NBCE Part IV case studies
NBCE Part IV · Put your knowledge to work in context.
Part IV is the examination the National Board of Chiropractic Examiners lists under its Testing menu as the "Pre-Licensure Practical Exam (Part IV)." The NBCE's navigation places it in a separate category from the "Pre-Licensure Computer-Based Exams (Parts I, II, III, PHT)," which indicates that Part IV is the performance-based, hands-on element of the pre-licensure sequence rather than another multiple-choice computer test. It is intended for chiropractic students and graduates who are moving through the national board sequence on the way to state licensure, and it is typically taken near the end of that sequence, after the computer-based parts. The NBCE Part IV case studies are 5 cases and about 4,287 words.
1New Mid-Thoracic Rest Pain in a Patient With a Cancer History
A 63-year-old retired machinist presents with 6 weeks of progressive mid-thoracic pain that has never fully resolved. The pain is now present at rest, wakes him at 2–3 a.m., and is not eased by any position, including side-lying.
784 words, about 4 min2Bilateral Hand Clumsiness and Unsteady Gait
A 57-year-old right-handed woman reports 8 months of bilateral hand numbness and clumsiness - she drops coins, cannot fasten buttons, and has twice burned herself while cooking. Over the same period she has developed progressive unsteadiness, worst in the dark, with two falls in the last 3 months.
852 words, about 4 min3Acute Low Back Pain on Warfarin With Severe Osteoporosis
A 72-year-old woman presents 3 weeks after lifting a bag of groceries with acute low back pain rated 7/10. Pain is worse with standing and extension and eases with sitting.
807 words, about 4 min4Degenerative Spondylolisthesis With Neurogenic Claudication
A 54-year-old man has 6 months of intermittent low back pain radiating into the left buttock and posterior thigh, worse with standing and walking and relieved by sitting or by leaning forward over a shopping cart. Walking tolerance is now two blocks.
873 words, about 4 min5The Adjuster on the Phone and the Patient Who Wants “100% Disabled”
A 45-year-old warehouse worker is 6 weeks into care for an L4–L5 lumbar sprain/strain sustained lifting at work. Pain has fallen from 7/10 to 3/10, lumbar flexion has improved from 30° to 65°, and he now tolerates 30 minutes of continuous walking.
971 words, about 5 min