Site of thoracentesis/chest tube

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Miracoli

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Q1) Anatomic site of thoracentesis(there is NBME 13 question)
Q2) Anatomic site of chest tube drainage
Q3) Treatment of tension pneumothorax is emergent needle decompression into the pleural cavity to relieve the pressure. Where do you insert the needle?(anatomic location)

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1) no idea about this one
2) chest tube is normally inserted at the intersection of the nipple line and the mid axillary line, I think its between the 4th and 5th rib
3) superior margin of the 3rd rib at the Mid clavicular line

can't believe these are step one questions. Really seems a bit much to expect of a 2nd year.
 
Q1) Anatomic site of thoracentesis(there is NBME 13 question)
Q2) Anatomic site of chest tube drainage
Q3) Treatment of tension pneumothorax is emergent needle decompression into the pleural cavity to relieve the pressure. Where do you insert the needle?(anatomic location)

1. What does this question even mean? Asking about the borders of the pleural space? Differentiating thoracentesis from pericardiocentesis from amniocentesis from paracentesis?
2. Same as above?
3. already answered.
 
1. What does this question even mean? Asking about the borders of the pleural space? Differentiating thoracentesis from pericardiocentesis from amniocentesis from paracentesis?
I don't see any confusion here. What they asking is the surface anatomy of pleural spaces as well as the lung and liver.
The idea is to get into the pleural space and not injure the lung (above) and liver (below).
In general pleura lies two intercostal spaces below the lung (6, 8 & 10th IC space) in midclavicular line (8th), midaxillary line (10th), and paravertebral line (12th).
So, thoracocentasis can be done at costodiaphragmatic recess through the eighth or ninth intercostal space at the midaxillary line.
Gray965.png

Thoracentesis.jpg
 
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So, thoracocentasis can be done at costodiaphragmatic recess through the eighth or ninth intercostal space at the midaxillary line.
jrc140001f1.png

Well, I've seen it done at the paravertabral line (i.e from behind like in this image). In the reality, I don't think it is crucial to know which intercostal space you'll use since you just check for liquid with percussion and/or US before puncturing.
 
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Well, I've seen it done at the paravertabral line (i.e from behind like in this image). In the reality, I don't think it is crucial to know which intercostal space you'll use since you just check for liquid with percussion and/or US before puncturing.
You are right.
In most of the world it is almost always done under US guidance.
However, it is crucial to know the surface anatomy when US is not available.
 
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@Transposony; you are great with anatomy!
So when is thoracentesis done in paravertebral line and mid-axillary line?
Here are 3MCQs just to make it spicy.
Q4) is from NBME13
http://www.usmleforum.com/files/forum/2013/1/758890.php
Q5) This is a UW Q
A medical resident performs a diagnostic procedure on 32-year-old male. He inserts a needle along the upper border of the 10th rib at the right midaxillary line. Which of the following is most likely to be punctured as a result of the intervention?

A. Right lower lung lobe
B. Liver
C. Intercostal artery
D. Intercostal nerve
E. Hepatic veins
Q6)
An 87-year-old woman with a history of metastatic adenocarcinoma of the breast presents with difficulty in
breathing. A plain chest film reveals massive left pleural effusion. The physician chooses to drain the fluid with a thoracentesis. What is the proper location for placement of the cannula (hollow needle) to drain the pleural effusion?
(A) Midaxillary line—6th intercostal space
(B) Midaxillary line—9th intercostal space
(C) Parasternal line—6th intercostal space
(D) Parasternal line—2nd intercostal space
(E) Midclavicular line—5th intercostal space
 
So when is thoracentesis done in paravertebral line and mid-axillary line?
Here are 3MCQs just to make it spicy.
Depends on the etiology and site (e.g. loculated) but usually in the mid-axillary line since posterior axillary space is the most dependent part of the thorax.
I can't attempt the questions since still haven't done the Qbank or the NBMEs.
 
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@Transposony; you are great with anatomy!

Q5) This is a UW Q
A medical resident performs a diagnostic procedure on 32-year-old male. He inserts a needle along the upper border of the 10th rib at the right midaxillary line. Which of the following is most likely to be punctured as a result of the intervention?

A. Right lower lung lobe
B. Liver
C. Intercostal artery
D. Intercostal nerve
E. Hepatic veins
Q6)
An 87-year-old woman with a history of metastatic adenocarcinoma of the breast presents with difficulty in
breathing. A plain chest film reveals massive left pleural effusion. The physician chooses to drain the fluid with a thoracentesis. What is the proper location for placement of the cannula (hollow needle) to drain the pleural effusion?
(A) Midaxillary line—6th intercostal space
(B) Midaxillary line—9th intercostal space
(C) Parasternal line—6th intercostal space
(D) Parasternal line—2nd intercostal space
(E) Midclavicular line—5th intercostal space

b
b
 
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