CCEP Clinical Decision Making 3 — Questions and Answers
Question 1: A 60-year-old diabetic patient presents with bilateral burning foot pain worse at night and loss of protective sensation. What is the most appropriate clinical decision?
- Aggressive joint manipulation of the feet
- Refer for vascular duplex ultrasound only
- Comprehensive diabetic foot examination with monofilament testing and neurological referral (Correct answer)
- Prescribe custom orthotics without further assessment
Correct answer: Comprehensive diabetic foot examination with monofilament testing and neurological referral
Diabetic peripheral neuropathy requires thorough assessment including monofilament testing for protective sensation and potential neurological or endocrinology referral to prevent ulceration.
Question 2: When using the Ottawa Ankle Rules, which finding indicates the need for radiographic imaging?
- Diffuse soft tissue swelling without bony tenderness
- Point tenderness at the posterior edge of the lateral malleolus (Correct answer)
- Pain with resisted plantarflexion
- Positive anterior drawer test
Correct answer: Point tenderness at the posterior edge of the lateral malleolus
Ottawa Ankle Rules mandate X-rays if there is bony tenderness at the posterior 6 cm or tip of the lateral or medial malleolus.
Question 3: A pitcher presents with medial elbow pain during the late cocking and acceleration phases of throwing. Valgus stress testing at 30° flexion reveals laxity. Which structure is most likely injured?
- Radial collateral ligament
- Ulnar collateral ligament (anterior band) (Correct answer)
- Annular ligament
- Lateral epicondyle tendon
Correct answer: Ulnar collateral ligament (anterior band)
The anterior band of the UCL is the primary stabilizer against valgus stress at the elbow and is commonly injured in overhead throwing athletes.
Question 4: Which pattern of hip joint restriction is most consistent with early osteoarthritis of the hip using the capsular pattern?
- Equal restriction in all planes
- Greatest loss of internal rotation, then flexion, then abduction (Correct answer)
- Greatest loss of external rotation with preserved flexion
- Loss of extension only
Correct answer: Greatest loss of internal rotation, then flexion, then abduction
The capsular pattern of the hip joint involves greatest restriction of internal rotation, followed by flexion and abduction, indicating intra-articular pathology.
Question 5: A CCEP practitioner identifies joint hypomobility at the first MTP joint with limitation of dorsiflexion. This clinical pattern is consistent with which condition?
- Hallux valgus
- Hallux rigidus (Correct answer)
- Morton's neuroma
- Plantar fasciitis
Correct answer: Hallux rigidus
Hallux rigidus is characterized by loss of dorsiflexion at the first MTP joint due to degenerative changes, causing pain and stiffness during push-off.
Question 6: When evaluating shoulder instability, which test combination provides the highest diagnostic accuracy for anterior glenohumeral instability?
- Drop arm test and Speed's test
- Apprehension test and relocation test (Correct answer)
- Hawkins-Kennedy test and Neer test
- Active compression test and O'Brien test
Correct answer: Apprehension test and relocation test
The apprehension test combined with the relocation test (Jobe's relocation) has high sensitivity and specificity for anterior glenohumeral instability.
Question 7: A patient presents after ankle sprain with a positive squeeze test (fibular compression) and syndesmotic tenderness. Which injury should be suspected?
- Grade III ATFL sprain
- High ankle sprain (syndesmosis injury) (Correct answer)
- Calcaneofibular ligament rupture
- Peroneal tendon subluxation
Correct answer: High ankle sprain (syndesmosis injury)
A positive squeeze test with anterosuperior pain at the syndesmosis indicates a high ankle sprain, which requires more conservative management and longer recovery.
CCEP Clinical Decision Making 3
A 60-year-old diabetic patient presents with bilateral burning foot pain worse at night and loss of protective sensation.
What is the most appropriate clinical decision?