Deck 3: Therapeutic Heat

Question 1

Which of the following physiological responses to heat will facilitate vasodilation?

A) Increased nerve conduction velocity
B) Release of histamine and prostaglandins
C) Decreased oxygen uptake by heated tissues
D) Increased blood pressure

Answer 1

B

Question 2

When documenting the outcome of a heat therapy treatment, which of the following best indicates that the intervention was effective and should be continued?

A) Patient reports the heat felt warm and comfortable.
B) Skin was red and moist after application of the heat.
C) Patient reported stiffness of joint was reduced immediately following heat application.
D) A 15-degree increase in hamstring length occurred following heat application.

Answer 2

D

Question 3

Research studies on the effectiveness of paraffin for treatment of rheumatic arthritis found which of the following?

A) Pain and swelling were exacerbated following application of paraffin.
B) Paraffin combined with exercises provided beneficial short-term effects.
C) Patients were unable to tolerate the higher temperature of a paraffin bath.
D) Research is inconclusive and more studies are needed.

Answer 3

B

Question 4

Which method of stretching connective tissue is most likely to result in long-term deformation?

A) Stretching to end-range very quickly, then holding at end-range while heating to tissue temperature of 45°C
B) Heating to achieve tissue temperature of 45°C combined with long duration stretching with low external load
C) Heating tissue greater than 45°C followed by ballistic (high velocity) stretching
D) Intermittent stretching while heating to tissue temperature of 45°C

Question 5

Which of the following is an advantage of using heat rather than cold for patient interventions?

A) Inhibition of edema formation
B) Increased joint stiffness
C) Decreased pain
D) Increased tissue extensibility

Question 6

Which of the following temperature ranges is required for a thermal modality to cause a therapeutic effect?

A) 20°C to 25°C
B) 30°C to 35°C
C) 40°C to 45°C
D) 50°C to 55°C

Question 7

Decreased muscle tone or spasm in response to heat is primarily caused by

A) Increased rate of firing of type II efferents, resulting in relaxation response
B) Decreased rate of firing of type Ib efferents, resulting in decreased production of neurotransmitters at the neuromuscular junction
C) Increased golgi tendon organ (GTO) activity, resulting in decreased stretch on muscle spindle
D) Decreased gamma efferent activity, resulting in decreased muscle spindle activity

Question 8

Which of the following statements about Fluidotherapy is true?

A) Heat transfer with Fluidotherapy occurs via thermal conduction from the cellulose material to the superficial tissues.
B) Some people may be able to tolerate higher temperatures using Fluidotherapy versus other heating modalities because it is dry heat.
C) One disadvantage of Fluidotherapy is that a patient must hold a limb still during the treatment in order to maximize the therapeutic benefits.
D) The recommended temperature range of Fluidotherapy is much lower than that recommended for a hot whirlpool treatment.

Question 9

Regarding skeletal muscle blood flow, which of the following statements is true?

A) Increases in blood flow are equivalent with application of either heat pack or exercise.
B) Exercise results in greater increases in blood flow than application of heat pack.
C) Using a heat pack can result in greater increases in blood flow than exercise if the duration of heat application is greater than 30 minutes.
D) Neither exercise nor superficial heat can increase skeletal muscle blood flow, as it is primarily under metabolic regulation.

Question 10

The effects of heat on connective tissue include all of the following except

A) Increased elasticity
B) Increased viscosity
C) Decreased joint stiffness
D) Increased muscle flexibility

Question 11

Which of the following statements about paraffin baths is true?

A) Paraffin conducts heat to tissues slower than water of the same temperature.
B) Paraffin has a higher specific heat than water.
C) Paraffin should never be used over healed burn areas because this tissue is very fragile.
D) When used to increase joint range of motion, a patient should do active exercises while immersed in the paraffin.

Question 12

Which of the following is an expected neuromuscular response to heat?

A) Changes in pain threshold of the cutaneous area of a nerve following heat to the nerve
B) Decreased nerve conduction velocity
C) Increased muscle strength that declines after the source of heat is removed
D) Increased muscle spindle firing rates

Question 13

Which of the following lists only includes contraindications for heating agents?

A) Malignancy, acute inflammation, open wound
B) Acute inflammation, infection, vascular insufficiency
C) Poor thermal sensation, severe pain, peripheral vascular disease
D) Joint contracture, person unable to communicate, recent hemorrhage

Question 14

How does the application of heat to the body cause vasodilation of blood vessels remote from the application site?

A) Axon reflex
B) Release of chemical mediators
C) Increased postganglionic sympathetic adrenergic nerve activity
D) Local spinal cord reflex

Question 15

Which of the following would be the best choice in a clinic setting to minimize rheumatoid arthritis wrist pain and stiffness in an elderly female?

A) Any heating agent, because elderly people always prefer heat over cold.
B) Any cold therapy modality would be preferable to heat for this inflammatory problem.
C) Fluidotherapy, because the patient can do active range of motion during the heat treatment.
D) Electric heating pad, because it is easy to apply and the patient can use one at home.

Question 16

Which of the following are appropriate precautions to follow when applying a hot pack?

A) Use one or two layers of towels and check the skin every 10 minutes.
B) Place a moist towel on the skin and wrap the hot pack in several thin towels.
C) Wrap the hot pack in a hot pack cover and check the skin before and after application.
D) Place six to eight layers of towels on hot pack and check skin 5 minutes after application.

Question 17

One advantage of heat over cold therapy is

A) Heat increases the resistance of collagen to a deforming force, resulting in improved scar strength.
B) Heat decreases soft tissue swelling more than cold.
C) Heat decreases joint stiffness, while cold increases stiffness.
D) Heat decreases cellular metabolism, reducing the risk of hypoxic injury.

Question 18

Select which treatment duration is appropriate for the given heating agent.

A) Moist hot pack to increase blood flow in subacute thigh strain, no less than 45 minutes
B) Fluidotherapy to achieve "vigorous" heating of the hand, 5 minutes
C) Air-activated heat wrap for acute back pain, 4 to 8 hours
D) Paraffin bath "dip and reimmerse" to increase collagen extensibility, 3 minutes after creating wax glove

Question 19

Which of the following represents a risk one should consider when applying external heating modalities?

A) Increased tissue oxygen demand exceeds delivery of oxygen-rich blood.
B) Anti-inflammatory effect of heat results in increased joint effusion.
C) Heating a large volume of tissue results in compensatory cutaneous vasodilation, which increases risk for surface burns.
D) Systemic response of decreased heart rate results in cardiovascular complications.

Question 20

Which of the following statements is true regarding air-activated heat wraps?

A) They maintain a temperature of 40°C up to 8 hours.
B) Air activates small magnetic coils in the wraps, which produce heat.
C) They can be reused up to five times after activation.
D) They provide a comfortable prolonged low-level moist heat.

Question 21

On presentation to the clinic today, which of the following patients is the most appropriate choice for heat modalities?

A) A 13-year-old female with muscular neck pain from a motor vehicle accident last week
B) A 64-year-old male with referred back pain related to prostate cancer
C) A 78-year-old female with arthritic hand pain who applied a heat liniment just prior to today's visit
D) A 19-year-old male who is developing a hematoma following a thigh contusion sustained in basketball practice today

Question 22

A comparison of temperature changes in response to application of heat to the forearm will show which of the following?

A) Skin temperature rises fastest and maintains a high temperature the longest after the heat source is removed.
B) Muscle tissue heats up slowest, but the temperature gain is greatest from baseline to peak.
C) Subcutaneous tissue temperature changes the least during and after heat application.
D) Subcutaneous tissue and skin lose heat rapidly after the source of external heat is removed.

Question 23

Do the physiological effects of heat or cold last the longest? Select the best response.

A) Heat, because the vascular response to heat results in relatively cool blood entering the treatment area.
B) Heat, because the increased metabolic rate results in self-sustaining internal heating.
C) Cold, because the vascular response to cold limits how quickly relatively warm blood can enter the treatment area.
D) Cold, because the decreased nerve conduction velocity slows voluntary movements that would encourage rewarming.