Cardio-Pulmo Flashcards
Which of the following organs has the highest percentage of
oxygen extraction?
A) Kidney
B) Skin
C) Heart
D) Intestine
C) Oxygen
extraction can be assessed by the ratio of oxygen delivery and oxygen consumption in any organ system of the body. The heart has the highest percentage of oxygen extraction.
Cardiac output is defined as a product of which of the following
components?
A) Heart rate and stroke volume
B) Stroke volume and oxygen consumption
C) Ejection fraction and aerobic capacity
D) Myocardial oxygen capacity and heart rate
A) Heart rate and stroke volume
Which of the following is a physiologic measure expressing the
energy cost of physical
activities?
A) Metabolic oxygen consumption
B) Mean exercise training
C) Measure of exercise tolerance
D) Metabolic equivalent (MET) of task
D) Metabolic equivalent (MET) of task
Which of the following is not a proven therapeutic benefit of cardiac rehabilitation after a myocardial infarction (MI)?
A) Increased resting cardiac output
B) Decreased rate of recurrent MI
C) Improved left ventricular (LV) function
D) Decreased mortality
A) Increased resting cardiac output
Although cardiac rehabilitation increases maximum cardiac output, it does not increase resting cardiac output. Cardiac rehabilitation has been shown to reduce the rate of recurrent MI by 17%, decrease mortality secondary to MI by
15% to 20%, and increase LV ejection fraction after MI.
Which of the following is the medically acute inpatient cardiac rehabilitation phase? A) Phase 1 B) Phase 2 C) Phase 3 D) Phase 4
A) Phase 1
is the first acute inpatient rehabilitation phase that can last from 1 to 14 days. The focus of this phase is to closely monitor the patient while increasing metabolic equivalents (MET) by 1 to 2 each day until a MET of 4 is reached. This should start on the acute care fl oor, usually in the CCU, and continue in acute rehabilitation. Cardiac patients should not wait to start therapy until they are on the rehabilitation floor. Phases are tailored to the individual. It is possible to skip Phase 1 in some patients and go directly to Phase 2 (intermediate outpatient phase after a noninvasive procedure).
Which of the following is a useful tool in measuring exertion during a physical activity?
A) Wong-Baker scale
B) Borg scale
C) Ranchos Los Amigos scale
D) Disability rating scale
B) The Borg scale
is a widely used scale that quantifies exertion by the patient and help tailor rehabilitation for the patient.
In which of the following diseases should target heart rate not be
used as a guide for exercise tolerance?
A) Heart transplant
B) Diabetes
C) Post–myocardial infarction
D) Gout
A) Patients with heart transplant
lack vagal innervation to
the heart, resulting in a higher baseline heart rate and slow return to baseline after exercise. Another cause of a baseline heart rate post transplant is antirejection medication.
Rate control is mediated mostly by hemodynamic changes and catecholamines
Which of the following is included in the goals of cardiac rehabilitation?
A) Greater exercise tolerance
B) Long-term exercise plan
C) Smoking cessation
D) All of the above
D) All of the above
How does the heart physiologically compensate for increased end-diastolic volume?
A) Increased peripheral resistance
B) Increased respiratory rate
C) Increased systolic contractility
D) Decreased systolic contractility
C) Increased systolic contractility
The Frank-Starling law is an important concept to understand in patients undergoing cardiac rehabilitation. The law states that when venous return and the end diastolic volume increase, the force generated by the myocardium increases resulting in a higher stroke volume. This law is particularly important in heart transplant patients, where the heart
compensates to change in demand primarily due to hemodynamic
changes and catecholamines rather than autonomic innervation.
In the case of increased afterload, the heart reduces stroke
volume to compensate. Recall here that cardiac output is the
product of stroke volume and heart rate
Which of the following phases of cardiac rehabilitation is
considered a structured outpatient program?
A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4
B) Phase 2
is a supervised ambulatory outpatient program lasting 3 to 6 months. An exercise tolerance test is usually performed at this phase to guide further rehabilitation. This is the immediate outpatient phase that requires a higher level of monitoring.
Which of the following exercises are allowed during Phase 1 of cardiac rehabilitation?
A) Isometric exercises
B) Valsalva maneuvers
C) Raising legs above the heart
D) Dangle legs off bed
A) Isometric exercises
can raise the heart rate and demand on the heart. Although isometric exercises are initially held during cardiac rehabilitation, they are introduced later in short durations to condition the heart to handle increased demand. Valsalva maneuvers can cause arrhythmias and should be avoided in the acute phase of cardiac rehabilitation. Raising the legs above the heart can increase preload
Which of the following populations of patients has a higher energy cost during ambulation?
A) Prosthetic lower extremity
B) Peripheral vascular disease
C) Smoker
D) Diabetic
A) Prosthetic lower extremity
How can cardiac rehabilitation benefit a patient with angina
pectoris?
A) Increase myocardial oxygen consumption
B) Decrease the maximum heart rate
C) Change angina threshold
D) Improve efficiency
D) Improve efficiency
Which of the following patients will not be a candidate for rehabilitation on the basis of target heart rate?
A) Patient taking a statin
B) Patient taking a beta-blocker
C) Patient undergoing anticoagulation therapy
D) Patient taking a diuretic
B) Patient taking a beta-blocker
Which of the following components shows an increase in response to exercise training?
A) Heart rate
B) Myocardial oxygen capacity
C) Stroke volume
D) Peripheral resistance
C) Stroke volume
Stroke volume increases at rest and during exercise,
whereas heart rate decreases in response to exercise therapy.
Which of the following exercise phases is important to prevent
syncope?
A) Aerobic phase
B) Anaerobic phase
C) Cool-down phase
D) Stretching phase
C) Cool-down phase
Patients undergoing cardiac rehabilitation are at
a higher risk for postexercise hypotension or even syncope if a slow cool down phase is not incorporated into the exercise regiment. The heart continues to generate a higher cardiac output based on the increased demand during the conditioning phase and an abrupt stop in exercise may result in a drop in blood pressure causing
hypotension.
What is the target heart rate for a patient with stable arrhythmias during cardiac rehabilitation?
A) Maximum heart rate
B) Heart rate below the rate where arrhythmias
C) Heart rate 10 to 20 beats above the rate where arrhythmias are
noted
D) Patient is not a candidate for cardiac rehabilitation
B) Heart rate below the rate where arrhythmias
The goal of therapy for a patient with frequent stable arrhythmias is to condition the body to increase efficiency while maintaining the pulse under the heart rate where arrhythmias frequently occur.
How would postsurgical cardiac rehabilitation be different patient with intermittent vascular claudication?
A) Interspersed rest periods between exercises
B) Target heart rate to be set at 90% of maximum heart rate
C) Higher dosage of anticoagulation
D) Patient is not a candidate for cardiac rehabilitation
A) Interspersed rest periods between exercises
Which of the following phases begins when the patient has
plateaued in exercise
endurance?
A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4
D) Phase 4
The maintenance phase, also known as Phase 4 of cardiac rehabilitation, focuses on maintaining the goals met during the initial phases of rehabilitation by incorporating a home exercise program and continuing risk factor management. Initial gains made during the first three rehabilitation phases may decrease with time if the patient does not continue with exercises to
maintain conditioning.
Which of the following is considered to be the greatest single modifiable risk factor for cardiac disease?
A) Obesity
B) Hypertension
C) Hyperlipidemia
D) Smoking
D) Smoking
Which of the following phases of cardiac rehabilitation focuses
on determining the maximum exertion to be performed by the patient?
A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4
C) Phase 3
After the closely monitored outpatient Phase 2 cardiac
rehabilitation and determination of hemodynamic ability of the heart with exercise tolerance testing, Phase 3 begins. This phase sets a higher target heart rate for the patient and sets a goal to maximize the therapeutic benefit of cardiac rehabilitation before the maintenance phase begins.
Which of the following positions would have the highest stroke
volume?
A) Exercising in supine position
B) At rest in supine position
C) Exercising in prone position
D) At rest while standing
B) At rest in supine position
Which of the following is not an absolute contraindication for
cardiac rehabilitation?
A) Hypertrophic cardiomyopathy
B) Active pericarditis
C) Resting systolic blood pressure greater than 200
D) Third-degree heart block without pacemaker
A) Hypertrophic cardiomyopathy
The coronary arteries mostly perfuse the myocardium during
which heart phase?
A) Systole
B) Diastole
C) Mid-systole
D) End-systole
B) Diastole
If the patient is unable to undergo exercise echocardiography
because of deconditioning, which of the following tests can be used to guide further rehabilitation goals?
A) Restrained exercise tolerance testing
B) Forced ambulation
C) Exercise nuclear imaging
D) Pharmacologic stress testing
D) Pharmacologic stress testing
Which of the following changes would NOT be noted during exercise therapy for a patient with congestive heart failure?
A) Drop in ejection fraction
B) Decrease in stroke volume
C) Exertional hypotension
D) Decrease in heart rate
D) Decrease in heart rate
On the basis of metabolic equivalent of a task, a patient having
which of the following metabolic equivalent (MET) levels should
not return to employment after cardiac rehabilitation?
A) MET 6 to 7
B) MET 5 to 6
C) MET 4 to 5
D) MET 2 to 3
D) MET 2 to 3
goals of cardiac rehab (4)
. change the natural history
. reduce morbidity and mortality
. increase functional capacity
. limit or reverse the pathological process
benefits of cardiac rehab (9)
. anti-atherogenic effect . antithrombotic effect . endothelial . autonomic system effect . anti-ischemic effect . anti-arrhythmic effect . blood pressure effects . glucose effects . lipid effects
Canadian Cardiovascular Society grading scale
Class I
Class II
Class III
Class IV
“Angina only during strenuous or prolonged physical activity”
Class I
Class I - Angina only during strenuous or prolonged physical activity
Class II - Slight limitation, with angina only during vigorous physical activity
Class III - Symptoms with everyday living activities, ie, moderate limitation
Class IV - Inability to perform any activity without angina or angina at rest, ie, severe limitation
Canadian Cardiovascular Society grading scale
Class I
Class II
Class III
Class IV
“Slight limitation, with angina only during vigorous physical activity”
Class II
Class I - Angina only during strenuous or prolonged physical activity
Class II - Slight limitation, with angina only during vigorous physical activity
Class III - Symptoms with everyday living activities, ie, moderate limitation
Class IV - Inability to perform any activity without angina or angina at rest, ie, severe limitation
Canadian Cardiovascular Society grading scale
Class I
Class II
Class III
Class IV
“Symptoms with everyday living activities, ie, moderate limitation”
Class III
Class I - Angina only during strenuous or prolonged physical activity
Class II - Slight limitation, with angina only during vigorous physical activity
Class III - Symptoms with everyday living activities, ie, moderate limitation
Class IV - Inability to perform any activity without angina or angina at rest, ie, severe limitation
Canadian Cardiovascular Society grading scale
Class I
Class II
Class III
Class IV
“Inability to perform any activity without angina or angina at rest, ie, severe limitation”
Class IV
Class I - Angina only during strenuous or prolonged physical activity
Class II - Slight limitation, with angina only during vigorous physical activity
Class III - Symptoms with everyday living activities, ie, moderate limitation
Class IV - Inability to perform any activity without angina or angina at rest, ie, severe limitation
WHO diagnostic criteria for MI
- Clinical history of ischaemic type chest pain lasting for more than 20 minutes
- Changes in serial ECG tracings
- Rise and fall of serum cardiac biomarkers such as creatine kinase-MB fraction and troponin
describe MI ischemic type chest pain
. prolonged >30 min and at rest
. patterned
ischemic chest pain can be mimicked by (4)
. pericarditis
. reflux
. spontaneous pneumothorax
. musculoskeletal disease
what are 3 serious causes of severe chest pain
. acute MI
. aortic dissection
. pulmonary embolus
what are the ideal for a MI serum marker (4)
. presents early and late in the course of an MI
. highly specific
. sensitive for small amounts of myocardial damage
. measurements should be easy, accurate and inexpensive
what are the serum markers of MI (5)
which is most sensitive?
. CPK . CPK-MB . LDH . Myoglobin . Troponin T and I (most sensitive)
claudication
. arrhythmias . heart failure . pericardial disorders . heart valve disease . congenital heart disease . circulatory disorder
. circulatory disorder
Raynaud’s disease
. arrhythmias . heart failure . pericardial disorders . heart valve disease . congenital heart disease . circulatory disorder
. circulatory disorder
Takayasu’s arteritis
. arrhythmias . heart failure . pericardial disorders . heart valve disease . congenital heart disease . circulatory disorder
. circulatory disorder
long QT
. arrhythmias . heart failure . pericardial disorders . heart valve disease . congenital heart disease . circulatory disorder
. arrhythmias
pulmonary edema
. arrhythmias . heart failure . pericardial disorders . heart valve disease . congenital heart disease . circulatory disorder
. heart failure
Dressler’s syndrome
. arrhythmias . heart failure . pericardial disorders . heart valve disease . congenital heart disease . circulatory disorder
. pericardial disorders
which congenital heart diseases cause blue baby
. tetralogy of Fallot
. transposition of the great arteries
. tricuspid atresia
apparently healthy
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class A
established CHD that is clinically stable
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class B
moderate or high risk of cardiac complications
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class C
unstable disease
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class D
MET 5
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class C
METs 8
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class B
NYHA Class II
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class B
NYHA Class III
AHA Risk Stratification for Exercise Class A Class B Class C Class D
Class C
What is a MET and it’s values
. Metabolic Equivalent of Task
. total energy spent
. 1 MET = 3.5 cc of O2/kg/min in seated person at rest
. 1 MET = 1.2 Kcals/min
define VO2
rate of O2 consumed per minutes
. metabolic equivalent of power
. rate of oxygen uptake
define VO2 max
greatest amount of oxygen a person can take in from inspired air
evaluates physical work capacity
Functional ETT
Diagnostic ETT
Functional ETT
cardiovascular information
Functional ETT
Diagnostic ETT
Functional ETT
performed w/o cardiac meds
Functional ETT
Diagnostic ETT
Diagnostic ETT
endocarditis
Absolute Contraindication
Relative Contraindication
Absolute Contraindication
tachy/brady arrythmia
Absolute Contraindication
Relative Contraindication
Relative Contraindication
drug effect
Absolute Contraindication
Relative Contraindication
Relative Contraindication
electrolyte abnormality
Absolute Contraindication
Relative Contraindication
Relative Contraindication
L main coronary obstructive
Absolute Contraindication
Relative Contraindication
Relative Contraindication
hypertrophic cardiomyopathy
Absolute Contraindication
Relative Contraindication
Relative Contraindication
How long is warm up?
5-10 min
how long is conditioning?
20 min, preferably 30-45 min
how long is cool-down?
5-10 min
adverse consequences of no cool-down
hypotension, angina, ischemic ST-T changes, ventricular arrhythmia
calculate max hr
220 - age
using HR max, how is light, moderate, and heavy exercise intensity categorized
light <60
moderate 60-90
heavy 80%
A drop in systolic blood pressure of >10 mg Hg from baseline blood
pressure despite an increase in work load, becomes an absolute indication for terminating exercise testing when?
when accompanied by other evidence of ischemia
What is the most prevalent lung disease in adults living in the
United States?
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Cystic fibrosis
D) Sarcoidosis
B) Chronic obstructive pulmonary disease (COPD)
What risk factor is associated with most cases of chronic
obstructive pulmonary disease (COPD) in the United States?
A) Chronic asthma
B) Pneumonia
C) Smoking
D) Occupational exposure to irritants
C) Smoking
Which therapy has been shown to decrease mortality in chronic
obstructive pulmonary disease (COPD)?
A) Chest physiotherapy
B) Pulmonary rehabilitation program
C) Supplemental oxygen therapy
D) Noninvasive ventilation
C) Supplemental oxygen therapy
Among the following, which represents primary respiratory muscle(s) during quiet respiration?
A) Diaphragm
B) External intercostal muscles
C) Abdominal muscles
D) Trapezius
A) Diaphragm
What is the term for the volume of gas in the lungs at maximal
inspiration?
A) Functional residual capacity (FRC)
B) Vital capacity (VC)
C) Residual volume (RV)
D) Total lung capacity (TLC)
D) Total lung capacity (TLC)
TLC is achieved after maximal effort of the muscles of inspiration to expand the lungs. The FRC is the volume of air
remaining at the end of a normal exhalation. The RV is the volume remaining in the lungs after maximal exhalation. VC represents the volume of air that can be exhaled after maximal
inspiration.
The volume of gas in the lungs at the end of normal expiration is
called:
A) Functional residual capacity (FRC)
B) Vital capacity (VC)
C) Residual volume (RV)
D) Expiratory reserve volume (ERV)
A) Functional residual capacity (FRC)
The amount of gas moving in and out of the lungs during resting
respiration is called:
A) Vital capacity (VC)
B) Total lung capacity (TLC)
C) Tidal volume
D) Forced vital capacity (FVC)
C) Tidal volume
Tidal volume is the volume of air moved in and out of the lungs during normal respiration. VC represents the volume of air that can be exhaled following maximal inspiration. TLC is achieved following maximal effort of the muscles of inspiration to
expand the lungs. The FVC is the total volume of air expired after a full inspiration.
Which of the following is an autosomal recessive disease of chloride ion channels in exocrine glands?
A) Emphysema
B) Asthma
C) Cystic fibrosis
D) Chronic obstructive pulmonary disease (COPD)
C) Cystic fibrosis
What nerve supplies the diaphragm?
A) Long thoracic nerve
B) Thoracodorsal nerve
C) Lateral pectoral nerve
D) Phrenic nerve
D) Phrenic nerve
Which test best assesses the magnitude of functional impairment
in pulmonary disease?
A) Pulmonary function testing (PFT)
B) Arterial blood gas measurements (ABG)
C) Chest radiography
D) Ventilation perfusion (V/Q) lung scan
A) Pulmonary function testing (PFT)
Pathologic dilation of the distal airways with destruction of alveolar walls best describes which condition?
A) Asthma
B) Cystic firbrosis
C) Emphysema
D) Bronchitis
C) Emphysema
Which nerve roots contribute to the phrenic nerve?
A) C1-C3
B) C5-C7
C) C3-C5
D) C7-T1
C) C3-C5
Which of the following is most useful in diagnosing obstructive
lung disease?
A) Maximal static expiratory pressure (PE max)
B) Diffusing capacity for carbon dioxide
C) Forced vital capacity (FVC)
D) Ratio of the forced expiratory volume in 1 second to FVC
(FEV1/FVC)
D) Ratio of the forced expiratory volume in 1 second to FVC
(FEV1/FVC)
The FVC is the volume of air that can be maximally and forcibly exhaled from the lungs after having taken in the deepest breath possible. FEV1 represents the volume of air forcibly exhaled in the fi rst second of forced exhalation. The FEV1/FVC expresses the volume of FVC expelled in the fi rst second as a ratio of the total FVC.
A monophasic, high-pitched sound usually caused by partial
obstruction in the upper airway is called:
A) Wheezing
B) Ronchi
C) Crepitus
D) Stridor
D) Stridor
For an adult with a low oxygen requirement, delivery of supplemental oxygen is best achieved by using what interface?
A) Nasal cannula
B) Endotracheal intubation
C) Continuous positive airway pressure (CPAP)
D) Venturi face mask
A) Nasal cannula
Which oxygen delivery system provides close to 90% oxygen?
A) Nasal cannula
B) Nonrebreathing mask
C) Venturi face mask
D) Blow-by oxygen
B) Nonrebreathing mask
Which condition will most likely cause restrictive impairment of
ventilation?
A) Chronic bronchitis
B) Asthma
C) Cystic fi brosis
D) Guillain–Barré syndrome
D) Guillain–Barré syndrome
The maximum volume of air that a patient can hold with a closed glottis is called:
A) Vital capacity (VC)
B) Glossopharyngeal breathing (GPB)
C) Maximum insufflation capacity (MIC)
D) Intermittent positive-pressure ventilation (IPPV)
C) Maximum insufflation capacity (MIC)
Which device aids in secretion clearance by applying a positive
pressure to the airways followed by a negative pressure?
A) Mechanical insuffl ator-exsufflator
B) Yankauer suction wall unit
C) Bilevel positive airway pressure (BiPAP)
D) Chest percussion
A) Mechanical insuffl ator-exsufflator
When would a mechanical insufflator contraindicated?
A) High spinal cord injury
B) Bullous emphysema
C) Cerebral palsy
D) Neuromuscular disease
B) Bullous emphysema
Which test is used to diagnose central and obstructive sleep
apnea?
A) Polysomnography
B) Spirometry with pulmonary function testing
C) Diffusion capacity testing
D) Pulse oximetry
A) Polysomnography
In chronic obstructive pulmonary disease (COPD), what are
potential benefi ts of pulmonary rehabilitation?
A) Decreased anxiety
B) Improved in cognitive function
C) Increased exercise tolerance
D) Improved life expectancy
C) Increased exercise tolerance
Temporary bronchial narrowing induced typically by 15 minutes
of strenuous activity is likely:
A) Pneumonia
B) Exercise-induced asthma (EIA)
C) Duchenne muscular dystrophy
D) Chronic obstructive pulmonary disease (COPD)
B) Exercise-induced asthma (EIA)
In cystic fi brosis (CF), which measure is the best predictor of
survival?
A) Age at onset of diagnosis
B) Respiratory rate
C) Forced expiratory volume at 1 second (FEV1)
D) Tidal volume
C) Forced expiratory volume at 1 second (FEV1)
Which is a reasonable treatment modality for moderate to severe
obstructive sleep apnea (OSA)?
A) Tracheal intubation
B) Diaphragmatic pacing
C) Nocturnal pulse oximetry
D) Continuous positive airway pressure (CPAP)
D) Continuous positive airway pressure (CPAP)
Which lung volume increases in cervical spinal cord injury
(SCI)?
A) Residual volume
B) Total lung capacity
C) Vital capacity
D) Tidal volume
A) Residual volume
In the three-zone model of the lung, which zone has the highest
pulmonary arterial pressure (PAP) when upright?
A) Zone 1
B) Zone 2
C) Zone 3
D) None, they all have equivalent hydrostatic pressure
C) Zone 3
Which respiratory disease causes a restrictive, parenchymal
pattern of illness?
A) Myasthenia gravis
B) Asthma
C) Sarcoidosis
D) Ankylosing spondylitis
C) Sarcoidosis
What is the normal rate of FEV1 decline with age?
A) 5 mL/year
B) 30 mL/year
C) 50 mL/year
D) 75 mL/year
B) 30 mL/year
What intervention minimizes the reduction in vital capacity of
tetraplegic patients when they are sitting?
A) Use of an abdominal binder
B) Supplemental oxygen
C) Glossopharyngeal breathing
D) Compressive leg stockings
A) Use of an abdominal binder
During an acute episode of dyspnea in chronic obstructive pulmonary disease (COPD) patients, which breathing help to reduce symptoms and the work of breathing?
A) Controlled cough
B) Huffing
C) Pursed-lip breathing
D) Breath holds
C) Pursed-lip breathing
What is a contraindication for chest percussion therapy?
A) Anticoagulation therapy
B) Increased intracranial pressure
C) Flail chest
D) Severe osteoporosis
B) Increased intracranial pressure
Which tracheostomy tube is appropriate for patients able to speak
who only require intermittent ventilator assistance?
A) Cuffed tracheostomy tube
B) Nonfenestrated tube
C) Passy-Muir valve
D) Fenestrated tube
D) Fenestrated tube
What is a consequence when caloric intake fails to meet the
metabolic demands of increased work of breathing in chronic
obstructive pulmonary disease (COPD)?
A) Death
B) Cachexia
C) Osteoporosis
D) Acute exacerbation
B) Cachexia
What is the only genetic abnormality linked to chronic obstructive pulmonary disease (COPD)?
A) Absence or abnormality of CFTR protein
B) Dystrophin gene mutation
C) Alpha1-antitrypsin (A1AT) protein defi ciency
D) G6PD defi ciency
C) Alpha1-antitrypsin (A1AT) protein defi ciency
During normal inspiration, what is the action of the vocal cords?
A) The vocal cords should open
B) The vocal cords should close
C) The vocal cords should close then open
D) The vocal cords remain inactive during inspiration
A) The vocal cords should open
What technique uses gravity to assist in the ultimate clear secretions from specific lung areas?
A) Abdominal binder uses
B) Manual suction through tracheostomy
C) Postural drainage
D) Abdominal thrust
C) Postural drainage
According to the GOLD classification of chronic obstructive pulmonary disease (COPD), what class is have an FEV1 < 30% of predicted?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
D) Stage 4
The GOLD criteria is the result of a collaborative effort by the National Institute of Health and the World Health
Organization to devise a staging system for COPD. GOLD stands
for the “Global initiative for chronic obstructive lung disease.” This system stages patients from 0 to 4 depending on the degreeof airflow limitation (decline in FEV1) measured during
pulmonary function testing. Stage 0 (at risk) includes those at
risk who have normal spirometry results; stage 1 (mild COPD) is
FEV1/FVC ratio < 70% predicted with FEV1 ≥ 80% predicted;
stage 2 (moderate COPD) is FEV1/FVC < 70% predicted and
FEV1 50% to 79% predicted; stage 3 (severe COPD) is
FEV1/FVC < 70% and FEV1 30% to 49% predicted; stage 4
(very severe COPD) is FEV1/FVC < 70% predicted and FEV1 <
30% predicted.
What is an example of aerobic exercise?
A) Upper extremity free weight exercises
B) Leg press
C) Treadmill walking
D) Isometric quadriceps exercises
C) Treadmill walking
What describes “Ondine’s curse”?
A) Acquired central hypoventilation syndrome
B) Congenital central hypoventilation syndrome
C) High cervical spinal cord injury resulting in severe diaphragmatic
impairment
D) Polio syndrome affecting the upper trunk more than the lower
trunk and legs
B) Congenital central hypoventilation syndrome
Which invasive treatment is used in severe, advanced
emphysema?
A) Diaphragmatic pacing
B) Mouth intermittent positive pressure ventilation
C) Lung volume reduction surgery
D) Tracheostomy
C) Lung volume reduction surgery
Which functional test is commonly used to measure out before and after pulmonary rehabilitation and is thought to better reflect activities of daily living?
A) 30-minute walk test
B) 6-minute walk test
C) 2-minute walk test
D) Shuttle walk test
B) 6-minute walk test
Which device provides visual feedback for patients to practice
deep inspiration during the postoperative period?
A) Pulse oximeter
B) Heart rate monitor
C) Incentive spirometry
D) Mirror
C) Incentive spirometry
Which ventilator setting coordinates delivery of the ventilator
driven breath with the respiratory cycle of the patient?
A) Assist-control ventilation (ACV)
B) Intermittent mandatory ventilation (IMV)
C) Pressure support ventilation (PSV)
D) Synchronized intermittent mandatory ventilation (SIMV)
D) Synchronized intermittent mandatory ventilation (SIMV)
What is PEEP?
A) Fraction of inspired oxygen
B) The patient’s respiratory rate at a given tidal volume
C) Positive end-expiratory pressure
D) Adjunct to conventional modes of mechanical ventilation to
decrease work of Breathing
C) Positive end-expiratory pressure
What is the leading cause of mortality in chronic tetraplegic spinal cord injury (SCI) patients?
A) Decubitus ulcers
B) Urinary complications
C) Deep vein thrombosis (DVT)
D) Pneumonia
D) Pneumonia
Which test is useful in evaluating the phrenic nerve?
A) Electrodiagnostic studies (EMG/NCS)
B) Computed tomography (CT)
C) Magnetic resonance imaging (MRI)
D) Ultrasound
A) Electrodiagnostic studies (EMG/NCS)
Where are the central respiratory control centers located?
A) Thalamus
B) Hippocampus
C) Cortex
D) Medulla
D) Medulla
Central chemoreceptors of respiratory regulation are sensitive to
which of the following levels?
A) Hydrogen ions
B) PO2
C) PCO2
D) Both A and C
D) Both A and C
What is the most cost-saving and clinically effective way to
prevent chronic obstructive pulmonary disease (COPD)?
A) Pulmonary rehabilitation
B) Supplemental oxygen therapy
C) Smoking cessation
D) Daily aerobic training
C) Smoking cessation
What is “air shifting”?
A) A technique to decrease microatelectasis
B) A technique to promote secretion drainage
C) A technique to ventilate the apical lung fields
D) A technique to reduce respiratory rate in dyspneic patients
A) A technique to decrease microatelectasis
What is glossopharyngeal breathing (GPB)?
A) Breathing through a tracheostomy
B) Functional electrical stimulation technique used on the pharyngeal
muscles
C) Breathing technique used in the event of ventilator failure where a patient takes in several boluses of air
D) Airway secretion clearance technique
C) Breathing technique used in the event of ventilator failure where a
patient takes in several boluses of air
What is an intermittent abdominal pressure ventilator (IAPV)?
A) A method of introducing air into the abdomen to manually raise
the diaphragm
B) A treatment for obstructive sleep apnea
C) A cough assist device that exerts abdominal thrusts
D) A daytime inspiratory muscle aid worn underneath the clothing
D) A daytime inspiratory muscle aid worn underneath the clothing
When should supplemental oxygen be prescribed with exercise?
A) When the patient’s HR > 110 beats/minute
B) When the PaCO2 is > 50 mm Hg
C) When the exercise-induced SpO2 is <90%
D) When the patient is in atrial fibrillation
C) When the exercise-induced SpO2 is <90%
What is VO2max?
A) Maximal oxygen uptake and use by the body during exercise
B) Fraction of inspired oxygen necessary to maintain SpO2 > 90%
C) Maximum volume of oxygen necessary to carry out a designated
activity
D) Represents the arteriovenous oxygen difference
A) Maximal oxygen uptake and use by the body during exercise
What is the peak cough fl ow (PCF)?
A) The maximum volume of air a patient can hold with a closed
glottis
B) A breathing technique that can be taught to patients with
neuromuscular weakness
C) A method to check for intact gag reflex prior to extubation
D) The velocity of air expelled from the airways during a cough
maneuver
D) The velocity of air expelled from the airways during a cough
maneuver
What causes airfl ow limitation in emphysema?
A) Narrowed airway caliber
B) Neuromuscular weakness of the chest wall
C) Loss of elastic recoil and decreased air tethering
D) Upper airway obstruction
C) Loss of elastic recoil and decreased air tethering
How can respiratory muscles be rested in patients with chronic
obstructive pulmonary disease (COPD)?
A) Encourage daytime napping B) Nasal or mouthpiece intermittent positive pressure ventilation at bedtime C) Diaphragmatic breathing exercises D) Prescribing muscle relaxants
B) Nasal or mouthpiece intermittent positive pressure ventilation at
bedtime
When should a vibratory fl utter valve be used?
A) When a patient is experiencing acute respiratory failure
B) In a cooperative cystic fi brosis patient requiring assistance with
mucous mobilization
C) Tracking an asthmatic patient’s response to therapy
D) When a tracheostomy patient is ready to use a speaking valve
B) In a cooperative cystic fi brosis patient requiring assistance with
mucous mobilization
What is a potential benefit of home oxygen use in patients with
chronic obstructive pulmonary disease (COPD)?
A) Reduction in polycythemia
B) Reversal of disease process
C) Provides respiratory muscle rest
D) Prevents obstructive sleep apnea
A) Reduction in polycythemia
COPD is which number leading cause of death in US?
4th
pathogenesis of emphysema
excessive lysis of elastin and other structural proteins in the lung matrix
mechanism of death in COPD
pneumonia > pulmonary hypertension > cor pulmonale > chronic respiratory failure
what is a blue bloater?
chronic bronchitis
what is a pink puffer?
emphysema
radiographic findings with COPD
. low, flattened diaphragm
. increased AP diameter
what are the causes of dyspnea in COPD
. hyperinflation
. breathing at high volumes
. diaphragm flattening
What are the management tools for COPD (6)
. smoking cessation . pulmonary rehab . pharma . oxygen . non-invasive ventilation . srugical rememdies
SABA for COPD
Albuterol
LABA for COPD
Salmeterol, Formoterol, Tiotropium
mucokinetic agents
. guiafenesin
. SSKI
. mucomyst
. P & PD
GOLD stage I characteristic and medication
FEV1 >80%
prn SABA
GOLD stage II characteristic and medication
FEV1 50-80%
(SABA + tiotropium) or (SABA + formoterol) or salmeterol
GOLD stage III characteristic and medication
FEV1 30-50%
Minimum diagnostic for COPD
FEV1/FVC <70%
dosage for a1 antitrypsin deficiency
weekly infusions of 60 mg/kg
indications for o2 therapy
PaO2 < 55 mmHg
PaO2 > 55 but with coplications
SaO2 <88%
describe lung volume reduction surgery
20-30% of most diseased portions of lung removed
inclusion criteria for lung transplant
. life expectancy <3 years
. failure of medical therapy
. <60 yo
. no other organ failures
exclusion criteria for transplant
. coronary artery disease . continuing substance abuse . lack psychosocial support . extreme cachexia or obesity . recent malignancy . long term, high dose corticoid use
