Sacral Q-bank

15 Questions | By Babydoctor | Last updated: Jan 22, 2013

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COMLEX Style Sacrum Questions recommended by Dr. Burns.

Questions and Answers

1.

A 20-year old male presents with low back pain following a fall onto a concrete floor. The patient gives a history of episodic aching of the lumbar region prior to the fall. Examination of the patient in the prone position reveals a deep sulcus on the left, a posterior/inferior ILA on the right when compared to the opposite side, and a lumbosacral junction that springs freely upon compression. The most likely diagnosis is?

Discuss
- A.
  
  A forward sacral torsion on a right oblique axis
- B.
  
  A forward sacral torsion on a left oblique axis
- C.
  
  A backward sacral torsion on a left oblique axis
- D.
  
  A left unilateral sacral flexion
- E.
  
  Bilateral sacral extension
2.

A mildly obese patient comes to your office complaining of buttock pain. She fell on her buttocks about one week ago and she still has some residual pain. Inspection of her lumbar spine and gluteal region reveals a decreased lumbar lordosis. Standing flexion test and seated flexion test show no evidence of asymmetry. Sacral sulci are equal in depth. The lumbosacral junction does not spring. Based on the information given, what is the most likely diagnosis?

Discuss
- A.
  
  Bilateral sacral extension
- B.
  
  Forward sacral torsion on a left oblique axis
- C.
  
  Anterior sacral base
- D.
  
  Unilateral extended sacrum on the right
- E.
  
  Unilateral extended sacrum on the left
3.

In a patient with acute onset of low back pain, structural examination reveals a positive seated flexion test on the right. The left sacral base is anterior when compared to the right. The spring test is positive. Given the above information what is the most likely sacral diagnosis?
- A.
  
  Left sacral rotation on a right oblique axis
- B.
  
  Right sacral rotation on a right oblique axis
- C.
  
  Right sacral rotation on a left oblique axis
- D.
  
  Right unilateral sacral flexion
- E.
  
  Extended sacral base
4.

A patient has sacral torsion that resulted in a right anterior sacral base and a negative lumbosacral spring test. Based on the information given, what is the expected somatic dysfunction at L5?
- A.
  
  L5 N SLRR
- B.
  
  L5 N SRRL
- C.
  
  L5 E RRSL
- D.
  
  L5 F RLSL
- E.
  
  L5 F RRSL
5.

A 46-year old male presents to your office complaining of chronic lumbo-sacral pain. There is a negative standing flexion test and a positive seated flexion test. Structural examination reveals a deep sacral sulcus on the left, posterior/inferior ILA on the right, and the lumbosacral junction springs freely upon compression. The most likely diagnosis is:

Discuss
- A.
  
  Right sacral rotation on a right oblique axis
- B.
  
  Left sacral rotation on a left oblique axis
- C.
  
  Right sacral shear
- D.
  
  Right sacral rotation on a left oblique axis
- E.
  
  Left sacral rotation on a right oblique axis
6.

A patient is diagnosed with a right anterior innominate rotation. About which sacral axis does this rotation occur?
- A.
  
  Inferior transverse
- B.
  
  Oblique
- C.
  
  Middle transverse
- D.
  
  Sagittal
- E.
  
  Superior transverse
7.

A female patient complains of progressively worsening low back pain. The pain is located at the lumbosacral junction. Two days ago, she vaginally delivered a 9lbs. 2 oz baby boy. On examination the seated flexion test is negative. The most likely diagnosis is:

Discuss
- A.
  
  Left on left sacral torsion
- B.
  
  Bilateral sacral flexion
- C.
  
  Right innominate anterior
- D.
  
  Bilateral sacral extension
- E.
  
  Right inferior pubic shear
8.

A 33 year old patient with new onset left-sided low back pain comes into your office. Pain stems from the low back and radiates to the left knee. Structural examination reveals the following: A tenderpoint located at the right transverse process of L5 L5 neutral, rotated right and sidebent left Positive seated and standing flexion test on the right Deep right sacral sulcus, Left inferior lateral angle is posterior and inferior Springing at the lumbosacral junction is present PSIS on the right is caudad compared to the left PSIS with the patient in the prone position Apparent shorter leg on the right What is the most likely innominate diagnosis?

Discuss
- A.
  
  Right innominate anterior
- B.
  
  Right innominate posterior
- C.
  
  Right superior innominate subluxation
- D.
  
  Right inferior innominate subluxation
- E.
  
  There is not enough information in the question to differentiate from the above
9.

What is accepted muscle energy treatment patient position for a left sacral torsion diagnosis?

Discuss
- A.
  
  Right lateral Sims position
- B.
  
  Right lateral recumbent with torso turned left
- C.
  
  Left lateral Sims position
- D.
  
  Left lateral recumbent with the torso turned right
- E.
  
  Patient prone with right lower extremity slightly abducted
10.

A 34-year-old female enters your office complaining of hip pain following a fall off a stepladder 4 days earlier. X-rays taken in the emergency department revealed no fracture, and the patient has been very uncomfortable since the fall. The pain is localized on the left and does not radiate down the thigh. The left ASIS is cephalad, the left PSIS is caudad and the pubes are level. While performing a standing flexion test, you note that the left PSIS demonstrated greater excursion than the right. Which additional palpatory finding is most likely to be present in this patient?

Discuss
- A.
  
  Resistance to posterior compression of the right ASIS
- B.
  
  Backward sacral torsion on a left axis
- C.
  
  Longer leg on the right
- D.
  
  L5 neutral sidebent left, rotated right
- E.
  
  Exquisite pain upon palpation of the pubic symphysis
11.

Which of the following soft tissue dysfunctions is the most likely cause of a left innominate posterior dysfunction?
- A.
  
  Tight quadriceps
- B.
  
  Tight hip adductors
- C.
  
  Tight hip abductors
- D.
  
  Tight hamstrings
- E.
  
  Tight piriformis
12.

Which of the following is the best statement regarding typical muscle energy treatment for a left innominate posterior dysfunction?

Discuss
- A.
  
  Hip flexors are isometrically contracted to provide the necessary force to correct this dysfunction
- B.
  
  The patient is best treated in a seated position
- C.
  
  The patient is treated with her hip flexed and slightly abducted
- D.
  
  Hamstrings are activated by the patient to correct the dysfunction
- E.
  
  Muscle energy treatment is relatively contraindicated in the above patient
13.

If a right-sided psoas syndrome is suspected in a patient with a left innominate posterior dysfunction, which lumbar dysfunction is likely to be present?

Discuss
- A.
  
  L1 Neutral, sidebent left and rotated right
- B.
  
  L2 Extended, sidebent left and rotated left
- C.
  
  L1 Flexed, sidebent right and rotated right
- D.
  
  L2 Flexed, sidebent left and rotated left
- E.
  
  L4 Neutral, sidebent right and rotated left
14.

Which of the following is associated with a right on left sacral torsion?

Discuss
- A.
  
  A non-neutral dysfunction of L5 that is rotated left and sidebent left; and a positive seated flexion test on the right
- B.
  
  A non-neutral dysfunction of L5 that is rotated right and sidebent right; and a positive seated flexion test on the left
- C.
  
  A neutral dysfunction of L5 that is rotated right and sidebent left, and a positive seated flexion test on right
- D.
  
  A neutral dysfunction of L5 that is rotated left and sidebent right; and a positive seated flexion test on the left
- E.
  
  A flexed dysfunction of L5 that is rotated right and sidebent right, and a positive seated flexion test on the right
15.

Which sacral region in a right on left sacral torsion will spring freely?

Discuss
- A.
  
  Left superior sulcus
- B.
  
  Right superior sulcus
- C.
  
  Left inferior lateral angle
- D.
  
  Right inferior lateral angle
- E.
  
  Sacral base

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