1
OMM Exam 1 Block 3 Questions with
Answers (100% Correct Answers)
what should be on your differential if a patient comes in with thoracic pain?
(what is the acronym that is used?) 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? 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? 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? Answer: Neoplastic thoracic pain:
Pain does not improve with rest or conservative therapy. Pain is worse at night.
(history of cancer and abnormal labs)
, 2
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? 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? 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? 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? 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.
OMM Exam 1 Block 3 Questions with
Answers (100% Correct Answers)
what should be on your differential if a patient comes in with thoracic pain?
(what is the acronym that is used?) 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? 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? 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? Answer: Neoplastic thoracic pain:
Pain does not improve with rest or conservative therapy. Pain is worse at night.
(history of cancer and abnormal labs)
, 2
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? 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? 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? 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? 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.
