NBCE PART III: CLINICAL COMPETENCY
Chiropractic Licensing Examination Practice Assessment
2025 Practice Edition
200 Multiple-Choice Questions with Answers and Rationales
Original practice assessment aligned to public NBCE Part III competency domains; not
actual NBCE examination items or an official/endorsed exam
Page 1 of 71
,Table of Contents
Section 1: Case History, Physical Examination & Patient Communication (Questions 1–25)
........................................ 3
Section 2: Neuromusculoskeletal Examination & Orthopedic Testing (Questions 26–50)
........................................ 12
Section 3: Neurological Examination & Diagnostic Correlation (Questions 51–75)
........................................ 20
Section 4: Radiographic Interpretation & Imaging Fundamentals (Questions 76–100)
........................................ 28
Section 5: Clinical Diagnosis & Differential Diagnosis (Questions 101–125) ........................................
37
Section 6: Chiropractic Management, Treatment Planning & Technique Considerations (Questions
126–150) ........................................ 46
Section 7: Patient Safety, Complications & Red Flags (Questions 151–175) ........................................
54
Section 8: Professional Practice, Ethics, Documentation & Integrated Care (Questions 176–200)
........................................ 63
Page 2 of 71
,Section 1: Case History, Physical Examination & Patient
Communication (Questions 1–25)
Q1: A new patient reports low-back pain. Which opening question best elicits the
patient’s main concern without prematurely narrowing the history?
A. What brings you in today, and what concerns you most about it? [CORRECT]
B. Is the pain caused by a disc?
C. You do not have leg symptoms, correct?
D. Would you like an adjustment now?
Correct Answer: A
Rationale: An open-ended question invites the patient’s account and priorities before the
clinician tests a hypothesis.
Q2: A patient describes pain but gives little detail. Which history framework most
systematically characterizes the symptom?
A. Onset, location, duration, character, aggravating/relieving factors, radiation, timing, and
severity [CORRECT]
B. Only pain intensity and posture
C. Only prior treatment response
D. Only the patient’s age and occupation
Correct Answer: A
Rationale: A structured symptom history captures clinically relevant features and helps guide
examination and differential diagnosis.
Q3: A patient reports a new severe headache that reached maximal intensity within
seconds. What is the best next step?
A. Arrange emergency evaluation for a possible acute intracranial event [CORRECT]
B. Proceed with routine cervical manipulation
C. Schedule a routine review in one month
D. Treat the presumed muscle tension first
Correct Answer: A
Rationale: A thunderclap headache is a time-critical red flag and requires emergency
assessment rather than routine musculoskeletal care.
Page 3 of 71
, Q4: A patient says, “I am worried this pain means I will never work again.” Which
response best supports communication?
A. Reflect the concern, ask what the patient fears, and explore function-focused goals
[CORRECT]
B. Dismiss the fear because imaging is normal
C. Promise complete recovery
D. Change the subject to avoid distress
Correct Answer: A
Rationale: Empathic listening and clarification uncover beliefs and goals; reassurance should
be honest and not guarantee an outcome.
Q5: A patient’s medication list includes an anticoagulant. Why is this important before
manual care?
A. It may increase bleeding risk and affect technique selection or referral decisions [CORRECT]
B. It proves the patient has a fracture
C. It means no examination is permitted
D. It eliminates the need for consent
Correct Answer: A
Rationale: Anticoagulants can increase bleeding risk, so the clinician should assess context
and modify or defer procedures when appropriate.
Q6: A patient reports a new change in bowel and bladder control with bilateral leg
weakness. What should the clinician do?
A. Arrange urgent emergency assessment for possible cauda equina compression [CORRECT]
B. Begin lumbar traction and reassess next week
C. Perform repeated end-range spinal testing
D. Document the symptoms but continue routine care
Correct Answer: A
Rationale: New sphincter dysfunction with bilateral neurologic deficits is a serious red flag
requiring urgent evaluation.
Page 4 of 71
Chiropractic Licensing Examination Practice Assessment
2025 Practice Edition
200 Multiple-Choice Questions with Answers and Rationales
Original practice assessment aligned to public NBCE Part III competency domains; not
actual NBCE examination items or an official/endorsed exam
Page 1 of 71
,Table of Contents
Section 1: Case History, Physical Examination & Patient Communication (Questions 1–25)
........................................ 3
Section 2: Neuromusculoskeletal Examination & Orthopedic Testing (Questions 26–50)
........................................ 12
Section 3: Neurological Examination & Diagnostic Correlation (Questions 51–75)
........................................ 20
Section 4: Radiographic Interpretation & Imaging Fundamentals (Questions 76–100)
........................................ 28
Section 5: Clinical Diagnosis & Differential Diagnosis (Questions 101–125) ........................................
37
Section 6: Chiropractic Management, Treatment Planning & Technique Considerations (Questions
126–150) ........................................ 46
Section 7: Patient Safety, Complications & Red Flags (Questions 151–175) ........................................
54
Section 8: Professional Practice, Ethics, Documentation & Integrated Care (Questions 176–200)
........................................ 63
Page 2 of 71
,Section 1: Case History, Physical Examination & Patient
Communication (Questions 1–25)
Q1: A new patient reports low-back pain. Which opening question best elicits the
patient’s main concern without prematurely narrowing the history?
A. What brings you in today, and what concerns you most about it? [CORRECT]
B. Is the pain caused by a disc?
C. You do not have leg symptoms, correct?
D. Would you like an adjustment now?
Correct Answer: A
Rationale: An open-ended question invites the patient’s account and priorities before the
clinician tests a hypothesis.
Q2: A patient describes pain but gives little detail. Which history framework most
systematically characterizes the symptom?
A. Onset, location, duration, character, aggravating/relieving factors, radiation, timing, and
severity [CORRECT]
B. Only pain intensity and posture
C. Only prior treatment response
D. Only the patient’s age and occupation
Correct Answer: A
Rationale: A structured symptom history captures clinically relevant features and helps guide
examination and differential diagnosis.
Q3: A patient reports a new severe headache that reached maximal intensity within
seconds. What is the best next step?
A. Arrange emergency evaluation for a possible acute intracranial event [CORRECT]
B. Proceed with routine cervical manipulation
C. Schedule a routine review in one month
D. Treat the presumed muscle tension first
Correct Answer: A
Rationale: A thunderclap headache is a time-critical red flag and requires emergency
assessment rather than routine musculoskeletal care.
Page 3 of 71
, Q4: A patient says, “I am worried this pain means I will never work again.” Which
response best supports communication?
A. Reflect the concern, ask what the patient fears, and explore function-focused goals
[CORRECT]
B. Dismiss the fear because imaging is normal
C. Promise complete recovery
D. Change the subject to avoid distress
Correct Answer: A
Rationale: Empathic listening and clarification uncover beliefs and goals; reassurance should
be honest and not guarantee an outcome.
Q5: A patient’s medication list includes an anticoagulant. Why is this important before
manual care?
A. It may increase bleeding risk and affect technique selection or referral decisions [CORRECT]
B. It proves the patient has a fracture
C. It means no examination is permitted
D. It eliminates the need for consent
Correct Answer: A
Rationale: Anticoagulants can increase bleeding risk, so the clinician should assess context
and modify or defer procedures when appropriate.
Q6: A patient reports a new change in bowel and bladder control with bilateral leg
weakness. What should the clinician do?
A. Arrange urgent emergency assessment for possible cauda equina compression [CORRECT]
B. Begin lumbar traction and reassess next week
C. Perform repeated end-range spinal testing
D. Document the symptoms but continue routine care
Correct Answer: A
Rationale: New sphincter dysfunction with bilateral neurologic deficits is a serious red flag
requiring urgent evaluation.
Page 4 of 71
