NBCE Part IV key terms

The patient's own words describing the main reason for the visit, recorded early in the interview and used to focus the remaining history and examination.

A chronological account of the current problem covering onset, location, quality, severity, duration, and what makes it better or worse, organized to reveal patterns that narrow the diagnostic possibilities.

A structured series of questions that screens for symptoms system by system, uncovering problems the patient did not volunteer and indicating areas needing examination or referral.

A symptom, sign, or history element that raises suspicion of serious pathology such as fracture, infection, or tumor, calling for caution or prompt referral instead of routine care.

Activities, positions, or treatments that reliably worsen or ease the patient's symptoms, helping identify the involved tissue and shape both the working diagnosis and initial management.

Motion the patient performs without help, showing willingness to move, coordination, and the range at which pain begins; it is observed before the examiner takes over.

Motion produced by the examiner while the patient stays relaxed, revealing the true available range and the quality of resistance met at the limit.

The quality of resistance the examiner feels at the end of passive motion, such as firm, springy, or empty, helping separate normal capsular tightness from spasm or serious disease.

Graded resistance applied by the examiner to a contracting muscle in a standard position, estimating strength from absent to normal and helping localize weakness to nerve, muscle, or effort.

Measurements of blood pressure, pulse, respiration, and temperature that establish a baseline, screen for systemic illness, and flag cases where manual care should be modified or deferred.

A quick stretch of a tendon that triggers a reflex muscle contraction, graded from absent to hyperactive; asymmetry or abnormal grading points to disturbed sensory or motor pathways.

The band of skin supplied by sensory fibers from one spinal nerve root; mapping reduced sensation or pain along these bands helps identify the level of nerve involvement.

The muscles chiefly innervated by a single spinal nerve root; testing these groups for weakness helps place a lesion at a specific nerve root level.

A finding such as a positive Babinski response or exaggerated reflexes that suggests damage above the anterior horn cell, separating central from peripheral causes of weakness.

A test in which the examiner lifts the relaxed, extended leg; reproduction of leg pain in a dermatomal pattern suggests nerve root tension or irritation.

Cervical compression with sidebending and rotation toward the painful side; provocation of radiating arm pain suggests foraminal narrowing or nerve root irritation.

The patient stands with feet together and eyes closed; new loss of balance that was absent with eyes open suggests impaired position sense rather than a purely cerebellar problem.

The sense of body position and movement arising from receptors in muscles, tendons, and joints; testing it helps detect sensory ataxia and dorsal column dysfunction.

A test that deliberately stresses a structure to reproduce the patient's familiar symptoms, supporting or weakening a suspected diagnosis when read with the rest of the examination.

Hands-on assessment of how each segment moves during active or passive motion, identifying joints that feel restricted, asymmetrical, or hypermobile before and after treatment.

Small accessory movements within a joint that the patient cannot produce voluntarily but that are needed for normal motion; their loss or excess guides technique choice and dosage.

Altered function of somatic structures identified by tenderness, asymmetry, restricted motion, and tissue texture change, which together direct where and how manual treatment is applied.

A quick, controlled force delivered through a short distance at a chosen joint to restore motion; its speed separates it from slower, gentler forms of manual therapy.

The direction in which force is delivered during an adjustment, chosen to follow the plane of the restricted joint so the thrust is effective and comfortable.

The specific part of the hand, such as the pisiform or thenar eminence, placed on the patient to deliver force, concentrating the thrust and protecting the patient.

The patient and doctor positioning arranged before a thrust, including table height, stance, and joint preload, which largely determines the safety and accuracy of the force.

A condition in which thrust procedures could cause harm, such as unstable fracture, severe osteoporosis, or progressive neurologic deficit, requiring a different approach or referral.

Terms for how structures look on a radiograph: radiopaque structures appear white because they absorb more x-rays, while radiolucent areas appear darker because more x-rays pass through.

A frontal projection in which the beam travels front to back, showing side-to-side alignment, symmetry, and lateral deviation of structures such as the spine.

A side projection that shows structures from front to back, useful for judging curvature, vertebral body height, disc space, and forward or backward displacement.

Forward slippage of one vertebra on the one below, graded by the amount of displacement, which can narrow the canal and affect the safety of certain manual procedures.

A measure of scoliotic curvature made by drawing lines along the endplates of the most tilted vertebrae and measuring the angle between them, used to track progression.

A written outline of goals, visit frequency, expected duration, and review points that communicates the intended course of care and gives a basis for changing it.

A standardized questionnaire or test scored at intervals to quantify pain, function, or disability, helping the doctor judge whether care is helping and justify continuing or stopping.

An estimate of the likely course and duration of a condition based on its nature, the patient's characteristics, and early response to care, used to set expectations and review dates.

A ranked list of plausible explanations for the patient's presentation, built from history and examination and revised as new findings or treatment responses appear.

A decision aid that combines several examination findings to estimate the probability of a diagnosis or of responding to a treatment, supporting more consistent clinical decisions.

Transferring part of a patient's care to another practitioner with needed expertise, sending relevant findings and a clear question while the original doctor keeps appropriate responsibility.

A progress note divided into subjective, objective, assessment, and plan sections, giving a consistent and defensible record of findings, reasoning, and next steps.

A discussion in which the patient receives understandable information about a proposed procedure's nature, risks, benefits, and alternatives, then freely agrees; the agreement is documented.