Use this as a preview, not a simulation or full syllabus. The 2026 NPLEX Part II blueprint lists Minor Surgery and Acupuncture as separate 75-question multiple-choice electives with separate cut scores; it gives 90 minutes per elective, while the 2025 version gives 2 hours, so timing depends on the source version. NABNE administers NPLEX for licensure/registration in the U.S., U.S. Territories, and Canada, but eligibility and administration rules must be checked in the current NABNE Examinee Handbook, which is not provided here. The acupuncture material covers Zang-Fu diagnosis, technique, and safety but not full point-prescription training; the Minor Surgery elective is listed without its detailed competency list, so any minor-surgery-adjacent content is subject review and general safety reasoning, not a verified current minor-surgery blueprint, and the four biomedical topics are supporting knowledge rather than official elective weightings, with no official weighting beyond the text, pass mark, or fee asserted. The 20 items are a supporting-knowledge check, not a simulation. Each item's correctAnswer index is its key, and each explanation gives the reasoning. Use the open-task and rubric for performance practice.
Credential identity and tested skills
The electives test minimal competence in additional practice areas; prepare mechanisms, safety, and interpretation rather than isolated labels.
NPLEX, Inc. is an independent nonprofit that prepares board-level licensing exams for naturopathic medicine in the U.S., U.S. Territories, and Canada. NABNE administers the exams and sets policies. The supplied blueprint states that Part II Clinical Science Examinations measure readiness to practice, while Part II Elective Examinations assess minimal competence in additional areas that may not be addressed on the core examination. The two electives named in this package are Minor Surgery and Acupuncture.
The supplied 2026 excerpt states that each elective has 75 multiple-choice questions and a separate cut score; the 2025 excerpt states 2 hours per elective, while the 2026 excerpt states 90 minutes. Because these are versioned source statements, confirm current administration details. The acupuncture excerpt lists diagnosis through pulse, tongue, appearance, and the Ten Questions; technique in needling, moxibustion, electroacupuncture, acupressure, and cupping; and safety including universal precautions, needle handling, contraindications, complications, and urgent referral. Minor Surgery appears in the table of contents, but its detailed competency list is not in the supplied excerpt.
Treat the four topics—structure/function, biochemistry/physiology/genetics, microbiology/immunology, and pathology—as supporting science for safe clinical decisions. They are not evidence of an official elective weighting. Expect questions that ask you to apply a mechanism to a short scenario, not merely recall a name.
Scope boundaries and jurisdiction
This is a preview with review flags; do not treat it as the full blueprint or a jurisdiction-specific licensure rule.
Jurisdiction matters. NPLEX results may be used by agencies that regulate naturopathic medicine in the U.S., U.S. Territories, and Canada, but licensure/registration requirements differ. This preview does not provide eligibility, fees, deadlines, or jurisdiction-specific practice rules, so consult the current NABNE Examinee Handbook and the relevant regulator.
Keep these limits in mind: the blueprint does not give the Minor Surgery competency list, current pass marks, or any fixed percentage weight for the four topics. Acupuncture point prescriptions and needling depths are not fully covered here; this preview teaches safety principles and mechanism-based reasoning. The MCQ sample is a written supporting-knowledge check, not a practical simulation, and it does not claim audio, images, or workbooks.
Priority map
Prioritize high-yield mechanisms that change clinical interpretation or safety decisions.
First-pass priorities: (1) localize upper-limb nerve deficits using motor and sensory patterns; (2) connect shoulder abduction phases to rotator cuff and deltoid mechanics; (3) know diaphragm innervation and proximal nephron function; (4) use rate-limiting enzymes, insulin/GLUT4, Mendelian risks, and vitamin K-dependent carboxylation as metabolic anchors; (5) apply Gram-stain, MHC, IgE/mast-cell, and toxin mechanisms; (6) distinguish reversible injury from necrosis, identify acute-inflammation steps, explain foam-cell formation, and separate carcinoma from sarcoma metastatic patterns.
For the acupuncture elective, prioritize safety over point trivia: universal precautions, clean-needle technique, sharps disposal, contraindications, recognition of pneumothorax and other complications, post-treatment infection/hematoma education, and referral thresholds. For Minor Surgery, until the current detailed competencies are verified, use general sterile-field, wound-assessment, and red-flag reasoning only as subject review. Spend more time on mechanisms that explain why a finding occurs than on isolated lists.
Worked scenario: upper limb, shoulder, diaphragm, kidney
Pattern recognition works best when you link anatomy to the first failing function.
A patient has wrist drop and numbness over the dorsal first web space after a midshaft humeral fracture. The radial nerve runs in the spiral groove; it supplies wrist extensors and that sensory patch. Median nerve compression at the carpal tunnel would more often cause nocturnal palmar thumb/index/middle numbness and thenar weakness, not wrist drop. Ulnar neuropathy at the cubital tunnel affects intrinsic hand muscles and the ring/pinky distribution. Musculocutaneous injury affects elbow flexion and lateral forearm sensation.
For shoulder abduction, supraspinatus initiates the first 15 degrees and the deltoid becomes dominant thereafter, with scapular rotation contributing. The diaphragm is innervated by C3-C5 via the phrenic nerve. In the kidney, the proximal convoluted tubule has a brush border and high metabolic capacity and reabsorbs the largest fraction of filtered sodium and water. A useful exam habit is to write one sentence for each structure: if this fails, the patient cannot do a specific movement, and sensation changes in a specific territory.
Worked scenario: glycolysis, insulin, pedigree, vitamin K
Metabolic and genetic questions usually test a control point, a transport step, or a modification.
In a hepatocyte with high ATP and citrate, phosphofructokinase-1 is inhibited, slowing the rate-limiting step of glycolysis. AMP and fructose-2,6-bisphosphate relieve that inhibition. Insulin lowers postprandial glucose partly by signaling GLUT4 to the surface of skeletal muscle and adipose cells; impaired insulin-stimulated GLUT4 translocation explains postprandial hyperglycemia with relatively normal fasting glucose.
For two unaffected carriers of an autosomal recessive condition, each pregnancy has a 1/4 chance of an affected child, a 2/4 chance of an unaffected carrier, and a 1/4 chance of an unaffected non-carrier; prior children do not change the next probability. Vitamin K is required for gamma-carboxylation of glutamate residues in factors II, VII, IX, and X. Warfarin reduces vitamin K recycling, so functional vitamin K-dependent factors fall and PT prolongs. This is mechanism teaching, not a dosing recommendation.
Worked scenario: microbiology and immunity
Use a stepwise lab algorithm and separate antigen-presentation pathways from effector responses.
Gram-positive cocci in clusters that are catalase-positive and coagulase-positive point to Staphylococcus aureus. Streptococcus pyogenes is gram-positive in chains, catalase-negative, and beta-hemolytic; Staphylococcus epidermidis is coagulase-negative; Enterococcus is typically in pairs/chains and has different biochemical patterns.
Viral peptides made inside a cell are presented by MHC class I to CD8+ cytotoxic T cells; extracellular peptides are presented by MHC class II to CD4+ helper T cells. Immediate type I hypersensitivity involves IgE cross-linking mast cells and histamine release, producing vasodilation, edema, and bronchoconstriction. Tetanospasmin blocks release of inhibitory GABA/glycine from interneurons, causing spastic paralysis; botulinum toxin blocks acetylcholine release at the neuromuscular junction, causing flaccid paralysis. Learn the site of action, not just the organism.
Worked scenario: injury, inflammation, atheroma, neoplasia
Distinguish reversible stress from irreversible death, then place cells in the correct sequence.
ATP depletion impairs the Na+/K+ ATPase, causing cellular swelling; this is reversible if the insult is removed. Loss of plasma membrane integrity, massive enzyme leak, and nuclear breakdown indicate irreversible injury/necrosis. In acute inflammation, selectins mediate rolling, integrins mediate firm adhesion, and chemotaxis follows transmigration.
Early atherogenesis begins with endothelial injury and LDL entry. Oxidized LDL is taken up by monocyte-derived macrophages, which become foam cells. Carcinomas as a group more often spread first through lymphatics, whereas sarcomas more often spread hematogenously. Apoptosis is caspase-driven and generally non-inflammatory; necrosis often releases contents and provokes inflammation. These distinctions support biopsy interpretation and complication reasoning.
Safety reasoning: acupuncture and minor-surgery-adjacent practice
Stop, assess, and refer when a complication could be urgent; document teaching and follow-up.
Acupuncture safety questions should be answered with universal precautions, clean-needle technique, immediate sharps disposal without recapping, and respect for contraindications. For a patient with a supratherapeutic INR or other significant bleeding risk, elective needling should be deferred and coordinated with the prescriber; deep needling is not a shortcut. After upper-back or chest needling, sudden dyspnea and chest pain suggest possible pneumothorax and require urgent emergency evaluation, not observation at home.
Post-treatment education should mention that mild temporary bruising can occur, but expanding swelling, fever, spreading redness, or worsening pain should prompt assessment. For minor-surgery-adjacent scenarios, use general subject-review reasoning: sterile technique, careful wound/lesion assessment, and referral for red flags such as exposed deep structures, uncontrolled bleeding, or signs of infection. The supplied excerpt does not verify a detailed Minor Surgery procedure list, so do not treat these as official procedural rules.
Integrated practice task and self-check rubric
Use one case to rehearse localization, mechanism, safety, and communication in sequence.
Open-task practice (25 minutes): A 58-year-old with type 2 diabetes and hypertension requests acupuncture for chronic shoulder pain. They take warfarin, and a recent INR was above the therapeutic range. They also report a 3-week history of night pain and unintentional weight loss. Task: (a) list two urgent red flags; (b) state whether elective needling should proceed, defer, or be modified, and why; (c) explain one shoulder-abduction mechanism relevant to the exam; (d) write a one-sentence referral/coordination note. Do not provide an invasive procedure or dosing recipe.
Self-check rubric (1 point each): 1. Urgent flags identified (night pain/weight loss and supratherapeutic anticoagulation). 2. Safe disposition with coordination/deferral rather than proceeding. 3. Correct mechanism (e.g., supraspinatus initiates early abduction; deltoid dominates later). 4. Clear communication/documentation. 5. No unsupported claim about official pass marks or current procedure rules. If you miss a safety point, review the complication and referral sections before drilling more facts. The MCQ set below checks supporting knowledge; it is not a simulation of the elective.
Practical study sequence
Use short cycles of retrieval, error analysis, and applied writing.
Weeks 1-2: study anatomy and physiology in 30-minute blocks, then close the book and draw the brachial plexus, shoulder abduction phases, diaphragm innervation, and nephron. Weeks 2-3: pair biochemistry/genetics with one worked pedigree and one enzyme-control scenario; then microbiology/immunology with a Gram-stain algorithm, MHC comparison, and toxin table. Weeks 3-4: pathology through four contrasts—reversible vs irreversible injury, rolling vs adhesion, foam cell formation, carcinoma vs sarcoma—and apoptosis vs necrosis.
Add safety every other day: list contraindications, sharps rules, and urgent complications from memory. Use the 20 questions as a diagnostic, not a score to brag about; log each error as knowledge gap, misread, or unsafe shortcut. Rehearse the integrated task aloud, then write a five-line note. Final week: mixed 15-question sets, review explanations, and confirm current format and policies from the latest NABNE materials. No study sequence can guarantee a pass.
References and further reading
Use these references to explore the concepts and check the latest information from the relevant organizations.