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83 Cards in this Set

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Causes of pediatric somatic dysfunction?
Rapid Growth
Asymmetric muscular mechanics
Malposition
Molding
(and trauma although it wasn't on the list)
Define synchondrosis
Cartilaginous connections of osseous components turn into bone before adult life
When does SBS ossify?
Between 8 and 18 years of age
When do sphenoid and temporal bones ossify?
By age 2
How many parts of the occipital bone are there at birth and when do they ossify?
4 bones at birth
Ossify between 7 and 9 years of age
So if all of the cartilaginous joints of the pediatric skull are turned to bone by adulthood, why did we spend a whole quarter on Cranial Manipulation?
Bones are moveable remember. Like the frontal bone and it's imaginary metopic suture where no suture ever existed. it's bendy.
What creates a template for growing bones in the skull
Dural membrane
What are the roles of the dural membrane in pediatric development?
1 creates template for growing skull bones
2. "plays an important role in transmission of intracranial forces" (I don't know what this means)
3. Provides a pathway for venous sinuses and cranial nerves
Very young tissues are ________
Malleable

Unlike adults, children's bones actually do bend, which is why kids can get up and walk away from falls and accidents that would leave old farts like me in traction.
Why practice OMT on a child?
1. To decrease physical discomfort (DEcrease. Not INcrease)
2. To improve function
3. To ultimately affect structure (which you can't do much of in adults)
No HVLA in children under ____ years old!
6
When should a baby be able to lift head and chest while lying on stomach?
By 3 months (often happens sooner, but if it hasn't happened by 3 months, consider contacting the manufacturer to discuss your warranty)
By what age should a baby be able to follow a moving object or person with his eyes?
3 months
By what age should a baby be able to use single syllable words?
6 months.
Preferably "Da" "Da-Da" "Ma-Ma" "yes" "please" or even "pee-pee" bc at least that's telling you something, but the favorite one syllable word is most likely going to be "NO!"
Still that's a lot better than some other one-syllable words that our testing schedule makes me think of.
When should a child be able to sit up unsupported ?
6 months
By what age should a child be able to crawl and pull himself up to standing position?
10 months
When should a child be able to take steps holding onto furniture like the coffee table or the couch, a.k.a. "cruising"
12 months
When should a child be able to grasp things between thumb and forefinger, a.k.a. The pincer grasp?
12 months
By what age should a child be able to walk without assistance?
18 months
By what age should a child be able to combine two word sentences?
20-24 months
By age 3, what are some of the things a child should be able to do?
Hop. Climb stairs like a normal person. Know the parts of their body (and talk about them openly to strangers). Draw a self portrait (don't expect DaVinci here. We're talking a circle with eyes, a mouth, two sticks for arms and two sticks for legs. )
When should a child be able to roll over on his own?
6 months.
Once they start rolling over, assume they are mobile. They will no longer be in the same place they were when you set them down and went to the bathroom or answered the phone. They don't have to be able to crawl to get across a room. They learn quickly that they can just keep rolling.
At what age should a child be able to run?
24 months

At this point, you might be thinking that these age milestones seem kind of high. It's true. Most kids do these things well ahead of the milestone markers. The markers are there to catch early dysfunction so that docs can discuss early intervention before developmental delays become lifelong occupational challenges.
Is it okay if I encourage my child to walk before he crawls?
No. "each step is essential in the development of integrated coordinated cerebral function."
If you teach your child to walk before he can crawl, talk before he can think, he'll drive before he can run, and wind up as the deadbeat boyfriend on Teen Moms because he did something else before he was supposed to....
During vaginal births, most babies have their heads squished and misshapen. This is called "molding." When does this correct itself?
Within hours after birth.
Babies that have not corrected this problem on their own within the first 24hrs of life, are considered "deformed" and should probably be sold to a circus freak show.
What is a fancy medical word for "weird shaped head" with or without dysfunction?
Plagiocephaly
Causes of Plagiocephaly?
Intrauterine position
Birth trauma
Feeding and sleeping positions
Tortucullis
What can be done about plagiocephaly?
1. Parental reassurance - "No need to worry, Mr. and Mrs. Brooks, this is a very correctable deformity."
2. OMT - "I just put one hand on either side of the infant's cranial sutures and squeeze it back into shape like THIS... Trust me. I'm a doctor."
3. Encourage tummy time - while child is awake. Sleeping on stomach is thought to be a contributing factor to SIDS.
Why is Tortucullis associated with cranial dysfunction of occipital and temporal bones?
Both bones act on CNXI - the Accessory Nerve - which innervates SCM and Trapezius.
If a child is having trouble suckling, what cranial nerve is most likely involved?
What others might be involved?
CN XII - hypoglossal is most associated
CNs IX, X, and XI may also be involved
How does impingement on CN XII affect suckling response?
Innervates tongue muscle. A weak tongue = a weak suck
How do CNs IX, X and XI affect suckling?
Innervate muscles that coordinate swallowing
What OMT techniques might help a baby who isn't latching and feeding well?
"First decompress condylar parts to restore Neuro-integration
then teach the child to suck" (I'd comment here but it's just too obvious)
How does condylar decompression improve an infants GERD issues?
May free up vagus nerve between occipital and temporal bone through the jugular foramen
OMT tecchniques for pediatric URI?
Galbraith maneuver on mandible
Sinus effleurage
Ear pull (for OM)
What is the most common cause of childhood pneumonia?
Viral infection.
Can OMT cure this?
No. But it can speed up healing process
Leading cause of childhood ER visits?
Asthma
Which nerve is "hyperactive" in asthma?
Vagus, baby. Vagus.
What position are the ribs usually stuck in for asthma patients?
Stuck in inhalation. I.e. restricted in exhalation
Which muscles are usually hypertonic in asthma patients?
Accessory respiratory muscles

Not good enough. What are the names of the muscles?
Scalenes
SCM
QL
Psoas
Which OMT treatment for asthma is designed to balance sympathetic and parasympathetic nerves?
Rib raising
Which ribs are you raising to treat a seated asthma patient?
T2-6 and thoracic-lumbar junction
After you've raised the ribs, what other treatments should you give your asthma patient?
Diaphragm release
And anything else you want to bill for
When in doubt, do a C4, UNLESS __________
Patient is pregnant and not to full term yet
Why?
Because evidently the C4 is so miraculous that it may actually induce labor... It can also stop labor. So if you accidentally induce labor with a C4, try doing another one to stop it.
Newborn infant with problems breathing suggests problems with ____________.
One or both temporal bones.
Why?
Primary Respiratory Motion drives proper breathing in lungs and rib cage
V spread fixes vomit
No question here. Just interesting correlation. V spread fixes Vomit.
Esotropia, or Strabismus, is caused by problems with which cranial nerve?
CN VI.
An unopposed medial rectus with a dysfunctional lateral rectus (CN VI) leads to Esotropia
Where do the anterior cervical lymph nodes enter the thoracic cage?
Under Rib 2
Which of the following is "age-related treatment" for pediatric URI?
A. CV4
B. Rib Raising
C. Galbraith Manuever
D. Ear Pull
E. Sinus Efflurage
D. Ear Pull
It is age related in that the patient must be old enough to be able to hold still while doing the treatment
What is the goal of the Ear Pull treatment?
Which direction do you pull?
Goal is to balance the temporals.
Pull up and out to increase internal rotation/extension
Pull down and in to increase external rotation/flexion
Where/what are the "four diaphragms"
Abdominal Diaphragm
Thoracic inlet (cervical-thoracic junction)
Pelvic diaphragm
OA
True or false?
Peds pts can be treated more frequently & and respond quicker than adults
True
Savarese board pearl
Most common cause of discogenic LBP?
A. Herniated NP of L4-L5 IVD
B. Herniated NP L5-S1 IVD
C. Cauda Equina syndrome
D. Nerve root irritation due to somatic dysfunction
D. Nerve root irritation due to somatic dysfunction

Although L4-L5 IVD is the most common herniated disk, slipped discs only account for 4% of LBP complaints. Muscle imbalance, aka somatic dysfunction, can also cause nerve root irritation and is a far more common cause for LBP complaint (70%)
MCC of LBP in patients over 60?
Spinal stenosis
Differentiate spinal stenosis symptoms from vascular claudication
Both are chronically progressive, can be uni- or bilateral, and radiate to buttocks, thighs, but pain with SS may not improve by stopping ambulation. Pain from claudication is aggravated by lower extremity exertion and will often improve once patient stops walking
A narrowing of the spinal canal
Spinal stenosis
Slippage of one vertebral body onto the next
Spondylolithesis
Separation of pars interarticularis of the vertebral arch
Spondylolysis
A degenerative disease of the spinal column, especially one leading to fusion and immobilization of the vertebral bones
Spondylolyis
Graded by severity of vertebral displacement
Spondylolithesis
How to you confirm diagnosis of spondylolysis?
Oblique lumbar X-ray
How to confirm diagnosis of spondylolithesis?
Lateral lumbar X-ray
Pt complains of muscle spasms in his lower back. Pain is worse in the morning and lessens with physical activity. It is worse in extension and does not radiate. Neuro exam is normal. Most likely initial diagnosis?
Facet joint syndrome
Gold standard diagnosis for disc herniation?
MRI
Deep sacral sulcus contralateral to posterior ILA
Torsion
Deep sacral sulcus ipsilateral to posterior ILA
Shear
Deep sulcus R
Post. ILA L
Positive spring test
Left on Right sacral torsion
FDLMP = 4/4/12
Using Naegles rule, what is estimated date of delivery?
1/11/13
In which trimester is US crown to rump measurement used to estimate gestational age?
First trimester
In which trimester is US femur length used to estimate gestational age?
Second trimester
In which trimester is US estimate of gestational age most accurate?
First trimester
Once fetal movements are felt, how often should mom feel them?
10 times every 12 hours
How much does CO increase by wk 6 of gestation?
30-50%
Cause of edema and clots in pregnancy?
IVC compressed by uterus/baby
Causes decrease venous return and distal venous stasis
Why do prego women get CTS?
Increased fluids In body
Up to 6.5 L increase
CI for OMT during pregnancy
Undoagnosed vaginal bleeding
Ectopic pregnancy
Placental abrupt ion
Untreated DVT
Elevated maternal BP
Preterm labor
Unstable maternal vital signs
Fetal distress
OMT for dysmenorrhea
Sacral inhibition
OMT for hemorroids
IT spread baby
Risk factors for LBP during pregnancy
AMA
Multiparity
Previous hx
Why is right lateral recumbent position uncomfortable during preg
IVC gets compressed
Which HVLA technique is okay to use on prego pt?
Kirksville crunch
What OMT technique is contraindicated in preterm labor
All of them
She specifically said this about CV4, but she also said that OMT is CI during preterm labor
What does Feet on Wall technique help?
Morning sickness