Exam 1 Flashcards by Eric Yang

HTN: Treatment Sequence

1) Venous sinus drainage technique
2) OA decompression
3) Indirect treatment of thoraco-lumbar junction
4) Soft Tissue technique of T10-T12 paraspinal musculature

Go from head first all the way down.

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Indirect treatment of thoraco-lumbar junction

- Contacts ______ process of T-L junction

Spinous!

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Soft Tissue technique of T10-T12: paraspinal musculature
: Kneading and Stretching
- Contacts __________

Patient is lateral recumbent

- contacts medial aspect of erector spinae muscles

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CHF: Treatment Sequence

1) Indirect Tx: C3-C5, phrenic nerve
2) Indirect Diaphragm Release
3) Thoracic Inlet Myofascial Release
4) Thoracic Lymphatic Pump
5) Pedal Lymphatic Pump

CHF so definitely have to deal with lympatics but before that, need to do all the releasing! From head to thoracic.

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Acute Myocardial Infarction: Treatment Sequence

1) Paraspinal inhibition
2) Indirect treatment T1-T6
3) Pectoral Traction
4) CV4

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CV4 Technique: Compression of Fourth Ventricle

Hand technique
Phase

Volleyball technique + Thenar eminences MUST be medial to the occipito-mastoid suture.
- encourage the flexion of occiput and extension of sphenoid. Which means Extension Phase.

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Asthma: Treatment Sequence

1) T2-T7 indirect myofascial release
2) Diaphragm Release
3) C3-C5 indirect: Phrenic Nerve
4) Rib Raising = Sympathetic

Asthma: Lungs, therefore T2-T7 (sympathetic) of lungs, then diagphragm release to loosen it up, then effect the nervous system of it. Then rib raising to work out the muscles around.

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Chronic Bronchitis: Treatment Sequence

1) Thoracic Inlet: 3 different techniques = both scalene stretch techniques + Rib 1 dysfunction
2) Rib INHALATION Dysfunction: ME
3) Diaphragm
4) Quadratus Lumborum
5) Ribs 11-12

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Pneumonia: Treatment Sequence

Exhalation dysfunction
Inhalation restriction

1) Thoracic Inlet
2) Sternal Releases****
3) Rib EXHALATION dysfunction: ME = Hand positions
4) T11-T12 paraspinal inhibition
5) Thoracic and Pedal Lymphatic Pumps (Because has to do with lypmhatics at the end)

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Respiration: Necessary elements

Diffuse Spaces
Intact Circulation
Lymphatics
Neural Control

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Dominant control of respiration

Parasympathetics

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Maintenance of mucosal barrier is via…

- through secretions of clear saliva/sticky mucous blanket

parasympathetics

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Sympathetic Influence on Lungs

Pathologic Response

Inflammatory
Decreased surfactant
Increased exudate/edema
Vasoconstriction and hypoperfusion of lung from exudate and edema
Dilation of bronchial tubes: Initially beneficial but persistent = local arteriole vasoconstriction

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Lungs: SNS and PNS

SNS = T2-T7
PNS = Vagus Nerve

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Bronchioles = Chapman Points

Anterior: Rib 2-3, intercostal space at sternal border
Posterior: T2, between SP and TP

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Upper Lung = Chapman Points

Anterior: Rib 3-4, intercostal space at sternal border

Posterior T2-T3 and T3-T4 between SP and TP

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Lower Lung = Chapman Points

Anterior: Rib 4-5, intercostal space at sternal border

Posterior T4-T5 between SP and TP

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Attachments of Muscles of Respiration

Anterior: Xiphoid Process
Anterior/Lateral: Ribs 6-12
Posterior: L2-L3

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Diaphragmatic Openings + Effect of Diaphragm

T8 = Vena Cava Opening, Widens via diaphragm contract.
T10 = Esophagus Opening, Closes via Diaphragm contract.
T12 = Aortic Opening, NO EFFECT

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Muscles of Respiration: Elevation of Ribs

Scalenes: Anterior, middle = 1st Rib
Scalenes: Posterior = 2nd rib
Serratus Posterior Superior = Ribs 2- 5
Levatores Costorum = general
Quadratus Lumborum - assists diaphragm in inhalation

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Muscles of Respiration: Depression of Ribs

Transverse Thoracis = Ribs 2- 6
Serratus Posterior Inferior = Ribs 8 - 12
Subcostal Muscles = General

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Muscles of Respiration: Other

Intercostals
Serratus Anterior: protracts and rotates scapula
Diaphragm

Physiologic Features: Lung

Elasticity = tendency to deflate
Inflated via active contraction of diaphragm and negative intrathoracic pressure (Muscles of Respiration)

Graph: Plateu Graph

Physiologic Features: Chest Wall

f(x) = provides structure and protection + creates negative intrathoracic pressure.

Graph = exponential Increase

Lung Volumes!

KNOW IT COLD + Addition/Subtraction of values

FEV1

Forced expiratory volume in first second of forced expiration

FRC | - Definition

Functional Residual Volume - volume of gas left in the lungs after normal exhalation. - Volume where the tendency of the lung to collapse is opposed by the opposite tendency of the chest wall to expand and provide support.

TLC: | - Definition

Total Lung volume: - Maximum force applied by the muscles of inspiration to expand lungs which is primarily opposed by the inward recoil of the muscle.

RV: | - Definition

Residual Volume: Force exerted by the expiratory muscles to exhale further to reduce RV is counteracted by the recoil of the chest wall

FRC: Changes

- Increase if: loss of chest wall recoil or added positive pressure due to air trapping or mechanical disease.

TLC: Changes

- Decreased: Stiffer/Less compliant lungs, increased inward recoil. - Increased: More compliant lungs, decreased inward recoil.

RV: Changes

RV: Affected by the strength of the muscles of exhalation + airway outflow - Increase via: Weak Muscles or Airway outflow obstruction illness

Treatment approach to obstructive disease: | - The pathology that may improve/or worsen

Emphysema

Obstructive Pulmonary Disease: | Which Lung measurements change and how?

Decreased FEV1/VC = used in diagnosis of Obstructive vs Restrictive Decreased FEF 25%-75% Increased RV/TLC

Obstructive Pulmonary Disease: | Pathologies

Asthma, COPD, Chronic Bronchitis, Emphysema, Bronchiectasis, Cystic Fibrosis, Bronchiolitis

Restrictive Pulmonary Disease: | Pathologies

Everything else including neuromuscular/chest wall

Importance of Lymphatic Function = 4

1) Fluid balance in the body 2) Purification 3) Defense against infection 4) Nutrition

Articular Tissues: - Acute segmental facilitation is seen in ______ - Underlying treatment is for the tissues sending ________

- soft tissues | - Somatic nociceptive information

Innervation of Anterior/Middle Fossa

Trigeminal Nerve

Innervation of Posterior Fossa

Upper 3 cervical branches: Symphathetic branches, vagus, and hypoglossal

Supoccipital muscles supplied by _______

Suboccipital nerve (posterior ramus of C1)

Myodural bridge attaches...

Rectus capitis Minor, Major and Oblique Capitis inferior

Migraine Mechanism: Neurochemical | - Micragine suffers have _______ and use ______ to treat it

- Low Serotonin levels | - Triptans = block inflammatory chemical in the meninges which come via cerebrovenous outflow

Chronic or transformed migraine occur ________ or more days per month

- 15 days or more

Screening Test for Migraine | - Questions

- Disability, Nausea, and Photophobia

Cerebrovenous system system sends signals to the ________

trigeminal nerve

Migraine: Convergence of Shared Innervation Meninges, - Facial, Skin, and cervical musculature afferents converge on the ___________ leading to _________

- spinal trigeminal nucleus | - Viscersomatic reflex

Occipital Nerve

- Originates from C2, C3 | - Innervates scalp at the top of the head, the top of the ear and over the parotid glands

Ansa cervicalis

- Loop formed from C1 - C3 - Geniohyoid, thyrohyoid = C1 only - Sternothyroid, Sternohyoid, Omohyoid

Cluster Headache

- Focal orbital or temporal pain, always unilateral, pounding pain. - Lacrimation, nasal discharge, pupillary changes, conjunctival injection, ptosis.

Location of Occipital Notches for monitoring - Greater - Lesser

- Greater occipital notch = 1 cm lateral to inion | - Lesser occipital notch = halfway between inion and mastoid

Location of Trigeminal for monitoring | - V1, V2, V3

- OA: Find tenderness and reciprocal changes | - Note: Check C2, which is where the TCC lives (trigemino-cervical complex: Trigger migraine headaches)

BLT for T4 | - Hand contacts _____ of dysfunctional segment

Spinous Process

Secondary Headache Disorders: Diagnostic Tests (had little stars)

- Metabolic evaluation: ESR/CRP - Neuroimaging: MRI/MRA/MRV - Lumbar Puncture