Acute Medical Conditions (Braddom 5th Ed Ch. 27)

Question 1

Most common complaint of cardiopulmonary patients?

Answer 1

Fatigue

Question 2

Prime complaint of patients with cardiopulmonary disease?

Answer 2

Dyspnea

Question 3

How much does atrial contraction contribute to the cardiac output?

Answer 3

15-20%

Question 4

Physiology of heart contraction? (in terms of signal conduction)

Answer 4

SA node –> AV node –> Bundle of His –> left and right bundles

Question 5

Enumerate the vessels for coronary circulation

Answer 5

Left Main Coronary Artery –> Left Anterior Descending Artery –> Left and Right Circumflex Arteries –> Posterior Descending Artery (from the Left Circumflex Artery; seen in 10-15% of individuals).

The right coronary artery continues on as a single vessel

60% of the population have right dominant circulation. 10-15% as mentioned. And the remaining 30% have a balanced circulation coming from the left posterior descending artery and the right coronary artery

Question 6

Control of venous return with respect to fluid volume maintains which part of the cardiac cycle?

A. Preload
B. Afterload
C. Cardiac Output
D. VO2 Max

Answer 6

Preload

Question 7

Normal breathing is regulated by which part of the respiratory center?

Answer 7

Medulla Oblongata

Question 8

In COPD and emphysema, exhalation is passive, true or false?

Answer 8

False. In normal breathing, exhalation is passive. In COPD and emphysema, work of breathing is increased due to the need for active exhalation.

Question 9

Term used to describe the measure of work capacity and is the oxygen consumed by the individual

Answer 9

VO2 Max

Question 10

What does physical conditioning do to the slope of the relationship of heart rate and VO2 Max? (Increase or decrease)?

Answer 10

Decrease. Physical conditioning causes less heart rate increase for a VO2 max

Question 11

What happens to stroke volume (SV) in exercises? Increase, decrease or no change?

Answer 11

Increase

Question 12

How does advanced age affect stroke volume?

Answer 12

Decrease SV

Question 13

Formula for cardiac output?

Answer 13

Stroke Volume x Heart Rate

This is the main determinant of VO2 Max

Question 14

Term used to describe the oxygen consumption of the heart relative to increasing workload

Answer 14

Myocardial oxygen consumption (MVO2)

Question 15

Best evaluation of capacity to exercise in cardiopulmonary conditions?

Answer 15

CPET (Cardiopulmonary exercise test)

Question 16

Target exercise intensity for primary prevention?

Answer 16

80-85% of the predicted maximum heart rate

Question 17

Target exercise intensity for secondary prevention (patients already with diseases)

Answer 17

60% of predicted maximum heart rate

Question 18

Effect of aerobic exercise on Tidal Volume

Answer 18

Increased during exertion but decreased in respiratory rate and dyspnea

Question 19

Effect of aerobic exercise on Cardiac Output (CO, SV, resting HR)?

Answer 19

Maximum CO increases, resting CO is stable, SV is increased, resting heart rate is decreased at rest)

Question 20

Effect of aerobic exercise on minute ventilation?

Answer 20

Decreased

Minute ventilation is the volume of air inspired and expired by a person in one minute (approx 6L on a normal person)

Question 21

Hallmarks of severe COPD?

Answer 21

Active exhalation and CO2 retention

COPD may be caused by upper or lower airway obstruction. Exacerbations may involve acute conditions like asthma, with concomitant chronic conditions like COPD

Question 22

Which is affected in Restrictive Lung Disease?

A. FVC
B. TV
C. FEV
D. Peripheral Resistance

Answer 22

B. TV

Question 23

Post-heart transplant patients have what changes in the ff parameters?

Stroke volume
Heart rate (resting and peak during exercise)

Answer 23

Stroke volume LIMITED
Resting HR increased
Peak HR limited

Question 24

Target exercise intensity for post-cardiac/lung transplant?

Answer 24

60-70% of maximum predicted HR, 30-60 mins/session, 3-5x/week

Question 25

Domains of Frailty

Answer 25

Grip Strength, Activity, Weight Loss, Exhaustion, Walking Speed

Question 26

Decreased ability to adapt to stressors accompanied by a reduced physiologic reserves and reduced energy metabolism

Answer 26

Frailty Syndrome

Question 27

Term used to describe partially treated uremia in patients with renal failure receiving dialysis

Answer 27

Residual Syndrome

Question 28

What is the percentage of muscle strength lost in between ages 70-80 yo?

Answer 28

30%

Question 29

What is the percentage of muscle strength lost in between ages 50-70 yo?

Answer 29

15%

Question 30

Which among the following medications can increase PT-INR?

A. Carbamazepine
B. Amiodarone
C. Haloperidol
D. Vitamin C

Answer 30

Amiodarone

Increases PT-INR: acetaminophen, NSAIDs, amiodarone, aspirin, sulfonamide (TMP-SMX)

Decreases PT-INR: adrenocorticoids, antihistamines, antacids, vitamin C, haloperidol, carbamazepine

Question 31

Which physiological change occurs in the cardiovascular system with aging?

(a) Increased resting heart rate
(b) Increased resting cardiac output
(c) Decreased ejection fraction
(d) Decreased orthostatic hypotension

Answer 31

C

As a person ages, decreased inotropic responsiveness to adrenergic stimuli leads to decreased myocardial contractility and, hence, to a decrease in ejection fraction. Resting heart rate does not change with aging, but maximal heart rate with exercise does decrease progressively. Cardiac output at rest and with modest exercise is maintained by early involvement of the Frank-Starling mechanism. There is an increased incidence of orthostatic hypotension in the elderly due to decreased baroreceptor sensitivity and diminished reflex tachycardia. (De Lisa)