Physical Medicine & Rehabilitation - Part I Written Exam
What the written exam rewards
The Part I written exam tests breadth across the specialty with a strong emphasis on functional anatomy, electrodiagnosis, musculoskeletal medicine, neurorehabilitation, and prosthetics/orthotics. Candidates must be fluent in lesion localization (peripheral nerve, plexus, root, cord, brain), the physiology behind spasticity and gait, and the evidence base for rehabilitation interventions.
Core concepts to master
- Electrodiagnosis: understand the difference between axonal loss (reduced amplitude) and demyelination (prolonged latency/slowing), the timing of Wallerian degeneration, and when needle EMG shows fibrillation potentials (roughly 2–3 weeks after injury).
- Neurorehabilitation: lesion-level reasoning - UMN vs LMN signs, Brown-Séquard, central cord, cauda equina vs conus medullaris.
- Gait and biomechanics: identify the primary cause of a deviation rather than memorizing lists.
- Spasticity management: mechanism, Ashworth scale, and matching focal vs systemic treatment to distribution.
Common traps
Questions often hinge on timing (when a test becomes abnormal), distribution (focal vs diffuse), or a distractor that is true but not the best next step. Read for the single best answer, not the most comprehensive one.
Rule of thumb
Localize first, then match the test or treatment to that localization. If two answers both seem right, the one addressing the anatomical level you identified is usually correct.
Worked example: A patient has foot drop with preserved ankle inversion. The lesion is likely common peroneal nerve at the fibular head (tibialis posterior, invertor, is spared because it is supplied by the tibial nerve). This reasoning beats memorized lists.