FLORIDA BOARD OF MEDICINE PHYSICAL
MEDICINE CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 62-year-old man with a history of hypertension and type 2
diabetes presents with 8 months of progressive bilateral lower-
extremity weakness. Examination demonstrates bilateral hip-flexor
and knee-extensor weakness, absent patellar reflexes, preserved
ankle reflexes, and decreased sensation over the anterior thighs. He
reports difficulty climbing stairs and rising from a chair. MRI
demonstrates severe lumbar spinal canal stenosis at L2–L4. Which
finding would most strongly support neurogenic claudication rather
than vascular claudication?
A. Calf pain that occurs at a fixed walking distance regardless of posture
B. Symptoms relieved by sitting or lumbar flexion
C. Absent posterior tibial pulses
D. Coolness and pallor of the feet
E. Pain reproduced by passive ankle dorsiflexion
Answer: B. Symptoms relieved by sitting or lumbar flexion
Rationale: Neurogenic claudication from lumbar spinal stenosis is
characteristically aggravated by standing and lumbar extension and
relieved by sitting, squatting, or forward flexion because flexion
increases the available cross-sectional area of the spinal canal and
foramina. Vascular claudication is more closely related to exertional
oxygen demand and is typically relieved simply by stopping activity,
1
,regardless of spinal position. Diminished pulses, cool skin, and trophic
changes support peripheral arterial disease.
2. A 45-year-old woman develops severe burning pain, edema,
temperature asymmetry, and allodynia of the right hand 6 weeks
after a distal radius fracture. Radiographs show patchy regional
osteopenia. Which diagnosis best explains the presentation?
A. Complex regional pain syndrome type I
B. Complex regional pain syndrome type II
C. Cervical radiculopathy
D. Peripheral vascular disease
E. Somatic symptom disorder
Answer: A. Complex regional pain syndrome type I
Rationale: CRPS type I occurs without a confirmed major nerve injury
and commonly follows fractures or other trauma. Hallmark findings
include disproportionate regional pain, allodynia or hyperalgesia,
vasomotor changes, sudomotor abnormalities, edema, and
motor/trophic changes. CRPS type II requires a definable nerve
injury.
3. A 29-year-old competitive runner develops lateral hip pain that
worsens when lying on the affected side and during prolonged
walking. Examination reveals tenderness directly over the greater
trochanter and pain with resisted hip abduction. Hip radiographs
are normal. Which diagnosis is most likely?
A. Femoral neck stress fracture
B. Greater trochanteric pain syndrome
C. Hip osteoarthritis
2
,D. Meralgia paresthetica
E. Sacroiliac joint dysfunction
Answer: B. Greater trochanteric pain syndrome
Rationale: Greater trochanteric pain syndrome encompasses disorders
involving the gluteus medius/minimus tendons and peritrochanteric
structures. Lateral hip tenderness, pain with resisted abduction, and
pain when lying on the affected side are classic. It is frequently
incorrectly labeled simply as “trochanteric bursitis.”
4. A 58-year-old man with chronic low-back pain undergoes
electrodiagnostic testing. Nerve conduction studies are normal.
Needle EMG demonstrates fibrillation potentials and positive sharp
waves in the tibialis anterior, tensor fasciae latae, and lumbar
paraspinal muscles. Which diagnosis is most consistent with these
findings?
A. Common peroneal neuropathy at the fibular head
B. L5 radiculopathy
C. Length-dependent polyneuropathy
D. Sciatic neuropathy
E. Lateral femoral cutaneous neuropathy
Answer: B. L5 radiculopathy
Rationale: L5 radiculopathy can involve the tibialis anterior and
tensor fasciae latae and may produce denervation in corresponding
paraspinal muscles. Normal sensory nerve action potentials favor
radiculopathy because the dorsal root ganglion is distal to the lesion.
In a common peroneal neuropathy, muscles innervated by the
superficial peroneal division and/or proximal muscles depending on
lesion level would show a different pattern, while paraspinal
abnormalities would not be expected.
3
, 5. A patient with a traumatic T10 spinal cord injury has flaccid
paralysis immediately after injury, absent reflexes, and urinary
retention. Six weeks later, he develops increased tone, hyperreflexia,
and extensor spasms in both legs. Which pathophysiologic
phenomenon best explains this transition?
A. Progressive peripheral nerve degeneration
B. Resolution of spinal shock with development of upper motor neuron
syndrome
C. Development of cauda equina syndrome
D. Acute motor axonal neuropathy
E. Lower motor neuron recovery
Answer: B. Resolution of spinal shock with development of upper
motor neuron syndrome
Rationale: Spinal shock immediately after acute spinal cord injury
causes transient flaccid paralysis, areflexia, and autonomic
dysfunction below the lesion. As spinal shock resolves, descending
inhibitory control remains disrupted, allowing hyperreflexia, increased
tone, clonus, and spasticity to emerge.
6. A 41-year-old patient with incomplete cervical spinal cord injury
develops painful flexor spasms that interfere with transfers and
hygiene. Oral baclofen provides partial benefit but causes excessive
sedation. Which intervention provides a logical next treatment for
severe focal spasticity involving selected muscle groups?
A. Increase baclofen indefinitely
B. Botulinum toxin injection into appropriately selected muscles
C. Long-term systemic corticosteroids
4
MEDICINE CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 62-year-old man with a history of hypertension and type 2
diabetes presents with 8 months of progressive bilateral lower-
extremity weakness. Examination demonstrates bilateral hip-flexor
and knee-extensor weakness, absent patellar reflexes, preserved
ankle reflexes, and decreased sensation over the anterior thighs. He
reports difficulty climbing stairs and rising from a chair. MRI
demonstrates severe lumbar spinal canal stenosis at L2–L4. Which
finding would most strongly support neurogenic claudication rather
than vascular claudication?
A. Calf pain that occurs at a fixed walking distance regardless of posture
B. Symptoms relieved by sitting or lumbar flexion
C. Absent posterior tibial pulses
D. Coolness and pallor of the feet
E. Pain reproduced by passive ankle dorsiflexion
Answer: B. Symptoms relieved by sitting or lumbar flexion
Rationale: Neurogenic claudication from lumbar spinal stenosis is
characteristically aggravated by standing and lumbar extension and
relieved by sitting, squatting, or forward flexion because flexion
increases the available cross-sectional area of the spinal canal and
foramina. Vascular claudication is more closely related to exertional
oxygen demand and is typically relieved simply by stopping activity,
1
,regardless of spinal position. Diminished pulses, cool skin, and trophic
changes support peripheral arterial disease.
2. A 45-year-old woman develops severe burning pain, edema,
temperature asymmetry, and allodynia of the right hand 6 weeks
after a distal radius fracture. Radiographs show patchy regional
osteopenia. Which diagnosis best explains the presentation?
A. Complex regional pain syndrome type I
B. Complex regional pain syndrome type II
C. Cervical radiculopathy
D. Peripheral vascular disease
E. Somatic symptom disorder
Answer: A. Complex regional pain syndrome type I
Rationale: CRPS type I occurs without a confirmed major nerve injury
and commonly follows fractures or other trauma. Hallmark findings
include disproportionate regional pain, allodynia or hyperalgesia,
vasomotor changes, sudomotor abnormalities, edema, and
motor/trophic changes. CRPS type II requires a definable nerve
injury.
3. A 29-year-old competitive runner develops lateral hip pain that
worsens when lying on the affected side and during prolonged
walking. Examination reveals tenderness directly over the greater
trochanter and pain with resisted hip abduction. Hip radiographs
are normal. Which diagnosis is most likely?
A. Femoral neck stress fracture
B. Greater trochanteric pain syndrome
C. Hip osteoarthritis
2
,D. Meralgia paresthetica
E. Sacroiliac joint dysfunction
Answer: B. Greater trochanteric pain syndrome
Rationale: Greater trochanteric pain syndrome encompasses disorders
involving the gluteus medius/minimus tendons and peritrochanteric
structures. Lateral hip tenderness, pain with resisted abduction, and
pain when lying on the affected side are classic. It is frequently
incorrectly labeled simply as “trochanteric bursitis.”
4. A 58-year-old man with chronic low-back pain undergoes
electrodiagnostic testing. Nerve conduction studies are normal.
Needle EMG demonstrates fibrillation potentials and positive sharp
waves in the tibialis anterior, tensor fasciae latae, and lumbar
paraspinal muscles. Which diagnosis is most consistent with these
findings?
A. Common peroneal neuropathy at the fibular head
B. L5 radiculopathy
C. Length-dependent polyneuropathy
D. Sciatic neuropathy
E. Lateral femoral cutaneous neuropathy
Answer: B. L5 radiculopathy
Rationale: L5 radiculopathy can involve the tibialis anterior and
tensor fasciae latae and may produce denervation in corresponding
paraspinal muscles. Normal sensory nerve action potentials favor
radiculopathy because the dorsal root ganglion is distal to the lesion.
In a common peroneal neuropathy, muscles innervated by the
superficial peroneal division and/or proximal muscles depending on
lesion level would show a different pattern, while paraspinal
abnormalities would not be expected.
3
, 5. A patient with a traumatic T10 spinal cord injury has flaccid
paralysis immediately after injury, absent reflexes, and urinary
retention. Six weeks later, he develops increased tone, hyperreflexia,
and extensor spasms in both legs. Which pathophysiologic
phenomenon best explains this transition?
A. Progressive peripheral nerve degeneration
B. Resolution of spinal shock with development of upper motor neuron
syndrome
C. Development of cauda equina syndrome
D. Acute motor axonal neuropathy
E. Lower motor neuron recovery
Answer: B. Resolution of spinal shock with development of upper
motor neuron syndrome
Rationale: Spinal shock immediately after acute spinal cord injury
causes transient flaccid paralysis, areflexia, and autonomic
dysfunction below the lesion. As spinal shock resolves, descending
inhibitory control remains disrupted, allowing hyperreflexia, increased
tone, clonus, and spasticity to emerge.
6. A 41-year-old patient with incomplete cervical spinal cord injury
develops painful flexor spasms that interfere with transfers and
hygiene. Oral baclofen provides partial benefit but causes excessive
sedation. Which intervention provides a logical next treatment for
severe focal spasticity involving selected muscle groups?
A. Increase baclofen indefinitely
B. Botulinum toxin injection into appropriately selected muscles
C. Long-term systemic corticosteroids
4
