Pulmonary Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Pulmonary Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations

A 54-year-old woman with multiple chronic conditions, including GERD and secondary hyperparathyroidism, presents with intermittent sharp right shoulder pain that worsens during deep breaths following a viral cough illness. Her vital signs normalized after initial anxiety, and exam reveals mild splinting at end-inspiration but otherwise normal findings. What anatomical relationship could explain her pleuritic shoulder pain, and what pulmonary structures might be involved in this clinical scenario? VIDEO INFO Category: Pulmonary Anatomy, Human Anatomy, USMLE Step 1 Difficulty: Hard - Advanced level - Challenges experienced practitioners Question Type: Patient Communication Case Type: Common Scenario Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 54-year-old woman with gastroesophageal reflux disease, secondary hyperparathyroidism, nasal polyps, prior hookworm infection, and remote coccidioidomycosis presents to clinic for intermittent sharp right shoulder pain that worsens with deep breaths after a recent viral cough illness. She occasionally uses marijuana, follows a low-sodium diet, and works in education. She does not smoke. She reports ibuprofen intolerance with stomach pain.... OPTIONS A. Explain that irritation of diaphragmatic parietal pleura travels via the phrenic nerve (C3-C5), so pain is felt at the shoulder and neck on the same side B. Explain that the visceral pleura is richly pain-sensitive via intercostal and sympathetic nerves, creating sharply localized chest wall pain C. Explain that the parietal pleura has no pain fibers, so pleuritic pain comes only from lung tissue and bronchi D. Explain that pleuritic shoulder pain here most likely reflects myocardial ischemia of the inferior left ventricle CORRECT ANSWER A. Explain that irritation of diaphragmatic parietal pleura travels via the phrenic nerve (C3-C5), so pain is felt at the shoulder and neck on the same side EXPLANATION The correct answer is "Explain that irritation of diaphragmatic parietal pleura travels via the phrenic nerve (C3-C5), so pain is felt at the shoulder and neck on the same side" - Her sharp shoulder pain with deep inspiration suggests pleuritic referral. The diaphragmatic parietal pleura is innervated by the phrenic nerve (C3-C5), which refers pain to the ipsilateral shoulder (C4 dermatome). This fits her clinical picture of pleuritic shoulder pain after a cough illness, with normal lung exam aside from mild splinting. "Explain that the visceral pleura is richly pain-sensitive via intercostal and sympathetic nerves, creating sharply localized chest wall pain" is incorrect because visceral pleura lacks pain fibers and is insensitive to sharp pain; parietal pleura is pain-sensitive. "Explain that the parietal pleura has no pain fibers, so pleuritic pain comes only from lung tissue and bronchi" is incorrect because the parietal pleura is richly innervated by intercostal nerves (costal/mediastinal pleura) and the phrenic nerve (diaphragmatic/mediastinal pleura).... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------