OSI Flashcards
what are the 3 basic body types?
endomorph, ectomorph, mesomorph
what are the 3 basic body types?
endomorph, ectomorph, mesomorph
person whose body habitus is comprised of tissues predominantly endoderm (obese, fatty)
endomorph
person whose body habitus is comprised of tissues predominantly from endoderm (tall, lanky)
ectomorph
color can be an important indicator in clinical observation. what are some colors to watch out for in patients and what might they mean?
pale- bad red- erythema, inflammation yellow- jaundice (liver disease) blue- cyanosis black- necrosis
what is the proper order for assessing structural diagnosis? (always do structural exam in context of total H&P)
observe, auscultate, percuss, palpate
what factors create asymmetry?
bone or joint deformity, kyphoscoliosis, dress, occupation, mental attitude, habit, lower extremity defects, somatic dysfunction
which of the following is likely to cause postural asymmetry?
a. belt
b. eye color
c. organ transplant
d. anatomical short leg
e. type of muscle tissue
d. anatomical short leg
which of the following is likely to cause postural asymmetry?
a. belt
b. eye color
c. organ transplant
d. anatomical short leg
e. type of muscle tissue
d. anatomical short leg
what are some landmarks we use to assess symmetry of the patients anterior side?
eye level nose angle to midline ear lobe level shoulder height clavicle alignment fingertip level breast crest of ilium angle of patella medial or lateral malleolus
what are some landmarks we use to assess symmetry of the patients posterior side?
shoulder level inferior angle of scapula fingertip level iliac crest height gluteal line popliteal space medial and lateral malleolus
What is TART?
Tissue texture changes
asymmetry
restriction of motion
tenderness
what is active ROM?
patient demonstrates the activity (less than passive)
what is passive ROM?
patient is not active, examiner takes the relaxed limb through ROM (no muscles only ligaments stop motion)
what is an anatomic barrier?
limit of motion imposed by anatomic structure (just beyond passive ROM)
what is an elastic barrier?
range between physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption (between active and passive)
what is a restrictive barrier?
functional limit within anatomic ROM which abnormally diminishes normal range of motion
what is the term we use to describe impaired or altered function of related components of the somatic system: skeletal, arthrodial, myofascial structures and related vascular lymphatic and neural elements
somatic dysfunction
what is OMT
osteopathic manipulative treatment: therapeutic application of manual forces used to improve physiologic function and support homeostasis
term describing the normal feel of muscle in the relaxed state?
tone
(hypertonicity when spastic paralysis)
(hypotonicity when flaccid paralysis)
term describing abnormal shortening of muscle due to fibrosis often resulting from a chronic condition
contracture
what is abnormal contraction of muscle maintained by physiologic need? (hint it often is accompanied by pain and restriction of motion)
spasm (hypertonicity)
state of muscle with increased fluid in hypertonic muscle (like a wet sponge)
bogginess
state of muscle with hard, firm, rope like tone usually indicating a chronic condition
ropiness
what are qualities of vascular textures that indicate acute dysfunction? chronic?
actue: inflamed, peptide release VASODILATION
chronic: sympathetic tone increases VASOCONSTRICTION
what is end feel?
palpatory experience or quality of motion when a joint is moved to its limit or barrier is approached
what are the 4 types of abnormal end feels and an example of each
early muscle spasm- protective after injury
late muscle spasm- chronic
hard capsular- frozen shoulder
soft capsular-synovitis (knee swells after injury)
what is the term for: discomfort or pain elicited by physician through palpation (unusual sensitivity to touch or pressure)
tenderness
what are acute TART affects?
Texture: red, swollen, boggy, increased tone
asymmetry: present
restriction: present and painful with motion
tenderness: sharp pain
What are chronic TART effects?
Texture: dry, cool, ropy, pale, decrease tone
asymmetry: present, compensation occurs
restriction: present (maybe not guarded)
tenderness: dull, achy pain or paresthesias
What are chronic TART effects?
Texture: dry, cool, ropy, pale, decrease tone
asymmetry: present, compensation occurs
restriction: present (maybe not guarded)
tenderness: dull, achy pain or paresthesias
how do we name somatic dysfunction
“where they like to live”
position of ease
if it freely rotates left and is restricted right we name it: rotated left
to decrease the angle between bones of a joint
flexion
what is fryettes principle (#1)
Type 1 mechanics become Type 1 dysfunction!
FP#1. when thoracic and lumbar spine are in neutral position (no flexion or extension), the coupled motion of side bending and rotation occur in opposite directions for each group of vertebrae (to ration occurs toward convexity)
Remember by TONGO (Type One Neutral Group goes Opposite for rotation and side bending )
what happens when someone gets restriction of motion in the spine?
reduce efficiency (as body tries to compensate)
impair fluid flow
alter nerve function
throws off balance
where are flexor muscles of the spine located in relation to the spine
ventral to the spine (anterior)
where are extensor muscles of the spine located?
dorsal (posterior) to spine
if you are assessing a spinal segment and vertebra will not rotate to the right (hard end feel) how would you name this dysfunction?
rotated left somatic dysfunction
what is fryettes principle (#2)
FP#2. when thoracic and lumbar spine are sufficiently flexed or extended, the coupled motion of side bending and rotation in a vertebral unit occur in the same direction (usually occurs in a single segment) rotation is toward the concavity
this type of mechanics occur in lumbar thoracic AND typical cervical spine segments (excluding OA joint)
to chart Type I somatic dysfunction we locate vertebra (or group), indicate position (neutral), indicate side bending and rotation. How would you chart “restriction is to rotation left and side bending right”
T1-3 N R(R) S(L)
Thoracic vertebrae 1-3 in a neutral position are rotated right and side bent left
to chart Type II somatic dysfunction we locate vertebra, indicate position (flexion or extension), indicate side bending and rotation. How would you chart “restriction is to flexion, rotation left and side bending left”
T6 E R(R) S(R)
thoracic vertebra 6 in an extended position is rotated right and side bent left
what is freyettes principle (#3)
initiating vertebral segment motion in any plane of motion will modify movement of that segment in other planes of motion (motions are coupled)
what is PTP on the right a result of ?
PTP: posterior transverse process
result of segment rotated to the right
what type of mechanics are displayed at the OA joint
modified Type I
with type I mechanics, rotation and side bending occur to the ___ side
opposite
with type II mechanics, rotation and side bending occur to the ___ side
same
correct the following:
OA N R(R) S(R)
OA joint follows modified type 1 mechanics so we know R and S occur to opposite sides
correct the following:
C5 F R(R) S(R)
this is correct because C2-7 follow type II mechanics
correct the following:
T6 F R(R) S(L)
T6 in flexion is looking at Type II mechanics so R and S must be to the same side
T6 F R(R) S(R)
correct the following:
L2-4 N R(L) S(L)
think of TONGO
L2-4 N R(L) S(R)
lymphatic development begins at week __ of pregnancy but is significantly present by week __ however it remains immature at birth until 6-9 years
5, 20
what is the largest mass of lymphoid tissue
spleen (beneath ribs 9-11 on the left)
what does it mean that the spleen and liver are pressure sensitive?
movement of diaphragm is important for homeostatic movement of fluid
what is the spleens job?
destroy damaged RBCs
synthesize Igs
clear bacteria
what do we find in the right upper quadrant of the abdomen (palpable)
liver
who is the gate keeper of the shared hepato-biliary-pancreatic vein and lymph drainage
liver
this lymphoid organ is found in anterior mediastinum, it is large in infancy and replaced by fatty tissue as we age
thymus
what is Thymus’s job
maturation of T cells
what are the 3 types of tonsils located in posterior oropharynx
palatine, lingual, pharyngeal
what is the job of tonsils
provide cells to build immunity (esp in childhood)
this little guy is located at the proximal end of the cecum and contains lymphoid pump to help GALT
appendix
what are important features of GI lymph tissue
peyer patches in ileum
lacteals in sm intestine (absorb large chylomicrons into lymph)
where do we find superficial lymph nodes? how bout the deep ones?
superficial- within subQ tissue along superficial veins
deep- beneath fascia, muscle, organs
what is the most highly organized lymph tissue
lymph node
what lymph node characteristics should cause us to look for cuts/ bites/ rashes/ infection near the node
swollen painful node
what LN characteristics should cause us to thing malignancy/ disease
swollen, indurated, nonpainful
what is palpable virchow’s node?
L supraclavicular node (indicates abdominal or thoracic cancer)
what does palpable supratrochlear node indicate?
SYPHILIS
do lymph vessels have valves?
yep (low pressure needs to prevent back flow somehow)
vessels perfuse all body tissues except what??
bone marrow
epidermis
cartilage
muscle endomysium
what composes lymph fluid?
proteins, electrolytes, immune cells, Ags, bacteria, viruses, clotting factors, chylomicrons (after eating)
what is the largest lymph vessel between aorta and azygous vein? what does it pierce? which side of the body does it drain?
thoracic duct
pierces sibson’s fascia
left side (and both sides below umbilicus)
this is a dilation of the distal thoracic duct anterior to L1-2 and posterior to right crura of diaphragm receiving lymph from R and L lumbar lymphatic trunks
cisterna chyli
what drains into the right lymphatic duct?
R arm, head, neck, thorax
heart
lungs (except left upper lobe)
valves that prevent back flow of venous blood into the lymphatic system are under what kind of neural control
sympathetic (thus increased tone decreases lymph flow into the venous system)
how much fluid moves from capillary to interstitial space each day? (10% drains into lymph system)
30 L
what is the normal interstitial fluid pressure? at what pressure do lymph capillaries collapse causing flow to cease?
-6.3 mmHg
flow ceases at 0
in large lymph vessel walls what does smooth muscle do?
peristalsis
what are the two diaphragms in the body that are essential for pushing lymph fluid superiorly and centrally?
thoracic and pelvic
whats the biggest consequence of poorly functioning lymph system
edema (causing HTN, CHF, decreased plasma pressure, increased capillary permeability, compression of neuromuscular structures, decreased filtration of fluid)
chronic conditions warrant lymphatic OMM treatments that are what?
shorter and more frequent
what are indications for lymphatic OMM?
CHF, URI, LRI, asthma, COPD, sprains, acute somatic dysfunction, pregnancy
what are acute contraindications for lymphatic OMM?
anuria (need kidneys to process extra fluid return)
necrotizing fasciitis in treatment area
relative contraindications for lymphatic OMM
fracture or dislocation in area that will be stressed, splenomegaly due to mono, acute hepatitis, malignancy, bacterial infection, coagulopathy, unstable cardiac condition
whats the sequence for whole body lymphatic OMM treatment?
- thoracic inlet
- abdomen
- upper extremity
- lower extremity
- head and heck
- thoracic inlet
