Neck and Arm Pain and this Chest X Ray! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-22-2011
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 333
Threads: 162
Thanked 282 Times in 146 Posts
Reputation: 292
X Ray Neck and Arm Pain and this Chest X Ray!

A 48-year-old woman presented to the clinic of the Toronto Western Hospital with a chief complaint of progressive left sided neck and arm pain. The pain started 14 months previously after seeing a chiropractor for chronic mechanical low back pain. During the course of treatment, his neck was manipulated and he subsequently began experiencing neck pain. The pain became constant and was associated with numbness and tingling into his left forearm extending to the tips of his 4th and 5th fingers. He felt that the symptoms were worsening and becoming more severe, awakening him at night. A systems review revealed that he had been a heavy smoker for many years, but did not report any respiratory symptoms. He felt otherwise well, except for a general feeling of discouragement due to his chronic pain. The initial cervical radiographs and those repeated nine months later, revealed minimal degenerative changes. Multiple examinations had been completed prior to the neurosurgical consultation. Upon examination, marked swelling in the supraclavicular region extending up to the lateral and posterior aspect of the left side of his neck was noted. The tissues in this area were soft and boggy to palpation with no evidence of lymphadenopathy. There was marked distention of the superficial vessels of the left side of the lower neck, upper chest and the left upper arm. Chest radiographs including apical views were taken:

Neck and Arm Pain and this Chest X Ray!-chest-x-ray-1.jpg
click image to enlarge

Which of the following statements is not correct regarding this condition?

A) The patient symptoms are due to the involvement of cervical sympathetic plexus
B) It is mostly related to non-small cell cancers of lung.
C) This condition is typically found in conjunction with a smoking history.
D) The clinical signs and symptoms can be confused with neurovascular compromise at the level of the thoracic outlet.
E) It is a type of lung cancer defined primarily by its location situated at the top end of lung.
Reply With Quote Quick reply to this message
The above post was thanked by:
MANIAKOS (10-23-2011), shyangel18 (10-25-2011), usmle 99 (10-26-2011), zohra (10-26-2011)



  #2  
Old 10-22-2011
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 79
Threads: 19
Thanked 33 Times in 11 Posts
Reputation: 43
Default

D........thoracic outlet
Reply With Quote Quick reply to this message
  #3  
Old 10-22-2011
jahn77's Avatar
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 326
Threads: 20
Thanked 220 Times in 124 Posts
Reputation: 232
Default

b) non small cell cr is not correct
Reply With Quote Quick reply to this message
 
  #4  
Old 10-22-2011
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 333
Threads: 162
Thanked 282 Times in 146 Posts
Reputation: 292
Thumbs Down

Quote:
Originally Posted by jahn77 View Post
b) non small cell cr is not correct
To jahn77 and umeraulakh:

Hey friends,
Your answers are wrong.
There are some clues in the patient's presentation...
Reply With Quote Quick reply to this message
  #5  
Old 10-22-2011
jahn77's Avatar
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 326
Threads: 20
Thanked 220 Times in 124 Posts
Reputation: 232
Default

o ye, there are no symptoms of sympatic plexus involvement,
a)
I hope that's right
Reply With Quote Quick reply to this message
The above post was thanked by:
Evergreen (10-22-2011)
  #6  
Old 10-22-2011
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 333
Threads: 162
Thanked 282 Times in 146 Posts
Reputation: 292
Thumbs Up

Quote:
Originally Posted by jahn77 View Post
o ye, there are no symptoms of sympatic plexus involvement,
a)
I hope that's right
yeaaaaaaaa, the symptoms are due to brachial plexus roots involvement.
Reply With Quote Quick reply to this message
  #7  
Old 10-23-2011
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 79
Threads: 19
Thanked 33 Times in 11 Posts
Reputation: 43
Default

AHH..I dint even read properly,qs is which is not correct...
..So..A)
Reply With Quote Quick reply to this message
The above post was thanked by:
Evergreen (10-23-2011)
  #8  
Old 10-24-2011
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 235 Times in 128 Posts
Reputation: 245
Send a message via MSN to shyangel18
Default

Its a pancoast tumor. Cirrect answer z B!
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #9  
Old 10-25-2011
USMLE Forums Master
 
Steps History: Not yet
Posts: 674
Threads: 264
Thanked 959 Times in 393 Posts
Reputation: 969
Send a message via Yahoo to ricko335
Default

I guess if it is brachial plexus involvement then it is a lesion cervical sympathethic plexus i
Reply With Quote Quick reply to this message
  #10  
Old 10-25-2011
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 333
Threads: 162
Thanked 282 Times in 146 Posts
Reputation: 292
Default

Quote:
Originally Posted by ricko335 View Post
I guess if it is brachial plexus involvement then it is a lesion cervical sympathethic plexus i
They are different, I think. Sympathetic involvement causes Horner syndrome: Ptosis, miosis and anhidrosis, which are not present in this patient.

This is actually a case of Pancoast syndrome,mainly due to the non-small cell cancers of the upper part of the lung.
Reply With Quote Quick reply to this message
  #11  
Old 10-25-2011
yasirsattar75's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 395
Threads: 51
Thanked 292 Times in 111 Posts
Reputation: 302
I agree its B

its pancoast tumor .. typically at apex of lung and its causes horner syndrome .... coz they have asked which one is NOT correct so its B .....
__________________
study study till ur brain is saturated
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #12  
Old 10-25-2011
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 333
Threads: 162
Thanked 282 Times in 146 Posts
Reputation: 292
Post

Quote:
Originally Posted by yasirsattar75 View Post
its pancoast tumor .. typically at apex of lung and its causes horner syndrome .... coz they have asked which one is NOT correct so its B .....
A is correct. Although it is pancoast syndrome, the patient does not have symptoms of Horner's syndrome, indicating that sympathetic plexus is intact in this particular case.
The symptoms are mainly due to pressure on cervical nerve roots and involvement of barchial plexus not just sympathetic one. So A is the answer.
Reply With Quote Quick reply to this message
The above post was thanked by:
yasirsattar75 (10-25-2011)
  #13  
Old 10-25-2011
yasirsattar75's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 395
Threads: 51
Thanked 292 Times in 111 Posts
Reputation: 302
Default

Quote:
Originally Posted by Evergreen View Post
A is correct. Although it is pancoast syndrome, the patient does not have symptoms of Horner's syndrome, indicating that sympathetic plexus is intact in this particular case.
The symptoms are mainly due to pressure on cervical nerve roots and involvement of barchial plexus not just sympathetic one. So A is the answer.
source of this q ? plz tell me
__________________
study study till ur brain is saturated
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #14  
Old 10-25-2011
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 333
Threads: 162
Thanked 282 Times in 146 Posts
Reputation: 292
Thumbs Up Pancoast Tumour

Quote:
Originally Posted by yasirsattar75 View Post
source of this q ? plz tell me
See the following link (It is a real case):

http://www.ncbi.nlm.nih.gov/pmc/arti...00044-0024.pdf
Reply With Quote Quick reply to this message



Reply

Tags
Anatomy-, Pathology-, Radiographs-, Respiratory-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Neck and Hip Girdle Pain + Morning Stiffness Ace3 USMLE Step 2 CK Forum 11 07-15-2012 07:48 AM
Pain and Neck Stiffness, which consultation needed! ricko335 USMLE Step 1 Forum 9 08-12-2011 06:21 AM
migraine with chest pain ricko335 USMLE Step 1 Forum 5 08-12-2011 05:34 AM
Cause of Dyspnea and chest pain in a young man usmle2011 USMLE Step 1 Forum 6 07-29-2011 10:23 AM
Chest Pain and Esophageogram Case! USMLE-Syndrome USMLE Step 2 CK Forum 8 06-26-2011 02:13 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)