CCEP Patient Management 4 — Questions and Answers
Question 1: A patient presents with a 'click' in the hip during flexion, reproduced consistently. The most likely diagnosis is:
- Hip osteoarthritis
- Snapping hip syndrome (coxa saltans) (Correct answer)
- Acetabular labral tear
- Femoral stress fracture
Correct answer: Snapping hip syndrome (coxa saltans)
Snapping hip syndrome (coxa saltans) is characterized by a reproducible snap or click during hip movement, caused by tendons sliding over bony prominences.
Question 2: When co-managing an extremity patient with a medical physician, the chiropractor's primary responsibility is to:
- Defer all clinical decisions to the physician
- Communicate relevant findings and collaborate within their scope of practice (Correct answer)
- Avoid documentation overlap with the physician
- Limit treatment to passive modalities only
Correct answer: Communicate relevant findings and collaborate within their scope of practice
Effective co-management requires clear communication of clinical findings and collaborative decision-making within each provider's scope of practice.
Question 3: A 17-year-old athlete presents with knee pain after a jump landing. Imaging reveals a tibial tubercle avulsion fracture. Management should include:
- Immediate manipulation of the knee joint
- Immobilization and urgent orthopedic referral (Correct answer)
- Aggressive quadriceps strengthening exercises
- Ultrasound therapy to the tibial tubercle
Correct answer: Immobilization and urgent orthopedic referral
Avulsion fractures in skeletally immature patients require immobilization and orthopedic referral to assess the need for surgical fixation.
Question 4: Which clinical feature differentiates medial epicondylitis (golfer's elbow) from lateral epicondylitis (tennis elbow)?
- Pain with resisted wrist extension vs. wrist flexion
- Pain with resisted wrist flexion vs. wrist extension (Correct answer)
- Numbness in the ring and little fingers in both conditions
- Both conditions are identical clinically
Correct answer: Pain with resisted wrist flexion vs. wrist extension
Medial epicondylitis causes pain with resisted wrist flexion and pronation, while lateral epicondylitis causes pain with resisted wrist extension.
Question 5: Which reassessment interval is most consistent with evidence-based chiropractic extremity practice for an acute soft tissue injury?
- Reassess only when the patient complains of worsening symptoms
- Reassess every 6 months regardless of progress
- Formal reassessment at 4–6 visits or when a treatment goal is reached (Correct answer)
- Reassess once at the end of a 12-week treatment course
Correct answer: Formal reassessment at 4–6 visits or when a treatment goal is reached
Formal reassessment at 4–6 visits allows the clinician to modify the treatment plan based on objective outcome data and progress toward stated goals.
Question 6: Taping the ankle in slight eversion after a lateral ankle sprain is intended primarily to:
- Reduce edema by compressing lymphatic vessels
- Limit inversion and protect healing lateral ligaments (Correct answer)
- Improve proprioceptive feedback only
- Prevent medial ligament strain during rehabilitation
Correct answer: Limit inversion and protect healing lateral ligaments
Taping or bracing the ankle to limit inversion mechanically protects the healing lateral ligament complex and reduces re-injury risk.
Question 7: A patient asks about the risks of chiropractic manipulation of the elbow. The most important risk to disclose is:
- Permanent joint fusion
- Transient post-manipulation soreness (Correct answer)
- Immediate rupture of the ulnar collateral ligament
- Conversion to a surgical condition
Correct answer: Transient post-manipulation soreness
Transient post-manipulation soreness is the most common adverse event following elbow manipulation and should be disclosed as part of informed consent.
CCEP Patient Management 4
A patient presents with a 'click' in the hip during flexion, reproduced consistently.
The most likely diagnosis is: