Past-Part-B-Boards-Review.pptx.pdf

Part B Boards Review By Baxter Hickey 2019 Questions Radiology Portion  Case 1 25-year-old female was in a MVA 2 days prior and presented to the chiropractic clinic with a lot of pain and stiffness in her neck. X-rays were taken to rule out any form of pathology or...

Part B Boards Review By Baxter Hickey 2019 Questions Radiology Portion  Case 1 25-year-old female was in a MVA 2 days prior and presented to the chiropractic clinic with a lot of pain and stiffness in her neck. X-rays were taken to rule out any form of pathology or fracture First question asked what was present. The only finding was that there was a loss of cervical lordosis. This was a bit tricky because people were looking for teardrop fractures, but there were none. Next question asked what the cause of her pain would be, which was muscular contracture and hypertonicity Last question asked what would do for this patient. In this case, since there were no fractures or any contraindications to care, you could proceed with conservative management  Case 2 This case had a father bringing in his 16-month-old son in for a check-up since the child would not walk and was having difficulties crawling. The image was a pelvic x-ray and it showed a child with developmental dysplasia of the hip (DDH) First question wanted you to mention what the findings were, which were the classic Putti’s Triad (shallow acetabulum, superolaterally located femoral epiphysis, and a small epiphysis). Second question wanted the diagnosis, which was DDH Third question wanted to know the POM, which was to send to orthopedic referral for bracing  Case 3 A 66-year-old man with a stiff and tight low back pain since he was 16 presented to the office after he had a fall and hit his head on the island table when he felt a popping sensation in his neck. X-ray showed classic AS findings First question wanted to know the findings, which were trolley track/bamboo spine, ghost SI joints, and syndesmophytes Second question asked what finding was present in the cervical spine, which was a carrot stick fracture (this makes sense as he had a trauma and felt a popping sensation in his neck Third question wanted to know POM, which was to send to ER with a neck brace on  Case 4: A 54-year-old construction worker came into the clinic with a sore low back of idiopathic onset. X-rays were taken In this case, the patient had moderate to severe DDD with a spondylolytic spondylolisthesis of L5 on S1. First question wanted you to describe where the most pertinent finding was. So I chose spondy of L5 on S1. Second question wanted to know what the name of the assessment tool was for describing the most pertinent finding based on your last answer. Answer was Meyerding’s Method  Case 5 A 42-year-old patient came in with right shoulder pain and restricted ROM. A shoulder x-ray series was taken You could see calcification of the supraspinatus tendon First question wanted to know what the finding was (see above) Second question wanted to know the pathophysiology of the finding was, which was deposition of hydroxyapatite crystals in the tendon Third question wanted to know your POM, which was to proceed with treatment (this condition is self-limiting anyways, with or without treatment)  Case 6 A chest film of a patient with a productive cough with a lot of sputum production. This was an x-ray of lung consolidation First question wanted to know which lobe the finding was in, which was the right upper lobe Second question wanted to know what sign was present, which was air bronchogram sign (only consolidation has this finding) Third wanted to know the diagnosis, which was lobar pneumonia.  Case 7 An older male patient came in with a primary complaint of low back pain with occasional abdominal pain. Lumbar x-ray showing severe DDD and calcific plaquing in the abdominal aorta seen on the lateral view, but no evidence of aneurysm. This was kind of a weird case, since the questions weren’t really related to one another First question wanted to know what the most likely cause of his low back pain, which was the DDD Second question wanted to know how you would manage the visceral finding, which in this case was the atherosclerosis of the abdominal aorta, which would be to send them to GP for Doppler ultrasound and possible medication prescription  Case 8 A 12-year-old patient came in with a complaint of an “ugly curvature” in her back that she is self-conscious about. This was a scoliosis case, quite a severe one to be honest First question wanted you to describe what kind of scoliosis it was, which in this case was a double s-shaped thoracolumbar scoliosis Second question wanted to know what the assessment method is called that is used to assess the curve, which is Cobb’s method Third question wanted to know what your plan of management would be. The only option that made sense was refer for bracing  Case 9 This case was super easy. It was a young male patient who came in and you notice a “palpable lump” close to their GH joint X-ray showed a pedunculated osteochondroma Only question from this case wanted to know what type of bone tumor it was, which is benign, since it wasn’t causing any pain  Case 10 Last rad case was a young male patient who came in because he wanted help with his “bad posture”. They had an image of a tightly collimated T/spine showing irregular endplates and anterior wedging. Only question wanted to know the radiographic reason for the bad posture, which was loss of anterior vertebral body height Conversely, one of the practice questions on the CCEB website had a similar question, but it wanted to know the pathophysiology of the disease, which would be irregular endplates due to the vascular disease that it is). So a lot of people chose that as the answer Multiple Choice Questions  1. A 58-year-old male patient comes in with overall back stiffness. He also reports gastrointestinal distress, urinary incontinence, and a bruise on his iliac crest. Physical exam reveals bilateral restrictions from T7-9. From the restrictions noted and the findings in the patient’s history, which would be a possible visceral symptom? Urinary incontinence Iliac bruise Gastrointestinal distress Mechanical back pain  2. An older male patient presents with low back pain that is felt in the midline of his spine. Physical exam reveals decreased perception of vibration in both great toes as well as a general loss of crude touch in the lower extremities. What is the diagnosis? Diabetic neuropathy Lumbar disc herniation Syringomyelia Central stenosis  3. A 76-year-old female patient comes in with a complaint of low back pain and pain down into her left leg. Additionally, she has had an MRI examination done in her lumbar spine to assess for stenosis. The report reveals IVF narrowing of the left L4-5 IVF. What part of her lower extremity will have decreased sensation? Medial portion of the leg (L4) Lateral portion of the leg (L5) Web of the big toe (L5) Plantar aspect of the foot (S1)  4. An elderly patient comes to the clinic for a maintenance adjustment. The patient also brings in an x-ray report, which is read as follows: “Bone density appears osteopenic in this patient. Additionally, there is evidence of multiple punched-out lytic lesions seen in the femurs, spine, and skull.” What would lab testing reveal in this patient? Increased PSA Decreased serum calcium Bence-Jones proteins in urine Increased acid phosphatase  5. An 18-year-old male soccer player comes into the clinic after suffering an inversion sprain in their ankle 3 days prior. Examination reveals a lot of swelling around the ankle mortise joint with limited ROM in all ranges and was tender to touch, although the patient could weight bear. X-rays were taken, which did not show any fractures. What is the most appropriate next step to take for treatment? Work on ROM exercises Begin ankle proprioception exercises Focus on limiting pain Resume normal activity  6. A 24-year-old female softball player comes in with a primary complaint of pain on the inside of her forearm in the area of the medial epicondyle. Physical examination revealed that the medial epicondyle was tender to touch, elbow ROM was limited in extension and flexion by 40%, and muscular palpation was shown to be tender along the wrist flexor muscular group. What is the most appropriate next step for treatment? Work on improving ROM Begin eccentric and concentric loading of the elbow to treat Focus on pain management Promote return to sport protocol  7. A 33-year-old male patient comes in and is diagnosed with non-specific mechanical low back pain. As a part of his treatment, he is prescribed an exercise, which specifically targets the low back. Which of the following descriptions is one of those exercises? Patient is lying supine and performs a full range sit-up Patient is lying prone and brings chest and legs off ground for 30 seconds Patient is on hands and knees and lifts opposite hands and leg, alternating back and forth Patient lies prone on an incline bench with a heavy weight and holds this position until fatigued  8. A 65-year-old male patient comes into the clinic with some mid-back tightness and he is seeking treatment. The history revealed that he consumes 3 drinks/day and recently had his gallbladder removed in the past year. Physical exam revealed an abnormal amount of mid-back tightness and pain in the area of T4-9. What is the most likely diagnosis, given the historical and physical exam findings? Non-specific back pain Pancreatitis Cholecystitis Spinal metastasis  9. A 27-year-old male office worker comes in with a primary complaint of neck and hand pain that has been going on for a few months now. Physical examination revealed a diagnosis of thoracic outlet syndrome, which was determined with a positive Roo’s test and Wright’s test. What structure is implicated with a positive Wright’s test? Cervical rib Tight pec minor Anterior scalene tightness Costoclavicular entrapment  10. An 18-year-old female runner comes in with a complaint of lateral knee pain. She notices that it get progressively worse as she runs. A physical exam was performed and the doctor had her lying on her side with the affected leg facing up. He then had her drop her leg posteriorly off the backside of the table, which reproduced her chief complaint of lateral leg pain. What test was performed? Lateral pivot shift Ober’s test Fair’s test Faber’s test  11. A young male powerlifter came into the chiropractor’s office with some pain along his lateral thigh to his knee. He has recently increased his training load as he prepares for a weight lifting competition coming up. Physical examination revealed tenderness originating from the posterolateral portion of the thigh, with a similar sensation experienced along the entire lateral thigh. Noble's compression was also positive for the main complaint. What is the diagnosis? Glut med strain Lumbar radiculopathy IT band syndrome Meralgia paresthetica  12. A female cyclist presented to the office with some medial leg pain. No trauma was experienced, although she had recently completed a very long bike ride of approximately 100 km. Her pain was recreated with active thigh adduction and knee flexion of the affected limb. What is the most likely diagnosis? Athletic pubalgia Femoral hernia Pes anserine syndrome Saphenous nerve neuropathy  13. A father brings in his newborn for a wellness check. The father mentions that his son is having difficulties walking and crawling. The doctor has the baby supine and notices that when his knees are brought up to 90, the left knee is higher. Based on this finding, additional testing would show what? Orthopedic evaluation would find that abduction and anterior pressure on greater trochanter would make a pop in the left hip Orthopedic evaluation would find that abduction and anterior pressure on greater trochanter would make a pop in the right hip Orthopedic evaluation would find that adduction and posterior pressure on femurs would make a pop in the left hip Orthopedic evaluation would find that adduction and posterior pressure on femurs would make a pop in the right hip  14. A 12-year-old patient came to the clinic and was determined to have a scoliosis measuring 20 degrees using the Cobb method. She is x-rayed again after 6 months and it is discovered that her curve has now progressed to 30 degrees. What is the most appropriate POM at this time? Adjust the spine, as this condition is self-limiting Refer for a Milwaukee brace to stop curve progression Refer for dietary consult Do nothing  15. A middle-aged patient presents to the clinic with a primary complaint of low back and buttock pain. No red flags were noted during the history. Physical exam was as follows: Kemp’s and Maigne’s challenge was positive bilaterally for the low back and buttock complaint and Valsalva and SLR was negative. Based on this information, what is the most likely diagnosis? Facet irritation SI syndrome Facet syndrome Lumbar radiculopathy  16. A 16-year-old female athlete is referred by her GP for a scoliosis screening. Examination reveals a slight right-sided curve, which seems to straighten out when she laterally bends towards the right. What is the cause for this patient’s scoliosis? Structural scoliosis Functional scoliosis Neuromuscular scoliosis Traumatic scoliosis  17. A 36-year-old male factory worker presents with some low back pain that had come on after lifting a heavy box at work. Additionally, he reports no symptoms traveling into his legs. Physical exam reveals pain with flexion, which is relieved by extension. What is the most likely diagnosis? Lumbar radiculopathy Spinal stenosis Intervertebral disc derangement QL spasm  18. You have been treating a patient for mechanical neck pain using SMT and their symptoms have started to resolve. On their third visit, they mention that they don’t like the pop that they feel with the neck adjustments and she wanted to know if there were other options. What do you do? Continue treating the way you have been since she is getting better anyways Try using mobilization and soft tissue techniques Attempt using a different way to adjust her neck Stop administering treatment and discharge the patient  19. A new patient comes in off the street seeking treatment. While in the waiting room, they are being aggressive toward the staff and demanding to see the doctor. What is the most appropriate step to deal with this situation? Take them in and do an assessment, but then send them to another clinic for treatment Have the staff escort the patient out of the clinic Have the lead doctor escort the patient out of the clinic Take them in and treat them  20. A doctor does an intake on a new patient at the clinic. The paperwork involved includes intake forms, SOAP notes, and a ROF. By law, what form(s) is required to have the patient’s name on it? Intake forms SOAP notes ROF All of the above  21. You have just finished treating a patient and are in the process of completing their SOAP note for that visit. After completing, you realize that you have made a note on the wrong date. What is the most appropriate course of action? Discard of the note and start a new one Leave it Signature beside your mistake a make a note on the proper date Start a new file for the patient  22. In clinical practice, when is it necessary to have the patient sign a new ROF and informed consent? After 3 weeks of treatment After the patient’s symptoms have resolved Every visit If any aspect of the treatment has changed, which may carry separate and unique risks  23. A patient presents to his chiropractor’s clinic with radicular-like symptoms down his leg. Physical exam is unremarkable and radicular symptoms are only elicited upon palpation of the deep gluteal musculature. What is the most likely diagnosis? Piriformis syndrome Lumbar radiculopathy Glut med syndrome Meralgia paresthetica  24. A patient presents to the clinic and is diagnosed with mechanical low back pain with likely radiculopathy. Seeing as there is no contraindication, the doctor would like to utilize side posture lumbar manipulation. Upon setting up the patient, they report an uncomfortable exacerbation of their symptoms. How should the doctor proceed? Try to set up the patient again Push the patient’s upside shoulder further back and proceed normally Utilize lumbosacral flexion-distraction Have the patient perform resisted hip extension exercises  25. A 47-year-old female patient presents to the clinic with a depressed mood and bilateral neck and upper trap pain. She also reports that she has had a hard time eating. She recently had some blood work completed, which showed a very high ESR and normochromic anemia. What is this patient likely suffering from? Metastatic carcinoma Syringomyelia Mechanical neck pain Polymyalgia rheumatica  26. An older male patient comes in seeking some treatment for his low back. During the history, you discover that he’s been noticing some blood in his stool, he’s had some difficulty urinating, and he’s been sweating a lot more at night. Additionally, he has noticed that he’s lost a significant amount of weight without trying. What is this most likely diagnosis? Indigestion Facet syndrome Spinal subluxation Metastatic carcinoma  27. A patient you have been treating for right-sided lumbar radiculopathy calls the office reporting some new symptoms, so he comes into the clinic for a reassessment. He has noticed his low back pain has started hurting a lot more, his patellar reflexes are slightly diminished, he has absent sensation in his sacral area, and his leg pain is still present. Of all the present symptoms, which is the most concerning and most conducive to the most likely diagnosis? Increased low back pain severity Slightly diminished patellar reflexes Absent sensation in the sacral area Leg pain still present  28. A patient is reported to have tinnitus and slight hearing loss. Examination showed that the patient’s hearing loss was conductive in nature. Additionally, the patient also has café au lait spots on their body. What is the most likely diagnosis? Myringitis Acoustic neuroma Stroke Meniere’s disease  29. A 45-year-old female has been consistently treated for approximately 3 months from chronic neck pain with radiculopathy. Her symptoms are primarily experienced on the right side of her neck and into her lateral forearm and thumb. An X-ray report showed IVF narrowing impacting the nerve root that is causing her radiculopathy. What is the diagnosis? C4 radiculopathy due to C3-4 IVF narrowing C5 radiculopathy due to C4-5 IVF narrowing C6 radiculopathy due to C5-6 IVF narrowing C7 radiculopathy due to C6-C7 IVF narrowing  30. A younger female patient comes in with a pain that is felt in her wrist whenever she grasps things with her thumb. Neurological exam was normal and cervical radiculopathy tests were negative. A test was performed when the patient grasped their own thumb on the affected side and brought their hand into passive ulnar deviation, which recreated her symptoms. What test was performed? Finkelstein’s test Mill’s test Tinel’s test Watson’s test  31. You have been treating a patient for neck pain and pain in their posterior shoulder. Recovery hasn’t been progressing the way you were hoping and now the patient reports that their pain has now traveled to their elbow. How should this patient be managed? Ultrasound study on their posterior shoulder Nerve velocity conduction study Stop adjusting the neck Continue treating normally  32. A basketball player comes into the clinic after suffering a FOOSH injury during a game. Examination leads the doctor to believe that the patient has a scaphoid fracture. An x-ray was taken, which did not show a fracture. What is the next best step? Re-x-ray in a week as fracture may be occult Have patient return to sport Re-x-ray in a month Adjust the wrist and perform soft tissue work  33. A patient had a fall on the ice and experienced a FOOSH injury. An initial x-ray was reported to be normal. The doctor had another x-ray performed a week later, which was still read as normal. The doctor still has a high suspicion of fracture. What should he do next? X-ray in a month Splint the wrist Bone scan Wait and see  34. A patient has been treated at your clinic for approximately 4 months and their symptoms seem to change each day and they report that they aren’t getting better. Patient’s file reveals that they suffer from a somatoform disorder in addition to depression. How should this patient be managed? Keep treating the same way you have been Perform more adjustments and passive care Incorporate more modalities Decrease the amount of times she comes in for adjustments and encourage more active care  35. An office worker comes in with a persistent wrist pain and weakness that is felt in the left hand. Examination for cervical radiculopathy was negative and neurological exam was relatively unremarkable. When instructed to make an OK sign with the left hand, the patient was unable to do it without the pad of her index and thumb coming flattening together. What is the most likely diagnosis? Carpal tunnel syndrome Ulnar nerve entrapment Anterior interosseous syndrome Radial nerve entrapment  36. A young softball player comesthto the clinic with a complaint of medial forearm numbness that extends into her 5 digit. Neurological examination was normal and tests for cervical radiculopathy was normal. However, sustained pressure over a bony groove on the medial underside of the elbow reproduced that numbness along the medial forearm. What is the most likely diagnosis? Ulnar radiculopathy Little leaguer's elbow Pronator teres syndrome Cubital tunnel syndrome  37. A elderly female patient presents to the clinic with right-sided pain in her face after falling in the shower and hitting the side of her face off the wall. She now has pain felt along her TMJ and the surrounding musculature. Additionally, her SCM and traps are tight upon palpation as well. What is the most likely diagnosis? Myofascial pain syndrome from the SCM and traps Cervicogenic headache Subdural hematoma TMJD  38. Someone has recently suffered an anterior shoulder dislocation and had to have it relocated. What actions should they avoid doing for the next little bit so that they don’t risk having another dislocation? Abduction and external rotation Adduction and internal rotation Horizontal adduction and adduction Internal rotation and extension  39. During a hockey game, a player is aggressively checked into the boards. He has suffered an anterior shoulder dislocation and has the followings signs: loss of normal humeral curvature, patient supporting elbow on affected side, pain in the area of the humeral head, and diminished radial pulse. What is the most worrisome finding? Loss of normal humeral curvature Patient supporting elbow on affected side Pain in the area of the humeral head Diminished radial pulse  40. A patient has presented to the clinic with vertigo. The following symptoms were reported: nausea during each bout of vertigo, vertigo that comes on when she looks up, neck pain, and occasional tinnitus. After the examination, she has been given a diagnosis of positional vertigo. Out of the findings in the history, which one is most conducive to her diagnosis? Nausea Symptom aggravation when looking up Neck pain Occasional tinnitus  41. A middle-aged female patient came in with neck pain and vertigo after being involved with an MVA a week prior. Examination revealed that it was not due to position and was likely cervicogenic in nature. How would you determine the cause of the vertigo? Dix-Hallpike Maneuver Cranial nerve screen Rotary chair test Epley’s maneuver  42. An active male presents to the clinic with right-sided headaches that have been bothering him for approximately 2 weeks. Physical examination reveals tightness along the cervical facets, but does not reproduce the headache. Palpation of the right traps reproduces the headaches. What is the most likely diagnosis? Cervicogenic headache Cluster headache Tension-type headache Muscle tension headache  43. A young male patient presents to the clinic with bilateral low back and SI pain, which is felt most in the morning and takes about 2 hours to feel better. Blood testing shows that he is carrier of HLA B-27. Based on the most likely diagnosis, how should treatment proceed? Spinal adjustments and soft tissue techniques Nutritional consultation Postural rehab and aerobic training, such as swimming Flexion-based strength training  44. A mother brings in her 14-year-old son to have you help him with his very poor posture. She mentions that it’s likely because he is always on his phone. X-ray examination shows multiple vertebral wedging and irregular endplates, likely causing his postural deformity. How should this patient be managed? Extension-based spinal adjustments Rehab focused on rhomboid strengthening Proprioceptive exercises on a Bosu ball Do nothing as this is self-limiting  45. A patient has a primary complaint of left lateral hip and thigh pain. Physical exam consisted of tests for lumbar radiculopathy, SI syndrome, and lower limb neuro, all of which were normal. However, palpation along a muscle in the superolateral gluteal region reproduced the chief complaint. What is the most likely diagnosis? Glut med myofascial pain syndrome TL syndrome Disc bulge Meralgia paresthetica  46. A slightly overweight male patient presents to the chiropractor with numbness and tingling along the anterior and lateral thigh. The doctor palpated just medial to the ASIS, which reproduced these same symptoms. What structure is likely involved and what is being impacted? Pectineus compressing obturator nerve Rec fem compressing femoral nerve Sartorius compressing lateral femoral cutaneous nerve Vastus medialis compression saphenous nerve  47. A child was playing soccer when he injured himself trying to kick the ball. He had gone to kick it when his foot caught on the ground instead. Immediately, he felt pain and bruising in his hip and ASIS. Based on this information, how should this patient be managed? Immediately begin soft tissue work on the hip and thigh musculature X-ray series for the hip and pelvis Adjust for spinal subluxations Hip rehab protocol  48. You are examining a patient with a foot complaint and you are wanting to rule out any nerve involvement. You perform Tinel’s posterior to the medial malleolus. If this exam was shown to be abnormal, what would your findings be? Tingling felt along the sole and arches of the foot Muscular twitching in the plantar foot musculature Pain on the dorsum of the foot Nothing  49. A young female patient comes in complaining of elbow pain. When questioned about it, she mentions that she was carrying chairs yesterday with her shoulder in a flexed position and wrist in pronation. Physical exam reveals pain with resisted wrist flexion and tenderness along the medial epicondyle. What is the diagnosis? Ulnar nerve entrapment Lateral epicondylosis Medial epicondylosis Cervical radiculopathy  50. You have been treating an elderly female patient for a few years and she comes monthly for regular treatments. On this visit, the right side of her neck is feeling more stiff than usual. Upon questioning, she mentions that she usually watches TV with her head turned to the right. How should this be addressed? Provide more spinal adjustments to relieve tension Perform more soft tissue work Cease treatment completely as there is nothing you can do Advise her to change her living room arrangement so her head isn’t in prolonged static postures 2020 Questions  51. A middle-aged female patient has been experiencing sudden headaches recently with all the stress of work impacting her. Before she gets these headaches she experiences halos in her vision and then 15 minutes later, she has a headache. What is her diagnosis? Migraine headache with aura Cervicogenic headache Tension-type headache Migraine headache without aura  52. You have been treating a female CEO with neck and upper back pain for a few years, but she has started experiencing different symptoms and her GP believes she might have MS. She has been a lot more stressed at work. Signs and symptoms are as follows: upper and lower extremity reflexes 1+ bilaterally, feeling more fatigued than usual, optic neuritis and bilateral diminished sensations, feeling depressed. What is the most concerning sign/symptom? Upper and lower extremity reflexes 1+ bilaterally Feeling more fatigued than usual Optic neuritis and bilateral diminished sensations Feeling depressed  53. A 27-year-old male patient presents to the ER with a colicky-type abdominal and low back pain that is also felt in his testicles. He is unable to remain still and is experiencing excruciating pain. The medical doctor described it as the most “exquisite demonstration of pain”. What is the most likely diagnosis? Appendicitis Inguinal hernia Kidney stones Ruptured bladder  54. You have been treating a female patient who is 6 months pregnant for pregnancy-related low back pain. Which modality would be contraindicated in this patient? Lower Level Laser Therapy on her low back Ultrasound on her low back Local vibratory therapy on her low back Acupuncture on her low back  55. A 56-year-old slightly overweight male patient has been experiencing multiple episodes of shortness of breath with left arm pain that is relieved with nitroglycerin therapy. Physical examination reveals that he is hypertensive and he has high cholesterol. What is the most likely cause of his presenting symptoms? Congestive heart failure Heart attack Angina pectoralis Liver cirrhosis  56. A 23-year-old male patient has started running in order to manage his weight. Recently he has noticed that his left foot has been fatiguing faster than the right and he has noticed it slapping against the ground whenever he runs. What is the diagnosis?. L4 radiculopathy L5 radiculopathy S1 radiculopathy Lumbar spine stenosis  57. A 47-year-old female patient presents to the clinic with a chief complaint of shortness of breath and a productive cough. She also mentions that her sputum has bloody streaks in it. Based on this information, what is the patient likely experiencing and the cause of their symptoms? Bacterial pneumonia Pneumoconioses Coccidiomycoses Bronchogenic carcinoma  58. A 12-year-old boy comes into your practice with some pain that he has been experiencing on the bottom of their foot. Physical exam reveals tenderness during palpation along the medial aspect of the plantar calcaneal tubercle and pain with passive dorsiflexion of the great toe. What is the diagnosis? Plantar fasciosis Turf toe Hammer toe Pes planus  59. A 14-year-old female soccer player experienced a fall during her game last night. She presents to the clinic with a painful right foot and ankle, which has noted swelling seen on the lateral aspect. Physical examination reveals pain with passive inversion of the ankle and tenderness along the superolateral ankle. Based on the information above, what is the structure that is most likely damaged. CFL Deltoid ligament PTFL ATFL  60. You are doing a new intake on a young male patient. Throughout the intake, you notice that this patient has an increased thoracic kyphosis and suspect that he has Scheuermann’s kyphosis. What might be important to include in your physical assessment of this patient? Postural assessment Balance testing Rapid alternating movements Cranial nerve screen  61. A 30-year-old female marathon runner finishes a race when she has a sudden burning sensation in the medial aspect of both of her legs with paresthesia over the dorsum of the foot. Evaluation reveals cyanosis on the dorsum of both feet, decreased st pedal pulse, decreased active ankle dorsiflexion, and decreased sensation in the 1 web space of both feet. At this time, what do you think would be the most appropriate plan of management? Soft tissue therapy on the anterior leg muscles Refer care to her GP Have her transferred to an ER Do nothing as this condition is self-limiting  62. A 27-year-old electrician was working on the job site when his foot got stuck in a pothole, which caused him to fall. He immediately felt pain along the medial aspect of his ankle and was experiencing pain with walking when he presented to your clinic. What is the most likely injured structure? Talus ATFL Deltoid ligament Achilles’ tendon  63. A retired 77-year-old male patient of your has been experiencing a pain into his posterior thigh and leg, which is progressively getting worse. You send him out for an MRI examination, which reveals degenerative disc disease, facet hypertrophy, and ligamentum flavum hypertrophy as well throughout the lumbar spine. Based on these findings, what is the most likely diagnosis? Lumbar disc herniation Lateral stenosis Central stenosis Vascular claudication  64. A 52-year-old male patient has been experiencing a significant amount of intermittent chest pain. Further inquiry into the patient’s history reveals that his diet consists primarily of processed and frozen meals. He also mentions that his chest pain is worse after eating a heavy meal. What is the most likely diagnosis? Angina pectoralis Hiatal hernia GERD Heart attack  65. An elderly female patient presents to the clinic to join a Fall Prevention Program since she has been experiencing unsteadiness in her gait recently. A neurological assessment was performed, which revealed hyporeflexia at the level of C5 and C6 (1+), but hyperreflexia at C7, L4, and L5 (3+). What is the most likely diagnosis? Lumbar canal stenosis BPPV CSM Meniere’s Disease  66. A 8-year-old boy had fallen on an outstretched hand while playing at the park. He presents with elbow pain and severely limited range of motion due to pain. Physical exam reveals severe tenderness along the radial head. What is the likely diagnosis? Cervical radiculopathy Chisel fracture Strain of brachioradialis Olecranon fracture  67. A male football player presents with a chief complaint of pain on the bottom of his foot after a long day of training. Physical exam reveals pain upon weight-bearing with palpation at the head of the 1st metatarsal reproducing his pain. However, passive dorsiflexion did not recreate any pain. What is the diagnosis? Plantar fasciosis Hallux valgus Sesamoiditis Tibial nerve entrapment  68. A 13-year-old very active male has been experiencing a significant amount of knee pain. He mentions it is aggravated when he pivots when playing basketball. Examination reveals pain with resisted knee extension, tender tibial tuberosities, and pain with squatting. Additionally, observation reveals red, hot, and swollen on the anterior aspect of the tibia. What is the diagnosis? Patellofemoral pain syndrome Medial meniscus irritation Osgoode-Schlatters Calf strain  69. A young female is playing soccer when another player accidentally slide tackles into her leg. Instantly, she feels a sharp pain in her knee and feels a pop. As you approach her on the field, you notice a significant amount of swelling in her knee. She is diagnosed with ACL rupture. What would be the most appropriate immediate plan of management for this patient? Ice and compression Rest for 3 weeks Refer to ER Isometric strengthening of her quads  70. A middle-aged female patient has been experiencing some calf pain ever since she got off a plane after a 6-hour flight. She presents with unilateral swelling in her calf, which is tender to touch and is noticeably warm. What is her diagnosis? Calf strain Lumbar radiculopathy Osteomyelitis Deep vein thrombosis  71. A 54-year-old female presents with a complaint of headaches. During your assessment, she mentions that when her headaches come on, she starts to lose vision in her left eye, which also becomes significantly painful. What is the most likely cause of this patient’s headache? Migraine headache with aura Migraine headache without aura Glaucoma Cervicogenic headache  72. You have been treating a patient with known PMR. During one of her regular visits, she mentions that she’s been having more unilateral headaches. You decide to do an assessment to determine the cause of her headaches. Cranial nerve examination was unremarkable, but auscultation on the side of her head revealed bruits. What is the problem here? Cervicogenic headaches Stroke Fibromyalgia Temporal arteritis  73. A mildly overweight patient presents to the clinic who has been experiencing some mid back pain. During your evaluation, he mentions that he has also been experiencing some abdominal pain, especially after eating a meal. If these two symptoms are related, what is the most likely diagnosis? Appendicitis Stomach cancer Ulcerative colitis Pancreatitis  74. A patient presents to the ER with severe and sudden abdominal pain. As he is waiting, he finds relief by sitting in a hunched forward posture, as to avoid aggravating his symptoms. Based on this presentation, what is the most likely diagnosis? Kidney stones Appendicitis Small bowel obstruction Ruptured urinary bladder  75. A child is playing tag with some friends when he falls and scrapes his knee. During the next few weeks, his knee becomes red, hot, and swollen and he is unable to put any weight on it. What is this patient’s diagnosis? Suppurative osteomyelitis of the knee Reactive arthritis Psoriatic arthritis Osteoarthritis  76. A chest x-ray in a patient revealed Kerley A lines. What condition is this indicative of? Lymphoma Tuberculosis Congestive heart failure Pericardial effusion  77. A 25-year-old male electrician comes in with a complaint of right-sided neck pain and shoulder pain that has been ongoing for 1 year. Range of motion revealed a decrease in lateral flexion and rotation on the right. Kemp’s reproduced right-sided neck pain and shoulder pain. What is the diagnosis? Cervical disc herniation Cervical spondylotic myelopathy Cervical facet syndrome Cervical facet irritation  78. A male patient presents with a unilateral headache located near the eye, that is accompanied by eye watering and nasal congestion on the same side. What is his most likely diagnosis? Classic migraine with aura Tension-type headache Rebound headache Cluster headache  79. A young female patient presents to your office with a complaint of dizziness, vertigo, a slight loss of hearing on the left, and tinnitus. Upon further questioning, you discover that she also has a fever. What is the most likely diagnosis? Benign paroxysmal positional vertigo Labyrinthitis Ménière’s disease Cervicogenic vertigo  80. A middle-aged female patient presents with diffuse arm pain, pins and needles, and numbness in her right arm. Spurling’s, Jackson’s, and cervical compression are negative and do not reproduce her symptoms. What is her diagnosis? T4 syndrome Cervical radiculopathy Thoracic outlet syndrome Diabetic neuropathy  81. When cervical traction is applied, how many pounds of traction are needed to have a physiological effect? 10-14 lbs 15-19 lbs 20-24 lbs 25-30 lbs  82. A 65-year-old male presents to your office with chronic mid back pain. History reveals that he is a 2 pack-a-day smoker and has emphysema. Physical exam revealed that thoracic range of motion was limited in all ranges due to stiffness and Kemp’s was positive for his mid back pain. Based on the above information, what is the most likely diagnosis? Lung cancer Thoracic facet irritation Thoracic facet syndrome Cervicogenic dorsalgia  Radiography Information to Know! There was a question asking about what the purpose of the grid was for (to reduce scatter radiation) There was a question asking x-raying a larger patient and if you need to increase kVp or Mas (you would increase kVp) The other question was asking the reason for setting up the x-ray taking room in with the control panel being north-south and x-ray beam being east-west (perpendicular) – this is so the doctor can avoid as much scatter radiation as possible Forms of Radiation during an X-Ray Coherent radiation = 8% of interaction Compton radiation = 62% of interaction Photoelectric absorption = 30% of interaction 2021 Questions  Feb 2021 Radiology Cases Ankylosing Spondylitis with a carrot stick fracture AC joint separation Simple Bone Cyst in humerus with a fracture (fallen fragment sign) Paget’s disease in the hemipelvis Fibular fracture Knife clasp deformity with spina bifida occulta at S1 Transitional lumbosacral vertebra with accessory articulation of L5/S1  83. A young mother brings in her baby for a maintenance adjustment. She inquires about whether or not she should have her child vaccinated. How should you respond? Tell her that she should have her child vaccinated Tell her the benefits of a delayed vaccine schedule Tell her to not have her child vaccinated Refer to someone who can discuss vaccines in their scope of practice  84. A patient is reported to have tinnitus and slight hearing loss. Examination showed that the patient’s hearing loss was conductive in nature. Additionally, the patient also has café au lait spots on their body. What is the most likely diagnosis? Myringitis Acoustic neuroma Stroke Meniere’s disease  85. A middle-aged female patient came in with neck pain and vertigo after being involved with an MVA a week prior. Examination revealed that it was not due to position and was likely cervicogenic in nature. How would you determine the cause of the vertigo? Dix-Hallpike Maneuver Cranial nerve screen Rotary chair test Epley’s maneuver  86. A patient presents to their chiropractors office following a bad fall off their bike on the weekend. Through the history, the chiropractor discovers that the patient had braced themselves prior to impacting the ground and they did not strike their head. Upon physical examination, they have a loss of cervical range of motion, cervical Kemp’s is positive, and doorbell test and East’s are negative. What is the most likely diagnosis? WAD I WAD II WAD III WAD IV  87. An older male farmer presents to the office with right-sided forearm and wrist pain and numbness into the hand. Physical exam reveals that Jackson’s, Spurling’s, and doorbell were all negative on the right, but sustained pressure over the pronator teres reproduced his wrist and hand symptoms. What is the most likely diagnosis? Cervical radiculopathy Thoracic outlet syndrome Carpal tunnel syndrome Pronator teres syndrome  88. If painful arc is present when assessing a patient’s shoulder range of motion and empty can is positive, what muscle is likely responsible? Infraspinatus Supraspinatus Biceps long head Teres minor  89. Which of the following is not a consideration for the Ottawa ankle rules? Pain in the malleolar region Bony tenderness along the distal 6 cm of the posterior edge of the tibia Bony tenderness along the distal 6 cm of the posterior edge of the fibula Inability to bear weight for 2 steps  90. A new patient comes in off the street seeking treatment. While in the waiting room, they are being aggressive toward the staff and demanding to see the doctor. What is the most appropriate step to deal with this situation? Take them in and do an assessment, but then send them to another clinic for treatment Have the staff escort the patient out of the clinic Have the lead doctor escort the patient out of the clinic Take them in and treat them  91. A doctor does an intake on a new patient at the clinic. The paperwork involved includes intake forms, SOAP notes, and a ROF. By law, what form(s) is required to have the patient’s name on it? Intake forms SOAP notes ROF All of the above  92. While treating a patient with a known case of Bell’s Palsy, a chiropractor decides to incorporate some modalities into the treatment plan. Based on evidence-based guidelines, what modality has been shown to be effective for treating this condition? TENS IFC Microcurrent Low level laser therapy  93. You are treating a patient with adhesive capsulitis of the shoulder. Current symptoms are painful active and passive range of motion and a moderate loss in range of motion What phase of the condition is he in? Freezing Frozen Thawing Hot  94. A young child is experiencing intense headaches, neck pain and stiffness, and sensitivity to light. What is the most likely diagnosis? Classic migraine with aura Meningitis Cluster headache Glaucoma  95. An x-ray in a 21-year-old male with chronic and long-standing low back pain shows non-marginal syndesmophytes in the thoracolumbar region. What is the diagnosis? Degenerative disc disease Spondylodiscititis Ankylosing spondylitis Lumbar radiculopathy  96. A female softball player has been diagnosed with lateral epicondylitis. What muscle should be stretched as a part of her treatment plan? Flexor carpi ulnaris Extensor carpi radialis brevis Extensor carpi radialis longus Brachioradialis  97. A young boy presents to your office with a diffuse rash along his legs and intense lingering pain in his hips and knees. Blood work revealed that he was positive for ANA antibody. What is his diagnosis? Psoriatic arthritis Ankylosing spondylitis Juvenile rheumatoid arthritis Spondylodiscitis  98. A rugby player presents with a locking sensation in his knee when he tries to go into extension. An x-ray is taken, which revealed a fragment on the lateral aspect of the medial condyle. What is his diagnosis? Osteochondritis dissecans ACL rupture Medial meniscus tear Fibular head fracture  99. In a ligament sprain injury, what would most likely reproduce the patient’s symptoms the most? Active range of motion Resisted muscle testing Light pressure Passive overpressure  100. A young girl has persistent thigh pain, which is particularly bad at night. It has been going on for about 3 months and continues to get worse. X-ray reveals an expansile lytic lesion with a sunburst periosteal reaction and soft tissue invasion. What is the most likely diagnosis in this case? Ewing’s sarcoma Osteosarcoma Osteomyelitis Childhood lymphoma  101. A middle-aged male athlete presents to his doctors office for a general check up. The doctor tests the patient's reflexes by striking the patient’s lateral forearm, which causes his arm to pull back slightly. What nerve root is being assessed in this situation? C4 C5 C6 C7  102. A 67-year-old male patient comes in with severe low back pain with radicular symptoms into both legs. Further questioning reveals that he is experiencing a loss of bowel and bladder control and has saddle paresthesia. Based on the most likely diagnosis, what is the appropriate course of action? Refer to patient’s GP Treat conservatively based on physical exam findings Take a “watch and see” approach to their condition Refer patient to ER  103. A father brings in his newborn for a wellness check. The father mentions that his son is having difficulties walking and crawling. The doctor has the baby supine and notices that when his knees are brought up to 90, the left knee is higher. Based on this finding, additional testing would show what? Orthopedic evaluation would find that abduction and anterior pressure on greater trochanter would make a pop in the left hip Orthopedic evaluation would find that abduction and anterior pressure on greater trochanter would make a pop in the right hip Orthopedic evaluation would find that adduction and posterior pressure on femurs would make a pop in the left hip Orthopedic evaluation would find that adduction and posterior pressure on femurs would make a pop in the right hip  104. Stroking a baby’s cheek causes the baby to turn his head toward the side that was touched. What reflex is this? Rooting Galant Moro Babinski  105. A 66-year-old female experiences pain in her legs when she’s walking. She feels a sense of fatigue and heaviness after walking 200 metres, at which time she needs to sit down until it settles. What is the diagnosis? Neurogenic claudication Vascular claudication Lumbar radiculopathy Cervical spondylotic myelopathy  106. Following a car accident, a patient experiences a loss of cervical range of motion and stiffness in the neck. Upper limb neurological exam was unremarkable. Based on the most likely diagnosis, what is the best plan of management? Spinal manipulative therapy Soft tissue therapy Cervical range of motion exercises All of the above  107. An elderly patient is shown to have osteoporosis and is looking for ways to maintain her bone mineral density. What is a safe and effective way to do so? High intensity interval training Walking Light body weight resistance training Bed rest  108. A chronic smoker who has known lung cancer, which was left untreated, is experiencing widespread pain through his low back, upper back, and neck. In order to determine the extent of possible metastasis, what diagnostic modality should be used? MRI Bone scan CT Ultrasound  109. A positive Hawkins Kennedy test would be indicative of what condition? Cervical radiculopathy Subacromial impingement Acromioclavicular sprain Glenohumeral instability  110. Someone has recently suffered an anterior shoulder dislocation and had to have it relocated. What actions should they avoid doing for the next little bit so that they don’t risk having another dislocation? Abduction and external rotation Adduction and internal rotation Horizontal adduction and adduction Internal rotation and extension  111. A soccer player gets hit in their knee with a slide tackle. He felt a pop in his knee and there was instant swelling that appeared. What structure was most likely injured? PCL MCL ACL Medial meniscus  112. A skateboarder falls on an outstretched hand after attempting to do a trick and hurts his wrist. Upon examination, he has tenderness on his anatomical snuff box. What is the most likely diagnosis? Lunate dislocation Hamate fracture Triquetrum fracture Scaphoid fracture  113. When performing an adjustment on the radial head, what should the line of drive be? Extension and pronation Flexion and supination Extension and supination Flexion and pronation  114. Sharp and stabbing pain at the ball of the foot, particularly with walking, would be indicative of what? Fat pad syndrome Heel spur Extensor hallucis longus strain Morton’s neuroma  115. In anterior interosseous nerve entrapment, what muscle is likely to be impacted? Ulnar half of flexor digitorum profundus Pronator quadratus Pronator teres Abductor pollIcis longus  116. A pregnant women comes in with a complaint of right-sided wrist and thumb pain, but no history of a fall. Exam reveals swelling around the wrist and thumb and Finkelstein’s was positive for her chief complaint. What is her diagnosis? Scaphoid fracture Carpal tunnel syndrome DeQuervain’s tenosynovitis Ulnar nerve entrapment  117. A man presents to the ER with severe low back pain on the right. He cannot hold still and is writhing in pain. The doctor examines him and notices that there is a sharp exacerbation of pain when he strikes the patients lower thoracic region near his paraspinals. What is the diagnosis? Appendicitis Costovertebral joint dysfunction Non-specific mechanical low back pain Kidney stones  118. A patient is diagnosed with a classic upper cross syndrome and wishes to correct her posture. What exercise would you prescribe her? Supermans Bird-dogs Bent over rows Biceps curls  119. A man in his 60’s has been experiencing a very stiff neck and difficulty swallowing. History reveals that he is diabetic. An x-ray is taken, which reveals thick flowing hyperostosis along the anterior vertebral bodies in his cervical spine. Based on this information, what condition does he have? Cervical spondylotic myelopathy Ankylosing spondylitis Diffuse idiopathic skeletal hyperostosis Ossification of the posterior longitudinal ligament  120. Following a fall from their dirt bike, a patient presents with chest pain and a fullness in their chest. Chest x-ray reveals a small oval opacity along the lateral edge of the rib, which indicated the patient had a rib fracture. What sign is being described here? Extrapleural sign Silhouette sign Meniscus sign Cervicothoracic sign  121. An accountant presents to their chiropractor‘s office with a complaint of neck pain and headaches. During the physical exam, the doctor was able to reproduce the patient’s headache by applying sustained pressure to the patient’s suboccipitals. What is the dIagnosis? Cluster headache Classic migraine with aura Glaucoma Cervicogenic headache  May 2021 - Radiology Cases Type 1 Salter-Harris fracture of the femur Scheuermann’s kyphosis Osteosarcoma of the distal femur AC joint separation Trimalleolar fracture Cervical spine DISH Paget’s disease of the pelvis Winking owl sign (differentiate between pedicle agenesis and lytic metastasis) Structural scoliosis due to hemivertebra  122. A 79-year-old female patient presents to the chiropractors office with right foot pain after twisting her ankle. Exam reveals tenderness along the lateral malleolus and she is unable to weight bear for 2 steps. Based on the most likely diagnosis, what should the chiropractor do? Adjust the ankle Use shockwave on her ankle Perform soft tissue on the affected muscles Refer to ER  123. A 10-year-old boy falls while on the slide and presents with left-sided shoulder pain. An x-ray is taken which reveals a slightly expansive geographic lytic lesion that has a “fallen fragment sign” What is his diagnosis? Enchondroma Simple bone cyst AC joint separation Anterior shoulder dislocation  124. A child was playing soccer when he injured himself trying to kick the ball. He had gone to kick it when his foot caught on the ground instead. Immediately, he felt pain and bruising in his hip and ASIS. Based on this information, how should this patient be managed? Immediately begin soft tissue work on the hip and thigh musculature X-ray series for the hip and pelvis Adjust for spinal subluxations Hip rehab protocol  125. A 20-year-old female has chronic mid-back pain with an enhanced thoracic kyphosis. X-rays are taken, which reveal anterior vertebral body wedging at multiple levels, irregular end plates, and well-maintained disc spaces. Based on the findings, what is the most likely diagnosis? Ankylosing spondylitis Diffuse idiopathic skeletal hyperostosis Spondylodiscitis Scheuermann’s disease  126. 20-year-old male presents with acute low back pain after falling off a ladder and landing flat on his back, 5 days prior. His pain has decreased, but it is still present. X-rays are taken, which reveals a missing pedicle at L2 with noted sclerosis of the remaining pedicle of L2. What is his diagnosis? Lytic metastasis Pedicle agenesis Pedicle fracture Spondylolisthesis  127. 78-year-old male is experiencing progressive spinal stiffness that is characterized as mildly achy in his thoracic spine. Upon further questioning, he mentions that it is challenging to swallow food or water. What might you expect to find on his cervical x-rays? Non-marginal syndesmophytes Thick, flowing hyperostosis Vertebral body destruction Vertebral endplate erosion  128. A 10-year-old male presents with severe pain in his leg after falling on his bike. Examination reveals severe bruising, there was high amounts of muscular rigidity at the site of injury, decreased sensation on the dorsum of the foot, and a slightly diminished dorsal pedal pulse. Based on the most likely diagnosis, what is the most appropriate action to take? RICE Treat conservatively, using soft tissue therapy and mobilizations Use therapeutic ultrasound on the bruised site Refer to ER  129. A 35-year-old male patient is diagnosed with ankylosing spondylitis. What cardiac condition is often times related? Aortic aneurysm Myocardial hypertrophy Pericarditis Aortic semilunar valve disease  130. A 34-year-old male patient presents to their chiropractor with headache, neck pain, and numbness into 4th and 5th digits on the left following an MVA 3 days prior. Physical examination revealed upper limb reflexes 2+ bilaterally, normal sensory, motor 5/5 bilaterally, limited cervical range of motion globally, and muscular palpation of scalenes and SCM revealed localized tenderness bilaterally. Based on the most likely diagnosis, what is the most appropriate plan of management for this patient? Conservative management using SMT, mobilizations, soft tissue therapy, and rehab Cervical spine x-rays Refer to patient’s GP for medical management Therapeutic ultrasound  131. An 11-year-old female swimmer presents to the office with pain and fatiguing in her right shoulder. The doctor instructs the patient to abduct her shoulder to 90 degrees while he passively externally rotates the shoulder, which causes her shoulder to give out. What is her most likely diagnosis? Shoulder impingement Glenohumeral instability Rotator cuff strain AC joint sprain  132. A 19-year-old male javelin athlete presents to your office with a primary complaint of achy and sharp pain on the outside of his right shoulder. Physical exam reveals an impaired scapulohumeral rhythm on the right; Hawkins-Kennedy and Neer’s were both positive, shoulder instability tests were positive, and supraspinatus, infraspinatus, and teres minor were tender upon palpation. What would be the best rehab exercise to give this patient as a part of your plan of management? Weighted lateral raise Weighted external rotation with elbows at 90 degree flexion Weighted farmer’s carry Weighted front raises  133. A 69-year-old male patient presents with a sudden onset of acute shoulder pain that has impacted his ADL’s. He is experiencing a substantial amount of pain and stiffness in his shoulder, which is most noticeable with passive range of motion in all directions. Based on the most likely diagnosis, what is the best plan of management? Unsupervised shoulder exercise with weights Joint mobilization and soft tissue therapy directed at shoulder Instrument-assisted soft tissue therapy Electrotherapy modalities  134. A 59-year-old post-menopausal marathon runner presents to your office with groin pain following a race. Radiographs are taken, which reveals uniform sclerosis in the inferior pubic ramus. What is her most likely diagnosis? Blastic metastasis Enthesopathy Myositis ossificans Stress fracture  135. 68-year-old male presents with numbness and tingling into right arm. Upon examination, the patient realizes that his symptoms are relieved when he is instructed to abduct his shoulder and bring his hand behind his head. What is his most likely diagnosis? Cervical facet syndrome Cervical spondylotic myelopathy Cervical radiculopathy Syringomyelia  136. In order to successfully diagnose a patient with anterior interosseous nerve syndrome, what sign needs to be present? Weakness of flexor pollicis longus Paresthesia of lateral hand Night pain Positive Tinel’s test at carpal tunnel  137. 24-year-old female patient is experiencing a dull pain on her lateral elbow and forearm for the past 2 weeks. Physical exam reveals pain with resisted wrist extension and tenderness upon palpation of the lateral elbow and proximal forearm musculature. Which muscle is the main pain generator in this condition? Anconeus Brachioradialis Extensor digitorum Extensor carpi radialis brevis  138. You are seeing a patient at your office for regular maintenance care. His wife comes in one day and requests to see his file. What should you do? Allow her access to his file Do not allow her access to his file Allow her to only look at a copy of his file Allow her to only look at his most recent patient visit files  139. A 10-year-old female was at dance camp when she suddenly felt a sharp, shooting pain in the ball of her foot. Physical exam reveals that she walks with excessive pronation and squeezing the forefoot recreates the pain in the ball of her foot. What structure is most likely entrapped? Common plantar digital nerve Deep fibular nerve L4 nerve root Superficial fibular nerve  140. A 38-year-old male motorcyclist fell off his bike and landed on his head, experiencing a cervical hyperflexion injury. A cervical radiograph was taken, which revealed a clay shoveler's fracture. What radiographic view would this best be seen on? AP cervical PA cervical Cervical obliques Lateral cervical  141. A 19-year-old female patient is experiencing left jaw pain. Her symptoms are exacerbated when she protrudes her jaw forward and when she laterally deviates to the left. Tenderness is experienced on her left lateral pterygoid and temporalis. What is her diagnosis? Cervical radiculopathy Dental infection Temporomandibular joint dysfunction Cranial nerve VII palsy  142. 20-year-old female fell off a ladder and landed on her feet and immediately felt severe right low back pain. Her pain is constant and worsens when she moves, coughs, and sneezes. Range of motion is limited in all ranges. Lower limb neuro was unremarkable. What is her most likely diagnosis? Vertebral compression fracture Disc herniation Lumbar sprain/strain injury Spinous process fracture  143. During a physical exam, the doctor performs Thomas test, which was positive for low back pain. Based on this finding, what exercise or stretch should be recommended to this patient? Plank Hip flexor stretch Squat Quadriceps stretch  144. The doctor performs Hibb’s test on a 65-year-old female patient, which reproduces left buttock pain. Trendelenburg’s was negative and lower limb neuro was unremarkable. Given this information, what is her diagnosis? Lumbar radiculopathy Myofascial pain syndrome of gluteus medius Sacroiliac joint syndrome iliopsoas strain  145. A 14-year-old male presents to your office with pain on the top and outside portion of the right shoulder that is worse when reaching overhead and throwing. Physical exam reveals a painful arc between 70-110 degrees abduction. What would be the best ortho test to perform to best diagnosis the most likely condition? Belly press Hawkins-Kennedy Lift-off Speed’s  146. A 25-year-old female soccer player is experiencing left knee pain and a locking sensation with extension. An x-ray is taken, which shows that she has osteochondritis dissecans. Where would you expect to find this condition? Inferior patella Lateral aspect of medial condyle Medial aspect of lateral condyle Tibial tuberosity  147. A 50-year-old male presents to your office with a complaint of achy low back pain for the past 6 years. He mentions that standing for long periods of time aggravates it, but heat relieves it. Physical exam reveals restrictions from L3-5 bilaterally and Kemp’s was positive (right worse than left). Radiographs were taken, which showed facet sclerosis and anterior osteophytes from L2-5. What is his diagnosis? Degenerative disc disease Lumbar facet irritation Spina bifida occulta Lumbar radiculopathy  148. A 54-year-old male patient presents with left-sided neck pain that travels down the back of the left arm into the middle finger. In order to rule out cervical radiculopathy, what test should be performed? Sharp and dull sensation on medial forearm Elbow flexor strength Triceps deep tendon reflex Tinel’s at the cubital tunnel  149. A 72-year-old female patient was diagnosed with cancer 2 years ago. She is undergoing testing to see if it has metastasized. What test would be the most indicative for spinal metastasis? Alkaline phosphatase levels CT MRI Bone scan  150. It is discovered that your 11-month old patient has early signs of a hemivertebra at the level of T2. What might this predispose this patient to through skeletal maturity? Spina bifida occulta Syringomyelia Scoliosis Scheuermann’s disease  151. A 49-year-old male truck driver experienced left-sided neck pain that radiates to his left arm after shoulder checking 2 weeks ago. He mentions that he heard a popping sound and then 2 hours later, felt diffuse arm pain. Physical exam reveals upper limb neuro unremarkable, cervical spine myospasm and joint fixations on the left, which recreated his left neck and arm pain. What is the most appropriate plan of management? MRI Medical management X-ray Conservative therapy  152. When cervical traction is applied, how many pounds of traction are needed to have a physiological effect? 10-14 lbs 15-19 lbs 20-24 lbs 25-30 lbs  153. A 22-year-old male university student presents with left low back pain, heel pain, skin rashes. X-ray revealed early signs of sacroiliitis on the left. What is his most likely diagnosis? Lumbar radiculopathy Sacroiliac syndrome Reactive arthritis Ankylosing spondylitis  154. For patients with chronic low back pain, what are three key exercises that should be prescribed? Sit ups, back extension, and leg raises Curl ups, bird-dogs, and side bridges Curl ups, back extension, and push-ups Sit ups, leg raises, and bird-dogs  155. A 60-year-old male patient is experiencing unrelenting pain deep in his bones that is worse at night and is unrelieved by rest. He also experiencing nausea, fatigue, and muscle weakness. What is his diagnosis? Myocardial infarction Obesity Osteomalacia Anemia  156. An older female patient has a DEXA T-score of -2.6. What is the best way for her to maintain her bone mineral density? Biking Swimming Range of motion exercise Resistance training  157. A 17-year-old female experienced a sudden headache on the side and front of her head after playing frisbee. Physical exam was relatively unremarkable. SMT and soft tissue directed at the neck resolved all of her symptoms. Based on this information, what is her most likely diagnosis? Thunderclap headache Tension-type headache Exertion headache Rebound headache  158. An elderly male is experiencing dizziness, vomiting, nausea, and headache for 1 week. He experiences relief when lying on his side. He also reports a fullness in his ears and mild hearing loss. Blood pressure reading was shown to be 118/79. What is his diagnosis? Acoustic neuroma BPPV Labyrinthitis Menières  159. A patient comes in with neck pain that radiates from the left lower neck to the chest and down the left arm and into the upper back along the medial border of the left scapula. The upper traps, levator scapulae, rhomboids, scalenes, and SCM are tight and tender on the left. They are experiencing hypoesthesia on the C7 and C8 dermatome. A test is performed in which the left arm is abducted and externally rotated, which recreates the hypoesthesia in the left upper extremity. What is the diagnosis? Cervical radiculopathy Thoracic outlet syndrome Cervical rib compression Myocardial compression  160. A tall and lean 15-year-old boy has a chest x-ray taken, which shows rib notching. What condition is this finding most likely related to? Cardiomyopathy Costochondritis Pneumonia Coarctation of the aorta  161. A patient presents with left-sided neck pain with pain and numbness that travels to the anterolateral aspect of the forearm. If motor testing were to be performed, which action would be weakened? Elbow extension Finger abduction Shoulder abduction Wrist extension  162. A 43-year-old female patient visits her chiropractor with a complaint of burning pain into her forearm near her elbow and tingling into the thumb and index finger after training her biceps at the gym. Resisted elbow flexion and supination recreates pain. If this condition was due to a nerve entrapment, which muscle would be implicated? Supinator Pronator quadratus Pronator teres Bicipital aponeurosis  163. A 30-year-old male patient experienced a dislocation-relocation injury of his shoulder and is now experiencing weakness in wrist extension and a loss of sensation over posterior forearm. Which nerve is damaged? Median nerve Ulnar nerve Medial cutaneous nerve of arm Radial nerve  164. A 50-year-old male presents with a stiff neck, headache, and flu for 2 days. The patient then proceeds to lie on their back with their knees bent. The examiner then passively extends the patient’s legs. Based on the most likely diagnosis, what would you expect to happen if the test was positive? Increased neck pain Shooting electrical pain down spine Nausea and vertigo Low back pain  165. An overweight woman in her 40’s presents to the office with right shoulder pain. Physical exam shows that cervical and shoulder range of motion is full and pain-free and Murphy’s sign recreated the right shoulder pain. What is her most likely diagnosis? Subacromial impingement Acute pancreatitis Kidney stones Acute cholecystitis  166. An alcoholic male in his mid-50’s presents with persistent upper abdominal pain and mid back stiffness. He also experiencing fever and nausea. Physical exam reveals tenderness when touching the abdomen. Based on the above information, what is the most likely diagnosis? Cholecystitis Pancreatitis Peritonitis Appendicitis October 2021 Questions  October 2021 - Radiology Cases AC sprain Transitional lumbosacral vertebra Idiopathic structural scoliosis in a skeletally mature adult Degenerative joint disease in cervical spine 2 girls (one 3-years-old and one 18 months old) with multiple bowing deformities and rib fractures and a supracondylar fracture and fraying of the metaphysis - Rickets Calcification of the splenic artery Rib fracture leading to shortness of breath Avulsion fracture of the greater trochanter Pedicle agenesis (with compensatory sclerosis) Scheuermann’s disease  167. A 70-year-old male patient presents to your office with severe low back pain, which was followed by an inability to complete a bowel movement. Physical examination reveals a non-dermatomal loss of sensation and generalized weakness in the lower extremity. What is the diagnosis? Cauda equina syndrome Lateral stenosis Diabetic neuropathy Mechanical low back pain  168. During a neonatal assessment, the doctor performs a test in which he adducts the baby’s hips and applies a posterior pressure. What test is being performed? Ortolani’s test Moro reflex Barlow’s test Babinski’s reflex  169. During a neonatal assessment, the doctor performs a test in which the baby is being held in his arms and then he rapidly lowers the baby to the table. What test is being performed? Moro reflex Tonic neck reflex Parachute response Rooting reflex  170. When assessing a patient for a segmental radiculopathy, what finding would be the most indicative for this condition? Sharp pain in the buttocks Localized low back pain Pain with extension Shooting pain into the leg and foot  171. A patient comes into your office and you observe them to be very tall, with enlarged hands, forehead, and jaw. They present to your office with a primary complaint of headaches and visual changes. What is the cause for this condition being described? Ankylosing of the C1-2 articulation Retinal detachment Pituitary tumour Build up of pressure behind eye  172. A 47-year-old male construction workers presents to your office following a lifting injury at the job site. Radiographs are ordered to rule out fractures. The images reveal widespread blastic changes seen throughout the pelvis and lumbar vertebra. Further inquiry reveals that he has been experiencing night pain for the past few months. What is the most likely cause of his pain? Non-specific mechanical low back pain Spinal metastasis Multiple myeloma Compression fracture  173. A father brings in his 10-year-old son who had a small fall and injured his knee and now has a small bruise on it. You’re about to perform an assessment on it, but his father demands that you just adjust the knee so they can get on with their day. What is the best way to proceed? Adjust the knee without performing a thorough history and physical exam Insist on an examination of the knee Give the father an x-ray requisition and have them return once images are obtained Tell the father you refuse to treat his son  174. A male patient in his mid-30’s presents to your office with a complaint of severe headache, unilateral eye pain, and excessive tear formation in the eye. What is his most likely diagnosis? Tension headache Glaucoma Cervicogenic headache Cluster headache  175. Based on the diagnosis from the last question, what is the most appropriate plan of management? Treat conservatively Refer them to their GP Refer them to ER Do nothing and have them rest at home  176. A patient comes in with a complaint of severe ear pain, hearing loss, fever, and a feeling of fullness in the ear. What is the most likely diagnosis? Acoustic neuroma Myringitis Obstructed ear canal Multiple sclerosis  177. In a patient with lateral spinal stenosis that extends into the left leg, what radiographic finding would be present that would explain their leg pain? Disc degeneration Anterior osteophytes Facet degeneration Central disc herniation  178. During an examination for hearing loss, the doctor taps a tuning fork on their foot and then places it on the top of their head to see what side the patient hears the sound better. What is the name of the test being performed? Rinne’s test Rhomberg’s Head impulse test Weber’s test  179. An 80-year-old patient comes in with a complaint of neck stiffness and numbness and tingling in the hands and feet. Physical examination reveals stiffness in all cervical ranges of motion, hyporeflexia at C5 and C6, and hyperreflexia at C7, L4, and S1. Based on the information above, what is the diagnosis? Syringomyelia Cervical spondylotic myelopathy Transverse myelitis Diabetic neuropathy  180. A patient comes in with a complaint of chest pain that is described as heartburn. She has noticed issues with regurgitation after eating and the occasional difficulty swallowing. What is her most likely diagnosis? Gastric ulcer Duodenal ulcer Hiatal hernia Pneumoperitoneum  181. An overweight male patient who is a 2-pack a day smoker is experiencing sharp, stabbing chest pain and difficulty breathing. Vitals are taken, which reveals a blood pressure reading of 180/150. Based on the most likely diagnosis, what is the most appropriate plan of management? Treat conservatively Send to GP Send to ER Do nothing and have patient rest at home  182. Following being checked into the boards during a hockey game, the player comes to your office with a complaint of shoulder pain. The physical exam revealed painful range of motion in internal and external rotation and Crank’s test was positive on the affected side. What is the most likely diagnosis? Anterior shoulder dislocation SLAP lesion Rotator cuff tendinopathy Adhesive capsulitis  183. A 25-year-old electrician comes into your office with a complaint of right-sided shoulder pain, which is especially bad with overhead movements. Physical exam reveals a positive Hawkin’s-Kennedy test on the right. What is his diagnosis? Subacromial impingement AC joint sprain Cervical radiculopathy Teres minor trigger point  184. Following a severe head trauma, a patient presents to your office with a complaint of dizziness, severe headache, and lack of sensation on the right side of her body. What is the most likely reason for her symptoms? Cervicogenic headache Classic migraine with headache Cerebral hemorrhage Spinal tumour  185. An 18-year-old female student has been experiencing neck pain that is also accompanied by a headache. Physical exam reveals a global loss of range of motion in the cervical spine and palpation of the suboccipitals recreated her headache. Based on her diagnosis, what is the best plan of management? Treat conservatively using a combination of spinal adjusting, soft tissue therapy, and rehabilitation Refer to her GP Refer to ER Do nothing and have her rest at home  186. A truck driver presented to your office 2 weeks prior with a complaint of neck pain following a shoulder check, which was accompanied by a popping sound. You have been treating him with spinal adjustments for 2 weeks and have not noticed any resolution in his symptoms at all. What would be the most appropriate next step? Continue to treat using manual therapy Obtain cervical radiographs Obtain cervical MRI Obtain cervical ultrasound  187. A factory worker presents to your office with a complaint of low back pain that began after lifting a heavy box. Physical exam reveals relief with lumbar flexion, pain with lumbar extension, and Kemp’s was + on the left for localized low back pain. What is the most likely diagnosis? Lumbar radiculopathy SI joint syndrome Lumbar facet irritation Lateral stenosis  188. A 30-year-old office manager comes in with a complaint of bilateral pain and swelling in her hands. X-rays are taken, which revealed bony erosion at her proximal interphalangeal joints and early findings of deformity noted. What is her diagnosis? Psoriatic arthritis Rheumatoid arthritis Ankylosing spondylitis Scleroderma  189. In a patient with an L5/S1 radiculopathy due to lumbar disc herniation, what reflex should be tested to confirm the diagnosis? L4 L5 S1 S2  190. A woman in her mid-20’s is experiencing left lower quadrant pain that comes and goes, which is typically accompanied by low back pain. Both of these conditions occur at the same time as her period and she is also experiencing intermittent spotting. What is her diagnosis? Appendicitis Ectopic pregnancy Pelvic inflammatory disease Peritonitis  191. A 70-year-old male comes in complaining of severe low back pain that is worsened with coughing. History reveals that he is a pack a day smoker. Physical exam reveals a pulsatile mass in his abdomen. Based on the most likely diagnosis, what is the most appropriate plan of management? Refer to GP Refer to ER Treat conservatively Do nothing and have the patient rest  192. A chiropractor is performing a test in which the patient is supine on the table, one knee is flexed into the chest while the other leg hangs off the edge of the table. What condition is this test assessing for? IT band syndrome Glut med strain Congenital hip dysplasia Iliopsoas strain  193. An active male patient is diagnosed by his chiropractor with winging scapular. What is the best exercise to help treat this condition? Eccentric lateral raises Concentric front raises Push-up plus Farmer’s carry  194. A patient is diagnosed with a supraspinatus strain. What is the best way to rehab this injury? Eccentric lateral raises Concentric front raises Push-up plus Farmer’s carry  195. After completing a thorough history and physical exam, a chiropractor diagnosis a patient with adhesive capsulitis. What is the best way to treat this condition? Treat with firm joint mobilizations and soft tissue therapy Treat with gentle joint mobilizations Refer to their medical doctor Refer to ER  196. In a patient with a Morton’s neuroma, what structure is being compressed? Tibial nerve Interdigital nerve Deep fibular nerve Superficial fibular nerve  197.A patient presents with an acute ankle injury. During the examination, what symptom would be the most concerning? Pain with passive inversion Pain with passive eversion Severe pain along the lateral malleolus Bruising on lateral ankle  198. Following an acute lower extremity injury, a patient presents to their chiropractor’s office with severe leg pain. Physical exam revealed severe tenderness along the anterolateral leg and diminished pulses on the dorsum of the foot. Based on the most likely diagnosis, what is the best plan of management? Refer to ER Refer to GP Treat conservatively Do nothing and have the patient rest  199. A 60-year-old female patient comes in with a complaint of unilateral calf pain. Physical exam reveals unilateral swelling, pitting edema on the dorsum of the foot, and tenderness along the calf musculature. What is the diagnosis? Acute calf strain Lumbar radiculopathy Deep vein thrombosis High ankle sprain  200. Following a knee injury, a soccer player presents with a swollen knee and painful to weight-bear. Questioning reveals the injury occurred after he sustained a pivoting injury. What would be the best test to perform to assess for the most likely diagnosis? Posterior drawer test Lachman’s test Log roll test Slump test  201. A patient is experiencing severe headaches, heaviness and pain in the upper back, and has an ESR that is 7 times higher than normal. What is her diagnosis? Migraine Cervicogenic headache Cluster headache Polymyalgia rheumatica  202. A patient presents with their neck in a left laterally flexed and right rotated position. What muscle is likely affected? Right SCM Right anterior scalenes Left SCM Left anterior scalenes  203. A women comes in who is 30 weeks pregnant and she is experiencing pain into her thumbs bilaterally. Physical exam reveals a positive Finkelstein’s bilaterally and swelling around the wrist and forearm. What is her diagnosis? Cervical radiculopathy De Quervain's tenosynovitis Carpal tunnel syndrome Myocardial infarction  204. You have been treating a patient in a workers compensation case for 3 months and you are performing a re-assessment. You suspect this patient might be a malingerer. What tests should be performed to evaluate this? Pain scale Oswestry Waddell’s tests Range of motion  205. You are evaluating a patient’s x-ray for basilar impression. What is the best Roentgoenometric to assess for this? George’s line Chamberlain’s line Spinolaminar line Skinner’s line  206. A patient’s cervical x-ray reveals an ossification that can be seen on the anterior vertebral bodies of 4 continuous segments, but no ossification or ankylosis of the posterior vertebral elements. What is the diagnosis? Ankylosing spondylitis Ossification of the posterior longitudinal ligament Psoriatic arthritis Diffuse idiopathic skeletal hyperostosis  207. A patient received an x-ray of their elbow, which revealed a medial epicondyle avulsion fracture. What would be the most likely mechanism of injury that would have caused this? Punching a wall Throwing a baseball Aggressively serving a volleyball Falling off a skateboard  208. What is the most likely mechanism of injury for a kid who sustained a scaphoid fracture? Punching a wall Throwing a baseball Aggressively serving a volleyball Falling off a skateboard  209. What is the most likely mechanism of injury for a teenager who sustained a boxer fracture? Punching a wall Throwing a baseball Aggressively serving a volleyball Falling off a skateboard 2022 Questions  February 2022 - Radiology Cases C/S degenerative disc disease with pons ponticus Asking which complication related to the pons ponticus (may cause headaches) Lung consolidation in a woman with a productive cough and fever Asked which lobe it’s in and what the finding was (Consolidated lung with silhouette sign) SCFE What the etiology of the disease is (post-traumatic) Lumbar scoliosis with osteophyte formation Asked to identify what was present in the lower lumbar spine (osteophyte formation) Transitional lumbosacral vertebra Asked what the appropriate POM was (conservative chiropractic treatment) Skull with Paget’s disease Asked what the diagnosis was (Paget’s) and what a serious complication of the disease would be (pathological fracture) Scheuermann’s disease Asked diagnosis (Scheuermann’s disease) and another asked the finding present (irregular end plates) Fracture of the greater trochanter Asked about the etiology of the condition (trauma) Child abuse in two kids Asked about the findings of one of the kids x-rays (metaphyseal corner fracture of distal femur, multiple rib fractures at various stages of healing). The other findings on the other x-ray showed a massive fracture in the middle of the humeral diaphysis (which is indicative of child abuse rather than Ricket’s, which many people may consider). They asked what would be the most appropriate POM (calling child protective services)  210. An older male patient comes into your clinic for regular chiropractic treatment. History reveals that he has low back pain with no other comorbidities or complications. Other than conservative chiropractic treatment, what other advice would you give him? Exercise Consulting his GP Increase his saturated fat consumption Decrease water consumption  211. A patient presents with sensory losses in the 1st 3 fingers and weakness in abductor pollicis brevis. Which nerve is entrapped in this case? Ulnar nerve Anterior interosseous nerve Median nerve Radial nerve  212. A patient has headaches that start at the back of her head and then move up to the temporal and frontal regions. What muscle would you want to stretch to help give her relief? Scalenes Upper trapezius SCM Suboccipitals  213. A 44-year-old patient has a known spondylolisthesis and their x-rays reveal an elongated pedicle. What kind of spondylolisthesis is this classified as? Isthmic Degenerative Traumatic Congenital  214. X-rays of an 80-year-old female patient are given to you that shows multiple vertebrae that look less radiodense in the image. Other than occasional aches and pains in her low back, she does not have any other symptoms. Given this information, what is the most likely diagnosis? Lytic metastasis Blastic metastasis Osteoporosis Blastic phase of Paget’s  215. You’re examining a patient who has come to you with a chief complaint of arm pain. You palpate a muscle at the proximal ⅓ of the anterior humerus which recreates the pain. Which muscle did you palpate? Biceps tendon Brachialis tendon Triceps tendon Brachioradialis tendon  216. A patient who is scheduled to come in and see you today calls in to let you know that she has rosacea. Given this information, what would you expect to see? Warts on her face Varicose veins Goiter Redness over her face  217. A factory worker presents to your office with a complaint of low back pain that began after lifting a heavy box. Physical exam reveals relief with lumbar flexion, pain with lumbar extension, and Kemp’s was + on the left for localized low back pain. What is the most likely diagnosis? Lumbar radiculopathy SI joint syndrome Lumbar facet irritation Lateral stenosis 218. A middle-aged patient presents to the clinic with a primary complaint of low back and buttock pain. No red flags were noted during the history. Physical exam was as follows: Kemp’s and Maigne’s challenge was positive bilaterally for the low back and buttock complaint and Valsalva and SLR was negative. Based on this information, what is the most likely diagnosis? Facet irritation SI syndrome Facet syndrome Lumbar radiculopathy  219. A 17-year-old female experienced a sudden headache on the side and front of her head after playing frisbee. Physical exam was relatively unremarkable. SMT and soft tissue directed at the neck resolved all of her symptoms. Based on this information, what is her most likely diagnosis? Thunderclap headache Tension-type headache Exertion headache Rebound headache  220. A teenage patient comes into your office with a primary complaint of upper back pain. Your exam reveals a enhanced thoracic kyphosis, more than normal. You decide to take an x-ray and determine that this patient has Scheuermann’s kyphosis. What radiographic finding would be present in this patient? Anterior vertebral body wedging Scoliosis Disc space narrowing Marginal syndesmophytes  221. A female office worker comes in with wrist and thumb pain. Your examination reveals tenderness along the radial aspect of her wrist and into the thumb. Additionally, Finkelstein's was positive for the chief complaint. What is her diagnosis? Cervical radiculopathy Ulnar nerve entrapment Lateral epicondylitis De Quervain’s tenosynovitis  222. During a neonatal assessment, the doctor performs a test in which the baby is being held in his arms and then he rapidly lowers the baby to the table. What test is being performed? Moro reflex Tonic neck reflex Parachute response Rooting reflex  223. A patient presents to a radiology clinic for an x-ray of their low back. Upon visual inspection, the patient appears to be moderately obese. In order to get a clear image, what setting should be modified? Increase KVP and include a grid Decrease KVP and include a grid Increase KVP and don’t include a grid Decrease KVP and don’t include a grid  224. What chemical material is found in the X-ray tube? Aluminum Gold Tungsten Platinum  225. You are treating a female patient for cervicogenic headaches who happens to be an office worker. Which of the following would be an appropriate POM for this patient? Referring to GP A course of manual therapy including SMT, mobilizations, and rehab Referring to ER Rehab exercises only 226. You are treating the same female patient in the previous question for cervicogenic headaches who happens to be an office worker. After treating her for 2 weeks, she comes in with a headache that she describes as the ”worst headache she has ever experienced”. Which of the following would be an appropriate POM for this patient? Referring to GP A course of manual therapy including SMT, mobilizations, and rehab Referring to ER Rehab exercises only  227. If you were to take an x-ray of a patient with a known diagnosis of acromegaly, what finding would you expect to be present? C1-C2 fusion Decreased disc heights Cotton wool appearance of the visualized bones Increased blastic activity  228. A patient jumps off of a 1 story building and lands straight on their feet. Based on this mechanism of injury, what would be the most likely injury they would present with? Lumbar disc herniation Thoracic spine compression fracture Spondylolisthesis Cauda equina syndrome  229. A 14-year-old gymnast presents to your office with right-sided hip pain that extends into her right anterior and lateral thigh. Physical exam reveals a negative slump, Valsalva, and SLR. Sustained pressure medial to the right ASIS reproduced her chief complaint. Based on her most likely diagnosis, what is the appropriate POM? Lumbar SMT Refer her for lumbar radiographs Refer to GP Trigger point therapy of hip flexors  230. In an X-ray of a patient with early findings of ankylosing spondylitis, what would you expect to see? Non-marginal syndesmophytes Trolley track sign Pseudo widening of the SI joints Dagger spine  231. A patient presents with lateral elbow and forearm pain. Physical exam reveals tenderness along the common extensor, positive Cozen’s, and positive resisted middle finger extension. Based on the most likely diagnosis, what muscle is likely affected in this case? Extensor carpi radialis brevis Extensor carpi radialis longus Brachioradialis