Free Special Purposes Examination for Chiropractic Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Special Purposes Examination for Chiropractic practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1At intake, a new patient tells the chiropractor, "My lower back has been killing me since I moved a couch last weekend." When recording the chief complaint, which approach is consistent with the standard definition of the chief complaint?

   1. A. An inventory of symptoms elicited by questioning across each of the body systems
   2. B. A concise statement of the reason for the visit, usually in the patient's own words
   3. C. The examiner's working diagnosis, recorded in place of the patient's own description
   4. D. A chronological account of how the problem developed from the first symptom to now

   Answer: B

   Explanation: The CMS documentation guidelines define it this way: "The CC 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 patient's quoted statement is therefore the core of the chief complaint. A chronological account describes the history of present illness ("The HPI is a chronological description of the development of the patient’s present illness"), and a symptom inventory across body systems describes the review of systems ("A ROS is an inventory of body systems obtained through a series of questions"). Replacing the patient's words with the examiner's diagnosis departs from the definition.

   Source: 1997 Documentation Guidelines for Evaluation and Management Services — Section III.A, Chief Complaint (CC)

2. 2During the general survey, a chiropractor counts a seated adult patient's respirations after several minutes of rest. According to MedlinePlus, what is the normal resting breathing rate for the average healthy adult?

   1. A. 12 to 18 breaths per minute
   2. B. 6 to 10 breaths per minute
   3. C. 20 to 30 breaths per minute
   4. D. 30 to 40 breaths per minute

   Answer: A

   Explanation: MedlinePlus lists the normal resting ranges for the average healthy adult, including "Breathing: 12 to 18 breaths per minute". Rates of 6 to 10, 20 to 30, or 30 to 40 breaths per minute fall outside this adult range.

   Source: Vital signs: MedlinePlus Medical Encyclopedia — Normal vital sign ranges for the average healthy adult while resting

3. 3During gait analysis, a 58-year-old patient with lower leg weakness lets the forefoot hang with the toes pointing down, so the toes scrape the floor unless the patient lifts the leg higher than normal with each step. Which gait pattern does this describe?

   1. A. Waddling gait
   2. B. Propulsive gait
   3. C. Antalgic gait
   4. D. Steppage gait

   Answer: D

   Explanation: MedlinePlus defines "Steppage gait -- foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking." The patient's foot drop with a compensatory high leg lift matches steppage gait. A waddling gait is "a duck-like walk," a propulsive gait is "a stooped, stiff posture with the head and neck bent forward," and an antalgic gait occurs "when pain prevents the normal motion of the feet or legs."

   Source: Walking abnormalities: MedlinePlus Medical Encyclopedia — Considerations, named walking abnormalities

4. 4A 34-year-old office worker has had low back pain for 9 days after gardening, with no focal neurologic deficits and no red flags on history or examination. What does the 2022 VA/DoD guideline recommend regarding imaging?

   1. A. Recommends against routinely obtaining imaging studies for this patient
   2. B. Recommends lumbar radiographs to document alignment before any treatment
   3. C. Recommends lumbar MRI so that disk pathology can be excluded early on
   4. D. Recommends a bone scan to screen for occult fracture or tumor activity

   Answer: A

   Explanation: Recommendation 3 states: "For patients with acute low back pain, without focal neurologic deficits or other red flags (e.g., signs, symptoms, history), we recommend against routinely obtaining imaging studies or performing invasive diagnostic tests." Imaging is reserved for situations described in Recommendation 2, "when neurologic deficits are progressive or otherwise serious or when other red flags (e.g., signs, symptoms, history) are present."

   Source: VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain (2022) — Recommendation 3, Evaluation and Diagnostic Approach (page 29)

5. 5A chiropractor reviews an in-office urinalysis for a patient with flank discomfort. According to MedlinePlus, which of the following results falls within normal findings?

   1. A. Glucose detected on the dipstick
   2. B. Urine specific gravity of 1.020
   3. C. A dipstick positive for nitrites
   4. D. Red blood cells on microscopy

   Answer: B

   Explanation: MedlinePlus gives "The normal range for urine specific gravity is 1.005 to 1.030", so 1.020 is normal. The urinalysis page states that "Usually, glucose, ketones, protein, and bilirubin are not detectable in urine" and that nitrites and red blood cells are among the substances "not normally found in urine".

   Source: Urine specific gravity test: MedlinePlus Medical Encyclopedia — Normal Results

6. 6A 71-year-old reports buttock and calf pain that comes on whenever he stands or walks for a few minutes and fades once he sits down or leans forward on a shopping cart. Which diagnosis does this history most suggest?

   1. A. Lumbar disk herniation
   2. B. Plantar fasciitis
   3. C. Lumbar spinal stenosis
   4. D. Peripheral artery disease

   Answer: C

   Explanation: MedlinePlus describes spinal stenosis symptoms that "are more likely to be present or get worse when you stand or walk. They often lessen or disappear when you sit down or lean forward." By contrast, NHLBI notes that "PAD pain is often brought on by leg exercise and is quickly relieved by rest with no need to change position," whereas this patient needs to sit or flex forward. Disk herniation pain typically worsens with sitting, coughing, or sneezing, and plantar fasciitis causes heel pain.

   Source: Spinal stenosis: MedlinePlus Medical Encyclopedia — Symptoms

7. 7A chiropractor is considering high-velocity thrust to the thoracic spine of a patient who takes warfarin for atrial fibrillation. Under the contraindication framework in the Medicare Benefit Policy Manual, how is anticoagulant therapy classified with respect to dynamic thrust?

   1. A. An absolute contraindication only when the thrust is directed to the cervical spine
   2. B. A condition that requires spinal radiographs before any dynamic thrust is applied
   3. C. A relative contraindication that adds risk but does not rule out dynamic thrust
   4. D. An absolute contraindication to dynamic thrust near the proposed manipulation site

   Answer: C

   Explanation: The manual states that "A relative contraindication is a condition that adds significant risk of injury to the patient from dynamic thrust, but does not rule out the use of dynamic thrust," and lists "Bleeding disorders and anticoagulant therapy" among the relative contraindications. The absolute list (for example, malignancy of the vertebral column, or vertebrobasilar insufficiency syndrome for cervical manipulation) does not include anticoagulant therapy, and the manual adds that "The doctor should discuss this risk with the patient and record this in the chart."

   Source: Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services — Section 240.1.3.B, Contraindications

8. 8A chiropractor is deciding whether to add TENS and therapeutic ultrasound to care for a patient with low back pain. What does the 2022 VA/DoD guideline conclude about these modalities for low back pain?

   1. A. Both modalities are recommended (strong for) for chronic pain only
   2. B. Both modalities are suggested against (weak against) for all patients
   3. C. The evidence is insufficient to recommend for or against either modality
   4. D. Both modalities are suggested (weak for) as adjuncts to exercise care

   Answer: C

   Explanation: Recommendation 17 states: "For patients with low back pain, there is insufficient evidence to recommend for or against cupping, laser therapy, transcutaneous electrical nerve stimulation, and ultrasound." The guideline therefore neither supports nor opposes these passive modalities.

   Source: VA/DoD Clinical Practice Guideline for the Diagnosis and Treatment of Low Back Pain (2022) — Recommendation 17, Non-pharmacologic and Non-invasive Therapy

9. 9A chiropractor is writing the initial treatment plan for a Medicare beneficiary with an acute lumbar subluxation. Which set of elements does the Medicare Benefit Policy Manual say the treatment plan should include?

   1. A. Total fee for the episode, the patient's employer, and the name of the referring physician
   2. B. A three-generation family history, a full review of systems, and an x-ray of the spine
   3. C. The planned number of visits only, since goals and measures belong to the progress notes
   4. D. Recommended level of care, specific treatment goals, and objective measures of effectiveness

   Answer: D

   Explanation: The manual states: "Treatment Plan: The treatment plan should include the following: Recommended level of care (duration and frequency of visits); Specific treatment goals; and Objective measures to evaluate treatment effectiveness." An x-ray is not required to demonstrate the subluxation, and fees or employer details are not treatment plan elements.

   Source: Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services — Section 240.1.2.A.5, Treatment Plan

10. 10A patient returns to the office solely because the chiropractor asked to re-evaluate the lumbar spine after four weeks of care; the patient reports no new symptoms. How should the chief complaint for this encounter be understood?

    1. A. The chief complaint must restate the initial diagnosis from the first visit word for word
    2. B. A physician-recommended return can itself be the reason recorded as the chief complaint
    3. C. No chief complaint can be recorded, because a chief complaint must name a current symptom
    4. D. The chief complaint must be replaced by a complete review of systems for this encounter

    Answer: B

    Explanation: The CMS definition lists a physician-requested return among the possible reasons for an encounter: "The CC is a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for the encounter". A chief complaint is therefore not limited to a current symptom, and the guideline still expects that "The medical record should clearly reflect the chief complaint," so it is neither omitted nor replaced by a review of systems. Nothing in the definition requires repeating the prior diagnosis verbatim.

    Source: 1997 Documentation Guidelines for Evaluation and Management Services — Section III.A, Chief Complaint (CC)