ORTHOTICS/PROSTHETICS/GAIT EXAM QUESTIONS &
DETAILED ANSWERS ALREADY GRADE A+ ACED
20. Which of the following orthoses or shoe modifications is used in the conservative
management of plantar fasciitis? (a) Heel lift (b) Posterior night splint (c) Lateral heel wedge (d)
Metatarsal bar - CORRECT ANSWER >>>20 (b) A heel lift plantarflexes the foot and is used for
Achilles tendinitis. A metatarsal bar is used for metatarsalgia. A lateral heel wedge can be used
for the conservative management of osteoarthritis of the knee. A posterior night splint
dorsiflexed to 5/ is the correct answer.
30. During normal human locomotion, the center of gravity travels through a sinusoidal pathway
that is modified by 6 determinants of gait. Which of the following is not considered 1 of the 6
determinants? (a) Pelvic extension (b) Foot and ankle synchronization (c) Knee flexion (d) Lateral
pelvic displacement - CORRECT ANSWER >>>30 (a) The 6 determinants are as follows: lateral
displacement that reduces horizontal excursion from 6" down to 1.7"; knee flexion that reduces
vertical excursion 7/16"; pelvic rotation that reduces vertical excursion 3/8"; pelvic tilt that
reduces vertical excursion 3/16"; and foot and ankle synchronization as well as ankle and knee
synchronization that both serve to smooth out the sinusoidal curve but do not decrease
excursion.
39. The most common complication after amputation in the immature child is (a) phantom
limb pain. (b) diffuse edema. (c) terminal overgrowth. (d) painful neuroma. - CORRECT ANSWER
>>>39 (c) Terminal overgrowth at the transected end of a long bone is the most common
complication after amputation in the skeletally immature child. It occurs most frequently in the
humerus, fibula, tibia, and femur, in that order. The oppositional growth may be so vigorous
that the bone pierces the skin. The treatment of choice is surgical revision.
40. A 79-year-old cachectic woman with coronary artery disease and unstable angina
sustains a right hip fracture after a fall. After an open-reduction internal fixation of the hip joint
with the use of a dynamic hip screw, the orthopedic surgeon determines that the patient is 25%
partial weight bearing to the right side. She has weak upper body strength and good balance.
1|Page
,Which of the following assistive devices is most appropriate? (a) Standard walker (b) Rolling
walker (c) Axillary crutches (d) Quad cane - CORRECT ANSWER >>>40 (b) Standard walkers
require good standing balance and good upper body strength. Crutches require good upper
body strength and have an increased energy expenditure of 40%-60%, which would be
contraindicated in unstable angina. Quad canes are not appropriate when significant weight-
bearing relief is required. Rolling walkers are most appropriate for patients who lack upper body
strength and provide safer gait than crutches or canes.
59. In considering selection of a lower limb prosthesis for a child with a congenital transfemoral
amputation, a knee joint should be included (a) at initial fitting. (b) between 3 to 5 years of age.
(c) when sports activities are anticipated. (d) when the child pulls to stand. - CORRECT ANSWER
>>>59 (b) The lower limb deficient child should be fitted with a prosthesis when he or she is
ready to pull up to a standing position, usually between 9 and 12 months. A knee joint is added
between 3 and 5 years.
70. What level of amputation has the highest acceptance rate for an upper extremity
prosthesis? (a) Wrist disarticulation (b) Transradial (c) Elbow disarticulation (d) Transhumeral -
CORRECT ANSWER >>>70 (b) Overall rejection of prosthetic usage occurs in 33%-38% of
unilateral upper extremity amputees. The highest acceptance rate is transradial at about 93%,
and the lowest is wrist disarticulation at about 6%.
80. When considering realistic functional goals for the majority of transhumeral amputees, the
maximal weight (in pounds) that can be carried with the body-powered prosthesis is (a) 7. (b)
15. (c) 30. (D) 50. - CORRECT ANSWER >>>80 (b) Handling of heavy objects is limited in upper
extremity amputees. A transhumeral amputee is expected to lift 10lb to 15lb, unless the
residual limb is very short or sensitive. A transradial amputee is expected to lift 20lb to 30lb
unless the residual limb is very short or sensitive.
82. In the orthotic and prosthetic clinic, a patient with Parkinson's disease presents for gait
analysis. The primary gait disturbance found is an alternation in stride length and altered
cadence. A gaittraining program for a person with Parkinson's disease should include (a) visual
cueing techniques. (b) bilateral ankle-foot orthoses. (c) patterning techniques. (d) vestibular
stimulation exercises. - CORRECT ANSWER >>>82 (a) Treatment options for gait disturbance in
2|Page
,patients with Parkinson's disease include visual and auditory cueing, in addition to traditional
endurance and strengthening exercises.
100. When comparing quadrilateral sockets with ischial containment sockets, a successful fitting
ismore likely in a quadrilateral socket when (a) the adductor musculature is intact. (b) the
residual limb is fleshy. (c) trunk stability demands are high at mid stance. (d) the residual limb is
shorter. - CORRECT ANSWER >>>100 (a) Chances of a successful fitting of a quadrilateral socket
are best when the residual limb is longer with a firm residuum and intact adductor musculature.
Ischial containment sockets are more successful than quadrilateral sockets for persons with
shorter, fleshy, unstable residual limbs.
104. In a patient with bilateral hip flexion contractures, which of the following gait deviations
would bemost likely? (a) Bilateral Trendelenburg gait (b) Early heel rise during stance (c)
Swingphase circumduction (d) Increased knee flexion in stance - CORRECT ANSWER >>>104 (d)
In normal gait, hip extension to neutral occurs during stance phase. When mild hip flexion
contractures are present, a compensatory increase in lumbar lordosis occurs to maintain upright
trunk posture. As the extent of the hip flexion contractures worsens, there is usually an
additional compensatory increase in knee flexion during stance phase.
110. Which of the following knee types provides good stability in early stance phase and ease of
flexionwhile weight bearing during the pre-swing phase (terminal stance) of the gait cycle? (a)
Single axis (b) Stance phase control (c) Polycentric (d) Manual locking - CORRECT ANSWER
>>>110 (c) Many polycentric knees are designed so that the center of rotation moves anteriorly
very rapidly during the first few degrees of knee flexion, quickly passing in front of the floor
reaction line and facilitating the swing phase. Because the polycentric knee can be flexed under
weight bearing during the terminal stance, when properly dynamically aligned it can offer both
excellent stance stability and ease of swing-phase flexion. Furthermore, all polycentric knees
shorten mechanically to a slight degree during flexion, adding additional toe clearance during
midswing.
120. An amputee presents for evaluation of distal blistering and evidence of vascular
congestion. Youdiagnose choke syndrome. Which of the following would NOT be an acceptable
treatment for choke syndrome? (a) Expanding the proximal socket (b) Increasing the auxiliary
3|Page
, suspension to decrease vertical pull (c) Relieving the distal socket where it interfaces with the
choked surface (d) Padding the distal socket where it corresponds to the choked surface -
CORRECT ANSWER >>>120 (c) The choke syndrome (proximal soft tissue constriction leading to
vascular congestion) may occur with suction sockets or self-suspending systems. Relieving the
proximal socket to allow vascular return, providing auxiliary suspension to decrease the vertical
pull on the residual limb, and improving the intimacy of the socket-limb interface correct this
problem. Relieving the distal socket where it interfaces with the choked surface would increase
the vacuum effect in this area and thereby increase the choke phenomenon.
130. Which of the following shoe components distinguishes a blucher-style shoe from a balstyle
shoe? (a) Throat (b) Toe box (c) Heel (d) Vamp - CORRECT ANSWER >>>130 (a) There are two
shoe types, the blucher and the bal. The components of a blucher shoe include the tongue, lace
stay, open throat, toe box, toe spring, vamp, ball, shank, breast, quarter, and heel. The major
difference with a bal style is that the throat is closed, limiting the ability of the shoe to open and
accommodate an orthosis. For this reason, a blucher is the style of dress shoe most often
recommended to patients who require an orthosis.
140. A 35-year-old man experiences a severe S1 radiculopathy. As a result, he loses essentially
allstrength within the posterior compartment of the leg. It is 6 months later, and you are
consulted to provide an orthosis to aid his ambulation. The best recommendation would be (a)
a posterior leaf spring ankle-foot orthosis (AFO). (b) an articulating AFO with plantar flexion
stop. (c) an articulating AFO with dorsiflexion stop. (d) an articulating AFO with dorsiflexion
assist. - CORRECT ANSWER >>>140 (c) In this condition, lack of active plantar flexion occurs,
heel-rise is delayed, the mid-stance phase is prolonged, and push-off force is reduced. A
dorsiflexion stop can accommodate for this weakness. Setting the stop at 5° of dorsiflexion
substitutes best for gastrocnemius function.
150. A 75-year-old woman falls and fractures her distal humerus. In the process, the ulnar nerve
is damaged. She presents 6 months later with weakness in the fourth and fifth digits, claw
deformity, and loss of grip power. Which of the following orthotic components could benefit this
patient and, therefore, should be included in the orthotic prescription? (a) Dorsal outrigger (b) C
bar (c) Lumbrical bar (d) Opponens bar - CORRECT ANSWER >>>150 (c) A dorsal
metacarpophalangeal extension stop (also called a lumbrical bar) to the fourth and fifth digits is
usually quite effective at preventing hyperextension of the fourth and fifth
4|Page
DETAILED ANSWERS ALREADY GRADE A+ ACED
20. Which of the following orthoses or shoe modifications is used in the conservative
management of plantar fasciitis? (a) Heel lift (b) Posterior night splint (c) Lateral heel wedge (d)
Metatarsal bar - CORRECT ANSWER >>>20 (b) A heel lift plantarflexes the foot and is used for
Achilles tendinitis. A metatarsal bar is used for metatarsalgia. A lateral heel wedge can be used
for the conservative management of osteoarthritis of the knee. A posterior night splint
dorsiflexed to 5/ is the correct answer.
30. During normal human locomotion, the center of gravity travels through a sinusoidal pathway
that is modified by 6 determinants of gait. Which of the following is not considered 1 of the 6
determinants? (a) Pelvic extension (b) Foot and ankle synchronization (c) Knee flexion (d) Lateral
pelvic displacement - CORRECT ANSWER >>>30 (a) The 6 determinants are as follows: lateral
displacement that reduces horizontal excursion from 6" down to 1.7"; knee flexion that reduces
vertical excursion 7/16"; pelvic rotation that reduces vertical excursion 3/8"; pelvic tilt that
reduces vertical excursion 3/16"; and foot and ankle synchronization as well as ankle and knee
synchronization that both serve to smooth out the sinusoidal curve but do not decrease
excursion.
39. The most common complication after amputation in the immature child is (a) phantom
limb pain. (b) diffuse edema. (c) terminal overgrowth. (d) painful neuroma. - CORRECT ANSWER
>>>39 (c) Terminal overgrowth at the transected end of a long bone is the most common
complication after amputation in the skeletally immature child. It occurs most frequently in the
humerus, fibula, tibia, and femur, in that order. The oppositional growth may be so vigorous
that the bone pierces the skin. The treatment of choice is surgical revision.
40. A 79-year-old cachectic woman with coronary artery disease and unstable angina
sustains a right hip fracture after a fall. After an open-reduction internal fixation of the hip joint
with the use of a dynamic hip screw, the orthopedic surgeon determines that the patient is 25%
partial weight bearing to the right side. She has weak upper body strength and good balance.
1|Page
,Which of the following assistive devices is most appropriate? (a) Standard walker (b) Rolling
walker (c) Axillary crutches (d) Quad cane - CORRECT ANSWER >>>40 (b) Standard walkers
require good standing balance and good upper body strength. Crutches require good upper
body strength and have an increased energy expenditure of 40%-60%, which would be
contraindicated in unstable angina. Quad canes are not appropriate when significant weight-
bearing relief is required. Rolling walkers are most appropriate for patients who lack upper body
strength and provide safer gait than crutches or canes.
59. In considering selection of a lower limb prosthesis for a child with a congenital transfemoral
amputation, a knee joint should be included (a) at initial fitting. (b) between 3 to 5 years of age.
(c) when sports activities are anticipated. (d) when the child pulls to stand. - CORRECT ANSWER
>>>59 (b) The lower limb deficient child should be fitted with a prosthesis when he or she is
ready to pull up to a standing position, usually between 9 and 12 months. A knee joint is added
between 3 and 5 years.
70. What level of amputation has the highest acceptance rate for an upper extremity
prosthesis? (a) Wrist disarticulation (b) Transradial (c) Elbow disarticulation (d) Transhumeral -
CORRECT ANSWER >>>70 (b) Overall rejection of prosthetic usage occurs in 33%-38% of
unilateral upper extremity amputees. The highest acceptance rate is transradial at about 93%,
and the lowest is wrist disarticulation at about 6%.
80. When considering realistic functional goals for the majority of transhumeral amputees, the
maximal weight (in pounds) that can be carried with the body-powered prosthesis is (a) 7. (b)
15. (c) 30. (D) 50. - CORRECT ANSWER >>>80 (b) Handling of heavy objects is limited in upper
extremity amputees. A transhumeral amputee is expected to lift 10lb to 15lb, unless the
residual limb is very short or sensitive. A transradial amputee is expected to lift 20lb to 30lb
unless the residual limb is very short or sensitive.
82. In the orthotic and prosthetic clinic, a patient with Parkinson's disease presents for gait
analysis. The primary gait disturbance found is an alternation in stride length and altered
cadence. A gaittraining program for a person with Parkinson's disease should include (a) visual
cueing techniques. (b) bilateral ankle-foot orthoses. (c) patterning techniques. (d) vestibular
stimulation exercises. - CORRECT ANSWER >>>82 (a) Treatment options for gait disturbance in
2|Page
,patients with Parkinson's disease include visual and auditory cueing, in addition to traditional
endurance and strengthening exercises.
100. When comparing quadrilateral sockets with ischial containment sockets, a successful fitting
ismore likely in a quadrilateral socket when (a) the adductor musculature is intact. (b) the
residual limb is fleshy. (c) trunk stability demands are high at mid stance. (d) the residual limb is
shorter. - CORRECT ANSWER >>>100 (a) Chances of a successful fitting of a quadrilateral socket
are best when the residual limb is longer with a firm residuum and intact adductor musculature.
Ischial containment sockets are more successful than quadrilateral sockets for persons with
shorter, fleshy, unstable residual limbs.
104. In a patient with bilateral hip flexion contractures, which of the following gait deviations
would bemost likely? (a) Bilateral Trendelenburg gait (b) Early heel rise during stance (c)
Swingphase circumduction (d) Increased knee flexion in stance - CORRECT ANSWER >>>104 (d)
In normal gait, hip extension to neutral occurs during stance phase. When mild hip flexion
contractures are present, a compensatory increase in lumbar lordosis occurs to maintain upright
trunk posture. As the extent of the hip flexion contractures worsens, there is usually an
additional compensatory increase in knee flexion during stance phase.
110. Which of the following knee types provides good stability in early stance phase and ease of
flexionwhile weight bearing during the pre-swing phase (terminal stance) of the gait cycle? (a)
Single axis (b) Stance phase control (c) Polycentric (d) Manual locking - CORRECT ANSWER
>>>110 (c) Many polycentric knees are designed so that the center of rotation moves anteriorly
very rapidly during the first few degrees of knee flexion, quickly passing in front of the floor
reaction line and facilitating the swing phase. Because the polycentric knee can be flexed under
weight bearing during the terminal stance, when properly dynamically aligned it can offer both
excellent stance stability and ease of swing-phase flexion. Furthermore, all polycentric knees
shorten mechanically to a slight degree during flexion, adding additional toe clearance during
midswing.
120. An amputee presents for evaluation of distal blistering and evidence of vascular
congestion. Youdiagnose choke syndrome. Which of the following would NOT be an acceptable
treatment for choke syndrome? (a) Expanding the proximal socket (b) Increasing the auxiliary
3|Page
, suspension to decrease vertical pull (c) Relieving the distal socket where it interfaces with the
choked surface (d) Padding the distal socket where it corresponds to the choked surface -
CORRECT ANSWER >>>120 (c) The choke syndrome (proximal soft tissue constriction leading to
vascular congestion) may occur with suction sockets or self-suspending systems. Relieving the
proximal socket to allow vascular return, providing auxiliary suspension to decrease the vertical
pull on the residual limb, and improving the intimacy of the socket-limb interface correct this
problem. Relieving the distal socket where it interfaces with the choked surface would increase
the vacuum effect in this area and thereby increase the choke phenomenon.
130. Which of the following shoe components distinguishes a blucher-style shoe from a balstyle
shoe? (a) Throat (b) Toe box (c) Heel (d) Vamp - CORRECT ANSWER >>>130 (a) There are two
shoe types, the blucher and the bal. The components of a blucher shoe include the tongue, lace
stay, open throat, toe box, toe spring, vamp, ball, shank, breast, quarter, and heel. The major
difference with a bal style is that the throat is closed, limiting the ability of the shoe to open and
accommodate an orthosis. For this reason, a blucher is the style of dress shoe most often
recommended to patients who require an orthosis.
140. A 35-year-old man experiences a severe S1 radiculopathy. As a result, he loses essentially
allstrength within the posterior compartment of the leg. It is 6 months later, and you are
consulted to provide an orthosis to aid his ambulation. The best recommendation would be (a)
a posterior leaf spring ankle-foot orthosis (AFO). (b) an articulating AFO with plantar flexion
stop. (c) an articulating AFO with dorsiflexion stop. (d) an articulating AFO with dorsiflexion
assist. - CORRECT ANSWER >>>140 (c) In this condition, lack of active plantar flexion occurs,
heel-rise is delayed, the mid-stance phase is prolonged, and push-off force is reduced. A
dorsiflexion stop can accommodate for this weakness. Setting the stop at 5° of dorsiflexion
substitutes best for gastrocnemius function.
150. A 75-year-old woman falls and fractures her distal humerus. In the process, the ulnar nerve
is damaged. She presents 6 months later with weakness in the fourth and fifth digits, claw
deformity, and loss of grip power. Which of the following orthotic components could benefit this
patient and, therefore, should be included in the orthotic prescription? (a) Dorsal outrigger (b) C
bar (c) Lumbrical bar (d) Opponens bar - CORRECT ANSWER >>>150 (c) A dorsal
metacarpophalangeal extension stop (also called a lumbrical bar) to the fourth and fifth digits is
usually quite effective at preventing hyperextension of the fourth and fifth
4|Page
