1.2 Format, Sessions, and Test Day

NBCE Part II Examination Exam

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1 Introduction & Exam Overview

1.1 Current Exam Facts 1.2 Format, Sessions, and Test Day 1.3 Scoring, Fees, and Retakes 1.4 Study Strategy by Domain Weight

2 General Diagnosis: History and Physical Examination

2.1 Case History 2.2 Vital Signs 2.3 Head and Neck Examination/Findings 2.4 Thorax Examination/Findings

3 General Diagnosis: Abdomen, Urogenital Exam, and Labs

3.1 Abdominal Examination/Findings 3.2 Rectal and Male Urogenital Examination/Findings 3.3 Laboratory Interpretation

4 General Diagnosis: Clinical Impression — EENT through Blood

4.1 Eyes, Ears, Nose, and Throat Diseases 4.2 Respiratory Diseases 4.3 Cardiovascular Diseases 4.4 Blood and Lymphatic Diseases

5 General Diagnosis: Clinical Impression — GI, GU, Endocrine

5.1 Gastrointestinal Diseases 5.2 Genitourinary Diseases 5.3 Endocrine and Metabolic Disorders

6 General Diagnosis: Clinical Impression — Immune, Nutrition, Infection

6.1 Immunological Disorders 6.2 Nutritional Disorders 6.3 Infectious Diseases

7 NMS Diagnosis: History, Posture, and Cervical/Thoracic Orthopedics

7.1 NMS Case History 7.2 Posture and Gait Assessment 7.3 Orthopedic Examination: Cervical Spine 7.4 Orthopedic Examination: Thoracic Spine

8 NMS Diagnosis: Lumbar/Extremity Orthopedics and Neuro Exam Basics

8.1 Orthopedic Examination: Lumbar Spine and Pelvis 8.2 Orthopedic Examination: Extremities 8.3 Neurologic Examination: Cranial Nerve and CNS Testing 8.4 Neurologic Examination: Motor and Sensory Testing

9 NMS Diagnosis: Reflexes, CNS, and Peripheral Disorders

9.1 Neurologic Examination: Reflex Testing 9.2 Diagnosis: CNS Disorders 9.3 Diagnosis: Peripheral Neurologic and Neurovascular Disorders

10 NMS Diagnosis: Muscular and Bone/Joint Disorders

10.1 Diagnosis: Muscular Disorders 10.2 Diagnosis: Bone and Joint Disorders

11 Diagnostic Imaging: Technology and Positioning

11.1 Imaging Technology 11.2 Radiographic Positioning and Normal Anatomy: Spine and Pelvis 11.3 Radiographic Positioning and Normal Anatomy: Extremities, Thorax, and Abdomen

12 Diagnostic Imaging: Congenital, Trauma, Arthritis, Tumors

12.1 Congenital Anomalies and Normal Variants 12.2 Trauma 12.3 Arthritides 12.4 Tumors and Tumor-like Processes

13 Diagnostic Imaging: Metabolic, Infectious, and Visceral Findings

13.1 Nutritional, Metabolic, Endocrine, and Hematologic Imaging Findings 13.2 Infectious and Miscellaneous Skeletal Conditions 13.3 Thoracic and Abdominal Imaging Conditions

14 Diagnostic Imaging: Interpretation Methods and Special Imaging

14.1 Methods of Interpretation 14.2 Clinical Applications of Special Imaging

15 Principles of Chiropractic: Paradigm and Subluxation Models

15.1 The Chiropractic Paradigm 15.2 Subluxation Models: Neural and Reflex Theories 15.3 Subluxation Models: Vascular, Trophic, Immune, and Biomechanical

16 Principles of Chiropractic: Basic Science and Applied Principles

16.1 Basic Science Concepts in Chiropractic 16.2 Applied Chiropractic Principles

17 Chiropractic Practice: Analysis, Technique, and Case Management

17.1 Spinal Analysis and Patient Evaluation 17.2 Chiropractic Adjustive Technique: Cervical and Thoracic 17.3 Chiropractic Adjustive Technique: Lumbar, Pelvic, Costal, and Extremity 17.4 Patient Care: Case Management and Contraindications

18 Chiropractic Practice: Rehab, Community, and Occupational Health

18.1 Patient Care: Home Care, Prevention, and Rehabilitation 18.2 Community Health and Wellness 18.3 Occupational and Environmental Health

19 Associated Clinical Sciences: Geriatrics, Dermatology, and STDs

19.1 Geriatrics 19.2 Dermatology 19.3 Sexually Transmitted Diseases

20 Associated Clinical Sciences: Toxicology, Emergency, and Psychology

20.1 Toxicology 20.2 Emergency Procedures 20.3 Psychology

21 Associated Clinical Sciences: OB/GYN, Pediatrics, and Jurisprudence

21.1 Gynecology and Obstetrics 21.2 Pediatrics 21.3 Jurisprudence, Ethics, and Basic Economics

1.2 Format, Sessions, and Test Day

Key Takeaways Explain This Topic AI

You receive 3 hours 26 minutes of active testing time inside a 4-hour appointment that includes check-in and administrative procedures.

NBCE computer-based exams run forward-only: you must answer each item before advancing and cannot revisit answered questions, so there is no review pass.

Session 1 is diagnosis- and imaging-heavy (56% of items); Session 2 shifts to chiropractic principles, practice standards, and associated clinical sciences.

Part II is delivered only at Prometric centers and approved chiropractic college CBT sites—plan logistics early for high-demand windows.

Pacing near 48 seconds per question across 255 items is the realistic target for finishing without a frantic final 30 minutes.

Last updated: July 2026

Computer-Based Format: What "CBT" Means on Test Day

Computer-based testing (CBT) for NBCE Part II means every item is presented on a secure workstation with standardized navigation: stem text, multiple answer choices, and an on-screen timer. Since August 2024 the NBCE has used forward-only functionality on Parts I, II, III, and Physiotherapy: you must answer each item before advancing, and you cannot return to a previously answered question . There is no flag-and-review pass, no paper test booklet, and no return to a prior session once it ends. The NBCE does provide a blank sheet of paper and a pencil for scratch work.

Understanding the human factors of CBT is part of exam competency. You will scroll long vignettes, toggle between imaging descriptions and answer choices, and manage visual fatigue from bright testing rooms. If your prep has been entirely paper-based, schedule at least three full-length timed sessions on a laptop before test day.

Appointment Length vs. Testing Time

NBCE distinguishes two time concepts that candidates often conflate:

Time Element Duration What It Covers
Total testing time 3 hours 26 minutes Active time answering items across both sessions
Appointment window 4 hours Check-in, identity verification, instructions, optional break, and testing

The 4-hour appointment is your reservation block at Prometric or a college site. Arrive early—late arrival can forfeit the seat under Prometric rules even if NBCE fees were paid. The 3 hours 26 minutes figure is the published testing allocation for the 255-item exam; it is not "extra study time" you can borrow from check-in.

Pacing mathematics

255 questions ÷ 206 minutes ≈ 0.81 minutes per question (about 48 seconds). That average is unforgiving:

A 90-second struggle on five items costs you nearly four minutes—roughly five additional questions of buffer.

Because navigation is forward-only, there is no end-of-session review sweep to rescue skipped items—every answer is final when you advance.

Build a personal pacing ladder:

First third of session: at or under 45 seconds/item (confidence builders).

Middle third: up to 50 seconds/item (mixed vignettes).

Final third: protect enough margin that fatigue-heavy imaging and multi-step diagnosis items still get a deliberate first pass—your only pass.

Session Architecture

Part II is divided into two sessions that mirror the domain grouping in the official test plan.

Session 1 — Diagnostic Block
Domains included: General Diagnosis (19%), Neuromusculoskeletal Diagnosis (20%), Diagnostic Imaging (17%)

Candidate experience: Session 1 feels like a continuous clinical reasoning marathon. Items may chain history → exam → study → impression without labeling the domain. A single vignette can test whether you:

Recognize non-MSK red flags requiring referral (General Diagnosis).

Localize radicular vs. referred pain patterns (Neuromusculoskeletal Diagnosis).

Choose imaging modality or interpret a described film (Diagnostic Imaging).

Common trap: spending disproportionate time on orthopedic minutiae while missing systemic differentials—General Diagnosis is nearly as large as NMS and often carries higher surprise factor.

Optional Break After Session 1

NBCE specifies an optional 15-minute break after Session 1. Treat this as a performance tool, not a courtesy:

Take the break if you used >95% of Session 1 time or felt rushed on imaging items.

Skip or shorten only if you are ahead of pace and mentally fresh—rare for first-time testers.

Hydrate and eat something stable (low sugar spike) during the break; Session 2 includes ethics and pharmacology items that punish foggy thinking.

Confirm in your candidate instructions whether the break pauses the master clock or draws from the 4-hour appointment envelope—NBCE bulletins and Prometric center procedures should be treated as authoritative if wording differs from third-party prep sites.

Session 2 — Practice and Clinical Sciences Block

Domains included: Principles of Chiropractic (14%), Chiropractic Practice (17%), Associated Clinical Sciences (13%)

Candidate experience: Session 2 items often feel more "policy and principle" until pharmacology or emergency scenarios appear under Associated Clinical Sciences. Chiropractic Practice at 17% is the largest Session 2 domain—documentation, informed consent, boundaries, and referral standards are high-frequency.

Trap: assuming Session 2 is "easier" because associated sciences is only 13%. Those items are frequently standalone traps on drug interactions, contraindications, and acute presentations.

Test Center Logistics: Prometric vs. College Sites
Prometric testing centers

Standardized environment, frequent administrations.

Strict ID rules—name must match MyNBCE registration exactly.

Lockers for personal items; expect metal detection or wanding.

Noise-reduction headsets usually available on request.

Chiropractic college CBT sites

Offered during designated windows ; seats may be limited to students/graduates of that institution or region per NBCE scheduling rules.

Familiar building can reduce stress—but do not assume relaxed proctoring; security rules mirror high-stakes CBT standards.

Parking and check-in flows differ; do a dry-run arrival if the site is on your campus.

Regardless of venue, no watches, phones, or study materials reach the testing room. Current NBCE rules permit only a valid government-issued photo ID (digital IDs are not accepted), one car key , one clear plastic water bottle with a lid , and a wedding band . Violations are reportable offenses with score consequences.

Test Day Timeline (Sample)

Phase Typical Actions
T−30 min Arrive, park, locate suite
T−15 min ID check, photograph, palm scan or fingerprint
T−5 min Locker storage, earplugs/headset request
Session 1 ~56% of items, diagnostic focus
Break Optional 15 minutes
Session 2 Remaining items, practice/science focus
Check-out Score release timeline per NBCE (not instant at desk)
Item Styles You Should Expect

While NBCE does not publish every live item, the Part II test plan describes clinical application formats:

Best next step in diagnosis or workup.

Most likely diagnosis given mixed findings.

Imaging choice or finding identification from textual descriptions.

Contraindication to adjustive care or need for referral.

Documentation or ethical best answer in practice scenarios.

Train by reading the last sentence first (what is the question actually asking?) before re-reading the vignette—this saves precious seconds across 255 items.

Physical and Cognitive Endurance

Three hours twenty-six minutes exceeds most classroom exams you have taken. Mitigate fatigue:

Sleep: two full nights of adequate sleep beat last-minute cramming.

Caffeine: use your usual dose—test day is not the time to double espresso.

Eyes: practice looking at mid-distance during breaks to reduce screen strain.

Posture: subtle tension in shoulders and neck during Session 1 can literally distract a chiropractic candidate—micro-stretches during break help.

What Success Looks Like Leaving the Center

You will not receive an unofficial pass/fail printout at Prometric for NBCE exams. Scores release through MyNBCE on NBCE's published timeline. After you submit Session 2:

Note any technical irregularities (freeze, time loss) at the proctor desk immediately.

Avoid post-exam item reconstruction discussions—NBCE confidentiality rules apply.

Log the topic areas that felt weakest in a private journal for targeted retake prep if needed.

Mastering Part II format is not separate from mastering Part II content—the clock is part of the clinical standard you are being measured against.