< 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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