OEBC Written Exam cheat sheet

Four core tenets: body is a unit; structure and function are reciprocally interrelated; body possesses self-regulatory and self-healing mechanisms; rational treatment rests on these principles.

A.T. Still's framing: disease arises when the body's inherent capacity for health is obstructed; the physician's role is to remove impediments rather than impose cure.

Somatic dysfunction definition: impaired or altered function of related components of the somatic system - skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.

TART mnemonic for somatic dysfunction: Tissue texture abnormality, Asymmetry, Restriction of motion, Tenderness.

Five models of osteopathic care: biomechanical, respiratory-circulatory, neurologic, metabolic-nutritional, behavioral-biopsychosocial.

Structure-function reciprocity is bidirectional: altered mechanics can drive visceral or neural dysfunction, and visceral disease can produce somatic findings (viscerosomatic reflexes).

Health is framed as a continuum of adaptation, not merely absence of disease; the body's homeostatic reserve determines expression of illness.

Philosophy informs clinical decisions: treat the whole patient, address modifiable mechanical and lifestyle contributors, and support self-healing capacity alongside conventional care.

Fascial planes connect regions continuously: thoracolumbar fascia links latissimus dorsi, gluteus maximus, and contralateral tissues, transmitting force across the body.

Diaphragm attachments: xiphoid process, lower six costal cartilages, L1-L3 vertebral bodies via crura, and arcuate ligaments; openings at T8 (caval), T10 (esophageal), T12 (aortic).

Thoracic duct drains into the junction of the left internal jugular and left subclavian veins; right lymphatic duct drains into the right subclavian-jugular junction.

Sympathetic outflow is T1-L2; parasympathetic cranial outflow is via CN III, VII, IX, X, and sacral outflow is S2-S4.

Cranial sutures are synarthrodial joints with fibrous connective tissue; the sphenobasilar synchondrosis is the key articulation in cranial models.

Lumbar plexus (L1-L4) gives femoral and obturator nerves; sacral plexus (L4-S4) gives sciatic nerve, which exits via the greater sciatic foramen below piriformis.

Rotator cuff muscles (SITS): supraspinatus, infraspinatus, teres minor, subscapularis; supraspinatus initiates abduction, deltoid continues above 15 degrees.

Inguinal canal contents: spermatic cord (male) or round ligament (female), ilioinguinal nerve; deep ring lateral to inferior epigastric vessels, superficial ring medial.

Frank-Starling relationship: increased preload increases stroke volume up to a point of overstretch; cardiac output = heart rate x stroke volume.

Mean arterial pressure approximates diastolic pressure + 1/3 pulse pressure; cerebral autoregulation maintains flow across roughly 60-150 mmHg MAP.

Starling forces govern capillary exchange: filtration driven by hydrostatic pressure, reabsorption by oncotic pressure; lymphatic flow returns excess interstitial fluid.

Acid-base: respiratory compensation is rapid via CO2 change; renal compensation is slow (hours to days) via bicarbonate regulation.

Sympathetic activation raises heart rate, contractility, and vascular tone; chronic elevation contributes to hypertension and insulin resistance.

Pain modulation involves descending pathways from periaqueductal gray to dorsal horn; gate control theory holds that large-fiber input can inhibit small-fiber nociceptive transmission.

Inflammation phases: vascular (vasodilation, permeability), cellular (neutrophil then macrophage), and resolution; chronic inflammation drives fibrosis and sensitization.

Viscerosomatic reflex: afferent input from a diseased viscus converges on the same spinal cord segment as somatic afferents, producing segmental muscle and skin changes.

SOAP structure: Subjective (history, symptoms), Objective (exam, imaging, labs), Assessment (diagnosis, differential), Plan (treatment, follow-up).

Red flags requiring urgent workup: unexplained weight loss, night pain, fever, neurologic deficit, bowel or bladder changes, history of cancer, trauma.

Motion testing: active, passive, and resisted; springing assesses joint play; end-feel distinguishes normal capsular, bony, and spasm restrictions.

Segmental diagnosis uses TART plus named criteria: tissue texture, asymmetry, restriction, tenderness; record spinal level and direction of restriction.

Viscerosomatic findings by level: heart T1-T5 (left), lungs T2-T7, stomach T5-T9, liver and gallbladder T5-T9 (right), small intestine T9-T11, colon T11-L2.

Chapman's points are anterior and posterior tissue texture changes associated with visceral dysfunction; used as diagnostic and treatment landmarks.

Neurologic screening includes deep tendon reflexes, dermatomal sensation, myotomal strength, and pathologic reflexes (Babinski, Hoffman).

Orthopedic special tests are interpreted in clusters; a single positive test has limited specificity, so combine with history and imaging when indicated.

Direct technique engages the restrictive barrier and moves toward it; indirect technique moves away from the barrier into the direction of ease.

Muscle energy: patient performs voluntary contraction against operator counterforce from a controlled position, using post-isometric relaxation.

High-velocity low-amplitude (HVLA): rapid thrust through a restrictive barrier after positioning; contraindicated in fracture, severe osteoporosis, and unstable spine.

Counterstrain: patient held in a position of comfort for about 90 seconds to reduce tender point reflex activity.

Myofascial release uses sustained traction and torsion forces to lengthen restricted fascial planes; indirect approach follows the tissue's preferred direction.

Lymphatic technique uses light rhythmic pumping to enhance flow; indicated in edema and congestion, contraindicated in acute infection or malignancy without clearance.

Cranial technique applies light forces (about 5 grams) to assess and treat cranial rhythmic impulse and dural tension.

Contraindications to OMT: acute fracture, hemorrhage, malignancy at site, untreated infection, unstable medical condition, and lack of patient consent.

Low back pain: most cases are mechanical and self-limited; imaging is indicated with red flags or neurologic deficit, not routine early imaging.

Sciatica from disc herniation typically follows a dermatomal pattern; straight-leg raise is sensitive, crossed straight-leg raise is highly specific.

Carpal tunnel syndrome: median nerve compression at the wrist; symptoms in thumb, index, middle, and radial half of ring finger, worse at night.

Cervical radiculopathy: pain radiating into the arm with dermatomal sensory loss and reflex changes; Spurling's test narrows the foramen.

Frozen shoulder (adhesive capsulitis) progresses through painful, frozen, and thawing phases; capsular pattern limits external rotation most.

Migraine versus tension headache: migraine is unilateral, pulsating, with nausea and photophobia; tension is bilateral, pressing, without vomiting.

Radiculopathy is a root lesion with dermatomal findings; peripheral neuropathy follows a nerve distribution; both differ from referred somatic pain.

Concussion: graded return to activity after symptom resolution; red flags include worsening headache, vomiting, seizure, and focal deficit.

Viscerosomatic reflex: visceral afferents converge on the dorsal horn with somatic afferents at the same segment, producing segmental hyperalgesia and muscle spasm.

Somatovisceral reflex: somatic dysfunction can alter autonomic outflow to a viscus, contributing to visceral dysfunction.

Facilitated segment: a spinal segment with lowered threshold for afferent input, maintaining abnormal reflex activity and somatic dysfunction.

Heart and pericardium: T1-T5 left; lungs: T2-T7; stomach and pancreas: T5-T9; liver and gallbladder: T5-T9 right; appendix: T10-T12 right.

Kidney and bladder: T10-L2; uterus and ovaries: T10-L2; prostate: T10-L2; rectum: T11-L2.

Parasympathetic cranial findings: CN X influences thoracic and abdominal viscera; sacral segments S2-S4 influence pelvic viscera.

Chapman's points: anterior points are tender nodules, posterior points are deeper; used to corroborate visceral diagnosis and guide treatment.

Pulmonary findings in asthma may include upper thoracic somatic dysfunction and restricted rib motion; treatment aims to improve mechanics and lymphatic drainage.

Integrate OMT with conventional care: treat modifiable mechanical contributors while managing the primary disease with evidence-based therapy.

Priority sequencing: treat life-threatening issues first, then address the most restrictive or symptomatic somatic dysfunctions.

Documentation of OMT includes region, technique, findings before and after, and patient response, supporting medical necessity.

Chronic pain management uses a multimodal approach: exercise, manual therapy, behavioral therapy, and judicious medication use.

Osteoporosis and fall risk: assess balance, medication review, and home safety; avoid high-velocity techniques in severely osteopenic patients.

Pediatric and geriatric considerations: adjust force magnitude and positioning; account for altered physiology and comorbidities.

Follow-up should reassess measurable outcomes such as pain score, range of motion, and function, and modify the plan accordingly.

Shared decision-making includes discussing risks, benefits, and alternatives, and respecting patient preference and autonomy.

Informed consent requires disclosure of diagnosis, proposed treatment, risks, benefits, alternatives, and the right to refuse.

Confidentiality is governed by HIPAA; exceptions include imminent harm, mandated reporting of abuse, and court order.

Boundary violations include sexual misconduct and financial exploitation; maintain professional boundaries and document interactions.

Mandatory reporting: suspected child abuse, elder abuse, and certain communicable diseases per jurisdiction.

Scope of practice: perform only within licensure and training; refer when the condition exceeds competence or requires specialist care.

Safety: screen for contraindications before OMT, use proper body mechanics, and modify technique for patient anatomy and condition.

Conflict of interest: disclose financial or personal interests that could influence clinical recommendations.

Impaired colleague: report through appropriate channels while protecting patient safety; encourage rehabilitation and monitoring.