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Osteopathic Skills--Lexie > Lymphatics OSCE > Flashcards

Lymphatics OSCE Flashcards

1
Q

if the shape of a lymph node is irregular, what should you think?

A
  • regular is round

- think cancer

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2
Q

color of skin observations

A
  • should be unchanged from baseline
  • red: infection
  • pale: other
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3
Q

tenderness of lymph nodes

A
  • regular: none
  • large and tender: infection (fast process)
  • large and non tender: lymphoma (slower process)
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4
Q

what is the regular consistency of lymph nodes?

A
  • regular: spongy

- hard is not normal

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5
Q

Virchow’s Node

A
  • on left side, supraclavicular
  • enlarged due to metastasis
  • could mean intra-abdominal cancer because abdomen drains to deep visceral–>cisterns chyli–>thoracic duct–>Virchow
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6
Q

where is the superior and inferior inguinal LN?

A
  • find ASIS and move medial and inferior

- –inferior to femoral triangle

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7
Q

what is the significance in the epitrochlear inguinal LN?

A
  • superior and posterior to medial humeral epicondyle

- if it is enlarged, could mean secondary syphilis

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8
Q

5 treatment zones of lymphatic OMT treatment

A
  1. thoracic inlet down to thoracoabdominal diaphragm
  2. abdominal diaphragm down to pelvic diaphragm
  3. upper extremities
  4. lower extremities
  5. head and neck
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9
Q

goal of lymphatic OMT treatment

A

move lymph centrally

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10
Q

what to start with and end with in lymphatic OMT treatment?

A
  • open thoracic inlet

- treat thoracic inlet again at end

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11
Q

thoracic inlet myofascial release

A
  • purpose move lymph centrally
  • position: drive the bus, pt supine with doc at head of table
  • technique: index fingers on SC joint, angle rib 1, thumb on T1 transverse process
  • –press toward pt’s feet and twist hands to feel ROM
  • –if restrict to one side, perform direct technique until feel tissue creep
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12
Q

pectoral traction treatment

A
  • purpose: increasing negative pressure on thorax
  • position: pt supine with doc at head of table
  • technique: grasp inferior border of pec at anterior axilla
  • –arms extended, apply cephalic traction bilaterally
  • –pull when pt inhales and resist on exhale
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13
Q

doming diaphragm

A
  • purpose: relax diaphragm so it can produce greater pressure gradients to promote lymph drainage back to venous circulation–improves diaphragm excursion/frees up diaphragmatic motion and thus improves ability to move lymph back centrally
  • position: pt supine with doc at side of table facing cephalad
  • technique: doc’s hand on infracostal region, below thoracic cage (xiphoid process) with fingertips/thumbs pointing cephalad
  • –have pt take deep breath and press down on exhalation and resist on inhalation
  • –repeat 3-4 times on last time move thumbs cephalad under xiphoid
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14
Q

rib raise seated

A
  • purpose: stimulates sympathetic chain ganglia, improved lymph flow
  • position: pt seated with doc standing facing pt
  • technique: pt cross arms and lean towards doc
  • –grasp posterior inferior rib angle lateral to transverse process
  • –apply anterolateral traction and pull cephalad toward doc
  • –continue up ribs
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15
Q

rib raise supine

A
  • purpose: stimulates sympathetic chain ganglia, improved lymph flow
  • position: pt supine with doc standing on side to treat
  • technique: contact rib angles–start bottom to top
  • –flex fingers and apply traction by rocking backward
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16
Q

tapotement treatment

A
  • purpose: loosen up lateral in lungs and get expulsion of it
  • position: pt supine with doc at side of table
  • technique:
  • –hacking–karate chop its ulnar side of hands
  • –cupping–cup hands
  • –slapping–palmar surface
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17
Q

thoracic pump

A
  • purpose: affect pressure gradients, indicated for clearing thoracic dict region especially for COPD, URI, LRI, swollen upper extremities, enhance immune fcn
  • repetitive
  • position: pt supine with doc at head of table
  • technique: place thenar eminence of each hand over respective pectoral muscle just inferior to clavicle on ribs 2-4
  • –apply rhythmic pumping at a rate of 110-120 times/min
18
Q

vacuum version of thoracic pump

A
  • purpose: affect pressure gradients, indicated for clearing thoracic dict region especially for COPD, URI, LRI, swollen upper extremities, enhance immune fcn
  • position: pt supine with doc at head of table
  • technique: place thenar eminence of each hand over respective pectoral muscle just inferior to clavicle on ribs 2-4
  • –as pt exhales, apply a compressive force downward and maintain end point in inhalation
  • –continue for 4-5 breaths
  • –at beginning of last inhalation, briskly remove hands to allow for rapid deep inhalation
19
Q

abdominal pump treatment

A
  • purpose: indirectly affects pressure gradients, indirectly massage thoracic duct at its origin in cisterna chyli
  • position: pt supine with doc next to pt
  • technique: palms on abdomen with fingers towards the pt’s head and thumbs side by side
  • –pump in a rhythmic manner at 20-30 times per minute
20
Q

sacral rocking

A
  • purpose: relax muscles at lumbosacral joint
  • position: pt prone with doc at side
  • technique: heal of cephalad hand on sacral base with fingers pointing towards the coccyx, caudad hand on top
  • –exert a gentle pressure downward
  • –alternate direction following respiration
21
Q

effleurage of zone 3

A
  • purpose: aid in movement of lymph toward central core
  • position: pt supine, doc at side, standing
  • –raise pt’s arm up to allow gravity to assist in drainage
  • technique: doc’s other hand induces a stroking force directed distal to proximal on affected arm
22
Q

petrissage of zone 3

A
  • purpose: aid in movement of lymph toward central core
  • position: pt supine, doc at side, standing
  • –raise pt’s arm up to allow gravity to assist in drainage
  • technique: doc induces a kneading/twisting force directed distal to proximal on affected arm utilizing both hands
23
Q

effleurage of zone 4

A
  • purpose: aid in movement of lymph toward central core
  • position: pt supine, doc at side, standing
  • –raise pt’s leg up to allow gravity to assist in drainage
  • technique: doc’s other hand induces a stroking force directed distal to proximal on affected arm
24
Q

petrissage of zone 4

A
  • purpose: aid in movement of lymph toward central core
  • position: pt supine, doc at side, standing
  • –raise pt’s leg up to allow gravity to assist in drainage
  • technique: doc induces a kneading/twisting force directed distal to proximal on affected arm utilizing both hands
25
Q

pedal pump

A
  • purpose: motion/fluid wave in body passively moves fluid centrally by creating an oscillatory pump
  • position: pt supine with doc at feet
  • technique: contact plantar portion of feet, dorsiflex feet
  • –apply a cephalad force to induce repetitive force to khyperdorsiflex feet
  • –do at 100x/min
26
Q

iliotibial band effleurage

A
  • purpose: reduce lymphatic congestion to aid other treatments to the IT band
  • position: pt is lateral recumbent with affected side up and doc facing pt
  • technique: doc’s cephalad hand contacts the pt’s greater trochanter for stabilization
  • –make a C shape and contact IT band
  • –start 1/2 way down leg and move distal to proximal
  • –then, after freeing of some congestion, move just superior to knee and stroke distal to proximal
27
Q

cervical stroking

A
  • purpose: stretch muscle groups surrounding cervical vertebrae
  • position: pt supine with doc at head of table
  • technique: place hands along paravertebral muscles and slowly stroke in a caudal direction
28
Q

anterior cervical traction

A
  • purpose: stretch muscle groups surrounding cervical vertebrae
  • position: pt supine with doc at head of table
  • technique: locate anterior and posterior border of inferior portion of SCM muscle
  • –place thumb along anterior margin, the second through 5th digits on posterior margin
  • –gently lidt anteriorly and laterally until relaxation
  • –move superiorly to middle portion then again at most superior
  • –repeat up to 3 times
29
Q

pre and post auricular

A
  • purpose: move congested lymph in ear region, temporal scalp, and lateral eyelids
  • position: pt seated with doc at front or behind pt
  • technique: spread fingers around ear to contact
  • –apply a CW and CCW motion to auricular lymph nodes
30
Q

mandibular drainage: galbreath technique

A
  • purpose: direct pressure technique to move lymph for eustachian tube dysfunction, lymphatic congesting in ENT, or submandibular region
  • position: pt supine and rotate head to doc, doc opposite side of tx
  • technique: place cephalad hand on TMJ with fingertips and thenar eminence on rams
  • –apply a slow, repetitive downward traction on mandible from angle out (face raking)
31
Q

submandibular

A
  • purpose: direct pressure technique to move lymph around trachea and esophagus
  • position pt supine or seated with doc at head
  • technique: walking fingers motion under mandible to chin, massage
32
Q

anterior tracheal/deep cervical

A
  • purpose: direct pressure technique to move lymph around trachea and esophagus
  • position: pt supine or seated with doc at head of table
  • technique: place fingers lateral to trachea, move from side to side in downward direction
33
Q

supra hyoid and infra hyoid cricoid release

A
  • purpose: direct pressure technique to move lymph from tongue, lips, upper neck jaw
  • position: pt supine with doc standing
  • technique: place fingers lateral to hyoid bone, gently move from side to side
34
Q

what LN can you use for otitis externa?

A

-pre and post auricular

35
Q

what does normal LN feel like?

A

-pea sized, round, spongy, moveable

36
Q

what does abnormal LN feel like?

A

irregular, larger, tender, red, warm

37
Q

4 parts of axillary triangle

A
  • apex at top
  • rib: central/medial
  • scapula: posterior axillary
  • pectoral: anterior axillary
38
Q

epitrochlear LN

A
  • medial on epicondyle

- enlarged in secondary syphilis

39
Q

what is the contraindication for bacterial infection?

A

-do not do if no antibiotics and temp above 102 deg

40
Q

thoracic pump rate

A

110-120

41
Q

abdominal pump rate

A

20-30

42
Q

pedal pump

A

100

Osteopathic Skills--Lexie (16 decks)

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