OCS Exam Questions and answers

OCS Exam Questions and answers 2023- 2024 What is characteristic of a migraine HA? - CORRECT ANSWER-PRIMARY HA -pulsating/pounding -unilateral in nature -4-72 hrs -nausea is associated -light/noise sensitivity also activity increases HA 4/5 present + LR 24 which significant shifts post-test probability of the dx being present American College of Radiology would recommend what imaging modality for migraines - CORRECT 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? - CORRECT ANSWER-multiple audible pops bilaterally at C1-2 If the Sharp Purser is (+) - why are you still skeptical about instability? - CORRECT 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? - CORRECT 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 - CORRECT ANSWER-TRUE What are 3 types of people who have an increased risk for upper cervical instability? - CORRECT ANSWER-RA Down's hx of Cervical Spine Trauma Is the VBI test validated? - CORRECT 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? - CORRECT ANSWER-Hypoglossal! CN 12 What is associated with Alar Ligament Instability? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT ANSWERbetween 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? - CORRECT ANSWERTransverse - prevents anterior movement of C1 on C2 Where are the joints of Luschka located? - CORRECT 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? - CORRECT ANSWERposterior; 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? - CORRECT ANSWER-between the first and second cervical vertebra on the left What are absolute contraindications for manual therapy? - CORRECT ANSWEROsteomyelitis Nerve Root Compression with increasing neuro deficits Influenze with Fever Pregnancy is a relative one! Pt's who are not good for cervical manipulation include? - CORRECT ANSWERradicular sx to mid-forearm these people would do better with centralization techniques severe spondylosis without radic are ok During Cervical Artery Dissection, which arteries would you suspect to be involved? - CORRECT ANSWER-Vertebrobasilar, which is the posterior arterial system perfusing the hindbrain and the internal carotid artery which is the anterior arterial system perfusing the cerebral hemispheres and eyes Trying to differentiate if a pt's dizziness is 2/2 to a cervical artery dissection or nonvascular vestibular dizziness. What would you expect if te pt had dizziness 2/2 cervical artery dissection, rather that non-vascular vestibular dizziness - CORRECT ANSWER-- dizziness is reproduced with active cervical rotation and active trunk rotation with head stable -if pt's dizziness is 2/2 vestibular disorder you'd expect dizziness to be reproducible with active cervical rotation but not trunk rotation since the vestibular canals remain unchanged in this position If your pt has neck pain starts to develop symptoms related to hindbrain ischemia, all of the following CN would likely be involved expect - CORRECT ANSWER-CN 1, 2 Acute dissection of Internal Carotid, what CN is involved? - CORRECT ANSWER-CN 12 What CN's would NOT be effected with Internal Carotid Dissection? - CORRECT ANSWER-CN 1 (olfactory) 2-4 can be Which syndrome is common after Internal Carotid dissection and results is ptosis, miosis, anhidrosis and enopthalmosis? - CORRECT ANSWER-Horner's Syndrome What kind of malignancy will cause radiculopathy in C8-T1 nerve distribution? What visceral structure? - CORRECT ANSWER-Pancoast Tumor Heart What is the best intervention for cervical radic? - CORRECT ANSWER-Intermittent mechanical traction What should you be thinking about when determining spondylosis vs radic? - CORRECT ANSWER-AGE older age suspect spondylosis over a HNP C8-T1 arthritic changes are more common in the cervical spine than the thoracic/lumbar. Disc herniations are common in the lumbar. Describe the AIN in terms of Presentation - CORRECT ANSWER-no sensory sx weakness of FPL and FDP and Pronator Quadratus = inability to make OK sign DDX: FPL rupture What nerve pathology can result in AIN s/s and inability to bring thumb and tip of finger together? - CORRECT ANSWER-Parsonage Turner Syndrome defined as neuritis involving the brachial plexus, this syndrome commonly involves the upper trunk of the brachial plexus but has been frequently reported in other parts as well According to McKenzie, a pt with neck pain can be classified into one of 3 syndromes. What are they? - CORRECT ANSWER-Derangement Dysfunction Postural McKenzie: if pt's unilateral radic s/s centralize from their hand to elbow with repeated cervical retraction, the pt should be classified into what group>? - CORRECT ANSWERderangement this is the most common classification, pt's sx centralize or peripheralize they are in this group McKenzie: 68 y/o M presents to PT with FHP and hx of decompression and laminectomy at C3-4 2 yrs ago. You're exam reveals he only has pain at end range cervical retraction - what group? - CORRECT ANSWER-dysfunction typically pts are classified into the dysfunction category when they experience pain at end range Tx: in this category = perform exercises into the direction that causes pain pt has R lateral cervical foramen narrowing at C5-6 resulting from radiculopathy, upon observing their posture at IE, what is the most likely position of the pt's head to avoid reproduction of their radiculopathy? - CORRECT ANSWER-head rotated and SB to the left and slightly flexed = max opening of the right lateral foramen Pt presents with pain btw their shoulder blades and n/t of L hand in stocking glove pattern, what is the most likely dx? - CORRECT ANSWER-T4 Syndrome will have sx in thoracic region with paresthesias of the hands in a stocking glove pattern. the pattern of paresthesias can mimic sx of DM or radic. Which muscles are innervated by the AIN? - CORRECT ANSWER-Radial half of FDP FPL Pronator Quadratus NOT Pronator Teres (median nerve) When r/o a sinister pathology, a PT should use a test that is highly sensitivity to decrease the ... - CORRECT ANSWER-likelihood of a false negative. very Sn tests identify most pts with a condition whereas very sp tests help to r/o those without a condition. Those with myelopathy present how? - CORRECT ANSWER-multiple dermatomes affected vs radic d/t stenosis may have dermatomal loss with specific nerve root(s) >45 y/o weakness in legs gait disturbances Pt has thoracic spine pain, she has long term hx of corticosteroid use. What else would increase suspicion of compression fx? - CORRECT ANSWER-age >50 this and corticosteroid use significant increase your suspicion of compression fx What are high RF for Canadian Cspine rules? - CORRECT ANSWER-age > 65 hx of paresthesias in extremities fall from height of 6 ft What are pathologies associated with predisposed cervical instability or ligamentous instability? - CORRECT ANSWER-Marfan Morquio - bone dysplasia associated with C1-2 subluxation RA Down's EDS? What's another name for the Waiting Room Sign? - CORRECT ANSWER-Bakody Sign = cerivcal radic Describe the difference in suprascapular notch and spinoglenoid notch with nerve entrapment? - CORRECT ANSWER-when the suprascapular nerve is entrapped at the suprascapular notch you would expect atrophy of both the supraspinatus and infraspinatus