FAMILY MEDICINE I MODULES
Which of the following is true regarding Fryette’s Principles?
a. Fryette’s Principle 2 describes mechanics of group curves
b. The lower cervical spine follows Fryette’s Principle 1
c. In Fryette’s Principle 2, sidebending and rotation occur to the same side
d. Fryette’s Principle 2 describes motion in a neutral position
e. Fryette’s Principle 1 only applies to the lumbar spine
2. Which of the following is true regarding thoracic diagnosis?
a. Rotation is named for the side of the deeper transverse process
b. If rotation only becomes more symmetrical in flexion, the dysfunction is an
extension dysfunction
c. If rotation becomes symmetrical in both flexion and extension, sidebending
occurs to the same side as rotation
d. If rotation only becomes more symmetrical in flexion, the dysfunction follows
Fryette’s Principle 2
e. Rotation and sidebending always occur to the same side regardless of the
change in flexion and extension
3. You examine L3 and find the right transverse process to be deeper than the left. The findings are
unchanged in flexion and become symmetrical in extension. Which of the following is the correct
diagnosis?
a. L3 flexed, sidebent left, rotated left
b. L3 flexed, sidebent right, rotated right
c. L3 extended, sidebent left, rotated left
d. L3 extended, sidebent right, rotated left
e. L3 flexed, sidebent left, rotated right
4. You assess OA translation and find translation to be easier to the right. The findings persist in both
flexion and extension. Which of the following is the correct diagnosis?
a. Flexed, rotated right, sidebent left
b. Neutral, rotated left, sidebent right
c. Neutral, rotated right, sidebent left
d. Neutral, rotated left, sidebent left
e. Extended, rotated right, sidebent right
5. You assess C4 translation and find translation to be easier to the left. The findings become
symmetrical in flexion but not in extension. Which of the following is the correct diagnosis?
a. Flexed, rotated right, sidebent left
b. Neutral, rotated left, sidebent right
c. Neutral, rotated right, sidebent left
d. Flexed, rotated right, sidebent right
e. Extended, rotated right, sidebent right
6. Which of the following is true regarding rib motion?
a. Rib 7 is primarily caliper motion
b. Motion occurs on a vertical axis
c. Rib 11 is predominantly bucket handle motion
d. Rib 1 is predominantly anterior/posterior motion
e. Rib 3 is both pump handle and bucket handle motion X
7. Which of the following is a finding of a rib inhalation somatic dysfunction?
a. Lives in exhalation
b. Prominence on anterior chest
c. Limitation to inhalation
d. Prominence on posterior chest
e. Recession on anterior chest
8. Which of the following is true regarding rib diagnosis?
a. Ribs that only move during inhalation are exhalation dysfunctions
b. Palpation of Rib 1 is performed inferior to the clavicle
c. Bucket handle motion is assessed in the mid-axillary line
d. Anterior rib prominence is a finding of an exhalation dysfunction
e. An inhalation dysfunction will have both anterior and posterior prominence
9. Which of the following is a test of laterality for assessment of innominate dysfunctions?
a. Respiratory motion test
b. ASIS compression test
c. ASIS to midline distance
d. Seated flexion test
e. Relative static PSIS heights
10. Which of the following findings would be expected in a right innominate anterior somatic
Dysfunction?
a. Positive seated flexion test on the right
b. Positive ASIS compression test on the left
c. Right ASIS inferior compared to left
d. Left PSIS superior compared to right
e. Right ASIS closer to midline than right
11. You assess the innominates and find the following:
Positive standing flexion test on the left
Right ASIS inferior compared to left
Right PSIS inferior compared to left
ASIS to midline distance equal bilaterally
Which of the following is the correct diagnosis?
a. Right innominate anterior
b. Left superior innominate shear
c. Left innominate posterior
d. Left innominate inflare
e. Right innominate posterior
12. Which of the following is true regarding the seated flexion test?
a. If both sides rise the same amount, it indicates that no dysfunction is present
b. The test is positive opposite the side of greatest PSIS excursion
c. The axis of a sacral torsion is located on the same side of greatest excursion
d. A unilateral dysfunction will be on the same side of the greater excursion
e. A false negative occurs with unilateral dysfunctions
13. Which of the following is true regarding sacral torsions?
a. The right base moves forward in a left on right torsion
b. The axis passes through the right base in a left on left torsion
c. A right on right torsion is termed a backward sacral torsion
d. The right sulcus is deeper in a right on right torsion
e. Points along the axis do not move in a sacral torsion
14. Which of the following is true regarding a bilateral sacral extension?
a. The sacral sulci are deep bilaterally
b. The seated flexion test will be positive
c. The base will not move posteriorly during inhalation
d. The base will not move posteriorly during exhalation
e. The sacral sulci are shallow bilaterally
15. You assess the sacrum and find the following:
Positive seated flexion test on the left
Left sulcus shallow
Left ILA markedly superior
Which of the following is the correct diagnosis?
a. Right on left sacral torsion
b. Right unilateral sacral flexion
c. Left on right sacral torsion
d. Left unilateral sacral extension
e. Left on left sacral torsion
16. You examine T7 and find the left transverse process to be deeper than the right. The findings
become symmetrical in flexion and are unchanged in extension. Which of the following is the correct
diagnosis?
a. T7 flexed, sidebent left, rotated left
b. T7 flexed, sidebent right, rotated right
c. T7 extended, sidebent left, rotated left
d. T7 extended, sidebent right, rotated left
e. T7 flexed, sidebent left, rotated right
17. Which of the following is true regarding lumbar diagnosis?
a. Rotation and sidebending occur to opposite sides in flexion dysfunctions
b. If the right transverse process is deeper, the vertebra is rotated to the left
c. Rotation and sidebending occur to the same side in neutral dysfunctions
d. A lumbar dysfunction that becomes symmetrical in both flexion and extension
is an extension dysfunction
e. Only Fryette’s Principle 1 applies to the lumbar spine
18. Which of the following is true regarding cervical mechanics/diagnosis?
a. Motion testing of the AA is performed by translation
b. C2-C7 only follow Fryette’s Principle 1
c. The OA is the only cervical segment that must be tested in flexion, extension and neutral
d. Right translation is equal to left sidebending at C4
e. Left translation is equal to left rotation at C6
19. Which of the following is true regarding sacral dysfunctions?
a. A right unilateral sacral flexion will have a positive seated flexion test on the left
b. A left on left sacral torsion will have a deep right sulcus
c. A right on left sacral torsion will have a deep right sacral sulcus
d. A left unilateral seated flexion will have a significantly higher ILA on the left
e. A bilateral sacral flexion will have bilaterally shallow sulci
20. Which of the following is true regarding innominate dysfunctions?
a. Innominate flares are named for the side on which the ASIS is closer to midline
b. The standing flexion test is negative with an innominate shear
c. The ASIS compression test will be positive on the side opposite the positive standing flexion test
d. A positive seated flexion test is expected on the right with a right innominate posterior
e. The right ASIS is inferior with a right innominate anterior
21. You evaluate the 3rd ribs bilaterally and find the following:
Right 3rd rib more prominent anteriorly
Both sides rise during inhalation
Only the left side falls during exhalation
Which of the following is the correct diagnosis?
a. Right 3rd rib inhalation dysfunction
b. Left 3rd rib inhalation dysfunction
c. Right 3rd rib inferior dysfunction
d. Left 3rd rib exhalation dysfunction
e. Left 3rd rib superior dysfunction
22. Which of the following is paired correctly?
a. Fryette’s Principle 1 – Typically involves a single segment
b. AA dysfunctions – Assessed with rotation
c. Ribs 11 & 12 – Predominantly superior/inferior motion
d. Left oblique sacral axis – Positive left seated flexion test
e. Right innominate posterior – Positive left standing flexion test
23. Which of the following dysfunctions will have a left positive standing flexion test and
a negative AP compression test?
a. Left innominate posterior
b. Right superior innominate shear
c. Left innominate outflare
d. Right innominate inflare
e. Left inferior innominate shear
24. You examine L1 and find the right transverse process to be more shallow than the left. The findings
are unchanged in both flexion and extension. Which of the following is the correct diagnosis?
a. L1 flexed, sidebent left, rotated left
b. L1 neutral, sidebent right, rotated right
c. L1 neutral, sidebent left, rotated left
d. L1 extended, sidebent right, rotated left
e. L1 neutral, sidebent left, rotated right
25. Which of the following is true regarding a right superior innominate shear?
a. Negative standing flexion test
b. Negative AP compression test
c. ASIS and PSIS both superior on the right
d. Right ASIS closer to midline
e. Positive standing flexion test on the left
MODULE 2
1. Which of the following is true regarding muscle energy treatment?
a. Contraindicated in patients with osteopenia
b. Primary treatment for patients in the ICU
c. Utilizes patient force with equal physician counterforce X
d. Patient effort is held for 90 seconds
e. A-P curve must be flattened out during treatment
2. A patient is diagnosed with a right anterior innominate dysfunction. Which of the
following is the correct description for muscle energy treatment of this dysfunction?
a. Right hip extended – patient flexes hip against resistance
b. Right hip flexed – patient extends hip against resistance X
c. Right hip extended – patient extends hip against resistance
d. Right hip externally rotated – patient internally rotates hip against resistance
e. Right hip abducted – patient adducts hip against resistance
3. Which of the following is true regarding HVLA thrust technique?
a. Indirect technique
b. Useful in patients with joint hypermobility
c. Thrust applied after backing away from barrier for 1-2 seconds
d. Lumbar HVLA is contraindicated in patients with Down Syndrome
e. Restrictive barrier must be engaged in all planes of motion X
4. Which of the following is true regarding Counterstrain treatment?
a. Restrictive barrier must be engaged in all planes of motion
b. Treatment position should decrease tenderness by at least 70% X
c. Treatment position is held for 3-4 seconds, then released
d. Patient assists in positioning for treatment
e. Patient must slowly bring himself to neutral after treatment
5. Which of the following is correctly matched?
a. Counterstrain treatment of hip flexor – patient’s hip passively flexed X
b. FPR treatment of shoulder external rotator – patient’s shoulder internally rotated
c. HVLA treatment of C3 ERRSR – C3 placed into extension, right rotation and right sidebending
d. Muscle energy treatment of a bilateral sacral flexion – pressure on sacral base
e. HVLA treatment of right unilateral sacral extension – superior thrust on right ILA
6. The heart receives sympathetic innervation from which of the following levels?
a. OA
b. T1-T5 X
c. T5-T9
d. T10-L2
e. S2-S4
7. Which of the following is true regarding FPR treatment?
a. Restrictive barrier must be engaged in all planes of motion
b. Treatment position should decrease tenderness by at least 70%
c. Treatment position is held for 3-4 seconds, then released X
d. A-P curve is accentuated during treatment
e. Facilitating force is an isometric contraction of the involved muscles
8. Which of the following is true about autonomic control of the lungs?
a. Sympathetic stimulation results in bronchoconstriction
b. The lower lungs receive parasympathetic innervation from S2-S4
c. Sympathetic innervation arises from the T5-T9 levels
d. Increased thick secretions are a result of increased sympathetic activity X
e. Sacral rocking will result in increased thin, watery secretions
9. Which of the following techniques would be most useful in improving upper GI
motility in a patient with ileus?
a. Sacral rocking
b. Rib raising for 30 seconds
c. OA decompression
d. Paraspinal inhibition for 120 seconds X
e. Sacral inhibition
10. You assess C4 translation and find translation to be easier to the left. The findings
become symmetrical in flexion but not in extension. Which of the following is the
correct position of C4 for a HVLA thrust?
a. Flexed, rotated right, sidebent left
b. Extended, rotated left, sidebent left X
c. Neutral, rotated right, sidebent left
d. Flexed, rotated right, sidebent right
e. Extended, rotated right, sidebent right
11. You examine L3 and find the right transverse process to be deeper than the left. The
findings are unchanged in flexion and become symmetrical in extension. Which of
the following is the correct position of L3 for FPR treatment?
a. Flexed, sidebent left, rotated left
b. Flexed, sidebent right, rotated right
c. Extended, sidebent left, rotated left X
d. Extended, sidebent right, rotated left
e. Flexed, sidebent left, rotated right
12. Which of the following is true regarding autonomic innervation to the GU system?
a. Sympathetic stimulation increases ureteral peristalsis
b. Sympathetic stimulation relaxes the bladder wall X
c. Parasympathetic stimulation activates the bladder sphincter
d. Parasympathetic stimulation activates the trigone
e. Sympathetic stimulation increases GFR
13. Which of the following is a result of parasympathetic stimulation?
a. Peripheral vasodilation
b. Ejaculation
c. Increased salivation X
d. Uterine contraction
e. Ureterospasm
14. The gall bladder receives sympathetic innervation from which of the following
levels?
a. OA
b. T1-T5
c. T5-T9 X
d. T10-L2
e. S2-S4
15. You are attempting to treat a right 7th rib exhalation dysfunction with counterstrain.
Which of the following is correct regarding the treatment?
a. Shaft of right 7th rib positioned closer to shaft of right 8th rib X
b. Position should decrease tenderness by 50%
c. Position is held for 30 seconds
d. Angle of right 7th rib tractioned inferiorly
e. Positioning involves left sidebending and extension
16. Which of the following is correctly matched?
a. Muscle energy – indirect treatment
b. HVLA – articulation positioned in free motion
c. Counterstrain – starts with a pain scale X
d. FPR – active direct treatment
e. Muscle energy – useful for painful muscle groups
17. Which of the following would be most likely to inhibit uterine contractions in a
patient in premature labor?
a. Sacral rocking X
b. OA decompression
c. Paraspinal inhibition >90 seconds at T5-T9
d. Rib raising <60 seconds at T10-L2
e. Sacral inhibition
18. You assess the innominates and find the following:
Positive standing flexion test on the left
Right ASIS inferior compared to left
Right PSIS inferior compared to left
ASIS to midline distance equal bilaterally
Which of the following correctly describes a treatment for this dysfunction?
a. Muscle energy – left hip flexed, patient extends against resistance
b. HVLA thrust – thrust directed inferiorly on left innominate X
c. FPR – right innominate pushed inferiorly for 3-4 seconds
d. Muscle energy – right hip pushed superiorly, patient pushes inferiorly
e. Counterstrain – left innominate held inferiorly for 90 seconds
19. The pancreas receives parasympathetic innervation from which of the following
levels?
a. OA X
b. T1-T5
c. T5-T9
d. T10-L2
e. S2-S4
20. Which of the following would most likely directly decrease gastric secretions?
a. Sacral rocking
b. OA decompression
c. Paraspinal inhibition >90 seconds at T10-L2
d. Rib raising <60 seconds at T5-T9 X
e. Sacral inhibition
21. Which of the following statements is true regarding osteopathic treatment techniques?
a. Counterstrain is contraindicated for painful muscle groups
b. Osteoporosis is a contraindication for FPR
c. Muscle energy should not be used on a person in the CCU X
d. HVLA is useful in patients with active Rheumatoid Arthritis
e. The restrictive barrier is engaged when using indirect techniques
22. You examine T7 and find the left transverse process to be deeper than the right. The
findings become symmetrical in flexion and are unchanged in extension. Which of
the following is the correct starting position for a muscle energy treatment?
a. T7 flexed, sidebent left, rotated left
b. T7 flexed, sidebent right, rotated right
c. T7 extended, sidebent left, rotated left X
d. T7 extended, sidebent right, rotated left
e. T7 flexed, sidebent left, rotated right
23. The sigmoid colon receives parasympathetic innervation from which of the following
levels?
a. OA
b. T1-T5
c. T5-T9
d. T10-L2
e. S2-S4 X
24. You assess OA translation and find translation to be easier to the right. The findings
persist in both flexion and extension. Which of the following is the correct position
for FPR treatment?
a. Flexed, rotated right, sidebent left
b. Neutral, rotated left, sidebent right
c. Neutral, rotated right, sidebent left X
d. Neutral, rotated left, sidebent left
e. Extended, rotated right, sidebent right
25. Which of the following would most likely directly increase lacrimation?
a. Sacral rocking
b. OA decompression X
c. Paraspinal inhibition >90 seconds at T5-T9
d. Rib raising <60 seconds at T1-T4 X
e. Sacral inhibition
MODULE 3 – Joanne Smith
1.
2.
3.
4.
Top 5 ddx: peptic ulcer, GERD, costochondritis, Pancreastitis, MI angina pectoris
E. no contraindications
A. OA
E. strep throat
dysfunctions
1. Examine the cervical region for somatic dysfunction
A. OA – left/right translation
1. neutral
Performed

Omitted



2. flexion


3. extension
2. Examine the thoracic spine for dysfunction (T5-T9)
A. palpate transverse processes for rotation


1. neutral


2. flexion


3. extension
B. palpate soft tissue for TART findings


1. trapezius


2. rhomboids


3. levator scapulae


4. T5 – T9 Paraspinal muscles
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.


1. Assume OA NSLRR: appropriate techniques to include: HVLA, muscle
energy, articulatory, Still, counterstrain/indirect, myofascial release, facilitated
positional release


2. Assume T7 FRLSL: appropriate techniques to include: HVLA, muscle
energy, articulatory, Still, counterstrain/indirect, myofascial release, facilitated
positional release


3. Assume acute bilateral spasm of upper thoracic (T5-T9) paraspinal
muscles: appropriate techniques to include: soft tissue, counterstrain/indirect,
facilitated positional release


4. Autonomic technique for altered vagal tone: OA decompression


5. Autonomic technique for hypersympathetic tone in T5-T9 paraspinal
muscles: rib raising or paraspinal inhibition for > 90 seconds
MODULE 4- Ernesto Rodriguez
PRETEST:
1. Back pain from Colon cancer, Lumbar strain, Osteomyelitits, Diverticulitis, Back pain,
osteoarthritis, Cauda equina syndrome
2. D
3. E
Osteopathic Diagnosis: assess where you would expect to find somatic
dysfunctions
1. Examine the lumbar region (L1-L5) for somatic dysfunction
Performed
Omitted
A. palpate transverse processes for rotation
1. neutral
_
2. flexion
_
3. extension
_
B. palpate soft tissue for TART (Tenderness, Asymmetry, Restrictions, Tissue texture change) findings
1. quadratus lumborum muscles
_
2. Piriformis muscles
_
3. Paraspinal muscles
_
2. Examine the sacrum for somatic dysfunction (requires at least one motion test)
A. depth at 4 corners of sacrum
_
B. ILA levelness
_
C. seated flexion test
_
D. motion at 4 corners of sacrum
_
E. motion in backward bending test
_
F. respiratory motion of sacrum assess at 4 corners
_
3. Examine the pelvis for somatic dysfunction
A. standing flexion test or AP compression test
_
B. ASIS heights
_
C. PSIS heights
_
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your examination.
1. Assume L5 FRLSL:
_
2. Assume left on left sacral torsion:
_
3. Assume left innominate anterior:
_
4. Assume spasm/tender point in the left piriformis muscle: appropriate techniques to
-
include: counterstrain/indirect, myofascial release
MODULE 5 – Connie Jones
Pretest
1.
2.
3.
4.
5.
Bradycardia, acute pulmonary edema/CHF, pneumonia, acute MI, Acute pulmonary edema CHF
A
A
A
For the video this is what was done and not done:
OA - n,f **NO E -->N,sl,rr
no AA dx done
no cervical dx done
T1-T5 - n,f,e --> t2, f, sl rl
parapsinals TART --> L upper thoracic paraspinal
no levator scapula, no trap, no rhomboids dx
tx T2: HLVA
OA decompr – for vagal tone
rib raisin for sympth.
MODULE 6 – Gretchen White
1.
2.
3.
4.
5.
Atrial fibrillation, hyperthyroidism and,/,- thyrotoxicosis, thyroid cancer, hyperthryroid
a
a
a
Osteopathic Diagnosis: assess where you would expect to find somatic
dysfunctions
Performed
1. Examine the cervical region for somatic dysfunction
A. OA – left/right translation
1. neutral
X
Omitted
2. flexion
X
6. 3. extension
X
7. B. AA – rotation
X
8. 2. Examine the upper thoracic spine for dysfunction (T1-T5)
A. palpate transverse processes for rotation
1. neutral
X
2. flexion
X
3. extension
X
B. palpate soft tissue for TART findings
1. trapezius
X
2. rhomboids
X
3. levator scapulae
X
4. T1-T5 paraspinal muscles
X
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your examination.
1. Assume OA NSLRR: appropriate techniques to include:
counterstrain/indirect, myofascial release, facilitated positional release
2. Assume T2 FSLRL: appropriate techniques to include:
counterstrain/indirect, myofascial release, facilitated positional release
X
X
3. Assume acute spasm of left upper thoracic paraspinal muscles:
appropriate techniques to include: counterstrain/indirect, myofascial
release, and facilitated positional release
X
4. Autonomic technique for altered vagal tone: OA decompression
5. Autonomic technique for hypersympathetic tone: rib raising or
paraspinal inhibition for > 90 seconds
MODULE 7 – Emmitt Brown
X
X
1. AAA, kidney stones, groin hernia, ileus, kidney/bladder CA, testicular torsion, kidney/bladder
infection, appendicitis,
2. C
3. D
Osteopathic Diagnosis: assess where you would
Performed
Omitted
expect to find somatic dysfunctions
1. Examine the cervical region for somatic dysfunction
A. OA – left/right translation
1. neutral
X
2. flexion
X
3. extension
X
B. AA – rotation, must flex at least 45°
X
2. Examine the thoracic spine for dysfunction (T10-L2)
A. palpate transverse processes for rotation
1. neutral
X
2. flexion
X
3. extension
X
B. palpate soft tissue for TART findings
4. T10 – L2 Paraspinal muscles
X
3. Examine the sacrum for somatic dysfunction (requires at least one motion test)
A. depth at 4 corners of sacrum
X
B. ILA levelness
X
C. seated flexion test
X
D. motion at 4 corners of sacrum
X
E. motion in backward bending test
X
F. respiratory motion of sacrum assess at 4 corners
X
4. Examine the pelvis for somatic dysfunction
A. standing flexion test or AP compression test
X
B. ASIS heights
X
C. PSIS heights
X
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found
during your examination.
1. Assume OA NSLRR: appropriate techniques to include:
X
_
HVLA, muscle energy, articulatory, Still,
counterstrain/indirect, myofascial release, facilitated
positional release
2. Assume T10 NRRSL: appropriate techniques to
X
include: HVLA, muscle energy, articulatory, Still,
counterstrain/indirect, myofascial release, facilitated
positional release
3. Assume acute bilateral spasm of thoracolumbar (T10X
L2) paraspinal muscles R>L: appropriate techniques to
include: soft tissue, counterstrain/indirect, facilitated
positional release
4. Assume left on right sacral torsion: appropriate
techniques to include: muscle energy,
counterstrain/indirect, myofascial release, and facilitated
positional release (No HVLA)
X
5. Autonomic technique for hypersympathetic tone in T10L2 paraspinal muscles: rib raising or paraspinal inhibition
for > 90 seconds
X
MODULE 8 – Peter Parker
1. Kidney stone, Psoas syndrome, spondylolysis, piriformis syndrome, lumbar compression
fracture, appendicitis, pelvic/abdominal CA
2. C
3. B
Osteopathic Diagnosis: assess where you would expect to find
Performed
Omitt
somatic dysfunctions
1. Examine the thoracolumbar region (T10-L5) for somatic dysfunction
A. palpate transverse processes for rotation
1. neutral
_
2. flexion
_
3. extension
_
B. palpate soft tissue for TART (Tenderness, Asymmetry, Restrictions, Tissue texture change) findings
1. Psoas muscles
_
2. Piriformis muscles
_
3. Paraspinal muscles
_
2. Examine the sacrum for somatic dysfunction (requires at least one motion test)
A. depth at 4 corners of sacrum
_
B. ILA levelness
_
C. seated flexion test
_
D. motion at 4 corners of sacrum
_
E. motion in backward bending test
_
F. respiratory motion of sacrum assess at 4 corners
_
3. Examine the pelvis for somatic dysfunction
A. standing flexion test or AP compression test
_
B. ASIS heights
_
C. PSIS heights
_
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.
1. Assume L1 FRRSR: appropriate techniques to include: muscle energy,
counterstrain, indirect, myofascial release, facilitated positional release (No HVLA)
2. Assume left on right sacral torsion: appropriate techniques to include: muscle
energy, counterstrain/indirect, myofascial release, and facilitated positional release
(No HVLA)
3. Assume spasm/tender point in the right psoas muscle: appropriate techniques to
include: counterstrain/indirect, myofascial release, FPR, ME
4. Assume spasm/tender point in the left piriformis muscle: appropriate techniques to
include: counterstrain/indirect, myofascial release, FPR, ME
_
_
_
_
MODULE 9 – Ingrid Bergman
1. Lumbar strain, Dysmenorrhea, PID, lumbar strain, ovarian cyst, sacral somatic dysfunction
2. D
3. E
Osteopathic Diagnosis: assess where you would expect to find
Performed
Omitt
somatic dysfunctions
1. Examine the lumbar region (L1-L5) for somatic dysfunction
A. palpate transverse processes for rotation
1. neutral
_
2. flexion
_
3. extension
_
B. palpate soft tissue for TART (Tenderness, Asymmetry, Restrictions, Tissue
texture change) findings
1. quadratus lumborum muscles
_
2. Piriformis muscles
_
3. Paraspinal muscles
_
2. Examine the sacrum for somatic dysfunction (requires at least one motion test)
A. depth at 4 corners of sacrum
_
B. ILA levelness
_
C. seated flexion test
_
D. motion at 4 corners of sacrum
_
E. motion in backward bending test
_
F. respiratory motion of sacrum assess at 4 corners
_
3. Examine the pelvis for somatic dysfunction
A. standing flexion test or AP compression test
_
B. ASIS heights
_
C. PSIS heights
_
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.
1. Assume L3 FRLSL:
2. Assume left on right sacral torsion:
3. Assume left superior innominate shear:
4. Autonomic technique for altered parasympathetic tone:
_
_
Module 10 – Minnie Driver
Pretest:
1. Pneumonia, dissecting aortic aneurysm, thoracic spine fracture, MI, pleurisy
2. B
3. E
Osteopathic Diagnosis: assess where you would expect to find somatic
dysfunctions
Performed
Omitted
1. Examine the cervical region for somatic dysfunction
A. OA – left/right translation


1. neutral


2. flexion


3. extension


B. AA – rotation, must flex at least 45°
C. C2-C7 - translation


1. neutral


2. flexion


3. extension
2. Examine the thoracic spine for dysfunction (T5-T9)
A. palpate transverse processes for rotation


1. neutral


2. flexion


3. extension
B. palpate soft tissue for TART findings


1. trapezius


2. rhomboids


3. levator scapulae


4. T5 – T9 Paraspinal muscles
3. Examine the ribs for somatic dysfunction
A. Pump handle ribs (ribs 2-6) at or near sternal junction


1. static


2. motion
B. Bucket handle ribs (ribs 6-10) between anterior and posterior axillary lines


1. static


2. motion
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.
1. Assume T5 ESLRL:
2. Assume acute bilateral spasm of upper thoracic (T4-T8) paraspinal
muscles:
3. Assume (R) Rib 2 pump handle inhalation dysfunction
4. Autonomic technique for altered vagal tone: OA decompression








MODULE 11 – Jeff Weaver
1. Cervical radiculopathy, thoracic outlet syndrome, cubital tunnel syndrome, carpal tunnel
syndrome, angina pectoris, ulnar groove entrapment, Guillian Barre
2. A
3. B
4. C
Osteopathic Diagnosis: assess where you would expect to find somatic
dysfunctions
Performed
Omitted
1. Examine the cervical region for somatic dysfunction
A. C2-C7 - translation


1. neutral


2. flexion


3. extension
B. palpate soft tissue for TART (Tenderness, Asymmetry, Restrictions, Tissue texture change) findings


1. cervical paraspinal muscles


2. sternocleidomastoids


3. scalenes
2. Examine the thoracic spine for somatic dysfunction
A. palpate transverse processes for rotation


1. neutral


2. flexion


3. extension
B. palpate soft tissue for TART findings


1. trapezius


2. pectoral musculature


3. T1-T4 paraspinal muscle
3. Examine the 1st rib for somatic dysfunction


1. static


2. dynamic
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.

1. Assume hypertonic left pectoral muscle: Appropriate techniques to include: ME,
MFR, counterstrain

2. Assume hypertonic left scalene muscle: Appropriate techniques to include: MFR,
counterstrain, ME


3. Assume T4 NRLSR: appropriate techniques to include: HVLA, muscle energy,
articulatory, Still, counterstrain/indirect, myofascial release, facilitated positional release
4. Assume left sided thoracic paraspinal hypertonicity T1 – T4: appropriate techniques
to include: soft tissue, deep pressure, counterstrain/indirect, facilitated positional
release
5. Assume left 1st rib inhalation somatic dysfunction: appropriate techniques to include:
HVLA, ME, Still’s, articulatory






MODULE 12 – Scarlett O-Hara
1. Osteoarthritis, piriformis syndrome, spinal stenosis, lumbar radiculopathy, DVT
2. C
3. D
Osteopathic Diagnosis: assess where you would expect to find
Performed
Omitt
somatic dysfunctions
1. Examine the lumbar region (L1-L5) for somatic dysfunction
A. palpate transverse processes for rotation
1. neutral
_
2. flexion
_
3. extension
_
B. palpate soft tissue for TART (Tenderness, Asymmetry, Restrictions, Tissue texture change) findings
1. Psoas muscles
_
2. Piriformis muscles
_
3. Paraspinal muscles
_
2. Examine the sacrum for somatic dysfunction (requires at least one motion test)
A. depth at 4 corners of sacrum
_
B. ILA levelness
_
C. seated flexion test
_
D. motion at 4 corners of sacrum
_
E. motion in backward bending test
_
F. respiratory motion of sacrum assess at 4 corners
_
3. Examine the pelvis for somatic dysfunction
A. standing flexion test or AP compression test
_
B. ASIS heights
_
C. PSIS heights
_
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.
1. Assume left on right sacral torsion: appropriate techniques to include: muscle
energy, counterstrain/indirect, myofascial release, and facilitated positional release (No
HVLA)
2. Assume left innominate anterior: appropriate techniques to include: muscle energy
counterstrain/indirect, myofascial release, and facilitated positional release (No HVLA)
3. Assume spasm/tender point in the left piriformis muscle: appropriate techniques to
include: counterstrain/indirect, myofascial release
_
_
MODULE 13: Clark Kent
1. Asthma, atypical pneumonia, bronchitis, upper respiratory infection, pneumothorax
2. B
3. A
Osteopathic Diagnosis: assess where you would expect to find somatic
dysfunctions
Performed
Omitted
1. Examine the cervical region for somatic dysfunction
A. OA – left/right translation
1. neutral
2. flexion
3. extension
B. AA – rotation, must flex at least 45°
C. C2-C7 - translation
1. neutral
2. flexion
3. extension
2. Examine the thoracic spine for dysfunction (T1-T4)
A. palpate transverse processes for rotation
1. neutral
2. flexion
3. extension
B. palpate soft tissue for TART findings
1. trapezius
X
2. rhomboids
X
3. levator scapulae
X
4. T1 – T4 Paraspinal muscles
X
3. Examine the ribs for somatic dysfunction
A. Pump handle ribs (ribs 2-6) at or near sternal junction
1. static
X
2. motion
X
B. Bucket handle ribs (ribs 6-10) between anterior and posterior axillary lines
1. static
X
2. motion
X
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.
1. Assume OA NSLRR: appropriate techniques to include: HVLA, muscle energy,
articulatory, Still, counterstrain/indirect, myofascial release, facilitated positional
release
2. Assume T2-4 NSLRR: appropriate techniques to include: HVLA, muscle energy,
articulatory, Still, counterstrain/indirect, myofascial release, facilitated positional
release
3. Assume (L) ribs 2-4 exhalation pump handle: appropriate techniques to include:
HVLA, muscle energy, articulatory, Still, counterstrain/indirect, myofascial release,
facilitated positional release
4. Autonomic technique for altered vagal tone: OA decompression
5. Autonomic technique for hypersympathetic tone in T1-T5
X
paraspinal muscles: rib raising or paraspinal inhibition for > 90
seconds
MODULE 14: Bruce Wayne
1. Depression, thyroid disorder, migraine headache, tension, tension headache, migraine
2. C
3. A
Osteopathic Diagnosis: assess where you would expect to find
Performed
Omitted
somatic dysfunctions
1. Examine the cervical region for somatic dysfunction
A. OA – left/right translation
1. neutral
2. flexion
3. extension
B. AA – rotation, must flex at least 45°
C. C2-C7 - translation
1. neutral
2. flexion
3. extension
2. Examine the thoracic spine for dysfunction (T1-T4)
A. palpate transverse processes for rotation
1. neutral
X
2. flexion
X
3. extension
X
B. palpate soft tissue for TART findings
1. trapezius
X
2. T1 – T4 Paraspinal muscles
X
Osteopathic Treatment: You must treat a minimum of 2 dysfunctions you found during your
examination.
1. Assume OA NSRRL: appropriate techniques to include: HVLA, muscle energy,
articulatory, Still, counterstrain/indirect, myofascial release, facilitated positional
release
2. Assume C4 FSLRL: appropriate techniques to include: HVLA, muscle energy,
articulatory, Still, counterstrain/indirect, myofascial release, facilitated positional
release
2. Assume T2-4 NSLRR: appropriate techniques to include: HVLA,
muscle energy, articulatory, Still, counterstrain/indirect, myofascial
release, facilitated positional release
4. Autonomic technique for altered vagal tone: OA decompression