, 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.
