OTC Orthopaedic Technologist Certified Cast Complications and Removal 2 — Questions and Answers
Question 1: A patient with a short arm cast reports burning pain that started 30 minutes after application. The most appropriate immediate action is:
- Apply ice over the cast
- Bivalve the cast immediately (Correct answer)
- Reassure the patient and observe for 2 hours
- Administer oral analgesics and recheck in 24 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 2: Which of the following is the MOST common site for a pressure ulcer in a patient wearing a long leg cast?
- Tibial crest
- Lateral malleolus
- Medial malleolus
- Fibular head (Correct answer)
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 3: 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)
- Circular rotation around the limb
- Diagonal sweeping strokes
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 4: A patient's cast has developed a foul odor and the patient reports fever. These findings most likely indicate:
- Normal cast curing process
- Infection beneath the cast (Correct answer)
- Cast material degradation
- 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 5: After bivalving a cast, the two halves should be secured with:
- Medical-grade superglue
- Elastic bandage (ACE wrap) (Correct answer)
- Additional plaster layers
- Waterproof tape only
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 6: Which sign indicates venous congestion rather than arterial compromise in a casted extremity?
- Absent distal pulse
- Pallor of the fingers
- Cyanosis and swelling of digits (Correct answer)
- 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 7: When removing a cast from a child, the preferred technique to reduce anxiety includes:
- Proceeding as quickly as possible without explanation
- Allowing the child to hold the cast saw briefly before use
- Demonstrating the saw on the parent's hand first (Correct answer)
- Performing the procedure in a dimly lit room
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.
OTC Orthopaedic Technologist Certified Cast Complications and Removal 2
A patient with a short arm cast reports burning pain that started 30 minutes after application.
The most appropriate immediate action is: