337.An elderly woman visits the hospital emergency room with the recent
onset of grotesque swelling of the right arm, neck, and face. Her right jugu-
lar vein is visibly engorged and her right brachial pulse is diminished. On
the basis of these signs, her chest x-rays might show which of the following?
a. A left cervical rib
b. A mass in the upper lobe of the right lung
c. Aneurysm of the aortic arch
d. Right pneumothorax
e. Thoracic duct blockage in the posterior mediastinum
338.A 3-year-old child suspected of aspirating a small, cloth-covered
metal button is seen in the emergency room. Although the child does not
complain of pain, there is frequent coughing. Diminished breath sounds
are most likely to be heard in which of the following?
a. In both lungs
b. In the lingula of the left inferior lobe
c. In the right inferior lobe
d. In the left superior lobe
e. In the right superior lobe
339.A 58-year-old man comes into your emergency room with difficulty
breathing. He also reports some left side chest pain and points to the inferior
portion of his ribs. You listen to his lung sounds and there seems to be
reduced breath sounds in the inferior half of his left plural cavity. Both PA and
lateral chest films confirm what is likely fluid in the inferior 1/3 of the left
pleural space. There were noobvious rib fractures. You wish to determine the
nature of the fluid accumulating in the left pleural cavity, since that will dic-
tate the appropriate treatment. What structures will your 19 g needle pene-
trate as you pass from skin to fluid at the midaxillary line below the sixth rib?
a. Skin, subcutaneous tissue, external intercostal muscle, internal intercostal mus-
cle, innermost intercostal muscle, parietal pleura
b. Skin, subcutaneous tissue, external intercostal muscle, internal intercostal mus-
cle, parietal pleura, innermost intercostal muscle
c. Skin, subcutaneous tissue, parietal pleura, external intercostal muscle, internal
intercostal muscle, innermost intercostal muscle
d. Skin, parietal pleura, external intercostal muscle, internal intercostal muscle,
innermost intercostal muscle, subcutaneous tissue
e. Skin, subcutaneous tissue, innermost intercostal muscle, internal intercostal
muscle, external intercostal muscle, parietal pleura
462 Anatomy, Histology, and Cell Biology