Understanding Your Combined Written Exam Results

If you received your test results for the Combined Written exam only to learn that you did not pass the exam, the following information may help you focus your study for retaking the exam. Your test results notice indicates your score in each Content Domain along with the maximum score in each area. We recommend that you focus your exam study on those Content Domains where you performed the weakest. Below, along with a description of the Content Domain, are sample questions to help you determine the types of questions that you may have missed.

Patient Evaluation

Take a comprehensive patient history, including previous use of a prosthesis, diagnosis, work history, avocational activities, signs and symptoms and medical history. Perform a diagnosis-specific functional clinical examination of sensory function, range of motion, joint stability and skin integrity. Utilize knowledge of anatomy, muscle functions, normal gait parameters, pathologies, related surgical techniques and disease processes to guide assessment. Refer patient to other health care providers for intervention beyond orthotic/prosthetic scope of practice.

A trendelenburg gait occurs with weakness of the:

1. Gluteus medius

2. Gluteus maximus

3. Adductor magnus

4. Rectus femoris

An amputation that removes the midfoot and forefoot saving the talus and calcaneus is called a:

1. Modified Symes

2. Lisfranc

3. Chopart

4. Transmetatarsal

Which of the following muscles are transected in a transmetatarsal amputation?

1. Peroneus longus

2. Extensor hallicus longus

3. Tibialis posterior

4. Tibialis anterior

Which of the following is the primary flexor of the elbow?

1. Biceps brachii

2. Brachioradialis

3. Anconeus

4. Brachialis

In normal gait the hip reaches maximum flexion during:

1. Loading response

2. Initial contact

3. Midstance

4. Mid swing

The most common congenital absence of a long bone in the extremities is:

1. Fibular hemimelia

2. Proximal Focal Femoral Deficiency

3. Congenital hypoplasia of the Tibia

4. Tibial phocomelia

Formulation of the Treatment Plan

Evaluate the findings to determine a prosthetic treatment plan. Consult with physician/referral source/appropriately licensed health care provider to modify, if necessary, the original prescription and/or treatment plan. Identify design, materials and components to support treatment plan, including how the prosthesis will address the specific functional needs.

One advantage of a knee disarticulation amputation is:

1. The ability to maintain rotational control of the socket

2. The ability to bear weight on the distal end

3. The ability to match the knee center on the sound side

4. The ability to provide good cosmesis with the prosthesis

The most appropriate control system for a patient with a self-suspending transradial prosthesis would be a:

1. Figure 8 harness with cross-back strap

2. Figure 8 harness with flexible elbow hinges

3. Figure 9 harness with single control cable

4. Figure 9 harness with chest strap

Which amputation level is MOST likely to develop an equinus contracture?

1. Chopart

2. Lisfranc

3. Symes

4. Transmetatarsal

Which of the following is considered a pressure tolerant area on a transtibial residual limb?

1. Tibial crest

2. Medial tibial flare

3. Fibular head

4. Tibial condyle

Implementation of the Treatment Plan

Select appropriate materials/techniques in order to obtain a patient model/image. Select appropriate materials and components for prosthesis based on patient criteria to ensure optimum strength, durability and function. Complete or delegate fabrication of prosthesis including positive mould rectification. Assess/align prosthesis for accuracy in sagittal, transverse and coronal planes in order to provide maximum function/comfort. Educate patient and/or caregiver about the use and maintenance of the prosthesis. Documentation using established record-keeping techniques to verify implementation of treatment plan.

During the initial dynamic alignment of a transfemoral prosthesis with an ischial containment socket you note a lateral shift of the socket during mid-stance. What is the most likely cause?

1. Lack of ischial containment

2. Foot is too far outset

3. A/P dimension is too large

4. Prosthesis is too short

The length of the forearm section of a transradial prosthesis is determined by measuring the sound side from the:

1. Acromion to thumb tip

2. Acromion to lateral epicondyle

3. Lateral epicondyle to ulnar styloid

4. Olecranon to thumb tip

What anatomical landmark is used when establishing the height of a transtibial prosthesis?

1. Fibular head

2. Medial tibial plateau

3. Tibial condyle

4. Adductor tubercle

Flexible elbow hinges on a long transradial residual limb prosthesis allow for rotation and:

1. Provide M/L stability

2. Limit elbow extension

3. Limit elbow flexion

4. Provide suspension

When establishing the static alignment for a transfemoral prosthesis with a microprocessor hydraulic knee component, the TKA line should be:

1. Through the mechanical knee joint axis

2. 0-5mm anterior to the mechanical knee joint axis

3. 0-5mm posterior to the mechanical knee joint axis

4. 5-10mm posterior to the mechanical knee joint axis

During the initial dynamic alignment of a transtibial prosthesis there is an excessive varus moment at mid-stance. This can be resolved by:

1. Increasing the adduction of the socket

2. Increasing the abduction of the socket

3. Insetting the foot

4. Externally rotating the foot

Continuation of the Treatment Plan

Obtain feedback from patient and/or caregiver to evaluate outcome (e.g., wear schedule/tolerance, comfort, ability to don and doff, proper usage and function. Assess patient’s function and note any changes. Assess fit of prosthesis with regard to strategic contact and to anatomical relationships to prosthesis to determine need for changes relative to initial treatment goals. Address evidence of excessive skin pressures or lack of corrective forces and formulate plan to modify prosthesis accordingly. Revise treatment plan based on assessment of outcomes.

At a follow-up visit for a patient who was fit with a body powered transhumeral prosthesis, they complain that they are not able to open the terminal device with the elbow fully flexed. One possible solution to this problem is to:

1. Add a cross back strap to the harness

2. Add an elbow flexion assist component

3. Add additional rubber bands to the terminal device

4. Tighten the control attachment strap

A patient is seen for an initial follow-up after receiving a transfemoral prosthesis. They are ambulating with an abducted gait. What is the MOST likely prosthetic cause?

1. Prosthesis is too short

2. Foot is too inset

3. Prosthesis is too long

4. Knee flexion resistance is too strong

A patient is seen for follow-up for their PTB-SC prosthesis with pelite liner. The alignment of the prosthesis is good, however the patient states that the socket feels less secure recently and you note a gap between the socket and their limb at the lateral proximal brim. What is the MOST appropriate adjustment to address this problem?

1. Increase the thickness of the liner at the lateral proximal aspect

2. Increase the thickness of the liner at the medial proximal aspect

3. Increase sock ply thickness

4. Add padding to the medial tibial flare

A patient who has missed multiple follow-up appointments for their transtibial prosthesis is seen. The patient has been noncompliant with hygiene instructions and has developed a Wagner Grade 2 ulcer on the anterior distal end of their residual limb. The practitioner’s PRIMARY responsibility at this time is to:

1. Modify the prosthesis and suggest the patient follow-up with their physician

2. Modify the prosthesis and schedule a two-week follow-up appointment

3. Inform the patient to take a break from using the prosthesis and follow-up in two weeks

4. Instruct the patient to discontinue use of the prosthesis and notify the physician

 

 

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These sample questions are only examples of the type of test content you will see in the exam. For additional information about how to prepare for the exam, check out the Practice Analysis Resident Guide.  Access all the Practioner Exam Prep resources available on ABCop.org.

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