Notes Flashcards
1
Q
The classic triad of Horner’s syndrome is ptosis, miosis, and anhidrosis. Which of the following structural findings might produce these symptoms on the left?
A. Anterior right clavicle B. Elevated left first rib C. Hypertonic right scalenes D. Inhaled left 3rd rib E. T10 F RR SR
A
B. Elevated left first rib
In terms of osteopathic structural exam in a pt presenting with Horner’s syndrome, attention should be paid to the course of the sympathetic input from the hypothalamus, down to the upper thoracic vertebrae, and back up along the cervical chain ganglion. It finally finds its route along the internal carotid artery until it terminates at target organs on the ipsilateral face and head.
2
Q
Characterized by lateral deviation of the first MTP with female predominance
A. Bunionette deformity B. Calcification of plantar fascia C. Hallux valgus D. Hammertoe deformity E. Morton foot
A
C. Hallux valgus
[aka bunion]
3
Q
Treatment position for inion tenderpoint
A
Marked flexion
4
Q
CV4 bulb decompression is a cranial technique in which the lateral angles of the occiput squama are manually approximated, slightly exaggerating the posterior convexity of the occiput and producing cranial _________
A
Extension
5
Q
Which of the following is the location for the AT6 tenderpoint?
A. Angle of Louis
B. Anterior axillary line on inferior margin of 4th rib
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
D. Midline of xiphosternal junction
E. Tip of the xiphoid
A
D. Midline of xiphosternal junction
6
Q
OSE reveals the sphenoid and occipital bones to be inferior on the left and superior on the right. The left temporal bone and parietal bones appear to be in external rotation. The most likely dx is:
A. Left lateral strain B. Left sidebending rotation C. Left torsion D. Right sidebending rotation E. Right torsion
A
B. Left sidebending rotation
The SBR dysfunction is named for the side of convexity. In this example, the sphenoid and occiput rotate toward the left causing both to be inferior in comparison to the right. Rotation of the sphenoid clockwise and the occiput counterclockwise around their respective vertical axes causes a convexity to form on the left side of the cranium. Palpably the left temporal bone and left parietal bone will feel like they are stuck in external rotation
7
Q
A pt presents 6 weeks after an inversion ankle sprain. He continues to complain of foot pain and PE reveals decreased height of his transverse arch. There is restriction of lateral rotation at the calcaneus with plantar displacement of the cuboid. The most appropriate osteopathic manipulative therapy is
A. Hiss plantar whip B. Locke’s technique C. Metatarsal articulation D. Talar tug E. Talo-calcaneal crunch
A
A. Hiss plantar whip
The Hiss plantar whip technique provides direct force applied to the cuboid. Tarsal bone is carried dorsally to restrictive barrier and HVLA thrust is applied dorsally.
8
Q
Anatomical short leg syndrome results in a _______ sacral base and _______ rotated innominate on the ipsilateral side.
The lumbar spine will rotate ______ and sidebend ______ relative to the short leg.
The iliolumbar and sacroiliac joints will be stressed on the _______ side of the short leg
A
Lower; anteriorly
Toward; away
Ipsilateral
9
Q
Which side is the convexity located in dextroscoliosis?
A
Right
10
Q
Nursemaids elbow results from subluxation of the head of the radius at the elbow. Children present holding their arm in pronation and against the chest wall. What is the technique for reduction?
A
Flex the child’s arm while slowly supinating it
11
Q
Innervation of pronator teres m. and pronator quadratus m.
A
Median n.
12
Q
Scoliosis is usually found in adolescents during routine screening, but may also be found later in life due to symptoms from the misalignment. It is most often idiopathic, but one of the causes of acquired scoliosis is short-leg syndrome. Which of the following is used to calculate the necessary heel lift height?
A. Greater trochanter unleveling B. Sacral base unleveling C. Iliac crest height D. Lateral femoral epicondyle height E. Medial malleoli unleveling
A
B. Sacral base unleveling
The difference in the sides of the sacral base (aka sacral base unleveling) is input into the Heilig formula along with estimated duration of dysfunction, and if any compensation is present to determine the lift required.
13
Q
Which of the following is contraindicated in a pt who recently underwent abdominal surgery?
A. Cervical soft tissue B. CV4 C. Pectoral traction D. Pedal pump E. Rib raising
A
D. Pedal pump
Pedal pump is contraindicated due to tendency to augment thoracoabdominal pressure and potential endangerment of stability of operative site. Other contraindications include DVT or recent lower extremity fracture
14
Q
Chapman’s point on posterior/lateral margin of IT band
A
Prostate in males
Broad ligament in females
15
Q
Muscle(s) and nerve(s) responsible for abduction of the arm up to 90 degrees
A
Suprapinatus (suprascapular n.)
Deltoid (axillary n.)
[beyond 90 degrees it is upper trapezius and serratus anterior]
16
Q
Which of the following is the most appropriate patient position for treating the low ilium tender point with counterstrain?
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
B. Pt supine with b/l flexion of the hips and knees with external rotation of the thighs
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
D. Pt supine with knees and hips flexed and rotated away
E. Pt supine with marked right hip flexion
A
E. Pt supine with marked right hip flexion
17
Q
Following a seizure, a pt is found to be holding his arm in adduction and internal rotation, and is unable to externally rotate the arm. The right coracoid process appears prominent and there is flattening of the anterior shoulder. What type of shoulder dislocation?
A
Posterior dislocation
This is much less common than anterior dislocation and is found classically following electrocution or tonic-clonic seizures due to violent muscle contraction. They result in IR of the arm
18
Q
________ _______ syndrome is a compressive neuropathy of the tibial nerve or its branches, posterior to the medial malleolus. Pain is diffuse and poorly localized to the medial ankle. Paresthesia or dysesthesias are common in the region of medial ankle. Pain is worse with walking or exercise but may also occur at night
A
Tarsal tunnel syndrome
19
Q
Which of the following is the location for the AL4 tenderpoint?
A. Inferior AIIS pressing cephalad B. Lateral AIIS pressing medially C. Medial AIIS pressing laterally D. Medial ASIS pressing laterally E. Superior pubic ramus 1 cm lateral to pubic symphysis
A
A. Inferior AIIS pressing cephalad
Tx involves flexion to the L4-L5 level and rotating L4 away from the point by sidebending the pelvis toward the point
20
Q
Anterior fibular head dysfunctions are coupled with a preference for _______ rotation of the talus, and _________+__________+_________ of the ankle/foot
A
External; dorsiflexion+eversion+abduction
21
Q
Somatic dysfunction of the temporal bone may cause tinnitus.
_______ rotation of the temporal bone causes low-pitched roaring tinnitus and _________ mandible deviation
________ rotation of the temporal bone causes high-pitched humming/buzzing tinnitus and _________ mandible deviation
A
External; ipsilateral
Internal; contralateral
22
Q
What muscle should be treated for ribs 9-11 somatic dysfunctions?
A
Latissimus dorsi m.
23
Q
Which of the following is the location for the AL3 tenderpoint?
A. Inferior AIIS pressing cephalad B. Lateral AIIS pressing medially C. Medial AIIS pressing laterally D. Medial ASIS pressing laterally E. Superior pubic ramus 1 cm lateral to pubic symphysis
A
B. Lateral AIIS pressing medially
Tx by standing on opposite side from tender point, flex pt hips and knees b/l to induce flexion at L3-L4, sidebend pelvis away from point which rotates torso and L3 segment toward the point
24
Q
Why is patellofemoral syndrome more common in females?
A
Females have widened Q angle
25
Chapman’s point 1” superior and 1” lateral to umbilicus
Kidney
26
The paravertebral hump observed in juvenile dextroscoliosis is the result of:
```
A. Contralateral paravertebral atrophy
B. Ipsilateral muscular hypertrophy
C. Spinal extension
D. Spinal rotation
E. Spinal sidebending
```
D. Spinal rotation
Scoliosis is a pathological Fryette type I spinal mechanics. The asymmetric paravertebral prominence is a result of the rotational component of spinal group curves
27
The _______ test is a test for stability of the bicipital tendon in the bicipital groove. It is performed by stabilizing the forearm, then flexing the elbow to 90 degrees with the humerus in neutral position then externally rotating the shoulder/supinating the forearm against resistance.
Yergason’s test
28
Medial epicondylitis is due to a strain or overuse of the ______ muscles within the forearm
Flexor
29
Nerve roots for median nerve
C5, C6, and C7 of lateral cord
C8 and T1 of medial cord
30
Treatment of which of the following may help conditions such as cluster headaches and Horner’s syndrome?
```
A. 1st intercostal space, sternal
B. C3-5 paraspinal muscles
C. Sphenopalatine ganglion
D. Stellate ganglion
E. Venous sinus
```
D. Stellate ganglion
The first paravertebral ganglion associated with the heart is the cervicothoracic (stellate) ganglion, where some preganglionic axons excite ganglion cells whose axons also run directly to the heart. Compression of the stellate ganglion secondary to the upper thoracic or upper rib (elevated first rib) dysfunction has been known to contribute to Cluster headaches. The associated Horner’s syndrome is due to an abnormality with the sympathetic nerve supply to the orbit
31
Ottawa ankle rules
1. Tenderness to palpation along the posterior margin of the medial or lateral malleolus
2. Inability to bear weight immediately after the injury and inability to take 4 steps in the ED
3. The presence of midfoot pain along with pain at the navicular or fifth metatarsal along with inability to bear weight as defined above
[An ankle series is only indicated for pts who have pain in the malleolar zone AND have bone tenderness at posterior region of lateral or medial malleolus OR are unable to bear weight
A foot series is only indicated for pts who have pain in the midfoot zone AND have bone tenderness at the base of the fifth metatarsal or navicular OR are unable to bear weight]
32
Which of the following is used for diagnosis of 1st metatarsal dorsal glide in which force is applied to the joint of the 1st metatarsal and first cuneiform?
```
A. Hiss plantar whip
B. Locke’s technique
C. Metatarsal articulation
D. Talar tug
E. Talo-calcaneal crunch
```
B. Locke’s technique
33
What 3 motions of the foot contribute to ankle supination?
Plantar flexion
Inversion
Adduction
34
Which of the following is the most appropriate patient position for treating piriformis tender point with counterstrain in a pregnant patient?
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
B. Pt supine with b/l flexion of the hips and knees with external rotation of the thighs
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
D. Pt supine with knees and hips flexed and rotated away
E. Pt supine with marked right hip flexion
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
35
What muscle corresponds to the tenderpoint located on the posterior surface of the ascending ramus of the mandible 2 cm above the angle of the mandible on the side opposite of jaw deviation?
Medial pterygoid
36
You diagnose a sacral dysfunction as a right on right sacral torsion. What is the most likely intersegmental somatic dysfunction at L5?
```
A. E RL SR
B. E RR SL
C. F RL SL
D. N RL SR
E. N RR SR
```
D. N RL SR
L5 and the sacrum always rotate in opposite directions. Sidebending of L5 corresponds to the oblique axis on which sacral rotation occurs.
37
What nerve root is tested by the achilles reflex?
S1
Also responsible for dermatome covering much of the posterior thigh and calf and lateral lower leg and lateral foot. The gastrocnemius (responsible for toe-walking) is innervated by S1.
38
What cranial dysfunction is diagnosed when there is perceived motion of the greater wings of the sphenoid travelling too far caudally, and may indicate an axial loading injury?
Superior vertical strain
39
Ankle eversion causes the proximal fibular head to move ______
Anteriorly
40
Which of the following is the location for the AL5 tenderpoint?
```
A. Inferior AIIS pressing cephalad
B. Lateral AIIS pressing medially
C. Medial AIIS pressing laterally
D. Medial ASIS pressing laterally
E. Superior pubic ramus 1 cm lateral to pubic symphysis
```
E. Superior pubic ramus 1 cm lateral to pubic symphysis
Tx by standing same side as tender point, flex the hips and knees b/l to induce flexion to L5-S1 level, sidebend and rotate the pelvis toward the point, which rotates the torso and lumbar segment away from the point
41
Posterior tibia or anterior talus dysfunctions correlate with what motion at the ankle?
Plantar flexion
Posterior tibial or anterior talus dysfunctions are commonly seen in pts whose activities require prolonged plantar flexion, such as dancers or women who wear high heels frequently
42
The __________ is the only muscle involved in opening the jaw, and somatic dysfunction of this muscle will cause the chin to deviate to the ______ side when opening the jaw
Lateral pterygoid; contralateral
43
Which of the following is the most appropriate patient position for treating AL1 and AL5 tender points with counterstrain?
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
B. Pt supine with b/l flexion of the hips and knees with external rotation of the thighs
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
D. Pt supine with knees and hips flexed and rotated away
E. Pt supine with marked right hip flexion
D. Pt supine with knees and hips flexed and rotated away
44
Which of the following is useful for testing for acromioclavicular joint impingement and supraspinatus tendon tear/weakness?
```
A. Hawkin’s sign
B. Jobe’s test
C. Speed’s sign
D. Sulcus sign
E. Yergason test
```
A. Hawkin’s sign
Performed by first having the pt flex their arm and elbow to 90 degrees. Stabilize this position and internally rotate their shoulder. Positive test is pain at AC joint/subacromial space
45
Pt presents with right foot pain and exam reveals excessive right foot pronation while walking, elongation of second digit compared to the first, and callus formation on plantar forefoot under the 2nd and 3rd metatarsal heads. Plain film reveals thickening of second metatarsal bone. Most likely dx?
```
A. Bunionette deformity
B. Calcification of plantar fascia
C. Hallux valgus
D. Hammertoe deformity
E. Morton foot
```
E. Morton foot
Morton foot/Morton’s toe = shortening of first metatarsal in relation to second metatarsal, causing majority of weight bearing to be transferred to second metatarsal. This results in pain in ball and arch of the foot as well as callus formation. Also causes excessive pronation of foot with internal hip rotation and functional shortening of the leg.
Tx is foot orthotics w/ metatarsal pad to redistribute weight bearing to first toe
46
You dx a pt with maxillary sinusitis. OMM to aid in drainage should be directed to the
```
A. Anterior cervical chain
B. Mandibular foramen
C. Pterygopalatine fossa
D. Suboccipital region
E. Supraorbital foramen
```
C. Pterygopalatine fossa
[pterygopalatine ganglion aka sphenopalatine ganglion]
47
The anterior T7 to T9 tender points are located bilaterally, between the tip of the xiphoid and umbilicus. What is the treatment positioning for these?
F StRa, with pt supine
48
Chapman’s point on the lesser trochanter of the femur
Rectum
49
Which of the following is the most helpful for dysmenorrhea?
```
A. Celiac ganglion release
B. HVLA lumbar spine
C. Lateral thigh chapman inhibition
D. Pelvic diaphragm release
E. Sacral inhibition
```
E. Sacral inhibition
50
What muscle should be treated for ribs 3-5 somatic dysfunctions?
Pectoralis minor m.
51
OSE reveals the left greater wing of the sphenoid bone is more inferior in comparison to the right greater wing. The right side of the occipital bone is lower than the left. What is the most likely dx?
```
A. Inferior shear
B. Left sidebending rotation
C. Left torsion
D. Right sidebending rotation
E. Right torsion
```
E. Right torsion
A torsional strain pattern occurs when the sphenoid and occipital bones rotate in opposite directions around an AP axis that runs through the sphenoid and occiput. This motion occurs in a coronal plane
52
The most common cause of scapular winging is injury to the long thoracic nerve that results in paralysis of the serratus anterior m. The nerve roots most likely affected are
```
A. C3-5
B. C4-6
C. C5-7
D. C6-8
E. C7-T1
```
C. C5-7
Nerve roots C3-5 make up the phrenic nerve which innervates the diaphragm. The C5-6 nerve roots supply the musculocutaneous, radial, axillary, suprascapular, superior subscapular, and inferior subscapular innervating muscles in the arm and shoulder girdle. The C4 nerve root provides part of the innervation to the levator scapulae with the nerve root of C3 and dorsal scapular nerve (C5). The C6-8 nerve roots supply the musculocutaneous, median, radial, and thoracodorsal nerves. The C7-T1 nerve roots supply the median, ulnar, and radial (posterior interosseous nerves).
53
Which of the following is the location for the AL2 tenderpoint?
```
A. Inferior AIIS pressing cephalad
B. Lateral AIIS pressing medially
C. Medial AIIS pressing laterally
D. Medial ASIS pressing laterally
E. Superior pubic ramus 1 cm lateral to pubic symphysis
```
C. Medial AIIS pressing laterally
Tx by standing opposite tender point, flex hips and knees b/l to L2-L3 level, sidebend pelvis away from point which rotates torso and L2 segment toward point
54
Claw hand deformity is caused by injury to the ____ nerve
Ulnar
55
In short leg syndrome, the sacral base will be _______ on the side of the short leg. The innominate will be rotated ________ on the short side, and the lumbar spine will be sidebent ______ and rotated ______ the short side.
Lower; anteriorly; away; toward
56
Which of the following is the location for the AT2 tenderpoint?
A. Angle of Louis
B. Anterior axillary line on inferior margin of 4th rib
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
D. Midline of xiphosternal junction
E. Tip of the xiphoid
A. Angle of Louis
57
A Travell trigger point in the right pectoralis muscle may cause or perpetuate a supraventricular tachyarrhythmia. Where would you expect to find a Chapman’s reflex associated with cardiac pathology?
Left 2nd intercostal space near the sternum
58
During physiologic cranial extension, you expect the base of the occiput will
A. Ascend and parietal bones will externally rotate
B. Ascend and the parietal bones will internally rotate
C. Ascend and the temporal bones will internally rotate
D. Descend and the parietal bones will externally rotate
E. Descend and the temporal bones will internally rotate
E. Descend and the temporal bones will internally rotate
During craniosacral extension, the basiocciput and basisphenoid will descend toward the sacrum and the paired bones (temporal and parietal) will internally rotate. The overall impression is that the cranium narrows.
59
Anterior shoulder dislocations result in _______ rotation of the arm, and pts are at risk for _______ nerve injury resulting in sensory loss over deltoid and upper arm
External; axillary
60
Normal CRI
10-14 cycles per minute
61
The _______ tenderpoint is located anterior to the ascending ramus of the mandible. Hypertonicity of this muscle can cause jaw deviation to the ipsilateral side when lowering the jaw
Masseter
[note that medial pterygoid causes contralateral jaw deviation with lowering of the jaw]
62
Which of the following is the location for the AT7 tenderpoint?
A. Angle of Louis
B. Anterior axillary line on inferior margin of 4th rib
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
D. Midline of xiphosternal junction
E. Tip of the xiphoid
E. Tip of the xiphoid
63
In treating short leg syndrome, the maximum heel lift possible is _______ mm. For larger leg length discrepancies, a shoe lift is necessary.
Heel lifts should start at 3 mm, and increased by 3 mm every _______ to allow the body to adapt to change
10-12 mm
1-2 weeks
64
What type of cranial dysfunction should be suspected in a pt with history of injury applied in an axial direction (above or below); the practitioners hands will feel as though the sphenoid is moving very minimally caudad and is overall restricted?
Inferior vertical strain
65
Exam reveals a tender point located 1 cm lateral to the pubic symphysis on the superior ramus. Name the tenderpoint and treatment position
AL5
FSaRa
66
What muscle should be treated for ribs 6-8 somatic dysfunctions?
Serratus anterior m.
67
Which of the following pertains to dorsal nerve roots as they relate to specific dermatomes, as well as the concept of reciprocal inhibition?
```
A. Law of Laplace
B. Percutaneous reflex of Morley
C. Sensitization of the least splanchnic nerve
D. Sherrington’s law
E. Wolff’s law
```
D. Sherrington’s law
68
There are several types of winging of the scapula, including lateral and medial winging. Medial winging of the scapula is due to _________ muscle paralysis, while lateral winging of the scapula (much less common) is typically due to ________ muscle paralysis
Serratus anterior; trapezius
69
Which of the following is the location for the AR4 tenderpoint?
A. Angle of Louis
B. Anterior axillary line on inferior margin of 4th rib
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
D. Midline of xiphosternal junction
E. Tip of the xiphoid
B. Anterior axillary line on inferior margin of 4th rib
70
An 18 y/o presents with left elbow pain after falling onto it 2 days ago. PE reveals tenderness and swelling over the left medial epicondyle and a clawed hand. Muscle strength exam is most likely to reveal loss of
```
A. Arm abduction beyond 90 degrees
B. Forearm pronation
C. Forearm supination
D. Thumb adduction
E. Wrist extension
```
D. Thumb adduction
This pt is suffering ulnar nerve damage at the elbow, likely due to medial epicondyle fracture. This is represented by claw hand deformity which is flexion at PIPs and DIPs of 4th and 5th digits along with MCP extension of the 4th and 5th digits. It results from loss of innervation to the lumbricals of 4th and 5th digits which results in unopposed action of extensor muscles.
The ulnar nerve is comprised of nerve roots C8-T1 and is responsible for abduction and adduction of the fingers. It also innervates the adductor pollicis muscle, responsible for thumb adduction. The adductor pollicis is the only muscle of the thenar eminence innervated by the ulnar nerve, the rest are innervated by the median nerve.
71
The ______ _______ fascia encloses the lymphatic vessel for which it is named. It is a sac-like structure that receives the lower body (subdiaphragmatic) lymphatic fluid, almost entirely. It becomes the _______ ______ once it passes through the aortic hiatus into the thorax
Cysterna chyli; thoracic duct
72
What nerve root is responsible for medial lower leg sensation, ankle dorsiflexion, and part of knee extension?
L4
73
Which of the following pertains to forces exerted against the walls of a structure from the inside, often applied to aneurysms?
```
A. Law of Laplace
B. Percutaneous reflex of Morley
C. Sensitization of the least splanchnic nerve
D. Sherrington’s law
E. Wolff’s law
```
A. Law of Laplace
74
With extension at the SBS, you expect the sacral base to be _________ (anterior/posterior) and _________ (superior/inferior)
Anterior; inferior
75
Which of the following is most likely to be weak in a pt with L4 radiculopathy?
A. Abduction of lower extremity
B. Dorsiflexion and inversion of the foot
C. Dorsiflexion of the great toe
D. Flexion of the hip and extension of the knee
E. Plantarflexion and eversion of the foot
B. Dorsiflexion and inversion of the foot
L4 nerve root compression causes decreased patellar reflex, decreased sensation at medial leg/foot, and weakness with foot/ankle inversion and dorsiflexion
76
What muscle should be treated for rib 12 somatic dysfunctions?
Quadratus lumborum m.
77
13 y/o presents with c/o bilateral posterior heel pain. There is no pain at rest or with walking, but worsens within a few minutes of playing lacrosse. There is no swelling or tenderness of heel or achilles tendon. There is pain with medial-lateral compression at insertion of achilles tendon b/l. Reflexes, strength, and sensation intact. There is b/l posterior heel pain upon passive dorsiflexion of the ankles. Most likely dx?
```
A. Achilles tendonopathy
B. Calcaneal apophysitis
C. Heel pad syndrome
D. Plantar fasciitis
E. Tarsal tunnel syndrome
```
B. Calcaneal apophysitis
Aka sever disease — MCC of heel pain in children, usually between 5-11 y/o. Tx involves decreasing pain-inducing activities, anti-inflammatories, ice, stretching, and strengthening of gastrocnemius-soleus complex, and use of orthotics
78
What muscle should be treated for ribs 1-2 somatic dysfunctions?
Scalenes
79
Which of the following is the most appropriate patient position for treating lumbar L5 tender point with counterstrain?
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
B. Pt supine with b/l flexion of the hips and knees with external rotation of the thighs
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
D. Pt supine with knees and hips flexed and rotated away
E. Pt supine with marked right hip flexion
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
[note that L5 is a maverick tenderpoint]
80
Which of the following is associated with a dropped navicular bone?
```
A. Decreased medial longitudinal arch
B. Positive anterior drawer test
C. Positive posterior drawer test
D. Posterior fibular head
E. Tender lateral longitudinal arch
```
A. Decreased medial longitudinal arch
The medial longitudinal arch is made up of the calcaneus, talus, cuneiforms, and first three metatarsals. The navicular bone is the keystone of the medial longitudinal arch.
The lateral longitudinal arch is comprised of the calcaneus, cuboid, and fourth and fifth metatarsals.
81
In plantar flexion, the distal talus moves _______ and the tibia moves _______
Anteriorly; posteriorly
82
Which of the following explains the phenomenon of pain and/or guarding of the abdomen upon palpation in the presence of visceral pathology?
```
A. Law of Laplace
B. Percutaneous reflex of Morley
C. Sensitization of the least splanchnic nerve
D. Sherrington’s law
E. Wolff’s law
```
B. Percutaneous reflex of Morley
83
The _______ _______ m. is the only muscle of the thenar eminence innervated by the ulnar nerve. The rest are innervated by the ________ n.
Adductor pollicis; median
84
Viscerosomatics for proximal vs. distal ureter
T10-T11 = proximal ureter
T12-L2 = distal ureter
85
List steps for Spencer’s technique in order
1. Extension
2. Flexion
3. Circumduction with compression
4. Circumduction with traction
5. Abduction
6. Internal rotation
7. Pump
[EFCTAIP]
86
What 3 foot motions contribute to ankle pronation?
Dorsiflexion
Eversion
Abduction
87
Forearm supination is a function of the _______ nerve innervating the biceps brachii and the posterior interosseous division of the _____ nerve innervating the supinator m.
Musculocutaneous; radial
88
A 15 y/o male presents with c/o back pain and poor posture with reports of always slouching. PE reveals abrupt anterior curvature of the spine that is worse in flexion. He has a normal neuro exam. X-ray reveals Schmorl’s nodes. Most likely dx?
```
A. Congenital kyphosis
B. Congenital scoliosis
C. Postural kyphosis
D. Scheuermann kyphosis
E. Spondylolisthesis
```
D. Scheuermann kyphosis
This condition is characterized by rigid curvature that is not corrected with changes in position. Radiographic findings are anterior wedging of at least 3 adjacent vertebral bodies and endplate abnormalities. Schmorl’s nodes are small protrusions of the intervertebral discs into adjacent vertebral bodies. The etiology is unknown but the disease is typically diagnosed in adolescent boys during rapid growth period
89
Patellofemoral syndrome shows a female predominance and is characterized by anterior and deep knee pain. Weakness in which of the following muscles most likely contributes to the pain associated with patellofemoral syndrome?
```
A. Piriformis
B. Biceps femoris
C. IT band
D. Gastrocnemius and soleus
E. Vastus medialis oblique
```
E. Vastus medialis oblique
With patellofemoral syndrome, the vastus medialis and vastus lateralis compete for tracking of the patella during motion of the knee. Patients usually complain of pain with loading of the joint during flexion-extension, such as climbing stairs or running. To address this, patients are instructed to focus on the VMO by isometric contraction. The VMO is most active during the final 10-15 degrees of knee extension
90
For symptomatic relief of sinusitis including nasal congestion and rhinorrhea, osteopathic manipulation should focus on the:
```
A. 1st intercostal space, sternal
B. C3-5 paraspinal muscles
C. Sphenopalatine ganglion
D. Stellate ganglion
E. Venous sinus
```
C. Sphenopalatine ganglion
Intraoral stimulation of the sphenopalatine ganglia, inhibition of the lateral pterygoid muscle trigger points, and CV4 and trigeminal nerve stimulation techniques will produce parasympathetic stimulation and production of thin nasal secretions
91
Sidebending rotations occur around _____ separate axes. What are they?
3 separate axes — 1 anterior-posterior, 2 vertical
The sphenoid and occiput rotate in the same direction around one anterior-posterior axis that passes through the sphenoid and occiput. They also rotate in opposite directions around 2 vertical axes. One vertical axis passes through the sphenoid, the other through the foramen magnum within the occipital bone
92
Chapman’s reflex for the _______ is located along the superior edge of the 2nd rib anteriorly, approximately at the midclavicular line. Note that the reflexes for the _____ and ______ are located more medially.
Sinuses; larynx; tongue
93
In a sudden acquired leg length discrepancy, such as after a total hip arthroplasty or hip fracture, the target heel lift height should correct the full amount of the discrepancy.
In long-standing, anatomical leg length discrepancies, the final heel lift height should be _____ to _____ the measured leg length discrepancy.
1/2 to 3/4
94
The crus of the diaphragm attach to what lumbar levels?
L1-L3
95
Which of the following is the location for the AL1 tenderpoint?
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A. Inferior AIIS pressing cephalad
B. Lateral AIIS pressing medially
C. Medial AIIS pressing laterally
D. Medial ASIS pressing laterally
E. Superior pubic ramus 1 cm lateral to pubic symphysis
```
D. Medial ASIS pressing laterally
Tx by standing same side as tender point, flex the hips and knees b/l to induce flexion to L1-L2 level, sidebend pelvis toward the point, which rotates torso and L1 away from point
96
After cranial OSE, you diagnose a patient with a left sidebending rotation. The axes of rotation in this patient’s dysfunction are
A. One AP axis and two transverse axes
B. One AP axis and two vertical axes
C. One transverse axis and two vertical axes
D. Two AP axes and one vertical axis
E. Two transverse axes and one vertical axis
B. One AP axis and two vertical axes
97
Which of the following is the location for the AT5 tenderpoint?
A. Angle of Louis
B. Anterior axillary line on inferior margin of 4th rib
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
D. Midline of xiphosternal junction
E. Tip of the xiphoid
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
98
Forward sacral torsions correlate with type ____ dysfunctions at L5, and backward sacral torsions correlate with type ____ dysfunctions at L5
Type I; Type II
99
Mid shaft humerus fractures cause injury to the ____ nerve and result in wrist drop
Radial
100
Cranial sidebending rotation dysfunctions are named for the side of ________
Convexity
101
Abnormal bony protruberance on lateral side of fifth MTP with overlying hard corn frequently present. Associated with tight-fitting narrow pointed shoes.
```
A. Bunionette deformity
B. Calcification of plantar fascia
C. Hallux valgus
D. Hammertoe deformity
E. Morton foot
```
A. Bunionette deformity
102
Fixed flexion deformity at PIP joint without deformity of DIP or MTP joints. Often functional and may be associated with myofascial trigger pionts in dorsal interossei of the foot
```
A. Bunionette deformity
B. Calcification of plantar fascia
C. Hallux valgus
D. Hammertoe deformity
E. Morton foot
```
D. Hammertoe deformity
103
Which of the following pertains to the idea that bone structure will remodel to help support the patterns of stress?
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A. Law of Laplace
B. Percutaneous reflex of Morley
C. Sensitization of the least splanchnic nerve
D. Sherrington’s law
E. Wolff’s law
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E. Wolff’s law
104
Structural exam of the cranium reveals the sphenoid prefers anterior rotation with the base of the occiput inferior relative to the base of the sphenoid. Name the dysfunction
Superior vertical shear
105
What type of cranial dysfunction should be suspected in a pt with history of a direct blow in the anterior-posterior direction and vice versa?
SBS compression
106
Before entering the venous system, lymphatic drainage from the right arm will pass through which of the following?
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A. Cysterna chyli fascia
B. Left thoracic inlet
C. Right hemidiaphragm fascia
D. Right thoracic inlet
E. Thoracic duct fascia
```
D. Right thoracic inlet
The majority of lymphatic fluid flows through the left thoracic duct, which flows into the left subclavian vein. However, the right thoracic duct receives drainage of the right upper extremity, the right side of the head and neck, the heart, and a portion of the lungs. The right thoracic inlet is also known as Sibson’s fascia.
107
_______ sign is a test for bicipital tendon stability in the bicipital groove. It is performed by having the pt flex their arm to 90 with the elbow extended and forearm in supination. Then apply a downward force and instruct pt to keep the arm flexed. This engages the arm flexors and a positive test is pain at the bicipital groove
Speed’s sign
