Clinical Integration OMM
Describe what the Posterior Drawer Test evaluates.
What is the Posterior Cruciate Ligament? This test is positive when there is a posterior tibial shift which makes the femoral condyles more prominent. The Anterior Cruciate Ligament is evaluated with the Anterior Drawer Test.
Obj. 12403
Diabetes is irreversible T/F.
What is False? IDK that iLAB was crazy...Just remember that pre-diabetes is not "pre-disease" and that CV disease, T2DM, and early prostate disease are reversible with a plant-based, whole-food diet.
iLAB
What is ipsilateral? This reflex controls balance and extensor tone. On the contrary, the Vestibulocervial Reflex (VCR) has bilateral projections primarily to cervical cord levels.
iLAB
Define Mononeuropathy.
What is type of nerve damage outside the brain and spinal cord?
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Define Ageism
What is the stereotypical construction of older people, aging, and old age?
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Name the anterior and posterior Chapman's points for the heart.
What is the Medial 2nd intercostal space adjacent to the sternum and T2 transverse processes?
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Name the fat-soluble vitamins.
What are A, D, E, and K? Sketchy likes to use "A deck" (A DEK) for the fat-soluble vitamins.
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Name the three main parts of the inner ear that play a part in balance.
BONUS! Name the direction for each
What are the semicircular ducts, saccule, and utricle? These are all part of the "membranous labyrinth" of the inner ear. The semicircular ducts have the gelatinous mass of the cupula which is not affected by gravity, but the otolithic membrane of the utricle and saccule is.
BONUS! Semicircular ducts are angular acceleration, utricle is horizontal acceleration, and the saccule is verticle acceleration.
Obj. 8815
What is no perception of stimulus vs. spontaneous sensation without a stimulus?
iLAB
Define Structural Violence and describe the fish-lake-groundwater analogy.
What are social forces that harm certain groups of people and the analogy describes the interconnection between systems? The analogy discusses how if there is one dead fish, then we attribute it to the failings of the individual, but only think of the system when there is more than one dead fish, especially if in multiple "lakes"
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18 y/o female pt presents to the office with c/o low back pain. Pt denies any major trauma or IV drug abuse, with no PMHx that is concerning. Identify the red flag(if there is one) with this pt.
What is the pt has low back pain, but is <20 y/o? The red flags for Low back pain include major trauma, >50 y/o or <20 y/o, cancer hx, recent bacterial infection, IV drug abuse, immune suppression, constitutional symptoms, and cauda equina symptoms.
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Name the vitamins that act as antioxidants and the one(s) that help regenerate other antioxidants.
What are A, C, and E with Vitamin C being the one that helps regenerate antioxidants?
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Pt presents with a rapidly correcting right-beating nystagmus. Identify the side of the lesion.
What is the left side, most likely in the left vestibular apparatus or nerve? Physiological nystagmus is slow correcting but rapid is when it is pathological and is usually away from the lesion.
iLAB
Explain the difference between multiple mononeuropathy and polyneuropathy.
What is the damage of one or more peripheral nerves making it a group of symptoms, not a disease whereas polyneuropathy is the simultaneous malfunction of many peripheral nerves throughout the body?
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When an individual is taking Isoniazid, name the vitamin(s) that they could be deficient and an important symptom demonstrated.
What are Vitamin B3 and B6 which would show Peripheral Neuropathy? This was mentioned in the iLAB. Isoniazid directly impacts the metabolism of B6 and B3 causing symptoms of deficiency.
iLAB
Name the region that should be treated in a pt with GERD and Chapman's point associated with the acidity of the stomach.
What is T5-T10 with Chapman's point located at the Left medial 5th intercostal space?
Objs. 7445 and 12404
Identify the Vitamin/Mineral that was discussed that is a coenzyme for 5 enzymes and name 2.
BONUS! For each enzyme, match with biochemical reaction.
What is Thiamine (B1)? See BONUS for full answer due to space.
BONUS!
Pyruvate dehydrogenase --> glycolysis/glucose metabolism
Alpha-ketoglutarate dehydrogenase --> TCA
Branched-chain alpha-keto acid dehydrogenase --> mitochondrial oxidative decarboxylation of alpha-keto acids
Alpha-ketobutyrate dehydrogenase --> same as above
Transketolase --> Pentose phosphate pathway
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Identify the first step of dx if a 68y/o male pt presents to the office with c/o vertigo and difficulty speaking with a PMHx of HTN and T2DM and the type of vestibular pathology you are looking for in this case.
What is getting a Brain MRI for the pt looking for a central vestibular pathology? A CVA should always be a differential, especially if they have a PMHx of hyperlipidemia, T2DM, and HTN.
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Pt is in the need of a test that inserts needle electrodes into a muscle to test electrical activity during rest and movements. Name this test and some limitations/blind spots.
What is EMG which has blind spots in small, un-myelinated nerve fibers, fat/edema, autonomic neuropathies, etc?
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Describe when it is necessary for an individual to be referred to a neuropsychologist.
What is when there is a suspicion of cognitive dysfunction or decline and when the condition is not easily uncovered by using other investigations? This is straight from the article that they put for that objective.
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Describe the 7 stages of Spencer's Techniques.
What are:
Milking
Flexion/Extension with flexed elbow
Flexion/Extension with extended elbow
Chicken wing arm (in front) with Flexion/Extension
Chicken wing amr (in back) with Flexion/Extension
Milking
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30 y/o pregnant female pt presents to the office with fatigue and pallor. Testing reveals that the individual has macrocytic, megaloblastic anemia. When determining the cause, vitamins were investigated based on the pt's PMHx and it was found that the vitamin that is deficient has the active form of THF. Identify this deficient vitamin and the concern specific to this pt due to their condition.
What is Vitamin B9 deficiency which holds a major risk for neural tube defects in fetal development in this pt? Reminder from earlier in the semester that Vitamin B9 and B12 can cause macrocytic (MCV>100), and megaloblastic anemia. The big difference is that B12 will show peripheral neuropathy in addition to anemia symptoms.
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Pt is a 20 y/o male that presents to the office with c/o dizziness when he gets off the couch and out of bed. Pt states that it usually lasts about 20 seconds each time. Examination finds that there is no nystagmus when the individual is directly their gaze left or right. Identify the dx test, type of vestibular pathology, and tx for this pt.
What is Dix-Hallpike Test, peripheral vertigo, and Epley Maneuver? This is a presentation of BPPV which is the most common Peripheral Vestibular Pathology. The Dix-Hallpike Test is only indicated when there is no nystagmus when directing gaze left or right, if it had, the Hints exam would be indicated. The Epley maneuver is useful to correct and remove the stone that is usually causing the problem in BPPV.
Objs. 8816 and 8817
Pt presents to the office with c/o weakness in their thighs. Pt states that it started in their ankles and has progressed to their thighs bilaterally. The medication list indicates a recent prescription of Tamiflu about 2 weeks ago. Further, examination exhibits absent patellar DTRs bilaterally with elevated protein in the CSF. Identify the most likely cause of neuropathy in this pt and treatment.
BONUS! Identify if corticosteroids would benefit this pt.
What is GBS with the treatment being supportive, plasma exchange, or IVIG? GBS is an ascending paralysis that is symmetrical with absent DTRs. It is typically seen 2-4 weeks after a URI/GI illness.
BONUS! No, corticosteroids do not benefit these pts.
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Healthy pt presents to the office for routine vaccinations and screening for their Medical School paperwork. Since the pt is here, they also have their physical with no new complaints. Results appeared 2 days after, and it was found that the person tested positive for the Mantoux Tuberculin Skin Test (>15mm). The pt is then sent for a CXR, to confirm or rule out TB. Identify the pt's dx if there are no signs of infection on the CXR and one treatment option.
What is Latent TB which can be treated with Isoniazid alone or with Rifapentine? The definition of an LTBI is one in which Mycobacterium tuberculosis is found to be present in an individual, but with no signs/symptoms or radiographic/bacteriologic evidence of TB disease. On the other hand, Primary TB Infection is when there are signs/symptoms, radiographic, or bacteriologic evidence of M. tuberculosis. Additionally, when TB infection is tested using the TST, the induration of the reaction is measured, not the erythema. When it is >15mm in an otherwise healthy individual, TB is confirmed to be present. Based on the health history, the size of the duration changes and that can be found in AMBOSS. The treatment can also be found on AMBOSS and it is up to the discretion of the pt and physician.
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