Archive for October, 2008

Distribution Testing & Malingering

Dr. Lockwood’s pics in the last couple labs have been a bit hard to see, so here they are. These will help you to test the distribution of L4-S1, as well as spot malingerers who claim to have issues in these areas.

L4 Testing

L4 Testing

L5 Testing

L5 Testing

S1 Testing

S1 Testing

So say someone comes in complaining they can’t work either b/c of sharp pain in their buttock and down their leg, or more specifically, sciatica. You can perform this test, where you pull on their leg while seated. For people with sciatica, this will further pinch this nerve, and they will lean back to relieve the pain. Those who don’t have it won’t know to lean back b/c you are focused on the lower leg.

Malingering sciatica= doesn't lean back

Malingering sciatica

Now say, someone rolls in your office in a wheelchair claiming their left leg just doesn’t work or is too painful to move. Have them lay down and perform the Hoover’s test, which is where you have them raise the good leg with your hand under the bad leg. A positive Hoover’s sign is when they lower the bad leg when the good one is raised. This is a reflex, like Babinski’s. If they do not do this, then they either have a major neurological problem, or they are malingering.

Hoover's sign

Hoover

Corrected Upper Extremity Lab

In Dr. Halma’s Upper Extremity Lab, there was an error on flexion vs extension of the wrist on one slide:

Corrected Slide

Corrected Slide

Flexion (or Palmar Flexion) is when the wrist moves the hand in the direction of the palm:

Wrist flexion

Wrist flexion

Extension (or Dorsiflexion) is when the wrist moves the hand in the direction of the dorsum:

Wrist extension

Wrist extension

Business Attire for Practicals

Dr. Eric requested this information be sent about the dress requirements for the practicals. Starting on page 5 of your syllabus…

“BUSINESS ATTIRE FOR LABORATORY PRACTICALS
A component of the practical examination is professionalism. As such, student physicians are expected to dress professionally (including white coat) for their practical examination. Students will be scheduled for two practical encounters (each lasting approximately 15 minutes). On one day, the student will perform in the capacity of the doctor and dress accordingly (Business Casual). On the other day, the student will perform in the capacity of the patient and dress in appropriate lab attire (upper body, lower body, or full body lab dress). Assignments and schedules will be posted outside the lab door and on the Portal prior to the practical.

What to aspire to

What to aspire to

Business Attire
Different industries have different norms about professional dress. With regards to the outpatient clinical setting business causal is the standard, but also a healthy respect towards infection control must be considered. Scrubs should be used only for nights on call and days in
the ER or OR. Below are some guidelines on what is considered professional dress for physicians in training. Remember your job must instill confidence in your patients. See articles posted on the Portal regarding professional dress.

Business Casual

Lab Coat
Appropriate – Clean, white, and pressed with name tag and stethoscope
Inappropriate – Dirty, ripped, or stained especially at the collar or sleeves

Slacks
Appropriate – Clean, wrinkle-free slacks
Inappropriate – Jean (any color), sweatpants, athletic pants, shorts, spandex legging, excessively form fitting pants, bib overalls, ripped clothing.

Shirts
Appropriate – Dress shirts, casual sport shirts, golf shirts, sweaters, turtlenecks. All shirts should cover the back and abdomen.
Inappropriate – Sweatshirts, shirts with large lettering or logos unless part of a uniform, tops with bare shoulders, and tank tops, halter tops and t-shirts unless worn under another blouse, dress shirt or jacket; any shirt that allows the bare midriff to be seen; suggestive, revealing or excessively tight fitting shirts

Dresses and skirts
Appropriate – Casual dresses and skirts should be no shorter than four inches above the knee. A general rule is that business skirts and dresses should cover the thighs when seated.
Inappropriate – Mini skirts. Sun dresses, spaghetti strap dresses should not be worn unless under a jacket; suggestive, revealing or excessively tight fitting dresses.

Footwear
Appropriate – Loafers, flats, dress shoes, dress sandals (not open toed), clogs, dress boots (Many hospitals will require socks and stockings)
Inappropriate – Athletic shoes, sneakers, open toed shoes, slippers, excessively high heels

Jewelry and other accessories

Appropriate – Conservative jewelry with no visible body piercing other than ears. Ties should be clean. Cover all tattoos. Exemptions can be made for items of religious significance.
Inappropriate – Excessive jewelry especially on the hands (more likely to spread disease or injure patient during palpation), facial piercing especially on the eyebrow, lip, and tongue or nose rings, visible tattoos.

Grooming and hygiene
– Physicians should be the epitome of good hygiene
Appropriate – Clean fingernails and hands. Hair within the natural color scheme. (It is very difficult for a 65-year-old patient to feel confident in a young doctor with blue hair.) Long hair should be pulled back to avoid falling on patients during physical examinations or OMT. Facial hair and fingernails should be neatly trimmed.
Inappropriate – Dirty hands, excessively long fingernails, excessive body odor or perfume (many patients are very sensitive to smells), hair in outrageous styles or colors such as blue, green, or pink. No artificial nails – they harbor bacteria.”

Here is the link about ironing,
which Dr. Eric suggested, for those who need it

Pay SPECIAL attention to the warning section on the website as well

Pay SPECIAL attention to the warning section on the website as well

Scotty Dog

There were several questions during lab today about what the “Scotty Dog” is on page 7 of Dr. Lockwood’s lab today.
The Scotty Dog Sign is a radiological finding.

In an oblique view of a normal lumbar spine, the outline of a Scotty Dog can be seen. The transverse process is the nose.  The pedicle is the eye.  The pars interarticularis is the neck.  The superior articular facet is the ear.  The inferior articular facet is the front leg.

A break in the neck of the dog, or a black dog collar, corresponds to a fracture in the region of the pars interarticularis, which is specific for spondylolysis. It is important to recognize as it is a cause of low back pain.

First Year Practice Session moved to 7:30pm

We were recently informed about protected society time tomorrow afternoon so the practice session has been moved from 5pm to 7:30pm!  Sorry for the change but have fun at the society things and then join us if you would like.

Tomorrow (Tuesday) at 7:30pm in the OMM lab.

See you there!!
~The OMM Fellows

Get email updates for your class only!

Don’t have a blog subscription service, or even better, only want updates that are pertinent to your year?

Then email ommfellows@gmail.com with your class year (2011 or 2012), and you will receive email notices when the website is updated with info important to your class!

Videos are on the portal!

We finally have gotten the video link situation sorted out and Richelle was kind enough to post them on the portal. So just go to the OMM Dept page and all the lab videos are posted in the video section. We will still keep up with the DVDs and EtherneTV for at least a couple weeks as backups. Thanks for your patience!

The Kimberly Project

Very hush hush

Coordinating the shot

Coordinating the shot

Filming the technique

Filming the technique

Clean off all the drawings on Bethany

Clean off all the drawings on Bethany

We know a couple things other than OMM

Though our primary focus is OMM obviously, we suffered through learned all the subjects you had to, some to the point where we feel confident tutoring them. Here’s a list of what we are all happy to help you with:

Michelle: Autonomics, Principles, Infectious, Neuro
Bethany: Infectious, Principles
Zach: Infectious, Principles, Anatomy
James: Complete DO, Principles, Biochem

Counterstrain Practice Session tonight!

Remember this?

Remember this?

Reminder! We will be meeting Wed, Oct 1st …tonight… @ 6pm in the Blumenthal Lab to go over Dr. Karen Snider’s Counterstrain Lab. Come if you have any questions or would like more practice. See you there!

Next Page »


ABOUT THE SITE

Looking for tutoring availability?
-Check the individual fellows pages

Do we tutor anything other than OMM?
-Yes! Check out this post for who does what

Looking for info relevant to your class?
-Click on the tag in the tag cloud above that matches your class & quarter

Need to make up a lab?
-If you know in advance you'll miss it, let Richelle know so that you can get it excused and all the points back. Either way, then watch the video off the portal, and contact one of us to go over it with you.

Want to go over a test?
-Contact one of us to meet with you, and let us know if we need to print you out a new scantron before hand.

Want to make an appt at the Fellow's Clinic?
-Call the OMM Clinic at 626-2304

Need to get a hold of us?
-Check the individual fellows pages for contact info

But its an emergency!!
-Call the fellows office at 626-2111, or Patty Lyons 626-2537 who can page us

How do I keep up to date on new posts?
-Subscribe to our feed below, check out our facebook page, or sign up for email announcements of posts relevant to your class by sending an email to ommfellowsblog at gmail dot com with your (1st or 2nd yr) in the subject heading!

 

October 2008
M T W T F S S
« Sep   Nov »
 12345
6789101112
13141516171819
20212223242526
2728293031  

Follow

Get every new post delivered to your Inbox.