CCEP Patient Management 3 — Questions and Answers
Question 1: A 45-year-old runner presents with lateral knee pain that worsens with downhill running. The Noble compression test is positive. Which structure is most likely involved?
- Lateral collateral ligament
- Iliotibial band (Correct answer)
- Biceps femoris tendon
- Lateral meniscus
Correct answer: Iliotibial band
A positive Noble compression test at the lateral femoral epicondyle is characteristic of iliotibial band syndrome, a common overuse injury in runners.
Question 2: When establishing short-term goals for an extremity patient, goals should ideally be:
- Vague to allow flexibility in treatment
- Measurable, time-bound, and functional (Correct answer)
- Set solely by the treating chiropractor
- Based exclusively on radiographic findings
Correct answer: Measurable, time-bound, and functional
SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound) are the standard framework for setting meaningful clinical goals.
Question 3: A CCEP patient has been non-compliant with home exercises. The most therapeutically appropriate first response is to:
- Discharge the patient for non-compliance
- Explore barriers to adherence and modify the program accordingly (Correct answer)
- Document non-compliance only and continue treatment unchanged
- Add more exercises to increase motivation
Correct answer: Explore barriers to adherence and modify the program accordingly
Exploring barriers (pain, time, confusion) and simplifying or modifying the program improves adherence and produces better outcomes.
Question 4: Which finding during a shoulder examination most warrants immediate referral rather than chiropractic management?
- Mild supraspinatus weakness with positive empty can test
- Shoulder pain reproducing with cervical compression
- Rapidly progressing deltoid atrophy with complete arm weakness (Correct answer)
- Acromioclavicular joint tenderness after a fall
Correct answer: Rapidly progressing deltoid atrophy with complete arm weakness
Rapidly progressive neurological deficits such as deltoid atrophy and complete weakness suggest serious pathology (e.g., Parsonage-Turner syndrome or cord compression) requiring urgent referral.
Question 5: In extremity chiropractic, the Thomas test is primarily used to assess:
- Hip flexor tightness and iliopsoas contracture (Correct answer)
- Sacroiliac joint mobility
- Lumbar facet joint involvement
- Femoral nerve tension
Correct answer: Hip flexor tightness and iliopsoas contracture
The Thomas test detects hip flexor tightness by observing whether the contralateral hip flexes off the table when one knee is drawn to the chest.
Question 6: A patient with diabetes mellitus presents with foot numbness and tingling. Before initiating extremity manipulation of the foot, the chiropractor should FIRST:
- Perform a complete sensory and vascular examination of the lower extremity (Correct answer)
- Apply ultrasound therapy to improve circulation
- Immediately refer to podiatry without examination
- Begin manipulation and reassess after three visits
Correct answer: Perform a complete sensory and vascular examination of the lower extremity
Diabetic neuropathy and peripheral vascular disease must be assessed first, as impaired sensation and circulation alter treatment safety and prognosis.
Question 7: Which principle guides the decision to discontinue active chiropractic extremity care and transition a patient to self-management?
- The patient's insurance benefits are exhausted
- The patient has reached maximum therapeutic benefit with functional stability (Correct answer)
- The chiropractor's schedule no longer permits appointments
- The patient requests discharge after one session
Correct answer: The patient has reached maximum therapeutic benefit with functional stability
Care should be discontinued when the patient achieves maximum therapeutic benefit, functional goals are met, and they can self-manage their condition.
CCEP Patient Management 3
A 45-year-old runner presents with lateral knee pain that worsens with downhill running.
The Noble compression test is positive.
Which structure is most likely involved?