NBCE PART 4 ORTHOPEDICS EXAM
COMPREHENSIVE PRACTICE (2026/2027 Edition)
National Board of Chiropractic Examiners • Part 4 Practical / Orthopedic Emphasis
Orthopedic Case Management • 200 Questions with Answers & Rationale
Format: 200 multiple-choice questions (single best answer, A–D).
Structure: Eight sections spanning orthopedic examination (spine, upper/lower
extremity), differential diagnosis, imaging, case management, orthopedic
conditions, and integrated scenarios.
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 4 test blueprint, current clinical guidelines, evidence-based
chiropractic practice, and orthopedic case management standards.
Special Imaging interpretation items; treatment/rehabilitation planning; comprehensive
inclusions: multi-region case studies.
Important This is an independent practice exam for educational study; it is not an official
note: NBCE exam.
, Section 1: Orthopedic Physical Examination – Spine (30 questions)
Q1: Which special test reproduces radiating arm pain in a patient with cervical radiculopathy?
A. Spurling test [CORRECT]
B. Straight Leg Raise
C. Phalen's test
D. Neer test
Correct Answer: A
Rationale: A is correct: Spurling's test reproduces cervical radiculopathy. B is lumbar; C is carpal tunnel; D is
shoulder.
Q2: Which special test is used to assess for cervical radiculopathy by lateral flexion/rotation with
axial compression?
A. Jackson test
B. Spurling test [CORRECT]
C. Valsalva maneuver
D. Slump test
Correct Answer: B
Rationale: A is correct: the Spurling test compresses the neural foramen. B (Jackson) is similar but different
technique; C and D are incorrect.
Q3: Which test involves the patient performing a forceful exhalation against a closed glottis to
reproduce radicular pain?
A. Spurling test
B. Phalen's test
C. Valsalva maneuver [CORRECT]
D. Lachman test
Correct Answer: C
Rationale: A is correct: the Valsalva maneuver increases intrathecal pressure. B, C, and D are incorrect.
Q4: A positive Lhermitte's sign (electric shock down the spine on neck flexion) suggests:
A. Carpal tunnel
B. Tennis elbow
C. Gout
D. Cervical myelopathy or demyelination [CORRECT]
Correct Answer: D
Rationale: A is correct: Lhermitte's sign suggests cord/demyelinating pathology. B, C, and D are incorrect.
Q5: Which test reproduces radiating leg pain in a patient with a lumbar disc herniation?
A. Straight Leg Raise (SLR) [CORRECT]
B. Spurling test
C. Phalen's test
D. Neer test
Correct Answer: A
Rationale: A is correct: the SLR reproduces sciatica. B, C, and D are incorrect.
NBCE Part 4 Orthopedics Exam (2026/2027) Page 2
, Q6: Which test is a variant of the SLR that increases tension on the nerve root (ankle dorsiflexion)?
A. Slump test
B. Braggard test [CORRECT]
C. Kernig test
D. Trendelenburg test
Correct Answer: B
Rationale: A is correct: the Braggard test adds dorsiflexion during the SLR. B, C, and D are incorrect.
Q7: Which test reproduces pain in a patient with suspected lumbar nerve root tension?
A. Phalen's test
B. Finkelstein test
C. Slump test [CORRECT]
D. Lachman test
Correct Answer: C
Rationale: A is correct: the slump test increases neural tension. B, C, and D are incorrect.
Q8: Which test is used to assess for meningeal irritation (neck stiffness) in possible meningitis?
A. SLR test
B. Phalen's test
C. Ober test
D. Kernig test [CORRECT]
Correct Answer: D
Rationale: A is correct: the Kernig test assesses meningeal irritation. B, C, and D are incorrect.
Q9: Which test involves flexing the hip and knee and then extending the knee to test meningeal
irritation?
A. Brudzinski/Kernig (meningeal) test [CORRECT]
B. SLR test
C. Lachman test
D. Trendelenburg test
Correct Answer: A
Rationale: A is correct: this tests meningeal irritation. B, C, and D are incorrect.
Q10: Which test is used to assess for sacroiliac joint dysfunction by flexing the hip to 90 degrees
and adducting/externally rotating (FABER/Patrick)?
A. SLR test
B. Patrick (FABER) test [CORRECT]
C. Ober test
D. Thomas test
Correct Answer: B
Rationale: A is correct: the FABER/Patrick test stresses the SI joint. B, C, and D are incorrect.
Q11: Which test assesses for iliotibial band tightness by abducting and extending the hip?
A. Patrick (FABER) test
B. Thomas test
C. Ober test [CORRECT]
D. Lachman test
Correct Answer: C
Rationale: A is correct: the Ober test assesses IT band tightness. B, C, and D are incorrect.
NBCE Part 4 Orthopedics Exam (2026/2027) Page 3
, Q12: Which test assesses for hip flexor tightness by having the patient lie supine and flex one hip?
A. Ober test
B. Trendelenburg test
C. Patrick test
D. Thomas test [CORRECT]
Correct Answer: D
Rationale: A is correct: the Thomas test assesses hip flexor tightness. B, C, and D are incorrect.
Q13: Which test assesses for gluteus medius weakness (pelvic drop when standing on one leg)?
A. Trendelenburg test [CORRECT]
B. Thomas test
C. Ober test
D. Patrick test
Correct Answer: A
Rationale: A is correct: the Trendelenburg test assesses gluteus medius. B, C, and D are incorrect.
Q14: Which is a red flag for cauda equina syndrome?
A. Mechanical low back pain
B. Saddle anesthesia and bowel/bladder dysfunction [CORRECT]
C. Muscle spasm
D. Radicular pain only
Correct Answer: B
Rationale: A is correct: saddle anesthesia and bowel/bladder dysfunction are red flags. B, C, and D are not.
Q15: Which is a red flag for a vertebral fracture?
A. Mechanical pain
B. Muscle spasm
C. Age over 70, trauma, or corticosteroid use [CORRECT]
D. Relief with rest
Correct Answer: C
Rationale: A is correct: advanced age, trauma, and steroid use are fracture red flags. B, C, and D are not.
Q16: Which is a red flag for a spinal tumor or infection?
A. Mechanical pain
B. Muscle spasm
C. Relief with rest
D. Night pain, fever, and unintentional weight loss [CORRECT]
Correct Answer: D
Rationale: A is correct: night pain, fever, and weight loss are red flags. B, C, and D are not.
Q17: Which condition is suggested by neurogenic claudication (pain with walking relieved by
leaning forward)?
A. Lumbar spinal stenosis [CORRECT]
B. Lumbar disc herniation
C. Sacroiliac dysfunction
D. Muscle strain
Correct Answer: A
Rationale: A is correct: spinal stenosis causes neurogenic claudication. B, C, and D are incorrect.
NBCE Part 4 Orthopedics Exam (2026/2027) Page 4
COMPREHENSIVE PRACTICE (2026/2027 Edition)
National Board of Chiropractic Examiners • Part 4 Practical / Orthopedic Emphasis
Orthopedic Case Management • 200 Questions with Answers & Rationale
Format: 200 multiple-choice questions (single best answer, A–D).
Structure: Eight sections spanning orthopedic examination (spine, upper/lower
extremity), differential diagnosis, imaging, case management, orthopedic
conditions, and integrated scenarios.
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 4 test blueprint, current clinical guidelines, evidence-based
chiropractic practice, and orthopedic case management standards.
Special Imaging interpretation items; treatment/rehabilitation planning; comprehensive
inclusions: multi-region case studies.
Important This is an independent practice exam for educational study; it is not an official
note: NBCE exam.
, Section 1: Orthopedic Physical Examination – Spine (30 questions)
Q1: Which special test reproduces radiating arm pain in a patient with cervical radiculopathy?
A. Spurling test [CORRECT]
B. Straight Leg Raise
C. Phalen's test
D. Neer test
Correct Answer: A
Rationale: A is correct: Spurling's test reproduces cervical radiculopathy. B is lumbar; C is carpal tunnel; D is
shoulder.
Q2: Which special test is used to assess for cervical radiculopathy by lateral flexion/rotation with
axial compression?
A. Jackson test
B. Spurling test [CORRECT]
C. Valsalva maneuver
D. Slump test
Correct Answer: B
Rationale: A is correct: the Spurling test compresses the neural foramen. B (Jackson) is similar but different
technique; C and D are incorrect.
Q3: Which test involves the patient performing a forceful exhalation against a closed glottis to
reproduce radicular pain?
A. Spurling test
B. Phalen's test
C. Valsalva maneuver [CORRECT]
D. Lachman test
Correct Answer: C
Rationale: A is correct: the Valsalva maneuver increases intrathecal pressure. B, C, and D are incorrect.
Q4: A positive Lhermitte's sign (electric shock down the spine on neck flexion) suggests:
A. Carpal tunnel
B. Tennis elbow
C. Gout
D. Cervical myelopathy or demyelination [CORRECT]
Correct Answer: D
Rationale: A is correct: Lhermitte's sign suggests cord/demyelinating pathology. B, C, and D are incorrect.
Q5: Which test reproduces radiating leg pain in a patient with a lumbar disc herniation?
A. Straight Leg Raise (SLR) [CORRECT]
B. Spurling test
C. Phalen's test
D. Neer test
Correct Answer: A
Rationale: A is correct: the SLR reproduces sciatica. B, C, and D are incorrect.
NBCE Part 4 Orthopedics Exam (2026/2027) Page 2
, Q6: Which test is a variant of the SLR that increases tension on the nerve root (ankle dorsiflexion)?
A. Slump test
B. Braggard test [CORRECT]
C. Kernig test
D. Trendelenburg test
Correct Answer: B
Rationale: A is correct: the Braggard test adds dorsiflexion during the SLR. B, C, and D are incorrect.
Q7: Which test reproduces pain in a patient with suspected lumbar nerve root tension?
A. Phalen's test
B. Finkelstein test
C. Slump test [CORRECT]
D. Lachman test
Correct Answer: C
Rationale: A is correct: the slump test increases neural tension. B, C, and D are incorrect.
Q8: Which test is used to assess for meningeal irritation (neck stiffness) in possible meningitis?
A. SLR test
B. Phalen's test
C. Ober test
D. Kernig test [CORRECT]
Correct Answer: D
Rationale: A is correct: the Kernig test assesses meningeal irritation. B, C, and D are incorrect.
Q9: Which test involves flexing the hip and knee and then extending the knee to test meningeal
irritation?
A. Brudzinski/Kernig (meningeal) test [CORRECT]
B. SLR test
C. Lachman test
D. Trendelenburg test
Correct Answer: A
Rationale: A is correct: this tests meningeal irritation. B, C, and D are incorrect.
Q10: Which test is used to assess for sacroiliac joint dysfunction by flexing the hip to 90 degrees
and adducting/externally rotating (FABER/Patrick)?
A. SLR test
B. Patrick (FABER) test [CORRECT]
C. Ober test
D. Thomas test
Correct Answer: B
Rationale: A is correct: the FABER/Patrick test stresses the SI joint. B, C, and D are incorrect.
Q11: Which test assesses for iliotibial band tightness by abducting and extending the hip?
A. Patrick (FABER) test
B. Thomas test
C. Ober test [CORRECT]
D. Lachman test
Correct Answer: C
Rationale: A is correct: the Ober test assesses IT band tightness. B, C, and D are incorrect.
NBCE Part 4 Orthopedics Exam (2026/2027) Page 3
, Q12: Which test assesses for hip flexor tightness by having the patient lie supine and flex one hip?
A. Ober test
B. Trendelenburg test
C. Patrick test
D. Thomas test [CORRECT]
Correct Answer: D
Rationale: A is correct: the Thomas test assesses hip flexor tightness. B, C, and D are incorrect.
Q13: Which test assesses for gluteus medius weakness (pelvic drop when standing on one leg)?
A. Trendelenburg test [CORRECT]
B. Thomas test
C. Ober test
D. Patrick test
Correct Answer: A
Rationale: A is correct: the Trendelenburg test assesses gluteus medius. B, C, and D are incorrect.
Q14: Which is a red flag for cauda equina syndrome?
A. Mechanical low back pain
B. Saddle anesthesia and bowel/bladder dysfunction [CORRECT]
C. Muscle spasm
D. Radicular pain only
Correct Answer: B
Rationale: A is correct: saddle anesthesia and bowel/bladder dysfunction are red flags. B, C, and D are not.
Q15: Which is a red flag for a vertebral fracture?
A. Mechanical pain
B. Muscle spasm
C. Age over 70, trauma, or corticosteroid use [CORRECT]
D. Relief with rest
Correct Answer: C
Rationale: A is correct: advanced age, trauma, and steroid use are fracture red flags. B, C, and D are not.
Q16: Which is a red flag for a spinal tumor or infection?
A. Mechanical pain
B. Muscle spasm
C. Relief with rest
D. Night pain, fever, and unintentional weight loss [CORRECT]
Correct Answer: D
Rationale: A is correct: night pain, fever, and weight loss are red flags. B, C, and D are not.
Q17: Which condition is suggested by neurogenic claudication (pain with walking relieved by
leaning forward)?
A. Lumbar spinal stenosis [CORRECT]
B. Lumbar disc herniation
C. Sacroiliac dysfunction
D. Muscle strain
Correct Answer: A
Rationale: A is correct: spinal stenosis causes neurogenic claudication. B, C, and D are incorrect.
NBCE Part 4 Orthopedics Exam (2026/2027) Page 4
