DHA Physical Medicine & Rehabilitation exam questions

6 worked Physical Medicine & Rehabilitation practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Amputation, Prosthetics and Orthotics

   A transtibial prosthesis user shows rapid, excessive knee flexion just after heel strike. Which prosthetic alignment or component problem most likely causes this?

   1. AHeel cushion too soft
   2. BFoot set in excessive plantarflexion
   3. CHeel cushion too stiff
   4. DSocket set too far posterior
   Show answer and explanation

   Correct answer: C. Heel cushion too stiff

   A stiff heel cushion fails to compress at heel strike, so the ground reaction force passes posterior to the knee and drives it rapidly into flexion. A soft heel or excessive plantarflexion produces the opposite deviation of knee hyperextension.

   Reference: Orthotics and Prosthetics in Rehabilitation, 4th ed. (Lusardi)

2. Question 2 · Musculoskeletal, Spine and Pain Medicine

   A 42-year-old carpenter has lateral elbow pain. Which examination finding most supports lateral epicondylalgia?

   1. APain on resisted wrist flexion
   2. BPain on resisted wrist extension
   3. CPositive Tinel sign at the cubital tunnel
   4. DPain on valgus stress of the elbow
   Show answer and explanation

   Correct answer: B. Pain on resisted wrist extension

   Lateral epicondylalgia involves the common extensor origin, especially extensor carpi radialis brevis, so resisted wrist or middle finger extension reproduces the pain. Pain on resisted wrist flexion suggests medial epicondylalgia.

   Reference: Brukner and Khan's Clinical Sports Medicine, 5th ed.

3. Question 3 · Musculoskeletal, Spine and Pain Medicine

   A 55-year-old man has shoulder pain after lifting. Pain and weakness occur when he resists downward pressure with the arms abducted to 90 degrees in the scapular plane and thumbs pointing down. Which tendon is most likely affected?

   1. ASupraspinatus
   2. BInfraspinatus
   3. CSubscapularis
   4. DLong head of biceps
   Show answer and explanation

   Correct answer: A. Supraspinatus

   This is the empty can (Jobe) test, which isolates the supraspinatus. Infraspinatus is tested by resisted external rotation and subscapularis by the lift-off or belly-press test.

   Reference: Magee's Orthopedic Physical Assessment, 7th ed.

4. Question 4 · Musculoskeletal, Spine and Pain Medicine

   A 50-year-old man has right leg pain radiating to the dorsum of the foot, weakness of great toe extension and ankle dorsiflexion, and normal knee and ankle reflexes. Which nerve root is most likely affected?

   1. AL3
   2. BL4
   3. CS1
   4. DL5
   Show answer and explanation

   Correct answer: D. L5

   L5 radiculopathy causes weakness of extensor hallucis longus and ankle dorsiflexors, sensory change over the dorsum of the foot, and often no change in standard reflexes. S1 involvement would reduce the ankle reflex and weaken plantarflexion.

   Reference: Magee's Orthopedic Physical Assessment, 7th ed.

5. Question 5 · Paediatric and Neuromuscular Rehabilitation

   A 63-year-old man with amyotrophic lateral sclerosis reports morning headaches and orthopnoea. His forced vital capacity has fallen to 45% of predicted. What is the most appropriate respiratory intervention?

   1. AOffer non-invasive ventilation
   2. BElective tracheostomy at once
   3. CHome oxygen therapy alone
   4. DRepeat spirometry in 6 months
   Show answer and explanation

   Correct answer: A. Offer non-invasive ventilation

   Symptoms of nocturnal hypoventilation with FVC below 50% predicted are an indication for non-invasive ventilation, which improves survival and quality of life in ALS. Oxygen alone can suppress respiratory drive and worsen hypercapnia.

   Reference: AAN Practice Parameter Update: Care of the Patient with ALS 2009

6. Question 6 · Spasticity, Pharmacology and Interventional Procedures

   A man with an intrathecal baclofen pump presents with rebound spasticity, itching, fever of 39.4 C and tachycardia. The pump alarm indicates a low reservoir. What is the most important treatment?

   1. AStart oral dantrolene as sole therapy
   2. BRestore intrathecal baclofen delivery urgently
   3. CGive IV antibiotics and observe closely
   4. DStart low-dose oral tizanidine overnight
   Show answer and explanation

   Correct answer: B. Restore intrathecal baclofen delivery urgently

   Abrupt intrathecal baclofen withdrawal can progress to rhabdomyolysis, multiorgan failure and death, and the definitive treatment is urgent restoration of intrathecal delivery. High-dose oral baclofen and benzodiazepines are only bridging measures because oral baclofen crosses into the CSF poorly.

   Reference: Lioresal Intrathecal (baclofen) Prescribing Information, Boxed Warning