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OS IV > Midterm > Flashcards

Midterm Flashcards

1
Q

How can the approach to osteopathic treatment of children change based on age

A

Young children may need to be held by parent; warm hands, approach child condifdently

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2
Q

What treatment modalities are not used in children

A

HVLA (contraindicated in anyone with hyper mobile joints), ME may be difficult in young children

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3
Q

What treatments are used in children

A

Articulatory, myofascia, indirect, FPR, lymphatic, cranial

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4
Q

What are cranial treatments in infants and children useful for

A

Poor suckle, infant constipation, birth trauma (vomiting, excessive crying, poor suck)
Techniques to use: condylar decompression, BMT

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5
Q

What curvatures of the spine have yet to develop in infants

A

Thoracic kyphosis and lumbar lordosis

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6
Q

What cranial bone is most susceptible to SD in an infant

A

Occiput; CN XII and IX can lead to poor suck, CN X can lead to reflux, vomiting, and colic, CNXI can lead to colic, muscular dysfunction

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7
Q

What can temporal dysfunction in children cause

A

If internally rotated, increases risk of otitis media

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8
Q

What an forceps or vacuum delivery cause

A

CN VI: lateral rectus palsy

CN VII: facial palsy

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9
Q

How can you tell the diff btw synostosis and positional plagiocephaly

A

If ear on flattened side more post -> synostosis; if more ant -> positional plagiocephaly
If forehead protruding on side of flattening suggests positional
Unilateral bald spot suggests position

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10
Q

What is recommended for OMT in infants

A

Indirect treatments; BMT, BLT, condylar decompression, MFR to diaphragms, suboccipital release

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11
Q

What is the anterior Chapman’s point for intestines

A

Just below ASIS

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12
Q

What OMT can you do for ab complaints in children

A

Poor feeding: cranial, esp condylar decompression

  • GERD: cranial, viscerosomatics T5-9, OA, AA
  • constipation viscerosomatic (upper and lower GI), pelvic dysfunctions, mesenteric release
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13
Q

What is the parasympathetic treatment for the nose

A

Facial nerve

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14
Q

What are the respiratory Chapman’s points

A
  • Nasal sinuses: anterior is inferomedial clavicle lateral to SC junction, superior second rib at MCL; posterior is mastoid process
  • larynx: anterior is superior second rib medial to sinus; posterior is lateral to spinous process of C2
  • pharynx: anterior is inferior first rib at sternocostal junction; posterior is lateral to spinous process of C2
  • tonsils: anterior is lateral manubrium
  • middle ear: anterior is superior clavicle lateral to SC junction; posterior is base of occiput at OA joint
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15
Q

What is the Muncie technique used to treat

A

Otitis media

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16
Q

What are the 5 model treatment or asthma

A
  • neuro: Beta2 agonist
  • immmune: ICS
  • biomechanics: rib dysfunction
  • behavioral: avoid triggers, use meds prior to exposure
  • resp/circ: rib raise, lymph tx
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17
Q

What are the indications for abx for acute otitis media

A

Ear pain non responsive to analgesic meds, age <6 months, exclusive formula feeding, fever >102.2 or non responsive to anti-pyretics

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18
Q

What are the OMT techniques for otitis media

A

Sinus drainage, galbreath, submandibular walking, pre-post auricular drainage, cervical drainage, temporal pull, BMT

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19
Q

What are the effects of chronic MSK conditions on pregnancy

A
  • scoliosis: more pain; increase risk of premature birth
  • RA: improved sx
  • Ankylosing spondylitis: aggravated by pregnancy due to increased stress on SI joints
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20
Q

What MSK changes occur during pregnancy

A

Ligamentous laxity, exaggerated lordosis of lower back, forward flexion of the neck, downward movement of shoulders, weakness and separation of ab mm, joint laxative of anterior and posterior longitudinal ligaments, widening and increased mobility of SI joints and pubic symphysis, anterior tilt of pelvis, compression of structures due to fluid retention

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21
Q

What is tensegrity

A

Property of skeleton structures that employ continuous tension members and discontinuous compression members in such a way that each member operates with maximum efficiency and economy

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22
Q

What causes an anterior pelvic tilt

A

Hypertonic quads, quadratus lumborum and iliopsoas

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23
Q

What causes a posterior pelvic tilt

A

Hypertonic iliopsoas and Piriformis

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24
Q

What are the risk factors for m imbalance and postural de compensation

A

Gravitational strain
Congenital (pelvic tilt, short leg syndrome, scoliosis)
Altered proprioceptive input (trauma, sedentary lifestyle, poor exercise technique, m weakness)
Stress
Hormonal
Nutritional
Aging

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25
Q

What is sherrington’s law

A

When a m receives a nerve impulse to contract, its antagonists receive an impulse to relax

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26
Q

What are the signs of lower crossed syndrome

A

Increased sacral flexion btw ilia; increased lumbar lordosis, increased flexion of hip and knee, hyper mobility in sagittal and coronal planes in L4-5 and L5-S1, sitting up from supine and forward bending are dysfunctional

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27
Q

What are the hypertonic and hypotonic mm in lower crossed syndrome

A
  • hypertonic: iliopsoas, quadratus lumborum, tensor fascia lata, hamstrings, rectus femoris, Piriformis, adductors, gastrocnemius, soleus
  • hypotonic: gluteals, abdominals, vastus medialis, anterior tibialis, peroneals
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28
Q

What are the sx of each of the spastic m groups in lower crossed syndrome

A
  • iliopsoas: inability to st and straight; pain in groin
  • QL: pain referral to groin and hip, exhalation rib 12 dysfunction, diaphragm restriction
  • hamstrings: pain sitting or walking, pain disturbs sleep, pain referral to post thighs, limited straight leg raise
  • Piriformis: pain down post thigh; pelvic floor dysfunction, dyspareunia
  • adductors: pain referral to inguinal ligament, inner thigh and knee
  • gastroc: nocturnal leg cramps
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29
Q

What are the sx of the inhibited m groups in low cross syndrome

A
  • glut min: pain when rising from chair;
  • glut med: pain with walking
  • glut max: restlessness
  • vastus medialis: buckling knee, weakness going upstairs; chondromalaccia patellae
  • rectus abdominis: increased lordosis, constipation
  • tibialis anterior: pain to great toe and anteromedial ankle; foot drag
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30
Q

What is the difference btw form and force closure

A
  • form: properties of the surfaces of the joint; requires proper size and shape of articulating surface
  • force: compression produced by body weight, m action, and ligament force
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31
Q

What mm affect the SI joint

A

Posteriorly: lat, thoracolumbar fascia, glut max, ITB
Anteriorly: ab obliques, linea alba, transverse abdominals

32
Q

What does difference in perception at each of the levels (iliac crests, midway, greater trochanter) indicate

A
  • iliac crest: multifidus, lat, levator scapula, lumbar vertebrae, lumbo-sacral junction
  • midway: gluteals, SI joint, sacrum, inominate
  • greater trochanter: pelvic diaphragm, hamstrings, STL
33
Q

What should the firing pattern be of LE extension

A

Ipsilateral hamstring, ipsilateral glut max, contralateral erector spinae, ipsilateral erector spinae

34
Q

What is the correct firing pattern or LE abduction m balance

A

Ipsilateral glut med, ipsilateral TFL, ipsilateral QL, ipsilateral erector spinae

35
Q

What are signs of upper crossed syndrome

A

Forward head posture, increased lordosis, incrased kyphosis, protraction of shoulders, internal rotation of humerus, stress C4-C5 and cervicocranial and cervicothoracic junctions

36
Q

What mm will be hypertonic vs weak in upper crossed syndrome

A
  • hypertonic: levator scapula, upper trap, pectorals, last, SCM, scalene, subscapularis, UE flexors
  • hypotonic: mid and lower trap, infraspinatus, supraspinatus, rhomboids, UE extensors, deltoid, serratus anterior, deep neck flexors
37
Q

What does the b/l shoulder flexion test

A

Resting length latissimus; checks pectorals

38
Q

What is the 5 models plan for muscle imbalance

A
  • biomech: protect osteoarticular system by reducing strain
  • neuro: restore neuro balance
  • resp: optimize fluid flow
  • metabolic: improve functional capacity with OMT, proper nutrition, hydration and sleep/rest
  • behavioral: empower pts by giving exercise
39
Q

How much and how often should you prescribe stretching exercises

A

12 weeks of stretching 3 days a week on non consecutive days; hold stretch for 10 s for 9 repetitions or for 30 s for 3 repetitions - study
-rx: 2-3 on each side 2-3 times/day for 12 seconds or 3 deep breaths

40
Q

What should you do after stretching

A

Perform retraining exercise 2-3 times per day

41
Q

When should you evaluate CV or resp systems when rx exercise

A

Extreme fatigue after exercise, pain above waist, inability to maintain convo due to SOB, CV dz family hx

42
Q

What are sx of posterior pelvic pain

A

Distal and lateral to lumbo-sacral junction, radiates down posterior thigh to knee, no m weakness or sensory impairment, normal 2/4 reflexes, pain may be due to relaxation of ligaments

43
Q

What are alarm findings for back pain

A

Severe pain that interferes with function (non positional persistent pain at night), increased pain with cough, sneeze, valsalva, neuro deficits (bladder and bowel incontinence; paresis), weakness, sensory deficits, abnormal reflexes

44
Q

What are the etiologies of radicular pain

A

Herniated or bulging disc; mechanical pressure of ligamentous structures of the spine on nerve root; presents as paresthesias in ilioinguinal and genitofemoral n *lightning pains

45
Q

What are the risk factors for back pain in pregnancy

A

Multiparity, higher BMI, smoking, age, strenuous work, pain during menstruation

46
Q

When do most of the sx concerning lymphatics occur in pregnancy

A

3rd trimester; hemorrhoids, vulvar and LE varicosity

47
Q

What does progesterone do to contribute to SD

A
  • changes in mechanical configuration of thoracic cage: circumference increases, subcostal angle widens, diaphragm pushed superiorly, incrased tidal volum
  • promotes fluid retention: decreased oxygen and met; increased met waste products in soft tissue
48
Q

What are the indications for OMM in OB patients

A

SD, scoliosis or structural condition, edema, congestion

49
Q

What are the relative contraindications to OMT in OB patient

A

Premature rupture of membranes; premature labor

50
Q

What are the absolute contraindications to OMT in OB patient

A

Undiagnosed vaginal bleeding, prolapsed umbilical cord, placental abruption, ectopic, placenta previa, threatened or incomplete abortion, severe pre-eclampsia/eclampsia

51
Q

What should you do during a first trimester visit with an OB patient

A

Complete hx; look for dysfunction, postural exam; thoracic inlet facia, thoracic cage, pelvis and sacrum, CRI; *hyperemesis gravidarum treat C2 and T5-9

52
Q

What should you do during the last 4 weeks of pregnancy

A

Evaluate pelvic diameters

  • inlet: iliopectineal line to sacrum
  • mid-pelvis: structures btw inlet and outlet
  • outlet: pubic bone, ischial tuberosities, coccyx
53
Q

What OMT can you do during labor

A

Soft tissue or MFR to lumbo-sacral region and pelvis; thoracic spine soft tissue can regulate uterine contractions

54
Q

What is the treatment for rupture of pubic symphysis

A

Conservative: bed rest lateral recumbent, pelvic binder, spine and pelvic OMM

55
Q

What should you do postpartum for OMT

A

Treat prior to resolution of hormonal changes; evaluate sacrum - anterior sacral base - cranial extension assoc with fatigue, depression

56
Q

When is the second visit postpartum

A

4 weeks; screen for SD, assess need for future contraception

57
Q

What are the recommendations for exercise during pregnancy

A

30 min of moderate exercise most/all days of the week

58
Q

What exercises should be avoided in pregnancy

A

High risk of falling, ab trauma, jumping, skydiving, hot yoga, valsalva maneuver, scuba diving, activity over 6000 feet

59
Q

What are the relative contraindications to aerobic exercise during pregnacy

A

Severe anemia, chronic bronchitis, poorly controlled T1DM, extreme morbid obesity, extreme underweight, hx of extremely sedentary lifestyle, IUGR, unevaluated maternal cardiac arrhythmia, poorly controlled HTN, orthopedic limitations, poorly controlled seizure disorder or hyperthyroidism

60
Q

What are the absolute contraindications to aerobic exercise in OB patient

A

Hemodynamically significant heart dz, restrictive lung dz, incompetent cervix, multiple gestation (triplets or more), IUGR, persistent 2nd or 3rd trimester bleeding, placenta previa >28 weeks, premature labor, ruptured membranes, preeclampsia/pregnancy induced HTN

61
Q

What is FPR sacral

A

Pillow under ab and beneath mid thigh; flex leg off table with knee extended until ILA moves posteriorly; slight abduction at hip and IR/ER; cephalic motion at the near eminence

62
Q

What is FPR Piriformis

A

Pillow under ab; flex leg off table and adduct hip; axial compression through palm at knee

63
Q

What is FPR glut max

A

Pillow under ab; flex hip off table with knee flexed; extend hip; add torsion via external rotation

64
Q

What is FPR hamstring

A

Prone pillow under stomach; extend hip and flex knee IR/ER; axial traction or compression

65
Q

What is FPR quads

A

Pillow under head; bend both knees; flex hip with knee extended; direct patella towards monitoring hand; IR/ER and ab/addiction; axial traction or compression

66
Q

What is FPR for costochondral

A

Have pt sit up straight; add compression through spine, rotate patient towards

67
Q

What is FPR post rib

A

Sit up; add compression; flex patient towards and add rotation and SB towards

68
Q

What is FPR in/exhalation rib dysfution

A

Grab rip posteriorly and anterolaterally; have patient sit up, lean into you and turn head away;

69
Q

What is a negative vs positive cervical flexion test

A

Positive: immediate recruitment of SCM and scalene
Negative: longus colli activation causes chin nod with SCM and scalene firing late

70
Q

What is the counterstrain for scalene

A

FStRt

71
Q

What is levator scapulae counterstrain

A

Hand on patients ipsilateral wrist - extend arm and places it under traction or compression

72
Q

What is the SCM counterstrain

A

FSTRA

73
Q

What is the Ac-1 counterstrain

A

rotate away; on posterior aspect of ascending ramus of mandible at level of earlobe

74
Q

What is the AC2-6 counterstrain

A

On anterolateral aspect of corresponding anterior; FSara

75
Q

What is the AC7 counterstrain

A

On posterior-superior surface of clavicle at clavicular attachment of SCM; FStRa

76
Q

What is AC-8

A

On medial head of clavicle at sternal attachment of SCM FSara

77
Q

What is pectoralis counterstrain

A

Adduct arm across midline

OS IV (2 decks)

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