OCS EXAM 4 PRACTICE QUESTIONS WITH
DETAILED EXPLANATIONS 2026
◉ American College of Radiology would recommend what imaging
modality for migraines
Answer: CT without IV contrast
- for sudden onset, severe HA
◉ If you perform a manip to C1-2, where do you expect the
cavitation to occur?
Answer: multiple audible pops bilaterally at C1-2
◉ If the Sharp Purser is (+) - why are you still skeptical about
instability?
Answer: test is only diagnostic for subjects with RA
-specific test for transverse ligament, however it's only been
validated in subjects with RA and Down's Syndrome; also it may be
dangerous to perform the test after a traumatic MOI ??
◉ Pt is referred to you with mechanical neck pain and they test (+)
for flexion rotation test at C1-2, what intervention is best for most
immediate relief?
,Answer: C1-2 manip and upper thoracic manipulation
manip is superior to mobs for short term effects for mechanical neck
pain
◉ T/F: there is no increased risk to the VBI for chiro vs PCP
Answer: TRUE
◉ What are 3 types of people who have an increased risk for upper
cervical instability?
Answer: RA
Down's
hx of Cervical Spine Trauma
◉ Is the VBI test validated?
Answer: NO, a neg test doesn't not r/o dissection and can be
dangerous within itself
◉ What is the most commonly affected CN if a pt has an Internal
Carotid Artery Dissection?
Answer: Hypoglossal!
CN 12
,◉ What is associated with Alar Ligament Instability?
Answer: Neck Tongue Syndrome
what a pt rotates their head they may experience numbness along
half of their tongue
(+) Sharp Purser= transverse ligament compromise in pt's with RA,
Downs or post trauma
Horners Syndrome = common after internal carotid artery
dissection
Cervical Flexion Rotation Test = used for CGH identification
VBI = 5D's 3 N's hindbrain TIA, Wallenberg
◉ When preparing to perform a cervical manip, what's the purpose
of the pre-manip hold?
Answer: assess pt's comfort and response to position
◉ Pt after MVA with neck pain, she flexes her neck and has increased
paresthesia into her hands and feet, what's the next step?
Answer: appropriate answers:
cervical collar
refer to ER
refer for imaging
, Sharp Purser is not appropriate
◉ What spinal segments do NOT have an intervertebral disc?
Answer: between occiput and first cervical vertebrae
between the 1st and 2nd cervical vertebrae
◉ What ligament prevents the dens of the axis from pressing on the
during active cervical flexion and is commonly compromised during
trauma?
Answer: Transverse - prevents anterior movement of C1 on C2
◉ Where are the joints of Luschka located?
Answer: c-spine C3-7 and these jts are commonly assoc with
degenerative spine conditions and cervical radiculopathy
◉ What part of the cervical intervertebral discs is the weakest?
Answer: posterior; the annulus fibrosis is thick anteriorly but thin
and weak posteriorly
◉ During passive cervical rotation to the right, where does the
vertebral artery get compressed?
Answer: between the first and second cervical vertebra on the left
DETAILED EXPLANATIONS 2026
◉ American College of Radiology would recommend what imaging
modality for migraines
Answer: CT without IV contrast
- for sudden onset, severe HA
◉ If you perform a manip to C1-2, where do you expect the
cavitation to occur?
Answer: multiple audible pops bilaterally at C1-2
◉ If the Sharp Purser is (+) - why are you still skeptical about
instability?
Answer: test is only diagnostic for subjects with RA
-specific test for transverse ligament, however it's only been
validated in subjects with RA and Down's Syndrome; also it may be
dangerous to perform the test after a traumatic MOI ??
◉ Pt is referred to you with mechanical neck pain and they test (+)
for flexion rotation test at C1-2, what intervention is best for most
immediate relief?
,Answer: C1-2 manip and upper thoracic manipulation
manip is superior to mobs for short term effects for mechanical neck
pain
◉ T/F: there is no increased risk to the VBI for chiro vs PCP
Answer: TRUE
◉ What are 3 types of people who have an increased risk for upper
cervical instability?
Answer: RA
Down's
hx of Cervical Spine Trauma
◉ Is the VBI test validated?
Answer: NO, a neg test doesn't not r/o dissection and can be
dangerous within itself
◉ What is the most commonly affected CN if a pt has an Internal
Carotid Artery Dissection?
Answer: Hypoglossal!
CN 12
,◉ What is associated with Alar Ligament Instability?
Answer: Neck Tongue Syndrome
what a pt rotates their head they may experience numbness along
half of their tongue
(+) Sharp Purser= transverse ligament compromise in pt's with RA,
Downs or post trauma
Horners Syndrome = common after internal carotid artery
dissection
Cervical Flexion Rotation Test = used for CGH identification
VBI = 5D's 3 N's hindbrain TIA, Wallenberg
◉ When preparing to perform a cervical manip, what's the purpose
of the pre-manip hold?
Answer: assess pt's comfort and response to position
◉ Pt after MVA with neck pain, she flexes her neck and has increased
paresthesia into her hands and feet, what's the next step?
Answer: appropriate answers:
cervical collar
refer to ER
refer for imaging
, Sharp Purser is not appropriate
◉ What spinal segments do NOT have an intervertebral disc?
Answer: between occiput and first cervical vertebrae
between the 1st and 2nd cervical vertebrae
◉ What ligament prevents the dens of the axis from pressing on the
during active cervical flexion and is commonly compromised during
trauma?
Answer: Transverse - prevents anterior movement of C1 on C2
◉ Where are the joints of Luschka located?
Answer: c-spine C3-7 and these jts are commonly assoc with
degenerative spine conditions and cervical radiculopathy
◉ What part of the cervical intervertebral discs is the weakest?
Answer: posterior; the annulus fibrosis is thick anteriorly but thin
and weak posteriorly
◉ During passive cervical rotation to the right, where does the
vertebral artery get compressed?
Answer: between the first and second cervical vertebra on the left
