, 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
2
, 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
2
, 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
3
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
2
, 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
2
, 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
3
