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CCEB Part B Exam Question and Answers 100% Correct 2024
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Exam of 47 pages for the course CCEB at CCEB (CCEB Part B Exam)
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CCEB Part B ExamWhat is the difference between lumbar facet syndrome and lumbar joint dysfunction -
answer Facet syndrome has a referral pattern (ex. Into the buttock)
Joint dysfunction has no referral pattern and just localized px
Kemps Test: + with a referral into the buttocks - answer Lumbar Facet syndrome
Kemps test: + with localized low back pain - answer Lumbar joint dysfunction
Which range of motions are painful for facet syndrome/joint dysfunction? Which provide
relief? - answerPx= extension
Relief= Flexion
POM for lumbar facet syndrome/joint dysfunction - answer Conservative chiropractic
treatment
Difference b/w a lumbar sprain/strain - answer Sprain = ligaments
Strain = muscles
Most common MOI for lumbar sprain/strain - answerFalling injury/ overuse injury
What ROM would be painful for a lumbar strain - answerActive ROM
POM for lumbar sprain/strain - answerConservative chiropractic treatment
S/S Localized pain in the top and deep buttock region typically on one side over the
other, either after trauma or prolonged sitting - answerSI joint dysfunction
Painful movements with SIJ Dysfunction? Relief? - answerPain = Sit to stand with
extension
Relief = Flexion
Difference b/w SIJ dysfunction and Syndrome? - answerSI syndrome will have referral
to the knee (NOT PAST)
Provocative tests for SIJ dysfunction/syndrome - answerThigh thrust, open book, side
lying compression, static palpation
POM for SIJ Dysfunction/syndrome - answerConservative chiropractic treatment
,Difference b/w internal derangement and disc herniation - answerInternal derangement
= breaking down of annular fibres (prior to disc bulge)
Disc herniation = protruding nucleus pulposus creating a localized inflammatory reponse
on the nerve root
S/S localized LBP, numbness/tingling/lack of sensation in the thigh/leg/foot, lack of
motor control - answerLumbar disc herniation/internal derangement/segmental
radiculopathy
Is lumbar disc herniation typically unilateral or bilateral? - answerUnilateral
Two common presentations seen in patients with lumbar disc herniations - answerSlap
foot or foot drop during gait
Patient may have antalgic positioning AWAY from side of herniations
Painful and relieving positions for lumbar disc herniations - answerFlexion = painful
Extension = relieving
+ orthopedic tests for lumbar disc herniations - answerSLR, valsalva, braggards, bow
string
Neuro exam findings for lumbar disc herniation - answerLoss of sensation, decreased
muscle strength, loss of reflexes
POM for lumbar disc herniation - answerConservative treatment with extension based
exercises
S/S unilateral low back of flank px when pressed with focused pressure creates referral
into lateral buttock (near iliac crest and greater trochanter) - answerMyofascial trigger
point of QL
Lateral flexion toward affected side reproduces symptoms as well as sustained pressure
on the QL, which reproduces referral - answerMyofascial trigger point of QL
POM of myofascial trigger point of QL - answerConservative chiropractic treatment
S/S not typically symptomatic and often found incidentally on radiograph. S/S can range
from LBP to neurological findings - answerSpondylolisthesis
Classification system for spondylolisthesis - answerMyerding classification system
(Grade I to IV)
Isthmic spondy - answerOccurs due to a stress fx in the pars that occurs in childhood
and results in a slow and progressive slippage over time
,Degenerative spondy - answerOccurs due to a degenerative elongation of the pars,
which may result in compression on the nerve (causing a condition called lateral
stenosis)
Dysplastic spondy - answerCongenital defect of facet
Traumatic spondy - answerSingle traumatic event that caused a break and subsequent
slippage
Pathologic spondy - answerCaused by secondary disease
Types of Spondy (5) - answerIsthmic
Degenerative
Dysplastic
Traumatic
Pathologic
Secondary condition that can occur as a result of degenerative spondy - answerLateral
stenosis
Physical presentation of spondy - answerIncreased lumbar lordosis w/ weakness is
anterior core muscles and tight hamstrings (lower cross)
Neuro findings of spondy - answerPresent in the case of degenerative spondy
Decreased sensory, weakened motor, and decreased DTRs (lower motor neuron
lesion)
POM for spondylolisthesis - answerConservative chirpopractic treatment with a focus on
core strengthening
When would you refer for bracing for a spondy? - answerIn the event that the patient is
a child and there are early signs of pars stress fx seen on xray w/ no slippage. Refer for
bracing until healed
S/S: occurs as a result of posterior osteophytes or central disc herniation. B/L
neurological symptoms (MSRs). SHOPPING CART SIGN experiencing relief on flexion
- answerCentral stenosis
S/S: occurs as a result of degenerative spondy or severe facet degeneration narrowing
the IVF of one side. Unilateral neuro symptoms. Experiences relief from lateral bending
AWAY from side - answerLateral stenosis
Most common type of spinal stenosis - answerLateral
, POM for spinal stenosis - answerConservative chiropractic treatment with neurological
consult as surgical management might be beneficial if they do not respond to
conservative treatment
S/S: deep gluteal px at the top centre of the gluteal region occuring typically after a fall
of the buttocks. Severe px with prolonged sitting and going from a seated to standing
position or supine to sitting. - answerCoccyx subluxatin/fixation
Physical Exam Results for a coccyx subluxation/fixation - answerCoccyx typically
towards one side over the other.
tuning fork negative
Xray may show rotation of the coccyx (= subluxation not fixation)
POM for coccyx subluxation/fixation - answerconservative chiropractic treatment.
Internal coccygeal adjustments might be warranted if they do not respond to external
adjustments
S/S: Pain caused by too little blood flow to the legs which occurs as a symptom of
peripheral artery disease. The arteries that supply the limbs of the lower limb are
narrowed due to them being atherosclerotic. Most often, this pain occurs after walking
for a certain time (depending on the severity of the condition), but is relieved by rest -
answerVascular claudication
Physical exam: pulse measurement (diminished), ankle brachial index (<0.90), exercise
testing (pain after small amount of exercising), doppler ultrasound (diminished) -
answerVascular claudication
POM for vascular claudicaiton - answergoals are to reduce pain and manage risk
factors that contribute to vascular claudication. For example, although exercise is
painful, it is the best thing to do (in moderation and slowly increasing intensity) to
combat the effects. In severe cases, vascular surgery may be warranted
S/S: severe low back pain that radiates down both legs. Numbness around the anus
and reproductive organs and a loss of bowel or bladder control. The onset is either rapid
or gradual. - answerCauda equina syndrome. A condition that occurs when the cauda
equina has a severe inflammatory reaction
S/S: pain that refers from the neck into the shoulder - answerCervical facet
SYNDROME
S/S: Localized pain in the neck - answerCervical joint dysfunction
Physical: Cervical kemps reproduce referral into the shoulder. S/S reproduced with
static palpation and motion palpation. Neuro WNL. Passive and active ROM are painful
upon extension. Relieved with flexion - answerCervical facet syndrome
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