Cert Test Flashcards
Who did Dr. Pierce Sr. collaborate with in making of the DTG instrument
Stillwagon
What does DTG stand for
Dermo-Thermo-graph
T/F
Increase in Parasympatheic response indicates Hotter readings
True
T/F
Increase in Sympathetic response indicates colder respsonse
True
How many Probes does the DTG have? how many does the Tytron have ?
One for DTG
Two for Tytron
Does the Pierce Results System use pattern or break analysis
pattern
is the tyrton scan time dependent or time sensitive
what about the DTG
Tyrton is time sensitive
DTG is time dependent
what is the ideal skin temperature of the human body
93.5
List some examples of conditions that lead to a bad or altered thermal instrument reading
- smoking
- taking a shower before visit
- exercising before
- heated car seats
What are the five Major listings in the pelvis
- sacrum
- Posterior inferior (PI) Pelvis
- Anterior Superior (AS) Pelvis
- Internal Rotation (IN) of the ilium
- External Rotation (EX) of the ilium
Patient education line starts from the ____ to the middle of ___
- anterior tubercle
- T2
George’s line should be a ____ line on the back of the vertebral bodies
- curved
Atlas angles:
- Inferior(-)
- Inferior
- Normal
- Superior (+)
- Superior (++)
- inferior 18<
- normal 18 - 24
- Superior + 24- 30 mm
- Superior ++ > 30 mm
what is the normal Z angle
45 degrees
what is the normal rang for the z angle
35-55 degrees
what is the z angle determine in an x- ray analysis
(2 things)
determines if the neck can be returned to the actual normal curve .. also determines line of drive for the adjustment of the particular vertebrae
What is the whitehorn’s angle
line at the bottom of the body of the axis
what is considered a 0 degree whitehorns
when the body of the axis is parallel to the floor (normal)
what is considered normal for the axis relating to the whitehorns angle
either body of axis parallel to the floor or slight posterior and inferior
if the odontoid of axis is tilted forward, and the second line is drawn parallel to the floor and touch the most inferior tip of body which is the anterior portion … is this a negative or positive whitehorn’s angle?
Negative
if the odontoid of axis is tilted posterior and the line is drawn with it touching the posterior, inferior tip of the axis of the body … is this a negative or positive whitehorn’s angle
positive
normal whitehorns
positive whitehorns
negative whtehorns
0 degrees
+ 12 degrees
- 12 degrees
T/F
A positive whitehorn’s is associated with a kyphotic neck
False
negative whitehorns- if the angle is formed below the line drawn parallel with the bottom of the film
T/F
A positive whitehorn’s is associated with hyperkyphotic or combination cervical spine
true
if the angle is formed above the parallel line
What should George’s line measure on a normal neck?
- military?
- lordotic
- kyphotic
- normal =17cm
- military = 500 cm
- anything +
- anything -
T/F
The Gravity weight line should approximate between C3/C4 disc space
False
C4/C5
Deviation of the gravity weight line ____ will anteriorly load the cervical spine and deviation of the line ___ will posteriorly load the cervical spine
- anteriorly
- posteriorly
Atlas angles:
- Superior ++
- Superior +
- Superior (N)
- Inferior
- Inferior -
- > 30 degrees
- 24- 30 degrees
- 18 - 24 degrees
- 0- 18 degrees
- < 0 degrees
A ___ will be a point on a cervical x- ray, where a curve or a straight line changes direction or becomes a different angle
- Kink ( or vector intersection)
When the atlas is on an ____ tilt and no vertebral bodies are touching the + 17 cm arc .. this is considered a total involvement
inferior tilt
T/F
A partial involvement in the cervical spine is when the atlas is on a inferior tilt and some of the vertebrae touch the normal +17 cm arc
False
it is when the atlas is on a superior tilt
( Total involvement would be on a inferior tilt)
List the reasons to use the axis/ cervical ruler
- to determine laterality of the atlas and the position of axis
- measure all angles
- to bisect the foramen magnum
List the characteristics of a normal lateral cervical view
- 17cm curve with the anterior portion of bodies (C2-T2) sitting on the line
- George’s line being a + 17 cm curve
- Atlas with superior tilt ( 18 - 24 degrees)
- Atlas 50/50
- Axis with 0 degree whitehorn’s
- Z angle between 35- 55 degrees (normal 45)
- all discs space uniformed without spurring
T/F
A lordotic neck is considered the most common of all subluxations and the easiest to correct
False
I was describing a Kyphotic neck
What is typical in a kyphotic patient?
they usually had only one accident and never has been under chiropractic care
In most cases with kyphotic necks, the ____ cervical is the major problem
- 5th cervical
A Kyphotic neck consists of:
- reversed cervical curve
- a NEGATIVE axis angle/ whitehorne’s (-15)
- atlas loses the superior tilt and begins to go inferior in a complete reverse
- Decrease in the normal potential ruler of more than + 17 cm up to + 500 cm ( then reverses from - 500 cm to a complete - 17cm curve)
Which type of neck is usually found in patients who have experienced numerous accidents or patients that have been in long term chiropractic patients.
Combination Necks
T/F
with a combination neck there will be two curves forming a definite kink
True
T/F
in a combination neck a kink usually occurs between 5th and 6th cervicals and very seldom between 3rd and 4th cervicals
False
it seldom occurs between 5th and 6th
usually occurs between 3rd and 4th
occasionally between 4th and 5th
with the combination neck, the double problem must be corrected in a proper order … explain the proper order for this type of neck
- the lower problem must be corrected first
- usually the lower locking occurs between 4th, 5th or 6th
- must verify by a lateral flexion and extension view
- After correction of the lower curve, must take a post x- ray
Combination neck consists of:
- double problem ( correct lower curve first the upper)
- has two curves creating kinks
- has an upper cervical curve that usually fits on the normal + 17 cm curve , but lower curve is greater than + 17 cm or straight or kyphotic
- Has a Superior + Atlas angle
- Has a positive Whitehorn’s Angle
After correction of the lower curve in a combination neck and post x- ray is given, what usually is seen in the post x- ray?
the upper cervical will appear to have lordotic curve
T/F
There are very few lordotic necks. They are usually found in the very young or very old patients
True
T/F
In a lordotic neck (axis major) the real problem being anteriority of atlas, axis and third cervical
False
will be a posteriority
The rule of a lordotic neck ( Axis major adjustment) is:
- Superior + or Superior ++ atlas
2. Positive whitehorne’s axis angle
The lordotic neck characteristics are:
- a hyperlordotic curve
- lower cervical curve that is normal ( +17 cm) and upper cervical curve that is more than + 17 cm
- Has posteriority of atlas, axis and 3rd cervical
- atlas angle that is greater than 18 - 24 degree range ( more superior atlas then atlas on a combination neck)
- Makes it a superior ++
In a lordotic neck with 3rd cervical major , all the factors are the same except what two things?
- will have a perfect atlas angle
- 0 degree whitehorne’s angle
- also the 3rd cervical will subluxate posterior
T/F
In a lordotic neck ( 3rd cervical major) , this type of neck usually occurs from correcting the lower cervical curve of a combination neck
False
this neck is usually caused by an accident
The rule for Lordotic neck ( 3rd cervical major) is:
- Normal atlas
2. Normal or negative whitehorne’s angle
On flexion, the ___ of __ should move closer to ___ and the distance between the spinous process and posterior arch of atlas ___
- posterior arch
- occiput
- increases
on extension, the spine should roll smoothly into a hyperlordotic neck with no ___ of vertebrae . the occiput, posterior arch of atlas and axis should ___
- stacking
- approximate
Almost all posterior locked vertebrae are locked on ___
flexion
Name the Cervical Mates:
- occiput=
- Atlas=
- Axis =
- C3=
- C4=
- C5=
- C6 =
- C7 =
- T1=
- T2=
- T3
- occiput= T3
- Atlas = T2
- Axis= T1
- C3 = C7
- C4= C6
- C5= C5
Name the vertebras that are usually are locked on flexion
- Occiput
- C1
Name the vertebrae that are usually locked on extension with rotation
C7
T1
T2
T3
which vertebrae is locked on extension without rotation
- C3
T/F
In a kinking down involvement, adjust the first vertebrae above the kink
False
Adjust the vertebrae below the kink
Kinking up on flexion usually occurs at which vertebral level
C3, 4, 5 and 6
____ extension locks is associated with occiput extension lock
C3
Name the Spinouses Rule for :
- neutral lateral
- Flexion
- Extension
- neutral lateral : even spacing should be evident between all spinouses
- Flexion - Spinouses should flare and even spacing should be maintained throughout the cervical spine
- Extension: Spinouses should approximate one another
Name the IVF Rule
- Neutral lateral
- Flexion
- Extension
Neutral lateral - should appear thin with very narrow opening except at C3 and C7 there should be a medium sized hole
- Flexion - open, round to oval in shape between all cervical and upper thoracic vertebrae
- Extension- closed, depending on the view all IVF’s should appear uniformly closed
Define the exostosis repeatable pattern formation
- exostosis will form on the anterior inferior end plate of the subluxated vertebrae
- Exostosis will then form across the disc on the anterior superior portion of the first vertebrae below the sublimated vertebra.
- Exostosis will next form on the anterior inferior end plate of the first vertebra above the subluxated vertebra
- Exostosis will continue in this pattern below- above-below- above unless the problem is corrected
T/F
the exostosis rule states that when one vertebra is exostotic this is the vertebra to be adjusted
True
Explain how to determine the year of the accident in a patient
count the number of vertebra with exostosis, multiply by five and add an additional five… example with 3 vertebra involved:
3 X5= 15
15+ 5 = 20
20 years ago this patient had some type of hyper flexion injury
T/F
atlas and axis are most commonly to have exostosis
False
they rarely have it due to the fact that they exhibit more movement than any other vertebra even if they are subluxated
T/F
if bony spurs are pronounced suspect a serious violent accident
true
T/F
when a pelvis subluxates, they usually both subluxate in opposite directions
False
usually in the same direction
when then pelvis subluxates, they can go in opposite ways due to what?
rotation
T/F
it is very common to see a AS-PI pelvis on X-ray
False
it is very seldom
The major pelvic listing is almost always on the side of the ___ ___, the ____ ____ ____, Lumbar ____ ____ and the side of lumbar _____
- short leg
- sacrum base inferiority
- body rotation
- scoliosis
Name the five major pelvic listings
- sacrum
- Posterior inferior pelvis
- Anterior superior pelvis
- internal rotation of the ilium
- external rotation of the ilium
List the characteristics of a normal pelvis
- heart- shaped pelvic opening
- almond shaped obturators that are same size and shape
- sacrum base, iliac crest and femur heads are level
- tailbone in right alignment with pubic symphysis and sitting 1 and half up the pelvic opening
- both ilium the same width
- no lumbar body rotation
- lateral lumbar curve range +19 cm to +24 cm
- distance to ischial tuberosity to the bottom of the x - ray film will be the same when compared to the other side
- if pelvis cut in half, each half will fit perfectly
T/F
the normal lumbar curve has an arc radius of 19 - 24 cm. this is measured along the posterior side of the vertebral body
False
Measured on along the anterior side
An arc radius less than 19cm is commonly seen in patients with _____
a double AS pelvis
An arc radius greater than 24 cm is commonly seen in patients with ____
a double PI
PI is the most often seen pelvic problem because it is the bottom end of the perfect compensation caused by the most common subluxation ____
the 5th cervical
List the characteristics of a Double PI pelvis
- pelvic opening becomes smaller vertically
- both obturators become large vertically
- the tailbone sits very low in the pelvic opening
- sacrum base goes posterior
- straightening of the lumbar curve of more than + 24 cm
- no detectable short leg
list the characteristics of a single PI pelvis
- lumbar body rotation to the major side
- sacrum base is posterior and inferior on PI side
- short leg is on the PI side
- tailbone favors side of normal ilium
- many time accompanied with a EX
List the characteristics of Both PI with a major and minor side
- the short leg is on the major PI
- Sacrum is inferior and posterior on the major side
- lumbar bodies are rotated to the major PI side
- tailbone favors minor side
List the characteristics of the Anterior Superior Pelvis
- the sacrum base has gone anterior
- the sacral apex has gone posterior
- the obturator are small vertically
- tailbone sitting high in pelvic opening
- lateral lumbar curve is hyperlordotic .. a curve that measures less than +19 cm with the normal potential ruler
Points of importance in analyzing internal and external rotation are the position of the center of the _____ ____
sacral apex
most corrections of the IN-EX problems is by adjusting the ____
sacrum
what is the second choice of adjusting the IN - EX?
the PI or AS
List the characteristics of Internal rotation
- ala of ilium becomes wider horizontally
- obturator foramina become narrow
- iliac spine becomes prominent in the pelvic opening
List the characteristics of external rotation
- ala of the ilium becomes narrow horizontally
2. obturator foramina become wide horizontally
What is most common in IN-EX pelvis ?
- one ilium in IN
- short leg is on the IN side
- No lumbar body rotation
- EX is on the opposite side
- tailbone favors the EX side
- smaller pelvic opening between the sacrum and ilium on the EX side
List the characteristics of the EX pelvis
- one side is normal
- one side is EX
- tailbone favors the EX side
- short leg is on the EX side
What is the main difference with a IN- EX with lumbar body rotation ?
Lumbar body rotation to the IN side
T/F
the sacrum can go inferior left or right, the lumbar bodies will usually rotate to the side of base opposite of inferiority and that is usually the side of a short leg
False
it occurs on the side of inferiority of sacrum
You must correct the pelvis when :
the coccyx is out of alignment
the sacral apex deviation indicates a pelvic problem, not only a sacral problem
the major pelvic side is found on the side of:
- sacral base inferiority
- short leg
- lumbar body rotation
- unless the patient has a congenital abnormality or a history of double lumbar roles
a spine with perfectly compensated reverse curves will show a ____ ____
Double PI pelvis
A double AS that is perfectly balanced with no symptoms has a congenital abnormality between ____
L5/S1
Sciatica is nearly always what kind of problem?
what else to look for?
atlas problem
also check upper dorsal
___ and ___ are controlled by the sacrum
L4 and L5
List the order of occurrence of subluxations with the time of life that can occur and the cause
- Atlas — birth to 10 months — Birth
- Sacrum – 10 months to 2 years —- falls on buttocks
- C3 — 3 years to 12 years — falls on head
- C4,C5,C6—- 12 years to death —- whiplash accidents
- T1 —– childhood to onward—– catching yourself with hands when falling forward
____ extension lock is associated with Occiput extension lock
C3
