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Hand Therapy Certification Examination practice questions

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Question 1Upper limb assessment and evaluation

Which carpal bone is most commonly fractured and is best evaluated clinically by tenderness in the anatomic snuffbox?

  1. Trapezium
  2. Hamate
  3. Scaphoid Correct answer.
  4. Pisiform

Explanation

The scaphoid is the most frequently fractured carpal bone, and its dorsal radial location places it directly under the anatomic snuffbox. Snuffbox tenderness is therefore the classic screening finding, and clinical suspicion warrants immobilization and imaging even with normal early radiographs.

Question 2Upper limb assessment and evaluation

A patient reports numbness in the thumb, index, and middle fingers that wakes them at night. Which nerve is most likely involved?

  1. Posterior interosseous nerve
  2. Median nerve Correct answer.
  3. Ulnar nerve
  4. Radial nerve

Explanation

The median nerve supplies sensation to the palmar thumb, index, middle, and radial half of the ring finger. Nocturnal paresthesias in this distribution suggest carpal tunnel syndrome. Ulnar and radial distributions are different and are used to discriminate the level of nerve involvement.

Question 3Upper limb assessment and evaluation

Which motion of the shoulder girdle is produced primarily by the upper trapezius and levator scapulae?

  1. Elevation Correct answer.
  2. Protraction
  3. Downward rotation
  4. Depression

Explanation

The upper trapezius and levator scapulae both attach to the superior scapula and cervical spine, producing scapular elevation. Depression and downward rotation are actions of the lower trapezius and rhomboids, and protraction is driven by the serratus anterior.

Question 4Upper limb assessment and evaluation

During goniometric measurement of shoulder flexion, where should the stationary arm of the goniometer be aligned?

  1. Parallel to the humerus
  2. Perpendicular to the floor
  3. Along the midaxillary line of the thorax Correct answer.
  4. Along the spine of the scapula

Explanation

For shoulder flexion the stationary arm follows the lateral midline of the thorax, approximately the midaxillary line, while the moving arm follows the humerus. This reference allows the measured angle to reflect true glenohumeral-plus-scapular motion relative to the trunk.

Question 5Upper limb assessment and evaluation

Which muscle is the primary flexor of the elbow regardless of forearm position?

  1. Pronator teres
  2. Brachialis Correct answer.
  3. Biceps brachii
  4. Brachioradialis

Explanation

The brachialis inserts on the ulna and crosses the elbow as a pure flexor, so its moment arm is unaffected by forearm rotation. The biceps and brachioradialis contribute more when the forearm is supinated or neutral, respectively.

Question 6Upper limb assessment and evaluation

Which finding is most consistent with a positive Phalen test?

  1. Reproduction of median nerve paresthesias during sustained wrist flexion Correct answer.
  2. Pain at the elbow with resisted forearm supination
  3. Pain at the lateral epicondyle with resisted wrist extension
  4. Reproduction of symptoms with passive thumb extension into the palm

Explanation

The Phalen test holds the wrists in full flexion for about a minute to increase carpal tunnel pressure and provoke median nerve symptoms. Resisted wrist extension tests for lateral epicondylalgia, and the other maneuvers assess different structures.

Question 7Upper limb assessment and evaluation

A patient cannot actively abduct the shoulder past 90 degrees and has pain in the mid-arc of elevation. Which muscle is most likely involved?

  1. Pectoralis major
  2. Teres major
  3. Latissimus dorsi
  4. Supraspinatus Correct answer.

Explanation

The supraspinatus initiates abduction and is the most commonly torn rotator cuff tendon, producing a painful arc in mid-elevation. Teres major, pectoralis major, and latissimus dorsi are adductors and medial rotators rather than abductors.

Question 8Upper limb assessment and evaluation

In a patient with a suspected distal radius fracture, which clinical finding most strongly suggests an associated median nerve injury?

  1. Weakness of wrist extension
  2. Numbness over the volar index fingertip Correct answer.
  3. Loss of sensation over the dorsal first web space
  4. Inability to abduct the fingers

Explanation

The median nerve supplies the volar index finger, so sensory loss there indicates median nerve involvement. Wrist extension is radial nerve function, finger abduction is ulnar nerve function, and dorsal first web space sensation is radial nerve territory.

Question 9Upper limb assessment and evaluation

A therapist measures elbow flexion as 0 to 140 degrees. Which value represents the documented range of motion?

  1. The values indicate a 140-degree deficit
  2. 140 degrees is the starting position and 0 degrees is the end range
  3. 0 degrees is the starting position and 140 degrees is the end range Correct answer.
  4. Both values describe the axis position

Explanation

Range of motion is recorded as the starting position followed by the end position, so 0 to 140 degrees means full extension to 140 degrees of flexion. The first number is not a deficit but the reference starting angle.

Question 10Upper limb assessment and evaluation

Which test is used to assess for a SLAP lesion of the superior labrum?

  1. Cozen test
  2. Finkelstein test
  3. Speed test
  4. O'Brien active compression test Correct answer.

Explanation

The O'Brien active compression test places the shoulder in flexion, adduction, and internal rotation to compress the superior labrum and reproduce symptoms of a SLAP lesion. Speed test assesses the biceps tendon, Finkelstein assesses the first dorsal compartment, and Cozen assesses the lateral epicondyle.

Question 11Upper limb assessment and evaluation

A patient has weakness of thumb opposition and thenar atrophy. Which nerve is affected?

  1. Ulnar nerve
  2. Radial nerve
  3. Axillary nerve
  4. Median nerve Correct answer.

Explanation

The thenar muscles, including opponens pollicis, are innervated by the recurrent branch of the median nerve. Thenar atrophy with weak opposition is a hallmark of advanced median nerve compression. Ulnar, radial, and axillary nerves do not supply the thenar eminence.

Question 12Upper limb assessment and evaluation

Which landmark is used to align the stationary arm when measuring forearm pronation?

  1. Along the dorsum of the hand
  2. Parallel to the floor
  3. Parallel to the humerus Correct answer.
  4. Along the lateral epicondyle

Explanation

Forearm pronation is measured with the elbow flexed to 90 degrees, the stationary arm parallel to the humerus, and the moving arm aligned with the dorsum of the hand. The humerus provides a stable reference while the hand rotates.

Question 13Upper limb assessment and evaluation

A patient demonstrates winging of the scapula with weakness in forward reaching. Which muscle is most likely impaired?

  1. Serratus anterior Correct answer.
  2. Rhomboid major
  3. Trapezius
  4. Levator scapulae

Explanation

The serratus anterior protracts the scapula and holds it against the thoracic wall, so its weakness produces medial border winging, especially during forward reach. The rhomboids and trapezius retract or elevate the scapula and do not produce this pattern.

Question 14Upper limb assessment and evaluation

Which finding best distinguishes lateral epicondylalgia from radial tunnel syndrome during assessment?

  1. Presence of grip weakness
  2. Pain with passive wrist flexion
  3. Presence of pain with resisted wrist extension
  4. Location of maximal tenderness distal to the lateral epicondyle Correct answer.

Explanation

Radial tunnel syndrome produces tenderness over the radial nerve in the proximal forearm, distal to the lateral epicondyle, without the epicondylar tenderness typical of lateral epicondylalgia. Both conditions can cause pain with resisted wrist extension and grip weakness, so location is the key discriminator.

Question 15Upper limb assessment and evaluation

A patient reports pain over the radial styloid that worsens with thumb and wrist movement. Which test is most appropriate?

  1. Phalen test
  2. Tinel sign at the wrist
  3. Watson scaphoid shift test
  4. Finkelstein test Correct answer.

Explanation

The Finkelstein test stretches the first dorsal compartment and provokes pain in de Quervain tenosynovitis at the radial styloid. The Tinel and Phalen tests assess the median nerve, and the Watson test assesses scaphoid instability.

Question 16Upper limb assessment and evaluation

Which muscle action is lost when the axillary nerve is injured?

  1. Elbow flexion
  2. Wrist extension
  3. Finger abduction
  4. Shoulder abduction and external rotation Correct answer.

Explanation

The axillary nerve supplies the deltoid and teres minor, which abduct and externally rotate the shoulder. Elbow flexion is musculocutaneous, wrist extension is radial, and finger abduction is ulnar.

Question 17Upper limb assessment and evaluation

Which position is used for the empty can test?

  1. Shoulder adducted across the chest
  2. Shoulder extended with elbow flexed
  3. Shoulder abducted 90 degrees with thumb down Correct answer.
  4. Shoulder flexed 90 degrees with thumb up

Explanation

The empty can test positions the shoulder in 90 degrees of abduction with full internal rotation so the thumb points down, then applies downward resistance to assess the supraspinatus. The thumb-up position corresponds to the full can test.

Question 18Upper limb assessment and evaluation

A patient has a positive drop arm test. Which structure is most likely compromised?

  1. Supraspinatus tendon Correct answer.
  2. Long head of triceps
  3. Biceps tendon
  4. Subscapularis tendon

Explanation

The drop arm test assesses the ability to control the arm as it is lowered from abduction, which depends on an intact supraspinatus and rotator cuff. A positive result suggests a significant cuff tear, most often of the supraspinatus.

Question 19Upper limb assessment and evaluation

Which measurement best reflects functional hand dexterity during upper limb evaluation?

  1. Nine-hole peg test time Correct answer.
  2. Two-point discrimination distance
  3. Passive wrist extension range
  4. Grip strength in kilograms

Explanation

The nine-hole peg test times a functional task requiring grasp, transport, and release, giving an index of dexterity. Grip strength and range of motion measure impairment, and two-point discrimination measures sensory acuity.

Question 20Upper limb assessment and evaluation

A patient has loss of sensation over the little finger and weakness of finger abduction. Which nerve is affected?

  1. Musculocutaneous nerve
  2. Radial nerve
  3. Median nerve
  4. Ulnar nerve Correct answer.

Explanation

The ulnar nerve supplies the little finger and the dorsal interossei, so this pattern indicates an ulnar neuropathy. Median, radial, and musculocutaneous lesions produce different sensory and motor distributions.

Question 21Upper limb assessment and evaluation

During assessment of a patient with a suspected posterior shoulder dislocation, which finding is most characteristic?

  1. Prominence of the humeral head anteriorly
  2. Severe pain with active abduction
  3. Blocked external rotation with the arm at the side Correct answer.
  4. Crepitus over the acromioclavicular joint

Explanation

Posterior dislocations lock the humerus in internal rotation, so external rotation is markedly limited or blocked. Anterior prominence would suggest an anterior dislocation, and AC crepitus suggests AC joint pathology.

Question 22Upper limb assessment and evaluation

Which finding on the lift-off test indicates subscapularis dysfunction?

  1. Pain with resisted shoulder abduction
  2. Weakness with resisted elbow extension
  3. Inability to lift the hand off the lumbar spine Correct answer.
  4. Pain with resisted wrist flexion

Explanation

The lift-off test asks the patient to lift the hand away from the lumbar spine with the arm internally rotated, which isolates the subscapularis. Failure or pain indicates subscapularis pathology. The other maneuvers test unrelated muscle groups.

Question 23Upper limb assessment and evaluation

In a patient with cubital tunnel syndrome, which clinical finding is most expected?

  1. Weakness of thumb opposition
  2. Atrophy of the first dorsal interosseous Correct answer.
  3. Loss of wrist extension
  4. Numbness of the palmar index finger

Explanation

Cubital tunnel syndrome affects the ulnar nerve at the elbow, and the first dorsal interosseous is an ulnar-innervated intrinsic muscle that atrophies early. Index finger sensation and thumb opposition are median functions, and wrist extension is radial.

Question 24Upper limb assessment and evaluation

A patient with a C6 tetraplegia has active elbow flexion and wrist extension but no finger flexion. Which level of injury is most consistent?

  1. C4
  2. C5
  3. C7
  4. C6 Correct answer.

Explanation

C6 innervation provides elbow flexion through the biceps and wrist extension through the extensor carpi radialis, while finger flexors are largely C7-C8. Preserved elbow flexion and wrist extension with absent finger flexion fits a C6 level.

Question 25Upper limb assessment and evaluation

A patient has a positive Watson scaphoid shift test. What does this finding suggest?

  1. Scapholunate ligament instability Correct answer.
  2. Ulnar collateral ligament tear of the thumb
  3. Carpal tunnel syndrome
  4. Medial epicondylitis

Explanation

The Watson test applies pressure to the scaphoid while the wrist moves from ulnar to radial deviation; a painful clunk indicates the scaphoid is subluxing due to scapholunate ligament insufficiency. The other conditions involve different structures and tests.

Question 26Upper limb assessment and evaluation

Which muscle is primarily responsible for shoulder abduction from 0 to 15 degrees?

  1. Infraspinatus
  2. Supraspinatus Correct answer.
  3. Teres minor
  4. Deltoid

Explanation

The supraspinatus initiates abduction in the first 15 degrees, after which the deltoid becomes the primary abductor. Infraspinatus and teres minor are external rotators and do not contribute significantly to abduction.

Question 27Upper limb assessment and evaluation

A patient reports numbness and tingling in the thumb, index, and middle fingers that worsens at night. Which nerve is most likely compressed?

  1. Radial nerve
  2. Ulnar nerve
  3. Median nerve Correct answer.
  4. Axillary nerve

Explanation

The median nerve supplies sensation to the palmar aspect of the thumb, index, middle, and radial half of the ring finger. Nocturnal worsening is classic for carpal tunnel syndrome, which compresses the median nerve.

Question 28Upper limb assessment and evaluation

Which clinical finding is most characteristic of a posterior shoulder dislocation?

  1. Positive drop arm test
  2. Fixed internal rotation Correct answer.
  3. Fixed external rotation
  4. Positive lift-off test

Explanation

Posterior dislocation typically presents with the arm held in internal rotation and adduction, and external rotation is blocked. A drop arm test suggests rotator cuff tear, and a lift-off test suggests subscapularis dysfunction.

Question 29Upper limb assessment and evaluation

Which test is most appropriate for assessing lateral epicondylalgia?

  1. Cozen test Correct answer.
  2. Watson scaphoid shift test
  3. Tinel sign at the elbow
  4. Phalen test

Explanation

The Cozen test resists wrist extension and provokes pain at the lateral epicondyle, indicating lateral epicondylalgia. Phalen and Tinel at the elbow assess nerve compression, and the Watson test assesses scaphoid instability.

Question 30Upper limb assessment and evaluation

A patient has weakness of elbow extension and sensory loss over the posterior forearm. Which nerve is most likely affected?

  1. Ulnar nerve
  2. Median nerve
  3. Musculocutaneous nerve
  4. Radial nerve Correct answer.

Explanation

The radial nerve innervates the triceps and supplies sensation to the posterior forearm. Musculocutaneous nerve affects elbow flexion, median nerve affects forearm pronation and hand sensation, and ulnar nerve affects intrinsic hand muscles.

Question 31Upper limb assessment and evaluation

During assessment of a patient with a suspected distal radius fracture, which clinical finding most strongly suggests an associated median nerve injury?

  1. Loss of sensation over the dorsal first web space
  2. Weakness of finger abduction
  3. Loss of sensation in the little finger
  4. Inability to abduct the thumb Correct answer.

Explanation

Thumb abduction is mediated by the median nerve (abductor pollicis brevis), so inability to abduct the thumb suggests median nerve involvement. Little finger sensation and finger abduction are ulnar nerve functions, and dorsal first web space sensation is radial nerve.

Question 32Upper limb assessment and evaluation

A patient with cubital tunnel syndrome is most likely to demonstrate which clinical finding?

  1. Positive Tinel sign at the elbow Correct answer.
  2. Weakness of thumb abduction
  3. Positive Phalen test
  4. Atrophy of the thenar eminence

Explanation

Cubital tunnel syndrome involves ulnar nerve compression at the elbow, so a Tinel sign at the cubital tunnel is expected. Thumb abduction weakness and thenar atrophy indicate median nerve involvement, and a positive Phalen test indicates carpal tunnel syndrome.

Question 33Upper limb assessment and evaluation

A patient with a C6 tetraplegia has active elbow flexion and wrist extension but no finger flexion. Which level of injury is most likely?

  1. C7
  2. C4
  3. C5
  4. C6 Correct answer.

Explanation

C6 innervation includes the biceps (elbow flexion) and extensor carpi radialis (wrist extension), but finger flexors are innervated by C7 and C8. Therefore, preserved elbow flexion and wrist extension with absent finger flexion indicates a C6 level.

Question 34Upper limb assessment and evaluation

During assessment of a patient with a suspected SLAP lesion, which test is most specific?

  1. O'Brien active compression test Correct answer.
  2. Yergason test
  3. Apprehension test
  4. Speed test

Explanation

The O'Brien active compression test is designed to detect SLAP lesions by provoking pain at the superior labrum. Speed and Yergason tests assess biceps tendinopathy, and the apprehension test assesses anterior shoulder instability.

Question 35Upper limb assessment and evaluation

A patient is unable to actively abduct the shoulder past 90 degrees and shows excessive scapular upward rotation during attempted abduction. Which condition is most likely?

  1. Scapular dyskinesis Correct answer.
  2. Rotator cuff tear
  3. Acromioclavicular joint arthritis
  4. Adhesive capsulitis

Explanation

Scapular dyskinesis is characterized by altered scapular motion and positioning, often with excessive upward rotation or winging, which can limit overhead abduction. Rotator cuff tears typically present with weakness in specific ranges but not necessarily excessive scapular rotation. Adhesive capsulitis causes global restriction, and AC joint arthritis causes localized pain.

Question 36Upper limb assessment and evaluation

During an upper limb assessment, which muscle is primarily responsible for elbow flexion when the forearm is in supination?

  1. Biceps brachii Correct answer.
  2. Pronator teres
  3. Brachialis
  4. Brachioradialis

Explanation

The biceps brachii is a powerful elbow flexor and is most effective when the forearm is supinated because its tendon inserts on the radial tuberosity. Brachialis is a pure flexor regardless of forearm position, brachioradialis is most effective in neutral, and pronator teres is primarily a pronator.

Question 37Upper limb assessment and evaluation

A patient reports weakness when lifting objects with the arm extended and the forearm pronated. Which muscle is most likely affected?

  1. Brachialis
  2. Brachioradialis Correct answer.
  3. Biceps brachii
  4. Triceps brachii

Explanation

The brachioradialis is most active as an elbow flexor when the forearm is in a neutral or pronated position, as during lifting with the arm extended. Biceps brachii is most effective in supination, brachialis is a pure flexor, and triceps is an extensor.

Question 38Upper limb assessment and evaluation

Which clinical test is most appropriate for assessing the integrity of the ulnar collateral ligament of the elbow?

  1. Cozen's test
  2. Mill's test
  3. Valgus stress test Correct answer.
  4. Varus stress test

Explanation

The ulnar collateral ligament is located on the medial side of the elbow and is stressed by applying a valgus force. Varus stress tests the lateral (radial) collateral ligament. Cozen's and Mill's tests assess for lateral epicondylalgia.

Question 39Upper limb assessment and evaluation

A patient presents with weakness of thumb opposition and sensory loss over the palmar aspect of the thumb, index, and middle fingers. Which nerve is most likely affected?

  1. Ulnar nerve
  2. Median nerve Correct answer.
  3. Musculocutaneous nerve
  4. Radial nerve

Explanation

The median nerve innervates the thenar muscles responsible for thumb opposition and provides sensation to the palmar aspect of the thumb, index, middle, and lateral half of the ring finger. Ulnar nerve compression affects intrinsic hand muscles and sensation of the little finger. Radial nerve affects wrist and finger extension, and musculocutaneous nerve affects elbow flexion.

Question 40Upper limb assessment and evaluation

During assessment of a patient with a suspected thoracic outlet syndrome, which provocative test involves having the patient hyperabduct the arms and monitor for symptom reproduction?

  1. Wright's test Correct answer.
  2. Adson's test
  3. Roos test
  4. Costoclavicular maneuver

Explanation

Wright's test (hyperabduction maneuver) involves hyperabducting the arm to assess for compression of the neurovascular bundle under the pectoralis minor or coracoid process. Adson's test assesses the scalene triangle, costoclavicular maneuver assesses the costoclavicular space, and Roos test involves sustained arm abduction with opening and closing of the hands.

Question 41Treatment planning and intervention

A patient scheduled for hyperbaric oxygen therapy has a history of bleomycin chemotherapy. Which planning consideration is most important?

  1. The session duration should be doubled
  2. Risk of oxygen-toxic pulmonary injury is increased Correct answer.
  3. Systemic blood pressure will fall predictably
  4. The patient should receive oral steroids beforehand

Explanation

Prior bleomycin exposure is a recognized relative contraindication because hyperoxia can precipitate pulmonary toxicity. The plan should weigh benefit against this increased risk and involve the prescribing physician.

Question 42Treatment planning and intervention

Which finding on a pre-treatment assessment most strongly suggests a patient should not undergo hyperbaric oxygen therapy without further evaluation?

  1. Stable angina
  2. Controlled type 2 diabetes
  3. Mild claustrophobia
  4. Untreated tension pneumothorax Correct answer.

Explanation

An untreated pneumothorax is an absolute contraindication to hyperbaric oxygen because pressure changes can cause a tension pneumothorax. It must be resolved before treatment is considered.

Question 43Treatment planning and intervention

A patient with a healing problem asks why the treatment plan includes a specific number of hyperbaric sessions rather than a single treatment. What is the best rationale?

  1. Tissue repair from hyperoxia is cumulative and requires repeated exposure Correct answer.
  2. Repeat sessions are needed only to satisfy billing requirements
  3. A single session risks immediate oxygen toxicity in all patients
  4. One session permanently saturates all tissue oxygen stores

Explanation

Therapeutic benefit in wound healing and similar indications depends on repeated hyperoxic exposures supporting angiogenesis and repair over time. A single session does not produce durable tissue changes.

Question 44Treatment planning and intervention

During a hyperbaric treatment plan, which parameter is typically held constant while the patient breathes oxygen at depth?

  1. Chamber pressure during the treatment phase Correct answer.
  2. Chamber humidity
  3. Ambient temperature
  4. Patient heart rate

Explanation

The prescribed protocol specifies a treatment pressure that is maintained during the oxygen-breathing phase. Other physiologic and environmental variables are monitored but not held as protocol constants.

Question 45Treatment planning and intervention

A patient is being planned for a wound-healing adjunct. Which patient factor most directly affects the choice of adjunctive modality?

  1. Patient's preferred appointment time
  2. Insurance coverage limits
  3. Number of prior clinic visits
  4. Presence of adequate perfusion to the wound bed Correct answer.

Explanation

Adjunctive wound therapies depend on adequate blood flow to deliver oxygen and nutrients. Perfusion status guides whether modalities such as hyperbaric oxygen will be effective.

Question 46Treatment planning and intervention

Which statement best describes the role of transcutaneous oximetry in treatment planning?

  1. It estimates tissue oxygenation to help predict healing potential Correct answer.
  2. It determines the exact number of treatments required
  3. It measures arterial blood pressure directly
  4. It replaces the need for clinical wound assessment

Explanation

Transcutaneous oximetry provides an estimate of tissue oxygen tension that can inform prognosis and modality selection. It supplements, rather than replaces, clinical evaluation.

Question 47Treatment planning and intervention

A burn patient is being evaluated for hyperbaric oxygen therapy. Which factor is most relevant to the treatment decision?

  1. Depth and extent of the burn and presence of compromised grafts Correct answer.
  2. Patient's occupation
  3. Family history of diabetes
  4. Time of day of injury

Explanation

Hyperbaric oxygen may be considered for selected burns with compromised perfusion or grafts, so burn depth, extent, and graft status are the key planning factors. Unrelated demographic data do not guide the decision.

Question 48Treatment planning and intervention

When planning hyperbaric oxygen for a patient with a compromised flap, what is the primary therapeutic goal?

  1. Reduce the need for postoperative analgesia
  2. Improve tissue oxygenation to support flap survival Correct answer.
  3. Shorten the surgical incision length
  4. Eliminate the need for antibiotics

Explanation

The goal is to enhance oxygen delivery to ischemic tissue, supporting graft and flap viability. Analgesia, incision length, and antibiotic use are not the primary objectives.

Question 49Treatment planning and intervention

A patient with decompression illness is being planned for recompression therapy. Which principle best guides the treatment plan?

  1. Rapid decompression to sea level is preferred
  2. Treatment should be delayed until symptoms fully resolve
  3. Only oral hydration is required
  4. Recompression reduces bubble size and hyperoxia accelerates resolution Correct answer.

Explanation

Recompression therapy reduces intravascular and tissue bubble volume while hyperbaric oxygen promotes resolution of symptoms. Delay can worsen outcomes, so treatment should not wait for spontaneous resolution.

Question 50Treatment planning and intervention

Which patient instruction is most appropriate before a scheduled hyperbaric session?

  1. Avoid alcohol and smoking before treatment Correct answer.
  2. Wear petroleum-based skin ointments
  3. Take a large meal immediately before entry
  4. Remove hearing aids only after pressurization

Explanation

Alcohol and smoking can affect vasoconstriction and oxygen delivery, so they are typically avoided before treatment. Petroleum-based products pose a fire risk and should not be used.