is NOT a normal occurance with increasing age?
A. Vital capacity of the lung decreases.
B. Residual volume increases.
C. Functional residual capacity increases.
D. Inspiratory capacity decreases.
E. Expiratory reserve volume increases.

10. Which of the following does NOT happen during inspiration?
A. The ribs move upward.
B. The diaphragm lifts up.
C. The antero-posterior dimensions of the chest are increased.
D. The tranverse dimensions of the thorax are increased.
E. The scalene and sternocleidomastoid muscles can be recruited for inspiration.

11. During inspiration, how does alveolar pressure compare to atmospheric pressure?
A. Alveolar pressure is greater than atmospheric.
B. Alveolar pressure is less than atmospheric.
C. Alveolar pressure is the same as atmospheric.
D. Alveolar pressure is one of the few pressures where the reference pressure is not atmospheric.

12. Which of the following represents the pressure difference that acts to distend the lungs?
A. Alveolar pressure
B. Airway opening pressure
C. Transthoracic pressure
D. Transpulmonary pressure
E. Esophageal pressure.

13. If a patient had a progressive lung disease that required an ever increasing pressure to fill the same volume of lung, how would the lung’s compliance be affected?
A. It would increase it.
B. It would stay the same.
C. It would decrease it.
D. These variables do not affect lung compliance.

14. An asthma sufferer finds she has to breathe at twice her normal rate. How does that affect her dynamic compliance?
A. It stays the same.
B. It decreases.
C. It increases.
D. Static compliance, not dynamic, is the variable affected by asthma.

16. Which of the following is FALSE concerning the production and role of lung surfactant?
A. It is part of a lipoprotein called dipalmitoyl phosphatidyl-choline.
B. It is synthesized by alveolar type II cells.
C. As the alveolar surface area decreases during the compression curve, the surfactant decreases the surface tension at a constant rate.
D. When surfactant density is decreased during expansion, surface tension initially rises rapidly, then slows down until it reaches the starting point.

surfactant is briefly defined as a material that can greatly reduce the surface tension of water when used in very low concentrations.

The lungs and visceral pleura receive parasympathetic innervation from:

Correct answer: the vagus nerve

Inhaled objects are more likely to become trapped in:

Correct answer: the right main bronchus

The horizontal fissure separates:

Correct answer: The right superior lobe from the middle lobe

The oblique fissure:

Correct answer: Is found in both the right and left lungs, separating the middle and inferior, and superior and inferior lobes respectively

The lingula is found

Correct answer: On the medial aspect of the left lung

The lingual is a projection of the upper lobe of the left lung. There are two segments of the lingula: superior and inferior

The apex of the lungs is covered by:

Correct answer: Cervical pleura

Which of the following is not a subdivision of the parietal pleura

Correct answer: Visceral

The potential space between the visceral and parietal pleura is known as the

Correct answer: pleural cavity

Which of the following vessels supplies the lungs themselves with oxygen?

Correct answer: Bronchial artery

Which of the following is NOT found on the right lung?

Correct answer: Groove for arch of aorta

All of the following are exclusive to the left lung except

Correct answer: Cardiac impression

A ‘stony dull’ sound on percussion is typically suggestive of:

Correct answer: Pleural effusion

The external intercostals contract during inspiration

Correct answer: TRUE

Which of the following refers to regions of poorly perfused alveoli?

Correct answer: Alveolar dead space

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