ROR Flashcards by Giselle Celine Cerrillo

Your 48 year old cook has been complaining of shoulder pain for the past 6 months. She decided
to consult a doctor since the pain is increasing in intensity. There is no history of trauma.

If this pain is due to a rotator cuff tendinitis which will you note on PE?
A. Presence of taut bands on the lateral portion of the proximal aspect of the arm
B. Pain radiating to the lateral epicondyle with extension of the shoulder
C. Pain is increased as patient resists the force applied while she lifts the affected arm in slight
abduction
D. Range of motion in all planes is limited

C
With taut bands think MPS, lateral epicondyle = tennis elbow, limited ROM in all planes adhesive
capsulitis.

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After passively extending the humerus by lifting the elbow posteriorly, which among the
following rotator cuff muscles is directly under the acromion?
A. Supraspinatus
B. Infraspinatus
C. Teres minor
D. Subscapularis

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if the patient happens to have a pathology to the coracoid process of the scapula, which of the
following would be relatively weak because of the pain?
A. Shoulder abductors
B. Shoulder flexors
C. Shoulder extensors
D. Shoulder external rotators

B
Since the coracobrachialis and short head of the biceps brachii attach to the coracoid process,
muscles responsible for shoulder flexion

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Which particular test will you order if you are suspecting a rotator cuff tendinitis?
A. X-ray of the shoulder
B. CT scan
C. DEXA (dual energy x-ray absorptiometry)
D. Diagnostic musculoskeletal ultrasound

You’d want the modality that can best visualize soft-tissue.

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Which particular medication will you prescribe the patient if in the history you elicit that she has
a kidney disease?
A. Diclofenac
B. Iburpofen
C. Tramadol
D. Naproxen

C
Medyo testmanship since tramadol is the only non-NSAID. Also, it is eliminated thru metabolism
in the liver.

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In the evaluation of shoulder pain, which of the following historical data would be important to
establish?
A. Occupational hazards
B. Smoking
C. Family history of arthritis
D. Exposure to chemicals

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A 47 year old female programmer has been complaining of neck pain for the past 5 years. She
tells you that there is also numbness of the digits of her left hand.

Upon examination, you note that there is impaired sensation on the tip of the ring and little
finger as well as weakness of grip strength. If you are suspecting a left cervical radiculopathy,
which particular nerve roots may be involved?
A. C4, C5
B. C5, C6
C. C7, C8
D. C8, T1

D
You can figure out based on the pattern of the impaired sensation that there is ulnar nerve
involvement. The roots of the ulnar nerve are C8T1.

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Which of the following is true with regard to cervical radiculopathy?
A. It often manifests with a positive ten second test
B. It is most often caused by tumors
C. It is an upper motor neuron lesion
D. It is provoked by Spurlings test

Spurlings is indicated exactly for determining the presence of cervical radiculopathy

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How does one perform the Spurlings test? Tell the patient to
A. Flex the neck and rotate it
B. Laterally flex the neck
C. Extend and laterally rotate the neck
D. Extend the neck

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You order an x-ray which reveals presence of foraminal stenosis of C6C7 and C7T1. Which
particular nerve roots will be affected?
A. C5, C6, C7, and T1
B. C5, C6, C7, C8
C. C6, C7, C7
D. C7, C8

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Which among these tests will be helpful in determining the nerve root/s affected?
A. CT scan
B. Electrodiagnostic test
C. Ultrasonography
D. Functional MRI

B
EMG-NCV, in other words, which is the modality of choice in determining nerve conduction
pathologies.

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If a patient with cervical radiculopathy tells you that she has trouble sleeping because of the
nagging pain and numbness, which drug will be most useful?
A. Baclofen
B. Naproxen
C. Paracetamol
D. Gabapentin

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This is a weak opioid drug used for pain and one of its side effect is dizziness.
A. Carbamazepine
B. Tizanidine
C. Ketoprofen
D. Tramadol

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A 52 year old homemaker complains of wrist pain on ulnar deviation. There is tenderness on the
radial aspect of the wrist.

Which maneuver will help you diagnose De Quervains tenosynovitis?
A. Radially deviate the wrist
B. Ulnarly deviate the wrist
C. Flex the wrist and apply resistance
D. Extend the wrist and apply resistance

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Which of the tendons are affected in De Quervains tenosynovitis?
A. Abductor pollicis longus
B. Abductor pollicis brevis
C. Adductor pollicis
D. Extensor pollicis longus

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YD, a 31 year old actress, consults you because she has been suffering from low back pain of 5
days duration. Upon further history taking, you did NOT note any red flag sign nor any history of
trauma

What is the most appropriate way of managing this particular patient?
A. Request for a lumbosacral spine x-ray in supine position
B. Request for lumbosacral spine upright
C. Do MRI of the lumbosacral spine
D. NOTA

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Which of the following is NOT considered as a red flag sign in patients complaining of low
back pain?
A. Incontinence
B. Paralumbar spasm
C. Febrile episodes
D. Weight loss

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Which of the following medications for acute low back pain is LEAST effective according to
the ACP guidelines?
A. Paracetamol
B. Diclofenac
C. Tramadol
D. Oral prednisone

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If this patient develops numbness over the sole of the right foot and on examination ankle
reflex on the right is absent, you will suspect the following nerve root to be affected
A. L4
B. L5
C. S1
D. S2

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MJ is a basketball superstar. He accidentally twisted his left knee upon rebounding, causing
immediate pain and tenderness. On examination the knee joint was swollen

If an audible click was demonstrated upon flexion and extension of the knee joint while
rotating the lower leg from the heel, this test will help you check for involvement of the
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial collateral ligament
D. Meniscus

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Which of the following is an external rotator of the knee?
A. Sartorius
B. Gracilis
C. Semitendinosus
D. Biceps femoris

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With the hip and knee flexed to 90 degrees, the tibia is pulled forward. You compare the
results of this maneuver also on the opposite extremity. Which structure is being assessed by the
test described?
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial collateral ligament
D. Tensor fascia latae

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TW is a semi-pro golfer who complains of elbow pain. She claims that pain is localized and is
primarily elicited by resisted wrist extension. This is an enthesistis of the epicondyle.

What is your impression?
A. Golfer’s elbow
B. Tennis elbow
C. Panner’s elbow
D. Shooter’s elbow

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Which muscle is affected in a patient with Golfer’s elbow?
A. Brachioradialis
B. Flexor carpi radialis
C. Flexor pollicis longus
D. Flexor digitorum profundus

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Your 65 year old aunt who is an accountant complains of numbness on the left wrist and hand. Numbness is described as affecting the radial 3 digits. ``` If the pathology is on the wrist, what nerve is affected? A. Posterior interosseus nerve B. Median nerve C. Ulnar nerve D. Musculocutaneous nerve ```

``` If you ask this patient to put both wrists in palmar flexion, numbness to the thumb and index finger is elicited. This is a positive A. Prayer tests B. Tinel’s test C. Phalen’s test D. Finkelstein’s test ```

``` Which particular examination will help clinch the diagnosis? A. Nerve conduction studies B. X-ray of the hand and wrist C. Bone scan D. CT scan of the hand ```

A 31 year old male sees you in the clinic because of back pain of several years duration. On gross examination you note that trunk mobility is limited. You do another maneuver called the Schober’s test which turns out positive. Which of the following statement is true about this test? A. The test shows limited mobility if the distance between the 2 points is less than 5 cm upon extension B. The test shows limited mobility if the distance between the 2 points is less than 5 cm upon flexion C. The ASIS is used as a landmark for the horizontal line D. The PSIS is used as a landmark for the horizontal line

D Limited mobility is the distance between the 2 points is less than 4 cm upon flexion. The PSIS is the landmark used for the horizontal line.

If your primary working impression in this case is ankylosing spondylitis, which among the following will be the least helpful in diagnosing this condition? A. Adam’s test B. Schober’s test C. Checking chest expansion D. FABERE test

A | Used for scoliosis, not AS

Due to the presence of the decrease in trunk mobility you decide to order for lumbosacral xrays that showed a classic bamboo spine appearance. In which particular view of the xray will the bamboo spine be best appreciated? A. Lumber spine AP B. Lumbar spine lateral C. Lumbar spine oblique D. Judet views

You request other laboratory tests and other imaging studies of the lumbar spine and pelvis which were highly suggestive of sacroillitis. What is the minimum number of (SPa) spondyloarthritis features needed to fulfill the ASAS criteria for axial spondyloarthritis? A. 1 B. 2 C. 3 D. 4

A 67/F had been complaining of bilateral knee pains and difficulty in ambulation for 6 months. This patient who has a BMI of 28 complains of pain especially after standing up from a prolonged sitting position. On PE, both knees appear enlarged. There is no joint swelling, tenderness,, nor erythema. Presence of crepitus is noted on active motion of the knees. You also note the presence of a varus deformity of both legs. ``` Which of the following conditions is this patient suffering from? A. Gouty arthritis B. Osteoarthritis C. Rheumatoid arthritis D. Reactive arthritis ```

``` Which compartment of the knee joint is most likely affected? A. Lateral compartment B. Medial compartment C. Posterior compartment D. Patellofemoral compartment ```

``` Which particular special test will you do if the patient has a concomitant meniscal tear? A. Anterior drawers test B. Posterior drawers test C. McMurray’s test D. Faberes test ```

Which drug is recommended for this patient who also has GERD and hypertension if the pain level most of the time is moderate to severe with a numerical rating score from 7 to 8? A. Paracetamol B. Naproxen C. Celecoxib D. Tramadol

``` The non-pharmacologic management for this condition is A. Using a R-sided cane B. Stair climbing exercises C. Jogging exercises D. Use of a walker ```

A 45 year old female consults for arthritis of the hands, elbows, and shoulders of 2 months duration and recently has ankle swelling as well. She has difficulty walking and has stiffness of joints almost the whole day and is feverish and weak. Which of the manifestations point to an inflammatory arthritis? A. Chronic presentation B. Lower extremity joint involvement C. Morning stiffness D. Arthritis of the upper extremity joints

``` Which of the following polyarticular arthritis is positive for anti-s1RNP in 100% of cases? A. SLE B. Mixed connective tissue disease C. Sjogren’s syndrome D. RA ```

``` Which polyarticular inflammatory arthritis will have absent or minimal systemic involvement? A. Rheumatoid arthritis B. SLE C. Scleroderma D. Psoriatic arthritis ```

``` In the setting of early inflammatory polyarthritis, which of the following tests can distinguish RA from other arthritides? A. ANA B. Rheumatoid factor C. Anti-EBV D. Anti-CCP ```

D | RF is sensitive but not specific.

A 42 year old businessman consults for severe pain and swelling of the big toe of 2 days duration. This has developed overnight after an alcohol binge with friends. There was fever on the first day, and he took paracetamol and diclofenac with some relief of symptoms. However, the pain in the big toe was still intolerable. He remembers a similar arthritis 2 years back, lasting 2 days with intake of diclofenac. ``` Which other joint is commonly affected by acute gouty arthritis? A. Shoulder B. Knees C. Sacroiliac joints D. Wrists ```

In the treatment of gout, which of the following drugs prevents acute gouty attacks by inhibiting chemotaxis of granulocytes to the site of uric acid crystals deposits? A. COX inhibitors B. Colchicine C. Prednisone D. Febuxostat

``` Which of the following conditions is the possible cause of anemia in this gout patient? A. CKD B. Acute liver disease C. GI bleeding D. Hemolysis ```

``` Based on the pathophysiology of hyperuricemia, which is the drug of choice to lower blood urate levels? A. Colchicine B. Indomethacin C. Allopurinol D. Probenecid ```

Which of the following presenting manifestations is common in gouty arthritis? A. Arthritis of the ankle and heel after a bout of sexually transmitted disease B. Chronic knee pain, aggravated by long walks C. Acute low back pain, more severe in the morning on waking up D. Acute monoarthritis involving the first MTP

``` Which of the following non-pharmacologic prescriptions should you give an obese gout patient? A. Stop smoking B. Avoid eating legumes C. Weight loss D. Regular exercise / sports ```

``` Which among the following non-phmarcologic agents can be given in patients with acute gout? A. Hot moist pack B. Shockwave therapy C. Ultrasound D. Ice pack ```

``` Which of the following medications would you remove or modify since it could lead to more frequent and prolonged gouty attacks? A. Simvastatin B. Hydrochlorothiazide C. Digoxin D. Dypiridamole ```

A 15 year old female is brought by her mother to your clinic because of noticeable shoulder asymmetry ``` Which of the following is a screening test for scoliosis? A. Schober’s test B. Adam’s test C. Hawkin’s test D. Cozen’s test ```

Which of the following is true regarding scoliosis? A. Most are congenital B. The most commonly affected are pre-teen girls C. Most would have neurologic deficits D. A brace has not been shown to be effective

78 y/o former cashier consults your clinic with a waddling gait. She tells you that she has pain on both hips radiating to the knees. PE reveals limited ROM and tenderness in the hip area. ``` Given this condition, what is needed to clinch a diagnosis of avascular necrosis? A. Hx of pesticide exposure B. Hx of prednisone intake C. Hx of DM T2 D. Hx of Gouty arthritis ```

``` Ficat classification with crescent sign A. 1 B. 2 C. 3 D. 4 ```

``` Which particular muscle is likely weak in a patient with waddling gait? A. Semitendinosus B. Gluteus maximus C. Gluteus minimus D. Gluteus medius ```

``` Test for hip problem? A. Patrick’s Test B. straight leg raise C. McMurray’s D. Schober’s ```

``` Positive Trendelenburg on the R implies weakness of? A. Right gluteus maximus B. Left gluteus maximus C. Right gluteus medius D. Left gluteus medius ```

(vague according to Sir, C or D)

38 y/o female dentist consults you for pain of the upper and lower back. She complains that she has difficulty sleeping at night and feels tired most of the time. ``` What is your diagnosis? A. Myofascial Pain Syndrome B. Malingering C. Fibromyalgia D. Polymyalgia rheumatica ```

``` Which of the following advice is least helpful? A. Get enough sleep B. Relaxation Training C. Avoid changes in diet D. Tell her to join weekend marations ```

``` These medications are useful in the treatment of fibromyalgia except? A. Fluoxetine B. Amitryptiline C. Trazodone D. Tramadol ```

``` Low back pain considered as surgical emergency A. Grade 1 spondylolisthesis B. Cauda equina syndrome C. Sacroilietis D. Osteoporosis ```

The patient suddenly developed weakness of the big toe extensor and an absence of the ankle reflex. Which nerve roots are affected? A. L4L5 B. L2L3 C. L5S1 D. L3L4

``` Which of the following is true regarding lumbar radiculopathy? A. SLR is highly specific B. Crossed SLR is highly sensitive C. It is a diagnosis of exclusion D. It is a clinical diagnosis ```

25 y/o security guard complains of LBP of 5 days duration. No red flags were noted in history and PE What is the appropriate management of this patient? A. Request for lumbosacral spine Xray in supine B. Request for lumbosacral spine Xray upright C. MRI of the lumbosacral spine D. None

``` This patient underwent MRI which revealed spondylolysis. Which view would show the Scotty dog sign? A. Lumbosacral AP B. Lumbosacral Standing C. Lumbosacral lateral D. Lumbosacral Oblique ```

Which of the following interventions has been shown to provide moderate benefit with good level of evidence (Panel B recommendation) for Chronic back pain? A. Yoga B. Skeletal muscle relaxants C. Interferential therapy D. Ultrasonography

What structure is being tested when the thigh and leg are held at 90 degrees and the tibia is pulled forward, after which the test is repeated on the other side for comparison? A. ACL B. PCL C. MCL D. Tensor fasciae latae

``` What is the imaging test of choice for cervical radiculopathy? A. MRI B. Xray C. CT D. UTZ ```

``` If the Yergason’s test is (+), which bony landmark do you need to identify to be able to palpate the affected structure? A. Acromion B. Bicipital groove C. Coracoid process D. Clavicle ```

``` The best way to check for impingement syndrome is A. Flexing the shoulder B. Extending the shoulder C. Abducting the shoulder D. Adducting the shoulder ```

``` Which particular rotator cuff muscle is most predisposed to being impinged? A. Subscapularis B. Infraspinatus C. Teres minor D. Supraspinatus ```

65 y/o vendor with L knee pain. She has valgus deformity of the leg. ``` What compartment of the leg is affected? A. Anterior compartment B. Lateral compartment C. Medial compartment D. Posterior compartment ```

``` Which of the following is not a test for knee stabilty? A. Valgus stress test B. Anterior Drawer’s test C. Apley’s test D. Posterior Drawer’s test ```

``` Which of the following structure is being tested when you push the tibia posteriorly? A. ACL B. Menisci C. LCL D. PCL ```

32 y/o female accountant complains of upper back pain of 6 months duration ``` The trigger points in MPS are usually seen in the following muscles except? A. upper back B. pectoralis major C. sternocleidomastoid D. gluteus muscles ```

``` Tender points in MPS are paplated A. Anywhere along the muscle B. On the point of attachment of the muscle C. On muscle tendon D. In the belly of the muscle ```

``` In older individuals with MPS, most common coexisting disease is A. OA B. RA C. Muscle tear D. Muscle impingement ```

28 y/o housewife complains of arthritis in both hands and ankles of 2 months duration. There is associated low grade fever and fatigue. She is only able to perform half of her usual work load. ``` Which are important signs and symptoms that would point to a connective tissue disease like lupus? A. History of binge eating B. Previous infection C. Discoid ulcers on skin D. Photosensitivity and oral uclers ```

``` Additional complaints of dry irritated eyes may point to which possible coexisiting autoimmune disease in RA? A. SLE B. Behçet’s Syndrome C. Systemic Sclerosis D. Sjogren’s syndrome ```

What is the recommended maintenance drug for lupus nephritis which has been shown to most effective at preventing progression to ESRD? A. Hydroxychloroquine B. Cyclosporine C. Prednisone D. Azathioprine

45 year old male with recurrent swelling of the big toe for 2 years. Naproxen and Dexamethasone for 6 months. Stopped drinking alcohol and follows a low purine diet. Despite this patient still experiences acute arthritis. Currently asymptomatic and MSK is normal. Same attack happened 4 weeks ago. On lab exam, which is consistent with his current status? a. Leukocytosis and neutrophilia b. Elevated ESR c. Normo/hyperurecemia d. Urinarlysis with alkaline pH and high WBC

Which drug may be started in this asymptomatic phase of the disease a. Colchicine b. NSAIDS c. Prednisone d. Allopurinol

Which of the following will be the lab result in her case a. Normal levels of acute phase reactants b. Elevated ESR, CRP c. Anti-CCP d. RF high

The housewife above soon developed malar rash and edema. She has improved with initial low dose steroids and was able to do household chores again, although she continued to have fatigue. What rash in SLE is scarring and disfiguring? a. Malar rash b. Hyperkeratotic plugging and hyperpigmentation c. Discoid rash d. Erythema multiforme

What dose of steroids is indicated in life or organ threatening SLE? a. 0.15 – 0.30 mg/kg/day b. 0.5 – 1.0 mg/kg/day c. 1-2 mg/kg/day d. > 2mg/kg/day

For Ankylosing spondylitis, what exercise is emphasized? a. Balance Exercises b. Breathing Exercises c. Coordination

``` Tenderness and swelling on metacarpal head of the Right index finger. Which structure is being palpated that would cause pain? a. MCP Joint b. Median Nerve c. Extensor digitorum d. Flexor digitorum superficialis ```

Finger locking is secondary to a. Nerve entrapment b. Tenosynovitis c. Ulnar nerve palsy d. Osteoarthritis

Initial management for Golfer’s elbow except a. Rest b. NSAIDS c. UTZ d. Surgery

What is the genetic marker for ankylosing spondylitis? a. HLA B51 b. HLA DR4 c. HLA B27 d. HLA B21

Must be clarified in a patient with a diagnosis of osteoporosis a. Hx of trauma b. Hx of menstruation c. Hx of UTI d. AOTA

Exercises that can be done by an osteoporotic patient a. Balance exercises b. Treadmill exercises c. Tai Chi d. AOTA