SAE Prep

[myrandom2003]

so anyone have any ideas on how to better prepare? Need to do better than last year I know the SAE's are for our own benefit in evaluating our progress compared to our peers, but apparently some programs use it for more than just that, mine happens to be one of them... how they use it? i dont know yet, but i dont want to find out, just heard that for past residents, if they didnt do well or improve, PD wouldnt sign the form allowing them to take the written boards... only heard of this happening like 4 years ago... plus i want to learn and stuff too

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[rehab_sports_dr]

The best resources, in rank order:

1. Old SAE exams (should be available on the AAPMR website). Some programs have a test file for these (which are not banned- old board exams are)

2. The SAEs that are included in the red journal.

3. Cuccorullo

They are worth studying for. They do help a lot when you are studying for boards. I also saw two odd patients this week that I only knew how to treat because of obscure questions that I studied for the SAE.

 

[LTS6776]

I would definitely agree with reviewing the old SAE exams - questions and topics tend to repeat. Might also be worthwhile to review some industrial rehab and occupational medicine- type material; those were the questions that took everyone by surprise last year.

 

[myrandom2003]

thanks... by red journal are you referring to the archives of pmr?

 

[Ludicolo]

thanks... by red journal are you referring to the archives of pmr?

Yes

Red journal = Archives of PM&R. Formerly the journal of both the AAPMR and ACRM. Now will just be the journal of the American Congress of Rehabilitation Medicine.

Blue journal = American Journal of PM&R. Journal of the Association of Academic Physiatrists.

Purple journal = PM&R. New journal of the AAPMR, which will carry the SAE/study guide from now on.

 

[Nico47]

Great thread. Thanks so much.

 

[Hemisphere]

Hi anybody reviewing for SAE's come across question #148 from 2003??

They are saying its likely a radic/root avulsion because the median SNAP is normal Answer A, but I chose answer D since only 5 days after injury, Wallerian degeneration of sensory nerves would not yet have occurred so there could still be a more proximal median sensory injury (distal to the DRG) and wouldn't start showing up until day 7-11.

Hmm, I am convinced I am right and the question writer is wrong... Any thoughts?

 

[topwise]

I agree with you, Hemisphere.... at least, I think that the injury could be distal to the dorsal root ganglia. The fact that the delt and biceps are involved speak against a median nerve injury, but why can't it be early upper trunk, prior to WD? Yes, the median motor amp is slightly lower on the right than on the left, but not by much.

 

[Ludicolo]

I got a chance to look over the question – you guys are thinking along the right lines. Distal motor axons remain excitable for up to 7 days post-injury, distal sensory axons up to 11 days. So SNAPs could be normal in a post-DRG lesion 5 days post-injury. Given the EMG findings (biceps, delt, PT), this best localizes to upper trunk or C6 radic.

 

[Hemisphere]

another questionable question?
#185 from 2004
"Which statement is true regarding the vascular supply to the spinal cord"
A. Paired anterior spinal arteries... (obviously false)
B. Posterior spinal artery is a single vessel... (obviously false)
C. The watershed region is supplied only via the radicular arteries.
D. The artery of Adamkiewicz provides circulation to the lumbosacral region.

Author's answer C -
and explanation: there is a watershed zone from T4-6 vulnerable to ischemia, the artery of Adamkiewicz enters between about T9 and T10.

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Hemisphere's counterpoint: The question asks the spinal cord supply, but the radicular arteries proper do not supply the spinal cord, they supply the spinal nerve roots and terminate before anastamosing with the spinal arteries. Source: Frank Netter see plate 157 and 158 and his commentary at the bottom of the pages. Only the segmental medullary arteries go on to anastomose with the anterior spinal artery and thereby supplying the spinal cord proper. Additionally, while Adamkiewicz can enter between T9-10, it can actually enter anywhere from T5-L5 (source: spine secrets) and according to Hollingshead textbook of anatomy most commonly enters at L1. It's blood supply does eventually anastamose with the anterior spinal artery and go on to supply the lumbosacral enlargement of the spinal cord.

----------------------------------------

Hemisphere's conclusion: Is there a peer review process for questions submitted for inclusion on the SAE exams? We are using this exam as a yearly in-service nationwide for PM&R residents. Certain program directors take the scores seriously and use it as a marker of resident progress in the core competency of knowledge base. We need to set the bar higher for the questions and answer explanations included on this exam, both for training and evaluation purposes.

 

[nleeds24]

another questionable question?
#185 from 2004
"Which statement is true regarding the vascular supply to the spinal cord"
A. Paired anterior spinal arteries... (obviously false)
B. Posterior spinal artery is a single vessel... (obviously false)
C. The watershed region is supplied only via the radicular arteries.
D. The artery of Adamkiewicz provides circulation to the lumbosacral region.

Author's answer C -
and explanation: there is a watershed zone from T4-6 vulnerable to ischemia, the artery of Adamkiewicz enters between about T9 and T10.

---------------------------------------

Hemisphere's counterpoint: The question asks the spinal cord supply, but the radicular arteries proper do not supply the spinal cord, they supply the spinal nerve roots and terminate before anastamosing with the spinal arteries. Source: Frank Netter see plate 157 and 158 and his commentary at the bottom of the pages. Only the segmental medullary arteries go on to anastomose with the anterior spinal artery and thereby supplying the spinal cord proper. Additionally, while Adamkiewicz can enter between T9-10, it can actually enter anywhere from T5-L5 (source: spine secrets) and according to Hollingshead textbook of anatomy most commonly enters at L1. It's blood supply does eventually anastamose with the anterior spinal artery and go on to supply the lumbosacral enlargement of the spinal cord.

----------------------------------------

My Netter is from 1997. Both it and Slipman's Interventional Spine-2008- list distal proximal arteries supplying nerve roots turning into proximal radicular arteries feeding into ant & post spinal arteries. However I looked on Grant's Atlas 2009 via the web and it diagrams radicular arteries supplying the nerve roots which then turn into segmental medullary arteries which run along rootlets before anastomosing with ant & post spinal arteries: Backing up what you wrote.

I would think Grant's Atlas trumps Slipman's book. Perhaps the question was written a while back before there was consensus on what to call those arteries.

 

[Hemisphere]

thanks for all your responses guys...

I found another doozy...
what do you think about this questions, moving into the realm of SCI...

From 2009 exam, #125. A 48-year-old is admitted to your rehabilitation facility 3 weeks after sustaining a spinal cord injury. The motor and sensory examination is as follows:

R Motor L Motor
Deltoid 5 5
Biceps 5 5
Wrist extensor 5 3
Triceps 3 1
Finger flexors 1 1
Intrinsics 1 1
Hip flexors 0 0
Knee extensors 0 0
Dorsiflexors 0 0
Plantarflexors 0 0

Sensory exam revealed intact pinprick and light touch sensation through C7. Sensation is absent below C7 except for intact perianal sensation.

What is the patient's ASIA score?

(a) C7 ASIA B
(b) C6 ASIA B
(c) C6 ASIA C
(d) C7 ASIA C Please select a response.

The correct response is (a) C7 ASIA B.
Based on the ASIA classification system this patient would be classified as C7, given the normal sensation in that myotome and a muscle grade of 3/5 at C7with the level above being 5/5. The trace activity in finger flexors and intrinsics are within 3 segments of the level of injury and cannot be used to suggest the patient is motor incomplete (ASIA C). The patient is classified as ASIA B because of the retained sacral sensation.

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Ok did anybody else have a problem with this answer and explanation??
From my readings on SCI, the neurological level is the lowest level where both sensory AND motor are intact on BOTH sides. They have given the left
tricep (C7) a motor score of "1" how can they score this as a neurological level of C7 when the lowest level intact motor and sensory on both sides is clearly C6? I was going by the classification method listed below. Please let me know if you think this SAE question needs revision.

STEPS IN CLASSIFICATION
The following order is recommended in determining the classification
of individuals with SCI.
1. Determine sensory levels for right and left sides.
2. Determine motor levels for right and left sides.
3. Determine the single neurological level. This is the lowest segment where motor and sensory function is normal on both sides, and is the most cephalad of the sensory and motor levels determined in steps 1 and 2.

 

[Hemisphere]

Hey guys, guess what... found another doozy from 2009 SAE check it out...
128. Which electrodiagnostic finding is most consistent with neurogenic thoracic outlet syndrome?
(a) Small median motor response from the thenar muscles
(b) Abnormal response of the lateral antebrachial cutaneous nerve
(c) Abnormal median sensory responses
(d) Abnormal spontaneous activity in the pronator teres muscle Please select a response.

Author's explanation: The correct response is (b) Abnormal response of the lateral antebrachial cutaneous nerve.
Neurogenic thoracic outlet syndrome involves the lower trunk of the brachial plexus; hence, sensory and motor loss develops in the C8–T1 distribution. Thumb abduction is often affected. Sensory changes are usually in the distribution of the ulnar and medial antebrachial cutaneous nerves.

Ref: Preston DC, Shapiro BE. Brachial plexopathy. In: Preston DC, Shapiro BE, editors. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. Boston: Butterworth-Heinemann; 1998. p 438.


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Hemisphere's comment:
?Lateral antebrachial cutaneous nerve, comes from musculocutaneous nerve, C5-C6. I think the explanation is correct, but not their answer choice. Maybe choice B was supposed to say "medial antebrachial cutaneous nerve??" Comments?

 

[PM&R gal]

I agree.. I think the answer should be Medial Antibrachial Cutaneous Nerve. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus.. which would be the MAC nerve, not the LAC nerve...

 

[topwise]

I agree with both your corrected answers.

 

[latinman]

Hemisphere, regarding the last question... The answer should be A. TOS can give you low APB motor amplitude. (APB Motor and MABC sensory are the best studies). TOS generally involves T1 Fibers >>> than C8 fibers.. You could also stick a needle in his APB.

Trust me on this one... I did a presentation on TOS...


Regarding the ASIA Q, I think you got to pull up the SAE test again. I think you misread the question. His TRICEPS is 3 out of 5 symmetrically (both sides). Not the way you have placed it above. Go read the question again.

 

[Ludicolo]

Good luck on the SAEs tomorrow guys.

 

[Hemisphere]

hey nice response on the TOS question... would be nice to see your presentation... about the SCI question 2009 #125, I went back to the PDF file (paper version) and you are correct it is 3's for b/l triceps. However, if you look at the online version of the 2009 test, as you can take it on the aapmr website, I think they typed it wrong and listed 1 for the tricep by mistake, ps I just copied and pasted the answer/explanation from the online version... Anyways, Good luck all!

Hemisphere, regarding the last question... The answer should be A. TOS can give you low APB motor amplitude. (APB Motor and MABC sensory are the best studies). TOS generally involves T1 Fibers >>> than C8 fibers.. You could also stick a needle in his APB.

Trust me on this one... I did a presentation on TOS...


Regarding the ASIA Q, I think you got to pull up the SAE test again. I think you misread the question. His TRICEPS is 3 out of 5 symmetrically (both sides). Not the way you have placed it above. Go read the question again.

 

[WaterAvatar]

So SAE question for you all. How important are these SAE score when applying for fellowship. Lets say Sport/Spine or Pain fellowships. Do they ask for your scores? (I'm assuming yes). Do they only look at your PGY-3 SAE scores? ... basically I'll be a PGY-2 soon, should I bust my butt studying for it or just wait for PGY-3 year.

 

[Painabalater]

hey guys what did u think of the sae?
only 150 ?.. harder to do better
hard hit on sci and tbi
otherwise easier than last year?
anyothers thought it was easier??

 

[myrandom2003]

yeah i was surprised by the reduced number of questions. I felt that they had quite a number more EMG questions than before, but then again i could be mistaken. Agree with the tbi and sci questions having more representation, and other random questions like the parenteral feeding one.

 

[DistantMets]

My favorite was the magnetic knee wrap question. With fewer questions that really made the cut?

 

[Redmen27]

I was surprised by the reduced number of question as well. Overall, thought it was fair though. In previous years I thought there was too much statistics, research, ethics, HIPPA, CARF, etc type questions. Nice to see them decrease those.

 

[asus177]

Can someone let me know where to find old SAE? In the AAPM&R online learning portal I just see SAE-P and one old SAE with 50 questions from 2019.