NBCE PART IV: ORTHOPEDICS
Chiropractic Orthopedic Competency Practice Assessment
2025 Practice Edition
200 Multiple-Choice Questions with Answers and Rationales
Original orthopedic study assessment aligned broadly to NBCE clinical competency
domains; not actual NBCE exam items or an official/endorsed exam.
Format note: NBCE Part IV is a practical clinical assessment. This written
multiple-choice review is a study aid, not a simulation or replica of the practical exam
format.
Page 1 of 69
,Table of Contents
Section 1: Orthopedic Principles, Terminology & Biomechanics (Questions 1–25)
........................................ 3
Section 2: Cervical Spine & Upper Extremity Orthopedics (Questions 26–50)
........................................ 11
Section 3: Thoracic Spine, Ribs & Lumbar Spine Orthopedics (Questions 51–75)
........................................ 20
Section 4: Pelvis, Hip & Lower Extremity Orthopedics (Questions 76–100) ........................................
28
Section 5: Orthopedic Special Tests & Clinical Examination (Questions 101–125)
........................................ 36
Section 6: Trauma, Fractures, Dislocations & Sports Injuries (Questions 126–150)
........................................ 44
Section 7: Inflammatory, Degenerative & Metabolic Bone Conditions (Questions 151–175)
........................................ 53
Section 8: Diagnostic Reasoning, Treatment Planning & Case Management (Questions 176–200)
........................................ 62
Page 2 of 69
,Section 1: Orthopedic Principles, Terminology & Biomechanics
(Questions 1–25)
Q1: A patient actively moves a joint through its available range without assistance. This
is:
A. Active range of motion [CORRECT]
B. Passive range of motion
C. Accessory motion
D. Isometric testing
Correct Answer: A
Rationale: Active range is produced by the patient’s own muscle activation; passive range is
moved by an examiner or external force.
Q2: An examiner moves a relaxed patient’s shoulder through the available range. This
assesses:
A. Passive range of motion [CORRECT]
B. Active range of motion
C. Muscle endurance
D. Reflex latency
Correct Answer: A
Rationale: Passive range evaluates movement supplied externally while the patient relaxes.
Q3: A patient’s painful shoulder has less active than passive range. Which explanation is
most plausible?
A. Pain, weakness, or impaired motor control may limit active movement [CORRECT]
B. A fixed capsular contracture is proven
C. The joint is normal
D. A fracture is excluded
Correct Answer: A
Rationale: A larger active limitation may reflect pain inhibition, weakness, or motor control
problems; it is not diagnostic by itself.
Page 3 of 69
, Q4: A patient’s active and passive shoulder motion are both globally restricted,
especially external rotation. Which pattern is suggested?
A. Capsular restriction such as adhesive capsulitis [CORRECT]
B. Isolated muscle weakness only
C. Normal shoulder mechanics
D. Radial nerve palsy
Correct Answer: A
Rationale: Global active and passive restriction, particularly external rotation, is a common
capsular pattern in adhesive capsulitis.
Q5: A sprain is an injury primarily to which tissue?
A. Ligament [CORRECT]
B. Muscle belly
C. Tendon only
D. Articular cartilage only
Correct Answer: A
Rationale: A sprain affects a ligament; a strain affects muscle or tendon.
Q6: A runner has an acute hamstring strain. Which tissue has been injured?
A. Muscle-tendon unit [CORRECT]
B. Joint capsule only
C. Ligament only
D. Subchondral bone only
Correct Answer: A
Rationale: A strain involves muscle or tendon fibers, commonly from tensile overload.
Q7: A tendon is loaded gradually during rehabilitation. Which response is most
consistent with tendon adaptation?
A. Collagen remodeling and improved load capacity over time [CORRECT]
B. Immediate conversion into ligament
C. Complete healing in one day
D. Permanent loss of vascularity
Correct Answer: A
Rationale: Progressive, appropriate loading can support collagen remodeling and function;
tendon adaptation takes time.
Page 4 of 69
Chiropractic Orthopedic Competency Practice Assessment
2025 Practice Edition
200 Multiple-Choice Questions with Answers and Rationales
Original orthopedic study assessment aligned broadly to NBCE clinical competency
domains; not actual NBCE exam items or an official/endorsed exam.
Format note: NBCE Part IV is a practical clinical assessment. This written
multiple-choice review is a study aid, not a simulation or replica of the practical exam
format.
Page 1 of 69
,Table of Contents
Section 1: Orthopedic Principles, Terminology & Biomechanics (Questions 1–25)
........................................ 3
Section 2: Cervical Spine & Upper Extremity Orthopedics (Questions 26–50)
........................................ 11
Section 3: Thoracic Spine, Ribs & Lumbar Spine Orthopedics (Questions 51–75)
........................................ 20
Section 4: Pelvis, Hip & Lower Extremity Orthopedics (Questions 76–100) ........................................
28
Section 5: Orthopedic Special Tests & Clinical Examination (Questions 101–125)
........................................ 36
Section 6: Trauma, Fractures, Dislocations & Sports Injuries (Questions 126–150)
........................................ 44
Section 7: Inflammatory, Degenerative & Metabolic Bone Conditions (Questions 151–175)
........................................ 53
Section 8: Diagnostic Reasoning, Treatment Planning & Case Management (Questions 176–200)
........................................ 62
Page 2 of 69
,Section 1: Orthopedic Principles, Terminology & Biomechanics
(Questions 1–25)
Q1: A patient actively moves a joint through its available range without assistance. This
is:
A. Active range of motion [CORRECT]
B. Passive range of motion
C. Accessory motion
D. Isometric testing
Correct Answer: A
Rationale: Active range is produced by the patient’s own muscle activation; passive range is
moved by an examiner or external force.
Q2: An examiner moves a relaxed patient’s shoulder through the available range. This
assesses:
A. Passive range of motion [CORRECT]
B. Active range of motion
C. Muscle endurance
D. Reflex latency
Correct Answer: A
Rationale: Passive range evaluates movement supplied externally while the patient relaxes.
Q3: A patient’s painful shoulder has less active than passive range. Which explanation is
most plausible?
A. Pain, weakness, or impaired motor control may limit active movement [CORRECT]
B. A fixed capsular contracture is proven
C. The joint is normal
D. A fracture is excluded
Correct Answer: A
Rationale: A larger active limitation may reflect pain inhibition, weakness, or motor control
problems; it is not diagnostic by itself.
Page 3 of 69
, Q4: A patient’s active and passive shoulder motion are both globally restricted,
especially external rotation. Which pattern is suggested?
A. Capsular restriction such as adhesive capsulitis [CORRECT]
B. Isolated muscle weakness only
C. Normal shoulder mechanics
D. Radial nerve palsy
Correct Answer: A
Rationale: Global active and passive restriction, particularly external rotation, is a common
capsular pattern in adhesive capsulitis.
Q5: A sprain is an injury primarily to which tissue?
A. Ligament [CORRECT]
B. Muscle belly
C. Tendon only
D. Articular cartilage only
Correct Answer: A
Rationale: A sprain affects a ligament; a strain affects muscle or tendon.
Q6: A runner has an acute hamstring strain. Which tissue has been injured?
A. Muscle-tendon unit [CORRECT]
B. Joint capsule only
C. Ligament only
D. Subchondral bone only
Correct Answer: A
Rationale: A strain involves muscle or tendon fibers, commonly from tensile overload.
Q7: A tendon is loaded gradually during rehabilitation. Which response is most
consistent with tendon adaptation?
A. Collagen remodeling and improved load capacity over time [CORRECT]
B. Immediate conversion into ligament
C. Complete healing in one day
D. Permanent loss of vascularity
Correct Answer: A
Rationale: Progressive, appropriate loading can support collagen remodeling and function;
tendon adaptation takes time.
Page 4 of 69
