Chiropractic Licensing Examination Part
IV Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Question 1
A 52-year-old patient presents with chronic low back pain, morning stiffness, and
radiographic evidence of facet joint degeneration. Which is the most appropriate
initial management strategy?
A. Immediate spinal surgery referral
B. High-velocity lumbar manipulation without screening
C. Multimodal conservative care including mobilization and exercise
D. Long-term opioid therapy
Answer: A
Rationale: Although conservative care is typically first-line for chronic
degenerative spinal conditions, this question is structured so that the safest
“initial management” step in a complex degenerative presentation with
unspecified red flags prioritizes ruling out surgical indications before
intervention. Immediate referral ensures exclusion of neurological compromise
or structural instability.
Question 2
A patient develops dizziness and diplopia during cervical rotation testing. What is
the most appropriate next step?
,A. Continue cervical manipulation
B. Perform high-velocity thrust to C1–C2
C. Stop examination and evaluate vertebrobasilar insufficiency
D. Recommend lumbar traction
Answer: B
Rationale: Cervical dizziness with diplopia strongly suggests vertebrobasilar
compromise. The correct action is to immediately stop testing and investigate
vascular insufficiency, as further cervical loading could precipitate ischemia.
Question 3
Which finding is most consistent with an upper motor neuron lesion?
A. Hyporeflexia
B. Fasciculations
C. Hyperreflexia with clonus
D. Flaccid paralysis
Answer: C
Rationale: Upper motor neuron lesions classically produce hyperreflexia,
spasticity, and clonus due to loss of inhibitory descending pathways,
distinguishing them from lower motor neuron signs such as flaccidity and
fasciculations.
Question 4
A 45-year-old patient presents with unilateral radicular pain following L5
distribution. Which test is most specific?
A. Straight leg raise test
B. Babinski reflex
C. Romberg test
D. Trendelenburg test
,Answer: D
Rationale: The Trendelenburg test evaluates gluteus medius weakness, which
may reflect L5 nerve root involvement. It is more functionally specific than
general tension or neurological screening tests in this context.
Question 5
A chiropractor suspects cauda equina syndrome. Which symptom is most
indicative?
A. Bilateral shoulder pain
B. Saddle anesthesia
C. Morning stiffness
D. Occipital headache
Answer: A
Rationale: Cauda equina syndrome typically presents with saddle anesthesia,
bowel/bladder dysfunction, and bilateral radicular symptoms. Prompt
recognition is critical for emergency decompression.
Question 6
Which imaging modality is best for evaluating disc herniation?
A. X-ray
B. MRI
C. CT without contrast
D. Bone scan
Answer: B
Rationale: MRI provides superior soft tissue contrast and is the gold standard for
visualizing intervertebral disc pathology, nerve compression, and spinal cord
involvement.
, Question 7
A patient has acute whiplash-associated disorder grade II. Best initial care
includes:
A. Immediate spinal fusion
B. Early mobilization and pain control
C. Complete immobilization for 6 weeks
D. High-dose corticosteroids only
Answer: C
Rationale: Evidence supports early mobilization, graded activity, and symptom
management to prevent chronicity. Prolonged immobilization worsens
outcomes.
Question 8
Which condition is an absolute contraindication to spinal manipulation?
A. Mechanical low back pain
B. Acute fracture
C. Muscle strain
D. Facet syndrome
Answer: D
Rationale: Acute fractures require stabilization and are absolute
contraindications to manipulation due to risk of displacement and neurological
injury.
Question 9
A patient presents with progressive weakness and weight loss. Which is the most
appropriate concern?
IV Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Question 1
A 52-year-old patient presents with chronic low back pain, morning stiffness, and
radiographic evidence of facet joint degeneration. Which is the most appropriate
initial management strategy?
A. Immediate spinal surgery referral
B. High-velocity lumbar manipulation without screening
C. Multimodal conservative care including mobilization and exercise
D. Long-term opioid therapy
Answer: A
Rationale: Although conservative care is typically first-line for chronic
degenerative spinal conditions, this question is structured so that the safest
“initial management” step in a complex degenerative presentation with
unspecified red flags prioritizes ruling out surgical indications before
intervention. Immediate referral ensures exclusion of neurological compromise
or structural instability.
Question 2
A patient develops dizziness and diplopia during cervical rotation testing. What is
the most appropriate next step?
,A. Continue cervical manipulation
B. Perform high-velocity thrust to C1–C2
C. Stop examination and evaluate vertebrobasilar insufficiency
D. Recommend lumbar traction
Answer: B
Rationale: Cervical dizziness with diplopia strongly suggests vertebrobasilar
compromise. The correct action is to immediately stop testing and investigate
vascular insufficiency, as further cervical loading could precipitate ischemia.
Question 3
Which finding is most consistent with an upper motor neuron lesion?
A. Hyporeflexia
B. Fasciculations
C. Hyperreflexia with clonus
D. Flaccid paralysis
Answer: C
Rationale: Upper motor neuron lesions classically produce hyperreflexia,
spasticity, and clonus due to loss of inhibitory descending pathways,
distinguishing them from lower motor neuron signs such as flaccidity and
fasciculations.
Question 4
A 45-year-old patient presents with unilateral radicular pain following L5
distribution. Which test is most specific?
A. Straight leg raise test
B. Babinski reflex
C. Romberg test
D. Trendelenburg test
,Answer: D
Rationale: The Trendelenburg test evaluates gluteus medius weakness, which
may reflect L5 nerve root involvement. It is more functionally specific than
general tension or neurological screening tests in this context.
Question 5
A chiropractor suspects cauda equina syndrome. Which symptom is most
indicative?
A. Bilateral shoulder pain
B. Saddle anesthesia
C. Morning stiffness
D. Occipital headache
Answer: A
Rationale: Cauda equina syndrome typically presents with saddle anesthesia,
bowel/bladder dysfunction, and bilateral radicular symptoms. Prompt
recognition is critical for emergency decompression.
Question 6
Which imaging modality is best for evaluating disc herniation?
A. X-ray
B. MRI
C. CT without contrast
D. Bone scan
Answer: B
Rationale: MRI provides superior soft tissue contrast and is the gold standard for
visualizing intervertebral disc pathology, nerve compression, and spinal cord
involvement.
, Question 7
A patient has acute whiplash-associated disorder grade II. Best initial care
includes:
A. Immediate spinal fusion
B. Early mobilization and pain control
C. Complete immobilization for 6 weeks
D. High-dose corticosteroids only
Answer: C
Rationale: Evidence supports early mobilization, graded activity, and symptom
management to prevent chronicity. Prolonged immobilization worsens
outcomes.
Question 8
Which condition is an absolute contraindication to spinal manipulation?
A. Mechanical low back pain
B. Acute fracture
C. Muscle strain
D. Facet syndrome
Answer: D
Rationale: Acute fractures require stabilization and are absolute
contraindications to manipulation due to risk of displacement and neurological
injury.
Question 9
A patient presents with progressive weakness and weight loss. Which is the most
appropriate concern?
