NBCE PART 3 EXAM
COMPREHENSIVE PRACTICE (2026/2027 Edition)
National Board of Chiropractic Examiners • Part 3 Clinical Competency
Case Management • 200 Questions with Answers & Rationale
Format: 200 multiple-choice questions (single best answer, A–D).
Structure: Ten sections spanning diagnosis, decision-making, case management, MSK,
neurology, systemic disease, special populations, imaging/labs, protocols,
and case studies.
Cognitive ~30% recall • ~50% application • ~20% analysis.
levels:
Grading: One point per question; correct answer and rationale provided after each
item.
Content basis: NBCE Part 3 test blueprint, current clinical guidelines, evidence-based
chiropractic practice, and diagnostic decision-making standards.
Special Imaging/lab interpretation items; red flags/contraindications; comprehensive
inclusions: multi-system case studies.
Important This is an independent practice exam for educational study; it is not an official
note: NBCE exam.
, Section 1: General Diagnosis – History, Exam, and Differential (25 questions)
Q1: Which is the first step in evaluating a patient with low back pain?
A. Obtain a thorough history including red flags [CORRECT]
B. Order an MRI
C. Perform a manipulation
D. Start on pain medication
Correct Answer: A
Rationale: A is correct: history taking, including red flags, is the first step. B, C, and D are premature.
Q2: Which is a 'red flag' in a patient with back pain?
A. Mechanical pain relieved by rest
B. Unexplained weight loss and night pain [CORRECT]
C. Localized muscle spasm
D. Pain with movement
Correct Answer: B
Rationale: A is correct: weight loss and night pain are red flags. B, C, and D suggest mechanical pain.
Q3: Which is a red flag for cauda equina syndrome?
A. Localized back pain
B. Muscle spasm
C. Saddle anesthesia and bowel/bladder dysfunction [CORRECT]
D. Radicular pain only
Correct Answer: C
Rationale: A is correct: saddle anesthesia and bowel/bladder dysfunction are cauda equina red flags. B, C,
and D are not.
Q4: Which is an appropriate part of a focused neurological examination?
A. Only the history
B. Only inspection
C. Only palpation
D. Motor, sensory, and reflex testing [CORRECT]
Correct Answer: D
Rationale: A is correct: a neuro exam includes motor, sensory, and reflexes. B, C, and D are incomplete.
Q5: Which is the correct order for a physical examination?
A. Inspection, palpation, percussion, and auscultation [CORRECT]
B. Auscultation first
C. Palpation before inspection
D. No specific order
Correct Answer: A
Rationale: A is correct: inspection, palpation, percussion, and auscultation is standard. B, C, and D are
incorrect.
Q6: Which special test reproduces radiating leg pain in a patient with a lumbar disc herniation?
A. Spurling test
B. Straight Leg Raise (SLR) [CORRECT]
C. Phalen's test
D. Lachman test
Correct Answer: B
Rationale: A is correct: SLR reproduces sciatica. B is cervical; C is carpal tunnel; D is ACL.
NBCE Part 3 Exam (2026/2027) Page 2
, Q7: Which special test reproduces radiating arm pain in cervical radiculopathy?
A. Straight Leg Raise
B. Phalen's test
C. Spurling test [CORRECT]
D. Neer test
Correct Answer: C
Rationale: A is correct: Spurling's test for cervical radiculopathy. B is lumbar; C is carpal tunnel; D is
shoulder.
Q8: Which is a component of the review of systems (ROS)?
A. Only the chief complaint
B. Only the family history
C. Only the social history
D. Asking about symptoms in each body system [CORRECT]
Correct Answer: D
Rationale: A is correct: the ROS surveys body systems. B, C, and D are other parts of the history.
Q9: Which is appropriate when a patient's back pain is accompanied by fever?
A. Suspect infection and refer/imaging [CORRECT]
B. Perform manipulation
C. Reassure
D. Treat as mechanical
Correct Answer: A
Rationale: A is correct: fever suggests infection, requiring evaluation. B, C, and D are unsafe.
Q10: Which historical factor increases the risk of a serious cause of back pain?
A. Mechanical pain
B. A history of cancer [CORRECT]
C. Relief with rest
D. Recent mild activity
Correct Answer: B
Rationale: A is correct: a cancer history is a red flag. B, C, and D are reassuring.
Q11: Which is appropriate when a patient has new headache with visual disturbances?
A. Manipulate immediately
B. Reassure
C. Evaluate for serious causes and red flags [CORRECT]
D. Treat as tension headache
Correct Answer: C
Rationale: A is correct: new headache with visual symptoms warrants evaluation. B, C, and D are unsafe.
Q12: Which is a 'red flag' for a vertebral artery concern?
A. Mechanical neck pain
B. Muscle spasm
C. Tension headache
D. Sudden severe headache, dizziness, and neurological deficits [CORRECT]
Correct Answer: D
Rationale: A is correct: sudden headache/dizziness/neuro deficits suggest vascular concern. B, C, and D are
mechanical.
NBCE Part 3 Exam (2026/2027) Page 3
, Q13: Which is appropriate when a patient reports chest pain?
A. Evaluate for cardiac causes and red flags [CORRECT]
B. Treat as a muscle strain
C. Manipulate the spine
D. Reassure
Correct Answer: A
Rationale: A is correct: chest pain requires evaluation for cardiac causes. B, C, and D are unsafe.
Q14: Which is a component of the past medical history?
A. Only the chief complaint
B. Prior illnesses, surgeries, and hospitalizations [CORRECT]
C. Only current symptoms
D. Only the medications
Correct Answer: B
Rationale: A is correct: PMH includes prior illnesses/surgeries. B, C, and D are incomplete.
Q15: Which is appropriate when a patient has a 'worst headache of life'?
A. Manipulate
B. Reassure
C. Refer urgently (possible subarachnoid hemorrhage) [CORRECT]
D. Treat as tension
Correct Answer: C
Rationale: A is correct: a worst-ever headache is a red flag requiring urgent evaluation. B, C, and D are
unsafe.
Q16: Which is a component of the social history?
A. Only the chief complaint
B. Only the age
C. Only the gender
D. Occupation, alcohol, tobacco, and drug use [CORRECT]
Correct Answer: D
Rationale: A is correct: social history includes occupation and substance use. B, C, and D are incomplete.
Q17: Which is appropriate when a patient reports unintentional weight loss?
A. Investigate for a systemic cause [CORRECT]
B. Reassure
C. Treat as mechanical
D. Manipulate
Correct Answer: A
Rationale: A is correct: unintentional weight loss is a red flag. B, C, and D are incorrect.
Q18: Which is a normal finding on inspection of the spine?
A. Severe scoliosis
B. Symmetric muscle contours and normal alignment [CORRECT]
C. Visible mass
D. Muscle atrophy
Correct Answer: B
Rationale: A is correct: symmetric contours and alignment are normal. B, C, and D are abnormal.
NBCE Part 3 Exam (2026/2027) Page 4
COMPREHENSIVE PRACTICE (2026/2027 Edition)
National Board of Chiropractic Examiners • Part 3 Clinical Competency
Case Management • 200 Questions with Answers & Rationale
Format: 200 multiple-choice questions (single best answer, A–D).
Structure: Ten sections spanning diagnosis, decision-making, case management, MSK,
neurology, systemic disease, special populations, imaging/labs, protocols,
and case studies.
Cognitive ~30% recall • ~50% application • ~20% analysis.
levels:
Grading: One point per question; correct answer and rationale provided after each
item.
Content basis: NBCE Part 3 test blueprint, current clinical guidelines, evidence-based
chiropractic practice, and diagnostic decision-making standards.
Special Imaging/lab interpretation items; red flags/contraindications; comprehensive
inclusions: multi-system case studies.
Important This is an independent practice exam for educational study; it is not an official
note: NBCE exam.
, Section 1: General Diagnosis – History, Exam, and Differential (25 questions)
Q1: Which is the first step in evaluating a patient with low back pain?
A. Obtain a thorough history including red flags [CORRECT]
B. Order an MRI
C. Perform a manipulation
D. Start on pain medication
Correct Answer: A
Rationale: A is correct: history taking, including red flags, is the first step. B, C, and D are premature.
Q2: Which is a 'red flag' in a patient with back pain?
A. Mechanical pain relieved by rest
B. Unexplained weight loss and night pain [CORRECT]
C. Localized muscle spasm
D. Pain with movement
Correct Answer: B
Rationale: A is correct: weight loss and night pain are red flags. B, C, and D suggest mechanical pain.
Q3: Which is a red flag for cauda equina syndrome?
A. Localized back pain
B. Muscle spasm
C. Saddle anesthesia and bowel/bladder dysfunction [CORRECT]
D. Radicular pain only
Correct Answer: C
Rationale: A is correct: saddle anesthesia and bowel/bladder dysfunction are cauda equina red flags. B, C,
and D are not.
Q4: Which is an appropriate part of a focused neurological examination?
A. Only the history
B. Only inspection
C. Only palpation
D. Motor, sensory, and reflex testing [CORRECT]
Correct Answer: D
Rationale: A is correct: a neuro exam includes motor, sensory, and reflexes. B, C, and D are incomplete.
Q5: Which is the correct order for a physical examination?
A. Inspection, palpation, percussion, and auscultation [CORRECT]
B. Auscultation first
C. Palpation before inspection
D. No specific order
Correct Answer: A
Rationale: A is correct: inspection, palpation, percussion, and auscultation is standard. B, C, and D are
incorrect.
Q6: Which special test reproduces radiating leg pain in a patient with a lumbar disc herniation?
A. Spurling test
B. Straight Leg Raise (SLR) [CORRECT]
C. Phalen's test
D. Lachman test
Correct Answer: B
Rationale: A is correct: SLR reproduces sciatica. B is cervical; C is carpal tunnel; D is ACL.
NBCE Part 3 Exam (2026/2027) Page 2
, Q7: Which special test reproduces radiating arm pain in cervical radiculopathy?
A. Straight Leg Raise
B. Phalen's test
C. Spurling test [CORRECT]
D. Neer test
Correct Answer: C
Rationale: A is correct: Spurling's test for cervical radiculopathy. B is lumbar; C is carpal tunnel; D is
shoulder.
Q8: Which is a component of the review of systems (ROS)?
A. Only the chief complaint
B. Only the family history
C. Only the social history
D. Asking about symptoms in each body system [CORRECT]
Correct Answer: D
Rationale: A is correct: the ROS surveys body systems. B, C, and D are other parts of the history.
Q9: Which is appropriate when a patient's back pain is accompanied by fever?
A. Suspect infection and refer/imaging [CORRECT]
B. Perform manipulation
C. Reassure
D. Treat as mechanical
Correct Answer: A
Rationale: A is correct: fever suggests infection, requiring evaluation. B, C, and D are unsafe.
Q10: Which historical factor increases the risk of a serious cause of back pain?
A. Mechanical pain
B. A history of cancer [CORRECT]
C. Relief with rest
D. Recent mild activity
Correct Answer: B
Rationale: A is correct: a cancer history is a red flag. B, C, and D are reassuring.
Q11: Which is appropriate when a patient has new headache with visual disturbances?
A. Manipulate immediately
B. Reassure
C. Evaluate for serious causes and red flags [CORRECT]
D. Treat as tension headache
Correct Answer: C
Rationale: A is correct: new headache with visual symptoms warrants evaluation. B, C, and D are unsafe.
Q12: Which is a 'red flag' for a vertebral artery concern?
A. Mechanical neck pain
B. Muscle spasm
C. Tension headache
D. Sudden severe headache, dizziness, and neurological deficits [CORRECT]
Correct Answer: D
Rationale: A is correct: sudden headache/dizziness/neuro deficits suggest vascular concern. B, C, and D are
mechanical.
NBCE Part 3 Exam (2026/2027) Page 3
, Q13: Which is appropriate when a patient reports chest pain?
A. Evaluate for cardiac causes and red flags [CORRECT]
B. Treat as a muscle strain
C. Manipulate the spine
D. Reassure
Correct Answer: A
Rationale: A is correct: chest pain requires evaluation for cardiac causes. B, C, and D are unsafe.
Q14: Which is a component of the past medical history?
A. Only the chief complaint
B. Prior illnesses, surgeries, and hospitalizations [CORRECT]
C. Only current symptoms
D. Only the medications
Correct Answer: B
Rationale: A is correct: PMH includes prior illnesses/surgeries. B, C, and D are incomplete.
Q15: Which is appropriate when a patient has a 'worst headache of life'?
A. Manipulate
B. Reassure
C. Refer urgently (possible subarachnoid hemorrhage) [CORRECT]
D. Treat as tension
Correct Answer: C
Rationale: A is correct: a worst-ever headache is a red flag requiring urgent evaluation. B, C, and D are
unsafe.
Q16: Which is a component of the social history?
A. Only the chief complaint
B. Only the age
C. Only the gender
D. Occupation, alcohol, tobacco, and drug use [CORRECT]
Correct Answer: D
Rationale: A is correct: social history includes occupation and substance use. B, C, and D are incomplete.
Q17: Which is appropriate when a patient reports unintentional weight loss?
A. Investigate for a systemic cause [CORRECT]
B. Reassure
C. Treat as mechanical
D. Manipulate
Correct Answer: A
Rationale: A is correct: unintentional weight loss is a red flag. B, C, and D are incorrect.
Q18: Which is a normal finding on inspection of the spine?
A. Severe scoliosis
B. Symmetric muscle contours and normal alignment [CORRECT]
C. Visible mass
D. Muscle atrophy
Correct Answer: B
Rationale: A is correct: symmetric contours and alignment are normal. B, C, and D are abnormal.
NBCE Part 3 Exam (2026/2027) Page 4
