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