PAM Treatment Protocols & Procedures 3 — Questions and Answers
Question 1: Which of the following best describes the mechanism of the gate control theory as applied to conventional TENS?
- Large-diameter A-beta fibers activated by TENS close the 'gate' in the dorsal horn, inhibiting pain signal transmission (Correct answer)
- Small C-fibers stimulated by TENS release substance P to block pain
- TENS activates descending pathways exclusively through endorphin release
- High-frequency TENS works by depolarizing motor neurons in the spinal cord
Correct answer: Large-diameter A-beta fibers activated by TENS close the 'gate' in the dorsal horn, inhibiting pain signal transmission
Conventional TENS activates large-diameter A-beta fibers that inhibit transmission of nociceptive signals at the dorsal horn gate, reducing perceived pain.
Question 2: When using cryotherapy via ice massage, the sequence of sensations the patient should experience in order is:
- Pain → burning → aching → numbness
- Cold → burning → aching → numbness (Correct answer)
- Numbness → aching → burning → cold
- Burning → cold → aching → numbness
Correct answer: Cold → burning → aching → numbness
The CBAN sequence (Cold, Burning, Aching, Numbness) is the expected progression during ice massage, indicating adequate cooling before treatment.
Question 3: A patient is being treated with diathermy over a recent metal implant in the knee. The therapist should:
- Reduce intensity by 50% and proceed carefully
- Use pulsed mode only, as it avoids all thermal effects
- Avoid diathermy entirely over the area containing the metal implant (Correct answer)
- Apply the diathermy perpendicular to the implant to minimize heating
Correct answer: Avoid diathermy entirely over the area containing the metal implant
Metal implants concentrate electromagnetic energy and can cause excessive heating and burns, making diathermy over implanted metal an absolute contraindication.
Question 4: For phonophoresis to be effective, the coupling medium containing the medication must have a transmission value of at least:
- 50%
- 70% (Correct answer)
- 90%
- 100%
Correct answer: 70%
A transmission value of at least 70% is required for the coupling medium in phonophoresis to ensure adequate acoustic energy reaches the tissue along with the medication.
Question 5: Which clinical sign during fluidotherapy treatment would prompt the therapist to immediately discontinue the session?
- Patient reports mild warmth
- Erythema resolving after 5 minutes
- Blister formation or tissue breakdown (Correct answer)
- Patient verbally rates comfort at 6/10
Correct answer: Blister formation or tissue breakdown
Blistering or tissue breakdown during any thermal modality indicates a thermal burn and requires immediate discontinuation and wound assessment.
Question 6: The effective radiating area (ERA) of an ultrasound transducer is important because:
- It determines the maximum frequency the unit can produce
- It defines the actual area of the transducer head that emits acoustic energy, affecting dosage calculations (Correct answer)
- It indicates the maximum tissue depth the sound can reach
- It determines which coupling media can be used
Correct answer: It defines the actual area of the transducer head that emits acoustic energy, affecting dosage calculations
ERA is the portion of the transducer face that actively emits ultrasound; intensity is calculated as power divided by ERA, so it directly affects dosage accuracy.
Question 7: A therapist is treating a patient with a wound using pulsed lavage with suction. Which precaution is most critical?
- Limit session to 5 minutes to avoid excessive heating
- Use sterile technique and direct the spray away from exposed vessels or tendons (Correct answer)
- Apply a TENS unit simultaneously to enhance circulation
- Ensure the area is thoroughly dried before applying the device
Correct answer: Use sterile technique and direct the spray away from exposed vessels or tendons
Sterile technique and careful direction of the irrigation stream protect exposed structures; aiming spray at vessels or tendons can cause trauma or introduce infection.
PAM Treatment Protocols & Procedures 3
Which of the following best describes the mechanism of the gate control theory as applied to conventional TENS?