Download Putting It All Together: Genitourinary System

OMM #29
Wed., 10/08/03 3pm
Various Drs and PDFs
J. Uxer for Jason Varghese
Page 1 of 4
Putting It All Together: Genitourinary System
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This was not a lecture but was a question IML session.
Be sure to look at the handouts/ppts and the scribes for all the lectures,
especially those given by Dr. Fotopoulos.
Correct answers are in bold.
I. Questions for Dr. Fotopoulos’ Lectures
Question #1: In treating a patient for an innominate outflare, the knee is
A. Flexed
B. Moved laterally
C. Adducted
This is the best answer for this question.
If it’s on the exam, the word ‘knee’ will be changed to hip or thigh.
This is just a question over a technique.
D. Externally rotated
E. Decompressed
Question #2: Direct inhibition or myofascial release is used with:
A. Innominate inflaer/outflare treatments
B. Pubic symphysis compression/decompression
C. Psoas stretching
D. Collateral ganglion release This is the last technique (last slide) in the specific
lecture.
Question #3: The sitting, direct muscle energy technique for the thoracic spine is
used for:
A. forward bent lesions
B. neutral lesions
C. Type II lesions
D. Extension lesions Also known as backward bending lesions
E. Compressed lesions
A 35 y/o Caucasian female presents with dysuria, and urinary urgency and frequency.
She denies flank pain, fever, chills, nausea, & vomiting. However, she admits to
some mild suprapubic tenderness. Otherwise she denies any abdominal pain.
Question #1: The sympathetic reflexes involved for the kidneys & ureter would be
at:
A. T10 – L1
B. T12 – L2 includes the bladder
C. S2 – S4 splanchnic
D. OA parasympathetic, vagus
E. T5 – T9 parasympathetic
OMM #29
Wed., 10/08/03 3pm
Various Drs and PDFs
J. Uxer for Jason Varghese
Page 2 of 4
Question #2: The bladder would have preganglionic fibers synapsing at the:
A. Celiac ganglion
B. Superior mesenteric ganglion
C. Inferior mesenteric ganglion
D. Ptergopalatine ganglion
E. Stellate ganglion
Question #3: The effects of increased sympathetic tone would lead to the:
A. Vasodilation of afferent arterioles to the kidney
B. Increased GFR
C. Decreased tone to external ureteral sphincter
D. Facilitation of contraction of trigone muscles
E. Voiding of the bladder
↑ sympathetic tone → vasoconstrict afferent arterioles → ↓ blood flow and ↑ tone of
the external sphincter because sympathetics are for fight or flight, & you don’t want
to pee while you’re running.
II. Questions for Dr. Chapman’s Lecture
Case #1: A 23yo white male presents with the complaint of fever & unilateral scrotal
pain with tenderness & swelling. Palpation of the scrotum is described as feeling like
a “bag of worms.” Patient relates history of unprotected sex 2 weeks ago.
Question #1: Where are the anterior Chapman’s points for the urethra located?
A. Posterior margin of the iliotibial band Point for the prostate.
B. Between the acetabulum & the sciatic notch
C. Superior margin of the pubic ramos adjacent to the symphysis. Same
position as the Jones Counterstrain point for L5
D. Junction of the pubic ramus and ischium
E. Between the ASIS and greater trochanter
We will see Chapman’s points on our board exams.
Question #2: What bacterium is implicated in the vast majority of cases of prostatitis
in heterosexual males under the age of 35?
A. Neisseria gonorrhoeae 30% of cases
B. Chlamydia trachomatis 70% of cases
C. Pseudomonas aeruginosa Think of hospitalized patients
D. Enterococcus faecalis From bowels
E. Escherichia coli From bowels
Remember: When you treat for Chalmydia, also treat for Neisseria and vise versa.
Question #3: What Osteopathic findings would most strongly correlate with the
patient in the above case?
A. Somatic dysfunction at T5 – 9 Celiac ganglia
B. Somatic dysfunction at L3 – 5 No strong correlation
OMM #29
Wed., 10/08/03 3pm
Various Drs and PDFs
J. Uxer for Jason Varghese
Page 3 of 4
C. Somatic dysfunction of the abdominal diaphragm Not the most strongly
indicated
D. Somatic dysfunction of the pelvic diaphragm
E. Somatic dysfunction of the thoracic diaphragm (inlet)
Question #4: The most appropriate Osteopathic manipulative treatment for the above
patient is:
A. Lumbar roll
B. Suboccipital release
C. Pubic decompression Most correct technique to treat the pelvic diaphragm.
D. Lower extremity muscle energy
E. Thoracic HVLA
III. Questions for Dr. Gustowski’s Lecture
Case #2: A 63yo female presents with low back & left-sided soreness. She denies
significant trauma, despite playing & lifting her grandchildren while babysitting
yesterday. No numbness or tingling. The pain begins in the middle of her back &
radiates to the left groin & left lateral thigh. DTR’s 2+/4. Osteopathic exam reveals
L5 RrSr, sacrum has a right torsion, right innominate anteriorly rotated, left inguinal
ligament tender point & left iliotibial band tenderness.
Question #1: The pain in the patient’s groin is referred pain from which site?
A. Sacrum
B. Innominate
C. Lumbar spine
D. Iliolumbar ligament
E. Sacroteuberous ligament
Question #2: NOT ON EXAM!. Where is the inguinal ligament tender point located?
A. Below the ASIS
B. 1 inch medial to the ASIS
C. The pubic bone On the lateral part of the pubic ramus
D. The ischiorectal fossa
E. 1 inch above the pubic symphysis This is a midline structure, so it’s not the right
answer.
Question #3: You treat the inguinal ligament using Jones strain/counterstrain. What
is your goal in using this technique?
A. To reduce the efferent gamma-gain (that’s tightened up due to strain)
B. To stretch the muscle
C. To remove waste products
D. Balance the sympathetics
E. Remove the restriction
OMM #29
Wed., 10/08/03 3pm
Various Drs and PDFs
J. Uxer for Jason Varghese
Page 4 of 4
IV. Questions for PDF Mo Som’s Lecture
A 54yo woman presents to your clinic with an acute case of glomerulonephritis.
Question #1: In addition to prescribing antibiotics, you address the quadratus
lumborum spasm to enhance the function of which organ?
A. Adrenal glands
B. Diaphragm She noted that she knows this isn’t an organ. It is, however, the
major driver in lymphatic flow and venous return.
C. Kidney
D. Liver
E. Stomach
Question #2: Lloyd’s sign, a clinical finding in kidney pathology is the result of what
type of response?
A. Somatoemotional response
B. Somatosomatic response
C. Somatovisceral response Somatic dysfunction is projected back to the
viscera/organs.
D. Viscerosomatic response From the viscera to the somata (skeletal system)
E. Viscervisceral response.
Be sure to know the difference between somatovisceral response and viscerosomatic
response.
Question #3: The sympathetic innervation to the kidneys is
A. T5 – T9
B. T12
C. T10 – T11
D. T10 – T12
E. T12 – L2
This is different from Dr. Fotopoulos’ question because his included the kidneys and
ureters.