exam 1

Question 1

Adaption

Answer 1

Impulse frequency decreases over time as a stimulus is continually applied
tonic sensory input adapts slowly and continues to produce action potentials over the course of the stimulus.
phasic sensory input adapts quickly and cell response diminishes very quickly

Question 2

Sensory homunculus

Answer 2

Distorted human figure used to represent the relative area of the cerebral cortex devoted to sensation of corresponding skin areas

Question 3

Stereognosis

Answer 3

Ability to recognize three-dimensional objects by the sense of touch

Question 4

Summation

Answer 4

Cumulative temporal or spatial effect of a number of stimuli applied to a muscle, nerve, etc.
Spatial Summation = in other words: Stimulation of one presynaptic terminal at a synapse by one pre-synaptic nerve may not elicit an excitatory post-synaptic potential (EPSP) great enough for firing, However, stimulation at several pre-synaptic terminals can elicit an EPSP strong enough for an Action Potential.

Temporal Summation = presynaptic terminal fires – membrane channels open for a millisecond or so, but the changed post synaptic potential lasts around 15 milliseconds after the membrane channels have closed. Opening the channels again can increase the postsynaptic potential. Higher the rate, the greater the likelihood of eliciting an AP

Question 5

Tactile discrimination

Answer 5

Ability to differentiate information through the sense of touch

Question 6

Threshold

Answer 6

The least amount of energy or force that causes a measurable response

Question 7

Palpation

Answer 7

The application of the fingers to the surface of the skin or other tissues, using varying amounts of pressure, to selectively determine the condition of the parts beneath. Most Important Aspect of Osteopathic Physical Diagnosis

Question 8

Touch

Answer 8

May be divided into the following sensations
Temperature
Pain
Pressure
Light touch
Perception of vibration and proprioception

Question 9

The stages of processing touch:

Answer 9

detection, amplification, interpretation

Question 10

Detection

Answer 10

Sensation comes to your attention

Question 11

Amplification

Answer 11

Learning to decrease attention to other stimuli and focus on finer nuances of touch input

Question 12

Interpretation

Answer 12

Processing phase, generally done non-verbally after learning

Question 13

Exteroceptors

Answer 13

Deal with sensations from the surface of the body

Question 14

Interoceptors

Answer 14

Respond to stimuli within the body

Question 15

Nociceptors

Answer 15

Detect damage occurring in the tissues (whether chemical or physical)

Question 16

Proprioceptors

Answer 16

Deal with the physical state of the body, including position, tendon and muscle sensations, pressure sensations (from the bottom of the feet), and even equilibrium

Question 17

Thermoreceptors

Answer 17

Detect changes in temperature

Question 18

types of mechanoreceptors

Answer 18

Meissner corpuscles = abundant in fingertips and lips/ non-hairy skin. Adapt quickly. Abundant where spatial discrimination is needed. (touch, adjustment of grip strength)

Merkel Disks = Fingertips and also hairy skin. Transmission is initially strong, but partially adapting. Then, continues with a weaker signal that adapts slowly. (determines continuous touch against the skin, form, texture)

Meissner’s Corpuscles and Merkel Disks together are important in localizing touch sensations to specific surface areas of the body and determining texture of what is felt.

Ruffini Endings = adapt slowly/ responsible for signaling continuous states of deformation. (Heavy prolonged touch and pressure). Also found in joint capsules and help signal the degree of joint rotation. (stretch)

Pacinian Corpuscles = quick adaptation/ detecting tissue vibration or other rapid changes in mechanical state of tissue

Free nerve endings- pain, heat, cold

All located in the dermis except free nerve endings. Pacinian Corpuscle and Ruffini Endings are the deepest

Question 19

Equilibrial Triad

Answer 19

Vestibular system
Visual system
Proprioceptors

Question 20

Landmark locations

Answer 20

Suprasternal (jugular) notch
At the level of T2 vertebral body

Sternal angle (Angle of Louis)
At the level of the T4-T5 invertebral disc
At the attachment of rib 2 to the sternum

Xiphoid process
At the level of T9 vertebral body

Vertebral prominens is the spinous process of C7

Spine of scapula
At the level of the spinous process of T3

Inferior angle of the scapula
At the level of the spinous process of T7
At the level of the T8 vertebral body

Umbilicus
At the level of the L3 vertebral body

Iliac crest
At the level of the L4 vertebral body

Question 21

Posterior landmarks

Answer 21

External auditory meatus
Temporal bone
Tip of the mastoid process
Occiput
Inion (External occipital protuberance)
Vertebral prominens (spinous process of C7)
Spinous processes of the thoracic spine
Scapula
Spine
Medial border
Inferior angle
Acromion process
Iliac crest
Greater trochanter
ischial tuberosity
Popliteal fossa
Biceps femoris tendon
Semimembranosus tendon
Achilles tendon

Question 22

Anterior landmarks

Answer 22

Suprasternal (jugular) notch
Manubrium
Sternal angle (Angle of Louis)
Sternal body
Xyphoid process
Clavicle
Supraclavicluar fossa
Sternoclavicular joint
Iliac crest
anterior superior iliac spine
anterior inferior iliac spine
pubic symphysis
greater trochanter
Patella
Tibia
Tibial tuberosity
Medial malleolus
Fibula
Fibular head
Lateral malleolus

Question 23

Definition of direct and indirect techniques

Answer 23

Direct: Move the tissues toward the restrictive barrier
Directly confront the barrier (bind)
Myofascial structures are stretched, and then relax

Indirect: Move the tissues away from the restrictive barrier
No confrontation with the restrictive barrier (ease)
Tissues are relaxed as tension is taken off of them
Guarding mechanisms are decreased or released (which can allow you to do other work)

Question 24

ST Technique: Diagnostic criteria (TART)

Answer 24

Tissue Texture Abnormalities (TTA)
Asymmetry of Tissues
Restriction of Motion: Active/Passive
Tenderness (with palpation)

Question 25

ST Technique: Indications

Answer 25

Use as part of the musculoskeletal screening examination to quickly identify regions of restricted motion, tissue texture changes, and sensitivity Reduce muscle hypertonicity, muscle tension, fascial tension, and muscle spasm Stretch and increase elasticity of shortened, inelastic, and/or fibrotic myofascial structures to improve regional and/or intersegmental ranges of motion Improve circulation to the specific region being treated by local physical and thermodynamic effects or by reflex phenomena to improve circulation in a distal area (e.g., through somatosomatic or somatovisceral reflexes) Increase venous and lymphatic drainage to decrease local and/or distal swelling and edema and potentially improve the overall immune response. This will improve local tissue nutrition, oxygenation, and removal of metabolic wastes Stimulate the stretch reflex in hypotonic muscles Promote patient relaxation Reduce patient guarding during implementation of other osteopathic manipulative techniques or additional medical treatment Potentiate the effect of other osteopathic techniques

Question 26

ST Technique: Mechanisms (traction, kneading and inhibition)

Answer 26

1) Parallel Traction (“Stretching”) - Origin and insertion of the myofascial structures are stretched longitudinally 2) Perpendicular Traction (“Kneading”) - A rhythmic, lateral stretching of a myofascial structure - Origin and insertion are held stationary - The central portion is stretched like a bowstring - Direction of stretch is 90 degrees to the origin and insertion - -Note: Do not roll over the skin or soft tissue 3) Direct Inhibitory Pressure (“Inhibition“) - Sustained deep pressure compressing hypertonic myofascial structures

Question 27

ST Technique: Principles of treatment

Answer 27

1) Directed into the soft tissue Gradually sink into the tissues. Deep enough to engage the muscles. Introduced gently enough so as to be comfortable to the patient 2) Two primary forms of application -Force is applied in a rhythmic, alternating (pressure on, pressure off) manner. -Inhibitory pressure style – constant, deeply induced force over a period of time. Applied for more than 30 seconds OR Until the tissue releases Technique effective when tissues are noted to have: Increased in length Decrease in tension

Question 28

diagnosis for soft tissue is predominantly made by examining bilaterally for ___

Answer 28

tissue texture abnormalities

Question 29

ST Technique: Contraindications

Answer 29

Absolute Contraindications - Inability of patient to respond to treatment/severe illness - Lack of patient consent or cooperation - Inability to position patient appropriately Relative Contraindications - Use with caution, as common medical sense is the rule. For example, in an elderly osteoporotic/osteopenic patient, the soft tissue prone pressure technique may be contraindicated over the thoracocostal and pelvic regions, but the lateral recumbent methods can be more safely applied - Contact and stretching over an acutely strained or sprained myofascial, ligamentous, or capsular structure may exacerbate the condition. Therefore, in these situations, caution should prevail, and the soft tissue technique may be withheld until tissue disruption and inflammation have stabilized - Fracture or dislocation - Neurologic or vascular compromise - Malignancy. Most restrictions are for treatment in the affected area of malignancy; however, care should be taken in other distal areas depending on the type of malignancy and/or lymphatic involvement - Infection (e.g., osteomyelitis), contagious skin diseases, painful rashes or abscesses, acute fasciitis, and any other conditions that would preclude skin contact - Organomegaly secondary to infection, obstruction, or neoplasm - Undiagnosed visceral pathology/pain

Question 30

ST Technique: Contraindications

Answer 30

Absolute Contraindications - Inability of patient to respond to treatment/severe illness - Lack of patient consent or cooperation - Inability to position patient appropriately Relative Contraindications - Use with caution, as common medical sense is the rule. For example, in an elderly osteoporotic/osteopenic patient, the soft tissue prone pressure technique may be contraindicated over the thoracocostal and pelvic regions, but the lateral recumbent methods can be more safely applied - Contact and stretching over an acutely strained or sprained myofascial, ligamentous, or capsular structure may exacerbate the condition. Therefore, in these situations, caution should prevail, and the soft tissue technique may be withheld until tissue disruption and inflammation have stabilized - Fracture or dislocation - Neurologic or vascular compromise - Malignancy. Most restrictions are for treatment in the affected area of malignancy; however, care should be taken in other distal areas depending on the type of malignancy and/or lymphatic involvement - Infection (e.g., osteomyelitis), contagious skin diseases, painful rashes or abscesses, acute fasciitis, and any other conditions that would preclude skin contact - Organomegaly secondary to infection, obstruction, or neoplasm - Undiagnosed visceral pathology/pain

Question 31

Somatic dysfunction creates a ___

Answer 31

restrictive barrier

Question 32

Somatic dysfunction

Answer 32

functional and positional change; muscle length and tone are unable to return to physiologic neutral; joint surface apposition is in a position which will not allow normal range of motion

Question 33

Differentiate and identify symmetry and asymmetry in human anatomy

Answer 33

ok symmetry-Equality or correspondence in form of parts distributed around: a center or an axis at the extremities or poles on the opposite sides of any body (Stedman’s Medical Dictionary) The similar arrangement in form and relationships of parts around a common axis, or on each side of a plane of the body (Dorland‘s Medical Dictionary) asymmetry-disproportion between two normally like parts

Question 34

Identify the landmarks on the anterior, lateral and posterior gravity lines

Answer 34

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Question 35

Somatic dysfunction

Answer 35

Impaired or altered function of related components of the somatic (body framework) system ---Skeletal, arthrodial, and myofascial structures and their related vascular, lymphatic, and neural elements. Is the ONLY indication for OMT!

Question 36

Primary dysfunction

Answer 36

The somatic dysfunction that maintains a pattern of dysfunction (“Key Lesion” or “AGR”) The initial or first somatic dysfunction to appear temporally Caused by trauma or repetitive microtrauma Can be initiating event for multiple symptoms and events including: local pain, somatosensory referred pain, muscle guarding, somatosomatic and somatovisceral reflexes, and creation of secondary dysfunction

Question 37

Secondary dysfunction

Answer 37

Arise as a response to other conditions (i.e. DDD, facet arthritis, mechanical effects of spinal deformities, primary somatic dysfunctions or other secondary dysfunctions).

Question 38

TART Criteria

Answer 38

T: Tissue Texture Changes A: Asymmetry R: Restriction of Motion T: Tenderness Diagnosis of Somatic Dysfunction requires two of the above

Question 39

Anatomic Barrier

Answer 39

Limit of motion imposed by an anatomic structure; the limit of passive range of motion.

Question 40

Physiologic Barrier

Answer 40

Limit of Active Range of motion

Question 41

Elastic Barrier

Answer 41

Range between the physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption.

Question 42

Restrictive Barrier

Answer 42

A functional limit that abnormally diminishes the normal physiologic range

Question 43

Pathologic Barrier

Answer 43

Restriction of joint motion associated with pathologic change of tissues

Question 44

Indication for OMT

Answer 44

Somatic dysfunction

Question 45

Distinguishing characteristics of Acute versus Chronic Somatic Dysfunction

Answer 45

Pain Acute = Severe, Cutting, Sharp Chronic = Dull, achy with paresthesias Skin Changes Acute = Warm, moist, red, inflamed Chronic = Cool, pale Musculature Acute = Locally increased muscle tone, muscle contraction, spasm, ropiness Chronic = Decreased muscle tone, flaccid, mushy, somatosomatic reflexes common Soft Tissue Acute = Boggy Edema, Acute congestion Chronic = Congestion, doughy, stringy, fibrotic, thickened, resistant, contracted Visceral Acute = Minimal somatovisceral reflex effects Chronic = Common somatovisceral reflex effects

Question 46

Write/recite, word-for-word, the four tenets of osteopathic medical philosophy

Answer 46

- The human being is a dynamic unit of function - The body possesses self-regulatory mechanisms that are self-healing in nature - Structure and function are interrelated at all levels - Rational treatment is based on these principles

Question 47

Identify and correlate the four tenets of osteopathic medical philosophy with medical practice concepts

Answer 47

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Question 48

The principles, characteristics, and concept of myofascial release

Answer 48

A system of diagnosis and treatment which engages continual palpatory feedback to achieve release of myofascial tissues Direct MFR A restrictive barrier is engaged for the dysfunctional myofascial tissues; these tissues are then loaded with a constant force until tissue release occurs. Indirect MFR The position of ease is engaged for the dysfunctional myofascial tissues; these tissues are guided along the path of least resistance until free movement is achieved. Combined MFR A treatment whereby the direct and indirect barriers are simultaneously engaged. (This is a more advanced technique) The physician Contacts the myofascial structures of a patient Adjusts the tissues to normal position and function Promotes a positive change in a patient’s body

Question 49

Anatomic characteristics associated with fascia

Answer 49

A sheet of fibrous tissue that envelops the body beneath the skin; it also encloses muscles and groups of muscles and separates their several layers or groups ``` Contractility Irritability Distensibility Change in length Elasticity Plasticity Viscosity Stress Strain Relaxation Creep Change in energy Hysteresis The response exhibited by a body in reacting to changes in the forces Piezoelectricity Electric polarization in a substance resulting from the application of mechanical stress Hooke’s law Newton’s 3rd law Davis’ Law ```

Question 50

History of myofascial release development

Answer 50

Myofascial-like techniques were first described by A. T. Still and his early students A system of diagnosis and treatment was termed “Myofascial Release” by osteopathic physicians: Robert C. Ward, John Goodridge, John Peckham, and Anthony Chila ``` MFR related or subcategories Balanced Ligamentous Tension (BLT) Facilitated Positional Release (FPR) Fascial Ligamentous Release (FLR) Facilitated Oscillatory Release (FOR) Ligamentous Articular Strain (LAS) Integrated Neuromusculoskeletal Release (INR) Fascial Unwinding ```

Question 51

Anatomic landmarks associated with myofascial release in the thoracic region

Answer 51

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