LATEST NEUROMUSCULAR MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PHYSICAL MEDICINE &
REHABILITATION (ABPMR) | COMPLETE EXAM
Q&A WITH RATIONALES
1. A 45-year-old male presents with progressive
proximal muscle weakness (difficulty rising from a
chair, climbing stairs) for 6 months. Creatine kinase
(CK) is 2500 U/L. Electromyography (EMG) shows
short-duration, small-amplitude motor unit potentials
with early recruitment. Which is the most likely
diagnosis?
A) Inclusion body myositis (IBM)
B) Polymyositis
C) Duchenne muscular dystrophy
D) Lambert-Eaton myasthenic syndrome (LEMS)
Correct answer: B
Rationale: Progressive proximal weakness with
elevated CK and myopathic EMG (short-duration,
small-amplitude MUAPs, early recruitment) suggests
inflammatory myopathy. Polymyositis has subacute
onset.
,2. A 70-year-old male presents with slowly
progressive weakness of finger flexors (difficulty
gripping) and quadriceps (knee buckling) for 3 years.
CK is 350 U/L. EMG shows myopathic changes with
fibrillation potentials. Which is the most likely
diagnosis?
A) Polymyositis
B) Inclusion body myositis (IBM)
C) Dermatomyositis
D) Limb-girdle muscular dystrophy
Correct answer: B
Rationale: IBM presents with slowly progressive,
asymmetric weakness (finger flexors, quadriceps),
CK normal to mildly elevated, and EMG showing
myopathic changes with fibrillations (irritative
myopathy).
3. A 45-year-old female presents with a heliotrope
rash on the eyelids, Gottron papules over the
knuckles, and proximal muscle weakness. CK is 1800
U/L. Which autoantibody is most specific for this
condition?
A) Anti-Jo-1
B) Anti-Mi-2
,C) Anti-SRP
D) Anti-HMGCR
Correct answer: B
Rationale: Anti-Mi-2 is highly specific for
dermatomyositis (classic rash). Anti-Jo-1 is
associated with antisynthetase syndrome
(mechanic's hands, interstitial lung disease).
4. A 30-year-old female presents with fluctuating
ptosis, diplopia, and bulbar weakness (dysarthria,
dysphagia). Symptoms worsen with repetition.
Edrophonium test is positive. Which antibody is most
specific?
A) Anti-MuSK
B) Anti-AChR (acetylcholine receptor)
C) Anti-LRP4
D) Anti-Agrin
Correct answer: B
Rationale: Anti-AChR antibodies are found in 80-90%
of generalized myasthenia gravis. Anti-MuSK is more
common in ocular/bulbar predominant or treatment-
resistant cases.
, 5. A 40-year-old female presents with acute-onset
ascending weakness, areflexia, and
albuminocytologic dissociation (elevated CSF
protein, normal WBC). Which is the most appropriate
first-line treatment?
A) Intravenous immunoglobulin (IVIG)
B) Plasma exchange
C) High-dose corticosteroids
D) Rituximab
Correct answer: A
Rationale: Guillain-Barré syndrome (acute
inflammatory demyelinating polyneuropathy) is
treated with IVIG or plasma exchange (equivalent
efficacy). Corticosteroids are not beneficial.
6. A 35-year-old male presents with progressive
weakness of the hands (thenar wasting) and feet (foot
drop), fasciculations, and hyperreflexia with Babinski
signs. Sensory examination is normal. Which is the
most likely diagnosis?
A) Multifocal motor neuropathy (MMN)
B) Amyotrophic lateral sclerosis (ALS)
C) Spinal muscular atrophy (SMA)
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PHYSICAL MEDICINE &
REHABILITATION (ABPMR) | COMPLETE EXAM
Q&A WITH RATIONALES
1. A 45-year-old male presents with progressive
proximal muscle weakness (difficulty rising from a
chair, climbing stairs) for 6 months. Creatine kinase
(CK) is 2500 U/L. Electromyography (EMG) shows
short-duration, small-amplitude motor unit potentials
with early recruitment. Which is the most likely
diagnosis?
A) Inclusion body myositis (IBM)
B) Polymyositis
C) Duchenne muscular dystrophy
D) Lambert-Eaton myasthenic syndrome (LEMS)
Correct answer: B
Rationale: Progressive proximal weakness with
elevated CK and myopathic EMG (short-duration,
small-amplitude MUAPs, early recruitment) suggests
inflammatory myopathy. Polymyositis has subacute
onset.
,2. A 70-year-old male presents with slowly
progressive weakness of finger flexors (difficulty
gripping) and quadriceps (knee buckling) for 3 years.
CK is 350 U/L. EMG shows myopathic changes with
fibrillation potentials. Which is the most likely
diagnosis?
A) Polymyositis
B) Inclusion body myositis (IBM)
C) Dermatomyositis
D) Limb-girdle muscular dystrophy
Correct answer: B
Rationale: IBM presents with slowly progressive,
asymmetric weakness (finger flexors, quadriceps),
CK normal to mildly elevated, and EMG showing
myopathic changes with fibrillations (irritative
myopathy).
3. A 45-year-old female presents with a heliotrope
rash on the eyelids, Gottron papules over the
knuckles, and proximal muscle weakness. CK is 1800
U/L. Which autoantibody is most specific for this
condition?
A) Anti-Jo-1
B) Anti-Mi-2
,C) Anti-SRP
D) Anti-HMGCR
Correct answer: B
Rationale: Anti-Mi-2 is highly specific for
dermatomyositis (classic rash). Anti-Jo-1 is
associated with antisynthetase syndrome
(mechanic's hands, interstitial lung disease).
4. A 30-year-old female presents with fluctuating
ptosis, diplopia, and bulbar weakness (dysarthria,
dysphagia). Symptoms worsen with repetition.
Edrophonium test is positive. Which antibody is most
specific?
A) Anti-MuSK
B) Anti-AChR (acetylcholine receptor)
C) Anti-LRP4
D) Anti-Agrin
Correct answer: B
Rationale: Anti-AChR antibodies are found in 80-90%
of generalized myasthenia gravis. Anti-MuSK is more
common in ocular/bulbar predominant or treatment-
resistant cases.
, 5. A 40-year-old female presents with acute-onset
ascending weakness, areflexia, and
albuminocytologic dissociation (elevated CSF
protein, normal WBC). Which is the most appropriate
first-line treatment?
A) Intravenous immunoglobulin (IVIG)
B) Plasma exchange
C) High-dose corticosteroids
D) Rituximab
Correct answer: A
Rationale: Guillain-Barré syndrome (acute
inflammatory demyelinating polyneuropathy) is
treated with IVIG or plasma exchange (equivalent
efficacy). Corticosteroids are not beneficial.
6. A 35-year-old male presents with progressive
weakness of the hands (thenar wasting) and feet (foot
drop), fasciculations, and hyperreflexia with Babinski
signs. Sensory examination is normal. Which is the
most likely diagnosis?
A) Multifocal motor neuropathy (MMN)
B) Amyotrophic lateral sclerosis (ALS)
C) Spinal muscular atrophy (SMA)
