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AOBNMM NMM/OMM practice questions

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Question 1Neuromusculoskeletal Medicine (Written Certification Exam)

Which cranial bone is considered the primary site of involuntary motion of the cranial mechanism, as described in osteopathic cranial theory?

  1. Frontal
  2. Parietal
  3. Sphenoid Correct answer.
  4. Occiput

Explanation

In osteopathic cranial theory the sphenoid and occiput articulate at the sphenobasilar synchondrosis and are regarded as the core of involuntary cranial motion. The sphenoid is classically described as the anterior pole of this mechanism.

Question 2Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has a sacral base that has rotated anteriorly on the right. Which sacral motion restriction is most consistent with this finding?

  1. Left unilateral sacral extension Correct answer.
  2. Bilateral sacral flexion
  3. Right unilateral sacral flexion
  4. Bilateral sacral extension

Explanation

Anterior rotation of the sacral base on one side corresponds to unilateral sacral extension on that side in standard sacral nomenclature. A right anteriorly rotated base is therefore a right unilateral extension rather than flexion.

Question 3Neuromusculoskeletal Medicine (Written Certification Exam)

A positive standing flexion test localizes somatic dysfunction to which region?

  1. The hip on the side of the higher PSIS
  2. The lumbar spine at the level of the restriction
  3. The pubic symphysis
  4. The sacroiliac joint on the side of the higher PSIS Correct answer.

Explanation

The standing flexion test identifies the side of sacroiliac dysfunction: the PSIS that rises higher or earlier during forward bending indicates the involved sacroiliac joint. It is a screening test rather than a measure of lumbar or hip motion.

Question 4Neuromusculoskeletal Medicine (Written Certification Exam)

In Fryette mechanics, which statement correctly describes type I (group) somatic dysfunction?

  1. It occurs when the spine is in a neutral position and involves sidebending and rotation in opposite directions. Correct answer.
  2. It describes motion of the sacrum relative to the ilia.
  3. It occurs in a flexed or extended position and involves sidebending and rotation in the same direction.
  4. It is a single vertebral segment that rotates opposite the group above it.

Explanation

Fryette type I mechanics apply in neutral and are characterized by group curves with sidebending and rotation to opposite sides. Type II mechanics, by contrast, occur in flexion or extension and couple sidebending and rotation to the same side.

Question 5Neuromusculoskeletal Medicine (Written Certification Exam)

A patient's lumbar spine shows a group curve with sidebending to the left and rotation to the right. Which Fryette type and neutral position does this represent?

  1. Type I, neutral Correct answer.
  2. Type I, non-neutral
  3. Type II, non-neutral
  4. Type II, neutral

Explanation

Opposite coupling of sidebending and rotation defines type I mechanics, which occur in the neutral position. Same-side coupling would indicate type II non-neutral mechanics.

Question 6Neuromusculoskeletal Medicine (Written Certification Exam)

Which palpatory finding best distinguishes a posteriorly rotated innominate from an anteriorly rotated innominate on the same side?

  1. Both the ASIS and PSIS are equally superior.
  2. The pubic tubercle is displaced inferiorly.
  3. The ASIS is more inferior and the PSIS is more superior. Correct answer.
  4. The ASIS is more superior and the PSIS is more inferior.

Explanation

In posterior rotation of the innominate, the ASIS moves inferiorly and the PSIS moves superiorly. Anterior rotation produces the opposite pattern, with a superior ASIS and inferior PSIS.

Question 7Neuromusculoskeletal Medicine (Written Certification Exam)

A patient reports pain at the lateral epicondyle that worsens with resisted wrist extension. Which counterstrain tender point is most appropriate to treat?

  1. Olecranon tender point
  2. Thenar eminence tender point
  3. Lateral epicondyle tender point Correct answer.
  4. Medial epicondyle tender point

Explanation

Resisted wrist extension reproducing lateral epicondylar pain implicates the common extensor origin, treated at the lateral epicondyle tender point. Counterstrain positions the patient to reduce that specific tender point.

Question 8Neuromusculoskeletal Medicine (Written Certification Exam)

In muscle energy technique, the patient is instructed to contract the muscle against a precisely controlled counterforce. What is the recommended initial contraction force?

  1. Maximal effort
  2. About 50 percent of maximal effort
  3. About 80 percent of maximal effort
  4. Minimal, about 10 to 20 percent of maximal effort Correct answer.

Explanation

Muscle energy technique classically begins with a low-intensity isometric contraction, roughly 10 to 20 percent of maximal effort, to engage the muscle without overpowering the operator. Force may be increased in later repetitions if tolerated.

Question 9Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement best describes the mechanism of action of high-velocity low-amplitude (HVLA) thrust technique?

  1. It applies a slow, sustained force held for several minutes at the restrictive barrier.
  2. It uses a reflex position held for 90 seconds to reduce tenderness.
  3. It relies on voluntary patient contraction against resistance.
  4. It applies a rapid, low-amplitude force to carry a joint through a restrictive barrier. Correct answer.

Explanation

HVLA uses a rapid, low-amplitude thrust delivered at the restrictive barrier to restore motion. The other choices describe different techniques such as prolonged stretch, muscle energy, and counterstrain.

Question 10Neuromusculoskeletal Medicine (Written Certification Exam)

Which finding is an absolute contraindication to HVLA thrust technique at the cervical spine?

  1. Chronic mechanical neck pain
  2. Mild muscle guarding
  3. Acute vertebral artery dissection Correct answer.
  4. Recent uncomplicated ankle sprain

Explanation

Vertebrobasilar or vertebral artery pathology such as dissection is an absolute contraindication to cervical HVLA because of the risk of catastrophic vascular injury. Mild guarding, chronic mechanical pain, and unrelated remote injuries are not absolute contraindications.

Question 11Neuromusculoskeletal Medicine (Written Certification Exam)

A patient is positioned supine with the physician seated at the head, the head rotated away, and a cephalad traction applied. This setup is most consistent with treatment of which structure?

  1. The sacroiliac joint
  2. The lumbar spine in extension
  3. The upper cervical spine in rotation Correct answer.
  4. The thoracic inlet

Explanation

Supine positioning at the head with rotation and traction targets the upper cervical region. The combination of rotation and cephalad traction addresses upper cervical somatic dysfunction.

Question 12Neuromusculoskeletal Medicine (Written Certification Exam)

Which reflex arc is the basis for the Chapman reflex points used in osteopathic diagnosis?

  1. Somatosomatic reflex
  2. Viscerovisceral reflex
  3. Somatovisceral reflex
  4. Viscerosomatic reflex Correct answer.

Explanation

Chapman points are described as viscerosomatic reflexes, with palpable tissue changes in predictable locations reflecting visceral dysfunction. They are used diagnostically to support, not replace, other clinical findings.

Question 13Neuromusculoskeletal Medicine (Written Certification Exam)

Anterior Chapman points for the lungs are most classically located where?

  1. Anteriorly between the second and third ribs near the sternum Correct answer.
  2. Anteriorly along the costal margin on the left
  3. Posteriorly between the transverse processes of T5 and T6
  4. Posteriorly at the tip of the twelfth rib

Explanation

Anterior Chapman points for the lung are described in the anterior intercostal spaces between the second and third ribs near the sternum. Posterior Chapman points are found between the transverse processes of the corresponding upper thoracic segments.

Question 14Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has a T4 sympathetic facilitation pattern. Which visceral referral is most consistent with this level?

  1. Stomach
  2. Heart Correct answer.
  3. Liver
  4. Kidney

Explanation

The heart receives sympathetic innervation around T1 to T4, so a T4 facilitation pattern may accompany cardiac dysfunction. Stomach, liver, and kidney referrals correspond to lower thoracic and upper lumbar levels.

Question 15Neuromusculoskeletal Medicine (Written Certification Exam)

Which muscle is the primary flexor of the hip and is commonly associated with a tender point near the anterior superior iliac spine in counterstrain?

  1. Iliopsoas Correct answer.
  2. Adductor longus
  3. Biceps femoris
  4. Gluteus maximus

Explanation

The iliopsoas is the principal hip flexor and has an anterior tender point near the ASIS region. Counterstrain treatment positions the hip to shorten the muscle and reduce tenderness.

Question 16Neuromusculoskeletal Medicine (Written Certification Exam)

Which finding on a sacral examination indicates a left on left sacral torsion?

  1. The sacral sulcus is deep on the left and the inferior lateral angle is prominent on the left. Correct answer.
  2. Both sulci are shallow and both inferior lateral angles are symmetric.
  3. The sacral sulcus is deep on the right and the inferior lateral angle is prominent on the right.
  4. The sacral base is anterior bilaterally with symmetric inferior lateral angles.

Explanation

In a left on left sacral torsion, the sacrum rotates around a left oblique axis with the left sulcus deep and the left inferior lateral angle prominent. The right-sided pattern describes a right on right torsion.

Question 17Neuromusculoskeletal Medicine (Written Certification Exam)

Which is the most appropriate first step when a patient reports dizziness and visual change during cervical rotation testing before any thrust technique?

  1. Apply cervical traction and continue the examination.
  2. Repeat the rotation more rapidly to confirm the finding.
  3. Proceed with the thrust at a lower amplitude.
  4. Stop the maneuver and evaluate for vertebrobasilar insufficiency. Correct answer.

Explanation

Symptoms suggesting vertebrobasilar insufficiency during cervical motion require immediate cessation of the maneuver and further vascular evaluation. Proceeding with or repeating the provocative motion risks serious harm.

Question 18Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement correctly describes the motion of the sacrum during craniosacral flexion?

  1. The sacral base moves posteriorly and the apex moves anteriorly. Correct answer.
  2. The sacral base moves anteriorly and the apex moves posteriorly.
  3. The sacral base moves anteriorly and the apex moves anteriorly.
  4. The sacrum moves as a rigid unit with no change in base or apex.

Explanation

During cranial flexion, the sacrum follows the sphenobasilar mechanism with the base moving posteriorly and the apex moving anteriorly. This is the sacral counterpart of the flexion phase of the cranial rhythmic impulse.

Question 19Neuromusculoskeletal Medicine (Written Certification Exam)

Which technique relies on the principle of reciprocal inhibition by placing a hypertonic muscle in a position of shortening while the patient remains relaxed?

  1. Facilitated positional release
  2. Strain-counterstrain Correct answer.
  3. Myofascial release
  4. Ligamentous articular strain

Explanation

Strain-counterstrain uses a position of comfort that shortens the involved muscle, reducing proprioceptive input and tenderness. The position is held for approximately 90 seconds while the patient is relaxed.

Question 20Neuromusculoskeletal Medicine (Written Certification Exam)

Which rib motion occurs primarily with inhalation at ribs 1 through 5?

  1. Pump-handle motion with the anterior rib end moving superiorly Correct answer.
  2. Pump-handle motion with the anterior rib end moving inferiorly
  3. Caliper motion with the rib shaft moving inferiorly
  4. Bucket-handle motion with the lateral rib shaft moving superiorly

Explanation

Upper ribs (1 to 5) predominantly show pump-handle motion, in which the anterior end moves superiorly and anteriorly on inhalation. Lower ribs (7 to 10) show more bucket-handle motion.

Question 21Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has an inhalatory rib restriction at rib 6 on the right. Which treatment approach is most consistent with an indirect technique?

  1. Performing a high-velocity thrust after exhalation
  2. Positioning the rib toward its freedom of motion and holding until release Correct answer.
  3. Positioning the rib into its restrictive barrier and applying a rapid thrust
  4. Applying sustained posterior pressure directly over the rib angle

Explanation

Indirect technique moves the dysfunctional structure away from the restrictive barrier, toward the direction of ease, and holds until tissue release. Direct techniques engage the barrier with forces such as thrust or sustained pressure.

Question 22Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement best describes the role of the thoracolumbar fascia in lumbar stabilization?

  1. It serves primarily as a site of hematopoiesis.
  2. It functions as a synovial joint capsule.
  3. It is the principal flexor of the lumbar spine.
  4. It provides a passive and active tension band linking the latissimus dorsi, gluteus maximus, and transversus abdominis. Correct answer.

Explanation

The thoracolumbar fascia transmits tension among the latissimus dorsi, gluteus maximus, and abdominal musculature, contributing to lumbopelvic stability. It is a connective tissue structure, not a muscle or capsule.

Question 23Neuromusculoskeletal Medicine (Written Certification Exam)

Which cranial nerve is most commonly associated with the gag reflex tested during an osteopathic structural examination?

  1. Glossopharyngeal Correct answer.
  2. Trochlear
  3. Optic
  4. Vestibulocochlear

Explanation

The gag reflex involves the glossopharyngeal nerve for the afferent limb and the vagus nerve for the efferent limb. The other listed nerves serve vision, hearing and balance, and eye movement.

Question 24Neuromusculoskeletal Medicine (Written Certification Exam)

A patient demonstrates a positive seated flexion test on the left and a left anterior innominate rotation. Which additional finding would most support a left on left sacral torsion?

  1. A deep left sacral sulcus with a prominent left inferior lateral angle Correct answer.
  2. A shallow left sacral sulcus with a posterior left inferior lateral angle
  3. A deep right sacral sulcus with a prominent right inferior lateral angle
  4. Bilateral symmetric sulci with a prominent sacral base

Explanation

Left on left sacral torsion is characterized by a deep left sulcus and prominent left inferior lateral angle on the same side as the positive seated flexion test. This combination is consistent with the innominate and sacral findings described.

Question 25Neuromusculoskeletal Medicine (Written Certification Exam)

Which structure is the primary target of the suboccipital release technique?

  1. The thoracic duct
  2. The suboccipital muscles and the posterior atlanto-occipital membrane Correct answer.
  3. The anterior longitudinal ligament
  4. The median nerve at the carpal tunnel

Explanation

Suboccipital release targets the suboccipital muscles and the posterior atlanto-occipital membrane to reduce tension and improve cranial and cervical motion. The other structures are unrelated to this technique.

Question 26Neuromusculoskeletal Medicine (Written Certification Exam)

Which spinal motion segment is most commonly the site of a somatic dysfunction described as a type I (group) curve in the thoracic spine?

  1. A group of segments with rotation and sidebending to opposite sides
  2. A group of segments with rotation and sidebending to the same side Correct answer.
  3. A single segment with rotation and sidebending to opposite sides
  4. A single segment with rotation and sidebending to the same side

Explanation

Type I mechanics are described by neutral group curves in which sidebending and rotation occur to the same side across several segments. Type II mechanics are non-neutral single-segment dysfunctions with rotation and sidebending to opposite sides.

Question 27Neuromusculoskeletal Medicine (Written Certification Exam)

A patient's right innominate is found to be anteriorly rotated. Which motion restriction would be expected on the right side?

  1. Restricted anterior rotation of the right innominate
  2. Restricted superior glide of the right innominate
  3. Restricted inferior glide of the right innominate
  4. Restricted posterior rotation of the right innominate Correct answer.

Explanation

An anteriorly rotated innominate is held in anterior rotation, so the barrier to posterior rotation is engaged first and posterior motion is restricted. The restriction is named for the direction opposite the positional fault.

Question 28Neuromusculoskeletal Medicine (Written Certification Exam)

Which muscle is the primary target of a counterstrain tender point located at the tip of the twelfth rib?

  1. Quadratus lumborum Correct answer.
  2. Iliopsoas
  3. Rectus abdominis
  4. Latissimus dorsi

Explanation

The classic tender point at the tip of the twelfth rib is associated with quadratus lumborum, which attaches to the twelfth rib and lumbar transverse processes. Counterstrain treatment shortens the muscle to relieve the reflex arc.

Question 29Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has a left lateral strain of the sacrum. Which finding best supports this diagnosis?

  1. A deep sulcus on the right with a shallow sulcus on the left
  2. A prominent sacral base with an absent inferior lateral angle
  3. Bilateral deep sulci with a prominent sacral base
  4. A deep sulcus on the left with a shallow sulcus on the right Correct answer.

Explanation

In a lateral strain the sacrum is sidebent to one side, producing a deep sulcus on the side toward which it is sidebent and a shallow sulcus on the opposite side. A left lateral strain therefore yields a deep left sulcus.

Question 30Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement best describes the mechanism of an indirect (functional) osteopathic technique?

  1. The physician moves the part away from the restrictive barrier into the position of ease Correct answer.
  2. The physician positions the part at the barrier and asks for active contraction
  3. The physician applies a steady force directly into the restrictive barrier
  4. The physician engages the restrictive barrier and applies a rapid thrust

Explanation

Indirect technique follows the path of least resistance, positioning the region away from the restrictive barrier toward ease and allowing inherent forces to resolve the dysfunction. Direct technique, by contrast, engages the barrier.

Question 31Neuromusculoskeletal Medicine (Written Certification Exam)

A patient's seated flexion test is positive on the right. Which structure is most likely restricted?

  1. Left sacroiliac joint
  2. Sacrococcygeal joint
  3. Symphysis pubis
  4. Right sacroiliac joint Correct answer.

Explanation

The seated flexion test identifies the side of a sacroiliac restriction; a positive test on the right indicates impaired motion at the right sacroiliac joint. The test relies on the sacral base moving posteriorly on the restricted side during forward bending.

Question 32Neuromusculoskeletal Medicine (Written Certification Exam)

Which cranial bone motion occurs during the inhalation phase of the primary respiratory mechanism?

  1. The sphenoid and occiput rotate in the same direction about a transverse axis
  2. The sphenoid and occiput glide laterally without rotation
  3. The sphenoid and occiput approximate at the sphenobasilar synchondrosis
  4. The sphenoid and occiput rotate in opposite directions about a transverse axis Correct answer.

Explanation

During flexion (inhalation), the sphenobasilar synchondrosis rises and the sphenoid and occiput rotate in opposite directions about transverse axes, widening the angle. Extension reverses this pattern.

Question 33Neuromusculoskeletal Medicine (Written Certification Exam)

Which viscerosomatic reflex level is most associated with the heart?

  1. T5 to T9
  2. T10 to T12
  3. L1 to L2
  4. T1 to T4 Correct answer.

Explanation

Sympathetic innervation to the heart arises from the upper thoracic cord, classically T1 through T4, so cardiac dysfunction may produce facilitated segments at these levels. Lower thoracic levels correspond to other viscera.

Question 34Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has a rib dysfunction in which the right sixth rib is held in exhalation. Which motion is restricted?

  1. Both inhalation and exhalation equally
  2. Inhalation Correct answer.
  3. Exhalation
  4. Neither motion is restricted

Explanation

A rib held in exhalation is unable to move into inhalation, so inhalation is the restricted motion. The barrier is engaged in the direction opposite the positional fault.

Question 35Neuromusculoskeletal Medicine (Written Certification Exam)

Which finding is most consistent with a left anterior innominate rotation on palpation of the iliac crests?

  1. The left anterior superior iliac spine is superior and the left posterior superior iliac spine is inferior
  2. The left anterior superior iliac spine is inferior and the left posterior superior iliac spine is superior Correct answer.
  3. Both the left anterior and posterior superior iliac spines are superior
  4. Both the left anterior and posterior superior iliac spines are inferior

Explanation

In an anteriorly rotated innominate, the anterior superior iliac spine moves inferiorly and the posterior superior iliac spine moves superiorly on the affected side. The opposite pattern occurs with posterior rotation.

Question 36Neuromusculoskeletal Medicine (Written Certification Exam)

Which technique is most appropriate for a muscle that is hypertonic and has a restrictive barrier in its shortened range?

  1. High-velocity low-amplitude thrust
  2. Facilitated positional release
  3. Muscle energy with post-isometric relaxation
  4. Strain-counterstrain Correct answer.

Explanation

Strain-counterstrain places the hypertonic muscle in a position of shortening to reduce the reflex-mediated tension. The tender point is monitored while the position of ease is held.

Question 37Neuromusculoskeletal Medicine (Written Certification Exam)

A patient reports a burning sensation over the lateral forearm and thumb with weakness of the biceps reflex. Which level is most likely involved?

  1. C7
  2. C5 Correct answer.
  3. C4
  4. T1

Explanation

The C5 nerve root supplies the biceps reflex and sensation over the lateral forearm and thumb, so a lesion here produces these findings. C7 and T1 have different reflex and sensory distributions.

Question 38Neuromusculoskeletal Medicine (Written Certification Exam)

Which finding best distinguishes a somatic dysfunction of the upper cervical spine from a lower cervical spine dysfunction?

  1. Upper cervical segments are restricted to flexion and extension only
  2. Upper cervical segments allow rotation and sidebending to opposite sides in neutral Correct answer.
  3. Upper cervical segments allow rotation and sidebending to the same side
  4. Upper cervical segments do not rotate at all

Explanation

The upper cervical spine (occiput to C2) has unique coupled motion, with rotation and sidebending occurring to opposite sides in a neutral position. Lower cervical segments follow the typical type I and type II mechanics.

Question 39Neuromusculoskeletal Medicine (Written Certification Exam)

Which is the most appropriate initial step when a patient reports dizziness during a cervical rotation test?

  1. Have the patient perform active range of motion against resistance
  2. Apply an HVLA thrust to the cervical spine
  3. Continue the test to confirm the finding
  4. Stop the test and reassess for vertebrobasilar insufficiency Correct answer.

Explanation

Dizziness, visual change, or nausea during cervical motion testing may indicate vertebrobasilar insufficiency, so testing should be stopped and the patient reassessed. Proceeding with manipulation could be dangerous.

Question 40Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement best explains why a facilitated segment may produce tenderness on palpation?

  1. Motor neuron activity is reduced at the segment
  2. Decreased sympathetic outflow raises the threshold of nociceptors
  3. Parasympathetic outflow directly sensitizes the somatic tissues
  4. Increased sympathetic outflow lowers the threshold of nociceptors in the somatic tissues Correct answer.

Explanation

A facilitated segment reflects increased sympathetic activity that sensitizes somatic structures, lowering the nociceptive threshold so that palpation produces tenderness. This is the basis for viscerosomatic and somatovisceral reflexes.

Question 41Neuromusculoskeletal Medicine (Written Certification Exam)

Which muscle energy technique is used to treat a posteriorly rotated innominate?

  1. A muscle energy technique that recruits hip adductors to rotate the innominate medially
  2. A muscle energy technique that recruits hip flexors to rotate the innominate anteriorly Correct answer.
  3. A muscle energy technique that recruits hip extensors to rotate the innominate posteriorly
  4. A muscle energy technique that recruits hip abductors to rotate the innominate laterally

Explanation

For a posteriorly rotated innominate, the goal is to restore anterior rotation, so the technique uses hip flexor contraction to pull the innominate anteriorly. The direction of the corrective force is opposite the positional fault.

Question 42Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has a positive seated flexion test on the left and a left anterior innominate rotation. Which additional finding is most consistent with a left on left sacral torsion?

  1. A symmetric sacrum with a positive seated flexion test
  2. A deep sulcus on the left with a negative lumbosacral spring test
  3. A shallow sulcus on the right with a negative lumbosacral spring test
  4. A deep sulcus on the right with a positive lumbosacral spring test Correct answer.

Explanation

A left on left sacral torsion occurs when the sacrum rotates about a left oblique axis, producing a deep sulcus on the right and typically a positive lumbosacral spring test. The axis and the side of the positive seated flexion test help define the torsion.

Question 43Neuromusculoskeletal Medicine (Written Certification Exam)

Which finding is most consistent with a posterior fibular head dysfunction?

  1. Restricted posterior glide of the fibular head
  2. Restricted anterior glide of the fibular head Correct answer.
  3. Restricted inferior glide of the fibular head
  4. Restricted superior glide of the fibular head

Explanation

A posterior fibular head is held posteriorly, restricting anterior glide. The diagnosis is named for the direction of the positional fault, and the restriction is in the opposite direction.

Question 44Neuromusculoskeletal Medicine (Written Certification Exam)

Which is the most appropriate treatment for a trigger point in the upper trapezius using spray and stretch?

  1. Apply a vapocoolant in a circular pattern while the muscle contracts
  2. Apply ice and perform resisted contraction of the muscle
  3. Apply a vapocoolant in parallel sweeps while passively stretching the muscle Correct answer.
  4. Apply heat and maintain the muscle in a shortened position

Explanation

Spray and stretch uses a vapocoolant applied in parallel sweeps over the muscle while it is passively stretched to reduce trigger point activity. The cooling reduces pain and the stretch lengthens the muscle.

Question 45Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement best describes the motion of the sacrum during craniosacral flexion?

  1. The sacrum rotates about a transverse axis only
  2. The sacrum moves as a rigid unit without any motion
  3. The sacral base moves posteriorly and the apex moves anteriorly Correct answer.
  4. The sacral base moves anteriorly and the apex moves posteriorly

Explanation

During craniosacral flexion, the sacral base moves posteriorly and the apex moves anteriorly, accompanying the cranial flexion phase. Extension reverses this pattern.

Question 46Neuromusculoskeletal Medicine (Written Certification Exam)

Which viscerosomatic reflex level is most associated with the stomach?

  1. T1 to T4
  2. T10 to T12
  3. T5 to T9 Correct answer.
  4. L1 to L2

Explanation

Sympathetic innervation to the stomach arises from the mid-thoracic cord, classically T5 through T9. Dysfunction may produce facilitated segments at these levels.

Question 47Neuromusculoskeletal Medicine (Written Certification Exam)

Which statement best describes the mechanism of action of muscle energy technique?

  1. A rapid thrust at the barrier restores joint motion
  2. Voluntary contraction against a counterforce followed by relaxation lengthens the muscle Correct answer.
  3. Sustained pressure on a tender point reduces muscle tension
  4. Passive positioning at the barrier without contraction lengthens the muscle

Explanation

Muscle energy technique uses a voluntary contraction against a controlled counterforce, followed by relaxation and repositioning at the new barrier, to lengthen the muscle and improve joint motion. Post-isometric relaxation is the underlying principle.

Question 48Neuromusculoskeletal Medicine (Written Certification Exam)

A patient has a right anteriorly rotated innominate and a positive seated flexion test on the right. Which additional finding is most consistent with a right on right sacral torsion?

  1. A deep sulcus on the left and a negative lumbosacral spring test
  2. A shallow sulcus on the right and a negative lumbosacral spring test
  3. A deep sulcus on the right and a positive lumbosacral spring test Correct answer.
  4. A symmetric sacrum with a positive lumbosacral spring test

Explanation

A right on right sacral torsion involves rotation about a right oblique axis and produces a deep sulcus on the right with a positive lumbosacral spring test. The side of the deep sulcus and the axis determine the torsion.

Question 49Neuromusculoskeletal Medicine (Written Certification Exam)

Which finding is most consistent with an anteriorly rotated innominate on the affected side?

  1. The anterior superior iliac spine is superior and the posterior superior iliac spine is inferior
  2. The anterior superior iliac spine is inferior and the posterior superior iliac spine is superior Correct answer.
  3. The anterior superior iliac spine is superior and the posterior superior iliac spine is superior
  4. The anterior superior iliac spine is inferior and the posterior superior iliac spine is inferior

Explanation

In anterior rotation, the innominate tilts forward so the anterior superior iliac spine descends and the posterior superior iliac spine rises. This pattern is the reverse of posterior rotation.

Question 50Neuromusculoskeletal Medicine (Written Certification Exam)

A 34-year-old patient reports a deep, aching pain in the left lower cervical region that began after prolonged computer work. Palpation reveals a tissue texture change and restricted motion at C5-C6 on the left. Which term best describes this finding?

  1. Radiculopathy
  2. Myelopathy
  3. Somatic dysfunction Correct answer.
  4. Fibromyalgia

Explanation

Somatic dysfunction is defined as impaired or altered function of related components of the somatic system, identified by TART findings (tissue texture change, asymmetry, restriction of motion, tenderness). Radiculopathy and myelopathy are neurologic diagnoses requiring distinct findings such as dermatomal loss or long-tract signs.