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COMLEX Flashcards

1
Q

Freyette’s Principle 1

A 
Neutral mechanics
Sidebend and Rotate in OPPOSITE directions
Multiple segments
Creates Lateral Curves
Gradual onset
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2
Q

Freyette’s Principle 2

A 
Flexed/ Extended
Sidebend and Rotate in SAME direction
Single segment
Creates flattening or exaggeration of AP curves
Abrupt onset
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3
Q

Freyette’s Principle 3

A

Motion in any single plane modifies motion in other planes

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4
Q

Spine of Scapula is at spinal level

A

T3

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5
Q

Inferior angle of scapula is at spinal level

A

T7

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6
Q

Sternal notch is at spinal level

A

T2

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7
Q

Sternal angle is at which levels anteriorly and posteriorly?

A

Anterior: 2nd rib
Posterior: T4

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8
Q

Iliac crest is at spinal level

A

L4

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9
Q

Spinous Process

Rule of 3’s

A 
T1-T3 same level as TP
T4-T6 is half level below TP
T7-T9 is level of TP below
T10 is level of TP below
T11 is half level below TP
T12 is same level as TP
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10
Q

Superior Facets of cervical spine

A

Oblique

Face backwards, upwards, medial (BUM)

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11
Q

Superior Facets of thoracic spine

A

Coronal

Face backwards, upwards, lateral (BUL)

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12
Q

Superior Facets of lumbar spine

A

Sagittal

Face backwards, medial (BM)

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13
Q

Anatomic Barrier

A

Anatomy limits motion

Limit of passive motion

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14
Q

Physiologic Barrier

A

Limit of active motion

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15
Q

5 Models of Osteopathy

A 
Biomechanical/ Structural Model
Respiratory-Circulatory Model
Metabolic Model
Neurological Model (CS, Chapman)
Behavioral Model
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16
Q

5 Components of Primary Respiratory Mechanism

A

Inherent brain motility is the driving force
CSF is hydraulics moving concurrently
Bones of the skull move
Membranes move –> reciprocal tension membrane
Involuntary motion of sacrum
CNS -> CSF -> Dura -> skull -> sacrum = PRM

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17
Q

Normal Rate of Cranial Rhythmic Impulse

A

Rate 8-14/ min

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18
Q

Factors that Increase CRI

A

Exercise
Fever
Following OMT of craniosacral mechanism

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19
Q

Factors that Decrease CRI

A

Stress (physical and emotional)
Depression
Chronic fatigue
Chronic Infections

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20
Q

Pterion is the joint of (4 bones)

A 
Frontal
Sphenoid
Parietal
Temporal
*at the temple*
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21
Q

Asterion is the joint of (3 bones)

A

Occiput
Parietal
Temporal
just above mastoid

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22
Q

Bregma is the junction of (2 sutures)

A

Coronal

Sagittal

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23
Q

Lambda is the junction of (2 sutures)

A

Lambdoid

Sagittal

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24
Q

Basion location

A

Ventral aspect of Foramen Magnum

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25
Q

Opisthion location

A

Dorsal aspect of Foramen Magnum

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26
Q

Midline Bones pertinent to cranial motion

A

Sphenoid
Occiput
Sacrum

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27
Q

Paired Bones pertinent to cranial motion

A 
Frontals
Parietals
Temporals
Nasals
Zygomas
Maxillae
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28
Q

Motion of midline bones

A

Flexion and Extension

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29
Q

Motion of Paired bones

A

Internal and External Rotation

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30
Q

_____ influences motion of anterior cranial bones

A

Sphenoid

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31
Q

_____ influences the motion of bones of posterior cranium

A

Occiput

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32
Q 
During Cranial Flexion
SBS \_\_\_\_\_ 
Sacrum \_\_\_\_\_
Midline bones \_\_\_\_\_
Paired bones \_\_\_\_\_
AP diameter \_\_\_\_\_
A 
SBS rises
Sacrum extends (counternutation)
Midline bones Flex
Paired bones External Rotation ("flEXternal")
AP diameter Decreases (widened head)
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33
Q 
During Cranial Extension
SBS \_\_\_\_\_ 
Sacrum \_\_\_\_\_
Midline bones \_\_\_\_\_
Paired bones \_\_\_\_\_
AP diameter \_\_\_\_\_
A 
SBS falls
Sacrum flexes (nutation)
Midline bones Extend
Paired bones Internally rotate
AP diameter Increases (narrowed head)
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34
Q

Cranial Vault Hold

A 
Forearms on table
Index- Great wing
Middle- Temporal bone, just anterior to EAM
Ring- Petrous temporal
Pinky- Occiput
Thumbs- Sagittal suture
Palms conform to skull
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35
Q

Galbreath Technique

A 
For Otitis Media (drain middle ear)
Pt supine, head elevated 30 deg
Turn head so affected ear is up
Sit on side OPP dysfunction
Cephalic hand on forehead
Caudad hand on mandible
Gently press down and in
Repeat every 3-5 sec over 30-60 sec (up to 10-20 mins as needed)
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36
Q

Sphenoid motion during cranial flexion

A

Sphenoid body rises and slightly anterior
Wings move anterior, laterally, and slightly inferior
*extension motion is opposite

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37
Q

Occiput motion during cranial flexion

A

Base rises and moves slightly posterior
Squamous portion moves inferior and laterally
*extension motion is opposite

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38
Q

Sphenoid and Occiput circumduct in _____ direction about _____ axis(es)

A

Circumduct in OPPOSITE directions

About 2 TRANSVERSE axes

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39
Q

Axis of Cranial Torsion

A

AP

Opposite directions

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40
Q

Cranial torsion is named for

A

High sphenoid

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41
Q

Axis of Cranial Sidebending Rotation Strain Pattern

A

2 vertical = sidebend (opposite directions)

AP = rotation (same direction)

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42
Q

Physiologic Cranial Strain Patterns

A

Torsion

Sidebending Rotation

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43
Q

Pathologic Cranial Strain Patterns

A

Lateral Strain

Vertical Strain

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44
Q

Sidebending Rotation Cranial Strains are named for

A

Convex side

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45
Q

Lateral Cranial Strain is named for

A

Freer motion of sphenoid

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46
Q

Axis of Cranial Lateral Strain

A

2 vertical axes

Both same direction

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47
Q

Axis of Cranial Vertical Strain

A

2 transverse axes

Both same direction

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48
Q

Cranial Vertical Strain is named for

A

Base of sphenoid

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49
Q

Motion testing of Cranial Sidebending Rotation Strain

A

Inferior motion separates fingers

Superior motion brings fingers together

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50
Q

Internally rotated Temporal bone will cause

A

High pitched tinnitus

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51
Q

Externally rotated Temporal bone will cause

A

Low pitched tinnitus

Jaw deviates toward Ext Rot temporal

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52
Q

Occipital-Mastoid Suture Compression can affect _____ and is treated with _____

A

Can affect Jugular foramen (CN 9. 10, 11)

Treated with V-Spread

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53
Q

CN 2-6 Issues can be caused by a _____ dysfunction

A

Sphenoid

  • CN 2,4,6 = Diplopia
  • CN 3,4,6 = Strabismus
  • Trigeminal Neuralgia
  • Pituitary Dysfunctions
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54
Q

Suckling disorders in Newborn should clue you into

A 
Jugular foramen (CN 9, 10, 11)
Compression of occipital condyle (Hypoglossal canal, CN 12)
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55
Q

Typical Cervical Vertebrae

A

C2-C7

Sidebend and Rotate in SAME direction

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56
Q

Occiput Sidebends and Rotates to _____ side

A

OPPOSITE

Major motion is flexion and extension

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57
Q

Motion of the Atlas

A

Rotation only

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58
Q

Superior articular facets of C2-C7 are at a _____ angle

A

45 deg

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59
Q

Biceps Reflex tests what muscles

A

Deltoid

Biceps

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60
Q

Biceps Reflex tests what disc and nerve root

A

Disc C4-C5

Nerve root C5

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61
Q

Biceps Reflex tests sensation to

A

Lateral Arm

Axillary nerve

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62
Q

Brachioradialis Reflex tests what muscles

A

Wrist extensors

Biceps

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63
Q

Brachioradialis Reflex tests what disc and nerve root

A

Disc C5-C6

Nerve root C6

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64
Q

Brachioradialis Reflex tests sensation to

A

Lateral forearm

Musculocutaneous Nerve

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65
Q

Triceps reflex tests what muscles

A

Wrist flexors
Finger extension
Triceps

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66
Q

Triceps reflex tests what disc and nerve root

A

Disc C6-C7

Nerve root C7

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67
Q

Triceps reflex tests sensation to

A

Middle finger

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68
Q

C8 provides motor innervation to what muscles

A

Finger Flexors

Hand intrinsics

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69
Q

C8 provides sensation to

A

Medial forearm

Medial Ant. Brachial Cutaneous Nerve

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70
Q

T1 provides motor innervation to what muscles

A

Hand intrinsics

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71
Q

T1 provides sensation to

A

Medial arm

Medial Brachial Cutaneous Nerve

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72
Q

Ulnar Nerve Palsy results in

A

Claw Hand

  • No finger extensors at IP joint
  • Permanent flexion of fingers
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73
Q

Median Nerve Palsy results in

A

Ape Hand

-Inability to oppose thumb

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74
Q

Radial Nerve Palsy results in

A

Wrist Drop

  • No wrist extension
  • No forearm extension
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75
Q

Ulnar Nerve can be impinged at what locations

A 
Cubital Tunnel (medial epicondyle)
Ulnar/ Guyon's Canal (pisiform, hook of hamate)
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76
Q

Medial Nerve can be impinged at what locations

A 
Pronator Teres Syndrome
Carpal Tunnel (flexor retinaculum)
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77
Q

Most common Dysfunction of the Elbow

A

Cubitus Valgus / ABducted Ulna
Olecranon –> medial
Distal Ulna –> lateral
Wrist is ADducted

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78
Q

Lateral Epicondylitis

A

Tennis elbow
Overuse
Extensor Carpi Radialis Brevis
Resisted wrist extension

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79
Q

Medial Epicondylitis

A 
Golf Elbow
Overuse
Pronator Teres and Flexor Carpi Radialis
Resisted pronation and wrist flexion
"Medial --> Masters --> Golf"
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80
Q

_____ Radial Head favors Supination

A

Anterior Radial Head

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81
Q

_____ Radial Head favors Pronation

A

Posterior Radial Head

“P for posterior and pronation”

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82
Q

Radial Head Dysfunction expected from a backward FOOSH

A

Anterior Radial Head

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83
Q

Muscle Energy for Anterior Radial Head

A

Posterior pressure on radial head

Pronate hand against resistance

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84
Q

Radial Head Dysfunction expected from a forward FOOSH

A

Posterior Radial Head

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85
Q

Muscle Energy for Posterior Radial Head

A

Anterior pressure on radial head

Supinate hand against resistance

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86
Q

Nursemaids elbow

A

Subluxation of annular ligament
Sudden longitudinal traction to hand
Tx: closed reduction –> either supination or hyperpronation techniques

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87
Q

Spurling’s Test

A

Nerve root compression
Sidebend, extend, compress neck
+ if reproduces radicular symptoms

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88
Q

Neer’s Test

A

Impingement / Irritation of Supraspinatus
Shoulder INT ROT and ADducted
Doc passively flexes humerus
“Neer to the ear”

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89
Q

Hawkin’s Test

A

Impingement of Supraspinatus
Shoulder ADducted and flexed
Doc passively INT ROT humerus

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90
Q

Jobe’s Test (Empty Can Sign)

A

Tear of Supraspinatus
Arms ABducted and in plane of scapula
Thumbs down and resist down pressure

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91
Q

Speed’s Test

A

Irritation of Long Head of Biceps Brachii
Arms 90 deg flexion, palms up
Doc presses down on forearm

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92
Q

Apprehension Sign

A

Anterior and Inferior Instability secondary to shoulder dislocation
Arm ABducted and elbow flexed
Doc pushes shoulder joint from behind

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93
Q

Sulcus Sign

A

Inferior instability of Glenohumeral joint

Bone sticking out w indent where deltoid should be

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94
Q

Drop Arm Sign

A

Tears of Rotator Cuff

95
Q

Apley Scratch Test

A

Decreased ROM of the shoulder
Reach hand behind head down back
Reach hand behind back and up spine

96
Q

Anterior/ Posterior Drawer Test of Arm

A

Anterior / Posterior Instability of Glenohumeral Joint

97
Q

Jobe’s Test or Empty Can Sign can give a false positive for _____

A

Subacromial Brusitis

98
Q

Upper Ribs (1-5) have primarily _____ motion

A

Pump handle

99
Q

Middle Ribs (6-10) have primarily _____ motion

A

Bucket handle

100
Q

_____ Ribs have a larger spinotransverse angle

A

Upper Ribs (1-5)

101
Q

_____ Ribs have a smaller spinotransverse angle

A

Middle Ribs (6-10)

102
Q

Lower Ribs (11-12) have primarily _____ motion

A

Caliper

103
Q

Secondary muscles of respiration

A 
Scalenes (ribs 1-2)
Pectoralis minor (ribs 3-5)
Serratus ant and post (ribs 4-9)
Latissimus dorsi (ribs 10-11)
Quadratus lumborum (rib 12)
104
Q

Atypical Ribs

A

1, 2, 11, 12

*all have 1s and 2s

105
Q

Ribs _____ are true ribs

A

1-7

Attach directly to sternum

106
Q

Ribs _____ are false ribs

A

8-12
Ribs 8-10 indirectly attach via cartilage
Ribs 11-12 do not attach to sternum (floating)

107
Q

Treatment of Key Rib of group dysfunctions

A

BITE
Bottom rib for Inhaled group
Top rib for Exhaled group

108
Q

_____ pulls the 11th and 12th ribs up

A

Latissimus dorsi

109
Q

_____ pulls the 12th rib down

A

Quadratus lumborum

110
Q

Rib 1 uses __(muscle)___ for treatment using muscle energy

A

Anterior and Middle Scalenes

111
Q

Rib 2 uses __(muscle)___ for treatment using muscle energy

A

Posterior Scalenes

112
Q

Ribs 3-5 use __(muscle)___ for treatment using muscle energy

A

Pectoralis minor

113
Q

Ribs 6-9 use __(muscle)___ for treatment using muscle energy

A

Serratus anterior

114
Q

Ribs 10-11 use __(muscle)___ for treatment using muscle energy

A

Latissimus dorsi

115
Q

Rib 12 uses __(muscle)___ for treatment using muscle enertgy

A

Quadratus lumborum

116
Q

Thoracic and Lumbar Intervertebral foramina are located _____ on the spine

A

Laterally

117
Q

Zygapophyseal Facets of the Thoracic Spine

A

60-70 deg angle

118
Q

Rib Articulations with thoracic vertebrae occur in whole and demi facets

A 
Demi = Ribs 1-9
Whole = 1, 10-12
119
Q

Spinal Group Curves are measured by

A

Cobb Angle
5-15 deg = mild
20-45 deg = moderate
>50 deg = severe

120
Q

Respiratory compromise begins at Cobb angle of _____

Cardiovascular compromise at _____

A

Respiratory 45-50 deg

Cardiovascular approx 75 deg

121
Q

Most common spinal group curve

A

Upper thoracic dextroscoliosis (convex right)

122
Q

Short Leg syndrome creates spinal compensation with a crossover point of _____ between the thoracic and lumbar curves

A

T7

123
Q

Ilium rotates _____ to compensate for a short leg

A

Anteriorly

124
Q

Short leg treatment goal

A

Level sacral base

  • heel lift (1/2 the LLI)
  • start at 1/8” and recheck in 2 weeks
  • 3/8 is maximum inside shoe before building up sole
  • Heilig formula
125
Q

Piriformis Syndrome

A 
Creates Sciatica (stops at knee)
Caused by opposite side iliopsoas spasm (body flexes forward and to one side, stretches contralateral piriformis)
126
Q

Piriformis treatment goals

A 
Improve sciatica
Improve hip extension
Improve pelvic side shift
TREAT CONTRALATERAL PSOAS FIRST
Strengthen core muscles and glutes
127
Q

Tentorium Cerebelli

A

Transverse dura
Separates cerebellum and cortex
Area of automatic shifting suspension fulcrum (of Sutherland)

128
Q

Sibson’s Fascia

A

Thoracic Inlet
Attaches C7-T1 around 1st rib to manubrium
Attaches to capula of lung
Made of fascia from scalenes and longs colli muscles
Thoracic duct travels through it

129
Q

Thoracoabdominal Diaphragm

A

60% of motive force for inhalation
Innervated by C3-C5
Hiatuses

130
Q

Vena Caval Hiatus in thoracoabdominal diaphragm is located at spinal level

A

T8

131
Q

Esophageal Hiatus in thoracoabdominal diaphragm is located at spinal level

A

T10

132
Q

Aorta and Thoracic Duct pass thru thoracoabdominal diaphragm at spinal level

A

T12

133
Q

Pelvic Diaphragm

A

Comprised of Levator ani and Coccygeus muscles
Somatic and parasympathetic innervation via
S2-S4 and pelvic splanchnics

134
Q

Medial Longitudinal Arch of the Foot is made of

A

Navicular and Plantar fascia

135
Q

Zink Fascial Pattern Locations

A 
OA
Thoracic Inlet
Thoracolumbar
Lumbosacral
*coincide w diaphragms of the body
136
Q

Most common Zink Fascial Pattern

A

LEFT OA
RIGHT Thoracic
LEFT Thoracolumbar
RIGHT Lumbosacral

137
Q

Zink Fascial Patterns are considered physiologic or compensated as long as the pattern ______

A

Alternates

138
Q

Zygopophyseal Joints of the Lumbar Spine

A

30-60 deg angle

139
Q

Spondylolysis

A

Fracture of the Pars Interarticularis
Scotty Dog Collar on oblique view
Unilateral or Bilateral
Bilateral –> Slippage (spondylolisthesis)

140
Q

Spondylolisthesis Slippage Grading

A

Grade 1: <25%
Grade 2: 25-50%
Grade 3: 50-75%
Grade 4: >75%

141
Q

Sacral Axis of Motion Mnemonic

A

CRAIN
Cranial-Superior Axis-(craniosacral flex/extend)
Respiratory-Middle Axis- (flex/extend)
Anatomical-Inferior Axis-(bending over)
INnominate-Oblique Axis-(changes in weight bearing)

142
Q

Nutation

A

Sacral base moves anteriorly and inferiorly (flexes)

Cranial Extension

143
Q

Counternutation

A

Sacral base moves posteriorly and superiorly (extends)

Cranial Flexion

144
Q

Sacral Torsions are in relation to

A

L5

145
Q

Seated flexion test is positive on the _____ side of the oblique axis

A

Opposite

146
Q

L5 rotation is _____ sacral rotation

A

Opposite

147
Q

Spring test differentiates _____

A

Forward or Backward Sacral Torsions

148
Q

Sphinx Technique and Interpretation

A

Thumbs in sulci and pt assumes Sphinx position
Asymmetry improves = forward torsion or unilateral flexion
Asymmetry worsens = POSITIVE result, backward torsion or unilateral extension

149
Q

Spring Test Technique

A

Anterior force on L5

150
Q

Spring Test - Negative

A

L5 springs anterior
Increased lumbar lordosis
Forward Torsion

151
Q

Spring Test - Positive

A

L5 resists anterior pressure
Flattened lumbar lordosis
Backward Torsion

152
Q

Innominates move about the _____ axis of the sacrum

A

Inferior Transverse Axis

153
Q

Positive Standing Flexion test is _____ side of innominate dysfunction

A

SAME side

154
Q

Superior innominate is commonly caused by a _____

A

Laxity of Sacrotuberous ligament

*tightness causes an inferior innominate

155
Q

Standing Flexion test is positive on _____ side of a pubic dysfunction

A

SAME side

156
Q

Normal Femoral Neck and Shaft angle

A

120-135 deg

< 120 Coxa Vara
> 135 Coxa Valga

157
Q

Q (quadriceps) Angle landmarks for measurement

A

ASIS- Patella

Tibial Tubercle- Patella

158
Q

Normal Q (quadriceps) Angle

A

10-12 deg

< 10 Genu Varum (bowlegged)
> 12 Genu Valgum (knock-kneed)

159
Q

Features of Posterior Fibular Head

A

Anterior Malleolus
Internal rotation of talus –>
Ankle Inversion and Plantarflexion are free

160
Q

Features of Anterior Fibular Head

A

Posterior Malleolus
External rotation of talus –>
Ankle Eversion and Dorsiflexion are free

161
Q

Structure commonly injured with Fibular head dysfunctions

A

Common Peroneal Nerve

162
Q

Obers Test

A

IT Band tightness
Pt on side, affected leg up, hip neutral
Bottom knee bent and hip flexed to 90 deg
Doc lifts (ABducts) top thigh, extends, lowers
Stabilize pelvis
POS- knee does NOT touch table
Bounce Up Sign: leg bounces up after the release of slight ADduction pressure

163
Q

Bounce Home Test

A

Torn Meniscus, Capsular Sprain, Joint Fluid, Laxity
Pt supine, Doc on side of bad knee
Support ankle/heel w one hand
Other hand under knee/calf
Completely flex knee and allow to passively extend
POS- incomplete extension, rubbery end, pain, guarding

164
Q

Lever Sign

A 
Integrity of ACL
Pt supine
Fist under proximal tibia (top of calf)
Press down on distal femur
POS- foot does NOT lift off table
165
Q

Apley Distraction Test

A

Torn Collateral Ligaments
Pt prone, knee flexed 90 deg
Doc stabilizes thigh and hand on pt’s foot
After compression test, distract and repeat internal and external rotation
POS- pain with both compression and distraction

166
Q

Apley Compression Test

A

Torn Meniscus
Pt prone w knee flexed 90 deg
Stabilize thigh and place hand on pt’s foot
Compress down tibia
Internally and Externally Rotate leg
Follow with Apley’s Distraction Test
POS- pain with compression that is relieved w distraction

167
Q

McMurray’s Test

A

Torn Meniscus
Pt supine, Doc flexes knee w one hand on heel
Other hand fingers medial joint line, thumb lateral line
Medial Meniscus:
-Apply medial pressure (valgus stress) and
-Externally rotate tibia and extend leg
Lateral meniscus: lateral (varus) pressure, internally rotate
POS- pain, +/- click

168
Q

Patellar Apprehension Test

A

Subluxation of the patella
Pt supine, leg extended
Translate patella laterally
POS- pain, apprehension, subluxation of patella

169
Q

Patellar Grind Test

A

Chondrolalacia of Patella or Inflammation at Patellofemoral Joint
Thumb and Fingers of both hands on margin of patella
Gentle inferior/ superior and medial/ lateral motion
Provocative test: downward/ posterior pressure and ask pt to contract quad
POS- pain, grinding

170
Q

Squeeze Test

A

Integrity of Interosseous Membrane
Hang foot off table
Grasp leg w both hands, squeeze tibia against fibula
POS- pain, high ankle sprain, syndesmosis, fx of fibula, stress fx, compartment syndrome, DVT
Sensitivity > specificity

171
Q

Thompson Test

A

Ruptured Achilles
Pt prone w foot up, apply dorsiflexion force to foot
Squeeze calf and foot plantar flexes if Achilles is intact

172
Q

Anterior Drawer Test of Ankle

A

Anterior Talofibular Ligament
Foot hangs off table, natural neutral position (20 deg plantar flexion)
Stabilize lower leg, other hand grasps foot
Pull talus forward
POS- increased anterior translation of talus, pain w motion

173
Q

Talar Tilt

A

Calcaneofibular Ligament
Foot hangs off table
One hand stabilizes lower leg, other grabs calcaneus
Foot in anatomic position
Attempt to invert ankle
POS- increased inversion or instability, pain w motion

174
Q

Metatarsal Compression Test

A

InterMetatarsal (Morton’s) Neuroma (3rd-4th metatarsals)
Foot hangs off table
Squeeze medial and lateral sides of metatarsals
POS- reproduction of symptoms

175
Q

Tinel’s Sign of Lower Extremity

A

Irritation to Tibial Nerve
Foot hangs off table
Percuss area of tarsal tunnel in medial ankle
POS- pain, reproduction of neurological symptoms

176
Q

SA node is innervated by

A

Right sympathetic fibers

177
Q

AV node is innervated by

A

Left sympathetic fibers

178
Q

Path of Sympathetics of Head and Neck

A

T1-T4 –>
Superior Cervical Ganglia at level C1-C3
Follow arterial supply thru Spenopalatine Ganglion (WITHOUT synapsing) to eyes, nose… etc

179
Q

_____ Nerve carries Sympathetic Fibers within the head

A

Deep Petrosal Nerve

180
Q

_____ Ganglion is a Parasympathetic mechanism mainly from CN 7 to throat, sinus, ears, etc

A

Sphenopalatine Ganglion

181
Q

_____ Nerve carries Parasympathetic Fibers in the head

A

Greater Petrosal Nerve

182
Q

Right Vagus Nerve (CN X)

A 
aka Posterior Vagal Trunk
Gives rise to Celiac Branch
Innervates SA node
Innervates Ascending Colon and first 2/3 of Transverse
Longer than the Left Vagus
183
Q

Left Vagus Nerve (CN X)

A

Gives rise to Hepatic Branch
Innervates AV node
Innervates liver and part of duodenum

184
Q

Hering- Breuer Reflex

A

Mediated by CN X
Occurs when lung air sacs are filled w fluid
Respiratory centers perceive need for more O2
Increase diaphragmatic rate
Rapid and Shallow breaths

185
Q

There is no parasympathetic innervation to the _____

A

Extremities

186
Q

_____ innervate from left colon to genital cavernous tissue (except adrenals)

A

Pelvic Splanchnic Nerves (S2-S4)

187
Q

Pupils receive parasympathetic innervation via _____

A

CN 3- occulomotor

Thru Ciliary Ganglion

188
Q

Submandibular and Sublingual glands receive parasympathetic innervation via _____

A

CN 7- facial

Thru Submandibular Ganglion

189
Q

Parotid Gland receives parasympathetic innervation via ____

A

CN 9- Glossopharyngeal

Thru Otic Ganglion

190
Q

Nasal and Lacrimal Glands receive autonomic innervation from ____

A

CN 7- facial

via Pterygopalatine Ganglion

191
Q

Left Colon and Pelvis receive autonomic innervation from _____

A

Pelvic Splanchnic Nerves (S2-S4)

192
Q

Carotid Body and Sinus receive autonomic information via _____

A

CN 9 and CN X- Glossopharyngeal and Vagus

Blood pressure regulation and CO2/O2 tension

193
Q

Vagus Nerve supplies Parasympathetic innervation to _____

A

All viscera above diaphragm
GI tract up to Splenic Flexure (esophagus to transverse colon)
Upper GU tract including kidneys and upper ureters
Ovaries/ Testes

194
Q

Pelvic Splanchnic Nerves supply Parasympathetic Innervation to _____

A

GI tract below splenic flexure (transverse colon to anus)
Lower GU tract (lower ureters and bladder)
All reproductive organs (except ovaries/ testes)

195
Q

Sympathetic Innervation to the head and neck comes from spinal levels _____

A

T1-T4

196
Q

Sympathetic Innervation to the Heart comes from spinal levels _____

A

T1-T5

197
Q

Sympathetic Innervation to the Lungs comes from spinal levels _____

A

T2-T7

198
Q

Sympathetic Innervation to the Upper Extremities comes from spinal levels _____

A

T2-T8

199
Q

Sympathetic Innervation to the Upper GU (kidneys, upper ureters) comes from spinal levels _____

A

T10-T11

200
Q

Sympathetic Innervation to the Lower GU (lower ureters, bladder) comes from spinal levels _____

A

T11-T12

201
Q

Sympathetic Innervation to the Reproductive Organs comes from spinal levels _____

A

T10-L2

202
Q

Chapman’s Points

A

Anterior and Posterior fascial tissue abnormalities assumed o be reflections of visceral dysfunction
Thought to be NEUROLYMPHATIC response of tissue
Nodular, firm, small, painful, non-radiating
Treat 10-30 sec circular pressure to point

203
Q

Theory of Muscle Energy

A

Direct technique
Golgi Tendon Organ Reflex
Pulling tendon –>
Activation of Lg myelinated Group 1B afferent fibers –>
Golgi tendon organ signals spinal cord –>
Inhibitory interneurons signal a-motor neurons for reflex relaxation

204
Q

Theory of Counterstrain

A

Indirect Technique
Employs Muscle Spindle Reflex (so does FPR)
Decreases gamma gain
Stops inappropriate proprioceptor activity
Apply mild strain to a muscle’s antagonist
Put in position of ease, Slow return after 90 sec

205
Q

Theory of HVLA

A

Direct Technique
Golgi Tendon Organ and Muscle Spindle Reflex
Thrust initiates massive afferent input to CNS –>
CNS turns down gamma gain to muscles (relaxation)
1/8” to 1/4” Stretch may produce barrage of inhibition
Central Inhibitory Reflex

206
Q

Counterstrain- Cervical- Anterior Tender Points C2-C6

A 
Points located on lateral masses
Seated at head
Flexion, SR away (F SaRa)
Monitor TP, hold position 90 seconds
Return to neutral
207
Q

Counterstrain- Cervical- Posterior Tender Points C4-C7

A

Points located on sides of spinous processes
SEGMENT ABOVE
Seated at head, may suspend pt’s head off table
Extension, SR away
Not too much extension
*can use anterior translation instead of extension
Fine tune with SR, hold 90 seconds
Return to neutral

208
Q

Posterior C4 tender point pay present as

A

Anterior shoulder pain

209
Q

Muscle Energy- Rib 1 and Rib 2- Exhaled Dysfunction (inhalation restriction)

A

Pt supine, Doc opposite side dysfunction
Pt rotate head 30 deg away from dysfunction
Dysfunction side wrist on forehead
Your head hand on wrist
Caudad hand lateral caudal traction on rib angle
Deep breath (inhale engages barrier)
Same time as breath, pt raises head, you resist
Maintain 30 deg rotation
Muscle energy it

210
Q

Muscle Energy- Ribs 3, 4, 5- Exhaled Dysfunction (inhalation restriction)

A

Pt supine, Doc opposite side dysfunction
Dysfunction side palm behind head
Your head hand on flexed elbow
Caudad hand lateral caudal traction on rib angle
Deep breath (inhale engages barrier)
Same time as breath, pt raises elbow, you resist
Muscle energy it

211
Q

Muscle Energy- Ribs 6, 7, 8, 9, 10- Exhaled Dysfunction (inhalation restriction)

A

Pt supine, Doc same side as dysfunction
ABduct arm 90 deg
Caudad hand on angle of dysfunctional rib
Anterior Lateral traction to disengage rib
Same time as deep breath, pt pushes arm against your hip
Pull Inferior and Lateral on rib angle
Muscle energy it

212
Q

Muscle Energy- Ribs 2, 3, 4, 5, 6- Inhaled Dysfunction (exhalation restriction)

A

Pt supine, Doc at head on side of dysfunction
Thumb and thenar eminence on intercostal space above dysfunctional key rib’s anterior superior surface
Support pt head/ neck in flexion w other hand or leg
Deep breath in and out thru mouth
On exhalation, exaggerate pump handle (push inferior)
Exaggerate bucket handle motion by sidebending down to rib
Hold at new position as pt inhales deeply (isometric contraction)
Muscle energy it

213
Q

Muscle Energy- Ribs 7, 8, 9, 10- Inhaled Dysfunction (exhalation restriction)

A

Pt supine, Doc near head on side of dysfunction
Sidebend torso to side of dysfunction to specific rib
Thumb and index on superior lateral of rib
Inhale and Exhale deeply
On exhalation, exaggerate bucket handle
On inhalation, resist motion of the rib
Muscle energy it

214
Q

Counterstrain - Rib 1-5 - Anterior (depressed) Tender Points - Pt Supine

A

Pt supine, doc stands side of tender point
2-3 pillows under head for flexion
Good side hand under head
Sidebend torso to dysfunction
Pad of your thumb on tender point to monitor
Grasp dys side forearm to fine tune w Int/ Ext rotation, ADduction
Simultaneously depress and protract shoulder with monitor hand
Hold 90 sec, return to neutral

215
Q

Anterior Rib tender points are located

A

Bilaterally over anterior chest

216
Q

Rib 1 Anterior tender point location

A

Costosternal Junction

Just inferior to SC junction

217
Q

Rib 2 Anterior tender point location

A

Over 2nd rib

Midclavicular line

218
Q

Ribs 3-10 Anterior tender point location

A

Over respective ribs

Anterior axillary line

219
Q

Muscle Energy- Anterior Fibular Head

A

Pt supine, Knee and hip both 90 deg
Doc on side of dysfunction
Thenar eminence of head hand pushes down on anterior fibular head
Other hand grasps ankle just inferior to malleoli
Thumb pushes upward on lateral malleolus
Fingers around arch of foot
Internally rotate tibia and maintain as pt rotates out
Muscle energy it

220
Q

Muscle Energy- Posterior Fibular Head

A

Pt supine, Knee and hip both 90 deg
Doc on side of dysfunction
1st MCP joint of index behind posterior fibular head
Thumb over anterior surface of fibula
Other hand grasps just superior to malleolus
Thumb pushes down on lateral malleolus
Externally rotate tibia and maintain as pt rotates out
Muscle energy it

221
Q

Counterstrain- Rib- Anterior (depressed) Tender Point- Pt Seated

A

Pt seated, Doc standing behind
Index finter on tender point (monitor)
Your knee in GOOD side armpit
Pt puts foot of good side (where your foot is) under dysfunctional side knee
Pt drops dysfunctional side arm off table behind with internal rotation
Translate pt by moving your knee
Fine tune thru Flexion and RS toward dysfunction
Use your free hand to control pt’s head
Hold 90 secs, return to neutral

222
Q

Counterstrain- Rib- Posterior (elevated) Tender Point- Pt Supine

A 
Pt supine, Doc same side of dysfunction
Head hand under pt's scapula
Index or middle contacting tender point
Other hand grasps wrist and flexes GH joint
Fine tune w all planes of arm motion
Hold 90 sec, return to neutral
223
Q

Counterstrain- Rib- Posterior (elevated) Tender Point- Pt Seated

A 
Pt seated, Doc standing behind
Thumb on tenderpoint (monitor)
Your knee in BAD side armpit, translate pt
Other hand guides head
Fine tune with Flexion, RS away
Hold 90 sec, return to neutral
224
Q

Muscle Energy- Sacrum- Backward torsion

A

Pt lying on side dys DOWN
Top foot on table in front of back foot
Monitor Lumbosacral junction throughout
Move bottom leg into extension
Grasp pt’s bottom arm and pull anterior, caudad (neutral, opp SR)
Contact pt’s top shoulder and have them grasp table
3-5 inhalation/ exhalation cycles
Shoulder to table with each
Drop top leg off table and contact proximal tibia
Have pt lift (ABduct) their leg to ceiling
Muscle energy it and return to neutral

225
Q

Muscle Energy- Sacrum- Forward Torsion

A

Pt prone w arms off table
Move hips so pelvis and knees 90 deg, axis DOWN
Legs off edge of table, ankles drop to floor
Monitor Lumbosacral junction
Using your thighs, flex pt’s lumbars
L5 must be neutral
Hand on scapula, Breath into reaching for floor
During breathing bring knees up to head
Hold feet down and muscle energy em

226
Q

Articulation- Spencer Technique

A

Extend 6-8x (you want ice cream)
Flex 6-8x (I want ice cream)
Circumduct both directions elbow bent (small cone)
Circumduct both directions w wrist traction (big cone)
ABduct 6-8x (fly there?)
INT ROT w hand behind back and anterior pressure on elbow (who’s gonna pay)
Traction stretch (let’s be friends)

227
Q

HVLA- Anterior Radial Head

A

Grasp pt’s hand as if to shake
Other hand grasps elbow, thumb in AC w firm pressure to radial head
Fingers contact olecranon
Induce PRONATION and FLEXION of forearm and wrist
*can articulate barrier rather than HVLA it

228
Q

Muscle Energy- Anterior Radial Head

A

Grasp pt’s hand as if to shake
Other hand grasps elbow, thumb in AC w firm pressure to radial head
Fingers contact olecranon
Induce PRONATION and SLIGHT FLEXION
Pt supinates and extends against resistance
Muscle energy it and return to neutral

229
Q

HVLA- Posterior Radial Head

A

Grasp pt’s wrist and proximal forearm
Thumb applying anterior pressure to radial head
Maintain anterior pressure on radial head
Corrective SUPINATION and EXTENSION of elbow

230
Q

Muscle Energy- Posterior Radial Head

A

Grasp pt’s wrist and proximal forearm
Thumb applying anterior pressure to radial head
Maintain anterior pressure on radial head
Engage barrier with supination and slight extension
Pt pronates arm and slightly flexes elbow
Muscle energy it and return to neutral

231
Q

Counterstrain- Lateral Epicondylitis- Tennis Elbow Tender Point

A

Your thumb monitors tender point in proximal extensor tendons
Other hand contacts pt’s hand to hold it in extension
Fine tune w pronation/ supination
Maximal release, hold 90 sec, return to neutral

232
Q

Muscle Energy- Anterior Lateral Malleolus

A

Pt supine, Doc at foot
Cup pt’s heel w your dys side thumb over anterior lateral malleolus
Other thumb over first one
Use your body to press foot into dorsiflexion
Maintain posterior pressure on malleolus
Pt plantar flexes and holds 3-5 seconds for each muscle energy action

233
Q

Muscle Energy- Posterior Lateral Malleolus

A

Pt prone, Doc at foot
Your dys side thumb over posterior lateral malleolus
Other thumb over first one, encircle ankle
Put foot in plantar flexion
Maintain anterior pressure on malleolus
Pt dorsiflexes and holds 3-5 sec for each muscle energy action

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