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CONTENTS
Contributors vii
Preface ix
Acknowledgments xi
S EC T I O N I G U I D E TO E F F I C I E N T E X AM I NAT I O N P R E PAR AT I O N 1
Introduction 3
S EC T I O N I I O M T F U N DA M E N TA LS 11
Somatic Dysfunction 13
Overview of Techniques 23
S EC T I O N I I I R E G I O NAL AN D SYST E M S-BA S E D A S S E S S M E N T 31
Regional Diagnosis 33
Osteopathic Principles and Considerations of Clinical Medicine: A Systems-Based Approach 109
S EC T I O N I V H I STO R I C AL H I G H LI G H TS, K E Y PO I N TS, AN D 147
M U S C U LO S K E LE TAL T E STS
High-Yield Topics for the COMLEX 149
S EC T I O N V O ST E O PAT H I C T R E AT M E N TS AN D T E C H N I Q U E S 191
Cranial Treatment 193
Cervical Treatment 199
Thoracic, Rib, and Diaphragm Techniques 205
Lumbar Techniques 213
Sacrum and Pelvis Techniques 223
Extremity Techniques 231
Systemic Techniques 245
Appendix: Abbreviations 253
Index 255
v
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CONTRIBUTORS
Tamar Gibli Dawn Nye, DO
OMM Fellow Resident
Class of 2009 Department of Anesthesiology
Midwestern University Oregon Health and Science University
Chicago College of Osteopathic Medicine Portland, Oregon
Downers Grove, Illinois Class of 2006
Midwestern University
Melissa Greer Chicago College of Osteopathic Medicine
Downers Grove, Illinois
OMM Fellow
Class of 2010
Midwestern University Terry Pexton, DO
Chicago College of Osteopathic Medicine Resident
Downers Grove, Illinois Department of Internal Medicine
Scripps Mercy Hospital
Kerri Kulovitz San Diego, California
OMM Fellow
OMM Fellow
Class of 2007
Class of 2010
Midwestern University
Midwestern University
Chicago College of Osteopathic Medicine
Chicago College of Osteopathic Medicine
Downers Grove, Illinois
Downers Grove, Illinois
Melissa A. Novak, DO
Resident
North Memorial Medical Center Family Medicine Program
University of Minnesota
Minneapolis, Minnesota
OMM Fellow
Class of 2007
Midwestern University
Chicago College of Osteopathic Medicine
Downers Grove, Illinois
vii
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PREFACE
First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review is
a high-yield board review text of osteopathic manipulative medicine (OMM)
for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)
Steps 1, 2, and 3. Osteopathic concepts are taught in various frameworks across
the country at different institutions. Please be assured that the information in
this text was only collected from widely accepted osteopathic literature in order
to include the majority of this information.
The focus of the text is to emphasize the material most commonly encoun-
tered on the COMLEX. That being noted, it must be understood there is no
guarantee that this text covers every single osteopathic manipulative medicine
question presented on the exam. Your feedback is strongly encouraged regard-
ing the content of the review book in addition to how well prepared you felt
for the OMM portion of the examination after using this text. Should you
wish to share this feedback with the authors directly, you may do so by send-
ing an email to: fi[email protected].
First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review
was designed to be used as a review guide for the OMM portion of the
COMLEX. In no way is it meant to be used as an all-inclusive reference source.
Therefore, please note that the authors take no responsibility for consequences
of applications or interpretations of information within this text including, but
not limited to technique descriptions.
ix
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ACKNOWLEDGMENTS
We would like to thank the many individuals who helped us write First Aid for
the COMLEX. Our appreciation extends to Aaron Bruce, whose tireless efforts
helped to initiate this process. For greatly contributing to this book we thank
Terry Pexton. For additional contributions we thank Tamar Gibli, Kerri Kulovitz,
Melissa Greer, Dawn Nye, and Melissa Novak. For taking the time to review
our works, we thank Daniel Davison, DO, Mark McKeigue, DO, Charles
Mok, Jr., DO, Kenneth Nelson, DO, Mark Robinson, DO, and Melicien
Tettambel, DO. For use of the Yogatrek Center and endless support, we thank
Ben and Joan Taylor. For current and future revisions, we are grateful to our
editor, Elise Halajian. For last-minute phone calls, questions, and for always
being available, we thank Marsha Loeb. And finally, we extend gratitude to
our publishing editor, Catherine Johnson, for guiding us through these uncharted
waters.
xi
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SECTION I
Guide to Efficient
Examination
Preparation
䉴 Introduction
1
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CHAPTER 1
Introduction
How to Use This Book 4
COMLEX Levels 1, 2, and 3 4
DESCRIPTION OF THE COMLEX 4
GRADING OF THE EXAMINATION 6
OMT ON THE COMLEX 7
PE Examination 7
OUTLINE OF EXAMINATION 7
WALK THROUGH OF TEST DAY 8
CONTENT OF CLINICAL ENCOUNTERS AND OMT 8
DON’T FORGET TO 9
SOAP NOTE 10
SCORING AND EVALUATION 10
PREPARATION FOR THE EXAMINATION 10
3
EXAM I NATION PRE PARATION
G U I DE TO E FFIC I E NT
䉴 H OW TO U S E T H I S B O O K
First Aid for the COMLEX: An Osteopathic Manipulative Medicine Review is a
high-yield board review text of osteopathic manipulative medicine (OMM) for
the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)
Steps 1, 2, and 3.
There are five main sections in this text. The first section is comprised of a
guide to efficient examination preparation. The second section provides an
overview of various OMM technique modalities (specific technique descrip-
tions are included later in the text). The third section looks at regional diagno-
sis and treatment, focusing on relevant anatomy and key diagnostic points.
The fourth section contains a variety of high-yield tables for viscerosomatic/
I NTRODUCTION
Chapman reflexes, Jones’ counterstrain tenderpoints, musculoskeletal tests,
and noteworthy historical references. The fifth section involves an overview of
commonly encountered techniques and includes brief descriptions and indi-
cations for each.
Information regarding OMM for clinical specialties (obstetrics and gyne-
cology, pediatrics, the hospitalized patient, cardiology, gastroenterology, etc)
is included in the second section. These topics are particularly useful when
reviewing for board examinations because a large majority of OMM ques-
tions found in the COMLEX focus on specific patient cases and clinical
vignettes.
Aside from the high-yield review of osteopathic manipulation concepts, stu-
dents will also find information regarding the COMLEX performance evalua-
tion (PE). Particular emphasis is placed on the role of OMM in the examination
and the various OMM techniques permitted during the examination.
The vast differences in terminology and techniques used between various
osteopathic colleges make creating an osteopathic review text difficult. The
fifth section in this book attempts to describe techniques commonly included
in board examination questions. The technique descriptions provide informa-
tion about the techniques relevant to the COMLEX written examination
(ie, indications, patient positioning, and the predominant final corrective
force) and are not meant to replace technique manuals at specific osteopathic
colleges. Although each technique described in this book is referenced from a
major osteopathic source, they are not recommended for use in passing practi-
cal examinations.
䉴 CO M LE X LE V E LS 1, 2, AN D 3
Description of the COMLEX
The COMLEX is designed to assess both medical knowledge and clinical
skills. In order to accomplish this, the National Board of Osteopathic Medical
Examiners (NBOME) has developed an overall blueprint. This general blue-
print is used for each step of the COMLEX examination (see Table 1-1); how-
ever, the content of each examination is tailored to the knowledge level of the
test taker. The examination covers two main areas. The first (Dimension I) is
known as the clinical presentation. This involves health topics frequently
encountered by general practice osteopathic physicians. The second area
(Dimension II) is known as the physician task. This involves the decision-making
abilities that physicians use to problem-solve a particular medical issue. Osteo-
pathic manipulative techniques (OMT) topics are dispersed throughout this
blueprint, covering all areas within these two sections.
4
EXAM I NATION PRE PARATION
G U I DE TO E FFIC I E NT
TA B L E 1- 1 . The COMLEX Examination Blueprint
Dimension I: Patient Presentation
LEVEL 1, LEVEL 2-CE, LEVEL 3
Asymptomatic and general symptoms 8%-16%
Symptoms and disorders of digestion 4%-10%
and metabolism
Symptoms and disorders of sensory 28%-38%
alternations
I NTRODUCTION
Symptoms and disorders of motor alternations 6%-12%
Symptoms and disorders related to human 3%-8%
sexuality and urination
Symptoms and disorders of respiration 8%-16%
and circulation
Symptoms and disorders of thermoregulation 2%-6%
Symptoms and disorders of the tissues 8%-16%
and trauma
Symptoms and disorders of human development 3%-8%
Dimension II: Physician Tasks
LEVEL 1 LEVEL 2-CE LEVEL 3
Health promotion and disease 1%-5% 15%-20% 15%-20%
prevention
History and physical 5%-15% 30%-40% 10%-20%
Diagnostic technologies 1%-5% 10%-20% 15%-25%
Management 2%-7% 10%-20% 25%-40%
Scientific understanding of 70%-85% 5%-15% 5%-10%
mechanisms
