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FAMILY NAME:………….....………………………….
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FORMAL EXAMINATION PERIOD: SESSION 1, JUNE 2021

Unit Code: CHIR8101

Unit Name: Clinical Chiropractic 1

Duration of Exam 2 hours (plus 10 minutes reading time)

(including reading time if applicable):

Total No. of Questions: 31

Total No. of Pages 13

(including this cover sheet):

GENERAL INSTRUCTIONS TO STUDENTS:

• Students are required to follow directions given by the Final Examination Supervisor and must refrain from communicating in any way with another student once they have entered
the final examination venue.
• Students may not write or mark the exam materials in any way during reading time.
• Students may only access authorised materials during this examination. A list of authorised material is available on this cover sheet.
• All watches must be removed and placed at the top of the exam desk and must remain there for the duration of the exam. All alarms, notifications and alerts must be switched off.
• Students are not permitted to leave the exam room during the first hour (excluding reading time) and during the last 15 minutes of the examination.
• If it is alleged you have breached these rules at any time during the examination, the matter may be reported to a University Discipline Committee for determination.

EXAMINATION INSTRUCTIONS:

Answer all questions in this examination paper in the space provided.

AIDS AND MATERIALS PERMITTED/NOT PERMITTED:

Dictionaries: No dictionaries permitted
Calculators: No calculators permitted
Other: Closed book – No notes or textbooks permitted

Copyright © Macquarie University. Copying or distribution of part or all of the contents in any form is prohibited.
Q1. Consider the graph below:

Use the above graph to inform your treatment plan for a new patient who has presented
with acute onset low back pain. What would you say to this new patient to assist their
understanding of how their care will change over time? (3 marks)
Care will start off with passive care and a low integration of active care when the patient
___________________________________________________________________________
gradually shows signs of improvements as well as staying consistent with the education
___________________________________________________________________________
that is taught to the patient throughout the patient. The patient will gradually transition
___________________________________________________________________________
into more active care and eventually cut down on the amount of passive care required in
the later stages.

Q2. A new patient presents to you with recent-onset acute low back pain. The patient
expresses that they are worried that they will now be stuck with this pain forever. What will
you say to this patient to reduce their fear? Cite the reference for any facts and figures you
use in your answer. (4 marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 2

Q3. Jen case
Jen is a 32-year-old female business manager who presents to your office complaining of a
3-month history of dull aching in her upper neck. She relates that work has been very
stressful lately and that she is putting in longer than usual hours on the computer. She
complains of mild headaches worse at the end of the day and relieved by rest. Jen has
suffered from migraines in the past and she confirms that these headaches are not
migraine.
List and explain your top 3 further clinical details and/or history questions that you would
like to ask. (3 marks)

1__________________________________________________________________________
Does the headache radiate elsewhere?

___________________________________________________________________________

2__________________________________________________________________________
What would you scale the pain for the dull ache in the upper neck from 1-10?

___________________________________________________________________________
Does certain movements relieve the tension or aggravate it?
3__________________________________________________________________________

___________________________________________________________________________
Right lateral flexion & left rotation
Jen's physical exam reveals the findings
recorded here to the right  Cº spine. Occ/C1

List two occiput adjustment techniques to

address these findings. (1 mark)

Occiput technique 1__________________________________________________________

Occiput technique 2__________________________________________________________

Discuss which adjustment you would select to use in this case and give the clinical reasoning
for your decision. In what clinical scenario would you select the other adjustment? (6 marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 3

Q4. Roy case
Roy is a 24-year-old male who presents to your office complaining of a 2-day history of
sharp pain in his lumbar region on the left after a collision during a football match.
Compare and contrast the clinical factors that will help you determine if their pain is coming
from their facet joints or from a herniated disc. (4 marks)
Facet joint pain tends to be localized to a specific area of the affected joint. It is also aggrevated
___________________________________________________________________________
by repetitive movements, and is tender upon palpation over the affected joints. Whereas Herniated
___________________________________________________________________________
disc can radiate along the path of the affected nerve and is exaberated by activities that increase
___________________________________________________________________________

___________________________________________________________________________
the load on the disc. Physical examination findings to test for disc herniation can include: positive

nerve tension tests, muscle weakness or changes in reflex associated with the affected nerve.
___________________________________________________________________________

___________________________________________________________________________
Right rotation & right lateral flexion
Roy's physical exam reveals the following
findings recorded here to the right  Lº spine. L4/L5

List one long-lever technique to address

these findings and one short-lever
technique to address these findings.
(1 mark)

Lumbar: BLR, Forearm contact, Anterior-superior

Long lever technique _________________________________________________________

Discuss which adjustment you would select to use in this case and give the clinical reasoning
for your decision. How would the situation need to be different for you to have selected the
other adjustment? (6 marks)
It involves rotating the spine as well as contralaterally laterally flexing the spine.
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 4

Q5. Consider the below diagrams

a. Provide a 'National College' (Standard Diversified) listing for the above static depiction of
a spinal motion unit. (1 mark)
*Note - Both images are the same, Image B is rotated 90º to the left

Listing = ___________________________________________________________________

b. If you lay this patient down on their left side as depicted in Image B. Which adjustment
would contact the L3 transverse process and follow the line of correction indicated on the
image? (1 mark)

___________________________________________________________________________

c. Name a 'long-lever' adjustment that would also address the above listing? (1 mark)

___________________________________________________________________________

d. On which side would you need the patient lay down upon for the adjustment you named
in 5c? (1 mark)

___________________________________________________________________________

CHIR8101 Final Exam 2021 5

Q6. Compare and contrast the following adjustments with respect to clinical indications,
biomechanics and adjustment classification.

Cervical: Supine, Bilateral index contact, lateral flexion, close H/L

vs
Cervical: Cradle hold, Lateral flexion

Compare and contrast
Clinical indications
(1 mark)
Cervical: Supine, Bilateral Cervical: Cradle hold, Lateral
index contact, lateral flexion
flexion, close H/L

Biomechanics
(3 marks)

Adjustment classification
(1 mark)

Q7. Compare and contrast the following adjustments with respect to clinical indications,
biomechanics and adjustment classification.

Sacroiliac: BLR, Pisiform contact, Extension

vs
Sacroiliac: FLR, Forearm contact, Ischial

Compare and contrast Sacroiliac: BLR, Pisiform Sacroiliac: FLR, Forearm

contact, Extension contact, Ischial
Clinical indications
(1 mark)

Biomechanics
(3 marks)

Adjustment classification
(1 mark)

CHIR8101 Final Exam 2021 6

Q8. Compare and contrast the following adjustments with respect to clinical indications,
biomechanics and adjustment classification.

Thoracic: Prone, Crossed pisiform, Flexion

vs
Thoracic (mid-lower): Sitting, Winglift, Elbow hold, Extension

Compare and contrast Thoracic: Prone, Crossed Thoracic (mid-lower):

pisiform, Flexion Sitting, Winglift, Elbow hold,
Extension
Clinical indications (1 mark)

Biomechanics (3 marks)

Adjustment classification
(1 mark)

Q9a. What does an RPI ilium listing indicate? (1 mark)

___________________________________________________________________________

Q9b. On a postural analysis, what structural signs would be consistent with an RPI ilium?
(2 marks)

___________________________________________________________________________

___________________________________________________________________________

Q9c. What motion restrictions are consistent with an RPI ilium? (1 mark)

___________________________________________________________________________

Q10. What may be the clinical significance of a static listing? (1 mark)

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 7

Q11a. Consider a motion palpation finding of left P-A rotation restriction at L3-4.
List 2 adjustments to address that motion restriction. (2 marks)

___________________________________________________________________________

___________________________________________________________________________

Q11b. State which listing would match the motion palpation finding of left P-A rotation
restriction at L3-4. (1 mark)

___________________________________________________________________________

Q12a. Consider a motion palpation finding of left lateral flexion restriction at the Occiput-C1
joint complex. List 2 adjustments to address that motion restriction. (2 marks)

___________________________________________________________________________

___________________________________________________________________________

Q12b. State which listing would match the motion palpation finding of left lateral flexion
restriction at Occiput-C1. (1 mark)

__________________________________________________________________________

Q13a. Consider a motion palpation finding of right lateral flexion and P-A rotation restriction
at T4-5. List 2 adjustments to address that motion restriction. (2 marks)

___________________________________________________________________________

___________________________________________________________________________

Q13b. State which listing would match the motion palpation finding of right lateral flexion
and P-A rotation restriction at T4-5. (1 mark)

__________________________________________________________________________

Q14. Describe the movement of anterior pelvic tilt and how it may become dysfunctional
due to poor muscle control. (4 marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 8

Q15. As a registered health practitioner in Australia, you have a requirement to notify the
Chiropractic Board of Australia of certain events within seven days of becoming aware of
the event or a change in the event's status.
What are the three events that you must notify the Chiropractic Board of within seven
days? (3 marks)

1__________________________________________________________________________

2__________________________________________________________________________

3__________________________________________________________________________

Q16. Consider the below passage from the Chiropractor Code of Conduct:

If a chiropractic student was to engage in cheating on quizzes and exams during their
University days studying for their chiropractic degrees, how could they evolve into the
ethical and trustworthy practitioner that society rightly expects? What do you think a
patient would feel if they were to learn that their chiropractor regularly cheated on quizzes
and exams when they were a student? (4 marks)
Lack of trust towards the practitioner as well as a sense of disrespect towards the practitioner
___________________________________________________________________________

___________________________________________________________________________
because they didn't work towards what was necessary but instead cheated their way into becoming

a so called "practitioner". Advice that would be provided to the patient would not be taken as seriously
___________________________________________________________________________

___________________________________________________________________________
as the patient doesn't know whether they can trust the practitioner to provide a good service even

if the service he provides may be great.

CHIR8101 Final Exam 2021 9

Q17. Why may an adverse event reporting system be useful for chiropractors? (2 marks)

___________________________________________________________________________
Helps with collecting and analyzing information about adverse events, incidents, or errors that

occur within healthcare settings. These settings aim to improve patient safety, identify areas
___________________________________________________________________________
for improvement, and prevent future occurences of similar incidents.
___________________________________________________________________________

Q18. What are some of the challenges in getting any healthcare practitioner to engage with
adverse event reporting? (4 marks)
The fear with legal consequences with reporting adverse events. Concerns with malpractice,
___________________________________________________________________________
liability, damage to their reputation, etc. Chiropractors may also have the concern about the
___________________________________________________________________________
confidentiality and privacy of the information. Chiropractors may also lack the awareness or training
___________________________________________________________________________
to understand the importance of adverse event reporting.
___________________________________________________________________________

Q19. What did Schneider, Murphy and Hartvigsen say, in their 2016 paper about the
attempts of chiropractors to define their own profession? (3 marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Q20. Name and discuss up to 3 headache 'triggers' associated with migraine. (3 marks)
If you list more than 3, only your first 3 will be marked.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 10

 Q21. Define 'informed consent'? (1 mark)

___________________________________________________________________________
It is ensuring the patient acknowledges about the information that is provided to them about

what they're about to do before providing an answer as to whether they want to participate in it.
___________________________________________________________________________

Q22. Why is informed consent so vital for cervical thrust procedures where there is the
spectre of risk of vertebrobasilar stroke? (3 marks)
High risk of injury as well as other issues that can arise so asking for consent is necessary
___________________________________________________________________________

___________________________________________________________________________
as it could also can get you sued if the patient didn't provide consent to allow you to perform

this procedure on them.

___________________________________________________________________________

Q23. The requirements of an expert witness in an Expert Witness Code of Conduct includes
that the expert has a 'duty to the court'. In your own words, what does this mean? (3 marks)
The obligation to provide accurate information to disclose any relevant evidence or information,
___________________________________________________________________________
and to act in a manner that upholds the administration of justice. It promotes justice and
___________________________________________________________________________

___________________________________________________________________________
helps to maintain public trust in the legal system.

Q24. In your own words, explain what it means if a chiropractor was found to be 'negligent'
through a legal action brought in tort.
In your answer:
a) Define health care negligence, including the elements of negligence. (4 marks)
b) Include what you must do as a chiropractor to exercise your duty of care. (4 marks)
c) You may wish to use an example to help your explanation.

___________________________________________________________________________
a) It is a situation where the practitioner doesn't provide the standard of care that is expected of

in that field that could result to injury or harm to the patient. Elements of negligence includes:
___________________________________________________________________________
duty of care (Legal obligation to act reasonably & not to harm others), breach of duty (failing to act
___________________________________________________________________________
reasonably), causation (Demonstrating defendant's actions directly caused injuries or damage,
___________________________________________________________________________
proximate cause (assessing harm suffered by plaintiff) & damages (Plaintiff must have suffered
___________________________________________________________________________
actual damages from the defendent's negligence. b) Making sure to provide a quality service
___________________________________________________________________________
without neglecting the needs of the patients. This includes posessing the skills & knowledge,
___________________________________________________________________________
assessing and diagnosing the patient on what needs to be worked on, asking for informed consent,
___________________________________________________________________________
treatment & care based off the assessment, safety and risk management to minimize risk of harm &
referring the patient when it is out of a chiropractors scope of practice.
CHIR8101 Final Exam 2021 11
Q25. In your own words what is meant by 'professional boundaries'? (1 mark)
Professional boundaries refers to guidelines and limitations that are placed in order to provide
___________________________________________________________________________
a service that maintains professionism, trust and respect in this setting.
___________________________________________________________________________

Q26. Why are professional boundaries important for practitioners and patients? (2 marks)
Provides a safe place for the practitioner as well as patients. By setting a boundary it
___________________________________________________________________________

___________________________________________________________________________
allows individuals to receive the appropriate & unbiased services, while also fostering a

respectful & safe environment for everyone

___________________________________________________________________________

Q27. What are some examples of practitionerssbreaking professional boundaries to the

detriment of their patients and themselves? (2 marks)
Sexual relationships between the practitioner or patient, abusing ones power to get what
___________________________________________________________________________

___________________________________________________________________________
they want from the patient or practitioner, providing therapy to a close family or friend and blurring

the professional relationship with them, etc.

___________________________________________________________________________

Q28. Good clinical record keeping can be one of the most effective ways to protect a health
practitioner from being successfully sued in negligence.
Why are good clinical records so crucial in proving a health practitioner was not negligent in
providing care? (1 mark)
Patient could mention that on a specific day when they came in to get treated and the practitioner
___________________________________________________________________________

___________________________________________________________________________
gets accused for not providing a good service. This could cause trouble for the practitioner but if he written

what he had done throughout the procedure (as evidence) the practitioner would not get in trouble with it.

Q29. According to the Chiropractor’s Code of Conduct, what are the minimum points of
information that 'good' clinical records should contain? (3 marks)
Patient identification, medical history, chief compliant, presenting symptoms and informed consent
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

CHIR8101 Final Exam 2021 12

 Connective tissue disorders

genetics
Trauma
smoking
Q30. List and discuss the ‘environmental’ and ‘inherited’ risk factors for cervical artery
dissection? (4 marks)
Trauma to the neck region is associated with an increase in risk for CAD. Smoking (Tobacco/cigarette)
___________________________________________________________________________
has been identified as an environmental risk for CAD. The inherited risk factors for CAD includes
___________________________________________________________________________
genetics whereby specific mutations related to the arterial health and structure can increase the risk for CAD.
___________________________________________________________________________
Connective tissue disorders such as Marfan syndrome and Ehlers-Danlos can predispose individuals with
___________________________________________________________________________
CAD.

Q31. In 2016, Bruce Walker proposed a 10-point-plan that aspired to see the chiropractic
profession enjoy an improved status in the eyes of other health providers, policy makers
and the public.

Select and discuss at least 4 of the above 10 points. (8 marks)

Evidence based practice is crucial as it provides the current studies that prove that the treatment/
___________________________________________________________________________

___________________________________________________________________________
services they provide are up to date and not based off presumptions when treating the patient

(best interest in the patient). When a profession also supports research it shows their continual
___________________________________________________________________________
willingness to absorb new information on the field that will allow them to become a great practitioner
___________________________________________________________________________
by continuing their learning. It also shows that their services will change based off research
___________________________________________________________________________
and not rely on old methods that are no longer beneficial to the patient. University trained means
___________________________________________________________________________
the practitioner took the time to educate themselves through years of experience before working
___________________________________________________________________________
in the actual field. By taking years to educate oneself require dedication and gains the respect from
___________________________________________________________________________
other practitioners in the field. 7. Striving to improve the clinical practice is crucial as it shows the continual
growth of the clinic isn't solely based on making money off from patients but instead providing a quality
service to help others in need by feeling the need to continually learn and improve the clinic to tailor it to
client needs.
CHIR8101 Final Exam 2021 13