NBCE Part IV flashcards

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

Saddle anesthesia red flag

Loss of sensation in the perineal or saddle distribution, especially with bowel or bladder changes, suggests cauda equina syndrome and requires emergency referral for imaging.

OPQRST pain mnemonic

Onset, Provocation and Palliation, Quality, Region and Radiation, Severity, Timing: a structured sequence used during the interview to fully characterize a complaint.

SAMPLE history format

Signs and symptoms, Allergies, Medications, Past medical history, Last oral intake, Events prior: a screening format that ensures allergies and anticoagulant use surface before treatment.

Open-ended versus closed questions

Open-ended prompts elicit narrative and unexpected detail early in the interview, while closed or direct questions later confirm specific facts, chronology, and severity.

True versus apparent leg length

True leg length is measured from the ASIS to the medial malleolus; apparent length runs from the umbilicus to the medial malleolus and reflects pelvic obliquity.

Kemp's test

Cervical or lumbar extension combined with rotation and compression that reproduces radicular pain, suggesting foraminal narrowing or nerve root compression.

FABER (Patrick) test

Hip flexion, abduction, and external rotation; groin or anterior hip pain suggests hip joint pathology, whereas posterior pain suggests sacroiliac involvement.

Manual muscle test grades

Grade 0 no contraction, 1 trace contraction, 2 movement without gravity, 3 against gravity, 4 against gravity with some resistance, 5 normal strength.

C7 reflex and dermatome

Triceps reflex and middle finger sensation assess the C7 nerve root; radiculopathy may also weaken elbow extension or wrist flexion.

Babinski sign

Dorsiflexion of the great toe with fanning of the other toes after plantar stimulation in an adult indicates an upper motor neuron lesion.

Achilles reflex nerve root

The S1 nerve root mediates the Achilles tendon reflex; diminished response suggests S1 radiculopathy, which may also reduce lateral foot sensation.

Romberg test

The patient stands with feet together and eyes closed; marked sway or loss of balance indicates proprioceptive or vestibular dysfunction.

HVLA defined

High-velocity, low-amplitude thrust: a rapid, short-lever manual force delivered at a joint's end range, the defining characteristic of diversified-style chiropractic adjustment.

Manipulation absolute contraindications

Acute fracture or dislocation, unstable ligamentous injury, or a destructive bone lesion at the target segment contraindicates thrust manipulation because further structural displacement may occur.

Flexion-distraction technique

A gentle, non-thrust, table-assisted method applying cyclic traction and flexion to the lumbar spine, often selected for disc herniation or stenosis.

Cavitation sound explained

The audible pop during an adjustment comes from gas and pressure release within the synovial joint capsule, not from bone being moved back into place.

Open-mouth odontoid view

An anteroposterior radiograph taken through the open mouth that visualizes C1–C2, used to assess lateral mass symmetry, dens integrity, and atlantoaxial alignment.

Scottie dog anatomy

On oblique lumbar films the ear is the superior articular process, the nose the transverse process, the eye the pedicle, and the neck the pars interarticularis.

Meyerding grading

Grades I through IV describe anterior vertebral body slip in 25% increments of the superior endplate width; grade V indicates complete spondyloptosis.

Cobb angle

The angle measured between lines drawn along the endplates of the most tilted vertebrae in a scoliosis; curves exceeding 10 degrees are considered scoliotic.

Oswestry Disability Index

A condition-specific questionnaire scoring lumbar-related functional limitation from 0 to 100%, used to track change across a course of care.

Cryotherapy application time

Cold is typically applied for 15 to 20 minutes with periodic skin checks; longer exposure raises the risk of tissue injury and reflex vasodilation.

SOAP note format

Subjective, Objective, Assessment, Plan: the standard documentation structure linking patient report, examination data, diagnosis, and treatment strategy.

Acute versus chronic staging

Pain under about six weeks is acute, six to twelve weeks is subacute, and beyond twelve weeks is chronic, which guides technique intensity and prognosis.

Positive likelihood ratio

LR+ equals sensitivity divided by one minus specificity; values above 10 substantially raise the probability that the diagnosis is present.

Confirmation bias

The tendency to seek and favor information supporting an initial impression while discounting contradictory findings, a common source of diagnostic error.

VINDICATE mnemonic

Vascular, Infectious, Neoplastic, Degenerative, Iatrogenic, Congenital, Autoimmune, Traumatic, Endocrine: a systematic checklist for building a differential diagnosis.

Occam's razor in diagnosis

Prefer the single explanation accounting for all findings; atypical or nonresponsive presentations, however, justify reconsidering multiple concurrent conditions.

Informed consent elements

Diagnosis, nature of the proposed procedure, material risks, expected benefits, reasonable alternatives, consequences of declining, and the patient's voluntary agreement.

Teach-back method

Asking the patient to restate the plan or risks in their own words confirms comprehension and reveals gaps better than asking whether they understand.

SBAR communication

Situation, Background, Assessment, Recommendation: a structured format for handing off or communicating clinical findings to another provider.

Minimum necessary standard

The HIPAA principle limiting disclosures of protected health information to the least amount needed to accomplish the purpose at hand.