OCS EXAM QUESTIONS AND ANSWERS.
VERIFIED 2026.
What is characteristic of a migraine HA? - ANS PRIMARY HA
-pulsating/pounding
-unilateral in nature
-4-72 hrs
-nausea is associated
-light/noise sensitivity
also activity increases HA
4/5 present + LR 24 which significant shifts post-test probability of the dx being present
American College of Radiology would recommend what imaging modality for migraines -
ANS CT without IV contrast
- for sudden onset, severe HA
If you perform a manip to C1-2, where do you expect the cavitation to occur? - ANS multiple
audible pops bilaterally at C1-2
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,If the Sharp Purser is (+) - why are you still skeptical about instability? - ANS test is only
diagnostic for subjects with RA
-specific test for transverse ligament, however it's only been validated in subjects with RA and
Down's Syndrome; also it may be dangerous to perform the test after a traumatic MOI ??
Pt is referred to you with mechanical neck pain and they test (+) for flexion rotation test at C1-2,
what intervention is best for most immediate relief? - ANS C1-2 manip and upper thoracic
manipulation
manip is superior to mobs for short term effects for mechanical neck pain
T/F: there is no increased risk to the VBI for chiro vs PCP - ANS TRUE
What are 3 types of people who have an increased risk for upper cervical instability? -
ANS RA
Down's
hx of Cervical Spine Trauma
Is the VBI test validated? - ANS NO, a neg test doesn't not r/o dissection and can be
dangerous within itself
What is the most commonly affected CN if a pt has an Internal Carotid Artery Dissection? -
ANS Hypoglossal!
CN 12
What is associated with Alar Ligament Instability? - ANS Neck Tongue Syndrome
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,what a pt rotates their head they may experience numbness along half of their tongue
(+) Sharp Purser= transverse ligament compromise in pt's with RA, Downs or post trauma
Horners Syndrome = common after internal carotid artery dissection
Cervical Flexion Rotation Test = used for CGH identification
VBI = 5D's 3 N's hindbrain TIA, Wallenberg
When preparing to perform a cervical manip, what's the purpose of the pre-manip hold? -
ANS assess pt's comfort and response to position
Pt after MVA with neck pain, she flexes her neck and has increased paresthesia into her hands
and feet, what's the next step? - ANS appropriate answers:
cervical collar
refer to ER
refer for imaging
Sharp Purser is not appropriate
What spinal segments do NOT have an intervertebral disc? - ANS between occiput and first
cervical vertebrae
between the 1st and 2nd cervical vertebrae
What ligament prevents the dens of the axis from pressing on the during active cervical flexion
and is commonly compromised during trauma? - ANS Transverse - prevents anterior
movement of C1 on C2
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Where are the joints of Luschka located? - ANS c-spine C3-7 and these jts are commonly
assoc with degenerative spine conditions and cervical radiculopathy
What part of the cervical intervertebral discs is the weakest? - ANS posterior; the annulus
fibrosis is thick anteriorly but thin and weak posteriorly
During passive cervical rotation to the right, where does the vertebral artery get compressed? -
ANS between the first and second cervical vertebra on the left
What are absolute contraindications for manual therapy? - ANS Osteomyelitis
Nerve Root Compression with increasing neuro deficits
Influenze with Fever
Pregnancy is a relative one!
Pt's who are not good for cervical manipulation include? - ANS radicular sx to mid-forearm
these people would do better with centralization techniques
severe spondylosis without radic are ok
During Cervical Artery Dissection, which arteries would you suspect to be involved? -
ANS Vertebrobasilar, which is the posterior arterial system perfusing the hindbrain and the
internal carotid artery which is the anterior arterial system perfusing the cerebral hemispheres
and eyes
Trying to differentiate if a pt's dizziness is 2/2 to a cervical artery dissection or non-vascular
vestibular dizziness. What would you expect if te pt had dizziness 2/2 cervical artery dissection,
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
VERIFIED 2026.
What is characteristic of a migraine HA? - ANS PRIMARY HA
-pulsating/pounding
-unilateral in nature
-4-72 hrs
-nausea is associated
-light/noise sensitivity
also activity increases HA
4/5 present + LR 24 which significant shifts post-test probability of the dx being present
American College of Radiology would recommend what imaging modality for migraines -
ANS CT without IV contrast
- for sudden onset, severe HA
If you perform a manip to C1-2, where do you expect the cavitation to occur? - ANS multiple
audible pops bilaterally at C1-2
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,If the Sharp Purser is (+) - why are you still skeptical about instability? - ANS test is only
diagnostic for subjects with RA
-specific test for transverse ligament, however it's only been validated in subjects with RA and
Down's Syndrome; also it may be dangerous to perform the test after a traumatic MOI ??
Pt is referred to you with mechanical neck pain and they test (+) for flexion rotation test at C1-2,
what intervention is best for most immediate relief? - ANS C1-2 manip and upper thoracic
manipulation
manip is superior to mobs for short term effects for mechanical neck pain
T/F: there is no increased risk to the VBI for chiro vs PCP - ANS TRUE
What are 3 types of people who have an increased risk for upper cervical instability? -
ANS RA
Down's
hx of Cervical Spine Trauma
Is the VBI test validated? - ANS NO, a neg test doesn't not r/o dissection and can be
dangerous within itself
What is the most commonly affected CN if a pt has an Internal Carotid Artery Dissection? -
ANS Hypoglossal!
CN 12
What is associated with Alar Ligament Instability? - ANS Neck Tongue Syndrome
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,what a pt rotates their head they may experience numbness along half of their tongue
(+) Sharp Purser= transverse ligament compromise in pt's with RA, Downs or post trauma
Horners Syndrome = common after internal carotid artery dissection
Cervical Flexion Rotation Test = used for CGH identification
VBI = 5D's 3 N's hindbrain TIA, Wallenberg
When preparing to perform a cervical manip, what's the purpose of the pre-manip hold? -
ANS assess pt's comfort and response to position
Pt after MVA with neck pain, she flexes her neck and has increased paresthesia into her hands
and feet, what's the next step? - ANS appropriate answers:
cervical collar
refer to ER
refer for imaging
Sharp Purser is not appropriate
What spinal segments do NOT have an intervertebral disc? - ANS between occiput and first
cervical vertebrae
between the 1st and 2nd cervical vertebrae
What ligament prevents the dens of the axis from pressing on the during active cervical flexion
and is commonly compromised during trauma? - ANS Transverse - prevents anterior
movement of C1 on C2
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Where are the joints of Luschka located? - ANS c-spine C3-7 and these jts are commonly
assoc with degenerative spine conditions and cervical radiculopathy
What part of the cervical intervertebral discs is the weakest? - ANS posterior; the annulus
fibrosis is thick anteriorly but thin and weak posteriorly
During passive cervical rotation to the right, where does the vertebral artery get compressed? -
ANS between the first and second cervical vertebra on the left
What are absolute contraindications for manual therapy? - ANS Osteomyelitis
Nerve Root Compression with increasing neuro deficits
Influenze with Fever
Pregnancy is a relative one!
Pt's who are not good for cervical manipulation include? - ANS radicular sx to mid-forearm
these people would do better with centralization techniques
severe spondylosis without radic are ok
During Cervical Artery Dissection, which arteries would you suspect to be involved? -
ANS Vertebrobasilar, which is the posterior arterial system perfusing the hindbrain and the
internal carotid artery which is the anterior arterial system perfusing the cerebral hemispheres
and eyes
Trying to differentiate if a pt's dizziness is 2/2 to a cervical artery dissection or non-vascular
vestibular dizziness. What would you expect if te pt had dizziness 2/2 cervical artery dissection,
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
