Practice Quiz - Superior Mediastinum & Lungs

Below are written questions from previous quizzes and exams. Click here for the new
format Practical Quiz. Click here for the old format Practical Quiz.

1. You are called to perform thoracentesis (remove fluid from the pleural cavity). If you are
to avoid injuring lung or neurovascular elements, where would you insert the aspiration
needle?

the top of interspace 8 in the midclavicular line

the bottom of interspace 8 in the midclavicular line

the top of interspace 9 in the midaxillary line

the bottom of interspace 9 in the midaxillary line

the top of interspace 11 in the scapular line

2. The pleural space into which lung tissue just above the cardiac notch would tend to
expand during deep inspiration is the:

Anterior mediastinum

Costodiaphragmatic recess

Costomediastinal recess

Cupola

Pulmonary ligament
3. Which feature is found only in the left lung?

Cardiac notch

Horizontal fissure

Oblique fissure

Superior lobar bronchus

Three lobes
4. Which of the following nerves would be most vulnerable to irritation when the
tracheobronchial lymph nodes are enlarged due to a diseased situation?

Right phrenic

Left phrenic

Right recurrent laryngeal

Left recurrent laryngeal

Right vagus
5. Which part of the left lung might partially fill the costomediastinal recess in full
inspiration?

Apex

Cupola

Hilum

Lingula

Middle lobe
6. The oblique fissure of the right lung separates which structures?

Lower lobe from lingula

Lower lobe from upper lobe only

Lower lobe from both upper and middle lobes

Lower lobe from middle lobe only

Upper from middle lobe

7. In a post-soccer match brawl, a 35-year-old man was stabbed in the back with a knife
that just nicked his left lung halfway between its apex and diaphragmatic surface. Which
part of the lung was most likely injured?

Hilum

Inferior lobe

Lingula

Middle lobe

Superior lobe
8. A 4-year-old girl is brought in with coughing, and you are told by her mother that she had
been playing with some beads and had apparently aspirated one (gotten it into her
airway). Where would you expect it to most likely be?
 Apicoposterior segmental bronchus of left lung

Left main bronchus

Lingular segment of left lung

Right main bronchus

Terminal bronchiole of right lung, lower lobe

9. Which statement is true about the right lung?

it is slightly smaller than the left lung

it has a lingular segmental bronchus

it occupies the rightmost portion of the mediastinum

its upper lobar bronchus lies behind and above the right pulmonary artery

it has the right phrenic nerve passing posterior to the lung root
10. During a surgical procedure in the vicinity of the descending aorta, a surgeon
accidentally cuts the first aortic intercostal arteries. Which of the following structures
might be deprived of its main source of blood supply?

first posterior intercostal space

first anterior intercostal space

left bronchus

right bronchus

fibrous pericardium
11. A sick person, lying supine in bed, aspirates (breathes in) some fluid into her lungs while
swallowing. It would most likely end up in which of the following bronchopulmonary
segments?

anterior segmental bronchus of right superior lobe

medial segmental bronchus of right middle lobe

superior segmental bronchus of right inferior lobe

medial basal segmental bronchus of left inferior lobe

inferior segmental bronchus of lingular lobe

12. A 22-year-old male involved in a bar-room brawl suffered a stab wound through the
posterior thoracic wall that entered the posterior surface of the right lung half way
between its apex and diaphragmatic surface. Which part of the lung did the knife first
enter?
 Cupola

Inferior lobe

Lingula

Middle lobe

Superior lobe
13. A 20-year-old man was stabbed in the back with a knife that just nicked his right lung
halfway between its apex and diaphragmatic surface. Which part of the lung was most
likely injured?

Middle lobe

Inferior lobe

Cardiac notch

Lingula

Superior lobe
14. A 10-year-old boy underwent a tonsillectomy under general anesthesia. At home he lay
supine in bed for two weeks and developed a fever and chest pain with cough. He
returned to the hospital and was diagnosed as having right lung pneumonia due to
aspiration of infectious material during the tonsillectomy. In which bronchopulmonary
segment of the lung would fluid (pus) most likely have accumulated by the simple force
of gravity?

Anterior basal segment--inferior lobe

Anterior segment--superior lobe

Lateral segment--middle lobe

Superior segment--inferior lobe

Superior lingual segment--lingula

15. You are observing a doctor perform a bronchoscopy. As he passes the bronchoscope
down the trachea, a cartilagenous structure is observed separating the right and left
main stem bronchi. He asks what it is called. You reply that it really does look like a
ship's keel and that it is called the:

Carina

Cricoid cartilage

Costal cartilage
 Pulmonary ligament

Tracheal ring
16. The minor (horizontal) fissure separates:

the lower lobe from the lingula

the upper lobe from the lingula

the lower lobe from both the middle and upper lobes

the lower lobe from the middle lobe

the middle lobe from the upper lobe

17. Your patient, an 86-year-old female who has been bed-ridden and lying supine for many
weeks, has developed a right lung abscess that is draining by gravity into one particular
region of the lung. Where is the most likely site of fluid accumulation?

Apical segment of upper lobe

Lingula

Lower lobe

Middle lobe

Superior segment of lower lobe

18. Because of its angle with the trachea and size of the main bronchus, a bronchoscope
would pass more readily into which lung?

Left

Right
19. Which vessel courses across the mediastinum in an almost horizontal fashion?

Left subclavian artery

Left subclavian vein

Left brachiocephalic vein

Left internal jugular vein

Left common carotid artery

20. A 78-year-old female presented with edema of the left upper limb due to poor venous
return. Examination revealed an aneurysm of the ascending aorta that was impinging on
a large vein lying immediately anterosuperior to it, most likely the:

Azygos v.

Internal thoracic v.
 Left brachiocephalic v.

Left superior intercostal v.

Right brachiocephalic v.
21. An 8-year-old boy is found to have a mid-line tumor of the thymus gland that is impinging
posteriorly on a blood vessel. The affected vessel is most likely the:

left brachiocephalic vein

left pulmonary vein

left bronchial vein

right pulmonary artery

right superior intercostal vein

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Practice Quiz - Pectoral Region, Posterior Shoulder & Breast

Below are written questions from previous quizzes and exams. Click here for a Practical
Quiz - old format or Practical Quiz - new format.

1. A woman with breast cancer subsequently develops metastases in her vertebral column.
The most direct route for spread of the tumor to the vertebral column was via:

branches of the cephalic vein

branches of the lateral thoracic vein

branches of the thoracoacromial veins

lymphatic vessels draining into the axilla

branches of the intercostal veins

2. The clavipectoral fascia is penetrated by which artery?

Anterior circumflex humeral

 Axillary

Subscapular

Thoracoacromial

Thoracodorsal
3. Mastitis is a condition which involves:

A type of leukemia

Inflammation of the breast

Infection of lymph nodes

Mast cells

Tumors of glandular tissue

4. In the process of doing an axillary lymph node dissection in a 50 year-old patient, the
surgery resident cleans the space between the pectoralis major and minor muscles, in
an attempt to remove all of the lateral pectoral lymph nodes. Upon recovery it is noted
that the patient's lower pectoralis major is paralyzed. The nerve most likely injured is
the:

axillary

lateral pectoral

medial pectoral

suprascapular

thoracodorsal
5. In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into
which group of nodes?

Central axillary

Deltopectoral

Lateral axilllary

Parasternal

Subscapular
6. The prognosis in breast cancer is poorer as more proximal lymph nodes are found to
have cancerous cells in them. Spread of cancer to which of the following axillary nodes
would indicate the worst prognosis?

apical
 central

lateral

pectoral

subscapular
7. You are in the emergency room when a patient is brought in, the loser in a street fight.
He has received a stab wound about 1.5 cm long in the right side of the chest about 1.5
cm below and 1 cm medial to the coracoid process of the scapula. He has lost a lot of
bright red blood from a large (~1.2 cm in diameter) severed artery found deep at this
location. Intravenous fluids are immediately administered and a surgeon is called in to
repair the artery. He begins by making an incision through the skin and subcutaneous
tissue just below the clavicle, then cuts the clavicular head of the pectoralis major
muscle and retracts it downward to obtain sufficient exposure of the area. He next
encounters a partially severed muscle running downward and medially from the coracoid
process. He divides the remaining fibers of the muscle and has you retract it downward.
This exposes a bloody fat-filled space full of vessels and nerves.

The muscle running downward and medially from the coracoid process which was
partially severed was the:

Coracobrachialis

Pectoralis minor

Long head of the biceps

Subclavius

Subscapularis

8. Postoperative examination revealed that the medial border and inferior angle of the left
scapula became unusually prominent (projected posteriorly) when the arm was carried
forward in the sagittal plane, especially if the patient pushed with outstretched arm
against heavy resistance (e.g., a wall). What muscle must have been denervated during
the axillary dissection?

Levator scapulae

Pectoralis major

Rhomboideus major

Serratus anterior

Subscapularis
9. During a motorcycle accident, an 18-year-old male landed on the right lateral side of his
rib cage with his right upper limb abducted. In the hospital he was found to have
 "winging" of the right scapula. Which nerve was likely damaged in the accident?

Accessory

Lateral pectoral

Long thoracic

Phrenic

Vagus
10. During the planning of therapeutic intervention for a 54-year-old female patient with
cancer of the right breast, a 3rd year medical student would need to first consider where
most of the cancer cells would metastasize, which would be:

Abdominal wall

Anterior mediastinum

Axillary lymph nodes

Opposite breast

Parasternal lymph nodes

11. After a jarring blow to the left anterior shoulder region, a young field hockey player was
told by an examining physician that she had a muscle tear that resulted directly from the
superolateral distraction of a fractured coracoid process. Which muscle was torn?

Deltoid

Pectoralis major

Pectoralis minor

Serratus anterior

Subclavius
12. Breast cancer cells can spread directly to the cranial cavity and brain via the vertebral
venous plexus. Through which route can they reach this plexus?

Axillary lymph nodes

Internal thoracic vein

Intercostal veins

Parasternal lymph nodes

Thoracoacromial artery
13. Upon finding a malignant tumor in the medial portion of the breast of a 40-year-old
female, the surgeon began to search for the lymph nodes that would be the first ones
 reached by metastatic spread of cancer cells from this site. Which group(s) would have
to be examined to determine whether metastasis had occurred?

Central only

Parasternal only

Parasternal and apical

Parasternal and lateral

Parasternal and pectoral

14. After being thrown from a motorcycle moving at high speed, a 16-year-old female was
found to have a paralyzed right pectoralis major muscle. Which set of movements at the
shoulder joint would be found greatly weakened?

Abduction and extension

Abduction and lateral rotation

Adduction and flexion

Lateral rotation and extension

15. While observing a mastectomy on a 60-year-old female patient, a medical student was
asked by the surgeon to help tie off the arteries that supply the medial side of the breast.
The artery that gives origin to these small branches is the:

Internal thoracic

Musculophrenic

Posterior intercostal

Superior epigastric

Thoracoacromial
16. In the axilla the pectoralis minor is a landmark, being closely related to all of the
following structures except:

cephalic vein

cords of the brachial plexus

lateral thoracic artery

medial pectoral nerve

second part of the axillary artery

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 Practice Quiz - Thoracic Wall, Pleura, & Pericardium

Below are written questions from previous quizzes and exams. Click here for the new
format Practical Quiz. Click here for the old format Practical Quiz.

1. The second costal cartilage can be located by palpating the:

costal margin

sternal angle

sternal notch

sternoclavicular joint

xiphoid process
2. The thoracic wall is innervated by:

Dorsal primary rami

Intercostal nerves

Lateral pectoral nerves

Medial pectoral nerves

Thoracodorsal nerves
3. The sternocostal surface of the heart is formed primarily by the anterior wall of which
heart chamber?

Left atrium

Left ventricle

Right atrium

Right ventricle
4. A patient involved in an automobile accident presents with a sharp object puncture of the
middle of the sternum at about the level of the 4th or 5th costal cartilage. If the object
also penetrated pericardium and heart wall, which heart chamber would most likely be
damaged?
 Left atrium

Left ventricle

Right atrium

Right ventricle
5. You are caring for a 68-year-old male who has copious amounts of fluid in the left pleural
cavity due to acute pleurisy. When you examine him as he sits up in bed (trunk upright),
where would the fluid tend to accumulate?

costodiaphragmatic recess

costomediastinal recess

cupola

hilar reflection

middle mediastinum
6. A 23-year-old male injured in an industrial explosion was found to have multiple small
metal fragments in his thoracic cavity. Since the pericardium was torn inferiorly, the
surgeon began to explore for fragments in the pericardial sac. Slipping her hand under
the heart apex, she slid her fingers upward and to the right within the sac until they were
stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart.
Her fingertips were then in the:

coronary sinus

coronary sulcus

costomediastinal recess

oblique sinus

transverse sinus
7. When inserting a chest tube, intercostal vessels and nerves are avoided by placing the
tube immediately:

above the margin of a rib

below the margin of a rib

8. A hand slipped behind the heart at its apex can be extended upwards until stopped by a
line of pericardial reflection that forms the:

Cardiac notch

Costomediastinal recess

Hilar reflection
 Oblique pericardial sinus

Transverse pericardial sinus

9. The first rib articulates with the sternum in close proximity to the:

Nipple

Root of the lung

Sternal angle

Sternoclavicular joint

Xiphoid process
10. The portion of the parietal pleura that extends above the first rib is called the :

costodiaphragmatic recess

costomediastinal recess

costocervical recess

cupola

endothoracic fascia
11. You are attending an operation to remove a thymic tumor from the superior
mediastinum. The surgeon asks, "What important nerve lying on and partly curving
posteriorly around the arch of the aorta should we be careful of as we remove this
mass?" You quickly answer, "The--

left phrenic

left sympathetic trunk

left vagus

right phrenic

right sympathetic trunk

12. In cardiac surgery it is sometimes necessary to clamp off all arterial flow out of the heart.
This could be done within the pericardial sac by inserting the index finger immediately
behind the two great arteries and compressing them with the thumb of the same hand.
The index finger would have to be inserted into which space?

Cardiac notch

Coronary sinus

Oblique pericardial sinus

 Coronary sulcus

Transverse pericardial sinus

13. A needle inserted into the 9th intercostal space along the midaxillary line would enter
which space?

Cardiac notch

Costodiaphragmatic recess

Costomediastinal recess

Cupola

Oblique pericardial sinus

14. During a heart transplant procedure, the surgeon inserted his left index finger through
the transverse pericardial sinus, and then pulled forward on the two large vessels lying
ventral to his finger. Which vessels were these?

Pulmonary trunk and brachiocephalic trunk

Pulmonary trunk and aorta

Pulmonary trunk and superior vena cava

Superior vena cava and aorta

Superior vena cava and right pulmonary artery

15. While observing in the OR, you see the resident insert a needle through the body wall
just above the ninth rib in the mid-axillary line. She was obviously trying to enter the:

Costodiaphragmatic recess

Costomediastinal recess

Cupola

Hilar reflection

Pulmonary ligament
16. The pleural cavity near the cardiac notch is known as the:

Costodiaphragmatic recess

Costomediastinal recess

Cupola

Hilum

Pulmonary ligament
17. The tubercle of the 7th rib articulates with which structure?

Body of vertebra T6

Body of vertebra T7

Body of vertebra T8

Transverse process of vertebra T6

Transverse process of vertebra T7

18. The ductus arteriosus sometimes remains open after birth requiring surgical closure.
When placing a clamp on the ductus, care must be taken to avoid injury to what
important structure immediately dorsal to it?

Accessory hemiazygos vein

Left internal thoracic artery

Left phrenic nerve

Left recurrent laryngeal nerve

Thoracic duct
19. A 16-year-old male suffered a stab wound in which a knife blade entered immediately
superior to the upper edge of the right clavicle near its head. He was in extreme pain,
which was interpreted by the ER physician as a likely indicator of a collapsed lung
following disruption of the pleura. If that was true, what portion of the pleura was most
likely cut or torn?

costal pleura

cupola

hilar reflection

mediastinal pleura

pulmonary ligament
20. During a lung transplant procedure, an observing 4th year attempted to pass his index
finger posteriorly inferior to the root of the left lung, but he found passage of the finger
blocked. Which structure would most likely be responsible for this?

Costodiaphragmatic recess

Cupola

Inferior vena cava

 Left pulmonary vein

Pulmonary ligament
21. Which of the following layers provides a natural cleavage plane for surgical separation of
the costal pleura from the thoracic wall?

Deep fascia

Endothoracic fascia

Parietal pleura

Visceral pleura

Transversus thoracis muscle fascia

22. The lowest extent of the pleural cavity, into which lung tissue does not extend, is known
as the:

costodiaphragmatic recess

costomediastinal recess

cupola

inferior mediastinum

pulmonary ligament
23. The sternal angle is a landmark for locating the level of the:

Costal margin

Jugular notch

Second costal cartilage

Sternoclavicular joint

Xiphoid process
24. A 3rd-year medical student was doing her first physical exam. In order to properly place
her stethoscope to listen to heart sounds, she palpated bony landmarks. She began at
the jugular notch, then slid her fingers down to the sternal angle. At which rib (costal
cartilage) level were her fingers?

3
 4

Can't be determined

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Practice Quiz - Anterior Triangle of the Neck

Below are written questions from previous quizzes and exams. Click here for a Practical
Quiz - old format or Practical Quiz - new format.

1. A person receives a shallow knife wound just behind the sternocleidomastoid muscle
and about 1 1/2 inches above the clavicle. There is an immediate numbness of the skin
below the wound and over the acromion and clavicle. The nerve most likely severed was
the

greater auricular

lesser occipital

supraclavicular

suprascapular

transverse cervical
2. Which muscle is innervated by a branch of the ansa cervicalis?

Sternocleidomastoid

Platysma

Sternohyoid

Trapezius
3. The layer of encircling cervical fascia that splits to enclose sternocleidomastoid and
trapezius muscles is the:

Superficial fascia

Superficial layer of deep fascia

 Infrahyoid fascia

Prevertebral fascia

Visceral fascia
4. Which of the following is a dorsal ramus of a spinal nerve?

Supraclavicular n.

Transverse cervical n.

Great auricular n.

Greater occipital n.

Lesser occipital n.
5. Which of the following is true of the inferior thyroid arteries?

They arise from the external carotid arteries

They cross over the superior cervical sympathetic ganglion

They supply most of the anterior surface of the thyroid gland

They often supply all four parathyroid glands

6. A 20 year old man was brought into the emergency room with a stab wound in the upper
part of the neck. Although there was no major damage done, he lost sensation from the
skin over the angle of the jaw. Which nerve has been cut?

Supraclavicular n.

Transverse cervical n.

Great auricular n.

Greater occipital n.

Lesser occipital n.
7. The triangle in which the superior branch of the ansa cervicalis separates from the
hypoglossal nerve is the:

Carotid

Muscular

Subclavian

Submental

Occipital
8. Exploration of the tracheoesophageal groove at the level of the thyroid gland would
reveal what important structure bilaterally?

Cervical sympathetic trunk

Phrenic nerve

Pyramidal lobe

Recurrent laryngeal nerve

Superior thyroid artery

9. A 35 year old woman was diagnosed with an adenoma of the thyroid gland. This
required excision of the lower pole (left lobe) of the gland and ligation of the artery
supplying that region. Which of the following nerves accompanying the artery is most
likely to be damaged if the surgeon is not careful?

External branch of the superior laryngeal

Internal branch of the superior laryngeal

Recurrent laryngeal

Vagus proper

Sympathetic trunk
10. One of the motor components of the cervical plexus, the ansa cervicalis, innervates all of
the following muscles except the:

Omohyoid

Sternohyoid

Sternothyroid

Stylohyoid

Thyrohyoid
11. A man has metastatic carcinoma and enlarged deep cervical lymph nodes. One of his
symptoms is a hoarse voice, barely heard above a whisper. Subsequently he succumbs
to the disease and at autopsy it is found that one of the enlarged nodes has put pressure
on a nerve in the tracheoesophageal groove. Presumably this was the reason for the
hoarse voice. What nerve was involved?

External branch of the superior laryngeal nerve

Internal branch of the superior laryngeal nerve

Nerve to the cricothyroid muscle

 Pharyngeal branch of the glossopharyngeal nerve

Recurrent laryngeal branch of vagus

12. You are called on to do a venous catheterization to measure central venous pressure in
the heart. Which muscle of the neck would provide the best area of approach to the
internal jugular vein?

Anterior scalene

Digastric

Omohyoid

Sternocleidomastoid

Sternohyoid
13. A patient is brought into the Emergency Room in respiratory distress. It is quickly
decided to create an emergency airway to restore respiration. At what level could you
rapidly create an airway below the vocal cords with a minimum danger of hemorrhage?

Just above the jugular notch

Just above the thyroid cartilage

Just below the cricoid cartilage

Just below the thyroid cartilage

Through the 3rd tracheal ring

14. A 47-year-old woman is diagnosed as having a thyroid tumor. Surgery to remove the
cancerous growth is undertaken. In which triangle of the neck will the surgeon make an
incision to gain access to the gland?

Carotid

Muscular

Subclavian

Submandibular

Submental
15. A 50-year-old woman is brought to the operating room for a biopsy of a suspicious
looking nevus (mole) which is found along the anterior border of her sternocleidomastoid
muscle at about its midlength. What nerve must be locally anesthetized for the operation
to proceed without pain?

Ansa cervicalis

External branch of the superior laryngeal

 Great auricular

Supraclavicular

Transverse cervical
16. Following surgery on the upper pole of the right lobe of the thyroid gland, a patient
complains of hoarseness and weakness of voice. What nerve may have been injured?

Ansa cervicalis

External branch of the superior laryngeal

Inferior laryngeal

Internal branch of the superior laryngeal

Recurrent laryngeal
17. These structures are all located in the superficial fascia of the neck EXCEPT

External jugular vein

Platysma muscle

Cervical branch of the facial nerve

Omohyoid muscle

Transverse cervical nerve

18. The superior belly of the omohyoid forms the anterior border of which cervical triangle?

Carotid

Muscular

Omoclavicular

Posterior

Submandibular
19. The cervical plexus innervates all of the following structures EXCEPT:

Diaphragm

Omohyoid muscle

Platysma

Skin over thyroid cartilage

Skin over clavicle

20. An emergency room patient presented with considerable bleeding from a shallow stab
wound in the omoclavicular triangle. Which vessel was most likely cut?

Axillary vein

Common carotid artery

External jugular vein

Inferior thyroid vein

Superior thyroid artery

21. Which structure or area receives NO nerve fibers from the cervical plexus?

Diaphragm

Skin over the angle of the mandible

Skin over the external occipital protuberance

Thyrohyoid muscle
22. A six-year-old child, whose medical history includes a rather difficult birth, has a
permanently tilted head posture, with the right ear near the right shoulder and the face
turned upward and to the left. Which of the following muscles was very likely damaged
during birth?

Anterior scalene

Omohyoid

Sternocleidomastoid

Trapezius

Platysma
23. Any irritation of the diaphragm (e.g. infection, tumor) may create referred pain that
seems (to the patient) to originate in the area atop the shoulder. This is due to the fact
that the phrenic nerve shares spinal segments with what cutaneous nerve in the
shoulder region?

Dorsal scapular

Lesser occipital nerve

Long thoracic nerve

Supraclavicular nerve

Suprascapular nerve
 24. Which of the following statements about the cervical plexus is true?

It comprises spinal segments C1-C3

It consists solely of cutaneous nerves

It consists solely of ventral rami of spinal nerves

It supplies motor innervation to platysma

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Practice Quiz - Posterior Triangle of the Neck

Below are written questions from previous quizzes and exams. Click here for a Practical
Quiz - old format or Practical Quiz - new format.

1. A muscular patient who regularly lifts weights presents with pain and weakness in his
right upper limb that has been slowly developing over time. His limb is cool and there is
an obvious vascular insufficiency in his upper extremity. Subsequent tests show that a
large vessel passing between the anterior and middle scalene muscles is being
occluded by hypertrophy (enlargement) of the muscles due to the excercise. The artery
involved is the:

axillary

brachial

brachiocephalic

subclavian

suprascapular
2. In repairing a damaged right subclavian artery, the surgeon notices and protects a large
nerve passing around to the posterior surface of the artery. This nerve, which does not
encircle the subclavian on the left side, is the:

Phrenic

Vagus
 Recurrent laryngeal

Sympathetic trunk

Ansa cervicalis
3. A stab wound just above the left clavicle, lateral to the sternocleidomastoid muscle, may
be life-threatening because of the possibility of injury to the:

Brachial plexus

Internal jugular vein

Axillary artery

Subclavian artery

Thoracic duct
4. A 27-year-old man who is a professional weight lifter comes to his physician complaining
of recent weakness in his left arm and frequent tingling in his hand and fingers during
exercise sessions which subsides with rest. He is diagnosed as having vasuclar
insufficiency due to scalenus anticus syndrome and as a remedy it is decided to transect
the anterior scalene muscle where it inserts on the first rib. During surgery, which
structure in contact with the anterior surface of the muscle must the surgeon be careful
of sparing?

Inferior trunk of the brachial plexus

Long thoracic nerve

Phrenic nerve

Sympathetic trunk

Vagus nerve
5. A 60-year-old man with a previous history of right carotid endarterectomy, comes to his
physician complaining of light-headedness and dizziness whenever he uses his right
hand vigorously. He is diagnosed as having subclavian steal syndrome due to an
atherosclerotic plaque at the point where his subclavian artery branches from the
brachiocephalic trunk. The cerebral insufficiency is the result of blood being stolen from
which artery?

External carotid

Internal carotid

Middle cerebral

Thyrocervical trunk

Vertebral
6. A first year resident attempts to insert a central venous catheter into the heart by a
subclavicular approach to the subclavian vein. Following the attempt, it is noted that the
patient has difficulty breathing. What nervous structure lying immediately deep to the
subclavian vein, as it crosses the anterior scalene muscle, may have been injured?

External branch of the superior laryngeal nerve

Phrenic nerve

Recurrent laryngeal nerve

Sympathetic trunk

Vagus nerve
7. Which statement is true of the internal jugular vein?

It drains all of the thyroid gland on that side of the body

It drains into the external jugular vein

It is accompanied by the deep cervical chain of lymph nodes

It lies deep to the prevertebral fascia

It passes superficial to the sternocleidomastoid muscle

8. Which structure lies immediately anterior to the right anterior scalene muscle at its costal
attachment?

Subclavian artery

Subclavian vein

Thoracic duct

Thyrocervical trunk

Vagus nerve
9. A person develops a primary tumor of the thyroid gland and, among other symptoms,
drooping of the eyelid and constriction of the pupil on the right side of the eye are noted.
What nerve fibers have been interrupted by the tumor?

postganglionic parasympathetic

postganglionic sympathetic

preganglionic parasympathetic

the carotid nerve

the cervical sympathetic trunk

10. An abscess was surgically removed from the middle of the posterior triangle on the right
side. During recovery the patient noticed that her shoulder drooped and she could no
longer raise her right hand above her head to brush her hair. Which nerve has been
cut?

Accessory (XI)

Ansa cervicalis

Facial (VII)

Hypoglossal (XII)

Suprascapular
11. A surgeon doing a deep cervical lymph node dissection may encounter these structures
upon the anterior surface of the anterior scalene muscle EXCEPT:

Phrenic nerve

Subclavian vein

Middle trunk of the brachial plexus

Transverse cervical artery

Cervical part of the thoracic duct

12. The middle cervical sympathetic ganglion, recurrent laryngeal nerve, and parathyroid
glands are all closely related with which blood vessel?

Inferior thyroid artery

Inferior thyroid vein

Superior thyroid artery

Superior thyroid vein

13. During surgical procedures of the neck, structures within the carotid sheath can be
retracted (pulled aside) as a unit. Which of the following structures would remain in place
when the carotid sheath is retracted?

common carotid artery

cervical sympathetic trunk

internal jugular vein

internal carotid artery

vagus nerve
 14. Which of the following nerves is derived from the dorsal primary rami of spinal nerves?

great auricular

greater occipital

lesser occipital

phrenic

supraclavicular
15. Which of the following hyoid muscles is an important landmark in both the anterior and
posterior triangles of the neck?

geniohyoid

mylohyoid

omohyoid

sternohyoid

stylohyoid

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CRANIAL NERVES

1. An 84-year old woman suffers a stroke, with paralysis on the right side of her body.
Neurological tests show that the intracerebral hemorrhage has interrupted the blood
supply to the posterior part of the frontal, the parietal and medial portions of the temporal
lobes of the left cerebral hemisphere. Which vessel was involved?

Anterior cerebral artery

Great cerebral vein

Middle cerebral artery

Middle meningeal artery

Posterior cerebral artery

2. A sixty-four-year old man was diagnosed with an acoustic neuroma (tumor of the VIIIth
cranial nerve) where it entered the temporal bone. What other cranial nerve might also
be affected since this nerve uses the same foramen as the VIIIth in its course?

Abducens

Facial
 Glossopharyngeal

Trigeminal

Vagus
3. A patient who has sustained a fracture to the middle cranial fossa following a fall from a
height, might have any of these nerves injured EXCEPT:

Trigeminal

Oculomotor

Abducens

Trochlear

Hypoglossal
4. The most likely source of blood in a patient with an epidural hemorrhage is:

Vertebral artery

Middle meningeal artery

Superior cerebral veins

Anterior cerebral artery

Circle of Willis
5. In a fall from a horse, a rider sustains a severe neck injury at the C6 level. In addition to
crushing the spinal cord, the left transverse process of the C6 vertebra is fractured. What
artery is endangered?

Common carotid

Costocervical

Inferior thyroid

Internal carotid

Vertebral
6. A 35-year-old man was admitted to the hospital complaining of double vision (diplopia),
inability to see close objects, and blurred vision in the right eye. A vertebrobasilar
angiogram revealed an aneurysm of the superior cerebellar artery close to its origin on
the right side. The doctor attributed the symptoms to the compression of an adjacent
cranial nerve by the aneurysm. The compressed nerve is the:

Abducens (CN VI)

Oculomotor (CN III)

 Optic (CN II)

Trigeminal (CN V)

Trochlear (CN IV)

7. You have been asked to assess the neurological deficit that might exist in a patient
diagnosed with cavernous sinus thrombosis. You will focus your examination on cranial
nerves related to the sinus that includes all the following EXCEPT:

Abducens (CN VI)

Facial (CN VII)

Oculomotor (CN III)

Ophthalmic division of the trigeminal nerve (CN V1)

Trochlear (CN IV)

8. The glossopharyngeal nerve exits the skull via what opening?

Foramen ovale

Carotid canal

Jugular foramen

Hypoglossal canal

Stylomastoid foramen
9. A person develops a cavernous sinus thrombosis. Because of its relationship to the
sinus, which cranial nerve might be affected?

Abducens

Facial

Mandibular V3

Olfactory

Optic
10. All of the following nerves exit the cranial cavity by way of bony openings located in the
middle cranial fossa EXCEPT:

Abducens

Trochlear

Oculomotor
Trigeminal

Facial