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Physical Therapy > Cardiopulm - Medical Tests > Flashcards

Cardiopulm - Medical Tests Flashcards

1
Q

What 2 processes maintain homeostasis in the body?

A
  • Movement of water

- Exchange of solutes

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2
Q

What is regulated by the processes of homeostasis?

A
  • Electrolyte concentration

- pH

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3
Q

What 2 functions can be interrupted by an imbalance in homeostasis?

A
  • Cellular functioning

- Impaired organ function

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4
Q

How much of the body is water, and how is this distributed throughout the body?

A

60 % water

  • 40 % intracellular
  • 20 % extra cellular
    • 5 % intravascular
    • 15 % interstitial
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5
Q

What are 5 sources of our body’s water?

A
  • Drink
  • Food
  • Digestion
  • Metabolism
  • IV
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6
Q

What effect can an imbalance of sodium have on the body?

A

Too much: moves fluid from cell to interstitium

Too little: From interstitium to cells (damages brain)

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7
Q

What are 3 methods of passive transport within the body?

A
  • Osmosis: solute concentration gradients (water moves to higher)
  • Filtration: Hydrostatic concentration
  • Diffusion: Solutes move from higher to lower concentration
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8
Q

What is active transport, and where does this occur?

A
  • Requires energy

- occurs in the heart

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9
Q

What are the most typical causes of hypervolemia (fluid overload)?

A
  • CHF

- Kidney problems

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10
Q

In whome is hypovolemia common?

A

The elderly

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11
Q

What are the effects of hypovolemia?

A
  • Decreased blood volume
  • Decreased preload
  • Low blood volume
  • High heart rate
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12
Q

What are electrolytes? What are 2 types?

A
  • Solutes that generate a charge when dissolved in water
  • Anions (negative)
  • Cations (positive)
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13
Q

What are 6 vital functions of electrolytes within the body?

A
  • Nerve conduction
  • Muscular contraction & relaxation
  • Cardiac rhythm & conductin
  • Bone health
  • Blood coagulation
  • Fluid balance
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14
Q

What system manages electrolytes and fluid levels during fluid/ solute volume changes?

A

The renal system.

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15
Q

What solutes do not have a charge?

A
  • O2
  • Glucose
  • CO2
  • Proteins
  • Lipids
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16
Q

What electrolyte can have a huge effect on heart rhythm?

A

Potassium.

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17
Q

What is the major cation in ECF, and what is the major cation in the ICF?

A

ECF: Sodium
ICF: Potassium

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18
Q

** See screening profiles slide **

A

** See screening profiles slide **

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19
Q

What electrolyte is related to mental status changes?

A

Sodium.

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20
Q

What electrolyte is related to heart arrhythmia?

A

Potassium.

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21
Q

What electrolyte is related to hydration, and acid/base balance?

A

Chloride.

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22
Q

What electrolyte is related to the function of the liver/ kidneys?

A

BUN (blood urea nitrogen)

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23
Q

What electrolyte is related to kidney function?

A

Creatinine.

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24
Q

What electrolyte is related to blood glucose?

A

Glucose.

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25
Q

What electrolyte is related to the level of CO2 in the body, which is regulated by the kidneys?

A

HCO3

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26
Q

What drug increases unrinary Na+ excretion?

A

Diuretics.

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27
Q

What is the most abundant cation in the intracellular compartment?

A

Potassium.

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28
Q

What organ controls long term regulation of potassium?

A
  • The kidneys.
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29
Q

How symptoms of potassium deficiency and excess different?

A

They are very similar.

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30
Q

Which electrolyte is the major anion of ECF?

A

Chloride.

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31
Q

What electrolyte’s movement is linked to that of chloride?

A

Sodium.

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32
Q

What homeostatic functions does chloride play a role in?

A
  • Fluid balance

- pH

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33
Q

What conditions can lead to a deficiency of chloride?

A
  • Vomiting
  • Diarrhea
  • Burns
  • Acidosis
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34
Q

What conditions lead to an excess of chloride?

A
  • Dehydration
  • Hyperventilation
  • Anemia
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35
Q

What 4 processes does calcium play a role in?

A
  • Bone formation
  • Cell division/ growth
  • Blood coagulation
  • Cardiac and smooth muscle contraction
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36
Q

What are the 2 roles of phosphate?

A
  • 85 % deposited within skeletal system

- 15 % used in acid base balance

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37
Q

What is an excess of phosphate associated with?

A
  • Renal failure

- Chemo

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38
Q

What is a deficiency of phophate associated with?

A
  • Too much calcium

- Diabetes

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39
Q

What is the 4th most abundant cation in the body?

A

Magnesium.

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40
Q

Where is magnesium mostly found?

A

In bone and muscle.

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41
Q

What processes does magnesium play a role in?

A
  • Carbohydrate metabolism
  • Protein synthesis
  • Muscular contraction
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42
Q

How is magnesium obtained?

A

Through diet.

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43
Q

What are the effects of a deficiency in magnesium?

A
  • Hyperactive tendon reflexes

- Cardiac irritability

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44
Q

In whom is an excess of magnesium found?

A
  • Elderly

- Critically ill

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45
Q

What specific form of tachycardia is related to low magnesium?

A

Torsades.

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46
Q

What is BMP?

A

Basal metabolic panel.

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47
Q

What are 3 kidney BMP tests?

A
  • Blood Urea Nitrogen
  • HCO3
  • Creatinine
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48
Q

What are 2 blood glucose BMP measures?

A
  • Fasting blood glucose

- HbA1C or A1C

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49
Q

What does HbA1C or A1C measure?

A

Amount of hemoglobin carrying glucose.

An average of the last few months.

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50
Q

If an individual has elevated levels of BUN, what may be their symptoms?

A
  • Low level of endurance
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51
Q

Why are typical causes of dehydration in the elderly?

A
  • Not enough preload, or cardiac output.
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52
Q

What are 5 symptoms of dehydration?

A
  • Brain uptakes water, making an individual thirsty
  • Kidneys are overloaded
  • Digestive problems (constipation, acid reflux, etc.)
  • Heat shock, fainting, and other body temperature related symptoms
  • Heart works harder (increased BP, viscocity, clotting)
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53
Q

What is measured in a CBC?

A
  • RBCs
  • WBCs
  • Hematocrit
  • Hemoglobin
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54
Q

What is the main function of RBCs?

A
  • Carry O2
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55
Q

What is the main function of WBCs?

A
  • Protect against infection
56
Q

What are 5 types of WBCs?

A
  • Neutrophils
  • Eosinophils
  • Basophils
  • Monocytes
  • Lymphocytes
57
Q

Where do WBCs originate?

A
  • Bone marrow

- Spleen

58
Q

What is the hematocrit?

A
  • % red blood cells in blood
59
Q

What is a normal hemtaocrit?

A

45 %.

60
Q

What is the main function of hemoglobin?

A

Carries O2 to tissues.

61
Q

What are 3 effects of low RBC?

A
  • Fatigue
  • SOB
  • Dizziness
62
Q

What are the effects of low WBCs?

A
  • Susceptible to infection
63
Q

Below what level of WBC is exercise contraindicated? when is light exercise indicated? When is infection indicated?

A

< 5000: With fever, no exercise
> 5000: light exercise
> 11,000: Infection

64
Q

What level hemoglobin contraindicates exercise? light exercise? resistive exercise permitted?

A

< 8: no exercise
8 - 10: light exercise
> 10: resistive

65
Q

What level hematocrit contraindicates exercise? light exercise? normal exercise?

A

< 25 %: no exercise
> 25 %: light exercise
30 - 32 %: Exercise as tolerated

66
Q

What is more important than comparison with standard normal values in CBC

A

Comparison with individualized baseline.

67
Q

What is a normal value for platelets?

A

150k to 350k/ uL

68
Q

What levels of platelets contraindicate exercise, indicate light exercise, and permit resistive exercise?

A

< 20,000: No exercise
20,000 - 50,000 –> Light AROM exercise
> 50,000 –> Resistive

69
Q

What the term for low platelet levels, and what are its effects?

A

Thrombocytopenia leads to bleeding after minor trauma, and increased bleeding post surgery.

70
Q

What are 4 coagulation panels?

A
  • D-dimer
  • PT (prothrombin time)
  • PTT (partial prothrombin time)
  • INR (internationalized normalized ratio)
71
Q

What does an increase in coagulation panels indicate?

A
  • Increased risk of bleeding
72
Q

What does a decrease in coagulation panels indicate?

A
  • Risk of clotting
73
Q

What are 4 blood thinning meds?

A

Warfarin (coumadin), plavix, heparin, aspirin, and Pradaxa.

74
Q

What are 2 lab tests related to heart failure?

A
  • ANP: a-type natriuretic peptide.; found in atria
  • BNP: B-type natriuretic peptide. Found in ventricular tissue

These are both hormones released by the heart to act as diuretics and antihypertensives in repsonse to fluid imbalance.

75
Q

What blood tests are ordered for MI?

A

Cardiac enzymes:

  • CK
  • CKMB
  • Myoglobin
  • Cardiac Troponins

Cholesterols:

  • HDL
  • LDL
  • Total
  • Triglycerides
  • Ratio
76
Q

What is a halter monitor? When would it be used?

A

Telemetry device worn continuously to assess arrhythmia during ADLs.

It is worn when the arrhythmia, but do not show up during office visits.

77
Q

What 6 measures are performed with cardiac catheters?

A
  • Heart chamber, and pulmonary pressure
  • Blood flow between heart chambers
  • Determine valve competency
  • Monitor cardiac wall contractility
  • Detect intracardiac shunts
  • Visualize coronary arteries
78
Q

When would a rt heart catheter be applied?

A
  • Pulmonary hypertension
79
Q

Why may cardiac catheterization not be ultilized?

A
  • Invasive
  • Expensive
  • Issues with kidney problems
80
Q

What is the purpose of angiography of coronary ateries performed during catheterization?

A
  • Looking for obstructions or aneurysms.
81
Q

How is conventional angiography typically performed?

A
  • Iodine based contrast delivered via catheter though femoral vein to heart
  • Image viewed through fluoroscopy
82
Q

How can an echocardiogram assess valve function?

A
  • Stenosis

- Regurgitation

83
Q

What is an echocardiogram?

A
  • Ultrasound of the heart
84
Q

What motion of the heart wall indicates ischemia?

A
  • Hypokinesis

- Dyskinesis

85
Q

What motion of the heart wall indicates infract?

A
  • Akinesis
86
Q

What can be used to observe flow rates of the heart?

A
  • A doppler
87
Q

What combination of tests observe changes in the heart with exercise?

A

Stress test or “Stress - Echo”

88
Q

How is a transesophageal echo (TEE) performed?

A
  • US combined with endoscopy
  • Probe (transducer) inserted into esophagus
  • Images taken from posterior of heart
89
Q

What is the benefit of images being taken posteriorly in a TEE?

A
  • Less interference from chest wall structures

- High quality pictures of thoracic aorta

90
Q

What type of patient typically receives a TEE instead of other procedures?

A
  • Obese patients
91
Q

What are some risks associated with TEE?

A
  • More invasion
  • Respiration due to sedation/ vagal nerve stimulation
  • Aspiration/ perforation of esophagus
92
Q

What is a positron emission test (PET), and what does it measure?

A
  • Radioisotopes given to patient that target blood and glucose.
  • Assess myocardial metabolism
  • Normal flow/ glucose –> Coronary artery perfusion
  • Decreased flow/ glucose met –> Ischemia/ necrosis
  • Can also detect tumor in lungs
93
Q

What is a V/Q scan, and what does it measure?

A
  • Ventilation/ Perfusion scan of lungs.
  • Measures air flow & blood in lungs
  • Typically detects embolisms in pulmonary artery
  • Lung function in COPD
  • Pre/ post lobectomies
94
Q

How is the V measured in a V/Q scan?

A
  • Patient inhales radioactive Xenon, and pictures are taken to determine which lobes of lung are reached
95
Q

How is Q measured in V/Q scan?

A

Radioisotope inject through IV, and photos are taken.

96
Q

How are the V/Q used to diagnose PE?

A

The images are compared and evaluated to determine inconsistencies.

97
Q

What is an older technique alternative to V/Q used to diagnose PEs?

A

Computer Tomography Pulmonary Angiography: CTPA

  • Contract injected into peripheral vein, and plain film taken.
98
Q

What type of technique detects calcium deposits in the heart?

A

CT cardiac/ angiography

  • Contrast dye detects perfusion in pericardium and myocardium
99
Q

What is a nuclear perfusion study?

A
  • Radioisotopes are used together with stress tests to evaluate the coronary arteries
100
Q

How is a nuclear perfusion study performed?

A
  • Radioisotope tracer targeting specific cells of heart muscle is given intravenously.
  • HR is increased by exercise or drugs
  • Photos taken before, after, and a few hours after
  • Check for obstruction of coronary arteries.
101
Q

What are the 4 potential outcomes following a nuclear perfusion study?

A
  • Unobstructed flow
  • Normal perfusion at rest, but decreasing during exercise
  • Decreased perfusion at rest and during exercise
  • Combination of reversible and nonreversible
102
Q

Which result is a reversible defect?

A

Normal perfusion at rest, decreased during exercise.

103
Q

What result indicates a complete block of the coronary arteries?

A

Decreased perfusion at rest and during exercise.

104
Q

Which result is common in patients with CVD?

A

Combination of reversible and nonreversible.

105
Q

What is a MUGA scan?

A
  • Multigated Aquisition
  • Isotope injected, and images taken from EDV to ESV
  • Determines heart function
106
Q

What does the MUGA scan evaluation?

A

Function of ventricles

107
Q

What test is MUGA more accurate than?

A

An echocardiogram

108
Q

What patients would recieve repeated MUGA scans?

A

Chemo patients to monitor the impact on the heart

109
Q

What is a cardiac MRI?

A
  • High resolution 3 dimensional image of heart done with or without a contrast agent.
110
Q

What is a cardiac MRI used for?

A
  • Creates still and moving pictures of the heart

- Differentiates various tissues such as: blood, fat, and myocardium

111
Q

What is MRA?

A

Magnetic resonance angiography

  • Describes a group of MRI pulse sequences that generate a signal from flowing blood.
112
Q

What is an MRA used to study?

A

Cerebrovascular system, aorta, renal arteries, and LEs.

113
Q

What are advantages of MRA?

A
  • Noninvasive
  • No contrasts
  • No exposure to ionizing radiation
114
Q

What is the disadvantage of the MRA?

A
  • Not as successful as CT angiography

- High cost

115
Q

What is common stress testing protocol?

A

Bruce protocol.

Continued until pt becomes symptomatic, and they show signs of intolerance.

116
Q

What sign is used to locate lesions in specific lobes of the heart?

A

Silhouette sign, in which the border between tissues of 2 similar densities disappears.

117
Q

What are 4 commonly obliterated borders within the lungs?

A
  • Superior mediastinum: lesion in upper lobes
  • Border of right heart: Lesion in right middle lobe
  • Border of right hemi-diaphragm: lesion at right lower lobe
  • Border of left hemi-diaphragm: lesion at left lower lobe
118
Q

What is the cardiothoracic ratio? What is normal in adults?

A
  • Estimates the size of the heart using a plain film

- In adults: widest portion of heart should be less than half the width of the chest at the diaphragmatic level

119
Q

What are 3 causes of an englarged heart?

A
  • Cardiomyopathy
  • CHF
  • Incompetent valves
120
Q

What are 4 reasons a heart may appear enlarged, when it is not?

A
  • AP view taken during expiration, not inspiration
  • Diaphragm displaced superiorly due to pregnancy
  • Abdominal distension
  • Pericardial effusion present
121
Q

What are the borders of the mediastinum?

A

Sternum, spine, lungs

122
Q

What are the contents of the mediastinum?

A
  • Heart
  • Vessels
  • Trtachea
  • Esophagus
123
Q

What are the only borders that can be distinguished in a radiograph of the mediastinum?

A

The air filled lungs

124
Q

What 3 things can cause a shift of the mediastinum?

A
  • Removal of lung
  • Pleural effusion
  • Lobular collapse
125
Q

What will cause the mediastinum contents to the opposite side?

A

Pleural effusion.

126
Q

What will displace the mediastinal contents to the same side?

A

Lung collapse or volume loss.

127
Q

What type of masses can be detected within the mediastinum?

A
  • Goiter
  • Lymphoma
  • Esophageal
  • Bronchial cancers
  • Aortic aneurysms
128
Q

Why can the diaphragm be seen in an x-ray?

A

It borders the air-filled lungs.

129
Q

What is the white area portion of the diaphragm?

A
  • Liver
  • Spleen
  • Stomach
  • Posterior lungs
  • Diaphragm next to x-ray beam
130
Q

Where is the dome of the diaphragm typically aligned?

A

To the level of the 10th rib.

131
Q

What are 3 reasons for the diaphragm becoming elevated?

A
  • Excessive fluid in peritoneal space
  • Later stages of pregnancy
  • Splinting after abdominal surgery
132
Q

Why might the diaphragm be flattened?

A
  • Increased lung volume due to:
  • Emphysema
  • Pleural effusions
  • Masses in lung
133
Q

What is the highest point of the diaphragm?

A

The middle 1/3rd.

134
Q

Which hemi-diaphragm is higher, and why?

A

Right is higher because of the liver.

135
Q

Which hemi-diaphragm contains the stomach?

A

The left.

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