2005

SELF-ASSESSMENT EXAMINATION
FOR RESIDENTS (SAE-R)

Abridged Version

Copyright © 2005
American Academy of Physical Medicine and Rehabilitation
Chicago, Illinois
 Abridged Version
2005 Self-Assessment Examination for Residents (SAE-R)

1. An overhead athlete with shoulder pain is found to have shoulder posterior capsule tightness. A
biomechanical consequence of this tightness is

(a) posterior displacement of the humeral head relative to the glenoid when the shoulder is
flexing.
(b) glenohumeral internal rotation deficit with range of motion less than 15° from neutral.
(c) impingement of the humeral head onto the superior glenoid labrum when the shoulder is
abducted less than 90°.
(d) posterior tilting of the scapula in the static position and with shoulder abduction.

5. According to the Consortium for Spinal Cord Medicine’s Clinical Practice Guidelines for the
Prevention of Thromboembolism in Spinal Cord Injury, individuals with motor complete (ASIA A
or B) spinal cord injury should receive

(a) warfarin (Coumadin), international normalized ratio target: 2–3.

(b) low-molecular-weight heparin or adjusted-dose unfractionated heparin.
(c) inferior vena cava filter.
(d) unfractionated heparin, 5000 units every 12 hours.

6. A patient with multiple myeloma presents with a new pathologic fracture of the superior pubic
ramus. Computed tomography scans and plain radiographs fail to reveal additional myelomatous
involvement of the pelvic ring. When consulted regarding weight-bearing recommendations you
advise

(a) bed rest.

(b) non-weight bearing on ipsilateral lower extremity.
(c) weight bearing as tolerated.
(d) toe touch weight bearing until surgical stabilization.

7. The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to

(a) ensure that a patient’s medical record is available only to health care providers as directed by
the patient.
(b) make sure that only qualified physicians have access to a patient’s medical record.
(c) allow a lawyer access to a medical record only if litigation is pending.
(d) allow only the treating physician to know the patient’s diagnosis.

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8. Which statement is TRUE about volume conduction as it relates to electrophysiologic studies?

(a) Volume conduction is the transmission of an electrical potential through intracellular tissue.
(b) Volume conducted potentials produce a biphasic waveform as an advancing action potential
approaches and then passes beneath a recording electrode.
(c) The negative peak of a recorded waveform represents the time that the action potential is
beneath the active electrode.
(d) Volume conducted near field potential amplitudes does not characteristically depend on the
distance between the recording electrode and the source.

11. Which exercise creates the least stress of the rotator cuff musculature?

(a) Arms in the scapula plane in internal rotation with weights

(b) Arms in the scapula plane in external rotation with weights
(c) Prone horizontal shoulder abduction in external rotation
(d) Quadruped push-up

12. Which diagnosis is associated with an increased risk of post-traumatic hydrocephalus?

(a) Diffuse axonal injury

(b) Subdural hematoma
(c) Epidural hematoma
(d) Subarachnoid hemorrhage

16. Amputation rather than limb salvage is recommended for the surgical management of high-grade
sarcomas involving the

(a) humerus.
(b) distal tibia.
(c) ilium.
(d) distal femur.

17. The Americans with Disabilities Act (ADA) was passed in order to

(a) require employers to hire individuals with disabilities.

(b) protect individuals with disabilities from having to work.
(c) ensure that the pay of workers with disabilities is equal to that of nondisabled workers.
(d) ensure that workers with disabilities have equal access in the work environment.

18. Which statement is TRUE about F-wave and H-reflex responses?

(a) They both are obtained with supramaximal stimulation.

(b) F waves can only be obtained from posterior tibial and median nerves.
(c) They both involve conduction along motor and sensory fibers.
(d) They both can be helpful in the diagnosis of S1 radiculopathy.

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19. The Gross Motor Functional Measure (GMFM) is designed to measure

(a) motor changes over time.

(b) quality of motor performance.
(c) achievement of motor milestones.
(d) only walking, running, and jumping ability.

24. What is the major factor limiting ambulation in Duchenne muscular dystrophy?

(a) Joint contracture

(b) Weakness
(c) Scoliosis
(d) Restrictive lung disease

25. A 25-year-old man with L5 complete paraplegia is admitted to your rehabilitation service 2 weeks
after his injury. On admission you note that he is tolerating an oral diet but has not produced a
bowel movement for 6 days. At this point, you recommend

(a) oxybutynin (Ditropan) 3 times a day.

(b) a contact irritant suppository with digital stimulation daily.
(c) manual removal of stool from the rectum 1–2 times daily.
(d) nasogastric decompression for a presumed ileus.

31. A 35-year-old female tennis player and data entry clerk presents with a 6-week history of lateral
elbow pain. Which factor is promoting her injury?

(a) Her strong scapular stabilizer muscle strength

(b) Her leading with the shoulder when performing the backhand tennis stroke
(c) Her keyboard being placed at too high a level at work
(d) Her tennis racquet string tension being recently increased from a low to a moderate string
tension.

32. What is the most common primary malignant tumor of the brain in adults?

(a) Medulloblastoma
(b) Meningioma
(c) Glioblastoma multiform
(d) Ependymoblastoma

34. A 19-year-old man with Charcot-Marie-Tooth disease has begun falling frequently and you note 2/5
bilateral ankle dorsiflexion strength. He ambulates with a steppage gait pattern. You would recommend
which of the following?

(a) Knee-ankle-foot orthosis

(b) Ankle-foot orthosis
(c) High top shoes with rocker bottom
(d) Supramalleolar orthosis

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41. An 8-year-old boy presents with an insidious onset of diffuse right elbow pain. Physical
examination reveals loss of full right-elbow extension. Radiographs reveal bone fragment
contiguous with the capitellum. Your advice to the patient and his parents is

(a) reassurance that this condition is self-limiting.

(b) referral to an orthopedic surgeon for surgery.
(c) start a weight-training program of his upper body.
(d) short-arm casting of the elbow for 4 to 6 weeks.

43. What is the most likely diagnosis in a 45-year-old man with a rash over the upper and lower eyelids
who complains of insidious onset of difficulty getting out of a chair and ascending stairs?

(a) Inclusion body myositis

(b) Ankylosing spondylitis
(c) Dermatomyositis
(d) Guillain-Barré syndrome

44. A 68-year-old man with diabetes-related peripheral neuropathy presents with a painful forefoot.
Physical examination reveals a pes cavus foot with hammertoe deformity. Your initial recommendation
is

(a) surgical referral for correction of deformity.

(b) physical therapy focusing on plantar fascia lengthening and intrinsic foot muscle strengthening.
(c) custom-made, total-contact foot orthotic with a built-up arch and metatarsal bar.
(d) botulinum toxin injection of the foot intrinsic muscles.

45. In preparation for discharge from your rehabilitation unit, an individual with T12 ASIA A
paraplegia requests information regarding access to a home with 5 steps. You suggest a ramp that,
for every 1 inch in elevation, should have a length of

(a) 12 inches.
(b) 8 inches.
(c) 16 inches.
(d) 24 inches.

46. Which adjuvant analgesic medication acts at ion channels to stabilize neuronal cell membranes?

(a) Gabapentin (Neurontin)

(b) Amitriptyline (Elavil)
(c) Clonidine (Catapres)
(d) Baclofen (Lioresal)

49. What percentage of American children with myelomeningocele requires a shunt to manage
hydrocephalus?

(a) 10–20
(b) 25–50
(c) 60–70
(d) 80–90

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50. What does the acronym SACH stand for?

(a) Simple amputation, cadence heel

(b) Single axis, carbon heel
(c) Standard adult, control heel
(d) Solid ankle, cushion heel

51. A 20-year-old female long-distance runner presents with a l-week history of worsening lateral hip
pain. Magnetic resonance imaging reveals bone edema at the lateral aspect of the femoral neck,
without evidence of a fracture line or cortical break. What is the next step in management?

(a) Relative rest for 4 weeks

(b) Refer to orthopedic surgeon for surgical evaluation
(c) Order a triple-phase bone scan to determine acuity of the injury
(d) Physical therapy with closed kinetic chain exercise emphasis

53. A 45-year-old man complains of wrist, thumb, and elbow pain and swelling after being on a high-
protein diet for 12 weeks. Aspiration of the elbow reveals negatively birefringent intracellular
crystals on microscopic examination. What would you expect to see on radiographs of his hands
and wrists?

(a) Distal interphalangeal joint osteophytes

(b) Pencil-in-cup deformity
(c) Juxtarticular osteopenia
(d) Joint erosion with sclerotic borders

54. What is the primary underlying cause of the restrictive lung disorders that are common in many
neuromuscular disorders?

(a) Recurrent pneumonia

(b) Prolonged wheelchair use
(c) Respiratory muscle weakness
(d) Intrinsic lung damage

57. The term maximum medical improvement (MMI) indicates that

(a) no deterioration of the condition is expected to occur.

(b) no further treatment for the condition is required.
(c) no further treatment is reasonably expected to improve the condition.
(d) physician and patient agree that the condition has stabilized.

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63. A 60-year-old woman with diabetes and hypertension complains of right foot swelling and mild
discomfort on ambulation. There is no history of trauma. Examination demonstrates decreased
sensation in the foot and a plantar ulcer. There is no sinus tarsi tenderness and no ankle instability.
What is the most likely diagnosis?

(a) Charcot’s joint

(b) Lateral ankle sprain
(c) Tarsal tunnel syndrome
(d) Plantar fasciitis

65. You are told by a physical therapist that your patient with acute C5 ASIA A tetraplegia is having
difficulty breathing, but only when sitting upright. Appropriate lab tests and radiologic studies are
unremarkable. To address the patient’s breathing difficulty, you suggest

(a) bilateral above-knee compression stockings.

(b) a tilt table program.
(c) intermittent positive pressure breathing treatments.
(d) the use of an abdominal binder.

66. The surgical transplant service requests physical therapy recommendations for a patient beginning
to reject a single lung transplant. In addition to pursed lip and diaphragmatic breathing,
recommendations should include

(a) a focus on passive stretching and isometrics.

(b) telemetry monitoring while out of bed.
(c) an aerobic exercise program.
(d) minimizing of supplemental oxygen.

69. A 9-year-old girl with C5 ASIA A spinal cord injury sustained 2 years ago is evaluated for upper
extremity splinting. Which statement regarding this scenario is TRUE?

(a) A resting hand splint should be prescribed for daytime use to preserve function.
(b) A wrist extension splint would be contraindicated for daytime use because it would interfere
with function.
(c) A mobile arm support or balanced forearm orthosis could be prescribed to make self-feeding
possible.
(d) A short hand splint should be prescribed to strengthen wrist extensor muscles.

71. Which structure is NOT part of the pain pathway for rapid transmission of immediate pain?

(a) Rexus lamina 2,3

(b) Lissauer’s tract
(c) C fibers
(d) Periaqueductal gray matter

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72. A 26-year-old woman is admitted to the inpatient rehabilitation unit following a traumatic brain
injury. She is confused, inappropriate, agitated, and requires a padded floor bed. What is her
Rancho Los Amigos level?

(a) IV
(b) V
(c) VI
(d) VII

73. A 55-year-old woman complains of bilateral thumb pain with activities. Examination reveals pain
with axial grinding of the first carpometacarpal joints as well as Heberden and Bouchard nodes in
the hands. What is an appropriate initial treatment?

(a) Resting wrist splints in neutral

(b) Thumb spica splints
(c) Compression gloves
(d) Buddy taping the digits

77. Which statement about workers’ compensation cases is TRUE?

(a) The most recent publication of the American Medical Association guidelines for disability
are used uniformly in every state.
(b) Parameters that guide entry to evaluation and treatment are unique to each state.
(c) States require subspecialty board certification for physicians who practice industrial
medicine.
(d) Most states allow injured workers to choose the physician who manages their care.

78. Which compound muscle action potential (CMAP) finding is the most compatible with myasthenia
gravis?

(a) A 15% decrement in the amplitude between the 1st and 4th responses with repetitive
stimulation at 3 hertz
(b) A low amplitude response with supramaximal stimulation of the ulnar nerve and pick-up over
the hypothenar muscles
(c) A 100% increase in the amplitude with stimulation of the spinal accessory nerve and pick-up
over the trapezius muscle immediately post exercise
(d) A 50% increment in the amplitude between the 1st and 4th responses with repetitive
stimulation at 30 hertz

80. Which muscle is primarily responsible for clearance of the leg during swing phase?

(a) Iliopsoas
(b) Hamstrings
(c) Quadriceps
(d) Tibialis anterior

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81. A 70-year-old man with severe bilateral knee osteoarthritis states that over the counter nonsteroidal
anti-inflammatory drugs and aceteminophen are not controlling his knee pain. He inquires about a
more potent anti-inflammatory medication he saw on a television commercial. Once treatment has
been initiated, which recommendation would be most appropriate?

(a) Check kidney function and a hematocrit for anemia every 6 months.
(b) Start concomitant anti-hypertensives if the patient develops high blood pressure.
(c) Switch to a cyclooxygenase-2 inhibitor if the patient is on aspirin for cardioprotective effects.
(d) Start concomitant proton pump inhibitor or histamine H2-receptor antagonists.

82. The mechanism of action of a phenol nerve block is

(a) reduction of calcium release from the sarcoplasmic reticulum.

(b) agonist action at alpha-adrenergic receptor sites.
(c) denaturation of protein in myelin sheaths and axons.
(d) inhibiton of presynaptic acetylcholine release.

83. Which agent acts on osteoblasts to increase bone formation?

(a) Calcium
(b) Calcitonin
(c) Vitamin D
(d) Estrogen

85. Based on the revised edition of the American Spinal Injury Association (ASIA) Impairment Scale,
published in the year 2000, which condition would be sufficient to categorize a spinal cord injury as
motor incomplete?

(a) Some motor function more than 2 levels below the motor level
(b) Voluntary anal sphincter contraction
(c) A well-defined zone of partial preservation
(d) An anterior spinal artery syndrome

88. Which filter setting is usually considered appropriate for routine sensory nerve conduction studies?

LOW-FREQUENCY FILTER HIGH-FREQUENCY FILTER

(a) 2–10Hz 10,000Hz
(b) 2–10Hz 2,000Hz
(c) 20–30Hz 10,000Hz
(d) 20–30Hz 2,000Hz

92. In anoxic brain injury, which area of the brain is most susceptible to hypoxemia and hypotension?

(a) Hippocampus
(b) Pons
(c) Basal ganglia
(d) Cerebellum

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94. A 16-year-old with Duchenne muscular dystrophy presents to your office with a 3-month history of
worsening shortness of breath and pressure-like chest pain. His pulmonary function testing has not
changed significantly. The most likely cause for his complaints is

(a) decreased cardiac output.

(b) bacterial pneumonia.
(c) pulmonary embolus.
(d) aspiration pneumonia.

96. You elect to treat a patient with chronic pain and a seizure disorder with an opioid. Which
medication should be avoided due to potential accumulation of a neurotoxic metabolite?

(a) Meperidine (Demerol)

(b) Hydromorphone (Dilaudid)
(c) Methadone (Dolophine)
(d) Fentanyl (Duragesic, Actiq)

98. The inferior gluteal nerve innervates which muscle?

(a) Gluteus maximus

(b) Gluteus medius
(c) Gluteus minimus
(d) Tensor fascia latae

99. A normal 6-month-old infant may demonstrate which reflex?

(a) Rooting
(b) Automatic walking
(c) Plantar grasp
(d) Posterior protective extension

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100. What is the arrow pointing to in this upper extremity prosthesis?

(a) An excursion cable

(b) An anterior split cable
(c) The elbow-lock control cable
(d) The elbow flexion cable

104. A 60-year-old woman presents with severe bulbar involvement at the time of initial diagnosis with
amyotrophic lateral sclerosis. Regarding her prognosis, which statement is TRUE?

(a) Riluzole (Rilutek) will improve life expectancy by 3 years.

(b) Her prognosis is quite poor and her life expectancy is less than 5 years.
(c) With aggressive speech therapy her prognosis will significantly improve.
(d) Bulbar symptoms at the time of initial diagnosis have a positive influence on prognosis.

105. In regards to quality of life after spinal cord injury, which factor has the LEAST correlation with
life satisfaction?

(a) Level of injury (paraplegia versus tetraplegia)

(b) Access to leisure activities
(c) Marriage
(d) Number of hospitalizations

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107. A data entry operator presents to your office complaining of a 2-week history of bilateral elbow
pain that increases in severity the longer she types. She denies sensory changes or weakness. She
has not had treatment. The only significant exam finding is pain on palpation of the proximal
extensor forearm muscles just distal to the lateral epicondyles. You recommend

(a) ice, physical therapy, evaluation of keyboard placement.

(b) heat, extensor strengthening exercises, raising of keyboard height.
(c) ultrasound, elbow brace to limit flexion, raising of monitor height.
(d) iontophoresis, wrist splint to limit extension, lowering of monitor height.

109. Which statement is TRUE about swallowing in infants?

(a) Sucking and swallowing are well-coordinated for oral intake by 34 weeks of gestation.
(b) The infant’s larynx is low, about the level of the sixth cervical vertebra.
(c) The infant’s tongue fills less of the oral cavity than the adult’s tongue.
(d) Oral breathing occurs at birth and may interfere with sucking.

110. The primary advantage of a 4-point crutch gait over a 2-point crutch gait is

(a) stability.
(b) speed.
(c) weight-bearing relief.
(d) efficiency of gait.

111. A 28-year-old non-pregnant woman presents with persistent lancinating pain along her right
zygomatic arch. The pain is intermittent and often triggered by chewing. What is the initial
management?

(a) Transcutaneous electrical nerve stimulation

(b) Carbamazepine (Tegretol)
(c) Botulinum toxin (Botox)
(d) Cervical epidural injection

112. In multiple sclerosis, which factor is associated with poor prognosis?

(a) Female sex

(b) Onset before age 30 years
(c) Positive Lhermitte sign
(d) Cerebellar involvement at onset

114. A 55-year-old man with limb girdle muscular dystrophy has severe lordosis and chronic low-back pain.
What is your initial recommendation?

(a) Thoracolumbosacral orthosis

(b) Aquatic therapy program
(c) Lumbar facet intra-articular steroid injections
(d) Core strengthening exercises

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115. Which statement is TRUE regarding treatment of spasticity in individuals with spinal cord injuries?

(a) Over 75% of individuals require treatment for their spasticity at the time of discharge from
rehabilitation.
(b) The use of a muscle relaxant such as carisoprodol (Soma) is effective in spasticity of spinal
origin.
(c) Botulinum toxin injections are effective because of their long (6–12 month) duration of
effect.
(d) Intrathecal baclofen delivery often eliminates the need for oral antispasticity medication.

117. A factory owner consults you to make recommendations on how to reduce workers’ compensation
claims. You recommend evaluation of workers’ ergonomics and equipment. Educating the
employer regarding psychosocial factors is important because workers

(a) who do not enjoy their job are more likely to report a back injury.
(b) will claim low back injuries for attention.
(c) employed in factories often have a psychiatric history.
(d) claiming injuries after ergonomic evaluation are malingerers.

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118. A 55-year-old man has had worsening symptoms of right arm pain and numbness in the right index
and long fingers. He does not have any bowel or bladder problems or symptoms in the other limbs.
His electrodiagnostic studies on the right (R) side show the following:

MOTOR NERVE CONDUCTION STUDIES

Nerve Stimulation Site Distal Latency (ms) Amplitude (mV) NCV (m/s)
R Median Wrist 3.6 8.4
Elbow 8.1 53
R Ulnar Wrist 3.5 8.9
Below elbow 8.5 57
Above elbow 8.1 55

SENSORY NERVE CONDUCTION STUDIES

Nerve Stimulation Site Recording Site Distal Latency (ms) Amplitude (µV)
R Median Wrist - 14 cm Digit II 3.2 55
R Ulnar Wrist - 14 cm Digit V 3.1 47
R Median- mixed Palm - 8 cm Wrist 1.9 76
R Ulnar - mixed Palm - 8 cm Wrist 1.8 45

NEEDLE ELECTROMYOGRAPHY
Abnormal
Spontaneous
Muscle Activity Recruitment
R Triceps 1+ Reduced
R Biceps 0 Normal
R Brachioradialis 1+ Reduced
R Extensor Digitorum 0 Normal
Communis
R Pronator Teres 2+ Reduced
R Flexor carpi ulnaris 0 Normal
R 1st dorsal interosseous 0 Normal
R Supraspinatus 0 Normal
R Cervical-paraspinals upper 0
R Cervical-paraspinals middle 2+
R Cervical-paraspinals lower 0

These findings are most consistent with right

(a) median neuropathy.

(b) radial neuropathy at the spiral groove.
(c) middle trunk plexopathy.
(d) C6/C7 radiculopathy.

121. During a physical examination, which structure CANNOT be effectively assessed by the modified
Thomas test?

(a) Iliotibial band

(b) Hip flexors
(c) Knee extensors
(d) Hamstrings

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122. Which physical diagnosis finding is associated with poor functional outcome following stroke?

(a) Loss of pinprick sensation

(b) Prolonged flaccid period
(c) Generalized increase in tone
(d) Significant shoulder subluxation

123. A 25-year-old nulliparous woman with a history of psoriasis complains of low-back pain and
occasional groin discomfort. There is no history of recent trauma. Which finding would you
expect on pelvic radiographs?

(a) Avulsion fracture at the pubic tubercle

(b) Osteitis condensans ilii
(c) Traction apophysitis
(d) Sacroiliitis

125. The majority of new spinal cord injuries in the United States are a result of

(a) violence.
(b) falls.
(c) motor vehicle accidents.
(d) sports.

126. During acute herpes zoster infection, empiric use of which medication was shown in a randomized,
blinded trial to reduce the incidence of postherpetic neuralgia?

(a) Gabapentin (Neurontin)

(b) Amitriptyline (Elavil)
(c) Clonidine (Catapres)
(d) Lamotrigine (Lamictal)

127. Studies have shown that case managers working with injured workers have

(a) interfered with the physician’s recommendations.

(b) made recommendations that favor the insurer.
(c) reduced workers’ compensation costs and lost-time cases.
(d) interfered in the relationship between physician and patient.

129. You are performing a consult on an 8-year-old child who has sustained a traumatic brain injury.
The child has hyperthermia, hypertension, tachycardia, and rigidity. The best management for this
child would be

(a) Propranolol (Inderal).

(b) Baclofen (Lioresal).
(c) Nonsteroidal anti-inflammatory drugs (NSAIDs).
(d) Amantadine (Symmetrel).

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133. A 40-year-old woman with history of Hodgkin’s lymphoma was treated with radiation 20 years
ago. She complains of left groin and thigh pain aggravated by weight-bearing. Symptoms have
been insidious in onset and there is no evidence of recurrent cancer. She has limited active hip
flexion, abduction, and external rotation. She has no back pain with passive hip extension and knee
flexion in the prone position. What is the most likely diagnosis?

(a) Avascular necrosis of the femoral head

(b) Herniated nucleus pulposus at L3/L4
(c) Iliotibial band friction syndrome
(d) Snapping hip syndrome

135. Which statement is TRUE regarding spasticity in the individual with spinal cord injury?

(a) Most antispasticity medications can completely eliminate spasticity.

(b) The incidence of spasticity is higher in individuals with lower thoracic spinal cord injury than
in those with cervical spinal cord injuries.
(c) Spasticity can offer a functional benefit to some individuals with spinal cord injuries.
(d) Clonus is an example of a tonic stretch reflex.

137. At the time of the initial evaluation of an injured worker, the physiatrist should

(a) define the anticipated time frame that pain medications will be used.
(b) ensure that the worker understands narcotic medications will be used if necessary up until
time to return to work.
(c) recommend that only non-narcotic pain medications will be used during rehabilitation.
(d) recommend patient-directed use of pain medications during rehabilitation and return to work.

140. In order to obtain a semi-electric hospital bed for a patient who requires frequent changes in body
position, which Medicare guideline must be met?

(a) The patient requires a bed with side rails for positioning the body in ways not feasible with an
ordinary bed.
(b) The patient requires a heavy-duty bed due to morbid obesity, with body weight over 500 lbs.
(c) The caregiver requires a bed to be raised up to 48 inches to facilitate wound care.
(d) The patient requires traction equipment that can be attached only to a hospital bed.

141. Which statement regarding the multifidi muscles of the back is TRUE?

(a) Atrophy of the multifidi occurs in patients with low back pain.
(b) Contraction of the multifidi causes gross trunk extension.
(c) The multifidi muscles cross 4 or more spinal levels.
(d) The multifidi have a low composition of muscle spindles.

146. Which finding supports a diagnosis of complex regional pain syndrome type I?

(a) Sensory deficits in a dermatomal distribution

(b) Cutaneous allodynia
(c) Focal motor weakness
(d) Side-to-side symmetry of dermal temperature

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147. A 49-year-old, right-handed man who works at an automobile plant painting cars presents with a 4-
week history of right shoulder pain. His pain increases with overhead activities and with donning
his coat. He is unable to sleep due to pain at night. With regards to work, you recommend physical
therapy, ibuprofen and

(a) modifying work activities to reduce overhead activities.

(b) staying off work for 4 weeks.
(c) no work restrictions or modifications.
(d) staying off work until pain free with strengthening activities.

148. A 73-year-old hospitalized patient complains of pain in the inguinal area 6 hours after a cardiac
angiogram. Examination reveals hip flexion and knee extension weakness. There is decreased
sensation over the medial ankle. Which test would you order first?

(a) Electrodiagnostic testing

(b) Arteriogram of the legs
(c) Venogram of the legs
(d) Computerized tomography of the pelvis

149. The Education for All Handicapped Children Act (EHA, PL 94-142), passed in 1976, and the
Individuals with Disabilities Education Act (IDEA, PL 105-17), passed in 1997, guarantee that
children with disabilities have

(a) education in special schools.

(b) medical care at school.
(c) education in the least restrictive environment.
(d) education in regular classrooms.

150. One disadvantage to adding camber to a wheelchair is that it

(a) decreases side to side stability.

(b) exposes the hands to injury.
(c) results in poor ergonomic positioning of push rims.
(d) makes maneuvering in narrow spaces difficult.

151. The medical literature supports the use of lumbar epidural steroid injections for which condition?

(a) Sclerotomal pain from facet-mediated low back pain

(b) Referred pain from a quadratus lumborum trigger point
(c) Neurogenic claudication due to lumbar spinal stenosis
(d) Radiculopathy caused by foraminal disc herniation

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152. A 45-year-old man with left hemiparesis following a stroke complains of left shoulder pain with
ambulation. Which of the following is the most probable cause?

(a) Cervical radiculopathy

(b) Impingement syndrome
(c) Adhesive capsulitis
(d) Shoulder subluxation

154. A 29-year-old dancer presents with right groin pain. The musculoskeletal examination is
significant for pain to palpation over the right psoas tendon and tightness in the right hip flexor. A
muscle energy technique used to reduce pain and improve range of motion of the right hip would
include

(a) isometric contraction with the hip placed in flexion.

(b) isotonic contraction with the hip placed in flexion.
(c) isometric contraction with the hip placed in neutral position.
(d) eccentric contraction with the hip placed in extension.

156. Which fitness program has been shown to improve both balance and eccentric quadriceps strength?

(a) Pilates
(b) Tai Chi
(c) Hatha Yoga
(d) Jazzercise

160. Which statement is NOT TRUE about the practice of evidence-based medicine?

(a) It incorporates the conscientious and explicit use of the current best evidence in making
treatment decisions.
(b) It includes use of the medical literature to develop strict standards of care for clinical practice.
(c) It integrates individual clinical expertise with the best available clinical evidence from
systematic research.
(d) It includes life-long, self-directed learning because caring for patients creates the need for
clinically important information.

163. Which condition is a contraindication to high velocity low amplitude manipulation of the cervical
spine?

(a) Facet arthropathy

(b) Vertebral osteomyelitis
(c) Discogenic pain
(d) History of remote carotid endarterectomy

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164. The maximum safe exposure of the skin to heated water is 45° Celsius for 30 minutes. Paraffin dip-
wrap coats the skin with a mixture of mineral oil and paraffin at a temperature of 52° Celsius. Why
does the skin not get burned?

(a) Protective subcutaneous fat layer enhanced by mineral oil

(b) More rapid cutaneous vasodilation with paraffin
(c) Conversion of thermal energy to kinetic energy
(d) Paraffin’s lower thermal conductivity

167. Abdominal belts worn by workers have been shown to restrict which motions in the lumbar spine?

(a) Lateral bending and rotation

(b) Lateral bending and flexion
(c) Rotation and translation
(d) Flexion and translation

168. Federal research regulations stipulate that each institutional research review board (IRB) is
responsible for approving all research studies at their particular institution. What condition is the
IRB NOT specifically required to determine prior to approving a research protocol?

(a) That risks related to the research are minimized

(b) That selection of subjects is equitable
(c) That protections for privacy and confidentiality are in place
(d) That research does not involve vulnerable subjects such as prisoners

169. Once an individual becomes board-certified in the specialty of physical medicine and rehabilitation,
he/she must continue to fulfill certain requirements in order to maintain certification status. Which
action is NOT a requirement for maintenance of certification?

(a) Continuing medical education credits

(b) Maintenance of active medical licensure
(c) Completion of a recertification examination every 10 years
(d) Publication of at least 1 article in a scientific journal every 10 years

170. Which attribute is a characteristic of an experimental research design?

(a) It allows one to determine a cause-and-effect relationship.

(b) It permits no manipulation of experimental variables.
(c) It is retrospective in nature.
(d) It is an observation of the natural history of a disease process.

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

(a) Metoclopramide (Reglan)

(b) Omeprazole (Prilosec)
(c) Erythromycin (E-Mycin)
(d) Sucralfate (Carafate)

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173. Which is a site where ultrasound should be used with caution?

(a) Lumbar laminectomy

(b) Osteoporotic hip fracture
(c) Lateral epicondyle
(d) Patellar bursa

178. One factor that is NOT pertinent to determining an individual’s decision-making capacity
concerning informed consent and participation in treatment decisions is the ability to

(a) express a choice, either verbally or nonverbally.

(b) understand specific information related to treatment decisions.
(c) seek advice from other health care providers.
(d) appreciate the significance of information as it applies to one’s condition.

180. The Commission on Accreditation of Rehabilitation Facilities (CARF) defines program evaluation
as a

(a) systematic procedure for measuring the outcomes of care.

(b) method of preventing medical complications.
(c) routine means of building team relations.
(d) procedure to develop new programs for rehabilitation.

182. In traumatic brain injury, magnetic resonance imaging (MRI) is preferred to computed tomography
(CT) scan in the

(a) evaluation of acute brain injury.

(b) detection of subarachnoid hemorrhage.
(c) detection of epidural hematomas.
(d) evaluation of diffuse axonal injury.

183. Non-swimming aquatic therapy in late poliomyelitis patients provides which benefit?

(a) Increased peak oxygen uptake

(b) Reduction in knee joint effusion
(c) Improved muscle strength in affected muscles
(d) Reduction of heart rate with same work load

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185. A 25-year-old man is admitted to your rehabilitation facility 3 weeks after sustaining a spinal cord
injury. His motor and sensory examination is as follows:
Motor Examination
__________________________________________________________________________
Muscle Tested Right Side Left Side
Deltoids 5 5
Biceps 5 5
Wrist Extensor 5 5
Triceps 3 3
Finger Flexors 1 1
Intrinsics 0 0
Hip Flexors 0 0
Knee Extensors 0 0
Dorsiflexors 1 0
Plantarflexors 0 1

Sensory exam reveals intact pinprick and light touch sensation through C7. Sensation is absent
below C7 except for intact perianal sensation.

What is the patient’s ASIA score?

(a) C7 ASIA C
(b) C6 ASIA C
(c) C6 ASIA B
(d) C7 ASIA B

187. You are asked to make specific exercise recommendations regarding how to reduce low back
injuries in a factory’s workers. As part of your program, you recommend that workers

(a) be fitted for a lumbar corsets.

(b) with heavy lifting work requirements avoid participation in sports.
(c) with a history of low back pain be moved to more sedentary, seated jobs.
(d) be instructed to reduce the amount of early morning flexion.

189. You have just finished admitting a 60-year-old diabetic man who has recently undergone a right
below-knee amputation. The patient's son stops you in the hallway and inquires about his father's
health status and prognosis for walking again. You have never met the patient's son before, and
before answering the questions, you would first

(a) further review the patient's medical record and determine his cardiac status.
(b) perform a literature review of outcomes research in individuals with below-knee amputations.
(c) ask the patient for permission to discuss his health status with his son.
(d) ask the son if the patient has a living will or a health care power-of-attorney.

192. The association of apolipoprotein-E (APOE-4) allele and history of traumatic brain injury increases
the risk of developing

(a) hydrocephalus.
(b) alzheimer’s disease.
(c) post-traumatic epilepsy.
(d) cerebral neoplasms.

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193. A 65-year-old woman with shoulder osteoarthritis asks how to use ice for her shoulder pain. For
how many minutes per session should she apply ice to her shoulder?

(a) 5–10
(b) 10–15
(c) 20–30
(d) 30–40

196. Acupuncture is described as reducing pain through neuromodulation. Through what mechanism is
neuromodulation theorized to reduce pain?

(a) Stimulation of large sensory afferent fibers that suppress pain perception
(b) Release of local cytotoxins that induce inflammation
(c) Inhibition of sensory afferent fibers that transmit pain perceptions
(d) Central nervous system reorganization of the somatosensory cortex

200. You have been asked to evaluate a 60-year-old man who suffered a left internal capsule ischemic
stroke 3 days ago. He is currently hospitalized and he has been deemed by his primary care
provider to be medically stable for transfer to an inpatient rehabilitation program. The patient has a
right hemiparesis and dysarthria. On your assessment, cognition appears intact. You agree that the
patient is an appropriate candidate for admission. You discuss the benefits of inpatient
rehabilitation with the patient and his family, but the patient elects to go home with home health
services instead of being admitted for inpatient rehabilitation. The ethical principle followed in
abiding by the patient’s wishes is the principle of

(a) beneficence.
(b) autonomy.
(c) paternalism.
(d) social justice.

End of Examination

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