LATEST PEDIATRIC REHABILITATION
MEDICINE CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PHYSICAL MEDICINE &
REHABILITATION | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 4-year-old male with spastic diplegic cerebral
palsy (GMFCS level II) is learning to walk with ankle-
foot orthoses (AFOs). Which gait deviation is most
characteristic of spastic diplegia?
A) Scissoring gait with hip adduction and internal
rotation
B) Steppage gait with foot drop
C) Trendelenburg gait with hip abductor weakness
D) Antalgic gait with shortened stance phase
Correct answer: A
Rationale: Spastic diplegia presents with scissoring
gait (hip adduction, internal rotation, knee flexion,
equinus) due to spasticity of adductors and
hamstrings.
2. A 6-year-old female with spastic quadriplegic
cerebral palsy (GMFCS level IV) has severe hip
adductor spasticity causing pain and difficulty with
,perineal care. Which is the most appropriate next
step?
A) Botulinum toxin injection to adductors
B) Selective dorsal rhizotomy (SDR)
C) Intrathecal baclofen (ITB) pump
D) Adductor tenotomy
Correct answer: A
Rationale: Botulinum toxin is first-line for focal
spasticity (hip adductors) to improve hygiene and
reduce pain. ITB or SDR for generalized spasticity.
3. A 2-year-old male with global developmental delay,
hypotonia, and characteristic facial features
(almond-shaped eyes, thin upper lip) is diagnosed
with Prader-Willi syndrome. Which is the most
important early intervention to prevent obesity?
A) Growth hormone therapy
B) Strict dietary control and parental education
C) Metformin
D) Physical therapy only
Correct answer: B
Rationale: Hyperphagia and obesity in Prader-Willi
syndrome require early dietary restriction and
,environmental control. Growth hormone improves
body composition but does not prevent obesity
without diet.
4. A 10-year-old male with Duchenne muscular
dystrophy (DMD) is currently ambulatory with
bilateral ankle-foot orthoses (AFOs). His forced vital
capacity (FVC) is 65% predicted. Which is the most
appropriate next step in respiratory management?
A) Annual pulmonary function testing (PFT) and flu
vaccination
B) Initiate non-invasive ventilation (NIV) at night
C) Mechanical insufflation-exsufflation (cough assist)
daily
D) Polysomnography
Correct answer: A
Rationale: In DMD, FVC >60% is monitored annually.
NIV is indicated when FVC <50% or symptoms of
hypoventilation. Cough assist is for weak cough.
5. A 12-year-old female with cerebral palsy (GMFCS
level III) has hip pain and limited abduction. X-ray
shows hip subluxation (Reimers migration index
40%). Which is the most appropriate next step?
, A) Observation with follow-up X-ray in 6 months
B) Botulinum toxin to adductors
C) Hip surveillance with X-ray every 6-12 months
D) Surgical hip reconstruction (femoral osteotomy)
Correct answer: C
Rationale: Hip surveillance (X-ray every 6-12 months)
is standard for GMFCS III-V. Surgery is indicated for
migration index >30-40% with progressive
subluxation or pain.
6. A 3-year-old male with myelomeningocele (L4
motor level) has a neurogenic bladder. Which is the
most appropriate bladder management to preserve
renal function?
A) Clean intermittent catheterization (CIC) every 3-4
hours
B) Indwelling Foley catheter
C) Condom catheter
D) Voiding on schedule (timed voiding)
Correct answer: A
Rationale: CIC is the gold standard for neurogenic
bladder in children to prevent hydronephrosis and
preserve renal function. Indwelling catheters
increase infection risk.
MEDICINE CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PHYSICAL MEDICINE &
REHABILITATION | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 4-year-old male with spastic diplegic cerebral
palsy (GMFCS level II) is learning to walk with ankle-
foot orthoses (AFOs). Which gait deviation is most
characteristic of spastic diplegia?
A) Scissoring gait with hip adduction and internal
rotation
B) Steppage gait with foot drop
C) Trendelenburg gait with hip abductor weakness
D) Antalgic gait with shortened stance phase
Correct answer: A
Rationale: Spastic diplegia presents with scissoring
gait (hip adduction, internal rotation, knee flexion,
equinus) due to spasticity of adductors and
hamstrings.
2. A 6-year-old female with spastic quadriplegic
cerebral palsy (GMFCS level IV) has severe hip
adductor spasticity causing pain and difficulty with
,perineal care. Which is the most appropriate next
step?
A) Botulinum toxin injection to adductors
B) Selective dorsal rhizotomy (SDR)
C) Intrathecal baclofen (ITB) pump
D) Adductor tenotomy
Correct answer: A
Rationale: Botulinum toxin is first-line for focal
spasticity (hip adductors) to improve hygiene and
reduce pain. ITB or SDR for generalized spasticity.
3. A 2-year-old male with global developmental delay,
hypotonia, and characteristic facial features
(almond-shaped eyes, thin upper lip) is diagnosed
with Prader-Willi syndrome. Which is the most
important early intervention to prevent obesity?
A) Growth hormone therapy
B) Strict dietary control and parental education
C) Metformin
D) Physical therapy only
Correct answer: B
Rationale: Hyperphagia and obesity in Prader-Willi
syndrome require early dietary restriction and
,environmental control. Growth hormone improves
body composition but does not prevent obesity
without diet.
4. A 10-year-old male with Duchenne muscular
dystrophy (DMD) is currently ambulatory with
bilateral ankle-foot orthoses (AFOs). His forced vital
capacity (FVC) is 65% predicted. Which is the most
appropriate next step in respiratory management?
A) Annual pulmonary function testing (PFT) and flu
vaccination
B) Initiate non-invasive ventilation (NIV) at night
C) Mechanical insufflation-exsufflation (cough assist)
daily
D) Polysomnography
Correct answer: A
Rationale: In DMD, FVC >60% is monitored annually.
NIV is indicated when FVC <50% or symptoms of
hypoventilation. Cough assist is for weak cough.
5. A 12-year-old female with cerebral palsy (GMFCS
level III) has hip pain and limited abduction. X-ray
shows hip subluxation (Reimers migration index
40%). Which is the most appropriate next step?
, A) Observation with follow-up X-ray in 6 months
B) Botulinum toxin to adductors
C) Hip surveillance with X-ray every 6-12 months
D) Surgical hip reconstruction (femoral osteotomy)
Correct answer: C
Rationale: Hip surveillance (X-ray every 6-12 months)
is standard for GMFCS III-V. Surgery is indicated for
migration index >30-40% with progressive
subluxation or pain.
6. A 3-year-old male with myelomeningocele (L4
motor level) has a neurogenic bladder. Which is the
most appropriate bladder management to preserve
renal function?
A) Clean intermittent catheterization (CIC) every 3-4
hours
B) Indwelling Foley catheter
C) Condom catheter
D) Voiding on schedule (timed voiding)
Correct answer: A
Rationale: CIC is the gold standard for neurogenic
bladder in children to prevent hydronephrosis and
preserve renal function. Indwelling catheters
increase infection risk.
