Orthopaedic Technologist Certified (OTC) Examination — Questions and Answers

Question 1: Which cast is the standard immobilization for an uncomplicated Colles fracture after reduction?

Short arm cast in full extension
Long arm cast in full supination
Short arm cast in slight flexion and ulnar deviation (Correct answer)
Thumb spica cast

Correct answer: Short arm cast in slight flexion and ulnar deviation

A short arm cast with the wrist in slight flexion and ulnar deviation counteracts the deforming forces of a Colles fracture.

Question 2: Which of the following is a critical first step in cast application?

Shaping the cast edges
Choosing cast color
Applying padding over bony prominences (Correct answer)
Mixing the casting material

Correct answer: Applying padding over bony prominences

A critical first step in cast application is to apply adequate padding, especially over bony prominences. This padding protects the patient's skin and underlying tissues from pressure sores, skin breakdown, and nerve compression that can result from the rigid casting material. Proper padding ensures patient comfort and prevents complications throughout the immobilization period.

Question 3: Which cast technician action constitutes practicing outside the scope of practice?

Independently diagnosing a fracture and prescribing a cast without clinician order (Correct answer)
Documenting neurovascular findings
Applying a cast per a written clinician order
Educating the patient about cast care

Correct answer: Independently diagnosing a fracture and prescribing a cast without clinician order

Diagnosis and prescription are physician functions; casting technicians apply casts based on clinician orders and do not independently diagnose or prescribe treatment.

Question 4: Which fracture pattern describes a bone that bends but does not completely break, seen primarily in children?

Spiral fracture
Greenstick fracture (Correct answer)
Comminuted fracture
Stress fracture

Correct answer: Greenstick fracture

Greenstick fractures occur in pediatric patients whose immature, flexible bone bends and fractures on one cortex while the other remains intact.

Question 5: A pathologic fracture is defined as a fracture occurring:

At the site of a previous surgical repair
In the growth plate of a child
After normal-energy trauma in a healthy individual
Through bone weakened by underlying disease such as tumor or osteoporosis (Correct answer)

Correct answer: Through bone weakened by underlying disease such as tumor or osteoporosis

Pathologic fractures occur through abnormal bone and may occur with minimal trauma; the underlying condition must be addressed alongside fracture management.

Question 6: Which nerve is at risk of injury when the cast padding is applied too tightly over the medial epicondyle of the humerus?

Ulnar nerve (Correct answer)
Median nerve
Radial nerve
Musculocutaneous nerve

Correct answer: Ulnar nerve

The ulnar nerve passes through the cubital tunnel posterior to the medial epicondyle and is highly susceptible to pressure injury there.

Question 7: A patient with a recently applied long leg cast reports numbness of the little toe and the lateral aspect of the foot. Which nerve is most likely compressed?

Tibial nerve
Sural nerve (Correct answer)
Superficial peroneal nerve
Deep peroneal nerve

Correct answer: Sural nerve

The sural nerve provides sensation to the lateral foot and little toe, and is vulnerable to compression along the lateral ankle area.

Question 8: Which ligament of the lateral ankle complex is most frequently torn in an inversion sprain and is commonly protected by short-leg casting?

Calcaneofibular ligament (CFL)
Posterior talofibular ligament (PTFL)
Deltoid ligament
Anterior talofibular ligament (ATFL) (Correct answer)

Correct answer: Anterior talofibular ligament (ATFL)

The ATFL is the weakest of the three lateral ankle ligaments and the first to tear during an inversion-plantarflexion injury.

Question 9: A 'three-point pressure system' in cast molding refers to which concept?

Using counter-pressure at three points to hold a fracture in reduction (Correct answer)
Applying plaster in three separate dipping sessions
Three sequential wrapping passes around the limb
Applying three different types of padding materials

Correct answer: Using counter-pressure at three points to hold a fracture in reduction

Three-point molding applies a corrective force at the fracture apex balanced by opposing forces proximal and distal, maintaining fracture reduction within the cast.

Question 10: The term 'scope of practice' for an orthopedic casting technician is best defined as:

The range of procedures and responsibilities the technician is legally and professionally authorized to perform (Correct answer)
The number of patients the technician can treat per shift
The types of insurance a technician is permitted to bill for services
The geographic region in which the technician is licensed to work

Correct answer: The range of procedures and responsibilities the technician is legally and professionally authorized to perform

Scope of practice defines the legal and professional boundaries of what a certified casting technician is authorized to perform.

Question 11: A patient reports severe burning pain under the cast starting 2 hours after application. The plaster was mixed with water at approximately 40°C. The most likely explanation is:

Thermal burn from exothermic plaster setting reaction potentiated by hot water (Correct answer)
Allergic contact dermatitis to plaster additives
Compartment syndrome from the casting pressure
Infection from improper aseptic technique

Correct answer: Thermal burn from exothermic plaster setting reaction potentiated by hot water

Hot water accelerates plaster setting, intensifying the exothermic reaction and producing temperatures capable of causing burns.

Question 12: An orthopedic casting technician witnesses a colleague performing a procedure that the technician believes is causing patient harm. The most appropriate action is to:

Wait until the end of the shift to report the concern
Discuss the concern with other coworkers before deciding to act
Intervene immediately to stop potential patient harm and report through the facility's chain of command (Correct answer)
Assume the colleague knows best and continue working

Correct answer: Intervene immediately to stop potential patient harm and report through the facility's chain of command

Patient safety requires immediate intervention to stop ongoing harm, followed by reporting through proper channels per facility policy.

Question 13: A patient with a short arm cast reports numbness and tingling in the little finger and the medial half of the ring finger. Which nerve is most likely compromised?

Radial nerve
Anterior interosseous nerve
Median nerve
Ulnar nerve (Correct answer)

Correct answer: Ulnar nerve

The ulnar nerve provides sensory innervation to the little finger and the medial half of the ring finger on both palmar and dorsal surfaces.

Question 14: Testing motor function of the ulnar nerve is best accomplished by asking the patient to:

Extend the wrist against resistance
Oppose the thumb to the index finger
Flex the elbow against resistance
Abduct the fingers (spread them apart) (Correct answer)

Correct answer: Abduct the fingers (spread them apart)

Finger abduction is performed by the dorsal interossei, which are innervated by the ulnar nerve, making this the primary motor test for ulnar integrity.

Question 15: Which instrument is the standard tool for cast removal?

Bandage scissors
Plaster knife
Electric drill
Oscillating cast saw (Correct answer)

Correct answer: Oscillating cast saw

The oscillating cast saw vibrates rather than rotates, cutting hard cast material while minimizing risk of skin laceration.

Question 16: What is the minimum recommended number of plaster layers for a walking cast intended to bear body weight?

12–16 layers
20+ layers
2–4 layers
6–8 layers (Correct answer)

Correct answer: 6–8 layers

Weight-bearing plaster casts typically require 6–8 layers (more over stress areas) to provide adequate structural strength for ambulation.

Question 17: When caring for a patient with dementia in a cast, which instruction to caregivers is MOST critical?

Sedate the patient if they attempt to touch the cast
Monitor for signs of cast removal attempts and skin breakdown daily (Correct answer)
Apply additional restraints to prevent the patient from moving
Lock all cutting instruments to prevent cast removal

Correct answer: Monitor for signs of cast removal attempts and skin breakdown daily

Dementia patients may attempt cast removal and cannot communicate discomfort reliably; daily visual inspection and behavioral monitoring are essential.

Question 18: When removing a cast, the saw should be moved in which pattern?

In circular motions around the extremity
In a continuous drag along the length
In and out (plunging motion) along the cast surface, not dragged (Correct answer)
In a single long cut straight down the center

Correct answer: In and out (plunging motion) along the cast surface, not dragged

A plunging in-and-out motion prevents overheating and reduces the risk of skin burns and lacerations.

Question 19: Ear protection during cast removal with an oscillating saw is recommended primarily for:

Only the technician performing frequent removals
Neither, as the saw is below OSHA noise thresholds
The patient and technician, as prolonged noise can cause discomfort (Correct answer)
The patient only, as technicians are trained to tolerate the noise

Correct answer: The patient and technician, as prolonged noise can cause discomfort

Both patient and technician benefit from ear protection during cast removal, especially for children or those sensitive to noise.

Question 20: Cyanosis of the toes in a patient with a lower extremity cast most likely indicates:

Venous congestion and impaired venous return (Correct answer)
Superficial skin irritation from casting material
Arterial occlusion
Normal post-casting discoloration

Correct answer: Venous congestion and impaired venous return

Cyanosis (blue discoloration) results from deoxygenated blood pooling in the tissues, indicating impaired venous return rather than arterial occlusion.

Question 21: Why must growth plates (physes) receive special consideration when reviewing X-rays before pediatric casting?

Physeal injuries can affect bone growth and require specific fracture classification (Correct answer)
Physeal injuries always require surgical repair, making casting unnecessary
Growth plates cause the cast to heat up during application
Growth plates are not visible on X-ray and cannot be assessed

Correct answer: Physeal injuries can affect bone growth and require specific fracture classification

Salter-Harris physeal fractures have implications for long-term growth and may change cast type, duration, or referral urgency.

Question 22: A Colles fracture is a distal radius fracture with which characteristic displacement?

Volar displacement of the distal fragment
Dorsal displacement and angulation of the distal fragment (dinner fork deformity) (Correct answer)
Impaction without angulation
Transverse fracture with lateral displacement

Correct answer: Dorsal displacement and angulation of the distal fragment (dinner fork deformity)

The classic Colles fracture produces dorsal tilt of the distal fragment, creating the dinner fork silhouette on lateral X-ray.

Question 23: Which of the 'five P's' of compartment syndrome represents the LATEST and most ominous sign?

Pain
Pressure
Paresthesia
Pulselessness (Correct answer)

Correct answer: Pulselessness

Pulselessness is a very late sign indicating arterial occlusion; by this stage irreversible muscle and nerve necrosis is likely already occurring.

Question 24: Volkmann's ischemic contracture is a devastating complication that most commonly results from:

Excessive cast padding that restricts motion
Infection under the cast padding
Prolonged but uncomplicated immobilization
Unrelieved compartment syndrome in the forearm (Correct answer)

Correct answer: Unrelieved compartment syndrome in the forearm

Volkmann's ischemic contracture results from untreated compartment syndrome causing ischemic necrosis of forearm muscles, leading to permanent flexion contracture.

Question 25: Which of the following transmission routes is most relevant when applying a cast to a patient with active influenza?

Contact transmission
Fecal-oral transmission
Vector-borne transmission
Droplet transmission (Correct answer)

Correct answer: Droplet transmission

Influenza spreads primarily through large respiratory droplets, requiring droplet precautions during close-contact procedures like casting.

Question 26: During fracture healing, which phase involves the formation of a soft callus by chondrocytes?

Soft callus phase (Correct answer)
Hard callus phase
Remodeling phase
Inflammatory phase

Correct answer: Soft callus phase

The soft callus phase occurs when chondrocytes produce fibrocartilage that bridges the fracture gap before mineralization.

Question 27: Wolff's Law states that bone remodels in response to which stimulus?

Mechanical stress applied to it (Correct answer)
Vascular supply changes
Calcium intake levels
Hormonal fluctuations

Correct answer: Mechanical stress applied to it

Wolff's Law describes bone's adaptation to the mechanical loads placed on it, laying down more matrix along lines of stress.

Question 28: What does the term 'cast index' refer to in orthopedic casting?

The ratio of cast length to patient height
The angle of wrist position measured inside the cast
A measurement used to assess cast molding adequacy for forearm fractures (Correct answer)
The number of plaster layers divided by the cast circumference

Correct answer: A measurement used to assess cast molding adequacy for forearm fractures

The cast index is the sagittal cast width divided by coronal cast width on X-ray; a value ≤0.70 indicates adequate three-point molding for forearm fractures.

Question 29: The classic '5 P's' of neurovascular assessment include all of the following EXCEPT:

Perspiration (Correct answer)
Paresthesia
Pain
Pallor

Correct answer: Perspiration

The 5 P's are Pain, Pallor, Paresthesia, Pulselessness, and Paralysis/Paresis — perspiration is not included.

Question 30: When applying a short arm cast, the wrist should typically be positioned in how many degrees of dorsiflexion?

10–20 degrees (Correct answer)
0 degrees (neutral)
50–60 degrees
30–45 degrees

Correct answer: 10–20 degrees

The wrist is typically positioned in 10–20 degrees of dorsiflexion for a functional short arm cast, allowing optimal hand function.

Question 31: Before casting a diabetic patient, which additional assessment is MOST important?

Detailed skin integrity check for neuropathic ulcers or insensate areas (Correct answer)
Peripheral blood smear
Blood glucose level measurement
Dietary history for the past 24 hours

Correct answer: Detailed skin integrity check for neuropathic ulcers or insensate areas

Diabetic patients may have peripheral neuropathy and impaired wound healing, making skin inspection before casting critical.

Question 32: Which modification is typically made when casting an elderly patient with osteoporotic skin?

Increased padding and lower circumferential pressure (Correct answer)
Use of only plaster to allow custom molding
Thinner padding to keep the cast lightweight
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 33: Which color-coded system is used to guide padding at vulnerable areas in pediatric casts?

There is no color system; anatomy landmarks guide extra padding placement (Correct answer)
Red padding for high-risk areas, green for low-risk
Standard hospital color bands matching allergy status
Blue marks for bony prominences, yellow for skin folds

Correct answer: There is no color system; anatomy landmarks guide extra padding placement

Padding placement in pediatric casts is guided by anatomical landmarks rather than a color-coded system; extra padding is placed over identified bony prominences.

Question 34: In toddlers and infants, which type of cast is commonly used to treat developmental dysplasia of the hip (DDH)?

Spica cast (Correct answer)
Short arm cast
Slipper cast
Long leg cast

Correct answer: Spica cast

A hip spica cast holds the hips in the abducted, flexed position required to seat the femoral head in the acetabulum during DDH treatment.

Question 35: Thermal burns beneath a plaster cast most commonly result from:

Exothermic reaction of plaster setting in too-hot water or with too many layers (Correct answer)
Fiberglass off-gassing during curing
Patient skin sensitivity to calcium sulfate
Allergic reaction to the stockinette material

Correct answer: Exothermic reaction of plaster setting in too-hot water or with too many layers

Plaster generates heat as it sets; using water above 24°C or applying excessive layers dramatically increases burn risk.

Question 36: Which anatomical feature of the tibia makes it the weight-bearing bone of the leg, as opposed to the fibula?

The tibia has a larger medullary canal
The tibia is more lateral in position
The tibia contains more cancellous bone than the fibula
The tibia articulates with the femur at the knee and talus at the ankle (Correct answer)

Correct answer: The tibia articulates with the femur at the knee and talus at the ankle

The tibia is the primary weight-bearing bone because it forms the tibiotalar (ankle) joint inferiorly and the tibiofemoral joint superiorly, directly transmitting axial load.

Question 37: The deltoid ligament of the ankle is located on which side and resists which movement?

Medial side; resists inversion
Lateral side; resists inversion
Lateral side; resists eversion
Medial side; resists eversion (Correct answer)

Correct answer: Medial side; resists eversion

The deltoid ligament is a strong medial ligament complex that resists excessive eversion of the ankle.

Question 38: Which structure connects muscles to bones?

Cartilage
Bursae
Tendons (Correct answer)
Ligaments

Correct answer: Tendons

Tendons are strong, fibrous connective tissues that serve to connect muscles to bones. They are essential for transmitting the force generated by muscle contractions to the skeletal system, thereby facilitating movement. In contrast, ligaments connect bones to other bones, providing stability to joints.

Question 39: A comminuted fracture is best described as:

An incomplete fracture of one cortex
A fracture with three or more bone fragments (Correct answer)
A fracture with two clean fragments
A fracture at the growth plate

Correct answer: A fracture with three or more bone fragments

Comminuted fractures involve multiple fragments, typically from high-energy trauma, and often require surgical fixation rather than casting alone.

Question 40: A patient with latex allergy is scheduled for casting. The casting technician should:

Use latex-free gloves, padding, and stockinette and ensure all room supplies are latex-free (Correct answer)
Apply a barrier layer of standard stockinette to prevent skin contact with latex
Proceed normally since casting materials do not contain latex
Simply avoid using gloves during the procedure

Correct answer: Use latex-free gloves, padding, and stockinette and ensure all room supplies are latex-free

Latex allergy requires a completely latex-free environment including gloves, padding, and all contact supplies to prevent allergic reactions.

Question 41: The epiphyseal plate (growth plate) in a pediatric patient is composed primarily of which tissue?

Hyaline cartilage (Correct answer)
Elastic cartilage
Dense fibrous tissue
Fibrocartilage

Correct answer: Hyaline cartilage

The epiphyseal plate consists of hyaline cartilage where longitudinal bone growth occurs in children.

Question 42: Which Salter-Harris fracture type passes completely through the physis and is associated with the highest risk of growth disturbance?

Type III (through physis and epiphysis)
Type I (through the physis only)
Type II (through physis and metaphysis)
Type V (crush injury to the physis) (Correct answer)

Correct answer: Type V (crush injury to the physis)

Salter-Harris Type V is a compression (crush) injury of the growth plate that may appear normal on initial X-ray but carries the greatest risk of growth arrest.

Question 43: Waterproof casting liner systems (e.g., Gore-Tex liner) allow patients to:

Replace standard stockinette entirely in all cases
Remove the liner at home for drying
Swim competitively without any cast degradation
Shower and submerge the cast without damaging the padding (Correct answer)

Correct answer: Shower and submerge the cast without damaging the padding

Waterproof liner systems allow the inner cast to get wet and dry without holding moisture, enabling showering and light water exposure.

Question 44: Which assessment finding would prompt immediate cast removal rather than a bivalve procedure?

Minor swelling above the cast edge
Compartment pressures exceeding 30 mmHg with limb pallor and pulselessness (Correct answer)
Slight skin discoloration at cast borders
Mild itching under the cast

Correct answer: Compartment pressures exceeding 30 mmHg with limb pallor and pulselessness

Compartment pressures above 30 mmHg with signs of vascular compromise require emergent fasciotomy after full cast removal.

Question 45: What does the acronym 'CSM' stand for in orthopedic casting assessment?

Compress, Stabilize, Monitor
Contour, Secure, Mold
Cast, Splint, Mobilize
Circulation, Sensation, Movement (Correct answer)

Correct answer: Circulation, Sensation, Movement

CSM — Circulation, Sensation, Movement — is the standard neurovascular checklist performed before and after cast application.

Question 46: Which of the following best describes 'bivalving' a cast?

Removing the cast entirely with a saw
Adding a second layer of fiberglass over the primary cast
Cutting the cast longitudinally on two sides to create two halves (Correct answer)
Splitting only the padding and stockinette without cutting the cast shell

Correct answer: Cutting the cast longitudinally on two sides to create two halves

Bivalving involves making two longitudinal cuts on opposite sides of the cast, converting it into two clamshell-like halves to relieve pressure.

Question 47: A cast that is too loose will most likely result in which complication?

Thermal burn during curing
Malunion due to inadequate fracture immobilization (Correct answer)
Compartment syndrome
Skin maceration from trapped moisture

Correct answer: Malunion due to inadequate fracture immobilization

A loose cast allows fracture fragments to move, potentially leading to malunion or malreduction of the fracture during the healing period.

Question 48: A patient reports a burning sensation under the cast just before scheduled removal. The correct response is:

Apply ice over the cast surface
Administer oral pain medication and wait
Remove the cast immediately and assess the skin (Correct answer)
Tell the patient to tolerate it until the next appointment

Correct answer: Remove the cast immediately and assess the skin

Burning under a cast suggests pressure necrosis or skin breakdown; prompt removal and assessment is required.

Question 49: If a patient refuses to have their cast removed despite a physician's order, the casting technician should:

Stop, document the refusal, and notify the supervising physician (Correct answer)
Restrain the patient with assistance and proceed
Attempt to persuade the patient and then remove the cast
Proceed with removal since it is a physician's order

Correct answer: Stop, document the refusal, and notify the supervising physician

Competent patients have the right to refuse treatment; the technician must respect this, document it, and notify the physician.

Question 50: Which cast material requires the MOST caution during saw removal due to increased heat generation?

Thermoplastic
Fiberglass (Correct answer)
Plaster of Paris
Cotton-based splint material

Correct answer: Fiberglass

Fiberglass generates more heat during sawing than plaster, increasing burn risk if the saw lingers in one position.

Question 51: Which tool is used to measure compartment pressure when acute compartment syndrome is suspected before or after casting?

Intracompartmental pressure monitor (Correct answer)
Sphygmomanometer
Pulse oximeter
Doppler ultrasound

Correct answer: Intracompartmental pressure monitor

Intracompartmental pressure monitoring (Stryker device or equivalent) directly measures pressures within fascial compartments.

Question 52: Which of the following signs indicates that a patient's cast may be too tight and requires immediate evaluation?

Increased pain, numbness, or inability to move distal digits (Correct answer)
Mild warmth over the fracture site
Mild pruritus (itching) under the cast
Visible plaster dust on the cast surface

Correct answer: Increased pain, numbness, or inability to move distal digits

Increasing pain, numbness, or loss of motor function distal to the cast are warning signs of vascular compromise or compartment syndrome requiring emergent evaluation.

Question 53: Which assessment finding in a casted lower extremity requires IMMEDIATE notification of the supervising provider?

Slight itching sensation under the cast
Absence of the dorsalis pedis pulse (Correct answer)
Warm and pink toes with brisk capillary refill
Mild swelling of the toes

Correct answer: Absence of the dorsalis pedis pulse

Absence of a pedal pulse indicates potential vascular occlusion and is an emergency requiring immediate physician notification.

Question 54: Before cast removal, what should the technician tell the patient to reduce anxiety about the saw?

The saw is completely painless and silent
The patient should not look at the saw at any time
The saw vibrates but will not cut skin if used correctly (Correct answer)
The process takes only a few seconds

Correct answer: The saw vibrates but will not cut skin if used correctly

Explaining how the oscillating saw works reassures patients and encourages cooperation, which improves safety during removal.

Question 55: Which technique is used to relieve pressure in a circumferential cast?

Bivalving (Correct answer)
Stripping
Wrapping
Padding

Correct answer: Bivalving

Bivalving is the technique of cutting a circumferential cast lengthwise into two halves. This procedure is performed to relieve pressure, particularly in cases of anticipated or actual swelling that could lead to compartment syndrome, or to allow for wound care and physical therapy access. It helps prevent neurovascular compromise and facilitates ongoing patient management.

Question 56: When performing hand hygiene with an alcohol-based hand rub, the technician should rub their hands until:

The product is completely dry, typically 20–30 seconds (Correct answer)
Hands are rinsed clean under running water
Hands feel cool from evaporation after approximately 5 seconds
A visible lather has formed on the skin

Correct answer: The product is completely dry, typically 20–30 seconds

WHO and CDC guidelines specify rubbing until hands are completely dry, which takes approximately 20–30 seconds for adequate antimicrobial action.

Question 57: In pediatric casting, 'fracture remodeling' potential influences cast selection primarily because:

Plaster is contraindicated in all patients under 12 years old
Acceptable angular deformity tolerances are greater in younger children with open growth plates (Correct answer)
Pediatric fiberglass casts must be changed every 2 weeks
Children require more cast layers due to higher activity levels

Correct answer: Acceptable angular deformity tolerances are greater in younger children with open growth plates

Children with open growth plates can remodel significant angular deformity over time, so clinicians may accept greater initial angulation and choose less rigid casting approaches.

Question 58: What is the primary advantage of using a waterproof cast liner (e.g., Gore-Tex liner) under a fiberglass cast?

It increases the structural strength of the cast
It reduces the exothermic heat during curing
It allows the patient to bathe or swim without cast damage (Correct answer)
It eliminates the need for stockinette

Correct answer: It allows the patient to bathe or swim without cast damage

Waterproof cast liners allow water to pass through and dry quickly, enabling patients to bathe, shower, or swim without damaging the cast or macerating skin.

Question 59: A patient reports that an object was pushed under the cast to relieve itching, and there is now an area of skin tenderness beneath. The correct action is:

Remove the cast to fully assess the skin for laceration or ulceration (Correct answer)
Apply anti-itch spray into the cast opening
Reassure the patient and advise against inserting objects again
Irrigate the cast interior with cool water to soothe the area

Correct answer: Remove the cast to fully assess the skin for laceration or ulceration

Foreign objects under a cast can cause lacerations, infection, or pressure ulcers that require direct visualization to assess and treat properly.

Question 60: A Doppler ultrasound probe is used during neurovascular assessment primarily to:

Measure compartment pressure directly
Evaluate venous thrombosis under a cast
Detect arterial blood flow when a pulse is not palpable (Correct answer)
Assess nerve conduction velocity

Correct answer: Detect arterial blood flow when a pulse is not palpable

A handheld Doppler probe detects the audible signal of moving blood in an artery when the pulse is too faint to palpate, confirming the presence of arterial flow.

Question 61: Which fracture results from repetitive loading rather than acute trauma?

Pathologic fracture
Comminuted fracture
Stress fracture (Correct answer)
Avulsion fracture

Correct answer: Stress fracture

Stress fractures develop from cumulative microtrauma — such as repetitive impact in athletes — rather than a single traumatic event.

Question 62: When removing a cast from a patient with a known MRSA infection, which PPE combination is most appropriate?

Gloves, gown, N95 respirator, and eye protection
Gloves, gown, and surgical mask (Correct answer)
Gloves and gown
Gloves only

Correct answer: Gloves, gown, and surgical mask

Contact precautions for MRSA require gloves, gown, and a mask to protect against splatter during cast removal.

Question 63: Which component of the neurovascular bundle runs through the carpal tunnel along with the flexor tendons?

Ulnar nerve
Median nerve (Correct answer)
Radial nerve
Anterior interosseous nerve

Correct answer: Median nerve

The median nerve passes through the carpal tunnel beneath the flexor retinaculum along with the flexor digitorum superficialis, profundus, and flexor pollicis longus tendons.

Question 64: After applying a fiberglass cast, the technician notices a focal hard ridge running lengthwise along the inner surface. The correct action is:

Pad over the ridge externally with elastic bandage
Remove and reapply the cast to eliminate the ridge before it causes a pressure ulcer (Correct answer)
Leave it; fiberglass ridges are normal and resolve as the cast cures
Apply heat to soften and smooth the ridge

Correct answer: Remove and reapply the cast to eliminate the ridge before it causes a pressure ulcer

An internal ridge creates a pressure point that will cause skin breakdown; the cast must be removed and reapplied correctly.

Question 65: When molding a cast, which technique is recommended to avoid creating pressure points?

Using the palm and thenar eminence to apply broad, even pressure (Correct answer)
Rolling a dowel rod along the cast surface
Applying strips of tape over the wet cast for additional support
Using fingertip pressure to create contoured indentations

Correct answer: Using the palm and thenar eminence to apply broad, even pressure

Broad palm and thenar eminence molding distributes pressure evenly, preventing focal pressure points that can cause skin breakdown.

Question 66: An ankle fracture involving only the lateral malleolus without ligamentous instability is MOST commonly treated with:

Cylinder cast
Short leg cast or walking boot for 4-6 weeks (Correct answer)
Thumb spica cast
Long leg cast in full extension

Correct answer: Short leg cast or walking boot for 4-6 weeks

Stable isolated lateral malleolus fractures are managed conservatively with a short leg cast or functional brace allowing controlled weight-bearing.

Question 67: A torus (buckle) fracture is most commonly seen in which population?

Children under 10 years old (Correct answer)
Young adult athletes
Middle-aged manual laborers
Elderly women with osteoporosis

Correct answer: Children under 10 years old

Torus fractures occur in pediatric bone where the cortex buckles under compression without complete cortical breach, typical of falls onto an outstretched hand.

Question 68: A fiberglass cast is applied too tightly over a diabetic patient's foot. Which complication is of GREATEST concern in this population?

Increased risk of cast cracking from reduced bone density
Delayed fracture healing due to restricted blood flow
Higher likelihood of allergic reaction to fiberglass resin
Undetected pressure ulceration progressing to osteomyelitis due to peripheral neuropathy (Correct answer)

Correct answer: Undetected pressure ulceration progressing to osteomyelitis due to peripheral neuropathy

Diabetic peripheral neuropathy masks pain from pressure injuries, allowing ulcers to progress to deep infection and osteomyelitis without warning.

Question 69: A Jones fracture is located at which anatomical site?

Distal fifth metatarsal
Base of the fifth metatarsal at the metaphyseal-diaphyseal junction (Correct answer)
Fifth metatarsal head
Calcaneus

Correct answer: Base of the fifth metatarsal at the metaphyseal-diaphyseal junction

The Jones fracture occurs at the proximal fifth metatarsal junction, where poor vascularity makes healing difficult and often requires non-weight-bearing casting.

Question 70: When compartment syndrome is suspected in a casted extremity, the MOST appropriate immediate action is to:

Elevate the extremity and apply ice packs
Apply a compression wrap over the cast
Administer analgesics and reassess in 30 minutes
Bivalve the cast and notify the physician immediately (Correct answer)

Correct answer: Bivalve the cast and notify the physician immediately

Bivalving (splitting the cast on both sides) along with cutting the underlying padding relieves pressure immediately, while prompt physician notification ensures definitive treatment.

Question 71: Before casting a patient who takes anticoagulant medication, the casting technician should:

Double the padding to account for anticipated swelling
Delay casting for 24 hours
Proceed without modification
Note the medication and alert the supervising clinician (Correct answer)

Correct answer: Note the medication and alert the supervising clinician

Anticoagulants increase bleeding risk and may affect cast management decisions; the supervising clinician must be informed.

Question 72: The 'three-point mold' technique is especially important in pediatric casting because:

Children have softer bones that may angulate if the cast is not properly molded (Correct answer)
Children require casts to be removed more frequently
Children cannot tolerate fiberglass materials
Pediatric casts use faster-setting plaster

Correct answer: Children have softer bones that may angulate if the cast is not properly molded

Proper three-point molding maintains fracture alignment in children whose immature bone remodeling relies heavily on correct cast geometry.

Question 73: How is capillary refill time assessed in a patient about to receive a cast?

Auscultate for distal pulse with a stethoscope
Measure blood pressure distally
Check skin temperature with a thermometer
Press the nail bed, release, and count seconds until color returns (Correct answer)

Correct answer: Press the nail bed, release, and count seconds until color returns

Normal capillary refill is less than 2 seconds; prolonged refill suggests compromised circulation.

Question 74: Which fracture classification describes a fracture in which one cortex buckles but does not completely break, common in pediatric patients?

Greenstick fracture
Torus (buckle) fracture (Correct answer)
Stress fracture
Comminuted fracture

Correct answer: Torus (buckle) fracture

A torus fracture involves a buckling of one cortex without a complete break, occurring in children due to their more porous, compliant bone.

Question 75: Which type of cast material is preferred when the patient requires MRI imaging during the treatment period?

Plaster with metal reinforcement rods
Standard plaster of Paris
Fiberglass with fiberglass splints (Correct answer)
Fiberglass with aluminum splints

Correct answer: Fiberglass with fiberglass splints

Fiberglass cast materials are MRI-compatible because they contain no ferromagnetic metals, making them safe in magnetic fields.

Question 76: A patient returns with a plaster cast that has become soft and dented. The most appropriate action is:

Replace the cast immediately (Correct answer)
Apply an elastic bandage over the cast
Pad the soft area and reassess in one week
Reinforce the cast with fiberglass tape

Correct answer: Replace the cast immediately

A soft or dented cast has lost its structural integrity and must be replaced to maintain proper fracture alignment.

Question 77: Which compartment of the lower leg contains the anterior tibial artery and deep peroneal nerve?

Posterior compartment
Deep posterior compartment
Lateral compartment
Anterior compartment (Correct answer)

Correct answer: Anterior compartment

The anterior compartment of the lower leg contains the anterior tibial artery, deep peroneal nerve, and the dorsiflexor muscles.

Question 78: Which information is REQUIRED to be included on every cast application record?

The patient's diagnosis and surgical history
Patient's insurance information and billing codes only
Date, time, type of cast, materials used, neurovascular status, and technician name (Correct answer)
Only the cast type and date

Correct answer: Date, time, type of cast, materials used, neurovascular status, and technician name

A complete cast record includes procedure details, materials, neurovascular findings, and technician identification to ensure accountability and continuity of care.

Question 79: Which technique reduces pressure necrosis risk at bony prominences during cast application?

Placing felt or foam padding over prominences before casting (Correct answer)
Using extra-tight bandaging to prevent migration
Wetting the cast material before molding over prominences
Applying the cast without padding to improve fit

Correct answer: Placing felt or foam padding over prominences before casting

Felt or foam padding over bony prominences distributes pressure and prevents focal necrosis beneath the cast.

Question 80: Which combination of findings most strongly suggests adequate neurovascular status in a casted extremity?

Mild swelling with absent radial pulse
Pink, warm digits with capillary refill under 2 seconds and intact sensation (Correct answer)
Cyanotic digits with pain at rest
Pale, cool digits with capillary refill of 4 seconds

Correct answer: Pink, warm digits with capillary refill under 2 seconds and intact sensation

Pink, warm digits with brisk capillary refill under 2 seconds and intact sensation together confirm adequate arterial perfusion, venous return, and nerve function.

Question 81: What is the correct instruction for skin care immediately after cast removal?

Gently wash with mild soap and water; apply moisturizer (Correct answer)
Avoid washing for 48 hours
Vigorously scrub dead skin with a brush
Apply rubbing alcohol to disinfect the skin

Correct answer: Gently wash with mild soap and water; apply moisturizer

Gentle cleansing and moisturization remove accumulated dead skin and restore normal hydration without traumatizing fragile post-cast skin.

Question 82: Which casting material generally has the HIGHEST tensile strength per unit weight?

Standard plaster of Paris
Thermoplastic splint material
Fiberglass (polyurethane-impregnated glass fiber) (Correct answer)
Cotton-based orthopedic padding

Correct answer: Fiberglass (polyurethane-impregnated glass fiber)

Fiberglass casting tape provides superior tensile strength at a lighter weight compared to plaster, which is why it requires fewer layers for equivalent support.

Question 83: Which part of the bone contains the growth plate in children?

Metaphysis (Correct answer)
Diaphysis
Epiphysis
Periosteum

Correct answer: Metaphysis

The metaphysis is the region of a long bone that connects the diaphysis (shaft) to the epiphysis (end). It contains the growth plate, or epiphyseal plate, which is crucial for longitudinal bone growth in children and adolescents. Damage to this area can significantly impact a child's bone development and length.

Question 84: Which complication is most directly prevented by prompt bivalving of a tight cast?

Wound dehiscence
Acute compartment syndrome (Correct answer)
Skin maceration
Bone non-union

Correct answer: Acute compartment syndrome

Bivalving relieves circumferential pressure that, if left unaddressed, can progress to compartment syndrome and ischemia.

Question 85: When assessing the neurological status of a hand in a cast, a patient's inability to make an 'OK' sign (circle between thumb and index finger) suggests compromise of which nerve?

Musculocutaneous nerve
Radial nerve
Ulnar nerve
Anterior interosseous nerve (branch of median) (Correct answer)

Correct answer: Anterior interosseous nerve (branch of median)

The 'OK' sign tests the anterior interosseous nerve (a motor branch of the median nerve), which innervates the flexor pollicis longus and index finger flexor digitorum profundus.

Question 86: Which cast saw blade type is recommended for cutting fiberglass casts?

Diamond-tip rotary blade
Serrated hacksaw blade
Fine-toothed oscillating blade designed for synthetic materials (Correct answer)
Standard plaster blade with wide teeth

Correct answer: Fine-toothed oscillating blade designed for synthetic materials

Fine-toothed blades designed for synthetic casting materials cut fiberglass efficiently while minimizing heat generation.

Question 87: What is a common skin complication associated with long-term casting?

Maceration (Correct answer)
Eczema
Psoriasis
Hives

Correct answer: Maceration

Maceration is a common skin complication associated with long-term casting, characterized by the softening and breakdown of skin due to prolonged exposure to moisture. The warm, moist environment within a cast, often from sweat or inadequate drying, creates ideal conditions for skin maceration, leading to irritation, itching, and an increased risk of infection.

Question 88: The dorsalis pedis pulse is most reliably palpated on the:

Lateral border of the foot
Dorsum of the foot between the first and second metatarsals (Correct answer)
Plantar surface of the heel
Posterior aspect of the medial malleolus

Correct answer: Dorsum of the foot between the first and second metatarsals

The dorsalis pedis artery crosses the dorsum of the foot between the first and second metatarsals and is the standard site for assessing dorsal foot perfusion.

Question 89: Which cast provides the best immobilization for a metatarsal shaft fracture that requires protected weight-bearing?

Cylinder cast
Foot slipper cast only
Long leg cast
Short leg walking cast or walking boot (Correct answer)

Correct answer: Short leg walking cast or walking boot

A short leg walking cast or removable walking boot immobilizes the forefoot while allowing controlled weight-bearing and ambulation.

Question 90: For obese patients requiring lower extremity casting, which casting consideration is most important?

Limiting padding to reduce cast bulk
Applying the cast in a standing position
Using plaster only due to its lower cost for larger casts
Using stronger fiberglass layers and ensuring adequate support to prevent cast breakage (Correct answer)

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 91: If a casting technician observes signs of abuse in a pediatric patient, they are legally obligated to:

Report the suspicion to the appropriate authority per mandatory reporting laws (Correct answer)
Keep the suspicion confidential to protect patient privacy
Confront the caregiver directly before documenting anything
Document the findings but take no further action

Correct answer: Report the suspicion to the appropriate authority per mandatory reporting laws

Healthcare workers are mandatory reporters in all US states; suspected child abuse must be reported to child protective services regardless of certainty.

Question 92: What is the approximate full weight-bearing time after application of a standard plaster long leg cast for a stable fracture?

At 2 weeks after radiographic confirmation
Immediately after cast hardens (24 hours)
Not until the cast is removed
At 48–72 hours once the cast is fully dry (Correct answer)

Correct answer: At 48–72 hours once the cast is fully dry

Plaster reaches adequate strength for limited weight-bearing within 24–48 hours as it fully dries and crystallizes, though physician guidance determines timing.

Question 93: Which sign or symptom is typically the EARLIEST indicator of acute compartment syndrome?

Pulselessness
Paralysis of affected muscles
Pallor of the distal extremity
Pain with passive stretch of muscles in the compartment (Correct answer)

Correct answer: Pain with passive stretch of muscles in the compartment

Pain with passive stretch is the earliest and most sensitive clinical indicator of compartment syndrome, preceding pulselessness and paralysis.

Question 94: In a patient with a spinal cord injury who lacks sensation, the primary casting concern is:

Bone healing being slower due to paralysis
Muscle spasticity breaking the cast
Pressure injury that the patient cannot feel or report (Correct answer)
Autonomic dysreflexia triggered by the cast saw

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 95: The subscapularis, infraspinatus, teres minor, and supraspinatus make up the rotator cuff; which one is responsible for internal rotation and is most commonly involved in shoulder impingement if the arm is cast in the wrong position?

Supraspinatus
Teres minor
Infraspinatus
Subscapularis (Correct answer)

Correct answer: Subscapularis

The subscapularis is the only rotator cuff muscle that internally rotates the shoulder and can be impinged or strained when the arm is immobilized in excessive internal rotation.

Question 96: Before applying a long arm cast, the technician should document motor function by asking the patient to:

Perform deep breathing
Squeeze a blood pressure cuff
Walk on the extremity
Flex and extend the fingers and wrist (Correct answer)

Correct answer: Flex and extend the fingers and wrist

Active range of motion of fingers and wrist documents baseline motor nerve function before the cast is applied.

Question 97: Cast saw blades should be changed or sterilized between patients primarily to prevent:

Excessive vibration that causes patient discomfort
Inaccurate cuts that damage the underlying padding
Cross-contamination of microorganisms between patients (Correct answer)
Blade dulling that causes excessive heat

Correct answer: Cross-contamination of microorganisms between patients

Reusing unsterilized blades can transfer pathogenic microorganisms from one patient to another.

Question 98: After both medial and lateral cuts are made during bivalving, which instrument is used to separate the cast halves?

Cast spreader (Correct answer)
Kelly forceps
Bandage scissors
Hemostat

Correct answer: Cast spreader

A cast spreader (or cast bender) is inserted into the saw cuts to gently pry the two halves apart without stressing the extremity.

Question 99: A cast window is most appropriately cut in order to:

Reduce the overall weight of the cast
Allow the patient to perform range-of-motion exercises
Inspect a wound site or assess vascular access (Correct answer)
Improve ventilation and reduce cast odor

Correct answer: Inspect a wound site or assess vascular access

A cast window is cut to provide direct access to a specific area such as a wound for inspection, or to palpate a pulse when there is concern about vascular status.

Question 100: What is the primary chemical reaction that causes plaster of Paris to harden?

Hydration of calcium sulfate hemihydrate (Correct answer)
Oxidation of calcium carbonate
Polymerization of resin monomers
Cross-linking of polyurethane chains

Correct answer: Hydration of calcium sulfate hemihydrate

Plaster of Paris hardens through hydration: calcium sulfate hemihydrate reacts with water to form calcium sulfate dihydrate (gypite).

Question 101: When casting a child with an upper extremity fracture, the wrist is typically positioned in:

Full flexion to relax the flexor tendons
Neutral (0 degrees) for all pediatric wrist injuries
Slight extension (10-15 degrees) for most forearm fractures (Correct answer)
Full extension to maximize immobilization

Correct answer: Slight extension (10-15 degrees) for most forearm fractures

Slight wrist extension is the standard functional position for most pediatric forearm and wrist fractures unless otherwise specified by the clinician.

Question 102: Which complication is MOST associated with the use of fiberglass casting material compared to plaster?

Greater skin laceration risk during cast removal (Correct answer)
Significantly higher risk of thermal burns
Higher risk of cast cracking under load
Increased cast weight and bulk

Correct answer: Greater skin laceration risk during cast removal

Fiberglass is harder and more rigid than plaster, making the oscillating cast saw more likely to lacerate skin if the saw is not used correctly during removal.

Question 103: A casting technician smells alcohol on a coworker's breath before a patient procedure. The most appropriate action is to:

Document the observation for the next performance review
Remove the coworker from the situation discreetly and report to a supervisor immediately (Correct answer)
Allow the coworker to proceed and monitor them carefully
Confront the coworker loudly in front of the patient

Correct answer: Remove the coworker from the situation discreetly and report to a supervisor immediately

Patient safety requires immediate action; the impaired colleague should be removed from patient care and the situation reported to a supervisor.

Question 104: What is the primary contraindication for closed casting of an open (compound) fracture?

Open fractures always require amputation
Open fractures require immediate casting to prevent further bone displacement
High infection risk requires wound management before casting (Correct answer)
The cast would not adhere over an open wound

Correct answer: High infection risk requires wound management before casting

Open fractures carry high infection risk; wound irrigation, debridement, and often surgical fixation are performed before any definitive cast application.

Question 105: Which elements MUST be documented before a cast is applied to meet the standard of care?

The patient's height and weight
Pre-cast neurovascular assessment (CSM), skin integrity, patient consent, and allergy history (Correct answer)
Only the type of cast material used
The name of the ordering physician and clinic location

Correct answer: Pre-cast neurovascular assessment (CSM), skin integrity, patient consent, and allergy history

Pre-procedure documentation of CSM, skin status, allergies, and consent establishes a baseline and demonstrates that safety checks were performed.

Question 106: A parent asks if their child can bathe with a fiberglass cast. The correct response is:

Fiberglass casts are fully waterproof and bathing is allowed
Sponge bath only is needed and the cast can get minimally wet
Bathing must be avoided entirely until cast removal
The cast must be kept dry; use a waterproof cast cover for bathing (Correct answer)

Correct answer: The cast must be kept dry; use a waterproof cast cover for bathing

Standard fiberglass casts are not fully waterproof because the inner padding absorbs water; a waterproof liner system is required for water exposure.

Question 107: When documenting cast care instructions, which teaching point is MOST critical for the patient to verbalize back correctly?

The signs and symptoms of neurovascular compromise requiring immediate emergency evaluation (Correct answer)
The specific brand of waterproof cast cover to purchase
The recommended sleep position for the casted extremity
The maximum walking speed permitted in a walking cast

Correct answer: The signs and symptoms of neurovascular compromise requiring immediate emergency evaluation

Patients must be able to recognize and report neurovascular warning signs—numbness, pallor, severe pain, pulselessness—because delayed response can result in permanent disability.

Question 108: Which condition is a CONTRAINDICATION to circumferential casting immediately after acute injury?

Chronic stress fracture of the metatarsal
Significant anticipated swelling (acute compartment risk) (Correct answer)
Stable mid-shaft radius fracture
Buckle fracture in a pediatric patient

Correct answer: Significant anticipated swelling (acute compartment risk)

Circumferential casts applied when significant swelling is expected can compress neurovascular structures, causing compartment syndrome.

Question 109: A patient with a hip spica cast develops nausea, vomiting, and abdominal distension on post-operative day 3. Cast syndrome is suspected. The immediate management is:

Oral antiemetics and a liquid diet until symptoms resolve
Prone positioning to relieve duodenal compression
NPO, nasogastric tube decompression, and opening or removing the abdominal portion of the cast (Correct answer)
Advancing to a regular diet to stimulate peristalsis

Correct answer: NPO, nasogastric tube decompression, and opening or removing the abdominal portion of the cast

Treatment of cast syndrome includes decompressing the abdomen by cutting or removing the cast, along with NGT decompression and IV fluids.

Question 110: The plantar aponeurosis originates from which structure and plays a key role in foot arch support?

Talus
Calcaneus (Correct answer)
Navicular
Cuboid

Correct answer: Calcaneus

The plantar fascia/aponeurosis originates from the medial tubercle of the calcaneus and supports the longitudinal arch of the foot.

Question 111: What is the purpose of cast windowing?

To ventilate the skin
To decorate the cast
To keep the cast dry
To relieve pressure or provide wound access (Correct answer)

Correct answer: To relieve pressure or provide wound access

Cast windowing involves cutting a small opening in the cast. This technique is used to relieve localized pressure over a bony prominence or a specific area of discomfort, or to provide direct access for inspecting, dressing, or treating an underlying wound without removing the entire cast. It helps prevent pressure sores and facilitates targeted wound management.

Question 112: Which professional behavior is consistent with maintaining ethical standards in orthopedic casting practice?

Performing a cast application outside your competency level when no one else is available
Sharing patient clinical photos on social media to educate colleagues
Agreeing to falsify documentation to expedite a patient's insurance claim
Refusing to perform a procedure you are not trained for and escalating to qualified staff (Correct answer)

Correct answer: Refusing to perform a procedure you are not trained for and escalating to qualified staff

Ethical practice requires practitioners to recognize and stay within their competency boundaries, escalating to qualified personnel when needed.

Question 113: What is the recommended number of layers of stockinette that should extend beyond each end of a standard cast?

No stockinette extension is used
Stockinette is folded back 10–15 cm for maximum padding
1 layer folded back 1–2 cm
2–5 cm of stockinette folded back over the cast edges (Correct answer)

Correct answer: 2–5 cm of stockinette folded back over the cast edges

Approximately 2–5 cm of stockinette is folded back over the cast edges and incorporated to create a smooth, padded border that prevents skin irritation.

Question 114: What is the purpose of bivalving a cast?

To reinforce the cast with additional layers
To split the cast into two halves to relieve pressure or allow for swelling (Correct answer)
To apply a new synthetic cast over the existing one
To remove the cast entirely

Correct answer: To split the cast into two halves to relieve pressure or allow for swelling

Bivalving cuts both sides of the cast and releases the underlying padding, reducing circumferential pressure while maintaining some immobilization.

Question 115: Which type of joint allows the rotational movement required for forearm pronation and supination?

Gliding joint
Hinge joint
Pivot joint (Correct answer)
Ball-and-socket joint

Correct answer: Pivot joint

Pivot joints, such as the proximal and distal radioulnar joints, allow the rotation needed for pronation and supination.

Question 116: Which of the following is an example of a 'sharps injury' that must be reported under OSHA's Bloodborne Pathogens Standard?

An abrasion from plaster particles
A needlestick from a used suture needle during cast window creation (Correct answer)
A blister from repeated use of casting scissors
A laceration from a cast edge

Correct answer: A needlestick from a used suture needle during cast window creation

A puncture from a contaminated sharp object such as a used suture needle is a reportable sharps injury under the Bloodborne Pathogens Standard.

Question 117: A child is very anxious and uncooperative during casting. The BEST approach is:

Reschedule until the child is calmer
Firmly restrain the child and complete the cast quickly
Administer sedation before proceeding
Involve the caregiver, explain each step simply, and work calmly and efficiently (Correct answer)

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 118: In patients with peripheral vascular disease, casting should be approached with caution because:

Vascular disease makes the skin too slippery for cast adhesion
Impaired circulation reduces wound healing and increases ischemia risk under the cast (Correct answer)
Peripheral vascular disease causes abnormally fast cast setting
Arterial stents may be damaged by cast pressure

Correct answer: Impaired circulation reduces wound healing and increases ischemia risk under the cast

Poor peripheral circulation compromises tissue oxygenation; even mild cast pressure can precipitate ischemic skin breakdown.

Question 119: A cast window has been created and the underlying skin is beginning to bulge through the opening. This 'window edema' can be prevented by:

Enlarging the window to relieve pressure
Applying a compression bandage directly over the skin in the window
Leaving the window open to air to reduce swelling
Replacing the cut piece of cast back into the window and securing it (Correct answer)

Correct answer: Replacing the cut piece of cast back into the window and securing it

Replacing the cut plug and securing it maintains circumferential pressure and prevents soft tissue from herniating into the window.

Question 120: Which of the following materials is used to make a thermoplastic splint moldable?

Exposure to ultraviolet (UV) light
Immersion in cold water (0–5°C)
Heating to 60–80°C using a heat gun or warm water (Correct answer)
Mixing with a catalyst powder

Correct answer: Heating to 60–80°C using a heat gun or warm water

Thermoplastic materials become pliable when heated to 60–80°C and harden as they cool to room temperature, allowing custom contouring to the patient's limb.

Question 121: How does an oscillating cast saw avoid cutting the patient's skin?

Its blade is coated with a protective plastic layer
The blade automatically stops when it contacts skin
It vibrates rapidly but does not rotate, cutting rigid material but bouncing off soft tissue (Correct answer)
It uses suction to pull the cast away from the skin

Correct answer: It vibrates rapidly but does not rotate, cutting rigid material but bouncing off soft tissue

The oscillating motion cuts through hard fiberglass or plaster but does not slice soft, pliable skin when proper technique is used.

Question 122: When caring for a fresh plaster cast, which instruction is MOST important to give the patient?

Apply a heating pad to speed up the drying process
Keep the cast dry and elevate the extremity (Correct answer)
Ambulate immediately to prevent stiffness
Apply ice directly over the cast to reduce swelling

Correct answer: Keep the cast dry and elevate the extremity

Keeping the cast dry prevents plaster breakdown and skin maceration, while elevation reduces swelling and associated neurovascular complications.

Question 123: When padding a bony prominence (e.g., the fibular head) before casting, what is the standard approach?

Remove all padding from the area and apply cast directly
Avoid padding prominences to ensure firm contact
Use petroleum jelly over the prominence instead of padding
Apply extra layers of cast padding over the prominence (Correct answer)

Correct answer: Apply extra layers of cast padding over the prominence

Extra layers of cast padding over bony prominences reduce direct pressure and the risk of pressure ulcers and nerve injuries beneath the cast.

Question 124: When assessing skin integrity before casting, which condition requires special padding or delay of casting?

Dry skin
Hair on the extremity
Open wound or skin breakdown over the cast area (Correct answer)
Mild redness from the injury

Correct answer: Open wound or skin breakdown over the cast area

Open wounds or skin breakdown over the planned cast area require special wound management or clinical consultation before casting.

Question 125: Why is elevation recommended immediately after cast placement?

To harden the cast faster
To ease mobility
To prevent itching
To reduce swelling and promote circulation (Correct answer)

Correct answer: To reduce swelling and promote circulation

Elevation of the casted limb above heart level immediately after cast placement is recommended to reduce swelling and promote circulation. This helps to decrease fluid accumulation in the tissues and promotes venous return, thereby minimizing pain and reducing the risk of complications such as compartment syndrome. It aids in maintaining adequate arterial blood flow to the injured area.

Question 126: Which nerve must be assessed in a distal humerus fracture?

Sciatic nerve
Median nerve
Ulnar nerve
Radial nerve (Correct answer)

Correct answer: Radial nerve

The radial nerve runs in close proximity to the posterior aspect of the humerus, making it particularly vulnerable to injury in distal humerus fractures. Damage to this nerve can result in 'wrist drop' and sensory deficits in the hand. Therefore, assessing radial nerve function (e.g., thumb extension, sensation) is a critical step to detect potential nerve impingement or transection.

Question 127: Which standard of practice determines what a casting technician is legally permitted to do?

The policies of the employing hospital or clinic alone
The tasks described in the casting technician's job posting
Scope of practice defined by the certifying body and state law (Correct answer)
The preferences of the supervising orthopedic physician

Correct answer: Scope of practice defined by the certifying body and state law

Scope of practice is legally defined by state statutes and regulations, as well as the certification body's standards, which supersede employer policies.

Question 128: Which scenario represents a reportable incident in a healthcare setting?

A cast saw laceration of the patient's skin during removal (Correct answer)
Normal cast drying time during application
Mild skin dryness found after cast removal
Patient requesting cast removal sooner than planned

Correct answer: A cast saw laceration of the patient's skin during removal

Any unintended patient injury — such as a saw laceration — is an adverse event that must be documented in the medical record and reported per facility policy.

Question 129: A capillary refill time greater than how many seconds is considered abnormal in a casted extremity?

6 seconds
4 seconds
2 seconds (Correct answer)
1 second

Correct answer: 2 seconds

Capillary refill greater than 2 seconds indicates impaired peripheral perfusion and requires prompt evaluation.

Question 130: Which of the following best describes 'standard precautions' in orthopedic casting practice?

Precautions used only when a patient has a known infectious disease
Precautions limited to bloodborne pathogen exposure
Precautions applied to all patients regardless of infection status (Correct answer)
Precautions required only in surgical settings

Correct answer: Precautions applied to all patients regardless of infection status

Standard precautions treat all patients as potentially infectious and are applied universally regardless of known infection status.

Question 131: Which joint is classified as a hinge joint?

Elbow (Correct answer)
Shoulder
Wrist
Hip

Correct answer: Elbow

The elbow is classified as a hinge joint because it primarily allows movement in one plane, similar to a door hinge, permitting flexion and extension. This type of joint provides stability while facilitating a specific range of motion. The shoulder and hip, for example, are ball-and-socket joints, offering a much wider range of multi-directional movement.

Question 132: When converting a circumferential cast to a bivalved cast for home use, how are the two shells secured?

By taping the shells together with duct tape
By stapling the edges of the shells
With an elastic (ACE) bandage wrapped over both halves (Correct answer)
By applying a new thin layer of plaster over the cut lines

Correct answer: With an elastic (ACE) bandage wrapped over both halves

An elastic bandage holds bivalved cast shells in place while allowing removal for skin inspection and physical therapy.

Question 133: A long arm cast is indicated instead of a short arm cast for which type of fracture?

Boxer's fracture
Scaphoid fracture (stable)
Both-bone forearm fracture (radius and ulna) requiring rotational control (Correct answer)
Isolated distal radius torus fracture

Correct answer: Both-bone forearm fracture (radius and ulna) requiring rotational control

Both-bone forearm fractures require elbow immobilization to control forearm rotation, which a short arm cast cannot provide.

Question 134: Why is extra padding used when casting pediatric patients compared to adults?

Children have more prominent bony areas and less subcutaneous tissue (Correct answer)
Pediatric skin is thicker and requires more compression
Children move less, so padding prevents cast loosening
Children require thicker casts for activity restriction

Correct answer: Children have more prominent bony areas and less subcutaneous tissue

Bony prominences in children have less protective fat and are at greater risk for pressure injury, requiring additional padding.

Question 135: The posterior tibial pulse in a patient with a short leg cast is best assessed by palpating:

At the popliteal fossa
Over the lateral malleolus
Behind the medial malleolus (Correct answer)
On the dorsum of the foot between the first and second metatarsals

Correct answer: Behind the medial malleolus

The posterior tibial artery passes posterior to the medial malleolus and is palpated there to assess distal perfusion of the foot.

Question 136: Which of the following is TRUE regarding cast padding application?

Padding is optional when using fiberglass tape
Each successive layer should overlap the previous by 25–50% (Correct answer)
Padding should only be applied at the proximal and distal ends
Padding should be applied tightly to minimize bulk

Correct answer: Each successive layer should overlap the previous by 25–50%

Cast padding is applied in overlapping layers of 25–50% to ensure uniform thickness and prevent gaps that could cause pressure points.

Question 137: Which material is preferred for initial casting when significant swelling is expected?

Plastic
Resin
Fiberglass
Plaster (Correct answer)

Correct answer: Plaster

Plaster of Paris casts are generally preferred for initial casting when significant swelling is expected because they are more conformable and allow for slight expansion as swelling fluctuates. Unlike fiberglass, plaster can be easily molded to the limb and, if needed, removed or modified more readily in the acute phase. This flexibility helps prevent complications such as compartment syndrome in the early stages of injury.

Question 138: Fiberglass casting tape should be dipped in water at approximately what temperature for optimal working time?

Room temperature water (20–25°C) (Correct answer)
Ice-cold water (0–5°C)
Warm water (35–40°C)
Hot water (50–60°C)

Correct answer: Room temperature water (20–25°C)

Room temperature water is recommended for fiberglass tape to provide adequate working time; warm water accelerates the setting reaction.

Question 139: After bivalving, what is the NEXT step to fully relieve circumferential pressure?

Soak the cast in warm water
Cut and spread the underlying cast padding (Correct answer)
Apply an elastic bandage over the bivalved cast
Remove one shell and discard it

Correct answer: Cut and spread the underlying cast padding

The inner padding layer also contributes to circumferential pressure and must be cut along the same bivalve lines to fully decompress.

Question 140: Which sign is most concerning for compartment syndrome in a casted limb?

Mild swelling
Severe pain unrelieved by analgesics (Correct answer)
Pain on light touch
Dry skin under cast

Correct answer: Severe pain unrelieved by analgesics

Severe pain that is disproportionate to the injury and unrelieved by standard analgesics is the most concerning sign for compartment syndrome in a casted limb. This condition occurs when increased pressure within a confined muscle compartment compromises circulation and nerve function. It is a medical emergency requiring immediate intervention to prevent permanent tissue damage.

Question 141: A patient with a forearm cast develops skin maceration and a rash following exposure to water. The best management is:

Remove the cast, treat the skin, and reapply with waterproof liner if appropriate (Correct answer)
Allow the cast to air-dry and apply talcum powder at the proximal edge
Apply antifungal powder through the cast opening
Reinforce the cast with fiberglass tape to limit future moisture entry

Correct answer: Remove the cast, treat the skin, and reapply with waterproof liner if appropriate

Wet skin under a cast leads to maceration and fungal infection requiring cast removal, skin treatment, and reassessment of cast material choice.

Question 142: The radial pulse is best assessed in a patient with a short arm cast by palpating at the:

Antecubital fossa
Dorsum of the hand
Lateral wrist at the base of the thumb (Correct answer)
Medial aspect of the wrist

Correct answer: Lateral wrist at the base of the thumb

The radial pulse is palpated at the radial aspect of the wrist, proximal to the base of the thumb, just lateral to the flexor carpi radialis tendon.

Question 143: When disposing of a removed fiberglass cast contaminated with wound drainage, it should be treated as:

Hazardous chemical waste due to the resin content
Regulated medical waste requiring biohazard disposal (Correct answer)
Recyclable material due to its fiberglass composition
Regular trash that can be discarded in any waste bin

Correct answer: Regulated medical waste requiring biohazard disposal

Casting material saturated with blood or wound drainage is classified as regulated medical waste and requires biohazard disposal.

Question 144: For a pediatric patient with an upper extremity fracture, what thumb position is standard in a thumb spica cast?

Thumb fully adducted against the palm
Thumb in palmar abduction and slight opposition, as if holding a glass (Correct answer)
Thumb flexed completely into the palm
Thumb fully extended in line with the forearm

Correct answer: Thumb in palmar abduction and slight opposition, as if holding a glass

The functional thumb position mimics a gentle grasp, preventing contracture while immobilizing the first ray structures.

Question 145: A patient in a thumb spica cast complains that the thumb tip is numb and the nail bed does not refill within 2 seconds. The FIRST action is:

Elevate the extremity and reassess in 30 minutes
Apply ice over the cast to reduce swelling
Immediately notify the supervising physician and prepare for cast modification or removal (Correct answer)
Reassure the patient and schedule follow-up in 48 hours

Correct answer: Immediately notify the supervising physician and prepare for cast modification or removal

Numbness with delayed capillary refill indicates neurovascular compromise requiring urgent physician notification and potential cast alteration.

Question 146: A patient with a newly applied short leg walking cast is instructed not to bear weight for 48 hours primarily because:

Insurance protocols require a 48-hour non-weight-bearing period
Walking activates muscles that cause pain during the acute phase
Fiberglass requires 48 hours to achieve full strength
Plaster needs adequate time to dry and reach full structural hardness before load-bearing stress (Correct answer)

Correct answer: Plaster needs adequate time to dry and reach full structural hardness before load-bearing stress

Plaster casts require 24–48 hours to fully cure and develop maximum strength; early weight-bearing can indent or crack the cast.

Question 147: A fiberglass cast becomes warm during setting. This heat is primarily due to which process?

Friction from wrapping the tape
Oxidation of the fiberglass fibers
Endothermic moisture absorption
An exothermic polyurethane curing reaction (Correct answer)

Correct answer: An exothermic polyurethane curing reaction

Fiberglass tape contains a polyurethane prepolymer that undergoes an exothermic curing reaction when activated by water, generating heat.

Question 148: Why is it important to use gloves when handling casting material?

To prevent skin irritation and burns (Correct answer)
To shape the cast faster
To improve grip strength
To avoid staining the cast

Correct answer: To prevent skin irritation and burns

It is crucial to use gloves when handling casting material because both plaster and fiberglass resins undergo an exothermic reaction (heat-generating) during the setting process. Direct contact with these materials can cause skin irritation or thermal burns. Gloves provide a protective barrier, safeguarding the technician's skin from chemical exposure and heat.

Question 149: Which layer of the skin, composed of dead keratinized cells, acts as the outermost protective barrier and must be protected during cast application?

Stratum granulosum
Stratum basale
Stratum corneum (Correct answer)
Stratum spinosum

Correct answer: Stratum corneum

The stratum corneum is the outermost, waterproof layer of the epidermis made of dead keratinized cells that protect deeper tissues.

Question 150: For a long leg cast, the knee is typically immobilized in how many degrees of flexion?

5–10 degrees of flexion
0 degrees (full extension)
45–60 degrees of flexion
20–30 degrees of flexion (Correct answer)

Correct answer: 20–30 degrees of flexion

A long leg cast is typically applied with 20–30 degrees of knee flexion to provide stability while allowing the patient to bear weight comfortably.

Question 151: Heat generated by the oscillating saw can cause skin burns. This risk is BEST reduced by:

Using a plunging motion and limiting contact time at each point (Correct answer)
Cooling the blade with water during cutting
Using a lower-frequency saw setting
Pressing firmly to cut faster

Correct answer: Using a plunging motion and limiting contact time at each point

Repeated brief contacts with the oscillating saw prevent heat accumulation; prolonged contact causes thermal burns even without laceration.

Question 152: During application of a short leg cast, which position of the ankle is MOST commonly used for a neutral functional cast?

15 degrees of inversion
20 degrees of plantarflexion
90 degrees (plantigrade/neutral) (Correct answer)
Maximum dorsiflexion

Correct answer: 90 degrees (plantigrade/neutral)

The ankle is positioned at 90 degrees (plantigrade/neutral) for a functional short leg cast, which facilitates weight-bearing and prevents equinus deformity.

Question 153: What is the recommended minimum contact time for most EPA-registered disinfectants used to clean a casting table between patients?

30 seconds of active scrubbing followed by immediate drying
Immediate — wipe and the surface is ready
24 hours to allow full chemical penetration
The wet contact time specified on the product label (typically 1–10 minutes) (Correct answer)

Correct answer: The wet contact time specified on the product label (typically 1–10 minutes)

Disinfectants require the surface to remain wet for their specified contact (dwell) time to achieve the claimed level of microbial kill.

Question 154: After cast removal, which skin finding requires the clinician's evaluation before the patient is discharged?

Mild skin dryness and scaling
Open pressure sore or wound (Correct answer)
Slight pallor of the skin
Muscle atrophy visible in the limb

Correct answer: Open pressure sore or wound

Any open wound or pressure injury discovered post-removal must be assessed by the clinician for infection and wound care planning.

Question 155: HIPAA regulations require the casting technician to:

Post patient casting records in the waiting room for family access
Retain patient records for at least 30 days only
Share neurovascular findings with the patient's employer upon request
Protect patient health information and share it only with authorized individuals (Correct answer)

Correct answer: Protect patient health information and share it only with authorized individuals

HIPAA mandates confidentiality of all patient health information and permits disclosure only with patient authorization or for treatment, payment, and operations.

Question 156: A patient's cast becomes wet and the padding is saturated. From an infection control standpoint, the wet cast is concerning because:

A moist, warm environment under the cast promotes bacterial and fungal growth (Correct answer)
Wet fiberglass loses its structural integrity immediately
Water dissolves the antibacterial properties of stockinette
Wet casts are more likely to cause pressure sores only

Correct answer: A moist, warm environment under the cast promotes bacterial and fungal growth

Moisture trapped under a cast creates a warm, humid environment that promotes proliferation of bacteria and fungi, increasing infection risk.

Question 157: In Volkmann's ischemic contracture, which muscle group is primarily affected due to compartment syndrome of the forearm?

Extensors of the forearm
Intrinsic muscles of the hand
Supinator muscle
Deep flexors of the forearm (Correct answer)

Correct answer: Deep flexors of the forearm

The deep flexor compartment of the forearm has the highest tissue pressure in forearm compartment syndrome, leading to ischemia and fibrosis of the flexor digitorum profundus and flexor pollicis longus.

Question 158: Sensation in the first dorsal web space between the first and second toes is supplied by which nerve?

Sural nerve
Tibial nerve
Deep peroneal nerve (Correct answer)
Superficial peroneal nerve

Correct answer: Deep peroneal nerve

The deep peroneal nerve provides sensory innervation exclusively to the first dorsal web space of the foot and is assessed to detect compression at the anterior ankle.

Question 159: Which part of the body would most likely require a short arm cast?

Ankle
Wrist and forearm (Correct answer)
Knee
Upper arm

Correct answer: Wrist and forearm

A short arm cast extends from just below the elbow to the metacarpal heads, effectively immobilizing the wrist and forearm. This type of cast is commonly used for fractures of the distal radius, ulna, or carpal bones, as well as for severe sprains in this region. It allows for full elbow and finger movement while stabilizing the injured area.

Question 160: Which layer is applied FIRST when constructing a traditional cast?

Stockinette (Correct answer)
Fiberglass or plaster tape
Cast padding (Webril or equivalent)
Elastic bandage (ACE wrap)

Correct answer: Stockinette

Stockinette is applied first directly over the skin, followed by cast padding, and then the casting material (plaster or fiberglass).

Question 161: During cast removal, the skin under a long-standing plaster cast is commonly found to be:

Thickened from pressure
Infected in most cases
Dry, flaky, and possibly malodorous (Correct answer)
Deeply pigmented

Correct answer: Dry, flaky, and possibly malodorous

Weeks of immobilization causes skin dryness, desquamation (scaling), and sometimes odor due to trapped dead skin cells and moisture.

Question 162: Which physiological process, driven by the inflammatory response, is responsible for clearing debris and necrotic tissue in the first stage of fracture healing?

Periosteal callus formation
Phagocytosis by macrophages and neutrophils (Correct answer)
Fibrocartilage deposition by chondrocytes
Osteoclastic bone resorption

Correct answer: Phagocytosis by macrophages and neutrophils

In the inflammatory phase, macrophages and neutrophils infiltrate the fracture hematoma to phagocytose debris and necrotic tissue, initiating the healing cascade.

Question 163: What position should a patient's extremity be in during pre-cast neurovascular assessment?

Fully extended
Dependent (hanging down)
Elevated above heart level only
Functional position appropriate for the injury (Correct answer)

Correct answer: Functional position appropriate for the injury

The extremity should be held in the planned functional casting position so that assessment reflects the post-cast condition.

Question 164: Pallor of the fingers in a patient with a freshly applied long arm cast most likely indicates:

Arterial compromise (Correct answer)
Adequate venous return
Venous congestion
Normal post-application swelling

Correct answer: Arterial compromise

Pallor signifies lack of oxygenated blood reaching the digits, indicating arterial compromise that requires immediate intervention.

Question 165: Which nerve is assessed by testing sensation in the first dorsal web space (between the thumb and index finger) of the hand?

Median nerve
Anterior interosseous nerve
Ulnar nerve
Superficial radial nerve (Correct answer)

Correct answer: Superficial radial nerve

The superficial radial nerve provides sensory innervation to the first dorsal web space and dorsolateral hand.

Orthopaedic Technologist Certified (OTC) Examination

The OTC exam certifies orthopaedic technologists in patient assessment, casting and splinting techniques, surgical procedures, and clinic management. It is administered by the National Board for Certification of Orthopaedic Technologists (NBCOT).

165

Questions

180 min

Time Limit

70%

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