OTC Orthopaedic Technologist Certified Neurovascular Assessment 2 — Questions and Answers
Question 1: The posterior tibial pulse is most accurately palpated at which anatomical location?
- Posterior to the medial malleolus (Correct answer)
- Anterior to the lateral malleolus
- In the popliteal fossa
- Along the medial tibial border
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 2: Which of the following is the most appropriate initial action when an orthopaedic technologist identifies signs of acute neurovascular compromise in a casted extremity?
- Immediately notify the supervising physician and prepare for cast bivalving or removal (Correct answer)
- Elevate the extremity and reassess in 30 minutes
- Apply ice to reduce swelling and reassess
- Document findings and notify the physician at the next scheduled check
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 3: 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)
- 50 mmHg
- 10 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 4: Testing the ability to abduct and adduct the fingers assesses function of which nerve in the upper extremity?
- Ulnar nerve (Correct answer)
- Median nerve
- Radial nerve
- Musculocutaneous nerve
Correct answer: Ulnar nerve
The ulnar nerve innervates the intrinsic hand muscles (interossei and hypothenar muscles) responsible for finger abduction and adduction.
Question 5: 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?
- Median nerve (Correct answer)
- Ulnar nerve
- Radial nerve
- Anterior interosseous 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 6: Which color change in the skin most strongly suggests arterial occlusion in a limb with an orthopaedic injury?
- Pallor (white/pale) (Correct answer)
- Cyanosis (blue)
- Erythema (red)
- 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 7: How frequently should neurovascular checks be performed immediately following cast or splint application in an acute fracture patient?
- Every 30 to 60 minutes for the first few hours, then per protocol (Correct answer)
- Once every 8 hours
- Only if the patient reports pain
- 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.
OTC Orthopaedic Technologist Certified Neurovascular Assessment 2
The posterior tibial pulse is most accurately palpated at which anatomical location?