100+ Free ABPMR PM&R Practice Questions

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Question 1

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A 58-year-old man with a C5 ASIA A SCI becomes acutely flushed with blood pressure 210/115 mmHg, pounding headache, and diaphoresis above the level of injury. What is the FIRST step in management?

Place the patient in the upright seated position and loosen constrictive clothing

Administer IV labetalol immediately

Lay the patient flat and elevate the legs

Order a stat head CT to evaluate for intracranial hemorrhage

to track

2026 Statistics

Key Facts: ABPMR PM&R Exam

~240

Total MCQ Items

ABPMR Part I Written Examination

~8 hr

Total Exam Time

1-day computer-based test including breaks

~18-22%

MSK Weight

Largest domain on 2026 ABPMR Part I content outline

$1,850

2026 Part I Fee

ABPMR initial certification

4 yr

Required Training

1 transitional + 3 PM&R residency (ACGME)

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABPMR Part I exam is a 1-day computer-based test administered at Pearson VUE containing ~240 single-best-answer MCQs over ~8 hours. The 2026 content outline emphasizes musculoskeletal (~18-22%), SCI (~12-15%), stroke/neuromuscular (~12-15%), electrodiagnostics (~10-12%), TBI (~8-10%), interventional pain (~8-10%), amputee rehab (~6-8%), pediatric rehab (~6-8%), prosthetics/orthotics/AT (~6-8%), medical rehab/outcomes (~6-8%), and cardiopulmonary rehab (~4-6%). Initial Part I fee is ~$1,850; requires ACGME-accredited PM&R residency.

Sample ABPMR PM&R Practice Questions

Try these sample questions to test your ABPMR PM&R exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man with a C5 ASIA A SCI becomes acutely flushed with blood pressure 210/115 mmHg, pounding headache, and diaphoresis above the level of injury. What is the FIRST step in management?

A.Place the patient in the upright seated position and loosen constrictive clothing

B.Administer IV labetalol immediately

C.Lay the patient flat and elevate the legs

D.Order a stat head CT to evaluate for intracranial hemorrhage

Explanation: Autonomic dysreflexia is a life-threatening emergency in SCI at T6 or above. First action is to sit the patient UP (orthostatic effect lowers BP) and loosen tight clothing, then immediately search for noxious stimulus — most commonly bladder distension (check Foley/irrigate/straight cath), then bowel impaction. Pharmacologic therapy is reserved for persistent systolic BP >150.

2According to the ASIA Impairment Scale, which classification corresponds to 'motor incomplete with at least half of key muscles below the neurologic level of injury graded 3/5 or greater'?

A.ASIA D

B.ASIA A

C.ASIA B

D.ASIA C

Explanation: ASIA A = complete (no sensory or motor at S4-S5). ASIA B = sensory incomplete only. ASIA C = motor incomplete with more than half of key muscles below the neurologic level graded <3/5. ASIA D = motor incomplete with at least half of key muscles graded ≥3/5. ASIA E = normal.

3An elderly man falls forward striking his forehead, causing hyperextension. He develops weakness that is markedly worse in the upper extremities than lower extremities, with variable sensory loss. Which incomplete SCI syndrome is most likely?

A.Brown-Séquard syndrome

B.Anterior cord syndrome

C.Central cord syndrome

D.Posterior cord syndrome

Explanation: Central cord syndrome is the most common incomplete SCI, classically caused by cervical hyperextension in an elderly patient with preexisting spondylosis. Upper-extremity weakness exceeds lower-extremity weakness because cervical corticospinal fibers are more centrally located (somatotopic organization). Sensory loss and bladder dysfunction vary. Prognosis is fair — many regain ambulation but hand function often remains impaired.

4A patient with a penetrating spinal cord injury has ipsilateral motor weakness and loss of vibration/proprioception with contralateral loss of pain and temperature below the lesion. Which syndrome is this?

A.Anterior cord syndrome

B.Brown-Séquard syndrome

C.Central cord syndrome

D.Cauda equina syndrome

Explanation: Brown-Séquard (hemisection) causes ipsilateral loss of motor function and dorsal column modalities (vibration, proprioception) and contralateral loss of spinothalamic modalities (pain and temperature) because the spinothalamic tract decussates within 1-2 segments. It has the BEST prognosis of the incomplete SCI syndromes for ambulation recovery.

5A 22-year-old male with a complete T10 SCI is found to have elevated alkaline phosphatase and increasing hip stiffness 6 weeks post-injury. A bone scan shows increased uptake anterior to the hip. What is the most likely diagnosis?

A.Osteomyelitis

B.Septic arthritis

C.Deep vein thrombosis

D.Heterotopic ossification

Explanation: Heterotopic ossification (HO) occurs in 10-50% of SCI patients, typically 1-4 months post-injury around the hip (most common), then knee, shoulder, elbow. Early findings: warmth, swelling, decreased ROM, elevated alkaline phosphatase. Triple-phase bone scan is the most sensitive early test. Treatment: etidronate, NSAIDs, ROM preservation; surgical excision delayed until bone matures (~12-18 months).

6Which pressure injury stage is characterized by full-thickness skin loss with visible fat but NO exposed muscle, bone, or tendon?

A.Stage 4

B.Stage 1

C.Stage 2

D.Stage 3

Explanation: Per NPIAP staging: Stage 1 — intact skin with non-blanchable erythema. Stage 2 — partial-thickness with exposed dermis (shallow ulcer or intact/ruptured blister). Stage 3 — full-thickness skin loss with visible fat; undermining or tunneling may be present; no exposed bone/muscle/tendon. Stage 4 — full-thickness with exposed bone/muscle/tendon. Unstageable = full thickness obscured by slough/eschar. Deep tissue injury (DTI) = persistent non-blanchable deep-purple discoloration.

7A stroke patient's arm is flaccid on day 3, then becomes spastic with minimal voluntary movement only in synergy patterns. Per Brunnstrom, which stage of motor recovery is this?

A.Stage 1

B.Stage 3

C.Stage 2

D.Stage 6

Explanation: Brunnstrom stages of post-stroke motor recovery: I — flaccidity, no voluntary movement; II — spasticity appears with minimal voluntary movement and synergies emerging; III — marked spasticity with voluntary movement only in synergy; IV — spasticity decreases, some movement out of synergy; V — spasticity decreases further, independent joint movement; VI — spasticity disappears, near-normal coordination.

8A patient has contralateral leg weakness greater than arm weakness, along with abulia and urinary incontinence. Which vascular territory is affected?

A.Vertebrobasilar system

B.Middle cerebral artery (MCA)

C.Posterior cerebral artery (PCA)

D.Anterior cerebral artery (ACA)

Explanation: ACA stroke causes contralateral leg weakness > arm (medial motor homunculus), abulia/apathy, urinary incontinence (paracentral lobule), and transcortical motor aphasia if dominant. MCA: contralateral face/arm > leg weakness, aphasia (dominant) or neglect (non-dominant), homonymous hemianopia. PCA: homonymous hemianopia, alexia without agraphia (dominant), memory impairment.

9A post-stroke patient has a flaccid hemiplegic shoulder with a palpable sulcus between the acromion and humeral head. What is the most appropriate initial intervention?

A.Proper positioning, supportive sling during transfers, and neuromuscular electrical stimulation (NMES)

B.Immediate open surgical capsulorrhaphy

C.Intra-articular corticosteroid injection

D.Prolonged full-arm immobilization in internal rotation

Explanation: Glenohumeral subluxation in the flaccid hemiplegic shoulder is prevented and treated with proper positioning (avoid pulling the arm), supportive slings during ambulation/transfer, and NMES to the supraspinatus and posterior deltoid to maintain muscle tone and glenohumeral alignment. Prolonged immobilization risks adhesive capsulitis. Surgery is not first-line.

10According to the modified Ashworth Scale, which grade indicates 'marked increase in tone through most of range of motion, but the affected part is easily moved'?

A.Grade 1

B.Grade 2

C.Grade 3

D.Grade 4

Explanation: Modified Ashworth: 0 = no increase in tone; 1 = slight increase with catch-release at end of ROM; 1+ = slight increase with catch followed by minimal resistance through less than half of ROM; 2 = more marked increase through most of ROM, but affected part easily moved; 3 = considerable increase, passive movement difficult; 4 = affected part rigid in flexion or extension.

About the ABPMR PM&R Exam

The ABPMR Part I Written Examination is the first of two certifying exams from the American Board of Physical Medicine and Rehabilitation. The computer-based test contains approximately 240 single-best-answer MCQs spanning musculoskeletal medicine, spinal cord injury (ASIA, autonomic dysreflexia, neurogenic bladder/bowel), stroke rehabilitation (NIHSS, Brunnstrom, FIM, spasticity management), traumatic brain injury (GCS, Rancho Los Amigos, PTA), amputee rehabilitation and prosthetics (K-levels, socket/suspension/foot systems), pediatric rehabilitation (CP GMFCS, DMD, spina bifida, obstetric brachial plexopathy), electrodiagnostics (EMG/NCS), chronic pain and interventional spine procedures, prosthetics/orthotics, wheelchairs/seating, cardiopulmonary rehab, and medical rehabilitation (dysphagia, pressure injury staging, DVT). Requires completion of an ACGME-accredited PM&R residency (1 transitional + 3 PM&R years).

Questions

240 scored questions

Time Limit

1-day CBT (~8 hours including breaks)

Passing Score

Criterion-referenced scaled score set by ABPMR (modified Angoff)

Exam Fee

~$1,850 initial Part I certification fee (ABPMR 2026) (American Board of Physical Medicine and Rehabilitation (ABPMR) / Pearson VUE)

ABPMR PM&R Exam Content Outline

~18-22%

Musculoskeletal Medicine

Shoulder (rotator cuff, impingement, adhesive capsulitis, AC joint), knee (meniscus, ACL/PCL/MCL, patellofemoral), hip (OA, labral tear, greater trochanteric pain), spine (cervical/lumbar radiculopathy, myelopathy, spondylolisthesis), tendinopathy, osteoarthritis, inflammatory arthritis (RA, spondyloarthropathies, gout/CPPD), sports medicine, concussion return-to-play.

~12-15%

Spinal Cord Injury

ASIA Impairment Scale A-E (ISNCSCI), neurologic level, complete vs incomplete — central cord (MVA hyperextension, elderly spondylosis), anterior cord (axial loading), Brown-Séquard (hemisection), cauda equina vs conus medullaris. Autonomic dysreflexia >T6 (sudden HTN + headache + diaphoresis), neurogenic bladder/bowel, heterotopic ossification (alk phos, bone scan, etidronate/NSAIDs), pressure injury (NPIAP), Braden, DVT prophylaxis.

~12-15%

Stroke & Neuromuscular Rehabilitation

NIHSS, MCA syndrome (contralateral face/arm > leg weakness, aphasia if dominant), ACA (leg > arm, abulia), PCA (homonymous hemianopia, alexia without agraphia), lacunar syndromes, Brunnstrom stages I-VI, FIM scoring, glenohumeral subluxation (support, NMES), shoulder-hand syndrome/CRPS, spasticity (modified Ashworth, baclofen, tizanidine, botulinum toxin, ITB).

~10-12%

Electrodiagnostics (EMG/NCS)

NCS technique (temperature >32°C, supramaximal stimulation, reference electrode), CMAP/SNAP amplitude, distal latency, conduction velocity, F-waves, H-reflex, repetitive nerve stimulation (decremental response in MG, incremental in LEMS), needle EMG (fibrillations and positive sharp waves = active denervation; MUAP morphology, recruitment), carpal tunnel, ulnar at elbow, ALS, CIDP/GBS (demyelinating features — conduction block, prolonged F-waves), radiculopathy.

~8-10%

Traumatic Brain Injury

GCS (severe ≤8, moderate 9-12, mild 13-15), Rancho Los Amigos I-X (from no response to purposeful), post-traumatic amnesia (GOAT score ≥75 × 2 days), Disability Rating Scale, agitation (propranolol, buspirone, trazodone, valproate; AVOID benzodiazepines and typical antipsychotics — worsen recovery), second-impact syndrome, diffuse axonal injury, concussion graded return-to-play.

~8-10%

Chronic Pain & Interventional

Fluoroscopic spine injections — facet, medial branch block followed by radiofrequency ablation, sacroiliac joint, epidural (transforaminal vs interlaminar vs caudal). CDC 2022 opioid guidance (shared decision, MME monitoring, caution >50 MME, taper slowly), state PDMP, urine drug screening (expected vs unexpected results), CRPS Budapest criteria, fibromyalgia (duloxetine/milnacipran/pregabalin), neuropathic pain (gabapentinoids, TCAs, SNRIs), spinal cord stimulation.

~6-8%

Amputee & Prosthetic Rehabilitation

Transtibial (PTB socket, pin-lock/suction/vacuum suspension, SACH vs dynamic-response foot) vs transfemoral (ischial containment or quadrilateral socket, single-axis/polycentric/hydraulic/microprocessor knee — C-Leg, Rheo), Medicare K-levels 0-4 dictate prosthetic components, preprosthetic shrinker and desensitization, phantom limb pain (gabapentinoids, mirror therapy) vs non-painful phantom sensation, residual limb care.

~6-8%

Pediatric Rehabilitation

Cerebral palsy (GMFCS I-V, spastic diplegia/hemiplegia/quadriplegia, hip surveillance by GMFCS, selective dorsal rhizotomy, baclofen ITB), spina bifida (L2 household ambulation with KAFO/RGO, L4 community with AFO), Duchenne MD (Xp21 dystrophin deletion, Gower sign, corticosteroids — prednisone/deflazacort, exon-skipping — eteplirsen, ataluren), obstetric brachial plexopathy (Erb C5-C6 — waiter's tip; Klumpke C8-T1 — claw hand + Horner).

~6-8%

Prosthetics, Orthotics & Assistive Technology

Ankle-foot orthoses — solid AFO, articulated, posterior leaf spring (flexible dorsiflexion assist for footdrop), ground-reaction AFO for crouch gait, KAFO for quadriceps weakness, reciprocating gait orthosis (RGO) for thoracic-level paraplegia, spinal orthoses (Milwaukee/Boston for scoliosis, TLSO for compression fx), upper-limb myoelectric vs body-powered, wheelchairs (manual vs power), cushions (Roho air, Jay gel, foam).

~6-8%

Medical Rehab & Outcomes

Dysphagia (modified barium swallow/VFSS with Penetration-Aspiration Scale; FEES), neurogenic bladder (CIC, anticholinergics — oxybutynin/tolterodine, mirabegron beta-3 agonist, onabotulinumtoxinA detrusor injection, alpha-blockers for DSD), neurogenic bowel program, DVT prophylaxis, pressure injury (NPIAP stages 1-4, unstageable, DTI), outcome measures — FIM, Barthel, Berg Balance (<45 falls risk), Dynamic Gait Index, ABC Scale, 6-minute walk.

~4-6%

Cardiopulmonary Rehabilitation

Cardiac rehab phases I (inpatient) → II (outpatient monitored) → III (conditioning) → IV (maintenance), MET levels (self-care 2-3, light housework 3-4, climbing stairs 5-6, heavy work >7), post-MI and post-CABG progression, exercise prescription (FITT — frequency/intensity/time/type), pulmonary rehab (exercise, education, pursed-lip and diaphragmatic breathing), COPD GOLD staging, oxygen titration.

How to Pass the ABPMR PM&R Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABPMR (modified Angoff)
Exam length: 240 questions
Time limit: 1-day CBT (~8 hours including breaks)
Exam fee: ~$1,850 initial Part I certification fee (ABPMR 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABPMR PM&R Study Tips from Top Performers

1Autonomic dysreflexia (AD) is a life-threatening emergency in SCI patients with injuries at T6 or above. Triad = sudden severe HTN + pounding headache + diaphoresis (with bradycardia from unopposed vagal reflex). First step: sit the patient UP (orthostatic drop lowers BP), loosen tight clothing, then search for the noxious stimulus — bladder distension is #1 (check Foley, irrigate, then straight cath), then bowel impaction (lidocaine jelly before disimpaction). Use short-acting antihypertensives (nitrates, nifedipine) if BP >150. DO NOT lay flat.

2ASIA Impairment Scale: A = complete (no motor/sensory at S4-S5); B = sensory incomplete (sensory but not motor below level, including S4-S5); C = motor incomplete, more than half key muscles below level have grade <3/5; D = motor incomplete, at least half have grade ≥3/5; E = normal. The neurologic level is the LOWEST level with intact sensation AND ≥3/5 strength with normal function above.

3Incomplete SCI syndromes — memorize the causes and deficits: Central cord (hyperextension in elderly with cervical spondylosis) → upper > lower extremity weakness, variable sensory. Anterior cord (axial load, anterior spinal artery) → loss of motor + pain/temp below level, preserved vibration/proprioception (worst prognosis). Brown-Séquard (penetrating or hemisection) → ipsilateral motor + vibration/proprioception loss, contralateral pain/temp loss (best prognosis). Cauda equina → LMN, areflexic, asymmetric.

4EMG/NCS pearls: Needle EMG fibrillations and positive sharp waves appear 2-3 weeks after axonal injury and indicate active denervation. Polyphasic, long-duration, high-amplitude MUAPs with reduced recruitment = chronic neurogenic (reinnervation). Small, short, polyphasic MUAPs with early recruitment = myopathic. Demyelinating NCS features: prolonged distal latency, slowed CV (<75% LLN), conduction block, temporal dispersion, prolonged F-waves (classic in GBS and CIDP). Myasthenia gravis: decremental response on low-frequency (2-3 Hz) RNS.

5Rancho Los Amigos Levels of Cognitive Functioning in TBI: I — no response; II — generalized response; III — localized response; IV — confused-agitated (the classic agitation phase — use environmental modifications first, propranolol, buspirone, trazodone; AVOID benzodiazepines and typical antipsychotics which worsen cognitive recovery); V — confused-inappropriate; VI — confused-appropriate; VII — automatic-appropriate; VIII — purposeful-appropriate; IX-X — modified independent with cognitive demands.

Frequently Asked Questions

What is the ABPMR Part I Written Examination?

The ABPMR Part I Written Examination is the first of two certifying exams administered by the American Board of Physical Medicine and Rehabilitation. It is a 1-day computer-based multiple-choice exam taken at Pearson VUE test centers. Part I assesses foundational knowledge across all PM&R content areas including musculoskeletal medicine, spinal cord injury, stroke and neuromuscular rehabilitation, traumatic brain injury, electrodiagnostics, amputee rehabilitation, pediatric rehabilitation, pain medicine, prosthetics/orthotics, and cardiopulmonary rehab. After passing Part I, candidates must pass the Part II oral exam to achieve full ABPMR certification.

Who is eligible to take the ABPMR Part I exam?

Candidates must have completed an ACGME-accredited PM&R residency program, which is a 4-year postgraduate training: 1 transitional or preliminary year plus 3 years of dedicated PM&R residency. Candidates must hold a valid unrestricted medical license and have program director attestation of satisfactory completion. Application is submitted through the ABPMR website within the designated eligibility window.

What is the format of the ABPMR Part I exam?

Part I is a 1-day computer-based examination administered at Pearson VUE test centers, consisting of approximately 240 single-best-answer multiple-choice questions delivered over roughly 8 hours including breaks. Questions frequently include clinical vignettes, imaging (MRI, X-ray, ultrasound), EMG/NCS tracings, ECGs, and photographs of physical exam findings, wounds, orthoses, and prostheses. Content is distributed across the 2026 ABPMR Part I content outline.

How much does the 2026 ABPMR Part I exam cost?

The 2026 ABPMR Part I initial certification fee is approximately $1,850. Cancellation and refund policies follow the ABPMR schedule with decreasing refunds as the exam date approaches. Part II oral examination has a separate fee (approximately $2,000). Continuing Certification (MOC) includes annual LLSA activities and a 10-year recertification cycle, each with associated fees. Retakes within the eligibility window require full re-registration and fee payment.

When is the 2026 exam administered?

The ABPMR Part I Written Examination is typically offered once per year in a testing window (historically August). Applications open in the spring with a submission deadline prior to the testing window. Candidates schedule specific Pearson VUE appointments after application approval. Exact 2026 dates should be confirmed on the ABPMR Exams page.

How is the exam scored?

ABPMR uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score rather than on other test-takers. Score reports include subdomain performance to guide future study. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics include: ASIA Impairment Scale and SCI complete vs incomplete syndromes (central cord, anterior cord, Brown-Séquard, cauda equina, conus medullaris), autonomic dysreflexia at T6 or above (HTN/headache/diaphoresis management), NCS and needle EMG pattern recognition (carpal tunnel, ulnar at elbow, radiculopathy, ALS, CIDP, myopathy, myasthenia gravis with decremental RNS), Rancho Los Amigos levels and TBI agitation pharmacology, stroke vascular syndromes (MCA/ACA/PCA), Brunnstrom stages, spasticity management (modified Ashworth, baclofen, botulinum toxin, ITB), pressure injury NPIAP staging, and Medicare K-levels in amputee rehabilitation.

How should I study for ABPMR Part I?

Use a structured 12-18 month plan during PGY-3 and PGY-4. Map to the ABPMR Part I content outline: lead with musculoskeletal medicine, then neurologic rehab (SCI, stroke, TBI), then electrodiagnostics, amputee and pediatric rehab, prosthetics/orthotics, pain medicine, cardiopulmonary, and medical rehab/outcomes. Core resources include Braddom's Physical Medicine and Rehabilitation, Cuccurullo Board Review, DeLisa's Physical Medicine and Rehabilitation, O'Young Secrets, AAPM&R Self-Assessment Exam for Residents (SAE-R), and AANEM resources for EMG/NCS. Drill high-volume MCQs with timed sets and complete 2-3 full-length timed mock exams.