< Osteopathic Manipulative Medicine

Checkpoint Questions and Answers

Question Answer
What barrier is the limit of motion a patient can voluntarily perform in the absent any restriction? Physiologic barrier
Edema, decreased motion, and muscle hypertonicity are a result of what type of somatic dysfunction? Acute somatic dysfunction
How are the sagittal plane and sagittal axis different? Plane: divides left and front; Axis: passes posterior to anterior
Does adduction of the fingers and toes mean they are drawn together or spreading apart? Drawn together
Is somatic dysfunction characterized by the ease of motion or restriction of motion? Ease of motion
What treatment technique is performed to release entrapped synovial folds? HVLA
Lymphatic techniques are an extension of which treatment technique? Myofascial release
How would a technique in which the physician takes the patient into a restrictive barrier and the patient provides no motion be described? Passive, direct
What type of muscle energy requires the patient to push into their restriction? Reciprocal inhibition muscle energy
What structure is targeted during a post-isometric muscle energy treatment? Golgi tendon organ
For how long is a counterstrain treatment position held? 90 seconds
Who was the first to describe muscle energy treatment techniques? Fred Mitchell DO
In what plane do flexion and extension of the cervical spine occur? Sagittal plane
In what plane does sidebending of the cervical spine occur? Coronal plane
What landmark is used to assess rotation for regional motion testing of the cervical spine? Articular pillars
Where do the spine nerve roots for C7 exit? C7 nerve exits between C6 and C7 vertebrae
Where do the spine nerve roots for C8 exit? C8 nerve exits between C8 and T1 vertebrae
A patient with a C3 ERLSL shows restriction of translation in what direction? Right to left (sidebending dysfunction is opposite that of translation; rotation is the same)
What position is the patient placed in for the treatment of posterior tenderpoints? Extension
What term describes the normal curvature of the thoracic spine? Kyphosis
In what plane of motion does flexion and extension of the thoracic spine occur? Sagittal plane
In what plane of motion does sidebending of the thoracic spine occur? Coronal plane
What is the orientation of the facet joints of the thoracic spine? Backward, upward, and lateral (or coronal)
What spinal landmark is used to assess rotation for intersegmental motion of the thoracic spine? Transverse process
Where do the spine nerve roots for T1 exit? T1 nerve exits between T1 and T2 vertebrae
What muscle attaches the occiput to the clavicle? Trapezius
What are the true ribs? Ribs 1-7
What are the false ribs? Ribs 8-10
Which ribs are considered typical ribs? Ribs 3-9
What are the attachments of the respiratory diaphragm? Xiphoid process, ribs 6-12, and the vertebral bodies of L1-L3
How is the motion of ribs 11-12 described? Caliper motion
What is the key rib in an exhalation dysfunction? The top rib
What is the orientation of the facet joints of the lumbar spine? Backward, upward, and medial (or sagittal)
What ligament forms the anterior wall of the spinal canal? Posterior longitudinal ligament
What spinal ligament is affected when a patient has a lumbar disc herniation? Posterior longitudinal ligament
What is the most likely direction for a lumbar disc herniation to occur? Posteriolateral
What type of curve is found for the lumbar vertebrae? Lordosis
What is the orientation of the facet joints of the lumbar spine? Backward, upward, and medial
What lumbar vertebrae corresponds to the level of the end of the conus medullaris? L2
What spinal ligament prevents hyperextension of the lumbar spine? Anterior longitudinal ligament
What three bones compromise the innominate? Ilium, ischium, pubis
On what side would a right anterior innominate dysfunction show a positive standing flexion test? Right
On what side would a left superior pubic shear show a positive standing flexion test? Left
What landmark is used to diagnose inflare and outflare somatic dysfunctions? Umbilicus
Hypertonicity of what muscle leads to a posterior innominate dysfunction? Hamstring
Hypertonicity of what muscle leads to an anterior innominate dysfunction? Quadriceps
On what side would a right on right sacral torsion show a positive seated flexion test? Left
What would the relative locations of the sacral sulci and ILAs be? Deep sulci on right; shallow ILA on left
On what side would a right on left sacral torsion show a positive seated flexion test? Left
What would the relative locations of the sacral sulci and ILAs be? Shallow sulci on the right; deep ILA on left
At what spinal level does sacral motion occur during respiration? S2
The motion of which anatomic landmark is used to name sacral diagnoses? Sacral promontory
What is the L5 diagnosis for a left on left sacral torsion? L5 NSLRR (type 1)
What is the L5 diagnosis for a left on right sacral torsion? L5 F/E SRRR (type 2; can't tell F or E)
What muscle is used to treat a physiologic sacral torsion somatic dysfunction? Gluteus maximus
What are the attachments of the muscle used to treat and posterior sacral torsion? Anterior sacrum and greater trochanter (Piriformis muscle)
A hypertonic psoas will show what compensatory somatic dysfunction on the contralateral side? A hypertonic piriformis
What nerve could be affected by an anterior fibular head dysfunction? Common fibular nerve (Common peroneal nerve)
With a left anterior fibular head dysfunction, would the ankle prefer pronation or supination? Pronation
What nerve could be affected by a left posterior fibular head somatic dysfunction? Common fibular nerve (Common peroneal nerve)
Injury of what nerve leads to foot drop? Common fibular nerve (Common peroneal nerve)
With a left posterior fibular head dysfunction, would the ankle prefer pronation or supination? Supination
With a left anterior tibia on talus dysfunction, would the ankle prefer dorsiflexion or plantarflexion? Dorsiflexion
With a left posterior tibia on talus dysfunction, would the ankle prefer dorsiflexion or plantarflexion? Plantarflexion
Which motions comprise supination of the ankle? Plantarflexion, inversion, and adduction
In what plane of motion does abduction and adduction of the extermities occur? Coronal
What muscles comprise the rotator cuff? Supraspinatus, infraspinatus, teres minor, and subscapularis
Overuse of the flexor muscles of upper extremity can lead to what type of tendonitis? Medial epicondylitis (Golfer's elbow)
Which wrist bone is the most commonly fractured? Scaphoid bone
Which vertebral levels correspond to the celiac ganglia? T5-T9
Which vertebral levels correspond to the superior mesenteric ganglia? T10-T11
Which vertebral levels correspond to the inferior mesenteric ganglia? T12-L2
At which ganglion does the sympathetic innervation of the liver synapse? Celiac ganglion
What supplies parasympathetic innervation to the left (descending) colon? Pelvic splanchnic nerves (S2-S4)
What are 2 GI symptoms associated with increased sympathetic nervous system activity? Constipation, abdominal pain, flatulence, distension
What are 2 GI symptoms associated with increased parasympathetic nervous system activity? Diarrhea, nausea/vomiting, headache
What spinal levels supply sympathetic innervation to the ascending colon? T10-T11
What are the red flags indicating a neurological cause of low back pain? Bowel or bladder incontinence, saddle anesthesia, bilateral sciatic, leg weakness, and sexual dysfunction
What are the red flags indicating an immune or systemic disease cause of low back pain? Cancer, nighttime pain, unexplained weight loss
What muscle is the primary external rotator of the hip? Piriformis
Which gait involves the trunk and pelvis hyperextending to maintain center of gravity behind the involved hip? Gluteus maximus gait
Which type of gait involves a wide base and a tendency to fall toward the side of the lesion? Ataxic gait
Which type of gait involves rolling side to side with pelvic rotation and tilt on the swing side increased? Waddling gait
What does a positive Trendelenberg test on the right indicate? Weakness/Paralysis of gluteus medius and gluteus minimus on the left
During which phase of gait is the limb in contact with the ground? Stance phase
During which phase of gait does limb advancement and limb clearance occur? Swing phase
During heel strike, which structure experiences the greatest weight load? Calcaneus
During which phase of the gait cycle is the center of gravity at its highest? Midstance
Name the attachments of the dura mater. Foramen magnun, C2, C3, and S2
Name the attachments of the falx cerebri. Occiput, parietal bones, frontal bone, crista galli
Which venous sinuses are embedded in the temporal bone? Sigmoid sinus
Which venous sinuses are embedded in the occiput? Confluence of sinus, straight sinus, transverse sinus, and occipital sinus
Which bones comprise the pterion? Frontal, sphenoid, temporal, and parietal
Which bones comprise bregma? Frontal and both parietals
Which bones comprise lambda? Occiput and both parietals
How does the sacrum move during craniosacral flexion? Upward and backward (Counternutation)
How does the sacrum move during craniosacral extension? Forward and downward (Nutation)
How are lateral strains named? By the side the basisphenoid points toward
What muscles attach to the temporal bone? Temporalis, sternocleidomastoid, stylohyoid, masseter, splenius capitus, and others
What cranial dysfunction is associated with positional plagiocephaly? Lateral strain
What is the motion of the frontal bones during craniosacral extension? Internal rotation
What is the most common type of headache? Tension headache
Where is the Chapman's point for the sinuses found? Inferior clavicular border 1/3 from midline (also first rib)
Where is the Chapman's point for the upper and lower lungs? Third and fourth intercostal space, respectively
What vertebral levels correspond to sympathetic innervation of the heart and lungs? Heart: T1-T4; Lungs: T2-T5 (approximately; +/- 1 vertebral level acceptable)
What nerve innverates the extensor carpi radialis muscle? Radial nerve
Which forearm muscle groups attach to the medial epicondyle? Forearm flexors and pronators
Which forearm muscle groups attach to the lateral epicondyle? Forearm extensors and supinators
What fingers does the median nerve innervate? The first three and the lateral half of the ring finger
What fingers does the ulnar nerve innervate? The medial half of the ring finger and the fifth finger
Where do the lymphatics of the head and neck drain? Right lymphatic duct
Where do the lymphatics of the GI system drain? Thoracic duct
What are four contraindications to lymphatic techniques? Metastatic cancer, deep venous thrombosis, mononucleosis, acute exacerbation of chronic heart failure
What structures comprise the thoracic inlet/outlet? The thoracic inlet: the manubrium, ribs 1-2, and T1-T4; The thoracic outlet: anterior and middle scalenes, the clavicle, and ribs 1-2
What physiologic changes occur during pregnancy? Increased estrogen, increased adrenal hormones, increased progesterone, increased gastrin, increased relaxin, and decreased motilin
What structural changes occur during pregnancy? Forward tilting of the pelvis, increased lumbar lordosis, psoas muscle shortening, increased thoracic kyphosis, and widening of the pubic symphysis
What are some study outcomes shown for performing OMT during pregnancy? Decreased labor time, decreased meconium-stained amniotic fluid, decreased forceps use, decreased pre-term delivery, and decreased back pain
What are contraindications to performing OMT during pregnancy? Undiagnosed vaginal bleeding, ectopic pregnancy, placental abruption, untreated DVT, elevated maternal blood pressure, pre-term labor, unstable maternal vital signs, and fetal distress
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