OCC OCC Pediatric & Special Population Casting 2 — Questions and Answers
Question 1: Which modification is typically made when casting an elderly patient with osteoporotic skin?
- Increased padding and lower circumferential pressure (Correct answer)
- Thinner padding to keep the cast lightweight
- Use of only plaster to allow custom molding
- Omitting stockinette to reduce layers
Correct answer: Increased padding and lower circumferential pressure
Elderly patients have fragile, atrophic skin prone to tearing and pressure injury, requiring extra padding and careful tensioning.
Question 2: In a patient with a spinal cord injury who lacks sensation, the primary casting concern is:
- Pressure injury that the patient cannot feel or report (Correct answer)
- Muscle spasticity breaking the cast
- Autonomic dysreflexia triggered by the cast saw
- Bone healing being slower due to paralysis
Correct answer: Pressure injury that the patient cannot feel or report
Lack of sensation means pressure sores can develop silently; aggressive padding and very frequent skin checks are mandatory.
Question 3: When casting a pregnant patient, which body position is recommended during the procedure?
- Left lateral tilt or left lateral decubitus to prevent aortocaval compression (Correct answer)
- Supine flat with legs extended
- Seated upright in a chair
- Prone to access posterior injuries
Correct answer: Left lateral tilt or left lateral decubitus to prevent aortocaval compression
After the first trimester, supine positioning can compress the inferior vena cava; a left tilt maintains cardiac output.
Question 4: For obese patients requiring lower extremity casting, which casting consideration is most important?
- Using stronger fiberglass layers and ensuring adequate support to prevent cast breakage (Correct answer)
- Using plaster only due to its lower cost for larger casts
- Applying the cast in a standing position
- Limiting padding to reduce cast bulk
Correct answer: Using stronger fiberglass layers and ensuring adequate support to prevent cast breakage
Increased body weight places greater mechanical stress on the cast; additional fiberglass layers and structural support prevent early cast failure.
Question 5: A child is very anxious and uncooperative during casting. The BEST approach is:
- Involve the caregiver, explain each step simply, and work calmly and efficiently (Correct answer)
- Firmly restrain the child and complete the cast quickly
- Administer sedation before proceeding
- Reschedule until the child is calmer
Correct answer: Involve the caregiver, explain each step simply, and work calmly and efficiently
Caregiver involvement, age-appropriate explanations, and a calm demeanor reduce anxiety and improve cooperation without restraint or medication.
Question 6: Which feature of a pediatric hip spica cast requires specific skin care instructions for parents?
- The perineal opening must be kept clean and dry to prevent skin breakdown (Correct answer)
- The cast must be painted weekly to maintain moisture resistance
- The child must remain completely supine for the full treatment period
- The cast must be removed nightly for skin inspection
Correct answer: The perineal opening must be kept clean and dry to prevent skin breakdown
The perineal area is prone to soiling and maceration in a spica cast; parents must receive detailed hygiene instructions to prevent infection.
OCC OCC Pediatric & Special Population Casting 2
Which modification is typically made when casting an elderly patient with osteoporotic skin?