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Occupational Therapist's Management of Upper Extremity Burns (Day 4)

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1.  A patient with arm and hand burns is referred to you in the outpatient clinic. After assessing the skin during the initial evaluation, you note several areas of scar with open wounds remaining. Your therapy plan includes:
  1. Strengthening for return to work as soon as possible
  2. Keeping the joints near open areas immobilized, no motion should occur until all wounds are closed
  3. Local wound care, scar management where appropriate, advancing motion and strength
  4. Wound care only, scar cannot be addressed until wounds are closed
2.  Your patient has a large TBSA burn with both hands involved. The surgeons have not been able to graft the hands which are full thickness burns on the dorsal surface. You notice the hands are posturing into a claw position. You should:
  1. Fabricate orthotics as close to intrinsic plus as possible and avoid composite flexion until exten-sor tendon integrity is determined
  2. Fabricate finger gutter orthotics to keep the IP joints in extension
  3. Mobilize the hands into composite fist flexion to avoid loss of functional motion
  4. Treat aggressively for edema
3.  A patient is referred to your clinic directly from a burn center with healing bilateral hand burns. One hand is completely closed and in a compression glove without a dressing. The other hand has an open area over the dorsal PIP joint and is posturing in PIP flexion. You suspect:
  1. The central slip is at risk for exposure and attenuation, a PIP extension orthotic is required
  2. The hand is ready for a compression glove to manage edema and scar
  3. The hand is still swollen and apply Coban over a small dressing
  4. A contracture has occurred an allow fusion in this position
4.  You are seeing a patient who has healed autograft on the dorsal hand into the webspaces and dorsal digits. You notice thickened and raised scar at the graft borders. Scar management op-tions include:
  1. Coban wrap for edema then a custom fitted compression glove
  2. Pressure or silicone along the graft borders with a custom fitted compression glove
  3. Strengthening to prevent functional loss
  4. Scar massage and active motion
5.  You have been following a patient over a month with an isolated dorsal digital burn. The wound closed and scar has been forming over the dorsal surface. You notice composite flexion is lim-ited but now the patient cannot fully extend the DIP joint. What has likely occurred?
  1. A mallet injury from tendon ischemia
  2. Intrinsic tightness limiting composite flexion
  3. The central slip has ruptured and a boutonniere deformity is evident
  4. Scar management wasn't aggressive enough
6.  A patient with arm and hand burns was admitted to the ICU overnight and has escharotomies to both arms and hands. After assessing the wounds and completing the evaluation, your therapy priorities are:
  1. Positioning and edema management, hands and arms cannot be mobilized after escharotomy
  2. Keeping the patient comfortable, hands and arms cannot be mobilized after escharotomy
  3. Strengthening for return to work as soon as possible
  4. PROM, AROM if able, positioning and edema management
7.  An elbow flexion contracture with a firm to hard end feel is best treated by:
  1. A static progressive orthotic
  2. A dynamic mobilization orthotic
  3. Serial static casting
  4. A nonconforming static orthotic
8.  Petrolatum topical can be safely used on skin, open wound and scar but is not as useful for:
  1. Deep 2nd and 3rd degree burns
  2. Dry healed skin
  3. Scar massage
  4. Newly formed scar with small open areas
9.  Negative pressure wound therapy is commonly used at burn and trauma centers. One disad-vantage of a "VAC" dressing is:
  1. Cannot be used with large amount of wound exudate
  2. No motion or positioning is allowed while in the dressing
  3. Cannot be used on deeper, 4th degree wounds
  4. The wound cannot be visualized within the dressing
10.  Early excision and autograft is considered the optimal treatment for deep upper extremity burns. Autografts are:
  1. Taken from the patient's own donor skin and immobilized for 14 days
  2. Taken from the patient's own donor skin and can typically be mobilized within 3-5 days
  3. A temporary covering that is removed when permanent coverage becomes available
  4. Only used on dorsal hand burns