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OTM - Cranial Exam With Correct Answers 100% Verified
Motility - ANSWER -The ability to move spontaneously, to exhibit spontaneous motion
Mobility - ANSWER -Something movable, not stationary, or the capability of being moved by an external force
Primary respiratory mechanism - ANSWER -Inherent motility of the brain and spinal cord -Fluctuation of the CSF -Mobility of the intracranial and intraspinal membranes -Articular mobility of the cranial bones -Involuntary mobility of the sacrum between ilia
Ethmoid - ANSWER -Only basicranial bone entirely of endochondral origin
Basicranium - ANSWER Inferior portions of temporals, sphenoid, occipital bones, midline nasal septum
Sphenobasilar synchondrosis - ANSWER
Vault hold - ANSWER Fingers contact greater wing of the Sphenoid, anterior to the tragus, mastoid region, lateral occiput -To observe transverse widening, direct attention to your PIP joints
Sphenoid bone articulation with temporal bone - ANSWER
Functions of the sphenoid bone - ANSWER Forms anterior middle and posterior cranial fossa Part of the orbit
- Houses pituitary -Permits passage of cranial nerves -Guides facial bones during movement -T primary synchondrosis of sphenobasilar synchondrosis***
Sphenoid composite motion -ANSWER-Physiological motion in horizontal axis through center of body -Inhalation phase = flexion -Exhalation phase = extension
SBS During inhalation -ANSWER-bends (in response to pull of the reciprocal tension membrane, falx and tentorium) -Torsion in opposite direction from each other about parallel transverse axes from occiput -Greater wings move laterally, anteriorly, and inferiorly -Angle between sphenoid and basiocciput becomes more acute
SBS during exhalation - ANSWER -Extends (relaxation of reciprocal tension membrane, falx and tentorium) -Rotates in opposite directions about parallel transverse axis from occiput -Greater wings move superiorly, medially, and posteriorly
The Becker (base) hold - ANSWER -Fingers contact occiput and greater wing of the sphenoid -To observe transverse widening, direct attention to your thenar eminence
-Less oval, more circular
Exhalation changes on coronal and sagittal sutures - ANSWER -Decreased volume -More oval, less circular
Fronto-occipital hold - ANSWER -Fingers contact greater wings of the sphenoid and frontals
Temporal composite functions - ANSWER -Completes enclosure of the tympanic cavity -Forms lateral portion of calvarium -Forms cranial articulation for the mandible -Provides attachment for temporalis and masseter ms.
Petrosal bone functions - ANSWER -Transverse buttreses of the cranium -Encloses, stabilizes otovestibular organ -Attachment of the tentorium -Attachment of the aponeurosis of the pharynx -Encloses the carotid artery -Forms lateral part of the jugular forament -Styloid process and ligaments attach
Temporal bone articulations - ANSWER -Occiput -Sphenoid -Zygoma -Parietal -Mandible
Bilateral temporal bone hold - ANSWER -Fingers contact temporal bones bilaterally
Temporal bone relations - ANSWER -CN III thru XI -Brain -Meningeal septa -Foregut-eustachean tube -Major vessels of the brain
Temporal bone and reciprocal tension membrane - ANSWER -Tentorum cerebelli -Falx cerebri -Anterior dural septum
Temporal bone articulation and ligaments - ANSWER -Stylohyoid -Tempromandibular -Stylomandibular -Intra-articular disc
Temporal bone and vulnerable structures - ANSWER -Vestibular apparatus -Labyrinth -Eustachean tube -TMJ -CN III, IV, VI, V1, VII -Gassarian Ganglia -CN IX, X, XI
Temporal bone physiological motion - ANSWER -Guided and influenced by occiput -Axis is from jugular surface to petrous apex below petrous ridge
-Greater and lesser wings
Bones of the orbit - ANSWER -Frontal -Maxilla -Palatine -Lacrimal -Ethmoid -Zygoma -Sphenoid
Sphenoid composite fascia and ligaments - ANSWER -Sphenomandibular -Angular spine -Midline fascias -Midline dural septum -Anterior inferior attachment of the tent
Occipital composite regions - ANSWER -Supraocciput/squamous portion -Basiocciput -Condylar portion or exocciput
Occiput at birth - ANSWER -In 4 parts -Condylar/squamous parts fuse by age 2 -Condylar/base parts fuse by age 6
Temporal composite parts - ANSWER -Derived from midline basilar cartilage and intramembranous ossification -Squama
-Petrous portion -Tympanic ring -Styloid process
Functions of the squamous portion of temporal bone - ANSWER -Completes enclosure of the tympanic cavity -Forms lateral portion of calvarium -Forms cranial articulation for mandible -Provides attachment for temporalis and masseter muscles
Petrous portion development - ANSWER -Formed in cartilage -Ossifies from multiple centers -Otic annulus - fuses at 36-38w gestation
Temporal bone foramina and surface features - ANSWER -External auditory canal -Internal auditory canal -Pharygnotympanic canal -Carotid canal -Stylomastoid foramen -Impression for Gasserian ganglion -Mandibular fossa
Palpating the cranium for motion - ANSWER -Eyes closed or looking off into distance -Have patient move down table towards their feet -Physician rests forearms on the table -Adjust table height to minimize slouching -Light palpation pressure; enough to compress finger pads but not enough to blanch nail beds of the finger
Pterion - ANSWER Junction of frontal, parietal, sphenoid, and temporal bones
Lateral landmarks (4 of 5) - ANSWER
Lateral landmarks (5 of 5) - ANSWER
Anterior landmarks (2 of 3) - ANSWER
Anterior landmarks (3 of 3) - ANSWER
Inherent motility of the brain and spinal cord - ANSWER -Brain involuntarily and rhythmically moves within the skull -CNS coils and uncoils -Biphasic rhythmic fluctation (inhalation and exhalation)
Expansive phase - ANSWER -Inhalation/flexion
Contractile phase - ANSWER -Exhalation/extension
Motion during inhalation phase - ANSWER -Neural axis shortens towards junction of 3rd ventricle and lateral ventricle -Spinal cord shortens and is drawn upward -Cerebral hemispheres unfold, increasing lateral (transverse) diameter -Brain substance becomes more thin and compact -Ventricles dilate
Fluctuation of the CSF - ANSWER -Produced by choroid plexus of ventricular system -CSF fluctuates within cranium, around spinal cord, within dural sheaths
-Fluctuates within a near closed container (subarachnoid space)
Fluctuation of CSF during inhalation phase - ANSWER -Ventricles and subarachnoid space increase in size -CSF production increases -Increased intracranial volume -Skull widens transversely
Fluctuation of CSF during exhalation phase - ANSWER -Ventricles and subarachnoid space decrease in size -CSF absorption increases -Decreased intracranial volume -Skull narrows transversely
Dural membranes ANSWER Limit and direct the expansile motion
Reciprocal tension membrane (RTM) ANSWER Anatomic internal restrain to semi-flexible cranium -Tentorium cerebelli -Falx cerebri -Spinal dura extending to S
Core link ANSWER Dural envelope created by attachment of the mesodermal dura to S during neural tube development
Involuntary mobility of sacrum between ilia ANSWER Passive motion dictated by dural elements at S -Functional dural connection = core link
Petrojugular sutures - ANSWER -Gomphosis (peg and socket type)
Who is the father of Cranial Osteopathy? - ANSWER William Garner Sutherland
What is the CRI? - ANSWER The palpable manifestation of the motion of the PRM.
How do paired bones of the body respond to flexion and extension of the PRM? - ANSWER Paired bones rotate externally with the flexion phase and rotate internally with the extension phase.
The sacral base moves in response to the movement of the PRM in which direction? - ANSWER -moves about the superior transverse axis -aka respiratory axis -posteriorly and superiorly with the flexion phase -anteriorly and inferiorly with the extension phase.
With flexion of the PRM, what happens to the anterior posterior (fronto-occipital) and transverse (biparietal) dimensions of the cranium? - ANSWER -The AP diameter of the cranium decreases with flexion of the midline bones -The transverse diameter of the cranium increases (widens).
List several physiological/ anatomical changes that occur with flexion at the SBS. - ANSWER -The biparietal dimension of the cranium increases. -Tentorium cerebelli flattens -The sacrum rotates about the respiratory axis such that the sacral base moves posterior and superior -Brain parenchyma shortens anteriorly/posteriorly -The mandible retrudes -Orbits widen -The slope of the forehead increases
-The sternum rises
What is the normal frequency of the primary respiratory mechanism and the cranial rhythmic impulse? - ANSWER Classically - 10-14 cycles per minute. Recent data has analyzed different rates
List the different types of strain patterns that occur at the SBS. -ANSWER-Flexion or extension -Left or right sidebending rotation -Left or right torsion -Superior or inferior vertical strain -Left or right lateral strain -Compression at the SBS
The eponymically named cranial strain patterns have various axes about which the dysfunction occurs. Which have a component of dysfunction about an anterior-posterior axis? -ANSWER-Left and right torsion -Right and left sidebending rotation
The named cranial strain patterns have several axes about which the dysfunction occurs. Which have a component of dysfunction about paired horizontal (transverse) axes? -ANSWER-Left and right flexion/extension -Left and right vertical strain
The named cranial strain patterns have several axes about which the dysfunction occurs. Which have a component of dysfunction about paired vertical axes? -ANSWER-Left and right lateral strain -Left and right sidebending rotation
For which of the cranial strain patterns would one find a component of: A. a superior greater wing of the sphenoid?
What are the considered fixed attachments of the dura mater and the spinal cord? -ANSWER-Around the foramen magnum -C2, C -S
Which bones are considered midline or unpaired bones? - ANSWER -Ethmoid -Occiput -Sacrum -Sphenoid -Sternum -Sometimes the hyoid
What is the function of the sphenobasilar synchondrosis (or symphysis - SBS) in the cranial concept? -ANSWER- key articulation of the PRM -articulation is below the occiput and sphenoid and flexes and extends in response to the pull of nasal membranes
Which cranial bone(s) are associated with somatic dysfunction of the cranium presenting in a patient with vestibular problems and tinnitus? - ANSWER Temporal
Which structures are associated with somatic dysfunction of the cranium presenting in a patient with temporal mandibular joint syndrome (TMJ)? - ANSWER -Articulation at the temporal bone -Mandible Sphenoid mandibular ligament connecting the sphenoid to the mandible Temporo-mandibular ligament from the temporal bone to the mandible
Name the seven bones of the orbit of which somatic dysfunction could affect ocular function - ANSWER -Frontal Maxilla
Palatine Lacrimal Ethmoid Zygoma Sphenoid
What are the articulations of the sacrum? - ANSWER The left and right innominates and the fifth lumbar vertebra.
What are the five named functional poles of attachment of the reciprocal tension membrane? -ANSWER -Crista galli of the ethmoid -Anterior clinoid processes of the sphenoid -Petrous ridge of the temporals -Foramen magnum of the occiput -Sacrum at S
What is balanced membranous tension? - ANSWER The normal physiological state of harmonious equilibrium in the tension of the dura mater of the cranium and spinal cord
What is the Sutherland Fulcrum? -ANSWER-aka Falx-Tentorial Fulcrum -the name often is used for the "automatic shifting suspension" fulcrum of the membranous articular mechanism of the PRM -located at the junction of the falx cerebri and the tentorium cerebelli
What is CSF fluctuation? -ANSWER- cerebrospinal fluid fluctuates, rather than circulates, in a rhythmic cycle of reciprocating activity
What are the midline venous sinuses of the cranium? -ANSWER- Superior sagittal sinus
have anosmia caused by injury to which CN? - ANSWER -CN I
The patient with injury or dysfunction of which CN can experience bitemporal hemianopsia, better known as "tunnel vision?" - ANSWER -CNII (Optic) -this type of vision loss would occur with a lesion of CNII taking place at the sphenoid bone optic chasm.
Injury or dysfunction to which CN will cause the ipsilateral eye in a patient to deviate downward and laterally with ptosis? - ANSWER CN III (Oculomotor); the ptosis is caused by paralysis of the levator palpebrae superioris muscle
The patient with injury or dysfunction to which CN would experience a median gaze? - ANSWER CN IV (Trochlear)
Injury or dysfunction of which CN as it exits the stylomastoid foramen of the temporal bone can cause a patient to have Bell's Palsy? - ANSWER -CN VII (the Facial nerve)
Patients presenting with dysfunction affecting the jugular foramen can experience interference with the normal function of which cranial nerves? - ANSWER -CN IX, X, and XI all pass through the jugular foramen.
Somatic dysfunction of which CN can be associated with a patient presenting with vertigo or hearing loss? - ANSWER -CN VIII (the Vestibulocochlear nerve)
Dysfunction of the ethmoid bone in patients is associated with somatic dysfunction of which CN? - ANSWER -CN I (Olfactory) dysfunction can produce an altered sense of smell
Patients presenting with somatic dysfunction of the superior orbital fissure will have effects to which CN that exits the skull through this pathway? -ANSWER- CN III (Oculomotor), CN IV (Trochlear), CN V (Trigeminal) division 1, and CN VI (Abducens)
Somatic dysfunction affecting which cranial nerve will affect the afferent limb of the corneal blink reflex, which it controls? -ANSWER- CN V, the Trigeminal nerve, division 1, the ophthalmic division
Somatic dysfunction of the foramen rotundum will affect which division of CN V, Trigeminal, that exits the skull through this pathway? -ANSWER- CNV, Trigeminal, division 2, the maxillary division
Somatic dysfunction affecting which CN would cause dysphagia and deviation of the tongue to the ipsilateral side? - ANSWER -CN XII (the Hypoglossal nerve)
Describe the hand and finger placement for the vault hold and the desired purpose for each contact. - ANSWER -Index fingers contact the greater wing of the sphenoid -Pinky fingers contact the occiput below the inion -ear is between the middle and ring fingers -fourth finger (ring finger) on the mastoid process. After appropriate trialing of the patient, what is a relative contraindications to the use of techniques of cranial osteopathy?-ANSWER-Increased intracranial pressure -Unstable skull fractures -Ongoing seizure -Intracranial Bleeding What is some common side effects seen after the use of techniques of cranial osteopathy?- ANSWER-Light headedness -Vertigo -Tinnitus -Change in balance and equilibrium -Cephalgia -Alteration in blood pressure, heart rate, respiratory rate.
For which subpopulations would you expect a lower rate for the PRM? - ANSWER -Endosseous depression
