Exam #2 Flashcards
Anterior Cervical 1
- location
- position
Location: Lateral aspect of the transverse process of C1
Position: RA
Ant Cervical 2-6
- location
- position
Location: anterolateral aspect of the corresponding anterior tubercle of the transverse process
Postion: F SARA
Ant Cervical 7
- location
- position
Location: clavicular attachment of the SCM
Postion: F STRA
Ant Cervical 8
- location
- position
Location: sternal attachment of the SCM on the medial end of the clavicle
Postion: F SARA
Cardiac Sympathetics
T1-6 with synapses in upper thoracic and cervical chain
Sympathetic Supply to Upper Extremity Vasculature
T2 to T8 levels
Sympathetic Supply to Lower Extremity Vasculature
T11 to L2 levels
Myocardium, Thyroid, Esophagus, Bronchus chapman point
- Ant
- Post
Anterior: 2nd intercostal space near sternum
Posterior: Midway between the spinous process and tips of the transverse process at T2
Upper Lung
chapman point
-Ant
-Post
Anterior: 3rd intercostal space near sternum
Posterior: Midway between the spinous processes and tips of the transverse processes of T3 and T4
Lower lung
chapman point
-Ant
-Post
Anterior: 4th intercostal space near sternum
Posterior: Midway between the spinous processes and tips of the transverse processes of T4 and T5
Adrenal gland
chapman point
-Ant
-Post
Anterior: 1” Lateral and 2” Superior to Umbilicus Ipsilaterally
Posterior: Intertransverse Spaces of T11 and T12 Ipsilaterally Midway Between Spinous and Transverse Processes
kidney
chapman point
-Ant
-Post
Anterior: 1” Lateral and 1” Superior to Umbilicus Ipsilaterally
Posterior: Intertransverse Spaces Midway Between Spines and Transverse Tips of T12-L1
Cardiac parasympathetics
CN X (Vagus nerve): OA, C1, C2 somatic dysfunction can affect CN X
Do not use cardiac lymphatic pump techniques on patients
Congestive Heart Failure (decompensated),
Acute Myocardial Infarction
Do not treat cardiac in supine position
Congestive Heart Failure
COPD
Chapman reflex Myocardium (MI)
- ant
- post
anteriorly: 2nd intercostal space near sternum
posteriorly: between T2 and T3
Anterior infarct- somatic diagnosis
T2-T3
Inferior wall somatic diagnosis
T3-T5, C2
…. associated with supraventricular tachyarrhythmia due to sympathetic nervous system
Right pectoralis major trigger point 5th intercostal space (ICS)
somatic dysfunction pattern for hypertension
C6
T2
T6
THIS IS WHERE ACE INHIBITORS WOULD WORK
(T10-T11)
Rib raising done for a short period of time (less than 2 minutes)
will usually stimulate the sympathetic effects. For example, bronchodilation
Rib raising done for a longer period of time (greater than 2 minutes)
will usually lessen the sympathetic effects
Diaphragm Biomechanically
Where the thoracoabdominal diaphragm attaches: lower ribs, thoraco-lumbar junction, T10-L3 are examples
pump-handle ribs
Ribs 1-5
bucket-handle motion ribs
Ribs 6-12
Acute asthmatic attack must address
- Oxygen
- Medications (β2 agonists, Anticholinergic, Steroids)
- Nebulizers
steroids for extended periods of can lead to
osteoporosis
diabetes mellitus
adrenal insufficiency
Bucket handle best palpated
mid-axillary
B.I.T.E
Bottom Rib is key rib in Inhalation dysfunction
Top Rib is key rib in Exhalation dysfunction
Exhaled ribs are prominent
posteriorly
Inhaled ribs are prominent
anteriorly
Anterior Rib Counterstrain Points are associated with (rib)
Exhalation Rib Somatic Dysfunction
Posterior Rib Counterstrain Points are associated with (rib)
Inhalation Rib Somatic Dysfunction
AR1-2 Counterstrain
Laying down STRT
AR3-10 Counterstrain
Sitting up STRT
-doc leg on opposite side of dysfunction
PR1 counterstrain
sitting up STRT
-doc leg on same side of dysfunction
PR2-10 counterstrain
sitting up SARA
-doc leg on same side as dysfunction
Type II thoracic HVLA position and push angle
smiley face
Type I thoracic HVLA position and push angle
frowny face
Flexed type II HVLA
Physician places left thenar eminence (caudad hand) under the posterior transverse process of the dysfunctional segment
-push down
Ext type II HVLA
Physician places left thenar eminence (caudad hand) on the right transverse process below the dysfunctional segment
-45 degree angle
Exhalation Dysfunction Ribs 1 – 10 physician contacts the key rib
posteriorly at the rib angle
Rib 1: Rib 2: Ribs 3 – 5: Ribs 6 – 8: Ribs 9 – 11: Rib 12: -muscle **if muscle becomes hypertonic can cause inhalation dysfunction
Rib 1: Anterior and mid scalene Rib 2: Posterior Scalene Ribs 3 – 5: Pectoralis Minor Ribs 6 – 8: Serratus anterior Ribs 9 – 11: Latissimus Dorsi Rib 12: Quadratus Lumborum
Rib 1: Rib 2: Ribs 3 – 5: Ribs 6 – 8: Ribs 9 – 11: Rib 12: **muscle energy motion
Rib 1: anterior
Rib 2: rotate head away and ask patient to rotate ant
Ribs 3 – 5: pushes their elbow to their contralateral ASIS
Ribs 6 – 8: pushes their elbow toward the ceiling/ or ipsilateral ASIS
Ribs 9 – 11: ADduct their arm
Rib 12:
Rib 1 HVLA
sidebend the cervical spine towards the dysfunctional rib and rotates head away from dysfunctional rib
Rib HVLA 2-10
Place thenar eminence (fulcrum) on posterior aspect of rib angle instead of transverse process
Displacement
getting yelled at by boss then coming home and yelling at husband
Reaction formation
replacing a warded off idea or feeling w an emphasis on it opposite (having lustful thought so enter monastery)
Sublimation
replacing an unacceptable with with a course of action that I like will but socially acceptable (getting angry and playing golf)
Repression vs Suppression
Repression: unconscious
Suppression: conscious
Dissociative Fuge
reversible amnesia for personal identity, including the memories, personalities, and other identifiable characteristics
Antisocial Age
evidence of actions occurring since age 15 but not diagnosable until age 18
Avoidant personality disorder
would like to have a relationship but are afraid to
mean age of onset for GAD
30
Hoarding average age of symptoms start
13
PTSD drugs
SSRI and Pozosin
Acute distress disorder vs PTSD
ADS: symptoms leave over time w PTSD they do not
Acute distress disorder diagnosis days
symptoms for at least 3 days
conversion disorder
college student becomes blind every Monday but clears up right before weekend
- physiological stressor present
- issue can be disproven w tests
Benzos not metabolized by liver
Oxazepam
Temazepam
Lorazepam
Buspirone MOA, use, pharmacodynamics
MOA: Partial 5-HT1a agonist
Use: GAD
Pharmacodynamics: slow onset
Benzos suffix and MOA
-am
GABA agonist
what is given for performance anxiety
Beta blocker
anti nightmare drug
Prazosin - alpha 1 adrenergic receptor antagonist
Bulimia treatment
fluoxitine
Stanine
score 1-9
Reliability
test consistency and reproducibly of the test over time
Validity
the test measures what it is suppose to measure
Dyspareunia
pain during intercourse
Frotteuristic Disorder
touching/rubbing against unsuspecting people
Sexual Masochism vs. Sexual Sadism
Masochism: victim
Sadism: perpetrator
Voyeuristic disorder
peeping tom
reward center of brain
Nucleus accumbens
4 medical ethics
autonomy - patient has control of their body
beneficence - always do good
nonmaleficence - do no harm
justice - fairness
Criterion-referenced tests
measure the number of correct responses based on a specific, often minimum ‘criterion’ of what is expected to pass the exam. expressed in a percentage correct out of the total
4 steps of the Psychological assessment process
General functioning
Intellectual functioning
Memoring functioning
Content of thought
Transference
patient redirects their feeling from significant other or person to their life to the physician
-patient putting a physician in a paternal/maternal role
Counter Transference
occurs when a physician redirects their feelings onto a patient
-A physician treating a patient who reminds him of his mother who is very dependent on him and transfers his feelings becoming very prescriptive, discounting the patient’s questions about treatments.
NSTEMI EKG
depression
T inversion
treatment for prinzmetal angina
ca channel blockers and nitrites
shallow breathing bc pain on deep inspiration
pleural disease
inc tactile fremitus
consolidation (lobar pneumonia)
obstructive grade mild moderate severe very severe
mild: 100-80
moderate: 50-79
severe: 30-49
very severe: <30
restrictive grade mild moderate severe very severe
mild: >80
moderate: 60-80
severe: 50-60
very severe: <50
projection
cheating husband says wife is cheating
dissociative identity disorder
multiple personality disorder
Schizotypical
willy Wonka
> 50% of Schizotypicals have at least one major depressive episode
major depressive episode
Borderline behavior therapy treatment
dialectical behavioral therapy
-think Brittany spears
anxiety is controlled by the
limbic system
bulimia behaviors must occur on average
once per week for three months
Somatic Symptoms disorders
focus on physical symptoms that cannot by scientifically explained
transference vs countertransference
transference: patient -> clinician
countertransference: clinician -> patient
