Exercise Testing & Prescription in Peds

Question 1

The 3-4x increase in Q during exercise is due mostly to ____

Answer 1

HR, not SV

Question 2

is there a gender difference in Q or a-VO2?

Answer 2

no

Question 3

HR

• ___ is 10-20 bpm lower
• high temp/humidity can ________
• pharm

Answer 3

• boys
• increase HR by 10-20 bpm
• can cause change in HR by 10-30 bpm

Question 4

BP

• rhythmic exercise __ SBP
• smaller children have _____ BP
• boys have __ BP
• DBP should change how much
• SBP> ___ is concerning

Answer 4

• increases SBP
• lower SBP and DBP
• higher
• +/-6-10 mmHg. Not > 20
• 220

Question 5

Children have lower responses to exercise in all variables except

Answer 5

relative VO2 and HR

Question 6

primary cause of fainting/dizziness

Answer 6

hypohydration

Question 7

for older kids. Most traditional. Steep grades for young pts., large MET increase b/w patients, 3 min stages w/ grade starting at 10%. Increase by 2% with each stage. Slight speed increase

Answer 7

Bruce Protocol

Question 8

good for younger kids. Don’t like kids to go over 12 min

Answer 8

CMH max protocol

Question 9

several variations. Speed usually constant at 3.0 or 3.5 mph. Grade increases 2% every minute or 2.5% every 2 minutes. Good for children with perceived low aerobic capacity

Answer 9

Balke protocol

Question 10

Tilt table testing indications

Answer 10

syncope or presyncope, persistent dizziness, tachycardia, extreme fatigue

Question 11

• passive tilt table testing

- active tilt table testing

Answer 11

• 20 min supine, 20 min at 80 degree head up tilt

- exercise test followed by 20 at 80 degree head up tilt

Question 12

passive tilt table indications

Answer 12

symptoms occur with change in position/standing. Common in slender, growing adolescents. usually girls who skip breakfast and drink little water

Question 13

active tilt table indications

Answer 13

symptoms during/after exercise. competitive athletes and active teens

Question 14

positive tilt test

Answer 14

loss of consciousness,symptomatic hypotension, symptomatic bradycardia/asystole, persistent tachycardia w/o decrease in BP, hypotension w/ inappropriate HR response

Question 15

Pediatric chest pain and SOA

• cardiac causes
• noncardiac causes

Answer 15

• pericarditis, trauma (hemopericardium), arrhythmias

- pulmonary (pneumothorax, pneumonia, pleurodynia), Esophageal (acute esophagitis, foreign body)

Question 16

Vocal cord dysfunction

• occurs more in ___
• what is it?

Answer 16

• females
• paradoxical closure of vocal cords during inspiration. Causes airflow obstruction, throat tightness, suffocation/choking

Question 17

Symptoms of VCD

Answer 17

-stridor (like wheezing but on inhale), chest/throat tightness, can’t get air in, chronic cough, tingling arms/legs

Question 18

Gerd

• ___ of asthma pts have it
• 95% of VCD have it and are ___
• treating it helps ____

Answer 18

• 2/3
• overachievers
• asthma

Question 19

protocol for Ex induced SOA

Answer 19

elevate HR to 160-180 bpm and sustain for 6-8 min on tread or cycle. PFT pre and at 5, 10, 15 min post exercise

Question 20

FEV1 in obstruction

• mild
• mod
• severe

Answer 20

-65-80%
-50-65%
-

Question 21

Bethesda guidelines

Answer 21

physical activity guidelines for congenital defects

Question 22

Single ventricle abnormal findings

Answer 22

blunted HR response, low fxnal capacity, ECG abnormalities, decreased O2 sat

Question 23

when do dysrhythmias become a “big deal”

Answer 23

when they occur in groups