NBCE Part II Cheat Sheet

General Diagnosis

19% of exam
Physical Exam Cardiopulmonary Signs Gastrointestinal Findings Genitourinary Pathology Endocrine Signs

Neuromusculoskeletal Diagnosis

20% of exam
Spine Orthopedics Extremity Tests Neurologic Examination Radiculopathy Signs Myelopathy Signs

Diagnostic Imaging

17% of exam
Plain Film Rules Spinal Instability Radiographic Lines Arthritides Bone Pathologies

Principles of Chiropractic

14% of exam
Biomechanics Chiropractic Models Neurophysiology Tissue Mechanics Research Interpretation

Chiropractic Practice

17% of exam
Patient Care Informed Consent Documentation Outcome Measures Community Health

Associated Clinical Sciences

13% of exam
Geriatrics Dermatology Toxicology Emergency Care Pediatrics Psychology Obstetrics and Gynecology

Quick Facts

Item count 255 questions across six domains
Session structure Two sessions; three domains each
Testing time 206 minutes; 3 hours 26 minutes
Appointment 4 hours including optional break
Passing score 375 scaled; whole Part II
Exam fee 710 US dollars
Test locations Eligible colleges and Prometric centers
Retakes Full examination; no domain retakes

Possible Posterior Circulation Warning Symptoms GE

Five Ds prompt assessment; absence never clears vascular risk
D = Dizziness D = Drop attacks D = Diplopia D = Dysarthria D = Dysphagia

Neurogenic Versus Vascular Claudication GE

Neurogenic Claudication

Often relieved by spinal flexion
Standing walking may provoke symptoms
Pulses may remain palpable
Lumbar stenosis is one cause

Vascular Claudication

Exertional symptoms improve with rest
Posture alone less influential
Pulses may be reduced
Assess ankle-brachial index when indicated
Patterns overlap; bedside tests are adjuncts

Abdominal and Vascular Red Flags GE

Murphy sign Supports gallbladder inflammation Not diagnostic alone
Rovsing sign Right-sided pain from left palpation Appendicitis concern
Blumberg sign Rebound suggests peritoneal irritation Urgent assessment
Pulsatile mass Raises abdominal aneurysm concern Ultrasound; emergency if symptomatic
CVA tenderness Possible renal or nonrenal cause Assess urinary symptoms
Grey Turner Flank ecchymosis may indicate bleeding Not pancreatitis-specific
Cullen sign Periumbilical ecchymosis may indicate bleeding Urgent assessment

Cardiopulmonary and Neurologic Red Flags GE

Horner syndrome Ptosis miosis; sometimes anhidrosis Painful onset: vascular emergency
Abdominojugular reflux Sustained jugular rise supports congestion Interpret with other findings
Kernig sign Pain resistance during knee extension Absence cannot exclude meningitis
Brudzinski sign Hip flexion during neck flexion Meningeal irritation concern
Saddle sensory change Perineal sensation reduced or altered Cauda equina concern
New urinary retention Possible sacral nerve dysfunction Emergency assessment and MRI
Claudication bicycle test Postural relief supports neurogenic cause Cannot exclude vascular disease

Upper Versus Lower Motor Neuron NE

Upper Motor Neuron

Hyperreflexia below established lesion
Extensor plantar response may occur
Spasticity or clonus may develop
Acute lesions may initially be flaccid

Lower Motor Neuron

Reduced reflexes in affected distribution
Weakness with reduced muscle tone
Atrophy develops with denervation
Fasciculations may occur; not mandatory
Patterns guide localization; exceptions occur

Spine Presentation Assessment and Referral NE

New bladder dysfunction saddle sensory change → Immediate emergency assessment; urgent MRI ( Possible cauda equina syndrome )
New unusual headache focal neurologic signs → Emergency vascular and neurological assessment ( Avoid manipulation and positional provocation )
Back pain with possible infection malignancy → Prompt medical workup; appropriate MRI ( Emergency if septic or neurologically compromised )
Severe or progressive motor deficit → Urgent medical or spinal assessment ( Do not prescribe automatic decompression )
Exertional bilateral leg symptoms → Assess neurologic and vascular causes ( Consider pulses and ankle-brachial index )
Arm pain with positive Spurling → Correlate strength reflex sensation history ( Test alone does not select treatment )
Localized extension-related spinal pain → Assess differential and functional limitations ( No automatic facet diagnosis or adjustment )
Posterior pelvic provocation pain → Use cluster and assess hip alternatives ( Exclude fracture infection inflammatory disease )
Uncomplicated persistent mechanical back pain → Education activity and individualized exercise ( Manual therapy only within assessed care )

Cervical Spine Orthopedic Tests NE

Spurling test Reproduces familiar radiating arm symptoms Supports radiculopathy
Cervical distraction May relieve familiar radicular symptoms Supportive finding only
Bakody sign Arm elevation may relieve symptoms Possible cervical radiculopathy
Lhermitte sign Electric shock with neck flexion Cord disease assessment
Hoffmann reflex Thumb index flexion after flick Not pathognomonic
Jerk test Provokes posterior shoulder symptoms Posterior instability concern
Adson test Pulse change has limited specificity Cannot diagnose thoracic outlet syndrome

L5 Versus S1 Radiculopathy NE

L5 Nerve Root

Great-toe extension often weak
Dorsal foot sensory change possible
No reliable routine tendon reflex
Heel walking may be impaired

S1 Nerve Root

Plantarflexion often weak
Lateral foot sensory change possible
Achilles reflex may decrease
Toe walking may be impaired
Combine motor sensory and reflex patterns

Lumbar and Pelvic Orthopedic Tests NE

Straight leg raise Reproduces familiar radicular leg pain Usually L5 or S1
Crossed straight-leg raise Opposite lift reproduces symptomatic pain Supports disc-related radiculopathy
Bragard maneuver Dorsiflexion modifies neural tension symptoms Not confirmatory alone
Kemp test Extension rotation provokes spinal pain Limited diagnostic specificity
Patrick FABER Groin or posterior pain localization Interpret within examination cluster
Gaenslen test Stresses sacroiliac region Single test insufficient
Yeoman test Hip extension provokes regional pain Not ligament-specific

Shoulder and Knee Orthopedic Tests NE

Neer test Elevation provokes shoulder pain Subacromial pain concern
Hawkins Kennedy Internal rotation provokes shoulder pain Not lesion-specific
Drop arm test Difficulty controlling arm lowering Raises rotator cuff concern
Empty can test Pain weakness during resisted elevation Cannot determine tear depth
Lachman test Increased anterior translation soft endpoint Supports ACL injury
McMurray test Joint-line click pain during movement Supports meniscal pathology
Apley grind test Compression rotation provokes joint pain Not diagnostic alone

Inflammatory Versus Degenerative Arthritis DI

Inflammatory Arthropathy

Often uniform joint-space loss
Marginal erosions may occur
Prolonged morning stiffness may occur
Inflammatory markers may be normal

Degenerative Arthropathy

Often asymmetric joint-space narrowing
Osteophytes and subchondral sclerosis
Morning stiffness usually briefer
Laboratory markers often normal
Patterns support differential; neither is universal

Diagnostic Imaging Modality Selection DI

Acute ankle knee injury meeting rules → Site-specific radiographs as indicated ( Ottawa rules do not cover spine )
Possible spinal cancer or infection → Appropriate MRI and medical workup ( Contrast depends on clinical question )
Uncomplicated acute radicular low-back pain → Usually no immediate imaging ( Reassess persistence progression or red flags )
Acute cord compression or myelopathy → Urgent MRI and specialist assessment ( Protocol follows suspected cause )
Persistent concern for pars stress injury → MRI or targeted CT when indicated ( No mandatory oblique radiographs )
Bone fragility risk assessment → DXA and clinical fracture assessment ( Z-score interpretation for younger adults )
Possible symptomatic abdominal aortic aneurysm → Emergency assessment; immediate aortic ultrasound ( Vascular service directs further imaging )
Adult cervical trauma requiring imaging → CT generally first-line ( MRI for indicated neural ligament assessment )
Hot swollen painful joint with fever → Urgent assessment; consider joint aspiration ( Imaging cannot exclude septic arthritis )

Cervical Radiographic Lines and Signs DI

Atlantodental interval Adult radiographic limit conventionally 3 mm Pediatric and CT limits differ
Posterior body line Step indicates altered vertebral alignment Not proof of dynamic instability
Spinolaminar line Posterior spinal canal alignment reference Interpret with other lines
Chamberlain line Posterior hard palate to opisthion Craniovertebral assessment
McGregor line Posterior palate to lowest occiput Technique-dependent interpretation
C2 prevertebral tissue Adult radiograph conventionally ≤7 mm Position and modality matter
C6 prevertebral tissue Adult radiograph conventionally ≤22 mm Not pediatric CT thresholds

Lumbar and Bone Pathologies DI

Scotty dog collar Lucency through pars interarticularis Obliques not routinely required
Meyerding grade Slip percentage relative to body below Instability needs further assessment
Winking owl sign Absent or poorly visualized pedicle Congenital or destructive causes
Ivory vertebra Diffuse vertebral body sclerosis Metastasis lymphoma Paget differential
Bamboo spine Bridging marginal syndesmophytes Ankylosed spine fracture risk
Pencil in cup Erosion with adjacent bone remodeling Psoriatic arthritis pattern
Spondylodiscitis pattern Endplate destruction with disc narrowing Early films may be normal

Five Component Subluxation Conceptual Model PR

Motion Nerves Muscle Tissue Chemistry; theory requires evidence
N = Neuropathophysiology neural dysfunction K = Kinesiopathology aberrant mechanics M = Myopathology muscular imbalance H = Histopathology inflammatory edema B = Pathobiochemistry biochemical mediators

Conceptual Models Versus Clinical Evidence PR

Conceptual Model

Organizes proposed mechanisms
Can generate testable hypotheses
May include subluxation terminology
Does not establish systemic disease causation

Clinical Evidence

Measures patient-important outcomes
Compares benefits harms and alternatives
Depends on population and condition
Requires reassessment of actual response
Plausible mechanism does not prove efficacy

Biomechanics and Chiropractic Conceptual Models PR

Cervical coupling Bending often accompanies ipsilateral rotation Subaxial tendency; not universal
Lumbar coupling Varies with level posture task Avoid universal directional rules
Instantaneous axis Kinematic reference for instantaneous rotation Not a palpation diagnosis
Kinesiopathology Abnormal motion within conceptual model Model; not systemic disease proof
Neuropathophysiology Proposed neural component of model Evaluate neurologic findings clinically
Tissue hysteresis Energy loss during loading cycles Viscoelastic property
Tissue creep Deformation increases under constant load Contrast constant-deformation stress relaxation

Medicare Subluxation Documentation Criteria CH

Two PART findings; include A or R
P = Pain and tenderness A = Asymmetry misalignment landmark R = Range motion abnormality T = Tissue tone texture

Absolute Versus Relative Thrust Contraindications CH

Major Reasons to Defer Thrust

Destructive spinal malignancy
Acute fracture or instability
Cauda equina or cord compression
Suspected spinal infection or vascular emergency

Additional Risk Assessment

Bone fragility or prior fracture
Spondylolisthesis stability and symptoms
Anticoagulation and bleeding risk
Hypermobility and connective-tissue disease
Assess pathology region and proposed procedure

Practice Standards and Informed Consent CH

Pain tenderness Document location and relevant findings PART criterion P
Asymmetry finding Segmental asymmetry or misalignment A or R required
Range abnormality Altered active passive accessory motion A or R required
Tissue abnormality Tone texture temperature changes Two PART findings required
Informed consent Capacity voluntariness risks benefits alternatives Jurisdictional requirements vary
Oswestry index Patient-reported low-back functional disability Higher scores indicate greater disability
Neck disability index Patient-reported neck-related functional disability Thresholds depend on population

Malignant Melanoma Clinical Screening Criteria AS

Asymmetry Border Color Diameter Evolving Skin Spot
A = Asymmetry of lesion B = Border irregular scalloped C = Color variation variegation D = Often >6 mm; sometimes smaller E = Evolving changing size shape

Clinical Pharmacology and Emergency Signs AS

NSAID toxicity Gastrointestinal renal cardiovascular harms Review medicines and risk factors
Systemic corticosteroids Fracture infection osteonecrosis risks Assess dose duration symptoms
Herpes zoster Usually unilateral dermatomal vesicular rash Prompt antiviral assessment
DXA osteoporosis Diagnostic T-score ≤−2.5 Postmenopausal women; men ≥50
Nursemaid elbow Radial head annular ligament displacement Atypical findings suggest fracture
Melanoma ABCDE Asymmetry border color diameter evolution Small lesions may be malignant
Cervical artery dissection New unusual pain or neurological signs Emergency assessment; no manipulation

Common Traps

Treating Claudication Patterns as Definitive

Neurogenic symptoms often improve with flexion ≠ Vascular symptoms often improve with rest

Ordering Routine Lumbar Oblique Views

Scotty dog is traditional radiographic anatomy ≠ Obliques add radiation; not universally required

Diagnosing From One Provocative Test

Local neck pain alone is nonspecific ≠ Radiculopathy may lack a textbook pattern

Assuming Low-force Treatment Is Automatically Safe

Osteoporosis includes T-score exactly −2.5 ≠ Assess age population and fracture history

Misreading Medicare PART Criteria

At least two findings are required ≠ Include either A or R

Using Five Ds as Vascular Clearance

Dissection may initially cause isolated pain ≠ Carotid disease may cause painful Horner

Converting Theory Into a Treatment Rule

Listings do not prove symptom causation ≠ Creep does not establish traction efficacy

Last Minute

1. Recall current 255-question 206-minute format
2. Recall the official domain weight distribution
3. Treat possible cauda equina as emergency
4. Combine signs with full clinical context
5. Apply Medicare PART and active-care requirements
6. Assess vascular and neurogenic claudication
7. Avoid routine imaging without appropriate indications
8. Document consent under applicable jurisdictional rules
9. Separate scoliometer screening from Cobb measurement
10. Use age-appropriate DXA classification and reference
11. Distinguish theoretical models from demonstrated benefit

NBCE Part II

Practice Questions 274 questions Study Guide 67 topics Cheat Sheet 70 facts Flashcards 50 cards Games 20 terms Shorts 2 short s Podcast
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