Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
, Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition
t t t t t t t
Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems Test
t t t t t t t t t
t Bank
MULTIPLE CHOICE t
1. Which of the following chest wall structures is located level with the second costal cartilage
t t t t t t t t t t t t t t
anteriorly and thoracic vertebra T4 and T5 posteriorly?
t t t t t t t t
A. Sternal angle t
B. Jugular notch t
C. Xiphoid process t
D. Third costal cartilage t t
ANS: A t t
The sternal angle of the “angle of Louis” is level with the second costal cartilage anteriorly and
t t t t t t t t t t t t t t t t
thoracic vertebrae T4 and T5 posteriorly.
t t t t t t
PTS: 1
2. Pectus excuvatum is BEST described as:
t t t t t
A. Deformity of the sternum caused by trauma t t t t t t
B. Caved-in appearance of the chest t t t t
C. Diminished rib angle anteriorly t t t
D. Conical shape of the thoracic cage t t t t t
ANS: B t t
Pectus excuvatum is a common congenital deformity of the anterior wall of the chest, in which
t t t t t t t t t t t t t t t
several ribs and the sternum grow abnormally; it produces a caved-in or sunken appearance of
t t t t t t t t t t t t t t t
the chest.
t t
PTS: 1
3. The true ribs are BEST defined by which of the following statements?
t t t t t t t t t t t
A. Vertebrochondral ribs t
B. Vertebrosternal ribs t
C. Ribs 11 and 12 t t t
D. Ribs 8, 9, and 10 t t t t
ANS: B t t
The first seven ribs attach via their costal cartilages to the sternum and are called the true ribs (also
t t t t t t t t t t t t t t t t t t
known as the vertebrosternal ribs).
t t t t t
PTS: 1
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-2
4. Which of the following interventions is MOST appropriate for a patient with lower rib fractures?
t t t t t t t t t t t t t t
A. Short, shallow breaths t t
B. Pursed lip breathing t t
C. Deep breaths with splinting t t t
D. Breathing with arms raised t t t
ANS: C t t
It is important for all therapists to recommend breathing (deep breathing), splinting (i.e., pillow), and
t t t t t t t t t t t t t t
coughing strategies for patients with rib fractures.
t t t t t t t
PTS: 1
5. Which of the following positions facilitates greater excursion of both hemidiaphragms at rest?
t t t t t t t t t t t t
A. Supine position t
B. Sidelying position t
C. Standing position t
D. Sitting position t
ANS: A t t
In the supine position, without the effects of gravity, the level of the diaphragm in the thoracic cavity
t t t t t t t t t t t t t t t t t
rises. This allows for a relatively greater excursion.
t t t t t t t t
PTS: 1
6. Which of the following muscles help to achieve the active process of inspiration at rest?
t t t t t t t t t t t t t t
A. Sternocleidomastoid
B. Diaphragm
C. Abdominal muscles t
D. Trapezius
ANS: B t t
The diaphragm and internal intercostals (intercartilaginous portion) are the essential muscles to
t t t t t t t t t t t
achieve the active process of inspiration at rest. Abdominal muscles assist with expiration. The
t t t t t t t t t t t t t t
sternocleidomastoid and trapezius are accessory muscles and assist with a more forceful
t t t t t t t t t t t t
inspiration.
t
PTS: 1
7. Which of the following accessory muscles of ventilation function to elevate and fix the first and
t t t t t t t t t t t t t t t
second ribs?
t t
A. Sternocleidomastoid muscle t
B. Serratus anterior t
C. Latissimus dorsi t
D. Scalene muscle t
tANS: D t
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-3
The scalene muscles lie deep to the sternocleidomastoid, but may be palpated in the posterior
t t t t t t t t t t t t t t
triangle of the neck. These muscles function as a unit to elevate and fix the first and second ribs. The
t t t t t t t t t t t t t t t t t t t t
sternocleidomastoid muscle elevates the sternum.
t t t t t
PTS: 1
8. When the arms and shoulders are fixed, by leaning on the elbows or grasping onto a table, this
t t t t t t t t t t t t t t t t t
muscle can use its insertion as its origin and facilitate an increase in the A-P diameter of the
t t t t t t t t t t t t t t t t t t
thorax.
t
A. Upper trapezius t
B. Pectoralis major t
C. Sternocleidomastoid
D. Serratus anterior t
ANS: B t t
When the insertion and origin of the pectoralis muscle are reversed by leaning on a table to fix the
t t t t t t t t t t t t t t t t t t
arms, the muscle will pull on the anterior chest wall, lifting the ribs and sternum to increase the A-
t t t t t t t t t t t t t t t t t t t
P diameter of the thoracic cage.
t t t t t
PTS: 1
9. The serous fluid within the pleural space serves to provide which of the following functions?
t t t t t t t t t t t t t t
A. Create a constant negative pressure t t t t
B. Assist with venous return of blood to the heart
t t t t t t t t
C. Reduce friction between the lungs and thoracic wall t t t t t t t
D. Serve to allow separation of the pleural layers
t t t t t t t
ANS: C t t
The serous fluid within the pleural space serves to hold the pleural layers together during ventilation
t t t t t t t t t t t t t t t
and reduce friction between the lungs and the thoracic wall. The space creates the negative pressure
t t t t t t t t t t t t t t t t
to maintain lung inflation, not the fluid itself.
t t t t t t t t
PTS: 1
10. Irritation of the phrenic supplied pleura results in which of the following pain referral patterns?
t t t t t t t t t t t t t t
A. Thoracic wall t
B. Abdominal wall t
C. Mediasternal region t
D. Lower neck and shoulder t t t
ANS: D t t
Irritation of the phrenic supplied pleura can result in referred pain in the lower neck and shoulder,
t t t t t t t t t t t t t t t t
whereas, irritation of the intercostally innervated pleura may result in referral of pain to the thoracic
t t t t t t t t t t t t t t t t
or abdominal wall.
t t t
PTS: 1
11. An abnormal pleural friction rub on auscultation BEST indicates which of the following?
t t t t t t t t t t t t
A. Infection with a resultant inflammatory response within the pleura t t t t t t t t
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
, Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition
t t t t t t t
Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems Test
t t t t t t t t t
t Bank
MULTIPLE CHOICE t
1. Which of the following chest wall structures is located level with the second costal cartilage
t t t t t t t t t t t t t t
anteriorly and thoracic vertebra T4 and T5 posteriorly?
t t t t t t t t
A. Sternal angle t
B. Jugular notch t
C. Xiphoid process t
D. Third costal cartilage t t
ANS: A t t
The sternal angle of the “angle of Louis” is level with the second costal cartilage anteriorly and
t t t t t t t t t t t t t t t t
thoracic vertebrae T4 and T5 posteriorly.
t t t t t t
PTS: 1
2. Pectus excuvatum is BEST described as:
t t t t t
A. Deformity of the sternum caused by trauma t t t t t t
B. Caved-in appearance of the chest t t t t
C. Diminished rib angle anteriorly t t t
D. Conical shape of the thoracic cage t t t t t
ANS: B t t
Pectus excuvatum is a common congenital deformity of the anterior wall of the chest, in which
t t t t t t t t t t t t t t t
several ribs and the sternum grow abnormally; it produces a caved-in or sunken appearance of
t t t t t t t t t t t t t t t
the chest.
t t
PTS: 1
3. The true ribs are BEST defined by which of the following statements?
t t t t t t t t t t t
A. Vertebrochondral ribs t
B. Vertebrosternal ribs t
C. Ribs 11 and 12 t t t
D. Ribs 8, 9, and 10 t t t t
ANS: B t t
The first seven ribs attach via their costal cartilages to the sternum and are called the true ribs (also
t t t t t t t t t t t t t t t t t t
known as the vertebrosternal ribs).
t t t t t
PTS: 1
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-2
4. Which of the following interventions is MOST appropriate for a patient with lower rib fractures?
t t t t t t t t t t t t t t
A. Short, shallow breaths t t
B. Pursed lip breathing t t
C. Deep breaths with splinting t t t
D. Breathing with arms raised t t t
ANS: C t t
It is important for all therapists to recommend breathing (deep breathing), splinting (i.e., pillow), and
t t t t t t t t t t t t t t
coughing strategies for patients with rib fractures.
t t t t t t t
PTS: 1
5. Which of the following positions facilitates greater excursion of both hemidiaphragms at rest?
t t t t t t t t t t t t
A. Supine position t
B. Sidelying position t
C. Standing position t
D. Sitting position t
ANS: A t t
In the supine position, without the effects of gravity, the level of the diaphragm in the thoracic cavity
t t t t t t t t t t t t t t t t t
rises. This allows for a relatively greater excursion.
t t t t t t t t
PTS: 1
6. Which of the following muscles help to achieve the active process of inspiration at rest?
t t t t t t t t t t t t t t
A. Sternocleidomastoid
B. Diaphragm
C. Abdominal muscles t
D. Trapezius
ANS: B t t
The diaphragm and internal intercostals (intercartilaginous portion) are the essential muscles to
t t t t t t t t t t t
achieve the active process of inspiration at rest. Abdominal muscles assist with expiration. The
t t t t t t t t t t t t t t
sternocleidomastoid and trapezius are accessory muscles and assist with a more forceful
t t t t t t t t t t t t
inspiration.
t
PTS: 1
7. Which of the following accessory muscles of ventilation function to elevate and fix the first and
t t t t t t t t t t t t t t t
second ribs?
t t
A. Sternocleidomastoid muscle t
B. Serratus anterior t
C. Latissimus dorsi t
D. Scalene muscle t
tANS: D t
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
, Test Bank 1-3
The scalene muscles lie deep to the sternocleidomastoid, but may be palpated in the posterior
t t t t t t t t t t t t t t
triangle of the neck. These muscles function as a unit to elevate and fix the first and second ribs. The
t t t t t t t t t t t t t t t t t t t t
sternocleidomastoid muscle elevates the sternum.
t t t t t
PTS: 1
8. When the arms and shoulders are fixed, by leaning on the elbows or grasping onto a table, this
t t t t t t t t t t t t t t t t t
muscle can use its insertion as its origin and facilitate an increase in the A-P diameter of the
t t t t t t t t t t t t t t t t t t
thorax.
t
A. Upper trapezius t
B. Pectoralis major t
C. Sternocleidomastoid
D. Serratus anterior t
ANS: B t t
When the insertion and origin of the pectoralis muscle are reversed by leaning on a table to fix the
t t t t t t t t t t t t t t t t t t
arms, the muscle will pull on the anterior chest wall, lifting the ribs and sternum to increase the A-
t t t t t t t t t t t t t t t t t t t
P diameter of the thoracic cage.
t t t t t
PTS: 1
9. The serous fluid within the pleural space serves to provide which of the following functions?
t t t t t t t t t t t t t t
A. Create a constant negative pressure t t t t
B. Assist with venous return of blood to the heart
t t t t t t t t
C. Reduce friction between the lungs and thoracic wall t t t t t t t
D. Serve to allow separation of the pleural layers
t t t t t t t
ANS: C t t
The serous fluid within the pleural space serves to hold the pleural layers together during ventilation
t t t t t t t t t t t t t t t
and reduce friction between the lungs and the thoracic wall. The space creates the negative pressure
t t t t t t t t t t t t t t t t
to maintain lung inflation, not the fluid itself.
t t t t t t t t
PTS: 1
10. Irritation of the phrenic supplied pleura results in which of the following pain referral patterns?
t t t t t t t t t t t t t t
A. Thoracic wall t
B. Abdominal wall t
C. Mediasternal region t
D. Lower neck and shoulder t t t
ANS: D t t
Irritation of the phrenic supplied pleura can result in referred pain in the lower neck and shoulder,
t t t t t t t t t t t t t t t t
whereas, irritation of the intercostally innervated pleura may result in referral of pain to the thoracic
t t t t t t t t t t t t t t t t
or abdominal wall.
t t t
PTS: 1
11. An abnormal pleural friction rub on auscultation BEST indicates which of the following?
t t t t t t t t t t t t
A. Infection with a resultant inflammatory response within the pleura t t t t t t t t
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
