Quiz Osteopathic Part 3 of 4

Osteopathic Principles & Practice – Part 3 25Mar2009
OPP #1 – Osteopathic Approach To Clinical Problems

1) Which of the following is NOT one of the first four principles of Osteopathic
Medicine?
a) The body is a unit
b) Structure and function are reciprocally inter-related
c) The movement of body fluids is essential to the maintenance of health
d) The body possesses self-regulatory mechanisms
e) The body has the inherent capacity to defend and repair itself
2) Under ICD-9 for 2008, which of the following codes is used for somatic dysfunction
(non-allopathic lesions)?
a) 276.x
b) 303.x
c) 565.x
d) 739.x
e) 799.x
3) Which of the following is the first step in the neuromusculoskeletal evaluation?
a) Palpation
b) Observation
c) Physical Exam
d) Motion Testing
e) History
4) Which of the following is the major goal of OMT?
a) Restore anatomical and functional relationships
b) Restore normal vascular supply
c) Restore venous and lymphatic drainage
d) Restore neurological function
e) Restore homeostasis
f) Restore bioenergetic balance
5) Sympathetic nerves arise from the IML in the gray matter of the spinal cord at what
levels?
a) C1-C7
b) T1-L2
c) T5-L1
d) T5-T9
e) L2-L4
6) Treatment of which of the following would involve the sacral portion of the autonomic
nervous system?
a) Bladder
b) Liver
c) Pancreas
d) Thyroid
e) Lungs
7) Dr. I.M. Korr felt that all disease processes were associated with:
a) Hypoparasympathetic activity
b) Hyposympathetic activity
c) Hyperparasympathetic activity
DO NOT DISTRIBUTE -1-

d) Hypersympathetic activity
8) When nociceptors are triggered by pain in the enteric plexuses of the stomach, which
ganglion does the neural signal pass through first on its path to the spinal cord?
a) Spinal sensory ganglion
b) Sympathetic trunk ganglion
c) Celiac ganglion
d) Ventral root
e) Splanchnic ganglion
9) The cervical ganglion associated with the heart originates from what spinal levels?
a) C1-C4
b) C5-C8
c) T1-T4
d) T5-T9
e) T10-T11
10) Which area should be focused on for treatment if the goal is to normalize the vagus
nerve (CN X)?
a) Upper cervical
b) Lower cervical
c) Thoracic
d) Lower lumbar
e) Sacral
11) For palpation and treatment of the sympathetic collateral ganglia via inhibition, the
abdomen is divided into three equal parts with the three ganglia lying between each part.
This division begins as the xiphoid process and ends at the:
a) T10 rib line
b) T12 rib line
c) Umbilicus
d) Iliac crests
e) Pubic symphysis
12) Which of the following receives dual sympathetic post-ganglionic innervation from
the celiac and superior mesenteric ganglia?
a) Gallbladder
b) Jejunum
c) Spleen
d) Duodenum
e) Liver
13) Innervation by the least splanchnic nerve and inferior mesenteric ganglion begins at
which of the following anatomical locations?
a) Hepatic flexure
b) Proximal 1/3 colon
c) Distal 1/3 colon
d) Splenic flexure
e) Sigmoid colon
14) What pre-ganglionic sympathetic level is associated with the ileum?
a) T1-T4
b) T5-T9

c) T10-T11
d) T12-L2
e) L3-L4
15) Which of the following is NOT true regarding an acute facilitated spinal segment due
to increased sympathetic tone?
a) Bogginess or puffiness
b) Decreased range of motion due to contracture
c) Extension and side-bending/rotation to predominant
d) A “bounce off” felt during HVLA
e) Hyperirritability
16) Which of the following sympathetic Chapman points is associated with the fifth
intercostal space on the right?
a) Liver
b) Liver, Gallbladder
c) Stomach acid
d) Stomach peristalsis
e) Pyloris
17) Which of the following techniques would be used to normalize sympathetic tone?
a) Pterygopalatine ganglion treatment
b) Rib raising treatment
c) Sacral inhibition
d) OA or AA manipulation
e) Ischiorectal fossa techniques
18) Which of the following tests would be diagnostic for hip/coxal (innominate)
dysfunction on the right side?
a) Positive standing flexion test on right, Negative seated flexion test
b) Positive standing flexion test on left, Negative seated flexion test
c) Positive standing flexion test on right, Positive seated flexion test on right
d) Positive standing flexion test on left, Positive seated flexion test on right
e) Positive standing flexion test on right, Positive seated flexion test on left
19) Which of the following is correct if a deeper OA sulcus is palpated on the right and
the OA evens out when flexion is induced?
a) OA F RR SR
b) OA E RR SR
c) OA F RR SL
d) OA E RR SL
20) Which of the following would be the most likely diagnosis if the articular pillars were
palpated more posteriorly from C4-C6 on the right?
a) C4-C6 RR SR
b) C4-C6 RR SL
c) C4-C6 RL SR
d) C4-C6 RL SL
21) Which of the following is the correct setup position for treating a forward sacral
torsion with muscle energy?
a) Sim’s position with dysfunction side down
b) Sim’s position with dysfunction side up

c) Lateral recumbent position with dysfunction side down

d) Lateral recumbent position with dysfunction side up
OPP #2 – Lymphatics
1) Complete shutdown of the lymphatic system can lead to death within 24 hours due to
which of the following?
a) Pulmonary emboli
b) Pneumothorax
c) Gastric rupture
d) Splenomegaly
e) Anasarca
2) The thoracic duct begins with the cysterna chyli at what spinal level?
a) T1
b) T5
c) T10
d) L2
e) L4
3) The thoracic potion of the thoracic duct is bordered anatomically on the right by the:
a) Aorta
b) Pulmonary trunk
c) Azygos vein
d) Subclavian vein
e) Internal jugular vein
4) Which of the following areas contains lymphatics?
a) Spinal cord
b) Brain
c) Adenoids
d) Bone marrow
5) As the right lymphatic duct courses toward the right internal jugular and right
subclavian vein, what muscle does it follow?
a) Anterior scalene
b) Middle scalene
c) Posterior scalene
d) Mylohyoid
e) Omohyoid
6) Clinically, the thoracic inlet consists of:
a) T1, Ribs 1 & 2, Manubrium
b) T1-T4, Ribs 1 & 2, Manubrium
c) T1, Rib 1, Superior aspect of manubrium
d) T1-T4, Rib 1, Superior aspect of manubrium
e) T1, Ribs 1 & 2, Superior aspect of manubrium
7) A patient from Boulder, Colorado suffers damage to the major lymph nodes of their
right axilla. If this affected drainage of 10% of body’s lymph, how much could be
displaced into tissues of the right arm (edema)?
a) 20L
b) 2L

c) 200mL
d) 20mL
e) 2mL
8) Which of the following would lead to edema via decreased intravascular oncotic
pressure?
a) Congestive heart failure
b) Lymphatic obstruction
c) Lymphatic inflammation
d) Malnutrition
e) Immobility
9) Which of the following techniques would involve treating the posterior attachments at
L1, L2, and L3?
a) Pedal (Dalrymple) pump
b) Rib raising
c) Thoracic inlet
d) Pectoral traction
e) Diaphragm doming
f) Liver pump
g) Splenic pump
OPP #3 – Integrative Approach To Hypertension

1) About what percentage of hypertension cases are essential (primary), meaning no
specific medical cause can be found?
a) 5-10%
b) 20-25%
c) 50-55%
d) 70-75%
e) 90-95%
2) Which of the following is NOT a likely cause of essential hypertension?
a) Stress-induced norepinephrine release
b) Drinking alcohol on a daily basis
c) Drinking tea on a daily basis
d) Obesity due to inactivity
e) Using tobacco products
3) According to the Joint Commission on Hypertension (7th meeting, JNC IV, 2003),
there should be an increased emphasis on all of the following lifestyle modifications
EXCEPT: (sometimes considered a major cause of morbidity and mortality)
a) Sodium restriction
b) Alcohol reduction
c) Weight loss through exercise
d) Improved nutrition
e) Stress reduction
4) In a 2000 study using the Dietary Approaches to Stop Hypertension (DASH), the study
group had a mean drop in blood pressure and a decrease in which of the following
markers used for hypertension? (Circulation 102: 852-57)
a) Homocysteine

b) S-adenosylmethionine
c) Carnitine
d) Tryptophan
e) Glutamic acid
5) A diet rich in which of the following could increase monounsaturated fatty acids,
increase HDL, and increase oleate-rich LDL? (2000 Arch Int Med. 160: 837-842)
a) Sodium
b) Olive oil
c) Omega-3
d) Beta-carotene
e) Vitamin C
6) Coronary artery disease (CAD) has been shown to decrease in individuals on which of
the following diets? (2001. Prev. Cardiol. (4) 171-177)
a) Animal-based
b) Plant-based
c) Soy-based
d) Vitamin-based
e) Mineral-based
7) Of the following compounds shown to decrease hypertension, which one is a
component of the electron transport chain participating in the generation of ATP and may
decrease the effects of warfarin?
a) Omega-3
b) Ca++
c) Vitamin C
d) Ubiquinone
e) K+
8) Of the following compounds shown to decrease hypertension, which one interferes
with prostaglandin synthesis in platelets and blood vessels?
a) Omega-3
b) Ca++
c) Vitamin C
d) Ubiquinone
e) K+
9) Of the following compounds shown to decrease hypertension, which has been shown
effective in African American, pregnant, and “salt sensitive” patients?
a) Omega-3
b) Ca++
c) Vitamin C
d) Ubiquinone
e) K+
10) Which of the following is a source of magnesium?
a) Salmon
b) Broccoli
c) Dairy
d) Nuts
e) Bananas

11) Which of the following is a common dosage for daily vitamin C supplements?
a) 3g/day
b) 6mg/kg/d
c) 1500mg/day
d) 500mg/day
e) 60mg/day
12) Precaution should be taken for using garlic supplements (1-2 cloves/day) in patients
using what type of drugs?
a) Antibiotics
b) Antiarrhythmics
c) Anticoagulants
d) Antihypertensives
e) Antipsychotics
13) Which of the following, in excess, has been shown to cause hypertension as well as
hypokalemia, which could potentially lead to life-threatening Torsade de Pointes (TdP)?
a) Panax ginseng
b) Ephedra
c) Caffeine
d) Acupuncture
e) Licorice
14) According to the American College of Sports Medicine (ACSM) and the American
Heart Association (AHA), which of the following is a recommended exercise program
for decreasing hypertension and improving health?
a) 3 days a week for 30 minutes at 75% VO2max
b) 3 days a week for 90 minutes at 50% VO2max
c) 5 days a week for 60 minutes at 50% VO2max
d) 5 days a week for 90 minutes at 75% VO2max
e) 7 days a week for 10 minutes at 90% VO2max
OPP #4 – Sequencing: Part 1

1) What is “an architectural system in which structures stabilize themselves by balancing
counteracting forces of compression and tension”?
a) Elasticity
b) Compresegrity
c) Tensegrity
d) Blastity
e) Clastity
2) When determining the area of greatest restriction (AGR), what vertebral level is the
divide between upper and lower?
a) C7
b) T4
c) T8
d) T12
e) L5

3) A medical student presents with neck pain after studying for long hours in front of a
computer. If the AGR is found in the cervical region, what should the treatment be using
a patient specific sequencing flow chart?
a) Treat the most restricted cranial pattern or suture
b) Treat the occipitoatlantal (OA) or atlantoaxial (AA) dysfunction
c) Treat the C2-C7 cervical dysfunction
d) Treat the most restricted cervical area
e) Treat the most restricted sacral (dural connection) area
4) A patient presents with a bilateral horizontal band somatic dysfunction in the thoracic
region. Further palpation reveals the band is more dysfunctional as it travels lateral.
Which of the following is the appropriate sequencing treatment?
a) Treat the most restricted upper extremity area
b) Treat the key rib that is maintained in expiration or inspiration
c) Treat the most restricted thoracic area
d) Treat the cervical area on the contralateral side
e) Treat the thoracic outlet on the ipsilateral side
5) A diffuse unilateral vertical band is found on the medial border of the scapula at the T3
level. This would indicate the source of the dysfunction is at the:
a) Shoulder
b) Upper arm
c) Elbow
d) Lower arm
e) Hand
6) During a patient examination, a positive standing forward bending test is found. Which
of the following would be the next step in sequencing for treatment of this patient?
a) Treat the most restricted lower extremity area
b) Treat the most restricted lumbar area
c) Treat the most restricted pelvic area
d) Treat the upshear, downshear, up/down pubes, sacrum, or ilial rotation
e) Rescreen the lumbar vertebrae and sacroiliac joint
7) A medical student presents with low back pain after sitting in a lecture hall all day.
Examination reveals tight paraspinal musculature at the level of L3. This would indicate
the source of the dysfunction is at the:
a) Hip
b) Thigh
c) Knee
d) Lower leg
e) Foot
8) If the area of greatest restriction is found at the L5 level, which of the following should
be further examined?
a) Adductor and abductor dysfunction
b) Osseous femur strain
c) Internally/externally rotated tibia, anterior/posterior fibular head
d) Interosseous tibia/fibula strain
e) Distal fibular, talar, cuboid, navicular dysfunction

OPP #5 – Sequencing: Part 2

1) A 37-year-old male comes into the office complaining of neck pain started after he did
some heavy lifting at home while moving furniture 3 days ago. Past medical history:
HTN, OA, Asthma, left ankle sprain. Meds: atenolol, Motrin, albuterol. Which of the
following medications should the patient NOT be taking?
a) Atenolol
b) Motrin
c) Albuterol
d) A & B
e) B & C
2) A patient presents with a left first rib that is superior on palpation, comes up with
inhalation, but does not move with exhalation. What is the diagnosis?
a) Exhalation somatic dysfunction of the first rib
b) Inhalation somatic dysfunction of the first rib
c) Exhalation somatic dysfunction of the clavicle
d) Inhalation somatic dysfunction of the clavicle
3) A patient presents with hypertension and a tight left sternocleidomastoid. What nerve
arises from the occipital-mastoid suture, which could be affecting the patient’s blood
pressure?
a) Trigeminal (CN V)
b) Facial (CN VII)
c) Vagus (CN X)
d) Accessory (CN XI)
e) Hypoglossal (CN XII)
4) A patient presents with a left ankle sprain. Where might tissue-texture changes be
found on palpation of the back?
a) L3 on the left
b) L3 on the right
c) L5 on the left
d) L5 on the right
e) L5 bilaterally
5) A patient presents with pain in their lower back. A standing flexion test is negative and
a seated flexion test is positive. Using sequencing, what is the next step?
a) Treat the sacroiliac dysfunction
b) Treat the iliosacral dysfunction
c) Treat the superior or inferior shear
d) Treat the lumbar dysfunction
e) Rescreen the lumbar and sacroiliac joint
6) A patient presents with a unilateral diffuse vertical band of tissue-texture change on
the right side at L1. Using sequencing, what area should be screened next?
a) Right hip
b) Left hip
c) Right knee
d) Left knee
e) Right ankle

7) If bilateral bands of tissue-texture change are found in the lumbar region and testing
reveals dysfunction of the sacrum and innominate, which of the following should be
treated first?
a) Innominate rotation
b) Sacrum
c) Pubic dysfunction
d) Up/downshear
e) Order does not matter
8) Which of the following is a false positive for a standing flexion test?
a) Carryover from a seated flexion test
b) Ipsilateral tight hamstrings
c) Contralateral tight hamstrings
d) Tight quadratus lumborum
e) A & B
f) A & C
9) Which of the following is a false positive for a seated flexion test?
a) Carryover from a standing flexion test
b) Ipsilateral tight hamstrings
c) Contralateral tight hamstrings
d) Tight quadratus lumborum
e) A & B
f) A & B
10) In sequencing, what is the scale for area of greatest restriction (AGR)?
a) Dx, Dy, Dz
b) A-E
c) 1-3
d) 1-5
e) 1-6
11) What nerve level is being tested when a patient is asked to walk on their heels?
a) L3
b) L4
c) L5
d) S1
e) S2
12) A patient presents with difficulty toe-walking and a decreased Achilles reflex. Which
of the following areas might the patient have numbness?
a) Posterolateral thigh and lateral calf
b) Anterolateral thigh and anterior knee
c) Posterior thigh, posterior calf, bottom of the foot
d) Posterior thigh, lateral calf, top of the foot
e) Anterolateral thigh, medial calf, bottom of the foot
13) What nerve level is associated with the peroneus longus and brevis muscle, as well as
the gastrocnemius?
a) L2
b) L3
c) L4
DO NOT DISTRIBUTE - 10 -
d) L5
e) S1
14) What does the straight leg raise test for?
a) Sciatic nerve compression
b) Herniated L1
c) Low back pain
d) Tight hamstrings
e) False perceived pain
15) Which of the following would test for iliopsoas spasm?
a) Murphy test
b) Thomas test
c) McMurray test
d) Ober test
e) Straight leg raise
16) As lactic acid and metabolites can build up with manipulative therapy, what should a
patient be asked to do after treatment?
a) Use compression bandages for 48 hours
b) Use ice for 4 hours then heat for 6 hours
c) Take extra strength ibuprofen or aspirin
d) Sleep no more than 6 hours that night
e) Drink lots of water
17) What is the suggested anti-inflammatory treatment using hot and cold packs after the
onset of symptoms of injury?
a) Ice for 24-48 hours, 20 minutes on and 20 minutes off, then either hot or cold
b) Heat for 24-48 hours, 20 minutes on and 20 minutes off, then either hot or cold
c) Ice for 24-48 hours continuously, then either hot or cold
d) Heat for 24-48 hours continuously, then either hot or cold
e) Ice and heat have equal effectiveness at any point during treatment
OPP #6 – Common Compensatory Pattern (CCP)

1) Which of the following is NOT considered a transitional area to examine for common
compensatory pattern (CCP)?
a) Occipitoatlantal
b) Thoracic inlet
c) Thoracocervical
d) Thoracolumbar
e) Lumbosacral
2) What is the most common compensatory pattern, seen in 80% of well individuals?
a) Left, Right, Left, Right
b) Right, Left, Right, Left
c) Left, Left, Right, Right
d) Right, Right, Left, Left
e) Right, Right, Right, Right
3) What dysfunction might be seen at the upper cervical (OA/AA) level in patients with
common compensatory pattern?
a) OA/AA RL SL
b) OA/AA RR SR
c) OA/AA RL SR
d) OA/AA RR SL
4) What dysfunction might be seen at the thoracic inlet in patients with common
compensatory pattern?
a) Inlet RL SL
b) Inlet RR SR
c) Inlet RL SR
d) Inlet RR SL
5) What sacral dysfunction might be seen in patients with common compensatory
pattern?
a) Sacrum left on right
b) Sacrum right on left
c) Sacrum left on left
d) Sacrum right on right
6) Which of the following dysfunctions might be seen in patients with common
a) Long right leg, high iliac crest on the right
b) Long right leg, high iliac crest on the left
c) Long left leg, high iliac crest on the right
d) Long left leg, high iliac crest on the left
7) Which of the following dysfunctions might be seen in patients with common
a) Right piriformis spasm, left psoas spasm
b) Right piriformis spasm, right psoas spasm
c) Left piriformis spasm, left psoas spasm
d) Left piriformis spasm, right psoas spasm
8) What dysfunction might be seen at the thoracolumbar junction in patients with
common compensatory pattern?
a) Junction RL SL
b) Junction RR SR
c) Junction RL SR
d) Junction RR SL
9) What dysfunction might be seen at the lower lumbar region in patients with common
a) Lumbar RL SL
b) Lumbar RR SR
c) Lumbar RL SR
d) Lumbar RR SL
OPP #7 – Cardiovascular
1) What levels correspond to the middle sympathetic cervical chain ganglion?
a) C2
b) C3-C4
c) C4-C5
d) C5-C6
e) C6-C7
2) What levels correspond to sympathetic innervation of the adrenals?
a) C4
b) T1-T5
c) T1-T7
d) T8-T10
e) T11-L1
3) A patient presents with dizziness and a pounding feeling in his chest. The paramedics
say there was no response to vagal maneuvers or adenosine. An ECG is performed,
shown below. Which of the following best describes the type of activity and location of
the nerve fibers involved?
a) Hyper-sympathetic activity; T1-T5 on the Right

b) Hyper-sympathetic activity; T1-T5 on the Left
c) Hyper-parasympathetic activity; Vagus nerve on the Right
d) Hyper-parasympathetic activity; Vagus nerve on the Left
4) A patient presents after a Stokes-Adams attack and is being examined for possible
implantation of an electronic pacemaker. An ECG is performed, shown below. Which of
the following best describes the type of activity and location of the nerve fibers involved?

5) A unconscious patient is bought to the Emergency Room. An ECG is performed,
shown below and a nurse sets the cardiac monitor to defibrillation mode. Which of the
following best describes the type of activity and location of the nerve fibers involved?


6) A patient presents after a syncopal episode. The paramedics say there was a slight
response to atropine. An ECG is performed, shown below. Which of the following best
describes the type of activity and location of the nerve fibers involved?

7) Which of the following is NOT a result of hyper-sympathetic activity?
a) Increased cardiac contractility
b) Increased myocardial oxygen demand
c) Coronary artery vasospasm
d) Increased cardiac irritability
e) Predisposition to atrioventricular block
8) Which of the following would NOT increase vagal tone?
a) Pressure on the globe of the eye
b) Intravenous atropine
c) Urination or defecation
d) Inferior wall myocardial infarction
e) Somatic dysfunction at the occipitomastoid suture, OA, AA, C2
f) Cold water facial immersion or Valsalva maneuver
g) Carotid sinus massage or irritation of the larynx
h) Severe pain, fright, or coughing
i) Prolonged standing with dehydration (Bezold-Jarisch reflex)
9) Renal artery stenosis or increased sympathetic tone at what level would most likely
cause the release of renin from the juxtaglomerular apparatus, contributing to essential
hypertension?
a) T1-T5
b) T5-T9
c) T8-T10
d) T11-L1
e) T12-L5
f) C & D
10) Increased sympathetic tone at what level would lead to increased cardiac output via
the release of catecholamines (e.g. norepinephrine)?
a) T1-T5
b) T5-T9
c) T8-T10
d) T11-L1
e) T12-L5
f) C & D
11) Although a cause-effect relationship has not been established, there has been shown
to be a clinically significant correlation between hypertension and what somatic
dysfunction pattern?
a) C2, T2, T6
b) C6, T2, T6
c) C2, C6, T2
d) C2, C6, T6
e) None of the above
12) A patient presents with shortness of breath that has become progressively worse as
well as difficulty breathing while in a reclined position (orthopnea). A B-type Natriuretic
Peptide (BNP) blood test reveals elevated levels. In addition to standard medical,
surgical, and interventional treatment, osteopathic manipulation is performed to reduce
hyper-sympathetic activity. What other form of OMT could be helpful for this patient?
a) Craniosacral
b) Myofascial release
c) Lympathics
d) Facilitated positional release
e) Chapman reflexes and trigger points
f) Cervical HVLA
13) Which of the following describes Still techniques?
a) Active moving from direct to indirect
b) Active moving from indirect to direct
c) Passive moving from direct to indirect
d) Passive moving from indirect to direct
14) Which of the following is NOT true for using the Still technique for a patient who has
OA SR RL?
a) The monitoring hand is placed on the right side
b) The head is side-bent to the right initially
c) The head is rotated to the left initially
d) About 5 pounds of distraction pressure is used
e) The head is carried to neutral, into the barrier, and back to neutral
15) Which of the following techniques stretches the pectoralis minor muscle and thus can
release pressure on the thoracic duct to improve lymphatic return?
a) Doming the diaphragm
b) Thoracic inlet HVLA
c) Thoracic inlet myofascial release
d) Cervical perpendicular stretch
e) Pectoral traction
16) Which of the following locations corresponds to the anterior Chapman point for the
heart?
a) 2nd intercostal space at the sternal border
b) 2nd intercostal space at the midclavicular line
c) 5th intercostal space at the sternal border
d) 5th intercostal space at the midclavicular line
e) All of the above
17) Which of the following locations corresponds to the anterior Chapman point for the
kidneys?
a) One inch lateral and two inches superior to the umbilicus ipsilaterally
b) One inch lateral and one inch superior to the umbilicus ipsilaterally
c) One inches lateral and two inches superior to the umbilicus contralaterally
d) One inches lateral and one inch superior to the umbilicus contralaterally
18) Which of the following locations corresponds to the posterior Chapman point for the
adrenals?
a) T10 intertransverse space midway between spinous and transverse processes
b) T11 intertransverse space midway between spinous and transverse processes
c) T12 intertransverse space midway between spinous and transverse processes
d) L1 intertransverse space midway between spinous and transverse processes
e) L2 intertransverse space midway between spinous and transverse processes
OPP #8 – Respiratory
1) Which of the following may be considered typical or atypical as it attaches at only one
vertebral level?
a) 1st rib
b) 2nd rib
c) 10th rib
d) 11th rib
e) 12th rib
2) Which of the following best describes ribs 8-10?
a) Pump-handle ribs
b) Caliper ribs
c) True ribs
d) False ribs
e) Floating ribs
3) Which of the following describes the articulation of rib 9?
a) Costovertebral joints of T8 & T9, transverse process of T9, costal cartilage
b) Costovertebral joints of T9 & T10, transverse process of T9, costal cartilage
c) Costovertebral joints of T8 & T9, transverse process of T8, costal cartilage
d) Costovertebral joints of T9 & T10, transverse process of T10, costal cartilage
e) Costovertebral joints of T9 & T10, transverse process of T9, floating
4) Which of the following describes all of the ribs that have “bucket handle” motion?
a) Ribs 1-5
b) Ribs 1-7
c) Ribs 6-10
d) Ribs 8-10
e) Ribs 11-12
5) Which of the following describes the relation of the brachial plexus to the scalene
muscles?
a) Anterior to the anterior scalene
b) Between the anterior and middle scalenes
c) Piercing the middle scalene
d) Between the middle and posterior scalenes
e) Posterior to the posterior scalene

Match the muscle attachment with the primary ribs moved by that muscle:
6) Pectoralis minor a) 1st rib
7) Latissiumus dorsi b) 2nd rib
8) Quadratus lumborum c) Ribs 3-5
9) Anterior & middle scalenes d) Ribs 6-9
10) Serratus anterior e) Ribs 10-11
11) Posterior scalene f) 12th rib
12) The diaphragm attaches to what rib levels?
a) T3-T5
b) T4-T10
c) T7-T9
d) T6-T12
e) T8-T11
13) What structure pierces the diaphragm at the T10 level, closing on inhalation?
a) Inferior vena cava
b) Thoracic duct
c) Esophagus
d) Aorta
e) Cysterna chyli
14) Which of the following muscles is NOT involved in inspiration?
a) Rectus abdominus
b) External intercostals
c) Scalenes
d) Sternocleidomastoid
e) Diaphragm
15) Which of the following would occur with denervation of the long thoracic nerve?
a) Loss of the first 15 degrees of arm abduction
b) Inability to flex the arm at the elbow or supinate the forearm
c) Inability to shrug the shoulders or rotate the scapula
d) Inability to retract of the scapula from the thoracic wall
e) Inability to protract of the scapula to the thoracic wall
16) The bronchiol mucosa and alveoli are innervated by:
a) Right vagus nerve
b) Left vagus nerve
c) Sympathetic efferents
d) Sympathetic afferents
e) Sacral splanchnic nerves
17) The carotid baroreceptors (CN IX, X) and vagus nerve (CN X) deliver information
into which of the following areas, which uses a reflex arch to stimulate the phrenic nerve
and intercostal nerves during normal inspiration?
a) Arcuate nucleus
b) Ventromedial nucleus
c) Solitary nucleus
d) Posterior nucleus
e) Dorsomedial hypothalamic nucleus
18) Parasympathetic activity would cause which of the following?

a) Bronchiolar smooth muscle dilation and thinning of mucous
b) Bronchiolar smooth muscle contraction and thinning of mucous
c) Bronchiolar smooth muscle dilation and thickening of mucous
d) Bronchiolar smooth muscle contraction and thickening of mucous
19) What levels correspond to sympathetic innervation of the lung, trachea, bronchi, and
visceral pleura?
a) T1-T4
b) T1-T5
c) T1-T6
d) T1-T7
e) T1-T8
20) A patient presents with dysfunction of ribs 3-5 and pain with inspiration. During
expiration, the ribs move downward. During inspiration, the ribs do not move upward.
Which of the following describes the dysfunction and the key rib for treatment?
a) Exhalation dysfunction, inhalation restriction, key rib is 3
b) Exhalation dysfunction, inhalation restriction, key rib is 5
c) Inhalation dysfunction, exhalation restriction, key rib is 3
d) Inhalation dysfunction, exhalation restriction, key rib is 5
21) An inspiration somatic dysfunction of the ribs is associated with thoracic extension
somatic dysfunction.
a) True
b) False, it is associated with flexion dysfunction
22) What is the key area of lymphatic obstruction at the thoracic inlet?
a) T1-T2, Ribs 1 & 2, Manubrium
b) T1-T4, Ribs 1 & 2, Manubrium
c) T1-T2, Rib 1, Manubrium
d) T1-T4, Rib 1, Manubrium
e) Rib 1, Clavicle, Manubrium
23) A patient presents with symptomatic rib dysfunction. Evaluation of which of the
following areas would be the least helpful for this patient?
a) C2 vagus nerve
b) C3-C5 parasympathetics
c) T1-T4 sympathetics
d) Thoracolumbar junction
e) Lumbosacral junction
24) An anterior counterstrain point is found at the midclavicular line at what rib level?
a) 1st Rib
b) 2nd Rib
c) 3rd Rib
d) 4th Rib
e) 5th Rib
25) The respiratory center of the medulla is located on the floor or the fourth ventricle.
Manipulation at which location could directly affect this center?
a) Thoracic inlet
b) OA
c) AA
d) Diaphragm
e) CV4
26) According to the Hering-Breuer reflex, as alveolar air sacs fill with fluid in a patient
with pulmonary edema, how does breathing change?
a) Becomes slow and shallow
b) Becomes slow and deep
c) Becomes rapid and shallow
d) Becomes rapid and deep
e) Breathing does not change
27) Pre-operation and post-operation treatment at what levels has been shown to prevent
post-operative pneumonia in patients with abdominal surgery?
a) OA, AA, C1-C2
b) C3-C5
c) C6-C7
d) T1-T2
e) T3-T5
28) Which of the following Chapman point locations is associated with the broncus?
a) Posterior, in soft tissue between T1 spinous process and T2 transverse process
b) Anterior, 3rd intercostal space near sternum
c) Posterior, in soft tissue between T2 spinous process and T3 transverse process
d) Anterior, 4th intercostal space near sternum
e) Posterior, in soft tissue between T3 spinous process and T4 transverse process
29) The upper lung Chapman point is located anterior at the:
a) 2nd intercostal space near sternum
b) 3rd intercostal space midclavicular
c) 3rd intercostal space near sternum
d) 4th intercostal space midclavicular
e) 4th intercostal space near sternum
30) Counterstrain tender points that do not include the ribs are typically held for how
long during treatment?
a) 3-5 seconds
b) 30-seconds
c) 60-seconds
d) 90-seconds
e) 120-seconds
31) When treating depressed anterior ribs with counterstrain (AR1-AR6), what position
should the patient be in with respect to the dysfunction?
a) Side-bent away, rotated toward
b) Side-bent away, rotated away
c) Side-bent toward, rotated toward
d) Side-bent toward, rotated away
32) When treating elevated posterior rib 1 with counterstrain (PR1), what position should
the patient be in with respect to the dysfunction?

33) When treating elevated posterior ribs 2-6 with counterstrain (PR1), what position
should the patient be in with respect to the dysfunction?
34) Counterstrain rib tender points are typically held for how long during treatment,
including the wait period?
a) 30-seconds
b) 60-seconds
c) 90-seconds
d) 120-seconds
e) 150-seconds
OPP #9 – Head, Eyes, Ears, Nose, & Throat (HEENT): Part 1

1) Which of the following is a condition characterized by an asymmetrical distortion
(flattening of one side) of the skull without closure of the skull bones?
a) Craniosynostosis
b) Scaphocephaly
c) Plagiocephaly
d) Oxycephaly
e) Macrocephaly
2) Dysfunction of the temporal bone at the stylomastoid foramen could cause which of
the following?
a) Horner syndrome
b) Adie syndrome
c) Duane syndrome
d) Hypertension
e) Bell palsy
3) Which of the following cranial nerves does NOT arise from the jugular foramen with
the internal jugular vein?
a) Sigmoid sinus
b) CN IX
c) CN XI
d) CN X
e) CN VII
4) Which of the following arteries branches from the external carotid and runs behind
(internal to) the temporomandibular joint (TMJ)?
a) Facial artery
b) Maxillary artery
c) Lingual artery
d) Superficial temporal artery
e) Posterior auricular artery
5) Which of the following arteries forms the dental branches, supplying blood to the
lower teeth?
a) Masseteric artery
b) Pterygoid artery
c) Sphenopalantine artery
d) Inferior alveolar artery
e) Anterior superior alveolar artery
6) Which of the following complications has been associated with cervical manipulation,
with hyperextension seeming to be associated?
a) Nerve root lesion
b) Blocked lymph flow
c) Cervical radiculopathy
d) Vertebral artery insufficiency
e) Vertebrobasilar thrombosis
7) Entrapment of which vein between the occipital and temporal bones would have the
greatest affect on venous return?
a) Vertebral vein
b) External jugular vein
c) Internal jugular vein
d) Maxillary vein
e) Facial vein
8) Increasing flow (drainage) of which lymph node group would likely have the greatest
affect on a patient with otitis media?
a) Anterior cervical nodes
b) Submandibular nodes
c) Occipital nodes
d) Auricular nodes
e) Buccal nodes
9) Increasing parasympathetic stimulation of the sphenopalantine ganglion from within
the mouth could lead to the patient “tearing up” on the ipsilateral side due to innervation
of the lacrimal gland by what nerve?
a) CN III
b) CN VII
c) CN IX
d) CN X
10) Which of the following parasympathetic cranial nerves synapses at the otic ganglion
before innervating the parotid gland?
a) CN III
b) CN VII
c) CN IX
d) CN X
11) The sublingual and submandibular glands are innervated by:
a) CN III
b) CN VII
c) CN IX
d) CN X
12) Sympathetic innervation to the head arises from:

a) C1 & C2
b) C3-C5
c) C6-C7
d) T1-T4
e) T5-T9
13) Increased sympathetic response would lead to all of the following EXCEPT:
a) Increased cracking of mucous membranes
b) Decrease immune response
c) Increased secretions
d) Decreased lymphatic drainage
e) Vasoconstriction
14) Chronic sympathetic response would lead to all of the following EXCEPT:
a) Dilation of pupils
b) Increased goblet cells
c) Thick, tenacious secretions
d) Increased clouding of lens
e) Increased columnar cells
15) Which of the following would be seen with increased parasympathetic activity?
a) Increased thin, watery secretions
b) Pharyngeal hyperesthesia
c) Palpitations
d) Tinnitius
e) Photophobia
16) Which of the following cranial nerves is NOT vulnerable to dural strain, as the others
pass under the petrosphenoidal ligament formed by the tentorum cerebelli?
a) CN III
b) CN IV
c) CN V
d) CN VI
17) Which of the following nerve ganglia would be affected by treatment of the thoracic
inlet with release of the Sibson fascia?
a) Stellate ganglia
b) Superior cervical ganglia
c) Middle cervical ganglia
d) Thoracic aortic plexus
e) Esophageal plexus
18) Diaphragm release can be obtained with treatment of which attachment points?
a) T1-T4
b) T5-T9
c) T10-T12
d) L1-L2
e) L3-L5
19) Treatment of the OA and AA is aimed at which of the following?
a) Normalizing sympathetic flow
b) Normalizing parasympathetic flow
c) Lymphatic drainage
d) Soft tissue
e) Effleurage
20) Which of the following is a treatment option for the eye, not the ear?
a) Cranial balance of temporal bones
b) Hyoid bone dysfunction
c) Medial pterygoid dysfunciton
d) Auricular drainage
e) Effleurage
21) What is the aim when treating nose or throat dysfunction with sphenopalantine
ganglion manipulation?
a) Decrease redness
b) Increase number of PMNs
c) Thin secretions
d) Decrease lymphatic flow
e) Increase swelling
22) Which of the following describes the sphenopalantine ganglion release technique?
a) Physician’s finger lateral to patient’s back upper molar with medial force
b) Physician’s finger medial to patient’s back upper molar with lateral force
c) Physician’s finger lateral to patient’s back lower molar with medial force
d) Physician’s finger medial to patient’s back lower molar with lateral force
23) A 29-year-old female presents with complaints of headache, facial pain, stuffy nose,
cough, general malaise, and fever (101ºF) times 3 days. Patient currently complains of
large amounts of yellow and green mucous when she blows her nose. She states that she
suffers from seasonal allergies and they were really bothering her for a few weeks before
this happened. She took over-the-counter pseudoephedrine and diphenhydramine daily
for relief of allergy symptoms. She also took some over-the-counter flu medication, but
she can’t remember what it was. What is the most likely diagnosis?
a) Kartanger syndrome
b) Viral upper respiratory infection
c) Allergic rhinitis
d) Sinusitis
e) Cystic fibrosis
24) In children, the Eustachian tube is shorter and more ____ as it connects to the nasal
cavity, increasing the chance of otitis media.
a) Horizontal
b) Vertical
25) Which of the following describes the Galbreath technique?
a) Alternating nasal pressure
b) Submandibular release
c) Mandibular drainage
d) Cervical chain drainage
e) Frontal temporomandibular drainage
26) Which of the following lymph nodes drains the tonsils?
a) Parotid lymph nodes
b) Submandibular lymph nodes
c) Retropharyngeal lymph nodes

d) Deep cervical lymph nodes
e) Jugulodigastric lymph nodes
27) Which of the following describes the location of the Chapman point for the pharynx?
a) Medial 1/3 of clavicle on superior border
b) Medial 1/3 of clavicle on inferior border
c) Right sternal border, inferior to clavicle
d) Right sternal border, first intercostal space
e) Right sternal border, angle of Louis
28) A 3-year-old child presents to the ER with fever, cough, and runny nose. He is also
pulling at his ears. The doctor’s diagnosis is viral syndrome and prescribes Tylenol. The
child returns to the ER on the next day around 1 am with a temperature of 104ºF and is
still coughing. After an HEENT physical exam, Zithromax (azithromycin) is prescribed.
Which of the following locations would the clinician likely find a Chapman point?
29) Which of the following describes the location of the Chapman point associated with
the nasal sinuses?
30) An anesthesiologist is asked to do a trigeminal nerve block on a patient who will
receive minor maxillary surgery (V2 branch). Which of the following describes the
location for the injection?
a) Just anterior to the tragus of the ear
b) About an inch lateral to the indentation of the chin
c) About an inch lateral to the nares
d) Just below the eyebrow, centered with the eye
e) About two inches medial to the ear at the peak of the cheek bone
OPP #10 – Head, Eyes, Ears, Nose, & Throat (HEENT): Part 2
1) Approximately 35% of what type of headache is associated with an aura?
a) Tension headache
b) Migraine headache
c) Cluster headache
d) Aneurysm headache
e) Thrombosis headache
2) A 20-year-old female college student presents with a headache that came on gradually
and is now severe. She has right frontal throbbing, nausea, and photophobia. She states
she was at a dance club prior to onset. She has a history of similar headaches for years
now and her mother has headaches. Physical exam is normal. Which of the following
would likely NOT be a trigger for her headaches?
a) Tyramines (cheeses, red wine)
b) NSAIDs (ibuprofen, aspirin)
c) Nitrates (cold cuts)
d) MSG (snack foods, fast food)
e) Caffeine, chocolate, stress
3) Which cranial bone is most likely involved in a patient with a somatic dysfunction
migraine headache? (side-bending and rotation patterns)
a) Frontal
b) Occipital
c) Parietal
d) Temporal
e) Sphenoid
4) A patient presents with a bilateral, pressing “band-like” tightness headache. He denies
nausea, vomiting, or aura. He says he exercises regularly and the headache does not
change in intensity. Treatment to which of the following areas would be LEAST effective
for his tension headache?
a) OA
b) AA
c) Upper thoracic
d) Lumbar spine
e) Trapezius and levator scapula
5) Which of the following is associated with vertex myofascial pain?
a) Splenius capitus
b) Semispinalis
c) Multifidus
d) Suboccipitals
e) SCM muscle
6) Which of the following is NOT involved in temporal myofascial pain?
a) Trapezius
b) SCM sternal head
c) SCM clavicular head
d) Temporalis
7) A male patient presents with severe, unilateral pain around the orbit. They say the pain
usually occurs at night and is associated with tearing and runny nose. They have had a
few episodes daily for the past three months since starting medical school. OMT
treatment is aimed at cranial, C1-C3, upper thoracics, and sphenopalatine ganglion
release. Which of the following is most likely?
a) Tension headache
c) Cluster headache
d) Aneurysm headache
e) Thrombosis headache
8) Which of the following causes Bell palsy?
a) CN III, IV, VI dysfunction
b) CN V upper motor neuron dysfunction

c) CN V lower motor neuron dysfunction
d) CN VII upper motor neuron dysfunction
e) CN VII lower motor neuron dysfunction
9) Where does cranial nerve VII exit the internal acoustic meatus?
a) Superior orbital fissure
b) Foramen rotundum
c) Foramen ovale
d) Stylomastoid foramen
e) Jugular foramen
10) Which of the following forms of treatment for Bell palsy has insufficient evidence for
efficacy?
a) Prednisone
b) Acyclovir
c) Eye protection
d) Facial nerve decompression
11) Bell palsy could arise from internal rotation of what cranial bone?
a) Frontal
b) Occipital
c) Parietal
d) Temporal
e) Sphenoid
12) A 35-year-old mother of four children presents with unilateral facial pain that feels
like a dull ache. She has “popping” jaw sounds that are worse with chewing. Her husband
reports nocturnal bruxism (teeth grinding). Physical exam reveals tenderness over the
angle of the jaw that radiates to the ear. Which of the following is most likely?
a) Tension headache
c) Cluster headache
d) TMJ dysfunction
e) Tooth abscessed
13) Which of the following muscles opens the mouth?
a) Temporalis
b) Masseter
c) Lateral pterygoid
d) Medial pterygoid
OPP #11 – Osteopathy In The Cranial Field: Part 1

1) Which of the following is NOT one of the five principles of cranial osteopathy?
a) Inherent motility of the CNS (oligodendroglia)
b) Fluctuation of the cerebrospinal fluid (CSF)
c) Mobility of the intracranial and intraspinal membranes
d) Articular mobility of the cranial bones
e) Involuntary motion of the iliac crests on the sacrum
2) The choroid plexus forms approximately 70% of the CSF. Where is it located?
a) Lateral ventricles
c) Third ventricle
d) Aqueduct of Sylvius
e) Forth ventricle
f) Foramen of Magendie
g) Foramen of Luschka
3) The common origin (“Sutherland fulcrum”) for the falx cerebri, falx cerebelli, and
tentorium cerebellis is called the:
a) Transverse sinus
b) Sigmoid sinus
c) Straight sinus
d) Cavernous sinus
e) Saggital sinuses
4) Gliding motion is seen specifically at what type of suture?
a) Serrate (sawtooth)
b) Squamous (scale-like)
c) Harmonic (edge-to-edge)
d) Squamoserrate
5) Rocking motion is seen specifically at what type of suture?
a) Serrate (sawtooth)
b) Squamous (scale-like)
c) Harmonic (edge-to-edge)
d) Squamoserrate
6) What are the common phases seen in the cranial rhythmic impulse (CRI) mechanism?
a) Internal & external rotation
b) Left & right side-bending
c) Forward & backward torsion
d) Flexion & extension
e) Side-bending & rotation
7) Which of the following is INCORRECT for cranial flexion?
a) Increased transverse diameter
b) Sphenoid anteriorly rotates
c) Basiocciput moves posteroinferiorly
d) Sacral base draws posteriorly
e) Decreased anteroposterior diameter
8) Which of the following is a midline bone?
a) Parietal
b) Temporal
c) Sphenoid
d) Frontal
e) Innominates
9) The movement of cranial bones is most likely due to:
a) CSF
b) Respiration
c) Pulse
d) Dural membranes
e) CNS inherent movement
10) Which of the following is NOT a component of the primary respiratory mechanism
(PRM)?
a) CNS
b) Dural membranes
c) Cranial bones
d) Innominates
e) Sacrum
11) What is the approximate rate of the cranial rhythmic impulse (CRI)?
a) 1-2 or 2-4 cycles per minute
b) 4-8 or 6-8 cycles per minute
c) 8-12 or 10-14 cycles per minute
d) 16-18 or 10-24 cycles per minute
e) 60-100 cycles per minute
12) Which of the following describes the motion of the temporal bone in cranial
extension?
a) Flexion
b) Extension
c) Internal rotation
d) External rotation
e) They do not move
13) What is the Still Point?
a) The straight sinus origin
b) The axis at which all cranial motion ceases
c) The sphenobasilar synchondrosis (SBS)
d) A pause in the CRI
e) The cranial location first discovered by A. T. Still
14) Which of the following describes a lateral strain pattern?
a) Twisting at the SBS
b) Rotation in the same direction around anterior-posterior axis
c) Rotation in same direction around two parallel vertical axes
d) Rotation in same direction around two parallel transverse axes
e) Convexity to one side
15) A newborn presents with spitting, difficulty sucking, difficulty swallowing, and
torticollis. Occipital condylar compression is diagnosed. What cranial nerve is likely
NOT involved?
a) CN VII
b) CN IX
c) CN X
d) CN XI
16) Balanced ligamentous tension (BLT) specifically treats the:
a) CNS
b) CSF
c) Dural membranes
d) Cranial bones
e) Sacrum
17) What form of balanced ligamentous tension treatment is used on young children, in
trauma, and with over-riding sutures?
a) Indirect action
b) Direct action
c) Disengagement
d) Opposite physiologic motion, direct
e) Opposite physiologic motion, indirect
18) What is the center point for all cranial CNS motion?
a) Still point
b) Sutherland fulcrum (straight sinus)
c) Sphenoid bone
d) Occipital and sacral bones
e) Sphenobasilar junction (SBS)
OPP #12 – Integrative Approach To Asthma

1) Which of the following techniques should be avoiding in a patient with asthma who
may be on long-term steroids?
a) Myofascial release
b) Muscle energy
c) Counterstrain
d) Lymphatic
e) HVLA
2) What is the most likely organism involved in sick building syndrome?
a) Virus
b) Bacteria
c) Fungi
d) Protozoa
e) Algae
3) Which of the following medications is associated with induction of asthma?
a) Tylenol
b) Ibuprofen
c) Naproxen
d) Aspirin
e) Opiates
4) Which of the following is considered a non-steroidal anti-inflammatory drug?
a) Albuterol
b) Cromolyn sodium
c) Ipratropium bromide
d) Theophylline
e) Salmeterol
5) Which of the following would NOT be recommended in the treatment of asthma?
a) Cervical OA/AA muscle energy
b) Thoracic lymph pump
c) Rib HVLA
d) Rib raising
e) Diaphragm doming
6) In traditional Chinese medicine (TCM), which of the following elements corresponds

to the lung, as well as the large intestine and the fall season?
a) Fire
b) Earth
c) Metal
d) Water
e) Wood
7) Which of the following allergenic foods may increase mucous production and increase
asthma symptoms?
a) Dairy
b) Liquor
c) Tomatoes
d) Bread
e) Fruits
8) Increasing intake of which of the following would be anti-inflammatory, and thus help
improve asthma symptoms?
a) Omega-6 fatty acids
b) Omega-3 fatty acids
c) Partially hydrogenated fatty acids
d) Trans-fatty acids
9) Ginkgo (Ginkgo biloba), ginkgolide, may decrease airway inflammation. Ginkgo may
cause unwanted side-effects in patients taking:
a) Anti-arrhythmics
b) Anti-inflammatories
c) Anti-parasympathetics
d) Anti-coagulants
e) Anti-gout agents
10) Which of the following has side effects that may make asthma symptoms worse?
a) Coleus (Coleus forskohlii)
b) Ma Huang (Ephedra sinica)
c) Vitamin C
d) Vitamin B6
e) Magnesium (gluconate)

1) What suture connection is the most cephalad, located near the cranial apex?
a) Asterion
b) Bregma
c) Lambda
d) Pterion
2) Which of the following types of motion occurs with cranial flexion?
a) Sacrum moves anterior (flex), ASISs spread apart
b) Sacrum moves anterior (flex), ASISs come together
c) Sacrum moves posterior (extend), ASISs spread apart
d) Sacrum moves posterior (extend), ASISs come together
3) Which of the following would increase the rate and quality of the CRI?
a) Stress
b) Depression
c) Chronic fatigue
d) Systemic fever
e) Chronic infection
4) Which of the following facial bones is considered midline?
a) Maxilla
b) Zygoma
c) Nasal
d) Vomer
e) Palatine
5) Craniosacral motion occurs on what sacral axis, through the S2 segment?
a) Superior transverse axis
b) Middle transverse axis
c) Inferior transverse axis
d) Right oblique axis
e) Left oblique axis
6) Innominate rotation occurs on what sacral axis?
a) Superior transverse axis
b) Middle transverse axis
c) Inferior transverse axis
d) Right oblique axis
e) Left oblique axis
7) Which of the following does NOT occur with cranial flexion?
a) Midline bones flex
b) Paired bones externally rotate
c) Sacral base moves posteriorly
d) Sphenoid rotates anteriorly
e) Foramen magnum moves inferiorly
8) What cranial bones have motion that flare in and out?
a) Occiput
b) Temporals
c) Parietals
d) Sphenoid
e) Frontals
9) Which of the following strain patterns is NOT matched correctly?
a) Lateral strain; Pathological
b) Torsions; Physiological
c) Vertical strain; Pathologic
d) Side-bending/rotations; Physiological
e) Sphenobasilar symphysis compression; Physiological
10) What axis do cranial torsions occur on?
a) Two parallel vertical and one AP axis
b) Two parallel vertical axes
c) Two parallel transverse axes
d) Anteroposterior (AP) axis

e) No axis
11) How are cranial torsions named (right and left)?
a) Apex of the occiput
b) Base of the occiput
c) High great wing of sphenoid
d) Low great wing of sphenoid
e) Base of the sphenoid
12) What axis do cranial side-bending rotations occur on?
b) Two parallel vertical and one transverse axis
c) Two parallel transverse and one AP axis
e) No axis
13) In cranial side-bending rotations, the sphenoid and occiput rotate in opposite
directions about what axis?
a) Vertical
b) Transverse
c) AP
d) None of the above
14) What axis do cranial lateral strains occur on?
e) No axis
15) In lateral strains, rotation occurs in the same direction with the sphenoid and occiput.
How is the strain named?
a) Apex of the occiput
b) Base of the occiput
c) High great wing of sphenoid
d) Low great wing of sphenoid
e) Base of the sphenoid
16) When palpating a patient’s cranium in the vault hold, how would your index fingers
point in a left lateral strain?
a) Superiorly
b) Inferiorly
c) To the left
d) To the right
17) What axis do cranial vertical strains (shears) occur on?
e) No axis
18) When palpating a patient’s cranium in the vault hold, how would your index fingers
point in a superior vertical strain?
a) Superiorly
b) Inferiorly
c) To the left
d) To the right
19) A patient presents after falling backwards off their skateboard and landing on the
back of their head. Palpation of the cranium reveals SBS compression. What is the axis of
movement for this dysfunction?
e) No axis
20) Which of the following is NOT a contraindication to cranial OMT?
a) Decreased intracranial pressure
b) Intracranial hemorrhage
c) Cranial aneurysm
d) Skull fracture
e) Tumors
21) In facial observation, the supranasal vertical fold moves to the side on which what
cranial bone has moved (posteriorly in internal rotation)?
a) Occiput
b) Temporal
c) Parietal
d) Sphenoid
e) Frontal
22) In facial observation, the superomedial-inferolateral orbital diameter is greater on the
side where which of the following is high?
a) Occiput
b) Temporal
c) Parietal
d) Sphenoid
e) Frontal
23) When using the cranial vault hold, where should your ring finger be placed?
a) Greater wing of the sphenoid
b) Zygomatic arch of the frontal bone
c) Zygomatic arch of the temporal bone
d) Mastoid process of the temporal bone
e) Squamous portion of the occipital bone
24) Which of the following describes the hold for palpating cranial sacral rhythm?
a) Both hands cupping the sacrum
b) One hand cupping the sacrum, the other supporting the lumbar spine
c) One hand cupping the sacrum, the other arm across the iliac crests
d) One hand cupping the sacrum, the other arm across the ASISs
e) One hand cupping the sacrum, the other arm across the AIISs
25) Which of the following occurs with a right torsion?

a) Greater wing of the sphenoid is superior on the right
b) Occiput is inferior on the left
c) Occiput is superior on the right
d) Greater wing of the sphenoid is superior on the left
26) While palpating a patient’s cranium, you notice your left hand spreads wider and
moves inferior while your right fingers approximate. Which of the following is most
likely?
a) Left torsion
b) Right torsion
c) Left side-bending/rotation
d) Right side-bending/rotation
e) SBS compression
27) In a right side-bending/rotation pattern, what bones move anterior/superior?
a) Left occiput and left greater wing of the sphenoid
b) Left occiput and right greater wing of the sphenoid
c) Right occiput and right greater wing of the sphenoid
d) Right occiput and left greater wing of the sphenoid
28) A blow to the top of the head posterior to the plane of the SBS would likely cause
what cranial strain pattern?
a) Left lateral strain
b) Right lateral strain
c) Superior strain
d) Inferior strain
e) SBS compression
29) A blow from below the head anterior to the plane of the SBS would likely cause what
cranial strain pattern?
a) Left lateral strain
b) Right lateral strain
c) Superior strain
d) Inferior strain
e) SBS compression

1) The spinal dura has firm connections at all of the following EXCEPT:
a) Foramen magnum
b) C2
c) C3
d) C7
e) S2
2) Dysfunction to what cranial foramen would affect the majority of the vascular
drainage from the head?
b) Foramen rotundum
c) Foramen ovale
d) Stylomastoid foramen
e) Jugular foramen
3) What cranial bone has foramen for cranial nerves II though VII?
a) Frontal
b) Temporal
c) Sphenoid
d) Occipital
e) Ethmoid
4) Trigeminal branch V2, associated with Tic Doloureux (suicide disease), exits through
what foramen?
b) Foramen rotundum
c) Foramen ovale
d) Foramen spinosum
e) Jugular foramen
5) Through what foramen does the middle meningeal artery exit?
b) Foramen rotundum
c) Foramen ovale
d) Foramen spinosum
e) Jugular foramen
6) Trigeminal branch V3, associated with mandibular sensation, exits through what
foramen?
b) Foramen rotundum
c) Foramen ovale
d) Foramen spinosum
e) Jugular foramen
7) A patient presents with diploplia and decreased sensation to the eyelid and scalp.
Damage at what foramen may have caused these symptoms?
b) Foramen rotundum
c) Foramen ovale
d) Foramen spinosum
e) Jugular foramen
8) Increased dural strain may cause all of the following EXCEPT:
a) Sheehan syndrome
b) Vascular compromise
c) Pituitary dysfunction
d) Entrapment of ocular cranial nerves
e) Entrapment of hypoglossal and accessory cranial nerves
9) Which of the following nerves innervates the spinal dura?
a) Recurrent meningeal nerve of Luschka
b) Trigeminal nerve (V1, V2, V3)
c) C1
d) C2 and C3
e) Superior cervical ganglion
10) What cranial nerve has a branch that re-enters the cranium though the foramen
magnum?
a) CN VII
b) CN IX
c) CN X
d) CN XI
e) CN XII
11) Amblyopia is associated with all of the following cranial nerves EXCEPT:
a) CN I
b) CN II
c) CN III
d) CN IV
e) CN VI
12) Strabismus is particularly associated with what cranial nerve?
a) CN II
b) CN III
c) CN IV
d) CN VI
13) Bell palsy is associated with what cranial nerve?
a) CN V
b) CN VII
c) CN IX
d) CN X
e) CN XII
14) Trismus is associated with TMJ and what cranial nerve?
a) CN V
b) CN VII
c) CN IX
d) CN X
e) CN XII
15) Cardiac arrhythmia, headaches, GI upset, and respiratory problems could occur with
dysfunction at what foramen?
b) Foramen rotundum
c) Foramen ovale
d) Foramen spinosum
e) Jugular foramen
16) Sucking and swallowing problems in infants may involve all of the following cranial
nerves EXCEPT:
a) CN VII
b) CN IX
c) CN X
d) CN XI
e) CN XII
17) A 34-year-old male presents with facial paralysis. History reveals a recent viral upper
respiratory tract infection. The patient has lost some sense of taste to the anterior portion
of his tongue and says everything sounds louder on the right side. Which of the following
is most likely?
a) CN VII damage on the left
b) CN VII damage on the right
c) CN VIII damage on the left
d) CN VIII damage on the right
18) What treatment should be done for a child with a poor suck reflex?
a) Venous sinus technique
b) CV4 bulb decompression
c) Occipital condylar decompression
d) SBS decompression
e) Temporal rocking
19) A patient presents with dizziness, tinnitus, and vertigo. If CN VIII is affected, what
bone may be dysfunctional?
a) Frontal
b) Temporal
c) Sphenoid
d) Occipital
e) Ethmoid
20) An intoxicated patient presents with unknown trauma. With palpation, the cranium is
described as feeling like a bowling ball. What treatment should be done?
e) V-spread technique
21) Which of the following treatments is performed in the frontal-occipital hold?
22) How would a patient’s legs move with craniosacral flexion?
a) Internally rotate
b) Externally rotate
c) Shorten
d) Lengthen
23) When palpating a patient’s cranium you notice that the greater wing of the sphenoid
feels more superior on the right than the left. You also notice that the occiput is rotated in
the opposite direction. Which of the following is most likely?
a) Right torsion
b) Left torsion
c) Left lateral strain
d) Left side-bending rotation

e) Right side-bending rotation
24) Somatic dysfunction in all of the following may cause diploplia EXCEPT:
a) Sphenoid bone
b) Temporal bone
c) Occipital bone
d) CN III
e) CN VI
25) All of the following cranial nerves exit the jugular foramen EXCEPT:
a) CN IX
b) CN X
c) CN XI
d) CN XII
26) Somatic dysfunction of C2 may alter the function of what cranial nerve?
a) CN IX
b) CN X
c) CN XI
d) CN XII
Match the cranial technique with the result:
27) Enhance blood flow through venous sinuses a) Venous sinus
28) Separate restricted or impacted sutures b) CV4
29) A technique to help with TMJ dysfunction c) Vault hold
30) Diagnoses strains at the SBS d) Temporal rocking
31) Enhances the amplitude of the CRI e) V spread
OPP #15 – Integrative Approach To Hematology & Oncology

1) Cancer is the second leading cause of death in the United States, accounting for $190
billion dollars in health care spending (NIH 2003). What is the probability of developing
cancer during a man’s lifetime?
a) 63%
b) 50%
c) 38%
d) 21%
e) 6%
2) Which of the following is the most powerful risk factor for developing lung cancer?
a) Body
b) Mind
c) Spirit
d) Emotions
e) Smoking
3) Which of the following steps in carcinogenesis falls under secondary prevention?
a) Viruses
b) Nutrition
c) Genetic changes
d) Radiation
e) Environment
4) Which of the following is likely NOT seen with cancer patients who undergo
chemotherapy?
a) Depression
b) Weight gain
c) Alopecia
d) Nausea
e) Pain
5) Approximately 1/3 to 2/3s of oncology patients experience emotional distress
(depression, anxiety, etc). Which of the following is NOT one of the five emotional
stages (Kubler-Ross) that these patients may undergo?
a) Denial
b) Anger
c) Bargaining
d) Frustration
e) Acceptance
6) Kava (Piper methysticum) is an herbal supplement that some patients may use for:
a) Depression
b) Nausea
c) Insomnia
d) Anger
e) Anxiety
7) Valerian (Valerianaceae) is an herbal supplement that some patients may use for:
a) Depression
b) Nausea
c) Insomnia
d) Anger
e) Anxiety
8) St. John Wort (Hypericum perforatum, Tipton weed) is an herbal supplement that
some patients may use for:
a) Depression
b) Nausea
c) Insomnia
d) Anger
e) Anxiety
9) What is the incidence of weight loss seen in cancer patients?
a) 5-10%
b) 10-20%
c) 20-50%
d) 50-80%
e) 80-90%
10) CoQ10 (ubiquinone) may be protective against the toxicities of the chemotherapy
anthracyclines (daunorubicin, idarubicin). What is the major toxicity of these drugs?
a) Renal
b) Hepatic
c) Cardiac
d) Nervous
e) Splenic
f) Optic
11) Which of the following anti-emetic options is a serotonin-3 receptor antagonist?
a) Dexamethasone
b) Ondansetron (Zofran)
c) Ginger root extracts
d) Marijuana
e) Acupuncture
f) Hypnosis
12) Which of the following is high in beta-glucans (1,3), which may be immunoadjuvant
in cancer?
a) Organic fruits
b) Organic vegetables
c) Green tea
d) Mushrooms
e) Astragalus root
13) John Kanzius of Erie, PA is an inventor who created a device to treat cancer that uses
what concept?
a) Anti-neoplastons
b) High dose IV vitamin C
c) Ozone
d) Radiofrequency
e) Hyperthermia

1) The Sutherland fulcrum is located in which of the following?
a) Transverse sinus
b) Sigmoid sinus
c) Straight sinus
d) Transverse cerebelli
e) Faux cerebri
2) Which of the following would NOT be associated with cranial nerve IX dysfunction?
a) Loss of gag reflex
b) Taste disorder and dysphagia
c) Cardiac arrhythmia
d) Blood pressure changes
e) Nystagmus
3) Dysphonia, dysphagia, and dysfunction of the larynx or pharynx would involve what
cranial nerves?
a) CN VII & XII
b) CN IX & X
c) CN X & XI
d) CN XI & XII
e) CN XII & X
4) Gastrointestinal complaints including colic and vomiting would most likely involve
what cranial nerve?
a) CN VII
b) CN VIII
c) CN IX
d) CN X
e) CN XII
5) What cranial nerves pass through the foramen spinosum?
a) CN III, IV, V1, VI
b) CN V2
c) CN V3
d) CN IX, X, XI
e) None
6) The superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum
are all located within what cranial bone?
a) Frontal
b) Temporal
c) Sphenoid
d) Occipital
e) Ethmoid
7) Which of the following lies within the fourth ventricle?
a) Medulla
b) Pituitary
c) Straight sinus
d) Pineal process
e) Corpus callosum
8) The choroid plexus is located within the third ventricle as well as the:
a) Fourth ventricle
b) Median aperature
c) Lateral ventricle
d) Lateral aperture
e) Cisterna magna
9) A female patient who is 7-months pregnant presents with headaches. Which of the
following techniques is contraindicated as it could lead to spontaneous abortion?
10) Which of the following techniques normalizes the PRM and can reduce fevers?
11) Which of the following tests should be performed for new onset headaches to rule out
vertebral artery insufficiency (HVLA contraindication) by holding the patient’s head in
extension/rotation for 30 seconds and assessing for dizziness or visual changes?
a) Spurling test
b) Adson test
c) Yergason test
d) McMurray test
e) Wallenberg test
12) Which of the following symptoms is associated with tension headaches?
a) Ipsilateral lacrimation and redness of the eye
b) Nausea and vomitting
c) Stuffy nose, rhinorrhea, pallor
d) Photophobia and phonophobia
e) No associated symptoms
13) 20% of children between 6-months and 6-years-old get otitis media. What is the
major reason?
a) Increased likelihood of playing in dirty areas
b) Use of hands for playing and eating
c) Infections with different bacteria (compared with adults)
d) Anatomic structure of Eustachian tube
e) Easily bypassed (immature) immune system
14) A 12-month-old presents with left ear pulling, poor feeding, fever, and vomiting.
History reveals similar symptoms two other times within the past six months. Otoscopic
exam reveals a red membrane with no cone of light. Eustachian tube dysfunction is
diagnosed. What cranial bone is most likely involved?
a) Frontal
b) Occipital
c) Parietal
d) Temporal
e) Sphenoid
15) Which of the following patterns would most likely occur with a blow to the top of the
head in front of the axis of the sphenobasilar junction?
a) Lateral strain
b) Left side-bending/rotation
c) Right side-bending/rotation
d) Superior vertical strain
e) Inferior vertical strain
16) Which of the following cranial techniques separates opposing surfaces before
balancing?
a) Exaggeration
b) Direct action
c) Disengagement
d) Opposite physiologic motion
e) Molding
17) Which of the following cranial techniques moves toward physiologic motion to
normalize contours of the bone?
a) Exaggeration
b) Direct action
c) Disengagement
d) Opposite physiologic motion

e) Molding
18) Which of the following drainage techniques involves finger-tip pressure at the inion?
a) Transverse sinus drainage
b) Occipital sinus drainage
c) Confluence of sinuses drainage
d) Superior saggital sinus drainage
e) Metopic suture drainage
19) What straight sinus drainage technique is performed with a crossed-thumb technique?
a) Metopic suture drainage
b) Superior saggital sinus drainage
c) Confluence of sinuses drainage
d) Occipital sinus drainage
e) Transverse sinus drainage
20) Which of the following techniques involves having the fingers crossed and thumbs
gently folded inward into a “volleyball bump” position, holding the head medial to the
occipitomastoid suture?
21) A 64-year-old female presents with a chief complaint of right-sided headaches. Her
headaches occur three to four times per month, with each headache lasting about 24-36
hours. No OTC treatment is fully effective, but she gets some relief with ibuprofen. She
reports the pain as moderate to severe, and sometimes the headaches are associated with
photophobia. Treating all of the following areas would be beneficial EXCEPT:
a) Cranial
b) Cervical
c) Thoracic
d) Lumbar
e) Sacral
OPP #17 – Urinary

1) A 25-year-old female presents with complaints of lower abdominal pain and burning
with urination. The pain has been getting worse and small volumes are produced with
each urination. The patient has a slight fever and costovertebral angle (CVA) tenderness.
After a urinalysis and urine culture with sensitivity, a urinary tract infection (UTI) is
diagnosed and trimethoprim/sulfamethoxazole (TMP-SMX) is prescribed. If OMT is to
be performed for the bladder and distal ureters, where should it be focused for the
sympathetic and parasympathetics?
a) T11-L2 and S2-S4
b) T5-T9 and T11-T12
c) T11-T12 and S2-S4
d) T11-L2 and L4-S1
e) T10-T11 and S1-S3
2) To normalize sympathetic hyperactivity to the bladder, rib raising should be focused to

what areas?
a) T5-T9
b) T10-L2
c) T11-T12
d) T11-L2
e) T1-T4
3) Where is pain focused to with pyelonephritis?
a) Bladder
b) Flank
c) Low back
d) Sacrum
e) Abdomen
4) The ureters descend across what muscular fascia, which courses obliquely and laterally
displaces the lower poles of the kidney?
a) Obturator
b) Quadratus lumborum
c) Piriformus
d) Psoas
e) Rectus abdominus
5) Which direction do the kidneys move with inhalation?
a) Caudad and lateral
b) Caudad and medial
c) Cephalad and lateral
d) Cephalad and medial
e) They do not move
6) Which of the following describes renal ptosis, seen mainly in tall thin females?
a) Kidney slips superior and only moves with respiration
b) Kidney slips superior and will not move with respiration
c) Kidney slips inferior and only moves with respiration
d) Kidney slips inferior and will not move with respiration
7) Pyelonephritis causing psoas spasm would:
a) Exaggerate thoracic lordosis
b) Exaggerate thoracic kyphosis
c) Exaggerate lumbar lordosis
d) Exaggerate lumbar kyphosis
e) Exaggerate cervical lordosis
8) What is the sympathetic innervation for the kidney and upper ureter?
a) T5-T9
b) T10-L1
c) T11-L2
d) T12-L4
e) L2-L4
9) Which of the following would be increased with increased renal sympathetic tone?
a) Glomerular filtration rate
b) Urine volume
c) Renal arterial pressure

d) Urine flow
10) To which lymph nodes do the kidneys drain?
a) Virchow node
b) Lateral aortic nodes
c) Internal iliac nodes
d) External iliac nodes
e) Femoral lymph nodes
11) Which of the following is most associated with flank pain that radiates to the
ipsilateral groin, sometimes with nausea (vagal parasympathetics)?
a) Nephrolithiasis
b) Pyelonephritis
c) Urinary tract infection
d) Osteoarthritis of the hip
e) Hernia
12) A patient is scheduled for extracorporeal shock wave lithotripsy (ESWL) in two days.
What diet should the patient be on during their wait?
a) Low carbohydrate
b) Low fat
c) Low protein
d) Low salt
e) Low vitamin C
13) A patient presents with T11-T12 somatic dysfunction involving the kidney. Direct
OMT treatment would relax surrounding blood vessels, nerves, and lymphatics. Which
direction should the kidneys be directed?
a) Caudad and lateral
b) Caudad and medial
c) Cephalad and lateral
d) Cephalad and medial
14) Which of the following describes the anterior Chapman point(s) for the bladder?
a) One inch lateral and two inches superior to the umbilicus, ipsilaterally
b) One inch lateral and one inch superior to the umbilicus, ipsilaterally
c) Two inches lateral and two inches superior to the umbilicus, ipsilaterally
d) Two inches lateral and one inch superior to the umbilicus, ipsilaterally
e) Periumbilical region
15) Which of the following describes the posterior Chapman point(s) for the bladder?
a) Between the spinous and transverse processes of T11 and T12
b) Between the spinous and transverse processes of T12 and L1
c) Between the spinous and transverse processes of L1 and L2
d) A & B
e) B & C
16) The external urinary sphincter tone relies on innervation from the pudendal nerve,
which arises from:
a) T12-L2
b) L2-4
c) L4-L5
d) S1-S2
e) S2-S4
17) Which of the following techniques affects the parasympathetics by having the patient
supine with one hand in the sacrum hold and the other arm spreading the patient’s ilia
apart (external rotation)?
a) Lumbosacral/thoracolumbar decompression
b) Pubic symphysis release
c) Celiac/inferior mesenteric ganglion release
d) Sacral balancing/inhibition
e) Pelvic diaphragm release
18) Which of the following techniques involves the patient having their knees bent with
heels together then abducting against resistance and finally adducting against resistance?
a) Pubic symphysis release, muscle energy
b) Pubic symphysis release, Still technique
c) Pelvic diaphragm release
d) Rib raising of the 11th/12th ribs
e) Lumbosacral/thoracolumbar decompression
19) Which of the following techniques is performed with one leg at a time and involves
circumduction of the patient’s leg while maintaining a compressive force?
d) Rib raising of the 11th/12th ribs
20) With the patient’s knees bent, the pelvic diaphragm can be palpated just medial to
which structure?
a) Iliac crests
b) ASISs
c) Ishial tuberosities
d) Inferior pubic ramus
e) SI joint
21) Which of the following techniques requires respiratory assistance?
d) Celiac/inferior mesenteric ganglion release
OPP #18 – Clinical Upper Extremity: Part 1

1) Which of the following athletes is the LEAST prone to shoulder dislocation?
a) Hockey goalies making glove saves
b) Collegiate wrestlers
c) Swimmers doing the freestyle stroke
d) Soccer goalies making diving saves
e) Football plays involving interceptions by linemen
2) Which of the following joints connects the axial skeleton with the upper limb?
a) Glenohumeral
b) Scapulothoracic
c) Sternoclavicular
d) Acromioclavicular
3) A runner reaches behind her in the car from the driver’s seat to adjust a gym back
sitting on the back seat. What muscle is most responsible for this motion?
a) Supraspinatus
b) Infraspinatus
c) Teres minor
d) Subscapularis
4) What muscle is most used when a person fastens a bra behind their back?
a) Supraspinatus
b) Infraspinatus
c) Teres minor
d) Subscapularis
5) Which of the following internally rotates and depresses the humeral head?
a) Supraspinatus
b) Infraspinatus
c) Teres minor
d) Subscapularis
6) When evaluating the shoulder, an x-ray is used for what reason?
a) Fracture
b) Radiculopathy
c) Infection
d) Tumor
e) All of the above
Match the shoulder movement with the range of motion:
7) Abduction a) 180-degrees
8) Adduction b) 100-degrees
9) Flexion c) 90-degrees
10) Extension d) 60-degrees
11) Internal rotation e) 50-degrees
12) External rotation
13) A football player has their shoulder pushed sharply downward as they have their arm
extended for a block. Elbow flexion and wrist extension is diminished. Brachioradialis
reflex is weak. Which nerve root is likely irritated?
a) C5
b) C6
c) C7
d) C8
e) T1
14) Which of the following tests for a rotator cuff tear?
a) Hawkin test
b) Drop arm test
c) Neers test
d) Clunk test
e) Speed test
f) Yergason test
15) A patient undergoing an O’Brien test says there is much more pain when they
perform the test with their thumb down. Which of the following is most likely?
a) Impingement
b) Frozen shoulder
c) AC separation
d) Clavicle fracture
e) SLAP lesion
16) What does the apprehension test screen for?
a) AC joint separation
b) SLAP lesion
c) Posterior shoulder dislocation
d) Frozen shoulder syndrome
e) Chronic shoulder dislocation
17) A college rugby player presents with complains of not being able to brush her hair.
She states it started after being tackled during a game. During testing, pushing against a
wall reveals very slight protrusion of the scapula. What nerve was likely damaged?
a) Suprascapular nerve
b) Lower subscapular nerve
c) Long thoracic nerve
d) Axillary nerve
e) Dorsal scapular nerve
18) Scapholunate dissociation is defined as a gap between the scaphoid and lunate bone
greater than:
a) 1mm
b) 2mm
c) 3mm
d) 4mm
e) 5mm
19) Which of the following is NOT a stage of Spencer technique for the shoulder, as it
may increase the likelihood of dislocation?
a) Flexion
b) Extension
c) Compression circumduction
d) Traction circumduction
e) Abduction
f) Adduction
g) Internal rotation
h) External rotation
i) Humeral traction
OPP #19 – Clinical Upper Extremity: Part 2

1) Osteoarthritis is associated with ____ nodes and affects the ____ joints.
a) Bouchard; PIP & MCP
b) Bouchard; DIP & PIP
c) Heberden; PIP & MCP

d) Heberden; DIP & PIP
2) What imaging modality is most useful for a scaphoid fracture?
a) X-ray
b) X-ray with contrast
c) CT
d) MRI
e) SPECT
OPP #20 – Clinical Lower Extremity: Part 1

1) Which of the following is the most unstable plane in the body and can lead to ACL
tears in football runningbacks even without contact from another player?
a) Saggital
b) Frontal
c) Transverse
d) A & B
e) B & C
2) How much of a runner’s body weight is transmitted up the kinetic chain toward their
hip when their foot hits the ground?
a) 0.25 to 0.5 times body weight
b) 0.5 to 1 times body weight
c) 1 to 2 times body weight
d) 2 to 3 times body weight
e) 3 to 4 times body weight
3) What vertebral level corresponds to the iliac crests?
a) L2
b) L3
c) L4
d) L5
e) S2
4) What vertebral level corresponds to the posterior superior iliac spine (PSIS)?
a) S4
b) S3
c) S2
d) S1
e) L5
5) Which of the following structure is located most lateral in the femoral triangle?
a) Femoral artery
b) Femoral nerve
c) Femoral vein
d) Inguinal lymph nodes
6) What muscle marks the lateral border of the femoral triangle?
a) Vastus lateralis
b) Vastus medialis
c) Adductor longus
d) Sartorius
e) Gracilis
7) Which of the following test screens for a tight iliotibial (IT) band?
a) Ober test
b) Trendelenberg test
c) Patrick test
d) Thomas test
e) Rectus femoris test
8) What is the classic muscle that is reciprocally inhibited by iliopsoas?
a) Gluteus maximus
b) Biceps femoris
c) Adductor magnus
d) Semitendinosus
e) Semimembranosus
9) Which of the following, along with gracilis, adducts the hip?
a) Tensor fascia lata
b) Sartorius
c) Piriformis
d) Pectineus
e) Obturator internus
10) A patient presents with pain mimicking sciatic nerve symptoms. Testing shows weak
internal rotation and a positive Trendelenberg test. Which of the following is the most
likely cause?
a) Tensor fascia lata
b) Gluteus maximus
c) Gluteus medius
d) Gluteus minimus
e) Gracilis
Match the hip motion with the range of motion:
11) Flexion, knee flexed a) 20 to 30-degrees
12) Flexion, knee extended b) 30-degrees
13) Extension c) 35-degrees
14) Adduction d) 45-degrees
15) Abduction, knee flexed e) 45 to 50-degrees
16) Abduction, knee extended f) 70 to 75-degrees
17) Internal rotation g) 90-degrees
18) External rotation h) 120-degrees
19) Which of the following test screens for a tight iliopsoas?
a) Ober test
b) Trendelenberg test
c) Patrick test
d) Thomas test
e) Rectus femoris test
20) What stage of Spencer technique for the hip is performed first?
a) Circumduction
b) Flexion
c) Extension
d) Internal rotation
e) External rotation
f) Abduction
g) Adduction
OPP #21 – Clinical Lower Extremity: Part 2

1) What knee pathology is seen in the radiograph here?
a) Tibial plateau fracture
b) Torn anterior cruciate ligament
c) Patellar fracture
d) Tibial plafond fracture
e) Osteoarthritis of the knee
2) A slightly overweight 25-year-old female presents with knee pain. History reveals she
has been training for a marathon and does “quite a bit” of hill exercise. The pain is worse
with squatting and there is a grinding sound present at the kneecap. Strength testing
reveals that the quadriceps muscle is pulling laterally and the anterior tibialis is pulling
medial. Which of the following is most likely?
a) Torn anterior cruciate ligament
b) Patellofemoral syndrome
c) Osgood-Schlatter disease
d) Patellar fracture
e) Tibial plateau fracture
3) Which of the following is associated with fragmentation of the tibial tubercle, swelling
of the overlying soft tissue, and is most commonly seen in active adolescents?
a) Torn anterior cruciate ligament
b) Patellofemoral syndrome
c) Osgood-Schlatter disease
d) Patellar fracture
e) Tibial plateau fracture
4) Which of the following is NOT a component of the ankle deltoid ligament (medial
collateral ligaments)?
a) Tibionavicular ligament
b) Calcaneotibial ligament
c) Anterior talotibial ligament
d) Posterior talotibial ligament
e) Calcaneofibular ligament
5) Which of the following is a normal arch angle for the foot (not pes plantus or cavus)?
a) 5-degrees
b) 8-degrees
c) 12-degrees
d) 20-degrees
e) 36-degrees
6) What foot deformity is seen here?
a) Hammer toe
b) Claw toe
c) Mallet toe
d) Bunion
e) Gout
7) Haglund disease involves bursitis affecting what foot bone?
a) Navicular
b) Calcaneous
c) Cuboid
d) Talus
e) Cuneiform
8) For an ankle sprain, which of the following is recommended after 24-hours?
a) Rest
b) Ice
c) Heat
d) Compression
e) Elevation
9) The Lachman test is used to determine if which of the following is torn?
a) Anterior cruciate ligament
b) Posterior cruciate ligament
c) Medial collateral ligament
d) Lateral collateral ligament
e) Medial meniscus
10) The last 15-degrees of knee extension is when which of the following muscles comes
into play?
a) Vastus intermedius
b) Vastus lateralis
c) Vastus medialis
d) Rectus femoris
e) Iliopsoas
11) Which of the following involves the patient being prone with involved leg hanging
off the table and the clinician using a “whip” technique?
a) Talotibial HVLA
b) Navicular HVLA
c) Cuboid HVLA
d) Metatarsal HVLA
e) Phalange HVLA
12) What is the most common type of ankle sprain?
a) Eversion
b) Inversion
c) Dorsiflexion
d) Plantarflexion
James Lamberg
AnswerKey 11) D OPP #7 26) C 4) D

OPP #1 12) C 1) C 27) B 5) A
1) C 13) E 2) D 28) A 6) C
2) D 14) A 3) A 29) C 7) C
3) E 4) D 30) D 8) E
4) E OPP #4 5) B 31) C 9) D
5) B 1) C 6) C 32) A 10) D
6) A 2) D 7) E 33) B 11) D
7) D 3) D 8) B 34) D 12) D
8) C 4) B 9) F 13) C
9) C 5) C 10) C OPP #9
10) A 6) E 11) B 1) C OPP #11
11) C 7) C 12) C 2) E 1) E
12) D 8) E 13) D 3) E 2) A
13) C 14) D 4) B 3) C
14) C OPP #5 15) E 5) D 4) B
15) B 1) D 16) A 6) E 5) A
16) A 2) B 17) B 7) C 6) D
17) B 3) C 18) B 8) D 7) C
18) A 4) C 9) B 8) C
19) C 5) E OPP #8 10) C 9) A
20) A 6) A 1) C 11) B 10) D
21) A 7) D 2) D 12) D 11) C
8) F 3) A 13) C 12) C
OPP #2 9) D 4) C 14) E 13) D
1) E 10) C 5) B 15) A 14) C
2) D 11) C 6) C 16) C 15) A
3) C 12) C 7) E 17) A 16) C
4) C 13) E 8) F 18) D 17) B
5) A 14) A 9) A 19) B 18) E
6) B 15) B 10) D 20) E
7) C 16) E 11) B 21) C OPP #12
8) D 17) A 12) D 22) A 1) E
9) E 13) C 23) D 2) C
OPP #6 14) A 24) A 3) D
OPP #3 1) B 15) E 25) C 4) B
1) E 2) A 16) D 26) E 5) C
2) C 3) C 17) C 27) C 6) C
3) E 4) B 18) B 28) A 7) A
4) A 5) C 19) C 29) B 8) B
5) B 6) D 20) A 30) C 9) D
6) B 7) A 21) A 10) B
7) D 8) A 22) B OPP #10
8) A 9) D 23) E 1) B OPP #13
9) B 24) B 2) B 1) B
10) D 25) E 3) D 2) C
3) D 18) C 16) C 16) E

4) D 19) B 17) E 17) C
5) A 20) D 18) C 18) C
6) C 21) D 19) B 19) H
7) E 22) B 20) B
8) B 23) A 21) C OPP #19
9) E 24) C 1) D
10) D 25) D OPP #17 2) D
11) C 26) B 1) A
12) A 27) A 2) C OPP #20
13) A 28) E 3) B 1) C
14) B 29) D 4) D 2) D
15) E 30) C 5) A 3) C
16) D 31) B 6) D 4) C
17) C 7) C 5) B
18) B OPP #15 8) B 6) D
19) E 1) B 9) C 7) A
20) A 2) E 10) B 8) A
21) E 3) C 11) A 9) D
22) D 4) B 12) C 10) C
23) D 5) D 13) C 11) H
24) D 6) E 14) E 12) G
25) A 7) C 15) E 13) B
26) C 8) A 16) E 14) A
27) A 9) D 17) D 15) F
28) C 10) C 18) A 16) E
29) C 11) B 19) B 17) C
12) D 20) C 18) D
OPP #14 13) D 21) C 19) D
1) D 20) B
2) E OPP #16 OPP #18
3) C 1) C 1) C OPP #21
4) B 2) E 2) D 1) C
5) D 3) B 3) A 2) B
6) C 4) D 4) B 3) C
7) A 5) E 5) D 4) E
8) E 6) C 6) E 5) D
9) A 7) A 7) A 6) A
10) D 8) C 8) E 7) B
11) A 9) B 9) A 8) C
12) D 10) B 10) C 9) A
13) B 11) E 11) B 10) C
14) A 12) E 12) D 11) C
15) E 13) D 13) B 12) B
16) A 14) D 14) B
17) B 15) E 15) E

Quiz Osteopathic Part 3 of 4

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Quiz Osteopathic Part 3 of 4

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Osteopathic Principles & Practice – Part 3 25Mar2009

OPP #1 – Osteopathic Approach To Clinical Problems

DO NOT DISTRIBUTE -1-

DO NOT DISTRIBUTE -2-

DO NOT DISTRIBUTE -3-

c) Lateral recumbent position with dysfunction side down

DO NOT DISTRIBUTE -4-

OPP #3 – Integrative Approach To Hypertension

DO NOT DISTRIBUTE -5-

DO NOT DISTRIBUTE -6-

OPP #4 – Sequencing: Part 1

DO NOT DISTRIBUTE -7-

DO NOT DISTRIBUTE -8-

OPP #5 – Sequencing: Part 2

DO NOT DISTRIBUTE -9-

OPP #6 – Common Compensatory Pattern (CCP)

a) Hyper-sympathetic activity; T1-T5 on the Right

a) Hyper-sympathetic activity; T1-T5 on the Right

a) Hyper-sympathetic activity; T1-T5 on the Right

c) Hyper-parasympathetic activity; Vagus nerve on the Right

a) Hyper-sympathetic activity; T1-T5 on the Right

e) Posterior to the posterior scalene

18) Parasympathetic activity would cause which of the following?

c) Side-bent toward, rotated toward

OPP #9 – Head, Eyes, Ears, Nose, & Throat (HEENT): Part 1

12) Sympathetic innervation to the head arises from:

c) Retropharyngeal lymph nodes

b) CN V upper motor neuron dysfunction

OPP #11 – Osteopathy In The Cranial Field: Part 1

OPP #12 – Integrative Approach To Asthma

6) In traditional Chinese medicine (TCM), which of the following elements corresponds

OPP #13 – Osteopathy In The Cranial Field: Part 2

d) Anteroposterior (AP) axis

25) Which of the following occurs with a right torsion?

OPP #14 – Osteopathy In The Cranial Field: Part 3

d) Left side-bending rotation

OPP #15 – Integrative Approach To Hematology & Oncology

OPP #16 – Osteopathy In The Cranial Field: Part 4

d) Opposite physiologic motion

OPP #17 – Urinary

2) To normalize sympathetic hyperactivity to the bladder, rib raising should be focused to

c) Renal arterial pressure

OPP #18 – Clinical Upper Extremity: Part 1

OPP #19 – Clinical Upper Extremity: Part 2

c) Heberden; PIP & MCP

OPP #20 – Clinical Lower Extremity: Part 1

OPP #21 – Clinical Lower Extremity: Part 2

AnswerKey 11) D OPP #7 26) C 4) D

3) D 18) C 16) C 16) E

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