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Exam
Question 1. Which K-level most accurately describes a patient who walks on uneven terrain, climbs stairs without assistance, and can walk for more than six blocks continuously? A) K1 – Limited household ambulator B) K2 – Limited community ambulator C) K3 – Community ambulator with variable cadence D) K4 – Unlimited community ambulator Answer: C Explanation: K3 patients have the ability to ambulate in the community, negotiate variable terrain, and maintain a variable cadence, matching the described functional profile. Question 2. During the residual limb physical examination, which finding would most strongly contraindicate the use of a total surface bearing (TSB) socket? A) Presence of a well-healed distal end scar B) Excessive soft tissue volume fluctuation during the day C) A prominent tibial tuberosity D) Skin maceration over the medial distal stump Answer: D Explanation: Skin maceration indicates compromised skin integrity; a TSB socket distributes pressure over the entire stump and could exacerbate maceration, making it contraindicated. Question 3. The most reliable method for measuring the circumferential dimension of a transtibial residual limb is: A) Measuring with a flexible tape while the patient is seated B) Measuring with a flexible tape while the patient is standing, weight-bearing on the stump C) Measuring with a rigid measuring device while the patient is supine
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D) Estimating based on the length of the limb Answer: B Explanation: Weight-bearing measurements reflect true limb shape under load, providing the most accurate circumferential data for socket design. Question 4. Which suspension system provides the highest level of proximal-distal stability for an active transtibial amputee? A) Suction socket B) Pin-lock lock C) Vacuum-assisted suspension (VAS) D) Sleeve suspension Answer: C Explanation: VAS creates a negative pressure seal that minimizes pistoning and maximizes stability, especially for high-activity users. Question 5. An energy-storing foot is most appropriate for a patient who: A) Requires maximum durability for heavy work environments B) Walks primarily on level surfaces at a slow pace C) Engages in high-impact activities such as jogging or running D) Has a K1 functional level Answer: C Explanation: Energy-storing feet store and release kinetic energy, benefitting high-impact, dynamic activities like jogging. Question 6. In dynamic alignment, an observed excessive lateral trunk lean during stance phase most likely indicates: A) Knee hyperextension on the prosthetic side
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Question 9. When selecting a knee mechanism for a patient with poor balance and frequent stumbling, which feature is most critical? A) Low friction lock-out at terminal swing B. Polycentric swing-phase geometry C) Microprocessor-controlled stance-phase resistance D) Hydraulic swing-phase damping Answer: C Explanation: Microprocessor-controlled knees can adapt stance-phase resistance in real time, providing enhanced stability for patients with balance deficits. Question 10. The quadrilateral socket design differs from the ischial containment design primarily by: A) Extending proximally to the iliac crest B) Providing a deeper posterior wall for better suspension C) Allowing more freedom of hip motion by not capturing the ischial tuberosity D) Using a total surface bearing interface exclusively Answer: C Explanation: Quadrilateral sockets do not contain the ischial tuberosity, thereby permitting greater hip range of motion but offering less medial-lateral control. Question 11. During static alignment, the prosthetic pelvis should be level with the sound side when the patient is: A) Standing on the prosthetic side only B) Standing with weight evenly distributed on both limbs C) Sitting with legs dangling D) Lying supine
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Answer: B Explanation: A level pelvis with equal weight bearing indicates correct prosthetic length and alignment during static assessment. Question 12. Which component adjustment is most likely to reduce a “whip” gait pattern in a transfemoral amputee? A) Increase foot dorsiflexion resistance B) Decrease knee flexion resistance during stance C) Add anterior-posterior offset to the pylon D) Increase pylon stiffness Answer: B Explanation: A “whip” gait is often caused by excessive knee flexion resistance; reducing it allows smoother transition through stance and reduces the whip effect. Question 13. A patient reports distal end pressure that worsens after walking for 30 minutes. The most appropriate first intervention is: A) Replace the foot with a higher-profile model B) Add a distal gel liner pad C) Increase the socket volume by adding a plaster cast D) Switch to a patellar-tendon-bearing (PTB) socket design Answer: B Explanation: Adding a gel pad directly addresses localized distal pressure without altering socket geometry, providing immediate relief. Question 14. Which of the following is a common sign of suspension failure (pistoning) in a suction socket? A) Skin breakdown over the patellar tendon B) Audible “click” during swing phase
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A) To concentrate load on the distal end of the residual limb B) To distribute weight over the patellar tendon and medial distal stump while relieving pressure on the proximal tibia C) To provide a rigid, non-compressible interface for high-impact activities D) To eliminate the need for a prosthetic foot Answer: B Explanation: PTB sockets intentionally load the patellar tendon area and distal stump, sparing the proximal tibia and improving comfort. Question 18. During donning, the most common mistake that leads to poor proximal socket fit is: A) Pulling the liner off the limb before placing the socket B) Seating the residual limb too far anteriorly in the socket C) Aligning the prosthetic foot with the contralateral foot D) Using a sock ply that is too thick for the day’s volume Answer: B Explanation: Seating the limb too far anteriorly causes excessive distal pressure and proximal instability, compromising socket fit. Question 19. When a patient experiences “knee buckling” during mid-stance, the most likely prosthetic cause is: A) Excessive heel height on the foot B) Insufficient stance-phase resistance in the knee unit C) Over-lengthened pylon D) Inadequate socket trim line on the anterior femur Answer: B Explanation: Insufficient stance-phase resistance fails to support the load, leading to knee buckling during weight bearing.
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Question 20. Which of the following is a key indicator that a transtibial prosthetic foot is too stiff for a patient’s activity level? A) Increased hip flexor fatigue after short walks B) Frequent stumbling on uneven ground C) Persistent heel pain after walking D) Reduced push-off power during terminal stance Answer: D Explanation: An overly stiff foot limits energy return, reducing push-off power and efficiency during terminal stance. Question 21. A transfemoral amputee presents with pain over the ischial tuberosity after 2 weeks of prosthetic use. The most likely cause is: A) Excessive distal end pressure B) Inadequate socket padding over the ischial area C) Over-tightened suspension lock D) Use of a total surface bearing socket Answer: B Explanation: Ischial tuberosity pain often results from insufficient padding or pressure concentration in that area within the socket. Question 22. Which of the following best explains why a microprocessor-controlled knee is advantageous for a patient with a high-K level who frequently navigates stairs? A) It provides a constant lock-out during stance phase B) It automatically adjusts stance resistance based on gait phase and terrain C) It eliminates the need for a prosthetic foot D) It reduces the overall weight of the prosthesis Answer: B
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C) Trim the anterior distal stump to reduce volume D) Switch to a PTB socket design Answer: B Explanation: A flexible anterior panel accommodates volume changes without excessive compression, improving comfort. Question 26. Which of the following is the most appropriate method for educating a new amputee about prosthetic care? A) Provide a lengthy pamphlet and expect the patient to read it independently B) Demonstrate cleaning procedures, then have the patient practice under supervision C) Rely on the patient’s caregiver to handle all maintenance tasks D) Schedule a group lecture without individualized instruction Answer: B Explanation: Hands-on demonstration with supervised practice ensures comprehension and skill acquisition. Question 27. During a gait analysis, a patient exhibits a “circumduction” pattern on the prosthetic side. The most likely prosthetic cause is: A) Excessive foot dorsiflexion resistance B) Knee flexion lock-out during swing phase C) Insufficient socket rotation control (excessive medial-lateral movement) D) Over-lengthened prosthetic limb Answer: C Explanation: Medial-lateral instability leads the patient to swing the foot outward (circumduction) to clear the ground.
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Question 28. Which of the following best describes the function of a “pylon” in a lower-extremity prosthesis? A) To provide cosmetic shape and external appearance B) To transmit loads between the socket and terminal device while providing structural support C) To house electronic components for microprocessor knees D) To act as a shock-absorbing element for high-impact activities Answer: B Explanation: The pylon’s primary role is to transmit forces from the socket to the foot and provide rigidity. Question 29. A prosthetist notes that a patient’s residual limb volume decreases by 1 cm in circumference each afternoon. Which intervention would most effectively manage this change? A) Use a rigid, non-adjustable socket B) Provide a vacuum-assisted suspension system C) Increase the number of sock ply during the day D) Switch to a total surface bearing socket Answer: B Explanation: VAS maintains consistent socket-limb interface pressure despite volume fluctuations, reducing the need for daily sock changes. Question 30. Which of the following is the most critical factor when selecting a prosthetic foot for a patient who primarily works in a construction environment with heavy loads? A) Energy storage capability B) High durability and load-bearing capacity C) Low weight for increased speed D) Adjustable heel height
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Question 33. A patient with a transfemoral amputation reports “locking” of the knee during swing, causing a “stiff-knee” gait. The most likely prosthetic adjustment is: A) Increase the hydraulic damping in swing phase B) Decrease the friction lock-out resistance in swing phase C. Add a heel wedge to the foot D) Shorten the pylon length Answer: B Explanation: Reducing swing-phase resistance allows the knee to flex freely, eliminating the stiff-knee gait. Question 34. Which clinical sign suggests that the femoral component of a transfemoral socket is too distal? A) Excessive hip flexion while standing B) Posterior pelvic tilt and difficulty achieving full extension on the prosthetic side C) Anterior knee pain on the sound side D) Increased gait speed Answer: B Explanation: A distal socket pushes the femur forward, causing posterior pelvic tilt and limiting full hip extension. Question 35. When evaluating a residual limb for skin integrity, which observation would most likely indicate the need for a change in liner material? A) Dry, scaly skin on the anterior tibia B) Redness and warmth over the distal end after a day of wear C) Presence of superficial callus formation on the lateral side D) Normal skin texture and tone throughout the limb
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Answer: B Explanation: Redness and warmth suggest irritation or early breakdown; a liner with better moisture management may be required. Question 36. Which of the following components is most likely to be adjusted to reduce a “vaulted gait” in a transtibial amputee? A) Increase the forefoot stiffness of the prosthetic foot B) Decrease the heel height of the prosthetic foot C) Add a posterior pad to the socket D. Shorten the pylon length Answer: B Explanation: Reducing heel height decreases the need for the patient to lean forward (vault) to clear the foot during swing. Question 37. The primary advantage of a “single-axis” prosthetic knee over a polycentric knee for a low-activity user is: A) Greater mechanical complexity for smoother gait B) Simpler alignment and fewer maintenance issues C) Automatic stance-phase locking D. Adjustable hydraulic resistance Answer: B Explanation: Single-axis knees are mechanically simple, easier to align, and require less maintenance, suiting low-activity users. Question 38. A patient who uses a pin-lock suspension reports occasional “pin-pull” discomfort during gait. The most appropriate modification is: A) Replace the pin-lock with a suction socket B) Trim the anterior distal socket wall to reduce pin tension
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A) Excessive foot dorsiflexion resistance B) Insufficient knee flexion during swing phase C) Over-lengthened pylon D) Inadequate socket suspension Answer: B Explanation: Limited knee flexion forces the hip to lift (hike) to achieve foot clearance during swing. Question 42. Which of the following best describes the role of “socket flexion” in a transfemoral prosthesis? A) To allow the socket to bend during gait, reducing stress on the residual limb B) To lock the knee in extension during stance C) To provide an adjustable angle for the foot during swing D. To increase the weight of the prosthesis for better balance Answer: A Explanation: Socket flexion enables controlled bending of the socket, improving comfort and mimicking natural limb movement. Question 43. A prosthetist must document a patient’s informed consent for a new microprocessor knee. Which element is NOT required in the documentation? A) Description of the device’s functions and limitations B) Statement of the patient’s understanding and agreement C) List of all alternative prosthetic knee options considered D. The prosthetist’s personal opinion about the patient’s lifestyle Answer: D
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Explanation: While the prosthetist’s recommendation may be noted, personal opinions unrelated to clinical decision-making are not required in consent documentation. Question 44. Which of the following is the most appropriate method to assess residual limb volume fluctuations throughout the day? A) Measuring limb circumference with a flexible tape at multiple time points B. Estimating volume based on patient’s weight changes C) Using a digital scanner only in the morning D) Relying on patient’s subjective report of tightness Answer: A Explanation: Direct circumferential measurements at several intervals provide objective data on volume changes. Question 45. When a patient experiences “pistoning” in a suction socket, which immediate corrective action is most effective? A) Increase the socket’s proximal wall thickness B) Apply an external strap to the socket C) Re-seal the socket-limb interface by cleaning the skin and ensuring no debris is present D. Replace the socket with a vacuum-assisted system without further assessment Answer: C Explanation: Removing debris and ensuring a clean seal often restores suction and eliminates pistoning. Question 46. Which of the following best explains why a patient with a high-K level may benefit from a “dynamic response” foot? A) It provides maximum cushioning for low-impact activities B) It stores and releases energy, enhancing walking efficiency and speed
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A) Allows quick length adjustments and component changes without full socket replacement B. Provides built-in energy storage for the prosthesis C) Eliminates the need for a prosthetic foot D) Guarantees a permanent vacuum seal Answer: A Explanation: Modular pylons enable easy length modifications and component swaps, facilitating adjustments for volume changes. Question 50. During a static alignment check, the patient’s prosthetic limb appears 1 cm longer than the sound limb, resulting in a tilted pelvis. The most appropriate corrective action is: A) Add a distal shoe lift to the sound side B. Shorten the pylon by the measured discrepancy C) Increase the socket length on the prosthetic side D) Adjust the foot’s heel height on the prosthetic side Answer: B Explanation: Shortening the pylon directly corrects the length discrepancy and levels the pelvis. Question 51. Which of the following best characterizes “microprocessor-controlled ankle” technology? A) A fixed-angle foot that does not adapt to terrain B. A foot that senses ground reaction forces and adjusts dorsiflexion/plantarflexion in real time C) A foot with interchangeable carbon plates for different activities D) A foot that requires manual adjustment before each use Answer: B
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Explanation: Microprocessor ankles use sensors to detect forces and modify ankle motion dynamically. Question 52. A patient with a transtibial amputation experiences “skin maceration” over the distal stump after a day of wear. The most appropriate short-term intervention is: A) Switch to a total surface bearing socket immediately B. Replace the liner with a moisture-wicking, breathable material C) Increase the number of sock ply to reduce pressure D) Add a hard acrylic liner over the distal area Answer: B Explanation: Moisture-wicking liners reduce maceration by managing sweat and moisture, providing immediate relief. Question 53. Which of the following is the most accurate description of “hip abductor moment” during prosthetic gait? A) The torque generated by the prosthetic foot during push-off B) The force produced by the hip abductors to maintain pelvic stability in stance C. The resistance offered by the knee unit during swing D) The energy stored in the pylon during mid-stance Answer: B Explanation: The hip abductor moment counters the lateral shift of the center of mass, keeping the pelvis level during stance. Question 54. In a patient with a transfemoral amputation, which socket design is most likely to reduce “socket pistoning” caused by rapid volume loss during activity? A) Patellar-tendon-bearing socket B) Vacuum-assisted suspension socket with a flexible liner
