Notes Flashcards
The classic triad of Horner’s syndrome is ptosis, miosis, and anhidrosis. Which of the following structural findings might produce these symptoms on the left?
A. Anterior right clavicle B. Elevated left first rib C. Hypertonic right scalenes D. Inhaled left 3rd rib E. T10 F RR SR
B. Elevated left first rib
In terms of osteopathic structural exam in a pt presenting with Horner’s syndrome, attention should be paid to the course of the sympathetic input from the hypothalamus, down to the upper thoracic vertebrae, and back up along the cervical chain ganglion. It finally finds its route along the internal carotid artery until it terminates at target organs on the ipsilateral face and head.
Characterized by lateral deviation of the first MTP with female predominance
A. Bunionette deformity B. Calcification of plantar fascia C. Hallux valgus D. Hammertoe deformity E. Morton foot
C. Hallux valgus
[aka bunion]
Treatment position for inion tenderpoint
Marked flexion
CV4 bulb decompression is a cranial technique in which the lateral angles of the occiput squama are manually approximated, slightly exaggerating the posterior convexity of the occiput and producing cranial _________
Extension
Which of the following is the location for the AT6 tenderpoint?
A. Angle of Louis
B. Anterior axillary line on inferior margin of 4th rib
C. Midline of the sternum, 1 inch superior at the xiphosternal junction
D. Midline of xiphosternal junction
E. Tip of the xiphoid
D. Midline of xiphosternal junction
OSE reveals the sphenoid and occipital bones to be inferior on the left and superior on the right. The left temporal bone and parietal bones appear to be in external rotation. The most likely dx is:
A. Left lateral strain B. Left sidebending rotation C. Left torsion D. Right sidebending rotation E. Right torsion
B. Left sidebending rotation
The SBR dysfunction is named for the side of convexity. In this example, the sphenoid and occiput rotate toward the left causing both to be inferior in comparison to the right. Rotation of the sphenoid clockwise and the occiput counterclockwise around their respective vertical axes causes a convexity to form on the left side of the cranium. Palpably the left temporal bone and left parietal bone will feel like they are stuck in external rotation
A pt presents 6 weeks after an inversion ankle sprain. He continues to complain of foot pain and PE reveals decreased height of his transverse arch. There is restriction of lateral rotation at the calcaneus with plantar displacement of the cuboid. The most appropriate osteopathic manipulative therapy is
A. Hiss plantar whip B. Locke’s technique C. Metatarsal articulation D. Talar tug E. Talo-calcaneal crunch
A. Hiss plantar whip
The Hiss plantar whip technique provides direct force applied to the cuboid. Tarsal bone is carried dorsally to restrictive barrier and HVLA thrust is applied dorsally.
Anatomical short leg syndrome results in a _______ sacral base and _______ rotated innominate on the ipsilateral side.
The lumbar spine will rotate ______ and sidebend ______ relative to the short leg.
The iliolumbar and sacroiliac joints will be stressed on the _______ side of the short leg
Lower; anteriorly
Toward; away
Ipsilateral
Which side is the convexity located in dextroscoliosis?
Right
Nursemaids elbow results from subluxation of the head of the radius at the elbow. Children present holding their arm in pronation and against the chest wall. What is the technique for reduction?
Flex the child’s arm while slowly supinating it
Innervation of pronator teres m. and pronator quadratus m.
Median n.
Scoliosis is usually found in adolescents during routine screening, but may also be found later in life due to symptoms from the misalignment. It is most often idiopathic, but one of the causes of acquired scoliosis is short-leg syndrome. Which of the following is used to calculate the necessary heel lift height?
A. Greater trochanter unleveling B. Sacral base unleveling C. Iliac crest height D. Lateral femoral epicondyle height E. Medial malleoli unleveling
B. Sacral base unleveling
The difference in the sides of the sacral base (aka sacral base unleveling) is input into the Heilig formula along with estimated duration of dysfunction, and if any compensation is present to determine the lift required.
Which of the following is contraindicated in a pt who recently underwent abdominal surgery?
A. Cervical soft tissue B. CV4 C. Pectoral traction D. Pedal pump E. Rib raising
D. Pedal pump
Pedal pump is contraindicated due to tendency to augment thoracoabdominal pressure and potential endangerment of stability of operative site. Other contraindications include DVT or recent lower extremity fracture
Chapman’s point on posterior/lateral margin of IT band
Prostate in males
Broad ligament in females
Muscle(s) and nerve(s) responsible for abduction of the arm up to 90 degrees
Suprapinatus (suprascapular n.)
Deltoid (axillary n.)
[beyond 90 degrees it is upper trapezius and serratus anterior]
Which of the following is the most appropriate patient position for treating the low ilium tender point with counterstrain?
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
B. Pt supine with b/l flexion of the hips and knees with external rotation of the thighs
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
D. Pt supine with knees and hips flexed and rotated away
E. Pt supine with marked right hip flexion
E. Pt supine with marked right hip flexion
Following a seizure, a pt is found to be holding his arm in adduction and internal rotation, and is unable to externally rotate the arm. The right coracoid process appears prominent and there is flattening of the anterior shoulder. What type of shoulder dislocation?
Posterior dislocation
This is much less common than anterior dislocation and is found classically following electrocution or tonic-clonic seizures due to violent muscle contraction. They result in IR of the arm
________ _______ syndrome is a compressive neuropathy of the tibial nerve or its branches, posterior to the medial malleolus. Pain is diffuse and poorly localized to the medial ankle. Paresthesia or dysesthesias are common in the region of medial ankle. Pain is worse with walking or exercise but may also occur at night
Tarsal tunnel syndrome
Which of the following is the location for the AL4 tenderpoint?
A. Inferior AIIS pressing cephalad B. Lateral AIIS pressing medially C. Medial AIIS pressing laterally D. Medial ASIS pressing laterally E. Superior pubic ramus 1 cm lateral to pubic symphysis
A. Inferior AIIS pressing cephalad
Tx involves flexion to the L4-L5 level and rotating L4 away from the point by sidebending the pelvis toward the point
Anterior fibular head dysfunctions are coupled with a preference for _______ rotation of the talus, and _________+__________+_________ of the ankle/foot
External; dorsiflexion+eversion+abduction
Somatic dysfunction of the temporal bone may cause tinnitus.
_______ rotation of the temporal bone causes low-pitched roaring tinnitus and _________ mandible deviation
________ rotation of the temporal bone causes high-pitched humming/buzzing tinnitus and _________ mandible deviation
External; ipsilateral
Internal; contralateral
What muscle should be treated for ribs 9-11 somatic dysfunctions?
Latissimus dorsi m.
Which of the following is the location for the AL3 tenderpoint?
A. Inferior AIIS pressing cephalad B. Lateral AIIS pressing medially C. Medial AIIS pressing laterally D. Medial ASIS pressing laterally E. Superior pubic ramus 1 cm lateral to pubic symphysis
B. Lateral AIIS pressing medially
Tx by standing on opposite side from tender point, flex pt hips and knees b/l to induce flexion at L3-L4, sidebend pelvis away from point which rotates torso and L3 segment toward the point
Why is patellofemoral syndrome more common in females?
Females have widened Q angle
Chapman’s point 1” superior and 1” lateral to umbilicus
Kidney
The paravertebral hump observed in juvenile dextroscoliosis is the result of:
A. Contralateral paravertebral atrophy B. Ipsilateral muscular hypertrophy C. Spinal extension D. Spinal rotation E. Spinal sidebending
D. Spinal rotation
Scoliosis is a pathological Fryette type I spinal mechanics. The asymmetric paravertebral prominence is a result of the rotational component of spinal group curves
The _______ test is a test for stability of the bicipital tendon in the bicipital groove. It is performed by stabilizing the forearm, then flexing the elbow to 90 degrees with the humerus in neutral position then externally rotating the shoulder/supinating the forearm against resistance.
Yergason’s test
Medial epicondylitis is due to a strain or overuse of the ______ muscles within the forearm
Flexor
Nerve roots for median nerve
C5, C6, and C7 of lateral cord
C8 and T1 of medial cord
Treatment of which of the following may help conditions such as cluster headaches and Horner’s syndrome?
A. 1st intercostal space, sternal B. C3-5 paraspinal muscles C. Sphenopalatine ganglion D. Stellate ganglion E. Venous sinus
D. Stellate ganglion
The first paravertebral ganglion associated with the heart is the cervicothoracic (stellate) ganglion, where some preganglionic axons excite ganglion cells whose axons also run directly to the heart. Compression of the stellate ganglion secondary to the upper thoracic or upper rib (elevated first rib) dysfunction has been known to contribute to Cluster headaches. The associated Horner’s syndrome is due to an abnormality with the sympathetic nerve supply to the orbit
Ottawa ankle rules
- Tenderness to palpation along the posterior margin of the medial or lateral malleolus
- Inability to bear weight immediately after the injury and inability to take 4 steps in the ED
- The presence of midfoot pain along with pain at the navicular or fifth metatarsal along with inability to bear weight as defined above
[An ankle series is only indicated for pts who have pain in the malleolar zone AND have bone tenderness at posterior region of lateral or medial malleolus OR are unable to bear weight
A foot series is only indicated for pts who have pain in the midfoot zone AND have bone tenderness at the base of the fifth metatarsal or navicular OR are unable to bear weight]
Which of the following is used for diagnosis of 1st metatarsal dorsal glide in which force is applied to the joint of the 1st metatarsal and first cuneiform?
A. Hiss plantar whip B. Locke’s technique C. Metatarsal articulation D. Talar tug E. Talo-calcaneal crunch
B. Locke’s technique
What 3 motions of the foot contribute to ankle supination?
Plantar flexion
Inversion
Adduction
Which of the following is the most appropriate patient position for treating piriformis tender point with counterstrain in a pregnant patient?
A. Pt prone with hip and knee flexed and legs internally rotated and adducted
B. Pt supine with b/l flexion of the hips and knees with external rotation of the thighs
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
D. Pt supine with knees and hips flexed and rotated away
E. Pt supine with marked right hip flexion
C. Pt supine with flexion of right hip and knee with thigh abducted and externally rotated
What muscle corresponds to the tenderpoint located on the posterior surface of the ascending ramus of the mandible 2 cm above the angle of the mandible on the side opposite of jaw deviation?
Medial pterygoid
You diagnose a sacral dysfunction as a right on right sacral torsion. What is the most likely intersegmental somatic dysfunction at L5?
A. E RL SR B. E RR SL C. F RL SL D. N RL SR E. N RR SR
D. N RL SR
L5 and the sacrum always rotate in opposite directions. Sidebending of L5 corresponds to the oblique axis on which sacral rotation occurs.
What nerve root is tested by the achilles reflex?
S1
Also responsible for dermatome covering much of the posterior thigh and calf and lateral lower leg and lateral foot. The gastrocnemius (responsible for toe-walking) is innervated by S1.
What cranial dysfunction is diagnosed when there is perceived motion of the greater wings of the sphenoid travelling too far caudally, and may indicate an axial loading injury?
Superior vertical strain
Ankle eversion causes the proximal fibular head to move ______
Anteriorly
Which of the following is the location for the AL5 tenderpoint?
A. Inferior AIIS pressing cephalad B. Lateral AIIS pressing medially C. Medial AIIS pressing laterally D. Medial ASIS pressing laterally E. Superior pubic ramus 1 cm lateral to pubic symphysis
E. Superior pubic ramus 1 cm lateral to pubic symphysis
Tx by standing same side as tender point, flex the hips and knees b/l to induce flexion to L5-S1 level, sidebend and rotate the pelvis toward the point, which rotates the torso and lumbar segment away from the point
Posterior tibia or anterior talus dysfunctions correlate with what motion at the ankle?
Plantar flexion
Posterior tibial or anterior talus dysfunctions are commonly seen in pts whose activities require prolonged plantar flexion, such as dancers or women who wear high heels frequently
The __________ is the only muscle involved in opening the jaw, and somatic dysfunction of this muscle will cause the chin to deviate to the ______ side when opening the jaw
Lateral pterygoid; contralateral
