CLT Patient Selection & Contraindications 3 — Questions and Answers
Question 1: A patient with active tuberculosis of the skin (lupus vulgaris) requests laser therapy. What is the correct clinical decision?
- Treat with antibacterial settings
- Laser therapy is contraindicated over active TB skin lesions (Correct answer)
- Reduce wavelength to bactericidal range
- Proceed with a patch test first
Correct answer: Laser therapy is contraindicated over active TB skin lesions
Active infectious skin conditions including cutaneous tuberculosis are a contraindication because laser energy may spread the infection or worsen tissue damage.
Question 2: Why is direct laser application over a malignant tumor considered an absolute contraindication?
- Tumors absorb too much energy and cause device damage
- Laser energy may stimulate cellular proliferation and promote tumor growth (Correct answer)
- Malignant tissue reflects laser light dangerously
- Tumors prevent accurate dosimetry calculation
Correct answer: Laser energy may stimulate cellular proliferation and promote tumor growth
Laser's biostimulatory effects on cellular metabolism raise concern that it may promote growth or metastasis of malignant cells.
Question 3: A patient with insulin-dependent diabetes wants laser therapy for a foot wound. What is the primary safety consideration?
- Diabetes makes laser therapy ineffective
- Altered sensation and circulation increase risk of undetected tissue damage (Correct answer)
- Blood glucose interferes with light absorption
- Insulin reacts chemically with laser energy
Correct answer: Altered sensation and circulation increase risk of undetected tissue damage
Diabetic patients may have peripheral neuropathy and impaired circulation, reducing their ability to sense overheating and increasing the risk of burns.
Question 4: When treating a patient with hemophilia, what contraindication principle applies?
- Laser therapy is fully contraindicated in all hemophilia patients
- High-power laser settings may trigger uncontrolled bleeding due to vasodilation (Correct answer)
- Low-level laser is safe; only surgical lasers are contraindicated
- The primary risk is photosensitivity from clotting medications
Correct answer: High-power laser settings may trigger uncontrolled bleeding due to vasodilation
High-power laser can cause vasodilation and increase local blood flow, which may trigger or worsen bleeding episodes in patients with clotting disorders.
Question 5: A patient is taking tetracycline for an infection. Why is this relevant to laser therapy?
- Tetracycline reduces muscle response to laser
- Tetracycline is a photosensitizing antibiotic that increases adverse skin reactions (Correct answer)
- Tetracycline blocks laser absorption at the cellular level
- Tetracycline causes the skin to reflect laser energy
Correct answer: Tetracycline is a photosensitizing antibiotic that increases adverse skin reactions
Tetracycline and other photosensitizing antibiotics increase skin sensitivity to light, raising the risk of burns, rashes, or other adverse effects during laser therapy.
Question 6: A patient has a fresh (3-day-old) surgical incision near the intended treatment area. What is the appropriate action?
- Apply laser directly to promote faster healing (Correct answer)
- Avoid the incision site and treat only unaffected peripheral tissue
- Postpone all laser therapy until the incision is fully healed
- Use the lowest available power setting directly over the incision
Correct answer: Apply laser directly to promote faster healing
Low-level laser applied directly to fresh surgical incisions can support healing by reducing inflammation and stimulating tissue repair, and is not contraindicated.
Question 7: Which of the following is a relative contraindication, requiring therapist judgment rather than an absolute treatment ban?
- Pregnancy
- Active malignancy at the treatment site
- Mild osteoporosis in a non-treatment area (Correct answer)
- Photosensitive epilepsy
Correct answer: Mild osteoporosis in a non-treatment area
Mild osteoporosis in an area away from the treatment site is a relative contraindication requiring clinical judgment, unlike the absolute contraindications of pregnancy, cancer, and photosensitive epilepsy.
CLT Patient Selection & Contraindications 3
A patient with active tuberculosis of the skin (lupus vulgaris) requests laser therapy.
What is the correct clinical decision?