CPO
1. A patient with a unilateral transtibial amputation presents with a poorly fitting prosthetic socket
that induces excessive pressure on the fibular head during stance phase. The patient reports pain
and has developed a bursa over the fibular head. Which of the following biomechanical
modifications to the socket design is most likely to alleviate this issue?
A. Increasing the mediolateral dimension of the socket to reduce compression
B. Adding a relief over the fibular head and increasing the anteroposterior dimension
C. Reducing the posterior wall height to allow more tibial rotation
D. Incorporating a flexible inner liner with a rigid frame to distribute pressure
Answer: B
Rationale: The fibular head is a bony prominence that requires relief in the socket to avoid excessive
pressure. Adding a relief and increasing the AP dimension helps accommodate the fibular head and
improves socket fit. Option A would increase instability; option C could compromise suspension; option
D does not directly address the focal pressure point.
2. A patient with bilateral transtibial amputations secondary to peripheral vascular disease is
being evaluated for prosthetic fitting. The patient has a history of poorly controlled diabetes and
hypertension. Which of the following factors is MOST critical in determining the appropriate
prosthetic prescription for this patient?
A. The patient's age and body mass index
B. The patient's functional level and cognitive ability
C. The residual limb shape and tissue quality
D. The availability of advanced prosthetic components
Answer: B
Rationale: For a patient with bilateral amputations and comorbidities, functional level and cognitive
ability are paramount as they dictate the patient's potential for prosthetic use and rehabilitation. Age
and BMI are less predictive than functional classification. Tissue quality is important but secondary to
overall functional potential. Advanced components are irrelevant if the patient cannot use them.
3. A patient with a unilateral transfemoral amputation is fitted with a microprocessor-controlled
knee. During gait analysis, the patient exhibits excessive hip hiking and circumduction on the
prosthetic side during swing phase. Which of the following adjustments to the prosthetic knee is
MOST likely to address this gait deviation?
A. Increasing swing phase flexion resistance
B. Decreasing swing phase extension resistance
C. Increasing the damping in the stance phase
D. Lengthening the prosthetic pylon
Answer: A
Page 1
,Rationale: Hip hiking and circumduction are often compensatory strategies for inadequate toe clearance during swing.
Increasing swing phase flexion resistance slows knee flexion, allowing more time for foot clearance and reducing the need for
hip hiking. Decreasing extension resistance would have the opposite effect. Stance phase damping and pylon length are less
directly related to swing clearance.
4. A patient with a spinal cord injury at the T10 level presents for orthotic management to enable
ambulation. Which of the following orthoses would be MOST appropriate to achieve reciprocal
gait with minimal energy expenditure?
A. Reciprocating gait orthosis (RGO)
B. Hip-knee-ankle-foot orthosis (HKAFO) with locked hips
C. Ankle-foot orthosis (AFO) with plantarflexion stop
D. Knee-ankle-foot orthosis (KAFO) with free knee
Answer: A
Rationale: An RGO is designed for patients with high thoracic lesions to produce reciprocal gait by
coupling hip flexion on one side to extension on the other, reducing energy expenditure. A locked
HKAFO would require significant upper body effort. AFOs and KAFOs do not provide sufficient hip
control for a T10 injury.
5. A patient with a unilateral partial foot amputation (Lisfranc level) complains of difficulty
walking on uneven terrain and feels unstable. Which of the following prosthetic solutions provides
the BEST combination of stability and proprioceptive feedback?
A. A silicone toe filler with a rigid forefoot plate
B. A custom-molded shoe insert with a carbon fiber spring plate
C. A total contact socket with a dynamic response foot
D. A prosthetic foot with a split toe design
Answer: A
Rationale: A silicone toe filler restores the length of the foot and provides stability, while a rigid forefoot
plate enhances push-off and reduces pressure on the residual limb, improving proprioception. A carbon
fiber plate might be too flexible for stability. A total contact socket is not indicated for partial foot. A
split toe design is for toe clearance, not stability.
6. A patient with a diagnosis of multiple sclerosis presents with bilateral foot drop and mild
spasticity. The patient is ambulatory but fatigues easily. Which of the following orthotic
interventions is MOST appropriate to improve gait efficiency and reduce energy expenditure?
A. Bilateral posterior leaf spring AFOs
B. Bilateral solid ankle AFOs with dorsiflexion assist
C. Bilateral hinged AFOs with plantarflexion stop and dorsiflexion assist
D. Bilateral dynamic ankle-foot orthoses with tone-reducing features
Answer: C
Rationale: Hinged AFOs with a plantarflexion stop prevent foot drop and provide dorsiflexion assistance
during swing, while allowing some ankle motion during stance, which is more energy-efficient than a
solid AFO. Posterior leaf springs may not provide enough control for spasticity. Dynamic AFOs with
tone-reducing features may be too restrictive for a patient who fatigues easily.
Page 2
,7. A patient with a unilateral transradial amputation is being fitted with a body-powered
prosthesis. The patient is a manual laborer and needs a prosthesis that can withstand heavy use.
Which of the following terminal devices would be MOST appropriate?
A. A voluntary-closing split hook
B. A voluntary-opening split hook
C. A myoelectric hand
D. A cosmetic passive hand
Answer: B
Rationale: A voluntary-opening split hook is durable, provides strong grip, and is well-suited for heavy
manual labor. Voluntary-closing hooks offer better control but are less robust and may fatigue the user.
Myoelectric hands are less durable and require battery maintenance. Cosmetic hands are not functional
for heavy work.
8. A patient with a unilateral transtibial amputation is using a patellar tendon-bearing (PTB)
socket with a neoprene sleeve suspension. The patient reports that the prosthesis rotates on the
residual limb during walking. Which of the following modifications would MOST effectively
reduce rotational instability?
A. Adding a waist belt with a fork strap
B. Incorporating a supracondylar suspension
C. Changing the sleeve to a silicone liner with a pin lock
D. Increasing the socket trim lines proximally
Answer: B
Rationale: Supracondylar suspension provides a mechanical lock around the femoral condyles, reducing
rotation. A waist belt can reduce pistoning but not rotation. A silicone liner with pin lock primarily
addresses vertical suspension, not rotation. Increasing trim lines may cause discomfort and does not
directly control rotation.
9. A patient with a unilateral transfemoral amputation is fitted with a hydraulic knee unit. During
stair descent, the patient reports a feeling of the knee buckling. Which of the following parameters
should be adjusted to improve stance phase control?
A. Increase swing phase flexion resistance
B. Decrease swing phase extension resistance
C. Increase stance phase flexion resistance
D. Decrease stance phase extension resistance
Answer: C
Rationale: Knee buckling during stair descent indicates insufficient stance phase flexion resistance (i.e.,
the knee flexes too easily under load). Increasing stance phase flexion resistance provides more stability.
Swing phase adjustments do not affect stance stability. Decreasing extension resistance would worsen
buckling.
Page 3
, 10. A patient with a unilateral transtibial amputation presents with a painful neuroma at the distal
end of the residual limb. The patient has been using a total surface bearing (TSB) socket. Which of
the following socket modifications is MOST likely to reduce pressure on the neuroma?
A. Creating a relief cavity over the neuroma site
B. Increasing the overall socket volume to reduce pressure
C. Adding a distal end pad to distribute pressure
D. Changing to a patellar tendon-bearing (PTB) socket design
Answer: A
Rationale: A relief cavity directly offloads the neuroma, reducing focal pressure. Increasing overall
volume would reduce control and may not relieve the neuroma. A distal end pad could increase pressure
on the neuroma. Changing to PTB might shift pressure but not necessarily offload the neuroma.
11. In the context of the Capability Maturity Model Integration (CMMI) for Development, which
of the following best describes the relationship between the 'Continuous Representation' and the
'Staged Representation' in achieving process improvement?
A. Continuous representation allows organizations to select specific process areas for improvement, while
staged representation requires sequential achievement of predefined maturity levels; both can be used to achieve
equivalent capability levels.
B. Continuous representation is applicable only to software processes, whereas staged representation is used for
integrated product and process development.
C. Staged representation provides a single rating for the organization, while continuous representation provides
separate ratings for each process area; they are mutually exclusive and cannot be combined.
D. Continuous representation focuses on organizational maturity, while staged representation focuses on process
area capability; they are different views of the same underlying model.
Answer: A
Rationale: CMMI's continuous representation enables organizations to target specific process areas for
improvement, while staged representation provides a roadmap of maturity levels. Both representations
can lead to equivalent capability levels, but they offer different approaches to assessment and
improvement. Option A correctly captures this flexibility, whereas B, C, and D misstate the applicability,
exclusivity, or focus of the representations.
12. A project manager is implementing Earned Value Management (EVM) on a software
development project. At month 6, the planned value (PV) is $500,000, the earned value (EV) is
$450,000, and the actual cost (AC) is $480,000. The project has a cost performance index (CPI) of
0.9375 and a schedule performance index (SPI) of 0.9. Assuming that the cost performance will
continue as experienced to date, what is the estimate at completion (EAC) using the most typical
formula for this scenario?
A. $1,066,667
B. $1,120,000
C. $1,200,000
D. $1,280,000
Answer: A
Rationale: The most typical formula for EAC when cost performance is expected to continue is EAC =
BAC / CPI. Given BAC is typically $1,000,000 (common assumption in such problems), CPI = 0.9375,
Page 4
1. A patient with a unilateral transtibial amputation presents with a poorly fitting prosthetic socket
that induces excessive pressure on the fibular head during stance phase. The patient reports pain
and has developed a bursa over the fibular head. Which of the following biomechanical
modifications to the socket design is most likely to alleviate this issue?
A. Increasing the mediolateral dimension of the socket to reduce compression
B. Adding a relief over the fibular head and increasing the anteroposterior dimension
C. Reducing the posterior wall height to allow more tibial rotation
D. Incorporating a flexible inner liner with a rigid frame to distribute pressure
Answer: B
Rationale: The fibular head is a bony prominence that requires relief in the socket to avoid excessive
pressure. Adding a relief and increasing the AP dimension helps accommodate the fibular head and
improves socket fit. Option A would increase instability; option C could compromise suspension; option
D does not directly address the focal pressure point.
2. A patient with bilateral transtibial amputations secondary to peripheral vascular disease is
being evaluated for prosthetic fitting. The patient has a history of poorly controlled diabetes and
hypertension. Which of the following factors is MOST critical in determining the appropriate
prosthetic prescription for this patient?
A. The patient's age and body mass index
B. The patient's functional level and cognitive ability
C. The residual limb shape and tissue quality
D. The availability of advanced prosthetic components
Answer: B
Rationale: For a patient with bilateral amputations and comorbidities, functional level and cognitive
ability are paramount as they dictate the patient's potential for prosthetic use and rehabilitation. Age
and BMI are less predictive than functional classification. Tissue quality is important but secondary to
overall functional potential. Advanced components are irrelevant if the patient cannot use them.
3. A patient with a unilateral transfemoral amputation is fitted with a microprocessor-controlled
knee. During gait analysis, the patient exhibits excessive hip hiking and circumduction on the
prosthetic side during swing phase. Which of the following adjustments to the prosthetic knee is
MOST likely to address this gait deviation?
A. Increasing swing phase flexion resistance
B. Decreasing swing phase extension resistance
C. Increasing the damping in the stance phase
D. Lengthening the prosthetic pylon
Answer: A
Page 1
,Rationale: Hip hiking and circumduction are often compensatory strategies for inadequate toe clearance during swing.
Increasing swing phase flexion resistance slows knee flexion, allowing more time for foot clearance and reducing the need for
hip hiking. Decreasing extension resistance would have the opposite effect. Stance phase damping and pylon length are less
directly related to swing clearance.
4. A patient with a spinal cord injury at the T10 level presents for orthotic management to enable
ambulation. Which of the following orthoses would be MOST appropriate to achieve reciprocal
gait with minimal energy expenditure?
A. Reciprocating gait orthosis (RGO)
B. Hip-knee-ankle-foot orthosis (HKAFO) with locked hips
C. Ankle-foot orthosis (AFO) with plantarflexion stop
D. Knee-ankle-foot orthosis (KAFO) with free knee
Answer: A
Rationale: An RGO is designed for patients with high thoracic lesions to produce reciprocal gait by
coupling hip flexion on one side to extension on the other, reducing energy expenditure. A locked
HKAFO would require significant upper body effort. AFOs and KAFOs do not provide sufficient hip
control for a T10 injury.
5. A patient with a unilateral partial foot amputation (Lisfranc level) complains of difficulty
walking on uneven terrain and feels unstable. Which of the following prosthetic solutions provides
the BEST combination of stability and proprioceptive feedback?
A. A silicone toe filler with a rigid forefoot plate
B. A custom-molded shoe insert with a carbon fiber spring plate
C. A total contact socket with a dynamic response foot
D. A prosthetic foot with a split toe design
Answer: A
Rationale: A silicone toe filler restores the length of the foot and provides stability, while a rigid forefoot
plate enhances push-off and reduces pressure on the residual limb, improving proprioception. A carbon
fiber plate might be too flexible for stability. A total contact socket is not indicated for partial foot. A
split toe design is for toe clearance, not stability.
6. A patient with a diagnosis of multiple sclerosis presents with bilateral foot drop and mild
spasticity. The patient is ambulatory but fatigues easily. Which of the following orthotic
interventions is MOST appropriate to improve gait efficiency and reduce energy expenditure?
A. Bilateral posterior leaf spring AFOs
B. Bilateral solid ankle AFOs with dorsiflexion assist
C. Bilateral hinged AFOs with plantarflexion stop and dorsiflexion assist
D. Bilateral dynamic ankle-foot orthoses with tone-reducing features
Answer: C
Rationale: Hinged AFOs with a plantarflexion stop prevent foot drop and provide dorsiflexion assistance
during swing, while allowing some ankle motion during stance, which is more energy-efficient than a
solid AFO. Posterior leaf springs may not provide enough control for spasticity. Dynamic AFOs with
tone-reducing features may be too restrictive for a patient who fatigues easily.
Page 2
,7. A patient with a unilateral transradial amputation is being fitted with a body-powered
prosthesis. The patient is a manual laborer and needs a prosthesis that can withstand heavy use.
Which of the following terminal devices would be MOST appropriate?
A. A voluntary-closing split hook
B. A voluntary-opening split hook
C. A myoelectric hand
D. A cosmetic passive hand
Answer: B
Rationale: A voluntary-opening split hook is durable, provides strong grip, and is well-suited for heavy
manual labor. Voluntary-closing hooks offer better control but are less robust and may fatigue the user.
Myoelectric hands are less durable and require battery maintenance. Cosmetic hands are not functional
for heavy work.
8. A patient with a unilateral transtibial amputation is using a patellar tendon-bearing (PTB)
socket with a neoprene sleeve suspension. The patient reports that the prosthesis rotates on the
residual limb during walking. Which of the following modifications would MOST effectively
reduce rotational instability?
A. Adding a waist belt with a fork strap
B. Incorporating a supracondylar suspension
C. Changing the sleeve to a silicone liner with a pin lock
D. Increasing the socket trim lines proximally
Answer: B
Rationale: Supracondylar suspension provides a mechanical lock around the femoral condyles, reducing
rotation. A waist belt can reduce pistoning but not rotation. A silicone liner with pin lock primarily
addresses vertical suspension, not rotation. Increasing trim lines may cause discomfort and does not
directly control rotation.
9. A patient with a unilateral transfemoral amputation is fitted with a hydraulic knee unit. During
stair descent, the patient reports a feeling of the knee buckling. Which of the following parameters
should be adjusted to improve stance phase control?
A. Increase swing phase flexion resistance
B. Decrease swing phase extension resistance
C. Increase stance phase flexion resistance
D. Decrease stance phase extension resistance
Answer: C
Rationale: Knee buckling during stair descent indicates insufficient stance phase flexion resistance (i.e.,
the knee flexes too easily under load). Increasing stance phase flexion resistance provides more stability.
Swing phase adjustments do not affect stance stability. Decreasing extension resistance would worsen
buckling.
Page 3
, 10. A patient with a unilateral transtibial amputation presents with a painful neuroma at the distal
end of the residual limb. The patient has been using a total surface bearing (TSB) socket. Which of
the following socket modifications is MOST likely to reduce pressure on the neuroma?
A. Creating a relief cavity over the neuroma site
B. Increasing the overall socket volume to reduce pressure
C. Adding a distal end pad to distribute pressure
D. Changing to a patellar tendon-bearing (PTB) socket design
Answer: A
Rationale: A relief cavity directly offloads the neuroma, reducing focal pressure. Increasing overall
volume would reduce control and may not relieve the neuroma. A distal end pad could increase pressure
on the neuroma. Changing to PTB might shift pressure but not necessarily offload the neuroma.
11. In the context of the Capability Maturity Model Integration (CMMI) for Development, which
of the following best describes the relationship between the 'Continuous Representation' and the
'Staged Representation' in achieving process improvement?
A. Continuous representation allows organizations to select specific process areas for improvement, while
staged representation requires sequential achievement of predefined maturity levels; both can be used to achieve
equivalent capability levels.
B. Continuous representation is applicable only to software processes, whereas staged representation is used for
integrated product and process development.
C. Staged representation provides a single rating for the organization, while continuous representation provides
separate ratings for each process area; they are mutually exclusive and cannot be combined.
D. Continuous representation focuses on organizational maturity, while staged representation focuses on process
area capability; they are different views of the same underlying model.
Answer: A
Rationale: CMMI's continuous representation enables organizations to target specific process areas for
improvement, while staged representation provides a roadmap of maturity levels. Both representations
can lead to equivalent capability levels, but they offer different approaches to assessment and
improvement. Option A correctly captures this flexibility, whereas B, C, and D misstate the applicability,
exclusivity, or focus of the representations.
12. A project manager is implementing Earned Value Management (EVM) on a software
development project. At month 6, the planned value (PV) is $500,000, the earned value (EV) is
$450,000, and the actual cost (AC) is $480,000. The project has a cost performance index (CPI) of
0.9375 and a schedule performance index (SPI) of 0.9. Assuming that the cost performance will
continue as experienced to date, what is the estimate at completion (EAC) using the most typical
formula for this scenario?
A. $1,066,667
B. $1,120,000
C. $1,200,000
D. $1,280,000
Answer: A
Rationale: The most typical formula for EAC when cost performance is expected to continue is EAC =
BAC / CPI. Given BAC is typically $1,000,000 (common assumption in such problems), CPI = 0.9375,
Page 4
