Resp. Cases DSA/CIS

Question 1

Gallbreath technique

Answer 1

Purpose – to increase blood flow through the pterygoid plexus of veins and lymphatics, drainage of the Eustachian tube, stretching of the peri-pharyngeal muscles and fascia

Patient supine (or seated in treating physician’s lap)
Affected side down (or away from physician’s treating hand)
Grasp mandible of affected side
Draw mandible downward and transversely with mild force for 3-5 seconds, repeating for 30-60 seconds

Question 2

Pertinent sympathetics for respiration?

Answer 2

T1-2 = upper airway, head
Superior cervical ganglion
Stellate ganglion (= inferior cervical and 1st thoracic)

T2-6 = bronchioles, lungs

Superior Cervical Ganglion
fused ganglia of C1 through C4
provides postganglionic innervation to the head and neck

Stellate Ganglion
fusion of the inferior cervical sympathetic ganglion with the ganglion of T1
middle cervical and stellate ganglia innervate the heart, lungs, and bronchi.

Stimulation of the sympathetic system causes:

• Airway relaxation
• Blood vessel constriction
• Inhibition of glandular secretion
• Increased release of water, which lowers the viscosity of mucus

Question 3

parasympathetic pertinent for respiration?

Answer 3

Parasympathetic innervation of the lungs and upper airway arises from the vagus.

Pterygopalatine (Sphenopalatine) ganglia supply parasympathetic innervation to the sinuses, nose, lacrimal gland, and blood flow to the nasal mucosa.

Stimulation of the parasympathetic system leads to :

• *Airway constriction
• Blood vessel dilation
• *Increased glandular secretion
• Increased synthesis of mucus glycoprotein, which raises the viscosity of mucus

Question 4

kyphosis?

Answer 4

Reduction of thoracic kyphotic angles demonstrated a reduced vital capacity, inspiratory capacity, total lung capacity, and lateral expansion

Effects of balloon kyphoplasty:
Measured pain scores reduced significantly
FVC and maximum voluntary ventilation (MVV) are significantly increased after 3 days

Question 5

effects of dimished lymphatic flow?

Answer 5

1. Diminished antigen/allergen presentation
2. Tissue congestion
   Sinus congestion
   Pleural effusion
   Pulmonary infiltrates
3. Prolonged recovery from infectious etiologies

Question 6

tx for chapman’s points?

Answer 6

Anterior points are diagnostic

Posterior points are for treatment

Alternative way to treat: hold anterior and posterior points, connect with firm thought, wait for connection to resolve

Question 7

anterior middle ear point?

Answer 7

upper edge of the clavicle, just lateral where it crosses the 1st rib

Question 8

anterior upper lung?

Answer 8

Upper lung - 3rd and 4th intercostal space close to the sternum

Question 9

Myocardium CP posteriorly?

Answer 9

– intertransverse space, midway between spinous and transverse processes of 2nd and 3rd vertebra

Question 10

upper/lower lung CP posteriorly?

Answer 10

Upper lung - intertransverse space, midway between spinous and transverse processes of 3rd and 4th vertebra

Lower lung - intertransverse space, midway between spinous and transverse processes of 4th and 5th vertebra

Question 11

tonsils CP anteriorly?

Answer 11

1st and 2nd intercostal space close to the sternum

Question 12

Bronchus, Esophagus, Thyroid anterior CP?

Answer 12

2nd and 3rd rib intercostal space close to the sternum

Question 13

sinuses CP anteriorly?

Answer 13

3 ½” from the sternum, on the upper edge of 2nd rib and in the 1st intercostal space above

Question 14

Larynx, Sinuses, Tongue posterior CP?

Answer 14

midway between the TP and SP of C2 on the superior aspect of the TP

Question 15

Bronchus, Esophagus, Thyroid posterior CP?

Answer 15

• midway between the TP and SP of T2 on the posterior aspect of the TP

Question 16

middle ear posterior CP?

Answer 16

upper edge of the posterior aspect of the tip of C1 TP

Question 17

Vomer movement?

Answer 17

The vomer is a midline bone that sits above the inter-maxillary (palatine) suture. Its motion is flexion and extension as it is driven by the motion of sphenoid.

The vomer moves in a postero-inferior direction during flexion and the opposite motion in extension.

Vomer Release:

• Palpation is done at the cruciate ligament.
• You can self-treat by placing your thumb pad over the cruciate ligament.
• Gently resting your head on the thumb and your elbow on the table.
• Wait for several cycles of flexion and extension for the vomer to be encouraged to resume its usual motion.

Question 18

Vertebropleural Ligament

Answer 18

The function of this “ligament” is to ensure that each lung is
equally aerated much like guide ropes on a hot air balloon.

Restriction here can limit lung 
function and C7 motion.

Question 19

where does vagus travel through if want to tx it?

Answer 19

AA and OA

Question 20

child’s eustachian tube

Answer 20

shorter and more horizontal than adults - making it easier for bacteria to travel from throat to middle ear

• morepliable, less cartilaginous
• increased incidence of reflux

purpose: TVP assists in these 
Equilibrates pressures
Aids in sound transmission
Prevents reflux
Drains fluids

Question 21

right lymphatic duct?

Answer 21

right side of head + right arm + heart and lungs

Question 22

left lymphatic duct?

Answer 22

whole left side (aside from heart and lungs)

Question 23

tx of pt. w/ pneumonia?

Answer 23

rib raising, improvement of lymph flow through fascial diaphragm tx of thoracic inlet/abdominal diaphragm, rib tx

exhalation rib dysfunction more often seen w/ coughing - plays part in resp. problems

Question 24

common SD of asthma?

Answer 24

might see SD of third / fourth rib

Question 25

infections leading to otitis media?

Answer 25

viral: think RSV

bacterial:
strep pneumonia
H. influenza
M. catarrhalis

Question 26

AOM vs. OME?

Answer 26

OME = occurs when fluid is trapped in middle ear - no otalgia, otorrhea or signs of systemic infection - will have hearing impairment
** usually resolves w/out treatment

AOM: occurs when middle ear becomes infected - nonspecific systemic sx, pain otorrhea, hearing impairment, bulging erythematous TM