NBCE Part III cheat sheet

Record the chief complaint in the patient's own words, including onset, duration, frequency, intensity, location, radiation, and aggravating or relieving factors.

Use OPQRST for pain: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing.

Screen for red flags: bowel or bladder dysfunction, saddle anesthesia, unexplained weight loss, fever, night pain, cancer history, trauma, and progressive neurologic deficit.

Past medical history includes chronic illnesses, prior surgeries, hospitalizations, injuries, allergies, immunizations, medications, family history, and social history.

Review of systems surveys constitutional, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurologic, endocrine, skin, and psychiatric symptoms.

Medication review should identify anticoagulants, corticosteroids, opioids, antihypertensives, glucose-lowering agents, and documented adverse reactions.

Social and occupational history includes job demands, repetitive loads, ergonomics, smoking, alcohol use, exercise, and home responsibilities.

For pediatric, geriatric, pregnant, or cognitively impaired patients, obtain collateral history and screen for abuse or neglect when indicated.

Vital signs include blood pressure, heart rate, respiratory rate, temperature, height, weight, and BMI; orthostatic hypotension is a systolic drop of at least 20 mm Hg or diastolic drop of at least 10 mm Hg.

Examination sequence commonly proceeds with inspection, palpation, percussion, and auscultation, followed by region-specific orthopedic and neurologic testing.

Range of motion is assessed actively and passively, noting restriction, pain provocation, crepitus, and end-feel.

Neurologic screening includes dermatomal sensation, myotomal strength, deep tendon reflexes, proprioception, and pathologic reflexes such as Babinski.

Deep tendon reflexes are graded 0 absent, 1+ diminished, 2+ normal, 3+ exaggerated, and 4+ with clonus.

Manual muscle testing is graded 0 to 5: 0 no contraction, 1 trace, 2 movement without gravity, 3 against gravity, 4 against some resistance, and 5 normal.

Orthopedic tests include straight leg raise, Spurling, Kemp, Gaenslen, Patrick/FABER, Phalen, and Tinel, each interpreted with corresponding history and neurologic findings.

Vascular assessment includes pulses, capillary refill, edema, skin color and temperature, and comparison of bilateral extremities.

Plain radiography is indicated for trauma, suspected fracture or dislocation, deformity, red flags, and failure to improve after conservative care.

MRI is preferred for suspected disc herniation with radiculopathy, spinal cord compression, infection, tumor, cauda equina syndrome, and unexplained neurologic deficit.

CT provides detailed bony anatomy and is useful for complex fractures or when MRI is contraindicated.

Ultrasound evaluates soft-tissue structures, gallbladder disease, vascular flow, and obstetric conditions without ionizing radiation.

Common laboratory studies include CBC, comprehensive metabolic panel, ESR, CRP, HbA1c, lipid panel, TSH, and urinalysis, selected according to the differential diagnosis.

Gadolinium contrast is avoided in severe renal impairment, especially eGFR below 30 mL/min/1.73 m², and requires caution in pregnancy or prior contrast reaction.

Radiation safety follows ALARA: As Low As Reasonably Achievable, with shielding, limited fields, and avoidance of unnecessary studies.

Bone scan can detect occult fracture, metastasis, or infection; EMG/NCS evaluates peripheral nerve and radicular dysfunction.

Rule out serious pathology first: fracture, infection, tumor, cauda equina syndrome, spinal cord compression, vascular emergency, and progressive neurologic deficit.

Radiculopathy is supported by dermatomal sensory change, myotomal weakness, diminished reflex, and positive tension signs in a corresponding nerve root distribution.

Cauda equina syndrome is suggested by saddle anesthesia, bowel or bladder dysfunction, bilateral leg weakness, and abrupt onset; it requires urgent MRI and referral.

A differential diagnosis is generated, prioritized, and revised as history, examination, imaging, and laboratory data accumulate.

The clinical impression synthesizes the chief complaint, history, examination, and test results into a working diagnosis that guides care.

ICD-10 coding should be as specific as the documented diagnosis allows and must be supported by the record.

Comorbidities and psychosocial factors can alter prognosis and treatment response and should be included in diagnostic reasoning.

Distinguish a working diagnosis from a definitive diagnosis and document the basis for each diagnostic conclusion.

High-velocity, low-amplitude manipulation applies a rapid thrust to a specific joint; mobilization uses slower, graded movement.

Screen for contraindications including fracture, dislocation, unstable ligamentous injury, severe osteoporosis, spinal infection, tumor, bleeding disorder, and anticoagulation.

Obtain and document informed consent before manipulation, including expected benefits, material risks, alternatives, and the right to refuse.

Flexion-distraction uses table-assisted flexion and traction and is often selected for discogenic pain or radiculopathy when thrust manipulation is not tolerated.

Therapeutic modalities include cryotherapy, heat, electrical stimulation, ultrasound, traction, and soft-tissue techniques, selected by condition and stage of healing.

Exercise prescription specifies frequency, intensity, duration, and progression, with reassessment of tolerance and functional response.

Document the technique, region treated, patient response, and any adverse reaction after each treatment.

Reassess after a defined trial of care and modify or discontinue treatment if functional improvement is not occurring.

Urgent referral is indicated for suspected fracture, infection, tumor, cauda equina syndrome, progressive neurologic deficit, vascular emergency, or unexplained systemic symptoms.

Consider referral or advanced imaging when a patient fails to improve after an appropriate trial of care, typically four to six weeks.

Co-management requires sharing examination findings, diagnosis, and treatment plans with another clinician while clarifying each provider's responsibilities.

Referral letters should state the reason for referral, relevant history, objective findings, working diagnosis, treatments provided, and requested consultation.

Case management includes informed consent, patient education, goal setting, outcome measurement, and coordination of ancillary services.

Discharge is appropriate when goals are met, symptoms are stable, the patient can self-manage, or maximal benefit has been reached.

Document referrals, communications, authorizations, and patient responses to maintain continuity and defensibility.

Insurance and payer requirements may include preauthorization, medical necessity documentation, and periodic treatment plan review.

Practice within the state-defined scope of chiropractic care and maintain active licensure and required continuing education.

Informed consent requires disclosure of diagnosis, proposed treatment, expected benefits, material risks, alternatives, and the right to refuse.

HIPAA protects individually identifiable health information by limiting use and disclosure and requiring appropriate safeguards.

Malpractice requires proof of duty, breach of the standard of care, causation, and damages.

Mandatory reporting may include suspected child or elder abuse, certain communicable diseases, and impaired colleagues as defined by state law.

Maintain professional boundaries, avoid dual relationships, and refrain from misrepresentation of credentials or treatment outcomes.

Fraud and abuse include billing for services not rendered, upcoding, and improper inducements; documentation must support every claim.

Risk reduction includes timely records, clear consent, appropriate referral, and avoidance of treatment beyond competence or scope.

Use the SOAP format: Subjective, Objective, Assessment, and Plan, to organize each encounter and support clinical reasoning.

Record the chief complaint, history, examination findings, diagnosis, treatment provided, patient response, and follow-up plan for every visit.

Objective documentation includes vital signs, range of motion, neurologic tests, orthopedic tests, and validated outcome scores.

Document informed consent, risks and benefits discussed, alternatives offered, and the patient's decision.

Late entries must be dated, timed, identified as late, signed, and must not alter the original record.

Amendments should preserve the original entry and include the date, time, and identity of the person making the change.

Maintain confidentiality and secure records in compliance with HIPAA and state privacy laws.

Follow state and payer record-retention requirements and document referrals, communications, and release authorizations.

Record the chief complaint in the patient's own words, including onset, duration, frequency, intensity, location, radiation, and aggravating or relieving factors.

Use OPQRST for pain: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing.

Screen for red flags: bowel or bladder dysfunction, saddle anesthesia, unexplained weight loss, fever, night pain, cancer history, trauma, and progressive neurologic deficit.

Past medical history includes chronic illnesses, prior surgeries, hospitalizations, injuries, allergies, immunizations, medications, family history, and social history.

Review of systems surveys constitutional, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurologic, endocrine, skin, and psychiatric symptoms.

Medication review should identify anticoagulants, corticosteroids, opioids, antihypertensives, glucose-lowering agents, and documented adverse reactions.

Social and occupational history includes job demands, repetitive loads, ergonomics, smoking, alcohol use, exercise, and home responsibilities.

For pediatric, geriatric, pregnant, or cognitively impaired patients, obtain collateral history and screen for abuse or neglect when indicated.

Vital signs include blood pressure, heart rate, respiratory rate, temperature, height, weight, and BMI; orthostatic hypotension is a systolic drop of at least 20 mm Hg or diastolic drop of at least 10 mm Hg.

Examination sequence commonly proceeds with inspection, palpation, percussion, and auscultation, followed by region-specific orthopedic and neurologic testing.

Range of motion is assessed actively and passively, noting restriction, pain provocation, crepitus, and end-feel.

Neurologic screening includes dermatomal sensation, myotomal strength, deep tendon reflexes, proprioception, and pathologic reflexes such as Babinski.

Deep tendon reflexes are graded 0 absent, 1+ diminished, 2+ normal, 3+ exaggerated, and 4+ with clonus.

Manual muscle testing is graded 0 to 5: 0 no contraction, 1 trace, 2 movement without gravity, 3 against gravity, 4 against some resistance, and 5 normal.

Orthopedic tests include straight leg raise, Spurling, Kemp, Gaenslen, Patrick/FABER, Phalen, and Tinel, each interpreted with corresponding history and neurologic findings.

Vascular assessment includes pulses, capillary refill, edema, skin color and temperature, and comparison of bilateral extremities.

Plain radiography is indicated for trauma, suspected fracture or dislocation, deformity, red flags, and failure to improve after conservative care.

MRI is preferred for suspected disc herniation with radiculopathy, spinal cord compression, infection, tumor, cauda equina syndrome, and unexplained neurologic deficit.

CT provides detailed bony anatomy and is useful for complex fractures or when MRI is contraindicated.

Ultrasound evaluates soft-tissue structures, gallbladder disease, vascular flow, and obstetric conditions without ionizing radiation.

Common laboratory studies include CBC, comprehensive metabolic panel, ESR, CRP, HbA1c, lipid panel, TSH, and urinalysis, selected according to the differential diagnosis.

Gadolinium contrast is avoided in severe renal impairment, especially eGFR below 30 mL/min/1.73 m², and requires caution in pregnancy or prior contrast reaction.

Radiation safety follows ALARA: As Low As Reasonably Achievable, with shielding, limited fields, and avoidance of unnecessary studies.

Bone scan can detect occult fracture, metastasis, or infection; EMG/NCS evaluates peripheral nerve and radicular dysfunction.

Rule out serious pathology first: fracture, infection, tumor, cauda equina syndrome, spinal cord compression, vascular emergency, and progressive neurologic deficit.

Radiculopathy is supported by dermatomal sensory change, myotomal weakness, diminished reflex, and positive tension signs in a corresponding nerve root distribution.

Cauda equina syndrome is suggested by saddle anesthesia, bowel or bladder dysfunction, bilateral leg weakness, and abrupt onset; it requires urgent MRI and referral.

A differential diagnosis is generated, prioritized, and revised as history, examination, imaging, and laboratory data accumulate.

The clinical impression synthesizes the chief complaint, history, examination, and test results into a working diagnosis that guides care.

ICD-10 coding should be as specific as the documented diagnosis allows and must be supported by the record.

Comorbidities and psychosocial factors can alter prognosis and treatment response and should be included in diagnostic reasoning.

Distinguish a working diagnosis from a definitive diagnosis and document the basis for each diagnostic conclusion.

High-velocity, low-amplitude manipulation applies a rapid thrust to a specific joint; mobilization uses slower, graded movement.

Screen for contraindications including fracture, dislocation, unstable ligamentous injury, severe osteoporosis, spinal infection, tumor, bleeding disorder, and anticoagulation.

Obtain and document informed consent before manipulation, including expected benefits, material risks, alternatives, and the right to refuse.

Flexion-distraction uses table-assisted flexion and traction and is often selected for discogenic pain or radiculopathy when thrust manipulation is not tolerated.

Therapeutic modalities include cryotherapy, heat, electrical stimulation, ultrasound, traction, and soft-tissue techniques, selected by condition and stage of healing.

Exercise prescription specifies frequency, intensity, duration, and progression, with reassessment of tolerance and functional response.

Document the technique, region treated, patient response, and any adverse reaction after each treatment.

Reassess after a defined trial of care and modify or discontinue treatment if functional improvement is not occurring.

Urgent referral is indicated for suspected fracture, infection, tumor, cauda equina syndrome, progressive neurologic deficit, vascular emergency, or unexplained systemic symptoms.

Consider referral or advanced imaging when a patient fails to improve after an appropriate trial of care, typically four to six weeks.

Co-management requires sharing examination findings, diagnosis, and treatment plans with another clinician while clarifying each provider's responsibilities.

Referral letters should state the reason for referral, relevant history, objective findings, working diagnosis, treatments provided, and requested consultation.

Case management includes informed consent, patient education, goal setting, outcome measurement, and coordination of ancillary services.

Discharge is appropriate when goals are met, symptoms are stable, the patient can self-manage, or maximal benefit has been reached.

Document referrals, communications, authorizations, and patient responses to maintain continuity and defensibility.

Insurance and payer requirements may include preauthorization, medical necessity documentation, and periodic treatment plan review.

Practice within the state-defined scope of chiropractic care and maintain active licensure and required continuing education.

Informed consent requires disclosure of diagnosis, proposed treatment, expected benefits, material risks, alternatives, and the right to refuse.

HIPAA protects individually identifiable health information by limiting use and disclosure and requiring appropriate safeguards.

Malpractice requires proof of duty, breach of the standard of care, causation, and damages.

Mandatory reporting may include suspected child or elder abuse, certain communicable diseases, and impaired colleagues as defined by state law.

Maintain professional boundaries, avoid dual relationships, and refrain from misrepresentation of credentials or treatment outcomes.

Fraud and abuse include billing for services not rendered, upcoding, and improper inducements; documentation must support every claim.

Risk reduction includes timely records, clear consent, appropriate referral, and avoidance of treatment beyond competence or scope.

Use the SOAP format: Subjective, Objective, Assessment, and Plan, to organize each encounter and support clinical reasoning.

Record the chief complaint, history, examination findings, diagnosis, treatment provided, patient response, and follow-up plan for every visit.

Objective documentation includes vital signs, range of motion, neurologic tests, orthopedic tests, and validated outcome scores.

Document informed consent, risks and benefits discussed, alternatives offered, and the patient's decision.

Late entries must be dated, timed, identified as late, signed, and must not alter the original record.

Amendments should preserve the original entry and include the date, time, and identity of the person making the change.

Maintain confidentiality and secure records in compliance with HIPAA and state privacy laws.

Follow state and payer record-retention requirements and document referrals, communications, and release authorizations.

Record the chief complaint in the patient's own words, including onset, duration, frequency, intensity, location, radiation, and aggravating or relieving factors.

Use OPQRST for pain: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing.

Screen for red flags: bowel or bladder dysfunction, saddle anesthesia, unexplained weight loss, fever, night pain, cancer history, trauma, and progressive neurologic deficit.

Past medical history includes chronic illnesses, prior surgeries, hospitalizations, injuries, allergies, immunizations, medications, family history, and social history.

Review of systems surveys constitutional, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurologic, endocrine, skin, and psychiatric symptoms.

Medication review should identify anticoagulants, corticosteroids, opioids, antihypertensives, glucose-lowering agents, and documented adverse reactions.

Social and occupational history includes job demands, repetitive loads, ergonomics, smoking, alcohol use, exercise, and home responsibilities.

For pediatric, geriatric, pregnant, or cognitively impaired patients, obtain collateral history and screen for abuse or neglect when indicated.

Vital signs include blood pressure, heart rate, respiratory rate, temperature, height, weight, and BMI; orthostatic hypotension is a systolic drop of at least 20 mm Hg or diastolic drop of at least 10 mm Hg.

Examination sequence commonly proceeds with inspection, palpation, percussion, and auscultation, followed by region-specific orthopedic and neurologic testing.

Range of motion is assessed actively and passively, noting restriction, pain provocation, crepitus, and end-feel.

Neurologic screening includes dermatomal sensation, myotomal strength, deep tendon reflexes, proprioception, and pathologic reflexes such as Babinski.

Deep tendon reflexes are graded 0 absent, 1+ diminished, 2+ normal, 3+ exaggerated, and 4+ with clonus.

Manual muscle testing is graded 0 to 5: 0 no contraction, 1 trace, 2 movement without gravity, 3 against gravity, 4 against some resistance, and 5 normal.

Orthopedic tests include straight leg raise, Spurling, Kemp, Gaenslen, Patrick/FABER, Phalen, and Tinel, each interpreted with corresponding history and neurologic findings.

Vascular assessment includes pulses, capillary refill, edema, skin color and temperature, and comparison of bilateral extremities.

Plain radiography is indicated for trauma, suspected fracture or dislocation, deformity, red flags, and failure to improve after conservative care.

MRI is preferred for suspected disc herniation with radiculopathy, spinal cord compression, infection, tumor, cauda equina syndrome, and unexplained neurologic deficit.

CT provides detailed bony anatomy and is useful for complex fractures or when MRI is contraindicated.

Ultrasound evaluates soft-tissue structures, gallbladder disease, vascular flow, and obstetric conditions without ionizing radiation.

Common laboratory studies include CBC, comprehensive metabolic panel, ESR, CRP, HbA1c, lipid panel, TSH, and urinalysis, selected according to the differential diagnosis.

Gadolinium contrast is avoided in severe renal impairment, especially eGFR below 30 mL/min/1.73 m², and requires caution in pregnancy or prior contrast reaction.

Radiation safety follows ALARA: As Low As Reasonably Achievable, with shielding, limited fields, and avoidance of unnecessary studies.

Bone scan can detect occult fracture, metastasis, or infection; EMG/NCS evaluates peripheral nerve and radicular dysfunction.

Rule out serious pathology first: fracture, infection, tumor, cauda equina syndrome, spinal cord compression, vascular emergency, and progressive neurologic deficit.

Radiculopathy is supported by dermatomal sensory change, myotomal weakness, diminished reflex, and positive tension signs in a corresponding nerve root distribution.

Cauda equina syndrome is suggested by saddle anesthesia, bowel or bladder dysfunction, bilateral leg weakness, and abrupt onset; it requires urgent MRI and referral.

A differential diagnosis is generated, prioritized, and revised as history, examination, imaging, and laboratory data accumulate.

The clinical impression synthesizes the chief complaint, history, examination, and test results into a working diagnosis that guides care.

ICD-10 coding should be as specific as the documented diagnosis allows and must be supported by the record.

Comorbidities and psychosocial factors can alter prognosis and treatment response and should be included in diagnostic reasoning.

Distinguish a working diagnosis from a definitive diagnosis and document the basis for each diagnostic conclusion.

High-velocity, low-amplitude manipulation applies a rapid thrust to a specific joint; mobilization uses slower, graded movement.

Screen for contraindications including fracture, dislocation, unstable ligamentous injury, severe osteoporosis, spinal infection, tumor, bleeding disorder, and anticoagulation.

Obtain and document informed consent before manipulation, including expected benefits, material risks, alternatives, and the right to refuse.

Flexion-distraction uses table-assisted flexion and traction and is often selected for discogenic pain or radiculopathy when thrust manipulation is not tolerated.

Therapeutic modalities include cryotherapy, heat, electrical stimulation, ultrasound, traction, and soft-tissue techniques, selected by condition and stage of healing.

Exercise prescription specifies frequency, intensity, duration, and progression, with reassessment of tolerance and functional response.

Document the technique, region treated, patient response, and any adverse reaction after each treatment.

Reassess after a defined trial of care and modify or discontinue treatment if functional improvement is not occurring.

Urgent referral is indicated for suspected fracture, infection, tumor, cauda equina syndrome, progressive neurologic deficit, vascular emergency, or unexplained systemic symptoms.

Consider referral or advanced imaging when a patient fails to improve after an appropriate trial of care, typically four to six weeks.

Co-management requires sharing examination findings, diagnosis, and treatment plans with another clinician while clarifying each provider's responsibilities.

Referral letters should state the reason for referral, relevant history, objective findings, working diagnosis, treatments provided, and requested consultation.

Case management includes informed consent, patient education, goal setting, outcome measurement, and coordination of ancillary services.

Discharge is appropriate when goals are met, symptoms are stable, the patient can self-manage, or maximal benefit has been reached.

Document referrals, communications, authorizations, and patient responses to maintain continuity and defensibility.

Insurance and payer requirements may include preauthorization, medical necessity documentation, and periodic treatment plan review.

Practice within the state-defined scope of chiropractic care and maintain active licensure and required continuing education.

Informed consent requires disclosure of diagnosis, proposed treatment, expected benefits, material risks, alternatives, and the right to refuse.

HIPAA protects individually identifiable health information by limiting use and disclosure and requiring appropriate safeguards.

Malpractice requires proof of duty, breach of the standard of care, causation, and damages.

Mandatory reporting may include suspected child or elder abuse, certain communicable diseases, and impaired colleagues as defined by state law.

Maintain professional boundaries, avoid dual relationships, and refrain from misrepresentation of credentials or treatment outcomes.

Fraud and abuse include billing for services not rendered, upcoding, and improper inducements; documentation must support every claim.

Risk reduction includes timely records, clear consent, appropriate referral, and avoidance of treatment beyond competence or scope.

Use the SOAP format: Subjective, Objective, Assessment, and Plan, to organize each encounter and support clinical reasoning.

Record the chief complaint, history, examination findings, diagnosis, treatment provided, patient response, and follow-up plan for every visit.

Objective documentation includes vital signs, range of motion, neurologic tests, orthopedic tests, and validated outcome scores.

Document informed consent, risks and benefits discussed, alternatives offered, and the patient's decision.

Late entries must be dated, timed, identified as late, signed, and must not alter the original record.

Amendments should preserve the original entry and include the date, time, and identity of the person making the change.

Maintain confidentiality and secure records in compliance with HIPAA and state privacy laws.

Follow state and payer record-retention requirements and document referrals, communications, and release authorizations.