Match List I with List II:

List I (Tissue of origin of pain): List II (Site of Referred pain):

(A) Heart, (I)Groin

(B) Uterus, (II) Right shoulder,

(C) Kidney, (III) Low Back,

(D) Liver (IV) Left shoulder

Choose the correct answer:

1. A

   (A)-(III), (B)-(IV), (C)-(II), (D)-(I)

2. B

   (A)-(III), (B)-(IV), (C)-(I), (D)-(II)

3. C

   (A)-(IV), (B)-(III), (C)-(II), (D)-(I)

4. D

   (A)-(IV), (B)-(III), (C)-(I), (D)-(II)

Appeared in: BHU NO - 12 April 2024

Explanation

• The correct combination is (A)-(IV), (B)-(III), (C)-(I), (D)-(II).
• Pain from the heart (A) is classically referred to the left shoulder (IV) because their sensory nerves converge at the same spinal cord levels (C3-T5).
• Uterine pain (B), such as from labor or menstruation, is commonly felt in the low back (III).
• Kidney pain (C), often from renal colic, radiates from the flank down to the groin (I).
• Liver or gallbladder inflammation (D) irritates the diaphragm, causing referred pain to the right shoulder (II) via the phrenic nerve.

Why Other Options Were Wrong

• Option A: This option incorrectly matches the Heart with the Low Back and the Uterus with the Left shoulder. Cardiac pain refers to the left shoulder, and uterine pain refers to the low back.
• Option B: This option incorrectly matches the Heart with the Low Back and the Uterus with the Left shoulder. While it correctly matches the Kidney and Liver, the initial pairings are wrong.
• Option C: This option incorrectly matches the Kidney with the Right shoulder and the Liver with the Groin. Kidney pain refers to the groin, and liver pain refers to the right shoulder.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Referred Pain Patterns for Visceral Organs as background academic context rather than a clinical decision trigger.
• Recognizing referred pain patterns is a critical diagnostic skill for nurses. It allows for rapid assessment and suspicion of serious underlying conditions.
• A patient presenting with left shoulder, arm, or jaw pain should be immediately evaluated for a potential myocardial infarction (heart attack).
• Understanding these patterns helps differentiate between musculoskeletal pain and more serious visceral pain, guiding appropriate interventions and escalation of care.

How to Approach the Question

• First, understand the question type. This is a 'Match the Following' question requiring knowledge of specific physiological facts.
• Analyze List I (Origin of Pain) and List II (Site of Referred Pain).
• Take each organ from List I one by one and recall its classic referred pain location. For example, start with 'Heart'.
• Recall that heart pain is referred to the left shoulder. Find 'Left shoulder' in List II, which is item (IV). So, the first pair is (A)-(IV).
• Repeat this process for Uterus (B) → Low Back (III), Kidney (C) → Groin (I), and Liver (D) → Right shoulder (II).
• Finally, look for the option that contains the complete correct set of matches: (A)-(IV), (B)-(III), (C)-(I), (D)-(II).

Concept Tested & Keywords

• Concept Tested: Referred Pain Patterns for Visceral Organs
• Stem keywords: Referred pain, Heart, Uterus, Kidney, Liver
• Lead-in keywords: Match List I with List II, Choose the correct answer

Question ID

QFrn4tVE56wKsYmxKisoRB

Copy ID

Reference Book

E6 Physiology Essentials Sembulingam 10e Part 3 p. 110-112

E6 Physiology Guyton 4SAE Part 3 p. 108-110

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 11-13