OTC Orthopaedic Technologist Certified Patient Assessment and Management 2 — Questions and Answers
Question 1: When assessing a patient for compartment syndrome after tibial fracture casting, which finding is the most reliable early indicator?
- Pain out of proportion to the injury (Correct answer)
- Skin pallor distal to the cast
- Absence of distal pulse
- Paresthesia in all toes
Correct answer: Pain out of proportion to the injury
Pain out of proportion to the injury is the earliest and most reliable clinical indicator of compartment syndrome.
Question 2: During neurovascular assessment of a patient in a long arm cast, the OT notes the patient cannot extend their wrist or fingers. Which nerve is most likely compromised?
- Radial nerve (Correct answer)
- Ulnar nerve
- Median nerve
- Musculocutaneous nerve
Correct answer: Radial nerve
The radial nerve controls wrist and finger extension; compression at the lateral humerus or within a tight cast can produce this deficit.
Question 3: A patient returns for a cast check 48 hours after application and reports a burning sensation under the cast. The most appropriate initial action is to:
- Bivalve or remove the cast to inspect the skin (Correct answer)
- Reassure the patient that discomfort is normal
- Apply ice over the cast
- Elevate the extremity and recheck in 24 hours
Correct answer: Bivalve or remove the cast to inspect the skin
A burning sensation under a cast suggests skin breakdown or pressure injury and requires immediate cast removal or bivalving for inspection.
Question 4: When documenting capillary refill time in a post-fracture assessment, a normal result in adults is:
- Less than 2 seconds (Correct answer)
- 2–4 seconds
- 4–6 seconds
- Less than 5 seconds
Correct answer: Less than 2 seconds
Normal capillary refill time in adults is less than 2 seconds; values of 2 seconds or greater may indicate circulatory compromise.
Question 5: A patient with a short leg cast reports numbness over the dorsum of the foot and inability to dorsiflex the ankle. Which nerve is most likely compressed?
- Common peroneal nerve (Correct answer)
- Sural nerve
- Posterior tibial nerve
- Saphenous nerve
Correct answer: Common peroneal nerve
The common peroneal nerve wraps around the fibular head and is vulnerable to compression there, causing foot drop and dorsal foot numbness.
Question 6: An OT is performing a skin assessment before applying a cast to an elderly patient with diabetes. Which finding would be the greatest contraindication to cast application without specialist consultation?
- An open wound or ulceration at the planned cast site (Correct answer)
- Mild dry skin
- Slight hair loss on the extremity
- Visible superficial veins
Correct answer: An open wound or ulceration at the planned cast site
An open wound or ulceration under a cast creates a high risk for infection and tissue necrosis, requiring specialist input before casting.
Question 7: Which grading scale is most commonly used by orthopaedic technologists to document muscle strength during a manual muscle test?
- Medical Research Council (MRC) 0–5 scale (Correct answer)
- American Spinal Injury Association (ASIA) scale
- Lovett scale rated A–F
- Visual Analog Scale (VAS)
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).
OTC Orthopaedic Technologist Certified Patient Assessment and Management 2
When assessing a patient for compartment syndrome after tibial fracture casting, which finding is the most reliable early indicator?