Free NCBTMB Pathology and Contraindications Questions and Answers — Questions and Answers
Question 1: A new client reports having osteoporosis. Which of the following is the most appropriate modification for their massage session?
- Use firm, deep strokes to release chronic muscle tension.
- Incorporate vigorous stretching to increase joint flexibility.
- Avoid all forms of tapotement.
- Utilize gentle pressure and avoid forceful movements. (Correct answer)
Correct answer: Utilize gentle pressure and avoid forceful movements.
Osteoporosis is a condition characterized by decreased bone density, making bones fragile and susceptible to fractures. Therefore, massage for clients with osteoporosis requires caution. Gentle techniques are recommended, while deep pressure, vigorous stretching, and forceful movements should be avoided to prevent injury.
Question 2: A client presents with a localized area on their calf that is red, warm to the touch, swollen, and painful. They mention the pain does not change with movement. Which of the following conditions might be present, and what is the correct course of action?
- A muscle strain; apply deep tissue massage to the area.
- Varicose veins; use light, circulatory strokes over the area.
- Deep Vein Thrombosis (DVT); immediately stop the session and refer the client for emergency medical evaluation. (Correct answer)
- A simple contusion; apply cold packs and proceed with the massage, avoiding the immediate area.
Correct answer: Deep Vein Thrombosis (DVT); immediately stop the session and refer the client for emergency medical evaluation.
The signs and symptoms described (unilateral swelling, pain, warmth, and redness in the calf) are classic indicators of Deep Vein Thrombosis (DVT), a blood clot in a deep vein. This is a systemic contraindication for massage, as dislodging the clot could lead to a life-threatening pulmonary embolism. The only safe and ethical action is to cease the massage and refer the client for immediate medical attention.
Question 3: Which of the following is considered a systemic contraindication for massage, requiring the therapist to postpone the session?
- A small, localized sunburn on the shoulder.
- Psoriasis with a few non-inflamed patches on the elbows.
- A healing paper cut on the finger.
- A fever of 101°F (38.3°C). (Correct answer)
Correct answer: A fever of 101°F (38.3°C).
A fever is a systemic contraindication, indicating the body is fighting a widespread infection. Massage can increase circulation, potentially spreading the infection and exacerbating the client's condition, as well as putting the therapist at risk. The other options are local contraindications, meaning massage can proceed by avoiding the specific affected area.
Question 4: A client with a history of cancer, currently undergoing chemotherapy, has requested a massage. Which modification is essential for the therapist to implement?
- Perform a 90-minute deep tissue massage to address all their aches.
- Use unscented lotion and light pressure, avoiding areas with ports or tumors. (Correct answer)
- Focus the massage directly over known tumor sites to promote healing.
- Insist on using aromatherapy with strong essential oils for relaxation.
Correct answer: Use unscented lotion and light pressure, avoiding areas with ports or tumors.
Clients undergoing cancer treatment often have compromised systems. Massage should be gentle and modified for safety. It's crucial to use light pressure, avoid areas with medical devices like ports or catheters, and never massage directly over tumor sites or areas receiving radiation. Many clients are sensitive to scents during treatment, making unscented products the safest choice.
Question 5: A client presents with a highly contagious bacterial skin infection characterized by red sores that can blister and ooze, primarily around the nose and mouth. Which of the following conditions is described, and how should the massage therapist proceed?
- Eczema; proceed with the massage using hypoallergenic lotion.
- Psoriasis; avoid the affected areas but massage the rest of the body.
- Impetigo; reschedule the appointment until the infection has completely resolved. (Correct answer)
- Rosacea; use light, gentle strokes on the face and body.
Correct answer: Impetigo; reschedule the appointment until the infection has completely resolved.
The description matches impetigo, a highly contagious bacterial skin infection. Due to its contagious nature, massage is systemically contraindicated to prevent spreading the infection to other parts of the client's body, to the therapist, or to subsequent clients. The appointment must be postponed until a doctor confirms the infection is no longer active.
Question 6: Pitting edema is identified when pressure on a swollen area leaves a persistent indentation. This finding is a significant precaution for massage because it often indicates:
- A simple muscle strain that would benefit from flushing strokes.
- Benign fluid retention from a high-salt meal.
- An underlying systemic condition such as heart, kidney, or liver disease. (Correct answer)
- Normal post-exercise inflammation.
Correct answer: An underlying systemic condition such as heart, kidney, or liver disease.
Pitting edema can be a sign of serious underlying systemic pathologies like congestive heart failure, liver cirrhosis, or kidney disease. Performing massage without medical clearance is contraindicated because increasing fluid circulation could potentially overwhelm these already compromised systems. Therefore, it is considered a contraindication requiring medical clearance before proceeding.
Free NCBTMB Pathology and Contraindications Questions and Answers
A new client reports having osteoporosis.
Which of the following is the most appropriate modification for their massage session?