2008 SELF-ASSESSMENT EXAMINATION FOR RESIDENTS (SAE-R)

Copyright 2008 American Academy of Physical Medicine and Rehabilitation Chicago, Illinois

2008 Self-Assessment Examination for Residents (SAE-R) Abridged Version

3.

The most common clinical manifestation of Lyme disease is (a) (b) (c) (d) monoarticular or oligoarticular arthritis. facial-nerve palsy. atrioventricular block. erythema migrans.

6.

You are consulting on a 28-year-old woman with metastatic cervical cancer. She is married with one young child. At this time, she requires minimum to moderate assistance with her mobility and activities of daily living. The oncology service is debating whether to discharge the patient to home with hospice care or to give her inpatient rehabilitation. You inform them that acute inpatient rehabilitation (a) (b) (c) (d) improves function and quality of life despite the patient being at the end of her life. is too much of a physical demand for her and agree with hospice care. takes time away from the patient being with her family, so hospice is preferable. will help the patient to some extent, but not as much as a patient without cancer.

7.

Cyclobenzaprine is a medication that is used to treat acute musculoskeletal pain. While the exact mechanism of action is unknown, its structure and side effects are similar to what class of drug? (a) (b) (c) (d) Central alpha2-adrenergic agonist Tricyclic antidepressant agent Antihistamine -aminobutyric acid agonist

9.

You are asked to evaluate a 1-year-old patient who is not yet walking but is developmentally appropriate. Which reflex would you expect to find? (a) (b) (c) (d) Asymmetric tonic neck Symmetric tonic neck Palmar grasp Plantar grasp

10.

Individuals with diabetes are at high risk of amputation despite ankle pressures greater than 55 mmHg because (a) (b) (c) (d) the ankle brachial pressure index must be greater than or equal to 0.3 to prevent limb threatening ischemia. ankle pressures seldom correlate with severity of symptoms and are unreliable. calcification of the arterial media results in a spuriously high pressure. transcutaneous oxygen partial pressures and not ankle pressures correlate with ischemia.

11.

An 11-year-old baseball player presents to your clinic complaining of elbow pain. X-rays of the affected side reveal an 8-mm separation of the medial epicondyle. What should be the next step in management? (a) (b) (c) (d) Relative rest for at least 6 weeks Long arm cast for at least 4 weeks Refer to pediatric orthopedic surgeon Physical therapy for strengthening

12.

Which of the brain tumors listed is a benign tumor? (a) (b) (c) (d) Medulloblastoma Astrocytoma Glioblastoma Craniopharyngioma

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.

15.

Based on the revised edition of the American Spinal Injury Association (ASIA) Impairment Scale, published in 2000, which condition would be sufficient to categorize a spinal cord injury as motor incomplete? (a) (b) (c) (d) Some motor function more than 1 level below the motor level Voluntary anal sphincter contraction A well-defined zone of partial preservation An anterior spinal artery syndrome

16.

Lambert-Eaton myasthenic syndrome is most commonly associated with cancer in the (a) (b) (c) (d) prostate. breast. lung. brain.

24.

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) check 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.

A 24-year-old man with T6 complete paraplegia whose injury occurred 16 weeks ago. He is concerned he can no longer reach down to put on and tie his right shoe. Upon evaluation, he has significant loss of range of motion in the right hip with mild warmth at the hip. There is no swelling at the knee, lower leg, ankle, or foot. The most likely diagnosis is (a) (b) (c) (d) hip dislocation. deep vein thrombosis. heterotopic ossification. iliopsoas abscess.

26.

A patient with a history of cancer treated with chemotherapy complains that her feet feel swollen, cold, and painful. The pain is described as shooting and is rated 10/10. On examination, there is no swelling and no temperature changes, but there is hypesthesia and dysesthesia. Of the following choices, which is the most appropriate pain management for this patient? (a) (b) (c) (d) MS Contin (extended release morphine sulfate) 15 mg every 12 hours Prednisone taper starting at 60 mg daily Neurontin (gabapentin) 300 mg 3 times a day Naprosyn (naproxen) 500 mg twice daily

27.

A 50-year-old construction worker has received a 30% whole person impairment rating because of his pericardial heart disease. According to the fifth edition of the American Medical Association Guides to the Evaluation of Permanent Impairment, this workers status indicates that (a) (b) (c) (d) he is 100% disabled from performing his work activities. his general functioning and ability to perform activities of daily living is reduced by 30%. he has a 30% reduction in work capability. he should receive 30% of his future wages and benefits in a disability payment.

28.

A 14-year-old girl is sent to you for electrodiagnostic evaluation of a left foot drop. The mother reports that the left foot drop has been present for about 2 months and that her daughter has lost about 40 pounds in the last 6 months. Nerve conduction studies and needle electromyography show the following data: MOTOR NERVE CONDUCTION STUDIES Stimulation Site Distal Latency (ms) Amplitude (mV) Ankle Below knee Above knee Ankle Below knee Above knee Ankle Knee 4.2 1 0.5 NR 5.4 5.0 4.8 9 8.5

Nerve L Peroneal

NCV (m/s) 35

R Peroneal

4.5

47 52 53

L Tibial

4.4

Nerve L Sural L Superficial peroneal R Superficial peroneal

SENSORY NERVE CONDUCTION STUDIES Stimulation Site Distal Latency (ms) Amplitude (V) Ankle - 14 cm 3.6 17 Ankle - 12 cm NR Ankle - 12 cm 3.1 15

Needle Electromyography Muscle

L Vastus medialis L Semimembranosus L Short head of biceps femoris L Tibial anterior L Medial gastrocnemius L Peroneus longus L Lumbar paraspinals NCV = Nerve Conduction Velocity NR = No response

Abnormal Spontaneous Activity 0 0 0 3+ 0 2+ 0

Recruitment

Normal Normal Normal Reduced None Reduced --

The patients symptoms are most likely due to left (a) (b) (c) (d) peroneal nerve injury at the fibular head. deep peroneal nerve injury. sciatic nerve injury. lumbosacral plexopathy.

40.

The most common reason for prescribing a plastic leaf-spring ankle-foot orthosis is to (a) (b) (c) (d) overcome ankle spasticity. reduce lower-extremity edema. prevent plantar flexion deformity. support weak ankle dorsiflexors.

42.

A 67-year-old man with Parkinson disease is experiencing more falls. These falls usually occur shortly after getting up in the morning, or after a large meal. You suspect his falls are due to (a) (b) (c) (d) vestibular dysfunction. orthostatic hypotension. increased lower extremity weakness. increased rigidity.

43.

The most significant risk factor for continued structural destruction of the knee in osteoarthritis is (a) (b) (c) (d) joint malalignment. obesity. prior surgery. occupational bending and lifting.

44.

Cognitive deficits are common in (a) (b) (c) (d) Duchenne muscular dystrophy. inclusion body myositis. fascioscapulohumeral dystrophy. Becker muscular dystrophy.

45.

Which statement is correct regarding the management of labor and delivery for women with cervical spinal cord injuries? (a) (b) (c) (d) Pre-eclampsia is 3 times more likely to occur than in able-bodied women. Vaginal delivery is contraindicated. Autonomic dysreflexia occurs 60%--80% of the time. Spinal and epidural anesthesia are contraindicated

47.

In assisting patients returning to their previous level of work, work hardening programs can achieve return-to-work rates of (a) (b) (c) (d) less than 25%. 25%--49%. 50%--75%. more than 75%.

48.

What is the total duration of the motor unit action potential shown above? (a) (b) (c) (d) 8 ms 12 ms 18 ms 22 ms

51.

A 35-year-old man with history of psoriatic arthritis complains of localized low back pain of insidious onset. The pain is worse in the morning and improves as the day progresses. What is the most likely cause of his back pain? (a) (b) (c) (d) Piriformis strain Sacroiliitis Quadratus lumborum strain Discitis

52.

During the initial, acute evaluation of a young spinal cord injury patient, which factor would make you suspicious of a concomitant brain injury? (a) (b) (c) (d) Fall as the mechanism of injury Female patient Higher level spinal cord injury African-American patient

53.

A forty-year-old woman with rheumatoid arthritis (RA) complains of right wrist pain that limits her ability to use her computer and phone at work as a computer analyst. On exam, she has metacarpal phalangeal ulnar deviation, wrist radial deviation, and several boutonniere deformities in her fingers. There is no active synovitis. You suggest occupational therapy and (a) (b) (c) (d) oral prednisone. short forearm cast. a resting wrist orthotic. finger splints.

54.

All hereditary sensory motor neuropathies are characterized by (a) (b) (c) (d) decreased Intelligence Quotient scores. absent spinal deformities. muscle weakness. joint contractures.

57.

If a man injures his low back while on the job and is off work for 6 months, then the chance that he will return to work is (a) (b) (c) (d) 25%. 35%. 50%. 75%.

59.

Acquired subluxation or dislocation of the hips in spastic cerebral palsy is usually due to muscular imbalance with excessive tone of which muscles? (a) (b) (c) (d) Hip flexors and tensor fascia lata Hip flexors and hip adductors Rectus femoris and hip abductors Tensor fascia lata and hip extensors

62.

A 19 year-old male is seen after a traumatic brain injury. The patients mother is at the bedside and is asking you questions about the patients prognosis for recovery. As you consider your response, which statement is TRUE? (a) (b) (c) (d) Severe disability is unlikely if the length of coma is less than 1 month. Good recovery is unlikely if posttraumatic amnesia (PTA) lasts longer than 3 months. An initial Glasgow Coma Scale score of less than 8 is associated with a poor outcome. Neuroimaging studies are not helpful to determine a patients prognosis.

63.

The arthropathy in persons with systemic lupus erythematosus (SLE) generally is in the wrists, knees and small joints of the hands. It is also (a) (b) (c) (d) symmetric and non-erosive. symmetric and erosive. asymmetric and non-erosive. asymmetric and erosive.

66.

A 52-year-old woman with a history of non-alcoholic steatohepatitis underwent a recent liver transplant. Her protein and albumin levels are very low and, on exam, she has anasarca. Your inpatient rehabilitation admission orders should include (a) (b) (c) (d) referral for paracentesis. nursing orders to avoid use of an abdominal binder. high protein diet with high protein oral supplements. oxandrolone and monitoring of liver enzymes.

67.

According to current guidelines, for the injured factory worker with acute low back pain, what is the recommendation? (a) (b) (c) (d) >6 4-5 2-3 <1

69.

In children with spastic cerebral palsy, which approach strengthens weak muscles? (a) (b) (c) (d) Ankle-foot orthotics Tendon transfer surgery Intrathecal baclofen Functional training

72.

Which type of traumatic brain injury results in the most morbidity? (a) (b) (c) (d) Focal cerebral contusion Subarachnoid hemorrhage Epidural hematoma Diffuse axonal injury

73.

In addition to routine weight-bearing exercises and calcium supplements, vitamin D is important in persons with osteoporosis because it (a) (b) (c) (d) decreases the amount of calcium supplementation needed. enhances muscle strength and reduces the risk of falling. decreases bone turnover. improves the mechanism of action of biphosphonates.

77.

What percentage of patients with whiplash-associated disorders develop chronic symptoms? (a) (b) (c) (d) less than 25% 25%--49% 50%--75% more than 75%

78.

While recording an antidromic sensory nerve action potential, you increase the distance between the active and reference electrode from 1cm to 4cm by moving the reference electrode. What is the effect on the onset latency and peak latency? Onset Latency No change Increase Decrease Increase Peak Latency Increase No change Decrease Increase

(a) (b) (c) (d)

79.

The family of your 15-year-old patient who had a severe traumatic brain injury 6 weeks ago asks you if they may feed their son. You observe that the patient is agitated at times, has a hoarse voice, and drools. You try to feed him applesauce and notice that he seems to swallow part of it and does not cough. The most likely finding on the videofluoroscopic swallowing study will be (a) (b) (c) (d) Silent aspiration Reflux Coughing and gagging Normal swallow

86.

A 24-year-old man with T4 paraplegia has a sacral pressure ulcer measuring 2 cm by 2 without depth. The ulcer base has pink granulation tissue. Which dressing is LEAST appropriate in this case? (a) (b) (c) (d) Tegaderm (transparent adhesive dressing) Duoderm (hydrocolloid wafer dressing) Curasol (gel dressing) Accuzyme (enzymatic debridement)

87.

Which factor is most likely to be associated with the development of a work-related, repetitivestrain injury? (a) (b) (c) (d) Normal body weight Warm work environment Younger age Rheumatoid arthritis

90.

The gluteus maximus is primarily active during which part of the gait cycle? (a) (b) (c) (d) Pre swing Loading response Midstance Terminal stance

91.

A 32-year-old male runner presents with left foot pain 3 days after completing a marathon. If the patient has exquisite tenderness to palpation at the location of the examiners right thumb, pictured above, what is your next step? (a) (b) (c) (d) Order physical therapy for closed chain exercises. Order a plantarflexion night splint. Implement strict non-weight bearing. Prescribe oral steroids.

92.

Which Brunnstrom stage of motor recovery in a stroke patient with a hemiplegic arm is characterized by activating muscles selectively outside the flexor and extensor synergies? (a) (b) (c) (d) Stage 2 Stage 3 Stage 4 Stage 5

93.

A 24-year-old college student reports low back and lower limb joint pain for the past several months. His heels are especially painful, which makes it difficult for him to walk or stand for prolonged periods of time. He recalls an episode of gastroenteritis requiring hospitalization 6 months ago. Upon further questioning, he admits to some mild dysuria. His neurologic exam is normal. Radiographs of his ankles will most likely demonstrate (a) (b) (c) (d) a normal joint. osteophytes and subchondral cysts in the tibiotalar joint. periosteal reaction and bony erosions of the calcaneus. avascular necrosis of the talus.

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.

96.

Vacuum-assisted closure marketed as "Wound VAC" works primarily by (a) (b) (c) (d) increasing blood flow in the wound and adjacent tissue. drawing the edges of the wound together. sealing out potentially harmful bacteria from the wound. maintaining a moist, anaerobic environment.

98.

A 65-year-old man is sent to you for electrodiagnostic assessment of his right facial droop. He presented to his internist 4 weeks ago with right facial pain and weakness, and decreased hearing. He was treated with high dose steroids without any improvement. His nerve conduction studies are as follows: Nerve R Facial L Facial Distal Latency (ms) 3.5 3.2 Amplitude (mV) 0.8 2.2

Blink Reflex R Trigeminal L Trigeminal R1 early component

Recording Right Left Right Left

R1 (ms) Absent --11.5

R2 (ms) Absent 33 Absent 35

R2 late component These findings are most consistent with right (a) (b) (c) (d) facial nerve lesion. trigeminal nerve lesion. pons lesion. lateral medulla lesion.

100. Your patient demonstrates ipsilateral pelvic drop during gait. What is the most likely cause? (a) (b) (c) (d) Scoliosis Short contralateral limb Hip adductor weakness Weak hip extensors

101. A woman in her third trimester of pregnancy presents with severe burning pain in her right anterior thigh for the last 2 months. The pain is aggravated by prolonged standing. On examination of the right lower limb, there is no evidence of discoloration, edema, tenderness to palpation, or motor deficit. She has decreased sensation to pinprick over the lateral aspect of her distal thigh. What is the most likely diagnosis? (a) (b) (c) (d) Trochanteric bursitis Sacroiliitis Femoral neuropathy Meralgia paresthetica

102. For a patient with hemiplegia who prefers to use his legs and push his wheelchair backwards, the wheelchair should be configured with (a) (b) (c) (d) the back edge of the seat lower than the front edge. a single arm drive mechanism on the non-hemiplegic side. the large wheel axle plate moved to a more anterior position. large wheels in the front and casters in the back.

104. A 17 year old woman was involved in a motor vehicle crash 4 months ago. She suffered a shoulder dislocation. Electromyographic studies have confirmed a brachial plexus injury to her posterior cord and indicate nerve continuity (Sunderland 2 injury). 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 the patient to neurosurgery for exploratory surgery.

105. A 23-year-old man with C8 tetraplegia requests your opinion regarding routine urologic evaluations after spinal cord injury. You advise that (a) (b) (c) (d) an intravenous pyelogram (IVP) should be performed every 1 to 2 years. annual abdominal plain films are sufficient to detect early hydronephrosis. renal ultrasound should be performed every 5 years. it is reasonable to wait 10 years before getting his first cystoscopy.

106. A 47-year-old man with human immunodeficiency virus (HIV) presents with fever, headache, and memory loss. The most likely diagnosis is (a) (b) (c) (d) progressive multifocal leukoencephalopathy (PML). HIV encephalopathy. cryptococcal meningitis. central nervous system (CNS) lymphoma.

110. What is the 5-year mortality rate for persons with diabetes after sustaining a major lower limb amputation? (a) (b) (c) (d) 15% 25% 33% 50%

111. Which nerve does NOT innervate the outer annulus of the lumbar intervertebral disc? (a) (b) (c) (d) sinuvertebral nerve lumbar medial branches of dorsal rami grey rami communicantes lumbar ventral rami

112. Which statement about primary cerebral lymphoma is TRUE? (a) (b) (c) (d) It has an increased incidence in patients with (HIV) infection. It usually presents as a solitary tumor. It is treated surgically for improved outcome. It has a median survival of approximately 2 years.

113. A 50-year-old man complains of malaise, fatigue, and hand arthralgias for the past several months. He was recently diagnosed with diabetes mellitus. On exam, he has mild tenderness to palpation in his bilateral second and third metacarpophalangeal (MCP) joints with erosive lesions on radiographs. He also has a generalized bronzing of his skin. What is the most appropriate initial test to order? (a) (b) (c) (d) Complete blood count (CBC) Iron studies Erythrocyte sedimentation rate (ESR) Adrenocorticotropic hormone (ACTH) stimulation test

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)

125. Baclofen is thought to reduce spasticity by (a) (b) (c) (d) preventing the release of calcium from the sarcoplasmic reticulum. blocking sodium and potassium channels. depressing of brainstem neuronal activity. acting as a gamma-aminobutyric acid agonist.

126. A 70-year-old man underwent a 2-vessel coronary artery bypass graft and mechanical mitral valve replacement five days ago. You note that he is presently taking Coumadin (warfarin). The primary reason to put this patient on Coumadin after this procedure is to prevent (a) (b) (c) (d) deep vein thrombosis. embolic stroke. coronary artery occlusion. valvular adhesion.

127. According to the Joint Commission on Accreditation of Hospital Organizations (JCAHO), what is the minimum number of patient identifiers needed before medications, blood products, or other treatments or procedures may be administered? (a) (b) (c) (d) 1 2 3 4

130. A potential benefit of osseointegration (the direct skeletal attachment of the prosthesis to bone) is (a) (b) (c) (d) elimination of poor prosthetic socket fit. ability to return to running activities. early prosthetic fitting. ability to perform heavy manual work.

131. A 22-year-old female gymnast with chronic low back pain is diagnosed with spondylolysis of the right L5 pars interarticularis. Spondylolisthesis is not identified on plain x-rays. What is the best test to determine fracture healing? (a) (b) (c) (d) magnetic resonance imaging single photon emission computed tomography computed tomography scan flexion and extension lateral x-rays

137. According to the Joint Commission on Accreditation of Hospital Organizations (JCAHO) which abbreviation may be used when writing a prescription? (a) (b) (c) (d) U for units QD for once daily 2 mg for 2 milligrams MSO4 for morphine sulfate

138. In patients with radiculopathy, how long does it take for morphologic changes of increased duration and amplitude to occur in the motor unit action potentials? (a) (b) (c) (d) 1 day 1 week 3 weeks 6 weeks

139. A 3-year-old child has a high thoracic spinal cord injury. At age 10, which of the following is the most likely complication? (a) (b) (c) (d) Severe lordosis without scoliosis Scoliosis requiring surgical treatment Deep venous thrombosis Heterotopic ossification

140. An advantage of a knee disarticulation compared to a transfemoral amputation is that the knee disarticulation offers (a) (b) (c) (d) more options for a prosthetic knee. enhanced ability to create power during ambulation or running. better soft tissue coverage within the zone of injury. better prosthetic cosmesis.

141. Which factor increases the risk for long-term symptoms after a whiplash-type injury? (a) (b) (c) (d) Male gender Eastern European descent Preexisting hyperlordosis of cervical spine Presence of radiating pain into the limb

145. Compared to individuals without spinal cord injury, individuals with spinal cord injuries have a (a) (b) (c) (d) lower risk of osteoporosis. higher risk of diabetes. lower rate of dyslipidemia. higher rate of prostate cancer.

149. The most common congenital limb deficiency is (a) (b) (c) (d) right transtibial limb deletion. right transradial limb deletion. left transtibial limb deletion. left transradial limb deletion.

150. In adults, the prevalence of phantom limb pain, phantom sensation or residual limb pain after amputation is (a) (b) (c) (d) approximately 70% at 6 months postamputation. dependent on age at the time of amputation. directly related to surgical technique. primarily dependent upon the level of amputation.

152. As its mechanism of action, botulinum toxin (a) (b) (c) (d) inactivates the calcium pump at the sarcoplasmic reticulum. inhibits the troponin-tropomysin complex. inhibits the production of acethylcholine. inhibits the release of acethylcholine.

153. What articular abnormality is associated with systemic lupus erythematosus and its treatment? (a) (b) (c) (d) Avascular necrosis Erosions with subchondral sclerosis Erosions with overhanging edges Syndesmophytes

154. Which diagnosis is NOT an indication for transcutaneous electrical neurostimulation (TENS) therapy? (a) (b) (c) (d) Chronic low back pain Acute surgical pain Urinary urgency Angina

155. A 37-year-old woman with C5 ASIA A tetraplegia from trauma 1 month ago is admitted to your acute rehabilitation unit. She has a retrievable inferior vena cava (IVC) filter and no history of chemical prophylaxis for deep vein thrombosis (DVT). Her surgical team reports to you that they are no longer concerned with an acute bleeding potential related to her trauma and her hematocrit is stable. What should you do first? (a) (b) (c) (d) Order a lower extremity doppler study to look for DVT Start mechanical prophylaxis with sequential compression devices Tell the patient she is completely protected from pulmonary emboli Leave the IVC filter in place for a minimum of 4 months

156. Cervical traction is a useful modality for patients with (a) (b) (c) (d) cervical strain. diskitis. acute radiculopathy. vertebral compression fracture.

157. You see the significant other of a close friend in your office for knee pain. As part of her past medical history you note that she has a congenital heart defect. She says she has not yet told your friend that she has this condition. You decide to tell your friend about her congenital heart defect even though the patient did not give you permission to do so. What penalty do you face for knowingly disclosing individually identifiable health information, which is in violation of HIPAA rules? (a) (b) (c) (d) $50,000 and up to 1year of imprisonment No penalty $250,000 and up to 10 years imprisonment $100,000 and up to 5 years imprisonment

160. Informed consent requires that risks associated with participation in a study be described in terms of (a) (b) (c) (d) type, severity, and probability. probability alone. physical, but not psychological, risks. major, but not minor, risks.

161. Which route of epidural steroid administration is most likely to deliver steroid to the junction of the posterior disc and anterior dura? (a) (b) (c) (d) Transforaminal Caudal with catheter Interlaminar Caudal

162. Which factor is a risk for heterotopic ossification in traumatic brain injury? (a) (b) (c) (d) Late seizures Prolonged coma Male gender Diabetes insipidus

163. A patient presents to your office with knee pain from a flare of rheumatoid arthritis. She has a mild effusion and warmth at her knee. The therapist wants to use ultrasound to her knee for treatment. You advise that ultrasound (a) (b) (c) (d) accelerates healing. helps with pain control. is contraindicated. will not help with the pain.

167. Under the Health Insurance Portability and Accountability Act (HIPAA) Protected Health Information is data that (a) (b) (c) (d) a physician can withhold from a patient. a patients job supervisor can obtain from a physician. can be used to identify a patient. can be shared with family without permission.

169. Relevant to investigational studies, the principle of justice requires that (a) (b) (c) (d) harm be minimized and benefits maximized. informed consent includes full disclosure of risks and benefits. research subjects be treated fairly and selected equitably. investigators respect the privacy of research subjects.

170. Type 1 (alpha) error is best described as occurring in research when (a) (b) (c) (d) the study finds a positive benefit from the intervention, but no benefit really exists. the study finds no benefit from the intervention, but a benefit really exists. study results are biased by subject selection criteria. study results are not generalizable outside the research setting.

171. A far lateral L4-5 disc herniation pictured above will impinge on which nerve root? (a) (b) (c) (d) L3 L4 L5 S1

173. What is the measure of the rate of oxygen utilization for the production of energy? (a) (b) (c) (d) VO2min Peak VO2 VO2max VO2

174. What adaptations to strength training are seen in elderly persons engaged in a consistent exercise program? (a) (b) (c) (d) Hypertrophy of muscle only. Revascularization of the exercised muscle Strength gains from Neural and learning factors only Gains from both neural factors and hypertrophy

175. Your adult patient with a spinal cord injury needs to access his bathroom in his standard-width wheelchair. If no turn is required following entry into the bathroom, the minimal width of the doorway should be (a) (b) (c) (d) 26 inches. 32 inches. 36 inches. 40 inches.

176. Cervical and lumbar traction applied over a 20--60 minute time period is defined as (a) (b) (c) (d) continuous. sustained. intermittent. pulsed.

178. You are conducting a research study, and you want to use Functional Independence Measure (FIM) scores as 1 of your outcome measures. Because FIM information is scored on a 1 to 7 scale to describe the level of assistance an individual requires to perform a functional task, these scores represent which category of research data? (a) (b) (c) (d) Nominal Ordinal Ratio Interval

179. The process of developing and adopting quality standards for clinical practice (a) (b) (c) (d) is dependent on providers being mandated for reporting data. is ineffective in changing physician practice patterns. allows health insurance providers to deny reimbursement for care. helps to form expectations for safety among both providers and consumers.

181. Which statement describes the natural history of lumbar spinal stenosis (LSS)? (a) (b) (c) (d) The majority of individuals with LSS will develop focal weakness. Of patients treated nonsurgically, 25%--50% have satisfactory outcomes. Ambulation worsens in the majority of individuals with LSS. Early surgery improves long-term outcome.

182. A patient presents with right hemiparesis and dysarthria but language and sensation are intact. The lesion is most likely in the (a) (b) (c) (d) posterior limb of the internal capsule. left frontoparietal lobe. lateral pons. thalamus.

183. Vapocoolant spray produces its cooling effects through (a) (b) (c) (d) conduction. convection. conversion. evaporation.

184. High frequency electrical stimulation predominantly stimulates which type of muscle fiber? (a) (b) (c) (d) Type 1 Type 2 Type 3a Type 3b

186. In which modality do charged particles migrate across biological membranes under an imposed electrical field? (a) (b) (c) (d) Iontophoresis Phonophoresis Ultrasound Laser therapy

188. The benefits of quality outcomes management include (a) (b) (c) (d) providing guidance for alignment of the program with the needs of the patient. improved insurance reimbursement from third party payors. improved retention of staff. reduced expenses independent of outcomes.

190. Which K level best describes an individual who is able to ambulate within the household, but not out in the community? (a) (b) (c) (d) K1 K2 K3 K4

195. Trauma to the sacral roots would most likely result in (a) (b) (c) (d) vesicoureteral reflux. incontinence. detrusor hyperreflexia. small bladder capacity.

197. In 2003, which diagnosis-related group (DRG) had the most admissions to inpatient rehabilitation facilities? (a) (b) (c) (d) Stroke Unilateral joint replacement in a lower extremity Amputation for circulatory disorders except upper limb and toe Hip or pelvis fracture

End of Examination