Introduction to the Part IV Examination:

The Introduction section of the CNBA review describes the Part IV examination in detail and explains how the examination is administered. It takes you through the examination step by step and explains the process and the format of the examination. It also contains notes, samples of how the questions will be addressed, what is expected of you during the examination, and likely scenarios that may be presented. The Introduction section is very helpful and will allow you to understand exactly what is expected of you during the Part IV examination.

I. Diagnostic Imaging (DIM) aka X-ray interpretation


1. Consists of 20 stations. You are given 2 minutes per station.
2. During the DIM portion, you will be viewing diagnostic images on a monitor and answering two questions related to the images.
3. NBCE may also ask you to identify various types of special imaging such as: MRI, CT, Ultrasound, etc.

II. Case Management


1. Consists of 20 stations. You will be given 5 minutes in each station.

2. A pre-station is where the simulated patient will be. You will be given 5 minutes for all of the pre-stations.

3. A post-station immediately follows the pre-station. At the post-station, you will be required to answer questions regarding the simulated patient's case from the pre-station. You will also be given 5 minutes in all of the post stations.

4. The 20 stations consist of the following sections: Case History, Orthopedic/Neurological, and Physical Examination. For each of the sections listed below, you will be required to do the following: a. Case History—Perform a brief focused case history.

b. Orthopedic/Neurological—Perform a brief focused Orthopedic/Neurological examination.
c. Physical Examination—Perform a brief focused physical examination.

5. At each station you will be required to perform/choose one or more of the following:
a. Choose the most likely diagnosis and/or clinical impression.
b. Choose the most appropriate case management procedure.
c. Choose the neurological signs most likely to be present. 6. You will have the opportunity to perform the examinations on a patient who has been trained to simulate a clinical condition. There will be an observing doctor of chiropractic in the same room grading your performance.

7. Some stations will require you to interact with the observing doctor and the notation (verbal component) will be written next to the listed examination(s). When you see verbal component written, your job will be to perform and explain the procedure on the patient, and report your findings to the observing doctor.

8. In the post-stations, there will be two sections (A and B), and you will be required to select three of the “best” answers from each section related to the case presented in the pre-station. Additional clinical data regarding the patient will be provided in all of the post stations.

III. Chiropractic Technique


1. Consists of 5 stations. You will have 5 minutes to fully complete each station.

2. At each technique station, you will be given listings/subluxations from the following regions of the body: two cervical, two thoracic, two lumbar, two pelvic and two extremity. The instructions will state the type of set-up you would need to perform for each of the listings/subluxations. Patient position, doctor hand contact, and segmental contact will always be provided.

3. You will be required to “set-up” for each of these listings/subluxations. This means you will not and should not attempt to adjust the patient at any time during the examination ( You are only required to "set-up" on the patient).

4. At times, you may also be required to show static and or motion palpation techniques and to describe joint-related anatomical landmarks. For example: If a listing requires you to set-up on the C7 spinous process, the observing doctor may ask you to explain how you found the C7 spinous process.

5. You will be evaluated by an observing doctor (licensed chiropractor).