OMM 2

Question 1

somatic dysfxn of temp bone can do what?

Answer 1

partially/completely close E tube –> impaired mid ear drainage –> ear infxn

Question 2

lymphatic drainage of head/neck. what happens if there is a dysfxn in any of the structures?

Answer 2

head –> neck –> cervcial fascia –> thoracic inlet –> gen circ. hinder pathways –> lymphatic congestion

Question 3

what happens if there’s symph stim of lymph drainage?

Answer 3

constrict smooth msucle of lg lymphatic vessels in head/neck –> dec lymph drainage

Question 4

how does direct vs indirect OMM tx work?

Answer 4

stim flow or remove impediments of flow vs alleviate somatic dysfxn –> consequential nmlization/bal of autonomic nervous system

Question 5

L vs R side of head/neck lymph drainage

Answer 5

L thoracic duct vs R lymphatic duct; each empties to jxn of IJV & subclavian veins

Question 6

describe parasymph innerv (think anatomy)

Answer 6

CN7 fibers to sup salivatory nucleus –> pregang greater petrosal n w/ deep petrosal n –> vidian n/n of pterygoid canal –> sphenopalatine ganglion –> post ganglionic stuff –> vasodil, stim gland epith to make mucus

Question 7

describe symph innerv (think anatomy)

Answer 7

T1-4 fibers in cervical ganglia –> sup cervical ganglion –> postganglionic internal carotid plexus –> deep petrosal n –> vidian n/n of pterygoid canal –> sphenopalatine gang –> sinus –> vasoconstrict, inc nasal airway patency

Question 8

acute sinusitis. what factors should you consider?

Answer 8

inflamed mucous memb of paranasal sinuses & nasal cavity <4wks (chronic >12wks). anything dec airway patency -> limit air flow, or dec mucociliary transport

Question 9

2 sinus drainage patterns: ant vs post. what about maxillary drainage?

Answer 9

drain to ostemeatal unit under mid concha vs sphenoethmoid recess. go uphill -> requires mucociliary transport

Question 10

factors that can influence airway patency

Answer 10

deviated nasal septum, turbinate hypertrophy, collapsed nasal valve, nasal polyps, hypoactive symph, vasodil, virus, topical nasal decongestants

Question 11

noses, sinuses, mide ear = covered by what? 2 mucous film layers: sol vs gel phase

Answer 11

pseudostrat columnar ciliated epith w/ mucus blanket on top from goblets cells & submucosal glands. cilia w/in inner serious layer vs w/in outer viscous layer moved by synchronized action

Question 12

factors influencing mucociliary transport

Answer 12

mucus freq & viscosity, primary ciliary dyskinesia, antihist/dehydration/dairy, smoke, CF, DM

Question 13

neuro model of sinusitis

Answer 13

inc symph –> vasoconstrict & inc nasal airway patency –> thick mucus, dec lymph drain. parasymp imbal –> inc tear & runny nose. tissue text change in O/AA, C2, T1-4, upper ribs

Question 14

sinusitis sxs vs PE vs tx

Answer 14

nasal obstruction, biphasic illness, periorbital pain, purulent rhinorrhea, olf disturb, maxillary toothache, facial pressure, dull unilat HA worse in morning vs deviated septum, pus, inflamed nasal mucosa, nasal polyps, postnasal drain in post oropharynx vs open thoracic inlet, dec symph, facial effleurage, articulate nasal bones, abx

Question 15

otitis media. goals for OMM tx for this?

Answer 15

inflamed mid ear –> effusion –> TM can’t vibrate as much –> sound transmission impaired. improve lymph drain, dec mid ear effusion, improve E tube dysfxn or cranial/temp bone motion

Question 16

biomech vs neuro vs resp/circ vs metab vs biopsychosocial models for OM

Answer 16

address structural impediment vs dec neural compression vs improve mid ear drain vs dec stress of infxn vs improve pt’s environ vs

Question 17

conductive vs sensorineural hearing loss. pt has fine vs coarse hair?

Answer 17

BC>AC, pt hears better in noisy environ, quiet voice b/c inner ear/coch n intact; from cerumen, AOM, TM perforation, tympanosclerosis vs AC>BC, worse in noisy environ, loud voice b/c inner ear/coch n dmged. hyperthyroid vs hypothyroid

Question 18

conductive vs sensorineural phase of hearing

Answer 18

vib in air –> ext ear canal –> mid ear vs vib = coded & passed to coch n to brain

Question 19

AOME vs bullous myringitis vs serous effusion sxs

Answer 19

red, bulging, lost landmarks; pt has pain, fever, hearing loss; bact/viral/fungal vs painful hem vesicles of TM & canal; pt has pain, hearing loss; bact/viral vs air in mid ear –> bloodstream –> serous fluid; pt has pain, fullness, popping; viral URI, change in atm pressure from flying/diving, E tube not equalizing pressure

Question 20

TM perforation vs tympanosclerosis sxs

Answer 20

from infection/trauma; central or marginal vs deposited hyaline material not causing hearing loss; TM retracted. both can cause CHL

Question 21

what structures = post to tongue? what’s the pharynx?

Answer 21

ant/post pillars, tonsils, uvula, soft/hard palate. recess behind soft palate & tongue

Question 22

what are Stenson’s ducts?

Answer 22

aka parotid ducts next to upper M2

Question 23

actinic cheilitis vs angular cheilitis vs HSV. chancre vs carcinoma

Answer 23

too much sunlight, lower lip = scaly, thick, everted, lose color vs fissure at angles of mouth d/t malnut, ill fitting dentures, candida vs recurrent painful vesicular eruptions around lips that crust over. syphilis ulcer on lip vs scaly plaque ulcer wwo crusting

Question 24

angioedema vs hereditary hemorrhagic telangiectasia vs Peutz-Jegher’s syndrome

Answer 24

swell dermis & subq tissue d/t allergies vs mult small red spots -> chk h/o epistx & GI bleeds vs pigment on lips, mouth, face, hands d/t intestinal polyps

Question 25

acute necrotizing ulcerative gingivitis vs gingival hyperplasia vs preg tumor/pyogenic granuloma vs Hutchinson’s teeth

Answer 25

fever, malaise, enlarged LN, ulcer, gray pseudomembrane d/t bacteria vs enlarged, red, raised d/t dilantin, preg, leukemia vs interdental papilla, red, soft, bleeds vs small, notched, widely spaced teeth from congen syphilis

Question 26

geographic vs hairy vs fissured vs glossitis vs candidiasis vs hairy leukplakia

Answer 26

smooth scattered red areas, denuded vs benign after rx, yellow to black vs benign d/t age vs loss of papillae from niacin/folate/B12/B6/iron defic or chemo vs thick white from immunosuppress vs can’t be scraped, white feathery edges

Question 27

aphthous vs syphilis vs varicose vs leukoplakia vs tori mandibulares

Answer 27

painful oval ulcer, yellow/gray w/ red halo vs mucous patch, painless infectious oval raised gray membrane vs benign deep purple vv vs painless white patch -> bx vs benign oval bony growths

Question 28

pharyngitis vs diphtheria vs thrush vs Fordyce spots

Answer 28

bact/viral –> red & vascular vs dull red w/ grey exudate on uvula, possible airway obstruction vs Candida infxn from abx, immunosuppress, steroids -> thick white plaques vs enlarged yellow seb glands in buccal mucosa

Question 29

Koplik spots vs petechiae vs exudative tonsillitis vs torus palatinus

Answer 29

small white specks on red background near 1/2nd molars; measles vs small red spots d/t trauma, infxn, low PLTs vs white coat w/ fever –> test for strep & mono vs midline benign bony growth

Question 30

borders of ant vs post triangle of neck

Answer 30

mandible above, SCM lat, midline neck med vs clavicle below, trap lat, SCM med

Question 31

how to do integrated exam

Answer 31

similar to layered palpation
o Observe
o TART
o Gross ROM
o Neural & vasc associations
o TART of more subtle ROM => segmental dx