CAGEN

Study Guide:


Chiropractic Neurology Board Examination Study Guide:
The following guide will assist you in preparing for the Board Examination of the ACNB. The examination is divided into two main sections (written and practical).

Written:

The written examination is a twelve hour examination based on twelve domains of the neuraxis at eight percent (8%) of the examination falling to each of the domains with the additional four percent (4%) of the examination referencing ethics and techniques (see Blueprint). Within each domain a series of objectives guide the format for the test.). The Topics list further refines each domain (see Topics). Just over five percent (5.11%) of the questions relate to general knowledge in the domain area. The majority of the remaining questions will be case related. All cases will use the Case Template (see Case Template). Please refer to the Blueprint for the objectives and the percentages attached to each objective. The References are those used in the educational process you have just completed (See References). Tools and Modalities list the tools and testing/treatment modalities that the candidate is expected to know how to use (See Tools & Modalities). All questions are in a multiple-choice format.

Practical:

Candidates sitting the practical examination are assigned a specific examination period based upon the order in which they applied to take the examination and upon the retake status of the candidate.  The candidate is informed as to the time of his/her particular time segment and told where to report to await the examination.  The practical examination is divided into AM and PM segments with the candidates waiting their turns in a quiet room called a holding tank.  They may have personal materials but no electronic equipment with them in the holding tank and must leave all materials there when the escort arrives to take them to the practical examination room.

The practical is a simulation of patient interaction in a clinical setting. The practical is videotaped for review. The candidate is instructed to ignore the videotaping.  Many candidates find it helpful to practice doing procedures in front of a camera or recorder in order to feel more relaxed during the examination. The videotaping is necessary for examination documentation, review, etc. Candidates are randomly assigned to an examination room.
Upon entering the examining room, the candidate finds a “patient", two board examiners, and a trained video photographer, as well as all necessary examination tools.
The candidate is allowed eight (8) minutes to take a complete case history, thirty (30) minutes to perform a physical/neurological head to toe examination, ten (10) minutes to perform five (5) provocative neurological and/or orthopedic tests,  and thirty (30) minutes to view and answer questions on fifteen (15) video simulation clips. The candidate is scored on the completeness of the history, accuracy and completeness of the physical examination, accuracy and completeness of the special tests performance and accuracy and completeness of answering questions regarding the video clips. The history includes but is not limited to:

  • Present health care status and complaint
  • Past history
  • Family history-first & second degree relatives
  • Social history
  • Review of systems

The candidate addresses all questions to the patient, speaking loudly enough to allow both the examiners and the camera to “hear” your questions and the answers. Each candidate is graded on the completeness of the history and the ability to ask questions that provide leads toward a diagnosis and uncover pertinent information. The candidate then performs a complete physical examination and is graded on the completeness of the examination and the accuracy in the psychomotor skills performed. The candidate states aloud what he/she is examining. For example: candidate performs the sensory pen wheel exam for trigeminal nerve and states “trigeminal nerve sensory test using pen wheel”; candidate performs popliteal reflex and states “popliteal reflex text of nerve root S1 using a reflex hammer at the patellar-tibial (popliteal fossa) junction eliciting a reflex arc”.
It is advised that candidates conduct a comprehensive head-to-toes physical examination including but not limited to:

  • Vital signs
  • Sensory evaluation
  • Motor evaluation
  • Cranial nerve evaluation
  • Palpatory or provocative (orthopedic/chiropractic type) testing
  • Cardiovascular and visceral evaluation
  • Other neurological evaluation (balance testing, optokinetic etc.)

All physical examinations are performed on the patient to demonstrate the psychomotor skills involved.

At the conclusion of the physical examination, the candidate will be asked to perform five (5) special tests.  These include optokinetics, vestibular, orthopedic and other routine tests normally used by the chiropractic neurologist.  The candidate needs to know the proper procedure, the rationale for doing the test, and the implications of the findings.
Once that portion of the examination is completed, the candidate proceeds to a simulation examination where he/she is randomly assigned a set of video clips to view and respond to the questions regarding the findings. These clips will be of physical examination findings such as eye movements, gait, reflexes, blind spots, etc. At the conclusion of the clips, the candidate reviews the written notes may ask for one or more to be repeated. Only verbal answers will be scored. The written response is for the candidate’s use in asking for a repeat only. Candidates will not take any materials away from the exam.  This portion of the examination is allotted thirty (30) minutes (see Practical Blueprint )

In Conclusion:
The candidate should be able to demonstrate competency in obtaining a case history, obtaining complete physical findings, performing special tests and accurately identifying physical findings on video clip.

Candidates should review the Case History Form sample for examples of what type of information would be require of the candidate in his/her reporting. At the time of the examination the candidate will be given only a blank piece of paper and will not be allowed to refer to a chart or a series of questions. Familiarization with the flow sheet provided might be of assistance to the Candidate.