NBCE PART 4 UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
COMPREHENSIVE STUDY GUIDE
●● Hoover's Sign (procedure, positive, indication)
Answer: Patient is supine, doctor places one hand under each of the
patient's heels and asks the patient to lift the affected limb.
Positive: dr doesn't feel unaffected side pressing downward
Indication: malingering
●● Magnusson's (procedure, positive, indication)
Answer: At the beginning of each case history the patient is asked to
point to the site of pain in the back; the examiner marks it with a skin
marking pencil, later on the patient is again asked to point to the site of
pain.
Positive: pt doesn't point the same point
Indication: malingering
●● Mannkopf's Sign (procedure, positive, indication)
Answer: Doctor takes the patient's resting pulse, then applies pressure
over the painful area and takes the pulse again.
,Positive: increase of 10 beats per min
Indication: malingering
●● Chest Expansion Test (procedure, positive, indication)
Answer: Tape measure placed around the 4th intercostal space, the
patient exhales completely, measurement taken, then the patient inhales
deeply, measurement taken. Normal is 1.5-3 inches.
Positive: women <1.5" and men <2"
Indication: Ankylosing Spondylitis
●● Forrestier's Bowstring Sign (procedure, positive, indication)
Answer: While standing the patient performs side bending to both sides.
Positive: muscle tightening on concave side
Indication: Ankylosing Spondylitis
●● Lewin Supine Test (procedure, positive, indication)
Answer: Patient supine; dr holds the ankles on the table; the patietn is
then asked to sit up without using hands
Positive: unable to perform
,Indication: Ankylosing Spondylitis
●● Amos' sign (procedure, positive, indication)
Answer: Pt is asked to go from a supine position to a standing position.
(No assistance)
Positive: localized pain and/or lack of ROM
Indication: Ankylosing Spondylitis, Severe IVD syndrome, sprain/strain
●● Brudzinski's sign (procedure, positive, indication)
Answer: Patient supine. Dr passively flexes that patient's head
approximating the chin to chest.
Positive: buckling of the patient's knees
Indication: Meningitis
●● Kernig's sign (procedure, positive, indication)
Answer: Patient supine. Dr flexes the hip and knee to 90/90 position and
then attempts to extend knee.
Positive: Patient resists extension; resistance causes kicking motion
Indication: Meningitis
, ●● Lhermitte's sign (procedure, positive, indication)
Answer: Patient seated or supine, patient actively/passively flexes head
toward chest.
Positive: sharp electric shock like sensation down the spine into
extremities
Indication: Multiple Sclerosis, Myelopathy
●● Sternal Compression Test (procedure, positive, indication)
Answer: Dr applies downward pressure on the sternum while the patient
is in the supine position
Positive: pain localized at the lateral rib border
Indication: rib fracture
●● Foraminal Compression Test (procedure, positive, indication)
Answer: The patient is seated and actively rotates head from side to side.
Then the doctor exerts downward pressure and the head is rotated to
each side with pressure.
Positive: Radicular Pain
Indication: Nerve Root Compression
QUESTIONS AND CORRECT ANSWERS
COMPREHENSIVE STUDY GUIDE
●● Hoover's Sign (procedure, positive, indication)
Answer: Patient is supine, doctor places one hand under each of the
patient's heels and asks the patient to lift the affected limb.
Positive: dr doesn't feel unaffected side pressing downward
Indication: malingering
●● Magnusson's (procedure, positive, indication)
Answer: At the beginning of each case history the patient is asked to
point to the site of pain in the back; the examiner marks it with a skin
marking pencil, later on the patient is again asked to point to the site of
pain.
Positive: pt doesn't point the same point
Indication: malingering
●● Mannkopf's Sign (procedure, positive, indication)
Answer: Doctor takes the patient's resting pulse, then applies pressure
over the painful area and takes the pulse again.
,Positive: increase of 10 beats per min
Indication: malingering
●● Chest Expansion Test (procedure, positive, indication)
Answer: Tape measure placed around the 4th intercostal space, the
patient exhales completely, measurement taken, then the patient inhales
deeply, measurement taken. Normal is 1.5-3 inches.
Positive: women <1.5" and men <2"
Indication: Ankylosing Spondylitis
●● Forrestier's Bowstring Sign (procedure, positive, indication)
Answer: While standing the patient performs side bending to both sides.
Positive: muscle tightening on concave side
Indication: Ankylosing Spondylitis
●● Lewin Supine Test (procedure, positive, indication)
Answer: Patient supine; dr holds the ankles on the table; the patietn is
then asked to sit up without using hands
Positive: unable to perform
,Indication: Ankylosing Spondylitis
●● Amos' sign (procedure, positive, indication)
Answer: Pt is asked to go from a supine position to a standing position.
(No assistance)
Positive: localized pain and/or lack of ROM
Indication: Ankylosing Spondylitis, Severe IVD syndrome, sprain/strain
●● Brudzinski's sign (procedure, positive, indication)
Answer: Patient supine. Dr passively flexes that patient's head
approximating the chin to chest.
Positive: buckling of the patient's knees
Indication: Meningitis
●● Kernig's sign (procedure, positive, indication)
Answer: Patient supine. Dr flexes the hip and knee to 90/90 position and
then attempts to extend knee.
Positive: Patient resists extension; resistance causes kicking motion
Indication: Meningitis
, ●● Lhermitte's sign (procedure, positive, indication)
Answer: Patient seated or supine, patient actively/passively flexes head
toward chest.
Positive: sharp electric shock like sensation down the spine into
extremities
Indication: Multiple Sclerosis, Myelopathy
●● Sternal Compression Test (procedure, positive, indication)
Answer: Dr applies downward pressure on the sternum while the patient
is in the supine position
Positive: pain localized at the lateral rib border
Indication: rib fracture
●● Foraminal Compression Test (procedure, positive, indication)
Answer: The patient is seated and actively rotates head from side to side.
Then the doctor exerts downward pressure and the head is rotated to
each side with pressure.
Positive: Radicular Pain
Indication: Nerve Root Compression
