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136 Cards in this Set
- Front
- Back
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What does G PTPAL stand for?
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gravidity
Parity - term - preterm - abortions - living children |
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What is Naegle's Rule?
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for estimated date of confinement/delivery (EDC) add one week to the FDLMP (first day of last menstrual period) minus 3 months
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Where should the fundal height be at 12 weeks?
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symphysis pubis
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Where should the fundal height be at 16 weeks?
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between the symphysis pubis and umbilicus
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Where should the fundal height be at 20 weeks?
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umbilicus
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Where should the fundal height be after 20 week?
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each cm above the symphysis pubis equal to one additional week.
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What percentage of women don't know their FDLMP?
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40%
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What does the first trimester US measure to try to determine fetal age?
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crown to rump length - accurate between (+/-) 1-7 days
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What does the second trimester US measure to try to determine fetal age?
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measures femur length - accurate to within (+/-) 7 days
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What is the accuracy of determining fetal age during 3rd trimester
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accurate to within 3 weeks
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When is fetal movement first felt?
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primigravid: at ~20 weeks
multigravid: at ~15 weeks |
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How often should fetal movements be felt?
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should be felt 10 times in a 12 hour period
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What is the average weight gain during pregnancy?
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25-35 lbs
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When does the CNS develop?
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formation starts at 2 weeks
(be on folic acid before getting pregnant!) |
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When can the heart beat be seen on US?
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6-7 weeks gestation
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When can the sex of the child be determined?
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16-18 weeks
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What are 3 major osteopathic considerations of pregnancy?
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1. change in structure and biomechanics as a result of developing fetus.
2. change in body fluid circulation 3. hormonal changes |
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What happens to overall CO during pregnancy?
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increases
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How much blood goes to the uterus?
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blood flow to the uterus must increase to about 1 L/min )20% of normal CO) at term
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Why is hemoglobin lowered during pregnancy?
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lowered by dilution, from about 13.3 to 12.1 g/dL
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What happens to GFR during pregnancy?
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increases
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What happens to BUN and creat during pregnancy?
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decrease
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How much does the thoracic circumference increase during pregnancy?
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10 cm
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What is HPL?
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human placental lactogen - placenta produces it
Maintains fetal glucose levels - associated with gestational diabetes |
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When is gestational diabetes screened for?
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during 26-28 weeks
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What increases the risk of getting gestational diabetes?
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obesity
fam hx of DM |
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What causes the ligament laxity that occurs for passage of the baby?
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relaxin is secreted by the corpus luteum
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What is the correlation of relaxin to LBP?
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the higher levels of relaxin, the greater the incidence of LBP
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What are the risk factors for LBP in pregnancy?
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multiparity
advanced maternal age previous history of LBP or trauma |
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Factors NOT associated with LBP in pregnancy?
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Race
Occupation Fetal weight/size pre-pregnancy weight previous epidural injectin exercise habits sleep position mattress type heel height weight gain |
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What causes the lower extremity edema in pregnancy?
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the IVC is compressed by enlarging uterus and leads to decreased venous return and distal LE venous stasis
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How much does body fluid increase in pregnancy?
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~6.5 liters
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What are some C/I's to OMT during pregnancy? Figure out causes to some of these things first...
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Undiagnosed vaginal bleeding
ectopic pregnancy placental abruption untreated DVT elevated maternal BP preterm labor unstable maternal vital signs fetal distress |
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What is the vescerosomatic reflexes for uterus and urinary bladder?
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T10-L1
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What are the viscerosomatic reflexes for ovary and fallopian tubes?
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T9-10
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What are the parasympathetics for pelvis?
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S2-S4
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Why might neonates have asymmetric musculoskeletal mechanichs?
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intrauterine forces or positioning
birth trauma |
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how many fontanels do babies have?
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6
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What are Synchondroses?
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hinges - cartilaginous connections of osseous components - turn into bone before adult life
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When does the SBS ossify?
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between 8 and 18 years
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When does the Sphenoid and Temporal bones ossify?
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first 2 years
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When does the occipital bone (originally 4 parts at birth) ossify?
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7-9 years
When fused form occipital condyles and hypoglossal canal |
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Should you use direct or indirect techniques in pediatric patients?
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indirect due to pliability of structures
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What is the rule for HVLA in children?
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no HVLA under 6 years
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What are 2 absolute contraindications for cervical HVLA?
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Down syndrome or RA
- due to odontoid ligament susceptible to rupture |
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What does APGAR stand for?
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Appearance
Pulse Grimace Activity Respiration |
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Which type of birth trauma hematoma doesn't cross the midline?
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cephalohematoma
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Which type of birth trauma hematoma crosses the midline?
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Caput seccundum
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Which neurological reflexes should be evaluated in an infant exam?
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Moro
Grasp Asymmetrical tonic neck DTR Plantar reflexes |
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By the first month of life, what milestones should be hit?
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makes jerky, quivering arm thrusts
brings hands within range of eyes and mouth moves head from side to side while lying on stomach Head flops backward if unsupported Keeps hands in tight fists, strong reflex movements |
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By 3 months of age, what milestones should be hit?
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Lifts head and chest when lying on stomach
turns head from side to side when lying on stomach follows a moving object with his eyes often holds hands open or loosely fisted Grasps rattle wiggles and kicks with arms and legs |
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By 6 months of age, what milestones should be hit?
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single syllable words 6 months
sits up unsupported shakes a rattle rolls over reaches for objects |
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By 9-10 months of age, what milestones should be hit?
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crawls and pull to stand
combine syllables at 9 months |
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By 12 months of age, what milestones should be hit?
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Drinks from a cup with help
Feeds themselves finger foods Knocks 2 blocks together Pull up to stand or take steps holding onto furniture Pincer grasp - picks up objects by using thumb, index or forefinger |
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By 18 months of age, what milestones should be hit?
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Walks without assistance
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By 20-24 months of age, what milestones should be hit?
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Combines 2 words
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By 24 months of age, what milestones should be hit?
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runs
walks up and down stairs alone |
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By 36 months of age, what milestones should be hit?
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alternates feet with stair walking, jump on step
walk on toes or hop 2-3 times |
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By 3 years age, what milestones should be hit?
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knows the parts of their own body
can draw a self portrait |
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What does molding after the first day of life mean?
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bone deformation with or without cranial base strain
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What is functional plagiocephaly?
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a distorted shape of infant's skull, due to molding of unfused sutures
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What needs to be ruled out when a child presents with functional plagiocephaly?
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synostotic plagiocephaly - prematurely fused and misshapen. This will show up on head circumference growth curve
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What are some causes of plagiocephaly?
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intrauterine position
birth trauma feeding and sleeping positions |
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What are the osteopathic findings in a plagiocephalic skull of a newborn?
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Lateral strain - parallelogram towards flat side
OA rotation towards flat side |
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What is the muscle imbalance seen in torticollis?
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SCM, Trap, and/or Scalenes
Rotated and sidebent opposite |
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What type of suckling do infants born at < 32 weeks gestation have?
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non-nutritive suck predominates
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What could be the cause of poor feeding in an infant?
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nerve irritation may affect suck or swallowing:
hypoglossal foramen with CN XII --> tongue muslce weakness - poor suck |
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What runs through the jugular foramen and what effect can that have on suckling?
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Jugular foramen gives passage to 95% of the venous drainage of the head and houses CN's IX, X, XI
Muscle weakness that coordinate sucking and swallowing |
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What might be wrong in an infant with GERD?
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Vagus nerve between the occiput and temporal bone through the jugular foramen.
Throacoabdominal diaphragm - esophagus motility and dysfunction |
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What are some specific techniques that can be used for GI issues?
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condylar decompression
Mesentery release |
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Where do the extraocular muscles originate from?
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sphenoid, frontal, and maxilla bones
(the sphenoid bones also house the cavernous sinus and the innervation of the EOMs) |
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What are some clinical signs that there is a craniofacial somatic dysfunction?
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myopia
hyperopia strabismus lachrymal duct stenosis |
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Where is the Eustachian tube narrowest?
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at junction of osseous and cartilaginous parts - though the petrosphenoid articulation
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When do ear structures (ET, EAC) mature?
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~ age 6
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What are some specific techniques used for Ear problems?
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Mandibular drainage of Galbreath
Sinus effleurage Ear pull |
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What is the most common cause of pneumonia in children?
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viral: RSV, influenza, parainfluenza
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List the top 4 common causes of pneumonia in children under 5 years old.
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Strep pneumoniae
M. pneumoniae Chlamydia pneumoniae H influenza (uncommon in immunized populations |
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What is included in the OMT evaluation for pneumonia?
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Upper thoracic vertebrae, ribs, and sternum.
T1-T5 to address sympathetics to the lungs. OA junction to address parasympathetics Accessory muscles of respiration Throracic diaphragm: phrenic nerve C3-5 from cervical plexus Chapman's reflexes for lungs, sinuses Cranial sacral mechanism, SBS compression |
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What is the leading cause of childhood ER visits, hospital admissions, and school absenteeism?
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Asthma
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What is the normal tone of the lungs?
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PNS dominant via vagus nerve
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What is the OMT evaluation for asthma?
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neuromuscular imbalance: a restriction of exhalation phase of respiration (stuck in inhalation), hypertonic accessory muslces of respiration (especially scalenes, SCM, QL, psoas) Flattened diaphragm
Increased lumbar lordosis T1-12 (esp T1-6) paraspinal tissue texture changes (hypertonic, swollen, tender) restricting rib cage excursion further. |
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What OMT can you perform on an asthmatic pediatric patient?
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Rib raising: start in thoracics T2-T6 include TL jxn
Diaphragm release Cervical, thoracic, lumbar: - OA, vagus - decrease parasympathetic hyperactivity Chapman's reflexes (lungs, sinuses, adrenals) Lymphatic pump (pedal or thoracic) Cranial sacral (CV4) |
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When should the pacifier be discontinued?
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by age 2
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If the baby had trouble breathing at first, where is the problem?
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suggests one or both temporal bones are not working in an integrated fashion - the PRM drives proper breathing in lungs/rib cage
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If the baby had difficulty learning to suck, where is the problem?
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space exists between the Ant 1/3 and Posterior 2/3 of condylar parts.
Hypoglossal Nerve (XII) passes within this space and can be compressed resulting in trouble suckling |
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Does your baby spit up or vomit after feeding? Where is the problem?
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compression of the vagus nerve at the jugular foramen in the occipital-mastoid suture which is ant and lat to the occ condylar parts.
Decompression of the condylar parts also helps this Can V spread from long diagonal of the head |
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Which suture is most often injured in boys?
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naso-maxilla suture (left) due to trauma - "my right handed friend hit me"
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What does sinus effleurage do?
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stimulates trigeminal centers
stroking moves the lymphatic fluid in superficial fascia |
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When you pull the ears up and out what are you doing?
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increasing external rotation
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When you pull the ears down and in what are you doing?
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increasing internal rotation
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What is the 2nd most common reason people present to primary care?
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LBP
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What is the lifetime incidence of LBP?
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80%
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What % of workers comp cases are related to LBP?
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33%
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What age group do most acute cases of LBP occur?
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20-50 years
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What is the most common cause of LBP?
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mechanical, muscle imbalance
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What are the alarm symptoms of LBP?
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Age >50
Prior cancer hx unexplained fevers, night sweats, weight loss pain lasting more than one month often intractable and unrelieved with rest no improvement following conservative therapy |
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When doing straight leg raise, how high do you raise the leg?
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between 20 and 60 degrees of flexion - because tight hamstrings can give a false positive
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What is the most common cause of discogenic LBP?
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irritation of a nerve root
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Describe the pain in discogenic LBP.
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Sensory is often affected first with motor function last
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Which is the most common type/location of a herniated nucleus palposus?
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posterolateral herniation is the most common overall and L4-L5 is most common vertebral disc
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What can you use to treat neuropathic pain that is unresponsive to opioids?
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TCA's and Gabapentin
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What % of 20-80 yo have bulging or protruding discs on MRI and are asymptomatic?
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52%
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What % of cauda equina is due to tumor?
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50%
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Describe the pain of spinal stenosis.
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chronically progressive
often B/L and poorly localized Pain radiates to buttocks, thighs, legs Worsened with extension (stand/walk) Improves with flexion (sit/stoop) Stopping ambulation may not improve sx, unlike vascular claudication |
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Describe the pain of PVD claudication.
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chronically progressive
other risk factors/vascular disease: smoking, DM, hyperlipidemia, FmHx U/L or B/L, poorly localized Worse with any LE exertion Stopping ambulation will improve (like angina) PE reveals diminished pulses and cap refill w/ cyanotic coole extremities |
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What is spondylosis?
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a degenerative disease of the spinal column, especially one leading to fusion and immobilization of the vertebral bones
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What is spondylolysis?
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a separation of the pars interarticularis of the vertebral arch
*stress fracture* |
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What is spondylolysis associated with?
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associated with hyperextension injuries. Pain is often worse with extension and compressive loads
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How is spondylolysis diagnosed?
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oblique view lumbar XR
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What is spondylolithesis?
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slippage of one vertebral body onto the next
Grades I thru IV |
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Describe the pain of facet joint syndrome.
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pain in the back, in the facet region, with no radiation below the knee.
pain is felt in the morning, upon rising, tending to lessen with physical activity. Painful motion especially with hyperextension Normal neurologic exam |
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What are the major muscles involved in acute and chronic LBP are?
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Psoas
Piriformis QL Erector Spinae Gluteal muscles Abdominal muscles Hamstrings |
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How is spondylolisthesis diagnosed?
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lateral x-ray
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How is spondylolysis diagnosed?
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oblique x-ray
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What is the Gold standard for diagnosis of herniated disc?
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MRI
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What is the etiology of an anterior innominate rotation?
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tight quads
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What is the etiology of a posterior innominate rotation?
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tight hamstrings
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What is the etiology of a superior pubic shear?
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trauma or tight rectus abdominus muscle
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What is the etiology of an inferior pubic shear?
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trauma or tight adductors
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What the S2 axis of the sacrum called?
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Respiratory and Craniosacral axis
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Describe the motion of the respiratory axis of the sacrum.
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Engaged by respiration.
Sacral base moves posterior during inhalation. Sacral base moves anterior during exhalation. |
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Describe the motion of the craniosacral axis of the sacrum.
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Engaged by respiratory motion on sacrum.
During craniosacral flexion, sacral base counternutates (moves posterior) During craniosacral extension, sacral base nutates (moves anterior) |
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What is the middle transverse axis of the sacrum?
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postural motion: mostion of the ilia in relation to the sacrum.
During flexion, sacral base moves posterior (sacrotuberous ligaments are taut) During extension, sacral base moves anterior |
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For a sacral shear, what does it indicate if the sphinx test is negative/findings improve?
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Unilateral flexion
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For a sacral shear, what does it indicate if the sphinx test is positive/findings worsen?
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unilateral extension
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Treatment for sacral flexion or extension includes the pt up on the elbows in the sphinx position?
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Unilateral extension
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How do you treat a unilateral sacral flexion?
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Abduct the affected leg to area of maximum relaxation of the SI joint.
Using the heel of your hand, induce a CEPHALAD and anterior force to the affected ILA as the patient INHALES deeply (this will bring the sacral base up) |
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How do you treat a unilateral sacral extension?
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Abduct the affected leg to area of maximum relaxation of the SI joint.
Have pt come up into sphinx position (flexes sacrum) Using the heel of your hand, induce a CAUDAD and anterior force to the affected sacral base as the pt EXHALES deeply (this will help to further flex the sacrum) |
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What is the only thing that changes for the technique of unilateral sacral flexion/extension to bilateral?
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abduct BOTH legs to area of maximum relaxation of BOTH SI joints.
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Unilateral/Bilateral sacral flexion....GO!
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Cephalad and anterior
Pt inhales pressure on ILAs |
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Unilateral/Bilateral sacral extension...GO!
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Caudad and anterior
Pt exhales pressure on sacral base |
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What is the viscerosomatic relfex for morning sickness?
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C2, T5-9
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What does sacral inhibition help with?
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to decrease severity of dysmenorrhea
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What does ischial tuberosity spread help with?
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urinary incontinence, hemorrhoids, and pelvic pain
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What does Thoracolumbar stimulation help with?
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to improve the quality of contractions in uterine dystocia or prolonged labor
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Where is the percussion applied in Thoracolumbar stimulation?
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T12-L2 for 1 minute every 15 minutes as the pt tolerates or until the desired effect is achieved (labor)
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