OK

Question 1

1. What term best describes a change in length of a ligament or joint capsule when a continuous or
   sustained force is applied to it?
2. Strain
3. Viscosity
4. Stress
5. Creep

Answer 1

4. Creep

Question 2

2. Dr. Nate Intell reports to his parent that “irritation of the nerves from subluxations (joint
   dysfunction) in your lower spine may be the cause of your menstrual pain” which reflex is he
   referring to?
3. Utero spinal
4. Psyche somatic
5. Viscero-somatic
6. Somatico-visceral

Answer 2

4. Somatico-visceral

Question 3

3. In lab we said that creating relative extension preload (with 3-finger palpation) prior to adjusting
   the downwards sacroiliac joint, when our patient is lying with right side down, is most like what
   assessment procedure?
4. Seated motion scan for pelvis
5. Prone endfeel for external rotation
6. Asking the patient to raise the left knee while palpating her right SI in standing
   Gillet’s test
7. Prone endfeel for L/S extension (springing sacrum into nutation)

Answer 3

3. Asking the patient to raise the left knee while palpating her right SI in standing
   Gillet’s test

Question 4

4. Which of the following listing may be adjusted with an L2 contact, pisiform spinous push, patient
   right side up?
5. L2/L3 left rotation restriction/ Left lateral flexion restriction
6. L2 Right rotation malposition/ Right lateral flexion malposition
7. L2 PLI
8. L2/L3 Right rotation restriction/ Right lateral flexion restriction

Answer 4

4. L2/L3 Right rotation restriction/ Right lateral flexion restriction

Question 5

5. If you could give only one brief piece of advice to your habitually slumping patient with back
   and neck pain, what would it be?
6. Sit and stand tall
7. Do crunches
8. Get weekly adjustments for a year
9. Join a gym

Answer 5

4. Join a gym

Question 6

6. Your a 41 year old patient, Andrea has been practicing architect for 16 years. She just finished a
   big project and has logged many hours of computer time over the past 6 weeks. She admits her
   chair needs replacing. She presents to you with a thoracolumbar region stiffness and achiness,
   worsened by sitting and relieved with yoga. She has been to a chiropractor before with a similar
   complaint and did well with spinal manipulation, but has neglected the active care that her doctor
   prescribed. Andrea rates her pain 4/10 at its worst, it does not radiate, and coughing or sneezing
   does not increase the pain. Her thoracolumbar range of motion is mildly limited with a general
   feeling of stiffness. You palpate mild to moderate thoracolumbar paraspinal muscle hypertonicity.
   What is the most sensible beginning diagnostic impression?
7. Thoracolumbar joint dysfunction
8. Internal disc disruption with annular tear
9. Thoracolumbar joint dysfunction
10. Thoracolumbar facet tropism with meniscoid entrapment

Answer 6

4. Thoracolumbar facet tropism with meniscoid entrapment

Question 7

7. Eccentric contraction of the left QL muscle would control what trunk motion form the upright
   position?
8. Flexion
9. Contralateral extension and left rotation
10. Right lateral flexion
11. Negative rotation around the Z-axis

Answer 7

3. Right lateral flexion

Question 8

8. Which of the following terms would best help to quantify a diagnostic finding?
9. Texture
10. Color
11. Shape
12. Size

Answer 8

4. Size

Question 9

9. Subjective complaints can be measured, in that number can be assigned by utilizing?
10. Visual analog scale
11. Verbal analog Scale
12. Oswestry Low Back Disability scale
13. All the above
14. None of the above, only objective findings can be measured

Answer 9

4. All the above

Question 10

10. In the Gait cycle, Heel strike and Toe off are both in the category of:
11. Double support
12. Single support
13. Swing phase
14. Open kinetic chain

Answer 10

1. Double support

Question 11

11. When performing a side-lying hypothenar/sacral base push for a lumbosacral extension, why do
    we roll the patient forward as a unit?
12. To ensure sufficient extension preload in the downside SI joint
13. To apply a safe and ergonomically sound P to A thrust to the sacral base
14. To maintain lumbosacral y-axis pre-adjustive tension
15. So as not to create too much flexion of the L/S joint

Answer 11

1. To ensure sufficient extension preload in the downside SI joint

Question 12

12. During gait, a hyperpronated foot/ankle will cause internal rotation of the tibia and femur. This
    occurs due to the presence of?
13. An open kinetic chain
14. A closed kinetic chain in the single support phase
15. A tight piriformis muscle
16. The upper crossed syndrome

Answer 12

2. A closed kinetic chain in the single support phase

Question 13

13. You have decided to alter your spinal manipulation technique to better accommodate the
    anatomical limitations of your 81-year-old female patient. Which of the following conditions would
    most likely have influenced this decision?
14. Schmorl’s disease
15. Osteoporosis
16. Endplate fracture
17. Lower crossed syndrome

Answer 13

2. Osteoporosis

Question 14

14. If a patient complains of multiple symptoms of arthritis but her x-rays show few degenerative
    changes, she is almost certainly malingering (pretending symptoms for secondary gain, such as
    falsified disability)
15. True
16. False

Answer 14

2. False

Question 15

15. What is the patient positioning for Hypothenar (pisiform) spinous push to create left rotation/left
    lateral flexion in combination at L2/L3
16. Prone
17. Right side-lying position (left side up)
18. Left side-lying position (right side up)
19. Side-lying either side up with hip above 90 degrees

Answer 15

2. Right side-lying position (left side up)

Question 16

16. The Gonstead spinous listing L2 PLS could be corrected with which of these adjustive
    procedures?
17. Side-lying calcaneal/sacral apex push
18. Side-lying digit/spinous pull with a calcaneal assist, vector right to left
19. Side-lying hypothenar/ mamillary push with left side up
20. Side-lying hypothenar/spinous push for same side rotation/lateral flexion combination

Answer 16

4. Side-lying hypothenar/spinous push for same side rotation/lateral flexion combination

Question 17

17. What statement best defines Sherrington’s Law of reciprocal inhibition (Law of reciprocal
    innervation) ?
18. Tension in the primary movers recruits tone in the synergists
19. Increased hypertonicity of the stabilizers causes further weakness (inhibition) in the agonist
20. Low myofibril density inhibits muscle fiber firing
21. Increased hypertonicity of the agonist causes further weakness (inhibition) in the
    antagonist

Answer 17

4. Increased hypertonicity of the agonist causes further weakness (inhibition) in the
   antagonist

Question 18

18. Which of these patients exhibits the least fear avoidance behavior?
19. Ben: “ I need you to do your magic and get rid of my pain, you’re the expert not me”
20. Courtney: “I need advice on things I can do for myself to get through this”
21. Valerie: “ Every time I try exercise it hurts, none of these please”
22. Sam: “My hip clicked a little last night. Do you think it went out and I’ll be back on
    crutches”

Answer 18

2. Courtney: “I need advice on things I can do for myself to get through this”

Question 19

19. While walking his bloodhound. Elmer extends backward at the waist to observe a UFO passing
    directly overhead. This trunk extension motion was initiated with:
20. Eccentric contraction of his cluteais maximus
21. Isometric contraction of Iliopsoas
22. Inhibition of QL, bilaterally
23. Isotonic contraction of his erector spinae

Answer 19

4. Isotonic contraction of his erector spinae

Question 20

20. Which of these postural (tonic) muscle/ phasic muscles (in that order) that is also involved in
    Lower Crossed Syndrome?
21. Iliopsoas/Gluteus maximus
22. Abdominals/ Gluteus maximus
23. Erector spinae/ middle trapezius
24. Gluteus maximux/ Hip extensors

Answer 20

1. Iliopsoas/Gluteus maximus

Question 21

21. In lab, I said that if we apply true static concepts, the procedure “side-lying calcaneus/ sacral
    apex push for downside SI extension” is not an appropriate procedure to correct the static listing PI
    ilium because?
22. There is too much posterior movement of the upside ilium
23. The counternutation caused by the scoop-lunge sends the ilium in the wrong direction
24. A PI ilium can only be contacted with a prone drop move
25. You would need to correct the misaligned ilium to correct static listing, which you do
    not do when performing that named adjective procedure

Answer 21

4. You would need to correct the misaligned ilium to correct static listing, which you do
   not do when performing that named adjective procedure

Question 22

22. We have been able to assess and adjust for the movements of unilateral lumbosacral flexion and
    extension by virtue of which theoretical construct?
23. The oblique axis of the sacrum
24. L/S facet tropism
25. “The Dance”
26. SI internal and external rotation

Answer 22

3. “The Dance”

Question 23

23. In disc herniation terminology, an extruded disc that has separated from its parent disc, creating
    a free nuclear fragment is called a?
24. Disc bulge
25. Nuclear sequestration
26. Disc extrusion
27. Focal protrusion

Answer 23

2. Nuclear sequestration

Question 24

24. Which of the following is considered to be a subjective finding?
25. Orthopedic test
26. X-ray
27. Pain
28. Blood lab results

Answer 24

3. Pain

Question 25

25. What is the segmental contact point when adjusting to correct for a right unilateral lumbosacral
    flexion restriction?
26. Right side of sacral apex
27. Left side sacral apex
28. Right side of sacral base
29. Left side of sacral base

Answer 25

1. Right side of sacral apex

Question 26

26. Which of the following best describes the procedure we used to perform a prone reinforced
    Calcaneus/SI joint line push with gravity assist to correct a sacroiliac rotation restriction?
27. Push the misaligned ilium back into place
28. Pull the ilium back into neural using a thrust with a vector opposite the misalignment
29. Use multiple drops to gradually bring the PSIS closer to S2
30. Preload the joint in the direction of desired motion (internal rotation) and apply a
    gravity-assisted impulse

Answer 26

4. Preload the joint in the direction of desired motion (internal rotation) and apply a
   gravity-assisted impulse

Question 27

27. A viscero-somatic reflex chart can help you identify referred pain patterns in your patients
    which may be of non-musculoskeletal origin
28. TRUE
29. False

Answer 27

1. TRUE

Question 28

28. The Biopsychosocial Model of low back disorders was created to help clinicians
29. Take into account the totality of a patient’s life when considering the origin and/or persistence of their pain and disability
30. Discover which patients are faking symptoms for monetary gain
31. Offer more to patients with psychological services in addition to manual care
32. Obtain more visits from the workers compensation insurance company

Answer 28

1. Take into account the totality of a patient’s life when considering the origin and/or persistence of their pain and disability

Question 29

29. Which of these chiropractic clinics would most likely utilize a biopsychosocial approach to
    patient care?
30. Pop and go chiro “2 minute adjustments we don’t waste your time!”
31. Dr. Crunch– “Weekly body alignment package special ends Labor Day!”
32. Dr. Jack’s Crack Shack “Back out of whack? Come get a crack”
33. Main street Comprehensive Spinal Care– “We treat you as a person.”

Answer 29

4. Main street Comprehensive Spinal Care– “We treat you as a person.”

Question 30

30. Counter nutation of the sacrum is associated with which of the following motions?
31. Extension of the L/S junction and flexion of the SI joint
32. Flexion of both the L/S junction and the SI Joint
33. Extension of both the L/S Junction and the SI joint
34. Flexion of the L/S junction and extension of the SI joint

Answer 30

2. Flexion of both the L/S junction and the SI Joint

Question 31

31. Which of these terms could be used when referring to lumbar spine x-rays that show
    degenerative disc disease?
32. Signs and symptoms
33. Subjective evidence of arthritis
34. Objective findings
35. Disability

Answer 31

3. Objective findings

Question 32

32. As the intervertebral disc changes with age, the distinction between the nucleus and annulus
    becomes less apparent. This is partly due to:
33. Decreasing collagen content in both nucleus and annulus
34. Repeated herniations, which are often asymptomatic
35. The thickening of nuclear collagen fibers and the thinning of those in the annulus
36. Proteoglycan saturation and the resulting hyper-hydration

Answer 32

3. The thickening of nuclear collagen fibers and the thinning of those in the annulus

Question 33

33. “Hurt does not necessarily mean that there is harm.” You might say this to a patient with
    moderate back pain, in an effort to reassure him, if:
34. He is afraid to move at all, for fear he will just get worse
35. He doesn’t want to miss his weekly rugby match, where he often strains his back
36. He doesn’t want side posture adjusting because his back felt much worse after every visit to
    his previous chiropractor
37. He claims to have a very high pain threshold and believes “Anything that doesn’t kill me
    makes me stronger.”

Answer 33

1. He is afraid to move at all, for fear he will just get worse

Question 34

34. Patient findings must be qualified and quantified to give them meaning. Which of the following
    does not belong in the qualify category?
35. Color
36. Shape
37. Texture
38. Blood pressure

Answer 34

4. Blood pressure

Question 35

35. Which of these patients might most benefit from a Side-Lying Calcaneus/Sacral Apex Push for
    lumbosacral flexion?
36. Alan, who sits at a desk all day with a “rounded” (Flexed) lumbar spine
37. Betty, who has a forward head carriage and Upper Crossed Syndrome
38. Tamara, a 38 year old school crossing guard with lower crossed syndrome, including a
    significant hyperlordosis
39. Murph, a 54 year old roofing contractor with a posterior pelvic tilt and an L5 flexion
    malposition

Answer 35

3. Tamara, a 38 year old school crossing guard with lower crossed syndrome, including a
   significant hyperlordosis

Question 36

36. Which of these patients most likely has chronic systemic inflammation?
37. Sarah, who has a “pear-shaped” physique
38. Joe, who has a 44 inch waist and high blood pressure
39. Kevin, an athletic trainer with high HDL (“good”) cholesterol, who loves bagels with cream
    cheese
40. Dorothy, who drenches her salads in olive oil

Answer 36

2. Joe, who has a 44 inch waist and high blood pressure

Question 37

37. Your patient, who is in visible distress with a flexion antalgia, complains of severe lower back
    pain, graded 8 out of possible 10 on a verbal scale. He is able to bend forward to 45 of flexion when
    you ask him to, but cannot stand erect due to pain. This encounter involves all four of these patient
    assessment terms: subjective, objective, signs and symptoms.
38. True
39. False

Answer 37

1. True

Question 38

38. Your 34 year old female patient works at an Amazon distribution center. Five Days ago, early in
    her 10 hour shift, she lifted a box that she thought weighed 10 pounds, but actually weighed 40
    pounds. She was bent at the waist and twisted to the right when she did the lift. She states she heard
    a “pop” in her lower back, above her belt line, which was associated with a ‘jab’ of pain locally,
    followed by an ache which worsened through the remainder of her work day. The pain has not
    improved and is now described as deep ache across her lumbar region, graded 6 out of 10. Sitting
    definitely makes the pain worse, as does coughing or sneezing. She also has pain in her right
    buttock, but no leg pain. She has worked at this job for 10 years, with 3 or 4 prior back injuries,
    each much milder and resolving without care. What is the most likely cause of your patient’s pain?
39. Facet syndrome with meniscoid entrapment
40. Right PI Ilium
41. Contained disc lesion

Answer 38

3. Contained disc lesion

Question 39

39. Although osteoarthritis is considered a non-inflammatory joint disorder, diet-induced chronic
    systemic inflammation can worsen symptoms.
40. True
41. False

Answer 39

1. True

Question 40

40. What is the vector of correction (line of drive) for a side lying hypothenar/spinous process push
    performed to correct an L2/L3 left lateral flexion restriction?
41. Left to Right and S to I
42. Medial to Lateral and P to A
43. Right to Left and I to S
44. Left to Right and P to A

Answer 40

4. Left to Right and P to A

Question 41

41. Your 36 year old patient, Gary, is the mayor of your small town and also runs a feed and grain
    business. Three days ago he was walking through town while texting a customer and stepped off a
    curb he did not see. He experienced immediate pain at his right PSIS. The pain is worst when he
    steps out of his truck. By way of orthopedic testing and palpation you diagnose him with a right
    sacroiliac sprain. Full flexion of this joint and of the right hip is not painful, but any extension of
    the right hip/SI produces sharp pain. In fact, lying prone is quite uncomfortable. You palpate a left
    SI extension restriction and at his third visit you feel Gary can tolerate HVLA adjusting. Which of
    these adjective procedures should you perform to correct this restriction?
42. Prone thenar/sacral base, calcaneus/Ischial tuberosity push with gravity assist for right AS
    ilium
43. Side-lying calcaneus/sacral apex push to induce left SI (relative) extension, right side
    up
44. Prone reinforced calcaneus/SI joint line push for right SI internal rotation
45. Side-lying hypothenar/sacral base push for left lumbosacral extension, left side up

Answer 41

2. Side-lying calcaneus/sacral apex push to induce left SI (relative) extension, right side
   up

Question 42

42. Which statement most accurately connects pelvic function and gait?
43. The sacrum laterally flexes towards the side of the loading response
44. With each heel strike, the ipsilateral ilium subluxates AS
45. A shorter stride promotes SI hypermobility and instability
46. 80% double support during the gait cycle is a risk factor for pelvic stress fractures

Answer 42

2. With each heel strike, the ipsilateral ilium subluxates AS

Question 43

43. What term best describes asymmetry between right and left articulating facets in the lumbar
    spine?
44. Zygopophyseal orthogonal disassociation
45. Imbrication
46. Arbitrary meniscoid angulation
47. Facet tropism

Answer 43

4. Facet tropism

Question 44

44. The progressive decrease in range of motion of the aging lumbar spine is primarily due to
    stiffening of the
45. Ligamentum flavum
46. Intervertebral disc
47. Quadratus lumborum muscles
48. Transverse trabeculae of the vertebral body

Answer 44

2. Intervertebral disc

Question 45

45. Decreasing Body Mass Index helps decrease joint pain by what mechanism?
46. Less expression of inflammatory mediators from adipocytes
47. Decreased mechanical load on joints
48. Better Overall health encourages movement
49. All the Above

Answer 45

4. All the Above

Question 46

46. The adjustive procedure we learned to correct a Unilateral PS Sacrum in the prone position
    involves:
47. A reinforced calcaneus/midline sacral base contact
48. A reinforced thenar/sacral apex contact with 4-part vector
49. An inferior (inside) hand reinforced hypothenar/ipsilateral sacral base contact
50. A contralateral ulnar knife-edge/sacral groove contact

Answer 46

3. An inferior (inside) hand reinforced hypothenar/ipsilateral sacral base contact

Question 47

47. Heat, redness, swelling, pain, and loss of function are considered the “pillars” of which of the
    following?
48. Trigger points
49. Subluxation
50. Inflammation
51. Claudication

Answer 47

3. Inflammation

Question 48

48. Which of these is an example of a viscero-somatic reflex?
49. A heart attack causing left arm and jaw pain
50. Bowel distress due to anxiety over his exam
51. Low back muscle spasms causing constipation
52. The event triggered by pulling your grandfather’s finger

Answer 48

1. A heart attack causing left arm and jaw pain

Question 49

49. What is the correct order of the Negative Cascade (in the direction of initiation to end result) as
    described by Palmer/Kirkaldy-Willis/Schneider?
50. Stabilization, Hypertonic muscles, Joint dysfunction, Instability
51. Instability, Hypertonic muscles, Stabilization, Joint dysfunction
52. Joint dysfunction, Stabilization, Instability, Hypertonic muscles
53. Hypertonic muscles, Joint dysfunction, Instability, Stabilization

Answer 49

4. Hypertonic muscles, Joint dysfunction, Instability, Stabilization

Question 50

50. Which of these structures would be the “weakest link” (structure most likely to fail) under
    sudden axial compressive loading in an 85-year-old ?
51. Weakened cancellous bone structure with resulting vertebral body compression
    fracture
52. Pars Interarticularis, resulting in spondylolysis
53. Annulus fibrosis, resulting in disc extrusion and radicular pain
54. Articular processes, resulting in facet fracture

Answer 50

1. Weakened cancellous bone structure with resulting vertebral body compression
   fracture