DOCSLIB.ORG

OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives OMM PRACTICAL EXAM Saroj Misra, DO, FACOFP Rachel Nixon, DO Marissa Rogers, DO Family Medicine Goals/Objectives • Review Exam Day procedure • Understand scoring process • Discuss possible cases and 2 OMM techniques that may be used for each case Disclaimer: The material being presented is NOT necessarily identical to what will be tested upon. We are not affiliated with the actual exam. This is our approach to the practical exam material. EXAM DAY Exam day • You will be assigned a time slot based on your last name • You will select a partner within your time slot • May not partner with a spouse or relative • You will be asked to sign a waiver stating that if you choose to do HVLA you will not perform the corrective “thrust” • You will then stand in line with your partner and await entering the testing room Exam day • There will be two rooms - one in which you will review cases and the second where you will be tested • Once you enter the first room you will not be able to leave • If you DO leave, both you and your partner will be given new cases Exam day • You will be given 3 cases: • Spine • Extremities • Systemic Disease • You will enter your name, ID number and your partners ID number on each case before turning them over Exam day • Each case will have the following information: • HPI • PMH • PSH • FHx • SocHx • There will be multiple choice for the best answer for your diagnosis • You will have 20 minutes to choose the best answer and plan a treatment strategy for each of your cases Exam day • After the 20 minutes are complete, you will be moved into testing area and proceed to the first testing station where you and your partner will present your first cases • If you selected the incorrect answer, you will be given the correct diagnosis and asked to do OMT for the correct dx • You and your partner will each have 5 minutes to demonstrate and discuss OMT for your first case • You will then move with your partner to the next two stations where you will repeat the same process for your second and third cases Exam day • You may be asked to diagnose the specified area on your partner • Set up the treatment you would like to use and describe how you would perform the treatment • You will not actually treat your partner • They will check your hand placement so be sure to be accurate with placing your hands and with what you are feeling for Exam day • Once you have completed your treatment… • RECHECK • RECHECK • RECHECK • And don’t forget to RECHECK!!! Scoring criteria • For each case you will be scored on: • Correct diagnosis • Identification of landmarks for your technique • Implementation and demonstration of the technique • Ability to discuss each technique • To pass the exam, you must pass two of the three cases • If you do an HVLA “thrust” you will immediately fail the exam Common questions… • What if I don’t do the treatment correctly on a case? • The proctor may ask you to perform an additional technique • However, they may ask for another technique even if you did the first correctly • What if I don’t pass the exam? • You will retake the exam later in the day Head Commonly Cervical Spine tested areas Thoracic Spine Lumbar Spine Ribs Extremities CASES Case 1: Head • HPI: 31 year old female who is 29 weeks pregnant presents with facial pain, nasal drainage and a tender rib. Exam reveals tenderness to palpation over frontal and maxillary sinuses • Dx: Sinusitis/Sinus Congestion • DDx: Cephalgia, Rib dysfunction http://vitamin-resource.com/sinusitis-detecting-it.html Case 1: Sinusitis/Sinus congestion Treatment option 1 • OA Release - affects parasympathetic nervous system to thin nasal secretions and releases tension at OA • Patient supine with examiner at head of table. Slide hands down posterior skull to where you feel the softening of the tissues at the OA junction. Apply a gentle tension towards the patient eyes while gently applying cephalward traction - allowing the occiput to fall into the palm of your hands. Respiratory effort may be added • Hold until a release is felt or there is softening of the surrounding tissues • RECHECK Case 1: Sinus congestion/Sinusitis Treatment option 2 • Sinus Effleurage - decreases lymphatic congestion and assists in drainage • Patient supine, examiner at head of table. Place the dorsal surface of your thumbs on the lateral sides of the middle of the forehead just above the glabella. Apply just enough pressure downward to compress the tissues against the deep fascia of the head. Stroke the thumbs laterally and down towards chin. Repeat 3-4 times over frontal and maxillary sinuses. • RECHECK • May want to mention that you would open the thoracic inlet first so drainage has somewhere to go Case 2: Head • HPI: A 47 year old female presents with jaw pain, HA, B/ L ear pain. She reports recently having a crown put in. Exam shows B/L tenderness anterior to tragus with difficulty opening the mouth. • Dx: TMJ Dysfunction http://www.physiownc.com/tmj-treatment/#.UshyGXl3TwI • DDx: Tension Cephalgia, Dental abscess Case 2: TMJ Dysfunction Treatment option 1 • Counterstrain to muscles of mastication (Masseter): decreases tension of Masseter muscle • Patient lies supine with examiner at the head of the table. Tenderpoint is found just inferior to the zygoma in the belly of the masseter muscle on the side of the mandibular deviation. The examiner gently opens the patients jaw slightly and gently glides the patients jaw toward the side of the tender point. Fine tune positioning until tenderness is alleviated or at least reduced by 70% • Hold for 90 seconds or until a release is felt • Return jaw to neutral and RECHECK Atlas of Osteopathic Techniques, Nicholas Case 2: TMJ Dysfunction Treatment option 2 • ME to jaw dysfunction: decrease pain/ tension at TMJ, improve ROM of jaw • Jaw opening dysfunction: Patient supine, examiner at head of table. Hold patients mouth closed while patient attempts to gently open jaw against resistance. Repeat 3-5 times. RECHECK • Jaw closing dysfunction: Patient supine, examiner at head of table. Hold patients mouth open slightly, while patient attempts to gently close against resistance. Repeat 3-5 times. RECHECK • Jaw Lateral Deviation Dysfunction: Patient supine, examiner at head of table. Hold patients jaw slightly away from the affected side, while patient gently exerts force back toward neutral against resistance. Repeat 3-5 times. RECHECK Case 3: Cervical Spine • HPI: 32 y/o male presents with 2 year history of cephalgia. No hx of trauma or neuro deficits. On exam, C2- C6 prefers flexion and does not want to rotate right. • Dx: C2-6 FRLSL Somatic Dysfunction • DDx: Tension Cephalgia, C- spine strain/sprain http://www.advanced-wellness.net/blog/can-a-chiropractor-relieve-your-headache/ Case 3: Cervical dysfunction Treatment option 1 • Muscle Energy: decrease muscle tension, increase ROM • Treatment will be ERS right. Patient supine, examiner at head of table. Place thumb on the margin of the right articular pillar and push to column to the left inducing right side bending. Use the other hand to hold the head and induce extension to localize. Have patient push head isometrically to the left against resistance. Take up slack and repeat 3-5 times. • RECHECK Atlas of Osteopathic Techniques, Nicholas Case 3: Cervical dysfunction Treatment option 2 • Counterstrain to posterior cervical spine: decrease tension of associated cervical muscles • Patient supine, examiner at head of table. Tenderpoint can be found along posterior lateral aspect of articular process of associated dysfunctional segement. Extend patients head and neck to level of dysfxn segment. Add side bending and rotation away. Fine tune position until tenderness is alleviated or there is 70% reduction. • Hold for 90 seconds or until a release is felt. • Return to neutral and RECHECK Atlas of Osteopathic Techniques, Nicholas Case 4: Cervical Spine • HPI: 40 y/o male presents with neck pain after MVA 5 days ago. X-rays are negative. On exam, C3-6 are tender b/l and there is decreased lordosis. No increase of pain with addition of axial load. • Dx: C3-6 Flexed • DDx: C-spine strain, Tension cephalgia http://www.lwcmanhattan.com/my-symptoms/neck-pain/ Case 4: Cervical flexion Treatment option 1 • Muscle Energy: Decrease tension, increase ROM • Patient supine, examiner at head of table. Place middle phalanx of index finger of one hand midline at the interspinous space of middle of dysfunctional segments. Reinforce with index finger of other hand. Rest patients head on table while inducing extension to restrictive barrier. Have patient gently flex head against resistance. Take up slack and repeat 3-5 times. • RECHECK Case 4: Cervical flexion Treatment option 2 • Counterstrain to posterior cervical spine: decrease tension of associated cervical muscles • Patient supine, examiner at head of table. Tenderpoint can be found along posterior lateral aspect of articular process of associated dysfunctional segement. Extend patients head and neck to level of dysfxn segment. Add side bending and rotation away. Fine tune position until tenderness is alleviated or there is 70% reduction. • Hold for 90 seconds or until a release is felt. • Return to neutral and RECHECK Atlas of Osteopathic Techniques, Nicholas Case 5: Thoracic spine • HPI: 42 y/o male who presents with pain and tingling in the left shoulder and arm. He denies trauma and injury. Exam revelas Tinel’s, and Phalen’s tests are negative. • Dx: • Thoracic outlet syndrome • DDx: First rib dysfunction, C- Spine dysfunction http://www.howardluksmd.com/shoulder-faq/what-are-the- most-common-causes-of-shoulder-pain-rotator-cuff-labral-tears/ Case 5: Thoracic Outlet Syndrome Treatment option 1 • Thoracic Inlet Release: Releases facial tension, decreases pain • Patient supine, examiner at head of table.
Load more

Recommended publications
  • Diapositiva 1
    Thoracic Cage and Thoracic Inlet Professor Dr. Mario Edgar Fernández. Parts of the body The Thorax Is the part of the trunk betwen the neck and abdomen. Commonly the term chest is used as a synonym for thorax, but it is incorrect. Consisting of the thoracic cavity, its contents, and the wall that surrounds it. The thoracic cavity is divided into 3 compartments: The central mediastinus. And the right and left pulmonary cavities. Thoracic Cage The thoracic skeleton forms the osteocartilaginous thoracic cage. Anterior view. Thoracic Cage Posterior view. Summary: 1. Bones of thoracic cage: (thoracic vertebrae, ribs, and sternum). 2. Joints of thoracic cage: (intervertebral joints, costovertebral joints, and sternocostal joints) 3. Movements of thoracic wall. 4. Thoracic cage. Thoracic apertures: (superior thoracic aperture or thoracic inlet, and inferior thoracic aperture). Goals of the classes Identify and describe the bones of the thoracic cage. Identify and describe the joints of thoracic cage. Describe de thoracic cage. Describe the thoracic inlet and identify the structures passing through. Vertebral Column or Spine 7 cervical. 12 thoracic. 5 lumbar. 5 sacral 3-4 coccygeal Vertebrae That bones are irregular, 33 in number, and received the names acording to the position which they occupy. The vertebrae in the upper 3 regions of spine are separate throughout the whole of life, but in sacral anda coccygeal regions are in the adult firmly united in 2 differents bones: sacrum and coccyx. Thoracic vertebrae Each vertebrae consist of 2 essential parts: An anterior solid segment: vertebral body. The arch is posterior an formed of 2 pedicles, 2 laminae supporting 7 processes, and surrounding a vertebral foramen.
    [Show full text]
  • Ligaments of the Costovertebral Joints Including Biomechanics, Innervations, and Clinical Applications: a Comprehensive Review W
    Open Access Review Article DOI: 10.7759/cureus.874 Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine Erfanul Saker 1 , Rachel A. Graham 2 , Renee Nicholas 3 , Anthony V. D’Antoni 2 , Marios Loukas 1 , Rod J. Oskouian 4 , R. Shane Tubbs 5 1. Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies 2. Department of Anatomy, The Sophie Davis School of Biomedical Education 3. Department of Physical Therapy, Samford University 4. Neurosurgery, Complex Spine, Swedish Neuroscience Institute 5. Neurosurgery, Seattle Science Foundation Corresponding author: Erfanul Saker, [email protected] Abstract Few studies have examined the costovertebral joint and its ligaments in detail. Therefore, the following review was performed to better elucidate their anatomy, function and involvement in pathology. Standard search engines were used to find studies concerning the costovertebral joints and ligaments. These often- overlooked ligaments of the body serve important functions in maintaining appropriate alignment between the ribs and spine. With an increasing interest in minimally invasive approaches to the thoracic spine and an improved understanding of the function and innervation of these ligaments, surgeons and clinicians should have a good working knowledge of these structures. Categories: Neurosurgery, Orthopedics, Rheumatology Keywords: costovertebral joint, spine, anatomy, thoracic Introduction And Background The costovertebral joint ligaments are relatively unknown and frequently overlooked anatomical structures [1]. Although small and short in size, they are abundant, comprising 108 costovertebral ligaments in the normal human thoracic spine, and they are essential to its stability and function [2-3].
    [Show full text]
  • Of the Pediatric Mediastinum
    MRI of the Pediatric Mediastinum Dianna M. E. Bardo, MD Director of Body MR & Co-Director of the 3D Innovation Lab Disclosures Consultant & Speakers Bureau – honoraria Koninklijke Philips Healthcare N V Author – royalties Thieme Publishing Springer Publishing Mediastinum - Anatomy Superior Mediastinum thoracic inlet to thoracic plane thoracic plane to diaphragm Inferior Mediastinum lateral – pleural surface anterior – sternum posterior – vertebral bodies Mediastinum - Anatomy Anterior T4 Mediastinum pericardium to sternum Middle Mediastinum pericardial sac Posterior Mediastinum vertebral bodies to pericardium lateral – pleural surface superior – thoracic inlet inferior - diaphragm Mediastinum – MR Challenges Motion Cardiac ECG – gating/triggering Breathing Respiratory navigation Artifacts Intubation – LMA Surgical / Interventional materials Mediastinum – MR Sequences ECG gated/triggered sequences SSFP – black blood SE – IR – GRE Non- ECG gated/triggered sequences mDIXON (W, F, IP, OP), eTHRIVE, turbo SE, STIR, DWI Respiratory – triggered, radially acquired T2W MultiVane, BLADE, PROPELLER Mediastinum – MR Sequences MRA / MRV REACT – non Gd enhanced Gd enhanced sequences THRIVE, mDIXON, mDIXON XD Mediastinum – Contents Superior Mediastinum PVT Left BATTLE: Phrenic nerve Vagus nerve Structures at the level of the sternal angle Thoracic duct Left recurrent laryngeal nerve (not the right) CLAPTRAP Brachiocephalic veins Cardiac plexus Aortic arch (and its 3 branches) Ligamentum arteriosum Thymus Aortic arch (inner concavity) Trachea Pulmonary
    [Show full text]
  • Chapter 21 Fractures of the Upper Thoracic Spine: Approaches and Surgical Management
    Chapter 21 Fractures of the Upper Thoracic Spine: Approaches and Surgical Management Sean D Christie, M.D., John Song, M.D., and Richard G Fessler, M.D., Ph.D. INTRODUCTION Fractures occurring in the thoracic region account for approximately 17 to 23% of all traumatic spinal fractures (1), with 22% of traumatic spinal fractures occurring between T1 and T4 (16). More than half of these fractures result in neurological injury, and almost three-quarters of those impaired suffer from complete paralysis. Obtaining surgical access to the anterior vertebral elements of the upper thoracic vertebrae (T1–T6) presents a unique anatomic challenge. The thoracic cage, which narrows significantly as it approaches the thoracic inlet, has an intimate association between the vertebral column and the superior mediastinal structures. The supraclavicular, transmanubrial, transthoracic, and lateral parascapular extrapleural approaches each provide access to the anterior vertebral elements of the upper thoracic vertebrae. However, each of these approaches has distinct advantages and disadvantages and their use should be tailored to each individual patient’s situation. This chapter reviews these surgical approaches. Traditional posterior approaches are illustrated in Figure 21.1, but will not be discussed in depth here. ANATOMIC CONSIDERATIONS AND STABILITY The upper thoracic spine possesses unique anatomic and biomechanical properties. The anterior aspects of the vertebral bodies are smaller than the posterior aspects, which contribute to the physiological kyphosis present in this region of the spine. Furthermore, this orientation results in a ventrally positioned axis of rotation, predisposing this region to compression injuries. The combination and interaction of the vertebral bodies, ribs, and sternum increase the inherent biomechanical stability of this segment of the spine to 2 to 3 times that of the thoracolumbar junction.
    [Show full text]
  • 1 the Thoracic Wall I
    AAA_C01 12/13/05 10:29 Page 8 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 8 The thorax The thoracic wall I AAA_C01 12/13/05 10:29 Page 9 The thoracic cage Costal cartilages The thoracic cage is formed by the sternum and costal cartilages These are bars of hyaline cartilage which connect the upper in front, the vertebral column behind and the ribs and intercostal seven ribs directly to the sternum and the 8th, 9th and 10th ribs spaces laterally. to the cartilage immediately above. It is separated from the abdominal cavity by the diaphragm and communicates superiorly with the root of the neck through Joints of the thoracic cage (Figs 1.1 and 1.4) the thoracic inlet (Fig.
    [Show full text]
  • Neurogenic Thoracic Outlet Syndrome
    NEUROGENIC THORACIC OUTLET SYNDROME Karl A. Illig, MD, and Mathew Wooster, MD Perhaps no condition treated by vascular surgeons has been up undergoing thoracic outlet decompression. Although associated with more confusion, subjectivity, and nihilism at least two high outliers exist (Denver and St. Louis, with than neurogenic thoracic outlet syndrome (NTOS). Why is UCLA, Johns Hopkins, and several other practices also candi- this, a nerve compression syndrome, even treated by vascular dates), it is estimated that the 10 or 15 high-volume American surgeons? How is it diagnosed, and what other conditions TOS centers perform between 30 and 50 first rib excisions mimic its symptoms? Who should undergo treatment, and yearly, 75% or so for neurogenic symptoms. what exactly does treatment consist of? Is it a real entity or Although several notable thoracic surgeons and neuro- simply just one end of a continuum that is probably just a part surgeons have significant interest in NTOS, the vast majority of normal physiology? of these cases are treated by vascular surgeons. The reasons are The thoracic outlet is the area of the body at the base of the obscure, but almost certainly a large part of this arose from the neck and upper chest and shoulder region that contains the fact that “vascular” TOS —arterial and, more recently, venous nerves, artery, and vein as they pass from the upper extrem- pathology—was the first form to be recognized, and vascular ity to the spine and thorax [see Figure 1]. Each of these three surgeons initiated investigation and treatment of problems in structures can be compressed by abnormal anatomy in one of this area.
    [Show full text]
  • THE ANATOMY of the THORAX in RELATION to the FLOW of TIDAL AIR Lecture Delivered at the Symposium Held by the Faculty of Anesthetists on 21St February, 1953 by G
    THE ANATOMY OF THE THORAX IN RELATION TO THE FLOW OF TIDAL AIR Lecture delivered at the symposium held by the Faculty of Anesthetists on 21st February, 1953 by G. Causey, F.R.C.S. Sir William Collins Professor of Human and Comparative Anatomy, Royal College of Surgeons. That the thoracic cavity increases in volume during inspiration and decreases in volume during expiration is accepted by all, but exactly how this change in volume is brought about is by no means clear. On almost all points, whether of rib movements, of intercostal muscle activity, or of the quantitative contribution by the diaphragm, different and often opposing views are expressed. It may seem that enough has been written on the subject already, but I believe that, with the increasing use of muscular relaxants and controlled respiration in man, the search for a logically consistent hypothesis to explain the respiratory movements is not only an intellectual exercise, but a practical necessity. The bony skeleton of the thorax is formed by the thoracic vertebra, 12 pairs of ribs and their costal cartilages, and the sternum. The gaps in this bony skeleton are filled with fibrous and muscular tissues-the intercostal muscles and membranes at the side, the diaphragm below and the suprapleural (Sibson's) fascia, backed by the scalene muscles above. To the inside of this cavity, the outer surface of the lung is firmly held by the surface tension of the pleural fluid that needs a force of some 3600 mm.hg. per sq. cm. to break it. Every increase in the volume of this cavity is transmitted to the underlying lung and, assuming that the airway is patent, will draw air into the alveoli.
    [Show full text]
  • Thoracic Outlet Syndrome Anaesthesia Tutorial of the Week 286
    Sign up to receive ATOTW weekly - email [email protected] THORACIC OUTLET SYNDROME ANAESTHESIA TUTORIAL OF THE WEEK 286 17TH JUNE 2013 Dr Sandeep Kusre, Dr Richard Telford Royal Devon & Exeter Hospital, United Kingdom Correspondence to [email protected] QUESTIONS Before continuing, try to answer the following questions. The answers can be found at the end of the article, together with an explanation. 1. Which of the following are transmitted through the thoracic outlet? a. Internal jugular vein b. Thoracic duct c. Trachea d. Oesophagus e. Brachial plexus 2. List 5 different causes of thoracic outlet syndrome. 3. The following are important anaesthetic considerations in surgical correction of thoracic outlet syndrome. a. Risk of haemorrhage b. Risk of air embolus c. Invasive monitoring with an arterial line is often required d. Post-operative bleeding will be seen by closely monitoring losses into drains e. All patients should have a chest x-ray performed in recovery INTRODUCTION Thoracic outlet syndrome (TOS) refers to a constellation of symptoms caused by compression of the neurovascular bundle of the upper limb as they pass between the uppermost rib and clavicle en route to the axilla. Precise symptoms depend on the component affected – the brachial plexus, subclavian artery or subclavian vein – giving rise to neurogenic, arterial or venous TOS, respective AETIOLOGY Compression of the neurovascular bundle can be caused by congenital or acquired soft tissue and bony abnormalities. (table 1) Any process that narrows the passage through which these important neurovascular structures pass can lead to symptoms of thoracic outlet syndrome. Major locations of compression of the neurovascular structures include over the first rib, behind pectoralis minor and within the scalene muscle triangle.
    [Show full text]
  • An Osteopathic Approach Bridget E
    Lymphatic Complaints in the Dermatology Clinic: An Osteopathic Approach Bridget E. McIlwee, DO,* Jenifer R. Lloyd, DO,** Michael P. Rowane, DO, MS, FAAFP, FAAO*** *Dermatology Resident, OGME-3, University of North Texas Health Science Center/TCOM, Fort Worth, TX **Director, Dermatology Residency Program, University Hospitals Regional Hospitals; Department of Dermatology, Case Western Reserve University, Cleveland, OH ***Associate Clinical Professor of Family Medicine and Psychiatry, Case Western Reserve University; Director of Medical Education, University Hospitals Regional Hospitals; Director of Osteopathic Medical Education, University Hospitals Case Medical Center, Cleveland, OH Abstract The number of patients presenting to dermatologists with lymphatic complaints continues to grow, given our aging population and the increasing prevalence of predisposing chronic medical conditions. Sequelae may include pain, stasis skin changes, and chronic wounds. Lymphatic conditions impose a physical and psychological burden on patients, as well as a financial strain on both patients and the medical system. The medical community is in need of cost- and time-effective treatment measures. Osteopathic dermatologists are uniquely suited to meet this need through our training in osteopathic lymphatic manipulative treatment techniques. These techniques are suitable for use as primary or adjunct treatments for lymphatic dysfunction. However, in a busy dermatology clinic, lengthy osteopathic treatments are often seen as impractical. A five-minute osteopathic lymphatic manipulative treatment technique module has been developed for the management of lower extremity lymphatic complaints and is appropriate for use in the general dermatology clinic. Definition and Epidemiology than three months or (3) clinical characteristics lymph node dissection during diagnosis of Dermatologists are seeing an increasing number of lymphedema such as peau d’orange or woody breast cancer.
    [Show full text]
  • THORAX 1. in the Chest Wall: (A) the Intercostal a Is More Superficial Than
    THORAX 1. In the chest wall: (a) the intercostal a is more superficial than the v (b) the intercostal a lies between the intercostal n and v (c) the transversus m lies between the ext and int intercostals (d) the NV bundle lies between the ext and int intercostals (e) all of the above 2. The oesophageal opening in the diaphragm is opposite: (a) T6 (b) T8 (c) T10 (d) T11 (e) T12 3. The most superficial structure in the thoracic inlet is: (a) X (b) R subclavian a (c) L subclavian a (d) Thoracic duct (e) SVC 4. Trachea: (a) commences below the cricoid at level of C5 (b) enters the thoracic inlet slightly to the left (c) is marked at its lower end by the level of the sternal angle (d) supplied by IX (e) drains to axillary lymph nodes 5. the diaphragm: (a) has the oesophageal opening opposite the T8 vertebrae (b) is supplied by C4, C5, C6 (c) has a major role in expiration (d) has a vena cava opening at T10 (e) has an aortic opening opposite T12 6. Which passes through the diaphragm with the oesophagus (a) Azygous vein (b) Right X (c) Sympathetic trunks (d) Thoracic duct (e) Phrenic nerve 7. With regard to the coronaries: (2 CORRECT) (a) right arises from the posterior coronary sinus (b) left supplies the conducting system in most patients (c) right supplies the PDA in most patients (d) there are no arterial anastomoses between right and left (e) the right marginal vein drains directly into the coronary sinus (f) the anterior cardiac veins drain into the coronary sinus (g) venae cordis minimae occur most frequently in the right atrium (h) Cx is most commonly affected by disease 8.
    [Show full text]
  • Posterior Intercostal Arteries
    د تميم عبدالرزاق أخصائي جراحة صدر • Thoracic cage is an osteo- cartilagenous conical cage which has a narrow inlet & a wide outlet ? • Boundaries of thoracic cage. • Ant: Sternum, Costal cartilages and ribs. • Post: Thoracic vertebrae and ribs. • Lat: Ribs. • Thoracic Inlet (or outlet) • Ant: Upper border of manubrium sterni. • Post: 1st thoracic vertebra. • On each side: 1st rib & 1st costal cartilage. • It is sloping downwards & forward. • Suprapleural membrane • Dense fascia closes the lateral part of the thoracic inlet. • Triangular in shape • Apex: attached to transverse process of C7 • Base: Attached to medial border of the first rib • Superiorly: Related to subclavian vessels • Inferiorly: Apex of lung & cervical pleura • Thoracic vertebrae. • They are 12 vertebra. • From 2 to 9 they are called Typical. • Character of typical thoracic vertebrae: • Body: Heart shape & carries 2 demi-facet at its side. • Transverse process: has a facet for rib tubercle of the same number. • Spine: Long, pointed & directed downward and backward. • Vertebral foramen: Small & circular. Articulation between Thoracic vertebrae and the ribs Typical thoracic vertebra Lateral surface Superior surface • Atypical (Non typical ) 1st Thoracic thoracic vertebrae. • 1st, 10th,11th and 12th Vertebra • T1: • Has a complete facet. • One very small inferior demifacet. • Spine nearly horizontal • Has costal facet in transverse process for the tubercle of first rib. • It has a small body, looks like a cervical vertebra. • T10 • One complete facet tangential with the upper border • Small costal facet on transverse process. • T11 • One complete circular facet away from upper border. • No costal facet • T12 • Broad body & short, oblong spine. • One complete facet midway between upper & lower borders.
    [Show full text]
  • OMT in Pregnancy (MAOFP).Pdf
    OMM in pregnancy Saroj Misra, DO, FACOFP Marissa Rogers, DO Acknowledgements Laura Dreyer, DO Rachel Nixon, DO Molly DiMatteo, DO 2 Goals/Objectives Review evidence based benefits of OMT in pregnancy Understand the implications of pregnancy on the somatic system Recognize common somatic dysfunctions seen in pregnant women Discuss and demonstrate OMT techniques that can be used to treat the somatic dysfunctions associated with pregnancy 3 Why use OMT? Pain reduction during pregnancy and labor Eliminate somatic dysfunction and maintain proper structure Limit medication use Improve quality of life Return to homeostasis Decrease pregnancy and labor complications Patient satisfaction!!! 4 Background Been using OMT on pregnant patients since early 20th century 1911 -Whiting - 223 pregnant women Prenatal OMT decreased labor time by over 50% for pregnancies 1918 - Hart - 100 pregnant women Of 100 deliveries all receiving OMT - only 3 required use of forceps compared to 6-18% of women not receiving OMT, in addition to similar decreases in length of labor 5 Background (cont.) 1982 - Guthrie & Martin - 500 women Decreased need for analgesia during labor in women receiving OMT 1992 - Gitlin & Wolf Stimulated uterine contractions through craniosacral manipulation 6 Recent research 2003 - King et al Retrospective case control study - decreased probability of complications in treated women 2010 - Licciardone et al - 144 patients Randomized, placebo controlled trial revealed decreased back pain in OMT group 7 Structural changes Increased lumbar lordosis
    [Show full text]