OMM Exam 1 Block 3 Exam Updated
Actual Questions and CORRECT Answers
What should be on your differential if a patient comes in with thoracic pain?
(what is the acronym that is used?) - correct answer *vindicate*
Vascular, infectious, neoplastic, drugs, inflammatory/idiopathic, congenital, autoimmune,
trauma, endocrine/metabolic
*what are the main 3 must not miss diagnoses of thoracic back pain?* - correct
answer infection (osteomyelitis) seen in immunocompromised and diabetic patients
Fractures seen in elderly who use steroids
Primary tumor or metastasis which is commonly spread from breast and lung, worse pain at
night
What motions are seen in the thoracic spine? - correct answer sidebending is seen
throughout the thoracic spine, but highest degree of sidebending is in the lower thoracic.
*90% of rotation is seen in the lower thoracic.* (t9-t12)
*what are the differences between symptoms of neoplastic thoracic back pain versus
degenerative thoracic back pain?* - correct answer neoplastic thoracic pain: pain does
not improve with rest or conservative therapy. Pain is worse at night. (history of cancer and
abnormal labs)
Degenerative thoracic pain: pain increases with activity. Achy, but subsides with rest and
nsaid use.
, An 70 year old woman comes in with thoracic back pain. She has recently lost weight and
nsaids do not help. It is worse at night and she has a history of breast cancer. You highly
suspect metastatic cancer to the thoracic spine.
What test should you order to confirm? - correct answer mri is best test for diagnosis of
cancer
A patient presents with back pain, urinary retention, numbness on their inner thigh and groin,
leg weakness, and decreased anal sphincter tone.
Is this serious? What condition/syndrome does this patient have? - correct answer this
is *cauda equina syndrome*. This is a must not miss diagnosis for back pain. Cauda equina is
associated with lower lumbar disc herniation.
A patient presents with acute mechanical thoracic back pain.
How should this patient be treated? What do you recommend? - correct answer •75-90
% of nonspecific mechanical back pain improve within 4-6 weeks.
•bed rest does not help acute pain and may prolong the duration. Activity modifications
should be implemented.
Mr. J is a 55 year old man that works as a bank teller and sits for 12 hours a day. Recently he
has been experiencing radiating back pain that is worsened by sitting.
What is at the top of your differential? - correct answer *discogenic pain* should be at
the top of your differential.
•discogenic pain is usually worsened by sitting and may radiate. Increased prevalence in age
group 45-65.
•70% recover in 6 weeks; strengthening back muscles help
For appropriate thoracic cage motion, thoracic spine/sternum/ribs all need to be able to move
freely.
How do you treat a patient with issues in the thoracic cage? - correct answer •treat
thoracics first and ribs second ---> correcting the thoracic dysfunction may improve the rib
dysfunction
Actual Questions and CORRECT Answers
What should be on your differential if a patient comes in with thoracic pain?
(what is the acronym that is used?) - correct answer *vindicate*
Vascular, infectious, neoplastic, drugs, inflammatory/idiopathic, congenital, autoimmune,
trauma, endocrine/metabolic
*what are the main 3 must not miss diagnoses of thoracic back pain?* - correct
answer infection (osteomyelitis) seen in immunocompromised and diabetic patients
Fractures seen in elderly who use steroids
Primary tumor or metastasis which is commonly spread from breast and lung, worse pain at
night
What motions are seen in the thoracic spine? - correct answer sidebending is seen
throughout the thoracic spine, but highest degree of sidebending is in the lower thoracic.
*90% of rotation is seen in the lower thoracic.* (t9-t12)
*what are the differences between symptoms of neoplastic thoracic back pain versus
degenerative thoracic back pain?* - correct answer neoplastic thoracic pain: pain does
not improve with rest or conservative therapy. Pain is worse at night. (history of cancer and
abnormal labs)
Degenerative thoracic pain: pain increases with activity. Achy, but subsides with rest and
nsaid use.
, An 70 year old woman comes in with thoracic back pain. She has recently lost weight and
nsaids do not help. It is worse at night and she has a history of breast cancer. You highly
suspect metastatic cancer to the thoracic spine.
What test should you order to confirm? - correct answer mri is best test for diagnosis of
cancer
A patient presents with back pain, urinary retention, numbness on their inner thigh and groin,
leg weakness, and decreased anal sphincter tone.
Is this serious? What condition/syndrome does this patient have? - correct answer this
is *cauda equina syndrome*. This is a must not miss diagnosis for back pain. Cauda equina is
associated with lower lumbar disc herniation.
A patient presents with acute mechanical thoracic back pain.
How should this patient be treated? What do you recommend? - correct answer •75-90
% of nonspecific mechanical back pain improve within 4-6 weeks.
•bed rest does not help acute pain and may prolong the duration. Activity modifications
should be implemented.
Mr. J is a 55 year old man that works as a bank teller and sits for 12 hours a day. Recently he
has been experiencing radiating back pain that is worsened by sitting.
What is at the top of your differential? - correct answer *discogenic pain* should be at
the top of your differential.
•discogenic pain is usually worsened by sitting and may radiate. Increased prevalence in age
group 45-65.
•70% recover in 6 weeks; strengthening back muscles help
For appropriate thoracic cage motion, thoracic spine/sternum/ribs all need to be able to move
freely.
How do you treat a patient with issues in the thoracic cage? - correct answer •treat
thoracics first and ribs second ---> correcting the thoracic dysfunction may improve the rib
dysfunction
