OS Fall 2019 Midterm Flashcards
1
Q
What are the 7 components of the lateral gravitational line?
A
- external auditory canal
- lateral humeral head
- 3rd lumbar vert
- Anterior 1/3 sacrum
- Greater trochanter
- Lateral condyle of knee
- Lateral malleolus
2
Q
What plane and axis are used in side bending?
A
plane: frontal/coronal
Axis: AP/sagittal
3
Q
What plane and axis are used in flexion and extension?
A
Plane: sagittal/AP
Axis: Transverse
4
Q
What plane and axis are used in rotation?
A
Plane: horizontal/transverse
Axis: longitudinal/vertical/superior to inferior
5
Q
What are the 4 ROM qualities?
A
- Smooth- normal
- Ratcheting (ex: Parkinson’s)
- Restricted- contracture or SD
- Resistance to motion (ex: cerebral palsy)
6
Q
Whats static flexibility?
A
maximal ROM from external force
7
Q
what is the definition of flexibility
A
ROM in which joint(s) can effectively and completely move
8
Q
What is dynamic flexibility?
A
ROM of athletic in which they apply speed
9
Q
What is the concept of coupled motion in regards to joints? What joint specifically?
A
Consistent association of motion along 1 axis with another motion along a 2nd axis. The principle motion can’t be produced without associated motion occurring as well
-spine, each motion differs along different spinal segments
10
Q
What is the functional unit of the spine?
A
2 vertebrae (joint b/t vertebral bodies and joint b/t articulating processes) and their associated neuromuscular and soft tissue structures
11
Q
What is the flexion and extension ROM values for the cervical spine?
A
Flex: 45-90
E: 45-90
12
Q
What is the flexion and extension ROM values for the thoracic spine?
A
F: 25
E: 30
13
Q
What is the flexion and extension ROM values for the lumbar spine?
A
F: 40-90
E: 20-45
14
Q
What should be the normal arm span to height difference?
A
Height should be longer/taller than arm span
15
Q
Osteogenesis Imperfecta
A
genetic bone disorder characterized by fragile bones that break easily. It is also known as “brittle bone disease.”
- Pt has blue sclera indicating multiple fractures
- fractures in utero
- bone has calus formation
16
Q
Alport syndrome
A
genetic condition characterized by kidney disease, hearing loss, and eye abnormalities
-can have CT issues
17
Q
Menkes disease
A
X-linked recessive disorder caused by mutations in genes coding for the copper-transport protein ATP7A, leading to copper deficiency
-kinky hair, growth failure, and nervous system deterioration
18
Q
Ehler-Danlos syndrome
A
-collagen synthesis dysfunction: joint abnormality and stretchy skin
19
Q
Beighton scale: hyper mobility score
A
Points: 0-9
1 pt for Touching palm to floor
1 pt for each Pinky hyperextends to 90 degrees
1 pt for each thumb that touches forearm
1 pt for -10 hyperextend knee of each knee
1 point for each elbow that bends backwards to -10
20
Q
Breighton criteria scale, major
A
Major:
- Beighton score >4
- Arthralgia for > 3 months in 4+ joints
21
Q
Marfanoid habitus
A
wing span > 1.03 ration, upper segment less than lower segment >0.89 ratio, or arachnodactyly
22
Q
occular signs
A
drooping eyelids, myopia, antimongoloid slant
23
Q
Breighton criteria scale, minor
A
Minor:
- Beighton score 1-3
- Arthralgia >3 months in 1-3 joints, back pain >3 months, or spondylosis/spondylolysis/spondylolisthesis
- dislocation or sublimation in 1+ joints on more than 1 occasion
- 3+ ST lesions (epicondylitis, tenosynovitis, bursitis)
- marfanoid habitus
- skin striae, hyperextend, thin skin, abnorm scarring
- occular signs
- varicose veins, hernia, uterine or rectal prolapse, mitral valve prolapse
24
Q
What are the requirements for Ehler-Danlos
A
Any two of following:
- 2 major criteria
- 1 major, 2 minor
- 4 minor
- 2 minor criteria and affected 1st degree relative
25
Treatment plan for Ehler-Danlos
1. PT: strengthen muscles around joints
2. medications to control pain (non-narcotic)
3. surgery to repair joints
26
Myofascial dysfunction
tight elastic end point
| -scar tissue
27
lymphatic dysfunction
empty, boggy end feel
- lymphedema
- visceral dysfunction (CHF)
- acute injury (sprained ankle)
28
neural somatic dysfunction
crisp, empty end feel
- herniated disc
- thoracic outlet syndrome
29
ulnar-humeral (elbow) flexion ROM degree
140-150
30
ulnar-humeral (elbow) extension ROM degree
0 to -5
31
ankle dorsiflexion ROM degree
15 to 20
32
ankle plantar flexion ROM degree
55-65
33
ankle inversion ROM degree
20
34
ankle eversion ROM degree
10 to 20
35
wrist flexion ROM degree
80-90
36
wrist extension ROM degree
70
37
wrist adduction/ulnar deviation ROM degree
30-40
38
wrist abduction/radial deviation ROM degree
20-30
39
knee flexion ROM degree
145-150
40
knee extension ROM degree
0
41
c-spine rotation ROM degree
70-90
42
c-spine sidebending ROM degree
20-45
43
c-spine extension ROM degree
45-90
44
c-spine flexion ROM degree
45-90
45
lumbar spine sidebending ROM degree
15-30
46
lumbar spine flexion ROM degree
40-90
47
lumbar spine extension ROM degree
20-45
48
lumbar spine rotation ROM degree
3-18
49
hip flexion (knee extended) ROM degree
90
50
hip extension ROM degree
15-30
51
hip flexion (knee flexed) ROM degree
120-135
52
hip adduction ROM degree
20-30
53
hip abduction ROM degree
45-50
54
hip external rotation ROM degree
40-60
55
What are 4 outside environmental stressors to the 5 systems?
1. trauma
2. infection
3. nutrition
4. social
56
disease states associated with biomechanical system
- SD
- ineffective posture
- joint motion restriction or hyper mobility
- instability
57
disease states associated with resp-circ system
vascular compromise, edema, tissue congestion, poor gas exchange
58
disease states associated with neuro system
abnormal sensation
imbalance of ANS function
Central and peripheral sensitization/malfunction
pain syndrome
59
disease states associated with metabolic energy
```
fatigue
ineffective metabolic processes
toxic waste build
inflammation
infection, poor wound healing
poor nutrition
adverse med response
loss of endocrine control
```
60
disease states associated with behavioral systems
- ineffective secondary to drug abuse
- environmental chemical exposure or trauma
- poor lifestyle choices (inactivity, dietary)
- inability to adapt to stress or environment
61
How is energy loss determined?
hysteresis
62
____ CT into it's ____will bring about a ___ of the tissue?
stretching, plastic deformational range, lengthening
63
CT under a _____will elongate (deform) in response to the load
sustained, constant load
64
What is the resile of fascial restriction?
abnormal myofascial and joint abnormality
65
For every tightness, there is a 3D related looseness. Commonly, the looseness is in exactly the ___direction from the tightness.
opposite
66
What is strain (deformation) proportional to?
stress (force) placed upon it
67
direct myofascial technique
towards and through restrictive barrier (against name of SD)
| -engage w/ loaded, constant, directional force
68
indirect myofascial technique
away from restrictive barrier and towards name of SD
- tissue position of ease ID
- engage with direct pressure
- guide tissues along line of least resistance until free movement of all tissues occurs
69
integrated neuromusculoskeletal release (INR)
treatment system in which combined procedures are designed to stretch and reflexively release patterned soft tissue and joint related restrictions
70
soft tissue, direct
- directly applied to muscular and fascial structures
- also affects neural and vascular
- improves articular motion (historically fundamental to OMT)
- wide range of force applications: perpendicular, longitudinal, inhibitory
71
the ___is the place to look for the cause of disease, the place to consult and begin action of remedies in all diseases. Who said this
fascia
| -AT Still
72
tendons, ligaments, aponeurosis - what are these 3 things not?
fascia
73
What is fascia made of?
1. collagen
2. elastin fibers
3. hydrated proteoglycans (link together collagen network)
- 95% ECM and 5% cells
74
endomysial fascia
investing muscle fibers
75
fascia functions (2)
1. mobility and stability
| 2. support/stabilize
76
contractile cells of fascia
myofibroblasts-->fibroblasts
77
healing cells of fascia
macrophage and mast
78
c-fibers
unmyelinated, small diameter, low conduction velocity
79
piezoelectric
generate electric charge in response to mechanical stress
80
indications for soft tissue technique
- ID restricted motion, tissue texture change, sensitivity
- feedback regarding OMT tissue response
- improve local and systemic immune response
- relaxation
- enhance circulation
- tonic simulation
81
indications for MFR/INR
- SD: all soft tissues or joint restrictions
- HVLA or muscle energy contraindicated
- counterstain may be difficult secondary to pt being unable to relax
82
Goals of soft tissue technique for tissue texture abnormalities
1. stretch and increase elasticity of shortened myofascia to return symmetry
2. improve local tissue nutrition, oxygenation, removal of metabolic waste
83
Goals of soft tissue technique for asymmetry of muscle
(hypertonis muscles and muscle spasms)
| -return symmetry and normalize tone
84
Goals of soft tissue technique for tenderness (myofascial restriction)
release fascia
85
Goals of soft tissue technique for restricted ROM (abnormal neuro activity)
normalize neurologic activity (pain, guarding, proprioception) and improve abnormal somato-somatic and somato-visceral reflexes
86
How are soft tissue forces applied?
- gentle and low amplitude, can increase amplitude in response to tissues but rate remains same
- rhythmically for 1-2 sec
87
knead
repetitive pushing of tissue perpendicular to muscle fibers
88
inhibition
- push or hold perpendicular to fibers at musculotendinous part of hypertonic muscles
- hold until tissue relax
89
what are the 3 planes of restriction assessment for thoracolumbar MFR release?
1. flex/extend
2. rotation
3. side-bending
90
3 activating forces
1. inherent: using body primary respiratory mechanisms
2. resp cooperation: inhalation, exhalation, or holding breath to assist with manipulation
3. patient cooperation: move in specific directions to aid in mobilizing areas of restriction
91
3 palpable MFR treatment endpoints?
1. 3D release: warmth, softening, increased compliance/ROM
2. continuous application no longer produce change
3. symmetry after re-check
92
what does inherent (intrinsic) force work to improve?
bodys homeostasis (hydrodynamic and bioenergetic factors) around restricted tissues and articulations
93
4 types of respiratory force used for activating force during MFR
1. full cycle effort
2. particular phase of respiration: enhance position of treatment area
3. breath holding: release for general relaxation
4. coughing or sniffing: produces respiratory impulse to assist in tissue release
94
who is William Budd and what years was he alive?
1811-80
| epidemiology to prove cholera came from contaminated water source in Bristol
95
John Snow
1813-58
| -epidemiology to trace source of cholera outbreak in London in 1854
96
Ingaz Semmelweiss
1818-65
| -obstetrical clinic decreased mortality by 90% through hand washing, ironically died of infection
97
Joseph lister
1827-1912
- father of antiseptic surgery
- reduced surgical mortality from 45 to 15%
98
Robert kosh
isolated anthrax
99
Louis pasteir
discredited spontaneous generation
100
Nils Finsen
1860-1904
| -UV light in medicine
101
Wilhelm Rontgen
first to systematically study xrays
102
When were x-rays first used diagnostically?
1896
103
Conquer disease
if enough force were used, it would cast out demons
104
heroic medicine
- stimulants if patient was drowsy
- hypnotics if patient was agitated
- purgatives and cathartics were high as well as blood letting
105
AT still bday
august 6, 1828 in lee county, Virginia
106
AT still parents
father: abram (doctor)
mother: Martha (uneducated)
107
When did AT still make a rope swing to treat headache
1839
108
1849 AT still significance
married Mary Margaret Vaughn
109
1850 AT still significance
took over mission in Eudora, KS
110
1855 AT still significance
studied anatomy in Indian kadavers after cholera epidemic
111
1857 AT still significance
elected to Kansas legislature and active in anti-slavery movement
112
1859 AT still significance
Mary Margaret dies leaving him with 3 kids (2 died within days of birth)
113
1860 AT still significance
marries Mary Elvira turner
114
1861-64 AT still significance
flights in civil war (union) highest rank a major
115
1864 AT still significance
battle of Westport (KC) and 3 kids died from spinal meningitis and another from pneumonia so he returned home to farm to formulate change for medicine
116
10 AM June 22, 1874
AT Still flung banner of osteopathy to the breeze, spread news
117
1874 AT still significance
- presents new ideas to Baker university
- formally removed from Methodist church
- 1st "recorded" OM treatment in Macon, MO
118
1875 AT still significance
moved family to Kirksville, worked as traveling dr
119
1885 AT still significance
coins term "osteopathy"
| -continued to advertise as bone setter until 1890
120
1886 AT still significance
busy enough that he was able to stay and practice in Kirksville, unsuccessful apprentice of assistants
121
1892
American school of osteopathy opens
122
How many students were in first osteopathic class
22, 5 included his children
123
who were the first osteopathic class professors?
AT Still and Dr. William Smith
124
how many females were in the 1st osteopathic class
5
125
1894 AT Still significance
2nd class begins, 2nd year course was $500
126
How large was enrollment in 1895
28
127
how large was enrollment in 1896
102
128
how large was enrollment in 1900
700 students with 18 faculty
| -12+ sister schools started by graduates
129
1897 AT Still significance
AT still autobiography published
130
1899 AT Still significance
Philosophy of Osteopathy published
131
1910 AT Still significance
Research and Practice published and Mary Elvira dies (married 50 years)
132
1917 AT Still significance
death @ age 89
133
1953 AT Still significance
consensus statement of osteopathic philosophy
134
What year did MO grant DO licensure?
1897
135
What year and state was first legal DO license granted? Which state followed?
1896 in Vermont, followed by ND
136
What year was American Association for Advancement of Osteopathy (AAAO) founded?
1897
137
When did AAAO become American Osteopathic Association
1901
138
When did AOA adopt standards for approving osteopathic colleges?
1902
139
When did AOA start inspecting schools?
1903
140
What year was KCU founded? What 2 men established it? What was its original name?
1916 as KC College of Osteopathy and Surgery
| -established by AA Kaiser, DO and George Conley, DO
141
What feud happened in 1922?
AMA declares unethical for MD to associated with DO "cult"
142
When were student loan funds established and osteopathy sealed?
1931
143
What year was a low-point for DO enrollment?
1945 with 556 students
144
When were DO residencies first approved?
1947
145
What was the last state to grant DO licensure?>
Mississippi
146
What did KCCOS change its name to in 1980
KCCOS to University of Health Sciences College of Osteopathic Medicine
147
How many DO schools are there today?
33, 48 teaching locations, 27500 students
148
Today, how many DOs are there in the US?
102,200 (56% in PC)
149
What year were DO's accepted as equals to MD?
1963
150
Who first commissioned DOs into armed forces?
Harry J Walter in 1966
151
Who was the 1st Woman to receive DO degree?
Jeanette Bolles (also VP of AAAO)
152
Who was the 1st women graduate from KCU?
Mamie Johnston in 1917, but graduated in 1918 because curriculum changed to 4 year
- joing faculty in 1919, taught gyn and peds
- retired in 1981 (92! years old)
153
Who was the first female dean of a medical college?
Barbara Ross-Lee at Ohio University and 1st DO to win Robert Wood Johnson Health Policy Fellowship
154
What year was the National osteopathic Women Physician Association established?
1988
