Intensive Care Medicine (ICM) Practice Exam

If a patient has a lateral curve to the spine and asymmetrical chest expansion, which nerve lesion is most likely?

1. Accessory nerve

2. Phrenic nerve

3. Vagus nerve

4. Intercostal nerve

The correct answer is: Intercostal nerve

The presence of a lateral curve to the spine, often associated with conditions such as scoliosis, can lead to asymmetrical chest expansion due to uneven respiratory mechanics. The intercostal nerves are responsible for innervating the intercostal muscles, which play a crucial role in the mechanics of breathing and contribute to the expansion of the chest wall during respiration. In a scenario where there is an intercostal nerve lesion, the affected side may not adequately contract or expand, resulting in reduced movement and asymmetrical expansion of the chest. This can lead to a decremented ability of the thoracic cavity to inflate and deflate properly during breathing, highlighting the relationship between the intercostal nerves and symmetric thoracic mobility. The accessory nerve primarily innervates the sternocleidomastoid and trapezius muscles, which influence head position and shoulder elevation, but do not directly affect chest expansion. The phrenic nerve innervates the diaphragm, and while damage to this nerve can impair respiratory function, it does not specifically explain lateral curvature of the spine and asymmetrical chest expansion as observed. Lastly, the vagus nerve is involved in autonomic control of the heart and digestive tract and does not play a direct role in the mechanics of chest