OTD 433 Exam 1 Questions with Answers Correctly Solved, Quizzes of Medicine

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OTD 433 Exam 1 Questions with Answers Correctly Solved

1. What are the components of evidence based practice?: -clinical expertise -what is important to the patient -what is the best research available
2. Define Evidenced based practice: integration of clinical expertise , patient values, and the best research evidence into decision making process for patient care
3. Clinical Expertise: clinicians cumulated experience, education and clinical skills
4. T/F The patient brings to the encounter his or her own personal and unique concerns, expectations and values: True
5. Best evidence is usually found in relevant research that has bee conducted using sound .: clinically; methodology
6. T/F the evidence by itself makes the decision for you.: False: it can help support patient care process.
7. Functional Training: used to improve ability to perform physical actions, tasks, or activities in an efficient, typically expected, or competent manner
8. ADL Training: self care, accommodation/modification of home barriers, bathing, bed mobility, transfer, developmental activities, dressing, eating, feedings, grooming, toileting ,wheelchair, external supports
9. IADL training: domestic life; accommodation/modify. of home barriers, caring for dependents, driving/transportation, home maintenance, meal prep, shopping, yard work
10. AOTA addressed the issue dur to challenges to OT practice in and .: Florida, new York
11. What is the scope of practice issue with PAMS: challenge to the "use of heat, light, water, sound.."
12. T/F AOTA had an official position on PAMS: false
13. PAM task force was created in to explore issues and philo- sophical positions: 1990
14. Professional issues with PAMS: -many opposed -inconsistent with professions theory and philosophy
15. % physical disability practitioners felt PAMs was a natural evolution toward new technologies: 80%
16. % thought PAMS was consistent with the philosophical base: - 58%
17. Where do you go to find out about a state's modalities/thermal agent's specific law?: Department of Health and Human Services

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18. Outcome of PAMS: - inconsistency between desire to clinicians to obtain education and training at an academic level

3 / 28 -contributed to states adopting regulatory language to outline skills and training needed

19. states with licensing language or regulations specifying train- ing requirement for PAMS application: >
20. FL, NY, IL, NE, SD, CA, MT, NH, NJ, GA, MD, KY, TN: states that identify education/training requirements for PAMS and require separate license.
21. Educational programs only need to but not application of PAMS.: demonstrate; perform
22. -lack of understanding of theoretical framework -Top-down approach -occupation as the end and means -no reference to dx in the OT practice framework -insecurity and inconsistency in whether OT's diagnose: Theoretical issues of PAMS
23. What is the OTPF missing?: - we don't diagnose -but we can have a clinical impression
24. Activity demand: components and characteristic of activity will determine de- mand of activity and impact the skill or completion of performance
25. Activity demands are to specific .: - linked; client factors
26. Client factors: components which reside within or are unique biophysiological factors of teh individual
27. Client factors the ability to in occupations.: af- fects; engage
28. Difference between OT and PT education: -PT said to be medically based/ reductionistic -We went from reductionistic to a hybrid of medical and community components -OT needs to be better at medical component
29. What kind of patient has a better outcome after a hip or knee replacement?- : patient who are physically active prior to surgery
30. At what point do you put in a shoulder arthroplasty?: - when they have uncontrolled pain

• movement needs to be at 90 flexion and abduction

31. Significance of PAMS: - impact CF -influence biophysiological fctn of tissue

4 / 28 -influence cardio, hematological, and immunological systems -use preparatory to treating a variety of neuro-Musculo, movement related and sensory functions

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32. What caused a change in clinical reasoning for PAMS: - it impacts perfor- mance at cellular level -modifies cellular/histochemical activity within body
33. T/F you need to engage in activity and occupation when using PAMS: true
34. Physical agent modalities: procedures and interventions that are systemati- cally applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance
35. Purpose of using the energy of PAMS: - modulate pain -modify tissue healing -increase tissue extensibility -modify skin/scar tissue -decrease edema/inflammation
36. T/F PAMS are used in preparation for or concurrently with purposeful and occupation based activities: true
37. Types of energy: heat, cold, water, pressure, sound, electromagnetic, radiation and electrical currents
38. Types of Kinetic Energy: thermal, mechanical, electrical, magnetic
39. Types of potential energy: chemical, elastic, ,nuclear, gravitational
40. Soft tissue is made out of .: collagen
41. Why does your skin get wrinkly as it ages?: loss of collagen
42. Superficial thermal agents: hydrotherapy (whirlpool), cryotherapy, fluidothera- py, hot packs, paraffin, water, infrared
43. Superficial means a depth of penetration of .: 1-2 cm
44. Primary use or as a mechanism of action: conduction , convection
45. Conductive method of action: direct contact with the skin to control energy transferred into skin
46. Convective technique: energy is surrounding structure and kept in motion around body part
47. Examples of methods of heat transfer: - convection (whirlpool) -conduction (ice packs) -evaporation (cold sprays)
48. Deep thermal agents: - ultrasound

• phophoresis
• diathermy
• iontophoresis

49. Clinical effects of therapeutic ultrasound: increased tissue extensibility of tendons and joint capsules, decrease pain, decrease joint stiffness,

6 / 28 increased blood low, decrease muscle spasm, decrease chronic inflammation

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50. Physiological changes with tissue heating: increased metabolic rate, in- creased blood flow & tissue permeability, elevation of pain threshold, stimulating immune system
51. Ultrasound precautions: acute inflammation, fractures, breast implants, pt. with cognitive/language/sensory limitations
52. Ultrasound contraindications: pregnancy, over reproductive organs, over eyes, thrombophlebitis, plastic components, area of pacemaker, CNS tissue, ma- lignancy of tumors, active bleeding/infection
53. Phonophoresis: use of ultrasound to enhance delivery of topically applied durgs (most freq. corticosteroids)
54. Iontophoresis: electrical current to drive the medication into the tissue of the medication
55. What are electrotherapeutic agents: use electricity to facilitate tissue healing, improve muscle strength & endurance, decrease edema, modulate pain, decrease inflammatory response, modify healing process
56. When using lasers, there is no effects; it modulates biophysi- ology by adding to the cycle = heals tissues faster: - thermal; energy; ATP
57. Types of electrotherapeutic agents: -NMES, FES, TENS, ESTR, HVPC, ion- tophoresis
58. Mechanical agents: Vaso pneumatic devices, continuous passive motion(CPM)
59. PAMS are categorized as .: preparatory
60. PAMS can be used with purposeful activity or occupa- tional engagement.: concurrently
61. Wound: pathological state which tissues are separated from each other/de- stroyed and disruption of normal anatomical structure and function
62. Wound healing is a and process.: complex, dynamic
63. T/F A wound can be in a variety of stages throughout the surface of a wound: true
64. Impact for OT (wound healing): -foundational for occupational performance -bottom up approach -impacts all musculoskeletal conditions -soft tissue injuries -often overlooked

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65. Where does soft tissue injures (STI) trauma or overuse occur?: muscles, tendons, ligaments
66. Muscle contusions (bruises) result from and in severity and depth.: compression; vary
67. What is ecchymosis: tissue discoloration

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68. What causes ecchymosis: hemorrhage of blood vessels and lymph flow to body= swelling and formation of hard mass.
69. A hematoma can restrict joint , and lead to compression: motion/ nerve
70. Fibrosis: start to scar down and put pressure on the nerves and tendons= interfere with function
71. Soft tissue injuries are dependent upon factor.: causative
72. importance of knowing causative factor: important because we supply ener- gy to the structures of the body for healing process. -too much= destroy surgical repair
73. What causes the severity of an injury?: uncontrolled force
74. T/F tendons have the same strength as a ligament does: false
75. T/F ligaments and articular capsules are stronger than tendons: true
76. Sprain: an injury involving the stretching/tearing of a ligament or joint capsule that stabilizes/supports the body's joints
77. In severe injuries the portion will rupture first because ten- dons are twice as strong as muscles to which they attach.: muscle
78. Tendons develop tears when stretched - % beyond normal length.: - 5-8%
79. First degree strain/sprain: pain, micro tearing of collagen fibers and no readily observable tissue destruction
80. Second degree sprain/strain: results in more severe pain, extensive rupturing of tissue, detectable joint instability & muscle weakness
81. Third degree sprain/strain: severe pain, loss of tissue continuity, decreased range of motion, complete joint instability
82. S/S of muscle injury: - cramp/cronic type muscle pain -muscle spasm involuntary contraction for short time -inflammation (myosistis & fascitis)
83. Common soft tissue pain conditions: - tendonitis

• bursitis -myositis ossificans -calcific tendonitis

84. Tendonitis: inflammation of tendon/tendon sheath -can be acute/chronic -pain and swelling w/ movement
85. Bursitis: Sub acromion- deep over top of shoulder Subdeltoid: pain in middle of deltoid

10 / 28 Bursa in olecranon

86. Myositis ossificans: accumulation of mineral deposits in muscle
87. calcific tendonitis: mineral deposits in tendon
88. is the most frequently injured tissue of the body: skin
89. scratches, bruising and mild burns are healed by regenera- tion: epidermal
90. laceration: irregular tearing of the skin
91. 3 sequelae following tissue damage: resolution regeneration repair
92. Resolution: dead cellular material and debris removed by phagocytosis (origi- nal architecture still intact)
93. Regeneration: lost tissue replaced by proliferation of cells of same types
94. Repair: lost tissue replaced by fibrous scar
95. Barriers to healing process: - low blood oxygen content

• infection -lack of perfusion -sustained pressure
• malnutrition -systemic disease (diabetes) -Rx immunosuppressants

96. Pressure can produce cell damage or impair .: direct; perfusion
97. If pressure in wound areas exceeds closing pressure, there is blood flow, resulting in an barrier to healing.: - capillary; no; absolute
98. Local factors that affect healing: mechanical injury, infection, edema, topical agents, low oxygen tension
99. regional factors that affect healing: arterial insufficiency, neuropathy, venous insufficiency
100. Signs of infection: -yellow fibrin slough or necrotic tissue -heavy or malodorous exudate (muck) -prolonged inflammation -increased wound pain/tenderness
101. Healing response: tissue injured -> blood flows to injury -> platelets contact col- lagen ->vasodilation ->platelets release clotting

11 / 28 factors-> growth factors and cytokins and transforming growth factor beta

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102. Wound heal response is whether traumatic or surgically induced.: immediate 103.________________________________________ The wound progress through ____________________________________phases.: 3
103. Inflammation phase: -lasts from initial injury to 72 hours
104. Inflammation phase process: - neutrophils enter wound site and begin phagocytosis (remove unwanted foreign material)

• macrophages continue process by releasing PDGF & TGFb -blood vessels dilate, and swelling is caused -fibrinogen is released that coagulates in would and eventually matures into scar tissue 106................................................................................................ Too little inflammation means the healing response is..................................Too much inflammation means excessive are produced.: low; scars

107. What process decreases infection by disintegrating macrophages?:

• low dosage, pulsed ultrasound

108. Proliferation phase: rebuilds injured structure lasts for 6 wks.
109. Tensile strenght around week 3 is only % of normal.: 15%
110. Purpose of proliferation phase: resurface and impart strength to wound
111. Proliferation phase process: - epithelization (protective barrier to prevent loss of fluid) -wound contraction (pulls wound together) -collagen production (peak of wound healing)

• development of scar tissue

112. What does the skin look like in proliferation phase?: -red, highly vascular with thin transparent covering 113................................................................................. Wound contraction can be harmful to the........................................................ hand
113. Joint contractures can result from uncontrolled wound .: contraction
114. What is the window for closure in wound contraction during proliferative phase?: -14-21 day window; after 21 it won't close
115. pull epidermal layers inward: myofibroblasts
116. What theory shows that shape predicts the speed of contraction: picture frame theory 118............................................................ Linear wounds contract rapidly
117. Square/

13 / 28 rectangular wounds contract at a pace.: moderate 120......................................................... circular wounds contract slowly

121. Fibrosis: bulky mass of fibrous scar tissue completely surrounds injured region
122. Maturation phase: remodels the scar to approximate the surrounding tissue; lasts up to 2 years
123. Remodeling factors during maturation phase: -controlled stress/motion

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124. At 2 weeks wound has achieved -% of pre-wound strength: 20
125. At 5 weeks pre wound strength is about at --%: 50%
126. By 10 weeks wound has about % of pre wound strength: 80
127. Wounds heal from the up and from the in.- : bottom, outside
128. Macrophages signal regeneration: vascular
129. Intervention main goal: minimize all factors that can prevent/prolong inflam- mation
130. Treatment to assist in role of macrophage: antibiotics, debridement, wound cleaning Price regimen
131. Two types of wound closure methods: primary & secondary intervention
132. primary intervention: surgical wound closure opposes tissue layer. Improves tensile strength once remodeling of the wound occurs (surgical wound closure)
133. Secondary intervention: spontaneous healing; that follows 3 stages of heal- ing.
134. Selection of primary & secondary intervention are dependent upon: -lo- cation, confidence of completeness, depth of wound, characteristics of surrounding skin
135. Synthesis-Lysis Balance: high rate of collagen turnover during this phase is beneficial or detrimental. Collagen turnover is accelerated and continues until remodeling phase ends at 6months- year post injury
136. Scar Formations: normal synthesis; but inhibition of lysis
137. Hypertrophic scar: within borders of lesion; raised tissue (restored with pres- sure)
138. Keloid scar: beyond borders
139. Prolonged places the wound in an condition that results in decreased blood flow and oxygen to the tissue.: pres- sure; ischemic
140. Remodeling involves collagen being rearranged in both a and orientation: linear; lateral

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141. How does a change in scar orientation change tissue function?: scar is non-elastic; but if it forms with redundant folds it will permit mobility of the structures it is fixated to.
142. The physical weave pattern of fibers is responsible for the final behavior of the wound.: collagen; functional
143. Induction theory: scar mimics the surrounding tissue it is healing. ex. pliable tissue creates loose, less cross linked scar; collagen creates dense highly crossed link scar

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144. Tension theory: states a physical change in scar length can be achieved through a LOW LOAD, LONG DURATION APPLICATION of stress during the appropriate healing phase
145. Intervention approaches for tension theory: -dynamic splints, serial cast- ing, positional heat/stretching techniques, functional electrical stimulation, selective hand activities
146. Electrotherapeutic intervention is a safe and effective to surgical revascularization to improve the odds of ischemic wounds and promoting limb salvage.: complement; healing
147. What is the bioelectric system?: - direction electrical current occurs naturally in body to control the healing process -injury disrupts the body's natural electrical field -attracts cells that facilitate cellular secretion, orient cell structures and repair
148. Pain is a prevail medical problem that accounts for more than % of all physician visits: 80%
149. Ameri can pain foundation estimates that there are million people suffering from chronic pain each year: 50
150. Institute of medicine report, pain is significant public health problem that costs society at least billion annually, an amount equal to about for everyone living in the US.: $560-635 billion $2,000.
151. Individuals 50years + are as likely to have been diagnosed with chronic pain.: twice
152. abuse of and addiction to opioids such as heroin, morphine, and pre- scription pain relievers is a problem affecting health, social, and economic welfare of all societies.: global
153. million people in the US suffering from substance use disorders related to prescription opioid pain relievers: 2.
154. Pain: unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
155. Specificity theory: surgical interventions were derived from Descartes theory; pain regarded as a fact of life; believe pain during birth was a spiritual experience; one fixed pathway

17 / 28 Misconception: mental pain is different from physical

156. Phantom limb pain: discounted specificity theory; sensations occur in ampu- tated wound
157. When was the discovery of pain relief and the age of revolutions: 1800's
158. When did custom designed drugs to block pain occur: 20th century

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159. Gate control theory: Melzack & wall; spurred research into pain and elec- trotherapy; explains experience of pain and psychological factors
160. Pain results from a series of exchanges among what 3 components of the nervous system.: peripheral nerves, S.C., brain
161. What are the nerve receptors called that respond to touch, pressure, vibration, cold and warmth?: mechanoreceptors
162. Acute pain: the everyday experience that occurs in response to a a simple insult/injury (protective warning)
163. What mechanism generates nociceptive pain: transduction
164. Afferen t nerves conduct sensory information from the to the .: PNS; CNS
165. Where is the greatest concentration of peripheral nerves that is prone to injury: fingers & toes
166. Nociceptors have a threshold for activation: higher
167. Sensations of sever pain is transmitted .: simultaneously
168. Activity in afferent large -diameter and small-diameter fibers influence .: spinal gates
169. A-beta (large nerves): inhibit transmission
170. A-delta and C (small nerves): facilitate transmission (open gait- more pain)
171. Slow continuous pain: C-fibers
172. Fast pain: A-delta
173. N erve fibers transmit pain and enter the S.C> through the .: dorsal horn
174. The acts as a sorting and switching station.: thalamus
175. What 3 regions does the thalamus forward information to.: somatosensory cortex, limbic system, frontal cortex
176. Fast pathways of the brain: - brain stem can inhibit signal -produce endorphins -stress, excitement, vigorous exercise -fast pain travel to thalamus/cortex -cortex prompts decrease in pain/injury

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177. Slow pathway: - afferent pathway is chronic pain pathway -pathway to brain, hypothalamus, limbic system -Hypothalamus release stress hormones -Assigns meaning from brain
178. Efferent Pathway: -descend from brain to S.C>
179. Efferent pathway: -open/closes the gate
180. Descending messages can close the gait.: efferent
181. What factors open pain gates?: sensory, cognitive, emotional

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182. Acute pain may indicate damage.: tissue
183. pain occurs past point of tissue healing.: chronic
184. pain lasts more than 3-6 months: chronic
185. Examples of chronic pain & progressive disease: cancer, COPD, MS
186. experience autoimmune & chronic pain syndromes more often.: women
187. Pain perceived at a location other than the site of the painful stimulus/ori- gin: referred pain
188. When you have this type of pain higher centers cannot identify the actual input source.: referred pain
189. Nerve pain or neuropathy: neuropathic pain
190. This pain results from an injury or irritation to nerves; sensory or motor- : neuropathic pain
191. This type of pain is described as sharp, severe, stabbing, ongoing numb- ness, tingling, weakness,etc.: neuropathic pain
192. F ollowing incision or trauma, a cascade of events occurs in nervous system.: hyperexcitable.
193. Ph ysiological "wind-up" phenomenon starts at the .- : skin
194. Inflammatory cells surround areas of tissue damage and produce )) and .: cytokines, chemokines
195. sensitization is responsible for hypersensitivity.: cen- tral
196. changes in brain wiring and response are referred to as nerve or central .: plasticity; sensitiza- tion
197. Once central sensitization is established, doses of are required to suppress it.: larger; analgesics
198. cramping, dull, aching pain: muscle
199. sharp, shooting pain: nerve root
200. sharp, bright lighting like pain: nerve
201. burning, pressure like stinging, aching pain: sympathetic nerve
202. deep, nagging, dull pain: bone
203. sharp, sever, intolerable pain: fracture

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204. throbbing diffuse pain: vasculature
205. If sound head isn't moved , energy summates and a wave develops.: consistently; standing
206. Wave travel depends on the of molecules of a medium- : .closeness

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207. Acoustic impedance is the of a medium wave energy: imped- ance
208. More dense/heavy molecules = impedance and US reflection: greater
209. Each tissue layer transmits and absorbs US according to its properties.: acoustical
210. Fluid elements have the impedance values and acoustic absorption.: lowest
211. Bone has the impedance value and acoustic absorption.: highest; highest
212. E nergy absorbed by tissues from US wave lead to changes.: physiologic
213. More body tissues the ultrasound waves have to cross = greater .: attenuation
214. N erves, muscles, or fat have a unique property called .: acoustic impedance
215. Describes the number of complete wave cycles generated each sound: - frequency
216. Duration of each cycle and wavelength as number of cycles per second increases.: decreases
217. Freq uency of US influences the amount of energy .: ab- sorbed
218. 1 MHz penetrates to a depth of .: 5-7 cm
219. 3 MHz penetrates depth of .: 1-2 cm
220. the magnitude of force in a sound wave: intensity
221. The most significant factor in determining tissue response: intensity
222. Total power is measured in .: watts
223. Acute tissue state requires what intensity?: 0.1-0.2
224. Sub acute tissue state requires what intensity?: 0.3-0.7
225. Chronic tissue state requires what intensity?: 0.8-2.0

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226. What is also called pulsed ultrasound?: duty cycle
227. 10% cycle is used with ?: fragile conditions
228. % duty cycle is the most commonly used setting: 20
229. What duty cycle is mild heating but not therapeutic range: 50
230. What duty cycle is required for thermal US: 100 (continuous)
231. What duty cycles are considered a mechanical effect?: 50, 20, 10
232. In general, the larger the area, the the time required for US.: greater

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233. Effective radiating does for US is equal to the diameter of the sound head: 2x
234. Takes approx. min. to cover tx head over treatment tissue: 1
235. When is a thermal effect taking place?: - intensity high enough to heat tissue -same biophysiological effects of superficial thermal agents -increase metabolic rate, reduction of pain, alteration of nerve conduction, increased circulation
236. What does non-thermal heating do: facilitate healing
237. US therapeutic applications: - pain control -soft tissue extensibility -surgical skin incisions tendon injuries

• phonophoresis -fracture healing

238. US is most effective in heating dense tissue.: collagenous
239. Treatment parameters for thermal heating: continuous, > 0.5 W/cm2, up to 3.0 W/cm2 for 2-10 min
240. Parameters to decrease pain and tenderness with bicipital tendonitis: - 1.0-2.0 W/cm2 at 20% duty cycle
241. Thermal research: short term and mid term effectiveness with moderate idio- pathic carpal tunnel syndrome
242. What are the therapeutic parameters to decrease pain: 1-3MHz, 0.5-3.0 W/cm2, 2-10 min
243. What are therapeutic parameters for soft tissue extensibility: 1-3 MHz continuous US, 1.0 + w/cm2, 5-12 min
244. What is the window of opportunity for stretching after US?: 5-10 min
245. Non-thermal US causes a of the cell membrane = increased cellular .: destabilization; permeability
246. What are the wound healing effects of LIPUS attributed to?: cavitation and microstreaming
247. Fracture healing US parameters: 0.15 W/cm2 , 20% duty cycle, 1 MHz freq, 15-20 min daily
248. Skin incisions/ulcer US parameters: 0.5-0.8 w/cm2, pulsed 20%,

25 / 28 3-5 min, 3-5x/week

249. Purpose of photoresist: direct drug delivery to site
250. Factors affecting passage of phonophoresis: skin composition hydration vascularity skin thickness