Thoracic Spine Technique and Management (CHPR63231- 6th Quarter) - Sample Exam Questions Quizzes, Midterms, Finals
Written by Dr. Lew (revised 3/18/2012)
I am giving you examples of the short answer and essay questions ahead of time to allow you to prepare a very organized and complete presentation of the material. Stick figure drawings are welcome of course if they include the appropriate explanation. List form is best for easy organization of thoughts and presentation.
So, here is your chance to prepare! Don’t put this off. My suggestion is to prep early (this week) and then practice (over and over) writing (or speaking) the answers (without looking) in less than 40 minutes. The goal is that the midterm or the final exam should be only one hour.
The fill in the blank questions are for diagnosis, anatomy and treatment questions from CCE3 class and the first half of Tspine Tech class. Use the table of contents from the CCE3 notes to jog your memory or the syllabus.
For the REVIEW QUIZ
This will be fill in the blank or short answer questions pulled directly from previous CCE3 finals. If you knew the material before the break when you took your CCE3 final and your long term memory is intact, you are ahead of the game. Here is the link to the CCE3 page: http://w3.palmer.edu/makani.lew/cce3/questions.htm
For MIDTERM Exam
The Fill in the Blanks:
I will ask the diagnosis, anatomy and treatments covered in CCE3 class questions here. For instance:
_________ is a rash that appears along a dermatome and when the person has a history of Chicken Pox.
_________ is when anti-viral and/or corticosteroid prescriptions are most effective in the management of Herpes Zoster (Shingles)
_________ would be the symptoms of the prodrome of Herpes Zoster.
_________ describes Scheppelmann’s orthopedic test and what it is testing for.
Sample Midterm (or final) Short Answer questions (5 points each)
Describe the three dimensional approach of rotational breathing as given in Schroth Physiotherapy Treatment. AND What is the desired outcome and purpose of this treatment?
Describe the Schroth Physiotherapy approach to stretches and exercises for Scoliosis. AND Explain why this approach is different than regular exercises and stretching programs.
A patient has been given the diagnosis of T4 Syndrome- 1) Describe the movements that can cause the onset of T4 Syndrome. 2) What is the typical complaint of a person with T4 Syndrome? 3) What is the theory of the mechanism as to what causes the symptoms. 4)What areas do you expect you need to adjust? 5) What muscles do you expect to see involved?
Describe the key points of the Woggon approach to treating scoliosis
Describe at least 3 varieties of modified adjustment techniques to use to treat a 20 degree Right Thoracic Scoliosis.
Sample Midterm (or final) Essay Questions (10 points):
Essay Question (10 points) Please list out out an extensive and complete treatment plan for a patient to do at home over the next month to help with Upper to mid-thoracic discomfort. Include exercises, stretches, ice/heat, ergonomic tips, etc. Give instructions on how to do the various procedures and if appropriate discuss the intent of the procedures. Drawings are welcomed. Go for it… MORE is better. (Of course in your office you will do adjusting, this is just for the patient’s home care.)
Essay Question (10 points)
Please write out a treatment plan for a 14 year old asthenic female patient who has come to your office with a 20° right thoracic idiopathic scoliosis. Her Risser sign is 4. The scoliosis was diagnosed when she was 12 years old at 15° and the treatment has been to monitor the progression. She has a 35º thoracic kyphosis and anterior head carriage- her EAM is 1 inch anterior to her AC joint. Her shoulders are rolled forward. The plumbline falls anterior to her knees by 1 inch. She has some aches and pains in her back and neck and decreased mobility on motion palpation in various areas of her spine.
· Part 1: Describe to the patient what it means to have scoliosis. Tell her what things seem to work, what risk of progression there is, etc.
· Part 2: Describe what exercises and stretches, and any other things she should do at home to help her control her scoliosis.
· Part 3: Describe at least 3 varieties of modified adjustment techniques to fix her scoliosis. Include any other procedures you would like to do to treat her in your office.
Essay Question: (10 points)
A 30 year old mesomorphic female patient presents with classic symptoms of Postural Syndrome.
1) Describe Postural Syndrome in detail.
2) Create an Incremental Home Treatment Plan. This means give a week by week plan of what exercises, stretches, any modifications in activities of daily living that you would give. You may assume that she will be in your office weekly for her adjustments.
For the FINAL Exam (yes, of course it is comprehensive- and intended to be forever in your memory)
(that means CCE3 material, the review quiz material, the questions listed above and the midterm material are included as well)
Okay…. It’s not all essay….It's some fill in the blanks (1 pt each), Some short answers (5 pts each),1 long answer (10 pts), and maybe some multiple choice
Sample Short Answer Questions (5 points each)
Describe Scheuermann’s Disease, the possible prognosis, and a treatment plan including home stretches and exercises and types of adjustments.
In terms of the Scapulo-thoracic junction
Describe signs and symptoms of a restricted Scapula in the scapulo-thoracic junction. 2) What muscles do you expect to see involved? 3) What other areas do you expect you need to adjust? 4) Describe at least three ways to mobilize the scapula.
A patient has pain down her right arm into the thumb and index finger. She has pain in her Scalene muscles. 1) What other areas do you expect you need to adjust? 2) Describe an adjustment (or two) for each area. 3) What other muscles do you expect to see involved
A patient has pain at the base of her neck and along her shoulder in the first rib area. 1) What areas do you expect you need to adjust? 2) What muscles do you expect to see involved? 3) Describe two or more adjustments for the first rib.
When a person has a first rib subluxation, they often get other symptoms. Explain in detail and in a sequential event how the first rib can affect the shoulder girdle and spine. Drawings with explanations are welcome.
A patient has pain that is worse on inspiration in the 4th intercostal region on the left side of the sternum. 1) Give at least 5 differential diagnoses (from common to serious) 2) What are ways to manually test for a complaint in this area (name and describe them- drawings are welcome) and how they will rule in or out the diagnoses you’ve listed.
Describe how an anterior thoracic adjustment can be used to increase kyphosis (fix an extension fixation) or decrease kyphosis (fix a flexion fixation)
How do you differentially diagnose AS, DISH, Herniated disc, Potts?
How does PNF work in treatment of myofascial adhesions?
What does the Graston Technique do in the treatment of myofascial adhesions?
What are the key components (there are several) of managing a patient with Fibromyalgia?
Describe why Resisted Eccentric PNF work is not done in the early stages of rehabilitation and why it is important to include it as part of the overall treatment.
Using the concept of being a contractile test versus a stretching test, describe how the chest wall orthos differ and how a positive helps determine a diagnosis.
How does occulomotor movement affect stretching? Describe what the patient needs to do with his eyes when you are stretching his left QL.
What are 3 ways to stretch the QL? And 3 ways to do trigger point work on the QL? And 3 exercises to strengthen the QL?
Sample multiple choice questions:
1. Normal Costovertebral expansion should be
a. 1-3 cm
c. 1-7.5 cm
d. >7 cm
2. Which of the following would most likely be unable to adequately perform prone extension?
b. Scheuermann’s Disease
c. T4 Syndrome
d. Flat Back Syndrome
e. Myocardial infarction
3. Sprengel’s Deformity is a
a. Deformity that involves non-migration superiorly of the scapula resulting in descended scapula.
b. Deformity that involves non-migration inferiorly of the scapula resulting in an elevated scapula.
c. Deformity found as a key part of the triad defining Klippel Feil Syndrome.
d. Deformity associated with Klippel Feil Syndrome that affects the cardio-vascular system.
a. Has unilateral pain, tenderness and swelling in upper costochondral region (usually ribs 2-5), is seen in the younger population and responds well to chiropractic adjustments.
b. Has unilateral pain, tenderness and swelling in upper costochondral region (usually ribs 2-5), is seen in the older population and responds well to chiropractic adjustments.
c. Has bilateral pain, tenderness and swelling in upper costochondral region (usually ribs 2-5), is seen in the younger population and responds well to chiropractic adjustments.
d. Has unilateral pain, tenderness and swelling in upper costochondral region (usually ribs 2-5), is seen in the older population and adjusting may relieve or aggravate the condition.
5. Which of the following statements is true for classic idiopathic thoracic scoliosis?
a. On the convex side, there is rib humping while on the concave side, there is shortening of the pedicles and spinous deviation.
b. On the concave side, there is rib humping while on the convex side, there is shortening of the pedicles and spinous deviation.
c. On the convex side, there is rib humping while on the concave side, there is lengthening of the pedicles and spinous deviation.
d. On the convex side, there is a narrowing of the space between the ribs humping while on the concave side, there is shortening of the pedicles and spinous deviation.
6. The goal of the chiropractor in the treatment of a 10-year old pre-menarche female patient with idiopathic scoliosis: Risser sign: 0 and Cobb’s angle 20°
a. Monitor the progress of the scoliosis with xrays every 2 years.
b. Refer immediately for surgical consultation.
c. Refer immediately for bracing consultation.
d. Adjust to free up any segmental dysfunctions and to relieve and prevent pain.
7. You have a Cox-Flexion table in your office. How could you put it to use in the pre-setup position of a classic presentation of a right thoracic idiopathic scoliosis?
a. Patient is laterally flexed to the left and rotated to the left.
b. Patient is laterally flexed to the right and rotated to the left.
c. Patient is laterally flexed to the left and rotated to the right.
d. Patient is laterally flexed to the right and rotated to the right.
8. On motion palpation, your patient cannot laterally flex as well to the right as to the left at T9. On static palpation, tenderness to palpation on the left of the spinous process and decreased movement of the spinous under left to right joint play. What pre-setup position could you do before applying your regular well-directed single hand (unilateral pisiform) contact to the high transverse process?
a. No pre-setup position is necessary, leave the patient in neutral.
b. Laterally bend the patient to the right.
c. Laterally bend the patient to the left.
d. Only an anterior thoracic move should be used on this patient.
9. What is PARADOXICAL breathing?
a. During normal inspiration, the diaphragm goes down as the lungs fill, making the abdomen protrude.
b. During normal inspiration, the diaphragm goes up as the lungs fill, making the abdomen sink in.
c. A phenomenon that demonstrates the opposite of normal breathing in terms of the abdominal movement.
d. A phenomenon that demonstrates normal breathing.
10. A patient reports unilateral pain along the bottom 2 ribs and pinpoint tenderness along the upper lumbar spinous processes. Which muscle should be addressed along with the appropriate adjustments to the ribs and vertebrae?
a. Serratus Posterior Superior
b. Serratus Posterior Inferior
c. Lumbar Multifidi
d. Intercostal Muscles
Go Back to Dr. Lew's List of Classes
Palmer Website: www.palmer.edu
Dr. Lew's Faculty PCCW Website: http://w3.palmer.edu/pccw_faculty/LewM.htm
revised March 18, 2012