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

B. Right anterior innominate rotation

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

D. Right superior innominate shear

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

A. Superior vertebra on inferior

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

C. Above corresponding vertebra

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

A. Backward upward medial

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

D. OA two; C2-7 three

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

C. C1 and C2

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

B. Posterior

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

D. OA joint

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

B. Cervical spine

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

C. C1 inferior concave; C2 superior convex

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

D. Cruciform ligament

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

A. Rheumatoid arthritis

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

C. Cervical HVLA

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

D. Rotation

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

B. Uncinate processes

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

Tubercles for muscle attachment

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°

B. Toward the eye, 45°

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

B. Articular pillars

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

C. Proprioception

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

A. Rectus capitis anterior major/minor

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

D. Semispinalis cervicis, longissimus

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

B. Longus colli, rectus capitis anterior

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

C. Right sidebend, left rotate

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

A. Scalenes

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

B. SCM and trapezius

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

C1

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

C. Posterior ramus of C2

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

B. Semispinalis capitis

The 3rd occipital nerve root is:

C3

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

A. Third occipital nerve

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

C5

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

C6

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

C7

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

C8

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

Biceps reflex

A diminished C6 reflex most classically involves testing the

Brachioradialis tendon

The classic reflex used for C7 is the:

Triceps reflex

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

C. Vagus nerve

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

B. T1–T4

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

C. Third occipital nerve

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

D. T1–T4

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

C. Brachial plexus

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

B. Subclavian artery

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

B. Subclavian vein

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

C. First rib

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

D. Pectoralis minor

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

B. Anterior and middle scalenes

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

C. Cervical ribs

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

C. Paresthesias, weakness, arm pain

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

C. Ischemic tissue loss

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

D. Gangrene

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

B. Wallenburg

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

C. Subclavian artery

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

B. Scalenes

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

B. Seated

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

A. Supine

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

C. Spondylosis

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

B. Muscle spasm/imbalance

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

C. ACS referred pain

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

B. Carotid artery dissection

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

B. Stress

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

C. Hyperextension then hyperflexion

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

D. 45 degrees

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

B. 45 degrees off midline

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

B. Narrowing of spinal canal

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

C. Lumbar and cervical

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

B. Lumbar spine

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

D. Cervical spine

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

C. Thickened ligamentum flavum

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

C. Cysts

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

C. Compression fractures

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

C. Disc bulge into canal

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

B. Bone spurs

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

B. Shoulders, arms, hands

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

B. Brisk deep tendon reflexes

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

B. Infection

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

A. Upper ribs

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

D. Costoclavicular maneuver

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

C. Head/neck cancer

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

B. Nociceptive afferent

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

0/4

Which DTR grade is always abnormal because it includes clonus?

4/4

A brisk reflex response considered normal is graded:

2/4

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

3/4

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

1/4

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

C2

The hyoid bone landmark correlates best with:

C3

The top of the thyroid cartilage correlates best with:

C4

The bottom of the thyroid cartilage correlates best with:

C5

The cricoid cartilage landmark correlates best with:

C6

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

B. Rectus capitis anterior

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

A. Rectus capitis lateralis

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

C. Middle scalene and longus colli

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

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

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

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

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

A. SCM

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

B. Semispinalis capitis and rectus capitis posterior minor

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

A. Splenius capitis and suboccipitals

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

C. Greater occipital nerve

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

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

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

B. Semispinalis capitis, multifidus, rotatores

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

C. Greater and/or third occipital

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

B. Middle scalene, longus capitis, longus colli

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

B. Typical C3–C7

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

A. Flexion and extension

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

D. Side slipping/rotation

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

C. Wobble

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

B. Slight translation

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

A. Flexion/extension

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

D. Rotation only

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

C. Sidebending, rotation, flexion, extension

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

B. Extending the neck

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

C. Anteriorly than posteriorly

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

A. Lordosis during walking

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

B. Transverse wider than AP

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

D. L5

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

A. Concave; backward upward medial

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

C. Convex; laterally downward forward

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

B. Zygapophyseal joints

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

B. Facet tropism

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

C. Asymmetric spinal motion

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

B. Lumbarization rarer than sacralization

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

B. Widens intervertebral foramina

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

C. Narrows intervertebral foramina

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

C. Ligamentum flavum

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

A. Thoracolumbar fascia, multifidus sheath

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

C. Third decade

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

B. Thoracolumbar fascia alignment influence

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

C. One-half original width

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

B. Scalloped

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

B. Disc herniation and nerve impingement

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

C. L4 and L5

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

B. Iliac crest and SI regions

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

A. Extension

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

C. Groin pain

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

B. Iliolumbar

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

A. Diaphragm, QL, psoas major, psoas minor

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

C. Iliocostalis, longissimus, spinalis

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

B. Multifidus, rotatores, interspinales, intertransversarii

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

B. Two lumbar bodies

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

D. Three lumbar bodies

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

A. Rib 12, L-spine, iliac crest

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

B. T12, L1–L4

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

B. Extension and sidebending

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

B. T12–L5

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

C. Lesser trochanter

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

A. L1–L3 (L2–L4)

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

B. Hip flexion

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

A. T12 and L1

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

C. Pectineal line

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

C. L1

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

B. Weak lumbar flexor

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

C. L3–L4

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

B. L4–L5

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

D. Flex/extend > sidebending > rotation

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

Opposite

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

B. Group curves in lumbar spine

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

C. Anterior-posterior translation

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

B. Contralateral translatory slide

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

A. Disc compression

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

B. Parallel to sacral base floor

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

C. Hyper-lordosis of lumbar spine

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

C. 25–35°

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

A. L1–L4

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

B. T5–T9

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

C. T10–T11

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

B. T12–L2

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

C. Lateral femoral cutaneous nerve

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

B. Meralgia paresthetica

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

B. Pain and numbness

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

A. Tight belts

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

B. Mechanical

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°

D. 30–70°

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

A. Positive seated SLR

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

B. Add ankle dorsiflexion below pain

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

A. Dorsiflexion reproduces pain

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

B. Thomas test

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

B. Hoover test

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

C. Crossed extensor reflex

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

Spinal stenosis

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

B. Osteophytes, decreased disc space

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

A. Increase ROM, reduce restrictions, straighten canal

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

A. Hypertrophy of facet joints

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

A. Calcium deposits in LF and PLL

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

B. Loss of IV disc height

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

C. Seronegative spondylitis

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

B. HLA-B27

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

A. SI and facet joints

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

C. Worse night/morning, inactivity stiffness

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

A. Uveitis

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

A. IBD

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

B. Psoriasis

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

A. Cardiovascular and pulmonary

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

C. Oblique

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

B. Lateral view

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

C. Spondylolysis

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

C. Spondylolisthesis

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

C. Spondylolisthesis

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

C. Grade I

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

B. Grade II

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

A. Grade III

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

C. Grade IV

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

B. Below

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

C. Disc herniation/bulge

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

A. Leg pain > back pain

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

B. Loss of DTR

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

A. Massive central disc herniation

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

B. Cauda equina syndrome

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

A. Saddle anesthesia, bowel/bladder loss

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

C. Cauda equina syndrome

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

A. Lower-body muscle imbalance pattern

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

B. Hip flexors, lumbar extensors

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

C. Rectus abdominis, Gluteus Maximus/Minimus

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

C. Anterior pelvic tilt

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

B. flexion; hyperlordotic

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

A. L1 or L2

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

B. Prolonged shortening of psoas

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

C. Pelvic shift away from the side of spasm

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

B. Backward

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

B. Contralateral piriformis

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

C. Psoas syndrome

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

B. Stops at or above the knee

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

D. Piriformis syndrome

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

A. Driving long distances

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

B. Sitting with legs crossed

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

A. Groin, SI joint, lateral thigh

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

B. Destabilization states

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

C. Toward affected ligament

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

A. Tight hip adductors

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

B. Oblique sacral axis

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

D. Opposite to

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

false pelvis

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

true pelvis

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

D. Ilium ischium pubis

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

B. Late teens/early 20s

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

C. L5

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

A. Innominates

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

D. Sacral promontory

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

B. Concave

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

C. Convex

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

D. Articular processes

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

A. Transverse processes

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

C. Inferolateral angle (ILA)

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

B. Four pairs

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

A. Sacral hiatus

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

D. Sacrococcygeal joint

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

B. Sympathetic chains join

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

C. Coccyx

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

D. Above S2

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

B. Cranial primary respiratory mechanism

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

A. At S2

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

C. Middle transverse axis

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

D. Below S2

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

A. Inferior transverse sacral axis

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

Sacrospinous

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

Sacrotuberous

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

Sacrospinous

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

B. Sacrotuberous and sacrospinous

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

C. Ilioinguinal nerve

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

B. LS instability

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

B. Anterior SI ligament

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

A. Iliolumbar, sacrotuberous, sacrospinous

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

B. External iliac

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

C. Internal iliac

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

A. Iliolumbar, lateral sacral, superior gluteal

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

B. Inferior gluteal artery

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

B. L4–S4

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

C. S2–S4

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

A. L4–S3

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

B. L4–S2

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

C. L4–S3

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

C. Pudendal nerve

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

B. S2–S4

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

C. Tensor fascia lata

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

A. L4–S1

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

A. Gluteus maximus

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

B. L5–S2

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

A. L2–L4

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

C. Sacrotuberous ligament

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

C. S4–C0

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

B. S5 and C0

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

B. Anal triangle

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

B. T12–L2

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

B. Pelvic diaphragm

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

A. Rectus abdominis, QL, piriformis

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

A. Levator ani and coccygeus

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

A. Puborectalis

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

B. Abdominal diaphragm

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

C. Primary

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

C. Pudendal nerve

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

C. Ischiopubic rami

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

B. Perineal membrane

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

B. Sacrospinous

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

C. Superior subluxation

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

B. Inferior subluxation

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

B. Superior shear

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

B. Inferior shear

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

B. Inferior shear

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

B. Superior shear

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

C. Transverse axis

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

D. Decreased/shortened

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

B. Deep

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

A. Glute max, hamstrings, iliopsoas

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

A. Piriformis

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

B. increased; shallow

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

A. TFL, quads, QL

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

B. Xiphoid

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

B. Closer to midline

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

B. Further from midline

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

A. Wide

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

C. Narrow

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

C. Transverse

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

B. Pregnancy and childbirth

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

B. Interpubic disc with hyaline cover

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

B. Inguinal

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

A. Abduction

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

C. Superior/inferior, anterior/posterior, rotation

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

B. Pubic shears

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

A. Pelvic diaphragm

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

B. Pyramidalis

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

B. Neutral oblique axis

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

B. Weight-bearing leg

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

A. Anteriorly

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

B. Posteriorly

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

A. Myofascial and articular origin

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

B. Hip flop maneuver

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

A. Rotation; transverse

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

D. Joint mobilization using muscle force