DO Doctor of Osteopathic Medicine MCQ 4 — Questions and Answers
Question 1: A 68-year-old with congestive heart failure receives osteopathic treatment. Which technique would be MOST appropriate to avoid in this patient due to risk of fluid overload?
- Counterstrain to paraspinal muscles
- Myofascial release of the thoracic inlet
- Thoracic lymphatic pump (Correct answer)
- Soft tissue technique to the lumbar region
Correct answer: Thoracic lymphatic pump
The thoracic lymphatic pump mobilizes large volumes of lymph into venous circulation rapidly, which in CHF patients can precipitate acute decompensation and pulmonary edema.
Question 2: What is the primary structural finding that distinguishes a Type II (Fryette's Law II) vertebral dysfunction from a Type I?
- Type II involves a group of vertebrae rather than a single vertebra
- Type II occurs in flexion or extension with sidebending and rotation to the same side (Correct answer)
- Type II always involves the lumbar spine only
- Type II dysfunction does not involve coupled motion
Correct answer: Type II occurs in flexion or extension with sidebending and rotation to the same side
Fryette's Second Law applies to a single vertebral segment in flexion or extension, where sidebending and rotation couple to the SAME side — the opposite of the neutral (Type I) mechanics.
Question 3: A physician performing craniosacral therapy notes the cranial rhythmic impulse (CRI) has a rate of approximately 6 cycles per minute. This rate is considered:
- Markedly elevated and indicates intracranial pathology
- Within the normal range of 6-12 cycles per minute (Correct answer)
- Below normal and suggests CNS depression
- Unrelated to osteopathic cranial treatment
Correct answer: Within the normal range of 6-12 cycles per minute
The cranial rhythmic impulse (CRI) normally cycles at 6-12 times per minute; rates outside this range may reflect autonomic or CNS dysfunction and guide craniosacral treatment.
Question 4: The 'four tenets of osteopathic medicine' include which of the following?
- The body is a unit; structure and function are interrelated; the body has self-healing mechanisms; rational treatment is based on these principles (Correct answer)
- Disease is purely somatic; the mind has no effect on the body; manipulation cures all disease; osteopathic and allopathic medicine are incompatible
- All disease originates in the spine; the cranium is immobile; nutrition is the basis of health; surgery is never necessary
- The nervous system controls all healing; lymphatics are unimportant; fascia is the primary somatic structure; drugs should be avoided
Correct answer: The body is a unit; structure and function are interrelated; the body has self-healing mechanisms; rational treatment is based on these principles
A.T. Still's four tenets are: (1) the body is a unit of body, mind, and spirit; (2) structure and function are reciprocally interrelated; (3) the body is capable of self-regulation, self-healing, and health maintenance; (4) rational treatment is based on these principles.
Question 5: A patient presents with an acutely herniated L4-L5 disc causing right leg radiculopathy. Which osteopathic technique would be MOST appropriate as a conservative first-line approach?
- HVLA thrust at L4-L5
- Counterstrain or indirect myofascial release (Correct answer)
- Cervical muscle energy to reduce sympathetic tone
- Sacral inhibition with heavy axial traction
Correct answer: Counterstrain or indirect myofascial release
Gentle indirect techniques such as counterstrain or indirect myofascial release reduce muscle spasm and neural irritation without direct loading of the disc, making them the safest initial OMT approach for acute disc herniation.
Question 6: During the respiratory cycle, the sacrum moves in what direction during inhalation according to osteopathic craniosacral theory?
- The sacral base moves anteriorly (counternutation) (Correct answer)
- The sacral base moves posteriorly (nutation)
- The sacral base moves superiorly with no rotation
- The sacrum is fixed and does not move with respiration
Correct answer: The sacral base moves anteriorly (counternutation)
In craniosacral theory, during inhalation (flexion phase) the sacral base moves anteriorly (counternutation), synchronized with cranial flexion; during exhalation (extension phase) the base moves posteriorly (nutation).
Question 7: A physician suspects a facilitated segment at T5-T6 in a patient with recurrent gastric ulcers. Which finding on palpation would support this diagnosis?
- Decreased skin drag, cool skin temperature, and flaccid paraspinal muscles at T5-T6
- Increased skin drag, warm skin temperature, and hypertonic paraspinal muscles at T5-T6 (Correct answer)
- Bilateral paraspinal tenderness from T1 to T12 with no focal changes
- Posterior rib angles more prominent on the right at T3-T4
Correct answer: Increased skin drag, warm skin temperature, and hypertonic paraspinal muscles at T5-T6
A facilitated segment shows signs of increased sympathetic activity: increased skin drag (altered sweating), warmth (vasodilation/hyperemia), and paraspinal muscle hypertonicity due to lowered neural thresholds at that spinal level.
DO Doctor of Osteopathic Medicine MCQ 4
A 68-year-old with congestive heart failure receives osteopathic treatment.
Which technique would be MOST appropriate to avoid in this patient due to risk of fluid overload?