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AAPMR questions review > Patient management > Flashcards

Patient management Flashcards

1
Q

Which type of cryotherapy uses conduction for energy transfer?

A

cold packs

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2
Q

The accuracy of ultrasound guided sacroiliac injections is:

A

88%

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3
Q

Which of the following interventional procedures can be considered for intractable facial pain due to trigeminal neuralgia?

A

Gasserian ganglion block

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4
Q

Which of the following agents used for post-traumatic seizure prophylaxis is the best choice for a patient with thrombocytopenia?

A

Levetiracetam

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5
Q

What are common side effects of valproic acid

A

Bone marrow suppression, decreased platelet production, and thrombocytopenia

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6
Q

What is the recommended entry level for a cervical interlaminar epidural steroid injection?

A

C7-T1

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7
Q

The majority of throwing injuries in baseball pitchers occur during which phases of throwing?

A

Between late cocking and acceleration

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8
Q

Which of the following medications has the best evidence to accelerate functional recovery in patients with disorders of consciousness after severe TBI?

A

amantadine

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9
Q

Text Size
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User Note
In children with spina bifida, what is the primary goal of neurogenic bladder management?

A

Preserve the kidneys and renal function

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10
Q

A Functional Capacity Evaluation (FCE) will help determine an injured worker’s:

A

Current limitations/disability level

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11
Q

Which of the following is the most serious complication of a bupivacaine injection?

A

Cardiac dysrhythmia

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12
Q

When compared to conventional stroke rehabilitation methods, mirror therapy has been shown to improve:

A

Motor function

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13
Q

What factor directly influences a teen with spina bifida, who ambulated as a child, to discontinue walking?

A

Fatigue with obesity

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14
Q

What are some relative contraindications to neurotoxin?

A

neuromuscular disorders that could amplify the effect of the toxin, such as myasthenia gravis, Eaton-Lambert syndrome, myopathies, or motor neuron disease such as amyotrophic lateral sclerosis. Pregnancy

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15
Q

You are caring for a patient after traumatic brain injury who presents with hyponatremia. Labs reveal elevated urine osmolality and decreased serum osmolality. What is the most appropriate treatment for this patient?

A

Fluid replacement with normal saline

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16
Q

Which drug commonly used in TBI patients is known to cause hyponatremia?

A

Carbamazepine

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17
Q

Clinicians should approach patients with suspected limb-girdle muscular dystrophy (LGMD) by suggesting:

A

A clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations

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18
Q

n a patient with traumatic brain injury who has impaired speed of processing, inattention and decreased arousal, which medication is regarded as first-line therapy?

A

ritalin (not amantadine? SE profile)

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19
Q

Onabotulinum toxin A acts on muscle activity by:

A

Inhibiting acetylcholine release at the presynaptic membrane

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20
Q

A 70-year-old athletic man presents with painful osteoarthritis of the knee. Initial exercise recommendations at this stage should include:

A

Isometric quadriceps strengthening

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21
Q

Which of the following drugs is associated with increased seizure risk in patients with traumatic brain injury?

A

amitriptyline, bupropion and quinolones

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22
Q

A patient with Becker Muscular Dystrophy currently ambulates with knee-ankle-foot orthoses and forearm crutches. What exercise would you recommend?

A

Swimming twice weekly for 20 minutes

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23
Q

Manual therapy utilizes instructions and maneuvers to achieve maximal painless movement of the musculoskeletal system with a goal of improving:

A

Postural balance

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24
Q

A 25-year-old L5 complete paraplegic is admitted to your rehabilitation service two weeks after his injury. On admission you note that he tolerates an oral diet but has not produced a bowel movement for 6 days. What is the most appropriate intervention at this time?

A

Manual removal of stool from the rectum 1–2 times daily

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25
Q

A 45-year-old woman, who is hospitalized for an acute flare of dermatomyositis, is unable to get out of bed. On consultation, you recommend:

A

Passive range-of-motion exercises

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26
Q

A 45-year-old patient reports a long-standing history of unilateral headaches associated with visual scotoma and nausea. They state the headaches occur nearly daily and last for at least 4 hours per episode. They obtain relief with rest, quiet, and medications such as sumatriptan. Which of the following therapies would you recommend for headache prophylaxis?

A

Botox

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27
Q

A 30-year-old female has right knee pain after a near fall twisted her knee. She reports swelling and an inability to extend the knee, as well as locking/catching. MRI shows a meniscal tear involving the inner 1/3 of the right anterior horn medial meniscus. Which is the best surgical option for her?

A

resection of the injured portion

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28
Q

Which medication is a direct dopamine-2 (D2) antagonist?

A

haldol

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29
Q

Which of the following non-pharmacologic enhancement techniques is banned from competition by the International Olympic Committee?

A

high dose caffeine

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30
Q

Which of the following is a key feature for a bowel program in those with Spina Bifida?

A

Placing suppository on the rectal mucosa

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31
Q

Which of the following requires further evaluation before clearance for high school or college sports competition?

A

A blood pressure in a 13-year-old to be 150/80 and repeated 2 weeks later to be 147/78

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32
Q

Concerns of a pathologically thickened left ventricular wall begins at approximately ___ mm

A

13-15 (gray zone)

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33
Q

Intravenous immunoglobin (IVIg) is a commonly accepted treatment for:

A

GBS, CIDP, multifocal motor neuropathy, exacerbations of myasthenia gravis, Lambert–Eaton syndrome, dermatomyositis, and stiff person syndrome.

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34
Q

Which intervention best reduces the risk for sick leave in patients with low back pain who express concerns about their ability to maintain their employment?

A

Counseling addressing workplace barriers and leisure-time physical activity

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35
Q

Which is the best spine-board transfer technique to minimize movement at C5-6 level and achieve spinal immobilization after an on-the-field spine injury?

A

Lift and slide

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36
Q

A known complication from chronic bisphosphonate therapy is:

A

Jaw osteonecrosis & atypical femoral fractures

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37
Q

The physiological effect of warfarin is to inhibit:

A

Clotting factors II, VII, IX and X

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38
Q

Regarding the impact of spirituality on rehabilitation outcomes, which statement is important to consider?

A

Historical writings suggest an important relationship between spirituality and health

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39
Q

Which of the following muscles is useful in needle electromyography (EMG) to distinguish femoral neuropathy from L3 radiculopathy?

A

Adductors (because obturator nerve innervates)

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40
Q

A parent and child both test positive for CMT1B with a heterozygous MPZ mutation. You refer for genetic counseling and enrollment in a CMT registry. Your physiatric management and counseling includes:

A

Flexible or energy-storing AFOs for foot drop, falls reduction, and enhanced endurance for physical activity

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41
Q

Which of the following medications is a N-methyl-D-aspartate (NMDA) receptor antagonist?

A

ketamine, dextromethorphan, and methadone,

42
Q

Which Federal Act delineated the provision of special education and related services for children with disabilities?

A

Individuals with Disabilities Education Act

43
Q

Which of the following medications has labeled indications for treatment of post-herpetic neuralgia pain?

A

gabapentin, pregabalin, lidocaine 5% patch, and capsaicin 8% patch.

44
Q

A patient is undergoing a lumbar transforaminal epidural steroid injection and has immediate paralysis of the bilateral lower extremities following injection of the medication. Sensory examination reveals absence of pinprick below T10 with preservation of proprioception. What is the cause of the patient’s condition?

A

Compromise of the artery of Adamkiewicz

45
Q

Which medication has a direct effect on osteoblast/osteoclast activity to reduce bone mineral density?

A

Phenytoin

46
Q

side effects of phenobarbital and carbamazepine

A

up-regulate liver enzymes, leading to vitamin D deficiency, blood dyscrasias (carbamazepine)

47
Q

A 6-year-old boy with Down syndrome presents for evaluation of new-onset torticollis. There is no known trauma and symptoms started 2 weeks ago. The physician should assess for which etiology?

A

Atlantoaxial rotatory subluxation

48
Q

A spring placed in the posterior channel of a dual-channel (double action) ankle orthotic joint will result in:

A

Assistance with dorsiflexion

49
Q

According to the 2014 American Medical Association Code of Ethics Opinion, which statement is TRUE?

A

Individual gifts of minimal value from pharmaceutical representatives to physicians are permissible so long as the gifts are a benefit to patients.

50
Q

Isometric exercise has which of the following characteristics?

A

No physical work is performed

51
Q

Successful transition from adolescent to adult healthcare for persons with disability generally requires:

A

Ongoing developmental assessments

52
Q

A 38-year-old sheet metal worker with low back pain has difficulty sleeping so you prescribe medications, including cyclobenzaprine (Flexeril). You tell him that common side effects of cyclobenzaprine include sedation, lethargy and dry mouth. While the exact mechanism of action is unknown, cyclobenzaprine’s structure and side effect profile are similar to what class of drug?

A

TCAs

53
Q

Which treatment is shown to improve the symptoms of carpal tunnel syndrome for up to 1 year?

A

Wrist/hand splint

54
Q

An absolute contraindication for massage therapy is:

A

Deep venous thrombosis

55
Q

What are some contraindications to HVLA

A

malignancy, myelopathy and aseptic necrosis

56
Q

The physiologic increase in energy expenditure for normal cadence ambulation in a vascular transtibial amputee is closest to:

A

40-60%

57
Q

A 6-month-old boy with right Erb’s palsy is not able to bring his right hand to his mouth and has weak wrist extension. His right upper extremity passive range of motion is within normal limits. Which of the following is the most appropriate next step in treatment?

A

surgical referral

58
Q

A 20-year-old male with Duchenne Muscular Dystrophy complains of breathlessness when speaking, daily headache and fatigue. He has a forced vital capacity (FVC) of 20% predicted and end-tidal CO2 of 58 mmHg. What is the next step in management at this time?

A

Daytime assisted ventilation

59
Q

To denervate the left L4-L5 zygapophyseal joint with a neuroablative procedure, which nerve must be treated?

A

Medial branches of the dorsal rami of the left L3 and L4 spinal nerves

60
Q

An adverse effect associated with the use of phenol for chemical neurolysis in spasticity is the:

A

Occurrence of dysesthesias

61
Q

A 14-year-old obese boy complains of left hip pain with decreased range of motion, and ambulates with a limp for the past 2 weeks. Radiographs of the hip are consistent with Slipped Capital Femoral Epiphysis. What is the most appropriate treatment at this time?

A

Immediate referral to orthopaedics for surgical intervention

62
Q

You are the head team physician for a collegiate university football team. Your quarterback has sustained an anterior cruciate ligament tear confirmed on MRI. After informing the athlete of the results and obtaining consent to discuss results with the care team, whom do you communicate this news to next?

A

Head athletic trainer

63
Q

What is the most common medical complication during post-acute stroke rehabilitation?

A

Aspiration pneumonia

64
Q

Studies of basic physical therapy techniques in children with cerebral palsy have demonstrated:

A

Greater increase in strength than functional mobility

65
Q

What is the identified mechanism of action for Gabapentin?

A

voltage-gated Ca channels

66
Q

A 42-year-old patient with lumbar post-laminectomy syndrome s/p multiple surgeries and with a long history of depression presents to your clinic with concern of fatigue and decreased libido for the past 6 months. Of note, his pain has been stable on 120 mg of sustained release morphine daily and his depression is well-controlled on sertraline. What is the best next step?

A

Obtain a serum testosterone level and PSA

67
Q

Lubiprostone is used to treat constipation through the following mechanism:

A

Activating type 2 chloride channels to promote gastrointestinal motility

68
Q

A patient with a known history of chronic lymphocytic anemia and liver cirrhosis secondary to alcohol abuse presents with painful peripheral neuropathy. Which of the following antiepileptic medications is least likely to cause adverse effects in this patient?

A

Lyrica

69
Q

Work hardening programs are intended to:

A

Simulate specific job activities in a graded fashion

70
Q

The Americans with Disabilities Act requires that functional performance evaluations should:

A

Not discriminate against age and gender

71
Q

what are the physical and lab findings for SIADH?

A

acute neurologic changes, hyponatremia, low osmolality and inappropriately high urine osmolality and sodium.

72
Q

Which therapeutic intervention is considered essential to work hardening?

A

Work simulation

73
Q

The Fee for Service Model of payment makes separate payments to providers for the services that providers give to beneficiaries for a single illness or course of treatment (episode of care). This model of payment promotes:

A

Increased service utilization

74
Q

Treatment of lower limb long bone fractures in persons with chronic spinal cord injury is best accomplished by:

A

Immobilization with a soft, removable splint

75
Q

In cervical spinal cord neurapraxia (CCN), also known as transient quadriparesis (TQ), which of the following is an absolute contraindication concerning return to play?

A

Persistent neurologic deficits. Magnetic resonance imaging with evidence of cord swelling. Documented ligamentous instability. Persistent cervical pain with a loss of ROM.

76
Q

What is the most common complication associated with spinal cord stimulators (SCS)?

A

Electrode or lead problems

77
Q

Which electrodiagnostic finding is most consistent with neurogenic thoracic outlet syndrome?

A

Small median motor response from the thenar muscles. sensory and motor loss develops in the C8–T1 distribution. Thumb abduction is often affected. Sensory changes are usually in the distribution of the ulnar and medial antebrachial cutaneous nerves.

78
Q

You are caring for a patient with a severe burn and malnutrition on the acute rehabilitation unit and looking for an additional agent to support nutrition during his recovery process. Which of the following is an anabolic steroid that is FDA-approved to promote weight gain after severe physiologic stress?

A

Oxandrolone

79
Q

Which cervical injection technique has been associated with acute catastrophic neurologic injury?

A

Transforaminal epidural steroid injection

80
Q

Federal legislation that prohibits discrimination against individuals with disabilities in the areas of employment, transportation, public accommodations, state/local governments, and telecommunications is described under the following:

A

Public Law 101-336 or American with Disabilities Act (ADA, 1990)

81
Q

Which statement is correct about management of a urinary tract infection (UTI)?

A

Asymptomatic bacteriuria of urease producing organisms needs to be treated.

82
Q

An 8-year-old on the inpatient rehab service is undergoing chemotherapy for leukemia. What laboratory results are most likely to warrant activity restrictions?

A

platelet counts fall below 50,000/mm. If counts are between 30,000 and 50,000, resistance exercises are limited. With counts of 20,000-30,000, patients should limit activity to gentle exercise at bedside and all exercise should be minimized below 20,000

83
Q

beneficial effects of aquatic therapy in cardiac rehabilitation are:

A

increased stroke volume, decreased heart rate, lower end diastolic blood pressure, increased cardiac output, reduced vascular resistance

84
Q

Ultrasound utilizes the physiologic mechanism of:

A

conversion

85
Q

The advantage of using dantrolene sodium in a patient with paroxysmal sympathetic hyperactivity (PSH) and severe spasticity after brain injury is that it:

A

Works at the muscle sarcomere and reduces posturing

86
Q

Which of the following is a characteristic of an ischial containment transfemoral prosthetic socket?

A

Helps to maintain femoral adduction

87
Q

Where does the quadrilateral socket provide relief

A

The quadrilateral socket provides a relief in each corner for the hamstring tendon, gluteus maximus, rectus femoris, and the adductor longus

88
Q

Which medication for headache prophylaxis is associated with weight loss as a side effect?

A

topamax

89
Q

There is an increase in the number of urinary tract infections in the patients on the rehabilitation unit. Which action would be considered a reasonable initial management strategy?

A

Discuss the issue with the Rehabilitation Center Quality Improvement Committee and examine the rate of urinary tract infections over the past year.

90
Q

The accuracy of sacroiliac joint injections when performed without imaging guidance (ie, blindly) is about:

A

20%

91
Q

Individuals with motor complete spinal cord injury should receive which thromboprophylaxis in the acute phase following traumatic SCI once there is no evidence of bleeding?

A

LMWH

92
Q

A 12-year-old boy presents to you for right ankle pain. His parents brought a recent MRI, and a grade 3 osteochondritis dissecans lesion is noted at the talar dome. You recommend:

A

Referral to orthopedic surgery for surgical fixation

93
Q

What is the best medication class for treatment of trigeminal neuralgia in multiple sclerosis?

A

Anticonvulsants

94
Q

Sacroiliac pain and dysfunction can most reliably be diagnosed by:

A

Anesthetic block

95
Q

For adult patients with cystic fibrosis, the effects of regular aerobic exercise and an active lifestyle include:

A

Increased work capacity

96
Q

Which pharmacologic agent should be avoided because of its cognitive side-effects in individuals with brain injury?

A

Metoclopramide (Reglan)

97
Q

Disability as defined by the Americans with Disabilities Act (ADA) is:

A

A physical or mental impairment that substantially limits 1 or more major life activities

98
Q

Which massage technique has as its goal the breakup of tissue and muscle adhesions?

A

Pétrissage

99
Q

which massage technique uses a stroking motion that is beneficial for vascular and lymphatic drainage.

A

effleurage

100
Q

which massage technique uses circular motions to small areas of tissue to help with tendonitis and fasciitis.

A

Friction massage

AAPMR questions review (9 decks)

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