Examination, special tests and red flags

50 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Examination, special tests and red flags, part of Clinical Decision Making and Differential Diagnosis. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard

   A 45-year-old man has a sudden severe headache described as the worst of his life and neck pain after lifting. He asks for manual therapy. What is the right decision?

   1. ADo not treat and arrange emergency medical assessment
   2. BGive advice and a review in a week
   3. CStart deep neck flexor exercises
   4. DCervical mobilisation, since pain began with lifting

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   Answer: A · Do not treat and arrange emergency medical assessment

   A thunderclap headache with neck pain may signal subarachnoid haemorrhage or arterial dissection. It is a medical emergency. Manual therapy and exercise could worsen the situation.

   • B: A one-week delay can be fatal.
   • C: Exercises delay urgent diagnosis.
   • D: Mobilisation is unsafe with possible vascular pathology.

   Remember this

   Thunderclap headache with neck pain is an emergency; do not treat.

2. Question 2 · Easy

   A straight leg raise reproduces leg pain at 45 degrees of hip flexion. What does this test mainly screen for?

   1. ANeural tension of the lumbar roots
   2. BHip joint arthritis
   3. CHamstring tendinopathy
   4. DSacroiliac joint fracture

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   Answer: A · Neural tension of the lumbar roots

   A positive test reproduces radicular leg pain between about 30 and 70 degrees, because the sciatic nerve and the L5-S1 roots are tensioned. Pain below 30 or above 70 degrees is less likely to be neural. Ankle dorsiflexion adds tension to differentiate.

   • B: Hip arthritis limits hip motion and gives groin pain.
   • C: Hamstring pain is felt as posterior thigh stretching.
   • D: Fracture needs imaging, not this test.

   Remember this

   A positive SLR between 30 and 70 degrees suggests neural tension.

3. Question 3 · Medium

   A young footballer reports anterior groin pain on deep hip flexion. Passive flexion, adduction and internal rotation reproduces it. Which condition is suggested?

   1. AGreater trochanteric pain syndrome
   2. BSacroiliac joint dysfunction
   3. CLumbar disc herniation
   4. DFemoroacetabular impingement

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   Answer: D · Femoroacetabular impingement

   The FADIR test brings the femoral head-neck junction into contact with the acetabular rim. Anterior groin pain on this movement suggests femoroacetabular impingement or labral pathology. A cam or pincer morphology is often seen on imaging.

   • A: Trochanteric pain is lateral and is provoked by side-lying and palpation.
   • B: SIJ dysfunction gives pain over the posterior pelvis.
   • C: A disc herniation gives lumbar and radicular symptoms.

   Remember this

   Anterior groin pain on FADIR suggests femoroacetabular impingement.

4. Question 4 · Easy

   Which history feature is a red flag for possible spinal malignancy?

   1. AConstant night pain with unexplained weight loss
   2. BPain after lifting a heavy box
   3. CPain that eases with a change of position
   4. DStiffness lasting less than 5 minutes in the morning

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   Answer: A · Constant night pain with unexplained weight loss

   Pain unrelieved by rest or changes of position, worse at night and with unexplained weight loss, raises the possibility of cancer or metastasis. A prior history of cancer increases the risk further. These patients need medical referral.

   • B: Pain after lifting is typical mechanical back pain.
   • C: Pain that eases with position changes is mechanical.
   • D: Brief morning stiffness suggests degenerative change.

   Remember this

   Non-mechanical night pain with weight loss is a cancer red flag.

5. Question 5 · Medium

   A woman has pain at the radial styloid that is reproduced when she tucks the thumb into her fist and the examiner moves her wrist into ulnar deviation. Which condition does this suggest?

   1. AScapholunate instability
   2. BIntersection syndrome of the forearm
   3. CDe Quervain tenosynovitis
   4. DCarpal tunnel syndrome

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   Answer: C · De Quervain tenosynovitis

   The manoeuvre stretches abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment. Pain at the radial styloid indicates de Quervain tenosynovitis, common in new mothers and in repeated thumb use. In Finkelstein's original test the examiner pulls the thumb into ulnar deviation.

   • A: Scapholunate instability is tested with the Watson scaphoid shift test.
   • B: Intersection syndrome hurts 4 to 8 cm proximal to the wrist, often with crepitus.
   • D: Carpal tunnel syndrome gives median nerve tingling, tested with Phalen and Tinel.

   Remember this

   Pain at the radial styloid on the Finkelstein or Eichhoff manoeuvre suggests de Quervain tenosynovitis.

6. Question 6 · Medium

   A 62-year-old man treated for prostate cancer 3 years ago reports progressive thoracic pain that is worse at night and not eased by rest. What is the most appropriate action?

   1. AAdvise a heat pack and review in four weeks
   2. BApply mobilisation to the thoracic spine
   3. CRefer for urgent medical review and imaging
   4. DStart a progressive strengthening plan

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   During a clinic session in Abu Dhabi, a man develops chest tightness, sweating and left arm pain on exertion. What should the therapist do first?

   1. AAsk him to continue to build tolerance
   2. BStop the activity, sit him down and call emergency services
   3. CStart stretching the left arm
   4. DGive a hot pack

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   Pain over the bicipital groove increases with resisted forward flexion of the supinated arm at 90 degrees with the elbow extended. Which test is this?

   1. ADrop arm test
   2. BSpeed's test
   3. CNeer test
   4. DYergason's test

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   A patient with shoulder pain cannot lift the back of the hand away from the lumbar spine when the hand is placed there. Which test is positive and which muscle is weak?

   1. ALift-off test, subscapularis
   2. BDrop arm test, infraspinatus
   3. CSpeed's test, biceps
   4. DEmpty can test, supraspinatus

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    Sudden central back and abdominal pain develops in a male smoker aged 66, who also feels a pulsating mass near the umbilicus. What is the correct response?

    1. ABegin gentle lumbar mobilisation and review in one week
    2. BEmergency referral for a suspected abdominal aortic aneurysm
    3. CAdvise rest at home with simple analgesia
    4. DTreat as a lumbar strain with extension exercises

    Answer and explanation in LearnFree account

11. Question 11 · Hard

    A 40-year-old woman falls on her knee. She can walk four steps, can flex to 100 degrees and has no tenderness at the patella or fibular head. What do the Ottawa knee rules advise?

    1. ANo radiograph is needed
    2. BMRI to exclude fracture
    3. CRadiograph because of the fall
    4. DRadiograph because she is over 30

    Answer and explanation in LearnFree account

12. Question 12 · Medium

    A 72-year-old woman on long-term steroids develops sudden mid-back pain after a cough, worse on movement and with local tenderness. What is the most likely concern?

    1. AMuscle spasm only
    2. BFacet syndrome
    3. CVertebral compression fracture
    4. DDisc herniation

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    Before cervical manipulation, which symptom cluster should raise suspicion of cervical arterial dysfunction?

    1. ATension headache after screen work
    2. BStiffness on rising and easing during the day
    3. CPain on neck flexion alone
    4. DDizziness, diplopia, dysarthria and drop attacks

    Answer and explanation in LearnFree account

14. Question 14 · Easy

    Which test assesses iliotibial band tightness, with the patient in side-lying?

    1. ATrendelenburg test
    2. BApley grind test
    3. CThomas test
    4. DOber test

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15. Question 15 · Hard

    A patient with rheumatoid arthritis has neck pain and reports a sensation of the head shifting forward. During the Sharp-Purser test, a clunk is felt when the head is flexed and the atlas is pushed back and symptoms ease. Which problem is suspected?

    1. ACervical spondylosis
    2. BAtlantoaxial instability
    3. CTorticollis
    4. DThoracic outlet syndrome

    Answer and explanation in LearnFree account

16. Question 16 · Easy

    A man twists his ankle in a football match. Which finding meets the Ottawa criteria for an ankle radiograph?

    1. APain on moving the ankle only
    2. BMild swelling alone
    3. CInability to bear weight for four steps
    4. DA history of previous sprains

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17. Question 17 · Hard

    A woman has buttock pain. Distraction, thigh thrust, compression and sacral thrust tests are all positive. How are these findings interpreted?

    1. ATwo or more positives in this four-test cluster support sacroiliac joint pain
    2. BThey indicate a lumbar disc herniation
    3. CAny one positive test alone confirms sacroiliac joint pain
    4. DPositive provocation tests rule out a sacroiliac source

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18. Question 18 · Easy

    Which special test is used to assess the integrity of the anterior cruciate ligament?

    1. AValgus stress test
    2. BPosterior drawer test
    3. CMcMurray test
    4. DLachman test

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19. Question 19 · Hard

    A man with unilateral sciatica reports that the symptoms have spread to both legs and he has noted a weak urinary stream and reduced awareness of passing urine. No retention yet. What is the right interpretation?

    1. ARoutine progression, treat with traction
    2. BNormal ageing changes
    3. CAnxiety, so reassure and review next week
    4. DIncomplete cauda equina syndrome, an urgent emergency referral

    Answer and explanation in LearnFree account

20. Question 20 · Medium

    Pain at the lateral epicondyle on resisted wrist extension with the elbow extended and the fist clenched is a positive:

    1. AValgus stress test for the ulnar collateral ligament
    2. BCozen test for lateral epicondylitis
    3. CTinel's sign at the elbow
    4. DGolfer's elbow test for medial epicondylitis

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21. Question 21 · Medium

    A man has a painful arc and a positive drop arm test and cannot hold the arm at 90 degrees abduction. Which structure is most likely torn?

    1. ATeres major
    2. BBiceps long head
    3. CSupraspinatus tendon
    4. DSubscapularis tendon

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22. Question 22 · Medium

    A positive likelihood ratio of 12 for a test means that:

    1. AThe test is wrong 12% of the time
    2. BA positive result greatly increases the probability of disease
    3. CA positive result slightly increases it
    4. DA negative result rules out disease

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23. Question 23 · Medium

    A woman with neck pain has bilateral hand clumsiness, a positive Hoffmann sign, brisk reflexes and a wide-based gait. What does this suggest?

    1. ACervical myelopathy
    2. BThoracic outlet syndrome
    3. CTension-type headache
    4. DCarpal tunnel syndrome

    Answer and explanation in LearnFree account

24. Question 24 · Medium

    Which finding is a non-organic (Waddell) sign?

    1. AAbsent ankle jerk
    2. BPain on axial loading of the skull while standing
    3. CWeak great toe extension
    4. DPositive straight leg raise at 50 degrees

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25. Question 25 · Medium

    A test has a sensitivity of 95% and a specificity of 40%. How is it best used?

    1. AA positive result confirms the condition
    2. BIt cannot be used clinically
    3. CA negative result confirms the condition
    4. DA negative result helps rule out the condition

    Answer and explanation in LearnFree account