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AOBPMR PM&R study materials
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AOBPMR PM&R practice questions

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Question 1Physical Medicine & Rehabilitation (Part I Written Exam)

A 45-year-old man has a complete C6 spinal cord injury. Which upper extremity muscle function is most likely preserved?

  1. Finger abduction
  2. Elbow extension
  3. Wrist extension Correct answer.
  4. Thumb opposition

Explanation

C6 injury preserves the C6 myotome, which includes the extensor carpi radialis, allowing active wrist extension. Elbow extension is C7 (triceps), finger abduction is T1 (interossei), and thumb opposition is median-nerve C8-T1 function.

Question 2Physical Medicine & Rehabilitation (Part I Written Exam)

Which finding best distinguishes a peripheral vestibular lesion from a central cause in an acutely dizzy patient?

  1. Suppression of nystagmus with visual fixation
  2. Unidirectional horizontal nystagmus Correct answer.
  3. Presence of vertical nystagmus
  4. Nausea with vomiting

Explanation

Peripheral vestibular nystagmus is typically unidirectional and horizontal with the fast phase away from the affected side. Vertical nystagmus, direction-changing nystagmus, or failure to suppress with fixation suggests a central etiology.

Question 3Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a T4 complete paraplegia develops sudden severe headache, flushing, and diaphoresis above the lesion level. Blood pressure is 210/120 mmHg. What is the most appropriate first step?

  1. Sit the patient upright and remove noxious stimuli Correct answer.
  2. Place the patient supine and give IV fluids
  3. Obtain an urgent head CT
  4. Administer sublingual nitroglycerin

Explanation

This is autonomic dysreflexia, a medical emergency triggered by noxious stimuli below the lesion. Initial management is to sit the patient upright to produce orthostatic reduction in blood pressure and identify/remove the trigger (commonly bladder distension).

Question 4Physical Medicine & Rehabilitation (Part I Written Exam)

Which electrodiagnostic finding is most consistent with a demyelinating neuropathy?

  1. Absent sensory nerve action potentials with normal motor studies
  2. Prolonged distal latency with slowed conduction velocity Correct answer.
  3. Reduced compound muscle action potential amplitude with normal conduction velocity
  4. Fibrillation potentials on needle EMG

Explanation

Demyelinating processes slow conduction, producing prolonged distal latencies, slowed conduction velocities, and prolonged F-waves. Reduced amplitudes with normal velocities and fibrillation potentials reflect axonal loss.

Question 5Physical Medicine & Rehabilitation (Part I Written Exam)

Which muscle is the primary flexor of the hip during the swing phase of gait?

  1. Gluteus maximus
  2. Rectus femoris
  3. Iliopsoas Correct answer.
  4. Biceps femoris

Explanation

The iliopsoas is the primary hip flexor and advances the limb during swing phase. The gluteus maximus is a hip extensor, and the hamstrings (biceps femoris) extend the hip and flex the knee.

Question 6Physical Medicine & Rehabilitation (Part I Written Exam)

A 30-year-old runner has lateral knee pain worse with downhill running and tenderness over the lateral femoral epicondyle. The pain is reproduced by resisted knee flexion. What is the most likely diagnosis?

  1. Iliotibial band syndrome Correct answer.
  2. Medial collateral ligament sprain
  3. Popliteal cyst
  4. Patellofemoral pain syndrome

Explanation

Iliotibial band syndrome causes lateral knee pain aggravated by downhill running and tenderness at the lateral femoral epicondyle, with pain on resisted knee flexion near 30 degrees. Patellofemoral pain is anterior, and MCL sprain is medial.

Question 7Physical Medicine & Rehabilitation (Part I Written Exam)

Which medication is most appropriate for treating spasticity via intrathecal delivery in a patient with severe generalized spasticity?

  1. Dantrolene
  2. Baclofen Correct answer.
  3. Diazepam
  4. Tizanidine

Explanation

Intrathecal baclofen delivers a GABA-B agonist directly to the CSF, providing potent antispasticity effect with fewer systemic side effects. Dantrolene, tizanidine, and diazepam act systemically and are not typically given intrathecally.

Question 8Physical Medicine & Rehabilitation (Part I Written Exam)

Which nerve is most commonly injured during a total hip arthroplasty performed via the direct lateral approach?

  1. Sciatic nerve
  2. Superior gluteal nerve Correct answer.
  3. Obturator nerve
  4. Femoral nerve

Explanation

The direct lateral (Hardinge) approach risks injury to the superior gluteal nerve, which can cause postoperative abductor weakness and Trendelenburg gait. The sciatic nerve is at risk with the posterior approach.

Question 9Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a complete C5 tetraplegia wants to feed independently. Which orthosis or intervention is most appropriate?

  1. Reciprocal gait orthosis
  2. Mobile arm support Correct answer.
  3. Wrist-driven tenodesis splint
  4. Lumbrical bar splint

Explanation

Mobile arm supports use residual shoulder and elbow motion to support the arm against gravity, enabling hand-to-mouth function for feeding in high tetraplegia. Tenodesis splints require active wrist extension, which is absent at C5.

Question 10Physical Medicine & Rehabilitation (Part I Written Exam)

Which finding on physical examination is most characteristic of an upper motor neuron lesion?

  1. Muscle atrophy
  2. Hyporeflexia
  3. Babinski sign Correct answer.
  4. Fasciculations

Explanation

The Babinski sign is a pathologic extensor plantar response indicating corticospinal tract dysfunction. Fasciculations, hyporeflexia, and prominent atrophy are lower motor neuron findings.

Question 11Physical Medicine & Rehabilitation (Part I Written Exam)

A 62-year-old woman has a distal radius fracture treated with cast immobilization and develops numbness in the thumb, index, and middle fingers with thenar weakness. Which nerve is affected?

  1. Posterior interosseous nerve
  2. Median nerve Correct answer.
  3. Ulnar nerve
  4. Radial nerve

Explanation

Sensory loss in the thumb, index, and middle fingers with thenar weakness indicates median nerve compression, commonly carpal tunnel syndrome, which can be precipitated or worsened by cast immobilization.

Question 12Physical Medicine & Rehabilitation (Part I Written Exam)

Which parameter is most useful for assessing aerobic capacity during a graded exercise test in cardiac rehabilitation?

  1. Body mass index
  2. Respiratory rate
  3. Peak oxygen consumption (VO2 max) Correct answer.
  4. Maximal heart rate

Explanation

Peak oxygen consumption directly reflects the maximal rate of aerobic energy production and is the standard measure of aerobic capacity. Heart rate and respiratory rate are indirect and influenced by many factors.

Question 13Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with chronic low back pain is started on a graded activity program. Which principle best describes the rationale for this approach?

  1. Avoiding all flexion-based exercises
  2. Increasing activity tolerance despite pain Correct answer.
  3. Relying on passive modalities alone
  4. Encouraging rest until pain resolves

Explanation

Graded activity aims to improve function and tolerance by progressively increasing activity despite the presence of pain, reducing fear-avoidance and deconditioning. Prolonged rest and passive-only treatment are discouraged in chronic low back pain.

Question 14Physical Medicine & Rehabilitation (Part I Written Exam)

Which clinical feature best differentiates polymyositis from inclusion body myositis?

  1. Positive response to corticosteroids
  2. Distal and asymmetric weakness with finger flexor involvement Correct answer.
  3. Proximal muscle weakness
  4. Elevated creatine kinase

Explanation

Inclusion body myositis characteristically causes asymmetric distal weakness, notably of the finger flexors and quadriceps, and is poorly responsive to steroids. Polymyositis causes symmetric proximal weakness with steroid responsiveness.

Question 15Physical Medicine & Rehabilitation (Part I Written Exam)

A patient sustains a burn with blistering and pain over the anterior forearm. Based on depth, how is this burn best classified?

  1. Superficial partial-thickness (second-degree) Correct answer.
  2. Full-thickness (third-degree)
  3. Superficial (first-degree)
  4. Deep partial-thickness

Explanation

Superficial partial-thickness burns involve the epidermis and superficial dermis, presenting with blisters, moist tissue, and significant pain. Full-thickness burns are insensate and leathery, and superficial burns are dry and painful without blistering.

Question 16Physical Medicine & Rehabilitation (Part I Written Exam)

Which outcome measure is most appropriate for tracking functional independence during inpatient stroke rehabilitation?

  1. Mini-Mental State Examination
  2. Glasgow Coma Scale
  3. Visual Analog Scale
  4. Functional Independence Measure (FIM) Correct answer.

Explanation

The FIM quantifies the level of assistance required for motor and cognitive tasks, making it well suited to tracking functional independence in rehabilitation. The GCS assesses consciousness, the VAS measures pain, and the MMSE screens cognition.

Question 17Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a below-knee amputation has a residual limb that is shaped with a bulbous distal end and poor volume control. Which prosthetic design consideration is most relevant?

  1. Need for a total-contact socket with volume management Correct answer.
  2. Immediate fitting with a rigid plaster cast
  3. Use of a patellar tendon-bearing socket
  4. Selection of a microprocessor knee

Explanation

A bulbous, poorly shaped residual limb benefits from a total-contact socket design and careful volume management to distribute pressure and maintain fit. Patellar tendon-bearing sockets are for specific designs, and microprocessor knees address knee control rather than socket fit.

Question 18Physical Medicine & Rehabilitation (Part I Written Exam)

Which muscle is the primary target for botulinum toxin injection in a patient with spastic equinovarus foot deformity?

  1. Gastrocnemius-soleus complex Correct answer.
  2. Peroneus longus
  3. Extensor digitorum longus
  4. Tibialis anterior

Explanation

Equinovarus deformity results from spasticity of the plantarflexors and invertors, chiefly the gastrocnemius-soleus complex and tibialis posterior. The tibialis anterior and evertors oppose the deformity.

Question 19Physical Medicine & Rehabilitation (Part I Written Exam)

Which finding on a nerve conduction study suggests a focal demyelinating lesion at the carpal tunnel?

  1. Prolonged tibial motor distal latency
  2. Slowed ulnar sensory conduction
  3. Reduced median sensory amplitude with normal latency
  4. Prolonged median sensory distal latency with normal ulnar studies Correct answer.

Explanation

Carpal tunnel syndrome produces focal demyelination of the median nerve at the wrist, manifesting as prolonged median sensory and motor distal latencies with normal ulnar and other nerve studies. Reduced amplitude alone suggests axonal loss.

Question 20Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with multiple sclerosis has disabling fatigue. Which intervention has the strongest evidence for reducing MS-related fatigue?

  1. Strict bed rest
  2. High-dose corticosteroids
  3. Aerobic exercise and energy conservation strategies Correct answer.
  4. Passive stretching only

Explanation

Aerobic exercise combined with energy conservation and fatigue management strategies has evidence for reducing MS-related fatigue. Bed rest worsens deconditioning, and corticosteroids are used for acute relapses rather than chronic fatigue.

Question 21Physical Medicine & Rehabilitation (Part I Written Exam)

Which structure is most at risk during a posterior approach to the shoulder in a patient undergoing shoulder arthroplasty?

  1. Ulnar nerve
  2. Radial nerve
  3. Axillary nerve Correct answer.
  4. Musculocutaneous nerve

Explanation

The axillary nerve runs through the quadrangular space near the surgical neck of the humerus and is at risk in shoulder surgery, particularly with approaches near the deltoid and surgical neck. Radial nerve injury is more associated with humeral shaft fractures.

Question 22Physical Medicine & Rehabilitation (Part I Written Exam)

Which physical examination finding supports a diagnosis of adhesive capsulitis of the shoulder?

  1. Global restriction of both active and passive range of motion Correct answer.
  2. Pain only at end range with full passive motion
  3. Weakness on resisted external rotation
  4. Positive drop arm test

Explanation

Adhesive capsulitis (frozen shoulder) produces global loss of both active and passive motion, especially external rotation. Full passive motion with end-range pain suggests a different pathology, and the drop arm test indicates rotator cuff tear.

Question 23Physical Medicine & Rehabilitation (Part I Written Exam)

A 70-year-old woman with osteoporosis has a vertebral compression fracture. Which exercise recommendation is most appropriate?

  1. Spinal flexion exercises to improve mobility
  2. Extension-based strengthening and postural exercises Correct answer.
  3. Prolonged bed rest
  4. High-impact jumping to build bone density

Explanation

Extension-based strengthening and postural exercises are favored after osteoporotic vertebral compression fractures to reduce kyphosis and improve posture. Flexion and high-impact loading increase fracture risk, and bed rest promotes decline.

Question 24Physical Medicine & Rehabilitation (Part I Written Exam)

Which finding is most consistent with a complete median nerve transection at the wrist?

  1. Wrist drop
  2. Loss of finger abduction
  3. Sensory loss over the dorsum of the hand
  4. Loss of thenar opposition and sensory loss over the palmar thumb, index, and middle fingers Correct answer.

Explanation

A median nerve lesion at the wrist causes loss of thenar opposition/abduction and sensory loss over the palmar thumb, index, and middle fingers. Wrist drop indicates radial nerve injury, and finger abduction loss indicates ulnar nerve injury.

Question 25Physical Medicine & Rehabilitation (Part I Written Exam)

Which factor most strongly predicts functional outcome after stroke rehabilitation?

  1. Serum cholesterol level
  2. Family history of stroke
  3. Patient's handedness
  4. Initial stroke severity and motor impairment Correct answer.

Explanation

Initial stroke severity and degree of motor impairment are among the strongest predictors of functional recovery after stroke. Handedness, family history, and cholesterol levels do not directly predict rehabilitation outcome.

Question 26Physical Medicine & Rehabilitation (Part I Written Exam)

Which muscle is most commonly affected by spasticity in patients with hemiplegia after stroke, leading to an adducted and internally rotated shoulder?

  1. Teres minor
  2. Deltoid
  3. Pectoralis major Correct answer.
  4. Supraspinatus

Explanation

Spasticity of the pectoralis major, along with subscapularis and latissimus dorsi, contributes to the typical adducted and internally rotated shoulder posture in hemiplegia. The deltoid and supraspinatus are not typically spastic and may be weak. Teres minor is an external rotator and would not cause internal rotation.

Question 27Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with motor-complete C6 spinal cord injury has preserved elbow flexion and wrist extension but no active elbow extension. Which muscle has lost function, making push-up transfers more difficult?

  1. Deltoid
  2. Triceps brachii Correct answer.
  3. Biceps brachii
  4. Latissimus dorsi

Explanation

Triceps brachii provides active elbow extension and is the C7 key muscle in the spinal cord motor examination. Its absent function explains the described difficulty pushing up through the arms, although transfer strategies depend on many factors.

Question 28Physical Medicine & Rehabilitation (Part I Written Exam)

Which muscle is the primary target for botulinum toxin injection to treat spastic elbow flexion in a patient with stroke?

  1. Pronator teres
  2. Biceps brachii Correct answer.
  3. Triceps brachii
  4. Brachioradialis

Explanation

The biceps brachii is a major elbow flexor and is commonly targeted for spastic elbow flexion. Brachioradialis and brachialis may also be injected, but the biceps is primary. Triceps is an extensor and would not be injected for flexion spasticity.

Question 29Physical Medicine & Rehabilitation (Part I Written Exam)

Which nerve is most at risk during a total hip arthroplasty performed via the direct lateral approach?

  1. Superior gluteal nerve Correct answer.
  2. Femoral nerve
  3. Sciatic nerve
  4. Obturator nerve

Explanation

The superior gluteal nerve is at risk during the direct lateral approach due to its proximity to the gluteus medius and minimus muscles. Injury can cause a Trendelenburg gait. The sciatic nerve is at risk in posterior approaches, and the femoral and obturator nerves are less commonly injured in this approach.

Question 30Physical Medicine & Rehabilitation (Part I Written Exam)

A 30-year-old runner has lateral knee pain worse with downhill running and tenderness over the lateral femoral epicondyle. Which structure is most likely inflamed?

  1. Biceps femoris tendon
  2. Iliotibial band Correct answer.
  3. Lateral collateral ligament
  4. Popliteus tendon

Explanation

Iliotibial band syndrome is characterized by lateral knee pain worsened by downhill running and tenderness over the lateral femoral epicondyle. The popliteus tendon and biceps femoris tendon are less commonly involved in this typical presentation. The lateral collateral ligament is not typically inflamed in this overuse scenario.

Question 31Physical Medicine & Rehabilitation (Part I Written Exam)

A 62-year-old woman has a distal radius fracture treated with cast immobilization and develops numbness in the thumb, index, and middle fingers. Which nerve is most likely compressed?

  1. Radial nerve
  2. Ulnar nerve
  3. Anterior interosseous nerve
  4. Median nerve Correct answer.

Explanation

The median nerve is compressed in the carpal tunnel, causing numbness in the thumb, index, and middle fingers. The ulnar nerve supplies the little finger and half of the ring finger. The radial nerve supplies the dorsum of the hand, and the anterior interosseous nerve is purely motor.

Question 32Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a below-knee amputation has a residual limb that is shaped with a bulbous distal end and poor volume control. Which prosthetic socket design is most appropriate?

  1. Total surface-bearing socket Correct answer.
  2. Silicone suction socket
  3. Patellar tendon-bearing socket
  4. Pin-lock suspension

Explanation

A total surface-bearing socket distributes pressure evenly over the entire residual limb, accommodating a bulbous distal end and poor volume control. A patellar tendon-bearing socket provides focal loading and may not accommodate volume changes. Suction and pin-lock suspensions require good volume control.

Question 33Physical Medicine & Rehabilitation (Part I Written Exam)

Which muscle is most commonly injected with botulinum toxin for spastic hip adduction in a patient with spinal cord injury?

  1. Adductor longus Correct answer.
  2. Gluteus medius
  3. Tensor fasciae latae
  4. Iliopsoas

Explanation

The adductor longus is a primary hip adductor and is commonly targeted for spastic hip adduction. The iliopsoas is a hip flexor. Gluteus medius is a hip abductor. Tensor fasciae latae flexes and abducts the hip.

Question 34Physical Medicine & Rehabilitation (Part I Written Exam)

Which electrodiagnostic finding is most characteristic of Guillain-Barré syndrome?

  1. Prolonged distal latencies and conduction block Correct answer.
  2. Fibrillation potentials in paraspinal muscles
  3. Reduced sensory amplitudes only
  4. Normal nerve conduction studies

Explanation

Guillain-Barré syndrome is characterized by demyelinating features such as prolonged distal latencies, conduction block, and slowed conduction velocities. Fibrillation potentials may appear later. Normal studies do not rule out early GBS. Sensory amplitude reduction alone is not typical.

Question 35Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a T10 complete spinal cord injury is most likely to achieve which level of functional independence?

  1. Dependent for all mobility
  2. Independent with wheelchair mobility and community ambulation
  3. Independent with bed mobility and transfers Correct answer.
  4. Independent with all activities of daily living

Explanation

Patients with T10 complete injuries typically have good upper extremity and trunk control, allowing independence in bed mobility and transfers. Community ambulation is usually not achieved. Independence in all ADLs may be limited by bowel/bladder management. Dependence for all mobility is not expected.

Question 36Physical Medicine & Rehabilitation (Part I Written Exam)

Which muscle is most commonly affected by contracture in a patient with spastic hemiplegia after stroke, leading to limited ankle dorsiflexion?

  1. Tibialis anterior
  2. Gastrocnemius Correct answer.
  3. Extensor hallucis longus
  4. Peroneus brevis

Explanation

The gastrocnemius and soleus are plantarflexors that commonly develop spasticity and contracture, limiting dorsiflexion. Tibialis anterior is a dorsiflexor. Peroneus brevis everts the foot. Extensor hallucis longus extends the great toe.

Question 37Physical Medicine & Rehabilitation (Part I Written Exam)

Which medication is most appropriate for treating neuropathic pain in a patient with spinal cord injury?

  1. Oxycodone
  2. Diazepam
  3. Ibuprofen
  4. Gabapentin Correct answer.

Explanation

Gabapentin is a first-line treatment for neuropathic pain, including central pain after spinal cord injury. Ibuprofen is an NSAID for nociceptive pain. Oxycodone is an opioid and not first-line for neuropathic pain. Diazepam is a benzodiazepine used for spasticity, not neuropathic pain.

Question 38Physical Medicine & Rehabilitation (Part I Written Exam)

Which gait deviation is most characteristic of a patient with a steppage pattern due to a common peroneal nerve injury?

  1. Circumduction of the affected limb
  2. Excessive hip hiking to clear the limb
  3. Vaulting on the unaffected side
  4. Foot drop with exaggerated knee flexion during swing Correct answer.

Explanation

Common peroneal nerve injury weakens ankle dorsiflexors, producing foot drop; patients compensate by exaggerating hip and knee flexion during swing to clear the toe, creating a steppage gait. The other listed deviations reflect different compensatory strategies or weakness patterns.

Question 39Physical Medicine & Rehabilitation (Part I Written Exam)

A patient reports burning pain in the lateral forearm and dorsal hand with numbness in the distribution of the superficial radial nerve after a humeral shaft fracture. Which nerve is most likely injured?

  1. Axillary nerve
  2. Median nerve
  3. Radial nerve Correct answer.
  4. Ulnar nerve

Explanation

The radial nerve runs in the spiral groove of the humerus and is vulnerable in shaft fractures; injury produces wrist drop and sensory loss over the dorsal hand and lateral forearm. Ulnar and median nerves are not in the spiral groove, and the axillary nerve is injured with proximal humerus or shoulder dislocations.

Question 40Physical Medicine & Rehabilitation (Part I Written Exam)

Which finding on manual muscle testing corresponds to a grade of 3/5?

  1. Movement only when gravity is eliminated
  2. Full range against gravity without resistance Correct answer.
  3. Full range against gravity with added resistance
  4. Visible contraction without joint movement

Explanation

The Medical Research Council scale assigns grade 3 to active movement through full range against gravity but not against added resistance. Grade 4 requires some resistance, grade 2 allows movement only with gravity eliminated, and grade 1 shows contraction without movement.

Question 41Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a C5 complete spinal cord injury has intact diaphragm function. Which muscle is the primary spared inspiratory muscle in this patient?

  1. Sternocleidomastoid
  2. Diaphragm via the phrenic nerve Correct answer.
  3. Abdominal muscles
  4. External intercostal muscles

Explanation

The phrenic nerve arises from C3-C5, so the diaphragm is largely spared in a C5 injury and provides the main inspiratory effort. Intercostal and abdominal muscles receive lower thoracic innervation and are impaired.

Question 42Physical Medicine & Rehabilitation (Part I Written Exam)

Which type of exercise is most effective for improving aerobic capacity in a patient with chronic heart failure undergoing cardiac rehabilitation?

  1. Bed rest with passive range of motion
  2. Moderate-intensity continuous aerobic exercise Correct answer.
  3. High-intensity isometric resistance training
  4. Heavy eccentric resistance training

Explanation

Moderate-intensity continuous aerobic training is the cornerstone of cardiac rehabilitation and improves functional capacity and symptoms in stable heart failure. High-intensity isometric and heavy eccentric loading impose excessive afterload and are not first-line.

Question 43Physical Medicine & Rehabilitation (Part I Written Exam)

Which medication class is first-line for managing spasticity of cerebral origin in an ambulatory patient who wishes to avoid systemic side effects?

  1. Oral dantrolene
  2. Focal intramuscular botulinum toxin Correct answer.
  3. Oral baclofen
  4. Intrathecal phenol

Explanation

Focal botulinum toxin injection reduces spasticity in targeted muscles with minimal systemic effects, making it well suited for ambulatory patients with focal problems. Oral agents cause generalized weakness and sedation, and phenol is used for neurolysis in selected non-ambulatory cases.

Question 44Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with a transtibial amputation reports phantom limb pain. Which intervention has the strongest evidence as a first-line pharmacologic option?

  1. Ibuprofen
  2. Gabapentin Correct answer.
  3. Cyclobenzaprine
  4. Prednisone

Explanation

Gabapentinoids are first-line for neuropathic pain, including phantom limb pain. NSAIDs, corticosteroids, and muscle relaxants do not target the neuropathic mechanism.

Question 45Physical Medicine & Rehabilitation (Part I Written Exam)

Which outcome measure is most appropriate for documenting functional independence in a patient undergoing inpatient rehabilitation?

  1. Functional Independence Measure Correct answer.
  2. Visual analog pain scale
  3. Mini-Mental State Examination
  4. Glasgow Coma Scale

Explanation

The Functional Independence Measure quantifies independence in self-care, mobility, and cognition and is the standard rehabilitation outcome tool. The pain scale, coma scale, and cognitive screen assess different constructs.

Question 46Physical Medicine & Rehabilitation (Part I Written Exam)

A 55-year-old man with a T4 complete spinal cord injury develops sudden severe headache, diaphoresis above the lesion, and hypertension during a bowel program. What is the most appropriate initial management?

  1. Place the patient supine and elevate the legs
  2. Administer a vasopressor
  3. Give intravenous fluids rapidly
  4. Sit the patient upright and remove the noxious stimulus Correct answer.

Explanation

This presentation is autonomic dysreflexia, a hypertensive emergency triggered by a noxious stimulus below the lesion. The immediate steps are to sit the patient upright to lower blood pressure and remove the triggering stimulus, such as a distended bladder or impacted bowel.

Question 47Physical Medicine & Rehabilitation (Part I Written Exam)

A 40-year-old woman has weakness of shoulder abduction and external rotation with sensory loss over the lateral shoulder after a motor vehicle collision with shoulder dislocation. Which nerve is most likely injured?

  1. Suprascapular nerve
  2. Musculocutaneous nerve
  3. Long thoracic nerve
  4. Axillary nerve Correct answer.

Explanation

The axillary nerve wraps around the surgical neck of the humerus and is injured with shoulder dislocation, producing deltoid weakness and sensory loss over the lateral shoulder. The other nerves do not match this pattern of weakness and sensory loss.

Question 48Physical Medicine & Rehabilitation (Part I Written Exam)

A patient with rheumatoid arthritis has atlantoaxial instability. Which activity should be avoided until stability is confirmed?

  1. Cervical manipulation and end-range neck extension Correct answer.
  2. Isometric neck strengthening
  3. Gentle active range of motion in a neutral position
  4. Aquatic walking

Explanation

In atlantoaxial instability, end-range neck extension and manipulation can cause spinal cord compression and should be avoided. Gentle neutral-range exercise and aquatic activity are safer options.

Question 49Physical Medicine & Rehabilitation (Part I Written Exam)

A 60-year-old man with Parkinson disease has freezing of gait. Which cueing strategy is most likely to improve his walking?

  1. Lying down before walking
  2. Auditory rhythmic cueing Correct answer.
  3. Removing all visual cues
  4. Increasing stride length by running

Explanation

External rhythmic auditory or visual cues help bypass defective basal ganglia gait initiation and reduce freezing in Parkinson disease. Removing cues or running is not appropriate.

Question 50Physical Medicine & Rehabilitation (Part I Written Exam)

A patient in the intensive care unit after prolonged mechanical ventilation has generalized weakness and difficulty weaning. Which diagnosis is most consistent with this presentation?

  1. Duchenne muscular dystrophy
  2. Myasthenia gravis
  3. Critical illness polyneuropathy Correct answer.
  4. Guillain-Barré syndrome

Explanation

Critical illness polyneuropathy and myopathy cause diffuse weakness and failure to wean after prolonged critical illness and immobilization. Myasthenia and Guillain-Barré have different onset patterns and are not directly tied to critical illness.