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Free NBCE Part II Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the NBCE Part II practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1During the history, a patient with intermittent right-sided abdominal pain reports that the pain travels up to the right shoulder. Which condition does this pattern of radiation most suggest?

    1. A. Cholecystitis
    2. B. Pancreatitis
    3. C. Diverticulitis
    4. D. Appendicitis

    Answer: A

    Explanation: The Merck Manual Professional Version states, in its account of the gastrointestinal history, "For example, pain radiating to the shoulder may reflect cholecystitis because the gallbladder may be irritating the diaphragm." The same passage assigns a different radiation pattern to pancreatitis: "Pain radiating to the back may reflect pancreatitis." Diverticulitis and appendicitis are localized in the source to the left lower and right lower quadrants respectively rather than to shoulder radiation, so shoulder radiation points to cholecystitis.

    Reference: Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition — Evaluation of the Gastrointestinal Patient, section 'History in the GI Patient'

  2. 2A patient with low back pain reports that the pain is accompanied by urinary retention, fecal incontinence, and loss of sensation around the anus. Which structure does this combination of history findings implicate?

    1. A. The cauda equina
    2. B. A single lumbar nerve root
    3. C. The lumbar paraspinal muscles
    4. D. The thoracolumbar facet joints

    Answer: A

    Explanation: The Merck Manual Professional Version states: "If the cauda equina is affected, segmental deficits develop in the lumbosacral region, typically with disruption of bowel function (constipation or fecal incontinence) and bladder function (urinary retention or urinary incontinence), loss of perianal sensation, erectile dysfunction, and loss of rectal tone and sphincter (eg, bulbocavernosus, anal wink) reflexes." Single-root involvement is described differently on the same page: "If a nerve root is affected, pain may radiate distally along the distribution of that root (radicular pain)."

    Reference: Overview of Neck and Back Pain - Rheumatology and Orthopedics - Merck Manual Professional Edition — Evaluation of Neck and Back Pain, section 'Pathophysiology of Neck and Back Pain'

  3. 3On a conventional radiograph, which structure appears the darkest because it attenuates the fewest x-ray photons?

    1. A. Air or gas
    2. B. Fat
    3. C. Muscle
    4. D. Bone cortex

    Answer: A

    Explanation: The Merck Manual Professional Version explains attenuation and then orders the densities: "Different soft tissues attenuate x-ray photons differently, depending on tissue density; the denser the tissue, the whiter (more radiopaque) the image. The range of densities, from most to least dense, is represented by metal (white, or radiopaque), bone cortex (less white), muscle and fluid (gray), fat (darker gray), and air or gas (black, or radiolucent)." Air is the least dense and therefore the darkest of the listed tissues.

    Reference: Conventional Radiography - Special Subjects - Merck Manual Professional Edition — Conventional Radiography, opening section on image formation

  4. 4Which relationship is described as the one thought to be key to maintaining or restoring health in chiropractic?

    1. A. Between the structure of the spine and other articulating surfaces and the nervous system
    2. B. Between the circulation of lymph and the drainage of the peripheral joints
    3. C. Between the tone of the postural muscles and the endocrine response to stress
    4. D. Between the alignment of the pelvis and the capacity of the respiratory system

    Answer: A

    Explanation: The Merck Manual Professional Version states: "In chiropractic (a manipulative and body-based practice), the relationship between the structure of the spine and other articulating surfaces and their interaction with the nervous system is thought to be key to maintaining or restoring health. The main method for restoring this relationship is manipulation of the spine, other joints, and soft tissues."

    Reference: Chiropractic - Special Subjects - Merck Manual Professional Edition — Chiropractic, opening section

  5. 5For which two patient groups is spinal manipulation stated not to be recommended?

    1. A. Patients with osteoporosis and patients with symptoms of neuropathy
    2. B. Patients with hypertension and patients with a prior myocardial infarction
    3. C. Patients with diabetes mellitus and patients with chronic kidney disease
    4. D. Patients with asthma and patients with seasonal allergic rhinitis

    Answer: A

    Explanation: The Merck Manual Professional Version states: "Spinal manipulation is not recommended for patients with osteoporosis or symptoms of neuropathy (eg, paresthesias, loss of strength in a limb)." It marks a separate group as unresolved: "Whether manipulation is safe for patients who have had spinal surgery or stroke or who have a vascular disorder is unclear."

    Reference: Chiropractic - Special Subjects - Merck Manual Professional Edition — Chiropractic, section 'Possible Adverse Effects'

  6. 6At approximately what age do most age-related biologic functions peak, and what is the pattern of change thereafter?

    1. A. About age 30, with a gradual linear decline thereafter
    2. B. About age 45, with an abrupt decline after age 65
    3. C. About age 20, with a plateau until age 60 and then decline
    4. D. About age 50, with an exponential decline thereafter

    Answer: A

    Explanation: The Merck Manual Professional Version states: "Most age-related biologic functions peak at approximately age 30 and gradually decline linearly thereafter; the decline may be critical during stress, but it usually has little or no effect on daily activities. Therefore, disorders, rather than normal aging, are the primary cause of functional loss during old age."

    Reference: Physical Changes With Aging - Geriatrics - Merck Manual Professional Edition — Physical Changes With Aging, opening section

  7. 7A patient describes constant abdominal pain that he localizes to the right lower quadrant. Based on the location alone, which set of structures is most likely to be the site of the underlying inflammation?

    1. A. Appendix, terminal ileum, or cecum
    2. B. Pancreas, stomach, or small bowel
    3. C. Liver, gallbladder, and bile ducts
    4. D. Sigmoid colon, rectum, or anal canal

    Answer: A

    Explanation: The source maps abdominal pain location to likely structures: "Pain in the right lower quadrant may indicate inflammation of the appendix, terminal ileum, or cecum, suggesting appendicitis, ileitis, or Crohn disease." The other options name the structures the same passage assigns to different locations: "pain in the epigastrium may reflect problems in the pancreas, stomach, or small bowel" and "Pain in the right upper quadrant may reflect problems in the liver, gallbladder, and bile ducts such as cholecystitis or hepatitis."

    Reference: Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition — Evaluation of the Gastrointestinal Patient, section 'History in the GI Patient'

  8. 8In the review of systems of a patient with new back pain, which reported symptom set is identified as suggesting infection as the cause?

    1. A. Fever, sweats, and chills
    2. B. Cough, dyspnea, and worsening on inspiration
    3. C. Hematuria, flank pain, and colicky recurrence
    4. D. Fatigue, depressive symptoms, and headaches

    Answer: A

    Explanation: The source pairs each symptom cluster with the category of cause it suggests: "Review of systems should note symptoms suggesting a cause, including fever, sweats, and chills (infection); weight loss and poor appetite (infection or cancer)... cough, dyspnea, and worsening during inspiration (pulmonary disorders)... fatigue, depressive symptoms, and headaches (multifactorial mechanical neck or back pain)." The urinary cluster is assigned to "urinary tract disorders... especially if intermittent, colicky, and recurrent (nephrolithiasis)."

    Reference: Overview of Neck and Back Pain - Rheumatology and Orthopedics - Merck Manual Professional Edition — Evaluation of Neck and Back Pain, section 'Evaluation', subsection 'History'

  9. 9In magnetic resonance imaging, what is recorded by the coil built into the device to generate the image?

    1. A. The magnitude and rate of energy release as protons resume alignment
    2. B. The attenuation of a photon beam passing through different tissues
    3. C. The reflection of high-frequency sound waves from tissue interfaces
    4. D. The decay of an injected radionuclide concentrated in target tissue

    Answer: A

    Explanation: The source describes the signal that is captured: "The magnitude and rate of energy release that occurs as the protons resume this alignment (T1 relaxation) and as they wobble (precess) during the process (T2 relaxation) are recorded as spatially localized signal intensities by a coil (antenna) built within the MRI device." Photon attenuation is the basis of radiography and CT, sound-wave reflection of ultrasound, and radionuclide decay of nuclear scanning, each described on separate pages of the same corpus.

    Reference: Magnetic Resonance Imaging (MRI) - Special Subjects - Merck Manual Professional Edition — Magnetic Resonance Imaging (MRI), opening section on image formation

  10. 10Which method is identified as the main one used to restore the structure-and-nervous-system relationship in chiropractic practice?

    1. A. Manipulation of the spine, other joints, and soft tissues
    2. B. Prescription of anti-inflammatory medication and bed rest
    3. C. Injection of local anesthetic into the symptomatic joint
    4. D. Application of traction weights over a course of weeks

    Answer: A

    Explanation: The source states: "The main method for restoring this relationship is manipulation of the spine, other joints, and soft tissues." It lists adjuncts separately: "Chiropractors may provide physical therapies (eg, heat and cold, electrical stimulation, rehabilitation strategies), massage, or acupressure and may recommend exercises, ergonomic measures, or lifestyle changes."

    Reference: Chiropractic - Special Subjects - Merck Manual Professional Edition — Chiropractic, opening section

Topics in this practice bank

These topics describe the available practice for NBCE Part II. Review the examination outline and its sources for scope and allocation details.

  • General Diagnosis
    • Case History - 12% of the General Diagnosis domain
    • Vital Signs - 6% of the General Diagnosis domain
    • Head and Neck Examination/Findings - 9% of the General Diagnosis domain
    • Head and Neck Examination/Findings: Eye
    • Head and Neck Examination/Findings: Ear
    • Head and Neck Examination/Findings: Nose and sinuses
    • Head and Neck Examination/Findings: Mouth and throat
    • Head and Neck Examination/Findings: Neck
    • Thorax Examination/Findings (including heart and lungs) - 8% of the General Diagnosis domain
    • Thorax Examination/Findings (including heart and lungs): Inspection
    • Thorax Examination/Findings (including heart and lungs): Auscultation
    • Thorax Examination/Findings (including heart and lungs): Percussion
    • Thorax Examination/Findings (including heart and lungs): Palpation
    • Abdominal Examination/Findings - 8% of the General Diagnosis domain
    • Abdominal Examination/Findings: Inspection
    • Abdominal Examination/Findings: Auscultation
    • Abdominal Examination/Findings: Percussion
    • Abdominal Examination/Findings: Palpation
    • Rectal and Male Urogenital Examination/Findings - 6% of the General Diagnosis domain
    • Diagnosis or Clinical Impression - 40% of the General Diagnosis domain
    • Diagnosis or Clinical Impression: Eyes, ears, nose and throat
    • Diagnosis or Clinical Impression: Respiratory diseases
    • Diagnosis or Clinical Impression: Cardiovascular diseases
    • Diagnosis or Clinical Impression: Blood and lymphatic diseases
    • Diagnosis or Clinical Impression: Gastrointestinal diseases
    • Diagnosis or Clinical Impression: Genitourinary diseases
    • Diagnosis or Clinical Impression: Endocrine and metabolic disorders
    • Diagnosis or Clinical Impression: Immunological disorders
    • Diagnosis or Clinical Impression: Nutritional disorders
    • Diagnosis or Clinical Impression: Infectious diseases
    • Laboratory Interpretation - 11% of the General Diagnosis domain
    • Laboratory Interpretation: Urinalysis
    • Laboratory Interpretation: Hematology
    • Laboratory Interpretation: Chemistry/serology
    • Laboratory Interpretation: Special studies
  • Neuromusculoskeletal Diagnosis
    • Case History - 18% of the Neuromusculoskeletal Diagnosis domain
    • Posture and Gait Assessment - 10% of the Neuromusculoskeletal Diagnosis domain
    • Orthopedic Examination - 21% of the Neuromusculoskeletal Diagnosis domain
    • Orthopedic Examination: Cervical spine
    • Orthopedic Examination: Thoracic spine
    • Orthopedic Examination: Lumbar spine and pelvis
    • Orthopedic Examination: Extremities
    • Neurologic Examination - 21% of the Neuromusculoskeletal Diagnosis domain
    • Neurologic Examination: Cranial nerve/CNS testing
    • Neurologic Examination: Motor testing
    • Neurologic Examination: Sensory testing
    • Neurologic Examination: Reflex testing
    • Neurologic Examination: Reflex testing: Superficial reflexes
    • Neurologic Examination: Reflex testing: Deep tendon reflexes
    • Neurologic Examination: Reflex testing: Pathological reflexes
    • Diagnosis or Clinical Impression - 30% of the Neuromusculoskeletal Diagnosis domain
    • Diagnosis or Clinical Impression: CNS disorders
    • Diagnosis or Clinical Impression: Peripheral neurologic/neurovascular disorders
    • Diagnosis or Clinical Impression: Muscular disorders
    • Diagnosis or Clinical Impression: Bone and joint disorders
  • Diagnostic Imaging
    • Imaging Technology - 5% of the Diagnostic Imaging domain
    • Imaging Technology: Physics and principles
    • Imaging Technology: Quality assurance
    • Imaging Technology: Radiographic imaging
    • Imaging Technology: Radiologic protection
    • Radiographic Positioning and Normal Anatomy - 20% of the Diagnostic Imaging domain
    • Radiographic Positioning and Normal Anatomy: Spine and pelvis
    • Radiographic Positioning and Normal Anatomy: Extremities
    • Radiographic Positioning and Normal Anatomy: Thorax and abdomen
    • Imaging Diagnosis or Clinical Impression - 50% of the Diagnostic Imaging domain
    • Imaging Diagnosis or Clinical Impression: Congenital anomalies and normal variants
    • Imaging Diagnosis or Clinical Impression: Trauma
    • Imaging Diagnosis or Clinical Impression: Arthritides
    • Imaging Diagnosis or Clinical Impression: Tumors/tumor-like processes
    • Imaging Diagnosis or Clinical Impression: Nutritional, metabolic and endocrine conditions
    • Imaging Diagnosis or Clinical Impression: Hematologic conditions
    • Imaging Diagnosis or Clinical Impression: Infectious conditions
    • Imaging Diagnosis or Clinical Impression: Miscellaneous skeletal conditions
    • Imaging Diagnosis or Clinical Impression: Thoracic and abdominal conditions
    • Methods of Interpretation - 10% of the Diagnostic Imaging domain
    • Methods of Interpretation: Biomechanical analysis/mensuration procedures
    • Methods of Interpretation: Imaging evaluation (including common misinterpretations)
    • Clinical Applications of Special Imaging - 15% of the Diagnostic Imaging domain
    • Clinical Applications of Special Imaging: MRI
    • Clinical Applications of Special Imaging: CT
    • Clinical Applications of Special Imaging: Miscellaneous
  • Principles of Chiropractic
    • The Chiropractic Paradigm - 23% of the Principles of Chiropractic domain
    • The Chiropractic Paradigm: Core concepts
    • The Chiropractic Paradigm: Research principles and methods
    • Concepts of Subluxation and Spinal Lesions - 26% of the Principles of Chiropractic domain
    • Concepts of Subluxation and Spinal Lesions: Dysafferentation (proprioceptive insult)/somatosomatic reflex models
    • Concepts of Subluxation and Spinal Lesions: Neural compression/traction models
    • Concepts of Subluxation and Spinal Lesions: Visceral reflex models
    • Concepts of Subluxation and Spinal Lesions: Vascular insufficiency models
    • Concepts of Subluxation and Spinal Lesions: Axonal aberration/trophic models
    • Concepts of Subluxation and Spinal Lesions: Neuroimmunomodulation models
    • Concepts of Subluxation and Spinal Lesions: Biomechanical models
    • Concepts of Subluxation and Spinal Lesions: Other
    • Basic Science Concepts in Chiropractic - 25% of the Principles of Chiropractic domain
    • Basic Science Concepts in Chiropractic: Anatomical
    • Basic Science Concepts in Chiropractic: Pathophysiological
    • Basic Science Concepts in Chiropractic: Biomechanical
    • Applied Chiropractic Principles - 26% of the Principles of Chiropractic domain
    • Applied Chiropractic Principles: Subluxation etiologies
    • Applied Chiropractic Principles: General effects of adjustment and manipulation
    • Applied Chiropractic Principles: Wellness
  • Chiropractic Practice
    • Spinal Analysis and Patient Evaluation - 25% of the Chiropractic Practice domain
    • Spinal Analysis and Patient Evaluation: Case history and observation findings
    • Spinal Analysis and Patient Evaluation: Manual examination of the spine and extremities
    • Spinal Analysis and Patient Evaluation: Diagnostic procedures
    • Chiropractic Adjustive Technique - 26% of the Chiropractic Practice domain
    • Chiropractic Adjustive Technique: Cervical techniques
    • Chiropractic Adjustive Technique: Thoracic techniques
    • Chiropractic Adjustive Technique: Lumbar techniques
    • Chiropractic Adjustive Technique: Pelvic techniques
    • Chiropractic Adjustive Technique: Costal and extremity techniques
    • Patient Care - 27% of the Chiropractic Practice domain
    • Patient Care: Case management
    • Patient Care: Contraindications for treatment
    • Patient Care: Home care, prevention and rehabilitation
    • Community Health and Wellness - 12% of the Chiropractic Practice domain
    • Community Health and Wellness: Public health organizations
    • Community Health and Wellness: Healthy People initiatives
    • Community Health and Wellness: Screening activities for health promotion
    • Community Health and Wellness: Tobacco, alcohol, and substance abuse
    • Community Health and Wellness: Exercise and healthy diet for obesity
    • Community Health and Wellness: Behavior theories and lifestyle change
    • Community Health and Wellness: Wellness counseling
    • Occupational and Environmental Health - 10% of the Chiropractic Practice domain
    • Occupational and Environmental Health: Work-based health risks
    • Occupational and Environmental Health: Worker protection and ergonomics
    • Occupational and Environmental Health: Injury and violence
    • Occupational and Environmental Health: Impact of environment on human health
    • Occupational and Environmental Health: Pollution and wastes
  • Associated Clinical Sciences
    • Geriatrics - 15% of the Associated Clinical Sciences domain
    • Geriatrics: Anatomic and physiologic process of aging
    • Geriatrics: Geriatric disorders and case management
    • Dermatology - 11% of the Associated Clinical Sciences domain
    • Dermatology: Types of skin lesions
    • Dermatology: Microbial infections
    • Dermatology: Tumors
    • Dermatology: Dermatitis
    • Dermatology: Scaling diseases
    • Dermatology: Vesicular and bullous diseases
    • Dermatology: Pigmentary disorders
    • Dermatology: Inflammatory reactions
    • Dermatology: Disorders of hair follicles and sebaceous glands
    • Sexually Transmitted Diseases - 8% of the Associated Clinical Sciences domain
    • Sexually Transmitted Diseases: Gonorrhea
    • Sexually Transmitted Diseases: Syphilis
    • Sexually Transmitted Diseases: AIDS
    • Sexually Transmitted Diseases: Chlamydia
    • Sexually Transmitted Diseases: Herpes
    • Sexually Transmitted Diseases: Other
    • Toxicology - 10% of the Associated Clinical Sciences domain
    • Toxicology: Pharmacology
    • Toxicology: Poisoning
    • Toxicology: Environmental and occupational toxicology
    • Emergency Procedures - 13% of the Associated Clinical Sciences domain
    • Emergency Procedures: Cardiopulmonary arrest
    • Emergency Procedures: Poisoning
    • Emergency Procedures: Thermal injuries
    • Emergency Procedures: Shock
    • Emergency Procedures: Head and spinal injuries
    • Emergency Procedures: Choking
    • Emergency Procedures: Fractures, dislocations, strains and sprains
    • Emergency Procedures: Other
    • Psychology - 11% of the Associated Clinical Sciences domain
    • Psychology: Theories and general concepts
    • Psychology: Mental and emotional disorders
    • Psychology: Assessment methods and case management
    • Gynecology and Obstetrics - 11% of the Associated Clinical Sciences domain
    • Gynecology and Obstetrics: Gynecological examination
    • Gynecology and Obstetrics: Breast examination and disorders
    • Gynecology and Obstetrics: Gynecological disease and abnormalities
    • Gynecology and Obstetrics: Pregnancy
    • Gynecology and Obstetrics: Labor and delivery
    • Gynecology and Obstetrics: Postpartum
    • Gynecology and Obstetrics: Obstetric disorders
    • Pediatrics - 14% of the Associated Clinical Sciences domain
    • Pediatrics: Care of newborn
    • Pediatrics: Growth and development
    • Pediatrics: Congenital disorders
    • Pediatrics: Childhood infectious diseases
    • Pediatrics: Pathological conditions and childhood injuries
    • Pediatrics: Emotional disorders and learning disabilities
    • Pediatrics: Nutritional problems
    • Jurisprudence, Ethics and Basic Economics - 7% of the Associated Clinical Sciences domain

How to use these free practice questions

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These are independent study questions, not actual examination items. For examination requirements and official information, view NBCE Part II details.