Free Part III Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Part III practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A new patient tells a chiropractor that her neck has been stiff and sore since she fell asleep on a couch four days earlier. The record for that visit also notes a disc herniation diagnosed three years ago, a mother with rheumatoid arthritis, and restricted cervical rotation measured during the visit. Which of these entries is the chief complaint?

   1. A. The neck stiffness and soreness that prompted the patient's visit
   2. B. The intervertebral disc herniation diagnosed three years earlier
   3. C. The maternal family history of seropositive rheumatoid arthritis
   4. D. The restricted cervical rotation recorded during the examination

   Answer: A

   Explanation: The chief complaint is the reason the patient sought care, recorded as the patient states it: it is "a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for the encounter, usually stated in the patient's own words." The stiff, sore neck since the night on the couch is that statement. The disc herniation is part of past history, the mother's arthritis belongs to family history, and the restricted rotation is an examination finding rather than any part of the history.

   Reference: Medicare Physician Guide: — Section III.A, 'Chief Complaint (CC)'

2. 2A radiograph of a painful knee shows osteophytes at the joint margins, narrowing of the joint space, increased density of the subchondral bone, and subchondral cysts. Which diagnosis do these findings support?

   1. A. Osteoarthritis
   2. B. Rheumatoid arthritis
   3. C. Ankylosing spondylitis
   4. D. Neuropathic arthropathy

   Answer: A

   Explanation: This set of findings is described together for the degenerative process: "Radiographs generally reveal marginal osteophytes, narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodeling, and sometimes joint effusions." Rheumatoid disease produces marginal erosions with periarticular osteoporosis rather than subchondral sclerosis, ankylosing spondylitis produces syndesmophytes and sacroiliac change, and neuropathic arthropathy progresses to fragmentation and destruction.

   Reference: Osteoarthritis (OA) - Rheumatology and Orthopedics - Merck Manual Professional Edition — Diagnosis of Osteoarthritis, radiographs

3. 3An 82-year-old man presenting for hip and knee stiffness denies pain, swelling, and morning stiffness when asked directly, but volunteers that over the past year he has stopped his daily walks and given up volunteering at the hospital. What should the chiropractor conclude from this pattern?

   1. A. A disorder may be present and be manifesting only as functional decline
   2. B. A musculoskeletal disorder is unlikely because joint symptoms are absent
   3. C. The lost activities reflect the expected effect of normal aging by itself
   4. D. The symptoms were withheld because of a fear of being hospitalized

   Answer: A

   Explanation: In older adults "Disorders may manifest solely as functional decline. In such cases, standard questions may not apply." The source gives this exact situation as its example: "when asked about joint symptoms, patients with severe arthritis may not report pain, swelling, or stiffness, but if asked about changes in activities, they may, for example, report that they no longer take walks or volunteer at the hospital." Absent joint symptoms therefore do not argue against disease, the activity loss is not attributable to aging alone, and fear of hospitalization describes a patient who withholds information rather than one who reports the change himself.

   Reference: History-Taking in the Older Adult - Geriatrics - Merck Manual Professional Edition — Medical history considerations, 'Functional decline as the only manifestation'

4. 4A patient's knee radiograph shows advanced degenerative change but she reports only mild symptoms. How should this mismatch be regarded?

   1. A. As a common finding in this disorder
   2. B. As evidence that the images were mislabelled
   3. C. As proof that a second disorder is present
   4. D. As a reason to repeat the study in six weeks

   Answer: A

   Explanation: The mismatch is expected rather than exceptional: "Discrepancy between severity of symptoms and severity of changes in imaging is common." Nothing in that statement implies a labelling error, a second diagnosis, or a need to repeat the study; the finding is a recognized feature of the condition itself.

   Reference: Osteoarthritis (OA) - Rheumatology and Orthopedics - Merck Manual Professional Edition — Diagnosis of Osteoarthritis

5. 5A 78-year-old woman comes in for mid-back pain and, while giving her history, mentions recent dizziness and constipation, adding that she assumes both simply come with getting older. How should the chiropractor handle these two reported symptoms?

   1. A. Evaluate them before either one is ascribed to the effects of aging
   2. B. Record them and revisit them only if they persist for six more months
   3. C. Treat them as expected changes of aging that need no further evaluation
   4. D. Exclude them from the record because they are unrelated to the back pain

   Answer: A

   Explanation: Dizziness and constipation are named among the symptoms older patients wrongly dismiss as aging, and the rule on attribution is explicit: "no symptom should be attributed to normal aging unless a thorough evaluation is performed and other possible causes have been eliminated." Deferring the question for six months, accepting the patient's own attribution, and leaving the symptoms out of the record all skip that required evaluation.

   Reference: History-Taking in the Older Adult - Geriatrics - Merck Manual Professional Edition — Medical history considerations, 'Underreporting of symptoms'

6. 6A chiropractor wants the radiographic projection most sensitive for detecting joint space narrowing at the knee. Which view should be requested?

   1. A. A standing weight-bearing Merchant view with the knee flexed 30 degrees
   2. B. A supine anteroposterior view with the knee fully extended and externally rotated
   3. C. A cross-table lateral view taken with the patient lying on the affected side
   4. D. A tunnel view taken prone with the central ray angled toward the patient's head

   Answer: A

   Explanation: One projection is singled out for this purpose: "Standing weight-bearing Merchant view (tangential view with knee flexed 30°) radiographs of the knees are more sensitive in detecting joint space narrowing." A supine extended view removes the weight bearing that loads the joint, and the lateral and tunnel projections are obtained for other anatomic questions.

   Reference: Osteoarthritis (OA) - Rheumatology and Orthopedics - Merck Manual Professional Edition — Diagnosis of Osteoarthritis, radiographs

7. 7A patient returns solely because her chiropractor asked her to come back in four weeks so the earlier problem could be reassessed. She reports no new or changed symptoms at this visit. What should be entered as the chief complaint?

   1. A. The clinician-recommended return for reassessment of the earlier problem
   2. B. The working diagnosis recorded at the close of the previous course of care
   3. C. A note that the patient has no complaint and no stated reason for the visit
   4. D. The examination findings obtained at the beginning of the present appointment

   Answer: A

   Explanation: A recommended return is itself a recognized reason for an encounter. The chief complaint is "a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for the encounter," so the scheduled reassessment is what belongs in that field. Carrying forward the earlier diagnosis substitutes a conclusion for the reason for the visit, recording no reason contradicts the fact that a return was requested, and examination findings are not part of the history.

   Reference: Medicare Physician Guide: — Section III.A, 'Chief Complaint (CC)'

8. 8A radiograph of a patient with a long-standing neurologic disorder shows bone fragmentation, bone destruction, new bone growth, and loss of joint space in a relatively painless joint. Which diagnosis do these cardinal signs indicate?

   1. A. Neuropathic arthropathy
   2. B. Primary osteoarthritis
   3. C. Chronic infectious arthritis
   4. D. Calcium pyrophosphate arthritis

   Answer: A

   Explanation: The later radiographic picture is listed as a set of cardinal signs: "The cardinal signs later in disease progression are Bone fragmentation Bone destruction New bone growth Loss of joint space." The clinical setting matches as well, since the diagnosis "should be considered in a patient with a predisposing neurologic disorder who develops a destructive but relatively painless arthropathy." Early changes can mimic degenerative disease, because they "are often similar to those in osteoarthritis", but the advanced fragmentation is what separates them.

   Reference: Neuropathic Arthropathy - Rheumatology and Orthopedics - Merck Manual Professional Edition — Diagnosis of Neuropathic Arthropathy

9. 9An 84-year-old man arrives for a first visit and leaves in his bag the eyeglasses and hearing aids he normally wears. What should the chiropractor do before beginning to take the case history?

   1. A. Have him put on the eyeglasses and hearing aids that he normally wears
   2. B. Speak more loudly and proceed with the interview without the devices
   3. C. Obtain the history from the family member who accompanied him instead
   4. D. Shorten the interview to the presenting complaint and its duration only

   Answer: A

   Explanation: Sensory deficits are listed first among the circumstances that interfere with evaluating an older patient: "Dentures, eyeglasses, or hearing aids, if normally worn, should be worn to facilitate communication during the interview. Adequate lighting and elimination of visual or auditory distraction also help." Raising one's voice does not correct the visual deficit, substituting a relative removes the patient from his own history, and shortening the interview does not address the barrier at all.

   Reference: History-Taking in the Older Adult - Geriatrics - Merck Manual Professional Edition — Medical history considerations, 'Sensory deficits'

10. 10A patient with knee osteoarthritis has normal blood tests. What is the role of laboratory studies in this disorder?

    1. A. They are normal, and are used mainly to exclude other disorders or find an underlying cause
    2. B. They establish the diagnosis, which cannot be made without a supporting laboratory abnormality
    3. C. They are always abnormal, showing a raised sedimentation rate proportional to joint damage
    4. D. They are not performed, because the diagnosis rests entirely on the radiographic appearance

    Answer: A

    Explanation: The role is exclusionary rather than confirmatory: "Laboratory studies are normal in osteoarthritis but occasionally may be required to exclude other disorders or to diagnose an underlying disorder causing secondary osteoarthritis." Tests are therefore neither diagnostic in themselves, nor routinely abnormal, nor entirely dispensed with.

    Reference: Osteoarthritis (OA) - Rheumatology and Orthopedics - Merck Manual Professional Edition — Diagnosis of Osteoarthritis, laboratory studies