CCEP Patient Management 2 — Questions and Answers
Question 1: A patient with a suspected scaphoid fracture has a negative initial X-ray. What is the most appropriate next step in management?
- Discharge with ice and rest instructions
- Immobilize and order advanced imaging (MRI or CT) (Correct answer)
- Initiate aggressive mobilization to prevent stiffness
- Refer for immediate surgical consultation
Correct answer: Immobilize and order advanced imaging (MRI or CT)
Scaphoid fractures are frequently occult on initial X-ray, so immobilization and advanced imaging (MRI or CT) are indicated to avoid missing the diagnosis.
Question 2: When documenting a CCEP patient encounter, which element is LEAST likely to be required in a SOAP note?
- Chief complaint and history of present illness
- Patient's insurance billing preferences (Correct answer)
- Objective orthopedic and neurological findings
- Assessment with working diagnosis and differential
Correct answer: Patient's insurance billing preferences
Insurance billing preferences are administrative and not a clinical component of a SOAP note.
Question 3: A chiropractor is treating a patient for lateral ankle sprain and notices signs of deep vein thrombosis (DVT) in the calf. The appropriate response is to:
- Apply compression bandaging and elevate the limb
- Continue treatment but reduce intensity
- Immediately refer the patient to emergency care (Correct answer)
- Order an ultrasound and continue care while awaiting results
Correct answer: Immediately refer the patient to emergency care
DVT is a medical emergency requiring immediate referral, as manipulation or compression could dislodge a clot and cause pulmonary embolism.
Question 4: In the management of chronic Achilles tendinopathy, which rehabilitation approach has the strongest evidence base?
- Passive stretching only
- Eccentric loading exercise program (Correct answer)
- Complete rest and anti-inflammatory medication
- Surgical debridement
Correct answer: Eccentric loading exercise program
Eccentric loading protocols (e.g., Alfredson's protocol) have the strongest evidence for improving outcomes in chronic Achilles tendinopathy.
Question 5: Which informed consent principle requires the chiropractor to disclose alternatives to the proposed treatment?
- Beneficence
- Nonmaleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Autonomy requires that patients be given enough information, including treatment alternatives, to make an informed decision about their care.
Question 6: A patient presents with a positive Finkelstein's test. Which condition does this finding most strongly suggest?
- Carpal tunnel syndrome
- De Quervain's tenosynovitis (Correct answer)
- Trigger finger
- Cubital tunnel syndrome
Correct answer: De Quervain's tenosynovitis
A positive Finkelstein's test, which reproduces pain along the radial styloid with ulnar deviation of the wrist, is pathognomonic for De Quervain's tenosynovitis.
Question 7: Which outcome measure is most appropriate for tracking functional progress in a patient recovering from a rotator cuff injury?
- Oswestry Disability Index (ODI)
- DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire (Correct answer)
- WOMAC Osteoarthritis Index
- Lower Extremity Functional Scale (LEFS)
Correct answer: DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire
The DASH questionnaire is a validated upper-extremity-specific outcome measure ideal for monitoring functional recovery in shoulder and arm conditions.
CCEP Patient Management 2
A patient with a suspected scaphoid fracture has a negative initial X-ray.
What is the most appropriate next step in management?