Course on the Use of the AMA Guides

Disclaimer: The answers to these questions can be found in the audio recording and in the course handouts and represent the opinion of the speakers. They do not necessarily represent COA’s opinion or policy on the issue.

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* 1. Contact Information

Full Name and Title *

Email Address *

Phone Number

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* 2. Test Date

Date

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* 3. The AMA Guides is a snapshot of an injured worker's condition at the time of the evaluation.

A) True

B) False

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* 4. An impairment is considered permanent when it has reached its maximal medical improvement.

A) True

B) False

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* 5. An impairment evaluation is made up of only an impairment evaluation.

A) True

B) False

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* 6. The whole person's lifetime disability rating may not be more than 100%.

A) True

B) False

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* 7. The AMA Guides is an impairment rating schedule not a disability schedule.

A) True

B) False

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* 8. AMA publishes "The Guides Newsletter" to clarify issues that arise in the AMA Guides

A) True

B) False

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* 9. California's Division of Workers ' Compensation has adopted a new form, the PR-4 form, for treating physicians to complete when performing disability evaluations.

A) True

B) False

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* 10. When rating the Fibromyalgia syndrome for impairment:

A. Chapter 13, the Central and Peripheral Nervous System cannot be used as sections 13 .5-13.9 clearly do not apply

B. Chapter 14, Mental and Behavioral Disorders cannot be used, as the Fibromyalgia syndrome is not a DSM-Ill or DSM-IV recognized mental disorder.

C. Chapter 15, The Spine cannot be used as the Fibromyalgia syndrome is not either a spinal injury or a spinal disease.

D. Chapter 18, Pain, cannot be used, as section 18.3b says not to use this chapter for "ambiguous or controversial pain syndromes", and page 569 indicates that fibromyalgia is controversial.

E. All of the above are correct, and the Guides rating for fibromyalgia is zero percent.

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* 11. Which of the following is true about rating impairment for knee meniscal tears:

A. The medial meniscus has higher ratings than does the lateral meniscus.

B. Partial meniscectomy is rated with the same impairment percentage as total meniscectomy .

C. Ratings for meniscectomy can NOT be combined with ratings for ligamentous instability. One or the other may be rated, but not both.

D. The 5th edition contains no guidance for rating meniscal repair or meniscal replacement (transplant). The Guides Newsletter does provide guidance to help physicians consistently rate the impairment after these procedures.

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* 12. When rating arthrodesis of a lower extremity joint using the AMA Guides, 5th Edition:

A. As in the upper extremity chapter, impairment is rated from the joint specific figure or "pie chart" in the range of motion section.

B. The impairment for arthrodesis is combined with the impairment for range of motion of the involved joint.

C. The basic impairment for joint arthrodesis is stated in the text, and the tables are consulted for additional impairment if the joint arthrodesis is in less than optimal position.

D. Arthrodesis is rated only if occurs spontaneously due to injury or disease. Surgical created arthrodesis (joint fusion) is not ratable.

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* 13. The lower extremity gait derangement section and table:

A. Is the preferred method to rate most complex lower extremity impairments.

B. Is used rarely, and if used, the examiner must state why the case is so unusual that this rating method
is being used.

C. ls used by combining the gait impairment with the range of motion impairments for all joints in the lower extremity that have limited motion.

D. Is used when the examiner can not explain exactly why the examinee has a limp.

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* 14. Osteomyelitis with persisting drainage of pus:

A. Is rated by the Skin loss table.

B. Is rated by rating the angular deformity in the tibia or femur created by the infection.

C. Is rated by rating the infectious disease chapter in the AMA Guides, 5"' Edition.

D. Is not ratable by the AMA Guides, 5'" Edition.

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* 15. Of sensory testing and motor testing, motor testing is the most sensitive test for carpal tunnel.

A) True

B) False

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* 16. A positive nerve conduction test result means that the injured worker is entitled to a severe disability.

A) True

B) False

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* 17. Reflex Sympathetic Dystrophy (RSD) is now referred to as Complex Regional Pain Syndrome (CRPS).

True

False

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* 18. The preferred method of evaluating spinal impairment, according to the AMA Guides 5th Edition is:

A. The DRE model

B. The range of motion model

C. The range of motion model

D. All of the above

E. None of the above

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* 19. When computing impairment for spinal injuries in patients with chronic pain, the maximum amount of impairment that can be given for chronic pain is:

A. 1% whole person impairment

b. 2% whole person impairment

C. 3% whole person impairment

D. 4% whole person impairment

E. 5% whole person impairment

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* 20. The following statements are true regarding spinal impairment in the AMA Guides 5th Edition:

A. The 5th Edition rates the impairment at maximum medical improvement.

B. There is a 2% range differential in the DRE classifications for spinal impairment.

C. The 5th Edition includes arthrodesis in the definition of loss of structural integrity - fusion is now considered.

D. A and C are true

E. All of the above are true

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* 21. DRE Category IV has a range of impairment of:

A. 0% - 5% whole person impairment.

B. 5% - 8% whole person impairment.

C. 10% - 13% whole person impairment.

D. 20% - 23% whole person impairment.

E. 25% to 28% whole person impairment.

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* 22. The Range of Motion model of impairment is based on which of the following parameters:

A. Diagnosis

B.Range of motion

C. Upper or lower extremity pain/sensory loss

D. Upper or lower extremity motor loss.

E. All of the above are true

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* 23. Although the DRE method is the preferred method for determining spinal impairments, the Range of Motion method is indicated if:

A. There is rheumatoid arthritis with no injury

B. There is multilevel involvement, either by fracture or by disc herniation.

C. There is recurrent radiculopathy caused by a new or by a recurrent disc herniation, or recurrent injury

D. If apportionment is requested and the first injury/disease rating was performed using the range of motion model.

E. All of the above are true.

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* 24. If the patient is at maximum medical improvement, with persistent herniated LS-SI disc requiring discectomy and fusion, the DRE Category would be:

A. DRE Category I

B. DRE Category II

C. DRE Category III

D. DRE Category IV

E. DRE Category V

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* 25. If the patient is at maximum medical improvement and has had a lumbar laminectomy and discectomy, superimposed on documented bladder dysfunction with urodynamic testing, the rating would be consistent with:

A. Combining DRE Category III with either the loss of bladder function from the neurology chapter, or table 15-6 page 396.-7.

B Adding DRE Category Ill with either the loss of bladder function from the neurology chapter, or table 15-6, page 396-7

C. Both of the above are true

D. None of the above are true

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* 26. Corticospinal tract impairment is used in which of the following areas?

A. Station and gait

B. Bladder

C. Anorectal

D. Respiration loss

E. All of the above

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* 27. If a patient has minor findings at the time of the examination and determination of maximum medical improvement following a lumbar spine injury, the appropriate rating would be:

A. Category I - 0% whole person impairment

B. Category 11-5% - 8% whole person impairment

C. Category III - 10% - 13% whole person impairment

D. Category IV - 20% - 23% whole person impairment

E. Category V - 25% - 28% whole person impairment

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* 28. If a patient had a history of lumbar radiculopathy which was resolved without surgery at the time of maximum medical improvement, the appropriate DRE classification would be:

A. Category I - 0% whole person impairment

B. Category Il-5% - 8%whole person impairment

C. Category III- 10%- 13% whole person impairment

D. Category IV - 20% - 23% whole person impairment

E. Category V - 25% - 28% whole person impairment

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* 29. If a cervical or thoracic radiculopathy is at maximum medical improvement with persistent radiculopathy, the correct impairment is Category III - 10% - 13% whole person impairment?

True

False

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* 30. A 25% - 50% compression of the Ll vertebral body when at maximum medical improvement, would be rated at:

A. Category I - 0% whole person impairment

B. Category Il-5% - 8% whole person impairment

C. Category III- 10%- 13% whole person impairment

D. Category IV - 20% - 23% whole person impairment

E. Category V - 25% - 28% whole person impairment

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* 31. Lower extremity impairments are valued at 40% of the whole person.

True

False

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* 32. An injured worker's motivation and amount of pain they are experiencing does not affect range of motion testing.

True

False

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* 33. Range of motion findings must have an "organic basis."

True

False

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* 34. Results can be valid even if two observers have inconsistencies in their range of motion findings.

True

False

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* 35. Injured workers that have range of motion restrictions in multiple directions does result in an increased impairment rating.

True

False

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* 36. Fractures in and about joints with degenerative changes should be rated either by using diagnosis based estimates and combining rating with that for arthritis, or by using the loss of range-of-motion method.

True

False