Osteopathic Principles & Practice
(OPP)Practice Examination — 2026
Edition Advanced Clinical Reasoning
Manipulative Medicine
1. A 32-year-old patient presents with acute right-
sided neck pain after sleeping in an awkward position.
Examination reveals restricted cervical rotation to the
right, with the cervical segments preferring flexion,
rotation left, and sidebending left. Which diagnosis
best describes this somatic dysfunction?
A. C3 FRSr
B. C3 ERSr
C. C3 FRSr
D. C3 ERSl
Answer: B. C3 ERSr
The diagnosis of a cervical segment that prefers
extension, rotation right, and sidebending right is an
ERSr dysfunction. In the lower cervical spine, type II
mechanics apply, meaning rotation and sidebending
occur to the same side.
,2. A patient has a thoracic somatic dysfunction in
which T6 prefers flexion, rotation right, and
sidebending right. Which diagnosis is most
appropriate?
A. T6 ERSr
B. T6 FRSr
C. T6 FRSl
D. T6 NRSr
Answer: B. T6 FRSr
Thoracic vertebrae from T1–T12 demonstrate type II
mechanics when a single segment is dysfunctional. A
segment that prefers flexion, rotation right, and
sidebending right is diagnosed as FRSr.
3. Which osteopathic principle states that the body
possesses mechanisms capable of regulating,
defending, and repairing itself?
A. Structure governs function
B. The rule of the artery is supreme
C. The body is a unit
D. The body possesses self-regulatory and self-healing
mechanisms
,Answer: D. The body possesses self-regulatory and
self-healing mechanisms
One of the four major osteopathic principles is that the
body possesses self-regulatory mechanisms and has
the inherent capacity for healing and maintenance of
health.
4. A patient with chronic low-back pain is found to
have restricted motion of the lumbar spine, altered
pelvic mechanics, and abnormal gait. Which
osteopathic principle best explains why these findings
should be considered together rather than
independently?
A. Structure governs function
B. The body is a unit
C. The rule of the artery
D. Primary respiratory mechanism
Answer: B. The body is a unit
Osteopathic medicine views the body as an integrated
functional unit. Dysfunction in one region can
influence distant structures through biomechanical,
neurologic, circulatory, and fascial connections.
, 5. A patient presents with acute lumbar muscle spasm.
During counterstrain treatment, the physician places
the patient into a position that maximally shortens the
dysfunctional muscle and holds the position for
approximately 90 seconds. Which technique is being
used?
A. Muscle energy
B. HVLA
C. Counterstrain
D. Myofascial release
Answer: C. Counterstrain
Counterstrain is an indirect technique that places the
dysfunctional tissue in a position of maximal comfort,
usually by shortening the affected muscle and reducing
abnormal proprioceptive activity.
6. A patient has a posteriorly rotated right innominate.
Which finding would most likely be present?
A. Short right leg
B. Anterior right ASIS
C. Inferior right PSIS
D. Superior right ASIS
Answer: D. Superior right ASIS
(OPP)Practice Examination — 2026
Edition Advanced Clinical Reasoning
Manipulative Medicine
1. A 32-year-old patient presents with acute right-
sided neck pain after sleeping in an awkward position.
Examination reveals restricted cervical rotation to the
right, with the cervical segments preferring flexion,
rotation left, and sidebending left. Which diagnosis
best describes this somatic dysfunction?
A. C3 FRSr
B. C3 ERSr
C. C3 FRSr
D. C3 ERSl
Answer: B. C3 ERSr
The diagnosis of a cervical segment that prefers
extension, rotation right, and sidebending right is an
ERSr dysfunction. In the lower cervical spine, type II
mechanics apply, meaning rotation and sidebending
occur to the same side.
,2. A patient has a thoracic somatic dysfunction in
which T6 prefers flexion, rotation right, and
sidebending right. Which diagnosis is most
appropriate?
A. T6 ERSr
B. T6 FRSr
C. T6 FRSl
D. T6 NRSr
Answer: B. T6 FRSr
Thoracic vertebrae from T1–T12 demonstrate type II
mechanics when a single segment is dysfunctional. A
segment that prefers flexion, rotation right, and
sidebending right is diagnosed as FRSr.
3. Which osteopathic principle states that the body
possesses mechanisms capable of regulating,
defending, and repairing itself?
A. Structure governs function
B. The rule of the artery is supreme
C. The body is a unit
D. The body possesses self-regulatory and self-healing
mechanisms
,Answer: D. The body possesses self-regulatory and
self-healing mechanisms
One of the four major osteopathic principles is that the
body possesses self-regulatory mechanisms and has
the inherent capacity for healing and maintenance of
health.
4. A patient with chronic low-back pain is found to
have restricted motion of the lumbar spine, altered
pelvic mechanics, and abnormal gait. Which
osteopathic principle best explains why these findings
should be considered together rather than
independently?
A. Structure governs function
B. The body is a unit
C. The rule of the artery
D. Primary respiratory mechanism
Answer: B. The body is a unit
Osteopathic medicine views the body as an integrated
functional unit. Dysfunction in one region can
influence distant structures through biomechanical,
neurologic, circulatory, and fascial connections.
, 5. A patient presents with acute lumbar muscle spasm.
During counterstrain treatment, the physician places
the patient into a position that maximally shortens the
dysfunctional muscle and holds the position for
approximately 90 seconds. Which technique is being
used?
A. Muscle energy
B. HVLA
C. Counterstrain
D. Myofascial release
Answer: C. Counterstrain
Counterstrain is an indirect technique that places the
dysfunctional tissue in a position of maximal comfort,
usually by shortening the affected muscle and reducing
abnormal proprioceptive activity.
6. A patient has a posteriorly rotated right innominate.
Which finding would most likely be present?
A. Short right leg
B. Anterior right ASIS
C. Inferior right PSIS
D. Superior right ASIS
Answer: D. Superior right ASIS
