COMLEX: general Flashcards
1
Q
Fryette’s law I
A
sidebending precedes rotation, sidebending and rotation occur to opposite sides; typically group dysfunctions. Ex: T4-T7 NSrRl
2
Q
Fryette’s law II
A
rotation precedes sidebending, sidebending and rotation occur to the same side; typically single vertebra dysfunction. Ex: L2 FRrSr
3
Q
superior facet orientation in the cervical spine
A
BUM: backward, upward, and medial
4
Q
superior facet orientation in the thoracic spine
A
BUL: backward, upward, lateral
5
Q
superior facet orientation in the lumbar spine
A
BM: backward, medial
6
Q
name the axis and plane: flexion/extension
A
transverse axis, sagittal plane
7
Q
name the axis and plane: rotation
A
vertical axis, transverse plane
8
Q
name the axis and plane: sidebending
A
anterior-posterior axis, coronal plane
9
Q
direct treatment
A
towards the barrier. ex: lymphatic treatment, Chapman’s reflexes
10
Q
indirect treatment
A
away from the barrier. ex: counterstrain, facilitated positional release
11
Q
what is the most common cause of cervical nerve root pressure symptoms?
A
degenerative changes within the joints of Luschka and hypertrophy of the intervertebral (facet) joints
12
Q
which muscles help elevate the 1st rib during forced inhalation?
A
anterior and middle scalene
13
Q
which muscle helps elevate the 2nd rib during forced inhalation?
A
posterior scalene
14
Q
according to the rule of 3s, where is the spinous process from T1-T3?
A
the spinous process is located at the level of the corresponding transverse process; T12 follows this rule
15
Q
according to the rule of 3s, where is the spinous process from T4-T6?
A
the spinous process is located 1/2 segment below the corresponding transverse process; T11 follows this rule.
16
Q
according to the rule of 3s, where is the spinous process from T7-T9?
A
the spinous process is located at the level of the transverse process of the vertebrae below; T10 follows this rule
17
Q
name the corresponding spinal level: spine of the scapula
A
T3
18
Q
name the corresponding spinal level: inferior angle of the scapula
A
spinous process of T7
19
Q
name the corresponding spinal level: sternal notch
A
T2
20
Q
name the corresponding spinal level: sternal angle (angle of Louis)
A
T4; attaches to the 2nd rib
21
Q
name the corresponding spinal level: nipple
A
T4 dermatome
22
Q
name the corresponding spinal level: umbilicus
A
T10 dermatome
23
Q
what are the atypical ribs?
A
ribs 1, 2, 11, and 12, sometimes 10
24
Q
what are the true ribs?
A
ribs 1-7, attach to the sternum through costal cartilages
25
what are the false ribs?
ribs 8-12, do not attach directly to the sternum but instead connected by its costal cartilage to the cartilage of the rib superior.
26
what are the floating ribs?
ribs 11-12, unattached anteriorly
27
what is the primary motion of ribs 1-5?
pump-handle
28
what is the primary motion of ribs 6-10?
bucket-handle
29
what is the primary motions of ribs 11-12?
caliper
30
diagnostic findings for inhalation dysfunction of ribs 1-5
pump-handle ribs: rib elevated anteriorly. anterior part of the rib moves cephalad on inspiration and restricted on expiration. anterior narrowing of intercostal space above dysfunctional rib.
31
diagnostic findings for inhalation dysfunction of ribs 6-10
bucker-handle ribs: rib elevated laterally. lateral part (shaft) of rib moves slightly upward on inspiration and restricted on expiration. lateral narrowing of intercostal space above dysfunctional rib.
32
diagnostic findings for exhalation dysfunction of ribs 1-5
pump-handle ribs: rib depressed anteriorly. anterior part of rib moves caudad on expiration and restricted on inspiration. anterior narrowing of intercostal space below dysfunctional rib.
33
diagnostic findings for exhalation dysfunction of ribs 6-10
bucket-handle ribs: rib depressed laterally. lateral part (shaft) of rib moves slightly downward on expiration and restricted on inspiration. lateral narrowing of intercostal space below dysfunctional rib.
34
what is the key rib in an inhalation dysfunction?
the key rib is the lowest rib of the dysfunction
35
what is the key rib in an exhalation dysfunction?
the key rib is the uppermost rib of the dysfunction
36
what are the landmarks of a typical rib?
tubercle, head, neck, angle, shaft
37
what is the primary flexor of the hip?
iliopsoas
38
origin and insertion for iliopsoas
origin: T12-L5 vertebral bodies.
insertion: lesser trochanter of the femur.
39
diagnosis: contralateral pelvic side shift, positive Thomas test, somatic dysfunction of upper lumbar segment
iliopsoas dysfunction
40
what is spina bifida occulta?
no herniation through the defect. often a coarse patch of hair over the site. rarely associated with neuro deficits.
41
what is spina bifida meningocele?
herniation of the meninges through the defect
42
what is spina bifida meningomyelocele?
herniation of the meninges and the nerve roots through the defect. associated with neuro deficits.
43
what somatic dysfunction is commonly associated with flexion contracture of iliopsoas?
nonneutral dysfunction of L1 or L2
44
anterior displacement of one vertebrae in relation to the one below due to defect in the pars interarticularis, (+) vertebral step-off sign
spondylolisthesis, diagnose with lateral x-ray
45
defect of the pars interarticularis without anterior displacement of the vertebral body
spondylolysis, diagnose with oblique x-ray
46
oblique x-ray of spondylolysis
fracture of the pars interarticularis, often seen as a "collar" on the neck of the scotty dog
47
degenerative changes in the intervertebral disc and ankylosing of adjacent vertebral bodies
spondylosis
48
saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control
cauda equina syndrome
49
what ligament divides the greater and lesser sciatic foramen?
sacrospinous ligament
50
origin and insertion of piriformis
origin: inferior anterior aspect of the sacrum.
insertion: greater trochanter of the femur
51
externally rotates, extends thigh, and abducts thigh with hip flexed
piriformis
52
respiratory motion of the sacrum
motion occurs about the superior transverse axis of the sacrum. located approximately at S2. sacral base moves posterior on inhalation and anterior on exhalation.
53
inherent (craniosacral) motion of the sacrum
same axis as respiratory motion. sacral base rotates posteriorly (counternutates) on craniosacral flexion and anterior (nutates) on craniosacral extension.
54
postural motion of the sacrum
motion occurs about the middle transverse axis of the sacrum. sacral base moves anteriorly with forward bending and posteriorly with terminal flexion
55
dynamic motion of the sacrum
weight bearing on the left leg (stepping forward with the right leg) will cause a left sacral axis to be engaged
56
etiology of superior pubic shear
trauma or tight rectus abdominis muscle
57
etiology of inferior pubic shear
trauma or tight adductors
58
sacral torsion rules
1.) when L5 is sidebent, sacral oblique axis is engaged on the same side as the sidebending. 2.) when L5 is rotated, the sacrum rotates the opposite way on an oblique axis. 3.) the seated flexion test is found on the opposite side of the oblique axis.
59
forward sacral torsion
rotation is on the same side of the axis, LoL or RoR
60
backward sacral torsion
rotation is on the opposite side of the axis, RoL or LoR
61
what is a common dysfunction in postpartum patient?
bilateral sacral flexion
62
how does psoas syndrome affect L1 or L2?
may cause L1 or L2 to be flexed, sidebend, and rotated to the same side of the iliopsoas contracture
63
name the functions of the rotator cuff muscles
supraspinatus = ABduct arm.
infraspinatus = ext rotate arm.
teres minor = ext rotate arm.
subscapularis = int rotate arm.
64
what is the most common brachial plexus injury?
Erg-Duchenne's palsy, upper arm paralysis due to injury of C5-C6 nerve roots.
65
innervation of the primary flexors of the wrist and hand
median nerve, except flexor carpi ulnaris (ulnar nerve)
66
innervation of primary extensors of the wrist and hand
radial nerve
67
primary supinators of the forearm
biceps (musculocutaneous nerve) and supinator (radial nerve)
68
primary pronators of the forearm
pronator teres and pronator quadratus, both median nerve innervation
69
ulna and wrist movement with increased carrying angle (cubitus valgus)
ABduction of ulna, ADduction of wrist, medial glide of the olecranon
70
ulna and wrist movement with decreased carrying angle (cubitus varus)
ADduction of ulna, ABduction of wrist, lateral glide of the olecranon
71
radial head motion
pronation = posterior radial head. supination = anterior radial head
72
primary extensor of the hip
gluteus maximus
73
primary flexor of the hip
iliopsoas
74
primary extensor of the knee
quadriceps: rectus femoris, vastus lateralis/medialis/intermedius
75
primary flexor of the knee
hamstrings: semimembranosus and semitendinosus
76
external rotation somatic dysfunction of the hip
piriformis or iliopsoas spasm
77
internal rotation somatic dysfunction of the hip
spasm of internal rotators: gluteus minimus, hamstrings, TFL, adductor magnus/longus
78
anterior cruciate ligament (ACL)
posterior aspect of the femur to anterior aspect of the tibia. prevents anterior translation of tibia on femur (hyperextension of the knee)
79
posterior cruciate ligament (PCL)
anterior aspect of the femur to posterior aspect of the tibia. prevents posterior translation of the tibia on the femur
80
motion of the fibular head
ankle pronation (foot eversion, dorsiflexion) = anterior fibular head. ankle supination (foot inversion, plantarflexion) = posterior fibular head.
81
femoral nerve
L2-L4. motor to quadriceps, iliacus, sartorius, and pectineus. sensory to anterior thigh and medial leg.
82
sciatic nerve
L4-S3. divides into tibial and peroneal nerves.
83
tibial nerve
L4-S3. motor to hamstrings except short head biceps femoris, most plantar flexors, and toe flexors. sensory to lower leg and plantar aspect of foot.
84
peroneal nerve
L4-S3. motor to short head biceps femoris, evertors and dorsiflexors of the foot, most extensors of the toes. sensory to lower leg and dorsum of foot.
85
genu valgum
increased Q angle, knocked-kneed
86
genu varum
decreased Q angle, bowlegged
87
what nerve can be affected by posterior fibular head?
common peroneal (fibular) nerve, lies directly posterior to proximal fibular head
88
unhappy triad
common knee injury resulting in injury to the ACL, MCL, and medial meniscus
89
motions of the talus
plantarflexion = anterior glide. dorsiflexion = posterior glide.
90
most commonly injured ligament in the foot?
anterior talofibular ligament
91
coxa vara
decreased angle (
92
coxa valga
increased angle (>135º) between the neck and shaft of the femur
93
spinal cord level and corresponding nerve: upper GI tract (foregut)
T5-T9, greater splanchnic nerve and celiac ganglion
94
spinal cord level and corresponding nerve: middle GI tract (midgut)
T10-T11, lesser splanchnic never and superior mesenteric ganglion
95
spinal cord level and corresponding nerve: lower GI tract (hindgut)
T12-L2, least splanchnic nerve, inferior mesenteric ganglion
96
spinal cord level: appendix
T12
97
spinal cord level and corresponding nerve: kidneys
T10-T11, superior mesenteric ganglion
98
spinal cord level: adrenal medulla
T10
99
spinal cord level and corresponding nerve: upper ureters
T10-T11, superior mesenteric ganglion
100
spinal cord level and corresponding nerve: lower ureters
T12-L1, inferior mesenteric ganglion
101
spinal cord level: bladder
T11-L2
102
spinal cord level: gonads
T10-T11
103
spinal cord level: uterus and cervix
T10-L2
104
spinal cord level: prostate
T12-L2
105
spinal cord level: arms
T2-T8
106
spinal cord level: legs
T11-L2
107
PS innervation of viscera above the diaphragm
vagus nerve
108
PS innervation of GI tract
foregut and midgut = vagus. hindgut = pelvic splanchnic
109
PS innervation of GU tract
kidneys and upper ureter = vagus.
| lower ureter and bladder = pelvic splanchnic
110
PS innervation of reproductive system
ovaries and testes = vagus.
| everything else = pelvic splanchnic
111
sympathetic innervation of head and neck
T1-T4
112
sympathetic innervation of heart
T1-T5
113
sympathetic innervation of lungs
T2-T7
114
sympathetic innervation of GI tract
before ligament of Treitz (divides duodenum and jejunum) = T5-T9.
between ligament of Treitz and splenic flexure = T10-T11.
after splenic flexure = T12-L2
115
sympathetic innervation of upper extremities
T2-T8
116
anteriorly, smooth, firm discretely palpable nodules approximately 2-3mm in diameter, located within the deep fascia or on the periosteum of bone
Chapman's points
117
hypersensitive focus, usually within a taut band of skeletal muscle or in the muscle fascia. painful upon compression and can give rise to characteristic referred pain
trigger point
118
small tense edematous areas of tenderness about the size of a fingertip; do not refer pain beyond the location compressed.
tenderpoints. typically located near bony attachments of tendons, ligaments, or in the belly of some muscles.
119
4 physiologic diaphragms
tentorium cerebelli, thoracic inlet, abdominal diaphragm (most important), pelvic diaphragm
120
where does the left (major) duct drain?
into the junction of the left internal jugular and subclavian veins
121
what structures drain into the right (minor) lymphatic duct?
right upper extremity, right hemicranium (including head and face), heart and lobes of the lung (except left upper lobe)
122
which tissues bypass lymphoid tissue and drain directly into the thoracic duct?
thyroid, esophagus, coronary and triangular ligaments of the liver
123
sympathetic innervation of cisterna chylli
T11
124
true or false: Sibson's fascia is traversed by both the left and right lymphatic ducts.
true
125
sympathetic control to the lymphatic duct
topographically innervated by the intercostal nerves
126
narrowing of the neural foramina can cause referred pain into the ipsilateral arm upon compression of the cervical spine, due to nerve root compression
spurling test (compression test)
127
physician flexes patient's neck, holding it for 10 sec, then extend the neck holding it for 10 sec. same is done for head and neck rotation to the R and L, head and neck rotation R and L with the neck in extended position, and in positions that the physician would attempt to mobilize the C-spine.
Wallenberg's test for vertebral artery insufficiency. (+) = dizziness, visual changes, lightheadedness, nystagmus
128
purpose of the hip-drop test
evaluate sidebending (lateral flexion) of the lumbar spine
129
lumbosacral spring test
will be positive in all dysfunctions in which the sacral base moves posterior
130
valgus and varus stress tests
pushing the knee medial (with a lateral force) is the valgus stress test. pushing the knee lateral (with medial force) is the varus stress test.
131
trendelenberg test
assesses the hip abductors (strength of gluteus medius). (+) = pelvis falls, indicates weakness of contralateral gluteus medius.
132
thomas test
assesses possibility of flexion contracture of the hip, usually of iliopsoas origin.
133
most commonly injured ligament in the ankle
anterior talofibular ligament
134
what nerve can be impinged with posterior fibular head dysfunction?
common fibular (peroneal) nerve, dysfunction of eversion and dorsiflexion
