National Board of Chiropractic Examiners (NBCE) Practice Test

Midline back pain, bilateral activity-related leg cramps, and decreased lower extremity distal pulses indicate the need for which examination procedure?

1. CT scan of the lumbar spine

2. Doppler ultrasound of the lower extremities

3. Cervical spine X-ray

4. Neurological examination

The correct answer is: Doppler ultrasound of the lower extremities

The presentation of midline back pain, bilateral activity-related leg cramps, and decreased lower extremity distal pulses suggests a potential vascular issue, possibly involving the blood flow to the legs. The symptoms of activity-related leg cramps, particularly if they occur during exertion and relieve with rest, may indicate intermittent claudication, which is often due to peripheral artery disease. In this context, a Doppler ultrasound of the lower extremities is the appropriate examination procedure. This imaging technique assesses blood flow in the arteries and can help identify occlusions or other abnormalities in the vascular system that could be causing the symptoms observed. Furthermore, the decreased distal pulses indicate inadequate blood supply, making this investigation crucial in determining the underlying causes of the patient's issues. While other examination procedures such as a CT scan of the lumbar spine, cervical spine X-ray, or neurological examination could potentially provide valuable information, they do not directly assess the vascular status of the lower extremities. Thus, they are less relevant given the specific combination of symptoms presented.