Title: Bone Wizardry / OMM Mastery / 99 Original Transfer Questions
Tags: #BW_OMM::Type::MCQ BoneWizardry bonewizardry-free bonewizardry-transfer omm omt topic::cervical-spine topic::chapman-points topic::lumbar-spine topic::counterstrain-and-fpr topic::sacrum-and-innominates topic::shoulder topic::the-basics topic::craniosacral-motion topic::hvla topic::lower-extremities topic::lymphatics topic::muscle-energy topic::thorax-and-ribcage topic::upper-extremities topic::articulatory-techniques topic::facilitation topic::hips topic::knee topic::myofascial-release

Stem: A runner feels a sharp pull in the posterior thigh while accelerating. Exam shows pain with resisted knee flexion and hip extension. Which muscle group best matches both painful actions?
Option A: Quadriceps femoris
Option B: Hamstrings
Option C: Iliopsoas
Option D: Gluteus medius
Correct: B. Hamstrings
Explanation: Pair the two actions in the stem: knee flexion and hip extension. Only the hamstrings span both the hip and the knee, so they drive both motions. The quadriceps extend the knee, the iliopsoas flexes the hip, and the gluteus medius abducts and stabilizes the pelvis, so none of them covers both actions.
Bone Wizardry Lock: When the stem gives two joint actions, pick the muscle that crosses both joints in the right direction.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: A patient has weakness of the short head of the biceps femoris after injury near the fibular neck. Which nerve branch is most directly involved?
Option A: Tibial branch of the sciatic nerve
Option B: Femoral nerve
Option C: Common fibular branch of the sciatic nerve
Option D: Obturator nerve
Correct: C. Common fibular branch of the sciatic nerve
Explanation: The short head of biceps femoris is the odd one out among the hamstrings. The long head and the remaining hamstrings run on the tibial branch of the sciatic nerve, but the short head is supplied by the common fibular branch, which is why an injury near the fibular neck weakens it. The femoral nerve serves the anterior thigh and the obturator serves the medial thigh, so neither one fits.
Bone Wizardry Lock: Know the exception because boards love it: long hamstrings are tibial, short head biceps femoris is common fibular.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: A head-injury patient has impaired concentration. Cranial exam finds a very slow cranial rhythmic impulse and globally decreased motion of the cranial bones. Which cranial dysfunction fits best?
Option A: Flexion
Option B: Compression
Option C: Right torsion
Option D: Extension
Correct: B. Compression
Explanation: Two findings drive this: a slow cranial rhythmic impulse and globally reduced motion of the cranial bones after trauma. Compression jams the SBS and dampens motion in every direction. Flexion, extension, and torsion are each patterned, directional motions rather than a globally stuck cranium, so they do not fit a uniformly slow, restricted exam.
Bone Wizardry Lock: For cranial stems, decide whether the finding is global restriction or a directional pattern before naming the strain.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: During SBS assessment, the sphenoid and occiput rotate in the same direction around two transverse axes. Which strain pattern does this point to?
Option A: Torsion
Option B: Sidebending-rotation strain
Option C: Lateral strain
Option D: Vertical strain
Correct: D. Vertical strain
Explanation: Rotation about two transverse axes is the signature of a vertical strain, a shear pattern. Torsion turns about a single AP axis, sidebending-rotation combines an AP axis with vertical axes, and lateral strain works about vertical axes. None of those uses paired transverse axes, which leaves vertical strain.
Bone Wizardry Lock: Name the cranial strain from the axes first; direction comes second.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: A newborn's head palpates like a parallelogram after a difficult delivery. The sphenoid and occiput rotate in the same direction around vertical axes. Which SBS strain is most likely?
Option A: Flexion dysfunction
Option B: Vertical strain
Option C: Torsion
Option D: Lateral strain
Correct: D. Lateral strain
Explanation: Parallelogram head is the giveaway for lateral strain, and the axis clue agrees: lateral strain runs on vertical axes. Compare that with vertical strain, which uses transverse axes, and torsion, which pivots on an AP axis.
Bone Wizardry Lock: Use shape as a lock only after the axis pattern matches.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: Seated flexion test is positive on the left, spring test is negative, the left sacral sulcus is deep, and the left ILA is posterior/inferior. Which diagnosis fits best?
Option A: Left unilateral sacral extension
Option B: Right-on-right sacral torsion
Option C: Left unilateral sacral flexion
Option D: Left-on-left sacral torsion
Correct: C. Left unilateral sacral flexion
Explanation: All four findings line up on one side, which is the signature of one-sided forward sacral base motion. Left unilateral sacral flexion produces exactly that: a positive seated flexion test on the left, a negative spring test, a deep left sulcus, and a posterior/inferior left ILA.
Bone Wizardry Lock: For unilateral sacral dysfunctions, keep the side, spring test, sulcus, and ILA on one clean pattern.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: Months of gallbladder irritation leave a patient with persistent paraspinal tissue texture change at the matching thoracic levels. What reflex concept explains why that segment now fires so readily?
Option A: Post-isometric relaxation
Option B: Reciprocal inhibition
Option C: Crossed extensor reflex
Option D: Segmental facilitation
Correct: D. Segmental facilitation
Explanation: Chronic visceral input keeps a spinal segment electrically primed, so once facilitated even minor stimuli trigger an outsized response. Post-isometric relaxation describes the muscle release that follows an isometric contraction. Reciprocal inhibition quiets an antagonist when its opposing muscle contracts. The crossed extensor reflex is a withdrawal response distributed across limbs, not a segmental priming phenomenon.
Bone Wizardry Lock: Persistent visceral irritation keeps the linked spinal segment on a hair trigger. That is facilitation.
Topic: Facilitation
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
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- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Stem: Sympathetic viscerosomatic input to the gonads localizes to which spinal level?
Option A: T1-T4
Option B: T10-T11
Option C: S2-S4
Option D: T5-T9
Correct: B. T10-T11
Explanation: The gonads ride with the lower thoracic sympathetics at T10-T11. T1-T4 covers head, neck, and upper thorax; T5-T9 serves the upper GI tract; and S2-S4 is parasympathetic pelvic outflow rather than a sympathetic level at all.
Bone Wizardry Lock: Gonads follow ovarian and testicular vessel embryology: their sympathetics land at T10-T11, well above the pelvis.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: Which spinal level supplies the sympathetic viscerosomatic input to the prostate?
Option A: T12-L2
Option B: T5-T9
Option C: T1-T4
Option D: S2-S4 only
Correct: A. T12-L2
Explanation: The prostate maps to sympathetics at T12-L2. S2-S4 is the tempting pelvic pick, but it is parasympathetic outflow rather than the sympathetic lane the question wants, while T1-T4 and T5-T9 sit too far superior in the thoracic and upper abdominal patterns.
Bone Wizardry Lock: Pelvic organs carry dual innervation: sympathetics from T12-L2, parasympathetics from S2-S4. The question specifies which lane.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: The physician sets the dysfunctional segment in neutral, adds a mild compressive force toward the dysfunction, and keeps the patient passive throughout. Name the technique.
Option A: Articulatory treatment
Option B: HVLA
Option C: Facilitated positional release
Option D: Muscle energy
Correct: C. Facilitated positional release
Explanation: Neutral positioning combined with a gentle activating compression or torsion force is the FPR setup. Muscle energy would need active patient contraction, HVLA delivers a rapid thrust, and articulatory treatment relies on rhythmic joint motion.
Bone Wizardry Lock: FPR: place the segment in neutral, add a mild compressive or torsional activating force, keep the patient passive.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: A physician treats a tender point by positioning the patient until the pain drops sharply, holds there, then returns slowly to neutral. Which principle does this rely on?
Option A: High-velocity impulse
Option B: Restrictive barrier loading
Option C: Position of ease
Option D: Respiratory cooperation
Correct: C. Position of ease
Explanation: Counterstrain works by finding ease rather than forcing into the bind, and the sharp drop in pain is the sign that the reflex is quieting. Restrictive barrier loading is a direct-technique idea, respiratory cooperation assists muscle energy, and a high-velocity impulse describes HVLA.
Bone Wizardry Lock: Indirect techniques move away from the barrier first.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: An athlete twists on a planted knee and later reports joint-line pain. On exam the clinician flexes the hip and knee, applies a valgus force with external tibial rotation, and extends the knee. What injury does this maneuver look for?
Option A: Patellar tendon rupture
Option B: MCL sprain
Option C: Meniscal tear
Option D: ACL rupture
Correct: C. Meniscal tear
Explanation: That sequence is the McMurray maneuver, which loads the meniscus. Lachman is the ACL test, valgus stress isolates the MCL, and patellar tendon rupture shows up as a failure of active knee extension instead.
Bone Wizardry Lock: McMurray compresses and rotates to load the meniscus. Valgus and varus stress the collaterals. Lachman and the drawer load the cruciates.
Topic: Knee
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP knee evaluation
- AAFP knee pain history and exam
- AAFP knee injury tool

Stem: A lateral blow to the knee causes medial joint-line pain. Which test directly stresses the injured ligament?
Option A: Valgus stress test
Option B: Posterior drawer test
Option C: Varus stress test
Option D: McMurray test
Correct: A. Valgus stress test
Explanation: A blow from the lateral side gaps the medial joint and strains the MCL, and valgus stress recreates that same medial opening. Varus stress targets the LCL, the posterior drawer targets the PCL, and McMurray is a meniscal test.
Bone Wizardry Lock: Impact from outside opens the inside: lateral blow means MCL/valgus.
Topic: Knee
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP knee evaluation
- AAFP knee pain history and exam
- AAFP knee injury tool

Stem: A patient cannot smoothly lower an abducted arm from overhead; the arm drops suddenly. Which structure is most likely failing?
Option A: Ulnar collateral ligament
Option B: Median nerve
Option C: Long head of biceps tendon
Option D: Supraspinatus/rotator cuff
Correct: D. Supraspinatus/rotator cuff
Explanation: A positive drop-arm sign points to a rotator cuff tear, with supraspinatus the usual culprit. Long head of biceps trouble shows up as anterior shoulder pain, the UCL governs valgus stability at the elbow, and the median nerve covers wrist and hand territory.
Bone Wizardry Lock: A torn supraspinatus cannot maintain eccentric control as the arm descends. That failure is the drop-arm sign.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: Radial wrist pain is reproduced when the thumb is flexed into the palm and the wrist is guided into ulnar deviation. Which diagnosis is most supported?
Option A: Cubital tunnel syndrome
Option B: De Quervain tenosynovitis
Option C: Carpal tunnel syndrome
Option D: Scaphoid fracture
Correct: B. De Quervain tenosynovitis
Explanation: That is the Finkelstein maneuver, which loads the thumb tendons of the first dorsal compartment. Carpal tunnel syndrome is median nerve compression, a scaphoid fracture localizes to snuffbox and tubercle tenderness, and cubital tunnel syndrome is ulnar nerve trouble at the elbow.
Bone Wizardry Lock: Finkelstein is specific for first dorsal compartment disease. Snuffbox tenderness without it points toward the scaphoid instead.
Topic: Wrist
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Stem: A physician brings a restricted thoracic segment to its barrier and has the patient push gently against an equal counterforce before relaxing. Which treatment family is at work here?
Option A: Lymphatic pump
Option B: Muscle energy
Option C: Counterstrain
Option D: Balanced ligamentous tension
Correct: B. Muscle energy
Explanation: Active patient contraction against the physician's resistance is the signature of muscle energy. Counterstrain keeps the patient passive in ease, the lymphatic pump drives rhythmic fluid movement, and balanced ligamentous tension works by finding the joint's point of balance.
Bone Wizardry Lock: If the patient works, think muscle energy; if the patient stays passive, look elsewhere.
Topic: Muscle Energy
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: A patient with a somatic dysfunction is positioned passively into the restrictive barrier, and the physician delivers one short-amplitude, rapid corrective thrust. Which OMT technique is applied?
Option A: HVLA
Option B: Counterstrain
Option C: FPR
Option D: Muscle energy
Correct: A. HVLA
Explanation: A short, rapid force delivered at the restrictive barrier is HVLA. Muscle energy relies on active contraction, counterstrain moves into ease, and FPR uses neutral positioning plus a gentle activating force.
Bone Wizardry Lock: HVLA: engage the restrictive barrier directly, then one high-velocity, low-amplitude thrust.
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
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- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: Before using a pedal pump for lower-extremity edema, a physician treats the thoracic inlet and diaphragms. Why is that sequence preferred?
Option A: Pedal pump is contraindicated unless HVLA is performed first
Option B: The goal is to increase sympathetic tone
Option C: Central restrictions must be opened before peripheral fluid is pumped
Option D: The thoracic inlet directly innervates the foot
Correct: C. Central restrictions must be opened before peripheral fluid is pumped
Explanation: Lymphatic work is really a drainage problem, so if the central outlet stays blocked, pumping the periphery just pushes fluid toward a closed drain. None of the other options name a real reason for the sequence: a pedal pump does not require preceding HVLA, the aim is to free fluid flow rather than raise sympathetic tone, and the thoracic inlet does not innervate the foot.
Bone Wizardry Lock: Lymphatic sequence is central first, peripheral second.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: During myofascial treatment, the physician follows the tissues toward the direction of greatest freedom and waits for softening before reassessing. Which myofascial approach is that?
Option A: Direct myofascial release
Option B: Isolytic muscle energy
Option C: Indirect myofascial release
Option D: HVLA
Correct: C. Indirect myofascial release
Explanation: Following the tissue into ease defines the indirect approach. Direct myofascial release loads the bind instead, HVLA is a thrust technique, and isolytic muscle energy has the physician overpower the patient's contraction.
Bone Wizardry Lock: The tissue path reveals the technique: following into bind is direct MFR, following into ease is indirect MFR.
Topic: Myofascial Release
Review Links: - Bone Wizardry fascial subtypes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls myofascial pain
- StatPearls 5 diaphragm procedure
- WVSOM OMT methods
- OMM brief review

Stem: On exam the soft tissue is symmetric and painless with full range of motion, yet the patient reports vague soreness after exercise. Which TART element is still missing before this counts as a somatic dysfunction?
Option A: Objective restriction or tissue/asymmetry finding
Option B: A patient complaint
Option C: A named spinal level
Option D: Subjective tenderness
Correct: A. Objective restriction or tissue/asymmetry finding
Explanation: Tenderness alone is subjective, and a complaint is not a diagnosis. TART asks for objective structure or function evidence: a tissue texture change, asymmetry, or restriction. Without one of those findings there is nothing to label or treat, so the missing piece is the objective restriction or asymmetry.
Bone Wizardry Lock: Use TART to separate a symptom from an OMT target.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: A patient has rib pain after coughing. During inhalation, ribs 3 through 5 move upward easily, but during exhalation the group does not descend. Which rib is the key rib to treat first?
Option A: Rib 3
Option B: Rib 2
Option C: Rib 4
Option D: Rib 5
Correct: D. Rib 5
Explanation: These ribs are held in inhalation: they ride up easily but will not drop on exhalation. An inhaled group is treated at its bottom rib, the most inferior one, which here is rib 5. Shorthand is BITE: bottom rib for an inhaled group, top rib for an exhaled group.
Bone Wizardry Lock: Inhaled group: treat the most inferior rib. Exhaled group: treat the most superior rib. That is BITE.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: Ribs 7 through 10 descend on exhalation but remain inferior through the full inhalation phase. The physician applies muscle energy to the key rib. Which rib receives the treatment contact?
Option A: Rib 8
Option B: Rib 6
Option C: Rib 7
Option D: Rib 10
Correct: C. Rib 7
Explanation: The group is held in exhalation: the ribs sit down and will not rise on inhalation. An exhaled group is treated at its top rib, the most superior one, which here is rib 7. BITE: bottom rib for an inhaled group, top rib for an exhaled group.
Bone Wizardry Lock: Identify the respiratory pattern before counting ribs. Exhalation-stuck group: the top rib is your target.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: A rib rises during inhalation but stays elevated through exhalation and will not depress. How should the dysfunction be classified?
Option A: Neutral dysfunction
Option B: Compression dysfunction
Option C: Exhalation dysfunction
Option D: Inhalation dysfunction
Correct: D. Inhalation dysfunction
Explanation: A rib dysfunction takes its name from the position the rib holds, not from the motion it lost. This one stays elevated and refuses to depress, which is the inhaled position. Calling it exhalation dysfunction would mean the rib was stuck down, and the neutral or compression labels do not describe respiratory rib motion at all.
Bone Wizardry Lock: For rib naming, ask where the rib lives, not what motion it cannot do.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: Seated flexion test is positive on the right. The spring test is negative. L5 uses type I mechanics. The right sacral sulcus is deep and the left ILA is posterior. Which diagnosis fits best?
Option A: Right-on-right sacral torsion
Option B: Right unilateral extension
Option C: Left-on-right sacral torsion
Option D: Left-on-left sacral torsion
Correct: D. Left-on-left sacral torsion
Explanation: A negative spring test with type I mechanics at L5 places this in the forward, or anterior, torsion group. Positive seated flexion on the right puts the oblique axis on the left. A deep right sulcus paired with a posterior left ILA is the landmark set for rotation to the left, so the sacrum reads as left on left.
Bone Wizardry Lock: Three pieces complete a sacral torsion diagnosis: the oblique axis, the forward or backward bucket from the spring test, and the direction of sacral rotation from sulcus and ILA.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: Seated flexion is positive on the left, the spring test is positive, the right sulcus is deep, and the left ILA is posterior. Which torsion bucket comes first, before you name the axis?
Option A: No sacral dysfunction
Option B: Forward torsion
Option C: Bilateral flexion
Option D: Backward torsion
Correct: D. Backward torsion
Explanation: The spring test is the bucket clue here. A positive spring means the sacral base resists moving anterior because it is held posterior, which is the backward or extended group. That single finding sorts the dysfunction before you ever name the axis.
Bone Wizardry Lock: Use spring test as the bucket selector before wrestling with sulcus and ILA.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: A seated flexion test is positive on the right. Which side is the oblique axis for a sacral torsion?
Option A: Bilateral axis
Option B: No axis can be inferred
Option C: Left axis
Option D: Right axis
Correct: C. Left axis
Explanation: For a sacral torsion the seated flexion test flags the restricted side, and the oblique axis always sits on the opposite side. Restricted on the right means the axis runs to the left.
Bone Wizardry Lock: The deep sulcus shows where the sacrum rotated, not which axis it used. Seated flexion names the restricted side. The axis is always on the other side.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: A standing flexion test is positive on the left, but the seated flexion test is negative. Which structure is more likely driving the dysfunction?
Option A: Sphenoid
Option B: Thoracic inlet
Option C: Sacrum
Option D: Innominate
Correct: D. Innominate
Explanation: Standing flexion loads the pelvis through the lower extremity, so it picks up innominate motion. A negative seated flexion test makes the sacrum an unlikely primary driver, which leaves the innominate as the better answer.
Bone Wizardry Lock: Use standing versus seated flexion to decide ilium-on-sacrum versus sacrum-on-ilium.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: After delivery, a patient has bilateral deep sacral sulci and bilateral posterior/inferior ILAs. Which sacral dysfunction is most consistent?
Option A: Right unilateral extension
Option B: Left-on-right torsion
Option C: Bilateral sacral extension
Option D: Bilateral sacral flexion
Correct: D. Bilateral sacral flexion
Explanation: Deep sulci on both sides mean the sacral base sits anterior bilaterally, and posterior or inferior ILAs on both sides match that forward-flexed position. The postpartum setting fits a bilateral flexion picture as well.
Bone Wizardry Lock: When sulci are deep on both sides and ILAs are posterior on both sides, the pattern is bilateral, not a torsion. Bilateral flexion means the sacral base is anterior across both sides.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: A tender point is on the anterior body near the angle of Louis. Which initial counterstrain position is most likely?
Option A: Flexion
Option B: Neutral with compression
Option C: Extension
Option D: Sidebend away and rotate away
Correct: A. Flexion
Explanation: Anterior thoracic tender points are treated by folding the patient forward, and the angle of Louis marks an anterior upper thoracic point, so flexion is the starting position. Extension belongs to posterior points, and neutral with compression describes FPR rather than counterstrain.
Bone Wizardry Lock: Counterstrain location predicts position: anterior points usually flex, posterior points usually extend.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: A posterior thoracic tender point is found near the transverse process of T6. Which motion direction is usually favored for treatment?
Option A: Lymphatic pump
Option B: Pure axial compression
Option C: Extension
Option D: Flexion
Correct: C. Extension
Explanation: Posterior tender points settle when you extend into ease, while anterior points prefer flexion. Pure axial compression is closer to an FPR activating force, and a lymphatic pump moves fluid instead of positioning a tender point.
Bone Wizardry Lock: Anterior folds forward; posterior arches back.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: A psoas tender point is identified two-thirds of the distance from the ASIS to the umbilicus. Which position best treats it?
Option A: Hip flexion with sidebending toward and slight external rotation
Option B: Thoracic HVLA thrust
Option C: Cervical extension with rotation away
Option D: Hip extension with internal rotation
Correct: A. Hip flexion with sidebending toward and slight external rotation
Explanation: The psoas is an anterior tender point, and its position of ease is hip flexion with sidebending toward the point and slight external rotation. Extension with internal rotation would pull away from ease, and neither cervical positioning nor a thoracic thrust addresses the psoas.
Bone Wizardry Lock: For pelvic counterstrain, locate the tender point first; the body position follows the muscle being shortened.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: During counterstrain evaluation, a physician finds a tender point and positions the patient with marked bilateral hip flexion, knees bent, and both legs externally rotated. Which tender point is being treated?
Option A: Iliacus
Option B: Piriformis
Option C: Psoas
Option D: Posterior cervical
Correct: A. Iliacus
Explanation: Marked bilateral hip flexion with external rotation and the knees bent is the iliacus setup. The psoas position is related but not identical, piriformis is a posterior hip pattern, and a posterior cervical point is in the wrong region entirely.
Bone Wizardry Lock: The iliacus position uses marked bilateral hip flexion with knee flexion and external rotation, a more exaggerated bilateral setup than the psoas, which uses primarily ipsilateral hip flexion with sidebending toward the tender point.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: A patient with suspected appendiceal irritation has a small tender nodule near the tip of the right 12th rib. Which organ does this anterior Chapman point map to?
Option A: Prostate
Option B: Appendix
Option C: Ovary
Option D: Adrenal gland
Correct: B. Appendix
Explanation: The tip of the right 12th rib is the classic anterior appendix point. For contrast, the adrenal point sits above and lateral to the umbilicus, prostate maps to the lateral thigh, and ovary to the pubic tubercle.
Bone Wizardry Lock: Chapman points need organ plus location, not just a memorized body map.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
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- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: A patient with dysmenorrhea has a tender Chapman point at the pubic tubercle. Which organ does that point signal?
Option A: Ovary
Option B: Prostate
Option C: Appendix
Option D: Sigmoid colon
Correct: A. Ovary
Explanation: The pubic tubercle is the classic ovary Chapman point. Sigmoid colon and prostate points sit on the thigh, and the appendix point is at the tip of the right 12th rib.
Bone Wizardry Lock: The pubic tubercle maps to the ovary. Prostate and sigmoid colon project to the lateral thigh, so pubic tenderness paired with gynecologic symptoms points to the ovary, not a bowel structure.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: Where is the Chapman point for the sigmoid colon classically found?
Option A: Above proximal clavicle
Option B: Tip of right 12th rib
Option C: Medial scapular border
Option D: Upper left lateral thigh
Correct: D. Upper left lateral thigh
Explanation: On the standard Chapman map, the sigmoid colon localizes to the upper left lateral thigh. The tip of the right 12th rib marks the appendix, a point above the proximal clavicle reflects upper respiratory and ear structures, and the medial scapular border tracks with other musculoskeletal patterns rather than the gut.
Bone Wizardry Lock: Sigmoid colon projects to the upper left lateral thigh. That is the location to check when left lower quadrant symptoms suggest large bowel involvement, distinct from appendix at the right 12th rib tip.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: A spinal segment receives repeated nociceptive input from a dysfunctional rib and then fires with less stimulation than normal. Which phrase best describes that segment?
Option A: Cavitated
Option B: Inhibited
Option C: Compressed
Option D: Facilitated
Correct: D. Facilitated
Explanation: Facilitation describes a segment whose firing threshold has dropped, so ongoing input keeps it primed to react too easily. Inhibition would be the opposite, a suppressed output; cavitation refers to the audible joint release; and compression is a mechanical state rather than this change in reflex excitability.
Bone Wizardry Lock: Facilitation is an excitability diagnosis, not a structural position diagnosis.
Topic: Facilitation
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Stem: During muscle energy, a physician asks for a gentle isometric contraction, waits for relaxation, and then moves the joint farther into the new barrier. Which physiologic principle is most directly used?
Option A: Post-isometric relaxation
Option B: Lymphatic recoil
Option C: Still technique disengagement
Option D: High-velocity impulse
Correct: A. Post-isometric relaxation
Explanation: Once the isometric contraction stops, the muscle passes through a brief period of reduced tone, letting the physician take up slack to the new barrier. That sequence is post-isometric relaxation. A high-velocity impulse is a thrust, lymphatic recoil moves fluid rather than driving contract-relax, and Still technique works by disengaging and following a path of ease.
Bone Wizardry Lock: Post-isometric relaxation is the brief drop in muscle tone that follows an isometric contraction. That window is when the physician advances the joint to the next barrier.
Topic: Muscle Energy
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
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- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: Muscle energy is being applied to a posterior fibular head. Which position engages the restrictive barrier?
Option A: Plantarflexion and inversion
Option B: Hip external rotation
Option C: Dorsiflexion and eversion
Option D: Supination only
Correct: C. Dorsiflexion and eversion
Explanation: A posterior fibular head rests in ease toward plantarflexion and inversion, so the barrier to engage is the opposite combination, dorsiflexion and eversion. Reverse that and you would be treating an anterior fibular head instead.
Bone Wizardry Lock: For fibular head, diagnose the ease, then treat into the barrier.
Topic: Muscle Energy
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
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- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: A fibular head dysfunction prefers eversion and dorsiflexion and resists motion into inversion and plantarflexion. Which diagnosis fits best?
Option A: Inhaled fibular head
Option B: Medial meniscus tear
Option C: Anterior fibular head
Option D: Posterior fibular head
Correct: C. Anterior fibular head
Explanation: Ease into dorsiflexion and eversion is the anterior fibular head signature, while the posterior version favors plantarflexion and inversion. A medial meniscus tear and an inhaled-rib label describe different structures altogether, so neither fits the fibular head glide. A quick handle is DEA: dorsiflexion, eversion, anterior.
Bone Wizardry Lock: Use DEA/PIP as a motion signature: dorsiflexion-eversion anterior, plantarflexion-inversion posterior.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: A patient has a radial head dysfunction that prefers supination and has restricted pronation. Which diagnosis best matches?
Option A: Anterior radial head
Option B: Posterior radial head
Option C: Lateral epicondylitis
Option D: Medial meniscus tear
Correct: A. Anterior radial head
Explanation: Preference for supination with limited pronation defines the anterior radial head; the posterior radial head shows the mirror pattern. Lateral epicondylitis is a tendon overuse problem and a meniscus tear is a knee injury, so neither accounts for the radial head's glide preference.
Bone Wizardry Lock: For radial head, pair forearm rotation with glide direction before naming the dysfunction.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: On examination, a patient's forearm rotates easily into pronation but resists supination, and radial head dysfunction is suspected. Which diagnosis fits?
Option A: Anterior radial head
Option B: Exhaled rib
Option C: Anterior innominate
Option D: Posterior radial head
Correct: D. Posterior radial head
Explanation: Ease toward pronation with restricted supination marks the posterior radial head, whereas the anterior radial head favors supination. The remaining choices belong to other regions, an anterior innominate in the pelvis and an exhaled rib in the thoracic cage, so neither addresses forearm rotation.
Bone Wizardry Lock: Ease toward pronation with restricted supination identifies posterior radial head glide. The mirror finding, ease into supination with limited pronation, identifies the anterior type.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: Which patient should not receive cervical HVLA in a routine teaching scenario?
Option A: A patient with a reversible thoracic restriction
Option B: A patient with mild chronic paraspinal tenderness
Option C: A patient with signs concerning for vertebrobasilar insufficiency
Option D: A patient who can follow commands
Correct: C. A patient with signs concerning for vertebrobasilar insufficiency
Explanation: Cervical thrust calls for a vascular safety screen first, and findings concerning for vertebrobasilar insufficiency take HVLA off the table. Mild paraspinal tenderness, a reversible thoracic restriction, or a cooperative patient are not in themselves reasons to withhold treatment.
Bone Wizardry Lock: Before thrust, ask if the technique is safe, not just whether the segment is restricted.
Topic: HVLA
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
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- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: A physician uses rib raising and OA decompression to reduce sympathetic tone in a patient with anxiety-related somatic findings. Which OMT model does this approach reflect?
Option A: Respiratory-circulatory model only
Option B: Behavioral model only
Option C: Neurologic model
Option D: Metabolic-nutritional model
Correct: C. Neurologic model
Explanation: The treatment goal here is to shift autonomic tone, which places it in the neurologic model. Behavioral counseling might ease the anxiety, but the hands-on techniques described aim at neural and autonomic output rather than a respiratory-circulatory or metabolic-nutritional target.
Bone Wizardry Lock: Classify OMT models by the treatment goal, not by the patient's whole story.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: A patient has bilateral leg edema without cardiopulmonary instability. Which OMM treatment concept best explains why treating the thoracic inlet may help before lower-extremity pumping?
Option A: The thoracic inlet is a major lymphatic bottleneck
Option B: The thoracic inlet directly diagnoses meniscus tears
Option C: The thoracic inlet is the primary motor nerve to the legs
Option D: The thoracic inlet determines Q angle
Correct: A. The thoracic inlet is a major lymphatic bottleneck
Explanation: Lymph drains back toward the central circulation through the thoracic inlet, so clearing that junction first creates downstream capacity before pumping peripheral fluid upward. Motor innervation to the legs, the Q angle, and meniscal evaluation have no anatomic home at the thoracic inlet. The junction is lymphatic, not neurologic or orthopedic.
Bone Wizardry Lock: Lymphatic OMM is route management: clear the central gate before moving peripheral fluid.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
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- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: The sphenoid and occiput rotate in opposite directions around an anteroposterior axis. Which SBS pattern is most likely?
Option A: Compression
Option B: Torsion
Option C: Lateral strain
Option D: Vertical strain
Correct: B. Torsion
Explanation: Rotation around the anteroposterior axis is the defining feature of torsion at the sphenobasilar synchondrosis. Lateral and vertical strains are built on vertical and transverse axis relationships, and compression reflects a global loss of motion rather than a rotational strain.
Bone Wizardry Lock: For cranial patterns, identify the axis before naming the strain.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
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- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: Craniosacral assessment finds the sphenoid and occiput each rotating opposite to the other, both around vertical axes. Which SBS strain pattern is present?
Option A: Torsion
Option B: Vertical strain
Option C: Compression
Option D: Sidebending-rotation strain
Correct: D. Sidebending-rotation strain
Explanation: Vertical axes with opposing rotation is the mechanical signature of sidebending-rotation at the SBS. Torsion uses an anteroposterior axis instead. Vertical strain organizes around transverse axes, and compression is a global pattern with reduced motion rather than a directional strain.
Bone Wizardry Lock: Vertical axes plus opposite rotation means sidebending-rotation. Anteroposterior axis means torsion. The axes do all the sorting.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: A patient's shoulder pain is reproduced when the examiner passively flexes the arm forward while it is internally rotated. Which shoulder test is the examiner performing?
Option A: Neer test
Option B: Finkelstein test
Option C: McMurray test
Option D: Lachman test
Correct: A. Neer test
Explanation: Passive forward flexion of the internally rotated arm is the Neer impingement maneuver. Three of the four choices belong to the knee or wrist: Lachman tests ACL laxity, McMurray tests the meniscus, and Finkelstein stresses the wrist extensor tendons in de Quervain tenosynovitis. None of those joints are near the subacromial space.
Bone Wizardry Lock: Neer goes at the shoulder. Lachman, McMurray, and Finkelstein belong to other joints. Region mismatch eliminates three choices before you analyze the motion.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: A clinician positions the shoulder and elbow each at 90 degrees, then internally rotates the arm. The patient reports subacromial pain. Which maneuver is being performed?
Option A: FABER test
Option B: Valgus stress test
Option C: Drop-arm test
Option D: Hawkins-Kennedy test
Correct: D. Hawkins-Kennedy test
Explanation: Bringing the shoulder and elbow to 90 degrees and then internally rotating the arm closes down the subacromial space, which is the Hawkins-Kennedy sign. The drop-arm test watches for rotator cuff failure during slow arm lowering, a completely different mechanism. FABER belongs to the hip and sacroiliac joint. Valgus stress evaluates medial collateral ligaments and is not a shoulder test.
Bone Wizardry Lock: For shoulder impingement, Neer raises the arm; Hawkins-Kennedy flexes and internally rotates.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: Combined flexion, adduction, and internal rotation of the hip reproduces a patient's pain. Which provocative test is this?
Option A: FADIR
Option B: FABER
Option C: Trendelenburg
Option D: Lachman
Correct: A. FADIR
Explanation: The acronym FADIR maps directly to the maneuver: flexion, adduction, and internal rotation. FABER uses the same hip joint but reverses two of the directions, combining flexion, abduction, and external rotation to stress the sacroiliac joint instead. Trendelenburg is a stance-stability test for hip abductor strength, and Lachman evaluates ACL integrity at the knee.
Bone Wizardry Lock: Let the acronym do the work when the motions are spelled out.
Topic: Hips
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP hip evaluation
- PMC femoroacetabular impingement exam
- MET for pelvic dysfunction

Stem: During single-leg stance, the patient's pelvis drops on the unsupported side. Which muscle group is most likely weak on the stance side?
Option A: Hip abductors
Option B: Knee extensors
Option C: Hip adductors
Option D: Wrist flexors
Correct: A. Hip abductors
Explanation: A positive Trendelenburg sign tells you the gluteus medius and minimus on the weight-bearing side cannot keep the pelvis level. Adductors pull the thigh inward and the quadriceps extend the knee, so neither holds the pelvis horizontal during stance, and the wrist flexors are nowhere near this mechanism.
Bone Wizardry Lock: Trendelenburg is a pelvis-stability test, not a primary knee or ankle test.
Topic: Hips
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP hip evaluation
- PMC femoroacetabular impingement exam
- MET for pelvic dysfunction

Stem: Numbness and tingling in the median nerve distribution are reproduced when the wrists are held in flexion. Which test is positive?
Option A: Neer test
Option B: Phalen test
Option C: Finkelstein test
Option D: McMurray test
Correct: B. Phalen test
Explanation: Sustained wrist flexion that reproduces median nerve paresthesias is the Phalen maneuver. Finkelstein also tests the wrist but targets the extensor tendons at the radial styloid in de Quervain tenosynovitis, not a nerve. McMurray and Neer belong to different joints entirely. McMurray tests the knee meniscus and Neer lifts the arm into subacromial impingement.
Bone Wizardry Lock: For wrist tests, nerve symptoms and tendon pain lead to different answers.
Topic: Wrist
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Stem: Tapping over the volar wrist produces tingling into the thumb, index, and middle fingers. Which test is this?
Option A: FABER test
Option B: Tinel sign at the carpal tunnel
Option C: Drop-arm test
Option D: Valgus stress test
Correct: B. Tinel sign at the carpal tunnel
Explanation: Percussing the median nerve at the carpal tunnel and producing paresthesias defines a positive Tinel sign. FABER loads the hip joint, and the drop-arm test and valgus stress test belong to the shoulder and knee, respectively. Tapping a peripheral nerve to provoke paresthesias is not part of any of those examinations.
Bone Wizardry Lock: Tinel is percussion-provoked paresthesia over a nerve.
Topic: Wrist
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Stem: A physician finds a restricted cervical segment without fever, neurologic emergency, fresh wound, or fracture signs. What makes this a plausible OMT target?
Option A: Any complaint of pain alone
Option B: A fixed bony leg-length difference
Option C: The patient's age alone
Option D: A reversible mechanical motion restriction
Correct: D. A reversible mechanical motion restriction
Explanation: Somatic dysfunction is defined by reversible changes in the musculoskeletal system, summarized by TART: tissue texture change, asymmetry, restricted motion, and tenderness. A pain complaint alone does not meet those criteria. A fixed bony leg-length discrepancy is structural, not reversible. Age is not a treatable finding. Only a reversible motion restriction checks all those boxes.
Bone Wizardry Lock: Before choosing OMT, ask whether the finding is reversible and mechanical.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: Which finding should stop routine OMT and prompt medical evaluation first?
Option A: Nontraumatic rib motion asymmetry
Option B: Segmental restriction after sleeping awkwardly
Option C: Mild chronic paraspinal hypertonicity
Option D: Fever with systemic illness signs
Correct: D. Fever with systemic illness signs
Explanation: Fever with signs of systemic illness signals a process that manipulation cannot address, so it earns a medical workup first. Rib motion asymmetry, a segment that stiffened after an awkward night, and mild chronic paraspinal hypertonicity are all ordinary mechanical findings you could reasonably treat.
Bone Wizardry Lock: OMT safety starts by ruling out the problem that is not mechanical.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: A physician engages a joint's restrictive barrier and applies gentle repetitive springing forces to increase range of motion. Which OMT technique family is this?
Option A: Articulatory technique
Option B: Counterstrain
Option C: Cranial compression
Option D: Balanced ligamentous tension
Correct: A. Articulatory technique
Explanation: Engaging the restrictive barrier and adding repeated gentle springing is the signature of articulatory technique, a direct method. Counterstrain does the opposite and carries the patient into a position of ease, balanced ligamentous tension settles the tissues at a neutral point, and cranial compression names a dysfunction rather than a treatment.
Bone Wizardry Lock: For technique ID, name the action signature: thrust, active contraction, ease position, pump, or repetitive springing.
Topic: Articulatory Techniques
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
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- Articulatory sacral rocking
- BLT/LAS procedure
- StatPearls OMT topic index

Stem: Which phrase is another common name for articulatory treatment?
Option A: Respiratory assist
Option B: Position of ease
Option C: High velocity, low amplitude
Option D: Low velocity, moderate amplitude
Correct: D. Low velocity, moderate amplitude
Explanation: Articulatory treatment is also called springing or LVMA. HVLA names the thrust technique instead. Position of ease is the setup principle for counterstrain, the opposite of engaging a barrier. Respiratory assist coordinates treatment with the patient's breath and is a separate technique family.
Bone Wizardry Lock: Do not let similar acronyms blur: LVMA is articulatory, HVLA is thrust.
Topic: Articulatory Techniques
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- Articulatory sacral rocking
- BLT/LAS procedure
- StatPearls OMT topic index

Stem: Which patient finding is a contraindication to routine articulatory treatment of a joint?
Option A: A stable hospitalized patient needing gentle care
Option B: Mild reversible rib restriction
Option C: An inflamed or infected joint
Option D: Chronic paraspinal hypertonicity
Correct: C. An inflamed or infected joint
Explanation: Because articulatory work repeatedly moves the joint, an infected or acutely inflamed joint cannot tolerate it, and the same caution applies to a fracture. A stable hospitalized patient, a mild reversible rib restriction, and chronic paraspinal hypertonicity are all settings where gentle articulation is reasonable.
Bone Wizardry Lock: Infection and acute inflammation stop articulatory work. Fracture is also off-limits. Stable patients and those with chronic restriction or reversible rib dysfunction are reasonable candidates.
Topic: Articulatory Techniques
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- Articulatory sacral rocking
- BLT/LAS procedure
- StatPearls OMT topic index

Stem: Rib raising is used to improve chest wall motion, lymphatic return, and sympathetic balance. Which technique family is it usually grouped under?
Option A: Isolytic muscle energy
Option B: Articulatory
Option C: Counterstrain
Option D: Craniosacral
Correct: B. Articulatory
Explanation: Rib raising repeatedly mobilizes the rib angles and heads, which lands it squarely in the articulatory family. Its autonomic effect comes from the thoracic sympathetic chain sitting just anterior to the rib heads, so the maneuver can normalize sympathetic tone while it frees chest wall motion.
Bone Wizardry Lock: When a rib technique uses repetitive joint motion, place it in the articulatory bucket.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: Forward-bending exam shows a right thoracic rib hump. Which vertebral rotation pattern is expected in that thoracic curve?
Option A: Only cervical rotation
Option B: Thoracic vertebrae rotated right
Option C: No rotational component
Option D: Thoracic vertebrae rotated left
Correct: B. Thoracic vertebrae rotated right
Explanation: The rib hump rises on the convex side of the curve, which is also the side the vertebral bodies rotate toward. A right hump therefore reflects right rotation, with the posterior ribs and transverse processes pushed up on the right.
Bone Wizardry Lock: For scoliosis, name the curve by convexity and use the rib hump to find rotation.
Topic: Scoliosis and short leg syndrome
Review Links: - Bone Wizardry scoliosis
- Practice: All OMM Questions QBank
Show outside sources
- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Stem: A school-age patient is found to have a Cobb angle of 25 degrees on spinal radiograph. How should this curve be classified?
Option A: Severe scoliosis only
Option B: Moderate scoliosis
Option C: No scoliosis
Option D: Mild scoliosis
Correct: B. Moderate scoliosis
Explanation: Mild scoliosis runs roughly 5 to 15 degrees and moderate spans about 20 to 45 degrees. At 25 degrees, this curve has crossed out of mild but sits well short of severe, so moderate is correct.
Bone Wizardry Lock: Cobb classification: mild is about 5 to 15 degrees, moderate is 20 to 45, severe is above 45. Know the buckets before addressing management.
Topic: Scoliosis and short leg syndrome
Review Links: - Bone Wizardry scoliosis
- Practice: All OMM Questions QBank
Show outside sources
- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Stem: An anatomically short right leg creates a compensatory lumbar group curve. Which lumbar mechanics are expected?
Option A: No lumbar compensation
Option B: Sidebend right and rotate left
Option C: Sidebend left and rotate right
Option D: Sidebend and rotate right
Correct: C. Sidebend left and rotate right
Explanation: A short leg drops the sacral base on that side, and the compensating lumbar group curve sidebends away from the short leg while rotating toward it. A right short leg therefore produces left sidebending paired with right rotation.
Bone Wizardry Lock: For short leg stems, first identify the short side, then apply away-for-sidebend and toward-for-rotation.
Topic: Scoliosis and short leg syndrome
Review Links: - Bone Wizardry scoliosis
- Practice: All OMM Questions QBank
Show outside sources
- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Stem: A heel lift is chosen for an anatomic short leg. Which side receives the lift and what final height is commonly targeted?
Option A: Long-leg side, one-fourth of the discrepancy
Option B: Long-leg side, full measured discrepancy
Option C: Short-leg side, always the full discrepancy
Option D: Short-leg side, about one-half to three-fourths of the measured discrepancy
Correct: D. Short-leg side, about one-half to three-fourths of the measured discrepancy
Explanation: The lift belongs under the short leg. Clinicians often aim for one-half to three-fourths of the measured discrepancy rather than correcting the whole gap at once, adjusting for the patient's tolerance and chronicity.
Bone Wizardry Lock: Boards test the side first: lift goes under the short leg.
Topic: Scoliosis and short leg syndrome
Review Links: - Bone Wizardry scoliosis
- Practice: All OMM Questions QBank
Show outside sources
- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Stem: At the occipitoatlantal joint, what is the primary physiologic motion?
Option A: Circumduction
Option B: Flexion and extension
Option C: Pure rotation
Option D: Translation only
Correct: B. Flexion and extension
Explanation: The occipitoatlantal joint handles the head-nod, so flexion and extension are its primary motions. The AA joint one level below carries out rotation. Translation and circumduction are not physiologic motions of either upper cervical segment.
Bone Wizardry Lock: OA is the nodding joint (flexion and extension). AA is the rotating joint. Get the joint right before assigning the motion.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: A diagnosis reads OA extended, sidebent right, rotated left. Which coupling rule explains that combination?
Option A: OA follows rib bucket-handle mechanics
Option B: OA sidebending and rotation occur to opposite sides
Option C: OA has no sidebending
Option D: OA sidebending and rotation always occur to the same side
Correct: B. OA sidebending and rotation occur to opposite sides
Explanation: At the occipitoatlantal joint, sidebending and rotation always couple to opposite sides, which is why sidebent right with rotated left is a valid finding. Same-side coupling applies to the typical cervical segments below, not at OA. Saying OA has no sidebending misses the mechanics, and bucket-handle is a rib concept that does not belong at the cranial base.
Bone Wizardry Lock: At OA, check whether sidebending and rotation oppose each other.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: Which articulation provides the primary motion when a patient turns their head side to side?
Option A: The occiput rotates on C1
Option B: C1 rotates on C2
Option C: The sacral base nutates
Option D: C7 exits above C6
Correct: B. C1 rotates on C2
Explanation: At the atlantoaxial joint, the atlas rotates on the axis, making C1 turning on C2 the right answer. The OA joint one level up is occiput on C1. The C7 option is about the cervical nerve-root exit rule, not joint motion. Sacral base nutation is a pelvic finding with no bearing on upper cervical mechanics.
Bone Wizardry Lock: Think of AA as the 'no' joint: shaking the head side to side is rotation.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: During muscle energy setup for AA dysfunction, the cervical spine is commonly positioned at what angle to localize the atlantoaxial joint?
Option A: 45 degrees
Option B: 15 degrees
Option C: 0 degrees
Option D: 90 degrees
Correct: A. 45 degrees
Explanation: Flexing the cervical spine to about 45 degrees localizes the muscle energy setup to the atlantoaxial joint. The shallower angles do not engage AA, and 90 degrees is not a realistic cervical setup position.
Bone Wizardry Lock: 45 degrees of cervical flexion localizes the muscle energy treatment to the atlantoaxial joint. Shallower angles miss AA and engage segments below it.
Topic: Cervical Spine
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: Through the transverse foramina of which cervical vertebrae does the vertebral artery typically ascend?
Option A: C1-C6
Option B: C3-C7
Option C: C8-T1
Option D: C1-C7
Correct: A. C1-C6
Explanation: The vertebral artery threads up through the foramina transversaria of C1 through C6. C7 may carry a transverse foramen, but the artery does not run through it, so the C3-C7, C8-T1, and C1-C7 choices all miss.
Bone Wizardry Lock: The vertebral artery runs through C1-C6 transverse foramina. C7 may have a foramen but the artery bypasses it. That is the anatomical basis for pre-manipulation vascular safety screening at the cervical level.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: A patient has neck pain radiating into the right arm. Neck extension, right sidebending/rotation, and downward compression reproduce the pain. Which test is positive?
Option A: Finkelstein test
Option B: McMurray test
Option C: Spurling test
Option D: Straight leg raise
Correct: C. Spurling test
Explanation: Extension, sidebending and rotation toward the painful side, then axial compression narrows the cervical neuroforamen, and reproduced arm pain confirms a positive Spurling. Finkelstein is a wrist and thumb test, McMurray checks the knee meniscus, and straight leg raise targets the lumbar roots.
Bone Wizardry Lock: Match the region to the test: neck-into-arm pain is Spurling, low-back-into-leg pain is straight leg raise.
Topic: Cervical Spine
Review Links: - Bone Wizardry special tests
- Practice: All OMM Questions QBank
Show outside sources
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation
- Stanford shoulder exam
- AAFP hip evaluation
- AAFP knee evaluation

Stem: In neutral thoracic or lumbar mechanics, sidebending left will usually pair with which vertebral body rotation?
Option A: Rotation right
Option B: Rotation left
Option C: No rotation
Option D: Rotation toward the convex sacral base
Correct: A. Rotation right
Explanation: In a neutral segment, Fryette type I coupling sends sidebending and rotation to opposite sides, so left sidebending carries the vertebral body into right rotation. Same-side rotation would be a type II finding, and the no-rotation and sacral-base options do not match spinal coupling.
Bone Wizardry Lock: Type I applies only when the segment is neutral. Sidebending and rotation go to opposite sides: left sidebend pairs with right rotation. A flexed or extended segment moves to type II, where they pair to the same side.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: A nonneutral lumbar segment is flexed and sidebent right. Which rotation is expected by Fryette type II mechanics?
Option A: Rotation left
Option B: No rotation
Option C: Rotation alternates with respiration
Option D: Rotation right
Correct: D. Rotation right
Explanation: Type II mechanics appear in a flexed or extended segment and couple sidebending with rotation to the same side, so sidebent right means rotated right. Left rotation would be a neutral type I pattern, and respiration-linked or absent rotation do not apply to a single nonneutral segment.
Bone Wizardry Lock: Neutral couples to opposite sides (type I); flexed or extended couples to the same side (type II).
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: Fryette Law III says that introducing motion in one plane has what effect on the other planes?
Option A: It abolishes rotation only
Option B: It applies only to ribs
Option C: It increases all other motion equally
Option D: It decreases motion available in the other planes
Correct: D. It decreases motion available in the other planes
Explanation: Law III is the coupling-cost rule: motion introduced in one plane spends the range available in the others. That rules out the increases-all-motion choice, the rib-only restriction, and the idea that rotation alone disappears.
Bone Wizardry Lock: Law III is not a direction rule; it is a coupling-limit rule.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: A posterolateral disc herniation between L4 and L5 most classically irritates which nerve root in the lumbar region?
Option A: L4
Option B: L5
Option C: S2
Option D: Femoral nerve trunk only
Correct: B. L5
Explanation: A posterolateral, paracentral herniation spares the exiting L4 root and pinches the traversing root, which at the L4-L5 level is L5. S2 sits too far caudal for this disc, and the femoral trunk is not a single-root answer.
Bone Wizardry Lock: Paracentral lumbar discs compress the traversing root, so name the level below the disc.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: Low back pain radiates down the leg, straight leg raise is positive, Achilles reflex is decreased, and sensation is reduced over the lateral leg. Which root is most likely involved?
Option A: C7
Option B: L4
Option C: T10
Option D: S1
Correct: D. S1
Explanation: A positive straight leg raise puts this in the lumbosacral roots, and the reflex seals it: a diminished Achilles (ankle) reflex is the S1 signature, paired with sensory loss along the posterolateral leg and lateral foot. L4 would blunt the patellar reflex, C7 is a cervical root, and T10 maps to the trunk.
Bone Wizardry Lock: Solve radiculopathy stems with the reflex and dermatome together, not the pain pattern alone.
Topic: Lumbar Spine
Review Links: - Bone Wizardry special tests
- Practice: All OMM Questions QBank
Show outside sources
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation
- Stanford shoulder exam
- AAFP hip evaluation
- AAFP knee evaluation

Stem: Ferguson's lumbosacral angle is normally in which approximate range?
Option A: 45 to 60 degrees
Option B: 75 to 90 degrees
Option C: 25 to 35 degrees
Option D: 0 to 5 degrees
Correct: C. 25 to 35 degrees
Explanation: The Ferguson, or lumbosacral, angle sits between a horizontal reference line and the slope of the sacral base, normally around 25 to 35 degrees. A 0 to 5 degree reading is unnaturally flat, while values at 45 and above raise lumbosacral shear stress.
Bone Wizardry Lock: Normal Ferguson angle is 25 to 35 degrees. Values above 45 degrees increase anterior shear at the lumbosacral junction. The number is the anchor; the clinical significance follows from it.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: When treating psoas syndrome, which region should be addressed first?
Option A: Wrist flexors
Option B: Cranial SBS only
Option C: Lumbar or thoracolumbar spine
Option D: Distal fibular head only
Correct: C. Lumbar or thoracolumbar spine
Explanation: Psoas syndrome traces back to the upper lumbar and thoracolumbar junction where the muscle anchors, so that region is treated first. Wrist flexors, an isolated fibular head, and a cranial SBS pattern are nowhere near the psoas driver.
Bone Wizardry Lock: The psoas originates from the thoracolumbar junction and upper lumbar spine. Clearing that spinal region first is the correct sequence because the dysfunction traces to the vertebral attachment, not to the hip or any distal structure.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: Which region is generally treated before addressing cervical spine dysfunction?
Option A: Ribs and upper thoracic spine
Option B: Sacral base only
Option C: Distal fibula
Option D: Wrist and hand
Correct: A. Ribs and upper thoracic spine
Explanation: Upper thoracic and rib mechanics feed the cervical region through shared muscular attachments, so clearing them first keeps you from treating the neck in isolation. The sacrum, fibula, and wrist options sit outside that driver chain.
Bone Wizardry Lock: Upper thoracic dysfunction and restricted ribs reload the cervical spine through shared muscular attachments. Local cervical treatment will not hold if those drivers are left untreated.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
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- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: A patient has a persistent rib dysfunction despite local rib treatment. Which related region should generally be addressed before returning to the rib?
Option A: Contralateral ankle
Option B: Thoracic spine
Option C: Wrist
Option D: Cranial SBS
Correct: B. Thoracic spine
Explanation: Each rib articulates with its thoracic vertebra at the costovertebral and costotransverse joints, so a rib that will not stay treated often reflects an underlying thoracic dysfunction, which is why the thoracic spine is cleared first. The ankle, wrist, and cranial SBS options fall off the rib's articular chain.
Bone Wizardry Lock: A stubborn rib usually answers to its thoracic segment, so treat that before re-treating the rib.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: How many cervical nerve roots are there, and how do the upper seven exit relative to their corresponding vertebrae?
Option A: Eight roots; the upper seven exit above
Option B: Six roots; the upper six exit through sacral foramina
Option C: Eight roots; all exit below
Option D: Seven roots; all exit below
Correct: A. Eight roots; the upper seven exit above
Explanation: Eight cervical roots exist even though there are only seven cervical vertebrae, because C8 emerges between C7 and T1. Roots C1 through C7 leave above their matching vertebra, while every root from T1 downward exits below. The sacral-foramina choice is just the wrong region.
Bone Wizardry Lock: Eight roots, seven vertebrae. C1 through C7 exit above their corresponding vertebra. C8 exits between C7 and T1. Every root from T1 downward exits below its vertebra.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: During myofascial release, the physician palpates a fascial restriction, applies traction into the restrictive barrier, adds twisting or transverse force, and waits for release. Which approach is this?
Option A: Indirect myofascial release
Option B: Direct myofascial release
Option C: Pedal pump
Option D: Counterstrain
Correct: B. Direct myofascial release
Explanation: Loading the tissue into its restrictive barrier is the signature of direct myofascial release. Indirect MFR follows the fascia toward ease, counterstrain positions a tender point into comfort, and pedal pump is a lymphatic pump technique.
Bone Wizardry Lock: Direct MFR engages the restrictive barrier; indirect MFR follows the tissue into ease. The operator's direction of force is the deciding variable.
Topic: Myofascial Release
Review Links: - Bone Wizardry fascial subtypes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls myofascial pain
- StatPearls 5 diaphragm procedure
- WVSOM OMT methods
- OMM brief review

Stem: A physician treats fascia by applying compression, following the tissue into its easiest motion, and waiting for softening. Which myofascial approach is most likely?
Option A: Lachman test
Option B: Indirect myofascial release
Option C: Direct myofascial release
Option D: HVLA
Correct: B. Indirect myofascial release
Explanation: Compression plus ease is the signature of indirect MFR: the physician follows the tissue along its path of least resistance and waits for it to soften. Direct MFR does the opposite, loading the restrictive barrier with traction or stretch.
Bone Wizardry Lock: MFR can be direct or indirect; compression/ease points indirect, traction/bind points direct.
Topic: Myofascial Release
Review Links: - Bone Wizardry fascial subtypes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls myofascial pain
- StatPearls 5 diaphragm procedure
- WVSOM OMT methods
- OMM brief review

Stem: Which of the following accurately describes myofascial release as an OMT technique?
Option A: It is always a high-velocity thrust
Option B: It can be direct or indirect, active or passive
Option C: It always requires a tender point
Option D: It is only a cranial technique
Correct: B. It can be direct or indirect, active or passive
Explanation: MFR is a fascial approach that can be applied direct or indirect and active or passive, depending on how the physician engages the tissue. HVLA requires a rapid thrust, counterstrain repositions the patient around a tender point, and cranial techniques form a separate category.
Bone Wizardry Lock: MFR belongs to fascial technique, not thrust technique. Direct and indirect variants can each be active or passive depending on patient participation.
Topic: Myofascial Release
Review Links: - Bone Wizardry fascial subtypes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls myofascial pain
- StatPearls 5 diaphragm procedure
- WVSOM OMT methods
- OMM brief review

Stem: A spinal cord neuron pool is held in partial, subthreshold excitation so that less afferent input is needed to fire. Which OMM concept is this?
Option A: Facilitation
Option B: Fasciculation
Option C: Nutation
Option D: Cavitation
Correct: A. Facilitation
Explanation: A neuron pool sitting in subthreshold excitation needs less afferent input to discharge, which is the definition of facilitation. Cavitation is the joint pop produced during manipulation, nutation is sacral base motion, and fasciculation is an involuntary muscle twitch.
Bone Wizardry Lock: Facilitation is physiology, not a positional diagnosis.
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
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- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Stem: If facilitation occurs at one spinal level rather than as a diffuse systemic pattern, what is it called?
Option A: Reciprocal inhibition
Option B: Cranial torsion
Option C: Segmental facilitation
Option D: Crossed extensor reflex
Correct: C. Segmental facilitation
Explanation: When the facilitated state stays confined to a single spinal level, it is called segmental facilitation. Reciprocal inhibition belongs to muscle energy and the crossed extensor reflex is a withdrawal-reflex pattern, so neither fits a localized cord finding.
Bone Wizardry Lock: Facilitation confined to a single spinal cord segment is segmental facilitation. Diffuse hyperexcitability without level-specific localization is simply called facilitation.
Topic: Facilitation
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Stem: Which set of terms correctly categorizes HVLA as an OMT technique?
Option A: Indirect, passive, tender-point positioning only
Option B: Direct, passive, high-velocity and low-amplitude
Option C: Direct, active, sustained contraction
Option D: Indirect, active, low-velocity and high-amplitude
Correct: B. Direct, passive, high-velocity and low-amplitude
Explanation: HVLA engages the restrictive barrier and delivers a quick, small-amplitude thrust, which makes it direct and passive from the patient's side. The remaining phrases borrow from muscle energy and counterstrain rather than thrust technique.
Bone Wizardry Lock: HVLA is defined by three features: it is direct, passive, and delivered as a high-velocity, low-amplitude thrust. Each feature distinguishes it from other technique families.
Topic: HVLA
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: Which finding is an absolute stop sign before routine spinal HVLA?
Option A: Bony compromise from infection, tumor, trauma, or fracture concern
Option B: A stable chronic rib restriction
Option C: Mild chronic paraspinal tissue texture change
Option D: A patient who understands instructions
Correct: A. Bony compromise from infection, tumor, trauma, or fracture concern
Explanation: Bone weakened by infection, tumor, trauma, inflammation, or possible fracture cannot tolerate a thrust, so HVLA is off the table. A stable chronic restriction, mild tissue texture change, or a cooperative patient are not by themselves reasons to withhold treatment.
Bone Wizardry Lock: Bony compromise from infection, tumor, trauma, or fracture is the key absolute contraindication to HVLA. Acute neurologic signs are a second hard stop.
Topic: HVLA
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: A patient has acute myelopathy signs and spinal cord compression concern. What should happen to planned HVLA?
Option A: Use more rotational force
Option B: Proceed if a cavitation is likely
Option C: Do not perform HVLA; evaluate the neurologic emergency
Option D: Only thrust if the patient has chronic pain
Correct: C. Do not perform HVLA; evaluate the neurologic emergency
Explanation: Acute neurologic compromise is an emergency, not a somatic dysfunction to manipulate. Suspected cord compression, acute myelopathy, cauda equina, or a threatened nerve root all rule HVLA out and send the patient toward urgent evaluation instead.
Bone Wizardry Lock: When cord compression or acute myelopathy is suspected, the correct move is urgent evaluation, not spinal manipulation.
Topic: HVLA
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: A patient recently had abdominal surgery. Which lymphatic pump technique is specifically risky because it can raise thoracoabdominal pressure and stress the operative site?
Option A: OA decompression
Option B: Pedal pump
Option C: Counterstrain
Option D: Spurling test
Correct: B. Pedal pump
Explanation: Pedal pump drives thoracoabdominal pressure, so soon after abdominal surgery it can stress the healing operative site and is best avoided. OA decompression and counterstrain are not pumps, and Spurling is a cervical test, so none of them carry that specific risk.
Bone Wizardry Lock: Pedal pump raises thoracoabdominal pressure. That pressure effect is why it is contraindicated after abdominal surgery.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: Before treating upper-extremity lymph congestion with a posterior axillary fold technique, what should generally be opened first?
Option A: Thoracic inlet
Option B: Carpal tunnel
Option C: SBS compression
Option D: Talocrural joint
Correct: A. Thoracic inlet
Explanation: Lymphatic work moves from central to peripheral, so the thoracic inlet is opened first, followed by redoming the thoracoabdominal diaphragm and then the posterior axillary fold. The carpal tunnel is a median nerve structure, the talocrural joint is in the distal lower extremity, and SBS compression is a cranial concept.
Bone Wizardry Lock: Lymphatic sequencing is drainage logic: clear central gates before peripheral pumps.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: Before lymph from the right arm enters the venous system, it must pass through which key region?
Option A: Left SI joint
Option B: Right carpal tunnel
Option C: Right thoracic inlet
Option D: Left fibular head
Correct: C. Right thoracic inlet
Explanation: Lymph from the right arm has to cross the right thoracic inlet before it reaches the venous system, which is why inlet treatment anchors upper-extremity drainage. The left SI joint, right carpal tunnel, and left fibular head are nowhere on that route.
Bone Wizardry Lock: Right arm lymph must cross the right thoracic inlet before it reaches the venous system. That is what makes inlet treatment the prerequisite for upper-extremity drainage work.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: In reciprocal inhibition muscle energy, the patient pushes in which direction?
Option A: Only into cranial flexion
Option B: Only with respiratory exhalation
Option C: Toward the restrictive barrier
Option D: Away from the restrictive barrier
Correct: C. Toward the restrictive barrier
Explanation: In reciprocal inhibition, the patient contracts toward the restrictive barrier rather than away from it. That contraction triggers reflex relaxation of the antagonist on the opposite side, which is what frees the motion.
Bone Wizardry Lock: In reciprocal inhibition, the patient contracts toward the barrier, which triggers reflex relaxation of the opposing tissue. Patient effort direction is the variable that separates RI from other MET approaches.
Topic: Muscle Energy
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: A physician prepares to treat a patient with muscle energy. Which of the following patient factors would make the technique inappropriate?
Option A: Mild asymmetry with full alertness
Option B: Inability to follow instructions
Option C: A stable chronic thoracic restriction
Option D: A reversible rib exhalation dysfunction
Correct: B. Inability to follow instructions
Explanation: Muscle energy depends on the patient contracting on command against the physician's counterforce. A patient who cannot understand or safely follow directions cannot supply that controlled effort, so the technique does not apply. Mild asymmetry, a stable chronic restriction, and a reversible rib dysfunction all remain treatable.
Bone Wizardry Lock: Muscle energy requires the patient to contract on command. If they cannot follow instructions, the technique cannot be performed.
Topic: Muscle Energy
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: An examiner sets the leg into a figure-four position of flexion, abduction, and external rotation, then applies downward pressure on the bent knee. Name the test.
Option A: Spurling test
Option B: Lachman test
Option C: FADIR test
Option D: Patrick/FABER test
Correct: D. Patrick/FABER test
Explanation: The acronym is the answer: FABER stands for flexion, abduction, and external rotation, the exact figure-four setup, and Patrick/FABER screens the hip and SI joint. FADIR swaps in adduction and internal rotation, Lachman tests the ACL, and Spurling is a cervical radiculopathy maneuver.
Bone Wizardry Lock: Let the acronym decode the hip special test before choosing the pathology.
Topic: Hips
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP hip evaluation
- PMC femoroacetabular impingement exam
- MET for pelvic dysfunction

Stem: During Patrick/FABER testing, the figure-four position reproduces pain that intensifies with downward pressure. Where is that pain most likely arising?
Option A: Median and ulnar nerves
Option B: SBS and cranial base
Option C: ACL and PCL
Option D: Hip and SI joint
Correct: D. Hip and SI joint
Explanation: Patrick/FABER loads the hip and sacroiliac joint, so reproducible pain in the figure-four position points to those structures. Knee ligaments, wrist nerves, and cranial mechanics have no relationship to this maneuver or the loading it produces.
Bone Wizardry Lock: FABER loads the hip and SI joint together. Pain that reproduces in the figure-four narrows the source to those two structures.
Topic: Hips
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP hip evaluation
- PMC femoroacetabular impingement exam
- MET for pelvic dysfunction

Stem: A clinician stabilizes the distal femur, grasps the proximal tibia, and pulls the tibia anteriorly with the knee flexed about 20 to 30 degrees. Which test is this?
Option A: FABER test
Option B: McMurray test
Option C: Posterior drawer test
Option D: Lachman test
Correct: D. Lachman test
Explanation: Lachman pulls the tibia forward at slight flexion to test ACL integrity, which is exactly the maneuver described. Posterior drawer translates the tibia backward, McMurray screens the meniscus, and FABER is a hip and SI test.
Bone Wizardry Lock: Knee ligament tests are solved by tibial translation direction.
Topic: Knee
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP knee evaluation
- AAFP knee pain history and exam
- AAFP knee injury tool

Stem: An athlete injures the knee in a non-contact plant-and-cut maneuver and cannot bear weight afterward. Of the following physical exam tests, which has the highest sensitivity for an acute ACL tear?
Option A: Spurling test
Option B: McMurray test
Option C: Finkelstein test
Option D: Lachman test
Correct: D. Lachman test
Explanation: For an acute ACL tear, Lachman is the test with the highest sensitivity. McMurray loads the meniscus, Finkelstein screens for de Quervain tenosynovitis, and Spurling reproduces cervical radiculopathy, so none of them target the ACL.
Bone Wizardry Lock: An audible pop with anterior laxity at the knee should point you straight to Lachman.
Topic: Knee
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP knee evaluation
- AAFP knee pain history and exam
- AAFP knee injury tool

Stem: A patient falls forward onto a pronated forearm and later has elbow pain with restricted supination. Which radial head dysfunction is most likely?
Option A: Posterior radial head
Option B: Exhaled rib
Option C: Anterior radial head
Option D: Anterior innominate
Correct: A. Posterior radial head
Explanation: A forward fall onto a pronated forearm drives the radial head posterior. The dysfunction then restricts supination and resists anterior glide, which is the posterior radial head pattern.
Bone Wizardry Lock: Tie the radial head diagnosis to three clues: the fall mechanism, the rotation you lose, and the glide that resists.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: During a backward fall, a patient braces with a supinated forearm. In clinic the next day, pronation is limited at the elbow. Which radial head dysfunction explains this finding?
Option A: Anterior radial head
Option B: Left-on-left sacral torsion
Option C: Posterior radial head
Option D: Posterior fibular head
Correct: A. Anterior radial head
Explanation: A backward fall onto a supinated forearm carries the radial head anterior. Pronation becomes restricted and posterior glide meets resistance, which is anterior radial head.
Bone Wizardry Lock: Anterior radial head prefers supination and restricts pronation.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: Which nerve innervates most hypothenar muscles and interossei?
Option A: Musculocutaneous nerve
Option B: Radial nerve
Option C: Median nerve
Option D: Ulnar nerve
Correct: D. Ulnar nerve
Explanation: The ulnar nerve supplies the hypothenar group and the interossei. The median nerve runs the thenar muscles and most long flexors, the radial nerve drives the extensors, and the musculocutaneous nerve supplies the biceps.
Bone Wizardry Lock: Ulnar nerve: hypothenar group, all interossei, and the medial two lumbricals.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: A proximal fibular head resists anterior springing, and the distal fibula sits anteriorly. Which fibular head dysfunction is most likely?
Option A: Exhaled fibular head
Option B: Posterior fibular head
Option C: Medial meniscus tear
Option D: Anterior fibular head
Correct: B. Posterior fibular head
Explanation: When the proximal head resists an anterior spring and the distal fibula has drifted anterior, the diagnosis is a posterior fibular head. The two ends glide in opposite directions, so a posterior top pairs with an anterior bottom.
Bone Wizardry Lock: For fibular head, diagnose the proximal head by the spring it resists.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: A posterior fibular head dysfunction can disturb which nerve near the fibular neck?
Option A: Common fibular nerve
Option B: Obturator nerve
Option C: Tibial nerve in the tarsal tunnel only
Option D: Femoral nerve
Correct: A. Common fibular nerve
Explanation: The common fibular nerve curves around the fibular neck, so a fibular head dysfunction can compress or irritate it. The femoral and obturator nerves run nowhere near this region, and the tibial nerve in the tarsal tunnel is a separate entrapment down at the ankle.
Bone Wizardry Lock: A fibular head dysfunction at the neck can compress the common fibular nerve, producing foot drop and dorsal foot sensory loss.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: Tapping over the volar transverse carpal ligament produces paresthesia into the thumb, index, middle, and lateral half of the ring finger. Which test is positive?
Option A: Lachman test
Option B: Tinel test at the carpal tunnel
Option C: FABER test
Option D: Finkelstein test
Correct: B. Tinel test at the carpal tunnel
Explanation: A positive Tinel sign means percussion over a nerve reproduces its characteristic tingling. Tapping the median nerve at the carpal tunnel sends paresthesia into the thumb, index, middle, and lateral half of the ring finger, which is the median nerve's sensory territory.
Bone Wizardry Lock: Tinel at the wrist reproduces median nerve paresthesia: thumb through lateral ring finger, sparing the little finger.
Topic: Wrist
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Stem: Which Spencer sequence step uses glenohumeral circumduction with slight compression followed by traction?
Option A: A cervical HVLA setup
Option B: The fourth step of the Spencer technique
Option C: The final lymphatic pump step only
Option D: The first step only
Correct: B. The fourth step of the Spencer technique
Explanation: The Spencer technique follows a sequence of glenohumeral mobilizations. Step four pairs circumduction with slight axial compression, then shifts to traction. That combination distinguishes it from the surrounding range-of-motion steps. The full sequence closes with a lymphatic pump.
Bone Wizardry Lock: Step four is the pivot of the Spencer sequence: circumduction with compression, then traction. The pump closes the series.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: The Spencer technique primarily aims to improve motion in which joint?
Option A: Sacroiliac joint
Option B: Atlantoaxial joint
Option C: Talocrural joint
Option D: Glenohumeral joint
Correct: D. Glenohumeral joint
Explanation: Spencer is an articulatory shoulder sequence that frees glenohumeral motion while the scapula is held steady. Talocrural, sacroiliac, and atlantoaxial joints are nowhere near the shoulder, so each of those options is anatomically misplaced.
Bone Wizardry Lock: Spencer targets the glenohumeral joint. The scapula is stabilized while the humerus is cycled through its range.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: An elderly hospitalized patient has a reversible joint restriction and needs a gentle approach. Which technique is the safest choice?
Option A: Indirect technique or gentle direct articulatory technique
Option B: Routine thrust through an inflamed joint
Option C: Pedal pump after abdominal surgery
Option D: Forceful cervical HVLA in extension
Correct: A. Indirect technique or gentle direct articulatory technique
Explanation: Frail and hospitalized patients tolerate indirect work or a gentle direct articulatory approach far better than high-force methods. A thrust through an inflamed joint, a pedal pump soon after abdominal surgery, and forceful cervical HVLA in extension all push past the patient's safety margin.
Bone Wizardry Lock: Technique selection is a safety decision, not just a diagnosis match.
Topic: Articulatory Techniques
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- Articulatory sacral rocking
- BLT/LAS procedure
- StatPearls OMT topic index

Stem: During a contraction exercise, the physician and patient generate equal opposing force so the muscle does not change length. What contraction type is this?
Option A: Isotonic
Option B: Eccentric only
Option C: Isometric
Option D: Isolytic
Correct: C. Isometric
Explanation: Equal and opposing forces hold the muscle at a fixed length, which defines an isometric contraction. If the patient's effort is greater than the operator's, the contraction is isotonic; if the operator overpowers the patient, it is isolytic.
Bone Wizardry Lock: Isometric means neither side moves: operator and patient forces cancel exactly.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: The joints of Luschka are part of the vertebral bodies at which cervical levels?
Option A: C3-C7
Option B: T1-T4
Option C: L1-L5
Option D: C1-C2
Correct: A. C3-C7
Explanation: The joints of Luschka run from C3 to C7 along the cervical bodies, bracing the lateral edge of each disc, shielding the nerve roots, and guiding cervical sidebending. C1-C2 is occupied by the atlantoaxial and occipitoatlantal joints, and T1-L5 falls below the cervical column entirely.
Bone Wizardry Lock: The joints of Luschka are unique to C3-C7. They brace the lateral disc and guard the exiting nerve roots in those segments.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: Rib raising can affect sympathetic tone because the thoracic sympathetic chain ganglia lie directly anterior to which structure?
Option A: Costal cartilage only
Option B: Sternal angle
Option C: Corresponding rib heads
Option D: Spinous processes
Correct: C. Corresponding rib heads
Explanation: The thoracic chain ganglia rest just in front of the matching rib heads. Raising the ribs mobilizes that area, with a brief burst of sympathetic activity followed by longer-lasting inhibition.
Bone Wizardry Lock: Rib raising works because the rib heads sit right next to the sympathetic chain.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: An increased Ferguson lumbosacral angle is most associated with what mechanical problem?
Option A: Cranial torsion
Option B: Posterior radial head
Option C: Median nerve entrapment
Option D: Shear stress at the lumbosacral joint
Correct: D. Shear stress at the lumbosacral joint
Explanation: A steeper Ferguson angle increases shear across the lumbosacral junction and feeds into low back pain. Median nerve entrapment, cranial torsion, and posterior radial head are each bound to distant anatomy with no mechanical link to lumbosacral alignment.
Bone Wizardry Lock: A steeper Ferguson angle means more anterior slip force at L5-S1. That shear drives lumbosacral instability.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: Which etiology accounts for the large majority of scoliosis cases?
Option A: Idiopathic
Option B: Duchenne muscular dystrophy
Option C: Meningomyelocele
Option D: Poliomyelitis
Correct: A. Idiopathic
Explanation: Polio, Duchenne muscular dystrophy, and meningomyelocele can all produce scoliosis, but idiopathic disease accounts for the large majority of cases. A neuromuscular cause requires a clear trigger in the clinical picture to earn serious consideration.
Bone Wizardry Lock: Idiopathic scoliosis is the default. Neuromuscular and congenital causes come with distinct clinical findings.
Topic: Scoliosis and short leg syndrome
Review Links: - Bone Wizardry scoliosis
- Practice: All OMM Questions QBank
Show outside sources
- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Stem: A sacral torsion combines rotation of the sacrum about which axis with an associated L5 somatic dysfunction?
Option A: Longitudinal femoral axis
Option B: Middle transverse axis only
Option C: Oblique axis
Option D: Vertical cranial axis
Correct: C. Oblique axis
Explanation: Torsions rotate the sacrum on an oblique axis and always carry an L5 component. Bilateral flexion and extension, by contrast, pivot on the middle transverse axis.
Bone Wizardry Lock: Torsions pivot on an oblique axis and always come with L5 dysfunction. Bilateral sacral movements flex or extend on the middle transverse axis instead.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: Most thenar muscles are innervated by which nerve?
Option A: Median nerve
Option B: Radial nerve
Option C: Ulnar nerve
Option D: Axillary nerve
Correct: A. Median nerve
Explanation: Most thenar muscles are median-nerve territory, with adductor pollicis as the ulnar exception. The hypothenar group and the interossei belong to the ulnar nerve.
Bone Wizardry Lock: Separate the hand intrinsics by nerve before committing: thenar median, hypothenar and interossei ulnar.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: The fibular head glides anteriorly with which foot motion?
Option A: Inhalation
Option B: Supination
Option C: Pronation
Option D: Cranial flexion
Correct: C. Pronation
Explanation: Pronation drives the fibular head forward; supination pulls it back. Reading the foot position tells you which way the proximal fibula has moved.
Bone Wizardry Lock: For fibular head mechanics, pair pronation with anterior and supination with posterior.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: During craniosacral flexion, the sacral base moves in which direction?
Option A: Anteriorly, or nutation
Option B: Posteriorly, or counternutation
Option C: No sacral motion occurs
Option D: Laterally only
Correct: B. Posteriorly, or counternutation
Explanation: In the flexion phase the sacral base swings posteriorly, the motion called counternutation. The extension phase reverses it, tipping the base anteriorly, or nutation.
Bone Wizardry Lock: Cranial flexion swings the sacral base posteriorly. That is counternutation, not the other way around.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: In a facilitated segment, which change explains why a small input can trigger a large response?
Option A: Fixed bony fusion
Option B: Complete nerve conduction block
Option C: Loss of all afferent input
Option D: Higher resting membrane potential and hyperexcitable neural state
Correct: D. Higher resting membrane potential and hyperexcitable neural state
Explanation: Facilitation holds the segmental neurons closer to threshold, so a small afferent input is enough to fire them. That is hyperexcitability, not a conduction block and not a fused joint.
Bone Wizardry Lock: Facilitated neurons sit closer to firing threshold. Less afferent input is needed to trigger an efferent response.
Topic: Facilitation
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Stem: Which description best matches a Chapman point as a palpable finding?
Option A: Dermatomal vesicular rash
Option B: Large fluctuant abscess requiring drainage
Option C: Small tender fascial nodule associated with visceral dysfunction
Option D: Cavitating joint space
Correct: C. Small tender fascial nodule associated with visceral dysfunction
Explanation: A Chapman point is a small, tender fascial nodule that signals visceral dysfunction underneath. An abscess, a cavitating joint, or a rash are different problems entirely.
Bone Wizardry Lock: Trace the nodule back to its viscerosomatic reflex when you find a Chapman point.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: During a myofascial release, the physician applies a twisting force, adds a transverse force, layers in enhancers, and holds while the tissue changes. What is the physician waiting for?
Option A: Dermatomal rash
Option B: Cavitation
Option C: Release
Option D: Positive drawer sign
Correct: C. Release
Explanation: The endpoint of MFR is release: the tissue softens and motion frees up. The twist, transverse load, and enhancers are only the means of getting there. Cavitation belongs to HVLA, a dermatomal rash is dermatology, and a drawer sign is a ligament test.
Bone Wizardry Lock: Do not import HVLA endpoints into myofascial release questions.
Topic: Myofascial Release
Review Links: - Bone Wizardry fascial subtypes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls myofascial pain
- StatPearls 5 diaphragm procedure
- WVSOM OMT methods
- OMM brief review

Stem: You are treating upper-extremity lymphatic congestion. With the thoracic inlet already opened, what comes next?
Option A: Compress the carpal tunnel
Option B: Perform McMurray test
Option C: Redome the thoracoabdominal diaphragm
Option D: Thrust the cervical spine
Correct: C. Redome the thoracoabdominal diaphragm
Explanation: Lymphatic work runs proximal to distal: open the thoracic inlet, redome the thoracoabdominal diaphragm, then address the posterior axillary fold. McMurray is a meniscus test, a cervical thrust has nothing to do with drainage, and compressing the carpal tunnel would only aggravate the nerve. Order matters here: inlet, diaphragm, then axillary fold.
Bone Wizardry Lock: Lymphatic treatment order follows drainage gates, not the painful spot alone.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: The physician moves the patient into the position of greatest comfort, holds it, then guides the body slowly back to neutral. Which technique is this?
Option A: Fryette type I uses tender points
Option B: Counterstrain uses position of ease and slow return
Option C: Lymphatic pump treats only with thrust
Option D: HVLA requires a rapid return to neutral
Correct: B. Counterstrain uses position of ease and slow return
Explanation: Counterstrain treats tender points by folding the body into a position of ease, holding it, then easing slowly back to neutral. A fast thrust would make this HVLA instead.
Bone Wizardry Lock: If the patient is passively folded into comfort, think counterstrain before direct techniques.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: The patient's effort overcomes the physician's counterforce and the joint moves through a range. Which contraction type is that?
Option A: Cranial compression
Option B: Isometric
Option C: Isotonic
Option D: Isolytic
Correct: C. Isotonic
Explanation: When the operator's force is less than the patient's and motion results, the contraction is isotonic. Equal forces make it isometric, and an operator force greater than the patient's makes it isolytic.
Bone Wizardry Lock: The contraction type follows who overcomes whom. If the patient moves through the barrier, that is isotonic. If neither side gives, that is isometric. If the physician overrides the patient's effort, that is isolytic.
Topic: Muscle Energy
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: HVLA aims to deliver a therapeutic thrust through a restrictive barrier. Which endpoint is not required to call the technique successful?
Option A: A short low-amplitude impulse
Option B: Barrier engagement
Option C: An audible cavitation
Option D: Appropriate safety screening
Correct: C. An audible cavitation
Explanation: HVLA delivers a high-velocity, low-amplitude force at a restrictive barrier, but the audible pop is not the goal. Careful safety screening and accurate barrier setup matter far more than hearing a cavitation.
Bone Wizardry Lock: Do not let cavitation distract from safety and mechanics.
Topic: HVLA
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: The examiner flexes, adducts, and internally rotates the hip to reproduce anterior groin pain in a young athlete. What is this maneuver called?
Option A: FADIR
Option B: Phalen
Option C: FABER
Option D: Lachman
Correct: A. FADIR
Explanation: FADIR stands for flexion, adduction, and internal rotation. FABER pairs flexion with abduction and external rotation, Phalen is a wrist maneuver, and Lachman checks the ACL.
Bone Wizardry Lock: FADIR loads the anterior hip by pressing the femoral head inward and forward. FABER opens the posterior capsule instead. The letters spell out the direction of force before you even look at the test name.
Topic: Hips
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP hip evaluation
- PMC femoroacetabular impingement exam
- MET for pelvic dysfunction

Stem: A knee exam pushes the proximal tibia backward on the femur. Which ligament does this primarily test?
Option A: PCL
Option B: LCL
Option C: ACL
Option D: MCL
Correct: A. PCL
Explanation: Driving the tibia backward loads the posterior cruciate ligament, since the PCL is what stops the tibia from sliding posteriorly. Anterior translation checks the ACL, valgus stress checks the MCL, and varus stress checks the LCL.
Bone Wizardry Lock: Translate the tibia direction directly into the cruciate ligament.
Topic: Knee
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP knee evaluation
- AAFP knee pain history and exam
- AAFP knee injury tool

Stem: A patient reports numbness in the thumb, index, and middle fingers that worsens overnight and with prolonged wrist flexion. Phalen and Tinel signs are positive. Which nerve is entrapped at the wrist?
Option A: Radial nerve
Option B: Musculocutaneous nerve
Option C: Median nerve
Option D: Ulnar nerve
Correct: C. Median nerve
Explanation: Carpal tunnel syndrome traps the median nerve as it runs under the flexor retinaculum. Tinel, Phalen, and prayer tests all reproduce median symptoms. Ulnar entrapment shows up at Guyon canal or the cubital tunnel, the radial nerve runs the extensors, and the musculocutaneous nerve drives elbow flexion.
Bone Wizardry Lock: The median nerve passes under the flexor retinaculum, not through Guyon canal. Placing the anatomy before picking the test keeps ulnar and median entrapment from bleeding together.
Topic: Wrist
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Stem: A patient reports six months of progressively worsening shoulder stiffness with loss of both active and passive range in all planes. Imaging rules out fracture. Which OMT technique is indicated to restore glenohumeral mobility?
Option A: Pedal pump
Option B: Spencer technique
Option C: Spurling test
Option D: Sacral rocking only
Correct: B. Spencer technique
Explanation: Frozen shoulder, or adhesive capsulitis, is the classic indication for the Spencer technique to restore glenohumeral motion. Spurling targets cervical radiculopathy, and the pedal pump is a lymphatic technique.
Bone Wizardry Lock: Spencer technique addresses frozen shoulder through seven sequential glenohumeral motions. The clue is global loss of both active and passive motion, which points to capsular tightening rather than a rotator cuff problem.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: A physician performs rib raising in a patient recovering from pneumonia. The rib heads sit just lateral to the paravertebral sympathetic ganglia. What is the primary therapeutic rationale for this anatomic proximity?
Option A: Compress the median nerve
Option B: Increase Ferguson angle
Option C: Normalize sympathetic activity
Option D: Diagnose ACL rupture
Correct: C. Normalize sympathetic activity
Explanation: Rib raising mobilizes the rib heads, which lie just lateral to the sympathetic chain ganglia. Along with improving chest wall motion and lymphatic return, that proximity is what lets the technique calm overactive sympathetic output.
Bone Wizardry Lock: Rib raising works because the rib heads sit next to the sympathetic ganglia. The mobilization modulates autonomic tone through that proximity, not just through chest wall expansion.
Topic: Articulatory Techniques
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- Articulatory sacral rocking
- BLT/LAS procedure
- StatPearls OMT topic index

Stem: On exam, downward traction on the humerus opens a visible groove just below the acromion in a patient with shoulder pain and laxity. What is this positive finding called?
Option A: Spurling test
Option B: Tinel sign
Option C: Drop-arm test
Option D: Sulcus sign
Correct: D. Sulcus sign
Explanation: The sulcus sign screens for inferior glenohumeral instability and ligamentous laxity, and downward traction on the humerus is what opens that depression under the acromion. A positive Spurling would mean cervical radiculopathy, Tinel maps a peripheral nerve, and the drop-arm test points to a rotator cuff tear, so none of those explain an inferior-traction groove.
Bone Wizardry Lock: Sulcus sign indicates inferior glenohumeral laxity. The groove appears because the inferior capsule cannot resist downward traction. Spurling, Tinel, and drop-arm each test different anatomy and would not produce that inferior gap.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: Which set of cranial nerves exits through the jugular foramen?
Option A: CN I, II, and VIII
Option B: CN V1, V2, and V3
Option C: CN III, IV, and VI
Option D: CN IX, X, and XI
Correct: D. CN IX, X, and XI
Explanation: The jugular foramen transmits the glossopharyngeal, vagus, and accessory nerves, CN IX, X, and XI. CN XII leaves through the hypoglossal canal, the trigeminal branches use their own exits, and CN I, II, and VIII never run through the jugular foramen.
Bone Wizardry Lock: Jugular foramen carries CN IX, X, and XI as a fixed set. CN XII exits through its own hypoglossal canal and never shares this route.
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Stem: In a patient with cholelithiasis, which anterior Chapman point location corresponds to the gallbladder?
Option A: Pubic tubercle
Option B: Right 6th intercostal space
Option C: Tip of the right 12th rib
Option D: Left upper lateral thigh
Correct: B. Right 6th intercostal space
Explanation: Gallbladder dysfunction maps to the right 6th intercostal space in the anterior Chapman set. The right 12th rib tip belongs to the appendix, the upper left lateral thigh to the sigmoid colon, and the pubic tubercle region to the ovary.
Bone Wizardry Lock: Gallbladder anterior Chapman = right 6th ICS. Right 12th rib tip is the appendix. These two locations are the most common swaps on gallbladder Chapman questions.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: Screening shows cervical dysplasia. Which sympathetic viscerosomatic level lines up with uterine and cervical patterns?
Option A: T12-L2
Option B: T5-T9
Option C: T1-T4
Option D: S2-S4 only
Correct: A. T12-L2
Explanation: Uterine and cervical sympathetics arise from T12 through L2. The S2-S4 segment is parasympathetic, not sympathetic. Swapping the two nerve divisions is the most common error on pelvic innervation questions.
Bone Wizardry Lock: Pelvic organ autonomics split cleanly: sympathetic from T12-L2, parasympathetic from S2-S4. For uterine and cervical patterns, T12-L2 is the sympathetic answer.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management

Stem: You are setting up muscle energy for a right-on-left sacral torsion. In the lateral recumbent position, which side goes down?
Option A: Seated with both feet unsupported
Option B: Right side down
Option C: Supine only
Option D: Left side down
Correct: D. Left side down
Explanation: Backward sacral torsions are treated lateral recumbent with the axis side down. A right-on-left torsion runs on a left oblique axis, so the patient lies left side down.
Bone Wizardry Lock: Name the axis before choosing the treatment position.
Topic: Sacrum and innominates
Review Links: - Bone Wizardry sacral diagnosis
- Practice: All OMM Questions QBank
Show outside sources
- MET for sacral dysfunction
- Articulatory sacral rocking
- BLT/LAS procedure
- AAFP hip evaluation

Stem: During muscle energy for an inhaled rib dysfunction, the physician gently flexes the patient forward to unload the rib barrier. Which rib type does this setup treat?
Option A: Caliper rib dysfunction
Option B: Pump-handle rib dysfunction
Option C: Floating rib compression only
Option D: Bucket-handle rib dysfunction
Correct: B. Pump-handle rib dysfunction
Explanation: Inhaled pump-handle and inhaled bucket-handle ribs are set up differently. Flexing the patient down unloads a pump-handle rib, while reaching the patient toward the knee addresses a bucket-handle rib.
Bone Wizardry Lock: Flex the patient forward for pump-handle. Reach toward the knee for bucket-handle. The direction of patient motion is the discriminating cue.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: For muscle energy on an inhaled bucket-handle rib, the patient reaches toward which target?
Option A: The ceiling with both hands
Option B: The knee on the affected side
Option C: The physician's shoulder only
Option D: The opposite ear
Correct: B. The knee on the affected side
Explanation: For inhaled bucket-handle ribs, the patient reaches toward the knee on the affected side. That reach shifts the sidebending mechanics needed to address bucket-handle rib motion.
Bone Wizardry Lock: Bucket-handle ribs live in sidebending mechanics; the reach cue is the giveaway.
Topic: Thorax and Ribcage
Review Links: - Bone Wizardry rib mechanics
- Practice: All OMM Questions QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Stem: A clinician finds a position that reduces a tender point's pain by at least 70 percent, then holds the position. Which technique is the clinician applying?
Option A: Pedal pump
Option B: HVLA
Option C: Lachman test
Option D: Counterstrain
Correct: D. Counterstrain
Explanation: Counterstrain works by finding a position of ease that sharply lowers tender-point pain before the hold. HVLA relies on a thrust, the pedal pump moves lymph, and Lachman checks the ACL, so none of those depend on a position of ease.
Bone Wizardry Lock: In counterstrain, the diagnostic tender point becomes the treatment feedback gauge.
Topic: Counterstrain and FPR
Review Links: - Bone Wizardry counterstrain pelvis and lumbar
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls counterstrain and FPR
- StatPearls MET and counterstrain
- StatPearls OMT topic index

Stem: Which cervical structure supports the lateral side of the discs and helps protect nerve roots from disc herniation?
Option A: Sacral promontory
Option B: Joints of Luschka
Option C: Interosseous membrane
Option D: Costotransverse joints
Correct: B. Joints of Luschka
Explanation: The joints of Luschka sit at C3 through C7 and brace the lateral edge of the cervical discs, which helps protect the cervical nerve roots. The sacral promontory is pelvic anatomy, costotransverse joints are thoracic, and the interosseous membrane belongs to the forearm and leg.
Bone Wizardry Lock: Joints of Luschka run from C3 to C7 and brace the lateral edge of each cervical disc. Their degeneration is a direct pathway to nerve root compression at those levels.
Topic: Cervical Spine
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- StatPearls Spurling test
- Cleveland Clinic Spurling test
- APTA cervical arterial dysfunction screen
- AAFP neck pain evaluation

Stem: In the thoracic and lumbar spine, a nerve root generally exits the intervertebral foramen in what relationship to its corresponding vertebra?
Option A: Above its corresponding vertebra
Option B: Below its corresponding vertebra
Option C: Through the transverse foramen
Option D: Only through the sacral hiatus
Correct: B. Below its corresponding vertebra
Explanation: In the thoracic and lumbar regions, each nerve root exits the foramen below its matching vertebra, which is the reverse of the cervical spine, where each root exits above its matching vertebra.
Bone Wizardry Lock: Root localization changes at the cervical-thoracic transition.
Topic: Lumbar Spine
Review Links: - Bone Wizardry lumbar dysfunctions
- Practice: All OMM Questions QBank
Show outside sources
- MET for low back pain
- MET for pelvic dysfunction
- AAFP acute low back pain

Stem: The fibular head glides posteriorly with which foot motion?
Option A: Pronation
Option B: Supination
Option C: Cranial extension
Option D: Wrist flexion
Correct: B. Supination
Explanation: A posterior glide of the fibular head pairs with foot supination, while an anterior glide pairs with pronation. Wrist flexion is a forearm and hand motion and cranial extension is an SBS concept, so neither touches the proximal fibula.
Bone Wizardry Lock: Posterior fibular head pairs with supination. Anterior fibular head pairs with pronation. Lock both pairs and the head position follows from the foot.
Topic: Lower Extremities
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET and counterstrain for piriformis
- AAFP hip evaluation
- AAFP knee evaluation

Stem: Most wrist and hand flexors are innervated by which nerve, with flexor carpi ulnaris as a key exception?
Option A: Radial nerve
Option B: Axillary nerve
Option C: Femoral nerve
Option D: Median nerve
Correct: D. Median nerve
Explanation: The median nerve supplies most of the wrist and hand flexors; flexor carpi ulnaris is the main exception, running on the ulnar nerve. The radial nerve, by contrast, is the major extensor nerve.
Bone Wizardry Lock: Wrist and hand flexors run on the median nerve by default. Flexor carpi ulnaris breaks that rule and runs on the ulnar nerve. Radial nerve controls extension, not flexion.
Topic: Upper Extremities
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- MET for AC, clavicle, SC joint
- Stanford shoulder exam
- AAFP painful shoulder exam

Stem: Which physical tests are commonly used to reproduce symptoms of carpal tunnel syndrome?
Option A: Lachman, drawer, and McMurray tests
Option B: FABER and FADIR only
Option C: Tinel, Phalen, and prayer tests
Option D: Spurling and vertebral-artery screens only
Correct: C. Tinel, Phalen, and prayer tests
Explanation: Carpal tunnel syndrome is median nerve compression at the wrist, and the Tinel, Phalen, and prayer maneuvers all provoke those symptoms. Lachman, drawer, and McMurray are knee tests, FABER and FADIR screen the hip, and Spurling with vertebral-artery testing targets the neck.
Bone Wizardry Lock: Three tests, one target. Tinel taps over the tunnel. Phalen compresses the nerve in wrist flexion. The prayer test reproduces it in extension. All three provoke the same median nerve at the same location.
Topic: Wrist
Review Links: - Bone Wizardry upper extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Stem: Adhesive capsulitis most typically restricts which shoulder motions?
Option A: Only wrist flexion
Option B: Only cervical sidebending
Option C: Abduction plus internal and external rotation
Option D: Only elbow extension
Correct: C. Abduction plus internal and external rotation
Explanation: Adhesive capsulitis tightens the whole glenohumeral capsule, so the hallmark is lost abduction along with internal and external rotation. An isolated limit in elbow extension, wrist flexion, or cervical sidebending would steer you away from a frozen shoulder.
Bone Wizardry Lock: For adhesive capsulitis, look for global glenohumeral motion loss, not a single tendon test.
Topic: Shoulder
Review Links: - Bone Wizardry rotator cuff impingement
- Practice: All OMM Questions QBank
Show outside sources
- Stanford shoulder exam
- AAFP painful shoulder exam
- PMC subacromial impingement tests

Stem: Lateral hip pain with pelvic drop during single-leg stance points to abductor weakness. Which nerve lesion would reproduce that pattern?
Option A: Median nerve
Option B: Femoral nerve
Option C: Obturator nerve
Option D: Superior gluteal nerve
Correct: D. Superior gluteal nerve
Explanation: A Trendelenburg pattern reflects weak hip abductors, mainly the gluteus medius and minimus, both supplied by the superior gluteal nerve. The obturator nerve controls adduction, the femoral nerve drives hip flexion and knee extension, and the median nerve has no role in the lower limb.
Bone Wizardry Lock: Pelvic drop is a stance-side abductor problem.
Topic: Hips
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP hip evaluation
- PMC femoroacetabular impingement exam
- MET for pelvic dysfunction

Stem: A varus stress test opens the lateral side of the knee. Which ligament does this maneuver test?
Option A: MCL
Option B: LCL
Option C: PCL
Option D: ACL
Correct: B. LCL
Explanation: Varus stress loads the lateral collateral ligament. Valgus stress is what challenges the medial collateral, and the cruciates are checked with Lachman and the drawer maneuvers instead.
Bone Wizardry Lock: Knee collateral tests are named by the side they open.
Topic: Knee
Review Links: - Bone Wizardry lower extremity
- Practice: All OMM Questions QBank
Show outside sources
- AAFP knee evaluation
- AAFP knee pain history and exam
- AAFP knee injury tool

Stem: Pedal pump drives lymphatic return, and the pressure it generates is transmitted to specific abdominal organs. Which pair is most pressure-sensitive?
Option A: Liver and spleen
Option B: Sphenoid and occiput
Option C: ACL and PCL
Option D: Median and ulnar nerves
Correct: A. Liver and spleen
Explanation: The pressure wave from pedal pump reaches the liver and spleen, the pressure-sensitive organs behind its lymphatic effect. That same pressure logic is why recent abdominal surgery makes the technique a concern.
Bone Wizardry Lock: The pressure wave from pedal pump reaches the liver and spleen directly, so pathology in those organs and recent abdominal surgery are the key contraindications.
Topic: Lymphatics
Review Links: - Bone Wizardry lymphatics
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls lymphatic procedures
- StatPearls 5 diaphragm procedure
- OMM brief review

Stem: During a muscle energy contraction, the physician's force exceeds the patient's force. What type of contraction is that?
Option A: Isolytic
Option B: Isometric
Option C: Isotonic
Option D: Concentric only
Correct: A. Isolytic
Explanation: When operator force overcomes patient force, the contracting muscle is lengthened, which defines an isolytic contraction. Isometric means the two forces are equal, and isotonic means the patient's force wins out over the operator's.
Bone Wizardry Lock: Operator greater than patient means the physician lengthens the contracting muscle.
Topic: Muscle Energy
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Stem: Why do osteopathic physicians treat repeated upper-cervical hyperrotation in extension with caution?
Option A: It confirms carpal tunnel syndrome
Option B: It measures Ferguson angle
Option C: It can create unsafe cervical positioning for thrust or articulatory work
Option D: It is required before every lymphatic pump
Correct: C. It can create unsafe cervical positioning for thrust or articulatory work
Explanation: Repeated hyperrotation of the upper cervical spine in extension creates unsafe positioning, which makes it a contraindication concern for articulatory technique. That same caution applies before any cervical thrust.
Bone Wizardry Lock: Repeated upper cervical hyperrotation in extension can compromise vertebral artery flow, so this positioning is screened before applying thrust or articulatory technique at that level.
Topic: HVLA
Review Links: - Bone Wizardry cervical OMM
- Practice: All OMM Questions QBank
Show outside sources
- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Stem: Articulatory technique, also called springing, has what main therapeutic goal?
Option A: Measure Cobb angle
Option B: Increase range of motion in a restricted joint
Option C: Erase all visceral disease
Option D: Diagnose median nerve entrapment
Correct: B. Increase range of motion in a restricted joint
Explanation: Articulatory treatment applies gentle, repetitive force at the restrictive barrier to restore joint range of motion. A nerve entrapment diagnosis requires clinical and electrodiagnostic workup, a Cobb angle measures scoliosis severity, and no OMT technique can erase visceral disease, so those choices describe unrelated clinical tasks.
Bone Wizardry Lock: Articulatory equals repetitive joint motion at the barrier.
Topic: Articulatory Techniques
Review Links: - Bone Wizardry soft tissue techniques
- Practice: All OMM Questions QBank
Show outside sources
- Articulatory sacral rocking
- BLT/LAS procedure
- StatPearls OMT topic index

Stem: Adolescent scoliosis screening targets which age range in children?
Option A: Birth to 2 years only
Option B: 10-15 years
Option C: Over 65 years only
Option D: 25-35 years
Correct: B. 10-15 years
Explanation: Screening for adolescent scoliosis targets the 10 to 15 year window because the growth spurt drives the fastest curve progression. Scoliosis presenting in infancy is usually congenital, curves appearing after skeletal maturity are adult-onset, and late-life curves reflect degenerative change.
Bone Wizardry Lock: Idiopathic scoliosis curves progress most rapidly during the adolescent growth spurt, anchoring the 10 to 15 screening window.
Topic: Scoliosis and short leg syndrome
Review Links: - Bone Wizardry scoliosis
- Practice: All OMM Questions QBank
Show outside sources
- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Stem: A physician takes fascia into the barrier and adds traction. Which type of myofascial release is this?
Option A: Direct
Option B: Lymphatic only
Option C: Cranial
Option D: Indirect
Correct: A. Direct
Explanation: Direct MFR loads the tissue into the restrictive barrier, commonly using traction; indirect MFR moves toward ease and uses compression instead. Cranial and lymphatic techniques are separate treatment families classified by anatomic region and therapeutic aim, not by which end of the barrier-to-ease spectrum the physician targets.
Bone Wizardry Lock: MFR direction is decided by barrier versus ease.
Topic: Myofascial Release
Review Links: - Bone Wizardry fascial subtypes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls myofascial pain
- StatPearls 5 diaphragm procedure
- WVSOM OMT methods
- OMM brief review

Stem: How can a chronic rib dysfunction keep the paraspinal muscles at the same level hypertonic?
Option A: Sustained afferent input can maintain a facilitated segment
Option B: The rib becomes a cranial nerve
Option C: The knee collateral ligaments open
Option D: The spinal cord is physically severed
Correct: A. Sustained afferent input can maintain a facilitated segment
Explanation: Facilitation describes a neuron pool held near threshold by sustained afferent input or by lasting neuronal changes. Steady input from the chronic rib keeps that segment hyperexcitable, which sustains the paraspinal tone.
Bone Wizardry Lock: A dysfunctional rib sends sustained afferent signals into its cord segment, keeping those neurons near threshold and producing the chronic paraspinal hypertonia found on exam.
Topic: Facilitation
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Stem: Which of the following correctly defines somatic dysfunction?
Option A: It is always a surgical emergency
Option B: It is only a lab abnormality
Option C: It requires impaired or altered function of related body-framework components
Option D: It is any pain complaint without exam findings
Correct: C. It requires impaired or altered function of related body-framework components
Explanation: Somatic dysfunction is impaired or altered function of the body-framework components along with their related vascular, lymphatic, and neural elements. Pain may be part of the picture, but the complaint alone does not make the diagnosis.
Bone Wizardry Lock: Use TART and function to separate an OMT target from a symptom alone.
Topic: The Basics
Review Links: - Bone Wizardry OMM fundamentals
- Practice: All OMM Questions QBank
Show outside sources
- NBOME OPP/OMT blueprint
- AACOM osteopathic glossary
- PCOM OMT overview

Stem: In a patient with recurrent pancreatitis, where would you expect the anterior pancreas Chapman point?
Option A: Pubic tubercle
Option B: Right 6th intercostal space
Option C: Tip of the right 12th rib
Option D: Right 7th intercostal space
Correct: D. Right 7th intercostal space
Explanation: The anterior pancreas point sits in the right 7th intercostal space. One space up, the right 6th, belongs to the gallbladder and liver; the appendix point is the tip of the right 12th rib; and the pubic tubercle marks the ovary.
Bone Wizardry Lock: For GI Chapman points, one rib space can change the organ.
Topic: Chapman points
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: All OMM Questions QBank
Show outside sources
- StatPearls Chapman points
- NBOME OPP/OMT blueprint
- ACOFP osteopathic pain management