361.A 3-month-old girl is seen for the first time by a physician in your
free clinic. Her mother reports that she is OK, but she quits physical activ-
ity after short bursts of effort, thus likes to be held a lot. The girl recently
appears bluish when feeding or trying to crawl sometimes. When you lis-
ten to her chest there is an extra sound or murmur, especially during sys-
tole. You do a PA chest film and note a general increased density of both
lungs and the right inferior heart margin appears enlarged. There is no
enlargement of the aortic knob, but the left inferior border of the heart
margin also appears slightly enlarged. You schedule the girl for an echocar-
diogram because you suspect which of the following?
a. Tetralogy of Fallot
b. coarctation of the aorta
c. transposition of the great vessels
d. aortic stenosis
e. ventricular septal defect
362.When removing blood from the left pleural space, a chest tube is
placed into the pleural space typically below the normal extent of the lung.
The chest tubes are most conveniently placed at the midaxillary line
through intercostal muscles midway between the ribs to avoid damaging
subcostal nerve arteries and veins and their collateral branches. At the
midaxillary line, to which rib does the left lung normally extend?
a. Sixth
b. Eighth
c. Tenth
d. Twelfth
Thorax 473