{"id":3314,"date":"2023-04-19T17:12:00","date_gmt":"2023-04-19T17:12:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3314"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"omm-question-of-the-day-thoracic-muscle-energy","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy","title":{"rendered":"OMM Question of the Day: Thoracic muscle energy"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy\/#The_correct_answer_to_todays_OMM%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM\u00ae Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy\/#A_Level_of_the_left_atrium\" >A. Level of the left atrium<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another OMM-style practice question to test your knowledge of medical topics.&nbsp;<\/em><em>Today&#8217;s case focuses on a 56-year-old man who has difficulty swallowing. He has a history of jitteriness. Which of the following best describes the affected anatomic site that most likely resulted in this patient\u2019s clinical symptoms?&nbsp;<\/em><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 56-year-old man presents to his primary care physician for evaluation of difficulty swallowing. Over the past several weeks, the patient has had the sensation of \u201cfood getting stuck\u201d as he swallows. He also has a new history of intermittent \u201cjitteriness.\u201d Medical history is notable for long-standing hypertension, hyperlipidemia, diabetes, and esophageal reflux. The patient\u2019s medications include metoprolol, metformin, atorvastatin, and omeprazole. He has a history of medication non-compliance. Temperature 37.0\u00b0C (98.6\u00b0F), pulse is 89\/min, respirations are 16\/min, and blood pressure is 177\/92 mmHg. The patient\u2019s physical examination is unremarkable. A portion of the patient\u2019s telemetry strip is demonstrated below. Which of the following best describes the affected anatomic site that most likely resulted in this patient\u2019s clinical symptoms?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Image reproduced from&nbsp;<a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Atrial_Fibrillation_in_two_leads.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">Wikimedia Commons<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Level of the left atrium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Level of the cricopharyngeal muscle<\/strong><strong>C. Level of the aortic arch<br><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Level of the left main bronchus<\/strong><strong>E. Level of the diaphragm<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Level_of_the_left_atrium\"><\/span><strong>A. Level of the left atrium<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s OMM\u00ae Question are&#8230;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Level of the cricopharyngeal muscle<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Food impaction and stricture formation may result at the esophageal level of the cricopharyngeus muscle. However, this patient&#8217;s clinical presentation and ECG is more consistent with impaction at the level of the left atrium secondary to atrial dilation and associated compression of the esophagus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Level of the aortic arch&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Aortic arch dilation from aortic dissection or aortic aneurysm may impede the esophagus at this level. However, this patient&#8217;s clinical presentation and ECG is more consistent with impaction at the level of the left atrium secondary to atrial dilation and associated compression of the esophagus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Level of the left main bronchus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Impingement at the level of the left main bronchus may occur from mass effect due to associated trauma or tumor burden. However, this patient&#8217;s clinical presentation and ECG is more consistent with impaction at the level of the left atrium secondary to atrial dilation and associated compression of the esophagus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Level of the diaphragm<\/strong><strong>Incorrect:<\/strong>&nbsp;Esophageal constriction may occur at the diaphragm level due to long-standing esophageal reflux disease and associated stricture formation. Typically, affected individuals will have evidence of untreated disease, including epigastric pain, a metallic taste in the mouth, or a history of gastritis or peptic ulcer disease. This patient&#8217;s clinical presentation and ECG is more consistent with impaction at the level of the left atrium secondary to atrial dilation and associated compression of the esophagus.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6471ce.png?w=700\" alt=\"\" class=\"wp-image-3181\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6471ce.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_6471ce.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents for dysphagia evaluation and is found to have new-onset atrial fibrillation. Although rare,&nbsp;<strong>atrial fibrillation and associated left atrial dilation<\/strong>&nbsp;can result in compression of the esophagus and subsequent food impaction.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The esophagus has multiple compression sites as it courses from the oropharynx to the stomach. Superiorly, the esophagus may constrict as it enters the mediastinum, where the cricopharyngeus muscle may cause constriction. Thoracic constrictions occur where the arch of the aorta crosses the esophagus or at the levels of the&nbsp;<strong>left main bronchus<\/strong>&nbsp;and the&nbsp;<strong>left atrium<\/strong>. Lastly, the esophagus may constrict crossing the diaphragm.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pathologic insults at any anatomic site can ultimately slow the passage of solid foods and liquids. Over time, these insults can lead to esophageal stricture formation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The esophagus has multiple compression sites as it courses from the oropharynx to the stomach. These include the cricopharyngeus muscle, aortic arch, left main bronchus, left atria, and esophageal hiatus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cheng, H.T., Cheng, C.L., Lin, C.H., et al. (2008) Caustic ingestion in adults: The role of endoscopic classification in predicting outcome. BMC Gastroenterology. 8, 31. Doi: 10.1186\/1471-230X-8-31.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Smith, C.D. (2015) Esophageal strictures and diverticula. The Surgical Clinics of North America. 95(3), 669-681. Doi: 10.1016\/j.suc.2015.02.017.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;_________________________<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more OMM Questions as well as practice questions for USMLE\u00ae Step 1 and Step 2 CK?&nbsp;<\/strong><\/em><em><strong>Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_7a5611.png?w=700\" alt=\"\" class=\"wp-image-3272\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_7a5611.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_7a5611.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another OMM-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 56-year-old man who has difficulty swallowing. He has a history of jitteriness. Which of the following best describes the affected anatomic site that most likely resulted in this patient\u2019s clinical symptoms?&nbsp;Can you figure it out? [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3315,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,34,16],"tags":[],"class_list":["post-3314","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm","category-do"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: Thoracic muscle energy - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-thoracic-muscle-energy\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: Thoracic muscle energy - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another OMM-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 56-year-old man who has difficulty swallowing. He has a history of jitteriness. Which of the following best describes the affected anatomic site that most likely resulted in this patient\u2019s clinical symptoms?&nbsp;Can you figure it out? 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