PRACTICE TEST OCS EXAM

PRACTICE TEST OCS EXAM Protocol for thrust manipulation of the hip - CORRECT ANSWER-- Use long axis distraction hip manipulation, starting in open pack and progress to closed pack position in the patient's most restricted range Reason: Per the Hoeksma et al. studies in 2004 and 2005, long axis thrust manipulation of the hip was used, starting in open pack and progressing to a closed pack position where the patient was most restricted for a maximum of five manipulation attempts. (Hoeksma 2004 and Hoeksma 2005) Aquatic therapy for the hip - CORRECT ANSWER-- Aquatic therapy will provide short term benefit, so the patient should continue to perform some of her home exercises and go to a physical therapist if symptoms persist Reason: Per the clinical practice guidelines via the JOSPT, aquatic therapy is beneficial only in the short term so this would be the most appropriate answer to provide the patient. (Cibulka 2009) Right calf pain radiates to the ankle, no injury, unchanged by position or activity. started taking blood pressure and cholesterol medication - CORRECT ANSWER-- Popliteal artery obstruction Reason: Those with a popliteal artery obstruction will report calf and/or ankle pain or discomfort. This is likely peripheral vascular disease, and it is first showing as these symptoms. - Femoral artery obstruction would more likely present with thigh pain along with calf pain Symptoms: substernal pain radiating to the posterior thoracic spine and left shoulder. Pain is worse when laying down, and increases with coughing, taking a deep breath, or laughing hard. Leanig forward or holding breath decreases symptoms. - CORRECT ANSWER-- Refer for immediate medical attention for pericarditis - Although this could match angina, symptoms should improve with supine in angina. most appropriate medication for ankylosing spondylitis - CORRECT ANSWER-- Naproxen is in the class of non-steroidal anti-inflammatory drugs (NSAIDs), and one of the clinical features of ankylosing spondylitis is that individuals with the pathology respond positively to NSAIDs. (Jordan 2012) Treatment for chronic swan neck deformity - CORRECT ANSWER-- Many patients do not need treatment for a swan neck deformity, but in the case of this patient the symptoms ultimately affected their hand mobility and treatment is necessary. Splinting could be trialed with the patient, but ultimately many patients end up having surgical intervention on the deformity. (Cooper 2007) Symptoms of arthritis in the distal IP joints of the fingers and toes. Also has a diagnosis of iritis, affecting their sight. What condition? - CORRECT ANSWER-- Psoriatic arthritis Reason: This patient's presentation of symptoms only in the distal interphalangeal joints of the fingers and toes is one of the five possible clinical presentations of this type of arthritis. Iritis is also seen in individuals with psoriatic arthritis, along with other possible inflammatory eye conditions. (Dutton 2008) Hypermobility - precaution or contraindication to thrust joint manipulation? - CORRECT ANSWER-- Although hypermobility may appear to be a contraindication to thrust joint manipulation, it is a precaution as some individuals with hypermobility may still benefit from the use of thrust joint manipulation. (Rushton 2012) What kind of clinical preduction rule study type could lead to inappropriate treatment of the patient? - CORRECT ANSWER-- Derivation studies are a proposed mechanism of diagnosis, intervention or prognosis, and as such, should be used with caution due to the limitations of only being studied in a small group of patients with a small group of clinicians. (Beattie 2006) - derivation level 4 level 3 level 2 impact study of utility analysis Fritz 2007 - findings that would place a patient into amechanical traction subgroup - CORRECT ANSWER-1) presence of sciatica 2) signs of nerve root compression 3) peripheralization with extension movements 4) a positive crossed SLR test. Correct parameters utilized for lumbar mechanical traction? - CORRECT ANSWER-- Prone for a maximum of 12 minutes with 40-60% of body weight - Individuals were first placed in a prone position that promoted centralization of their symptoms, so that could have been in a slightly flexed or side flexed position. After three minutes of traction, the table was repositioned into a neutral or slightly extended position. Current evidence for 2 variables that help clinicians determine which patients with low back pain will benefit the most from mechanical traction? - CORRECT ANSWER-1) CENTRALIZATION with extension 2) Positive crossed straight leg raise After mechanical lumbar traction, what is the most appropriate therapeutic exercise intervention for them to complete? - CORRECT ANSWER-- Prone press-ups are the best intervention to perform after mechanical traction for an individual who fits into the traction subgroup because the traction will be performed in a prone position with the patient ultimately in a neutral or extended position. Hence, an extension based exercise would be most appropriate for the patient. (Fritz 2007b) What is seen in migraines and cervicogenic headaches, but not in tension headaches? - CORRECT ANSWER-Tension headaches are bilateral headaches, whereas migraine headaches and cervicogenic headaches are isolated to one side. (Headache Classification Subcommittee 2004) At how many degrees of cervical rotation should the C2 spinous process begin to move? - CORRECT ANSWER-- the spinous process of C2 should move immediately in the contralateral direction of head rotation. For what length of time should the physical therapist hold the patient in passive rotation for a pre-manipulative hold? - CORRECT ANSWER-- Ten seconds is an appropriate amount of time to determine if vertebral basilar artery insufficiency is present during premanipulative holds. (Rivett 2006) What age group is at highest risk of cervical radic? - CORRECT ANSWER-- 40s or 50s Symptoms of occipital headaches, intermittent numbness in the occipital region, significant limitations in all ranges of the c spine, and some clumsiness with gait. Condition? - CORRECT ANSWER-In upper cervical ligamentous instability, it is likely to see occipital numbness with occipital headaches, significant range of motion limitations in all directions, and signs and symptoms of cervical myelopathy, which here include clumsiness with gait. (Kerry 2006 and Kerry 2009) Clinical prediction rule for diagnosis of carpal tunnel syndrome? - CORRECT ANSWERNo special tests ended up being a part of the diagnostic clinical prediction rule for carpal tunnel syndrome, even though they were a part of the comprehensive examination/evaluation to determine those variables (Wainner 2005) Best sensitivity in the criteria for the clinical prediction rule for the diagnosis of carpal tunnel syndrome? - CORRECT ANSWER-Wrist ratio index 0.67 (Wrist ratio index 0.67 Symptom Severity Scale score 1.9 Median nerve sensation of the thumb Age) What is true regarding the use of corticosteroid injections for carpal tunnel syndrome? - CORRECT ANSWER-- There has been no demonstrated impact of corticosteroid injections after one month, so they are effective in the short term but that is all that is known at this point. (Stark and Amirfeyz 2013) - CSI is better than oral steroids - benefits are limited after 1 injection Which muscles will be weak with anterior interosseous nerve entrapment, but not weak with carpal tunnel syndrome? - CORRECT ANSWER-- The pronator quadratus, along with the flexor pollicis longus and flexor digitorum profundus (lateral half), would be weak with anterior interosseous syndrome (Netter 2014). - FDP and FPL would be weak in both After PCL tear, which should be strengthened to assist with stability of the knee and reducing the potential for excessive posterior translation? - CORRECT ANSWER--