2002

SELF-ASSESSMENT EXAMINATION
FOR RESIDENTS (SAE-R)

Abridged Version

Copyright  2002
American Academy of Physical Medicine and Rehabilitation
Chicago, Illinois
 Abridged Version
2002 Self-Assessment Examination for Residents (SAE-R)

1. A 32-year-old male runner presents to your office with foot pain for the last 3 weeks. He reports
severe pain on the bottom of his foot, which is worse with the first few steps in the morning after
getting out of bed. He has no history of trauma and previously ran up to 12 miles daily. His running
has been severely limited since this pain began. What is the most likely diagnosis?

(a) Morton’s neuroma

(b) Plantar fasciitis
(c) Tarsal tunnel syndrome
(d) Stress fracture

2. A 67-year-old woman who had a left cortical stroke 12 months ago wishes to improve her arm and
hand function. She has good cognition. Sensation is only mildly decreased to light touch. Muscle
strength is shoulder flexion 4-/5, elbow flexion 3/5, elbow extension 3-/5, wrist extension 3-/5,
finger flexion 2/5, and finger extension 2-/5. Which technique is most likely to result in functional
improvement in this patient?

(a) Constraint-induced movement

(b) Proprioceptive neuromuscular facilitation
(c) Electromyographic biofeedback to wrist and arm extensors
(d) Electrical stimulation to finger flexors

3. Trials on the use of glucosamine and chondroitin for knee and hip osteoarthritis have shown that
these compounds

(a) reduced subchondral sclerosis, as evidenced by x-ray.

(b) decreased proteoglycan synthesis in articular cartilage.
(c) had a moderate effect on pain symptoms.
(d) had an immediate effect on symptom severity.

5. Which change is included in the revised edition of the American Spinal Injury Association (ASIA)
Impairment Scale, published in the year 2000?

(a) The zone of partial preservation (ZPP) is defined as the most rostral segment with sensory
function.
(b) The Functional Independence Measure (FIM) has been added to the standards.
(c) The definition of a motor incomplete injury requires some motor function more than 3 levels
below the motor level.
(d) The sensory exam now includes a 5-point scale to include sharp and dull sensations,
proprioception, and vibration.

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6. A 65-year-old brain tumor patient receiving inpatient rehabilitation develops nausea, fever, and
headache several hours after radiation therapy. You prescribe

(a) ceftriaxone.
(b) dexamethasone.
(c) nimodipine.
(d) sumatriptan.

7. Which group would NOT be included on a list of occupations with the largest incidences of low
back injuries that receive workman’s compensation?

(a) Truck drivers

(b) House painters
(c) Machine operators
(d) Nurses

8. Which hypothesis does NOT explain a normal electromyograph (EMG) in a patient who has a
lumbar radiculopathy?

(a) Involvement of only the sensory root

(b) Limited sampling of muscles
(c) Oxycodone taken prior to the study
(d) Timing of the study

9. Which reflex is typically NOT seen in a normal 4-month-old infant?

(a) Extremities extend on the face side as the head is turned to the side.
(b) Fingers flex when the palm is touched.
(c) Extremities extend to the direction of displacement when center of gravity is displaced.
(d) Shoulder abduction, and shoulder, elbow, and finger extension occur when the neck is
suddenly extended.

11. A 38-year-old drywall hanger presents with shoulder pain after falling onto the tip of his shoulder.
He felt immediate pain in the upper part of his shoulder, but no numbness or tingling in his arm. On
examination, he has a visible deformity on the superior aspect of his shoulder. He has pain with
horizontal adduction of his left arm across his chest and is having difficulty lifting his arm. His
passive range of motion is good. The best treatment for this patient would involve

(a) use of an arm sling for at least 4 weeks.

(b) referral to an orthopedic surgeon for surgical repair.
(c) physical therapy for Codman exercises.
(d) corticosteroid injection after 10 days.

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12. Which factor is a prime determinant of successful return to work after traumatic brain injury?

(a) Presence of associated musculoskeletal injuries

(b) Glasgow Coma Scale score at 48 hours post injury
(c) Presence of post-injury depression
(d) Pre-injury occupation type

13. A 70-year-old woman complains of acute localized mid back pain. She has a non-focal neurologic
examination. An anteroposterior and lateral thoracic spine x-ray confirms your clinical suspicion of
an acute T8 compression fracture. Which recommendation would best help her to reduce her risk of
future fractures?

(a) Swimming laps 20-30 minutes daily

(b) Isotonic abdominal strengthening program
(c) A weight reduction diet
(d) Avoidance of tobacco use

14. A 57-year-old woman complains of the onset of tingling in her feet about 2 weeks ago. She now has
muscle weakness of both legs and weakness in her handgrip. She is complaining of pain in the back
of both thighs. On examination, she is noted to have mild weakness of the orbicularis oculi
bilaterally, intact extraocular muscle movements, intact peripheral sensation, decreased grip strength
and lower limb strength measured at 3-/5. Biceps reflexes are present at 1+ and other reflexes are
absent. Immediate management measures would include

(a) oral multivitamins and folate.

(b) twice daily vital capacity testing.
(c) intrathecal steroid injection.
(d) serial erythrocyte sedimentation rates.

15. For persons with spinal cord injury who survive the first 24 hours, what is the leading cause of death
the first year post-injury?

(a) Pulmonary embolism

(b) Pneumonia
(c) Renal insufficiency
(d) Nonischemic heart disease

17. Workers who participate in a cardiovascular training program have been found to

(a) communicate with their supervisors better.

(b) be more efficient.
(c) have better job performance evaluations.
(d) report fewer sick days.

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23. An otherwise healthy elderly woman with history of osteoporosis presents with the acute onset of
focal thoracic spine pain. Your management program should include

(a) William’s flexion exercises.

(b) epidural steroid injections.
(c) spinal extension brace.
(d) steroid iontophoresis.

24. What is a common musculoskeletal complication of acute inflammatory demyelinating

polyneuropathy?

(a) Joint capsule contractures

(b) Lumbar scoliosis
(c) Achilles tendinitis
(d) Two-joint muscle contractures

25. In the emotional stages of recovery from spinal cord injury, most individuals

(a) have prolonged feelings of guilt or worthlessness.

(b) undergo a true depressive episode.
(c) experience bereavement.
(d) feel diminished interest or pleasure in almost all activities.

26. A radical neck dissection for head and neck cancer, by definition, involves sacrifice of which nerve?

(a) Glossopharyngeal
(b) Hypoglossal
(c) Spinal accessory
(d) Auriculotemporal

27. A 42-year-old jackhammer operator presents with low back and left posterior-lateral thigh pain and
numbness that began at the end of his shift 1 week ago. He has been unable to return to his job since
the onset of pain. His physical examination reveals normal reflexes, strength, and sensory function
upon examination of both lower extremities. His pain is reproduced with forward flexion of the
lumbar spine and left straight leg raise. Your recommendations include

(a) ice, muscle relaxants, x-rays, 10 days of bedrest.

(b) nonsteroidal anti-inflammatory drugs, muscle relaxants, lumbar corset, return to work.
(c) nonsteroidal anti-inflammatory drugs, education in positions of comfort, physical therapy.
(d) narcotic pain medications, lumbar corset, lumbar discography.

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28. A 27-year-old previously healthy woman awoke with severe right scapular and shoulder pain 4
weeks ago. There is no history of trauma. She has no constitutional symptoms. Three weeks ago,
her pain began resolving and scapular winging developed. Electromyography (EMG) reveals 3+
positive waves and fibrillations with markedly decreased recruitment in the right serratus anterior.
EMG of the right deltoid, biceps, pronator teres, abductor pollicis brevis, first dorsal interosseous,
and cervical paraspinals is normal, as is EMG of the left serratus anterior. The most likely
diagnosis is

(a) systemic lupus erythematosus.

(b) compression neuropathy of the dorsal scapular nerve.
(c) idiopathic brachial neuropathy (neuralgic amyotrophy).
(d) C5 radiculopathy due to cervical disc herniation.

29. Which statement is true regarding spinal cord injury without obvious radiologic abnormality in
children?

(a) It most commonly occurs in lumbar rather than cervical injuries.

(b) There is a lower incidence in younger children.
(c) It is associated with larger head size and relatively weak neck muscles.
(d) Neurologic impairmen, if it occurs, is usually apparent within 2 to 4 hours post-injury.

31. Lumbar spondylolisthesis is the term for slippage of one vertebral body on the adjacent body
below. All of the following statements are true EXCEPT

(a) It is graded 0-4, by the percentage of slippage of the superior body on the inferior one.
(b) It is caused by a fracture or defect in the pars interarticularis.
(c) A TLSO brace is the best method to stabilize an unstable spondylolisthesis.
(d) A spondylolisthesis may cause neurologic compromise of the cauda equina.

32. A 45-year-old woman with multiple sclerosis reports that her fatigue is interfering with the
activities of daily living. You prescribe an energy conservation program and

(a) amantadine (Symmetrel).

(b) valproic acid (Depakote).
(c) beta-interferon (Avonex).
(d) adrenocorticotropic hormone (ACTH).

33. On the 4th day after revision of his left total hip arthroplasty with an anterior approach, your patient
complains of pain in the left thigh after bridging in bed for the bedpan. You notice that his left leg is
externally rotated and appears shorter than his right. The LEAST likely factor contributing to your
patient’s predicament is

(a) a surgically malpositioned implant.

(b) aseptic loosening of the implant.
(c) inadherence to precautions.
(d) profound soft tissue weakness.

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34. A nonambulatory 15-year-old boy with spinal muscular atrophy is requesting a new power
wheelchair after a growth spurt. An important feature of the wheelchair prescription will be

(a) a solid seat with foam padding.

(b) extra room at each side to allow for growth.
(c) seat back below the scapular ridge.
(d) back-slanted seat with pommel.

35. You are called to the bedside of an individual with a T3 spinal cord injury sustained 7 ½ weeks
earlier. The person complains of pounding headache and appears to have piloerection on the upper
extremities, neck, and face, as well as flushing. Blood pressure is 150/90. The first thing you do is

(a) instill a topical anesthetic into the rectum in order to decrease sensation for a rectal check.
(b) apply 1 inch of topical nitropaste above the level of injury.
(c) irrigate the indwelling urinary catheter with a small amount of normal saline.
(d) sit the person up and loosen any clothing.

36. The generation of speech following a tracheoesophageal puncture procedure requires

(a) use of an electrolarynx.

(b) swallow prior to vocalization.
(c) manual tracheostomy occlusion.
(d) insertion of a one way valve.

37. A 37-year-old male pipefitter has completed physical therapy you prescribed for a C6 radiculopathy.
He no longer requires pain medication and is independent in his home exercise program. He
complains of some pain and fatigue during physical therapy. His neurologic and strength
examination is normal. Your next recommendation is

(a) a functional capacity evaluation.

(b) return to work without restrictions.
(c) vocational rehabilitation.
(d) exercise program with weights at home.

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38. A 47-year-old soldier presents with left finger extensor weakness after repetitive wrist extension
exercises at the gym. Motor nerve conduction studies were as follows:

Extensor Indicis
Nerve Stimulation Site Amplitude(mV) Conduction Velocity (m/s)

L. Radial mid-forearm 6.0

L. Radial elbow 2.0 60
L. Radial spiral groove 2.0 65
R. Radial elbow 5.8

This patient has

(a) radial neuropathy just distal to the spiral groove with axonotmesis.
(b) radial neuropathy just distal to the spiral groove with neurapraxia.
(c) posterior interosseous neuropathy with axonotmesis.
(d) posterior interosseous neuropathy with neurapraxia.

39. A 3-year-old child has a high thoracic spinal cord injury. When he reaches the age 10 years, which
complication is the child most likely to have?

(a) Isolated lumbar lordosis

(b) Thoracolumbar scoliosis
(c) Deep venous thrombosis
(d) Heterotopic ossification

40. A patient is referred to your office by his primary care physician for evaluation of an unusual gait
pattern caused by a remote case of polio. You note excessive lateral trunk flexion to the left during
stance phase between foot flat and heel off. Swing phase is normal. On exam there is normal hip
flexor strength bilaterally. The gluteus medius is 4-/5 on the left and 5/5 on the right. Knee strength
is normal. The tibialis anterior is 4-/5 on the right and 5-/5 on the left. Range of motion is normal at
all joints. Which gait abnormality is occurring?

(a) Waddling gait

(b) Steppage gait
(c) Trendelenberg gait
(d) Circumducted gait

41. A 42-year-old amateur tennis player complains of severe right elbow pain for 6 months. He has tried
heat, ice, and compression wrap without relief. He denies numbness, but does report weakness in his
grip, especially with his backhand. On examination, the patient has severe pain with palpation just
inferior to the lateral epicondyle. Which finding will most likely be present on further examination?

(a) Pain will be increased with ulnar deviation of the wrist with resisted flexion.
(b) The patient’s brachioradialis reflex will be significantly diminished or absent.
(c) Resisted wrist extension with a straightened elbow will reproduce the patient’s pain.
(d) An audible click will be heard with active supination of the forearm.

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42. A 43-year-old man with a history of insulin dependent diabetes mellitus, gastroparesis, hypertension,
and obesity had a right cortical ischemic infarct 7 days ago. The nurses note that he is having
frequent small urinary voids with a weak voiding stream. What bladder mechanism is most
characteristic for this presentation?

(a) Small volume bladder with sphincter flaccidity

(b) Spastic detrusor activity with normal sphincter
(c) Flaccid detrusor with large volume bladder
(d) Hyperactive detrusor with large volume bladder

43. The most common cause of disability in the United States is

(a) arthritis.
(b) carpal tunnel syndrome.
(c) coronary artery disease.
(d) stroke.

44. A patient ambulates with a Trendelenburg gait. You suspect an injury to the

(a) femoral nerve.

(b) superior gluteal nerve.
(c) obturator nerve.
(d) sciatic nerve.

45. You are called to the neurology intensive care unit to evaluate a patient with new spinal cord injury;
you determine that the patient has sustained a C7 ASIA A spinal cord injury. Which change in the
respiratory system would be expected?

(a) Residual volume will decline to 30% of predicted value.

(b) Pulmonary function will not improve after the first 2 weeks postinjury.
(c) Expiratory reserve volume increases 40% 6 weeks postinjury.
(d) Vital capacity of 60% predicted value may be obtained within the first 6 months post-injury.

46. One year has elapsed since a 56-year-old patient received aggressive treatment for high grade ovarian
cancer. She now presents with a 2-week history of progressive unilateral lower extremity swelling and
weakness, as well as urinary incontinence. The most appropriate initial diagnostic test would be

(a) electromyogram.
(b) urodynamic studies.
(c) pelvic CAT scan.
(d) venogram.

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47. A 29-year-old painter presents to you with 2 days of knee pain and swelling after falling off a ladder
at work. The swelling began immediately after the fall. His neurologic examination is normal, and
peripheral pulses are normal at the knee and ankle. He is unable to fully extend or flex the knee
because of pain and swelling. He is ambulating with an antalgic gait limp. Your recommendations
include ice and

(a) knee immobilizer, crutches, x-rays, return to sedentary work, recheck in 5 days.
(b) crutches, magnetic resonance imaging, referral to an orthopaedic surgeon.
(c) narcotics, physical therapy, recheck in 3 weeks.
(d) nonsteroidal anti-inflammatory drugs, x-rays, return to work.

48. A 50-year-old man complains of paresthesias of the right lateral 3 ½ digits and wrist pain. Nerve
conduction studies for the right arm (norm in parentheses) are as follows:

Motor
Nerve Distal Latency (ms) Amplitude (mV) Conduction Velocity (m/s)
R. Median 5.3 (<4.2) 5.0 (>5) 48 (>45)
R. Ulnar 3.7 (<4.2) 9.0 (>5) 52 (>45) forearm
8.5 50 across the elbow

Sensory
Nerve Stimulation Site Peak Latency(ms) Amplitude ()V)
Median (digit II) wrist 14cm 5.2 (<3.8) 15 (>10)
mid palm 7cm 2.0 20
Ulnar (digit V) wrist 14cm 3.4 (<3.8) 20 (>10)

The most likely diagnosis is

(a) cubital tunnel syndrome.

(b) ulnar entrapment at Guyon’s canal.
(c) peripheral neuropathy.
(d) carpal tunnel syndrome.

49. Acquired subluxation or dislocation of the hips in spastic cerebral palsy is usually due to muscular
imbalance and pull of the

(a) hip flexors and tensor fascia lata.

(b) hip flexors and hip adductors.
(c) rectus femoris and hip abductors.
(d) tensor fascia lata and hip extensors.

50. Which of the following distinguishes running from walking?

(a) Shorter stance phase in walking

(b) No double support in running
(c) Longer step length in walking
(d) Shorter stride length in running

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51. A 21-year-old US Army recruit reports to boot camp. After 5 days of marching, he reports to the
base physiatrist with complaints of severe pain in his left shin. He states his pain began after a 10-
mile run in full gear this morning. The pain has gotten significantly worse over the last 2 hours. He
is now unable to bear weight on his left leg. On examination, his left shin is shiny and edematous.
He has severe pain with palpation and the muscles seem tight. The most appropriate treatment plan
for this patient would be to

(a) obtain an x-ray and a triple phase bone scan.

(b) measure the pressure in his tibialis anterior muscle immediately.
(c) wrap the foreleg with an Ace bandage, applying pressure from distal to proximal.
(d) apply ice and have the patient elevate his leg when he gets back to his barracks.

52. Findings commonly seen after a right hemispheric stroke include

(a) right hemiplegia.

(b) aphasia.
(c) visual-perceptual deficits.
(d) agraphia.

53. Mr. Smith comes to your office complaining of a hot, painful, swollen left foot. He denies any
history of trauma and states that he forgot to take his allopurinol the past several days. X-rays of his
foot may reveal

(a) chondrocalcinosis of articular cartilage.

(b) bony erosion with an overhanging edge.
(c) severe juxta-articular osteopenia.
(d) pencil in cup deformity.

54. For patients with amyotrophic lateral sclerosis, exercise should be prescribed for muscles with

(a) weakness and less than 2/5 strength.

(b) muscles with visible fasciculations.
(c) weakness and better than 3/5 strength.
(d) unaffected muscles.

55. Factors associated with poor prognosis in multiple sclerosis include

(a) female gender.

(b) age at onset less than 20 years.
(c) cerebellar involvement at onset.
(d) relapsing remitting course at onset.

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56. An HMO case manager questions the potential benefits of inpatient rehabilitation for a patient with
metastatic cancer. You explain that the presence of metastases

(a) extends inpatient rehabilitation stays.

(b) decreases durable medical equipment costs.
(c) precludes autonomous mobility and self-care.
(d) does not impact achievement of rehabilitation goals.

57. A 32-year-old welder suffered a brachial plexus injury falling off a scaffold. He is unable to use his
right upper extremity because of severe weakness. According to the World Health Organization
classification system, the patient’s weakness describes his

(a) injury.
(b) impairment.
(c) disability.
(d) handicap.

59. Your 15-year-old patient with Duchenne muscular dystrophy complains of new onset morning
headaches. What is the most likely cause?

(a) Neck extensor tightness

(b) Hypercarbia
(c) Migraines
(d) Vision changes

60. What is the leading cause of amputation in the upper extremity for men between the ages of 15 and
45 years?

(a) Diabetes mellitus and/or peripheral vascular disease

(b) Other disease states (excluding diabetes, peripheral vascular disease)
(c) Trauma
(d) Tumor

61. In which case is a corticosteroid injection contraindicated?

(a) A police officer with plantar fasciitis who will return to his usual street duties 2 days after
treatment
(b) A professional tennis player with acute elbow pain associated with her backhand 1 week
before a tournament
(c) A drywall hanger with chronic shoulder pain who has had 1 prior injection 6 months ago with
good results
(d) A diabetic weightlifter with subacute medial knee pain that is warm to touch compared to the
other leg

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62. An 18-year-old man incurs a mild traumatic brain injury in a bar dispute. He presents 2 months
later complaining of persistent headaches originating in the back of the neck and radiating
circumferentially forward. After a thorough history and physical examination, you feel his
principal problem is myofascial in origin; specifically, two offending trigger points are found. Your
first approach to treatment would be

(a) amitriptyline 100mg at bed time.

(b) injection with botulinum toxin.
(c) establishing an outpatient cognitive behavioral program through psychology to address a
subacute pain syndrome.
(d) injection with 1% lidocaine.

63. A 40-year-old woman with a history of irritable bowel syndrome and tension headaches complains of
increasing fatigue and diffuse muscle soreness in her neck, shoulders, and low back. She has a non-
focal neurologic examination. Initial treatment should include

(a) 30mg twice daily of sustained release morphine.

(b) 60mg prednisone with rapid taper.
(c) 1mg lorazepam twice daily.
(d) 25mg nortriptyline each night.

65. (This question has been eliminated from the exam, therefore, it was not scored.)
Which statement is TRUE regarding persons with complete spinal cord injury with concurrent
posterior rhizotomy who receive functional neuromuscular stimulation via an implanted device to
restore bowel and bladder function?

(a) Stimulation of the posterior S2, S3, S4 nerve roots will produce micturition.
(b) Stimulation will enhance reflex voiding.
(c) Stimulation will improve reflexogenic erection.
(d) Stimulation will increase bladder capacity.

66. You are conducting an exercise tolerance test on a patient 2 months after successful heart transplant.
Relative to a patient with similar clinical characteristics following coronary artery bypass grafting,
you would rely more heavily on monitoring which parameter?

(a) Heart rate

(b) Perception of pain
(c) Intracardiac pressure via Swan Ganz
(d) Electrocardiogram changes

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67. A 50-year-old insulin-dependent diabetic truck driver with a long-standing history of smoking is
sent to you after experiencing left hand weakness following a long haul across the country. Signs
and symptoms include weakness in hand intrinsics and wrist, with numbness in the ring and little
fingers. Exam demonstrates normal upper extremity reflexes. Motor strength is normal for deltoid,
biceps, triceps, pronator teres, and opponens pollicus. There is moderate weakness of the abductor
digiti minimi. Your diagnosis is

(a) C7 radiculopathy.
(b) carpal tunnel syndrome.
(c) ulnar compression at Guyon’s canal.
(d) ulnar neuropathy at the elbow.

68. Which technique may reduce stimulus artifact when performing sensory nerve conduction studies?

(a) Increasing the impedance of the recording electrodes

(b) Increasing the stimulus duration
(c) Rotating the anode around the cathode
(d) Decreasing the low frequency filter

69. Which insult is the most likely cause of spastic diplegic cerebral palsy?

(a) Intrauterine stroke

(b) Hyperbilirubinemia in the neonatal period
(c) Postnatal intraventricular hemorrhage
(d) Perinatal asphyxia

70. Which form of prosthetic suspension is NOT utilized with the transhumeral amputation?

(a) Harness
(b) Self-suspension
(c) Suction
(d) Joint and corset

73. A 20-year-old man complains of 4-month history of low back pain that radiates into the buttocks. The
pain began insidiously, is worse in the morning, and eases up after a hot shower. The neurologic
exam is normal. Which finding will help support your likeliest diagnosis?

(a) A negative HLA-B27

(b) Symmetric wrist swelling
(c) A negative Schober test
(d) Acute iritis

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74. Which neuromuscular disorder is NOT usually associated with thyroid disease?

(a) Peripheral neuropathy

(b) Neuromuscular junction disorder
(c) Myopathy
(d) Radiculopathy

78. The type of recruitment in this graph (gain: 500 )V/div, Sweep: 10 ms/div ) is most often seen in

(a) normals.
(b) neuropathy.
(c) myopathy.
(d) poor patient effort.

79. The best predictor of community ambulation beyond childhood in patients with myelomeningocele is

(a) body mass index.

(b) quadriceps strength.
(c) early surgical closure of the meningocele.
(d) bowel and bladder continence.

80. The best example of a dynamic orthosis is

(a) dorsal wrist hand orthosis with extension force in radial nerve injury.
(b) thermoplastic ankle foot orthosis in severe foot drop.
(c) wrist hand orthosis in 15° of extension for carpal tunnel syndrome.
(d) a C-bar in median nerve injury.

81. Which statement is TRUE regarding myofascial trigger points?

(a) They exhibit electrodiagnostic abnormalities on needle examination.

(b) Their symptoms can be reproduced with palpation over the trigger point.
(c) Their identification requires at least 8 kilograms of pressure.
(d) They resolve with isokinetic exercise of the affected muscle.

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82. Risk factors for heterotopic ossification in a 27-year-old man with severe traumatic brain injury
include

(a) total parenteral nutrition.

(b) prolonged coma.
(c) seizure disorder.
(d) hypotonicity.

84. Which presentation of multiple sclerosis is most common?

(a) Relapsing-remitting
(b) Primary progressive
(c) Secondary progressive
(d) Relapsing-progressive

85. On hospital rounds, you note that your patient, who has a T10 ASIA B spinal cord injury is now
using a rigid frame wheelchair in the therapy gym. In his attempt to show off as he propels toward
you, he suddenly flips over backward. What is the most likely problem?

(a) The rear axles are located directly under his center of gravity.
(b) The rolling resistance is increased.
(c) There is too much caster flutter.
(d) There is asymmetry in the chair’s camber angle from side to side.

86. An inpatient consultation is requested on a 56-year-old patient 3 days after uncomplicated coronary
artery bypass grafting. The cardiothoracic surgical resident maintains that the patient must remain
either in his bed or chair during exercise. In formulating a rehabilitation program you

(a) agree with the resident, adding that only isometric exercise be performed.
(b) agree with the resident, adding that no upper extremity strengthening be performed.
(c) maintain that progressive ambulation can be safely initiated after postoperative day 2.
(d) maintain that upper extremity ergometry should be used for aerobic conditioning.

87. A 55-year-old secretary presents to you with neck, shoulder, and arm pain. Her pain is worse on
Friday than Monday. She denies any trauma or history of previous similar complaints. Her work
station changed a week before the onset of her symptoms. You advise her that

(a) her job has nothing to do with the pain she is experiencing.
(b) taking a week off will reduce symptoms and allow her to return to work without problems.
(c) nonsteroidal anti-inflammatory medications and ice will resolve her problem.
(d) her work station should be evaluated.

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88. Regarding the electrodiagnostic testing of a patient with definite myasthenia gravis, which statement
is TRUE?

(a) An increment on repetitive stimulation at 1Hz of up to 25% is expected.

(b) A stimulation rate of 2-3Hz is most useful in demonstrating a decrement.
(c) An initial low amplitude compound motor action potential after a supramaximal stimulus is
expected.
(d) Motor unit variability is reflected by decreased jitter during single fiber EMG.

90. Which of the following is true regarding skeletal design of a lower extremity prosthesis?

(a) Endoskeletal tends to weigh less.

(b) Exoskeletal is less hardy.
(c) Endoskeletal tends to demand less maintenance.
(d) Exoskeletal is easily adjusted after fabrication.

91. A 22-year-old skier reports to your mountain ski clinic the day after falling over her ski pole. She
complains of severe pain in her left thumb along the medial aspect of the metacarpophalangeal joint.
She has minimal swelling and no ecchymosis, but is exquisitely tender along the ulnar collateral
ligament. No mediolateral laxity is found on exam. Optimal treatment for this patient should include

(a) immediate referral to a hand surgeon for a grade III ulnar collateral ligament tear.
(b) immobilization in a thumb spica splint for a period of 2 to 4 weeks.
(c) a corticosteroid injection at the site of pain to relieve the inflammation.
(d) no intervention indicated; she should be allowed to return to ski.

92. You are asked to evaluate a 25-year-old man who sustained a traumatic brain injury (TBI) in a car
crash. In the emergency department, he was unable to follow commands but withdrew to pain,
opened his eyes when spoken to, and was disoriented. Head computed tomography revealed a frontal
contusion. According to the Glasgow Coma scale, his injury can be classified as

(a) uncomplicated mild TBI.

(b) complicated mild TBI.
(c) moderate TBI.
(d) severe TBI.

94. Which myopathy can be either autosomal dominant or autosomal recessive?

(a) Facioscapulohumeral dystrophy

(b) Limb-girdle dystrophy
(c) Myotonic dystrophy
(d) Emery-Dreifuss muscular dystrophy

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97. Workers who sustain an injury causing continued impairment cannot return to work if

(a) they are at or over the age of 55 years.

(b) their job cannot be modified to accommodate their impairments.
(c) more than 3 months have elapsed since the injury.
(d) the worker was responsible for the injury.

98. The potentials shown in this graph are

(a) fibrillations.
(b) myopathic motor units.
(c) end plate spikes.
(d) complex repetitive discharges.

99. A child with C5 ASIA A spinal cord injury should eventually become independent in which
activity?

(a) Intermittent catheterization

(b) Transfer to level surfaces
(c) Feeding
(d) Bathing

100. A medical student asks you to show her how to assess the fit of a traditional quadrilateral socket.
You explain that the best evaluation is carried out by placing the examiner’s finger between the
ischial tuberosity (IT) and the ischial seat (IS). You then tell that during full weight bearing

(a) the IT slides down into the socket when properly fit.
(b) there should be 1 fingerbreath between the IT and the IS during knee extension.
(c) the best position for determining the relationship of the IT and the IS is knee flexion.
(d) there is no room to place a finger between the IT and the IS.

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102. A 28-year-old PM&R resident had a mild traumatic brain injury. He is now having problems
organizing and leading team meeting, although his ability to perform other aspects of his job as an
individual are unimpaired. Of the following, the most useful neuropsychologic test for assessing his
deficits is the

(a) Galveston Orientation and Amnesia Test.

(b) Wechsler Adult Intelligence Scale–Revised.
(c) Wechsler Memory Scale.
(d) Trails A and B test.

103. A person with Paget’s disease typically has

(a) alternating osteoblastic and osteoclastic phases.

(b) equivocal radiographs.
(c) evidence of syndesmophytes.
(d) blue sclera.

105. Compared with able-bodied individuals, persons with spinal cord injury are likely to have

(a) equivalent percentage of regional and total body lean tissue.

(b) higher testosterone levels.
(c) equivalent incidence of dyslipidemia.
(d) a lower resting metabolic rate.

106. In reviewing the pulmonary function tests of a patient with Duchenne muscular dystrophy before
prescribing an exercise program, relative to a healthy normal person, you would expect the patient to
have

(a) increased tidal volume and increased functional residual capacity.

(b) decreased tidal volume and decreased functional residual capacity.
(c) increased tidal volume and unchanged vital capacity.
(d) unchanged tidal volume and decreased vital capacity.

107. A data entry clerk presents with complaints of right wrist and hand pain. She attributes the problem
to prolonged use of the computer mouse. Which intervention should be included in the initial
treatment plan?

(a) Eccentric strengthening of the wrist extensors with hand weights

(b) Biweekly steroid injections to minimize symptoms
(c) Wrist splint to minimize symptoms
(d) Moving the mouse away from the keyboard

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109. A 6-month-old child presents in your office for rehabilitation assessment. She was born at full
term. There was mild transient respiratory distress at birth. The patient was noted to be diffusely
hypotonic at birth except for normal cranial nerves. There were no feeding issues once the
respiratory distress resolved within 24 hours. The baby has remained relatively hypotonic since
birth. However, she has become very socially alert and aware and attempts to use her arms to reach
for toys and pick up lightweight objects. She doesn’t roll. She cannot sit except very briefly when
propped and bearing weight through both arms with elbows extended. On examination, head
circumference is normal, length is normal, as is weight. There is a pronounced head lag. Arms,
while in the supine position, maintain a “jug-handle” posture. Reflexes are present but diminished.
There is no spasticity. The cranial nerves are normal except for fine fasciculations of the tongue.
The most likely diagnosis is

(a) myotonic muscular dystrophy.

(b) cerebral palsy.
(c) infantile botulism.
(d) spinal muscular atrophy.

110. A patient presents for evaluation of his new ankle-foot orthosis (AFO). During ambulation you
notice that he has reduced hip extension and stride length, and a slowed gait. At the initiation of
stance phase, heel strike is not consistently present. You conclude that the abnormal gait is due to
excessive

(a) knee extension at heel strike and recommend setting the AFO in greater dorsiflexion.
(b) hip flexion contracture and recommend setting the AFO in greater dorsiflexion.
(c) knee flexion at heel strike and recommend setting the AFO in greater plantar flexion.
(d) dorsiflexion of the ankle and recommend setting the AFO in plantar flexion.

111. Which maneuver is used to identify sacroiliac joint pathology?

(a) Lasegue
(b) Gaenslen
(c) Ober
(d) Thomas

112. What is the most common cause of traumatic brain injury in a child under the age of 1 year?

(a) Motor vehicle crash

(b) Near drowning in bath
(c) Inflicted injuries
(d) Fall from changing table

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113. For the past 2 months, a 75-year-old man has had low back pain that radiates in a posterolateral
distribution down his right leg when he stands or ambulates. The pain is relieved by pushing a cart in
the store. He has a non-focal neurologic examination and an x-ray rules out metastatic disease. Your
initial management plan should include

(a) neurosurgical evaluation.

(b) lumbosacral corset.
(c) epidural steroid injection.
(d) flexion based exercises.

114. Which muscles are usually innervated by the median nerve?

(a) Third and fourth lumbricals

(b) Third and fourth dorsal interossei
(c) First and second lumbricals
(d) First and second dorsal interossei

115. A 15-year-old presents to the trauma unit at your hospital after a gunshot wound to the right upper
back, with an exit wound at the posterior left neck. Physical exam is as follows
R L
biceps 5/5 5/5
wrist extensors 2/5 2/5
triceps 3/5 2/5
finger flexors 2/5 2/5
intrinsics 2/5 2/5
hip flexors 4/5 4/5
knee extensors 4/5 4/5
dorsiflexors 4/5 4/5
extensor hallicus 4/5 4/5
plantarflexors 4/5 4/5
Rectal exam reveals volitional sphincter control.

You determine that his ASIA level and class are

(a) C5 ASIA C
(b) C6 ASIA C
(c) C5 ASIA D
(d) C6 ASIA D

116. A patient with advanced chronic obstructive pulmonary disease (COPD), coronary artery disease,
and copious airway secretions has begun a pulmonary rehabilitation program. The program
involves progressive aerobic conditioning on a treadmill. In order to enhance the efficacy of the
program, you recommend all the following EXCEPT

(a) nutritional counseling and increased carbohydrate intake.

(b) application of positive airway pressure breathing.
(c) low flow supplemental intranasal oxygen.
(d) inspiratory resistive loading.

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117. You are being deposed regarding a 42-year-old factory worker you have diagnosed and treated with
carpal tunnel syndrome. Objective testing that confirms your diagnosis includes

(a) nerve conduction studies and electromyography.

(b) x-rays of the wrist.
(c) positive Tinel’s test at the wrist.
(d) paresthesias in the thumb and index finger.

118. Which muscle is innervated by the peroneal division of the sciatic nerve?

(a) Adductor magnus–anterior part

(b) Piriformis
(c) Semimembranosus
(d) Biceps femoris- short head

120. In a person with complete paraplegia, which gait has the highest energy expenditure per meter?

(a) Swing-through gait in standard knee-ankle-foot orthoses

(b) Swing-through gait in Scott-Craig knee-ankle-foot orthoses
(c) Reciprocating gait in a reciprocating gait orthosis
(d) Swing-to gait using a standard walker

121. A 19-year-old male competitive swimmer complains of medial knee pain for the last 6 weeks. He
specializes in the breaststroke, and his current practice regimen consists of sprinting 1 hour per day 4
days per week. On exam, he has no effusion or crepitus. His Lachman, McMurray and pivot shift
tests are all negative, and there is no significant laxity. His Q angle is 24° with his knee extended.
His strength is normal. Which action should be recommended?

(a) Strengthen his quadriceps, concentrating on the last 30° of extension.

(b) Modify his swimming program to 3 hours per day of endurance training 6 days per week.
(c) Quit swimming, as he does not have the knee joint architecture for the sport.
(d) Refer for arthroscopic evaluation for internal derangement.

122. A 25-year-old woman with multiple sclerosis is considering having a baby, and she wants your
advice. You tell her that

(a) multiple sclerosis is not compatible with pregnancy.

(b) pregnancy does not influence the long-term disease course.
(c) multiple sclerosis exacerbations are increased during pregnancy.
(d) interferon therapy poses no risks during pregnancy.

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123. A 45-year-old woman presents with patellofemoral pain syndrome. Which physical finding is
likely?

(a) Positive anterior drawer

(b) Tight lateral thigh structures that cross the joint
(c) Q angle less than 15°
(d) Medial patellar tilt

124. A 40-year-old construction worker presents with the gradual onset of aching pain in the forearm
and hand. He reports numbness of the thumb and index fingers and drops objects at work. On
exam, weakness is present in thumb opposition, wrist flexion, and finger flexion. Reflexes at the
biceps and triceps are intact. The most likely diagnosis is

(a) C7 radiculopathy.
(b) upper trunk plexopathy (Erb's palsy).
(c) median neuropathy at the elbow (pronator syndrome).
(d) carpal tunnel syndrome.

125. Which of the following is true regarding first-year costs for persons with complete spinal cord
injury?

(a) Average hospital charges for tetraplegia are almost double those for paraplegia.
(b) Average costs for medications and supplies are equivalent to those for paraplegics and
tetraplegics.
(c) Average costs for home modifications equal those for the acute rehabilitation hospitalization.
(d) Annual recurring costs for medical care and treatment of secondary complications approach
those for that of initial injury costs.

126. Regarding exercise in severe heart failure, which of the following is true?

(a) Strengthening should be done isometrically.

(b) Exercise heart rate should be at 80%-90% of estimated maximum heart rate.
(c) Rapid hemodynamic changes may occur during warm-water aquatic therapy.
(d) Telemetry is never necessary.

128. Surface electrodes for recording antidromic sural nerve conduction studies are best placed

(a) posterior to the medial malleolus.

(b) posterior to the lateral malleolus.
(c) anterior to the medial malleolus.
(d) anterior to the lateral malleolus.

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129. Secondary injury in pediatric brain trauma is caused by

(a) hypotension, hypoxia, and hydrocephalus.

(b) growing skull fractures.
(c) coup and contrecoup cerebral contusions.
(d) diffuse axonal injuries and punctate hemorrhages.

130. In a metal ankle joint (double action joint or Klenzak ankle joint) used in ankle-foot orthoses, which
component assists dorsiflexion?

(a) Anterior spring

(b) Anterior rod
(c) Posterior spring
(d) Posterior rod

131. Which statement is TRUE regarding corticosteroid injection for severe carpal tunnel syndrome?

(a) Axonal injury can be successfully reversed with this procedure.

(b) To recognize nerve injection, do not dilute the corticosteroid with anesthetics.
(c) New pain and numbness lasting for more than 48 hours are normal.
(d) Local tenderness and superficial hematomas are rare and indicate a complication.

134. A 29-year-old man returned from his Hawaiian honeymoon complaining of hand weakness. On
examination, you find the following on muscle testing: shoulder abduction 5/5, elbow flexion 5/5,
elbow extension 5/5, wrist flexion 4+/5, wrist extension 3-/5, finger flexion 4+/5, finger extension
3/5, thumb adduction 5/5, thumb opposition 5/5. What nerve is most likely affected?

(a) Axillary nerve at the humeral head

(b) Radial nerve at the spiral groove
(c) Ulnar nerve at the cubital tunnel
(d) Posterior interosseous nerve

135. In a 22-year-old man who incurred an acute C5-6 fracture-subluxation (complete C5 tetraplegia),
from diving with an initial restoration of arm function includes

(a) upper extremity tendon transfers as early as possible to enhance goals for acute rehabilitation.
(b) splinting in a flat hand position to avoid tightening of the flexor tendons.
(c) a short opponens orthosis or utensil cuff to initiate self-care activities.
(d) exclusive use of a manual wheelchair to enhance upper extremity muscle strength.

136. In patients with Duchenne muscular dystrophy, decline in vital capacity tends to coincide with the
onset of

(a) limb contractures.

(b) use of orthotic/assistive devices for ambulation.
(c) wheelchair dependence.
(d) dysphagia.

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137. What is the major determinant of successful return to work after a work related injury?

(a) Amount of lost time

(b) Type of injury sustained
(c) Type of job
(d) Surgical intervention was required

138. A 40-year-old patient presents with weakness and sensory loss in the left arm after a motor vehicle
accident. An EMG study 4 weeks after the injury shows the following results:
Muscle Positive Waves Fibrillations Fasciculations Recruitment
L. Deltoid 2+ 2+ 1+ mod decreased
L. Biceps 0 0 0 normal
L. Latissimus dorsi 2+ 1+ 1+ mild decreased
L. Triceps 2+ 2+ 1+ mod decreased
L. Pronator teres 0 0 0 normal
L. Abd pollicis brevis 0 0 0 normal
st
L. 1 dorsal interosseous 0 0 0 normal
L. Paraspinals 0 0 0
Based on these findings what is the cause of the patient’s weakness?

(a) C6 radiculopathy
(b) Upper trunk plexopathy
(c) Posterior cord plexopathy
(d) Lateral cord plexopathy

139. To prevent contractures, which position is the correct placement for children with major burns?

(a) Shoulder in external rotation

(b) Wrist in extension
(c) Hip in flexion
(d) Metacarpophalangeal joints in hyperextension

140. Bracing for curves developing after age 3, but before puberty onset (juvenile idiopathic scoliosis)
should commence when the curve reaches approximately how many degrees?

(a) 15°
(b) 25°
(c) 40°
(d) 60°

141. Which of the following is correctly associated with its kinetic chain?

(a) The hand during a biceps curl represents an open kinetic chain.
(b) The foot during heel strike represents an open kinetic chain.
(c) The hand waving is an example of a closed kinetic chain.
(d) The foot during a squat represents an example of an open kinetic chain.

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142. A 60-year-old woman with dysarthria and right arm weakness is admitted to your stroke unit. Her
lower extremity strength is intact. You would expect the infarct to be located in the

(a) posterior frontal lobe.

(b) ventromedial thalamus.
(c) lateral medulla.
(d) anterior limb of the internal capsule.

143. A 12-year-old girl complains of localized mid back pain for 3 months, with no history of trauma. She
has a non-focal examination with a prominent thoracic kyphosis and compensatory cervical and
lumbar lordosis. She also has compensatory hamstring tightness. The most likely diagnosis is

(a) idiopathic juvenile scoliosis.

(b) juvenile ankylosing spondylitis.
(c) Pagets disease.
(d) Scheuermann’s disease.

144. A 52-year-old African American woman presents with a 3-month history of fatigue, weight loss,
proximal weakness, and muscle pain. Laboratory studies reveal an elevated creatine kinase level.
Which treatment would NOT be considered appropriate?

(a) Glucocorticoids
(b) Methotrexate
(c) Plasmapheresis
(d) Intravenous gamma globulin

146. The most common symptom associated with cancer and its treatment is

(a) pain.
(b) weakness.
(c) anorexia.
(d) fatigue.

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148. A 34-year-old pregnant woman with nocturnal paresthesias of the right lateral 3 digits and pain in
the wrist and forearm is seen for electrodiagnostic studies. The studies (norms in parentheses) reveal
the following results:

Nerve Latency (ms) Amplitude (mV) Conduction Velocity (m/s)

Motor studies
R. Median – Wrist 4.2 (<4.3) 4 (>5)
R. Median – Elbow 4 (>5) 45 (>45)
R. Ulnar – Wrist 3.4 (<4.3) 7 (>5)
R. Ulnar – Elbow 6 (>5) 55 (>45)
L. Median – Wrist 3.9 (<4.3) 7 (>5)
L. Median – Elbow 7 (>5) 52 (>45)
L. Ulnar – Wrist 3.3 (<4.3) 8 (>5)
L. Ulnar – Elbow 7 (>5) 56 (>45)

Muscle Positive Waves Fibrillations Recruitment

R. Deltoid 0 0 normal
R. Biceps 0 0 normal
R. Triceps 0 0 normal
R. Pronator teres 2+ 2+ decreased
R. Flex carpi radialis 2+ 2+ decreased
R. Flex carpi ulnaris 0 0 normal
R. Flex pollicis longus 2+ 2+ decreased
R. Abd pollicis brevis 2+ 2+ decreased
R. 1st Dorsal interosseous 0 0 normal
R. Cervical paraspinals 0 0

The patient’s symptoms are most likely due to an entrapment of the

(a) median nerve at the wrist (carpal tunnel syndrome).

(b) median nerve at the pronator teres muscle.
(c) median nerve at the ligament of Struthers.
(d) anterior interosseous nerve of the forearm.

149. Which finding would indicate a poor long-term outcome in a 9-year-old child with a severe traumatic
brain injury?

(a) Bladder and bowel incontinence

(b) Agitation
(c) Dysphagia
(d) Hypertension and hyperpyrexia

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150. A balanced forearm orthosis is indicated for patients with weakness in which muscle-group
combination?

(a) Deltoid and elbow flexors

(b) Deltoid and triceps
(c) Pectoralis group and pronators
(d) Pectoralis group and triceps

End of Multiple Choice Examination

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