NBCOT Occupational Therapy Certification Final
Competency Certification Study Guide Exam Questions with
Certified for Accuracy Answers 2024/2025
What is the Bunnell test? - correct answer Test for *INTRINSIC TIGHTNESS* of the
hand
Perform PIP flexion with mcps blocked in extension, then in flexion. If there is intrinsic
tightness, there will be greater PIP flexion when the mcps are flexed.
What is the difference between intrinsic and extrinsic muscles of the hand? - correct
answer The intrinsic muscles are those that are entirely encased in the hand; they
both originate and insert there.
The extrinsic muscles are long muscles that originate in the forearm and insert in the
hand.
What is extrinsic tightness of the hand? - correct answer Greater PIP flexion when
mcps are extended.
Supposedly due to extensor tendon adhesions. Note that there are extrinsic hand
muscles on both the dorsal and volar aspect, so this doesn't really make sense :)
What are 4 interventions for hand fractures? - correct answer 1. Orthotics
2. Modalities
3. Early mobilization (3-6 weeks if fixation is stable)
4. HEP
Describe a median nerve injury - correct answer - Numbness/weakness in lateral
palm and 3 1/2 digits
- Loss of thumb opposition and palmar abduction.
,- *APE HAND* = resting hand position (low lesion)
- *SIGN OF BENEDICTION* = unable to flex 1-3rd digits when making a fist (high
lesion)
Low level - dorsal protection splint, wrist flexed 30
High level - same, but also splint elbow flexed 90
What is the Sign of Benediction? - correct answer - *MEDIAN NERVE* dysfunction,
high level
- Pt is unable to flex first 3 digits when asked to make a fist, so they remain extended
while the 4th-5th digits flex, resulting in what looks like the hand of a saint
Dorsal protection splint, wrist flexed 30 degrees plus elbow flexed to 90 degrees
Describe a radial nerve injury - correct answer *WRIST DROP* (impaired ability to
extend the wrist and digits).
Impairs ability to grasp, manipulate, and release objects.
Nonoperative = wrist cock up splint
Operative = wrist extension splint
Describe a ulnar nerve injury - correct answer - Numbness/weakness on ulnar side of
hand, 5th digit, and medial 1/2 of 4th digit
- *CLAW HAND DEFORMITY = resting hand position
- Loss of power grip (weak 4th and 5th digits)
- Decreased pinch strength (weak intrinsics)
Treated with MCP flexion block splint
,What is claw hand deformity? - correct answer - *ULNAR NERVE* dysfunction
- Hyperextension of 4th and 5th MP joints
- Flexion of 4th and 5th IP joints
- MCP flexion block splint
What is ape hand deformity? - correct answer - *MEDIAN NERVE* dysfunction, low
level
- Flat thenar eminence, thumb is adducted
- Loss of thumb opposition
Dorsal protection splint, wrist flexed 30 degrees
Median nerve distribution - correct answer Motor: Nearly all muscles of the anterior
forearm (flexors and pronators) and some hand intrinsics (thenar muscles and lateral 2
lumbricals)
Sensory: Palmar aspect of radial 3 1/2 digits, lateral palm, dorsal fingertips of lateral 3
digits
Radial nerve distribution - correct answer Motor: All muscles of the posterior arm and
forearm (triceps, extensors and supinators)
Sensory: Dorsal aspect of radial 3 1/2 digits, central and lateral posterior arm, central
posterior forearm, dorsal aspect of hand
Ulnar nerve distribution - correct answer Motor: The ulnar nerve innervates 2 anterior
forearm muscles (flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus) and
nearly all intrinsic hand muscles.
Sensory: 5th digit and ulnar 1/2 of 4th digit on palmar and dorsal surface
, What is heterotopic ossification? - correct answer The formation of bones in abnormal
areas. It typically occurs in soft tissue around the joint or joint capsule.
Look out for abnormal hard end feel and loss of ROM
What is the most common type of elbow fracture? - correct answer Radial head
fracture
- FOOSH injury
- Three types: nondisplaced, displaced with a single fragment, and comminuted
- Treated with long arm splint
What is the most common type of upper arm fracture? - correct answer Proximal
humeral fracture
- Early mobilization is key
- Treated with humeral fracture splint
What is Complex Regional Pain Syndrome (CRPS) and how do ots treat it? - correct
answer Excessive, prolonged, abnormal pain and inflammation following an injury.
Characterized by intense burning, swelling, sweating, and trophic changes
Gentle, pain free AROM for short periods (no PROM), stress loading, pain and edema
control techniques, energy conservation, desensitization.
What is cumulative trauma disorder? (Also called repetitive motion injury). - correct
answer - Trauma to soft tissue caused by repeated force
- E.g. Epicondylitis, dequarvain's, RTC tear, carpal tunnel, tendonitis, nerve
compression
Competency Certification Study Guide Exam Questions with
Certified for Accuracy Answers 2024/2025
What is the Bunnell test? - correct answer Test for *INTRINSIC TIGHTNESS* of the
hand
Perform PIP flexion with mcps blocked in extension, then in flexion. If there is intrinsic
tightness, there will be greater PIP flexion when the mcps are flexed.
What is the difference between intrinsic and extrinsic muscles of the hand? - correct
answer The intrinsic muscles are those that are entirely encased in the hand; they
both originate and insert there.
The extrinsic muscles are long muscles that originate in the forearm and insert in the
hand.
What is extrinsic tightness of the hand? - correct answer Greater PIP flexion when
mcps are extended.
Supposedly due to extensor tendon adhesions. Note that there are extrinsic hand
muscles on both the dorsal and volar aspect, so this doesn't really make sense :)
What are 4 interventions for hand fractures? - correct answer 1. Orthotics
2. Modalities
3. Early mobilization (3-6 weeks if fixation is stable)
4. HEP
Describe a median nerve injury - correct answer - Numbness/weakness in lateral
palm and 3 1/2 digits
- Loss of thumb opposition and palmar abduction.
,- *APE HAND* = resting hand position (low lesion)
- *SIGN OF BENEDICTION* = unable to flex 1-3rd digits when making a fist (high
lesion)
Low level - dorsal protection splint, wrist flexed 30
High level - same, but also splint elbow flexed 90
What is the Sign of Benediction? - correct answer - *MEDIAN NERVE* dysfunction,
high level
- Pt is unable to flex first 3 digits when asked to make a fist, so they remain extended
while the 4th-5th digits flex, resulting in what looks like the hand of a saint
Dorsal protection splint, wrist flexed 30 degrees plus elbow flexed to 90 degrees
Describe a radial nerve injury - correct answer *WRIST DROP* (impaired ability to
extend the wrist and digits).
Impairs ability to grasp, manipulate, and release objects.
Nonoperative = wrist cock up splint
Operative = wrist extension splint
Describe a ulnar nerve injury - correct answer - Numbness/weakness on ulnar side of
hand, 5th digit, and medial 1/2 of 4th digit
- *CLAW HAND DEFORMITY = resting hand position
- Loss of power grip (weak 4th and 5th digits)
- Decreased pinch strength (weak intrinsics)
Treated with MCP flexion block splint
,What is claw hand deformity? - correct answer - *ULNAR NERVE* dysfunction
- Hyperextension of 4th and 5th MP joints
- Flexion of 4th and 5th IP joints
- MCP flexion block splint
What is ape hand deformity? - correct answer - *MEDIAN NERVE* dysfunction, low
level
- Flat thenar eminence, thumb is adducted
- Loss of thumb opposition
Dorsal protection splint, wrist flexed 30 degrees
Median nerve distribution - correct answer Motor: Nearly all muscles of the anterior
forearm (flexors and pronators) and some hand intrinsics (thenar muscles and lateral 2
lumbricals)
Sensory: Palmar aspect of radial 3 1/2 digits, lateral palm, dorsal fingertips of lateral 3
digits
Radial nerve distribution - correct answer Motor: All muscles of the posterior arm and
forearm (triceps, extensors and supinators)
Sensory: Dorsal aspect of radial 3 1/2 digits, central and lateral posterior arm, central
posterior forearm, dorsal aspect of hand
Ulnar nerve distribution - correct answer Motor: The ulnar nerve innervates 2 anterior
forearm muscles (flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus) and
nearly all intrinsic hand muscles.
Sensory: 5th digit and ulnar 1/2 of 4th digit on palmar and dorsal surface
, What is heterotopic ossification? - correct answer The formation of bones in abnormal
areas. It typically occurs in soft tissue around the joint or joint capsule.
Look out for abnormal hard end feel and loss of ROM
What is the most common type of elbow fracture? - correct answer Radial head
fracture
- FOOSH injury
- Three types: nondisplaced, displaced with a single fragment, and comminuted
- Treated with long arm splint
What is the most common type of upper arm fracture? - correct answer Proximal
humeral fracture
- Early mobilization is key
- Treated with humeral fracture splint
What is Complex Regional Pain Syndrome (CRPS) and how do ots treat it? - correct
answer Excessive, prolonged, abnormal pain and inflammation following an injury.
Characterized by intense burning, swelling, sweating, and trophic changes
Gentle, pain free AROM for short periods (no PROM), stress loading, pain and edema
control techniques, energy conservation, desensitization.
What is cumulative trauma disorder? (Also called repetitive motion injury). - correct
answer - Trauma to soft tissue caused by repeated force
- E.g. Epicondylitis, dequarvain's, RTC tear, carpal tunnel, tendonitis, nerve
compression
