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OPP > 1-4 > Flashcards

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)

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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

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3
Q

5 steps to indirect Tx of viscera

A

layer palpate, fascial local listening, motion test, BLT, reassess

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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

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5
Q

Where is the liver chapman point? Anterior

A

right 5th intercostal space

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6
Q

Where is the liver AND gallbladder chapman point? Anterior

A

right 6th intercostal space

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7
Q

Where is the pancreas chapman point? Anterior

A

right 7th IC space

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8
Q

Where is the stomach acid chapman point? Anterior

A

left 5th IC space

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9
Q

Where is the stomach peristalsis chapman point?

A

left 6th IC space

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10
Q

Viscerosomatic reflexes at the left of T7 may be from what organ? Right of T7?

A

left is spleen right is pancreas

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11
Q

viscerosomatic reflexes in T10-11 are from where in the lower GI

A

right colon

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12
Q

viscerosomatic reflexes in T12-L2 are from here in the lower GI

A

left colon

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13
Q

Viscerosomatic reflexes in T12 are from here in the lower GI

A

appendix

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14
Q

viscerosomatic reflexes of the adrenals, kidneys, ovaries, and testes occur in what levels?

A

T10-11

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15
Q

T/F abdominal hernias are an absolute contraindication to visceral Tx

A

false they are relative C/I

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16
Q

T/F splenomegaly is an absolute contraindication to visceral Tx

A

true

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17
Q

T/F tumors are an absolute contraindication to visceral Tx

A

true

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18
Q

T/F GI obstruction and infections are absolute contraindications to visceral Tx

A

true

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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

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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

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21
Q

How does a Chapman point differ from a trigger point?

A

trigger points radiate

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22
Q

Right sided viscerosomatic dysfunctions in the T5-6 distribution imply this dysfunction

A

upper esophagus

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23
Q

right sided viscerosomatic dysfunctions in the T6-9 distribution imply these dysfunctions

A

liver and gallbladder

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24
Q

Left sided dysfunctions in the T5-9 distribution imply this dysfunction

A

lower esophagus/stomach

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25
Q

Left sided dysfunctions in the T6-9 distribution imply this dysfunction

A

spleen and pancreas

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26
Q

bilateral viscerosomatic reflexes in the T8-9 distribution imply this dysfunction

A

small intestine

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27
Q

Where are the receptors located for viscerosomatic pain vs. true visceral pain?

A

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

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28
Q

Encountering rubbery resistance when performing HVLA may alert the physician to this type of dysfunction

A

viscerosomatic dysfunction (and HVLA is unlikely to be effective)

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29
Q

Which “paraspinal” muscles are most often affected by viscerosomatic relflexes?

A

rotatores, this causes a non-neutral (type II) dysfunctions with predeliction for extension

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30
Q

These 2 structures are innervated by the left vagus

A

greater curvature of the stomach and the duodenum

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31
Q

These 4 (ish) structures are innervated by the right vagus

A

lesser curvature of the stomach, small intestines, right colon (quiz question), organs and glands up to the MID transverse colon

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32
Q

What is the proper Tx of somatic pain that lingers after the Tx of the causal visceral dysfunction?

A

Just straight up OMT

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33
Q

What is the normal visceral rhythm? With which part of the cranial rhythm do inspir and expir correlate with?

A

7-8 cycles/min, inspir = cranial flexion, expir = cranial extension

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34
Q

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?

A

paired organs should be tested together (also, how do you palpate the adrenal, anyway? What a psycho)

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35
Q

Infection of most visceral organs is a contraindication to OMT except for this

A

bladder

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36
Q

You should expect results from visceral Tx after how many cycles? Also, how much time should you wait between consecutive Tx?

A

15 cycles, 3-4 weeks

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37
Q

This is the purpose of the Fulford diaphragm (shock) release? Also, what is a likely Hx for this patient?

A

To reestablish diaphragm motion, MVA

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38
Q

The right colon and right half of the transverse colon are innervated by these spinal levels and ganglion

A

T10-11, SMG

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39
Q

The left half of the transverse colon and left colon are innervated by these spinal levels and ganglion

A

T12-L2, IMG

40
Q

What socially embarassing problem can hyperactivity of the parasympathetics have on the bowels?

A

diarrhea

41
Q

Which stages of the post-op patient (I-III) can paraspinal inhibition be used in?

A

all of them

42
Q

Describe a stage I post-op patient

A

immediately post-op, decreased or absent bowel sounds, decreased breathing

43
Q

Describe a stage II post-op patient

A

bowel sounds PRESENT, ingestion of oral fluids, regular breathing

44
Q

Describe a stage III post-op patient

A

patient is ambulatory and has increased oral intake

45
Q

What are the sympathetic dominant complaints?

A

constipation, flatulence, distension

46
Q

What are the parasympathetic dominant complaints?

A

nausea, vomiting, diarrhea, cramps

47
Q

A pt presenting with constipation, flatulence, and distension is likely to have what findings on palpatory exam?

A

Chapman points from T10-L2 as these are the findings in sympathetic dominant complaints

48
Q

A pt presenting with N/V, diarrhea and cramps is likely to have these structural exam findings (5)

A

OA, AA dysfxn, occipitomastoid suture, pelvic shear, sacral dysfxn

49
Q

What are the appropriate Tx for a pt presenting with flatulence, distension and constipation?

A

chapman points, rib raising (T10-L2), paravertebral inhibiton (T12-L2), INFERIOR mesenteric ganglion inhibition

50
Q

What are the appropriate Tx for a pt presenting with diarrhea, N/V, and cramps

A

subocc release, cranial, HVLA/ME to the cervicals, innominates, or sacrum, sacral rocking/inhibiton and condylar decompression

51
Q

The ligament that is usually the first ligament to become tender with lumbar posture changes is located here:

A

1” superior and lateral to the PSIS (iliolumbar ligament)

52
Q

The anterior longitudinal ligament extends between these 2 points

A

base of occiput and anterior sacrum

53
Q

What happens to the PLL as it descends?

A

narrows, allowing for lumbar disc herniations

54
Q

A straight leg raise test that is positive between 35-70 degrees indicates what problem? What if it is positive after 70 degrees?

A

sciatic; hip or joint

55
Q

What test is being described, and is the result positive? A patient raises their leg but the contralateral leg does not create pressure

A

Hoover test, this would be a positive result

56
Q

A positive Trendelenburg sign indicates a possible lesion in this nerve

A

superior gluteal, supplies the gluteus medius

57
Q

What effect will the valsalva maneuver have on a patient with disc herniations?

A

pain will increase

58
Q

These are the 2 most common LV discs to herniate (in order)

A

L5-S1 (hits S1), L4-L5 (hits L5)

59
Q

Inability to stand on the toes would imply a lesion in this root

A

S1

60
Q

loss of the patellar reflex implies a lesion of this root

A

L4

61
Q

loss of sensation on the lateral leg and dorsum of the foot would imply a lesion of this root

A

L5

62
Q

loss of the ability to dorsiflex the great toe would imply a lesion of this root

A

L5

63
Q

Loss of sensation the medial leg and foot implies a lesion to this nerve root

A

L4

64
Q

Which nerve roots are affected if A) pt cannot invert foot B) patient cannot evert foot

A

A) L4 B) S1

65
Q

A patient who has lost her patellar reflex may have herniated this disc

A

L3-L4 disc

66
Q

If a patient has herniated the most common lumbar disc would he lose his patellar reflex or achilles reflex?

A

achilles, the most common is L5-S1 = S1 nerve root affected

67
Q

What spinal levels are carried in the femoral nerve?

A

L2-L4

68
Q

What spinal levels are carried in the obturator nerve?

A

L2-L4

69
Q

Which nerve innervates the tibialis anterior?

A

deep peroneal nerve

70
Q

State the full differential diagnosis for low back pain

A

Do you need some ceftriaxone for your gunnerhhea? I’m kidding, don’t be ridiculous.

71
Q

Which forms of OMT (direct vs. indirect) are most appropriate for acute and chronic presentations of LBP

A

acute = indirect; chronic = direct

72
Q

This is the most common etiology for spinal stenosis

A

degnerative changes (i.e. osteoarthritis)

73
Q

Which positions improve and worsen spinal stenosis, respectively?

A

improve with sitting, worsened by lumbar extension

74
Q

What may happen to the anal sphincter of a person with spinal stenosis?

A

it may become hypotonic

75
Q

A likely OMT tx for a person with osteophytes on xray is this

A

myofascial and indirect (osteophytes = likely spinal stenosis)

76
Q

Sitting on your wallet for extended periods of time may cause this?

A

piriformis syndrome from a peripheral neuritis of the sciatic nerve

77
Q

Psoas syndrome may be caused from being in this position for long periods of time

A

prolonged hip flexion (sitting all day)

78
Q

Psoas syndrome may be caused from these 3 organic issues of local organs

A

appendicitis, ureteral calculi, salpingitis

79
Q

Psoas syndrome may cause an L1/L2 dysfunction on what side? A _________ spasm on this side?

A

Ipsilateral, b/c the tight psoas pulls on its attachements to L1/L2; piriformis spasm on the opposite side

80
Q

When should you consider imaging for the lumbosacral spine?

A

after 2-3 Tx with OMT

81
Q

Low back pain with rapidly progressing neurologic deficits may imply this

A

epidural abscess/infection (warning sign)

82
Q

Low back pain with claudication Sx may imply this

A

spinal stenosis (warning sign)

83
Q

Severe low back pain of a sudden onset and no Hx of trauma may imply this lesion

A

dissecting aortic aneurysm (warning sign)

84
Q

pain that wakes the patient up from sleep may imply this

A

malignancy (warning sign?. Technically it could be Pott’s Dz too, but they’ll prob go with malignancy)

85
Q

This is a defect or pars interarticularis fracture without anterior displacement of the vertebral body

A

spondylolysis

86
Q

This is when there are degerative changes within the IV disc with ankylosis of adjacent vertebral bodies

A

spondylosis

87
Q

This is when there is a pars defect/fracture with anterior displacement? Which vertebrae are most commonly involved?

A

Spondylolisthesis L5 anterior translation on S1

88
Q

What grade spondylolisthesis is it if 25-50% of the superior vertebral body translates over the inferior one

A

II

89
Q

What if it is greater than 75?

A

Grade IV

90
Q

What is a grade I spondylolisthesis (%)

A

0-25%

91
Q

What is a grade III spondylolisthesis (in %)

A

50-75%

92
Q

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?

A

These lesions do NOT radiate to the buttock (pain inc in extension too, btw)? Order oblique films

93
Q

T/F a pt with spondylolisthesis classically has a scaphoid abdomen

A

false, the abdomen should be protruding d/t the increased lordosis

94
Q

What minimum % of translation must be present for a pt to have neurological deficits in spondylolisthesis?

A

50 or more, since grades III and IV have neuro signs

95
Q

T/F: OMT is contraindicated in spondylolisthesis

A

partially true, HVLA is C/I but soft tissue and indirect is ok

96
Q

When does a spondylolisthesis patient need surgery

A

if grade III or IV (prob b/c of neuro signs)

97
Q

ME Tx in spondylolisthesis is guided towards this muscle group

A

hamstrings

OPP (2 decks)

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