NBCE - Chiropractic Principles Questions and Answers correct

NBCE - Chiropractic Principles Questions and Answers correct Inflammation Hypothesis inflammation either causes subluxation, is accompanied by subluxation or results from subluxation What are the key inflammatory substances? cytokines, nitric oxide, substance P What are the classic signs of inflammation? 1. Rubor (redness) 2. Tumor (swelling) 3. Calor (fever/heat) 4. Dolor (pain) 5. Functio laesa (loss of function) VSC Phase 1 Segmental Dysfunction; spinal fixation, lessened mobility of a segment, altered pressure threshold to pain, signs of neuromuscular dysfunction Segmental Facilitation aka segmental dysfunction, lowered threshold for firing in a spinal cord segment as a result of afferent bombardment associated with spinal lesions Somatovisceral reflex somatic origin causing visceral effects Muscle spindles and golgi tendons act together to regulate what? muscle stiffness Stiffness is defined as what? muscle tension change/muscle length change What are the 6 models of facet physiopathology? 1. Joint derangement 2. Degenerative change 3. Joint effusion with capsular distention 4. Joint effusion with direct diffusion 5. Joint adhesion 6. Joint meniscoids Z-joint meniscoids various tissues become trapped in the facet joints, can cause the acute locked back What are the effects of meniscoid entrapment? 1. Joint capsule tension 2. Capsular adhesions 3. Biochemical alterations 4. Degenerative changes What happens with joint capsule tension? decreased mechanoreceptor activity yielding increased nociception/lowered pain threshold What does capsular adhesions cause? capsule contracture, decreased joint space size What are the biochemical alterations associated with meniscoid entrapment? GAGs are lost from joint cartilage and ligaments Describe the degenerative changes associated with meniscoid entrapment. degeneration occurs prematurely when normal stresses are applied to an abnormal joint, bone loss with increasing hypomobility motor and ANS functions are affected in what? a facilitated zone Korr thought that what were the coordinators that increase/decrease contraction according to the direction of joint movement? muscle spindles (rather than joint receptors) sudden slack on the spine causes what? increased muscle spindle activity and muscle spasm Korr Model facilitation through muscle spindle control Patterson-Steinmetz Model spinal learning/fixation/neural scar Dvorak Model faciliation via mechanical/chemical stimulation of slow twitch/postural muscles Gatterman-Goe Model TRPs Mense Model focuses on nociceptors and mechanoreceptors MEH Model spine assumes position of minimal internal energy What is phase 2 of the VSC? instability; severe/repeated trauma and postural stresses w/ tissue damage results in instability/misalignment A spondylolisthesis falls under which phase of the VSC? 2 What is the VSC Phase 3? immobilization degeneration What happens to cartilage in ID? lose PG, thinning/ulceration, vascular invasion, sclerosis What is the function of aggrecan? bound by hyaluronan to form an aggregate that binds to water Lubricin contributes to what? joint viscosity What are the effects of ID on the synovial membrane? fibro-fatty consolidation leads to adhesions and deposition of hydroxyapatite What are the effects of ID on the subchondral bone? loss of trabecular mass, expansion of sinuses, invasion from subchondral bone into synovial space accelerates ankylosis What is the neuropathology hypothesis? true pressure on a nerve ("bone out of place pressing on a nerve") What things are most critical in the neuropathology hypothesis? ischemia and edema (vs. compression) T/F. Spinal nerve roots are less susceptible to irritation/compression than spinal nerves. false; more susceptible T/F. Nerve roots are more susceptible to mechanical irritation/compression than peripheral nerves. true T/F. Nerve roots fail under deformation prior to the peripheral nerves. true; NR lack tensile strength What is the microcirculatory hypothesis? vascular spasm and local tissue ischemia/edema are important in triggering LBP and neural dysfunction How does immobilization affect Batson's Venous Plexus? BVP (located in the spine) has no valves and therefore relies on spinal movement to rid the area of wastes. immobilization causes venous stasis which changes the chemical environment and causes degeneration Axoplasmic Aberration Hypothesis axonal transport may be altered when the spinal roots or nerves are compressed or irritated by vertebral subluxation and/or facilitation T/F. Anterograde axonal transport is faster than retrograde. true Neuropraxia localized conduction block w/ intact axons; usually from a contusion; light touch intact but diminished, returns to normal in days/weeks Axonotemesis axon is severed but the endoneurium remains intact; results from a crush injury; presents similarly to neuropraxia but with a present Tinel's sign, recovery is full but slow Neurotemesis complete transection of the nerve, recovery is unlikely without surgical repair Somatoautonomic Reflex Hypothesis spinal joint lesions may trigger facilitation-induced reflexes that impair or disturb visceral function What are the types of nociceptors (classifications)? mechanical, mechanothermal, thermal What are silent/sleeping nociceptors? nociceptors that are inactive in healthy tissue and only fire with inflammation (typically C fibers) Polymodal nociceptors found in somatic and visceral tissue and can be stimulated by thermal/chemical/mechanical noxious or non-noxious stimuli, regulate inflammation, wound healing and tissue homeostasis What is Dorsal Horn Reorganization? Inflammation causes group II mechanoreceptors to sprout collaterals and terminate in laminae I,II or V (vs. III/IV), this causes normal stimuli to become painful T/F. Reduced joint mobility and inflammation increase mechanoreceptor stimuli. false; decrease mechanoreceptor stimuli and therefore increase the processing of nociception Dysafferentation the loss of movement-based mechanoreceptor stimulus Myelopathy Hypothesis chiropractic subluxations can cause cord compression What are the sx of myelopathy? LMNL @ level of compression, UMNL below level of compression, bowel/bladder changes Neuroimmune/Neurodystrophy Hypothesis Spinal joint lesions may modify specific and non-specific immune responses and alter trophic function of the involved nerves, largely through sympathetics T/F. The terms neuroimmune and neurodystrophy are synonymous. true What are the 3 stages of the General Adaptation Syndrome? 1. Alarm 2. Resistance 3. Exhaustion What are diseases of adaptation? the long term outcome of failure to adapt, occur during the exhaustion phase of general adaptation syndrome; ie. HTN, hypo/hyperthyroid, collagen-vascular diseases, ect. The disease model reactive, symptom based, doctor centered Biopsychosocial model proactive, more holistic, multifactorial, patient centered What is health? a state of optimal well being including spiritual, physical, mental, emotional, social and environmental What is wellness? how we get to health; a process of optimal functioning and creative adaptation involving all aspects of life Vitalism vis medicatrix naturae holism humans are not a collection of parts humanism autonomy and dignitiy therapeutic conservatism doing no more than necessary