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120 Cards in this Set
- Front
- Back
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1. What are the five principles of cranial osteopathy?
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1. Inherent motility of the CNS
2. Fluctuation of the cerebrospinal fluid 3. Mobility of the intracranial and intraspinal membranes 4. Articular mobility of the cranial bones 5.Involuntary motion of the sacrum between the ilia |
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2. Who was William Sutherland, DO?
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Student of Still, M.D.
Noted joints within the skull. Saw potential for motion, specifically respiration like Spent a large amount of time palpating the body to define the CRI and the motion of the cranial bones Defined the dysfunctional motions of the bones and joints of the skull |
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3. What causes the inherent motility of the CNS?
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Coordinated contraction of oligodendroglia. These cells contain contractile elements.
If they do not contract, the brain and spinal cord would have to change shape to accommodate the changes in shape of the cranium during the CRI. Other studies show Schwann cell's contraction rates as comparable to the oligodendroglia. |
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4. What causes the fluctuation of the CSF?
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Pressure gradients produced by production and release of CSF into the cranial cavity by the choroid plexus in the ventricles, and drainage of CSF into the venous system.
This is usually considered a result of the primary respiratory mechanism. |
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5. What is the flow of the CSF?
6 steps... |
1. Lateral ventricles
2. Foramen of Monroe 3. Third ventricle 4. Cerebral aqueduct of sylivius 5. Fourth ventricle 6. Foramen of Magendie and Foramen fo Lushka |
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6. What are the names of the dural membranes?
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1. Falx cerebri
2. Falx cerebelli 3. Tentorium cerebelli These are the "three sickle shaped agencies". They insert into the various cranial bones. The dura invests all foramina leaving the skull. Any cranial nerve or vessel may be affected by changes in dural tension. |
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7. Where is the common origin of the dural membranes?
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The straight sinus - AKA "Sutherland fulcrum"
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8. What causes the articular mobility fo the cranial bones?
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The sutures form to accommodate the CRI as the skull ossifies. The sutures are joints and thus they allow motion.
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9. What are the four types of sutures and their respective motions?
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1. Serrate (sawtooth) - rocking motion
2. Squamous (scale-like) - gliding motion 3. Harmonic (edge to edge) - allows shearing 4. Squamoserrate - combination |
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10. What is the involuntary mobility of the sacrum?
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The sacrum rocks between the ilia on the transverse axis thru the articular pillar of the SECOND sacral segment.
This motion is different than respiratory sacral motion caused by spinal motion and contraction of the pelvic diaphragm. |
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11. What is the SBS?
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The sphenobasilar synchondrosis (SBS).
*The angle of the SBS defines Flexion and Extension phase |
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12. What occurs during flexion?
(7 things...) |
1. Increase in transverse diameter
2. Decrease in the AP diameter 3. Brain and spinal cord change shape slightly 4. Anterior rotation of the sphenoid 5. Basiocciput moves anterosuperiorly 6. Foramen magnum moves superiorly 7. Sacral base drawn posteriorly - opposite of anatomical flexion |
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13. What happens to the midline structures and paired structures during flexion?
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The midline structures flex
-occiput, sphenoid -ethmoid, vomer -sacrum The paired structures externally rotate -parietals, temporals, frontal -innominates -upper and lower extremities |
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14. What occurs during extension?
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1. Decrease in transverse diameter
2. Increase in the AP diameter 3. Brain and spinal cord change shape slightly 4. Posterior rotation of the sphenoid 5. Basiocciput moves posteroinferiorly 6. Foramen magnum moves inferiorly 7. Sacral base drawn anteriorly- opposite of anatomical extension |
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15. What happens to the midline structures and paired structures during extension?
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The midline structures extend
-occiput, sphenoid -ethmoid, vomer -sacrum The paired structures internally rotate -parietals, temporals, frontal -innominates -upper and lower extremities |
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16. What are the 5 characteristics of the typical motion of the CRI?
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1. 8-14 cycles per minute
2. 1 cycle is Flexion and Extension with pauses in-between phases 3. Flexion and Extension phases are smooth and forceful 4. Amplitude of the 2 phases should be equal 5. Amplitude can diminish with age |
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17. What are 5 rules of motion?
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1. Midline bones follow flexion/extension
2. Paired bones follow internal/external rotation 3. Sacrum follows the occiput 4. Temporals follow the occiput 5. Facial bones follow the sphenoid |
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18. What is the Still point?
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A pause in the CRI.
At the still point, the CRI will seem to stop. You may feel a sensation of a fine vibration which builds in a crescendo fashion to a peak, and then starts to diminish in a decrescendo fashion. At the end of the still point, there is a sense of softening and warmth in the occiput and a gentle rocking motion of flexion/extension returns. |
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19. What is a torsion?
Vertical strain? Lateral strain? Sidebending rotation? |
Torsions = A twisting at the SBS
Vertical = rotation in the same direction around transverse axis Lateral = rotation in same direction around AP axis Sidebending = convexity on one side |
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20. Where is the reciprocal tension membrane located?
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“Sutherland fulcrum” is at the junction of the falx cerebri and tentorium cerebelli.
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21. What strain pattern can significantly reduce the CRI?
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An SBS compression strain
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22. Inhalation enhances what phase of the CRI?
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Flexion
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23. Newborns with occipital condylar compression show what symptoms?
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Spitting, difficulty sucking, difficulty swallowing, torticollis
Entrapment of CN 9, 10, 11 |
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24. What is balanced membranous tension?
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Treating the dura mater itself, in the cranium, face, and sacrum.
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25. What are the 4 different types of balanced membranous tension and in what type of pt should we use them?
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Indirect action (exaggeration)
-ages 5 through adult -not in trauma Direct action -young children -trauma -overriding sutures Disengagement -Used when force or excessive membranous tension Opposite Physiologic Motion (Direct and Indirect) -Rarely used -Trauma has severely violated the physiologic pattern |
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26. What is the bregma?
What is the lambda? |
The bregma is the juncture of the coronal and saggital sutures.
The lambda is the juncture at the posterior end of the saggital suture. |
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27. What is hydrodynamic activity?
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The motility of the CNS combined with fluctuation of CSF manifests itself as hydrodynamic activity.
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28. What can increase/decrease the rate of the CRI?
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Increased rate: fast metabolism or acute infection
Decreased rate: slow metabolism, chronic infection, or fatigue |
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29. What can increase/decrease the amplitude of the CRI?
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Increased amplitude: increased ICP
Decreased amplitude: dural tension, SBS compression |
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30. Again, what are the midline cranial and facial bones?
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Sphenoid
Occiput Ethmoid Sacrum Vomer These flex and extend |
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31. What are the paired cranial and facial bones?
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Frontal
Parietal Temporal Maxilla Zygoma Lacrimal Nasal Palatines Paired bones have external/internal rotation |
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32. What 4 things make up the reciprocal tension membrane?
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1. Falx cerebri
2. Falx cerebelli 3. Tentorium 4. Spinal dura |
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33. What is the craniosacral axis?
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This is the superior transverse axis. It goes thru the S2 sacral segment.
Cranial flexion and extension |
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34. Review of bone movements during flexion...
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Cranial transverse diameter-increases
Cranial A/P diameter-decreases Basi-occiput: anteriorly/superiorly Paired bones: externally rotate Midline bones: flex Sacral bone: posteriorly Sphenoid: rotates anteriorly Foramen magnum: moves superiorly |
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35. Review of bone movements during extension...
overkill? yes, it is. |
Cranial transverse diameter: decreases
Cranial A/P diameter: increases Basi-occiput: posteriorly/inferiorly Paired bones: internally rotate Midline bones: extend Sacral bones: anteriorly Sphenoid: rotates posteriorly Foramen Magnum: moves inferiorly |
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36. Torsion strains
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Axis: AP
Rotation: Sphenoid & occiput rotate opposite directions about this AP axis Named: Side of the higher great wing of the sphenoid (L or R) Etiologies: Normal, Trauma, Postural strains Palpation: One hand rotates more posteriorly Index finger: Moves superiorly Little finger: Moves inferiorly |
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37. Sidebending rotations
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Axis: 2 parallel vertical axes + 1 AP axis
Rotation: -Sphenoid & occiput rotate opposite directions about the vertical axes -Sphenoid & occiput rotate the same direction about the side of the A/P axis Named: Side of the convexity Etiologies: Normal, Trauma, Postural strain Palpation: Fingers approximate on side of concavity Fingers spread on side of convexity (the side it’s named for) Ex. Left sidebending rotation: left hand spreads wider & moves inferiorly |
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38. Lateral strains
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Axis: 2 parallel vertical axes (1 through sphenoid, and 1 thru foramen magnum)
Rotation: Sphenoid & occiput rotate in the same direction Named: According to location of the base of the sphenoid Etiology: Trauma Palpation: “Parallelogram Head” Forefingers shift one direction & little fingers shift to opposite side. Ex. Left lateral Strain: Forefingers shift right Little fingers shift left |
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39. Vertical strains/shears
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Axis: 2 parallel transverse axes
Motion: Sphenoid & Occiput rotate in same direction (due to shearing force). One bone in flexion, the other in extension Named according to direction the sphenoid is moving Palpation: -Superior: both hands move inferiorly -Inferior: both hands move superiorly |
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40. What is the etiology of a superior vertical strain/shear?
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Blow on top of the head posterior to the plane of the SBS
Blow from below anterior to the plane of the SBS |
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41. What is the etiology of an inferior vertical strain/shear?
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Inferior shear:
Blow on top of the head anterior to the plane of the SBS Blow from below posterior to the plane of the SBS |
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42. What is SBS compression?
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Sphenoid & Occiput: Little or no motion (occurs when the sphenoid and occiput have been pushed together).
Etiologies: Trauma (esp to the back of the head), Severe depression |
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43. What are the five contraindications to cranial treatment?
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1. Increased ICP
2. Intracranial hemorrhage 3. Cranial aneurysms 4. Tumors 5. Skull fractures |
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44. Cranial vault hold: index and middle finger locations
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Index fingers on greater wings of sphenoid
Middle fingers on zygomatic processes of temporals |
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45. Cranial vault hold: ring and little finger locations
Thumb positions? |
Ring fingers on mastoid processes of temporals
Little fingers on squamous portion of the occiput Thumbs off the head. |
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46. What are the 6 dural attachments?
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1. Falx cerebri
2. Tentorium cerebelli 3. Falx cerebelli 4. Foramen magnum 5. C2 and C3 6. S2 |
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47. What structures run through the jugular foramen?
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CN 9, 10, 11
Petrosal and Sigmoid sinuses |
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48. Where does the middle meningeal artery pass?
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Foramen spinosum
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49. Dural strains may cause what three main dysfunctions?
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1. Vascular compromise
2. Cranial nerve entrapment 3. Pituitary dysfunction |
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50. What is the innervation of the supratentorial portion + tent of the cranial dura?
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Trigeminal nerve (V1, V2, V3)
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51. What is the innervation of the posterior cranial fossa portion of the cranial dura?
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C1, C2, C3
Superior cervical ganglion Enter through foramen magnum, hypoglossal canal, and jugular foramen with CN 10 and 12. |
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52. What is the innervation of the spinal dura?
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Recurrent meningeal nerve of Luschka (sinuvertebral n.)
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53. What are the 11 cranial nerve impingement disorders?
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1. Anosmia (CN I)
2. Visual disturbances, amblyopia (CN II, III, IV, VI) 3. Strabismus (esp. CN VI) (petrosphenoidal lig.) 4. Trigeminal neuralgia, trismus, headache (CN V) 5. Bell’s palsy, taste disorder (ant.), hearing disorder (tensor tympani m.) (CN VII) 6. Vertigo, tinnitus, nystagmus, hearing disorders (CN VIII) 7. Dysphagia, loss of gag reflex, taste disorder (post.), BP, cardiac arrhythmia (CN IX) 8. GI, respiratory, cardiac arrhythmia, colic, nausea/vomiting (CN X) 9. Dysphagia, dysphonia (CN IX, X) I.e. SVE innervating larynx, pharynx. 10. Torticollis (SCM), upper trapezius spasm or weakness (CN XI) 11. Sucking/swallowing problems in infant (CN IX, X, XI,XII) |
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54. Child w/ poor suck reflex is due to...?
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Child w/ poor suck reflex is due to CN XII,XI,X compression associated w/ condylar compression
Treatment: Condylar decompression and release petrosquamous |
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55. Pt c/o of dizziness/tinnitus/vertigo associated with...?
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Pt c/o of dizziness/tinnitus/vertigo associated w/ Temporal bone dysfunction CN 8
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56. If the chorda typani is cut, what deficits occur?
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Loss of taste anterior 2/3 of tongue
Hyperacusis b/c of paralyzed stapedius m. |
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57. The treatment for Bell's palsy should focus one what somatic dysfunctions?
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Temporal, sphenoid, occipital bones and stylomastoid foramen somatic dysfunctions
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58. What causes tinnitus?
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Compression of CN 8.
Tx: Temporal, Sphenoid, and Occipital bones and Sternocleidomastoid muscle |
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59. What is the problem of cancer?
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2nd leading cause of death (570,000)
Probability of developing cancer during lifetime: 50% men 38% women Health care costs (NIH 2003): $190 billion (direct/indirect) |
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60. What is the pathophysiology of CA?
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Viruses, radiation, chemicals, hereditary, free radicals cause normal cells go through initiation and promotion
Inflammation, endocrine factors, nutrition, environmental factors cause preneoplastic cells go through conversion and progression Malignant cells go through genetic changes |
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61. List 5 factors that contribute to alteration of normal cells into neoplastic ones
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1. Viruses
2. Radiation 3. Chemicals 4. Hereditary 5. Free radicals |
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62. How can we prevent CA?
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1. Avoid potential carcinogens-sunscreen, quit smoking, organic vs. nonorganic foods, avoid processed foods, chemicals, electromagnetic exposures, hormones, condoms
2. Screening exams: Breast, colonoscopy, gyn, prostate, PSA, testicular, skin 3. Treatment of potential problems: antioxidants, vitamins, GERD |
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63. If prevention fails, what happens when a pt is diagnosed with CA?
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Appropriate Conventional Treatment
Frank discussion of potential risks/benefits, side effects of chemo/radiation/surgery Ask questions, get answers to satisfaction Consider the devastation to and wishes of the patient Address body-mind-spirit Address FEARS of patient: -Pain, Dying, Death -Family not being able to carry on without patient -Burden to family |
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64. What are 6 adverse effects of cancer (besides death)?
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1. Psychological distress and depression
2. Weight loss and cachexia 3. Pain 4. Cardiac complications 5. Nausea and Vomiting 6. Alopecia |
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65. What is psychological distress in CA pts?
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1/3 - 2/3 of oncology patients experience distress (depression, anxiety, etc)
Major depression has negative impact on morbidity, length of hospitalization, disability, and mortality |
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66. What are the 5 Emotional Stages (Kubler-Ross) in psychological distress?
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1. Denial
2. Anger 3. Bargaining 4. Depression 5. Acceptance |
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67. What are some herbal supplements that are used to help CA pts with depression?
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St. John’s wort (depression)
Kava (anxiety) Valerian (insomnia) |
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68. What causes weight loss and cachexia in CA pts?
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50-80% incidence
Significant weight loss can decrease tolerance to therapies, as well as cause death Causes: Anorexia, impaired cellular metabolism, tumor-related increase in energy requirements |
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69. How does one treat weight loss and cachexia in CA pts?
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Nutritional:
Consult oncological dietician Eat 5-8 servings of fruits and vegetables Special diets (macrobiotic?) Increase omega 3-fatty acids, antioxidants (depending…) Herbals: Marijuana (consult state/US laws) SMOKE THE FATTY. |
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70. What causes pain in CA pts?
How to treat pain? |
Results from direct tumor invasion and Dx/Tx procedures (surgery)
Assess patient at each visit/pain level, etc. Tx: Conventional: opioids, P.o., i.m., i.v., patches, regional anesthesia, surgical ablation Integrative: Acupuncture, OMT, Mind-body, Marijuana (bong rips) |
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71. What vitamin/supplement is protective against dilated cardiomyopathy/CHF/ischemia/arrhythmias associated with chemo/radiation?
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Rx CoQ10 100-200 mg/day
Protective against anthracyclines – (daunorubicin or idarubicin) |
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72. What is the frequency of nausea and vomiting in CA pts?
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Experienced by >75% of patients receiving combination chemotherapy
Some patients develop anticipatory N/V If prolonged, can compromise nutritional status and electrolytes of patient |
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73. What is the treatment for nausea and vomiting in CA pts?
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Conventional:
Meds (ondansetron- serotonin 3 receptor inhibition) + dexamathasone Integrative: Herbals -Ginger root extracts .5-1g -Marijuana (gravity bong rips + brownies) Acupuncture (PC 6) Hypnosis |
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74. What is the difference between recurrence/metastases and secondary malignancies?
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Recurrence, mets depend on tumor type, treatment protocol, stage at Dx
Secondary malignancies depend on tumor type, pt age, chemo/radiation protocol |
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75. Describe strategies for prevention and treatment of recurrences, metastasis, secondary malignancies
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Basic protocol-avoid environmental toxins
Nutrition: 4-5 servings fruits and veggies (organic), 4-5 cups green tea, mushrooms (maitake, shiitake, reishe – high in beta 1,3 glucans) Peyote, ketamine Herbals: astragalus root (immunostimulating polysaccharides), avoid in cachectic patients, 4-5 cups green tea, mushrooms |
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76. What are some other controversial therapies for CA Tx?
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Prayer/Meditation/Spiritual Healing/Shamanic
Anti-neoplastons (A10, AS2-1; phenylacetate + phenylacetylglutamine) (Burzynski) Energy medicine (Reiki, HT, TT, acupuncture) Hi dose IV Vitamin C (blood levels 70x p.o.) Ozone therapies Hyperthermia |
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77. John Kanzius and his energy medicine
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John Kanzius, Erie, PA
Radiowaves used to treat cancer Nanoparticles (metal) attached to specific proteins that attach to cancer cells Radiowaves heat nanoparticles, selectively kill cancer cells without side effects |
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78. Discuss the role of OMT in the treatment of cancer patients
What are the contraindications to the use of OMT? |
May be indicated or contraindicated. Used to decrease pain
CONTRA: Metastasis to bone |
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79. Again, what is the order of the ventricular flow?
7 steps... |
1. Lateral ventricle
2. Foramen of Monro (interventricular foramen) 3. Third ventricle 4. Aquaduct of Sylvius 5. Fourth ventricle 6. Foramen of Magendie and Luschka *A back up at any site will lead to brain swelling |
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80. What is the Sutherland fulcrum?
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A balancing point or fulcrum located along the straight sinus where falx cerebri joins tentorium cerebelli.
*Provides balancing point from which membranes can shift in response to motion induced by primary respiratory mechanism. |
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81. Drainage of the superior/inferior sagittal sinuses?
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Superior sagittal sinus typically becomes right transverse sinus
Inferior sagittal sinus drains to straight sinus |
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82. Drainage of the straight and transverse sinuses?
Occipital sinus? |
Straight sinus typically becomes left transverse sinus
Transverse sinuses drain to sigmoid sinus Occipital sinus drains to confluence of sinuses |
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83. Drainage of the cavernous sinuses?
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Cavernous sinuses drain to superior and inferior petrosal sinuses
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84. Drainage of the superior/inferior petrosal sinuses?
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Superior petrosal sinus drain to transverse sinuses
Inferior petrosal sinus drain to internal jugular vein |
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85. Drainage of the sigmoid sinuses and sphenoparietal sinuses?
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Sigmoid sinuses drain to internal jugular vein
Sphenoparietal sinuses drain to cavernous sinuses |
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86. All CSF flow eventually drains into the...?
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All flow eventually drains into the internal jugular veins
CSF is reabsorbed into the subarachnoid space |
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87. What are the clinical applications of OCF?
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Head trauma/traumatic brain injury
Post-stroke Birth trauma Otitis media Labor Induction TMJ Headaches |
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88. Why are ear infections more common in children?
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Occurs on 20% of infants and children b/w ages 6mo.'s and 6 yrs
Their eustachian tubes are shorter, narrower, and more horizontal, which makes the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore. |
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89. What 3 structures can be associated with otitis media?
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Temporal bone
Eustachian tube Somatic dysfunction of pharynx |
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80. TMJ is associated with what type of dysfunction?
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Temporal bone dysfunction
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81. The fourth ventricle contains...?
What is the purpose of CV-4? |
Forth ventricle contains Medulla which regulates respiration.
CV4 is used to treat fluid motion/potency: -Through promotion of movement of nutrients into cells -Metabolic wastes out of the cells |
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82. What are 6 indications for CV-4 treatment?
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1. Normalize PRM
2. Reduce tone in sympathetic nervous system 3. Reduces fevers 4. Venous congestion 5. Promotes uterine contraction i.e. induction of labor 6. Arthritic/autoimmune disorders |
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83. What are 5 contraindications for CV-4 treatment?
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1. Acute CVA
2. Aneurysm 3. Malignant HTN*** -HTN w/end organ damage -Brain damage caused by increased ICP -CV4 increases ICP!!! 4. Skull fracture 5. Pregnancy from 7th month because may induce labor (stress-test is preferred in my opinion) |
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84. What are migraine headaches?
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1. Usually unilateral, can be bilateral
2. Throbbing, pulsating, crescendo pattern 3. Moderate-severe 4. Lasts 4-72 hours 5. Aggravated by exertion 6. Photo/phonophobia, nausea, vomiting 7. With or without aura- typically lasts 4-72 hours |
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85. What are tension headaches?
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1. Bilateral
2. Pressing, band-like, tightness which waxes and wanes 3. Mild to moderate intensity 4. *No prodrome or aura* 5. Variable duration |
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86. What are cluster headaches?
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1. Unilateral - always*
2. Severe and excruciating pain 3. Orbital, supraorbital, and/or temporal 4. Lasts 30 min - 3 hours 5. Ipsilateral lacrimation and redness of the eye, sensitivity to EtOH |
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87. If the temporal bone is not an answer choice on the exam, what is the next best choice?
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Occipital bone
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88. In a sidebending rotation, where is the force/trauma relative to the axes of motion?
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In the CENTER
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89. In a vertical strain where is the force/trauma relative to the axes of motion?
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Hit on the top of the head-
-Posterior to coronal suture: superior shear -Anterior to coronal suture: inferior shear Strike from below: -At sphenoid: sup vertical strain -At occiput: inf vertical strain |
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90. What are the 6 goals of treating somatic dysfunctions of craniosacral mechanism to restore Primary Respiratory Mechanism?
Huh? |
1. Normalize nerve function
2. Eliminate circulatory stasis 3. Normalize CSF fluctuation 4. Release Dural membranous tension 5. Correct cranial articular lesions 6. Modify gross structural patterns |
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91. What are the five choices of permitted motion in the treatment of cranial bones?
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1. Exaggeration (Move bones in to pattern of lesion)
2. Direct action (Retrace path of lesion toward more normal physiologic function) 3. Disengagement (Separate opposing surfaces before balancing) 4. Opposite physiologic motion (One component held toward physiologic position i.e. direct action and other one held away from it i.e. exaggeration) 5. Molding (Direct action to normalize contours of bone) Direct best for children Indirect best for adults |
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92. OMT in the renal system may do what?
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OMT may improve renal function alleviate pain, and decrease recovery time.
Can help with: Primary Musculoskeletal disturbances/dysfunctions Secondary Disturbances Related structures causing imbalance or strain General soft tissue relaxation Metabolic – Circulatory Benefits – Assist in healing Know your limitations and when to consult! |
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93. OMT may be helpful in what renal conditions?
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UTI
-cystitis (bladder) -pyelonephritis Nephrolithiasis |
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94. What are the anatomic relationships to the bladder and distal ureters?
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T11-L2 (sympathetics)
S2-S4 (paras. & pelvic splanchnics) Inferior Mesenteric Ganglion Pelvic Diaphragm Urogenital Diaphragm (Pubic symphysis & pelvic floor S.D.) Lymphatics |
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95. What are 4 things you should check associated with UTIs (bladder and distal ureter)?
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1. Pubic symphysis & pelvic floor S.D. (Urogenital diaphragm)
2. T11-L2: Normalize Sympathetic -Hyperactivity -Facilitated segments -Chapman Reflexes -Inferior Mesenteric Ganglion -Rib Raising 3. S2-S4 Normalize Parasympathetic Activity 4. Lymphatics: Renal lymphatics flow into pre-aortic nodes into thoracic duct and into subclavian vein -Assisted by Thoracic and Pelvic diaphragms -Thoracic Inlet (prior to lymphatic techniques) -Diaphragms & attachments |
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96. What are the anatomic relationships of the kidney & proximal ureters?
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Kidneys are retroperitoneal
Surrounding structures: 1. Quadratus lumborum 2. 12th Rib 3. Diaphragm 4. Psoas courses obliquely & laterally displaces the lower poles of the kidney *Psoas spasm: causes facial restrictions - Ureters descend across the psoas fascia |
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97. What is the movement of the renal fascia during respiration?
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The renal fascia surrounds the kidneys and allows downward and lateral motion with inhalation.
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98. What is renal ptosis?
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Renal Ptosis: Kidney slips inferior and won’t move with respiration
Occurs in tall, thin females Vague or acute symptoms |
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99. What are the fascial & diaphragmatic contributions to renal motion?
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Thoracolumbar junction
L1-L3 (diaphragm attachment) Lower Ribs Quadratus Lumborum Psoas* *Psoas spasm exaggerates lumbar lordosis and induces fascial pulls on the kidney and the ureters |
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100. What are the effects of sympathetic innervation to the kidney and upper ureters?
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T10-L1
Increased tone results in decreased peristalsis of ureters -Decreased Urine Flow Arteriolar Constriction -Decreased GFR and Urine Volume Renal fluid retention contributing to elevated arterial pressure (Hypertension) |
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101. What are the effects of parasympathetic innervation to the kidney and upper ureters?
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Vagus
S2-S4 Increased tone increases bladder wall tone |
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102. Where do the kidneys, ureters, and bladder drain their lymphatics?
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Kidneys:
Lateral Aortic Nodes Ureters: Lateral Aortic & Iliac Nodes Bladder: Internal & External Iliac Nodes |
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103. Where are the Chapman points for the adrenals?
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Anterior: 1 inch lateral and 2 inches superior to the umbilicus ipsilaterally
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104. Where are the Chapman points for the kidneys?
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Anterior: 1 inch lateral and 1 inch superior to umbilicus ipsilaterally
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105. Where are the Chapman points for the bladder?
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Anterior: Umbilical area
Posterior: Intertransverse space (midway between spines and transverse process tips of L1-L2 and T12-L1 respectively) |
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106. The external urinary sphincter tone relies on innervation from...?
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The pudendal nerve (S2-4).
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107. What causes urinary leakage?
What structures do we focus on treating? |
Increased abdominal and pelvic pressure results in contraction of the pelvic diaphragm and external urinary sphincter
Inadequate contraction = Incontinence, Urgency, Leakage Treat the Pelvic Diaphragm, Pubic Symphysis, (Urogenital diaphragm) to enhance normal function |
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108. Tumors in the urinary tract
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Presenting symptom:
Vague pain, hematuria, pelvic obstruction Misdiagnosis delays treatment Physical exam: Mass may not be evident Diagnostic Testing: CT Scan of Abdomen & Pelvis with Stone Protocol Urinary Obstruction can be intrinsic or extrinsic OMT: As tolerated to relieve pain & improve function |
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109. What are 3 general principles for OMT in the renal system?
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1. Normalize sympathetics
2. Normalize parasympathetics 3. Consider surrounding structures/attachments -Thoracolumbar decompression -Lumbosacral decompression -Inferior Mesenteric Ganglion -Pubes -Pelvic Diaphragm |
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110. An osteopathic structural examination would include evaluation of what areas?
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Palpate kidneys
-Thermal and Visceral T10-L2 (Facilitated Segments) & associated ribs Chapman’s reflexes Inferior Mesenteric Ganglion Cranial, OA, AA S2-S4, Sacrum, SI Joints Diaphragms (Pelvic, Respiratory, Thoracic Inlet) -Lymphatic Pumps |
