Board Questions

Which factor differentiates myotonic discharge from complex repetitive discharges (CRDs)? A. Amplitude and frequency of potentials B. Duration of the potentials C. Complexity of waveforms in CRDs D. Resemblance of myotonic discharge to triphasic motor unit response

A

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

A

Which level is the most common site of spinal cord injury (SCI) in an elderly patient? A. Cervical B. Upper thoracic C. Lower thoracic D. Lumbosacral

A

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

B

An expected motor conduction abnormality in severe radiculopathy is A. prolonged distal latency B. decreased amplitude C. slowed velocity D. abnormal temporal dispersion

B

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

C

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

C

What is the most common cause of knee pain in runners? A. Diskoid meniscus B. Hamstring tendinitis C. Baker cyst D. Patellofemoral pain syndrome

D

What is the preferred imaging technique to rule out Osgood-Schlatter disease? A. Conventional radiography B. Arthrography C. Ultrasonography D. Magnetic resonance imaging

A

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

A

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

A

What is the mechanism of heating with hot packs? A. Conduction B. Convection C. Conversion D. Radiation

A

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

A

A 28-year-old man develops insidious onset of chronic low back pain with morning stiffness. A diagnosis of ankylosing spondylitis requires A. radiographic demonstration of sacroiliac joint abnormality B. a positive HLA-B27 test C. ophthalmologic confirmation of acute anterior uveitis D. an elevated erythrocyte sedimentation rate

A

The most sensitive method available for early diagnosis of avascular necrosis of the hip is A. magnetic resonance imaging B. radionuclide bone scan C. computed tomography scan D. x-ray

A

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 range of motion C. active range of motion D. surgery

A

What is the most common diagnosis in young female gymnasts with chronic back pain? A. Spondylosis B. Spondylolysis C. Spondylitis D. Spondylolisthesis

B

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

B

Which condition would qualify as an impairment according to the International Classification of Function (ICF)? A. Short stature B. Loss of hearing due to occupational exposure C. Inability to work due to chronic illness D. Inability to walk one block

B

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

B

For patients with brain injuries who manifest agitation, carbamazepine is used because of its A. mood-stabilizing effect B. anticonvulsant effect C. sedative effect D. anti-anxiety effect

A

Mallet finger deformity results from rupture of the A. extensor tendon insertion B. profundus tendon C. distal collateral ligaments D. extensor indicis muscle

A

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

A

One week after a patient began a resistance/strengthening program, you note a 15% increase in the force of their maximum voluntary contraction. This is most likely secondary to a change in the A. motor unit recruitment pattern B. number of myofibrils C. number of muscle fibers present D. fiber density

A

The prehensile function of a myoelectric hand simulates which grip pattern? A. Three-jaw chuck B. Lateral C. Spherical D. Power

A

The test in this video is useful for diagnosing A. a syndesmosis injury B. anterior compartment syndrome C. an Achilles tendon rupture D. a peroneal tendon dislocation https://vimeo.com/131888181

A

What is the most common mechanism for Achilles tendon rupture? A. Eccentric dorsiflexion B. Eccentric plantar flexion C. Passive dorsiflexion D. Passive plantar flexion

A

What is the most common site of cerebral contusion following a traumatic brain injury (TBI)? A. Temporal lobe B. Occipital lobe C. Corpus callosum D. Midbrain

A

What is the most important aspect of wound care for a diabetic foot ulcer? A. Debridement of necrotic tissue B. Oral antibiotics C. Topical antiseptic application D. Chemical corn/callus removal

A

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

A

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

A

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

A

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

A

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

A

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

A

Which clinical feature puts a patient with a traumatic brain injury (TBI) at greatest risk for developing posttraumatic epilepsy? A. Penetrating injury B. Intracranial hematoma C. Subdural hematoma D. Prolonged coma

A

Which nerve is most commonly injured with traumatic anterior shoulder dislocations? A. Axillary B. Radial C. Long thoracic D. Thoracodorsal

A

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

B

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

B

What is the advantage of using closed kinetic chain exercises during the early stages of an anterior cruciate ligament (ACL) rehabilitation program? A. Improved targeting of the vastus medialis B. Decreased shear forces across the joint C. Improved terminal stretch D. Limited knee extensor synergist activity

B

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

B

What is the expected outcome of effective exercise training in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD)? A. Reduced need for supplemental oxygen B. Reduced dyspnea C. Improved radiologic status of the lung fields D. Slowed loss of forced expiratory volume

B

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

B

What is the most common pathology underlying rotator cuff disorders in the nonathlete? A. Deltoid atrophy B. Subacromial impingement C. Acromioclavicular arthritis D. Bicipital tendon disorder

B

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

B

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

B

Which clinical disorder is most likely to produce detrusor hyperreflexia? A. Poliomyelitis B. Multiple sclerosis C. Tabes dorsalis D. Muscular dystrophy

B

Which medication should be recommended for the patient in this video? A. Benztropine B. Carbidopa/levodopa C. Pyridostigmine D. Baclofen

B

Which provocative test evaluates both the hip and sacroiliac joints? A. Straight leg raise (or Lasègue) B. Patrick (or FABER) C. Trendelenburg D. Thomas, with resistance applied

B

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

Which exercise has the greatest effect on bone formation? A. Weight lifting B. Cycling C. Swimming D. Tai Chi stretching

A

What is the best orthotic management for an acute knee grade 2 medial collateral ligament sprain? A. Swedish B. Unloading C. Immobilizer D. Functional

C

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

C

What is the most common cause of lumbar stenosis? A. Disk herniation B. Vertebral compression fractures C. Degenerative disk disease D. Spondylolysis/spondylolisthesis

C

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

C

Sustained weakness (beyond two months) after a single episode of nerve compression is usually a result of A. isolated paranodal demyelination without conduction block B. multifocal demyelination with conduction block C. demyelination with underlying Wallerian degeneration D. axonal stenosis

C

The best example of an open kinetic chain exercise of the quadriceps is A. a stairclimbing machine B. a wind-resistance exercise bicycle C. an isokinetic knee extension machine D. a treadmill inclined to 7 degrees

C

The following tracing represents A. myokymia B. myotonia C. complex repetitive discharge D. endplate potentials https://vimeo.com/131888180

C

De Quervain disease is a tenosynovitis of the A. extensor pollicis longus and extensor pollicis brevis B. extensor pollicis longus and flexor pollicis longus C. abductor pollicis longus and extensor pollicis brevis D. adductor pollicis brevis and extensor pollicis brevis

C

During an exercise tolerance test, what percent of the maximum heart rate is the usual target? A. 65 B. 75 C. 85 D. 95

C

The long-term consequences of high bladder outlet resistance in children with myelomeningocele include A. flaccid detrusor B. retrograde ejaculation C. ureteral dilatation D. increased bladder compliance

C

What is the best initial knee imaging study on a patient with suspected Osgood-Schlatter disease? A. Magnetic resonance imaging B. Computed tomography scan C. Lateral radiograph D. Skyline view radiograph

C

Electrodiagnostic testing on a patient with carpal tunnel syndrome reveals prolonged median sensory latencies, prolonged median motor distal latencies, and thenar muscle partial denervation. Which additional finding is likely? A. Hypothenar denervation B. C7 myotome denervation C. Reduced median motor evoked amplitude D. Uniform median motor forearm slowing

C

A patient presents with joint pain and swelling with symmetric involvement of the ankles, heels, spine, and sacroiliac 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. Behçet syndrome

B.

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

C

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

C

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

C

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

C

Which wheelchair feature is useful for a person with hemiplegia? A. Asymmetric arm rests to prevent anterior glenohumeral subluxation B. Donut cushion to prevent pressure ulcers C. Low seat height to facilitate steering D. Heavy frame to prevent tipping

C

Which wheelchair modification is best for a 90-year-old woman with a short right transfemoral amputation and a left transtibial amputation who has good upper extremity function? A. Attendant-propelled geriatric chair B. Tilt-in-space chair C. Chair with the rear axle moved 3-5 cm posteriorly D. Chair with 10-15 pounds of weight added to the foot rest

C

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

In addition to magnetic resonance imaging (MRI), which test may help establish the diagnosis of multiple sclerosis (MS)? A. Electromyography B. Myelogram C. Sedimentation rate D. Cerebrospinal fluid analysis

D

In an older adult who previously had polio, new weakness is most consistent with postpolio syndrome when it occurs A. after recent disuse B. in proximal muscle groups of both the upper and lower extremities C. after recent weight gain D. in the muscles most severely involved in the initial illness

D

In complex regional pain syndrome (CRPS) type I of the upper extremity, sympathetic versus nonsympathetic mediated pain is best differentiated by A. causalgia B. trophic changes C. vasomotor instability D. stellate blockade-induced pain relief

D

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

D

Information obtained from the tibial H reflex to the triceps surae is most helpful in the diagnosis of A. tibial nerve injury at the tarsal tunnel B. tibial nerve injury in the distal thigh C. L5 radiculopathy D. S1 radiculopathy

D

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

D

When prescribing cervical traction for a patient with a radiculopathy, in which position should the neck be placed? A. Full extension B. Partial extension C. Full flexion D. Partial flexion

D

A 30-year-old man presents with low back, knee, and ankle pain of two months' duration. He also has had burning on urination. Physical examination reveals a rash over the palms and soles. Sacroiliitis is present on radiographs. The clinical diagnosis is A. ankylosing spondylitis B. psoriatic arthropathy C. gonococcal arthritis D. reactive arthritis (Reiter disease)

D

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

D

When a patient with recent onset of hemiplegia shows progressive motor recovery from Brunnstrom Stage 1 to Brunnstrom Stage 3, what do you expect? A. Decreasing tone and increasing isolated voluntary movements B. Unchanged tone and increasing isolated voluntary movements C. Decreasing tone and increasing synergistic movements D. Increasing tone and increasing synergistic movements

D

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

D

The most common abnormal urodynamic finding in stroke survivors is A. detrusor-sphincter dyssynergia B. the absence of urethral sphincter activity C. low bladder compliance D. detrusor hyperreflexia

D

To reduce flexion hypertonicity at the elbow following a stroke, the muscles to be considered for botulinum toxin injection include the biceps brachii, brachialis, and A. pectoralis major B. teres major C. coracobrachialis D. brachioradialis

D

Typical radiologic findings in osteoarthritis involving the knee are A. symmetrical joint space narrowing B. meniscal calcification C. trabecular sclerosis D. subchondral cysts

D

What is a contraindication for superficial heat? A. Joint replacement B. Hematoma C. Superficial thrombophlebitis D. Sensory deficit

D

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

D

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

D

What is the most common cause of diskitis? A. Pseudomonas B. Mycobacterium C. Streptococcus D. Staphylococcus

D

What is the most common site for osseous metastasis? A. Ribs B. Pelvis C. Long bones D. Spine

D

A patient complains of pain inferior to the anteromedial surface of the knee, especially while climbing stairs. On examination, there is tenderness to palpation over the proxial anteromedial tibia. What is the most likely diagnosis? A. Pes anserinus bursitis B. Iliotibial band syndrome C. Patellar tendinitis D. Prepatellar bursitis

A

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

A

Clinical findings resulting from the lesion demonstrated in the accompanying cranial computed tomography (CT) scan are A. right hemiparesis and aphasia B. left hemiparesis and left hemineglect C. right hemiataxia and dysphagia D. left hemiataxia and dysphagia

A

A patient experiences pain and decreased motion in the right shoulder following a radical neck dissection for laryngeal carcinoma. On examination, you note atrophy and weakness of the ipsilateral trapezius. Passive range of motion (ROM) is normal; however, active ROM shows decreased shoulder abduction and decreased scapular rotation. Your therapy orders should emphasize strengthening exercises for the A. rhomboids B. pectoralis major C. infraspinatus D. latissimus dorsi

A

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

A

A concrete worker tells you he injured his knee at work one week ago. In records furnished from the day of injury, he reported that playing basketball caused the injury. Although you record this discrepancy, the workers' compensation insurance company accepts responsibility. The patient has no personal health insurance. You should A. continue treating the patient B. refuse treatment of the patient due to an inconsistent history C. confront the patient with the medical records and insist the patient refuse workers' compensation benefits D. insist on fee for service prior to treating the patient

A

A patient with a moderately severe traumatic brain injury (TBI) made gradual improvements over two months but then developed a shuffling gait and has stopped initiating conversations. What is the most likely diagnosis? A. Communicating hydrocephalus B. Meningitis C. Depression D. Temporal lobe seizure

A

A 50-year-old man with type 2 diabetes mellitus presents for evaluation of a swollen ankle. An examination demonstrates diminished pinprick sensation in a stocking pattern, absent ankle jerks, and a warm, erythematous right ankle with a mild effusion. What is the most likely diagnosis relating to the right ankle? A. Charcot joint B. Rheumatoid arthritis C. Septic arthritis D. Avascular necrosis

A

A 50-year-old retired army paratrooper with diabetes complains of pain on ambulation due to degenerative joint disease in his right hip. You prescribe a single cane to A. decrease weight-bearing forces across the arthritic hip joint B. help in sensory feedback or environmental scanning C. compensate for gluteus medius weakness D. increase the base of support, thus increasing stability and balance

A

A 57-year-old man sustained a stroke one year ago. He now has good voluntary control of the affected arm, with elbow and shoulder strength at 4/5, wrist extension at 2+/5, finger extension at 2-/5, and fair grip. Tone is minimally increased throughout the arm and sensation is intact. What is the most effective means of improving his hand function? A. Restraining the unaffected hand during activities of daily living B. Electromyographic biofeedback for the wrist extensors C. Alternating hot and cold stimulation to the affected hand D. Intensive training of the unaffected hand in one-handed techniques

A

A 70-year-old woman presents with symmetrical stiffness, tenderness, and pain over both shoulders and proximal thighs. The symptoms have persisted for the past 10 weeks. The sedimentation rate is 110. The best therapeutic approach is to prescribe A. steroids B. colchicine C. methotrexate D. nonsteroidal anti-inflammatory drugs

A

A 76-year-old woman is referred for rehabilitation following a recent left total hip arthroplasty. To prevent hip dislocation, you instruct the patient to avoid hip A. adduction beyond neutral B. abduction greater than 20 degrees C. flexion greater than 45 degrees D. external rotation beyond neutral

A

A 45-year-old woman presents with a three-month history of nonradicular low back pain but no history of trauma. X-rays show degenerative changes and grade 2 spondylolisthesis at L4-5. What is the best recommendation? A. Bed rest for two weeks B. Abdominal muscle strengthening C. Isokinetic back extension strengthening D. A polypropylene body jacket

B

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

B

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

B

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

B

A 33-year-old cab driver was involved in a rear-end motor vehicle crash and hit his knee against the dashboard. He presents with a six-week history of knee pain, a positive posterior drawer sign, and difficulty walking down inclines. What is the most important muscle group to strengthen? A. Knee flexors B. Knee extensors C. Hip flexors D. Hip extensors

B

The proper length for a cane should be measured with the elbow in which position? A. Full extension B. 20 degrees of flexion C. 45 degrees of flexion D. 90 degrees of flexion

B

A 14-year-old boy presents with a three-month history of knee pain. The pain is most marked in the area of the tibial tubercles bilaterally and it increases with activity. Physical examination is unremarkable. What is the likely diagnosis? A. Patellar tendinitis B. Osgood-Schlatter disease C. Patellofemoral arthritis D. Rheumatoid arthritis

B

A 22-year-old patient with 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 10 Hz. These findings are most consistent with A. polymyositis B. no abnormality C. brachial plexopathy D. C6 radiculopathy

B

A 28-year-old patient with T2 paraplegia complains of symptoms of autonomic dysreflexia during her bowel routine. Which treatment is the best next step? A. CO2 suppositories B. Topical anesthetic application C. Digital stimulation with glycerin D. Bisacodyl enemas

B

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

B

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

B

A patient with gangrene of the distal foot has the following segmental pressures. What level of amputation is recommended for optimal healing and ambulation? ABI: 0.5 Lower Calf:0.6 Upper Calf:0.9 Lower thigh: 1.0 Upper thigh:1.2 A. Syme B. Below knee C. Above knee D. Hip disarticulation

B

According to World Health Organization (WHO) classification, an example of an impairment is A. ischemic brain damage B. weakness of one arm C. loss of ability to get dressed D. need for an ankle-foot orthosis to walk

B

After completing an independent medical evaluation on a patient with a work-related injury, you believe there is a 75% chance the described occurrence caused the patient's current symptoms. What is the appropriate legal term for the chance of causality? A. Possible B. Probable C. Likely D. Reasonable

B

Compared with conventional residual limb care for a patient with a transtibial amputation, the immediate postoperative rigid dressing technique A. provides less effective pain control B. promotes wound healing C. exposes the residual limb to excessive trauma D. provides less effective desensitization

B

During a trial of a new antispasticity medication, a preliminary analysis of results indicates that subjects treated with the medication have significantly more gastric ulcers than the control population. The study is suspended immediately. This action indicates respect for which ethical principle? A. Autonomy B. Nonmaleficence C. Beneficence D. Justice

B

During ambulation using a transfemoral prosthesis, a patient raises his entire body (vaults) with plantar flexion of the sound foot during the swing phase of the prosthetic extremity. To decrease the vaulting, you should A. lengthen the prosthesis B. tighten the socket suspension C. set the prosthetic foot in a few more degrees of plantar flexion D. add a knee extension aid

B

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

B

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

B

In a 35-year-old patient with Charcot-Marie-Tooth (CMT) disease, orthotic management will most likely consist of A. custom-molded, longitudinal arch supports B. an ankle-foot orthosis C. a knee cage brace D. a resting wrist splint set at 10 degrees of extension

B

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

B

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

B

In a patient who sustained a thalamic stroke, how are pain and temperature perception affected below the level of the lesion? Location Temperature A. Ipsilateral Loss B. Contralateral Loss C. Ipsilateral Intact D. Contralateral Intact

B

In a patient with an acute spinal cord injury (SCI), intermittent catheterization should be instituted A. within 24 hours of injury B. when regular, controlled fluid intake is occurring C. when spinal shock is resolved D. when the patient can perform self-catheterization

B

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

B

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

B

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

B

Recording of the F wave is particularly helpful early in the course of A. cervical radiculopathy B. acute inflammatory demyelinating polyradiculoneuropathy C. diabetic peripheral polyneuropathy D. critical illness polyneuropathy

B

Selection criteria for shunting for hydrocephalus after traumatic brain injury (TBI) include A. enlargement of the sulci on computed tomography scan B. deterioration in level of consciousness C. lumbar cerebrospinal fluid pressure of 10 mm Hg D. posttraumatic amnesia for more than 24 hours

B

The neurologic examination of a patient with T6 spinal cord injury (SCI) reveals no motor function below T6, but sensory sparing in the sacral segments. This patient would be classified as American Spinal Injury Association (ASIA) Impairment Scale grade A. A B. B C. C D. D

B

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

C

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

C

Chronic radicular pain in patients with a spinal cord injury (SCI) is most effectively treated with A. muscle relaxants B. narcotic analgesics C. anticonvulsants D. nonsteroidal anti-inflammatory drugs

C

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

C

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

C

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

A patient recently fell onto her outstretched hand with the wrist dorsiflexed and radially deviated. Physical examination is suggestive of a scaphoid fracture. Radiographs of the wrist and hand, including special scaphoid views, are negative. The appropriate initial treatment is A. observation B. an elastic bandage (eg, Ace wrap) C. a cast or splint D. operative intervention

C

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

C

A patient with low back pain of six weeks' duration has mild left calf atrophy, diminished plantar flexion strength, and absent Achilles reflex. Electrodiagnostic testing shows an absent H reflex; normal insertional activity in all muscles tested; moderately large amplitude, mildly polyphasic motor units in the left medial gastrocnemius, the lateral hamstring, and the gluteus maximus; and normal motor units elsewhere. What is the diagnosis? A. Acute S1 radiculopathy B. Old tibial neuropathy in the thigh C. Old S1 radiculopathy D. Lumbosacral polyradiculopathy

C

According to The Joint Commission patient safety guidelines for abbreviations, which order is written appropriately? A. 50 μ B. 5.0 μg C. 0.5 mg D. .05 mg

C

A 17-year-old football player sustained a noncontact knee injury while planting his leg to make a cut. He heard a pop and felt his knee buckle. What is the most sensitive clinical test to establish the diagnosis? A. Posterior drawer B. McMurray C. Lachman D. Anterior drawer

C

A 25-year-old restrained driver is involved in a head-on motor vehicle crash. Two weeks later, the individual complains of pain and paresthesias in the thigh. No loss of muscle strength is noted on examination, but there is a decrease in sensation in the symptomatic thigh. Which neuropathy is the most likely etiology for this patient's complaint? A. Ilioinguinal B. Obturator C. Lateral femoral cutaneous D. Saphenous

C

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

C

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

C

A 52-year-old office worker presents with chronic headaches. She has failed numerous modalities and pharmacologic remedies. There is no history of substance abuse. Opioids were prescribed by her primary care doctor with success at aborting the headaches. She is concerned with the risk of addiction. You suggest that A. she discontinue opioids since they are not indicated for headaches B. she take naloxone as an antagonist to reduce the risk of addiction C. addiction is highly unlikely if used for her medical treatment D. she enter a drug treatment program to eliminate the opioids

C

A 55-year-old multiparous woman with a history of mild stress urinary incontinence has significant urinary incontinence after a stroke. A cystometrogram performed with electromyographic monitoring of the external urinary sphincter is normal. Potentially useful pharmacologic interventions include A. cholinergic agonists B. alpha-adrenergic antagonists C. beta-adrenergic antagonists D. cholinergic antagonists

C

A 71-year-old man on the rehabilitation unit recovering from hip replacement surgery has sudden onset of aphasia and right hemiparesis. What is the first diagnostic test to obtain? A. Arterial blood gases B. Electroencephalogram C. Computed tomography scan D. Magnetic resonance arteriogram

C

A high titer of antibody to double-stranded DNA is specific for A. scleroderma (systemic sclerosis) B. Sjögren syndrome C. systemic lupus erythematosus D. mixed connective tissue disorder

C

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

C

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

C

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

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

C

On needle electromyography, a normal, fully relaxed muscle typically shows A. small amplitude polyphasic motor units B. positive sharp waves C. electrical silence D. fibrillation potentials

C

Postmenopausal women should ingest how many milligrams of calcium daily? A. 500 B. 1000 C. 1200 D. 2000

C

The test demonstrated in this video is designed to elicit symptoms from which nerve? A. Deep peroneal (fibular) B. Superficial peroneal (fibular) C. Tibial D. Sural

C

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

C

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

C

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

C

When using an anesthetic for local infiltration prior to shoulder injection, which compound has the longest duration of analgesia? A. Lidocaine B. Mepivacaine C. Bupivacaine D. Prilocaine

C

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

C

Which electrodiagnostic technique is most useful in diagnosing a radiculopathy? A. Nerve conduction study B. Late responses C. Needle electromyography D. Repetitive nerve stimulation

C

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

C

Which musculoskeletal disorder is most appropriately treated with ultrasound? A. Greater trochanteric bursitis following hip replacement B. Postlaminectomy syndrome C. Lateral hamstring tendinitis at the muscle origin D. Plantar fasciitis associated with peripheral neuropathy

C

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

c

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

D

Which modality should precede shoulder stretching in a patient with adhesive capsulitis? A. Massage B. Ice packs C. Electrical stimulation D. Ultrasound

D

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

D

A 36-year-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 (Martin-Gruber 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

A 42-year-old receptionist has a two-year history of severe radial wrist pain which is worse with pinching activities. 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

D

A 70-year-old man with a history of type 2 diabetes mellitus, hypercholesterolemia treated with a cholesterol-lowering agent, and hypothyroidism presented with a two-week history of pain in the left lower extremity and difficulty climbing stairs. Diagnostic testing, including lumbosacral magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis, was unremarkable. Electrodiagnostic testing results are shown below. Needle exam showed positive waves and fibrillations with decreased recruitment in the left rectus femoris, tensor fascia lata, and iliopsoas muscles. Other upper and lower extremity muscles were normal. What is the most likely diagnosis? A. Amyotrophic lateral sclerosis B. Acute inflammatory demyelinating polyneuropathy C. Inflammatory myopathy D. Diabetic amyotrophy

D

A patient complains of knee pain after falling on her flexed knee. Physical examination shows a positive "sag sign." Which ligament is injured? A. Medial collateral B. Lateral collateral C. Anterior cruciate D. Posterior cruciate

D

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

D

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

D

A patient with osteoarthritis presents with pain in the carpometacarpal joint of the thumb. What is the most appropriate splint? A. Ring B. Resting hand C. Spring coil extension assist D. Thumb spica

D

A patient with restrictive lung disease and mild scoliosis from Duchenne muscular dystrophy (DMD) develops nocturnal hypoventilation. What is the initial treatment? A. Incentive spirometry every four hours B. Tracheostomy and nocturnal mechanical ventilation with positive pressure C. Nocturnal supplemental low-flow oxygen D. Nocturnal noninvasive positive airway pressure and short periods of daytime hyperinsufflation

D

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

D

According to the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury, what is the key muscle defining motor level L4? A. Peroneus (fibularis) longus B. Extensor hallucis longus C. Vastus medialis D. Tibialis anterior

D

According to the Boston Classification System of Aphasia, the fluent aphasia associated with phonemic and semantic paraphasia and poor comprehension is A. transcortical B. anomia C. conduction D. Wernicke

D

Beneficence in the healthcare setting refers to A. the basic medical services required by all people B. respecting the values and beliefs of patients C. how to distribute the burdens and benefits of living in society D. promoting the health and well-being of patients

D

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

D

For geriatric patients in inpatient rehabilitation, what is the treatment of choice for shortterm insomnia? A. Amitriptyline B. Diphenhydramine hydrochloride C. Diazepam D. Zolpidem tartrate

D

In a boutonniére deformity, the proximal interphalangeal (PIP) joint is in A. extension and the distal interphalangeal joint is in hyperflexion B. extension and the distal interphalangeal joint is in hyperextension C. flexion and the distal interphalangeal joint is in hyperflexion D. flexion and the distal interphalangeal joint is in hyperextension

D

One week after onset of Bell palsy, what is the most reliable electrodiagnostic parameter for predicting ultimate recovery? A. Quantity of fibrillation potentials present in the denervated muscles B. Recruitment abnormalities in the affected muscles C. Blink reflex latencies D. Side-to-side comparison of motor evoked amplitudes

D

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

D

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

D

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

D

Three weeks after a severe traumatic brain injury (TBI) with basilar skull fracture, a 23-yearold patient in a rehabilitation 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

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

c