OCS Exam UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
What is characteristic of a migraine HA? - CORRECT ANSWER 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 -
CORRECT ANSWER 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? - CORRECT
ANSWER multiple audible pops bilaterally at C1-2
If the Sharp Purser is (+) - why are you still skeptical about instability? - CORRECT
ANSWER 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? - CORRECT ANSWER 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 - CORRECT
ANSWER TRUE
What are 3 types of people who have an increased risk for upper cervical instability? -
CORRECT ANSWER RA
Down's
hx of Cervical Spine Trauma
Is the VBI test validated? - CORRECT ANSWER 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? -
CORRECT ANSWER Hypoglossal!
CN 12
What is associated with Alar Ligament Instability? - CORRECT ANSWER Neck
Tongue Syndrome
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? -
CORRECT ANSWER 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? - CORRECT ANSWER appropriate answers:
,cervical collar
refer to ER
refer for imaging
Sharp Purser is not appropriate
What spinal segments do NOT have an intervertebral disc? - CORRECT
ANSWER 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? - CORRECT
ANSWER Transverse - prevents anterior movement of C1 on C2
Where are the joints of Luschka located? - CORRECT ANSWER 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? - CORRECT
ANSWER 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?
- CORRECT ANSWER between the first and second cervical vertebra on the left
What are absolute contraindications for manual therapy? - CORRECT
ANSWER 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? - CORRECT
ANSWER 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? -
CORRECT ANSWER 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, rather that non-vascular vestibular dizziness - CORRECT ANSWER -
dizziness is reproduced with active cervical rotation and active trunk rotation with head stable
-if pt's dizziness is 2/2 vestibular disorder you'd expect dizziness to be reproducible with
active cervical rotation but not trunk rotation since the vestibular canals remain unchanged in
this position
If your pt has neck pain starts to develop symptoms related to hindbrain ischemia, all of the
following CN would likely be involved expect - CORRECT ANSWER CN 1, 2
Acute dissection of Internal Carotid, what CN is involved? - CORRECT ANSWER CN
12
What CN's would NOT be effected with Internal Carotid Dissection? - CORRECT
ANSWER CN 1 (olfactory)
2-4 can be
Which syndrome is common after Internal Carotid dissection and results is ptosis, miosis,
anhidrosis and enopthalmosis? - CORRECT ANSWER Horner's Syndrome
AND CORRECT ANSWERS
What is characteristic of a migraine HA? - CORRECT ANSWER 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 -
CORRECT ANSWER 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? - CORRECT
ANSWER multiple audible pops bilaterally at C1-2
If the Sharp Purser is (+) - why are you still skeptical about instability? - CORRECT
ANSWER 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? - CORRECT ANSWER 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 - CORRECT
ANSWER TRUE
What are 3 types of people who have an increased risk for upper cervical instability? -
CORRECT ANSWER RA
Down's
hx of Cervical Spine Trauma
Is the VBI test validated? - CORRECT ANSWER 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? -
CORRECT ANSWER Hypoglossal!
CN 12
What is associated with Alar Ligament Instability? - CORRECT ANSWER Neck
Tongue Syndrome
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? -
CORRECT ANSWER 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? - CORRECT ANSWER appropriate answers:
,cervical collar
refer to ER
refer for imaging
Sharp Purser is not appropriate
What spinal segments do NOT have an intervertebral disc? - CORRECT
ANSWER 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? - CORRECT
ANSWER Transverse - prevents anterior movement of C1 on C2
Where are the joints of Luschka located? - CORRECT ANSWER 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? - CORRECT
ANSWER 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?
- CORRECT ANSWER between the first and second cervical vertebra on the left
What are absolute contraindications for manual therapy? - CORRECT
ANSWER 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? - CORRECT
ANSWER 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? -
CORRECT ANSWER 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, rather that non-vascular vestibular dizziness - CORRECT ANSWER -
dizziness is reproduced with active cervical rotation and active trunk rotation with head stable
-if pt's dizziness is 2/2 vestibular disorder you'd expect dizziness to be reproducible with
active cervical rotation but not trunk rotation since the vestibular canals remain unchanged in
this position
If your pt has neck pain starts to develop symptoms related to hindbrain ischemia, all of the
following CN would likely be involved expect - CORRECT ANSWER CN 1, 2
Acute dissection of Internal Carotid, what CN is involved? - CORRECT ANSWER CN
12
What CN's would NOT be effected with Internal Carotid Dissection? - CORRECT
ANSWER CN 1 (olfactory)
2-4 can be
Which syndrome is common after Internal Carotid dissection and results is ptosis, miosis,
anhidrosis and enopthalmosis? - CORRECT ANSWER Horner's Syndrome
