ABPMR Neuromuscular Medicine study guide
ABPMR Neuromuscular Medicine · Work through your exam, one topic at a time.
The Neuromuscular Medicine subspecialty certificate is issued by the American Board of Physical Medicine and Rehabilitation (ABPMR), an independent nonprofit organization that certifies physiatrists. It recognizes a physician who has met the ABPMR's subspecialty requirements and passed an examination demonstrating added expertise in disorders of the motor unit - spanning anterior horn cell and spinal cord disease, nerve root and plexus lesions, peripheral neuropathy, neuromuscular junction disorders, and myopathies - together with the electrodiagnostic and clinical reasoning skills used to localize and manage those conditions. The ABPMR Neuromuscular Medicine study guide has 6 sections and about 1,948 words.
01Anterior Horn Cell and Spinal Cord Disorders
Amyotrophic lateral sclerosis (ALS) is the prototypical anterior horn cell disorder: progressive, painless weakness combining upper motor neuron (UMN) and lower motor neuron (LMN) signs, with normal sensory examination and no sphincter involvement until late. Revised El Escorial/Awaji criteria require LMN degeneration in at least two regions plus UMN signs in at least one, or LMN in one region with UMN in two; fasciculation potentials plus chronic reinnervation changes can substitute for active denervation in the Awaji modification.
322 words, about 2 min02Nerve Root and Plexus Disorders
Radiculopathy is suggested by pain in a dermatome, weakness in a myotome, and a depressed reflex, with EMG showing denervation in at least two muscles of the same myotome supplied by different peripheral nerves, plus paraspinal muscles. Sensory nerve action potentials (SNAPs) stay normal because the lesion is proximal to the dorsal root ganglion.
335 words, about 2 min03Peripheral Nerve Disorders
Approach polyneuropathy by tempo, symmetry, fiber type, and electrodiagnosis. Length-dependent, symmetric distal sensory loss is typical of diabetes, alcohol, B12 deficiency, and chemotherapy; NCS show reduced sural and superficial peroneal SNAP amplitudes first.
312 words, about 2 min04Disorders of the Neuromuscular Junction
Myasthenia gravis (MG) causes fatigable ptosis, diplopia, bulbar and proximal weakness, with normal reflexes and sensation. Antibodies against acetylcholine receptor (AChR) are found in most generalized cases; MuSK and LRP4 antibodies occur in seronegative cases, and MuSK MG often has prominent bulbar and respiratory involvement.
334 words, about 2 min05Muscle Disorders (Myopathies)
Myopathic weakness is typically proximal, symmetric, and painless, with normal sensation and reflexes unless advanced. Creatine kinase may be elevated.
301 words, about 2 min06Electrodiagnostic Medicine and Clinical Neuromuscular Assessment
Nerve conduction studies must use supramaximal stimulation, fixed distances, and adequate limb temperature (at least 32°C for the upper limb and 30°C for the lower limb); cooling slows conduction and increases amplitudes, a common source of error. Sensory studies are antidromic or orthodromic; amplitude reflects axonal loss, while latency reflects demyelination or distance.
344 words, about 2 min