FSMTB MBLEx Exam Questions

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21.

It is common for a massage therapist to be the only person who regularly sees the skin of a person's back. For that reason, it is important for therapists to know the warning signs of skin cancer, so they can refer at-risk clients to their doctor for testing. What are the four primary warning signs of malignant melanoma, the most dangerous type of skin cancer?

  • Asymmetry, border irregularity, color change, diameter increase

  • Heat, redness, swelling, pain

  • Asymmetry, blush of surrounding skin, color change, diameter increase

  • Texture, color, location, hair

Correct answer: Asymmetry, border irregularity, color change, diameter increase

The four primary warning signs of malignant melanoma are asymmetry, border irregularity, color change, and diameter increase. The memory trick for these four signs is ABCD. If a massage therapist notices that a client has a mole with these qualities, they should suggest the client see a doctor for further testing.

Heat, redness, swelling, and pain are the signs of inflammation. The blush of surrounding skin is a common effect of palpation, and not necessarily a sign of pathology. The texture, location, and presence of hair on a mole do not indicate whether it might be cancerous. The color is only a sign of potential pathology if it is seen to change over time.

22.

A massage therapist is working with a patient who has sustained a sprain to the L4-5 region of the spine. What type of joint is involved?

  • Gliding

  • Condyloid

  • Pivot

  • Saddle

Correct answer: Gliding

The joints of the lumbar region are gliding joints. As the name suggests, gliding joints allow for gliding movement between articulating bones. These types of joints are found throughout the spine between the vertebrae. Other examples of gliding joints include the acromioclavicular joint and the superior tibiofibular joint. A sprain is an injury to a ligament, and ligaments are present in and around joints.

Condyloid joints only allow motion in two planes, as in the atlantooccipital joint. Pivot joints allow for rotation around a bone, as in the proximal radioulnar joint. Saddle joints connect the concave and convex surfaces of articulating bones, as in the carpometacarpal joints. None of these types of joints appear in the spinal column.

23.

What is the concentric action of the psoas major?

  • Flexion and lateral rotation of the thigh at the hip joint

  • Extension and medial rotation of the thigh

  • Flexion of the trunk at the spinal joints and posterior tilt of the pelvis at the lumbosacral joint

  • Flexion and medial rotation of the leg at the knee joint

Correct answer: Flexion and lateral rotation of the thigh at the hip joint

The concentric action of the psoas muscle is flexion and lateral rotation of the thigh at the hip joint, flexion and lateral flexion of the trunk at the spinal joints, and anterior tilt of the pelvis at the hip joint.

The eccentric action allows extension and medial rotation of the thigh and allows extension and contralateral lateral flexion of the trunk and posterior tilt of the pelvis. The gluteus maximus extends and laterally rotates the thigh at the hip joint. The semimembranosus flexes and medially rotates the leg at the knee joint.

24.

While calcium is important in healthy bones, it plays all the following roles except:

  • Movement of sodium across cell walls

  • Transmission of nerve impulses across synapses

  • Blood clotting

  • Muscle contraction

Correct answer: Movement of sodium across cell walls

Calcium helps to transmit nerve impulses across synapses, which is where an axon and a post-synaptic cell meet. It is also important in the processes of blood clotting and muscle contraction. 

Chloride, which is an electrolyte, easily diffuses across plasma membranes. This movement is closely linked to the movement of sodium. Chloride helps regulate osmotic pressure differences and maintain the body's pH balance.

25.

A massage therapist who has been trained in reflexology has been using it to improve the heart function of one of her clients. She has also been advertising the potential benefits of reflexology to the public.

Is this appropriate?

  • Yes, she has been trained in reflexology and this is within the scope of practice

  • Yes, diagnosis and treatment of heart conditions is within the scope of practice

  • No, organ systems cannot be affected by any massage techniques

  • No, reflexology and its effect on the heart are outside the scope of practice

Correct answer: Yes, she has been trained in reflexology and this is within the scope of practice

Treatment of energy flow and the use of reflexology, in theory, may influence heart function. Since this therapist has been trained these techniques, it is appropriate to treat clients with it and to advertise it to the public. It is not, however, appropriate to advertise it as an alternative to vital heart medication or treatment.

This should not be advertised as "medical" treatment, but rather, an alternative treatment. It should also be made clear, both in advertising and to any clients, that these techniques cannot and should not replace vital medications or procedures.

26.

Massage can offer a variety of benefits to clients suffering from mental illness. For example, massage has a normalizing effect on:

  • The autonomic nervous system

  • The sympathetic nervous system

  • The parasympathetic nervous system

  • The involuntary nervous system

Correct answer: The autonomic nervous system

Massage can offer a variety of benefits to clients suffering from mental illness. For example, massage has a normalizing effect on the autonomic nervous system. The autonomic nervous system (ANS) includes the sympathetic (fight or flight) and parasympathetic (rest and digest) nervous systems. By normalizing ANS activity, and particularly by activating the parasympathetic nervous system, massage can provide relief from many symptoms of various mental illnesses.

Massage usually decreases activity in the sympathetic nervous system and activates the parasympathetic nervous system.

Although the nervous system does control involuntary actions, such as respiration and reflexes, "involuntary nervous system" is not a commonly used term.

27.

When does the subacute phase of healing occur?

  • 14–21 days after injury

  • Immediately after the injury

  • 3–7 days after injury

  • More than 21 days after injury

Correct answer: 14–21 days after injury

Massage is indicated during the subacute phase of healing, which occurs 14–21 days after injury.

Massage is indicated during the acute phase of healing, but not immediately after injury; the therapist should wait three days before beginning treatment.

It is also indicated during the chronic phase of healing, which normally begins 14–21 days after injury.

Any pain experienced after 21 days is considered chronic pain, and can often still be treated with massage.

28.

Of the following options, which is not a mechanical force that can be produced by massage techniques?

  • Field force

  • Shear loading

  • Bending stress

  • Torsion

Correct answer: Field force

A field force is not a type of mechanical force. Gravity and magnetism are both examples of field forces. Field forces are not produced by massage techniques.

Shear loading is produced when tissues are made to slide against other tissues, as with frictioning techniques. Bending stress is a combination of compression and tension stress. Torsion is best described as pushing and pulling. 

29.

Which of the following is true of cardiac muscle?

  • It is a type of muscle found in the heart.

  • It is a voluntary muscle.

  • It is a type of muscle found around blood vessels.

  • It is the type of muscle that allows bones to move.

Correct answer: It is a type of muscle found in the heart.

Cardiac muscle, also known as striated involuntary muscle, is found only in the heart. It contracts rhythmically and involuntarily, continually pumping blood through the heart, the lungs, and the rest of the body.

Smooth muscle is found around blood vessels. Skeletal muscle is a voluntary muscle and allows bones to move.

30.

After performing a needs assessment for a new client, the massage therapist determines that the client may potentially have an orthopedic injury related to their low back. Neither the client nor the therapist can determine an underlying cause for this injury. It is most appropriate to:

  • Refer the client to his physician

  • Treat the low back with joint mobilizations

  • Instruct the client to take anti-inflammatory medication

  • Proceed as normal with massage therapy intervention, without offering a referral

Correct answer: Refer the client to his physician

Unless she is also a licensed medical doctor, treating this condition is outside a massage therapist's scope of practice. She is ethically obligated to refer the client to a specialist who is qualified to treat this injury.

It is inappropriate for a therapist to utilize joint mobilizations in an area with unknown cause of pain or injury. The massage therapist should never advise clients to take medication. Although the massage therapist may offer general interventions for wellness and health, this client should be referred to his physician for further medical evaluation.

31.

A therapist is working with a client who just had surgery and has some clear discharge coming from the incision site. When treating this client, what precautions should be used?

  • Standard precautions

  • Universal precautions

  • Contact precautions

  • Droplet precautions

Correct answer: Standard precautions

Standard precautions are used to prevent the transmission of disease through any bodily fluid. They should be used any time contact with blood, any bodily fluid, non-intact skin, or a mucous membrane is possible. In this case, the client has drainage coming from the incision, so the therapist must use standard precautions. These include handwashing, the use of gloves, and, potentially, gowns. 

Universal precautions were originally designed to be used only when contact with blood was possible. Contact precautions are used when a client knowingly has a contagious disease that is transmitted by touching the client (MRSA, C. diff, etc.), or with an open wound. A closed surgical incision is not considered an open wound. Droplet precautions are used when the client has a contagious disease/infection that is transmitted by droplets in the air through coughing or sneezing (pneumonia, whooping cough).

32.

When performing a technique that involves passive movement of the hip, what is the best way to drape to maintain client modesty, but still allow access to the upper thigh and hip?

  • Wrap the sheet around the proximal hip, exposing the rest of the leg.

  • Pull the sheet up to the proximal hip and allow it to rest there.

  • Leave the leg completely under the sheet.

  • Wrap the sheet around the knee, leaving the shin and foot exposed.

Correct answer: Wrap the sheet around the proximal hip, exposing the rest of the leg.

In order to maintain client modesty, the pelvic area should be draped very cautiously. When passively or actively working with hip movement, it is important to tuck the sheet around the proximal hip so that when hip movement occurs, no areas proximal to the hip are accidentally exposed. This style of draping allows for maximal access to the hip and upper thigh while still maintaining modesty. 

Simply letting the sheet rest at the proximal hip leaves the possibility of the sheet moving up and exposing sensitive areas. Additionally, if the hip is moved into flexion, the underside of the client would be exposed if the sheet is not tucked around the hip. Wrapping the sheet around the knee, while still maintaining modesty, would not allow for access to the hip and upper thigh. Leaving the leg under the sheet would not be ideal for any treatment to the upper thigh or hip since these areas cannot be directly accessed.

33.

A massage therapist positions a client's arm into elbow flexion and applies a prolonged force to elicit resistance in the triceps. What occurs in the tissue of the triceps during this technique?

  • The fiber of connective tissue enters the plastic range.

  • The fiber of connective tissue enters the elastic range.

  • The ground substance of connective tissue enters the plastic range.

  • The ground substance of connective tissue enters the elastic range.

Correct answer: The fiber of connective tissue enters the plastic range

The technique described here is a stretch of the triceps (flexing the elbow lengthens the triceps, and with prolonged force, it becomes a stretch). Stretching targets the fiber of connective tissue and eventually moves it into the plastic range. The plastic range occurs when tissue is elongated beyond its normal length, and a lasting change occurs. Prolonged force into resistance in elbow flexion will have this effect on the triceps. 

The elastic range of tissue occurs when tissue is elongated beyond its normal length and, when the force is removed, it returns to its resting length. Prolonged stretching will cause long-term elongation of the tissue, meaning it enters the plastic range. The ground substance is made up of glycosaminoglycans and is gelatinous; this is not the tissue targeted with stretching.

34.

During the first session with a client with low back pain, the client states he cannot tolerate laying on his stomach any more after 10 minutes in this position. What action should the massage therapist take next?

  • Place a pillow under the client's hips and under the feet and wait for symptom response before having him change positions.

  • Have the client transition to supine with a bolster under the knees.

  • Have the client transition to side-lying with a pillow between the knees and one under the arm and wait for symptom response.

  • Refer the client to a physician for further evaluation.

Correct answer: Place a pillow under the client's hips and under the feet and wait for symptom response before having him change positions.

Lying prone on a treatment table can cause excessive lumbar extension and an anterior pelvic tilt. This can cause lumbar pain if not addressed, especially in a client with low back pain. Therefore, the first step should be to place a pillow under the hips to reduce lumbar extension and under the feet to reduce lumbar tension. If and when this accommodation is insufficient, the massage therapist should have the client change positions.

While the other positions may be good alternatives, the therapist will be able to perform far more effective work to the lumbar spine while the client lies prone. Therefore, the therapist should attempt to maintain the relative position as long as possible, while providing accommodations (pillows and/or bolsters) to make it tolerable. Laying supine would be a difficult position in which to work on the tissues of the lumbar spine. This client is still appropriate for massage; however, if the pain is rated 10/10, comes on suddenly, and never changes, he should be referred out. 

35.

When a massage therapist washes his hands, what is the best way to turn off the water?

  • With a paper towel

  • With the pinky finger

  • With the thumb

  • With the fingers of the non-dominant hand

Correct answer: With a paper towel

After washing one's hands, especially just before starting a massage, it is important to avoid touch any surface that may not be equally clean. Touching the faucet directly will negate the benefits of handwashing. It is best to turn off the water with a paper towel, one's elbow, or upper arm.

36.

A client who has been diagnosed by her physician with lymphedema in her lower extremities comes to the clinic because she would like to reduce the amount of fluid in her legs. Which technique should the massage therapist use?

  • Short gliding strokes with light pressure near lymph vessels

  • Short gliding strokes with medium pressure from the hips to the toes

  • Moderate pressure from the inguinal region toward the toes along the skeletal muscle fiber direction

  • This client is not a candidate for massage and should be referred back to her physician

Correct answer: Short gliding strokes with light pressure near lymph vessels

Lymphedema occurs when the fluid in the interstitium is not moving into lymph vessels and not draining through those vessels effectively. Short gliding strokes with light to medium pressure are most effective in reducing interstitial fluid build-up. This technique helps this fluid move from the interstitium to lymph vessels which clears the fluid. This is most effective when done near lymph structures and from the toes toward the heart. 

While short gliding strokes with medium pressure are acceptable, moving from the hips or inguinal region to the toes would move the fluid away from the heart and major vessels which would not help to remove the fluid. Moderate pressure in the direction of skeletal muscle fibers will help with lymphedema, but movement must be towards the heart and major vessels, not away. Massage therapists can treat clients with lymphedema as long as treatment is provided under the supervision of the client's physician, so this client would be appropriate.

37.

A massage therapist is 70 inches tall and is trying to adjust the height of a new table. What is the best height for the table to be set?

  • 35 inches

  • 40 inches

  • 30 inches

  • 42 inches

Correct answer: 35 inches 

In general, table height should be half of the massage therapist's height (half of 70 inches is 35 inches). If nothing else, this is a good starting point, and then the table can be adjusted to the therapist's comfort. This general height will help to ensure proper body mechanics and reduce the risk of injury. 

35 inches +/- 2 or 3 inches would be ideal for this therapist, but no variation beyond 2 or 3 inches is recommended. This can change slightly based on the proportions of the individual therapist.

38.

Why should heavy percussion should be avoided in the flank area?

  • The kidneys are located in this area.

  • The muscles of the low back are too sensitive to heavy percussion.

  • The pancreas is located in this area.

  • The liver is located in this area.

Correct answer: The kidneys are located in this area.

The kidneys are located in the flank area and are loosely suspended in connective tissue. Heavy percussion to this endangerment site could injure them, and so should be avoided.

The pancreas is located anterior to the kidneys and is not as susceptible to massage techniques. The liver is located in the right upper quadrant of the abdomen and would not be directly affected by massage techniques to the posterior aspect of the body. The muscles of the low back are not usually too sensitive for heavy percussion, and this is certainly not the primary reason to avoid this technique in the flank region.

39.

A potential client has been diagnosed with kidney failure. What is this condition considered, and what should the therapist do?

  • A general contraindication; refuse treatment

  • A general contraindication; provide only light relaxation massage

  • A regional contraindication; provide massage only to the affected area

  • A regional contraindication; provide massage but avoid the affected area

Correct answer: A general contraindication; refuse treatment

Kidney failure is a general contraindication, so the therapist should refuse treatment. Kidney failure, or renal failure, is the inability of the kidneys to excrete waste and retain electrolytes. Massage can exacerbate this condition by increasing circulation.

When a therapist encounters a general contraindication, they should either refer the client to a physician or (in some cases) refuse treatment entirely.

When a client presents with a regional contraindication, the massage therapist should avoid the affected area. However, renal failure is not a regional contraindication.

40.

Earlier this year, a client broke her wrist and was placed in a cast. Her arm and hand were immobilized for 10 weeks. She now has decreased range of motion at the wrist. What is the most likely cause?

  • Hypomobility due to contracture

  • Hypomobility due to nerve damage

  • Hypermobility due to increased muscle tension

  • Hypermobility due to pain

Correct answer: Hypomobility due to contracture

With prolonged immobilization, connective tissues undergo changes. Most commonly, these tissues shorten to the position in which the joint was held immobile, which results in joint contracture. 

Hypomobility means restricted mobility. Hypermobility means excessive mobility.