1-4 Flashcards
1
Q
What is the phenomenon that occurs when your palpating hand is pulled in a particular direction upon palpating an organ?
A
local listening (fascial pull)
2
Q
9 layers through the abdominal wall
A
skin, superficial fascia, anterior rectus sheath, rectus abdominis, posterior rectus sheath, deep investing fascia, transversalis fascia, peritoneum, empty space, viscera
3
Q
5 steps to indirect Tx of viscera
A
layer palpate, fascial local listening, motion test, BLT, reassess
4
Q
4 steps to direct Tx of viscera
A
this would be like the mesenteric ganglion release, you pull into the umbilicus for each level of the colon
5
Q
Where is the liver chapman point? Anterior
A
right 5th intercostal space
6
Q
Where is the liver AND gallbladder chapman point? Anterior
A
right 6th intercostal space
7
Q
Where is the pancreas chapman point? Anterior
A
right 7th IC space
8
Q
Where is the stomach acid chapman point? Anterior
A
left 5th IC space
9
Q
Where is the stomach peristalsis chapman point?
A
left 6th IC space
10
Q
Viscerosomatic reflexes at the left of T7 may be from what organ? Right of T7?
A
left is spleen right is pancreas
11
Q
viscerosomatic reflexes in T10-11 are from where in the lower GI
A
right colon
12
Q
viscerosomatic reflexes in T12-L2 are from here in the lower GI
A
left colon
13
Q
Viscerosomatic reflexes in T12 are from here in the lower GI
A
appendix
14
Q
viscerosomatic reflexes of the adrenals, kidneys, ovaries, and testes occur in what levels?
A
T10-11
15
Q
T/F abdominal hernias are an absolute contraindication to visceral Tx
A
false they are relative C/I
16
Q
T/F splenomegaly is an absolute contraindication to visceral Tx
A
true
17
Q
T/F tumors are an absolute contraindication to visceral Tx
A
true
18
Q
T/F GI obstruction and infections are absolute contraindications to visceral Tx
A
true
19
Q
How would A) thoracics and B) cranial/cervical Tx be useful in treating visceral problems?
A
Thoracics Tx sympathetics and cranial/cervical Tx parasymp
20
Q
A therapeutic pulse may indicate the end of this kind of Tx
A
myofascial treatment, more commonly, you wait until the tissue releases
21
Q
How does a Chapman point differ from a trigger point?
A
trigger points radiate
22
Q
Right sided viscerosomatic dysfunctions in the T5-6 distribution imply this dysfunction
A
upper esophagus
23
Q
right sided viscerosomatic dysfunctions in the T6-9 distribution imply these dysfunctions
A
liver and gallbladder
24
Q
Left sided dysfunctions in the T5-9 distribution imply this dysfunction
A
lower esophagus/stomach
25
Left sided dysfunctions in the T6-9 distribution imply this dysfunction
spleen and pancreas
26
bilateral viscerosomatic reflexes in the T8-9 distribution imply this dysfunction
small intestine
27
Where are the receptors located for viscerosomatic pain vs. true visceral pain?
viscerosomatic pain involves receptors in the PARIETAL PERITONEUM whereas true visceral pain involves receptors (pacinian corpuscles, free nerve endings--activated by spasm or stretch) in the viscera
28
Encountering rubbery resistance when performing HVLA may alert the physician to this type of dysfunction
viscerosomatic dysfunction (and HVLA is unlikely to be effective)
29
Which "paraspinal" muscles are most often affected by viscerosomatic relflexes?
rotatores, this causes a non-neutral (type II) dysfunctions with predeliction for extension
30
These 2 structures are innervated by the left vagus
greater curvature of the stomach and the duodenum
31
These 4 (ish) structures are innervated by the right vagus
lesser curvature of the stomach, small intestines, right colon (quiz question), organs and glands up to the MID transverse colon
32
What is the proper Tx of somatic pain that lingers after the Tx of the causal visceral dysfunction?
Just straight up OMT
33
What is the normal visceral rhythm? With which part of the cranial rhythm do inspir and expir correlate with?
7-8 cycles/min, inspir = cranial flexion, expir = cranial extension
34
A student rotating on your service palpates and "listens" to the right adrenal and then moves on to the left adrenal, what has he done wrong?
paired organs should be tested together (also, how do you palpate the adrenal, anyway? What a psycho)
35
Infection of most visceral organs is a contraindication to OMT except for this
bladder
36
You should expect results from visceral Tx after how many cycles? Also, how much time should you wait between consecutive Tx?
15 cycles, 3-4 weeks
37
This is the purpose of the Fulford diaphragm (shock) release? Also, what is a likely Hx for this patient?
To reestablish diaphragm motion, MVA
38
The right colon and right half of the transverse colon are innervated by these spinal levels and ganglion
T10-11, SMG
39
The left half of the transverse colon and left colon are innervated by these spinal levels and ganglion
T12-L2, IMG
40
What socially embarassing problem can hyperactivity of the parasympathetics have on the bowels?
diarrhea
41
Which stages of the post-op patient (I-III) can paraspinal inhibition be used in?
all of them
42
Describe a stage I post-op patient
immediately post-op, decreased or absent bowel sounds, decreased breathing
43
Describe a stage II post-op patient
bowel sounds PRESENT, ingestion of oral fluids, regular breathing
44
Describe a stage III post-op patient
patient is ambulatory and has increased oral intake
45
What are the sympathetic dominant complaints?
constipation, flatulence, distension
46
What are the parasympathetic dominant complaints?
nausea, vomiting, diarrhea, cramps
47
A pt presenting with constipation, flatulence, and distension is likely to have what findings on palpatory exam?
Chapman points from T10-L2 as these are the findings in sympathetic dominant complaints
48
A pt presenting with N/V, diarrhea and cramps is likely to have these structural exam findings (5)
OA, AA dysfxn, occipitomastoid suture, pelvic shear, sacral dysfxn
49
What are the appropriate Tx for a pt presenting with flatulence, distension and constipation?
chapman points, rib raising (T10-L2), paravertebral inhibiton (T12-L2), INFERIOR mesenteric ganglion inhibition
50
What are the appropriate Tx for a pt presenting with diarrhea, N/V, and cramps
subocc release, cranial, HVLA/ME to the cervicals, innominates, or sacrum, sacral rocking/inhibiton and condylar decompression
51
The ligament that is usually the first ligament to become tender with lumbar posture changes is located here:
1" superior and lateral to the PSIS (iliolumbar ligament)
52
The anterior longitudinal ligament extends between these 2 points
base of occiput and anterior sacrum
53
What happens to the PLL as it descends?
narrows, allowing for lumbar disc herniations
54
A straight leg raise test that is positive between 35-70 degrees indicates what problem? What if it is positive after 70 degrees?
sciatic; hip or joint
55
What test is being described, and is the result positive? A patient raises their leg but the contralateral leg does not create pressure
Hoover test, this would be a positive result
56
A positive Trendelenburg sign indicates a possible lesion in this nerve
superior gluteal, supplies the gluteus medius
57
What effect will the valsalva maneuver have on a patient with disc herniations?
pain will increase
58
These are the 2 most common LV discs to herniate (in order)
L5-S1 (hits S1), L4-L5 (hits L5)
59
Inability to stand on the toes would imply a lesion in this root
S1
60
loss of the patellar reflex implies a lesion of this root
L4
61
loss of sensation on the lateral leg and dorsum of the foot would imply a lesion of this root
L5
62
loss of the ability to dorsiflex the great toe would imply a lesion of this root
L5
63
Loss of sensation the medial leg and foot implies a lesion to this nerve root
L4
64
Which nerve roots are affected if A) pt cannot invert foot B) patient cannot evert foot
A) L4 B) S1
65
A patient who has lost her patellar reflex may have herniated this disc
L3-L4 disc
66
If a patient has herniated the most common lumbar disc would he lose his patellar reflex or achilles reflex?
achilles, the most common is L5-S1 = S1 nerve root affected
67
What spinal levels are carried in the femoral nerve?
L2-L4
68
What spinal levels are carried in the obturator nerve?
L2-L4
69
Which nerve innervates the tibialis anterior?
deep peroneal nerve
70
State the full differential diagnosis for low back pain
Do you need some ceftriaxone for your gunnerhhea? I'm kidding, don't be ridiculous.
71
Which forms of OMT (direct vs. indirect) are most appropriate for acute and chronic presentations of LBP
acute = indirect; chronic = direct
72
This is the most common etiology for spinal stenosis
degnerative changes (i.e. osteoarthritis)
73
Which positions improve and worsen spinal stenosis, respectively?
improve with sitting, worsened by lumbar extension
74
What may happen to the anal sphincter of a person with spinal stenosis?
it may become hypotonic
75
A likely OMT tx for a person with osteophytes on xray is this
myofascial and indirect (osteophytes = likely spinal stenosis)
76
Sitting on your wallet for extended periods of time may cause this?
piriformis syndrome from a peripheral neuritis of the sciatic nerve
77
Psoas syndrome may be caused from being in this position for long periods of time
prolonged hip flexion (sitting all day)
78
Psoas syndrome may be caused from these 3 organic issues of local organs
appendicitis, ureteral calculi, salpingitis
79
Psoas syndrome may cause an L1/L2 dysfunction on what side? A _________ spasm on this side?
Ipsilateral, b/c the tight psoas pulls on its attachements to L1/L2; piriformis spasm on the opposite side
80
When should you consider imaging for the lumbosacral spine?
after 2-3 Tx with OMT
81
Low back pain with rapidly progressing neurologic deficits may imply this
epidural abscess/infection (warning sign)
82
Low back pain with claudication Sx may imply this
spinal stenosis (warning sign)
83
Severe low back pain of a sudden onset and no Hx of trauma may imply this lesion
dissecting aortic aneurysm (warning sign)
84
pain that wakes the patient up from sleep may imply this
malignancy (warning sign?. Technically it could be Pott's Dz too, but they'll prob go with malignancy)
85
This is a defect or pars interarticularis fracture without anterior displacement of the vertebral body
spondylolysis
86
This is when there are degerative changes within the IV disc with ankylosis of adjacent vertebral bodies
spondylosis
87
This is when there is a pars defect/fracture with anterior displacement? Which vertebrae are most commonly involved?
Spondylolisthesis L5 anterior translation on S1
88
What grade spondylolisthesis is it if 25-50% of the superior vertebral body translates over the inferior one
II
89
What if it is greater than 75?
Grade IV
90
What is a grade I spondylolisthesis (%)
0-25%
91
What is a grade III spondylolisthesis (in %)
50-75%
92
How are the Sx of spondylolysis/spondylolisthesis different from sciatica (1 MAJOR differentiating factor)? Also, if you suspect these lesions what should you do to confirm?
These lesions do NOT radiate to the buttock (pain inc in extension too, btw)? Order oblique films
93
T/F a pt with spondylolisthesis classically has a scaphoid abdomen
false, the abdomen should be protruding d/t the increased lordosis
94
What minimum % of translation must be present for a pt to have neurological deficits in spondylolisthesis?
50 or more, since grades III and IV have neuro signs
95
T/F: OMT is contraindicated in spondylolisthesis
partially true, HVLA is C/I but soft tissue and indirect is ok
96
When does a spondylolisthesis patient need surgery
if grade III or IV (prob b/c of neuro signs)
97
ME Tx in spondylolisthesis is guided towards this muscle group
hamstrings
