Omm Exam 2

Front 1

Sympathetic innervation to the Heart

Back 1

T1-T6

Front 2

Parasympathetic innervation to the heart

Back 2

Vagus N.

Front 3

Right side sympathetic innervation to the heart controls which node?

Back 3

SA node
Increased activity -> supraventricular tachycardia

Front 4

Left side sympathetic innervation tot he heart controls which node?

Back 4

AV node
increased activity -> ectopic foci & V-Fib

Front 5

Effect of parasympathetic activity on the heart

Back 5

decreases heart rate & contractility
A-Fib
Paroxysmal atrial tachy
acute inferior wall MI
Early HF

Front 6

What does the right lymphatic duct drain?

Back 6

heart, lungs, right upper extremities, part of head and neck

Front 7

What does the thoracic duct drain?

Back 7

everything except the heart, lungs, and right UE, as well as part of the head and neck

Front 8

Effects of increased sympathetic tone

Back 8

inhibits development of collateral circualtion post MI
Decreases lymphatic drainage
increases rate of contraction - risk of arrhythmias

Front 9

Three vertebral articulations that can produce parasympathetic viscerosomatic disorders

Back 9

OA, AA, or C2 - vagal nerve interactions

Front 10

Define a reflex

Back 10

an involuntary nervous system response to sensory input

Front 11

define a viscerosomatic reflex

Back 11

localized visceral stimuli that produces patterns of a reflex response that is segmentally related to a somatic structure

Front 12

Define a chapman point

Back 12

tissue abnormalities assumed to be related to visceral pathology (2-3 cm)

Front 13

What is the pectoralis trigger point?

Back 13

Right pectoralis MAJOR mm between sternal margin and nipple in the 5th IS - results in supraventricular tachy.

Front 14

Locate the posterior Adrenal gland chapman's points

Back 14

Between T11-T12 transverse processes

Front 15

Pancreatitis - Ranson's criteria

Back 15

Admission:
> 55 yrs
WBC > 16,000
Serum LDH > 350
Blood glucose > 200
SGOT > 250

Initial 48 hrs
Hct dec > 10%
BUN ince > 5
Ca++ < 8
PAO2 < 60
Base deficit > 4
fluid sequesteration > 6L

Front 16

OMM Goals

Back 16

enhance arterial blood supply
improve lymphatic & venous drainage
decrease viscerosomatic reflex activity

Front 17

Innervation of the pancreas

Back 17

greater splanchnic (T5-9), some T10-T11, vagas n.

Front 18

pancreatitis viscerosomatic reflex

Back 18

T7 on right or bilateral
typically non-neutral dysfunction

Front 19

Pancreas anterior Chapman points

Back 19

lateral to costal cartilage between 7th & 8th ribs on right

Front 20

Pancreas posterior Chapman points

Back 20

between transverse processes of T7-8 on the right (mid-way between spinous process and transverse process)

Front 21

Effects of vagal n. stimulation on pancrease

Back 21

increases pancreatic juices
stimulate bile production
headache (due to interchange w/somatic innervation in neck)

Front 22

Rare cause of PUD

Back 22

Zollinger-Ellison syndrome (gastrin producing tumor) - hallmark sign is profound hypersecreation of gastric acid

Front 23

Sympathetic innervation of upper GI tract

Back 23

T5-T9
greater splanchnic n, celiac ganglion
stomach, liver, part of pancrease, part of duodenum

Front 24

Sympathetic innervation of esophogus

Back 24

T2-T8
includes: heart, lungs, UE, head & neck

Front 25

sympathetic innervation of middle GI tract

Back 25

T10-T11
Lesser splanchnic n., superior mesentaric ganglion
pancrease, duodenum -> 2/3 transverse colon

Front 26

sympathetic innervation of lower GI tract

Back 26

T12-L2
least splanchnic n. (T12) & lumbar splanchnic (L1-L2), inferior mesentaric ganglion
distal 1/3 transverse colon, rectum, pelvic organs

Front 27

effects of increased sympathetic tone on GI tract

Back 27

decreased O2 & nutrient delivery to tissues -> bowel angina & ischemic bowel
decreased peristalsis
relaxation of gallbladder & ducts

Front 28

Sympathetic dominant GI complaints

Back 28

constipation
abdominal pain (from ileus, etc)
flatulence
distension

Front 29

parasympathetic upper GI tract innervation

Back 29

Vagus Nerve - lower 2/3 esophogus to mid-transverse colon
left: greater curvature of stomach & pyloric sphincter
right: upper GI tract, liver, gallbladder, right 1/2 colon, lesser curvature of stomach (i.e. everything else)

Front 30

Parasympathetic innervation of lower GI tract

Back 30

pelvic splanchnic nerves (S2-4)
innervates left colon & pelvis

Front 31

effects of increases parasympathetic tone on GI activity

Back 31

increases acid secretion
contraction of gallbladder & ducts
Peristalsis (I.e. sprue & diarrhea)

Front 32

parasympathetic dominant GI complaints

Back 32

nausea & vomiting
diarrhea
hypermotility related to cramping pain

Front 33

innervation of the pelvic diaphragm

Back 33

pudendal n. (S2-4) - pelvic splanchnic n.

Front 34

Upper GI (parasympathetic) reflex vertebral findings

Back 34

C2 Rl
T3 Rr
T5 Rl
T7 Rr

Front 35

Upper GI sympathetic reflexes

Back 35

Esophagus: T3 Rr
stomach: T5-8 Rl
duodenum: T7-8 Rr

Front 36

T12 Rr, tenderness over the tip of the 12th rib...

Back 36

appendix

Front 37

Bilateral (R>L) T8-T10

Back 37

small intestine

Front 38

T12-L1 rotated right

Back 38

cecum, ascending colon

Front 39

L2-3 rotated left

Back 39

descending colon

Front 40

functional GI diseases

Back 40

relates to function, NOT structure
physical complaint w/o organic pathology - consider somatovisceral reflex etiology
Nausea, vomiting, dyspepsia, flatulence, diarrhea, constipation

Front 41

most common cause of pancreatitisgs

Back 41

alcoholism (both acute & chronic)
biliary tract disease
trauma
infections
metabolic
drugs
vascular
mechanical
penetrating duodenal ulcer
hereditary

Front 42

What does the Rome criteria help diagnos?

Back 42

IBS

Front 43

What are the Rome criteria?

Back 43

abdominal pain/discomfort relieved w/ defecation, and/or w/ change in stool frequency, and/or w/ change in stool consistency
PLUS.. 2 or more at least 25% of the time: change in stool frequency, change in consistency, difficult stool passage, tenismus, presence of mucus in stool.
symptoms present >3 mos

Front 44

psychogenic or emotional diarrhea causes

Back 44

excessive stimulation of parasympathetic nervous system which greatly excites both motility & mucous secretion in the distal colon

Front 45

Thoracoabdominal diaphragm attachments

Back 45

right crus: L1-3(4)
Left crus: L1-2(3)
arcuate ligaments
xyphoid process
rib 6-12
quadratus lumborum
psoas m.

Front 46

Ogilvie's syndrome (acute colonic pseudo-obstruction)

Back 46

severe abdominal distention
Post-op, severe illness, mild abdominal pain, narcotics/anticholinergics
massive dilation of cecum or right colon

Front 47

define ileus

Back 47

functional inhibition of propulsive bowel activity, regardless of the pathogenic mechanism...there is no physical obstruction to the passage of the luminal contents of the bowel.

Front 48

pathway of lymphatic drainage of the duodenum

Back 48

pancreaticoduodenal nodes -> gastroduodenal nodes -> celiac nodes or SMA nodes -> intestinal trunk -> cisterna chyli -> thoracic duct

Front 49

pathway of lymphatic drainage of the jejunum & ileum

Back 49

mesentaric nodes -> SMA nodes -> intestinal trunk -> cisterna chyli -> thoracic duct

Front 50

parasympathetic ganglions

Back 50

CN III, VII, IX, X
ciliary
sphenopalantine
otic
submandibular
submaxillary
cervical of uterus
myenteric (Auerbach's)
Submucosal (Meissner')

Front 51

major symptoms of acute inferior wall MI

Back 51

hypotension & bradycardia regulated by the vagal n.

Front 52

parasympathetic hyperactivity affects on the heart

Back 52

Right (to SA node) - sinus bradyarrhythmias
left (to AV node) - AB block
could be due to: dysfunction of occipitomastoid suture, OA, AA (C1) or C2

Front 53

Mondor's Syndrome

Back 53

cords that develop in the lateral chest wall from breast implants - cause lateral chest wall pain