OTD 433 PAMS Comprehensive Exam
Questions with Correct Answers
What is evidence based practice? - Answer-integration of clinical expertise, patient
values, and best research evidence into the decision making process for patient care
What is categorized under medical complexity in the new medicare payment system? -
Answer-medical management
pulmonary
cardiovascular and coagulation
cancer
acute infection
What is categorized under orthopedic, neurological in the new medicare payment
system? - Answer-major joint replacement or spinal surgery
non-orthopedice surgery
acute neurologic
non-surgical orthopedic/musculoskeletal
medical management
What is the top/down definition of function? - Answer-client's performance of life roles
and meaningful activities that are part of those roles
assessment focused on client's participation restriction, occupational balance, and life
role configuration
uses occupation as means and an end
What is the bottom/up definition of function? - Answer-specific, discrete body
impairment that affects larger daily life activities
assessment focused on body impairment level pathology
What is systems theory? - Answer-all body systems work together to achieve
occupational performance and function
What states require special PAMs licensing? - Answer-Florida
New York
Illinois
Nebraska
South Dakota
California
Montana
New Hampshire
,New Jersey
Georgia
Maryland
Kenntucky
Tennessee
What are client factors? - Answer-components which reside within or are unique
biophysiological factors of the individual
affects ability to engage in occupation and activities
AOTA's definition: component that includes body function and body structures
What is the significance of PAMs? - Answer-used as a preparatory method to treating a
variety of neuro-musculoskeletal movement and sensory function
should be adjunctive to occupational performance
What are physical agents modalities? - Answer-procedures and interventions that are
systematically applied to modify specific client factors when neurological,
musculoskeletal, or skin conditions are present that may be limiting occupational
performance
use various forms of energy to modulate pain, modify tissue healing, increase tissue
extensibilitiy, and decrease edema/inflammation
What are superficial thermal agents? - Answer-penetrat 1-2cm with heating or cooling
energy
ex: hydrotherapy, whirlpool, cryotherapy, fluidotherapy, hot pack, paraffin, water,
infrared
How do superficial thermal agents work? - Answer-conduction: direct contact with tissue
convection: energy swirls around tissue
What are deep thermal agents? - Answer-penetrate 0-5cm with heating or cooling
energy
ex. therapeutic ultrasound, phonophoresis, diathermy
What are electrotherapeutic agents? - Answer-use electricity and electromagnetic
spectrum to facilitate tissue healing, improve muscle strength and enducarnce,
decrease edema, modulate pain, decrease inflammatory process, modify the healing
process
,ex. neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES),
transcutaneous electrical nerve stimulation (TENS), high voltage galvanic stimulation
(ESTR), high voltage pietsid current (HVPC), iontophoresis
What is pain? - Answer-unpleasant sensory and emotional experience associated with
actual or potential tissue damage or described in terms of such damage
What was specificity theory? - Answer-idea that pain is a direct transmission system of
a pain impulse from nociceptor carried by A-delta and C-fibers from periphery to pain
center in the brain via the lateral spinothalamic tract
mental pain is different from physical pain
What is the role of A-delta fibers? - Answer-small, fast, protective pain fibers
What is the role of C-fibers? - Answer-slow, chronic pain fibers
What is the role of A-beta fibers? - Answer-large pain inhibition fibers
What did Beecher discover about pain? - Answer-discovered there is no relationship
between wound severity and intensity of reported pain but there is a relationship
between psychological status and objective drug response
pain is more complex than originally believed
What is gate control theory? (Melzack and Wall) - Answer-pain results from a series of
exchanges among the peripheral nerves, spinal cord, and the brain
What are the three components of gate control theory? - Answer-peripheral nerves
spinal cord
brain
How does nociception work in the peripheral nerves? - Answer-nociceptors convert
external traumatic stimuli into electrical activity as primary afferent nerves that conduct
sensory information from PNS to CNS
CNS pain information is transmitted from primary sensory neuron to central projection
neurons
What are nociceptors? - Answer-detect sensation as other receptors with a higher
activation threshold to detect potential or actual tissue damage
What does the pain pathway look like in the spinal cord? (gate control) - Answer-pain
signal transmitted by nerve fibers enter the spinal cord at the dorsal horn (gate) and
release neurotransmitters to activate nerve cells in spinal cord and process information
and transmit it up to the brain
, What does the pain pathway look like in the brain? (gate control) - Answer-pain
messages travel up the spinal cord and arrive at the thalamus that forwards messages
to the somatosensory cortex, limbic system, and the frontal cortex
brain responds to messages by sending a secondary message to spinal cord to
moderate pain (gate control)
What is the fast pain pathway in the brain? - Answer-production of endorphins that
travel to the thalamus and cortex to decrease pain or injury by attaching to the Mu
receptors (opiod theory)
What is the slow pain pathway in the brain? - Answer-chronic afferent pathway to
hypothalamus and limbic system that releases stress hormone and pain i s assigned
meaning
What is the efferent pathway? (gate control) - Answer-messages descend from brain to
spinal cord that opens or closes the gate
What factors cause the pain gate to open? - Answer-sensory - injury, inactivity, drug
use, body mechanics, pacing of activities (cycle of pain)
cognition - focusing on pain, outside interest, worrying
emotional - depression, anger, anxiety, frustration, hopelessness, helplessness
What is acute pain? - Answer-protective function to indicate tissue damage that lasts a
short amount of time
What is acute recurrent pain? - Answer-episodes of pain with pain free periods between
"flare ups" that lasts less than 3 months with an identified physical process
What is chronic pain? - Answer-pain that occurs past the point of tissue healing and is
less indicative of tissue damage that lasts more than 3-6 months with a non specific
identifiable cause due to nerve damage or nervous system reaction
the brain and ANS do no think the tissue is healing
What is referred pain? - Answer-pain perceived at a location other than the site of
painful stimuli/origin due to network of interconnecting sensory nerves and different
tissue
What is neuropathic pain? - Answer-nerve pain/neuropathy causing injury or irritation to
nerve and pain persists unrelated to injury or condition
under chronic pain category
