Prosthetics and Orthotics Practice Questions

Q: At what level is a below-knee amputation typically performed?

10 cm below the tibial tuberosity. **Explanation:** The ideal level for a below-knee (transtibial) amputation is **10 cm below the tibial tuberosity** (or approximately 12.5–15 cm below the knee joint line). This level is considered the "gold standard" because it preserves a sufficient bony lever arm for efficient mobilization while ensuring adequate soft tissue coverage for prosthetic fitting. * **Why 10 cm is correct:** At this length, the stump is long enough to provide mechanical advantage for the quadriceps and hamstrings, yet short enough to allow for the bulky components of modern prosthetic sockets. It also ensures that the skin is well-vascularized, reducing the risk of flap necrosis. * **Why A (5 cm) is incorrect:** A stump shorter than 8–10 cm provides a very poor lever arm. The short segment often slips out of the prosthetic socket during flexion, making walking difficult and unstable. * **Why C & D (15–20 cm) are incorrect:** Amputations in the lower third of the leg are discouraged because the distal leg has poor vascularity and minimal muscle bulk. This leads to thin, fragile skin over the bone, frequent wound breakdown, and chronic pain due to inadequate padding. **High-Yield Clinical Pearls for NEET-PG:** * **Burgess Flap:** The standard technique uses a **long posterior myofascial flap** because the posterior calf skin has a better blood supply than the anterior skin. * **Nerve Management:** Nerves (like the tibial nerve) should be pulled distally, cut, and allowed to retract proximally to prevent the formation of painful **junctional neuromas**. * **Fibula Management:** The fibula is typically cut **1–2 cm shorter** than the tibia to prevent lateral pressure sores within the prosthesis. * **Ideal Stump Shape:** The final stump should be **conical** or cylindrical, never bulbous, to facilitate prosthetic use.

Q: What is the most common cause of amputation?

Peripheral vascular disease. **Explanation:** The correct answer is **Peripheral Vascular Disease (PVD)**. **1. Why Peripheral Vascular Disease is correct:** Globally and in modern clinical practice, PVD (often associated with **Diabetes Mellitus**) is the leading cause of limb amputations, accounting for nearly 80-90% of all cases in the elderly population. The underlying pathophysiology involves chronic ischemia, non-healing arterial ulcers, and subsequent gangrene. In diabetic patients, the combination of "angiopathy, neuropathy, and immunopathy" significantly increases the risk of lower-limb loss. **2. Why other options are incorrect:** * **Trauma:** While trauma is the leading cause of amputation in **young adults and children** (specifically machinery accidents or vehicular trauma), it ranks second to vascular diseases in the general population. * **Frostbite and Burns:** These are classified under thermal injuries. While they can lead to necrosis necessitating amputation, they represent a very small percentage of total cases compared to chronic systemic diseases. **3. NEET-PG High-Yield Pearls:** * **Most common cause overall:** Peripheral Vascular Disease (PVD). * **Most common cause in young adults:** Trauma. * **Most common site of amputation:** Lower limb (specifically the toe or transtibial/below-knee). * **Ideal Stump Shape:** Cylindrical (facilitates better prosthetic fitting). * **Myodesis vs. Myoplasty:** *Myodesis* (suturing muscle to bone) is preferred over *myoplasty* (suturing muscle to muscle) in major amputations to provide better distal muscle stabilization. * **Krukenberg Procedure:** A specialized amputation of the forearm that creates a "pincer" grip using the radius and ulna, indicated for bilateral hand loss in blind patients.

Q: The following splint is used in the treatment of?

Lumbrical paralysis. ***Lumbrical paralysis*** - The **lumbrical substitution splint** (knuckle-bender splint) is specifically designed to compensate for **lumbrical muscle paralysis** in ulnar nerve injuries by assisting **MCP flexion** and **IP extension**. - This splint prevents the **paradoxical extension** at MCP joints that occurs when lumbricals are paralyzed, allowing proper finger function and grip strength. *Claw hand* - While **claw hand deformity** can result from lumbrical paralysis, it's the broader clinical presentation rather than the specific target of this splint type. - Claw hand involves multiple muscle groups and may require different splinting approaches depending on the **underlying cause** and **severity of deformity**. *Wrist drop* - **Wrist drop** is treated with a **cock-up splint** that supports the wrist in extension, not the knuckle-bender splint shown. - This condition results from **radial nerve palsy** affecting **wrist extensors**, requiring different biomechanical support than lumbrical substitution. *None of the above* - This option is incorrect as the splint shown has a **specific clinical indication** for lumbrical paralysis. - The **lumbrical substitution splint** is a well-recognized orthotic device used in **hand rehabilitation** and ulnar nerve palsy management.

Q: Taylor's Brace is used for which of the following?

Dorsolumbar immobilization. **Explanation:** **Taylor’s Brace** is a high-yield spinal orthosis in orthopaedics. It is a **thoraco-lumbo-sacral orthosis (TLSO)** designed specifically for **dorsolumbar immobilization**. The brace consists of two vertical posterior bars (paraspinal bars) and a pelvic band. It works on the principle of **three-point pressure**, providing hyperextension to the spine. By limiting flexion and rotation of the thoracolumbar junction, it stabilizes the spine, making it the gold standard for conditions like **Pott’s disease (Spinal TB)** and stable compression fractures of the lower thoracic or upper lumbar vertebrae. **Analysis of Options:** * **A. Cervical immobilization:** This requires a cervical collar (e.g., Philadelphia collar) or a Halo-vest. Taylor’s brace does not extend high enough to stabilize the neck. * **C. Scoliosis:** While some TLSOs are used for scoliosis, the specific brace of choice is usually the **Milwaukee brace** (for high curves) or the **Boston brace** (for lower curves). Taylor’s brace is for immobilization, not for corrective lateral forces. * **D. Fracture femur:** Femur fractures are managed with traction, intramedullary nails, or plates; orthotic management involves a Thomas splint or a Knee-Ankle-Foot Orthosis (KAFO), not a spinal brace. **Clinical Pearls for NEET-PG:** * **Ashman’s/Knight’s Brace:** Used for Lumbo-sacral immobilization (LSO). * **Milwaukee Brace:** A CTLSO used for Scoliosis with an apex above T8. * **Somersault/SOMI Brace:** Used for cervical spine injuries (C4-C5 level). * **Key Component:** Taylor’s brace specifically restricts **flexion and extension** of the dorsolumbar spine.

Q: Which of the following is NOT a characteristic of an ideal amputation stump?

Adherent. ### Explanation An ideal amputation stump is designed to be functional, pain-free, and capable of efficient weight-bearing within a prosthesis. **Why "Adherent" is the Correct Answer:** An **adherent scar** is a major complication in amputation surgery. If the skin and subcutaneous tissues are fixed (adherent) to the underlying bone, the constant friction and shear forces between the prosthesis and the bone will lead to skin breakdown, chronic ulceration, and pain. An ideal stump must have **mobile, non-adherent skin** with a sufficient cushion of soft tissue (muscle and fat) over the bone end to prevent pressure necrosis. **Analysis of Incorrect Options:** * **Non-tender:** A stump must be non-tender to allow for comfortable weight-bearing. Tenderness often indicates the presence of a **neuroma** (specifically a "terminal neuroma") or underlying infection. * **Healed:** Complete primary healing of the surgical wound is mandatory before prosthetic fitting to prevent infection and dehiscence. * **Non-bullous:** The presence of bullae (blisters) or edema indicates poor vascularity, friction, or an ill-fitting socket, all of which contraindicate successful prosthetic use. **High-Yield Clinical Pearls for NEET-PG:** * **Shape:** The ideal stump shape is **conical** (in adults) or cylindrical to facilitate prosthetic fitting. * **Nerve Management:** Nerves should be pulled distally, cut cleanly, and allowed to retract proximally into soft tissue to prevent symptomatic neuromas. * **Muscle Management:** **Myodesis** (suturing muscle to bone) is generally preferred over myoplasty (suturing muscle to muscle) for better distal stabilization. * **Bone End:** Should be rounded and smooth; in children, overgrowth is a common complication.

Q: Cock-up splint is used in which of the following conditions?

Radial nerve injury. **Explanation:** **Radial Nerve Injury (Correct Answer):** The radial nerve innervates the extensors of the wrist and fingers. Injury to this nerve (commonly seen in mid-shaft humerus fractures) leads to **Wrist Drop**. A **Cock-up splint** is used to maintain the wrist in 20–30 degrees of extension. This prevents the overstretching of paralyzed extensor muscles and prevents contractures of the flexor tendons, thereby maintaining a functional position of the hand while the nerve recovers. **Analysis of Incorrect Options:** * **Median Nerve Injury:** This leads to "Ape Thumb Deformity" or "Pointed Index Finger." The appropriate orthosis is an **Opponens splint**, which maintains the thumb in opposition. * **Ulnar Nerve Injury:** This results in "Claw Hand" due to paralysis of the intrinsic muscles. The specific splint used is a **Knuckle Bender splint** (to prevent hyperextension at the MCP joints). * **Volkmann’s Ischemic Contracture (VIC):** This is a late sequela of compartment syndrome. While splinting is used, the classic orthosis is a **Turnbuckle splint** or a specialized static-progressive splint to stretch the flexor contractures. **High-Yield Clinical Pearls for NEET-PG:** * **Dynamic Cock-up Splint:** Specifically used for radial nerve palsy to allow active finger flexion while providing passive extension via rubber bands/springs. * **Saturday Night Palsy:** A common cause of radial nerve injury at the spiral groove. * **Functional Position of Wrist:** 20–30° extension with slight ulnar deviation. * **Aeroplane Splint:** Used for Brachial Plexus injuries or Axillary nerve palsy (to maintain abduction).

Q: Who invented the Jaipur foot?

P. K. Sethi. The **Jaipur Foot** is a world-renowned prosthetic limb specifically designed to meet the socio-cultural and geographical needs of patients in developing countries. ### **Explanation of Options** * **A. P. K. Sethi (Correct):** Dr. Pramod Karan Sethi, an orthopaedic surgeon, co-developed the Jaipur Foot in 1968 along with **Master Ram Chander Sharma** (a traditional craftsman). Dr. Sethi was awarded the Magsaysay Award and the Padma Shri for this innovation. The design was revolutionary because it allowed for squatting, sitting cross-legged, and walking on uneven terrain—activities difficult with the Western "SACH" (Solid Ankle Cushion Heel) foot. * **B. S. K. Verma:** Dr. S. K. Verma was a prominent figure in Physical Medicine and Rehabilitation (PMR) in India, but he was not the inventor of the Jaipur Foot. * **C. B. L. Sehgal:** Not associated with the primary invention or development of the Jaipur Foot. * **D. H. R. Gupta:** While there are many contributors to Indian orthopaedics, Dr. Gupta is not credited with the design of this specific prosthesis. ### **High-Yield Clinical Pearls for NEET-PG** * **Material:** The Jaipur Foot is made of **rubber** (outer), **wood** (inner), and **polyurethane**. It is waterproof and does not require shoes. * **Key Feature:** Unlike the SACH foot, the Jaipur Foot allows for **multi-axial mobility** (dorsiflexion, plantarflexion, inversion, and eversion), making it ideal for rural Indian conditions. * **Organization:** It is widely distributed by the NGO **Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS)**. * **Comparison:** While the **SACH Foot** is the most common prosthetic foot globally, the **Jaipur Foot** is the gold standard for barefoot walking and floor-level activities.

Q: "Cock-up" splint is used in the treatment of?

Radial nerve palsy. ### Explanation **Radial Nerve Palsy (Correct Answer)** Radial nerve injury leads to paralysis of the wrist and finger extensors, resulting in **Wrist Drop**. The **Cock-up splint** (also known as a wrist extension splint) is used to maintain the wrist in 20–30 degrees of extension. This prevents the overstretching of paralyzed extensor muscles and prevents contractures of the flexor tendons. By stabilizing the wrist, it also improves the "grip strength" by allowing the long finger flexors to work more efficiently. **Incorrect Options:** * **Ulnar Nerve Palsy:** Characterized by "Claw Hand." The specific orthosis used here is the **Knuckle Bender splint** (to prevent hyperextension at the MCP joints). * **Median Nerve Palsy:** Characterized by "Ape Thumb Deformity" and loss of opposition. The **Opponens splint** (Short or Long) is used to maintain the thumb in a functional position. * **Sciatic Nerve Palsy:** Results in "Foot Drop." The standard orthosis for this is an **AFO (Ankle-Foot Orthosis)** or a Foot Drop Splint to maintain the ankle in a neutral position. **Clinical Pearls for NEET-PG:** 1. **Dynamic Cock-up Splint:** Used specifically when there is a need to assist finger extension while allowing active flexion (often used in radial nerve recovery). 2. **Aeroplane Splint:** Used for Brachial Plexus injuries (Erb’s Palsy) or Axillary nerve injury to maintain the shoulder in abduction. 3. **Turnbuckle Splint:** Used to correct stiff joints and contractures (e.g., Elbow contractures). 4. **Somersault Test:** Used to check the integrity of the Radial nerve (ability to extend the thumb).

Q: Which of the following statements is FALSE about the SACH Foot?

Allows easy movement at the ankle. **Explanation:** The **SACH Foot (Solid Ankle Cushion Heel)** is the most commonly used non-articulated prosthetic foot. The core concept behind its design is that it provides **pseudo-motion** rather than true anatomical movement. 1. **Why Option A is False (Correct Answer):** The SACH foot is a **non-articulated** prosthesis, meaning it has no mechanical ankle joint. It does **not** allow actual movement (dorsiflexion or plantarflexion) at the ankle. Instead, the soft "cushion heel" compresses at heel strike, simulating plantarflexion to allow the forefoot to reach the ground. Because there is no actual joint, the statement that it "allows easy movement at the ankle" is incorrect. 2. **Why Option B is True:** Since the ankle is a solid internal wooden or plastic keel, there is no mechanism for mediolateral tilt. Therefore, **inversion and eversion are not possible**, making it unsuitable for uneven terrain. 3. **Why Option C is True:** SACH stands for **Solid Ankle Cushion Heel**, which accurately describes its components: a rigid internal keel (Solid Ankle) and a compressible foam heel (Cushion Heel). 4. **Why Option D is True:** The SACH foot is designed to be worn with a shoe (usually with a 3/4 inch heel). Without the shoe, the prosthesis loses its alignment and stability, making **barefoot walking impossible** or highly unstable. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** It absorbs shock at heel strike through heel compression. * **Indication:** Ideal for sedentary patients, children, and those requiring a durable, low-maintenance, and inexpensive prosthesis. * **Contraindication:** Not recommended for active individuals or those walking on uneven surfaces (due to lack of inversion/eversion). * **Comparison:** Unlike the **Madras Foot**, which allows barefoot walking and squatting, the SACH foot is restricted to shod (shoed) walking.

Question 1

At what level is a below-knee amputation typically performed?

Accepted Answer

10 cm below the tibial tuberosity

Answer

5 cm below the tibial tuberosity

Answer

15 cm below the tibial tuberosity

Answer

20 cm below the tibial tuberosity

Question 2

What is the most common cause of amputation?

Accepted Answer

Peripheral vascular disease

Answer

Trauma

Answer

Frostbite

Answer

Burns

Question 3

The Milwaukee brace is used in the treatment of which of the following conditions?

Accepted Answer

Scoliosis

Answer

Kyphosis

Answer

Cubitus varus

Answer

Genu varum

Question 4

The following splint is used in the treatment of?

Accepted Answer

Lumbrical paralysis

Answer

Claw hand

Answer

Wrist drop

Answer

None of the above

Question 5

Taylor's Brace is used for which of the following?

Accepted Answer

Dorsolumbar immobilization

Answer

Cervical immobilization

Answer

Scoliosis

Answer

Fracture femur

Question 6

Which of the following is NOT a characteristic of an ideal amputation stump?

Accepted Answer

Adherent

Answer

Non-tender

Answer

Healed

Answer

Non-bullous

Question 7

Cock-up splint is used in which of the following conditions?

Accepted Answer

Radial nerve injury

Answer

Median nerve injury

Answer

Ulnar nerve injury

Answer

Volkmann's ischemic contracture

Question 8

Who invented the Jaipur foot?

Accepted Answer

P. K. Sethi

Answer

S. K. Verma

Answer

B. L. Sehgal

Answer

H. R. Gupta

Question 9

"Cock-up" splint is used in the treatment of?

Accepted Answer

Radial nerve palsy

Answer

Ulnar nerve palsy

Answer

Median nerve palsy

Answer

Sciatic nerve palsy

Question 10

Which of the following statements is FALSE about the SACH Foot?

Accepted Answer

Allows easy movement at the ankle

Answer

No inversion and eversion

Answer

Solid ankle cushion heel

Answer

Base foot walking is not possible

Prosthetics and Orthotics — MCQs

Prosthetics and Orthotics — MCQs

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