Practice board questions OT Hand and Upper Extremity

An occupational therapist conducts a manual muscle test. When the biceps are tested, they are *weak* and the client reports *pain.* The occupational therapist documents these facts and interprets them as an indication of: A. A complete tendon rupture B. Tendonitis C. A partial tendon tear D. Adhesive capsulitis

C. A partial tendon tear A massive tear would be weak and painless Strong and painful would be tendonitis

34. A patient who has been hospitalized due to an acute flare up of RA is referred to OT. When reviewing joint protection techniques the OTR should instruct patient to: A. Cut food using a power grip B. Twist off jar lids with Left hand C. Carry shopping bags with forearms D. Use lateral pinch to manipulate small objects

C. Carry shopping bags with forearms Going along w/ #4 on this quizlet Open w/ right hand and close w/ left hand is something that is taught for RA pts...think about radial deviation and ulnar deviation. This method is to ensure pt turns toward radial side, not encouraging ulnar drift....this answer choice is not written that way

33. An effective OT home program for individuals with CRPS would include: A. Vigorous PROM exercises B. Avoiding AROM C. Edema control D. Extended rest periods

C. Edema control

An individual with rheumatoid arthritis has developed several boutonniere deformities. The OTR documents that the individual's presenting signs are: A. Hyperextension of the PIP joint and flexion of the DIP joint B. Ulnar deviation and subluxation of the MCP joints C. Flexion of the PIP joint and hyperextension of the DIP joint D. Herberden's nodes at the DIP joints and Bouchard's nodes at the PIP joints

C. Flexion of the PIP joint and hyperextension of the DIP joint

An OT home program for individuals with reflex sympathetic dystrophy (RSD) will MOST LIKELY include: A. Instructions for performing vigorous PROM exercises. B. Recommendations for avoiding active ROM. C. Instruction in edema control techniques. D. Recommendations for extended rest periods.

C. Instruction in edema control techniques. Stress loading protocol is more for weight bearing and AROM so A is not correct

30. An OTR is performing an UE functional assessment on an elderly client with rheumatoid arthritis. The OTR is MOST likely to determine that the client has limited internal rotation if the client is unable to touch the: A. Back of the neck. B. Top of the head. C. Lower back. D. Opposite shoulder.

C. Lower back.

An individual receives outpatient intervention at a work hardening program. During his treatment session, he reports that he fell the day before and thinks "he hurt his wrist" because he has been unable to "straighten his hand or fingers out". The therapist determines that further evaluation is needed to access if there is damage to the: A. Median nerve B. Ulnar nerve C. Radial nerve D. Carpal tunnel

C. Radial nerve Radial nerve provides innervation to muscles that extend wrist and fingers

While working, a 25 year-old cable repairman suffered a left median nerve injury from a laceration. Initially, he showed maximum motor and sensory losses. Prior to discharge to the work setting, he shows only moderate impairment in temperature perception. The therapist recommends that the repairman: A.lower the temperature of the hot water heater in his home B. mark all potentially hot objects at home and at work with bright stickers C. wear gloves for activities involving extreme temperatures D. wear a protective splint during the work day

C. wear gloves for activities involving extreme temperatures A. is also a good answer, but that is not at work

11. A secretary is referred to OT. Over the past few months, she has been experiencing increasing pain in the thumb CMC joint of the dominant hand, edema, weakness, and difficulty grasping. These symptoms are characteristic of: A. rheumatoid arthritis B. carpal tunnel syndrome C. gamekeeper's thumb D. degenerative joint disease

D. CMC typically means OA and that is the same thing

An OTR is fabricating a static splint for an individual with hand burns. To ensure that maximum length of the collateral ligaments of the MCP joints is maintained, the splint should be designed to position the fingers and wrist as indicated below: Order for answers below: MCP Joints IP Joints Wrist A. 20-30° flexion 15-25° flexion 25-30 ° extension B. 35-50 ° flexion 30-40 ° flexion Neutral C. Fully extended 45-60 ° flexion Neutral D. 60-75 °flexion 0-30 ° flexion 25-30 ° extension

D. 60-75 °flexion (MCP) 0-30 ° flexion (IP) 25-30 ° extension (Wrist) Two main positions are safe position (MCP flexed more, IPs are straight) and functional position (IP's slightly flexed) Goal is to try to get to 0 w/ IP's, but they may not be able to tolerate Extension of MCP for too long would cause ligaments to shorten ->contracture Thumb should be abducted to 45

An occupational therapist receives a referral to construct a Kleinert splint. The condition most likely to indicate a need for this type of Orthosis is: A. DeQuervains B. CMC joint arthritis C. Finger extensor tendon injury D. Finger flexion tendon injury

D. Finger flexion tendon injury Dorsal blocking splint allows for passive finger flexion

37. An adolescent incurred a spinal cord injury at the C-5 level. During a family caregiver education session, the occupational therapist instructs family members in the provision of passive range of motion (PROM) to the patient's wrist and fingers. Which method of PROM should the therapist teach the family members to perform? A. Extend the fingers with the wrist extended. B. Flex the fingers with the wrist flexed. C. Flex and extend the fingers with the wrist in a neutral position. D. Flex the fingers with the wrist fully extended and extend the fingers with wrist fully flexed.

D. Flex the fingers with the wrist fully extended and extend the fingers with wrist fully flexed Tenodesis stretch? They would not have the tenodesis grasp w/ C5 COMPLETE injury, but still would want to stretch that way Still have elbow flexion, important to prevent contractures w/ elbow flexion caused by unopposed bicep activity Total paralysis of wrist

31. A patient who had a recent ulnar collateral ligament repair of the thumb MCP joint is referred to OT for fabrication of a splint. The MOST effective type of splint for the OTR to fabricate is a/an: A. Dynamic flexor B. Forearm-based ulnar gutter C. Wrist immobilization D. Hand-based thumb spica

D. Hand-based thumb spica Check

An OTR has a physician referral to use a paraffin bath as a treatment modality to increase joint mobility for a patient who has a degenerative joint disease of the hand. In accordance with AOTA's guidelines on physical agent modalities, it would be BEST for the OTR to use this modality: A. to mobilize the affected joints B. if cold treatment has been ineffective in decreasing pain C. if moderate to severe edema is present in the affected joints D. as an adjunct to a purposeful activity

D. as an adjunct to a purposeful activity First line of official statement says "PAM may be used by OT when used as an adjunct or in preparation for purposeful activity."

A resident of a long-term care facility who had a fracture of the index finger has repeatedly removed the metal immobilization splint. Evaluation shows significant swelling and bruising of the index finger, thumb, and web space, and bruising on the palm at the distal, palmar crease where the metal splint rested. The OTR should INITIALLY: A. contact the nursing staff and discuss modifying the splint wearing schedule B. fabricate a new splint and implement a wearing schedule C. elevate the hand and devise a strapping system to prevent removal of the splint D. contact the physician to discuss possible alternatives for splinting

D. contact the physician to discuss possible alternatives for splinting "Metal splint" is insinuating that it is a pre-fabricated splint Long term care is different from SNF. Long term care unit is after person has been admitted, typically covered by Medicaid or Private Insurance -Swing beds: don't have a skilled nursing unit so have license to use room as both acute care and skilled nursing (usually in a hospital), SNF billed part A -In long term care it is considered outpatient, billed part B, no longer DRG Possible casting since pt is refusing to wear splint There is bruising on the palm though where it initially rested so should OT make new one?

35. A patient who has cubital tunnel syndrome is referred to OT. The OTR should INITIALLY provide: A. PROM B. Work site modification C. Elbow splints for nighttime use D. Grip strengthening

Key word is initially C. Elbow splints for nighttime use Especially important for non-surgical intervention 2nd thing would be to educate on activity modification

You receive an order for an OT eval and tx including a need for dynamic splint of a pt w/ a diagnosis of FDS tendon repair, zone II, onset 14 days ago. Which splint and features would be MOST appropriate during 1st session? Wrist cock-up Dorsal blocking splint Posterior elbow and wrist splint Wrist flexed to 30 Wrist extended to 30 Finger MCPs flexed to 60 Finger MCPs at zero Finger hook glued on finger Dynamic flexion of finger w/out palmar pulley Dynamic flexion of finger w/ palmar pulley Dynamic extension of finger

Tendon is most critical at this point Dorsal blocking splint Wrist flexed to 30 Finger MCPs flexed to 60 Finger hook glued on finger Dynamic flexion of finger w/out palmar pulley

Based on question39, which of the following would be most appropriate during the assessment? Wound eval Edema eval PROM assessment AROM assessment MMT Circulation eval ADL assessment

Wound eval Edema eval PROM assessment (don't do PROM on wrist, do it solely on the fingers) Circulation eval Does have full PROM, wound healing properly, circulation good

Refer to question 40. Pt is now at 8 wks, no longer using splint. Pt shows PROM and AROM 20-90 in the left index finger PIP joint. Which is most appropriate? Pulsed US Continuous US PROM exercises AROM blocking exercises Theraputty- extrasoft Theraputty -medium Light grip Heavy grip Scar massage Work simulation

lacks some flexion and some extension PROM exercises AROM blocking exercises Extra soft Theraputty Scar massage Light grip Ultrasound (both) to address scar tissue Firm gripping around 12 wks

An occupational therapist designs a dynamic splint for an individual recovering from tendon repair. To ensure an appropriate angle of pull, the OTR positions an outrigger at: A. 90° to the joint B. 45° to the joint C. 60° to the joint D. 110° to the joint

A. 90° to the joint

An OTR evaluates the efficacy of a dynamic splint and determines that joint movement has improved by 25%. The therapist readjusts the splint's outrigger to provide an angle of pull at: A. 90° to the joint B. 45° to the joint C. 60° to the joint D. 110° to the joint

A. 90° to the joint Maintain the direction of pull

When your patient complains of debilitating pain, especially pain that is disproportionate to the extent of the injury, you should consider the possibility of: A. Complex regional pain syndrome. B. Rheumatoid arthritis. C. Peripheral neuropathy. D. Radial tunnel syndrome.

A. Complex regional pain syndrome.

A 54 year-old accountant is referred to an outpatient hand clinic for treatment of DeQuervain's syndrome. The OTR determines that a splint is indicated for this person. The most appropriate splint for the therapist to construct is a: A. Forearm-based thumb spica splint B. Dorsal wrist splint with the wrist in neutral C. Volar wrist splint with the wrist in 30° of extension D. Resting hand splint

A. Forearm-based thumb spica splint

An occupational therapist evaluates an individual with an ulnar nerve injury. During sensory testing, the OT applies the stimulus: A. From distal to proximal B. At the C-7 dermatome C. At the C-8 dermatome D. From proximal to distal

A. From distal to proximal Always apply this way except for spinal cord injuries then apply proximal to distal

36. An individual is referred to a work hardening program for evaluation. The referral states that the person had attended another work program for 6 months but had been discharged due to lack of compliance with treatment recommendations. The physician wants the occupational therapist to determine if the person is applying maximal effort or if the person is magnifying symptoms. When measuring the grip strength of each hand to compare to norms, which evaluation protocol will be most effective for therapist to use? A. One trial on the dynamometer in all five positions. B. Three trials on the dynamometer at level #2. C. Five trials of lateral pinch. D. Three trial of lateral pinch.

A. One trial on the dynamometer in all five positions.

An OT practitioner is educating a client with a cumulative trauma disorder about common work-related risk factors. The OTR explains to the client that many of the PRIMARY risk factors are: A. Repetition, high force, and awkward joint postures. B. Progressive resistive exercise, joint mobilization, and weight bearing C. Inflammation, swelling, and pain. D. Fatigue, muscle cramps, and paresthesias.

A. Repetition, high force, and awkward joint postures. -cumulative trauma disorder: causes trauma on a regular basis...CTS, lateral/medial epicondylitis

An adult, who had a brachial plexus injury two weeks ago, has no sensation in the affected upper extremity. INITIAL intervention should focus on: A. Safety education B. Self-care training C. Movement therapy D. Sensory re-education

A. Safety education Safety is always top priority, could do sensory re-education but not INITIALLY

38. An occupational therapist evaluates an individual with a partial tear of the supraspinatus muscle. The therapist documents the results of muscle testing. Which is most accurate for the therapist to state when reporting these reports? A. Strength is fair and the person reports pain. B. Strength is fair and the person reports no pain. C. Strength is good and the person reports pain. D. Strength is good and the person reports no pain.

A. Strength is fair and the person reports pain. More significant pain would be less pain

An individual is being treated in an outpatient clinic for complex regional pain syndrome, type I. The most appropriate activity for the OTR to recommend for the person to complete at home is: A. Washing a car B. Doing light handwork in a craft of choice C. Playing cards or a table-top game D. Performing visualization relaxation exercises

A. Washing a car -Because it is very similar to the stress loading protocol

An OT practitioner is assessing the range of motion of an individual who demonstrates internal rotation of the shoulder to 70 degrees. The practitioner would MOST likely document the patient's active range of motion as: A. Within normal limits. B. Within functional limits. C. Hypermobility that requires further treatment. D. Limited mobility that requires further treatment.

A. Within normal limits.

A patient who has rheumatoid arthritis and bilateral ulnar drift of the MCPs reports difficulty managing utensils for feeding. The OTR should adapt the utensils by: A. building up the handles B. weighting the handles C. extending the handles D. wrapping the handles with non-slip material

A. building up the handle Weighted handles is more for tremmors or if need more proprioceptive input Extending handles would be more acceptable for limited ROM

After one week of treatment, an OTR re-measures a patient's AROM and finds an increase in shoulder flexion form 105° to 110°. The patient reports no changes in functional abilities and remains able to complete upper body dressing using adaptive equipment. The OTR should document the change in ROM as: A. not significantly changed and remaining below normal limits B. improved and now within functional limits C. not significantly changed and now within functional limits D. improved and now within normal limits

A. not significantly changed and remaining below normal limits (Correct!) WFL is when person is not normal, may still need AE, has reached max ROM, may not be able to gain ROM -Only use WFL is they can do everything by themselves, w/out AE, so why would you need to continue working toward s goal

A 30 year-old received daily OT after suffering lacerations, and median and ulnar nerve damage from shattered glass. The wounds are healed and the patient is being discharged. The final evaluation shows minimal limitations in palmar sensation, as well as joint ROM lacking 10-20° of full ROM, and palmar scarring. The discharge home program should include instruction on: A. tendon gliding exercises B. use of a resting splint for 23 hours per day C. weight-bearing activities D. homemaking tasks

A. tendon gliding exercises If scarring gets worse may lead to contracture

A 16 year-old baseball pitcher attends OT for intervention following a rotator cuff injury. The therapist progressively *grades resistive* exercises by increasing: A. ROM involved in completing the exercise B. Amount of resistance with a stronger level of therapy band C. Proximal load on the muscles D. Repetitions of external rotation exercises with a smaller amount of distal weight

B. Amount of resistance with a stronger level of therapy band

While providing consultation to a restorative nursing program, an OTR notices that several residents have been wearing splints incorrectly. In this situation, the OTR's BEST plan of action is to: A. Instruct family members in correct splint application. B. Instruct the resident and nursing staff on correct splint application. C. Present a lecture to the nursing staff on correct splint application. D. Adjust splints for a correct fit and follow up frequently.

B. Instruct the resident and nursing staff on correct splint application. Always educate pt even if they have cognitive issues. Restorative nursing program: discharged from therapy, typically a CNA is in charge of "home program" that OT/PT has given them

A method that an OT practitioner can use to document total finger flexion *without recording the measurement in degrees* would be to: A. Measure the passive flexion at each joint. B. Measure the distance from the fingertip to the distal palmar crease with the hand in a fist. C. Measure the active flexion at each joint and total the measurements. D. Measure the distance between the tip of the thumb and the tip of the fourth finger.

B. Measure the distance from the fingertip to the distal palmar crease with the hand in a fist.

An OT practitioner is treating a client who demonstrates pain, progressive weakness of the thumb, atrophy of the thenar muscles and numbness and tingling in the thumb, index, long, and half of the ring fingers. The client is not experiencing proximal upper extremity limitations so the practitioner will MOST likely suspect problems with which of the following? A. Ulnar nerve. B. Median nerve. C. Radial nerve. D. Brachial plexus.

B. Median nerve.

32. During an evaluation a patient who has carpal tunnel syndrome reports an 8 out of 10 pain level in the affected hand. The OTR should instruct the patient to complete a home program that includes: A. Progressive resistive exercises B. Rest, splinting, and nerve gliding exercises C. Weight bearing on both hands D. The scrub and carry technique

B. Rest, splinting, and nerve gliding exercises "Scrub and carry" is for CRPS AKA Stress loading protocol

The task that would be MOST DIFFICULT for an individual who has ulnar nerve palsy would be: A. Carrying a suitcase B. Turning a key in the car ignition C. Keyboarding on a computer D. Holding coins in the palm of the hand

B. Turning a key in the car ignition Median nerve would still innervate flexors of finger

An individual has right carpal tunnel syndrome. The OTR recommends that a splint be prescribed. The most appropriate splint is a: A. Resting hand splint B. Wrist splint at neutral C. Thumb spica splint D. Wrist splint at 30° of extension

B. Wrist splint at neutral Question does not say surgery, so assume that it is non-operative Wrist cock up w/ wrist extended may be appropriate after surgery Positive Berger's test, then wrist cock-up and block MPs at 20-40 degrees flexion

An OTR is treating a patient who has rheumatoid arthritis. When discussing joint protection techniques, the OTR should instruct the patient to use: A. the fingertips instead of the entire hand to grasp objects B. a wheeled shopping cart instead of a basket over the forearm C. weighted utensils and a plate guard D. right hand twisting to open jars

B. a wheeled shopping cart instead of a basket over the forearm Grasping is harder for them...and placing basket over forearm is a good answer, BUT a wheeled shopping cart is best answer