Beruflich Dokumente
Kultur Dokumente
Copyright 2007 American Academy of Physical Medicine and Rehabilitation Chicago, Illinois
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) (b) (c) (d) Call for an ambulance and stabilize the neck. Remove the athletes football helmet and palpate for any neck tenderness. Return the athlete to the game if his strength exam is normal. Walk the athlete to the locker room and perform a thorough neurologic examination.
3.
The initial treatment for osteoarthritis is (a) (b) (c) (d) medication to reverse articular cartilage damage. surgical correction of joint deformities. therapy to relieve joint symptoms. 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) (b) (c) (d) modified duty to allow no repetitive twisting or bending and no push/pull heavier than 20 lbs. return to sedentary work 8 hours daily for 1 week, and no push/pull heavier than 10 lbs. light duty to include no pushing/pulling, or lifting more than 25 lbs for 1 month. 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) (b) (c) (d) high tetraplegia, motor incomplete, occurred in motor vehicle accident paraplegia, complete, occurred in motor vehicle accident high tetraplegia, complete, caused by medical/surgical complications 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) (b) (c) (d) Multiple subcortical contusions Subdural hematoma with evacuation Midline shift greater than 5mm Bilateral parietal contusions
14.
Myositis is defined as (a) (b) (c) (d) muscle aching. muscle aching with weakness. muscle symptoms with creatine kinase elevation. 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) (b) (c) (d) return to work without restrictions. work conditioning for 4 weeks. a week of work hardening. functional capacity evaluation.
21.
An 18-year-old, right-handed hockey player presents to you after experiencing 3 right shoulder anterior 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) (b) (c) (d) Tell him that he will likely dislocate again and that he should relocate the shoulder by forcefully pushing the anterior shoulder against a wall. Refer him to a surgeon to consider shoulder stabilization surgery. Tell him he should not return to any sports because of his increased chance of dislocating again. 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) (b) (c) (d) discontinue the medication and check creatinine and thyroid stimulating hormone levels. order electrodiagnostic study. switch to a different class of lipid lowering medications. continue the medication with close monitoring of the creatine kinase levels.
25.
An individual with C7 ASIA D tetraplegia must have (a) (b) (c) (d) a bulbocavernosus reflex and voluntary sphincter contraction. a muscle grade of 3 or greater in at least half of the key muscles below C7. normal pinprick and light touch sensation through the sacral dermatomes. normal strength (5/5) in the C7 myotome.
26.
Osteoblastic lesions are seen in which type of cancer? (a) (b) (c) (d) Prostate Lung Breast 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) (b) (c) (d) Mini Mental Status Examination Disability Rating Scale Previous hospitalization 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 the dorsum of the left hand. Prior to any testing, which problem would you consider as the most likely? (a) (b) (c) (d) Posterior interosseous neuropathy C7 radiculopathy Posterior cord brachial plexopathy 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 family that a ventriculoperitoneal shunt (a) (b) (c) (d) is emergently needed, and immediate referral to neurosurgery is indicated. will not be helpful, because the findings on the CT scan are due to irreversible atrophy of brain tissue (hydrocephalus ex vacuo). is not indicated, because he does not have the triad of incontinence, gait disorder, and dementia. 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) (b) (c) (d) common patient and team goals. discipline-specific goals. concentration on specific clinical problems. treatment by multiple team members.
38.
Which description best localizes the extensor indicis proprius muscle (with the forearm fully pronated) for needle electrode examination? (a) (b) (c) (d) Junction of the upper and middle third of the forearm between the radius and ulna Four fingerbreadths proximal to the wrist and directly over the ulnar side of the radius Two fingerbreadths proximal to the ulnar styloid and just radial to the ulna Mid-forearm along the radial border of the ulna
40.
When should upper extremity prosthesis fitting be initiated in the adult? (a) (b) (c) (d) Within the first month after amputation When residual limb strength is full. When the patient requests a prosthesis When residual limb volume has stabilized
41.
Which injury level is the most common location for an osteoporotic vertebral compression fracture? (a) (b) (c) (d) Upper thoracic spine Middle thoracic spine Thoracolumbar junction 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) (b) (c) (d) motor vehicle accidents. violence. falls. 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) (b) (c) (d) Folding frame, sling seating Adaptive stroller, linear seating Tilt in space frame, custom seating Rigid frame, contoured seating
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) (b) (c) (d) case managers inhibit patient care and you dont wish to speak with them. as requested by the patient you will see the case manager following the interview and examination. you will speak with the case manager after the patient signs a release of information. the case manager should always be present at the time of the patients interview and examination despite the patients request to avoid the case manager.
58.
Blink reflex studies can be useful in diagnosing which condition? (a) (b) (c) (d) Neuromuscular junction disorder Axonal neuropathy Motor neuron disease 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) (b) (c) (d) humerus on the paretic side. proximal femur on the paretic side. distal radius on the paretic side. 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) (b) (c) (d) Etanercept (Enbrel) Abatacept (Orencia) Anakinra (Kineret) 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) (b) (c) (d) avoiding a breath control system for his power wheelchair. aggressive diaphragmatic strengthening exercises. initiating a weaning protocol by slowly decreasing tidal volume. an electrodiagnostic study to evaluate for a phrenic nerve pacemaker.
66.
Which pulmonary parameter is most commonly followed in a patient with amyotrophic lateral sclerosis (ALS)? (a) (b) (c) (d) Arterial blood gas (ABG) Oxygen saturation (O2 sat) Forced expiratory volume in 1 second (FEV1) Vital capacity (VC)
67.
The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to (a) (b) (c) (d) ensure that a patients medical record is available to health care providers as directed by the patient. allow qualified physicians access to the patients medical record. allow a lawyer access to a medical record only if litigation is pending. prohibit the release of confidential health information to insurance carriers.
70.
Double limb stance is what percent of the entire gait cycle? (a) (b) (c) (d) 5% 10% 20% 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) (b) (c) (d) a coma state. a minimally conscious state. a vegetative state. a sleep/wake cycle.
74.
Which one of the following characteristics is typically associated with Charcot Marie Tooth (CMT) disease type 2? (a) (b) (c) (d) minimal level of disability. minimal decrease in nerve conduction velocity. autosomal recessive inheritance. 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) (b) (c) (d) posterior spinal cord syndrome. central cord syndrome. anterior spinal cord syndrome. conversion disorder.
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) (b) (c) (d) a minimum of 4 weeks of physical therapy will be necessary to facilitate recovery. low back pain has been found to be more frequent in people exposed to whole body vibration. workers with low back pain should not sit while symptoms of radiculopathy are present. 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) (b) (c) (d) Prolonged or absent F waves Decreased recruitment ratio Motor unit potentials with amplitudes of 10 millivolts 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) (b) (c) (d) Insufficient knee friction Prosthesis too short Excessive medial brim pressures Inadequate hip extension
81.
To allow pronation of the foot, which 2 joints must have their axis of rotation in parallel? (a) (b) (c) (d) Lisfranc and talonavicular Subtalar and calcanocuboid Talocrural and subtalar 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) (b) (c) (d) 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. transfer to your inpatient rehabilitation unit to start aggressive PT and OT. transfer to a subacute rehabilitation center to allow the patient time to improve with less intensive therapy. that his OT start functional electrical stimulation to the flaccid arm to enhance neurologic recovery.
83.
Which of the following is the most important lifestyle modification for prevention of osteoporosis? (a) (b) (c) (d) Avoiding cigarette smoking and high intake of caffeine Decreasing the intake of alcohol Minimizing the use of nonsteroidal anti-inflammatory medications Eating a diet high in protein and phosphorus
85.
Autonomic dysreflexia is most commonly precipitated by (a) (b) (c) (d) bladder distension bowel impaction heterotopic ossification 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 entire thickness 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) (b) (c) (d) 1 2 3 4
90.
In a transtibial amputee, ambulation with a prosthesis, instead of unilateral non-weight bearing (with crutches) results in (a) (b) (c) (d) higher rate of energy expenditure. lower heart rate. higher respiratory exchange rate. equivalent amounts of energy to walk the same distance.
94.
A negative prognosticator for successful surgical nerve repair after trauma is (a) (b) (c) (d) partial transection of the nerve. distal nerve injury. prior radiation therapy. 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) (b) (c) (d) further diagnostic evaluation is indicated. she requires a physical therapy evaluation. she needs a neurology evaluation. these reflexes are normal reflexes.
102. It is recommended that a patient with a first ischemic stroke who is positive for an antiphospholipid antibody be treated with: (a) (b) (c) (d) aspirin, 325mg orally daily. warfarin, with an INR goal of 3.03.5. clopidogrel (Plavix), 75mg orally daily. 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) (b) (c) (d) arthritis mutilans. Auspitzs sign. dactylitis. 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) (b) (c) (d) reassure the patient and continue to monitor for improvement. continue occupational therapy for 4 additional weeks. initiate neuromuscular electrical stimulation to the affected muscles. 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 cord injury. The motor (right/left) examination reveals R Motor 2 2 2 2 1 1 0 0 0 0 L Motor 5 5 5 3 1 1 0 0 0 0
Deltoids Biceps Wrist extensor Triceps Finger flexors Intrinsics Hip flexors Knee extensors Dorsiflexors Plantarflexors
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) (b) (c) (d) C4 ASIA A Right C4/ Left C7 ASIA A C6 ASIA A Right C4/ Left C7 ASIA B
106. What is the target exercise intensity for optimal aerobic training in a healthy, young individual? (a) (b) (c) (d) Borg rating of perceived exertion 6. 70%80% of maximum heart rate. Borg rating of perceived exertion 20. 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) (b) (c) (d) Hypertension Tachypnea Rigidity Hypothermia
110. The primary goal of a knee orthosis is to (a) (b) (c) (d) prevent knee injury in athletes. control knee instability in the anterior direction. prevent recurvatum. decrease the quadriceps force across the knee.
111. Which statement describes the chronic-pain concept of central sensitization? (a) (b) (c) (d) The evoked response of A-delta fibers to subsequent input is amplified. The influx of sodium is fundamental to electrical signaling and subsequent generation of action potentials and excitatory postsynaptic potentials. A complex set of activation-dependent post-translational changes occurs at the dorsal horn, brainstem, and higher cerebral sites. 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) (b) (c) (d) astrocytoma. oligoblastoma. medulloblastoma. meningioma.
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) (b) (c) (d) sciatic nerve stretch injury. posterior tibialis tendon rupture. inadequate pain control. peroneal nerve injury.
115. Etidronate disodium (Didronel) is used in the management of heterotopic ossification to (a) (b) (c) (d) improve range of motion. reverse immature ossification. reverse mature ossification. 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?
Nerve and muscle biopsies Radiologic studies to assess for a tumor Skin biopsy to assess small nerve fibers 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) (b) (c) (d) respondent learning. operant learning. cognitive behavioral theory. trial and error.
122. In patients with a traumatic brain injury, which factor suggests a poor prognosis for emergence from unresponsiveness? (a) (b) (c) (d) Decorticate posturing Flaccid muscle tone Conjugate eye movement Reactive pupils
123.
When using local steroid injections in patients with tendinopathies (a) (b) (c) (d) injection into the tendon substance is optimal. minimum interval between injections is 2 weeks. select the finest needle that will reach the area. 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) (b) (c) (d) Aztreonam (Azactam) Gentamicin (Garamycin) Ceftriaxone (Rocephin) 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) (b) (c) (d) toxoplasmosis. cryptococcal meningitis. human immunodeficiency virus (HIV) encephalopathy. central nervous system (CNS) lymphoma.
127. The activity established as most predictive of developing a low back disorder is (a) (b) (c) (d) carrying an object at an increased horizontal distance from the body. lifting an object repeatedly at 20% less than the individuals maximum lift capacity. repetitive sit-to-stand transitions with a weighted back pack. 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) (b) (c) (d) Dependence Addiction Craving Tolerance
132. Which statement is TRUE regarding post-stroke central pain? (a) (b) (c) (d) Damage to the thalamus plays a central role in the pathogenesis of central pain. Amitriptyline is the drug of first choice to treat central pain. 80% of stroke patients with central pain develop the pain within a month of their stroke. 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) (b) (c) (d) observe for 2 to 4 weeks and repeat ASIA exam. perform electrodiagnostic testing to rule out peripheral nerve compression. order a magnetic resonance imaging study to look for posttraumatic syringomyelia. 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) (b) (c) (d) 1 3 5 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) (b) (c) (d) Amplitude Phases Firing rate 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) (b) (c) (d) Kugelberg Welander syndrome Duchenne muscular dystrophy Infantile botulism Tetraplegic cerebral palsy
140. The primary advantage of mag wheels over spoked wheels in the performance of a wheelchair is (a) (b) (c) (d) lighter weight. reduced maintenance. more maneuverability. 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) (b) (c) (d) L5-S1 facet joint. L4-5 facet joint. L3-4 facet joint. 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) (b) (c) (d) Decreased rate of bladder/kidney infections Decreased high bladder pressures Decreased rate of bladder/kidney stone formation 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) (b) (c) (d) review the chart and personally document his/her level of involvement in patient care, separate from documentation performed by the resident. examine the patient with the resident and co-sign the resident note. examine the patient and review the residents medical record documentation. 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) (b) (c) (d) cavus foot, early hip dislocation, hip and knee flexion contractures. calcaneus foot, late hip dislocation, hip and knee flexion contractures. cavus foot, late hip dislocation, hip adduction contractures. calcaneus foot, early hip dislocation, hip adduction contractures.
151. Which spinal level has the greatest depth of posterior epidural space? (a) (b) (c) (d) C3-4 C4-5 C5-6 C6-7
154. Which muscle fiber is characterized by fast-twitch oxidative metabolic properties? (a) (b) (c) (d) Type 1 Type 2a Type 2b 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) (b) (c) (d) Diazepam (Valium) Eszopiclone (Lunesta) Chloral hydrate 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) (b) (c) (d) an ankle foot orthosis with 5 of plantarflexion. Achilles tendon lengthening. phenol motor point injection to the hamstrings. 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) (b) (c) (d) closing the thumb web space. 30 to 40 of metacarpophalangeal flexion. promoting flattening of the palmar arch. supporting the wrist in 20 to 30 of extension.
166. Standing at ease is equivalent to how many metabolic equivalents (METs)? (a) (b) (c) (d) 1.5 to 2.0 2.5 to 3.0 4.0 to 4.5 5.0 to 5.5
167. Which condition is a cumulative trauma disorder that has been associated with intensive computer use? (a) (b) (c) (d) Herniated thoracic disc Shoulder adhesive capsulitis Post-traumatic stress syndrome Cervical myofascial pain
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) (b) (c) (d) understand the cause of the skin breakdown. select a strategy to decrease the incidence of pressure ulcers. organize a team to investigate the problem. 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) (b) (c) (d) It can account for variability between subjects. It permits medication trials with no washout period. It can establish cause and effect relationships. It is useful for interventions with prolonged or extended effects.
171. Which statement is TRUE regarding complex regional pain syndrome (CRPS)? (a) (b) (c) (d) Pain is characterized by allodynia. Local osteopenia is a common early occurrence. CRPS type 1 is also known as causalgia. Adults with CRPS have a better prognosis than children with CRPS.
173. Effects of prolonged bed rest include (a) (b) (c) (d) increased maximum oxygen consumption. increase of plasma volume. decreased resting heart rate. decreased cardiac stroke volume.
176. Performing a leg press exercise is an example of an (a) (b) (c) (d) open kinetic chain exercise. closed kinetic chain exercise. isokinetic exercise. isometric exercise.
178. Professionalism is the basis of medicines contract with society. Which item is a fundamental principle of medical professionalism? (a) (b) (c) (d) Social justice Physician paternalism Patient disclosure Free enterprise
179. Preventable medical errors are (a) (b) (c) (d) rarely associated with significant morbidity. most commonly a result of individual human error. associated with no impact on patient satisfaction. 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) (b) (c) (d) That the research study results are clinically significant That bias was eliminated from the study That the research study results are statistically significant 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) (b) (c) (d) The brain is more sensitive to trauma than the spinal cord. The spinal cord is more sensitive to trauma than the brain. The brain and the spinal cord are equally sensitive to trauma. 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) (b) (c) (d) yes, because ultrasound helps with bone healing. no, because ultrasound near arthroplasties is contraindicated. yes, because the heat may help with pain management. no, because ultrasound is expensive to use.
184. Electromyographic biofeedback for stroke patients is most beneficial when (a) (b) (c) (d) proprioception is preserved. used in the upper limb. the patient is young. the patient has flaccid paralysis.
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) (b) (c) (d) tamsulosin (Flomax). tolterodine (Detrol). terazosin (Hytrin). bethanechol (Urecholine).
186. Which method of paraffin bath heats the subcutaneous area to a greater degree? (a) (b) (c) (d) Dipping method Continuous method Wrap method Paint on method
188. Which statement accurately characterizes a meta-analysis? (a) (b) (c) (d) It summarizes the results of randomized controlled trials. It summarizes the findings of an expert panel. It groups research on a particular topic area into 3 tiers. 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) (b) (c) (d) The ability to locate, appraise, and assimilate evidence from scientific studies related to their clinical practice The ability to access and use information technology to support their own education The ability to apply knowledge of study designs and statistical methods to the appraisal of medical literature 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) (b) (c) (d) peak exercise capacity at 7 metabolic equivalents (METs). prior history of a stroke. controlled hypertension. severe valvular disease.
196. Which treatment has NOT been shown to improve epicondylitis? (a) (b) (c) (d) Low intensity laser irradiation Wrist extension strengthening exercises Acupuncture Extracorporeal shock-wave therapy
197. The Commission on Accreditation of Rehabilitation Facilities (CARF) (a) (b) (c) (d) requires mandatory surveys of all inpatient rehabilitation facilities. provides accreditation status that confers a preferred status with payors. provides accreditation status that signifies the rehabilitation facility holds itself to the highest standards in the field. 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) (b) (c) (d) respect. beneficence. justice. 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) (b) (c) (d) terminate the investigation if the investigational agent is found to be not effective. disclose this involvement in writing to subjects that are being enrolled in the study. end financial involvement in the company before the results of the research are revealed to the public. disclose this involvement to the investigator's medical center, to funding organizations, and to journals publishing the results.
End of Examination