Counterstrain for tender point on dorsum of wrist along extensor carpi radialis—correct position?
A. palpate the tender point, extend and abduct the wrist until 70% of the tenderness is reduced, hold for 90 seconds, slowly return to neutral, and recheck the tender point.
B. palpate the tender point, extend and adduct the wrist until 70% of the tenderness is reduced, have the patient hold his wrist there for 90 seconds, return to neutral, recheck the tender point.
C. palpate the tender point, extend and adduct the wrist until 70% of the tenderness is reduced, hold for 90 seconds, slowly return to neutral, and recheck the tender point.
D. palpate the tender point, flex and abduct the wrist until 70% of the tenderness is reduced, hold for 90 seconds, slowly return to neutral, and recheck the tender point.
E. palpate the tender point, flex and adduct the wrist until 70% of the tenderness is reduced, hold for 90 seconds, slowly return to neutral, and recheck the tender point.
A. palpate the tender point, extend and abduct the wrist until 70% of the tenderness is reduced, hold for 90 seconds, slowly return to neutral, and recheck the tender point.
Explanation:
Counterstrain for extensor carpi radialis tender point = wrist extension + abduction (radial deviation) for 90 seconds, then return to neutral and reassess.
Right posterior S1 tender point — correct counterstrain treatment?
A. anterior-to-posterior pressure on left inferior lateral angle
B. posterior-to-anterior pressure on left inferior lateral angle
C. posterior-to-anterior pressure on left sacral sulcus
D. posterior-to-anterior pressure on right inferior lateral angle
E. posterior-to-anterior pressure on right sacral sulcus
B. posterior-to-anterior pressure on the left inferior lateral angle of the sacrum for 90 seconds
Explanation:
Posterior S1 tenderpoint is treated by applying posterior-to-anterior pressure on the contralateral ILA and holding for 90 seconds.
Example of isokinetic training?
A. bicycling at a constant speed with varied resistance
B. bicycling at variable speed with constant resistance
C. running fixed distance with variable speeds
D. running variable speed w/ constant HR
E. swimming same distance at different speeds
A. bicycling at a constant speed with varied resistance
Explanation:
Isokinetic = constant speed with variable resistance.
The machine adjusts resistance so speed stays fixed throughout motion.
Elderly pt w/ LLQ pain + fever; CT shows fat stranding around colonic outpouching → diverticulitis. Most likely Chapman point?
A. distal left IT band
B. distal right IT band
C. proximal left IT band
D. proximal right IT band
E. tip of right 12th rib
C. proximal left IT band
Explanation:
Sigmoid colon (most common site of diverticulitis) → Chapman point at proximal left iliotibial band.
Balanced ligamentous tension (BLT) is best described as which type of osteopathic technique?
A. Direct, active
B. Direct, passive
C. Indirect, active
D. Indirect, passive
E. Combination direct/indirect
D. Indirect, passive
Explanation:
Balanced ligamentous tension (BLT) is an indirect, passive OMT technique. The joint is placed into its position of ease, allowing ligaments to balance and release tension.
40-year-old female with headaches and left ear pain after a recent root canal. Which finding would contraindicate cranial treatment?
A. headaches
B. jaw claudication
C. left ear pain
D. papilledema
E. recent dental procedure
D. papilledema
Explanation:
Papilledema indicates elevated intracranial pressure, which is a contraindication for cranial osteopathic treatment. Headaches, ear pain, jaw claudication, or a recent dental procedure do not alone contraindicate cranial treatment, though jaw claudication may warrant further evaluation for vascular causes.
A 40-year-old woman has right upper quadrant pain radiating to her right shoulder. Which nerve carries this referred pain?
A. greater thoracic splanchnic nerve
B. least thoracic splanchnic nerve
C. lesser thoracic splanchnic nerve
D. phrenic nerve
E. vagus nerve
D. phrenic nerve
Explanation:
Gallbladder inflammation can irritate the diaphragm. Sensory fibers of the phrenic nerve (C3–C5) carry pain to the shoulder (viscero-somatic reflex). Thoracic splanchnic nerves and the vagus nerve do not mediate shoulder referral.
A 49-year-old woman with long-term heavy alcohol use presents with dyspnea, peripheral edema, distended neck veins, S3 heart sound, and cardiac enlargement on chest X-ray. What is the primary mechanism of her cardiac dysfunction?
A. cardiac amyloidosis
B. disorganized hypertrophic myocardial fibers
C. impaired diastolic filling
D. left-to-right shunt
E. weak systolic contraction
Back:
E. weak systolic contraction
Explanation:
Chronic heavy alcohol use can cause alcoholic (dilated) cardiomyopathy, leading to congestive heart failure primarily due to systolic dysfunction. Mechanisms include mitochondrial dysfunction, oxidative stress, impaired calcium handling, and myocardial cell death. Dilated ventricles replace contractile myocardium with fibrotic tissue, causing weak left ventricular contraction.
A 14-year-old boy presents with sudden severe left testicular pain, nausea, vomiting, and a high-riding left testicle. Stroking the inner thigh retracts the right but not the left scrotum. Which vertebral segments correspond to the likely viscerosomatic reflex?
A. T5-T9
B. T10-T11
C. T10-T12
D. T11-L2
E. T12-L2
C. T10-T11
A 22-year-old man has left hip and groin pain with a snapping sensation on hip flexion. Structural exam shows L1 FSLR left and a positive pelvic shift test to the right. Which is the correct technique for the special test used to aid diagnosis?
A. patient is lateral; extend and adduct left leg toward exam table
B. patient is lateral; extend and adduct right leg toward exam table
C. patient is supine; flex and externally rotate right hip; extend and internally rotate right hip
D. patient is supine; flex left knee to chest; extend right leg to exam table
E. patient is supine; flex right knee to chest; extend left leg to exam table
E. patient is supine; flex right knee to chest; extend left leg to exam table
The patient presents with findings consistent with hip flexor tightness or a functional hip flexion dysfunction. The Thomas test is used to assess hip flexor tightness: the patient lies supine, flexes one knee to the chest, and the opposite leg is extended toward the table. If the extended leg cannot stay flat, hip flexor tightness is present. Here, flexing the left knee to chest and extending the right leg evaluates the contralateral hip flexor.
A 25-year-old woman has sharp pain on the bottom of her right heel for several weeks. Treated with orthotics and NSAIDs, she reports improvement at 6 months. Which additional finding was most likely present initially?
A. increased dorsiflexion of the right foot compared with the left
B. pain that was unaffected by rest
C. pain with passive dorsiflexion of the 1st metatarsophalangeal joint
D. palpable clunk between the 2nd and 3rd metatarsals when compressing the forefoot
E. reproduction of pain when tapping posterior and inferior to the medial malleolus
C. pain with passive dorsiflexion of the 1st metatarsophalangeal joint
A 24-year-old female ballet dancer has low back pain after stretching her legs. Exam shows a positive standing flexion test on the left, right ASIS superior to left, and left PSIS superior to right. Which finding is expected?
A. left anterior innominate rotation and hamstring dysfunction
B. left anterior innominate rotation and rectus femoris dysfunction
C. left posterior innominate rotation and hamstring dysfunction
D. right posterior innominate rotation and hamstring dysfunction
E. right posterior innominate rotation and rectus femoris dysfunction
B. left anterior innominate rotation and rectus femoris dysfunction
Explanation:
Right ASIS superior, left PSIS superior → indicates left anterior innominate rotation.
Ipsilateral rectus femoris tightness commonly causes anterior innominate rotation.
Hamstrings are typically stretched, not the source of the dysfunction.
A patient has anterior ankle tenderness worsened by dorsiflexion, restricted dorsiflexion, and a posteriorly positioned tibia on the talus. Which HVLA technique is appropriate?
A. supine, thumbs on plantar foot, traction and dorsiflexion, inferior thrust while increasing dorsiflexion
B. prone, thumbs on posterior ankle, traction and plantarflexion, superior thrust while increasing plantarflexion
C. seated, foot dorsiflexed, lateral force applied to ankle
D. lateral recumbent, external rotation with medial ankle thrust
E. supine, foot plantarflexed, traction with anterior ankle thrust
A. supine, thumbs on plantar foot, traction and dorsiflexion, inferior thrust while increasing dorsiflexion
Explanation:
Anterior talus somatic dysfunction: talus stuck anteriorly → dorsiflexion limited.
HVLA treatment: patient supine, thumbs on plantar foot, apply traction while dorsiflexing, deliver inferior thrust to push talus posteriorly.
Goal: restore normal talocrural joint motion and reduce tenderness.
A 50-year-old woman with prior abdominal surgeries presents with 12 hours of diffuse crampy abdominal pain, nausea, vomiting, abdominal distension, and high-pitched bowel sounds. Abdominal X-ray shows multiple dilated loops with air-fluid levels. Most likely cause?
A. a defect in the abdominal wall
B. intraabdominal scar formation
C. obstruction due to an intraluminal mass
D. overgrowth of intestinal bacteria
E. twisting of the bowel around its mesentery
B. intraabdominal scar formation
Explanation:
This presentation is consistent with small bowel obstruction (SBO): crampy pain, nausea, vomiting, distension, high-pitched/hyperactive bowel sounds, air-fluid levels on X-ray.
Most common cause in the U.S.: intraabdominal adhesions from prior surgeries.
Other causes: hernias (worldwide most common), tumors (third most common).
Labs may be normal early; lactic acid is normal here, suggesting no ischemia yet.
A 60-year-old man has fatigue, abdominal swelling, scleral icterus, palmar erythema, spider angiomas, gynecomastia, and tortuous veins around the umbilicus. Which vein is directly responsible for the venous distention?
A. azygos
B. left gastric
C. paraumbilical
D. right gastric
E. superior vena cava
C. paraumbilical
Explanation:
Caput medusae results from portal hypertension, often due to cirrhosis.
Increased portal pressure shunts blood through paraumbilical veins to the epigastric veins of the systemic circulation.
Clinical findings supporting cirrhosis: ascites, scleral icterus, spider angiomas, palmar erythema, gynecomastia, caput medusae.
Other veins listed are not directly responsible for the periumbilical venous distention.
A 65-year-old man has 2 days of bright red rectal bleeding. He has mild bloating but no abdominal pain, fever, or nausea. CT shows small outpouchings of the colon without bowel wall thickening or pericolic fat stranding. Hemoglobin is 7.5 g/dL. Most likely etiology?
A. a cavitated fluid collection
B. colitis of the affected colon
C. colonic perforation
D. herniation of the colonic mucosa through colonic muscle layer
E. inflammation of spherical colonic outpouchings
D. herniation of the colonic mucosa through colonic muscle layer
Explanation:
Patient has diverticulosis with acute painless lower GI bleeding.
Diverticula are herniations of mucosa and submucosa through the muscularis propria at points of weakness, often at vasa recta penetration sites.
Absence of wall thickening or fat stranding rules out diverticulitis (inflammation) or colitis.
Bleeding is usually painless, sudden, and can be significant, often self-limited.
A 1-day-old newborn has 3 episodes of bilious vomiting after attempted breastfeeding. Born at 38 weeks via C-section with polyhydramnios. Abdomen distended. X-ray shows two large air-filled spaces in the upper abdomen. Most likely cause?
A. an abnormal connection between the trachea and esophagus
B. failed neural crest cell migration
C. gastric outlet obstruction because of smooth muscle hypertrophy
D. failed lateral fold closure during embryologic development
E. failed recanalization of a portion of the small intestine
E. failed recanalization of a portion of the small intestine
Explanation:
Bilious vomiting in a newborn with polyhydramnios suggests intestinal obstruction.
Radiograph with “double bubble” sign (two air-filled spaces in the upper abdomen) is classic for duodenal atresia.
Duodenal atresia results from failed recanalization of the duodenum during embryologic development.
Other options:
A: tracheoesophageal fistula usually presents with drooling, choking, and possible nonbilious vomiting.
B: failed neural crest migration → Hirschsprung disease (delayed meconium, abdominal distension).
C: gastric outlet obstruction (pyloric stenosis) → projectile nonbilious vomiting at 2–6 weeks.
D: lateral fold closure failure → omphalocele or gastroschisis.
A 1-day-old newborn has bilious vomiting after attempted breastfeeding. Born at 38 weeks via C-section with a history of polyhydramnios. Abdomen is distended. X-ray shows two large air-filled spaces in the upper abdomen. Most likely cause?
A. an abnormal connection between the trachea and esophagus
B. failed neural crest cell migration
C. gastric outlet obstruction because of smooth muscle hypertrophy
D. failed lateral fold closure during embryologic development
E. failed recanalization of a portion of the small intestine
E. failed recanalization of a portion of the small intestine
Explanation:
Presentation is classic for duodenal atresia: bilious emesis and abdominal distention within 1–2 days of life.
Double bubble sign on X-ray: air in stomach and proximal duodenum.
Etiology: failed recanalization of the distal duodenum during embryologic development.
Associated findings: history of polyhydramnios, and increased risk of Down syndrome.
Management: fluid resuscitation, NG decompression, surgical repair.
A 21-year-old woman is obtunded after heavy alcohol use and possible overdose. She has nausea, vomiting, right upper quadrant pain, scleral icterus, AST 2520, ALT 1750, lactate 2.2, and PT 21 sec. Most appropriate treatment?
A. deferoxamine
B. flumazenil
C. fomepizole
D. N-acetylcysteine
E. naloxone
D. N-acetylcysteine
Explanation:
Presentation suggests acetaminophen (paracetamol) toxicity, with AST/ALT in the thousands.
Alcohol may exacerbate hepatotoxicity but is unlikely to cause such extreme transaminase elevation alone.
N-acetylcysteine (NAC) replenishes glutathione, detoxifies NAPQI, and prevents further liver injury.
Early treatment is critical, ideally within 8–10 hours of ingestion.
Other options:
A: deferoxamine → iron overdose
B: flumazenil → benzodiazepine reversal (risk in mixed overdose)
C: fomepizole → methanol or ethylene glycol
E: naloxone → opioid overdose
A 7-year-old girl with severe scoliosis develops postprandial nausea, bilious vomiting, and sharp abdominal pain 10 days after spinal surgery. Pain improves when lying in left lateral decubitus. Chapman’s points at T8–T10. Which embryologic structure gives rise to the vessel causing her symptoms?
A. ductus arteriosus
B. pharyngeal arch 1
C. umbilical arteries
D. umbilical vein
E. vitelline arteries
Presentation is consistent with superior mesenteric artery (SMA) syndrome: duodenal compression between SMA and aorta.
SMA originates from the vitelline arteries (embryologic vessels supplying the yolk sac).
Key features: postprandial pain, nausea, bilious vomiting, relief in left lateral decubitus (“knee-chest” or side-lying may relieve tension), and recent spinal surgery increasing mesenteric angle.
Other options:
Ductus arteriosus → fetal shunt
Pharyngeal arch 1 → maxillary/mandibular arteries
Umbilical arteries/vein → placental circulation
A 31-year-old man has 2 weeks of left knee pain after a dashboard injury. Exam shows tenderness in the center of the popliteal fossa and mild posterior tibial translation. Which counterstrain position is correct to treat this tender point?
A. patient supine with leg off table; physician internally rotates and abducts leg
B. patient supine with leg off table; physician internally rotates and adducts leg
C. patient supine with pillow under calf; physician pulls ankle anteriorly and externally rotates foot
D. patient supine with pillow under calf; physician pulls tibia anteriorly and internally rotates foot
E. patient supine with pillow under thigh; physician pulls tibia posteriorly
D. patient supine with pillow under calf; physician pulls tibia anteriorly and internally rotates foot
Explanation:
Popliteal tender points are treated with the knee slightly flexed and tibia positioned to reduce tension on the posterior structures.
Anteriorly pulling the tibia with internal rotation shortens the gastrocnemius and popliteal region, alleviating the tender point.
Counterstrain focuses on positioning that relaxes the involved tissues for 90 seconds
A 29-year-old woman has low back pain 3 months after her first delivery. Standing and seated flexion tests are negative. Spring test: sacral base moves freely, but both inferior lateral angles (ILAs) are restricted. Most likely diagnosis?
A. bilateral sacral extension
B. bilateral sacral flexion
C. left-on-left sacral torsion
D. left-on-right sacral torsion
E. right-on-left sacral torsion
B. bilateral sacral flexion
Explanation:
Bilateral sacral flexion often occurs postpartum due to pressure on the sacral apex during childbirth.
Sacral apex moves posterior, ILAs move posterior, sacral base moves anterior.
Seated flexion test is negative in symmetrical sacral dysfunctions (bilateral flexion or extension).
Spring test restriction at ILAs confirms the flexion dysfunction.
