, Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition
b9 b9 b9 b9 b9 b9 b9
Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems
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b9 Test Bank
b9
MULTIPLE CHOICE b9
1. Which of the following chest wall structures is located level with the second costal
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
cartilage anteriorly and thoracic vertebra T4 and T5 posteriorly?
b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Sternal angle b9
B. Jugular notch b9
C. Xiphoid process b9
D. Third costal cartilage b9 b9
ANS: A b 9 b 9
The sternal angle of the “angle of Louis” is level with the second costal cartilage anteriorly
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
and thoracic vertebrae T4 and T5 posteriorly.
b9 b9 b9 b9 b9 b9 b9
PTS: 1
2. Pectus excuvatum is BEST described as:
b9 b9 b9 b9 b9
A. Deformity of the sternum caused by trauma b9 b9 b9 b9 b9 b9
B. Caved-in appearance of the chest b9 b9 b9 b9
C. Diminished rib angle anteriorly b9 b9 b9
D. Conical shape of the thoracic cage b9 b9 b9 b9 b9
ANS: B b 9 b 9
Pectus excuvatum is a common congenital deformity of the anterior wall of the chest, in
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
which several ribs and the sternum grow abnormally; it produces a caved-in or sunken
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
appearance of the chest.
b9 b9 b9 b9
PTS: 1
3. The true ribs are BEST defined by which of the following statements?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Vertebrochondral ribs b9
B. Vertebrosternal ribs b9
C. Ribs 11 and 12 b9 b9 b9
D. Ribs 8, 9, and 10 b9 b9 b9 b9
ANS: B b 9 b 9
The first seven ribs attach via their costal cartilages to the sternum and are called the true
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
ribs (also known as the vertebrosternal ribs).
b9 b9 b9 b9 b9 b9 b9
PTS: 1
, Test Bank b9 1-2
4. Which of the following interventions is MOST appropriate for a patient with lower rib
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
fractures?
b9
A. Short, shallow breaths b9 b9
B. Pursed lip breathing b9 b9
C. Deep breaths with splinting b9 b9 b9
D. Breathing with arms raised b9 b9 b9
ANS: C b 9 b 9
It is important for all therapists to recommend breathing (deep breathing), splinting (i.e.,
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
pillow), and coughing strategies for patients with rib fractures.
b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
5. Which of the following positions facilitates greater excursion of both hemidiaphragms at rest?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Supine position b9
B. Sidelying position b9
C. Standing position b9
D. Sitting position b9
ANS: A b 9 b 9
In the supine position, without the effects of gravity, the level of the diaphragm in the
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
thoracic cavity rises. This allows for a relatively greater excursion.
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
6. Which of the following muscles help to achieve the active process of inspiration at rest?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Sternocleidomastoid
B. Diaphragm
C. Abdominal muscles b9
D. Trapezius
ANS: B b 9 b 9
The diaphragm and internal intercostals (intercartilaginous portion) are the essential muscles
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
to achieve the active process of inspiration at rest. Abdominal muscles assist with
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
expiration. The sternocleidomastoid and trapezius are accessory muscles and assist with a
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
more forceful inspiration.
b9 b9 b9
PTS: 1
7. Which of the following accessory muscles of ventilation function to elevate and fix the
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
first and second ribs?
b9 b9 b9 b9
A. Sternocleidomastoid muscle b9
B. Serratus anterior b9
C. Latissimus dorsi b9
D. Scalene muscle b9
b9 ANS: b 9 D
, Test Bank b9 1-3
The scalene muscles lie deep to the sternocleidomastoid, but may be palpated in the
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
posterior triangle of the neck. These muscles function as a unit to elevate and fix the first
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
and second ribs. The sternocleidomastoid muscle elevates the sternum.
b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
8. When the arms and shoulders are fixed, by leaning on the elbows or grasping onto a
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
table, this muscle can use its insertion as its origin and facilitate an increase in the A-P
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
diameter of the thorax.
b9 b9 b9 b9
A. Upper trapezius b9
B. Pectoralis major b9
C. Sternocleidomastoid
D. Serratus anterior b9
ANS: B b 9 b 9
When the insertion and origin of the pectoralis muscle are reversed by leaning on a table
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
to fix the arms, the muscle will pull on the anterior chest wall, lifting the ribs and
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
sternum to increase the A-P diameter of the thoracic cage.
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
9. The serous fluid within the pleural space serves to provide which of the following functions?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Create a constant negative pressure
b9 b9 b9 b9
B. Assist with venous return of blood to the heart
b9 b9 b9 b9 b9 b9 b9 b9
C. Reduce friction between the lungs and thoracic wall
b9 b9 b9 b9 b9 b9 b9
D. Serve to allow separation of the pleural layers
b9 b9 b9 b9 b9 b9 b9
ANS: C b 9 b 9
The serous fluid within the pleural space serves to hold the pleural layers together during
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
ventilation and reduce friction between the lungs and the thoracic wall. The space creates
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
the negative pressure to maintain lung inflation, not the fluid itself.
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
10. Irritation of the phrenic supplied pleura results in which of the following pain referral
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
patterns?
b9
A. Thoracic wall b9
B. Abdominal wall b9
C. Mediasternal region b9
D. Lower neck and shoulder b9 b9 b9
ANS: D b 9 b 9
Irritation of the phrenic supplied pleura can result in referred pain in the lower neck and
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
shoulder, whereas, irritation of the intercostally innervated pleura may result in referral of
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
pain to the thoracic or abdominal wall.
b9 b9 b9 b9 b9 b9 b9
PTS: 1
11. An abnormal pleural friction rub on auscultation BEST indicates which of the following?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Infection with a resultant inflammatory response within the pleura
b9 b9 b9 b9 b9 b9 b9 b9
b9 b9 b9 b9 b9 b9 b9
Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems
b9 b9 b9 b9 b9 b9 b9 b9
b9 Test Bank
b9
MULTIPLE CHOICE b9
1. Which of the following chest wall structures is located level with the second costal
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
cartilage anteriorly and thoracic vertebra T4 and T5 posteriorly?
b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Sternal angle b9
B. Jugular notch b9
C. Xiphoid process b9
D. Third costal cartilage b9 b9
ANS: A b 9 b 9
The sternal angle of the “angle of Louis” is level with the second costal cartilage anteriorly
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
and thoracic vertebrae T4 and T5 posteriorly.
b9 b9 b9 b9 b9 b9 b9
PTS: 1
2. Pectus excuvatum is BEST described as:
b9 b9 b9 b9 b9
A. Deformity of the sternum caused by trauma b9 b9 b9 b9 b9 b9
B. Caved-in appearance of the chest b9 b9 b9 b9
C. Diminished rib angle anteriorly b9 b9 b9
D. Conical shape of the thoracic cage b9 b9 b9 b9 b9
ANS: B b 9 b 9
Pectus excuvatum is a common congenital deformity of the anterior wall of the chest, in
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
which several ribs and the sternum grow abnormally; it produces a caved-in or sunken
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
appearance of the chest.
b9 b9 b9 b9
PTS: 1
3. The true ribs are BEST defined by which of the following statements?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Vertebrochondral ribs b9
B. Vertebrosternal ribs b9
C. Ribs 11 and 12 b9 b9 b9
D. Ribs 8, 9, and 10 b9 b9 b9 b9
ANS: B b 9 b 9
The first seven ribs attach via their costal cartilages to the sternum and are called the true
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
ribs (also known as the vertebrosternal ribs).
b9 b9 b9 b9 b9 b9 b9
PTS: 1
, Test Bank b9 1-2
4. Which of the following interventions is MOST appropriate for a patient with lower rib
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
fractures?
b9
A. Short, shallow breaths b9 b9
B. Pursed lip breathing b9 b9
C. Deep breaths with splinting b9 b9 b9
D. Breathing with arms raised b9 b9 b9
ANS: C b 9 b 9
It is important for all therapists to recommend breathing (deep breathing), splinting (i.e.,
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
pillow), and coughing strategies for patients with rib fractures.
b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
5. Which of the following positions facilitates greater excursion of both hemidiaphragms at rest?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Supine position b9
B. Sidelying position b9
C. Standing position b9
D. Sitting position b9
ANS: A b 9 b 9
In the supine position, without the effects of gravity, the level of the diaphragm in the
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
thoracic cavity rises. This allows for a relatively greater excursion.
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
6. Which of the following muscles help to achieve the active process of inspiration at rest?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Sternocleidomastoid
B. Diaphragm
C. Abdominal muscles b9
D. Trapezius
ANS: B b 9 b 9
The diaphragm and internal intercostals (intercartilaginous portion) are the essential muscles
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
to achieve the active process of inspiration at rest. Abdominal muscles assist with
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
expiration. The sternocleidomastoid and trapezius are accessory muscles and assist with a
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
more forceful inspiration.
b9 b9 b9
PTS: 1
7. Which of the following accessory muscles of ventilation function to elevate and fix the
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
first and second ribs?
b9 b9 b9 b9
A. Sternocleidomastoid muscle b9
B. Serratus anterior b9
C. Latissimus dorsi b9
D. Scalene muscle b9
b9 ANS: b 9 D
, Test Bank b9 1-3
The scalene muscles lie deep to the sternocleidomastoid, but may be palpated in the
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
posterior triangle of the neck. These muscles function as a unit to elevate and fix the first
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
and second ribs. The sternocleidomastoid muscle elevates the sternum.
b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
8. When the arms and shoulders are fixed, by leaning on the elbows or grasping onto a
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
table, this muscle can use its insertion as its origin and facilitate an increase in the A-P
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
diameter of the thorax.
b9 b9 b9 b9
A. Upper trapezius b9
B. Pectoralis major b9
C. Sternocleidomastoid
D. Serratus anterior b9
ANS: B b 9 b 9
When the insertion and origin of the pectoralis muscle are reversed by leaning on a table
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
to fix the arms, the muscle will pull on the anterior chest wall, lifting the ribs and
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
sternum to increase the A-P diameter of the thoracic cage.
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
9. The serous fluid within the pleural space serves to provide which of the following functions?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Create a constant negative pressure
b9 b9 b9 b9
B. Assist with venous return of blood to the heart
b9 b9 b9 b9 b9 b9 b9 b9
C. Reduce friction between the lungs and thoracic wall
b9 b9 b9 b9 b9 b9 b9
D. Serve to allow separation of the pleural layers
b9 b9 b9 b9 b9 b9 b9
ANS: C b 9 b 9
The serous fluid within the pleural space serves to hold the pleural layers together during
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
ventilation and reduce friction between the lungs and the thoracic wall. The space creates
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
the negative pressure to maintain lung inflation, not the fluid itself.
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
PTS: 1
10. Irritation of the phrenic supplied pleura results in which of the following pain referral
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
patterns?
b9
A. Thoracic wall b9
B. Abdominal wall b9
C. Mediasternal region b9
D. Lower neck and shoulder b9 b9 b9
ANS: D b 9 b 9
Irritation of the phrenic supplied pleura can result in referred pain in the lower neck and
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
shoulder, whereas, irritation of the intercostally innervated pleura may result in referral of
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
pain to the thoracic or abdominal wall.
b9 b9 b9 b9 b9 b9 b9
PTS: 1
11. An abnormal pleural friction rub on auscultation BEST indicates which of the following?
b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9 b9
A. Infection with a resultant inflammatory response within the pleura
b9 b9 b9 b9 b9 b9 b9 b9
