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