NBCE Part III Chiropractic Board Exam Study
Guide: Clinical Case Questions And Well
Graded Solutions With Rationales Updated
2026 2027
Pass your NBCE Part III Chiropractic Board Exam with confidence using this
comprehensive, high-yield study guide. Features 250 rigorous multiple-choice questions
broken down across core clinical categories, including case history, physical examination,
diagnostic imaging interpretation (DXI), chiropractic techniques, and case management.
Complete with full case vignettes, ASCII diagnostic diagrams, comparative tables, and
detailed rationales for every single answer. Perfect for final board prep.
Figure: Spinal Alignment Assessment
[ Normal Alignment ] [ Patient Presentation ]
| Cervical \ Cervical Right Lateral Flexion
| Thoracic | Thoracic Compensation
| Lumbar / Lumbar Left Rotation
1. A 34-year-old female presents with acute neck stiffness and restricted motion after
sleeping awkwardly. Examination reveals fixed right lateral flexion of the cervical
spine with severe pain during active left lateral flexion. Palpation identifies a
prominent, tender right posterior articular pillar at C3. What is the most likely
biomechanical listing according to Palmer-Gonstead nomenclature?
A. C3 PRS
1|Page
, B. C3 PRI-t
C. C3 PLS
D. C3 PLI-t
C3 PRS
Rationale: The prominent right posterior articular pillar indicates that the C3 spinous
process has rotated to the right (R). The restriction in left lateral flexion combined
with fixed right lateral flexion indicates a loss of joint space on the right, meaning the
spinous process has deviated superiorly on the side of rotation, or simply a simple
rotation and lateral flexion restriction combination consistent with a PRS listing
(Posterior, Right, Superior).
2. A 45-year-old construction worker presents with acute, severe low back pain after
lifting heavy drywall sheets. The pain radiates down the posterior aspect of his left
thigh and lateral calf to the dorsum of the foot. He exhibits a noticeable antalgic lean
away from the painful side. Which of the following nerve roots is most likely
compressed?
A. L4
B. L5
C. S1
D. S2
L5
Rationale: Radiation down the posterior thigh, lateral calf, and to the dorsum of the
foot maps directly to the L5 dermatome. Compression of the L5 nerve root commonly
results from a posterolateral disc herniation at the L4-L5 intervertebral level.
3. During an orthopedic evaluation of a 22-year-old college soccer player with acute
knee trauma, the clinician stabilizes the patient's distal femur with one hand and
applies an anterior traction force to the proximal tibia with the knee flexed at 20
degrees. This maneuver demonstrates significant forward translation of the tibia
compared to the uninjured side. What structure is damaged?
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial meniscus
D. Lateral collateral ligament
Anterior cruciate ligament
Rationale: This describes a positive Lachman test, which is the most sensitive
manual orthopedic examination for assessing the structural integrity of the anterior
cruciate ligament (ACL).
4. A 62-year-old male accountant presents with insidious onset of bilateral buttock and
thigh pain that worsens significantly when walking short distances. The pain is
completely relieved within minutes of sitting down or bending forward over a
shopping cart. Neurological examination at rest reveals intact reflexes and no focal
motor deficits. What is the most likely diagnosis?
A. Acute lumbar disc herniation
B. Piriformis syndrome
C. Trochanteric bursitis
D. Lumbar spinal stenosis
Lumbar spinal stenosis
Rationale: Neurogenic claudication caused by lumbar spinal stenosis
characteristically presents with bilateral lower extremity pain induced by walking
(extension) and relieved by sitting or forward flexion, which mechanically increases
the cross-sectional area of the spinal canal.
2|Page
,5. A patient presents with acute mid-back pain. The chiropractor performs a standard
posterior-to-anterior (P-A) chiropractic adjustment on the T6 spinous process.
According to spinal biomechanics and joint kinematics, which motion is primarily
induced at the targeted facet joints during this specific vector loading?
A. Extension
B. Flexion
C. Axial rotation
D. Lateral flexion
Extension
Rationale: A posterior-to-anterior (P-A) force applied directly to a thoracic spinous
process drives that vertebral segment forward relative to the segment below,
inducing a localized extension motion at the zygapophyseal joints.
Table: Neurological Examination Profiles
Patient Deep Tendon Reflexes Motor Function Sensory
Finding
A Absent (0/4) Flaccid Paresis Dermatomal
Loss
B Hyperactive (4/4) Spastic Paralysis Spinal Level
Cross
6. A 50-year-old female presents with progressive weakness in her right leg and an
altered gait. Clinical evaluation of the right lower extremity reveals a hyperactive
patellar reflex (4/4), a positive Babinski sign, and marked spasticity during passive
range of motion. The patient matches Profile B in the table. Where is the primary
lesion located?
A. Dorsal root ganglion
B. Ventral nerve root
C. Upper motor neuron pathway
D. Lower motor neuron pathway
Upper motor neuron pathway
Rationale: Hyperreflexia, spasticity, and a positive Babinski sign are classic clinical
indicators of an upper motor neuron (UMN) lesion, indicating pathology within the
central nervous system or corticospinal tracts.
7. A 28-year-old graphic designer presents with tingling and numbness in the palmar
surface of the thumb, index, and middle fingers of her right hand. The symptoms
worsen at night and during prolonged typing sessions. Tinel's sign is positive at the
wrist crease. Which anatomical tunnel is compromised?
A. Cubital tunnel
B. Tunnel of Guyon
C. Carpal tunnel
D. Radial tunnel
Carpal tunnel
Rationale: The median nerve travels through the carpal tunnel beneath the flexor
retinaculum. Compression here causes sensory paresthesia in the thumb, index, and
middle fingers, often accompanied by a positive wrist Tinel's sign.
8. An 18-year-old high school wrestler sustains a direct impact to his left shoulder while
being thrown onto the mat. He presents holding his left arm close to his side,
resisting any movement. Visual inspection reveals an obvious step-off deformity at
the lateral end of the clavicle, with localized swelling and severe exquisite
tenderness. What injury has occurred?
A. Anterior glenohumeral dislocation
3|Page
, B. Acromioclavicular separation
C. Rotator cuff tear
D. Clavicle mid-shaft fracture
Acromioclavicular separation
Rationale: A visible step-off deformity at the distal clavicle combined with localized
trauma in an athlete is the hallmark clinical presentation of a high-grade
acromioclavicular (AC) joint separation or sprain.
9. A 72-year-old female presents with persistent, localized thoracic pain following a
minor slip and fall in her kitchen two weeks ago. She has a documented history of
severe postmenopausal osteoporosis. Gentle percussion over the T8 spinous
process elicits sharp, localized discomfort. Neurological examination is
unremarkable. What is the most likely diagnosis?
A. Thoracic disc herniation
B. Intercostal neuralgia
C. Osteoporotic compression fracture
D. Spinal cord tumor
Osteoporotic compression fracture
Rationale: In a geriatric patient with severe osteoporosis, minor trauma such as a
minor slip can easily cause an axial compression fracture of a vertebral body,
characteristically presenting with sharp, localized bone pain on percussion.
10. A clinician performs an orthopedic test by having a seated patient actively rotate and
extend their head toward the symptomatic right side while the clinician applies a
gentle axial downward compression on the crown of the head. This maneuver
immediately reproduces sharp pain radiating down the patient's lateral right arm to
the hand. What does this test evaluate?
A. Thoracic outlet syndrome
B. Cervical radiculopathy
C. Brachial plexus traction injury
D. Vertebrobasilar artery insufficiency
Cervical radiculopathy
Rationale: This maneuver describes Spurling's test (Cervical Compression Test). A
positive test reproduces radicular arm symptoms by narrowing the neural foramina
on the side of head rotation and extension, confirming cervical nerve root
compression.
Figure: Brachial Plexus Schematic Trunk Identification
C5 ---\
+--- Upper Trunk ---> [ ? ]
C6 ---/
C7 ------------------------> Middle Trunk
C8 ---\
+--- Lower Trunk
T1 ---/
11. A 35-year-old mechanic presents with weakness when trying to lift his arm over his
head and difficulty flexing his elbow. Sensory testing demonstrates diminished
sensation along the lateral aspect of the arm and forearm. If the injury is isolated to
the upper trunk of the brachial plexus as highlighted in the figure, which peripheral
nerve is most likely directly affected?
A. Ulnar nerve
B. Median nerve
C. Musculocutaneous nerve
4|Page
Guide: Clinical Case Questions And Well
Graded Solutions With Rationales Updated
2026 2027
Pass your NBCE Part III Chiropractic Board Exam with confidence using this
comprehensive, high-yield study guide. Features 250 rigorous multiple-choice questions
broken down across core clinical categories, including case history, physical examination,
diagnostic imaging interpretation (DXI), chiropractic techniques, and case management.
Complete with full case vignettes, ASCII diagnostic diagrams, comparative tables, and
detailed rationales for every single answer. Perfect for final board prep.
Figure: Spinal Alignment Assessment
[ Normal Alignment ] [ Patient Presentation ]
| Cervical \ Cervical Right Lateral Flexion
| Thoracic | Thoracic Compensation
| Lumbar / Lumbar Left Rotation
1. A 34-year-old female presents with acute neck stiffness and restricted motion after
sleeping awkwardly. Examination reveals fixed right lateral flexion of the cervical
spine with severe pain during active left lateral flexion. Palpation identifies a
prominent, tender right posterior articular pillar at C3. What is the most likely
biomechanical listing according to Palmer-Gonstead nomenclature?
A. C3 PRS
1|Page
, B. C3 PRI-t
C. C3 PLS
D. C3 PLI-t
C3 PRS
Rationale: The prominent right posterior articular pillar indicates that the C3 spinous
process has rotated to the right (R). The restriction in left lateral flexion combined
with fixed right lateral flexion indicates a loss of joint space on the right, meaning the
spinous process has deviated superiorly on the side of rotation, or simply a simple
rotation and lateral flexion restriction combination consistent with a PRS listing
(Posterior, Right, Superior).
2. A 45-year-old construction worker presents with acute, severe low back pain after
lifting heavy drywall sheets. The pain radiates down the posterior aspect of his left
thigh and lateral calf to the dorsum of the foot. He exhibits a noticeable antalgic lean
away from the painful side. Which of the following nerve roots is most likely
compressed?
A. L4
B. L5
C. S1
D. S2
L5
Rationale: Radiation down the posterior thigh, lateral calf, and to the dorsum of the
foot maps directly to the L5 dermatome. Compression of the L5 nerve root commonly
results from a posterolateral disc herniation at the L4-L5 intervertebral level.
3. During an orthopedic evaluation of a 22-year-old college soccer player with acute
knee trauma, the clinician stabilizes the patient's distal femur with one hand and
applies an anterior traction force to the proximal tibia with the knee flexed at 20
degrees. This maneuver demonstrates significant forward translation of the tibia
compared to the uninjured side. What structure is damaged?
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial meniscus
D. Lateral collateral ligament
Anterior cruciate ligament
Rationale: This describes a positive Lachman test, which is the most sensitive
manual orthopedic examination for assessing the structural integrity of the anterior
cruciate ligament (ACL).
4. A 62-year-old male accountant presents with insidious onset of bilateral buttock and
thigh pain that worsens significantly when walking short distances. The pain is
completely relieved within minutes of sitting down or bending forward over a
shopping cart. Neurological examination at rest reveals intact reflexes and no focal
motor deficits. What is the most likely diagnosis?
A. Acute lumbar disc herniation
B. Piriformis syndrome
C. Trochanteric bursitis
D. Lumbar spinal stenosis
Lumbar spinal stenosis
Rationale: Neurogenic claudication caused by lumbar spinal stenosis
characteristically presents with bilateral lower extremity pain induced by walking
(extension) and relieved by sitting or forward flexion, which mechanically increases
the cross-sectional area of the spinal canal.
2|Page
,5. A patient presents with acute mid-back pain. The chiropractor performs a standard
posterior-to-anterior (P-A) chiropractic adjustment on the T6 spinous process.
According to spinal biomechanics and joint kinematics, which motion is primarily
induced at the targeted facet joints during this specific vector loading?
A. Extension
B. Flexion
C. Axial rotation
D. Lateral flexion
Extension
Rationale: A posterior-to-anterior (P-A) force applied directly to a thoracic spinous
process drives that vertebral segment forward relative to the segment below,
inducing a localized extension motion at the zygapophyseal joints.
Table: Neurological Examination Profiles
Patient Deep Tendon Reflexes Motor Function Sensory
Finding
A Absent (0/4) Flaccid Paresis Dermatomal
Loss
B Hyperactive (4/4) Spastic Paralysis Spinal Level
Cross
6. A 50-year-old female presents with progressive weakness in her right leg and an
altered gait. Clinical evaluation of the right lower extremity reveals a hyperactive
patellar reflex (4/4), a positive Babinski sign, and marked spasticity during passive
range of motion. The patient matches Profile B in the table. Where is the primary
lesion located?
A. Dorsal root ganglion
B. Ventral nerve root
C. Upper motor neuron pathway
D. Lower motor neuron pathway
Upper motor neuron pathway
Rationale: Hyperreflexia, spasticity, and a positive Babinski sign are classic clinical
indicators of an upper motor neuron (UMN) lesion, indicating pathology within the
central nervous system or corticospinal tracts.
7. A 28-year-old graphic designer presents with tingling and numbness in the palmar
surface of the thumb, index, and middle fingers of her right hand. The symptoms
worsen at night and during prolonged typing sessions. Tinel's sign is positive at the
wrist crease. Which anatomical tunnel is compromised?
A. Cubital tunnel
B. Tunnel of Guyon
C. Carpal tunnel
D. Radial tunnel
Carpal tunnel
Rationale: The median nerve travels through the carpal tunnel beneath the flexor
retinaculum. Compression here causes sensory paresthesia in the thumb, index, and
middle fingers, often accompanied by a positive wrist Tinel's sign.
8. An 18-year-old high school wrestler sustains a direct impact to his left shoulder while
being thrown onto the mat. He presents holding his left arm close to his side,
resisting any movement. Visual inspection reveals an obvious step-off deformity at
the lateral end of the clavicle, with localized swelling and severe exquisite
tenderness. What injury has occurred?
A. Anterior glenohumeral dislocation
3|Page
, B. Acromioclavicular separation
C. Rotator cuff tear
D. Clavicle mid-shaft fracture
Acromioclavicular separation
Rationale: A visible step-off deformity at the distal clavicle combined with localized
trauma in an athlete is the hallmark clinical presentation of a high-grade
acromioclavicular (AC) joint separation or sprain.
9. A 72-year-old female presents with persistent, localized thoracic pain following a
minor slip and fall in her kitchen two weeks ago. She has a documented history of
severe postmenopausal osteoporosis. Gentle percussion over the T8 spinous
process elicits sharp, localized discomfort. Neurological examination is
unremarkable. What is the most likely diagnosis?
A. Thoracic disc herniation
B. Intercostal neuralgia
C. Osteoporotic compression fracture
D. Spinal cord tumor
Osteoporotic compression fracture
Rationale: In a geriatric patient with severe osteoporosis, minor trauma such as a
minor slip can easily cause an axial compression fracture of a vertebral body,
characteristically presenting with sharp, localized bone pain on percussion.
10. A clinician performs an orthopedic test by having a seated patient actively rotate and
extend their head toward the symptomatic right side while the clinician applies a
gentle axial downward compression on the crown of the head. This maneuver
immediately reproduces sharp pain radiating down the patient's lateral right arm to
the hand. What does this test evaluate?
A. Thoracic outlet syndrome
B. Cervical radiculopathy
C. Brachial plexus traction injury
D. Vertebrobasilar artery insufficiency
Cervical radiculopathy
Rationale: This maneuver describes Spurling's test (Cervical Compression Test). A
positive test reproduces radicular arm symptoms by narrowing the neural foramina
on the side of head rotation and extension, confirming cervical nerve root
compression.
Figure: Brachial Plexus Schematic Trunk Identification
C5 ---\
+--- Upper Trunk ---> [ ? ]
C6 ---/
C7 ------------------------> Middle Trunk
C8 ---\
+--- Lower Trunk
T1 ---/
11. A 35-year-old mechanic presents with weakness when trying to lift his arm over his
head and difficulty flexing his elbow. Sensory testing demonstrates diminished
sensation along the lateral aspect of the arm and forearm. If the injury is isolated to
the upper trunk of the brachial plexus as highlighted in the figure, which peripheral
nerve is most likely directly affected?
A. Ulnar nerve
B. Median nerve
C. Musculocutaneous nerve
4|Page
