Practice Exam Flashcards
- A below knee amputee is seen in your clinic for a follow up appointment and states he feels anterior/distal discomfort in his prosthetic socket. Choose all correct answer(s) to address this problem:
Extend socket, add pretibial pads
- A below the knee amputee is seen in your clinic for a follow up appointment and states he has posterior knee or hamstring discomfort. Choose all correct answer(s) to address this problem:
A) lower the posterior medial brim on the prosthetic socket
C) Flex the prosthetic socket
D) Align prosthetic foot more posterior in relation to the prosthetic socket
Which level(s) of amputation may lead to an equinus gait deformity:
A) Lisfranc amputation
B) Chopart amputation
D) Transmetatarsal amputation
- A below knee amputee presents in clinic wearing a PTB style endoskeletal prosthesis with general knee pain and distal end pressure. The patient doffs her prosthesis and liner, upon examination of her residual limb you note redness on the distal tibia and inferior aspect of the patella bone. What would be the most logical clinical action(s) you could take at this point in addressing this problem:
C) Add a gastroc pad to prosthetic socket
D) Add a 1 ply prosthetic sock over liner
What are two advantages in the list below of myodesis over myoplasty with regards to amputations:
B) Decreased rate of muscular atrophy
C) Decreased rate of antagonistic muscular imbalances
- A TF patient is seen in clinic that exhibits lateral/proximal loss of contact in stance. Upon prosthetic fit examination it is noted the lateral wall is superior to the greater trochanter, the anterior wall contours to the adductor longus tendon, the posterior socket does not encompass the ischial tuberosity, the medial wall is located 65mm inferior to the perineum. What do you attribute to the cause of this deviation:
D) The medial wall is located too far inferior to the perineum
- With a Krukenberg procedure what muscle is the driver of the pincer grip:
B) Pronator teres
- What are simple option(s) for increasing the ease of pre-positioning the prosthetic elbow in flexion, for a TH amputee utilizing a body powered prosthesis who lacks glenohumeral flexion strength and biscapular abduction strength but can operate a elbow lock:
A) Have the forearm lift tab located distally/anterior-By moving the forearm lift tab anterior/distal you move the pull angle anterior to bridge the elbow joint whereby decreasing the force necessary to move the forearm section about the humeral section.
D) Check the level of resistance in the cable housing
- What bony landmark is utilized for a weight bearing prosthesis in a hip disarticulation:
C) Ischial tuberosity
- You are doing a gait assessment with your patient that has a below knee prosthesis. You notice that there is lateral trunk bending at mid stance to the prosthetic side. Choose the choice that would NOT be a potential cause of this gait deviation:
A) Prosthesis too short B) Residual limb pain C) Prosthesis too long D)WEAK QUADS
- A TF patient is seen in your clinic. It is noted that as he ambulates with a circumducted gait. Select ALL possible causes:
A) Prosthesis height is longer than his sound side ischial tuberosity to floor measurement
B) Prosthetic suspension is not adequate
C) The user does not have adequate hip flexor strength
D) Prosthetic foot is plantar flexed excessively
- TT prosthetic sockets that are excessively extended cause excessive pressure in what areas:
A) anterior/proximal
C) posterior/distal
- In a transmetatarsal amputation you would expect to see what gait deviation:
A) Absent push off
34.What muscle group would you expect to be the weakest in an above knee amputee:
D) Hip adductors
When flexing an AK socket to accommodate a flexion contracture what concurrent alignment adjustment should also be made:
D) Move the prosthetic knee posterior-When ever you flex an AK socket this move the prosthesis weight line posterior to the prosthetic knee whereby decreasing knee stability. By making a linear adjustment moving the prosthetic knee posterior knee stability can be maintained. Note: always utilize manufacturer instructions for pinpointing knee location with respect to the socket
- An AK patient is seen in clinic. When ambulating the patient complains of knee instability. What alignment change could possibly assist in regaining knee stability:
A) Extend the prosthetic socket-By making an angular adjustment moving the prosthetic socket into extension we can decrease ground reaction forces running posterior to the knee center whereby promoting knee stability. Note: extend socket with caution as to not cause hyperlordosis when range of motion at the hip is limited.
Choose all answers that are considered benefits of polycentric knees:
A) They relatively shorten in swing phase of AK prosthetic gait
B) They provide increased cosmesis when sitting
C) They are inherently stable
What muscle is responsible for scapular elevation:
A) Trapezius muscle
A TF client is seen in clinic, upon doffing the suction socket you notice a red, wart like formation, and cracked skin distally. Choose the name of this condition AND its cause:
A) Verrucous hyperplasia
D) Incomplete seating of residual limb in prosthetic socket
- A TH patient is seen in clinic. The patient is utilizing a body powered prosthesis and is wondering which terminal device would be best suited for holding a broom handle:
555
- With a hip disarticulation prosthesis, what is used for suspension:
Iliac crest
- When fitting a figure of 8 harness with a NW ring on a TR patient, why is it advantageous to locate the NW slightly toward the sound side and at the level of C7:
B) It will position the control cable optimally
- When recommending an ischial containment TF socket what are some of the biomechanical goals that accompany this design:
A) The ischial seat provides a weight bearing surface
B) By containing the ischium we can decrease distal lateral discomfort in weight bearing
- A TF patient is seen in clinic. Upon socket fit evaluation the ischial-tuberosity is not located on the seat but further down in the socket. What adjustment could you attempt to remedy this:
A) Add a prosthetic sock
C) Add pad adjacent to scarpas triangle
- With a below elbow amputation all of these muscles would be transected
A) Flexor carpi radialis
C) Brachioradialis
D) Pronator quadratus
- A TT patient is seen in clinic. The patient has been utilizing a TT prosthesis successfully for 10 years but the patient has a grade 1 osteochondral defect “OCD” to his medial femoral condyle that is painful in weight bearing . What alignment change could you incorporate assist in the clients discomfort:
A) Outset the foot 3mm—By outsetting the foot you can create an external genu valgum moment at the knee in weight bearing. By creating an external genu valgum moment you can assist in opening the medial knee compartment and pressure over the OCD
- Which muscle is the primary forearm supinator:
A) Biceps brachii
70. All of the following muscles make up the pes anserinus except: A) Sartorius B) Gracilis C) Semitendinosus D) Semimembranosus
D
- When evaluating fluid TF prosthetic knees, which type of resistance is most adversely effected by cold environmental temperature changes:
Hydraulic?
- In TF prosthetic alignment the relationship between the posterior socket shelf and the lateral wall is referred to as:
Adduction angle
- In determining the correct length of the prosthesis what bony landmark is NOT used:
A) Greater trochanter
B) Iliac crest
C) Anterior superior iliac spine D) Posterior superior iliac crest
A
- A force of 2 lbs. is exerted on a 1.5 foot lever arm. What amount of force must be exerted on a 2 foot lever arm to balance the system:
C - (2 * 1.5 = 2 * X), X =1.5 lbs
- A TF client is seen in clinic, a medial whip is noted in prosthetic gait. What adjustment would be appropriate to normalize swing phase alignment:
B) Internally rotate the prosthetic knee
- When a prosthetic foot inset is increased, socket pressures will become more apparent:
A) Lateral/Distal & Medial/Proximal —As prosthetic foot inset is increased pressures in the socket increase lateral/Distal & Medial/Proximal. (15, 21)
- When evaluating the mechanics of a prosthetic foot, it could be said that the resistance of the prosthetic keel is acting like which muscular group and what type of muscular contraction:
D) Ankle plantarflexors & Eccentric contraction
- When aligning the prosthetic socket posterior in relation to the prosthetic foot, forces present in the socket will increase where:
A) Anterior/Proximal & Posterior/distal-When moving the socket posterior in relation to the prosthetic foot the length of the prosthetic foot keel is relatively longer causing an extension moment at the knee in midstance as well as increased socket pressures anterior/proximal & posterior/distal.
- For prosthetic patients utilizing a cane in rehabilitation, why is it recommended that the cane be held in the hand opposite the side of involvement? Choose ALL correct answers:
A) To give tripod base for support
B) To facilitate natural arm swing
C) To facilitate normal prosthetic step length D) To encourage knee stability and confidence
- When recommending a prostheses for a bilateral TR patient what style of suspension would you not recommend:
A) Northwestern self suspending sockets
B) Custom silicone suction suspension sockets C) Munster self suspending sockets
D) Pin lock suspension sockets
C -Munster self suspending sockets are contraindicated for bilateral TR amputees as they require a pull sock to be utilized for donning the prosthesis which requires at least one sound hand to assist in the process. (20, 21, 25)
- When fabricating a TH prosthesis it is important to add pre-flexion to the prosthetic elbow, why is this:
B) To decrease force necessary to initiate elbow flexion
- With respect to TF quadrilateral socket measurements, which measurement would the following calculations be used for? (Measure the ischial level circumference and divide it by three, then subtract 6mm):
D) Medial/Lateral measurement-By measuring the ischial level circumference, dividing by 3, and then subtracting 6mm you are determining the M/L measurement for a Quadrilateral socket.
- Injury to the superior gluteal nerve will result in what gait deviation:
Trendelenburg gait
- A force of 9lbs is applied at the harness in a TR prosthesis, in order to maintain the minimum acceptable efficiency of the cable/cable housing, how much force must be needed in order to open the prosthetic hook:
6.3lbs-70% is the minimum accepted cable/cable housing efficiency. (9Lbs * .7 = 6.3lbs). (20, 21, 25)
When modifying a TF Quadrilateral plaster mold, if you are trying to increase the amount of adduction on the mold what must you do to maintain a level posterior shelf:
Shave plaster off laterally
- The talus does not articulate with the:
Cuboid
- The tibial nerve innervates muscles to the_____portion of the leg, while the deep fibular nerve innervates muscles on the _____ portion of the leg:
A) posterior, anterior
You place a shrinker on a below knee amputee patient 3 weeks post op and notice that he keeps a pillow under his knee. What joint(s) would you expect a contracture if this persists:
B) Knee flexion and hip flexion contracture
- T/F, A silesian belt is used to increase coronal plane stability in TF prosthesis applications:
False
- Your patient has a transtibial amputation and was just fitted with a PTB socket. During your session with the patient for initial fitting, you have him walk in the parallel bars. After which you inspect the skin of the residual limb. You would not expect redness in what area(s):
A) Distal residual limb
B) Anterior tibia and tibial crest
C) Fibular head and cut end of the fibula D) Tibial tuberosity and patellar bone
23 yo TF amputee with a 30 degree hip flexion contracture fit with? a. Polycentric with multiaxial, hydraulic with SACH, pneumatic with SACH, single axis
multi axial
K levels determined by all but
a. Months since amputation
b. Medical history
c. Activity level
d. Patient goals
Medical history
Subtalar joint is articulation of
talus with calcaneus
Removal of the hallux requires what of the sesamoid bones?
a. Fusion
b. Remain intact
c. Excise
Remain intact- keeps windlass mechanism
Amputation of the first ray results in what position of the foot?
Planovalgus
If the ischial tuberosity is placed too far toward the medial side of the IC seat, it results in:
Crowding of adductor muscles into small area, causing a burning sensation
When adductor longus tightness is observed during initial fitting or the AK socket you should:
Flare and contour anterior-medial corners
The suction socket prosthesis is aligned so that involuntary alignment stability is minimized and voluntary knee control by stump action is emphasized.
In order that a minimum amount of energy is consumed during walking
If the ischial seat of the AK socket is made too wide, it will cause
Burning sensation when the wearer is seated, because of excessive stretching of the skin
At push-off it is common for an AK amputee with well developed hamstrings muscles to force himself off the IC seat as his RL extends, how can this trouble be avoided?
Align the socket in a position of initial flexion
What is the effect of excessively shimming the DF stop to place the shank in a vertical position?
Excessive increase in range of PF with increase in knee stability
If the medial lateral dimension of the socket is too large:
Ischial tuberosity will move laterally on seat
What is the result of locating the toe-break too far forward in the prosthetic foot?
Give amputee a feeling of climbing a hill causing excessive energy consumption and awkward gait
When hamstring muscle tightness is observed during Intial fitting of the AK socket you should:
Relieve the lateral border of the scarpa’s bulge
AK vaulting factors:
Px too long
Excessive knee friction
Inadequate suspension
A characteristic of the constant friction knee
Reduces heel rise at normal cadence
Provides great stability-with break system is activated locking unit
Great for user with hip weakness
How is the medial lateral dimension of the quadrilateral AK socket determine?
Divide thigh circumference at ischial level by three
In a total contract suction socket, edema is prevented by
Alternating negative and positive pressures
Which adductor muscle is always transacted in a knee disarticulation amputation
Gracillis- connects to proximal tibia
A burning or stretching sensation near the ischial area of an AK patient, while he is sitting, is most likely to be caused by
Inadequate flare of the posterior wall
If the amount of adduction must be decreased on the AK plaster mold, how must the posterior shelf be modified (quad)
Add plaster lateral
In quad socket what can cause discomfort in the hamstring
Socket AP diameter too small
Excessively wide ischial shelf
Insufficient radius along ischial brim
When a mechanical friction knee is used in an AK prosthesis, it can be expected that excessive heel rise will occur
At faster than normal cadence
During dynamic alignment on a Berkeley AK adjustable leg. The pylons is noted to slant medially. This indicates that:
There is excessive adduction of the socket
Patients with short AK amputations generally exhibit lateral bending of the trunk furring locomotion due to:
Loss of an adequate lever arm
On an AK socket, where should the axis of a single-axis hip joint be located with reference to the patient’s greater trochanter?
Anterior and superior
One reason for initial flexion in an AK socket is to
Permit even stride length during walking
A common cause of excessive pressure on the inferior pubic ramps in a quadrilateral AK socket is:
Anterior posterior dimension that is too large
The center of gravity of the adult maple is located on the inline on the body at approximately the level of the
Second sacral vertebra
Pressure is derailed by
Force/area
During NHL, b/w heel contact and foot flat, the GRF tends to cause which moments at the hip?
Hip flexion, knee flexion
Which of the following muscles is most readily identified by palpating: Iliopsoas Vastus itermedius Sartorius Pectineus Gluteus minimus
Sartorius
The muscle which pass posterior to the medial malleolus at the ankle act to
Invert and PF
Bones that form the acetabulum
Ilium, pubis, ischium
Which of the following inserts on the lesser trochanter? Gluteus Maximus Adductor longus Vastus medialis Quadratus femoris Iliopsoas
Iliopsoas
In a Canadian hip disarticulation socket, which of the following is not affected by AP placement of the hip joint?
Hip joint alignment stability
Length discrepancy b/w px and anatomical knee during sitting
Toe clearance during swing
Lateral stability during stance phase
Stride length
Lateral stability during stance phase
With respect to the hip and knee joints at midstance, the ground reaction line for a hip disarticulation px passes:
Posterior to hip, anterior to knee
Immediate post-surgical fitting of the upper limb amputee offers all the following advantages except
Early maturation of RL
More rapid rehabilitation
Greater RL ROM
Early return of two handed grasp patterns
Greater RL ROM
A MECHANICAL Partial hand prosthesis would probably be contraindicated for a trans metacarpal amputation with:
The thumb and index finer remaining
In the medium length BE amputation, which of the following muscles are missing Supinator Pronation quadratus Brachioradialis Flexor carpi radialis Extensor carpi radialis longus
Pronation quadratus
If a BE px is harnessed with a split cable housing, which px joint has most likely been used:
Step-up hinge
Which components provides greatest ROM for bilateral BE amputee
Wrist flexion unit
Loss of the upper limb just distal to the supinator will result in what amputation level?
Short BE RL
What modifications is made to the fig 8 harness for bilateral BE
Cross back strap added,
Axilla loop are unnecessary
The force applied to open the TD of a BE prosthesis is 7lb. How many lbs of force applied at the harness would provide acceptable efficiency?
10
Patient with long bilateral BE who is also bling will have difficulties using conventional px devices. What surgical intervention can be most useful in this situation
Krudenberg’s operation
When a voluntary opening px hand is activated, the cable replaces function normally provided by the
Extensor carpi radialis longus and brevis
Prehension patterns are provided by a prosthetic hand
Cylindrical, spherical, palmar
Main supinator of forearm
Biceps
Excursion amplifier increased cable excursion but expense of:
Requires more force
AE amputation is sometimes performed for a complete brachial plexus injury. For optimum px function what other step would be helpful?
Shoulder fusion
Brachioradialis primarily
Flex elbow joint
Biceps brachii produces which of the following actions of the elbow and forearm
Flexion and supination
Pf of the foot
Tibialis post,
Plantaris
Peroneus longus
Gastrocnemius
Which muscles undergo a lengthening contraction b/w heel strike and foot flat?
Tibialis posterior
Tibialis anterior
Flexor hallucis longus
Inversion of foot
TA and posterior tib?
Active PF is strongest with:
Knee extended
