OCS Exam Questions (with Complete Solutions)
What is characteristic of a migraine HA? correct answers 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 answers 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 answers multiple audible pops bilaterally at C1-2
If the Sharp Purser is (+) - why are you still skeptical about instability? correct answers 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 answers 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 answers TRUE
What are 3 types of people who have an increased risk for upper cervical instability? correct answers RA
Down's
hx of Cervical Spine Trauma
Is the VBI test validated? correct answers 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 answers Hypoglossal!
CN 12
What is associated with Alar Ligament Instability? correct answers 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 answers 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 answers 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 answers 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? correct answers Transverse - prevents anterior movement of C1 on C2
Where are the joints of Luschka located? correct answers 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 answers 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? correct answers between the first and second cervical vertebra on the left
What are absolute contraindications for manual therapy? correct answers Osteomyelitis
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 answers radicular 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 answers 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 non-vascular vestibular dizziness. What would you expect if te pt had dizziness 2/2 cervical artery dissection, rather that non-vascular vestibular dizziness correct answers -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 answers CN 1, 2
Acute dissection of Internal Carotid, what CN is involved? correct answers CN 12
What CN's would NOT be effected with Internal Carotid Dissection? correct answers CN 1 (olfactory)
2-4 can be
Which syndrome is common after Internal Carotid dissection and results is ptosis, miosis, anhidrosis and enopthalmosis? correct answers Horner's Syndrome
What kind of malignancy will cause radiculopathy in C8-T1 nerve distribution? What visceral structure? correct answers Pancoast Tumor
Heart
What is the best intervention for cervical radic? correct answers Intermittent mechanical traction
What should you be thinking about when determining spondylosis vs radic? correct answers 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 answers 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 answers 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 answers 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 answers derangement
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 answers 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 answers 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 answers 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 answers 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 answers 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.
What is characteristic of a migraine HA? correct answers 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 answers 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 answers multiple audible pops bilaterally at C1-2
If the Sharp Purser is (+) - why are you still skeptical about instability? correct answers 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 answers 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 answers TRUE
What are 3 types of people who have an increased risk for upper cervical instability? correct answers RA
Down's
hx of Cervical Spine Trauma
Is the VBI test validated? correct answers 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 answers Hypoglossal!
CN 12
What is associated with Alar Ligament Instability? correct answers 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 answers 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 answers 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 answers 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? correct answers Transverse - prevents anterior movement of C1 on C2
Where are the joints of Luschka located? correct answers 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 answers 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? correct answers between the first and second cervical vertebra on the left
What are absolute contraindications for manual therapy? correct answers Osteomyelitis
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 answers radicular 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 answers 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 non-vascular vestibular dizziness. What would you expect if te pt had dizziness 2/2 cervical artery dissection, rather that non-vascular vestibular dizziness correct answers -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 answers CN 1, 2
Acute dissection of Internal Carotid, what CN is involved? correct answers CN 12
What CN's would NOT be effected with Internal Carotid Dissection? correct answers CN 1 (olfactory)
2-4 can be
Which syndrome is common after Internal Carotid dissection and results is ptosis, miosis, anhidrosis and enopthalmosis? correct answers Horner's Syndrome
What kind of malignancy will cause radiculopathy in C8-T1 nerve distribution? What visceral structure? correct answers Pancoast Tumor
Heart
What is the best intervention for cervical radic? correct answers Intermittent mechanical traction
What should you be thinking about when determining spondylosis vs radic? correct answers 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 answers 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 answers 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 answers 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 answers derangement
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 answers 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 answers 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 answers 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 answers 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 answers 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.
