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CAOM Block 14
KYCOM Block 14
90
Medical
Graduate
03/02/2014

Additional Medical Flashcards

 


 

Cards

Term
where is the iliolumbar ligament
Definition
1in superior and 1in lateral to PSIS
Term
where are the sacrotuberous and sacrospinous ligaments
Definition
the triangles coming off the sacrum/coccyx to the ischium
Term
where is the ligamentum flavum
Definition
between laminae
Term
what causes central hypertrophy of thus central spinal stenosis
Definition
ligamentum flavum
Term
name the reflexes for C5, C6, C7, L4, S1
Definition
C5: biceps
C6: brachioradialis
C7: triceps
L4: patella
S1: achilles
Term
motor function of L4, L5, L6
Definition
L4: extensior of quads
L5: dorsifle foot
S1: plantar flex foot and bit toe
Term
straight leg raise: when is it positive, what does this suggest
Definition
positive if produces symptoms below knee at <70deg hip flexion
lumbar pain without radiation is negative
hamstring tightness is negative
opposite side positive is strongly suggestive of nerve root lesion

suggests herniated disc
Term
well leg raise: when is it positive, what does this suggest
Definition
lift opposite leg to problem
if there is pain in the problem leg than it is positive

suggests meningeal irritation or herniated disc
Term
braggards: how is it done, what is positive, what does this suggest
Definition
life leg on problem side until pain, lower 5deg, dorsi flex
if this recreates cheif complaint tan it is positive

suggests inflammation of spinal nerves (esp sciatic)
Term
hoovers sign: how is it done, what is positive, what does this suggest
Definition
ask pt to lift affected leg with hand under unaffected side
positive is no pressure on hand

this suggests faking it
Term
how do you do a physical exam on thehip
Definition
flexion
abduction
external rotation
extension
Term
what is a schmorl's hernia
Definition
protrusion of cardilage of the intervertebral disc into vertebral body usually due to degeneration and aging with a strong family history, can cause necrosis of the vertebrae
Term
thomas test; how is it done, what is positive
Definition
patient supine on table, flex one knee up to chest, other extended
if opposite hip flexes or ASIS goes ip then its positive
Term
what is a vertebral body hemangioma
Definition
most common tumor of spinal axis
usually a incidental finding
Term
how do steroids affect the spin
Definition
cause advanced drug induced osteoperosis
AVOID OMT LOW VELOCITY
Term
how is the prostate related to problems in the spine, how is it diagnosed
Definition
it metastasis to the lumbar causing osteoblastic proliferation

see dense lesions through out pelvis and lower spine
Term
what is the most common spondyloarthropathy
Definition
ankylosing sopndylitis
Term
ankylosing spondylitis: age, gender, raced
Definition
15-35yo
M:F 4:1
caucasian:black 3:1
Term
ankylosing spondylitis: 4 signs
Definition
insidious onset of low back pain
stiffness
poor chest expansion
exaggergated drsal kyphosis
HLA-B positive in 90%
Term
what root is affected in relation to a lumbar disc bulge
Definition
root below
Term
what is spondylosis, most common location
Definition
defect of fracture of PARS INTERARTICULARIS (without slip)

usually L5
Term
spondylosis: pt history, X-ray signs
Definition
low back pain
worse with activity
decreased lumbar lordosis
scottie dog has a collar on lumbar oblique view
Term
what is spondylolisthesis, where is it most often located
Definition
slippage of vertebra on adjacent vertebra
isthmic L5-S1 most common
Term
spondylolisthesis: patient signs, x-ray signs
Definition
low back pain
worse with adtivities
may have radicular symptoms
may have sensory motor findings
decreased ROM
painful extension
graded 1-4 on lateral lumbar xray
Term
explain how a spondylolisthesis is graded
Definition
1. 1 unit off disc below
2. 2 units off
3. 3 units off
4. completely (or almost) off
Term
psoas origin and insertion and location
Definition
L1-4 or 5 to lesser trochanter
under medial arcuate ligament
Term
what does a spasm of psoas cause
Definition
flexed and sidebent
lumbar, hip, and or right pain
snapping or popping in hip
flexed at waist
sidebent towards
externally rotated at hip
Term
what is it called when the pubis like isnt connected
Definition
diastasis pubis
Term
common cause of psoas spasm
Definition
acute injury (often lifting) or overuse in athletes
Term
how is psoas syndrome treated
Definition
muscle energy and counterstain: avoid direct when associated with acute injury

treat associated lumbar and pelvic dysfunction

PT/HEP: home exercise critical

avoidance of repetitive hip flexion
Term
what is the common lumbar and inominate dysfunction associated with psoas syndrome
Definition
upper lumbar flexed, sidebent, and rotated to same side

posterior inominate and externally rotated hip
Term
DDX or red flags of neck and UE pain
Definition
MI (esp in women and DM pt)- ask about N/V, diaphoresis, SOB
masses in neck causing compression
swallowing problems
lymphadenopathy
UE edema
Term
explain cervical motion of OA, AA, and cervical spin
Definition
OA: F/E is primary, sideslipping (sidebend and rotate in opposite directions)

AA: rotation is primary, sidebending and rotation are in opposite dorections

C2-C7: sidebending and rotation are coupled
Term
explain how do to cervical HVLA
Definition
flexed dysfunction tx in extension
extended dysfunction tx in flexion

sidebend towards fulcrum and rotate away

apply HVLA towards the sidebend

recheck
Term
contraindications to cervical HVLA
Definition
severe RA
down syndrome -transverse lig laxity
severe osteoperosis
hypermobility -ehlers danlos
vascular insufficiency of C spine
oseomyelitis
Term
C5: motor and sensory areas
Definition
deltoid, bicep

lateral arm, axillary nerve
Term
C6: motor and sensory areas
Definition
wrist extension, bicep

lateral forearm, musculocutaneous nerve
Term
C4: motor and sensory areas
Definition
wrist flxors
finger extensors
tricep

sensory to middle finger
Term
C8-T1: motor and sensory
Definition
finger flexion
hand intrinsics

sensory: medial forearm, medial anterior brachial cutaneous nerve
Term
T1-T2: motor and sensory
Definition
hand intrinsics

medial arm, medial brachial cutaneous nerve
Term
explain how to do spurling manuver, what is positive, what does this suggest
Definition
sidebend, rotate, and compress
positive if pain radiates suggesting cervical root impingement
Term
what is addisons manuver used for, what is positive
Definition
pull arm back and if the subclavian is impinged by thoracic outlet syndrome then the hand will loose pulse
Term
where are the trigger point radiation areas for the sternal head of SCM
Definition
upper sternum
occiput
around eye
Term
where are the trigger points to the sternal head of the SCM
Definition
down the SCM
Term
where are the trigger points for the scalenes
Definition
down the muscle less on middle scalene
Term
where are the trigger point radiation areas for the scalenes
Definition
lateral upper arm
pec area
medial scapular
Term
where are the trigger points for the trapezius
Definition
tip of shoulder
medial shoulder
on scapula
medial scapula
Term
where are the trigger point radiation areas for the trapezius
Definition
occiput
tip of shoulder
medial scapula
Term
where are the trigger points for the levator scapular
Definition
posterior lateral neck
Term
where are the trigger point radiation areas for the levator scapulae
Definition
posterior lateral neck
Term
where are the trigger point radiation areas for the
Definition
anterior lateral shoulder
center pec
medial lower arm
Term
where are the trigger point radiation areas for the serratus posterior superior
Definition
scapulae
posterior shoulder
elbow
little finger
Term
where are the trigger points for the serratus posterior superior
Definition
scapulae
Term
where are the trigger point radiation areas for the pec minor
Definition
anerior lateral shoulder
down medial arm
Term
what is the composition of thoracic inlet
Definition
T1
1st rib
manubrium
Term
what are the contents of the thoracic inlet
Definition
viscera
vascular
nerves
CT - stibsons fascia
Term
what are the functions of the thoracic inlet
Definition
support head and neck
create platform for C spine
anchor UE (sternoclavicular joint is only bony attackment in UE to adial skeleton)
Term
what are the three causes of thoracic outlet syndrome and a sign of each
Definition
neurogenic: compression of brachial plexus, wasting numbness and tingling of hand muscles

vascular: compression of subclavian, pallor edema diminished pulse addisons positive

non-specific
Term
how does being pregnant changes the posture
Definition
shifts center of gravity anterior
pelvis rotates forward
body compensates with lumbar extension and shoulders going back
Term
how much does lordosis and kyphosis change in pregnancy
Definition
lumbar lordosos 7.2%
thoracic kyphosis 6.6%
Term
how does the change in posture in pregnancy cause somatic dysfunction
Definition
increased vertebral facet loading
increased shear across intervertebral discs
shortened segmental muscles
overstretched abdominals and psoas
Term
what are the signs of low back pain / problems in pregnancy
Definition
adaptive gair (waddling)
unleval sacral base
anterior pelvic tilt
bony and ligamentous strain (sacrotuberous)
SI and LS dysfunction
symphosilysis
Term
what innervates the sympathetic for the pelvic viscera
Definition
T10-L2
Term
what innervates the parasympathetic for pelvic viscera
Definition
S2-S4
Term
what areas are innervated by the same parasympathetic and sympathetic as the pelvic viscera
Definition
colon
appendex
kidney
ureter
adrenal medulla
bladder
Term
what are contraindications to treatment in pregnancy
Definition
undiagnosed vaginal bleeding
threatened abortion
ectopic pregnancy
placenta pevia or abruption
PROM or preterm labor
prolapsed cord
eclampsia or severe preeclampsia
Term
what are the best treatments to use in pregnancy
Definition
indirect fascial is DOC

if you do HVLA localize well

avoid supine techniques for supine compression syndrome

empower with self help techniques and exercises
Term
what OMT techniques are benificial in pregnancy
Definition
SI articulation or BLT
pelvic diaphragm release
side lying thoracolumbar soft tissue for paraspinals and rib release
frog leg
diaphragm doming
Term
explain how do do ischial tuberosity spread
Definition
put thumbs on ischial tuberosities and spread
Term
explain how to treat the pelvic diaphram
Definition
pt on side, leg off table, push fingers into muscles just beside ischial tuberosity
Term
explain how to do the frogleg sacral articulation
Definition
pt supine with knees flexed and spread
hand on sacrum and put in BLT
pull sacrum down as pt straightens legs
Term
what is in and out of pattern for ribs
Definition
REX BITE LIN
Term
if a rib resists exhalation it is...
if a rib resists inhalation it is...
Definition
inhaled dysfunction
exhaled dysfunction
Term
what does a rib articulate with
Definition
transverse process of the same vertebrae and the one above
Term
inspiratory action of: pectoralis, serratus anterior, scalenes, latassimus dorsi, diaphragm
Definition
scalenes: pull ribs 1-2 up
pec: pull ribs 2-5 up
serratus anterior: pull 5-9 up
lat: pull 11-12 down

diaphragm: uses central tendon as fulcrum, attached to quadratus lumborum to anchor 11-12 to contract against in inhalation
Term
what muscles indirectly effect rub function
Definition
errector spinae
trapezius
serratus posterior, superior, inferior
psoas
quadratus lumborum
Term
what does HUGS stand for when remembering viscerosomatic reflexes
Definition
H Heart T1-4
U Up GI T5-9
G Gonads T10-11
S seminal (prostate) T12
Term
what are the viscerals for the UE and LE
Definition
UE 2-8
LE 11-12
Term
what are the viscerals for head, heart, lungs
Definition
head 1-4
heart 1-4
lungs 2-7
Term
what are the viscerals for upper middle and lower GI
Definition
upper 5-9
middle 10-11
lower L1-2
Term
what are the viscerals for the upper and lower GU
Definition
upper 10-11
lower 11-12
Term
what are the viscerals for the gonads, uterus/cervix, prostate, electile tissue
Definition
gonad 10-11
uterus 10-12
prostate 12
erectile 11-L2
Term
what collects lymph from abdomen pelvis and LE, where is it
Definition
cisterna chyli
just below diaphragm
Term
how is lymph cleared from the lower body
Definition
cysterna chyli > diaphragm and abdominal visceral motion helps draw lymph superior to thoracic duct > thoracic inlet
Term
what tissues do lymphatics not perfuse
Definition
CNS
epidermis
endymysium of muscle and cartilage
marrow
some peripherial nerves
Term
what do lymphatics usually follow course of
Definition
veins
Term
explain the flow of lymph into thoracic duct
Definition
interstitium > blind ended permeable lymph capillaries > capillary plexuses > trunks > thoracic duct
Term
what drains into right lymphatic duct
Definition
rith head and neck
right arm
right chest and some heart and lungs
Term
explain the ways that fluids return from the tissues
Definition
90% capillaries
10% lymphatics
Term
what is the function of lymphatics
Definition
return proteins that cannot permeate blood capillaries
remove particulate matter, bacteria, and exudate from ECF
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