NBCE Part 3 Board Exam Practice
Questions And Well Graded
Solutions With Rationales Updated
2026 2027
Master the NBCE Part III exam with this premium study guide covering questions
214-250. This resource features realistic, board-style multiple-choice questions
testing core clinical competencies like orthopedic testing, neurology, laboratory
diagnosis, diagnostic imaging, and case management. Every question features
bolded answers and comprehensive, detailed rationales to sharpen your clinical
reasoning, boost your confidence, and ensure you pass your chiropractic boards
on the first try.
1. A 42-year-old male presents with severe right flank pain radiating to the groin. The
pain is sudden, sharp, and fluctuates in intensity. Urinalysis reveals microscopic
hematuria. What is the most likely diagnosis?
A) Acute appendicitis
B) Nephrolithiasis
C) Cholecystitis
D) Lumbar facet syndrome
Answer: B) Nephrolithiasis
Rationale: Flank pain radiating to the groin accompanied by hematuria is the classic
presentation for kidney stones (nephrolithiasis).
2. A patient exhibits a positive Trendelenburg test on the right side when standing on
the right leg. Which muscle is weak?
A) Right gluteus medius
B) Left gluteus medius
C) Right gluteus maximus
D) Left piriformis
Answer: A) Right gluteus medius
1|Page
, Rationale: A positive Trendelenburg sign occurs when the contralateral hip drops,
indicating weakness of the ipsilateral weight-bearing gluteus medius.
3. A 68-year-old female presents with neck stiffness and bilateral shoulder pain. Her
erythrocyte sedimentation rate (ESR) is significantly elevated, but rheumatoid factor
is negative. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Polymyalgia rheumatica
C) Osteoarthritis
D) Fibromyalgia
Answer: B) Polymyalgia rheumatica
Rationale: Polymyalgia rheumatica presents in older patients with proximal joint
stiffness and markedly elevated inflammatory markers like ESR.
4. Which orthopedic test involves passive internal rotation, flexion, and adduction of the
hip to detect piriformis syndrome?
A) Patrick's Test
B) Freiberg's Test
C) Thomas Test
D) Hibbs' Test
Answer: B) Freiberg's Test
Rationale: Freiberg's test stretches the piriformis muscle by forcing the hip into
internal rotation, reproducing sciatic nerve compression symptoms.
5. A 28-year-old baseball pitcher presents with deep anterior shoulder pain. Inspection
reveals localized tenderness over the bicipital groove. Pain is elicited when the
patient supinates the forearm against resistance. What test is this?
A) Speed's Test
B) Yergason's Test
C) Neer's Test
D) Hawkin's Test
Answer: B) Yergason's Test
Rationale: Yergason's test evaluates the biceps tendon stability and pathology by
resisting supination and external rotation.
6. Radiographs of a 14-year-old male's knee show fragmentation and swelling of the
tibial tubercle. What is the diagnosis?
A) Legg-Calve-Perthes disease
B) Osgood-Schlatter disease
C) Sinding-Larsen-Johansson syndrome
D) Osteochondritis dissecans
Answer: B) Osgood-Schlatter disease
Rationale: Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle
commonly seen in growing, active adolescents.
7. A patient presents with localized pain over the lateral epicondyle of the humerus.
Pain is exacerbated by resisted wrist extension. What condition is suspected?
A) Medial epicondylitis
B) Lateral epicondylitis
C) Pronator teres syndrome
D) Olecranon bursitis
Answer: B) Lateral epicondylitis
Rationale: Lateral epicondylitis (tennis elbow) involves the wrist extensors, primarily
the extensor carpi radialis brevis.
2|Page
,8. Which neurological reflex tests the integrity of the C7 nerve root?
A) Biceps reflex
B) Brachioradialis reflex
C) Triceps reflex
D) Patellar reflex
Answer: C) Triceps reflex
Rationale: The triceps reflex is primarily mediated by the C7 nerve root via the radial
nerve.
9. A patient with a history of long-standing rheumatoid arthritis requires cervical spine
radiographs before undergoing general anesthesia. Which view is most critical to
evaluate for instability?
A) AP Open Mouth
B) Lateral Neutral
C) Flexion and Extension Lateral
D) Right and Left Oblique
Answer: C) Flexion and Extension Lateral
Rationale: Rheumatoid arthritis can cause atlantoaxial subluxation; stress views
(flexion/extension) assess the stability of the ADI.
10. A 35-year-old male reports paresthesia in the medial hand and fifth digit.
Examination reveals a positive Tinel's sign at the elbow cubital tunnel. Which nerve
is compressed?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Musculocutaneous nerve
Answer: B) Ulnar nerve
Rationale: The ulnar nerve passes through the cubital tunnel at the elbow and
supplies sensory innervation to the fifth digit.
11. What is the standard normal measurement for the Atlantodental Interspace (ADI) in
an adult?
A) 1-3 mm
B) 1-5 mm
C) 5-7 mm
D) 0 mm
Answer: A) 1-3 mm
Rationale: In adults, the ADI should not exceed 3 mm. In children, up to 5 mm can
be normal.
12. A 52-year-old heavy smoker presents with sudden ptosis, miosis, and anhidrosis on
the left side of his face. What underlying condition should be ruled out immediately?
A) Pancoast tumor
B) Carpal tunnel syndrome
C) Multiple sclerosis
D) Myasthenia gravis
Answer: A) Pancoast tumor
Rationale: Horner's syndrome (ptosis, miosis, anhidrosis) can result from an apical
lung tumor damaging the sympathetic chain.
13. An x-ray demonstrates a "bamboo spine" appearance due to marginal
syndesmophytes and calcification of the anterior longitudinal ligament. What is the
diagnosis?
A) Diffuse Idiopathic Skeletal Hyperostosis (DISH)
3|Page
, B) Ankylosing Spondylitis
C) Psoriatic Arthritis
D) Osteoarthritis
Answer: B) Ankylosing Spondylitis
Rationale: Ankylosing spondylitis characteristically causes thin, marginal
syndesmophytes resulting in a classic bamboo spine appearance.
14. During an examination, tapping over the flexor retinaculum of the wrist elicits tingling
in the thumb, index, and middle fingers. What is this sign called?
A) Phalen's Sign
B) Tinel's Sign
C) Finkelstein's Sign
D) Froment's Sign
Answer: B) Tinel's Sign
Rationale: Tapping over a nerve to elicit paresthesia is a Tinel's sign, indicating
nerve irritation or regeneration.
15. A patient presents with exquisite pain in the first metatarsophalangeal joint. Joint
aspirate reveals negatively birefringent needle-shaped crystals. What is the
diagnosis?
A) Pseudogout
B) Gout
C) Septic arthritis
D) Osteoarthritis
Answer: B) Gout
Rationale: Monosodium urate crystals in gout appear needle-shaped and show
strong negative birefringence under polarized light.
16. Which of the following conditions is an absolute contraindication to high-velocity, low-
amplitude spinal manipulation at the affected segment?
A) Lumbar disc protrusion
B) Acute abdominal aortic aneurysm
C) Subacute muscle strain
D) Mild degenerative joint disease
Answer: B) Acute abdominal aortic aneurysm
Rationale: An aneurysm represents a vascular structural failure; applying force near
the area risks catastrophic rupture.
17. A 19-year-old female presents with a butterfly rash across her cheeks and bridge of
her nose, joint pain, and photosensitivity. Which lab test is most sensitive for this
condition?
A) Rheumatoid Factor (RF)
B) Antinuclear Antibody (ANA)
C) Human Leukocyte Antigen (HLA-B27)
D) Uric Acid
Answer: B) Antinuclear Antibody (ANA)
Rationale: ANA is highly sensitive for systemic lupus erythematosus (SLE), which
classicially presents with a malar/butterfly rash.
18. Radiographs of the lumbar spine reveal a radiopaque, geographic lesion in the
vertebral body with a "corduroy cloth" or striated appearance. What is the most likely
diagnosis?
A) Osteosarcoma
B) Hemangioma
C) Paget's disease
4|Page
Questions And Well Graded
Solutions With Rationales Updated
2026 2027
Master the NBCE Part III exam with this premium study guide covering questions
214-250. This resource features realistic, board-style multiple-choice questions
testing core clinical competencies like orthopedic testing, neurology, laboratory
diagnosis, diagnostic imaging, and case management. Every question features
bolded answers and comprehensive, detailed rationales to sharpen your clinical
reasoning, boost your confidence, and ensure you pass your chiropractic boards
on the first try.
1. A 42-year-old male presents with severe right flank pain radiating to the groin. The
pain is sudden, sharp, and fluctuates in intensity. Urinalysis reveals microscopic
hematuria. What is the most likely diagnosis?
A) Acute appendicitis
B) Nephrolithiasis
C) Cholecystitis
D) Lumbar facet syndrome
Answer: B) Nephrolithiasis
Rationale: Flank pain radiating to the groin accompanied by hematuria is the classic
presentation for kidney stones (nephrolithiasis).
2. A patient exhibits a positive Trendelenburg test on the right side when standing on
the right leg. Which muscle is weak?
A) Right gluteus medius
B) Left gluteus medius
C) Right gluteus maximus
D) Left piriformis
Answer: A) Right gluteus medius
1|Page
, Rationale: A positive Trendelenburg sign occurs when the contralateral hip drops,
indicating weakness of the ipsilateral weight-bearing gluteus medius.
3. A 68-year-old female presents with neck stiffness and bilateral shoulder pain. Her
erythrocyte sedimentation rate (ESR) is significantly elevated, but rheumatoid factor
is negative. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Polymyalgia rheumatica
C) Osteoarthritis
D) Fibromyalgia
Answer: B) Polymyalgia rheumatica
Rationale: Polymyalgia rheumatica presents in older patients with proximal joint
stiffness and markedly elevated inflammatory markers like ESR.
4. Which orthopedic test involves passive internal rotation, flexion, and adduction of the
hip to detect piriformis syndrome?
A) Patrick's Test
B) Freiberg's Test
C) Thomas Test
D) Hibbs' Test
Answer: B) Freiberg's Test
Rationale: Freiberg's test stretches the piriformis muscle by forcing the hip into
internal rotation, reproducing sciatic nerve compression symptoms.
5. A 28-year-old baseball pitcher presents with deep anterior shoulder pain. Inspection
reveals localized tenderness over the bicipital groove. Pain is elicited when the
patient supinates the forearm against resistance. What test is this?
A) Speed's Test
B) Yergason's Test
C) Neer's Test
D) Hawkin's Test
Answer: B) Yergason's Test
Rationale: Yergason's test evaluates the biceps tendon stability and pathology by
resisting supination and external rotation.
6. Radiographs of a 14-year-old male's knee show fragmentation and swelling of the
tibial tubercle. What is the diagnosis?
A) Legg-Calve-Perthes disease
B) Osgood-Schlatter disease
C) Sinding-Larsen-Johansson syndrome
D) Osteochondritis dissecans
Answer: B) Osgood-Schlatter disease
Rationale: Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle
commonly seen in growing, active adolescents.
7. A patient presents with localized pain over the lateral epicondyle of the humerus.
Pain is exacerbated by resisted wrist extension. What condition is suspected?
A) Medial epicondylitis
B) Lateral epicondylitis
C) Pronator teres syndrome
D) Olecranon bursitis
Answer: B) Lateral epicondylitis
Rationale: Lateral epicondylitis (tennis elbow) involves the wrist extensors, primarily
the extensor carpi radialis brevis.
2|Page
,8. Which neurological reflex tests the integrity of the C7 nerve root?
A) Biceps reflex
B) Brachioradialis reflex
C) Triceps reflex
D) Patellar reflex
Answer: C) Triceps reflex
Rationale: The triceps reflex is primarily mediated by the C7 nerve root via the radial
nerve.
9. A patient with a history of long-standing rheumatoid arthritis requires cervical spine
radiographs before undergoing general anesthesia. Which view is most critical to
evaluate for instability?
A) AP Open Mouth
B) Lateral Neutral
C) Flexion and Extension Lateral
D) Right and Left Oblique
Answer: C) Flexion and Extension Lateral
Rationale: Rheumatoid arthritis can cause atlantoaxial subluxation; stress views
(flexion/extension) assess the stability of the ADI.
10. A 35-year-old male reports paresthesia in the medial hand and fifth digit.
Examination reveals a positive Tinel's sign at the elbow cubital tunnel. Which nerve
is compressed?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Musculocutaneous nerve
Answer: B) Ulnar nerve
Rationale: The ulnar nerve passes through the cubital tunnel at the elbow and
supplies sensory innervation to the fifth digit.
11. What is the standard normal measurement for the Atlantodental Interspace (ADI) in
an adult?
A) 1-3 mm
B) 1-5 mm
C) 5-7 mm
D) 0 mm
Answer: A) 1-3 mm
Rationale: In adults, the ADI should not exceed 3 mm. In children, up to 5 mm can
be normal.
12. A 52-year-old heavy smoker presents with sudden ptosis, miosis, and anhidrosis on
the left side of his face. What underlying condition should be ruled out immediately?
A) Pancoast tumor
B) Carpal tunnel syndrome
C) Multiple sclerosis
D) Myasthenia gravis
Answer: A) Pancoast tumor
Rationale: Horner's syndrome (ptosis, miosis, anhidrosis) can result from an apical
lung tumor damaging the sympathetic chain.
13. An x-ray demonstrates a "bamboo spine" appearance due to marginal
syndesmophytes and calcification of the anterior longitudinal ligament. What is the
diagnosis?
A) Diffuse Idiopathic Skeletal Hyperostosis (DISH)
3|Page
, B) Ankylosing Spondylitis
C) Psoriatic Arthritis
D) Osteoarthritis
Answer: B) Ankylosing Spondylitis
Rationale: Ankylosing spondylitis characteristically causes thin, marginal
syndesmophytes resulting in a classic bamboo spine appearance.
14. During an examination, tapping over the flexor retinaculum of the wrist elicits tingling
in the thumb, index, and middle fingers. What is this sign called?
A) Phalen's Sign
B) Tinel's Sign
C) Finkelstein's Sign
D) Froment's Sign
Answer: B) Tinel's Sign
Rationale: Tapping over a nerve to elicit paresthesia is a Tinel's sign, indicating
nerve irritation or regeneration.
15. A patient presents with exquisite pain in the first metatarsophalangeal joint. Joint
aspirate reveals negatively birefringent needle-shaped crystals. What is the
diagnosis?
A) Pseudogout
B) Gout
C) Septic arthritis
D) Osteoarthritis
Answer: B) Gout
Rationale: Monosodium urate crystals in gout appear needle-shaped and show
strong negative birefringence under polarized light.
16. Which of the following conditions is an absolute contraindication to high-velocity, low-
amplitude spinal manipulation at the affected segment?
A) Lumbar disc protrusion
B) Acute abdominal aortic aneurysm
C) Subacute muscle strain
D) Mild degenerative joint disease
Answer: B) Acute abdominal aortic aneurysm
Rationale: An aneurysm represents a vascular structural failure; applying force near
the area risks catastrophic rupture.
17. A 19-year-old female presents with a butterfly rash across her cheeks and bridge of
her nose, joint pain, and photosensitivity. Which lab test is most sensitive for this
condition?
A) Rheumatoid Factor (RF)
B) Antinuclear Antibody (ANA)
C) Human Leukocyte Antigen (HLA-B27)
D) Uric Acid
Answer: B) Antinuclear Antibody (ANA)
Rationale: ANA is highly sensitive for systemic lupus erythematosus (SLE), which
classicially presents with a malar/butterfly rash.
18. Radiographs of the lumbar spine reveal a radiopaque, geographic lesion in the
vertebral body with a "corduroy cloth" or striated appearance. What is the most likely
diagnosis?
A) Osteosarcoma
B) Hemangioma
C) Paget's disease
4|Page
