OPP 101
23 year old female presents to the office after an injury to his left ankle during a basketball game 2 hours prior. What set of characteristics would you expect of the affected ankle?
A) warm, ropy, increased tissue drag, erythematous
B) prolonged blanching, warm, erythematous, moist
C) erythematous, increased tissue drag, dry, ropy
D) increased tissue drag, erythematous, warm, moist
A 57 year old male comes into the clinic complaining of chronic back pain. His lower back is cold to the touch, ropy, and has prolonged blanching. He is diagnosed with a Type I somatic dysfunction, which could be which of the following?
A) T5-8 extended, SLRL
B) T5-8 neutral, SLRR
C) T5-8 neutral, SLRL
D) T5 extended, SLRL
These nerve roots of the brachial plexus are affected when a child's head is pulled away from the shoulder, especially during prolonged or difficult labor.
C5 & C6 (Erb's palsy)
13 year old female presents to the ER with RLQ abdominal pain, fever, +Rosving sign and +McBurney's sign. Following CT evaluation she is sent to the OR for surgery. Given the presentation, the most likely location for an anterior Chapman's point is?
Tip of the RIGHT 12th rib
During craniosacral flexion, the sacral base rotates in this direction about the superior transverse axis of the sacrum.
Posterior (also known as counternutates)
62 year old patient presents to the clinic for a post-op follow-up after a right knee replacement. She has had little to no problems with her left knee, and can flex it on her own to approximately 120 degrees. Her right knee, after a couple physical therapy sessions can be flexed to 100 degrees. The 120 degree flexion of her left knee is considered flexed to which barrier?
Physiologic barrier
While evaluating the spine of a patient, you note that your right finger goes in deeper on the right of T7 than your left finger does at the left of the same segment. The discrepancy in finger depths is worse in flexion, persists in neutral, and is least in extension. What somatic dysfunction exists?
T7ERLSL
Common peroneal nerve
An obviously nervous 43 year old female presents to your office complaining of difficulty sleeping, shakiness and an apparent thinning of her hair. Her TSH level was decreased and her T4 level was elevated. Osteopathic structural exam may reveal which of the following?
A) T9FSRRR
B) T5-7 NSRRL
C) T2ESLRL
D) L2-4 N SLRR
If L5 is FRrSr, which is false regarding sacral mechanics?
A) Sacrum will be rotated left
B) Sacrum have a right oblique axis
C) The + seated flexion test will be on the left
D) Sacral torsion will be R on R
While evaluating a 19 year old who came into the clinic with 2 day history of acute neck pain, this plane of motion was evaluated to determine somatic dysfunction:
This plane of motion occurs in a transverse plane around a vertical axis.
Rotation
You are evaluating a patient that has been complaining of some arm weakness and neck pain that she has had since an MVA 3 weeks prior. MRI shows a herniation at the C4-C5 level. Which nerve root is affected?
C5
A 32 year old factory worker is diagnosed with an O'Donahue's triad injury following a fall off of some equipment at work. Which of the following would NOT be injured in the affected knee?
A) PCL
B) ACL
C) medial meniscus
D) MCL
While working up a 42 year old male for low back pain, a hypersensitive focus is felt within a muscle that refers pain to other areas. The pain has a history of increasing for the past week, and patient reports he has had a cold during that time also. Back pain increased during coughing, and the cough and pain kept him up at night. Which of the following is likely contributory?
A) Iliopsoas contracture
B) Quadratus lumborum trigger point
C) Chapman's point of L2 transverse processes
D) Gluteus minimus trigger point
The sacrum should be assessed in postpartum females who present with low back pain due to this sacral dysfunction being extremely common in patients who recently went through vaginal delivery or trauma.
Bilateral sacral flexion
A 40 year old librarian came into the office with elbow pain that hasn't gotten any better for 3 days. She states that she was putting a stack of books away when a "rowdy bunch of kids" stacked more books on the pile she was already carrying, causing her to be unable to bear the weight, dropping them all. This type of eccentric contraction is called what?
Isolytic contraction
This developmental anomaly usually occurs in the lumbar spine and contains herniated meninges, but lacks nerve root involvement.
Spina bifida meningocele
A 40 year old in the ER being treated after an MVA reports pain and tightness in his right leg, with periods of electric shock-like pain. PE reveals a swollen, erythematous right leg. A fasciotomy is performed to release pressure. Which compartment of the leg is most likely (most commonly) affected?
Anterior compartment
A 60 year old female is seen in the family practice office with complaints of increasing numbness and tingling in her left arm and wrist. She states that she keeps dropping things and sometimes the tingling is so bad it wakes her from sleep. Thoracic outlet syndrome is suspected, and you perform this special test, which is positive when the radial pulse is markedly decreased.
Adson's test
23 year old male college student presents with low back pain. On PE you find a + standing flexion test on the left, his left ASIS is inferior, the left PSIS is superior, and his right leg is shorter. What is the most likely diagnosis based on these findings?
Left anterior innominate
A 53 year old patient is being evaluated for migraine headaches. She is currently taking 50mg sumatriptan as needed to help the pain. You measure her CRI (10) and find that she has an inferior vertical strain. This type of strain moves about what type(s) of axis (axes)?
2 transverse axes
(One through sphenoid center and one just superior to the occiput)
A 10 year old female presented to your office with back pain after being referred to you by the school nurse. The child tells you she's had this back pain for "maybe a couple months or so", and you suspect structural scoliosis after an Adam's test. You order imaging, and a stage 0 Risser scale indicates this:
A) Less than 25% apophysis ossification and the curve will likely progress
B) Skeletal immaturity and the curve will likely get better with time
C) Less than 25% apophysis ossification and the curve will likely get better with time
D) Skeletal maturity and the curve will likely not get any worse than it currently is
A 53 year old male presents with tingling over the palmar surface of his left thumb. He states that the tingling sometimes radiates to his first and middle fingers as well. NSAIDs use to alleviate the symptoms temporarily, but they have become increasingly worse over the past couple months. Tinel's test at the wrist is positive. Which nerve is most likely impacted in this patients condition?
Median nerve
A 59 year old female presents to the clinic with painful urination, fever, and urgency. She denies being sexually active for over 5 years and her annual pap smear taken 2 months ago was normal. No back pain present, and PE was negative for Lloyd's sign. Where would you most likely treat the associated Chapman's point?
A) T8-T10 transverse processes
B) Periumbilical region
C) 1" lateral and 2" superior to the umbilicus
D) L2 transverse processes
A 40 year old daycare worker presents with sacroiliac pain. She states it started during work when she was running around with the kids one day. On PE you find a + seated flexion test on the right and L5 N SLRR. The ILA on the left is shallow compared to the right, and her right superior sulcus is deeper. Based on these, what is the likely diagnosis?
Left sacral rotation on a left oblique axis (L on L)