2001

SELF-ASSESSMENT EXAMINATION
FOR RESIDENTS (SAE-R)

MULTIPLE-CHOICE QUESTIONS BOOKLET

Abridged Version

Copyright © 2001
American Academy of Physical Medicine and Rehabilitation
Chicago, Illinois
 Abridged Version
2001 Self-Assessment Examination for Residents (SAE-R)

1. A 27-year-old female runner presents to your office with foot pain for the last 3 weeks. She reports
a severe pain on the bottom of her foot which is worse with the first few steps in the morning after
getting out of bed. She has no history of trauma and typically runs up to 5 miles per day. Her
running has been severely limited since this pain began. What is the best initial treatment option
for this patient’s pain?

(a) Walking cast for the affected foot

(b) Complete bed rest for several days
(c) Corticosteroid injection at the involved site monthly for 3 months
(d) Foot orthotic and stretching

(This question has been eliminated from the exam, therefore, it was not scored.)
2. What magnetic resonance imaging findings would help to distinguish an acute from a chronic
intracerebral hemorrhage?

(a) T1 decreased, T2 increased

(b) T1 decreased, T2 decreased
(c) T1 increased, T2 increased
(d) T1 increased, T2 decreased

3. Which of the following synovial fluid findings is most specific for infection?

(a) White blood cell count of 5,000/mm3

(b) Transparent, straw-colored fluid
(c) Ninety-eight percent neutrophils on a differential leukocyte count
(d) Negatively birefringent crystals under a polarizing microscope

6. A withdrawal syndrome produced by abrupt medication dose reduction or the administration of an

antagonist drug is referred to as

(a) tolerance.
(b) pseudoaddiction.
(c) physical dependence.
(d) addiction.

7. A nurse working in a rehabilitation hospital is most likely to injure her back while

(a) assisting a patient to perform a sliding-board transfer.

(b) catheterizing a patient.
(c) performing a wheelchair-to-toilet patient transfer.
(d) helping a patient move up in bed.

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9. The most useful clinical criterion to distinguish Becker muscular dystrophy from Duchenne
muscular dystrophy is

(a) creatine kinase values at the time of diagnosis.

(b) walking ability during the teen-age years.
(c) Gowers’ sign and calf enlargement.
(d) age at onset of diagnosis.

11. Dysesthesias on the plantar aspect of the foot may be associated with peripheral neuropathy or
tarsal tunnel syndrome. Which of the following would be most useful to help in distinguishing
between these?

(a) Reproduction of symptoms with compression inferior to the medial malleolus

(b) Sensory testing using a Semmes-Weinstein monofilament on the plantar aspect of the foot
(c) Plain anteroposterior and lateral radiographs of the foot, including the calcaneus
(d) Slowing of the medial and lateral plantar nerves on nerve conduction studies

12. A primary care physician started a relative of yours on donepezil (Aricept) for the treatment of
Alzheimer’s disease. This medication is used to modify

(a) expressive language skills.

(b) behavioral and cognitive symptoms.
(c) disease progression.
(d) restoring normalized sleep-wake cycles.

14. A 26-year-old woman presents with the new onset of lower extremity weakness and bladder
incontinence. Past medical history is remarkable for an episode of diplopia and blurred vision
which resolved spontaneously. The most likely diagnosis is

(a) multiple sclerosis.

(b) myasthenia gravis.
(c) myasthenic syndrome.
(d) amyotrophic lateral sclerosis.

15. The best possible expected functional outcome for a person with C7 ASIA A spinal cord injury is

(a) dependent with bladder, independent with bed mobility, and some assist with all transfers.
(b) dependent with bladder, independent with bed mobility, and independent with level transfers.
(c) independent with bladder, some assist with bed mobility, and independent with some
transfers.
(d) independent with bladder, independent with bed mobility, and independent with level
transfers.

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16. Which of the following conditions is least likely to exacerbate preexistent lymphedema?

(a) Scuba diving in cold water

(b) Airplane travel
(c) Phlebotomy
(d) Sun exposure

17. Functional recovery programs for the injured worker with chronic pain should

(a) be done on an inpatient basis to increase the likelihood of success.

(b) not be started until pain medications have been discontinued.
(c) focus on restoration of function.
(d) focus on reducing the patient’s pain symptoms.

18. Of the following, somatosensory studies would be the most useful in the diagnosis of

(a) tarsal tunnel syndrome.

(b) motor neuron disease.
(c) myasthenia gravis.
(d) multiple sclerosis.

19. The leading cause of childhood disability is

(a) traumatic brain injury.

(b) spinal muscular atrophy.
(c) spina bifida.
(d) cerebral palsy.

20. Which of the following orthoses or shoe modifications is used in the conservative management of
plantar fasciitis?

(a) Heel lift

(b) Posterior night splint
(c) Lateral heel wedge
(d) Metatarsal bar

22. A 32-year-old woman with known multiple sclerosis has frequent bladder sensation and urgency
but very little urination amounts. Nursing informs you that her void amounts are low, her post-void
residual is high, and the combined voided plus catheter specimen amounts are on the low-normal
side. You order urodynamic testing to verify

(a) an areflexic bladder with sphincter dyssynergia (increased tone).

(b) an areflexic bladder with normal sphincter tone.
(c) a hyperreflexic bladder with sphincter dyssynergia.
(d) a hyperreflexic bladder with normal sphincter tone.

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23. Which of the following glucocorticoid preparations has the longest therapeutic action?

(a) Triamcinolone diacetate (Aristocort)

(b) Methylprednisolone acetate (Depomedrol)
(c) Hydrocortisone phosphate (Hydrocortone)
(d) Dexamethasone sodium phosphate (Decadron)

25. Outcomes of inpatient rehabilitation for neoplastic versus traumatic spinal cord injury reveal that

(a) indices for depression were significantly higher in patients with neoplastic injury.
(b) patients with neoplastic spinal cord injury had significantly shorter lengths of stay.
(c) rate of functional change was significantly better in the traumatic population.
(d) neoplastic spinal cord injury was associated with a significantly higher rate of discharge to
the community.

26. During the initial reductive phase of decongestive physiotherapy for advanced lymphedema,
compressive bandaging should remain in place

(a) 1-2 hours per day.

(b) overnight.
(c) whenever patients are not bathing or being manually drained.
(d) only during exercise periods.

27. A 35-year-old fireman with a 3-month history of shoulder bursitis is referred to you for treatment.
Among the following, your initial management would include

(a) ice massage to the involved area.

(b) ultrasound to the involved area.
(c) transcutaneous electrical nerve stimulation.
(d) placing the arm in a shoulder sling.

29. The earliest weakness seen in skeletal muscle in Duchenne muscular dystrophy is located in

(a) knee extensors.

(b) hip flexors.
(c) neck flexors.
(d) ankle plantar flexors.

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30. During normal human locomotion, the center of gravity travels through a sinusoidal pathway that is
modified by 6 determinants of gait. Which of the following is not considered 1 of the 6
determinants?

(a) Pelvic extension

(b) Foot and ankle synchronization
(c) Knee flexion
(d) Lateral pelvic displacement

34. Clinical features of Friedreich's ataxia include

(a) sparing of sensory function.

(b) onset in the fourth decade of life.
(c) a high incidence of scoliosis.
(d) ambulation into late adulthood.

35. Five weeks after sustaining a T6 spinal cord injury, your patient is noted to have urinary
incontinence with intermittent catheterization volumes of less than 200mL. Urinalysis is
unremarkable. You consider starting

(a) sodium etidronate (Didronel).

(b) oxybutynin (Ditropan).
(c) urecholine (Bethanechol).
(d) terazosin (Hytrin).

37. A human resource firm working with a manufacturing company inquires about personal factors and
low back injuries. It is interested in matching individuals with work stations. Which of the
following was found to be most important in predicting injuries?

(a) Age greater than 40

(b) Obesity
(c) Psychologic factors
(d) Poor physical fitness

38. You are treating a 48-year-old man who has had two lumbar laminectomies for what you suspect is
a recurrent right L5 radiculopathy. You perform an electromyogram to confirm the diagnosis, and
it reveals 2+ positive waves and fibrillations with decreased recruitment in the right anterior
tibialis. The patient informs you that he can only tolerate the examination of one more muscle. Of
the following you would choose

(a) extensor hallucis longus.

(b) L5 paraspinals.
(c) vastus medialis.
(d) flexor digitorum longus.

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39. The most common complication after amputation in the immature child is

(a) phantom limb pain.

(b) diffuse edema.
(c) terminal overgrowth.
(d) painful neuroma.

40. A 79-year-old cachetic woman with coronary artery disease and unstable angina sustains a right hip
fracture after a fall. After an open-reduction internal fixation of the hip joint with the use of a
dynamic hip screw, the orthopedic surgeon determines that the patient is 25% partial weight
bearing to the right side. She has weak upper body strength and good balance. Which of the
following assistive devices is most appropriate?

(a) Standard walker

(b) Rolling walker
(c) Axillary crutches
(d) Quad cane

41. A 16-year-old boy presents 2 days after being injured during a weekend football game. He reports
receiving a direct blow on the right side from the helmet of a player. He had immediate pain in the
right lower part of the posterolateral trunk. On exam, you note ecchymosis and tenderness to
palpation just superior to the right iliac crest. Which of the following signs would be expected on
subsequent examination?

(a) Severe pain with internal rotation of the right hip

(b) Pain on the right side with left lateral bending of the trunk
(c) Numbness in the right femoral nerve distribution
(d) A positive Gillet test

42. A 75-year-old man with a recent anterior communicating artery aneurysm, treated by neurosurgical
clipping is admitted to the inpatient rehabilitation unit for poststroke care. Deep vein thrombosis
prophylaxis should include

(a) heparin 5,000 units BID.

(b) warfarin doses based on INR values.
(c) pneumatic compression stocking (ankle or calf).
(d) continuous passive motion devices.

45. The most common cause of upper limb pain in long-standing tetraplegia is

(a) shoulder pain of radicular origin.

(b) shoulder pain of musculoskeletal origin.
(c) elbow pain of radicular origin.
(d) elbow pain of musculoskeletal origin.

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46. A patient with metastatic lung cancer presents to the emergency department with new-onset back
pain and lower extremity weakness suspected to be due to spinal metastases. Initial management
should include

(a) observation for 24 hours and careful reexamination for progressive neurologic deficits.
(b) emergent irradiation prior to imaging.
(c) empiric administration of high-dose dexamethasone in the absence of contraindications.
(d) alteration of the patient's chemotherapy regimen.

47. A 63-year-old man was in a car accident 3 days ago. Cervical radiographs performed in the
emergency department demonstrate multilevel degenerative disc disease. He is currently
asymptomatic but is concerned about the radiographic findings. You inform him that

(a) this is diagnostic of central spinal stenosis.

(b) further neuroimaging is required.
(c) cervical spine immobilization with a soft collar is recommended.
(d) no evaluation or treatment is necessary until symptoms occur.

49. In children hospitalized with acute burns, early management should include

(a) avoidance of sedation.

(b) positioning for comfort to reduce severe pain.
(c) use of a pressure garment over areas of full-thickness burns.
(d) administration of narcotics and anesthetic agents.

52. A 77-year-old woman is admitted to the rehab inpatient unit with a diagnosis of general debility
after urosepsis and dehydration. Clinical exam reveals impaired memory, diminished abstract
reasoning, gait ataxia, and peripheral distal extremity numbness. Past medical/surgical history is
positive for coronary artery disease and poor nutrition. Lab data include Na 135, K 3.5, Cl 95, C02
24, WBC 7.4, Hgb 9.5, MCV 101, urinalysis negative, RPR negative, Cobalamin assay 200 pg/mL
(normal 170-900). You believe her neurologic abnormalities are attributable to

(a) normal-pressure hydrocephalus.

(b) latent neurosyphyilis.
(c) postdehydration cerebral infarction.
(d) pernicious anemia.

53. Use of continuous passive motion after total knee replacement surgery

(a) is associated with increased knee flexion at 6 months.

(b) decreases the risk of joint infection.
(c) facilitates knee flexion within the hospital stay.
(d) obviates deep vein thrombosis prophylaxis.

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54. A typical clinical finding in patients with alcoholic cerebellar disease is

(a) gait ataxia out of proportion to extremity ataxia.

(b) benign positional vertigo.
(c) severe upper extremity dysdiadochokinesia.
(d) vertical nystagmus.

55. Functional outcomes after the use of methylprednisolone in persons with penetrating spinal cord
injury as compared with blunt injury are

(a) markedly improved.

(b) better.
(c) unchanged.
(d) worse.

56. A 45-year-old colon cancer patient presents with new urinary incontinence and dull pain radiating
into the right buttock. Physical examination fails to reveal evidence of lower extremity motor or
sensory deficits. Of the following, the MOST appropriate next step in the patient's evaluation
would include

(a) pelvic computed tomography with contrast.

(b) lower extremity electromyogram.
(c) positron-emission tomography scan.
(d) urodynamics studies.

59. In considering selection of a lower limb prosthesis for a child with a congenital transfemoral
amputation, a knee joint should be included

(a) at initial fitting.

(b) between 3 to 5 years of age.
(c) when sports activities are anticipated.
(d) when the child pulls to stand.

60. Which one of the following cervical orthoses is the most restrictive to range of motion in flexion,
extension, axial rotation, and lateral bending, both actively and passively?

(a) Soft collar

(b) Philadelphia collar
(c) Philadelphia collar with thoracic extension
(d) Sternal-occipital-mandibular immobilizer collar

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63. You are asked to see a 35-year-old woman with systemic lupus erythematosus who has severe left
groin pain. She underwent a cadaveric renal transplant 4 years ago. She has a Trendelenburg gait
and pain upon internal rotation of the hip. There is reproduction of the groin pain with hip flexion.
Your diagnosis is

(a) L5 radiculopathy.
(b) trochanteric bursitis.
(c) avascular necrosis.
(d) femoral neuropathy.

64. A middle-aged man is evaluated 1 week after the onset of painless foot drop. On exam, 1/5 strength
of ankle dorsiflexion and eversion is present. Electrodiagnostic testing demonstrates a 90% loss in
the compound muscle action potential amplitude of the anterior tibialis without conduction block
across the fibular head. Markedly reduced motor unit recruitment is present in the anterior tibialis.
Of the following, the most appropriate recommendation is

(a) observation and a temporary ankle-foot orthosis, as the prognosis is excellent.

(b) a custom-molded ankle-foot orthosis with dorsiflexion assist.
(c) functional electrical simulation of the anterior tibialis to facilitate recovery.
(d) magnetic resonance imaging of the brain to rule out a lacunar stroke.

65. Persons with neurogenic bowel often use laxatives such as senna (Senokot), which acts by

(a) decreasing intraluminal fluid.

(b) lubricating the intestinal mucosa.
(c) stimulating the myenteric plexus.
(d) increasing the time for electrolyte resorption.

66. Electromyographic findings consistent with Lambert-Eaton myasthenic syndrome suggest the
presence of

(a) small cell lung cancer.

(b) malignant melanoma.
(c) inflammatory breast cancer.
(d) renal cell carcinoma.

68. The number of phases of a motor unit is related to the

(a) conduction time through collateral nerve sprouts.

(b) sweep speed setting on the oscilloscope screen.
(c) sensitivity (gain) setting on the oscilloscope screen.
(d) central conduction time and the state of the upper motor neuron.

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69. The earliest marker of abnormal central nervous system maturation is

(a) diffuse fasciculations.

(b) gross motor delay.
(c) delay of postural responses.
(d) persistence of primitive reflexes.

70. What level of amputation has the highest acceptance rate for an upper extremity prosthesis?

(a) Wrist disarticulation

(b) Transradial
(c) Elbow disarticulation
(d) Transhumeral

71. Fibromyalgia is a systemic disorder that affects primarily the musculoskeletal system and results in
pain and stiffness. Which of the following statements is true about the diagnosis and treatment of
fibromyalgia?

(a) It has an equal distribution in both men and women.

(b) The “tender points” associated with this condition cause radicular pain.
(c) Severe sleep disturbances and fatigue are common complaints.
(d) Palpable taut bands, which exhibit local twitch responses, are characteristic.

72. A 29-year-old woman with a traumatic brain injury is seen by you for consultation. On chart
review, it is noted that she has frequent episodes of emesis with percutaneous endoscopic
gastrostomy tube bolus feeding. Your initial recommendation would be

(a) placement of a jejunostomy tube.

(b) surgical consult for pyloroplasty.
(c) continuous tube feeding.
(d) switch to elemental formula tube feeding.

74. Which of the following symptoms is typically present in vascular claudication but not in
neurogenic claudication?

(a) Earlier onset of pain with uphill walking

(b) Pain in the posterior calf
(c) Leg paresthesias and numbness
(d) Pain relief with sitting

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78. During the electromyographic evaluation of a patient, you note discharges consistent with
myotonia and small motor units in the distal muscles of the upper and lower extremities. The most
likely diagnosis is

(a) paramyotonia congenita.

(b) myotonic dystrophy.
(c) myotonia congenita.
(d) hyperkalemic periodic paralysis.

79. A parent of an 18-month-old child reports that the child babbled as an infant but became much
quieter after about 8 months of age. She has no true words, though she will wave bye-bye. She
follows no verbal commands but will follow occasional pantomime commands. Her gross and fine
motor skills have been normal. The most likely diagnosis is

(a) autism.
(b) mental retardation.
(c) hearing impairment.
(d) oral motor apraxia.

80. When considering realistic functional goals for the majority of transhumeral amputees, the
maximal weight (in pounds) that can be carried with the body-powered prosthesis is

(a) 7.
(b) 15.
(c) 30.
(d) 50.

81. What is your recommended treatment of a T11 compression fracture in a 72-year-old woman?

(a) She should be referred to an orthopedic surgeon for immediate fusion because of the risk of
neurologic compromise.
(b) Neurologic compromise should be ruled out by physical examination, and the patient should
be sent home with reassurance that “time will heal this.”
(c) Neurologic compromise should be ruled out, and the patient should be given an appropriate
pain medication to provide adequate relief.
(d) To prevent neurologic compromise, the patient should be placed in a spinal orthosis.

82. In the orthotic and prosthetic clinic, a patient with Parkinson’s disease presents for gait analysis.
The primary gait disturbance found is an alternation in stride length and altered cadence. A gait-
training program for a person with Parkinson’s disease should include

(a) visual cueing techniques.

(b) bilateral ankle-foot orthoses.
(c) patterning techniques.
(d) vestibular stimulation exercises.

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83. Which of the following is associated with a good outcome following surgical decompression for
spinal stenosis?

(a) Leg more than back pain

(b) Long duration (more than 4 years) of symptoms
(c) Minimal constriction of the spinal canal
(d) Multilevel spondylosis and degenerative joint disease

85. The primary advantages associated with standing frames and standing wheelchairs for persons with
spinal cord injury include

(a) reduction in lower extremity edema.

(b) reduction in cost to make a workplace accessible.
(c) ease in transportation for everyday use.
(d) increased bone density in the hips.

86. Patients with head and neck malignancies who are receiving radiation therapy should be instructed
that cervical range-of-motion activities should be

(a) initiated only when radiation sessions have been completed.

(b) performed throughout the course of radiation therapy to prevent contracture.
(c) limited to movement planes contralateral to the involved side.
(d) initiated no sooner than 1 month after radiation therapy.

87. The most significant factor contributing to upper limb cumulative trauma disorders is

(a) size of the equipment used.

(b) age of the person.
(c) macrotrauma to the area.
(d) repeated forceful exertions.

88. Dorsal ulnar cutaneous nerve conduction studies are most useful in differentiating

(a) ulnar neuropathy at the elbow from lower trunk plexopathy.

(b) ulnar neuropathy at the elbow from ulnar neuropathy at the wrist.
(c) lower trunk plexopathy from medial cord plexopathy.
(d) ulnar neuropathy at the cubital tunnel from ulnar neuropathy at the ulnar groove.

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91. A 33-year-old female homemaker presents with pain in the area of the left “anatomic snuff box” for
the last 2 weeks. She has been knitting a blanket for her pregnant sister, and she reports that the
pain has significantly increased since she began this project. On examination, she has exquisite
tenderness to palpation at the site of the snuff box. There is no erythema, but mild swelling is noted
in the painful area. Which of the following statements is true about the patient’s condition?

(a) The inflamed tendon sheath should be injected with a corticosteroid and her hand placed in a
resting splint.
(b) The tendons most likely to be involved are the abductor pollicis brevis and the extensor
pollicis brevis.
(c) This condition is so severe that it warrants referral to a hand surgeon.
(d) She will have a negative Finkelstein’s test.

92. Characteristic x-ray findings of new bone formation in heterotopic ossification include densities
that are

(a) noncircumscribed, extra-articular, and extracapsular.

(b) noncircumscribed, extra-articular, and intracapsular.
(c) circumscribed, extra-articular, and extracapsular.
(d) circumscribed, intra-articular, and intracapsular.

93. The most successful treatment for adolescent idiopathic scoliosis with an upper thoracic spinal
curve of 30( is

(a) electrical stimulation.

(b) physical therapy.
(c) observation.
(d) Milwaukee brace for 23 hours daily.

94. A 70-year-old man with first-degree heart block presents with a painful distal sensory neuropathy.
Of the following, the most appropriate initial treatment is

(a) fluoxetine.
(b) gabapentin.
(c) oxycodone.
(d) trazodone.

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95. You have been following a person with a T4 spinal cord injury for 20 years. He is now 38, and he
presents with recent onset of frequent episodes of incontinence between catheterizations. His
intermittent catheterization volumes have increased to 600mL every 4-6 hours (they had been
300mL). He acknowledges an increase in his fluid intake, which he feels accounts for the increased
volumes. Your first priority is to order

(a) a blood glucose level.

(b) a urodynamic study.
(c) a basic metabolic panel.
(d) a prostate-specific antigen test.

96. In general, the risk of fracture is lower for blastic metastases than for lytic metastases. Which one
of the following tumors tends to form blastic metastases?

(a) Lung
(b) Multiple myeloma
(c) Prostate
(d) Renal cell

97. A 23-year-old painter is recovering from a rotator cuff injury after falling off a ladder. His
impairment would be influenced by

(a) the physical demands of his job.

(b) how he injured the shoulder.
(c) the treatment required.
(d) the extent of limitation of shoulder range of motion.

99. The most severe form of mental retardation in cerebral palsy occurs in association with

(a) spastic diplegia.

(b) ataxia.
(c) spastic quadriplegia.
(d) athetosis.

100. When comparing quadrilateral sockets with ischial containment sockets, a successful fitting is
more likely in a quadrilateral socket when

(a) the adductor musculature is intact.

(b) the residual limb is fleshy.
(c) trunk stability demands are high at mid stance.
(d) the residual limb is shorter.

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101. A 39-year-old mail sorter complains of severe right elbow pain for 6 months. He has tried anti-
inflammatory drugs without relief. He denies numbness, but does report weakness in his grip. On
examination, the patient has severe pain with palpation just inferior to the lateral epicondyle. The
best plan for treating the patient’s condition will include

(a) medical retirement because this condition is resistant to all forms of therapy.
(b) exercise consisting of wrist extensor strengthening and positioning the elbow at 90( flexion
and also full extension.
(c) corticosteroid injection into the elbow joint.
(d) surgical release of the extensor carpi ulnaris tendon to allow the wrist unresisted radial
deviation.

102. The most common neurologic disturbance associated with cranial irradiation is

(a) short-term memory deficit.

(b) anomia.
(c) bradykinesia.
(d) high-frequency hearing loss.

103. A 7-year-old boy is referred for evaluation and management of gradually progressive pain located
in the right medial thigh and knee, a limp, and limited painful hip motion. There was a similar
episode 3 months before which resolved spontaneously. Of the following conditions, the most
likely diagnosis is

(a) congenital hip dysplasia.

(b) slipped capital femoral epiphysis.
(c) Legg-Calvé-Perthes disease.
(d) epiphyseal fracture.

104. In a patient with bilateral hip flexion contractures, which of the following gait deviations would be
most likely?

(a) Bilateral Trendelenburg gait

(b) Early heel rise during stance
(c) Swing-phase circumduction
(d) Increased knee flexion in stance

105. Abrupt withdrawal of which of the following medications is most likely to result in death?

(a) tizanidine 8mg qid

(b) diazepam 15mg qid
(c) dantrolene 50mg qid
(d) baclofen 40mg qid

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106. In males, the energy cost of sexual activity with a married partner typically does not exceed how
many METs?

(a) 2
(b) 5
(c) 10
(d) 15

107. You are providing testimony in a worker’s compensation case. Of the following tests which, would
provide the most objective evidence for a lumbar radiculopathy?

(a) Straight leg raise

(b) Pin prick sensory examination
(c) Electromyogram
(d) Magnetic resonance imaging of the lumbar spine

108. The potentials above are

(a) complex repetitive discharges.

(b) myotonic discharges.
(c) neuromyotonia.
(d) myokymia.

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110. Which of the following knee types provides good stability in early stance phase and ease of flexion
while weight bearing during the pre-swing phase (terminal stance) of the gait cycle?

(a) Single axis

(b) Stance phase control
(c) Polycentric
(d) Manual locking

111. A 21-year-old US Army recruit reports to boot camp. After 5 days of marching, he reports to the
base physiatrist with complaints of severe pain in his left shin. He states that the pain began after a
10-mile run in full gear that morning. The pain has gotten significantly worse over the last 2 hours.
He is now unable to bear weight on his left leg. On examination, his left shin is shiny and
edematous. He has severe pain with palpation, and the muscles seem tight. You are suspicious that
this man has

(a) a severe muscle strain in the tibialis anterior.

(b) a muscle contusion due to a fall while running.
(c) an anterior leg compartment syndrome.
(d) a stress fracture in the left tibia.

112. A 58-year-old man with Parkinson’s disease has been on stable levodopa therapy for 2 years. He is
beginning to show signs of the “on-off” phenomenon. Your initial treatment considerations would
be

(a) referring him to neurosurgery for ablation.

(b) reducing levodopa dosing intervals.
(c) increasing dietary protein intake.
(d) adding an anticholinergic agent.

113. A 60-year-old man, on postoperative day 4 after total hip arthroplasty, experiences acute pain,
redness, and swelling of the first metatarsophalangeal joint. He has had similar episodes in the
past. You recommend

(a) warfarin.
(b) allopurinol.
(c) colchicine.
(d) dicloxacillin.

114. Recommended therapeutic interventions in orthostatic hypotension due to autonomic neuropathy

include

(a) amitriptyline use at bed time.

(b) sleeping in a head-down position.
(c) use of oral corticosteroids.
(d) avoidance of postprandial exercise.

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116. Elevated plasma levels of this substance have been determined to be a risk factor for
atherosclerosis.

(a) High-density lipoprotein cholesterol

(b) Vitamin E
(c) Homocysteine
(d) Vitamin C

117. A 62-year-old stevedore describes experiencing abrupt-onset shoulder pain after lifting a bale. He
has a positive drop arm test and difficulty with overhead reaching activities. He requests magnetic
resonance imaging (MRI) of his shoulder. You tell him that

(a) a rotator cuff tear is unlikely and MRI is not indicated.

(b) a rotator cuff tear is unlikely and MRI would be a very sensitive and specific test.
(c) a rotator cuff tear is likely and MRI will probably be abnormal.
(d) a rotator cuff tear is likely and MRI will probably be normal.

118. Comparing the results of electrodiagnostic studies on patients with clinical evidence of postpolio
syndrome and the results of those obtained in persons with a history of polio of similar severity and
duration since polio onset but no clinical evidence of postpolio syndrome, you find

(a) smaller motor units in the symptomatic group.

(b) more polyphasic motor units in the symptomatic group.
(c) more fasciculations in the symptomatic group.
(d) no significant differences between the groups.

120. An amputee presents for evaluation of distal blistering and evidence of vascular congestion. You
diagnose choke syndrome. Which of the following would NOT be an acceptable treatment for
choke syndrome?

(a) Expanding the proximal socket

(b) Increasing the auxiliary suspension to decrease vertical pull
(c) Relieving the distal socket where it interfaces with the choked surface
(d) Padding the distal socket where it corresponds to the choked surface

121. Which of the following statements about rupture of the bicipital tendon is true?

(a) Significant deficit in supination strength is usually associated with this condition.
(b) Rupture of this tendon requires surgical repair to maintain functional strength in the biceps.
(c) The tear occurs most commonly in the short head of the biceps and results in only a cosmetic
deformity.
(d) Tears most often occur in persons with long-standing shoulder impingement pain.

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122. A 22-year-old man with a severe brain injury has repeated episodes of inappropriate sexual
touching of female staff. An initial treatment option for decreasing this behavior would include

(a) assigning only male staff.

(b) precribing clomipramine (Anafranil) 25 mg BID.
(c) using of soft hand restraints for 3 minutes.
(d) offering firm verbal discouragement.

127. A wrist-hand orthosis used as symptomatic management for carpal tunnel syndrome should be

(a) limited to patients with short-duration symptoms.

(b) worn only during the day.
(c) worn with the wrist in neutral position.
(d) worn with the wrist in 30( of extension.

130. Which of the following shoe components distinguishes a blucher-style shoe from a bal-style shoe?

(a) Throat
(b) Toe box
(c) Heel
(d) Vamp

134. Foot ulcers in patients with diabetes

(a) are frequently associated with plantar foot callus.

(b) commonly occur even with clinically asymptomatic neuropathy.
(c) are most frequently located over the malleolus.
(d) are more common when subtalar hypermobility exists.

137. During an independent medical examination, maximum medical improvement is defined by

(a) the original symptoms having resolved.

(b) expected improvement on functional gains having occurred.
(c) the patient having returned to employment.
(d) a period of 12 months having elapsed since the injury.

138. In testing a patient with suspected myasthenia gravis, needle electromyography (EMG) of the right
upper extremity and orbicularis oculi is normal. Repetitive stimulation of the right ulnar nerve at a
rate of 2/second shows no decrement before or immediately after 1 minute of exercise. A 4%
decrement is noted 2 minutes after exercise. Your next electrodiagnostic step should be

(a) EMG of the lower extremities.

(b) EMG of the frontalis before and after edrophonium (Tensilon).
(c) repetitive stimulation of recording from a proximal muscle.
(d) ulnar somatosensory evoked potentials.

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139. Following severe traumatic brain injury, neuroendocrine dysfunction can result in diabetes
insipidus, SIADH (syndrome of inappropriate antidiuretic hormone), and cerebral salt wasting.
Cerebral salt wasting is manifested by

(a) hypernatremia.
(b) low serum osmolality.
(c) high urine output.
(d) dehydration.

140. A 35-year-old man experiences a severe S1 radiculopathy. As a result, he loses essentially all
strength within the posterior compartment of the leg. It is 6 months later, and you are consulted to
provide an orthosis to aid his ambulation. The best recommendation would be

(a) a posterior leaf spring ankle-foot orthosis (AFO).

(b) an articulating AFO with plantar flexion stop.
(c) an articulating AFO with dorsiflexion stop.
(d) an articulating AFO with dorsiflexion assist.

142. Risk factors for the development of Alzheimer’s disease include advancing age, family history,
presence of the gene APO E-4, and which of the following?

(a) low intelligence.

(b) large head circumference.
(c) male gender.
(d) co-morbidity with diabetes mellitus.

143. The American College of Rheumatology (ACR) criteria for fibromyalgia include all of the
following EXCEPT

(a) widespread pain.

(b) nonrestorative sleep.
(c) at least 11 of 18 tender points.
(d) symptom duration of at least 3 months.

144. Following a head injury, a 35-year-old woman presents with vertigo. She reports a sensation of
spinning beginning several seconds after standing up rapidly, bending over, or rolling in bed.
Symptoms lasts for approximately 30 seconds. Exam is notable for nystagmus during episodes of
vertigo, normal extremity coordination, and minimal increase in sway during Romberg testing. The
most likely diagnosis is

(a) benign positional vertigo.

(b) cerebellar contusion.
(c) unilateral vestibular paresis.
(d) bilateral vestibular paresis.

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145. Women who have sustained a spinal cord injury and become pregnant after injury are noted to have
pregnancy-related complications including

(a) high-birth-weight babies.

(b) late-onset labor.
(c) pressure sores.
(d) higher than average spontaneous abortions.

146. Noninvasive nocturnal assisted ventilation in patients with neuromuscular disease has been
associated with

(a) increased polycythemia.

(b) accelerated pulmonary hypertension.
(c) decreased daytime PaCO2.
(d) increased daytime fatigue.

147. Lumbar intradiscal pressure is lowest when a person

(a) stands erect.

(b) sits.
(c) stands with hips flexed.
(d) lies prone.

148. In evaluating a hypotonic infant with electromyography you find low-amplitude, short-duration
motor units with early recruitment. Based on these findings, the LEAST likely diagnosis would be

(a) central core disease.

(b) nemaline myopathy.
(c) type II glycogenosis (acid maltase deficiency).
(d) infantile spinal muscular atrophy.

149. In traumatic brain injury in children, outcome is primarily related to

(a) severity of original injury.

(b) location of injury.
(c) age at time of injury.
(d) associated injuries.

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150. A 75-year-old woman falls and fractures her distal humerus. In the process, the ulnar nerve is
damaged. She presents 6 months later with weakness in the fourth and fifth digits, claw deformity,
and loss of grip power. Which of the following orthotic components could benefit this patient and,
therefore, should be included in the orthotic prescription?

(a) Dorsal outrigger

(b) C bar
(c) Lumbrical bar
(d) Opponens bar

End of Multiple Choice Examination

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