Day 1 Flashcards
The spleen is located beneath ribs 9, 10, and 11 on the __ side of the body. It is in between the left __-diaphragm and __ cavity. If the __ is messed up, then the spleen can no longer move fluid throughout the body
left, hemi, peritoneal, diaphragm
Which is not a function of the spleen?
1) Destroy damaged RBCs
2) Metabolizes drugs
3) Synthesizes immunoglobulins
3) Clearance site for antigens, micro-organisms, and poorly organized bacteria
2 (thats the liver)
The __ is a major lymph channel for 3/4 of the body, back into circulation
Thoracic Duct
The liver is a pressure sensitive organ, affected by the muscular action of the __ diaphragm
thoraco-abdominal
The __ is largest and most active in an infant, and dies down (involutes) after puberty. It is the processing site for T-lymphocytes
Thymus
Name the tonsil
1) Located on the posterior 1/3 of tongue
2) Located at the lateral pharynx
3) Located at the nasopharyngeal border
1) Lingual
2) Palatine
3) Pharyngeal
__ is located at the medial surface of the cecum and presumed to offer support to the immune system
Apendix
__ system aids in filtration of toxins from the lungs and the GI system also has visceral lymphoid tissue
In the GI system, __ are located in the distal ilium, __ are lymphatic capillaries in each vili in the small bowel, and fats are cleared out that have entered circulation via GI system
Respiratory
Peyers patches, lacteals
__ nodes receive lymph from skin/deep tissues of upper and lower extremities/head and neck
They drain into three main groups, name them
Superficial
Cervical, axillary, and inguinal
Cervical lymph nodes from the head/supraclavicular and upper extremity drain into __ nodes
Axillary lymph nodes from infraclvicular to umbilicus drain into axillary nodes and then __
Inguinal lymph nodes from caudal to umbilicus drain into inguinal nodes and then __
Jugular
Subclavian
Lumbar
Lymph unites with one of which two ducts
Thoracic duct (75%) or right lymphatic duct (25%)
You are in the left supraclavicular region on the left side of the body, what node is located there?
Also, what is this associated with
Virchow’s node
Intra-abdominal or thoracic cancer
The thoracic duct starts off on the __ side of the body and then at the level of T-__ it moves __ of the midline and connects to the junction of the left subclavian and left brachiocephalic veins
Right side, 4, left
Which of the two ducts drains the left side of the head and neck, left arm, left side of thorax, left and right lower body, and viscera of thoracic?
Which duct drains the right head and neck, right arm, and right chest?
Thoracic duct
Right lymphatic duct
50% of plasma __ re-enter the system via lymph, so if you were to have a problem with lymph you could be malnourished
proteins
One way to move lymph is by ___ fluid pressure which has a normal pressure of ___ mmHg and hits a ceiling at 0 mmHG (when vessels collapse and obstruct flow)
Interstitial, Negative 6.3 (negative is the important part)
The __ pump works by using contraction forces to cause pressure gradients, which help move the fluid. However, when that fails, the __ pump is the only thing left which works by direct pressure on vessels to move lymph
Intrinsic
Extrinsic
What kind of system is the lymphatic system
“passive”
It is critical to start treatment at the level of the __ (thoracic inlet) which as said before, it at the junction of the duct and left subclavian vein/brachiocephalic vein
thoracic duct
ALWAYS ALWAYS ALWAYS go back to the __ after you finish your treatment session
Name what area each treatment does
1) Upper extermity
2) Head and neck
3) Thoracic
4) Lower extremity
5) Abdomen
Thoracic duct
1) Area 3
2) Area 5
3) Area 1
4) Area 4
5) Area 2
**Note that area 3 and 4 can be reversed
The lymph system is readily effected by external compression from your __
Diaphragm
Name what region the superficial node is found in. Choose from: Head/neck, abdomen, upper extremity, lower extremity
1) Popliteal
2) Cisterna chyli
3) Cubital
4) Celiac
5) Submental
6) Superficial ingunial
7) Virchow’s
8) Deltopectorial
9) Axillary
1) Lower Ex
2) Abdomen
3) Upper Ex
4) Abdomen
5) Head/neck
6) Lower Ex
7) Head/neck
8) Upper Ex
9) Upper Ex
Which one does the lymphatic system not do?
1) Maintain homeostasis
2) Facilitate immune function
3) Transport fat from digestive system to blood
4) Aid in the movement of oxygen
5) Assist the body in removing interstitial fluids and plasma proteins
4) Aid in the movement of oxygen
The right lower body is drained by ___
Thoracic duct
Match the reason for increased interstitial fluid pressure with its cause
1) HTN
2) Hepatic cirrhosis
3) Starvation/plasma hypoalbuminemia
4) Rattlesnake poison and other toxins
a) Increased interstitial fluid protein
b) Increased capillary permeability
c) Increased arterial capillary pressure
d) Decreased plasma colloidal osmotic pressure
1) c
2) d
3) a
4) b
Abnormal feeling indicating Otitis Externa would be found palpating what structure?
Pre and Post Auriculars
The superior and inferior inguinal lymph nodes are found in what structure?
Femoral triangle
The goal of lymphatic treatment is to move lymph __
centrally
Patient with COPD, URI, LRI, swollen upper extremities or enhanced immune function can be treated with what technique?
Thoracic pump
How fast do you perform the thoracic pump?
110-120 x/min
In the abdominal pump zone 2 technique, how fast do you pump and also this indirectly affects pressure gradients and indirectly messages the thoracic duct at its origin in ___
20-30x/min Cisterna Chyli
How fast can you perform the pedal pump?
100x/min
What technique can be used when a patient has eustachain tube dysfunction, lymphatic congestion in ENT or submandibular region
Mandibular drainage
Name the path of virchows lymph
Abdomen drains to deep visceral -> Cisterna chili -> thoracic duct -> virchow
Name range of motions
Hip
1) Flexion
2) Extension
3) Internal rotation
4) External rotation
5) Abduct
6) Adduct
Knee
1) Internal rotation
2) External rotation
3) Flexion
4) Extension
Ankle/foot
1) Dorsiflex
2) Plantarflex
3) Ankle Inversion
4) Ankle Eversion
5) Subtalar inversion
6) Subtalar eversion
7) Pronation
8) Supination
1) 90, or 120-135
2) 15-30
3) 30-40
4) 40-60
5) 45-50
6) 20-30
1) 10
2) 10
3) 145-150
4) 0
1) 15-20
2) 55-65
3) 35
4) 20
5) 10
6) 10
7) 5
8) 20
What are the borders of the femoral triangle?
Superiorly - Inguinal ligament
Medially - Medial border of adductor Longus muscle
Laterally - Medial border of sartorius muscle
What muscles make up the hamstring?
Biceps femoris, semitendinosus, semimembranosus
What is the function of the IT band/ tensor fascia lata?
Flexor, abductor
Name the grading scale for muscle strength
1) Active movement against gravity
2) Active movement against gravity and resistance
3) No muscular contraction detected
4) Active movement with gravity eliminated
5) Active movement against gravity and some resistance
6) Barley detectable flicker/trace of contraction
1) 3
2) 5
3) 0
4) 2
5) 4
6) 1
Name the nerve being tested
Hip
1) Flexion - iliopsoas
2) Extension - glut max
3) Abduction - glut med
4) Adduction - adductor longus
Knee
5) Flexion - Hamstrings
6) Extension - Quadriceps
Ankle/foot
7) Dorsiflexion and inversion - Tibialis anterior
8) Dorsiflexion - Extensor hallucis longus
9) Dorsiflexion - Extensor digitorum longus
10) Plantarflexion - Gastroc/soleus
11) PLantarflexion - FHL
12) PLantarflexion - FDL
13) Plantarflexion and inversion - Tibialis posterior
14) Evert - FIbularis longus and brevis
1) Femoral n L1-L2
2) Inferior gluteal nerve L5, S1, S2
3) Superior gluteal nerve L5, S1
4) Obturator nerve L2-L4
5) Sciatic n L5-S1
6) Femoral n L2-L4
7) Deep fib nerve L4, L5
8) Deep fib nerve L5
9) Deep fib Nerve L5
10) Tibial nerve S1/2
11) Tib nerve L5
12) Tib nerve L5
13) Tib nerve L5
14) Superficial fibular nerve L5,S1
Name the compatment
1) Labrum ligamentum teres, articular surfaces
2) Femoral neck, synovial lining
3) Guteus medius, gluteus minimus, IT band, trochanteric bursae
4) Iliopsoas insertion, iliopsoas bursae
1) Central
2) Peripheral
3) Lateral
4) Anterior
Adduction of the knee is the same thing as applying a __ force
Abduction of the knee is the same thing as applying a __ force
Therefore, an ABduction dysfunction would have restriction to what?
Valgus
Varus
Valgus
What nerve is subject to compression by the fibular head fracture or SD around the fibular head?
Common fibular (old term is peroneal) nerve
The __ angle is between the patella and tibial tuberosity and then the patella and ASIS to give an angle of __. It’s also large in women
Q, 15
If the fibula or tibia lateral? Also which one has the lateral malleolus and which one has the medial malleolus?
Fibula is lateral and has lateral malleolus
Inversion of the ankle and eversion checks for what kind of dysfunction? What about plantarflexion and dorsiflexion. What about dorsal and ventral glide?
What about dorsi/planta/abduct/adduct/internal/external motions?
Calcanus, Talus,
(Navicular, cuboid, cuneiform, metatarsa)
Metatarso-phalangeal
What makes up the trasnverse distal tarsal arch, lateral longitudinal arch, and medial longitudinal arch?
Transverse = Cuboid, navicular, 1-3 cuneiforms, metatarsals (proximal part)
Lateral longitudinal arch = Calcaneus, talus, cuboid, metatarsals 4-5
Medial longitudinal arch = Calcaneus, talus, navicular, cuneiforms 1-3, and metatarsals 1-3
What ligament is the primary stabilizer of the medial ankle?
Deltoid ligament
Which ligament is always the one to sprain first? (AKA if you get a sprained ankle what have you most likely injured?)
ATFL (Anterior talofibular ligament)
What injury is due to the unhappy triad (in the knee)
ACL, TCL, Lateral meniscus
Calcaneal inversion occurs between the __ and __ and the __ joint
Talus and calcaneus, subtalar
Are plantar or dorsiflexion injuries more common?
Also what can a plantar navicular dysfunction be due to?
Plantar
Tight plantar fascia
What make up the deltoid ligament?
Anterior tibiotalar ligament, tibiocalcaneal ligament, posterior tibiotalar ligament, and tibionavicular ligament
** Note it’s on the medial side, which is another reason why most ankle sprains occur on the lateral side
When checking for glenohumeral dysfunction what two areas are you most concerned about and what do you contact when assessing this problem
Anterior/inferior and posterior/superior and you contact the proximal humerus
What position maximizes AC joint motion?
60 degree coronal abduction and 60 degree horizontal abduction
The spine of the scapula is at the level of T__ and the inferior border of the scapula is at the level of __
T3, T7
Normal AC rotation is estimated to be __ degree each way
10
You place your fingers __ for SC flex and extend and on __ for SC abduction and adduction
Anteriorly, superior
Is adduction or abduction somatic dysfunction more common?
Adduction
Name the muscles that do the function for the scapula
1) Elevation
2) Depression
3) Protraction
4) Retraction
5) Upward rotation
6) Downward rotation
Name the muscles that do the function for the shoulder girlde
1) Flexion
2) Extension
3) Abduction
4) ADDuction
5) Internal rotation
6) External rotation
1) Upper traps and levator scapulae
2) Lower traps and rhomboid major
3) Serratus anterior
4) Both rhomboids and middle traps
5) Serratus anterior and upper traps
6) Levator scapulae, both rhomboids, and latissimus dorsi (LRRL)
1) CD (coracobrachialis and deltoids)
2) LT (Latissimus Dorsi and Teres Major)
3) Supraspinatus and mid delotid
4) Pec major and latissimus dorsi
5) Subscapularis and pec major
6) Infraspinatus and teres minor
What three bones make up the shoulder joint?
CLavicle, humerus, and scapula
What are the 2 accessory joints?
Costosternal and costovertebral
What mobile characteristics are seen in abnormal vs normal lymph
Normal = mobile Abnormal = Fixed, Discrete, Matted
Which lymph nodes drain the occipital and back of pharynx (throat)?
Posterior cervical
