Which of the following best illustrates the concept of mechanotransduction on a cellular level?
A contralateral relaxation of opposing muscles when the antagonist muscle is contracted
A hive occurring on the skin when someone is exposed to poison ivy
The initiation of the clotting cascade secondary to exposure to von Willebrand factor from a
damaged blood vessel
Thyroid hormone release when thyroid receptors are triggered by thyroid stimulating hormone
The right atrium of the heart releasing a hormone secondary to stretch from heart failure
Which of the following is a component of assessing the thoracic spine utilizing the area of greatest restriction screening?
With the patient seated, press anteriorly on the thoracic spinous processes and alternate flexion and extension of the spine
With the patient supine, place your hands along the mid-axillary line on either side of the rib cage and test for restriction by translating right and left
With the patient prone, place your fingertips on the spinous processes, adding a force in a cephalad to caudad direction down the spine
With the patient seated, sidebend the patient from both shoulders one side at a time and check for differences in sidebending right and left
With the patient seated, use one hand to palpate the transverse processes and the other to grasp the patient’s ipsilateral shoulder and guide the thorax into extension, sidebending, and rotation from the patient’s ipsilateral shoulder
A 13-year-old boy with a history of scoliosis presents to your office complaining of back pain. He states that this pain is worse with activity and prolonged standing. On examination you find that the area of greatest restriction is in the right lower thoracic region and the severity remains the same as you palpate
laterally. There are several other regions of restriction which are moderate to almost just as severe as the right lower thoracic finding. You treat the right lower thoracic region and feel that the dysfunction in that region is resolved. Upon rescreening, you find that the dysfunctions in the other regions did not
improve. What would you do next in your approach utilizing Dr. Stile’s area of greatest restriction (AGR) approach?
Screen just the upper extremity
Assess for a rib dysfunction
Screen just the lower extremity
Rescreen the entire person
Stop the OMM treatment
A 55-year-old male painter presents to your office complaining of increased right neck and back pain for one week. You conduct a global assessment and find that the most severe restriction is in the thoracic region. You find increased tissue texture hypertonicity and decreased springing in the right T2-T7 paravertebral region. As you palpate laterally, the tissue is softer with more spring. Based on Stile’s Area of Greatest Restriction (AGR) screening, which region should you further inspect for specific somatic dysfunction contributing to this person’s pain?
The lumbar region
The upper extremity
The rib cage
The cervical region
The thoracic region
A 20-year-old male who was in a motor vehicle accident two days ago, presents to the office with a 36-hour history of neck and lower back pain. On physical exam, his neurologic and cardiac exams are negative and he has a left on left forward sacral torsion. Which of the following findings would lead you to this sacral diagnosis?
Right deep sulcus
Positive backward bending test
Right axis of rotation
Right posterior inferior lateral angle
Sacral base prefers counter-nutation position
A 70-year-old female with spinal stenosis and worsening low back pain over the past few months is brought into the office by her spouse. She complains of low back pain which is 8/10 in severity on a scale of 0 to 10. The pain is exacerbated by trying to stand erect. On physical exam, she is neurologically intact and she has a negative seated flexion test and a positive lumbosacral spring test. At this point, which of the following diagnoses might you consider?
Left on left forward sacral rotation
Right unilateral sacral flexion
Bilateral sacral extension
Bilateral sacral flexion
Right on right forward sacral torsion
A 27-year-old figure skater presents to the office after falling onto her buttocks on the ice. This resulted in pain radiating from her left buttock to her posterolateral thigh. She is neurologically intact with no pain superior to her lumbosacral junction. Which of the following is true regarding the muscle that is likely to be causing her radicular pain symptoms?
It originates on the anterior-lateral surface of the sacrum
It inserts into the lesser trochanter
It functions as an internal rotator of the hip
It functions as hip flexor
It is innervated by the tibial nerve
A 29-year-old female presents to the clinic with a chief complaint of painful menses. The anti-inflammatory medications and birth control pills she has tried offer little relief and she is concerned about their side effect profile. On physical exam, you find a positive seated flexion test on the right and a positive backward bending test. At this point, which of the following diagnoses might you consider?
Left on left forward sacral torsion
Left on right backward sacral rotation
Left unilateral sacral extension
Right unilateral sacral extension
A 58-year-old male presents to your office complaining of constipation. He reports a low fiber diet and poor water consumption. Which of the following somatic dysfunctions is best associated with his complaint?
T4 extended rotated and side bent left
Left externally rotated tibia
Right externally rotated hip
Left outflare innominate
Right thigh adduction somatic dysfunction
You are a medical student on rotation with a primary care physician. An 18-year-old female competitive horseback rider presents to the office with complaint of headache. History reveals she fell off a horse onto her “tailbone” four months ago and has had headaches about every other day since then. When presenting the case to the attending, you suggest a treatment plan including OMT in addition to pharmacologic management. You decide to treat the pelvis and sacrum to help alleviate the patient’s headache. Which of the following structures of the sacrum and pelvis directly influences the patient’s cranium?
Dura attachment at S2
Greater sciatic foramen
A 19-year-old female presents to your office complaining of urinary urgency, frequency, and dysuria in addition to suprapubic pain for the past two days. She is afebrile and has no flank pain. After a urinalysis confirms a urinary tract infection and you prescribe the appropriate antibiotics, you decide to perform OMT to help relieve her pain, promote circulation and promote healing to her lower urinary tract. In which area would you expect to find the most severe somatic dysfunction?
The pubic bones
The fourth and fifth thoracic vertebrae
The tibiofemoral joint
The occipitoatlantal joint
The seventh costochondral joint
A 45-year-old male presents to your office with low back pain for the past 3 days. He admits to helping his mother move last weekend and tripping while carrying a large, heavy box. The standing flexion test is positive on the right. The ASIS compression test is positive on the left. You find the ASIS inferior on the left, the PSIS superior on the left, the medial malleolus inferior on the left. The pubic tubercles are even. What is true on the side for which you name the somatic dysfunction?
Hamstrings and quadriceps are shortened
Hamstrings are stretched and the quadriceps are shortened
Hamstrings are shortened and the quadriceps are stretched
Hamstrings and quadriceps are stretched
The leg is anatomically or functionally longer
Which of the following somatic dysfunctions is most closely associated with an “atypical vertebra”?
AA rotated right
C3 flexed, rotated, and sidebent right
C5 extended, rotated and sidebent right
C6 flexed, rotated and sidebent left
C7 neutral, sidebent right rotated left
A 29-year-old male blackjack dealer presents to your office complaining of a three month history of bilateral cold hands associated with numbness and weakness in his hands, neck pain and shoulder pain. He states that it feels like his arms are swollen and the symptoms worsen after working a shift of dealing cards. Which of the following tests would you consider most useful for aiding with discovering this patient’s diagnosis?
Drop arm test
Apley's scratch test
Which of the following areas would least likely have a somatic dysfunction caused by acute hyperextension-hyperflexion injuries?
You are on your family medicine rotation discussing cases with your colleagues at a morning lecture and one of your colleagues tells you he saw a 25-year-old man who had a left on right backward sacral torsion. Being skilled in osteopathic diagnosis, you know that the patient’s sacrum was:
Rotated left on a cephalo-caudal axis
Rotated left on a left oblique axis
Rotated left on a right oblique axis
Rotated right on a left oblique axis
Rotated right on a right oblique axis
A 32-year-old female basketball player presents to your office complaining of severe low back pain. She states that two weeks ago she fell backwards onto her buttocks after trying to block a shot. Nothing improves the pain and if she arches her back it becomes worse. The pain is sharp, non-radiating, and, on a scale of 0-10, she rates the pain as 8/10 in severity. Her neurological exam is normal. Examination reveals a right-sided posterior-inferior sacral inferior-lateral angle (ILA) which becomes more prominent during the backward bending test and a deep sacral sulcus on the left. L5 is rotated to the right. What is your sacral diagnosis?
Left on right backward sacral torsion
Right on left backward sacral rotation
A 47-year-old male accountant presents to your office complaining of lower back pain after “twisting his back wrong” while zip-lining over an Alaskan rain forest two weeks ago. He states the pain is sharp, non-radiating and 5/10 in severity on a scale from 0-10. His neurological exam is normal and reveals a negative backward-bending test, a posterior-inferior left sacral inferior-lateral angle (ILA), a deep sacral sulcus on the right, and an L5 posterior transverse process on the right which becomes more symmetrical with the left transverse process during extension. What is your sacral diagnosis?
Right on left backward sacral torsion
Right on right forward sacral rotation
A 27-year-old male zoo-keeper presents to your office complaining of lower back pain. The left low back pain began two weeks ago after he twisted awkwardly while trying to break up a fight between a gorilla and a rabbit. He states the pain is sharp, non-radiating and 5/10 in severity on a scale from 0-10. His neurological exam is normal and reveals a negative backward-bending test, a posterior-inferior left sacral inferior-lateral angle (ILA), a deep sacral sulcus on the left, and L5 rotated to the left. What is your sacral diagnosis?
Left unilateral sacral flexion
Right unilateral sacral extension
A 25-year-old male presents to the emergency department after injuring his left ankle while playing soccer earlier in the day. Which of the following physical findings would most likely suggest that he needs an X-Ray before you consider treating him with osteopathic manipulation?
Ecchymosis of the lateral aspect of the left ankle with mild edema
Inability to bear weight immediately and point tenderness over the styloid process of the fifth
Ability to bear weight immediately after the injury with no midfoot pain
Mild edema and the ability to walk for 6 consecutive steps in the emergency department hall
Mild edema and the ability to bear weight immediately after the injury
A 65-year-old female patient with peripheral diabetic neuropathy presents to your office with a chief complaint of lower extremity weakness bilaterally for the past two months. The patient cannot stand and walk on her toes. What nerve root is most likely affected?
A 22-year-old with unresolved edema from an ankle sprain 3 weeks ago presents to your office today because her gymnastics coach told her a D.O. might be able to help her get back to peak performance sooner. Which of the following areas contains lymph nodes most proximal to her injury site?
A 21-year-old female who is on the swim team, presents to your office complaining of a depressed rib on her right side. On physical exam, you find an exhalation dysfunction of ribs 1-4 on the right. Which is her key rib?
Rib 1 on the right
Rib 1 on the left
Rib 4 on the right
Rib 4 on the left
Rib 2 bilaterally
During inspiration in the bucket handle description, the lateral part of the rib moves:
In the sagittal plane
In the Journal of the American Osteopathic Association (JAOA) Review Article by Cymet and Sinkov, they discuss some potential anatomical or historical factors from the patient that could potentially accelerate the onset of osteoarthritis of the hip joint. Which of the following is one of the factors they discussed?
High body mass index (BMI)
Excessive femoral anteversion
A history of celiac disease
A history of asthma
A patient has 10 degrees of transverse plane orientation of the hip joint and femoral neck. This is classified as:
A 57-year-old female has loss of internal rotation of her left hip joint, and chondral inhomogeneity as seen on her MRI. She has difficulty tying her shoes, as well as difficulty putting her pants on and taking them off. She has had no recent trauma, and review of systems is otherwise negative. Which of the following is her most likely diagnosis?
A 41-year-old male seeks care for left ankle pain after a long hike. During your physical examination, you note that the left foot is freer in plantarflexion and internal rotation compared with the right foot. Which of the following would be a correct diagnosis of the left lower limb?
Posterior fibular head
Anterior fibular head
Pronation of the foot
Eversion of the foot
External rotation of the tibia
A 20-year-old patient presents with right knee pain and stiffness for the past two weeks without known trauma. On physical examination, there is significant reduction in both directions during active testing of the major motion of the right knee. Which of the following additional right-sided findings would best correlate with this reduced range of motion?
Tenderness of the medial and lateral patella borders
Tenderness of the fibular head
Tenderness just inferior to the anterior tibial tubercle
Tenderness of the lateral knee joint line
Tenderness in the middle of the politeal fossa
A 24-year-old football player sustains a strong lateral blow to the lateral part of the knee by a fellow player during a game. Which of the following is most likely true regarding this type of injury (assume that the patient can tolerate testing)?
Anterior drawer test is positive
Valgus testing is negative
Varus testing is positive
McMurry's test is negative
Patella grind test is positive
A 60-year-old male with a history of heavy alcohol intake presents to your office with productive cough, tactile fever, chills, and fatigue for one week. His oral temperature is 99.8°F. His vital signs are otherwise within normal limits. Pertinent physical exam findings include normal heart sounds and positive tactile fremitus in the right lower lung field. Which spinal level would you expect to find increased and persistent red reflex, increased diaphoresis and drag, increased temperature, and bogginess without a firm, stiff end point?
A 17-year-old female presents to her gynecologist with irregular menses and mid-cycle pelvic pain. On abdominal exam, there is a palpable, tender mass, approximately 2cm x 2cm in the left lower quadrant. In which spinal region would you expect to find somatic dysfunction?
When visceral afferent neurons are excited by excessive or chronic physical distension or contraction, chemical changes such as inflammation, or localized changes in temperature, a cellular crosstalk or spillover effect can lead to which of the following?
Crossed extension reflex
Deep tendon reflex
Which of the following Sir William Osler quotes is an example of the remapping process?
“Soap and water and common sense are the best disinfectants.”
"To confess ignorance is often wiser than to beat about the bush with a hypothetical diagnosis.”
“The first duties of the physician is to educate the masses not to take medicine.”
"Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
“The good physician treats the disease; the great physician treats the patient who has the disease.”
A 40-year-old obese female presents to the office complaining of a recent onset of heartburn. On structural exam, you firmly stroke the skin over the paravertebral muscles bilaterally and note the changes at the third to ninth thoracic level bilaterally. If this patient does indeed have a new reflux problem as you suspect, then, at the segment mentioned, this test would likely elicit:
A 33-year-old male presents to the clinic with new onset of back pain after lifting some boxes two hours ago. The pain has been constant since then and is located across the lumbo-sacral junction bilaterally. Sitting makes it worse; cold packs have helped a little. He denies numbness, tingling, radiation of pain and weakness. Which of the following tissue changes would you expect to find related to this new complaint?
Increased skin drag
An 8-year-old girl with a past medical history significant for near-sightedness had accidentally placed her right hand upon a hot burner at home. She reacted by instantaneously pulling her hand away from the noxious stimulus. Her body’s reaction in this case scenario correlates best with which osteopathic tenet or corollary?
The human person is a unit
The maintenance of a disease state has contributions from somatic manifestations
Rational treatment is based on the previous principles
The movement of body fluids is essential to the maintenance of health
The nervous system plays a crucial part in controlling the body
A 3-year-old girl presents to your office with a significant past medical history of torticollis since birth. You perform an osteopathic structural examination and note that her head and neck are slightly sidebent right and rotated to the left. In addition, you note greater prominence of the mastoid process on the side of the origin of the affected muscle. Which osteopathic tenet or corollary does her physical finding correlate with best?
The human person is a unit, including mind, body, and spirit
The body possesses self-regulatory mechanisms
Structure and function are reciprocally interrelated
A 78-year-old female’s recent laboratory work results show that her thyroid stimulating hormone (TSH) level is high, and her free T4 level is low. Which osteopathic tenet or corollary does this situation correlate with best?
Rational treatment is based on the main osteopathic principles
The somatic component is a manifestation of the disease state and could contribute to the maintenance of that state
In the spinal (vertebral) column, which of the following occurs with pulmonary inspiration?
There is a reduction of type II mechanics in the spine with pulmonary inspiration
There is induction of type II mechanics in the spine with pulmonary inspiration
The sagittal spinal curves flatten with pulmonary inspiration
The frontal spinal curves flatten with pulmonary inspiration
The sagittal spinal curves exaggerate with pulmonary inspiration
Using the Rule of Threes, the spinous process of T11 would be located:
In line with its own transverse processes
Half-way between its own transverse processes, and the transverse processes of the vertebra just below (T12)
Half-way between its own transverse processes, and the transverse processes of the vertebra just above (T10)
A full level below its own transverse processes, in line with the transverse processes of the vertebra below (T12)
A full level above its own transverse processes, in line with the transverse processes of the vertebra above (T10)
A 37-year-old female was competing in her local bowling league for two days straight, and she aggravated her mid-to-lower back area with all the excessive competitive bowling maneuvers. She presents to you complaining of back pain and you find T8 flexed, rotated left, sidebent left. What is the problem with the facet(s)?
The left facet is stuck closed, and cannot open
The left facet is stuck open and cannot close
The right facet is stuck closed and cannot open
The right facet is stuck open and cannot close
Both facets are stuck closed and cannot open
A 21-year-old male presents with complaints of increased back pain ever since he started training for a half marathon. He never was an avid runner and started training 3 months ago. On examination you notice that he has flat feet bilaterally. You tell him that you highly suspect that his back pain is related to his flat feet. He asks how that is possible. You explain that this best illustrates which of the following osteopathic principles?
The mind, body, spirit connection
The body has a self-regulatory mechanism
Disease ensues when homeostasis is maintained
Structure and function are interrelated
Which of the following correctly pairs the event with the correct year?
1840 - Dr. Andrew Taylor Still was born
1892 - The year the American School of Osteopathy opened
1935 - The Spanish flu pandemic infected about one-third of the world's population
1939 - DOs were first drafted into the military and thus fought in World War II
1983 - Louisiana was the last state to grant DOs licensure
A 67-year-old male with a history of lower back pain and a left knee replacement surgery two weeks ago, presents to the emergency department with a 2 day history of cough, fevers, and chills. His work up shows that he has developed right lower lobe pneumonia. On examination he has increased swelling in both legs and decreased excursion of his rib cage with respiration. He states that he has not been moving as much since the knee replacement due to pain. Which of the following is true regarding treatment of this patient with osteopathic manipulative treatment?
Osteopathic manipulation has not been shown to be helpful for patients with pneumonia
Treatment of the thoracic cage can help with improving the rib cage excursion
Lymphatic pumps would not help the swelling in the legs
Doming the diaphragm would cause the patient to hyperventilate
Treatment to the upper neck would not be effective for this patient’s pulmonary problem
According to Smuck and colleagues, the biggest indicator of lower back pain (LBP) in the USA is:
Exercise intensity has no impact on LBP
As BMI increases so does the chance of LBP
Smoking had little effect on LBP
LBP was more common in women
LBP was more common in older men
What type of contraction occurs when a muscle is actively contracted with no lengthening or shortening of the muscle?
Actively lengthening the fibers
Passively contracting the muscles
A 45-year-old male presents to your office with lower back pain. He has a sedentary job and spends more than half his day at work on a computer. He asks what he can do at home to improve his flexibility. One stretch you can demonstrate to improve his flexibility would be:
Knee extension to passively lengthen the hamstring muscles, and to hold it steady with no bouncing for 15-60 seconds
Knee extension to actively lengthen the hamstring muscles, and to hold it steady with no bouncing for 15-60 seconds
Knee flexion to passively lengthen the hamstring muscles, and to hold it steady with no bouncing for 15-60 seconds
Hip extension to passively lengthen the hamstring muscles, and to hold it steady with no bouncing for 15-60 seconds
Lie prone with arms extended. Lift arms, legs and head
A 23-year-old professional hockey player presents with the chief complaint of pain in her left shoulder. Upon examination you find the range of motion of the shoulder to be the following: flexion to 120 degrees, extension to 45 degrees, abduction to 180 degrees, adduction to 45 degrees, internal rotation to 55 degrees, and external rotation to 45 degrees. Which of the following motions is her restriction?
A 45-year-old female presents with the chief complaint of right sided shoulder pain for two weeks. She reports that the pain is achy and made worse with lifting heavy objects. You perform a test to localize the issue by flexing the elbow to 90 degrees, pronating the patient’s wrist and elbow, and asking the patient to supinate her arm while monitoring with your other hand on the humerus. She tells you that supinating her arm reproduces the pain. Which of the following is most likely causing her right shoulder pain based on your findings?
Thoracic outlet syndrome
Rotator cuff tear
Impingement of the rotator cuff tendons
As your patient abducts his arm 45 degrees, you notice that, with respect to the scapulohumeral joint rhythm:
The scapular moves 30 degrees and the humerus moves 15 degrees
The scapula moves 22.5 degrees and the humerus moves 22.5 degrees
The acromioclavicular joint moves 22.5 degrees
The scapula moves 15 degrees and the humerus moves 30 degrees
The scapular moves 45 degrees and the humerus moves 45 degrees
A 35-year-old construction worker presents to your office complaining of a painless and unexplainable mass on his wrist. On physical exam, you note an approximately 20 mm round and smooth swelling in thescapholunate area as well as restricted range of motion of the wrist. What is the most likely diagnosis?
A 54-year-old pianist presents to your office after playing a 4-hour recital. He complains of numbness and tingling over his 4th and 5th digits. After a thorough history and physical exam, you believe he is experiencing symptoms of nerve entrapment. A restriction through what anatomical area would most likely be responsible for his symptoms?
Which muscle group is paired correctly with its action?
Flexor carpi ulnaris: wrist flexion and hand abduction
Extensor carpi ulnaris: wrist extension and hand abduction
Flexor carpi radialis: wrist flexion and hand adduction
Palmaris longus: wrist flexion and hand abduction
Extensor carpi radialis longus & brevis: wrist extension and hand adduction
A 22-year-old male presents to your office complaining of moderate intermittent right elbow pain for the past week that is worse when he is playing hockey. He states that he started playing on a hockey team 4 weeks ago. On physical exam, there is tenderness upon palpation of his medial epicondyle. He experiences mild pain with full elbow extension and pain when he tries to flex his wrist against resistance. Which of the following muscles is most likely involved in this patient’s elbow pain?
Extensor digitorum muscle
Extensor carpi radialis brevis muscle
Flexor carpi radialis muscle
Abductor pollicis longus muscle
A 22-year-old male osteopathic medical student presents to your office with elbow pain. He was leaning on his right, flexed elbow while reading for several hours. When he changed position, he experienced tingling in his right elbow which radiated down his forearm. Performing which of the following special tests of the elbow would help to confirm your suspected diagnosis?
Varus stress test
Valgus stress test
Resisted wrist flexion
Forced wrist flexion
A 73-year-old female presents to your office complaining of mild pain in her left elbow and not being able to reach as well since she had a surgical fixation of an elbow fracture 5 weeks ago. Physical exam reveals pain in the elbow elicited with left elbow extension. She can only extend to 45 degrees. How would the somatic dysfunction of her left elbow be named?
Left elbow flexion dysfunction
Left elbow extension dysfunction
Left ulnohumeral abduction dysfunction
Left ulnohumeral adduction dysfunction
Left posterior radial head dysfunction
A 20-year-old male presents to the office with severe upper back pain after hurting his back 1 day ago lifting a heavy box when moving into his dorm room. Chest x-ray reveals no fracture. Which of the following tissue texture changes would most likely indicate an acute somatic dysfunction finding if detected on palpation of his back?
A lack of swelling or edema
A 15-year-old male with a history of scoliosis presents with increased back pain for the past couple of months. Images of his examination standing and forward bending are attached. Based on the attached images, which of the following movements would be the most significantly reduced with range of motion testing of the thoracic spine?
A 21-year-old male presents with localized back pain after twisting his back while playing basketball about 4 hours ago. On examination you localize the pain to the level of T8 on the right. With flexion, the right transverse process is more posterior and resists anterior springing compared to the left transverse process. In extension, the transverse processes are symmetrical bilaterally. Which of the following is the biomechanical etiology for his T8 somatic dysfunction?
The left facet will not open
The left facet will not close
The right facet will not open
The right facet will not close
There is no facet restriction as this is a Type I dysfunction
A 23-year-old male presents to your office complaining of left upper-back pain. After a complete history and exam, you diagnose a T5 flexed, rotated and sidebent left as the reason for the pain. At the level of T5 on T6, what would be the first step you would do in order to treat this patient with facilitated positional release?
Extend T5 on T6 until it is neither flexed nor extended
Rotate T5 on T6 to the left
Flex T5 on T6 to increase the thoracic kyphosis
Sidebend T5 on T6 to the left
Add a compressive force down to the T5-T6 segment
A 43-year-old male presents to your office complaining of right mid-back pain. As part of your exam, you note a T8 transverse process is posterior on the right. With flexion, it becomes more symmetrical on the left side. With extension, the right transverse process becomes even more posterior. You decide to treat it by putting the segment into extension, left sidebending and left rotation. This is the starting position for which of the following treatment modalities for this somatic dysfunction:
Facilitated positional release
Myofascial soft tissue technique
You are evaluating a weight lifter who is complaining of a tightness in his triceps, an elbow extensor. You note his triceps to be in spasm and decide to treat by fully extending the elbow while the patient does nothing other than lie comfortably on the treatment table. You hold the position until you note a softening of the triceps spasm. How would you classify this treatment?
Passive - indirect
Passive - direct
Active - indirect
Active - direct
Active - direct then indirect