CMT 4 Final Exam Notes with Complete Solutions
"Female presents with pain in her mid-foot between her 2nd and 3rd metatarsals. It is
worse with weight bearing. Pain can be reproduced with dorsiflexion and by applying
pressure or ""squeezing"" the metatarsals together. What are your recommendations?
a. Heel lift b. Refer to orthopedic surgeon c. Recommend larger, wider shoes and apply
metatarsal head pad d. Ice and adjust" - ANSWER-c. Recommend larger, wider shoes
and apply metatarsal head pad
"Gonstead adjusting is based on thrusting though the ""disc plane line"", _____ parallel
to the disc plane with minimal _____. a. PA, lateral flexion b. AP, lateral flexion c. PA,
rotation d. AP, rotation" - ANSWER-c. PA, rotation
"Mckenzie defines ""dysfunction syndrome: as A. Stress at initial range of damaged
structures B. End range stress on adaptively shortened structures C. Involving only
muscular structures D. Stress of anatomically disrupted tissue" - ANSWER-B. End
range stress on adaptively shortened structures
"McKenzie defines ""postural syndrome"" as: A. Deformation of normal soft tissue B.
Mechanical joint dysfunction C. Pathological muscles D. Not affecting contractile tissue"
- ANSWER-A. Deformation of normal soft tissue
"The clinical finding according to Thompson technique ""if in position 1 the legs are even
and then draw short with head rotation to the right and left"" is known as: a. Cervical
syndrome b. Bilateral cervical syndrome c. Positive Derefield d. Negative Derefield" -
ANSWER-b. Bilateral cervical syndrome
25 y/o female patient presents with achy occipital headache of unknown origin. When
the patient turns left they feel light headed, Would you manipulate this patient without
imaging or other testing? A. True B. False - ANSWER-B. False
29 year old male patient presents with LBP and right gluteal pain. Which of the following
would most indicate a mckenzie extension exercise treatment protocol? A. Gluteal pain
is alleviated with standing or prone extension B. Gluteal pain is alleviated with standing
flexion C. Gluteal pain is aggravated with standing extension D. Low back pain is
aggravated with standing extension - ANSWER-A. Gluteal pain is alleviated with
standing or prone extension
30 y/o male presents with sharp 9/10 right low back pain of sudden onset yesterday
from jumping up and reaching over the outfield wall to catch a potential home run. Pain
is now aggravated with sitting up straight and alleviated with rest. He sleeps through the
night without much discomfort, but difficulty arising from bed. He notes some burning
pain with activity. He denies any numbness or tingling or change in bowel or bladder
habits. By Halls criteria, and pattern classification, what is the prognosis? A. Good B.
Fair C. Guarded D. Unstable E. Poor - ANSWER-A. Good
, 75yo female patient presents in forward antalgic position and complains of sudden
onset of localized mid-thoracic pain. Exam reveals severe tenderness on motion
palpation. There is no palpable temperature differential. She is neurologically intact.
Taking into account indications/contraindications, what is your working diagnosis and
what should your next action be? A. Moderate OA/ lab testing B. Space occupying
lesion/ distraction C. Joint dysfunction/ HVLA manipulation D. Severe osteoporosis with
fracture / spinal X-Ray - ANSWER-D. Severe osteoporosis with fracture / spinal X-Ray
A 15-year-old female is brought into your office with an asymptomatic 15-degree
scoliosis and there is no aberrant motion. What would be your recommended course of
care? a. Do nothing and re-evaluate in 6 months b. Tell patient that is normal c. Spinal
manipulation to increase mobility d. Recommend a 20 degree heel lift - ANSWER-c.
Spinal manipulation to increase mobility
A 24yo female presents with sudden onset of low back pain with periodic radiation to
the right buttock. Onset was 3 days ago after running a 10K. Exam : MP restriction of
L4-5. Neurologically intact. Full hip ROM. FABQ=5What is the prognosis of the patient's
response to CMT? A. Poor B. Fair C. Good D. Excellent - ANSWER-D. Excellent
A 25-year-old male presents with a painful, red swollen right elbow. Physical exam
revealed erythematous swollen elbow, radiographic analysis shows increased joint
space. What should be done next? a. Joint aspiration b. Arthroscopy c. Trial
manipulation (adjustment) d. Motion palpation e. Ice and rest - ANSWER-e. Ice and rest
A 35 year female tennis player presents with intermittent lumbar pain without any
radiation. Pain is described as a catch that progresses to a soreness in the back. It feels
like back is not moving right. Pain recurs with serving the ball. She denies trauma.
Exam: Patient is neurologically intact. There is a positive Active SLR, prone instability
test, and hip extension test. What is your diagnosis? A. Radiculopathy B. Dynamic
instability C. Strained muscle D. Sprained ligaments - ANSWER-B. Dynamic instability
A 36-year-old male presents with low back and right leg pain following a fall off a ladder.
He has numbness over the right lateral malleolus and lateral aspect of the small toe of
the right foot. The patients posture is antalgic with the trunk inclined towards the left. A
positive _____ test would likely indicate the need to order an MRI to rule out a space-
occupying lesion. a. Nachlas b. Valsalvas c. Hyperextension d. Gaenslens - ANSWER-
b. Valsalvas
A 4-year-old child presents with his right arm in a sling. The child holds the humerus
flexed against his body with the forearm pronated. During the history the child says that
his dad was swinging him by his arms just prior. What is the most likely diagnosis? a.
Dislocated radial head b. Salter-Harris IV of distal humerus c. Rupture of the
supraspinatus muscle d. Shoulder dislocation - ANSWER-a. Dislocated radial head
A 46-year-old presents with pain localized in the lower cervical region. There is no
history of recent trauma or malignancy. Based on the radiograph provided and the
"Female presents with pain in her mid-foot between her 2nd and 3rd metatarsals. It is
worse with weight bearing. Pain can be reproduced with dorsiflexion and by applying
pressure or ""squeezing"" the metatarsals together. What are your recommendations?
a. Heel lift b. Refer to orthopedic surgeon c. Recommend larger, wider shoes and apply
metatarsal head pad d. Ice and adjust" - ANSWER-c. Recommend larger, wider shoes
and apply metatarsal head pad
"Gonstead adjusting is based on thrusting though the ""disc plane line"", _____ parallel
to the disc plane with minimal _____. a. PA, lateral flexion b. AP, lateral flexion c. PA,
rotation d. AP, rotation" - ANSWER-c. PA, rotation
"Mckenzie defines ""dysfunction syndrome: as A. Stress at initial range of damaged
structures B. End range stress on adaptively shortened structures C. Involving only
muscular structures D. Stress of anatomically disrupted tissue" - ANSWER-B. End
range stress on adaptively shortened structures
"McKenzie defines ""postural syndrome"" as: A. Deformation of normal soft tissue B.
Mechanical joint dysfunction C. Pathological muscles D. Not affecting contractile tissue"
- ANSWER-A. Deformation of normal soft tissue
"The clinical finding according to Thompson technique ""if in position 1 the legs are even
and then draw short with head rotation to the right and left"" is known as: a. Cervical
syndrome b. Bilateral cervical syndrome c. Positive Derefield d. Negative Derefield" -
ANSWER-b. Bilateral cervical syndrome
25 y/o female patient presents with achy occipital headache of unknown origin. When
the patient turns left they feel light headed, Would you manipulate this patient without
imaging or other testing? A. True B. False - ANSWER-B. False
29 year old male patient presents with LBP and right gluteal pain. Which of the following
would most indicate a mckenzie extension exercise treatment protocol? A. Gluteal pain
is alleviated with standing or prone extension B. Gluteal pain is alleviated with standing
flexion C. Gluteal pain is aggravated with standing extension D. Low back pain is
aggravated with standing extension - ANSWER-A. Gluteal pain is alleviated with
standing or prone extension
30 y/o male presents with sharp 9/10 right low back pain of sudden onset yesterday
from jumping up and reaching over the outfield wall to catch a potential home run. Pain
is now aggravated with sitting up straight and alleviated with rest. He sleeps through the
night without much discomfort, but difficulty arising from bed. He notes some burning
pain with activity. He denies any numbness or tingling or change in bowel or bladder
habits. By Halls criteria, and pattern classification, what is the prognosis? A. Good B.
Fair C. Guarded D. Unstable E. Poor - ANSWER-A. Good
, 75yo female patient presents in forward antalgic position and complains of sudden
onset of localized mid-thoracic pain. Exam reveals severe tenderness on motion
palpation. There is no palpable temperature differential. She is neurologically intact.
Taking into account indications/contraindications, what is your working diagnosis and
what should your next action be? A. Moderate OA/ lab testing B. Space occupying
lesion/ distraction C. Joint dysfunction/ HVLA manipulation D. Severe osteoporosis with
fracture / spinal X-Ray - ANSWER-D. Severe osteoporosis with fracture / spinal X-Ray
A 15-year-old female is brought into your office with an asymptomatic 15-degree
scoliosis and there is no aberrant motion. What would be your recommended course of
care? a. Do nothing and re-evaluate in 6 months b. Tell patient that is normal c. Spinal
manipulation to increase mobility d. Recommend a 20 degree heel lift - ANSWER-c.
Spinal manipulation to increase mobility
A 24yo female presents with sudden onset of low back pain with periodic radiation to
the right buttock. Onset was 3 days ago after running a 10K. Exam : MP restriction of
L4-5. Neurologically intact. Full hip ROM. FABQ=5What is the prognosis of the patient's
response to CMT? A. Poor B. Fair C. Good D. Excellent - ANSWER-D. Excellent
A 25-year-old male presents with a painful, red swollen right elbow. Physical exam
revealed erythematous swollen elbow, radiographic analysis shows increased joint
space. What should be done next? a. Joint aspiration b. Arthroscopy c. Trial
manipulation (adjustment) d. Motion palpation e. Ice and rest - ANSWER-e. Ice and rest
A 35 year female tennis player presents with intermittent lumbar pain without any
radiation. Pain is described as a catch that progresses to a soreness in the back. It feels
like back is not moving right. Pain recurs with serving the ball. She denies trauma.
Exam: Patient is neurologically intact. There is a positive Active SLR, prone instability
test, and hip extension test. What is your diagnosis? A. Radiculopathy B. Dynamic
instability C. Strained muscle D. Sprained ligaments - ANSWER-B. Dynamic instability
A 36-year-old male presents with low back and right leg pain following a fall off a ladder.
He has numbness over the right lateral malleolus and lateral aspect of the small toe of
the right foot. The patients posture is antalgic with the trunk inclined towards the left. A
positive _____ test would likely indicate the need to order an MRI to rule out a space-
occupying lesion. a. Nachlas b. Valsalvas c. Hyperextension d. Gaenslens - ANSWER-
b. Valsalvas
A 4-year-old child presents with his right arm in a sling. The child holds the humerus
flexed against his body with the forearm pronated. During the history the child says that
his dad was swinging him by his arms just prior. What is the most likely diagnosis? a.
Dislocated radial head b. Salter-Harris IV of distal humerus c. Rupture of the
supraspinatus muscle d. Shoulder dislocation - ANSWER-a. Dislocated radial head
A 46-year-old presents with pain localized in the lower cervical region. There is no
history of recent trauma or malignancy. Based on the radiograph provided and the
