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OPP > OPP Final 12/19/2022 > Flashcards

OPP Final 12/19/2022 Flashcards

1
Q

Free nerve endings that are non-encapsulated, responsive to noxious stimuli

A

Nociceptors

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2
Q

Two types of pain fibers

A
  1. A(delta) - responsive to intense and mechanical stimuli; myelinated fast
  2. C fibers - responsive to various stimuli; non myelinated so thinner
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3
Q

How is pain suppressed?

A

The brain sends signals to inhibit pain input, blocking signals, also substance P inhibits AP from pain receptors. Interneurons change polarity of post synaptic so it can’t receive info from presynaptic neurons, usually inhibitory

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4
Q

What are two pathway of ALS (anterior lateral system)?

A

primary neuron is afferent, secondary are neurons in thalamus, and third is neurons in cortex. Neospinothalamic - fast adelta fibers, glutamate mediated, terminates in brain stem, thalamus, and lamina. Paleospinothalamic tract - slow C types, glutamte and substance P mediated

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5
Q

Describe the brain’s analgesia system.

A

Brain can suppress afferent pain signals. Periaqueductal gray and periventricular areas send signals to the raphe magnus nucleus. These efferent signals then travel to the pain inhibitory complexes in the dorsal horns of the spinal cord this blocks further afferent pain signals and withdrawal reflexes

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6
Q

How is pain suppressed?

A

Brain blocks afferent signals, pain receptors barely adapt so this makes you aware of tissue damage persisting

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7
Q

What does the ALS examine?

A

pathways to consciousness via secondary neuron to thalamus, and tertiary neuron to cortex

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8
Q

Fast Adelta fibers, glutamate mediated, terminate in lamina, excites second order neurons, decussate through anterior commissure, and terminates in brain stem/thalamus

A

Neospinothalamic

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9
Q

Older system, slow C fibers, glutamate and substance P mediated, terminate in lamina, excite second order neurons, decussate through anterior commissure

A

Paleospinothalamic

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10
Q

What is analgesia systems?

A

Periaqueductal gray and periventricular signals areas to raphe and nucleus reticularis. Brain suppresses affents via efferents that go to pain inhibitory complexes of dorsal horn.

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11
Q

How do drugs inactivate pain pathways

A

Exogenous opiates, endogenous opiates, these bind to mu receptors in brain and spinal cord which alter excitability of receptors. OMM can increase endogenous opoids

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12
Q

What are characteristics of visceral pain?

A

C type fibers, recruits nerves T1-S2, thalamus relays to insular cortex. You can’t always tell where pain is coming from because convergence of multiple AP

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13
Q

A non-noxious stimulus is painful

A

allodynia

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14
Q

How does sensitization occur?

A

raised resting membrane potential causes neuron to exists in a hyper-excitable state, less stimuli is required for AP. Leads to allodynia

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15
Q

A noxious stimulus is more painful than expected

A

Hyperalglesia

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16
Q

Greater noxious stimulus is required to trigger AP with pain shooting directly to max. intensity and long lasting

A

hyperpathia

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17
Q

Maintenance and Exacerbation of somatic dysfunction is cased by…

A

chronic inflammation, vasoconstriction, and muscle spasm

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18
Q

What are some red flags for back/costal pain?

A

bladder/bowel incontinence, acute onset for kids and elderly, neuro defects, explained weight loss/gain, IV use, immunosuppression, or history of malignancy

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19
Q

Funneled breast, genetically from marfan’s, cobbler chest. Associated with mitral valve prolapse, can compromise cardio pulm

A

Pectus excavatum

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20
Q

Pigeon breasted, comes from rickets, marfan’s, Congenital heart disease, kyphoscoliosis

A

Pectus carinatum

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21
Q

Kyphosis, COPD, emphysema

A

barrel chest

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22
Q

Rib Fracture

A

very localized, stabbing piercing pain treat with OMM on opposite side, C3-C5 treatment. Also use braces, opiates unless respiratory dysfunction, no injections

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23
Q

When 3 or more ribs are fractures in 2 places, floating segment of rib will exhibit paradoxial motion

A

This is flail chest, don’t treat with OMM because high respiratory morbidity

24
Q

When pain is localized to costal cartilage, usually dull unless palpated, aggravated by shoulder motion, usually symmetric at 3rd, 4th, 5th ribs

A

Costochondritis

25
Q

How can you treat costochondritis?

A

treat restrictions with counterstrain, but if true costchondritis use lidocaine patch, NSAIDs, oral injection

26
Q

Which regions of visceral pain cause costal pain?

A

Heart, lungs, esophagus, Stomach, liver, pancreas. Look for somatic dysfunction

27
Q

Cardiac causes of costal pain

A

mycardial infarction, can feel heart beat, tachycardia, pericarditis

28
Q

Swelling irritation of thin tissue around heart, increases with deep breathe caused by irritated layers rubbing on each other

A

pericarditis

29
Q

Respiratory causes of costal pain

A

COPD, Pneumothorax, Coughing, Sneezing, pleurisy

30
Q

Inflammation of pleura, pleural friction rub head of ausculation

A

Pleurisy. Parietal is pain sensitive, and visceral is not. Treat with OMT depending on underlying cause

31
Q

Fractured rib

A
32
Q

Gastrointestinal causes of costal pain

A

cholecystitis, GERD, pancreatitis, IBS

33
Q

Pain can radiate up to right shoulder, pain against lower ribs due to gallbladder

A

Cholecystits

34
Q

Mimic heart attack, normally pain in mid ribcage, inflamed diaphragm

A

GERD

35
Q

What are dermatological and infectious causes of costal pain?

A

Herpes zoster, pleurisy, Tietze, osteomyelitis, sclerodoma

36
Q

“hard skin”, systemic sclerosis, caused by autoimmune disorder to CT; symptoms Raynaud phenomenon, puffy fingers, edema with erythema

A

scleroderma

37
Q

Infection of bone due to spread from direct inoculation, usually with swelling

A

osteomyelitis

38
Q

Classic dermatomal rash can be preceded by neuralgia

A

herpes zoster

39
Q

Herpes Zoster treatments

A

use OMT to treat at level of rash, abdominal pump, splenic stimulation. Medications: Valacyclovir, Famcyclovir, Acyclovir

40
Q

fusiform swelling, often 2nd 3rd costal cartilages, can be post parvovirus

A

Tietze which you can treat with OMT, lidocaine patch, NSAIDs, corticosteroids

41
Q

Costal Diagnosis

A

when ribs are stuck in inhalation or exhalation, asymmetric position, asymmetric motion

42
Q

What are the key ribs of inhalation and exhalation?

A

For inhalation it’s the bottom rib. For exhalation it’s the top rib

43
Q

What’s treatment to fix inhalation?

A

Respiratory assist - resist inhalation, follow exhalation 5-7 times then release

44
Q

What’s treatment to fix exhalation?

A

since muscles move bones, use the muscles attached to the ribs

45
Q

A muscle in space

A

when it contracts both sides pull towards middle, hold one side down so the free side contracts towards fixed side

46
Q

Scalene muscles

A

connect cervical vertebrae to ribs 1-2

47
Q

Pectoralis minor

A

connects coracoid process to ribs 3-5

48
Q

Serratus anterior

A

attaches the scapula to the ribs 6-8

49
Q

Latissimus dorsi

A

Connection between 9-10 ribs to thoracolumbnar fascia

50
Q

Quadratus lumborum

A

connects iliac crest to rib 12 (which pulls rib 11 with it)

51
Q

What if tight scalenes pull ribs 1 & 2 up?

A

Do post isometric relaxation, stretch scalenes to restrictive barrier. Have patient push head to ease 3-5 seconds, resist, then reposition patient to new barrier 3-5 times. Reassess

52
Q

articulate with sternum via their costal cartilages

A

ribs 1-7

53
Q

articulates with vertebral body

A

head of rib

54
Q

extends from head and terminates at the tubercle

A

neck of rib

55
Q

comprises an articular facet where the rib articulates with the transverse process

A

tubercle

OPP (25 decks)

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