200+ Free NBCE Part II Practice Questions

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A 55-year-old male presents with chest pain radiating to the left arm and jaw. The pain is described as crushing and is accompanied by diaphoresis and shortness of breath. What is the most likely diagnosis?

Acute myocardial infarction

Costochondritis

Gastroesophageal reflux disease

Muscle strain

to track

2026 Statistics

Key Facts: NBCE Part II Exam

80-85%

First-Time Pass Rate

NBCE 2024

255

Total Questions

NBCE blueprint

3h 26m

Time Limit

NBCE

60%

Diagnosis Content

General + NMS

$1,100

Exam Fee

NBCE 2025

375

Passing Score

Scaled score

The NBCE Part II has an 80-85% pass rate for first-time candidates from accredited chiropractic colleges. The exam contains 255 questions over 3 hours 26 minutes covering six clinical science domains. General Diagnosis and Neuromusculoskeletal Diagnosis combined account for 60% of the exam content. Passing Part II is required for chiropractic licensure.

Sample NBCE Part II Practice Questions

Try these sample questions to test your NBCE Part II exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 55-year-old male presents with chest pain radiating to the left arm and jaw. The pain is described as crushing and is accompanied by diaphoresis and shortness of breath. What is the most likely diagnosis?

A.Acute myocardial infarction

B.Costochondritis

C.Gastroesophageal reflux disease

D.Muscle strain

Explanation: Acute myocardial infarction (heart attack) classically presents with crushing chest pain that may radiate to the left arm, jaw, or neck. Associated symptoms include diaphoresis (sweating), shortness of breath, and nausea. This is a medical emergency requiring immediate referral. Costochondritis causes localized chest wall pain without radiation or systemic symptoms. GERD typically causes burning pain after meals. Muscle strain is localized and reproducible with movement.

2Which of the following laboratory findings is most consistent with iron deficiency anemia?

A.Elevated MCV, elevated MCH

B.Decreased MCV, decreased MCH

C.Normal MCV, elevated MCHC

D.Elevated MCV, decreased MCHC

Explanation: Iron deficiency anemia is a microcytic (decreased MCV <80 fL), hypochromic (decreased MCH <27 pg) anemia. The body lacks sufficient iron to produce hemoglobin, resulting in smaller, paler red blood cells. Elevated MCV suggests macrocytic anemias (B12/folate deficiency). Normal MCV with elevated MCHC is not a typical pattern. Elevated MCV with decreased MCHC is inconsistent.

3A patient presents with polyuria, polydipsia, and polyphagia along with unexplained weight loss. Which laboratory finding would confirm the suspected diagnosis?

A.Fasting blood glucose of 85 mg/dL

B.Fasting blood glucose of 110 mg/dL

C.Fasting blood glucose of 126 mg/dL or greater

D.Random blood glucose of 140 mg/dL

Explanation: The classic triad of polyuria, polydipsia, and polyphagia with weight loss suggests diabetes mellitus. According to ADA criteria, diabetes is diagnosed by: fasting plasma glucose ≥126 mg/dL, random plasma glucose ≥200 mg/dL with symptoms, 2-hour OGTT ≥200 mg/dL, or HbA1c ≥6.5%. A fasting glucose of 85 mg/dL is normal. 110 mg/dL indicates impaired fasting glucose (prediabetes). Random glucose of 140 mg/dL is non-diagnostic.

4What is the characteristic physical examination finding in a patient with congestive heart failure?

A.Decreased jugular venous pressure

B.Bibasilar crackles on auscultation

C.Decreased heart rate

D.Hyperactive bowel sounds

Explanation: Congestive heart failure results in fluid accumulation in the lungs (pulmonary edema), producing bibasilar crackles (rales) on auscultation. Other findings include elevated jugular venous pressure, S3 gallop, peripheral edema, and dyspnea. Decreased JVP suggests hypovolemia. Heart rate is typically increased (tachycardia) as compensation. Bowel sounds are not characteristically affected in CHF.

5Which ECG finding is most characteristic of atrial fibrillation?

A.Regular P waves preceding each QRS complex

B.Irregularly irregular rhythm with absent P waves

C.Sawtooth pattern of flutter waves

D.Prolonged PR interval

Explanation: Atrial fibrillation is characterized by an irregularly irregular ventricular rhythm with absent P waves. The atria quiver instead of contracting effectively, resulting in fibrillatory waves. Regular P waves indicate normal sinus rhythm. Sawtooth flutter waves indicate atrial flutter. Prolonged PR interval indicates first-degree AV block.

6A patient presents with fever, right upper quadrant pain, and jaundice. Which condition does this triad most likely represent?

A.Acute cholecystitis

B.Acute hepatitis

C.Cholangitis (Charcot's triad)

D.Pancreatitis

Explanation: Fever, right upper quadrant pain, and jaundice constitute Charcot's triad, which is characteristic of acute cholangitis (bile duct infection). When combined with hypotension and altered mental status, this becomes Reynolds' pentad. Acute cholecystitis causes RUQ pain and fever but jaundice is uncommon unless there is bile duct obstruction. Acute hepatitis may cause similar symptoms but the triad specifically suggests cholangitis.

7Which laboratory finding is most specific for chronic kidney disease?

A.Elevated blood urea nitrogen (BUN)

B.Elevated serum creatinine with decreased GFR

C.Decreased uric acid

D.Elevated alkaline phosphatase

Explanation: Chronic kidney disease is diagnosed by elevated serum creatinine and decreased glomerular filtration rate (GFR <60 mL/min/1.73m² for >3 months). While BUN may be elevated, it is affected by many factors including protein intake and hydration. Decreased uric acid is not associated with CKD. Elevated alkaline phosphatase suggests liver or bone disease.

8A patient with a history of smoking presents with hemoptysis, weight loss, and a persistent cough. What is the most important initial diagnostic step?

A.Chest X-ray

B.Complete blood count

C.Pulmonary function tests

D.Cardiac stress test

Explanation: A smoking history with hemoptysis, weight loss, and persistent cough raises high suspicion for lung cancer. Chest X-ray is the most important initial imaging study to identify masses, infiltrates, or other pulmonary abnormalities. While CBC may show anemia and PFTs assess lung function, chest X-ray is the critical first step for diagnosis. Cardiac stress test is not indicated for these symptoms.

9In a patient with suspected pulmonary embolism, which finding on physical examination is most characteristic?

A.Pleural friction rub

B.Pleuritic chest pain with dyspnea and tachypnea

C.Wheezing throughout all lung fields

D.Increased breath sounds

Explanation: Pulmonary embolism typically presents with sudden onset pleuritic chest pain, dyspnea (shortness of breath), and tachypnea (rapid breathing). These symptoms reflect impaired gas exchange and pleural irritation. Pleural friction rub suggests pleurisy or pericarditis. Wheezing is characteristic of asthma or COPD. Increased breath sounds are not typical of PE; decreased sounds may occur with effusion.

10Which urinalysis finding is most consistent with urinary tract infection?

A.Negative nitrites, negative leukocyte esterase

B.Positive nitrites and positive leukocyte esterase

C.Positive glucose, negative ketones

D.Negative blood, positive protein

Explanation: Urinary tract infection typically presents with positive nitrites (indicating bacterial conversion of nitrates) and positive leukocyte esterase (indicating white blood cells/pyuria). These findings together have high specificity for UTI. Negative findings make UTI unlikely. Positive glucose suggests diabetes. Blood and protein may be present but the combination of nitrites and leukocyte esterase is most specific.

About the NBCE Part II Exam

The NBCE Part II examination tests clinical science knowledge required for chiropractic practice. The exam consists of 255 multiple-choice questions covering six domains: General Diagnosis (30%), Neuromusculoskeletal Diagnosis (30%), Diagnostic Imaging (12%), Principles of Chiropractic (9%), Chiropractic Practice (12%), and Associated Clinical Sciences (7%). The exam is divided into two sessions and is computer-based at Prometric testing centers.

Questions

255 scored questions

Time Limit

3 hours 26 minutes

Passing Score

375 (scaled)

Exam Fee

$1,100 (NBCE (National Board of Chiropractic Examiners))

NBCE Part II Exam Content Outline

30%

General Diagnosis

History taking, physical examination, diagnostic studies, clinical reasoning, and differential diagnosis for general medical conditions

30%

Neuromusculoskeletal Diagnosis

Spinal and extremity examination, orthopedic tests, neurologic examination, and NMS clinical reasoning

12%

Diagnostic Imaging

Radiographic interpretation, MRI/CT basics, imaging appropriateness, and contraindications for chiropractic care

12%

Chiropractic Practice

Adjustive technique, clinical applications, case management, and documentation standards

Principles of Chiropractic

Chiropractic philosophy, history, professional ethics, and scope of practice

Associated Clinical Sciences

Nutrition, exercise rehabilitation, physiotherapy, and public health principles

How to Pass the NBCE Part II Exam

What You Need to Know

Passing score: 375 (scaled)
Exam length: 255 questions
Time limit: 3 hours 26 minutes
Exam fee: $1,100

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NBCE Part II Study Tips from Top Performers

1Focus on General Diagnosis and Neuromusculoskeletal Diagnosis - they make up 60% of the exam

2Master orthopedic and neurologic examination procedures for the spine and extremities

3Review diagnostic imaging interpretation - especially radiographic findings

4Practice with timed questions to simulate the 3 hour 26 minute exam condition

5Study chiropractic philosophy principles and professional ethics

6Understand case management and documentation standards for chiropractic practice

Frequently Asked Questions

What is the NBCE Part II pass rate?

The NBCE Part II pass rate is approximately 80-85% for first-time candidates from CCE-accredited chiropractic colleges. Pass rates vary by chiropractic college and typically range from 75-90%.

How many questions are on the NBCE Part II?

The NBCE Part II contains 255 multiple-choice questions administered over 3 hours and 26 minutes with an optional break between sessions.

What is the NBCE Part II format?

The exam is computer-based and administered at Prometric testing centers. Questions are distributed across six domains: General Diagnosis (30%), Neuromusculoskeletal Diagnosis (30%), Diagnostic Imaging (12%), Principles of Chiropractic (9%), Chiropractic Practice (12%), and Associated Clinical Sciences (7%).

How is the NBCE Part II scored?

NBCE Part II uses a scaled scoring system with a passing score of 375. The exam is graded across all domains collectively.

When should I take NBCE Part II?

Most chiropractic students take Part II after completing clinical science coursework, typically in their third year of chiropractic college. Check with your state board for specific requirements.

What happens if I fail NBCE Part II?

Candidates can retake the exam. Remedial coursework may be required depending on your chiropractic college policies. There is no limit on the number of attempts, but each requires the full exam fee.