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100 Cards in this Set
- Front
- Back
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Plagiocephaly
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an unsymmetrical and twisted condition of the head, resulting from irregular closure of the cranial sutures
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When does the anterior fontanelle close?
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20 months
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What is the anterior fontanelle?
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junction of the frontal and parietal bones at intersections of the metopic, coronal, and saggital sutures
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What is the posterior fontanell?
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junction of the lambdoid and sagittal sutures
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When does the posterior fontanelle close?
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3 months
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craniosynostosis
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premature closure of the cranial sutures
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Bells palsy
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unlateral facial paralysis of sudden onset
unlateral LMN disorder of CN 7 |
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Which glands does CN VII supply?
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submandibular and sublingual glands
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Through which foramen does CN VII exit the skull?
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stylomastioid foramen
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Which eye disorders shows increased sympathetic tone in T1-4
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dilated pupil
photophobia narrow angle glaucoma |
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How do the parasympathetics to the eye affect vision?
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contraction from parasympathetic nerve shortens the focal point and affects vision
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What are the causes of nystagmus?
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congenital
secondary to vision loss medications MS nerve compression of CN III, IV, VI near tentorium |
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What is the parasympathetic innervation to the eye?
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ciliary ganglion via CN III (goes to ciliary muscle)
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Galbreath technique
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indicated for lymphatic congestion in the ENT or submandibular region, especially with dysfunction in the eustachian tubes
place cephalad hand under head caudad hand with 3rd, 4th and 5th fingertips along hte posterior ramus of the mandible and the hypothenar eminence along the body of the mandible have pt open mouth slightly press caudad hand on the mandible and draw it slightly forward at the TMJ and gently toward the midline. Apply pressure for 30 sec to 2 min |
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What is the treatment of choice for temporal arteritis?
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steriods to protect eyesight
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Which nerves supply autonomic innervation to the HEENT?
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CN 3, 7, 9, 10
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Ciliary ganglion
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oculomotor nerve (III) to ciliary muscles
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Pterygopalatine gangilon
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facial nerve (VII) to lacrimal gland/NP mucosa
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Submandibular ganglion
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facial nerve (VII) to salivary gland
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otic ganglion
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glossopharyngeal nerve (IX) to parotid gland
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Which nerves supply parasympathetics to the head?
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oculomotor nerve (III)
facial nerve (VII) glossopharyngeal nerve (IX) |
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To where does 85% of the venous drainage from the head go? Via which vessels?
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internal jugular
via the venous sinuses |
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Where do the lymphatics from the head?
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deep cervical nodes
pass through the thoracic inlet |
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Where does the right eustachian duct drain?
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at area of the right brachiocephalic or junction of right internal jugular and subclavian veins
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Where does the left eustachian duct drain?
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at the junction of the left internal jugular and subclavian veins
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Sphenopalatine (Pterygopalatine) Syndrome
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Red, engorged mucous membranes, photophobia, tearing and pain behind the eye, nose, neck, ear and temple
Caused by irritation of the sphenopalatine ganglion = from facial nerve (VII) |
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What is the treatment for Sphenopalatine Syndrome?
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Stimulation of the sphenopalatine ganglion = Muncie Technique
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Forward/Backward bending is in which plane and around which axis?
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sagittal plane
transverse axis |
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Rotation is in which plane and around which axis?
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horizontal plane
vertical axis |
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Sidebending is in which plane and around which axis?
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coronal plane
anterior/posterior axis |
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Where do afferent visceral and somatic nerves synapse?
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the dorsal horn of the spinal cord
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Name the three types of headaches
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1. Tension type = somatic dysfunction or myofascial pain
2. Migraine = with aura (classic = 35%) or without aura (common) 3. Cluster |
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Where does cranial nerve entrapment usually occur? Which cranial nerves are most commonly affected?
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under the petrosphenoidal ligament (formed by the tentorum cerebelli)
CN VI is closest to the dura = most likely affected Also, CN III, IV, VI |
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What are the signs and symptoms of cranial nerve entrapment?
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blurred vision
diplopia nystagmus eye fatigue headache medial strabismus (CN VI) |
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What are the most common causes of EOM dysfunction?
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diabetes mellitus
aneurysm somatic dysfuction |
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Describe true visceral pain and viscerosomatic pain in appendicitis
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true visceral pain = initially referred pain and cramping is sensed in the periumbilical region
viscerosomatic pain = chapman reflex point at tip of 12th rib on right |
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Describe true visceral abdominal pain
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early pain from irritation, stretching, contraction of exaggerated physiologic motor activity and dysfunction
midline pain poorly localized described as vague, deep, diffuse burning ache |
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Describe vsicerosomatic abdominal pain
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facilitated cord segments causing hypersympathicotonia and paraspinal somatic changes, joint SD, dermatome hyperalgesia in somatic areas related to the vicera's sympathetic innervation
well localized asymmetric aggravated by jarring motions may be added to the visceral pain pattern or overwhelm and mask it |
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Are chapman points an example of true visceral or viscerosomatic pain?
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viscerosomatic pain
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sinuses chapman points
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anterior points = lie 7-9 cm lateral to the sternum on the upper edge of the second rib
posterior = upon C2 midway between the SP and tip of the TP |
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pharynx chapman points
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anterior = lie upon the first ribs 3-4 cm medial to where the ribs emerge from beneath the clavicles
posterior = upon C2 midway between the SP and the tip of the TP |
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Larynx chapman points
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anterior = lie upon the second ribs, 5-7 cm lateral to the sternocostal junction
posterior = upon C2 midway between the spinous process and the tip of the TP |
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Tonsil chapman point
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anterior = between the first and second ribs adjacent to the sternum
posterior = midway between the SP (posterior tubercle) and the tip of the TP |
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middle ear chapman points
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anterior = the superior anterior aspect of the clavicles just lateral to where they cross the first ribs
posterior = the posterior aspect of the tips of the TP of C1 |
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Eye (retina/conjunctive) chapman points
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anterior = anterior aspect of the humerus at the level of the surgical neck
posterior = the squamous portion of the occipital bone below the superior nuchal line |
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Where is vertex pain felt during temporal headaches?
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SCM (sternal)
spelius capitus |
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Where is occipital pain felt during temporal headaches?
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SCM (both)
Semispinalis Multifidus suboccipitals |
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Where is temporal pain felt during temporal headaches?
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trapezius
SCM (sternal) temporalis |
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Where is frontal pain felt during temporal headaches?
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SCM (both)
Frontalis (supraorbital pain) |
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Which two bones make up the occipitomastoid suture?
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the occipital bone and the mastoid portion of the temporal bone
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Dyfunctions in the sphenopalatine ganglion (sphenoid, palatine or maxilla) can cause which symptoms? why?
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excessive tear production and profuse thin secretions from the mucosa of the nasopharynx and sinuses
due to parasympathetic hyperactivity = parasympathetics from CN VII pass through and synapse in the sphenopalatine ganglion (in the pterygopalatine fossa) |
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From where do the structures of the head and neck receive their sympathetic innervation? Where do these fibers synapse?
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cell bodies located at T1-T4
they synapse in the upper thoracic region and/or cervical sympathetic ganglion |
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Where are the superior, middle and inferior cervical ganglion located?
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superior = C2
middle = C6 inferior = C7 |
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What does increased sympathetic tone in the head and neck area lead to in the nasopharyngeal and head areas?
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photophobia
tinnitus unsteadiness vasoconstriction = decreased blood flow and lymphatic and venous drainage to the head and neck, as well as decreased immune function thick and sticky nasal and pharyngeal secretions from increase in goblet cells in the nasal epithelium inhibits secretion = dryness of the nasopharyngeal mucosa --> leads to secondary bacterial infection |
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What does increased sympathetic tone to the eye lead to?
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dilation of the pupil (mydriasis) --> elevates intraocular pressure in patients with narrow angle glaucoma.
may be associated with lens cloudiness |
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Which sinuses are absent at birth?
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frontal and sphenoid sinuses = develop during childhood and adolescence
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Which nerves innervate the sinuses?
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branches of the trigeminal (V1, V2)
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To where do the frontal sinuses drain and which nerve innervates them?
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drain to the middle meatus
innervation = supraorbital nerve (V1) |
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To where do the ethmoid sinuses drain and which nerve innervates them?
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drain to the superior and middle meatus
innervation = branches of ophthlamic nerve (V)1 |
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To where do the sphenoid sinuses drain and which nerve innervates them?
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drain into the sphenoethmoidal recess (in close approximation to the cavernous sinuses)
innervation = posterior ethmoid nerve (V1) |
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To where do the maxillary sinuses drain and which nerve innervates them?
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drain to the middle meatus
innervation = maxillary nerve branches (V2) |
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In which bone do most of the structures of the ear reside?
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temporal bone
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What does internal rotation of the temporal bone lead to?
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either partial or complete closure of the eustachian tube
impairs drainage and establishes a medium for recurrent middle ear infections **use pterygopalatine fossa decongestion and galbreath techniques to help |
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In which portion of the the temporal bone is the vestibular apparatus found?
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the petrous portion of hte temporal bone
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What can internal or external rotation of the temporal bone lead to (temporal bone dysfunction)?
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can alter the normal position and function of the vestibular apparatus and contributes to vertigo and balance abnormalities
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What causes a high-pitched ringing in the ears (tinnitis)?
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internal rotation of the temporal bone (partially closes the eustachian tube and increases pressure)
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What causes a low-pitched roar in the ears?
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external rotation of the temporal bone (opens the eustachian tubes)
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Which muscle usually controls the opening of the ET? Which technique can help it to do it's job better?
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tensor veli palatini
relaxation of the pterygoid muscle through mandibular drainage |
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Characteristics of tension headaches
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bilateral
fullness, tightness or pressure sensation in the forehead, temporal area or back of the head or neck (especially suboccipital area) band-like sensation around head not usually associated with nausea or vomiting |
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Characteristics of migraine headaches
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unilateral
throbbing, pounding pain can radiate to the opposite side with or without aura nausea, vomiting, diarrhea, dizziness, tremors, photopobia, phonophobia, sweating and chills scotomas (blind spots in eye) photopsia (flashing lights) parasthesias (abnormal sensations) visual, olfactory and auditory hallucinations syncope |
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Characteristics of Cluster headaches
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occur in series or groups lasting several weeks to several months followed by pain-free intervals
unilateral excruciating, boring sensation behind or around one eye conjunctival erythema, tearing, nasal congestion, rhinorrhea, partial Horner Syndrome = sweating and flushing on the same side of face |
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Which type of OMT technique is used to best treat Bells Palsy?
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indirect technique
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What makes up the TMJ?
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formed by the head of the mandible and the mandibular fossa of the temporal bone
separated by a fibrocartilaginous articular disk stylomandibular ligament (angle of the mandible --> styloid process of the temporal bone) sphenomadibular ligament (medial aspect of the mandible to the spine of the sphenoid bone) |
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What is oligemia?
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a deficiency of blood in the body or any organ or tissue
can cause migraines |
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What can precipitate trigeminal neuralgia? Which nerve is it associated with?
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TMJ dysfunction
problems of occlusion or poor-fitting dentures Associated with V3 |
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What is the first thing that you do to lymphatics?
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open the thoracic inlet first
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Anterior rib counterstrain points
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EXHALED RIBS
R1 = first rib where it articulates with the manubrium R2 = on the second rib in the midclavicular line R3-6 = on the numbered rib in the anterior axillary line |
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Posterior rib counterstrain points
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INHALED RIBS
R1 = at the cervicothoracic junction, anterior to the trapezius R2-6 = superior surface of rib angles |
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What is the asthma reflex?
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T2
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What is the bronchial mucosal reflex?
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T3-4 usually rotate right
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What causes BPPV?
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small crystals of calcium carbonate (canaliths) from the utricle that collects within the inner ear
younger people = head injury older people = cause of vertigo in 50% of causes |
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What is the second most common cause of dizziness/vertigo in older persons?
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overmedication by prescription drugs
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What is "top shelf vertigo"?
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When BPPV is precipitated by a change in head position, particularly by looking upward
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How can you tell the difference between orthostatic hypotension or med ovedose from BPPV symptoms?
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orthostatic hypotension and med overdose causes dizziness or vertigo when the pt stands up
BPPV symptoms occur when a person lies down or puts their head back |
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What is the best treatment for BPPV?
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canalith repositioning procedure (CRP) = Epley maneuver
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Ranson criteria
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Acute stage:
- age > 55 y - WBC > 16,000 - blood glucose > 200 - Serum LDH > 350 - SGOT (AST) > 250 Within first 48 hours: - Hematocrit falls > 8 - BUN increases > 8 - Serum calcium < 8 - Arterial oxygen saturation < 60 - Base deficit > 4 - estimated fluid sequestration > 6 liters |
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What do you do first when treating an asthmatic patient?
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treat parasympathetics first!!
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How do you lock out lower vertebrae when doing cervical HVLA?
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SB and rotate to opposite side
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What is the goal of occupational medicine?
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prevent disability
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What is the difference between impairment and disability?
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Impairment – The loss and/or abnormality of a structure or function. It may be mental, emotional, physiological or structural
Disability – The inability or limitation in performing activities and roles expected of individuals within a social or physical environment |
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What is the difference between exacerbation and aggravation?
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Exacerbation = A temporary increase in symptoms from the underlying condition, a flare of symptoms
Aggravation = Implies a long-standing effect due to an event, resulting in a worsening or deterioration of the condition that has an ongoing substantial impact on the physical condition |
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What is apportionment?
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the act of attributing % of an injury or illness to a particular cause
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Where do the varios branches of CN V exit the skull and to which sinuses do they project?
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V1 = superior orbital fissure; supplies ethmoid sinus
V2 = foramen rotundum; supplies maxillary sinus V3 = foramen ovale; goes through inferior fissure through ptergopalatine fossa; referrs pain from sinusitis (i.e. to the teeth) |
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What is the answer to question number 100?
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Respiratory cooperation
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What is the cardiac reflex?
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C6, T2, T6
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What is the upper GI reflex?
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C2 left
T3 right T5 left T7 right |
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How is FPR performed?
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Start in neutral
Apply compressive force put patient in the position of ease (indirect technique) hold for 3-4 sec return to neutral |
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Reciprocal inhibition (indirect)
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if biceps muscle is in spasm, fully flex the elbow (the way it likes to go)
have pt contract triceps against resistance isometric force allows biceps muscle to relax and return to resting state |
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Reciprocal inhibition (direct)
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if biceps muscle is in spasm, fully extend the elbow (the way it doesn't like to go)
have pt contract triceps against resistance isometric force allows biceps muscle to relax and return to resting state |
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Which foramina are are painful in sinusitis?
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supraorbital foramen for frontal sinus
infraorbital foramen for ethmoid and maxillary sinuses |
