Drum Study Guide

Question 1

Know properties of therapeutic lasers

Answer 1

LASER = Light Amplification by Stimulated Emission of Radiation
Laser light differs from ordinary (white) light in three fundamental properties:

Question 2

Coherent

Answer 2

• Light waves are in phase
• Allows concentrated energy delivery

Question 3

Monochromatic

Answer 3

• Laser emits a single wavelength
• Allows targeted interaction with specific tissue chromophores (e.g., water, melanin, hemoglobin)

Question 4

Collimated

Answer 4

• Light rays travel parallel
• Minimal divergence → deeper tissue penetration

Question 5

ordinary white light

Answer 5

• Polychromatic
• Incoherent
• Disperses rapidly

Question 6

Wavelength

Answer 6

• Measured in nanometers (nm)
• Biological effect depends on wavelength
• Therapeutic window approximately 500–1100 nm
• Longer wavelengths scatter less and penetrate deeper

Question 7

Laser Classifications

Answer 7

Class 1
* Laser printers
* CD players
* No biological hazard
Class 2
* Low-power, diffuse output
Class 3
* Class 3a
o Laser pointers
o Some low-level therapy lasers
* Class 3b
o Therapeutic lasers
o Output < 500 mW
Class 4
* Surgical and high-power therapeutic lasers
* Can cut or coagulate tissue
* Examples: Pegasus therapy laser

Question 8

Laser Safety Procedures

Answer 8

Primary Safety Concern
* Eye protection
* Therapy lasers emit visible and invisible radiation
* Never aim beam toward eyes, even with eyewear
Safety Guidelines
* Follow manufacturer recommendations
* Keep extra people out of treatment area
* Post warning signage when possible
* Reduce reflective surfaces
* Keep laser in standby mode when not in use
* Never look into probe or beam path
Safety eyewear protects primarily against reflected beams, not the primary beam.

Question 9

Advantages of Therapeutic Laser

Answer 9

• Non-invasive
• Analgesic
• Anti-inflammatory
• Promotes tissue healing
• Improves microcirculation
• Enhances nerve regeneration

Question 10

Disadvantages of Therapeutic Laser

Answer 10

• Cost
• Numerous competing devices
• Operator-dependent dosing
• Risk of burns if misused
• Safety concerns
• Limited large-scale rigorous clinical trials

Question 11

Mechanism of Action / Benefits of Therapeutic Lasers

Answer 11

Photobiomodulation (PBM)
* Therapeutic lasers act via photochemical, not thermal effects
* Primary photoacceptor: cytochrome c oxidase in mitochondria
Cellular Effects
* Increased ATP production
* Increased RNA and DNA synthesis
* Increased metabolic activity
* Enhanced oxygen utilization

Tissue-Level Effects
* Increased leukocyte infiltration
* Increased macrophage activity
* Increased neovascularization
* Increased fibroblast proliferation
* Increased keratinocyte migration
* Accelerated epithelialization
* Increased tensile strength of healing tissue

Question 12

Clinical benefits (LASER)

Answer 12

• Analgesia (endorphin release)
• Edema reduction
• Faster wound healing
• Improved nerve regeneration
• Reduced healing time

Question 13

Contraindications of Therapeutic Lasers

Answer 13

• Active hemorrhage
• Eyes
• Testicles
• Pregnancy
• Epiphysitis
• Melanomas and sarcoids
• Cardiac conditions
• Concurrent corticosteroid therapy
• Photosensitizing medications

Question 14

E-Stim (Definition)

Answer 14

Electrotherapy is the application of low- or medium-frequency electrical current to stimulate sensory or motor nerves for:
* Pain control
* Muscle strengthening
* Muscle re-education
* Edema reduction
* Tissue healing

Question 15

TENS

Answer 15

Primary Use
* Pain control
Mechanisms
* Gate control theory
* Endogenous opiate (endorphin/enkephalin) release
* Counter-irritation
Parameters
* Frequency:
o Sensory (acute pain): 50–150 pps
o Motor (chronic pain): 2–10 pps
* Pulse duration:
o Sensory: 2–50 μsec
o Motor: >150 μsec
* Amplitude: Comfortable tingling (sensory) or visible contraction (motor)
* Depth of penetration: Shallow to moderate, dependent on amplitude and electrode spacing

Question 16

NMES (Neuromuscular Electrical Stimulation)

Answer 16

Primary Use
* Muscle contraction
* Strengthening
* Re-education
* Prevention of disuse atrophy
Parameters
* Frequency: 30–50 pps (tetanic contraction)
* Pulse duration: 100–300 μsec
* Amplitude: Strong visible contraction
* Duty cycle:
o Strength: 1:3–1:5
o Endurance: 1:1–1:2
* Ramp: Improves comfort and mimics physiologic recruitment
Depth of Penetration
* Increased by:
o Higher amplitude
o Medium-frequency currents
o Wider electrode spacing

Question 17

Frequency

Answer 17

Frequency
* Low frequency (<1000 pps): TENS
* Medium frequency (1000–10,000 pps): NMES, interferential
* Higher frequency → reduced skin impedance → deeper penetration

Question 18

Amplitude

Answer 18

*Determines depth of penetration
* Higher amplitude → deeper nerve recruitment
* Excessive amplitude → pain or unwanted muscle activation

Question 18

Pluse duration

Answer 18

• Short duration → sensory fibers
• Long duration → motor fibers
• Excessive duration → pain fiber activation

Question 19

Contraindication (E-Stim)

Answer 19

• Pacemakers
• Seizure disorders
• Over anesthetic skin
• Areas of neoplasia or infection
• Pregnancy (over trunk)
• Thrombophlebitis
• Peripheral vascular disease
• Where active motion is contraindicated (fresh wounds)

Question 20

Safety Considerations

Answer 20

• Tranquilization may be required
• Proper restraint and handler distance essential
• Skin preparation critical
• Monitor for non-verbal pain responses

Question 21

What is the acronym for LASER?

Answer 21

Light Amplification by Stimulated Emission of Radiation.

Question 22

What property of laser light means it emits a single wavelength?

Answer 22

Monochromatic.

Question 23

The monochromatic nature of laser light allows for targeted interaction with specific tissue _____.

Answer 23

chromophores (e.g., water, melanin, hemoglobin).

Question 24

What property of laser light means its light waves are in phase?

Answer 24

Coherent.

Question 25

What property of laser light means its light rays travel parallel to each other?

Answer 25

Collimated.

Question 26

How does the collimated property of laser light benefit therapy?

Answer 26

It allows for minimal divergence, leading to deeper tissue penetration.

Question 27

In contrast to laser light, ordinary white light is described as polychromatic, incoherent, and _____ rapidly.

Answer 27

disperses.

Question 28

In what units is the wavelength of therapeutic lasers measured?

Answer 28

Nanometers (nm).

Question 29

What is the approximate therapeutic window for laser wavelength?

Answer 29

500–1100 nm.

Question 30

How does wavelength relate to tissue penetration in therapeutic lasers?

Answer 30

Longer wavelengths scatter less and penetrate deeper.

Question 31

Which laser classification includes devices like CD players and laser printers, posing no biological hazard?

Answer 31

Class 1.

Question 32

Which laser classification includes laser pointers and some low-level therapy lasers?

Answer 32

Class 3a.

Question 33

Therapeutic lasers with an output of less than 500 mW typically fall into which classification?

Answer 33

Class 3b.

Question 34

Surgical and high-power therapeutic lasers, such as the Pegasus therapy laser, belong to which classification?

Answer 34

Class 4.

Question 35

What is the primary safety concern when using therapeutic lasers?

Answer 35

Eye protection.

Question 36

Safety eyewear used during laser therapy primarily protects against _____ beams, not the primary beam.

Answer 36

reflected.

Question 37

As a safety guideline, when a therapeutic laser is not in active use, it should be kept in _____ mode.

Answer 37

standby.

Question 38

List three advantages of therapeutic laser treatment.

Answer 38

Non-invasive, analgesic, anti-inflammatory, promotes tissue healing, improves microcirculation, or enhances nerve regeneration.

Question 39

List three disadvantages or risks associated with therapeutic laser treatment.

Answer 39

Cost, operator-dependent dosing, risk of burns if misused, safety concerns, or limited large-scale clinical trials.

Question 40

What is the term for the mechanism by which therapeutic lasers exert their effects through photochemical, not thermal, means?

Answer 40

Photobiomodulation (PBM).

Question 41

In photobiomodulation, what is the primary photoacceptor within the mitochondria?

Answer 41

Cytochrome c oxidase.

Question 42

What is the key cellular effect of photobiomodulation on energy production?

Answer 42

Increased ATP production.

Question 43

Name two tissue-level effects of therapeutic laser treatment.

Answer 43

Increased leukocyte infiltration, macrophage activity, neovascularization, fibroblast proliferation, or accelerated epithelialization.

Question 44

How do therapeutic lasers provide analgesia?

Answer 44

Through the release of endorphins.

Question 45

Laser therapy is contraindicated for use over the eyes, testicles, and in cases of active _____.

Answer 45

hemorrhage.

Question 46

Laser therapy should not be used in pregnant patients or over areas with what type of bone condition?

Answer 46

Epiphysitis.

Question 47

Laser therapy is contraindicated in patients with _____ and sarcoids.

Answer 47

melanomas.

Question 48

Concurrent therapy with what type of medication is a contraindication for laser treatment?

Answer 48

Corticosteroids or photosensitizing medications.

Question 49

What is electrotherapy?

Answer 49

The application of low- or medium-frequency electrical current to stimulate sensory or motor nerves.

Question 50

What is the primary use of TENS (Transcutaneous Electrical Nerve Stimulation)?

Answer 50

Pain control.

Question 51

What is the primary use of NMES (Neuromuscular Electrical Stimulation)?

Answer 51

To produce a muscle contraction for strengthening, re-education, or preventing disuse atrophy.

Question 52

One mechanism of TENS is the _____ theory of pain control.

Answer 52

gate control.

Question 53

For treating acute pain with TENS, what is the recommended frequency range?

Answer 53

50–150 pps (pulses per second).

Question 54

For treating chronic pain with TENS via motor stimulation, what is the recommended frequency range?

Answer 54

2–10 pps (pulses per second).

Question 55

To target sensory fibers with TENS, a _____ pulse duration (2–50 μsec) is used.

Answer 55

short.

Question 56

To target motor fibers with TENS or NMES, a _____ pulse duration (>150 μsec) is used.

Answer 56

long.

Question 57

For NMES, what frequency range is typically used to achieve a tetanic contraction?

Answer 57

30–50 pps.

Question 58

In NMES, what is the purpose of a ramp setting?

Answer 58

It improves comfort and mimics physiologic muscle recruitment.

Question 59

In E-Stim, which parameter is the primary determinant of the depth of penetration?

Answer 59

Amplitude.

Question 60

How does wider electrode spacing affect the depth of penetration in E-Stim?

Answer 60

It increases the depth of penetration.

Question 61

How do higher frequency currents affect skin impedance and penetration depth in E-Stim?

Answer 61

They reduce skin impedance, allowing for deeper penetration.

Question 62

E-Stim is contraindicated in patients with _____, seizure disorders, or thrombophlebitis.

Answer 62

pacemakers.

Question 63

E-Stim should not be applied over areas of neoplasia, infection, or _____ skin.

Answer 63

anesthetic.

Question 64

Bone is a dynamic, living tissue composed of cells and a matrix. What is the immature, irregular type of bone tissue found in a fetus or during early repair?

Answer 64

Woven bone.

Question 65

What is the mature, organized type of bone tissue that includes osteons?

Answer 65

Lamellar bone.

Question 66

What component of the inorganic bone matrix provides hardness and compressive strength?

Answer 66

Calcium hydroxyapatite.

Question 67

What component of the organic bone matrix provides tensile strength?

Answer 67

Collagen fibers.

Question 68

Which bone cells are responsible for bone formation?

Answer 68

Osteoblasts.

Question 69

Which bone cells are responsible for bone resorption?

Answer 69

Osteoclasts.

Question 70

Which bone cells are responsible for maintaining bone tissue?

Answer 70

Osteocytes.

Question 71

List three key properties of articular cartilage.

Answer 71

Avascular, aneural, and alymphatic.

Question 72

What is the primary cell type found in articular cartilage?

Answer 72

Chondrocytes.

Question 73

What is the primary type of collagen that forms the structural framework of the articular cartilage extracellular matrix?

Answer 73

Type II collagen.

Question 74

What is the primary aggregating proteoglycan in articular cartilage?

Answer 74

Aggrecan.

Question 75

In the 'joint as an organ' concept, which structure lines the joint and produces synovial fluid?

Answer 75

The synovial membrane.

Question 76

What is the primary function of hyaluronan (HA) and lubricin in synovial fluid?

Answer 76

Lubrication of articular surfaces.

Question 77

Besides lubrication, what is a key function of synovial fluid for cartilage health?

Answer 77

Nutrient delivery and removal of metabolic waste.

Question 78

Name two key classes of enzymes that contribute to cartilage degradation in joint disease.

Answer 78

Matrix metalloproteinases (MMPs) and aggrecanases.

Question 79

Name two pro-inflammatory cytokines that contribute to cartilage breakdown.

Answer 79

Interleukin-1 (IL-1) and Tumor necrosis factor-α (TNF-α).

Question 80

What condition is considered the primary therapeutic target in joint disease because it drives enzyme release and cartilage degeneration?

Answer 80

Synovitis.

Question 81

What imaging modality is considered the gold standard for diagnosing fractures and advanced osteoarthritis?

Answer 81

Radiography.

Question 82

Which advanced imaging modality is superior for detecting early subchondral sclerosis and lysis?

Answer 82

Computed Tomography (CT).

Question 83

Which imaging modality is best for evaluating soft tissues, cartilage, and subchondral bone in a joint?

Answer 83

Magnetic Resonance Imaging (MRI).

Question 84

What is the gold standard for direct evaluation of cartilage surfaces?

Answer 84

Arthroscopy.

Question 85

What is the mechanism of action for Non-steroidal Anti-inflammatory Drugs (NSAIDs)?

Answer 85

They inhibit cyclooxygenase (COX) enzymes.

Question 86

Which COX enzyme is considered inducible or 'bad' as it is associated with inflammation?

Answer 86

COX-2.

Question 87

Firocoxib (Equioxx®) is an example of an NSAID that is selective for which enzyme?

Answer 87

COX-2.

Question 88

Which intra-articular corticosteroid is considered chondroprotective?

Answer 88

Triamcinolone acetonide.

Question 89

Which intra-articular corticosteroid is associated with cartilage degeneration?

Answer 89

Methylprednisolone acetate.

Question 90

What is the primary therapeutic effect of Polysulfated Glycosaminoglycans (PSGAGs)?

Answer 90

They modulate cartilage metabolism and reduce enzyme-mediated degradation.

Question 91

PRP, bone marrow supernatant, and stem cells are all examples of what category of joint disease therapy?

Answer 91

Biologic therapies.

Question 92

What is the primary goal of bone adaptation in response to exercise?

Answer 92

To maintain an adequate strain environment.

Question 93

Process: Bone Modeling

Answer 93

Definition: A change in bone shape where resorption and formation are uncoupled.

Question 94

Process: Bone Remodeling

Answer 94

Definition: The replacement of existing bone where resorption and formation are coupled.

Question 95

What is the effect of exercise on bone density?

Answer 95

It increases bone density and improves subchondral bone strength.

Question 96

What is the effect of disuse on bone density and strength?

Answer 96

It leads to decreased bone density and weakened subchondral bone.