Reflex — PM&R Board Review

Rehabilitation Team, Settings, and Care Coordination. Topics: Team Models, Levels of Care, Life Care Planning, Handoffs, and Compliance Laws. Part of the Administration & Practice series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/ADMIN-04. On YouTube, every Administration & Practice episode in order: https://www.youtube.com/playlist?list=PLT_MXBHikBY8. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Episode Setup
3:02 Team models: inter, multi, trans
8:30 Physiatrist leadership and core disciplines
14:13 Rehab continuum and IRF criteria
18:52 SNF qualifying stay and Part A benefit
24:43 LTCH, home health, and outpatient therapy
28:59 Life care planning
32:25 Palliative care versus hospice
34:50 Double effect and withholding versus withdrawing
37:10 Pain ladder, dyspnea, and terminal secretions
40:53 Nausea and terminal delirium
43:48 Handoffs: I-PASS and SBAR
45:58 Transitions of care and health literacy
48:49 Compliance Laws: Stark, Anti-Kickback, False Claims, EMTALA
53:57 5 Things to Know Cold

Practice Management and Quality. Topics: HIPAA, Bioethics, PDSA, Patient Safety, Malpractice, and MIPS. Part of the Administration & Practice series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/ADMIN-03. On YouTube, every Administration & Practice episode in order: https://www.youtube.com/playlist?list=PLT_MXBHikBY8. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Opening case: tenfold morphine overdose
2:24 Episode Setup
4:17 HIPAA covered entities and PHI
7:26 HIPAA, PHI, and Permitted Disclosures
13:45 De-identification: safe harbor and expert determination
18:04 Security rule and breach notification
21:41 Four pillars of bioethics
25:02 Research ethics, Belmont, and the IRB
29:02 PDSA cycle and Donabedian measures
32:01 Levels of evidence and guideline appraisal
34:56 Value-based payment, IRF QRP, and MIPS
38:23 E/M documentation and telehealth
40:56 Sentinel events, SREs, and near misses
45:56 RCA, FMEA, and Just Culture
50:08 Swiss cheese model and error types
53:42 Malpractice and Risk Management
57:48 Risk management pillars
1:00:08 5 Things to Know Cold

Disability, Impairment, and Medicolegal Topics. Topics: ICF, AMA Guides 6th Edition, SSA, Workers' Comp, Capacity, and Daubert. Part of the Administration & Practice series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/ADMIN-02. On YouTube, every Administration & Practice episode in order: https://www.youtube.com/playlist?list=PLT_MXBHikBY8. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Opening Vignette: Pianist vs Professor
2:29 Impairment vs Disability and the ICF Framework
9:24 AMA Guides 6th Edition - Diagnosis-Based Impairment
13:30 Combined Values Formula and Apportionment
18:21 SSA Five-Step Sequence, SSDI and SSI
26:32 Workers' Comp, IME, and FCE
31:20 ADA and Section 504
35:45 FMLA Coverage and Eligibility
37:37 Informed Consent and Decision-Making Capacity
43:21 Advance Directives, POLST, DNR, Surrogates
46:56 Mandatory Reporting and Impaired Driving
48:36 Daubert vs Frye
51:53 End-of-Life: Hospice, Double Effect, Withdrawal
54:22 5 Things to Know Cold

CPT Coding, Billing, and Documentation. Topics: E/M Codes, Modifiers, the 8-Minute Rule, and IRF Requirements. Part of the Administration & Practice series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/ADMIN-01. On YouTube, every Administration & Practice episode in order: https://www.youtube.com/playlist?list=PLT_MXBHikBY8. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Episode Setup
2:41 The three code sets on a claim
4:36 Code Families and the E/M Hierarchy
12:43 The 2021 E/M revision: MDM or time
14:39 MDM elements and the two-of-three rule
18:56 Time pathway and prolonged services
22:44 Board trap: long note, low E/M level
24:28 Procedure coding by anatomy or count
29:09 Modifiers
33:35 Therapy units and the 8-minute rule
39:14 IRF 60% rule and the 13 conditions
48:14 IRF physician oversight and timelines
50:46 IRF-PAI, FIM, and Section GG
54:46 ICD-10 specificity
56:36 Other post-acute settings and the therapy cap
1:00:13 Documentation and compliance law
1:03:56 5 Things to Know Cold

Hereditary Spastic Paraplegia. Part of the Neurologic Conditions series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/NEURO-06. On YouTube, every Neurologic Conditions episode in order: https://www.youtube.com/playlist?list=PLJkObVZ0lTuI. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Setup
3:25 The Dying-Back Axonopathy
6:22 Pure vs Complicated HSP
9:37 The Big Four SPG Genes and the Genetic Landscape
14:48 Clinical Presentation and Gait Mechanics
17:05 Diagnostic Workup and Treatable Mimics
21:46 Rehabilitation Management of HSP
28:32 Spinocerebellar Ataxias as Lookalikes
30:46 HSP in the Landscape of Neurodegeneration: Series Synthesis
33:39 5 Things to Know Cold

Functional Neurologic Disorder. Part of the Neurologic Conditions series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/NEURO-05. On YouTube, every Neurologic Conditions episode in order: https://www.youtube.com/playlist?list=PLJkObVZ0lTuI. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Setup
2:34 The Rule-IN Diagnosis: DSM-5 and the Paradigm Shift
7:45 Positive Motor Signs: Hoover, Drift Without Pronation, Give-Way
11:07 Functional Tremor and Sensory Signs
14:29 Functional Seizures
16:44 Functional Gait and Dystonia
18:53 Epidemiology and Related Diagnoses
21:35 Treatment and Rehabilitation
24:56 5 Things to Know Cold

GBS, CIDP, Post-Polio Syndrome, and Neuromuscular Junction Disorders. Part of the Neurologic Conditions series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/NEURO-04. On YouTube, every Neurologic Conditions episode in order: https://www.youtube.com/playlist?list=PLJkObVZ0lTuI. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Setup
3:04 GBS Definition and Clinical Course
6:01 GBS Molecular Mimicry and Subtypes
10:29 GBS Early Electrodiagnostic Rules
12:41 GBS Antecedent Triggers and CSF
14:12 GBS Respiratory Monitoring and Dysautonomia
16:41 GBS Treatment and Prognosis
19:26 CIDP and Its Variants
23:23 Myasthenia Gravis
29:34 Lambert-Eaton Myasthenic Syndrome
32:28 Botulism and Organophosphate Poisoning
34:22 Post-Polio Syndrome
37:52 5 Things to Know Cold

Parkinson Disease and Movement Disorders. Part of the Neurologic Conditions series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/NEURO-03. On YouTube, every Neurologic Conditions episode in order: https://www.youtube.com/playlist?list=PLJkObVZ0lTuI. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Setup
2:48 Pathophysiology: Dopamine Loss and Basal Ganglia Circuits
6:30 TRAP Cardinal Features, Staging, and Diagnosis
12:42 Pharmacotherapy: Levodopa, Agonists, and Adjuncts
20:32 Deep Brain Stimulation
22:47 Rehabilitation and Dysphagia
27:00 Parkinson-Plus Syndromes and the Differential
33:30 Huntington Disease
35:11 Dystonia
36:41 Restless Legs Syndrome
40:00 Drug-Induced Parkinsonism, Tardive Dyskinesia, Tics, Myoclonus
41:35 5 Things to Know Cold

ALS and Motor Neuron Disease. Part of the Neurologic Conditions series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/NEURO-02. On YouTube, every Neurologic Conditions episode in order: https://www.youtube.com/playlist?list=PLJkObVZ0lTuI. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Split Hand Sign Vignette
3:29 The Diagnostic Hallmark and Selective Vulnerability
8:12 Motor Neuron Disease Variants and Epidemiology
10:39 Pathophysiology and the Four ALS Genes
15:10 Onset Patterns and Prognosis
16:52 Pseudobulbar Affect and FTD Overlap
18:52 ALSFRS-R, Survival, and Prognostic Factors
22:09 El Escorial, Awaji, and Electrodiagnosis
28:25 ALS Mimics and the Differential
30:33 Disease-Modifying Drugs
33:15 Symptom Management
37:10 Respiratory Monitoring and Ventilation
42:22 Anticipatory Prescription and Equipment Cascade
47:01 5 Things to Know Cold

Multiple Sclerosis. Part of the Neurologic Conditions series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/NEURO-01. On YouTube, every Neurologic Conditions episode in order: https://www.youtube.com/playlist?list=PLJkObVZ0lTuI. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Opening Case Vignette
2:27 Clinical Pearl - The CNS-PNS divide
5:52 MS Risk Factors: Environment, Genes, EBV
9:09 Immunopathogenesis and Plaque Pathology
15:57 Board Trap - RRMS vs PPMS demographics
17:30 McDonald Criteria, CSF, and Cord Lesions
19:45 High Yield - McDonald + classic signs
23:56 Fatigue, Spasticity, and Bladder Management
26:51 EDSS Disability Scale
28:21 Cognition, Mood, Pain, Sexual Dysfunction
31:52 Disease-Modifying Therapies and Landmark Trials
37:20 NMOSD and MOG-AD
40:43 5 Things to Know Cold

Spinal Cord, Cranial Nerve, and Peripheral Neuroanatomy. Topics: Reflex Arcs, ISNCSCI Key Muscles, Dermatomes, Cranial Nerves, Plexus Anatomy, and the Autonomic Nervous System. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-11. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
1:54 Reflex Root Levels and Peripheral Nerves
6:09 ISNCSCI Key Muscles and Motor Level
8:43 Sensory Dermatomes - Key Points and Board Landmarks
12:25 Cranial Nerves - Functions, Clinical Correlations, and Board Traps
19:50 Brachial Plexus
22:48 Lumbosacral Plexus
24:47 Autonomic Nervous System and Horner Syndrome
27:16 Spinal Cord Long Tracts
30:50 5 Things to Know Cold

Neuromuscular Junction Physiology. Topics: ACh Synthesis, Quantal Release, and the Safety Factor. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-10-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Episode Setup
2:55 NMJ Anatomy: Three Zones and Junctional Folds
5:15 Acetylcholine Synthesis, Quantal Packaging, and Calcium-Triggered Release
12:31 The Postsynaptic Receptor - Adult vs Fetal nAChR and the Succinylcholine Trap
16:30 The Nicotinic Receptor, the End-Plate Potential, and the Safety Factor
20:32 Case Vignette: Ptosis and the Ice Pack Test
22:26 Vesicle Pools, Repetitive Stimulation, and Single-Fiber Jitter
29:20 Myasthenia Gravis
32:08 Lambert-Eaton Myasthenic Syndrome
33:43 Botulism
36:03 Congenital Myasthenic Syndromes
37:39 The Succinylcholine Trap, Neuromuscular Blockers, and Reversal
43:44 Therapeutic Botulinum Toxin
46:28 5 Things to Know Cold

The Creatinine That Lies. Topics: Renal and Pharmacokinetic Aging, Cognitive and Sensory Decline, and the Geriatric Syndromes. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-09-b. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
1:14 Episode Setup
2:57 Treating the Osteoporotic Skeleton
12:59 Drug Holidays and Denosumab Rebound
16:10 The Aging Lung and Age-Adjusted Oxygenation
22:22 Age-Adjusted Blood Gas and Oxygen
26:37 Pharmacokinetic Aging Beyond the Kidney
34:45 Polypharmacy and Deprescribing Tools
39:01 Falls and Five Failing Balance Inputs
43:19 Fall Risk Assessment Tools
47:06 Multifactorial Fall Prevention
51:18 Frailty and the Fried Phenotype
54:11 Delirium and the CAM
57:14 5 Things to Know Cold

Musculoskeletal and Cardiopulmonary Aging. Topics: Sarcopenia, Osteoporosis Treatment, Isolated Systolic Hypertension, and the Age-Adjusted Blood Gas. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-09-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Episode Setup
3:37 Sarcopenia
9:43 Age-Related and Postmenopausal Bone Loss
13:49 Osteoporosis Diagnosis and Treatment Thresholds
16:46 Cardiac Aging and Heart Rate Reserve
19:19 Arterial Stiffness and Isolated Systolic Hypertension
21:09 Baroreflex and Orthostatic Hypotension
24:32 Exercise Prescription and VO2 Max Decline
26:45 Renal Aging, Creatinine Trap, and Drug Dosing
31:50 Brain Aging vs Alzheimer Disease
35:14 Peripheral Sensory, Vision, and Hearing Aging
39:15 5 Things to Know Cold

CNS Recovery and Neuroplasticity. Topics: Hebbian Learning, Cortical Reorganization, and Constraint-Induced Movement Therapy. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-08-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
1:13 Interhemispheric Paradox Hook
3:43 Opening Case Vignette
5:50 Hebbian Learning, LTP / LTD, and Cellular Plasticity Mechanisms
12:48 The Rehabilitation Dose Gap
15:11 Three Patterns of Cortical Reorganization
18:18 Diaschisis
19:59 Recovery Phases, Critical Period, and Proportional Recovery
23:50 Learned Non-Use
25:41 Kleim and Jones - Ten Principles of Experience-Dependent Plasticity
28:20 CIMT Pillars and the EXCITE Trial
30:19 EXCITE Eligibility Tiers and Modified CIMT
32:42 Treadmill Training, Robotics, FES, and Virtual Reality
37:53 Recovery Enhancer Drugs and SSRIs
40:17 Drugs That Impair Plasticity
42:29 Motor Learning and Practice Structure
46:42 Mirror Therapy and Phantom Limb Pain
50:31 Spasticity and Brunnstrom Stages
52:17 5 Things to Know Cold
55:23 Vignette Answer

Peripheral Nerve Recovery. Topics: Seddon/Sunderland, Wallerian Degeneration, and Regeneration. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-07-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Episode Setup
3:40 The Nerve as a Layered Cable
6:28 Seddon and Sunderland Classification
11:55 The Wallerian Degeneration Timeline
18:45 Regeneration, the Tinel Sign, and Reading the Needle Exam
22:52 End Plate Viability and Denervation Supersensitivity
24:40 Surgical Reconstruction: Repair, Grafts, Transfers, and Conduits
29:39 Canonical Nerve Injury Syndromes
34:37 Modulators of Recovery
36:18 Five-Part Rehabilitation Strategy
38:50 5 Things to Know Cold
40:58 Vignette Answer

Pharmacology Cross-Cutting. Topics: Opioid Equianalgesic Math, Neuropathic Pain Agents, and NSAIDs. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-06-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
1:22 Episode Setup
3:15 Opioid receptors: mu, kappa, delta
7:49 Equianalgesic anchor and the rotation rule
12:16 Tolerance loss, MME, and naloxone
15:08 Methadone ratio and half-life trap
19:20 Tramadol and morphine metabolite traps
21:35 Neuropathic pain: gabapentinoids, TCAs, SNRIs, topicals
26:15 Cyclooxygenase logic: NSAIDs, aspirin, acetaminophen
31:40 Anticoagulants, the Reversal Matches, and VTE Prophylaxis
37:38 TBI neuropsychiatric pharmacology
40:21 Injection steroids and local anesthetics
43:40 Bone health agents
46:58 Spasticity agents and neurolysis
50:48 Vignette Answer
53:29 5 Things to Know Cold

Biostatistics and Research Design. Topics: Measurement Scales, 2x2 Tables, Study Hierarchy, and Bias. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-05-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Cold Open Vignette: Lead-Time Survival and NNT
2:18 Measurement Scales, Central Tendency, and the Normal Distribution
12:24 The 2x2 Table - Sensitivity, Specificity, Predictive Values, and Likelihood Ratios
23:37 Study Design Hierarchy and Measures of Association
29:15 Bias Catalog and Confounding
33:34 Errors, Power, P-Values, Confidence Intervals, and NNT
35:41 Statistical Test Selection, Reliability and Validity, and the Bioethics Endgame
40:20 5 Things to Know Cold

Exercise Physiology. Topics: Energy Systems, VO2max, Fick, METs, Karvonen, FITT, and Training Adaptations. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-04-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Opening Vignette: Denervated Transplant Heart
3:43 Energy Systems and the Bioenergetic Continuum
9:30 VO2max, the Fick Equation, and Unit Conversion
16:38 METs and Rate-Pressure Product
18:54 Karvonen Formula and Borg RPE
23:56 FITT Principle and ACSM Targets
25:53 Hemodynamics: Aerobic vs Resistance Exercise
29:00 Board Trap: Systolic blood pressure drop with rising workload
31:21 Aerobic and Anaerobic Thresholds
34:03 Training Adaptations, Detraining, and Overtraining
38:18 Special Populations
42:45 Vignette Answer
44:29 5 Things to Know Cold

Normal Gait Analysis. Topics: The Gait Cycle, Rancho Los Amigos Phases, Muscle Choreography, and Three Rockers. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-03-a. On YouTube, every Foundational Sciences episode in order: https://www.youtube.com/playlist?list=PLAl2oRLyPSRE. Educational only, not medical advice. AI-narrated from the Reflex chapter.

Chapters:
0:00 Intro
0:31 Episode Setup
3:37 The Gait Cycle and the Eight Rancho Los Amigos Subphases
12:41 Muscle Choreography - Concentric Accelerators and Eccentric Brakes
18:15 The Three Rockers of Stance Phase
20:28 Board Trap - Which rockers does foot drop lose?
23:44 Ground Reaction Force and External Moments
27:51 Gait Parameters - The Numbers You Must Know
31:13 Saunders Six Determinants of Gait
34:16 Pathological Gait Patterns
39:29 Energy Cost of Walking and Amputation Level
41:59 Vignette Answer
45:45 5 Things to Know Cold