COMLEX Level 1: High-Yield Review of Anatomy, Pathology, Pharmacology, and Physiology

What are the four tenets of osteopathic medicine?

The body is a unit; the body is capable of self-regulation and self-healing; structure and function are interrelated; rational treatment is based on these principles.

Which osteopathic model focuses on postural imbalances and musculoskeletal complaints?

Biomechanical model

Which osteopathic model addresses lymphatic flow, venous return, and edema?

Respiratory-circulatory model

Which osteopathic model involves the autonomic nervous system and viscerosomatic reflexes?

Neurological model

Which osteopathic model focuses on psychosocial factors and stress?

Behavioral model

What does the acronym TART stand for in somatic dysfunction?

Tenderness, Asymmetry, Restricted range of motion, Tissue texture changes

How is somatic dysfunction named?

For the freedom of motion (the direction the segment moves more freely)

What are the tissue texture characteristics of an acute somatic dysfunction?

Boggy, edematous, warm, moist, tender, and erythematous

What are the tissue texture characteristics of a chronic somatic dysfunction?

Cool, dry, fibrotic, ropy, stringy, and reduced range of motion

What is Fryette's Law I (Type I mechanics)?

In neutral, sidebending and rotation occur to opposite sides in a group of vertebrae.

What is Fryette's Law II (Type II mechanics)?

In flexion or extension, sidebending and rotation occur to the same side in a single segment.

What is the primary motion of the OA (occipitoatlantal) joint?

Flexion and extension (nodding)

How do sidebending and rotation occur at the OA joint?

They occur to opposite sides.

What is the primary motion of the AA (atlantoaxial) joint?

Pure rotation

In sacral motion, what happens to the sacral base during inhalation?

It moves posterior (craniosacral flexion).

In sacral motion, what happens to the sacral base during exhalation?

It moves anterior (craniosacral extension).

What defines a physiologic (forward) sacral torsion?

The axis and rotation are to the same side.

What defines a non-physiologic (backward) sacral torsion?

The axis and rotation are to opposite sides.

Where is the deep sacral sulcus located in a sacral torsion?

On the side opposite the rotation.

What are the findings of an anterior innominate rotation?

ASIS inferior, PSIS superior, pubic symphysis inferior, and a longer leg on the affected side.

What are the findings of a posterior innominate rotation?

ASIS superior, PSIS inferior, pubic symphysis superior, and a shorter leg on the affected side.

What does the standing flexion test identify?

The side of the dysfunctional innominate.

What does the seated flexion test identify?

The side of the sacral dysfunction.

Which spinal region has facets oriented in the sagittal plane?

Lumbar spine

Which spinal region has facets oriented in the coronal plane?

Thoracic spine

What is the most commonly tested osteopathic tenet?

Structure and function are reciprocally interrelated.

What rib motion increases the anterior-posterior diameter of the thorax?

Pump-handle motion (ribs 1-5)

What rib motion increases the transverse diameter of the thorax?

Bucket-handle motion (ribs 6-10)

What is the key rib for an inhalation rib dysfunction?

The bottom rib of the dysfunctional group

What is the key rib for an exhalation rib dysfunction?

The top rib of the dysfunctional group

Which muscle is primarily responsible for treating rib 1 dysfunction?

Anterior and middle scalenes

Which muscle is primarily responsible for treating ribs 3-5 dysfunction?

Pectoralis minor

Which muscle is primarily responsible for treating ribs 11-12 dysfunction?

Quadratus lumborum

What is the diagnostic purpose of an anterior Chapman point?

It is used to diagnose visceral dysfunction

What is the purpose of a posterior Chapman point?

It confirms the diagnosis of visceral dysfunction

What is the anterior Chapman point for the heart?

2nd intercostal space near the sternum

What is the anterior Chapman point for the appendix?

Tip of the 12th rib on the right

What is the sympathetic innervation level for the stomach?

T5-T9

What is the sympathetic innervation level for the kidneys?

T10-T11

Which cranial nerve provides parasympathetic innervation to the GI tract up to the splenic flexure?

Vagus nerve (CN X)

What spinal levels provide parasympathetic innervation to the pelvic organs?

S2-S4 (pelvic splanchnic nerves)

What is a facilitated segment?

A spinal segment with a lowered threshold for firing due to sustained afferent input

How does a direct OMT technique differ from an indirect one?

Direct techniques engage the restrictive barrier, while indirect techniques move away from it

What are three absolute contraindications for HVLA?

Fracture, malignancy, and severe osteoporosis

What type of muscle contraction is used in Muscle Energy Technique (MET)?

Isometric contraction

What is the duration of the contraction phase in MET?

3-5 seconds

What is reciprocal inhibition in the context of MET?

Contraction of the agonist muscle leads to relaxation of the antagonist muscle

What is the anterior Chapman point for the liver/gallbladder?

Right 6th intercostal space at the mid-clavicular line

What is the sympathetic innervation level for the adrenal glands?

T10

What is the anterior Chapman point for the bladder?

Periumbilical region

What is the posterior Chapman point for the prostate?

L5 spinous process

What is the primary goal of HVLA?

To restore motion, not to produce a 'pop' or 'crack'

What is the primary goal of Counterstrain treatment?

To reduce tenderness at a tender point by at least 70%.

How long is a Counterstrain position typically held?

90 seconds.

What is the key difference between Direct and Indirect Myofascial Release?

Direct MFR loads tissues against the restrictive barrier, while Indirect MFR positions tissues into ease.

What is the distinguishing feature of Facilitated Positional Release (FPR) compared to Counterstrain?

FPR uses a facilitating force (compression or torsion) and has a much shorter hold time of 3-5 seconds.

What are the five components of the Primary Respiratory Mechanism (PRM)?

Inherent rhythmic motility of the CNS, fluctuation of CSF, mobility of intracranial/intraspinal membranes, articular mobility of cranial bones, and involuntary mobility of the sacrum.

What happens to the sacral base during craniosacral flexion?

The sacral base moves posteriorly.

What is the normal range for the Cranial Rhythmic Impulse (CRI)?

8-14 cycles per minute.

Name three contraindications for lymphatic pump techniques.

Fractures, active malignancy, and acute infection.

How are SBS Torsion dysfunctions named?

For the higher greater wing of the sphenoid.

Which SBS dysfunctions are considered physiologic?

Torsion and Sidebending-Rotation.

What OMT techniques are recommended for a hospitalized patient with pneumonia?

Thoracic/lymphatic pump and rib raising.

What are the sympathetic levels for the celiac ganglion?

T5-T9.

What are the sympathetic levels for the superior mesenteric ganglion?

T9-T12.

What are the sympathetic levels for the inferior mesenteric ganglion?

T12-L2.

What is the neurotransmitter for postganglionic sympathetic fibers, excluding sweat glands?

Norepinephrine.

How do preganglionic and postganglionic fiber lengths compare between sympathetic and parasympathetic systems?

Sympathetics have short preganglionic and long postganglionic fibers; parasympathetics have long preganglionic and short postganglionic fibers.

What is the cellular mechanism behind hydropic change (cellular swelling)?

Failure of the Na/K-ATPase pump leading to water influx.

What is the 'point of no return' in irreversible cell injury?

Calcium influx into the mitochondria.

What are the three types of nuclear changes in irreversible cell injury?

Pyknosis, karyorrhexis, and karyolysis.

Which type of necrosis is characterized by 'ghost outlines' of tissue?

Coagulative necrosis.

In which organ is liquefactive necrosis most commonly seen during ischemia?

The brain.

What type of necrosis is associated with tuberculosis and fungal infections?

Caseous necrosis.

What causes fat necrosis in the context of pancreatitis?

Enzymatic digestion by lipase leading to saponification.

What is the hallmark of fibrinoid necrosis?

Immune complex deposition in vessel walls.

What is the difference between dry and wet gangrene?

Dry gangrene is coagulative (ischemic), while wet gangrene has superimposed liquefactive necrosis/infection.

Which cranial nerves provide parasympathetic outflow?

CN III, VII, IX, and X.

What are the primary characteristics of apoptosis?

Programmed cell death, no inflammation, cell shrinkage, and formation of apoptotic bodies.

Which proteins are involved in the intrinsic mitochondrial pathway of apoptosis?

Cytochrome c, BAX, and BAK, which are inhibited by BCL-2.

What are the executioner caspases involved in both intrinsic and extrinsic apoptosis pathways?

Caspases 3, 6, and 7.

What is the difference between hypertrophy and hyperplasia?

Hypertrophy is an increase in cell size, while hyperplasia is an increase in cell number.

What is metaplasia?

The reversible replacement of one mature cell type with another, often due to chronic stress.

What distinguishes dysplasia from metaplasia?

Dysplasia involves disordered, precancerous cell growth with a loss of uniformity, whereas metaplasia is a change in cell type.

What are the five cardinal signs of acute inflammation?

Rubor (redness), calor (heat), tumor (swelling), dolor (pain), and functio laesa (loss of function).

Which molecules mediate the rolling and adhesion phases of leukocyte migration?

Selectins mediate rolling, while integrins mediate tight adhesion.

What is the function of LTB4 in inflammation?

It acts as a potent neutrophil chemotactic agent.

What characterizes granulomatous inflammation?

A collection of epithelioid macrophages.

What is the hallmark of granulation tissue in wound healing?

The presence of fibroblasts and new capillaries.

What are the components of Virchow's triad for thrombosis?

Endothelial injury, stasis of blood flow, and hypercoagulability.

What are the 'Lines of Zahn' and what do they indicate?

Alternating layers of platelets/fibrin and RBCs; they distinguish an ante-mortem thrombus from a post-mortem clot.

What is the classic triad for fat embolism?

Petechiae, respiratory distress, and neurologic symptoms.

How does cardiogenic shock differ from hypovolemic shock regarding CVP/PCWP?

CVP/PCWP is high in cardiogenic shock and low in hypovolemic shock.

What are the four malignant tumors that do not follow the '-oma' naming convention?

Melanoma, lymphoma, mesothelioma, and seminoma.

Which tumor marker is associated with hepatocellular carcinoma and yolk sac tumors?

Alpha-fetoprotein (AFP).

What does an elevated S-100 marker suggest?

Melanoma, Schwannoma, or Langerhans cell histiocytosis.

Which paraneoplastic syndrome is associated with small cell lung cancer and ADH secretion?

SIADH.

What is the underlying mechanism of Lambert-Eaton syndrome in small cell lung cancer?

Antibodies against presynaptic calcium channels.

What is the most common oncogene in human cancer?

RAS.

Which translocation is associated with Burkitt lymphoma and the MYC oncogene?

t(8;14).