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NPTE > Random Review CARDIOPULMONARY > Flashcards

Random Review CARDIOPULMONARY Flashcards

1
Q

What does the ABI do?

A

Compares systolic BP at the ankle and arm to check for peripheral artery disease

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2
Q

What is the formula for ABI?

A

ABI = Ankle/Brachial

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3
Q

Interpret an ABI >1.4

A
  • Indicates rigid arteries
  • Use ultrasound test to check for peripheral artery disease
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4
Q

Interpret an ABI 1.0-1.3

A

Normal

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5
Q

Interpret an ABI 0.8-0.99

A
  • Mild blockage
  • Beginning of PAD
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6
Q

Interpret an ABI 0.4-0.79

A
  • Moderate blockage
  • May have intermittent claudication during exercise
  • Compression is contraindicated
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7
Q

Interpret an ABI <0.4

A
  • Severe blockage, suggests severe PAD
  • May have claudication pain at rest
  • Compression is contraindicated
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8
Q

Normal blood pH

A

7.4 (7.35-7.45)

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9
Q

Normal PaCO2 Arterial Blood Gas

A

40 mmHg (35-45)

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10
Q

Normal PaO2 Arterial Blood Gas

A

97 mmHg (80-100)

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11
Q

Normal HCO3- Arterial Blood Gas

A

24 mEq/L (22-26

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12
Q

SaO2 Arterial Blood Gas

A

95-98%

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13
Q

Acidemia

A

Elevated acidity of arterial blood (pH <7.35)

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14
Q

Alkalemia

A

Decreased acidity of arterial blood (pH >7.45)

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15
Q

Eucapnia

A

Normal level of CO2 in arterial blood (PaCO2 35-45 mmHg)

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16
Q

Hypercapnia

A

Elevated level of CO2 in arterial blood (PaCO2 >45 mmHg)

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17
Q

Hypocapnia

A

Low level of CO2 in arterial blood (<35 mmHg)

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18
Q

Hypoxemia

A

Low level of O2 in arterial blood (<80 mmHg)

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19
Q

Mild Hypoxemia

A

60-79 mmHg

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20
Q

Moderate Hypoxemia

A

40-59 mmHg

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21
Q

Severe Hypoxemia

A

<40 mmHg

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22
Q

Hypoxia

A

low levels of O2 in tissue despite adequate perfusion of the tissue

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23
Q

Normal RBC count

A

Males: 4.3 - 5.6 x10^6/mL
Females: 4.0 - 5.2 x10^6/mL

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24
Q

Normal WBC count

A

3.54 - 9.06 x10^3/mm^3

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25
Q

Normal platelet count

A

165 - 415 x10^3/mm^3

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26
Q

Total cholesterol values

A

Desirable –> <200 mg/dL
Borderline –> 200-239 mg/dL
High –> >240 mg/dL

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27
Q

Which cholesterol is “good”, which one is “bad”?

A

HDL –> good
LDL –> bad

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28
Q

LDL cholesterol values

A

Optimal –> <100 mg/dL
Near optimal –> 100-129 mg/dL
Borderline –> 130-159 mg/dL
High –> 160-189 mg/dL
Very high –> >/= 190 mg/dL

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29
Q

HDL cholesterol values

A

Low –> <40 mg/dL
High –> >/= 60 mg/dL

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30
Q

Triglyceride cholesterol values

A

Desirable –> <150 mg/dL
Borderline –> 150-199 mg/dL
High –> 200-499 mg/dL
Very high –> >/= mg/dL

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31
Q

Tracheal and bronchial sounds

A
  • Loud, tubular sounds normally heard over the trachea
  • Inspiration shorter then expiration w/ a pause between
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32
Q

Note about bronchial sounds

A
  • When heard over distal airways they are abnormal
  • Indicate consolidation or compression of lung tissue
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33
Q

Vesicular breath sounds

A
  • High pitched/breezy sounds distally
  • Inspiration longer than expiration w/ no pause
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34
Q

Types of abnormal breath sounds

A
  • Adventitious
  • Crackle (rales)
  • Pleural friction rub
  • Rhonchi
  • Stridor
  • Wheeze
  • Bronchial
  • Decreased/diminished sounds
  • Absent sounds
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35
Q

Adventitious

A
  • Abnormal breath sounds that are heard in addition to the expected breath sounds
  • heard w/ inspiration and/or expiration that can be continuous or discontinuous
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36
Q

Crackle (rales)

A
  • Discontinuous, high-pitched popping sound heard usually during inspiration
  • Associated w/ restrictive or obstructive respiratory disorders
  • Can be “wet” or “dry”
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37
Q

Wet crackle

A

Usually represents the movement of fluid or secretions

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38
Q

Dry crackle

A

Sudden opening of closed airways

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39
Q

Conditions to think of when you hear crackles

A
  • Atelectasis
  • Fibrosis
  • Pulmonary edema
  • Pleural effusion
  • Pneumonia
  • Bronchiectasis
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40
Q

Pleural friction rub

A
  • Dry, crackling sound during inspiration and expiration
  • Because of inflamed visceral and parietal pleurae rubbing together
  • Heard over the spot of pleuritic pain
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41
Q

Rhonchi

A
  • Continuous low-pitched sounds
  • “Snoring” or “gurgling” heard during both inspiration and expiration
  • Caused by air passing through obstructed airways
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42
Q

Stridor

A
  • Continuous high-pitched wheeze heard w/ inspiration or expiration
  • Indicated upper airway obstruction
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43
Q

Wheeze

A
  • Continuous “musical” or whistling sound w/ a variety of pitches
  • Comes from turbulent flow and and the vibration of the walls of small airways
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44
Q

Bronchial breath sounds

A
  • Abnormal when in places that vesicular sounds are supposed to be heard
  • Can indicate pneumonia
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45
Q

Decreased/diminished sounds

A

Less audible sounds can indicate severe congestion, emphysema, or hypoventilation

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46
Q

Absent sounds

A

May indicate pneumothorax or lung collapse

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47
Q

Voice sounds

A

Spoken sounds are usually muffled, whispered words are faint
- Bronchophony
- Egophony
- Whispered pectorlioquy

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48
Q

Egophony

A
  • A form of bronchophony
  • Spoken long “E” sounds like a long, nasal-sounding “A”
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49
Q

Bronchophony

A

Increased vocal resonance w/ greater clarity and loudness of spoken words

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50
Q

Increases in volume and distinctness in voice sounds indicate ___?

A

Consolidation, atelectasis, or fibrosis

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51
Q

Whispered pectorlioquy

A

Recognition of whispered “1,2,3”

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52
Q

Stethoscope placement for listening to the aortic area

A

2nd intercostal space at the R sternal border

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53
Q

Stethoscope placement for listening to the pulmonic area

A

2nd intercostal space at the L sternal border

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54
Q

Stethoscope placement for listening to the mitral area

A

5th intercostal space, medial to the L midclavicular line

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55
Q

Stethoscope placement for listening to the tricuspid area

A

4th intercostal space at the L sternal border

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56
Q

S1 heart sound

A
  • “Lub”
  • First heart sound
  • From closure of the AV valves
  • Lower pitch and longer duration than S2
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57
Q

S2 heart sound

A
  • “Dub”
  • Second heart sound
  • From closure of the aortic and pulmonary valves
  • Higher pitch and shorter duration than S1
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58
Q

S3 heart sound

A
  • Vibrations of the distended ventricle walls from passive flow of blood from the atria during the rapid filling phase of diastole
  • Normal in healthy young children
  • Abnormal in adults, associated w/ heart failure (aka ventricular gallop)
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59
Q

S4 heart sound

A
  • Sound of vibration of the ventricular wall w/ ventricular filling and atrial contraction
  • May be associated w/ hypertension, stenosis, hypertensive heart disease or myocardial infarction
  • AKA atrial gallop
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60
Q

Heart murmurs

A
  • Vibrations of longer duration than the heart sounds
  • Often due to disruption of blood flow
  • Sounds like soft blowing or swishing
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61
Q

Normal respiratory rate for newborns-1 year

A

30 to 60 breaths/minute.

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62
Q

Normal respiratory rate a toddler (age 1-3 years)

A

24 to 40 breaths/minute

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63
Q

Normal respiratory rate for a child in elementary school (age 6-12 years)

A

18 to 30 breaths/minute

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64
Q

Normal respiratory rate for an adult (age 18 years and older)

A

12 to 20 breaths/minute

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65
Q

What does the P wave represent?

A

Atrial depolarization

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66
Q

What does the PR interval represent?

A
  • Time for atrial depolarization and conduction from the SA node to the AV node
  • Normal duration is 0.12-0.20 seconds
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67
Q

What does the QRS complex represent?

A
  • Ventricular depolarization and atrial repolarization
  • Normal duration is 0.06-0.10 seconds
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68
Q

What does the QT interval represent?

A
  • Time for both ventricular depolarization and repolarization
  • Normal duration is 0.20-0.40 seconds
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69
Q

What does the ST segment represent?

A

Isoelectric period following QRS when the ventricles are depolarized

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70
Q

What does the T wave represent?

A

Ventricular repolarization

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71
Q

Normal sinus rhythm

A

60-100 bpm

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72
Q

Sinus bradycardia

A

<60 bpm

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73
Q

Sinus tachycardia

A

> 100 bpm

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74
Q

Sinus arrhythmia

A

A sinus rhythm that quickens and slows at the SA node, results in a beat-to-beat variation in rate

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75
Q

Sinus arrest

A
  • A sinus rhythm w/ intermittent failure of either SA node impulse formation or AV node conduction
  • Results in the occasional complete absence of the P or QRS waves
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76
Q

Atrial dysrhythmias

A
  • Premature atrial contractions
  • Atrial flutter
  • Atrial fibrillation
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77
Q

Premature atrial contractions

A
  • Occurs when an ectopic focus in the atrium initiates an impulse before the SA node
  • P wave will be premature and have abnormal configuration
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78
Q

Clinical significance of PACs

A
  • Common and generally benign
  • May progress to atrial flutter, tachycardia or fibrillation
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79
Q

Atrial flutter

A
  • Ectopic, rapid atrial tachycardia
  • Atrial rate of 250-350 bpm
  • Ventricular rate depends on AV node conduction
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80
Q

What does atrial flutter look like on an ECG?

A

Saw-tooth shaped P wave

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81
Q

Clinical significance of atrial flutter

A
  • Occurs w/ valvular disease, ischemic heart disease, cardiomyopathy, hypertension, acute myocardial infarction, chronic obstructive lung disease, and pulmonary emboli
  • S/S- palpitations, lightheadedness, and angina due to a rapid rate
  • Stagnation of blood may predispose to thrombi in the atria
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82
Q

Atrial fibrillation

A

A common arrhythmia where atria are depolarized 350-600 bpm

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83
Q

What does atrial fibrillation look like on an ECG?

A

ECG shows characteristically irregular undulations of ECG baseline w/o discrete P waves

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84
Q

Clinical significance of atrial fibrillation

A
  • Can occur in healthy hearts
  • Coronary artery disease, hypertension, and valvular disease
  • S/S- Palpitations, fatigue, dyspnea, lightheadedness, syncope, and chest pain
  • Stagnation of blood may predispose to thrombi in the atria
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85
Q

Degrees of atrioventricular conduction blocks

A
  • 1st degree
  • 2nd degree
  • 3rd degree
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86
Q

1st degree atrioventricular conduction blocks

A

PR interval is longer than 0.2 seconds, but relatively consistent from beat to beat

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87
Q

Clinical significance of 1st degree atrioventricular conduction blocks

A
  • No symptoms or significant change in cardiac function
  • PR interval may become prolonged for many reasons including medications that suppress AV conduction
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88
Q

2nd degree atrioventricular conduction blocks

A
  • AV conduction disturbance, impulses b/t the atria and ventricles fail intermittently
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89
Q

Types of 2nd degree atrioventricular conduction blocks

A
  • Mobitz type I (Wenckebach)
  • Mobitz type II
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90
Q

Clinical significance of Mobitz type I 2nd degree atrioventricular conduction blocks

A
  • Progressive prolongation of PR interval until one impulse is not conducted
  • Generally benign
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91
Q

Clinical significance of Mobitz type II 2nd degree atrioventricular conduction blocks

A
  • Consecutive PR intervals are the same and normal, followed by nonconduction of 1+ impulses
  • More serious
  • May progress to 3rd degree heart block
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92
Q

3rd degree atrioventricular conduction blocks

A
  • All impulses blocked at the AV node
  • None transmitted to the ventricles
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93
Q

Clinical significance of 3rd degree atrioventricular conduction blocks

A
  • Medical emergency, PT is contraindicated
  • When ventricular rate slows, cardiac output drops and patient may faint
  • Common causes: degenerative changes of the conduction systems, digitalis, heart surgery, and acute MI
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94
Q

Ventricular arrhythmias

A
  • Premature ventricular complex
  • Ventricular tachycardia
  • Ventricular fibrillation
  • Ventricular asystole
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95
Q

Premature ventricular complex

A
  • ## Premature depolarization in ventricles due to ectopic focus
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96
Q

Unifocal Premature ventricular complex

A

Comes from the same ectopic focus and has the same configuration

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97
Q

Multifocal Premature ventricular complex

A

Comes from different ectopic foci and have different configurations

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98
Q

Clinical significance of PVCs

A
  • Common arrhythmia that occurs in healthy and diseased hearts
  • Patient may be asymptomatic or have palpitations
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99
Q

Common causes of PVCs

A

Anxiety, caffeine, stress, smoking, and all forms of heart disease

100
Q

Ventricular tachycardia

A
  • 3+ consecutive PVCs at a ventricular rate of >150 bpm
  • P waves are absent and QRS complexes are wide and aberrant in appearance
101
Q

Clinical significance of v-tach

A
  • > 30 seconds is life threatening and required emergency response
  • Unable to maintain adequate BP, become hypotensive
  • May turn into v-fib causing cardiac arrest
102
Q

Common causes of v-tach

A

MI, cardiomyopathy, and valvular disease

103
Q

Ventricular fibrillation

A
  • Ventricles don’t beat together, quiver asynchronously and ineffectively
  • No cardiac output, patient faints
104
Q

ECG for ventricular fibrillation

A

Characteristic fibrillatory waves w/ an irregular pattern that is either coarse or fine

105
Q

Clinical significance of ventricular fibrillation

A
  • Requires immediate defibrillation
  • Medications to support circulation and intravenous antiarrhythmic agents may be used
106
Q

Causes of ventricular fibrillation

A

Heart disease of any type, MI, and cocaine use

107
Q

Ventricular asystole

A
  • Ventricular standstill w/ no rhythm
  • ECG records a straight-line
108
Q

Clinical significance of ventricular asystole

A
  • Emergency CPR and medications to stimulate cardiac activity
109
Q

Common causes of ventricular asystole

A

Acute MI, ventricular rupture, cocaine use, lightning strikes, electric shock

110
Q

Signs of myocardial ischemia and infarction

A
  • ST segment depression
  • ST segment elevation
  • Q wave (longer than 0.04 msec, larger than 1/3 R wave amplitude)
  • T wave inversion
111
Q

Normal BP

A

<120/<80

112
Q

Elevated BP

A

120-129/<80

113
Q

Stage 1 Hypertension

A

130-139/80-89

114
Q

Stage 2 Hypertension

A

140+/90+

115
Q

Hypertensive Crisis BP

A

180+ and/or 120

116
Q

Cardiac tamponade

A

Compression of the heart caused by fluid collecting in the sac surrounding the heart

117
Q

Anatomic dead space volume (VD)

A

The volume of air that occupies the non-respiratory conducting airways

118
Q

Expiratory reserve volume (ERV)

A
  • The maximal volume of air that can be exhaled after a normal tidal exhalation
  • ~15% total lung volume
119
Q

Forced expiratory volume (FEV)

A

The maximal volume of air exhaled in a specified period of time

120
Q

Forced vital capacity (FVC)

A

Volume of air expired during a forced maximal expiration after a forced maximal inspiration

121
Q

Functional residual capacity (FRC)

A
  • Volume of air after normal exhalation
  • ~40% total lung volume
  • FRC = ERC + RV
122
Q

Inspiratory capacity (IC)

A
  • The maximal volume of air that can be inspired after a normal tidal exhalation
  • IC = TV + IRV
123
Q

Inspiratory reserve volume (IRV)

A
  • Maximal volume of air that can be inspired after normal tidal volume inspiration
  • ~50% total lung volume
124
Q

Minute volume ventilation (VE)

A
  • The volume of air expired in one minute
  • VE = TV x respiratory rate
125
Q

Peak expiratory flow (PEF)

A

Maximum flow of air during the beginning of a forced expiratory maneuver

126
Q

Residual volume (RV)

A
  • The volume of gas remaining in the lungs at the end of a maximal expiration
  • ~25% total lung volume
127
Q

Tidal volume (TV)

A
  • Total volume inspired and expired with each breath during quiet breathing
  • ~10% total lung volume
128
Q

Total lung capacity (TLC)

A
  • Volume of air in the lungs after a maximal inspiration
  • TLC = RV + VC
  • TLC = TRC + IC
129
Q

Vital capacity (VC)

A
  • Volume change that occurs between maximal inspiration and maximal expiration
  • ~75% total lung volume
130
Q

What FEV1/FVC indicates obstructive impairment in the lungs?

A
  • <70%
  • Characterized by decreased expiratory flows
131
Q

Obstructive classification for FEV1/FVC

A
  • > 100% = possible normal variant
  • 70-100% = mild obstruction
  • 60-70% = moderate obstruction
  • 50-60% = moderate to severe obstruction
  • <50% severe obstruction
132
Q

What FEV1/FVC indicates restrictive impairment

A
  • Reduced lung volumes and relatively normal expiratory flow rates
  • Inferred from spirometry when FVC is reduced and FEV1/FVC is normal or >80%
133
Q

Have normative values been established for 6MWT?

A

Yes

134
Q

Male/Female distances for 6MWT, ages 60-69

A

572/538

135
Q

Male/Female distances for 6MWT, ages 70-79

A

527/471

136
Q

Male/Female distances for 6MWT, ages 80-89

A

417/392

137
Q

Common side effect of sublingual nitroglycerin tablet

A
  • Used to treat angina
  • Headache
  • Diaphoresis
  • Hypotension
  • Xerostomia (sensation of oral dryness)
  • Nausea
138
Q

Diaphoresis

A

Sweating

139
Q

Xerostomia

A

a condition in which the salivary glands in your mouth don’t make enough saliva to keep your mouth wet

140
Q

What is the gold standard for determining the presence of coronary artery disease?

A

Computed tomography angiogram (CTA)

141
Q

Signs of a DVT

A
  • Active cancer or w/in 6 months of care
  • Recent paresis or immobilization of LE
  • Bed ridden 3+ days or w/in 12 weeks of a major surgery
  • Localized deep calf tenderness
  • Entire LE swelling
  • Calf swelling in affected leg >3 cm than other
  • Pitting edema greater in affected leg
  • Collateral superficial veins
142
Q

How large of a decrease in systolic BP would lead to stopping exercise?

A

Decrease of 10 mmHg or more

143
Q

Normal respiratory and heart rate for a newborn

A
  • Respiratory rate: 30-90 breaths/min
  • HR: 70-170 bpm (120 is the average)
144
Q

With a patient that has a history of Afib, what is the best way to assess pulse rate?

A
  • 2 fingers over radial pulse, count # of beats in 60 seconds
  • The history of Afib lets us know the patient may have an irregular heart rhythm, so counting to 60 gives us the best data
145
Q

What is the purpose of a Swan-Ganz catheter?

A

Hemodynamic monitoring of the heart

146
Q

What is the most important management strategy for patients with asthma?

A

Appropriate use of medications

147
Q

Signs of respiratory acidosis

A
  • Altered mental status
  • Hypoventilation
  • Lethargy
148
Q

What is the best location for auscultation of breath sounds?

A

B/t the scapula and spine on either side (T7-T9)

149
Q

When does an embolic stroke occur?

A
  • When clots migrate from the source to block more distal cerebral arteries
  • Causes cessation of brain tissue perfusion and ischemia
150
Q

Risk Factors for Embolic Stroke

A
  • Hypertension
  • Sleep apnea
  • Obesity
  • Atherosclerosis
  • Diabetes
  • Atrial fibrillation
  • Smoking
  • Sedentary lifestyle
  • Excessive alcohol intake
151
Q

Heart failure classification

A
  • Class I
  • Class II
  • Class III
  • Class IV
152
Q

Class I heart failure

A

Pt has heart disease, but no limitations of physical activity

153
Q

Class II heart failure

A
  • Comfortable at rest
  • Experiences fatigue, dyspnea, or anginal pain with ordinary levels of physical activity
154
Q

Class III heart failure

A
  • Comfortable at rest
  • Experiences fatigue, dyspnea, or anginal pain with less than ordinary levels of physical activity
155
Q

Class IV heart failure

A
  • Unable to do any physical activity w/o discomfort
  • May have anginal symptoms at rest
156
Q

Wells Clinical Prediction Rule for DVT

A

= Score of 2+ indicates high probability of DVT
- Active cancer or w/in 6 months of care (+1)
- Recent paresis or immobilization of LE (+1)
- Bed-ridden 3+ days or w/in 12 weeks of a major surgery (+1)
- Localized deep calf tenderness (+1)
- Entire LE swelling (+1)
- Calf swelling in affected leg >3 cm (+1)
- Pitting edema greater in affected leg (+1)
- Collateral superficial veins (+1)
- Alternate diagnosis likely (-2)

157
Q

What is respiratory distress syndrome?

A
  • Most common respiratory disorder in premature infants
  • Caused by deficient amount of pulmonary surfactant
158
Q

Characteristics of respiratory distress syndrome

A
  • Airless alveoli
  • Inelastic lungs
  • Respiration rate >60/min
  • Nasal flaring
  • Peripheral edema
159
Q

Incidence of respiratory distress syndrome over the course of gestation

A

Increases w/ decreasing gestational age (i.e. more likely if the baby is premature)

160
Q

Signs and symptoms of pneumothorax

A
  • Dyspnea w/ pain reported in chest and shoulder, especially w/ rib fracture
  • Considered a medical emergency
161
Q

Symptoms of vascular claudication

A
  • Pain is consistent w/ all spinal positions
  • Pain is brought on by physical exertion
  • Pain is relieved promptly by rest, usually w/in a few minutes
162
Q

Phases of cardiac rehab

A
  • Phase I- Inpatient Cardiac Rehab (acute)
  • Phase II- Oupatient or HEP (subacute)
  • Phase III- Community Exercise program (post-acute)
163
Q

Components of each phase of cardiac rehab

A
  • Time (post-infarct or post-op)
  • RPE
  • METS
164
Q

Phase I- Inpatient Cardiac Rehab (acute)

A
  • Time: <1 week for an uncomplicated MI
  • RPE: <13 (6-20 scale)
  • METS: progress from 2-3 initially to 3-5
165
Q

Phase II- Oupatient or HEP (subacute)

A
  • Time: 1-2 weeks after MI or surgery; up to 3 months post phase 1
  • RPE: 14-16
  • METS: 4-9
166
Q

Phase III- Community Exercise program (post-acute)

A
  • Time: 3-6 months up to 1 year after MI or surgery
  • RPE: 14-16
  • METS: 5+
167
Q

Indications for airway suctioning

A
  • Artificial airway
  • Excessive pulmonary secretion
  • Secretions that are unable to be cleared by any other less invasive measure
168
Q

Less invasive airway clearance methods to attempt before suctioning

A
  • Huffing
  • Positioning that stimulates a cough
  • Cough assist devices
169
Q

What test best assesses a patients ventilation and gas exchange

A
  • Arterial blood gases
  • Something like pulse ox is to susceptible to error to be considered “best”
170
Q

Abnormal systolic BP response to exercise

A
  • Increasing by more than 20-30
  • Decreasing 10+
171
Q

Abnormal diastolic BP response to exercise

A

Increase of 10+

172
Q

What is coarctation of the aorta?

A
  • Involves obstruction of the left ventricular flow due to narrowing of the aorta
  • Causes hypertension in the UE, normal to low pressure in LE
173
Q

Symptoms of AV septal defects (AVSDs)

A
  • In 15-40% of kids w/ DS
  • Pulmonary hypertension
  • Lung congestion
  • Heart failure
  • Surgery usually required in first few months of life
174
Q

Ductus arteriosus

A
  • Normal circulatory pathway b/t the descending aorta and the pulmonary artery in the fetus
  • Normally closes in 5-14 days after birth
175
Q

Symptoms of patent ductus arteriosus

A
  • Associated w/ prematurity or DS
  • Tachycardia
  • Increased respiratory distress
  • Poor weight gain
176
Q

What is truncus arteriosus?

A
  • Separation of the aorta and main pulmonary artery does not occur during fetal development
  • Causes R and L ventricle to empty into the same large vessel
177
Q

Symptoms of a pulmonary embolism

A
  • Dyspnea
  • Tachypnea
  • Tachycardia
  • Pleuritic chest pain
  • Diffuse chest discomfort
  • Apprehension, anxiety, restlessness
  • Hemoptysis (bloody sputum)
  • Fever
  • Persistent cough
178
Q

Risk factors for pulmonary embolism

A
  • Obesity
  • Varicose veins
  • Recent orthopedic surgery
  • Age
179
Q

ST segment depressions that indicate MI

A

1.0-1.5 mm

180
Q

Why would letting a patient self-select RPE during cardiac rehab be insufficient?

A

If left up to them, they may not reach the right intensity. In order for the rehab to be effective they’ll have to work hard eventually

181
Q

Heart and BP responses to dehydration

A
  • Tachycardia (due to low blood volume)
  • Hypotension
182
Q

Uses for incentive spirometry

A
  • Encourages full lung expansion
  • Prevents atelectasis
  • Encourages diaphragmatic breathing
  • Stimulates a cough
  • Encourages surfactant production
183
Q

How often should incentive spirometry be used?

A

Recommended to be used 10x per hour

184
Q

Raynaud’s Phenomenon

A
  • Episodic spasms of small arteries and arterioles, resulting in abnormal vasoconstrictor reflex
  • Exacerbated by exposure to cold or emotional stress
  • Occlusive disease is usually not a factor
185
Q

Symptoms of Raynaud’s phenomenon

A

Fingertips develop:
- Pallor
- Cyanosis
- Numbness
- Tingling

186
Q

Who is most often affected by Raynaud’s phenomenon?

A

Females

187
Q

Arteriosclerosis obliterans

A
  • AKA atherosclerosis
  • Chronic occlusive arterial disease of medium and large vessels
  • Usually affects LE’s
188
Q

Grading peripheral pulses

A

0 –> nonpalpable pulse,
1+ –> barely detectable pulse
2+ –> slightly diminished but greater than 1+,
3+ –> normal pulse and should be easily palpable
4+ –> “bounding”

189
Q

Use of inhaled steroids vs inhaled bronchodilators in managing asthma

A
  • Inhaled steroids are the first choice to prevent inflammation
  • Inhaled bronchodilators relieve symptoms after bronchoconstriction and inflammation have already occurred
190
Q

Target HR % for moderate intensity

A

70% HR max (technically 50-70, but 70% in healthy adults is better I guess)

191
Q

Target HR % for vigorous intensity

A

70-85%

192
Q

Etiology of percarditis

A
  • usually idiopathic
  • Infection (like COVID)
  • Myocardial injury
  • Autoimmune disorders
193
Q

Symptoms of percarditis

A
  • Often asymptomatic
  • Chest pain
  • Dyspnea
  • Increased temperature
  • Malaise
194
Q

Pain pattern of percarditis

A
  • Usually relieved by sitting upright or leaning forward
  • Can last hours-days
  • Located in substernal area, can radiate to neck, upperback, and left arm
195
Q

Normal prothrombin time

A

11-12.5 seconds

196
Q

Normal troponin levels

A

0.01-0.04 ng/mL

197
Q

How does celiac disease impact anemic status?

A

Celiac disease can lead to GI malabsorption, which leads to anemia

198
Q

Orthostatic hypotension

A
  • Decrease in SBP of 20
  • Decrease in DBP of 10

This has to occur w/in 3 minutes of transition from supine > sit or sit > stand

199
Q

Signs and Symptoms of Vertebrobasilar Artery Insufficiency

A

Dizziness
Diplopia
Dysarthria
Dysphagia
Ataxia
Nausea
Numbness
Nystagmus
Severe headache

200
Q

Nutritional Issues Caused By Cystic Fibrosis

A

Blockages in the gastrointestinal tract
Deficiency of fat-soluble vitamins such as A, D, E, K
Weight loss/failure to thrive
Thin extremities and muscle wasting
Diabetes mellitus
Malnutrition
Iron-deficiency anemia

201
Q

Best strategies for managing peripheral vascular disease

A
  • Reduction of cardiovascular risk factors
  • Improvement of walking ability
202
Q

What is the Y axis on a flow volume chart?

A

Flow

203
Q

What is the X axis on a flow volume chart?

A

Lung volume

204
Q

How does the flow volume chart change with restrictive lung diseases?

A
  • Flow is unchanged
  • Volume is less
205
Q

How does the flow volume chart change with obstructive lung diseases?

A
  • Flow is limited
  • Lung volume is normal/increased
206
Q

Which lung diseases are obstructive?

A
  • Chronic obstructive pulmonary disease (COPD) (includes emphysema and chronic bronchitis)
  • Asthma
  • Bronchiectasis
  • Cystic fibrosis
207
Q

Which lung diseases are restrictive?

A
  • Idiopathic pulmonary fibrosis
  • Sarcoidosis
  • Scleroderma
208
Q

Capillary refill test

A

Measures arterial flow of the small, distal vessels

209
Q

Normal time for capillary refill

A

<3 seconds

210
Q

What is associated w/ hyperresonance sound w/ mediate percussion?

A
  • Air is more abundant than normal for a specific area of the lungs
  • Associated w/ pneumothorax
211
Q

What can happen as a result of a mucus plug?

A
  • Can cause a ventilation-perfusion mismatch
  • Results in hypoxia
212
Q

What is an early sign of hypoxia?

A

Tachycardia

213
Q

Stable angina

A

chest pain or discomfort that most often occurs with activity or emotional stress

214
Q

Unstable angina

A

Is unpredictable and occurs at rest

215
Q

Safe positioning for therapeutic exercise in patients w/ congestive heart failure

A

Maintain sitting or at least semi-recumbent positions

216
Q

Dyspnea with congestive heart failure indicates what is occurring?

A

Increased fluid buildup

217
Q

At what point should a patient with a cardiopulmonary condition not engage in rehab?

A

If they are symptomatic at rest. Additional criteria should be met to determine if it is a medical emergency

218
Q

Afterload

A
  • the pressure against which the heart has to contract to pump blood into the aorta
  • inversely proportional to stroke volume
219
Q

Preload

A
  • the volume of blood returning to the heart
  • directly proportional to the stroke volume
220
Q

At what ABI is compression contraindicated?

A

<0.8

221
Q

How to determine pressure applied when taking BP

A
  • determine the amount of pressure needed to occlude flow at the radial artery (a distal site)
  • The therapist should take the actual blood pressure 30 to 60 seconds after occluding the radial artery
  • When taking the actual blood pressure, the therapist should inflate the cuff 15 to 20 mmHg MORE than required to occlude the radial artery.
222
Q

How far above the antecubital fossa should the BP cuff be applied?

A

2.5 cm superior

223
Q

Arm positioning when taking BP

A

Supported by the PT at the level of the heart

224
Q

How to tell if cardiac ischemia is present based on ECG

A
  • ST segment will be depressed
  • T wave may be inverted
225
Q

How to tell if an acute myocardial infarction is present w/ ECG

A

ST elevation

226
Q

Systolic murmur

A
  • Occur b/t S1 and S2, closer to S1
  • Can be due to aortic stenosis or mitral regurgitation
227
Q

Diastolic murmur

A
  • Occur immediately after S2
  • Can be due to aortic and pulmonary valves allowing regurgitation or mitral stenosis
228
Q

What is likely to occur w/ kids who have a congenital heart defect?

A
  • Defect can result in acute and/or chronic hypoxia from shunting and mixing oxygenated and unoxygenated blood
  • Tachycardia would occur to match the increased demand for oxygen during activity and play
229
Q

Pneumoperitoneum

A

the presence of air or gas in the abdominal (peritoneal) cavity

230
Q

ileus

A
  • temporary lack of the normal muscle contractions of the intestines
  • Abdominal surgery and medications that interfere with the intestine’s movements are common causes
  • Bloating, vomiting, constipation, cramps, and loss of appetite occur
231
Q

Buerger disease

A
  • typically found in people who smoke
  • caused by inflammation that results in occlusion of the arteries and veins of the arms and legs
232
Q

symptoms of Buerger disease

A
  • sores on the toes and fingers
  • pain
  • tingling in the extremities
233
Q

Cryotherapy and peripheral vascular disease

A

Due to induced vasoconstriction and increased blood viscosity, cryotherapy may make already poor circulation worse

DON’T DO IT

234
Q

Most common post-op pulmonary complications

A
  • Atelectasis
  • Pneumonia
  • Pulmonary edema
  • Pulmonary emboli
235
Q

Is pulmonary fibrosis considered a post-op pulmonary complication?

A

No

236
Q

Metoprolol is what kind of medication?

A
  • Beta blocker
  • Cardioprotective
  • Reduces HR and reduced cardiac output
237
Q

Exercise hypertension

A
  • > /= 90th percentile from relative normative data
  • > /= 190 mmHg for females
  • > /= 210 mmHg for males
238
Q

At what point should exercise tolerance testing be stopped due to BP?

A

> 250 mmHg

239
Q

The diaphragm of the stethoscope is used for hearing which heart/lung sounds?

A

S1 and S2

240
Q

The bell portion of the stethoscope is used for hearing which heart/lung sounds?

A

S3 and S4

241
Q

Upper chest paradoxical breathing pattern

A

chest expands during inhalation and the abdomen is drawn inwards and then during exhalation the abdomen is pushed outwards

242
Q

Effect of beta blockers

A
  • Slow HR and decrease force of contraction
  • Attenuates (lowers) HR increases normally seen w/ exercise
243
Q

Homan’s sign

A
  • Discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight
  • Sign of DVT
244
Q

Relationship b/t 6MWT and cardiopulmonary event

A

The shorter distance walked indicates higher likelihood of a cardiac event

245
Q

After taking beta blockers, would a drop of 20-30 bpm be of concern?

A

No, this amount of decrease would be expected

NPTE (75 decks)

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