Gray's Anatomy Chapter 56 - Mediastinum

Question Answer What is the mediastinum? B) The visceral compartment between the two lungs A) The space between the lungs and the Explanation: The mediastinum is defined as the visceral compartment between the two lungs heart...

Question Answer What is the mediastinum? B) The visceral compartment between the two lungs A) The space between the lungs and the Explanation: The mediastinum is defined as the visceral compartment between the two lungs heart and includes the mediastinal part of the parietal pleura. B) The visceral compartment between the two lungs C) The area above the diaphragm D) The region behind the sternum E) The space in front of the thoracic vertebral column What are the boundaries of the B) Laterally by the mediastinal parietal pleura, anteriorly by the sternum, posteriorly by the mediastinum? thoracic vertebral column A) Laterally by the lungs, anteriorly by the Explanation: The mediastinum is bounded laterally by the mediastinal parietal pleura, heart, posteriorly by the spine anteriorly by the sternum, and posteriorly by the thoracic vertebral column. B) Laterally by the mediastinal parietal pleura, anteriorly by the sternum, posteriorly by the thoracic vertebral column C) Laterally by the ribs, anteriorly by the diaphragm, posteriorly by the spine D) Laterally by the heart, anteriorly by the lungs, posteriorly by the diaphragm E) Laterally by the spine, anteriorly by the lungs, posteriorly by the heart How is the mediastinum divided? B) Into superior and inferior parts A) Into anterior and posterior parts Explanation: The mediastinum is divided into superior and inferior mediastina by the sternal B) Into superior and inferior parts plane. C) Into left and right parts D) Into upper and lower parts E) Into medial and lateral parts What structures are found in the superior B) Trachea, oesophagus, aortic arch mediastinum? Explanation: The superior mediastinum contains the trachea, oesophagus, aortic arch, A) Heart, lungs, diaphragm brachiocephalic trunk, left common carotid and subclavian arteries, among other structures. B) Trachea, oesophagus, aortic arch C) Liver, stomach, intestines D) Kidneys, bladder, ureters E) Pancreas, spleen, gallbladder What is the posterior boundary of the C) The thoracic vertebral column mediastinum? Explanation: The posterior boundary of the mediastinum is the thoracic vertebral column. A) The sternum B) The diaphragm C) The thoracic vertebral column D) The lungs E) The heart What is the significance of the sternal plane B) It divides the mediastinum into superior and inferior parts in the mediastinum? Explanation: The sternal plane passes horizontally from the manubriosternal joint to intersect A) It divides the mediastinum into left and the vertebral column, dividing the mediastinum into superior and inferior parts. right parts B) It divides the mediastinum into superior and inferior parts C) It marks the boundary between the heart and lungs D) It separates the anterior and posterior mediastinum E) It indicates the transition from the thoracic to the abdominal cavity What is found in the anterior mediastinum? C) Thymus and fibrous pericardium A) Heart and lungs Explanation: The anterior mediastinum lies between the sternal body and fibrous pericardium B) Trachea and oesophagus and contains the thymus or its remnants. C) Thymus and fibrous pericardium D) Diaphragm and liver E) Kidneys and bladder What structures are found in the middle B) Pericardia, heart, and ascending aorta mediastinum? Explanation: The middle mediastinum contains the pericardia, heart, and ascending aorta, A) Thymus gland and internal thoracic artery among other structures such as the intrapericardial half of the superior vena cava, tracheal B) Pericardia, heart, and ascending aorta bifurcation, and main bronchi. C) Descending thoracic aorta and esophagus D) Azygos vein and hemiazygos vein E) Thoracic duct and sympathetic trunks Which of the following structures is NOT D) Pulmonary trunk found in the posterior mediastinum? Explanation: The pulmonary trunk is located in the middle mediastinum, while the posterior A) Descending thoracic aorta mediastinum contains structures such as the descending thoracic aorta, esophagus, azygos B) Esophagus and hemiazygos venous systems, and thoracic duct. C) Azygos and hemiazygos venous systems Question Answer D) Pulmonary trunk E) Thoracic duct What is the significance of the sternocostal B) They are openings between the sternal and costal attachments of the diaphragm triangles (of Morgagni)? Explanation: The sternocostal triangles (of Morgagni) are openings between the sternal and A) They are filled with lymph nodes costal attachments of the respiratory diaphragm, filled with areolar tissue and crossed by the B) They are openings between the sternal superior epigastric vessels and some lymph vessels. and costal attachments of the diaphragm C) They contain the heart and pericardium D) They are the site of the tracheal bifurcation E) They are the origin of the azygos vein Which approach is commonly used to access B) Complete or partial median sternotomy the pericardium and heart? Explanation: The pericardium and heart are routinely approached by either a complete or A) Lateral thoracotomy partial median sternotomy, allowing for direct access to these structures. B) Complete or partial median sternotomy C) Posterior thoracotomy D) Subclavian approach E) Transabdominal approach What is the role of the thoracic duct in the B) It drains lymph from the lower body posterior mediastinum? Explanation: The thoracic duct in the posterior mediastinum is responsible for draining lymph A) It supplies blood to the heart from the lower body and returning it to the venous system. B) It drains lymph from the lower body C) It transmits the vagal trunks D) It carries oxygenated blood to the lungs E) It forms the root of the lung Which structures pass through the aortic B) Aorta, thoracic duct, and occasionally the azygos and hemiazygos veins hiatus at the level of the twelfth thoracic Explanation: The aortic hiatus at the level of the twelfth thoracic vertebra transmits the aorta, vertebra? thoracic duct, and occasionally the azygos and hemiazygos veins. A) Esophagus and vagal trunks B) Aorta, thoracic duct, and occasionally the azygos and hemiazygos veins C) Superior vena cava and pulmonary arteries D) Trachea and main bronchi E) Phrenic nerves and cardiac plexus Where does the azygos vein join the superior B) At the level of the fourth thoracic vertebra vena cava? Explanation: The azygos vein ascends in the posterior mediastinum to the level of the body of A) At the level of the first thoracic vertebra the fourth thoracic vertebra, where it arches anteriorly and joins the posterior aspect of the B) At the level of the fourth thoracic vertebra superior vena cava. C) At the level of the seventh thoracic vertebra D) At the level of the tenth thoracic vertebra E) At the level of the twelfth thoracic vertebra Which veins form the azygos vein? A) Right ascending lumbar and subcostal veins A) Right ascending lumbar and subcostal Explanation: The azygos vein is formed by the union of the right ascending lumbar and veins subcostal veins. B) Left ascending lumbar and subcostal veins C) Right and left brachiocephalic veins D) Right and left pulmonary veins E) Right and left renal veins What is the function of the accessory A) Drains the left fifth to eighth posterior intercostal veins hemiazygos vein? Explanation: The accessory hemiazygos vein functions as the left-sided mirror image of the A) Drains the left fifth to eighth posterior superior portion of the azygos vein and drains the left fifth to eighth posterior intercostal intercostal veins veins. B) Drains the right fifth to eighth posterior intercostal veins C) Drains the left first to fourth posterior intercostal veins D) Drains the right first to fourth posterior intercostal veins E) Drains the left ninth to eleventh posterior intercostal veins Which structure is NOT a major tributary of D) Left renal vein the azygos vein? Explanation: The left renal vein is not a major tributary of the azygos vein. The major A) Right intercostal veins tributaries include the right intercostal veins, right superior intercostal vein, right ascending B) Right superior intercostal vein lumbar vein, and hemiazygos vein. Question Answer C) Right ascending lumbar vein D) Left renal vein E) Hemiazygos vein What anatomical feature assists venous B) Aortic pulsations return in the azygos and hemiazygos veins? Explanation: Aortic pulsations may assist venous return in the azygos and hemiazygos veins, A) Presence of numerous valves although only a small and variable number of imperfect valves are present. B) Aortic pulsations C) High blood pressure D) Gravity E) Muscular contractions Which structure is located left lateral to the C) Thoracic duct azygos vein? Explanation: The thoracic duct is located left lateral to the azygos vein, along with the A) Right sympathetic trunk descending thoracic aorta and, where the vein arches anteriorly, the oesophagus, trachea, B) Right lung and parietal pleura and right vagus nerve. C) Thoracic duct D) Right greater thoracic splanchnic nerve E) Right posterior intercostal arteries What is the primary function of the B) Drains the left posterior intercostal veins hemiazygos vein? Explanation: The hemiazygos vein represents the left-sided equivalent of the more inferior A) Drains the right posterior intercostal veins part of the azygos vein and drains the left posterior intercostal veins. B) Drains the left posterior intercostal veins C) Drains the right superior intercostal vein D) Drains the left superior intercostal vein E) Drains the right ascending lumbar vein What is the significance of the A) It separates the azygos vein from the oesophagus azygo-oesophageal recess? Explanation: The azygo-oesophageal recess is a right-sided pleural recess that separates the A) It separates the azygos vein from the azygos vein from the oesophagus. oesophagus B) It separates the azygos vein from the trachea C) It separates the azygos vein from the right lung D) It separates the azygos vein from the thoracic duct E) It separates the azygos vein from the aorta What is the 'azygos lobe' and how is it B) A portion of the right superior lobe, identified by a fine radiopaque line identified on a chest radiograph? Explanation: The 'azygos lobe' is a portion of the right superior lobe within an accessory A) A portion of the left lung, identified by a azygos fissure, covered by four pleural layers. It can be identified on a chest radiograph as a dark line fine radiopaque line. B) A portion of the right superior lobe, identified by a fine radiopaque line C) A portion of the right inferior lobe, identified by a dark spot D) A portion of the left superior lobe, identified by a fine radiopaque line E) A portion of the left inferior lobe, identified by a dark spot What does the presence of the azygos vein B) A comma-shaped pseudo-nodule within the azygos fissure often present as on Explanation: The azygos vein located within the azygos fissure often presents as a lung a chest radiograph? 'pseudo-nodule' on a chest radiograph, typically comma-shaped, and should not be confused A) A rounded nodule with a more rounded appearance of early lung carcinoma or metastasis. B) A comma-shaped pseudo-nodule C) A dark spot D) A linear shadow E) A bright spot What does N2 indicate in the staging system C) Involvement of ipsilateral mediastinal and/or subcarinal nodes for lung cancer? Explanation: N2 indicates involvement of ipsilateral mediastinal and/or subcarinal nodes in A) No regional lymph node metastases the staging system for lung cancer. B) Involvement of ipsilateral peribronchial or hilar lymph nodes C) Involvement of ipsilateral mediastinal and/or subcarinal nodes D) Involvement of contralateral mediastinal or hilar nodes E) Involvement of ipsilateral or contralateral scalene nodes Which complications are associated with B) Haemorrhage and iatrogenic injury to the trachea or left recurrent laryngeal nerve mediastinoscopy? Explanation: Complications of mediastinoscopy include haemorrhage and iatrogenic injury to Question Answer A) Infection and fever the trachea or left recurrent laryngeal nerve. B) Haemorrhage and iatrogenic injury to the trachea or left recurrent laryngeal nerve C) Pneumonia and bronchitis D) Heart attack and stroke E) Kidney failure and liver damage Which lymph node stations can be accessed D) 2R, 2L, 4R, 4L, 7, 10R, 10L via mediastinoscopy? Explanation: Mediastinoscopy facilitates biopsy of the upper paratracheal 2R and 2L stations, A) 1, 2R, 2L, 4R, 4L, 7, 10R, 10L the right lower paratracheal 4R station, higher nodes from the left lower paratracheal 4L B) 3, 5, 6, 8, 9 station, the anterior part of subcarinal station 7, and bilateral hilar stations 10R and 10L. C) 1, 3, 5, 6, 8 D) 2R, 2L, 4R, 4L, 7, 10R, 10L E) 1, 2R, 2L, 4R, 4L, 5, 6, 7 What is the purpose of an anterior B) To biopsy nodes from the more inferior aspect of the left lower paratracheal station and mediastinotomy (Chamberlain procedure)? other specific stations A) To biopsy nodes from the upper Explanation: An anterior mediastinotomy (Chamberlain procedure) is performed to biopsy paratracheal stations nodes from the more inferior aspect of the left lower paratracheal 4L station, subaortic station B) To biopsy nodes from the more inferior 5, para-aortic station 6, and subcarinal station 7, and also facilitates anterior mediastinal aspect of the left lower paratracheal station mass biopsy. and other specific stations C) To remove the entire lung D) To treat pneumonia E) To perform a heart surgery Which lymph nodes are located near the B) Diaphragmatic (phrenic) lymph nodes diaphragm? Explanation: Diaphragmatic (phrenic) lymph nodes are specifically located near the A) Paratracheal lymph nodes diaphragm, distinguishing them from other lymph nodes in the mediastinum. B) Diaphragmatic (phrenic) lymph nodes C) Para-oesophageal lymph nodes D) Tracheobronchial lymph nodes E) Anterior mediastinal lymph nodes What is the function of the thoracic duct? C) Drains lymph from the lower body and left upper body A) Drains blood from the heart Explanation: The thoracic duct is a major lymphatic vessel that drains lymph from the lower B) Transports air to the lungs body and the left upper body, playing a crucial role in the lymphatic system. C) Drains lymph from the lower body and left upper body D) Supplies oxygen to the brain E) Filters toxins from the liver Which lymph nodes are found near the B) Para-oesophageal lymph nodes esophagus? Explanation: Para-oesophageal lymph nodes are located near the esophagus, which is A) Paratracheal lymph nodes reflected in their name. B) Para-oesophageal lymph nodes C) Tracheobronchial lymph nodes D) Anterior mediastinal lymph nodes E) Pericardial lymph nodes Which lymph nodes are located near the A) Paratracheal lymph nodes trachea and bronchi? Explanation: Paratracheal lymph nodes are located near the trachea and bronchi, which is A) Paratracheal lymph nodes indicated by their name. B) Diaphragmatic lymph nodes C) Para-oesophageal lymph nodes D) Intercostal lymph nodes E) Pericardial lymph nodes Which lymph nodes are named based on A) Paratracheal lymph nodes their location near the trachea and bronchi? Explanation: Paratracheal lymph nodes are named based on their location near the trachea A) Paratracheal lymph nodes and bronchi, reflecting their anatomical position. B) Diaphragmatic lymph nodes C) Para-oesophageal lymph nodes D) Intercostal lymph nodes E) Pericardial lymph nodes Which lymph nodes are located near the E) Pericardial lymph nodes heart? Explanation: Pericardial lymph nodes are located near the heart, as indicated by their name. A) Paratracheal lymph nodes B) Diaphragmatic lymph nodes C) Para-oesophageal lymph nodes D) Intercostal lymph nodes E) Pericardial lymph nodes What is the primary function of the thoracic C) To convey lymph from the majority of the body back to the venous circulation duct? Explanation: The thoracic duct's primary function is to convey lymph from the majority of the Question Answer A) To convey blood from the heart to the body back to the venous circulation, excluding lymph from specific regions such as the right lungs part of the head, neck, and heart. B) To transport oxygen from the lungs to the bloodstream C) To convey lymph from the majority of the body back to the venous circulation D) To carry nerve signals from the brain to the body E) To transport nutrients from the digestive system to the liver Where does the thoracic duct usually A) Anterior to the body of the first or second lumbar vertebra originate? Explanation: The thoracic duct usually originates anterior to the body of the first or second A) Anterior to the body of the first or second lumbar vertebra, where the intestinal and two lumbar lymphatic trunks join to form the lumbar vertebra cisterna chyli. B) At the base of the skull C) In the right atrium of the heart D) In the abdominal aorta E) At the diaphragm What is the typical length of the thoracic C) 36-45 cm duct? Explanation: The thoracic duct is commonly 36-45 cm in length, with its external diameter A) 10-15 cm varying according to the region. B) 20-25 cm C) 36-45 cm D) 50-60 cm E) 70-80 cm Which of the following structures does the A) Aortic hiatus thoracic duct pass through? Explanation: From the superior aspect of the cisterna chyli, the thoracic duct passes through A) Aortic hiatus the aortic hiatus and enters the posterior mediastinum. B) Foramen magnum C) Pulmonary valve D) Hepatic portal vein E) Renal artery Into which veins does the thoracic duct B) Left internal jugular and subclavian veins typically empty? Explanation: The thoracic duct typically empties into the venous circulation in the region of A) Right internal jugular and subclavian the left internal jugular and subclavian veins, either at their confluence or in proximity. veins B) Left internal jugular and subclavian veins C) Superior vena cava D) Inferior vena cava E) Pulmonary veins What is the cisterna chyli? C) A dilated sac at the lower end of the thoracic duct A) A valve in the thoracic duct Explanation: The cisterna chyli is a dilated sac at the lower end of the thoracic duct, where the B) A lymphatic vessel in the neck intestinal and two lumbar lymphatic trunks join. C) A dilated sac at the lower end of the thoracic duct D) A part of the heart E) A muscle in the diaphragm What is the diameter of the thoracic duct at C) 5-8 mm its origin? Explanation: When present as a single channel, the thoracic duct is 5-8 mm in diameter at its A) 1-2 mm origin. B) 3-4 mm C) 5-8 mm D) 9-10 mm E) 11-12 mm What is the daily lymphatic flow through the C) 1500-2400 ml thoracic duct? Explanation: The total lymphatic flow through the thoracic duct is 1500-2400 ml per day, in A) 500-1000 ml proportion to the dietary intake of fat, particularly long-chain triglycerides. B) 1000-1500 ml C) 1500-2400 ml D) 2500-3000 ml E) 3000-3500 ml Which of the following is NOT a tributary of D) Right bronchomediastinal trunk the thoracic duct? Explanation: The right bronchomediastinal trunk is not a tributary of the thoracic duct; it A) Cisterna chyli usually has an independent venous termination. B) Bilateral ascending lumbar lymphatic trunks C) Inferior intercostal lymphatic trunks D) Right bronchomediastinal trunk Question Answer E) Left jugular trunk What is the function of the bicuspid valve at B) To prevent the backflow of blood the termination of the thoracic duct? Explanation: The bicuspid valve at the termination of the thoracic duct may prevent the A) To regulate blood pressure backflow of blood, ensuring unidirectional flow of lymph into the venous system. B) To prevent the backflow of blood C) To control lymph flow rate D) To filter lymph E) To absorb nutrients At what level does the thoracic duct cross C) Fifth thoracic vertebra the mediastinum? Explanation: The thoracic duct crosses the mediastinum at, or at about, the level of the body A) First thoracic vertebra of the fifth thoracic vertebra. B) Third thoracic vertebra C) Fifth thoracic vertebra D) Seventh thoracic vertebra E) Ninth thoracic vertebra What is a potential consequence of thoracic A) Pleural effusion duct laceration? Explanation: Rupture of the thoracic duct leads to leakage of chyle, which can result in a A) Pleural effusion pleural effusion, specifically a chylothorax. B) Pneumothorax C) Hemothorax D) Atelectasis E) Pulmonary embolism Which imaging technique is used to identify C) Lymphangiography anomalies and sites of injury to the thoracic Explanation: Lymphangiography, often combined with CT scanning or lymphoscintigraphy, is duct? used to identify anomalies and sites of injury to the thoracic duct. A) MRI B) Ultrasound C) Lymphangiography D) PET scan E) Bone scan What is the incidence of thoracic duct injury B) 0.2-3% during trans-hiatal and thoracoscopic Explanation: The incidence of thoracic duct injury during trans-hiatal and thoracoscopic oesophageal surgery? oesophageal surgery ranges from 0.2% to 3%. A) 0.01-0.1% B) 0.2-3% C) 5-10% D) 10-15% E) 20-25% What is a diagnostic test for confirming the B) Electrophoretic confirmation presence of chylomicrons in pleural fluid? Explanation: Electrophoretic confirmation of the presence of chylomicrons in pleural fluid is A) Blood culture diagnostic for chylous effusions. B) Electrophoretic confirmation C) Urinalysis D) Sputum culture E) Skin biopsy What is a common cause of postoperative A) Damage to ductal tributaries chylous effusions? Explanation: Postoperative chylous effusions are usually the result of damage to ductal A) Damage to ductal tributaries tributaries rather than to the thoracic duct itself. B) Damage to the heart C) Damage to the lungs D) Damage to the liver E) Damage to the spleen What is the primary content of chyle that B) Chylomicrons leaks due to thoracic duct rupture? Explanation: Chyle is rich in lipid, protein, T lymphocytes, immunoglobulins, and fat-soluble A) Blood cells vitamins, with chylomicrons being a primary component. B) Chylomicrons C) Bile D) Urine E) Cerebrospinal fluid Which surgical approach may lead to B) Left cervical approach thoracic duct injury but is also used for Explanation: The thoracic duct may be injured during the left cervical approach for the deliberate ligation of the duct? exposure of the vertebral and subclavian arteries or the cervico-thoracic sympathetic A) Right cervical approach ganglion, but deliberate ligation at this level is an accepted surgical maneuver. B) Left cervical approach C) Abdominal approach D) Posterior approach E) Anterior approach Question Answer What are the three main tributaries of the A) Right jugular, subclavian, and bronchomediastinal trunks right lymphatic trunk? Explanation: The right lymphatic trunk's three main tributaries are the right jugular, A) Right jugular, subclavian, and subclavian, and bronchomediastinal trunks, which often empty separately into either the bronchomediastinal trunks right internal jugular and/or subclavian veins. B) Left jugular, subclavian, and bronchomediastinal trunks C) Right jugular, subclavian, and thoracic trunks D) Left jugular, subclavian, and thoracic trunks E) Right jugular, thoracic, and bronchomediastinal trunks What is the length of the right lymphatic B) 5-10 mm trunk in up to 20% of individuals? Explanation: In up to 20% of individuals, the right lymphatic trunk may aggregate to form a A) 1-2 mm structure that is usually 5-10 mm in length. B) 5-10 mm C) 15-20 mm D) 25-30 mm E) 35-40 mm What structures conceal the terminal A) Scalene fat pad portions of the right lymphatic trunk and Explanation: The terminal portions of the right lymphatic trunk and the thoracic duct are thoracic duct? concealed by the scalene fat pad, making them more vulnerable during surgery. A) Scalene fat pad B) Parietal pleura C) Diaphragmatic crus D) Aortic arch E) Mediastinal pleura Which ganglion is almost always fused with C) Inferior cervical ganglion the first thoracic ganglion? Explanation: The first thoracic ganglion is almost always fused with the inferior cervical A) Superior cervical ganglion ganglion, forming the cervicothoracic (stellate) ganglion. B) Middle cervical ganglion C) Inferior cervical ganglion D) Stellate ganglion E) Second thoracic ganglion What is the primary function of the greater C) Preganglionic efferent and visceral afferent nerve fibers thoracic splanchnic nerve? Explanation: The greater thoracic splanchnic nerve consists mainly of myelinated A) Motor to the circular non-striated muscle preganglionic efferent and visceral afferent nerve fibers. fibers of the bronchi B) Sensory from thoracic and abdominal viscera C) Preganglionic efferent and visceral afferent nerve fibers D) Postganglionic parasympathetic innervation of the ventricles E) Secretomotor to the mucous glands of the respiratory epithelium Which nerve is responsible for carrying D) Intrathoracic nerve of Kuntz sympathetic nerve fibers to the brachial Explanation: The intrathoracic nerve of Kuntz is thought to carry sympathetic nerve fibers to plexus without passing through the the brachial plexus without passing through the sympathetic trunk. sympathetic trunk? A) Greater thoracic splanchnic nerve B) Lesser thoracic splanchnic nerve C) Least thoracic splanchnic nerve D) Intrathoracic nerve of Kuntz E) Right recurrent laryngeal nerve What is the role of the vagus nerve in the C) Preganglionic parasympathetic innervation mediastinum? Explanation: The vagus nerve contains preganglionic parasympathetic nerve fibers that travel A) Motor to the circular non-striated muscle in its branches and synapse in minute ganglia in the visceral walls. fibers of the bronchi B) Sensory from thoracic and abdominal viscera C) Preganglionic parasympathetic innervation D) Postganglionic parasympathetic innervation of the ventricles E) Secretomotor to the mucous glands of the respiratory epithelium Which nerve descends posterior to the right C) Right vagus nerve internal jugular vein in the neck? Explanation: The right vagus nerve descends posterior to the right internal jugular vein in the A) Left vagus nerve neck and crosses anterior to the first part of the right subclavian artery to enter the thorax. Question Answer B) Right phrenic nerve C) Right vagus nerve D) Left recurrent laryngeal nerve E) Right recurrent laryngeal nerve What is the primary purpose of making tiny B) To insufflate a small amount of carbon dioxide into the thoracic cavity incisions posterior to the anterior axillary Explanation: The operation involves making tiny incisions posterior to the anterior axillary fold in the axilla during ETS? fold in the axilla and insufflating a small amount of carbon dioxide into the thoracic cavity to A) To remove the second thoracic ganglion allow access with a modified thoracoscope. B) To insufflate a small amount of carbon dioxide into the thoracic cavity C) To access the heart D) To treat chronic non-infectious rhinitis E) To perform a lung biopsy Which condition is treated by dividing the B) Facial blushing nerve fibers that run superiorly from the Explanation: In the treatment of facial blushing, it is sufficient to divide the nerve fibers that second thoracic ganglion over the neck of run superiorly from the second thoracic ganglion over the neck of the second rib, leaving the the second rib? second ganglion almost intact. A) Palmar hyperhidrosis B) Facial blushing C) Axillary hyperhidrosis D) Frostbite injury E) Chronic non-infectious rhinitis What is a major concern when treating B) Compensatory sweating palmar hyperhidrosis with ETS? Explanation: The risk of compensatory sweating is greatly reduced, though not completely A) Damage to the heart excluded, by limiting the number of ganglia treated to an absolute minimum. B) Compensatory sweating C) Infection D) Chronic pain E) Blood clots What is the cause of Horner’s syndrome in B) Damage to the stellate ganglion the context of ETS? Explanation: Horner’s syndrome is caused by damage to the stellate ganglion and A) Damage to the second thoracic ganglion interruption of the sympathetic nerve fibers from the ventral rami of spinal nerves C8–T1 that B) Damage to the stellate ganglion ascend around the arteries supplying the head and neck. C) Insufflation of carbon dioxide D) Thermal energy spreading along the trunk E) Dividing the nerve of Kuntz What side-effect may occur in up to B) Gustatory or olfactory sweating one-third of patients undergoing ETS? Explanation: Gustatory or olfactory sweating may occur in up to one-third of patients but is A) Severe pain rarely considered a problem. B) Gustatory or olfactory sweating C) Chronic fatigue D) Loss of appetite E) Vision problems Question Answer Which nerve is responsible for forming E) Right vagus nerve the right posterior pulmonary plexus Explanation: The right vagus nerve, along with rami from the second to fifth/sixth thoracic along with rami from the second to sympathetic ganglia, forms the right posterior pulmonary plexus. fifth/sixth thoracic sympathetic ganglia? A) Left recurrent laryngeal nerve B) Right recurrent laryngeal nerve C) Right greater thoracic splanchnic nerve D) Left vagus nerve E) Right vagus nerve What structure does the posterior vagal C) Oesophageal hiatus trunk pass through to enter the Explanation: The posterior vagal trunk, containing nerve fibers from both vagus nerves, passes abdomen? through the oesophageal hiatus in the respiratory diaphragm to enter the abdomen. A) Aortic arch B) Thoracic duct C) Oesophageal hiatus D) Pulmonary trunk E) Inferior vena cava Where does the left vagus nerve give off B) At the aortic arch the left recurrent laryngeal nerve? Explanation: The left vagus nerve gives off the left recurrent laryngeal nerve as it crosses the left A) At the level of the diaphragm side of the aortic arch. B) At the aortic arch C) At the left lung root D) At the left brachiocephalic vein E) At the left common carotid artery Which nerve fibers are contained in the C) Fibers from both vagus nerves anterior vagal trunk? Explanation: The anterior vagal trunk contains nerve fibers from both the left and right vagus A) Only fibers from the left vagus nerve nerves. B) Only fibers from the right vagus nerve C) Fibers from both vagus nerves D) Fibers from the phrenic nerve E) Fibers from the sympathetic trunk What forms the anterior oesophageal C) Branches from the left posterior pulmonary plexus plexus? Explanation: The anterior oesophageal plexus is formed by branches descending anteriorly on the A) Branches from the left recurrent oesophagus from the left posterior pulmonary plexus, which join with rami from the right posterior laryngeal nerve pulmonary plexus. B) Branches from the right posterior pulmonary plexus C) Branches from the left posterior pulmonary plexus D) Branches from the thoracic sympathetic trunk E) Branches from the phrenic nerve Which of the following structures is NOT D) Right inferior pulmonary vein associated with the descending thoracic Explanation: The right inferior pulmonary vein is not associated with the descending thoracic aorta? aorta. The other structures listed, such as the accessory hemiazygos vein, posterior bronchial A) Accessory hemiazygos vein branches (vagus nerve), thoracic duct, and azygo-oesophageal recess, are associated with the B) Posterior bronchial branches (vagus descending thoracic aorta. nerve) C) Thoracic duct D) Right inferior pulmonary vein E) Azygo-oesophageal recess What is the primary function of the C) Producing lymphocytes thymus? Explanation: The thymus is one of the primary lymphoid organs, along with the bone marrow, and A) Producing red blood cells its main function is to produce lymphocytes, which are crucial for the immune system. B) Filtering blood C) Producing lymphocytes D) Storing bile E) Regulating metabolism Where is the thymus located in relation C) Anterior to the ascending aorta? Explanation: The thymus is located just anterior to the ascending aorta and inferior to the left A) Posterior brachiocephalic vein, making it a key structure in the anterior mediastinum. B) Lateral C) Anterior D) Inferior E) Superior What happens to the thymus as a C) It undergoes fibrofatty degeneration person ages? Explanation: As a person ages, the thymus undergoes considerable fibrofatty degeneration, A) It enlarges and becomes more active although it remains active into old age. B) It remains the same size and activity level C) It undergoes fibrofatty degeneration Question Answer D) It becomes a bone-like structure E) It migrates to a different location Which imaging modality shows the C) CT scan thymus with homogeneous CT Explanation: CT scans show the thymus with homogeneous attenuation in younger individuals, attenuation in younger individuals? which is greater than that of the chest wall and cardiac muscles below the age of 1 year, and A) X-ray similar to these muscles after the age of 1 year. B) Ultrasound C) CT scan D) PET scan E) SPECT scan Which nerve is associated with the B) Vagus nerve transmission of intense pain from an Explanation: The vagus nerve, along with branches from the left sympathetic trunk, is involved in intramural aortic hematoma? transmitting the intense, excruciating pain of an intramural aortic hematoma from aortic A) Phrenic nerve dissection or laceration. B) Vagus nerve C) Sympathetic trunk D) Greater thoracic splanchnic nerve E) Left recurrent laryngeal nerve What is a notable change in the thymus C) Fibrofatty infiltration observed between a 9-year-old female Explanation: The thymus of an 80-year-old male shows fibrofatty infiltration, which is a notable and an 80-year-old male? change compared to the thymus of a 9-year-old female. A) Increase in size B) Decrease in size C) Fibrofatty infiltration D) Complete disappearance E) Calcification During a transcervical thymectomy, B) Left pole of the thymus which structure is typically seen first? Explanation: The left pole of the thymus usually extends higher and is seen first during the initial A) Right pole of the thymus stages of a transcervical thymectomy. B) Left pole of the thymus C) Thyroid gland D) Sternum E) Right lung Which artery does NOT supply the D) Carotid artery thymus? Explanation: The thymus is supplied by thymic branches originating from the internal thoracic, A) Internal thoracic artery inferior, and sometimes superior thyroid arteries, but not the carotid artery. B) Inferior thyroid artery C) Superior thyroid artery D) Carotid artery E) Thymic branches Which veins are involved in the drainage C) Thymic veins of the thymus? Explanation: Thymic veins drain to the left brachiocephalic, internal thoracic, and inferior thyroid A) Jugular veins veins, and occasionally directly into the superior vena cava. B) Pulmonary veins C) Thymic veins D) Renal veins E) Hepatic veins What is the primary function of the C) Provision of thymus-processed (T) lymphocytes thymus? Explanation: The thymus is responsible for the provision of thymus-processed (T) lymphocytes to A) Production of red blood cells the entire body, providing a unique microenvironment for thymocyte development and B) Filtration of blood differentiation. C) Provision of thymus-processed (T) lymphocytes D) Storage of fat E) Regulation of blood pressure Which nerve is NOT involved in the E) Sciatic nerve innervation of the thymus? Explanation: The thymus is innervated by the vagus nerve, phrenic nerve, sympathetic trunks, and A) Vagus nerve ansa cervicalis, but not by the sciatic nerve. B) Phrenic nerve C) Sympathetic trunks D) Ansa cervicalis E) Sciatic nerve Where might ectopic thymic tissue be A) Near the trachea found? Explanation: Ectopic thymic tissue may be found in various locations such as near the trachea, A) Near the trachea within mediastinal adipose tissue, or posterior to the brachiocephalic veins. B) In the liver C) In the kidneys Question Answer D) In the spleen E) In the pancreas What is the origin of the epithelial C) Pharyngeal endoderm reticular cells in the thymus? Explanation: The epithelial reticular cells in the thymus share a common origin from the A) Mesoderm pharyngeal endoderm. B) Ectoderm C) Pharyngeal endoderm D) Neural crest cells E) Mesenchyme What notable change occurs in the C) It undergoes fibrofatty infiltration thymus gland with age? Explanation: The thymus gland undergoes fibrofatty infiltration as it ages, which is evident when A) It increases in size comparing the thymus of a 9-year-old female to that of an 80-year-old male. B) It becomes more vascular C) It undergoes fibrofatty infiltration D) It becomes more lymphoid E) It remains unchanged What is observed in CT images of the C) The thymus reduces in volume and is replaced by fatty material thymus with age? Explanation: CT images show that the thymus reduces in volume relative to the great vessels with A) The thymus increases in volume age and is replaced by fatty material by late adulthood. B) The thymus remains the same size C) The thymus reduces in volume and is replaced by fatty material D) The thymus becomes more dense E) The thymus becomes more vascular Which of the following is NOT a type of D) Cells containing insulin non-lymphoid cell found in the thymus Explanation: The thymus medulla contains cells positive for vasoactive intestinal polypeptide, medulla? large non-myoid cells, and cells containing oxytocin and vasopressin, but not cells containing A) Cells positive for vasoactive intestinal insulin. polypeptide B) Large non-myoid cells C) Cells containing oxytocin D) Cells containing insulin E) Cells containing vasopressin What is the likely role of autonomic A) They have a vasomotor effect nerves in the thymus? Explanation: Many of the autonomic nerves in the thymus most likely have a vasomotor effect, A) They have a vasomotor effect although their exact roles remain little understood. B) They increase lymphocyte production C) They decrease thymic function D) They cause thymic hypertrophy E) They inhibit thymic function When is innervation of the thymus B) By the onset of thymic function complete? Explanation: Innervation of the thymus is complete by the onset of thymic function, indicating that A) By birth the nervous system plays a role from the beginning of thymic activity. B) By the onset of thymic function C) By adolescence D) By adulthood E) By old age What is the primary function of thymic B) To remove dying thymocytes (Hassall’s) corpuscles? Explanation: Thymic corpuscles are whorls of flattened, concentrically layered cells that perhaps A) To produce antibodies remove dying thymocytes, as indicated by their eosinophilic and partly keratinized centers B) To remove dying thymocytes containing cellular debris. C) To generate red blood cells D) To store fat E) To secrete hormones Which cells form a loose mesh of long B) Cortical epithelial reticular cells cytoplasmic processes in the thymus? Explanation: Cortical epithelial reticular cells form a loose mesh of long cytoplasmic processes, A) Medullary epithelial reticular cells contributing to the structure of the thymus. B) Cortical epithelial reticular cells C) Myoid cells D) Monocytes E) Interdigitating dendritic cells Where are myoid cells primarily located B) Medulla and corticomedullary junction in the thymus? Explanation: Myoid cells are relatively rare and are situated mainly in the medulla and at the A) Cortex corticomedullary junction. B) Medulla and corticomedullary junction Question Answer C) Subcapsular zone D) Blood vessels E) Thymic corpuscles What percentage of cortical thymocytes E) Over 95% die within the thymus? Explanation: Over 95% of cortical thymocytes die within the thymus, with the surviving T cells A) 10% migrating to secondary lymphoid tissues. B) 25% C) 50% D) 75% E) Over 95% What is the role of the blood–thymus B) To protect thymocytes from blood-borne antigens barrier? Explanation: The blood–thymus barrier, formed by sheaths of thymic epithelial reticular cells, lies A) To facilitate the entry of nutrients between the narrow perivascular space of the smaller cortical capillaries and cortical thymocytes, B) To protect thymocytes from protecting them from blood-borne antigens. blood-borne antigens C) To produce thymic hormones D) To store immune cells E) To generate new blood vessels Which cells are densely packed in the C) Cortical thymocytes cortex of the thymus? Explanation: The cortex is densely packed with small cortical thymocytes, which are presumptive T A) Myoid cells cells occupying the interstices of the epithelial reticulum. B) Thymic corpuscles C) Cortical thymocytes D) Monocytes E) Epithelial reticular cells What is the primary origin of thymic C) Bone marrow lymphocytes during later Explanation: During later developmental periods, it is probable that all thymic lymphocytes developmental periods? originate in the bone marrow before passing in the bloodstream to the thymus. A) Yolk sac B) Liver C) Bone marrow D) Spleen E) Lymph nodes What is the typical size of the thymus at C) 4-6 cm long birth? Explanation: At birth, the thymus is most often bilobar and is 4–6 cm long, 2.5–5 cm wide, and 1 cm A) 1-2 cm long thick. B) 2-3 cm long C) 4-6 cm long D) 7-8 cm long E) 9-10 cm long What is the primary function of B) To differentiate into T cells thymocytes in the thymus? Explanation: Thymocytes are precursors to T cells, which are essential for the adaptive immune A) To produce insulin response. They undergo differentiation and maturation in the thymus. B) To differentiate into T cells C) To secrete digestive enzymes D) To store fat E) To produce red blood cells What happens to the thymus as a C) It becomes thinner, greyer, and infiltrated by adipose tissue person ages? Explanation: With age, the thymus undergoes fatty infiltration, becoming thinner and greyer, and A) It increases in size and becomes more is increasingly infiltrated by yellow adipose tissue. vascular B) It remains the same size throughout life C) It becomes thinner, greyer, and infiltrated by adipose tissue D) It becomes more pyramidal in shape and firmer E) It becomes more lobulated and increases in lymphoid tissue Which congenital anomaly of the B) Thymic agenesis thymus is commonly associated with Explanation: Thymic agenesis is commonly associated with DiGeorge syndrome and is thought to DiGeorge syndrome? result from insufficient neural crest cell migration into the third pharyngeal pouch. A) Thymic hypertrophy B) Thymic agenesis C) Thymic cysts D) Accessory thymic bodies E) Undescended thymus Question Answer What is the average mass of the thymus B) 20 g during the first year of life? Explanation: During the first year of life, the mean mass of the thymus remains fairly constant at 20 A) 10 g grams. B) 20 g C) 30 g D) 40 g E) 50 g Which cells are found in the medulla of C) Epithelial reticular cells the thymus? Explanation: The medulla of the thymus contains epithelial reticular cells, which play a role in the A) CD4+ CD8- thymocytes maturation of thymocytes. B) CD4- CD8+ thymocytes C) Epithelial reticular cells D) B cells E) Adipocytes What is the length of the adult C) 20-25 cm oesophagus? Explanation: The adult oesophagus is a muscular tube that is between 20 and 25 cm long. A) 10-15 cm B) 15-20 cm C) 20-25 cm D) 25-30 cm E) 30-35 cm At which vertebral level does the C) C6 oesophagus start in females? Explanation: The oesophagus starts in the neck at the level of the lower border of the cricoid A) C4 cartilage, which corresponds to the body of the sixth cervical vertebra in females. B) C5 C) C6 D) C7 E) T1 Which structure causes a constriction in B) Aortic arch the oesophagus at 23 cm from the Explanation: The oesophagus is constricted at 23 cm from the incisor teeth where it is crossed incisor teeth? anteriorly by the aortic arch. A) Cricopharyngeus muscle B) Aortic arch C) Left main bronchus D) Respiratory diaphragm E) Gastric cardiac orifice What is the narrowest part of the D) Vermiform appendix alimentary tract? Explanation: The vermiform appendix is the narrowest part of the alimentary tract. A) Oesophagus B) Stomach C) Small intestine D) Vermiform appendix E) Large intestine Which hormone is known to induce C) Tri-iodothyronine (T3) hypertrophy of the thymus? Explanation: Tri-iodothyronine (T3), along with prolactin and growth hormone, is known to induce A) Insulin hypertrophy of the thymus. B) Cortisol C) Tri-iodothyronine (T3) D) Adrenaline E) Glucagon What is the primary reason thymectomy A) The thymus is fully developed is less debilitating after puberty? Explanation: By the onset of puberty, the main lymphoid tissues, including the thymus, are fully A) The thymus is fully developed developed, making thymectomy less debilitating. B) The immune system is weaker C) The thymus is smaller D) The thymus is more accessible E) The thymus is less active Which group of patients benefits the C) Myasthenic females with systemic muscular weakness most from thymectomy? Explanation: The most beneficial effects of thymectomy are seen in myasthenic females who A) Elderly patients present with systemic muscular weakness. B) Patients with isolated ocular symptoms C) Myasthenic females with systemic muscular weakness D) Patients with respiratory issues E) Patients with cardiovascular issues What is a common approach for B) Transcervical approach Question Answer performing a thymectomy? Explanation: Thymectomy is commonly performed through a transcervical approach or a A) Laparoscopic approach sternotomy, depending on the size and disposition of the diseased gland. B) Transcervical approach C) Posterior approach D) Lateral approach E) Endoscopic approach Which muscles are separated during the B) Sternothyroid and sternohyoid cervical approach of thymectomy? Explanation: During the cervical approach, the sternothyroid and sternohyoid muscles are A) Sternocleidomastoids separated to identify the superior poles of the thymus. B) Sternothyroid and sternohyoid C) Pectoralis major and minor D) Trapezius and deltoid E) Latissimus dorsi and teres major What is a common anatomical anomaly A) Upper poles of the thymus behind the left brachiocephalic vein that might result in retained thymic Explanation: The most common anomaly is the unanticipated location of the upper poles of the tissue after thymectomy? thymus behind the left brachiocephalic vein. A) Upper poles of the thymus behind the left brachiocephalic vein B) Lower poles of the thymus near the heart C) Thymic tissue in the lungs D) Thymic tissue in the liver E) Thymic tissue in the kidneys What symptoms might thymic tumors A) Hoarseness, cough, dysphagia, and venous engorgement cause due to compression? Explanation: Thymic tumors may compress the trachea, esophagus, and large veins in the neck, A) Hoarseness, cough, dysphagia, and causing hoarseness, cough, dysphagia, and venous engorgement of the head and neck. venous engorgement B) Fever, chills, and night sweats C) Abdominal pain and bloating D) Joint pain and stiffness E) Skin rashes and itching What is myasthenia gravis primarily B) Diminution in power of repetitive contraction in certain voluntary muscles characterized by? Explanation: Myasthenia gravis presents as a diminution in power of repetitive contraction in A) Muscle atrophy certain voluntary muscles, due to autoantibodies attacking acetylcholine receptor proteins at B) Diminution in power of repetitive neuromuscular junctions. contraction in certain voluntary muscles C) Increased muscle tone D) Uncontrolled muscle spasms E) Muscle hypertrophy In children, the length of the C) Height oesophagus is best correlated with Explanation: According to Yang et al. (2005), the length of the oesophagus in children is best which factor? correlated with height. A) Age B) Weight C) Height D) Gender E) Diet Where is the cervical portion of the B) Posterior to the trachea oesophagus located? Explanation: The cervical portion of the oesophagus is located posterior to the trachea, to which it A) Anterior to the trachea is attached by loose connective tissue. B) Posterior to the trachea C) Lateral to the trachea D) Inferior to the trachea E) Superior to the trachea Which structure ascends on each side of C) Recurrent laryngeal nerves the cervical oesophagus? Explanation: The recurrent laryngeal nerves ascend on each side in or near the A) Vagus nerves tracheo-oesophageal groove. B) Phrenic nerves C) Recurrent laryngeal nerves D) Sympathetic trunks E) Hypoglossal nerves Which artery is located laterally to the C) Common carotid artery cervical oesophagus? Explanation: Laterally, on each side of the cervical oesophagus, are the common carotid arteries A) Subclavian artery and the posterior part of the thyroid gland. B) Vertebral artery C) Common carotid artery D) Brachiocephalic artery E) Pulmonary artery Question Answer What is the immediate anterior relation B) Trachea of the thoracic oesophagus as it Explanation: As the thoracic oesophagus descends, its immediate anterior relations successively descends? are the trachea, tracheal bifurcation, right pulmonary artery, left main bronchus, fibrous A) Vertebral column pericardium (separating it from the left atrium), and the respiratory diaphragm. B) Trachea C) Azygos vein D) Thoracic duct E) Descending thoracic aorta Through which structure does the C) Oesophageal hiatus thoracic oesophagus enter the Explanation: The thoracic oesophagus enters the abdomen through the oesophageal hiatus at the abdomen? level of the superior half of the body of the eleventh thoracic vertebra. A) Aortic hiatus B) Caval foramen C) Oesophageal hiatus D) Subclavian artery E) Carina Which vein is related posteriorly to the C) Azygos vein thoracic oesophagus? Explanation: Posteriorly, the thoracic oesophagus is related to the vertebral column, longus colli, A) Inferior vena cava right posterior intercostal arteries, thoracic duct, azygos vein, and the terminal parts of the B) Pulmonary vein hemiazygos and accessory hemiazygos veins. C) Azygos vein D) Subclavian vein E) Jugular vein Which of the following structures is a C) Left subclavian artery left lateral relation of the oesophagus in Explanation: In the superior mediastinum, the left lateral relations of the oesophagus include the the superior mediastinum? terminal part of the aortic arch, left subclavian artery, thoracic duct, left mediastinal parietal A) Right mediastinal parietal pleura pleura, and the left recurrent laryngeal nerve. B) Azygos vein C) Left subclavian artery D) Right vagus nerve E) Inferior thyroid artery What is the main arterial supply to the A) Inferior thyroid artery cervical oesophagus? Explanation: The cervical oesophagus is supplied by the inferior thyroid artery, which is a key A) Inferior thyroid artery source of blood supply to this region. B) Left gastric artery C) Bronchial arteries D) Azygos vein E) Superior vena cava Which vein is primarily responsible for C) Azygos vein draining blood from the thoracic Explanation: Veins from the thoracic oesophagus drain into the superior vena cava predominantly oesophagus? via the azygos venous system. A) Inferior thyroid vein B) Left gastric vein C) Azygos vein D) Superior vena cava E) Hemiazygos vein What anatomical feature allows for the C) Collateral circulation between left gastric and lower oesophageal veins formation of oesophageal varices in Explanation: In portal hypertension, collateral circulation forms between the left gastric and lower portal hypertension? oesophageal veins, leading to the dilation of pre-existing channels and the formation of A) Increased nitric oxide production oesophageal varices. B) Competent valves in perforating vessels C) Collateral circulation between left gastric and lower oesophageal veins D) High compliance of hepatic vasculature E) Decreased vascular tone Which nerve becomes mainly posterior B) Right vagus nerve as it descends in contact with the Explanation: Inferior to the root of the lung, the right vagus nerve becomes mainly posterior as it oesophagus? descends in contact with the oesophagus, while the left vagus nerve is anterior. A) Left recurrent laryngeal nerve B) Right vagus nerve C) Left vagus nerve D) Phrenic nerve E) Thoracic duct Which structure is posterior and to the B) Thoracic duct right of the oesophagus low in the Explanation: Low in the posterior mediastinum, the thoracic duct is posterior and to the right of posterior mediastinum? the oesophagus. Question Answer A) Left subclavian artery B) Thoracic duct C) Azygos vein D) Inferior thyroid artery E) Left recurrent laryngeal nerve Which artery supplies the thoracic C) Bronchial and oesophageal branches of the descending thoracic aorta oesophagus? Explanation: The thoracic oesophagus is supplied by bronchial and oesophageal branches of the A) Inferior thyroid artery descending thoracic aorta. B) Left gastric artery C) Bronchial and oesophageal branches of the descending thoracic aorta D) Superior vena cava E) Azygos vein What is the anatomical basis for A) The close relationship between the oesophagus, the heart, and the thoracic aorta transoesophageal cardiovascular and Explanation: The close anatomical relationship between the oesophagus, the heart, and the aortic ultrasonography? thoracic aorta provides the basis for transoesophageal cardiovascular and aortic ultrasonography. A) The close relationship between the oesophagus, the heart, and the thoracic aorta B) The presence of the azygos vein C) The position of the left subclavian artery D) The location of the thoracic duct E) The proximity of the inferior thyroid artery Which lymph nodes do efferent vessels A) Deep cervical nodes from the cervical oesophagus drain to? Explanation: Efferent vessels from the cervical oesophagus drain to the deep cervical nodes either A) Deep cervical nodes directly or through the paratracheal nodes. B) Thoracic duct C) Subcarinal nodes D) Coeliac trunk nodes E) Right recurrent laryngeal nodes What is the primary nerve supply to the B) Recurrent laryngeal nerve upper oesophagus? Explanation: The upper oesophagus is supplied by the branches of the recurrent laryngeal nerve A) Vagus nerve and by postganglionic sympathetic fibres that travel along the inferior thyroid arteries. B) Recurrent laryngeal nerve C) Phrenic nerve D) Hypoglossal nerve E) Glossopharyngeal nerve What type of muscle is found in the C) Longitudinal smooth muscle muscularis mucosae of the Explanation: The muscularis mucosae is composed mainly of longitudinal smooth muscle and oesophagus? forms a thin sheet near the epithelium. A) Skeletal muscle B) Cardiac muscle C) Longitudinal smooth muscle D) Circular smooth muscle E) Oblique smooth muscle Which nerve fibres innervate the vessels A) Postganglionic fibres from the middle and inferior cervical ganglia of the cervical and upper thoracic Explanation: Vasomotor sympathetic nerve fibres destined for the oesophagus arise from the oesophagus? upper 4–6 thoracic spinal nerves and associated spinal cord segments. Those from the upper A) Postganglionic fibres from the middle thoracic ganglia pass to the middle and inferior cervical ganglia, where they synapse: and inferior cervical ganglia postganglionic fibres innervate the vessels of the cervical and upper thoracic oesophagus. B) Preganglionic fibres from the vagus nerve C) Postganglionic fibres from the coeliac ganglion D) Preganglionic fibres from the phrenic nerve E) Postganglionic fibres from the hypoglossal nerve What is the function of dendritic B) Antigen-processing and antigen-presenting (Langerhans) cells in the oesophageal Explanation: Dendritic (Langerhans) cells in the oesophageal epithelium perform epithelium? antigen-processing and antigen-presenting roles, which are important in immunostimulation of A) Secretion of mucus naïve T cells and mucosal defence. B) Antigen-processing and antigen-presenting C) Contraction of muscle fibers D) Absorption of nutrients E) Production of keratin Question Answer What is the primary role of the B) Protection against mechanical injury during swallowing oesophageal epithelium? Explanation: The oesophageal epithelium is an effective protection against mechanical injury A) Absorption of nutrients during swallowing because of its thickness and the presence of mucus at its surface. B) Protection against mechanical injury during swallowing C) Secretion of digestive enzymes D) Regulation of blood flow E) Production of hormones Which structure contains a mixture of B) Oesophageal plexus parasympathetic and sympathetic Explanation: The lower oesophagus is supplied by the oesophageal plexus, a wide-meshed nerve fibres that supply the lower autonomic network that surrounds the oesophagus below the level of the roots of the lungs, and oesophagus? contains a mixture of parasympathetic and sympathetic nerve fibres. A) Recurrent laryngeal nerve B) Oesophageal plexus C) Phrenic nerve D) Hypoglossal nerve E) Glossopharyngeal nerve What is the role of the submucosa in the C) Loosely connecting the mucosa and the muscularis externa oesophagus? Explanation: The submucosa loosely connects the mucosa and the muscularis externa, A) Absorption of nutrients penetrating the longitudinal ridges of the oesophageal lumen. It contains larger blood vessels, B) Secretion of digestive enzymes nerves, and mucous glands. C) Loosely connecting the mucosa and the muscularis externa D) Regulation of blood flow E) Production of hormones Question Answer What type of muscle is found in the upper C) Skeletal muscle third of the oesophagus? Explanation: The upper third of the oesophagus is formed by skeletal muscle, which is different A) Smooth muscle from the middle and lower thirds that contain smooth muscle. B) Cardiac muscle C) Skeletal muscle D) Mixed muscle E) No muscle Where do true oesophageal diverticula C) In the subdiaphragmatic or parabronchial part of the oesophagus occur? Explanation: True oesophageal diverticula occur in the subdiaphragmatic or parabronchial part A) In the upper third of the oesophagus of the oesophagus, as mentioned in the text. B) In the middle third of the oesophagus C) In the subdiaphragmatic or parabronchial part of the oesophagus D) In the lower third of the oesophagus E) In the anterior wall of the oesophagus What is the main function of the lower B) To regulate the passage of food into the stomach oesophageal sphincter? Explanation: The lower oesophageal sphincter is a specialized zone of circular smooth muscle A) To prevent food from entering the that regulates the passage of food into the stomach by maintaining tonic contraction and trachea relaxing briefly during swallowing. B) To regulate the passage of food into the stomach C) To aid in the digestion of food D) To produce digestive enzymes E) To absorb nutrients What type of muscle is found in the lower C) Smooth muscle third of the oesophagus? Explanation: The lower third of the oesophagus contains only smooth muscle, which is different A) Skeletal muscle from the upper third that contains skeletal muscle and the middle third that contains a mix of B) Cardiac muscle both. C) Smooth muscle D) Mixed muscle E) No muscle What fills the V-shaped space between the C) Circular oesophageal muscle fibers longitudinal muscle fascicles in the Explanation: The V-shaped space between the longitudinal muscle fascicles is filled by the oesophagus? circular oesophageal muscle fibers, which are thinly covered inferiorly by decussating A) Blood vessels longitudinal fibers and superiorly by the cricopharyngeal part of the inferior constrictor. B) Nerve fibers C) Circular oesophageal muscle fibers D) Fat tissue E) Lymphatic vessels What is the primary purpose of C) To examine the oesophagus for abnormalities oesophagoscopy? Explanation: Oesophagoscopy is a component of superior digestive endoscopic examination A) To measure blood pressure used to investigate persistent non-cardiac chest pain, dysphagia, odynophagia, or symptoms of B) To assess the heart's function reflux. C) To examine the oesophagus for abnormalities D) To evaluate kidney function E) To check for brain activity What is a common indication of a hiatus B) Cranial displacement of the Z line by more than 2 cm hernia during an oesophagoscopy? Explanation: During an oesophagoscopy, cranial displacement of the Z line by more than 2 cm is A) Whitish-pink mucosa indicative of a hiatus hernia. B) Cranial displacement of the Z line by more than 2 cm C) Presence of lymph nodes D) Absence of the aortic arch E) Normal echogenic characteristics What is the mortality rate associated with B) 10-15% oesophageal perforations if diagnosed and Explanation: Diagnosis and repair of oesophageal perforations within 24 hours is associated repaired within 24 hours? with a mortality rate of between 10% and 15%. A) 5% B) 10-15% C) 20% D) 25% E) 30% Which imaging technique is more sensitive C) Endoscopic transoesophageal ultrasound than CT in detecting mediastinal nodal Explanation: Endoscopic transoesophageal ultrasound is more sensitive than CT in detecting metastases? mediastinal nodal metastases, allowing for the assessment of nodes less than 10 mm in size. A) MRI B) PET scan C) Endoscopic transoesophageal ultrasound D) X-ray E) Fluoroscopy Question Answer What is the most common cause of C) Iatrogenic during instrumentation oesophageal ruptures? Explanation: The majority of oesophageal ruptures are iatrogenic and occur during the A) Trauma instrumentation of the oesophagus during procedures such as simple endoscopy. B) Infection C) Iatrogenic during instrumentation D) Cancer E) Congenital defects What is the significance of a hypoechoic or B) It suggests the presence of malignancy inhomogeneous echo portrayal on Explanation: A hypoechoic or inhomogeneous echo portrayal on endoscopic ultrasound is endoscopic ultrasound? considered more suspicious of malignancy. A) It indicates normal tissue B) It suggests the presence of malignancy C) It shows the presence of air D) It confirms the absence of lymph nodes E) It indicates a healthy oesophagus What is the purpose of a double-contrast B) To assess the oesophagus anatomically and functionally barium swallow with fluoroscopy? Explanation: A double-contrast barium swallow with fluoroscopy enables anatomical and A) To measure blood sugar levels functional assessment of the oesophagus, helping to evaluate constrictions, motor dysfunction, B) To assess the oesophagus anatomically varices, and gastro-oesophageal reflux. and functionally C) To evaluate liver function D) To check for brain tumors E) To measure lung capacity What is the typical appearance of the B) Whitish-pink oesophageal mucosa during an Explanation: The mucosa of the oesophagus normally appears whitish-pink in color during an oesophagoscopy? oesophagoscopy. A) Blue B) Whitish-pink C) Yellow D) Green E) Black What is the role of endoscopic B) To diagnose para-oesophageal nodes ultrasound-guided fine needle aspiration? Explanation: Endoscopic ultrasound-guided fine needle aspiration allows accurate diagnosis for A) To measure blood pressure para-oesophageal nodes. B) To diagnose para-oesophageal nodes C) To evaluate kidney function D) To check for brain activity E) To assess liver enzymes What is the most common location for B) Thoracic oesophagus oesophageal perforations? Explanation: The majority of oesophageal perforations occur in the thoracic oesophagus, A) Cervical oesophagus accounting for 60% of cases. B) Thoracic oesophagus C) Abdominal oesophagus D) Upper oesophagus E) Lower oesophagus Which muscle is involved in the relaxation B) Diaphragmatic muscle during the initial phase of vomiting? Explanation: During the initial phase of vomiting, the lower oesophageal sphincter and A) Cricopharyngeus peri-oesophageal crural muscle fibres relax, and rapid diaphragmatic and abdominal muscular B) Diaphragmatic muscle contraction commences, increasing intra-abdominal pressure. C) Broncho-oesophageal muscle D) Circular muscle layer E) Longitudinal muscle layer What is a primary motor disorder of the B) Achalasia oesophagus characterized by failure of Explanation: Achalasia is a primary motor disorder of the oesophagus in which there is failure of relaxation of the lower oesophageal relaxation of the lower oesophageal sphincter and loss of peristalsis in the oesophagus due to sphincter? degeneration of myenteric plexus neurones. A) Hiatus hernia B) Achalasia C) Gastro-oesophageal reflux disease D) Oesophageal atresia E) Dysphagia Which diagnostic technique shows a B) Barium swallow 'bird-beak' appearance in achalasia? Explanation: A barium swallow shows a classic 'bird-beak' appearance in achalasia due to the A) Chest radiograph failure of relaxation of the lower oesophageal sphincter and absence of peristalsis. B) Barium swallow C) Oesophageal manometry D) Endoscopy E) MRI Question Answer What is the function of the A) To aid in swallowing cricopharyngeus part of the inferior Explanation: The cricopharyngeus part of the inferior pharyngeal constrictor is involved in the pharyngeal constrictor? swallowing process, particularly in the relaxation phase to allow the passage of food. A) To aid in swallowing B) To prevent gastro-oesophageal reflux C) To increase intra-abdominal pressure D) To relax during vomiting E) To attach to the cricoid cartilage Which condition is associated with lower A) Hiatus hernia oesophageal sphincter dysfunction and Explanation: Hiatus hernia is associated with lower oesophageal sphincter dysfunction and failure of the respiratory diaphragmatic failure of the respiratory diaphragmatic component, contributing to gastro-oesophageal reflux. component? A) Hiatus hernia B) Achalasia C) Oesophageal atresia D) Dysphagia E) Gastro-oesophageal reflux disease What characterizes a 'corkscrew B) Simultaneous segmental contractions oesophagus' on a barium swallow? Explanation: A 'corkscrew oesophagus' is characterized by simultaneous segmental A) Normal peristalsis contractions that obliterate the oesophageal lumen, as seen on a barium swallow. B) Simultaneous segmental contractions C) Absence of contractions D) Continuous relaxation E) Irregular dilation What is a common feature of non-specific B) Decreased or absent peristalsis oesophageal motility disorder in the Explanation: Non-specific oesophageal motility disorder in the elderly, also known as elderly? presbyoesophagus, is characterized by decreased or even absent peristalsis after swallowing. A) Increased peristalsis B) Decreased or absent peristalsis C) Continuous relaxation of the lower oesophageal sphincter D) Increased incidence of normal peristalsis E) Enhanced oesophageal contractions Which condition is associated with C) Scleroderma oesophageal dysmotility due to atrophic Explanation: Oesophageal dysmotility is seen in scleroderma and other connective tissue smooth muscle being replaced by fibrous diseases where atrophic smooth muscle is replaced by fibrous tissue in the submucosa and tissue? lamina propria. A) Gastro-oesophageal reflux disease B) Hiatus hernia C) Scleroderma D) Peptic ulcer disease E) Barrett's oesophagus Which imaging techniques are used to B) X-ray, CT, and MRI view mediastinal structures? Explanation: Mediastinal structures may be viewed using X-ray, CT, and MRI, which are common A) Ultrasound and PET scan imaging techniques for this purpose. B) X-ray, CT, and MRI C) Endoscopy and colonoscopy D) Mammography and DEXA scan E) Fluoroscopy and angiography What is the 'thymic sail sign' seen in B) An opaque rightward triangular extension pediatric chest radiographs? Explanation: In pediatric patients, the right lobe of the thymus can show as an opaque A) An opaque leftward triangular extension rightward triangular extension, known as the 'thymic sail sign'. B) An opaque rightward triangular extension C) A clear rightward triangular extension D) A clear leftward triangular extension E) A circular opaque area What does the azygo-oesophageal line B) The medial border of the right lung represent on a chest radiograph? Explanation: The azygo-oesophageal line represents the medial border of the right lung in the A) The medial border of the left lung azygo-oesophageal recess. B) The medial border of the right lung C) The lateral border of the heart D) The superior border of the diaphragm E) The inferior border of the trachea What anatomical structure is directly C) Oesophagus posterior to the trachea? Explanation: The oesophagus is directly posterior to the trachea, as mentioned in the provided A) Aortic arch text. Question Answer B) Left main bronchus C) Oesophagus D) Right atrium E) Superior vena cava What is the significance of the retrosternal B) Its absence raises suspicion of a superior mediastinal tumour or lymphadenopathy lung in a lateral radiograph? Explanation: The absence of the retrosternal lung in a lateral radiograph raises a strong A) It indicates the presence of a heart suspicion of a superior mediastinal tumour or lymphadenopathy. condition B) Its absence raises suspicion of a superior mediastinal tumour or lymphadenopathy C) It confirms normal lung function D) It shows the position of the diaphragm E) It helps in identifying the aortic arch Which imaging technique provides C) CT excellent mediastinal delineation? Explanation: CT provides excellent mediastinal delineation, especially with intravenous contrast A) X-ray enhancement. B) Ultrasound C) CT D) PET scan E) Mammography What is the location of the subaortic node A) Between the aortic arch superiorly and the left pulmonary artery inferiorly station? Explanation: The subaortic node station is located between the aortic arch superiorly and the A) Between the aortic arch superiorly and left pulmonary artery inferiorly. the left pulmonary artery inferiorly B) Between the right lung and the trachea C) Between the left lung and the trachea D) Between the diaphragm and the vertebral bodies E) Between the superior vena cava and the right brachiocephalic vein What anatomical feature is visible as an B) Brachiocephalic veins extrapleural bulge directly posterior to the Explanation: The brachiocephalic veins are visible as an extrapleural bulge directly posterior to manubrium? the manubrium. A) Aortic arch B) Brachiocephalic veins C) Left atrium D) Right ventricle E) Respiratory diaphragm Which space is bordered by the trachea B) Pretracheal space posteriorly and the superior vena cava and Explanation: The pretracheal space is bordered by the trachea posteriorly and the superior vena right brachiocephalic vein anteriorly? cava and right brachiocephalic vein anteriorly. A) Subcarinal space B) Pretracheal space C) Posterior tracheal space D) Azygo-oesophageal recess E) Retrocrural space What anatomical structure is located in C) Descending thoracic aorta the retrocrural space? Explanation: The retrocrural space is traversed by the descending thoracic aorta, among other A) Left atrium structures. B) Right ventricle C) Descending thoracic aorta D) Superior vena cava E) Left pulmonary artery At the level of the first costochondral C) Oesophagus junction, which structure is labeled as '9' Explanation: In the axial CT thoracic section at the level of the first costochondral junction, the in the axial CT thoracic section? oesophagus is labeled as '9'. A) Trachea B) Scapula C) Oesophagus D) Left subclavian artery E) Right brachiocephalic vein Which structure is labeled as '6' at the level C) Left subclavian artery arising from brachiocephalic trunk of the vertebral body of T3 in the axial CT Explanation: At the level of the vertebral body of T3, the left subclavian artery arising from the thoracic section? brachiocephalic trunk (a normal variant) is labeled as '6'. A) Superior vena cava formation B) Pretracheal space C) Left subclavian artery arising from Question Answer brachiocephalic trunk D) Trachea E) Oesophagus At the level of the vertebral body of T4, D) Aortic arch which structure is labeled as '5'? Explanation: In the axial CT thoracic section at the level of the vertebral body of T4, the aortic A) Superior vena cava arch is labeled as '5'. B) Pretracheal space C) Trachea D) Aortic arch E) Oesophagus Which structure is labeled as '11' at the D) Inferior branch of the left pulmonary artery level of the vertebral body of T6 in the axial Explanation: At the level of the vertebral body of T6, the inferior branch of the left pulmonary CT thoracic section? artery is labeled as '11'. A) Right main bronchus B) Subcarinal space C) Left main bronchus D) Inferior branch of the left pulmonary artery E) Ascending aorta At the level of the vertebral body of T7, C) Oesophagus which structure is labeled as '3'? Explanation: In the axial CT thoracic section at the level of the vertebral body of T7, the A) Aortic root oesophagus is labeled as '3'. B) Left atrium C) Oesophagus D) Azygos vein E) Right ventricular outflow tract In a coronal thoracic CT section, which B) Right brachiocephalic vein structure is identified as '1' in Key A? Explanation: In Key A of the coronal thoracic CT section, '1' is identified as the right A) Left brachiocephalic vein brachiocephalic vein. B) Right brachiocephalic vein C) Pulmonary trunk D) Ascending aorta E) Left ventricle Which structure is labeled as '3' in Key C of C) Aortic arch the coronal thoracic CT section? Explanation: In Key C of the coronal thoracic CT section, '3' is identified as the aortic arch. A) Brachiocephalic trunk B) Left common carotid artery C) Aortic arch D) Superior vena cava E) Pulmonary trunk In Key D of the coronal thoracic CT section, D) Right pulmonary artery what is the structure labeled as '5'? Explanation: In Key D of the coronal thoracic CT section, '5' is identified as the right pulmonary A) Right subclavian artery artery. B) Trachea C) Aortic arch D) Right pulmonary artery E) Left superior pulmonary vein Which structure is labeled as '6' in Key E of E) Descending thoracic aorta the coronal thoracic CT section? Explanation: In Key E of the coronal thoracic CT section, '6' is identified as the descending A) Left subclavian artery thoracic aorta. B) Trachea C) Aortic arch D) Left pulmonary artery E) Descending thoracic aorta In Key B of the coronal thoracic CT section A) Horizontal fissure with lung window settings, what Explanation: In Key B of the coronal thoracic CT section with lung window settings, the anatomical feature is highlighted by horizontal fissure is highlighted by arrows. arrows? A) Horizontal fissure B) Oblique fissure C) Right atrium D) Left ventricle E) Pulmonary trunk What is the significance of 'Kuntz’s B) They join the first thoracic spinal nerve without passing through the stellate ganglion nerves' in relation to the sympathetic Explanation: 'Kuntz’s nerves' are intrathoracic somatic branches from the second thoracic blockade of the upper extremities? spinal nerve that join the first thoracic spinal nerve without passing through the stellate A) They pass through the stellate ganglion ganglion, explaining the incomplete sympathetic blockade of the upper extremities in stellate Question Answer B) They join the first thoracic spinal nerve ganglion blockade. without passing through the stellate ganglion C) They are part of the lumbar plexus D) They are responsible for motor control of the upper extremities E) They are found in the lower extremities What is the main focus of the IASLC lung B) Standardized grouping of lymph node stations into 'zones' cancer staging project proposed in 2009? Explanation: The IASLC lung cancer staging project proposed a standardized grouping of lymph A) Development of new chemotherapy node stations into 'zones' for consistency and future survival analyses. drugs B) Standardized grouping of lymph node stations into 'zones' C) Identification of new lung cancer biomarkers D) Introduction of new surgical techniques E) Development of a new imaging technology What anatomical structures are described B) Venous drainage of the posterior body wall in Loukas and Tubbs' 2016 work on venous Explanation: Loukas and Tubbs' 2016 work provides a description of the normal anatomy of the drainage? venous drainage of the posterior body wall, including variations and developmental anomalies. A) Arterial supply of the brain B) Venous drainage of the posterior body wall C) Lymphatic drainage of the lower limbs D) Musculature of the thoracic cavity E) Nervous system of the upper extremities What does the 2018 study by Wang et al. B) Lymphatic drainage and lymph node metastasis of thoracic esophageal cancer focus on regarding the oesophagus? Explanation: The 2018 study by Wang et al. reviews the various routes of lymphatic drainage of A) Blood supply to the oesophagus the oesophagus and lymph node metastasis rates to specific node groups. B) Lymphatic drainage and lymph node metastasis of thoracic esophageal cancer C) Muscular structure of the oesophagus D) Innervation of the oesophagus E) Developmental anomalies of the oesophagus What is discussed in the 2005 article by B) Radiographic and endoscopic measurements of esophageal length Yang et al. regarding pediatric patients? Explanation: The 2005 article by Yang et al. discusses the intersphincteric length of the A) Blood pressure variations oesophagus in a pediatric population, which best correlated with patient height and correlated B) Radiographic and endoscopic less well with weight and age. measurements of esophageal length C) Heart rate variability D) Lung capacity measurements E) Bone density analysis What is the primary focus of the study by B) The pleuro-esophageal muscle Bilge O, Celik S, and Aktug H. in 2013? Explanation: The study by Bilge O, Celik S, and Aktug H. in 2013 focuses on the A) The anatomy of the thymus in human pleuro-esophageal muscle, which is described as a disregarded anatomical structure. fetuses B) The pleuro-esophageal muscle C) The TNM classification of lung cancer D) Variations in the upper thoracic sympathetic trunk E) Lymphangiography in chyle leaks What anatomical variations are discussed B) Variations in the rami communicantes in the upper thoracic sympathetic trunk by Cho HM, Lee DY, and Sung SW in their Explanation: The study by Cho HM, Lee DY, and Sung SW in 2005 discusses anatomical variations 2005 study? of the rami communicantes in the upper thoracic sympathetic trunk. A) Variations in the thymus size B) Variations in the rami communicantes in the upper thoracic sympathetic trunk C) Variations in the cardiac nervous system D) Variations in the lymphatic drainage of the esophagus E) Variations in the azygos and hemiazygos veins What is the main subject of the study by B) The lymphatic drainage of the esophagus and lymph node metastasis Wang Y, Zhu L, Xia W et al. in 2018? Explanation: The study by Wang Y, Zhu L, Xia W et al. in 2018 reviews the various routes of A) The anatomy of the cardiac nervous lymphatic drainage of the esophagus and lymph node metastasis rates to specific node groups. system B) The lymphatic drainage of the esophagus and lymph node metastasis Question Answer C) The thymus size and child mortality D) The anatomy of the azygos and hemiazygos veins E) The variations in the upper thoracic sympathetic trunk What does the study by Yang GS, Bishop B) The intersphincteric length of the esophagus in pediatric patients WP, Smith BJ et al. in 2005 discuss? Explanation: The study by Yang GS, Bishop WP, Smith BJ et al. in 2005 discusses the A) The anatomy of the thymus in children intersphincteric length of the esophagus in a pediatric population, which best correlated with B) The intersphincteric length of the patient height. esophagus in pediatric patients C) The anatomy of the cardiac nervous system D) The variations in the upper thoracic sympathetic trunk E) The lymphatic drainage of the esophagus What is the focus of the study by Watanabe B) The anatomy of the esophagus and its variations K in 2016? Explanation: The study by Watanabe K in 2016 describes the esophagus, its development, and A) The anatomy of the thymus the acquired or congenital anomalies that can affect the organ, including variations in B) The anatomy of the esophagus and its esophageal musculature. variations C) The lymphatic drainage of the esophagus D) The variations in the upper thoracic sympathetic trunk E) The anatomy of the cardiac nervous system