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OMM BLOCK 1 fall23 > Fall 23 Block 1 Exam > Flashcards

Fall 23 Block 1 Exam Flashcards

(105 cards)

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1
Q

Muscle Energy (ME) definition

A

Direct (Active)- Pt muscles employed upon request, from a precise controlled position, in a specific direction, against doctor’s counterforce.
-golgi tendon: prevents excessive muscle tension by monitoring muscle force, within muscle tendons, responds to changes in force, NOT length, inhibits alpha motor neurons
-muscle spindle (intrafusal) protects muscle fiber from tearing. - innervated by gamma motor neuron.
Sensory information from the muscle spindle allows one to judge the position of the muscle (proprioception) and the rate at which it is changing position

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2
Q

Muscle Energy (ME) PEARLS

A

Decrease patient comfort
-treats acute or chronic
-pt should NOT experience pain

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3
Q

Muscle Energy (ME) Indications/Contraindications

A

Indications: relevant somatic dysfunction

Contraindication: cervical instability, RA, sever osteoporosis

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4
Q

Myofascial Release (MFR) definition

A

DIrect or Indirect (Active or Passive)
-engages in 3 direction: traction (up/down); compression (left/right); rotation (clockwise/counterclockwise)

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5
Q

Myofascial Release (MFR) PEARLS

A

-direct: uniquely chronic somatic dysfunction w/fibrotic changes and acute
-indirect: acute, feel unwinding, breathing, feel release

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6
Q

Myofascial Release (MFR) Indications/contraindications

A

Indications: somatic dysfunction, myofascial tissues and connective tissues

Contraindications: fracture, open wounds, soft tissue infections, DVT, anticoag, aortic aneurysm, fluids

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7
Q

Lympathic technique definitions

A

Direct or Indirect (passive)- starts centrally and moves peripherally: addresses thoracic inlet; maximize normal diaphragmatic motions. Designed to remove impediments to lymph circulation, and promote and augment the flow of interstitial fluid and lymph.

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8
Q

Lymphatic technique PEARLS

A

-Immune functions facilitation
-transport fats to the blood from digestive processes
-clear/circulate lymph

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9
Q

Lymphatic technique Indications/contraindications

A

Indications: Edema, infection, inflammation, tissue congestion, lymphatic stasis

Contraindications: anuresis, necrotizing fasciitis, CHF, COPD, acute asthma, pregnancy, acute chronic bacterial infection

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10
Q

cranial technique definition

A

Direct, Indirect, or Combined (passive)
Five phenomena:
-inherent rhythmic motion of brain and SC; fluctuation of CSF, mobility of intracranial & intraspinal membranes, articular mobility of cranial bones, and involuntary mobility of sacrum between ilia
- primary respiratory mechanism (PRM)
- balanced membranous and ligamentous tension (BMT and BLT)
-Many tx are indirect & take place in the “vault hold”

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11
Q

cranial technique PEARLS

A

direct: pediatric patients respond most effectively to DIRECT cranial tx
- don’t have to physically be on the head
- doctor as fulcrum

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12
Q

Cranial technique Indications/contraindications

A

Indications: cranial neuropathy, colic, headache, orofacial pain, ear infection, sinusitis, TMJ, vertigo, feeding difficulties, tinnitus
TBI (NOT acute)

Contraindications: - absolute: acute bleeding, stroke, acute TBI
- relative: coagulopathies, space occupying lesion in cranium, increased cranial pressure

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13
Q

Still techniques definition

A

Indirect –> direct (passive)
- first indirect, axial force added and maintained while carrying region past neutral toward/though restrictive barrier
- begins in position of ease; adds activating force (compression or traction targeting the vector to segment being treated
-passively move patient via a smooth arc through restrictive barrier

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14
Q

Still technique PEARLS

A
  • most segmental/joint somatic dysfunction
  • fast, painless
  • can be more than once
  • pediatric/language barrier bc no need for pt to follow directions, must be able to relax
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15
Q

Still technique indications/contraindications

A

Indications- articular somatic dysfunctions associated with intersegmental motion restriction
JOINT dysfunction but nothing major

Contraindications: bone and joint disorders, mild to moderate joint instability. Areas of strain or sprain. Spinal stenosis, RA

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16
Q

articulatory technique definition

A

Direct (passive)
- increases restricted joint by repeatedly engaging restricted barrier, low velocity, high amplitude (LVHA)
- force is smooth and rhythmical
- restrictive barrier shifts, reengage barrier

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17
Q

articulatory technique PEARLS

A
  • designed to stretch muscles, ligaments, capsules
  • decrease tissue tension; normalize resting tone
  • enhances lymphatic flow and circulation
  • useful in transitional zones and extremities
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18
Q

articulatory techniques Indications/Contraindications

A

Indications: lost articular motion

Contraindications: repeated rotation can damage vertebral artery
- acute inflamed joint, concern for infection or fracture

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19
Q

soft tissue technique definition

A

Direct (passive)
4 basic soft tissue mechanisms
- traction: longitudinal spread
- linear stretching: kneading parallel spread
- lateral stretching: kneading bow-stringing; perpendicular
- deep pressure: inhibitory

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20
Q

soft tissue technique PEARLS

A
  • used as ADJUNCT (reduce for pain, relaxation, restricted motion)
  • decreases O2 demand of muscle
  • increase venous and lymphatic drainage
  • stimulatory effect on stretch reflex in hypotonic muscles
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21
Q

soft tissue technique Indications/Contraindications

A

Indications: - soft tissue characterized by TART changes

Contraindications: - fracture, open wounds, DVT, abscesses, coagulation, neoplasm

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22
Q

high velocity low amplitude (HVLA) definition

A

Direct (passive) - rapid, force, brief duration, short distance

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23
Q

high velocity low amplitude (HVLA) PEARLS

A

NEED CORRECT DX
- restrictive barrier must feel solid but moveable
- engage barrier (take up slack) DONT BACK AWAY, hit it
- final activating force is a sudden gentle increase of force, small distance, DON’T substitute more force for poor localization, don’t hold past barrier

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24
Q

high velocity low amplitude (HVLA) Indications/Contraindications

A

Indications: articular somatic dysfunction
- hypermobile joint

Contraindications: pt does not give consent
- advanced RA
- Down Syndrome
- dwarfism
- acute herniated disc
- genetic/hereditary disorder

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25
strain-counterstrain definition
Indirect (passive) finding "tender point"; pt in position of ease, hold for 90sec and return to neutral - counterstrain points aka tender points, found at consistent anatomical locations (anterior and posterior) - PL5: strain-counterstrain posterior TP
26
strain-counterstrain PEARLS
-most painful tender point FIRST, if points in a row treat middle first - dose appropriately to avoid over-treatment reactions - good for muscle spasms with an inappropriately high set point (resets gamma gain to new lower level - elderly, hospitalized pts
27
strain-counterstrain Indications/Contraindications
Indications: - acute/chronic somatic dysfunctions w/ counterstrain point Contraindications: - fracture, ligamentous tear, cardiac, DVT, down syndrome, pregnancy, rheumatoid arthritis,
28
facilitated position release (FPR) definition
Indirect (passive) - myofascial, neutral position, speedy strain-counterstrain, looks like Still - monitored continuously
29
facilitated position release (FPR) PEARLS
- shorter ROM than Still - quick - can be repeated, easily incorporated
30
facilitated position release (FPR) Indications/Contraindications
Indications: - bone and joint - myofascial and articular Contraindications: - symptoms brought by treatment position, joint instability
31
Balanced Ligamentous Tension (BLT)/Ligamentous Articular Strain definition
Indirect (passive) - LAS = pathology - BLT = treatment position - DEB: 1. Disengage (compress/decompress) 2. Exaggerate (toward original position of injury) 3. Balance (maintain position of injury until release occurs)"
32
Balanced Ligamentous Tension (BLT)/Ligamentous Articular Strain PEARLS
- BLT: light touch, use more respiratory cooperation (1-3lbs of force) - LAS: more force, less respiratory (40lbs of force)
33
Balanced Ligamentous Tension (BLT)/Ligamentous Articular Strain Indications/Contraindications
Indications: - ligamentous, articular strains, muscle, fascia Contraindications: - recent surgeries
34
TART
diagnosis of somatic dysfunction usually requires at least 2 TART changes -Tissue texture change (acute: bogginess, ropey, edematous, chronic: firm) -Asymmetry (right vs. left generally) -Restriction of motion (best to document specifically in degrees of available motion to access improvement after tx! -Tenderness (the only patient-determined TART change)
35
Fascia definition
one continuous sheet of connective tissue -has its own blood supply, fluid drainage, innervation -If it's own organ system, largest of them all
36
Red Reflex
assessment of segment-specific vasomotor changes "redness" -occurs due to spinal facilitation at each given segment affecting the autonomic nervous system (ANS) -Prolonged Red Reflex- ACUTE -Rapidly fading Red Reflex- CHRONIC
37
Hypotension
Low blood pressure less than 90/60
38
Hypertensive Crisis
> 180/120 mmHg BP reading in a patient that is asymptomatic w/o evidence of end organ damage 180/120 mmHg w/acute impairment of one or more organs
39
High Blood Pressure Stage 1
130-139/80-89
40
High Blood Pressure Stage 2
140 or higher/ 90 or higher
41
Oxygen saturation range
Normal 95-97% to 100% Less than 90% is abnormal (hypoxemia)
42
Calculating BMI
Weight (lbs) x 703/height (in) squared or weight (kg)/height (m) squared
43
Temperature ranges
Average: 98.6 F or 37 C Fever (febrile) temp > 100.4 F Hypothermia <95 F
44
Respiration rates
Normal rate 12-20 breaths/min
45
Heart rate ranges
Normal 60-100 bpm Tachycardic (high) >100 bpm Bradycardic (low) <60 bpm
46
The 4 diagnostic techniques
-Inspection -gather information from observation (vision, hearing, smell, overall general impression) -Palpation- exam with hands -Percussion- to determine density or size of a tissue/organ/mass/fluid -Auscultation- listen to sound made by various body structures and functions
47
General Assessment descriptors
-apparent state of health -level of consciousness -Signs of distress -skin color and obvious lesions -Dress, grooming, and personal hygiene -facial expression -odors of body and breath -posture, gait, and motor activity
48
nail clubbing
rounded, bulbous nail base. Feels spongy -Causes: chronic hypoxia congenital heart disease, lung cancer Schamroth Window Test
49
nail- Beau Lines
transverse depressions secondary to trauma or systemic illness -Lines grow out with nail -1mm every 6-10 days
50
Nail- paronychia
Acute or chronic inflammation of the proximal & lateral nail folds. Nail folds are swollen, reddened, and tender Causes: frequent immersion in water, nail biting
51
Nail- Onychocryptosis
Ingrown toenail- usually involving the large toe. Nail grows into the dermis Causes: improperly cutting nails, tight shoes
52
Nail- Terry's nails
Mostly white with a distal band of reddish brown Causes: Aging, chronic disease such as cirrhosis
53
Nails- Leukonychia
Trauma to nails causing areas of white discoloration Causes: Trauma, repeated manicuring
54
Nails- Onycholysis
Painless separation of the nail plate from the nail bed Causes: Most common-trauma to long fingernails Other- psoriasis
55
Nails- Onychomycosis
Fungal infection of nail bed, plate or matrix Causes: Occlusive footwear, locker room exposure
56
Nail pitting
seen in autoimmune diseases like psoriasis, alopecia areata
57
Hair loss- Trichotillomania
hair loss from pulling, plucking, twisting hair -hair shaft broken and varying lengths -more common in children, psychosocial stress
58
Hair loss- Tinea Capitis
Round scaling patches -hair broken off close to surface of scalp -lymphadenopathy, itching -caused by fungal infection
59
Hair loss- Alopecia Areata
-Autoimmune -Smooth, no broken hairs
60
Hair types- Lanugo
soft, fine covers fetus; usually sheds prior to birth (36wks)
61
Hair types- Vellus
Fine, short, relatively unpigmented adult hair on face, trunk, limbs -growth not affected by hormones
62
Hair types- Terminal
Thick, usually pigmented adult hair found on scalp, beard, axillae, pubic areas, eyebrows/lashes -growth influenced by hormones
63
Appendages of skin
Hair, Nails, Sebaceous gland (oil), Sweat glands (eccrine and apocrine)
64
ABCs of malignant melanoma
A- asymmetry B- borders C- color D- diameter >6mm E- evolution F- "funny looking"
65
Acral Lentiginous Melanoma
<5% of all melanomas BUT, most COMMON type in darker-skinned individuals -Plantar is most common, also palmar & subungual (under nail)
66
Basal Cell
80% if all skin cancers slow growing, almost never metastasize -classic pearly papules + telangectasias; sometimes rolled borders
67
Squamous cell
16% of skin cancers -crusted hyperkeratotic; inflammed or ulcerated -rare metastasis
68
layers of skin
Epidermis, dermis, subcutis
69
Four major layers of epidermis (bottom-up)
Basal layer- source of epidurmal stem cells. Cell division occurs here. Keratinocytes start here and move upwards Spinous layer- center of epidermis, spiny appearance, "spines" desmosomes that hold the keratinoncytes together Granular layer- Lipids produced by the keratinocytes and secreted into the extracellular space between the keratinocytes; form "glue" that keeps cells together & water barrier that keeps water in the skin Stratum Corneum- made up of desquamating keratinocytes. Thick outer laters flattened keratinized non-nucleated cells provide barrier against trauma & infection
70
Bullous pemphigoid
autoimmune blistering disease (older patients) -Autoantibodies form to hemidesmosomes that attach to basal layer (BM). Epidermis separates from the dermis.
71
Psoriasis
The rate of optimal turnover is increased & keratinocytes over-proliferate (thickening) -Doesn't allow enough time to differentiate and causes a scale
72
Filaggrin
A protein later in granular layer -helps retain water & keep a barrier -Mutations in filaggrin cause atopic dermatitis (eczema)
73
Describe how skin as a barrier fits Osteopathic tenets?
Tenet #3 structure and function are interrelated -The major function of skin is to act as a barrier so if its disrupted it can lead to systemic issues and possible death
74
Skin serves three purposes
Barrier, Immunologic, Temperature regulation
75
Functions of skin
Sensory, UV Protection, Injury repair, Vit D production, Affects with appearance & quality of life
76
Physical exam of skin lesions/rashes
Color Symmetry Distribution (flexor creases) Arrangement (groups of 3; scattered) Shape
77
On Inspection, when considering COLOR, think about these 4 pigments
1- Carotene (yellow, in subQ & in palms/soles, precursor to Vit A) 2- Bilirubin- (yellow-brown, from breakdown of heme in RBCs) 3- Melanin (produced my melanocytes, amount is genetically determined, but also increased by sun exposure, High melanin = >photoprotection but also >post-inflammatory hyperpigmentation 4- Oxyhemoglobin- (bright red passes through capillaries; releases O2 to tissues) increased blood flow in capillaries = blushing decreased blood flow to capillaries = pallor 5- deoxyhemoglobin - oxyhemoglobin loses O2 passing through capillaries; changes to deoxyhemoglobin Increased levels = cyanosis
78
Melasma
increased pigmentation
79
Vitiligo
Absence of pigmentation
80
Central cyanosis
-patients have reduced arterial O2 sats (<85%) -consistent with cardiac or pulmonary disease -both skin and mucous membrane involvement
81
Peripheral cyanosis
Seen with cold exposure or anxiety & can also be seen with heart disease -Blood flow in peripheral skin is low and tissues extract more O2 than usual -No mucous membrane involvement
82
Four tenets of Osteopathic Medicine
1. The body is a unit: the person is a unit of body, mind, and spirit 2. The body is capable of self-regulation, self-healing, and health maintenance 3. Structure and function are reciprocally interrelated 4. Rational medical treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function
83
Anatomic barrier
normal end range of motion limited by bones, ligaments, and tendons. Passively tested- doctor can assist getting to the end range
84
Physiological barrier
limit of end range of motion produced by the patient. Actively tested
85
Restrictive/Pathological Barrier
Abnormal limited motion within the physiological range that is altered by somatic dysfunction
86
Direct technique
OMT in which the restrictive barrier is engaged, and a final activating force is applied to correct somatic dysfunction Move INTO or THROUGH the restrictive barrier
87
Indirect Technique
OMT in which the restrictive barrier is disengaged, and the dysfunctional body part is moved away from the restrictive barrier. Move AWAY from the restrictive barrier
88
Active treatment
The patient assists during treatment
89
Passive treatment
The patient relaxes during the treatment
90
Palpating Forearm
1- 1st layer of skin, is it warm or cool? 2- 2nd layer- subcutaneous layer 3- underlying musculature (nails blanching) 4- course forearm distally until you feel tissue change and reach musculotendinous junction 5-feel for radial and ulnar styloid, and scaphoid
91
Transverse carpal ligament
tendon that runs transverse to the tendons and binds tendons at the wrist
92
Fryette's Principle I
The thoracic and lumbar are in NEUTRAL -coupled motions of side bending and rotation for a GROUP of vertebrae occur in OPPOSITE directions TYPE I SOMATIC DYSFUNCTION
93
Fryette's Principle II
The thoracic and lumbar are sufficiently forward or backward bent (non-neutral) -Coupled motions of side bending and rotation of a SINGLE vertebra unit occur in the SAME direction, TYPE II SOMATIC DYSFUNCTION
94
Fryette's Principle IIl
Initiating motion of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion -if motion is restricted in one direction such as rotation, it will also be restricted in side bending and flexion/extension -if motion is improved (treated) in one direction, the other directions will improve as well
95
How to name segmental dysfunctions
-location of dysfunction -3 planes of motion -named for what IT CAN DO or LIKES TO DO -freer motion -position of ease
96
Naming Type I dysfunction
Neutral "group" curve Side bending comes before rotation Example: T7-T12 NSLRR Diffuse pain Curves of spine - lateral "GINO SR"
97
Naming Type II dysfunction
Single segment in non-neutral position (Flexed or Extended) Side bending comes after rotation Curves of spine - A/P Local pain
98
Fryette's Law of Motion EXCEPTIONS
Occiput: occiput (C0) on atlas (C1) -Primary motion- flexion /Extension "YES" joint -minor motions- side bending and rotation- occur in opposite directions -like Type-I mechanics Atlas: Atlas (C1) on axis (C2) primary motion- rotation "NO" joint Sacrum: sacrum with respect to ilia -rotation & side bending in opposite directions
99
Naming Cervical Motion
C0-C1 (O/A)- side bending and rotation occur in opposite directions in non-neutral position C0FSrRl C1-C2 (A/A): Pure rotation C1Rr C2-C7: follow Type II motion
100
Muscle Contraction- Isotonic Contractions
Tension is constant throughout the contraction -counterforce is less than the patient's force 2 types of isotonic contractions: - concentric and eccentric
101
Muscle Contractions - Concentric
type of isotonic contraction -movement in the direction of the muscle contraction -approx of muscle's origin and insertion -bringing barbell towards shoulders during bicep curl
102
Muscle Contractions - Eccentric
type of isotonic contraction -Lengthening of a muscle during a contraction due to an external force. -bringing the barbell away from the shoulder back towards the starting point with the biceps muscle still contracting but lengthening
103
Muscle Contractions - Eccentric Isolytic
Muscle contraction that occurs when an outside force completely breaks/overpowers the muscle's contraction force. - counterforce is greater than patient's force
104
Muscle Contractions - Isometric
Change in muscle tension without approximation of muscle origin and insertion -no change in muscle length -Counterforce is EQUAL to patient's force -used in many OMT tx
105

OMM BLOCK 1 fall23 (1 decks)

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