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OMM BLOCK 1 fall23 > Fall 23 Block 1 Exam > Flashcards

Fall 23 Block 1 Exam Flashcards

1
Q

Muscle Energy (ME) definition

A

Direct (Active)- Pt muscles employed upon request, from a precise controlled position, in a specific direction, against doctor’s counterforce.
-golgi tendon: prevents excessive muscle tension by monitoring muscle force, within muscle tendons, responds to changes in force, NOT length, inhibits alpha motor neurons
-muscle spindle (intrafusal) protects muscle fiber from tearing. - innervated by gamma motor neuron.
Sensory information from the muscle spindle allows one to judge the position of the muscle (proprioception) and the rate at which it is changing position

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2
Q

Muscle Energy (ME) PEARLS

A

Decrease patient comfort
-treats acute or chronic
-pt should NOT experience pain

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3
Q

Muscle Energy (ME) Indications/Contraindications

A

Indications: relevant somatic dysfunction

Contraindication: cervical instability, RA, sever osteoporosis

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4
Q

Myofascial Release (MFR) definition

A

DIrect or Indirect (Active or Passive)
-engages in 3 direction: traction (up/down); compression (left/right); rotation (clockwise/counterclockwise)

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5
Q

Myofascial Release (MFR) PEARLS

A

-direct: uniquely chronic somatic dysfunction w/fibrotic changes and acute
-indirect: acute, feel unwinding, breathing, feel release

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6
Q

Myofascial Release (MFR) Indications/contraindications

A

Indications: somatic dysfunction, myofascial tissues and connective tissues

Contraindications: fracture, open wounds, soft tissue infections, DVT, anticoag, aortic aneurysm, fluids

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7
Q

Lympathic technique definitions

A

Direct or Indirect (passive)- starts centrally and moves peripherally: addresses thoracic inlet; maximize normal diaphragmatic motions. Designed to remove impediments to lymph circulation, and promote and augment the flow of interstitial fluid and lymph.

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8
Q

Lymphatic technique PEARLS

A

-Immune functions facilitation
-transport fats to the blood from digestive processes
-clear/circulate lymph

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9
Q

Lymphatic technique Indications/contraindications

A

Indications: Edema, infection, inflammation, tissue congestion, lymphatic stasis

Contraindications: anuresis, necrotizing fasciitis, CHF, COPD, acute asthma, pregnancy, acute chronic bacterial infection

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10
Q

cranial technique definition

A

Direct, Indirect, or Combined (passive)
Five phenomena:
-inherent rhythmic motion of brain and SC; fluctuation of CSF, mobility of intracranial & intraspinal membranes, articular mobility of cranial bones, and involuntary mobility of sacrum between ilia
- primary respiratory mechanism (PRM)
- balanced membranous and ligamentous tension (BMT and BLT)
-Many tx are indirect & take place in the “vault hold”

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11
Q

cranial technique PEARLS

A

direct: pediatric patients respond most effectively to DIRECT cranial tx
- don’t have to physically be on the head
- doctor as fulcrum

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12
Q

Cranial technique Indications/contraindications

A

Indications: cranial neuropathy, colic, headache, orofacial pain, ear infection, sinusitis, TMJ, vertigo, feeding difficulties, tinnitus
TBI (NOT acute)

Contraindications: - absolute: acute bleeding, stroke, acute TBI
- relative: coagulopathies, space occupying lesion in cranium, increased cranial pressure

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13
Q

Still techniques definition

A

Indirect –> direct (passive)
- first indirect, axial force added and maintained while carrying region past neutral toward/though restrictive barrier
- begins in position of ease; adds activating force (compression or traction targeting the vector to segment being treated
-passively move patient via a smooth arc through restrictive barrier

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14
Q

Still technique PEARLS

A
  • most segmental/joint somatic dysfunction
  • fast, painless
  • can be more than once
  • pediatric/language barrier bc no need for pt to follow directions, must be able to relax
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15
Q

Still technique indications/contraindications

A

Indications- articular somatic dysfunctions associated with intersegmental motion restriction
JOINT dysfunction but nothing major

Contraindications: bone and joint disorders, mild to moderate joint instability. Areas of strain or sprain. Spinal stenosis, RA

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16
Q

articulatory technique definition

A

Direct (passive)
- increases restricted joint by repeatedly engaging restricted barrier, low velocity, high amplitude (LVHA)
- force is smooth and rhythmical
- restrictive barrier shifts, reengage barrier

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17
Q

articulatory technique PEARLS

A
  • designed to stretch muscles, ligaments, capsules
  • decrease tissue tension; normalize resting tone
  • enhances lymphatic flow and circulation
  • useful in transitional zones and extremities
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18
Q

articulatory techniques Indications/Contraindications

A

Indications: lost articular motion

Contraindications: repeated rotation can damage vertebral artery
- acute inflamed joint, concern for infection or fracture

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19
Q

soft tissue technique definition

A

Direct (passive)
4 basic soft tissue mechanisms
- traction: longitudinal spread
- linear stretching: kneading parallel spread
- lateral stretching: kneading bow-stringing; perpendicular
- deep pressure: inhibitory

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20
Q

soft tissue technique PEARLS

A
  • used as ADJUNCT (reduce for pain, relaxation, restricted motion)
  • decreases O2 demand of muscle
  • increase venous and lymphatic drainage
  • stimulatory effect on stretch reflex in hypotonic muscles
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21
Q

soft tissue technique Indications/Contraindications

A

Indications: - soft tissue characterized by TART changes

Contraindications: - fracture, open wounds, DVT, abscesses, coagulation, neoplasm

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22
Q

high velocity low amplitude (HVLA) definition

A

Direct (passive) - rapid, force, brief duration, short distance

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23
Q

high velocity low amplitude (HVLA) PEARLS

A

NEED CORRECT DX
- restrictive barrier must feel solid but moveable
- engage barrier (take up slack) DONT BACK AWAY, hit it
- final activating force is a sudden gentle increase of force, small distance, DON’T substitute more force for poor localization, don’t hold past barrier

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24
Q

high velocity low amplitude (HVLA) Indications/Contraindications

A

Indications: articular somatic dysfunction
- hypermobile joint

Contraindications: pt does not give consent
- advanced RA
- Down Syndrome
- dwarfism
- acute herniated disc
- genetic/hereditary disorder

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25
Q

strain-counterstrain definition

A

Indirect (passive) finding “tender point”; pt in position of ease, hold for 90sec and return to neutral
- counterstrain points aka tender points, found at consistent anatomical locations (anterior and posterior)
- PL5: strain-counterstrain posterior TP

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26
Q

strain-counterstrain PEARLS

A

-most painful tender point FIRST, if points in a row treat middle first
- dose appropriately to avoid over-treatment reactions
- good for muscle spasms with an inappropriately high set point (resets gamma gain to new lower level
- elderly, hospitalized pts

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27
Q

strain-counterstrain Indications/Contraindications

A

Indications: - acute/chronic somatic dysfunctions w/ counterstrain point

Contraindications: - fracture, ligamentous tear, cardiac, DVT, down syndrome, pregnancy, rheumatoid arthritis,

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28
Q

facilitated position release (FPR) definition

A

Indirect (passive)
- myofascial, neutral position, speedy strain-counterstrain, looks like Still
- monitored continuously

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29
Q

facilitated position release (FPR) PEARLS

A
  • shorter ROM than Still
  • quick
  • can be repeated, easily incorporated
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30
Q

facilitated position release (FPR)
Indications/Contraindications

A

Indications: - bone and joint
- myofascial and articular

Contraindications: - symptoms brought by treatment position, joint instability

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31
Q

Balanced Ligamentous Tension (BLT)/Ligamentous Articular Strain definition

A

Indirect (passive) - LAS = pathology
- BLT = treatment position
- DEB:
1. Disengage (compress/decompress)
2. Exaggerate (toward original position of injury)
3. Balance (maintain position of injury until release occurs)”

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32
Q

Balanced Ligamentous Tension (BLT)/Ligamentous Articular Strain PEARLS

A
  • BLT: light touch, use more respiratory cooperation (1-3lbs of force)
  • LAS: more force, less respiratory (40lbs of force)
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33
Q

Balanced Ligamentous Tension (BLT)/Ligamentous Articular Strain Indications/Contraindications

A

Indications: - ligamentous, articular strains, muscle, fascia

Contraindications: - recent surgeries

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34
Q

TART

A

diagnosis of somatic dysfunction usually requires at least 2 TART changes

-Tissue texture change (acute: bogginess, ropey, edematous, chronic: firm)
-Asymmetry (right vs. left generally)
-Restriction of motion (best to document specifically in degrees of available motion to access improvement after tx!
-Tenderness (the only patient-determined TART change)

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35
Q

Fascia definition

A

one continuous sheet of connective tissue
-has its own blood supply, fluid drainage, innervation
-If it’s own organ system, largest of them all

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36
Q

Red Reflex

A

assessment of segment-specific vasomotor changes “redness”
-occurs due to spinal facilitation at each given segment affecting the autonomic nervous system (ANS)

-Prolonged Red Reflex- ACUTE
-Rapidly fading Red Reflex- CHRONIC

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37
Q

Hypotension

A

Low blood pressure
less than 90/60

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38
Q

Hypertensive Crisis

A

> 180/120 mmHg BP reading in a patient that is asymptomatic w/o evidence of end organ damage
180/120 mmHg w/acute impairment of one or more organs

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39
Q

High Blood Pressure Stage 1

A

130-139/80-89

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40
Q

High Blood Pressure Stage 2

A

140 or higher/ 90 or higher

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41
Q

Oxygen saturation range

A

Normal 95-97% to 100%
Less than 90% is abnormal (hypoxemia)

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42
Q

Calculating BMI

A

Weight (lbs) x 703/height (in) squared
or
weight (kg)/height (m) squared

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43
Q

Temperature ranges

A

Average: 98.6 F or 37 C
Fever (febrile) temp > 100.4 F
Hypothermia <95 F

44
Q

Respiration rates

A

Normal rate 12-20 breaths/min

45
Q

Heart rate ranges

A

Normal 60-100 bpm
Tachycardic (high) >100 bpm
Bradycardic (low) <60 bpm

46
Q

The 4 diagnostic techniques

A

-Inspection -gather information from observation (vision, hearing, smell, overall general impression)
-Palpation- exam with hands
-Percussion- to determine density or size of a tissue/organ/mass/fluid
-Auscultation- listen to sound made by various body structures and functions

47
Q

General Assessment descriptors

A

-apparent state of health
-level of consciousness
-Signs of distress
-skin color and obvious lesions
-Dress, grooming, and personal hygiene
-facial expression
-odors of body and breath
-posture, gait, and motor activity

48
Q

nail clubbing

A

rounded, bulbous nail base. Feels spongy

-Causes: chronic hypoxia
congenital heart disease, lung cancer

Schamroth Window Test

49
Q

nail- Beau Lines

A

transverse depressions secondary to trauma or systemic illness
-Lines grow out with nail
-1mm every 6-10 days

50
Q

Nail- paronychia

A

Acute or chronic inflammation of the proximal & lateral nail folds. Nail folds are swollen, reddened, and tender

Causes: frequent immersion in water, nail biting

51
Q

Nail- Onychocryptosis

A

Ingrown toenail- usually involving the large toe. Nail grows into the dermis

Causes: improperly cutting nails, tight shoes

52
Q

Nail- Terry’s nails

A

Mostly white with a distal band of reddish brown

Causes: Aging, chronic disease such as cirrhosis

53
Q

Nails- Leukonychia

A

Trauma to nails causing areas of white discoloration

Causes: Trauma, repeated manicuring

54
Q

Nails- Onycholysis

A

Painless separation of the nail plate from the nail bed

Causes: Most common-trauma to long fingernails
Other- psoriasis

55
Q

Nails- Onychomycosis

A

Fungal infection of nail bed, plate or matrix

Causes: Occlusive footwear, locker room exposure

56
Q

Nail pitting

A

seen in autoimmune diseases like psoriasis, alopecia areata

57
Q

Hair loss- Trichotillomania

A

hair loss from pulling, plucking, twisting hair
-hair shaft broken and varying lengths
-more common in children, psychosocial stress

58
Q

Hair loss- Tinea Capitis

A

Round scaling patches
-hair broken off close to surface of scalp
-lymphadenopathy, itching
-caused by fungal infection

59
Q

Hair loss- Alopecia Areata

A

-Autoimmune
-Smooth, no broken hairs

60
Q

Hair types- Lanugo

A

soft, fine
covers fetus; usually sheds prior to birth (36wks)

61
Q

Hair types- Vellus

A

Fine, short, relatively unpigmented adult hair on face, trunk, limbs
-growth not affected by hormones

62
Q

Hair types- Terminal

A

Thick, usually pigmented adult hair found on scalp, beard, axillae, pubic areas, eyebrows/lashes
-growth influenced by hormones

63
Q

Appendages of skin

A

Hair, Nails, Sebaceous gland (oil), Sweat glands (eccrine and apocrine)

64
Q

ABCs of malignant melanoma

A

A- asymmetry
B- borders
C- color
D- diameter >6mm
E- evolution
F- “funny looking”

65
Q

Acral Lentiginous Melanoma

A

<5% of all melanomas
BUT, most COMMON type in darker-skinned individuals
-Plantar is most common, also palmar & subungual (under nail)

66
Q

Basal Cell

A

80% if all skin cancers
slow growing, almost never metastasize
-classic pearly papules + telangectasias; sometimes rolled borders

67
Q

Squamous cell

A

16% of skin cancers
-crusted hyperkeratotic; inflammed or ulcerated
-rare metastasis

68
Q

layers of skin

A

Epidermis, dermis, subcutis

69
Q

Four major layers of epidermis (bottom-up)

A

Basal layer- source of epidurmal stem cells. Cell division occurs here. Keratinocytes start here and move upwards

Spinous layer- center of epidermis, spiny appearance, “spines” desmosomes that hold the keratinoncytes together

Granular layer- Lipids produced by the keratinocytes and secreted into the extracellular space between the keratinocytes; form “glue” that keeps cells together & water barrier that keeps water in the skin

Stratum Corneum- made up of desquamating keratinocytes. Thick outer laters flattened keratinized non-nucleated cells provide barrier against trauma & infection

70
Q

Bullous pemphigoid

A

autoimmune blistering disease (older patients)
-Autoantibodies form to hemidesmosomes that attach to basal layer (BM). Epidermis separates from the dermis.

71
Q

Psoriasis

A

The rate of optimal turnover is increased & keratinocytes over-proliferate (thickening)
-Doesn’t allow enough time to differentiate and causes a scale

72
Q

Filaggrin

A

A protein later in granular layer
-helps retain water & keep a barrier
-Mutations in filaggrin cause atopic dermatitis (eczema)

73
Q

Describe how skin as a barrier fits Osteopathic tenets?

A

Tenet #3 structure and function are interrelated
-The major function of skin is to act as a barrier so if its disrupted it can lead to systemic issues and possible death

74
Q

Skin serves three purposes

A

Barrier, Immunologic, Temperature regulation

75
Q

Functions of skin

A

Sensory, UV Protection, Injury repair, Vit D production, Affects with appearance & quality of life

76
Q

Physical exam of skin lesions/rashes

A

Color
Symmetry
Distribution (flexor creases)
Arrangement (groups of 3; scattered)
Shape

77
Q

On Inspection, when considering COLOR, think about these 4 pigments

A

1- Carotene (yellow, in subQ & in palms/soles, precursor to Vit A)

2- Bilirubin- (yellow-brown, from breakdown of heme in RBCs)

3- Melanin (produced my melanocytes, amount is genetically determined, but also increased by sun exposure, High melanin = >photoprotection but also >post-inflammatory hyperpigmentation

4- Oxyhemoglobin- (bright red passes through capillaries; releases O2 to tissues)
increased blood flow in capillaries = blushing
decreased blood flow to capillaries = pallor

5- deoxyhemoglobin - oxyhemoglobin loses O2 passing through capillaries; changes to deoxyhemoglobin
Increased levels = cyanosis

78
Q

Melasma

A

increased pigmentation

79
Q

Vitiligo

A

Absence of pigmentation

80
Q

Central cyanosis

A

-patients have reduced arterial O2 sats (<85%)
-consistent with cardiac or pulmonary disease
-both skin and mucous membrane involvement

81
Q

Peripheral cyanosis

A

Seen with cold exposure or anxiety & can also be seen with heart disease
-Blood flow in peripheral skin is low and tissues extract more O2 than usual
-No mucous membrane involvement

82
Q

Four tenets of Osteopathic Medicine

A
  1. The body is a unit: the person is a unit of body, mind, and spirit
  2. The body is capable of self-regulation, self-healing, and health maintenance
  3. Structure and function are reciprocally interrelated
  4. Rational medical treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function
83
Q

Anatomic barrier

A

normal end range of motion limited by bones, ligaments, and tendons.
Passively tested- doctor can assist getting to the end range

84
Q

Physiological barrier

A

limit of end range of motion produced by the patient.
Actively tested

85
Q

Restrictive/Pathological Barrier

A

Abnormal limited motion within the physiological range that is altered by somatic dysfunction

86
Q

Direct technique

A

OMT in which the restrictive barrier is engaged, and a final activating force is applied to correct somatic dysfunction
Move INTO or THROUGH the restrictive barrier

87
Q

Indirect Technique

A

OMT in which the restrictive barrier is disengaged, and the dysfunctional body part is moved away from the restrictive barrier.
Move AWAY from the restrictive barrier

88
Q

Active treatment

A

The patient assists during treatment

89
Q

Passive treatment

A

The patient relaxes during the treatment

90
Q

Palpating Forearm

A

1- 1st layer of skin, is it warm or cool?
2- 2nd layer- subcutaneous layer
3- underlying musculature (nails blanching)
4- course forearm distally until you feel tissue change and reach musculotendinous junction
5-feel for radial and ulnar styloid, and scaphoid

91
Q

Transverse carpal ligament

A

tendon that runs transverse to the tendons and binds tendons at the wrist

92
Q

Fryette’s Principle I

A

The thoracic and lumbar are in NEUTRAL
-coupled motions of side bending and rotation for a GROUP of vertebrae occur in OPPOSITE directions
TYPE I SOMATIC DYSFUNCTION

93
Q

Fryette’s Principle II

A

The thoracic and lumbar are sufficiently forward or backward bent (non-neutral)
-Coupled motions of side bending and rotation of a SINGLE vertebra unit occur in the SAME direction,

TYPE II SOMATIC DYSFUNCTION

94
Q

Fryette’s Principle IIl

A

Initiating motion of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion

-if motion is restricted in one direction such as rotation, it will also be restricted in side bending and flexion/extension

-if motion is improved (treated) in one direction, the other directions will improve as well

95
Q

How to name segmental dysfunctions

A

-location of dysfunction
-3 planes of motion
-named for what IT CAN DO or LIKES TO DO
-freer motion
-position of ease

96
Q

Naming Type I dysfunction

A

Neutral “group” curve
Side bending comes before rotation
Example:
T7-T12 NSLRR

Diffuse pain
Curves of spine - lateral

“GINO SR”

97
Q

Naming Type II dysfunction

A

Single segment in non-neutral position (Flexed or Extended)
Side bending comes after rotation

Curves of spine - A/P
Local pain

98
Q

Fryette’s Law of Motion EXCEPTIONS

A

Occiput: occiput (C0) on atlas (C1)
-Primary motion- flexion /Extension
“YES” joint
-minor motions- side bending and rotation- occur in opposite directions
-like Type-I mechanics

Atlas: Atlas (C1) on axis (C2)
primary motion- rotation
“NO” joint

Sacrum: sacrum with respect to ilia
-rotation & side bending in opposite directions

99
Q

Naming Cervical Motion

A

C0-C1 (O/A)- side bending and rotation occur in opposite directions in non-neutral position
C0FSrRl

C1-C2 (A/A): Pure rotation
C1Rr

C2-C7: follow Type II motion

100
Q

Muscle Contraction- Isotonic Contractions

A

Tension is constant throughout the contraction
-counterforce is less than the patient’s force
2 types of isotonic contractions:
- concentric and eccentric

101
Q

Muscle Contractions - Concentric

A

type of isotonic contraction
-movement in the direction of the muscle contraction
-approx of muscle’s origin and insertion
-bringing barbell towards shoulders during bicep curl

102
Q

Muscle Contractions - Eccentric

A

type of isotonic contraction
-Lengthening of a muscle during a contraction due to an external force.
-bringing the barbell away from the shoulder back towards the starting point with the biceps muscle still contracting but lengthening

103
Q

Muscle Contractions - Eccentric Isolytic

A

Muscle contraction that occurs when an outside force completely breaks/overpowers the muscle’s contraction force.
- counterforce is greater than patient’s force

104
Q

Muscle Contractions - Isometric

A

Change in muscle tension without approximation of muscle origin and insertion
-no change in muscle length
-Counterforce is EQUAL to patient’s force
-used in many OMT tx

105
Q
A

OMM BLOCK 1 fall23 (1 decks)

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