Orthopaedic Technologist Certified (OTC) Examination — Questions and Answers

Question 1: A patient with a freshly applied long arm cast develops pain that worsens with passive extension of the fingers. This most likely indicates:

Cast too loose requiring reinforcement
Radial nerve palsy
Normal post-casting discomfort
Developing compartment syndrome (Correct answer)

Correct answer: Developing compartment syndrome

Pain with passive stretch of the muscles in a casted compartment is a hallmark sign of developing compartment syndrome and requires immediate evaluation.

Question 2: Which angle defines proper cervical neutral alignment when sizing a rigid cervical collar?

5° lateral tilt
10° flexion
10° extension
0° with chin slightly tucked (Correct answer)

Correct answer: 0° with chin slightly tucked

Neutral alignment with a slight chin tuck maintains the cervical spine in its optimal protected position.

Question 3: Which grading scale is most commonly used by orthopaedic technologists to document muscle strength during a manual muscle test?

Visual Analog Scale (VAS)
Medical Research Council (MRC) 0–5 scale (Correct answer)
American Spinal Injury Association (ASIA) scale
Lovett scale rated A–F

Correct answer: Medical Research Council (MRC) 0–5 scale

The MRC 0–5 scale is the standard clinical tool for grading muscle strength from no contraction (0) to full strength against resistance (5).

Question 4: What is the most appropriate first action when a surgical wound shows early signs of infection, including erythema, warmth, and purulent drainage?

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

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 5: 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?

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

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

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

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 7: To monitor for foot drop in a patient in lower extremity traction, the technologist assesses:

Grip strength of the ipsilateral hand
Sensation over the medial thigh
Ability to dorsiflex the foot against resistance (Correct answer)
Patellar reflex on the affected side

Correct answer: Ability to dorsiflex the foot against resistance

Foot drop results from peroneal nerve injury; assessment of dorsiflexion strength is the primary functional test for this complication.

Question 8: What is the primary purpose of bivalving a cast?

To convert a short cast to a long cast
To strengthen the structural integrity
To relieve pressure and accommodate swelling (Correct answer)
To allow the cast to dry faster

Correct answer: To relieve pressure and accommodate swelling

Bivalving (splitting the cast longitudinally on two sides) relieves circumferential pressure, accommodating acute swelling and reducing the risk of compartment syndrome.

Question 9: 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?

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

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 10: What is the recommended frequency for neurovascular checks in a newly admitted traction patient?

Every hour for the first 24 hours (Correct answer)
Every 8 hours
Every 4 hours for the first 24 hours, then every 8 hours
Once per shift after the initial assessment

Correct answer: Every hour for the first 24 hours

Newly applied traction demands hourly neurovascular checks for the first 24 hours to detect early vascular compromise or compartment syndrome.

Question 11: Which measurement is used to determine the correct height of a rigid cervical collar?

Head circumference
Ear-to-shoulder distance
Neck circumference
Chin-to-sternal notch distance (Correct answer)

Correct answer: Chin-to-sternal notch distance

The chin-to-sternal notch distance determines collar height to ensure proper fit without causing flexion or extension.

Question 12: Before removing a surgical drain from a post-operative orthopaedic wound, what is the most important prerequisite action?

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

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 13: Which dermatome assessment finding would suggest involvement of the L4 nerve root in a patient with lumbar spine pathology?

Decreased sensation over the anterior thigh
Decreased sensation over the posterior thigh
Decreased sensation over the medial lower leg and great toe (Correct answer)
Decreased sensation over the lateral foot and small toe

Correct answer: Decreased sensation over the medial lower leg and great toe

The L4 dermatome covers the medial lower leg and great toe; sensory changes in this distribution suggest L4 nerve root compression.

Question 14: Which special test is used to assess for shoulder impingement syndrome by internally rotating and flexing the arm to compress the supraspinatus?

Speed's test
Apprehension test
Yergason's test
Hawkins-Kennedy test (Correct answer)

Correct answer: Hawkins-Kennedy test

The Hawkins-Kennedy test internally rotates the shoulder in 90° of forward flexion, compressing the supraspinatus under the coracoacromial arch to reproduce impingement pain.

Question 15: A surgeon requests a 'K-wire' during a percutaneous pinning procedure for a pediatric supracondylar humerus fracture. The OT should provide:

A threaded Steinmann pin
A smooth Kirschner wire of the surgeon's requested diameter loaded in a power drill (Correct answer)
A cannulated screw guide wire
A flexible reamer wire

Correct answer: A smooth Kirschner wire of the surgeon's requested diameter loaded in a power drill

K-wires (Kirschner wires) are smooth, small-diameter stainless steel wires that are driven percutaneously with a power drill to temporarily stabilize pediatric fractures.

Question 16: An orthopaedic technologist is assessing a patient's gait post-femoral fracture repair. A Trendelenburg gait pattern indicates weakness of which muscle group?

Ankle plantar flexors (gastrocnemius)
Hip abductors (gluteus medius) (Correct answer)
Knee extensors (quadriceps)
Hip flexors (iliopsoas)

Correct answer: Hip abductors (gluteus medius)

A Trendelenburg gait occurs when the contralateral pelvis drops during single-leg stance, indicating weakness of the weight-bearing hip abductors.

Question 17: Which complication is most unique to skeletal traction compared to skin traction?

Pressure ulcers
Osteomyelitis from pin tract infection (Correct answer)
Muscle atrophy
Deep vein thrombosis

Correct answer: Osteomyelitis from pin tract infection

Pin tract infection leading to osteomyelitis is a risk specific to skeletal traction because the pin breaches the skin and cortex, providing a pathway for bacteria.

Question 18: Which condition is the most common indication for a thumb spica cast?

Hamate hook fracture
Scaphoid fracture (Correct answer)
Colles' fracture
Bennett's fracture-dislocation

Correct answer: Scaphoid fracture

Scaphoid fractures are among the most common indications for thumb spica casting because the scaphoid's blood supply requires prolonged immobilization.

Question 19: 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 20: A patient presents with a drop foot condition. Which ankle-foot orthosis (AFO) configuration is most appropriate for providing toe clearance during the swing phase?

Floor-reaction AFO
Solid ankle AFO
Patellar tendon-bearing AFO
Posterior leaf spring AFO (Correct answer)

Correct answer: Posterior leaf spring AFO

A posterior leaf spring AFO provides dorsiflexion assistance during swing phase to clear the toes while allowing some push-off at terminal stance.

Question 21: The primary goal of sterilization, as opposed to disinfection, is to destroy:

All microorganisms including bacterial spores (Correct answer)
All viruses but not bacterial spores
Only vegetative bacteria
Prions and fungi only

Correct answer: All microorganisms including bacterial spores

Sterilization eliminates all forms of microbial life including highly resistant bacterial endospores, which disinfection alone cannot achieve.

Question 22: A patient is being prepared for cast removal. Which statement by the Orthopaedic Technologist is most appropriate to manage patient anxiety?

"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."
"We need to get this off quickly, so just try to relax."
"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)

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 23: When performing a wound irrigation in a splint room, splash-generating procedures require the orthopaedic technologist to wear:

No PPE unless the patient is on contact precautions
Gloves and gown only
Gloves, gown, and eye protection (Correct answer)
Gloves only

Correct answer: Gloves, gown, and eye protection

Any procedure with splash or splatter potential requires gloves, gown, and eye/face protection per standard precautions.

Question 24: When molding a short leg posterior splint, you should mold it while the plaster is still:

Just removed from water before any reaction begins
Setting but still pliable (doughy stage) (Correct answer)
Completely dry and rigid
Fully exothermic and hot

Correct answer: Setting but still pliable (doughy stage)

The doughy stage provides the ideal consistency for molding to the limb contour before the plaster sets completely.

Question 25: The CROW (Charcot Restraint Orthotic Walker) boot is primarily indicated for which patient population?

Acute ankle sprains in athletes
Heel spur syndrome unresponsive to orthotics
Charcot neuroarthropathy in diabetic patients (Correct answer)
Post-tibial tendon rupture

Correct answer: Charcot neuroarthropathy in diabetic patients

The CROW boot immobilizes and offloads the foot in patients with Charcot neuroarthropathy to prevent progressive bony collapse and ulceration.

Question 26: Which skin area requires the most vigilant monitoring in a patient wearing a thoracolumbar TLSO brace?

Anterior chest wall
Mid-thoracic spinous processes
Lumbar paraspinals
Xiphoid process and iliac crests (Correct answer)

Correct answer: Xiphoid process and iliac crests

The xiphoid process and iliac crests are prominent bony areas most prone to pressure injury under rigid orthosis contact.

Question 27: During post-operative assessment of a patient who underwent open reduction internal fixation (ORIF) of an ankle fracture, the OT notes absent dorsal pedis pulse but intact sensation and capillary refill. The most appropriate action is to:

Apply a warm compress to improve circulation
Recheck the pulse in 30 minutes before reporting
Immediately report to the surgeon and document the finding (Correct answer)
Reassure the patient as other signs are normal

Correct answer: Immediately report to the surgeon and document the finding

An absent pulse after ORIF is an urgent vascular finding that requires immediate surgeon notification regardless of other intact signs, as isolated arterial injury is possible.

Question 28: The minimum temperature for high-level disinfection when using glutaraldehyde is:

15°C (59°F)
20°C (68°F)
37°C (98.6°F)
25°C (77°F) (Correct answer)

Correct answer: 25°C (77°F)

Glutaraldehyde achieves high-level disinfection at 25°C (77°F) or above; lower temperatures reduce its efficacy against resistant organisms.

Question 29: When is it appropriate to cut a cast window?

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

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 30: Dunlop traction is specifically indicated for which fracture?

Distal radius fractures in adults
Tibial plateau fractures in adolescents
Femoral shaft fractures in infants
Supracondylar humerus fractures in children (Correct answer)

Correct answer: Supracondylar humerus fractures in children

Dunlop traction is used for supracondylar humerus fractures in children when surgical fixation is delayed or as a temporizing measure.

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).

Questions

35 min

Time Limit

67%

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