NBCE Part III flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

OPQRST mnemonic

A structured pain history covering Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing; it improves consistency and completeness when characterizing a chief complaint.

Red flags in history

Findings such as bowel or bladder dysfunction, saddle anesthesia, fever, unexplained weight loss, night pain, cancer history, or progressive neurologic deficit that warrant urgent evaluation before routine care.

Review of systems

A systematic inquiry across body systems-constitutional, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurologic, endocrine, skin, and psychiatric-to uncover symptoms beyond the chief complaint.

Past medical history

A record of chronic illnesses, prior surgeries, hospitalizations, injuries, allergies, immunizations, family history, and medications that may affect diagnosis, contraindications, or treatment planning.

Orthostatic hypotension criterion

A fall in systolic blood pressure of at least 20 mm Hg or diastolic of at least 10 mm Hg within three minutes of standing, often accompanied by dizziness or syncope.

Deep tendon reflex scale

Graded 0 absent, 1+ diminished, 2+ normal, 3+ exaggerated, and 4+ with clonus; asymmetry or spread suggests neurologic dysfunction requiring further evaluation.

Straight leg raise test

With the patient supine, passive hip flexion with knee extension reproduces radicular leg pain below the knee, suggesting nerve root irritation, commonly at L4-S1.

Manual muscle test grades

Graded 0 to 5: 0 no contraction, 1 trace, 2 active movement without gravity, 3 against gravity, 4 against some resistance, and 5 normal resistance.

MRI indications

Suspected disc herniation with radiculopathy, spinal cord compression, infection, tumor, cauda equina syndrome, or neurologic deficit; it provides detailed soft-tissue and neural anatomy without ionizing radiation.

Gadolinium contraindication

Severe renal impairment, especially eGFR below 30 mL/min/1.73 m², increases risk of nephrogenic systemic fibrosis; pregnancy and prior reaction also require caution.

ALARA principle

Radiation protection principle meaning As Low As Reasonably Achievable; use the lowest dose, shield sensitive tissues, and avoid unnecessary imaging, especially in children and pregnant patients.

ESR and CRP

Nonspecific inflammatory markers; elevation may support infection, inflammatory arthritis, or malignancy but does not establish a diagnosis and should be interpreted with history and examination.

Cauda equina syndrome

A surgical emergency suggested by saddle anesthesia, bowel or bladder dysfunction, bilateral leg weakness, and abrupt onset; urgent MRI and referral are required to prevent permanent deficit.

Radiculopathy findings

Dermatomal sensory change, myotomal weakness, diminished deep tendon reflex, and positive tension signs in a corresponding nerve root distribution; imaging is considered when deficits are progressive or persistent.

Differential diagnosis process

Generate and prioritize plausible conditions, including serious pathology, by integrating history, physical examination, and diagnostic studies; revise the list as new data emerge.

Clinical impression

A concise working diagnosis that synthesizes the chief complaint, history, examination findings, and test results, and guides treatment, referral, and further diagnostic decisions.

HVLA manipulation

A high-velocity, low-amplitude thrust directed at a specific joint to restore motion and reduce pain; it requires accurate positioning, informed consent, and screening for contraindications.

Manipulation contraindications

Absolute or relative contraindications include fracture, dislocation, unstable ligamentous injury, severe osteoporosis, spinal infection, tumor, bleeding disorder, and anticoagulation; screen before applying thrust.

Flexion-distraction technique

A non-thrust table-assisted method using flexion and traction to distract the spine, often used for discogenic low back pain or radiculopathy when thrust manipulation is not tolerated.

Therapeutic exercise dosage

Prescribe frequency, intensity, duration, and progression based on patient tolerance and goals; reassess response and advance load gradually to restore strength, mobility, and function.

Referral red flags

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

Failure to improve

If a patient shows no meaningful functional improvement after an appropriate trial of care, typically four to six weeks, reassess the diagnosis and consider referral or advanced imaging.

Co-management definition

Coordinated care with another clinician, such as a primary care physician or specialist, sharing findings and treatment plans while clarifying responsibilities and maintaining continuity.

Discharge criteria

Discharge when treatment goals are met, symptoms are stable, the patient can self-manage, or maximal benefit is reached; document status, home program, and follow-up instructions.

Informed consent elements

Disclose diagnosis, proposed treatment, expected benefits, material risks, alternatives, and the right to refuse; obtain and document consent before care, especially for manipulation.

HIPAA privacy rule

Protects individually identifiable health information by limiting use and disclosure, requiring safeguards, and granting patients rights to access and amend their records.

Malpractice four elements

A plaintiff must prove duty, breach of the standard of care, causation, and damages; documentation and informed consent are central to risk reduction.

Mandatory reporting

Licensed clinicians must report suspected child or elder abuse, certain communicable diseases, and impaired colleagues as required by state law and professional regulations.

SOAP note format

Subjective, Objective, Assessment, and Plan; it organizes the encounter, supports clinical reasoning, and provides a defensible record of care and follow-up.

Late entry documentation

When adding to a record after the encounter, date and time the entry, identify it as a late entry, sign it, and avoid altering original content.

Objective documentation

Record measurable findings such as vital signs, range of motion, neurologic tests, and outcome scores rather than vague descriptors; this supports medical necessity and progress.

Record retention

Follow state and payer requirements for how long records are kept; retain them securely and ensure confidentiality, release authorization, and access during legal or insurance requests.