OMT Flashcards
Acute or chronic?
Decreased tone, flaccid, mushy, cool, pale, doughy, stringy, fibrotic, thickened, contracted
Chronic
Acute or chronic?
Increased tone, warm, moist, red, inflamed, boggy, edematous
Acute
3 fryette principles
- In neutral, SB precedes rotation and they occur in opposite directions (group SD)
- In non-neutral (F or E), SB and rotation occur in same direction (single segment SD)
- (Nelson) — motion in one plane diminishesd ability for motion in other planes
[Note: Fryette 1 and 2 only apply to thoracic and lumbar]
Facet orientation in cervical, thoracic, lumbar
BUM — cervical — backward, upward, medial
BUL — thoracic — backward, upward, lateral
BUM — lumbar — backward, upward, medial
Muscle contraction that results in the approximation of the muscle’s origin and insertion without a change in its tension; operator’s force is less than patient’s force
A. Concentric contraction B. Eccentric contraction C. Isotonic contraction D. Isolytic contraction E. Isometric contraction
C. Isotonic contraction
Muscle contraction that results in the increase in tension without an approximation of origin and insertion; operator’s force and patient’s force are equal
A. Concentric contraction B. Eccentric contraction C. Isotonic contraction D. Isolytic contraction E. Isometric contraction
E. Isometric contraction
Muscle contraction against resistance while forcing the muscle to lengthen; operator’s force is greater than patient force
A. Concentric contraction B. Eccentric contraction C. Isotonic contraction D. Isolytic contraction E. Isometric contraction
D. Isolytic contraction
Muscle contraction that results in the approximation of the muscles origin and insertion
A. Concentric contraction B. Eccentric contraction C. Isotonic contraction D. Isolytic contraction E. Isometric contraction
A. Concentric contraction
Lengthening of muscle during contraction due to an external force
A. Concentric contraction B. Eccentric contraction C. Isotonic contraction D. Isolytic contraction E. Isometric contraction
B. Eccentric contraction
The _____ ligament extends from the sides of the dens to the lateral margins of the foramen magnum. The _______ ligament of the atlas attaches to the lateral masses of C1 to hold the dens in place. RA and Downs synrome can weaken these ligaments leading to atlanto-axial subluxation
Alar; tranverse
Primary motions at OA and AA
OA: Flexion/extension (SB and rotation occur in opposite directions)
AA: rotation
Primary motion frm C2-C4 and from C5-C7
C2-C4: rotation
C5-C7: sidebending
The articular masses on the lateral aspects of the cervical vertebrae are most appropriately described as:
A. Anterior to the cervical transverse processes
B. The cervical transverse processes
C. The bone located between the superior and inferior facets
D. Medial to the cervical lamina
E. Medial to the cervical pedicle
C. The bone located between the superior and inferior facets
Indications for treatment of the ______ ganglion include thick secretions associated with a URI. The goal of treatment is to enhance ________ activity, which decreases goblet cells and thus encourages thin watery secretions
Sphenopalatine ganglion
Muscle of the shoulder that abducts, flexes, and extends shoulder
Deltoid
Innervation of deltoid
axillary n. (C5, C6)
Muscle of the shoulder that abducts arm
Supraspinatus
Innervation of supraspinatus and infraspinatus
Suprascapular n. (C4, C5, C6)
2 muscles of the shoulder that externally rotate arm
Infraspinatus
Teres minor
________ is a shoulder muscle that internally rotates the arm
________ is a shoulder muscle that adducts AND internally rotates the arm
_______ is a shoulder muscle that adducts, extends, AND internally rotates the arm
Subscapularis m.
Teres major m.
Lat.Dorsi m.
Innervation of subscapularis m.
Upper and lower subscapular n. (C5, C6, C7)
Innervation of teres major m.
Lower subscapular n. (C6, C7)
Innervation of Lat dorsi
Thoracodorsal n. (C6, C7, C8)
Rule of 3’s for thoracic spinous processes
T1-3 — located at the level of corresponding transverse processes
T4-6 — located 1/2 a segment below corresponding transverse processes
T7-9 — located at the level of the transverse process of the vertebrae below
T10 follows T7-9
T11 follows T4-6
T12 follows T1-3
The sternal angle (angle of Louis) attaches to rib ____ and is level with T____
Rib 2; T4
Main motion of the thoracic spine
Rotation
Which rib is considered atypical because it has a large tuberosity on the shaft for the serratus anterior?
Rib 2
Which ribs are considered atypical because they articulate only with the corresponding vertebrae and lack tubercles?
Rib 11 and 12
Ribs ___-____ are considered false ribs because they do not attach directly to the sternum
8-12
Which ribs are characterized by pump handle, bucket handle, and caliper motion?
1-5 = primarily pump handle
6-10 = primarily bucket handle
11-12 = primarily caliper
Most common anomaly of the lumbar spine
Facet (zygopophyseal) trophism — asymmetry of the facet joint angles where instead of following BUM pattern, they are more closely aligned to the coronal plane
Bony deformity in which one or both of the transverse processes of L5 are long and articulate with the sacrum
Sacralization
Main motion of lumbar spine
Flexion/extension
Sidebending of L5 will cause a sacral oblique axis to be engaged in the _______ direction
Rotation of L5 will cause the sacrum to rotate in the ______ direction
Same
Opposite
98% of lumbar disc hernations occur at what 2 levels?
Between L4-5
Between L5-S1
A herniation of the L3-L4 disc results in pressure on the _____ nerve root
L4
[A herniated disc in the lumbar region will exert pressure on the nerve root of the vertebrae below]
A flexion contracture of the iliopsoas is often associated with what type of lumbar dysfunction?
F or E dysfunction of L1 or L2
Anterior displacement of one vertebrae in relation to the one below; often occurs at L4 or L5 and is usually due to fatigue fractures in the pars interarticularis of the vertebrae
Spondylolisthesis
A defect usually of the pars interarticularis without anterior displacement of the vertebral body; oblique views on imaging will identify a fracture of the pars interarticularis often seen as a “collar” on the neck of a scotty dog
Spondylolysis
Radiographical term for degenerative changes within the intervertebral disc and ankylosing of adjacent vertebral bodies
Spondylosis
The Cobb angle for scoliosis is measured by: 1. Draw horizontal lines from the vertebral bodies of the extreme ends of the curve. 2. Draw perpendicular lines from these horizontal lines and measure the acute (Cobb) angle.
What degrees are associated with mild, moderate, and severe scoliosis?
Mild = 5-15 degrees
Moderate = 20-45 degrees
Severe = >50 degrees
At what degree of scoliosis is respiratory and cardiovascular function compromised?
Respiratory function is compromised if thoracic curvature is >50
CV function is compromised if thoracic curvature is >75
Short leg syndrome compensation at the sacral base
Sacral base will be lower on the side of the short leg
Short leg syndrome compensation at the innominate
Short leg side = anterior innominate rotation
Long leg side = posterior innominate rotation
Short leg syndrome compensation at the lumbar spine
Lumbar spine will sidebend away and rotate toward the side of the short leg
Lumbosacral (Ferguson’s) angle will increase 2-3 degrees
Accessory pelvic ligament that divides the greater and lesser sciatic foramen
Sacrospinous ligament
During craniosacral flexion, the sacral base rotates posteriorly, aka ___________
[nutation or counternutation?]
Counternutation
During craniosacral extension, the sacral base rotates anteriorly, or _______
[nutation or counternutation?]
Nutation
Postural motion of the sacrum occurs about the middle transverse axis. As a person begins to bend forward, the sacral base moves _____
At terminal flexion, the _______ ligaments become more taut, and the sacral base will move ______
Anteriorly
Sacrotuberous; posteriorly
Dynamic motion of the sacrum is that which occurs during ambulation. Weight bearing on the left leg (stepping forward with the right leg) will cause a _____ sacral axis to be engaged
Left
When motion testing the sacrum, the seated flexion test is found on the ______ side of the oblique axis
Opposite
If L5 is F RR SR, testing the sacrum will reveal:
A positive seated flexion test on the ______
The sacrum will be rotated to the _____ on a _____ oblique axis
Left
Left; right
If L5 is N SL RR, sacrum testing will reveal:
A positive seated flexion test on the ____
The sacrum will be rotated to the _____ on a _____ oblique axis
Right
Left; left
In sacral torsions, L5 will always rotate to the _____ side relative to the sacrum
Recently, the educational council on osteopathic principles has recognized another sacral SD called sacral rotation on an oblique axis. This dysfunction is similar to sacral torsions, however L5 is rotated to the ____ side relative to the sacrum
Opposite
Same
Cause of TOS if positive adsons test
Compression between scalenes
Cause of TOS if positive military posture test
Compression between clavicle and rib 1
Cause of TOS if hyperextension test is positive
Compression under pec minor
Continuous impingement of the greater tuberosity against the acromion as the arm is flexed and internally rotated
Supraspinatus tendinitis
Humeral dislocation usually occurs _____ and _______; injury to the _____ n. can occur
Anteriorly; inferiorly; axillary
Winging of the scapula is usually weakness in the ________ muscle due to a _____ nerve injury
Serratus anterior; long thoracic n
Most common brachial plexus injury causing upper arm paralysis due to C5 and C6 damage
Erb duchenne palsy
Which of the following is the primary internal rotator of the humerus?
A. Teres minor B. Subscapularis C. Infraspinatus D. Pectoralis minor E. Deltoid
B. Subscapularis
The head of the femur will glide ________ with external rotation of the hip
Anteriorly
The head of the femur will glide posteriorly with _____ _____ of the hip
Internal rotation
What 3 motions at the ankle create pronation?
Dorsiflexion
Eversion
Abduction
What 3 motions at the ankle create supination?
Plantarflexion
Inversion
Adduction
The fibular head will glide ______ with pronation of the foot
Anteriorly
The fibular head will glide posteriorly with ____ of the foot
Supination (plantarflexion, inversion, adduction)
The Q angle is formed by the intersection of a line from the ASIS through the middle of the patella, and a line from the tibial tubercle through the middle of the patella. A normal Q angle is 10-12 degrees. An increased Q angle is referred to as _______
Genu valgum — knock kneed
With patellofemoral syndrome, an imbalance of musculature of the quads (strong vastus lateralis and weak vastus medialis) causes the patella to deviate ______ and eventually lead to irregular or accelerated wearing on the _____ surface of the patella. The quadriceps imbalance is generally thought to be due to biomechanics related to a _____ Q angle
Laterally; posterior; larger
Partial tear resulting in decreased tensile strength with mild to moderate laxity. What degree of sprain?
A. First degree
B. Second degree
C. Third degree
D. None of the above
B. Second degree
No tear resulting in good tensile strength and no laxity. What degree of sprain?
A. First degree
B. Second degree
C. Third degree
D. None of the above
A. First degree
Complete tear resulting in no tensile strength and severe laxity. What degree of sprain?
A. First degree
B. Second degree
C. Third degree
D. None of the above
C. Third degree
O’donahue’s triad
Common knee injury resulting in injury to ACL, MCL, and medial meniscus
Plantarflexion is paired with _____ glide of the talus
Dorsiflexion is paired with _____ glide
Anterior
Posterior
The talus is wider anteriorly, making the foot more stable in _____
Dorsiflexion
[this is why 80% of ankle sprains occur in plantarflexion]
The _____ joint acts mostly as a shock absorber in the foot, and also allows internal and external rotation of the leg while the foot is fixed
Subtalar joint (talocalcaneal)
What bones form the medial longitudinal arch of the foot?
Talus
Navicular
Cuneiforms
1-3rd metatarsals
What bones form the lateral longitudinal arch of the foot?
Calcaneus
Cuboid
4-5th metatarsals
What bones form the transverse arch of the foot?
Navicular
Cuneiforms
Cuboid
The 3 lateral stabilizers of the ankle prevent excess supination and include anterior talofibular, calcaneofibular, and posterior talofibular. Due to the less stable supination position of the ankle, sprains often cause damage to these ligaments. How does this relate to their classification as type I, II, or III?
Type I involves ATF
Type II involves ATF and calcaneofibular
Type III involves ATF, calcaneofibular, and PTF
With a posterior fibular head dysfunction, ______ of the ankle will be restricted on the affected side
Dorsiflexion
The condition in which there is a decrease in the angle between the neck and shaft of the femur is called
A. Coxa valga B. Coxa vara C. Genu varum D. Genu valgum E. A decreased Q angle
B. Coxa vara
A decreased Q angle is associated with:
A. Genu valgum
B. Patellofemoral syndrome
C. A bow legged appearance
D. Coxa vara
C. A bow legged appearance
Dr. William Garner Sutherland stated that the CNS, CSF, dural membranes, cranial bones, and sacrum functioned as a unit that he called the ______
Primary respiratory mechanism (PRM)
5 anatomical-physiological elements of the primary respiratory mechanism (PRM)
- The inherent motility of the brain and spinal cord
- Fluctuation of CSF
- The movement of the intracranial and intraspinal membranes
- The articular mobility of the cranial bones
- The involuntary mobility of the sacrum between the ilia
The brain and spinal cord lengthens and thins during the _____ phase, and shortens/thickens during the _____ phase of the PRM
Exhalation; inhalation
Normal rate of the Cranial Rhythmic Impulse (CRI)
10-14 cycles per minute
4 major dural attachment points
Foramen magnum
C2
C3
S2
The meninges act as an inelastic rope causing the cranial bones to move in response to motility of the brain, spinal cord, and fluctuation of the CSF. Sutherland called this “inelastic rope” the ____________, which has been described as an automatic, shifting, suspension fulcrum
Reciprocal tension membrane (RTM)
Flexion will ____ the head slightly and _____ its AP diameter
Widen; decrease
Flexion of the SBS will cause the dura to be pulled cephalad, resulting in _____ of the sacrum
Counternutation (extension)
Craniosacral flexion is associated with what motions at the midline bones, sacral base, AP diameter of the cranium, and paired bones?
Flexion of midline bones
Sacral base posterior (counternutation)
Decreased AP diameter of the cranium
External rotation of paired bones
Craniosacral extension is associated with what motions at the midline bones, sacral base, AP diameter of the cranium, and paired bones?
Extension of midline bones
Sacral base anterior (nutation)
Increased AP diameter of the cranium
Internal rotation of the paired bones
_____ strain of the SBS can result in severely decreased CRI. It is usually due to trauma, especially to the back of the head
Compression
CN X SD can be due to ____, ____, and/or _____ dysfunction
OA, AA, C2
[occipital] condylar compression can affect CN ____, resulting in poor suckling in the newborn. Dysfunctions of ____ and _____ at the jugular foramen can also cause suckling dysfunctions in the newborn
XII; IX; X
The venous sinuses drain approximately 85-95% of the blood from the cranium. The remaining 5% of venous blood drains via the facial veins and external jugular. The purpose of the venous sinus technique is to increase venous flow thorugh these sinuses so blood may exit skull through jugular foramen. The procedure is to gently but directly spread apart the sutures of the cranium that overlay the ____, ____, and ____ sinuses
Occipital; transverse; sagittal
The CV4 technique is done by first resisting the flexion phase and encouraging extension until a still point is reached, then allowing restoration of normal flexion and extension to occur. It has been reportedly helpful in fluid homeostasis and induction of uterine contractions in post-date gravid women. The CV4 technique will increase the ____ of the CRI
Amplitude
Finger placement in vault hold
Index finger — greater wing of the sphenoid
Middle finger — temporal bone in front of ear
Ring finger — mastoid region of temporal bone
Little finger — squamous portion of occiput
2 absolute contraindications to craniosacral tx
Acute intracranial bleed or increased intracranial pressure
Skull fracture
2 relative contraindications to craniosacral tx
Pts with known seizure hx or dystonia
Traumatic brain injury
Which of the following strains can be considered physiologic if it does not interfere with the flexion/extension components of the PRM?
A. Vertical strain B. Lateral strain C. Compression at the SBS D. A torsion E. None of the above
D. A torsion
[torsions and sidebending-rotations can be considered physiologic if they do not interfere with F/E at the SBS]
Somatic dysfunction in all of the following may cause diplopia except:
A. Sphenoid B. Temporal C. Occiput D. CN III E. CN VI
C. Occiput
Dysfunction of which of the following can cause symptoms similar to Tic Douloureux?
A. CN V1 B. CN V2 C. CN V3 D. CN III E. CN VII
B. CN V2
Sympathetic viscerosomatics associated with head and neck
T1-4
Sympathetic viscerosomatics associated with heart
T1-5
Sympathetic viscerosomatics associated with respiratory system
T2-7
Sympathetic viscerosomatics associated with esophagus
T2-8
Sympathetic viscerosomatics associated with upper GI tract (from staomch to portions of pancreas and duodenum)
T5-9
Greater splanchnic n.
Celiac ganglion
Sympathetic viscerosomatics associated with middle GI tract (from portions of pancreas and duodenum to 2/3 of transverse colon)
T10-T11
Lesser splanchnic nerve
Superior mesenteric ganglion
Sympathetic viscerosomatics associated with lower GI tract (distal 1/3 of colon to rectum)
T12-L2
Least splanchnic n.
Inferior mesenteric ganglion
Sympathetic viscerosomatics associated with appendix
T12
Sympathetic viscerosomatics associated with kidneys
T10-11
Sympathetic viscerosomatics associated with adrenal medulla
T10
Sympathetic viscerosomatics associated with upper ureters vs. lower ureters
Upper ureters = T10-11
Lower ureters = T12-L1
Sympathetic viscerosomatics associated with bladder
T11-L2
Sympathetic viscerosomatics associated with gonads
T10-11
Sympathetic viscerosomatics associated with uterus and cervix
T10-L2
Sympathetic viscerosomatics associated with erectile tissue of penis and clitoris
T11-L2
Sympathetic viscerosomatics associated with prostate
T12-L2
Sympathetic viscerosomatics associated with extremities
UE = T2-8
LE = T11-L2
Parasympathetics of GI system
Proximal half up to ascending and transverse colon = Vagus n
Distal half including descending and rectosigmoid colon = pelvic splanchnic nn
Parasympathetic innervation of GU system
Proximal half including kidneys and upper ureter = vagus n
Distal half including lower uretery and bladder = pelvic splanchnic nn
In terms of parasympathetic innervation of the reproductive system, the ovaries and testes descend from a higher region in the posterior abdominal wall and are therefore innervated by the _______ nerve. All other reproductive structures are innervated by the ________
Vagus n; pelvic splanchnics
Useful landmarks for sympathetic viscerosomatics include the ligament of treitz (divides duodenum and jejunum) and the splenic flexure of the large intestine.
Anything before the ligament of treitz is innervated by ______
Anything between both landmarks is innervated by _____
Anything after the splenic flexure is innervated by _____
T5-9
T10-11
T12-L2
Anterior and posterior chapmans points associated with appendix
Anterior = Tip of right 12th rib
Posterior = transverse process of T11 vertebrae
Anterior and posterior chapmans points associated with adrenals
Anterior = 2” superior and 1” lateral to the umbilicus
Posterior = between the spinous and transverse processes of T11-12
Anterior and posterior chapmans points associated with kidneys
Anterior = 1” superior and 1” lateral to umbilicus
Posterior = between spinous and transverse processes of T12-L1
Bladder chapmans point
Periumbilical region
Colon chapmans point
On lateral thigh within IT band from greater trochanter to just above knee
A hypersensitive focus, usually within a taut band of skeletal muscle or in the muscle fascia that is painful upon compression, and can give rise to a characteristic referred pain, tenderness, and autonomic phenomena
Travell’s myofascial trigger points
What is the major difference between trigger points and tenderpoints regarding referred pain?
Trigger points may refer pain when pressed
Tenderpoints do NOT refer pain when pressed
4 physiologic diaphragms important in lymphatic return
Tentorium cerebelli
Thoracic inlet
Abdominal diaphragm
Pelvic diaphragm
4 compensatory curves of the spine (4 Zink locations)
- Occipitoatlantal junction
- Cervicothoracic junction
- Thoracolumbar junction
- Lumbosacral junction
Common compensatory pattern (80%) of rotation at the Zink junctions
L/R/L/R
[other 20% of healthy people will be R/L/R/L]
Most structures of the body are drained via the left (major) lymphatic duct. What structures are drained via the right (minor) lymphatic duct?
Right UE, right hemicranium (including head and face), and the heart and lobes of the lung (except left upper lobe)
The lymphatic drainage of the right (minor) lymphatic duct is variable; it usually drains into the _________ vein or the junction of the _____ and _____ veins
Right brachiocephalic; right IJV; subclavian
The lymphatic drainage of the left (major) lymphatic duct is more consistent than the right. It drains into the junction of the _____ and _____ veins
Left IJV and subclavian
Lymphatic drainage from an infection of the right first toe would drain into the _________ lymphatic duct via the _______ duct.
A right maxillary sinus infection would drain into the _____ lymphatic duct, as would extracellular fluid resulting from lymphedema of the right UE
Left; thoracic
Right
The _____, _____, and coronary and triangular ligaments of the _____ drain directly into the thoracic duct (thus they are not directly associated with lymphoid tissue)
Thyroid; esophagus; liver
Post-isometric relaxation is the typical technique for MET. However, another method that can be used is reciprocal inhibition — how does this technique work?
Instead of contracting the dysfunctional muscle against resistance, the antagonistic muscle is contracted against resistance (i.e., if biceps is dysfunctional, contracting the triceps against resistance)
Note that this can be direct or indirect and it is still considered MET
Setups for treating exhalation rib dysfunctions for rib 1, rib 2, ribs 3-5, ribs 6-9, and ribs 10-12
Rib 1 — pt raises head directly toward ceiling
Rib 2 — pt turns head 30 degrees away from dysfunction and lifts head toward ceiling
Rib 3-5 — pt pushes elbow of dysfunctional side toward opposite ASIS
Rib 6-9 — push arm anterior
Ribs 10-12 — pt adducts arm
What muscles are being treated with exhalation dysfunctions of rib 1, rib 2, ribs 3-5, ribs 6-9, ribs 10-11, and rib 12?
Rib 1 = Anterior and middle scalenes
Rib 2 = Posterior scalene
Ribs 3-5 = Pectoralis minor
Ribs 6-9 = Serratus anterior
Ribs 10-11 = Latissimus dorsi
Rib 12 = quadratus lumborum
Absolute contraindications to HVLA
Osteoporosis Osteomyelitis (including Pott’s disease) Fractures in the area Bone metastasis Severe RA Down’s syndrome
Relative contraindications to HVLA
Acute whiplash Pregnancy Post-surgical conditions Herniated nucleus pulposus Anticoagulated pts or hemophiliacs Vertebral artery ischemia (positive Wallenberg’s test)
When treating an extended SD in the thoracic spine with HVLA, the corrective thrust is directed at the vertebrae _____the dysfunctional segment, and the thrust is aimed 45 degrees _____
Below; cephalad
7 stages of spencer technique
- Stretching tissues and pumping fluids with arm extended
- Glenohumeral extension/flexion with elbow flexed
- Glenohumeral flexion/extension with elbow extended
- Circumduction and slight compression with elbow flexed/extended, THEN circumduction and traction with elbow extended
- Adduction and external rotation with elbow flexed
- Abduction and internal rotation with arm behind the back
- Stretching tissues and pumping fluids with the arm extended
2 Special tests for vertebral artery insufficiency prior to attempting HVLA
Wallenberg’s test = in supine position, doc flexes pts neck, holding for 10 seconds, then extends the neck and holds for 10 seconds. The same is done for head and neck rotation to the right and left, rotation right and left WITH extension, and in positions that the doc would attempt to mobilize the C spine. A positive test results when the pt complains of dizziness, visual changes, lightheadedness, or nystagmus occurs
Underbergs test = neck extended and head fully rotated to either side. If pt develops vascular or neuro symptoms, HVLA is contraindicated
What is the purpose of the hip-drop test?
To evaluate sidebending (lateral flexion) of the lumbar spine
A positive pelvic side-shift test is often seen with flexion contracture of the iliopsoas. A flexion contracture of the right iliopsoas will cause a positive pelvis shift test to the _____
Left
The trendelenberg test will assess which of the following muscle groups?
A. The hip extensors B. The hip flexors C. The hip abductors D. The hip adductors E. The hip external rotators
C. The hip abductors
In a pt with low back pain, the dysfunctional T12 segment is found to have a restriction in a transverse plane and around a transverse axis. Which of the following dysfunctions best describes the position of T12?
A. Flexed B. SB right C. Rotated left D. N SR RL E. E RR SR
E. E RR SR
The first cervical segment has the greatest degree of freedom in which plane(s)?
A. Transverse B. Coronal C. Sagittal D. Oblique E. Transverse and coronal
A. Transverse
Which of the folowing is considered to be the most common congenital anomaly in the lumbar spine?
A. Sacralization B. Lumbarization C. Facet hypertrophy D. Facet tropism E. Spina bifida occulta
D. Facet tropism
A pt is diagnosed with a right anterior innominate rotation. About which sacral axis does this rotation occur?
A. Inferior transverse B. Oblique C. Middle transverse D. Sagittal E. Superior transverse
A. Inferior transverse
Burning pain between the third and fourth metatarsal heads. What is most likely dx?
A. Hammer toe B. Claw toe C. Morton’s neuroma D. Bunion E. Corns
C. Morton’s neuroma
What is the primary reason for treating the thoracolumbar junction in a pt with a kidney stone?
A. Decrease pain
B. Increase function of contralateral kidney
C. To decrease ureterospasm and increase GFR
D. To decrease bladder spasm
E. To decrease pts BP
C. To decrease ureterospasm and increase GFR
In a pt with GERD, treatment of the anterior Chapman reflex point for their hyperacidity would be directed just lateral to the sternum at the interspace of:
A. Ribs 4 and 5 on the left B. Ribs 5 and 6 on the right C. Ribs 5 and 6 on the left D. Ribs 6 and 7 on the right E. Ribs 6 and 7 on the left
C. Ribs 5 and 6 on the left
A pt with low back pain presents to the clinic. On postural analysis, her head is located forward of the plum line. She has a slight increase in her cervical lordosis. Her thoracic spine is slightly kyphotic in the upper segments with a flattening of the lumbar spine. Her lumbar vertebrae are straightened and have moved posterior relative to the plum line. Which of the following best describes her posture?
A. Military posture B. Swayback posture C. Posterior postural deviation D. Flat back posture E. Anterior postural deviation
D. Flat back posture
Plexopathy involving the medial cord of the brachial plexus will have the greatest effect on which of the following?
A. Elbow flexion B. Elbow extension C. Finger abduction D. Shoulder abduction E. Shoulder external rotation
C. Finger abduction
Head and neck lymphatic congestion and drying of the nasopharyngeal mucosa is most likely associated with increased autonomic activity originating from the preganglionic nerve fibers of which structure?
A. Vagus n.
B. Inferior cervical ganglia
C. Superior cervical ganglia
D. Intermediolateral cells of the spinal cord at T1-4
E. Intermediolateral cells of the spinal cord at T5-7
D. Intermediolateral cells of the spinal cord at T1-4
A pt with a herniated disc has an EMG showing abnormalities in the anterior tibialis and extensor hallucis longus. Based on the innervation of these muscles, which nerve root is most likely affected?
A. L3 B. L5 C. S1 D. S2 E. Not enough info
B. L5
Patellofemoral syndrome is most closely associated with:
A. Genu recurvatum B. Increased Q angle C. Decreased Q angle D. Coxa valgus E. Coxa varus
B. Increased Q angle
The Chapmans point for the thyroid is just lateral to the sternum and at the interspace of:
A. Ribs 1 and 2 B. Ribs 2 and 3 C. Ribs 3 and 4 D. Ribs 4 and 5 E. Ribs 5 and 6
B. Ribs 2 and 3
For exhalation dysfunctions, Are anterior rib counterstrain points located on rib angles or at midaxillary line?
Midaxillary line
tx for tenderpoint on right articular process of C5
F SL RL
In a pt with a posterolateral disc herniation at the L3-4 level, weakness is most likely to be present in which of the following muscles?
A. Extensor hallucis longus B. Flexor hallucis longus C. Anterior tibialis D. Hamstrings E. Peroneus longus
C. Anterior tibialis
Which of the following is most associated with a vertical downward force on the sacrum at the SI joint:
A. Innominate anterior B. Innominate posterior C. Innominate inferior shear D. Forward sacral torsion E. Unilateral sacral flexion
E. Unilateral sacral flexion
Which of the following would have a viscerosomatic reflex with a pheochromocytoma?
A. Occiput B. Atlas C. T8 D. T10 E. L2
D. T10
Around which axis does craniosacral motion occur?
A. Inferior transverse B. Oblique C. Middle transverse D. Sagittal E. Superior transverse
E. Superior transverse
The median nerve is formed from which of the following spinal nerve roots?
A. C5-6 B. C5-7 C. C5-T1 D. C7-T1 E. C2-5
C. C5-T1
61 Which of the following is most likely to be associated with sacral dysfunctions?
A. Spasm of rectus abdominis B. Positive obers test C. Piriformis tenderpoint D. Tight hamstrings E. Quadratus lumborum tenderpoint
C. Piriformis tenderpoint
Piriformis is associated with sacral dysfunctions. Spasm of the rectus abdominis is associated with superior pubic shear. Positive obers test is associated with tight IT band. Tight hamstrings are more likely to produce innominate dysfunction, specifically posterior rotation. Quadratus lumborum is associated with lumbar sidebending dysfunctions and/or rib 12 dysfunction
Which of the following runs through the carpal tunnel?
A. Palmaris longus tendon B. Flexor carpi ulnaris C. Radial n D. Flexor pollicis longus tendon E. Adductor pollicis
D. Flexor pollicis longus tendon
Tinnitus that is associated with a low pitched roar is due to:
A. Imbalance of suprahyoid muscle B. TMJ disruption C. External rotation of temporal bone D. Internal rotation of temporal bone E. Barotrauma to TM
C. External rotation of temporal bone
A pt presents with weakness with wrist flexion and forearm pronation. Which nerve is most likely affected?
A. Axillary B. Musculocutaneous C. Ulnar D. Radial E. Median
E. Median
[the median and ulnar n innervate the wrist flexors, however only the median n. innervates the pronator teres and pronator quadratus]
