Fourth Orthotics Mock Exam

Question 1

A patient is seen in clinic for a follow up appointment and is disappointed with the results of his custom solid AFO as he still has a pronounced knee hyperextension moment during stance phase of gait. You noticed this at his last follow up and had your technician add 1/4” heel lift to relatively dorsiflex the AFO to decrease the knee extension moment in stance. What should your first reaction be to this?

Answer 1

Check the durometer of the 1/4” heel lift your technician added.
Often times practitioners add a heel wedge to an SAFO to decrease knee hyperextention thrust but, the durometer of the heel wedge is most important as a soft heel wedge will cause ground reaction forces to remain anterior to the knee during loading response whereby increasing knee hyperextention. By utilizing a firm durometer for the heel wedge you can promote knee flexion. Note: check quadriceps strength prior to doing this as they must be able to control the flexion moment.

Question 2

What all is found in the sartorius (femoral) triangle?

Answer 2

Femoral nerve, femoral artery, sartorius muscle and inquinal lymph nodes are all found within the scarpa’s triangle.
Note: Remember SAIL: Sartorius, adductor longus, inquinal ligament

Question 3

A patient is seen in clinic, you are filling in for a sick practitioner whom delivered a KAFO 1 week earlier. The patient was provided the KAFO as he has 30 degrees genu recurvatum and 15 degrees fixed plantarflexion contracture. The patient states he has a hard time getting over his foot at midstance and that, while his knee extension is decreased, he feels excessive pressure on the posterior aspect of his knee. What adjustments or additions can you make to remedy this problem?

Answer 3

Add a 15 degree tapered heel wedge to the foot plate and add a contralateral heel lift.
By adding a 15 degree tapered heel wedge you will neutralize the KAFO in the sagittal plane allowing for a smoother rollover at midstance. It will also be necessary to add a contralateral shoe lift equal to the height of the tapered heel wedge to maintain a level pelvis as well as to assure proper clearance of the KAFO during swing phase of gait.

Question 4

A patient is seen in clinic. The patient is utilizing foot orthotics with 3/8” heel lifts to decrease inflammation of her “achilles tendonitis”. What lumbar pathologies could this aggravate?

Answer 4

L5-S1 spondylolisthesis, DJD of the lumbar facet joints, lumbar spondylolsis.
When recommending heel lifts for achilles tendonitis recognize that it will increase lumbar lordosis. The listed lumbar pathologies are all treated by decreasing lumbar lordosis and can be aggravated by heel lifts on a relative scale.

Question 5

You are seeing a patient with a diagnosis of peripheral vascular disease. What is the common artery that you can palpate to asses blood flow?

Answer 5

Dorsalis pedis.

Palpate the dorsalis pedis pulse along with capillary refill

Question 6

What would you recommend for an addition to an articulated AFO for drop foot and posterior lateral hyperextension thrust of the knee (mild tone is present)?

Answer 6

PF stop will decrease drop foot in swing, 1/4” heel/lateral wedge will negate the posterior lateral knee extension thrust, and the metatarsal pad in combination with elevation of the 2nd-5th MTP’s and digits have been shown to decrease tone on a relative scale.

Question 7

What additions can you make to an AFO to decrease excessive pronation within the AFO?

Answer 7

Extrinsic medial wedge, medial sabolich tab or trim line and/or sustentaculum tali “ST” pad

Question 8

A patient has failed conservative treatment for plantar fasciitis including foot orthotics, physical therapy, shoe wear modification. What are the surgical interventions?

a. arthrodesis
b. ankle fusion
c. gastroc lengthening
d. plantar fascia release
e. a and b
f. c and d
g. All of the above

Answer 8

f. Gastroc lengething and plantar fascia release.
Ankle fusion and triple arthrodesis surgeries are not performed for plantar fasciitis. Usually treated arthritis with fusion of the calcanealcuboid, talonavicular, and talocalcaneal joints of the foot.

Question 9

A patient is seen in clinic. She presents with severe chronic bilateral posterior tibialis tendon dysfunction “PTTD”. She has worn custom UCBL’s in the past but they were ineffective. What would be the most appropriate recommendation given her presentation and past?

Answer 9

An articulated AFO.
Given that UCBL’s were ineffective, articulated AFO’s would be appropriate as they grasp the lower legs and can help to modify internal tibial rotation. By decreasing internal tibial rotation, pronation will decrease whereby decreasing the work load of tibialis posterior muscle

Question 10

A patient is seen in clinic whom has been diagnosed with guillain-barre syndrome. The patient has weak knee extensors, knee flexors, and ankle plantarflexors, and ankle dorsiflexors. What muscle groups would you expect to regain strength first if the syndrome begins to remit?

Answer 10

Knee extensors and flexors proximal to distal.

Question 11

Having a patient perform a heel raise, screens what myotomal level?

Answer 11

S1, having a patient plantarflex is a screening technique for S1 myotome.
Often in the clinic a clinician will have a patient walk on their toes for S1 myotome screen and then walk on their heels for L4-5 screen

Question 12

You have provided a patient with an articulated AFO and PF stop. When that patient ambulates you notice that they have pronounced knee flexion during loading response. What can cause this?

Answer 12

Firm extrinsic heel wedge, PF stop is too dorsiflexed. Both of these can cause ground reaction forces to translate posterior to the knee joint rapidly causing abrupt knee flexion during loading response

Question 13

True or false, when designing a ground reaction AFO “GRAFO” foot plate, length can be full or sulcus length.

Answer 13

False, GRAFO’s tend to be fabricated with full foot plates so as to utilize a longer lever arm to resist knee instabilities throughout stance phase of gait

Question 14

Damage to the femoral nerve will result in weakness of what main muscle group?

Answer 14

Knee extensors
The femoral nerve (L2, L3 and L4) innervates the quadriceps femoris muscle which serves to extend the knee. The hip extensors are innervated by the sciatic nerve. Hip abductors are innervated by the superior gluteal nerve. Ankle dorsiflexors are innervated by the tibial nerve

Question 15

What describes the design of a GRAFO?

Answer 15

Trim lines for a GRAFO include Anterior/distal and posterior/proximal opening as well as posterior/distal and anterior/proximal areas of AFO contact. NOTE: it is important to make sure the patient can fit their foot and lower leg through the opening which tends to be narrow, but it is important to trim carefully so as not to lose the supportive structure of the GRAFO

Question 16

True or False: a patient utilizing an articulated AFO with a full foot plate complains that it is hard to roll over their foot smoothly throughout stance. Recommending rocker sole shoe and or cutting the foot plate to sulcus length would be appropriate (assuming the have good knee stability in the sagittal plane)

Answer 16

True, sulcus length foot plates and rocker shoes can both contribute to a relatively smooth roll over in stance phase

Question 17

True or false, the duration of double support varies inversely with the speed of walking and, in running, double support is absent.

Answer 17

True, in slow walking double support increase compared to the swing phase.

Question 18

True or false, when fabricating a KAFO the distal/posterior thigh band and the proximal/posterior calf band should be located equidistant from the knee axis.

Answer 18

True, When fabricating a KAFO the distal/posterior thigh band and the proximal/posterior calf band should be located equidistant from knee axis so as not to impede knee flexion and soft tissue impingement in the popliteal fossa

Question 19

A patient is seen in clinic. the patient is utilizing a KAFO for post polio syndrome. The ankle joint height is located correctly but the mechanical ankle joint is in need of replacement for the third time. What could cause this?

Answer 19

Tibial torsion was not build into the KAFO. If premature wear is notice in a KAFO ankle joint that is located at the proper height often times tibial torsion was not build into the othosis causing a lick of congruency between the anatomical and mechanical ankle joint

Question 20

In normal gait, maximum knee flexion reaches approximately What degrees?

Answer 20

60 to 65 degrees, knee flexion durning swing phase in normal gait

Question 21

When taking an impression and delineation for a KAFO what landmark represents knee enter?

Answer 21

The midpoint between medial tibial plateau and adductor tubercle. When taking and impression and delineation for a KAFO, knee center is represented by the midpoint between MTP and the adductor tubercle

Question 22

Patellar tendon bearing AFO is indicated for which pathologies?

Answer 22

Charcot joint, avascular necrosis of the talus, osteoarthritis of the ankle joint, and calcaneal fracture are all pathologies potentially utilize a PTB AFO to un-weight the affected area during weight bearing

Question 23

What is the primary function of brachioradialis?

Answer 23

elbow flexion, Brachioradialis muscle serves to flex the elbow

Question 24

A KAFO patient is seen in clinic for follow up. The patient has utilize a KAFO for three years but has developed avascular necrosis “avn” of the femoral condyles. What change could you make to the current KAFO to allow for minimal ambulation with out slowing the reversal of AVN?

Answer 24

Incorporate ischial weight bearing. By fabricating an ischial weight bearing brim you can load proximally while unloading distally at the femoral condyles whereby allowing for minimal ambulation while treating AVN

Question 25

True or false, an RGO allows forward progression by harnessing energy from one hip extension and translating it into contralateral hip flexion

Answer 25

True, by harnessing energy from one hip's extension and translating it into contralateral hip flexion and RGO can facilitate forward progression

Question 26

The radial nerve is injured within the radial groove. What muscle would not be paralyzed?

Answer 26

Triceps, the triceps muscle is innervated by the radial nerve, but when injury occurs at the radial groove usually it is just weakness not paralyzed. All the muscles in the posterior compartment will be paralyzed leading to wrist drop

Question 27

When turning a conventional AFO into a dorsiflexion assist AFO, how would you set up double action ankle joint?

Answer 27

Springs in the posterior channel will produce dorsiflexion assist in double action ankle joint

Question 28

A patient is seen in clinic with flaccid ankle plantarflexors and dorsiflexors. Choose appropriate double action joint configurations.

Answer 28

Pins in the anterior and posterior channels or springs in the posterior channels and pins in the anterior channels, both these configurations will provide anterior and posterior support for flaccid ankle plantarflexors and dorsiflexors

Question 29

The claw hand appearance of the hand is due to damage to what nerve?

Answer 29

Ulnar nerve, Damage to the ulnar nerve commonly occurs where it passes posterior to the medial epicondyle on the humerus. The patient is likely to have difficulty making a fist due to paralysis of the intrinsic muscles of the hand. Claw hand comes from inability to flex the 4th and 5th MCP joint

Question 30

The patient is seen in clinic with flaccid ankle plantarflexors and dorsiflexors. The patient also buckles at the knee during loading response/heel strike. You have choosen to recommend a conventional with double action ankle joint. What would be the most appropriate configuration of the ankle joints?

Answer 30

Springs in the posterior channels and pins in the anteriors channels. By having springs in the posterior channels and pins in anterior channels you will provide adequate anterior posterior support to the lower leg muscular imbalance but the posterior springs will allow controlled plantarflexsion during loading response whereby keeping the ground reaction forces anterior to the knee joint to decrease knee buckling

Question 31

A patient with Duchennes muscular dystrophy is seen to ambulate with increased lumbar lordosis secondary to which muscular weakness?

Answer 31

Hip extensor. Individuals with duchennes muscular dystrophy often present with weakness of the hip extensors. By increasing lumbar lordosis the position of their center of mass is posterior to the hip joint which locks the hip against the Y-ligament allowing for stability in the sagittal plane.

Question 32

A patient sustains a hangman fracture. This fracture can cause quadriplegia. What vertebrae and location of the fracture is damaged?

Answer 32

Atlas, lamina (pars interarticularis) C2. Hangman's fracture occurs from fracture through the lamina of the axis. Another injury to the axis is displacement of the dens which may also cause quadriplegia

Question 33

When designing a thermoplastic KAFO for a patient with severe genu recuravatum, what can you incorporate that will help control the knee hyperextension?

Answer 33

Extending the distal/posterior thigh trim lines more distally, decreasing the depth of the thigh section, extending the proximal posterior calf trim line proximally and decreasing the depth of the calf section. All of these design modifications will aid in decreaseing genu recurvatum

Question 34

A patient wearing a KAFO is seen in clinic. The patient complains of anterior thigh pressure while sitting. What could be the cause?

Answer 34

the mechanical knee joint is too distal in relation to the anatomical joint. If the mechanical knee joint of a KAFO is too distal in relation to the anatomical joint the patient will experience pressure on the anterior portion of the thigh while sitting

Question 35

The erector spine muscles are found in the intermediate layer of the muscle layers of the muscles in the back. When they act bilaterally, they extend the vertebral column. When they act unilaterally what action do they perform?

Answer 35

Laterally bend the vertebral column. The erector spine muscles act to extend the vertebral column and unilaterally act to laterally bend the column. Stabilize vertebrae durning local movements of the vertebral column is performed by the deep layer known as transversospinal muscles (multifidi, semispinalis, rotatores).

Question 36

True or false. A child wearing a pavlic harness in treatment for congenital dislocation of the hips should have their hips oriented in flexion and adduction.

Answer 36

False, a child wearing a pavlic harness in treatment for congenital dislocation of the hips should have their hip oriented in flexion and abduction

Question 37

A 240lb female bears how much weight collectively through her right 2nd-5th MTP joints while standing evenly on both feet.

Answer 37

40lbs, A 240lbs patient when standing evenly on both feet will have 120lbs on each foot. 50% goes through the calcaneus and 50% goes through the MTP joints. MTP's 2-5 receive 66.6% of the total weight on the forefoot. .666X60lbs=40lbs

Question 38

The axillary nerve innervates teres minor. What other muscles does it innervate?

Answer 38

Deltoid, axillary nerve also innervates the deltoid. At times there is injury to this nerve with shoulder dislocation

Question 39

True or false, guillain-barre syndrome progresses in a ascending order.

Answer 39

True, Guillian-barre syndrome progresses in an ascending order "distal to proximal" and recovers in a descending order "proximal to distal".

Question 40

A child is seen in clinic. The child is playing on the floor and proceeds to use his hands to stand up by pushing off of his lower extremities until upright. What is the name of this maneuver and what diagnosis does this boy most likely have?

Answer 40

Gowers sign and duchennes muscular dystrophy. Duchennes muscular dystrophy is most common in you males and is characterized by the gowers sign "walking of the hands up lower extremities while standing" which is compensating for proximal lower extremity weakness

Question 41

The lumbricals act to do what?

Answer 41

Flex the MP joints and extend the IP joint. Lumbrials act to flex the MP joint and extend IP joints. The interossei muscles act to either adduction or abduct the digits along with pairing with the lumbricals to flex the MC joints and extend the IP joint

Question 42

When fabricating an AFO, the lateral proximal trim lines is located approximately 1 inch inferior to the fibular neck. What is the anatomical structure you are trying to avoid by doing this?

Answer 42

Common fibular nerve. The common fibular nerve "common peroneal nerve" runs just inferior to the fibular head superficially. Trim lines should be design to avoid impingement of this nerve when fabricating a AFO

Question 43

The nominate bone of the pelvic girdle is known as what?

Answer 43

Sacrum. The pelvic girdle is mad up of the innominate bones of the iliums that articulate with the sacrum known as the nominate bone

Question 44

The claw hand appearance is characterized by an injury to what nerve?

Answer 44

Ulnar nerve. Ulnar nerve injury will result in 4th and 5th MCP joints extended and IP joints of the same fingers are flexed

Question 45

Injury to the medium nerve will result in what characteristic appearance when a patient tries to make a fist?

Answer 45

Ape hand and hand of benediction. Injury to the median may result in loss of opposition and flexion of the thumb resulting in the ape hand deformity. Also the of benediction results from injury of the median nerve at the elbow or upper arm.

Question 46

At heel strike the knee joint is at ____ while the ankle joint is at_____.

Answer 46

At neutral/full extension, 90 degrees/neutral.

Question 47

Trendeleburg gait can be seen in patients after they have total hip arthroplasty, injury to the superior gluteal nerve, and poliomyelitis. This is caused by weakness in what muscle?

Answer 47

Gluteus medius. Weakness of the gluteus medius results in trendelenburg gait. durning the stance phase the pelvis on the opposite side drops due to weakness on the stance side

Question 48

A patient with C6 quadriplegia is able to use a tenodesis grip. What is the action that occurs?

Answer 48

Wrist extension which causes MP flexion. C6 quadriplegic patients functionally uses tenodesis grasp. This is caused by wrist extension which allows passive MP flexion

Question 49

The deltoid muscle acts to abduct the shoulder with what other muscle?

Answer 49

Supraspinatus. Supraspinatus part of the rotator cuff assists with a abduction of the glenohumeral joint.

Question 50

You are seeing a patient in acute rehab with a physical therapist. The patient has had a CVA. Upon examination you see foot drop durning gait, weak dorsiflexors grade 2, weak inversion and eversion grade 2, and increased tone in her plantar flexors. What would be an appropriate orthotic device?

Answer 50

A solid ankle AFO. A solid ankle AFO is indicated for a patient with drop who is also has spasticity as a spiral AFO and dorsiflexion assist AFO might increase her tone and are not sufficient to control spasticity.

Question 51

A 16 year old patient has suffered an L2 complete spinal cord injury. What would be the most likely functional expectation and orthosis for this patient?

Answer 51

Ambulation with bilateral AFO's and canes. A lesion at the level of L2 would be a lower motor neuron lesion as it is a cauda equina injury. You would expect that the patient would have intact hip flexion, hip adduction, and knee extension. This patient would only need AFO's as bracing for the knee is not needed due to knee extension is still intact

Question 52

Anterior displacement of the vertebral body on the lower vertebrae is called what?

Answer 52

Spondylolisthesis. Spondylolisthesis is described by the percentage of the anterior displacement of the vertebral body described by 4 grades (grade 1 0-25%, grade 2 25-50%, grade 3 50-75%, grade 4 75-100%) Spinal stenosis is the narrowing of the spinal column. Spondylosis is a term for osteoarthritis of the spinal column or neutral foramen. Spondylitis is inflammation of the vertebra

Question 53

A 54 old female patient recently referred to your office for a KAFO style orthosis after several FTA (fail to appear) missing appointments for final fitting, you should what?

Answer 53

Call the prescribing physician and advise him that the device has yet to be fitted. The physician should be notified as they referred the patient to your office so hippa laws apply

Question 54

When taking an impression for a KAFO, or the best possible impression, it is important to use the segmented impression procedure and what?

Answer 54

posterior popliteal rest. The posterior popliteal rest when properly positioned, helps to assure that correct positioning of the impression will help control recurvatum in the impression

Question 55

Your office receives a telephone call from a lawyer's office claiming to represent your patient Ms. couchkiller in her lawsuit with the local hospital. They are requesting a copy of her chart and are willing to pay you handsomely to send them overnight. You should reply to this request how?

Answer 55

Ask for the request in writing showing the signed release form of the patient for the information requested prior to complying with request. Hippa privacy law apply to all requests of personal information pertaining to the treatment or personal info

Question 56

A visually impaired 70 year old male patient is referred to your office with a prescription for a HYPEREXTENSION back brace for an anterior thoracic compression fracture as a result of a fall at home. Upon PE, you find a male with marked kyphosis and significant arthritis of both hands. Your choice of orthotic devices should include...

Answer 56

Utilization of velcro for the closure to adapt to the patients arthritis. If the patient cannot donn the devise, the weight and ability to make adjustments are of no value to him

Question 57

When evaluating a 14 year old female patient referred to your office with a prescription for a crouch gait orthosis. Upon observing her gait you are considering several styles of orthoses, they are...

Answer 57

custom molded floor reaction AFO with solid ankle and full footplates. The floor reaction design style includes an anterior pre-tibial shell to exert an anterior force keeping the knee in extension and controlling knee flexion. The solid ankle and full footplate help with the needed stability during all phases of gait.

Question 58

During a follow up appointment with a 71 year old status post CVA patient who lives alone you fitted with a custom fabricated AFO with solid ankle and flexible full footplate PE reveals a reddened area on the tibial crest area. The patient denies any pain or discomfort, prior to scheduling for her 6 month follow up visit, you should what?

Answer 58

Add a hypo allergenic pad to the anterior velcro closure. By adding a hypo allergenic pad to the velcro strap you are distributing the pressure exerted on the anterior tibial area and making sure it is hypo allergenic and the patient denies pain or discomfort as well as the fact that she lives alone, you are assuring there will be no further pressure or skin issues with the patient. Additionally, you should schedule her for a follow up appointment sooner than 6 months to make sure that your remedy corrected the redness

Question 59

True or False: When taking an impression for a dorsiflexion assist AFO, the patient's optimum ankle foot position is in sub talar pronation forefoot neutral.

Answer 59

False, the optimum placement of the foot/ankle complex is sub talar neutral and when the patient is wearing appropriate footwear, the ankle should be 0 to 5 degrees of dorsiflexion to allow the foot to clear the floor

Question 60

Mrs. Backscratch, a patient of Dr. Heart comes into your office and tells you that her friend was fitted with a lumbosacral support low back pain and that she tried ther corset on and it felt really good. You have and excellent working relationship with Dr. Heart, and you feel it will be ok with him for you to fit her with a corset similar to her friends. Are you correct in fitting he with device even though you do not have a prescription and plan on billing Mrs. Backscratch insurance company?

Answer 60

No, in order to submit a claim for third party reimbursement you must have a written, signed prescription from a physician. Also please not that it is good practice management to whenever possible, no matter how minor or simple you feel the device is to have a prescription for the dispensed device.

Question 61

Mrs. Smith is referred to your office with a prescription for a new replacement KAFO. Upon PE, you find that she had Polio as a child. When treating persons that have had polio, we must be aware that they will have decreased what?

Answer 61

Joint stability in all planes, sensation, and muscle function. Polio affects the muscles ligaments and nerves on the affected limbs although, unlike those persons suffering from a stroke, they do not have issues with propriception or speech

Question 62

Oftentimes, we are asked to see a patient with an abdominal hernia. When fitting patients with this disorder, they are best fitted in which position?

Answer 62

Lying on their back with knees flexed. By having the patient in the supine position, gravity works with you, keeping both the abdominal muscles at rest and strain of the hernia relaxed

Question 63

The term propriception means...

Answer 63

knowing where an extremity is in space. The term propriception means for latin proprius, meaning one's own and perception is the sense of the relative position of neighboring parts of the body

Question 64

A patient is referred to your facility for a LSO corset with three pull design. When fitting a the patient, the posterior staves should be shaped to the patient while in what position?

Answer 64

Standing. When the patient is standing, the spine is in the loading position meaning that the para spinal musculature is tensed. When sitting the spine is flattened and if the staves are shaped to this position they will offer little support

Question 65

True or False: When contouring the posterior bars of a PML, spinal orthosis LSO knight spinal the side bars should be contoured to the patient's lordosis with no voids

Answer 65

False: When contouring the paraspinal bars of any lumbosacral orthotic device. It is preferable to leave a slight void when standing and then have the patient sit ascertain the bars fit the contour of the patients spine while sitting to avoid excess pressure

Question 66

True or False: The tibialis anterior muscle functions in two roles during gait. It is an important dorsiflexor of the foot ankle complex as well as eccentrically contracts to slow plantarflexion of the ankle

Answer 66

True. The eccentric or lengthening contracture of the tibialis anterior muscle decrease foot slap by slowing plantar flexion moment at initial contact or heel strike during gait

Question 67

The primary muscles of the lower extremity that both flex the hip and extend the knee are know as the...

Answer 67

Quadriceps.

Question 68

The tricep muscles ____ the lower arm.

Answer 68

Extend

Question 69

True or False: When testing the quadricep muscles group, a grade of 3 or good requires the patient to be tested in the horizontal plane and holds test position with no added pressure.

Answer 69

A grade 3 would show, in the horizontal plane, the ability to move the femur with assistance through normal flexion.

Question 70

The radial nerve innervates the _____ of the wrist.

Answer 70

Extensors

Question 71

Both the dorsal and palmar interossei are innervated by what spinal root levels?

Answer 71

C8-T1

Question 72

What muscle weakness results in winging of the scapula?

Answer 72

serratus anterior

Question 73

Volar surface of the forearm contains the ____ muscles, which, as a group, originate at the ______ humeral epicondyle.

Answer 73

wrist flexor, medial

Question 74

Which of the following nerves innervates the majority of the anterior muscles of the upper arm?

Answer 74

musculocutaneus

Question 75

How is the subluxed shoulder typically managed in hemiplegia?

Answer 75

sling

Question 76

The 2nd MP joint is abducted by the...

Answer 76

1st dorsal interosseus

Question 77

A dynamic IP extension assist with a MP extension stop should be used if a patient has what?

Answer 77

has lumbrical weakness and has hyperextended MP's

Question 78

The most common MP joint deformity in rheumatoid arthritis is...

Answer 78

volar subluxation and ulna deviation

Question 79

The mobile segments of the hand's transverse arch are which metacarpals?

Answer 79

1, 4, and 5

Question 80

Swan neck deformity causes the PIP joint to _______ and the DIP joint to _______.

Answer 80

PIP joint to hyperextend and the DIP joint to flex

Question 81

Wrist driven orthoses in a C-6 quadriplegic are powered by...

Answer 81

extensor carpi radialis longus and brevis

Question 82

In using the wrist driven tenodesis orthosis, what causes what motion?

Answer 82

wrist extension causes MP flexion

Question 83

A humeral fracture can be managed orthotically if it is in the ____ of the humerus.

Answer 83

distal 2/3s, soft tissue compression

Question 84

Combined MP flexion and IP extension are performed primarily by the...

Answer 84

lumbricals, assisted by interossei

Question 85

The most important motor acquisition of the C5 quadriplegic is?

Answer 85

shoulder and elbow flexion

Question 86

Which body movement are typically used to power cable driven tenodesis orthosis?

Answer 86

glenohumeral flexion and biscapular abduction

Question 87

A boutonniere deformity consists of PIP _______ and DIP ________.

Answer 87

PIP flexion with DIP hyperextension

Question 88

A peripheral nerve injury at the wrist of the ulnar nerve could be orthotically managed with what?

Answer 88

short opponens HO with a MP extension stop

Question 89

Which nerve rootsform the brachial plexus?

Answer 89

C5-T1

Question 90

At the wrist, a WHO wrist driven flexor hinge orthosis functions to _____ motion in the coronal plan.

Answer 90

hold

Question 91

The functions of the bicep brachii are...

Answer 91

elbow flexion and forearm supination

Question 92

In dupuytren's contracture, the ______ is most often involved.

Answer 92

palmar aponeurosis

Question 93

The desirable length of a thumb post is...

Answer 93

mid nail bed

Question 94

The MP extension stop should be fitted where?

Answer 94

Just proximal to the PIP joints

Question 95

The claw hand deformity is the result of injury to which nerve?

Answer 95

medial and ulnar

Question 96

Abduction and adduction occur within the hand at...

Answer 96

metacarpophalangeal joint

Question 97

What is a positive froment's sign indicator?

Answer 97

ulnar nerve loss

Question 98

Two muscles act to abduct the shoulder, one is the deltoid, the other muscle is...

Answer 98

supraspinatus

Question 99

A C6 Quadriplegic would have all the following muscles intact except what?

Answer 99

extensor carpi ulnaris,

Question 100

You are asked to recommend an orthosis for a 20 year old male how has sustained a L1 burst fracture. What is the best orthotic recommendation?

Answer 100

TLSO polymer

Question 101

Which orthosis is best suited to manage a T6, 1 column compression fracture?

Answer 101

TLSO sagittal and coronal contral

Question 102

Which orthosis is best suited to manage a compression fracture 20% anterior compression at T11?

Answer 102

TLSO anterior control

Question 103

The pectoral membrane fibers combine with which ligament?

Answer 103

posterior longitudinal ligament

Question 104

The correct pin placement for a HALO is ______ in the ______

Answer 104

10mm superior to the eyebrow, lateral 1/3 of the eyebrow

Question 105

An adolescent female with idiopathic scoliosis presents in your facility with a prescription for orthotic management. Based on the prescription, how is the patient most likely to present?

Answer 105

Risser sign of 1+, cobb angle of 35 degrees

Question 106

On which side of the orthosis should the trochanteric extension be placed?

Answer 106

the side of decompensation,

Question 107

The orthotic management of a T1 level fracture will have its best 3 point pressure system with which orthosis?

Answer 107

cervical thoracic orthosis

Question 108

What is the correct posterior superior trim line for a polymer TLSO not for scoliosis?

Answer 108

10mm inferior to the level of the spine of the scapula

Question 109

Upon looking at the surface anatomy of the back, it can be said that the spine of the scapula is at which approximate vertebral level?

Answer 109

T3

Question 110

What makes up the erector spinae?

Answer 110

Spinalis, longissimus, lliocostalis

Question 111

The end point vertebrae in a scoliosis curve are the...

Answer 111

last convergent vertebrae most superior and inferior to the null point

Question 112

Of the three types of odontoid fractures, which is most common and tends to have the least favorable outcome?

Answer 112

type 2

Question 113

All of these are characteristics of sheuermann's Kyphosis...

Answer 113

wedged vertebrae, schmoris nodes, osteochondrosis, self limiting disease

Question 114

Which of the following conditions should be positioned in sagittal flexion when managing with a orthosis?

Answer 114

spinal stenosis

Question 115

The axillary's extension of a boston brace style scoliosis for a double curve should extend from the...

Answer 115

Window to about T5

Question 116

What does it mean when there is a grade II pedicle rotation?

Answer 116

pedicle is rotated 2/3 toward midline

Question 117

Which of the following is a modification that should be made to a scoliosis orthosis for a patient with hypokphosis?

Answer 117

extend the posterior superior trim line to T3

Question 118

Spastic paralysis may result from...

Answer 118

spinal cord injury and brain injury

Question 119

your patient has suffered a single level burst fracture. The greatest instability, given the nature of the fracture, would be in which plane?

Answer 119

transverse

Question 120

For the assembly of the TLSO anterior control what should be done to the overall height measurement?

Answer 120

decreased by 72mm

Question 121

Placement of a thoracic band on a conventional orthosis should be where?

Answer 121

10mm inferior to the most inferior inferior angle of the scapula

Question 122

In fitting milwaukee CTLSO, the height of the neck ring is located _____ to the mandible

Answer 122

36mm inferior

Question 123

What is not considered neuromuscular scoliosis?

Answer 123

neurofibromatosis

Question 124

In a scoliotic curve the spinous processes rotate toward the...

Answer 124

concavity

Question 125

In an adult the spinal cord terminates at about the level of which spinal segment?

Answer 125

L1

Question 126

What is the method used to find the baseline for corset measurement?

Answer 126

Inferior costal margin to iliac crest divided by two

Question 127

If you use a TLSO sagittal control and found the patient could not tolerate the strap pressure in the axilla what might be done?

Answer 127

Pad the strap, use a harness chest strap with sternal plate

Question 128

The nucleus pulposus of an intervertebral disc do what?

Answer 128

absorbs shock and equalizes stress

Question 129

An individual with neuromuscular scoliosis will most likely exhibit cardiopulmonary compromise when the curve reaches what magnitude?

Answer 129

70 degrees

Question 130

The lower motor neuron cell body is found in the _____ while the upper motor neuron cell body is found in the ____

Answer 130

ventral horn of the spinal cord, motor cortex of the brain

Question 131

For a typical right thoracic, left lumbar adolescent idiopathic scoliosis curve the superior aspect of the window should be ____ while the superior aspect of the axillary extension should be approximately at the level of ________.

Answer 131

at least one rib superior to the apical rib, T5

Question 132

Another name for a Knight orthosis is a...

Answer 132

LSO sagittal/coronal control

Question 133

In what position should spinal orthoses be tightened on a patient?

Answer 133

supine

Question 134

What are the clinical signs of scoliosis?

Answer 134

Positive adams test, asymmetrical gapping between arm and waist, shoulder asymmetry.

Question 135

In scoliosis an apical vertebra at T12 would indicate what kind of curve pattern?

Answer 135

Thoracolumbar

Question 136

Which stage of menarche would be mast suitable for orthotic management?

Answer 136

Greater than six months pre-menarche

Question 137

While under axial loading there is pressure on the nucleus pulposus which in turn causes the annulus fibrosis to stretch. This phenomenon is most consistent which biomechanical mechanism?

Answer 137

load sharing

Question 138

Hypokyphosis can be defined as having a sagittal curve magnitude in the range of...

Answer 138

0-20 degrees

Question 139

the TLSO anterior control has two anterior pads that provide a posteriorly directed force. The anteriorly directed force by the posterior pad should provide what amount of force?

Answer 139

equal to that posteriorly directed force

Question 140

What is the most likely mechanism of injury for a seatbelt fracture (chance fracture)?

Answer 140

flexion distraction

Question 141

In the spine, the most rotation occurs at which joint?

Answer 141

atlantoaxial joint

Question 142

What characteristic is unique to the cervical spine?

Answer 142

transverse foramen

Question 143

Two adjacent vertebrae and their intervening tissue are known as a...

Answer 143

motion segment

Question 144

A patient presents in your office with an atypical curve L thoracic R Lumbar this is most likely associated with what disease?

Answer 144

syringgomyelia

Question 145

A burst fracture of the vertebral body is most likely associated with which mechanism of injury?

Answer 145

axial load

Question 146

What could be considered the fracture site for spondylolysis?

Answer 146

isthmus, pars interarticularis, neural arch

Question 147

A Jefferson fracture is a fracture of _____ while a hangman fracture is a fracture of____.

Answer 147

C1 and C2

Question 148

Wedge vertebra, bar vertebra, and hemi vertebra are seen most frequently in which type of scoliosis?

Answer 148

congenital

Question 149

What measurements are needed to fabricate a milwaukee CTLSO?

Answer 149

sagittal diameter of neck, coronal diameter of neck, height to mandible

Question 150

What effect does reducing decompensation have on the critical load of the spine?

Answer 150

decreases