Certified Orthoptist (CO) Certification Exam — Questions and Answers

Question 1: Which of the following symptoms in a patient with a new spinal orthosis indicates a potential autonomic dysreflexia emergency (relevant in patients with high-level spinal cord injury)?

Decreased appetite after beginning brace wear
Sudden severe headache, profuse sweating above the level of injury, and hypertension (Correct answer)
Mild skin redness at brace contact points
Mild fatigue after wearing the brace for two hours

Correct answer: Sudden severe headache, profuse sweating above the level of injury, and hypertension

Autonomic dysreflexia presents with sudden severe headache, diaphoresis above the injury level, and dangerously high blood pressure, and requires immediate identification and removal of the triggering stimulus.

Question 2: A thermoplastic orthosis was in contact with a non-intact wound. According to Spaulding classification, this device is considered:

Semicritical (Correct answer)
Noncritical
Critical
Uncategorized

Correct answer: Semicritical

Devices contacting non-intact skin or mucous membranes are classified as semicritical items, requiring at minimum high-level disinfection.

Question 3: When writing a treatment plan for a unilateral transtibial amputee, what is the primary biomechanical purpose of a prosthetic sock fit check at each visit?

Assess cosmetic appearance of the prosthesis
Evaluate residual limb volume changes affecting socket fit (Correct answer)
Determine if the patient needs a new prosthetic foot
Check alignment of the ankle joint

Correct answer: Evaluate residual limb volume changes affecting socket fit

Residual limb volume fluctuates due to activity, edema, and tissue remodeling; sock ply adjustments ensure proper socket fit and prevent skin breakdown.

Question 4: During the treatment planning process, which factor should be evaluated FIRST before selecting an orthotic design?

Available materials in the facility
Pathomechanics and biomechanical assessment (Correct answer)
Patient's insurance coverage
Cosmetic preferences of the patient

Correct answer: Pathomechanics and biomechanical assessment

Pathomechanical and biomechanical assessment must occur first to identify functional deficits and guide appropriate orthotic intervention.

Question 5: In a comprehensive orthotic treatment plan, what is the purpose of establishing a reevaluation schedule?

To bill additional units of service without clinical justification
To satisfy payer requirements without clinical relevance
To replace devices on a fixed time schedule regardless of condition
To monitor device fit, patient progress, and modify the plan based on outcomes (Correct answer)

Correct answer: To monitor device fit, patient progress, and modify the plan based on outcomes

Scheduled reevaluations ensure device fit remains appropriate as the patient's condition evolves and allows timely modification of treatment goals based on functional outcomes.

Question 6: What is peer review in CO Infection Control & Prevention?

Quality evaluation by qualified colleagues for improvement (Correct answer)
Determining promotions
Creating competition
Reducing workloads

Correct answer: Quality evaluation by qualified colleagues for improvement

Peer review provides objective assessment by qualified professionals to identify improvements and ensure accountability.

Question 7: Phenytoin (Dilantin) is prescribed for a patient with seizures. Which musculoskeletal side effect should the orthotist be aware of?

Severe muscle hypertrophy requiring larger orthotic shells
Hypocalcemia and vitamin D deficiency leading to softened bones (Correct answer)
Hyperuricemia causing gout-like joint pain
Peripheral neuropathy and gingival hyperplasia

Correct answer: Hypocalcemia and vitamin D deficiency leading to softened bones

Long-term phenytoin use impairs vitamin D metabolism, leading to hypocalcemia and osteomalacia, which can cause bone pain and stress fractures relevant to orthotic management.

Question 8: When documenting an orthoptic evaluation, which entry best meets medicolegal standards?

'CT: 20 PD ET at distance, cover test performed under standard indoor illumination, manifest deviation confirmed.' (Correct answer)
'VA checked, glasses noted.'
'Eye turn present, parent concerned.'
'Patient seems to have strabismus; will watch.'

Correct answer: 'CT: 20 PD ET at distance, cover test performed under standard indoor illumination, manifest deviation confirmed.'

Objective, quantified findings with the conditions of testing constitute legally defensible documentation.

Question 9: Parks three-step test is used to identify which type of muscle palsy?

Bilateral superior oblique palsy
Horizontal rectus palsy
Cyclovertical muscle palsy (Correct answer)
Internuclear ophthalmoplegia

Correct answer: Cyclovertical muscle palsy

The three-step test (hypertropia, gaze position, and Bielschowsky head tilt) systematically isolates a single weak cyclovertical muscle.

Question 10: An orthotist is trimming a fiberglass cast and generates significant dust. Which respiratory protection is MOST appropriate?

Surgical face mask
No respiratory protection needed with good ventilation
Full-face air-purifying respirator
N95 filtering facepiece respirator (Correct answer)

Correct answer: N95 filtering facepiece respirator

Cast dust contains particles that can penetrate surgical masks; an N95 respirator filters at least 95% of airborne particles and is appropriate for this task.

Question 11: What is a needs assessment in CO Infection Control & Prevention practice?

Property appraisal
Identifying gaps between current conditions and desired outcomes (Correct answer)
Benefits survey
Office supply list

Correct answer: Identifying gaps between current conditions and desired outcomes

A needs assessment identifies gaps between current performance and desired outcomes to justify improvements.

Question 12: What is the correct sequence for donning PPE before entering a contact precaution room?

Gloves → gown → mask → eye protection
Eye protection → gown → gloves → mask
Mask → gloves → gown → eye protection
Gown → mask → eye protection → gloves (Correct answer)

Correct answer: Gown → mask → eye protection → gloves

The CDC-recommended donning sequence is gown first, then mask/respirator, then eye protection, then gloves last to avoid contaminating other PPE.

Question 13: The Edinger-Westphal nucleus provides parasympathetic innervation to which intraocular structures?

Sphincter pupillae and ciliary muscle (Correct answer)
Lateral rectus and sphincter pupillae
Ciliary muscle and superior oblique
Dilator pupillae and superior rectus

Correct answer: Sphincter pupillae and ciliary muscle

The Edinger-Westphal nucleus provides parasympathetic innervation via CN III to both the sphincter pupillae (pupil constriction) and the ciliary muscle (accommodation).

Question 14: According to Prentice's Rule, the prismatic effect in prism diopters equals:

Lens power divided by decentration in cm
Decentration in mm divided by lens power
Lens power squared
Lens power in diopters multiplied by decentration in centimeters (Correct answer)

Correct answer: Lens power in diopters multiplied by decentration in centimeters

Prentice's Rule states that prismatic effect (Δ) = lens power (D) × decentration (cm), essential for calculating induced prism from decentered lenses.

Question 15: The 4-prism diopter base-out test is used to detect:

Stereoblindness in adults
Fusional vergence range
Angle kappa
Central suppression scotoma (Correct answer)

Correct answer: Central suppression scotoma

A 4 PD base-out prism placed before one eye normally induces a versional movement; absence of the expected refixation indicates a central suppression scotoma.

Question 16: Which federal regulation requires orthotics facilities to have written exposure control plans for bloodborne pathogens?

HIPAA Privacy Rule
CMS Conditions of Participation
OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) (Correct answer)
ADA Title III

Correct answer: OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030)

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates that healthcare and clinical facilities maintain a written exposure control plan to protect workers from bloodborne pathogen risks.

Question 17: A patient with rheumatoid arthritis of the wrist and hand needs an orthosis. What is the recommended protocol regarding joint immobilization?

Use resting splints at night; mobilization splints during activity to preserve function (Correct answer)
Immobilize all affected joints continuously to prevent joint damage
Use dynamic splints exclusively to maximize ROM
Avoid all orthotic intervention as it causes muscle atrophy

Correct answer: Use resting splints at night; mobilization splints during activity to preserve function

Current RA management uses resting splints at night for pain control and mobilization splints during activity to balance joint protection with functional maintenance.

Question 18: Which treatment is first-line for convergence insufficiency in a school-age child?

Office-based vergence/accommodative therapy supplemented with home exercises (Correct answer)
Patching the dominant eye
Base-in prism glasses for all tasks
Bilateral medial rectus recession surgery

Correct answer: Office-based vergence/accommodative therapy supplemented with home exercises

The CITT trial showed that office-based vergence/accommodative therapy is significantly more effective than home exercises or prism glasses alone for convergence insufficiency.

Question 19: What is the critical path in CO project scheduling?

The longest sequence of dependent tasks determining minimum duration (Correct answer)
Tasks that can be skipped
The most expensive phase
The shortest route to complete cheaply

Correct answer: The longest sequence of dependent tasks determining minimum duration

The critical path identifies the longest chain of dependent tasks; delays on these directly delay project completion.

Question 20: The critical period for amblyopia treatment is primarily defined by:

The severity of strabismus
The degree of refractive error
The child's cooperation level
Neural plasticity of the visual cortex (Correct answer)

Correct answer: Neural plasticity of the visual cortex

The critical period for amblyopia treatment is defined by the period of neural plasticity in the visual cortex during which visual development can be influenced.

Question 21: A patient presents with Charcot-Marie-Tooth disease and bilateral foot drop. The treatment plan should include which primary orthotic consideration?

Serial casting to correct equinus deformity
Bilateral rocker-bottom shoes without orthoses
Knee orthoses to prevent hyperextension
Bilateral custom AFOs to assist dorsiflexion during gait (Correct answer)

Correct answer: Bilateral custom AFOs to assist dorsiflexion during gait

CMT causes progressive peroneal and anterior tibialis weakness; bilateral custom AFOs provide dorsiflexion assistance during swing and midfoot stability during stance.

Question 22: Which of the following is the MOST appropriate initial management for a 6-month-old with infantile esotropia measuring 45 prism diopters?

Prism glasses to fully correct the deviation
Immediate surgical correction
Full optical correction of any hyperopia and observation for 6 weeks (Correct answer)
Patching the left eye only

Correct answer: Full optical correction of any hyperopia and observation for 6 weeks

Before surgery, any significant refractive error must be corrected first to rule out an accommodative component, then early surgery is planned.

Question 23: A patient's ankle-brachial index (ABI) is measured at 0.6. How should this affect the orthotic assessment plan?

Avoid circumferential compression devices; consult vascular surgery (Correct answer)
Proceed with total contact casting as planned
Apply a compression stocking to improve circulation before fitting
Note the finding but proceed with a standard AFO fitting

Correct answer: Avoid circumferential compression devices; consult vascular surgery

An ABI of 0.6 indicates moderate peripheral arterial disease; circumferential compression devices are contraindicated and vascular consultation is required.

Question 24: During a clinical encounter, an interpreter is needed for a non-English-speaking patient. Which interpreter arrangement is LEAST appropriate?

Trained in-person hospital interpreter
Certified medical interpreter via video remote service
The patient's 8-year-old child (Correct answer)
A certified telephone interpreter service

Correct answer: The patient's 8-year-old child

Using minor children as interpreters is inappropriate because it burdens the child, compromises accuracy, and violates privacy by exposing minors to adult medical details.

Question 25: Which action by an orthotist BEST demonstrates compliance with the scope of practice guidelines when a patient presents with a newly identified wound under an orthotic device?

Discontinue device use, refer to the appropriate medical provider, and document findings (Correct answer)
Apply padding over the wound and proceed with fitting
Photograph the wound and schedule a follow-up in 2 weeks
Clean and dress the wound and continue with device delivery

Correct answer: Discontinue device use, refer to the appropriate medical provider, and document findings

Wound assessment and treatment are outside the orthotist's scope of practice; the appropriate action is to halt device use, refer to a physician or wound care specialist, and document all findings.

Question 26: A patient is prescribed a dynamic elbow orthosis following surgery for a radial nerve injury. During the first follow-up, the patient reports sharp paresthesias in the median nerve distribution. The orthotist should:

Reassure the patient that postoperative paresthesias are expected
Assess for orthosis-related compression of the median nerve and modify or remove the device (Correct answer)
Increase the dynamic assist tension to improve function
Refer the patient for a second surgical opinion before making adjustments

Correct answer: Assess for orthosis-related compression of the median nerve and modify or remove the device

New paresthesias in a different nerve distribution suggest the orthosis may be compressing the median nerve; immediate assessment and orthosis modification are required to prevent permanent nerve damage.

Question 27: An orthotist notices a colleague has been routinely billing for bilateral orthoses when only unilateral devices were delivered. The most appropriate course of action is to:

Ignore the situation as billing is handled by the administrative staff
Document the observations and wait to see if an audit identifies the issue
Report the suspected fraud through established compliance channels or the compliance officer (Correct answer)
Confront the colleague privately and advise them to correct billing practices

Correct answer: Report the suspected fraud through established compliance channels or the compliance officer

Billing fraud is a serious legal and ethical violation; orthotists have a professional and legal obligation to report suspected fraud through proper compliance channels, such as a compliance officer or hotline.

Question 28: A patient with hallux valgus deformity and metatarsalgia requires an orthotic treatment plan. Which feature is MOST important in the orthotic design?

Medial heel wedge only to correct rear-foot alignment
Rigid carbon fiber plate extending to the toes
Metatarsal pad placed proximal to the metatarsal heads to offload the forefoot (Correct answer)
Full toe extension stop to immobilize the first MTP joint

Correct answer: Metatarsal pad placed proximal to the metatarsal heads to offload the forefoot

A metatarsal pad placed just proximal to the metatarsal heads redistributes pressure off the painful metatarsal heads, directly addressing the metatarsalgia component.

Question 29: Low vision is generally defined as best-corrected visual acuity of:

Less than 20/200 exclusively
20/40 in either eye
20/70 or worse in the better eye (Correct answer)
Better than 20/40

Correct answer: 20/70 or worse in the better eye

Low vision is defined as best-corrected visual acuity of 20/70 or worse in the better eye that cannot be improved with standard optical correction.

Question 30: In Duane retraction syndrome type I, which finding is characteristic on attempted adduction?

Globe protrusion and widening of the palpebral fissure
Upshoot only in adduction
Marked limitation of abduction with normal adduction
Globe retraction and narrowing of the palpebral fissure (Correct answer)

Correct answer: Globe retraction and narrowing of the palpebral fissure

Type I Duane syndrome shows limited abduction and, on adduction, globe retraction with palpebral fissure narrowing due to co-contraction of horizontal recti.

Question 31: In testing color vision with Ishihara plates, which type of color deficiency is most commonly detected?

Tritanopia (blue-yellow)
Acquired optic nerve disease
Achromatopsia
Protan and deutan (red-green) deficiencies (Correct answer)

Correct answer: Protan and deutan (red-green) deficiencies

Ishihara plates are specifically designed to detect congenital red-green color deficiencies (protan and deutan types).

Question 32: In the Maddox rod test, when the red streak passes through the white light source, this indicates:

Orthophoria — no deviation is present (Correct answer)
A phoria equal to the prism neutralizing it
Maximum suppression depth
Cyclophoria is present

Correct answer: Orthophoria — no deviation is present

When the streak passes through the light, the eyes are aligned (orthophoria) since no dissociated deviation exists.

Question 33: What differentiates active from inactive records in CO?

Inactive have no value
Active are regularly referenced; inactive are retained but rarely accessed (Correct answer)
Active are digital; inactive are paper
Active are public; inactive are private

Correct answer: Active are regularly referenced; inactive are retained but rarely accessed

Active records are frequently referenced; inactive ones are retained for legal or historical purposes but rarely needed.

Question 34: A teenager discloses to you confidentially that they are being bullied but denies self-harm ideation. Your ethical obligation includes:

Breach confidentiality immediately and call police
Maintain complete confidentiality as the patient is a minor
Document the disclosure, provide crisis resources, and discuss with the supervising physician about reporting obligations (Correct answer)
Ignore the disclosure as it is outside orthoptic scope

Correct answer: Document the disclosure, provide crisis resources, and discuss with the supervising physician about reporting obligations

While strict confidentiality applies absent imminent harm, best practice requires documentation, providing support resources, and multidisciplinary consultation.

Question 35: A parent refuses patching therapy for their child's amblyopia, citing school concerns. What is the orthoptist's most appropriate ethical response?

Report the parent to child protective services
Document the refusal, educate on risks, and explore alternative treatments (Correct answer)
Proceed with patching without parental consent
Discharge the patient immediately

Correct answer: Document the refusal, educate on risks, and explore alternative treatments

Respecting autonomy means educating the family about risks while documenting the discussion and offering alternatives like atropine penalization.

Question 36: A patient taking warfarin presents for a lower extremity orthosis fitting. What special precaution should the orthotist take?

Discontinue the orthosis if INR is above 1.0
Avoid all metal components to prevent electromagnetic interference
Prescribe a KAFO instead of an AFO to reduce vascular compression
Use extra padding to minimize skin breakdown and bleeding risk (Correct answer)

Correct answer: Use extra padding to minimize skin breakdown and bleeding risk

Warfarin is an anticoagulant that increases bleeding risk, so extra padding reduces the likelihood of skin breakdown that could lead to significant bleeding.

Question 37: During functional assessment, a patient with a transtibial prosthesis demonstrates lateral trunk lean toward the prosthetic side during stance. In orthotic/prosthetic assessment, this deviation often suggests:

Prosthetic foot set in excessive dorsiflexion
Prosthetic foot set too far lateral
Prosthetic socket too long causing discomfort
Short prosthetic limb or excessive lateral wall pressure in the socket (Correct answer)

Correct answer: Short prosthetic limb or excessive lateral wall pressure in the socket

Lateral trunk lean toward the prosthetic side (Trendelenburg-like) is commonly caused by a short prosthesis or hip abductor weakness on that side.

Question 38: A patient treated with bisphosphonates for osteoporosis presents with an atypical femoral fracture. How should this influence the orthotic management?

Provide a protective KAFO to offload the femoral shaft during ambulation (Correct answer)
Avoid all weight-bearing orthotics permanently
Use only soft-goods orthoses to prevent further bone stress
Refer immediately for orthotic shoe inserts only

Correct answer: Provide a protective KAFO to offload the femoral shaft during ambulation

Atypical femoral fractures associated with bisphosphonate use require protective orthotics such as a KAFO to offload the fracture site and support ambulation.

Question 39: The purpose of a Bangerter foil in amblyopia management is to:

Improve contrast sensitivity in the amblyopic eye directly
Apply graded blur to the fellow eye as a penalization method (Correct answer)
Eliminate diplopia in strabismic patients
Protect the amblyopic eye from bright light

Correct answer: Apply graded blur to the fellow eye as a penalization method

Bangerter foils are translucent filters applied to the fellow eye's spectacle lens to penalize it with graded blur, encouraging preferential use of the amblyopic eye.

Question 40: Which cranial nerve is primarily responsible for lateral eye movement?

Optic nerve (II)
Trochlear nerve (IV)
Abducens nerve (VI) (Correct answer)
Oculomotor nerve (III)

Correct answer: Abducens nerve (VI)

The abducens nerve (cranial nerve VI) innervates the lateral rectus muscle, which is primarily responsible for abducting the eye, meaning moving it away from the midline. Damage to this nerve results in an inability to move the eye laterally and can cause esotropia (inward turning of the eye). The other nerves control different eye movements or sensory functions.

Question 41: When a patient refuses a recommended orthotic intervention, how should the orthotist document this in the medical record?

Transfer documentation responsibility to the referring physician
Document the refusal, the reason given, and the informed consent discussion that occurred (Correct answer)
Write only that 'patient declined' without further detail
Omit the refusal to protect the patient's privacy

Correct answer: Document the refusal, the reason given, and the informed consent discussion that occurred

Refusal of treatment must be documented with the patient's stated reason and a record that risks were explained, forming a refusal-of-treatment note.

Question 42: What is a milestone in CO project management?

An optional checkpoint
A daily required task
A significant event marking progress at a key point in the timeline (Correct answer)
A physical construction marker

Correct answer: A significant event marking progress at a key point in the timeline

Milestones are significant checkpoints marking completion of major deliverables or phase transitions.

Question 43: What does residual risk mean in CO practice?

Risk remaining after all controls are implemented (Correct answer)
Risk affecting waste materials
Initial risk before assessment
Budget overrun risk

Correct answer: Risk remaining after all controls are implemented

Residual risk is the level remaining after practical controls are applied. Some is usually accepted as eliminating all risk is rarely feasible.

Question 44: How should an orthoptist respond if a pediatric patient is uncooperative during an exam?

Use reassuring language and involve the parent (Correct answer)
Reschedule the exam immediately
Force the test quickly
Ignore the child’s discomfort

Correct answer: Use reassuring language and involve the parent

Pediatric patients can often be anxious or uncooperative during medical exams. An orthoptist should approach the situation with patience and empathy, using reassuring language to calm the child and involving the parent or guardian to help facilitate cooperation and comfort. This approach builds trust and often leads to a more successful examination.

Question 45: A patient's family member calls to ask about the patient's treatment plan. Without patient authorization, the orthotist should:

Decline to disclose protected health information without the patient's consent (Correct answer)
Provide a summary of the treatment but omit the diagnosis
Share details since the family member is clearly supportive
Transfer the call to the billing department to handle

Correct answer: Decline to disclose protected health information without the patient's consent

HIPAA prohibits disclosure of patient PHI to family members or others without explicit patient authorization.

Question 46: A pediatric patient is referred for scoliosis bracing with a Cobb angle of 28 degrees and is determined to be a Risser grade 1. This combination suggests:

Observation only is indicated; brace at 40 degrees
Skeletal maturity is near complete; bracing is unlikely to help
Surgical referral is immediately required
Significant remaining growth potential; bracing is typically indicated (Correct answer)

Correct answer: Significant remaining growth potential; bracing is typically indicated

Risser grade 1 indicates early skeletal maturity with significant growth remaining, making this patient an ideal candidate for orthotic bracing to halt curve progression.

Question 47: Which gait deviation should be documented using standardized terminology when recording observational gait analysis findings?

'Seems weak on the left'
Trendelenburg gait with ipsilateral trunk lean during right stance phase (Correct answer)
'Patient walks funny on the right side'
'Has trouble walking straight'

Correct answer: Trendelenburg gait with ipsilateral trunk lean during right stance phase

Standardized anatomical and biomechanical terminology ensures accurate communication and reproducibility across providers.

Question 48: When should an orthotist perform a fall-risk screen for a new outpatient receiving a lower extremity orthosis?

After the orthosis is delivered and worn for 30 days
Only when the patient is elderly (over 65)
At the initial evaluation and before each gait training session (Correct answer)
Only if the patient reports a history of falls

Correct answer: At the initial evaluation and before each gait training session

Fall-risk screening should occur at intake and be re-assessed prior to gait training sessions because new orthotic devices can alter balance and gait mechanics.

Question 49: During prism and alternate cover testing, you neutralize a deviation with 35 PD base-out. This measures the:

Manifest deviation only
Total deviation (manifest + latent) (Correct answer)
AC/A ratio
Fusional vergence amplitude

Correct answer: Total deviation (manifest + latent)

Alternate cover testing dissociates fusion, revealing the total deviation including any latent component.

Question 50: A staff member accidentally splashes a chemical solvent used in orthotic fabrication into their eyes. What is the correct immediate first aid action?

Apply a sterile eye patch and transport to the hospital without rinsing
Blot the eyes gently with a dry cloth and wait for symptoms to resolve
Apply antibiotic eye drops from the first aid kit
Flush the eyes with large amounts of water for at least 15–20 minutes, then seek medical care (Correct answer)

Correct answer: Flush the eyes with large amounts of water for at least 15–20 minutes, then seek medical care

Chemical eye exposure requires immediate, prolonged flushing with water for 15–20 minutes to dilute and remove the chemical before further medical treatment.

Question 51: Which test assesses contrast sensitivity in visual function testing?

Snellen chart
Ishihara test
Amsler grid
Pelli-Robson chart (Correct answer)

Correct answer: Pelli-Robson chart

The Pelli-Robson chart is specifically designed to measure contrast sensitivity, which is the ability to distinguish between an object and its background. Unlike Snellen charts that measure high-contrast visual acuity, the Pelli-Robson chart presents letters of decreasing contrast, providing a more comprehensive assessment of visual function, especially in conditions affecting the optic nerve or retina.

Question 52: An orthotist's certification lapses, but they continue to practice and bill using their expired credentials. This constitutes:

Fraud and misrepresentation of credentials (Correct answer)
An acceptable practice if clinical skills are maintained
A violation only if the state licensing board is notified
A minor administrative oversight with no ethical implications

Correct answer: Fraud and misrepresentation of credentials

Practicing with lapsed credentials and misrepresenting certification status is fraudulent and a serious ethical and legal violation.

Question 53: A child consistently fails visual acuity screening in one eye despite having no refractive error or structural pathology. The next best step is:

Patching the better eye empirically
Prescribing reading glasses
Referral for MRI of the brain
Repeat cycloplegic refraction and cover test evaluation (Correct answer)

Correct answer: Repeat cycloplegic refraction and cover test evaluation

Cycloplegic refraction may reveal latent hyperopia or anisometropia not apparent on manifest testing, and a cover test identifies strabismus.

Question 54: A patient wearing a lower limb orthosis reports sudden chest pain and shortness of breath during a fitting session. What is the orthotist's first priority?

Remove the orthosis immediately and send the patient home
Administer oxygen from the clinic supply
Continue the fitting and monitor the patient
Call 911 and have the patient rest in a comfortable position (Correct answer)

Correct answer: Call 911 and have the patient rest in a comfortable position

Sudden chest pain and shortness of breath are signs of a cardiac or pulmonary emergency requiring immediate activation of EMS.

Question 55: When correcting an error in a paper medical record, the orthotist should:

Leave the error and add an asterisk with a note at the bottom
Destroy the page and rewrite it correctly
Use correction fluid (white-out) to cover the mistake
Draw a single line through the error, initial, date, and write the correction (Correct answer)

Correct answer: Draw a single line through the error, initial, date, and write the correction

A single line through the error with initials and date maintains the original entry's visibility while clearly marking the correction.

Question 56: An orthotist learns during a fitting that a patient is experiencing domestic abuse. The MOST appropriate action is to:

Ignore the information to preserve the therapeutic relationship
Provide information about resources and follow mandatory reporting laws where applicable (Correct answer)
Immediately contact law enforcement without informing the patient
Document nothing to avoid legal liability

Correct answer: Provide information about resources and follow mandatory reporting laws where applicable

Practitioners have an ethical duty to connect patients with resources and comply with mandatory reporting laws while maintaining a supportive approach.

Question 57: What is the best practice when documenting patient information?

Wait until the end of the week to document
Record information accurately and immediately (Correct answer)
Rely on memory for later entries
Use abbreviations only

Correct answer: Record information accurately and immediately

Accurate and immediate documentation is critical in healthcare for patient safety, continuity of care, and legal reasons. Recording information promptly ensures that details are not forgotten or misinterpreted, provides an up-to-date record for all healthcare providers, and supports evidence-based decision-making.

Question 58: Which of the following is a symptom of poor binocular vision?

Irritation from contact lenses
Headache during reading (Correct answer)
Eye twitching
Blurry peripheral vision

Correct answer: Headache during reading

Poor binocular vision, such as from convergence insufficiency or uncorrected phorias, often causes symptoms related to eye strain and the effort to maintain single vision. Headaches, especially during prolonged near tasks like reading, are a classic symptom as the eyes struggle to work together efficiently. Other options like eye twitching or blurry peripheral vision are not typically primary symptoms of poor binocular vision.

Question 59: The four-prism diopter base-out test is used to detect:

Microtropia and monofixation syndrome (Correct answer)
Vertical phoria
Intermittent exotropia at distance
Convergence insufficiency

Correct answer: Microtropia and monofixation syndrome

The 4 PD BO test introduces a small fusional vergence demand; absence of the expected refixation movement indicates a central suppression scotoma, as seen in monofixation syndrome.

Question 60: The synoptophore is used clinically to measure:

Corneal topography
Retinal nerve fiber layer thickness
Angle of deviation and grades of binocular vision simultaneously (Correct answer)
Intraocular pressure

Correct answer: Angle of deviation and grades of binocular vision simultaneously

The synoptophore measures the objective angle of strabismus and assesses simultaneous perception, fusion, and stereopsis.

Question 61: An orthotist is fitting a functional electrical stimulation (FES) orthosis on a patient with a pacemaker. Which statement is correct regarding this situation?

FES is safe with all modern pacemakers
FES can be used if electrodes are placed distal to the pacemaker site
Low-frequency FES is universally safe for pacemaker patients
Electrical stimulation is contraindicated without clearance from the patient's cardiologist (Correct answer)

Correct answer: Electrical stimulation is contraindicated without clearance from the patient's cardiologist

FES and other electrical stimulation devices can interfere with pacemaker function and require explicit cardiologist clearance before use in any patient with a pacemaker or implantable cardiac device.

Question 62: Which principle BEST describes the orthotist's role when a patient's medication causes a side effect that complicates orthotic outcomes?

Document findings and communicate concerns to the prescribing physician as part of the interprofessional team (Correct answer)
Modify the medication schedule to optimize orthotic performance
Independently manage side effects using topical over-the-counter remedies
Discontinue orthotic treatment until the medication side effect resolves

Correct answer: Document findings and communicate concerns to the prescribing physician as part of the interprofessional team

Orthotists are integral interprofessional team members who document medication-related complications and communicate them to the prescribing physician for collaborative management.

Question 63: When disinfecting an orthotic workbench after a procedure involving a patient with active hepatitis B, which agent is appropriate?

Soap and water scrub only
Quaternary ammonium compound at standard dilution
70% isopropyl alcohol spray
An EPA-registered intermediate-level disinfectant (Correct answer)

Correct answer: An EPA-registered intermediate-level disinfectant

Hepatitis B virus requires at minimum intermediate-level disinfection; EPA-registered intermediate-level disinfectants carry a tuberculocidal claim indicating appropriate potency.

Question 64: A right CN IV palsy typically causes the right eye to be:

Esotropic with an upgaze limitation
Exotropic and hypotropic
Hypertropic, with the head tilted to the right
Hypertropic, with compensatory head tilt to the left (Correct answer)

Correct answer: Hypertropic, with compensatory head tilt to the left

A right CN IV palsy causes right hypertropia; the patient tilts the head to the left (away from the affected side) to reduce diplopia.

Question 65: A 4-year-old with unilateral amblyopia shows no improvement after 3 months of full-time patching. Before changing therapy, the orthoptist should FIRST:

Order MRI of the orbits
Verify refractive correction is current and patch compliance is adequate (Correct answer)
Discharge the patient
Switch to atropine penalization immediately

Correct answer: Verify refractive correction is current and patch compliance is adequate

Treatment failure is most commonly due to non-compliance or uncorrected refractive error, both of which must be ruled out before escalating therapy.

Question 66: The ABC Code of Ethics requires orthotists to maintain competence through:

Ongoing continuing education and professional development (Correct answer)
Limiting practice to procedures performed more than 100 times
Hiring experienced staff only
Annual peer review of all cases

Correct answer: Ongoing continuing education and professional development

The ABC Code of Ethics mandates that practitioners maintain and expand competence through continuing education throughout their career.

Question 67: A certified orthotist supervises a non-certified orthotic fitter. If the fitter makes an error resulting in patient harm, who bears professional responsibility?

Only the fitter, since they performed the service
No one, as errors are expected in training environments
The supervising orthotist shares responsibility for the supervised staff's actions (Correct answer)
The clinic owner bears sole responsibility

Correct answer: The supervising orthotist shares responsibility for the supervised staff's actions

The supervising practitioner shares professional and ethical responsibility for the outcomes of those they supervise.

Question 68: Which of the following is NOT a recognized amblyopia risk factor per the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines?

Astigmatism greater than 1.50 D in either eye
Anisometropia greater than 1.50 D sphere
Equal high myopia of -10.00 D in both eyes (Correct answer)
Constant unilateral strabismus

Correct answer: Equal high myopia of -10.00 D in both eyes

Bilateral symmetric high myopia, while a refractive condition, does not create interocular competition and is not a classic amblyopia risk factor.

Question 69: In the context of bloodborne pathogen exposure during orthotic fabrication (e.g., a needlestick from a wire), what is the first step the orthotist should take?

Apply a tourniquet proximal to the wound site
Notify the patient's physician within 24 hours
Complete an incident report and submit to HR
Wash the wound thoroughly with soap and water immediately (Correct answer)

Correct answer: Wash the wound thoroughly with soap and water immediately

Immediate thorough washing of the exposure site with soap and water is the first response to a bloodborne pathogen exposure to reduce infection risk.

Question 70: Most pediatric vision screening guidelines recommend referral if visual acuity is worse than which threshold in children aged 3–5 years?

20/60 in either eye
20/30 in either eye
20/40 in either eye (Correct answer)
20/50 in either eye

Correct answer: 20/40 in either eye

Most guidelines recommend referral if best-corrected visual acuity is worse than 20/40 in either eye in children aged 3–5 years.

Question 71: In treatment planning for plantar fasciitis, which orthotic feature is MOST supported by clinical evidence to reduce pain?

Medial arch support with heel cushioning (Correct answer)
Metatarsal bar positioned proximal to metatarsal heads
Toe separator between first and second digits
Rigid full-length carbon fiber insole

Correct answer: Medial arch support with heel cushioning

Medial arch support with heel cushioning reduces tensile loading of the plantar fascia and offloads the calcaneal enthesis, the primary pain source.

Question 72: A 30-year-old woman with pseudotumor cerebri (idiopathic intracranial hypertension) is most likely to complain of which ocular symptom?

Persistent binocular diplopia from CN III palsy
Transient visual obscurations lasting seconds (Correct answer)
Sudden monocular blindness
Loss of red-green color discrimination

Correct answer: Transient visual obscurations lasting seconds

Transient visual obscurations—brief greying or blackouts of vision lasting seconds, often triggered by postural changes—are the classic visual symptom of IIH.

Question 73: Which test is most appropriate for assessing visual acuity in a non-verbal 2-year-old child?

Snellen chart
Landolt C rings
Teller Acuity Cards (Correct answer)
LogMAR chart

Correct answer: Teller Acuity Cards

Teller Acuity Cards use preferential looking to assess grating acuity in preverbal or nonverbal children.

Question 74: Which visual field defect is typically associated with a lesion in the left occipital lobe?

Quadrantanopia
Left homonymous hemianopia
Bitemporal hemianopia
Right homonymous hemianopia (Correct answer)

Correct answer: Right homonymous hemianopia

The left occipital lobe processes visual information from the right half of the visual field for both eyes. Therefore, a lesion in the left occipital lobe will result in a loss of vision in the entire right half of the visual field, affecting both eyes, which is known as a right homonymous hemianopia. This defect occurs contralateral to the lesion.

Question 75: What does the acronym RICE stand for in musculoskeletal injury first aid?

Reduce, Immobilize, Cool, Evaluate
Reduce swelling, Ice pack, Cast, Exercise
Rest, Ice, Compression, Elevation (Correct answer)
Rest, Immobilize, Circulation check, Elevate

Correct answer: Rest, Ice, Compression, Elevation

RICE (Rest, Ice, Compression, Elevation) is the standard first aid protocol for soft tissue injuries such as sprains and strains.

Question 76: What is the correct hand hygiene protocol before examining a patient?

Wash hands for at least 20 seconds (Correct answer)
Rinse hands without soap
Wash only if visible dirt is present
Use gloves instead of washing hands

Correct answer: Wash hands for at least 20 seconds

Proper hand hygiene is the single most effective way to prevent the spread of infections in a healthcare setting. Washing hands thoroughly with soap and water for at least 20 seconds, or using an alcohol-based hand rub, is the standard protocol recommended by health organizations before and after patient contact to ensure patient and practitioner safety.

Question 77: Which instrument is primarily used to measure the angle of deviation in strabismus by projecting a light onto each cornea?

Hirschberg light reflex test
Krimsky test (Correct answer)
Prism cover test
Worth 4-dot test

Correct answer: Krimsky test

The Krimsky test uses a prism placed before one eye while observing corneal light reflexes to measure the angle of strabismic deviation.

Question 78: When measuring fusional vergence amplitudes with a prism bar, you record the 'break' point as:

When the patient reports diplopia or one eye is seen to deviate (Correct answer)
When the patient completes 10 seconds of comfortable fusion
When the patient first reports slight blurring
When the deviation is neutralized on cover test

Correct answer: When the patient reports diplopia or one eye is seen to deviate

The break point is defined as the prism power at which the patient first reports diplopia or the examiner observes a manifest deviation.

Question 79: What is suppression in binocular vision assessment?

Dominance of one eye
Visual signal blocked by retina
Focusing delay in one eye
Brain ignores input from one eye (Correct answer)

Correct answer: Brain ignores input from one eye

Suppression in binocular vision refers to the brain's active mechanism of ignoring or 'turning off' the visual input from one eye. This occurs to avoid diplopia (double vision) when the eyes are misaligned (strabismus) or when there is a significant difference in image quality between the two eyes. While it prevents double vision, prolonged suppression can lead to amblyopia.

Question 80: Why is accurate documentation important in CO?

Only for bureaucratic purposes
It supports decision-making, compliance, and legal defensibility (Correct answer)
No impact on quality
Only for medical/legal fields

Correct answer: It supports decision-making, compliance, and legal defensibility

Accurate documentation supports quality assurance, compliance, legal defensibility, and knowledge continuity.

Question 81: Which piece of information is most important to document after every orthotic device delivery appointment?

The retail price of competing devices considered
The name of the delivery courier
The patient's shoe size and brand preference
That the device was delivered, fit was assessed, patient education was provided, and patient demonstrated independence with donning/doffing (Correct answer)

Correct answer: That the device was delivered, fit was assessed, patient education was provided, and patient demonstrated independence with donning/doffing

Delivery documentation must confirm device receipt, fit assessment, patient education, and functional independence with the device to satisfy clinical and payer requirements.

Question 82: A patient reports seeing halos around lights at night and has a relative afferent pupillary defect. The most likely diagnosis is:

Corneal edema from acute angle-closure glaucoma
Macular degeneration
Posterior vitreous detachment
Optic neuritis with asymmetric optic nerve disease (Correct answer)

Correct answer: Optic neuritis with asymmetric optic nerve disease

An RAPD indicates asymmetric optic nerve or retinal disease; halos plus RAPD together may suggest acute glaucoma or optic neuropathy causing both symptoms.

Question 83: An orthotist is asked to provide a written testimonial for a legal case involving a patient they currently treat. The most significant ethical concern is:

The possibility of increased referrals from attorneys
Potential conflict of interest between advocacy and objective clinical testimony (Correct answer)
The time commitment required for legal proceedings
Whether the orthotist has malpractice coverage for expert witness work

Correct answer: Potential conflict of interest between advocacy and objective clinical testimony

Serving as an advocate for a current patient in legal proceedings can compromise the objectivity required of expert witnesses.

Question 84: What is informed consent in CO professional practice?

Verbal agreement only
Providing complete information about services, risks, and alternatives for voluntary decisions (Correct answer)
Third-party consent
Having clients sign without explanation

Correct answer: Providing complete information about services, risks, and alternatives for voluntary decisions

Informed consent requires clear, complete information about proposed services, risks, outcomes, and alternatives so clients can make knowledgeable decisions.

Question 85: Which behavior by an orthoptist represents a breach of professional boundaries?

Accepting a small gift basket from a grateful family
Discussing a difficult case with a supervising physician
Recommending the patient see an ophthalmologist for surgical evaluation
Initiating a personal social media friendship with a current patient (Correct answer)

Correct answer: Initiating a personal social media friendship with a current patient

Social media relationships with current patients blur the professional boundary and can compromise objectivity and confidentiality.

Question 86: A patient with multiple sclerosis is taking baclofen for spasticity. How does this affect lower extremity orthotic fitting?

Reduced spasticity from baclofen may change muscle tone baseline, affecting orthotic fit (Correct answer)
Baclofen increases spasticity, requiring stiffer orthotic materials
Baclofen causes joint contractures that necessitate serial casting
Baclofen has no pharmacological effect relevant to orthotic management

Correct answer: Reduced spasticity from baclofen may change muscle tone baseline, affecting orthotic fit

Baclofen reduces spasticity, which may alter the muscle tone the orthosis was fitted against, requiring reassessment as medication dosage changes.

Question 87: Deprivation amblyopia, caused by conditions such as congenital cataracts, is the MOST severe form because:

It affects only the peripheral visual field
It completely deprives the visual cortex of form vision during the critical period (Correct answer)
It is easily reversed with patching alone
It only occurs in bilateral cases

Correct answer: It completely deprives the visual cortex of form vision during the critical period

Deprivation amblyopia is most severe because form vision is completely blocked during the critical sensitive period, causing profound cortical underrepresentation.

Question 88: Under the principle of justice in healthcare ethics, an orthotist is obligated to:

Provide fair and equitable care regardless of a patient's socioeconomic status (Correct answer)
Prioritize patients based on their likelihood of a good outcome
Charge higher fees to patients without a referral
Treat only patients with the best insurance coverage

Correct answer: Provide fair and equitable care regardless of a patient's socioeconomic status

Justice requires equitable distribution of care and resources without discrimination based on socioeconomic or personal factors.

Question 89: Which component of the chain of infection does hand hygiene MOST directly break?

Reservoir
Mode of transmission (Correct answer)
Portal of entry
Susceptible host

Correct answer: Mode of transmission

Hand hygiene interrupts the mode of transmission by removing pathogens from hands before they can be transferred to another person or surface.

Question 90: A patient requests their orthoptic records to send to a specialist. Under HIPAA, you must comply:

Within 60 days, with one 30-day extension if documented (Correct answer)
Within 30 days of the patient's written request
Only after the specialist requests the records directly
Only if the treating ophthalmologist approves

Correct answer: Within 60 days, with one 30-day extension if documented

HIPAA mandates record release within 30 days, with a possible 30-day extension if the covered entity notifies the patient in writing.

Question 91: Which neonatal ocular condition can cause permanent severe vision loss if not treated within the first weeks of life?

Physiologic neonatal esotropia
Congenital nasolacrimal duct obstruction
Congenital cataracts (Correct answer)
Retinopathy of prematurity stage 1

Correct answer: Congenital cataracts

Congenital cataracts cause visual deprivation amblyopia and must be treated within the first weeks of life to prevent permanent, severe vision loss.

Question 92: The double Maddox rod test is used to assess:

Cyclodeviation (torsion) (Correct answer)
Aniseikonia
Stereoacuity threshold
Horizontal fusional vergence amplitudes

Correct answer: Cyclodeviation (torsion)

The double Maddox rod test quantifies excyclotorsion or incyclotorsion by measuring the angle required to realign the two horizontal streaks.

Question 93: An orthotist sustains a needlestick injury while working with a patient of unknown HIV status. What is the FIRST immediate action?

Test the patient for HIV
Start post-exposure prophylaxis immediately
Wash the wound thoroughly with soap and water (Correct answer)
Report the incident to the supervisor

Correct answer: Wash the wound thoroughly with soap and water

Immediate wound washing with soap and water is the first first-aid step after a needlestick; reporting and PEP evaluation follow.

Question 94: A patient discloses they are driving commercially but has vision below federal motor carrier standards. The orthoptist's legal obligation is to:

Refuse to treat the patient
Immediately contact law enforcement
Inform the patient of reporting requirements and document the counseling (Correct answer)
Maintain confidentiality at all costs

Correct answer: Inform the patient of reporting requirements and document the counseling

Orthoptists must advise patients of applicable reporting laws and document the counseling, balancing confidentiality with public safety duties.

Question 95: A patient's prefabricated wrist splint was used by multiple patients and is now visibly soiled with exudate. The BEST course of action is to:

Discard the device and replace with a new one (Correct answer)
Soak in 70% isopropyl alcohol for 10 minutes
Disinfect with low-level disinfectant and reassign
Sterilize with ethylene oxide and reassign

Correct answer: Discard the device and replace with a new one

Single-patient-use devices or those that cannot be adequately reprocessed after visible contamination should be discarded to prevent cross-contamination.

Question 96: Which test uses a graded prism bar to measure the fusional vergence range?

Near point of convergence test
Maddox rod test
Randot stereopsis test
Prism bar vergence testing (Correct answer)

Correct answer: Prism bar vergence testing

Prism bar vergence testing uses a prism bar with increasing prism values to measure positive and negative fusional vergence amplitudes.

Question 97: Which refractive error is most closely associated with accommodative esotropia?

Astigmatism
High myopia
Hyperopia (Correct answer)
Anisometropia

Correct answer: Hyperopia

Accommodative esotropia is most commonly associated with uncorrected hyperopia, as excessive accommodation drives convergence and causes esotropia.

Question 98: A patient with Guillain-Barré syndrome is recovering and has antigravity hip flexion but absent dorsiflexion. Which orthotic plan is most appropriate during this recovery phase?

No orthotic intervention until full recovery
Bilateral KAFOs with locked knee joints
Bilateral solid AFOs to prevent foot drop (Correct answer)
HKAFO to provide full lower limb support

Correct answer: Bilateral solid AFOs to prevent foot drop

GBS recovery is often incomplete and variable; AFOs address the most functionally limiting deficit (foot drop) while preserving voluntary movement at intact joints.

Question 99: When documenting the plan of care for a diabetic patient receiving a custom diabetic shoe insert, which co-morbidity information is most important to capture?

The patient's food preferences
Peripheral neuropathy status, vascular status, and history of prior ulceration, as these directly affect device design and follow-up intensity (Correct answer)
The patient's employment history
The patient's favorite recreational activities

Correct answer: Peripheral neuropathy status, vascular status, and history of prior ulceration, as these directly affect device design and follow-up intensity

Peripheral neuropathy, vascular compromise, and ulcer history are critical risk factors that directly inform the design, material selection, and monitoring frequency for diabetic footwear.

Question 100: During postural assessment of a patient in the sagittal plane, an increase in lumbar lordosis combined with anterior pelvic tilt is most often associated with:

Weak hip extensors and tight hip flexors (Correct answer)
Tight hamstrings and weak hip abductors
Shortened iliotibial band and weak knee extensors
Weak core stabilizers and tight ankle plantarflexors

Correct answer: Weak hip extensors and tight hip flexors

Anterior pelvic tilt with increased lumbar lordosis is classically caused by tight hip flexors pulling the pelvis forward and weak hip extensors failing to posteriorly tilt the pelvis.

Certified Orthoptist (CO) Certification Exam

The Certified Orthoptist (CO) certification validates an individual's expertise in the diagnosis and non-surgical management of disorders of the eye movements and associated visual problems.

100

Questions

180 min

Time Limit

70%

To Pass

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