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Exam Review

Key Facts: DACO Exam

DACO Part I is a 3-hour online written exam of multiple-choice and problem-solving items.

DACO Part II is a 4-hour online OSCE consisting of three interactive modules.

Eligibility requires a DC plus 300 postdoctoral hours in chiropractic orthopedics from a chiropractic college.

Exam fees total approximately $2,850 ($150 application + $1,350 Part I + $1,350 Part II).

Candidates must pass Part I before attempting Part II.

The credential is administered by IANM, formerly the Academy of Chiropractic Orthopedists (ACO).

Passing is criterion-referenced; IANM does not publish per-cycle pass rates.

Re-application after the one-year exam window expires costs an additional $100.

DACO is the diplomate-level chiropractic orthopedics credential administered by IANM (formerly the Academy of Chiropractic Orthopedists). Eligibility requires 300 postdoctoral hours through a chiropractic-college program plus 50 contact hours. Total exam-related fees are approximately $150 application + $1,350 Part I + $1,350 Part II. Passing is criterion-referenced and Part I must be passed before Part II.

Sample DACO Practice Questions

Try these sample questions to review concepts for the DACO exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 45-year-old presents with low back pain that radiates to the posterior thigh and calf. SLR is positive at 45 degrees with reproduction of leg pain. The most likely level of nerve root involvement is:
A.L2-L3
B.L3-L4
C.L5 or S1
D.T12-L1
Explanation: A positive SLR test reproducing leg pain (radicular pattern below the knee) is most associated with L5 or S1 nerve root tension, typically from a posterolateral disc herniation. SLR is sensitive but less specific; crossed SLR is more specific for nerve root compression.
2Which special test is MOST associated with cervical radiculopathy when included in Wainner's cluster?
A.Spurling test, cervical distraction, upper limb tension test A, ipsilateral cervical rotation <60 degrees
B.FABER and Gaenslen
C.Lachman and McMurray
D.Apley scratch and Speed's test
Explanation: Wainner's cluster (Spurling, cervical distraction, ULTT-A, ipsilateral cervical rotation <60 degrees) supports cervical radiculopathy when >=3 tests are positive. Spurling is specific; distraction relief is a positive test that supports nerve root compression.
3A 60-year-old has neurogenic claudication with leg pain relieved by leaning forward on a shopping cart. Which condition is MOST likely?
A.Vascular claudication from PAD
B.Lumbar spinal stenosis
C.Acute disc herniation with cauda equina syndrome
D.Hip osteoarthritis
Explanation: Lumbar spinal stenosis classically presents with neurogenic claudication: bilateral leg pain/heaviness with walking/standing, relieved by lumbar flexion (sitting, leaning forward). The 'shopping cart sign' is characteristic. Initial management is conservative (flexion-based exercise, walking program).
4Per the Meyerding classification, a spondylolisthesis with 30% slip would be:
A.Grade I (0-25%)
B.Grade II (26-50%)
C.Grade III (51-75%)
D.Grade V (>100%, spondyloptosis)
Explanation: Meyerding grades: I (0-25%), II (26-50%), III (51-75%), IV (76-100%), V (>100%, spondyloptosis). A 30% slip falls within Grade II. Higher grades increase the likelihood of neurologic symptoms and surgical referral.
5Which is the MOST common type of spondylolisthesis in young athletes (e.g., gymnasts, divers, football linemen)?
A.Degenerative (Type III)
B.Isthmic / pars defect (Type II)
C.Traumatic (Type IV)
D.Pathologic (Type VI)
Explanation: Isthmic spondylolisthesis (Type II per Wiltse-Newman) from pars interarticularis stress fractures is most common in young athletes with repetitive lumbar extension/rotation. Degenerative type is most common in older adults, particularly women >50 at L4-L5.
6A patient presents with sudden onset of bilateral lower extremity weakness, saddle anesthesia, and urinary retention after lifting a heavy box. The MOST appropriate immediate action is:
A.Manual therapy and re-evaluation in 1 week
B.Urgent referral for emergency MRI and neurosurgical evaluation; this is suspected cauda equina syndrome
C.Continue routine chiropractic care
D.Order outpatient PT only
Explanation: Saddle anesthesia, bilateral leg weakness, and bowel/bladder dysfunction are classic cauda equina syndrome features. CES is a SURGICAL EMERGENCY requiring immediate MRI and neurosurgical decompression to preserve neurologic function. Delayed treatment risks permanent dysfunction.
7Which red flag for low back pain MOST strongly suggests malignancy?
A.Pain reproduced with lumbar extension
B.History of cancer, age >50, unexplained weight loss, night pain unrelieved by position, failure to improve after 1 month of conservative care
C.Pain after a long drive
D.Pain that improves with exercise
Explanation: Malignancy red flags include prior cancer history, age >50, unexplained weight loss (>10 lb), night pain not relieved by position changes, and failure to improve after >4 weeks of conservative care. Any of these warrants further workup (labs, imaging, referral).
8Per ACR Appropriateness Criteria, the FIRST-line imaging for uncomplicated acute low back pain (<6 weeks, no red flags) is:
A.Routine MRI
B.No imaging is recommended in the first 6 weeks without red flags
C.Routine CT
D.Whole-spine X-ray series
Explanation: ACR Appropriateness Criteria, Choosing Wisely, and major LBP CPGs (NICE, APTA) recommend against imaging for uncomplicated acute LBP within the first 6 weeks unless red flags are present. Early imaging does not improve outcomes and increases incidental findings, cost, and over-treatment.
9Which dermatome corresponds to the lateral aspect of the foot and little toe?
A.L4
B.L5
C.S1
D.S2
Explanation: S1 dermatome covers the lateral foot and little toe. L4 covers the medial leg and medial foot/great toe; L5 covers the dorsum of the foot and middle toes. S1 reflex is the Achilles; L4 is patellar.
10Which reflex is associated with the C7 nerve root?
A.Biceps reflex
B.Brachioradialis reflex
C.Triceps reflex
D.Achilles reflex
Explanation: C7 nerve root: triceps reflex, triceps and wrist extensor strength, middle finger sensation. C5: biceps reflex, biceps strength, lateral arm. C6: brachioradialis reflex, wrist extension, thumb sensation. C8: finger flexors, medial forearm sensation.

About the DACO Exam

The DACO credential recognizes chiropractors with advanced expertise in orthopedic and neuromusculoskeletal assessment, differential diagnosis, imaging selection, and conservative management. The exam is delivered in two parts: Part I is a 3-hour online written exam of multiple-choice and problem-solving items; Part II is a 4-hour online OSCE comprising three interactive modules. Candidates must pass Part I before attempting Part II.

Exam sponsor: International Academy of Neuromusculoskeletal Medicine (IANM); formerly Academy of Chiropractic Orthopedists (ACO). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

100 questions

Time Limit

Part I online written: 3 hours; Part II online OSCE: 4 hours (3 modules)

Passing Score

Criterion-referenced (set by IANM); must pass Part I before Part II

Exam / Certification Fees

$150 application + $1,350 Part I + $1,350 Part II ($100 re-application fee if needed)

Exam sponsor website

Reported exam pass rate: Not published. IANM does not publish per-cycle pass rates Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

Large

Spine Orthopedics

Mechanical LBP, radiculopathy, spondylolisthesis, stenosis, scoliosis, DDD; SLR, Slump, Spurling, Kemp; cauda equina and other red flags

Medium

Shoulder & Upper Extremity

Rotator cuff (Jobe, lift-off, ER lag), impingement (Neer, Hawkins-Kennedy), instability (apprehension/relocation), AC joint, epicondylopathy, ulnar neuropathy, CTS, de Quervain, scaphoid

Medium

Lower Extremity

FAI/labrum (FADIR), hip OA, ACL (Lachman/pivot-shift), meniscus (McMurray/Thessaly), PFPS, ankle sprains (anterior drawer/talar tilt), plantar fasciitis

Medium

Pediatric & Systemic

SCFE, DDH (Barlow/Ortolani), Osgood-Schlatter, Sever, Perthes, scoliosis (Adams forward bend); spondyloarthropathy, RA vs OA, gout/CPPD

Medium

Imaging Selection

ACR Appropriateness Criteria, plain film vs MRI vs CT vs ultrasound, Ottawa rules (ankle/knee), red flag imaging workup

Medium

Co-Management & CPGs

AAOS, NASS, NICE, APTA, ACR guideline integration; post-op orthopedic considerations; surgical referral indications; ethics and scope

Required

Part II OSCE

Three interactive online OSCE modules within 4 hours, integrating exam, evaluation, imaging, diagnosis, and management decisions

Preparing for the DACO Exam

What You Need to Know

  • Passing score: Criterion-referenced (set by IANM); must pass Part I before Part II
  • Exam length: 100 questions
  • Time limit: Part I online written: 3 hours; Part II online OSCE: 4 hours (3 modules)
  • Exam / certification fees: $150 application + $1,350 Part I + $1,350 Part II ($100 re-application fee if needed) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

DACO: Suggested Study Strategy

1Build a region-by-region special-test grid (shoulder, elbow, wrist, hip, knee, ankle, spine) with sensitivity, specificity, and LR+ when known
2Memorize red flags for LBP (cauda equina, fracture, infection, malignancy) and the imaging pathway each one triggers
3Drill ACR Appropriateness Criteria and Ottawa Ankle/Knee Rules before Part I
4Study spondyloarthropathy serology (HLA-B27), inflammatory vs mechanical back pain features, and SI joint provocation cluster (Laslett)
5Review pediatric ortho pearls: SCFE in obese adolescent boys, DDH in breech infants, Perthes age 4-8, Sever heel pain
6Practice radiculopathy mapping: C5-T1 and L2-S1 myotomes, dermatomes, and reflexes
7Know post-op precautions for common ortho surgeries (THA approaches, ACL grafts, rotator cuff repair phases)
8Talk through cases aloud for Part II OSCE: history -> exam -> differential -> imaging -> diagnosis -> plan -> co-management

Frequently Asked Questions

What is the DACO exam format?

Two parts. Part I is an online written exam (multiple-choice and problem-solving) lasting 3 hours. Part II is an online OSCE with three interactive modules completed within 4 hours. Candidates must pass Part I before attempting Part II.

Who administers the DACO exam?

The International Academy of Neuromusculoskeletal Medicine (IANM), formerly known as the Academy of Chiropractic Orthopedists (ACO). The name changed but the DACO credential remains an earned designation.

What are the eligibility requirements?

A Doctor of Chiropractic degree plus 300 postdoctoral hours of chiropractic orthopedics / neuromusculoskeletal medicine through a chiropractic-college postgraduate program. The University of Bridgeport currently offers a 300-hour online pathway plus 50 contact hours.

How much does the DACO exam cost?

Approximately $150 application fee, $1,350 for Part I, and $1,350 for Part II. A $100 re-application fee applies if the one-year exam window expires after approval.

Is the DACO passing standard a fixed percentage?

No. IANM uses a criterion-referenced standard set per form. The board does not publish a fixed percentage cut-score or per-cycle pass rates.

How is DACO different from DABCO?

DACO is the diplomate credential issued through the IANM (formerly ACO) pathway. DABCO (Diplomate, American Board of Chiropractic Orthopedists) is a separate, historically distinct credential. Candidates should choose the pathway aligned with their state and post-graduate program.

Does the DACO test imaging interpretation?

Yes. The exam covers ACR Appropriateness Criteria, modality selection (plain film, MRI, CT, ultrasound), Ottawa Ankle/Knee Rules, and red flag imaging workups for fracture, infection, and malignancy.