General Cardiopulmonary

Question 1

Name 3 modifiable risk factors for cardiopulmonary disease.

Answer 1

Smoking
Hypertension
High Cholesterol
Physical Inactivity

Question 2

Name 3 non-modifiable risk factors for cardiopulmonary disease

Answer 2

Genetics
Male sex
Aging

Question 3

Reduced circulating red blood cell mass relative to an individual’s gender and age. Results in impaired RBC production and could be due to dietary deficiency

Answer 3

Anemia

• Can have hemolysis
• Can be caused by chronic inflammation, neoplasms, bone marrow diseases

Question 4

S/S of this sided heart failure(left or right) secondary to pulmonary congestion includes: dyspnea, dry cough, orthopnea, wheezing, pulmonary edema, cyanosis, diaphoresis, tachycardia.

Answer 4

Left ventricular failure

Question 5

S/S of this sided heart failure(left or right) secondary to low cardiac output include: hypotension, tachycardia, dizziness, fatigue, peripheral hypoperfusion

Answer 5

Left ventricular failure

Question 6

T/F S3 heart sound can be heard with left ventricular failure

Answer 6

True- ventricular gallop

Question 7

T/F S4 cannot be heard with left ventricular failure

Answer 7

False- 4th heart sound is atrial gallop, can sometimes be heard

Question 8

What is the most common cause of R ventricular failure?

Answer 8

Left ventricular failure

Question 9

This sided lung failure involves the following s/s:

Jugular vein distention, fatigue, weight gain, ascites, dependent edema, increased venous peripheral pressure

Answer 9

Right sides ventricular failure

Question 10

Cor pulmonale is another name for:

Answer 10

Right ventricular failure

Question 11

Would you heard S3 or S4 with right sided heart failure?

Answer 11

S3

Question 12

Which side, right or left, presents with more of a pulmonary presentation?

Answer 12

Left: orthopnea, wheezes, cough, tachpnea, dyspnea,

Question 13

Define orthopnea

Answer 13

SOB/dyspnea relieved with upright position

Question 14

Define paroxysmal nocturnal dyspnea

Answer 14

SOB that awakens you from your sleep often in conjunction with heart failure

Question 15

Patient presents with dyspnea, rales, jugular venous distention, peripheral edema, and fluid in the lungs. What could they have?

Answer 15

CHF

Question 16

The following are all symptoms of CHF except:

a. paroxysmal nocturnal dyspnea
b. weight gain
c. pulsus alterans
d. sinus bradycardia
e. peripheral edema

Answer 16

D. Sinus bradycardia

Will have sinu tachycardia

Question 17

What heart sound indicated a non-compliant left ventricle?

Answer 17

S3

Question 18

What heart sound is associated with CHF, left ventricular failure, and right ventricular failure?

Answer 18

S3

Question 19

Described as tightness, indigestion, pressure in chest that diminishes with rest or nitroglycerin

Answer 19

Classic Stable Angina

Question 20

Female patient enters clinic with c/o nausea, indigestion, discomfort between the shoulder blades and excessive fatigue. It is possible she had:

a. CHF
b. Heartburn
c. Prinzmetal Angina
d. Stable Angina
e. Pericarditis

Answer 20

D. Stable angina

Question 21

Patient presents with chest discomfort that changes in frequency and severity. He reports he has had this pain while sitting down. What type of angina may he have?

Answer 21

Unstable Angina, not responsive to nitroglycerin

Question 22

You read a ECG and see an elevated ST segment. The patient states the pain in his chest is most prevalent in the morning and does not precede activity(increase in myocardial O2 demand). What type of angina may he have?

a. Stable
b. Unstable
c. Prinzmetal

Answer 22

C. Prinzmetal- does not occur during predictable level of activity

Question 23

This type of angina occurs during a predictable level of activity and often associated with an increase in myocardial O2 demand?

Answer 23

Stable

Question 24

Patients pain appears at rest and worsens with activity. Does not respond to nitroglycerin but does respond NSAIDS.

Answer 24

Pericarditis- not relieved with rest of NTG

Question 25

``` Patient has pain/discomfort that is increased with palpation over the chest wall. What might he have? a. pericarditis b. chest wall pain c. pleuritic pain ```

Answer 25

chest wall pain- MSK in nature

Question 26

Patient has pain or discomfort with changes of breathing. This pain may be: a. pleuritic b. chest wall apin c. pericarditis

Answer 26

pleuritic

Question 27

Patient experiences SOB and chest pain with activity that increases in extreme cold whether. Patient requires a bronchodilator or to stop exercises. What might they have? a. pleuritic pain b. bronchospasms c. peircarditis

Answer 27

b

Question 28

Chest pain described as substernal pressure that can refer to right or left arm, jaw, cervical spine, or between shoulders

Answer 28

Angina

Question 29

Unstable angina is also called:

Answer 29

Acute Coronary Syndrome/ Acute Myocardial Infarction - chest discomfort accelerating in frequency or severity

Question 30

Angina is often a precursor to what major cardiac dysfunction?

Answer 30

Heart attack- prolonged symptoms can lead to this, lightheadedness, and squeezing pressure sensation.

Question 31

What happens to SV, HR, and CO for a hypertensive patient performing exercises?

Answer 31

Increased SV, decreased HR, decreased CO

Question 32

Exercise is beneficial for HTN patient because it decreased Systolic, Diastolic, or Both?

Answer 32

Both

Question 33

At what Systolic BP should you terminate exercises?

Answer 33

SBP >250

Question 34

At what Diastolic BP should you terminate exercises?

Answer 34

DPB >115

Question 35

Orthostatic HTN occurs when SBP drop more than ___ and DBP drops more than ___

Answer 35

20, 10

Question 36

Normal BP

Answer 36

<120/<80

Question 37

Prehypertension BP

Answer 37

120-139/80-89

Question 38

HTN Stage 1 BP

Answer 38

140-159/90-99 | Thiazide diuretics, ACE inhibitor, angiotensin II, Beta blocker, CCB

Question 39

HTN Stage 2 BP

Answer 39

>159/>99 | Two drug combo

Question 40

Disease where there is a destruction of pancreatic beta cells, decreasing ability to create insulin

Answer 40

Type I DM

Question 41

Disease where hyperglycemia causes insulin resistance and progressive decline in beta cell function.

Answer 41

Type II DM

Question 42

Function of insulin

Answer 42

Suppresses glucose production by the liver and promotes glucose transport across the cell membrane

Question 43

Major concern while DM patient exercises

Answer 43

Hypotension, hypglycemia

Question 44

Exercises benefits DM patient by providing:

Answer 44

glycemic control

Question 45

What intensity should a DM patient with mild-mod hyperglycemia perform their exercises?

Answer 45

Low-mod intensity exercises increases glucose uptake

Question 46

Which type of DM would have a higher concern for hypoglycemia?

Answer 46

Type 1

Question 47

T/F Insulin should be injected near the exercising muscle to decrease hypotension during exercise..

Answer 47

False, avoid being near the exercising muscle

Question 48

Frequent urination, dry mouth, increased thirst, and weakness are S/S of what?

Answer 48

Hyperglycemia

Question 49

Increased hunger, flue like aches, HA, and blurred vision are S/S of what?

Answer 49

Hyperglycemia

Question 50

Facial flushing, dry skin, N/V, abdominal pain, deep rapid breathing and coma are S/S of what?

Answer 50

Ketoacidosis

Question 51

This organ controls extracellular fluid volume, electrolyte and acid balance and secretion of hormones

Answer 51

Kidneys

Question 52

Impairment of glomerular filtration results in ____ insufficiency

Answer 52

renal/kidney

Question 53

Patient on dialysis for kidney dysfunction is more likely to ave right or left sided heart problems?

Answer 53

Left ventricular problems

Question 54

What is the treatment of ESRD?

Answer 54

Hemodialysis- leads to pulmonary complications(decreased arterial PA02)

Question 55

Name that Stage! | Kidney Failure

Answer 55

Stage 5, GFR <15

Question 56

Name that Stage! | Severely decreased GRF

Answer 56

Stage .4. GRR 15-29

Question 57

Name that Stage! | Kidney Damage with normal or increased GFR

Answer 57

Stage 1, GFR >90

Question 58

Name that Stage! | Kidney damage with mildly decreased GFR

Answer 58

Stage 2, GFR 60-89

Question 59

Name that Stage! | Moderatley decreased GFR

Answer 59

Stage 3, GFR 30-59

Question 60

GFR for the differing kidney stages increases by what each stage? And how many stages are there for kidney disease?

Answer 60

5 stages, 30 each time

Question 61

Exercises compliance is highest when sessions are performed _____ the dialysis treatment? a. a day before b. during c. a day after d. right before

Answer 61

During

Question 62

T/F PVD and PAD are normally used interchangeably

Answer 62

True

Question 63

Name major S/S of PAD

Answer 63

 Painful walking (intermittent claudication)  Elevated foot develops increased pallor  Venous filling developed following foot elevation  Redness of distal limb (dependent rubor)  Death of tissue (gangrene)

Question 64

Should the intervals of exercises be short or long with PAD patients?

Answer 64

Short: 1-5 minutes with rest periods

Question 65

Normal prothrombin time and what it is

Answer 65

11.6-13 seconds, time it takes to form a clot

Question 66

A high INR woul indicate:

Answer 66

Thinner blood

Question 67

A low INR would indicate:

Answer 67

Thicker blood

Question 68

Normal INR:

Answer 68

<1.1

Question 69

Therapeutic range for INR:

Answer 69

2.0-3.0 for people of Warfin(to prevent venous thrombus or PE)

Question 70

Normal troponin level

Question 71

Troponin of >.4 indicates

Answer 71

Diagnostic for MI(acute, recent, or evolving)

Question 72

Name 3 contraindications for exercise:

Answer 72

• Contraindications to low level testing o Unstable angina or angina at rest o Severe heart failure (overt left ventricular failure on exam with pulmonary rales and S3 heart sound) o Serious arrhythmias at rest o Second or third degree heart block o Disabling musculoskeletal abnormalities o Valvular heart disease o BP > 180/105 mmHg o Pt refuses to sign consent form • Absolute contraindications to exercise testing o Recent MI o Acute pericarditis or myocarditis o Resting or unstable angina o Serious ventricular or rapid arterial arrhythmias o Tachycardia a-fib o Unrelated second or third degree heart block o Any acute illness • Relative contraindications o Aortic stenosis o Known left main coronary artery disease o Severe HTN o Idiopathic hypertrophic subaortic stenosis o Severe depression of ST segment on resting ECG o Compensated heart failure

Question 73

Beta blockers, CCB, nitrates are all considered what type of drug?

Answer 73

Anti-ischemic

Question 74

o Event – closing of tricuspid and mitral valve o Corresponding event – onset of ventricular systole o Location to auscultate – tricuspid ( 4th and 5th intercostal space, L sternal border) mitral (L 5th intercostal space midclavicular line) o Best heard with – diaphragm

Answer 74

S1

Question 75

o Event – closing of the aortic and pulmonic valves o Corresponding event – start of ventricular diastole o Location to auscultate – aortic (2nd intercostal space at R sternal border) pulmonic (2nd intercostal space at L sternal border) o Best heard with – diaphragm

Answer 75

S2

Question 76

Event – possible CHF indicative of ventricular dysfunction o Corresponding event – early diastole o Location to auscultate – apex of the heart (pt L sidelying 45 deg forward) o Best heard with – bell Abnormal Ventricular gallop

Answer 76

S3

Question 77

Abnormal atrial gallop o Event – increase resistance to ventricular filling o Corresponding event – late diastole (just before S1) o Location to auscultate – apex of the heart o Best heard with – bell

Answer 77

S4

Question 78

Best heard at erb’s point – 3rd L intercostal space

Answer 78

murmurs