DO Doctor of Osteopathic Medicine MCQ 5 — Questions and Answers
Question 1: An osteopathic physician evaluates a patient post-operatively and notes restricted motion of the thoracic inlet. Which of the following structures passes through the thoracic inlet and is most affected by fascial restrictions in this area?
- Brachial plexus and subclavian vessels only
- Vagus nerve, esophagus, trachea, subclavian vessels, and thoracic duct (Correct answer)
- Only the phrenic nerve and internal mammary vessels
- The azygos vein and intercostal nerves exclusively
Correct answer: Vagus nerve, esophagus, trachea, subclavian vessels, and thoracic duct
The thoracic inlet is traversed by the vagus nerve, esophagus, trachea, subclavian arteries and veins, thoracic duct, brachial plexus, and other structures — fascial restriction here can impair multiple systems simultaneously.
Question 2: In the TART mnemonic used for somatic dysfunction diagnosis, what does the 'A' represent?
- Asymmetry of bony landmarks or tissue texture (Correct answer)
- Autonomic changes including sweating and temperature
- Atrophy of paraspinal muscles
- Articular crepitus on range of motion testing
Correct answer: Asymmetry of bony landmarks or tissue texture
TART stands for Tissue texture changes, Asymmetry of position, Restriction of motion, and Tenderness — the four cardinal signs used to identify and document somatic dysfunction.
Question 3: A 25-year-old presents with recurrent headaches originating at the occiput. The physician finds restriction of the occipito-atlantal (OA) joint in extension. Using muscle energy technique, the patient should actively:
- Flex the head while the physician prevents motion, then the physician moves into extension (Correct answer)
- Extend the head against resistance, then the physician moves further into flexion toward ease
- Rotate the head while holding neutral position to engage the rotational barrier
- Perform deep breathing to use respiratory assist with extension
Correct answer: Flex the head while the physician prevents motion, then the physician moves into extension
For an OA restriction in extension, muscle energy positions the joint in flexion (toward the barrier), has the patient resist into extension (isometric contraction), then after relaxation, the physician moves further into flexion to gain range.
Question 4: Which of the following best describes the role of the dura mater in the primary respiratory mechanism (PRM) according to osteopathic cranial concept?
- The dura is rigid and limits all cranial motion
- The reciprocal tension membrane (dura) transmits and balances fluctuations in CSF motion between cranium and sacrum (Correct answer)
- The dura generates the cranial rhythmic impulse independently of the CNS
- The dura connects only adjacent vertebrae and does not transmit force to the sacrum
Correct answer: The reciprocal tension membrane (dura) transmits and balances fluctuations in CSF motion between cranium and sacrum
In cranial osteopathy, the dural membrane system — including the falx cerebri, tentorium cerebelli, and spinal dura — acts as a reciprocal tension membrane that transmits motion of the primary respiratory mechanism from the cranium to the sacrum.
Question 5: A physician diagnoses a patient with a 'sprung rib' (rib 6 on the left). Inhalation is restricted. The rib is held in exhalation position. Correct muscle energy treatment involves:
- Patient inhales against physician resistance; physician repositions rib superiorly after each breath (Correct answer)
- Patient exhales against physician resistance; physician moves rib inferiorly after relaxation
- Physician applies HVLA thrust posteriorly during peak inhalation
- Patient rotates torso while physician holds the rib in neutral
Correct answer: Patient inhales against physician resistance; physician repositions rib superiorly after each breath
For an inhalation-restricted rib (held in exhalation), muscle energy has the patient inhale (engaging inhalation musculature) against the physician's resistance, and after relaxation the physician repositions the rib upward toward inhalation.
Question 6: A 40-year-old woman with irritable bowel syndrome (IBS) is treated with osteopathic techniques focused on the mesenteric plexus. The primary spinal levels targeted to modulate sympathetic tone to the large intestine are:
- T1-T4
- T5-T9
- T10-L2 (Correct answer)
- L3-S4
Correct answer: T10-L2
Sympathetic innervation to the large intestine (distal half of transverse colon through rectum) arises from T10-L2 spinal cord levels; normalizing somatic dysfunction at these levels can reduce viscerosomatic reflex activity contributing to IBS symptoms.
Question 7: A DO student is asked to explain 'balanced ligamentous tension' (BLT). Which statement best captures this osteopathic indirect technique?
- The physician applies a direct thrust to rupture adhesions within joint ligaments
- The physician guides the joint to a position of equal tension in all supporting ligaments, allowing inherent forces to restore normal motion (Correct answer)
- The patient contracts specific ligament-attached muscles while the physician holds the joint in extension
- The physician stretches shortened ligaments by moving the joint repeatedly through its full range
Correct answer: The physician guides the joint to a position of equal tension in all supporting ligaments, allowing inherent forces to restore normal motion
BLT is an indirect technique in which the physician positions the joint at the point of balanced tension in all ligaments — the 'still point' — allowing the body's inherent forces to resolve the somatic dysfunction.
DO Doctor of Osteopathic Medicine MCQ 5
An osteopathic physician evaluates a patient post-operatively and notes restricted motion of the thoracic inlet.
Which of the following structures passes through the thoracic inlet and is most affected by fascial restrictions in this area?