opp 2-2

Supination restriction at the elbow is associated with a radial head that resists: 1. anterior motion 2. posterior motion 3. anterior drawer testing 4. posterior drawer testing 5. adduction and abduction

1. anterior motion

After a vicious football collision with knee hyperextension, you are asked to examine a player's injured knee. You perform an orthopedic test with the patient supine, the knee flexed to 30 degrees, and the femur stabilized with one hand. You note that there is excessive motion of the tibia when pulled anteriorly with no firm endpoint. What would be the most likely diagnosis given this finding? 1. Collateral ligament tear 2. Medial meniscus tear 3. Posterior cruciate ligament tear 4. Anterior cruciate ligament tear 5. Patellar tendonitis

4. Anterior cruciate ligament tear

A patient is diagnosed with an anterior cruciate ligament tear. Of the following tests, which of the following is most likely positive? 1. Patella grind test 2. Apley grind test 3. Varus stress 4. Anterior drawer 5. Childress test

4. Anterior drawer

A 36-year-old female sustained an inversion ankle sprain after stepping off a curb. You wish to test the stability of the anterior talofibular ligament. Which diagnostic test with good sensitivity would best help in your diagnosis? 1. Squeeze test 2. Posterior drawer test 3. Inversion test 4. Anterior drawer test 5. Lachman's test

4. Anterior drawer test

A 22 year old male presents with an acute sprained ankle. Which of the following is the most common ligament injured in an ankle sprain? A. anterior talofibular ligament B. calcaneofibular ligament C. deltoid ligament D. posterior tibiotalar ligament E. posterior talofibular ligament

A. anterior talofibular ligament

On physical exam of motor function in the arm, resisted wrist extension is used to test the motor function of which cervical nerve root? A. C5 B. C6 C. C7 D. C8 E. T1

B. C6

A 27 year old male presents to your clinic with what he believes is an ankle sprain. He said that yesterday, he was playing ice hockey with his team when suddenly someone crashed into him he twisted his ankle. Upon examination, you find tissue texture abnormalities, swelling, and decide to diagnose somatic dysfunction of his ankle since he can tolerate it. You conclude he has an acute ankle sprain. What is the most likely somatic dysfunction finding in his talotibial joint? A. posterior glide of the talus with dorsiflexion B. medial glide of the talus with eversion C. anterior glide of the talus with plantarflexion D. lateral glide of the talus with inversion E. superior glide of the talus with abduction

C. anterior glide of the talus with plantarflexion

A patient presents to the office with an ankle sprain. You are educating him about the different ligaments of the foot and you explain to him which ligament is the least likely to be sprained. Which of the following is the least common ligament of the ankle to sprain? A. Anterior Talofibular Ligament B. Calcaneofibular Ligament C. Posterior Talofibular Ligament D. Deltoid Ligament

D. Deltoid Ligament

A 35-year-old right handed tennis player comes into your office with complaints of chronic right elbow pain for the past year. If he lifts an object such as a chair, he has pain in the lateral elbow, and he is having difficulties holding lightweight objects in his hand. He has full ROM in the elbow but with tenderness and mild swelling over the lateral aspect of his elbow. Wrist extension against resistance causes him pain at the lateral elbow. Based upon this clinical case, what is the most likely diagnosis? A. Fracture of Ulna B. Cellulitis C. Elbow joint effusion D. Medial epicondylitis E. Lateral epicondylitis

E. Lateral epicondylitis

A female complains of anterior knee pain that gets worse when she runs or climbs stairs. There is point tenderness on the undersurface of the patella & there is some patellar crepitus. During physical exam there is pain that is reproducible on squatting & when the knee is flexed. The most likely Dx is: A. Osgood-Shlatter's disease B. Baker's cyst C. Patellar tendonitis D. Housemaid's knee E. Patello-femoral syndrome

E. Patello-femoral syndrome

Which of the following muscles of the upper extremity is correctly matched with its correct reflex level and action? 1. Brachioradialis, C6, flexes the forearm 2. Triceps Brachii, C7, flexes the forearm 3. Biceps Brachii, C5, extends the forearm 4. Triceps Brachii, C6, extends the forearm 5. Brachioradialis, C5, flexes the forearm

1. Brachioradialis, C6, flexes the forearm

You identify T5 FRSR with a hard end feel to motion testing. You decide to use the Prone Thoracic HVLA (Texas Twist). Assuming you are going to treat on the side opposite the posterior transverse process, which of the following would NOT be an accurate step to this treatment? 1. Place your right hand on the side opposite at the same level of the posterior transverse process pointed caudad so that the force is directed inferiorly and anteriorly. 2. Place the pisiform of your left hand over the more anterior transverse process pointing caudad. 3. Lock out your elbows and center your body directly over the segment in question. 4. Take up the slack with both hands as the patient takes a deep breath and exhales. 5. Deliver a quick thrust downward on posterior transverse process to increase rotation to the left.

1. Place your right hand on the side opposite at the same level of the posterior transverse process pointed caudad so that the force is directed inferiorly and anteriorly.

During physical exam, the pain is reproducible on squatting & when the knee is flexed. There is point tenderness on the undersurface of the patella & there is some patellar crepitus. Decreasing myofascial restrictions in which muscle would most likely result in greatest reduction in this patient's symptoms? 1. Vastus lateralis 2. Semimembranosus 3. Semitendinosus 4. Vastus medialis 5. Quadriceps

1. Vastus lateralis

What is the HVLA corrective force and positioning in treatment of a posterior fibular head dysfunction? 1. Posteriorly against the lateral malleolus, increased flexion of the knee, and internal rotation of the tibia. 2. Anteriorly against the posterior aspect of the fibula head, increased flexion of knee, and external rotation of the tibia. 3. Anteriorly against posterior aspect of the fibula head, increased extension of the knee, and internal rotation of tibia. 4. Posteriorly against the anterior aspect of the fibular head, increased flexion of the knee, and internal rotation of the tibia. 5. Posteriorly against the anterior aspect of the fibular head, extension of the knee, and external rotation of the tibia.

2. Anteriorly against the posterior aspect of the fibula head, increased flexion of knee, and external rotation of the tibia.

A 47-year-old female courtroom stenographer presents to the clinic complaining of paresthesia specifically in the third and fourth fingers. The patient had done this job for the past twenty-two years and denied any trauma. Onset of paresthesia was noticed over "the past month or two." The physician completed both a Phalen's maneuver and Tinel's test and determined them to be positive. Other than these findings, the patient's examination was normal. Which of the following osteopathic procedures should the physician select as treatment to avert the need for surgery? 1. Spencer Technique 2. Opponen's roll 3. Medial epicondyle counterstrain 4. Galbreath technique 5. PIP joint counterstrain

2. Opponen's roll

A 34 year old female presents to the Osteopathic Physicians office because she is having pain in her knee on the right side. She has been taking NSAID's to try and help with the pain but it has not improved the pain much. She says that when she climbs the three flights of steps up to her apartment the pain is worse. After a physical exam and osteopathic structural exam you determine that she has Lateral Femoral Patellar Tracking Syndrome. What muscle dysfunctions are expected? 1. Strong vastus lateralis, strong vastus medialis 2. Strong vastus lateralis, weak vastus medialis 3. Weak vastus lateralis, weak vastus medialis 4. Weak vastus lateralis, strong vastus medialis

2. Strong vastus lateralis, weak vastus medialis

A 58-year-old male presents to the office with right upper extremity pain. The pain started while he was pitching at an intramural baseball game. The pain was sudden and severe 10/10 pain that was not relieved with acetaminophen. He presents to the office for the pain. An empty can test (Jobe's) was performed in the office and was positive. Which of the following muscles was most likely affected? 1. Infraspinatus 2. Supraspinatus 3. Teres Minor 4. Subscapularis

2. Supraspinatus

A 34 year old professional basketball player presents to the physician's office after rolling his ankle during a basketball game. On physical exam it is determined that the anterior talofibular and calcaneofibular ligaments are affected with the ankle sprain. Which type of ankle sprain would this be considered? 1. Type I 2. Type II 3. Type III 4. Type IV

2. Type II

A 12-year-old male presents with a several month history of left lateral foot pain after a sports related injury. You assess the arches of his feet and find a painful/dysfunctional left lateral longitudinal arch. Which is the most common somatic dysfunction found with an abnormal lateral longitudinal arch? 1. elevated talus 2. dropped cuboid 3. dropped 5th metatarsal 4. internally rotated lateral cuneiform 5. dropped navicular

2. dropped cuboid

You have been asked to perform a supine HVLA technique (Kirksville Krunch) on a patient with a firm end feel to the range of motion of T9 on T10. Which of the following is not a proposed mechanism for the HVLA technique? 1. Increase the joint motion by gapping the joint 2. Cavitation from liquid nitrogen released in a vacuum 3. Audible click or pop is necessary to be effective 4. Alters facilitation, nociception, and mechanoreceptors of the joint 5. Releases microadhesions

3. Audible click or pop is necessary to be effective

A 38-year-old male presents to your office with low back pain for the past 2 weeks. He works as an alligator wrangler and spends most of his day seated on a gator's back. He denies fevers, weight loss, or neurologic symptoms. Vitals are within normal limits. Physical exam demonstrates a well-developed male, with a normal cardiac, lung and abdominal exam. You find T12 ERSR with tenderness to palpation. You decide to treat him using seated lumbar HVLA. What is the proper initial set up position for the patient's T12 segment 1. ERSL 2. FRSR 3. FRSL 4. ERSR

3. FRSL

Structural exam reveals that the interspinous segment (space between L4 and L5 spinous processes) of L4 and L5 have less of a gap in flexion compared to the remaining lumbar interspinous segments. Also, using your thumbs to palpate, the transverse process of L4 is more pronounced on the left compared to the right. In which direction is the final corrective force to treat this somatic dysfunction using the Lumbar Walk-Around (seated) HVLA technique? 1. Flexion with sidebending and rotation to the left 2. Extension with sidebending and rotation to the left 3. Flexion with sidebending and rotation to the right 4. Extension with sidebending and rotation to the right 5. Flexion with rotation right and sidebending left

3. Flexion with sidebending and rotation to the right (dx is L4 E RSL, the smaller interspinous segment gap in flexion means the segment is extended)

Which of the following is not a contraindication to the use of HVLA? 1. The patient refuses 2. Infection in a joint 3. Somatic dysfunction with a hard end feel to motion testing 4. Prostate cancer with bony metastasis 5. Surgical fusion of the affected vertebrae

3. Somatic dysfunction with a hard end feel to motion testing

Opponens Roll OMT is aimed at accomplishing which of the following? 1. increasing sympathetic tone 2. decreasing compartment space of the carpal tunnel 3. stretching the muscles and the ligamentous attachments of the wrist 4. increasing parasympathetic tone 5. increasing muscle tone

3. stretching the muscles and the ligamentous attachments of the wrist

A 17-year-old male presents to your office with knee pain which began after he ran his first marathon two days ago. Upon examination of his knee, you find that his lateral knee is very tender, and you diagnose a somatic dysfunction at the tibiofibular joint. You decide to treat this patient with an indirect BLT technique, as the injury is acute and still very tender even just to the touch. You invert the patient's foot while monitoring the head of the fibula and push it slightly posteriorly until you reach a point of ease. You then have the patient inhale and exhale and then hold his breath at the point of most ease. The patient is instructed to hold his breath until he cannot hold it any more. What was the diagnosis of this patient's fibular head somatic dysfunction prior to treatment? 1. Fibular head lateral 2. Fibular head medial 3. Fibular head anterior 4. Fibular head posterior

4. Fibular head posterior

Which of the following is NOT a part of the appropriate set-up for the lateral recumbent lumbar HVLA technique? 1. Position patient so that the side of the posterior transverse process is closest to the table with the dysfunction side down. 2. Be sure your hands are monitoring the dysfunctional segment. 3. Flex patient's knees and hips until you feel gapping at the level of the dysfunctional segment. 4. Have patient extend his top knee and hip, while keeping his bottom knee and hip in flexion to maintain isolation of the dysfunctional segment. 5. Pulling the arm lying on the table superiorly or inferiorly will add sidebending in one direction or another.

4. Have patient extend his top knee and hip, while keeping his bottom knee and hip in flexion to maintain isolation of the dysfunctional segment.

A 34-year-old female was involved in a MVA yesterday and has come to the office today asking for treatment and pain relief. She was the restrained driver (had seatbelt on) stopped at a traffic light and rear ended by a car traveling 40 mph. Today she is complaining of severe neck pain with limited range of motion in extension. After a careful physical exam, you notice extreme tenderness rated at a 10/10 with palpation around her C7 spinous process. There are no neurologic deficits. She is asking for OMT and pain medication. How would you treat this patient? 1. Perform muscle energy engaging the barrier of extension in an attempt to increase ROM and decrease pain. 2. Refer to a neurosurgeon for laminectomy and cervical fusion. 3. Perform counterstrain on the patient placing her cervical spine in flexion in an attempt to release her muscle spasm and increase her ROM 4. Obtain a cervical neck x-ray to rule out fracture. 5. Defer OMT until the patient has less spasm, prescribe opioid pain medication, and recheck the patient in one week.

4. Obtain a cervical neck x-ray to rule out fracture.

Which statement regarding cervical HVLA of the OA ESLRR is correct? 1. Consent is not required for the O/A HVLA technique. 2. Extension of the cervical spine is necessary to avoid vertebral artery occlusion. 3. Physician is seated at head of the table while delivering a high velocity, low amplitude thrust. 4. The treatment position requires localized flexion, sidebending of the occiput to the right. 5. The thrust is rotational toward the opposite shoulder.

4. The treatment position requires localized flexion, sidebending of the occiput to the right.

A 46-year-old female patient with severe rheumatoid arthritis presents to the university clinic accompanied by her husband for terrible neck pain after taking an off-road jeep tour with her family while on vacation 1 week ago. You perform a neurological exam which is normal and find a diagnosis of C3FRSR. You elect to treat the dysfunction with HVLA. While preparing for the thrust, your attending physician suddenly stops you and states the patient is at risk of injuring what ligament? 1. Anterior longitudinal 2. Posterior longitudinal 3. Ligamentum flavum 4. Transverse (alar) ligament 5. Medial collateral ligament

4. Transverse (alar) ligament

A 40-year-old novelist complains of left sided medial elbow pain, 4-5th digit numbness, and feeling clumsy with her typing. She is left-handed, and she has been typing over 12 hours per day while resting her arms on the desk, as she is completing her novel about the secret underground world of unicorn gnome racing. She denies any other trauma, fever, or swelling. On physical exam, you palpate a tender point over the left medial epicondyle. She has full range of motion in both her elbow and wrist. You find left-sided hand weakness. What is the most likely cause of her symptoms? 1. Lateral epicondylitis 2. Medial nerve entrapment 3. Carpal tunnel syndrome 4. Ulnar nerve entrapment, cubital tunnel 5. Compartment syndrome of the forearm

4. Ulnar nerve entrapment, cubital tunnel

Which of the following best describes proper application of an HVLA technique? 1. The activating force is the patient's own muscular effort 2. It is important to go towards the barrier then back away slightly before applying the thrust 3. You lock down the joint against the barrier then force vigorously through it 4. You apply a small but rapid force using a lever arm over a fulcrum 5. You direct your force away from the barrier

4. You apply a small but rapid force using a lever arm over a fulcrum

A 34-year-old female complains of tingling in the 4th and 5th digits of her hand. Upon physical exam, you note sensory deficits in the medial hand and 5th finger. What nerve root has been most affected? 1. C6 2. C7 3. C5 4. T1 5. C8

5. C8

A 50-year-old female presents to her primary care physician complaining of moderate upper thoracic pain after gardening the day before. She had seen a chiropractor in the past for various conditions but expressed dislike and concern for HVLA techniques. Her history includes a prior stroke, heart disease, mild osteopenia, and smoking. Of the following, which factor is an absolute contraindication for HVLA of the thoracic spine? 1. History of stroke 2. History of heart disease 3. Osteopenia 4. History of smoking 5. Failure to gain consent

5. Failure to gain consent

A 27-year-old female presents with upper back pain and stiffness after relocating her pet rock collection from the 3rd floor to the 9th floor. The severity is 4/10, without radiation, and there are no neurologic deficits. Structural examination reveals a T5 FRSR. You elect to treat with the Thoracic Supine HVLA (Kirksville Krunch). Which of the following steps is incorrect? 1. Stand on the side of the patient opposite the posterior transverse process. 2. Apply a lever arm to direct a force down through the patient's arms/elbows. 3. Choose and set a fulcrum with the hand posterior to the patient. 4. Flex the upper trunk of the patient to localize down to the segment. 5. Have the patient inhale and hold their breath while the corrective force is delivered.

5. Have the patient inhale and hold their breath while the corrective force is delivered.

A 35-year-old female presents with numbness and tingling over the palmar surface of her right thumb with occasional radiation into her index and middle finger for the past 2 weeks, after typing all day. When she presses the dorsum of her hands together so that the wrist are fully flexed bilaterally and holds for one minute, her first 3 digits begin to go numb. The most appropriate conservative management of her condition would be? 1. Ordering MRI to rule out boney pathology of the wrist 2. Prompt surgical referral for decompression of the carpal tunnel 3. Muscle relaxants and narcotic pain medication 4. Home exercise program focused on core strengthening maneuvers 5. OMM direct techniques, rest ice, compression, elevation, and wrist splint

5. OMM direct techniques, rest ice, compression, elevation, and wrist splint

Which statement is accurate regarding an increase in carrying angle of the elbow? 1 . Greater in males compared to females 2. Olecranon moves laterally - abduction; Wrist - abduction 3. Olecranon moves medially - adduction; Wrist - abduction 4. Olecranon moves laterally - abduction; Wrist - adduction 5. Olecranon moves medially - adduction; Wrist - adduction

5. Olecranon moves medially - adduction; Wrist - adduction

A 55-year-old male patient presents to his Osteopathic physician with the complaint of neck stiffness after working in the yard the day before. He denies any history of neck trauma, recent illness or fever, and no pain or weakness down the arms. With active ROM testing he has decreased left rotation and sidebending while in flexion. When he markedly extends his neck and rotates and sidebends it to the right, he notes feeling dizzy and light-headed. The physician is considering performing HVLA of the cervical spine. Which of the following should be considered next? 1. Order MRI to confirm nerve impingement 2. Perform ME first by engaging the left sidebent/rotated barrier 3. Confirm findings with passive motion testing 4. Schedule an X ray of the neck to rule out arthritis 5. Order Doppler Ultrasound of the arteries of the neck

5. Order Doppler Ultrasound of the arteries of the neck

A 16-year-old High School Running Back is playing in a game in which you are the osteopathic physician on the sideline. During the play, an opponent's helmet strikes the running back's knee on the lateral side instituting a lateral to medial force. The patient immediately falls and has trouble getting back up to bear any weight. An X-ray is performed which is inconclusive, and a MRI of the knee is then done which showed O'Donoghue's Triad. Which of the following makes up this triad? A. Medial collateral ligament, medial meniscus and anterior cruciate ligament B. Medial collateral ligament, medial meniscus, and posterior cruciate ligament C. Lateral collateral ligament, medial meniscus, and anterior cruciate ligament D. Lateral collateral ligament, medial meniscus and posterior cruciate ligament

A. Medial collateral ligament, medial meniscus and anterior cruciate ligament