NPTE-PT Equipment and Therapeutic Modalities 5 — Questions and Answers
Question 1: A physical therapist applies cold pack cryotherapy. In what order do patients typically experience sensory changes during the application?
- Cold → burning → aching → numbness (Correct answer)
- Burning → cold → aching → numbness
- Numbness → aching → cold → burning
- Cold → numbness → burning → aching
Correct answer: Cold → burning → aching → numbness
The classic progression of sensory changes with cryotherapy is cold, then burning/stinging, then deep aching, then numbness (the CBAN sequence).
Question 2: A patient with a pressure injury (Stage III) on the ischium is receiving electrical stimulation for wound healing. Which waveform is FDA-cleared and MOST evidence-supported for this application?
- Symmetrical biphasic pulsed current
- High-voltage pulsed current (HVPC) (Correct answer)
- Interferential current (IFC)
- Russian stimulation
Correct answer: High-voltage pulsed current (HVPC)
High-voltage pulsed current (HVPC) has the strongest evidence and FDA clearance for promoting healing of chronic wounds including pressure injuries.
Question 3: A therapist is instructing a patient in stair climbing with bilateral Lofstrand crutches using a 3-point non-weight-bearing gait. When going UP stairs, the correct sequence is:
- Crutches first, then uninvolved leg, then involved leg
- Uninvolved leg first, then crutches and involved leg together (Correct answer)
- Involved leg first, then uninvolved leg, then crutches
- Crutches and uninvolved leg simultaneously, then involved leg
Correct answer: Uninvolved leg first, then crutches and involved leg together
Going up stairs with NWB: the uninvolved leg leads ('good goes up to heaven'), then crutches and the involved extremity follow.
Question 4: Which orthotics intervention is MOST appropriate for a patient with posterior tibialis tendon dysfunction (Stage II flatfoot)?
- Rigid total contact orthosis with medial arch support and rearfoot varus post
- Soft accommodative insert with no posting
- Lateral wedge with heel cup only
- UCBL orthosis with rigid medial longitudinal arch support (Correct answer)
Correct answer: UCBL orthosis with rigid medial longitudinal arch support
A UCBL (University of California Biomechanics Laboratory) orthosis provides rigid support to the medial longitudinal arch and controls subtalar pronation in Stage II PTTD.
Question 5: A physical therapist is using phonophoresis to deliver hydrocortisone through the skin. What is the PRIMARY mechanism by which ultrasound enhances drug delivery?
- Thermal dilation of skin pores increases passive diffusion
- Acoustic cavitation and acoustic streaming enhance skin permeability (Correct answer)
- Ultrasound directly ionizes the drug molecule
- Piezoelectric effect drives the drug via electrical current
Correct answer: Acoustic cavitation and acoustic streaming enhance skin permeability
Acoustic cavitation and streaming from ultrasound increase membrane permeability, facilitating transcutaneous drug penetration.
Question 6: A patient is receiving diathermy for hip osteoarthritis and has an intrauterine device (IUD). What is the MOST appropriate action?
- Proceed — IUDs are only contraindicated with TENS
- Avoid diathermy over the pelvis/lower abdomen due to the metal IUD (Correct answer)
- Use pulsed shortwave only, which is safe with metal implants
- Obtain written consent and proceed at lower intensity
Correct answer: Avoid diathermy over the pelvis/lower abdomen due to the metal IUD
Metal IUDs are contraindicated with diathermy in the pelvic region because the device can concentrate energy and cause tissue damage or heating.
Question 7: When measuring for axillary crutches, which measurement most accurately determines proper crutch length?
- Patient height minus 16 inches
- Distance from anterior axillary fold to a point 6 inches lateral to the fifth toe (Correct answer)
- Arm span divided by 2
- Standing height from floor to the axilla
Correct answer: Distance from anterior axillary fold to a point 6 inches lateral to the fifth toe
Proper crutch length is measured from the anterior axillary fold to a point 6 inches lateral and 2 inches anterior to the fifth toe with the patient standing.
NPTE-PT Equipment and Therapeutic Modalities 5
A physical therapist applies cold pack cryotherapy.
In what order do patients typically experience sensory changes during the application?