Free Practice Questions for NBCE Part III

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Key Facts: NBCE Part III Exam

75-80%

First-Time Pass Rate

NBCE 2024

130 (100 w/o DXI)

Total Questions

NBCE blueprint

3-4 hrs

Time Limit

NBCE

Content Domains

NBCE Part III

$710

Exam Fee

NBCE 2025

375

Passing Score

Scaled score

The NBCE Part III has a 75-80% pass rate for first-time candidates from accredited chiropractic colleges. The exam contains 130 items (100 items in the version without DXI) over about 4 hours of testing covering nine clinical competency domains. Diagnosis and Case Management combined account for nearly 30% of the exam content. Passing Part III is required for chiropractic licensure in most states.

Sample NBCE Part III Practice Questions

Try these sample questions to review concepts for the NBCE Part III exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 204+ question experience with AI tutoring.

1A 45-year-old male patient presents with sudden onset of severe low back pain that began while lifting a heavy box at work yesterday. Which element of the history is MOST important to document first?

A.Family history of cardiovascular disease

B.Detailed description of the mechanism of injury

C.Results of previous chiropractic treatments

D.Social history including smoking status

Explanation: When a patient presents with acute trauma, the mechanism of injury is the most critical element to document first. This information helps determine the forces involved, potential tissues affected, and guides both the examination and differential diagnosis. Understanding how the injury occurred (lifting mechanics, weight of object, position of body) provides essential context for identifying potential disc herniation, muscle strain, or ligamentous injury. While family history, previous treatments, and social history are important components of a complete history, the mechanism of injury takes priority in acute traumatic presentations.

2A 32-year-old female patient reports headaches that occur 2-3 times per week, described as throbbing pain on the right side of her head, accompanied by nausea and sensitivity to light. Each episode lasts 4-6 hours. Which classification of headache is MOST consistent with this presentation?

A.Tension-type headache

B.Migraine without aura

C.Cluster headache

D.Cervicogenic headache

Explanation: This presentation is classic for migraine without aura. The key diagnostic features include: unilateral location (right side), throbbing/pulsating quality, moderate to severe intensity (implied by functional impairment), nausea, and photophobia (sensitivity to light). The duration of 4-6 hours and frequency of 2-3 times per week are also consistent with episodic migraine. Tension-type headaches typically present as bilateral, non-throbbing, and without nausea or photophobia. Cluster headaches occur in attacks lasting 15-180 minutes with associated autonomic features (tearing, nasal congestion) and typically affect men more than women. Cervicogenic headaches are secondary to cervical spine pathology and typically worsen with neck movement.

3During the review of systems for a 58-year-old male patient with chronic neck pain, he mentions experiencing dizziness when turning his head to look over his shoulder while driving. Which associated symptom would be MOST concerning for vertebrobasilar insufficiency?

A.Mild muscle tension in the upper trapezius

B.Transient diplopia (double vision) during the episode

C.Occasional clicking sound with neck movement

D.Stiffness that improves with heat application

Explanation: Transient diplopia (double vision) during head turning is a classic symptom of vertebrobasilar insufficiency (VBI), indicating compromised blood flow to the posterior circulation of the brain. This is a red flag finding that requires immediate attention and careful evaluation before any cervical manipulation. The vertebral arteries pass through the transverse foramina of the cervical vertebrae and can be compromised by osteophytes, arterial disease, or extreme positions. Other symptoms of VBI include vertigo, nystagmus, dysarthria, dysphagia, and drop attacks. Muscle tension, clicking sounds, and stiffness that improves with heat are common musculoskeletal findings and do not indicate vascular compromise.

4A patient presents with low back pain and states, "I had the same thing about 5 years ago, and it lasted for months." Which aspect of the past medical history is the patient describing?

A.Family history

B.History of present illness

C.Prior similar episodes

D.Current medications

Explanation: The patient is describing prior similar episodes, which is an essential component of the past medical history. Understanding previous occurrences of the same or similar conditions helps establish whether the current complaint is acute, recurrent, or chronic. It also provides insight into the natural history of the condition, previous treatment responses, and potential prognosis. The patient specifically references a prior episode with similar characteristics ("same thing") and duration. Family history would involve relatives' health conditions. History of present illness focuses on the current episode only. Current medications would be a separate component of the history.

5A 28-year-old patient reports consuming 6-8 alcoholic beverages daily and smoking one pack of cigarettes per day. In which section of the case history should this information be recorded?

A.Chief complaint

B.Past medical history

C.Family history

D.Social history

Explanation: Information regarding alcohol consumption and tobacco use is documented in the social history. The social history includes lifestyle factors such as occupation, living situation, exercise habits, dietary patterns, substance use (alcohol, tobacco, recreational drugs), and stress levels. These factors can significantly impact a patient's musculoskeletal health, healing capacity, and response to treatment. For example, smoking is known to impair tissue healing and increase the risk of degenerative disc disease, while alcohol abuse can contribute to osteoporosis and peripheral neuropathy. The chief complaint focuses on the primary reason for the visit. Past medical history documents previous diagnoses and conditions. Family history records hereditary conditions affecting relatives.

6A 52-year-old patient with diabetes and hypertension presents with new-onset foot pain. Which finding in the family history would be MOST relevant to document?

A.Father with premature coronary artery disease

B.Mother with rheumatoid arthritis

C.Sibling with ankylosing spondylitis

D.Grandparent with osteoporosis

Explanation: In a patient with diabetes and hypertension presenting with foot pain, the father's premature coronary artery disease is the most relevant family history finding to document. Diabetes is a major risk factor for cardiovascular disease, and a family history of premature CAD (typically defined as CAD in male first-degree relatives before age 55 or female first-degree relatives before age 65) further increases cardiovascular risk. This information is crucial for comprehensive risk stratification. Additionally, diabetes-related foot pain could indicate peripheral neuropathy or peripheral arterial disease, making cardiovascular risk assessment even more important. While rheumatoid arthritis, ankylosing spondylitis, and osteoporosis are all relevant musculoskeletal conditions, they are less immediately concerning than cardiovascular risk in a diabetic patient with vascular risk factors.

7During the cardiovascular examination of a 67-year-old patient, you auscultate a regular rhythm with a rate of 72 beats per minute. You note an extra heart sound immediately preceding S1 that is low-pitched and heard best at the apex. This finding is MOST consistent with:

A.S3 gallop rhythm

B.S4 gallop rhythm

C.Mitral regurgitation murmur

D.Aortic stenosis murmur

Explanation: An extra heart sound immediately preceding S1 (the first heart sound) is an S4 gallop rhythm. The S4 is a low-pitched sound caused by atrial contraction forcing blood into a stiff, non-compliant ventricle. It occurs in late diastole, just before S1, and is best heard at the cardiac apex with the bell of the stethoscope. S4 is often associated with conditions causing left ventricular hypertrophy, such as hypertension, aortic stenosis, or ischemic heart disease. In contrast, S3 occurs immediately after S2 and is associated with heart failure or volume overload. Murmurs of mitral regurgitation and aortic stenosis occur during systole, not preceding S1.

8A patient presents with acute low back pain. Before performing orthopedic testing, which vital sign measurement would be MOST important to assess?

A.Blood pressure

B.Body temperature

C.Respiratory rate

D.Oxygen saturation

Explanation: Blood pressure is the most important vital sign to assess before performing orthopedic testing on a patient with acute low back pain. Significant hypertension could indicate a more serious condition such as an abdominal aortic aneurysm, which may present with back pain and is an absolute contraindication to certain physical examination maneuvers. Additionally, elevated blood pressure may increase the risk of complications during certain procedures. While body temperature is important for detecting infection (such as osteomyelitis or discitis), it is less immediately critical than blood pressure in the acute presentation. Respiratory rate and oxygen saturation are important for respiratory conditions but less critical for isolated musculoskeletal back pain.

9During a general survey of a 55-year-old patient, you observe pallor of the conjunctivae and nail beds, along with tachycardia at rest. These findings are MOST suggestive of:

A.Chronic obstructive pulmonary disease

B.Anemia

C.Hyperthyroidism

D.Anxiety disorder

Explanation: Pallor of the conjunctivae and nail beds, combined with resting tachycardia, is the classic presentation of anemia. The pallor represents decreased hemoglobin and reduced oxygen-carrying capacity, while the tachycardia is a compensatory mechanism to maintain adequate oxygen delivery to tissues. Anemia can cause non-specific musculoskeletal symptoms including fatigue, weakness, and exercise intolerance. COPD typically presents with cyanosis (not pallor) and respiratory symptoms. Hyperthyroidism causes tachycardia but would present with warm, moist skin and other metabolic signs rather than pallor. Anxiety can cause tachycardia but would not explain the pallor.

10During the respiratory examination of a patient with thoracic spine pain, which finding would be MOST concerning for a cardiopulmonary condition requiring immediate referral?

A.Mild decreased breath sounds at the bases bilaterally

B.Asymmetric chest expansion with reduced movement on the right

C.Occasional scattered wheezes throughout both lung fields

D.Tenderness to palpation over the thoracic paraspinal muscles

Explanation: Asymmetric chest expansion with reduced movement on one side is the most concerning finding, suggesting a potential pneumothorax, large pleural effusion, or significant atelectasis. This represents a possible emergency requiring immediate referral for imaging and medical evaluation. Asymmetric chest movement indicates that one lung is not expanding normally, which could compromise respiratory function. While decreased breath sounds bilaterally at the bases can occur with obesity or shallow breathing, unilateral findings are more ominous. Scattered wheezes may indicate asthma or bronchitis but are not immediately life-threatening. Paraspinal muscle tenderness is a common musculoskeletal finding and expected in thoracic spine pain.

About the NBCE Part III Exam

The NBCE Part III examination tests clinical competency and decision-making skills required for chiropractic practice. The exam consists of 130 items (80 Traditional Multiple-Choice Questions, 20 Extended Multiple-Choice Question case items, and 30 Diagnostic Imaging Interpretation (DXI) items) for candidates taking the version with DXI, or 100 items (80 TMCQ + 20 EMCQ) for the version without DXI. Content spans nine domains: Case History (11%), Physical Examination (9%), Neuromusculoskeletal Examination (11%), Diagnostic Imaging (11%), Clinical Laboratory and Special Studies (7%), Diagnosis or Clinical Impression (14%), Chiropractic Techniques (14%), Supportive Interventions (8%), and Case Management (15%).

Exam sponsor: NBCE (National Board of Chiropractic Examiners). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

130 questions

Time Limit

4 hours testing time (4.5-hour appointment)

Passing Score

375 (scaled)

Exam / Certification Fees

$710

Exam sponsor website

Reported exam pass rate: 75-80%. varies by chiropractic college This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

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

Official sources

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.

15%

Case Management

Patient follow-up, treatment planning, referrals, and ongoing care coordination

14%

Diagnosis or Clinical Impression

Differential diagnosis, clinical reasoning, diagnostic criteria, and diagnostic labeling

14%

Chiropractic Techniques

Adjustive technique selection, application, biomechanics, and contraindications

11%

Case History

Chief complaint, history of present illness, past medical history, family history, and social history

11%

Neuromusculoskeletal Examination

Spinal and extremity orthopedic testing, range of motion, palpation, and functional assessment

11%

Diagnostic Imaging

Radiographic interpretation, MRI/CT analysis, imaging appropriateness, and clinical correlation

Physical Examination

Vital signs, general inspection, cardiovascular, pulmonary, and abdominal examination

Supportive Interventions

Physiotherapy, exercise therapy, nutrition, and lifestyle counseling

Clinical Laboratory

Laboratory test interpretation, special studies, and clinical correlation of findings

Preparing for the NBCE Part III Exam

What You Need to Know

Passing score: 375 (scaled)
Exam length: 130 questions
Time limit: 4 hours testing time (4.5-hour appointment)
Exam / certification fees: $710 Official sources

Using Our Practice Resources

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NBCE Part III: Suggested Study Strategy

1Focus on Diagnosis/Clinical Impression and Case Management - they make up nearly 30% of the exam

2Master clinical reasoning and differential diagnosis processes

3Practice interpreting diagnostic imaging with clinical scenarios

4Review chiropractic technique selection and contraindications

5Study case history taking and physical examination procedures

6Understand when to refer and how to coordinate patient care

Frequently Asked Questions

What is the NBCE Part III pass rate?

The NBCE Part III pass rate is approximately 75-80% for first-time candidates from CCE-accredited chiropractic colleges. Pass rates vary by chiropractic college and typically range from 70-85%.

How many questions are on the NBCE Part III?

The NBCE Part III contains 130 items for candidates taking the version with Diagnostic Imaging Interpretation (DXI): 80 TMCQ + 20 EMCQ + 30 DXI questions. The version without DXI contains 100 items: 80 TMCQ + 20 EMCQ questions.

What is the NBCE Part III format?

The exam is computer-based and administered at Prometric testing centers. Questions include Traditional Multiple-Choice Questions (TMCQ) with single best answers and Extended Multiple-Choice Questions (EMCQ) with clinical scenarios and multiple questions per case.

How is the NBCE Part III scored?

NBCE Part III 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 III?

Most chiropractic students take Part III during their third year of chiropractic college after completing clinical coursework. Check with your state board for specific requirements.

What happens if I fail NBCE Part III?

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.

Free Practice Questions for NBCE Part III

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