CIS 3: Heme/Lymph

Question 1

What is the most common abnormal finding on PE of pt with CLL?

Answer 1

LAD (cervical, supraclavicular, axillary) and 2nd is splenomegaly (usually painless/non-tender)

Question 2

What is the most commonly involved non-lymphoid organ invaded by CLL cells at time of dx?

Answer 2

SKIN –> commonly the face and can be macules, papules, plaques, nodules, ulcers, or blisters

Question 3

In contrast to other lymphomas, involvement of which system is rarely seen in CLL?

Answer 3

GI mucosal involvement; meningeal leukemia is also unusual

Question 4

What is the most noteworthy lab abnormality found in CLL?

Answer 4

Lymphocytosis in the peripheral blood and BM –> >5000/microL (5x10⁹/L)

Question 5

Diagnostic evaluation of a patient suspected of having CLL should include what 3 components?

Answer 5

• A CBC with diff
• Examination of the peripheral smear
• An immunophenotypic analysis (flow cytometry) of the circulating lymphocytes

Question 6

Immunophenotyping using what is a key component to the diagnosis of CLL?

Answer 6

Flow cytometry

Question 7

What are the components of the CURB-65 mortality prediction tool for pt’s with community-acquired pneumonia?

Answer 7

• Confusion
• BUN >20 mg/dL
• Respiratory rate ≥30 breaths/min.
• BP (systolic <90 mmHg or diastolic <60 mmHg)
• Age ≥65 years

Question 8

Where are the anterior Chapman’s Points for the heart, bronchi, esophagus + upper lung + lower lung?

Answer 8

• Heart, bronchi, esophagus = 2nd ICS at SB b/l
• Upper lung = 3rd ICS at SB b/l
• Lower lung = 4th ICS at SB b/l

Question 9

Where are the posterior Chapman’s Points for the bronchi, esophagus + upper lung + lower lung?

Answer 9

• Bronchi/esophagus: Lateral to T2 SP’s
• Upper lung: Intertransverse space btw T2-T3 AND btw T3-T4
• Lower lung: Intertransverse space btw T4-T5

Question 10

What are 2 cranial considerations of the somatic nervous system for pt with pneumonia?

Answer 10

1. Dural tension
2. Tension around jugular foramen –> relieve Vagus n. (CN X)

Question 11

Which part of the ANS should be treated in pt with pneumonia to help with bronchiole dilation?

Answer 11

SNS —> T1-T7; direct inhibition, tenderpoints, and gentle rib-raising

Question 12

Which vertebral area should be considered in pt with pneumonia in regards to the motor component of the diaphragm?

Answer 12

C3-C5 = phrenic n. to the diaphragm; irritation caused by ↓ excursion and overuse

Question 13

Which OMT treatments using the metabolic-energetic-immune model are effective for pt with pneumonia?

Answer 13

OMT using lymphatic pumps has been shown to ↑ circulating leukocytes and enhance the immune response

Question 14

Which type of OMT techniques will be best for pt with pneumonia and why?

Answer 14

Indirect techniques will require less energy from the pt to accomodate to any changes from the manipulation techniques

Question 15

What are 3 ways of addressing the behavioral model for pt with pneumonia?

Answer 15

• Maintain hydration
• Nutritious diet
• Reassurance

Question 16

Where should fingers be placed when assessing the thyroid glands?

Answer 16

Index fingers lie just below cricoid cartilage

Question 17

A (+) valsalva test for central neuropathy indicates what?

Answer 17

Space occupying lesion in cervical canal

Question 18

A (+) Roos or EAST Test indicates what?

Answer 18

Thoracic outlet syndrome; specifically compression of subclavian a.

Question 19

A (+) Adson test with pt looking away from affected side vs. toward affected side indicates what?

Answer 19

• Looking away = compression of subclavian a. btw scalanes
• Looking toward = btw 1st rib or cervical rib

Question 20

(+) Wright’s Hyperabduction test indicates what?

Answer 20

Thoracic outlet syndrome; specifically neurovascular entrapment by pectoralis minor m.

Question 21

A Clay Shovelers’ fracture is of what vertebrae?

Answer 21

C6 or C7

Question 22

Hyperextension or avulsion force from muscle contraction leads to what type of fracture?

Answer 22

Spinous process fracture