NBCE Part II cheat sheet

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP). A highly sensitive test is best for ruling out disease when negative; a highly specific test is best for ruling in disease when positive.

Positive likelihood ratio = sensitivity/(1 − specificity); negative likelihood ratio = (1 − sensitivity)/specificity.

Convert probability to odds (odds = p/[1−p]), multiply by the likelihood ratio to get post-test odds, then convert back (p = odds/[1+odds]).

Sensitivity and specificity are prevalence-independent; positive and negative predictive values shift with disease prevalence in the tested population.

Diabetes diagnostic thresholds: fasting plasma glucose ≥126 mg/dL, 2-hour OGTT ≥200 mg/dL, HbA1c ≥6.5%, or random glucose ≥200 mg/dL with classic symptoms.

Glasgow Coma Scale ranges 3–15 (eye 1–4, verbal 1–5, motor 1–6); a score ≤8 indicates severe impairment with airway risk.

Appendicitis signs: McBurney point tenderness, Rovsing sign, psoas sign, obturator sign, and rebound tenderness.

Acute cholecystitis: Murphy sign - inspiratory arrest during right subcostal palpation.

ACC/AHA blood pressure stages: normal <120/<80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90 mmHg.

Dermatome landmarks: C5 lateral arm, C6 thumb, C7 middle finger, C8 little finger, T4 nipple, T10 umbilicus, L4 medial malleolus, L5 dorsum of foot/great toe, S1 lateral foot.

Myotomes: C5 deltoid, C6 biceps and wrist extensors, C7 triceps and wrist flexors, C8 finger flexors, L4 tibialis anterior, L5 extensor hallucis longus, S1 gastrocnemius.

Reflexes: C5–C6 biceps and brachioradialis, C7 triceps, L4 patellar, S1 Achilles.

Upper motor neuron lesion: hyperreflexia, spasticity, Babinski sign, clonus. Lower motor neuron lesion: atrophy, fasciculations, hypotonia, hyporeflexia.

Straight leg raise is positive for L4–S1 nerve root irritation when radicular pain reproduces between 30° and 70°; the femoral nerve stretch test assesses L2–L4.

Cervical radiculopathy: Spurling test (extension, ipsilateral rotation, axial compression). Cervical myelopathy: Hoffman sign, inverted radial reflex, gait disturbance.

Cauda equina red flags: saddle anesthesia, bowel/bladder dysfunction, bilateral sciatica, progressive motor deficit - emergent referral.

Three or more of five Waddell signs (tenderness, simulation, distraction, regional disturbance, overreaction) suggest non-organic pain behavior.

Canadian C-spine Rule and NEXUS criteria determine whether cervical imaging is required after trauma.

Five radiographic densities from radiolucent to radiopaque: air, fat, water/soft tissue, bone, metal.

T1-weighted MRI: fat bright, fluid dark. T2-weighted MRI: fluid bright. STIR and fat-suppressed sequences highlight edema.

MRI contraindications: ferromagnetic intracranial aneurysm clips, older cardiac pacemakers, cochlear implants, intraocular or intracranial metal, some implanted pumps.

CT delivers substantially more ionizing radiation than plain radiography; MRI uses no ionizing radiation.

Meyerding grading of spondylolisthesis: I = 0–25%, II = 26–50%, III = 51–75%, IV = 76–100%, V = >100% anterior translation.

Oblique lumbar films display the Scotty dog; a defect through the pars interarticularis (the dog's neck) indicates spondylolysis.

Cervical oblique views assess intervertebral foramina; flexion–extension views assess segmental instability.

Hounsfield units: air approximately −1000, water 0, cortical bone approximately +1000.

Red flags prompting early imaging in low back pain: age >50 with new onset, trauma, fever, cancer history, weight loss, night pain, neurologic deficit, bowel/bladder change, IV drug use, prolonged corticosteroid use.

Diversified: high-velocity low-amplitude thrust, short lever, pisiform contact, specific line of drive, commonly lumbar side-posture or prone.

Gonstead: full-spine, segment-specific listings, cervical chair and knee-chest tables, minimal rotation.

Thompson terminal point: drop-table technique with pelvic and thoracic drop pieces applied at end range.

Activator/instrument adjusting: low-force, high-velocity impulse; selected when manual thrust is poorly tolerated.

Cox flexion–distraction: slow flexion with traction, used for disc herniation, radiculopathy, and spinal stenosis.

Absolute contraindications to HVLA: acute fracture, dislocation, bone malignancy, spinal infection, upper cervical instability, cauda equina syndrome, acute myelopathy.

Relative contraindications: severe osteoporosis, anticoagulation, inflammatory arthropathy with instability, recent spinal surgery, pregnancy positioning limits.

Vertebrobasilar screen: five Ds (dizziness, diplopia, dysarthria, dysphagia, drop attacks) and three Ns (nausea, numbness, nystagmus).

Cavitation is gas released from synovial fluid; it is not a reliable indicator of a clinically successful adjustment.

Vertebral subluxation complex components: kinesiopathology, neuropathophysiology, myopathology, histopathology, and biochemical changes.

Adult vertebral count: 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, 4 coccygeal - 33 segments total before fusion.

1895: D. D. Palmer delivered the first adjustment to Harvey Lillard; the Palmer School of Chiropractic was founded in 1897.

Wilk v. AMA (1987 appellate ruling): the AMA boycott of chiropractors was found to violate antitrust law.

Informed consent requires disclosure of diagnosis, nature and risks of care, alternatives, and consequences of refusal, with documentation of voluntary agreement.

SOAP note format: Subjective, Objective, Assessment, Plan; objective findings, diagnosis code, and response to care must be recorded.

Impairment ratings commonly follow the AMA Guides to the Evaluation of Permanent Impairment (sixth edition current).

Triad of health model: structural, chemical, and emotional contributors to health status.

Scope of practice is set by state statute; chiropractic licensure includes diagnosis, treatment, and referral.

Anion gap = Na⁺ − (Cl⁻ + HCO₃⁻); normal 8–12 mEq/L; elevation suggests metabolic acidosis (MUDPILES).

Friedewald formula: LDL = total cholesterol − HDL − (triglycerides/5), valid only when triglycerides <400 mg/dL.

Normal adult CBC: WBC 4.5–11 ×10³/µL, platelets 150–450 ×10³/µL, hemoglobin 13.5–17.5 g/dL (men) and 12–15.5 g/dL (women).

Renal panel: BUN 7–20 mg/dL, creatinine 0.6–1.2 mg/dL; a BUN:creatinine ratio >20:1 suggests pre-renal azotemia.

TSH 0.4–4.0 mIU/L; elevated TSH with low free T4 indicates primary hypothyroidism.

ESR upper reference approximately age/2 in men and (age+10)/2 in women; CRP <1 mg/L low and >3 mg/L high cardiovascular risk.

Tissue healing phases: hemostasis (hours), inflammation (0–4 days), proliferation (4–21 days), remodeling (21 days–1 year).

Electrolyte reference ranges: sodium 135–145 mEq/L, potassium 3.5–5.0 mEq/L, calcium 8.5–10.5 mg/dL.

Cardiac markers: troponin rises 3–6 hours after infarction and remains elevated 7–10 days; CK-MB peaks at 12–24 hours.