CCEP Clinical Decision Making 2 — Questions and Answers
Question 1: A 45-year-old male presents with lateral elbow pain that worsens with resisted wrist extension. Cozen's test is positive. Which structure is most likely involved?
- Medial epicondyle tendon
- Common extensor tendon at lateral epicondyle (Correct answer)
- Ulnar collateral ligament
- Biceps tendon insertion
Correct answer: Common extensor tendon at lateral epicondyle
Cozen's test (resisted wrist extension with elbow extended) specifically stresses the common extensor tendon at the lateral epicondyle, indicating lateral epicondylitis.
Question 2: When evaluating a patient with suspected carpal tunnel syndrome, which electrodiagnostic finding is most diagnostic?
- Prolonged ulnar motor latency
- Prolonged median sensory latency across the wrist (Correct answer)
- Reduced radial nerve conduction velocity
- Abnormal EMG of the extensor digitorum
Correct answer: Prolonged median sensory latency across the wrist
Prolonged median sensory nerve conduction latency across the wrist is the most sensitive electrodiagnostic finding in carpal tunnel syndrome.
Question 3: A soccer player reports anterior knee pain that worsens when descending stairs and after prolonged sitting. Patellar grind test is positive. What is the most likely diagnosis?
- Patellar tendinopathy
- Patellofemoral pain syndrome (Correct answer)
- Prepatellar bursitis
- Osgood-Schlatter disease
Correct answer: Patellofemoral pain syndrome
Patellofemoral pain syndrome presents with anterior knee pain worsened by stairs and prolonged knee flexion, with a positive patellar grind test.
Question 4: In clinical decision making for extremity adjusting, which finding would most contraindicate high-velocity thrust to the wrist?
- Mild carpal hypomobility on motion palpation
- Rheumatoid arthritis with active synovitis (Correct answer)
- Chronic myofascial trigger points in the forearm
- Mild degenerative joint changes on X-ray
Correct answer: Rheumatoid arthritis with active synovitis
Active rheumatoid arthritis with synovitis is a contraindication to HVLA manipulation due to risk of joint damage, ligamentous laxity, and inflammatory exacerbation.
Question 5: A patient presents with foot drop following a fall. Which nerve is most likely injured based on this presentation?
- Sural nerve
- Tibial nerve
- Common peroneal nerve (Correct answer)
- Femoral nerve
Correct answer: Common peroneal nerve
The common peroneal nerve wraps around the fibular head and is vulnerable to injury there, causing foot drop due to weakness of ankle dorsiflexion and eversion.
Question 6: Which clinical test is most specific for a torn anterior talofibular ligament (ATFL)?
- Thompson test
- Anterior drawer test of the ankle (Correct answer)
- Talar tilt test
- Homans sign
Correct answer: Anterior drawer test of the ankle
The anterior drawer test of the ankle assesses ATFL integrity by translating the talus anteriorly relative to the tibia; excessive translation indicates ATFL rupture.
Question 7: A patient with chronic shoulder pain has a positive Neer impingement sign and positive empty can test. Which structure is most likely compromised?
- Subscapularis tendon
- Infraspinatus tendon
- Supraspinatus tendon (Correct answer)
- Long head of biceps tendon
Correct answer: Supraspinatus tendon
The empty can test (Jobe's test) isolates the supraspinatus, and combined with Neer's sign, suggests supraspinatus impingement or tear.
CCEP Clinical Decision Making 2
A 45-year-old male presents with lateral elbow pain that worsens with resisted wrist extension.
Cozen's test is positive.
Which structure is most likely involved?