DO Doctor of Osteopathic Medicine MCQ 3 — Questions and Answers
Question 1: A 55-year-old presents with right-sided neck pain and restricted rotation. Palpation reveals C5 ERSR. Which OMT technique uses a high-velocity, low-amplitude thrust directed to engage the motion barrier?
- Counterstrain
- Myofascial release
- High-velocity low-amplitude (HVLA) (Correct answer)
- Facilitated positional release
Correct answer: High-velocity low-amplitude (HVLA)
HVLA (high-velocity low-amplitude) technique directly engages and rapidly overcomes a restrictive barrier using a short, quick thrust to restore normal joint motion.
Question 2: Which of the following is an absolute contraindication to HVLA manipulation of the cervical spine?
- Acute muscle spasm with limited ROM
- Moderate osteoarthritis of C4-C5
- Down syndrome with atlanto-axial instability (Correct answer)
- Chronic cervicogenic headache
Correct answer: Down syndrome with atlanto-axial instability
Down syndrome is associated with atlanto-axial instability due to ligamentous laxity; HVLA at the cervical spine in this setting carries high risk of spinal cord injury and is absolutely contraindicated.
Question 3: A patient has a Chapman's reflex point palpated at the intercostal space between ribs 5 and 6 anteriorly on the right. This finding is most associated with pathology of which organ?
- Gallbladder (Correct answer)
- Liver
- Right kidney
- Small intestine
Correct answer: Gallbladder
The Chapman's reflex point for the gallbladder is located in the right intercostal space between ribs 5 and 6 anteriorly; these fascial ganglia reflect viscerosomatic reflexes from the associated organ.
Question 4: Fryette's Law I states that in a neutral lumbar spine, when a group of vertebrae sidebend, rotation occurs:
- To the same side as sidebending
- To the opposite side of sidebending (Correct answer)
- Only in the presence of flexion
- Independently of sidebending direction
Correct answer: To the opposite side of sidebending
Fryette's First Law: in the neutral (non-flexed, non-extended) position, sidebending and rotation of a vertebral group occur to opposite sides (coupled motion).
Question 5: During a lymphatic pump technique, the physician places their hands on the patient's chest and applies rhythmic compressions timed with respiration. The primary goal is to:
- Stimulate the autonomic nervous system via the anterior chest wall
- Increase intrathoracic pressure oscillations to enhance lymphatic flow (Correct answer)
- Stretch intercostal muscles to improve respiratory excursion
- Reduce sympathetic tone to the heart and lungs
Correct answer: Increase intrathoracic pressure oscillations to enhance lymphatic flow
The thoracic lymphatic pump creates alternating pressure gradients that propel lymph through the thoracic duct and right lymphatic duct into the subclavian veins, enhancing immune function and lymphatic drainage.
Question 6: A medical student on rotation notes that a patient's right shoulder is higher than the left when standing. Further exam reveals the right iliac crest is also higher. What is the most likely underlying cause?
- Left sacral shear dysfunction
- Functional leg length discrepancy from right iliac crest elevation
- True anatomic short left leg causing left pelvic drop (Correct answer)
- Right thoracic scoliosis with compensatory pelvic shift
Correct answer: True anatomic short left leg causing left pelvic drop
A true short left leg causes the left side of the pelvis to drop (left iliac crest lower), making the right iliac crest appear higher, with compensatory spinal curves including right shoulder elevation.
Question 7: Which of the following best describes the Still technique in osteopathic manipulative medicine?
- A direct inhibitory pressure applied to hypertonic muscles for 90 seconds
- An indirect technique using the patient's breathing to disengage fascial restrictions
- A combination of direct and indirect positioning followed by an activating force through the barrier (Correct answer)
- A passive positioning technique relying solely on inherent tissue forces
Correct answer: A combination of direct and indirect positioning followed by an activating force through the barrier
The Still technique is an indirect-then-direct method: the physician first unloads the joint indirectly, adds compression or traction, then applies a direct activating arc of motion through the restrictive barrier.
DO Doctor of Osteopathic Medicine MCQ 3
A 55-year-old presents with right-sided neck pain and restricted rotation.
Palpation reveals C5 ERSR.
Which OMT technique uses a high-velocity, low-amplitude thrust directed to engage the motion barrier?