Boards: Other systems part 2

how long should treatment be for disk related symptoms?

10 minutes or less

what degrees of flexion should the neck be in to target the midcervical spine in traction

10-20 degrees flexion

If a ramp is one foot high, how long should it be?

12 feet. A wheelchair ramp should have 12 inches of horizontal run for each inch of vertical rise. So a rise of 12 inches would dictate that it has 12 feet for each inch.

what degrees of flexion should the neck be in to target the lower cervical spine in traction?

25-35 degrees flexion

When applying a compression bandage, which scenario would result in the greatest amount of applied pressure? A. increased applied bandage tension to a limb with a small radius. B. increased applied bandage tension to a limb with a large radius. C. decreased applied bandage tension to a limb with a small radius. D. decreased applied bandage tension to a limb with a large radius.

A. increased applied bandage tension to a limb with a small radius. Compression bandages follow the Law of Laplace, which states that the pressure of a bandage system is directly related to the tension applied to the bandage and inversely related to the radius of the limb. Therefore, the larger the surface area that a bandage covers, the more spread out the constant force of a bandage is.

Which of the following is a contraindication for the use of iontophoresis? A. insensate skin. B. open wounds. C. adipose tissue. D. sensitive skin.

A. insensate skin. Insensate skin in the area to be treated is considered a contraindication for the use of iontophoresis since the patient cannot feel the current and provide accurate feedback related to intensity.

Which type of ion does the cathode repel? A. positive. B. negative. C. neutral. D. alternating positive and negative.

A. positive. The cathode is negative therefore it repels the positive ion.

Iontophoresis: list parameters for calcific deposits, myositis ossificans

Acetic acid. negative polarity.

Which of the following objective measures is the most essential to monitor in order to ensure safe intermittent compression levels? A. resting heart rate. B. maximum blood pressure. C. capillary refill. D. body temperature.

C. capillary refill. Monitoring and documenting CRT is vital to confirm that blood flow is not being occluded by the intermittent compression.

What iontophoresis agent would be the most appropriate to treat muscle or joint pain? A. calcium chloride. B. iodine. C. salicylates. D. zinc oxide.

C. salicylates. Salicylates are chemicals found naturally in plants and are a major ingredient in aspirin and other pain relieving medications.

Droplet precautions

Can only be spread by 3 feet away or less; from fluids transmitted via sneezing, coughing etc. gown, mask, gloves. meningitis; pneumonia; sepsis, diphtheria; pertussis; influenza; mumps; rubella.

Ultrasound application should be avoided over which of the following areas? a. the anterior chest b. the medial thigh c. the axillary region d. the lateral neck

Ultrasound should not be applied over the lateral neck area since the carotid sinus is located in this region. Stimulation of the baroreceptors in the carotid sinus could disturb the normal pacing of the heart.

Which type of compression garment would be most effective to actively reduce existing edema? A. compression pump. B. short-stretch bandage. C. long-stretch bandage. D. compression garment.

D. Compression garment.

Which material has the largest specific heat? A. air. B. fat. C. bone. D. muscle.

D. Muscle. Materials with high specific heat require more energy to achieve the same temperature increase than materials with low specific heat.

When performing an independent standing pivot transfer, what would be the appropriate positioning of the therapist's knees? A. both knees on the outside of the patient's knees. B. both knees on the inside of the patient's knees. C. one knee on the inside of the patient's knee with a foot on the outside of the patient's foot. D. therapist only uses standby assistance without physical contact.

D. therapist only uses standby assistance without physical contact.

When performing intermittent traction on a split traction table, the table should be split: A. at the start of the session B. when the session is over C. when the traction force is at its lowest level D. when the traction force approaches its maximum force

D. when the traction force approaches its maximum force. The use of a split traction table can eliminate the majority of friction between the patient's body and the treatment table. If intermittent traction is used, the table should be split when traction approaches its maximum force.

Iontophoresis: list parameters for inflammation

Dexamethasone. negative polarity.

Contact precautions

Gown and gloves and disinfectant all the equipment. used for gastrointestinal, respiratory, skin or wound infections. multi-drug resistant bacteria, hepatitis A, diphtheria, herpes, impetigo, scabies, zoster.

A physical therapist decides to use mechanical lumbar traction to treat a patient with an L4 disk herniation. Which of the following patient positions and treatment parameters would be the most appropriate? A. patient in prone with a force of 25% of total body weight. B. patient in prone with a force of 50% of total body weight. C. patient in supine with a force of 25% of total body weight. D. patient in supine with a force of 50% of total body weight.

Patient in prone with a force of 25% of total body weight.

min assist

Patient performs 75% or more of activity

Why should acetate be utilized with iontophoresis when treating a patient with myositis ossificans, or calcium deposits?

The desired physiologic effect when using acetate (e.g., acetic acid) is the absorption of calcium.

Conduction

The direct transfer of heat from one substance to another substance that it is touching. Examples include: cold pack; cryo cuff; ice massage; hot pack; paraffin.

Which of the following is most likely to decrease the likelihood of a burn during iontophoresis? A. increasing the current density. B. decreasing the current density. C. decreasing the treatment time. D. decreasing space between electrodes.

The likelihood of a burn can be decreased by increasing the size of the cathode relative to the anode, decreasing the current density, and increasing the space between the electrodes.

Convection

The transfer of heat by the movement of a fluid or gas. examples include: cold or hot whirlpool; fluidotherapy.

Three person carry/lift

Three therapists carry a person from a stretcher to a bed. one person supports the head and shoulders while the other supports the trunk, another supports the legs.

What is the ratio of cardiac compressions to breaths during two-person cardiopulmonary resuscitation? a. 5:1. b. 10:1. c. 15:1. d. 30:2.

30:2

Wheelchair requirements: hallways clearance

36 inches wide.

at what rate should the transducer be moved in ultrasound?

4 cm per second

Wheelchair requirements: wheelchair turning radius or U-turn

60 inch width. 78 inch length.

When using an intermittent vasopneumatic compression device to treat a patient with lower extremity edema, which value best represents the upper pressure limit? A. 20 mm Hg. B. 40 mm Hg. C. 60 mm Hg. D. 80 mm Hg.

80 mm Hg. When using an intermittent vasopneumatic compression device for the treatment of edema, 40-80 mm Hg is an appropriate pressure for the lower extremities, while 30-60 mm Hg would be appropriate for the upper extremities.

Compression garments are available over the counter if they have a compression class (CC) of less than: A. 20 mm Hg. B. 30 mm Hg. C. 40 mm Hg. D. 50 mm Hg.

A. 20 mm Hg. anything higher requires prescription.

Which hip precaution would be most relevant to avoid when instructing a patient with a total hip arthroplasty using a posterolateral approach to move from supine to sidelying? A. avoid hip adduction. B. avoid hip extension. C. avoid hip flexion beyond 90 degrees. D. avoid hip medial rotation.

A. avoid hip adduction. A total hip arthroplasty using a posterolateral approach requires the patient to avoid flexion of the hip beyond 90 degrees, adduction, and medial rotation. Although hip flexion beyond 90 degrees is considered a contraindication with this surgical procedure, it is unlikely to occur when moving from supine to sidelying.

The maximum compression pressure for treatment of venous edema most closely approximates the: A. diastolic blood pressure. B. systolic blood pressure. C. maximum heart rate. D. resting heart rate.

A. diastolic blood pressure.

What form of current is used to drive medicine through the skin during iontophoresis? A. direct current. B. alternating current. C. constant current. D. sound waves.

A. direct current. Iontophoresis is a modality which uses continuous, direct electrical current to deliver therapeutically charged ions through the skin and into the systemic circulation.

what degrees of flexion should the neck be in to target the upper cervical spine in traction

0-5 degrees flexion

Which of the following ultrasound parameters is the most appropriate when attempting to increase the elasticity of the biceps muscle in a slightly overweight individual? a. 3 MHz, pulsed. b. 3 MHz, continuous. c. 1 MHz, pulsed. d. 1 MHz, continuous.

1 MHz, continuous. A 1 MHz frequency is preferred since the patient is slightly overweight and the targeted muscle is the biceps which requires deeper heating. A continuous mode is preferred over a pulsed mode since the goal is to increase muscle elasticity.

What percent grade does a wheelchair ramp need to be

an 8.3% grade; and it should possess 12 inches of horizontal run for each inch of vertical rise.

A ramp should be how wide?

at least 36 inches wide.

Which of the following ultrasound settings would result in the fastest rate of superficial tissue heating over a period of 5 minutes? a. 1 MHz at 1.0 W/cm2. b. 1 MHz at 2.0 W/cm2. c. 3 MHz at 1.0 W/cm2. d. 3 MHz at 2.0 W/cm2.

b. 1 MHz at 2.0 W/cm2. An ultrasound frequency of 3 MHz will be absorbed more superficially than 1 MHz and an intensity of 2.0 W/cm2 will result in more vigorous heating than 1.0 W/cm2. Therefore, the fastest rate of superficial heating will occur at a setting of 3 MHz at 2.0 W/cm2.

Which transmission-based precaution would be appropriate for a patient with pneumonia? a. airborne precautions. b. droplet precautions. c. contact precautions. d. standard precautions.

b. droplet precautions

Which precautions would be necessary when working with a patient with known influenza? a. contact precautions. b. droplet precautions. c. airborne precautions. d. neutropenic precautions.

b. droplet precautions.

Which of the following is not an absolute contraindication to ultrasound use? a. pregnancy b. fracture c. pacemaker d. cancer

b. fracture. Low dose ultrasound has been shown to accelerate fracture healing whereas high dose ultrasound will cause increased pain. As a result, ultrasound over a fracture site is classified as a precaution.

Ultrasound should not be applied over the site of a: a. tenotomy. b. laminectomy. c. tenodesis. d. synovectomy.

b. laminectomy. Applying ultrasound over the site of a laminectomy, especially in the acute phase, may be potentially dangerous due to the risk of cavitation occurring in the cerebrospinal fluid.

Phonophoresis typically administers all of the following medications transdermally except: a. lidocaine b. methotrexate c. dexamethasone d. hydrocortisone

b. methotrexate. Medications regularly used in phonophoresis include anti-inflammatory agents and analgesics. Methotrexate is a cancer medication and would not be administered using phonophoresis.

A patient with low back pain should be instructed to attempt to move a heavy object with which of the following maneuvers first, prior to utilizing other techniques? a. traditional lift. b. push and/or pull. c. deep squat lift. d. power lift.

b. push and/or pull.

Which sign or symptom is not associated with cardiac arrest? a. apnea. b. red, warm skin. c. absence of carotid or femoral pulse. d. dilated pupils.

b. red warm skin. Cardiac arrest occurs when cardiac function stops. Signs of cardiac arrest include apnea, absence of a carotid or femoral pulse, and dilated pupils. Due to the lack of oxygen, the individual's skin may appear pale and feel cool to touch.

Which of the following is considered to be an endogenous infection? a. gonorrhea b. syphilis c. shingles d. meningitis

c. shingles. An endogenous infection occurs when the causative organism comes from microbial life harbored within a person, such as shingles. An exogenous infection occurs when the causative organism is acquired from other individuals. Gonorrhea, syphilis, and meningitis are all examples of exogenous bacteria that enter the host.

When using therapeutic ultrasound, what is the difference in size of the total treatment area compared to the effective radiating area of the transducer? a. two times smaller. b. four times smaller. c. two times larger. d. four times larger.

c. two times larger.

Iontophoresis: list parameters for scar tissue, keloids, muscle spasms

calcium chloride. negative polarity.

Indications for ultrasound

calcium deposits. chronic inflammation. delayed soft tissue healing. dermal ulcers. joint contracture. plantar warts.

Iontophoresis: list parameters for fungal infections

copper sulfate. positive polarity

A patient with a severely compromised immune system suffering from herpes zoster would require: a. contact isolation precautions. b. droplet isolation precautions. c. airborne isolation precautions. d. airborne isolation precautions and contact isolation precautions.

d. airborne isolation precautions and contact isolation precautions. A patient with herpes zoster should be treated using contact precautions, however, because of the patients severely compromised immune system it would also be necessary to use airborne isolation precautions.

Ultrasound using water immersion would be most likely used to treat the: a. cervical spine. b. shoulder. c. hip. d. ankle.

d. ankle

Which of the following is not a potential therapeutic effect produced by continuous ultrasound? a. increased tissue extensibility b. decrease muscle spasm c. increased tissue metabolism d. decreased nerve conduction velocity

d. decreased nerve conduction velocity. Thermal effects of continuous ultrasound include acceleration of metabolic rate, modulation of pain, reduction of muscle spasm, decreased joint stiffness, increased nerve conduction velocity, increased circulation, and increased soft tissue extensibility. The extent of the thermal effects are dependent on the intensity, duration, and frequency selected.

Increasing cell membrane permeability is a primary goal of: a. sensory electrical stimulation b. motor electrical stimulation c. continuous ultrasound d. pulsed ultrasound

d. pulsed ultrasound. produces non-thermal effects from the alternating compressions and rarefaction cycles of sound waves. Nonthermal effects of ultrasound include increased cell and skin membrane permeability, increased intracellular calcium levels, facilitation of tissue repair, and promotion of normal cell function.

Which of the following is not a physical effect of spinal traction? A. stretch soft tissue. B. relax muscles. C. reduce disk protrusion. d. reduce sequestration.

d. reduce sequestration. Sequestration is a stage of herniation in which the nucleus pulposus breaks through the annulus fibrosis and lies outside the disk in the spinal canal. Mechanical traction would be ineffective in reducing this type of herniated disc.

Frequency of ultrasound affects what aspect of ultrasound?

depth. 1 MHz is used for deeper tissues, penetrating up to 5 cm; and 3 MHz is used for shallower tissues, penetrating at 1-3 cm.

Which ion is used clinically with iontophoresis to treat inflammatory conditions such as tendonitis and plantar fasciitis? A. acetate. B. dexamethasone. C. iodine. D. zinc.

dexamethasone

Radiation

direct transfer of heat from a radiation energy source of higher temp to one of cooler temp. Examples include: infrared lamp; laser; ultraviolet light.

non thermal ultrasound used:

earlier in the healing process; as frequently as once a day

thermal ultrasound used:

for later in the healing process; 2-3 times a week.

Dépendant squat pivot transfer

for patients who can't stand independently, but can bear some weight through trunk and lower extremities. patient is positioned at a 45 degree angle to the mat surface. Therapist holds patient around hips and under glutes; while patient rests hands on therapist's shoulder. therapist pivots patient and lowers them.

What dimensions of a ramp would dictate that it needs handrails?

if it has a rise greater than 6 inches, or a horizontal run greater than 72 inches.

Which goal would be the most critical in the medical management of a patient with shock? a. increase hydration. b. increase peripheral resistance. c. increase oxygenation. d. increase mean arterial pressure.

increase oxygenation. Shock is characterized by a widespread serous reduction of tissue perfusion, that if prolonged, leads to generalized impairment of cellular functioning. As a result, the primary goal is to optimize oxygen delivery and reduce the demand placed on the heart.

non thermal effects of ultrasound

increased cell membrane permeability; increased intracellular calcium levels; facilitation of tissue repair; promotion of normal cell function. non thermal effects occur as a result of cavitation and acoustic micro streaming.

Iontophoresis: list parameters for scars, adhesive capsulitis

iodine. negative polarity.

Wheelchair requirements: carpet

less than 1/2 inch pile

Wheelchair requirements: Threshold

less than 3/4 inch for sliding doors. less than 1/2 inch for other doors.

Iontophoresis: list parameters for analgesia, inflammation:

lidocaine. positive polarity.

Wheelchair requirements: forward reach in wheelchair

low reach: 15 inches. high reach: 48 inches.

Iontophoresis: list parameters for muscle spasms, ischemia

magnesium sulfate. positive polarity.

Wheelchair requirements: Doorway

minimum of 32 inch width. maximum of 24 inch depth.

Mod A

moderate assistance - 50% or less

Conversion

non thermal energy is absorbed into tissue and transformed into heat. examples include: diathermy; ultrasound.

List contraindications for traction

osteoporosis. positive alar ligament test. positive vertebral artery test. pregnancy. advanced rheumatoid arthritis. TMJ dysfunction - requires a halter.

max assist

patient requires 75% assist from therapist to complete task

Which of the following will increase the absorption of topical medication when using phonophoresis on the forearm? a. dehydration. b. thick callous. c. preheating the skin. d. elevating the extremity.

preheating the skin

When setting the amount of pressure for an intermittent vasopneumatic compression device, which value would most likely restrict arterial blood flow and create a potential medical emergency? A. pressure greater than the recorded diastolic blood pressure. B. pressure less than the recorded diastolic blood pressure. C. pressure greater than the recorded systolic blood pressure. d. pressure less than the recorded systolic blood pressure.

pressure greater than the recorded systolic blood pressure. Failure to follow this guideline can result in serious cardiovascular complications.

Disk protrusions; which position do you treat them in for lumbar traction:

prone; the spine can extend and forces on the disk are directed anteriorly. most disk herniations occur in a posterolateral direction.

Wheelchair requirements: Side reach in wheelchair

reach over obstruction to 24 inches.

Airborne precautions

require respiratory protection when entering patients room. for diseases such as measles, varicella. tuberculosis.

Iontophoresis: list parameters for muscle and joint pain, plantar warts.

salicylates. negative polarity.

Two person lift

some patients cannot bear weight on their lower extremities and must be lifted onto the table; Standing behind the patient the first therapist should place their hands under the patients armpits. Then they cross their arms and grab the patient's opposite forearm as the patient has arms crossed. other therapist places one arm under mid to distal thighs and other arm is used to support the legs.

Spinal stenosis: which position do you treat them in for lumbar traction

supine and flexed spine position: increases intervertebral foramen opening.

Evaporation

transfer of heat energy when a liquid is changed to a gas. examples include: vapocoolant spray.

how long is traction for other conditions in the back other than disk?

up to 30 minutes

phonophoresis

use of ultrasound waves to introduce medication across the skin and into the subcutaneous tissues

Iontophoresis: list parameters for healing, dermal ulcers, wounds

zinc oxide. positive polarity.

Which of the following is considered an indication for the use of superficial heat? A. acute pain. B. chronic pain. C. acute thrombophlebitis. D. chronic thrombophlebitis.

B. chronic pain. Superficial thermotherapy is indicated for increasing range of motion, decreasing muscle guarding or spasm, managing subacute or chronic pain, and subacute or chronic inflammatory conditions. Thrombophlebitis, a blood clot, is a contraindication to the use of superficial thermotherapy.

If a patient is trying to move upward in bed, what should their starting position be? A. scapulae depressed, feet close to buttocks B. scapulae elevated, feet close to buttocks C. scapulae depressed, feet far away from buttocks D. scapulae elevated, feet far away from buttocks

B. scapulae elevated, feet close to buttocks. If a patient wishes to move upward in bed, they should begin with their hips and knees flexed with their feet close to their buttocks and with their scapulae elevated and elbows bent at their sides. The patient will then elevate their pelvis off the bed (i.e., bridge) as they push away with their feet and depress their scapulae to move upwards.

Which mode of traction is indicated for an acute condition? A. pulsed B. static C. intermittent D. continuous

B. static. Static traction is indicated for reduction of disk herniation, lengthening of soft tissue, and reduction of pain. This mode is chosen for more acute conditions to avoid the stretch reflex response and hypersensitivity of soft tissue that may be associated with intermittent traction.

Cervical traction parameters

Initial session: 10 lbs is recommended. a force of 7-10% of the patient's body weight or 11-15 lbs is adequate to treat muscle spasm and disk protrusion. 13-20% of the patient's body weight; or 20-30 lbs; is required for joint distraction. traction should not exceed 30 lbs.

Wheelchair requirements: bathroom sink

Not less than 29 inch height. not greater than 40 inches from floor to bottom of mirror or paper dispenser. 17 inch minimum depth under sink to back wall.

Americans with disabilities act

Passed by Congress in 1991, this act banned discrimination against the disabled in employment and mandated easy access to all public and commerical buildings. Divided into 5 titles: employment; public services; public accommodations; telecommunications; miscellaneous.

Lumbar traction parameters:

a force of 25% of the patient's body weight is required to overcome the force of friction on them. A max of 30 lbs should be applied for the initial traction session. 25% of body weight can be used for a soft tissue stretch as well as treating muscle spasm or disk protrusion. a force of 50% is required for actual separation of the vertebrae.

Which type of protective equipment needs to be worn if airborne precautions are being followed? a. N-95 respirator. b. gloves and gown. c. gloves, gown, and N-95 respirator. d. gloves, gown, and mask.

a. N-95 respirator.

Which of the following is not a sign or symptom of a severe allergic reaction? a. coughing. b. swelling of the face. c. difficulty speaking. d. nausea.

a. coughing. Signs and symptoms associated with a mild or moderate allergic reaction include itchy and red skin, rash, itchy and watery eyes, sneezing, and hives. Signs and symptoms with a severe reaction include swelling of the face and mouth, difficulty swallowing or speaking, wheezing and difficulty breathing, abdominal pain, nausea, vomiting, and dizziness or syncope.

Which form of traction provides the most specific and controlled distraction force? a. manual traction. b. inversion traction. c. mechanical traction. d. gravity-assisted traction.

a. manual traction. Manual traction is hands-on traction applied by a clinician that involves a continuous steady pull or intermittent pulls. The purpose of manual traction is to provide a very specific and controlled distraction force to the spine.

Which organ is most likely injured when signs and symptoms include shock, abdominal rigidity, nausea, vomiting, and Kehr's sign? a. spleen b. kidney c. liver d. stomach

a. spleen. Injuries to the spleen typically occur from a direct blow, splenomegaly or an enlargement from infectious mononucleosis. Kehr's sign is a reflex pain that occurs approximately a half hour after injury. The pain radiates to the left shoulder and down a small portion of the left arm.

Contraindications for ultrasound

acute and post acute conditions. areas of decreased circulation. over breast implants. over carotid sinus or cervical ganglia. over epiphyseal areas in young children. over eyes, heart, genitalia. over plastic or cement parts. pregnant women, over a pacemaker. thrombophlebitis. vascular insufficiency.