opp block 3 practice q's

true or false: most of the lymph in the body drains into the area behind the left clavicle

true

Chapman's point are characterized as which of the following?

A. Neurolymphatic reflex

B. Viscersomatic reflex

C. Somatovisceral reflex

D. Viscerolymphatic reflex

A. neurolymphatic reflex

true or false: the respiratory epithelium is primarily under sympathetic control

false

when not exercising, how much should you breathe through your mouth?

A. always

B. it doesn't really matter

C. never

D. 17% of the time

C. never

Which of these is a primary lymphoid organ?

A. thymus

B. spleen

C. bone marrow

D. peyer's patches

A. thymus

C. bone marrow

the drain for the maxillary sinus is...

A. on the roof of the sinus

B. through the occipital bone

C. on the floor of the sinus

D. there is no drain, there is just a complex system of resorption involving compression and tension elements

A. on the roof of the sinus

half of the body's lymph is formed in the...

A. gall bladder

B. spleen

C. liver

D. cisterna chyli

C. liver

how much does the rate of lymph flow increase with exercise?

A. 1-2 times

B. 10 times

C. minimally

D. 3-6 times

D. 3-6 times

true or false: when there is increased tension at Sibson's fascia, this will decrease lymphatic drainage

true

what feature do typical ribs have?

A. head

B. tubercle

C. neck

D. body

E. tuberosity

A, B, C, and D

where is the neurovascular bundle located?

A. at the costotransverse joints

B. at the inferior aspect of the ribs

C. at the superior aspect of the ribs

D. along the sympathetic chain

B. at the inferior aspect of the ribs

which scalene muscles are attached to rib 1?

A. anterior

B. middle

C. posterior

A and B (anterior and middle)

what muscle is attached to rib 12 that is used in both inhalation and exhalation dysfunction treatment with ME?

A. intercostal muscles

B. psoas

C. quadratus lumborum

D. iliolumbar ligament

C. quadratus lumborum

where is the hand placement on the ribcage for treating exhalation dysfunctions of the ribs with ME?

A. posterior

B. anterior

A. posterior

the muscle used to treat exhaled ribs 9-11 with ME is:

A. serratus anterior

B. latissimus dorsi

C. posterior scalene

D. pectoralis minor

B. latissimus dorsi

which physiological motion does rib 11 and 12 most have?

A. pump handle

B. bucket handle

C. caliper

C. caliper

pump handle motion is considered to rotate closest around which axis in the ribs?

A. transverse

B. sagittal

A. transverse

which muscles of quiet respiration are active during inhalation?

A. scalenes

B. diaphragm

C. internal intercostals

D. external intercostals

E. sternocleidomastoid

B, C, and D (diaphragm, internal intercostals, external intercostals)

(THIS ONE COULD BE WRONG I NEED TO DOUBLE CHECK IT)

the diaphragm attaches to:

A. T6-T11

B. rib 6-11

C. xiphoid process

D. T12-L3

E. manubruim

F. rib 12 only

B. rib 6-11

C. xiphoid process

D. T12-L3

the vast majority of the lymph in the human body drains behind what bony structures?

A. right clavicle

B. right 3rd rib

C. left clavicle

D. left 3rd rib

C. left clavicle

patients who are hospitalized, or for other reasons are not ambulatory, mobilize the majority of their lymph by what method?

A. eating

B. heart pumping

C. breathing

D. walking

E. yoga

C. breathing

what structure lies deep to the rib heads and regulates the lymphatic system?

A. lymph node

B. collecting ducts

C. parasympathetic chain ganglia

D. pre-lymphatics

E. sympathetic chain ganglia

E. sympathetic chain ganglia

what is the purpose of releasing the thoracic inlet when addressing the lymphatic system?

A. augment thoracic diaphragmatic function

B. stretch Sibson's fascia

C. assist transport of lymph into the vasculature

D. release myofascial restrictions

C. assist transport of lymph into the vasculature

true or false: the key rib for a group of inhaled dysfunctional ribs is typically the bottom rib

true (BITE)

which of the following ribs has primarily bucket handle motion?

A. 1

B. 7

C. 11

D. 2

E. 4

B. 7

which mechanism of muscle energy technique is primarily used for inhaled ribs?

A. reciprocal inhibition

B. joint mobilization using muscle force

C. post-isometric relaxation

D. respiratory asssitance

E. crossed-extensor reflex

C. post-isometric relaxation

you are seeing a patient in clinic who reports pain in their right mid to low back with bending and twisting movements. while performing the exam you notice that right ribs 9-12 move easily with inhalation but have decreased motion in exhalation compared with the left side. what is the key rib and which mechanism are you utilizing for movement?

A. rib 9; joint mobilization

B. rib 9; post-isometric relaxation and respiratory assist

C. rib 12; joint mobilization and respiratory assist

D. rib 12; joint mobilization only

E. rib 12; post-isometric relaxation and respiratory assist

C. rib 12; joint mobilization and respiratory assist

you are seeing a patient in an OMT clinic who is reporting neck and upper back pain that is worse since studying for an OPP theory exam last week. You notice on exam that the patient's right rib 1 is tender. Rib 1 moves freely with inhalation on both sides, but rib 1 on the right has less movement with exhalation. Muscle energy treatment of rib 1 involves primarily sidebending the patient's head ___ the rib and having the patient hold ___ while ___.

A. towards; exhalation; pushing their head into yours

B. away from; inhalation; lifting their head off the table

C. away from; exhalation; lifting their head off the table

D. away from; exhalation; pushing their head into your hand

E. away from; inhalation; pushing their head into your hand

D. away from; exhalation; pushing their head into your hand

your patient presents to the OMT clinic reporting right sided chest pain when they move around in certain ways. while performing your exam you notice that ribs 1-4 move freely into inhalation but right ribs 1-4 move less with exhalation compared with the left. how would you treat this dysfunction with muscle energy?

A. sidebend and extend the patient to rib 4 and follow the rib into exhalation

B. utilize the pectoralis minor muscle to mobilize rib 4

C. utilize the serratus anterior to mobilize rib 4

D. utilize the latissimus dorsi to mobilize rib 4

E. flex the patient to rib 4 and follow the rib into exhalation

E. flex the patient to rib 4 and follow the rib into exhalation

your patient presents with pain on the right lateral side of their rib cage. upon your physical examination you find that ribs 4-8 on the right exhale fully, but don't inhale well. using muscle energy for the ribs, how would you treat this dysfunction?

A. flex the patient to rib 8 and follow the rib into extension

B. sidebend the patient to rib 8 and follow the rib into extension

C. utilize the pectoralis minor muscle to mobilize rib 4

D. utilize the serratus anterior muscle to mobilize rib 4

E. utilize the latissimus dorsi muscle to mobilize rib 4

C. utilize the pectoralis minor muscle to mobilize rib 4

rib 2 does not move well in inhalation but moves well in exhalation. which of the following muscle(s) are primarily recruited and what physiologic mechanism is being utlized?

A. anterior scalene only; joint mobilization using muscle force

B. anterior and middle scalenes; post-isometric relaxation

C. anterior and middle scalenes; joint mobilization using muscle force

D. posterior scalene only; joint mobilization using muscle force

E. posterior scalene only; post-isometric relaxation

D. posterior scalene only; joint mobilization using muscle force

you are in the hospital rounding on your patient who is admitted with community acquired pneumonia. he is complaining of chest wall and upper back pain with respiration that worsens with coughing. auscultation reveals decreased lung sounds in the right upper lobe region, with palpatory TART findings at T2-T6, and right ribs 2-6 are exhaled. which of the following would best complete the statement describing the utility of using OMT on this patient? OMT for this patient is intended to:

A. increase allostatic load to help reach homeostasis

B. minimize lymphatic and venous drainage of tissues

C. decrease spinal segmental facilitation

D. increase pain medication requirement

E. increase sympathetic tone to promote vasodilation

C. decrease spinal segmental facilitation

you find that your patient has a group of exhaled ribs 6-10 on the right. what muscle or group of muscles will you be utilizing to mobilize the key rib?

A. intercostals

B. serratus anterior

C. latissimus dorsi

D. pectoralis major

E. pectoralis minor

B. serratus anterior

a 94 year old patient with a past medical history of Parkinson's disease had a traumatic fall and lands on his right side where there is significant bruising. the patient is awake and following commands. he reports difficulty breathing. your attending physician asks if you are able to offer OMT to relieve his symptoms. you examine the patient and find ribs 6-9 move well with exhalation, but not in inhalation. in this case, which of the following is an absolute contraindication?

A. patient is too old

B. lack of somatic dysfunction

C. rib fracture

D. recent myofascial injury

E. low vitality of patient

C. rib fracture

a 28 year old female sees you complaining of left sided back pain. you note that the left rib is tender to palpation and the left quadratus lumborum is hypertonic. rib 12 moves freely with exhalation but does not move with inhalation. what is the primary treatment modality for this somatic dysfunction?

A. isolytic lengthening

B. respiratory assistance

C. post-isometric relaxation

D. joint mobilization using muscle force

E. isokinetic strengthing

C. post-isometric relaxation

the anatomic significance of the tubercle on the shaft of rib 2 is best described by which of the following?

A. articulates with the transverse process of T1

B. articulates with the transverse process of T3

C. attachment of the middle scalene

D. attachment of the posterior scalene

E. divides the groove for subclavian artery and vein

D. attachment of the posterior scalene

the upper respiratory tract ciliated pseudostratified glandular columnar epithelium is generally described by which of the following?

A. parasympathetic

B. in balance between sympathetic and parasympathetic

C. sympathetic

D. neither sympathetic nor parasympathetic

A. parasympathetic

if a patient has congestion and increased fluid in his right maxillary sinus, where would the terminal lymphatic drainage occur?

A. right lymphatic duct

B. cisterna chyli

C. left lymphatic duct

D. right external jugular

A. right lymphatic duct

where do the cell bodies that innervate the respiratory epithelium reside?

A. lower cervical spine

B. T1-T5

C. T6-T10

D. upper cervical spine

E. brain

B. T1-T5

chapman's points approximately represent which of the following?

A. well-researched and mapped organ pathology points

B. sympathetic-parasympathetic reflex

C. clinically insignificant areas of tenderness

D. neuro-lymphatic reflex

E. somato-visceral reflex

D. neuro-lymphatic reflex

you are evaluating a 45 year old male patient with severe right-sided back pain, fever, and hematuria (blood in urine) in the emergency department. as you perform your evaluation, you note that he has significant tenderness to percussion at the costovertebral angle. you find exquisitely tender, stringy bands of tissue along the borders of a triangle circumscribing the umbilicus as well as 1 inch superior and 1 inch lateral to the umbilicus. you find boggy tissue texture changes at T10-T11. which organ(s) is/are most likely affected?

A. kidney and bladder

B. sigmoid colon

C. testicles and urethera

D. stomach and small intestine

E. liver

A. kidney and bladder

which of the following right sided structures of the body drain into the thoracic duct? right:

A. arm

B. breast

C.myocardium

D. colon

E. thoracic wall

D. colon

an 8 year old male presents to your office with his mother. he has a fever of 100.4 degrees F and complains of right ear pain. during your physical exam you note swollen and tender pre-auricular lymph nodes, and an erythematous tympanic membrane. of the following choices, which structure should be treated first to optimize lymphatic drainage in this patient?

A. cisterna chyli

B. right lymphatic duct

C. tentorium cerebelli

D. thoraco-abdominal diaphragm

E. thoracic duct

B. right lymphatic duct

a 32 year old male presents to your office after spraining his right ankle. on physical exam you note mild tenderness, erythema, and edema of his right ankle when compared to the left ankle. you decide to address his lymphatic system as part of your osteopathic treatment. of the following choices, which treatment would you do first to optimize lymphatic drainage in this patient?

A. pedal pump

B. right lymphatic duct release

C. thoracic inlet release

D. popliteal fossa release

E. thoraco-abdominal diaphragm release

C. thoracic inlet release

you are evaluating a patient with symptoms of rhinitis, cough, and sinus pressure. you decide to use osteopathic manipulation for appropriate structural findings. which of the following goals of treatment would be best utilized in treatment this patient with OMT?

A. balancing autonomic function

B. decreasing parasympathetic tone

C. decreasing sympathetic tone

D. increasing parasympathetic tone

E. increasing sympathetic tone

A. balancing autonomic function

what is the primary etiologic factor in the development of an upper respiratory infectious process?

A. compromised inherent healing potential of the host

B. increased local lymphatic drainage with decreased fluid viscosity

C. reduction of somatic dysfunction and associated sympathicotonia

D. any exposure to rhino, adeno, or corona viruses

E. secondary bacterial infection

A. compromised inherent healing potential of the host

which component or feature of terminal lymphatic vessels allows them to change shape and volume, and to resist collapse in response to tissue movement and edema?

A. anchoring filaments

B. discontinuous basement membrane

C. distensible layer of smooth muscle in the vessel wall

D. flap valves

E. single layer of overlapping endothelial cells

A. anchoring filaments

in what area of the spine are the cell bodies for the preganglionic neurons that provide sympathetic innervation of the upper respiratory tract epithelium located?

A. T1-T4

B. C1-C4

C. T5-T9

D. C5-C7

E. cranium/suboccipital

A. T1-T4

which of the following is one the challenges to maxillary sinus drainage?

A. cilia move fluid in an inferior direction

B. excess mucus is typically swallowed

C. maxillary ostia for sinus drainage are located in the superior medial wall

D. maxillary mucosa is normally under sympathetic nervous system control

E. normal maxillary mucosal drainage patterns include blind pouches

C. maxillary ostia for sinus drainage are located in the superior medial wall

what is the most important etiological factor in the pathogenesis of upper respiratory tract infections?

A. adenoviruses

B. bacteria like streptococcus

C. fungi

D. host healing potential

E. influenza and related viruses

D. host healing potential