OPP FINAL

Question 1

What plane and axis does ROTATION occur on?

Answer 1

Transverse Plane
Vertical Axis

Question 2

What plane and axis does SIDEBENDING occur on?

Answer 2

Coronal Plane
Anterior-Posterior Axis

Question 3

What plane and axis does FLEXION occur on?

Answer 3

Sagittal Plane
Transverse Axis

Question 4

What plane and axis does EXTENSION occur on?

Answer 4

Sagittal Plane
Transverse Axis

Question 5

The spinous process of T8 moves superiorly with which motion of the T8 vertebra?

Answer 5

FLEXION

Question 6

The LEFT transverse process of T5 moves posterioly with which motion of the T5 vertebra?

Answer 6

LEFT ROTATION

Question 7

Which Fryette law is responsible for a group curve?

Answer 7

TYPE 1

Question 8

Which Fryette Law?

a single vertebra that exhibits asymmetry in flexion or extension, with sidebending and rotation to the SAME sides

Answer 8

TYPE 2

Question 9

This cervical joint always exhibits sidebending and rotation in OPPOSITE directions

OCCIPITOATLANTAL joint

Answer 9

C0 C1

Question 10

This cervical joint only exhibits ROTATION

Atlantoaxial Joint

Answer 10

C1 C2

Question 11

What cervical joint exhibits rotatino and sidebending to the SAME side

Joints of Luschka

Answer 11

C2 – C7

Question 12

Facet Orientation
Cervical, Thoracic, and Lumbar Spine

Answer 12

BUM BUL BM

Question 13

Three adjacent vertebra have posterior TPs on the left and they exhibit worse asymmetry in flexion and extension. What type of dysfunction are they?

Answer 13

TYPE 1 – group curve

Question 14

What is made up of three parts: spinalis, longissimus, and iliocostalis and EXTENDS and ipsilaterally sidebends the spine

Answer 14

ERECTOR SPINAE

Question 15

Short Restrictors are likely to create what type of fryette dysfunction?

rotatores, levatores costarum, interspinalis, and intransversarii

Answer 15

type 2

Question 16

Long Restrictors are likely to create what type of fryette dysfunction

Multifidus, semispinalis thoarcis, spinalis, longissimus, iliocostalis

Answer 16

TYPE 1

Question 17

What is the main muscle of the lumbar spine which provides stability?

Answer 17

MULTIFIDUS

Question 18

These somatic dysfunctions you may see asssociated to what muscle?

Inhalation dysfunction (rib 12), L1-L4
Superior Shear of the innominate
Iliolumbar ligament tightness/tenderness

Answer 18

Hypertonic Quadratus Lumborum

Question 19

When the psoas muscle goes into SPASM what what happenes to the lumbar spine?

Answer 19

FLEXION

Fryette Type 2 dysfunction

Question 20

What 3 major structures pierce the diaphragm?

Answer 20

Aorta
Inferior Esophagus
Inferior Vena cava

Question 21

These somatic dysfunctions are associated to?

L1,2,3 somatic dysfunctions
Lower 6 Rib somatic dysfunction
Thoracic somatic dysfunction of the lower 6 thoracic vertebrae

Answer 21

Diaphragmatic tightness

Question 22

Ipsilateral or Contralateral?

Internal Obliques
External Obliques

Answer 22

Internal – Ipsilateral
External – Oblique

Question 23

The orientation of what facet of a vertebra determines spinal motion?

Answer 23

SUPERIOR Facets

Question 24

What is the preferred motion of the lumbar spine?

Answer 24

FLEXION and EXTENSION

BM
Right Left AXIS
Sagittal Plane

Question 25

What is the preferred motion of the **Thoracic Spine**?

Answer 25

ROTATION | BUL Superior-Inferior Axis Transverse Plane

Question 26

# Etiologies of what? Ruptured or herniated Disk Bone or Cord tumors Exostoses (bOne spurs) Spinal Stenosis Infection and Inflammation Systemic Dx -- Diabetes Mellitus

Answer 26

RADICULOPATHY

Question 27

Patient comes in complaining of unilateral pain below the knee Dull, burning, or lancing

Answer 27

Lumbar Radiculopathy

Question 28

Where are herniations most frequent?

Answer 28

L4-L5

Question 29

At what segment does the spinal cord end?

Answer 29

L2

Question 30

A herniated disc (HNP) will typically affect the nerve root named for the segment ABOVE or BELOW?

Answer 30

BELOW

Question 31

a herniated L5-S1 disc will affect which nerve root?

Answer 31

S1

Question 32

Due to large central disc herniation or other space- occupying lesion compressing the cauda equina  Bilateral or unilateral sciatica  Saddle anesthesia  Lower extremity weakness

Answer 32

Cauda Equina Syndrome

Question 33

# Neurologic Exam for Radiculopathy Deep tendon reflexes with patient seated  **Patellar**(?)  **Achilles** (?)

Answer 33

 Patellar(L4)  Achilles (S1)

Question 34

# Motor function testing of lower extremities Hip flexors(?) extensors(?)

Answer 34

Hip flexors(L1-L2) extensors(L4-L5)

Question 35

# Motor function testing of lower extremities Knee flexors (?) extensors(?)

Answer 35

Knee flexors (L5-S1) extensors(L3-L4)

Question 36

# Motor function testing of lower extremities Dorsiflexion (?) plantarflexion (?) Great toe extension(?)

Answer 36

Dorsiflexion (L4-L5) plantarflexion (S1-S2) Great toe extension(L5-S1)

Question 37

# What are these associated to?  Psoriatic arthritis  Ankylosing Spondylitis  Inflammatory Bowel Disease  Reactive Arthritis (aka Reiter’s Syndrome) | PAIR

Answer 37

Ankylosing spondylitis | FLATTENED in AP curvature

Question 38

What joint is first affected in patients with Ankylosing spondylitis

Answer 38

Sacroiliac Joint

Question 39

What antigen is diagnosed in about 90% patients with Ankylosing spondylitis

Answer 39

HLA-B27

Question 40

# What is the diagnosis? Congenital increase in thoracic A-P curvature Vertebral body grows unevenly; see wedging of vertebrae

Answer 40

Scheuermann's disease

Question 41

What segments are most commonly affected in patients with Scheuermann's disease

Answer 41

T7-T10

Question 42

What disease is associated with **wedge factures**?

Answer 42

Osteoporosis

Question 43

# Whats the diagnosis? Most common **fx. at T12** and apex of thoracic spine “**Dowager’s hump**”

Answer 43

Osteoporosis

Question 44

Patients with a flattened lumbar curvature typically have a non neutral dysfunctional at what segments?

Answer 44

L1-L2

Question 45

Patients that have a psoas spasm with sacral torsion usually have:

Answer 45

Backward Sacral Torsion 3. Contralateral Piriformis Spasm 4. Contralateral Sciatic Nerve Irritation

Question 46

Spondylolisthesis is secondary to what kind of fracture?

Answer 46

Pars interarticularis

Question 47

# Reversing the Curve This is commonly caused by

Answer 47

Spasms of paraspinal muscles | **Must treat INDIRECTLY in acute settings/rule out fracture prior to OMT

Question 48

**Numbness, tingling, weakness, or bowel and bladder dysfunction** suggest what?

Answer 48

nerve root or spinal cord injury

Question 49

Pain which radiates down the leg, **below the knee** seen in patients with :

Answer 49

Herniated Lumbar discs

Question 50

Pain which is **worsened by changes in position vs. exertion** is likely ______ Pain with deep breathing **without shortness of breath** is likely _____

Answer 50

SOMATIC

Question 51

outward curve vs inward curve

Answer 51

Outward = KYPHOTIC - thoracic Inward = LORDOTIC -- lumbar

Question 52

**facetogenic** **pain** is felt in what type of movements

Answer 52

Extension and rotation movements

Question 53

**Lumbosacral pain** is felt in what sort of movements

Answer 53

Upon standing and sitting

Question 54

# Differential Diagnosis of What region R/o cauda equina, malignancy Dx. of the spine/facets Muscular: Quadratus lumborum, psoas, paraspinals Ligamentous: Iliolumbar ligament, interspinous, A/P longitudinal Neural: Sciatic and cluneal nerve

Answer 54

LUMBAR REGION

Question 55

# Differential diagnosis for what region? R/o fracture, malignnacy, multiple myeoloma Consider osteoporotic or traumatic compression fracture/causes of osteoporosis Consider visceral causes * Aortic dissection, MI, pneumonia, pneumothroax, pericarditis, hepatobiliary dx referral pattern * nephrolithiasis or renal disease

Answer 55

THORACIC Region

Question 56

scolosis is named for direction of what

Answer 56

CONVEXITY

Question 57

scolosis severity greater than 50 degrees compromises what, and at 75 degrees

Answer 57

50 - resp function 75 - cardiovascular function

Question 58

# Osteopathic considerations How do the vertebrae rotate and sidebend in regards to convexity

Answer 58

rotate INTO sidebend AWAY from convexity

Question 59

# osteopathic considerations How do the ribs on the convex and concave side move

Answer 59

Convex -- seperate and move posterior Concave -- closer and anterior * disc spaces narrow on concave side

Question 60

What is the most clincially relevant element of **short leg syndrome biomechanics**

Answer 60

Sacral Base Unleveling | spine compenstates -- rotoscoliosis innominates rotate to compensate

Question 61

# Early Compensation of Short Leg Syndrome The head and should depress to which side Sacral Base, Iliac Crest and Spinal Convexity tilt towards what side?

Answer 61

Shoulder depresses **opposite** the side of pelvic depression Sacrum, Iliac Crest and Spinal Convexity are on the side of the SHORT LEG

Question 62

# Guiding principles for progressive compensation Which way do the innominates on the short side vs long side rotate

Answer 62

Short Side rotates ANTERIORLY to LENGTHEN Long Side rotates POSTERIORLY to SHORTEN

Question 63

iliolumbar ligament on which side of the short leg syndrome becomes stressed

Answer 63

on the side of the CONVEXITY

Question 64

What OMT treatment option can be utilized if patient has an anatomic short leg (growth or trauma)

Answer 64

Heel Lift Therapy Flexible spine -- 3mm heel lift Fragile spine -- 1.5mm

Question 65

# LIFT THERAPY If the patient had a sudden loss of leg length on one side and the pt had a level sacral base prior to developing the short leg, how much do you lift

Answer 65

lift the FULL fractional amount that was lost

Question 66

Most common location of compartment syndrome

Answer 66

Anterior compartment of lower leg

Question 67

As **compartment pressure rises**, what happens to **venous outflow and venous pressure**?

Answer 67

Venous outflow DECREASES Venous Pressure INCREASES | DEC in arteriovenous pressure gradient

Question 68

# Pathogenesis of Compartment Syndrome What gets released due to hypoxia

Answer 68

release of vasoactive substances serotonin, histamine -- allows capillatires to release more fluid in already tight compartment

Question 69

What happens sooner nerve ischemia or muscle ischemiA

Answer 69

NERVE ischemia -- after one hour

Question 70

What is the most common measurement technique for compartment syndrome

Answer 70

**Stryker Device** Simple Needle Manometer system The wick silt catheter

Question 71

overuse injury that typically affects young endurance athelets. result from inc pressure within muscle compartments

Answer 71

Chronic Exertional Compartment Syndrome CECS

Question 72

What is the prevalance of fibromyalgia in the US/Canada

Answer 72

2%

Question 73

What neurotransmitter is inhibitory in the pain pathway?

Answer 73

GABA

Question 74

How many tenderpoints are needed to establish a diagnosis of fibromyalgia using the 1990 ACR criteria?

Answer 74

11