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OMM > Fall 2015 written > Flashcards

Fall 2015 written Flashcards

1
Q

the ability to feel pain

A

nociception

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2
Q

what is nociception composed of (4)?

A

transduction, transmission, modulation, perception

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3
Q

when is the transition from an acute to a chronic pain staet?

A

3-6 months

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4
Q

chronic pain is due to permanent alteration in the _______?

A

dorsal horn

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5
Q

how is pain signal transferred to CNS?

A

double pain sensation: (1) fast/sharp pain (2) slow/chronic pain

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6
Q

which tract do fast pain fibers go thru?

A

neospinothalamic tract (glutamate)

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7
Q

which tract do slow pain fibers go thru?

A

paleospinothalamic pathway (substance P)

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8
Q

where mechanical and thermal pain receptors can elicit fast and slow pain, chemical pain receptors can ONLY elicit _____pain

A

slow

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9
Q

what substance is most responsible for causing pain following tissue damage?

A

bradykinin

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10
Q

the _____the rate of metabolism of the tissue, the more rapidly the pain appears

A

greater

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11
Q

how do muscle spasms cause pain? (3)

A

(1) direct stimulation of mechano-pain receptors
(2) compression of blood vessels–>ischemia
(3) incr metabolism rate–>worsened ischemia

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12
Q

increase in sensitivity of pain

A

hyperalgesia

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13
Q

causes of true visceral pain (5)

A
  1. tissue ischemia
  2. chemical damage
  3. smooth muscle spasm
  4. excess distension of a hollow viscous
  5. ligament stretching
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14
Q

what is trifurcation?

A

when the afferent nerves enter the spinal cord, they split into (1) branch into dorsal horn (2) ascending branch (3) descending branch

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15
Q

cutaneous pain can reach how many spinal cord levels?

A

2-3 segments

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16
Q

visceral pain can reach how many spinal cord levels

A

5+

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17
Q

stimulation or inhibition of A-beta sensory fibers from peripheral receptors can depress pain signal transmission

A

stimulation of A-beta sensory fibers

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18
Q

subacute pain is when?

A

pain >6 wks, but under 3 months

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19
Q

what can improve outcomes for acute LBP without radiculopathy?

A

spinal manipulation

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20
Q

what can long standing SD lead to?

A

disc pathology, facet arthritis or stenosis due to increased wear and tear.

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21
Q

do type 1 or type 2 lumbar segment dysfxns produce pain?

A

type 2 SD

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22
Q

do unilateral sacral flexions or extensions more commonly cause pain?

A

unilateral sacral flexions (downward sacral shears)

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23
Q

what is pelvic tilt syndrome? significance?

A

short leg (causes pain)

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24
Q

when L5 & sacrum rotate in the ____direction, it will produce pain

A

same

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25
Q

how do you know when you have successfully tx’d someone’s LBP?

A

The patient has been in CCP for two visits in a row and you have treated them for it.

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26
Q

in terms of what type of sacral dysfxns are most likely to cause LBP, what is the order?

A

backwards sacral torsions > unilateral sacral flexions > inominant upslips > forward sacral torsion

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27
Q

what is a 4/4 reflex grade?

A

hyperreflexia with sustained clonus

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28
Q

main root for quadriceps femoris reflex

A

L4 (patellar reflex)

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29
Q

main root for achilles/triceps surae reflex

A

S1

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30
Q

positive babinski?

A

extensor plantar response

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31
Q

what muscle strength: full range of motion (ROM) and full strength (normal)

A

5/5

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32
Q

what muscle strength: full ROM but with less than normal strength

A

4/5

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33
Q

what muscle strength: full ROM against gravity only (tested vertically and is overcome with ONLY one finger)

A

3/5

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34
Q

what muscle strength: 2/5: full ROM with gravity eliminated (usually tested horizontally)

A

2/5

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35
Q

what muscle strength: no joint motion, but a slight muscle contraction can be palpated or observed

A

1/5

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36
Q

what muscle strength: NO joint motion and no palpable or visualized muscle contraction

A

0/5

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37
Q

ankle plantarflexion?

A

motor level S1

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38
Q

CNS lesion associated with spastic or flaccid paralysis?

A

spastic paralysis

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39
Q

CNS lesion or PNS lesion assc’d with hyperreflexia?

A

CNS

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40
Q

CNS lesion or PNS lesion assc’d with hyporeflexia

A

PNS

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41
Q

CNS lesion or PNS lesion assc’d with significant denervation atrophy?

A

PNS

42
Q

CNS lesion or PNS lesion assc’d with clonus, babinski, hoffmans’ positive tests?

A

CNS

43
Q

CNS lesion or PNS lesion assc’d with fasciculations?

A

PNS

44
Q

CCP: C2 is rotate and sidebent _______

A

left

45
Q

CCP: The head side-bends ____

A

right

46
Q

CCP: T1 rotates and side-bends_________

A

right

47
Q

CCP: ______infraclavicular area is concave and easily compressible

A

right

48
Q

CCP: T2-6 are neutral side-bent ____ and rotated _____.

A

T2-6 are neutral side-bent left and rotated right.

49
Q

CCP: The lower thoracic area shifts ____ better than ____.

A

The lower thoracic area shifts left better than right

50
Q

CCP: The pelvis rolls ___ better than _____

A

The pelvis rolls right better than left

51
Q

CCP: The _____ iliac crest is more cephalad in the vertical plane.

A

left

52
Q

CCP: The pelvis torsions ____

A

The pelvis torsions left (Posterior Left/Anterior Right).

53
Q

CCP: The sacrum torsions ___

A

The sacrum torsions left (Left-on-Left).

54
Q

CCP: ______ arm is short

A

left

55
Q

CCP: The left leg is ____/right is ______.

A

The left leg is long/right is externally rotated.

56
Q

significant sacral SD (2)

A
  1. backward sacral torsion

2. unilateral sacral flexions

57
Q

type 1 SD is maintained by dysfxnal _______muscles

A

long restrictor

58
Q

TP in CCP: lev scap/upper trap

A

right

59
Q

TP in CCP: lat dors/lower trap

A

left

60
Q

TP in CCP: psoas

A

left

61
Q

TP in CCP: hammies

A

right

62
Q

LBP referred pain from visceral disease (4)

A
  1. PID
  2. prostatis
  3. dissecting AAA
  4. renal calculus
63
Q

LBP related to activity (4)

A
  1. facet joint pain
  2. discogenic pain
  3. stenotic
  4. arthritic
64
Q

is sciatica a dx?

A

No, it is decriptive; need to find out underlying dx

65
Q

causes of sciatica (5)

A
  1. radiculopathy
  2. sciatic nerve neuropathy
  3. peroneal neuropathy
  4. myofascial trigger point referral
  5. sacroiliac joint ligament referral
66
Q

what is cauda equina syndrome?

A

saddle anesthesia, recent onset of bladder dysfxn, progressive neuro defecit in LE

67
Q

flexion loads _____, stretches____

A

loads anterior elements (vertebral body, discs), stretches posterior elements

68
Q

extension loads _____, stretches _____

A

loads posterior elements (facets, pars interarticularis), stretches anterior elements

69
Q

sidebending closes _____

A

neuroforaminal canal, opesn the facets on the other side

70
Q

what capsular pattern is favored in lumbar spine

A

no direction is favored over another

71
Q

straight leg raise tests? what nerve root levels?

A

sciatic nerve root irritation, dural tension from L4, L5, S1

72
Q

bragard’s test

A

use post straight leg test

73
Q

what type of sign is the straight leg raise?

A

dural tension sign (pulling sciatic nerve roots from the leg to the spine)

74
Q

where might paresthesias occur during femoral nerve stretch?

A

anterior medial thigh (L2/L3), medial leg (L4)

75
Q

what is another dural tension test for the femoral nerve root?

A

passive knee flexion

76
Q

what to assess when examining neck movement (4)

A
  1. restriction in ROM
  2. weakness
  3. pain associated w/ movement
  4. location of pain
77
Q

how to tx painful capsular pattern of restrictive ROM of neck?

A

OMM is contraindicated until dx is given

78
Q

normal joint capsule will have what sort of end feel?

A

elastic

79
Q

where extra-articular soft tissues engage against each other

A

tissue approximation

80
Q

what is the contractile tissue pattern during restricted ROM?

A

pain on active & passive stretching direction + on isometric testing in opposite direction

81
Q

what does contractile tissue pattern indicate?

A

musculotendinous lesion

82
Q

when is spurlings test positive?

A

when radicular pain is reproduced

83
Q

when is distraction manuever positive?

A

when decr in radicular pain

84
Q

what does TART stand for?

A
  1. tissue texture changes
  2. asymmetry
  3. altered ROM
  4. tenderness
85
Q

imaging of acute LBP recommended when?

A

only initially in 4-6 weeks with FINS (fracture, infection, neoplasm, severe neuro deficits)

86
Q

when to refer to a physician spine specialist?

A
  1. disc diisease (HNP w/ radiculopathy)
  2. facet disease
  3. referred pain
87
Q

when to refer to neurosurg?

A
  1. cauda equina syndrome
  2. spinal cord compression
  3. progressive neurodeficit
88
Q

what is wolff’s law?

A

mechanical strain/pressure stimulates fibroblasts to produce collagen organized along the same stress lines as the direction of force

89
Q

MFR utilizes which neurons?

A

gamma motor neurons

90
Q

strain causes an incr in _____excitatory input

A

afferent

91
Q

take the tissue where it wants to go & hold for a release - direct or indirect?

A

indirect release

92
Q

FPR is enhanced by placing region in ______, and adding_____

A

enhanced by placing region in a neutral position, and adding a facilitating force

93
Q

is the still technique an indirect or direct technique?

A

go indirect 1st, then take the tissue direct

94
Q

what does still technique work very well for?

A

joint restrictions being held by fascial strains

95
Q

wat are the fxns of the lymphatics? (4)

A

nutrition, maintaining fluid balance, purification/cleansing of tissues, defense

96
Q

how much fluid leaks out of the capillaries per day?

A

30 liters, 90% drains back into them

97
Q

how much fluid drains into lymphatics/

A

10%

98
Q

when tissue is compressed, prssure inside the capillary _____ and the overlapping edges of the endothelial cells _____

A

increases, closes like valves

99
Q

what allows diaphragms to move together in unison (3)

A
  1. neuro control
  2. fascial attachments
  3. pressure differentials generated by the thoraco-abdominal diaphragm
100
Q

what is the flow rate of lymph back to the heart directly proportional to (2)

A
  1. rate of respiration

2. quality of respiration

101
Q

what is the heart of the lymphatic system?

A

the thoracoabdominal diaphragm

OMM (8 decks)

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