MIDTERM Flashcards by Elizabeth Jose

What grade WHIPLASH

No Physical Signs

GRADE 1

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What grade WHIPLASH

Musculoskeletal signs

Grade 2

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What grade WHIPLASH

Neurological Signs

Grade 3

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What grade WHIPLASH

Fracture or dislocation

NOT WHIPLASH

Grade 4

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What STAGE of Whiplash?

Flexion of C-spine

Stage 1

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What STAGE of Whiplash?

S-Shaped C Spine

Stage 2

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What STAGE of Whiplash?

Hyperextension

Stage 3

Stage 4 = HyperFLEXION

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What would you expect to find on an X-Ray/CT scan for a patient with WHIPLASH?

LOSS OF LORDOSIS “military neck”

Prevertebral edema
Swelling of alar and transverse ligaments

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What are NERVE results of whiplash injury?

Occipital headaches, blurred vision, diminished reflexes, paresthesias, proprioception issues

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ACUTE Stage Treatment for Whiplash Injury

moderate-severe ROM limitation, warm “boggy” tissue, echymosis

Ice
Rest
Cervical Collar
NSAIDS
**AVOID DIRECT TECHNIQUES **

INDIRECT, lymphaic

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When do you perform HVLA when treating someone with CHRONIC stage WHIPLASH injury?

NO HVLA (1 week to 1 month)

HVLA can be done when >1 month

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Which cervical disc RESISTS COMPRESSION and which RESISTS TENSILE LOADS?

NUCLEUS PULPOSIS = RESISTS COMPRESSION

ANNULUS FIBROSIS = RESISTS TENSILE LOADS

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Which cervical spine muscle is responsible for:
SB same side
Rotate opposite side
Bilateral Contraction flexes neck

STERNOCLEIDOMASTOID (SCM)

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Which cervical spine muscle is responsible for:
SB same side
bilateral contraction FLEXES neck

SCALENES

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Which cervical spine muscle is responsible for:
SB Same side
Bilateral contraction EXTENDS neck

TRAPEZIUS

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Which cervical spine muscle is responsible for:
Rotate same side

SPLENIUS

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Which cervical spine muscle is responsible for:
NECK EXTENSION

Semispinalis

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Usual presentation for congenital muscuklar torticollis?

Tx = physical therapy and stretching excercises

Lateral Neck Flexion (same side)
Neck Rotation (opposite side)

is sustained –> plagiocephaly = flattening on side of curvature

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Ocular Torticollis is usually due to ..

CN 4 (trochlear) or CN 6 (abducens) palsy
Present around 9 mo – child tilts head toward unaffected side of muscle/nerve dysfunction

Common presentation = child unable to see after getting up

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Juvenile RA –>

AA subluxation

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What type of TORTICOLLIS is resistant to all treatments?

Neurologic Torticollis

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involuntary contraction of cervical muscles – twisting and reptitive head movements and postures

Spasmodic Torticollis

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HALLMARK of Acute Torticollis

sudden onset – usually in morning with no hx of trauma

Acute Side-bending

TX = Botox A – temp. inhibits overactive neck muscles

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Which type of torticollis is usually a symptom of an underlying medical condition or injury?

Acquired Torticollis

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Which type of torticollis is characterized by **involuntary twisting movements of the neck**?

Cervical Dystonia

unilateral throbbing headache with assoc. nausea and visual changes =

MIGRANE

# type of headache pain is described as a **SQUEEZING BAND**

Tension Type

# cause of headache **Sudden** onset of **severe** headache with neurologic signs "**Worst headache of my life**" or "**thunderclap**" headache

Hemorrhage (SUBARACHNOID)

- superficial temporary artery vasculitis - Presentation: Age >50 , elevated ESR, pain worsening if stopping or lying flat | assoc. fever , weight loss, night sweats, joint pain

Temporal Arteritis

# WARNING SIGNS -- HEADACHES * Abrupt onset of pain < 1 week or sudden change in pattern * Stiff Neck * Altered conscciousness * Neurologic deficit * Progressively worsening * Vomiting precedes headache * **new onset in patients over 50**

* Abrupt onset of pain < 1 week or sudden change in pattern * Stiff Neck * Altered conscciousness * Neurologic deficit * Progressively worsening * Vomiting precedes headache * new onset in patients over 50

vascular dilations in the cerebral arteries -- circle of willis | oculomotor is affected --> dilation of the pupils

Berry Aneurysm

# Pathophysiology typically **vascular** in origin, increased contraction leads to low oxygen levels in that area **dropping level of serotonin** | **LOW SEROTONIN** -->

MIGRAINE

# Migraine with or without AURA? Sx: **Scintillating Scotoma** = visual disturbance Ascending paresthesia Weakness Aphasia

MIGRAINE WITH AURA

migranes WITHOUT AURA affect what location

Frontal or Periorbital

What is the most common adult headache? | typically in women

TENSION headaches

During a **TENSION headache** a **band of pain** is usually felt where?

Frontal Temporal

# Pathophysiology Myodural bridge between rectus capitis posterior minor and intracranial dura

Cervicogenic Headache

Triggers for Cluster Headaches

Alcohol Wind Exposure Heat

# Primary Respiratory Mechanism On **FLEXION**, what happens to unpaired and paired bones?

Unpaired (midline) -- FLEX Paired -- EXTERNALLY ROTATE

# Primary Respiratory Mechanism On **EXTENSION**, what happens to unpaired and paired bones?

Unpaired -- EXTEND Paired -- INTERNALLY ROTATE

the 5 principles of PRM involve what aspects

Cerebrospinal Fluid Fluctuation Membranes Motility of Neural Tube Articular Mobility of Cranial Bones Involuntary mobility of sacrum

Which **ventricle** serves as the **mixing chamber**?

4th Ventricle

**Firm Extracranial attachments** include what 4 things?

Foramen Magnum C2 C3 S2

What is the innermost membrane surrounding meninges

PIA MATER

During **INHALATION/FLEXION**, what happens to the **CNS and spinal cord**

CNS **shortens and thickens** and the spinal cord moves **upward**

During **EXHALATION/EXTENSION**, what happens to the **CNS and spinal cord**

CNS lengthens and thins Spinal Cord moves downward

What suture runs between occipital bone and temporal bone

Occipitomastoid Suture (OM) | **Houses CN IX, X, XI, Jugular vein**

develops from cartilage and bone develops by endochondral ossification

CRANIAL BASE

develops from membrane (flatter bones) and develops via intramembranous ossification

Cranial Vault

sacral rocking motion occurs around what axis?

superior (resp.) transverse sacral axis

while in VAULT HOLD, the **index** finger lies on

greater wing of sphenoid

while in VAULT HOLD, the **middle 2 fingers** lies on

zygomatic process of temporal bone and mastoid process

name the MIDLINE bones | FLEXION and EXTENSION

VOMER OCCIPUT SACRUM SPHENOID ETHMOID

INHALATION = FLEXION = EXTERNAL ROTATION

EXHALATION = EXTENSION = INTERNAL ROTATION

The base of the SPHENOID moves in what direction, while the base of the OCCIPUT moves in what direction?

SPHENOID -- CLOCKWISE OCCIPUT -- COUNTERCLOCKWISE

Which cranial strains are NON-Physiologic

Lateral and Vertical Strain

axis for flexion and extension

TWO PARALLEL TRANSVERSE AXIS

FLEXION Causes the sacrum to do what?

COUNTERNUTATES | sacrum goes posterior

EXTENSION causes the sacrum to do what?

NUTATE | sacrum goes anterior

describe the movement of the sphenoid and occiput during TORSION

move in opposite direction

TORSION occurs on which AXIS?

Single AP Axis

Left and Right TORSION are named based on ..

GREATER WING OF SPHENOID IS HIGHER ON THAT SIDE

SIDEBENDING occurs on which axis?

Two parallel vertical axis One AP axis

Lateral Strains occur on what axis?

Two Parallel Vertical Axes

lateral strains are named for

the postion of the base of the sphenoid

VERTICAL strains occur on what axis

TWO Parallel Transverse Axis

Whose studies show the **opening of sutures** with tissue in between Shows movement is **independent of respiration and HR**

RETZLAFF Studies

Whose studies show compliance in **cat model** **SKull bones moved** with inside and outside forces

HEISEY and ADAMS

Whose studies measured human skull motion with pick on parietal bones - found rhythm **varies with subjects / not synced with breathing**

FRYMANN

Whose study used **infrared recording device --> accurtely show skull movements** - acupuncture needles as markers - 100% detection at 45 microns

ZANAKIS

Whose study involved **Traub-Hering-Mayer oscillations** - measured with laer-doppler flowmeter

Chicago (NELSON)

Whose study revealed that a**ctive motion testing of the SBS** affects the cranial system to a level that results in a measurable effect?

SANDHOUSE

# Visceral Somatic Reflex Pituatary / Thyroid / Parathyroid (HEENT)

T1-4

# Visceral Somatic Reflex Pancreas

T7-9

# Visceral Somatic Reflex Adrenal

T 8-10

# Visceral Somatic Reflex GONADS

T10 - T11

# PARASYMPATHETICS The OA and SACRUM involve what

OA -- VAGUS Sacrum -- Pelvic Splanchnic

# DISORDER Muscle atrophy Myopathy with fatty infiltration infiltration acropachy-Graves Dz Pretibial myxedema, graves ophthalmopathy Shoulder adhesive capsulitis

HYPERTHYROID

# DISORDER Irregular or stippled Epiphyses Delayed bone maturation Proximal Muscle myopathy Carpal Tunnel syndrome

HYPOTHYROIDISM

# DISORDER Bone Resorption Soft tissue Calcifications Psteotos Fibrosa Cystica

HYPERPARATHYROID

# DISORDER MCP and Metatarsal Shortening Short middle and distal phalanges with canes epiphyses Short stature Rounded facies Central obesity Subcutaneous calcifications

HYPOPARATHYROIDISM

# DISORDER Osteopenia/osteoporosis Osteonecrosis Muscle wasting

Hypercortisolism (CUSHINGS)

the sympathetic nerves orginate from

THORACO-LUMBAR | Parasympathetic -- cervical and sacral

Celiac Ganglion involve which segments | stomach, duodenum, liver, GB, pancreas, spleen

T5-T9

Superior Mesenteric Ganglion involve which segments | SI beyond duodenum, r. colon, kidneys and adrenals

T10 - 11

Inferior Mesenteric Ganglion involve which segments | Left Colon / Pelvic Organgs

T12 - L2

**Poorly localized** pain, usually midline Vague, gnawing/cramping, **deep**

TRUE VISCERAL PAIN