The Breakdown of the Case Questions of NPLEX 2

Another common question I get is how NPLEX 2 exam questions are like. It’s a really good question and may seem daunting when one looks at practice questions NABNE posts in their outline, but it’s really straight forward as I will explain below.

NPLEX2 has a specific format that they will never deviate from. Each case (26 on average per day) contains 5 questions, and in those 5 questions has a set way of NABNE figuring out if you’re a good shooter or not. The case history will have all the pertinent information on chief complaint, diet and lifestyle, physical exam data, lab data (ie CBC, X-ray reports), allergies, medications the patient is on, and any other relevant information. All the information given is fair, they are not here to trick you. The goal is make sure you’re competent in reading basic patient data and figuring out quickly what’s going on.

So, let’s move on to the 5 multiple choice questions for each case:

1) The first question will always be a diagnosis question. So you have to be able to diagnose based on the key clinical features of the pathologies. It’s not hard if you study it well. Come unprepared and then you will shoot way off target and that will set a bad precedent and draw unwanted attention from NABNE. The goal is to try and get the diagnosis right for the majority of the questions. If you can get the right diagnosis, you’re already on the right track. They’re here to see if you’re paying attention to detail and focus.

2) The second question is often a lab diagnostic question. Would you perform MRI, CT, echocardiogram, or ultrasound? If the case says the patient has some metal implants or shrapnel imbedded, you want to avoid MRI, so pay attention to the case notes. Or it could ask you, based on your diagnosis, what would you expect to see on the CBC bloodwork? Study hematology well like the differences between AML, CML, ALL and AML. Or, what would you see on the ECG for cadiology? Or, what orthopedic test would you do to confirm? The lab section is not hard, it’s just you being competent enough to understand what you’re supposed to look for in each pathology. All pathologies for the lab questions are usually clear cut with little ambiguity. When you’re seeing real live patients, you have to know what to do to confirm the diagnosis. Lives depend on it.

3) The third question is often a pharmaceutical question. Typically if you have the diagnosis right, they’d ask you what pharmaceutical would you prescribe to treat the condition? You have to be able to think like our MD counterparts, because it will save lives when it comes down to it. NABNE could ask what are the interesting side effects of the drug that the patient is taking? Sometimes (rarely) they’ll ask you what are the pharmacological class of the drug. Knowing all 183 pharmaceutical drugs is a lot, so study it well. It’s quite clearly laid out in ‘Core Knowledge for NPLEX 2’ based on organ system for easy access.

Or they could ask a emergency medicine question here. Know the dosages and injection sites of epinephrine as this is a important aspect of saving lives when it comes down to it. Emergency medicine is equally emphasized as pharmaceuticals. We have to be able to save life and aid the injured, so be very competent in this area.

4) The fourth question is usually either a botanical medicine or homeopathic question (majority being the botanicals). Study these agents well. It takes time and patience to understand them. Review daily on them on however many you find comfortable. Botanicals can get a little confusing when they start asking you about interactions with medications. Usually this is common sense. In the history of knowing a lot of people who wrote NPLEX 2, nobody has ever failed the botanical medicine section. But that doesn’t mean you don’t have to study it. It’s a lot to cover. Homeopathy is challenging so make sure to review that daily. I find that if it’s neglected, the minute details will get lost, especially polycrest remedies.

5) The fifth question could be a basic psychology, nutrition (diets and supplements) or a physical medicine question. Often this entire section gets neglected from study. Usually some people fail the physical medicine section. Knowing stretching techniques, muscle energy testing; therapeutic machines and its indications and contraindications. It contains a lot of detail that requires time to look over. Do not neglect the physical medicine section.

So this is the entire overview of NPLEX 2 and hopefully I’ve shown you that it’s completely manageable and not some shock when you get to the exam site. It’s a lot to cover and balance in its entirety. But I have high hopes you will succeed if you cover all the sections mentioned above. Everyone who knows this basic setup of how NABNE tests ND candidates are more focused in goal-setting and being action oriented individuals into calmly shooting down NPLEX 2 and walking out of the exam knowing they passed with a high degree of certainty. If you have any questions, feel free to ask below or send us a message and I’ll see how I can assist.

Vincent Lun