NBCE PART 2 EXAM 2025 ACTUAL EXAM 100 QUESTIONS
AND CORRECT ANSWERS (PROFESSOR VERIFIED) |
ALREADY GRADED A+ | LATEST EDITION
Chiropractic Board Examination - Clinical Sciences | Key Domains: General Diagnosis,
Neuromusculoskeletal Diagnosis, Imaging (Radiology & MRI), Chiropractic Technique & Principles,
Associated Clinical Sciences (Pathology, Microbiology, Public Health), and Case Management |
Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NBCE Part 2 Exam for 2025 provides 100 high-quality exam-style questions with
correct answers and rationales. It emphasizes the integration of basic sciences with clinical
application, focusing on diagnostic reasoning, interpretation of diagnostic imaging, principles of
chiropractic adjustive techniques, and the development of appropriate patient management plans
for neuromusculoskeletal conditions.
Answer Format
All correct answers appear in bold and cyan blue, accompanied by concise rationales explaining
the diagnostic criterion, radiographic finding, chiropractic principle, or clinical decision-making
step, and why alternative options represent a misdiagnosis, contraindication, or improper clinical
management.
1. A 45-year-old male presents with acute low back pain radiating to the right buttock but
not below the knee. Neurological exam is normal. What is the most likely diagnosis?
A. Lumbar disc herniation with radiculopathy
B. Lumbar strain/sprain
C. Cauda equina syndrome
D. Ankylosing spondylitis
Rationale: Pain that does not extend below the knee and is accompanied by normal neurology is
consistent with mechanical low back pain (strain/sprain), not radiculopathy. Disc herniation typically
causes pain below the knee. Cauda equina would present with bowel/bladder dysfunction or saddle
anesthesia.
2. Which radiographic finding is characteristic of ankylosing spondylitis?
A. Osteophyte formation at vertebral bodies
,B. Vacuum disc phenomenon
C. Bamboo spine
D. Schmorl's nodes
Rationale: "Bamboo spine" results from syndesmophyte formation and fusion of vertebral bodies in
ankylosing spondylitis. Osteophytes are typical of degenerative disc disease; Schmorl's nodes are
herniations into vertebral bodies; vacuum disc indicates gas in the disc space.
3. A patient presents with unilateral facial droop, inability to close the eye, and loss of
forehead wrinkling. What is the most likely diagnosis?
A. Stroke
B. Bell's palsy
C. Trigeminal neuralgia
D. Multiple sclerosis
Rationale: Bell's palsy (idiopathic CN VII palsy) causes complete ipsilateral facial paralysis, including
forehead and eye closure. In a stroke (central lesion), forehead sparing occurs due to bilateral cortical
innervation.
4. Which of the following is a red flag for cauda equina syndrome?
A. Unilateral leg pain
B. Intermittent claudication
C. Urinary retention
D. Lumbar muscle spasm
Rationale: Urinary retention, saddle anesthesia, or bowel incontinence are red flags for cauda equina
syndrome—a surgical emergency. Unilateral leg pain and muscle spasm are common in mechanical
conditions.
5. In Fryette’s Principles, Type I somatic dysfunction is characterized by:
A. Motion restriction in neutral
B. Group curve with sidebending and rotation in opposite directions
C. Single segment dysfunction with sidebending and rotation in the same direction
D. Hypermobile segment
Rationale: Fryette’s First Principle (Type I) occurs in neutral posture: sidebending and rotation occur
in opposite directions and involve multiple segments. Type II occurs in non-neutral and involves a
single segment with sidebending and rotation in the same direction.
6. A 60-year-old female presents with sudden-onset severe headache, photophobia, and neck
stiffness. What is the most urgent diagnostic step?
A. Cervical spine X-ray
B. MRI brain
C. Non-contrast CT head
D. Lumbar puncture
Rationale: This presentation suggests subarachnoid hemorrhage. Non-contrast CT head is the
first-line test due to high sensitivity in the first 24 hours. LP is performed if CT is negative but suspicion
remains.
7. Which imaging modality is most appropriate to evaluate soft tissue injury of the knee?
A. X-ray
B. CT scan
, C. MRI
D. Bone scan
Rationale: MRI provides superior soft tissue contrast for ligaments, menisci, and cartilage. X-ray and
CT evaluate bone; bone scan assesses metabolic bone activity.
8. A patient with a history of IV drug use presents with back pain, fever, and elevated ESR.
What is the most likely diagnosis?
A. Herniated disc
B. Spinal stenosis
C. Vertebral osteomyelitis
D. Fibromyalgia
Rationale: IV drug use, fever, back pain, and elevated inflammatory markers suggest vertebral
osteomyelitis or discitis. This is an infection requiring urgent evaluation and antibiotics.
9. Which of the following is a contraindication to spinal manipulation?
A. Acute muscle spasm
B. Degenerative joint disease
C. Spinal cord compression
D. Myofascial pain syndrome
Rationale: Spinal cord compression (e.g., from tumor, severe stenosis, or fracture) is an absolute
contraindication to manipulation due to risk of neurological injury. Muscle spasm and DJD are
common indications for care.
10. A positive Spurling’s test indicates:
A. Shoulder impingement
B. Thoracic outlet syndrome
C. Cervical radiculopathy
D. Rotator cuff tear
Rationale: Spurling’s test (neck extension, rotation, and compression) reproduces radicular arm pain
and confirms cervical nerve root compression. It is not used for shoulder pathology.
11. Which muscle is most commonly involved in rotator cuff pathology?
A. Teres minor
B. Infraspinatus
C. Supraspinatus
D. Subscapularis
Rationale: The supraspinatus is most frequently torn due to its location beneath the acromion and
role in initiating abduction. It is vulnerable to impingement during overhead activities.
12. A patient presents with unilateral throbbing headache, nausea, photophobia, and aura.
What is the most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Temporal arteritis
Rationale: Migraine with aura includes reversible neurological symptoms (e.g., scintillating scotoma)
followed by headache, nausea, and photophobia. Tension headaches are bilateral and non-throbbing;
cluster headaches are severe, unilateral, and periorbital with autonomic features.
AND CORRECT ANSWERS (PROFESSOR VERIFIED) |
ALREADY GRADED A+ | LATEST EDITION
Chiropractic Board Examination - Clinical Sciences | Key Domains: General Diagnosis,
Neuromusculoskeletal Diagnosis, Imaging (Radiology & MRI), Chiropractic Technique & Principles,
Associated Clinical Sciences (Pathology, Microbiology, Public Health), and Case Management |
Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NBCE Part 2 Exam for 2025 provides 100 high-quality exam-style questions with
correct answers and rationales. It emphasizes the integration of basic sciences with clinical
application, focusing on diagnostic reasoning, interpretation of diagnostic imaging, principles of
chiropractic adjustive techniques, and the development of appropriate patient management plans
for neuromusculoskeletal conditions.
Answer Format
All correct answers appear in bold and cyan blue, accompanied by concise rationales explaining
the diagnostic criterion, radiographic finding, chiropractic principle, or clinical decision-making
step, and why alternative options represent a misdiagnosis, contraindication, or improper clinical
management.
1. A 45-year-old male presents with acute low back pain radiating to the right buttock but
not below the knee. Neurological exam is normal. What is the most likely diagnosis?
A. Lumbar disc herniation with radiculopathy
B. Lumbar strain/sprain
C. Cauda equina syndrome
D. Ankylosing spondylitis
Rationale: Pain that does not extend below the knee and is accompanied by normal neurology is
consistent with mechanical low back pain (strain/sprain), not radiculopathy. Disc herniation typically
causes pain below the knee. Cauda equina would present with bowel/bladder dysfunction or saddle
anesthesia.
2. Which radiographic finding is characteristic of ankylosing spondylitis?
A. Osteophyte formation at vertebral bodies
,B. Vacuum disc phenomenon
C. Bamboo spine
D. Schmorl's nodes
Rationale: "Bamboo spine" results from syndesmophyte formation and fusion of vertebral bodies in
ankylosing spondylitis. Osteophytes are typical of degenerative disc disease; Schmorl's nodes are
herniations into vertebral bodies; vacuum disc indicates gas in the disc space.
3. A patient presents with unilateral facial droop, inability to close the eye, and loss of
forehead wrinkling. What is the most likely diagnosis?
A. Stroke
B. Bell's palsy
C. Trigeminal neuralgia
D. Multiple sclerosis
Rationale: Bell's palsy (idiopathic CN VII palsy) causes complete ipsilateral facial paralysis, including
forehead and eye closure. In a stroke (central lesion), forehead sparing occurs due to bilateral cortical
innervation.
4. Which of the following is a red flag for cauda equina syndrome?
A. Unilateral leg pain
B. Intermittent claudication
C. Urinary retention
D. Lumbar muscle spasm
Rationale: Urinary retention, saddle anesthesia, or bowel incontinence are red flags for cauda equina
syndrome—a surgical emergency. Unilateral leg pain and muscle spasm are common in mechanical
conditions.
5. In Fryette’s Principles, Type I somatic dysfunction is characterized by:
A. Motion restriction in neutral
B. Group curve with sidebending and rotation in opposite directions
C. Single segment dysfunction with sidebending and rotation in the same direction
D. Hypermobile segment
Rationale: Fryette’s First Principle (Type I) occurs in neutral posture: sidebending and rotation occur
in opposite directions and involve multiple segments. Type II occurs in non-neutral and involves a
single segment with sidebending and rotation in the same direction.
6. A 60-year-old female presents with sudden-onset severe headache, photophobia, and neck
stiffness. What is the most urgent diagnostic step?
A. Cervical spine X-ray
B. MRI brain
C. Non-contrast CT head
D. Lumbar puncture
Rationale: This presentation suggests subarachnoid hemorrhage. Non-contrast CT head is the
first-line test due to high sensitivity in the first 24 hours. LP is performed if CT is negative but suspicion
remains.
7. Which imaging modality is most appropriate to evaluate soft tissue injury of the knee?
A. X-ray
B. CT scan
, C. MRI
D. Bone scan
Rationale: MRI provides superior soft tissue contrast for ligaments, menisci, and cartilage. X-ray and
CT evaluate bone; bone scan assesses metabolic bone activity.
8. A patient with a history of IV drug use presents with back pain, fever, and elevated ESR.
What is the most likely diagnosis?
A. Herniated disc
B. Spinal stenosis
C. Vertebral osteomyelitis
D. Fibromyalgia
Rationale: IV drug use, fever, back pain, and elevated inflammatory markers suggest vertebral
osteomyelitis or discitis. This is an infection requiring urgent evaluation and antibiotics.
9. Which of the following is a contraindication to spinal manipulation?
A. Acute muscle spasm
B. Degenerative joint disease
C. Spinal cord compression
D. Myofascial pain syndrome
Rationale: Spinal cord compression (e.g., from tumor, severe stenosis, or fracture) is an absolute
contraindication to manipulation due to risk of neurological injury. Muscle spasm and DJD are
common indications for care.
10. A positive Spurling’s test indicates:
A. Shoulder impingement
B. Thoracic outlet syndrome
C. Cervical radiculopathy
D. Rotator cuff tear
Rationale: Spurling’s test (neck extension, rotation, and compression) reproduces radicular arm pain
and confirms cervical nerve root compression. It is not used for shoulder pathology.
11. Which muscle is most commonly involved in rotator cuff pathology?
A. Teres minor
B. Infraspinatus
C. Supraspinatus
D. Subscapularis
Rationale: The supraspinatus is most frequently torn due to its location beneath the acromion and
role in initiating abduction. It is vulnerable to impingement during overhead activities.
12. A patient presents with unilateral throbbing headache, nausea, photophobia, and aura.
What is the most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Temporal arteritis
Rationale: Migraine with aura includes reversible neurological symptoms (e.g., scintillating scotoma)
followed by headache, nausea, and photophobia. Tension headaches are bilateral and non-throbbing;
cluster headaches are severe, unilateral, and periorbital with autonomic features.
