M1T3 OMM Final Flashcards by Gregory Skedros

Sympathetic innervation of the pulmonary system is from ________.

T1-T6

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Within the musculoskeletal and neurological exam, you could use ________ test and measure the angle of trunk rotation using a ________.

Adam’s forward bend, Scoliometer

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________ makes up for 80% of all structural scoliosis and at least ________ percent have a genetic etiologic basis.

Idiopathic, 90%

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For an acute myocardial infarction, OMT should be limited to ________ techniques.

Indirect

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The Charleston bending brace bends the patient towards the ________ of the curve and overcorrects. It is recommended for spinal curves of ________ degrees.

Convexity, 20-35

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In general, there is a greater risk for curve progression as the Risser Sign grade ________.

Decreases

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One of the problems with OMM research is in picking a ________ for the experimental group to be compared against.

Placebo

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________ percent of scoliosis is due to neuromuscular, syndromic, or congenital disorders.

20%

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________ is a local sensitivity to cold in peripheral vessels due to vasoconstriction.

Raynaud’s phenomenon

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Documenting changes can be difficult due to ________ being subjective.

Pain/symptoms

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The most popular modern underarm brace is known as the ________. It is prescribed for curves in the ________ or ________ spine.

Boston brace, lumbar, thoracolumbar

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Methods: 55 patients who underwent major GI operation received OMT or notResults: Significant difference in time to flatus and postoperative hospital LOS in OMT group when compared to non-OMT groupConclusions: OMT applied after major GI operation is associated with decreased time to flatus and postoperative hospital LOS

Study: Effect of OMT on incidence of postoperative ileus and hospital LOS in general surgery patients

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Neurological theories suggest that AIS patients may have lower levels of ________ and that children with idiopathic scoliosis may have a ________ deficit.

Cerebellar tonsillar, vestibular

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Left sided parasympathetic innervation of the heart may be associated with what pathology?

AV block

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In CHF, the goal of using ________ is to restore lymphatic return to normal levels.

Lymphatic pumps

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A flattened thoracic curve can be associated with

Tachyarrhythmias

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Researches were able to induce scoliosis in Zebra fish by mutating the ________ or ________ cilia genes. When the gene was repaired, they were able to ________ curves from forming.

c21, f59, prevent

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The best osteopathic techniques for scoliosis patients are ________, ________, and ________ techniques.

soft tissue, myofascial release, indirect

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________ is a subset of ITT analysis and induces only the people who completed the study.

Per-protocol population

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Children with congenital scoliosis who are surgical candidates need extensive ________ and ________ evaluations.

Cardiopulmonary, genitourinary

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Unlike the sympathetics, there is ________ parasympathetic activity on the lymphatics.

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The main way to tell the difference between NS/F and S scoliosis is that the curve ________ in NS/F and ________ in S.

Corrects, does not correct

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In addition to chondrification center defects, those with congenital scoliosis may also have ________ defects.

Genitourinary (20-40%)

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Left sided sympathetic innervation of the heart may be associated with what pathologies?

Ectopic foci and Vfib

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Congenital kyphosis can be caused by failure of ________ or failure of ________.

Formation, segmentation

Right sided sympathetic innervation of the heart may be associated with what pathology?

SVT

Facilitation due to heart issues generally occurs at the left paraspinal region at the levels of ________.

T2-T4

The parietal pleura (except the diaphragmatic pleura) is innervated by ________.

Intercostal nerves (ventral rami)

Patients with scoliosis will generally have pain less than ________ percent and is ________ after activity.

50%, worse

Juvenile scoliosis affects mainly ________ and is mainly a ________ convexity.

Girls, right sided thoracic

Osteopathic techniques will help optimize structure and function in scoliosis patients, but it is not intended to ________.

Straighten curves

Irritation of the ________ branches of the vagus have the strongest effect on slowing heart rate.

Pulmonary

Idiopathic scoliosis can be further broken down into ________, ________, and ________.

Infantile (0-3), juvenile (3-9), adolescent (>10)

Scoliosis can ________ even after skeletal maturity is achieved.

Progress

How is Wright’s test performed? Result?

Hyperabduct/externally rotate affected armFeel radial pulseIf decreased, test is positive

Sympathetic innervation for the head/neck vasculature comes from ________.

T1-T4

A right ________ curve is the most common type of curve, followed by a right ________ curve.

Thoracic, thoracolumbar

Intersegmental motion testing will change above and below the ________. Above will be ________ mechanics and below will be ________ mechanics.

Apex, type I, type II

The three classifications of structural scoliosis are ________, ________, and ________.

Idiopathic, congenital, neuromuscular

Although the inheritance pattern of scoliosis is unclear, ________ patients have a positive family history.

Adolescent idiopathic scoliosis (AIS)

Methods: 406 pneumonia patients at 7 community hospitals receiving OMT or conventional care only (CCO)Results: Significant difference in LOS and antibiotic duration when comparing OMT group vs CCO groupConclusions: Per protocol analysis found significant differences between OMT and CCO groups when looking at LOS, antibiotic duration, and respiratory failure/death

Study: Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE)

________ treatment can make it easier to conduct studies, however, OMT isn’t performed in such a rigid fashion normally.

Protocol-based

The posterior Chapman’s point for the upper lung is between the ________, midway between the spinous process and transverse process. The lower lung is similar but one level lower.

3rd and 4th transverse processes

Severity of scoliosis is best diagnosed by ________.

X-ray

Sympathetic innervation for the upper extremity vasculature comes from ________.

T2-T7

Scoliosis is described by the side to which its ________ is directed.

Convexity

Nonstructural/functional scoliosis is also known as ________ or ________. ________ refers to slight deviations that correct voluntarily and disappear with movement, while ________ is due to an underlying condition (shorter leg).

Postural, compensatory, postural, compensatory

________ percent of scoliosis is idiopathic.

80%

In the future, ________ will help OMT studies remain objective, quantifiable, and reproducible.

Biomarkers

Methods: COPD patients undergo pulmonary rehab (PR) + OMT or just PRResults: PR + OMT group showed an increased 6 min walk test and a significant difference in decreased RV when compared to the other groupConclusions: PR + OMT improves exercise capacity and reduces RV in severely impaired COPD patients compared to PR alone

Study: OMT effectiveness in severe COPD

The most common type of scoliosis is ________.

Adolescent Idiopathic Scoliosis (AIS)

On the osteopathic structural exam, ________ and ________ should be used to evaluate if someone has scoliosis.

Gait, static asymmetries

OMT directed at ________ can help reduce hypertension in certain situations.

T1-T5

Trigger points on the anterior right pectoralis muscle can be associated with ________.

SVTs

In nonstructural/functional scoliosis, the curve is ________ and the curve corrects itself when side bending ________ the convexity.

Flexible, towards

Methods: 400 pregnant women in third trimester received OMT or placeboResults: Back pain was significantly improved in OMT group compared with usual care groupConclusions: OMT was effective for mitigating pain and functional deterioration compared with usual care group

Study: Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE)

20% of the Vagus nerve is ________ while the remaining 80% is ________.

Efferent, afferent

Of the three causes of scoliosis, ________ is the worst one to have.

Neuromuscular

Adolescent scoliosis affects mainly ________ and is mainly a ________ convexity (90%).

Girls, right sided thoracic

A major etiology of scoliosis is thought to be ________.

Genetics

The goal of treatment for those with pulmonary disease is to maximize ________.

Homeostasis

In ________, there is no swelling of the anterior rib/sternal joints, however, this swelling is seen in ________.

Costochondritis, Tietze Syndrome

Within an area of autonomic innervation, facilitated segments should be treated ________.

First

Abnormalities in the ________ often lead to congenital scoliosis.

Chondrification centers

In thoracic outlet syndrome, symptoms caused by ________ are less common than those caused by neural/arterial etiologies.

Venous compression

How is Roos test performed? Result?

Hold both elbows at shoulder height and retract shouldersOpen and close fists for 3 minsOnset of severe heaviness/fatigue, test is positive

Methods: 39 subjects got Hep B vaccine with lymphatic pump or notResults: 50% of those who received pump had a response with average titer of 374 mlU/mL. Those who did not receive pump had an average of 96 mlU/mLConclusions: Lymphatic pump may result in higher titers after vaccination

Study: Effect of lymphatic and splenic pump techniques on the antibody response to hepatitis B vaccine

A ScoliScore™ of ≤50 equates to ________ risk of curve progression. A score of 51-180 equates to ________ risk and a score of 181-200 equates to ________ risk.

Low, intermediate, high

The anterior Chapman’s point for the upper lung is at the ________ parasternally, while the lower lung is at the ________ parasternally.

3rd intercostal space, 4th intercostal space

What are the clinical anatomical borders of the thoracic outlet?

Clavicle, rib 1 and 2 (superior)Manubrium to sternal angle (anterior)Lower cervical vertebrae/T1-T4 (posterior)

Progression of the curve in scoliosis can be increased in:

Patients <12GirlsPremenarchal womenCurves with initial Cobb ≥20˚Double/thoracic curvesRisser grade 0 or 1

________ is defined as a lateral curve of the spine greater than 10 degrees associated with vertebral rotation.

Scoliosis

Intersegmental motion testing will reveal rotation ________ the convexity (ALWAYS).

Towards

Failure of formation can result in a ________ or a ________.

Hemivertebra (30%), wedge vertebra

________ can be described as an anterior convexity or a posterior concavity.

Lordosis

The Milwaukee brace is also known as the ________. The goal of this brace is to ________.

Cervico-Thoraco-Lumbo-Scaral Orthosis (CTLSO), prevent progression in skeletally immature patients

How is Adson’s test performed? Result?

Abduct/externally rotate affected shoulderFeel radial pulseExtend/rotate head towards affected side.If decreased, test is positive

What are the two major complications of randomized controlled trials?

Noncompliance and missing outcomes

Failure of segmentation can result in a _______ or a ________.

Congenital bar (40%), block vertebra

In structural scoliosis, the curve is ________ and the curve ________ be voluntarily straightened.

Not flexible, cannot

Infantile scoliosis affects mainly ________ and is mainly a ________ convexity.

Boys, left sided thoracic

Treating viscerosomatic reflex changes from T1-T6 will improve ________, ________, and ________.

Venous return, lymphatic drainage, biomechanics of breathing

Both the Boston brace and the Charleston bending brace are types of ________.

Thoracic-Lumbar-Sacral Orthoses

The lymph of the right lung drains into the ________ lymphatic duct. The lymph of the left lung drains into the ________ lymphatic duct (except for the left inferior lobe).

Right, thoracic

Ventricular pain refers to the ________ dermatomes.

C8-T3

The two main types of scoliosis are ________ and ________.

Nonstructural/functional, structural

The ________ is used to assess skeletal maturity and evaluates the degree of ossification and fusion of the iliac apophysis.

Risser Sign

How do you calculate a Cobb angle?

Identify the most cranial vertebra that has the greatest tilt from horizontal, draw a line parallel to superior end plateIdentify the most caudal vertebra that has the greatest tilt from horizontal, draw a line parallel to inferior end plateDraw lines perpendicular to both parallel lines and measure angle between the intersection

The only group that suggests that screening for scoliosis has insufficient evidence regarding benefits/harms is the ________.

US Preventative Services Task Force

Methods: Healthy adults assigned to rib raising or light touchResults: Significant decrease in α-amylase activity in those who received rib raising compared to those who did notConclusions: SNS activity may decrease immediately after rib raising, but HPA and parasympathetic activity are not altered

Study: Effects of rib raising on the autonomic nervous system

The ________ brace targets neuromuscular dysfunction, growth asymmetry, postural disorganization, and spinal deformation. The best results are seen in patients who are ________ and who have Cobb angles of less than ________ degrees.

SpineCor, skeletally immature, 30

Congenital spine deformities can be caused by failure of ________ development.

Bone

The heart drains into the ________ lymphatic duct.

Right

________ can be described as a posterior convexity or an anterior concavity.

Kyphosis

Atrial pain refers to the ________ dermatomes.

T4-T6

Instead of documenting pain, ________ or ________ can be followed.

Financial outcomes, hospital length of stay

The Hueter-Volkmann principle states that increased ________ on a vertebral growth plate retards growth.

Pressure

Methods: Subjects with FEV1% <70% received OMT or shamResults: OMT group had significant decrease in forced expiratory flow and a significant increase in residual volume and TLC compared to the sham groupConclusion: Overall worsening of air trapping 30 mins after OMT sessionDo these results mean that OMT is bad for those with COPD?

Study: Immediate effects of OMT in elderly patients with COPDNo, it shows that the techniques used may not be suitable for this specific age group with this disease

The biomechanical theory of scoliosis is based on the ________ principle that suggests unequal ________ will cause change in vertebral bodies and cause wedging of the vertebrae.

Hueter-Volkmann, pressure

Sympathetic innervation for the lower extremity vasculature comes from ________.

T10-L2

________ analysis looks at all individuals in a study, regardless of whether they dropped out or not.

Intention to treat