Prosthetic Prep Exam 22 Flashcards

0
Q

When a prosthetic foot inset is increased, socket pressure will become more apparent?

A

Lateral distal/ medially proximal.

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1
Q

During normal gait you see the pelvis drop during midstance, what muscle weakness could cause this?

A

Gluteus medius– weakness in the gluteus medius will cause what is know as trendelenburg gait. One function of this muscle is to maintain lateral stability of the pelvis.

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2
Q

What is the maximum, amount of knee flexion contracture that could be fit with a traditional TT PTB socket?

A

25 degrees– they still can be fit with a traditional PTB socket, but further contractures may indicate a bent knee prosthetsis. which has very poor cosmesis.

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3
Q

What mucles of the quads will help steady the hip joint and help ilioposoas flex the him?

A

Rectus femoris– primarly due to the proximal attachment at the anterior inferior iliac spine.

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4
Q

When evaluating the mechanics of a prosthetic foot, it could be said that a prosthetic keel acts like which muscle group, and what type of contraction?

A

The plantarflexors, and eccentric contraction– the prosthetic foot keel is acting like ankle plantarflexors eccentrically contracting where by controlling the anterior translation of the prosthetic pylon and socket over the foot in stance.

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5
Q

When aligning the prosthetic socket, posterior to the prosthetic foot, forces present in the socket to increase where?

A

Anterior proximal/ posterior distal– when moving the socket posterior in relation to the prosthetic foot length of the prosthetic foot keel is relatively longer causing an extension moment at te knee in midstance as well as increased socket pressure anterior proximal/ posterior distal

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6
Q

When fabricating a below knee socket for a 4 year old patient it may be necessary to make a socket that includes multiple removable layers, called a “onion skin lamo”?

A

True— by providing removable layers this will allow for accommodation to the natural girth/volume change of the child as he/she grows. This will minimize the number of socket replacements.

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7
Q

In a TT patient seen at clinic, when evaluating gait you notice trendelenberg sign, on the prosthetic side during midstance. What muscle group would you expect to show low MMT scores on the prosthetic side?

A

Gluteus medius– gluteus medius is a hip abdutor, when this muscle is weak, the patient will lean over the involved side (trendelenberg sign) to create abduction whereby maintaining stability.

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8
Q

For a prosthetic patient utilizing a cane in rehab, why is it recommened that the cane be held in the opposite side of involvement?

A

The tripod is one of the most stable bases. In prosthetics this is created by the prosthetic side forwrad, ssoundsisde lower extremity back and uninvolved side hand with cane. In a normal gait during swing phase of the prosthesis, the contralateral arm swings to oppose the rotational torque “dog chasing tail” and allow forward progression to occur. with use of cane it will allow for potential equalized step length. Having the cane does promote knee stability and confidence with prostheic patient early on in their rehabilitation.

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9
Q

All are bony landmarks are easily palpable on the lower limb execpt?

A

The lesser trochanter cannot be palpated as it is on the proximal medial surface of the femur covered by soft tissue of the adductors.

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10
Q

A TF patient is seen in clinic, if the patient is utillizing suction suspension you can best differenciate the socket pressure as __________ in stance and ____________in swing phase?

A

Suction suspension provides positive pressure as the patients weight is going through the socket in stance phase and also negative pressure during swing phase.

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11
Q

An elbow disarticulatiuon patient is seen in clinic for a socket replacemment, what type of articulation at the elbow is indicated?

A

Outside locking hinger – allow center to be matrched in a long TH or ED they allow the patient to lock the elobw in multiple positions similar to a TH user with a hosmer locking elbow. note cosmesis can be poor.

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12
Q

T/F When fabricating a prostrhetic socket in general it is necessary to have all “like” fibers directly adjacent to aid in strength?

Why are flexible elbow hinges recommended for longer amputees. allow patient to maintain natural pronation/supination– by utilizing flexible hinges for langer TR amputees we can allow their natural pronation/supination to occue without the prostheic hinges impeding the motion.

A

False by alternating different fibers types in your lamination you can utilize principals similar to the I-beam effect.

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13
Q

When deciding to add a cross back strap to a figure of eight harness, which material would be best to fabricate a crosee back strap with?

A

An elastic strapping– cross back straps are used to promote increased excursion inelastic materals are ideal as they will capture more body motion in the form of a cable excursion where as elastic material will capture the excursion in the elasticity of the materals vs. cable excursion.

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14
Q

Why are flexible elbow hinges recommended for longer amputees. allow patient to maintain natural pronation/supination– by utilizing flexible hinges for langer TR amputees we can allow their natural pronation/supination to occue without the prostheic hinges impeding the motion.

A

By utilizing flexible hinges for langer TR amputees we can allow their natural pronation/supination to occue without the prostheic hinges impeding the motion.?

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15
Q

Partial foot amputees often present with a lack of controlled third rocker late in stance. what option can assist with this other thana partial foot insert with toe filler?

A

1) rigid sole shoe
2) rocker addition to shoe sole
3) carbon insert
4) OTS carbon AFO

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16
Q

When recommending a prosthetic Bilateral to a TR patient what style of suspension would you not recommend?

A

Munster self suspending sockets are contraindicated for bilateral TR amputees as they require a pull sock to be utilized for dinning the prosthesis which requires at least one sound hand to assist in the process

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17
Q

When fabricating a TH prosthesis it is important to add pre-flexion to the prosthetic elbow why is this?

A

By preflexing the prosthetic elbow in a TH application, a mechanical advantage is placed into the prosthetic system that will decrease the the force necessary to initiate elbow flexion whereby increasing the ease of operation on the amputee.

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18
Q

Transverse tarsal joints allow inversion and eversion of the foot. choose the other joint that allows inversion and eversion?

A

Inversion and eversion occur at subtalor, talocalceonavicular and transverse tarsal joints. Superior and inferior tibiofibular joints assist with proflexion and dorsiflexion.

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19
Q

With respect to TF quad socket measurements, which measurements would the following calculation be used for … meausre the ischial level circumference and divide it by three than subtract 6mm?

A

By measuring the ishcial level circumference, dividing by 3 and than subtracting 6MM you are determining the M/L measurement for a quad socket.

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20
Q

A TR patient needing the ability to very grip force on small delicate objects would benefit from which terminal device?

A

A voluntary closing hook offers ease of sight to the object as will as a variable “graded” grip force which can allow the patient to determine the exact amount of grip force they intend to use on the object.

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21
Q

Injury to the superior gluteal nerve will result in what gait deviation?

A

Trendelenbrug sign. –>superior gluteal nerve innervates gluteus medius and minimus, with injury these muscles are incative causing the pelvis to fall on the raised limb.

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22
Q

A force of 9lbs is applied to 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?

A

6.3 lbs, 70% is the minimum accepted cable/cable housing efficiency (9lbs * .7 = 6.3lbs)

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23
Q

When modifying a TF quad 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?

A

Shave plaster off laterally, by increasing the the adduction angle the medial posterior shelf is relatively raised, by then removing plaster laterally you can level out the posterior shelf and maintain proper ishcial tubersity dista end length.

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24
Q

The talus does not articulate with the?

A

Cuboid does not articulate with the talus

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25
Q

When fabricating TF socket with a hip joint, the hip joint should be located where in relation to the greater throchanter? 12mm anterior, and 25.4 mm superior–> socket hip joints location should match anatomical hip joint location for proper articulation. the anatomical hip joint location is 12mm anterior and 25.4mm superior to the greater trochanter.

A

12mm anterior, and 25.4 mm superior–> socket hip joints location should match anatomical hip joint location for proper articulation. the anatomical hip joint location is 12mm anterior and 25.4mm superior to the greater trochanter.

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26
Q

In TF application when inadequate socket flexion in incorporated into the prosthesis what will the patient be unable to do without a gait deviation?

A

Have symmetric step lengths–> proper flexion angle must be incorporated into the TF prosthesis in order to allow even step length when compared to the sound side.

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27
Q

The tibial nerve innervates muscles to the ________ portion of the leg, while the deep fibular nerve innervates muscles on the _______ protion of the leg?

A

Posterior, anterior –> the tibial nerve supplies posterior muscles of the leg and knee joint, while the deep fibular nerve supplies anterior muscles of the leg and dorsum of foot.

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28
Q

A TT patient in clinic, the patient has been utilizing a TT prosthesis without problem for years, the patient have PVD and has been expirencing ischemic pain within his prosthetic socket in what seems to be his gastroc muscle. What should be the most logical plan of action?

A

Decrease pressure on posterior and adjacent to the popliteal artery, recommend the patient be seen by a vascular specialist –> by decreasing pressure adjacent to the popliteal artery we can minimize ischemic pain as blood flow will be less restricted, all patients with new medical symptoms should be refereed to a physician for evaluation

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29
Q

T/F with regards to initial post operative porsthesis and rigid dressings, removing the device is indicated if the patient is running a temp beucase is it a hallmark sign of an infection?

A

True–> often you will be asked to remove the IPOP or RIGID cast, if the patient spikes a fever as it is a sign of infection which merits would examination note: in instance where more frequuent would chekcs are needed for a patient with infection a bi-valved deisgn can be more comvenient or a thermoplastic RRD.

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30
Q

You place a shrinker on a BK amputee patient 3 weeks post op and notice the he keeps a pillow under his knee, what joint would you expect a contracture if this persists?

A

Knee flexion and hip flexion contracture.

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31
Q

T/F when performing plaster mold modifications for a lateral stabilization bar in a TT PTB style socket, it is imperative that is does not extend too superior so as to aviod the common peroneal nerve?

A

True–> lateral stabization bar is located in between the fibular head and the cut end of the fibular, it should be located distal to the fibular head and proximal to the cut end to aviod pressure adjacent to the cut end and common peroneal nerve.

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32
Q

T/F a pull sock is often used to donn a TF suction suspension to draw tissue into the socket and facilitate hydrostatic loading?

A

True–> by drawing soft tissue into a fixed space it relatively solidifies the tissue

33
Q

If the sciatic nerve is severed at the level of the ischial tuberosity, muscle function will not be impaired at the?

A

Hip joint–> the sciatic nerve will still be able to innervate the hip joint but will contribute to weakness in the knee, ankle and foot. Thr sciatic nerve innervated posterior muscles of the hip and knee and divides into the tibial nerve and common fibular nerve which innervates the the ankle and foot muscles.

34
Q

T/F a silesican belt is ised to increase coroneal place stability in TF prosthesis application.

A

False–> with regards to TF prosthesis, silesian belt are utilized to decrease socket rotation and assist in suspension. A hip joint would be indicated for coronal place stabilization.

35
Q

At heel strike the knee joint is at________ while the ankle joint is at _______?

A

At neutral/ full extension, 90 degrees of neutral–> at heel strike the knee is at neutral or full extension while the ankle is at 90 degrees/ neutral.

36
Q

In normal gait, maximum knee flexion reaches approximately?

A

60-65 degrees, in normal gait cycle

37
Q

T/F the duration of double support varies inversely with the speed of walking and in running double support is absent? true–> in solw walking double support increases compared to the swing phase,

A

True–> in slow walking double support increases compared to the swing phase,

38
Q

the stance phase of gait make up what percent of the gait cytcle during ordinary walking speeds?

A

60% stance phase amke up 60 % of the gait cycle while swing phase make up the other 40%

39
Q

Your patient has a transtibial amputation and was just fitted with a PTB socket. during you 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 exoect redness in what areas?

A

Distal residual limb, anterior tibia and tibial crest, fibular head and cut end of the fibula, tibial turbersoity and patellar bone, all of the above areas should not have redness that presists loner than 20 post prosthetic use.

40
Q

when external rotation of the prosthetic foot is needed the toe lever or keel of the foot is relatively?
 
T/F unilateral BK amputees should be instructed to ascend stairs with the prosthesis leading first and decend with the sound limb leading first. false, lead with the good, go down with the bad, is often used to teach patients that they should lead with the sound limb as it is strong to ascend stairs leading with the “bad” side is their sound limb will need to perform the eccentric contraction to safely step down.

A

Shortened–> the keel would be relatively shortened when the prosthetic foot is externally rotated.

41
Q

T/F unilateral BK amputees should be instructed to ascend stairs with the prosthesis leading first and decend with the sound limb leading first.

A

False, lead with the good, go down with the bad, is often used to teach patients that they should lead with the sound limb as it is strong to ascend stairs leading with the “bad” side is their sound limb will need to perform the eccentric contraction to safely step down.

42
Q

During swing phase of the gait cycle what muscles are active to achive dorsiflexion?

A

Anterior tibalis, extensor hallucis longer, extensor digitorum longus, these muscles are slightly active during swing phase to prevent the foot and toes from dragging.

43
Q

The sciatic nerve innervates all thses muscles except?

A

Gluteus medius–> the sciatic nerve provides sensation to most of the leg and motor function of the posterior leg muscles, there is a tibial division and the common fibular division that innervates the biceps femoris. the gluteus medius is innervated by the superior gluteal nerve.

44
Q

You are seeing a patient with disgnosis of pheripheral vascular disease. what is the common artery that you can palpate to assess blood flow?

A

Dorsalis pedis–> clinicians at times will wants to assess blood flow in a patients foot. one way is to palpate the dorsalis pedis pulse along with capillary refill.

45
Q

What is the primary function of brachioradialis?

A

Elbow flexion.

46
Q

You have a patient that persents for evaluation for an above knee prosthesis. you notice he has had a forward flexed posture. what positive muscle length test would you expect to see associated with this posture?

A

Thoman test tests for iliopsoas hip flexion tightness. Often with hip flexor contractures the patient will present with a forward flexed posture when standing.

47
Q

To check prosthetic height the amputee?

A

Should support his weight equally on both legs.

48
Q

When walking, the normal foot should pass close to the AK prosthetic foot?

A

To facilitate shift of body weight.

49
Q

If the schial tuberosity is place too far towards the medial side of the ishcial seat it results in?

A

Crowding of adductor muscles into small area, causing burning sensation.

50
Q

The knee bolt of the prosthesis is usually found to be approximately?

A

5 degrees externally rotated.

51
Q

When adductor longus tightness is observed during initial fitting the AK socket you would?

A

Flare and contour anterior medial corner.

52
Q

When the AK amputee musr arch his back to maintain the center of gravity of his body in the proper position while pressing back with his stump, it is an indication that the?

A

Stump was fitted into a socket without adequate initial flexion.

53
Q

As an AK amputee places his weight on the prosthesis the femur presses towards the lateral wall, becuase of this the lateral socket wall should?

A

Adducted to stabilize the femur during locomotion.

54
Q

The suction socket prosthesis is aligned so that involuntary alignment stability is minimized and voluntary knee control by stump action is emphasized in?

A

In order that a minmum amount of energy is consumed during walking.

55
Q

Medial whip is caused by?

A

Excessive lateral rotation of knee bolt.

56
Q

In correcting an abducted socket on the adjustable leg, we should?

A

Release the lateral tilt screw and tighten the medial screw.

think to get foot flat on floor, not to get in a straight line

57
Q

When putting an amputee into a socket the most important anatomical landmark is?

A

The adductor longus tendon.

58
Q

If the ischial seat of the ak socket is made too wide, it will cause

A

Excessive adductor buldge because of insufficient room in the medial posterior area of socket.

59
Q

Which one of the following gait faults is due to incorrect function of the prosthesis? Circumduction

A

Circumduction

60
Q

At push off it is common for an AK amputee with well developed hamstrings muscles to force himself off the ischial seat as his stump extends. how can this trouble be avoided?

A

Align the socket in a position of initial extension.

61
Q

The change in orginal length of a body divided by it orginal length is the calculation for what material property? plastic deformation?

A

Plastic deformation.

62
Q

Material property stress definition? The amount of load carried by each unit of cross sectional area of a component

A

The amount of load carried by each unit of cross sectional area of a component.

63
Q

A cookie crusher circuit used for peds myoelectric prosthesis is analogous in function to a?

A

Voluntary opening TD, cookie crusher only has one site
TRS adept is a peds voluntary closing hand
APRL hand is voluntary closing

64
Q

Most common cause of lower extremity amputation?

A

Peripheral vascular disease.

65
Q

What is/are possible causes of the patient feeling he is walking up hill?

A

Foot too plantarflexed.

66
Q

If The forearm lift loop is moved distally from a position of 1.5 in away from the elbow axis to 2 in away from the elbow axis, flexing the elbow will require?

A

Less force, the greater the distance between the point center and line of pull of the cable the LESS FORCE, required to flex the elbow, however, as this distacne incereases the amputee must use a greater amount of body motion INCREASE CABLE EXCURSION.

67
Q

What might cause the person with a transtibial porsthesis to scuff his toe on the prosthetic side?

A

Foot to plantar flexed
socket too extended
prosthesis too long
inadquate suspension.

68
Q

Partial foot amputation often end up in what posture?

what bi-articular muscles flexes the knee and plantarflexes the foot? gastrocnemius

A

Equines

69
Q

Main extensor of the hip?

A

Gluteus max.

70
Q

What bi-articular muscles flexes the knee and plantarflexes the foot?

A

Gastrocnemius.

71
Q

The antero-medial relief in the quadrilateral socket is for?

A

The adductor longus muscle.

72
Q

In the PTB design, frontal place socket tilt should be ________ after bench alignment

A

5 degrees of flexion.

73
Q

What is the effect of excessively shimming the dorsiflexion stop to place the shank in vertical position?

A

Excessive shortening in range of plantar flexion, resulting in stiffened planter bumper action and knee stability.

74
Q

If the AK amputee complains of pressure in the pubic ramus, the posthetist should?

A

Lower the medial wall 1/8th at a time.

75
Q

Pronounced impact shock at full extension of the prosthetic knee indicates a need for?

A

More extension dampening control.

76
Q

During a swing phase, a tendency for the AK shin to make a moarked inward movement of the knee accompanied by an outward movement of the foot is called? Medial whip.

A

Medial whip.

77
Q

If the medial demension of the socket is too large?

A

The ischial tuberosity falls into the socket.

78
Q

What is the result of locating the toe break to far forward in the prosthetic foot?

A

Giving the amputee the feeling of “climbing a hill” causing excessive energy consumption and awkward gait.

79
Q

To determine the control system efficiency of an upper extremity prosthesis?

A

Divide the force meausred at the terminal device by the force meaured at hanger should be at least 80%.