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OS1 Final Exam > Final Material > Flashcards

Final Material Flashcards

1
Q

What is a vertebral unit?

A

2 adjacent vertebrae and the associated intervertebral disc

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2
Q

Describe the rule of 3 for T1-T3

A

spinous process is located at the level of the corresponding transverse process

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3
Q

Describe the rule of 3 for T4-T6

A

spinous process is located 1/2 segment below the corresponding transverse process

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4
Q

Describe the rule of 3 for T7-T9

A

spinous process is located at the level of the transverse process of the vertebrae below

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5
Q

Where do T10-T12 fit into the rule of 3

A

T10 is the same as T7-9
T11 is the same as T4-6
T12 is the same as T1-3

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6
Q

Describe cervical superior facet orientation

A

BUM -> backwards, upwards, and medial

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7
Q

Describe thoracic superior facet orientation

A

BUL -> backwards, upwards, and lateral

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8
Q

Describe lumbar superior facet orientation

A

BM -> backward and medial

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9
Q

Describe Fryette Principle: Type One Mechanics

A

SD is in neutral (not flexion or extension); sidebending and rotation are coupled in opposite directions; tends to be a group of vertebrae

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10
Q

TONGO

A

Type One Neutral Group Opposite

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11
Q

Describe Fryette Principle: Type Two Mechanics

A

SD is non-neutral (it’s either in flexion or extension); side bending and rotation are coupled in the same direction; tends to be a single vertebrae

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12
Q

TT(NN)SS

A

Type Two (Non-Neutral) Single Same

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13
Q

Describe Fryette: Third Principle

A

initiating movement of a vertebral segment in any plan of motion will modify the movement of that segment in other planes of motion; if movement is restricted in one direction, it will be restricted in other directions

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14
Q

For what parts of the spine does Fryette’s first 2 principles work for?

A

thoracic and lumbar spine only

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15
Q

Which part of the spine is located at the spine of the scapula?

A

T3 spinous process and transverse process

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16
Q

Which part of the spine is located at the inferior angle of the scapula?

A

T7 spinous process

T8 transverse process

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17
Q

Which part of the spine is located at the iliac crest?

A

L4 vertebrae

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18
Q

How is scoliosis named?

A

towards the convexity; levo = left; dextro = right

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19
Q

What will you see of PE of someone w/ scoliosis?

A

asymmetry at the waist and shoulder; possible rib cage prominence; leg length discrepancies; Cobb Angle

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20
Q

How do you manage scoliosis?

A

based on Cobb angle
<25 degrees: conservative: monitor w/ radiographs
25-45 degrees: non-operative: bracing
> 45 degrees: surgical fusion

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21
Q

What is seen w/ radiculopathy? How would you work it up?

A

pain w/ dermatomal distribution, LE weakness/diminished reflexes
Positive straight leg test and perform an MRI

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22
Q

What is considered a positive straight leg test? What does it indicate?

A

raise leg w/ knee extended; pain from 15-30 degrees -> lumbar disc etiology

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23
Q

What is seen w/ spinal stenosis? How would you work it up?

A

bilateral LE pain, LE weakness, diminished reflexes

Positive straight leg raise and perform an MRI

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24
Q

What is seen w/ caudal equine syndrome? How would you work it up?

A

emergency (usually traumatic) -> LE weakness, saddle anesthesia, urinary retention
Perform an MRI

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25
Q

Sympathetic influence of head and neck

A

T1-T4

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26
Q

Sympathetic influence of heart

A

T1-T5

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27
Q

Sympathetic influence of lungs

A

T2-T7

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28
Q

Sympathetic influence of esophagus and UEs

A

T2-T8

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29
Q

Sympathetic influence of bladder

A

T11-L2

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30
Q

Sympathetic influence of upper GU (kidney)

Sympathetic influence of lower GU

A 
upper GU (kidney to upper 1/3 of ureter) -> T10-T11
lower GU (lower 2/3 of ureter to urethra -> T12-L2
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31
Q

Sympathetic influence of upper GI
Sympathetic influence of middle GI
Sympathetic influence of lower GI

A 
upper GI (mouth to ligament of treitz) ->T5-T9
middle GI (L. of Treitz to ileocecal valve) -> T10-T11
lower GI (ileocecal  valve to anus)-> T12-L2
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32
Q

Sympathetic influence of uterus/cervix

A

T10-L2

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33
Q

Sympathetic influence of LE, urethra, and erectile tissue

A

T11-L2

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34
Q

Sympathetic influence of Prostate

A

T12-L2

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35
Q

Which parts of the spine have kyphosis?

Which parts have lordosis?

A 
kyphosis = thoracic and sacral
lordosis = cervical and lumbar
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36
Q

Flexion/Extension is in which plane? Axis?

A

Sagittal plane;

horizontal (left to right) axis

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37
Q

Sidebending is in which plane? Axis?

A

Coronal (frontal) plane; anterior-posterior axis

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38
Q

Rotation is in which plane? Axis?

A

Transverse (horizontal) plane; superior-inferior axis

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39
Q

On PE you determine a pt’s 7-9th thoracic vertebra are rotated right and sideband left; no change in flexion or extension. How would you document SD?

A

T7-9 N RrSl

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40
Q

What actions do the rotatores perform? What type of mechanics are they connected to?

A

Bilateral: extends T spine
Unilateral: rotates T spine to opposite side
Type 2 mechanics -> single segment

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41
Q

What actions do the multifidus M. perform? What type of mechanics are they connected to?

A

Bilateral: extends spine
Unilateral: flexes spine to same side; rotates to opposite side
Type 1 mechanics -> multiple segments

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42
Q

What actions do the semispinalis perform? What type of mechanics are they connected to?

A

Bilateral: extends T and C spine and head
Unilateral: bends head and rotates to opposite side
Type 1 mechanics -> multiple segments

43
Q

Which organs receive parasympathetic innervation from the pelvic splanchnic nerves?

A

bladder, lower GI, lower GU, uterus and cervix, LE, urethra, erectile tissue and prostate

44
Q

What are all other levels not innervated by pelvic splanchnic N. innervated by for parasympathetics?

A

Vagus N.

45
Q

Where do nerves exit cervical vertebrae?

A

ABOVE the vertebral body

46
Q

What is the OA joint?

What is the AA joint?

A

OA - atlanto-occipital joint

AA - atlanto-axial joint

47
Q

What is the primary motion of the AA joint? What does the joint not do?

A

primary motion is rotation; almost no sidebending or flexion/extension

48
Q

How are rotation and sidebending related in C2-C7? Which is most common in C2-C7 -> flexion/extension/neutral?

A

usually occur in same direction; type II like; flexion/extension most common

49
Q

Contraindications for soft tissue in cervical region

A

fractures, open wounds, surgical site, infection, DVT, coagulopathy, neoplasm

50
Q

Indications for soft tissue in cervical region

A

cervical SD w/ significant soft tissue component

51
Q

Indications for HVLA and ART in cervical region

A

SD with ROM restriction most likely attributed to SD in cervical facet joint, AA joint, or OA joint (hard, firm end-feel)

52
Q

Contraindications for HVLA and ART in cervical region

A

advanced RA, down’s syndrome, carotid artery disease, malignancy, radiculopathy, dwarfism

53
Q

Indications for MET or Still’s technique in cervical region

A

cervical SD

54
Q

Contraindications for MET or Still’s technique in cervical region

A

undiagnosed joint swelling, severe osteoporosis, neoplasm, infection, hematoma, RA, fracture, dislocation

55
Q

From what embryological structure does lymphatic vessels, lymph nodes, and spleen develop?

A

mesoderm

56
Q

From what embryological structure does the thymus and part of the tonsils develop?

A

endoderm

57
Q

Which parts of the lymphatic system are pressure sensitive? What does this mean?

A

Spleen and liver; movement of the diaphragm drives splenic and hepatic fluid movement

58
Q

Which organ creates half the body’s lymph?

A

liver

59
Q

Which lymphatic organs have little/no function in adults?

A

Thymus, Tonsils, and Appendix

60
Q

35-60% of the drainage through the thoracic duct is associated w/ what?

A

respiration

61
Q

Describe the histology of lymph channels

A

blind endothelial tubes composed of a single layer of leaky squamous epithelium

62
Q

Describe lymphangions

A

chain of muscular units that posses bicuspid valves; contract regularly throughout lymphatic system moving lymph in a peristaltic wave

63
Q

What are 7 factors to consider when evaluating lymph nodes?

A

size, shape, consistency, tenderness, mobility, color, warmth

64
Q

Describe Virchow’s node

A

left supra-clavicular node -> usually relates to intra-thoracic/ABD cancer

65
Q

What are epitrochlear nodes related to?

A

secondary syphilis

66
Q

What is the name of the origin of the thoracic duct? Where is it located?

A

cisterna chyli which is a dilation at L1-2

67
Q

Describe the termination of the thoracic duct

A

Pierces Sibson’s fascia at superior inlet, U turns to empty into L subclavian/internal jugular veins

68
Q

From where in the body does the thoracic duct drain?

A

left head/neck, left UE, left thorax/ABD, and everything inferior to the umbilicus

69
Q

From where in the body does the right lymphatic duct drain?

A

right head/neck, right UE, right thorax, heart, lungs (except LUL)

70
Q

Name the 4 functions of lymphatics

A

maintain fluid balance, tissue cleaning/purification, defense, nutrition

71
Q

Describe normal pressure of interstitial fluid. What happens if it goes wrong?

A

normal pressure is -6.3 mmHg (negative pressure system); if pressure is greater than/equal to 0, lymph capillaries collapse and flow ceases

72
Q

What role does the diaphragm play in mechanisms of lymphatic flow?

A

with each breath, contraction increases negative intrathoracic pressure and pulls fluid centrally; also exerts direct pressure on cisterna chyli which pushes fluid up

73
Q

What role does the pelvic diaphragm play in mechanisms of lymphatic flow? What may cause it to be dysfunctional?

A

helps move fluid from LE and pelvis to thoracic duct; may be dysfunctional in dysmenorrhea, endometriosis, post labor/delivery, BPH, etc.

74
Q

How does the sympathetic nervous system affect lymph valves?

A

increased sympathetics -> tighter valves -> decreased lymph flow into venous system

75
Q

How does the sympathetic nervous system affect lymphatic smooth muscle?

A

increased sympathetics -> decreased peristalsis -> lymphatic congestion

76
Q

What is the main consequence of a poorly functioning lymphatic system?

A

Edema

77
Q

What are some effects of edema?

A

compression of structures (vascular, neuronal, SOB), decreased tissue waste removal, decreased pathogen clearance and immunity, chronic states of fibrosis/contractures

78
Q

What are the indications of lymphatic OMT?

A

edema, tissue congestion, infection, inflammation

79
Q

Absolute contraindications for lymphatic OMT?

A

anuria -> need kidneys functioning to process fluid return
necrotizing fasciitis
pt unable to tolerate treatment
pt refuses treatment

80
Q

What are some relative contraindications for lymphatic OMT?

A

COPD, asthma exacerbation, unstable cardiac conditions, untreated coagulopathies, cancer, chronic infections, diseased organ, pregnancy, circulatory disorders

81
Q

What are the common and uncommon compensatory (zink) patterns?

A

common -> L/R/L/R (80%)

uncommon -> R/L/R/L (20%)

82
Q

What are the transition zones of the spine?

A

OA, C1, C2 -> craniocervical junction
C7, T1 -> cervical thoracic junction
T12, L1 - thoracolumbar junction
L5, Sacrum -> lumbosacral junction

83
Q

What is the sequence of treatment in lymphatics?

A

open pathways to remove restriction to flow -> maximize diaphragmatic functions -> increase pressure differentials -> mobilize targeted tissue fluids

84
Q

What does BLT stand for? What is another name for it?

A

Balanced Ligamentous Tension (BLT); LAS (ligamentous articular strain)

85
Q

What type of technique is BLT and what is the position of all treatments?

A

describes as indirect passive treatment where position of all treatments are done at shifted neutral

86
Q

What are the indications of BLT?

A

SD involving ligamentous articular strains and areas of lymphatic congestion or local edema

87
Q

What are the relative contraindications of BLT?

A

fractures, open wounds, ST or bony infections, abscesses, DVT, anticoagulation, post-operative, or aortic aneurysm

88
Q

Describe changes in ligament tensions?

A

ligaments don’t stretch and contract like muscles so their is very little change in tension; relationship between join’t ligaments will change as the joint changes position but tension will stay balanced throughout the ligament

89
Q

What happens to collagen during immobilization?

A

collagen is overall lost b/c the rate of degradation exceeds the rate of synthesis

90
Q

What are the 3 steps in BLT?

A
  • positioning -> place the segment in an indirect position (shifted neutral)
  • activating force -> have the pt hold their breath to facilitate release
  • reevaluate for motion improvement
91
Q

What does FPR stand for?

A

Facilitated Positional Release

92
Q

What type of treatment is FPR?

A

indirect passive treatment

93
Q

What are the advantages of FPR?

A

easily applied, effective, time efficient, pt satisfaction, thorough (b/c of time efficiency)

94
Q

FPR indications

A

myofascial or articular SD

95
Q

FPR Absolute Contraindications

A

unstable fracture, neurological sxs brought on by treatment position, exacerbation of life-threatening sx by treatment position in a monitored pt

96
Q

FPR relative contraindications

A

tx not tolerated well or significant sx during process, comorbidities that put pt at risk for fx, moderate to severe joint instability, spinal stenosis/root impingement

97
Q

What is the proposed mechanism of FPR?

A

SD maintained by increased gamma motor neurons of muscle in segment; by putting muscle in neutral position, it eliminates afferent excitatory input which unloads the joint and leads to soft tissue

98
Q

What are the 4 steps in FPR?

A
  • setup -> continuous assessment of SD and place pt in neutral position
  • activating force -> compression, torsion, or distraction
  • positioning -> hold 3-5 seconds
  • return to starting position and re-evaluate
99
Q

What type of treatment is Still’s technique?

A

Indirect and direct -> start at shifted neutral and end at anatomic barrier (push through restrictive barrier)

100
Q

Advantages of Still’s technique?

A

same as FPR -> easy, effective, time efficient, pt satisfaction, thorough

101
Q

Indications of Still’s

A

SD in virtually all tissues of the body

102
Q

Contraindications of Still’s

A

not advisable across recent wounds or fractures less than 6 weeks old

103
Q

What are the 5 steps to Still’s technique?

A
  • initial treatment position -> indirect
  • add localizing force (less than or equal to 5lbs compression)
  • move through RB while maintaining force in a smooth path
  • end at the final treatment position -> direct at anatomic barrier
  • return pt to neutral and reassess
104
Q

What usually accompanies a compression fracture? What is the work-up?

A

history of trauma or osteoporosis

Work-up: A-P and lateral fims

OS1 Final Exam (4 decks)

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