Opp Exam 1 Flashcards
(93 cards)
1
Q
Where’s the external occipital protuberance?
A
Level of superior nuchal line (nuchal ligament) & Trapezius m. insertions
Presence of counter strain tender points
2
Q
thoracic articulate processes
A
projections of the vertebra that serve the purpose of fitting with an adjacent vertebra
3
Q
cervical articulate process
A
4
Q
Lumbar facet joint
A
5
Q
What are structures of vertebrae?
A
6
Q
What’s difference between supraspinous, interspinous, and nuchal ligament?
A
Interspinous is ligament between our spinous processes that we can’t palpate, supraspinous ligament coats the spinous processes and is palpable, the ligamentum nuchal is between INION and C7
7
Q
What landmarks may be painful due to dysfunction of Levator Scapulae muscle?
A
Mastoid process
Base of occiput
8
Q
Importance of Cervical Transverse Processes
A
houses the vertebral artery, is where the levator scapulae muscles attach, and is used in assessing sidebending and rotation
9
Q
Transverse Process of the Atlas (C1)
A
the only palpable point on this vertebra, halfway between the gonion and the mastoid process, the other transverse processes are rudimentary (less mature), the landmark used most in atlantoociptal and atlantoaxial joint motion evaluation, also the focal point in counterstrain technique for dysfunction in this region
10
Q
Anterior surface of neck
A
11
Q
Posterior Cervical Landmark
A
A.Inion
B. Trapezius
C. Transversocostal muscle group
D. C7 spinous process
E. T1 spinous process
F. Nuchal ligament
G. Zygopophyseal joint (i.e., articular process, facet)
H. Suboccipital muscle
I. Greater occipital nerve
12
Q
Anterior Shoulder Girdle Landmarks
A
13
Q
What Attaches to the Coracoid Process?
A
14
Q
Shoulder & Upper Arm Landmarks
A
15
Q
What’s Important About These?Look at the Green on Right!
A
Sternal Head of Clavicle- SC joint
Coracoid Process- Pectoralis minor
Lesser tuberosity of Humerus- Subscapularis m.
Bicipital Groove- Long head of biceps
Greater tuberosity of humerus- Supraspinatus & bursa
Acromion process- Acromioclavicular joint & bursa
Superior angle of scapula- Levator scapula & bursa
Spine of scapula- Supra/infraspinatus, trapezius, & deltoid; ~T3 spinous process
Inferior angle of scapula- ~ T7 spinous process
16
Q
Sternum Anatomy
A
17
Q
Thoracic Anterior Landmarks
A
18
Q
Posterior Thoracic and Lumbar Landmarks
A
19
Q
Anterior Thoracic and Lumbar Landmarks Female
A
20
Q
Anterior Thoracic and Lumbar Landmarks Male
A
21
Q
Posterior Surface Anatomy & Landmarks
A
22
Q
Anterior View of the Abdomen and Pelvis Bone
A
23
Q
Anterior View of the Abdomen and Pelvis Musculature
A
24
Q
Lumbar, pelvic, hip landmarks
A
25
Pelvic Landmarks
26
Sacral Landmarks
27
Anterior Ligaments of Lumbar & Pelvic Regions
28
Lower Extremity Landmarks
29
What's rule of Threes
T1-T3: spinous processes in line with transverse processes
T4-T6: spinous processes ½ step below transverse processes
T7-T9: spinous processes 1 step below transverse processes
T10: behaves like T7-T9
T11: behaves like T4-T6
T12: behaves like T1-T3
30
Paraspinal Groove
Posterior to Sternocleidomastoid m.,
Lateral border/edge of Trapezius m.
Deeper is semispinalis capitis m.
31
Cervical Articular Pillars – The Column made by the Facets/Joints
32
Palpating the Anterior Superior Iliac Spines (ASIS)
Physician places thumbs under the ASIS
Thumbs point toward opposite ASIS
Direct pressure into patient
Then push in cephalad direction
This “hooks” thumb under the ASIS
33
Medial Malleoli Used for Screening for Leg Length Discrepancy
Place thumbs on each malleolus to determine if they are at the same level
Plantar & dorsiflexion of foot & ankle will not affect the malleoli
34
When do you see a gluteal fold?
when someone exhibits asymmetry horizontally
35
First Tenet of Osteopathic Medicine
The body is a unit; the person is a unit of body, mind, and spirit
36
What is meant by “spirit”?
The non-physical something that makes someone unique, who they are, The person who lives in the body
37
What did A. Still say about principles?
Spirit mind motion of matter
Life force powers the body
Body as machine, directed by mind, powered by spiritual life force
38
what are all 4 AOA tenets?
The body is a unit; the person is a unit of body, mind and spirit.
The body is capable of self-regulation, self-healing, and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
39
Physiologic Basis of Mind-Body
Conscious mind can affect pain perception in Medial prefrontal cortex and Dorsolateral prefrontal cortex.
Signals in the brain amplified by emotions Activating sympathetic system (fight/flight), which can increase pain via amygdala, thalamus, and other structures.
These in turn can amplify nociceptive input or even misinterpret other sensory input as pain
40
OMT Benefits
Reducing nociceptive input, which will decrease facilitation
Balancing dysfunctional aspects of the nervous system
Especially the autonomic nervous system
Affects body and mind
Affects serum endocannabinoids level
Improving structure and function
Affects mental state, such as reducing anxiety
41
Emotional Issues
Emotional issues can manifest as changes in somatic structures, especially myofascial tissue.
Therapeutic release of patterns (vectors) of injury in the myofascial tissue, with OMT, can improve structure and function as well as affect the psyche
Concept of somato-emotional release
42
True/False: Effects of writing about stressful experiences on symptom reduction in patients with asthma or RA
True
43
True/False: Writing About Testing Worries Boosts Exam Performance in the Classroom
True
44
Medical Decision Making
Spiritual beliefs and priorities affect patient decisions
Some will seek to extend life at all costs
Others want quality of life over quantity
Some will change life orientation and priorities to enhance this animating principle
45
Spiritual Growth
Personal growth of each of us, as physicians, is very important
Being open and aware of the spiritual aspect of ourselves and our patients is a way to grow
Patients raise profound questions that we do not always have answers to
It’s okay not to have all the answers, as long as you can be present with your patients when they ask
46
Acknowledging Mind, Body, & Spirit
Recognize each patient as a triune of body, mind, and spirit
Patients appreciate being treated as more than simply a machine
Not just a theoretical construct; this has ramifications
This leads to empathy and compassion, which make a difference
47
Empathy
The ability to understand, feel, and be sensitive to the feelings, thoughts, and experience of another
When you recognize someone as body, mind, spirit then it changes your interaction with that person
Prevents antipathy and physician burnout
Decreases risk of medical malpractice lawsuits
48
Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing
patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions
Mindfulness meditation (MM)-based stress reduction intervention guided by audiotaped instructions during light treatments
Or a control condition consisting of the light treatments alone with no taped instructions.
analysis showed that subjects in the MM groups reached the Halfway Point and the Clearing Point significantly more rapidly than those in the no-MM group, for both UVB and PUVA treatments.
49
One way to initiate a discussion on spiritual concerns is to ask the question...
“Are you at peace?”
50
What's unique about osteopathic physicians
Distinctive hands-on approach
Including specific OMT
Can facilitate patient care in physical and nonphysical ways
The power of touch is a powerful thing
51
Physician and Medical Student Wellness
Exercise-Medical aerobic or strength training sig. reduces burnout, physician emotional exhaustion and degree of depersonalization, Raised levels of vitality
Mindfulness- Self-directed practice for relaxing the body and calming the mind through focusing on present-moment awareness
Stress reduction program
Physician group therapy
52
describe how the body-mind-spirit approach applies to patient care and to physicians themselves
Approaching the patient in a context of body, mind and spirit, being aware of structure and function and the body’s inherent ability to heal itself, is a genuinely osteopathic approach, and is truly comprehensive, effective medicine.
It is better for your patients, and it is better for you
53
Somatic dysfunction
Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, & myofascial structures, and related vascular, lymphatic, and neural elements.
54
Objective diagnostic findings of SD are:
Asymmetry
Restricted motion (Regional; Intersegmental)
Tissue texture change
Tenderness
55
The Physiologic Spinal Curves
At Birth- one large Kyphotic curve
As the cervical extensor muscles develop, the head is raised and a Cervical Lordotic curve is formed
As the infant begins to crawl & walk, the Lumbar Lordotic curve develops
56
Transition zones
are areas commonly susceptible to somatic dysfunction & biomechanical stress. Occur at occipitocervical, cervicothoracic, thoracolumbar, and lumbopelvic junctions
OA, C7-T1, T12-L1, & L5-S1. Include arthrodial, skeletal & myofascial anatomy. Whereas “Cross-overs” occur wherever the postural line crosses the gravitational line (occur at the transition zones)
57
Performing structural exam sequence
Compare each body area bilaterally
Note the general contour of the anatomy
Look for unnatural positions of the extremities
Observe use of the extremities
Muscle tone from side to side
Observe truncal positions
58
Requirements for performing structural exam
Shoes are to be removed
Patient stands ‘comfortably’
Examiner stands near patient
Examiner brings his eyes up or down to the level of the region/landmark evaluated, and uses ‘Dominant eye midline’
59
types of hypertonicity
60
Hypertrichosis
hair patch on back, usually caused by CNS somatic dysfunction
61
Winging of the scapula
Caused by:
Trauma, iatrogenic (induced inadvertently by medical treatment or diagnostic procedures), and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior (long thoracic nerve), trapezius (spinal accessory nerve), or rhomboid muscles (dorsal scapular nerve)
62
Things to look at anteriorly
63
things to look at posteriorly
64
types of feet arches
65
types of feet bend
66
pectus carinatum vs pectus excavatum
Pectus carinatum has chest poking out and pectus excavatum has chest caving in
67
Spinal curves: normal descriptions
cervical (lordotic), posterior concavity
Thoracic (kyphotic), posterior convexity
Lumbar (lordotic), posterior concavity
Sacrum kyphotic), posterior convexity
68
whats gravity line
69
two parts of skeleton
axial = skull, sternum, ribcage, and vertebrae and appendicular = limbs, girdle
70
vertebral structure
The outside layer is cortical, and inside is cancellous spongy bone
71
superior facet
The superior articulates with inferior
72
What are the two types of vertebral joints?
1. Facet (zygopophysial) joints
2. Intervertebral joints Symphyses - good for compression
73
What makes up intervertebral disc?
Nucleus pulposus derived from notochord, which is made of hydrophilic jelly, and annulus fibrosis which is derived from sclerotome and made of laminae of fibrocartilage
74
Spinal ligaments and limitations
Limiting spinal extension is the anterior longitudinal ligament. Limiting spinal flexion is the posterior longitudinal ligament, the supraspinous/interspinous ligaments, and ligamentum flavum (yellow elastic). Limiting lateral bend is intertransverse ligaments
75
Atypical Cervical Vertebrae
C1 and C2. C2 has the Dens (odontoid process), it rests in the posterior tubercle of C1, which has no body. C1 = Atlas, C2 = Axis. Atlantooccipotal joint between skull and C1. C1 has a lot of movement around dens and is controlled by transverse ligament which prevents anterior displacement of atlas, and posterior displacement of dens
76
Thoracic vs lumbar vertebrae
Transverse costal = rib, hemifacets can be costal. Something present on both is vertbrae notch, and vertebral foramen
77
Sacrum and Coccyx
78
Joints of sacrum
79
What happens in herniated disc
As people age the nucleus pulposus becomes less jelly like, and annular fibrosis can rupture. Overtime causes the pulposus to push back posteriorly on posterior longitudinal ligament, so it goes around and pushes into spinal canal on nerves causing pain.
80
Lumbar MRI normal vs herniated
81
CNS vs PNS
CNS = brain, brainstem, and spinal cord. PNS = peripheral nerve, cranial nerve.
82
What's the structure of the typical spinal nerve?
83
What are types of neurons?
Multipolar - most common, and motor neurons; one axon, multiple dendrites
Pseudounipolar - sensory neurons; a type of neuron which has one extension from its cell body. This type of neuron contains an axon that has split into two branches; one branch travels to the peripheral nervous system and the other to the central nervous system.
Bipolar - retina, cochlea, vestibular; one axon, one dendrite
84
What are the divisions of the CNS?
Grey matter- cell bodies which makes up the core of the brain contains CNS's nuclei/lamina, and PNS's ganglia. White matter on the outside is all the axons. Spine has cervical, thoracic, lumbar, and sacral regions with enlargments at the cervical and lumbosacral regions, for the extremities. Conus medullaris is end of spinal cord, and Cauda equina is the PNS caudal to conus medullaris.
85
Dorsal vs lateral vs ventral horns
The neurons of the dorsal horns receive sensory information that enters the spinal cord via the dorsal roots of the spinal nerves. The lateral horns are present primarily in the thoracic region, and project to the sympathetic ganglia; autonomics. The ventral horns contains the cell bodies of motor neurons that send axons via the ventral roots of the spinal nerves to terminate on striated muscles for motor. The dorsal columns carry ascending sensory information from somatic mechanoreceptors. The lateral columns include axons that travel from the cerebral cortex to contact spinal motor neurons. These pathways are also referred to as the cortico-spinal tracts. The ventral columns carry both ascending information about pain and temperature, and descending motor information.
86
Which boy segments do vertebral column regions control?
Cervical = neck, arms, diaphragm. Thorax = abdomen. Lumbar/pelvis = leg, Sacrum = leg, bowel, bladder, reproductive organs
87
Spinal nerve exits
The spinal nerve is shorter than vertebral column, and ends around L1. Cervical vertebra are at spinal levels, thoracic and lumbar vertebrae correspond to lower spinal cord exits. So injury to lower region is worse because injure more nerves.
88
What's difference between dorsal root vs ventral vs. lateral?
Dorsal sensory neurons have an extra synapse outside of the dorsal horn. The first synapse is dorsal root ganglion. Lateral horn send info out that synapses on postganglion root before reaching autonomic system, and ventral goes straight to muscle
89
Sympathetic vs Parasympathetic responses
Sympathetic = vasoconstriction, pupil dilation, bronchial dilation, inhibits glands, decrease bowel peristalsis, urinary retention, ejaculation. Travels via: brain (hypothalamus > lateral corn of cord> exits T1-L2 > ascends/descends the trunk > preganglionic neuron synapses in ganglia > postganglion > and travels to target
Para sympathetic = vasodilation, pupil constriction, glands secrete, activate bowel, initiate defecation, erection. Has 2 paths: 1) brain > cranial nerves 3,7,9,10 > exits brainstem>preganglionic neuron> postganglionic to target. 2) Lateral horn > exits S2-S4>preganglionic>postganglionic to target
90
Define the meningeal coverings of spinal cord
First, conus medullaris stops at spinal cord (L1). Pia extends off of end of spinal cord (filum terminale internus), combines with arachnoid and dural layers to form the filum terminale externus at the end of the lumbar cistern and terminates at the coccyx. the lumbar cistern contains CSF
91
Where do you want to do lumbar puncture/epidural?
Below L1, around L2-L4
92
Intrinsic vs extrinsic back muscles
Extrinsic - attached to spine and move laterally
Intrinsic go up and down spinal cord
93
flexion vs extension
