AAPMR Q Bank Medical Rehabilitation Exam Questions AND Correct Answers
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 - ✔✔D:
This patient's symptoms are most consistent with plantar fasciitis. Classically,
this syndrome is most painful first thing in the morning upon arising and is
aggravated by overuse or change in footwear. Stretching the plantar fascia,
often before getting out of bed in the morning, and use of a heel cup or medial
longitudinal arch orthotic are the initial treatments for this condition.
Corticosteroid injection may be indicated at the insertion of the fascia into the
plantar aspect of the
calcaneus; however, this is usually not required on a repeated basis. Relative
rest from the aggravating activity may be useful, but bed rest is not indicated. A
walking cast would not allow stretch of the plantar fascia.
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. - ✔✔C:
Bladder dysfunction in patients with multiple sclerosis can be challenging from a
diagnostic perspective. The use of urodynamic testing provides useful
information. Bladder function in this scenario would be hyperreflexic, and with
high residual volumes it would indicate that bladder outlet pressure is high so as
to block urine flow, as if squeezing on a water balloon and holding the spout.
This outlet pressure is called dyssynergia, and treatment is directed at bladder
neck
relaxation.
A 10-year-old boy presents with fever, knee pain, and hematuria. Physical exam
reveals a malar rash, pericardial rub and bilateral knee effusions. His bloodwork
shows leukopenia and Anti-c1q autoantibodies. Involvement of which organ
involvement determines the long-term survival?
A.Heart
B.Brain
C.Skin
D.Kidney - ✔✔D:
Childhood Systemic Lupus Erythematosus (cSLE) has a more severe disease
course and higher mortality than adult SLE with increased rates of aggressive
renal disease, hematologic anomalies, photosensitivity, and neuropsychiatric
and mucocutaneous involvement. Skin involvement in cSLE is common at onset
and during the disease course. The malar, or erythematous "butterfly" rash, is
the most typical cutaneous manifestation; it may occur after exposure to
sunlight. Nonscarring frontal alopecia is often seen in cSLE. At disease onset,
there is often a combination of fever, weight loss, arthralgia, photosensitive or
,malar rash, and renal disease. Lupus nephritis is an important predictor of long-
term survival, especially if not controlled early. Anti-c1q autoantibodies are high
risk for the development of renal disease; vigilant monitoring of renal function
every three months is recommended, especially in males with cSLE.
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 - ✔✔B:
This scenario is classic for a contusion of the iliac crest or "hip pointer." It occurs
as a result of a direct blow to an unprotected iliac crest. Tenderness with
swelling and ecchymosis is common, as is pain on the affected side with lateral
bending away from the side of contact. This is not a hip injury, and internal
rotation of the hip should be normal. The Gillet test is used to evaluate
sacroiliac mobility. Numbness can be seen on the ipsilateral side because the
T12-L3 lateral cutaneous nerve branches are often injured.
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. - ✔✔C:
This patient has been performing excessive, unaccustomed, intense exercise. He
is at risk for a
compartment syndrome, which occurs when perfusion of muscle and nerve
tissues decreases to a level inadequate to sustain the viability of the tissues. The
intracompartmental pressure increases and produces venous obstruction. This
in turn increases the intracompartmental pressures even more, and necrosis of
muscle and nerve tissue may ensue in as little as 4-8 hours.
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. - ✔✔D:
Inappropriate sexual touching occurs more commonly in patients with a history
of frontal lobe damage. Treatment is best directed at staff education to make
certain all team members are consistent in responses. Behavior modification is
directed at telling the patient his behavior is wrong and firmly taking his hand
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 - ✔✔D:
This patient's symptoms are most consistent with plantar fasciitis. Classically,
this syndrome is most painful first thing in the morning upon arising and is
aggravated by overuse or change in footwear. Stretching the plantar fascia,
often before getting out of bed in the morning, and use of a heel cup or medial
longitudinal arch orthotic are the initial treatments for this condition.
Corticosteroid injection may be indicated at the insertion of the fascia into the
plantar aspect of the
calcaneus; however, this is usually not required on a repeated basis. Relative
rest from the aggravating activity may be useful, but bed rest is not indicated. A
walking cast would not allow stretch of the plantar fascia.
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. - ✔✔C:
Bladder dysfunction in patients with multiple sclerosis can be challenging from a
diagnostic perspective. The use of urodynamic testing provides useful
information. Bladder function in this scenario would be hyperreflexic, and with
high residual volumes it would indicate that bladder outlet pressure is high so as
to block urine flow, as if squeezing on a water balloon and holding the spout.
This outlet pressure is called dyssynergia, and treatment is directed at bladder
neck
relaxation.
A 10-year-old boy presents with fever, knee pain, and hematuria. Physical exam
reveals a malar rash, pericardial rub and bilateral knee effusions. His bloodwork
shows leukopenia and Anti-c1q autoantibodies. Involvement of which organ
involvement determines the long-term survival?
A.Heart
B.Brain
C.Skin
D.Kidney - ✔✔D:
Childhood Systemic Lupus Erythematosus (cSLE) has a more severe disease
course and higher mortality than adult SLE with increased rates of aggressive
renal disease, hematologic anomalies, photosensitivity, and neuropsychiatric
and mucocutaneous involvement. Skin involvement in cSLE is common at onset
and during the disease course. The malar, or erythematous "butterfly" rash, is
the most typical cutaneous manifestation; it may occur after exposure to
sunlight. Nonscarring frontal alopecia is often seen in cSLE. At disease onset,
there is often a combination of fever, weight loss, arthralgia, photosensitive or
,malar rash, and renal disease. Lupus nephritis is an important predictor of long-
term survival, especially if not controlled early. Anti-c1q autoantibodies are high
risk for the development of renal disease; vigilant monitoring of renal function
every three months is recommended, especially in males with cSLE.
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 - ✔✔B:
This scenario is classic for a contusion of the iliac crest or "hip pointer." It occurs
as a result of a direct blow to an unprotected iliac crest. Tenderness with
swelling and ecchymosis is common, as is pain on the affected side with lateral
bending away from the side of contact. This is not a hip injury, and internal
rotation of the hip should be normal. The Gillet test is used to evaluate
sacroiliac mobility. Numbness can be seen on the ipsilateral side because the
T12-L3 lateral cutaneous nerve branches are often injured.
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. - ✔✔C:
This patient has been performing excessive, unaccustomed, intense exercise. He
is at risk for a
compartment syndrome, which occurs when perfusion of muscle and nerve
tissues decreases to a level inadequate to sustain the viability of the tissues. The
intracompartmental pressure increases and produces venous obstruction. This
in turn increases the intracompartmental pressures even more, and necrosis of
muscle and nerve tissue may ensue in as little as 4-8 hours.
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. - ✔✔D:
Inappropriate sexual touching occurs more commonly in patients with a history
of frontal lobe damage. Treatment is best directed at staff education to make
certain all team members are consistent in responses. Behavior modification is
directed at telling the patient his behavior is wrong and firmly taking his hand
