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244 Cards in this Set
- Front
- Back
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What represents 2-3 % of all cancers?
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Renal
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What is the classic triad of Renal Cx?
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Hematuria, Abdominal Mass, Flank Pain
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What are some systemic manifestations w/ Renal Cx?
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Anemia, FUO, Weight Loss, HyerCALCEMIA
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What is the MOST common cx?
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Lung Cx
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What is responsible for 80-85% of lung and laryngeal cancers/
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Tobacco
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What is resonsible for 30% of ALL Cancer deaths?
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Tobacco
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What type of Lung Cx is most aggressive?
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Small Cell (Oat)
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Small Cell Cx = what altered CNS fxn?
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Endocrine Syndromes
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Osteoarthropathy= what altered CNS fxn?
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Adenocarcinoma
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What is the most common primary tumor of medullary bone?
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Mulitple Myeloma
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What cx is commonly overlooked in the pt. with back pain?
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Mulitple Myeloma
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What cx appears to have diffuse osteoporosis pattern on xray?
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Mulitple Myeloma
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What amount of pts. Complain of bone pain w/Multiple Myeloma?
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2/3 of them
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What is the most common complication seen w/ Multiple Myeloma?
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HyperCALCEMIA
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What is assoc. with Multiple Myeloma and has symptoms of HA, vertigo, fatigue, nystagmus, paresis, etc?
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Hyperviscosity Syndrome
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What is the Tx for Hyperviscosity Syndrome?
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Plasmapheresis and chemo
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What are the terminal events of Multiple Myeloma?
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Infxn and Renal Failure
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What is the prevalence of Breast Cx?
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more than 2/5 million
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_________ % primary site is where diagnosis is made.
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60%
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15-35% of women with masectomies have ____________________.
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Lymphedema
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Chronic Lymphedema can lead to ______________ and _________________.
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Tissue Fibrosis and Infections (cellulitis)
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Disproportionate Pain levels and atypical arthritis in kids we think _________________.
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Cx
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What OMT is recommended for acute illness or advancing age?
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Indirect
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What OMT is recommended for a stable pt when metastasis has been ruled out?
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Direct
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What OMT is recommended for atelectasis or constipation?
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Rib raising/thoracolumbar soft tissue
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What OMT is recommended for Lymphedema?
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Fascial diaphragms then lymphatic pumps
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What is the main motion of Thoracics?
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Rotation
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What limits rotation of Thoracics?
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Ribs
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What ribs have the greatest motion?
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Floating
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What plane do facets rotate in?
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Coronal
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What is a transitional thoracic segment that is vulnerable to trauma?
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T12
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Upper facet of T12 is in what orientation?
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Coronal
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Lower facet of T12 is in what orientation?
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Sagittal
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Shortened Pec Muscles, think?
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Rhomboid Major/Minor
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Pain along vertebral border of scapular and in supraspinous fossa?
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Rhomboid Major/Minor
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Pectoralis pain and Interscapular Pain?
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Trapezius M
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What are 7 Tachycardia etiologies?
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Pain, Anxiety, Fever, Cardiac Ischemia, CHF, Acute Gout, Hypersympathctonia T1-4, R1-4
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Thyrotoxicosis is an etiology for what?
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Tachypnea
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Poor Diaphragmatic Mtion is due to SD of _____________.
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C3-5
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What somatic dysfxn is seen with Tachypnea?
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SD C3-5 causing poor diaphragmatic motion
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When would you hear a pericardial frxn rub and pleural frxn rub?
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Rib Fx
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What OMM is done for Rib Fx?
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tx opposite side and diaphragm and tx c3-5 SD
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When will you see Hepatic/Splenic Enlargement or Tenderness?
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Costal Cartilage Fx
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What imaging is done for Costal Cartilage Fx?
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Chest X ray and Bone Scans
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What could be done for hepatic/splenic injury?
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Peritoneal Lavage
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What presents with persistent pain at the lower ribs posteriorly?
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Cough Fx
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what are the VS of Cough Fx?
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Fever and Rapid Respiration
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What does early pneumonia sound like?
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suppressed breath sounds
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What does later pneumonia sound like?
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bronchial breathing and crepitant rales
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what does bronchitis sound like?
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moist rales
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Percussion of Pneumonia?
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dullness
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Percussion of Bronchitis?
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NO dullness
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Pain w/deep inhalation?
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Cough Fx
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Restricted Diaphragmatic Breathing?
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Cough Fx
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What imaging is done for Cough Fx?
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Chest X ray and Bone Scans
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What OMT is for Cough Fx?
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Indirect
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What presents with pericarditis, CHF and cardiomyopathy?
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Scleroderma
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What presents w/Renal Probs?
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Scleroderma
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What what do you hear bibasilar rales and the patient has exertional dyspnea?
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Scleroderma
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What is assoc. with Carpel Tunnel Syndrome?
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Scleroderma
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Diffuse pain with pressure over sternum?
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Chest Wall syndrome (also shoulder and cervical spine pain)
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What presents with sharp 1-3 min. pain?
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Intercostal Muscle Spasms
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What are some tx options for Intercostal Muscle Spasms?
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OMM, Intercostal N Block, Trigger Point Injxn, Analgesic, and Muscle Relaxants
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What presents w/ pain with respiration, fascial nodularity, and tender intercostal space?
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Intercostal Myositis
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What are the tx options for Intercostal Myositis?
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OMM-Indirect, NSAIDS, Corticosteroids
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What is a pain in the anterior chest wall that is assoc. with rib dysfxn?
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Costochondral Pain
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What are the tx options for Costochondral Pain?
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OMM to correct rib dysfxn, counterstrain, Analgesics, Cortico injxn
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What presents with dull pain and aggrevated shoulder motion?
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Costochondritis
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Where will you have Costochondritis?
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symm. 3, 4, 5th Costochondral Joints
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What are the tx for Costochondritis?
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OMM-rib dysfxn, Lidocaine Patch, Corticosteroids
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What is a fusiform swelling of costal cartilage? (asymmetric 2nd and 3rd)?
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Tietz Syndrome
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What are some tx options for Tietze Syndrome?
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OMM (segmental dysfxn, thoracic pump, splenic stimulation), Lidocaine Patch, NSAIDS, Corticosteroids
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What is an inflammatory cause of Respiratory Pain?
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Costochronditis
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What are 2 causes of Osteomyelitis?
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Staphylococcal and Tuberculosis (Pott Dx)
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Burns, Sugical Scasrs, Adhesions and Lacerations can cause what?
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Cicatrix
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What are 2 causes of Loss of motion due to Atrophy or Myopathy?
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Post Polion Syndrome and Inclusion Body Myositis
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What are 2 syndromes assoc. with IBS?
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Crohn Dx and Ulcerative Colitis
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What is a Connective Tissue Dx that can cause a loss of motion?
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Scleroderma
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What are 3 ex. Of Spondyloarthropathies?
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Ankylosing Spondylitis, Psoaratic Arthritis, and Arthritis assoc. with bowel dx
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What is another name for Pectus Excavatum?
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Cobbler Chest
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What 2 dx would put you at risk for developing a Pectus Excavatum?
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Rickets and Marfans
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What deformity do you see Congenital Heart Dx and severe Kyphoscoliosis?
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Pectus Carinatum
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What are 3 reasons why a pt might develop Harrisons Grooves?
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Familial, Rickets, and Protubertan Abdomen during development
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What are 2 causes of a Barrel Chest?
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Kyphosis and Pulmonary Emphysema
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What is the congenital etiology of Arcuate Kyphosis?
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Anterior Failure of Segmentation
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What Neuro Dx is an etiology of kyphosis?
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Polio
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What are the 3 main reasons for an Acquired Kyphosis?
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Weak Paraspinal Muscles, Postural Collapse, Increased Lumbar Lordosis
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What is the Congenital reason for developing Angulate Kyphosis?
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Failure of Vertebral body formation
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What kind of trauma would result in Angulate Kyphosis?
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Compression Fx
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Tuberculus Osteomyelitis (Potts Dx) is assoc. with what type of Kyphosis?
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Angulate Kyphosis
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Osteogenesis Imperfecta is assoc. with what type of Kyphosis?
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Angulate Kyphosis
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Metastatic Cx is assoc. with what type of Kyphosis?
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Angulate Kyphosis
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What are 2 exercise options for kyphosis treatment?
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Kyphosis extension and abdominal Strengthening
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What percent of patients withmyocardial infarction also have concomitant chest wall pain?
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15%
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Symmetric polyarthritis similar to RA is a symptom assoc. with what syndrome?
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Scleroderma
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What dx presents with Increased Kyphosis, rigid thoracic spine, and xray findings of irregular endplates and vertebral wedging?
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Scheuermann Dx
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What are the 3 main causes of Atraumatic Respiratory Pain?
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Chest Wall Syndrome, Inflammatory, and Infx
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What presents with tenderness at the Serratus Anterior attachments?
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Intercostal M Spasms
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What is a post viral syndrome that is commonly seen before the age of 40?
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Tietz Syndrome
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What causes tenderness at the cutaneous branches of the Intercostal N?
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Intercostal Neuralgia
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When is the highest incidence in life to develop Herpes Zoster?
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60-80 years
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what % of Patiets wil endure a second round of Herpes Zoster in their life? :(
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2%
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Herpes Zoster most commonly affects where?
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T3-L3 dermatomes
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How long till Herpes Zoster vesicle form?
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3-5 days
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How long does a pt have Herpes Zoster?
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7-10 days
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What is the OMT tx for Herpes Zoster?
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Tx Segmental Dysfxn and Costal Dysfxn at rash level. (Prevents Post-Herpetic Neuralgia, so a good thing). Also Thoracic and Splenic Pump.
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What is the tx for Herpes Zoster?
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FAV---- Famcyclovir, Acyclovir, Valacyclovir; for pain give opiates, Lidocaine Patch, Nortriptyline, and Glucocorticoids
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What is the tx for Post Herpatic Neuralgia?
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Antiseizure Meds (Gabapentin, Topiramate, Lamotrigone)
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what presents with a knife like, shooting pain, fever and a CBC with Leukocytosis?
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Pleurisy
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Periphery of Diaphragm is innervated by what?
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T6 nerve root
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Patients with Diaphragmatic Pain also sense pain where?
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lateral neck and shoulder (about C4, C5, T1-5)
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What is the Devil's Grip?
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Epidemic Pleurodynia (aka Bornholme Dx)
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What presents with severe paroxysms of thoracic and abdominal pain?
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Epidemic Pleurodynia (aka Bornholme Dx)
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Severe thoracic and Abd. Pain, fever, HA and mild pharyngitis, what is your diagnosis?
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Epidemic Pleurodynia (aka Bornholme Dx)
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What is the etiology of Epidemic Pleurodynia?
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Coxsackie Virus Group B and Echo Virus
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What are 2 possible complications to having Epidemic Pleurodynia?
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Pericarditis and Orchitis
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What presents with such severe pain that often pt. end up in the ICU with a diagnosis of myocaridal Infaction or dissecting aneurysm?
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Epidemic Pleurodynia (aka Bornholme Dx)
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How do you diagnose Epidemic Pleurodynia?
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Viral Titres
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What are 6 possible reasons to develop Intercostal Neuralgia?
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Tabes Dorsalis, Neoplasm, Pott Dx, Neurofibromatosis, Fx Callous, and Herpes Zoster
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What is a sensory neuropathy involving one of the dorsal cutaneous rami of the upper thoracic region?
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Notalgia Paresthetica
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What are 4 symptoms seen with Notalgia Paresthetica?
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Pruritis, Dysesthesia, Hyperesthesia, and Skin Hyperpigmentation
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What would you treat with Botulinum Toxin Injxns, Anticonvulsants meds, and transcutaneous electrical N stimulation?
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Notalgia Paresthetica
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What presents with peripheral stretch neuropathy due to weight of rolls of hanging fat?
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Dercum Dx
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what is another name for Dercum Dx?
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Adiposa Dolorosa
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What is painful obesity?
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Dercum Dx
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What is thrombophlebitis of the Thoracoepigastric V?
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Mondor Dx
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What dx runs in the anterior lateral abdomen and thorax from the Femoral V to the AxillaryV?
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Mondor Dx
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What is a potential complication following mastitis, breast and abdominal surgeries?
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Mondor Dx
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What is the cause of Rachitis Rosary?
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Rickets (healing obliterates the costochondral knobs)
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What is a "Funnel Breast" or "Trichterbrust"?
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Pectus Excavatum
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What is found assoc. with coexsisting MV prolapse and 27% of women with MAC have it?
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Pectus Excavatum
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What is aka Pigeon Breast?
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Pectus Carinatum
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What is a test for compression btwn scalenes?
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Adson's Test
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What is a test for compression btwn Pec Minor and Upper Ribs?
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Wrights test
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What is the Arm HYPERextension test?
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Wrights test
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What is the Military Posture Test?
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Costoclavicular Syndrome test
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What is the test for compression btwen the clavicle and the 1st rib?
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Costoclavicular Syndrome test
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What is known about C8 in 54% of the TOS cases?
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nerve root stimulation below normal
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What is the best imaging for Thoracic Outlet Syndrome?
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MRI is best (plain xray reveals the cervical ribs)
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Vascular TOS injected with _________________ improved symptoms in 3 weeks.
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Botulism Toxin A
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What OMT technique is done for TOS?
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Mysofascial Release Techiques
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What is osteochondrosis of vertebral end plate growth plates that can lead to Arcuate Kyphosis?
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Scheuermann Dx
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At what age do you see Scheuremann Dx?
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10-16 yrs.
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_______________ % of population have Scheuermann Dx.
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1-2%
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What are the symptoms assoc. with Scheurmann dx?
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back pain (upper thoracics and neck) and Fatigue
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What can NOT be straightened with muscular effort?
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Scheuermann Dx
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What limits Straight Leg raising due to hypertonic hamstrings and increased pelvic tilt?
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Scheuermann Dx
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What is the criteria to be Scheuermann Dx?
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must affect 3 adjacent segments
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When would you see Schmorl Node Formation on an xray?
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Scheuermann Dx
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Why is your pt. involuntarily bending forward to decrease pressure on their painful joints?
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Facet Joint Arthritis
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What presents with hip and knee contractures and is a rigid arcuate kyphosis?
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Ankylosing Spondylitis
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What is common in elderly men and presents with Bone ache, HA, tinnitus, vertigo and increased Cardiac Output?
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Osteitis Deformans
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What is trabecular microfrxing with vertebral wedging?
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Osteitis Deformans
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When you would see an increase in serum Alkaline phoshpatase?
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Osteosarcoma
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What is the tx for Osteosarcoma?
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biphosphonate meds
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What is the cause of Osteitis Deformans?
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unknown---but maybe a VIRUS
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What is seen in 1% of the population at age 50 and presents with Candle Wax Osteophytes?
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DISH
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What is assoc. with Type II Diabetes Mellulitis?
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DISH
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What is a defect in Tyrosin and Pheny. Metabolism complication?
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Ochronosis
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Alkaptonuria is a possible cause of _____________________.
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Ochronosis
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With what dx will you have your urine turn from yellow to blue to black?
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Ochronosis
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What feels like a pulled muscle and is due to bone telescoping into itself with no displacement of fx fragments?
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Osteoporosis
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Costovertebral Joints allow gliding_____________ motion.
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rotary
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Costotransverse joints allow gliding ______________ motion.
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arcuate
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What rib joints do you see wht most dysfxns?
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Costotransverse
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What type of rib motion is the axis of the neck of the rib in an AP plane?
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Bucket Handle
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What type of rib motion is the axis in a coronal (lateral) plane?
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Pump Handle
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What type of rib motion is there primarly a change in the lateral diameter?
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Bucket Handle
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What type of rib motion is there primarlily a change in the AP diameter?
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Pump Handle
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Which is the only rib that attached via synchondrosis?
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Rib 1
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What is Rib 1 attached to?
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Serratus Anterior, Scalenes, Subclavius
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Inhalation Rib is kept by what muscle with a Rib 1 dysfxn?
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Ant and Middle Scalenes Hypertonic
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Arm swelling is seen with Rib 1 dysfxn. What is this due to?
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Subclavian V compressing against clavicle
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What is held by hypertonic Serratus Ant. M?
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Exhalation Rib Dsfxn of Rib 1
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what are the symptoms assoc. with Exhalation Rib Dysfxn Rib 1?
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tenderness at Costochondral Jxn anteriorly, unlar distal pain and parasthesia, and claudication of arm due to sub. A compression
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What dysfxns (2) are due to an Exhalation Rib Dysfxn?
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Mid-Cervical Dysfxn and Flexed Occipitoatlantal dysfxn
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What are the muscle attachments for Rib 2?
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Posterior Scalene and Serratus Anterior
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How does Rib 2 attach to the sternum?
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Bicompartmental Synovial Joint at Manubrio-Sternal Jxn
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Inhalation Rib of Rib 2 caused by _____________________.
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Hypertonic Posterior Scalene M
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What rib presents with neck pain due to exhalation rib dysfxn?
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Rib 2
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What are the attachments of the TRUE ribs (3-7)?
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Serratus Anterior, Pec. Minor, Iliocostalis Cervicis, and to sternum via Synovial Joint
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Pec. Minor attaches to what ribs? Hypertonic Pec. Minor can cause what?
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3,4 5 anteriorly. Inhalation Rib.
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Inhalation dysfxn creates a same side sidebending dysfxn in what region?
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Thoracic
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Exhalation dysfxn creates a CONTRA side sidebending dysfxn in what region?
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Cervical !
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How do the False Ribs (8-10) attach to the Costal Cartialge above?
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via Synovial Joint
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What do the False Ribs attach to?
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Iliocostal Thoracis and Lumborum, Serratus Anterior, Diaphragm, and Synovia Joint
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Scoliosis is named for the side of the ________________.
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Convexity
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what causes the rib hump seen in Scoliosis?
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Rotation
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What is the test done to test if Scoliosis is strxl or fxnl?
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Adams Test
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An Adams test had a result of the hump disappearing when the pt was asked to sidebend. What is the diagnosis?
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Functional Problem (SD)
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What happens if a Scoliotic rib hump DOES NOT get better with sidebending?
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Structural Problem :(
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Forward bending of Scoliosis exaggerates the sidebending and rotation. What law does this follow?
|
3rd law of spinal motion
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What is the most common method to measure Scoliosis?
|
Cobb Method
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Vertebral bodies move what direction with scoliosis?
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toward conVEX
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With rib cage distortion from Scoliosis what side of the rib cage is narrow? Convex or Concave.
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ConVEX
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Curves of more than 60 degrees are at risk for what?
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Pulmonary and Cardiac Compromise
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___________% of women with MAC had scoliosis of greater than 10 degree curve.
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52%
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What is Wolff's Law of Pelvic Distortion?
|
Bone is laid down along lines of stress
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With fxnl scoliosis what is seen with inhalation?
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curve straightens
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With strxl scoliosis what is seen with inhalation?
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pt. breathes in with BAD side
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Spinous process and pedicles move what direction with Scoliosis?
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toward concavity
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On what side of the rib cage, convex or concave, are your lamina thinner the vertebral canal is narrower?
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conCAVE
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What is done with a level of apex btwn 30-40 degrees?
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Brace it.
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What would you grade a vertebral rotation when the pedicles are dissappearing and there is migration within the 1st segment?
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grade 1
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What would you grade a vertebral roation when the pedicles have dissappeared and there is migration to 2nd segment?
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Grade 2
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What grade of vertebral rotation do you have migration to middle segment and the concave side is not visible?
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3
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What grade of vertebral rotation do you have migration PAST midline to concave side of VB?
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Grade 4
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What can cause the contact with the liver and cause increased liver enzymes?
|
Degenerative Spondylosis
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What can cause the rib cage to "sit" on the pelvis?
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Degenerative Spondylosis
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How is Scoliosis assessed?
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Plumb line analysis--- measures collapse
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What is a plumb line analysis that falls at mid sacrum?
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Completely compensated curve
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Plumb line analysis that falls at mid heel?
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Partially compensated curve
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Plumb line analysis that falls off mid sacrum AND mid heel?
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Decompensated or Collapsed Curve
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What MUST be done on all structural scoliosis patients?
|
Craniocervical jxn MRI
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What are some reversible neurologic etiologies of Strxl Scoliosis?
|
Chiari Malformations and Neurofibromatosis
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what is an example of a Chiari Malformation that can be a cause of Strxl Scoliosis?
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Syringomyelia
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What are 2 irreversible neurologic causes of Strxl Scoliosis?
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Cerebral Palsy and Muscular Dystrophy
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What is a Congenital Cause of Strxl Scoliosis?
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Hemivertebrae (tx with fusion)
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What is thought to be the cause of Idiopathic Strxl Scoliosis?
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Soft tissue growth abnormality
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Idiopathic Strxl Scoliosis affects _____________% of the population.
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2-3%
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What is the goal of exercise and traction tx for scoliosis?
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to maintain MOBILITY
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Bracing of Scoliosis is successful for what?
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HALTING progression (but not correcting it)
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what type of Scoliosis brace do you wear for 23 hours a day?
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Boston Brace
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What type of Scoliosis brace do you wear only when you sleep and attempts to correct the curve?
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Charleston Brace
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How do you measure the End of Bone Growth?
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Risser Scale
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What does the Risser Scale measure? Be specific.
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fusion of Iliac Crest Apophyses
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How long does fusion of Iliac Crest Apophyses take?
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12-36 months. Once this is complete you can do fusion.
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What device is good for growing kids with Scoliosis?
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Internal Fixation Device
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What is a Harrington Rod?
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Internal Metallic Device that is inserted during Scoliosis surgery
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What presents with infrascapular mid thoracic backache and pectoral pain?
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Latissimus Dorsi
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What muscle SD would cause you to have limited Scapular protrusion and pain?
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Rhomboid Major/Minor
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What muscle allows you to extend the neck and rotate the head to the same side?
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Capitis
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what muscle SD would refer pain down lower part of buttocks, upper lumbar fibers, and mid lumbar range?
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Longisimus Thoracis
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A 56-year-old woman presents to your office in congestive heart failure. The presence of a pericardial friction rub alerts you to the presence of Pericarditis. The skin on her hands is taut, shiny and smooth. Diagnosis?
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Scleroderma
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A 26-year-old man presents to your office with lower back pain & mid-line sternal pain. His xiphoid process is prominent and tender to palpation. Which of the following is most likely the etiology of his Xiphalgia?
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Ankylosing Spondylitis
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A 35-year-old woman presents to your office following a motor vehicle accident in which she sustained several fractures of the left costal cartilages. Which of the following is the best choice for manipulative management of this patient?
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HVLA to her somatic dysfxn at C3-5
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An 83-year-old woman presents to your office with what you diagnose as a post-herpetic neuralgia. Give an antiseizure medications that would best relieve her pain.
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Gabapentin
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A 72-year-old man presents to your office with a heart rate of 101 bpm. Which of the following is correct regarding this finding?
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You would examine him for Somatic Dysfunction in the T1 to T4 range
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What can be not be straightened by muscular effort and can cause kyphosis?
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Scheuermann Dx
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The kyphosis of which of the following diseases is caused by the patient involuntarily bending forward to take the pressure off the diseased facet joints?
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Osteoarthritis
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What produced typical candle wax osteophytes?
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DISH
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Which cancer frequently metastasizes to bone and can cause frequent pathologic frx?
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Breast
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If rib 1 is held in inhalation, what artery may be partially ocluded?
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Subclavian
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Rib 1 attaches to the sternum via what kind of joint?
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Synchondrosis
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