CPT Patient Assessment & Clinical Evaluation 2 — Questions and Answers
Question 1: During residual limb assessment, a prosthetist notes a positive Tinel's sign at the distal end. This finding most likely indicates:
- Adequate skin integrity for prosthetic fitting
- Neuroma formation requiring further evaluation (Correct answer)
- Normal scar tissue maturation
- Optimal bony contouring
Correct answer: Neuroma formation requiring further evaluation
A positive Tinel's sign (tingling elicited by percussion) at the residual limb tip indicates neuroma formation, which can cause pain with prosthetic use.
Question 2: When assessing a transtibial amputee's residual limb, you observe that the fibular head is prominent and unpadded. The primary concern for prosthetic fitting is:
- Difficulty achieving suspension
- Pressure ulcer risk over the bony prominence (Correct answer)
- Cosmetic appearance of the prosthesis
- Reduced ankle range of motion
Correct answer: Pressure ulcer risk over the bony prominence
A prominent fibular head is a bony prominence that receives direct pressure inside the socket, significantly increasing ulceration risk.
Question 3: A patient's K-level is determined primarily by:
- Age and weight alone
- Rehabilitation potential and functional ability (Correct answer)
- Type of amputation and limb length
- Insurance coverage criteria
Correct answer: Rehabilitation potential and functional ability
K-levels (0–4) classify Medicare Functional Classification Levels based on the patient's rehabilitation potential and expected ambulation ability.
Question 4: Which clinical finding in a residual limb would CONTRAINDICATE immediate prosthetic fitting?
- Well-healed cylindrical residual limb
- Open wound or active infection (Correct answer)
- Mild residual limb edema
- Flexible knee contracture under 10 degrees
Correct answer: Open wound or active infection
An open wound or active infection is a direct contraindication to prosthetic fitting because the socket would impede healing and risk spreading infection.
Question 5: When measuring a patient for a transfemoral socket, the most critical measurement to ensure proper ischial containment is the:
- Thigh circumference at 3-inch intervals
- Ischial tuberosity width and A-P dimension (Correct answer)
- Total residual limb length
- Hip abductor muscle bulk
Correct answer: Ischial tuberosity width and A-P dimension
The ischial tuberosity width and anterior-posterior dimension are critical for designing an ischial containment socket that properly seats and supports the pelvis.
Question 6: A patient reports phantom limb pain that is burning and constant in nature. The clinician should document this as:
- Residual limb pain
- Phantom sensation
- Neuropathic phantom pain (Correct answer)
- Referred musculoskeletal pain
Correct answer: Neuropathic phantom pain
Burning, constant pain perceived in the absent limb segment is classified as neuropathic phantom limb pain, distinct from phantom sensation (non-painful awareness) or residual limb pain.
Question 7: During gait assessment of a transtibial prosthetic user, you observe lateral trunk bending toward the prosthetic side during stance. This deviation is MOST commonly caused by:
- Prosthetic foot set too far medially
- Socket that is too long
- Insufficient socket support or painful residual limb (Correct answer)
- Excessive dorsiflexion in the prosthetic foot
Correct answer: Insufficient socket support or painful residual limb
Lateral trunk lean toward the prosthetic side during stance often results from an uncomfortable or poorly fitting socket causing the patient to unload the limb by shifting body weight over it.
CPT Patient Assessment & Clinical Evaluation 2
During residual limb assessment, a prosthetist notes a positive Tinel's sign at the distal end.
This finding most likely indicates: