All Thorax Clinicals

Clinical Reference Info

1-Rib Fractures BD pg. 197, 209 Weakest area of a rib is anterior to its angle

(imp) KLM pg. 302

2-Cervical Rib BD pg. 200, 209 In 0.5 - 2 \% cases Extra Rib above the first one causing
(imp) (Viva) Thoracic Inlet Syndrome
KLM pg. 303

Thoracic Inlet BD pg. 200 Compression of T1 Nerve and structures passing through
Syndrome the inlet
KLM pg. 304
Causes:
(imp) (Viva)
1. Cervical Rib
2. Hypertrophy of muscles
3. Tumour

3-Bone marrow BD pg. 211 Manubrium is often used for bone marrow biopsy
biopsy
KLM pg. 304

4-Phrenic Nerve KLM pg. 304 Paralysis of half diaphragm

Damage Paralysed dome ascends as it is pushed superiorly by
(imp) abdominal viscera
5-Funnel Chest BD pg. 211 Sternum pressed inward

(Physio)

6-Pigeon Chest BD pg. 211 Sternum pressed outward

(Physio)
7-Disc Prolapse BD pg. 216 Disk goes outward and starts pressing on the sciatic nerve
(Sciatica) causing sciatica

8-Referred Pain BD pg. 228 Irritation of intercostal nerves causes severe referred pain
to chest and arm called root pain or girdle pain (Usually by
(imp) KLM pg. 380
intercosto brachial nerve)
9-Herpes Virus BD pg. 228 Causes skin lesion giving sharp burning pain and muscular
weakness
KLM pg. 315

10-Paracentesis BD pg. 243 Aspiration of fluid from plural cavity is done on (Bd
thoracis/ KLM pg. 341 mentions it as 8th and KLM mentions this as 9th (Follow
Thoracocentesis KLM)) intercostal space at the mid axillary line on lower
border or middle of intercostal space (Solution to pleural
(Proff) (NUMS)
effusion)
(vvv.imp)
9-Pleural Effusion BD pg. 243 Inflammation of parietal pleura (Pleuritis only on parietal
SNELLS pg. 64 is pleura) causes pain called (Pleurisy) which then starts
(vvv.imp)
very good getting adhered to visceral pleura (Plural adhesion) which is
KLM pg. 342 heard on stethoscope (Plural Rub) so extra fluid comes in
plural cavity to lubricate (Pleural effusion) which makes it
difficult to breath and this has to be cured by paracentesis
10-Pneumothorax BD pg. 243 (Stab or gunshot) Injury to plural cavity causes excess air
SNELLS pg. 64 is stuck in plural cavity (Pneumothorax) when this becomes
(imp)
very good severe the excess air on one side of plural cavity with the
KLM pg. 341 deflated lung starts pushing on the mediastinum to
opposite lung causing Tension Pneumothorax
11-Haemothorax BD pg. 243 Collection of blood in pleural cavity
KLM pg. 341
12- BD pg. 243 Collection of water and air in pleural cavity
Hydropneumothora
KLM pg. 341
x

13-Empyema BD pg. 243 Collection of Pus in pleural cavity

KLM pg. 341
14-Needle SNELLS pg. 45 To relieve patients with tension pneumothorax
Thoracostomy 2nd intercostal space
Anterior approach is mid clavicular and Lateral approach is
anterior axillary
15-Tube SNELLS pg. 45 To relieve patients with tension pneumothorax
Thoracostomy 4th or 5th intercostal space
Middle of intercostal space at anterior axillary line
16-Thoracotomy KLM pg. 341 To relieve pneumo, hydro and haemothorax in life saving
(vvv.imp) (viva) SNELLS pg. 45 situation
5th or 6th intercostal space
Midaxillary line
If tube is angles upward it drains air and if angled down it
drains fluid
17-Thorascopy KLM pg. 342 Incision for tube at 1-3 intercostal spaces
18- BD pg. 255 Infection is usually restricted to one segment so it can easily
Bronchopulmonary be removed treating just that segment
Segments

19-Flail Chest BD pg. 256 In case of chest injury where a group of ribs are fractured,
during breathing those ribs will move paradoxically (when
(imp) KLM pg. 302
breathing in those ribs go inward while the rest go outward
like normal)
20-Common BD pg. 256 In right lower bronchi of lung as it is wider is less curved
location foreign
KLM pg. 343
objects can get
lodges in lungs

21-Mediastinal BD pg. 261 Compression of mediastinal structures

Syndrome Symptoms:
Dysphagia on oesophagus
Obstruction of Vena cava
Causes: Hodgkins disease (Large mediastinal lymph node
22-Cardiac BD pg. 265 Collection of fluid in pericardial cavity that hinders the
tamponade/ hearts contraction reducing efficiency solved by
KLM pg. 354
Pericardial Effusion pericardiocentesis

(Physio) (imp)

23- KLM pg. 354 Bore inserted through Left 5th or 6th intercostal space near
Pericardiocentesis sternum
(vv.imp)
24-Ligature through BD pg. 266 During heart surgery to prevent blood flow ligature through
Transverse Sinus transverse sinus is done to close aorta and pulmonary trunk

25-Stenosis BD pg. 275 Valves stuck and won't open so blood stuck in that
(physio) compartment causing its hypertrophy
26-Regurgitation BD pg. 275 Valves can't close so constant back flow so blood
stuck in that compartment causing its hypertrophy
(physio)

27-Angina pectoris BD pg. 280 Associated pain in the hearts area due to cornoary artery
KLM pg. 377 occlusion
(Proff)

28-Obstruction of BD pg. 289 Obstruction of SVC above Azygous opening: blood returned
SVC above and by azygous vein
below azygous vein Obstruction of SVC below Azygous opening: blood returned
opening by inferior Vena cava

(imp)

29-Ductus BD pg. 291 If ductus arteriosus of baby doesn’t close and become
arteriosus. Patent ligamentum arteriosus it's called patent ductus arteriosus
Ductus arteriosus, which causing shunting of blood from aorta to pulmonary
Ligamentum artery (left to right)
Arteriosus

(Embryo)

30-Coarctation of BD pg. 291 Constriction of aorta before the subclavian opening causing
the aorta intercostal arteries to look torturous de excess blood
KLM pg. 397
(imp)
 31-Oesophageal BD pg. 301 Hypertension of portal and systemic veins is called
varices oesophageal varices and these can burst causing vomiting
of blood (Haematemesis)
32-Achalasia cardia BD pg. 301 Inability of oesophagus to dilatate to a bolus of food due to
nerve problems
33-Dysphagia BD pg. 301 Compression of oesophagus due to mediastinal syndrome

By Bilal Safdar

NUMS-CMH Lahore

Contact Number for WhatsApp, 03114579803