I85PREP
⌘ K
NBCE SPEC study materials
NBCE SPEC study resources

NBCE SPEC practice questions

One question at a time. Build your NBCE SPEC understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Chiropractic clinical sciences and diagnosis

A patient reports sharp low back pain that worsens with coughing and sneezing and radiates down the posterior thigh. Which clinical finding most directly supports a diagnosis of lumbar disc herniation with nerve root irritation?

  1. Pain relieved by Valsalva maneuvers
  2. Positive straight leg raise on the affected side Correct answer.
  3. Bilateral symmetric patellar reflexes
  4. Isolated tenderness over the spinous processes

Explanation

A positive straight leg raise reproduces tension on the lumbosacral nerve roots and is a classic sign of disc herniation with root irritation. Radicular pain aggravated by coughing or sneezing reflects increased intrathecal pressure acting on a sensitized root, which supports the same diagnosis.

Question 2Chiropractic clinical sciences and diagnosis

Which spinal nerve root level is most commonly tested by the Achilles tendon reflex?

  1. S1 Correct answer.
  2. L4
  3. L5
  4. L3

Explanation

The Achilles reflex is mediated primarily by the S1 nerve root, so an absent or diminished reflex suggests S1 involvement. L4 is tested by the patellar reflex and L5 has no reliable single reflex, making S1 the correct association.

Question 3Chiropractic clinical sciences and diagnosis

A patient's leg pain is reproduced by hip extension combined with knee flexion while prone. This finding is most consistent with which structure as the pain source?

  1. Femoral nerve root compression Correct answer.
  2. Sacroiliac joint dysfunction
  3. Piriformis muscle syndrome
  4. Lumbar facet joint capsulitis

Explanation

The femoral nerve stretch test places tension on the femoral nerve and upper lumbar roots (L2-L4), so reproduction of anterior thigh pain indicates femoral nerve or upper lumbar root involvement. Hip extension with knee flexion is the standard maneuver for this test.

Question 4Chiropractic clinical sciences and diagnosis

A 45-year-old presents with a sudden severe headache, neck stiffness, and photophobia. Which finding on examination most raises concern for subarachnoid hemorrhage and warrants urgent referral?

  1. Restricted cervical rotation with muscle spasm
  2. Unilateral tender cervical paraspinal trigger points
  3. Pain reproduced by cervical compression
  4. Nuchal rigidity with a positive Kernig sign Correct answer.

Explanation

Meningeal signs such as nuchal rigidity and a positive Kernig or Brudzinski sign in the setting of thunderclap headache suggest meningeal irritation from subarachnoid hemorrhage or infection. These findings require emergency evaluation rather than manipulative care.

Question 5Chiropractic clinical sciences and diagnosis

In a patient with acute lumbar disc herniation, which presentation pattern most strongly suggests a large central or cauda equina lesion requiring emergency referral?

  1. Morning stiffness relieved by movement
  2. Saddle anesthesia with urinary retention Correct answer.
  3. Unilateral radicular pain in a single dermatome
  4. Pain limited to the paraspinal muscles

Explanation

Saddle anesthesia combined with bladder or bowel dysfunction indicates cauda equina compression and is a surgical emergency. Prompt imaging and referral are required to prevent permanent neurologic deficit.

Question 6Chiropractic clinical sciences and diagnosis

A patient with chronic neck pain has paresthesia in the thumb and index finger with weakness of elbow flexion. Which nerve root is most likely affected?

  1. C7
  2. C6 Correct answer.
  3. C5
  4. C8

Explanation

The C6 root supplies sensation to the thumb and index finger and contributes to elbow flexion through the biceps and brachialis. This combination of sensory and motor findings localizes the lesion to C6.

Question 7Chiropractic clinical sciences and diagnosis

Which dermatome corresponds to the level of the umbilicus?

  1. T12
  2. T10 Correct answer.
  3. T8
  4. T6

Explanation

The T10 dermatome encircles the umbilicus and serves as a standard landmark for sensory examination. This landmark helps localize thoracic spinal cord and root levels.

Question 8Chiropractic clinical sciences and diagnosis

A patient reports lateral elbow pain worsened by resisted wrist extension. Which condition is most likely?

  1. Medial epicondylitis
  2. Lateral epicondylitis Correct answer.
  3. De Quervain tenosynovitis
  4. Cubital tunnel syndrome

Explanation

Lateral epicondylitis involves the common extensor origin at the lateral epicondyle, and pain is reproduced by resisted wrist extension. Medial epicondylitis affects the flexor origin and is provoked by resisted wrist flexion.

Question 9Chiropractic clinical sciences and diagnosis

A patient with suspected adhesive capsulitis of the shoulder is examined. Which finding best supports this diagnosis?

  1. Crepitus over the acromioclavicular joint
  2. Pain reproduced by resisted elbow flexion
  3. Global loss of both active and passive glenohumeral motion Correct answer.
  4. Marked weakness of shoulder abduction with normal passive range

Explanation

Adhesive capsulitis produces a capsular pattern of restriction, most notably loss of external rotation, with both active and passive motion limited. The loss of passive motion distinguishes it from rotator cuff pathology, where passive motion is often preserved.

Question 10Chiropractic clinical sciences and diagnosis

Which clinical finding is most characteristic of a positive Phalen test?

  1. Weakness of the little finger on resisted abduction
  2. Pain reproduced by resisted wrist extension
  3. Paresthesia along the ulnar border of the hand after tapping the elbow
  4. Paresthesia in the median nerve distribution after sustained wrist flexion Correct answer.

Explanation

The Phalen test holds the wrist in maximal flexion for about a minute, increasing carpal tunnel pressure and reproducing median nerve paresthesia in the thumb, index, and middle fingers. It is a provocative test for carpal tunnel syndrome.

Question 11Chiropractic clinical sciences and diagnosis

A 30-year-old has a painful, red, swollen first metatarsophalangeal joint with a normal joint radiograph and elevated serum uric acid. Which diagnosis is most likely?

  1. Hallux rigidus
  2. Septic arthritis
  3. Rheumatoid arthritis
  4. Gout Correct answer.

Explanation

Acute monoarthritis of the first metatarsophalangeal joint with hyperuricemia is the classic presentation of gout (podagra). The joint is typically exquisitely tender and erythematous, and definitive diagnosis requires joint aspiration with negatively birefringent crystals.

Question 12Chiropractic clinical sciences and diagnosis

Which of the following is the most appropriate initial imaging study for a patient with suspected acute lumbar disc herniation and a new neurologic deficit?

  1. Bone scan
  2. Computed tomography without contrast
  3. Lumbar spine radiographs
  4. Magnetic resonance imaging Correct answer.

Explanation

MRI is the modality of choice for evaluating suspected disc herniation with neurologic deficit because it visualizes soft tissue, discs, and nerve roots. Plain radiographs and bone scans cannot assess disc herniation or root compression.

Question 13Chiropractic clinical sciences and diagnosis

A patient presents with unilateral facial droop, inability to close the eye, and loss of taste on the anterior tongue. Which diagnosis is most likely?

  1. Acoustic neuroma
  2. Bell palsy Correct answer.
  3. Trigeminal neuralgia
  4. Cerebrovascular accident affecting the lower face only

Explanation

Bell palsy is a peripheral facial nerve palsy affecting both upper and lower face, with associated loss of taste, hyperacusis, and impaired eye closure. Central lesions spare the upper face because of bilateral cortical innervation.

Question 14Chiropractic clinical sciences and diagnosis

Which of the following best describes the purpose of the Romberg test?

  1. Test cortical sensation of two-point discrimination
  2. Assess cerebellar coordination during rapid alternating movements
  3. Evaluate proprioceptive contribution to standing balance Correct answer.
  4. Measure lower extremity strength against resistance

Explanation

The Romberg test compares standing balance with eyes open and closed; marked worsening with eyes closed indicates impaired proprioception from dorsal column dysfunction. It assesses sensory contribution to balance rather than cerebellar coordination or strength.

Question 15Chiropractic clinical sciences and diagnosis

A patient with a suspected ankle sprain has tenderness over the anterior talofibular ligament. Which mechanism of injury is most consistent with this finding?

  1. Dorsiflexion with axial loading
  2. Forced eversion with external rotation
  3. Inversion with plantar flexion Correct answer.
  4. Direct blow to the medial malleolus

Explanation

The anterior talofibular ligament is the most commonly injured lateral ankle ligament, typically injured by inversion and plantar flexion. Eversion injuries stress the deltoid ligament on the medial side.

Question 16Chiropractic clinical sciences and diagnosis

Which of the following findings is most consistent with a diagnosis of fibromyalgia?

  1. Unilateral radicular pain with positive straight leg raise
  2. Progressive muscle weakness with elevated creatine kinase
  3. Elevated erythrocyte sedimentation rate with symmetric joint swelling
  4. Widespread pain with multiple tender points and normal inflammatory markers Correct answer.

Explanation

Fibromyalgia is characterized by chronic widespread pain, tenderness, fatigue, and normal inflammatory and muscle enzyme studies. Elevated inflammatory markers or objective weakness suggest an inflammatory or myopathic disorder instead.

Question 17Chiropractic clinical sciences and diagnosis

A patient reports a throbbing unilateral headache with nausea and photophobia that worsens with physical activity. Which diagnosis is most likely?

  1. Cervicogenic headache
  2. Migraine without aura Correct answer.
  3. Tension-type headache
  4. Cluster headache

Explanation

Migraine is characterized by unilateral throbbing pain, nausea, photophobia, and aggravation by routine physical activity. Tension headaches are typically bilateral and non-pulsating, while cluster headaches involve severe periorbital pain with autonomic features.

Question 18Chiropractic clinical sciences and diagnosis

Which of the following is the most reliable clinical indicator of a hip fracture in an elderly patient who fell?

  1. Lateral hip tenderness with normal gait
  2. Crepitus on active hip flexion
  3. Pain on passive hip rotation with inability to bear weight Correct answer.
  4. Groin pain relieved by rest

Explanation

Inability to bear weight combined with pain on passive rotation after a fall is highly suggestive of hip fracture in elderly patients and warrants imaging. Plain radiographs may be normal in occult fractures, so MRI or CT is used when suspicion remains high.

Question 19Chiropractic clinical sciences and diagnosis

Which of the following best describes the neurologic level of a lesion causing a positive Babinski sign on the right side?

  1. Lower motor neuron lesion at the right L5 root
  2. Upper motor neuron lesion affecting the right corticospinal tract Correct answer.
  3. Neuromuscular junction disorder
  4. Peripheral neuropathy of the right peroneal nerve

Explanation

A Babinski sign reflects loss of corticospinal inhibition, indicating an upper motor neuron lesion. Lower motor neuron and peripheral nerve lesions cause weakness and atrophy without an extensor plantar response.

Question 20Chiropractic clinical sciences and diagnosis

A patient has pain over the lateral aspect of the hip that is reproduced by resisted hip abduction. Which structure is most likely involved?

  1. Adductor longus tendon
  2. Gluteus medius tendon Correct answer.
  3. Sacrotuberous ligament
  4. Iliopsoas bursa

Explanation

Greater trochanteric pain syndrome commonly involves the gluteus medius or minimus tendons, and resisted abduction reproduces lateral hip pain. The iliopsoas bursa and adductor tendons produce anterior or medial pain, respectively.

Question 21Chiropractic clinical sciences and diagnosis

Which of the following findings on a thoracic examination most suggests a mechanical rather than visceral cause of chest pain?

  1. Pain described as pressure radiating to the jaw
  2. Pain reproduced by thoracic rotation and palpation Correct answer.
  3. Pain associated with diaphoresis and dyspnea
  4. Pain that is worse with exertion and relieved by rest

Explanation

Chest pain reproduced by thoracic movement and palpation suggests a musculoskeletal source. Exertional pressure radiating to the jaw with diaphoresis suggests cardiac ischemia and requires urgent evaluation.

Question 22Chiropractic clinical sciences and diagnosis

A patient with a recent upper respiratory infection develops acute severe low back pain with inability to bear weight and a low-grade fever. Which diagnosis should be considered?

  1. Vertebral osteomyelitis or discitis Correct answer.
  2. Ankylosing spondylitis
  3. Lumbar muscle strain
  4. Mechanical low back pain

Explanation

Fever with severe back pain and inability to bear weight after a systemic infection raises concern for spinal infection such as osteomyelitis or discitis. Inflammatory markers and imaging are needed, and manipulation should be deferred pending evaluation.

Question 23Chiropractic clinical sciences and diagnosis

Which of the following is the most appropriate initial management for a patient with suspected acute cauda equina syndrome?

  1. Begin a trial of spinal manipulation and reassess in one week
  2. Immediate emergency referral for imaging and surgical evaluation Correct answer.
  3. Prescribe oral corticosteroids and discharge home
  4. Apply lumbar traction in the office

Explanation

Cauda equina syndrome is a surgical emergency because delayed decompression can cause permanent bladder, bowel, and sensory deficits. Immediate referral for MRI and neurosurgical evaluation is required, and manipulative treatment is contraindicated.

Question 24Chiropractic clinical sciences and diagnosis

A patient with chronic inflammatory back pain has reduced chest expansion, sacroiliac tenderness, and morning stiffness improving with exercise. Which condition is most likely?

  1. Osteoporotic compression fracture
  2. Ankylosing spondylitis Correct answer.
  3. Lumbar disc herniation
  4. Facet joint osteoarthritis

Explanation

Ankylosing spondylitis presents with inflammatory back pain, reduced chest expansion, sacroiliac involvement, and stiffness that improves with activity. Disc herniation and osteoarthritis produce mechanical pain patterns without these inflammatory features.

Question 25Chiropractic clinical sciences and diagnosis

Which of the following is the most appropriate next step when a patient presents with a new focal neurologic deficit and suspected cervical myelopathy?

  1. Reassure and schedule routine follow-up
  2. Perform high-velocity cervical manipulation
  3. Prescribe a soft collar and reassess in six weeks
  4. Refer for urgent imaging and neurologic evaluation Correct answer.

Explanation

Cervical myelopathy with a focal deficit requires urgent imaging, typically MRI, and neurologic evaluation to identify cord compression. High-velocity manipulation is contraindicated in the setting of myelopathy because of the risk of worsening cord injury.

Question 26Chiropractic clinical sciences and diagnosis

A 45-year-old man reports burning pain in the lateral thigh that is reproduced by sustained hip extension and relieved by sitting. Which nerve root is most likely involved?

  1. L5
  2. L2 Correct answer.
  3. L4
  4. S1

Explanation

The lateral cutaneous nerve of the thigh (L2-L3) supplies the lateral thigh, and its entrapment (meralgia paresthetica) is classically provoked by hip extension and relieved by hip flexion. Femoral nerve root lesions at L2 also refer pain to the anterior and lateral thigh. The pattern of burning dysesthesia without motor loss fits this sensory territory.

Question 27Chiropractic clinical sciences and diagnosis

Which finding best distinguishes a true leg-length inequality from a functional (apparent) discrepancy during a standing examination?

  1. Asymmetric foot progression angles during gait
  2. Presence of a sacral base unleveling that persists in the seated position
  3. A positive Trendelenburg sign on the short-leg side
  4. Asymmetric iliac crest heights that correct when the patient sits Correct answer.

Explanation

A functional discrepancy arises from pelvic torsion or soft-tissue adaptation and typically resolves when weight bearing is removed, as in the seated position. A true anatomic discrepancy persists regardless of position. Comparing iliac crest heights standing versus seated is the classic bedside discriminator.

Question 28Chiropractic clinical sciences and diagnosis

A patient's blood pressure reads 148/94 mmHg in the right arm and 132/86 mmHg in the left arm on repeated measurement. Which interpretation is most appropriate?

  1. A normal variant requiring no further evaluation
  2. Evidence of isolated systolic hypertension
  3. An error that should be corrected by using only the left arm
  4. A significant interarm difference warranting evaluation for vascular or structural causes Correct answer.

Explanation

A consistent systolic difference of more than 10 to 15 mmHg between arms is abnormal and raises concern for subclavian stenosis, aortic dissection, or thoracic outlet pathology. It should prompt vascular evaluation rather than dismissal. Repeat measurement and correlation with pulses and symptoms are appropriate next steps.

Question 29Chiropractic clinical sciences and diagnosis

A 58-year-old woman has a painful, swollen knee with warmth and marked restriction of flexion. Which historical feature most increases the probability of a septic joint rather than a crystal arthropathy?

  1. Presence of subcutaneous nodules on the olecranon
  2. Recent intra-articular corticosteroid injection into the same knee Correct answer.
  3. Bilateral symmetric involvement of the knees
  4. Sudden onset reaching peak intensity within 12 hours

Explanation

Recent intra-articular injection, prosthetic joint, immunosuppression, and skin infection are recognized risk factors for septic arthritis. Crystal disease more often peaks extremely rapidly and can affect multiple joints. Risk-factor history shifts pretest probability toward infection and supports arthrocentesis.

Question 30Chiropractic clinical sciences and diagnosis

Which physical examination maneuver is designed to detect subtle leg-length difference by assessing the relative position of the medial malleoli with the patient supine?

  1. Allis sign Correct answer.
  2. Thomas test
  3. Ober test
  4. Faber test

Explanation

The Allis sign compares the heights of the medial malleoli with the hips and knees flexed and the feet together, revealing relative shortening. It is a quick screen for unilateral leg-length inequality. The other maneuvers assess soft-tissue tightness or sacroiliac dysfunction.

Question 31Chiropractic clinical sciences and diagnosis

A patient reports a deep, aching pain in the mid-thoracic region that is unrelated to movement, awakens them at night, and is accompanied by unexplained weight loss. Which feature most strongly suggests a non-mechanical cause?

  1. Pain relieved by lying prone
  2. Pain reproduced by thoracic rotation
  3. Pain that follows a dermatomal band
  4. Nocturnal pain with constitutional symptoms Correct answer.

Explanation

Nocturnal pain unrelieved by positional change plus weight loss, fever, or night sweats are red flags for infection or malignancy. Mechanical thoracic pain is typically posture- and movement-dependent. Constitutional symptoms should prompt further workup rather than manipulative care alone.

Question 32Chiropractic clinical sciences and diagnosis

During cranial nerve testing, a patient cannot shrug the shoulders against resistance and reports weakness turning the head to the left. Which nerve is most likely affected?

  1. Facial nerve
  2. Spinal accessory nerve Correct answer.
  3. Hypoglossal nerve
  4. Glossopharyngeal nerve

Explanation

The spinal accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid. Weakness in shoulder shrug and head rotation against resistance localizes to CN XI or its peripheral course. This pattern is distinct from lower cranial nerve or facial deficits.

Question 33Chiropractic clinical sciences and diagnosis

A patient with suspected carpal tunnel syndrome has equivocal findings on Phalen and Tinel testing. Which additional bedside test most improves diagnostic confidence?

  1. Carpal compression test Correct answer.
  2. Adson test
  3. Finkelstein test
  4. Cozen test

Explanation

The carpal compression test applies direct pressure over the carpal tunnel and has good sensitivity and specificity for median nerve compression. Combining it with Phalen and Tinel improves overall accuracy. The other tests evaluate different structures entirely.

Question 34Chiropractic clinical sciences and diagnosis

A patient presents with a pulsatile abdominal mass and new-onset back pain. Which action is most appropriate?

  1. Reassure the patient and schedule follow-up in two weeks
  2. Begin spinal manipulation after a careful segmental examination
  3. Arrange urgent imaging and referral for suspected abdominal aortic aneurysm Correct answer.
  4. Apply interferential electrical stimulation to the lumbar region

Explanation

A pulsatile abdominal mass with new back pain is a red flag for abdominal aortic aneurysm, which can be life-threatening if it ruptures. Urgent imaging and immediate referral are required before any manual therapy. Manipulation or electrical stimulation would delay definitive care.

Question 35Chiropractic clinical sciences and diagnosis

A 34-year-old woman has fatigue, cold intolerance, weight gain, and a delayed relaxation phase of the deep tendon reflexes. Which laboratory finding is most consistent with this presentation?

  1. Normal TSH with elevated free T3
  2. Low TSH with elevated free T4
  3. Elevated TSH with low free T4 Correct answer.
  4. Elevated free T4 with suppressed TSH

Explanation

Primary hypothyroidism produces low thyroid hormone levels with a compensatory rise in TSH. Delayed reflex relaxation (Woltman sign) is a classic finding. The symptom cluster of cold intolerance and weight gain also supports hypothyroidism.

Question 36Chiropractic clinical sciences and diagnosis

Which finding on a dermatologic examination most suggests a malignant rather than benign pigmented lesion?

  1. Multiple lesions distributed symmetrically on sun-exposed skin
  2. A lesion that blanches with pressure
  3. A lesion that has changed in color and border over three months Correct answer.
  4. Symmetric shape with uniform brown pigmentation

Explanation

Evolution in color, size, or border is a key warning sign in the ABCDE criteria for melanoma. Symmetry and uniform color favor a benign nevus. Change over time warrants biopsy or dermatologic referral.

Question 37Chiropractic clinical sciences and diagnosis

A patient describes a sudden, severe headache that reached maximum intensity within seconds while at rest. Which diagnosis must be excluded first?

  1. Medication-overuse headache
  2. Subarachnoid hemorrhage Correct answer.
  3. Cervicogenic headache
  4. Tension-type headache

Explanation

A thunderclap headache reaching peak intensity within seconds is a red flag for subarachnoid hemorrhage. Urgent imaging and, if indicated, lumbar puncture are required. The other headache types have gradual onset or positional triggers.

Question 38Chiropractic clinical sciences and diagnosis

A patient with low back pain has pain reproduced by ipsilateral hip extension while prone and relieved by hip flexion. Which structure is most likely irritated?

  1. Sacroiliac joint
  2. Lumbar facet joint
  3. Femoral nerve root Correct answer.
  4. Piriformis muscle

Explanation

Femoral nerve traction is provoked by hip extension and relieved by flexion, consistent with an upper lumbar root or femoral nerve lesion. This pattern is sometimes termed a positive femoral nerve stretch. Facet and sacroiliac pain do not typically follow this extension-flexion pattern.

Question 39Chiropractic clinical sciences and diagnosis

A patient has a positive drop-arm test and painful arc between 60 and 120 degrees of abduction. Which structure is most likely involved?

  1. Acromioclavicular joint
  2. Long head of biceps tendon
  3. Subscapularis tendon
  4. Supraspinatus tendon Correct answer.

Explanation

A painful mid-range arc with a positive drop-arm sign reflects supraspinatus pathology in the rotator cuff. The supraspinatus initiates abduction and is compressed under the acromion in this range. Other structures produce different provocative patterns.

Question 40Chiropractic clinical sciences and diagnosis

Which finding on a sensory examination indicates a peripheral nerve lesion rather than a nerve root lesion?

  1. Sensory loss in a cape distribution
  2. Sensory loss following the distribution of a named peripheral nerve Correct answer.
  3. Sensory loss in a stocking distribution
  4. Sensory loss confined to a single dermatome

Explanation

Peripheral nerve lesions follow the anatomic territory of that nerve, which often crosses dermatomal boundaries. Root lesions follow a single dermatome, and polyneuropathy follows a length-dependent stocking-glove pattern. Cape distribution suggests a central cord lesion.

Question 41Chiropractic clinical sciences and diagnosis

A patient reports pain over the greater trochanter that worsens when lying on the affected side and is reproduced by resisted hip abduction. Which diagnosis is most likely?

  1. Femoral neck stress fracture
  2. Obturator hernia
  3. Gluteus medius tendinopathy Correct answer.
  4. Hip osteoarthritis

Explanation

Lateral hip pain with tenderness over the greater trochanter and pain on resisted abduction indicates gluteus medius tendinopathy or trochanteric pain syndrome. Night pain when lying on the side is classic. Osteoarthritis produces groin pain and restricted rotation.

Question 42Chiropractic clinical sciences and diagnosis

A patient with acute low back pain has a positive straight leg raise at 30 degrees on the left with reproduction of pain below the knee. What does this finding most suggest?

  1. Sacroiliac joint dysfunction
  2. Lumbar spinal stenosis
  3. L5 or S1 nerve root irritation Correct answer.
  4. Hip joint capsulitis

Explanation

A straight leg raise that reproduces radicular pain below the knee at a low angle suggests lower lumbar nerve root irritation, most often L5 or S1. Pain confined to the back or buttock is less specific. The test is a neurodynamic provocation, not a measure of hip flexibility.

Question 43Chiropractic clinical sciences and diagnosis

A patient has a resting tremor that is asymmetric, improves with voluntary movement, and is accompanied by cogwheel rigidity. Which diagnosis is most likely?

  1. Physiologic tremor
  2. Parkinson disease Correct answer.
  3. Essential tremor
  4. Cerebellar tremor

Explanation

Asymmetric resting tremor with rigidity and bradykinesia is the classic triad of Parkinson disease. Essential tremor is typically postural and action-related and often bilateral. Cerebellar tremor is intention-related and worsens with goal-directed movement.

Question 44Chiropractic clinical sciences and diagnosis

A patient with a history of atrial fibrillation develops sudden left-sided weakness and neglect. Which finding best localizes the lesion to the right cerebral hemisphere?

  1. Right homonymous hemianopia alone
  2. Bilateral lower extremity weakness
  3. Aphasia with right arm weakness
  4. Left hemiparesis with left hemineglect Correct answer.

Explanation

Left hemiparesis with left hemineglect localizes to the right (non-dominant) hemisphere, commonly the parietal lobe or middle cerebral artery territory. Neglect is a cortical sign that helps distinguish hemispheric from brainstem lesions. Aphasia and bilateral leg weakness suggest other localizations.

Question 45Chiropractic clinical sciences and diagnosis

Which finding on a chest examination most suggests a pneumothorax on the affected side?

  1. Hyperresonance to percussion with decreased breath sounds Correct answer.
  2. Increased tactile fremitus and dullness to percussion
  3. Crackles at the lung bases with egophony
  4. Wheezing throughout both lung fields

Explanation

A pneumothorax produces hyperresonance and diminished or absent breath sounds on the affected side because air separates the lung from the chest wall. Tactile fremitus is reduced. Dullness and increased fremitus indicate consolidation or effusion instead.

Question 46Chiropractic clinical sciences and diagnosis

A patient with a suspected rotator cuff tear has weakness of external rotation and a positive external rotation lag sign. Which tendon is most likely involved?

  1. Subscapularis
  2. Teres major
  3. Infraspinatus Correct answer.
  4. Supraspinatus

Explanation

The infraspinatus is the primary external rotator of the shoulder, and a lag sign indicates a tendon tear. Weakness in external rotation localizes to the infraspinatus or its nerve supply. Supraspinatus and subscapularis have different functions.

Question 47Chiropractic clinical sciences and diagnosis

A patient's MRI report notes a disc extrusion at L4-L5 with inferior migration. Which clinical finding would best correlate with this lesion?

  1. Weakness of great toe dorsiflexion Correct answer.
  2. Weakness of hip adduction
  3. Positive femoral nerve stretch test
  4. Diminished patellar reflex

Explanation

An L4-L5 disc herniation most often compresses the traversing L5 root, producing weakness of great toe extension (extensor hallucis longus). The L5 root also supplies sensation to the dorsum of the foot. Other findings correspond to different levels.

Question 48Chiropractic clinical sciences and diagnosis

Which of the following best describes the purpose of the Spurling test?

  1. To evaluate vertebral artery patency during neck rotation
  2. To provoke cervical nerve root compression by extension and rotation Correct answer.
  3. To assess for sacroiliac joint inflammation
  4. To detect ligamentous instability of the ankle

Explanation

The Spurling test combines cervical extension, lateral flexion, and axial compression to narrow the intervertebral foramen and reproduce radicular symptoms. It is a provocative test for cervical radiculopathy. Vertebral artery assessment and ankle stability use different maneuvers.

Question 49Chiropractic clinical sciences and diagnosis

A patient presents with a painful, swollen calf after prolonged immobilization. Which finding most increases concern for deep vein thrombosis?

  1. Visible varicose veins without swelling
  2. Unilateral calf swelling with tenderness along the deep venous system Correct answer.
  3. Bilateral symmetric calf swelling after exercise
  4. Calf pain relieved by elevation alone

Explanation

Unilateral swelling with tenderness along the deep veins in a patient with immobilization risk factors is classic for deep vein thrombosis. Calf circumference difference and Homans sign may support but are not definitive. Bilateral or exercise-related swelling suggests other causes.

Question 50Chiropractic clinical sciences and diagnosis

A patient has a positive Romberg test with preserved strength and sensation. Which structure is most likely affected?

  1. Corticospinal tracts
  2. Cerebellar hemisphere
  3. Peripheral motor neurons
  4. Dorsal columns of the spinal cord Correct answer.

Explanation

A positive Romberg test indicates loss of proprioceptive input from the dorsal columns, which is compensated by vision. When the eyes close, balance is lost. Cerebellar lesions impair balance with eyes open and do not produce a true Romberg sign.