Patient presents to chiropractor with low back pain. Participant reviews intake paper work. Participant then completes a history of present illness (HPI) regarding the patient’s chief complaint. Initially, the participant must use the patient’s intake paperwork and HPI to provide three appropriate differential diagnoses. In subsequent states, the participant must perform vitals, select appropriate examination procedures, and interpret the findings. Using this information, the participant must make an accurate diagnosis, and determine if imaging or referral are indicated. Finally, the case will proceed to a de-briefing where the participant can review key aspects of this case and clinical reasoning to enhance future performance.