If you received your test results for the Combined Written exam only to learn that you did not pass the exam, the following information may help you focus your study for retaking the exam. Your test results notice indicates your score in each Content Domain along with the maximum score in each area. We recommend that you focus your exam study on those Content Domains where you performed the weakest. Below, along with a description of the Content Domain, are sample questions to help you determine the types of questions that you may have missed.
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Take a comprehensive patient history, including previous use of a prosthesis, diagnosis, work history, avocational activities, signs and symptoms and medical history. Perform a diagnosis-specific functional clinical examination of sensory function, range of motion, joint stability and skin integrity. Utilize knowledge of anatomy, muscle functions, normal gait parameters, pathologies, related surgical techniques and disease processes to guide assessment. Refer patient to other health care providers for intervention beyond orthotic/prosthetic scope of practice.
A trendelenburg gait occurs with weakness of the:
1. Gluteus medius
2. Gluteus maximus
3. Adductor magnus
4. Rectus femoris
An amputation that removes the midfoot and forefoot saving the talus and calcaneus is called a:
1. Modified Symes
2. Lisfranc
3. Chopart
4. Transmetatarsal
Which of the following muscles are transected in a transmetatarsal amputation?
1. Peroneus longus
2. Extensor hallicus longus
3. Tibialis posterior
4. Tibialis anterior
Which of the following is the primary flexor of the elbow?
1. Biceps brachii
2. Brachioradialis
3. Anconeus
4. Brachialis
In normal gait the hip reaches maximum flexion during:
1. Loading response
2. Initial contact
3. Midstance
4. Mid swing
The most common congenital absence of a long bone in the extremities is:
1. Fibular hemimelia
2. Proximal Focal Femoral Deficiency
3. Congenital hypoplasia of the Tibia
4. Tibial phocomelia
Evaluate the findings to determine a prosthetic treatment plan. Consult with physician/referral source/appropriately licensed health care provider to modify, if necessary, the original prescription and/or treatment plan. Identify design, materials and components to support treatment plan, including how the prosthesis will address the specific functional needs.
One advantage of a knee disarticulation amputation is:
1. The ability to maintain rotational control of the socket
2. The ability to bear weight on the distal end
3. The ability to match the knee center on the sound side
4. The ability to provide good cosmesis with the prosthesis
The most appropriate control system for a patient with a self-suspending transradial prosthesis would be a:
1. Figure 8 harness with cross-back strap
2. Figure 8 harness with flexible elbow hinges
3. Figure 9 harness with single control cable
4. Figure 9 harness with chest strap
Which amputation level is MOST likely to develop an equinus contracture?
1. Chopart
2. Lisfranc
3. Symes
4. Transmetatarsal
Which of the following is considered a pressure tolerant area on a transtibial residual limb?
1. Tibial crest
2. Medial tibial flare
3. Fibular head
4. Tibial condyle
Select appropriate materials/techniques in order to obtain a patient model/image. Select appropriate materials and components for prosthesis based on patient criteria to ensure optimum strength, durability and function. Complete or delegate fabrication of prosthesis including positive mould rectification. Assess/align prosthesis for accuracy in sagittal, transverse and coronal planes in order to provide maximum function/comfort. Educate patient and/or caregiver about the use and maintenance of the prosthesis. Documentation using established record-keeping techniques to verify implementation of treatment plan.
During the initial dynamic alignment of a transfemoral prosthesis with an ischial containment socket you note a lateral shift of the socket during mid-stance. What is the most likely cause?
1. Lack of ischial containment
2. Foot is too far outset
3. A/P dimension is too large
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4. Prosthesis is too short
The length of the forearm section of a transradial prosthesis is determined by measuring the sound side from the:
1. Acromion to thumb tip
2. Acromion to lateral epicondyle
3. Lateral epicondyle to ulnar styloid
4. Olecranon to thumb tip
What anatomical landmark is used when establishing the height of a transtibial prosthesis?
1. Fibular head
2. Medial tibial plateau
3. Tibial condyle
4. Adductor tubercle
Flexible elbow hinges on a long transradial residual limb prosthesis allow for rotation and:
1. Provide M/L stability
2. Limit elbow extension
3. Limit elbow flexion
4. Provide suspension
When establishing the static alignment for a transfemoral prosthesis with a microprocessor hydraulic knee component, the TKA line should be:
1. Through the mechanical knee joint axis
2. 0-5mm anterior to the mechanical knee joint axis
3. 0-5mm posterior to the mechanical knee joint axis
4. 5-10mm posterior to the mechanical knee joint axis
During the initial dynamic alignment of a transtibial prosthesis there is an excessive varus moment at mid-stance. This can be resolved by:
1. Increasing the adduction of the socket
2. Increasing the abduction of the socket
3. Insetting the foot
4. Externally rotating the foot
Obtain feedback from patient and/or caregiver to evaluate outcome (e.g., wear schedule/tolerance, comfort, ability to don and doff, proper usage and function. Assess patient’s function and note any changes. Assess fit of prosthesis with regard to strategic contact and to anatomical relationships to prosthesis to determine need for changes relative to initial treatment goals. Address evidence of excessive skin pressures or lack of corrective forces and formulate plan to modify prosthesis accordingly. Revise treatment plan based on assessment of outcomes.
At a follow-up visit for a patient who was fit with a body powered transhumeral prosthesis, they complain that they are not able to open the terminal device with the elbow fully flexed. One possible solution to this problem is to:
1. Add a cross back strap to the harness
2. Add an elbow flexion assist component
3. Add additional rubber bands to the terminal device
4. Tighten the control attachment strap
A patient is seen for an initial follow-up after receiving a transfemoral prosthesis. They are ambulating with an abducted gait. What is the MOST likely prosthetic cause?
1. Prosthesis is too short
2. Foot is too inset
3. Prosthesis is too long
4. Knee flexion resistance is too strong
A patient is seen for follow-up for their PTB-SC prosthesis with pelite liner. The alignment of the prosthesis is good, however the patient states that the socket feels less secure recently and you note a gap between the socket and their limb at the lateral proximal brim. What is the MOST appropriate adjustment to address this problem?
1. Increase the thickness of the liner at the lateral proximal aspect
2. Increase the thickness of the liner at the medial proximal aspect
3. Increase sock ply thickness
4. Add padding to the medial tibial flare
A patient who has missed multiple follow-up appointments for their transtibial prosthesis is seen. The patient has been noncompliant with hygiene instructions and has developed a Wagner Grade 2 ulcer on the anterior distal end of their residual limb. The practitioner’s PRIMARY responsibility at this time is to:
1. Modify the prosthesis and suggest the patient follow-up with their physician
2. Modify the prosthesis and schedule a two-week follow-up appointment
3. Inform the patient to take a break from using the prosthesis and follow-up in two weeks
4. Instruct the patient to discontinue use of the prosthesis and notify the physician
These sample questions are only examples of the type of test content you will see in the exam. For additional information about how to prepare for the exam, check out the Practice Analysis Resident Guide. Access all the Practioner Exam Prep resources available on .The type of knee used on an above-knee prosthesis depends on the patient’s activity level, the patient’s weight, the patient’s strength and ability to control the knee, residual limb length, funding, and patient preference.
Friction is used in the knees in order to control the knee joint during walking. Friction controls how far and how fast the knee bends and straightens during gait. Some knees have mechanical friction while others have hydraulic resistance. Computerized knees are also available that control the knee speed based on the person’s gait. Mechanical knees provide constant friction where the hydraulic knees and computerized knees change the knee speed depending on how fast the person is walking.
The manual locking knee is the most stable knee used in prosthetics. The knee is locked during gait and the patient releases the lock mechanism in order to sit down. Manual locking knees are primarily used with patients who have very short residual limbs and/or poor hip strength and are unable to control the knee.
Single Axis Prosthetic Knee Joint
Single-axis knees are basic knees that bend freely. The amputee must rely on his own muscle control for stability. The single-axis constant friction knee is generally used by children who have a lower center of gravity or for patients with excellent musculature control that walk at a single speed. Friction in the knee can be adjusted by tightening a bolt. For exoskeletal knees, an extension strap made of elastic may be added to the front of the prosthesis to aid the knee in kicking forward. This knee is very durable and is easy to maintain and repair.
Single-axis knees can be exoskeletal (hard plastic) or endoskeletal (metal components). Oftentimes, hydraulic or pneumatic controls are added to single axis knees to allow for variable speed walking. Stance control may also be added to improve stability.
The weight-activated stance control knee is one of the most widely used knees in prosthetics. This knee is a single axis constant friction knee with a braking mechanism. When weight is put on the knee during gait, a braking mechanism is applied and the knee will not buckle. Using this knee, the patient must unload or take weight off of the prosthesis in order for the knee to bend. The wearer will need to unload the knee to sit or to initiate the swing phase of gait. This knee is sometimes referred to as the “safety” knee.
Four-Bar Pneumatic Knee Joint
The polycentric knee has a variable center of rotation allowing for stability at all phases of gait. The 4 bar linkage also allows the knee to collapse better during the swing phase of gait, essentially shortening the shin and allowing the foot to clear the ground easier. This collapsing feature also allows the knee to bend easier for sitting and is the ideal knee for knee disarticulation or long above knee amputees. The swing phase control can be either mechanical friction or hydraulic resistance. There are many manufacturers of polycentric knees.
Hydraulic and pneumatic knees allow adjustment of walking speed by the use of hydraulics (either liquid or air) within the knee. As a person’s walking speed increases or decreases, the hydraulics adjust to control the speed at which the shin of the prosthesis swings forward and bends backward. This type of knee is often used for more active patients who vary their walking speeds and do not need assistive walking devices. Hydraulics can be used with single axis or polycentric knees. The following knees are just a few of the various hydraulic knees that are now available.
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