BLOCK 5 - OMM| TOP SCORES MADE SIMPLE | TRUSTED
TEST SOLUTIONS!
A 36-year-old female presents to the outpatient clinic with acute pharyngitis. Which of
the following best explains the existence of the concurrent finding of T2 F RLSL?
A. Mechanical effects of laryngeal muscles
B. Reduced respiratory motion
C. Shared innervation of the vagus nerve
D. The effect of lymphatic congestion
E. Viscerosomatic reflex Answer: B. Reduced respiratory motion
Viscerosomatic reflex spinal levels Answer: T1-T4
A 57-year-old male presents with symptoms consistent with an acute myocardial
infarction. T3 demonstrates a diagnosis of F RRSR. Which of the following statements
best describes a characteristic of the neurologic milieu affecting this somatic
dysfunction?
A.The afferent sympathetic neurons at this segment are maintained at an
electrophysiological state above the normal firing threshold.
B. The electrophysiological state of the neuron can be sustained by normal central
nervous system activity.
C.The afferent parasympathetic neurons at this segment are maintained at an
electrophysiological state above the normal firing threshold.
D.The electrophysiological state of the neuron is sustained by diminished central
nervous system activity.
E.The somatic dysfunction is likely related to neuro-lymphatic tissue texture changes
related to increased parasympathetic activity. Answer: B. The electrophysiological state
of the neuron can be sustained by normal central nervous system activity.
- Spinal facilitation
Spinal facilitation Answer: Maintenance of a pool of neurons in a state of partial or
subthreshold excitation
- The electrophysiological state of the neuron can be sustained by normal central
nervous system activity
1
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,A 69-year-old male presents to the ED with substernal chest pain which radiates into his
left jaw and arm, shortness of breath, and anxiety. The symptoms awoke him from sleep
about 30 min ago. After medical stabilization, treatment of an OA dysfunction would
most likely improve survival rates through which of the following mechanisms?
A.Increasing hyaluronic acid deposition into the affected tissues
B.Increasing the tissue levels of tyrosine hydroxylase
C.Decreasing the tissue levels of growth associated protein-43
D.Increasing the subthreshold stimulation of the stellate ganglia
E.Reducing the dephosphorylation of connexin 43 Answer: E. Reducing the
dephosphorylation of connexin 43
- Release of the suboccipital region will allow the body to autoregulate vagal tone more
efficiently. Increase in vagal tone lead to reduction in the dephosphorylation of connexin
43 which may have a stabilizing effect on the electrical connections in cardiac myocytes
by helping to maintain tight electrical gap junctions.
Connexin 43 Answer: Protein that forms gap junctions, which are tiny channels that
directly connect neighboring cells. These channels let small molecules and electrical
signals pass between cells, helping them communicate and coordinate activities
- Increasing vagal tone (OA treatment) will decrease the dephosphorylation of connexin
43 and help maintain tight electrical gap junctions
Increased vagal tone effect on Connexin 43 Answer: Dephosphorylation of Connexin
43 is decreased -> Tight gap junctions are formed
Mechanism of Cardio-Protection from Enhanced Vagal Tone (Vagal Stimulation)
Answer: Dephosphorylation of Connexin 43 is decreased -> maintains tight gap
junction electrical coupling in cardiac myocytes
Treatment of which of the following somatic dysfunctions is most likely to influence
parasympathetic tone in a patient with a chief complaint of pneumonia?
A. OA E SRRL
B. Right rib 1 inhaled
C. T3 F SLRL
D. Right hemidiaphragm myofascial tension
E. Right on right sacral torsion Answer: A. OA E SRRL
2
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,- Somatic dysfunction in the OA-C2 region can have a direct biomechanical influence on
vagus nerve function
Which of the following somatic dysfunctions would be treated first to optimize lymphatic
flow in a patient with a history of chronic CHF?
A. Inhaled left rib 1
B. Exhaled right rib 6
C. Right hemidiaphragm myofascial tension
D. Inguinal myofascial tension
E. Pedal pump Answer: A. Inhaled left rib 1
- Principles of lymphatic treatment typically start with removing impediments to
lymphatic flow, starting centrally and moving peripherally, followed by maximizing
normal diaphragmatic and respiratory motions, and ending with providing external force
to induce flow to mobilize targeted tissue fluids into the lymphatic and venous systems
(pump or effleurage). Thus treatment of the a dysfunctional first rib (inhaled left rib 1)
would be the first somatic dysfunction to address given its biomechanical influence on
the thoracic duct and Sibson's fascia.
Lymphatic treatment order Answer: 1. Start centrally (thoracic duct and sibson's fascia)
and move peripherally
2. Maximise normal diaphragmatic and respiratory motions
3. Providing external force to induce flow to mobilize targeted tissue fluids into the
lymphatic and venous systems (pump or effleurage
Increasing vagal tone may provide cardioprotective effects by:
A. Increasing heart rate
B. Decreasing conduction time between the atrium and the ventricle
C. Increasing the concentration of phosphorylated Connexin-43
D. Increasing oxygen demand of the myocardium Answer: C. Increasing the
concentration of phosphorylated Connexin-43
- Increasing concentration of phosphorylated Connexin-43 -> maintains tight gap
junction electrical coupling in cardiac myocytes
Increasing lymphatic return in a patient with a medically stabilized acute myocardial
infarction may be beneficial by which of the following mechanisms?
3
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, A. Increasing the dephosphorylation of Connexin-43
B. Increasing the space between myocytes allowing for better contraction
C. Decreasing the vasodilatory hyperemic responses in the coronary arteries
D. Improving microcirculation in the region of the infarction Answer: D. Improving
microcirculation in the region of the infarction
A patient is admitted to the hospital with a diagnosis of congestive heart failure. Which
of the following diagnoses would the physician treat to address autonomic tone for this
condition?
A. C5 F RLSL
B. T7 F RLSL
C. OA N SLRR
D. Left on left sacral torsion Answer: C. OA N SLRR
The patient has a diagnosis of T5 FRLSL. Using BLT for treatment, which of the
following would be used to help localize this segment to the point of balanced ease?
A.Pulling the spinous process inferiorly
B.Pulling the spinous process leftward
C.pushing the right transverse process anteriorly
D.pushing the left transverse process anteriorly Answer: C. Pushing the right
transverse process anteriorly
- Pushing right transverse process anteriorly -> RL
When doing BLT (Balanced Ligamentous Tension), you want to move the segment
toward [ease/resistance] Answer: Ease
- Ex: If patient is T3 FRRSR: Sit on the left side of the patient and position in flexion,
sidebending right, and rotation right (by pulling spinous process towards left)
Which of the following are possible/typical cervical somatic dysfunctions? (Select all that
apply)
A.OA E SRRL
B.OA F SLRL
C.C1 RL
D.C1 E RRSR
4
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TEST SOLUTIONS!
A 36-year-old female presents to the outpatient clinic with acute pharyngitis. Which of
the following best explains the existence of the concurrent finding of T2 F RLSL?
A. Mechanical effects of laryngeal muscles
B. Reduced respiratory motion
C. Shared innervation of the vagus nerve
D. The effect of lymphatic congestion
E. Viscerosomatic reflex Answer: B. Reduced respiratory motion
Viscerosomatic reflex spinal levels Answer: T1-T4
A 57-year-old male presents with symptoms consistent with an acute myocardial
infarction. T3 demonstrates a diagnosis of F RRSR. Which of the following statements
best describes a characteristic of the neurologic milieu affecting this somatic
dysfunction?
A.The afferent sympathetic neurons at this segment are maintained at an
electrophysiological state above the normal firing threshold.
B. The electrophysiological state of the neuron can be sustained by normal central
nervous system activity.
C.The afferent parasympathetic neurons at this segment are maintained at an
electrophysiological state above the normal firing threshold.
D.The electrophysiological state of the neuron is sustained by diminished central
nervous system activity.
E.The somatic dysfunction is likely related to neuro-lymphatic tissue texture changes
related to increased parasympathetic activity. Answer: B. The electrophysiological state
of the neuron can be sustained by normal central nervous system activity.
- Spinal facilitation
Spinal facilitation Answer: Maintenance of a pool of neurons in a state of partial or
subthreshold excitation
- The electrophysiological state of the neuron can be sustained by normal central
nervous system activity
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
,A 69-year-old male presents to the ED with substernal chest pain which radiates into his
left jaw and arm, shortness of breath, and anxiety. The symptoms awoke him from sleep
about 30 min ago. After medical stabilization, treatment of an OA dysfunction would
most likely improve survival rates through which of the following mechanisms?
A.Increasing hyaluronic acid deposition into the affected tissues
B.Increasing the tissue levels of tyrosine hydroxylase
C.Decreasing the tissue levels of growth associated protein-43
D.Increasing the subthreshold stimulation of the stellate ganglia
E.Reducing the dephosphorylation of connexin 43 Answer: E. Reducing the
dephosphorylation of connexin 43
- Release of the suboccipital region will allow the body to autoregulate vagal tone more
efficiently. Increase in vagal tone lead to reduction in the dephosphorylation of connexin
43 which may have a stabilizing effect on the electrical connections in cardiac myocytes
by helping to maintain tight electrical gap junctions.
Connexin 43 Answer: Protein that forms gap junctions, which are tiny channels that
directly connect neighboring cells. These channels let small molecules and electrical
signals pass between cells, helping them communicate and coordinate activities
- Increasing vagal tone (OA treatment) will decrease the dephosphorylation of connexin
43 and help maintain tight electrical gap junctions
Increased vagal tone effect on Connexin 43 Answer: Dephosphorylation of Connexin
43 is decreased -> Tight gap junctions are formed
Mechanism of Cardio-Protection from Enhanced Vagal Tone (Vagal Stimulation)
Answer: Dephosphorylation of Connexin 43 is decreased -> maintains tight gap
junction electrical coupling in cardiac myocytes
Treatment of which of the following somatic dysfunctions is most likely to influence
parasympathetic tone in a patient with a chief complaint of pneumonia?
A. OA E SRRL
B. Right rib 1 inhaled
C. T3 F SLRL
D. Right hemidiaphragm myofascial tension
E. Right on right sacral torsion Answer: A. OA E SRRL
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
,- Somatic dysfunction in the OA-C2 region can have a direct biomechanical influence on
vagus nerve function
Which of the following somatic dysfunctions would be treated first to optimize lymphatic
flow in a patient with a history of chronic CHF?
A. Inhaled left rib 1
B. Exhaled right rib 6
C. Right hemidiaphragm myofascial tension
D. Inguinal myofascial tension
E. Pedal pump Answer: A. Inhaled left rib 1
- Principles of lymphatic treatment typically start with removing impediments to
lymphatic flow, starting centrally and moving peripherally, followed by maximizing
normal diaphragmatic and respiratory motions, and ending with providing external force
to induce flow to mobilize targeted tissue fluids into the lymphatic and venous systems
(pump or effleurage). Thus treatment of the a dysfunctional first rib (inhaled left rib 1)
would be the first somatic dysfunction to address given its biomechanical influence on
the thoracic duct and Sibson's fascia.
Lymphatic treatment order Answer: 1. Start centrally (thoracic duct and sibson's fascia)
and move peripherally
2. Maximise normal diaphragmatic and respiratory motions
3. Providing external force to induce flow to mobilize targeted tissue fluids into the
lymphatic and venous systems (pump or effleurage
Increasing vagal tone may provide cardioprotective effects by:
A. Increasing heart rate
B. Decreasing conduction time between the atrium and the ventricle
C. Increasing the concentration of phosphorylated Connexin-43
D. Increasing oxygen demand of the myocardium Answer: C. Increasing the
concentration of phosphorylated Connexin-43
- Increasing concentration of phosphorylated Connexin-43 -> maintains tight gap
junction electrical coupling in cardiac myocytes
Increasing lymphatic return in a patient with a medically stabilized acute myocardial
infarction may be beneficial by which of the following mechanisms?
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, A. Increasing the dephosphorylation of Connexin-43
B. Increasing the space between myocytes allowing for better contraction
C. Decreasing the vasodilatory hyperemic responses in the coronary arteries
D. Improving microcirculation in the region of the infarction Answer: D. Improving
microcirculation in the region of the infarction
A patient is admitted to the hospital with a diagnosis of congestive heart failure. Which
of the following diagnoses would the physician treat to address autonomic tone for this
condition?
A. C5 F RLSL
B. T7 F RLSL
C. OA N SLRR
D. Left on left sacral torsion Answer: C. OA N SLRR
The patient has a diagnosis of T5 FRLSL. Using BLT for treatment, which of the
following would be used to help localize this segment to the point of balanced ease?
A.Pulling the spinous process inferiorly
B.Pulling the spinous process leftward
C.pushing the right transverse process anteriorly
D.pushing the left transverse process anteriorly Answer: C. Pushing the right
transverse process anteriorly
- Pushing right transverse process anteriorly -> RL
When doing BLT (Balanced Ligamentous Tension), you want to move the segment
toward [ease/resistance] Answer: Ease
- Ex: If patient is T3 FRRSR: Sit on the left side of the patient and position in flexion,
sidebending right, and rotation right (by pulling spinous process towards left)
Which of the following are possible/typical cervical somatic dysfunctions? (Select all that
apply)
A.OA E SRRL
B.OA F SLRL
C.C1 RL
D.C1 E RRSR
4
APPHIA - Crafted with Care and Precision for Academic Excellence.
