and we’re back! with BRAND SPANKIN' NEW tangents!
to snoo-finity ... and beyond!
NBME 21 Answers
A 37-year-old man is brought to the emergency ...
Visceral pain is typically poorly localized (heart attacks are usually described as "crushing pressure" that radiates to the shoulder or neck), so this patients "sharp" right-sided pain in the setting in multiple right-sided rib fractures is likely related to the ribs. The intercostals run with the ribs and provide sensation to the chest wall.
I think its just that the patient is CONSCIOUSLY experiencing chest pain. Because he is consciously feeling the pain and would be able to directly point to it (and that it is not referred visceral pain) it has to be a somatic afferent nerve fiber. This narrows it down exclusively to the intercostal nerve exc;usively. https://en.wikipedia.org/wiki/Intercostal_nerves
IMportant to the patients "right sided chest pain" is his history of MVA and x-ray confirming multiple rib fractures.
I think this is correct? Does that make sense ? All of the other choices do not carry SA fibers in that area