Section 1: Osteopathic Principles & Practice
(Questions 1-40)
**1. A patient has a right L4 transverse process that is more posterior than the left. The asymmetry
worsens with lumbar flexion and normalizes with extension. What is the correct somatic
dysfunction?**
A) L4 Neutral, Rotated Right, Sidebent Left
B) L4 Flexed, Rotated Left, Sidebent Left
C) L4 Extended, Rotated Right, Sidebent Right
D) L4 Extended, Rotated Left, Sidebent Left
**Answer: C**
*Rationale:* The asymmetry normalizes in extension, indicating an **extension somatic dysfunction
(Type II mechanics)**. Type II mechanics dictate that rotation and sidebending occur to the **same
side**.
**2. In a Type I somatic dysfunction of the thoracic spine, what is the relationship between
sidebending and rotation?**
A) They occur to the same side
B) They occur to opposite sides
C) Rotation occurs without sidebending
D) Sidebending occurs without rotation
**Answer: B**
*Rationale:* Type I mechanics describe a group of vertebrae in a neutral position, with rotation and
sidebending occurring in **opposite directions**.
**3. A patient has a positive left seated flexion test and a positive right standing flexion test. Which
sacral dysfunction is most likely?**
A) Left-on-left torsion
B) Right-on-left torsion
C) Bilateral sacral flexion
D) Unilateral sacral extension
**Answer: A**
*Rationale:* In a **left-on-left sacral torsion**, the standing flexion test is positive on the opposite
side (right), while the seated flexion test is positive on the same side as the axis (left). This
distinguishes sacral from iliac dysfunction.
,**4. What is a contraindication to the use of HVLA (High-Velocity Low-Amplitude) technique?**
A) Acute low back pain
B) Muscle spasm
C) Sacroiliac dysfunction
D) Osteoporosis
**Answer: D**
*Rationale:* **Osteoporosis** is a contraindication to HVLA due to the risk of vertebral fracture.
Other contraindications include fractures, malignancies, and infections.
**5. For a tender point at the insertion of the pes anserinus (medial knee), which counterstrain
position is used?**
A) Flexion, Abduction, External Rotation
B) Flexion, Adduction, Internal Rotation
C) Extension, Abduction, External Rotation
D) Extension, Adduction, Internal Rotation
**Answer: B**
*Rationale:* The medial knee tender point is treated with hip/knee **flexion, adduction, and internal
rotation** of the tibia to shorten the involved tissue.
**6. Which osteopathic principle states that the body possesses self-healing and self-regulatory
mechanisms?**
A) The body is a unit
B) Structure and function are reciprocally interrelated
C) The body possesses self-healing mechanisms
D) Rational treatment is based on these principles
**Answer: C**
*Rationale:* The principle that "the body possesses **self-healing and self-regulatory mechanisms**"
recognizes the body's inherent ability to heal itself. The physician's role is to facilitate this process.
**7. A patient with an occipitoatlantal (OA) joint restriction and headaches. What is the correct
treatment approach?**
A) Direct, high-velocity thrust
B) Indirect, myofascial release
C) Balancing the membranes
D) Stabilizing the cervical spine
**Answer: C**
*Rationale:* OA joint restrictions are closely associated with the cranial base and dura mater. They
are often treated with cranial techniques, particularly **balanced membranous tension (BMT)**.
,**8. A patient has an elevated right rib 3. What is the correct treatment?**
A) Apply a direct force to depress the rib
B) Apply an indirect force to elevate the rib further
C) Apply a counterstrain technique
D) Apply a balanced membranous tension release
**Answer: A**
*Rationale:* An elevated rib is stuck in inhalation. Treatment involves applying a **direct force to
depress the rib** (exhalation) to restore normal motion.
**9. Which treatment would help reduce sympathetic tone to the lungs in a patient with asthma?**
A) Rib raising to ribs 1-5
B) Inhibitory pressure to the T2-T7 paravertebral sympathetic ganglia
C) Thoracic pump lymphatic drainage
D) Suboccipital release
**Answer: B**
*Rationale:* Inhibitory pressure or rib raising applied to the **T2-T7 thoracic paraspinal regions**
targets the sympathetic chain ganglia to reduce hypersympathetic outflow to the pulmonary tree.
**10. In a Type II cervical dysfunction with restriction in right rotation, how is the direct HVLA
technique applied?**
A) Position away from the restrictive barrier
B) Engage the barrier in right rotation
C) Apply counterstrain
D) Use balanced membranous tension
**Answer: B**
*Rationale:* In direct techniques, the barrier is engaged. The patient is positioned in flexion or
extension (depending on the specific diagnosis) and then rotated to the right, followed by the thrust.
**11. The craniosacral technique to release the sphenobasilar symphysis (SBS) involves hand
placement on which structures?**
A) Occiput and sacrum
B) Temporal bones
C) Frontal and occipital bones
D) Parietal bones
**Answer: A**
*Rationale:* The SBS release technique involves placing one hand on the patient's **occiput** and
the other hand on the **sacrum**.
, **12. A patient has a sacral base that is shallow and anterior on the left. What is the most likely
diagnosis?**
A) Left sacral torsion
B) Right sacral torsion
C) Bilateral sacral flexion
D) Unilateral sacral extension
**Answer: A**
*Rationale:* A sacral base that is **shallow and anterior on the left** indicates a **left sacral
torsion**.
**13. Which Chapman's point is associated with the kidney?**
A) Right 10th intercostal space, near the sternum
B) Left 10th intercostal space, near the sternum
C) Right 12th intercostal space, near the sternum
D) Left 12th intercostal space, near the sternum
**Answer: B**
*Rationale:* The Chapman's point for the **kidney** is located in the **left 10th intercostal space**,
near the sternum.
**14. What is the most appropriate treatment for a sacral torsion?**
A) Direct HVLA
B) Muscle energy
C) Counterstrain
D) Cranial osteopathy
**Answer: B**
*Rationale:* **Muscle energy** is commonly used to treat sacral torsions by using the patient's own
muscle contractions to correct the dysfunction.
**15. A patient has a positive standing flexion test on the right. What is the most likely somatic
dysfunction?**
A) Right anterior innominate
B) Left anterior innominate
C) Right posterior innominate
D) Left posterior innominate
**Answer: A**
*Rationale:* A positive standing flexion test indicates iliosacral dysfunction on that side. An
**anterior innominate** is a common dysfunction presenting with a positive standing flexion test.
(Questions 1-40)
**1. A patient has a right L4 transverse process that is more posterior than the left. The asymmetry
worsens with lumbar flexion and normalizes with extension. What is the correct somatic
dysfunction?**
A) L4 Neutral, Rotated Right, Sidebent Left
B) L4 Flexed, Rotated Left, Sidebent Left
C) L4 Extended, Rotated Right, Sidebent Right
D) L4 Extended, Rotated Left, Sidebent Left
**Answer: C**
*Rationale:* The asymmetry normalizes in extension, indicating an **extension somatic dysfunction
(Type II mechanics)**. Type II mechanics dictate that rotation and sidebending occur to the **same
side**.
**2. In a Type I somatic dysfunction of the thoracic spine, what is the relationship between
sidebending and rotation?**
A) They occur to the same side
B) They occur to opposite sides
C) Rotation occurs without sidebending
D) Sidebending occurs without rotation
**Answer: B**
*Rationale:* Type I mechanics describe a group of vertebrae in a neutral position, with rotation and
sidebending occurring in **opposite directions**.
**3. A patient has a positive left seated flexion test and a positive right standing flexion test. Which
sacral dysfunction is most likely?**
A) Left-on-left torsion
B) Right-on-left torsion
C) Bilateral sacral flexion
D) Unilateral sacral extension
**Answer: A**
*Rationale:* In a **left-on-left sacral torsion**, the standing flexion test is positive on the opposite
side (right), while the seated flexion test is positive on the same side as the axis (left). This
distinguishes sacral from iliac dysfunction.
,**4. What is a contraindication to the use of HVLA (High-Velocity Low-Amplitude) technique?**
A) Acute low back pain
B) Muscle spasm
C) Sacroiliac dysfunction
D) Osteoporosis
**Answer: D**
*Rationale:* **Osteoporosis** is a contraindication to HVLA due to the risk of vertebral fracture.
Other contraindications include fractures, malignancies, and infections.
**5. For a tender point at the insertion of the pes anserinus (medial knee), which counterstrain
position is used?**
A) Flexion, Abduction, External Rotation
B) Flexion, Adduction, Internal Rotation
C) Extension, Abduction, External Rotation
D) Extension, Adduction, Internal Rotation
**Answer: B**
*Rationale:* The medial knee tender point is treated with hip/knee **flexion, adduction, and internal
rotation** of the tibia to shorten the involved tissue.
**6. Which osteopathic principle states that the body possesses self-healing and self-regulatory
mechanisms?**
A) The body is a unit
B) Structure and function are reciprocally interrelated
C) The body possesses self-healing mechanisms
D) Rational treatment is based on these principles
**Answer: C**
*Rationale:* The principle that "the body possesses **self-healing and self-regulatory mechanisms**"
recognizes the body's inherent ability to heal itself. The physician's role is to facilitate this process.
**7. A patient with an occipitoatlantal (OA) joint restriction and headaches. What is the correct
treatment approach?**
A) Direct, high-velocity thrust
B) Indirect, myofascial release
C) Balancing the membranes
D) Stabilizing the cervical spine
**Answer: C**
*Rationale:* OA joint restrictions are closely associated with the cranial base and dura mater. They
are often treated with cranial techniques, particularly **balanced membranous tension (BMT)**.
,**8. A patient has an elevated right rib 3. What is the correct treatment?**
A) Apply a direct force to depress the rib
B) Apply an indirect force to elevate the rib further
C) Apply a counterstrain technique
D) Apply a balanced membranous tension release
**Answer: A**
*Rationale:* An elevated rib is stuck in inhalation. Treatment involves applying a **direct force to
depress the rib** (exhalation) to restore normal motion.
**9. Which treatment would help reduce sympathetic tone to the lungs in a patient with asthma?**
A) Rib raising to ribs 1-5
B) Inhibitory pressure to the T2-T7 paravertebral sympathetic ganglia
C) Thoracic pump lymphatic drainage
D) Suboccipital release
**Answer: B**
*Rationale:* Inhibitory pressure or rib raising applied to the **T2-T7 thoracic paraspinal regions**
targets the sympathetic chain ganglia to reduce hypersympathetic outflow to the pulmonary tree.
**10. In a Type II cervical dysfunction with restriction in right rotation, how is the direct HVLA
technique applied?**
A) Position away from the restrictive barrier
B) Engage the barrier in right rotation
C) Apply counterstrain
D) Use balanced membranous tension
**Answer: B**
*Rationale:* In direct techniques, the barrier is engaged. The patient is positioned in flexion or
extension (depending on the specific diagnosis) and then rotated to the right, followed by the thrust.
**11. The craniosacral technique to release the sphenobasilar symphysis (SBS) involves hand
placement on which structures?**
A) Occiput and sacrum
B) Temporal bones
C) Frontal and occipital bones
D) Parietal bones
**Answer: A**
*Rationale:* The SBS release technique involves placing one hand on the patient's **occiput** and
the other hand on the **sacrum**.
, **12. A patient has a sacral base that is shallow and anterior on the left. What is the most likely
diagnosis?**
A) Left sacral torsion
B) Right sacral torsion
C) Bilateral sacral flexion
D) Unilateral sacral extension
**Answer: A**
*Rationale:* A sacral base that is **shallow and anterior on the left** indicates a **left sacral
torsion**.
**13. Which Chapman's point is associated with the kidney?**
A) Right 10th intercostal space, near the sternum
B) Left 10th intercostal space, near the sternum
C) Right 12th intercostal space, near the sternum
D) Left 12th intercostal space, near the sternum
**Answer: B**
*Rationale:* The Chapman's point for the **kidney** is located in the **left 10th intercostal space**,
near the sternum.
**14. What is the most appropriate treatment for a sacral torsion?**
A) Direct HVLA
B) Muscle energy
C) Counterstrain
D) Cranial osteopathy
**Answer: B**
*Rationale:* **Muscle energy** is commonly used to treat sacral torsions by using the patient's own
muscle contractions to correct the dysfunction.
**15. A patient has a positive standing flexion test on the right. What is the most likely somatic
dysfunction?**
A) Right anterior innominate
B) Left anterior innominate
C) Right posterior innominate
D) Left posterior innominate
**Answer: A**
*Rationale:* A positive standing flexion test indicates iliosacral dysfunction on that side. An
**anterior innominate** is a common dysfunction presenting with a positive standing flexion test.
