PPOM 2 Week 2 LEC 12-20 WORK IN PROGRESS

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Lecture 12, lmao...

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72 Terms

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(12) Primary Respiratory Mechanism

Concept of 5 separate phenomena within movement of the cranial bones that Dr. Sutherland perceived; discovered as an involuntary motion in the body

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(12) 5 Phenomena of the Primary Respiratory Mechanism

The inherent Motility of the brain and spinal cord; The fluctuation of the cerebrospinal fluid (The potency of the Tide); The mobility of the dural membranes; The mobility of the cranial bones; The involuntary mobility of the sacrum

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(12) Cranial motions associated with inhalation

The cranium widens transversely and narrows both A/P and vertical dimensions

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(12) Cranial motions associated with exhalation

The cranium widens A/P and narrows transversely

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(12) Serrate suture

Interlocking spicules allow a rocking/hinge-like movement, necessary to allow a widening of the parietal bones. E.g. Sagittal Suture

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(12) Squamous suture

Marked overlapping with little interdigitating. This allow a gliding movement, necessary to accommodate the increasing and decreasing transverse diameter during inhalation and exhalation.

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(12) (13) The bones of the cranial base (petrous temporal, sphenoid body, and occiput below superior nuchal line) are formed in:

cartilage

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(12) (13) The bones of the cranial vault (parietals, frontals, squamous temporal and occiput, etc) are formed in:

membrane

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(12) Flexion (PRM)

The rotation of the midline bones during inhalation phase of the PRM

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(12) Extension (PRM)

The rotation of the midline bones during Exhalation phase of the PRM

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(12) Function of Dura

attaches to each of the bones of the cranial base; act as ligaments, guiding and limiting the motion of the bones

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(12) The Falx Cerebri attaches to the:

occiput and ethmoid

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(12) The Tentorium Cerebelli attaches to the:

occiput, temporals, and sphenoid

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(12) The “core link”, or the spinal continuation of the dura, connects the:

occiput to the sacrum; includes the sacrum in the primary respiratory mechanism

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(12) Circulation of CSF begins at:

Choroid Plexus

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(12) Circulation of CSF ends at:

Arachnoid Granulations; empties into venous sinuses

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(12) Motility of the CNS

Coiling and uncoiling of CNS which begin as its developmental movement. Moves synchronously with the phases of the PRM

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(12) Fluctuation of the CSF

A to and fro movement involved in the physiology of the CNS produced by an unknown force

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(12) Mobility of the Dural membranes

Act as check ligaments, guiding and limiting the movement of the cranial bones; Motion is arcing, like that of a sickle; Operates from a fulcrum, found along the straight sinus

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(13) At birth, the Occiput is in ___ parts.

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(13) At birth, the Sphenoid is in ___ parts.

3

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(13) At birth, the Temporal is in ___ parts.

3

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(13) At birth, the Maxillae is in ___ parts.

2

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(13) At birth, there are ___ Fontanelles and no mastoid process.

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(13) Sphenobasilar Synchodrosis (SBS)

The articulation between the Occiput and the Sphenoid; Similar motion can occur here as in the spine (flexion/extension, rotation and side bending)

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(13) Flexion in Vault Contact

the greater wings of the sphenoid and occipital squama move inferiorly as SBS rises

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(13) Extension in Vault Contact

the greater wings of the sphenoid and occipital squama move superiorly as SBS falls

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(13) CN IX (Glossopharyngeal), X (Vagus), and XI (Spinal Accessory) exit through the:

Jugular Foramen

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(13) CN XII (Hypoglossal) exits through the:

Hypoglossal Canal

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(13) Plagiocephaly

Medical condition characterized by an asymmetrical distortion (flattening of one side) of the skull

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(13) Brachycephaly

Medical condition also known as flat-head syndrome - shortened front-to-back diameter of the skull.

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(13) Craniosynostosis

Medical condition of early closure of a cranial suture

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(13) Duane’s Retraction Syndrome

Medical condition of Congenital absence or poor development of the abducens nuclei, with aberrant innervation by the oculomotor nerve, that leads to impaired ocular motility

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(13) Physiologic SBS Cranial Strain patterns

Flexion (Inhalation), Extension (Exhalation), Torsion, Sidebending and rotation

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(13) Non-Physiologic SBS Cranial Strain patterns

Vertical Shears, Lateral Shears, Compression

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(13) Lateral Strains: “Parallelogram Head”

Medical condition in which the sphenoid and occiput rotate in the same direction; Can be due to compressive force, positional, in utero or plagiocephaly secondary to torticollis or trauma from a lateral force

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(13) CN VII (Facial) and VIII (Vestibulocochlear) exit through the:

internal acoustic meatus

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(13) CN I (Olfactory) exits through the:

Cribiform plate – ethmoid

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(13) CN II (Optic) exits through the:

optic canal – sphenoid

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(13) CN III (Oculomotor) exits through the:

superior orbital fissure (SOF) – sphenoid

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(13) CN IV (Trochlear) exits through the:

superior orbital fissure (SOF) – sphenoid

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(13) CN V (Trigeminal) exits through the:

V1 – SOF, V2 – Foramen Rotundum, V3 – Foramen Ovale – sphenoid

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(13) CN VI (Abducens) exits through the:

SOF – sphenoid & petrosphenoid ligament

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(13) Superior vertical strain

Occiput rotates into relative extension; Sphenoid rotates into relative flexion

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(13) Inferior vertical strain

Occiput rotates into relative flexion; Sphenoid rotates into relative extension

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(13) SBS compression - “Bowling Ball Head”

Medical condition often secondary to trauma with a compressive force directed towards midline, jamming the SBS together.

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(13) Absolute Contraindications to Osteopathic Cranial Manipulative Medicine (OCMM)

Acute intracranial bleeding, Skull fracture, Acute cerebrovascular accident

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(13) Relative Contraindications to Osteopathic Cranial Manipulative Medicine (OCMM)

Coagulopathies, Space occupying lesion in cranium, Increased intracranial pressure

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(15) Calcium (Ca²⁺)

Primary structural role in bone formation (99% stored in bone as hydroxyapatite). Critical for muscle contraction, blood clotting, nerve transmission, and cardiac conduction

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(15) Phosphate (PO₄³⁻)

Major role in cell metabolism (ATP production), oxygen release from hemoglobin (2,3-BPG), buffering acid-base balance, and muscle contraction. Stored largely in bone (86%), with smaller portions in intracellular fluid (14%) and negligible in extracellular fluid

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(15) Parathyroid Hormone (PTH)

Hormone that is released when serum calcium is low (Stimulated by hypocalcemia)

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(15) Calcitriol (1,25-dihydroxyvitamin D)

Hormone that is Active vitamin D; formed in proximal tubules by 1-α-hydroxylase (stimulated by PTH); Inhibits PTH secretion

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(15) Calcitonin

Produced by thyroid parafollicular (C) cells when calcium is high; “tones down” calcium

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(15) Fibroblast Growth Factor 23 (FGF23)

Bone-derived hormone; decreases serum phosphate by decreasing renal phosphate reabsorption and decreasing calcitriol synthesis

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(15) Parathyroid Hormone (PTH) effects on bone

Indirectly stimulates osteoclasts → bone resorption → ↑ Ca²⁺ and PO₄³⁻ release

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(15) Calcitriol (1,25-dihydroxyvitamin D) effects on bone

↑ Osteoclast activity → ↑ release of Ca²⁺ and PO₄³⁻

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(15) Calcitonin effects on bone

Inhibits osteoclasts which decreases bone resorption

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(15) Parathyroid Hormone (PTH) effects on kidney

↑ Ca²⁺ reabsorption, ↓ PO₄³⁻ reabsorption, ↑ calcitriol synthesis (via 1-α-hydroxylase).

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(15) Calcitriol (1,25-dihydroxyvitamin D) effects on kidney

↑ Ca²⁺ and PO₄³⁻ reabsorption

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(15) Calcitonin effects on kidney

Decreases Ca²⁺ reabsorption

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(15) Calcitriol (1,25-dihydroxyvitamin D) effects on GI tract

↑ Absorption of Ca²⁺ and PO₄³⁻

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(15) rickets/osteomalacia

Medical condition of Vitamin D deficiency; presents with hypocalcemia, bone softening

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(15) Thiazide diuretics

Medications that Reduce urinary calcium excretion so that there’s less calcium available to form kidney stones; Prescribed to patients with recurrent nephrolithiasis

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(15) PTH effect on Ca²⁺

increases serum Ca²⁺

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(15) PTH effect on PO₄³⁻

decreases reabsorption (phosphate-trashing hormone)

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(15) FGF-23 function

lowers serum PO₄³⁻ by reducing reabsorption & calcitriol production

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(15) Calcitriol primary role

↑ intestinal absorption of Ca²⁺ & PO₄³⁻

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(15) Calcium handling in Proximal Tubule

70% reabsorbed; Paracellular reabsorption (passive), Na⁺-driven; Driven by positive lumen potential; Not hormonally regulated

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(15) Phosphate handling in Proximal Tubule

80% reabsorbed (Minimal phosphate reabsorption in other nephron segments); Na⁺/PO₄³⁻ cotransporter

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(15) Calcium handling in Loop of Henle

20% reabsorbed; Paracellular transport, driven by lumen-positive potential

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(15) Calcium handling in Distal Convoluted Tubule

8% reabsorbed; transcellular, PTH & calcitriol regulated

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(15) Mechanism of Action of Thiazide diuretics

Block Na⁺/Cl⁻ cotransporter in DCT, Cause mild volume contraction; Directly stimulate Ca²⁺ reabsorption in DCT