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2007SELF-ASSESSMENT EXAMINATION

FOR RESIDENTS (SAE-R)

Abridged Version

Copyright 2007American Academy of Physical Medicine and Rehabilitation

Chicago, Illinois

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Abridged Version

2007 Self-Assessment Examination for Residents (SAE-R)

1. You are called onto a football field immediately after a defensive player involved in a spearheading

tackle complains of neck pain and right greater than left arm tingling. What should be the next

step?

(a) Call for an ambulance and stabilize the neck.

(b) Remove the athletes football helmet and palpate for any neck tenderness.

(c) Return the athlete to the game if his strength exam is normal.

(d) Walk the athlete to the locker room and perform a thorough neurologic examination.

3. The initial treatment for osteoarthritis is

(a) medication to reverse articular cartilage damage.

(b) surgical correction of joint deformities.

(c) therapy to relieve joint symptoms.

(d) immobilization of the joint to prevent deformity.

7. A 42-year-old car mechanic with a 3-week history of low back pain and lower limb pain after

lifting equipment at work is referred to you for management. He has been taking ibuprofen

800mg 4 times daily without improvement. He is unable to flex through the lumbar spine or sit

without pain. Your recommendations to his employer regarding work include

(a) modified duty to allow no repetitive twisting or bending and no push/pull heavier than 20

lbs.

(b) return to sedentary work 8 hours daily for 1 week, and no push/pull heavier than 10 lbs.

(c) light duty to include no pushing/pulling, or lifting more than 25 lbs for 1 month.

(d) remain off work until lumbar flexion, sitting, and lifting are no longer painful.

9. According to national databases of spinal cord injury (SCI), children under the age of 6 years are

more likely to have which epidemiologic pattern of spinal cord injury?

(a) high tetraplegia, motor incomplete, occurred in motor vehicle accident

(b) paraplegia, complete, occurred in motor vehicle accident

(c) high tetraplegia, complete, caused by medical/surgical complications

(d) paraplegia, motor incomplete, caused by medical/surgical complications

12. What is the greatest risk factor for late post-traumatic seizures in patients with a traumatic brain

injury?

(a) Multiple subcortical contusions

(b) Subdural hematoma with evacuation

(c) Midline shift greater than 5mm

(d) Bilateral parietal contusions

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14. Myositis is defined as

(a) muscle aching.

(b) muscle aching with weakness.

(c) muscle symptoms with creatine kinase elevation.

(d) muscle symptoms with creatine kinase and creatinine elevations.

17. A 55-year-old paramedic is under your care for a work-related shoulder injury. She has

completed physical therapy, no longer requires pain medications, and wants to return to work.

She does not have full shoulder abduction and has some pain with overhead activities. Ideally,

you recommend

(a) return to work without restrictions.

(b) work conditioning for 4 weeks.

(c) a week of work hardening.

(d) functional capacity evaluation.

21. An 18-year-old, right-handed hockey player presents to you after experiencing 3 right shoulderanterior dislocations in the prior season after falls on ice. Magnetic resonance imaging shows

supraspinatus tendonitis but no other lesions or tears. After 6 sessions of physical therapy, he is

pain free. He has been invited to play professionally in 6 months. What is your next

recommendation?

(a) Tell him that he will likely dislocate again and that he should relocate the shoulder by

forcefully pushing the anterior shoulder against a wall.

(b) Refer him to a surgeon to consider shoulder stabilization surgery.

(c) Tell him he should not return to any sports because of his increased chance of dislocating

again.

(d) Stress the importance of compliance with his home exercise program.

24. [ITEM WAS NOT SCORED ON 2007 SAE-R]

You have evaluated a 50-year-old man for lower extremity muscle pain and discomfort. The pain

increases with jogging. You have reviewed his medications, which include simvastatin (Zocor).

Baseline laboratory studies were normal 6 months ago. The creatine kinase level is mildly elevated

at 185 units/L. The next most appropriate step is to

(a) discontinue the medication and check creatinine and thyroid stimulating hormone levels.

(b) order electrodiagnostic study.

(c) switch to a different class of lipid lowering medications.

(d) continue the medication with close monitoring of the creatine kinase levels.

25. An individual with C7 ASIA D tetraplegia must have

(a) a bulbocavernosus reflex and voluntary sphincter contraction.

(b) a muscle grade of 3 or greater in at least half of the key muscles below C7.

(c) normal pinprick and light touch sensation through the sacral dermatomes.

(d) normal strength (5/5) in the C7 myotome.

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26. Osteoblastic lesions are seen in which type of cancer?

(a) Prostate

(b) Lung

(c) Breast

(d) Renal

27. Under the prospective payment system for inpatient rehabilitation facilities, which item is used in

assigning a patient to a case-mix group?

(a) Mini Mental Status Examination

(b) Disability Rating Scale

(c) Previous hospitalization

(d) FIM instrument motor score

28. A 40-year-old man sustained an injury to his left arm, 3 weeks ago, when he lost his balance and

crashed into a bookshelf. His complaints include left arm pain, weakness with extension of his

wrist and fingers, and decreased hand grip. He denies any numbness but has odd sensations over thedorsum of the left hand. Prior to any testing, which problem would you consider as the most

likely?

(a) Posterior interosseous neuropathy

(b) C7 radiculopathy

(c) Posterior cord brachial plexopathy

(d) Radial neuropathy

32. A 25-year-old man with a history of a traumatic brain injury is noted to have a marked functional

decline from his normal level of functioning. You order a computed tomography (CT) scan, which

reveals large ventricles with flattening of the sulci and periventricular lucency. You tell the familythat a ventriculoperitoneal shunt

(a) is emergently needed, and immediate referral to neurosurgery is indicated.

(b) will not be helpful, because the findings on the CT scan are due to irreversible atrophy of

brain tissue (hydrocephalus ex vacuo).

(c) is not indicated, because he does not have the triad of incontinence, gait disorder, and

dementia.

(d) may be helpful, because about 50% of patients with post-traumatic brain injury

hydrocephalus experience significant improvement.

37. The interdisciplinary approach to patient care emphasizes

(a) common patient and team goals.

(b) discipline-specific goals.

(c) concentration on specific clinical problems.

(d) treatment by multiple team members.

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38. Which description best localizes the extensor indicis proprius muscle (with the forearm fully

pronated) for needle electrode examination?

(a) Junction of the upper and middle third of the forearm between the radius and ulna

(b) Four fingerbreadths proximal to the wrist and directly over the ulnar side of the radius

(c) Two fingerbreadths proximal to the ulnar styloid and just radial to the ulna

(d) Mid-forearm along the radial border of the ulna

40. When should upper extremity prosthesis fitting be initiated in the adult?

(a) Within the first month after amputation

(b) When residual limb strength is full.

(c) When the patient requests a prosthesis

(d) When residual limb volume has stabilized

41. Which injury level is the most common location for an osteoporotic vertebral compression fracture?

(a) Upper thoracic spine(b) Middle thoracic spine

(c) Thoracolumbar junction

(d) Middle lumbar spine

45. According to data from the Model Spinal Cord Injury Care System, the leading cause of traumatic

spinal cord injury in the United States is

(a) motor vehicle accidents.

(b) violence.

(c) falls.

(d) diving accidents.

49. Your 5-year-old patient with spastic tetraplegic cerebral palsy needs a wheelchair prescription. He

is dependent for transfers, but cognitively normal. He is able to feed himself and uses a

communication device. His family transports him in their car in an adapted car seat. On

examination, he is unable to sit unsupported, but sits well with minimal support; he has no scoliosis,

and his passive range of motion is full. Which elements would be best to include in his wheelchair

prescription?

(a) Folding frame, sling seating

(b) Adaptive stroller, linear seating

(c) Tilt in space frame, custom seating(d) Rigid frame, contoured seating

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57. A case manager comes to your office accompanying the injured worker you are managing. The

front desk person asks if you will see the case manager with the patient. You respond that

(a) case managers inhibit patient care and you dont wish to speak with them.

(b) as requested by the patient you will see the case manager following the interview and

examination.

(c) you will speak with the case manager after the patient signs a release of information.

(d) the case manager should always be present at the time of the patients interview andexamination despite the patients request to avoid the case manager.

58. Blink reflex studies can be useful in diagnosing which condition?

(a) Neuromuscular junction disorder

(b) Axonal neuropathy

(c) Motor neuron disease

(d) Midpontine lesion

62. [ITEM WAS NOT SCORED ON 2007 SAE-R]The largest change in bone mineral density in a hemiplegic patient 1 year after a stroke occurs in

the

(a) humerus on the paretic side.

(b) proximal femur on the paretic side.

(c) distal radius on the paretic side.

(d) lumbar spine.

63. Which medication that binds to B-lymphocyte CD20 surface antigens (monoclonal antibody) has

recently received a new indication for treatment of rheumatoid arthritis in patients who have failed

tumor necrosis factor (TNF) alpha antagonists and who are receiving concomitant methotrexate(Trexall)?

(a) Etanercept (Enbrel)

(b) Abatacept (Orencia)

(c) Anakinra (Kineret)

(d) Rituximab (Rituxan)

65. A 21-year-old man is evaluated in your spinal cord injury clinic 12 months after a C2 complete

spinal cord injury requiring full-time mechanical ventilation. You recommend

(a) avoiding a breath control system for his power wheelchair.(b) aggressive diaphragmatic strengthening exercises.

(c) initiating a weaning protocol by slowly decreasing tidal volume.

(d) an electrodiagnostic study to evaluate for a phrenic nerve pacemaker.

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66. Which pulmonary parameter is most commonly followed in a patient with amyotrophic lateral

sclerosis (ALS)?

(a) Arterial blood gas (ABG)

(b) Oxygen saturation (O2 sat)

(c) Forced expiratory volume in 1 second (FEV1)

(d) Vital capacity (VC)

67. The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to

(a) ensure that a patients medical record is available to health care providers as directed by the

patient.

(b) allow qualified physicians access to the patients medical record.

(c) allow a lawyer access to a medical record only if litigation is pending.

(d) prohibit the release of confidential health information to insurance carriers.

70. Double limb stance is what percent of the entire gait cycle?

(a) 5%

(b) 10%

(c) 20%

(d) 30%

72. A 23-year-old woman who is unresponsive after an acute traumatic brain injury can visually track.

She periodically pushes the nurses hand away when the nurse administers a subcutaneous heparin

injection. The patient is exhibiting

(a) a coma state.

(b) a minimally conscious state.(c) a vegetative state.

(d) a sleep/wake cycle.

74. Which one of the following characteristics is typically associated with Charcot Marie Tooth (CMT)

disease type 2?

(a) minimal level of disability.

(b) minimal decrease in nerve conduction velocity.

(c) autosomal recessive inheritance.

(d) absence of sensory deficits.

75. A 60-year-old woman is seen in consultation by your rehabilitation team after elective surgery. She

has a new finding of 1/5 strength in her lower extremities, but retained propioception and vibratory

sense. You make the diagnosis of

(a) posterior spinal cord syndrome.

(b) central cord syndrome.

(c) anterior spinal cord syndrome.

(d) conversion disorder.

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77. A 55-year-old long-distance truck driver is recovering from a work related low back injury that

occurred during lifting. The worker has completed 2 weeks of physical therapy and continues to

have low back pain, lower extremity pain, and paresthesias. The employer calls you and is upset

that you have restricted the worker from truck driving during the treatment phase, citing that

driving is sedentary work. You recommend that the driver refrain from truck driving because

(a) a minimum of 4 weeks of physical therapy will be necessary to facilitate recovery.

(b) low back pain has been found to be more frequent in people exposed to whole bodyvibration.

(c) workers with low back pain should not sit while symptoms of radiculopathy are present.

(d) the employer is unlikely to follow the restrictions you recommend.

78. A 55-year-old man presents with a 2-month history of progressive weakness. On examination he

has mild proximal weakness in the upper and lower limbs. His muscle tone and bulk are normal

and he has no facial weakness. Sensation is normal and deep tendon reflexes are 1+ and

symmetrical. Which finding on electrodiagnostic testing is most consistent with this patients

presentation?

(a) Prolonged or absent F waves(b) Decreased recruitment ratio

(c) Motor unit potentials with amplitudes of 10 millivolts

(d) Normal number of phases of the motor unit potentials

80. What is a possible cause for circumduction during mid swing in the transfemoral amputee?

(a) Insufficient knee friction

(b) Prosthesis too short

(c) Excessive medial brim pressures

(d) Inadequate hip extension

81. To allow pronation of the foot, which 2 joints must have their axis of rotation in parallel?

(a) Lisfranc and talonavicular

(b) Subtalar and calcanocuboid

(c) Talocrural and subtalar

(d) Talonavicular and calcaneocuboid

82. You are seeing a 56-year-old male patient in consultation 3 days after a severe stroke. He is

medically stable and has flaccid hemiplegia with poor sitting balance. He is sitting up in a chair for

2 hours twice daily and has just started bedside physical therapy (PT) and occupational therapy(OT). You recommend

(a) continued bedside therapy with OT and PT, focusing on sitting balance, followed by transfer

to your inpatient rehabilitation unit when he can sit and stand with minimum assistance.

(b) transfer to your inpatient rehabilitation unit to start aggressive PT and OT.

(c) transfer to a subacute rehabilitation center to allow the patient time to improve with less

intensive therapy.

(d) that his OT start functional electrical stimulation to the flaccid arm to enhance neurologic

recovery.

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83. Which of the following is the most important lifestyle modification for prevention of osteoporosis?

(a) Avoiding cigarette smoking and high intake of caffeine

(b) Decreasing the intake of alcohol

(c) Minimizing the use of nonsteroidal anti-inflammatory medications

(d) Eating a diet high in protein and phosphorus

85. Autonomic dysreflexia is most commonly precipitated by

(a) bladder distension

(b) bowel impaction

(c) heterotopic ossification

(d) atelectasis

86. An 80-year-old man with peripheral neuropathy and multiple medical conditions fell at home and

was found several hours later. He was admitted to the hospital for a sacral insufficiency fracture

and failure to thrive. During your initial consultation, you notice a skin ulcer in which the entirethickness of the skin is involved without involvement of the underlying fascia. According to the

National Pressure Ulcer Advisory Panel, the patient's ulcer is classified as stage

(a) 1

(b) 2

(c) 3

(d) 4

90. In a transtibial amputee, ambulation with a prosthesis, instead of unilateral non-weight bearing

(with crutches) results in

(a) higher rate of energy expenditure.

(b) lower heart rate.

(c) higher respiratory exchange rate.

(d) equivalent amounts of energy to walk the same distance.

94. A negative prognosticator for successful surgical nerve repair after trauma is

(a) partial transection of the nerve.

(b) distal nerve injury.

(c) prior radiation therapy.

(d) nerve repair within 4 months of injury.

99. On examination, a 3-month-old girl still has a Moro reflex, asymmetric tonic neck reflex, and

plantar grasp reflex. She does not have any protective extension. You advise her parents that

(a) further diagnostic evaluation is indicated.

(b) she requires a physical therapy evaluation.

(c) she needs a neurology evaluation.

(d) these reflexes are normal reflexes.

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102. It is recommended that a patient with a first ischemic stroke who is positive for an antiphospholipid

antibody be treated with:

(a) aspirin, 325mg orally daily.

(b) warfarin, with an INR goal of 3.03.5.

(c) clopidogrel (Plavix), 75mg orally daily.

(d) ticlopidine (Ticlid), 250mg orally twice daily.

103. A 40-year-old man with psoriatic arthritis consults you regarding his hand pain. On examination,

you notice that his left index finger is noticeably shorter than all of his other fingers and has extra

folds of skin. The most likely diagnosis is

(a) arthritis mutilans.

(b) Auspitzs sign.

(c) dactylitis.

(d) Jaccouds arthritis.

104. A 17-year-old female was involved in a motor vehicle crash 4 months ago. She sustained a

shoulder dislocation. Electromyographic studies have confirmed a brachial plexus injury to her

posterior cord and indicate nerve continuity. Although she has completed 4 weeks of occupational

therapy, she has had no improvement in her strength from baseline. Your next step would be to

(a) reassure the patient and continue to monitor for improvement.

(b) continue occupational therapy for 4 additional weeks.

(c) initiate neuromuscular electrical stimulation to the affected muscles.

(d) refer her to neurosurgery for exploratory surgery.

105. A 32-year-old man is admitted to your rehabilitation facility 3 weeks after sustaining a spinal cordinjury. The motor (right/left) examination reveals

R Motor L Motor

Deltoids 2 5

Biceps 2 5

Wrist extensor 2 5

Triceps 2 3

Finger flexors 1 1

Intrinsics 1 1

Hip flexors 0 0

Knee extensors 0 0

Dorsiflexors 0 0Plantarflexors 0 0

Sensory exam reveals intact pinprick and light touch sensation through C4 on the right and C7 on

the left. Sensation is absent below C5 on the right and C7 on the left.

What is this patients ASIA score?

(a) C4 ASIA A

(b) Right C4/ Left C7 ASIA A

(c) C6 ASIA A

(d) Right C4/ Left C7 ASIA B

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106. What is the target exercise intensity for optimal aerobic training in a healthy, young individual?

(a) Borg rating of perceived exertion 6.

(b) 70%80% of maximum heart rate.

(c) Borg rating of perceived exertion 20.

(d) 50%60% of maximum heart rate.

109. Which of the following is NOT a feature of central autonomic dysfunction in traumatic brain injury

in children?

(a) Hypertension

(b) Tachypnea

(c) Rigidity

(d) Hypothermia

110. The primary goal of a knee orthosis is to

(a) prevent knee injury in athletes.(b) control knee instability in the anterior direction.

(c) prevent recurvatum.

(d) decrease the quadriceps force across the knee.

111. Which statement describes the chronic-pain concept of central sensitization?

(a) The evoked response of A-delta fibers to subsequent input is amplified.

(b) The influx of sodium is fundamental to electrical signaling and subsequent generation of

action potentials and excitatory postsynaptic potentials.

(c) A complex set of activation-dependent post-translational changes occurs at the dorsal horn,

brainstem, and higher cerebral sites.(d) The so-called inflammatory soup, rich in algesic substances, causes a lowering of threshold

for activation and subsequent evoked pain.

112. The most common benign brain tumor in adults is

(a) astrocytoma.

(b) oligoblastoma.

(c) medulloblastoma.

(d) meningioma.

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113. A 66-year-old woman with rheumatoid arthritis is admitted to inpatient rehabilitation following a

right total knee arthroplasty (TKA). On her initial day of therapy, she had difficulty walking with

her physical therapist. Her medications included methotrexate (Trexall), etanercept (Enbrel),

ezetimibe (Zetia), multi-vitamin, calcium with vitamin D, alendronate (Fosamax),

acetaminophen/hydrocodone (Norco), and warfarin (Coumadin). Re-examination shows hip

flexion 5/5, knee extension 4/5, knee flexion 4/4, ankle dorsiflexion 12/5, ankle plantar flexion

5/5. You suspect

(a) sciatic nerve stretch injury.

(b) posterior tibialis tendon rupture.

(c) inadequate pain control.

(d) peroneal nerve injury.

115. Etidronate disodium (Didronel) is used in the management of heterotopic ossification to

(a) improve range of motion.

(b) reverse immature ossification.

(c) reverse mature ossification.

(d) prevent ossification.

118. A 70-year-old man presents with a 3-month history of numbness in patchy areas over the limbs and

torso. His numbness began in the left foot, then the right hand, followed by numbness over the

back and all the limbs. He has no complaints of bowel or bladder problems. He has a long history

of smoking. His examination reveals normal strength, normal cranial nerve function, but sensation

is decreased to pin prick, vibration, and position in the limbs. Deep tendon reflexes are absent.

Electrophysiologic studies show normal motor nerve conduction and needle examination of the

upper and lower limb muscles. The sensory nerve conduction studies show small or absent

responses. Based on this information what test would you order next?

(a) Nerve and muscle biopsies

(b) Radiologic studies to assess for a tumor

(c) Skin biopsy to assess small nerve fibers

(d) Repetitive nerve conduction studies

121. When an individual is exposed to a stimulus that causes tissue damage, an immediate response

occurs that involves withdrawal and/or attempts to escape the stimulus. This reaction is an example

of

(a) respondent learning.

(b) operant learning.(c) cognitive behavioral theory.

(d) trial and error.

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122. In patients with a traumatic brain injury, which factor suggests a poor prognosis for emergence

from unresponsiveness?

(a) Decorticate posturing

(b) Flaccid muscle tone

(c) Conjugate eye movement

(d) Reactive pupils

123. When using local steroid injections in patients with tendinopathies

(a) injection into the tendon substance is optimal.

(b) minimum interval between injections is 2 weeks.

(c) select the finest needle that will reach the area.

(d) early postinjection local anesthesia is a complication.

124. A 56-year-old woman with myasthenia gravis is in the intensive care unit with urosepsis. Which

antibiotic should be avoided in this patient?

(a) Aztreonam (Azactam)

(b) Gentamicin (Garamycin)

(c) Ceftriaxone (Rocephin)

(d) Ciprofloxacin (Cipro)

126. A 45-year-old woman with advanced acquired immunodeficiency syndrome (AIDS) presents with a

gradual onset of forgetfulness and inattention without other focal neurologic deficits. Review of

systems is negative for headache and fever. The most likely diagnosis is

(a) toxoplasmosis.

(b) cryptococcal meningitis.(c) human immunodeficiency virus (HIV) encephalopathy.

(d) central nervous system (CNS) lymphoma.

127. The activity established as most predictive of developing a low back disorder is

(a) carrying an object at an increased horizontal distance from the body.

(b) lifting an object repeatedly at 20% less than the individuals maximum lift capacity.

(c) repetitive sit-to-stand transitions with a weighted back pack.

(d) bending at knees rather than at the waist to lift an object.

131. Which term describes a maladaptive pattern of drug use marked by increasing doses to achieve a

similar pain relieving effect and a withdrawal syndrome?

(a) Dependence

(b) Addiction

(c) Craving

(d) Tolerance

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132. Which statement is TRUE regarding post-stroke central pain?

(a) Damage to the thalamus plays a central role in the pathogenesis of central pain.

(b) Amitriptyline is the drug of first choice to treat central pain.

(c) 80% of stroke patients with central pain develop the pain within a month of their stroke.

(d) The pain usually resolves spontaneously and does not require medication.

135. A 46-year-old man with a 1-year history of C8 ASIA A spinal cord injury presents to your clinic

with a 1-month history of increasing bilateral upper extremity weakness and pain. There is no

history of trauma. You would

(a) observe for 2 to 4 weeks and repeat ASIA exam.

(b) perform electrodiagnostic testing to rule out peripheral nerve compression.

(c) order a magnetic resonance imaging study to look for posttraumatic syringomyelia.

(d) initiate a workup for pernicious anemia.

136. A 58-year-old man sustained a myocardial infarction 1 week ago. He is undergoing phase 1 of

cardiac rehabilitation. His activity level should be limited to how many metabolic equivalents(METs)?

(a) 1

(b) 3

(c) 5

(d) 7

138. What parameter of the motor unit action potential (MUAP) is the most sensitive to the distance

between the generator source and recording electrode?

(a) Amplitude(b) Phases

(c) Firing rate

(d) Duration

139. A 2-month-old infant presents to you for evaluation of delayed development. He was the product

of a normal term pregnancy, labor, and delivery. Birth weight was 3500 grams. He has had

difficulty feeding since birth. Family history is negative for developmental problems. On physical

examination, he is awake, but not alert. Weight is 3600 grams. Respiration is unlabored. He has

poor head control and decreased tone throughout. Deep tendon reflexes are absent. What is the

most likely diagnosis?

(a) Kugelberg Welander syndrome

(b) Duchenne muscular dystrophy

(c) Infantile botulism

(d) Tetraplegic cerebral palsy

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140. The primary advantage of mag wheels over spoked wheels in the performance of a wheelchair is

(a) lighter weight.

(b) reduced maintenance.

(c) more maneuverability.

(d) general preference by active wheelchair users.

141. If the L3 and L4 medial branches of the dorsal rami are ablated, the patient will experience blocked

afferents from the

(a) L5-S1 facet joint.

(b) L4-5 facet joint.

(c) L3-4 facet joint.

(d) L2-3 facet joint.

145. What is one reason for placing a suprapubic catheter in a person with a complete cervical spinal

cord injury who currently uses intermittent catheterization?

(a) Decreased rate of bladder/kidney infections

(b) Decreased high bladder pressures

(c) Decreased rate of bladder/kidney stone formation

(d) Reduced risk of developing autonomic dysreflexia

147. In order to appropriately follow Medicare regulations for teaching physicians, when caring for a

patient with a resident physician, the attending physician must

(a) review the chart and personally document his/her level of involvement in patient care,

separate from documentation performed by the resident.

(b) examine the patient with the resident and co-sign the resident note.(c) examine the patient and review the residents medical record documentation.

(d) examine the patient, review the residents documentation, and personally document

involvement in the history, exam, and medical decision-making.

149. The most common musculoskeletal abnormalities seen in a child with L5 myelodysplasia with

sparing of the L5 segment and above are

(a) cavus foot, early hip dislocation, hip and knee flexion contractures.

(b) calcaneus foot, late hip dislocation, hip and knee flexion contractures.

(c) cavus foot, late hip dislocation, hip adduction contractures.

(d) calcaneus foot, early hip dislocation, hip adduction contractures.

151. Which spinal level has the greatest depth of posterior epidural space?

(a) C3-4

(b) C4-5

(c) C5-6

(d) C6-7

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154. Which muscle fiber is characterized by fast-twitch oxidative metabolic properties?

(a) Type 1

(b) Type 2a

(c) Type 2b

(d) Type 3

161. A 45-year-old woman with fibromyalgia presents to you with complaints of poor sleep. She notes

that she has no trouble falling asleep but has a difficult time staying asleep. She has improved her

sleep hygiene and eliminated caffeine from her diet. Which medication would you recommend?

(a) Diazepam (Valium)

(b) Eszopiclone (Lunesta)

(c) Chloral hydrate

(d) Fluoxetine (Prozac)

162. A patient with a recent stroke and hemiplegia presents to your clinic and is noted to have a genu

recurvatum gait pattern. An aggressive stretching program has improved ankle range-of-motion,but not her spasticity and gait. The most appropriate treatment is

(a) an ankle foot orthosis with 5 of plantarflexion.

(b) Achilles tendon lengthening.

(c) phenol motor point injection to the hamstrings.

(d) botulinum toxin injection to the gastrocsoleus muscle group.

165. For an individual who has C5 tetraplegia, orthotic splinting attempts to maintain the functional

position of the hand. This usually includes

(a) closing the thumb web space.(b) 30 to 40 of metacarpophalangeal flexion.

(c) promoting flattening of the palmar arch.

(d) supporting the wrist in 20 to 30 of extension.

166. Standing at ease is equivalent to how many metabolic equivalents (METs)?

(a) 1.5 to 2.0

(b) 2.5 to 3.0

(c) 4.0 to 4.5

(d) 5.0 to 5.5

167. Which condition is a cumulative trauma disorder that has been associated with intensive computer

use?

(a) Herniated thoracic disc

(b) Shoulder adhesive capsulitis

(c) Post-traumatic stress syndrome

(d) Cervical myofascial pain

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169. An unusually high incidence of pressure ulcers is noted on your inpatient rehabilitation unit. As the

medical director for the unit, you decide to implement a quality improvement process. The next

best step in process would be to

(a) understand the cause of the skin breakdown.

(b) select a strategy to decrease the incidence of pressure ulcers.

(c) organize a team to investigate the problem.

(d) reprimand the nurse manager for the unit.

170. Which statement describes an advantage of a single-subject research design (that is, A-B-A or

multiple baseline design)?

(a) It can account for variability between subjects.

(b) It permits medication trials with no washout period.

(c) It can establish cause and effect relationships.

(d) It is useful for interventions with prolonged or extended effects.

171. Which statement is TRUE regarding complex regional pain syndrome (CRPS)?

(a) Pain is characterized by allodynia.

(b) Local osteopenia is a common early occurrence.

(c) CRPS type 1 is also known as causalgia.

(d) Adults with CRPS have a better prognosis than children with CRPS.

173. Effects of prolonged bed rest include

(a) increased maximum oxygen consumption.

(b) increase of plasma volume.

(c) decreased resting heart rate.(d) decreased cardiac stroke volume.

176. Performing a leg press exercise is an example of an

(a) open kinetic chain exercise.

(b) closed kinetic chain exercise.

(c) isokinetic exercise.

(d) isometric exercise.

178. Professionalism is the basis of medicines contract with society. Which item is a fundamentalprinciple of medical professionalism?

(a) Social justice

(b) Physician paternalism

(c) Patient disclosure

(d) Free enterprise

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179. Preventable medical errors are

(a) rarely associated with significant morbidity.

(b) most commonly a result of individual human error.

(c) associated with no impact on patient satisfaction.

(d) associated with patients loss of trust in the health care system.

180. Your co-resident presents an article in journal club on a new medication and its impact on outcomes

following traumatic brain injury. On which point would you NOT need assurance before you

decide to use this medication in your clinical practice?

(a) That the research study results are clinically significant

(b) That bias was eliminated from the study

(c) That the research study results are statistically significant

(d) That research investigators used valid outcome measures

182. Which statement is TRUE about the relative responses of the brain and the spinal cord after

concussive trauma?

(a) The brain is more sensitive to trauma than the spinal cord.

(b) The spinal cord is more sensitive to trauma than the brain.

(c) The brain and the spinal cord are equally sensitive to trauma.

(d) The brains neurologic recovery is less predictable than the spinal cords in its response to a

given amount of trauma.

183. A 70-year-old woman presents with a cemented right total hip arthroplasty. She is partial weight

bearing and struggling with physical therapy. The therapist asks to use ultrasound to the right hip

to help with bone healing and ultimately progress the patient to weight bearing as tolerated. You

advise

(a) yes, because ultrasound helps with bone healing.

(b) no, because ultrasound near arthroplasties is contraindicated.

(c) yes, because the heat may help with pain management.

(d) no, because ultrasound is expensive to use.

184. Electromyographic biofeedback for stroke patients is most beneficial when

(a) proprioception is preserved.

(b) used in the upper limb.

(c) the patient is young.(d) the patient has flaccid paralysis.

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185. Five weeks after sustaining a T6 complete spinal cord injury, your patient is noted to have new

urinary incontinence with intermittent catheterization volumes of less than 150cc. Work-up is

negative for a urinary tract infection. You consider starting

(a) tamsulosin (Flomax).

(b) tolterodine (Detrol).

(c) terazosin (Hytrin).

(d) bethanechol (Urecholine).

186. Which method of paraffin bath heats the subcutaneous area to a greater degree?

(a) Dipping method

(b) Continuous method

(c) Wrap method

(d) Paint on method

188. Which statement accurately characterizes a meta-analysis?

(a) It summarizes the results of randomized controlled trials.

(b) It summarizes the findings of an expert panel.

(c) It groups research on a particular topic area into 3 tiers.

(d) It summarizes findings of a single research protocol that is carried out a multiple centers.

190. Practice-based learning and improvement is considered by the Accreditation Council of Graduate

Medical Education (ACGME) to be an aspect of medical practice in which all physicians need to

achieve and maintain competency. Which characteristic is NOT a key aspect of practice-based

learning and improvement?

(a) The ability to locate, appraise, and assimilate evidence from scientific studies related to theirclinical practice

(b) The ability to access and use information technology to support their own education

(c) The ability to apply knowledge of study designs and statistical methods to the appraisal of

medical literature

(d) The ability to advocate for quality patient care and assist patients in dealing with system

complexities

194. An exclusion criterion for resistance training in patients with stable cardiac disease is

(a) peak exercise capacity at 7 metabolic equivalents (METs).

(b) prior history of a stroke.(c) controlled hypertension.

(d) severe valvular disease.

196. Which treatment has NOT been shown to improve epicondylitis?

(a) Low intensity laser irradiation

(b) Wrist extension strengthening exercises

(c) Acupuncture

(d) Extracorporeal shock-wave therapy

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197. The Commission on Accreditation of Rehabilitation Facilities (CARF)

(a) requires mandatory surveys of all inpatient rehabilitation facilities.

(b) provides accreditation status that confers a preferred status with payors.

(c) provides accreditation status that signifies the rehabilitation facility holds itself to the highest

standards in the field.

(d) provides accreditation for comprehensive inpatient rehabilitation programs, but not specialty

programs in areas such as spinal cord injury.

199. Investigators must address ethical considerations when designing and implementing research

studies. One such consideration requires investigators to design protocols that will provide

generalizable knowledge and ensure that the benefits of the research are proportionate to the risks

assumed by the subjects. This ethical consideration is referred to as

(a) respect.

(b) beneficence.

(c) justice.

(d) autonomy.

200. In instances where a researcher has financial investments in a company and is researching the

effectiveness of one of the companys products, the researcher is obligated to

(a) terminate the investigation if the investigational agent is found to be not effective.

(b) disclose this involvement in writing to subjects that are being enrolled in the study.

(c) end financial involvement in the company before the results of the research are revealed to

the public.

(d) disclose this involvement to the investigator's medical center, to funding organizations, and to

journals publishing the results.

End of Examination