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Block 3 > OMM > Flashcards

OMM Flashcards

1
Q

HPI complaints for thoracic spine: joint vs muscular vs skel vs neuro vs injury. how to tx?

A

uni/bil, swelling/red, stiff/dec ROM vs achy/sharp, atrophy, loss ctrl/paralysis vs deformity, gait, pain w/ movement, pressure sensation vs uni/bil, numb/tingly, weak, HA vs pop, tear, snap, direct trauma. PRICE-H, NSAIDs, muscle relaxers, manual, OMT/PT

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2
Q

special considerations for peds vs preg vs elderly

A

fine/motor develop, obese, sports, spurts vs gest age, injuries in prev preg vs prev falls, meds, bone screen, poor vision, change in ease movement, nocturnal sxs

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3
Q

PE inspection for posture vs skin vs muscle vs resp

A

kyphosis/lordosis, symm vs swelling, red, mass vs symm, hyper/atrophy, fasc, spasm vs rate/amp, location (abd)

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4
Q

PE palpation for skin, muscle, bone, joints. spinous process?

A

TART; swelling, crepitus, fluctuance/effusion. common for chronic pain but if severe –> infxn, fx, arthritis

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5
Q

PE: ROM for thoracic

A

R > SB > F > E; rotation better in lower thoracic b/c closer to lumbar anatomy

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6
Q

sclerotome vs myotome vs radicular pain

A

nerves at tendon, lig, facets on bone –> dull, achy, diffuse pain vs nerves at myofascial tissue planes around muscle –> dull, achy, diffuse, crampy, tight pain vs nerve root compression –> sharp shooting pain, paresthesia, dec DTR

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7
Q

schuermann dz sxs vs dx vs tx

A

congen wedge thoracic vertebra –> rigid kyphosis, worse w/ flex vs standing lat radiographs showing ant wedging > 5 in 3 consecutive vertebrae vs conservative (strength, stretch, oral analgesics, brace), surg if kyphosis > 60degrees

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8
Q

scolio types: congenital vs neuromuscular vs syndromic vs idio

A

hemivertebrae, bars, blocks vs CP, Spina bifida, Muscular dystrophies vs Marfan’s, NF-1, Ehlers-Danlos vs Infantile, Juvenile, Adolescent

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9
Q

idio adolescent scolio sxs vs dx vs tx

A

back pain vs skel maturity (5 = completely fused), Cobb angle; thorac > 2x major > thoracolumbar > lumbar vs conservative (heat, OMT/PT), observation for curves <25/skel immature or curves <50/skel mature, brace for >25/skel immtaure, surg >50

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10
Q

atypical adolescent schuermann’s sxs vs dx vs tx

A

thoracolumbar jxn pain worse w/ physical activity, long standing/rest vs 3 successive vertebrae w/ >/=10% wedging + schmorl nodes (nucleus pulposus hern) vs OMT/PT

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11
Q

mobility vs stability of joints: nml vs dysfxn

A

multiplane motion, stiff/injured vs single motion, unstable

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12
Q

postural/static vs phasic/movement system

A

prone to hyperactivity –> shortening, not susceptible to fatigue b/c using low lvl tone all the time vs prone to inhibition –> lengthening/weakening, susceptible to fatigue b/c shorter bursts of activity w/ rest in b/w

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13
Q

upper cross syndrome sxs vs tx

A

Muscle imbalance around head/shoulder –> ant head carriage, kyphosis. weak scalene, longus coli -> mid/low trap, rhomboids; tight up trap, lev scap, suboccipital -> pecs vs stretch tight muscles to strengthen, OMT/PT, wet/dry needling, acupuncture

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14
Q

lower cross syndrome sxs vs tx

A

Muscle imbalance about the pelvis –> Low back/hip pain, Patellofemoral dysfunction, Ant pelvic tilt, lumbar lordosis. weak rectus/transversus abdominis, obliques -> glut; tight erector spinae, quad lumborum -> iliopsoas, rectus femoris, TFL vs same w/ upper cross

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15
Q

mechanical vs nonmechanical fx

A

vertebral, rib –> localized pain, severe w/ movement; from chronic steroids, elderly, ankylosing spondylitis vs pain in T spine d/t 2ndary causes: tumors/mets (PB KTL), HNP, infxn

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16
Q

trigger point vs tender point. can trigger points be txed w/ counterstrain?

A

characteristic pain pattern, only in muscle, taut, twitch, dermographia over skin vs no characteristic pain pattern, muscle/tendon/lig/fascia, no taut/twitch/dermographia. yes

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17
Q

counterstrain tx seq

A
  1. do H&P, TART
  2. tenderness scale = 10/10, put pt in max comfort & hold for 90 sec
  3. chk q 30s for tenderness & readjust
  4. slow return back to nml, pt still passive
  5. aim for <3/10
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18
Q

absolute vs relative contraindic of counterstrain

A

fx, lig tear, life threatening exac, pt request vs cardiac event, DVT, gravely ill, neuro condition, joint replacement, OA, RA, preg, Down syndrome

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19
Q

what are Maverick points? how to tx mult tender points?

A

when counterstrain points = not in reg motion when F/E, S/R like C4. tx most tender first vs tx middle first

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20
Q

atypical vs typical cervical vertebrae. atypical vs typical cervical joints. how are spinal nerves named?

A

C1, C2 vs C3-C7. C0 on C1, C1 on C2 vs C2-C7 w/ C7 on T1 (C7). above associated vertebral bodies

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21
Q

does atlas have vertebral body? how does it move about C2? do cervicals follow Fryette’s principles? know how OA/AA does rot/sidebend too

A

no. rotates around C2 d/t cruciform/transverse lig. no: C1 = type 1-like, 50% does F/E at OA (C2-7 does rest); C2 = only 50% rotation at AA w/ transverse lig (C3-7 does rest); C3-C7 = type 2-like

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22
Q

know cervical landmarks

A

C1: b/w mastoid process and mandible
C2: between mastoid process and angle of mandible (level with SP)
C3: hyoid
C4: slightly above thyroid cartilage notch
C5: slightly below thyroid cartilage notch
C6: first cricoid ring of trachea and carotid tubercle
C7: vertebral prominens

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23
Q

how far can PROM go in sagittal vs coronal vs transverse plane

A

50 degrees chin to chest, 60 degrees directly looking at ceiling vs 45 degrees ear to shoulder vs 80 degrees head turn to shoulder

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24
Q

what is pos for spurling’s test? Lhermette’s sign = sx of what?

A

radicular pain on ipsi head rotation & compression. myelitis, MS, B12 defic, disc hern, Chiari, tumor

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25
Q

how to do OA vs AA dx

A

like nml, name type 1-like vs cup fingers on occiput and fingers on AA –> fully flex head –> rotate –> find dysfxn

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26
Q

joints of Luschka

A

▪ Unciform joints, synovial joints
▪ Assist in maintaining stability
▪ Act as a guide rail for F/E
▪ Limits translatory motion, subluxation sideways

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27
Q

how to find typical C3-C7 articular pillars

A

Superior Facet of above vertebrae + Inferior Facet of below vertebrae, 2-3cm posterolat from spinous process; OPEN = forward bending or sidebending away, CLOSE = backward bending or sidebending towards

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28
Q

how to chk for rotation vs sidebending when pt is supine during dx

A

force ventrally on L lat mass –> rotate R, on R lat mass –> rotate L vs R to L –> sidebend R, L to R –> sidebend L

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29
Q

OA somatic dysfxn: flexion sd vs extension sd. how are OA asymm compensated?

A

post condyles on C1, space b/w occiput & C1 = deeper, chin tucking in vs ant condyles on C1, space b/w occiput & C1 = shallower, chin tucking out. suboccipital muscles, OA = last thing to compensate for gravity/posture

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30
Q

prevention of cerebrovasc dz: HTN, wt vs smoking, DM vs dyslipidemia

A

leading risk of ischemic & hem stroke, inc risk 2x vs 2x ischemic/3x subarach hem, 2-3x inc vs 5-17x stroke

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31
Q

causes of CN1 impairment vs how to test CN1?

A

nasal obstruction, foreign body, intracranial lesion vs close eyes & one nostril –> introduce smell; don’t do noxious smells –> activate pain fibers CN5

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32
Q

CN2 fundoscopic exam

A

look at both retinas with an ophthalmoscope; Optic discs: Point of entry of optic nerve, Retinal vasculature & abnlities

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33
Q

CN2 visual acuity test: far vision vs near vision

A

snellen chart, 20 ft away, distance from chart/distance avg eye can read line) vs rosenbaum chart, 14”/arm’s distance

34
Q

visual field test: confrontational testing. how to test extraocular movements?

A

pt covers 1 eye fixed on dr’s nose, dr holds how many fingers in sup temp/nasal & inf temp/nasal quadrants. follow finger in 6 cardinal direction

35
Q

pupillary light rxn CN2 (sensory) & CN 3 (motor) test. accommodation vs convergence

A

beam of light shining into one retina causes pupillary constriction in that eye (DIRECT RESPONSE) and in the contralateral eye (CONSENUAL RESPONSE). inc convexity lens for near objects vs bil MR muscle activation

36
Q

CN3 vs CN4 vs CN6 GSE

A

levator palpebrae sup muscle vs eye adducts –> depression, eye abducts –> intorsion vs LR to abduct

37
Q

Horner’s syndrome = interruption of what pathway?

A

oculosympathetic pathway –> anhidrosis, ptosis, constricted pupil. lung mass can push up pathway

38
Q

Marcus Gunn. cause? vs Argyll Robertson pupil. cause?

A

no ipsi direct pupil constriction, but contralat consensual does. lesion in optic n, eye, retina vs no ipsi pupil constriction but ipsi accommodation. syphilis

39
Q

how to test for CN5 sens vs motor vs corneal reflex

A

Qtip or pin at forehead, cheek, jaw bil –> see if same or diff both sides vs pt clenches teeth –> feel bulging muscle bellies vs hold eyebrow & head –> pt looks L –> cotton wisp on R cornea –> bil eyelid closure reflex

40
Q

CN7 facial n tests. describe facial droop

A

-raise eyebrows
-close eyes tight and doctor tries to pen up eye against resistance
-puff out cheeks and resist
-bare teeth, smile
* Upper Motor Neuron Lesion –> Contralat lower face weakness, Spares contralateral forehead, CVA
* Lower Motor Neuron Lesion –> Total ipsi face paralysis, Bells Palsy

41
Q

CN8 vestibular/hearing: FINGER RUB TEST. know the hearing pathways, air & bone condux

A

pt eyes closed –> Examiner rub fingers together near 1 ear at a time –> pt raises hand on side where rubbing occurred

42
Q

rinne conductive hearing loss test

A

compare AC to BC. 512 Hz tuning fork –> mastoid –> pt tells when they can’t hear anymore –> external acoustic meatus; pos if can hear at meatus after mastoid –> AC > BC, neg if can’t –> BC > AC –> conductive hearing loss

43
Q

Weber test conductive or sensorineural loss

A

512 Hz tuning fork middle forehead –> hearing in mid or lat. nml if mid; abnl if lat: unilat conductive loss for sound on affected side, unilat sensorineural loss for sound on unaffected side

44
Q

palate eval vs gag reflex vs CN11 strength test

A

say ah –> palate up, uvula midline, post pharynx medial vs qtip in –> palate up, pharynx constrict. CN9 = sensory, CN10 = motor vs pt rotates head –> dr pulls lat chin for pt to resist; pt shrugs shoulders up –> dr bring them down on AC joint

45
Q

CN12 innervates what? how does dev happen? impairment causes?

A

intrinsic tongue muscles. tongue pushes toward abnl side. UMN cortex, LMN CN12 lesion, tongue muscle lesion, neuromuscular jxn

46
Q

articulation testing of CN 7/10/12. impairment causes?

A

“pah, pah pah” –> labial sounds (CNVII)
“cah, cah, cah” –> pharyngeal sounds (CNX)
“tah, tah, tah” –> tongue sounds (CNXII).
motor cortex, BG, cerebellum; articulation muscles, neuromuscular jxns; periph or central CN 5/7/9/10/12

47
Q

muscle stretch reflex/DTR pathway. C5 vs C6 vs C7 vs L4 vs S1 tendon reflex

A

tap tendon in partially stretched muscle –> special sensory fibers –> sensory impulse to periph n to spinal cord –> ant horn cells –> neuromuscular jxn –> muscle ctx to complete reflex. biceps vs brachioradialis vs triceps vs patellar vs achilles

48
Q

C5 structures for shoulder abdux vs elbow flex

A

delt, axillary n, post cord, post division, mid trunk vs biceps, brachialis, lat cord, ant division, sup trunk

49
Q

C6 wrist ex vs C7 elbow ex vs C8 grip structures

A

extensor carpi radialis longus/brevis, radial n, post cord, post division vs triceps, radial n, post cord, post trunk vs flex digitorum superficialis/profundus, median & ulnar n

50
Q

T1 finger abdux vs L2 hip flex vs L3 knee ex structures

A

doral intereossei, ulnar n, med cord, ant division, inf trunk vs iliospoas, femoral n vs quads, fem n

51
Q

L4 ankle dorsiflex vs L5 great toe dorsiflex vs S1 plantarflex

A

ant tibialis, deep fib n vs extensor hallucis longus, deep fib n vs gastroc/sol, tibial n

52
Q

where to test C2 vs C3 vs C4 vs C5 vs C6 vs C7 vs C8 vs T1 vs T2 sensation?

A

1cm lat to inion vs supraclavicular fossa vs sup AC joint vs radial antecubital fossa vs dorsal prox thumb vs dorsal prox mid finger vs dorsal prox pinky vs ulnar antecubital fossa vs apex axilla

53
Q

where to test L1 vs L2 vs L3 vs L4 vs L5 vs S1 vs S2 vs S3 vs S4/5 sensation?

A

b/w T12 & L2 vs anteromed thigh vs med epicondyle vs med malleolus vs dorsal foot vs lat calcaneus vs popliteal fossa vs ischial tuberosity vs perianal

54
Q

primary sensory eval: vib vs proprio

A

128 Hz tuning fork on heel of hand –> bring to distal joint (finger/toe) –> pt closes eyes and says when vib stops; if abnl, proceeds to finger/toe > knee/elbow > hip/shoulder vs grab pt’s toe/thumb and tell them which is up/down –> pt closes eyes and dr moves up/down –> pt reports direction; if abnl proceed joints like in vib

55
Q

discriminatory exam: stereognosis vs graphesthesia vs 2 pt discrim vs localization vs extinction

A

ID object by sensation (eyes closed) vs ID number drawn on hand eyes closed vs feeling 2 points w/ smallest distance possible <5mm on finger pads vs replicate point on body that was palpated eyes closed vs feel simult touch on both sides of body; abnl if pt only feels one side

56
Q

coordination requires what 4 systems?

A

Motor system (strength)
Cerebellar system (rhythmic movement and steady posture)
Vestibular system (balance and coordinating eye/head/body movements)
Sensory system (position sense)

57
Q

appendicular vs truncal ataxia

A

defect in cerebellar hemis –> axial & prox limb weakness vs defect in cerebellar vermis –> falling on ipsi side

58
Q

coordination: rapid alternating movements: UE vs UE finger vs LE toe

A

hands on thighs vs tap index & thumb vs toe tapping; abnl if slow or clumsy

59
Q

coordination: point to point

A

finger to nose: abnl if dysmetria, ataxia, tremor
heel to shin: abnl if dysmetria, ataxia, intention tremor
Romberg: lose bal when closing eyes 30-60s

60
Q

Brudzinski vs Kernig test

A

both test for mengingeal, nerve root, dural irritation. 1. Patient actively flexes head onto the chest; POSITIVE = pain in the neck or spine vs 1. Patient actively raises leg –> If pain in neck or spine occurs, patient flexes knee; POSTIVE = pain disappears when flexing knee

61
Q

extension & rotation of occiput can occlude what artery?

A

opposite vertebral a

62
Q

describe lig in cervical context

A

narrow elastic support for head, ctrls great ROM and protects spinal cord/nerves; become primary support when muscles = fatigued

63
Q

know the muscle groups for fl, ex, rot, sb for head/neck

A

OMM peer tutor study guide, pg 28

64
Q

mechanical neck pain pattern. assoc w? ddx? exam findings?

A

aching pain in cervical paraspinal muscles, stiff in neck/shoulders +/- HA up to 6 wks. poor posture, sleep, stress. fibromyalgia, torticollis, somatic dysfxn. dec ROM, pain w/ movement, no neuro deficit

65
Q

whiplash. how long is chronic? what must be excluded before making dx? exam findings?

A

paracervical pain/stiff d/t neck hyperfl/ex like in rear end collisions; +/- occipital HA, fatigue, dizzy. >6mo. causes of cervical cord compression like fx, hern, head injury. dec ROM, paracervical tenderness, perceived weakness

66
Q

cervical radiculopathy. causes? exam findings?

A

paresthesia in neck + 1 arm. hern disc, spondylosis, dysfxn of C-spine, nerve root probs, tumor, syrinx, MS. C7 –> weak triceps, finger flex; C6 –> weak biceps, brachioradialis, elbow ex

67
Q

cervical myelopathy. ddx? exam findings?

A

when cervical disc compresses on spinal cord –> neck pain, paresthesia in U/LE, incont, clumsy hands, walk/gait. cervical spondylosis (abnl wear/tear in cartilage), cervical stenosis from osteophytes, disc hern. UMN sxs, gait, +/- Lhermette

68
Q

know how to fix ant tenderpoints C1-C8

A

OMM peer tutor study guide, pg 10

69
Q

foraminal vs cervical nucleus pulposus hern

A

unilat dermatomal –> around a rib vs pain LE, numb/weak, inc DTRs

70
Q

osteomyelitis spread vs micro vs sxs vs risk factors

A

hematogenous, contig, direct inoc vs s. aureus, strep, p. aeruginosa vs insidious & progressive localized pain vs DM, immunocompromised

71
Q

spinal epidural abscess spread vs micro vs sxs vs risk factors

A

hematogenous, contig = direct inoc vs s. aureus, strep, gram neg bacilli, pyogenic staph vs triad: fever, back pain, neuro deficits vs bacteremia from IVDU, intravasc devices, dental abscess

72
Q

CN5 sensory vs motor

A

pain/temp/, vib/proprio for face, mouth, ant 2/3, nasal sinuses, meninges vs tensor tympani & mastication muscles

73
Q

hypo vs hyperactive reflexes causes

A

ant horn d/o, myopathies vs pyramidal, electrolyte abnlities, hyperthyroid

74
Q

thoracic costal facets has 3 parts:

A

2 demifacets on vertebral body (for typicals only), 1 demifacet on transverse process

75
Q

primary vs secondary mm for inhalation? for exhalation?

A

diaphragm, scalene, external intercostal vs SCM, upper trap, serratus. lung recoil, diaphragm vs internal intercostal, abd, serratus

76
Q

sympathetic chain ganglia located on what bone? sympathetic nervous system involved in what reflexes?

A

ant rib heads. somatovisceral, viscerosomatic

77
Q

chapman’s reflex. what is a pos Chapman reflex? acute vs chronic characteristics

A

viscerosomatic; reflex points presenting predictable ant/post fascial tissue texture abnlities reflecting visceral dysfxns. both ant/post point present. tender, nonradiating vs less/non tender

78
Q

parts of thoracic inlet

A

T1-4, R1-2, manubrium; scapula, 1st rib, clavicle, neurovasc bundle

79
Q

know rule of three’s. what’s coupled motion? Law 3 of Fryette’s?

A

Lec 2, slide 19. principal motion can’t occur w/o secondary motion (ex: rotation & sidebending). motion in 1 plane dec –> motion in all other planes dec if motion alrdy occurred

80
Q

direct vs indirect OMM tx examples

A

soft tissue, ME, myofascial release vs bal lig tension, counterstrain, myofascial release

81
Q

motor exam: bulk vs tone vs strength & reflexes

A

hyper/atrophy, fasciculation, spasm vs nml = sm sensation, inc = rigid/spastic, dec = flaccid, limp vs you know the scale

82
Q

CN9 vs 10 for muscles, parasympathetics, sens, taste, chemo/baro

A

stylopharyngeus. parotid. post 1/3, ex ac, mid ear, pharynx. post 1/3. carotid vs ph/larynx, ex ac, meninges. heart, lungs, GI. pharynx, epiglottis. aortic arch

Block 3 (23 decks)

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