PM&R Final Exam Prep (2026-2027) Exam Blueprint
Overview (Based on ABPMR Part 1 & MOC Outlines)
Class 1: Type of Problem / Organ System QUESTION AND
ANSWERS ALREADY GRADED A+ MATERIAL
• Neurologic Disorders: 30-31%
• Musculoskeletal Medicine: 32%
• Amputation: 5%
• Medical Rehabilitation: 6-8%
• Rehabilitation Problems & Outcomes: 13-15%
• Basic Sciences: 10-13%
Class 2: Focus of Question / Patient Management
• Patient Evaluation & Diagnosis: 31-35%
• Electrodiagnosis: 11-15%
• Patient Management: 32-41%
• Equipment & Assistive Technology: 5-10%
• Applied Sciences: 8-12%
Section 1: Musculoskeletal Medicine (Questions 1-20)
Q1. A 45-year-old patient presents with lateral elbow pain exacerbated by gripping and wrist
extension. Physical examination reveals tenderness over the lateral epicondyle and pain with
resisted wrist extension. What is the most appropriate initial treatment?
A) Surgical release of the common extensor origin
B) Corticosteroid injection
C) Activity modification with counterforce bracing and eccentric exercise
D) Complete immobilization in a long arm cast
Answer: C – Activity modification with counterforce bracing and eccentric exercise
,Rationale: Lateral epicondylitis (tennis elbow) is an overuse tendinopathy of the common
extensor origin (primarily extensor carpi radialis brevis). First-line treatment includes activity
modification, counterforce bracing, and eccentric strengthening exercises. Corticosteroid
injections provide short-term relief but are associated with higher recurrence rates and may
impair tendon healing. Surgery is reserved for refractory cases after at least 6-12 months of
conservative management. Complete immobilization is not indicated and may lead to stiffness.
Q2. A 55-year-old female presents with bilateral knee pain that is worse with weight-bearing
activities and improves with rest. Morning stiffness lasts approximately 10 minutes. Radiographs
show joint space narrowing, osteophytes, and subchondral sclerosis. What is the most likely
diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gouty arthritis
D) Septic arthritis
Answer: B – Osteoarthritis
Rationale: Osteoarthritis (OA) is the most common joint disorder, characterized by non-
inflammatory joint pain that worsens with activity and improves with rest, morning stiffness <30
minutes, and radiographic findings including asymmetric joint space narrowing, osteophytes,
subchondral sclerosis, and subchondral cysts. Rheumatoid arthritis typically presents with
symmetric inflammatory polyarthritis, morning stiffness >1 hour, and systemic symptoms. Gout
presents with acute monoarthritis, often of the first MTP joint. Septic arthritis presents with
acute, hot, swollen joint with systemic symptoms.
Q3. A 65-year-old patient with known knee osteoarthritis has failed conservative management
including physical therapy, weight loss, and acetaminophen. What is the next most appropriate
pharmacologic treatment?
A) Oral tramadol
B) Topical diclofenac
C) Oral NSAIDs
D) Intra-articular hyaluronic acid
Answer: C – Oral NSAIDs
,Rationale: According to the American College of Rheumatology (ACR) guidelines, topical NSAIDs
are first-line pharmacologic treatment for knee OA (especially for patients >75 or those with
high bleeding risk). However, for patients who have failed topical therapy or have more severe
symptoms, oral NSAIDs (naproxen, ibuprofen, celecoxib) are recommended next, with
gastroprotective agents as needed. Tramadol is reserved for patients with contraindications to
NSAIDs. Intra-articular hyaluronic acid has shown modest, inconsistent benefits and is
considered later-line therapy.
Q4. A 70-year-old male presents with atraumatic right shoulder pain and inability to actively
abduct the arm. Passive range of motion is full. The most likely diagnosis is:
A) Adhesive capsulitis
B) Rotator cuff tear
C) Glenohumeral osteoarthritis
D) Shoulder impingement syndrome
Answer: B – Rotator cuff tear
Rationale: The presentation of full passive range of motion with limited active abduction
suggests a rotator cuff tear (massive or full-thickness), specifically involving the supraspinatus
tendon. Adhesive capsulitis (frozen shoulder) presents with both active AND passive range of
motion limitations in a capsular pattern (external rotation most limited). Glenohumeral OA
presents with pain and crepitus, not typically isolated weakness. Impingement syndrome
presents with painful arc (60-120 degrees of abduction) but not complete inability to abduct.
Q5. A 45-year-old runner presents with medial knee pain. Physical examination reveals
tenderness over the medial joint line and a palpable "pop" with valgus stress at 30 degrees of
knee flexion. This finding is most consistent with:
A) Medial collateral ligament injury
B) Medial meniscus tear
C) Pes anserine bursitis
D) Patellofemoral pain syndrome
Answer: A – Medial collateral ligament injury
Rationale: Valgus stress testing at 30 degrees of knee flexion isolates the medial collateral
ligament (MCL). A palpable "pop" or endpoint with pain suggests MCL injury (grade I-III based
on laxity). Medial meniscus tear typically presents with joint line tenderness and may have a
, positive McMurray test but not with valgus stress instability. Pes anserine bursitis presents with
tenderness distal to the medial joint line (over the pes anserine bursa). Patellofemoral pain
syndrome presents with anterior knee pain.
Q6. A 35-year-old patient presents with low back pain radiating to the right lower extremity
below the knee. Straight leg raise reproduces the radicular pain at 40 degrees. The most likely
diagnosis is:
A) Lumbar strain
B) Lumbar radiculopathy from disc herniation
C) Sacroiliac joint dysfunction
D) Spinal stenosis
Answer: B – Lumbar radiculopathy from disc herniation
Rationale: A positive straight leg raise (pain reproduction at 30-70 degrees) suggests nerve root
irritation, most commonly from a lumbar disc herniation. The test has high sensitivity (80-90%)
for L5-S1 radiculopathy. Lumbar strain would not reproduce radicular symptoms. SI joint
dysfunction may have pain with FABER or thigh thrust tests but not typically a positive straight
leg raise. Spinal stenosis typically presents with neurogenic claudication (pain with
walking/extension, relieved by flexion/sitting) rather than a positive straight leg raise.
Q7. Following a total knee arthroplasty, which gait deviation is most commonly observed in the
early postoperative period?
A) Vaulting
B) Antalgic gait with reduced stance time on the operative leg
C) Circumduction
D) Trendelenburg gait
Answer: B – Antalgic gait with reduced stance time on the operative leg
Rationale: Antalgic gait (shortened stance phase on the painful leg) is the most common gait
deviation following total knee arthroplasty due to pain and swelling. Vaulting (elevating on toes
of the unaffected leg) and circumduction are more commonly seen with longer limb length
discrepancies or spasticity. Trendelenburg gait (pelvic drop on contralateral side during stance)
indicates hip abductor weakness.
Overview (Based on ABPMR Part 1 & MOC Outlines)
Class 1: Type of Problem / Organ System QUESTION AND
ANSWERS ALREADY GRADED A+ MATERIAL
• Neurologic Disorders: 30-31%
• Musculoskeletal Medicine: 32%
• Amputation: 5%
• Medical Rehabilitation: 6-8%
• Rehabilitation Problems & Outcomes: 13-15%
• Basic Sciences: 10-13%
Class 2: Focus of Question / Patient Management
• Patient Evaluation & Diagnosis: 31-35%
• Electrodiagnosis: 11-15%
• Patient Management: 32-41%
• Equipment & Assistive Technology: 5-10%
• Applied Sciences: 8-12%
Section 1: Musculoskeletal Medicine (Questions 1-20)
Q1. A 45-year-old patient presents with lateral elbow pain exacerbated by gripping and wrist
extension. Physical examination reveals tenderness over the lateral epicondyle and pain with
resisted wrist extension. What is the most appropriate initial treatment?
A) Surgical release of the common extensor origin
B) Corticosteroid injection
C) Activity modification with counterforce bracing and eccentric exercise
D) Complete immobilization in a long arm cast
Answer: C – Activity modification with counterforce bracing and eccentric exercise
,Rationale: Lateral epicondylitis (tennis elbow) is an overuse tendinopathy of the common
extensor origin (primarily extensor carpi radialis brevis). First-line treatment includes activity
modification, counterforce bracing, and eccentric strengthening exercises. Corticosteroid
injections provide short-term relief but are associated with higher recurrence rates and may
impair tendon healing. Surgery is reserved for refractory cases after at least 6-12 months of
conservative management. Complete immobilization is not indicated and may lead to stiffness.
Q2. A 55-year-old female presents with bilateral knee pain that is worse with weight-bearing
activities and improves with rest. Morning stiffness lasts approximately 10 minutes. Radiographs
show joint space narrowing, osteophytes, and subchondral sclerosis. What is the most likely
diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gouty arthritis
D) Septic arthritis
Answer: B – Osteoarthritis
Rationale: Osteoarthritis (OA) is the most common joint disorder, characterized by non-
inflammatory joint pain that worsens with activity and improves with rest, morning stiffness <30
minutes, and radiographic findings including asymmetric joint space narrowing, osteophytes,
subchondral sclerosis, and subchondral cysts. Rheumatoid arthritis typically presents with
symmetric inflammatory polyarthritis, morning stiffness >1 hour, and systemic symptoms. Gout
presents with acute monoarthritis, often of the first MTP joint. Septic arthritis presents with
acute, hot, swollen joint with systemic symptoms.
Q3. A 65-year-old patient with known knee osteoarthritis has failed conservative management
including physical therapy, weight loss, and acetaminophen. What is the next most appropriate
pharmacologic treatment?
A) Oral tramadol
B) Topical diclofenac
C) Oral NSAIDs
D) Intra-articular hyaluronic acid
Answer: C – Oral NSAIDs
,Rationale: According to the American College of Rheumatology (ACR) guidelines, topical NSAIDs
are first-line pharmacologic treatment for knee OA (especially for patients >75 or those with
high bleeding risk). However, for patients who have failed topical therapy or have more severe
symptoms, oral NSAIDs (naproxen, ibuprofen, celecoxib) are recommended next, with
gastroprotective agents as needed. Tramadol is reserved for patients with contraindications to
NSAIDs. Intra-articular hyaluronic acid has shown modest, inconsistent benefits and is
considered later-line therapy.
Q4. A 70-year-old male presents with atraumatic right shoulder pain and inability to actively
abduct the arm. Passive range of motion is full. The most likely diagnosis is:
A) Adhesive capsulitis
B) Rotator cuff tear
C) Glenohumeral osteoarthritis
D) Shoulder impingement syndrome
Answer: B – Rotator cuff tear
Rationale: The presentation of full passive range of motion with limited active abduction
suggests a rotator cuff tear (massive or full-thickness), specifically involving the supraspinatus
tendon. Adhesive capsulitis (frozen shoulder) presents with both active AND passive range of
motion limitations in a capsular pattern (external rotation most limited). Glenohumeral OA
presents with pain and crepitus, not typically isolated weakness. Impingement syndrome
presents with painful arc (60-120 degrees of abduction) but not complete inability to abduct.
Q5. A 45-year-old runner presents with medial knee pain. Physical examination reveals
tenderness over the medial joint line and a palpable "pop" with valgus stress at 30 degrees of
knee flexion. This finding is most consistent with:
A) Medial collateral ligament injury
B) Medial meniscus tear
C) Pes anserine bursitis
D) Patellofemoral pain syndrome
Answer: A – Medial collateral ligament injury
Rationale: Valgus stress testing at 30 degrees of knee flexion isolates the medial collateral
ligament (MCL). A palpable "pop" or endpoint with pain suggests MCL injury (grade I-III based
on laxity). Medial meniscus tear typically presents with joint line tenderness and may have a
, positive McMurray test but not with valgus stress instability. Pes anserine bursitis presents with
tenderness distal to the medial joint line (over the pes anserine bursa). Patellofemoral pain
syndrome presents with anterior knee pain.
Q6. A 35-year-old patient presents with low back pain radiating to the right lower extremity
below the knee. Straight leg raise reproduces the radicular pain at 40 degrees. The most likely
diagnosis is:
A) Lumbar strain
B) Lumbar radiculopathy from disc herniation
C) Sacroiliac joint dysfunction
D) Spinal stenosis
Answer: B – Lumbar radiculopathy from disc herniation
Rationale: A positive straight leg raise (pain reproduction at 30-70 degrees) suggests nerve root
irritation, most commonly from a lumbar disc herniation. The test has high sensitivity (80-90%)
for L5-S1 radiculopathy. Lumbar strain would not reproduce radicular symptoms. SI joint
dysfunction may have pain with FABER or thigh thrust tests but not typically a positive straight
leg raise. Spinal stenosis typically presents with neurogenic claudication (pain with
walking/extension, relieved by flexion/sitting) rather than a positive straight leg raise.
Q7. Following a total knee arthroplasty, which gait deviation is most commonly observed in the
early postoperative period?
A) Vaulting
B) Antalgic gait with reduced stance time on the operative leg
C) Circumduction
D) Trendelenburg gait
Answer: B – Antalgic gait with reduced stance time on the operative leg
Rationale: Antalgic gait (shortened stance phase on the painful leg) is the most common gait
deviation following total knee arthroplasty due to pain and swelling. Vaulting (elevating on toes
of the unaffected leg) and circumduction are more commonly seen with longer limb length
discrepancies or spasticity. Trendelenburg gait (pelvic drop on contralateral side during stance)
indicates hip abductor weakness.
