NBCOT COTA Exam 2022 Questions and Answers

OT code of ethics & ethics standards - ANSWER developed to address the most frequently encountered ethical issues in OT across a variety of settings; for employers, consumers, students. concepts of ethics standards ( ...

OT code of ethics & ethics standards - ANSWER developed to address the most frequently encountered ethical issues in OT across a variety of settings; for employers, consumers, students. concepts of ethics standards ( 7) - ANSWER Altruism, Equality, Freedom, Justice, Dignity, Truth, Prudence. Altruism - ANSWER placing the needs of others before your own Equality - ANSWER promote fairness in interactions with others Freedom - ANSWER desires of client must guide OT interventions Justice - ANSWER respect and adhere to the applicable laws and standards regarding area of practice Dignity - ANSWER treating each client respectfully and as an individual by enabling client to engage in meaningful occupations- regardless of disability Truth - ANSWER OT practitioner provides accurate information orally and written Prudence - ANSWER using clinical and ethical reasoning skills to make decisions Code of Ethics Principle 1 - ANSWER Beneficence; OT personnel shall demonstrate a concern for the well being and safety of the recipients of service Code of Ethics Principle 2 - ANSWER Nonmaleficence; OT personnel shall intentionally refrain from actions that cause harm Code of Ethics Principle 3 - ANSWER Autonomy/ Confidentiality; OT personnel shall respect the right of individuals self-determination Code of Ethics Principle 4 - ANSWER Social Justice; OT personnel shall provide services in a fair and equitable manner Code of Ethics Principle 5 - ANSWER Procedural Justice; OT personnel shall comply with institutional rules, local, state, federal, and international laws and AOTA documents applicable to the profession of OT. Code of Ethics Principle 6 - ANSWER Veracity; OT personnel shall provide comprehensive, accurate, and objective information when representing the profession Code of Ethics Principle 7 - ANSWER OT personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity. Categories of Ethical Problems (3) - ANSWER ethical temptations, ethical distress, ethical dilemmas Ethical temptations - ANSWER occurs when it is difficult to follow through on course of action, when you know its right, because he/she is tempted to go against it Ethical distress - ANSWER occurs when it is difficult to follow through on what the person knows is the right course of action, because policies or procedures Ethical decision making steps - ANSWER 1. determine the type of problem ( ethical issue, distress, or dilemma) 2. Identify ethical or legal issues 3. What facts are known, what needs to be obtained 4. Who's involved that may influence and resolve issue 5. Formulate possible resolutions 6. Identify resources 7. Determine course of action 8. Identify possible results of course of action Ethical dilemmas - ANSWER occur when it is difficult to identify what the best ethical course of action would be because of conflicts that occur when determining the resolution Acronym for correct documentation - ANSWER C.A.R.E C: Clarity A: Accuracy R: Relevance E: Exceptions Types of Documentation - ANSWER Order/Refferal Screening Evaluation Report Intervention plan Written Goals Contact & Progress notes Re-evaluation or Reassessment report Transition plan Discharge summary Order/ Refferal - ANSWER Referral for OT services, sometimes needed by physician to get reimbursed. Screening - ANSWER To identify whether a person would benefit from OT ( chart review & observation) Evaluation - ANSWER The process of obtaining & interpreting data necessary for intervention Intervention plan - ANSWER Summary of evaluation and reccommendations, goals, strategies, duration, intensity, frequency, of OT. OTR responsible but collaborates with OTA Written Goals - ANSWER OTA contributes to goal writing Acronym for Goal Writing - ANSWER COAST C: client O: occupation A: assistance level S: specific task/ condition T: Timeline Acronym for Progress notes - ANSWER S.O.A.P S: subjective information quoted or paraphrased O: objective information from session (measurements, observable data, etc.) A: Assessment P: Plan Standards for Continuing Competence - ANSWER Standard 1: Knowledge Standard 2: Critical reasoning Standard 3: Interpersonal skills Standard 4: Performance skills Standard 5: Ethical practice Standards of Practice - ANSWER Standard I: Professional Standing & Responsibility Standard II: Screening, Evaluation, Re-evaluation Standard III: Intervention Standard IV: Outcomes Areas of Occupation - ANSWER ADLs IADLs Rest & Sleep Work Education Play Leisure Social COTA roles in delivery of OT services - ANSWER COTA may contribute to eval process; performing delegated assessments & delivering reports. COTA must understand eval results COTA must be knowledgeable about clients goals & choose appropriate activities COTA must understand client specific outcomes & document COTA may measure outcomes & offer resources Burn size - ANSWER Adults; the rule of nines- divides the body into 9s to calculate total surface area Child/infant; Lund-Browder Chart- based on age Superficial 1st degree burn - ANSWER Top layer of epidermis Min-Mod pain 3-7 days healing Superficial partial 2nd degree burn - ANSWER Epidermis & Upper dermis Significant pain (wet blisters) 1-3 weeks healing Deep partial 2nd degree burn - ANSWER Epidermis & Deep dermis Severe pain (erythema) 3-5 weeks healing Impaired sensation Increase risk of infection Increased scare risk Full thickness 3rd degree burn - ANSWER Epidermis & Dermis No pain, No sensation Requires skin graft Extremely high hypertrophic scar risk Subdermal burn - ANSWER Full thickness burn, damage to underlying tissue such as Fat, Muscles, Bone Burn Management: Emergent Phase - ANSWER 0-72 hours after injury 1. Sustaining life 2. Controlling infection 3. Managing pain Burn Management: Acute Phase - ANSWER 72 hrs/ until wound heals 1. Infection control 2. Pain management 3. Proper nutrition & hydration 4. Cardiopulmonary stability Burn Management: Rehabilitation Phase - ANSWER Continues with skin grafts and reconstruction surgery as needed for movement and function OT Intervention : Burns - ANSWER Emergent Phase: Splinting in antideformity positions Acute Phase: Splinting/positioning & early ADLs Edema Management - wrapping, elevation, AROM Early ADLs- adaptive strategies Surgical/ Postoperative Phase: Immobilization (3-10 days) Walking (5-7 days) Wrapping with elastic band AROM after immobilization period Rehabilitation Phase: Skin conditioning - lubricating, massage Scar management- bandage Burn Related Complications & Management - ANSWER Contracture; early anticontracture positioning, continuous exercise, serial splinting. Hypertrophic scar; compression therapy Heterotrophic ossification; surgical intervention Pain; education on ROM, pain management techniques, Heat intolerance; accommodations Sun exposure; protection & exposure management Priorities; compression garments Common heart diagnoses - ANSWER Myocardial infarction Coronary Artery disease Congestive heart failure Cardiomyopathies Cardiac Rehab - ANSWER Inpatient/ Phase 1: Monitor EKG, progression of ADLs, MET levels, symptoms of intolerance , etc. Outpatient/ Phase 2: Tolerance & MET levels, weight training, Education, Community/ Phase 3: Stress test, activities & tolerance Common respiratory diagnoses - ANSWER Chronic obstructive pulmonary disease Emphysema Chronic bronchitis Specific testing for hand & UE - ANSWER ROM: goniometer measurements Strength: manual muscle testing, dynamomenter, pinch gauge Edema: volunteer or centimeter tape Vascular : color & trophic changes, pulse, temp, Allens test Sensation: Semmes- Weinstein monofilament Coordination: O'Conner Dexterity Test, nine hole peg, etc. Fractures of the Hand - ANSWER 1. proximal fracture 2. Carpal fracture 3. Avulsion injuries Mallet finger: splint in extension Boutonnière deformity: splint PIP in extension & DIP flexion exercises Swan neck deformity: splint PIP in slight flexion Intervention for Hand fractures - ANSWER Orthotic fabrications Modalities for pain relief (heat, ultrasound, cryotherapy, paraffin, TENS) Exercise to increase ADLs; AROM 3-6 weeks after fracture is fixated Wrist Injuries - ANSWER Median Nerve injury; produces carpal tunnel-like symptoms ( palmar numbness, weakness, numbness from 1st digit to half of 4th) Ulnar Nerve injury Complex Regional Pain Syndrome (CRPS) - ANSWER Pain disproportionate to an injury that is either sympathetically maintained or independent of the sympathetic nervous system Types of CRPS, Symptoms, & Intervention - ANSWER Type 1: developes after noxious events Type 2: developes after nerve injury Symptoms: Allodynia, Hyperalgia, Edema, Contractures, etc. Gentle pain-free AROM, pain control, Edema control, joint protection, Cumulative Trauma Disorder (CTD) - ANSWER Trauma to soft tissues caused by repeated force. Indicated the mechanism of injury but not diagnosis Symptoms & Grades of CTD - ANSWER Muscle fatigue, pain, chronic inflammation, sensory inpairment. Grade I: pain after activity, resolves quick Grade II: pain during activity, resovles @ end Grade III: pain persists after activity, affecting work Grade IV: pain in extremity up to 75% , work is limited Grade V: Unrelenting pain, unable to work OT intervention for CTD - ANSWER Acute phase: reduce inflammation & pain, static splinting, ice, contrast baths, ultrasound, iontophoresis, Subacute phase: slow stretching, progressive resistive exercises as tol. Education action on triggers,. Nerve Injuries & Syndromes - ANSWER A. Radial nerve injury B. Radial tunnel syndrome C. Anterior interosseous syndrome D. Pronation syndrome E. Median nerve injury F. Double crush syndrome G. Carpal tunnel syndrome H. Cubical tunnel syndrome I. De user aim syndrome J. Claw deformity K. Digital stenosis tensynovitis (trigger) L. Sensory reeducation after nerve injury Carpal Tunnel Syndrome - ANSWER Caused by entrapment of the median nerve as it courses through the carpal tunnel. Leads to sensory impairment generally involving numbness & tingling in the thumb, index, and middle fingers. Physical Agent Modalities (PAMs) - ANSWER Cryotherapy, Thermotherapy, Ultrasound, Phonophoresis, Electrotherapy, ion Cryotherapy - ANSWER cools tissues 1-2 cm depth, including ice massage, ice, towels, cold packs, cold immersion baths, etc. Effects include pain relief, decreased edema, decreased muscle spasms, decreased inflammation, Thermotherapy - ANSWER Heats tissue to 1-2 cm depth, including whirlpool, fluids therapy, hot packs, contrast baths, paraffin baths, etc. Effects on patient include increased blood flow, increased muscle contraction, increased pain, decreased muscle spasms, Ultrasound - ANSWER Heats tissue 1-5 cm depth; thermal and non thermal effects. A. Thermal; increase tissue extensibility and blood flow, decreased pain, joint stiffness, muscle spasms, and chronic inflammation. B. Nonthermal; increase protein synthesis, bone healing, decrease inflammation. Electrical Stimulation (TENS, NMES, iontophoresis) - ANSWER A. NMES promotes wound healing, maintains muscle mass, increases ROM, decreases edema, decreases spasms and spasticity. B. TENS primarily controls pain through ; gate control, endorphins release, acupuncture. C. Iontophoresis decreases inflammation and controls pain Splinting - ANSWER An orthopedic device designed, fabricated, or selected to temporarily support, protect, or immobilize a body part. Types of splints - ANSWER A. Static splints, Static progressive splints, and Serial casting have no moving parts. B. Resting hand splints maintain wrist @ 20-30 degrees ext, thumb 45 degrees palmar abduction, MCPs at 35-45 degrees flexion, PIPs & DIPs in slight flexion. C. Antideformity splints maintain wrist at 30-40 degrees ext, thumb 45 degrees palmar abduction, MCPs @ 70-90 degrees flexion, and PIPs & DIPs in full extension D. Dynamic Splints have moving parts and soft splints allow movement. Designed to correct contractures, increase passive motion, protect recent surgery or substitute for lost active motion. Amputation Etiology, Signs & Symptoms - ANSWER Can be congenital or caused by traumatic or surgical removal. A. Postop & preprosth. - pain, edema, bone spurs, phantom limb, neuroma on distal end B. Prosthetic - skin ulcer, sebaceous cysts, edema, sensory changes, Level of Amputation - ANSWER Above knee- transfemoral Below knee- transtibital Below ankle- transmetatarsal Above elbow- transhumeral Below elbow- transradial Below wrist- transmetacarpal Across joint- Disarticulation Amputation OT interventions - ANSWER A. Preposthetic: Training in limb hygiene, wound healing ( whirlpool and massage), limb shrinkage and shaping in elastic bandage, reduce edema, desensitization through weight bearing, massage, tapping, increasing flexibility B.Prosthetic: Client education, training to donn & doff prosthesis, wearing schedule, limb hygiene, care of prosthesis Contractures - ANSWER Fixed posture because of shortening of skin, ligaments, joint capsule, tendons, and muscles resulting from conditions such as burns, wound healing, muscle imbalance, SCI, increased tone from stroke, head injury, CP, etc. Soft tissue; responds to therapy. Honey block; requires surgery to release Contracture OT intervention - ANSWER (1) superficial and deep heat to increase tissue extensibility, (2) slow stretch, (3) static splinting Splints to reduce soft- tissue contractures - ANSWER Antideformity( safe position) burn splint Elbow/Knee ext splint Wrist ext splint Thumb abduction Lumbrical bar splint Resting hand antispasticity Soft neoprene Splint to decrease foot drop Serial casting Dynamic splinting Fibromyalgia - ANSWER A syndrome consisting of widespread pain affecting the entire musculoskeletal system. Symptoms of widespread tissue pain, no restorative sleep, fatigue, inability to think, paresthesias, joint swelling, depression, anxiety. Hip Fractures - ANSWER Primarily caused by trauma, osteoporosis is significant risk factor, generally occurs when bones ability to absorb tension, compression or force is exceeded. Types of hip fractures - ANSWER 1. Femoral neck; caused by trauma or rotational force 2. Intertrochanteric; results from direct blow to area between greater & lesser trochanter 3. Subtrochanteric; results from direct blow to lesser trochanter Hip fracture weight bearing restrictions - ANSWER 1. Non-weight bearing; no weight on affected extremity 2. Toe touch; touch for balance <10% weight 3. Partial; 50% of weight 4. As tolerated; client judges, based on pain 5. Full; 100% weight allowed Hip replacement precautions - ANSWER 1. No hip flexion > 90 degrees, no internal rotation, no abduction, no affected hip joint. 2. No external rotation, no extension, no adduction of affected hip joint Low Back Pain - ANSWER 1. Sciatic pain: nerve is trapped by herniated disc 2. Spinal stenosis: narrowing of the intervertebral foramen 3. Facet joint pain: inflammation or changes of spinal joints 4. Spondylitis: stress fracture of the dorsal to transverse process 5. Spondylolisthesis: slippage of a vertebra out of position 6. Herniated nucleus pulposus: stress tearing of fibers of disc, causing outward bulge pressing on spinal nerves. LBP ADLs & IADLs - ANSWER 1. Bathing - shower provides neutral spine - shower head reduces twisting 2. Dressing - dress while sitting - lie flat when pulling clothing up - slip on shoes - thread belt before donning pants 3. Functional mobility - logrolling - lower onto toilet with neutral spine 4. Personal hygiene - kitchen sinks vs bathroom sinks 5. Sexual activity - lower back in neutral, 6. Sleep - firm supportive mattress - neck supportive pillow 7. Toileting - reach between legs 8. Child care - avoid sudden movements 9. Computer use - wrists in neutral, elbows 90 degrees - monitor @ eye level 10. Driving - sit on seat and turn entire body 11. Home care - use golfers light ( leg opposite arm) 12. Shopping - rest on one knee to retrieve from low shelf Oncology - ANSWER "Cancer" is a disease of the body's cells which abnormal cells multiply rapidly. Affected by genetics and environment Oncology treatment - ANSWER Chemotherapy: toxic chemicals Radiation: radioactive materials Surgery: removal of cell, tissues, or organs Hormone therapy: to decrease estrogen Immunotherapy: medication to block or heighten immune system Osteoarthritis - ANSWER The most common joint disorder. A non inflammatory condition that causes breakdown in articulated cartilage. A. Primary with localized or generalized joint involvement B. Secondary related to trauma, congenittal abnormalities, infection, necrosis Symptoms: stiffness, limited ROM, inflammation, OT intervention for Osteoarthritis - ANSWER A. PAM's : superficial heating ( paraffin, fluid therapy, hot packs, hydrotherapy, ESTIM) to decrease pain & increase ROM B. Exercise; AROM -> PROM C. Transfers for THR & TKR D. Education on management, disease process, joint protection, fatigue management, community resources. Osteoporosis - ANSWER A progressive condition characterized by low bone mass or density and deterioration leading to bone fragility Risk factors include inadequate calcium intake, estrogen deficiency, and sedentary lifestyle Osteoporosis OT intervention - ANSWER Adaptations & modifications for pain, stiffness, ROM, instability. Encourage positioning and posture, Rheumatoid Arthritis ( RA) - ANSWER A chronic, systemic, synovitis, inflammatory condition. Symptoms: pain, redness, warmth, tenderness, morning stiffness, ROM limitations, weight loss, fatigue, depression RA deformities - ANSWER 1. Boutonnière: flexion of PIP, hyperext. of DIP 2. Swan neck: hyperext. of PIP flexion of DIP 3. Mallet finger: flexion of DIP 4. Ulnar drift: radial deviation of wrist, ulnar deviation of MCP 5. Subluxation of wrist 6. Joint fusion/ Ankylosis 7. Extensor tendon rupture 8. Trigger finger 9. Mutilans deformity 10. Thumb 11. Subcutaneous nodules 12. Claw toe 13. Hammer toe 14. Cock-up toe 15. Hallucinate vagus RA OT intervention - ANSWER Limit activities during flare-ups, assistive devices to compensate ROM, strength, PAM's ( heat and cold), exercise ( AROM -> PROM), splinting, Cardiopulmonary Dysfunction; pediatric - ANSWER Congenital Heart Disease - compromised endurance - activities should be appropriately paced Dysrhythmia; pediatric - ANSWER Bradydysrhythmia Tachydysrhythmia Respiratory Problems; pediatric - ANSWER Respiratory distress syndrome (acute) Bronchopulmonary dysphasia (chronic) Asthma (chronic) - educate about exposure to irritants - teach self-management strategies - teach breathing exercises Cystic Fibrosis - teach energy conservation - teach breathing efficiency Hematologist Disorders; pediatric - ANSWER Erythrocytosis- too many RBCs & WBCs Hemophilia- loss of clotting proteins Anemia- iron deficiency Sickle cell anemia - abnormal shaped RBCs Musculoskeletal Disorders; pediatrics - ANSWER Osteogenesis Imperfecta - brittle bones Marfan's syndrome -excessive growth plates, hyper mobility joints Achondroplasia - Stunt of growth plates ( midgets) Arthrogryposis multiplex congenital - incomplete contracture of joints Congenital clubfoot - for foot adduction/ supination Congenital club hand - absence of radius and bowing of ulnar shaft Developmental dysphasia of the hip - dislocation of the hip, genetics and environmental Amelia - absence of a limb or distal segments Soft tissue injuries - strain sprain, bruise, JRA - joint inflammation, stiffness, contractures, - use of splints, AROM & PROM, energy concervation & adaptive equipment Fractures - pain, swelling, bruising, broken bones Curvatures of the spine Types of Fractures - ANSWER Complete- bone broken straight through Comminuted- broken into many splintered pieces Compound- leads to external wound Epiphyseal- between shaft & epiphysis Greenstick- partially broken Intrauterine- broken in utter Types of Curvatures - ANSWER Lordosis- anteroposterior curvature (hollow back) Kyphosis- posterior convexity ( round back/ Scheurmanns disease) Scoliosis- lateral curvature, spinal rotation, thoracic hypokyphosis Neuromuscular Disorders - ANSWER CP - nonprogressive condition ( neurological, motor, and postural deficits) *spasticity: increased flexor or extensor tone * athetosis: fluctuation of tone low to normal * Choreoathetosis: fluctuation of tone low to high *Flaccidity: low tone * Ataxia: tone usually within normal range Muscular Dystrophies Progressive deterioration & weakness *Duchennes (only affects boys) Neural tube defects * Encephalocele * Anencephaly * Spina bifida Traumatic Brain Injury - ANSWER Closed - caused by rapid movements of head in which brain strikes skull Open- caused when object enters brain TBI: Ranchos Levels - ANSWER TOTAL ASSIST Level I: no response Level II: generalized response Level III: periods of awake; follow some simple commands MAXA Level IV : confused and agitated Level V: confused, short attention span, step by step instruction MODA Level VI: memory and cognitive processing problems MINA Level VII: Attenion decreased still, completes self-care routines SBA Level VIII: actions are purposeful & appropriate Intellectual disabilities - ANSWER Mild; IQ 55-70 Mod; IQ 40-55 Severe; IQ 25-40 Profound; IQ below 25 - caused by trauma, toxins, infections, genetics, Autism Spectrum Disorder - ANSWER - a spectrum of conditions that reflect a range of deficits - Charactersed by severe & complex impairments in social interaction & communication - difficulty with sensory processing & sesory stimulation -difficulties with cognition - difficulties with motor skills - difficulties with communication ADHD - ANSWER -A behavioral disorder with unknown causes - difficulty maintaining attention & increased hyperactivity & impulsivity *Assesment of Motor & process skills * Canadian occ perf measure * Child occ self-assessment * Sensory profile Learning Disabilities - ANSWER Dyslexia: difficulty reading Dysgraphia: difficulty writing Dyscalculia: difficulty with math Implications: sensory integration, play, socialization, & self help. Perceptual- motor integration, writing skills. Independent living skills, social skills, development of compensatory & adaptive techniques. Trisomy 21/ Down Syndrome - ANSWER Short, stout stature, slack jaw, single crease in hands, commonly cardiovascular abnormalities, intellecutual disabilities, - OT interviews, observations, standardized assessments, Other genetic disorders - ANSWER Trisomy 13/ Patau's syndrome - multiple abnormalities affecting eyes, ears, nose, lip palate, digits, microcephaly Turners Syndrome - webbing of neck, congenital edema of extremities, cardiac problems, difficulty with visual perception Cri du Chat - catlike cry, microcephaly, Klinefelter's syndrome -Extra X Chromosome, small genitalia Fragile X syndrome - craniofacial deformities, prominent jaw, peas plants (flat feet) Neurofibromatosis -multiple tumors, Prayer-Willi Syndrome - moderate intellectual disabilities, underdeveloped sex organs Williams Syndrome: -cerebral & cardiovascular abnormalities, intellectual disability, difficult with visual, spatial, and motor skills. Diabetes - ANSWER - a metabolic condition that involves pancreas producing insufficient amounts of insulin Type 1: acute and requires administration of insulin Type 2: controlled by diet, exercise, and insulin Visual- perceptual impairments - ANSWER Visual attention: alertness, selective attention, visual vigilance, divided or shared attention Visual memory: integrated visual information with past experiences Visual discrimination: recognition, matching, and categorizing Object perception: form constancy, visual closure, visual-figure ground Spatial perception: position in space, depth perception, topographic orientation. Visual imagery: the ability to imagine people, objects, or experiences. Handwriting readiness - ANSWER 10-12 mo: scribbles on paper 2yrs: imitates horizontal, vertical, circular marks 3 yrs: copies vertical line, horizontal line, and circle 4-5yrs: copies cross, right oblique, square, left diagonal line, left oblique cross, some letters and numbers, possibly name 5-6 yrs: copies triangle, prints name, copies most letters Pencil grasp - ANSWER Primitive grip: whole hand & pronated forearm while holding feeding utensils Transitional grip: writing utensil is held with flexed fingers with pronated forearm & radial side downprogressing to supinate forearm Mature grip: writing utensil is stabilized by distal phalanges of thumb, middle, and index finger Dynamic tripod: pads of finger control movement, thumb is opposed to index, pencil rests on distal phalanx of radial side of middle finger Lateral tripod: fingers control movement, thumb is not opposed, pencil rests against radial size of middle finger Dynamic Quad: pads & fingers control movement, thumb is opposed to index, pencil rests against distal phalanx of radial side of ring finger Lateral Quad: pads of fingers control movement, thumb not opposed, pencil rests against radial side of ring finger. Sensory integration - ANSWER