T2M2 Omm Test 2/9/07

Front 1

define a trigger point.

Back 1

area of hypersensitivity in a muscle; this muscle sends sensory pain information to the spinal cord where it then refers pain to some location. the area from which the pain arises is the trigger point

Front 2

the area that the trigger point refers pain to is called______?

Back 2

reference zone

Front 3

how far back does the idea that trigger points are associated with some internal pathology?

Back 3

back several millennia; the origin of TP is from Germany and Scandanavian countries

Front 4

Who and when spent 50 years researching and documenting pain patterns?

Back 4

Janet Travell, MD; 1940s

Front 5

who worked with the internist in co-authoring a book on trigger points? name the book.

Back 5

David G Simon, MD; Myofascial Pain and Dysfunction: The Trigger Point Manual

Hint 5

None

Front 6

If you were to biopsy an acute trigger point, what would you see?

Back 6

normal muscle

Front 7

If you were to biopsy a chronic trigger point, what would you see?

Back 7

muscle atrophy with fatty infiltration, increased number of nuclei per muscle fiber, fibrosis, serous exudates and abnormal mucopolysaccharide deposits

Front 8

Name the 3 types of trigger points.

Back 8

Active TP, Latent TP, and Tenderpoint

Front 9

what is the difference in the 3 types of trigger points?

Back 9

Active TP: hurts without touching it or when moving the involved muscle; Latent: hurts with digital stimulation; Tenderpoint: located at trigger point and tender to deep palpation, normal people are not tender to deep palpation

Front 10

how does one acquire a TP?

Back 10

same way you get somatic dysfunction or possibly a manifestation of somatic dysfunction

Front 11

What maintains the TP?

Back 11

MNMPCO: Mechanical Stress, Nutritional Inadequacies, Metabolic & Endo deficits; Psychological factors; Chronic infection or Infestation; Other factors

Front 12

List the mechanical stresses that maintain TP.

Back 12

poor posture, repetitive movements, short leg, short first long second toe (aka Morton's Foot); constriction of muscles, abuse of muscles, immobility, small hemipelvis, short upper arms

Front 13

List the nutritional inadequacies that maintain TP.

Back 13

lack of B1,B6,B12, folic acid, vitC, Mg2+, Fe, Ca, K+

Front 14

What metabolic or endo deficits can maintain a TP?

Back 14

hypothyroidism, hypoglycemia, gout

Front 15

What psychological factors can maintain TPs?

Back 15

Stoic personality (workaholic), hopelessness, depression

Front 16

What chronic infections can maintain TPs?

Back 16

Viral Dz, Bacterial Infections: UTIs, Sinusitis, Dental Infections

Front 17

What chronic infestations can maintain TPs?

Back 17

Diphyllobothrium latum (fish tapeworm); Giardia lamblia "Bever Fever"; Entamoeba histolytica

Front 18

Name some other factors that can maintain TPs?

Back 18

allergic rhinitis, impaired sleep, and nerve entrapments

Front 19

what are the steps in diagnosing a trigger Point?

Back 19

1. get pt to identify painful area; 2. use the reference charts to find out what muscles could contain TP that could produce that pain; 3) search each muscle for TP

Front 20

Trapezius, SCM(sternal), temporalis, and semispinalis capitis are the possible muscles involved in what type of pain?

Back 20

Temporal Headache

Front 21

SCM (clavicular and sternal), frontalis, and zygomaticus major are possible muscles involved in what type of pain?

Back 21

Frontal Headache

Front 22

What are the steps in treating a TP?

Back 22

1)do something to the TP (OMT,Physical Modalities, Injections; 2)stretch the muscle containing the TP, 3)recheck the TP

Front 23

What are some physical modalities shown to help relieve a TP?

Back 23

apply cold then stretch; U/S, Electrical Muscle Stim; Magnetic Therapy, Energy Techniques

Front 24

Name some things that are injected into TP to help relieve them.

Back 24

local anesthetics, corticosteroids, botox, opiates, ketorolac tromethamine (Toradol), sterile saline, bee venom, diazepam, Sarapin, dry needling

Front 25

What types of OMT help relieve TP?

Back 25

muscle energy, counterstrain, direct soft tissue/myofascial release, deep inhibitory pressure, percussion vibrator, correct the original segmental dysfunction that contains the TP

Hint 25

None

Front 26

what outcomes can one expect after treating a TP?

Back 26

1) total relief, 2)nearly total -mild, 3)step-like with repeated spraying, 4)no relief

Front 27

name the abnormalities or cranial dysfunctions that cause various symptoms.

Back 27

abnormal suture tension, abnormal dural tension, alteration of muscle origins and insertions, Cranial nerve entrapment and irritation, Alteration of arterial flow, reduction in venous drainage, alterations in CSF production, reabsorption and circulation

Front 28

the first cranial nerve passes through what bone to serve its purpose?

Back 28

olfactory nerve passes through the cribiform plate in the ethmoid bone

Front 29

What are some symptoms that occur when CN1 is entrapped or irritated?

Back 29

ansomia, hyperosmia, dysgeusia (can't taste)

Front 30

name the bones that can be dysfunctional in an olfactory nerve entrapment or irritation.

Back 30

Ethmoid, Frontal, sphenoid, nasal, vomer, maxillae

Front 31

through what passage does the optic nerve take to get to the eye?

Back 31

optic foramen in the lesser wing of the sphenoid

Front 32

What are some symptoms that occur when CN2 is entrapped, compressed, or irritated?

Back 32

blurry vision, visual dimming, photophobia

Front 33

name the bones that can be dysfunctional in an optic nerve entrapment or irritation.

Back 33

SPHENOID, occiput, parietal, temporal, frontal, ethmoid, zygoma, maxilla, and vomer

Front 34

discuss the tract the oculomotor nerve takes to get to the eye.

Back 34

midbrain over the anterior border of the tentorium at the petrous apex (where it is vulnerable to compression by external rotation of the temporal bone)--> then it passes through the cavernous sinus and exits the skull throught the superior orbital foramen between the lesser and greater wings of the sphenoid

Front 35

What are some symptoms that occur when CN3 is entrapped or irritated?

Back 35

eye twitching and/or a variety of ocular movement disorders

Front 36

What bone dysfunctions can cause CN3 to be symptomatic?

Back 36

problem between two wings of the sphenoid or any dysfunction of the sphenoid bone

Front 37

discuss the tract the trochlear nerve takes to get to the eye.

Back 37

off posterior midbrain --> through the anterior border of the tentorium (external rotation of the temporal bone can cause symptoms), then follows oculomotor nerve -->it passes through the cavernous sinus and exits the skull throught the superior orbital foramen between the lesser and greater wings of the sphenoid

Front 38

What are some symptoms that occur when CN4 is entrapped or irritated?

Back 38

weakness in the superior oblique muscle, diplopia, eye twitching

Front 39

What dysfunctions cause symptoms for the trochlear nerve?

Back 39

anything that tightens the tentorium - temporal external rotation; sphenoid or occipital dysfunctions

Front 40

where do the muscles of the orbit attach?

Back 40

onto a fibrous ring surrounding the optic nerve and attach around the optic foramen in the lesser wing of the sphenoid

Front 41

what drains the orbit and what dysfunctions cause symptoms?

Back 41

ophthalmic vein exits the optic foramen, then empties into the cavernous sinus. any dysfunctions of the sphenoid can create orbital venous congestion with resultant ocular pain, conjunctival injection, and swelling

Front 42

What are some symptoms that occur when CN5 is entrapped or irritated?

Back 42

trigeminal neuralgia, facial numbness, facial paresthesias, dental pain without dental dz, sinus pain without sinus dz, spasm or hypertonicity of the muscles of mastication, TMJ dysfunction

Front 43

Discuss the tract of the trigeminal nerve.

Back 43

pons--> over the petrous ridge beneath the anterior border of the tentorium --> 3 different branches go through the= V1: cavernous sinus --> superior orbital fissure --> supraorbital notch or foramen; V2: cavernous sinus --> inferior orbital fissure --> infraorbital notch in the maxilla, and V3: mandibular nerve --> foramen ovale passes b/w the tensor veli palantini and the lateral pterygoid muscles than enters the alveolar canal of the mandible.

Hint 43

None

Front 44

Cranial nerve V1 is susceptible to dysfunctions of what bones?

Back 44

frontal and sphenoid bones

Front 45

Cranial nerve V2 is susceptible to dysfunctions of what bones?

Back 45

sphenoid and maxilla

Front 46

Cranial nerve V3 is susceptible to dysfunctions of what bones?

Back 46

sphenoid, temporal, and mandible (temporal and mandible related to TMJ)

Front 47

what commonly follows dental extractions?

Back 47

trigeminal neuralgia

Front 48

How will the symptom pattern differ when extracting lower vs. upper teeth in producing trigeminal neuralgia?

Back 48

lower tooth pulled: neuralgia occurs on the opposite side; upper tooth pulled: neuralgia is on the same side as missing tooth; also,in trigeminal neuralgia, look for severly internally rotated temporal bones

Front 49

How will a newborn act if there are birth injuries?

Back 49

vomitting, excessive crying, colic, spasticity, sleeplessness, tremor, poor sucking and unable to latch onto nipple

Front 50

What bone/s is/are usually involved in birth injuries?

Back 50

sphenobasilar dysfunction or compression of the condylar parts of the occiput

Front 51

Discuss the tract of the hypoglossal nerve.

Back 51

brainstem--> hypoglossal canal(anterolateral to the occipital condyle) --> innervates the "midnight muscle"

Front 52

what can cause a dysfunctional hypoglossal nerve?

Back 52

compression of the condylar parts

Front 53

explain the path of the vagus nerve.

Back 53

brainstem --> exits cranium via jugular foramen (JF is in a suture b/w the occipital condyle and petrous temporal)

Front 54

what can cause a dysfunctional vagus nerve?

Back 54

any dysfxn of the suture containing jugular foramen can result in hyperparasympathecotonia. severe dysfxn can cause sufficient compression and cause sympathetic dominance - cuts out vagus/parasymp

Front 55

Through what foramen does 85% of the blood entering the cranium leave?

Back 55

jugular foramen

Front 56

impingement of the jugular foramen can cause what?

Back 56

general cerebral congestion, over distention of accessory circulation (Batson's Veins, Emissary Veins) and a wide range of cerebral, cervical, facial, and other symptoms.

Front 57

What nerves utilize the jugular foramen to exit the cranium?

Back 57

9,10,11 - glossopharyngeal, vagus, and accessory

Front 58

discuss the course of the spinal accessory nerve.

Back 58

originates from cervical spinal cord C1-C8 and enters the cranium via the foramen magnum and exits the cranium via the juglar foramen

Front 59

irritation of CN11 can cause what?

Back 59

congenital torticollis; if in an infant, compression can cause a floppy appearing baby that is unable to hold its head up at the appropriate age

Front 60

how does an asthmatic hold his/her head?

Back 60

they often show severe extension of the head with a high arched palate, creating nasal obstruction and mouth breathing

Front 61

what OMT technique is used for an acute asthmatic attack?

Back 61

CV-4; also, look for dysfunctions influencing the Vagus (hyperparasympathecotonia results in bronchoconstriction)

Front 62

what 3 things can be caused by a dysfunctional temporal bone?

Back 62

tinnitus, vertigo, and otitis media

Hint 62

None

Front 63

in regard to tinnitus, what type of rotation of the temporal bone will cause the eustachian tube to OPEN and create a LOW pitched roaring tinnitus?

Back 63

Externally rotated temporal bones cause the eust. to open and low pitched roaring tinnitus to occur

Front 64

in regard to tinnitus, what type of rotation of the temporal bone will cause the eustachian tube to CLOSE and create a HIGH pitched roaring tinnitus?

Back 64

INTERNALLY rotated temporal bones cause the eust. to CLOSE and and cause a HIGH pitched hum or ringing tinnitus to occur

Front 65

if vertigo is due to cranial somatic dysfunction, it is often due to what?

Back 65

dysfxn of temporal bone and associated cervical musculature; commonly one temporal bone is internal and the other is externally rotated

Front 66

Internal rotation of the temporal bones tend to _____ the eustachian tube and cause what?

Back 66

closed; high pitched tinnitus and chronic serous otitis media

Hint 66

None

Front 67

External rotation of the temporal bones tend to open the eustachian tube and cause what?

Back 67

low pitched tinnitus and a retrograde transit of food particles and liquids and result in recurrent acute otitis media

Front 68

what dysfunctions are associated with migraines?

Back 68

impaired jugular foramen and its venous drainage

Front 69

where in the cranium does the internal carotid enter?

Back 69

carotid canal in the temporal bone (the artery makes a right angle within the temporal bone)

Front 70

where in the cranium does the vertebral artery enter and what does it carry?

Back 70

foramen magnum and it carries sympathetic fibers to the posterior fossa region

Front 71

what bone is rotated what way in epilepsy?

Back 71

parietal bones are internally rotated

Front 72

if epilepsy follows a head injury, cranial manipulation may be ____________.

Back 72

curative

Front 73

do infantile seizures respond to cranial manipulation?

Back 73

No, they don't respond, it is NOT indicated

Hint 73

None

Front 74

cerebral palsy does not cause cranial somatic dysfunction but a co-existing cranial dysfunction may exist. should you treat it?

Back 74

if you find a dysfxn treat it. if there is no improvement after about 3 months of weekly tx, there never will be...discontinue

Front 75

Is treatment warranted with Post-concussion syndrome?

Back 75

yes, it may improve dramatically; the closer tx is to the time of concussion, the better; if not working after 3 months of weekly tx; discontinue

Front 76

What bones are possibly dysfunctional in sinusitis?

Back 76

ethmoid, maxillae, vomer, sphenoid, zygoma, temporalis, frontal, and palatines

Front 77

what time period after a stroke should you NOT do cranial manipulation?

Back 77

you should not preform cranial OMT on a stroke victim for the 1st 3 weeks - may lower ICP and cause bleeding

Front 78

Should you do cranial OMT on acute cerebral bleeds and infarcts?

Back 78

NO

Front 79

What are the indications for cranial OMT?

Back 79

1) presence of cranial somatic dysfunction; 2) absence of C/I to tx; 3) presence of symptoms which may resond to a cranial approach

Front 80

What is the epidemiology of temporomandibular dysfunction? What effect does age have on TMJ dysfunction?

Back 80

20% of pop'n has temporomandibular dysfunction (TMD); incidence of TMJ dysfunction increases with increasing age.

Front 81

What are the agreed upon symptoms of TMJ dysfunction?

Back 81

unilateral pain in or around the ear: pain may radiate to other areas of the head and neck, the pain increases during the day, the pain is exacerbated at mealtime.

Front 82

list common symptoms of TMJ (not the most agreed upon, but generally accepted)

Back 82

Tenderness of the masticatory muscles. Clicking or popping noises in the TMJ. the joint sound must be accompanied by pain. 50% of the population or more have "benign" TM Joint Sounds. Limited Range of Motion of the jaw; Lateral Deviation of the mandible on opening

Hint 82

None

Front 83

What are regional sxs in the TMJ joint attributed to TMJ dysfunction?

Back 83

TMJ joint clicking, popping, poor occlusal contact, crepitance, restricted range of motion, and pain.

Front 84

What are regional sxs in the ear attributed to TMJ dysfunction?

Back 84

conductive hearing loss, tinnitus, hissing, dizziness, vertigo, itching, pressure, fullness, earache, buzzing, stuffy sensation, loss of balance, otitis externa, and otitis media.

Front 85

What are regional sxs in the eye attributed to TMJ dysfunction?

Back 85

Nystagmus, eyelid twitching, diploplia, tearing, blurred vision, iritis.

Front 86

What are pains attributed to TMJ dysfunction?

Back 86

Headache, burning tongue, burning side of nose, shoulder, fingers, face, muscle tenderness, otalgia, burning throat, neck, arms, upper back, sinusitis, trigeminal neuralgia.

Front 87

What are miscellaneous sxs of TMJ dysfunction?

Back 87

dry mouth, difficulty swallowing, dyslexia, mental illness, parkinsonism, clicking of the teeth, sleep disorders, choking, snoring, nervousness, fatigue, speech difficulties, ADHD, bruxism, accelerated aging, periodontal disease, digestive disorders.

Front 88

What are the big 6 types of TMJ dysfunction? aka What are the main factors involved in getting a TMJ dysfunction?

Back 88

joint, teeth, muscles of mastication, cranium, cerival spine, psychological.

Hint 88

None

Front 89

Describe normal TMJ mechanics?

Back 89

with jaw slightly open one gets predominantly a hinge effect btw the condyle of the mandible and the articular meniscus. With full opening add to this a translatory gliding motion btw the meniscus and the temporal bone.

Front 90

What is the normal opening range of motion of the mouth?

Back 90

46-55mm

Hint 90

None

Front 91

What is the normal ROM for symmetric lateral excursion of the jaw?

Back 91

10-12mm

Front 92

What is the normal ROM for protrusion of the jaw?

Back 92

9-10mm

Front 93

What is the normal ROM for retraction of the jaw?

Back 93

highly variable from pt to pt

Front 94

What could cause a loss of gliding motion of jaw?

Back 94

articular meniscus may become adherent to the temporal bone with loss of the gliding motion.

Front 95

what could cause a loss of hinge motion of jaw?

Back 95

articular meniscus may become adjerent to the condyle of the mandible with loss of the hinge motion.

Front 96

Describe location palpation and normal joint motion of the TMJ?

Back 96

joint palpable placing index fingers in ear canals with pads facing anteriorly. pt instructed to open mouth slowly. Normally: smooth, synchronous, symmetric motion can be palpated in both joints simultaneously.

Hint 96

None

Front 97

Describe abnormal movements felt on palpation? How would the pain associate to the restricted side?

Back 97

an abnormal joint can be felt to move asymmetrically. often one joint is restrained in the temporal fossa while the other becomes hypermobile to compensate. often the pain occurs in the hypermobile joint structures while the real problem is on the OPPOSITE (restricted) side. Usu problem on side opposite pain and sxs.

Front 98

Describe the pathophysiology of a typical whiplash injury of the meniscus? What type of OMM would be contraindicated in this pt?

Back 98

typical whiplash injury can force the condyle of the mandible up against the articular eminence of the temporal bone and impact it into the meniscus. This also puts tremendous tension on the lateral pterygoid muscle and can result in stretching or rupture of the retrodiscal tissues. CAUTION: do not use traction for any reason.

Front 99

What are two outcomes of the typical whiplash injury?

Back 99

condyles can impact into the temporal bone's meniscus. then, the lateral pterygoid tenses and causes stretching or rupturing of the retrodiscual tissues. Stretching of the retrodiscal ligament then results in an anteriorly displaced meniscus with loss of condylar capture of the meniscus. The pt gets pain on opening the mouth and an opening "lock", a loss of ROM on opening with jaw deviation to the same side. Stretching or rupture of the pterygoid attachment to the meniscus can result in retrodisplacement of the meniscus. This causes pain on closing the mouth and a closing "lock", an inability to fully close the mouth.

Hint 99

None

Front 100

What would the treatment be for situations where menisceal capture is lost? How long is the treatment window period, and what happens after that time?

Back 100

Direct manipulation of the jaw to recapture the meniscus and guide it back into the fossa. This works within a short time (weeks) after loss of capture. If it is allowed to persist too long, fibrosis and shortening of soft tissue occurs and a surgical approach becomes the only option.

Front 101

What is the normal joint space distance of the TMJ, and what does smaller distance indicate?

Back 101

On plain x-ray the bone to bone distance across the TMJ measures 3mm. Smaller joint space indicates loss of capture of the meniscus or loss of articular cartilage.

Hint 101

None

Front 102

What is the effect lacking of posterior teeth?

Back 102

The posterior teeth are responsible for maintaining normal joint space in the TMJ. Loss of the posterior teeth without replacement will result in increased pressure across the joint and premature osteoarthritis.

Front 103

What is the effect of the cusps of the teeth not meshing normally?

Back 103

If the cusps of the teeth do not mesh normally, abnormal lateral and anterior-posterior gliding motions will be introduced. These additional motions can put stress on painful joint structures. They can also produce excessive stress on the muscles of mastication, and/or lead to the development of cranial somatic dysfunction.

Front 104

What are the ligaments that the mandible hangs from?

Back 104

In addition to the joint capsular structures, the mandible is suspended by two ligaments: stylomandibular ligament and sphenomandibular ligament.

Front 105

What are the effects of anterior head carriage?

Back 105

anterior head carriage increases the tension on the anterior strap muscles of the neck with attach to the hyoid bone and then to the mandible. This tends to pull the mouth open. Causes downward pull that is offset by temporalis, masseter, and medial pterygoid muscle pull upward. These muscles then become painful from overuse.

Front 106

What is the function of lateral pterygoid? medial pterygoid muscles in motion of jaw?

Back 106

lateral - jaw protrusion; medial - jaw closure.

Front 107

What does trigeminal nerve supply?

Back 107

sensory innvervation of the joint itself, capsule and ligaments. Motor supply to the muscles of mastication. sensory nuclues of the trigeminal extends out of the brain stem and down into the spinal chord. some 'authorities' place the lowest extent of the sensory nucleus anywhere from C3 to the C7 spinal chord levels.

Front 108

What level of spinal dysfunction is associated with TMJ dysfunction?

Back 108

cervical somatic dysfunction C3, C4, and C5 (midcervicals).

Front 109

If the facial nerve is involved secondarily in a TMJ dysfunction, what would be seen? in a severely involved case? how different from bell's palsy?

Back 109

Manifests as facial twitching or spasm of the mucles of facial expression. If severly involved, there may be weakness or drooping of the face on the side of involvement. This differs from Bells Palsy which is caused by swelling of the nerve within the facial canal of the temporal bone.

Front 110

What muscle straightens the eustachian tube? And what are the effects of hypertonicity of this muscle?

Back 110

Tensor valli palatini m. and hypertonicity results in prolonged opening of the eustachian tube. This can result in roaring tinnitus or recurrent middle ear infections due to retrograde passage of saliva and food particles up into the middle ear. The isthmus of the tube normally serves as a sort of valve to prevent this retrograde passage from occurring, closing the eustachian tube when the tensor valli palatini muscle relaxes.

Front 111

What innervates the tensor valli palatini m. and what are effects of increased tone?

Back 111

Innervated by a branch of the mandibular nerve, part of the trigeminal system. Increased trigeminal tone results in reflex hypertonicity of this muscle with prolonged opening of the eustachian tube.

Front 112

What are psychological factors that contribute to generalized muscle hypertonicity?

Back 112

anxiety, stress, depression

Front 113

Define bruxism.

Back 113

clenching or grinding of teeth. may be caused by pscychological stress causing severely dysfunctional cranium. Sometimes resolves once cranial restrictions are removed. Can be seen with anger - grinding teeth.

Front 114

What are other conditions that can cause TMJ dysfunction?

Back 114

it is a synovial joint and subject to all the dz of synovial joints (rhuematoid arthritis, etc.); muscles of mastication can be involved in muscular dz such as McArdle's dz and other rare muscle conditions; muscles are more commonly involved in diseases of the CNS neurologic origin. May manifest as jaw clonus. Clonus will occur in any muscle exhibiting spasticity of CNS origin

Front 115

Muscle spasm may also arise as a result of which metabolic diseases?

Back 115

hyperthyroidism, hypokalemia, hypocalcemia (produces muslce spasm in response to muscle percussion)

Front 116

What is the Chvostek sign?

Back 116

Hypocalcemia produces muscle spasm in respone to muscle percussion. sign of tetany. stimulate medial to the angle of the jaw

Hint 116

None

Front 117

what is the leading cause of disability in adults >65 yo?

Back 117

rheumatologic disease

Front 118

define rheumatologic disease.

Back 118

RD are acute and/or chronic conditions marked by MIP - muscle soreness and stiffness; inflammation; and pain in joints and associated structures.

Front 119

define arthritis.

Back 119

joint inflammation accompanied by pain, swelling, stiffness, and deformity

Front 120

What's difference in Rheumatic disease and arthritis?

Back 120

arthritis only affects joints; Rheumatic disease affects tissues and organs as well as joints

Front 121

What's difference in Rheumatic disease and rheumatic arthritis?

Back 121

rheumatic arthritis is a type of rheumatic disease; RA is an autoimmune disorder that involves multiple joints at the same time; pain is also worse in the morning

Front 122

list some Rheumatic diseases.

Back 122

osteoarthritis, rheumatoid arthritis, degenerative joint disease, ankylosing spondylitis, seronegative spondyarthropathies, Fibromyalgia, and Systemic Lupus Erythematosus, gout, bursitis, tendonitis, scleroderma, polymyositis (muscle inflam. and weakness), and polymyalgia rheumatica (involves muscle, tendons, ligaments, tissues around joints)

Front 123

in terms of rheumatic diseases, which one is most common?

Back 123

OA=15%; Fibromyalgia=2%; RA=1%, Ankylosing spondylitis=<0.4%; SLE= 0.015%

Front 124

which rheumatic diseases are most common in women?

Back 124

SLE 9:1; FM 9:1; RA 2-3:1; Scleroderma; the only ones that are men dominated are ankylosing spondylitis and gout

Front 125

when thinking about the history of a rheumatic patient, you think about the pattern of involvement. what is the difference in migratory and progressive?

Back 125

migratory is having pain subside in the joint before starting up in another joint; progressive is first joint stays painful while new joints become involved in the pain process

Front 126

What are the major consequences of having a rheumatic disease?

Back 126

DISUSE MUSCLE ATROPHY; INTERFERENCE WITH ADLs; pain, pain equivalents, numbness, muscle spasm, chronically increased muscle tone, depression

Front 127

What do you do in a Physical exam when faced with a rheumatic disease?

Back 127

passive joint motion testing; LABS: CBC, Chem panal, u/a, RF, ESR, ANA (possibly a synovial fluid exam and/or autoantibody and immune assay); X-RAYs, U/S, MRI, CT

Front 128

What are some pitfalls of diagnosing a rheumatic disease?

Back 128

RA pts can have a +ANA; ANA is anti-nuclear antibody which is + in autoimmune disorder(double stranded ANA is specific to SLE); Pts>60 y/o can be RF+ in absence of RA; ESR only tells you there is inflammation, not specific;

Hint 128

None

Front 129

describe arthritis.

Back 129

most common arthritis is osteoarthritis; it affects cartilage, involves weight-bearing joints, difficulty using a joint normally, warmth and redness in a joint

Front 130

describe RA.

Back 130

multi-systemic autoimmune inflammatory disease. primarily in the synovium and results in premature death; fatigue, low-grade fevers, mild to moderate anemia, pleural/pericardial effusions (serositis), multisystemic vasculitis

Front 131

List the American College of Rheumatology's diagnostic criteria for RA.

Back 131

a min. of 6 weeks of at least 4 of the 7: 1)morning stiffness for at least one hour, 2)simultaneous soft tissue swelling in 3 or more joint groups 3)radiographic evidence of RA bone erosions in the wrist and hands, 4)hands joints must be involved 5)+RF 6)rheumatoid nodules 7)symmetric joint involvement

Front 132

Describe gout.

Back 132

monosodium urate crystals get deposited in articular cartilage of joints and tendons; commonly affects males 1st MTP (big toe)

Front 133

Name this seronegative spondyloarthropathy (-RF). most affects males' spines, +sacroilitis, +peripheral inflammatory arthritis, HLA-B27.

Back 133

ankylosing sponkylitis - hips, shoulders, knees may also be involved; tendons and ligaments around bones and joints become inflamed

Hint 133

None

Front 134

Name this potentially debilitating autoimmune disease. affects mostly women, attacks the body's cells and tissue, resulting in inflammation and tissue damage. polyarthritis with characteristic butterfly rash. can affect any part of the body but most often harms the heart, joints (hands, wrists, and knees most commonly), skin, lungs, blood vessels, liver, kidney, and CNS.

Back 134

Systemic Lupus erythematosus

Front 135

This disease involves chronic widespread musculoskeletal pain, stiffness, paresthesias, disturbed sleep, easily fatigued, with multiple painful tenderpoints.

Back 135

Fibromyalgia

Front 136

What is unique in the rheumatic disease, Fibromyalgia?

Back 136

there is no inflammation, connective tissue, or diagnostic muscle abnormalities

Front 137

What can trigger Fibromyalgia?

Back 137

Pathogenesis is unknown; triggered by emotional stress, infections and other medical illness, surgery, HYPOthyroidism, Trauma

Front 138

What four diseases are associated with the HLA-B27 (not in OMM lecture - freebie)?

Back 138

"PAIR" = Psorasis, Ankylosing Spondylitis, Inflammatory Bowel Disease, and Reiter's Syndrome

Front 139

What 2 diagnosis overlap with the diagnosis of Fibromyalgia?

Back 139

Chronic Fatigue Syndrome and Depression

Front 140

List the co-morbid conditions with Fibromyalgia?

Back 140

IBS, irritable bladder, headaches, dysmenorrhea, PMS, RLS, TMJ, non-cardiac chest pain

Front 141

List the classification criteria for fibromyalgia.

Back 141

history of widespread pain with all of the following: Pain in left and right side of the body, Pain above and below the waist, and Axial skeletal pain (in any of: cerivcal spine, anterior chest, thoracic spine, low back) Must also have pain on palpation of at least 11 of the 18 tenderpoints (there are 9, but it is bilateral): 1. occiput:suboccipital muscle insertion; 2)low cervical, anterior aspect of intertransverse space C5-C7; 3)trapezius, midpoint upper border; 4) supraspinatus, above scapular spine near medial border; 5)2nd rib; 6)lateral epicondyle; 7)gluteal, upper outer quadrant of butt; 8) greater trochanter 9)knee, medial fat pad

Front 142

How do you treat Fibromyalgia?

Back 142

1)improve quality of sleep with tricyclics (amitriptyline or nortriptyline); 2)next treat depression and anxiety (beware of non-compliance); 3)exercise prescription; 4)NSAIDs, partial improvement; 5)Tylenol, Tramedol for pain; 6) Gabapentin; 7)heat,massage, TP injection; 8) biofeedback, hypnotherapy, stress management 9)identify life stresses and discuss NOT Helpful or of little use: corticosteroids (not inflammatory) and opiate analgesics

Front 143

What are the general treatments of Rheumatic Diseases?

Back 143

NSAIDs (ibuprofen, naproxen sodium, aspirin - monitor s/e with aspirin), Corticosteriods, DMARDs (Disease modifying anti-rheumatic drugs), surgery, OMT

Front 144

List the possible side-effects of NSAIDs.

Back 144

GI toxicity or bleeding, Renal Toxicity (this is how most are eliminated), platelet dysfunction, hypersensitivity reactions

Front 145

If a rheumatic disease pt is unresponsive to NSAIDs, what is the next step? also list this treatment's side-effects.

Back 145

corticosteroid injections (good for neg long-term s/e), Orally - low dose of prednisone (5-20mg) then progress to 1-2mg/kg qd if needed. side-effects: adrenal suppression, immunosuppression, endocrine abnormalities (cushingnoid), M/S problems like osteopenia, steroid myopathy, ischemic bone necrosis, mental status changes, and ocular effects (can increase IOP and cause glaucoma)

Front 146

What DMARD (tx for rheumatic diseases) is the most widely used and effective for long-term treatment of RA? list it's side-effects.

Back 146

Methotrexate; s/e: hepatotoxicity, bone marrow suppression, oral ulcers, life-threatening pneumonitis (take 1mgqd of Folic acid to reduce methotrexate toxicity)

Front 147

List the 3 DMARDS used to treat RA.

Back 147

Methotrexate (MC used), Enbrel (recombinant TNF receptor inhibitor for severe RA), and cyclosporin (immunosuppressant for refractory RA).

Front 148

What are the indications for tx an RA pt with Enbrel?

Back 148

severe RA that is highly effective at controlling the symptoms and disease progression with a low toxicity; however, it is very expensive and potentially can induce cancer and infections

Front 149

What are the side-effects of the immunosuppressant cyclosporin (used for tx refractory RA)?

Back 149

renal tox, hypertension, liver dysfunction, and oncogenicity

Front 150

in regard to rheumatic diseases and surgery, what devices give excellent results?

Back 150

hip and knee prosthetic devices

Front 151

List common OMT for Rheumatic diseases.

Back 151

1)soft tissue OMT to periarticular tissues improves blood flow and decreases hypersympathetic activity; 2)segmental facilitation; 3)indirect stacking for tender, inflammed tissues; 4)Liver and Gallbladder pumps; 5)lymphatic drainage; 6)CV4 (also good for asthmatics); 7)non-weight-bearing compression of joint surfaces improves local nutrition and decreased stiffness (RA hallmark) 8) treat the GI system if affected by NSAIDs DO NOT do CERVICAL HVLA; there is a high incidence of weakened cruciate ligaments with potential pathologic subluxations

Front 152

How is the prognosis for recovery for rheumatologic diseases?

Back 152

there is NO CURE; treat symptoms, improve functioning, and improve sense of well-being with pharmacology and OMT

Front 153

if the articular meniscus of the TMJ becomes adherent to the temporal bone one loses _________ motion. if the articular meniscus becomes adherent to the mandible's condyles, then you lose the _________ motion.

Back 153

adherent to temporal bone - lose GLIDING (would be difficult to fully open mouth); adherent to condyle - lose HINGE (difficult to slightly open mouth)

Front 154

when the jaw is slightly open, the normal motion is ___________. when the jaw if fully opened, the motion is _____________.

Back 154

slighty open - hinge; fully open - gliding

Front 155

a whiplash injury does what to the mandible and pterygoid muscles?

Back 155

whiplash can force the condyles up against the articular eminence and impact them into the meniscus of the temporal bone; it can also stretch or rupture the retrodiscal tissues of the lateral pterygoid muscle

Hint 155

None

Front 156

on a plain x-ray, if the distance across the TMJ measures less than 3mm there is either loss of __________ or loss of __________.

Back 156

loss of capture or loss of articular cartilage

Front 157

what TMJ problems can result in premature osteoarthritis, indicated by a beak appearance of the condyle?

Back 157

torn or perforated meniscus and/or lack of posterior teeth without replacement

Front 158

what 4 things will tend to pull the mouth open?

Back 158

asthma, whiplash, and anterior head carriage (and of course, hatchet face due to myotonic dystrophy - another freebie)

Front 159

an open eustachian tube can be caused by what factors?

Back 159

hypertonicity of the tensor velli palatini muscle; external rotation of the temporal bone = all may cause a low-pitched roaring tinnitus and possibly lead to retrograde materials getting into middle ear and causing otits media

Front 160

often the pain that occurs in TMJ occurs on the __________ while the real problem is on the ___________ (restricted) side.

Back 160

hypermobile side; opposite (the joint that is restrained in the temporal fossa)