NBCE EXAM PART 3 EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
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EXAM COVERAGE
1. Case History and Interview Techniques
2. Neuromusculoskeletal Examination
3. Diagnostic Imaging and Laboratory Findings
4. Chiropractic Technique and Case Management
5. Professional Practice, Jurisprudence, and Ethics
1. A 45-year-old male presents to the clinic with chronic, progressive lower back pain radiating
down the right posterior thigh to the lateral calf over the past three months. He reports no bowel
or bladder dysfunction, but physical examination reveals diminished right Achilles tendon reflex,
weak plantar flexion, and a positive sensory deficit along the S1 dermatome. What is the most
appropriate initial diagnostic imaging modality to evaluate this patient's clinical presentation?
A. Plain film lumbar spine radiographs (anteroposterior, lateral, and spot views)
B. Magnetic resonance imaging (MRI) of the lumbar spine without contrast
C. Diagnostic musculoskeletal ultrasound of the lumbosacral plexus
D. Computed tomography (CT) scan of the lumbar spine with intrathecal contrast
CORRECT ANSWER : B
Rationale: MRI of the lumbar spine without contrast is the gold standard imaging modality for
evaluating suspected lumbar disc herniations, nerve root compression, and soft tissue
pathologies causing radiculopathy. Plain films (Option A) are useful for assessing osseous
structures, alignment, and instability, but lack the soft-tissue resolution needed to visualize disc
material compressing the S1 nerve root. CT with contrast (Option D) and ultrasound (Option C)
are not the primary modalities of choice for routine lumbar radiculopathy evaluation due to
radiation exposure or limited depth and visualization of deep spinal structures.
,2. A 32-year-old female presents with recurrent right-sided throbbing headaches accompanied by
photophobia, phonophobia, and mild nausea occurring twice a week. She notes that her
headaches are frequently preceded by shimmering visual scotomas lasting approximately 20
minutes. Which of the following is the most definitive clinical classification for this specific type
of headache?
A. Chronic tension-type headache with migrainous features
B. Migraine with aura
C. Cluster headache with autonomic manifestations
D. Hemiplegic migraine with brainstem focal deficits
CORRECT ANSWER : B
Rationale: Migraine with aura is characterized by recurrent attacks of headache pain preceded
by fully reversible focal neurological symptoms, most commonly visual disturbances such as
shimmering scotomas lasting 5 to 60 minutes. Tension-type headaches (Option A) lack
associated aura and severe autonomic or migrainous symptoms like photophobia. Cluster
headaches (Option C) present with severe, strictly unilateral periorbital pain accompanied by
ipsilateral cranial autonomic features. Hemiplegic migraine (Option D) involves reversible
motor weakness, which is not present in this clinical description.
3. During a routine physical examination of a 60-year-old male patient, auscultation of the carotid
arteries reveals a harsh, high-pitched systolic bruit heard unilaterally on the left. The patient is
currently asymptomatic regarding focal neurological deficits. What is the most appropriate next
clinical step for this patient?
A. Immediate referral to the emergency department for intravenous thrombolytic evaluation
B. Ordering a duplex Doppler ultrasound of the carotid arteries to assess degree of stenosis
C. Performing high-velocity, low-amplitude cervical manipulation to improve local vascular
perfusion
D. Reassuring the patient and scheduling routine follow-up in one year
CORRECT ANSWER : B
Rationale: An asymptomatic carotid bruit warrants non-invasive vascular imaging, specifically a
duplex Doppler ultrasound, to quantify the percentage of luminal stenosis and evaluate plaque
morphology. Emergency referral (Option A) is indicated for acute symptomatic stroke or
transient ischemic attacks, not asymptomatic bruits. High-velocity, low-amplitude cervical
manipulation (Option C) is contraindicated or requires extreme caution in the presence of
significant vascular stenosis or carotid bruits due to potential risk of arterial dissection.
, Reassuring without further workup (Option D) fails to rule out potentially severe, asymptomatic
cerebrovascular disease.
4. A 28-year-old female presents with widespread musculoskeletal pain, chronic fatigue, and
unrefreshing sleep persisting for 14 months. She reports tenderness to light palpation across
multiple designated body sites, including the trapezius, second costochondral junction, and
lateral epicondyle. Comprehensive laboratory workup, including complete blood count,
erythrocyte sedimentation rate, and thyroid panel, returns completely normal. What is the
primary diagnosis that fits this clinical presentation?
A. Polymyalgia rheumatica
B. Fibromyalgia syndrome
C. Rheumatoid arthritis
D. Myofascial pain syndrome with regional trigger points
CORRECT ANSWER : B
Rationale: Fibromyalgia syndrome is characterized by chronic widespread musculoskeletal
pain, multiple tender points, fatigue, and sleep disturbances in the presence of normal laboratory
inflammatory markers. Polymyalgia rheumatica (Option A) typically affects patients over 50 and
is marked by elevated inflammatory markers (ESR, CRP) and severe proximal girdle stiffness.
Rheumatoid arthritis (Option C) presents with symmetrical inflammatory joint synovitis and
positive autoantibodies (RF, anti-CCP). Myofascial pain syndrome (Option D) typically involves
regional pain originating from specific taut muscle bands and active trigger points rather than
widespread symmetrical tender points.
5. A 55-year-old male presents with deep, boring right shoulder pain that worsens significantly at
night, particularly when lying on the affected side. Active range of motion reveals a painful arc
between 60 and 120 degrees of abduction, and Hawkins-Kennedy and Neer tests are both
positive. Which anatomical structure is most directly implicated in this classic presentation of
shoulder impingement syndrome?
A. Supraspinatus tendon
B. Long head of the biceps brachii tendon exclusively
C. Subscapularis tendon insertion at the lesser tubercle
D. Glenoid labrum posteroinferior margin
CORRECT ANSWER : A
, Rationale: The supraspinatus tendon passes directly beneath the coracoacromial arch and is the
most frequently impinged rotator cuff tendon, producing a classic painful arc of abduction and
positive Hawkins-Kennedy and Neer tests. While the long head of the biceps tendon (Option B)
can be involved in impingement, isolated biceps pathology typically presents with anterior
bicipital groove tenderness and a positive Speed's test. The subscapularis (Option C) is an
internal rotator tested via the lift-off test. The glenoid labrum (Option D) is implicated in
instability and labral tears, assessed via tests like O'Brien's or Crank.
6. A 50-year-old female presents with insidious onset of left shoulder pain and a progressive,
severe loss of both active and passive range of motion, particularly external rotation and
abduction. She reports that simple daily activities, such as reaching into a back pocket or
fastening a bra, have become nearly impossible over the past six months. What is the most likely
diagnosis?
A. Full-thickness rotator cuff tear
B. Adhesive capsulitis
C. Acromioclavicular osteoarthritis
D. Calcific tendinitis of the rotator cuff
CORRECT ANSWER : B
Rationale: Adhesive capsulitis (frozen shoulder) is characterized by a marked and progressive
restriction of both active and passive ranges of motion, with external rotation being
disproportionately limited. A full-thickness rotator cuff tear (Option A) typically preserves
passive range of motion despite significant active weakness. Acromioclavicular osteoarthritis
(Option C) presents with localized superior shoulder pain and pain at the extremes of cross-body
adduction. Calcific tendinitis (Option D) causes acute, intensely painful calcium crystal
deposition within the tendon, distinguishable from the global capsular restriction of adhesive
capsulitis.
7. A 22-year-old collegiate soccer player presents with acute right knee pain and a sensation of the
knee "giving out" immediately after planting his foot and pivoting sharply during a match. He
heard a distinct "pop" followed by rapid joint swelling within two hours. Which orthopedic test
is most sensitive and specific for confirming an injury to the structure most commonly
implicated in this mechanism?
A. Apley compression test
B. Valgus stress test at 30 degrees of flexion
C. Lachman test
D. Posterior drawer test
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Case History and Interview Techniques
2. Neuromusculoskeletal Examination
3. Diagnostic Imaging and Laboratory Findings
4. Chiropractic Technique and Case Management
5. Professional Practice, Jurisprudence, and Ethics
1. A 45-year-old male presents to the clinic with chronic, progressive lower back pain radiating
down the right posterior thigh to the lateral calf over the past three months. He reports no bowel
or bladder dysfunction, but physical examination reveals diminished right Achilles tendon reflex,
weak plantar flexion, and a positive sensory deficit along the S1 dermatome. What is the most
appropriate initial diagnostic imaging modality to evaluate this patient's clinical presentation?
A. Plain film lumbar spine radiographs (anteroposterior, lateral, and spot views)
B. Magnetic resonance imaging (MRI) of the lumbar spine without contrast
C. Diagnostic musculoskeletal ultrasound of the lumbosacral plexus
D. Computed tomography (CT) scan of the lumbar spine with intrathecal contrast
CORRECT ANSWER : B
Rationale: MRI of the lumbar spine without contrast is the gold standard imaging modality for
evaluating suspected lumbar disc herniations, nerve root compression, and soft tissue
pathologies causing radiculopathy. Plain films (Option A) are useful for assessing osseous
structures, alignment, and instability, but lack the soft-tissue resolution needed to visualize disc
material compressing the S1 nerve root. CT with contrast (Option D) and ultrasound (Option C)
are not the primary modalities of choice for routine lumbar radiculopathy evaluation due to
radiation exposure or limited depth and visualization of deep spinal structures.
,2. A 32-year-old female presents with recurrent right-sided throbbing headaches accompanied by
photophobia, phonophobia, and mild nausea occurring twice a week. She notes that her
headaches are frequently preceded by shimmering visual scotomas lasting approximately 20
minutes. Which of the following is the most definitive clinical classification for this specific type
of headache?
A. Chronic tension-type headache with migrainous features
B. Migraine with aura
C. Cluster headache with autonomic manifestations
D. Hemiplegic migraine with brainstem focal deficits
CORRECT ANSWER : B
Rationale: Migraine with aura is characterized by recurrent attacks of headache pain preceded
by fully reversible focal neurological symptoms, most commonly visual disturbances such as
shimmering scotomas lasting 5 to 60 minutes. Tension-type headaches (Option A) lack
associated aura and severe autonomic or migrainous symptoms like photophobia. Cluster
headaches (Option C) present with severe, strictly unilateral periorbital pain accompanied by
ipsilateral cranial autonomic features. Hemiplegic migraine (Option D) involves reversible
motor weakness, which is not present in this clinical description.
3. During a routine physical examination of a 60-year-old male patient, auscultation of the carotid
arteries reveals a harsh, high-pitched systolic bruit heard unilaterally on the left. The patient is
currently asymptomatic regarding focal neurological deficits. What is the most appropriate next
clinical step for this patient?
A. Immediate referral to the emergency department for intravenous thrombolytic evaluation
B. Ordering a duplex Doppler ultrasound of the carotid arteries to assess degree of stenosis
C. Performing high-velocity, low-amplitude cervical manipulation to improve local vascular
perfusion
D. Reassuring the patient and scheduling routine follow-up in one year
CORRECT ANSWER : B
Rationale: An asymptomatic carotid bruit warrants non-invasive vascular imaging, specifically a
duplex Doppler ultrasound, to quantify the percentage of luminal stenosis and evaluate plaque
morphology. Emergency referral (Option A) is indicated for acute symptomatic stroke or
transient ischemic attacks, not asymptomatic bruits. High-velocity, low-amplitude cervical
manipulation (Option C) is contraindicated or requires extreme caution in the presence of
significant vascular stenosis or carotid bruits due to potential risk of arterial dissection.
, Reassuring without further workup (Option D) fails to rule out potentially severe, asymptomatic
cerebrovascular disease.
4. A 28-year-old female presents with widespread musculoskeletal pain, chronic fatigue, and
unrefreshing sleep persisting for 14 months. She reports tenderness to light palpation across
multiple designated body sites, including the trapezius, second costochondral junction, and
lateral epicondyle. Comprehensive laboratory workup, including complete blood count,
erythrocyte sedimentation rate, and thyroid panel, returns completely normal. What is the
primary diagnosis that fits this clinical presentation?
A. Polymyalgia rheumatica
B. Fibromyalgia syndrome
C. Rheumatoid arthritis
D. Myofascial pain syndrome with regional trigger points
CORRECT ANSWER : B
Rationale: Fibromyalgia syndrome is characterized by chronic widespread musculoskeletal
pain, multiple tender points, fatigue, and sleep disturbances in the presence of normal laboratory
inflammatory markers. Polymyalgia rheumatica (Option A) typically affects patients over 50 and
is marked by elevated inflammatory markers (ESR, CRP) and severe proximal girdle stiffness.
Rheumatoid arthritis (Option C) presents with symmetrical inflammatory joint synovitis and
positive autoantibodies (RF, anti-CCP). Myofascial pain syndrome (Option D) typically involves
regional pain originating from specific taut muscle bands and active trigger points rather than
widespread symmetrical tender points.
5. A 55-year-old male presents with deep, boring right shoulder pain that worsens significantly at
night, particularly when lying on the affected side. Active range of motion reveals a painful arc
between 60 and 120 degrees of abduction, and Hawkins-Kennedy and Neer tests are both
positive. Which anatomical structure is most directly implicated in this classic presentation of
shoulder impingement syndrome?
A. Supraspinatus tendon
B. Long head of the biceps brachii tendon exclusively
C. Subscapularis tendon insertion at the lesser tubercle
D. Glenoid labrum posteroinferior margin
CORRECT ANSWER : A
, Rationale: The supraspinatus tendon passes directly beneath the coracoacromial arch and is the
most frequently impinged rotator cuff tendon, producing a classic painful arc of abduction and
positive Hawkins-Kennedy and Neer tests. While the long head of the biceps tendon (Option B)
can be involved in impingement, isolated biceps pathology typically presents with anterior
bicipital groove tenderness and a positive Speed's test. The subscapularis (Option C) is an
internal rotator tested via the lift-off test. The glenoid labrum (Option D) is implicated in
instability and labral tears, assessed via tests like O'Brien's or Crank.
6. A 50-year-old female presents with insidious onset of left shoulder pain and a progressive,
severe loss of both active and passive range of motion, particularly external rotation and
abduction. She reports that simple daily activities, such as reaching into a back pocket or
fastening a bra, have become nearly impossible over the past six months. What is the most likely
diagnosis?
A. Full-thickness rotator cuff tear
B. Adhesive capsulitis
C. Acromioclavicular osteoarthritis
D. Calcific tendinitis of the rotator cuff
CORRECT ANSWER : B
Rationale: Adhesive capsulitis (frozen shoulder) is characterized by a marked and progressive
restriction of both active and passive ranges of motion, with external rotation being
disproportionately limited. A full-thickness rotator cuff tear (Option A) typically preserves
passive range of motion despite significant active weakness. Acromioclavicular osteoarthritis
(Option C) presents with localized superior shoulder pain and pain at the extremes of cross-body
adduction. Calcific tendinitis (Option D) causes acute, intensely painful calcium crystal
deposition within the tendon, distinguishable from the global capsular restriction of adhesive
capsulitis.
7. A 22-year-old collegiate soccer player presents with acute right knee pain and a sensation of the
knee "giving out" immediately after planting his foot and pivoting sharply during a match. He
heard a distinct "pop" followed by rapid joint swelling within two hours. Which orthopedic test
is most sensitive and specific for confirming an injury to the structure most commonly
implicated in this mechanism?
A. Apley compression test
B. Valgus stress test at 30 degrees of flexion
C. Lachman test
D. Posterior drawer test
