NBCE PART 3 BOARD EXAM ULTIMATE
PREP QUESTIONS, ANSWERS &
DETAILED RATIONALES (GRADED A+)
Master the NBCE Part 3 board exam with this
comprehensive, 100% correct question and answer bank
designed to maximize your study efficiency. This high-yield
review document covers critical case management vignettes,
diagnostic imaging interpretation, and orthopedic assessment
rationales that are frequently tested on the official examination.
Perfect for quick scanning and active recall, this guide guarantees
top marks and serves as an essential resource for chiropractic
students aiming for an A+ grade.
1. A 64-year-old male presents with deep, boring low back pain that is
worse at night and unrelated to activity. Radiographic evaluation
reveals a generalized increase in bone density with a thickened
cortical border and coarsened trabeculae in the lumbar vertebrae.
Laboratory analysis reveals markedly elevated serum alkaline
phosphatase with normal calcium and phosphorus levels. What is the
most likely diagnosis?
A) Osteoblastic metastasis
B) Paget's disease
C) Osteopetrosis
D) Hodgkin's lymphoma
Answer: B
,Rationale: Paget's disease (osteitis deformans) typically presents in males
over 50 with a characteristic triad of radiographic findings: cortical
thickening, coarsened trabeculae, and bone enlargement. The hallmark
laboratory finding is a markedly elevated serum alkaline phosphatase with
normal serum calcium and phosphorus levels. Osteoblastic metastasis
would present with normal or slightly elevated alkaline phosphatase but
would typically show focal, irregular blastic ivory vertebrae without cortical
thickening.
2. An overweight 13-year-old male presents with progressive right
groin and knee pain, resulting in an antalgic gait. Physical
examination reveals a restriction in internal rotation and abduction of
the hip. What is the immediate clinical protocol?
A) Begin high-velocity, low-amplitude chiropractic adjustments of the
lumbar spine and pelvis
B) Order a lumbar MRI to rule out L4 nerve root compression
C) Recommend non-weight bearing status and refer to an orthopedic
surgeon
D) Initiate aggressive physical therapy stretching of the hip adductors
Answer: C
Rationale: This presentation is highly classic for Slipped Capital Femoral
Epiphysis (SCFE), a common adolescent hip pathology. Immediate
management requires keeping the patient non-weight bearing via crutches
or a wheelchair to prevent further slippage or avascular necrosis, followed
by a direct referral to an orthopedic surgeon for internal fixation pin
stabilization.
3. During a comprehensive neurological examination, a 45-year-old
patient exhibits a positive Hoffmann sign, hyperreflexia of the patellar
tendon, and spasticity in the lower extremities. Which of the following
clinical signs is also expected in this patient?
A) Fasciculations
,B) Hypotonia
C) Absent Babinski sign
D) Ankle clonus
Answer: D
Rationale: A positive Hoffmann sign, hyperreflexia, and spasticity are
classic signs of an Upper Motor Neuron Lesion (UMNL). Ankle clonus is a
rhythmic, involuntary muscle contraction associated with hyperreflexia in
UMN lesions. Fasciculations, hypotonia, and hyporeflexia are signs of a
Lower Motor Neuron Lesion (LMNL).
4. A high school baseball pitcher presents with paresthesia and
numbness along the medial aspect of the forearm and into the 4th and
5th digits. Examination reveals a positive Tinel sign at the cubital
tunnel. What conservative management instruction is most
appropriate for this patient?
A) Sleep with the elbow fully flexed to reduce fascial tension
B) Sleep with an elbow splint maintaining 45 degrees of flexion
C) Immobilize the wrist in 20 degrees of extension
D) Avoid all passive extension of the wrist and fingers
Answer: B
Rationale: Cubital tunnel syndrome involves compression of the ulnar
nerve at the elbow. Sleeping with the elbow splinted in approximately 45
degrees of flexion minimizes tension and compression on the ulnar nerve,
preventing nocturnal exacerbations without causing joint stiffness from full
extension or full flexion.
5. A 52-year-old patient presents with small, irregular, unequal pupils.
Clinical assessment demonstrates that the pupils contract when the
patient focuses on a near object, but there is zero constriction when a
direct light is shone into either eye. What is this phenomenon called,
and what is its historical etiology?
, A) Adie's tonic pupil; Viral ciliary ganglionitis
B) Marcus Gunn pupil; Optic nerve neuritis
C) Argyll Robertson pupil; Neurosyphilis
D) Horner's syndrome; Pancoast tumor
Answer: C
Rationale: The Argyll Robertson pupil is classically described as a pupil
that "accommodates but does not react" to light. It is caused by a lesion in
the pretectal nucleus of the midbrain and is highly specific for neurosyphilis
(tertiary syphilis).
6. A 34-year-old construction worker presents with sharp, localized
lower back pain following a twisting injury. The pain is exacerbated by
lumbar extension and relieved by flexion. There is no radiation of pain
into the lower extremities, and all neurological tests are within normal
limits. Kemp's test is positive bilaterally for localized lower back pain.
What is the clinical impression?
A) Lumbar disc herniation with radiculopathy
B) Lateral recess stenosis
C) Lumbar facet syndrome
D) Spondylolytic spondylolisthesis
Answer: C
Rationale: Lumbar facet syndrome presents with localized back pain that
does not radiate past the knee. Because the facet joints carry more weight
during extension, extension and rotation (such as during Kemp's test)
compress the joint surfaces and provoke the pain. Disc lesions are typically
aggravated by flexion.
7. A 28-year-old female presents with chronic diarrhea, abdominal
bloating, weight loss, and fatigue. Laboratory testing reveals IgA anti-
tissue transglutaminase antibodies. Biopsy of the small intestine
demonstrates severe villous atrophy and damage to the mucosa of
PREP QUESTIONS, ANSWERS &
DETAILED RATIONALES (GRADED A+)
Master the NBCE Part 3 board exam with this
comprehensive, 100% correct question and answer bank
designed to maximize your study efficiency. This high-yield
review document covers critical case management vignettes,
diagnostic imaging interpretation, and orthopedic assessment
rationales that are frequently tested on the official examination.
Perfect for quick scanning and active recall, this guide guarantees
top marks and serves as an essential resource for chiropractic
students aiming for an A+ grade.
1. A 64-year-old male presents with deep, boring low back pain that is
worse at night and unrelated to activity. Radiographic evaluation
reveals a generalized increase in bone density with a thickened
cortical border and coarsened trabeculae in the lumbar vertebrae.
Laboratory analysis reveals markedly elevated serum alkaline
phosphatase with normal calcium and phosphorus levels. What is the
most likely diagnosis?
A) Osteoblastic metastasis
B) Paget's disease
C) Osteopetrosis
D) Hodgkin's lymphoma
Answer: B
,Rationale: Paget's disease (osteitis deformans) typically presents in males
over 50 with a characteristic triad of radiographic findings: cortical
thickening, coarsened trabeculae, and bone enlargement. The hallmark
laboratory finding is a markedly elevated serum alkaline phosphatase with
normal serum calcium and phosphorus levels. Osteoblastic metastasis
would present with normal or slightly elevated alkaline phosphatase but
would typically show focal, irregular blastic ivory vertebrae without cortical
thickening.
2. An overweight 13-year-old male presents with progressive right
groin and knee pain, resulting in an antalgic gait. Physical
examination reveals a restriction in internal rotation and abduction of
the hip. What is the immediate clinical protocol?
A) Begin high-velocity, low-amplitude chiropractic adjustments of the
lumbar spine and pelvis
B) Order a lumbar MRI to rule out L4 nerve root compression
C) Recommend non-weight bearing status and refer to an orthopedic
surgeon
D) Initiate aggressive physical therapy stretching of the hip adductors
Answer: C
Rationale: This presentation is highly classic for Slipped Capital Femoral
Epiphysis (SCFE), a common adolescent hip pathology. Immediate
management requires keeping the patient non-weight bearing via crutches
or a wheelchair to prevent further slippage or avascular necrosis, followed
by a direct referral to an orthopedic surgeon for internal fixation pin
stabilization.
3. During a comprehensive neurological examination, a 45-year-old
patient exhibits a positive Hoffmann sign, hyperreflexia of the patellar
tendon, and spasticity in the lower extremities. Which of the following
clinical signs is also expected in this patient?
A) Fasciculations
,B) Hypotonia
C) Absent Babinski sign
D) Ankle clonus
Answer: D
Rationale: A positive Hoffmann sign, hyperreflexia, and spasticity are
classic signs of an Upper Motor Neuron Lesion (UMNL). Ankle clonus is a
rhythmic, involuntary muscle contraction associated with hyperreflexia in
UMN lesions. Fasciculations, hypotonia, and hyporeflexia are signs of a
Lower Motor Neuron Lesion (LMNL).
4. A high school baseball pitcher presents with paresthesia and
numbness along the medial aspect of the forearm and into the 4th and
5th digits. Examination reveals a positive Tinel sign at the cubital
tunnel. What conservative management instruction is most
appropriate for this patient?
A) Sleep with the elbow fully flexed to reduce fascial tension
B) Sleep with an elbow splint maintaining 45 degrees of flexion
C) Immobilize the wrist in 20 degrees of extension
D) Avoid all passive extension of the wrist and fingers
Answer: B
Rationale: Cubital tunnel syndrome involves compression of the ulnar
nerve at the elbow. Sleeping with the elbow splinted in approximately 45
degrees of flexion minimizes tension and compression on the ulnar nerve,
preventing nocturnal exacerbations without causing joint stiffness from full
extension or full flexion.
5. A 52-year-old patient presents with small, irregular, unequal pupils.
Clinical assessment demonstrates that the pupils contract when the
patient focuses on a near object, but there is zero constriction when a
direct light is shone into either eye. What is this phenomenon called,
and what is its historical etiology?
, A) Adie's tonic pupil; Viral ciliary ganglionitis
B) Marcus Gunn pupil; Optic nerve neuritis
C) Argyll Robertson pupil; Neurosyphilis
D) Horner's syndrome; Pancoast tumor
Answer: C
Rationale: The Argyll Robertson pupil is classically described as a pupil
that "accommodates but does not react" to light. It is caused by a lesion in
the pretectal nucleus of the midbrain and is highly specific for neurosyphilis
(tertiary syphilis).
6. A 34-year-old construction worker presents with sharp, localized
lower back pain following a twisting injury. The pain is exacerbated by
lumbar extension and relieved by flexion. There is no radiation of pain
into the lower extremities, and all neurological tests are within normal
limits. Kemp's test is positive bilaterally for localized lower back pain.
What is the clinical impression?
A) Lumbar disc herniation with radiculopathy
B) Lateral recess stenosis
C) Lumbar facet syndrome
D) Spondylolytic spondylolisthesis
Answer: C
Rationale: Lumbar facet syndrome presents with localized back pain that
does not radiate past the knee. Because the facet joints carry more weight
during extension, extension and rotation (such as during Kemp's test)
compress the joint surfaces and provoke the pain. Disc lesions are typically
aggravated by flexion.
7. A 28-year-old female presents with chronic diarrhea, abdominal
bloating, weight loss, and fatigue. Laboratory testing reveals IgA anti-
tissue transglutaminase antibodies. Biopsy of the small intestine
demonstrates severe villous atrophy and damage to the mucosa of
