NBCE EXAM PART 3 ACTUAL EXAM 2026/2027 HIGH YIELD PRACTICE
QUESTIONS AND STUDY GUIDE COMPLETE APPROVED QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES (100%
CORRECT VERIFIED SOLUTIONS) LATEST UPDATED VERSION 2026
EDITION |ALREADY GRADED A+ (BRAND NEW!)
SECTION 1: CASE HISTORY & PHYSICAL EXAMINATION (Questions 1-20)
Question 1
A 43-year-old male auto mechanic presents with sharp, intense pain in the right
thoracic region that began one day ago following a traumatic lifting injury. The
pain is constant, moderate in severity, and worsens with deep inspiration. No
radiation is reported. Past medical history is unremarkable. What is the most likely
diagnosis?
A) Rib subluxation
B) Thoracolumbar fracture
C) Pleurisy
D) Myocardial infarction
E) Pneumothorax
Correct Answer: A) Rib subluxation
Rationale: The presentation of sharp, intense pain following traumatic injury that
worsens with deep inspiration is classic for rib subluxation or costovertebral strain.
The patient's occupation as an auto mechanic with acute onset after lifting supports
a musculoskeletal origin. The absence of red flags, radiation, or systemic
symptoms makes more serious conditions like fracture, pleurisy, or MI less likely .
Management options include adjustment of the ribs and thoracics, ergonomic
training, and performing spinous percussion and rib compression tests .
,Question 2
A 41-year-old female presents with a 2-month history of headaches that worsened
3 days ago. She describes throbbing pain in the temple area that spreads to the base
of the neck. Rest and quiet make it better, while noise, activity, and work
exacerbate symptoms. She appears nervous and emotional. Her mother has a
history of headaches. Which of the following is the most appropriate next step?
A) Trial of chiropractic adjustments
B) Referral to a neurologist
C) Referral to an oncologist
D) Prescription for antidepressant medication
E) Cervical spine radiographs
Correct Answer: B) Referral to a neurologist
Rationale: This patient presents with chronic headache features including
throbbing quality, exacerbation with activity, and concerning symptoms of
dizziness and clumsiness. The 2-month duration with recent worsening, combined
with neurological symptoms (dizziness, clumsiness), warrants neurological
evaluation. While migraine is possible, the presence of neurological deficits and
the progressive nature of symptoms necessitate specialist referral to rule out
intracranial pathology .
Question 3
A 25-year-old female housewife presents with joint pain in the wrists and
shoulders that began approximately one year ago following the birth of her child.
,She reports achy pain, fatigue, and feeling "hurt all over." Her gynecologist
attributed symptoms to postpartum depression. ROS reveals kidney infections, skin
rashes, and swollen hands and feet. Family history is positive for depression. What
is the most likely diagnosis?
A) Rheumatoid arthritis
B) Fibromyalgia
C) Systemic lupus erythematosus
D) Gonococcal arthralgia
E) Postpartum depression
Correct Answer: C) Systemic lupus erythematosus
Rationale: This patient's presentation of bilateral joint pain in wrists and shoulders,
skin rashes, kidney infections, and swelling of hands and feet with fatigue is
characteristic of systemic lupus erythematosus (SLE). The multisystem
involvement—musculoskeletal, dermatological, renal, and constitutional
symptoms—points toward SLE rather than the other options. Fibromyalgia would
not account for kidney infections or skin rashes. RA typically presents with more
significant morning stiffness and specific joint patterns. The appropriate
management would be referral to a rheumatologist .
Question 4
A 58-year-old male heavy equipment manager presents with low back pain that has
been ongoing for 2 years. He reports difficulty getting out of bed and has been
waking 2-3 times nightly to urinate. The pain is described as a deep ache radiating
into the left foot with severity 8-9/10. He has hypertension and takes diuretics. He
reports feeling that his bladder is always full but cannot void as well as he used to.
What is the most likely diagnosis?
, A) Lumbar disc herniation
B) Lumbar spinal stenosis
C) Prostate disease
D) Lumbar facet syndrome
E) Sacroiliac joint dysfunction
Correct Answer: C) Prostate disease
Rationale: The combination of low back pain radiating to the lower extremity with
urinary symptoms (frequency, nocturia, feeling of incomplete bladder emptying,
and difficulty voiding) in a 58-year-old male is highly suggestive of prostate
disease, which can present with both urinary symptoms and referred pain to the
low back and lower extremities. While disc involvement is possible, the urinary
symptoms and age make prostate pathology a priority consideration. A digital
rectal exam and appropriate laboratory studies (PSA, urinalysis) would be
indicated. Additional testing might include radionuclide studies, bone panel, and
cystometric evaluation .
Question 5
A patient presents with chest pain. Which of the following is the number one cause
of chest pain?
A) Myocardial infarction
B) Heartburn (gastroesophageal reflux)
C) Pulmonary embolism
D) Costochondritis
QUESTIONS AND STUDY GUIDE COMPLETE APPROVED QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES (100%
CORRECT VERIFIED SOLUTIONS) LATEST UPDATED VERSION 2026
EDITION |ALREADY GRADED A+ (BRAND NEW!)
SECTION 1: CASE HISTORY & PHYSICAL EXAMINATION (Questions 1-20)
Question 1
A 43-year-old male auto mechanic presents with sharp, intense pain in the right
thoracic region that began one day ago following a traumatic lifting injury. The
pain is constant, moderate in severity, and worsens with deep inspiration. No
radiation is reported. Past medical history is unremarkable. What is the most likely
diagnosis?
A) Rib subluxation
B) Thoracolumbar fracture
C) Pleurisy
D) Myocardial infarction
E) Pneumothorax
Correct Answer: A) Rib subluxation
Rationale: The presentation of sharp, intense pain following traumatic injury that
worsens with deep inspiration is classic for rib subluxation or costovertebral strain.
The patient's occupation as an auto mechanic with acute onset after lifting supports
a musculoskeletal origin. The absence of red flags, radiation, or systemic
symptoms makes more serious conditions like fracture, pleurisy, or MI less likely .
Management options include adjustment of the ribs and thoracics, ergonomic
training, and performing spinous percussion and rib compression tests .
,Question 2
A 41-year-old female presents with a 2-month history of headaches that worsened
3 days ago. She describes throbbing pain in the temple area that spreads to the base
of the neck. Rest and quiet make it better, while noise, activity, and work
exacerbate symptoms. She appears nervous and emotional. Her mother has a
history of headaches. Which of the following is the most appropriate next step?
A) Trial of chiropractic adjustments
B) Referral to a neurologist
C) Referral to an oncologist
D) Prescription for antidepressant medication
E) Cervical spine radiographs
Correct Answer: B) Referral to a neurologist
Rationale: This patient presents with chronic headache features including
throbbing quality, exacerbation with activity, and concerning symptoms of
dizziness and clumsiness. The 2-month duration with recent worsening, combined
with neurological symptoms (dizziness, clumsiness), warrants neurological
evaluation. While migraine is possible, the presence of neurological deficits and
the progressive nature of symptoms necessitate specialist referral to rule out
intracranial pathology .
Question 3
A 25-year-old female housewife presents with joint pain in the wrists and
shoulders that began approximately one year ago following the birth of her child.
,She reports achy pain, fatigue, and feeling "hurt all over." Her gynecologist
attributed symptoms to postpartum depression. ROS reveals kidney infections, skin
rashes, and swollen hands and feet. Family history is positive for depression. What
is the most likely diagnosis?
A) Rheumatoid arthritis
B) Fibromyalgia
C) Systemic lupus erythematosus
D) Gonococcal arthralgia
E) Postpartum depression
Correct Answer: C) Systemic lupus erythematosus
Rationale: This patient's presentation of bilateral joint pain in wrists and shoulders,
skin rashes, kidney infections, and swelling of hands and feet with fatigue is
characteristic of systemic lupus erythematosus (SLE). The multisystem
involvement—musculoskeletal, dermatological, renal, and constitutional
symptoms—points toward SLE rather than the other options. Fibromyalgia would
not account for kidney infections or skin rashes. RA typically presents with more
significant morning stiffness and specific joint patterns. The appropriate
management would be referral to a rheumatologist .
Question 4
A 58-year-old male heavy equipment manager presents with low back pain that has
been ongoing for 2 years. He reports difficulty getting out of bed and has been
waking 2-3 times nightly to urinate. The pain is described as a deep ache radiating
into the left foot with severity 8-9/10. He has hypertension and takes diuretics. He
reports feeling that his bladder is always full but cannot void as well as he used to.
What is the most likely diagnosis?
, A) Lumbar disc herniation
B) Lumbar spinal stenosis
C) Prostate disease
D) Lumbar facet syndrome
E) Sacroiliac joint dysfunction
Correct Answer: C) Prostate disease
Rationale: The combination of low back pain radiating to the lower extremity with
urinary symptoms (frequency, nocturia, feeling of incomplete bladder emptying,
and difficulty voiding) in a 58-year-old male is highly suggestive of prostate
disease, which can present with both urinary symptoms and referred pain to the
low back and lower extremities. While disc involvement is possible, the urinary
symptoms and age make prostate pathology a priority consideration. A digital
rectal exam and appropriate laboratory studies (PSA, urinalysis) would be
indicated. Additional testing might include radionuclide studies, bone panel, and
cystometric evaluation .
Question 5
A patient presents with chest pain. Which of the following is the number one cause
of chest pain?
A) Myocardial infarction
B) Heartburn (gastroesophageal reflux)
C) Pulmonary embolism
D) Costochondritis
