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OPP Exam 1

front 1

A 26-year-old runner has right-sided SI pain. Exam shows right ASIS inferior and right PSIS superior. Which dysfunction best fits?
A. Right posterior innominate rotation
B. Right anterior innominate rotation
C. Right superior innominate shear
D. Right inferior innominate shear

back 1

B. Right anterior innominate rotation

front 2

A patient has pelvic asymmetry: right ASIS superior and right PSIS superior. Which dysfunction best fits?
A. Right anterior innominate rotation
B. Right posterior innominate rotation
C. Left superior innominate shear
D. Right superior innominate shear

back 2

D. Right superior innominate shear

front 3

When naming vertebral motion in somatic dysfunction, motion is described as the:
A. Superior vertebra on inferior
B. Inferior vertebra on superior
C. Both vertebrae on sacrum
D. Segment relative to midline

back 3

A. Superior vertebra on inferior

front 4

During a C5–C6 foraminal procedure, the surgeon asks where the C6 nerve root exits relative to the C6 vertebra.
A. Below corresponding vertebra
B. Through vertebral body
C. Above corresponding vertebra
D. At same-level pedicle

back 4

C. Above corresponding vertebra

front 5

A resident is palpating cervical facet orientation. The superior articular facets in the cervical spine face:
A. Backward upward medial
B. Backward downward lateral
C. Forward upward lateral
D. Forward downward medial

back 5

A. Backward upward medial

front 6

Which pairing correctly matches “column support” descriptions?
A. OA three; C2-7 two
B. OA three; C2-7 three
C. OA two; C2-7 two
D. OA two; C2-7 three

back 6

D. OA two; C2-7 three

front 7

Which set is classified as atypical cervical vertebrae?
A. C3 to C7
B. C2 to C7
C. C1 and C2
D. C4 and C5

back 7

C. C1 and C2

front 8

In the atlas (C1), the cervical nerve root passes _____ to the vertebral artery.
A. Anterior
B. Posterior
C. Inferior
D. Lateral

back 8

B. Posterior

front 9

About 50% of cervical flexion/extension occurs primarily at the:
A. AA joint
B. C3-C4 joint
C. C7-T1 junction
D. OA joint

back 9

D. OA joint

front 10

Fryette’s 1st and 2nd principles do not apply to the:
A. Thoracic spine
B. Cervical spine
C. Lumbar spine
D. Sacrum

back 10

B. Cervical spine

front 11

Which statement best matches facet shape at C1–C2?
A. C1 inferior convex; C2 superior concave
B. C1 inferior concave; C2 superior concave
C. C1 inferior concave; C2 superior convex
D. C1 inferior convex; C2 superior convex

back 11

C. C1 inferior concave; C2 superior convex

front 12

In preventing catastrophic cord compression at C1–C2, the most crucial stabilizer is the:
A. Alar ligament
B. Apical ligament
C. PLL ligament
D. Cruciform ligament

back 12

D. Cruciform ligament

front 13

Which condition most strongly predisposes to cruciform ligament laxity at C1–C2?
A. Rheumatoid arthritis
B. Ankylosing spondylitis
C. Osteoporosis
D. Gout

back 13

A. Rheumatoid arthritis

front 14

A 12-year-old with trisomy 21 needs OMT for neck pain. Which is an absolute contraindication?
A. Cervical counterstrain
B. Cervical soft tissue
C. Cervical HVLA
D. Cervical myofascial release

back 14

C. Cervical HVLA

front 15

The AA joint contributes approximately 50% of cervical:
A. Flexion
B. Extension
C. Sidebending
D. Rotation

back 15

D. Rotation

front 16

A patient has radicular symptoms, but imaging shows reduced tendency for lateral cervical disc herniation. Which structure is most protective?
A. Ligamentum flavum
B. Uncinate processes
C. Nuchal ligament
D. Interspinous ligaments

back 16

B. Uncinate processes

front 17

Compared with typical transverse processes elsewhere, C3–C7 are best described as having:

back 17

Tubercles for muscle attachment

front 18

The C3–C7 facets lie in a plane oriented roughly:
A. Toward the ear, 30°
B. Toward the eye, 45°
C. Toward the nose, 60°
D. Toward the chin, 15°

back 18

B. Toward the eye, 45°

front 19

During a seated cervical exam, the paired bony “columns” you monitor for segmental rotation are the:
A. Spinous processes
B. Articular pillars
C. Transverse processes
D. Laminae

back 19

B. Articular pillars

front 20

The suboccipital muscles most strongly support head stability via:
A. Phasic force generation
B. Venous return pumping
C. Proprioception
D. Diaphragm recruitment

back 20

C. Proprioception

front 21

Which is NOT a suboccipital muscle?
A. Rectus capitis anterior major/minor
B. Obliquus capitis inferior
C. Rectus capitis posterior major/minor
D. Obliquus capitis superior

back 21

A. Rectus capitis anterior major/minor

front 22

A patient has persistent cervical extension dysfunction after whiplash. Which posterior muscles most contribute?
A. Splenius capitis, scalenes
B. Longus colli, SCM
C. Levator scapulae, pectoralis minor
D. Semispinalis cervicis, longissimus

back 22

D. Semispinalis cervicis, longissimus

front 23

A desk worker presents with a flexion dysfunction pattern. Which anterior muscles are most implicated?
A. Scalenes, longissimus
B. Longus colli, rectus capitis anterior
C. Trapezius, splenius capitis
D. Semispinalis cervicis, multifidus

back 23

B. Longus colli, rectus capitis anterior

front 24

A patient’s right SCM is in spasm. The expected head posture is:
A. Left sidebend, left rotate
B. Right sidebend, right rotate
C. Right sidebend, left rotate
D. Left sidebend, right rotate

back 24

C. Right sidebend, left rotate

front 25

In COPD, prominent neck accessory breathing and lateral neck stabilization most implicate the:
A. Scalenes
B. Suboccipitals
C. Infrahyoids
D. Masseter

back 25

A. Scalenes

front 26

In the neck, the investing layer of deep cervical fascia splits to enclose:
A. Scalenes and levator scapulae
B. SCM and trapezius
C. Longus colli and prevertebrals
D. Splenius capitis and semispinalis

back 26

B. SCM and trapezius

front 27

A patient has pain in the suboccipital triangle region. The suboccipital nerve root is:

back 27

C1

front 28

A patient has classic greater occipital neuralgia. The greater occipital nerve arises from:
A. Anterior ramus of C2
B. Posterior ramus of C1
C. Posterior ramus of C2
D. Anterior ramus of C3

back 28

C. Posterior ramus of C2

front 29

During a nerve block, the greater occipital nerve is targeted after it pierces the:
A. Splenius capitis
B. Semispinalis capitis
C. Trapezius
D. Levator scapulae

back 29

B. Semispinalis capitis

front 30

The 3rd occipital nerve root is:

back 30

C3

front 31

In a posterior neck dissection, the nerve found medial to the greater occipital nerve is the:
A. Third occipital nerve
B. Lesser occipital nerve
C. Great auricular nerve
D. Transverse cervical nerve

back 31

A. Third occipital nerve

front 32

A patient has shoulder abduction weakness and reduced elbow flexion strength. Which root best matches?

back 32

C5

front 33

A patient can’t extend the wrist well and also has weaker elbow flexion. Which root fits best?

back 33

C6

front 34

A patient has weak elbow extension plus impaired finger extension. Which root best matches?

back 34

C7

front 35

A patient has weak finger flexion and weak interossei. Which root is most likely?

back 35

C8

front 36

Loss of the C5 deep tendon reflex most directly reflects impaired:

back 36

Biceps reflex

front 37

A diminished C6 reflex most classically involves testing the

back 37

Brachioradialis tendon

front 38

The classic reflex used for C7 is the:

back 38

Triceps reflex

front 39

During an anterior approach near C2, which structure is expected to pass anterior to the axis?
A. Phrenic nerve
B. Accessory nerve
C. Vagus nerve
D. Greater occipital nerve

back 39

C. Vagus nerve

front 40

A patient has ipsilateral ptosis and miosis from a neck mass affecting sympathetics to the head. Preganglionic roots are primarily:
A. C5–T1
B. T1–T4
C. T5–T9
D. C1–C4

back 40

B. T1–T4

front 41

A nerve pierces semispinalis capitis and runs medial to the greater occipital nerve. Which nerve is this?
A. Lesser occipital nerve
B. Great auricular nerve
C. Third occipital nerve
D. Transverse cervical nerve

back 41

C. Third occipital nerve

front 42

In Horner syndrome from cervical sympathetic chain involvement, the sympathetics traveling through the neck to the head originate mainly from:
A. C1–C4
B. C5–C8
C. T5–T9
D. T1–T4

back 42

D. T1–T4

front 43

A 29-year-old with overhead-work pain has hand paresthesias. Which structure is classically implicated in TOS?
A. Sciatic nerve
B. Phrenic nerve
C. Brachial plexus
D. Femoral nerve

back 43

C. Brachial plexus

front 44

A climber develops arm claudication and cold-induced color change. In TOS, which vessel is most implicated?
A. Vertebral artery
B. Subclavian artery
C. Carotid artery
D. Axillary vein

back 44

B. Subclavian artery

front 45

A pitcher has arm swelling and venous congestion after repetitive abduction. In TOS, which vessel is most implicated?
A. Subclavian artery
B. Subclavian vein
C. Vertebral artery
D. Internal jugular

back 45

B. Subclavian vein

front 46

Which bony structure is part of the thoracic outlet region?
A. Olecranon
B. Scapular spine
C. First rib
D. Humeral head

back 46

C. First rib

front 47

Which muscle commonly contributes to TOS by abnormal insertion?
A. Levator scapulae
B. Splenius capitis
C. Trapezius
D. Pectoralis minor

back 47

D. Pectoralis minor

front 48

Excessive tension in which muscles is a listed cause of TOS?
A. Trapezius and rhomboids
B. Anterior and middle scalenes
C. Posterior scalenes only
D. Sternohyoid and omohyoid

back 48

B. Anterior and middle scalenes

front 49

Which dysfunction is explicitly listed as causing TOS?
A. Coccygeal fracture
B. Lumbar scoliosis
C. Cervical ribs
D. Sacral torsion

back 49

C. Cervical ribs

front 50

Which cluster best matches common TOS symptoms?
A. Diplopia, ataxia, dysarthria
B. Hemoptysis, fever, rash
C. Paresthesias, weakness, arm pain
D. Abdominal pain, jaundice, pruritus

back 50

C. Paresthesias, weakness, arm pain

front 51

Which symptom most suggests severe vascular compromise in TOS?
A. Mild stiffness
B. Localized tenderness
C. Ischemic tissue loss
D. Brief muscle twitch

back 51

C. Ischemic tissue loss

front 52

A patient’s fingertips are blackened. Which TOS complication is listed?
A. Cellulitis
B. Eczema
C. Purpura
D. Gangrene

back 52

D. Gangrene

front 53

Which is listed as a cervical spine special test?
A. Phalen
B. Wallenburg
C. Tinel
D. McMurray

back 53

B. Wallenburg

front 54

A positive Adson test indicates compression of the:
A. Subclavian vein
B. Vertebral artery
C. Subclavian artery
D. Brachial plexus

back 54

C. Subclavian artery

front 55

Adson positivity is attributed to either a cervical rib or tight:
A. Trapezius
B. Scalenes
C. Levator scapulae
D. Pectoralis major

back 55

B. Scalenes

front 56

Spurling, Valsalva, Adson, Wright's, and Military Brace are typically:
A. Standing
B. Seated
C. Supine
D. Prone

back 56

B. Seated

front 57

Compression, Distraction, and Wallenburg tests are typically:
A. Supine
B. Lateral recumbent
C. Seated
D. Standing

back 57

A. Supine

front 58

Which is a mechanical cause of neck pain?
A. Head/neck cancer
B. ACS referred pain
C. Spondylosis
D. Carotid dissection

back 58

C. Spondylosis

front 59

A patient’s neck pain began after minor strain with guarding. Which is a mechanical cause?
A. Infection
B. Muscle spasm/imbalance
C. Head/neck cancer
D. Carotid dissection

back 59

B. Muscle spasm/imbalance

front 60

A 58-year-old has neck pain plus exertional chest pressure. Which cause is listed?
A. Disc bulge
B. Muscle imbalance
C. ACS referred pain
D. Somatic dysfunction

back 60

C. ACS referred pain

front 61

Sudden neck rotation precedes focal neurologic symptoms. Which cause is listed?
A. Whiplash
B. Carotid artery dissection
C. Somatic dysfunction
D. Muscle spasm

back 61

B. Carotid artery dissection

front 62

Chronic neck pain worsens with poor sleep and strain. Which factor is listed?
A. Disc bulge
B. Stress
C. Spondylosis
D. Stenosis

back 62

B. Stress

front 63

Whiplash injuries classically occur in what sequence?
A. Hyperflexion then hyperextension
B. Rotation then sidebending
C. Hyperextension then hyperflexion
D. Sidebending then rotation

back 63

C. Hyperextension then hyperflexion

front 64

Normal cervical extension range of motion is approximately:
A. 15 degrees
B. 60 degrees
C. 90 degrees
D. 45 degrees

back 64

D. 45 degrees

front 65

Neck extension decreases by ~50% when rotated:
A. 75 degrees off midline
B. 45 degrees off midline
C. 15 degrees off midline
D. 90 degrees off midline

back 65

B. 45 degrees off midline

front 66

Spinal stenosis refers to abnormal:
A. Hypermobile facet joints
B. Narrowing of spinal canal
C. Tearing of annulus fibrosus
D. Widening of neural foramina

back 66

B. Narrowing of spinal canal

front 67

Most common sites of spinal stenosis include:
A. Thoracic and coccygeal
B. Cervical and sacral
C. Lumbar and cervical
D. Thoracic and sacral

back 67

C. Lumbar and cervical

front 68

Overall, spinal stenosis is most common in the:
A. Thoracic spine
B. Lumbar spine
C. Cervical spine
D. Sacral canal

back 68

B. Lumbar spine

front 69

Spinal stenosis is most dangerous in the:
A. Thoracic spine
B. Lumbar spine
C. Sacral canal
D. Cervical spine

back 69

D. Cervical spine

front 70

Which is a listed cause of spinal stenosis?
A. Ruptured ACL
B. Thyroid enlargement
C. Thickened ligamentum flavum
D. Myocardial ischemia

back 70

C. Thickened ligamentum flavum

front 71

Facet joint arthritis can cause stenosis via breakdown and:
A. Hernias
B. Calcaneal spurs
C. Cysts
D. Bursitis

back 71

C. Cysts

front 72

Stenosis after vertebral collapse most implicates:
A. Dural tear
B. Carotid plaque
C. Compression fractures
D. SCM hypertonicity

back 72

C. Compression fractures

front 73

Canal compromise from a posterior disc contour is listed as:
A. Ligament rupture
B. Annular tear without bulge
C. Disc bulge into canal
D. Disc herniation lateral

back 73

C. Disc bulge into canal

front 74

Degenerative stenosis can be driven by osteophytes, also called:
A. Bone cysts
B. Bone spurs
C. Stress fractures
D. Calcific nodules

back 74

B. Bone spurs

front 75

A patient with stenosis reports aching in which areas?
A. Hips, knees, ankles
B. Shoulders, arms, hands
C. Chest, abdomen, pelvis
D. Thighs, calves, feet

back 75

B. Shoulders, arms, hands

front 76

Symptoms of spinal stenosis may include:
A. Dermatomal vesicles
B. Brisk deep tendon reflexes
C. Miosis and ptosis
D. Hypothermia

back 76

B. Brisk deep tendon reflexes

front 77

A febrile patient with neck pain raises concern for which listed cause?
A. Spondylosis
B. Infection
C. Whiplash
D. Muscle imbalance

back 77

B. Infection

front 78

In TOS, which additional bony group is listed in the outlet region?
A. Upper ribs
B. Pelvic brim
C. Lower ribs
D. Lumbar transverse

back 78

A. Upper ribs

front 79

Which TOS special test is also called “military brace”?
A. Wallenburg test
B. Valsalva test
C. Spurling test
D. Costoclavicular maneuver

back 79

D. Costoclavicular maneuver

front 80

Unexplained neck pain with weight loss raises concern for:
A. Whiplash
B. Somatic dysfunction
C. Head/neck cancer
D. Muscle imbalance

back 80

C. Head/neck cancer

front 81

A patient has neck pain radiating into the upper thorax. The upper thoracic spine receives which fiber type from the cervical spine?
A. Visceral efferent
B. Nociceptive afferent
C. Somatic efferent
D. Parasympathetic afferent

back 81

B. Nociceptive afferent

front 82

Reflex hammer tap produces no response. How is this graded?

back 82

0/4

front 83

Which DTR grade is always abnormal because it includes clonus?

back 83

4/4

front 84

A brisk reflex response considered normal is graded:

back 84

2/4

front 85

A very brisk reflex response that may or may not be normal is graded:

back 85

3/4

front 86

A slight but definite reflex response that may or may not be normal is graded:

back 86

1/4

front 87

Palpation at the angle of the mandible corresponds most closely to which level?

back 87

C2

front 88

The hyoid bone landmark correlates best with:

back 88

C3

front 89

The top of the thyroid cartilage correlates best with:

back 89

C4

front 90

The bottom of the thyroid cartilage correlates best with:

back 90

C5

front 91

The cricoid cartilage landmark correlates best with:

back 91

C6

front 92

A tenderpoint at AC1 (mandible) is most associated with which muscle?
A. Longus colli
B. Rectus capitis anterior
C. SCM
D. Splenius capitis

back 92

B. Rectus capitis anterior

front 93

A tenderpoint at AC1 (transverse process) is most associated with:
A. Rectus capitis lateralis
B. Middle scalene
C. Longus capitis
D. Semispinalis capitis

back 93

A. Rectus capitis lateralis

front 94

AC2 tenderpoint is most associated with which pair?
A. SCM and trapezius
B. Splenius capitis and rotatores
C. Middle scalene and longus colli
D. Longus capitis and multifidus

back 94

C. Middle scalene and longus colli

front 95

AC3 and AC4 tenderpoints are associated with which grouping?
A. Posterior scalene, SCM, trapezius
B. Anterior and middle scalenes, longus capitis, longus colli
C. Semispinalis capitis, multifidus, rotatores
D. Rectus capitis posterior, obliquus inferior

back 95

B. Anterior and middle scalenes, longus capitis, longus colli

front 96

AC5 and AC6 tenderpoints are associated with:
A. SCM only
B. Anterior/middle/posterior scalenes, longus capitis, longus colli
C. Rectus capitis posterior minor, splenius capitis
D. Multifidus and rotatores only

back 96

B. Anterior/middle/posterior scalenes, longus capitis, longus colli

front 97

AC7 and AC8 tenderpoints are primarily associated with:
A. SCM
B. Longus colli
C. Semispinalis capitis
D. Middle scalene

back 97

A. SCM

front 98

PC1 (inion) tenderpoint is associated with medial border of:
A. Splenius capitis and SCM
B. Semispinalis capitis and rectus capitis posterior minor
C. Longus capitis and longus colli
D. Multifidus and rotatores

back 98

B. Semispinalis capitis and rectus capitis posterior minor

front 99

PC1 (occiput) tenderpoint is associated with:
A. Splenius capitis and suboccipitals
B. Middle and posterior scalenes
C. SCM and longus colli
D. Multifidus and rotatores

back 99

A. Splenius capitis and suboccipitals

front 100

PC2 (occiput) tenderpoint is associated with semispinalis capitis and the:
A. Lesser occipital nerve
B. Phrenic nerve
C. Greater occipital nerve
D. Vagus nerve

back 100

C. Greater occipital nerve

front 101

PC2 midline tenderpoint is associated with:
A. Rectus capitis posterior major/minor and obliquus capitis inferior
B. Longus colli and longus capitis
C. Splenius capitis and SCM
D. Semispinalis cervicis and longissimus

back 101

A. Rectus capitis posterior major/minor and obliquus capitis inferior

front 102

PC4–PC8 midline tenderpoints are associated with which muscle set?
A. Scalenes and SCM
B. Semispinalis capitis, multifidus, rotatores
C. Rectus capitis anterior, longus colli
D. Splenius capitis, trapezius

back 102

B. Semispinalis capitis, multifidus, rotatores

front 103

A patient has a PC3 midline tenderpoint with suboccipital pain. This point is most associated with irritation of the:
A. Lesser occipital nerve only
B. Great auricular nerve only
C. Greater and/or third occipital
D. Suprascapular and axillary nerves

back 103

C. Greater and/or third occipital

front 104

A PC3 midline tenderpoint may reflect hypertonicity in C3-innervated muscles. Which set best matches?
A. SCM, scalenes, trapezius
B. Middle scalene, longus capitis, longus colli
C. Splenius capitis, levator scapulae, rhomboids
D. Semispinalis capitis, multifidus, rotatores

back 104

B. Middle scalene, longus capitis, longus colli

front 105

After accounting for OA and AA contributions, which segments provide the remaining ~50% flex/ext and remaining ~50% rotation?
A. C1 only
B. Typical C3–C7
C. C2 only
D. T1–T4

back 105

B. Typical C3–C7

front 106

Typical cervical vertebrae (C3–C7) have the least motion in:
A. Flexion and extension
B. Rotation and sidebending
C. Translation and shear
D. Compression and distraction

back 106

A. Flexion and extension

front 107

The minor motion at the OA level is best termed:
A. Wobble
B. Slight translation
C. Coupled rotation
D. Side slipping/rotation

back 107

D. Side slipping/rotation

front 108

The minor motion at the AA joint is called:
A. Side slipping
B. Slight translation
C. Wobble
D. Springing

back 108

C. Wobble

front 109

The minor motion at C2–C7 is termed:
A. Wobble
B. Slight translation
C. Side slipping
D. Pure rotation

back 109

B. Slight translation

front 110

The major motion at the OA joint is primarily:
A. Flexion/extension
B. Rotation
C. Sidebending
D. Translation

back 110

A. Flexion/extension

front 111

The major motion at the AA joint is:
A. Sidebending only
B. Flexion/extension
C. Translation only
D. Rotation only

back 111

D. Rotation only

front 112

The major motions at C2–C7 include:
A. Rotation only
B. Flexion/extension only
C. Sidebending, rotation, flexion, extension
D. Sidebending and translation

back 112

C. Sidebending, rotation, flexion, extension

front 113

During cervical HVLA setup, the critical motion to avoid is:
A. Sidebending to barrier
B. Extending the neck
C. Rotating to barrier
D. Slight flexion to neutral

back 113

B. Extending the neck

front 114

Lumbar vertebral bodies are higher ______ than ______.
A. Posteriorly than anteriorly
B. Laterally than medially
C. Anteriorly than posteriorly
D. Inferiorly than superiorly

back 114

C. Anteriorly than posteriorly

front 115

This lumbar body orientation most contributes to developing:
A. Lordosis during walking
B. Kyphosis during sitting
C. Scoliosis during running
D. Lordosis during lying supine

back 115

A. Lordosis during walking

front 116

In lumbar vertebrae, which relationship is correct?
A. AP wider than transverse
B. Transverse wider than AP
C. Equal transverse and AP
D. Variable by segment only

back 116

B. Transverse wider than AP

front 117

A lateral lumbar image shows a vertebra with a larger body, thicker/shorter TPs, smaller SP, and markedly higher anteriorly. Which level fits best?
A. L1
B. L3
C. L4
D. L5

back 117

D. L5

front 118

Superior lumbar articular facets are ______ and face ______.
A. Concave; backward upward medial
B. Convex; laterally downward forward
C. Concave; laterally downward forward
D. Convex; backward upward medial

back 118

A. Concave; backward upward medial

front 119

Inferior lumbar articular facets are ______ and face ______.
A. Concave; backward upward medial
B. Concave; laterally upward backward
C. Convex; laterally downward forward
D. Convex; backward upward medial

back 119

C. Convex; laterally downward forward

front 120

The superior and inferior articular facets form the:
A. Costovertebral joints
B. Zygapophyseal joints
C. Uncovertebral joints
D. Atlantoaxial joints

back 120

B. Zygapophyseal joints

front 121

A 46-year-old with chronic low back pain has imaging showing asymmetric facet joint angles at L4–L5. This anomaly is most consistent with:
A. Lumbarization
B. Facet tropism
C. Sacralization
D. Spondylolysis

back 121

B. Facet tropism

front 122

Facet tropism most directly increases degeneration risk by promoting:
A. Symmetric muscle tension
B. Reduced disc hydration
C. Asymmetric spinal motion
D. Posterior ligament redundancy

back 122

C. Asymmetric spinal motion

front 123

Which statement about prevalence is correct?
A. Sacralization rarer than lumbarization
B. Lumbarization rarer than sacralization
C. They occur equally often
D. Both are extremely rare

back 123

B. Lumbarization rarer than sacralization

front 124

A patient with foraminal stenosis reports less radicular pain when bending forward. Lumbar flexion likely:
A. Narrows intervertebral foramina
B. Widens intervertebral foramina
C. Compresses facet capsules
D. Tightens PLL at L5

back 124

B. Widens intervertebral foramina

front 125

A patient’s radicular symptoms worsen when standing upright and extending the lumbar spine. Lumbar extension likely:
A. Widens intervertebral foramina
B. Decreases intradiscal pressure
C. Narrows intervertebral foramina
D. Reduces nerve root tension

back 125

C. Narrows intervertebral foramina

front 126

Thickening and calcification of which ligament can contribute to foraminal narrowing, stenosis, and nerve root compression?
A. Anterior longitudinal
B. Posterior longitudinal
C. Ligamentum flavum
D. Supraspinous

back 126

C. Ligamentum flavum

front 127

The interspinous ligament anchors which structures to facet joint capsules?
A. Thoracolumbar fascia, multifidus sheath
B. Iliolumbar ligament, psoas sheath
C. Dura mater, PLL fibers
D. Sacrotuberous, sacrospinous

back 127

A. Thoracolumbar fascia, multifidus sheath

front 128

A 38-year-old with reduced lumbar fascial adaptability is suspected to have age-related interspinous ligament changes. Chondrification typically begins after:
A. First decade
B. Second decade
C. Third decade
D. Fifth decade

back 128

C. Third decade

front 129

Chondrification of the interspinous ligament may increase injury risk primarily by diminishing:
A. Disc diffusion capacity
B. Thoracolumbar fascia alignment influence
C. Iliolumbar ligament stiffness
D. Facet joint synovial production

back 129

B. Thoracolumbar fascia alignment influence

front 130

At L5, the posterior longitudinal ligament is approximately:
A. Same width as cervical
B. Twice original width
C. One-half original width
D. Completely absent

back 130

C. One-half original width

front 131

At L5, the posterior longitudinal ligament characteristically becomes:
A. Thickened and smooth
B. Scalloped
C. Fused to lamina
D. Fenestrated laterally only

back 131

B. Scalloped

front 132

The combination of PLL thinness and scalloping at L5 most predisposes to:
A. Central cord syndrome and nerve impingement
B. Disc herniation and nerve impingement
C. Vertebral compression fracture and nerve impingement
D. Sacroiliitis and nerve impingement

back 132

B. Disc herniation and nerve impingement

front 133

The iliolumbar ligament attaches to transverse processes of:
A. L2 and L3
B. L3 and L4
C. L4 and L5
D. L5 and S1

back 133

C. L4 and L5

front 134

The iliolumbar ligament extends primarily to the:
A. Ischial spine and pubis
B. Iliac crest and SI regions
C. Greater trochanter and femur
D. Sacral hiatus and coccyx

back 134

B. Iliac crest and SI regions

front 135

The major function of the iliolumbar ligament is restricting motion at the lumbosacral junction, especially:
A. Extension
B. Sidebending
C. Flexion
D. Rotation

back 135

A. Extension

front 136

The earliest complaint from iliolumbar ligament irritation may present as:
A. Periumbilical pain
B. Posterior thigh numbness
C. Groin pain
D. Flank colic

back 136

C. Groin pain

front 137

In lumbosacral postural stress with decompensation, the first ligament to become tender is often the:
A. Supraspinous
B. Iliolumbar
C. ALL
D. Sacrotuberous

back 137

B. Iliolumbar

front 138

Which set contains only extrinsic muscles related to the lumbar region?
A. Diaphragm, QL, psoas major, psoas minor
B. Iliocostalis, longissimus, spinalis
C. Multifidus, rotatores, interspinales, intertransversarii
D. Semispinalis, splenius, levator scapulae

back 138

A. Diaphragm, QL, psoas major, psoas minor

front 139

Which set contains only intrinsic superficial lumbar muscles?
A. Diaphragm, QL, psoas major
B. Multifidus, rotatores, interspinales
C. Iliocostalis, longissimus, spinalis
D. Longus colli, longus capitis, SCM

back 139

C. Iliocostalis, longissimus, spinalis

front 140

Which set contains only intrinsic deep lumbar muscles?
A. Iliocostalis, longissimus, spinalis, QL
B. Multifidus, rotatores, interspinales, intertransversarii
C. Diaphragm, psoas, iliocostalis, rotatores
D. QL, multifidus, spinalis, psoas

back 140

B. Multifidus, rotatores, interspinales, intertransversarii

front 141

The left crus of the diaphragm is associated with the first:
A. One lumbar bodies
B. Two lumbar bodies
C. Three lumbar bodies
D. Four lumbar bodies

back 141

B. Two lumbar bodies

front 142

The right crus of the diaphragm is associated with the first:
A. Two lumbar bodies
B. Four lumbar bodies
C. One lumbar bodies
D. Three lumbar bodies

back 142

D. Three lumbar bodies

front 143

Quadratus lumborum attachments include:
A. Rib 12, L-spine, iliac crest
B. Rib 10, sacrum, ischium
C. Rib 12, sacrum, pubis
D. Rib 11, T-spine, femur

back 143

A. Rib 12, L-spine, iliac crest

front 144

Quadratus lumborum innervation is best described as:
A. C5–T1
B. T12, L1–L4
C. L4–S2
D. T1–T4

back 144

B. T12, L1–L4

front 145

Quadratus lumborum primary actions include:
A. Flexion and rotation
B. Extension and sidebending
C. Abduction and ER
D. Pronation and supination

back 145

B. Extension and sidebending

front 146

Psoas major attaches proximally from:
A. T6–T12
B. T12–L5
C. L1–S1
D. T1–T4

back 146

B. T12–L5

front 147

Psoas major inserts on the:
A. Greater trochanter
B. Ischial tuberosity
C. Lesser trochanter
D. Pectineal line

back 147

C. Lesser trochanter

front 148

Psoas major innervation is best described as:
A. L1–L3 (L2–L4)
B. T12–L2 only
C. S1–S4
D. C8–T2

back 148

A. L1–L3 (L2–L4)

front 149

The primary action of the psoas major is:
A. Hip extension
B. Hip flexion
C. Hip abduction
D. Hip adduction

back 149

B. Hip flexion

front 150

Psoas minor attaches from:
A. T12 and L1
B. L2 and L3
C. L4 and L5
D. S1 and S2

back 150

A. T12 and L1

front 151

Psoas minor inserts on the:
A. Lesser trochanter
B. Greater trochanter
C. Pectineal line
D. Ischial spine

back 151

C. Pectineal line

front 152

A cadaveric dissection reveals a small psoas minor muscle belly. Its innervation is most consistent with:
A. L2
B. T12
C. L1
D. L4

back 152

C. L1

front 153

A patient with mild anterior lumbar discomfort has isolated psoas minor involvement. Its primary action is best described as:
A. Strong hip flexor
B. Weak lumbar flexor
C. Hip abductor
D. Lumbar extensor

back 153

B. Weak lumbar flexor

front 154

On abdominal exam, the clinician uses the umbilicus level to estimate vertebral level and aortic bifurcation. This landmark corresponds to:
A. L1–L2
B. L2–L3
C. L3–L4
D. L4–L5

back 154

C. L3–L4

front 155

A student palpates the iliac crest to approximate spinal level. This landmark corresponds most closely to:
A. L2–L3
B. L4–L5
C. L5–S1
D. L3–L4

back 155

B. L4–L5

front 156

When ranking lumbar spine motion magnitude, the correct order is:
A. Sidebending > rotation > flex/extend
B. Rotation > sidebending > flex/extend
C. Flex/extend > rotation > sidebending
D. Flex/extend > sidebending > rotation

back 156

D. Flex/extend > sidebending > rotation

front 157

In lumbosacral mechanics, rotation occurs in ______ directions for L5 and the sacrum.

back 157

Opposite

front 158

A patient develops a compensatory lumbar scoliosis due to a primary thoracic curve. This pattern is most consistent with:
A. Single apex structural curve
B. Group curves in lumbar spine
C. Pelvic obliquity only
D. Sacral torsion primary

back 158

B. Group curves in lumbar spine

front 159

In the lumbar spine, flexion and extension are coupled with:
A. Axial compression
B. Medial glide
C. Anterior-posterior translation
D. Contralateral slide

back 159

C. Anterior-posterior translation

front 160

During lumbar sidebending, the coupled translational component is typically a:
A. Ipsilateral slide
B. Contralateral translatory slide
C. Anterior translation
D. Posterior translation

back 160

B. Contralateral translatory slide

front 161

In the lumbar spine, rotation is coupled with:
A. Disc compression
B. Disc distraction
C. Foraminal widening
D. Facet gapping only

back 161

A. Disc compression

front 162

On lateral lumbar radiograph, Ferguson’s angle is formed using a line:
A. Perpendicular to sacral base
B. Parallel to sacral base floor
C. Along L5 spinous process
D. Along iliac crest

back 162

B. Parallel to sacral base floor

front 163

Ferguson’s angle is primarily used to assess:
A. Thoracic kyphosis
B. Spondylolisthesis grade
C. Hyper-lordosis of lumbar spine
D. Pelvic incidence

back 163

C. Hyper-lordosis of lumbar spine

front 164

Normal Ferguson’s angle is closest to:
A. 5–15°
B. 15–25°
C. 25–35°
D. 35–45°

back 164

C. 25–35°

front 165

The lumbar plexus is composed of branches of T12 plus ventral rami of:
A. L1–L4
B. L2–L5
C. L3–S1
D. T10–L2

back 165

A. L1–L4

front 166

A patient has epigastric visceral pain referred via sympathetic fibers. The celiac ganglion roots are:
A. T1–T4
B. T5–T9
C. T10–T11
D. T12–L2

back 166

B. T5–T9

front 167

A patient has midgut-type visceral pain distribution. Superior mesenteric ganglion roots are:
A. T12–L2
B. T5–T9
C. T10–T11
D. T1–T4

back 167

C. T10–T11

front 168

A patient has hindgut-type visceral pain distribution. Inferior mesenteric ganglion roots are:
A. T10–T11
B. T12–L2
C. T5–T9
D. L3–L5

back 168

B. T12–L2

front 169

A patient has burning pain and numbness over the anterolateral thigh after weight gain and tight belts. Which nerve is compressed?
A. Femoral nerve
B. Obturator nerve
C. Lateral femoral cutaneous nerve
D. Ilioinguinal nerve

back 169

C. Lateral femoral cutaneous nerve

front 170

This entrapment under the inguinal ligament near the ASIS is called:
A. Piriformis syndrome
B. Meralgia paresthetica
C. Tarsal tunnel syndrome
D. Carpal tunnel syndrome

back 170

B. Meralgia paresthetica

front 171

Meralgia paresthetica most classically presents with:
A. Posterior thigh weakness
B. Pain and numbness
C. Foot drop
D. Groin swelling

back 171

B. Pain and numbness

front 172

Which is a listed risk factor for meralgia paresthetica?
A. Tight belts
B. Hypothyroidism
C. Smoking
D. Vitamin C deficiency

back 172

A. Tight belts

front 173

The most common broad category of low back pain causes is:
A. Malignancy
B. Mechanical
C. Infection
D. Vascular

back 173

B. Mechanical

front 174

A 41-year-old has radicular pain with passive straight leg elevation. A positive straight leg raise between which angles is most suggestive of lumbar disc herniation?
A. 0–20°
B. 20–30°
C. 70–90°
D. 30–70°

back 174

D. 30–70°

front 175

A patient has a clearly positive straight leg raise (SLR) supine. Which follow-up finding should also be present if the exam is consistent?
A. Positive seated SLR
B. Negative seated SLR
C. Positive Thomas test
D. Negative Braggard’s

back 175

A. Positive seated SLR

front 176

Braggard’s test is performed by raising the straight leg, then:
A. Add hip adduction at pain
B. Add ankle dorsiflexion below pain
C. Add lumbar extension at pain
D. Add knee flexion above pain

back 176

B. Add ankle dorsiflexion below pain

front 177

Braggard’s test is considered positive if:
A. Dorsiflexion reproduces pain
B. Plantarflexion relieves pain
C. Inversion reproduces weakness
D. Eversion reproduces numbness

back 177

A. Dorsiflexion reproduces pain

front 178

A patient with anterior hip tightness is suspected to have psoas hypertonicity. Which test is most appropriate?
A. Hoover test
B. Thomas test
C. Braggard’s test
D. Wallenberg test

back 178

B. Thomas test

front 179

A clinician suspects symptom exaggeration during lower-extremity strength testing. Which test is used for malingering?
A. Thomas test
B. Hoover test
C. Spurling test
D. Adson test

back 179

B. Hoover test

front 180

Hoover test validity is based on which physiologic principle?
A. Golgi tendon reflex
B. Stretch reflex
C. Crossed extensor reflex
D. Withdrawal reflex

back 180

C. Crossed extensor reflex

front 181

A 68-year-old has low back pain radiating to the legs that worsens with extension and improves with flexion. This pattern most suggests:

back 181

Spinal stenosis

front 182

Radiology suggests spinal stenosis. Which finding best matches?
A. Lytic lesions, decreased disc space
B. Osteophytes, decreased disc space
C. Widened disc space, decreased disc space
D. Vertebral lucencies, decreased disc space

back 182

B. Osteophytes, decreased disc space

front 183

Treatment goals for spinal stenosis include:
A. Increase ROM, reduce restrictions, straighten canal
B. Fuse SI joints, limit motion, brace spine
C. Increase kyphosis, reduce flexion, rest
D. Reduce lordosis, immobilize spine, traction

back 183

A. Increase ROM, reduce restrictions, straighten canal

front 184

Which mechanism can narrow canal/foramina in stenosis and compress roots?
A. Hypertrophy of facet joints
B. Increased disc height
C. Thinned ligamentum flavum
D. Enlarged interspinous space

back 184

A. Hypertrophy of facet joints

front 185

Which stenosis contributor is specifically listed?
A. Calcium deposits in LF and PLL
B. Calcium deposits in ALL only
C. Complete PLL absence at L3
D. Increased facet cartilage only

back 185

A. Calcium deposits in LF and PLL

front 186

Loss of which feature contributes to stenosis-related compression?
A. Increased IV disc height
B. Loss of IV disc height
C. Increased foraminal diameter
D. Ligament laxity only

back 186

B. Loss of IV disc height

front 187

Ankylosing spondylitis (AS) is best classified as a:
A. Seropositive spondylitis
B. Crystal arthropathy
C. Seronegative spondylitis
D. Septic arthritis

back 187

C. Seronegative spondylitis

front 188

A lab association commonly seen in AS is:
A. HLA-DR4
B. HLA-B27
C. Anti-CCP
D. ANA positivity

back 188

B. HLA-B27

front 189

In ankylosing spondylitis, which joints commonly ossify causing “bamboo spine”?
A. SI and facet joints
B. Hip and knee joints
C. Atlanto-occipital joints
D. Shoulder and elbow joints

back 189

A. SI and facet joints

front 190

AS inflammatory back pain is characteristically:
A. Better with rest, inactivity stiffness
B. Worse with activity, activity makes stiffness
C. Worse night/morning, inactivity stiffness
D. Worse midday, relieved supine

back 190

C. Worse night/morning, inactivity stiffness

front 191

Which is an extraarticular AS manifestation?
A. Uveitis
B. Nephrolithiasis
C. Gouty tophi
D. Otitis externa

back 191

A. Uveitis

front 192

Another extraarticular association listed for AS is:
A. IBD
B. Hyperparathyroidism
C. Pancreatitis
D. Celiac sprue only

back 192

A. IBD

front 193

Which skin condition is listed among AS extraarticular manifestations?
A. Vitiligo
B. Psoriasis
C. Rosacea
D. Pemphigus

back 193

B. Psoriasis

front 194

AS may increase risk of which broader disease categories?
A. Cardiovascular and pulmonary
B. Renal and endocrine
C. Hepatic and hematologic
D. Dermatologic and ocular only

back 194

A. Cardiovascular and pulmonary

front 195

Spondylolysis best seen on which lumbar x-ray view?
A. AP
B. Lateral
C. Oblique
D. Flexion-extension

back 195

C. Oblique

front 196

Spondylolisthesis best seen on:
A. Oblique view
B. Lateral view
C. AP pelvis
D. Open-mouth odontoid

back 196

B. Lateral view

front 197

A patient has a pars interarticularis defect without anterior translation. This is:
A. Spondylosis
B. Spondylolisthesis
C. Spondylolysis
D. Spinal stenosis

back 197

C. Spondylolysis

front 198

A patient has pars defect with anterior displacement of the vertebra. This is:
A. Spondylolysis
B. Spondylosis
C. Spondylolisthesis
D. Disc bulge

back 198

C. Spondylolisthesis

front 199

Meyerding’s classification is used to grade severity of:
A. Spinal stenosis
B. Spondylolysis
C. Spondylolisthesis
D. Spondylosis

back 199

C. Spondylolisthesis

front 200

A patient has 1-25% anterior slip. Meyerding grade is:
A. Grade II
B. Grade III
C. Grade I
D. Grade IV

back 200

C. Grade I

front 201

A patient has 26-50% anterior slip. Meyerding grade is:
A. Grade I
B. Grade II
C. Grade IV
D. Grade III

back 201

B. Grade II

front 202

A patient has 51-75% anterior slip. Meyerding grade is:
A. Grade III
B. Grade IV
C. Grade I
D. Grade II

back 202

A. Grade III

front 203

A patient has 76-100% anterior slip. Meyerding grade is:
A. Grade I
B. Grade II
C. Grade IV
D. Grade III

back 203

C. Grade IV

front 204

Lumbar disc herniations typically affect the nerve root of the vertebra:
A. Above
B. Below
C. Same level
D. Contralateral

back 204

B. Below

front 205

A 38-year-old has shooting leg pain greater than back pain, worsened by prolonged sitting and flexion, relieved by extension. Most consistent with:
A. Facet irritation
B. Iliolumbar strain
C. Disc herniation/bulge
D. Ankylosing spondylitis

back 205

C. Disc herniation/bulge

front 206

In disc herniation/bulge, which pain pattern is most typical?
A. Leg pain > back pain
B. Back pain > leg pain
C. Equal pain always
D. Back pain only

back 206

A. Leg pain > back pain

front 207

A patient with radicular symptoms has objective weakness and paresthesias. Which additional finding is listed?
A. Hyperactive DTR
B. Loss of DTR
C. Babinski sign
D. Normal DTR always

back 207

B. Loss of DTR

front 208

After lifting, a patient develops urinary retention and saddle anesthesia. Most likely cause:
A. Massive central disc herniation
B. Piriformis spasm
C. Iliolumbar strain
D. Foraminal osteophyte

back 208

A. Massive central disc herniation

front 209

The scenario above represents a surgical emergency termed:
A. Conus medullaris syndrome
B. Cauda equina syndrome
C. Meralgia paresthetica
D. Psoas syndrome

back 209

B. Cauda equina syndrome

front 210

Which symptom set best supports cauda equina syndrome?
A. Saddle anesthesia, bowel/bladder loss
B. Night pain, morning stiffness
C. Claudication, Raynaud phenomenon
D. Shoulder pain, paresthesias

back 210

A. Saddle anesthesia, bowel/bladder loss

front 211

Acute low back pain with decreased rectal sphincter tone is most concerning for:
A. Lumbar strain
B. Facet arthropathy
C. Cauda equina syndrome
D. Piriformis syndrome

back 211

C. Cauda equina syndrome

front 212

Lower crossed syndrome is best described as:
A. Lower-body muscle imbalance pattern
B. Autoimmune spinal arthritis
C. Vascular claudication syndrome
D. Primary nerve root disorder

back 212

A. Lower-body muscle imbalance pattern

front 213

In lower crossed syndrome, which muscles are typically tight?
A. Abdominals, gluteals
B. Hip flexors, lumbar extensors
C. Hamstrings, abdominals
D. Gluteals, adductors

back 213

B. Hip flexors, lumbar extensors

front 214

In lower crossed syndrome, which muscles are typically weak?
A. Lumbar extensors, Gluteus Maximus/Minimus
B. Hamstrings, Gluteus Maximus/Minimus
C. Rectus abdominis, Gluteus Maximus/Minimus
D. Quadriceps, Gluteus Maximus/Minimus

back 214

C. Rectus abdominis, Gluteus Maximus/Minimus

front 215

The postural pattern of lower crossed syndrome most often includes:
A. Posterior pelvic tilt
B. Flat lumbar spine
C. Anterior pelvic tilt
D. Decreased hip flexion

back 215

C. Anterior pelvic tilt

front 216

Lower crossed syndrome commonly produces increased hip _____ and a _____ lumbar spine.
A. extension; kyphotic
B. flexion; hyperlordotic
C. adduction; neutral
D. abduction; flattened

back 216

B. flexion; hyperlordotic

front 217

The key dysfunction in psoas syndrome is a Type II SD of:
A. L1 or L2
B. L3 or L4
C. L4 or L5
D. T12 or L1

back 217

A. L1 or L2

front 218

The most direct cause of psoas syndrome is:
A. Acute tearing of psoas
B. Prolonged shortening of psoas
C. Central disc herniation
D. SI joint infection

back 218

B. Prolonged shortening of psoas

front 219

Which of the following findings is most consistent with psoas syndrome?
A. Pelvic shift toward the side of spasm
B. Forward sacral torsion
C. Pelvic shift away from the side of spasm
D. Ipsilateral piriformis spasm

back 219

C. Pelvic shift away from the side of spasm

front 220

In psoas syndrome, sacral rotation is:
A. Forward
B. Backward
C. Always right
D. Always left

back 220

B. Backward

front 221

In psoas syndrome, which muscle spasms?
A. Ipsilateral piriformis
B. Contralateral piriformis
C. Ipsilateral QL
D. Contralateral gluteus medius

back 221

B. Contralateral piriformis

front 222

A patient leans forward and slightly to one side and cannot stand straight. Most consistent with:
A. Disc herniation
B. Ankylosing spondylitis
C. Psoas syndrome
D. Meralgia paresthetica

back 222

C. Psoas syndrome

front 223

Psoas syndrome posterior thigh pain usually:
A. Radiates below the knee
B. Stops at or above the knee
C. Always reaches the foot
D. Always causes weakness

back 223

B. Stops at or above the knee

front 224

Deep buttock pain radiates in sciatic pattern but stops at/above knee; leg rests externally rotated and resists internal rotation. Diagnosis?
A. Lumbar stenosis
B. Disc herniation
C. Iliolumbar sprain
D. Piriformis syndrome

back 224

D. Piriformis syndrome

front 225

Which is a listed cause of piriformis syndrome?
A. Driving long distances
B. Walking uphill
C. Throwing overhead
D. Cycling standing

back 225

A. Driving long distances

front 226

A classic positional trigger for piriformis syndrome is:
A. Sleeping supine
B. Sitting with legs crossed
C. Standing neutral
D. Lying prone

back 226

B. Sitting with legs crossed

front 227

Iliolumbar ligament pain referral includes:
A. Groin, SI joint, lateral thigh
B. Posterior calf, heel, foot
C. Neck, shoulder, arm
D. Epigastrium, chest, jaw

back 227

A. Groin, SI joint, lateral thigh

front 228

Iliolumbar ligament irritation can be triggered by:
A. Increased stability states
B. Destabilization states
C. Vitamin deficiency only
D. Bradycardia states

back 228

B. Destabilization states

front 229

A 47-year-old with iliolumbar ligament pain stands shifted. In iliolumbar ligament syndrome, pelvic side shift is usually:
A. Away from painful side
B. No side shift present
C. Toward affected ligament
D. Toward the opposite ligament

back 229

C. Toward affected ligament

front 230

In iliolumbar ligament syndrome, which ipsilateral finding is common?
A. Tight hip adductors
B. Weak hip adductors
C. Tight hip abductors
D. Weak hip abductors

back 230

A. Tight hip adductors

front 231

Sidebending of L5 most directly induces which sacral axis?
A. Vertical sacral axis
B. Oblique sacral axis
C. Longitudinal axis
D. Pure transverse axis

back 231

B. Oblique sacral axis

front 232

During lumbosacral coupling, L5 rotation occurs _____ the sacrum.
A. Same as
B. Ipsilateral to
C. Independent of
D. Opposite to

back 232

D. Opposite to

front 233

the superior, broad portion of the pelvis situated above the pelvic brim/inlet, bounded by the iliac wings, and considered part of the abdominal cavity

back 233

false pelvis

front 234

the lower, bowl-shaped bony cavity situated below the pelvic brim (linea terminalis), containing the pelvic inlet, cavity, and outlet

back 234

true pelvis

front 235

The innominate bone consists of:
A. Ilium sacrum pubis
B. Ischium sacrum pubis
C. Ilium coccyx pubis
D. Ilium ischium pubis

back 235

D. Ilium ischium pubis

front 236

Complete fusion of the innominate occurs by:
A. Early childhood
B. Late teens/early 20s
C. Mid-30s
D. After menopause

back 236

B. Late teens/early 20s

front 237

Superiorly, the sacrum articulates with:
A. L4
B. S1
C. L5
D. T12

back 237

C. L5

front 238

Bilateral sacral articulation completing the pelvic ring is with the:
A. Innominates
B. Femurs
C. Iliolumbar ligaments
D. Coccyx

back 238

A. Innominates

front 239

The anterior superior portion of S1 is the:
A. Sacral ala
B. Sacral hiatus
C. ILA
D. Sacral promontory

back 239

D. Sacral promontory

front 240

The anterior surface of the sacrum is:
A. Flat
B. Concave
C. Convex
D. Irregular

back 240

B. Concave

front 241

The posterior sacral surface is _____ with palpable tubercles.
A. Concave
B. Flat
C. Convex
D. Smooth

back 241

C. Convex

front 242

The medial row of sacral tubercles forms from fused:
A. Spinous processes
B. Transverse processes
C. Costal elements
D. Articular processes

back 242

D. Articular processes

front 243

The lateral row of sacral tubercles forms from fused:
A. Transverse processes
B. Articular processes
C. Spinous processes
D. Vertebral bodies

back 243

A. Transverse processes

front 244

The inferior curve of the lateral tubercle row is the:
A. Sacral promontory
B. Sacral hiatus
C. Inferolateral angle (ILA)
D. Median sacral crest

back 244

C. Inferolateral angle (ILA)

front 245

The sacrum has how many pairs of sacral foramina?
A. Two pairs
B. Four pairs
C. Five pairs
D. Three pairs

back 245

B. Four pairs

front 246

A caudal epidural is performed through the:
A. Sacral hiatus
B. Sacral promontory
C. ILA
D. Arcuate line

back 246

A. Sacral hiatus

front 247

The coccyx attaches to the sacral apex via the:
A. Pubic symphysis
B. SI joint
C. Lumbosacral joint
D. Sacrococcygeal joint

back 247

D. Sacrococcygeal joint

front 248

The ganglion impar is the site where:
A. Parasympathetics synapse
B. Sympathetic chains join
C. Ventral rami fuse
D. Dorsal roots decussate

back 248

B. Sympathetic chains join

front 249

The ganglion impar rests on the anterior surface of the:
A. Sacral promontory
B. Sacral base
C. Coccyx
D. Iliac crest

back 249

C. Coccyx

front 250

The superior transverse sacral axis is located:
A. At S4
B. At S2
C. Below S2
D. Above S2

back 250

D. Above S2

front 251

Motion around the superior transverse sacral axis is driven by the:
A. Gait cycle mechanism
B. Cranial primary respiratory mechanism
C. Valsalva maneuver
D. Pelvic diaphragm contraction

back 251

B. Cranial primary respiratory mechanism

front 252

The middle sacral transverse axis is found:
A. At S2
B. Above S1
C. Below S4
D. At S5

back 252

A. At S2

front 253

Forward/backward sacral bending at the SI joint occurs around the:
A. Inferior transverse axis
B. Superior transverse axis
C. Middle transverse axis
D. Vertical sacral axis

back 253

C. Middle transverse axis

front 254

The inferior transverse sacral axis is located:
A. At S2
B. Above S2
C. At S1
D. Below S2

back 254

D. Below S2

front 255

Rotation of the innominates occurs around the:
A. Inferior transverse sacral axis
B. Middle transverse sacral axis
C. Superior transverse sacral axis
D. Lumbosacral junction axis

back 255

A. Inferior transverse sacral axis

front 256

A pelvic anatomy question asks which ligament directly contributes to forming both the greater and lesser sciatic foramina.

back 256

Sacrospinous

front 257

A cadaver shows a ligament from the inferior medial sacrum to the ischial tuberosity and posterior sciatic notch margins. Which is it?

back 257

Sacrotuberous

front 258

A surgeon identifies a ligament running to the ischial spine from a point anterior to the sacrotuberous ligament. Which ligament is this?

back 258

Sacrospinous

front 259

Which pair primarily restrains anterior sacral movement within the pelvis?
A. Iliolumbar and ALL
B. Sacrotuberous and sacrospinous
C. Interspinous and PLL
D. Inguinal and lacunar

back 259

B. Sacrotuberous and sacrospinous

front 260

A 52-year-old with lumbosacral instability has focal tenderness near the iliac crest with groin referral mimicking an inguinal hernia. The referral pathway is via the:
A. Genitofemoral nerve
B. Femoral nerve
C. Ilioinguinal nerve
D. Pudendal nerve

back 260

C. Ilioinguinal nerve

front 261

The ligament above is prone to irritation particularly from:
A. Cervical rib compression
B. LS instability
C. Hip OA only
D. Thoracic kyphosis

back 261

B. LS instability

front 262

Lower fibers of the iliolumbar ligament integrate with which ligament, linking SI mechanics to the lumbar spine?
A. Posterior SI ligament
B. Anterior SI ligament
C. Sacrotuberous ligament
D. Sacrospinous ligament

back 262

B. Anterior SI ligament

front 263

Stress on which ligament set can drive lumbosacral imbalance and degeneration?
A. Iliolumbar, sacrotuberous, sacrospinous
B. ALL, PLL, interspinous
C. Nuchal, supraspinous, flavum
D. Inguinal, lacunar, pectineal

back 263

A. Iliolumbar, sacrotuberous, sacrospinous

front 264

Which artery supplies the lower extremity?
A. Internal iliac
B. External iliac
C. Inferior epigastric
D. Obturator

back 264

B. External iliac

front 265

Which artery primarily supplies the pelvis?
A. Femoral
B. External iliac
C. Internal iliac
D. Popliteal

back 265

C. Internal iliac

front 266

Which set contains only posterior trunk branches listed?
A. Iliolumbar, lateral sacral, superior gluteal
B. Obturator, internal pudendal, inferior gluteal
C. Superior vesical, middle rectal, umbilical
D. Inferior vesical, vaginal, obturator

back 266

A. Iliolumbar, lateral sacral, superior gluteal

front 267

The terminal branch noted for the anterior trunk list is the:
A. Superior gluteal artery
B. Inferior gluteal artery
C. Lateral sacral artery
D. Iliolumbar artery

back 267

B. Inferior gluteal artery

front 268

The sacral plexus is formed by ventral rami of:
A. L2–S2
B. L4–S4
C. L1–L5
D. S1–S5

back 268

B. L4–S4

front 269

Pelvic splanchnic nerves carry parasympathetic fibers from:
A. T12–L2
B. L4–S2
C. S2–S4
D. S1–S3

back 269

C. S2–S4

front 270

Sciatic nerve roots are:
A. L4–S3
B. L5–S2
C. L2–L4
D. S2–S4

back 270

A. L4–S3

front 271

Common fibular nerve roots are:
A. L4–S3
B. L4–S2
C. L5–S3
D. S1–S4

back 271

B. L4–S2

front 272

Tibial nerve roots are:
A. L2–L4
B. L4–S2
C. L4–S3
D. S2–S4

back 272

C. L4–S3

front 273

A nerve passes through the lesser sciatic foramen inferior to piriformis to innervate perineal skin and muscles. Which nerve?
A. Sciatic nerve
B. Superior gluteal nerve
C. Pudendal nerve
D. Obturator nerve

back 273

C. Pudendal nerve

front 274

Pudendal nerve roots are:
A. L4–S1
B. S2–S4
C. L2–L4
D. L5–S2

back 274

B. S2–S4

front 275

The superior gluteal nerve innervates gluteus medius/minimus and:
A. Gluteus maximus
B. Piriformis
C. Tensor fascia lata
D. Obturator internus

back 275

C. Tensor fascia lata

front 276

Superior gluteal nerve roots are:
A. L4–S1
B. L5–S2
C. L2–L4
D. S2–S4

back 276

A. L4–S1

front 277

Inferior gluteal nerve innervates:
A. Gluteus maximus
B. Gluteus medius
C. Tensor fascia lata
D. Gluteus minimus

back 277

A. Gluteus maximus

front 278

Inferior gluteal nerve roots are:
A. L4–S1
B. L5–S2
C. L4–S3
D. S4–C0

back 278

B. L5–S2

front 279

Obturator nerve roots are:
A. L2–L4
B. L4–S3
C. S2–S4
D. L5–S2

back 279

A. L2–L4

front 280

The perforating cutaneous nerve passes through the:
A. Sacrospinous ligament
B. Inguinal ligament
C. Sacrotuberous ligament
D. Iliolumbar ligament

back 280

C. Sacrotuberous ligament

front 281

The coccygeal plexus nerve roots are:
A. L4–S4
B. S2–S4
C. S4–C0
D. L5–S2

back 281

C. S4–C0

front 282

Which roots penetrate coccygeus, sacrospinous, and sacrotuberous ligaments (as listed)?
A. S1 and S2
B. S5 and C0
C. S2 and S3
D. L5 and S1

back 282

B. S5 and C0

front 283

S5 and C0 join S4 to form anococcygeal nerves that innervate skin of the:
A. Urogenital triangle
B. Anal triangle
C. Gluteal region
D. Lateral thigh

back 283

B. Anal triangle

front 284

Sympathetic roots innervating pelvic viscera via paravertebral trunk and sacral splanchnics are:
A. T6–T12
B. T12–L2
C. L4–S4
D. S2–S4

back 284

B. T12–L2

front 285

The primary “muscle” region providing core pelvic support is best described as the:
A. Urogenital diaphragm
B. Pelvic diaphragm
C. Gluteal sling
D. Thoracolumbar fascia

back 285

B. Pelvic diaphragm

front 286

Which set contains only secondary pelvic muscles with partial attachment to the true pelvis?
A. Rectus abdominis, QL, piriformis
B. Levator ani, coccygeus, obturator internus
C. Gluteus medius, adductors, TFL
D. Psoas major, multifidus, diaphragm

back 286

A. Rectus abdominis, QL, piriformis

front 287

The intrinsic pelvic diaphragm is composed of:
A. Levator ani and coccygeus
B. Piriformis and obturator internus
C. Rectus abdominis and obliques
D. QL and transversus abdominis

back 287

A. Levator ani and coccygeus

front 288

The levator ani consists of iliococcygeus, pubococcygeus, and:
A. Puborectalis
B. Semispinalis
C. Obturator externus
D. Quadratus femoris

back 288

A. Puborectalis

front 289

The intrinsic pelvic diaphragm moves synchronously with the:
A. Thoracolumbar fascia
B. Abdominal diaphragm
C. Intercostal muscles
D. Piriformis

back 289

B. Abdominal diaphragm

front 290

Support during defecation and lumbosacral pelvic support is attributed to the _____ muscles of the perineum.
A. Secondary
B. Intrinsic
C. Primary
D. Superficial only

back 290

C. Primary

front 291

The primary perineal muscles are innervated by the:
A. Femoral nerve
B. Obturator nerve
C. Pudendal nerve
D. Sciatic nerve

back 291

C. Pudendal nerve

front 292

The urogenital triangle/diaphragm spans between the:
A. Ischial spines
B. Iliac crests
C. Ischiopubic rami
D. Sacral alae

back 292

C. Ischiopubic rami

front 293

The urogenital triangle is filled by a thick fibrous sheet called the:
A. Sacral fascia
B. Perineal membrane
C. Endopelvic fascia
D. Interosseous membrane

back 293

B. Perineal membrane

front 294

Coccygeus muscles overlie which ligaments and attach to the ischial spine?
A. Sacrotuberous
B. Sacrospinous
C. Iliolumbar
D. Inguinal

back 294

B. Sacrospinous

front 295

Superior innominate shear refers to:
A. Inferior subluxation
B. Posterior rotation
C. Superior subluxation
D. External flare

back 295

C. Superior subluxation

front 296

Inferior innominate shear refers to:
A. Superior subluxation
B. Inferior subluxation
C. Inflare
D. Outflare

back 296

B. Inferior subluxation

front 297

“Upslipped” is another term for:
A. Inferior shear
B. Superior shear
C. Anterior rotation
D. Posterior rotation

back 297

B. Superior shear

front 298

"Downslipped” is another term for:
A. Superior shear
B. Inferior shear
C. Inflare
D. Outflare

back 298

B. Inferior shear

front 299

Which innominate shear is rare and tends to improve with walking?
A. Superior shear
B. Inferior shear
C. Inflare
D. Posterior shear

back 299

B. Inferior shear

front 300

A patient fell onto one ischial tuberosity and later has apparent pelvic asymmetry. Which shear is most suggested?
A. Inferior shear
B. Superior shear
C. Downslip
D. Inflare

back 300

B. Superior shear

front 301

A posterior innominate rotation is defined by rotation posteriorly around a:
A. Vertical axis
B. Longitudinal axis
C. Transverse axis
D. Oblique axis

back 301

C. Transverse axis

front 302

Posterior innominate rotation may cause inguinal pain (rectus femoris) or knee pain (sartorius). The apparent leg length is:
A. Increased/lengthened
B. Unchanged
C. Variable only
D. Decreased/shortened

back 302

D. Decreased/shortened

front 303

With posterior innominate rotation, the sacral sulcus becomes:
A. Shallow
B. Deep
C. Symmetric always
D. Obliterated

back 303

B. Deep

front 304

Which set contains only posterior rotators of the innominate (as listed)?
A. Glute max, hamstrings, iliopsoas
B. TFL, quads, internal obliques
C. Lat dorsi, iliocostals, QL
D. Rectus abdominis, TA, obliques

back 304

A. Glute max, hamstrings, iliopsoas

front 305

Which muscle listed is a posterior rotator with only a weak action?
A. Piriformis
B. TFL
C. QL
D. Quads

back 305

A. Piriformis

front 306

Anterior innominate rotation produces an apparent _____ leg length and _____ sacral sulcus.
A. decreased; deep
B. increased; shallow
C. increased; deep
D. decreased; shallow

back 306

B. increased; shallow

front 307

Which set contains only anterior rotators of the innominate (as listed)?
A. TFL, quads, QL
B. Glute max, hamstrings, piriformis
C. Iliopsoas, external oblique, multifidus
D. Semitendinosus, biceps femoris, QL

back 307

A. TFL, quads, QL

front 308

When determining innominate flare, distance is measured from the umbilicus or the _____ to each ASIS.
A. Pubic symphysis
B. Xiphoid
C. Manubrium
D. PSIS

back 308

B. Xiphoid

front 309

In an innominate inflare, the ASIS is:
A. Further from midline
B. Closer to midline
C. More inferior
D. More lateral

back 309

B. Closer to midline

front 310

In an innominate outflare, the ASIS is:
A. Closer to midline
B. Further from midline
C. More posterior
D. More superior

back 310

B. Further from midline

front 311

An innominate inflare typically makes the sacral sulcus:
A. Wide
B. Narrow
C. Shallow
D. Deep

back 311

A. Wide

front 312

An innominate outflare typically makes the sacral sulcus:
A. Wide
B. Deep
C. Narrow
D. Flat

back 312

C. Narrow

front 313

During normal gait, pubic symphysis motion occurs around a _____ axis.
A. Vertical
B. AP
C. Transverse
D. Oblique

back 313

C. Transverse

front 314

Pubic symphysis dysfunctions are especially common during:
A. Marathon training
B. Pregnancy and childbirth
C. Osteoporosis treatment
D. Viral infections

back 314

B. Pregnancy and childbirth

front 315

“Synarthrosis” here refers to:
A. Fibrocartilage without shears
B. Interpubic disc with hyaline cover
C. Pure synovial capsule
D. Ligament-only union

back 315

B. Interpubic disc with hyaline cover

front 316

Which ligament is emphasized as a palpatory surgical landmark?
A. Sacrotuberous
B. Inguinal
C. Iliolumbar
D. Sacrospinous

back 316

B. Inguinal

front 317

The most common pubic symphysis dysfunction during pregnancy/childbirth is:
A. Abduction
B. Adduction
C. Superior shear
D. Inferior shear

back 317

A. Abduction

front 318

Which list correctly includes all 3 planes of pubic symphysis motion?
A. Medial/lateral, rotation, translation
B. Flex/extend, abduct/adduct, rotate
C. Superior/inferior, anterior/posterior, rotation
D. Compression, distraction, torsion

back 318

C. Superior/inferior, anterior/posterior, rotation

front 319

A patient with constipation, urinary symptoms, dyspareunia, and suprapubic pain is suspected of which pelvic dysfunction?
A. Sacral torsion
B. Pubic shears
C. Piriformis syndrome
D. Lumbar stenosis

back 319

B. Pubic shears

front 320

Pubic shears are caused primarily by uneven tension on the:
A. Pelvic diaphragm
B. Thoracolumbar fascia
C. Iliolumbar ligament
D. Abdominal diaphragm

back 320

A. Pelvic diaphragm

front 321

Superior pubic symphysis muscles include rectus abdominis and:
A. Psoas minor
B. Pyramidalis
C. Obturator internus
D. Coccygeus

back 321

B. Pyramidalis

front 322

With each step, walking induces sacral mechanics about the:
A. Longitudinal axis
B. Neutral oblique axis
C. Superior transverse axis
D. AP axis

back 322

B. Neutral oblique axis

front 323

During gait, lumbar sidebending occurs toward the:
A. Non–weight-bearing leg
B. Weight-bearing leg
C. Side with inflare
D. Side with outflare

back 323

B. Weight-bearing leg

front 324

During gait, the weight-bearing ilium rotates:
A. Anteriorly
B. Posteriorly
C. Inferiorly
D. Externally

back 324

A. Anteriorly

front 325

During gait, the contralateral ilium rotates:
A. Anteriorly
B. Posteriorly
C. Superiorly
D. Internally

back 325

B. Posteriorly

front 326

Primary indications for muscle energy include SD of:
A. Myofascial and articular origin
B. Visceral and vascular origin
C. Dermatologic and endocrine origin
D. Neurologic and infectious origin

back 326

A. Myofascial and articular origin

front 327

Before any supine landmark checks (and after treatment reassessment), you should perform the:
A. Lumbar roll maneuver
B. Hip flop maneuver
C. Slump maneuver
D. Patrick maneuver

back 327

B. Hip flop maneuver

front 328

Muscular forces on each pubic ramus can cause _____ about a _____ axis at the symphysis.
A. Rotation; transverse
B. Shear; vertical
C. Translation; AP
D. Abduction; oblique

back 328

A. Rotation; transverse

front 329

The MET style used to treat the pubic symphysis in this course is:
A. Post-isometric relaxation
B. Reciprocal inhibition
C. Respiratory assistance
D. Joint mobilization using muscle force

back 329

D. Joint mobilization using muscle force