Part 2 DCCJP Final Exam Flashcards
Richardson: “Arch and ring”
Chondrosarcoma
Richardson: “silent sinus”
Atelectasis of a sinus
Richardson: “Pain at night, relieved by aspirin”
Osteoid osteoma
Richardson: “Wormian bones”
Osteogenesis imperfecta
Richardson: “Brown tumor”
Something to do with either renal failure or kidney disease
Richardson: “Pseudosubluxation”
Swischuk line
Richardson: “Where CBCT falls short”
Poor contrast for soft tissue, cannot diagnose Chiari or any soft tissue condition
Distinguish suture and fractures on CBCT
Fractures: sharp edges, nonsclerotic borders, often CROSS sutures, increase in diameter as approaching a suture, may widen sutures
Sutures: join other sutures without crossing, do not widen other sutures, uniform in diameter, zigzag, sclerotic borders
Basilar Impressions…
Secondary basilar invagination acquired later in life. Rheumatoid Arthritis patients, Osteogenesis Imperfecta (due to frequent microfractures and sclerosis at skull base)
Primary hyperparathyroidism
Most common cause is parathyroid adenoma causing hypersecretion of parathyroid hormone; 3% have a brown tumor
Secondary hyperparathyroidism
Usually seen in end-stage renal failure; 1.5% have brown tumor. MORE COMMON than primary, so BROWN TUMORS ARE MORE ASSOCIATED WITH SECONDARY HYPERPARATHYROIDISM
Julie: Children develop adult movement by age…
Age 8-10
Julie: Fulcrum of the headpiece should be placed…
1/8” below the mastoid process
Julie: Motion is greatest in children at which segment?
C2/C3
Julie: “The curvatures of the vertebral column increase its resistance to axial compression forces. Loss of the optimum normal curvatures therefore…
Results in inability to dissipate normal vertical load and rotatory stress based on the above principles.”
DMX: Number of cervical ligaments that can be evaluated on DMX
22
DMX measures…
Ligamentous sub-failure
3Ps
Painful, progressive, permanent
Alar ligaments withstand up to…
200N
CCJ ligaments limiting flexion
Nuchal ligament
Tectorial membrane
Transverse Occipital Ligament
CCJ ligaments limiting extension
Tectorial membrane
Barkow’s ligament
Anterior atlanto-occcipital membrane
CCJ ligaments limiting rotation
Alar ligaments
Accessory atlantoaxial ligament
Transverse Occipital Ligament
CCJ ligaments limiting lateral bending
Alar ligaments
Lateral atlantoaxial ligament
Transverse Occipital Ligament
Coupled ________________ was opposite of axial rotation
Lateral bending
Left lateral bend creates what kind of coupled motion…
Right upper cervical rotation and left subaxial rotation
Right lateral bend creates what kind of coupled motion…
Left upper cervical rotation and right subaxial rotation
Developed neurocalometer
Dosa Evans
Secret sauce of knee chest
Step down method
Reviver of knee chest
Michael Kale
Internal component of the medullary lock
Dentate ligament
BJ started the knee chest technique by adjusting on which landmark?
Transverse process
Description of bone problem
stiff in the morning, gets better with movement
Description of muscle problem
Achy, spasm, and cramping
Ligament problem description
Painful joint motion never gets better
Nerve problem description
Burning, sharp, shooting, tingling and weak
Describe a problem that requires a referral
None of the symptoms make sense and/or you cannot reproduce the pain
In lower cross syndrome, what needs to be stretched?
Hips and quads
Which muscles of the rotator cuff is responsible for internal rotation?
Subscapularis
What levels are involved in the lumbar plexus?
T12-L4
Fracture vs suture
Suture doesn’t cross the suture line or widen them, sclerotic boarders
Stork tests…
Spondy or quadrant
Psoas muscle
How many AC joint injuries are there?
6
Painful arch
?
Drea study, CSF flow was measured at which levels?
C3, T2, T5
Epigenetic/Long term changes
Adaptation
Immediate response/change
Compensation
What is a transducer?
Device that transforms a non-electrical physical quality into an electrical one (like voltage or current)
CO2 sensors
Astrocytes
Tensor veil palatine innervation
CN V3, not CN 10
Drea study found…
CSF flows cephalad with exhalation and venous drainage increases
Glymphatic system is active in…
Stage 3 sleep (deep sleep, DELTA WAVE)
Apnea is…
The complete cessation of breathing for 10 seconds
What is the definition of occlusion?
The end point of the BODY in respect to the plantar surfaces of the FEET, and within these two boundaries, all functional spaces for physiological processes must accommodate
The sphenoid bone contains which structures?
All of the above: superior orbital fissure, foramen rotundum, foramen spinosum, and optic canal
Tongue deviation to the left represents which of the following?
CN XII weakness on the left
What is the name of specialized connective tissue with a high collagen content but no mineral content?
Cartilage
What is the approximate speed (velocity) of the Spinocerebellar pathways
100 meters/sec
What is the primary role of the thalamus?
Relay system for all sensory information
A Grabb-Oakes measurement of 10mm indicates possible ____?
Ventral brainstem compression
What term is used to describe a tortuous and enlarged vertebral artery abutting/compressing the brain stem?
Dolichoectasia
When determining the classification of misalignment, the only two orthogonal classification systems to consider head tilt and angular rotation are Orthospinology (alternate) and:
NUCCA
The Council on Chiropractic Guidelines – Clinical Compass is considered what type of database?
Pre-appraised source
Which of the following is a correct KVP and mA and time setting for a CBCT?
5-25 mA, 80-120 kVp, 5-9 seconds
The oxidative phosphorylation system (oxphos) is located where?
Inner mitochondrial membrane
Per the Blair radiographic analysis, what two angles are found on the Base Posterior film?
Left convergence and right convergence
Assessing for Arnold-Chiari malformations is not possible with CBCT at this time due to _____?
Low contrast resolution
Which alar ligament checks the side of rotation and lateral bending?
Right alar checks left rotation of C1 on C2
How many ligaments can Digital Motion X-ray identify in the cervical spine?
22
At what age would adult motion characteristics of the cervical spine be observed in children?
Eight to ten years old
Which statement is true regarding the Ishii et al. 2004 study of in vivo active head rotation?
a. Coupled lateral bending with axial rotation was observed in the opposite direction to that of axial rotation at Oc-C1 (mean, 4.1 +/- 1.4 deg) and C1-C2 (mean 3.8 +/- 3.0 deg)
b. Coupled extension with axial rotation occurred at C0-C1 (mean 13.3 +/- 4.9 deg) and C1-C2 (mean 6.9 +/- 3.0 deg) irrespective of the direction of head rotation
c. Axial rotation of C1-C2 (mean 36.3 deg) was not observed to be coupled with lateral bending at Oc-C1 during head rotation
a. Coupled lateral bending with axial rotation was observed in the opposite direction to that of axial rotation at Oc-C1 (mean, 4.1 +/- 1.4 deg) and C1-C2 (mean 3.8 +/- 3.0 deg)
b. Coupled extension with axial rotation occurred at C0-C1 (mean 13.3 +/- 4.9 deg) and C1-C2 (mean 6.9 +/- 3.0 deg) irrespective of the direction of head rotation
As atlas rotates on the axis, which of the following best describes the direction of movement on the vertical plane?
Inferior
When listening to the patient describe their symptoms of “stiff in the morning and gets better with movement” is a key word for what type of problem?
Bone
Which muscle is not a primary mandible depressor?
Posterior belly of the temporalis
Colic and the rule of 3’s?
Unexplained uncontrollable crying in 0-3 month olds, more than 3 hrs per day, and more than 3 days per week for 3 weeks
Colic best responder to chiropractic?
Chiropractic is the best responder to colic.
1989 chiropractic colic study, 316 babies were evaluated and adjusted, 94% improvement under avg. of 2 weeks of care and 3 adjustments.
There is no study currently that shows a medicine’s efficaciousness with colic.
Passive sub-system
Vertebrae, disc, joints, and ligaments - the static stabilizers
Active sub-system
Muscles, tendons surrounding spine - the applies forces to the spinal column
Controlling sub-system
CNS (medulla, brainstem, pons, midbrain, spinal cord), PNS (spinal nerves, cranial nerves) - spinal monitoring and various transducer signals, directing the active sub-system to provide the needed
What encompasses all three spinal subsystems (passive, active, and controlling)?
Fascia
A dysfunction/injury of a component of any subsystem may result in:
Compensation - response
Adaptation - permanent change express
Injury
Malocclusion
Solution for a complex adaptive system to remain in equilibrium
Monroe-Kelli Doctrine
If either blood, CSF, or brain parenchyma increases, one of the others must decrease (compensate) to balance intracranial pressure.
Dreha-Kulaczewski CSF conclusion
Respiration drives CSF into the brain primarily through forced inspiration
Forced inspiration increases venous outflow from the skull and influx of CSF into the skull as…
Forced expiration reduces venous outflow and efflux of CSF from the skull
Cephalad CSF flow and increased venous drainage during _________ sleep bestows brain parenchymal neuro-protection
Delta-wave
Disrupted Sleep –> disrupted delta-wave respiration –>…
Disruptive CSF flow
_______ corrects O2 desaturations in mild OSA
Bruxism
Animals lacking the water channel _______________ in astrocytes exhibit slowed CSF influx through this system and a ~70% reduction in interstitial solute clearance, suggesting that the bulk fluid flow between these anatomical influx and efflux routes is supported by astrocytic water transport
Aquaporin-4 (AQP4)
Growth hormone reaches peak during this stage of sleep
Stage 4
Delta or slow wave sleep stage, also known as neuroprotective sleep…
Stage 3 and Stage 4
Sleep Architecture
Non-REM: Stage 1, transitional phase (5%); Stage 2 Light sleep (50%); Stage 3 & 4, Delta Slow Wave Sleep (20%)
REM Sleep: The Dream Stage (20%)
Astrocyte-CO2 sensitivity mechanism
With increased blood CO2, there will be increased H+ in tissue, lowering pH; resulting in peeing out the H+
How does sleep position affect CSF?
The recumbent position increases the inflow of CSF
Smallest voxel size
- or 0.3 micrometer
Orthogonal FOV for CBCT
23x26cm
Blair FOV for CBCT
13x15cm
BP must be taken within _______ of central ray
1/8”
On CN III test, catchup siccades are controlled by what?
Cerebellum & Pons
Describe Prukinje system
Purkinje fibers lie on top of outer cerebellar covering sending “don’t do it” signal to inhibit deep cerebellar nuclei - 90% of what the brain does is inhibit and the cerebellum has more neurons than the cerebellum
What does autophagy do for the brain?
Cleanses brain by removing metabolic waste and inflammation
Duel tasking tests what region of the brain?
Frontal lobe
Describe D1 and D2 pathways. Which indicate basal ganglia breakdown?
D1 - Makes movement, turns on brain, basal ganglia dysfunction is found here
D2 - Inhibits movement
Caudate regulates ________ movement, and putamen regulates ____________ movement
Caudate… NONMOTOR
Putamen… MOTOR
Early detectors of Parkinson’s…
Unresolved constipation (Parkinson’s starts in the gut)
Frozen shoulder without trauma
Progressive micrography (due to D1 breakdown
The substantia nigra compacta is related to which of the following in early Parkinson’s?
D1 - Putamen
Which cranial nerves feed into the ventral vagal system?
V, VII, IX, X
BJ Palmer was the first to x-ray the spine, which he called a…
Spinography
What is required for subluxation to manifest?
Time, subluxation unchecked will lead to unwinding dysfunction
What is the 5th element to subluxation added by BJ Palmer?
3-directional torque misalignment
[The other 4: Misalignment, occlusion, pressure, interference]
What is the medullary lock?
Innate mechanism that secures the medulla in center of both the foramen magnum and upper cervical neural canal
Dysfunction of dural attachment or connective tissue bridges at certain locations can cause medullary lock. Give examples.
Foramen magnum
C1-C2 posterior arch
RCPm
RCPM
Ligamentum Flavum
OCm
Nuchal ligament
Vertebrodural ligament
To-be-named ligament
Distinguish myelinated from nonmyelinated regions of the vagus nerve…
Unmyelinated - DORSAL part, origin DORSAL motor nucleus, regulates BELOW DIAPHRAGM
Myelinated - VENTRAL part, origin is nucleus AMBIGUUS, regulates ABOVE DIAPHRAGM (social engagement)
Cranial nerves that feed into social engagement…
III, V, VII, IX, X, XII
The ventral vagus system exerts modulatory control over…
The sympathetic nervous system
The main contributor to SIDS (in context to polyvagal theory)…
Freeze response
Dry mouth presentation… sympathetic or parasympathetic?
Parasympathetic
What the sympathetic system uses for body circulation…
Norepinephrine
Facial symmetry is regulated by…
CN VII
Tongue deviation controlled by…
CN XII (deviates towards the weak side)
Corneal reflex is controlled by…
CN V
Set of muscles with the most spindles and reason…
Suboccipital muscles, stimulates the brain through “tummy time”
Microglial cells are WBCs in the brain, which in activation, suggests big problem in the brain. If aluminum aggravates microglial cells, causing over reaction, which polyvagal stage is affected?
Pruning
Left head tilt indicates a weak ______ cerebellum
Weak right cerebellum
“68% of people see a head tilt away from the weak cerebellum”
During pregnancy, less of the SI locking mechanism…
The more weight bearing falls on the ligaments, leading to increased likelihood of SI strain after pregnancy
Proposed brainstem epicenter for start of autism development
Dorsal vagal complex
Neonate atlas discontinuous _____% of the time
80%
Odontoid completely fuses with vertebral body at….
3 to 6 yoa
Primary CCJ ligament stabilizers in development…
Tectorial membrane
Alar
Apical
Cruciate
Towbin’s key symptom to diagnosing a birthing injury
Respiratory distress (latent spinal cord and brain stem injury)
Chiropractic and ear infections
Frequent infections due to fluid not being drained, due to lymph drainage problem. Chiropractic addresses the lymph problem in the neck adjustment, removing tension, so the drainage can correct.
________ determine biomechanical properties of CCJ, while _________ determine biomechanical properties of C1-C2
Bony structures… CCJ
Ligaments… C1-C2
Ligament that prevents odontoid from impinging spinal canal
Tectorial membrane
Ligament with high proprioceptive fiber count
Nuchal ligament
Tensile strength of lateral atlanto-occipital ligament
37.5 N
In rotation, occiput __________ relative to atlas
Occiput… rises
In rotation, atlas moves ________ relative to axis
Atlas… inferior
Coupled motion with left rotation
Right lateral bend and extension
Coupled motion with right rotation
Left lateral bend and extension
In ligamental sub-failure, bones and joints degenerate…
6 to 10 time faster
5th element of subluxation
3d torque
Needed for subluxation to manifest
Time
Convexity of the C0-C1 joint determines the level of ____________ in a subluxation
Rotation
The characteristic of the atlas misalignment is determined by the…
Track side condyle
Six steps to knee chest adjustment:
Doctor/Patient position
Contact
Tissue Pull
Roll in
Step Down
Body Drop
Primarily responsible for stabilizing the GH joint…
Supraspinatus
Main external rotator in shoulder…
Infraspinatus
Main internal rotator in shoulder…
Subscapularis
Levels involved in the brachial plexus…
C5-T1
Sacral Plexus levels
L4-Coo
What to strengthen in lower cross syndrome…
Psoas
Core
Gluts
Hamstrings
Stretching for upper cross syndrome…
Pec stretch
Thoracic mobility
What to strengthen for upper cross syndrome…
Deep neck flexor
Mid and lower back
Subscapularis
Serratus Anterior
Innervation for the tensor veli palatini
CN V3
CN V3 innervates this muscle responsible for keeping the bolus out of the nasopharynx
Tensor Veli Palatini
Mandible depressors are primarily innervated by CN V3, except for…
Mylohyoid (Cervical Plexus C1)
Specialized cells in the brainstem that detect increase CO2 and will send a signal to make musculoskeletal, cardiorespiratory, and nervous system changes to accomodate
Astrocytes
Pharyngeal space insufficiency may lead the body to…
Shift forward, forward head carriage, to open up space
Main driver for CSF exiting the skull into the spinal cord
Cardiac systole
Main driver for CSF moving into the skull
Respiration inhalation
Disordered or obstructed sleep breathing interrupts normal respiratory tidal pressure gradients in the ____________ and leads to aberrant and disruptive CSF flow
Thoracic cavity
Light controls the body clock by activating the…
Suprachiasmatic Nucleus
Neuroprotective sleep occurs…
Delta wave sleep (Stage 3 & 4)
Deep sleep can be totally absent by age…
40-60
Stage of sleep where problem solving can occur during…
REM sleep
Body paralysis and dream sleep can occur during…
REM sleep
Pioneered CT scanner
Hounsfield
The lower the voxel…
the better the resolution
If requesting a CBCT, voxels between ________ is acceptable.
0.3 - 0.2 micrometers
(Note: if not on exam, pick the lowest)
Initial neurotransmitter release following a blow to the head
Glutamate
NMDA leads to calcium influx into the cell. What keeps thus receptor in check, which is often deficient in concussion??
Magnesium
After the initial hypermetabolic state, a sub-acute hypometabolic state is unregulated through inflammation genes and ____________, which usually lasts 7 to 10 days, but may persist up to 30.
Cytokines
Period of greatest metabolic imbalance following a concussion…
3 days post injury
Astrocyte found in the white matter
Fibrous astrocyte
Astrocyte found in the grey matter
Protoplasmic astrocyte
Describe astrocytes function
Remove waste around neurons
Store emergency glycogen, can produce glucose, and lactate for cell respiration
Produce glutathione against oxidative stress
A part of the repair process, but cost is producing beta-amyloid proteins
What balances an influx of Ca2+, meaning what controls in efflux of Ca2+?
Mitochondria
