A 53-year-old man comes to the physician because of a 3-month history of noproductive cough. He has also had a 4.6-kg (10-lb) weight loss over the past 6 months. He has smoked one pack of cigarettes daily for 35 years. He recently developed left shoulder pain. Examination shows dry mucous membranes. The pupils are equal and react sluggishly to light. An x-ray of the chest shows a pulmonary nodule in the left lung. Compression of a nerve arising from which of the following locations is most likely causing this patient's recent symptoms?

Question

A 53-year-old man comes to the physician because of a 3-month history of noproductive cough. He has also had a 4.6-kg (10-lb) weight loss over the past 6 months. He has smoked one pack of cigarettes daily for 35 years.   He recently developed left shoulder pain. Examination shows dry mucous membranes. The pupils are equal and react sluggishly to light. An x-ray of the chest shows a pulmonary nodule in the left lung. Compression of a nerve arising from which of the following locations is most likely causing this patient's recent symptoms?

Quizplus · Accepted Answer

Eductional Objective: The phrenic nerve arises from the C3-C5 segments of the spinal cord and innervates the ipsilateral hemidiaphragm.  Intrathoracic spread of lung cancer may affect the phrenic nerve, causing hiccups and diaphragmatic paralysis with dyspnea.  Brachial plexus involvement can cause pain in the distribution of the C8, T1, and T2 nerve roots.  Involvement of the recurrent laryngeal nerve may cause hoarseness.

A 53-Year-Old Man Comes to the Physician Because of a 3-Month