Module 5 Cardio Questions Flashcards
A 50 year male patient with a second-degree heart block (Mobitz Type I AV block), presents
his EKG report to the physical therapist. What would a physical therapist expect to find on his
EKG?
A. An increase in PR interval with no dropped beats
B. No relationship between P waves and QRS complexes
C. Normal PR intervals in all the beats preceding a dropped beat
D. A gradual increase in PR interval length in all the beats preceding a dropped beat
Correct Answer: D
Mobitz Type I AV block, also known as Wenckebach, presents with a gradual increase in PR
interval length in the preceding beats and then an eventual dropped beat. Option A. is a first
degree heart block, B. is a third degree heart block, C. is a second degree heart block Mobitz
Type II AV block.
During a cardiac rehabilitation session, the PT notices that the ECG strip is displaying an
increased PR interval, while the rest of everything is normal. Which of the following would be
indicative of this findings?
A. First degree AV block
B. Second degree Mobitz Type II AV block
C. Third degree AV block
D. Second degree Mobitz Type I AV block
Correct answer: A
First degree heart block occurs when the conduction time through the A-V node is prolonged;
therefore, the ECG will have an increased length of the PR interval.
A 50 year old male patient is performing a Bruce protocol in the clinic. During the protocol,
the PT sees the EKG as below. What does it mean and what should the PT do?
A) CVA causing a lateral medullary syndrome and the PT should stop the protocol and call 911
B) First degree AV block and the PT should continue the protocol
C) Myocardial Ischemia with ST segment depression of more than 2 mm and the PT should stop
the protocol
D) Myocardial Infarction with ST segment elevation greater than 1 mm and the PT should stop
the protocol
Correct answer: C
ST segment depression is seen with myocardial ischemia. The American College of Sports
Medicine recommends termination of test/exercise when the ST segment is depressed 2.0 mm
or more.
A 50 year old male patient with peripheral artery disease was referred for physical therapy.
During the evaluation, the PT examines the patient’s peripheral pulse as shown in the picture.
Which artery is being palpated in the picture?
A. Popliteal artery
B. Dorsalis pedis artery
C. Femoral artery
D. Posterior tibial artery
Correct answer: B
Dorsalis pedis is palpated on the dorsal, medial aspect of foot, lateral to the tendon of the
extensor hallicus longus and the ankle should be slightly dorsiflexed. It is used to monitor
circulation to the feet.
Which anatomical structure is auscultated in the below image?
A) Apical Pulse
B) Aortic valve
C) Tricuspid valve
D) Pulmonic valve
Correct answer: A
The apex of the normal heart is in the fifth intercostal space at the midclavicular line. In a
healthy heart, this area, known as the apical pulse/ point of maximal impulse (PMI), is where
the contraction of the LV is most pronounced.
A 45 year old male patient had an incident of uncomplicated myocardial infarction 6 weeks
ago. The patient was in cardiac rehab and now the PT has to give strength training to the
patient. Which is the MOST appropriate protocol that can be given to this patient?
A) Wait 2 more weeks for strength training
B) Start using 5 pounds free weights or dumbbells with UE and LE training
C) Use 5-10 pounds for UE and 10-15 pounds for LE
D) Exercise with light weights based on 30%–40% of the one-repetition
Correct answer: D
Participation in resistance training can begin a minimum of five weeks post MI including four
weeks of continuous program participation. Resistance exercise is traditionally prescribed based
on the individual’s measured or estimated maximal strength or the “one-repetition maximum.”
General strength prescription in cardiac patients involves 30%–40% of the one-repetition. The
patient can exercise with light weights and elastic bands.
A physical therapist is designing exercise for a patient who is on beta blockers, which of the
following is NOT correct about the effect of beta blockers:
A) Decrease HR with exercise
B) Decrease contractility
C) Decrease myocardial oxygen demand
D) Increase afterload
Correct answer: D
Beta blockers decrease beta-sympathetic activity on the heart, resulting in a decrease in blood
pressure, HR and contractility and therefore reduced energy demand. Beta blockers do not
increase afterload.
A 58 year old male patient in is phase II cardiac rehabilitation. On the initial examination,
the therapist noted that the patient is taking atenolol. Which of the following is the BEST
measure to monitor the patient’s exertion level while exercising?
A) Heart rate
B) VO2 max
C) RPE scale
D) Systolic blood pressure
Correct Answer: C
Atenolol is a beta blocker which is a category of drugs that block the sympathetic beta receptors
and decrease both resting HR and HR response to exercise. They are commonly used in the
treatment of angina pectoris, arrhythmias, and hypertension. Patients taking beta blockers
typically experience early fatigue with exercise; an alternative to HR monitoring, such as Ratings
of Perceived Exertion scale, should be considered to monitor exercise intensity.
A 26 year old woman is diagnosed with a high risk pregnancy and is in her second trimester.
She would like advice on resting positioning from her PT. What is the most beneficial position
for this patient?
A) Supine
B) Right side-lying
C) Supine with head end of bed elevated to 20 degrees
D) Left side-lying
Correct answer: D
The position of choice for the high risk patient is left side-lying, which is optimal for reducing
pressure on the inferior vena cava and for maximizing cardiac output, thereby enhancing
maternal and fetal circulation.
A 60 year old healthy male comes to the outpatient clinic for aerobic exercise program. On
examination, the resting heart rate of the patient is 70 bpm. Which of the following is the MOST
appropriate exercise intensity for this patient?
A. Exercise at 6-7 METs
B. Exercise at target heart rate of 115-133 beats/min
C. Exercise at 40% of HR max
D. Exercise at 85% to 95% of VO2max.
Correct answer: B
We can use Karvonen formula for calculating the target heart range. Karvonen formula (target
HR = [(HRmax – HRrest) × % intensity] + HRrest).
For moderate-intensity exercise, the CDC recommends that the target HR be 50% to 70% of
predicted HR maximum and for vigorous-intensity exercise, it should be 70% to 85%. Lower
exercise intensities are indicated for individuals with low fitness levels.
HRmax: 220-age i.e. 220-60=160
HRR= HRmax- HRrest, 160-70, i.e. 90
Intensity= 50%-70%
Using the formula, Target Heart rate= 90*(50%-70%)+70
50% intensity: 45+70=115
A patient presents with intermittent claudication pain after walking for 5 minutes. Upon
examination the patient has a 0.85 ABI score. What does this score of ABI indicate?
A. Severe arterial disease
B. Normal- no arterial disease
C. Mild arterial disease
D. Moderate arterial disease
Correct Answer: C
An ABI score between 0.75-0.94 indicates mild arterial disease.
A 53 year old female patient presented to the PT clinic complaining of a large, swollen,
wound on the medial aspect of left leg. Upon examination, the therapist noted extremity was
warm; hemosiderin deposition and granulation tissue were present at the base of the
wound. What kind of ulcer it is?
A. Stage II pressure ulcer
B. Diabetic ulcer
C. Arterial ulcer
D. Venous ulcer
Correct Answer: D
The characteristics of venous ulcer are: Swelling of unilateral or bilateral LEs relieved in the early
stages by elevation, Complaints of itching, fatigue, aching, heaviness in involved limb, Skin
changes including hemosiderin staining and lipodermatosclerosis, Fibrosis of the dermis,
Increase in skin temperature of lower legs, Wounds are most frequently located on the LEs:
proximal to the medial malleolus although can occur anywhere.
A patient arrives to outpatient therapy and the physical therapist notices that the patient
has edema. When testing for the edema, the PT notices that there is a deep indentation that
returns to normal in 25 seconds. The edema can be graded as:
A) 4+
B) 2+
C) 3-
D) 3+
Correct answer: D
1+: Indentation is barely detectable.
2+: Slight indentation visible when skin is depressed, returns to normal in 15 seconds.
3+: Deeper indentation occurs when pressed and returns to normal within 30 seconds.
4+: Indentation lasts for more than 30 seconds.
A physical therapist is supervising a patient who is doing exercises in cardiac rehabilitation
center. The physical therapist decides that the patient should STOP doing exercise immediately
if there is:
A) Increase in systolic blood pressure up to 150 mmHg
B) Failure of the systolic blood pressure to rise as exercise continues
C) Respiratory rate of 25 breaths/min
D) Heart rate of 120 bpm
Correct answer: B
Failure of the systolic pressure to rise as the exercise continues is an indication to terminate the
exercise session. All other can be considered normal responses to exercise for this patient.
A PT is conducting a 6MWT in a 50 year old male patient diagnosed with hypertension.
The patient uses quad cane for ambulation. Which of the following is not true regarding 6MWT?
A. The patient could walk as far as he can in a normal walking pace
B. Standardized encouragement is provided periodically by the PT
C. The patient could use his quad cane during the test
D. The time stops when the patient stops and rest
Correct answer: D
In the 6MWT, options A, B and C are all part of the protocol. In this test, the patients walk as far
as they can at their usual pace for 6 minutes while using their customary assistive devices and
orthotics. They can stop and rest as needed, but the stopwatch continues. Standardized
encouragement is provided periodically.
