Part IV Test Plans

There are two sections in the ‘updated’ version of the Part IV Exam – Chiropractic Technique and Case Management with Post-Encounter Probe (PEP) Stations.

Chiropractic Technique

You will be given two adjustment listings in each of the five areas listed below, for a total of 10 techniques. From the information provided in the case scenario, you will demonstrate patient placement, doctor placement, hand placement, procedure and the line of drive for the following regions;

  • Cervical adjusting
  • Thoracic adjusting
  • Lumbar adjusting
  • Pelvic/sacral adjusting
  • Extremity adjusting
    Case Management - Simulated Patient Encounters

    There will be 10 patient stations which are divided as follows:

    4 – Orthopedic and neurologic examinations
    5 – Case history taking
    1 – Physical examination

    You will address cases that:

    1. Are commonly encountered in practice
    2. Present cautions or contra-indications to chiropractic case management
    3. Require early referral to preserve the life/health of the patient
    4. Present significant diagnostic challenges

    Each interaction between the case management examinee and the standardized patient is followed by a post-encounter probe (PEP) station. 


    At the PEP station immediately following the simulated patient stations, you are presented with a binder that contains additional clinical information, such as physical findings and laboratory results.

    At the PEP stations, you will complete two multiple-choice questions based on your interactions with the standardized patients in the previous stations and on the additional clinical information presented. Each multiple-choice question will have 8 choices. You will be required to select three of the most correct answers for each question.

    The third section for Diagnostic Imaging (DIM), is included only in the ‘original’ version of the Part IV Exam. You will automatically be assigned the correct version of the Part IV Exam you are eligible for when you apply.

    Diagnostic Imaging (DIM)

    You will answer two multiple-choice questions related to the condition at each of the 20 stations you visit. A test committee will have selected the conditions according to the following criteria:

    1. Conditions that are commonly encountered in practice
    2. Conditions that present cautions or contraindications to chiropractic case management
    3. Conditions that require early detection to preserve life/health of the patient


    • Congenital anomalies and skeletal variants
    • Scoliosis
    • Spondylolysis and spondylolisthesis
    • Intervertebral disc disease and spinal stenosis
    • Traumatic skeletal disorders (spine and extremities)
    • Arthritic disorders (spine and extremities)
    • Tumors and tumor-like processes (spine and extremities)
    • Hematological and vascular conditions
    • Bone infections and miscellaneous conditions

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