S1_L3: Therapeutic Ultrasound and Shockwave Therapy

Question 1

TRUE OR FALSE: A deep heating modality that has both thermal and mechanical effects on tissues. An ultrasound has both thermal and mechanical effects on tissues

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

Answer 1

A. Both statements are true

Source: Michlovitz

Question 2

The following statements are true about ultrasounds, EXCEPT:

A. uses a sound that is beyond what human ear can hear
B. uses a mechanical form of energy
C. requires a medium
D. used for improving connective tissue extensibility
E. None of the above

Answer 2

E. None of the above

NOTE: US also utilized a form of acoustic, or sound, energy

Question 3

Match the following zones.

1. Far Field
2. Absence of divergence
3. Length depends on diameter of treatment head and frequency
4. Distribution of energy is nonuniform
5. Maxima (compressed) and minima (spread out) are close to each other

A. Fraunhofer Zone
B. Fresnel Zone

Answer 3

1. A
2. B
3. B
4. B
5. B

Question 4

Match the following zones.

1. near part of the far field
2. Beam is more divergent
3. Near Field
4. Practical Application: Underwater technique
5. Nearly absent interference which gradually decreases with increasing distance to the transducer

A. Fraunhofer Zone
B. Fresnel Zone

Answer 4

1. A
2. A
3. B
4. A
5. A

Question 5

TRUE OR FALSE: US is not ideal for muscles

Answer 5

True

US must be used on the insertion or tendon, not the belly of the muscle. This is because high collagen content in tendons absorbs the US more than the muscle

Question 6

US may have both (1)_______ and (2)_______ effects

Answer 6

1. Thermal
2. Non-thermal (mechanical)

Question 7

Higher temperatures are achieved in tissues with high (1)_______ and with the application of high (2)_______US

Answer 7

1. collagen content
2. frequency

Question 8

TRUE OR FALSE: Based on US parameters, frequency and penetration has a direct relationship

Answer 8

False

Question 9

The following statements are true, EXCEPT:

A. Maximum temperature achieved is higher in 3 MHz
B. Depth of penetration is lower in 3 MHz
C. Temperature and frequency has a direct relationship
D. 1MHZ is able to penetrate up until 2cm deep
E. None of the above

Answer 9

D. 1MHZ is able to penetrate up until 2cm deep

It is up to 5cm deep

Question 10

TRUE OR FALSE: Using 3 MHz ultrasound as compared with 1 MHz ultrasound in tissues with higher collagen content, the depth of ultrasound penetration is less. However, a higher maximum temperature is achieved.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

Answer 10

A. Both statements are true

Source: Cameron

Question 11

TRUE OR FALSE: sound travels slower through denser connective tissues. sound travels in a sinusoidal pattern.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

Answer 11

D. Only the 2nd statement is true

Source: Michlovitz

Question 12

This is the distance between two successive peaks in the pressure wave

Answer 12

Wavelength

Source: Michlovitz

Question 13

What is the available human ear sound frequency range?

Answer 13

16,000–20,000 Hz

Question 14

Ultrasound enters the body and is attenuated in the tissue by (1)____, (2)_____ and (3)_____

Answer 14

1. absorption
2. reflection
3. refraction

Question 15

Generation of US waves are by (1)_____ through the application of a high frequency (2)_____ to a piezoelectric crystal

Answer 15

1. reverse piezoelectric effect
2. alternating current (AC)

Question 16

Differentiate a direct piezoelectric effect from a reverse piezoelectric effect.

Answer 16

Direct: mechanical to electrical
Indirect: electrical to mechanical energy, resulting to production of sound

Question 17

Match the US parameter.

1. 100% duty cycle
2. Increase cell membrane permeability
3. Increase intracellular calcium ions
4. Promotes macrophage responsiveness
5. Increase blood flow

A. Pulsed Mode
B. Continuous Mode

Answer 17

1. B
2. A
3. A
4. A
5. B

Question 18

Match the US parameter.

1. Increase rate of protein synthesis by fibroblasts
2. Increase soft tissue extensibility
3. May stimulate local histamine release
4. Increase metabolic rate
5. May stimulate changes in vascular tone

A. Pulsed Mode
B. Continuous Mode

Answer 18

1. A
2. B
3. A
4. B
5. A

Question 19

Match the US parameter.

1. Increase nerve conduction velocity
2. Reduction of pain & spasm
3. Good for stretching and vasodilating
4. Important in tissue and wound healing
5. Stable cavitation & acoustic streaming

A. Pulsed Mode
B. Continuous Mode

Answer 19

1. B
2. B
3. B
4. A
5. A

Question 20

TRUE OR FALSE: Wavelength is inversely related to frequency

Answer 20

True

Question 21

TRUE OR FALSE: Ultrasound cannot effectively travel through air because all of the energy is reflected back toward the transducer

Answer 21

True

Question 22

US head should be applied (1)_____ and in contract with the (2)_____ of the pt

Answer 22

1. perpendicular
2. body surface area

Question 23

measure of the decrease in sound energy as the sound wave travels, either by absorption, reflection, or refraction

Answer 23

Attenuation

Question 24

_______ refers to a material’s ability to transmit sound and is related to the molecular density and structure of the material.

Answer 24

Acoustic impedance

Question 25

Select the letters that has a structure or condition contraindicated when using an either one mode of an ultrasound. A. Pregnancy B. Acute Inflammation C. Pacemaker D. Fractures E. Eyes

Answer 25

A,C,E, NOTE: Those NOT considered as contraindication in the question above is only a precaution. In addition, pulse mode is allowable for inflammation.

Question 26

Select the letters that has a structure or condition contraindicated when using an ultrasound. A. Sensory Deficit B. Thrombophlebitis C. CNS tissue D. Breast implants E. Reproductive organs

Answer 26

A,B,C,E NOTE: Those NOT considered as contraindication in the question above is only a precaution.

Question 27

Select the letters that has a structure or condition contraindicated when using an ultrasound. A. Epiphyseal plates of long bones B. Malignant tumor C. Laminectomy (2-4 inches away) D. Surgical Skin Incision E. Joint cement or plastic components of arthroplasty

Answer 27

B, E NOTE: Those NOT considered as contraindication in the question above is only a precaution. US may be indicated on well-stitched surgical skin incisions.

Question 28

TRUE OR FALSE: Ultrasound may be used over areas with metal implants such as screws, plates, or allmetal joint replacements because metal is not rapidly heated by ultrasound, and ultrasound has been shown not to loosen screws or plate

Answer 28

True Source: Cameron

Question 29

TRUE OR FALSE: Both high frequency and low-frequency ultrasound can promote healing of surgical skin incisions and can relieve pain from scars even when applied months or years after surgery

Answer 29

True

Question 30

Determine the missing or wrong components and edit the documentation. Cont. US using big head X 1 MHz X 1.5 W/cm2 X 2 mins on the shoulder using direct method to inc tissue extensibility.

Answer 30

WRONG: 2 mins MISSING: pt position, part and laterality of shoulder / description of SH position CORRECT FORMAT: Cont. US using big head X 1 MHz X 1.5 W/cm2 X 5 mins on the anteroinferior aspect of (L) shoulder (abducted 90º and externally rotated) in supine using direct method to inc tissue extensibility.

Question 31

TRUE OR FALSE: US may be applied before using a HMP or cold compress

Answer 31

True

Question 32

Enumerate the methods of application available for ultrasounds

Answer 32

1. direct method 2. glove/ balloon/ bladder technique 3. underwater treatment

Question 33

Match the mode indicated for using an ultrasound. 1. Transdermal drug delivery 2. used before stretching shortened (tight) soft tissues/contractures 3. Reduction of pain via modulation of inflammation or neuronal pain signaling 4. Reduction of pain via gate control theory, relaxation, and vasodilation A. Non-thermal / Pulsed US B. Thermal / Continuous US

Answer 33

1. A 2. B 3. A 4. B

Question 34

Match the mode indicated for using an ultrasound. 1. Used for acute conditions 2. Used for sub-acute or chronic conditions 3. To accelerate tissue healing A. Non-thermal / Pulsed US B. Thermal / Continuous US

Answer 34

1. A 2. B 3. A

Question 35

_______ is sound with a frequency greater than 20,000 cycles per second (Hz) that, when applied to the body, has thermal and non-thermal effects

Answer 35

ultrasound

Question 36

Absorption accounts for about ____ of attenuation

Answer 36

one-half source: Cameron

Question 37

This is a a measure of the actual cross-sectional area of the ultrasound beam as it exits the metal end plate and is expressed in square centimeters (cm2). This is determined by the size and vibrational properties of the piezoelectric crystal and is always smaller than the cross-sectional area of the metal end plate

Answer 37

Effective Radiating Area (ERA)

Question 38

TRUE OR FALSE: Attenuation is tissue and frequency specific. It increases with the collagen content of tissues and with the frequency of the ultrasound A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 38

B. both statements are correct Source: Cameron

Question 39

The following statements are true of SWT, EXCEPT: A. uses high-energy sound waves B. uses single impulse acoustic sound waves C. induces a rapid rise in pressure D. pulse duration is extremely short E. pulse duration is generated at high frequencies

Answer 39

E. pulse duration is generated at high frequencies pulse duration of the shock wave is extremely short (3 to 5 μs) and is generated at low frequencies

Question 40

TRUE OR FALSE: No thermal effect is generated in using SWT

Answer 40

True

Question 41

TRUE OR FALSE: Tissues with high absorption coefficients generally have higher collagen content. Tissues with low absorption coefficients generally have lower collagen content but higher water content. A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 41

B. both statements are correct Source: Cameron

Question 42

TRUE OR FALSE: SWT is noninvasive but has a deep penetration. It is able to penetrate more compared in a US. A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 42

B. both statements are correct

Question 43

TRUE OR FALSE: Ultrasound most effectively heats deep tissue with a high collagen content but does not overheat the fat.

Answer 43

True

Question 44

TRUE OR FALSE: If acoustic impedance is high, transmission is high and the material absorbs little sound. If acoustic impedance is low, the material absorbs more of the energy and less is available for transmission A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 44

A. both statements are wrong high impedance = more absorption = less transmission

Question 45

TRUE OR FALSE: Ultrasound heats tissues with a high ultrasound absorption coefficient less than tissues with low absorption coefficients. The rate of tissue heating by ultrasound is proportional to the absorption coefficient of the tissue at the applied ultrasound frequency. A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 45

D. only the 2nd statement is correct Ultrasound heats tissues with a high ultrasound absorption coefficient **more than** tissues with low absorption coefficients.

Question 46

TRUE OR FALSE: Area 20 cm2, ERA of 10 cm2 = 5-10 mins Area 40 cm2, ERA of 10 cm2 = 10-20 mins A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 46

B. both statements are correct

Question 47

TRUE OR FALSE: Pulsed ultrasound, with a duty cycle of 20%, is most commonly used to produce the nonthermal benefits of ultrasound. As the patient progresses, increase the duty cycle by small increments until reaching 100% A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 47

B. both statements are correct

Question 48

The following statements are true of US application, EXCEPT: A. Stretching is recommended to be applied during heating and maintained for 5-10 mins B. Stretch is not done before US application C. Highest temperature is generally produced at soft tissue–bone interfaces where reflection is greatest D. All E. None

Answer 48

E. None

Question 49

TRUE OR FALSE: Muscle has a relatively low absorption coefficient

Answer 49

True

Question 50

TRUE OR FALSE: Thinner crystals are used to generate higher frequencies of ultrasound.

Answer 50

True

Question 51

TRUE OR FALSE: US is used for managing scar tissue, promoting pain relief, and enhancing tissue healing and remodeling in the care of tendinopathies

Answer 51

True Source: Michlovitz

Question 52

TRUE OR FALSE: Attenuation occurs the greatest in tissues with high collagen and low protein content and with the use of high US frequencies

Answer 52

FALSE high collagen, high protein, high frequency

Question 53

TRUE OR FALSE: A piezoelectric material expands and contracts continuously in response to AC. When the crystal expands, it compresses the material in front of it; when it contracts, it rarefies the material. A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 53

B. both statements are correct

Question 54

TRUE OR FALSE: Pregnant women are contraindicated for use of SWT. Children are contraindicated for use of SWT A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 54

B. both statements are correct

Question 55

Match the attenuation of a 1MHz US beam. 1. 59 %/cm 2. 3 %/cm A. Blood B. Fat C. Muscle D. Blood Vessel E. Skin F. Tendon G. Cartilage H. Bone

Answer 55

1. F 2. A

Question 56

Match the attenuation of a 1MHz US beam. 1. 24 %/cm 2. 96 %/cm 3. 13 %/cm A. Blood B. Fat C. Muscle D. Blood Vessel E. Skin F. Tendon G. Cartilage H. Bone

Answer 56

1. C 2. H 3. B

Question 57

Match the attenuation of a 1MHz US beam. 1. 32 %/cm 2. 39 %/cm 3. 68 %/cm A. Blood B. Fat C. Muscle D. Blood Vessel E. Skin F. Tendon G. Cartilage H. Bone

Answer 57

1. D 2. E 3. G

Question 58

steady, circular flow of cellular fluids induced by US A. Microsteaming/ Acoustic Streaming B. Micromassage C. Cavitation

Answer 58

A. Microsteaming/ Acoustic Streaming

Question 59

formation, growth, and pulsation of gas-filled bubbles by US A. Microsteaming/ Acoustic Streaming B. Micromassage C. Cavitation

Answer 59

C. Cavitation

Question 60

microscopic movement of oscillation of body fluids and tissues induced by US A. Microsteaming/ Acoustic Streaming B. Micromassage C. Cavitation

Answer 60

B. Micromassage

Question 61

The following statements are indications of SWT, EXCEPT: A. Tension headache B. Calcium tendonitis of the rotator cuff C. Lateral epicondylitis D. Achilles tendinopathy E. Chronic plantar fasciitis

Answer 61

A. Tension headache

Question 62

The following statements are physiological effects of SWT, EXCEPT: A. Disintegrating calcium deposits B. Hyperstimulation analgesia C. Neovascularization D. Changes in cell permeability E. None

Answer 62

E. None

Question 63

Match the following conditions 1. Hematoma 2. Hemorrhage 3. Petechiae 4. Pacemakers 5. Acute injuries A. side effects of SWT B. contraindicated for SWT

Answer 63

1. A 2. B 3. A 4. B 5. B

Question 64

This is a phenomenon in which the crystal generates an electric voltage when mechanically compressed

Answer 64

Piezoelectricity

Question 65

TRUE OR FALSE: Higher frequency should be partnered with low intensity.

Answer 65

True

Question 66

TRUE OR FALSE: Generation of US is by reverse piezoelectric effect. The most common materials used are quartz A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 66

C. only the 1st statement is correct PZT – most commonly used, cheap, efficient

Question 67

TRUE OR FALSE: Increasing the temperature of soft tissue temporarily increases its extensibility. But this increases the risk of tissue damage. A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 67

C. only the 1st statement is correct

Question 68

TRUE OR FALSE: Absorption coefficients increase with increased collagen content and in proportion to the ultrasound frequency. Changing the absorption coefficient alters the heat distribution but does not change the total amount of energy being delivered A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 68

B. both statements are correct

Question 69

What should be the ratio of Beam Non-uniformity Ratio (BNR)?

Answer 69

less that or equal to 6:1

Question 70

If the spatial average intensity of a US is 1.5 W/cm2, what should be the spatial peak intensity?

Answer 70

9 W/cm2

Question 71

refers to the spatial average intensity of the ultrasound beam between interruptions during pulsed ultrasound. A. Spatial Average Intensity (SAI) B. Spatial Peak Intensity (SPI) C. Spatial Average Temporal Peak Intensity (ISATP)

Answer 71

C. Spatial Average Temporal Peak Intensity (ISATP)

Question 72

acoustic power of the ultrasound beam at its highest point which typically occurs somewhere within the central third of the ERA A. Spatial Average Intensity (SAI) B. Spatial Peak Intensity (SPI) C. Spatial Average Temporal Peak Intensity (ISATP)

Answer 72

B. Spatial Peak Intensity (SPI)

Question 73

a measure of the average acoustic power across the ERA and is expressed in watts per square centimeter (W/cm2) A. Spatial Average Intensity (SAI) B. Spatial Peak Intensity (SPI) C. Spatial Average Temporal Peak Intensity (ISATP)

Answer 73

A. Spatial Average Intensity (SAI)

Question 74

What is the most common adverse effect in the use of US?

Answer 74

burn

Question 75

TRUE OR FALSE: The following documentation of parameters may be used for CTS using US. Pulsed US using underwater technique x 0.5 W/cm2 x 1 MHz x 15 mins in sitting to decrease pain

Answer 75

True Range of Parameter: 0.5 - 1.0 W/cm2, 1 MHz (underwater or gloved, 3 MHz for direct application), pulsed 1:4 for 5 – 15 mins

Question 76

TRUE OR FALSE: The following documentation of parameters may be used for bone fractures using US. Pulsed US x 0.15 W/cm2 x 3 MHz x 20% duty cycle x 15 mins in to decrease pain

Answer 76

False Frequency must be 1.5 MHz only. Remember that only very LOW dosage is allowed

Question 77

TRUE OR FALSE: The following documentation of parameters may be used for wound healing using US. ContUS using underwater technique x 1 W/cm2 x 3 MHz x 20% duty cycle x 5 mins in to decrease pain

Answer 77

False Pulsed US must be used

Question 78

TRUE OR FALSE: The following documentation of parameters may be used for pain relief using US. Cont US using underwater technique x 0.5 W/cm2 x 3 MHz x 5 mins in to decrease pain

Answer 78

True

Question 79

TRUE OR FALSE: The following documentation of parameters may be used for chronic Tendon Repair using US. Pulsed US using underwater technique x 0.5 W/cm2 x 3 MHz x 20% duty cycle x 15 mins in to decrease pain

Answer 79

False When chronic, a clinical must use high intensity to increase tissue temperature, therefore, continuous mode must be set.

Question 80

Soft tissue temperature increases by approximately _____°C per minute in vivo in healthy humans when ultrasound is delivered at 1 W/cm2 at 1 MHz

Answer 80

0.2

Question 81

TRUE OR FALSE: The following documentation of parameters may be used for phonophoresis using US. Pulsed US using underwater technique x 0.5 W/cm2 x 3 MHz x 20% duty cycle x 5 mins in to maximize use of topical drug

Answer 81

True

Question 82

This is the percentage or ratio of the pulse duration to the pulse period

Answer 82

Duty cycle

Question 83

What is the formula for Duty cycle?

Answer 83

Duty cycle = duration of pulse (on time) / pulse period (on + off time)

Question 84

The following are indications to increase US duration, EXCEPT: A. lower intensities are used B. higher frequencies are used C. areas larger than twice ERA D. heating effects are desired E. NONE

Answer 84

B. higher frequencies are used It is increased in lower frequencies

Question 85

TRUE OR FALSE: Tissue temperature elevation of 1°C (1.8°F) increases metabolic rate.

Answer 85

True

Question 86

How much must US strokes overlap?

Answer 86

by half of ERA

Question 87

What should be the rate of movement using an US when using a direct method of application?

Answer 87

4cm/sec NOTE: Cameron recommends speed of moving the US head between 2 and 8 cm/sec only

Question 88

The following statements are true of SWT, EXCEPT: A. it is electrohydraulic B. it is electromagnetic C. it is generated through reverse piezoelectric D. often done 1x/wk E. NONE

Answer 88

E. NONE

Question 89

TRUE OR FALSE: Elevations in the range of 2°C to 3°C reduce muscle spasm and pain and increase blood flow. Temperature increases of 4°C or greater are necessary to boost collagen extensibility and inhibit parasympathetic activity A. both statements are wrong B. both statements are correct C. only the 1st statement is correct D. only the 2nd statement is correct

Answer 89

C. only the 1st statement is correct It inhibits SYMPATHETIC activity Source: Michlovitz

Question 90

TRUE OR FALSE: Local soft tissue swelling and transient pain may be possible side effects of SWT application

Answer 90

True

Question 91

TRUE OR FALSE: The alternating compression-rarefaction generated from piezoelectric material is the ultrasound wave

Answer 91

True

Question 92

Point of maximum acoustical intensity is found where?

Answer 92

between near and far fields

Question 93

This is a phase where molecules adjacent to the energy source are compressed together (condensations)

Answer 93

positive pressure phase Source: Michlovitz

Question 94

Match the following conditions to the amount of heat indicated upon US application. 1. hematoma 2. healing 3. Subacute injury A. Non-thermal B. Mid Thermal C. Moderate Thermal D. Vigorous

Answer 94

1. B 2. A 3. B

Question 95

Match the following conditions to the amount of heat indicated upon US application. 1. Acute injury 2. Chronic inflammation 3. Edema A. Non-thermal B. Mid Thermal C. Moderate Thermal D. Vigorous

Answer 95

1. A 2. C 3. A

Question 96

This is a phase where molecules in the same region disperse (rarefactions)

Answer 96

negative pressure phase Source: Michlovitz

Question 97

Match the following conditions to the amount of heat indicated upon US application. 1. stretch collagen 2. pain 3. trigger points A. Non-thermal B. Mid Thermal C. Moderate Thermal D. Vigorous

Answer 97

1. D 2. C 3. C

Question 98

What is the range of a low, moderate and high intensity SWT? Answer using mJ/mm2

Answer 98

Low - < 0.1 mJ/mm2 Moderate - 0.1 - 0.2 mJ/mm2 High - > 0.2 mJ/mm2