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ABPMR Questions Flashcards

1
Q

A patient presents with joint pain and swelling with symmetric involvement in the ankles, heels, spine, and SI joints with calcaneal spurs and periosteal proliferation near the involved joints. This is characteristic of the arthropathy associated with:

A. Psoriatic Arthritis
B. Reactive Arthritis (Reiter disease)
C. chondrocalcinosis
D. Behcet Syndrome

A

B

Reference: Fishman S et al. Bonica’s Management of Pain 4th ed. 2010 page 442

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2
Q

Three weeks after a severe TBI with basinal skull fracture, a 23-year old patient in a rehab unit develops new onset ocular pain, unilateral proptosis, and unilateral orbital vascular congestion. What is the most likely diagnosis?

A. Detached retina
B. Acute narrow angle glaucoma
C. Carotid cavernous fistula
D. Retrobulbar hematoma

A

C

Ref: Zasler ND et al. Brain injury medicine. 2nd edition. 2013 page 740

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3
Q

In a person with a transfemoral amputation, an abnormal prosthetic gait with lateral trunk bending toward the involved side in midstance most commonly occurs with hip:

A. Adductor weakness
B. Extension contracture
C. Flexion contracture
D. Abductor weakness

A

D

Ref: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and Practice. 5th Ed. 2010, page 2023

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4
Q

Which modality should precede shoulder stretching in a patient with adhesive capsulitis?

A. Massage
B. Ice packs
C. Electrical stimulation
D. Ultrasound

A

D

Ref: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and Practice. 5th Ed. 2010, page 913

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5
Q

A 22-year-old patient with a mild suprascapular pain and radiation into the ipsilateral upper extremity is examined with a monopolar needle electrode at minimal voluntary contraction. In the biceps brachii, the second motor unit to fire is observed when the first noted motor unit fires at 10Hz. These findings are most consistent with:

A. Polymyositis
B. no abnormality
C. Brachial plexopathy
D. C6 Radiculopathy

A

B

Ref: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 200.

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6
Q

A 36-yr-old manual laborer sustained a surgically visualized complete laceration of the median nerve at the wrist. However, he continues to have grade 3 strength of thumb abduction. Needle electromyography of the opponens pollicis shows abundant fibrillation potentials and reduced numbers of normal-appearing voluntary motor units. The most likely explanation of these findings is anomalous innervation of the median nerve innervated muscles via

A. a median to ulnar nerve forearm communication (M-G anastomosis)
B. an ulnar to median nerve forearm communication
C. a radial to ulnar nerve hand communication (Froment-Rauber anastomosis)
D. an ulnar to median nerve hand communication (Riche-Cannieu anastomosis)

A

D

Ref: Dumitru D, et al. Electrodiagnostic medicine. 2nd ed. 2002, page 193

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7
Q

Concentric activation of the iliopsoas muscle is essential to which phase of the gait cycle?

A. Midstance
B. Terminal stance
C. Preswing
D. Terminal swing

A

C

Ref Delisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and Practice. 5th ed. 2010, page 123.

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8
Q

What is the preferred imaging technique to rule out Osgood-Schlatter disease?

A. Conventional radiography
B. Arthrography
C. Ultrasonography
D. Magnetic resonance imaging

A

A

Ref: Braddom RL, ed. Phys Med and Rehab 4th ed. 2011, page 860

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9
Q

Considering safety and comfort, what is the preferred location for needle electrode insertion when studying the diaphragm?

A. The fourth or fifth interspace, at the anterior axillary line
B. The fourth or fifth interspace, at the posterior axillary line
C. The eighth or ninth interspace, at the anterior axillary line
D. Overlying the subscapularis, directed tangential to the skin

A

C

Ref: Kimura J Electrodiagnosis in Diseases of Nerve and muscle 4th ed.

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10
Q

What is the most common cause of diskitis?

A. Pseudomonas
B. Mycobacterium
C. Streptococcus
D. Staphylococcus

A

D

Braddom RL. Ed, Phys Med and Rehab. 4th ed. 2011, page 1307

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11
Q

A 70-year-old woman presents with symmetrical stiffness, tenderness, and pain over both shoulders and proximal thighs. The symptoms have persisted for the past 10 weeks. The sedimentation rate is 110. The best therapeutic approach is to prescribe

A. Steroids
B. Colchicine
C. Methotrexate
D. Nonsteroidal anti-inflammatory drugs

A

A

Klippel JH. Primer on the Rheumatic Diseases. 13th ed. 2008, page 406

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12
Q

A 76-year-old woman is referred for rehabilitation following a recent left total hip arthroplasty. To prevent hip dislocation, you instruct the patient to avoid hip

A. adduction beyond neutral
B. abduction greater than 20 degrees
C. Flexion greater than 45 degrees
D. External rotation beyond neutral

A

A

O’Young et al. PMR secretes. 2nd ed. 2002, page 286

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13
Q

Which risk factor is most clearly implicated in the development of degenerative lumbar diskogenic disease?

A. Hyperlordosis
B. Smoking
C. Body build
D. Posture

A

B

Braddom RL, ed. Phys Med and Rehab. 3rd ed. 2007, page 921

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14
Q

The treatment program for a 43-year-old patient during the first week following an impacted humeral neck fracture should include

A. Immobilization
B. Active assisted ROM
C. Active range of motion
D. Surgery

A

A

Delee JC et al. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice 3rd ed. 2010., page 1039

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15
Q

A 43-year-old runner presents with right-sided hip pain. On examination, you note tenderness to palpation over the greater trochanter on the affected side. No focal neurologic deficits are noted and no other areas of tenderness are elicited. A key part of your treatment plan should include strengthening of the hip

A. internal rotators
B. extensors
C. abductors
D. adductors

A
  1. CORRECT ANSWER: C
    Class 1 code: B2j | Class 2 code: C3b
    Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
    Practice. 5th ed. 2010, page 1430.
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16
Q

Which cardiorespiratory outcome would you expect from an elderly person participating in an aerobic program?

A. A decrease in VO2max but an increase in walking speed
B. No change in tolerance during activities of daily living
C. Improvement in VO2max
D. No change in stroke volume and a reduction in systemic vascular resistance

A

CORRECT ANSWER: C
Class 1 code: F | Class 2 code: E2c
Reference: Gonzalez EG et al. Downey and Darling’s Physiological Basis of Rehabilitation
Medicine. 3rd ed. 2001, page 572

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17
Q

A patient complains of pain inferior to the anteromedial surface of the knee, especially while climbing stairs. On examination, there is tenderness to palpation over the proxial anteromedial tibia. What is the most likely diagnosis?

A. Pes anserinus bursitis
B. Iliotibial band syndrome
C. Patellar tendinitis
D. Prepatellar bursitis

A

CORRECT ANSWER: A
Class 1 code: B2j | Class 2 code: A2
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 859.

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18
Q

Typical radiologic findings in osteoarthritis involving the knee are

A. symmetrical joint space narrowing
B. meniscal calcification
C. trabecular sclerosis
D. subchondral cysts

A

CORRECT ANSWER: D
Class 1 code: B1b | Class 2 code: A3e
Reference: Frontera WR et al. Essentials of Physical Medicine and Rehabilitation. 3rd ed.
2015, page 362.

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19
Q

When treating a patient with a traumatic brain injury (TBI) for detrusor hyperreflexia using anticholinergic agents, what is a possible adverse effect?

A. Bradycardia
B. Diarrhea
C. Worsening of delirium
D. Pupillary constriction with blurred vision

A

CORRECT ANSWER: C
Class 1 code: D3e | Class 2 code: C4f
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1148.

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20
Q

A 50-year-old retired army paratrooper with diabetes complains of pain on ambulation due to degenerative joint disease in his right hip. You prescribe a single cane to

A. decrease weight-bearing forces across the arthritic hip joint
B. help in sensory feedback or environmental scanning
C. compensate for gluteus medius weakness
D. increase the base of support, thus increasing stability and balance

A

CORRECT ANSWER: A
Class 1 code: B1b | Class 2 code: D3g
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 845

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21
Q 
The most common mechanism for Achilles tendon rupture is
A.	 active dorsiflexion
B.	 active plantar flexion
C.	 passive dorsiflexion
D.	 passive plantar flexion
A

CORRECT ANSWER: B
Class 1 code: B2a | Class 2 code: E4
Reference: DeLee JC et al. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and
Practice. 3rd ed. 2010., page 2002.

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22
Q

Which factor differentiates myotonic discharge from complex repetitive discharges (CRDs)?

A. Amplitude and frequency of potentials
B. Duration of the potentials
C. Complexity of waveforms in CRDs
D. Resemblance of myotonic discharge to triphasic motor unit response

A

CORRECT ANSWER: A
Class 1 code: F | Class 2 code: B4
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 200.

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23
Q 
What is the most frequent cause of stroke?
A. Intracranial hemorrhage
B. Large vessel thrombosis
C. Cerebral embolism
D. Vasculitis
A

CORRECT ANSWER: B
Class 1 code: A1 | Class 2 code: E6
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1178.

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24
Q

The pattern of responses depicted here is recorded after 50 Hz stimulation of the median nerve of an infant. Which diagnosis is most likely?

A. Spinal muscular atrophy
B. Botulism
C. Inflammatory myopathy
D. Human immunodeficiency virus infection

A

CORRECT ANSWER: B
Class 1 code: A5o | Class 2 code: B5
Reference: Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 4th ed. 2013, page
822.

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25
Q

A 42-year-old receptionist has a two-year history of severe radial wrist pain, which is worse with pinching activities and wrist ulnar deviation. Job modification, extensive physical
therapy, and multiple cortisone shots have failed to provide much relief. What is the best recommendation?

A. Wrist arthrodesis
B. Referral to a pain program
C. Wrist tendon lengthening surgery
D.Surgical decompression of the first extensor compartment

A

CORRECT ANSWER: D
Class 1 code: B2j | Class 2 code: C1
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 929.

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26
Q

During nerve conduction studies (NCSs), what is defined as the maximal stimulus?
A. The highest intensity of stimulus that the patient can tolerate
B. Stimulus beyond which there is no further increase in the evoked amplitude
C. Stimulus about 20-30% greater than the threshold stimulation
D. Any stimulus which is greater than the threshold stimulus

A

CORRECT ANSWER: B
Class 1 code: F | Class 2 code: B3
Reference: Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 4th ed. 2013, page
76.

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27
Q

When poor initiation is noted during rehabilitation of a patient with a traumatic brain injury
(TBI), which region of the brain is the suspected location of injury?
A. Frontal
B. Temporal
C. Parietal
D. Occipital

A

CORRECT ANSWER: A
Class 1 code: A3 | Class 2 code: E1a
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 603.

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28
Q

When viewing magnetic resonance imaging (MRI) of the cervical spine, which tissue type is
dark on a T1-weighted image and bright on a T2-weighted image?
A. Interspinal ligaments
B. Facet joints
C. Spinal cord
D. Nucleus pulposus

A

CORRECT ANSWER: D
Class 1 code: F | Class 2 code: A3e
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 168

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29
Q

Which finding correlates with a high risk of ischemic ulceration?
A. Ankle/brachial ratio of 0.40
B. Transcutaneous oxygen (TcPO2
) of 50 mm Hg
C. Serum albumin 3.2 gm/dl
D. Stenotic lesion of the superficial femoral artery

A

CORRECT ANSWER: A
Class 1 code: C2 | Class 2 code: A3a
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1179.

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30
Q 
Which anticonvulsant medication is most likely to cause bone marrow suppression?
A.	 Carbamazepine
B. Gabapentin
C. Lamotrigine
D. Valproic acid
A

CORRECT ANSWER: A
Class 1 code: E1d | Class 2 code: C4b
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1753

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31
Q 
Which transverse deficiency represents the most common upper extremity congenital limb
loss?
A. Transhumeral
B. Elbow disarticulation
C. Transradial
D. Wrist disarticulation
A

CORRECT ANSWER: C
Class 1 code: C1 | Class 2 code: E6
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 3rd ed. 2007, page 267.

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32
Q

Neurochemical changes following a traumatic brain injury (TBI) may contribute to secondary
brain injury by the mechanism of increased
A. free-radical production
B. extracellular concentrations of magnesium
C. extracellular concentrations of calcium
D. influx of potassium

A

CORRECT ANSWER: A
Class 1 code: A3 | Class 2 code: E3a
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1136.

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33
Q

What is the anatomic location of a stroke which produces impaired expression,
comprehension, and repetition, with normal fluency?
A. Precentral gyrus
B. Temporal gyrus
C. Arcuate fasciculus
D. Cingulate gyrus

A

CORRECT ANSWER: B
Class 1 code: E2a | Class 2 code: E1a
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1183

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34
Q 
Which corticosteroid has the longest duration of anti-inflammatory activity?
A. Betamethasone
B. Methylprednisolone
C. Triamcinolone
D.	 Hydrocortisone
A

CORRECT ANSWER: A
Class 1 code: B2j | Class 2 code: C4e
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1749.

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35
Q

An elderly patient with advanced spondylosis on plain spine radiographs presents with
radicular pain. Which diagnostic study is most likely to confirm neurologic dysfunction?
A. Computed tomography
B. Electrodiagnostic testing
C. Magnetic resonance imaging
D. Myelography

A

CORRECT ANSWER: B
Class 1 code: B2h | Class 2 code: C1
Reference: Dumitru D, et al. Electrodiagnostic Medicine. 2nd ed. 2002, page 420

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36
Q 
Which fibers transmit poorly localized, dull, visceral pain to the spinal cord?
A. Myelinated A-alpha
B. Myelinated A-delta
C. Unmyelinated gamma
D. Unmyelinated C
A

CORRECT ANSWER: D
Class 1 code: E4 | Class 2 code: E3a
Reference: Skirven TM. Rehabilitation of the Hand and Upper Extremity. 6th ed. 2011, page
1454.

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37
Q 
Which equipment modification is suitable for a tennis player with lateral epicondylitis?
A. Larger racquet head
B. Larger handle diameter
C. Increased string tension
D. Stiffer racquet
A

CORRECT ANSWER: B
Class 1 code: B2b | Class 2 code: D3g
Reference: DeLee JC et al. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and
Practice. 3rd ed. 2010., page 1200

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38
Q

Which cardiopulmonary parameter should improve in a patient with congestive heart failure
who is participating in a cardiac rehabilitation program?
A. VO2max
B. Systolic ejection fraction
C. Diastolic ventricular filling
D. Pulmonary blood flow

A

CORRECT ANSWER: A
Class 1 code: D1a | Class 2 code: E3c
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 732.

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39
Q

A patient diagnosed with a lateral medullary stroke exhibits ipsilateral loss of pain/
temperature sensation of the face. Where is the corresponding neuroanatomic site?
A. Descending sympathetic tract
B. Vestibular nuclei
C. Spinal tract of the trigeminal nerve
D. Spinothalamic tract

A

. CORRECT ANSWER: C
Class 1 code: A1 | Class 2 code: E1a
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1187.

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40
Q

In nondisabled subjects walking at self-selected normal speeds, the normal distribution of
time spent in double support is approximately
A. 10%
B. 20%
C. 30%
D. 40%

A

CORRECT ANSWER: B
Class 1 code: F | Class 2 code: A3b
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 100.

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41
Q 
For a patient with dysphagia following stroke, the chin-tuck maneuver is effective because
it decreases
A. pharyngeal peristalsis
B. esophageal sphincter excursion
C. pharyngeal pressure
D. airway opening
A

CORRECT ANSWER: D
Class 1 code: E1h | Class 2 code: E3f
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 594.

42
Q 
Which modality most effectively treats the periarticular tissue of the hip joint?
A.	 Hot packs
B. Shortwave diathermy
C. Ultrasound
D. Electrical stimulation
A

CORRECT ANSWER: C
Class 1 code: B2k | Class 2 code: C2d
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 135.

43
Q 
Chronic compartment syndrome can be confirmed with which test?
A. Plethysmography
B. Ultrasound
C. Slit catheter
D. Magnetic resonance imaging
A

CORRECT ANSWER: C
Class 1 code: B2l | Class 2 code: A3g
Reference: DeLee JC et al. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and
Practice. 3rd ed. 2010., page 650.

44
Q 
What is the most common cause of death in patients with ventilator-dependent tetraplegia
who have survived the first 24 hours?
A. Renal failure
B. Pneumonia
C. Pressure ulcer infection
D. Pulmonary embolism
A

CORRECT ANSWER: B
Class 1 code: A2 | Class 2 code: A5
Reference: Lin VW et al. Spinal Cord Medicine: Principles and Practice. 2nd ed. 2010, page
175.

45
Q

Nerve conduction findings in patients with critical illness polyneuropathy include
A. conduction block
B. reduced sensory and motor evoked amplitudes
C. temporal dispersion
D. significant decrement to repetitive stimulation

A

CORRECT ANSWER: B
Class 1 code: A4b | Class 2 code: B3
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1161

46
Q 
What is the initial treatment plan for pain in a patient with acute spinal pain from bony
metastasis?
A. Methadone
B. Oxycodone
C. Ibuprofen
D. Gabapentin
A

CORRECT ANSWER: C
Class 1 code: D4 | Class 2 code: C4a
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1154

47
Q 
A patient presents with complaints of
numbness in the ring and little fingers
with intrinsic hand weakness. Results
from an ulnar motor nerve conduction
study (NCS) with short segment
incremental study (inching) is shown
in this nerve conduction image. The
findings are most consistent with a
A. temporal dispersion
B. conduction block
C. decrement
D. normal study
A

CORRECT ANSWER: B
Class 1 code: A4a | Class 2 code: B3
Reference: Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill; 2009,
page 1239-1240

48
Q

Physical therapy treatment for patients with Parkinson disease includes
A. teaching the individual to turn en bloc
B. training the individual not to focus on foot position
C. shortening step length to prevent freezing
D. using verbal and visual cueing

A

CORRECT ANSWER: D
Class 1 code: A5n | Class 2 code: C3a
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 648.

49
Q 
A man with chronic tetraplegia,
ASIA Impairment Scale A, manages
his bladder with an indwelling
catheter. This cystogram reveals
A. nephrolithiasis
B. ureteral atony
C.	 vesicoureteral reflux
D.	 detrusor hyperreflexia
A

CORRECT ANSWER: C
Class 1 code: D3a | Class 2 code: A3c
Reference: Pollack HM, et al. Clinical Urology. 2nd ed. 2000, page 1105.

50
Q 
A person who had a lacunar infarct in the posterior limb of the internal capsule would most
likely present with
A. dysarthria-clumsy hand syndrome
B. ataxic hemiparesis
C. pure sensory stroke
D. pure motor stroke
A

CORRECT ANSWER: D
Class 1 code: A1 | Class 2 code: A1
Reference: Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill; 2009,
page 772.

51
Q

Which clinical feature is most likely seen in acute inflammatory demyelinating
polyradiculopathy (Guillain-Barré syndrome)?
A. Areflexia
B. Asymmetric weakness of at least two extremities
C. Mild sensory loss
D. Autonomic dysfunction

A

CORRECT ANSWER: A
Class 1 code: A5d | Class 2 code: A2
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1072.

52
Q

In a child with Duchenne muscular dystrophy (DMD), which muscle group has the most
significant weakness at the time of presentation?
A. Proximal upper extremities
B. Proximal lower extremities
C. Distal upper extremities
D. Distal lower extremities

A

CORRECT ANSWER: B
Class 1 code: A5g | Class 2 code: B4
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1106.

53
Q

In a 45-year-old man with a spinal cord injury (SCI) and a history of coronary heart disease,
which risk factor is an indication for the most stringent control of low-density lipoprotein
(LDL)?
A. Hypertension
B. Diabetes
C. Low high-density lipoprotein level
D. Family history of coronary heart disease

A

CORRECT ANSWER: B
Class 1 code: D6 | Class 2 code: E6
Reference: JAMA. Vol 285 No 19. 2001, page 2487.

54
Q 
Assuming the use of prostheses, which lower extremity amputation requires the greatest
energy expenditure for ambulation?
A. Bilateral above knee
B.	 Hemipelvectomy
C. Unilateral hip disarticulation
D. Below knee plus above knee
A

CORRECT ANSWER: A
Class 1 code: C2 | Class 2 code: D1
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 310.

55
Q

A patient with a burn has undergone lower extremity grafting and immediate postoperative
fitting with an edema control dressing. The earliest time for safe ambulation is how many
days after the operation?
A. 1
B. 5
C. 10
D. 15

A

CORRECT ANSWER: A
Class 1 code: B2e | Class 2 code: C1
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 4th ed. 2005, page 1873.

56
Q 
What is an advantage of intermittent positive pressure breathing (IPPB) devices for patients
with postpolio syndrome?
A. Cosmetic appeal
B. Portability
C. Low cost
D. Minimal noise
A

CORRECT ANSWER: B
Class 1 code: A5c | Class 2 code: D3e
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 747.

57
Q

What is the most appropriate prescription for a patient with progressive communication
deficits due to flaccid dysarthria secondary to amyotrophic lateral sclerosis (ALS)?
A. Articulation training
B. Speech exercises emphasizing optimum performance
C. Adaptive speech strategies such as slow speaking rate
D. Computer-based augmentative communication system

A

CORRECT ANSWER: D
Class 1 code: A5b | Class 2 code: D3d
Reference: Kirshblum S et al. Spinal Cord Medicine. 2nd ed. 2011, page 643.

58
Q 
What is the most important factor to consider when injecting myofascial trigger points?
A. Type of medication injected
B.	 Localization of trigger points
C. Frequency of injection
D.	 Size of needle
A

CORRECT ANSWER: B
Class 1 code: B2d | Class 2 code: C5d
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 992.

59
Q

What property of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) is most likely
to cause an acute adverse event when used to treat a patient with a severe quadriceps
contusion?
A. Analgesic
B. Antiplatelet
C. Antipyretic
D. Anti-inflammatory

A

CORRECT ANSWER: B
Class 1 code: B2a | Class 2 code: C4e
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 855.

60
Q

In patients with a spinal cord injury (SCI), which type of pain is most responsive to
transcutaneous electrical nerve stimulation (TENS)?
A. Deafferentation central
B. Radicular
C. Complex regional pain syndrome
D. Visceral

A

CORRECT ANSWER: B
Class 1 code: A2 | Class 2 code: D3c
Reference: Lin VW et al. Spinal Cord Medicine: Principles and Practice. 2nd ed. 2010, page
517.

61
Q 
When using an anesthetic for local infiltration prior to shoulder injection, which compound
has the longest duration of analgesia?
A. Lidocaine
B. Mepivacaine
C. Bupivacaine
D. Prilocaine
A
  1. CORRECT ANSWER: C
    Class 1 code: F | Class 2 code: E9
    Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 521.
62
Q 
What is the best orthotic management for an acute knee grade 2 medial collateral
ligament sprain?
A. Swedish
B. Unloading
C.	 Immobilizer
D. Functional
A

CORRECT ANSWER: C
Class 1 code: B2i | Class 2 code: D2
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 857

63
Q

According to the American Spinal Injury Association (ASIA) International Standards for
Neurological Classification of Spinal Cord Injury, testing of a key muscle should begin in
which grade position?
A. 1
B. 2
C. 3
D. 4

A

CORRECT ANSWER: C
Class 1 code: A2 | Class 2 code: A4
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1302

64
Q

What are the sensitivity and specificity of D-dimer as a screening test for occult deep
venous thrombosis (DVT) following traumatic brain injury (TBI)?
Sensitivity Specificity
A. Good Good
B. Good Poor
C. Poor Good
D. Poor Poor

A

CORRECT ANSWER: B
Class 1 code: D1d | Class 2 code: A3d
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1363.

65
Q 
When being used as an antispasmodic medication for spinal cord injury (SCI), what is the
primary receptor site for diazepam?
A. GABA A receptors
B. GABA B receptors
C. Alpha 1 receptors
D. Alpha 2 receptors
A

CORRECT ANSWER: A
Class 1 code: A2 | Class 2 code: E9
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1326.

66
Q 
When a patient with cancer is returning home with hospice care, what is the most likely
goal of inpatient rehabilitation?
A. Transfer training
B. Endurance training
C. Caregiver training
D. Contracture management
A

CORRECT ANSWER: C
Class 1 code: D4 | Class 2 code: C6d
Reference: Franklin DJ. Phys Med Rehabil Clin N Am. Vol 18. 2007, page 919

67
Q

Pharmacologic strategies employed to improve arousal for patients in a minimally
conscious/vegetative state after severe traumatic brain injury (TBI) would most likely
include stimulation of
A. glutamate receptors
B. gamma-aminobutyric acid inhibition pathways
C. serotonergic pathways
D. dopaminergic pathways

A

CORRECT ANSWER: D
Class 1 code: E3d | Class 2 code: E9
Reference: Zasler ND et al. Brain Injury Medicine. 2nd ed. 2013, page 525.

68
Q

A 28-year-old woman presents with distal weakness, dysarthria, and dysphagia with
facial weakness. Physical examination reveals normal sensation, areflexia, and diffuse
weakness. What is the earliest electrodiagnostic finding expected in this patient?
A. Prolonged distal onset motor latencies
B. Absent sural sensory response
C. Abnormal late responses
D. Low-amplitude compound muscle action potential

A

CORRECT ANSWER: C
Class 1 code: A5d | Class 2 code: B6
Reference: Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 4th ed. 2013, page
672.

69
Q 
When using a spinal cord stimulator for the management of neuropathic pain, electrodes
are placed into which space?
A. Epidural
B. Subarachnoid
C. Interdiskal
D. Subdural
A

CORRECT ANSWER: A
Class 1 code: E4 | Class 2 code: C5d
Reference: Lin VW et al. Spinal Cord Medicine: Principles and Practice. 2nd ed. 2010, page
516.

70
Q 
The following tracing represents
A. myokymia
B. myotonia
C. complex repetitive discharge
D. endplate potentials
A

CORRECT ANSWER: C
Class 1 code: A5l | Class 2 code: B4
Reference: Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 4th ed. 2013, page
372.

71
Q

When providing patient education to a 23-year-old woman with a complete T4 spinal cord
injury (SCI), you should tell her that she will be unable to experience
A. orgasm
B. sexual arousal
C. psychogenic vaginal lubrication
D. pregnancy

A

CORRECT ANSWER: C
Class 1 code: A2 | Class 2 code: E3a
Reference: Kirshblum S et al. Spinal Cord Medicine. 2nd ed. 2011, page 411.

72
Q

Which assessment tool can be used to evaluate functional limitations in patients with
myofascial pain?
A. McGill Pain Questionnaire
B. Numeric rating scale
C. Sickness Impact Profile
D. Minnesota Multiphasic Personality Inventory

A

CORRECT ANSWER: C
Class 1 code: B2d | Class 2 code: A4
Reference: Frontera WR et al. Essentials of Physical Medicine and Rehabilitation. 3rd ed.
2015, page 486

73
Q

Which therapeutic modality combines a biologically active substance with a coupling
medium and uses ultrasound to force the active material into tissue?
A. Diathermy
B. Iontophoresis
C. Phonophoresis
D. Fluidotherapy

A

CORRECT ANSWER: C
Class 1 code: F | Class 2 code: C2d
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1697.

74
Q

A 35-year-old man who sustained a severe traumatic brain injury (TBI) 48 hours ago has
now developed new tachycardia, hypertension, agitation, and hallucinations. What is the
most likely diagnosis?
A. Posttraumatic agitation
B. Dysautonomia
C. Hyponatremia
D. Alcohol withdrawal

A

CORRECT ANSWER: D
Class 1 code: A3 | Class 2 code: A2
Reference: Lombard LA et al. Am J Phys Med Rehabil. Vol 84 No 10, page 800.

75
Q

A middle-aged man who fell on his outstretched arm has pain in his shoulder and is unable
to initiate abduction of the arm. Examination reveals weakness of shoulder abduction and
external rotation and tenderness under the acromion. What is the most likely diagnosis?
A. Partial C5 root avulsion
B. Clavicular fracture
C. Rotator cuff tear
D. Suprascapular nerve injury

A

CORRECT ANSWER: C
Class 1 code: B2a | Class 2 code: A1
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 913.

76
Q 
Which recreational activity is contraindicated following a total knee arthroplasty?
A.	 Hiking
B. Power walking
C. Jogging
D. Cycling
A

CORRECT ANSWER: C
Class 1 code: B1b | Class 2 code: C1
Reference: DeLee JC et al. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and
Practice. 3rd ed. 2010., page 1789.

77
Q

Which class of antidepressant medication has a narrow therapeutic index and is
associated with fatal heart block or ventricular arrythmias at toxic doses?
A. Selective serotonin reuptake inhibitors
B. Serotonin-norepinephrine reuptake inhibitors
C. Tricyclic antidepressants
D. Monoamine oxidase inhibitors

A

CORRECT ANSWER: C
Class 1 code: E3a | Class 2 code: C4d
Reference: Janicak PG et al. Principles and Practice of Psychopharmacotherapy. 4th ed.
2006, page 269.

78
Q

A patient on methadone presented with euphoria, agitation, and pupillary constriction. He
subsequently had progressive drowsiness leading into a coma. He most likely has opioidrelated
A. allergic reaction
B. psychotic disorder
C. withdrawal
D. intoxication

A

CORRECT ANSWER: D
Class 1 code: E3b | Class 2 code: A2
Reference: Medline Plus (www.nlm.nih.gov), page .

79
Q

The decision to discontinue antiepileptic drug therapy in a patient with a history of epilepsy
is appropriate when the patient has been seizure-free for at least how many months?
A. 6
B. 12
C. 18
D. 24

A

CORRECT ANSWER: D
Class 1 code: E1d | Class 2 code: C1
Reference: Zasler ND et al. Brain Injury Medicine. 2nd ed. 2013, page 651.

80
Q

A patient who sustained a stroke presents with spasticity in the wrist flexors which has
been treated with botulinum toxin. Which modality will be most effective when applied to
the wrist extensors?
A. Massage
B. Ultrasound
C. Muscle cooling
D. Electrical stimulation

A

CORRECT ANSWER: D
Class 1 code: E1a | Class 2 code: D3b
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 653

81
Q

A patient with a recent traumatic brain injury (TBI) developed right lower extremity
spasticity and knee flexion contracture which has been treated unsuccessfully with range
of motion (ROM) and positioning. What is the next step in the management of this patient?
A. Additional ROM
B. Serial casting
C. Electrical stimulation
D. Surgical tendon lengthening

A

CORRECT ANSWER: B
Class 1 code: E1a | Class 2 code: C3e
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1148.

82
Q

A 29-year-old dancer presents with pain that originates on the sole of her foot. She is
tender to palpation along the anterior calcaneus and medial arch. What is the most likely
diagnosis?
A. Calcaneal bursitis
B. Tibiotalar impingement
C. Lisfranc joint subluxation
D. Plantar fasciitis

A

CORRECT ANSWER: D
Class 1 code: B2j | Class 2 code: A2
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 960

83
Q 
. The test in this video is useful for diagnosing
A. a syndesmosis injury
B. anterior compartment syndrome
C. an Achilles tendon rupture
D. a peroneal tendon dislocation
A

CORRECT ANSWER: A
Class 1 code: B2a | Class 2 code: A2
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 25.

84
Q

A 77-year-old man who sustained a stroke with right hemiplegia and marked receptive
aphasia three months ago is being evaluated for electromyographic and force biofeedback
after developing improvements in voluntary motor control. You advise against this therapy
because of his
A. age
B. aphasia
C. duration of stroke
D. shoulder subluxation

A

CORRECT ANSWER: B
Class 1 code: A1 | Class 2 code: C6e
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 4th ed. 2005, page 277

85
Q 
What is the preferred treatment for a patient with acute complex regional pain syndrome
(CRPS) type I with edema?
A. Topical dimethyl sulfoxide
B. Baclofen
C. Prednisone
D. Ibuprofen
A

CORRECT ANSWER: C
Class 1 code: B2c | Class 2 code: C4e
Reference: DeLee JC et al. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and
Practice. 3rd ed. 2010., page 362.

86
Q

After sustaining a stroke, a patient presents with restricted shoulder abduction. A
diagnostic block of which nerve will be most helpful in distinguishing muscle overactivity
from fixed contracture?
A. Spinal accessory
B. Musculocutaneous
C. Thoracodorsal
D. Dorsal scapular

A

CORRECT ANSWER: C
Class 1 code: A1 | Class 2 code: E1b
Reference: Elovic EP et al. PM&R Vol 9 No 1. 2009, page 848.

87
Q

In the nonoperative treatment of a proximal humerus fracture, when should shoulder
passive range of motion (ROM) exercises begin?
A. Within one week
B. Within 2-3 weeks
C. Within 4-6 weeks
D. When fracture is healed

A

CORRECT ANSWER: A
Class 1 code: B2f | Class 2 code: C3b
Reference: Skirven TM. Rehabilitation of the Hand and Upper Extremity. 6th ed. 2011, page
1623.

88
Q 
A patient with a lesion in the left inferior frontal gyrus would most likely have which type of
aphasia?
A. Conduction
B. Anomic
C. Broca
D. Wernicke
A

CORRECT ANSWER: C
Class 1 code: E2a | Class 2 code: A2
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 55.

89
Q 
In severe carpal tunnel syndrome, weakness and atrophy primarily involve the flexor pollicis
brevis, abductor pollicis brevis, and
A.	 flexor pollicis longus
B. adductor pollicis
C. abductor pollicis longus
D. opponens pollicis
A

CORRECT ANSWER: D
Class 1 code: A4c | Class 2 code: A1
Reference: Dumitru D, et al. Electrodiagnostic Medicine. 2nd ed. 2002, page 1051.

90
Q 
Following a burn injury, transparent custom total contact face mask orthoses are used to
A.	 cover the disfigurement
B. preserve facial contours
C. increase eyelid eversion
D. prevent infection
A

CORRECT ANSWER: B
Class 1 code: B2e | Class 2 code: D2
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1145.

91
Q 
A patient with gangrene of the distal foot has the following segmental pressures.
Ankle brachial index .50
Lower calf brachial index .60
Upper calf .90
Lower thigh 1.00
Upper thigh 1.20
What level of amputation is recommended for optimal healing and ambulation?
A. Syme
B. Below knee
C. Above knee
D.	 Hip disarticulation
A

CORRECT ANSWER: B
Class 1 code: C2 | Class 2 code: C1
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 4th ed. 2005, page 787, 1835.

92
Q 
What is the final activating force used in the muscle energy technique?
A. Patient muscle contraction
B. Movement to the barrier
C. Position hold by the practitioner
D. Low-amplitude, high-velocity thrust
A

CORRECT ANSWER: A
Class 1 code: B2d | Class 2 code: C3d
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 433

93
Q 
An individual with spina bifida presents with this lower extremity deformity.
What is the term for this abnormality?
A. Equinovarus
B. Equinovalgus
C. Calcaneovalgus
D. Vertical talus
A

CORRECT ANSWER: C
Class 1 code: A5f | Class 2 code: A1
Reference: Alexander & Matthews. Pediatrics Rehabilitation, Principles and Practice. 4th ed.
2010, page 217.

94
Q

Which nerve conduction finding would be expected in a C6 radiculopathy?
A. Abnormal ulnar compound motor action potential with pickup over the abductor digiti
minimi
B. Abnormal median compound motor action potential with pickup over the abductor
pollicis brevis
C. Normal median sensory nerve action potential
D. Abnormal radial sensory nerve action potentia

A

CORRECT ANSWER: C
Class 1 code: A5m | Class 2 code: B3
Reference: Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 4th ed. 2013, page
638.

95
Q

A 70-year-old man with a history of type 2 diabetes mellitus, hypercholesterolemia treated with a cholesterol-lowering agent, and hypothyroidism presented with a two-week history of pain in the left lower extremity and difficulty climbing stairs. Diagnostic testing, including lumbosacral magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis, was unremarkable. Electrodiagnostic testing results are shown below.

Needle exam showed positive waves and fibrillations with decreased recruitment in the left rectus femoris, tensor fascia lata, and iliopsoas muscles. Other upper and lower extremity muscles were normal. What is the most likely diagnosis?

A. Amyotrophic lateral sclerosis
B. Acute inflammatory demyelinating polyneuropathy
C. Inflammatory myopathy
D. Diabetic amyotrophy

(ms) Amplitude Conduction Velocity
(m/s) F Wave (ms)
Left sural 4.2 4 µV 45
Left superficial peroneal (fibular) 4.0 3 µV 40
Left tibial to abductor hallucis 5.2 4.6 mV 45 50
Left peroneal (fibular) to extensordigitorum brevis
4.8 3.5 mV 46 49
Left femoral torectus femoris 5 mV
Right femoral torectus femoris 1 mV

A

CORRECT ANSWER: D
Class 1 code: A4b | Class 2 code: B1
Reference: Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 4th ed. 2013, page
663.

96
Q 
In a patient who sustained a thalamic stroke, how are pain and temperature perception
affected below the level of the lesion?
Nerve Latency
(ms) Amplitude Conduction Velocity
(m/s) F Wave (ms)
Left sural 4.2 4 µV 45
Left superficial
peroneal (fibular) 4.0 3 µV 40
Left tibial to
abductor hallucis 5.2 4.6 mV 45 50
Left peroneal
(fibular) to extensor
digitorum brevis
4.8 3.5 mV 46 49
Left femoral to
rectus femoris 5 mV
Right femoral to
rectus femoris 1 mV
Location Temperature
A. Ipsilateral Loss
B. Contralateral Loss
C. Ipsilateral Intact
D. Contralateral Intact
A

CORRECT ANSWER: B
Class 1 code: A1 | Class 2 code: A1
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 1307.

97
Q 
What is the most commonly used switch access method for alternative and augmentative
communication devices?
A. Picture text scanning
B. Noun verb scanning
C. Row column scanning
D. Line checkbox scanning
A

CORRECT ANSWER: C
Class 1 code: E2a | Class 2 code: D3d
Reference: DeLisa JA, ed., et al. Physical Medicine and Rehabilitation Medicine: Principles and
Practice. 5th ed. 2010, page 2004.

98
Q

When combined with active range of motion (ROM) exercise, which modality can improve
hand function in individuals with scleroderma (systemic sclerosis) or rheumatoid arthritis
(RA)?
A. Transcutaneous electrical nerve stimulation
B. Therapeutic ultrasound
C. Cryotherapy
D. Paraffin baths

A

CORRECT ANSWER: D
Class 1 code: B1c | Class 2 code: C2a
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 453.

99
Q

A patient presents with progressive, unrelenting low back pain. Two months ago, an
uncomplicated diskectomy successfully relieved the patient’s radicular symptoms. Which
imaging study would most likely confirm the diagnosis at this time?
A. X-ray of lumbosacral spine
B. Magnetic resonance imaging with contrast
C. Ultrasound
D. Three-phase bone scan

A

CORRECT ANSWER: B
Class 1 code: B2h | Class 2 code: A3e
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 143

100
Q

In order to differentiate a lesion of the common peroneal (fibular) nerve from the deep
peroneal (fibular) nerve at the fibular head, which muscle should be tested with needle
electromyography?
A. Long head of the biceps femoris
B. Short head of the biceps femoris
C. Peroneus (fibularis) longus
D. Tibialis anterior

A

.CORRECT ANSWER: C
Class 1 code: A4a | Class 2 code: B4
Reference: Braddom RL, ed. Physical Medicine and Rehabilitation. 4th ed. 2011, page 1089.

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