Vadesha Sadler Board Style Questions

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University of Louisiana, Monroe *

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4019

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Medicine

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Dec 6, 2023

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Vadesha Sadler OMM/OPP Board Style Questions A 35-year-old female presents to the ED with new onset of upper extremity weakness, miosis, anhidrosis, and ptosis. Diagnostic work up reveals a Pancoast tumor in the patient’s left upper lobe. According to the radiologist, the tumor appears to be invading the inferior trunk of the brachial plexus, which is the likely etiology of the patient’s upper extremity weakness. Based on the tumor's location in the brachial plexus, what physical exam findings would you expect this Pt to have? A. Winging of the scapula The winging of the scapula is due to injury to the long thoracic nerve, which is formed by the C5-C7 nerve roots. B. Weakness w/ finger abduction The inferior trunk is formed by the C8 & T1 nerve roots. As a result, this will produce weakness w/ the intrinsic muscles of the hand (interossi) & deep finger flexors. It will also likely produce numbness in the little finger (C8) as well. C. Weakness w/ arm abduction The deltoid which is innervated by the axillary nerve and the supraspinatus which is innervated by the suprascapular nerve are responsible for arm abduction. These nerves receive the C5 and C6 nerve roots of the brachial plexus. D. Weakness w/ elbow flexion E. Numbness of the lateral aspect of the forearm Numbness at the lateral aspect of the forearm & elbow flexion (musculocutaneous nerve) would not be affected since it stems from the superior trunk of the brachial plexus. Resources : American Osteopathic Association. Foundations of Osteopathic Medicine . Ed. Anthony Chila. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2010. Print. DiGiovanna, Eileen, Christopher Amen, and Denise Burns. An Osteopathic Approach to Diagnosis and Treatment . 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2020. Print.

Vadesha Sadler OMM/OPP Board Style Questions A 45-year-old African American female comes to your office with the complaint of frequent burning epigastric pain. She reports that the pain is associated with the consumption of a fatty meal and that it is relieved with over-the-counter anti-acids. She also reports that the pain has been present for about 1 year but has progressively worsened over the past several weeks. Based on the above diagnoses, palpatory changes are likely to arise at which of the following vertebral levels? A. C5 C5 is not closely associated w/ autonomic innervation to the upper GI tract B. T3 Efferents from T3 affects sympathetic tone in the heart, lung & head. C. T6 This patient is most likely to be presenting with a gastric ulcer or possibly GERD. Unlike a duodenal ulcer, a gastric ulcer’s symptoms typically worsen with consumption of food. Stimuli from the gastric mucosa with enter the spinal cord at the T5-T9 level. D. T10 T10 - T11 is associated w/ sympathetic tone in portions of the duodenum & the pancreas, jejunum, ileum & proximal 2/3 of transverse colon. E. T12 T12 - L2 is associated w/ sympathetic tone in the distal 1/3 of the transverse colon & rectum Resources : American Osteopathic Association. Foundations of Osteopathic Medicine . Ed. Anthony Chila. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2010. Print. DiGiovanna, Eileen, Christopher Amen, and Denise Burns. An Osteopathic Approach to Diagnosis and Treatment . 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins, 2020. Print.

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