NBCE EXAM PART 3 | ACTUAL EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
ACTUAL IMAGES | 2 DIFFERENT VERSIONS |
CORRECT SOLUTIONS | GRADED A+ | LATEST
UPDATE 2026/2027 | GUARANTEED PASS.
1. A patient presents with acute-onset severe headache, neck stiffness, and photophobia. Vital
signs: temperature 39.2°C, heart rate 110 bpm, blood pressure 140/90 mmHg. Kernig and
Brudzinski signs are positive. Which of the following is the most appropriate immediate action?
A. Perform cervical spinal manipulation to relieve muscle spasm
B. Administer intravenous antibiotics after obtaining blood cultures and lumbar puncture
C. Prescribe oral analgesics and schedule follow-up in 48 hours
D. Apply cervical traction and recommend bed rest
Answer: B
Rationale: The presentation is classic for bacterial meningitis. Immediate administration of empiric
antibiotics after cultures is critical to reduce morbidity and mortality. Spinal manipulation is
contraindicated due to risk of neurological deterioration. Oral analgesics and traction delay definitive
treatment.
2. A patient with chronic low back pain has a positive straight leg raise test at 40° on the left, with
cross-over pain to the right leg. MRI reveals a large paracentral disc herniation at L4-L5
compressing the left L5 nerve root. Which of the following is the most likely accompanying
physical finding?
A. Weakness of left ankle plantarflexion
B. Decreased sensation over the left medial malleolus
C. Absent left patellar reflex
D. Weakness of left great toe dorsiflexion
Answer: D
Rationale: L5 nerve root compression typically causes weakness of great toe dorsiflexion (extensor
hallucis longus) and foot dorsiflexion. Plantarflexion is S1, medial malleolus sensation is L4, and
patellar reflex is L4.
3. Which of the following best describes the mechanism of action of NSAIDs in the context of acute
musculoskeletal inflammation?
A. Selective inhibition of COX-2 reduces prostaglandin synthesis, decreasing pain and inflammation without
affecting platelet aggregation
Page 1
,B. Non-selective COX inhibition reduces prostaglandin and thromboxane synthesis, providing analgesia and
anti-inflammatory effects but increasing bleeding risk
C. Inhibition of lipoxygenase pathway reduces leukotriene production, primarily affecting bronchoconstriction
D. Antagonism of substance P at NK1 receptors modulates pain transmission in the dorsal horn
Answer: B
Rationale: NSAIDs non-selectively inhibit COX-1 and COX-2, reducing prostaglandins (inflammation)
and thromboxane (platelet aggregation). Option A describes selective COX-2 inhibitors, which have less
antiplatelet effect. Option C refers to leukotriene inhibitors used in asthma. Option D describes NK1
antagonists (e.g., aprepitant) used for chemotherapy-induced nausea.
4. A patient presents with progressive weakness and atrophy of the thenar eminence and first
dorsal interosseous muscle, without sensory loss. Electrodiagnostic studies show reduced
compound muscle action potential amplitude and fibrillation potentials in abductor pollicis brevis.
Which of the following is the most likely diagnosis?
A. Carpal tunnel syndrome
B. Cervical radiculopathy C8-T1
C. Ulnar nerve entrapment at the elbow
D. Amyotrophic lateral sclerosis (ALS)
Answer: D
Rationale: Pure motor weakness and atrophy in a distal upper extremity distribution with denervation on
EMG suggests motor neuron disease. ALS typically presents with painless weakness, atrophy, and
fasciculations without sensory loss. Carpal tunnel syndrome and C8 radiculopathy have sensory
components. Ulnar neuropathy affects hypothenar muscles and has sensory loss.
5. In a patient with chronic low back pain and suspected sacroiliac joint dysfunction, which of the
following test clusters has the highest diagnostic accuracy for confirming SI joint pain?
A. Gaenslen test, FABER test, and thigh thrust test
B. Straight leg raise, crossed straight leg raise, and slump test
C. Hip abduction strength, Ober test, and Thomas test
D. Valsalva maneuver, cough impulse, and prone knee bending test
Answer: A
Rationale: The cluster of Gaenslen, FABER, and thigh thrust tests has been shown to have high sensitivity
and specificity for SI joint pain. Straight leg raise and slump test are used for lumbar radiculopathy. Hip
tests (Ober, Thomas) assess hip pathology. Valsalva and cough tests are for discogenic pain.
6. A patient with a history of recurrent anterior shoulder dislocations presents with apprehension
and pain at 90° abduction and external rotation. Which of the following is the most appropriate
initial imaging modality to evaluate for a Bankart lesion?
A. Plain radiography with anteroposterior and axillary views
B. Ultrasound of the shoulder
C. MRI arthrography
D. CT arthrography
Page 2
,Answer: C
Rationale: MRI arthrography is the gold standard for detecting labral tears, including Bankart lesions,
due to its high soft tissue contrast and ability to delineate the labrum. Plain radiographs may show a
Hill-Sachs lesion but not labral tears. Ultrasound is operator-dependent and less sensitive for labral
pathology. CT arthrography is used when MRI is contraindicated but involves radiation.
7. Which of the following nutritional interventions is most strongly supported by evidence for
reducing the risk of progression from prediabetes to type 2 diabetes?
A. High-protein, low-carbohydrate diet with emphasis on red meat
B. Mediterranean diet supplemented with extra-virgin olive oil and nuts
C. Low-fat diet with increased whole grains and legumes
D. Intermittent fasting with 16-hour daily fasts
Answer: B
Rationale: The PREDIMED trial demonstrated that a Mediterranean diet supplemented with olive oil or
nuts significantly reduced the incidence of type 2 diabetes in high-risk individuals. High red meat intake
is associated with increased diabetes risk. Low-fat diets have shown modest benefit. Intermittent fasting
lacks long-term trial data for diabetes prevention.
8. A patient presents with acute onset of vertigo, nausea, and nystagmus that is horizontal and
unidirectional, with normal hearing and no neurological deficits. The symptoms are exacerbated
by head movement. Which of the following is the most likely diagnosis and appropriate initial
management?
A. Meniere's disease; prescribe a low-sodium diet and diuretics
B. Benign paroxysmal positional vertigo (BPPV); perform the Epley maneuver
C. Vestibular neuritis; administer corticosteroids and vestibular suppressants
D. Central vertigo; obtain MRI brain with and without contrast
Answer: B
Rationale: BPPV presents with brief episodes of vertigo triggered by head movement, with horizontal
nystagmus that is fatigable. The Epley maneuver is the standard treatment. Meniere's disease includes
hearing loss and tinnitus. Vestibular neuritis has continuous vertigo lasting days with vertical
nystagmus. Central vertigo has neurological signs.
9. A patient with chronic neck pain and stiffness has a positive Sharp-Purser test. Which of the
following is the most appropriate next step?
A. Perform cervical high-velocity low-amplitude manipulation to the upper cervical spine
B. Obtain flexion-extension cervical radiographs to assess for atlantoaxial instability
C. Refer for surgical evaluation due to suspected transverse ligament rupture
D. Initiate a program of isometric neck exercises and postural correction
Answer: B
Rationale: A positive Sharp-Purser test suggests atlantoaxial instability, which is a contraindication to
cervical manipulation. Flexion-extension radiographs are indicated to evaluate instability. Immediate
surgical referral is not warranted without imaging confirmation. Isometric exercises may be appropriate
if instability is ruled out.
Page 3
, 10. A patient presents with acute onset of severe right-sided low back pain radiating to the groin,
accompanied by nausea and hematuria. Urinalysis shows microscopic hematuria. Which of the
following is the most likely diagnosis?
A. Lumbar disc herniation with nerve root compression
B. Acute pyelonephritis
C. Ureteral colic due to nephrolithiasis
D. Abdominal aortic aneurysm rupture
Answer: C
Rationale: The combination of acute flank pain radiating to the groin, nausea, and hematuria is classic
for ureteral colic from a kidney stone. Disc herniation typically has radicular pain along a dermatome
and no hematuria. Pyelonephritis presents with fever and costovertebral angle tenderness. AAA rupture
presents with hypotension and pulsatile mass.
11. A 45-year-old patient presents with acute low back pain that began after lifting a heavy box.
Neurological examination reveals diminished patellar reflex on the right and decreased sensation
over the anterior thigh. Which nerve root is most likely compressed?
A. L2
B. L3
C. L4
D. L5
Answer: C
Rationale: The patellar reflex is primarily mediated by the L4 nerve root. Diminished reflex and sensory
loss over the anterior thigh (L4 dermatome) point to L4 radiculopathy. L2 and L3 do not contribute to
the patellar reflex, and L5 affects the medial hamstring reflex and lateral leg sensation.
12. A patient presents with neck pain and stiffness following a motor vehicle collision. Radiographs
reveal a loss of cervical lordosis and a 3 mm anterior translation of C4 on C5. Which instability
grading is most consistent with these findings?
A. Grade I instability
B. Grade II instability
C. Grade III instability
D. Grade IV instability
Answer: A
Rationale: According to the White and Panjabi criteria for clinical instability, translation >3.5 mm or
angular motion >11° is considered unstable. Here, 3 mm translation is borderline but less than 3.5 mm,
and loss of lordosis alone does not indicate instability. Thus, this is Grade I (mild) instability. Grade II
involves translation >3.5 mm, Grade III includes neurologic deficit, and Grade IV indicates gross
instability.
13. A patient with chronic low back pain undergoes a lumbar MRI that shows a high-intensity zone
(HIZ) in the posterior annulus of L5-S1 on T2-weighted images. Which of the following best
describes the clinical significance of this finding?
Page 4
QUESTIONS WITH VERIFIED ANSWERS AND
ACTUAL IMAGES | 2 DIFFERENT VERSIONS |
CORRECT SOLUTIONS | GRADED A+ | LATEST
UPDATE 2026/2027 | GUARANTEED PASS.
1. A patient presents with acute-onset severe headache, neck stiffness, and photophobia. Vital
signs: temperature 39.2°C, heart rate 110 bpm, blood pressure 140/90 mmHg. Kernig and
Brudzinski signs are positive. Which of the following is the most appropriate immediate action?
A. Perform cervical spinal manipulation to relieve muscle spasm
B. Administer intravenous antibiotics after obtaining blood cultures and lumbar puncture
C. Prescribe oral analgesics and schedule follow-up in 48 hours
D. Apply cervical traction and recommend bed rest
Answer: B
Rationale: The presentation is classic for bacterial meningitis. Immediate administration of empiric
antibiotics after cultures is critical to reduce morbidity and mortality. Spinal manipulation is
contraindicated due to risk of neurological deterioration. Oral analgesics and traction delay definitive
treatment.
2. A patient with chronic low back pain has a positive straight leg raise test at 40° on the left, with
cross-over pain to the right leg. MRI reveals a large paracentral disc herniation at L4-L5
compressing the left L5 nerve root. Which of the following is the most likely accompanying
physical finding?
A. Weakness of left ankle plantarflexion
B. Decreased sensation over the left medial malleolus
C. Absent left patellar reflex
D. Weakness of left great toe dorsiflexion
Answer: D
Rationale: L5 nerve root compression typically causes weakness of great toe dorsiflexion (extensor
hallucis longus) and foot dorsiflexion. Plantarflexion is S1, medial malleolus sensation is L4, and
patellar reflex is L4.
3. Which of the following best describes the mechanism of action of NSAIDs in the context of acute
musculoskeletal inflammation?
A. Selective inhibition of COX-2 reduces prostaglandin synthesis, decreasing pain and inflammation without
affecting platelet aggregation
Page 1
,B. Non-selective COX inhibition reduces prostaglandin and thromboxane synthesis, providing analgesia and
anti-inflammatory effects but increasing bleeding risk
C. Inhibition of lipoxygenase pathway reduces leukotriene production, primarily affecting bronchoconstriction
D. Antagonism of substance P at NK1 receptors modulates pain transmission in the dorsal horn
Answer: B
Rationale: NSAIDs non-selectively inhibit COX-1 and COX-2, reducing prostaglandins (inflammation)
and thromboxane (platelet aggregation). Option A describes selective COX-2 inhibitors, which have less
antiplatelet effect. Option C refers to leukotriene inhibitors used in asthma. Option D describes NK1
antagonists (e.g., aprepitant) used for chemotherapy-induced nausea.
4. A patient presents with progressive weakness and atrophy of the thenar eminence and first
dorsal interosseous muscle, without sensory loss. Electrodiagnostic studies show reduced
compound muscle action potential amplitude and fibrillation potentials in abductor pollicis brevis.
Which of the following is the most likely diagnosis?
A. Carpal tunnel syndrome
B. Cervical radiculopathy C8-T1
C. Ulnar nerve entrapment at the elbow
D. Amyotrophic lateral sclerosis (ALS)
Answer: D
Rationale: Pure motor weakness and atrophy in a distal upper extremity distribution with denervation on
EMG suggests motor neuron disease. ALS typically presents with painless weakness, atrophy, and
fasciculations without sensory loss. Carpal tunnel syndrome and C8 radiculopathy have sensory
components. Ulnar neuropathy affects hypothenar muscles and has sensory loss.
5. In a patient with chronic low back pain and suspected sacroiliac joint dysfunction, which of the
following test clusters has the highest diagnostic accuracy for confirming SI joint pain?
A. Gaenslen test, FABER test, and thigh thrust test
B. Straight leg raise, crossed straight leg raise, and slump test
C. Hip abduction strength, Ober test, and Thomas test
D. Valsalva maneuver, cough impulse, and prone knee bending test
Answer: A
Rationale: The cluster of Gaenslen, FABER, and thigh thrust tests has been shown to have high sensitivity
and specificity for SI joint pain. Straight leg raise and slump test are used for lumbar radiculopathy. Hip
tests (Ober, Thomas) assess hip pathology. Valsalva and cough tests are for discogenic pain.
6. A patient with a history of recurrent anterior shoulder dislocations presents with apprehension
and pain at 90° abduction and external rotation. Which of the following is the most appropriate
initial imaging modality to evaluate for a Bankart lesion?
A. Plain radiography with anteroposterior and axillary views
B. Ultrasound of the shoulder
C. MRI arthrography
D. CT arthrography
Page 2
,Answer: C
Rationale: MRI arthrography is the gold standard for detecting labral tears, including Bankart lesions,
due to its high soft tissue contrast and ability to delineate the labrum. Plain radiographs may show a
Hill-Sachs lesion but not labral tears. Ultrasound is operator-dependent and less sensitive for labral
pathology. CT arthrography is used when MRI is contraindicated but involves radiation.
7. Which of the following nutritional interventions is most strongly supported by evidence for
reducing the risk of progression from prediabetes to type 2 diabetes?
A. High-protein, low-carbohydrate diet with emphasis on red meat
B. Mediterranean diet supplemented with extra-virgin olive oil and nuts
C. Low-fat diet with increased whole grains and legumes
D. Intermittent fasting with 16-hour daily fasts
Answer: B
Rationale: The PREDIMED trial demonstrated that a Mediterranean diet supplemented with olive oil or
nuts significantly reduced the incidence of type 2 diabetes in high-risk individuals. High red meat intake
is associated with increased diabetes risk. Low-fat diets have shown modest benefit. Intermittent fasting
lacks long-term trial data for diabetes prevention.
8. A patient presents with acute onset of vertigo, nausea, and nystagmus that is horizontal and
unidirectional, with normal hearing and no neurological deficits. The symptoms are exacerbated
by head movement. Which of the following is the most likely diagnosis and appropriate initial
management?
A. Meniere's disease; prescribe a low-sodium diet and diuretics
B. Benign paroxysmal positional vertigo (BPPV); perform the Epley maneuver
C. Vestibular neuritis; administer corticosteroids and vestibular suppressants
D. Central vertigo; obtain MRI brain with and without contrast
Answer: B
Rationale: BPPV presents with brief episodes of vertigo triggered by head movement, with horizontal
nystagmus that is fatigable. The Epley maneuver is the standard treatment. Meniere's disease includes
hearing loss and tinnitus. Vestibular neuritis has continuous vertigo lasting days with vertical
nystagmus. Central vertigo has neurological signs.
9. A patient with chronic neck pain and stiffness has a positive Sharp-Purser test. Which of the
following is the most appropriate next step?
A. Perform cervical high-velocity low-amplitude manipulation to the upper cervical spine
B. Obtain flexion-extension cervical radiographs to assess for atlantoaxial instability
C. Refer for surgical evaluation due to suspected transverse ligament rupture
D. Initiate a program of isometric neck exercises and postural correction
Answer: B
Rationale: A positive Sharp-Purser test suggests atlantoaxial instability, which is a contraindication to
cervical manipulation. Flexion-extension radiographs are indicated to evaluate instability. Immediate
surgical referral is not warranted without imaging confirmation. Isometric exercises may be appropriate
if instability is ruled out.
Page 3
, 10. A patient presents with acute onset of severe right-sided low back pain radiating to the groin,
accompanied by nausea and hematuria. Urinalysis shows microscopic hematuria. Which of the
following is the most likely diagnosis?
A. Lumbar disc herniation with nerve root compression
B. Acute pyelonephritis
C. Ureteral colic due to nephrolithiasis
D. Abdominal aortic aneurysm rupture
Answer: C
Rationale: The combination of acute flank pain radiating to the groin, nausea, and hematuria is classic
for ureteral colic from a kidney stone. Disc herniation typically has radicular pain along a dermatome
and no hematuria. Pyelonephritis presents with fever and costovertebral angle tenderness. AAA rupture
presents with hypotension and pulsatile mass.
11. A 45-year-old patient presents with acute low back pain that began after lifting a heavy box.
Neurological examination reveals diminished patellar reflex on the right and decreased sensation
over the anterior thigh. Which nerve root is most likely compressed?
A. L2
B. L3
C. L4
D. L5
Answer: C
Rationale: The patellar reflex is primarily mediated by the L4 nerve root. Diminished reflex and sensory
loss over the anterior thigh (L4 dermatome) point to L4 radiculopathy. L2 and L3 do not contribute to
the patellar reflex, and L5 affects the medial hamstring reflex and lateral leg sensation.
12. A patient presents with neck pain and stiffness following a motor vehicle collision. Radiographs
reveal a loss of cervical lordosis and a 3 mm anterior translation of C4 on C5. Which instability
grading is most consistent with these findings?
A. Grade I instability
B. Grade II instability
C. Grade III instability
D. Grade IV instability
Answer: A
Rationale: According to the White and Panjabi criteria for clinical instability, translation >3.5 mm or
angular motion >11° is considered unstable. Here, 3 mm translation is borderline but less than 3.5 mm,
and loss of lordosis alone does not indicate instability. Thus, this is Grade I (mild) instability. Grade II
involves translation >3.5 mm, Grade III includes neurologic deficit, and Grade IV indicates gross
instability.
13. A patient with chronic low back pain undergoes a lumbar MRI that shows a high-intensity zone
(HIZ) in the posterior annulus of L5-S1 on T2-weighted images. Which of the following best
describes the clinical significance of this finding?
Page 4
