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2014 Winter Quarter Written 1 Flashcards

1
Q

What happened in 1917 to the AOA?

A

Right to serve in uniformed services. President Roosevelt supported it. Vetoed by Gorgas.

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2
Q

What happened in 1963 to the AOA?

A

DO’s accepted by civil service as medical officers

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3
Q

What happened in 1966?

A

Robert McNamara, Sec of Defense, makes DOs as qualified medical officers.

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4
Q

What types of patients frequently have thoracic dysfunction?

A

Patients with shortness of breath, chest pain, or GI complaints

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5
Q

A flattening of the thoracic spine may indicate what type of dysfunction?

A

Extended dysfunction

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6
Q

At what vertebral level is the sternal notch?

A

T2 anteriorly

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7
Q

At what vertebral level is the Xipho-sternal level?

A

T9

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8
Q

What are the relations of spinous processes to their bodies?

A

T1-3: same level
T4-6: 1/2 level down
T7-9: 1 level down
T10-12: same-ish

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9
Q

Where are viscerosomatic tissue texture changes seen the most in thoracics?

A

rib angles

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10
Q

What layer is viscersomatic reflexes seen the most?

A

subcutaneous tissue

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11
Q

In what direction do you palpate for muscles?

A

perpendicular to muscle fibers

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12
Q

Fryette’s Type 1>

A

Group curves; sidebending and rotation occur in opposite directions.

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13
Q

Fryette’s Type 2?

A

Single unit effected. sidebending and rotation in the same direction

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14
Q

Fryette’s Type 3?

A

Initiating motion of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion

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15
Q

What structures exhibit reciprocal motion?

A

ulna and radius ; tibia and fibula

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16
Q

What is caliper motion?

A

motion of ribs 11 and 12; analogous to internal and external rotation.

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17
Q

In what direction is the axis of rib motion?

A

from the head of the rib to the rib angle. But, at 1st rib, axis is in coronal plane. Axis moves more posterior as you move inferior

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18
Q

Describe motion testing in various positions

A

Seated: focused on palpation.
Supine: Rib motion, Jones tender points, Fascial restriciton
Prone: thoracic spine

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19
Q

Describe Type 2 segmental dysfunction?

A

Very common in upper thoracics
Found out of step with group curves
Can effect A-P curvature (E or F)

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20
Q

Describe Type 1 segmental dysunction?

A

related to short leg or pelvic sideshift
Seen in idopathic scoliosis
Seen in postural patterns from repetitive activity
Seen in long standing viscerosomatic reflexes

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21
Q

Describe Muscular/Fascial dysfunction

A

Seen in repetitive use, macro-trauma, and poor posture

Co-dependent with articular dysfunction

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22
Q

Describe A-P Curve Problems

A

may be a long standing postural change to nocceptive or viscerosomatic input

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23
Q

What is the definition of viscerosomatic reflexes?

A

Localized visceral stimuli producing patterns of reflex and response in segmentally related somatic structures

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24
Q

Name Cardiac, Pulmonary, and Upper GI viscerosomatic examples?

A

Cardiac: texture change in upper L thoracics
Pulmonary: Texture change bilateral or unilateral
GI: Texture with alternating pattern in upper and mid thoracics

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25
What do double-labeling studies show at CCOM?
An anatomic connection bw visceral and somatic structures in DRG
26
What is the difinition of somato-visceral reflexes?
Localized somatic stimuli producing aptters of reflex response in segmentally related visceral structures
27
When is HVLA appropriately used?
When the main component is articular. If the barrier is less distinct then try indirect
28
What do articular dysfunction and Co-existent Orthopedic disease have in common?
the joint is jammed with a rock hard endpoint. Do not lose localization during setup.
29
Name examples of treatments for tender points
Jones counterstrain, Chapmans inhibitory pressure, Travell and Simon trigger point spray, Injection
30
What are trigger points?
They radiate to a pain reference zone
31
What happened to AOA in 1939?
First specialty board is formed - Radiology
32
What is unique about ribs 11 and 12?
They haev no costotransverse articulation
33
Describe properties of the rib segments
1-7 are true. 8-10 are false. 11-12 are floating. Ribs 1, 11, 12 are atypical
34
Where does the brachial plexus pass through?
Between the anterior and posterior scalenes
35
Name 3 sites of thoracic outlet sydrome
1. Bw anterior and middle scalene (ant. scalene syndome) 2. bw clavicle and 1st rib (costoclavicular syndrome) 3. bw pec minor and chest wall
36
Describe fluid movement in thoracic outlet
negative intrathoracic pressure + positive intra-abdominal pressure.
37
Pump handle motion
affects AP diameter, upper ribs 1-5
38
bucket handle motion
effects transverse diameter, lower ribs 6-10
39
Which rib is more associated with elevation of the rib?
1st rib
40
Which ribs have the most pump handle motion
Ribs 1 and 2. Predominance of this motion decreases as you move inferiorly. BUT all ribs exhibit both pump and bucket handle - just to varying degrees
41
Describe the motion of ribs 11 and 12
pincer, caliper motion. Move posteriorly and laterally on inhalation, and anteriorly and medially on exhalation
42
What are respiratory ribs?
Exhibit motion restriction in the movement of inhalation/exhalation
43
What are structural ribs?
Exhibit restriction of motion associated with thoracic cage restriction/dysfunction
44
What is Greenman's list of structural ribs?
Anterior sublux Posterior sublux External rib torsion (associated with E dysfunction) Sup. 1st rib sublux A-P rib compression Lateral Rib Compression Lateral flexed rib (usually 2nd) ('bucket bail')
45
What is associated with a Reflex dysfunction?
Tender points, viscerosomatic patterns
46
What is a key rib?
For exhalation group: top rib is key rib restricting inhalation For inhalation group: bottom rib is key rib restricting exhalation (key rib is often structural rib and should be treated)
47
Describe structural ribs
often presents as intercostal neuralgia. usually fixed when thoracics are treated. ant-post sublexes: tension of iliocostalis
48
Who is Dr. Irwin Korr?
PHysio prof at KCOM. Paper on autonomic activity at the level of dermatomes and the relationship to reflex motor activity.
49
Who is Dr. Louisa Burns?
studied viscerosomatic and somatovisceral reflexes and the effect of OMT
50
What did Dr. Louis Burns; studies conclude?
1. Pathway of viscerosomatic enters sinal chord through post. roots 2. somatvisceral reflexes are less circumscribed and direct than V.S. 3. normal visceral activity depends on somato-sensory nerves 4. V.S. aids in diagnosis
51
What did Dr. Korr and Dr. Denslow conclude?
Physiology of spinal segmental facilitation and its somatic dysfunction.
52
What fibers are activated in V.S and S.V reflexes?
nociceptive, general visceral afferents; somatosensory nociceptive neurons, respctively
53
Where and with what do primary afferent neurons synapse?
In the dorsal horn with internuncial neurons
54
What is facilitation?
A state of irritability of ongoing irritation of internuncial nn, whether VS or SV.
55
How does afferent activity effect the stimulus?
The response/threshold is lower and easier to reach in that segmental area
56
Describe the difference in activity of ventral horn motor synapses and intermediolateral cell column synapses.
Ventral horn: segmental myospasticity in primary SD and VS reflexes Inter: segmental somato-somatic, somatovisceral and viscero-visceral reflex sympathicotonia
57
What do VS reflexes represent?
the somatic reflection of visceral pathology (SD secondary to visceral inflammation)
58
Usually intensity of VS reflexes mirror severity of visceral pathology. What is the exception?
Visceral neoplasia, because they are avascular and not innervated. The surrounding effected tissue transmits the response.
59
What are Chapmans reflexes?
2-3mm nodular masses, palpable in soft tissue. Sharp, pinpoint, non-radiating. Dysfunction of segmental symp. system w effected lymphatics. Anterior pionts diagnostics and posterior points are treated. In deep fascia or periosteum
60
What are signs of chronic SD?
local vasospasm, subcu fibrosis, low temp, low skin drag
61
What did Beal ccontribute?
reviewed anecdotal literature and gave review of locations of VS reflexes
62
At what level do organs above diaphragm experience VS reflexes
at or above T5 (below T5 for organs below diaphragm)
63
Where are parasympatetc reflexes found?
vagus nerve, and S2,3,4
64
What occured in 1910?
Flexner report of Rockefeller. AOA developed standards and led to accredidation
65
Anatomy of C0 on C1
occipital condyles converge anteriorly at 30 deg. Major motion: Flexion/Extension 15 deg. Atypical mechanics-rotation/sidebending opposite
66
Anatomy of C1 on C2
major motion: rotation 35 deg each direction. | Atypical: restriction occurs onsly in rotation
67
Anatomy of C2-C7
facets point toward eye 45 deg. | Atypical: sidebending induces rotation twowards concavity in both Type 1 and 2
68
Describe range of motion of cervical spine
flexion/extension - 130 deg. side bending - 35 deg left and right rotation - 90 deg left and right
69
What muscles cause flexed and extended dysfunction in cervical spine?
anterior: (longus colli,/rectus capitus anterior) cause flexed dysfunction posterior: (semispinalis, cervicis, longissimus) cause extended dysfuction
70
Vagus n receives branches from which root?
C2
71
Which arteries are at risk of arterioal occlusion with extension and rotation?
Vertebral aa
72
Which muscles are involved in acute and chronic neck problems?
Acute: (prevertebral) scalenes, sternocledio Chronic: postural, trap, levator scapula
73
What is associated with whiplash?
extended upper thoracic dysfunctions; use indirect techniques
74
What is a common GI pattern?
C2 left, T3 right, T5, left, T7, right
75
What test is positive for Compression syndromes?
Adson's test

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