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