Scientific Basis of Chiropractic Midterm Examination
Spring 2022
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1. Which of the following commonly accumulates as a consequence of chronic inflammation?
A. lymphocytes
B. insulin
C. killer t-cells
D. lose bodies
2. The first relay site in the transmission of nociceptive information from the periphery to the brain occurs in
the ______.
A. intervertebral foramen
B. spinal cord
C. cerebellum
D. thalamus
3. Inflammation is the key driver of sensitization. Put these process related to sensitization and chronic pain
causation in the correct order:
A. Neurogenic inflammation, central sensitization, peripheral sensitization, chronic pain
B. Neurogenic inflammation, peripheral sensitization, central sensitization, chronic pain
C. Chronic pain, central sensitization, peripheral sensitization, neurogenic inflammation
D. Chronic pain, peripheral sensitization, central sensitization, neurogenic inflammation
4. Touch, vibration, and position perception are transmitted by ______ fibers from the periphery to the central
nervous system.
A. A alpha
B. A beta
C. A delta
D. C
5. Pain resulting from a stimulus that ordinarily does not elicit a painful response is known as _________.
A. nociceptive pain
B. secondary hyperalgesia
C. allodynia
D. neuropathic pain
6. The concept that describes how the nervous system is adaptive and dynamic is known as __________.
A. dynamic adaptability
B. neuroplasticity
C. global attenuation
D. central sensitization
7. Changes in the dorsal horn of the spinal cord from central sensitization are responsible for which of the
following clinical phenomenon?
A. acute pain
B. imprecise pain localization
C. hypoesthesia
D. sharp, shooting pain
8. Autonomic reflex centers in the _________ coordinate visceral activities within the ANS.
A. basal ganglia
B. hypothalamus
C. reticular formation
D. limbic system
9. Dysafferentation that purportedly results from joint subluxation refers to a marked increase in ___________
and a marked decrease in __________ reporting from the affected joint.
A. proprioception; nociception
B. nociception; mechanoreception
C. mechanoreception; proprioception
D. sensory transduction; mechanoreception
10. The intervertebral disc is largely avascular. What component or region of the disc is the exception?
A. The interface between the nucleus pulposus and innermost annulus fibrosis
B. The posterior aspect of the disc
C. The outer annulus fibrosis
D. The neovascular remnants within the nucleus pulposus
11. The following ascending tract conveys sensations of proprioception, vibration, and tactile discrimination:
A. Spinothalamic
B. Spinocerebellar
C. Spinoreticular
D. Dorsal Columns/medial lemniscus
12. Which process occurs when tissue is damaged and pain persists for a few days and leads to adaptation of
unimodal nociceptors?
A. secondary hyperalgesia
B. hypoalgesia
C. desensitization
D. primary hyperalgesia
Cfibers
by
13. Once the dorsal horn has been sensitized by a conditioning stimulus, sensory input from ______ results in
20hyperalgesia.
A. A-beta
B. A-delta
C. B
D. C
14. The phenomenon of central sensitization involves hyperactivity of which of the following structures?
A. golgi tendon organs
B. muscle spindle cells
C. interneurons
D. glial cells
15.Which of the following is NOT a component of the nerve complex?
A. nerve root
B. posterior root ganglion
C. intervertebral foramen
D. dura mater
16. Which of the following processes is most likely responsible for the persistence of pain observed in many
patients with long-term joint dysfunction?
A. acute inflammation
B. chronic inflammation
C. neurogenic inflammation
D. polymodal inflammation
17. If axonal transport of a nerve is blocked, which of the following is most likely to occur at the target
tissue(s)?
A. hypertrophy
B. atrophy
C. pallor
D. ATP deficiency
18. The intervertebral disc is composed of different components, which include all of the following except:
A. nucleus pulposus
B. annulus fibrosis
C. vertebral endplate
D. anterior longitudinal ligament
19. Which portion of the nervous system functions to receive sensory stimuli?
A. Somatic motor neuron
B. Autonomic ganglion
C. Dorsal root ganglia
D. Alpha motor neuron
20. All of the following are chemical mediators released in neurogenic inflammation except ______.
A. Bradykinin
B. Serotonin
C. Glutamate
D. Prostaglandin
21. The usual outcome in the repair phase of tissue healing is _________?
A. pain, swelling, and loss of function
B. collagen fiber production
C. increased tissue strength
D. realignment of collagen fibers
22. The A-delta sensory fibers from peripheral receptors are responsible for the transmission of ______ to the
dorsal horn.
A. epicritic pain
B. low intensity pain
C. mechanotransduction
D. slow pain
23. Which of the following is FALSE with respect to nociception?
A. inflammation drives the experience of pain
B. nociceptive signalling is directly correlated to pain intensity
C. hypervigilance usually intensifies the pain experience
D. pain can be modulated both peripherally and centrally
24. In addition to pain, nociceptive stimulation may also result in which of the following phenomena?
A. increased motor activity
B. increased autonomic responses
C. optimal endocrine responses
D. dysesthesia
25. Pain and inflammation are typically associated with spinal subluxation. What term describes the state in
which C-fibers and local tissue cells perpetuate inflammation?
A. chronic inflammation
B. acute inflammation
C. neurogenic inflammation
D. reflex sympathetic dystrophy
26. Once the dorsal horn has been sensitized by a conditioning stimulus, sensory input from ______ results in
allodynia.
A. A-beta
B. A-delta
C. B
D. C
27. Which of the following is a clinical attribute of radicular spinal pain?
A. sharp and shooting pain distally
B. chronic in nature
C. difficult to pinpoint its location
D. bilateral in its localized distribution
28. Primary hyperalgesia results from sensitization of which of the following structures?
A. C fibers
B. A-delta fibers
C. dorsal horn neurons
D. peripheral receptors
29. Increased immune system function and improved sleep are health benefits associated with a chiropractic
lifestyle.
A. True
B. False
30. The _____ is a complex structure positioned between two adjacent vertebrae where, in addition to
protecting the spinal cord and segmental spinal nerves, it confers flexibility, multi-axial spinal motion and load
transmission to the spine.
A. IVD
B. muscle
C. joint capsule
D. nuchal ligament
31. The mechanical force transmission that occurs at the macroscopic level and may affect tissues at the
cellular level is also known as ________.
A. mechanoreception
B. mechanotransduction
C. proprioception
D. nociception
32. Mechanoreception functions as the driver of the subluxation complex.
A. True
B. False
33. Spinal lesion pathology is typically exemplified by which of the following processes?
A. inflammation and degeneration
B. trauma and inflammation
C. trauma and degeneration
D. inflammation and radiculopathy
34. All of the following are factors that may improve healing except _________.
A. Younger age
B. Anabolic steroids
C. Laughter and a positive mood
D. Corticosteroids
E. Good sleep habits
35. Which subluxation etiology most likely accounts for joint restriction that arises from limited levels and kinds
of physical activity?
A. spinal buckling
B. neural compression
C. immobilization degeneration
D. altered trophic function
36. Which of the following ligaments tends to hypertrophy as the intervertebral disc degenerates?
A. ligamentum flavum
B. anterior longitudinal ligament
C. posterior longitudinal ligament
D. interspinous ligament
37. Mechanical force transmission that occurs at the macroscopic level may affect tissues at the cellular level.
A. True
B. False
38. When plasticity occurs in the dorsal horn from sustained nociceptor activity, this manifests as chronic pain
and is a/an ___________ central sensitization response.
A. initial
B. deactivated
C. learned
D. acute
39. What is the most important anatomical structure for joint position sense (proprioception)?
A. muscle spindles
B. joint capsule mechanoreceptors
C. cutaneous tactile receptors
D. unmyelinated free nerve endings
40. Which of the following is NOT found in the IVF?
A. arteries and veins
B. dorsal root ganglion
C. denticulate ligaments
D. lymphatic vessels
41. All of following are hallmarks of disc degeneration EXCEPT ________:
A. nucleus pulposus dehydration B. osteophyte formation
C. Intact of annular fibers
D. degeneration of facets
42. A football player suffers a herniated (ruptured) intervertebral disk in his neck. The disk compresses the
spinal nerve exiting through the intervertebral foramen between the 5th and 6th cervical vertebrae. Which
spinal nerve is affected?
A. C4
B. C5
C. C6
D. C7
E. C8
43. According to the gate control theory of pain, activation of which fibers open the gate?
A. A Alpha nerve fibers
C. C nerve fibers
B. A Beta nerve fibers causeperipheral
D. A Gamma nerve fibersmodulation
44. The term “Healing” best describes which of the following?
ofpain
A. Damage to the tissue that initiate a set of vascular and cellular events
B. Unpleasant sensory and emotional experience associated with actual tissue damage
C. The replacement of destroyed tissue by living tissue in the body.
45. All of the following is true about muscle repair except?
A. It forms scar tissue
B. It leaves the muscle weaker
C. It leaves the muscle less flexible
D. It decreases risk of re-injury
46. Which tissue can heal without forming a fibrous scar?
A. Bone
B. Skin
C. Tendon
D. Ligament
E. Muscle
47. Which of the following presentation is a clinical attribute of demyelination of efferent motor nerves?
A. sharp and shooting pain
B. chronic pain
C. Numbness and tingling
D. Muscle weakness
48. The spinal cord consists of ascending tracts and descending tracts of axons. Which of the following are
correct in reference to those tracts?
A. The ascending tracts are found in the white matter and transmit sensory information. The descending
tracts are found in the gray matter and transmit motor information.
B. The ascending tracts are found in the gray matter and transmit sensory information. The descending
tracts are found in the white matter and transmit motor information.
C. Both tracts are found in the white matter. The ascending tract transmits sensory information while the
descending tracts transmit motor information.
D. Both tracts are found in the white matter. The ascending tract transmits motor information while the
descending tracts transmit sensory information.
49. What is the name of the structures that hold the spinal cord in position within the vertebral foramen?
A. Filum terminale
B. Dorsal root ganglia
C. Denticulate ligaments
D. Arachnoid layer
50. Acute inflammation can be initiated by:
A. Mast cells activation
B. Lysozymes
C. by vascular permeability
D. Influx of neutrophils
51. Which of the following is the correct sequential order of the phases of healing?
A. Bleeding, inflammatory, proliferative and remodeling
B. inflammatory, bleeding, proliferative and maturation
C. Remodeling, inflammation, hemostasis and repair
D. Inflammation, maturation, proliferation and bleeding
52. Which of the following is a clinical attribute of radicular spinal pain?
A. sharp and shooting characteristic
B. chronic in nature
C. difficult to pinpoint its location
D. bilateral in its localized distribution
53. What is the origin of pain in a degenerated disk?
A. nerve entrapment
B. lack of nutrition
C. injury to the anulus fibrosus
D. damage to the nucleus pulposus
54. Subluxation may affect organ function and general health is the chiropractic concept put forth by _______.
A. DD Palmer
B. Rosner's paradigm
C. Association of Chiropractic Colleges
D. Spine care paradigm
55. If a spinal segment is restricted along the sagittal plane, which motions are restricted?
A. Right and left lateral flexion
B. Flexion and extension
C. Right and left rotation
D. right and left translation
56. ________ occurs when there is loss of energy within a viscoelastic structure subjected to repetitive cycles
of loading and unloading.
A. Creep
B. Hysteresis
C. Strain
D. Load relaxation
57. Which of the following positions places the least pressure on the disk?
A. sitting
B. standing
C. lying on the side
D. lying supine
58. In the stabilization stage of spinal degeneration, osteophytes form and protrude from the vertebral
endplates as the disc degenerates, in the body's attempt to fuse the motion segment and make it less mobile.
A. True
B. False
59. Which of the following is a characteristic of acute pain?
A. it is a special therapeutic challenge
B. it is uncoupled from a causative event
C. its intensity correlates with amount of damage
D. it becomes a disease in its own right
60. Which of the following is true regarding chronic pain?
A. severity correlates with the amount of tissue damage
B. often associated with depression, anger, and fears
C. pain warns of actual tissue damage
D. the parasympathetic nervous system predominates
61. Which of the following is an example of a CNS neuropathy?
A. migraine
B. diabetic neuropathy
C. pancreatitis
D. fibromyalgia
62. Diffuse palpation tenderness and disproportionate pain are common in which of the following pain
categories?
A. nociceptive pain
B. peripheral neurogenic pain
C. central sensitization
D. visceral pain
E. musculoskeletal pain
63. Identify the component of the PARTS acronym that is most closely associated with the kinesiopathological
component of the vertebral subluxation complex.
A. pain and tenderness
B. asymmetry
C. range of motion abnormality
D. tissue tone, texture, and temperature abnormality
64. At which level of sensory processing does modulation occur?
A. 1st
B. 2nd
C. 3rd
D. 4th
65. Which of the following is true regarding neuropathic pain?
A. neuropathic pain is a reaction to pathology
B. neuropathic pain usually resolves after the initiating event has healed
C. neuropathic pain is not usually accompanied by tissue injury
D. neuropathic pain often persists long after the initiating event has healed