Orthopaedic Technologist Certified (OTC) Examination — Questions and Answers

Question 1: A patient's cast becomes wet and the padding is saturated. From an infection control standpoint, the wet cast is concerning because:

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

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

Lock all cutting instruments to prevent cast removal
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

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

Psoriasis
Maceration (Correct answer)
Eczema
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 4: Which complication is MOST associated with the use of fiberglass casting material compared to plaster?

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

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 5: The 'anatomical snuffbox' is bordered by the tendons of the abductor pollicis longus and extensor pollicis brevis radially and the extensor pollicis longus ulnarly; palpation tenderness here suggests fracture of which bone?

Scaphoid (Correct answer)
Trapezium
Lunate
Capitate

Correct answer: Scaphoid

Tenderness in the anatomical snuffbox is the classic clinical sign of a scaphoid fracture even when initial X-rays appear normal.

Question 6: Before applying a long arm cast, the technician should document motor function by asking the patient to:

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

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 7: Which question is MOST important to ask a patient before cast application regarding allergies?

Allergy to contrast dye
Allergy to penicillin
Allergy to latex or plaster (Correct answer)
Allergy to shellfish

Correct answer: Allergy to latex or plaster

Latex allergy is critical because stockinettes and gloves may contain latex, and plaster allergy can cause skin reactions.

Question 8: What is the function of the periosteum?

Stores calcium
Cushions joints
Protects and nourishes bone (Correct answer)
Attaches muscles to bone

Correct answer: Protects and nourishes bone

The periosteum is a dense, vascular connective tissue membrane that covers the outer surface of most bones. Its primary functions include protecting the bone, providing a surface for muscle and ligament attachment, and containing cells vital for bone growth, repair, and nourishment. It also houses nerve endings, contributing to bone sensitivity.

Question 9: 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 allows the patient to bathe or swim without cast damage (Correct answer)
It eliminates the need for stockinette
It reduces the exothermic heat during curing

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

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

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 11: 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)
Bone healing being slower due to paralysis
Muscle spasticity breaking the cast
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 12: After bivalving, what is the NEXT step to fully relieve circumferential pressure?

Apply an elastic bandage over the bivalved cast
Cut and spread the underlying cast padding (Correct answer)
Soak the cast in warm water
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 13: What is the professional responsibility of a certified orthopedic technician?

Ensure safe and ethical practice (Correct answer)
Limit communication with patients
Follow only verbal instructions
Work independently without oversight

Correct answer: Ensure safe and ethical practice

A certified orthopedic technician has a professional responsibility to ensure safe and ethical practice in all aspects of their work. This includes adhering to established protocols, maintaining patient confidentiality, communicating effectively, and working within their scope of practice under appropriate supervision. Prioritizing patient well-being and upholding high standards of care are paramount.

Question 14: Which of the following is a contraindication to applying a circumferential cast immediately after an acute injury?

Absence of neurovascular compromise at initial assessment
A stable, nondisplaced fracture confirmed by radiograph
An open wound that has been irrigated and dressed
Significant soft tissue swelling expected to increase over the next 24–48 hours (Correct answer)

Correct answer: Significant soft tissue swelling expected to increase over the next 24–48 hours

Progressive swelling in a circumferential cast can cause compartment syndrome; a splint is preferred initially to allow for expansion.

Question 15: The dorsalis pedis pulse is most reliably palpated on the:

Plantar surface of the heel
Lateral border of the foot
Dorsum of the foot between the first and second metatarsals (Correct answer)
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 16: Which type of fracture is suggested by a spiral pattern on X-ray in a non-ambulatory infant?

Stress fracture from excessive swaddling
Pathologic fracture from bone tumor
Non-accidental trauma (child abuse) must be considered (Correct answer)
Normal birth fracture pattern

Correct answer: Non-accidental trauma (child abuse) must be considered

Spiral fractures in non-ambulatory infants are a well-recognized radiographic red flag for non-accidental trauma and mandate a mandatory report and full skeletal survey.

Question 17: Why must growth plates (physes) receive special consideration when reviewing X-rays before pediatric casting?

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

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 18: 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 19: Which physiological process, driven by the inflammatory response, is responsible for clearing debris and necrotic tissue in the first stage of fracture healing?

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

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

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

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

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

Correct answer: Significant anticipated swelling (acute compartment risk)

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

Question 22: Which layer is applied FIRST when constructing a traditional cast?

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

Correct answer: Stockinette

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

Question 23: Which of the following best describes 'bivalving' a cast?

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

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

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

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 25: 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 26: A long arm cast is indicated instead of a short arm cast for which type of fracture?

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

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 27: 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?

Superficial peroneal nerve
Deep peroneal nerve
Sural nerve (Correct answer)
Tibial 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 28: Which nerve is assessed by testing sensation in the first dorsal web space (between the thumb and index finger) of the hand?

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

Correct answer: Superficial radial nerve

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

Question 29: Which cast provides the best immobilization for a metatarsal shaft fracture that requires protected weight-bearing?

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

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

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

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.

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).

Questions

35 min

Time Limit

70%

To Pass

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