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1

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

B

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

2

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

C

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

3

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

D

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

4

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

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

D

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

5

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

B

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

6

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)

D

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

7

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

C

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

8

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

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

A

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

9

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

C

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

10

What is the most common cause of diskitis?

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

D

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

11

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

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

12

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

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

13

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

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

B

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

14

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

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

15

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

15. 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.

16

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

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

17

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

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

18

Typical radiologic findings in osteoarthritis involving the knee are

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

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.

19

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

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

20

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

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

21

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

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.

22

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

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

23

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

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

24

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

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.

25

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

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.

26

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

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.

27

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

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.

28

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

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

29

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

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.

30

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

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