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Question 1.Which of the following bones is part of the appendicular skeleton? A) Scapula B) Vertebra C) Sternum D) Sacrum Answer: A Explanation: The scapula is a shoulder girdle bone belonging to the appendicular skeleton; vertebrae, sternum, and sacrum are axial. Question 2.What is the primary function of the intervertebral disc? A) Produce cerebrospinal fluid B) Transmit nerve impulses C) Absorb shock and allow motion D) Anchor ribs to the spine Answer: C Explanation: Intervertebral discs act as cushions, absorbing compressive forces and permitting flexion/extension. Question 3.The cranial nerve that supplies the diaphragm is: A) Vagus (X) B) Phrenic (C3-C5) C) Accessory (XI) D) Hypoglossal (XII) Answer: B Explanation: The phrenic nerve, though not a cranial nerve, innervates the diaphragm; among cranial nerves, the vagus supplies parasympathetic fibers to thoracic/abdominal viscera. Question 4.In the autonomic nervous system, the neurotransmitter released by post-ganglionic sympathetic fibers is: A) Acetylcholine B) Norepinephrine C) Dopamine D) Serotonin Answer: B Explanation: Sympathetic post-ganglionic neurons typically release norepinephrine onto target organs. Question 5.Which of the following enzymes catalyzes the conversion of pyruvate to acetyl-CoA? A) Hexokinase B) Pyruvate dehydrogenase C) Lactate dehydrogenase D) Citrate synthase Answer: B Explanation: Pyruvate dehydrogenase links glycolysis to the citric acid cycle by forming acetyl-CoA. Question 6.The primary hormone responsible for calcium homeostasis is: A) Calcitonin B) Parathyroid hormone C) Thyroxine D) Insulin Answer: B Explanation: Parathyroid hormone (PTH) raises serum calcium by acting on bone, kidney, and vitamin D activation. Question 7.Which vitamin acts as a co-factor for the enzyme gamma-glutamyl transpeptidase in glutathione metabolism? A) Vitamin B6 B) Vitamin C C) Vitamin
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B12 D) Vitamin B2 (riboflavin) Answer: D Explanation: Riboflavin (vitamin B2) is a co-factor for many oxidoreductases, including gamma-glutamyl transpeptidase. Question 8.Inflammation is characterized by all of the following EXCEPT: A) Rubor (redness) B) Tumor (swelling) C) Calor (heat) D) Fibrosis Answer: D Explanation: Fibrosis is a later reparative process, not an acute inflammatory sign. Question 9.The Gram-positive bacterium most commonly associated with skin infections in athletes is: A) Staphylococcus aureus B) Streptococcus pyogenes C) Pseudomonas aeruginosa D) Escherichia coli Answer: A Explanation: Staph aureus is a Gram-positive cocci that frequently causes impetigo, folliculitis, and cellulitis in active individuals. Question 10.The immunoglobulin class primarily responsible for mucosal immunity is: A) IgG B) IgM C) IgA D) IgE Answer: C Explanation: Secretory IgA predominates in mucosal surfaces, neutralizing pathogens. Question 11.The most reliable clinical sign of lumbar nerve root compression is: A) Paraspinal muscle spasm B) Positive straight-leg raise test C) Decreased lumbar lordosis D) Increased deep tendon reflexes Answer: B Explanation: A positive straight-leg raise reproduces radicular pain due to nerve root tension. Question 12.In a neurological exam, the dermatome corresponding to the L nerve root is located on: A) Medial aspect of the foot B) Lateral aspect of the calf C) Dorsum of the foot D) Medial aspect of the thigh Answer: A Explanation: L dermatome supplies the medial malleolus and the medial foot. Question 13.The myotome that tests the strength of the tibialis anterior muscle is innervated by: A) L2 B) L3 C) L4 D) L5 Answer: D Explanation: Tibialis anterior is primarily supplied by the deep peroneal nerve (L4-L5), with L5 being the key myotome.
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Question 20.The most appropriate adjunctive therapy for acute low-back muscle spasm is: A) Continuous ultrasound B) Cryotherapy C) Heat packs D) Electrical stimulation Answer: B Explanation: Cryotherapy reduces inflammation and muscle spasm in the acute phase. Question 21.The “red flag” symptom that mandates immediate referral for possible cauda equina syndrome is: A) Night pain relieved by NSAIDs B) Bilateral leg weakness with saddle anesthesia C) Unilateral sciatica D) Mild low-back ache Answer: B Explanation: Saddle anesthesia and motor weakness suggest cauda equina compression, requiring urgent care. Question 22.In a blood chemistry panel, an elevated alkaline phosphatase in a patient with back pain may indicate: A) Hyperparathyroidism B) Liver disease C) Bone turnover such as fracture healing D) Renal failure Answer: C Explanation: Alkaline phosphatase rises with increased osteoblastic activity, seen in fracture repair or Paget disease. Question 23.The most common cause of a “pseudarthrosis” after spinal fusion is: A) Infection B) Inadequate immobilization C) Smoking D) Excessive bone graft D Answer: C Explanation: Smoking impairs osteogenesis, leading to non-union or pseudarthrosis. Question 24.Which of the following is a contraindication to high-velocity, low-amplitude (HVLA) cervical adjustment? A) Acute cervical sprain B) Hypertension C) Diabetes mellitus D) Osteoarthritis of the knee Answer: A Explanation: Acute cervical trauma may cause ligamentous injury; HVLA could exacerbate damage. Question 25.The spinal segment most commonly involved in thoracic outlet syndrome is: A) C5-C6 B) T1-T2 C) T4-T5 D) C7-T1 Answer: D Explanation: The neurovascular bundle passes between the anterior and middle scalene muscles at the C7-T1 level.
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Question 26.In the context of chiropractic biomechanics, the term “neutral zone” refers to: A) The range of motion with minimal muscular tension B) The point of maximal spinal curvature C) The area of greatest ligament laxity D) The segmental joint that is hypermobile Answer: A Explanation: The neutral zone is the intervertebral range where passive structures provide little resistance, allowing low-load motion. Question 27.The most appropriate imaging modality to evaluate a suspected spinal infection is: A) Plain radiograph B) CT scan C) MRI D) Bone scan Answer: C Explanation: MRI provides superior soft-tissue contrast and detects early discitis, osteomyelitis, and epidural abscess. Question 28.The primary metabolic pathway that generates ATP anaerobically in skeletal muscle during high-intensity effort is: A) Oxidative phosphorylation B) Glycogenolysis C) Lactic acid fermentation D) Beta-oxidation Answer: C Explanation: When oxygen is limited, pyruvate is reduced to lactate, regenerating NAD⁺ for glycolysis. Question 29.Which of the following hormones directly stimulates osteoclast activity? A) Calcitonin B) Parathyroid hormone C) Growth hormone D) Thyroxine Answer: B Explanation: PTH increases RANKL expression, promoting osteoclast differentiation and bone resorption. Question 30.The “Hoffmann’s sign” is considered a sign of: A) Upper motor neuron lesion B) Lower motor neuron lesion C) Peripheral neuropathy D) Myopathy Answer: A Explanation: Hoffmann’s sign (thumb flexion on flicking the distal phalanx) indicates corticospinal tract dysfunction. Question 31.In pharmacology, the drug that antagonizes the effects of acetylcholine at muscarinic receptors is: A) Atropine B) Neostigmine C) Pilocarpine D) Bethanechol Answer: A Explanation: Atropine is a competitive muscarinic
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Question 38.The “cardinal movements” of the spine include all EXCEPT: A) Flexion B) Extension C) Lateral flexion D) Rotation E) Axial compression Answer: E Explanation: Axial compression is a load, not a movement; the four cardinal movements are flexion, extension, lateral flexion, and rotation. Question 39.In the context of chiropractic case management, “frequency of care” is typically determined by: A) Patient’s insurance limits B) Severity of symptoms and response to treatment C) Number of available clinic slots D) Practitioner’s personal schedule Answer: B Explanation: Treatment frequency is individualized based on clinical response and symptom acuity. Question 40.The legal doctrine that protects a chiropractor from liability when providing standard care is: A) Res ipsa loquitur B) Informed consent C) Good Samaritan law D) Standard of care doctrine Answer: D Explanation: Adherence to the accepted standard of care shields practitioners from negligence claims. Question 41.Which of the following statements about the sacroiliac joint is true? A) It is a synovial joint with a capsule B) It allows extensive gliding motion C) It is a synarthrosis that transfers load from spine to lower limbs D) It is primarily innervated by the vagus nerve Answer: C Explanation: The SI joint is a syndesmosis (fibro-cartilaginous) joint that transmits forces between the axial skeleton and pelvis. Question 42.The “migratory” pattern of pain that radiates from the lumbar spine to the posterior thigh is most indicative of irritation of which nerve root? A) L2 B) L3 C) L4 D) L5 Answer: D Explanation: L5 radiculopathy commonly produces pain down the lateral thigh to the dorsum of the foot. Question 43.In a patient with suspected disc herniation, the most sensitive clinical test is: A) Kemp’s test B) Straight-leg raise C) Patrick’s FABER test D) McKenzie extension test Answer: B Explanation: The straight-leg raise reproduces radicular pain due to nerve root tension.
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Question 44.The primary role of the ligamentum flavum in the spine is to: A) Prevent anterior translation B) Provide elasticity during flexion C) Limit posterior translation D) Protect the spinal cord from compression Answer: B Explanation: The elastic ligamentum flavum assists in returning the spine to neutral after flexion. Question 45.The most common site of a thoracic vertebral fracture in a high-energy trauma is: A) T1 B) T6 C) T12 D) T8 Answer: C Explanation: The thoracolumbar junction (T12-L1) is a transitional zone susceptible to burst fractures. Question 46.In chiropractic radiography, the “Cobb angle” is used to quantify: A) Scoliosis curvature B) Sagittal lordosis C) Disc height loss D) Vertebral rotation Answer: A Explanation: The Cobb method measures the degree of lateral spinal curvature in scoliosis. Question 47.The term “hypertonicity” in muscle assessment refers to: A) Decreased muscle bulk B) Increased resting muscle tension C) Loss of reflexes D) Muscle atrophy Answer: B Explanation: Hypertonic muscles are overly tight at rest, often contributing to restricted motion. Question 48.The most appropriate initial management for a patient with acute lumbar strain is: A) Cervical manipulation B) Rest, ice, and NSAIDs C) Full-body massage D) Electrical stimulation for 30 minutes Answer: B Explanation: Conservative care with rest, cryotherapy, and NSAIDs reduces inflammation and pain in acute strains. Question 49.The “posterior longitudinal ligament” is located: A) Anterior to the vertebral bodies B) Within the spinal canal posterior to the vertebral bodies C) Lateral to the facet joints D) Between the spinous processes Answer: B Explanation: The PLL runs along the posterior aspect of the vertebral bodies inside the spinal canal.
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Question 56.The “Hawkins-Kennedy” test is used to assess: A) Sacroiliac joint dysfunction B) Rotator cuff impingement C) Lumbar facet irritation D) Cervical radiculopathy Answer: B Explanation: Positive Hawkins-Kennedy reproduces pain with shoulder internal rotation, indicating impingement. Question 57.The most appropriate imaging for a suspected scaphoid fracture when initial X-ray is negative is: A) CT scan B) MRI C) Bone scan D) Ultrasound Answer: B Explanation: MRI has high sensitivity for occult scaphoid fractures and avoids radiation. Question 58.In the endocrine system, the hormone that stimulates erythropoiesis is: A) Thyroxine B) Cortisol C) Erythropoietin D) Aldosterone Answer: C Explanation: Erythropoietin, produced by the kidneys, promotes red blood cell production. Question 59.The primary function of the meniscus in a synovial joint is to: A) Generate joint movement B) Provide vascular supply C) Distribute load and improve congruency D) Produce synovial fluid Answer: C Explanation: Menisci act as shock absorbers, distributing compressive forces across the joint surface. Question 60.The most common side effect of long-term corticosteroid therapy on bone is: A) Osteogenesis B) Osteoporosis C) Osteopetrosis D) Paget disease Answer: B Explanation: Chronic glucocorticoid use reduces bone formation and increases resorption, leading to osteoporosis. Question 61.In chiropractic ethics, “informed consent” requires: A) Verbal explanation only B) Written signature without explanation C) Disclosure of risks, benefits, alternatives, and patient understanding D) No disclosure if the patient is low risk Answer: C Explanation: Ethical practice mandates that patients receive comprehensive information to make autonomous decisions.
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Question 62.The “Murphy’s sign” is used to evaluate pathology of which organ? A) Liver B) Gallbladder C) Appendix D) Kidney Answer: B Explanation: Palpation of the right upper quadrant during inspiration elicits pain if the gallbladder is inflamed. Question 63.The most common cause of a “sciatic notch” tenderness in a patient with low back pain is: A) Piriformis syndrome B) Hamstring strain C) Gluteus maximus trigger point D) Sacroiliac joint dysfunction Answer: A Explanation: Piriformis syndrome compresses the sciatic nerve beneath the greater sciatic notch, causing tenderness. Question 64.In the context of spinal manipulation, a “contact-first” technique emphasizes: A) Applying thrust before positioning B) Establishing contact and positioning prior to the thrust C) Using only instrument-assisted adjustments D) Delivering multiple low-force thrusts Answer: B Explanation: Contact-first ensures proper hand placement and patient safety before the high-velocity thrust. Question 65.The physiological response of the baroreceptor reflex to acute hypertension is to: A) Increase heart rate B) Decrease sympathetic outflow C) Increase renin release D) Stimulate vasoconstriction Answer: B Explanation: Baroreceptors trigger parasympathetic activation and inhibit sympathetic tone, lowering heart rate and vascular resistance. Question 66.The most sensitive laboratory marker for myocardial injury, which may be relevant in differential diagnosis of chest-related back pain, is: A) CK-MB B) Troponin I C) Myoglobin D) LDH Answer: B Explanation: Cardiac troponin I is highly specific and sensitive for myocardial necrosis. Question 67.The typical angle of lumbar lordosis in a healthy adult is approximately: A) 5- 10 ° B) 20- 40 ° C) 45- 60 ° D) 70- 90 ° Answer: B Explanation: Normal lumbar lordosis ranges from 20° to 40° measured by Cobb method.
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Question 74.The term “myofascial trigger point” refers to: A) A bony prominence B) A palpable nodule within a taut band of muscle C) An inflamed joint capsule D) A nerve root compression site Answer: B Explanation: Trigger points are hyperirritable spots in skeletal muscle that produce referred pain. Question 75.The most appropriate method for measuring spinal range of motion in a research setting is: A) Visual estimation B) Goniometer C) Palpation D) Patient self-report Answer: B Explanation: Goniometers provide objective, quantitative angular measurements of spinal mobility. Question 76.The “C1-C2” joint is classified as which type of articulation? A) Plane synovial B) Hinge synovial C) Pivot synovial D) Saddle synovial Answer: C Explanation: The atlanto-axial joint permits rotation via a pivot (trochoid) mechanism. Question 77.The primary function of the posterior longitudinal ligament is to: A) Prevent posterior translation of vertebrae B) Limit flexion C) Limit extension D) Protect the spinal cord from anterior disc herniation Answer: D Explanation: The PLL resists posterior displacement of disc material into the spinal canal. Question 78.The most common cause of “bacterial meningitis” in adults is: A) Neisseria meningitidis B) Streptococcus pneumoniae C) Haemophilus influenzae D) Listeria monocytogenes Answer: B Explanation: Streptococcus pneumoniae is the leading bacterial pathogen in adult meningitis. Question 79.In the context of chiropractic radiographic safety, the principle of “ALARA” stands for: A) As Low As Reasonably Achievable B) Always Limit And Reduce Exposure C) Avoid Light And Radiation Accidents D) Apply Light And Radiation Appropriately Answer: A Explanation: ALARA emphasizes minimizing radiation dose while obtaining diagnostic quality images. Question 80.The most common cause of a “sciatic nerve” injury during a lumbar adjustment is: A) Excessive cervical rotation B) Over-forceful lumbar extension C)
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Improper hand placement causing direct nerve compression D) Use of an instrument that vibrates the nerve Answer: C Explanation: Incorrect hand positioning can compress the nerve root or spinal nerve, leading to irritation. Question 81.The “Thoracic Outlet Syndrome” classification includes neurogenic, venous, and arterial types. The most prevalent is: A) Neurogenic B) Venous C) Arterial D) Mixed Answer: A Explanation: Neurogenic compression of brachial plexus fibers accounts for >90 % of cases. Question 82.The “Bicycle test” assesses which component of spinal function? A) Flexibility B) Endurance C) Core stability D) Balance Answer: C Explanation: The bicycle (or “dead-bug”) test evaluates trunk muscle endurance and coordination. Question 83.In a patient presenting with “red-flag” fever and back pain, the most urgent diagnostic step is: A) Plain radiograph B) MRI of the spine C) CT scan D) Ultrasound Answer: B Explanation: MRI rapidly detects spinal infection, epidural abscess, or vertebral osteomyelitis. Question 84.The most frequent adverse reaction to therapeutic ultrasound is: A) Skin burns B) Muscle hypertrophy C) Decreased circulation D) Nerve hyperexcitability Answer: A Explanation: Excessive intensity or prolonged exposure can cause superficial burns. Question 85.The “sciatic notch” is anatomically located on which bone? A) Ilium B) Sacrum C) Pubis D) Ischium Answer: A Explanation: The greater sciatic notch is a deep indentation on the posterior border of the ilium. Question 86.The “Biceps brachii” is innervated by which spinal nerve roots? A) C5-C6 B) C7-C8 C) T1-T2 D) C3-C4 Answer: A Explanation: The musculocutaneous nerve (C5-C6) supplies the biceps.
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Question 93.In the context of chiropractic case documentation, “SOAP” stands for: A) Subjective, Objective, Assessment, Plan B) Systemic, Orthopedic, Anatomical, Procedural C) Standardized, Objective, Analytic, Practical D) Surgical, Orthopedic, Anatomical, Physical Answer: A Explanation: SOAP notes organize patient records into four sections. Question 94.The most common cause of “thoracic spine” pain in athletes is: A) Vertebral fracture B) Rib fracture C) Muscular strain D) Disc herniation Answer: C Explanation: Repetitive rotational and extension forces often result in paraspinal muscle strain. Question 95.The “lumbar flexion-distraction” technique is primarily used to treat: A) Cervical radiculopathy B) Lumbar disc herniation C) Sacroiliac joint dysfunction D) Thoracic kyphosis Answer: B Explanation: Flexion-distraction decompresses disc material and reduces intradiscal pressure. Question 96.The “biomechanical principle of tension-compression” states that: A) Tension forces increase bone density B) Compression forces cause ligament laxity C) Adjacent structures experience opposite forces during movement D) Muscles generate only compressive forces Answer: C Explanation: When one tissue is placed under tension, neighboring tissue often experiences compression, maintaining joint stability. Question 97.In a patient with “post-ural” pain, the most likely source is: A) Sacroiliac joint B) Lumbosacral junction C) Upper cervical spine D) Thoracolumbar junction Answer: C Explanation: Post-ural pain refers to discomfort at the base of the skull (occiput) often linked to upper cervical dysfunction. Question 98.The “McKenzie method” primarily utilizes: A) High-velocity spinal thrusts B) Repeated directional exercises and sustained positions C) Passive joint mobilization D) Electrical stimulation Answer: B Explanation: The McKenzie approach emphasizes patient-directed repeated movements to centralize pain.
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Question 99.The “Patellar reflex” evaluates integrity of which neural pathway? A) S1-S2 B) L2-L3 C) L4-L5 D) T12-L1 Answer: C Explanation: The patellar reflex involves the L4-L5 spinal segments. Question 100.The “Cervical disc” most prone to herniation is located at: A) C3-C4 B) C4-C5 C) C5-C6 D) C6-C7 Answer: C Explanation: The C5-C6 intervertebral disc experiences the greatest mechanical stress. Question 101.The “Biceps reflex” (C5) is elicited by striking which tendon? A) Patellar B) Achilles C) Biceps brachii D) Triceps brachii Answer: C Explanation: Tapping the biceps tendon tests the C5 reflex arc. Question 102.In a patient with “cervicogenic headache,” the hallmark finding is pain that originates from: A) Occipital nerve B) Upper cervical facet joints C) Temporal artery D) Trigeminal nerve Answer: B Explanation: Cervicogenic headaches arise from irritation of C1-C3 facet joints. Question 103.The most common cause of “lumbar scoliosis” in adults is: A) Congenital vertebral anomaly B) Degenerative changes C) Neuromuscular disease D) Traumatic fracture Answer: B Explanation: Degenerative scoliosis results from asymmetric disc degeneration and facet arthropathy. Question 104.The “Herniation” of a lumbar disc most frequently occurs at which level? A) L1-L2 B) L2-L3 C) L3-L4 D) L4-L5 Answer: D Explanation: The L4-L5 disc endures high shear forces, making it the most common herniation site. Question 105.The “Barrett’s esophagus” is a complication primarily associated with which condition? A) Peptic ulcer disease B) Gastroesophageal reflux disease C) Crohn’s disease D) Celiac disease Answer: B Explanation: Chronic GERD can lead to metaplastic changes known as Barrett’s esophagus.
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Question 113.The “Cervical spine” typically exhibits how many vertebrae? A) 5 B) 6 C) 7 D) 8 Answer: C Explanation: The cervical region consists of seven vertebrae (C1-C7). Question 114.The “Sacral hiatus” is an opening located at the: A) Upper sacrum B) Mid sacrum C) Lower sacrum D) Coccyx Answer: C Explanation: The sacral hiatus is formed by the failure of the laminae of S5 to fuse, creating an opening at the inferior sacrum. Question 115.The “Vagus nerve” (cranial X) provides parasympathetic innervation to all EXCEPT: A) Heart B) Lungs C) Liver D) Skeletal muscle Answer: D Explanation: Parasympathetic fibers do not innervate skeletal muscle; they affect visceral organs. Question 116.The “Cervical facet joints” are oriented primarily in which plane? A) Sagittal B) Coronal C) Oblique D) Horizontal Answer: B Explanation: Cervical facets are oriented in a coronal plane, allowing rotation and limiting flexion/extension. Question 117.The “Stirling” sign is associated with which condition? A) Rotator cuff tear B) Patellofemoral pain C) Sacroiliac dysfunction D) Thoracic outlet syndrome Answer: C Explanation: The Stirling sign (pain on sacral palpation) can indicate SI joint irritation. Question 118.The “Erythrocyte sedimentation rate (ESR)” is most useful in detecting: A) Acute infection B) Chronic inflammation C) Hyperglycemia D) Electrolyte imbalance Answer: B Explanation: ESR rises in chronic inflammatory states such as rheumatoid arthritis. Question 119.The “Cervical disc” provides which type of movement? A) Flexion only B) Extension only C) Rotation and lateral flexion D) No movement, only load
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transmission Answer: C Explanation: Cervical discs allow flexion/extension, rotation, and lateral flexion. Question 120.The “Patellofemoral pain syndrome” is most commonly precipitated by: A) Direct trauma B) Overuse and malalignment C) Infection D) Neuropathy Answer: B Explanation: Repetitive stress and improper tracking of the patella cause anterior knee pain. Question 121.In the “Gonstead” system, the “neutral zone” is identified by: A) Palpation of muscle spasm B) Listening for joint sounds C) Finding the point of minimal resistance during movement D) Measuring skin temperature Answer: C Explanation: The neutral zone is the intersegmental range where resistance is lowest, detected by passive motion. Question 122.The “Kundalini” concept is NOT part of chiropractic philosophy. Which of the following is? A) Vitalism B) Holism C) Energetics D) Homeopathy Answer: D Explanation: Homeopathy is an alternative medical system, not a core chiropractic tenet. Question 123.The “Thoracic outlet syndrome” may present with edema of the hand due to obstruction of which vessel? A) Subclavian artery B) Subclavian vein C) Axillary artery D) Brachial vein Answer: B Explanation: Venous thoracic outlet syndrome causes upper extremity swelling from subclavian vein compression. Question 124.The “Cervical spine” supports the weight of the head, approximately: A) 2 kg B) 5 kg C) 10 kg D) 15 kg Answer: C Explanation: The average adult head weighs about 10–12 kg, requiring cervical support. Question 125.The “Biceps femoris” is part of which muscle group? A) Quadriceps B) Hamstrings C) Adductors D) Calf muscles Answer: B Explanation: Biceps femoris belongs to the posterior thigh hamstring group.
