HILLEGASS: ESSENTIALS OF CARDIOPULMONARY PHYSICAL F F F F
THERAPY, 4TH EDITION
F F F
Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems Test
f f f f f f f f f
f Bank
MULTIPLE CHOICE f
1. Which of the following chest wall structures is located level with the second costal cartilage
f f f f f f f f f f f f f f
anteriorly and thoracic vertebra T4 and T5 posteriorly?
f f f f f f f f
A. Sternal angle f
B. Jugular notch f
C. Xiphoid process f
D. Third costal cartilage f f
ANS: A f f
The sternal angle of the “angle of Louis” is level with the second costal cartilage anteriorly and
f f f f f f f f f f f f f f f f
thoracic vertebrae T4 and T5 posteriorly.
f f f f f f
PTS: 1
2. Pectus excuvatum is BEST described as:
f f f f f
A. Deformity of the sternum caused by trauma f f f f f f
B. Caved-in appearance of the chest f f f f
C. Diminished rib angle anteriorly f f f
D. Conical shape of the thoracic cage f f f f f
ANS: B f f
Pectus excuvatum is a common congenital deformity of the anterior wall of the chest, in which
f f f f f f f f f f f f f f f
several ribs and the sternum grow abnormally; it produces a caved-in or sunken appearance of
f f f f f f f f f f f f f f f
the chest.
f f
PTS: 1
3. The true ribs are BEST defined by which of the following statements?
f f f f f f f f f f f
A. Vertebrochondral ribs f
B. Vertebrosternal ribs f
C. Ribs 11 and 12 f f f
D. Ribs 8, 9, and 10 f f f f
ANS: B f f
The first seven ribs attach via their costal cartilages to the sternum and are called the true ribs (also
f f f f f f f f f f f f f f f f f f
known as the vertebrosternal ribs).
f f f f f
PTS: 1
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
f f f f f f f f f f
, Test Bank f 1-2
4. Which of the following interventions is MOST appropriate for a patient with lower rib fractures?
f f f f f f f f f f f f f f
A. Short, shallow breaths f f
B. Pursed lip breathing f f
C. Deep breaths with splinting f f f
D. Breathing with arms raised f f f
ANS: C f f
It is important for all therapists to recommend breathing (deep breathing), splinting (i.e., pillow),
f f f f f f f f f f f f f
and coughing strategies for patients with rib fractures.
f f f f f f f f
PTS: 1
5. Which of the following positions facilitates greater excursion of both hemidiaphragms at rest?
f f f f f f f f f f f f
A. Supine position f
B. Sidelying position f
C. Standing position f
D. Sitting position f
ANS: A f f
In the supine position, without the effects of gravity, the level of the diaphragm in the thoracic cavity
f f f f f f f f f f f f f f f f f
rises. This allows for a relatively greater excursion.
f f f f f f f f
PTS: 1
6. Which of the following muscles help to achieve the active process of inspiration at rest?
f f f f f f f f f f f f f f
A. Sternocleidomastoid
B. Diaphragm
C. Abdominal muscles f
D. Trapezius
ANS: B f f
The diaphragm and internal intercostals (intercartilaginous portion) are the essential muscles to
f f f f f f f f f f f
achieve the active process of inspiration at rest. Abdominal muscles assist with expiration. The
f f f f f f f f f f f f f f
sternocleidomastoid and trapezius are accessory muscles and assist with a more forceful
f f f f f f f f f f f f
inspiration.
f
PTS: 1
7. Which of the following accessory muscles of ventilation function to elevate and fix the first and
f f f f f f f f f f f f f f f
second ribs?
f f
A. Sternocleidomastoid muscle f
B. Serratus anterior f
C. Latissimus dorsi f
D. Scalene muscle f
fANS: D f
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
f f f f f f f f f f
, Test Bank f 1-3
The scalene muscles lie deep to the sternocleidomastoid, but may be palpated in the posterior
f f f f f f f f f f f f f f
triangle of the neck. These muscles function as a unit to elevate and fix the first and second ribs. The
f f f f f f f f f f f f f f f f f f f f
sternocleidomastoid muscle elevates the sternum.
f f f f f
PTS: 1
8. When the arms and shoulders are fixed, by leaning on the elbows or grasping onto a table, this
f f f f f f f f f f f f f f f f f
muscle can use its insertion as its origin and facilitate an increase in the A-P diameter of the
f f f f f f f f f f f f f f f f f f
thorax.
f
A. Upper trapezius f
B. Pectoralis major f
C. Sternocleidomastoid
D. Serratus anterior f
ANS: B f f
When the insertion and origin of the pectoralis muscle are reversed by leaning on a table to fix
f f f f f f f f f f f f f f f f f
the arms, the muscle will pull on the anterior chest wall, lifting the ribs and sternum to increase
f f f f f f f f f f f f f f f f f f
the A-P diameter of the thoracic cage.
f f f f f f f
PTS: 1
9. The serous fluid within the pleural space serves to provide which of the following functions?
f f f f f f f f f f f f f f
A. Create a constant negative pressure f f f f
B. Assist with venous return of blood to the heart
f f f f f f f f
C. Reduce friction between the lungs and thoracic wall f f f f f f f
D. Serve to allow separation of the pleural layers
f f f f f f f
ANS: C f f
The serous fluid within the pleural space serves to hold the pleural layers together during
f f f f f f f f f f f f f f
ventilation and reduce friction between the lungs and the thoracic wall. The space creates the
f f f f f f f f f f f f f f f
negative pressure to maintain lung inflation, not the fluid itself.
f f f f f f f f f f
PTS: 1
10. Irritation of the phrenic supplied pleura results in which of the following pain referral patterns?
f f f f f f f f f f f f f f
A. Thoracic wall f
B. Abdominal wall f
C. Mediasternal region f
D. Lower neck and shoulder f f f
ANS: D f f
Irritation of the phrenic supplied pleura can result in referred pain in the lower neck and shoulder,
f f f f f f f f f f f f f f f f
whereas, irritation of the intercostally innervated pleura may result in referral of pain to the thoracic
f f f f f f f f f f f f f f f f
or abdominal wall.
f f f
PTS: 1
11. An abnormal pleural friction rub on auscultation BEST indicates which of the following?
f f f f f f f f f f f f
A. Infection with a resultant inflammatory response within the pleura f f f f f f f f
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
f f f f f f f f f f
, Test Bank f 1-4
B. A buildup of fluid in the pleural space following cardiothoracic surgery
f f f f f f f f f f
C. The presence of blood in the pleural space
f f f f f f f
D. A bacterial infection with resultant pus in the pleural space
f f f f f f f f f
ANS: A f f
Infection with a resultant inflammatory response within the pleura is termed pleuritis or pleurisy
f f f f f f f f f f f f f
and is best appreciated through the presence of pleural chest pain and an abnormal pleural friction
f f f f f f f f f f f f f f f f
rub on auscultation. A buildup of fluid, blood, or air in the space would result in diminished or
f f f f f f f f f f f f f f f f f f
absent breath sounds in the area.
f f f f f f
PTS: 1
12. The presence of four segments (anterior basal, superior basal, lateral basal, posterior basal)
f f f f f f f f f f f f
BEST describes which of the following lobes?
f f f f f f f
A. Right upper lobe f f
B. Left upper lobe f f
C. Right middle lobe f f
D. Right lower lobe f f
ANS: D f f
The lowermost lobe, the right lower lobe, consist of four segments (anterior basal, superior basal,
f f f f f f f f f f f f f f
lateral basal, posterior basal).
f f f f
PTS: 1
13. The physical therapist performs auscultation of the lateral portion of right middle lobe. Which of
f f f f f f f f f f f f f f
the following stethoscope locations BEST identifies this lung segment?
f f f f f f f f f
A. Adjacent to the 5th rib lateral right chest wall f f f f f f f f
B. Adjacent to 3rd–5th rib posterior right chest wall f f f f f f f
C. Adjacent to the 4th rib lateral right chest wall f f f f f f f f
D. Adjacent to the 8th thoracic vertebra lateral chest wall
f f f f f f f f
ANS: A f f
The right middle lobe is subdivided into the lateral and medial lobes. This lobe is the smallest of the
f f f f f f f f f f f f f f f f f f
three lobes. Its inferior border is adjacent to the fifth rib laterally and sixth rib medially.
f f f f f f f f f f f f f f f f
PTS: 1
14. The BEST reason why a physical therapist should acquire an understanding of the various lobes
f f f f f f f f f f f f f f
and segments and their anatomical orientation is which of the following?
f f f f f f f f f f f
A. Provide tactile feedback for segmental breathing
f f f f f
B. Placement of a stethoscope for auscultation f f f f f
C. Perform appropriate positioning during pulmonary hygiene
f f f f f
D. Educate patients on best positioning during coughing
f f f f f f
ANS: C
f f
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.f f f f f f f f f f
THERAPY, 4TH EDITION
F F F
Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems Test
f f f f f f f f f
f Bank
MULTIPLE CHOICE f
1. Which of the following chest wall structures is located level with the second costal cartilage
f f f f f f f f f f f f f f
anteriorly and thoracic vertebra T4 and T5 posteriorly?
f f f f f f f f
A. Sternal angle f
B. Jugular notch f
C. Xiphoid process f
D. Third costal cartilage f f
ANS: A f f
The sternal angle of the “angle of Louis” is level with the second costal cartilage anteriorly and
f f f f f f f f f f f f f f f f
thoracic vertebrae T4 and T5 posteriorly.
f f f f f f
PTS: 1
2. Pectus excuvatum is BEST described as:
f f f f f
A. Deformity of the sternum caused by trauma f f f f f f
B. Caved-in appearance of the chest f f f f
C. Diminished rib angle anteriorly f f f
D. Conical shape of the thoracic cage f f f f f
ANS: B f f
Pectus excuvatum is a common congenital deformity of the anterior wall of the chest, in which
f f f f f f f f f f f f f f f
several ribs and the sternum grow abnormally; it produces a caved-in or sunken appearance of
f f f f f f f f f f f f f f f
the chest.
f f
PTS: 1
3. The true ribs are BEST defined by which of the following statements?
f f f f f f f f f f f
A. Vertebrochondral ribs f
B. Vertebrosternal ribs f
C. Ribs 11 and 12 f f f
D. Ribs 8, 9, and 10 f f f f
ANS: B f f
The first seven ribs attach via their costal cartilages to the sternum and are called the true ribs (also
f f f f f f f f f f f f f f f f f f
known as the vertebrosternal ribs).
f f f f f
PTS: 1
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
f f f f f f f f f f
, Test Bank f 1-2
4. Which of the following interventions is MOST appropriate for a patient with lower rib fractures?
f f f f f f f f f f f f f f
A. Short, shallow breaths f f
B. Pursed lip breathing f f
C. Deep breaths with splinting f f f
D. Breathing with arms raised f f f
ANS: C f f
It is important for all therapists to recommend breathing (deep breathing), splinting (i.e., pillow),
f f f f f f f f f f f f f
and coughing strategies for patients with rib fractures.
f f f f f f f f
PTS: 1
5. Which of the following positions facilitates greater excursion of both hemidiaphragms at rest?
f f f f f f f f f f f f
A. Supine position f
B. Sidelying position f
C. Standing position f
D. Sitting position f
ANS: A f f
In the supine position, without the effects of gravity, the level of the diaphragm in the thoracic cavity
f f f f f f f f f f f f f f f f f
rises. This allows for a relatively greater excursion.
f f f f f f f f
PTS: 1
6. Which of the following muscles help to achieve the active process of inspiration at rest?
f f f f f f f f f f f f f f
A. Sternocleidomastoid
B. Diaphragm
C. Abdominal muscles f
D. Trapezius
ANS: B f f
The diaphragm and internal intercostals (intercartilaginous portion) are the essential muscles to
f f f f f f f f f f f
achieve the active process of inspiration at rest. Abdominal muscles assist with expiration. The
f f f f f f f f f f f f f f
sternocleidomastoid and trapezius are accessory muscles and assist with a more forceful
f f f f f f f f f f f f
inspiration.
f
PTS: 1
7. Which of the following accessory muscles of ventilation function to elevate and fix the first and
f f f f f f f f f f f f f f f
second ribs?
f f
A. Sternocleidomastoid muscle f
B. Serratus anterior f
C. Latissimus dorsi f
D. Scalene muscle f
fANS: D f
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
f f f f f f f f f f
, Test Bank f 1-3
The scalene muscles lie deep to the sternocleidomastoid, but may be palpated in the posterior
f f f f f f f f f f f f f f
triangle of the neck. These muscles function as a unit to elevate and fix the first and second ribs. The
f f f f f f f f f f f f f f f f f f f f
sternocleidomastoid muscle elevates the sternum.
f f f f f
PTS: 1
8. When the arms and shoulders are fixed, by leaning on the elbows or grasping onto a table, this
f f f f f f f f f f f f f f f f f
muscle can use its insertion as its origin and facilitate an increase in the A-P diameter of the
f f f f f f f f f f f f f f f f f f
thorax.
f
A. Upper trapezius f
B. Pectoralis major f
C. Sternocleidomastoid
D. Serratus anterior f
ANS: B f f
When the insertion and origin of the pectoralis muscle are reversed by leaning on a table to fix
f f f f f f f f f f f f f f f f f
the arms, the muscle will pull on the anterior chest wall, lifting the ribs and sternum to increase
f f f f f f f f f f f f f f f f f f
the A-P diameter of the thoracic cage.
f f f f f f f
PTS: 1
9. The serous fluid within the pleural space serves to provide which of the following functions?
f f f f f f f f f f f f f f
A. Create a constant negative pressure f f f f
B. Assist with venous return of blood to the heart
f f f f f f f f
C. Reduce friction between the lungs and thoracic wall f f f f f f f
D. Serve to allow separation of the pleural layers
f f f f f f f
ANS: C f f
The serous fluid within the pleural space serves to hold the pleural layers together during
f f f f f f f f f f f f f f
ventilation and reduce friction between the lungs and the thoracic wall. The space creates the
f f f f f f f f f f f f f f f
negative pressure to maintain lung inflation, not the fluid itself.
f f f f f f f f f f
PTS: 1
10. Irritation of the phrenic supplied pleura results in which of the following pain referral patterns?
f f f f f f f f f f f f f f
A. Thoracic wall f
B. Abdominal wall f
C. Mediasternal region f
D. Lower neck and shoulder f f f
ANS: D f f
Irritation of the phrenic supplied pleura can result in referred pain in the lower neck and shoulder,
f f f f f f f f f f f f f f f f
whereas, irritation of the intercostally innervated pleura may result in referral of pain to the thoracic
f f f f f f f f f f f f f f f f
or abdominal wall.
f f f
PTS: 1
11. An abnormal pleural friction rub on auscultation BEST indicates which of the following?
f f f f f f f f f f f f
A. Infection with a resultant inflammatory response within the pleura f f f f f f f f
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.
f f f f f f f f f f
, Test Bank f 1-4
B. A buildup of fluid in the pleural space following cardiothoracic surgery
f f f f f f f f f f
C. The presence of blood in the pleural space
f f f f f f f
D. A bacterial infection with resultant pus in the pleural space
f f f f f f f f f
ANS: A f f
Infection with a resultant inflammatory response within the pleura is termed pleuritis or pleurisy
f f f f f f f f f f f f f
and is best appreciated through the presence of pleural chest pain and an abnormal pleural friction
f f f f f f f f f f f f f f f f
rub on auscultation. A buildup of fluid, blood, or air in the space would result in diminished or
f f f f f f f f f f f f f f f f f f
absent breath sounds in the area.
f f f f f f
PTS: 1
12. The presence of four segments (anterior basal, superior basal, lateral basal, posterior basal)
f f f f f f f f f f f f
BEST describes which of the following lobes?
f f f f f f f
A. Right upper lobe f f
B. Left upper lobe f f
C. Right middle lobe f f
D. Right lower lobe f f
ANS: D f f
The lowermost lobe, the right lower lobe, consist of four segments (anterior basal, superior basal,
f f f f f f f f f f f f f f
lateral basal, posterior basal).
f f f f
PTS: 1
13. The physical therapist performs auscultation of the lateral portion of right middle lobe. Which of
f f f f f f f f f f f f f f
the following stethoscope locations BEST identifies this lung segment?
f f f f f f f f f
A. Adjacent to the 5th rib lateral right chest wall f f f f f f f f
B. Adjacent to 3rd–5th rib posterior right chest wall f f f f f f f
C. Adjacent to the 4th rib lateral right chest wall f f f f f f f f
D. Adjacent to the 8th thoracic vertebra lateral chest wall
f f f f f f f f
ANS: A f f
The right middle lobe is subdivided into the lateral and medial lobes. This lobe is the smallest of the
f f f f f f f f f f f f f f f f f f
three lobes. Its inferior border is adjacent to the fifth rib laterally and sixth rib medially.
f f f f f f f f f f f f f f f f
PTS: 1
14. The BEST reason why a physical therapist should acquire an understanding of the various lobes
f f f f f f f f f f f f f f
and segments and their anatomical orientation is which of the following?
f f f f f f f f f f f
A. Provide tactile feedback for segmental breathing
f f f f f
B. Placement of a stethoscope for auscultation f f f f f
C. Perform appropriate positioning during pulmonary hygiene
f f f f f
D. Educate patients on best positioning during coughing
f f f f f f
ANS: C
f f
Copyright ©2011, 2001, 1994 by Saunders, an imprint of Elsevier Inc.f f f f f f f f f f
