OPP First Exam

Question 1

effleurage

Answer 1

A delicate stroking motion in massage

To compress underlying subcutaneous tissue, and move fluid into and along lymphatic channels
Moves distal to proximal

Question 2

Stretching/Traction

Answer 2

Separation of the origin and insertion of a muscle with forces applied parallel to the long axis of the muscle.

Question 3

Kneading

Answer 3

Force applied perpendicularly to the long axis of the muscle (like a bowstring is deformed)

Question 4

Describe the technique of inhibition and how its applied for various size muscle groups.

Answer 4

Consists of a slow application of pressure, held to the point of muscle relaxation, followed by a slow release of pressure.

For large flat muscles the heel of the hand is often used.
For smaller muscles inhibition is applied by the thumb or first finger

Question 5

List the five models of osteopathic care and each of the treatment goals associated with them.

Answer 5

Bio-mechanical: Adjustment and mobilization of joints.
Respiratory-Circulatory: Improve all of the diaphragm restrictions in the body.
Neurologic: Attain autonomic balance and address neural reflex activity.
Metabolic-Energy: Enhance the self-regulatory and self-healing mechanisms and energy conservation in the body.
Behavioral: Improve the bio,psych, and social components of health.

Question 6

What are the four osteopathic principles and how do they relate to health and disease states?

Answer 6

1. The body is a unit; the person is a unit of body, mind, and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance
3. Structure and function are interrelated.
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function

compressed: 1) unity 2) self-regulation 3) S&F 4) recap

Question 7

Define haptics

Answer 7

The study of the properties of touch;especially the hand.

“the hand ends at the brain”

Question 8

Define mechanotransduction, and why it’s such a big deal in osteopathy

Answer 8

The conversion of external stimulus into an internal cellular change.
It’s a big deal b/c mechanical forces can stimulate cell proliferation and vascular remodeling which are critical components to wound healing and tissue expansion.

Question 9

Describe how ridges augment the sense of touch

Answer 9

Enhance grip as they provide more points of contact

Each ridge has a sweat gland which helps with grip and friction

Question 10

Describe the value of touch for communication, diagnosis and treatment.

Answer 10

Communication- caring, competence, and confidence
Diagnosis by palpation- sensitivity needed to find somatic dysfunction
Theraputic-basis of OMT

Question 11

Define fascia

Answer 11

Unites all aspects of the body. Acts like a packing system and organ cushion. Complete with blood supply, drainage, and innervation. It has irregularly arranged fibrous element of different densities and is involved in tissue protection and healing of surrounding systems.

Question 12

What is the function of fascia

Answer 12

To provide a distensible cushion for the protection and covering of multiple body systems, facilitated by its cellular elements and viscoelastic properties.

Provides a plane for the movement of lymph, nerve fibers, and blood vessels through the body and is important in wound healing a tissue repair in this capacity

Question 13

Describe the four fascial layers

Answer 13

Panniculus/superficial-surrounds the entire body

Axial/investing- internal layer forms epimysium of skeletal muscle, periosteum of bone, peritendon of tendon

Meningeal/third layer-surrounds the nervous system

Visceral/fourth layer- surrounds the viscera and body cavities, in addition to serving as a conduit for neuro, vascular and lymphatic bundles

Question 14

Describe the cellular elements of fascia

Answer 14

Fibroblasts-principle cell type
Myofibroblasts-act like smooth muscle and give fascia the ability to contract
Macrophages, mast cells, and integrins.
Integrins: Are transmembrane receptors that initiate cell signaling related to mechanotransduction (ECM); its ligands include laminin.

Question 15

Explain two biomechanical and two viscoelastic properties of fascia.

Answer 15

Creep-stretches under a load

Compliance-term for cranial sutures “smaller creep”

Hysteresis- restoration of resting length will be a split between the viscous and elastic models. It has viscoelastic properties

Time frequency dependent length-tension: high frequency stretch responds differently than a slow one.

Question 16

What is a common clinical presentation of a fascia strain? How does the function of fascia relate to its associated clinical pathologies?
What is one common denominator among those with fascial pathologies?

Answer 16

Patient presentations may be in the form of limited range of motion

Fascia forms pathway for lymphatic vessels, arteries, veins, and nerves.
• Torsion of these pathways hinder the functions of these vessels and nerves

Many human pathologies are related to abnormalities in mechanotransduction.

Question 17

What are the seven landmarks of the LMGL?

Answer 17

External auditory meatus
lateral head of the humerus
midbody of L3 (spine of scapula)
anterior 1/3 of sacrum
greater trochanter
lateral condyle of the knee
lateral malleolus

Question 18

what are the 6 landmarks of uneveness?

Answer 18

mastoid process
acromioclavicular joint
interior angle of the scapula
iliac crest
PSIS
greater trochanter

Question 19

What are a few indications of soft tissue injury?

Answer 19

TART

Question 20

What’s the benefit to working on soft tissue injuries?

Answer 20

Relaxes hypertonic muscles, increase elasticity of fascial tissues, improves abnormal reflex activity

Question 21

What are some contraindications related to working on soft tissue injuries?

Answer 21

Skin disorders, most acute disorders: strains of the ligaments, and muscles. DVT, bleeding disorders etc

Question 22

What major events in osteopathic history happened in 1874, 1892, 1910, and 1962?

Answer 22

1874-AT Still quits mainstream medicine and moved toward osteopathy
1892-American School of Osteopathy in Missouri opened (ATSU-KCOM)
1910- Abraham Flexner releases report on the state of medical education, resulting in stricter requirements in the medical education cirriculum.
1962- CA predicament: MD-DO merger didn’t work resulting in a revival of Osteopathic medicine in CA.

Question 23

What impact did WWII have on the medical education of osteopathic physicians?

Answer 23

There was a major effort to change the old limited practice laws. These efforts combined with changes in osteopathic education enabled the enactment of new practice laws in all 50 states.

Question 24

What are the 3 components of the lymphatic system?

Answer 24

Collecting system
Lymphatic tissue/organized
Lymph

Question 25

Where does the lymph that drains into the deep pelvic node come from?

Answer 25

Ovaries, testicles, and prostate

These do NOT drain into the inguinal nodes

Question 26

What is the longest lymph vessel in the body? Where does it begin and what important structures does in pass through?

Answer 26

Thoracic duct which passes through the diaphragm and begins as the cysterna chyli.

Question 27

Where does the right lymphatic duct and thoracic duct drain?

Answer 27

Between the subclavian and internal jugular vein (on both sides) as they converge to form the brachiocephalic vein.

Question 28

Which organ produces half of the bodies lymph? When combined with which other organs does this number become 2/3rds ?

Answer 28

liver

intestines

Question 29

What is a lymphagion?

Answer 29

It’s the functional unit of a lymph vessel that lies between two semilunar valves

Question 30

What are the 4 basic functions of lymph?

Answer 30

Maintain body fluid balance in the body
Purifies and cleanses tissues
Defense-transports leukocytes
Nutrition-fat soluble vitamins

Question 31

What are some of the effects of edema?

Answer 31

Compression of lymphatics as well as blood vessels and nerves
Decreased function
Decreased bio-availability of drugs and hormones, hampers medical management.

Question 32

What are some mechanical factors that affect lymph flow?

Answer 32

Torsion of fascial layers

OA CT TL LS transitional areas, thoracic inlet release and the pedal pumping. OMT to facilitate drainage of lymph

Question 33

What are some indications for lymphatic treatment?

Answer 33

• Acute somatic dysfunction
• Sprains/strains
• Edema, tissue congestion, lymphatic/venous stasis
• Pregnancy
• Inflammation, dermatitis, cellulitis
• Pathologies with significant venous/lymphatic congestion

Question 34

Who developed the system of diagnosis and treatment of fascial patterns?
What are the four reference area?
What’s so special about these areas?

Answer 34

Dr. Gordon Zink

• Craniocervical (OA)
• Cervicothoracic (CT)
• Thoracolumbar (TL)
• Lumbosacral (LS)

Transitional zones are areas in the vertebral column where there is significant change in anatomical structure. Anatomical changes create potential for greatest functional change.

Fascial twisting, especially at junctional areas, tends to impede flow to lymphatics traveling through these areas.

Question 35

What are the 4 common ways the body responds to postural disturbance?

Answer 35

Alternating directions of spinal curve and fascial preference

Tends to slightly overcorrect

Body curves tends to alternate from one spinal region to the next to support and maintain postural balance.

The body’s reaction to a disturbance of posture tends to occur above and below initial disturbance.

Question 36

What are some factors that lead to postural compensation?

Answer 36

Traumatic decompensation
personal habits, activities, or changes
abnormal gait

Question 37

How does the diaphragm facilitate lymph flow?

Answer 37

When the diaphragm contracts allowing for inspiration, the vena cava dilates at the hiatus allowing more blood to pass from the abdomen to the thorax. In a similar manner the diaphram helps to move lymph up to the right lymphatic duct and thoracic duct.

Question 38

Name a few intrinsic and extrinsic forces affecting lymph flow

Answer 38

extrinsic- skeletal muscle contraction, repiration

intrinsic- lymphangion contractions, sympathetic innervation