Free practice questions
OCS Lumbar Spine Practice Questions
The lumbar spine is the most heavily weighted region on the OCS, about 19% of the exam according to the ABPTS content outline. Try this free case based question. Pick an answer to see the full explanation, including why each wrong answer is wrong.
Free sample question
A 58 year old man with diabetes was treated for prostate cancer 6 years ago and for a urinary tract infection 4 weeks ago. He now has worsening low back pain, night sweats, a temperature of 38.3°C and focal tenderness at L3. Which condition is MOST likely?
Answer: B. Fever, a recent urinary infection and diabetes point to spinal infection. A is wrong because his cancer history is the trap; metastasis can cause night sweats, but fever after a recent infection fits infection better. C is wrong because a fracture needs trauma or fragile bone and does not cause fever. D is wrong because a mechanical problem does not cause fever or night sweats.
Ref: Finucane et al, JOSPT 2020.
What the OCS asks about the lumbar spine
- Red flags first. Cauda equina, fracture, malignancy and infection come from the history: new bladder changes, saddle numbness, unexplained weight loss, fever, night pain. Image only when a red flag or a failed course of care points there. Red flags framework, JOSPT 2020
- Classify by irritability. Treatment based classification sorts patients into symptom modulation, movement control or function optimization, and patients move between them during a flare. Alrwaily, PTJ 2016
- Know the interventions. Exercise is the core recommendation for chronic low back pain, with manual therapy and pain neuroscience education added to it, not used alone. Low back pain CPG, JOSPT 2021
- Stenosis vs vascular claudication. Neurogenic claudication eases with sitting or bending forward. Vascular claudication eases with standing rest and comes with weak pulses.
- Young athletes. Low back pain that worsens with extension in an adolescent athlete should make you think spondylolysis.
Every practice exam question explains why the right answer is right and links its source.
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