OB patient, jons cox

Question 1

What occurs in pregnancy to arterial venous system

Answer 1

venous system can not keep up with excess arterial supply so lymphatics play crucial role

Question 2

hyperSAN tone causes what

Answer 2

constriction lymph flow

Question 3

dysfunction in MSK system can increase E requirement by how much

Answer 3

300%

Question 4

When is OMT avoided in pregnancy

Answer 4

PROM, premature labor, abruptio placenta, ectopic pregnancies

Question 5

ddx Low back pain in OB patient

Answer 5

biomechanical instability
lumbosacral plexopathy
neuropathy
spinal facet
spondylolisthesis
congenital disorders
discogenic
trauma

Question 6

factors that contribute to low back pain in OB

Answer 6

multifetal gestation
spinal curves (scoliosis)
leg length inequality
weight gain
ligamentous laxity
somatic dysfunction

Question 7

most common cause low back pain in pregnacy

Answer 7

biomechanical instability

Question 8

postural effects of pregnancy

Answer 8

increased anterior pelvic tilt
lumbar spin lordosis
thoracic spin kyphosis

Question 9

compensatory posture in pregnancy

Answer 9

shoulders back
head forward
sacrum nutates, ribs flare
feet flatten
stance widens in ambulation

Question 10

what can occur with increased lumbar lordosis

Answer 10

increased load on facets
shearing intervertebral disc spaces
posterior paraspinal muscles shorten and unbalanced by overstretched abdominals
psoas mm shorten

Question 11

what can occur with increased anterior elvic rotation

Answer 11

strain lumbar and SI joints

Question 12

relaxin and Estrogen change pubic symphysis how

Answer 12

widens begining 10th-12th week

can refer to low back and medial thighs

Question 13

which area is at hgiher risk for spondylolisthesis in women who have had children before

Answer 13

L4-5

Question 14

What do you need to rule out for complaint of hip pain

Answer 14

transient osteoporisis and avascular necrosis of femoral head

Question 15

clinical setting of transient osteoporisis

Answer 15

rare. 3rd trimester
pain increases with weightbearing
limited ROM
sudden or insidious

Question 16

Tx for transient osteoporosis of hip

Answer 16

reduced weightbearing (bedrest or wheelchair)

Question 17

Dx for transient osteoporosis of hip

Answer 17

XR
MRII
pelvic US

Question 18

Sx avascular necrosis of femoral head

Answer 18

pain in hip, pelvis, groin with weight bearing in 3rd trimester
may radiate to knee thigh or back

Question 19

Dx avascular necrosis femoral head

Answer 19

hip ROM

Question 20

Tx avascular necrosis of femoral head

Answer 20

reduced weightbearing to allow revascularization

Question 21

women who have lumbo pelvic pain in pregnancy are at icnreased risk for what

Answer 21

postpartum depression

Question 22

what is meralgia paresthetica

Answer 22

burning and numbness at waistband and lateral thigh

Question 23

Tx LBP in pregnant women

Answer 23

avoid excess heat
nurtion- vit D, Ca, fish oil, Mg
exercise: gentle, normal temp
maternity back supports and sacroiliac support
accupuncture
OMT

Question 24

indications for OMT in pregnancy

Answer 24

SD present
scoliosis or other structural condition
edema, congestion or other pregnancy assoc condition amenable to OMT

Question 25

CI to OMT in pregnancy women

Answer 25

``` unDx vaginal bleeding threatened abortion ectopic placenta previa placental abruption PROM preterm labor prolapsed umbilical cord severe preeclampsia and eclampsia ```

Question 26

Stages of Tx in preganncy

Answer 26

structural congestive preparatory Recovery and maintenance

Question 27

what is the early structural stage of pregnancy

Answer 27

0-12 weeks

Question 28

what do you examine in early structural stage

Answer 28

``` postural thoracic inlet fascia thoracic cage pelvis and sacrum viscerosomatic chapmans CRI ```

Question 29

what are the sympathetics to uterus

Answer 29

T10-L2

Question 30

parasympathetics to cervi

Answer 30

S2-S4

Question 31

anterior chapman stomach hyeracidity

Answer 31

5th intercostal space mid clavicular line to L of sternum

Question 32

anterior chapman liver/gallbladder

Answer 32

6th intercostal space from mid clavicular line to R of sternum

Question 33

posterior chapman stomach hyperacidity

Answer 33

intertransverse space, midway spinous and transverse processes between 5th and 6th vertebrae on L

Question 34

posterior chapman liver gallbladder

Answer 34

intertransverse space midway spinous and transverse processes between 6th and 7th on R

Question 35

ant chapman ovaries

Answer 35

round ligaments from upper border pubic bone to attachment of mm on lower border

Question 36

ant chapman uterus

Answer 36

laterally on sides pubic symphysis

Question 37

ant chapman broad ligament

Answer 37

trochanter down to outer aspect femur within 2 " knee joint

Question 38

post chapman ovaries

Answer 38

intertransverse space between 9th and 10th vertebrae and 10th adn 11th vertebrae

Question 39

post chapman uterus

Answer 39

tip of TP or L5 toward iliac crest

Question 40

post chapman broad ligament

Answer 40

between PSIS and spinous process L5

Question 41

ant chapman fallopian tube

Answer 41

midway from acetabelum and sciatic notch

Question 42

chapman for spastic constipation or colitis

Answer 42

TP of L2, TP of L4 and traingular area reaching across to iliac crest

Question 43

Tx areas for hyperemesis gravidarum

Answer 43

C2 and T5-9

Question 44

expect what SD in late structual stage

Answer 44

pelvis rotated anterior increase in lumbar lordosis compensatoy thoracic kyphosis

Question 45

Tx for late structural stage

Answer 45

``` fascial release (direct/indirect) anterior counterstrain points L3-5 may help round ligament pain Tx sacrum and pelvis with any modality comfortable to patient ```

Question 46

spinal changes in mid to late pregnancy

Answer 46

increased lumbar lordosis increased thoracic kyphosis increased cervical lordosis

Question 47

when is the congestive stage of pregnancy

Answer 47

28-36 weeks

Question 48

what occurs in congestive stage

Answer 48

gravitational effects on the uterus accentuate abdominal fascial drag on inguinal tissues increase interstitial fluids increase uterus size

Question 49

what cuases edema in congestive stage

Answer 49

the increased uterus can become a vlave to the vv of lower extremity some some get hypotensice if supine

Question 50

common complaints during congestive stage

Answer 50

loss of balance, back pain, gait changes | GERD, constipation, hemorrhoids, leg edema

Question 51

techniques for congestive stage

Answer 51

myofascial, soft tissue, effleurage, petrissage

Question 52

viscerosomatics for upper GI

Answer 52

T5-9

Question 53

viscersomatics to adrenal, ovaries and uterus

Answer 53

T10-L2

Question 54

why avoid cranial Tx in congestive stage

Answer 54

may induce uterine contractions

Question 55

Tx what areas in congestive stage

Answer 55

sacral, lumbar, thoracic, cervical

Question 56

what typ eof lymph in congestive stage

Answer 56

pectroal traction

Question 57

how do you treat thoacolumbar jucntion in congestive stage

Answer 57

diaphragm and vertebrae

Question 58

goal of preparatory stage of pragnangcy

Answer 58

maintain good structural balance and lymphatic flow

Question 59

how do you influence contractions via sympathetics

Answer 59

work thoracic spine

Question 60

what will Tx sacral base do in labro

Answer 60

influence cervical dilation via parasypathetics

Question 61

what can be used to influence uterine contractions

Answer 61

CV4

Question 62

when do start recorvery and maintenance stage

Answer 62

post partum day 2

Question 63

goal of first recovery and maintenance visit

Answer 63

screen SD assist body to return to normal state evaluate sacrum

Question 64

a bilateral flexed sacrum and extended L5 is assoc with what Sx

Answer 64

fatigue, depression and low energy

Question 65

when is the final visit for recovery and maintenance

Answer 65

6 weeks post partum

Question 66

plan for final recovery and maintenance visit

Answer 66

screen SD review strucutal changes advise follow up for chronic problems