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pther 504 > Quiz 1 - 2 > Flashcards

Quiz 1 - 2 Flashcards

1
Q

dyspnea - 5

A

Shortness breath at rest, with mild exertion or usual activities - anything that makes the heart work harder - cold weather, inclines, large meal
○ Abnormally uncomfortable awareness of breathing
○ Strenuous exertion in healthy trained
○ Mod exertion in healthy untrained
○ Abnormal
§ Occurs at a level of exertion not expected to evoke symptom
□ May indicate heart failure or pulmonary disease

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2
Q

Unusual fatigue - 4

A

gradual decline in energy levels - not aging
○ May be benign and caused by deconditioning
○ May signal of change in CV or metabolic disease
○ May be accompanied by dyspnea

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3
Q

dizziness or syncope

A

Loss of consciousness, tunnel vision confusion, slurred speech impaired motor function

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4
Q

KEY QUESTIOns for usual fatigue - 2

A

Key questions
§ How many flights of stairs can you do
□ Unable to do >1-2 w/o stopping
How many blocks can you walk with out stopping
Unable to do >2-3 blocks w/o breaks

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5
Q

2 causes for dizziness/syncope

during exercise

A

§ Blunted or reduced CO
§ Reduced perfusion to brain
During exercise may be due to cardiac disorders

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6
Q

2 factors to consider for dizziness or syncope

A

§ Meds - HR, BP, diuretics/water pills - dehydrated

§ Hydration/fluid restrictions

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7
Q

dizziness in healthy

A

After ex cessation may be due to reduced venous return to heart

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8
Q

Orthopnea or proximal nocturnal dyspnea - 2

A

short of breath - cant sleep - tired - ejection fraction - 60% is normal
○ Both indication of heart failure - left ventricular dysfunction - built up fluid in lungs

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9
Q

Orthopnea - 2

A

§ Dyspnea occurring at rest in recumbent position

§ Relieved by sitting upright or standing

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10
Q

Paroxysmal nocturnal dyspnea - 2

A

§ Dyspnea beginning 2-5 hrs after sleep

Relieved by sitting upright or getting out of bed

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11
Q

ankle edema

A
  • larger or puffy limbs, shoes don’t fit as well, indentations from socks, accompanied by shortness or breath/fatigue - new symptom to emerge, not new go to GP
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12
Q

bilateral ankle edema - 2

A

§ Most evident at night

§ Indication of heart failure or chronic venous insufficiency

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13
Q

unilateral ankle edema

A

Indication of venous thrombosis or lymphatic blockage of limb

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14
Q

generalized ankle edema

A

Kidney disease, heart failure or liver disease

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15
Q

factors to consider - ankle edema

A

Sudden change in weight >2kg in 1-3 days

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16
Q

palpitations
remember to
could be induced by

A

sit for a few mins before you measure their HR
Unpleasant awareness of forceful or rapid heart beat
various disorders of cardiac rhythm, anxiety or high CO states - anemia/fever

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17
Q

Normal RHR

A

60-100

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18
Q

Tachycardia

A

fast HR >100

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19
Q

Bradycardia

A

slow HR < 60 - when accompanied by other symptoms - dizziness confusion , change in consciounsness

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20
Q

Intermittent claudication - 1- 6

A 
blockage of artery 
○ Pain in LE brough on with exercise 
○ Disappear within 1-2 min of rest 
○ Doesn’t occur with sitting/standing 
○ Reproducible day to day 
○ Described as cramping 
Aggravated by stairs and hills
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21
Q

known heart - murmur - 2

questions to ask

A

○ Indication of valvular disease or CVD
Most commonly related to exertion related sudden cardiac death
specialist? Additional workup?

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22
Q

2 possible conditions - known heart murmur

A

§ Aortic stenosis - aortic anerysyms

Hypertrophic cardio myopathy - lethal arrythmias - may not have preceding symptoms - restrictions/parameters of GP first

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23
Q

7 absolute contraindications to aerobic exercise testing

A
  • Acute myocardial infarction within <3-5days
  • Ongoing unstable angina
  • Uncontrolled arrhythmia with hemodynamic compromise - symptoms
  • Symptomatic severe aortic stenosis - symptoms
  • Decompensated heart failure - symptoms
  • Active or acute infection - endocarditis, myocarditis, pericarditis
  • Acute pulmonary embolism, pulmonary infarction, deep vein thrombosis, physical disability that precludes safe and adequate testing
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24
Q

what to do with absolute contraindications

A

symptoms in front of you - ER, follow up with GP otherwise

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25
Q

7 relative contraindication to aerobic ex

A
  • Known obstructive left main coronary artery stenosis
  • Mod to severe aortic stenosis with uncertain relationship to symptoms
  • Tachyarrhythmias with uncontrolled ventricular rates HR>120
  • Acquired advanced heart block or complete heart block HR<60
  • Recent stroke or transient ischemia attack
  • Resting hypertenstion with systolic >180 or diastolic >110
    Uncorrelated/treated med conditions - anemia, hyperthyroidism
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26
Q

what does a relative contraindication to aerobic ex mean

A

still may be able to work, parameters from specialist/GP

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27
Q

diabetes

if managed?

A
  • Gp of metabolic disorders characterized by a decrease in the production, release and/or effectiveness, and action of insulin (break down glucose)
    not a huge issue by itself - can lead to others or make others worse
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28
Q

9 symptoms for diabetes

A 
○ Increased thirst
○ Dry mouth 
○ Frequent urination 
○ Weak tired feeling 
○ Blurred vision
○ Numbness or tingling in hands or feet 
○ Slow healing sores or cuts 
○ Dry and itchy skin 
○ Frequent yeast infections or urinary tract infections
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29
Q

goal for resting blood glucose

A
  • 4-8mmol - want your sugar a little higher before you start bc exercise burns glucose so you need a buffer - juice box?
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30
Q

BG for post exercise hypoglecemia in insulin dependent

A

<5.5

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31
Q

Risk of vascular damage is exercising with BG

A

> 16.5

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32
Q

Neropathy central and peripheral for diabetes - 3

A

impair ability to feel pain/discomfort
○ Interesting if they are symptomatic
Feet blisters - don’t feel them

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33
Q

foot care for diabetes

A

foot ulcers

cotton socks - change frequently

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34
Q

14 signs of hypoglycemia - 1

A 
Feeling weak 
	Shakiness/trembling 
	Dizziness 
	Sweating 
	Hunger 
	Irritability or mood 
	Anxiety or nervousness 
	Headache 
	Tiredness 
	Clumsiness 
	m.weakness 
	Difficulty speaking 
	Blurry or double vision 
	Confusion 
ask what they feel like when they are low - some heart meds can mask these symptoms, diabetic pt not feeling well - check your blood sugar
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35
Q

BG green zone for exercise

A

5.5-16.5

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36
Q

BG Yellow zone for exercise

A

<5.5 (ingest carbs) or >16.5 (hydrate)

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37
Q

when adjusting BG for exercise

A

retest sugar before ex

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38
Q

if the BG is 8 before ex

A

limit intensity

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39
Q

if BG is 20 or above before ex

A

forget it for the day

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40
Q

what do you ask your pt if BG was abnormal?

A

meds? eaten? diff PA?

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41
Q

BG management with exercise - 2 things you need

A
  • Need ability to monitor BG before during and after exercise - esp change in meds, eaten, diff PA - bring it with you! For as soon as symptoms happen
    • Readily available fast acting source of carbs - juice, hard candy, fruit - hold you over till you can eat something substantial
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42
Q

when to give carb

A
  • BG <5.5 pre/post ex give carb
    - 15-20g will raise BG 1.7-4.4 depending on body weight
    - Carb given wait 15-20m before rechecking
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43
Q

To reduce risk of hypoglycemia - 3

A

avoid ex longer or higher intensity, also consider type of med - oral meds quite rare for hypoglycemia - you want to know which one they are on

	- During peak insulin action - fast vs long acting 
	- Late at night - BG will cont to drop into night
44
Q

3 safety precautions for BG management

A
  • Don’t exercise alone
    • Wear/carry med ID
      Phone to call
45
Q

incidence of sudden cardiac death

A
  • > 35 yr 1/15000 -1/50000

<35 1/100,000

46
Q

placement on BP cuff - 4

A
  • Line up line with brachial art
  • Right size cuff - cover 80% of arm
  • Bottom about 2 inches above fold of elbow
    Ensure it’s tight and doesn’t slip
47
Q

What to pump the BP cuff to?

A

20-30mmHg above 1st korotkoff sound/normal resting BP

48
Q

BP source of error - 13

A
  • Inaccurate sphygmomanometer
    • Improper cuff size
    • Rate of inflation or deflation of cuff pressure
    • Faulty equipment
    • Auditory acuity of technician
    • Experience of technician
    • Rxn time of technician
    • Flexed elbow
    • Improper steth placement or pressure
    • Not having cuff at heart level
    • Certain physiologic abnormalities
    • Background noise
      Allowing pt to hold treadmill handrails
49
Q

Pre-hypertensive

A

120-139 or 80-89

encourage lifestyle modification but no drugs unless compelling indication

50
Q

Pre-hypertensive

A

120-139 or 80-89

encourage lifestyle modification but no drugs unless compelling indication

51
Q

stage one hypertension

A

140-159 or 90-99, encourage lifestyle change, anti - hypertensive drugs indicated, drugs for compelling indications, one anti hypertensive drug as needed

52
Q

stage two hypertension

A

> /- 160 or >/- 100, encourage lifestyle change, anti hypertensive drugs indicated, 2 drug combo indicated

53
Q

measure resting BP pre-exercise - SBP < 180 and/or DBP <110 - symptomatic

A

do not start exercise

54
Q

measure resting BP pre-exercise - SBP < 180 and/or DBP <110

A

SBP >90, proceed

55
Q

measure resting BP pre-exercise - SBP < 90 and/or DBP <110

A

assess symptoms
verify meds
hydrate
wait 5-10 mins

56
Q

measure resting BP pre-exercise - SBP >180 and/or DBP > 110

A

assess symptoms, verify meds, rest for 5-10 mins

57
Q

Cardio resp fitness - 1-4

A 
- Body's ability to take in, transport and utilize o2 in the exercising m. to produce ATP during prolonged PA - aerobic metabolism 
	○ Aerobic fitness/endurance 
	○ Aerobic capacity 
	○ Exercise capacity 
	○ Functional capacity
58
Q

Cardioresp fitness measured as

A

max o2 intake - VO2 max

59
Q

absolute vs relative VO2max

A

○ O2L/min vs O2ml/kg/min - bigger person might just have a bigger heart
§ Other limiting factors to exercise

60
Q

Metabolic equivalent - 4

A
  • An index of energy expenditure
  • The ratio of the rate of energy expended during an act to the rate of energy expended at rest - based on resting metabolic rate
  • One MET is the rate of exercise expenditure while sitting at rest - body size and age should be in consideration but isnt
    ○ 3.5mL/kg*min - can get VO2 with factor of 3.5
    Compendium of PA
61
Q

aerobic fitness -
predictor of?
peak at?

A 
predictor of how long you will live 
- Peaks at early 20s 
	○ Lose 10% every decade after that 
		§ 50/55 women menopause men lose testosterone and both lose lots of m. mass 
			□ Then decline accelerates
62
Q

health related QOL

A

perception of well being and absense of disease - beliefs goals and expectations - meaning of life

63
Q

9 Factors to consider when choosing a test

A
  • Purpose - info used for?
  • Health status - co morbidities
  • Safety concerns? - ACSMs ex management for persons with chronic diseases and disabilities
  • Physician supervision? Speed dial or appt?- physician is the brain - you still have to do work for the pt
  • Max vs submax
  • Length of test
  • Willingness of pt - familarity - someone whos nevver walked on a treadmill
  • Cost of test
  • Facilities and equipment?
64
Q

Aerobic ex and COVID 19 - 6

A
  • Screen your pts for COVID 19
  • Wear a mask and perform hand hygiene, frequent cleaning, heavy breathing, sneezing, coughing
    ○ Exercising with masks, greater distance between ppl -
  • During ex social distance >/- 3 meters
  • Additional PPE required <3m from pt (if not wearing a mask
  • Sanatize everything within the pts’ bubble - clean everything within 3m of them
  • Can still do chest compression and use AED
    Cover your face
65
Q

3 purpose of aerobic exercise testing

A

diagnosis
prognosis
eval of ex response

66
Q

diagnosis

A

Determine presence of disease (i.e. ischemic heart disease)

67
Q

prognosis - 3

A

○ Predict risk of CV events/mortality
○ Eval of severity of disease - more severe lower fitness
Assess response to therapy/intervention - how much they can to do make a plan, symptoms then what you wanna monitor

68
Q

eval of ex response - 3

A

○ Determine functional capacity/ex tolerance
○ Symptoms
○ Help guide ex prescription/plan

69
Q

Principles of ex testing - 4

A
  • Protocol should accommodate ind’s ability to perform the ex
    ○ Lower impact/less demanding
  • If using a multi stage protocol, intensity should increase gradually in 2-3 mins stages - metabolism to stabilize and reach a steady state - not solely anaerobic
  • Increments in work rate should be chosen to test time ranges bw 8-12 mins
  • Typically, HR, BP and ratings of perceived exertion are measured and symptoms
    ○ ACSM’s guidelines for ex testing and prescription
70
Q

Gen testing procedures - 9

A
  • Review how pt is feeling - health status change?
  • Verify meds/ that they have taken them
  • Ensure pt is wearing comfortable clothing and appropriate footwear - tell them to prepare before hand - closed toe shoes
  • Familiarize participant with protocol/equipment/consent form
  • Obtain resting vitals - i.e. HR, BP, O2 stat
  • Monitor vitals and RPE as appropriate during test (HR last 10-15 seconds of each stage, BP last 30-60 seconds, Re LAST 10-15 SECONDS - then active recovery - walk to get their HR and BP back to normal - presyncope or syncope if stopped too quickly
    ○ BP in 30 seconds or less
  • PT’s appearance and symptoms should be monitored regularly
  • Cont low level ex until HR and BP stabilize but not necessarily until they reach pre-ex values
    Recheck vitals in recovery for at least 5 mins unless abnormal
71
Q

13 general indications for stopping a test

A
  • Onset of mod=severe angina or angina-like symptoms (>/- 3/5 on standard angina scale) ○ Track numbers to see if there is any change
  • Increase nervous system symptoms - ataxia, dizziniess, or near syncope
  • Signs of poor perfusion - i.e. light-headedness, confusion, pallor, cyanoisis, nausea, or cold and clammy skin)
  • Shortness of breathe, wheezing, leg cramps, claudication
  • Physical or verbal manifestation of severe fatigue
  • Drop in SBP >/- 10mmHg with an increase in work rate, or if SBP decrease below value obtained in same position prior to testing
  • Excessive rise in BP:SBP>250mmHg and or DBP >115 mmHg
  • Failure of HR to increase with increase in ex intensity
  • O2sat - 80, normal >/- 95%
  • HR > age predicted max (i.e. 220-age) - accurate within 10 beats - closer - closer to being done the test - good to use 85% of max
  • Failure of the testing equipment
  • Participant requests to stop
    Participant has completed the protocol
72
Q

when to measure BP

A

5 mins after pt comes in

73
Q

6 abnormal BP response to ex

A
  • Hypertensive SBP >/- 250
  • Exaggerated response SBP >/-210 in men, 190 in women
  • Hypotensive
    ○ Decrease in SBP below pretest values
    Or drop in SBP >10 after initial increase
  • blunted
    SBP during ex is slower compared to normal
    diastolic BP
    ○ Peak DBP >90 or an increase >10 pretest resting values is abnormal
    post ex response
    SBP should return to resting values or lower within 6 min of recovery
74
Q

max effort - 2 -2

A

○ Cardipulmonary ex testing
§ Directly measure VO2max
○ Symptom limited testing
Ex tolerance test/ex stress test

75
Q

submax tests and VO2

A

○ Estimated/extrapolated VO2max based off of HR response or time

76
Q

field tests

A

Max or submax

77
Q

CP ex testing advantages - 2

A

○ Gold standard for assessing ex capacity

○ Direct measurement of VO2 used during exercise using a metabolic cart

78
Q

CP ex testing limitations - 4

A

○ Specialized equipment required
○ Staffing - number and training - BP at the same time, calibration, how to
○ Time consuming
Cost

79
Q

CP ex testing typically used in 3

A

○ Athletes - NHL
○ Research
Select clinical pop. - pulmonary. Heart failure, congenital heart disease

80
Q

symptom limited testing

A

stress test, ex tolerance test - push them till they develop symptoms

81
Q

Symptom limited vs CPET

A

○ No metabolic cart to directly measure VO2

82
Q

symptom limited advantages - 2

A

○ Max test limited by symptoms

○ More cost effective than CPET

83
Q

symptom limited limitations - 2

A

○ Not optimal for low functioning pts

Tendency to over estimate ex capacity hold on nice and tight with your hands makes it safe but also easier

84
Q

symptom limited risk of adverse event

A

1/10000

85
Q

bruce protocol

A

aggreive - comorbidities, sedentary or not very fit

86
Q

bruce protocol mostly used because - 3

A

§ Physician familarity
§ Efficient use of time
§ Prediction equation for functional capacity

87
Q

class I functional classification - 3

A

no limitations with ordinary act more than or equal to 6-7 mets, more than or equal to 6 min Bruce, VO2 more than or equal to 20
clinically fit

88
Q

class II functional classification - 3

A

slight limitation with ordinary act - fatigue, palpitations, dyspnea, angina
5-7 METs, 3-6 min Bruce, VO2 14-20
symptoms at higher intensity - mowing grass/ 2 flights of stairs

89
Q

class III functional classification - 3

A

marked limitation with less than ordinary act
2-5 METs, less than or equal to 3 min on Bruce, 10-14 VO2
symptoms with lower intensity - little bit of cooking and cleaning

90
Q

class IV functional classification - 2

A

symptomatic at rest/ with min exertion

less than 2METs, VO2 <10

91
Q

2 advantages for submaximal tests

A

○ Used when max test is not feasible due to time, equipment, sraff, cost
Not max exertion, better tolerated by participants

92
Q

How to estimate VO2max with submax tests

A

HR/time

93
Q

limitation of submax tests

A

○ Requires assumptions in order to estimate VO2 max - breaking those would affect your results

94
Q

6 assumptions to estimate VO2 max

A
  1. A linear - straight line - relationship exists bw HR, VO2 and workload (i.e. HR 110-150bpm)
    1) Stroke volume plateaus in this range
  2. Diff bw actual and predicted max HR is minimal
    1) i.e. predicted Hrmax = 220-age, accuracy +/- 10bpm
  3. A steady - state HR is obtained at each work rate in 3-4 min
    1) HR in last two min of stage - 5bpm
  4. Mechanical efficiency is the same for everyone at a given workload
  5. Participant is not on any meds that alter HR response (i.e. beta-blocker)
  6. Participant is not on high quantities of caffeine, ill or in a high temp environment - all may alter HR response to ex
95
Q

4 ex of submax tests

A
  • YMCA cycle ergometer test
  • Astrand - ryhming cycle ergometer test
  • mCAFT step test
  • Ebbling Single Stage treadmill test
96
Q

field test

A

Involves walk/run a set distance or time

97
Q

advantages of field tests

A

○ Easy to administer to large number of participants at same time
○ Little equipment needed

98
Q

limitations of field tests

A

○ May be near-max for some ind. (i.e. low CRF)

Inability to monitor for test termination criteria (i.e. BP)

99
Q

ex of field tests

A

○ Beep test/incremental shuttle walk test
○ Rockport 1 mile walk test
○ 6 min walk test

100
Q

10 factors influencing the 6MWT

A 
height 
weight 
age 
corridor length
chronic disease (CVD, Pulmonary D, MSK)
impaird cognition 
motivation 
prev done test 
medication 
O2 supplementation
101
Q

3 advantages of 6MWT

A

self paced
most ppl can walk
can take breaks as needed

102
Q

limitations of 6MWT

A

walking a short distance is non-specific/non-diagnostic

103
Q

functional class in steps

A

I > 401
II 301 - 400
III 201 -300
IV < 200

104
Q

less than 300m in steps in 6MWT

A

associated with a worse short term prognosis

105
Q

minimal clinically significant change for 6MWT

A

25-50m in most chronic conditions

pther 504 (3 decks)

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