Orthopaedic Technologist Certified (OTC) Examination — Questions and Answers

Question 1: An Orthopaedic Technologist is assisting with the care of a patient in skeletal traction via a pin in their proximal tibia. Which of the following is a critical and routine responsibility for the technologist regarding the pin site?

Applying antibiotic ointment daily to prevent infection.
Tightening the pin clamps on the traction bow every shift.
Regularly cleaning the site as per protocol to prevent infection. (Correct answer)
Ensuring the pin rotates freely within the bone.

Correct answer: Regularly cleaning the site as per protocol to prevent infection.

The point where the pin enters the skin is a direct portal for bacteria to enter the body and bone, creating a high risk for a pin tract infection. A key responsibility of the care team, including the technologist, is to perform routine pin site care according to the institution's protocol, which involves cleaning the area to remove crusting and drainage, monitoring for signs of infection (redness, swelling, purulent drainage), and keeping the area clean and dry.

Question 2: A wound left open to heal from the base upward through granulation tissue formation is healing by which method?

Tertiary intention
Secondary intention (Correct answer)
Primary intention
Direct closure

Correct answer: Secondary intention

Secondary intention healing allows a wound to fill with granulation tissue from the bottom up when primary closure is not possible, such as in infected or contaminated wounds.

Question 3: Testing the ability to abduct and adduct the fingers assesses function of which nerve in the upper extremity?

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

Correct answer: Ulnar nerve

The ulnar nerve innervates the intrinsic hand muscles (interossei and hypothenar muscles) responsible for finger abduction and adduction.

Question 4: After bivalving a cast, the two halves should be secured with:

Waterproof tape only
Medical-grade superglue
Elastic bandage (ACE wrap) (Correct answer)
Additional plaster layers

Correct answer: Elastic bandage (ACE wrap)

After bivalving, an elastic bandage is wrapped around the cast halves to hold them in place while still allowing circumferential decompression.

Question 5: A patient presents with a suspected scaphoid fracture but initial X-rays are negative. The most appropriate next step is:

Order a bone scan and discharge without immobilization
Discharge with activity restrictions only
Apply a thumb spica splint and arrange follow-up imaging (Correct answer)
Apply a long arm cast immediately

Correct answer: Apply a thumb spica splint and arrange follow-up imaging

Scaphoid fractures are frequently occult on initial radiographs; thumb spica immobilization is initiated and MRI or repeat X-rays at 10-14 days are recommended.

Question 6: What is the primary function of a pneumatic tourniquet when used during surgery on an extremity?

To reduce the patient's metabolic rate
To create a bloodless (hemostatic) surgical field (Correct answer)
To provide regional anesthesia to the limb
To assist in the reduction of the fracture

Correct answer: To create a bloodless (hemostatic) surgical field

The pneumatic tourniquet is inflated to a pressure sufficient to occlude arterial blood flow into the limb, which creates a 'bloodless' or hemostatic field. This improves visualization of anatomical structures for the surgeon, facilitating a safer and more efficient procedure.

Question 7: A patient with a cast reports tingling and numbness in the fingertips shortly after application. The FIRST action by the OT should be:

Elevate the extremity and reassess in 30 minutes
Bivalve or split the cast and notify the physician (Correct answer)
Document the complaint and reassess in 2 hours
Apply ice over the cast to reduce swelling

Correct answer: Bivalve or split the cast and notify the physician

New onset paresthesias after casting may indicate neurovascular compromise; bivalving relieves pressure immediately and physician notification is mandatory.

Question 8: Compartment syndrome is BEST assessed by evaluating which of the following?

Skin color and cast tightness alone
Range of motion and muscle strength
Capillary refill and pulse oximetry only
Pain with passive stretch, paresthesia, and compartment pressure (Correct answer)

Correct answer: Pain with passive stretch, paresthesia, and compartment pressure

The classic assessment of compartment syndrome includes pain out of proportion, pain with passive stretch, paresthesia, and direct compartment pressure measurement.

Question 9: When performing a neurovascular check after cast application, the orthopaedic technologist notes the patient has increased pain with passive stretch of the fingers. This finding most likely indicates:

Peripheral neuropathy
Normal post-casting discomfort
Developing compartment syndrome (Correct answer)
Arterial spasm only

Correct answer: Developing compartment syndrome

Pain with passive stretch of muscles within a compartment is an early and reliable sign of developing compartment syndrome, which requires immediate evaluation.

Question 10: Which type of cast is most appropriate for a stable distal radius fracture requiring immobilization of the wrist while allowing elbow motion?

Long arm cast
Cylinder cast
Short arm cast (Correct answer)
Sugar tong splint

Correct answer: Short arm cast

A short arm cast extends from below the elbow to the metacarpal heads, immobilizing the wrist while leaving the elbow free.

Question 11: When applying a posterior short leg splint, the technologist should ensure the splint extends from the metatarsal heads to where?

Approximately 2 inches distal to the fibular head. (Correct answer)
The mid-calf level.
Just above the malleoli.
The level of the tibial tuberosity.

Correct answer: Approximately 2 inches distal to the fibular head.

To avoid compression of the common peroneal nerve, a posterior short leg splint should terminate approximately 2 inches (or 2-3 fingerbreadths) distal to the fibular head. Extending it too proximally can lead to nerve palsy and foot drop.

Question 12: A patient is being fitted for a functional hinged knee brace following an ACL reconstruction. What is the primary purpose of the adjustable hinges on this type of brace?

To increase varus and valgus stress for ligament testing.
To apply continuous cold therapy to the surgical site.
To provide rigid immobilization of the knee joint.
To allow for a controlled and gradually increasing range of motion. (Correct answer)

Correct answer: To allow for a controlled and gradually increasing range of motion.

Functional hinged knee braces are designed to protect the healing ligament while allowing for controlled movement. The adjustable hinges can be set by the physician or technologist to limit flexion and extension to a specific, safe range, which is gradually increased as the patient progresses through rehabilitation.

Question 13: A patient presents to the emergency department with an acute, severe ankle sprain with significant swelling. Which of the following is the most appropriate initial method of immobilization?

A posterior ankle splint combined with a stirrup splint. (Correct answer)
Immediate surgical fixation.
A short leg walking boot.
Application of a circumferential fiberglass cast.

Correct answer: A posterior ankle splint combined with a stirrup splint.

In acute injuries with significant swelling, a circumferential cast is contraindicated due to the risk of compartment syndrome. A combination of a posterior ankle splint and a stirrup splint provides excellent immobilization while allowing for swelling to subside. A walking boot may not provide sufficient stability for a severe sprain, and surgery is not the initial treatment.

Question 14: Which fracture classification system uses Types I, II, and III to describe open fractures based on wound size and soft tissue damage?

Garden Classification
Gustilo-Anderson Classification (Correct answer)
Neer Classification
AO/OTA Classification

Correct answer: Gustilo-Anderson Classification

The Gustilo-Anderson classification categorizes open fractures into Types I, II, and III based on wound size, contamination level, and soft tissue injury severity.

Question 15: Which of the following describes the safest technique for an Orthopaedic Technologist to use when removing a cast with an oscillating cast saw?

Ensuring the blade is slightly dull to prevent skin injury.
Advancing the blade along a continuous line as if cutting with a knife.
Using a firm, in-and-out or "plunging" motion through the cast material. (Correct answer)
Applying steady, continuous pressure in one spot to cut through quickly.

Correct answer: Using a firm, in-and-out or "plunging" motion through the cast material.

A cast saw blade oscillates (vibrates back and forth) rather than spins. The correct and safest technique is to use a firm, plunging motion, pushing the blade through the cast material and then lifting it out before moving to the next adjacent spot. This method prevents the blade from dragging along the skin, which can cause friction burns or lacerations.

Question 16: During an open reduction and internal fixation (ORIF) procedure, the surgeon drills a hole through a bone cortex and then uses a depth gauge. What is the direct purpose of using the depth gauge at this stage?

To confirm the fracture has been adequately reduced
To measure the density of the bone
To select the correct diameter for the drill bit
To determine the appropriate length of the screw to be used (Correct answer)

Correct answer: To determine the appropriate length of the screw to be used

The depth gauge is a calibrated instrument used to measure the depth of a drilled hole in bone. This measurement allows the surgeon to select a screw of the correct length to ensure optimal purchase and fixation without protruding excessively, which could damage soft tissues.

Question 17: In a neurovascular assessment, 'paresthesia' refers to:

Complete loss of motor function
Abnormal sensations such as tingling, numbness, or burning (Correct answer)
Increased pain at the fracture site
Skin color changes indicating poor perfusion

Correct answer: Abnormal sensations such as tingling, numbness, or burning

Paresthesia describes abnormal nerve sensations including tingling, numbness, or burning, and is an early indicator of nerve compression or ischemia.

Question 18: Which fracture type is characterized by three or more bone fragments at the fracture site?

Impacted
Greenstick
Stress
Comminuted (Correct answer)

Correct answer: Comminuted

A comminuted fracture produces three or more bone fragments at the injury site and is commonly the result of high-energy trauma.

Question 19: Cast itch (pruritus) should be managed by:

Applying hydrocortisone cream through a cast window
Pouring water inside the cast to soothe the skin
Using a knitting needle to scratch inside the cast
Blowing cool air into the cast with a hair dryer on cool setting (Correct answer)

Correct answer: Blowing cool air into the cast with a hair dryer on cool setting

Blowing cool air into the cast with a hair dryer on the cool (not hot) setting is a safe method to relieve itching without risking skin injury.

Question 20: Which dressing type is most appropriate for managing a heavily exudating orthopaedic wound?

Alginate dressing (Correct answer)
Transparent film dressing
Dry gauze dressing
Hydrocolloid dressing

Correct answer: Alginate dressing

Alginate dressings are highly absorbent and ideal for heavily exudating wounds; they form a moist gel on contact with exudate, supporting an optimal healing environment.

Question 21: A patient in pelvic skin traction is given permission to use the restroom and requests assistance from the orthopaedic teacher to stand up. Should the orthopaedic technologist?

remove the weights and the pelvic belt and apply back brace
remove the weights and the pelvic belt and apply back brace
remove the weights and leave the pelvic belt in place
remove the weights and then the pelvic belt (Correct answer)

Correct answer: remove the weights and then the pelvic belt

When a patient in pelvic skin traction needs to stand, the traction force must first be released to prevent injury. This is achieved by carefully removing the weights that apply the traction. Once the weights are removed, the pelvic belt, which is directly applying the traction, can then be safely removed to allow the patient full mobility to stand up without resistance or risk of sudden jarring.

Question 22: The youngster continues to play a video game on an electronic table while the orthopaedic technologist is interviewing him. What should the orthopaedic technologist do first?

asking the boy if he is feeling anxious about the interview
asking the boy what kinds of apps he likes (Correct answer)
telling the boy to put his tablet away
asking a question and then remaining silent until the boy looks up

Correct answer: asking the boy what kinds of apps he likes

When interviewing a child who is distracted, the most effective initial approach is to build rapport and engage them on their level. Asking about their video game or apps shows genuine interest in their world, helps establish a connection, and can make them feel more comfortable and willing to participate in the interview. This empathetic approach is more likely to yield cooperation than immediately demanding they stop their activity or remaining silent.

Question 23: When the distal fracture fragment deviates laterally away from the midline, which alignment term applies?

Procurvatum
Valgus (Correct answer)
Recurvatum
Varus

Correct answer: Valgus

Valgus angulation describes lateral deviation of the distal fragment away from the body midline, while varus refers to medial (inward) deviation.

Question 24: A patient's cast has developed a foul odor and the patient reports fever. These findings most likely indicate:

Normal cast curing process
Cast material degradation
Infection beneath the cast (Correct answer)
Excessive perspiration only

Correct answer: Infection beneath the cast

Foul odor combined with fever are classic signs of infection under a cast, requiring urgent cast removal and wound assessment.

Question 25: During cast removal, the cast saw should be moved in which motion to minimize skin injury?

Continuous sweeping side-to-side motion
Up-and-down plunge motion without lateral sweeping (Correct answer)
Circular rotating motion
Single straight cut from proximal to distal

Correct answer: Up-and-down plunge motion without lateral sweeping

The cast saw oscillates and should be used with an up-and-down plunge technique rather than dragging to avoid heat buildup and skin lacerations.

Question 26: Which test is specifically used to determine the danger of falls when the orthopaedic technologist evaluates an elderly patient's functional ability?

Instrumental Activities of Daily Living
Functional Ability Rating Scale
Ktaz Activities of Daily Living (ADL) scale
Timed Up and Go (TUG) (Correct answer)

Correct answer: Timed Up and Go (TUG)

The Timed Up and Go (TUG) test is a widely recognized and validated screening tool specifically designed to assess an elderly patient's functional mobility and risk of falls. It measures the time it takes for a patient to stand from a chair, walk three meters, turn, walk back, and sit down, providing a quick and reliable indicator of balance and gait impairment.

Question 27: When applying a short arm cast for a distal radius fracture, what is the correct distal landmark for the plaster or fiberglass?

The distal interphalangeal (DIP) joints
The proximal palmar crease (Correct answer)
The wrist crease
The mid-palm

Correct answer: The proximal palmar crease

The distal edge of a short arm cast should extend to the proximal palmar crease (or metacarpal heads) to allow for full flexion of the metacarpophalangeal (MCP) joints. Extending it further would unnecessarily immobilize the fingers.

Question 28: While setting up a sterile field for a joint aspiration, the technologist notices a small tear in the outer wrapper of a sterile gauze package. What is the correct course of action?

Open the package carefully, avoiding the torn area.
Discard the entire package and obtain a new, intact one. (Correct answer)
Use the gauze since the inner contents are likely still sterile.
Cover the tear with a sterile gloved finger and then open the package.

Correct answer: Discard the entire package and obtain a new, intact one.

The integrity of the packaging is essential for maintaining sterility. Any tear, puncture, or water damage compromises the sterile barrier, and the item must be considered contaminated. The only safe action is to discard the compromised package and obtain a new one.

Question 29: When applying a fiberglass cast, the OT should wear gloves primarily to:

Protect against dermatitis from the resin (Correct answer)
Prevent burns from exothermic reaction
Prevent contamination of the cast
Improve grip on the casting material

Correct answer: Protect against dermatitis from the resin

Fiberglass casting tape contains resin that can cause contact dermatitis with prolonged skin exposure, making glove use essential.

Question 30: For treatment of a left humerus fracture, a patient will receive side arm skin traction. In what areas are traction tapes used?

to the upper arm, extending past the elbow and to the forearm, extending to the wrist
to the upper arm, extending past the elbow, and to the forearm, extending beyond the hand (Correct answer)
to the forearm, extending beyond the hand
to the forearm, extending to the wrist

Correct answer: to the upper arm, extending past the elbow, and to the forearm, extending beyond the hand

For side arm skin traction, the traction tapes must be applied to both the upper arm and the forearm to effectively distribute the pulling force and stabilize the humerus fracture. Extending the tapes past the elbow on the upper arm and beyond the hand on the forearm ensures maximum surface area for adhesion. This broad application helps to maintain proper alignment, prevents skin irritation, and provides optimal traction mechanics for the fracture.

Question 31: A torus (buckle) fracture in a pediatric patient is best characterized by which finding?

Fracture through the growth plate
Complete fracture through both cortices
Cortical bulging without complete fracture (Correct answer)
Spiral fracture pattern through the diaphysis

Correct answer: Cortical bulging without complete fracture

A torus fracture causes a buckling or bulging of the cortex at the metaphysis without complete fracture, as the bone compresses under axial load.

Question 32: The hip and repair patient is at danger because of the fracture bed position.

back strain
diminished lung capacity
pressure to genitalia (Correct answer)
sliding and shearing

Correct answer: pressure to genitalia

Patients with hip fractures often require specific bed positioning, such as maintaining leg abduction with pillows or specialized devices, to ensure proper alignment and healing. This positioning can inadvertently create sustained pressure on the perineal area or genitalia, increasing the risk of skin breakdown, discomfort, or pressure injuries in this sensitive region.

Question 33: After cast removal, the skin commonly appears:

Uniformly smooth and moisturized
Pale, scaly, and with accumulated dead skin cells (Correct answer)
Bright red with open sores
Deeply tanned and thickened

Correct answer: Pale, scaly, and with accumulated dead skin cells

Following cast removal, the skin typically appears pale, scaly, and covered with accumulated dead cells due to lack of exposure and normal desquamation under the cast.

Question 34: Which position is recommended for the wrist when applying a cock-up wrist splint for carpal tunnel syndrome?

10-20 degrees of flexion
Full pronation with neutral wrist
30-40 degrees of extension
Neutral to slight extension (0-10 degrees) (Correct answer)

Correct answer: Neutral to slight extension (0-10 degrees)

A neutral to slight extension position minimizes pressure within the carpal tunnel and reduces median nerve compression.

Question 35: During a patient interview, an elderly patient accompanied by a family member seems hesitant to describe the circumstances of their wrist injury, frequently looking at the family member before answering. What is the most appropriate approach for the Orthopaedic Technologist?

Document 'patient is a poor historian' and proceed with the physical exam.
Direct all questions to the family member to get the information quickly.
Continue the interview with both present, but rephrase questions in a non-judgmental and open-ended manner. (Correct answer)
Ask the family member to leave the room to ensure patient privacy.

Correct answer: Continue the interview with both present, but rephrase questions in a non-judgmental and open-ended manner.

The primary goal is to obtain an accurate history in a safe and comfortable environment. Rephrasing questions in a non-threatening, open-ended way allows the patient to share information more freely. Asking the family member to leave may escalate a potentially sensitive situation, while ignoring the patient's hesitation could miss crucial information. Effective communication techniques are a key skill in patient assessment.

Question 36: An Orthopaedic Technologist is removing a K-wire from a patient's finger in the clinic. After the wire is removed, what is the MOST appropriate immediate action for disposing of the contaminated wire?

Hand it back to the physician to examine.
Wipe it with an alcohol pad and place it on the instrument tray.
Place it directly into a designated, puncture-resistant sharps container. (Correct answer)
Wrap it in gauze and place it in the regular trash can.

Correct answer: Place it directly into a designated, puncture-resistant sharps container.

Contaminated K-wires, needles, and scalpel blades are considered sharps and pose a risk for percutaneous injury. They must be disposed of immediately in a designated, puncture-resistant, appropriately labeled sharps container to prevent injury and transmission of bloodborne pathogens.

Question 37: How frequently should neurovascular checks be performed immediately following cast or splint application in an acute fracture patient?

Only if the patient reports pain
Once every 8 hours
Every 30 to 60 minutes for the first few hours, then per protocol (Correct answer)
Every 24 hours

Correct answer: Every 30 to 60 minutes for the first few hours, then per protocol

Frequent neurovascular monitoring (every 30–60 minutes initially) is critical in the acute post-application period when swelling peaks and compartment syndrome risk is highest.

Question 38: Which of the following is the MOST common site for a pressure ulcer in a patient wearing a long leg cast?

Fibular head (Correct answer)
Tibial crest
Medial malleolus
Lateral malleolus

Correct answer: Fibular head

The fibular head is a prominent bony prominence and a high-risk site for pressure ulcer development beneath a long leg cast.

Question 39: A patient reports intense, burning pain and swelling in their hand 6 hours after a short arm cast was applied for a wrist fracture. Their fingers appear pale and cool to the touch. Which of the following is the MOST critical immediate action?

Reassure the patient that some swelling and pain is normal.
Schedule a follow-up appointment for the next day to check the cast fit.
Administer pain medication and instruct the patient to elevate the arm.
Immediately bivalve or remove the cast and notify the physician. (Correct answer)

Correct answer: Immediately bivalve or remove the cast and notify the physician.

The patient's symptoms are classic signs of compartment syndrome, a serious condition caused by increased pressure within a muscle compartment that can lead to muscle and nerve damage. The only appropriate immediate action is to relieve the pressure by splitting or removing the cast and urgently consulting the physician.

Question 40: A patellar tendon-bearing (PTB) cast or brace is used primarily for fractures of the:

Tibial shaft (Correct answer)
Proximal tibia
Distal tibia
Distal femur

Correct answer: Tibial shaft

PTB functional bracing transfers weight-bearing load through the patellar tendon and soft tissues, most commonly used for tibial shaft fractures.

Question 41: When splitting a cast for bivalving, the second cut is placed:

On the medial side regardless of cast location
Parallel and adjacent to the first cut
At a 45-degree angle to the first cut
180 degrees opposite the first cut (Correct answer)

Correct answer: 180 degrees opposite the first cut

Bivalving requires two cuts placed on opposite sides of the cast (180° apart) to create two equal halves that can spread open.

Question 42: Before removing a surgical drain from a post-operative orthopaedic wound, what is the most important prerequisite action?

Flush the drain with sterile saline
Remove all sutures from the wound edges first
Confirm a physician order for drain removal (Correct answer)
Apply a pressure dressing before removal

Correct answer: Confirm a physician order for drain removal

Drain removal must always be performed under a physician's order, as premature removal can lead to hematoma, seroma, or fluid accumulation.

Question 43: Which imaging method from the list below is best for identifying osteomyelitis brought on by an infected traumatic injury?

standard radiograph
ultrasound
Computed tomography CT scan
Magnetic resonance imaging (MRI) (Correct answer)

Correct answer: Magnetic resonance imaging (MRI)

Magnetic Resonance Imaging (MRI) is considered the most sensitive and specific imaging modality for diagnosing osteomyelitis, especially when caused by an infected traumatic injury. MRI provides excellent soft tissue contrast, allowing for early detection of bone marrow edema, abscess formation, and soft tissue involvement, which are characteristic signs of infection. Other methods like standard radiographs are often normal in early stages, and CT scans are less sensitive for marrow changes.

Question 44: A 13-year-old patient with a progressive thoracic curve is prescribed a Milwaukee brace (CTLSO). Which of the following is the primary condition this brace is designed to treat?

Spondylolisthesis
Lumbar lordosis
Cervical kyphosis
Scoliosis (Correct answer)

Correct answer: Scoliosis

The Milwaukee brace, a cervico-thoraco-lumbo-sacral orthosis (CTLSO), is specifically designed to treat spinal curvatures like scoliosis and kyphosis in growing adolescents. It applies corrective forces to the spine to prevent the curve from progressing.

Question 45: For traction to be effective, a counter-traction force must be established. In most forms of lower extremity traction, what typically provides the primary source of counter-traction?

Additional weights applied to the head of the bed
Manual pressure applied by the technologist
The patient's own body weight (Correct answer)
A fixed point on the traction frame itself

Correct answer: The patient's own body weight

Effective traction requires a pulling force (traction) and an opposing force (counter-traction). In many applications, such as Buck's or Russell's traction, the patient's own body weight provides the counter-traction. This is often enhanced by elevating the foot of the bed, which uses gravity to pull the body in the opposite direction of the traction weights.

Question 46: Prolonged immobilization of a patient on a rigid long spine board is MOST associated with an increased risk of which of the following complications?

Deep vein thrombosis
Pressure ulcer formation (Correct answer)
Hypertension
Improved respiratory function

Correct answer: Pressure ulcer formation

The hard, unforgiving surface of a long spine board creates significant pressure over bony prominences like the sacrum, scapulae, and occiput. Prolonged time on the board can restrict blood flow to the skin and underlying tissues, leading to ischemia and the formation of pressure ulcers (pressure injuries). Immobilization can also restrict respiration, not improve it. While DVT is a risk of general immobility, pressure ulcers are the most direct and well-documented complication of the backboard itself.

Question 47: A patient in a hip spica cast for a femur fracture develops severe, cramping abdominal pain, persistent nausea, and bilious vomiting several days after application. These symptoms are MOST indicative of which serious complication?

Compartment Syndrome
Pulmonary Embolism
Deep Vein Thrombosis (DVT)
Cast Syndrome (SMA Syndrome) (Correct answer)

Correct answer: Cast Syndrome (SMA Syndrome)

Cast syndrome, or Superior Mesenteric Artery (SMA) syndrome, is a rare complication where a large body or spica cast compresses the third portion of the duodenum between the SMA and the aorta. This creates a functional bowel obstruction, leading to symptoms of severe nausea, vomiting, and abdominal pain.

Question 48: The Garden classification system is used specifically to categorize fractures of which anatomical location?

Tibial plateau
Proximal humerus
Femoral neck (Correct answer)
Distal femur

Correct answer: Femoral neck

The Garden classification (Grades I–IV) categorizes intracapsular femoral neck fractures to guide treatment decisions and predict avascular necrosis risk.

Question 49: Which fracture type is most commonly seen in pediatric patients due to incomplete bone ossification?

Pathologic
Stress
Avulsion
Greenstick (Correct answer)

Correct answer: Greenstick

Greenstick fractures occur in children because their incompletely ossified bones are more pliable, causing the bone to crack on one cortex without complete separation.

Question 50: An Orthopaedic Technologist is preparing a patient's leg for a total knee arthroplasty. Which of the following is most commonly used as the primary antiseptic agent for the surgical skin prep?

Hydrogen peroxide
Isopropyl alcohol 70% alone
Sterile saline
Chlorhexidine gluconate (CHG) (Correct answer)

Correct answer: Chlorhexidine gluconate (CHG)

Chlorhexidine gluconate (CHG), often in an alcohol-based solution, is a broad-spectrum antiseptic agent commonly used for surgical skin preparation in orthopaedics. It has a rapid onset and persistent antimicrobial effect, making it highly effective at reducing the microbial load on the skin before incision.

Question 51: When is it appropriate to cut a cast window?

To reduce swelling by allowing the limb to expand
To inspect or treat a wound beneath the cast (Correct answer)
To routinely allow the skin to breathe every few days
To permit routine neurovascular checks

Correct answer: To inspect or treat a wound beneath the cast

A cast window is cut to provide direct access to a wound for dressing changes or inspection without requiring full cast removal.

Question 52: A scrubbed Orthopaedic Technologist is assisting in an intramedullary nailing of a femur. Which of the following actions would constitute a break in sterile technique?

Clasping hands together and holding them below waist level (Correct answer)
Adjusting the overhead surgical light with sterile handles
Facing the sterile field at all times
Passing another scrubbed team member back-to-back

Correct answer: Clasping hands together and holding them below waist level

The sterile field for a gowned and gloved person is considered to exist from the chest to the level of the sterile field, and the sleeves from two inches above the elbow to the cuff. Gowns are considered sterile in front from the shoulder to the waist level. Gloved hands that are dropped below waist or table level are considered contaminated.

Question 53: A patient returns with a cast applied 5 days ago and the cast is now loose and poorly fitting. The most likely reason is:

Material fatigue of the cast
Incorrect casting technique
Normal bone healing progression
Reduction in swelling since application (Correct answer)

Correct answer: Reduction in swelling since application

Post-injury edema typically resolves within days, causing the cast to become loose as the limb volume decreases.

Question 54: Which of the following is a primary advantage of using a sugar-tong splint over a circumferential cast for an acute, unstable distal forearm fracture?

It accommodates for initial swelling better than a circumferential cast. (Correct answer)
It allows for earlier range of motion at the wrist.
It is less expensive than a traditional cast.
It provides superior immobilization of the elbow.

Correct answer: It accommodates for initial swelling better than a circumferential cast.

A key advantage of splints, like the sugar-tong, is that they are not circumferential. This allows them to better accommodate the significant soft tissue swelling that often occurs with acute fractures, reducing the risk of compartment syndrome.

Question 55: Which of the following is a primary advantage of using a splint over a circumferential cast for an acute lower extremity fracture?

It accommodates for soft tissue swelling. (Correct answer)
It requires less padding.
It provides more definitive immobilization.
It is more durable for weight-bearing.

Correct answer: It accommodates for soft tissue swelling.

The main advantage of a splint in the acute setting is that it is non-circumferential, which allows for swelling that naturally occurs after an injury. This significantly reduces the risk of pressure-related complications like skin breakdown and compartment syndrome compared to a rigid, circumferential cast.

Question 56: Which patient population requires the MOST vigilance for pressure complications during cast immobilization?

Pediatric patients under age 10
Patients with diabetes or peripheral neuropathy (Correct answer)
Athletic young adults
Post-surgical patients with normal sensation

Correct answer: Patients with diabetes or peripheral neuropathy

Patients with diabetes or peripheral neuropathy have impaired sensation and cannot reliably detect pressure-related pain under a cast.

Question 57: When educating a patient about cast care, which instruction regarding moisture is correct?

Both plaster and standard fiberglass casts are fully waterproof
Plaster casts can get wet if dried with a hair dryer
Moisture only affects the outer shell, not the structural integrity
Plaster casts must be kept dry; fiberglass casts may be waterproof if lined with Gore-Tex (Correct answer)

Correct answer: Plaster casts must be kept dry; fiberglass casts may be waterproof if lined with Gore-Tex

Plaster casts are weakened by moisture, while fiberglass casts with a waterproof liner (e.g., Gore-Tex padding) can safely get wet.

Question 58: Which gait pattern is used when a patient can bear partial weight on one extremity and uses two crutches?

Two-point gait
Four-point gait
Three-point gait (Correct answer)
Swing-through gait

Correct answer: Three-point gait

Three-point gait involves advancing both crutches together with the affected limb, then swinging the unaffected limb forward, used for partial or non-weight-bearing.

Question 59: When assessing a patient for an orthopaedic injury, which part of the examination involves evaluating the skin for color, temperature, and integrity?

Auscultation
Palpation
Range of Motion
Inspection (Correct answer)

Correct answer: Inspection

Inspection is the visual examination of the patient. During the patient assessment, the technologist visually inspects the injured area for any abnormalities, including swelling, bruising, deformity, and changes in the skin's color, temperature (by feel, but observation of mottling/color is key), and integrity (cuts, abrasions).

Question 60: An Orthopaedic Technologist is assisting in a total hip arthroplasty using a posterior approach. The surgeon places a retractor to expose the posterior acetabulum. The technologist must be aware that this maneuver places which of the following nerves at the greatest risk of injury?

Obturator nerve
Femoral nerve
Lateral femoral cutaneous nerve
Sciatic nerve (Correct answer)

Correct answer: Sciatic nerve

The sciatic nerve runs directly behind the short external rotators and posterior acetabulum, which are key structures in the posterior approach to the hip. Retractor placement in this area can directly compress or stretch the nerve, leading to injury.

Question 61: After cutting a cast window, the removed piece should be:

Padded and used as a splint over the area
Replaced and secured to prevent 'window edema' (Correct answer)
Left off permanently for wound monitoring
Discarded to allow maximum air circulation

Correct answer: Replaced and secured to prevent 'window edema'

The cast window plug should be replaced and secured after each wound inspection to prevent localized swelling (window edema) in the exposed area.

Question 62: A patient with a short leg cast for an ankle fracture complains of numbness and a "pins and needles" sensation on the top of their foot, along with difficulty lifting their toes toward their shin. Which underlying structure is MOST likely being compressed?

Sural nerve
Peroneal nerve (Correct answer)
Saphenous nerve
Tibial nerve

Correct answer: Peroneal nerve

The common peroneal nerve runs superficially around the neck of the fibula. A tight or poorly padded short leg cast can compress this nerve, leading to sensory deficits on the dorsum (top) of the foot and motor weakness of the ankle dorsiflexors, causing a condition known as "foot drop".

Question 63: Which of the following is a critical component of patient and family education after the application of a cast?

Providing a detailed overview of the surgical procedure that necessitated the cast.
Guaranteeing a specific timeframe for cast removal.
Demonstrating how to properly use a wire hanger to scratch an itch under the cast.
Explaining the signs and symptoms of complications that require immediate medical attention. (Correct answer)

Correct answer: Explaining the signs and symptoms of complications that require immediate medical attention.

Patient safety is paramount. Educating the patient and family on the warning signs of complications, such as excessive swelling, numbness, tingling, skin discoloration, or severe pain, is essential for early intervention and prevention of permanent damage. While other information is helpful, recognizing an emergency is the most critical aspect of cast care instructions.

Question 64: What is the most appropriate first action when a surgical wound shows early signs of infection, including erythema, warmth, and purulent drainage?

Increase the frequency of dressing changes independently
Notify the treating physician immediately (Correct answer)
Apply topical antibiotic without physician order
Apply a compression bandage

Correct answer: Notify the treating physician immediately

Signs of wound infection must be promptly reported to the supervising physician so that appropriate intervention — antibiotics, wound opening, or cultures — can be ordered.

Question 65: A Colles' fracture is best described as a:

Intra-articular fracture of the distal radius
Fracture of the ulnar styloid only
Distal radius fracture with dorsal angulation and radial shortening (Correct answer)
Distal radius fracture with volar angulation

Correct answer: Distal radius fracture with dorsal angulation and radial shortening

A Colles' fracture is a distal radius fracture with dorsal angulation, producing the classic 'dinner fork' deformity and often radial shortening.

Question 66: Which orthotic device is specifically designed to limit dorsiflexion and plantarflexion while allowing mediolateral motion?

Hinged AFO with limited motion stops (Correct answer)
Patellar tendon-bearing brace
Arizona brace
Solid ankle-foot orthosis (AFO)

Correct answer: Hinged AFO with limited motion stops

A hinged AFO with adjustable stops can be set to restrict sagittal plane motion (dorsiflexion/plantarflexion) while leaving coronal plane motion unrestricted.

Question 67: Following successful serial casting for congenital clubfoot, an infant is prescribed a brace consisting of shoes attached to a bar. What is the name of this orthosis, used to maintain correction and prevent relapse?

A Swedish Knee Cage
A Boston Brace
A Denis Browne Bar (Correct answer)
A Jewett Brace

Correct answer: A Denis Browne Bar

A Denis Browne Bar (or splint) is a foot abduction orthosis used to maintain the correction achieved through casting for conditions like clubfoot. It consists of a bar that connects to the patient's shoes, holding the feet in an externally rotated position to prevent the deformity from recurring.

Question 68: Which of the following is a primary advantage of skeletal traction over skin traction for a significantly displaced long bone fracture?

It can be applied without anesthesia.
It allows for the use of greater pulling force. (Correct answer)
It eliminates the need for daily skin checks.
It carries a lower risk of infection.

Correct answer: It allows for the use of greater pulling force.

Skeletal traction involves inserting a pin or wire directly into the bone. This direct connection allows for the application of significantly more weight and a stronger pulling force compared to skin traction, which is limited by the integrity of the skin and soft tissues. This makes skeletal traction more suitable for managing unstable fractures or when a large amount of force is needed to achieve or maintain reduction.

Question 69: The Neer classification system is used to categorize fractures of which bone?

Proximal radius
Distal tibia
Proximal humerus (Correct answer)
Proximal femur

Correct answer: Proximal humerus

The Neer classification categorizes proximal humerus fractures into two-, three-, or four-part patterns based on displacement of the major bony segments.

Question 70: An orthopaedic technologist is assessing a patient with a distal radius fracture and notices the patient cannot oppose the thumb to the little finger. Which nerve is most likely compromised?

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

Correct answer: Median nerve

Thumb opposition (opponens pollicis) is controlled by the recurrent branch of the median nerve; loss of opposition is a hallmark of median nerve injury at the wrist.

Question 71: Which of the following best describes the role of an Orthopaedic Technologist relative to physician supervision?

OTs are equivalent to PAs and NPs in scope of practice
OTs practice independently and make autonomous clinical decisions
OTs perform technical tasks under the direction and supervision of a licensed physician (Correct answer)
OTs supervise other allied health professionals in the cast room

Correct answer: OTs perform technical tasks under the direction and supervision of a licensed physician

Orthopaedic Technologists are trained to perform technical orthopedic procedures but always work under the direction and supervision of a licensed physician.

Question 72: The Ottawa Ankle Rules help clinicians determine the need for:

Radiographic imaging after ankle injury (Correct answer)
Immobilization type for confirmed fractures
Weight-bearing restrictions post-fracture
Surgical referral criteria

Correct answer: Radiographic imaging after ankle injury

The Ottawa Ankle Rules are clinical decision tools that identify which ankle and foot injuries require X-rays to rule out fracture.

Question 73: When using a cast saw to remove a fiberglass cast, the blade should be moved in which motion to avoid skin injury?

Continuous sliding motion along the cast length
Up-and-down oscillating plunge cuts (Correct answer)
Diagonal sweeping strokes
Circular rotation around the limb

Correct answer: Up-and-down oscillating plunge cuts

The oscillating saw blade should be used with up-and-down plunge cuts rather than dragging, which reduces heat buildup and risk of laceration.

Question 74: Sensation over the web space between the first and second toes is used to assess which nerve?

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

Correct answer: Deep peroneal nerve

The deep peroneal nerve supplies sensation to the first dorsal web space between the great toe and second toe and is assessed with lower extremity injuries.

Question 75: To ensure adequate protection and prevent skin irritation, how should cast padding be applied?

Tightly stretched to reduce bulk
Applied only over the fracture site
With a 25% overlap between layers
With a 50% overlap and extra layers over bony prominences (Correct answer)

Correct answer: With a 50% overlap and extra layers over bony prominences

Cast padding should be applied with approximately 50% overlap to create at least two layers between the skin and the cast material. Bony prominences require extra padding to prevent pressure sores. Applying padding too tightly can be constrictive, while too little overlap can leave skin unprotected.

Question 76: A fresh leg cast must be put on a patient. When the original cast is taken off, dead, scaly skin is left on the skin's surface. Should the orthopaedic technician?

lightly brush off dead skin (Correct answer)
gentky wash the skin
leave the skin untouched
brush the skin and apply oil

Correct answer: lightly brush off dead skin

After a cast is removed, it is common for dead, scaly skin to accumulate on the skin's surface. The recommended first course of action for an orthopaedic technician is to lightly brush off this dead skin. This gentle removal helps to prevent irritation, promote skin hygiene, and prepare the skin for normal function without causing damage or excessive dryness.

Question 77: When applying skin traction to a patient's lower leg, which of the following areas requires careful padding to prevent a common nerve injury?

The head of the fibula (Correct answer)
The patellar tendon
The Achilles tendon
The medial malleolus

Correct answer: The head of the fibula

The head of the fibula, located on the outer side of the leg just below the knee, is where the common peroneal nerve is most superficial. Applying pressure here with traction straps or bandages can lead to nerve compression, resulting in foot drop and sensory deficits. Therefore, this area must be well-padded and the straps applied carefully to avoid this complication.

Question 78: A figure-of-eight brace is most commonly used for fractures of the:

Scapula
Clavicle (Correct answer)
Sternum
Humerus

Correct answer: Clavicle

Figure-of-eight braces retract the shoulders posteriorly to maintain alignment of midshaft clavicle fractures.

Question 79: A patient with a new short leg cast complains of a 'pins and needles' sensation and coolness in their toes. Which of the following is the MOST appropriate initial action for the Orthopaedic Technologist?

Instruct the patient to elevate the leg and apply ice.
Immediately perform a neurovascular assessment of the affected extremity. (Correct answer)
Loosen the cast slightly and reassure the patient that this is normal.
Document the findings and inform the physician at the next rounding.

Correct answer: Immediately perform a neurovascular assessment of the affected extremity.

The patient's symptoms suggest potential neurovascular compromise, a serious complication. The priority is to perform a thorough neurovascular assessment, checking for circulation (capillary refill, color, temperature, pulse), sensation, and motor function. This assessment provides the critical information needed to determine the severity and guide subsequent actions, including immediately notifying the physician.

Question 80: What temperature should the water be while casting with extra-quick-setting plaster?

cold (Correct answer)
hot
room temperature
warm

Correct answer: cold

The setting time of plaster of Paris is directly influenced by water temperature. Extra-quick-setting plaster is designed to set very rapidly, so using cold water helps to slow down the chemical reaction. This provides the orthopaedic technologist with a slightly longer and more manageable working time to mold and apply the cast accurately before it hardens completely, ensuring proper fit and alignment.

Question 81: The posterior tibial pulse is most accurately palpated at which anatomical location?

Anterior to the lateral malleolus
Along the medial tibial border
In the popliteal fossa
Posterior to the medial malleolus (Correct answer)

Correct answer: Posterior to the medial malleolus

The posterior tibial pulse is found just posterior and inferior to the medial malleolus and is essential in assessing distal lower extremity perfusion.

Question 82: A patient with a femoral fracture is placed in Buck's traction prior to surgery. The Orthopaedic Technologist observes that the weight is resting on the floor. Which of the following is the MOST critical implication of this finding?

The patient may experience excessive skin shearing.
The traction is ineffective at reducing the fracture or muscle spasms. (Correct answer)
The risk of peroneal nerve injury is significantly increased.
The patient is receiving too much traction force.

Correct answer: The traction is ineffective at reducing the fracture or muscle spasms.

A fundamental principle of traction is that the weights must hang freely at all times to provide a constant, prescribed pulling force. If the weight is resting on the floor, no pulling force is being applied to the limb, rendering the traction completely ineffective for its intended purpose of reducing pain, minimizing muscle spasms, and maintaining alignment.

Question 83: When applying a rigid cervical collar to a trauma patient, what is the MOST critical initial action before the device is placed around the neck?

Log-rolling the patient to inspect the posterior neck.
Maintaining manual in-line stabilization of the head and neck. (Correct answer)
Selecting the collar size based on the patient's weight.
Asking the patient to actively move their neck to assess the range of motion.

Correct answer: Maintaining manual in-line stabilization of the head and neck.

Before, during, and immediately after the application of a cervical collar, the patient's head and neck must be held in a neutral, in-line position by a trained rescuer. This manual stabilization is the highest priority to prevent any movement that could cause or worsen a neurological injury. All other actions, such as sizing the collar (based on neck length, not weight), inspecting the back, or applying the device, are secondary to maintaining continuous manual control of the C-spine. Asking the patient to move is strictly contraindicated.

Question 84: A patient with a short arm cast reports burning pain that started 30 minutes after application. The most appropriate immediate action is:

Bivalve the cast immediately (Correct answer)
Administer oral analgesics and recheck in 24 hours
Apply ice over the cast
Reassure the patient and observe for 2 hours

Correct answer: Bivalve the cast immediately

Burning pain shortly after cast application suggests pressure or thermal injury, requiring immediate bivalving to relieve pressure and inspect the skin.

Question 85: When assessing radial nerve function after a humeral shaft fracture, which specific motor action should the orthopaedic technologist evaluate?

Wrist flexion
Finger abduction
Wrist and finger extension (Correct answer)
Thumb opposition

Correct answer: Wrist and finger extension

The radial nerve innervates the wrist and finger extensors; inability to extend the wrist (wrist drop) is the classic sign of radial nerve injury associated with humeral shaft fractures.

Question 86: The occupational technologist should count how many major reflexes when assessing the musculoskeletal system.

three
four
five (Correct answer)
six

Correct answer: five

When assessing the musculoskeletal system, an orthopaedic technologist typically evaluates five major deep tendon reflexes. These include the biceps, triceps, brachioradialis, patellar (knee-jerk), and Achilles (ankle-jerk) reflexes. Assessing these reflexes helps to evaluate the integrity of specific spinal nerve roots and the peripheral nervous system.

Question 87: Which of the following is the most appropriate initial action when an orthopaedic technologist identifies signs of acute neurovascular compromise in a casted extremity?

Apply ice to reduce swelling and reassess
Document findings and notify the physician at the next scheduled check
Elevate the extremity and reassess in 30 minutes
Immediately notify the supervising physician and prepare for cast bivalving or removal (Correct answer)

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

Neurovascular compromise is a surgical emergency; the orthopaedic technologist must notify the physician immediately and prepare to bivalve or remove the cast to relieve pressure.

Question 88: Which sign indicates venous congestion rather than arterial compromise in a casted extremity?

Cyanosis and swelling of digits (Correct answer)
Absent distal pulse
Pallor of the fingers
Severe pain with passive extension

Correct answer: Cyanosis and swelling of digits

Cyanosis (bluish discoloration) combined with swelling suggests venous outflow obstruction rather than arterial insufficiency.

Question 89: What is the primary purpose of wound debridement in orthopaedic wound care?

Apply topical antibiotics to the wound bed
Provide a moist wound environment
Remove necrotic tissue and contamination to reduce infection risk (Correct answer)
Promote scar formation

Correct answer: Remove necrotic tissue and contamination to reduce infection risk

Debridement removes devitalized tissue, foreign material, and bacterial burden from the wound to create a clean bed that supports healing.

Question 90: Which of the following details is most crucial for determining a patient's degree of interest?

type of activity, cost of activity, and feasibility of participation
type of activity, physical ability, and current interest
type of activity and availability of activity resources
type of activity, past interest, recent past interest, current participation, and future interest in participation (Correct answer)

Correct answer: type of activity, past interest, recent past interest, current participation, and future interest in participation

To accurately determine a patient's degree of interest, a comprehensive assessment is required that goes beyond just the type of activity. It involves understanding their historical engagement (past and recent past interest), their current involvement (current participation), and their future aspirations (future interest in participation). This holistic view provides a more accurate measure of their personal investment and motivation, which is crucial for effective care planning.

Question 91: Which mnemonic is commonly used to remember the key components of neurovascular assessment in orthopaedic patients?

The 3 Cs: Circulation, Capillary refill, Color
The 5 Ps: Pain, Pallor, Pulselessness, Paresthesia, Paralysis (Correct answer)
The 4 Ds: Discoloration, Dysfunction, Drainage, Deformity
The 6 Ss: Swelling, Stiffness, Sensation, Spasm, Strength, Skin

Correct answer: The 5 Ps: Pain, Pallor, Pulselessness, Paresthesia, Paralysis

The 5 Ps (Pain, Pallor, Pulselessness, Paresthesia, Paralysis) are the classic signs used to assess neurovascular compromise in orthopaedic injuries.

Question 92: Which term describes the fracture malalignment where bone fragments overlap side-by-side rather than end-to-end?

Distraction
Rotational malalignment
Angulation
Bayonet apposition (Correct answer)

Correct answer: Bayonet apposition

Bayonet apposition describes fracture fragments lying parallel and overlapping each other side-by-side, causing shortening of the bone segment.

Question 93: Which of the following is the MOST significant factor contributing to thermal injury (burns) to the patient's skin during the application of a plaster cast?

Molding the cast with the palms instead of the fingers
Applying fewer than 8 layers of plaster
Allowing the cast to air dry instead of using a fan
Using water that is too hot to dip the plaster (Correct answer)

Correct answer: Using water that is too hot to dip the plaster

The chemical reaction between plaster of Paris and water is exothermic, meaning it releases heat as it cures. Using water with a temperature greater than 24°C (75°F) dramatically increases the peak temperature of this reaction, significantly raising the risk of causing a thermal burn to the patient's underlying skin.

Question 94: A 15-year-old athlete presents with localized pain, swelling, and tenderness over the tibial tubercle. They report the pain is worse after running and jumping. This presentation is most consistent with which of the following conditions?

Tibial stress fracture
Patellar tendonitis
Compartment syndrome
Osgood-Schlatter disease (Correct answer)

Correct answer: Osgood-Schlatter disease

Osgood-Schlatter disease is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). It is a common cause of knee pain in growing adolescents, particularly those who participate in sports involving running and jumping. The symptoms described are classic for this condition.

Question 95: When passing a sharp instrument, such as a #10 blade on a scalpel handle, to the surgeon, what is the MOST accepted safety practice?

Handing it to the surgeon with the blade pointed towards them for easy access
Placing it firmly in a designated 'neutral zone' on the sterile field (Correct answer)
Holding it by the blade and offering the handle to the surgeon
Tapping the surgeon's hand with it to get their attention

Correct answer: Placing it firmly in a designated 'neutral zone' on the sterile field

Using a hands-free transfer technique, such as placing the sharp instrument in a designated neutral zone (e.g., a small basin or magnetic mat), is the safest method. This prevents hand-to-hand transfer and minimizes the risk of sharps injuries for both the technologist and the surgeon.

Question 96: The PRIMARY reason for applying a well-molded cast rather than a poorly fitting one is to:

Allow earlier weight-bearing by the patient
Decrease the amount of padding required
Prevent fracture displacement and maintain reduction (Correct answer)
Improve patient comfort and reduce anxiety

Correct answer: Prevent fracture displacement and maintain reduction

A well-molded cast conforms to the limb's contours to maintain fracture reduction and prevent displacement during healing.

Question 97: When instructing a patient on the proper use of a Controlled Ankle Motion (CAM) walker boot, which of the following is a critical fitting instruction?

The heel should be positioned as far forward as possible in the boot.
The patient's heel should be seated securely at the very back of the boot. (Correct answer)
Straps should be tightened to the point of causing mild discomfort to ensure stability.
The uprights of the boot should be angled towards the back of the leg.

Correct answer: The patient's heel should be seated securely at the very back of the boot.

Proper fitting of a CAM walker is essential for its effectiveness. The patient's heel must be positioned all the way at the back of the boot to ensure the ankle is in the correct position for immobilization and that the rocker bottom sole functions correctly during ambulation.

Question 98: An Orthopaedic Technologist is assisting with the application of a pelvic binder on a trauma patient. To be MOST effective at reducing pelvic volume and controlling hemorrhage, the center of the binder should be positioned over which anatomical landmark?

The lumbar spine at L4-L5
The umbilicus
The iliac crests
The greater trochanters (Correct answer)

Correct answer: The greater trochanters

The correct placement for a pelvic binder is centered over the greater trochanters of the femurs. This position allows for the most effective circumferential compression of the pelvic ring, which helps to reduce the pelvic volume, stabilize the fracture, and tamponade bleeding sources. Placing it higher over the iliac crests is incorrect and less effective, and positioning over the umbilicus or lumbar spine would serve no therapeutic purpose for a pelvic fracture.

Question 99: When a patient is in a long leg cast and reports extreme pain, swelling, and a foul odor, the OT should first:

Reassure the patient and schedule a follow-up appointment
Immediately notify the supervising physician (Correct answer)
Bivalve the cast to relieve pressure without physician notification
Administer analgesics and observe for 24 hours

Correct answer: Immediately notify the supervising physician

These signs may indicate infection or compartment syndrome, both of which are emergencies requiring immediate physician evaluation.

Question 100: A cast that becomes wet and begins to soften should be:

Replaced with a new cast after skin care (Correct answer)
Reinforced with additional layers of the same wet material
Left to dry on its own over 48 hours
Dried with a heat gun set to high

Correct answer: Replaced with a new cast after skin care

A wet, softened cast loses its structural integrity and must be removed, the skin assessed and cared for, and a new cast applied.

Question 101: The 'gravity stress test' radiograph is used to assess ligamentous stability of which joint?

Ankle mortise
Knee
Elbow (Correct answer)
Shoulder

Correct answer: Elbow

The gravity stress view of the elbow is used in suspected lateral condyle fractures in children to evaluate whether the fracture is stable or unstable.

Question 102: Which of the following methods is required to achieve surgical sterilization of instruments, such as pin cutters, that will be used in an invasive procedure?

Soaking in a high-level disinfectant solution.
Washing with antiseptic soap and hot water.
Processing in an autoclave using steam under pressure. (Correct answer)
Wiping thoroughly with 70% isopropyl alcohol.

Correct answer: Processing in an autoclave using steam under pressure.

Sterilization is the process of eliminating all microorganisms, including bacterial spores. An autoclave, which uses steam under high pressure and temperature, is the standard and most reliable method for sterilizing surgical instruments. High-level disinfection kills most microorganisms but not necessarily all bacterial spores, making it insufficient for invasive surgical instruments.

Question 103: Which pulse is assessed at the dorsum of the foot to evaluate vascular integrity of the lower extremity distal to a tibial fracture?

Dorsalis pedis pulse (Correct answer)
Popliteal pulse
Posterior tibial pulse
Femoral pulse

Correct answer: Dorsalis pedis pulse

The dorsalis pedis pulse, located on the dorsum of the foot between the first and second extensor tendons, is a primary distal pulse assessed after tibial fractures.

Question 104: A patient with a stable thoracic compression fracture is fitted with a Jewett brace. This type of brace primarily functions by limiting which spinal motion?

Flexion (forward bending) (Correct answer)
Extension
Rotation
Lateral bending

Correct answer: Flexion (forward bending)

The Jewett brace is a hyperextension orthosis that works on a three-point pressure system. It has pads on the sternum and the pubis anteriorly, and a pad over the thoracolumbar spine posteriorly. This design specifically restricts spinal flexion (bending forward) to offload the anterior portion of the vertebral bodies, allowing compression fractures to heal.

Question 105: The principle of 'balanced' suspension traction, such as a Thomas splint with a Pearson attachment, is primarily designed to:

Allow the patient to move in bed without disrupting the line of pull. (Correct answer)
Increase the total amount of weight that can be applied.
Apply traction to two different parts of the limb simultaneously.
Eliminate the need for counter-traction from body weight.

Correct answer: Allow the patient to move in bed without disrupting the line of pull.

Balanced suspension traction supports the limb in a splint and suspends it using a system of pulleys and weights. This setup is 'balanced' because it allows the patient some mobility, such as lifting themselves with a trapeze for personal care, while the leg and the traction force move with them, maintaining the alignment and the line of pull on the fracture.

Question 106: Which finding during neurovascular checks REQUIRES immediate physician notification?

Slightly cool fingertips immediately after casting
Patient-reported mild aching at the fracture site
Absent radial pulse in a newly casted forearm (Correct answer)
Mild swelling of the digits within the first 24 hours

Correct answer: Absent radial pulse in a newly casted forearm

An absent radial pulse indicates arterial compromise, which is a vascular emergency requiring immediate physician intervention.

Question 107: An Orthopaedic Technologist is fitting a 3-month-old infant with a Pavlik harness. This appliance is the primary treatment for which of the following conditions?

Developmental Dysplasia of the Hip (DDH) (Correct answer)
Metatarsus adductus
Tibial torsion
Congenital clubfoot (talipes equinovarus)

Correct answer: Developmental Dysplasia of the Hip (DDH)

The Pavlik harness is a soft brace specifically designed to treat Developmental Dysplasia of the Hip (DDH) in infants. It holds the hips in a position of flexion and abduction, which encourages the femoral head to seat properly within the acetabulum, promoting normal hip joint development.

Question 108: When an Orthopaedic Technologist is instructed to bivalve a cast to relieve pressure, what is the correct procedure?

Making one longitudinal cut and spreading the cast apart.
Making two complete longitudinal cuts on opposite sides of the cast. (Correct answer)
Cutting a single small window over the area of pain.
Removing only the proximal half of the cast.

Correct answer: Making two complete longitudinal cuts on opposite sides of the cast.

Bivalving a cast means to cut it into two separate shells, typically an anterior and posterior half, by making two longitudinal cuts on opposite sides. This allows the cast to be spread or the top half to be removed completely, which fully relieves circumferential pressure while still allowing the bottom half to be used as a resting splint.

Question 109: When measuring for axillary crutches, the armrest should be positioned approximately:

1-2 inches below the axilla (Correct answer)
Flush with the axilla
3-4 inches below the axilla
At shoulder height

Correct answer: 1-2 inches below the axilla

Axillary crutch pads should rest 1-2 inches (2-3 finger widths) below the axilla to prevent brachial plexus compression.

Question 110: A fracture occurring through bone that has been weakened by a pre-existing condition such as cancer or osteoporosis is classified as which type?

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

Correct answer: Pathologic fracture

A pathologic fracture occurs through diseased or structurally weakened bone and can result from minimal or no trauma.

Question 111: Which skin complication commonly results from prolonged exposure to moisture under casts or dressings?

Ecchymosis
Maceration (Correct answer)
Keloid formation
Hypertrophic scarring

Correct answer: Maceration

Maceration occurs when skin is overexposed to moisture from perspiration or wound exudate, causing softening, breakdown, and increased susceptibility to infection.

Question 112: An Orthopaedic Technologist is preparing materials for a lower extremity splint on an average-sized adult. Which of the following represents the recommended number of plaster layers for adequate strength?

4 to 6 layers
12 to 15 layers (Correct answer)
18 to 20 layers
6 to 10 layers

Correct answer: 12 to 15 layers

For a lower extremity splint on an average-sized adult, 12 to 15 layers of plaster are typically required to provide sufficient strength and support. Upper extremities generally require fewer layers (6-10), while using too few on a lower extremity would compromise stability.

Question 113: Which term best describes a fracture where one bone end is driven into the other by compressive force?

Bayonet apposition
Comminuted fracture
Distracted fracture
Impacted fracture (Correct answer)

Correct answer: Impacted fracture

An impacted fracture occurs when compressive force drives one bone fragment into the other, often resulting in a relatively stable fracture pattern.

Question 114: A patient is required to wear a wrist immobilization splint, however as the patient movements her fingers and elbow, the splint frequently migrates. Which of the following first steps is recommended to lessen friction and migration?

Tighten the straps securing the splint.
cover her skin with a stockinet or elastic tubular bandage (such as Tubigrip) (Correct answer)
Increase the number of straps securing the splint
change the size of the splint

Correct answer: cover her skin with a stockinet or elastic tubular bandage (such as Tubigrip)

Splint migration often occurs due to friction between the skin and the splint material, or inadequate securing. To lessen friction and prevent migration, covering the patient's skin with a stockinet or an elastic tubular bandage (like Tubigrip) provides a smooth, low-friction interface. This helps the splint stay in place more effectively without needing to overtighten straps, which could cause pressure issues.

Question 115: When molding a plaster splint to the lower extremity, what part of the hand should the technologist primarily use to avoid creating pressure points?

The knuckles.
The fingertips.
The side of the index finger. (Correct answer)
The palm of the hand.

Correct answer: The side of the index finger.

To ensure even pressure distribution and prevent indentations that can lead to pressure sores, the Orthopaedic Technologist should use the broad, flat surface of the palm and thenar eminence to mold the splint to the contours of the limb. Using fingertips or knuckles creates focal pressure points.

Question 116: The 5 P's used to assess neurovascular status in a casted limb include pain, pallor, pulselessness, paresthesia, and:

Paralysis (Correct answer)
Pressure
Perspiration
Pigmentation

Correct answer: Paralysis

The classic 5 P's of neurovascular compromise are pain, pallor, pulselessness, paresthesia, and paralysis (inability to move).

Question 117: What is considered a normal capillary refill time (CRT) in an adult orthopaedic patient?

2 to 4 seconds
4 to 6 seconds
Less than 1 second
Less than 2 seconds (Correct answer)

Correct answer: Less than 2 seconds

Capillary refill time less than 2 seconds is considered normal in adults; a CRT greater than 2 seconds may indicate impaired peripheral circulation.

Question 118: An Orthopaedic Technologist is checking a patient's external fixator. Which of the following signs at a pin site is the MOST definitive indicator of a localized infection requiring medical attention?

Tenting of the skin up the pin.
Minor redness immediately around the pin entry point.
Clear, serous drainage upon cleaning.
Purulent drainage (pus) from the site. (Correct answer)

Correct answer: Purulent drainage (pus) from the site.

While some redness, tenderness, and clear drainage can be part of the normal inflammatory response, the presence of purulent drainage (pus) is a classic and definitive sign of a bacterial infection that requires medical evaluation and likely treatment with antibiotics.

Question 119: When layering a wound dressing, which material should be placed in direct contact with the wound surface?

Absorbent outer dressing
Non-adherent contact layer (Correct answer)
Compression bandage
Secondary foam dressing

Correct answer: Non-adherent contact layer

A non-adherent contact layer (e.g., Adaptic, Telfa) placed directly on the wound prevents trauma during dressing changes and protects fragile granulating tissue.

Question 120: What is the correct technique for wound irrigation using normal saline in orthopaedic wound care?

High-pressure spray directed forcefully at the wound bed
Gentle low-pressure irrigation flowing from center outward (Correct answer)
Vigorous scrubbing with gauze in a circular motion
Soaking the wound in a saline basin

Correct answer: Gentle low-pressure irrigation flowing from center outward

Wound irrigation should use gentle pressure (5–15 psi) directed from the center outward to remove debris without traumatizing tissue or spreading contamination to clean areas.

Question 121: Anterior interosseous nerve syndrome is a branch of which nerve?

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

Correct answer: Median nerve

The anterior interosseous nerve is a motor branch of the median nerve that innervates the FPL, FDP to the index and middle fingers, and pronator quadratus.

Question 122: Which of the following suture materials is classified as absorbable and does not require removal?

Stainless steel wire
Polypropylene (Prolene)
Nylon (Ethilon)
Polyglactin 910 (Vicryl) (Correct answer)

Correct answer: Polyglactin 910 (Vicryl)

Vicryl (polyglactin 910) is an absorbable synthetic suture broken down by hydrolysis over approximately 56–70 days, eliminating the need for suture removal.

Question 123: A patient with a mid-shaft ulnar and radial fracture (both-bone forearm fracture) requires immobilization. Which casting technique is MOST appropriate to effectively control forearm rotation?

Long arm cast (Correct answer)
Short arm cast
Ulnar gutter splint
Sugar-tong splint

Correct answer: Long arm cast

A long arm cast, which immobilizes the elbow in 90 degrees of flexion, is necessary to control pronation and supination of the forearm, thereby preventing displacement of both-bone forearm fractures. Short arm casts do not adequately control forearm rotation.

Question 124: A patient reports inserting a pencil inside their cast to scratch an itch and now has increased pain at that site. The FIRST priority is:

Remove the cast and inspect for skin injury (Correct answer)
Request an X-ray to rule out re-fracture
Reassure the patient and apply ice externally
Prescribe topical antibiotics through the cast opening

Correct answer: Remove the cast and inspect for skin injury

Foreign objects inside a cast can cause pressure sores or lacerations, so removing the cast to inspect the skin is the first priority.

Question 125: A patient's wrist and forearm are both in splints, but there is window edema between the straps that hold them in place. Which of the following is the recommended first course of action in addition to elevating the extremity?

leave the straps loose until the edema subsides
apply water straps to better distribute the force
replace the straps with bias-cut wrapping, from the distal end to the proximal end (Correct answer)
remove the splint until the edema subsides

Correct answer: replace the straps with bias-cut wrapping, from the distal end to the proximal end

Window edema indicates localized swelling due to uneven pressure from the splint's straps. While elevation helps, the most effective first step to better distribute pressure and reduce edema is to replace the constrictive straps with bias-cut wrapping. This wrapping technique, applied from the distal (further from the body) to the proximal (closer to the body) end, provides more uniform compression and promotes venous return, thereby alleviating swelling.

Question 126: Which technique helps prevent skin maceration when padding a cast?

Ensuring padding is smooth without wrinkles or ridges (Correct answer)
Applying excessive amounts of stockinette
Using wet padding directly against the skin
Omitting padding over bony prominences

Correct answer: Ensuring padding is smooth without wrinkles or ridges

Smooth, wrinkle-free padding distributes pressure evenly and prevents focal pressure points that cause skin breakdown and maceration.

Question 127: Compartment pressures are considered critical and typically warrant emergency fasciotomy when they reach within how many mmHg of the patient's diastolic blood pressure?

30 mmHg (Correct answer)
10 mmHg
50 mmHg
20 mmHg

Correct answer: 30 mmHg

Fasciotomy is indicated when compartment pressure is within 30 mmHg of the diastolic blood pressure (delta-p ≤ 30 mmHg), as perfusion becomes critically compromised.

Question 128: Which assessment tool uses a 0-10 numerical scale and is considered appropriate for adult patients who can communicate verbally?

Wong-Baker FACES scale
CRIES scale
Numeric Rating Scale (NRS) (Correct answer)
FLACC scale

Correct answer: Numeric Rating Scale (NRS)

The Numeric Rating Scale (NRS) asks patients to rate pain from 0 (no pain) to 10 (worst imaginable), making it ideal for verbal adults.

Question 129: The classic '5 P's' of compartment syndrome include Pain, Pallor, Pulselessness, Paresthesia, and which fifth sign?

Palliation
Petechiae
Paralysis (Correct answer)
Pressure

Correct answer: Paralysis

The five P's — Pain (worst with passive stretch), Pallor, Pulselessness, Paresthesia, and Paralysis — characterize compartment syndrome, with paralysis and pulselessness being late, ominous signs.

Question 130: When using a head halter to apply cervical skin traction, the traction should pull the chin.

into a neutral positin
backward
down towards the chest (Correct answer)
upward

Correct answer: down towards the chest

When applying cervical skin traction with a head halter, the traction force should be directed to pull the chin downwards towards the chest. This specific positioning induces a slight flexion of the cervical spine. This flexion helps to decompress the cervical vertebrae, reduce muscle spasms, and alleviate pressure on nerve roots, promoting healing and pain relief.

Question 131: When molding a short arm cast, which part of the hand should be used to apply pressure and conform the material to the limb's anatomy?

Thenar eminence/palms (Correct answer)
Knuckles
Back of the hand
Fingertips

Correct answer: Thenar eminence/palms

The palms and thenar eminence should be used to mold a cast. Using fingertips can create indentations in the cast, which can lead to pressure sores and skin breakdown for the patient underneath.

Question 132: A post-surgical hematoma forming beneath a wound should be managed by which action?

Monitoring without action if small
Notifying the surgeon immediately (Correct answer)
Independently aspirating the hematoma with a needle
Applying warm compresses to the area

Correct answer: Notifying the surgeon immediately

A surgical hematoma requires prompt surgeon notification, as evacuation may be needed to prevent wound dehiscence, pressure necrosis, or secondary infection.

Question 133: In the RICE protocol for acute soft tissue injuries, what does the letter 'E' stand for?

Elevation (Correct answer)
Exercise
Resistance exercises
External support

Correct answer: Elevation

RICE (Rest, Ice, Compression, Elevation) is the standard initial management for acute soft tissue injuries, with elevation reducing swelling via gravity-assisted venous drainage.

Question 134: Which wound closure method uses adhesive strips such as Steri-Strips rather than sutures or staples?

Delayed primary closure
Tape closure (Correct answer)
Primary closure with sutures
Secondary intention healing

Correct answer: Tape closure

Tape closure uses adhesive strips to approximate wound edges non-invasively and is appropriate for small, clean, low-tension lacerations.

Question 135: When removing a cast from a child, the preferred technique to reduce anxiety includes:

Allowing the child to hold the cast saw briefly before use
Proceeding as quickly as possible without explanation
Performing the procedure in a dimly lit room
Demonstrating the saw on the parent's hand first (Correct answer)

Correct answer: Demonstrating the saw on the parent's hand first

Demonstrating the cast saw on the parent's hand shows the child the saw does not cut skin, effectively reducing fear and improving cooperation.

Question 136: According to the principles of Standard Precautions, when should an Orthopaedic Technologist wear gloves?

Only when visible blood is present on the patient.
When anticipating contact with any blood, body fluids, or non-intact skin. (Correct answer)
Only during invasive procedures like suture removal.
When interacting with any patient, regardless of the task.

Correct answer: When anticipating contact with any blood, body fluids, or non-intact skin.

Standard Precautions are based on the principle that all blood, body fluids (except sweat), non-intact skin, and mucous membranes from all patients are potentially infectious. Therefore, gloves must be worn whenever there is a potential for contact with these substances, not just when contamination is visible.

Question 137: Compartment syndrome in a casted limb is BEST confirmed by:

Radiographic evaluation
Observation of skin color alone
Patient's verbal pain rating
Measurement of compartment pressure (Correct answer)

Correct answer: Measurement of compartment pressure

Definitive diagnosis of compartment syndrome requires direct measurement of intracompartmental pressure, typically using a pressure monitor.

Question 138: A baby with a clubfoot is wearing progressive plaster casts, and the present cast needs to be taken off. What is the most effective way to remove the cast?

soak the cast in a warm water with 1 tbsp of vinegar for 10 minutes
soak the cast in a warm water with 1 tbsp of vinegar for 1 hour (Correct answer)
use a cast cutter while he is sleeping
use a cst cutter while the parents hold the child

Correct answer: soak the cast in a warm water with 1 tbsp of vinegar for 1 hour

For a baby's progressive plaster cast, soaking it in warm water with vinegar is a gentle and safe method for removal. The vinegar helps to dissolve the plaster, making it soft and pliable, which allows for easy and atraumatic removal without the need for a cast cutter. A longer soaking time, such as one hour, ensures the cast is thoroughly softened, minimizing discomfort and potential skin irritation for the infant.

Question 139: Which instruction is MOST important to give a patient regarding cast hygiene?

Wrap the cast in plastic for showering without concern
Keep the cast dry at all times unless it is waterproof (Correct answer)
Clean inside the cast with a damp cloth daily
Use talcum powder freely to relieve itching

Correct answer: Keep the cast dry at all times unless it is waterproof

Keeping a conventional plaster or fiberglass cast dry prevents cast softening, skin maceration, and infection.

Question 140: A boxer's fracture most commonly involves a fracture through the neck of which metacarpal?

Fourth
Second
First
Fifth (Correct answer)

Correct answer: Fifth

A boxer's fracture typically involves the neck of the fifth (small finger) metacarpal, usually resulting from an axial load delivered by a closed-fist punch.

Question 141: A patient with a thumb spica cast develops numbness and tingling in the thumb and index finger. This finding suggests compression of the:

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

Correct answer: Median nerve

The median nerve supplies sensation to the thumb, index, and middle fingers; compression under a thumb spica cast produces these symptoms.

Question 142: A patient presents 3 weeks after cast application with a documented fracture that appears malaligned on X-ray. The MOST appropriate initial step is:

Notify the supervising physician (Correct answer)
Apply a new cast immediately
Discharge the patient with instructions to follow up in 2 weeks
Attempt closed reduction and recast

Correct answer: Notify the supervising physician

Fracture malalignment discovered during follow-up requires physician notification to determine whether reduction or surgical intervention is needed.

Question 143: What is the primary therapeutic purpose of applying a pelvic binder or circumferential sheet to a patient with a suspected unstable pelvic fracture?

To immobilize the femurs and prevent lower extremity rotation.
To provide definitive anatomical reduction of the fracture fragments.
To reduce pelvic volume and provide compression to control hemorrhage. (Correct answer)
To allow for early, partial weight-bearing during transport.

Correct answer: To reduce pelvic volume and provide compression to control hemorrhage.

The main life-threatening risk of an unstable pelvic fracture is massive internal hemorrhage. A pelvic binder works by applying circumferential compression to close the pelvic ring, which reduces the internal volume of the pelvis. This action helps to stabilize the fracture temporarily and, most importantly, creates a tamponade effect to control venous and bony bleeding. It is a temporary, life-saving measure, not a tool for definitive reduction, and it does not allow for weight-bearing.

Question 144: Following the removal of a long arm cast that was in place for 8 weeks, which of the following is considered a normal and expected finding?

A foul odor with purulent drainage from the skin.
Complete and immediate return to full range of motion.
Severe, pitting edema of the hand and fingers.
Muscle atrophy and dry, scaly skin. (Correct answer)

Correct answer: Muscle atrophy and dry, scaly skin.

After prolonged immobilization, disuse muscle atrophy (a decrease in muscle size) is expected. The skin underneath the cast has not exfoliated normally, resulting in a buildup of dead skin cells that appears dry and flaky. These are common and expected findings that resolve with gentle cleaning, moisturizing, and gradual return to activity.

Question 145: Which classification system is the international standard for staging pressure injuries by depth of tissue involvement?

Wagner classification
NPIAP/EPUAP pressure injury classification (Correct answer)
Salter-Harris classification
Gustilo-Anderson classification

Correct answer: NPIAP/EPUAP pressure injury classification

The NPIAP/EPUAP pressure injury staging system defines four stages plus two additional unstageable categories based on tissue depth and wound characteristics.

Question 146: The 'unhappy triad' of the knee involves injury to the:

ACL, PCL, and LCL
ACL, MCL, and medial meniscus (Correct answer)
PCL, LCL, and lateral meniscus
MCL, LCL, and lateral meniscus

Correct answer: ACL, MCL, and medial meniscus

The unhappy triad (O'Donoghue's triad) classically describes combined injury to the ACL, MCL, and medial meniscus from a valgus force with external rotation.

Question 147: Which of the following BEST describes a Salter-Harris Type II fracture?

Fracture through the physis only
Fracture through the epiphysis into the joint
Fracture through the physis and epiphysis
Fracture through the physis and metaphysis (Correct answer)

Correct answer: Fracture through the physis and metaphysis

Salter-Harris Type II fractures cross through the physis and extend into the metaphysis, making them the most common physeal fracture type.

Question 148: Which traction type applies force directly through surgically implanted pins or wires into bone?

Skeletal traction (Correct answer)
Buck's traction
Dunlop traction
Russell traction

Correct answer: Skeletal traction

Skeletal traction uses pins or wires placed directly into bone to apply and maintain traction force, unlike skin traction which acts on soft tissue.

Question 149: To minimize the risk of cutting or burning the patient's skin, what is the proper technique for using an oscillating cast saw?

Angling the blade at 45 degrees to the cast surface.
Dragging the blade along the cast in one continuous motion.
Using a series of short, repeated "in-and-out" pressing motions. (Correct answer)
Applying a lubricant to the blade before starting the cut.

Correct answer: Using a series of short, repeated "in-and-out" pressing motions.

An oscillating saw blade vibrates rapidly back and forth; it does not spin. The correct technique is to press the blade perpendicularly into the cast until it cuts through, then lift it and repeat this motion along the cut line. This "in-and-out" or "press-and-lift" method prevents heat buildup from friction and avoids dragging the blade across the skin, which could cause an abrasion or burn.

Question 150: The Ottawa Ankle Rules are a clinical decision tool used primarily to determine the need for which diagnostic study?

Ankle radiographs (Correct answer)
Bone scan
MRI of the ankle
Ultrasound of ankle ligaments

Correct answer: Ankle radiographs

The Ottawa Ankle Rules guide clinicians on whether ankle and foot X-rays are indicated based on specific bony tenderness and ability to weight bear.

Question 151: Which color change in the skin most strongly suggests arterial occlusion in a limb with an orthopaedic injury?

Cyanosis (blue)
Erythema (red)
Pallor (white/pale) (Correct answer)
Mottling only

Correct answer: Pallor (white/pale)

Pallor indicates loss of arterial blood supply; while cyanosis suggests venous congestion, pallor with pulselessness is the classic sign of arterial occlusion.

Question 152: The cast spreader tool used during bivalving is inserted into the cut to:

Guide the cast saw along the correct line
Measure the compartment pressure
Cut through the underlying padding
Pry the two halves apart to decompress the limb (Correct answer)

Correct answer: Pry the two halves apart to decompress the limb

The cast spreader is inserted into the bivalve cuts to gently pry the halves apart, widening the cast to relieve constrictive pressure.

Question 153: A fracture line running perpendicular (at a right angle) to the long axis of the bone is best described as which type?

Transverse (Correct answer)
Spiral
Oblique
Comminuted

Correct answer: Transverse

A transverse fracture runs at approximately 90° to the long axis of the bone and is typically caused by direct bending force.

Question 154: Wound healing where edges are directly approximated and closed with sutures or staples is referred to as healing by which intention?

Primary intention (Correct answer)
Secondary intention
Tertiary intention
Granulation

Correct answer: Primary intention

Primary intention (primary closure) occurs when wound edges are directly approximated, resulting in minimal scarring and the fastest healing time.

Question 155: The Schatzker classification is most commonly applied to fractures of which anatomical location?

Talus
Distal femur
Calcaneus
Tibial plateau (Correct answer)

Correct answer: Tibial plateau

The Schatzker classification divides tibial plateau fractures into six types (I–VI) based on fracture pattern, location, and degree of comminution or depression.

Question 156: Which clinical finding is the defining characteristic of wound dehiscence?

Separation of wound edges (Correct answer)
Mild swelling at the incision line
Serosanguineous drainage from the wound
Surrounding erythema and warmth

Correct answer: Separation of wound edges

Wound dehiscence is defined as partial or complete separation of previously approximated wound edges, representing a failure of the wound healing process.

Question 157: Acute compartment syndrome is definitively confirmed by which diagnostic method?

MRI scan
Direct compartment pressure measurement (Correct answer)
Plain X-ray
Clinical observation of skin color alone

Correct answer: Direct compartment pressure measurement

Direct intracompartmental pressure measurement is the definitive diagnostic tool for compartment syndrome, with fasciotomy indicated when pressures exceed safe thresholds.

Question 158: When setting plaster of Paris casting material, the exothermic reaction can reach temperatures high enough to cause burns. To reduce this risk, the OT should:

Use cool water and avoid excess plaster thickness (Correct answer)
Apply the cast over wet stockinette only
Pre-soak rolls in hot water for uniform setting
Use warm water to accelerate setting

Correct answer: Use cool water and avoid excess plaster thickness

Cool water slows the setting reaction and reduces peak temperature; thick sections also trap more heat, so excessive layers should be avoided.

Question 159: A patient is being prepared for cast removal. Which statement by the Orthopaedic Technologist is most appropriate to manage patient anxiety?

"The cast saw vibrates to cut the hard material but is unlikely to harm your skin. It will be noisy and you will feel warmth and a tickling sensation." (Correct answer)
"We need to get this off quickly, so just try to relax."
"This will be very loud, but it is important to hold as still as possible so you don't get cut."
"Don't worry, this saw is designed not to cut skin, so you'll be fine."

Correct answer: "The cast saw vibrates to cut the hard material but is unlikely to harm your skin. It will be noisy and you will feel warmth and a tickling sensation."

This statement provides accurate, reassuring information in a calm and professional manner. It explains what the patient can expect (vibration, noise, warmth) while also addressing their primary fear (being cut) in a way that builds confidence rather than causing more alarm. Effective communication is a key part of patient management.

Question 160: Which fracture pattern is most commonly associated with child abuse in pediatric patients?

Transverse mid-shaft fracture
Greenstick fracture
Classic metaphyseal lesion (bucket-handle fracture) (Correct answer)
Torus fracture

Correct answer: Classic metaphyseal lesion (bucket-handle fracture)

Classic metaphyseal lesions, also called corner or bucket-handle fractures, are highly specific for non-accidental trauma in infants and young children.

Question 161: In a Salter-Harris Type II physeal fracture, the fracture line passes through which structures?

Only the epiphysis
Only the physis
The physis and metaphysis (Correct answer)
The physis and epiphysis

Correct answer: The physis and metaphysis

Salter-Harris Type II is the most common physeal fracture, with the fracture line extending through the growth plate (physis) and into the metaphysis.

Question 162: Thermal injury during cast removal is most commonly caused by:

Heat generated by the oscillating saw blade (Correct answer)
Body heat trapped under the cast
Chemical reaction of the casting material
Ambient room temperature

Correct answer: Heat generated by the oscillating saw blade

The oscillating saw blade generates friction heat, which can burn the skin if held too long in one spot, especially over bony prominences.

Question 163: The primary purpose of stockinette applied beneath a cast is to:

Reduce the weight of the cast
Prevent moisture from entering the cast
Protect the skin and provide a smooth inner surface (Correct answer)
Provide additional structural rigidity

Correct answer: Protect the skin and provide a smooth inner surface

Stockinette protects the skin from plaster or fiberglass abrasion and is folded back over the cast edges to create a smooth, padded border.

Question 164: Which of the following spinal orthoses is specifically designed to limit flexion of the thoracolumbar spine by applying a three-point pressure system?

Milwaukee brace
Soft lumbar corset
Philadelphia collar
Jewett brace (Correct answer)

Correct answer: Jewett brace

The Jewett brace, a type of hyperextension orthosis, uses a three-point pressure system to control spinal flexion. It has a posterior pad at the thoracolumbar junction that pushes anteriorly, and two anterior pads (one sternal, one suprapubic) that push posteriorly. This system effectively prevents the patient from bending forward and is often used for stable compression fractures. A soft corset provides support but minimal motion restriction, a Milwaukee brace is primarily for scoliosis, and a Philadelphia collar immobilizes the cervical spine.

Question 165: When padding a cast, bony prominences such as the fibular head should receive:

A felt donut pad only if pain is reported
Extra padding to prevent pressure sores (Correct answer)
No additional padding to maintain cast conformity
Rigid plastic padding to distribute load

Correct answer: Extra padding to prevent pressure sores

Bony prominences are at high risk for pressure necrosis and must receive extra cast padding to prevent skin breakdown.

Orthopaedic Technologist Certified (OTC) Examination

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

165

Questions

180 min

Time Limit

67%

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Sources & references

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nbcot.net — Renewal, fees, late registration, registration deadline, retake policy, test dates, score validity, score release · verified Oct 2026
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