Deck 4: Therapeutic Ultrasound

Question 1

The optimal coupling medium used to apply ultrasound is

A) Regular tap water
B) Creams and ointments
C) Ultrasonic gel
D) There is no difference between any of these coupling media in terms of the efficiency of transmission of ultrasonic energy.

Answer 1

C

Question 2

Which of the following proposed effects of nonthermal ultrasound have been clearly demonstrated in human tissues in vivo?

A) Cavitation
B) Acoustic streaming
C) Changes in cellular permeability
D) None of the proposed effects of nonthermal ultrasound have been clearly demonstrated in human tissues in vivo.

Answer 2

D

Question 3

Which of the following does NOT have an influence on the amount of heating produced in a tissue by US?

A) US frequency
B) US intensity
C) Movement speed of the US applicator
D) Use of pulsed or continuous US

Answer 3

C

Question 4

There is strong substantiated evidence for the use of pulsed US to treat

A) Various inflammatory conditions including lateral epicondylitis
B) Pain and dysfunction of carpal tunnel syndrome
C) Calcific tendinitis and bursitis
D) There is no compelling evidence for any use of pulsed US.

Question 5

There are variations between the heating rates of different tissues. Which of the following is the relationship between the heating of tendons or ligaments and skeletal muscle under similar sonication conditions?

A) The heating rate and temperature rise seen in tendons/ligaments is between 2.5 and 3 times the rate seen in skeletal muscle.
B) The heating rate and temperature rise seen in skeletal muscle is between 2.5 and 3 times the rate seen in tendons/ligaments.
C) The heating rate and temperature rise seen in tendons/ligaments is between about one-half to one-third the rate seen in skeletal muscle.
D) The heating rate and temperature rise do not significantly vary between tendons/ligaments and skeletal muscle.

Question 6

The technique used to reduce the risk of burning while still getting an effective treatment with an ultrasound applicator with a high beam nonuniformity ratio (BNR) is to

A) Move the US applicator while applying the US.
B) Use pulsed rather than continuous US.
C) Turn down the intensity of the applied US.
D) Use water rather than ultrasonic gel during the US application.

Question 7

The relationship between US frequency and depth of penetration is

A) Higher frequency US penetrates deeper than lower frequency US.
B) Lower frequency US penetrates deeper than higher frequency US.
C) Lower frequency US penetrates less deep when compared to higher frequency US.
D) There is no relationship between the US frequency and the depth of penetration.

Question 8

Ultrasound (US) creates heat in tissues most likely as the result of

A) Acoustic steaming
B) Stable cavitation
C) Molecular vibration
D) Acoustic reflection

Question 9

Which of the following statements regarding the use of phonophoresis is most correct?

A) Results from all studies for phonophoretically applied lidocaine clearly show a greater lessening of pain or increased skin analgesia than with any other modality.
B) Results from all studies for phonophoretically applied salicylates clearly show a greater lessening of pain or increased skin analgesia than with any other modality.
C) From the available research evidence, phonophoresis is highly recommended over the many other approaches that are available to treat pain and inflammatory conditions.
D) Results of studies involving the phonophoretic application of hydrocortisone are conflicting, with some studies showing improvement in various conditions while others show little or no effect.

Question 10

Noncontact low-frequency ultrasound (NCLFUS) involves all of the following except

A) It is the aerosolization of saline water to treat wounds.
B) It is commonly known by its commercial name of MIST Therapy.
C) Evidence suggests that the NCLFUS stimulates wound healing by atraumatic selective tissue debridement, wound stimulatory effects, and antibacterial activity.
D) The approach is done by applying ultrasound in the same say as conventional ultrasound using the same frequencies and intensities.

Question 11

You have an athlete with a limitation in ankle dorsiflexion. Which of the following applications of US would you choose to treat this patient?

A) 3 MHz, continuous US at 1 watt/cm² for 3 to 4 minutes over an area of the Achilles tendon of 2 ERA while moving the ankle into dorsiflexion
B) 1 MHz, continuous US at 1.5 watts/cm² for 7 to 8 minutes over the gastrocnemius muscle belly while moving the ankle into dorsiflexion
C) 1 MHz, continuous US at 1 watt/cm² for 3 to 4 minutes over an area of the Achilles tendon of 2 ERA while moving the ankle into dorsiflexion
D) 3 MHz, continuous US at 1 watt/cm² for 3 to 4 minutes over an area of the Achilles tendon of 2 ERA 3 to 5 minutes prior to doing dorsiflexion stretching

Question 12

The best estimate of effective radiating area (ERA) of the ultrasound applicator is

A) Area of the faceplate of the applicator
B) Area of the piezoelectric crystal
C) Area of the total applicator including handle
D) There is no way to estimate the ERA.

Question 13

A common mistake made by therapists in heating a tissue using ultrasound is

A) Selecting the incorrect frequency
B) Selecting the incorrect applicator size
C) Selecting the incorrect mode: pulsed or continuous
D) Applying US over too large of an area

Question 14

Added heat buildup at the periosteal junction of bone can occur most likely as a result of

A) Acoustic wave reflection producing standing waves
B) Acoustic wave absorption in the very dense periosteum
C) Acoustic wave refraction into bone
D) Acoustic wave absorption into bone

Question 15

All of the following are true of low-intensity pulsed ultrasound (LIPUS) except

A) It is delivered at much lower intensities (0.03 watts/cm²) than conventionally delivered US.
B) It is delivered via a moving applicator that contacts the skin through the regular ultrasonic gel just like other forms of US.
C) It produces fracture healing by increasing bone angiogenesis and stimulating osteogenesis.
D) Application is standardized and does not have to be set but is programmed into the applicator.

Question 16

In general, ultrasound seems to be most effective in treating

A) Inflammatory conditions
B) Limitations in range of motion
C) Painful conditions
D) Deficits in nerve conduction

Question 17

The optimal treatment area to get the most rapid heating of the tissue is

A) Two times the ERA
B) Four times the ERA
C) Ten times the ERA
D) There is no relationship between treatment area and the rapidity of tissue heating.

Question 18

There is strong substantiated evidence for the use of continuous US to treat

A) Pain and dysfunction of carpal tunnel syndrome
B) Pain and dysfunction associated with lateral epicondylitis
C) Limited range of motion (ROM) associated with frozen shoulder
D) Dysfunction associated with nonspecific shoulder conditions

Question 19

Evidence is moderate to strong for the contraindication of the use of continuous US in all of the following areas and conditions EXCEPT

A) Cancer-over a known or suspected area of malignancy
B) Active bone growth at the epiphysis
C) Pregnancy-over the shoulders, upper back, and cervical regions
D) Hemorrhagic conditions-over an area of active bleeding

Question 20

The optimal intensity to achieve a heating effect of US in muscle tissue is

A) 1 watt/cm²
B) 1.5 watts/cm²
C) 2 watts/cm²
D) There is no optimal intensity because the intensity must be adjusted to meet the needs of the specific patient and the characteristics of the specific US device.