CCEP Patient Management 5 — Questions and Answers
Question 1: Which neurological screen is most important before performing cervicothoracic junction manipulation in a patient with radiating upper extremity symptoms?
- Babinski reflex test
- Upper motor neuron assessment including Hoffman's sign (Correct answer)
- Romberg's test
- Beevor's sign
Correct answer: Upper motor neuron assessment including Hoffman's sign
Upper motor neuron signs (e.g., Hoffman's sign, hyperreflexia, clonus) suggest cervical myelopathy, which is a contraindication to high-velocity manipulation.
Question 2: A patient with plantar fasciitis fails to improve after 6 weeks of conservative care. The next most appropriate step is to:
- Continue the same treatment plan indefinitely
- Re-evaluate biomechanics, modify the plan, and consider co-management or referral (Correct answer)
- Immediately refer for surgical plantar fascia release
- Discontinue treatment and advise rest only
Correct answer: Re-evaluate biomechanics, modify the plan, and consider co-management or referral
Lack of progress after 6 weeks warrants re-evaluation of the diagnosis, biomechanical contributing factors, and consideration of co-management or referral.
Question 3: In managing a pediatric patient (age 8) with a suspected Salter-Harris Type II fracture of the distal radius, the chiropractor should:
- Apply manipulation to realign the growth plate
- Refer to orthopedics; growth plate injuries require specialist management (Correct answer)
- Immobilize and continue routine chiropractic care
- Begin passive range-of-motion exercises immediately
Correct answer: Refer to orthopedics; growth plate injuries require specialist management
Growth plate (Salter-Harris) fractures in children require orthopedic referral to prevent premature physeal closure and limb length discrepancy.
Question 4: Which special test is used to assess integrity of the ulnar collateral ligament of the elbow?
- Valgus stress test at 30° elbow flexion (Correct answer)
- Varus stress test in full extension
- Cozen's test
- Mill's test
Correct answer: Valgus stress test at 30° elbow flexion
The valgus stress test at 30° elbow flexion isolates the ulnar collateral ligament by unlocking the olecranon from the fossa and directly stressing the medial stabilizer.
Question 5: A patient's treatment plan requires modifying exercise intensity due to a cardiovascular comorbidity. The chiropractor's best course of action is to:
- Proceed with the original plan and monitor heart rate manually
- Consult with the patient's cardiologist before modifying the exercise prescription (Correct answer)
- Avoid all exercise recommendations and use only passive treatment
- Discharge the patient as they fall outside chiropractic scope
Correct answer: Consult with the patient's cardiologist before modifying the exercise prescription
Consulting the cardiologist ensures exercise modifications are safe given the patient's cardiovascular status and reflects appropriate interprofessional practice.
Question 6: Which finding on a shoulder examination is most consistent with a full-thickness supraspinatus tear rather than tendinopathy?
- Painful arc between 60°–120° of abduction
- Complete inability to initiate abduction with a positive drop arm test (Correct answer)
- Pain with the Neer impingement sign
- Positive Speed's test for biceps involvement
Correct answer: Complete inability to initiate abduction with a positive drop arm test
A positive drop arm test with inability to maintain or initiate abduction suggests a full-thickness rotator cuff tear disrupting active force transmission.
Question 7: A patient in acute care for a Grade II ankle sprain asks when they can return to sport. The most evidence-based criterion for return-to-sport clearance is:
- Complete absence of pain at rest for 48 hours
- Restoration of full strength, proprioception, and sport-specific functional testing (Correct answer)
- Completion of 10 chiropractic visits
- Normal X-ray findings
Correct answer: Restoration of full strength, proprioception, and sport-specific functional testing
Return-to-sport decisions should be based on functional criteria including full strength, balance, proprioception, and successful completion of sport-specific tasks.
CCEP Patient Management 5
Which neurological screen is most important before performing cervicothoracic junction manipulation in a patient with radiating upper extremity symptoms?