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M1 Block 1 > Osteopathic Patient Care > Flashcards

Osteopathic Patient Care Flashcards

1
Q

Name the 4 principles of osteopathy

A

1.) Body = mind + body + spirit
2.) Body is self healing and regulating
3.) Body system = function
4.) Rational treatment is based on these 3 tenants

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2
Q

What is somatic dysfunction

A

Impaired or altered function of related components of the body: skeletal, arthrodial, myofascial, lymphatic

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3
Q

What does TART stand for/mean?

A

T: Tissue texture changes
A: Asymmetry that is palpable
R: Restrictive range of motion
T: Tenderness

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4
Q

List the 5 types of tissue changes

A

1.) Temperature
2.) Edema
3.) Moisture
4.) Texture
5.) Tension

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5
Q

Describe temperature as a tissue change in acute and chronic setting

A

Acute: Temp increased
Chronic: slight increases or decreases (coolness)

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6
Q

Describe texture as a tissue change in an acute and chronic setting

A

Acute: Boggy, more rough
Chronic: Thin, smooth

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7
Q

Describe moisture as a tissue change in the acute and chronic condition setting

A

Acute: Increased moisture
Chronic: more dry

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8
Q

Bogginess can be resultant from congestion caused by increased fluid content in the __________________ condition setting. What does bogginess refer to?

A

Acute texture change
A tissue texture abnormality characterized by a palpable sense of sponginess in the tissue

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9
Q

Describe tension as a tissue change in the acute and chronic condition setting

A

Acute: Rigid, board like
Chronic: Slight increase, ropy, stringy

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10
Q

Describe tenderness as a tissue change in the acute and chronic condition setting

A

Acute: greatest tenderness
Chronic: Still present but to a lesser extent

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11
Q

Describe edema as a tissue change in the acute and chronic condition setting

A

Acute: edema present
Chronic: not present

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12
Q

Describe blood vessels as a tissue change in the acute and chronic condition setting

A

Acute: venous congestion
Chronic: Neovascularization

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13
Q

Describe erythema test as a tissue change in the acute and chronic condition setting

A

Acute: redness lasts
Chronic: redness fades quickly or blanching occurs (red reflex)

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14
Q

What is erythema?

A

Redness due to increased blood flow

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15
Q

Name the 4 barriers to motion

A

1.) Anatomic
2.) Physiologic
3.) Pathologic
4.) Restrictive

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16
Q

Describe physiologic barrier in relation to ROM

A
  • The natural movement of any joint
  • The point to which a patient may actively move a given joint
  • Normal ROM
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17
Q

Describe anatomic barrier in relation to ROM

A
  • The point where body joint may supersede physiologic barrier with external force
  • The point where the joint may be passively moved past the physiologic barrier
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18
Q

Describe restrictive barrier in relation to ROM

A
  • Exists within the physiologic ROM, between neutral and physiologic ROM
  • What is dx when palpating somatic dysfunction
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19
Q

Describe pathologic barrier in relation to ROM

A
  • Result of trauma or disease
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20
Q

Name the 3 main anatomic planes

A
  • Coronal
  • Sagittal
  • Transverse
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21
Q

What does the coronal plane separate?

A

Anterior vs Posterior

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22
Q

What does the sagittal plane separate?

A

R v L

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23
Q

What does the transverse plane separate

A

Inferior & Superior

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24
Q

List the 3 main axes

A

1.) Vertical
2.) Transverse
3.) Anterior Posterior

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25
Q

Describe the vertical axis

A

Running from top of head to feet at the midline

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26
Q

Describe the transverse axis

A

Through the pelvis from L to R

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27
Q

Describe the anterior posterior axis

A

Running through belly button Front to back

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28
Q

The motion of flexion/extension is along the _______________ plane and the __________________ axis

A

Sagittal plane
Transverse axis

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29
Q

Flexion increases or decreases the angle

A

Decreases the angle

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30
Q

Extension increases or decreases the angle

A

Increases the angle

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31
Q

The motion of rotation is along the _______________ plane and the __________________ axis

A

Transverse plane
Vertical axis

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32
Q

The motion of side bending along the _______________ plane and the __________________ axis

A

Anterior posterior axis
Coronal plane

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33
Q

Neutral spinal mechanics occur in the absence of: _____________________ _____ ______________________ &

A

Flexion or extension
At normal posture

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34
Q

Non-neutral mechanics occur:

A

In either flexed or extended position

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35
Q

How many principles comprise Fryette’s principles?

A

3 principles

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36
Q

Describe Fryette’s First Principle

A

In neutral, side bending and rotation occur in OPPOSITE direction
Type 1: group dysfunction

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37
Q

Describe Fryette’s Second Principle

A

Flexion/Extension: side bending & rotation occur in the SAME direction
Type 2: Single segment

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38
Q

To what parts of the spine do Fryette’s principles apply?

A

Thoracic and lumbar only

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39
Q

Desrcibe Fryette’s Third Principle:

A

Motion in any one plane limits motion in other

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40
Q

Type I (_________________________) Mechanics: N-S-R dysfunctions, the side bending precedes rotation and: _________________ ___________________, then _________________________ occurs TOWARD the convexity

A

Neutral
produces concavity
Rotation

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41
Q

Type II (__________________) Mechanics: In the _____________________ or ____________________ position if a __________________ ____________________ ROTATES, it forces side bending in the SAME direction

A

Non-neutral
Flexed
Extended
SINGLE vertebrae

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42
Q

T/F: Sid bending and rotation are always coupled according to Fryette’s Principles and occur in the same direction

A

False, only in flexion or extension (Type II) are they in the same direction
Coupled does not mean same direction

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43
Q

Describe a “Focused/problem oriented history”

A

For specific complaints, i.e. cough

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44
Q

What is the correct term for “surgical clearance”

A

Presurgical evaluation

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45
Q

List 4 possible components of a “Health maintenance/preventative visit”

A

Screenings
Smoking cessation
Weight loss
High risk sexual behavior

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46
Q

When is it appropriate to use closed ended questions?

A

During Review of systems & clarifying information

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47
Q

Subjective components of a patient encounter include:
___________________
___________________
Medical history of patient
Surgical history of patient
Allergies
______________________
Family history
Social history

A

HPI
ROS
Medications taken and what they are supposed to be taken

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48
Q

What is an HPI?

A

All the questions related to what brought the patient into clinic
Questions to figure out what is going on

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49
Q

What is the acronym for all portions of the HPI?

A

OLD CARRATS

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50
Q

After the first component of Chief Complaint, what does
O
L
D
stand for in the HPI acronym?

A

Onset
Location
Duation

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51
Q

After the chief complaint and OLD, what does
C
A
R
R
A
T
S
stand for when referring to the HPI?

A

Characteristic: description-achy, sharp, burning, stabbing
Aggravating Factors
Relieving
Radiating
Associated symptoms
Timing/Temporal
Severity

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52
Q

What are “associated symptoms”?

A

Chief complaint: URI
ASSOCIATED SYMPTOMS: fever, sore throat, runny nose

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53
Q

What is the pain scale used for pediatric or non-verbal patients?

A

FLACC pain scale

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54
Q

What are some questions that might be included in a social history?

A

1.) Occupation
2.) Relationship status
3.) Sexual status & orientation
4.) Habits
5.) Spiritual
6.) LMP

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55
Q

What is the more precise verbiage for toboacco/smoking history?

A

“Do you use any form of nicotine?”

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56
Q

What are the parameters for orthostatic hypotension?

A

Systolic drops more than 20 mmHg
Diastolic drops more than 10 mmHg

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57
Q

Right iliac crest higher than the left will indicate:

A

Right lumbar sidebending

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58
Q

Type 1 disfunction involves:

A

Long restrictor, i.e. erector spinae
Brings things lateral from the muscle closer together

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59
Q

Left shoulder lowered indicates:

A

Left side bending

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60
Q

Heightened left iliac crest indicates:

A

Left side bending

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61
Q

What is the main difference between myofascial release and soft tissue techniques

A

Myofascial release

62
Q

Soft tissue technique is used to:

A

Treat general areas of hypertonic muscle

63
Q

When can soft tissue techniques be considered myofascial technique?

A

If there is a diagnoses of tissue motion preference made and treated

64
Q

Myofascial Release is:

A

Based on a specific tissue diagnosis of motion preference OR the direction of fibers

65
Q

Soft tissue uses what kind of motion?

A

Repetitive & rhythmic motion

66
Q

Myofascial release uses:

A

Sustain pressure until myofascial creep is not appreciated anymore under the tissue

67
Q

What is prone lumbar soft tissue lumbar technique?

A

Patient is prone, 1 hand on paraspinal muscles on side away from practitioner
Second hand will connect with ASIS
Light pressure on the paraspinal muscles, lift the ASIS toward practitioner
Lower ASIS with sustained light pressure on paraspinal muscles

68
Q

What is the indication for Prone Lumbar Soft Tissue technique?

A

Thoracic or lumbar paraspinal muscle tension associated with back pain, chest wall pain

69
Q

What is Lumbosacral prone two handed traction soft tissue technique?
When might this technique be considered myofascial?

A

1.) Hands crossed in an “X” formation, apply slight pressure, and move hands away from teach other
2.) If find an area of hypertonicity, can hold the traction until resistance of muscles decreases

70
Q

What are the indications for Lumbosacral prone two-handed traction technique?

A

Lumbosacral tension related to back pain, SI pain, pelvic pain

71
Q

What areas of the back can two-handed traction technique be applied?

A

Thoracic and Lumbar region

72
Q

What is prone regional thoracic myofascial release technique?

A
  • Start medial to spinous process and inferior angle of scapula
  • Up, down, left & right, rotate clockwise, counterclockwise
  • Physician can engage tissue indirectly or directly
  • Force is held 20-60 seconds or until a release is palpated
  • Repeat until resistance is no longer found
73
Q

What is Mid and Lower Thoracic region soft tissue technique

A
  • Want to stretch muscle fibers perpendicular to their direction
  • Patient laying on side
  • Patient arm over top forearm closest to the head
  • Physician applies force and stretch, hold, and slowly release
  • Repeat in rhythmic and kneading fashion
74
Q

What are the indications for mid and lower thoracic region soft tissue?

A

Reduce muscle hypertonicity, muscle tension, fascial tension and muscle spasm

75
Q

What are the indications for prone regional thoracic myofascial release technique

A

Reduce muscle tension, fascial tension. Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures

76
Q

What is pectoral traction?

A
  • Patient is supine
  • Find pectoralis major at midaxillary line & hook under the pec muscle
  • Lift the pec muscle while patient has hands on their belly button
  • Patient breathes in and out while hold of pectoralis is sustained
77
Q

Is pectoral traction direct or indirect treatment? Why

A

Direct

78
Q

What are indications for pectoral traction?

A

Increase venous and lymphatic drainage to alleviate congestion associated with decreased A-P diamete of thorax
- Atelectasis, bronchitis, pneumonia
- Improve excessive protration of shoulder
Release tension of clavipectoral fascia

79
Q

What is the thoracic inlet?

A

Borders of T1-First rib-manubrium (bone that forms jugular notch)

80
Q

What is thoracic outlet?

A

Bounded by scapula, first rib on lateral, clavicle
- Looking from top down

81
Q

What are biaural tubes?

A

The metal portion of ear pieces

82
Q

What is the diaphragm of the stethoscope?

A

The flat portion which touches the patient skin

83
Q

The smaller side of the stethoscope is traditionally used for pediatrics listening to heart, lungs, abdomen. When might you use this side on adults?

A

To listen to the carotid artery on an adult

84
Q

The diaphragm of the stethoscope is used to hear what sounds?
What does the bell of the stethoscope used for?

A

Diaphragm: High frequency sounds
Bell: lowest frequency sounds

85
Q

How do you use the stethoscope to differentiate murmors from bruits/regurgitation?

A

Murmors use: Diaphragm
Regurg: Bell

86
Q

List the 4 layers of Fascia

A
  1. Pannicular
  2. Axial and Appendicular
  3. Meningeal
  4. Visceral
87
Q

Describe pannicular fascia

A

Loose and dense irregular connective tissue
Variable fat content

88
Q

Describe axial and appendicular fascia

A

Surrounds the muscle and the torso, fibers tend to to run in the direction of the muscle fibers

89
Q

What layer of fascia matches this description? Loose and dense irregular connective tissue
Variable fat content

A

Pannicular

90
Q

What type of fascia matches this description?
- Surrounds the muscles and torso, fibers tend to run in the direction of the muscle fibers

A

Axial and appendicular

91
Q

What type of fascia matches this description
Dural and other membranes surrounding the CNS

A

Meningeal

92
Q

Describe meningeal fascia

A

Dural and other membranes surrounding the CNS

93
Q

Where is visceral fascia?

A

Mediastinum (chest cavity region), other surrounding organs

94
Q

Where is subserous fascia?
Describe it

A
  • Loose, elastic tissue
  • Covering peritoneum and visceral pleura
  • Area can accumulate inflammatory cells
95
Q

T/F: Fascia is continuous with bone, muscle, tendon

A

True

96
Q

What is compartment syndrome?

A
  • Swelling/infection within a body compartment stops blood flow = necrosis
97
Q

The 7 “P’s”
Pain
Pallor
Pressure
Paresthesia
Paralysis
Pulseless
Cold (Poikilothermic)
are used to diagnose

A

Compartment syndrome

98
Q

What is a common cause of compartment syndrome?

A

Crush injury, i.e. dropping a safe on your foot

99
Q

What is elasticity?

A

Recoverable deformation

100
Q

What is plasticity?

A

Nonrecoverable deformation

101
Q

What is viscosity?

A

The rate of how quickly the fascia moves
I.e. injured fascia moves less while normal fascia moves quickly

102
Q

What is stress?

A

When place tension on the bicep, the stress is distributed throughout all the fascia of the region

103
Q

When fasica cannot be stressed such that the effect of a force is NOT normalized over an area, what happens?

A

Increase risk of injury

104
Q

What is strain?

A

The a result of prolonged stress that the tissue has been reformed/reshaped and preserves its new shape

105
Q

What is Plastic deformation

A

Stressed, formed, or molded tissue preserves its new shape

106
Q

What is elastic deformation?

A

A stress, formed or molded tissue recovers its original shape

107
Q

What is creep?

A
108
Q

What is an example of creep?

A

Fascia has undergone plastic deformation
As applied myofascial treatment, feel the fascia return to its normal position

109
Q

What is Hooke’s Law

A

1.) Strain or deformation placed on an elastic body is proportional to the stress or force placed upon it
2.) An applied stretch or compression to a tissue results in proportional change in length
3.) Fascia meets the demand upon it

110
Q

What is Hooks Law in simpler terms:
The strain or deformation placed on an elastic body is proportional to the stress or forced or placed on it

A

The more force placed on something, the more deformation occurs

111
Q

What is Hooke’s Law in simpler terms:
An applied stretch or compression to a tissue results in a proportional change in length

A

If there is applied stress, the fascia will lengthen overtime

112
Q

T/F: Wolff’s law of “form follows function” is applicable to every part of the body

A

True

113
Q

Direct fascial release engages what barrier?

A

Restrictive barrier
Force is maintained until release is felt

114
Q

In direct fascial release, there is engagement of the restrictive barrier where force can be applied in what direction(s)

A

Perpendicular or parallel

115
Q

____________ fascial release utilitizes the point of ease during passive range of motion, where elastic forces are in balance.

A

Indirect fascial

116
Q

Myofascial release uses _____________ vs ______________ and direct vs. indirect

A

Perpendicular vs parallel

117
Q

Soft tissue is used to treat

A

General hypertonicity of an area

118
Q

What is the goal of myofascial release?

A

Diminish restrictions in physiologic range of motion
Used to ease tension within sheets of fascia

119
Q

Muscle energy requires

A

Patient actively using their muscles

120
Q

Muscle energy requires

A

Patient actively using their muscles

121
Q

__________ __________ tones inactive muscles which are weak

A

Muscle energy

122
Q

__________ __________ tones inactive muscles which are weak

A

Muscle energy

123
Q

What is an example of Inherent motion?

A

Respiration

124
Q

What is the elastic range?

A

The barrier intermedium between physiologic and anatomical barriers

125
Q

Direct treatment:

A

Starts by engaging the restrictive barrier

126
Q

Indirect Treatment:

A

Starts by moving away from the restrictive barrier

127
Q

What is concentric contraction?

A

Contraction of a muscle resulting in the approximation of insertion and origin
-Flexion

128
Q

Eccentric contraction:

A

Muscle tension allows insertion and origin to separate to LENGTHEN
- extension

129
Q

What is isolytic contraction?

A

When external forces overcome muscle contraction
i.e. dropping a weight that is too heavy to lift
- External force is the weight
- Muscle contraction was trying to lift

130
Q

When a Golgi Tendon reaches a critical tension it produces:

A

Relaxation to prevent damage

131
Q

If part of a muscle is hypertonic, what happens to the other portions of the same muscle?

A

Muscle spindle sends signal for contraction over the muscle

132
Q

What are monoarticular muscles

A

Short restrictors
Maintain type II segmental dysfunction

133
Q

What are polyarticular muscles

A

Long restrictors
Maintain Type I dysfunction

134
Q

What is Post-isometric relaxation?
What is the force applied?

A
  • When muscle is in refractory period where contraction cannot occur we stretch the muscles to normal lengfht
  • Force: Sustained gentle pressure
135
Q

Post isometric relaxation uses muscle spindle, golgi tendon organ, or reciprocal inhibition?

A

Golgi tendon organ

136
Q

What is Joint mobilization using force?

A

Using muscles around a joint to force a joint through a restrictive barrier

137
Q

What is the purpose of Joint mobilization?

A

Restore joint motion by using muscle contractions to free up restricted motion using force

138
Q

What is respiratory assistance?

A
  • Form of muscle energy
  • Improve physiology with voluntary respiratory motion to reduce rib dysfunction
139
Q

What is oculocephalic reflex?
What might be a indication for this treatment?

A
  • Body following where eyes move to improve C1/C2 dysfunction
140
Q

What is reciprocal inhibition?

A
  • Lengthen/relax hypertonic muscle by contracting the antagonist muscle
  • Form of gentle muscle energy
141
Q

__________ ____________ law is described as: when a muscle receives a nerve impulse to contract, its antagonist receives, simultaneeously, an impulse to relax

A

Sheerington’s Second Law

142
Q

Sherrington’s second law is applicable to what form of muscle energy technique?

A

Reciprocal inhibition

143
Q

What is crossed extensor reflex?

A

Similar to reciprocal inhibition but using muscles on the OPPOSITE side of the body

144
Q

What is particularly useful about crossed extensor reflex?

A

Can relax hypertonic muscle on an acute injury side by inducing contraction of the opposite side

145
Q

What is isokinetic strengthening

A

Strengthening of weakend muscle

146
Q

Which muscle is weakened and which is hypertonic in isokinetic strengthening?

A

Contracted muscle is hypertonic
Its AGONIST is weakened from being consistently relaxed

147
Q

Isolytic lengthening is a more invaisve muscle energy treatment, why?

A

It is used in cases where the tissue is approaching a pathologic barrier

148
Q

When might you be particularly concerned about inappropriate excessive force on tendons

A

Long term use of steroids can make tendons more prone to rupture which would:

149
Q

Principles of Tx Muscle Energy:
1.)
2.) Physician directs patient to contract appropriate muscle
3.) Physician applies counterforce equal to patient contraction and ________ _____________ until _________ _________ ___________ ___ _________
4.) Patient is to relax and physician matches relaxation
5.) Take up slack permitted by the procedure: move patient further into restrictive barrier
6.)_______________
7.)

A

1.) Place patient into restrictive barrier
2.) Physican applies counterforce equal to the patient contraction and maintains force until appropriate patient contraction is perceived at monitored area
6.) Repeat 5-7 times
7.) Return patient to restrictive barrier once more and then place patient to neutral

150
Q

When trying to lengthen a muscle, what might be your first step?

A

Address weakness of the antagonist muscle and strengthen prior to lengthening the hypertonic agonist

M1 Block 1 (6 decks)

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