iRAT 4 Head and Neck Practice Test 2026 – Complete Exam Prep

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Andrew Phillips, a 22 year old presenting with arm numbness and hand tingling, asks which procedures the medical community would use to reach the same diagnosis. According to the Merck Manual, diagnosis of TOS usually includes which of the following?

Nerve Conduction Study

MRI of the brachial plexus and cervical spine

Clinical evaluation

All of these

Diagnosing thoracic outlet syndrome requires a multifaceted approach because symptoms can mimic other conditions and there isn’t a single test that confirms it. A thorough clinical evaluation—taking history, performing a focused physical exam, and using provocative maneuvers to elicit neurovascular compression—forms the foundation. To support the diagnosis, nerve conduction studies and electromyography assess whether nerve function is affected and help characterize the pattern of involvement. Imaging, specifically MRI of the brachial plexus and cervical spine, visualizes the anatomy around the outlet, can identify sources of compression such as anomalous ribs or scalene muscle hypertrophy, and helps rule out other causes like cervical radiculopathy. Since no one test is definitive, combining clinical evaluation with these studies gives the most reliable assessment, which is why the approach described includes all of these elements.