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1. What are the main divisions of the thoracic cavity?
→ The thoracic cavity is divided into three compartments:
Right pleural cavity (contains right lung)
Left pleural cavity (contains left lung)
Mediastinum (central space containing heart, great vessels, trachea, and oesophagus)
2. What is pleura?
→ The pleura is a serous membrane made of mesothelium, forming a closed sac around each lung. It has two layers — parietal pleura lining the thoracic wall and visceral pleura covering the lung surface.
3. What is the difference between parietal and visceral pleura?
→
Parietal pleura: Lines thoracic cavity; pain sensitive (somatic supply).
Visceral pleura: Covers lung; insensitive to pain (autonomic supply).
4. Name the parts of the parietal pleura.
→ Costal, diaphragmatic, mediastinal, and cervical pleura (cupula).
5. What is the pleural cavity?
→ It is a potential space between the parietal and visceral pleura containing a thin film of serous fluid that allows smooth gliding of the lung during respiration.
6. What is the pulmonary ligament?
→ A double fold of mediastinal pleura extending downward from the root of the lung, allowing descent of the lung root during inspiration.
7. What are pleural recesses?
→ These are potential spaces where pleurae of adjacent regions come into contact.
Costodiaphragmatic recess (deepest, for lung expansion).
Costomediastinal recess (shallow, near cardiac notch).
8. What is the nerve supply of the pleura?
→
Parietal pleura: Intercostal nerves (costal part), phrenic nerve (central part).
Visceral pleura: Autonomic fibres (sympathetic and vagus).
9. Which part of pleura is pain-sensitive?
→ The parietal pleura only — especially the costal and diaphragmatic parts.
10. What is the clinical significance of pleural recesses?
→ They serve as reservoirs for pleural fluid and are important sites for pleural effusion and thoracocentesis (needle aspiration).
11. What are the boundaries of the costodiaphragmatic recess?
→
Outer wall: Costal pleura
Inner wall: Diaphragmatic pleura
Medial wall: Mediastinal pleura
12. What is pleurisy?
→ Inflammation of pleura, producing sharp chest pain due to friction between inflamed pleural layers.
13. Why is pain in diaphragmatic pleurisy referred to the shoulder?
→ Because the phrenic nerve (C4) supplies the diaphragmatic pleura and the skin over the shoulder, causing referred pain to the C4 dermatome.
14. What is pleural effusion?
→ Accumulation of fluid in the pleural cavity, commonly due to infection, tuberculosis, or heart failure.
15. What is pneumothorax?
→ Presence of air in the pleural cavity, causing collapse of the lung due to loss of negative intrapleural pressure.
16. What is haemothorax and empyema?
→
Haemothorax: Accumulation of blood in pleural cavity.
Empyema: Accumulation of pus in pleural cavity.
17. What is the nerve supply responsible for referred pain from pleura to the shoulder?
→ Phrenic nerve (C4) — irritation of mediastinal or central diaphragmatic pleura causes shoulder tip pain.
18. What is paracentesis thoracis (pleural tap)?
→ A procedure to remove fluid from the pleural cavity; the needle is inserted just above the upper border of a rib, usually in the 8th intercostal space, midaxillary line.
19. What is the difference between pleural cavity and pericardial cavity?
→
Pleural cavity: Surrounds each lung.
Pericardial cavity: Surrounds the heart, lying within the mediastinum.
20. Why is the pleura clinically important?
→ Because pleural diseases (effusion, pneumothorax, empyema, fibrosis) directly affect lung expansion and respiration, and understanding pleural anatomy is essential for surgical and diagnostic procedures like chest drainage or thoracotomy.
1. The thoracic cavity is divided into how many compartments?
a) 1
b) 2
c) 3
d) 4
Answer: c) 3
2. The central compartment of the thoracic cavity is called the:
a) Pleural cavity
b) Mediastinum
c) Pericardial cavity
d) Thoracic inlet
Answer: b) Mediastinum
3. The pleura is derived embryologically from:
a) Endoderm
b) Ectoderm
c) Mesoderm
d) Neural crest
Answer: c) Mesoderm
4. Parietal pleura develops from:
a) Splanchnopleuric mesoderm
b) Somatopleuric mesoderm
c) Neural crest
d) Endoderm
Answer: b) Somatopleuric mesoderm
5. Visceral pleura develops from:
a) Splanchnopleuric mesoderm
b) Somatopleuric mesoderm
c) Ectoderm
d) Endoderm
Answer: a) Splanchnopleuric mesoderm
6. The space between the visceral and parietal pleura is called:
a) Mediastinum
b) Pleural cavity
c) Thoracic duct
d) Pericardial sac
Answer: b) Pleural cavity
7. The pleural cavity normally contains:
a) Air
b) Blood
c) Serous fluid
d) Lymph
Answer: c) Serous fluid
8. The pleural cavity is a:
a) True cavity
b) Potential space
c) Synovial space
d) Lymphatic sinus
Answer: b) Potential space
9. Which part of pleura covers the lung surface?
a) Parietal pleura
b) Visceral pleura
c) Mediastinal pleura
d) Costal pleura
Answer: b) Visceral pleura
10. The parietal pleura lines all except:
a) Thoracic wall
b) Diaphragm
c) Lung surface
d) Mediastinum
Answer: c) Lung surface
11. Which of the following is not a part of the parietal pleura?
a) Costal
b) Diaphragmatic
c) Mediastinal
d) Pulmonary
Answer: d) Pulmonary
12. The cervical pleura is also known as:
a) Pleural cupula
b) Costal pleura
c) Mediastinal pleura
d) Apical pleura
Answer: a) Pleural cupula
13. The cervical pleura extends above the first rib by about:
a) 0.5 cm
b) 1 cm
c) 2.5 cm
d) 4 cm
Answer: c) 2.5 cm
14. The pleural fluid is secreted by:
a) Costal pleura
b) Diaphragmatic pleura
c) Mesothelial cells
d) Endothelial cells
Answer: c) Mesothelial cells
15. The pulmonary ligament is a:
a) Fold of visceral pleura
b) Fold of mediastinal pleura
c) Ligament of pericardium
d) Fibrous tissue of lung root
Answer: b) Fold of mediastinal pleura
16. The costodiaphragmatic recess lies between:
a) Costal and mediastinal pleura
b) Costal and diaphragmatic pleura
c) Mediastinal and diaphragmatic pleura
d) Costal and cervical pleura
Answer: b) Costal and diaphragmatic pleura
17. The costodiaphragmatic recess is deepest at:
a) Midclavicular line
b) Midaxillary line
c) Scapular line
d) Parasternal line
Answer: b) Midaxillary line
18. The costomediastinal recess is prominent on which side?
a) Right
b) Left
c) Both
d) Neither
Answer: b) Left
19. The pleural reflections are:
a) Junction lines of two parts of parietal pleura
b) Folds of visceral pleura
c) Adhesions between pleural layers
d) Lymphatic channels
Answer: a) Junction lines of two parts of parietal pleura
20. Which part of pleura is insensitive to pain?
a) Parietal pleura
b) Visceral pleura
c) Costal pleura
d) Mediastinal pleura
Answer: b) Visceral pleura
21. The parietal pleura is supplied by:
a) Autonomic nerves
b) Intercostal and phrenic nerves
c) Vagus nerve
d) Sympathetic chain
Answer: b) Intercostal and phrenic nerves
22. The visceral pleura is supplied by:
a) Intercostal nerves
b) Vagus and sympathetic nerves
c) Phrenic nerve
d) Recurrent laryngeal nerve
Answer: b) Vagus and sympathetic nerves
23. Pain from costal pleura is referred along:
a) Neck
b) Abdomen
c) Intercostal spaces
d) Shoulder
Answer: c) Intercostal spaces
24. Pain from diaphragmatic pleura is referred to:
a) Epigastrium
b) Umbilicus
c) Shoulder tip
d) Back
Answer: c) Shoulder tip
25. The nerve responsible for referred shoulder pain in pleurisy is:
a) Vagus
b) Phrenic
c) Intercostal
d) Sympathetic
Answer: b) Phrenic
26. The pleural cavity extends up to which rib in the midaxillary line?
a) 6th
b) 8th
c) 10th
d) 12th
Answer: c) 10th
27. The lung margin crosses the 6th rib in:
a) Midclavicular line
b) Midaxillary line
c) Paravertebral line
d) Scapular line
Answer: a) Midclavicular line
28. The pleural cavity extends below the lung margin by about:
a) One rib
b) Two ribs
c) Three ribs
d) Four ribs
Answer: b) Two ribs
29. Thoracocentesis (pleural tap) is done in which intercostal space?
a) 4th
b) 5th
c) 6th
d) 8th
Answer: d) 8th
30. In pleural tap, the needle should be inserted:
a) Below the lower border of rib
b) Above the upper border of rib
c) Through the middle of rib
d) In the costal cartilage
Answer: b) Above the upper border of rib
31. The main blood supply to the parietal pleura is via:
a) Bronchial arteries
b) Intercostal and internal thoracic arteries
c) Pulmonary arteries
d) Azygos veins
Answer: b) Intercostal and internal thoracic arteries
32. The venous drainage of parietal pleura is mainly into:
a) Pulmonary veins
b) Azygos and internal thoracic veins
c) Bronchial veins
d) Pericardiophrenic veins
Answer: b) Azygos and internal thoracic veins
33. The lymphatic drainage of parietal pleura is into:
a) Bronchopulmonary nodes
b) Posterior intercostal and internal mammary nodes
c) Hilar nodes
d) Tracheobronchial nodes
Answer: b) Posterior intercostal and internal mammary nodes
34. The pleural cupula is strengthened by which fascia?
a) Endothoracic fascia
b) Sibson’s fascia
c) Prevertebral fascia
d) Buccopharyngeal fascia
Answer: b) Sibson’s fascia
35. Which of the following conditions is due to air in the pleural cavity?
a) Hydrothorax
b) Pneumothorax
c) Haemothorax
d) Empyema
Answer: b) Pneumothorax
36. Fluid accumulation in pleural cavity is called:
a) Pneumothorax
b) Pleural effusion
c) Hydronephrosis
d) Hydrocele
Answer: b) Pleural effusion
37. Blood in pleural cavity is termed:
a) Haemothorax
b) Pneumothorax
c) Empyema
d) Hydrothorax
Answer: a) Haemothorax
38. Pus in pleural cavity is termed:
a) Pneumothorax
b) Empyema
c) Hydrothorax
d) Chylothorax
Answer: b) Empyema
39. Milky fluid in pleural cavity is due to injury of:
a) Azygos vein
b) Internal thoracic artery
c) Thoracic duct
d) Bronchial veins
Answer: c) Thoracic duct
40. Referred shoulder pain in pleurisy is due to involvement of:
a) Intercostal nerves
b) Phrenic nerve
c) Vagus nerve
d) Sympathetic chain
Answer: b) Phrenic nerve
41. The visceral pleura receives blood supply from:
a) Bronchial arteries
b) Pulmonary arteries
c) Intercostal arteries
d) Internal thoracic arteries
Answer: a) Bronchial arteries
42. The parietal pleura is supplied by which arteries?
a) Bronchial
b) Intercostal
c) Pulmonary
d) Coronary
Answer: b) Intercostal
43. Which nerve supplies the costal pleura?
a) Vagus
b) Intercostal
c) Phrenic
d) Sympathetic
Answer: b) Intercostal
44. Which nerve supplies the mediastinal pleura?
a) Vagus
b) Phrenic
c) Intercostal
d) Sympathetic
Answer: b) Phrenic
45. Which part of the pleura is related to the pericardium?
a) Mediastinal pleura
b) Costal pleura
c) Diaphragmatic pleura
d) Cervical pleura
Answer: a) Mediastinal pleura
46. The costodiaphragmatic recess is obliterated first in:
a) Pneumothorax
b) Pleural effusion
c) Pulmonary fibrosis
d) Pneumonia
Answer: b) Pleural effusion
47. Which of the following conditions causes lung collapse?
a) Pleural effusion
b) Pneumothorax
c) Empyema
d) Haemothorax
Answer: b) Pneumothorax
48. In dry pleurisy, the characteristic sound heard is:
a) Pleural rub
b) Rales
c) Crepitation
d) Wheeze
Answer: a) Pleural rub
49. Which structure lies closest to the cupula of the pleura?
a) Subclavian artery
b) Internal thoracic artery
c) Common carotid artery
d) Superior vena cava
Answer: a) Subclavian artery
50. During central line (subclavian) insertion, pleural injury leads to:
a) Chylothorax
b) Pneumothorax
c) Haemothorax
d) Empyema
Answer: b) Pneumothorax
Q1. What are the main compartments of the thoracic cavity?
→ The thoracic cavity has three compartments — right pleural cavity, left pleural cavity, and the mediastinum in the centre.
Q2. What is pleura?
→ A serous membrane made of mesothelium that forms a closed sac around each lung, allowing frictionless movement during respiration.
Q3. Name the two layers of pleura.
→ Parietal pleura and visceral pleura.
Q4. What is the main difference between parietal and visceral pleura?
→ Parietal pleura lines the thoracic cavity and is pain-sensitive.
Visceral pleura covers the lungs and is insensitive to pain.
Q5. What are the parts of the parietal pleura?
→ Costal, diaphragmatic, mediastinal, and cervical (cupula) pleura.
Q6. Which part of the pleura covers the diaphragm?
→ The diaphragmatic pleura.
Q7. Which part of the pleura forms the lateral wall of the mediastinum?
→ The mediastinal pleura.
Q8. What is the cupula of pleura?
→ The cervical pleura that extends into the root of the neck above the first rib.
Q9. What structure strengthens the cervical pleura?
→ Sibson’s fascia (suprapleural membrane).
Q10. What is the pleural cavity?
→ A potential space between parietal and visceral pleura containing a thin film of serous fluid.
Q11. What is the function of pleural fluid?
→ It lubricates the pleural surfaces and allows smooth lung movement during respiration.
Q12. What is the pulmonary ligament?
→ A double fold of mediastinal pleura below the lung root that allows descent of the lung root during inspiration.
Q13. What are pleural recesses?
→ Potential spaces where pleural layers come in contact; they allow lung expansion during deep inspiration.
Q14. Name the pleural recesses.
→ Costodiaphragmatic and costomediastinal recesses.
Q15. Which recess is deeper?
→ The costodiaphragmatic recess, especially along the midaxillary line.
Q16. Which side shows a larger costomediastinal recess?
→ The left side, near the cardiac notch of the left lung.
Q17. What is the nerve supply of parietal pleura?
→ Intercostal nerves (costal and peripheral diaphragmatic pleura) and phrenic nerve (mediastinal and central diaphragmatic pleura).
Q18. What is the nerve supply of visceral pleura?
→ Autonomic nerves from the vagus and sympathetic trunks.
Q19. Which part of pleura is sensitive to pain?
→ Parietal pleura, not the visceral pleura.
Q20. Why is the visceral pleura insensitive to pain?
→ It is supplied by autonomic nerves, which do not carry somatic pain fibres.
Q21. Why does irritation of diaphragmatic pleura cause shoulder pain?
→ Because it is supplied by the phrenic nerve (C4), and pain is referred to the C4 dermatome (shoulder tip).
Q22. What is the blood supply of the parietal pleura?
→ Intercostal, internal thoracic, and musculophrenic arteries.
Q23. What is the venous drainage of the parietal pleura?
→ Azygos, internal thoracic, and musculophrenic veins.
Q24. What is the lymphatic drainage of the pleura?
→
Parietal pleura: Internal mammary, intercostal, and posterior mediastinal nodes.
Visceral pleura: Bronchopulmonary nodes at the hilum.
Q25. What is pleurisy?
→ Inflammation of pleura producing sharp pain during breathing due to friction between inflamed pleural surfaces.
Q26. What is pleural effusion?
→ Collection of fluid in the pleural cavity, compressing the lung and restricting expansion.
Q27. What is pneumothorax?
→ Presence of air in pleural cavity, leading to lung collapse.
Q28. What is haemothorax?
→ Blood accumulation in the pleural cavity, usually after trauma.
Q29. What is empyema?
→ Pus in pleural cavity due to infection.
Q30. What is chylothorax?
→ Lymph (chyle) accumulation in pleural cavity from thoracic duct injury.
Q31. Why is the pleura clinically important in chest injuries?
→ Because even a small breach can allow air entry, leading to pneumothorax and lung collapse.
Q32. Where is the needle inserted for pleural tap (thoracocentesis)?
→ Above the upper border of a rib, usually in the 8th intercostal space in the midaxillary line.
Q33. Why should the needle be inserted above the rib and not below it?
→ To avoid injury to intercostal vein, artery, and nerve that run along the lower border of the rib.
Q34. What happens if pleural fluid accumulates excessively?
→ The costodiaphragmatic recess is obliterated, and the lung is compressed.
Q35. What is the normal relationship of the pleura to ribs?
→
Midclavicular line → pleura at 8th rib.
Midaxillary line → pleura at 10th rib.
Paravertebral line → pleura at 12th rib.
Q36. What are the corresponding lung levels to pleural reflections?
→
Midclavicular → lung 6th rib, pleura 8th rib.
Midaxillary → lung 8th rib, pleura 10th rib.
Paravertebral → lung 10th rib, pleura 12th rib.
Q37. What is a tension pneumothorax?
→ A life-threatening condition where air enters pleural cavity but cannot escape, raising pressure and shifting the mediastinum to the opposite side.
Q38. Why is pleural friction rub heard in dry pleurisy?
→ Because the pleural layers become roughened and rub against each other during respiration.
Q39. Why does the left costomediastinal recess exist?
→ Due to the cardiac notch of the left lung.
Q40. What is the clinical importance of Sibson’s fascia?
→ It protects the pleural cupula during procedures like subclavian vein catheterization, reducing the risk of pneumothorax.
Q41. What happens if the thoracic duct is injured?
→ Chylothorax — milky fluid collects in the left pleural cavity.
Q42. How does pleural effusion appear on X-ray?
→ Blunting of costophrenic angle and a meniscus-shaped shadow.
Q43. What are the effects of fibrosis of the pleura?
→ Restricted lung movement, dyspnea, and mediastinal shift toward the affected side.
Q44. Which part of pleura is related to pericardium?
→ Mediastinal pleura.
Q45. Which condition obliterates the pleural cavity?
→ Pleural adhesions following chronic pleurisy or tuberculosis.
Q46. Which nerve supplies both the diaphragm and its pleura?
→ Phrenic nerve (C3–C5).
Q47. What is the physiological importance of negative intrapleural pressure?
→ It keeps the lungs inflated and prevents collapse.
Q48. Which structure separates the two pleural cavities?
→ The mediastinum.
Q49. Which is the most dependent part of the pleural cavity in standing position?
→ The costodiaphragmatic recess.
Q50. Which clinical procedure makes use of pleural anatomy knowledge?
→ Thoracocentesis (pleural tap) and chest tube drainage.
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