Pulmonary Omm Lecture 1 Lecom

Front 1

The thoracic kyphosis decreases during ___ (breathing)

Back 1

inhalation

Front 2

The thoracic kyphosis increases during ___ (breathing)

Back 2

exhalation

Front 3

What removes particulates in the respiratory system?

Back 3

Ciliated epithelium

Front 4

___ as major contributor to kyphosis in elderly population

Back 4

Osteoporosis

Front 5

Sympathetic levels for respiration

Back 5

T1-6

Front 6

ParaSympathetic levels for respiration

Back 6

CN 10 vagus

Front 7

What are the Lymphatics for Pulmonary?

Back 7

Tracheal, bronchial, bronchopulmonary, and pulmonary nodes

Front 8

Where do the Lymphatics of the Pulmonary system drain to?

Back 8

right Lymphatic Duct

Front 9

What muscles are you using in your muscle energy techniques? 1st Rib

Back 9

Anterior & Middle Scalenes

Front 10

What muscles are you using in your muscle energy techniques? 2nd Rib

Back 10

Posterior Scalene

Front 11

What muscles are you using in your muscle energy techniques? Ribs 3-5

Back 11

Pectoralis Minor

Front 12

What muscles are you using in your muscle energy techniques? Ribs 6-8 (9)

Back 12

Serratus anterior

Front 13

What muscles are you using in your muscle energy techniques?
Ribs 9-11

Back 13

Latissimus dorsi

Front 14

What muscles are you using in your muscle energy techniques? Rib 12

Back 14

Quadratus lumborum

Front 15

Cranial nerves for the carotid bodies?

Back 15

CN IX, X

Front 16

What is the purpose of the Carotid body?

Back 16

BP, CO2, O2 Regulation

Front 17

What do the parasympathetics do to the bronchial muscles?

Back 17

constrictions

Front 18

What sites do you evaluate for parasympathetics with respiration?

Back 18

OA, AA, C1, C2

Front 19

SYMPATHETICS lvls for Lungs?

Back 19

T1-T6

Front 20

SYMPATHETICS lvls for trachea and Bronchi?

Back 20

T1-T6

Front 21

SYMPATHETICS lvls for Visceral Pleura?

Back 21

T1-T6

Front 22

SYMPATHETICS lvls for Parietal Pleura?

Back 22

T1-T11

Front 23

What do the sympathetics do to the Bronchial glands?

Back 23

Increased Goblet/Ciliated Ratio: Secretion of Thick Mucous

Front 24

What do the sympathetics do to the Bronchial muscles?

Back 24

dilation

Front 25

Sympathetics increased number of goblet cells with decreased vascular elements which will result in what?

Back 25

leads to thick and sticky respiratory epithelium (hyperplasia)= decreased mobility of the mucous

Front 26

How do sympathetics lead to secondary bacterial infections in the pulmonary system?

Back 26

inhibits secretion-- leading to dryness and cracking of the mucosa

Front 27

___ transmit signals via the vagus. When the lungs are inflated, this signal turns off the respiration

Back 27

Stretch receptors

Front 28

What does the carotid body sense?

Back 28

senses need for more oxygen – and an increased rate of respiration.

Front 29

When treating a patient with bronchospasm, treat the ___ side of the autonomic system first to decrease any neurally mediated bronchoconstriction

Back 29

parasympathetic

Front 30

What happens if you treat the sympathetics of a patient with bronchospasm first?

Back 30

the patient may go into acute refractory bronchospasm

Front 31

With lung tissue congestion, the respiratory center receives information from the____(that the alveoli are full) to limit excursion of the diaphragm

Back 31

vagus nerve

Front 32

Dome of the Diaphragm =

Back 32

zone of apposition

Front 33

Diaphragm’s greatest excursion is in the___ position

Back 33

supine

Front 34

Increased work load on the diaphragmatic muscles results in strain of its attachments to the ____ and the___ producing a increase in the lumbar lordosis and a flattening of the dome of the diaphragm

Back 34

lower six ribs, thoracolumbar junction

Front 35

Diaphragm innervation?

Back 35

Phrenic Nerve C3-5

Front 36

Diaphragm inhalation cause what pressure?

Back 36

Negative intra-thoracic pressure

Front 37

Diaphragm exhalation cause what pressure?

Back 37

Positive intra-thoracic pressure

Front 38

Diaphragm flattens and moves inferiorly with ___

Back 38

inhalation when skeletal muscle contracts

Front 39

Diaphragm Domes move upward and ascends with ___

Back 39

exhalation as skeletal relaxes

Front 40

Anterior and middle scalenes attach cervical vertebrae to ____

Back 40

1st ribs

Front 41

The 1st rib is also attached to the clavicle by the ____ and its sternoclavicular joint

Back 41

costoclavicular ligament

Front 42

The brachial plexus emerges between the ____

Back 42

ant. & middle scalenes

Front 43

What are the accessory anterior muscles for forced inhalation?

Back 43

Sternocleidomastoid, Scalenes, Serratus anterior, External intercostals

Front 44

Innervation of the External intercostals

Back 44

Ventral rami of thoracic spinal nerves

Front 45

What is the innervation of the Scalenes?

Back 45

ventral rami of C3-C8

Front 46

Attachment of the anterior Scalene?

Back 46

TP of C3-C6 and first rib

Front 47

Attachment of the middle Scalene?

Back 47

TP of C1-C7 and first rib

Front 48

Attachment of the posterior Scalene?

Back 48

TP of C5-C6 and second rib

Front 49

Innervation of the Internal intercostals m?

Back 49

Ventral rami of thoracic spinal nerves

Front 50

Breathing with your Neck will cause?

Back 50

Thoracic outlet syndrome

Front 51

Breathing with your back will cause __

Back 51

Extreme acute fatigue

Front 52

In a Inhalation Rib Dysfunction, where is the Key rib?

Back 52

bottom of rib group

Front 53

Inhalation Rib Dysfunction Associated with ____ in thoracic spine

Back 53

extension

Front 54

Inhalation Rib Dysfunction, It’s motion will stop early in ____

Back 54

expiration

Front 55

Inhalation Rib Dysfunction, Pain with full expiration & may cause___

Back 55

rapid shallow breathing

Front 56

In a Exhalation Rib Dysfunction, where is the Key rib?

Back 56

“Key Rib” is top rib in group

Front 57

Exhalation Rib Dysfunction Associated with ____ in thoracic spine

Back 57

Flexion

Front 58

Exhalation Rib Dysfunction, It’s motion will stop early in ____

Back 58

inspiration

Front 59

Exhalation Rib Dysfunction, Difficulty taking a full breath in ___

Back 59

inspiration

Front 60

Consequences of Somatic Restriction in Pulmonary Disease: Diaphragm Restrictions

Back 60

Poor lymphatic and venous return

Front 61

An imaginary line drawn between the ___ and ___ is the axis that defines the direction of rib motion

Back 61

costo-transverse and costovertebral joints

Front 62

The upper ribs have ___ motion as their major motion

Back 62

pump handle

Front 63

The lower ribs have ___ motion as their major motion

Back 63

bucket handle

Front 64

Rib 1: the costovertebral costotransverse axis is nearly ___, almost in the ___plane

Back 64

horizontal transverse, coronal

Front 65

Rib 7: the axis is about ___ below the horizontal transverse and the costotransverse end of the axis is posterior relative to the costovertebral end

Back 65

45degree

Front 66

Pump Handle: Anterior ribs move ___ and ___

Back 66

cephalad and anteriorly

Front 67

Pump handle Raises sternum ___

Back 67

cephalad

Front 68

Pump handle motion is mainly ribs __

Back 68

2 and 3

Front 69

Pump Handle Increases ___ diameter of thorax

Back 69

anterior-posterior

Front 70

Bucket handle are mainly ribs ___

Back 70

Ribs 8-10

Front 71

Bucket handle Intercostal muscles raise ____

Back 71

superiolaterally

Front 72

Bucket handle ___ diameter of thorax increases

Back 72

Transverse

Front 73

The 11th and 12th thoracic vertebrae do not have___ or ___ articulations

Back 73

hemifacets or costotransverse

Front 74

Which are the atypical ribs?

Back 74

11 and 12

Front 75

Motion of the 11 and 12th ribs?

Back 75

caliper motion

Front 76

What makes up the Thoracic inlet?

Back 76

manubrium of the sternum, the proximal clavicles anteriorly, the first ribs laterally and the body of T1 posteriorly

Front 77

Sympathetic nerves travel to their target organs via the ___ to the respective organs

Back 77

arterial supply

Front 78

The pulmonary viscerosomatic reflexes are transmitted to the ___ by general visceral afferent neurons that travel with the sympathetic innervation of the lungs and bronchi

Back 78

specific spinal level

Front 79

The viscerosomatic patterns most frequently encountered in the pulmonary patient include:3 things?

Back 79

Lung, Bronchomotor, Bronchial mucosa

Front 80

What is the asthma reflex?

Back 80

Bronchomotor: T2 left

Front 81

viscerosomatic patterns: Lung: Upper thoracic, particularly___ to the side of the lung pathology

Back 81

T3-4 lateralized

Front 82

Viscerosomatic patterns: Bronchial mucosa:___, more often ___ sided

Back 82

T2-3 lateralized, right

Front 83

The Occiput-C2 reflex is encountered in any condition where the viscera receive ___ innervation from the ___ nerve

Back 83

parasympathetic, Vagus

Front 84

Chapman’s reflexes are small nodules of tissue texture change that are ___ in diameter, that demonstrate ___, ___ tenderness

Back 84

2-3 mm, sharp, pinpoint nonradiating

Front 85

The posterior tender points are treated, by applying ____in a slow circular fashion for 10 to 30 seconds until any associated tissue texture change resolves

Back 85

inhibitory pressure

Front 86

Where is the Chapman’s Reflexes for the Anterior Bronchial?

Back 86

Intercostal space between the 2nd and 3rd ribs close to the sternum

Front 87

Where is the Chapman’s Reflexes for the Posterior Bronchial?

Back 87

midway between the spinous process and the tips of the transverse processes at T2

Front 88

Where is the Chapman’s Reflexes for the Anterior Upper Lung?

Back 88

Intercostal space between the 3rd and 4th ribs close to the sternum

Front 89

Where is the Chapman’s Reflexes for the Posterior Upper Lung?

Back 89

midway between the spinous processes and the tips of the transverse processes of T3 and T4

Front 90

Where is the Chapman’s Reflexes for the Anterior Lower Lung?

Back 90

Intercostal space between the 4th and 5th ribs close to the sternum

Front 91

Where is the Chapman’s Reflexes for the Posterior Lower Lung?

Back 91

midway between the spinous processes and the tips of the transverse processes of T4 and T5

Front 92

In chronic respiratory diseases, like asthma and emphysema the accessory muscles of respiration develop an ___syndrome producing symptoms in the __ or __

Back 92

overuse ; neck or upper extremities

Front 93

The key areas to be evaluated in pulmonary disease are:

Back 93

"Occiput, C1, C2: vagus, parasympathetic (viscerosomatic/somato-visceral)
C3-5: phrenic nerve, motor and sensory diaphragm (somatosomatic)
Thoracolumbar junction and diaphragm (mechanical)
Thoracic outlet (mechanical)
Entire thoracic cage (mechanical).
T1-6: sympathetic for pulmonary tract (viscerosomatic/somato-visceral)
Chapman’s reflexes (viscerosomatic/somato-visceral)"

Front 94

Osteopathic treatment of the patient with pulmonary disease necessitates that you identify three areas of impact of somatic dysfunction

Back 94

"The mechanical effects
The neuro-reflex (parasympathetic and sympathetic) effects
The circulatory (arterial, venous, and lymphatic) effects
"

Front 95

Sympathetics vasoconstriction results in what to the Pulmonary system?

Back 95

"diminishes nutrient supply to the tissues (incl. medications)
reduces lymphaticovenous drainage"

Front 96

Parasympathetic hyperactivity of the pulmonary systems leads to ___

Back 96

"Bronchoconstriction
Pulmonary vasodilation
responsible for production of profuse, clear, thin secretions from the mucosa of the nasophayrnx and sinuses"

Front 97

What do the parasympathetics do to the bronchial glands?

Back 97

"Bronchial glands inhibited
Increased Ciliated/Goblet Ratio: Thinning of Mucous"

Front 98

"Thoracic Diaphragm motion increases the volume of the thorax in Three Planes of Motion
What are they?"

Back 98

"Inferior/Superior (limited by mediastinum)
*Transverse (Ribs 6-12, buck-handle motion)
*Anterior/Posterior (Ribs 1-5, pump-handle)
"

Front 99

What are the attachments of the diaphragm?

Back 99

"Xiphoid/Sternum
Ribs 6-12
Anterolateral surface of T12-L3"

Front 100

What are the Apertures of the Diaphragm?

Back 100

"Aorta
Lymphatics/Cisterna chyli
Inferior vena cava
Opens in inhalation
Esophagus (Hiatal hernia)
Closes in inhalation
"

Front 101

"Muscles for Quiet Ventilation
Exhalation
?
Inhalation
??
"

Back 101

"Quiet Ventilation
Exhalation
Passive - no muscular effort
Inhalation
Diaphragm
External Intercostal Muscles
"

Front 102

What are the muscles for Deep Inhalation?

Back 102

"Deep Inhalation
Diaphragm
External Intercostal mm
Scalene mm
Sternocleidomastoid mm
Levator Costorum mm
Serratus Posterior Superior mm
Levator Scapulae mm
Trapezius m
Rhomboid mm
Pectoralis major & minor mm
Serratus Anterior mm"

Front 103

What are the muscles needed for forced exhalation?

Back 103

"Exhalation
Quadratus Lumborum mm
Internal Intercostal mm
Subcostal mm
Transverse Thoracic mm
Serratus Posterior Inferior mm
Internal & External Abdominal Oblique mm
Rectus Abdominus mm"

Front 104

"Normal Quiet Respiration
___ of total body work"

Back 104

2-3%

Front 105

"Vigorous Exercise
___ of total body work"

Back 105

3-4%

Front 106

"Asthma and Other Pulmonary Diseases
Up to ___of total body work
Death results from exhaustion of the respiratory muscles, hypoventilation and subsequent hypoxia"

Back 106

33% ,

Front 107

What is the innervation and attachment of the Serratus anterior?

Back 107

"Long Thoracic Nerve
Upper eight ribs
Inferior angle of the scapula"

Front 108

Innervation and attachment of Sternocleidomastoid m.?

Back 108

"Innervated by Spinal Accessory Nerve
Manubrium of sternum
Lateral 1/3 of clavicle
"

Front 109

Accessory Muscles of Respiration Anterior for Forced exhalation

Back 109

"Rectus abdominus
Internal intercostals"

Front 110

Innervation and attachment of the Rectus abdominus m. ?

Back 110

"Innervated by lower 6 thoracic and first lumbar segmental nerve
5th, 6th & 7th Costal Cartilage above
Pubic symphysis below"

Front 111

Consequences of Somatic Restriction in Pulmonary Disease: Coughing

Back 111

"Exhaled rib dysfunctions
Pain in seratus anterior muscles"

Front 112

Consequences of Somatic Restriction in Pulmonary Disease: Scalene Overuse

Back 112

"Thoracic outlet syndrome
Cervical myositis"

Front 113

Consequences of Somatic Restriction in Pulmonary Disease: Poor Chest Cage Compliance

Back 113

"Restrictive pattern/lung disease
Correlation of pulmonary function tests"

Front 114

Consequences of Somatic Restriction in Pulmonary Disease: Upper Thoracic Dysfunction

Back 114

"Bronchiole hyperactivity
Wheezing/Dyspnea"