Quiz Osteopathic Part 4 of 4

Osteopathic Principles & Practice – Part 4 28Mar2009
OPP #1 – Visceral: Upper Gastrointestinal

Match the viscerosomatic reflex level with the organ:
1) Small intestine a) T5-6 Right
2) Spleen & pancreas b) T5-9 Left
3) Upper esophagus c) T6-9 Right
4) Lower esophagus d) T6-9 Left
5) Liver & gallbladder e) T8-9 Bilateral
6) Stomach
7) Where is the Chapman reflex point for the pancreas?
a) 5th intercostal space on the right
b) 5th intercostal space on the left
c) 6th intercostal space on the right
d) 6th intercostal space on the left
e) 7th intercostal space on the right
8) Which of the following is found in the mesentery and senses true visceral pain,
activated by spasm or stretch?
a) Meissner corpuscles
b) Merkel nerve endings
c) Pacinian corpuscles
d) Ruffini ending
9) Which of the following describes typical viscerosomatic reflex spinal motion, which
may involve the rotatores specifically?
a) Neutral type motion, rotated toward the organ affected
b) Neutral type motion, rotated away from the organ affected
c) Non-neutral type motion, extended, rotated toward the organ affected
d) Non-neutral type motion, extended, rotated away from the organ affected
e) Non-neutral type motion, flexed, rotated toward the organ affected
f) Non-neutral type motion, flexed, rotated away from the organ affected
10) Which of the following, along with the duodenum, is innervated by the left vagus
nerve (not the right vagus)?
a) Lesser curvature of the stomach
b) Small intestines
c) Right colon
d) Greater curvature of the stomach
e) Appendix
11) What is the goal of the mesenteric lift technique?
a) Normalize sympathetics
b) Normalize parasympathetics
c) Free lymphatic pathways
d) Relieve spinal muscular tension
e) Increase blood flow to the gallbladder
12) What rate describes the normal visceral rhythm?
a) 3-7 cycles per minute
b) 7-8 cycles per minute
c) 8-12 cycles per minute
d) 15-18 cycles per minute
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13) The inspiration phases (inspir) of visceral motility coincides with:

a) Cranial flexion
b) Cranial extension
c) No cranial motion (SBS compression)
14) Which of the following is NOT a contraindication for visceral treatment?
a) Acute appendicitis
b) Acute UTI
c) Intrauterine device (IUD)
d) Calculi
e) Thrombosis
15) A fascial unwinding technique involving pressure under the xiphoid process would be
helpful for which of the following patients?
a) Cirrhosis
b) Cholecystitis
c) Splenomegaly
d) Traumatic injury
e) GERD
16) The Fulford diaphragm release technique would be helpful for which of the following
patients?
a) Cirrhosis
b) Cholecystitis
c) Splenomegaly
d) Traumatic injury
e) GERD
OPP #2 – Visceral: Lower Gastrointestinal

1) What levels make up the sympathetic innervation to the right half of the colon?
a) T5-T9
b) T9-T10
c) T10-T11
d) T12-L2
e) S2-S4
2) What levels make up the sympathetic innervation to the left half of the colon?
a) T5-T9
b) T9-T10
c) T10-T11
d) T12-L2
e) S2-S4
3) Where is the Chapman reflex point for the cecum?
a) Right distal iliotibial band
b) Left distal iliotibial band
c) Right proximal iliotibial band
d) Left proximal iliotibial band
e) Triangle between L2 and iliac crests
4) Hyper-sympathetic activity to the colon would cause all of the following EXCEPT:
a) Diarrhea

b) Flatulence
c) Ileus
d) Abdominal distension
e) Difficulty defecating
5) The pelvic diaphragm is innervated by what nerve or plexus?
a) Vagus
b) Celiac
c) Superior mesenteric
d) Inferior mesenteric
e) Pudendal
6) A thoracolumbar fracture would lead to which of the following?
a) Paralytic ileus
b) Severe diarrhea
c) Mild constipation
d) Nausea and vomiting
e) Abdominal cramps and flushing
7) Post-surgical patients should be treated how many times per day until bowel sounds
return?
a) Once
b) Twice
c) Three times
d) Four times
e) Five times
8) At what stage of post gastrointestinal surgery should one be most concerned about a
patient’s hemodynamics and electrolyte balance?
a) Stage I
b) Stage II
c) Stage III
d) Stage IV
e) None of the above
9) Rib raising bilaterally may be most useful to inhibit sympathetic flow at what stage of
post-gastrointestinal surgery?
a) Stage I
b) Stage II
c) Stage III
d) All of the above
10) Pectoral traction with lymphatic and pedal pumps may be most useful at what stage
of post-gastrointestinal surgery?
a) Stage I
b) Stage II
c) Stage III
d) All of the above
11) The CV4 cranial technique may be beneficial at what stage of post-gastrointestinal
surgery?
a) Stage I
b) Stage II

c) Stage III
d) All of the above
12) Where are the posterior Chapman points located for the colon?
a) Right distal iliotibial band
b) Left distal iliotibial band
c) Right proximal iliotibial band
d) Left proximal iliotibial band
e) Triangle between L2 and iliac crests
13) Treatment to which of the following areas would be most helpful for left-sided colon
dysfunction?
a) OA, AA
b) Condylar decompression
c) C3-C5
d) Sacrum
14) Treatment to which of the following areas would be helpful for a patient with an
upper GI complaint?
a) Vagus nerve
b) Celiac ganglion
c) Superior mesenteric ganglion
d) Inferior mesenteric ganglion
e) Pudendal nerve
OPP #3 – Visceral: Layer Palpation

1) A patient presents with a palpable thermal radiation on their back between the spine
and the bottom edge of the left scapula. What organ may be dysfunctional?
a) Gallbladder
b) Liver
c) Stomach
d) Spleen
e) Kidney
2) Which of the following is the correct order of abdominal layers starting at the skin and
moving inward to the peritoneum?
a) Camper fascia, Scarpa fascia, deep fascia, external oblique, internal oblique,
transversus abdominus, transversalis fascia
b) Scarpa fascia, Camper fascia, deep fascia, external oblique, internal oblique,
transversus abdominus, transversalis fascia
c) Camper fascia, Scarpa fascia, deep fascia, external oblique, internal oblique,
transversalis fascia, transversus abdominus
d) Scarpa fascia, Camper fascia, deep fascia, external oblique, internal oblique,
e) Camper fascia, deep fascia, Scarpa fascia, internal oblique, external oblique,
3) Which of the following attaches to the lesser curvature of the stomach?
a) Greater omentum
b) Lesser omentum
c) Phrenicogastric ligament

d) Gastrosplenic ligament
4) Which of the following techniques may be the most beneficial for a patient, as many
structures are anatomically related to the treated area?
a) Fulford release
b) Diaphragmatic release
c) Celiac ganglion release
d) Superior mesenteric ganglion release
e) Mesenteric root release
5) Treatment for singultus should be focused on what levels?
a) OA, AA
b) C3-5
c) T5-9
d) T10-11
e) T12-L2
6) What type of radiation is sensed by the hand using manual thermal diagnosis?
a) Ultraviolet
b) Gamma
c) Infrared
d) Visible light
e) Microwave
7) When palpating just below the xiphoid process, what organ will you feel?
a) Stomach
b) Pancreas
c) Liver
d) Gallbladder
e) Spleen
8) When doing layer palpation of the abdomen, the clinician puts their hand softly on the
abdomen and presses until they reach what layer?
a) Skin
b) Camper fascia
c) Scarpa fascia
d) Transversalis fascia
e) Peritoneal organ
9) What technique would you do to release pressure at the mesenteric root?
a) Balanced ligamentous tension
b) Fulford release
c) Celiac ganglion release
d) LLQ mesentery lift
e) Muscle energy
OPP #4 – Clinical: Lumbar

1) Which of the following is NOT true of the lumbar anatomy?
a) The iliac crests are at L4 level
b) Lumbar vertebrae are wedged shaped and higher in front
c) Lumbar spinous processes are at the same level as the vertebral body
d) Lumber transverse processes are long, thin, and directed medially

2) A patient presents with low back pain after reaching over their head. They also
complain of shoulder pain. Which muscle may be to blame?
a) Gluteus maximus
b) Piriformis
c) Psoas
d) Quadratus lumborum
e) Latissimus dorsi
3) A patient presents with shooting low back pain and an externally rotated leg. Which
muscle may be to blame?
a) Gluteus maximus
b) Piriformis
c) Psoas
e) Latissimus dorsi
4) The Thomas test would be most useful for contracture of what muscle?
a) Gluteus medius
b) Piriformis
c) Psoas
e) Latissimus dorsi
5) What is the first ligament to become tender with lumbar posture changes?
a) Iliolumbar ligament
b) Sacroiliac ligament
c) Sacrospinous ligament
d) Sacrotuberous ligament
e) Ligamentum flavum
6) A patient presents with sharp low back pain with radiculopathy. The pain is worse with
valsalva maneuver. Testing reveals +1/4 Achilles reflex, loss of sensation on the lateral
foot, and difficulty toe walking. Heel walking and squat & rise are normal. What disc
may be herniated?
a) L2 (L2-L3)
b) L3 (L3-L4)
c) L4 (L4-L5)
d) L5 (L5-S1)
e) S1 (S1-S2)
7) An elderly patient presents with aching low back pain that goes to the lower legs.
History reveals the pain is worse with walking but relieved with sitting. Extending the
lumbar spine creates pain for the patient. Which of the following is most likely?
a) Herniated disk
b) Spinal stenosis
c) Paget disease
d) Spondylolysis
e) Epidural abscess
8) A wrestler presents with severe low back pain after a match. An oblique standing x-ray
shows a broken neck on the collar of the Scottie dog. Where is the defect?
a) Pedicle

b) Transverse process
c) Inferior articular process
d) Pars interarticularis
e) Lamina
9) Spondylolisthesis is most commonly found at what level?
a) L2 on L3
b) L3 on L4
c) L4 on L5
d) L5 on S1
e) S1 on S2
10) A patient presents with hypertonic hamstrings, backward tilting of the pelvis,
protruding abdomen, and neurologic defects. Radiograph shows a 55% spondylolisthesis
slippage. What classification is this?
a) Class I
b) Class II
c) Class III
d) Class IV
11) A patient presents with aching low back pain that radiates to the groin. Testing
reveals a positive Thomas test and positive pelvic shift test to the contralateral side.
Sacral dysfunction is found on an oblique axis and the contralateral piriformis is tight.
Extension somatic dysfunction is found at L1-L2. Which of the following is most likely?
a) Sciatica
b) Psoas syndrome
c) Spondylitis
d) Spondylolysis
12) Which of the following would be seen in a right psoas syndrome?
a) Positive Thomas Test on the left
b) L2 F RL SL
c) R on R sacral dysfunction
d) Right piriformis spasm
13) Which of the following should be ruled out with severe low back pain that has sudden
onset and no trauma?
a) Spinal stenosis
b) Malignancy
c) Aortic aneurysm
d) Epidural assess
e) Spondylolisthesis
14) A patient presents to the Emergency Room with severe low back pain. History
reveals they have chronic back pain relieved specifically with narcotics. Supine straight
leg raise is positive. Seated straight leg raise is negative. Hoover test is positive. Which of
the following is most likely?
a) Spinal stenosis
b) Sciatica
c) Spondylolysis
d) Herniated disc
e) Malingering

15) Which of the following lumbar somatic dysfunctions would be treated in the Sim
position (face down lateral recumbent)?
a) L2-L4 N RR SBL
b) L2-L4 N RL SBR
c) L4 F RR SBR
d) L2 F RL SBL
e) L4 E RR SRR
16) Which of the following tests for gluteus medius weakness?
a) Straight leg raise
b) Hoover test
c) Thomas test
d) Trendelenberg test
e) Ober test
17) In a lumbar type-one curve, which of the following is true of the patient’s legs?
a) Up above the table, patient pushing down
b) Up above the table, patient pushing up
c) Down below the table, patient pushing up
d) Down below the table, patient pushing down
e) One leg up above the table, patient pushing down
18) In a lumbar type-two flexed somatic dysfunction, which of the following is true of the
patient’s legs?
a) Up above the table, patient pushing down
b) Up above the table, patient pushing up
c) Down below the table, patient pushing up
d) Down below the table, patient pushing down
e) One leg up above the table, patient pushing down
OPP #5 – Clinical: Sacrum

1) Which of the following lies between the gemellus superior and inferior?
a) Piriformis
b) Gluteus medius
c) Gluteus minimus
d) Obturator internus
e) Quadratus femoris
2) Which of the following occurs at the sacral middle transverse axis?
a) Innominate rotation
b) Respiratory motion
c) Postural motion
d) Craniosacral motion
3) Which of the following could create a false positive in the standing flexion test?
a) Ipsilateral tight hamstrings
b) Contralateral tight hamstrings
c) Ipsilateral tight quadratus lumborum
d) Contralateral tight quadratus lumborum
4) A patient has a negative standing flexion test and a positive seated flexion test, which
of the following is true?

a) Patient has a unilateral sacral torsion

b) Patient may have contralateral tight hamstrings
c) Patient may have ipsilateral tight hamstrings
d) Patient has an iliosacral dysfunction
e) Patient may have a tight quadratus lumborum
5) A negative spring test would suggest what sacral pattern?
a) Backward torsion
b) Unilateral sacral flexion
c) Unilateral sacral extension
d) Bilateral sacral extension
6) When doing a sphinx test (backward bending test), which of the following results
would suggest a forward torsion or unilateral sacral flexion?
a) Positive test, becomes more symmetric
b) Positive test, becomes more asymmetric
c) Negative test, becomes more symmetric
d) Negative test, becomes more asymmetric
7) When the sacral deep sulcus is opposite the inferior ILA, there is a:
a) Bilateral sacral flexion
b) Bilateral sacral extension
c) Unilateral sacral flexion
d) Unilateral sacral extension
e) Sacral torsion
8) A patient has a positive seated flexion test on the right, positive spring test, and L5 F
SBR RR. What is the sacral diagnosis?
a) Right on Right
b) Left on Left
c) Right on Left
d) Left on Right
9) A patient is found to have a negative sphinx test, deep sacral sulcus on the right, and
posterior ILA on the left. What is the sacral diagnosis?
a) Right on Right
b) Left on Left
c) Right on Left
d) Left on Right
10) A patient is found to have a positive seated flexion test on the right and a deep sulcus
on the left. The right ILA is mildly anterior and significantly superior. A spring/sphinx
test is positive. What is the diagnosis?
a) Left unilateral sacral extension
b) Left unilateral sacral flexion
c) Right unilateral sacral extension
d) Right unilateral sacral flexion
e) Right on Left torsion
11) A patient has a negative sphinx test and a positive seated flexion test on the right.
They are found to have a deep right sulcus and the right ILA is slightly posterior and
significantly inferior. What is the diagnosis?
a) Left unilateral sacral extension

b) Left unilateral sacral flexion

c) Right unilateral sacral extension
d) Right unilateral sacral flexion
e) Left on Left torsion
12) Movement against gravity only would be given what muscle strength grade?
a) 1/5
b) 2/5
c) 3/5
d) 4/5
e) 5/5
13) A patient with an abnormal Babinski reflex is found to have brisk, unsustained clonus
of the deep tendon reflexes on the left lower limb. What grade would this be given?
a) +0/4
b) +1/4
c) +2/4
d) +3/4
e) +4/4
14) What dermatome corresponds to sensation on the lateral calf?
a) L3
b) L4
c) L5
d) S1
e) S2
15) What dermatome corresponds to sensation in the popliteal fossa?
a) L3
b) L4
c) L5
d) S1
e) S2
16) What dermatome corresponds to sensation at the Achilles tendon and 5th tarsal?
a) L3
b) L4
c) L5
d) S1
e) S2
17) Ankle dorsiflexion is accomplished via what nerve innervation?
a) Femoral
b) Peroneal
c) Gluteal
d) Sciatic
e) Tibial
18) Ankle plantar flexion is accomplished via what nerve innervation?
a) Femoral
b) Peroneal
c) Gluteal
d) Sciatic
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e) Tibial
19) What nerve levels correspond to ankle dorsiflexion and inversion?
a) L2-L3
b) L3-L4
c) L4-L5
d) L5-S1
e) S1-S2
20) What nerve root is most responsible for motor movement of the extensor hallicus
longus?
a) L1
b) L2
c) L3
d) L4
e) L5
f) S1
21) What is the most common cause of low back pain?
a) Ankylosing spondylitis
b) Reiter syndrome
c) Multiple myeloma
d) Mechanical
e) Infection
22) The straight leg raise tests for:
a) Disc herniation
b) Spondylolisthesis
c) Sciatic nerve compression
d) Weak gluteus medius
e) Tight iliopsoas
23) A middle-aged man presents with low back pain. X-ray shows a bamboo spine.
Which of the following is most likely?
b) Reiter syndrome
c) Multiple myeloma
d) Neoplasm
e) Coccygodynia
24) A young woman presents with complains of low back pain that worsens with sitting.
She says she recently slipped on ice and fell on her butt. She also complains of pain
during intercourse and bowel movements. Which of the following is most likely?
b) Reiter syndrome
c) Multiple myeloma
d) Cauda equina syndrome
e) Coccygodynia
25) Which of the following is most associated with saddle anesthesia, loss of
bowel/bladder function, and needs to be treated within 6 hours?
b) Reiter syndrome
c) Multiple myeloma
d) Cauda equina syndrome
e) Coccygodynia
26) A patient is found to have a positive seated flexion test on the right, L5 N SBL RR,
shallow left ILA, deep right superior sulcus, and the lumbar spine is convex to the right.
What is the sacral diagnosis?
a) Right on Right
b) Left on Left
c) Right on Left
d) Left on Right
27) When performing the iliolumbar ligament treatment with ligamentous articular strain
(LAS), the physician places their hand superior and medial to the PSIS to contact the
iliolumbar ligament and uses this to monitor during treatment. The clinician then lifts the
ipsilateral leg and:
a) Abducts the leg then compresses toward the iliolumbar ligament
b) Flexes the leg then distracts away from the iliolumbar ligament
c) Adducts the leg then compresses toward the iliolumbar ligament
d) Flexes the leg then distracts away from the iliolumbar ligament
e) They do not lift the ipsilateral leg
28) Which of the following describes the location of the gluteus medius counterstrain
point and the position that the patient’s ipsilateral leg is placed during treatment?
a) Between L4-L5 on the iliac crest; leg is flexed
b) Between L4-L5 on the iliac crest; leg is extended
c) Between L3-L4 on the iliac crest; leg is flexed
d) Between L3-L4 on the iliac crest; leg is extended
29) Which of the following is NOT true of facilitated positional release (FPR) for the
sacrum?
a) Clinician stands on side opposite of restricted SI joint
b) Clinician places hand on contralateral sulcus
c) Clinician leg ipsilateral to SI joint
d) Clinician externally rotates leg
30) Which of the following is NOT true when treating a left on left forward sacral torsion
with muscle energy?
a) Patient lies on left side
b) Patient rotates so they are face down
c) Clinician monitors at superior pole
d) Patient’s legs are raised above the table
e) Clinician opposes patient’s leg force toward neutral
31) Which of the following is NOT true when treating a left on right forward sacral
torsion with muscle energy?
a) Patient lies on left side
b) Patient rotates so they are face up
c) Clinician monitors at superior pole
d) Patient’s lower leg is lowered below the table
e) Clinician opposes patient’s leg force toward neutral
OPP #6 – Clinical: Pelvis

1) Anterior and posterior rotation of the pelvis about the SI joint involving the respiratory
and cranial axis occurs at what level?
a) L4
b) L5
c) S1
d) S2
e) S3
2) A patient is found to have an inferior ASIS on the left, a superior PSIS on the left, and
an inferior pubic ramus on the left. Which of the following is most likely?
a) Left posterior rotation
b) Right posterior rotation
c) Left superior shear
d) Right inferior shear
e) Right anterior rotation
3) A patient with a history of hip replacement is found to have a superior shear. When
treating this shear, one should NOT:
a) Abduct the leg
b) Adduct the leg
c) Internally rotate the leg
d) Externally rotate the leg
e) Apply light traction to leg
4) Which of the following patients would most likely require lift therapy due to a short
leg after hip surgery?
a) Patient with osteomyelitis
b) Athletic, middle-aged man
c) Diabetic patient with poorly controlled blood glucose
d) Teenage patient with depression
e) Elderly patient with dementia
5) A patient is found to have a positive standing flexion test. The distance from the ASIS
to midline on the ipsilateral side is decreased. Their ASIS is superior and PSIS is
superior. Pubic rami and ischial tuberosities are found to be equal. What is the diagnosis?
a) Superior shear
b) Inferior shear
c) Outflare
d) Inflare
e) Pubic abduction
6) Which of the following often refers pain to the groin (anterior hip region)?
a) Osteoarthritis
b) Acute low back strain
c) Sacroilitis
d) Sciatica
e) Coccidynia
f) Lateral trochanteric bursitis
7) A patient presents with suspected nephrolithiasis. An x-ray shows a calcium stone

lodged at the ureterovesical (UV) junction. What type of somatic dysfunction will likely
predominate?
a) Pubic
b) Iliac
c) Sacral
d) Coccygeal
e) Lumbar
8) Which of the following is NOT true when treating an anterior pelvic rotation with
HVLA?
a) Patient is lateral recumbent
b) Dysfunction side is up
c) Patient’s top foot is in their popliteal fossa
d) Patient rotates upper torso upward
e) Thrust is away from clinician and downward with semi-circular motion
9) When treating a posterior innominate with HVLA leg-pull technique, which of the
following is true?
a) Patient supine, leg raised upward, leg adducted and externally rotated
b) Patient supine, leg raised upward, leg abducted and internally rotated
c) Patient supine, leg lowered off table, leg adducted and externally rotated
d) Patient supine, leg lowered off table, leg abducted and internally rotated
10) What position is the patient placed in for muscle energy treatment of a posterior
innominate rotation?
a) Prone and leg raised above table
b) Prone and leg lowered below table
c) Lateral recumbent and top leg flexed
d) Sims position and bottom leg straight
e) Supine and leg abducted slightly
11) Which of the following structures divides the greater and lesser sciatic foramen?
a) Sacrotuberous ligament
b) Sacrospinous ligament
c) Sacroiliac ligament
d) Tendon of the obturator internus muscle
e) Tendon of the piriformis muscle
OPP #7 – Gait
1) Which of the following is NOT true?
a) The ileum is anterior during the swing phase and posterior during stance
b) A normal base is 2-4”
c) A normal step length is 12”
d) A normal cadence is 90-120 steps/minute
e) Stride length is measured from heel strike to heel strike
2) The center of gravity oscillates with an amplitude of 2” during gait, with ileum motion
moving 40 degrees with each step. Where is the center of gravity located?
a) 2” anterior to S2
b) 2” posterior to S2
c) 1” superior to L4
d) 2” anterior to L4
e) 2” posterior to L4
3) Which of the following is an analysis of forces that produce motion?
a) Dynamic EMG
b) Kinesthetics
c) Kinematics
d) Kinetics
e) Momentum
4) 60% of the total gait cycle is spent in:
a) Stance phase
b) Double support
c) Swing phase
d) Heel strike
e) Push off
5) Which of the following is NOT existent during running?
a) Stance phase
b) Double support
c) Swing phase
d) Heel strike
e) Push off
6) Which of the following provides a loading response, waiting for the opposite foot to be
ready for swing?
a) Heel strike
b) Foot flat
c) Midstance
d) Push off
e) Acceleration
f) Midswing
g) Deceleration
7) During heel strike, how is the ipsilateral ileum positioned?
a) Rotates anteriorly and internally
b) Rotates anteriorly and externally
c) Rotates posteriorly and inferiorly
d) Rotates posteriorly and superiorly
e) Rotated maximally posteriorly
8) During flat foot, how is the ipsilateral ileum positioned?
9) During push off, how is the ipsilateral ileum positioned?

10) When does ankle dorsiflexion occur during the swing phase?
a) Acceleration
b) Midswing
c) Deceleration
d) All of swing
e) It does not dorsiflex
11) Innominate rotation occurs on what axis and at what level?
a) Superior transverse axis, S2
b) Middle transverse axis, S2
c) Middle transverse axis, S3
d) Inferior transverse axis, S2
e) Inferior transverse axis, S3
12) If someone starts to take a right step forward, how will his or her lumbar spine and
sacrum move?
a) L5 SL RL with L on L torsion
b) L5 SL RR with L on L torsion
c) L5 SR RR with R on R torsion
d) L5 SR RL with R on R torsion
13) What variation of normal gait is seen here?
a) Toeing in
b) Toeing out
c) Genu valgum
d) Genu varum
e) Diplegia
14) A patient presents with an abnormal gait second to a neurologic disorder. The patient
has limited dorsiflexion, preventing tibial forward progression. This results in knee
hyperextension and loss of the propulsive phase of gait. During the swing phase, the
plantar flexed foot leads to clearance difficulties. Which of the following is most likely?
a) Trendelenburg gait
b) Ataxic gait
c) Antalgic gait
d) Steppage gait
e) Equinovarus
15) A patient with degenerative joint disease (DJD) of the hip presents with an abnormal
gait. During walking, the patient’s pelvis drops on the non-weight bearing side with the
trunk following. Which of the following is most likely?
b) Ataxic gait
c) Antalgic gait
d) Steppage gait
e) Equinovarus
16) A patient presents with chronic knee problems and an abnormal gait. The patient uses
a cane on the affected side and spends a short amount of time in the stance phase on the
affected side. The pelvis and trunk shift away from the affected side. Which of the
following is most likely?
b) Ataxic gait
c) Antalgic gait
d) Steppage gait
e) Equinovarus
17) A child with cerebral palsy walks with very stiff legs. You note very little knee
flexion during swing and nearly no ankle plantarflexion. There is a very wide base.
During heel strike, it appears the child lands with such force that the knee hyperextends.
Which of the following is most likely?
b) Ataxic gait
c) Antalgic gait
d) Steppage gait
e) Equinovarus
f) Quadriceps avoidance
18) A man presents with an abnormal gait. You note an out-toeing and a lack of heel
strike. Leg lengths are equal. Which of the following is most likely?
a) Equinovalgus
b) Femoral anteversion
c) Vaulting gait
d) Femoral retroversion
e) Equinovarus
OPP #8 – Outpatient
1) Which of the following is NOT part of the definition of somatic dysfunction?
a) Arthroidal
b) Skeletal
c) Myofascial
d) Cranial
e) Neural
f) Lymphatic
g) Vascular
2) When sequencing techniques, which of the following is NOT true?
a) Treat axial skeleton before extremities
b) Treat proximal before distal dysfunction
c) Treat subacute changes before acute changes
d) Treat primary dysfunction before facilitating dysfunction
e) Any somatic dysfunction is significant until determined otherwise
3) With regard to dosage and treatment, which of the following is NOT true?
a) Treat key areas first
b) Allow time for the patient to respond to treatment
c) Chronic disease requires chronic treatment
d) Acute cases have a shorter interval between treatments
e) Sicker patients require increased doses
4) Which of the following statements may be the most helpful for a patient who has never
received osteopathic care?
a) “I am an Osteopathic Physician, in addition to the types of treatment you have
had in the past, I use my hands evaluate your muscles and bones and can use
manipulation as part of your treatment plan”
b) “I am an Osteopathic Physician, which is basically a bone doctor”
c) “I am an Osteopathic Physician, instead of treatments you have had in the past,
I use my hands to provide Physical Therapy, Massage, and Chiropractic
manipulation”
d) “I am an Osteopathic Physician, so my treatment plan will be far different from
that of an M.D.”
e) “I am an Osteopathic Physician trained in the fine arts first enunciated by
Andrew Taylor Still”
5) Where are the counterstrain points located for the knee?
a) Anterior on the patella
b) Medial and lateral patella
c) Superior and inferior patella
d) Mid-popliteal fossa
e) No points exist
6) Where is the Chapman reflex point for the pharynx?
a) Inferior to 1st rib, lateral to sternum
b) Inferior to 1st rib, mid-clavicular
c) Inferior to 2nd rib, lateral to sternum
d) Inferior to 2nd rib, mid-clavicular
e) Mid-sternal
7) Still technique aimed at what rib may be helpful for a patient with carpal tunnel
syndrome?
a) 1st rib, ipsilateral
b) 1st rib, contralateral
c) 2nd rib, ipsilateral
d) 2nd rib, contralateral
e) 12th ribs, bilateral
OPP #9 – Obstetrics & Gynecology

1) A 31-year-old P0G1 white female, 35 weeks gestation, presents for routine visit with
chief complaint of unremitting frontal headache, purulent nasal drainage, and nausea.
Nausea is mostly in the morning hours. She is certain this is related to the cold her
husband has given to her and she wishes he could be pregnant for just one day. After
careful history and exam, a very tender frontal sinus is found on the right, along with OA
F RR SL. Which of the following would be contraindicated in this patient?
a) Azithromycin (Zithromax)
b) Amoxicillin (Augmentin)
c) Sinus drainage technique
d) Salt water lavage
e) OA muscle energy
f) CV4 technique
2) When performing OA manipulation techniques on a pregnant patient (third trimester),

what is the best patient positioning?
a) Left Sims position
b) Right lateral recumbent
c) Supine with left uterine displacement
d) Supine with right uterine displacement
e) Supine with pillow under left hip
3) A 32-year-old P0G1, 29 weeks gestation with twins, presents with shortness of breath,
fatigue, generalized non-radiating low back pain, right-sided groin pain and a 50lb weight
gain. Vital signs and physical exam are unremarkable from chief complaint. Structural
exam reveals TART in lumbar region, L1 E SR RT, a tight anterior tenderpoint at L5
location (pubic symphysis), and a left-sided diaphragmatic rotational barrier in the sitting
position. Which of the following is most likely?
a) Herniated lumbar disc
b) Pulmonary embolism
c) Prader-Willi syndrome
d) Spondylolisthesis
e) Round ligament syndrome
4) When treating an L5 counterstrain tenderpoint, how should the patient’s legs be
positioned, while holding for 90-seconds?
a) Side-bend toward and rotate toward tenderpoint
b) Side-bend toward and rotate away from tenderpoint
c) Side-bend away from and rotate toward tenderpoint
d) Side-bend away from and rotate away from tenderpoint
5) A 25-year-old Asian female G2P1 presents at 38 weeks gestation with a chief
complaint of heartburn. Testing reveals TART T3-T9 on the left with T4-T8 N RL SR.
Grasp is weaker on the right with a bilaterally positive Tinel and Phalen sign. Which of
the following treatment options may be the most difficult for the patient to follow?
a) OMM to the thoracic spine
b) Sleep in an upright position
c) Take antacids
d) Avoid food after 7pm
e) Avoid spicy foods
f) Carpal tunnel and palmar release
6) Where are the Chapman points for the esophagus?
a) T1 left paraspinal, T1-2 parasternal costochondral junction
b) T1 right paraspinal, T1-2 parasternal costochondral junction
c) T2 left paraspinal, T2-3 parasternal costochondral junction
d) T2 right paraspinal, T2-3 parasternal costochondral junction
7) Which of the following is NOT a physiologic change seen in pregnancy?
a) GFR increases by 50% early on
b) Creatinine levels run around 0.5mg/dL (low)
c) BUN runs around 8-9mg/dL (low)
d) Creatinine clearance decreases
e) Progesterone and beta-endorphins increase
8) Which of the following physiologic respiratory changes, likely caused by

progesterone, does NOT occur in normal pregnancy?
a) Respiratory rate increase 50%
b) Tidal volume increases 40%
c) Minute ventilation increases 50%
d) FRC is reduced by 20%
e) Residual volume decreases
9) Which of the following physiologic cardiovascular changes does NOT occur in normal
pregnancy?
a) Blood and plasma volume increases 40%
b) Heart rate decreases by 15%
c) Cardiac output increases 40%
d) Stroke volume increases by 40%
e) An innocent grade 1-2 systolic flow murmur may occur
f) Hypercoagulability and higher susceptibility to pulmonary embolism
10) Lumbar lordosis may be exaggerated in pregnant patients. Spinal curves allow the
spine to resist how much more weight than a standard “stay and mast” arrangement, with
the iliopsoas making up the “mainstay” in the mast system?
a) 2 times
b) 3 times
c) 5 times
d) 7 times
e) 10 times
11) How should a pregnant patient be positioned during cardiopulmonary resuscitation
(CPR) attempts?
a) Supine on a backboard
b) Left Sims position
c) Supine with left uterine displacement
d) Supine with right uterine displacement
e) Supine with pillow under left hip
12) Which of the following is NOT a component of pre-eclampsia?
a) Systolic BP > 140mmHg or 30mmHg increase over baseline
b) Diastolic BP > 90mmHg or 15mmHg increase over baseline
c) Proteinuria
d) Edema
e) Tonic clonic seizure
OPP #10 – Hospitalized Patient

1) Lateral leg numbness and numbness of the first three toes would be seen in a
herniation of what disc?
a) L2-L3
b) L3-L4
c) L4-L5
d) L5-S1
e) S1-S2
2) Inability to move the flexor digitorum superficialis and profundus would indicate a
nerve lesion at what root?
a) C3-5
b) C5
c) C5-6
d) C6-7
e) C7-8
f) C8
g) C8-T1
3) Inability to extend the great toe would indicate a nerve lesion at what root?
a) L2-3
b) L3-4
c) L4-5
d) L5-S1
e) S1-S2
f) S2-4
4) Which of the following is NOT associated with parasympathetic stimulation?
a) Vagus nerve (CN X)
b) Carotid body (CN IX, X)
c) Thickening of mucous
d) Contraction of bronchiolar smooth muscle
e) OA, AA, C1, C2
5) Which of the following has sympathetic innervation from T7-T11 as well as T1-T6?
a) Parietal pleura
b) Visceral pleura
c) Lung
d) Trachea
e) Bronchi
6) Which of the following Chapman points is incorrect?
a) Upper lung is anterior T3
b) Lower lung is anterior T4
c) Upper lung is posterior T2
d) Lower lung is posterior T3
e) Heart is posterior T1
7) Pelvic splanchnics (S2-4) supply parasympathetics to all of the following EXCEPT:
a) Prostate
b) Genitals and rectum
c) Upper ureter
d) Descending colon
e) Uterus
8) Innervation to the midgut (jejunum, ileum) would involve which of the following?
a) Celiac ganglion (post-ganglionic)
b) Greater splanchnic (pre-ganglionic, T5-T9)
c) Superior mesenteric ganglion (post-ganglionic)
d) Least splanchnic (pre-ganglionic, T12-L2)
e) Inferior mesenteric ganglion (post-ganglionic)
9) What is the pathogenic factor in post-op ileus?

a) Increased sympathetic output
b) Decreased sympathetic output
c) Increased parasympathetic output
d) Decreased parasympathetic output
10) Visceral somatic reflex pain involves afferent fibers to collateral sympathetic
ganglion, carried to the cortex via what tract?
a) Corticobulbar (corticonuclear)
b) Corticospinal and reticulospinal
c) Medial longitudinal fasciculus (MLF)
d) Posterior column, medial lemniscus (PCML)
e) Spinothalamic tract
11) Which of the following drugs can stimulate motility and acts as a motilin agonist?
a) Morphine
b) Erythromycin
c) Cisapride
d) Somastatin
e) Neostigmine
12) Which of the following drugs can assist in rapid re-establishment of colonic tone and
thus is beneficial in patients with acute colonic distention, but not mechanic obstruction?
a) Morphine
b) Erythromycin
c) Cisapride
d) Somastatin
e) Neostigmine
13) Hyoid release would be most useful for which of the following patients?
a) Uncontrolled diabetic in the Emergency Department
b) Bronchitis patient in the primary care clinic
c) Intensive Care Unit patient on a ventilator
d) Smoker with emphysema
e) Pediatric patient with allergic rhinitis
14) Myofascial release of the thoracic inlet is held for 20 to 60 seconds. The functional
thoracic inlet includes:
a) T1-4
b) Ribs 1 & 2
c) Manubrium
d) All of the above
OPP #11 – Surgical Patient

1) What is the role of the Auerbach (outer) GI plexus?
a) Controls motility
b) Controls GI secretions
c) Controls blood flow
d) A & B
e) B & C
2) Peri-umbilical pain is associated with midgut structures, innervated by what nerve

roots?
a) T1-T4
b) T5-T9
c) T8-T11
d) T11-L1
e) L2-L4
3) A-delta pain fibers transmit appendicitis pain to what region?
a) Peri-umbilical
b) RUQ
c) LUQ
d) RLQ
e) LLQ
4) Which of the following is NOT seen during surgery?
a) Decreased BP
b) Decreased cardiac contractility
c) Vasodilation
d) Positive pressure ventilation
e) Increased venous return
5) What is the most common cause of low back pain after surgery?
a) Malignant hyperthermia
b) Extended sacrum
c) Bladder distension
d) Succinylcholine
e) Morphine or fentanyl
6) What is the most common cause of hypertension after surgery?
a) Malignant hyperthermia
b) Extended sacrum
c) Bladder distension
d) Succinylcholine
e) Morphine or fentanyl
7) Opioids reset CO2 receptor and apneic threshold, which can lead to post-op
hypercarbia and a release of catecholamines. What effect would this have?
a) Low-grade fever and increased parasympathetic tone
b) Low-grade fever and increased sympathetic tone
c) Chills and increased parasympathetic tone
d) Chills and increased sympathetic tone
8) In the 1993 Sleszynski study, patients who received what treatment had earlier return
to pre-op values for FEV1 and FVC?
a) Thoracic lymphatic pump
b) BLT to thoracic spine
c) Indirect myofascial release of the sternum
d) Occipital release
e) Rib raising
9) A 76-year-old white female underwent an uneventful ORIF of her left proximal
humerus two days ago. Today her temperature is 100.5 degrees F (38 C). BP 135/75 P
110, R 16/min. However, she is quite drowsy and falls asleep in mid sentence. Physical
exam reveals Elevated 1st rib left and T1 RR SR. Bilateral basilar crackles on
auscultation. Which of the following is most likely?
a) Pneumonia
b) Atelectasis
c) Pneumothorax
d) Ascites
e) Ileus
10) A 45-year-old white male, right hand dominant, complains bitterly of low back pain
following an 11-hour operation to re-attach and repair 4 fingers, to his right hand
following a lawnmower mishap. He has TART changes in his lumbar spine bilaterally
and his sacrum moves better during inhalation than exhalation. He cannot do a Spring test
in bed. He says his pain is constant, achy, non-radiating and 8/10. Sacral motion is not
noticeable during respiration. Sulcus is tender, shallow bilat, ILA’s symmetrical, and
seated flexion test +/-. Which of the following is most likely?
a) Bladder distension
b) Atelectasis
c) Pneumothorax
d) Ascites
e) Ileus
11) Where is the anterior Chapman point for the kidneys?
a) 2cm lateral and 2cm cephalad of umbilicus
b) 4cm lateral and 4cm cephalad of umbilicus
c) 2cm superior to umbilicus
d) 4cm superior to umbilicus
e) Peri-umbilical
OPP #12 – Review & Pediatrics

1) Andrews Taylor Still was born in August of which of the following years?
a) 1828
b) 1850
c) 1865
d) 1874
e) 1892
2) The neuromusculoskeletal system is profoundly important and comprises what
percentage of the body?
a) 50%
b) 60%
c) 70%
d) 75%
e) 80%
3) An epidemic of which of the following diseases took the lives of Still’s children?
a) Cholera
b) Influenza
c) Meningitis
d) Smallpox
e) Typhoid fever
4) A. T. Still broke with orthodox medicine and “flung the banner of osteopathy to the
breeze.” He developed a form of manipulation to help keep the body fit with
unobstructed circulation and innervation. He did this on the 22nd of June in which year?
a) 1874
b) 1875
c) 1876
d) 1877
e) 1878
5) In which of the following years did Dr. Still open the American School of Osteopathy
in Kirksville, MO?
a) 1828
b) 1850
c) 1874
d) 1892
e) 1917
6) Medical Education in the United States and Canada was a scathing exposé of medical
schools in North America. A few medical schools were closed but medical education was
improved. Who was the author of this report?
a) Flexner
b) Jones
c) Mitchell
d) Palmer
e) U.S. Public Health Service
7) Due to AMA antagonism, Osteopathic Physicians were not allowed to practice in the
armed forces during several wars. This situation subsequently strengthened their practices
within the United States. The involved wars included which of the following?
a) Civil and Spanish American Wars
b) World War II and Korean War
c) World War I and War of 1912
d) World Wars I and II
e) Korean and Vietnam Wars
8) Presently (2009), excluding branch campuses, how many schools of Osteopathic
Medicine exist?
a) 21
b) 23
c) 25
d) 27
e) 28
9) Dr. Still died at the age of 89 in what year?
a) 1817
b) 1850
c) 1874
d) 1892
e) 1917
10) Licensing of osteopathic physicians in California was halted and M.D. degrees were
granted by the former Osteopathic College to nearly 2,500 D.O.s for a fee. The Los
Angeles College of Osteopathic Physicians and Surgeons becomes an allopathic medical
school, later affiliated with the University of California system. This all happened in what
years?
a) 1960-61
b) 1961-62
c) 1962-63
d) 1963-64
e) 1964-65
11) When the Osteopathic profession suffered a major setback in California, D.O.s could
purchase an M.D. degree for how much?
a) $55
b) $65
c) $75
d) $85
e) $1,000
12) Osteopathic medicine is first and foremost:
a) Osteopathic manipulation
b) Allopathic medicine and manipulation
c) A system based on using minute dosages of medication
d) A medical philosophy
e) A system based solely on the fact that the body is a unit
13) Cellular structures stabilize themselves by balancing counteracting forces of
compression and tension via microtubules, microfilaments, cell membranes, and fascial
collagen. This phenomenon is known as:
a) Bioelectricity
b) Elasticity
c) Plasticity
d) Viscosity
e) Tensegrity
14) When is the best time to treat a newborn, according to Fulford?
a) Within 6 hours
b) After 6 hours, but no longer than 24-hours
c) After a 24-hour waiting period
d) Between days 1 and 3
e) Between days 3 and 5
15) Although all of the following can be treated with occipital condylar decompression,
which of the following is specific to CN IX (glossopharyngeal)?
a) Torticollis
b) Reflux
c) Colic
d) Pyloric stenosis
e) Sucking
16) When treating the thoracic inlet in the prone position, how should the patient’s head
be positioned with respect to the dysfunctional side?
a) Rotate and sidebend away

b) Rotate and sidebend toward
c) Rotate away, sidebend toward
d) Rotate toward, sidebend away
17) When performing cervical HVLA of the OA or C3-7, how is the barrier engaged?
a) Sidebend toward, rotate away
b) Sidebend away, rotate toward
c) Sidebend and rotate toward
d) Sidebend and rotate away
18) Which of the following describes HVLA techniques?
a) Active and direct
b) Active and indirect
c) Passive and direct
d) Passive and indirect
19) A 35-year-old female presents after changing a flat tire on the side of the road. She
said she bent forward to pick up the flat tire and felt a “pop” as she twisted, then felt
immediate pain. You palpate a posterior transverse process at T10 on the right. Which of
the following describes this patient’s somatic dysfunction?
a) T10 N RR SBL
b) T10 E RL SBL
c) T10 E RR SBR
d) T10 F RL SBL
e) T10 F RR SBR
James Lamberg
AnswerKey OPP #4 26) B 6) A OPP #12

OPP #1 1) D 27) A 7) A 1) A
1) E 2) E 28) B 2) B
2) D 3) B 29) C OPP #9 3) C
3) A 4) C 30) D 1) F 4) A
4) B 5) A 31) A 2) C 5) D
5) C 6) D 3) E 6) A
6) B 7) B OPP #6 4) C 7) D
7) E 8) D 1) D 5) D 8) C
8) C 9) D 2) B 6) C 9) E
9) C 10) C 3) C 7) D 10) B
10) D 11) B 4) E 8) A 11) B
11) C 12) C 5) D 9) B 12) D
12) B 13) C 6) C 10) E 13) E
13) A 14) E 7) A 11) C 14) A
14) B 15) E 8) C 12) E 15) E
15) E 16) D 9) B 16) D
16) D 17) A 10) A OPP #10 17) A
18) E 11) B 1) C 18) C
OPP #2 2) F 19) E
1) C OPP #5 OPP #7 3) D
2) D 1) D 1) C 4) C
3) C 2) C 2) A 5) A
4) A 3) B 3) D 6) E
5) E 4) E 4) A 7) C
6) A 5) B 5) B 8) C
7) C 6) C 6) B 9) A
8) A 7) E 7) B 10) E
9) B 8) D 8) D 11) B
10) C 9) B 9) E 12) E
11) D 10) C 10) B 13) C
12) E 11) D 11) E 14) D
13) D 12) C 12) B
14) B 13) D 13) A OPP #11
14) C 14) E 1) A
OPP #3 15) E 15) A 2) C
1) C 16) D 16) C 3) D
2) A 17) B 17) B 4) E
3) B 18) E 18) D 5) B
4) E 19) C 6) C
5) B 20) E OPP #8 7) B
6) C 21) D 1) D 8) A
7) C 22) C 2) D 9) B
8) E 23) A 3) E 10) E
9) A 24) E 4) A 11) A
25) D 5) B

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Osteopathic Principles & Practice – Part 4 28Mar2009

OPP #1 – Visceral: Upper Gastrointestinal

DO NOT DISTRIBUTE -1-

13) The inspiration phases (inspir) of visceral motility coincides with:

OPP #2 – Visceral: Lower Gastrointestinal

DO NOT DISTRIBUTE -2-

DO NOT DISTRIBUTE -3-

OPP #3 – Visceral: Layer Palpation

DO NOT DISTRIBUTE -4-

OPP #4 – Clinical: Lumbar

DO NOT DISTRIBUTE -5-

DO NOT DISTRIBUTE -6-

DO NOT DISTRIBUTE -7-

OPP #5 – Clinical: Sacrum

DO NOT DISTRIBUTE -8-

a) Patient has a unilateral sacral torsion

DO NOT DISTRIBUTE -9-

b) Left unilateral sacral flexion

OPP #6 – Clinical: Pelvis

7) A patient presents with suspected nephrolithiasis. An x-ray shows a calcium stone

d) Rotates posteriorly and superiorly

OPP #9 – Obstetrics & Gynecology

2) When performing OA manipulation techniques on a pregnant patient (third trimester),

8) Which of the following physiologic respiratory changes, likely caused by

OPP #10 – Hospitalized Patient

9) What is the pathogenic factor in post-op ileus?

OPP #11 – Surgical Patient

2) Peri-umbilical pain is associated with midgut structures, innervated by what nerve

OPP #12 – Review & Pediatrics

a) Rotate and sidebend away

AnswerKey OPP #4 26) B 6) A OPP #12

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