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Block 4 > OMM > Flashcards

OMM Flashcards

1
Q

cardiac risk equivalents. risk factors for CAD

A

Symptomatic carotid artery disease, PAD, AAA, CKD. >65yo esp older women, men > women generally, race, tob, chol, HTN (best to be <115/75), DM, obese/metab syndrome, stress

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2
Q

Framingham offspring study. Framingham heart study

A

inc BMI –> inc risk of CAD. inc risk if fhx premature CAD on dad <55yo or mom <65yo –> better to screen earlier for pos fhx than age of dx of relatives

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3
Q

dx metab syndrome via 3 of 5 traits

A

waist circumference (men >40in, women >35in), TG >150, low HDL (men/peds <40, women <50), fasting glu >100, bp >130/85

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4
Q

no exer vs smoke vs no fruit/veg vs no drinking inc CAD risk by what?

A

12% vs 6x women, 3x men vs 14% vs 7%

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5
Q

statins = primary prevention –> prevent 1-2 attacks in 100ppl who take it for 5y. but what are we underestimating? SLCO1B1*5 variant affect what?

A

risks & side effects. Cochrane review says little to no mortality benefit. statin and catechin metabolism

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6
Q

rib anatomy (5 parts)

A

head articulating w/ vertebrae & one above, tubercle articulating w/ transverse process, neck, angle = handle of bucket, shaft

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7
Q

inhal vs exhal mm. primary vs secondary breathing mm? abd & pel diaphragms during inhal vs exhal?

A

diaphragm –> ctx & flattens, external intercostal –> elev ribs ant vs diaphragm –> passively loosens & domes, internal intercostal –> depress ant. mentioned above vs Scalene, Pec minor, Serratus ant/post, Quadratus lumborum, Latissimus dorsi. abd diaphragm ctxs & moves inf, pel diaphragm relaxes & moves inf vs abd diaphragm relax & moves sup, pel diaphragm ctx & moves sup

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8
Q

good vs bad chest fxn –>

A

dec congestion; inc CO, circ, nutrition, immunity vs dec venous & lymphatic return

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9
Q

ribs can have dysfxn where Tspine has dysfxn –> dmg integrity of costotransverse and/or costovertebral ligamentous articulations. how to tx exhal vs inhal dysfxn vs both w/ goal?

A

improve rib motion & resp fxn, dec pain, inc lymphatics & circ. screen & tx thoracic dysfxn first; ME w/ 2o resp mm vs resp cooperation w/ 1o resp mm, pt’s own resp vs facilitated position release –> indirect, mixed, pt passive, resp –> dec mm hypertonicity & restore lost motion

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10
Q

etio vs clinical tests vs dx criteria for acute MI

A

coronary plaque rupture –> thrombus & blockage; coronary spasm, arrhythmia, anemia, sudden cardiac death vs EKG, CK & troponin, coronary angio vs ischemia + EKG changes, path Q waves, img shows loss viable myocardium or MI; sudden cardiac death + EKG/angio changes; biomarkers >3x w/ PCI or >5x w/ CABG + EKG changes; patho evidence of MI

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11
Q

STEMI vs NSTEMI criteria

A

CP + >1mm ST elev in >2 contig leads or new LBBB –> transmural infarct vs subendocardial tissue

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12
Q

aortic dissection sxs vs PE vs clinical test. if pt <45yo w/ CP doing cocaine?

A

CP radiating to back, HTN vs bp asym in UE, CXR wide mediastinum vs TEE, CT. consider aortic dissection

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13
Q

pleural effusion sxs vs clinical tests. egophany vs parapneumonic effusion vs neoplastic effusion

A

cough, SOB, dyspnea +/- CP, dec breath sounds, dullness to chest percussion vs CXR, thoracentesis. when “e” sounds like “a” vs sxs relating to PNA vs dyspnea alone + systemic sxs –> underlying ca

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14
Q

pericarditis sxs vs PE vs clinical tests. take home points?

A

CP relieved leaning forward; from viral infxn (Coxsackie, echo, adeno), TB, HIV vs friction rub vs echo, EKG -> diffuse ST elev. pericarditis mimics MI; empyema = med emergency -> img and drain

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15
Q

fxns of lymphatic system. 6 components?

A

fluid bal (30L filtered qd, 90% resorbed into capillaries, 10% resorbed to lymphatics), purify & cleanse tissue, T/B cell defense, nutrition by fat/chol/chylomicrons & remove toxins. liver/spleen, thymus, LN, thoracic duct, cisterna chyli

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16
Q

what’s lymphatic fluid? what does it consist of?

A

Ultrafiltrate that leaks out of arterial capillaries into interstitium and back into lymphatic vessels.
o Lymphocytes (the primary cell of lymph)
o Protein and salts
o Postprandial water
o Soluble fats
o Clotting factors
o Bacteria and smaller viruses

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17
Q

Collecting ducts = largest trunks drain into venous system. explain R vs L drainage

A

R thoracic duct -> R subclavian v -> upper right quadrant/1/4 body vs L thoracic duct –> L subclavian v –> 3/4 of body

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18
Q

superficial/palpable vs deep/nonpalpable LN examples

A

Cervical, axillary, supraclavicular, epitrochlear, inguinal vs deep cervical, Intrathoracic, intraabdominal, pelvic, glymphatic system

19
Q

goals of lymphatic tx

A
  • restore function, system & pH bal
  • Removing edema, proper fluid dynamics
  • Increased resorption of fluids, circ & resp
  • Decreased proteins in the interstitium
  • immune response
20
Q

Seq of lymphatic treatments

A
  • Correct somatic dysfunction → remove restriction
  • Open thoracic inlet → removes restriction
  • Doming abd diaphragm → improve effective pressure gradients b/w thoracic and abd cavities; can do in/direct fascials
  • Ischiorectal fossa release → improves ability of pelvic diaphragm to produce effective pressure gradients between pelvic and thoracic cavities
  • Rib raising → reduces sympathetic hyperactivity to lymphatic vessels and inc rib mobility –> enhance resp
  • Lymphatic pump techniques → promotes and augments lymphatic flow
  • Direct pressure techniques → promotes and augments lymphatic flow
21
Q

CI for lymph tx

A

fx/dislocation, bacterial infxn >102, organ friability, malig

22
Q

4 major causes of aortic regurg. diff b/w acute vs chronic AR?

A

Rheum fever, endocarditis (veg of valve), HTN, aortic dissection. causes heart fail or cardiogenic shock vs asx; progressive exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea; chronic = better b/c body has more time to adapt

23
Q

most freq cause vs atrial pressure of mitral stenosis. pulm HTN can occur too but how?

A

rheum fever vs inc LAP -> more fluid in lung interstitium -> dyspnea; -> afib; -> hemoptysis -> thromboembolism. retrograde transmission of LAP, pulm arteriolar constriction, interstitial edema, or obliterative change in pulm vascular bed

24
Q

most common causes vs sxs of mitral regurg

A

MVP, dmged tissue cords that anchor flaps, rheum fever, endocarditis vs chordae tendinae or papillary mm rupture vs inc LV vol overload -> inc LV stroke work -> inc LV filling pressure -> more blood from LV to LA -> high LAP -> pulm edema & dyspnea

25
Q

S3/ventricular vs S4/atrial gallop

A

low pitch in early diastole esp in apex/L lat decubitus. caused by dec compliance, HTN, HCM, inc atrial pressure. in CHF/post MI, preg, athletes vs low pitch in late diastole in apex/supine. caused by dec compliance & stiff LV, HTN, HCM, aortic stenosis -> early MI

26
Q

ROS for CVD vs pulm vs PAD

A

high bp, rheum fever, heart murmurs, CP, orthopnea, paroxysmal nocturnal / dyspnea, edema vs cough, sputum, hemoptysis, dyspnea, abnl CXR vs Intermittent claudication, leg cramps, varicose veins, Raynauds

27
Q

assoc of palpitations vs edema vs syncope

A

anxiety, sleep deprivation, caffeine (& energy drinks!), exertion, Sinus tachy vs L sided dysfunction, progress throughout day and better w/ rest vs if brady– quick onset, if Tachy– “gray out”

28
Q

cardiac vs vasc vs arrhythmic causes of collapse

A

stenosis, cardiomyopathy vs pulm embolism or HTN, air embolism, acute MI, subclavian steal syndrome vs tachy, v/afib w/ fast conduxn, WPW, prolonged QT, Brugada; AV block, afib w/ slow condxn, sick sinus syndrome

29
Q

carotid pulses: Percussion wave vs Tidal wave vs Dicrotic notch. Jugular venous pulse: A wave vs X descent vs C wave vs V wave vs Y descent

A

rate flow in the artery (systolic) vs pressure in artery (diastolic) vs closure of aortic valve.
RA contraction
atrial relaxation
tricuspid closure
RA filling
tricuspid opens

30
Q

symp vs parasymp autonomics to heart

A

pre-ganglionic nucleus intermediolateralis in lat horn spinal cord -> sup/med/inf cervical ganglia -> post-ganglionic cardiac plexus -> inc HR vs pre-ganglionic vagal nucleus in medulla -> Wristberg ganglia -> post-ganglionic sA/AV node -> dec HR

31
Q

how to find PMI?

A
  • Stand patient’s right
  • patient sitting up or left lateral decubitus
  • Palpate w/ fingerpads in the midclavicular line at 5th intercostal space
32
Q

cause vs maneuvers of heart murmurs

A

turbulent flow of blood d/t Stiff/incompetent valves or Septal defects vs Sitting up, leaning forward, holding exhalation; Left lateral decubitus brings heart closer, Valsalva dec venous return, squat inc venous return

33
Q

office based vs stations based PPE

A

PCP involved -> med record, preventive medicine; private; not covered by ins; may not communicate w/ school ATC vs PCP not involved, multispecialty -> no access to med record; not private; communicate w/ school ATC

34
Q

most common anomaly in mid school vs HS/college. anomalies = more common in which demographic? 1st sign of cardiac abnormality =?

A

anomalous coronary aa vs hypertrophic cardiomyopathy. black, males, football, basketball. sudden cardiac death

35
Q

sudden cardiac death vs HCM vs commotio cordis

A

nontraumatic, nonviolent, unexpected w/in 6 of nml health d/t HCM, idio LVH, anomalous coronary aa, commotio cordis vs auto dom structural heart abnlities -> LVH, septal hypertrophy -> obstructed outflow from LV -> distort mitral valve vs blunt trauma to L chest during ventric repol just before T wave peak -> vfib; not involved in structural change

36
Q

screening questions to ask for personal hx vs fhx vs PE

A

CP, unexplained syncope, unexplained fatigue w/ exer, heart murmur, high bp vs disability of premature CAD in relative <50yo vs heart murmur, fem pulses, Marfan, brachial a bp

37
Q

in a screening exam, chk pulses vs bp vs murmur vs arrhythmia

A

r/o coarct & for sym vs both UE vs can be common so do maneuvers; investigate if systolic >3/6, diastolic vs yep

38
Q

when to do EKG vs echo vs cardiac MRI. what other clinical tests can you do?

A

practical & cost-effective; – Long QT, Brugada, ventricular arrhythmia, myocarditis vs HCM, LV wall thickness, congen, annual for pos fhx HCM vs if nml or borderline LVH on echo & still sus for HCM; most useful noninvasive test for identifying structural abnormalities. exer test, holter, tilt table for postural HoTN, electrophysio test for SVT

39
Q

biomechanical vs neuro vs metab vs behavior model goals

A

structural/postural, gait, seg motion to improve ROM of joints, tissue texture, MSK relationships vs restore parasymp dominance vs dec energy requirements & restore homeostasis vs dec somatic dysfxn, limbic system for pain, hypophyseal axis for hormone bal

40
Q

what are the 5 diaphragms. how should they move?

A

diaphragm muscle, pelvic floor, floor of mouth, thoracic outlet, tentorium of the cerebellum. all in same direction at same time; free movement -> pressure gradient -> heart moves fluid/gas better; dec gradient -> passive congestion

41
Q

sites of passive congestion. OMM tx for CHF w/ lower edema? major objectives for this tx?

A

Achilles, popliteal spaces, lateral thighs, inguinal regions, axillary folds, supraclavicular areas, suboccipital areas (boggy tissue texture changes).
1) OPEN the DRAIN (Thoracic Duct) – thoracic inlet/outlet
2) REMOVE the CLOGs - SD, diaphragms, &/or fascial restriction
3) PRIME the PUMP – thoracoabdominal diaphragm
4) Move Fluids – lymphatic pumps (never start with this).
1. dec work of breathing, restore resp
2. unlock venous and lymphatic channels (start central then distal vessels)
3. speed up flow rate in larger vessels to utilize Bernoulli principle for aspiration of smaller tributaries

42
Q

cranial vs pelvic splanchnic nn parasymp

A

occipitomastoid sutures -> jug foramen -> vagus n; anatomically connected to C1/2; sup/inf ganglia ant to O/AA; inf wall MI -> change in C2 & cranial base vs s2-4 lat horns; same organs w/ least splanchnic n

43
Q

what’s on a Marfan vs sickle screen? what’s on a PPE form?

A

tall/thin, long extremities, arachnodactyly/joint hypermobility, high arched palate vs strenuous exer -> hyperthermia, RBC dehydration, metab acidosis, hypoxemia; altitude inc risk. acknowledge risk, confirm ins, HIPAA release, emergency info

44
Q

SD vs autonomic innerv vs somatic innerv vs lymph drainage of CV?

A

OA, low cerv to mid thor, R1/2 elev, lumbosacral compression vs symp T1-4, sup/inf cerv ganglia; parasymp ciliary, otic, submandib, pterygopalatine ganglia vs from cerv somites -> prevertebral/ventral rami, postvertebral/dorsal rami, ansa cervicalis for straps. cerv spinal n = C2-4 for ant/lat neck & post scalp/neck vs glymphatics

Block 4 (18 decks)

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