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PTRS 825 Final Exam > Exercise Testing and Prescription in Peds > Flashcards

Exercise Testing and Prescription in Peds Flashcards

1
Q

CV Responses for Children

A

CO increases 3-4 times above resting level (due to HR)
Low SV compared to adults; therefore, higher HR
Boys: HR is lower and SV slightly higher

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2
Q

Submax HR

A

Declines with age

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3
Q

Max HR

A

Ranges from 195-210

Declines in late teens or early 20s

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4
Q

Boys

A

Faster post-exercise decline in HR than girls

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5
Q

Obese Children

A

Higher submax HR than lean -> reduces HR reserve

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6
Q

Environment

A

High temp and humidity increase HR 10-20 bpm

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7
Q

Fear or Apprehension

A

HR may increase due to being scared

See if they can relax more after test, than take a resting HR

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8
Q

Mode of Testing

A

Affect HR

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9
Q

Pharmacologic agents

A

May increase or decrease HR

Rely on 1-20 scale instead

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10
Q

BP

A

Rhythmic exercise will cause rise in systolic proportion to exercise intensity
African americans have higher BP due to stiffer arterial surfaces

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11
Q

Normal Responses to Exercise

A

SBP increases
>220 = concern
DBP varies +/- 6-10

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12
Q

Unique Responses to Exercise

A

VO2 - higher at submax, higher/equal at max
HR - higer at both max/submax
All other variables are lower

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13
Q

Voluntary Hypohydration

A

Even forced to drink, most children are underhydrated

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14
Q

Perpetual Response Difference to Exercise

A

Children tend to be slower/weaker BUT perceive intensities to be lower, recover faster

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15
Q

Considering Exercise Testing a Child

A

Begin around 6-8 yo

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16
Q

Testing Protocols

A

Bruce/Modified Bruce
Balke
CMH Max
Manual

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17
Q

Bruce/Modified Bruce

A

Most traditional
3 min stages at 10% grade and increase grade 2% each stage
Steep grades/large MET increases/long stages difficult for young pts

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18
Q

Balke

A

3.0-3.5 mph with 2% increase every min or 2.5% increase every 2 min

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19
Q

CMH Max

A

Used with athletes

No longer than 12 minutes

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20
Q

Tilt Table Indications

A

Presyncope
Dizziness
Tachycardia
Extreme fatigue

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21
Q

Tilt Table Monitoring

A

HR
BP
O2 Sat

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22
Q

Passive Tilt

A

20 min supine
20 min with HOB @ 80 deg
Assess patients whose symptoms occur with change of position/non-exercise related
Most common in slender, rapidly growing adolescents w/limited fluid intake

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23
Q

Active Tilt

A

Exercise test followed by 20 min with HOB @ 80 deg
Assess patients whose symptoms are related to exercise
Most common in competitive athletes

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24
Q

Tilt Table Positive Findings

A

LOC
Symptomatic hypotension/bradycardia/asystole
Persistent tachycardia w/o dec BP (POTS)
Inappropriate hypotension (HR gives out before BP)

25
Ped Chest Pain and SOB
More likely in chronic/recurring issues
26
Ped Chest Pain and SOB Acute Causes
Pericarditis Trauma Arrhythmias
27
Ped Chest Pain and SOB Non-cardiac Causes
Pneumothorax Pleurodynia Acute esophagitis Foreign body
28
Ped Chest Pain and SOB Chronic Causes
``` MI Coronary artery anomalies Pericarditis Esophagitis Costochondritis Asthma Sickle cell Vocal cord dysfunction ```
29
Asthma
Spirometry changes on expiration Most common serious chronic childhood disease Don't have to have a wheeze
30
Exercise Induced Asthma Symptoms
Coughing Wheezing Tightness Typically begin 5-20 min after exercise on dry/cold days
31
EIA Management
Use Rx 10-20 min prior to exercise Quick acting: beta agonists, albuterol, anticholinergics, atrovent Long acting: anti-inflammatories, leukotriene modifiers corticosteroids
32
Treatment with Short Acting Beta Agonist
2/3 must be positive to ddx reversible airway obstruction: 1. FEV1 - 200 mL or 12% increase after abutter dose 2. FVC - 10+% increase 3. FEF 25-75% - 20% increase
33
Vocal Cord Dysfunction
Spirometry changes on inspiration, normal expiration Paradoxical closure or adduction of vocal cords during inspiration Mimics EIA but symptoms don't respond to asthma meds Occur with high intensities, but not sport specific
34
VCD Triggers
``` Bronchitis/pneumonia Fumes/odors Smoke Post nasal drip Emotions Singing ```
35
VCD Symptoms
Stridor (noise on inhale) Tightness Abrupt onset/resolution Feeling faint
36
VCD Treatment
Education Belly breathing Throat relaxation Swallow-breath technique
37
GERD
Treating can improve both EIA and VCD Dehydration believe to increase incidence Can lead to tracheal malacia
38
Spirometry Purpose
Classify lung function
39
Spirometry Contraindications
Pneumothorax Thoracic aneurysms Eye/ab/thoracic symptoms MI/unstable angina
40
FVC
Max volume of air forcefully exhaled after deepest inhale Decreased with restrictive Decrease or normal with obstructive
41
FEV1
Forced expiratory volume in 1 sec Indicator of large airway obstruction >80% predicted
42
FEV1/FVC
Ratio to classify lung function | Obstructive =
43
FEF 25-75%
Mean forced expiratory flow during middle half of FVC Indicator of SMALL airway function Norm = >60-70% Obstructive = decreased
44
EISOB Evaluation Protocol
Get HR to 160-180 bpm for 6-8 min | Perform flow-volume loops pre-exercise and 5/10/15 min post-exercise
45
Airway Obstruction
Any disease affecting diameter of airways | Low flow rate relative to lung volume
46
Obstruction Classification
Mild - 65-80% Moderate - 50-60% Severe -
47
Restricted Lung Disease
Restriction of lung tissue or capacity of lungs to expand and hold predicted volumes of air Low volumes with normal flow rates
48
RLD Causes
Fibrosis Scarring Physical deformity
49
Combined Lung Disease
CF | Excessive mucous production and damage to lung tissue
50
Bethesda Guidelines
For which activities/sports can be participated in | Conservative, probably lower PA level than needed
51
Aortic Stenosis
Valves don't open/close properly allowing back flow into ventricles
52
Aortic Coarctation
"Kink in hose" Elevated S/DPB Better assessed with right arm BP Typically treated with stent
53
Hypertrophic Cardiomyopathy
Strong, thick muscle that doesn't pump effectively, smaller ventricles, altered conduction
54
HTCM Evaluation
For ischemic changes, ventricular ectopy and abnormal BP response ST depression Decrease in SPB
55
Coronary Conditions
Kawasaki's Anomalous origin/course of coronary artery Transposition of great vessels
56
Single Ventricle
Blunted HR response EKG abnormalities Decrease O2
57
Dysrhythmia
Lack of sleep Stress Caffeine
58
Dysrhythmia Types
Ectopic: PVC, PAC Sick Sinus Syndrome Long QT Syndrome Tachyarrhythmias

PTRS 825 Final Exam (13 decks)

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