prosthetics Flashcards
question
answer
In patients aged 15 to 50, what is the most common cause of lower extremity amputation?
A) Trauma
B) Cancer
C) Infection
D) Vascular disease
A) Trauma
In general, what is the most common type of amputation seen among new amputees?
A) Transfemoral
B) Syme’s
C) Transtibial
D) Hip disarticulation
C) Transtibial
The most common type of amputation is a transtibial or below knee amputation (BKA). Transfemoral or above knee amputations are approximately half as common as BKA, whereas Syme’s (ankle disarticulation) and hip disarticulation are very uncommon.
In a standard transtibial amputation, the amputation is approximately what percentage of the tibial length?
A) < 20
B) 20 to 50
C) > 50
D) > 75
B) 20 to 50
A standard transtibial amputation is 20% to 50% of the tibial length. A long transtibial is > 50% of the tibial length, whereas a short transtibial amputation is < 20% of the tibial length
Which of the following is an amputation at the tarsometatarsal junction?
A) Transmetatarsal
B) Syme’s
C) Lisfranc
D) Chopart
C) Lisfranc
. Transmetatarsal - midsection of all metatarsals
. Syme’s - ankle disarticulation
with attachment of heel pad to distal end of the tibia
. Chopart - midtarsal amputation where
only the talus and calcaneus remain
What is the ideal shape for a transtibial residual limb?
A) Rectangular
B) Conical
C) Pyramidal
D) Cylindrical
D) Cylindrical
. Conical is best after a transfemoral amputation
In the postoperative management of the residual limb a “shrinker” should be worn for
how many hours out of the day?
A) 24
B) 12
C) 8
D) Shrinkers are not utilized after amputation
A) 24
Which of the following would be acceptable in contracture prevention for the transtibial amputee?
A) Sitting with the knee extended on a towel-wrapped board under the wheelchair cushion
B) Sitting with the residual limb hanging over the edge of the bed
C) Sitting with a pillow placed under the knee
D) Sitting with a pillow placed between the legs
A) Sitting with the knee extended on a towel-wrapped board under the wheelchair cushion
All others would lead to either knee flexion or hip flexion contractures.
All of the following are components of a transtibial prosthesis except:
A) Socket
B) Rotor
C) Shank
D) Suspension
B) Rotor
All of the following are pressure-tolerant areas for a below knee amputation prosthetic
except:
A) Patellar tendon
B) Medial tibial flare
C) Fibular head
D) Popliteal fossa—gastrocsoleus muscles
C) Fibular head
reliefs must be built into this
area in order to ensure that skin breakdown or damage to the peroneal nerve does not
occur
Which is not a pressure-sensitive area in regard to lower extremity prosthetics?
A) Pretibial muscles
B) Hamstring tendons
C) Patella
D) Distal tibia
A) Pretibial muscles
Which of the following prosthetic foot is the most affordable?
A) Multiaxis foot
B) Solid ankle cushion heel (SACH)
C) Energy storing
D) Single-axis foot
B) Solid ankle cushion heel (SACH)
The single-axis foot permits movement of the foot-ankle complex in the plantar flexion/dorsifl exion axis, whereas the multiaxis foot allows some controlled movement in the normal anatomic planes (plantar flexion, dorsiflexion, inversion, eversion, and rotation).
Which of the following prosthetic options would allow for participations in most vigorous sports?
A) Flex-foot
B) Single-axis foot
C) Rigid keel
D) Multiaxis foot
A) Flex-foot
Tenderness on the anterior distal femur, lateral lurch when walking, and increased skin irritation at the ischium and pubis are all disadvantages of which above knee amputation socket?
A) Narrow mediolateral
B) Ischial containment
C) Contoured Adductor Trochanteric-controlled Alignment Method (CAT-CAM)
D) Quadrilateral transfemoral
D) Quadrilateral transfemoral
The Silesian belt, total elastic suspension belt, and pelvic band are all types of suspension for which type of prosthesis?
A) Below knee amputation (transtibial)
B) Above knee amputation (transfemoral)
C) Hip disarticulation
D) Syme’s amputation
B) Above knee amputation (transfemoral)
Other suspension systems for the transfemoral prosthesis include the suction socket (total suction vs. partial suction) and gel liners with a pin or strap.
Which of the following knee units cannot be used in someone with bilateral transfemoral amputee?
A) Polycentric/four-bar knee
B) Manual locking knee
C) Stance control knee
D) Fluid controlled knee unit
C) Stance control knee
Brawny edema, induration, and discoloration of the skin of the distal stump in a circular shape may indicate which dermatologic complication in an amputee?
A) Allergic dermatitis
B) Epidermoid cyst
C) Folliculitis
D) Choked stump syndrome
D) Choked stump syndrome
This may result when the residual limb becomes too large to fi t properly in the total contact socket. The socket will become too tight proximally and therefore obstruct venous outfl ow. An edematous distal residual limb will result. Folliculitis, cysts, and dermatitis are all potential complications of a prosthesis, yet do not result in edema and induration.
Which dermatologic complication results from inadequate socket wall contact with subsequent edema formation causing wart-like skin overgrowth?
A) Tinea corporis
B) Verrucous hyperplasia
C) Hyperhidrosis
D) Folliculitis
B) Verrucous hyperplasia
Tinea corporis mainly results from sweating and can be prevented and treated with good socket hygiene and antifungal medications. Hyperhidrosis
may cause maceration of the skin, which predisposes the skin to infection. Folliculitis is
an infection of the hair root resulting from poor hygiene, sweating, and either pistoning
or poor socket fi t.
Which of the following describes an awareness of a nonpainful sensation in the amputated part?
A) Allodynia
B) Phantom pain
C) Hyperalgesia
D) Phantom sensation
D) Phantom sensation
All of the following are reasonable pharmacologic interventions for the treatment of phantom pain except:
A) Tricyclic antidepressants
B) Serotonin reuptake inhibitors
C) Narcotics
D) Anticonvulsants
C) Narcotics
In addition to the other answers, norepinephrine reuptake inhibitors, calcitonin, capsaicin, and propranolol are reasonable pharmacologic medical interventions
When compared with normal walking without a prosthesis or assistive device, which condition requires the greatest increase in energy expenditure?
A) Transtibial amputation
B) Transfemoral amputation
C) Bilateral transtibial
D) Wheelchair use
B) Transfemoral amputation - 99%
transtibial - 23%
bilateral transtibial - 41%
wheelchair - 9%
Which type of amputee will expend the most energy when being compared with normal walking?
A) Transfemoral-transtibial
B) Bilateral transtibial
C) Transfemoral with use of crutch
D) Transfemoral
A) Transfemoral-transtibial - 118%
bilateral transtibial - 41%
transfemoral with use of a crutch - 92%
unilateral transfemoral - 99%
What will be the result of a heel cushion that is too soft, or a prosthetic foot in excessive plantarflexion?
A) Excessive knee flexion
B) Insufficient knee flexion
C) Excessive knee extension
D) Insufficient knee extension
B) Insufficient knee flexion
In describing prosthetic feet, what does SACH stand for?
A) Solid action cushioned heel
B) Single-axis ankle cooperative heel
C) Single assembly coordinated heel
D) Solid ankle cushioned heel
D) Solid ankle cushioned heel
It is the most commonly used prosthetic foot.
In terms of gait analysis for the transtibial amputee, which is the cause of high pressure against the patella throughout most of the stance phase as well as the heel being off the floor when standing?
A) Foot too far posterior
B) Foot too dorsiflexed
C) Foot too plantar-flexed
D) Foot too far anterior
C) Foot too plantar-flexed
Which of the following is not a cause for a circumducted gait in a transfemoral amputee with a prosthesis?
A) Prosthesis is too long
B) Inadequate suspension
C) Abduction contracture of the residual limb
D) Too much adduction built into the prosthesis
D) Too much adduction built into the prosthesis
The surgical removal of the entire lower limb plus all or a major portion of the ileum is known as what type of amputation?
A) Hemipelvectomy
B) Hip disarticulation
C) Boyd amputation
D) Pirogoff amputation
A) Hemipelvectomy
Which amputation allows a patient to stand easily and walk on the end of the residual limb without wearing a prosthesis for short household distances?
A) Long transtibial
B) Syme’s
C) Short transtibial
D) Hemicorporectomy
B) Syme’s
What is the most common congenital upper extremity limb deficiency?
A) Transradial
B) Transhumeral
C) Absence of ulna
D) Absence of carpal, metacarpals, phalanges
A) Transradial
What is the leading cause of acquired amputation in the upper extremity?
A) Cancer
B) Diabetes
C) Trauma
D) Burns
C) Trauma
What is the definition of a prosthesis?
A) An artificial substitute for a missing body part
B) An external device applied to intact body parts to provide support
C) A brace
D) A device used to assist with balance
A) An artificial substitute for a missing body part
What is the most commonly used type of terminal device in the upper extremity?
A) Passive
B) Voluntary closing (VC)
C) Voluntary opening (VO)
D) Myoelectric
C) Voluntary opening (VO)
What is the most commonly used suspension for a transradial amputee?
A) Suction
B) Figure 8 (O ring) harness
C) Figure 9 harness
D) Chest strap with shoulder saddle
B) Figure 8 (O ring) harness
Why is a disarticulation (separation at the joint level) of upper extremity amputation preferred in children?
A) More cosmetic
B) Preserves epiphyses
C) Easier to fi t with a prosthesis
D) Easier to perform activities of daily living (ADLs)
B) Preserves epiphyses
What is a congenital terminal limb deficiency?
A) A deficiency in the long axis
B) A deficiency in the short or transverse axis
C) A deficiency of both long and short axes
D) An absence of a joint
B) A deficiency in the short or transverse axis
intercalary defi ciency describes a limb defi ciency in the long axis where normal skeletal elements may be present distal to the affected segment
Which of the following acquired upper extremity amputations is the most common in the USA?
A) Above the elbow/transhumeral
B) Below the elbow/transradial
C) Wrist disarticulation
D) Shoulder disarticulation
B) Below the elbow/transradial
What is a forequarter amputation?
A) Involves removal of part of the humerus
B) Involves removal of part of the radius and ulna
C) Involves removal of the entire humerus, radius, ulna, carpals, metacarpals, phalanges
D) Involves removal of the scapula, part or all of the clavicle, entire humerus, radius, ulna, carpals, metacarpals, phalanges
D) Involves removal of the scapula, part or all of the clavicle, entire humerus, radius, ulna, carpals, metacarpals, phalanges
What does the term prehensile refer to?
A) Balance
B) Grasp by wrapping around
C) Weakness in the arm
D) Apprehension
B) Grasp by wrapping around
How is myodesis different from myoplasty?
A) Myodesis refers to suturing agonist-antagonist muscles to each other
B) Myoplasty refers to suturing agonist-antagonist muscles to each other
C) Myodesis refers to directly suturing residual muscle or tendon to bone/periosteum
D) Both B and C are correct
D) Both B and C are correct
Myoplasty refers to suturing agonist-antagonist muscles to each other. Myodesis refers to directly suturing residual muscle or tendon to bone/periosteum.
In order to increase the likelihood of prosthetic use, how soon after surgery should an upper limb amputee be fi tted with a prosthesis?
A) Immediately after surgery, within the first week
B) 3 to 6 months after surgery
C) 12 months after surgery
D) At least 2 years after surgery
B) 3 to 6 months after surgery
Which of the following is not an immediate goal of rehabilitation care after amputation?
A) Wound healing
B) Edema control
C) Prevention of contractures
D) Treadmill training
D) Treadmill training
What is the difference between phantom sensation and phantom pain?
A) Phantom pain is pain perceived in the intact part of the limb
B) Phantom pain is the same as phantom sensation
C) Phantom sensation is nonpainful perceptions of the missing part of the limb
D) Phantom sensation is painful perceptions of the missing part of the limb
C) Phantom sensation is nonpainful perceptions of the missing part of the limb
What is the best of type medication for the treatment of phantom pain?
A) Opioid
B) Selective serotonin reuptake inhibitor (SSRI)
C) Tricyclic antidepressant (TCA)
D) Acetaminophen
C) Tricyclic antidepressant (TCA)
Which of the following is true about amputee patients?
A) It is ok to delay a visit to the rehabilitation physician and prosthetic team until 6 months postamputation
B) It is best for the patient to be seen by the rehabilitation physician and prosthetic team prior to surgery
C) It is best for the patient to be seen by the rehabilitation physician and prosthetic team 2 to 4 weeks after surgery
D) It is best for the patient to be seen by the rehabilitation physician and prosthetic team only after the residual limb has healed
B) It is best for the patient to be seen by the rehabilitation physician and prosthetic team prior to surgery
Which of the following is important in the acute post-op period for the new amputee?
A) Psychological counseling
B) Skin desensitization
C) Pain management
D) All of the above
D) All of the above
What is the name for the amputation that removes the entire radius, ulna, carpals, metacarpals, and phalanges?
A) Below the elbow
B) Above the elbow
C) Mid elbow
D) Elbow disarticulation
D) Elbow disarticulation
What is the preferred term for the remaining portion of the limb after amputation?
A) Residual limb
B) Stump
C) Stub
D) Post-surgical limb
A) Residual limb
How often does a prosthesis need to be replaced in a child age 0 to 5?
A) Every 6 months
B) Every 12 months
C) Every 18 months
D) Every 24 months
B) Every 12 months
Which of the following is not a common dermatological problem in patients with prosthetic devices?
A) Hyperhidrosis
B) Folliculitis
C) Skin breakdown
D) All of the above are common
D) All of the above are common
Which of the following is not a type of terminal device in upper limb prosthetics?
A) Mechanical
B) Electrical
C) Passive
D) Piston
D) Piston
Which of the following is true about joint contractures after amputation surgery?
A) Prevention is harder than treatment
B) It is ok to wait to prevent joint contractures until many weeks after amputation surgery
C) It will not increase the patient’s risk of contracture if there is a burn present
D) In the case of a concomitant nerve injury, passive and assisted range of motion should be implemented to preserve joint mobility
D) In the case of a concomitant nerve injury, passive and assisted range of motion should
be implemented to preserve joint mobility
What is a benefi t of elbow disarticulation surgery as opposed to transradial or transhumeral?
A) Less blood loss
B) More blood loss
C) Longer surgery time
D) Better cosmesis and prosthetic fit
A) Less blood loss
What is true about edema as a complication following amputation surgery?
A) It is an uncommon complication
B) A fi gure 8 dressing should not be used
C) The ideal shape of the residual limb in the upper extremity is cylindrical
D) It is ok to re-wrap the residual limb every 24 hours to provide optimum edema control
C) The ideal shape of the residual limb in the upper extremity is cylindrical
Which is a benefi t of an immediate post-op rigid dressing (IPORD)?
A) Desensitization of the residual limb
B) Control edema
C) Protection of the residual limb
D) All of the above
D) All of the above
Which of the following is not a key function of the prosthetic socket?
A) Adequate cosmesis
B) Secure suspension of prosthesis
C) Effi cient energy transference to the prosthesis
D) Grasp objects
D) Grasp objects
Which of the following body actions will not activate the terminal device on an upper
extremity prosthetic?
A) Scapular abduction
B) Shoulder extension
C) Chest expansion
D) Humeral flexion
B) Shoulder extension
What could be considered a positive aspect of a child with a congenital limb deficiency?
A) The prosthesis is perceived as an aid rather than a replacement
B) The child does not usually experience a sense of loss since the limb was absent from birth
C) The child does not put limitations on oneself
D) All of the above
D) All of the above
What is the natural position caused by the resting muscle tension of the hand?
A) Wrist flexed, metacarpophalangeal (MCP) joint fl xed, proximal interphalangeal (PIP)
joint flexed, distal interphalangeal (DIP) joint flexed
B) Wrist extended, MCP extended, PIP flexed, DIP flexed
C) Wrist flexed, MCP extended, PIP flexed, DIP flexed
D) Wrist extended, MCP extended, PIP extended, DIP extended
C) Wrist flexed, MCP extended, PIP flexed, DIP flexed