Eval/ Diagnosis
Eval/ Diagnosis 2
Examination
Examination 2
Intervention
100
A patient presents with hemosiderin changes and increased lower extremity edema. What diagnosis are these changes consistent with?
Chronic venous insufficiency
Acute venous insufficiency
Acute arterial insufficiency
Chronic arterial insufficiency
A. Lower extremity edema is usually due to incompetent valves, which causes the edema. Long- standing edema causes staining of the legs because of increased iron from pooling blood. (A 65 eval/ diagnosis)
100
What is one of the most common signs of right ventricular failure?
Paroxysmal nocturnal dyspnea
Exertional dyspnea
Pulmonary edema
Dependent edema
D. if the rest ventricle fails, the increased fluid will back up. Traveling backward from the right ventricle, the edema goes into the right atrium and then the periphery. This causes dependent edema. (A184 eval, diagnosis)
100
A therapist in monitoring the blood pressure of a healthy athlete exercising on a treadmill. The speed and incline steadily increase during the exercise period. The therapist would expect the blood pressure response to demonstrate which of the following?
Blunted rise in systolic pressure and a slight decrease in diastolic pressure
Slight drop in systolic pressure and either a slight increase or decrease in diastolic pressure
Steady increase in systolic pressure accompanied by a steady increase in diastolic pressure
Steady increase in systolic pressure and either a slight increase or decrease in diastolic pressure
D. A steady increase in systolic pressure and either a slight increase or decrease in diastolic pressure is a normal response to ramp exercise protocol. With a continual, steady increase in exercise, the systolic blood pressure will continue to rise because the patient is not permitted to reach steady state. (A146 exam)
100
What are the major benefits of using the 6 minutes walk test as an outcome measure?
Accurately documents maximal exercise capacity
Provides good correlation with functional abilities
Allows determination of severity of lung disease
Provides determination of peak oxygen uptake.
B. The 6 minute walk test shows good correlation with function, as the 6MWT is a submax test, and function is performed at submax work level (B74 exam)
100
What is the minimal recommended work interval duration for a non deconditioned adult performing aerobic interval training?
5 minutes
10 minutes
20 minutes
30 minutes
B. guidelines for interval training call for performance of intermittent exercise of at least 10 minutes of duration (American College of Sports Medicine) (A145 interventions)
200
A patient with congestive heart failure is on a regimen of diuretics (chlorothiazide). What are the potential adverse effects of this medication that the PT should be alert for?
Hyperkalemia and premature ventricular contractions (PVCs)
Myalgia and joint pains
Orthostatic hypotension and dizziness
Reflex tachycardia and unstable BP
C. thiazide diuretics are used to manage mild to moderate hypertension. Adverse side effects include orthostatic hypotension and dizziness, along with drowsiness, lethargy, and weakness. These represent a safety risk during functional training and gait. (B43 eval/diagnosis)
200
What are some of the common adverse effects that patients taking nitrates, diuretics, beta- blockers, or calcium antagonists might experience?
Hypotension and dizziness
Arrhythmia and unstable blood pressure
Extreme fatigue and arrhythmias
Hypotensions and decreased electrolytes
A. All of these medications lower blood pressure. If the dosage is too great for patient's, they will be hypotensive and likely feel dizzy. (A141 eval/ diagnosis )
200
During the evaluation, you listen for your patient's heart sounds. You want to hear the heart sound for the tricuspid valve. Where should you place your stehoscope on the patient?
1. 4th intercostal space
2. 5th left intercostal space
3. 2nd left intercostal space
4. 2nd right intercostal space
1. 4th left intercostal space. Landmark for pulmonic valve is in 2nd left intercostal space. Landmark for aortic valve is 2nd right intercostal space. Landmark for mitral valve is 5th intercostal space.
200
Which of the following is a semilunar valve that prevents left backflow of blood into the left ventricle during diastole?
1. Bicuspid valve
2. Aortic valve
3. Tricuspid valve
4. Pulmonary valve
2. Aortic valve.
200
An outpatient physical therapist is examining a patient who underwent a total knee arthroplasty 2 weeks ago. The patient reports that the entire leg has started swelling in the past 2 days. On examination there is pitting edema throughout the lower leg and foot with tenderness throughout the mid calf. Girth measurements reveal a 3.5 cm increase in the size of the mid calf in the symptomatic leg. What recommendation should the physical therapist make to the patient?
Rest, ice, and elevate the affected lower extremity
Go home and monitor symptoms. Phone physician if there is no improvement in 24 hours
Go immediately to the emergency department
Go to the physician's office after the therapy session for further assessment
C. the patient scores a 3 on Well's criteria for deep vein thrombosis, placing him/her in the high probability category. The most appropriate response for the physical therapist would be to send the patient to the emergency department for further assessment. (B69 intervention)
300
The patient has a history of angina pectoris and limited physical activity. As the patient participates in the second exercise class, the PT suspects that angina is unstable and may be indicative of preinfarction state. What signs and symptoms would the therapist use to determine the presence of unstable angina?
Prolonged cessation of pain following the administration of nitroglycerin for angina
Angina that responds to rest and interval training but not continuous training
Arrhythmias of increasing frequency, especially atrial arrhythmias
Angina of increasing intensity that is unresponsive to the nitroglycerin or rest
D. preinfarction or unstable angina pectoris is unrelieved by rest or nitroglycerin (measures that typically reduce most angina). The pain is described as increasing in intensity. Unstable angina is an absolute contraindication to exercise. (B138 eval/ diagnosis)
300
After myocardial infarction, a patient was placed on medications that included a beta-adrenergic blocking agent. When monitoring this patient's response to exercise, what changes in HR are expected?
Increase proportionally to changes in diastolic BP
Be low at rest and rise very little with exercise
Increase proportionally to changes in systolic BP
Be low at rest and rise linearly as a function of increasing workload
B. Beta- adrenergic blocking agents are used to treat hypertension, prevent angina pectoris, and prevent certain arrhythmias. In individuals taking these drugs, HR is low at rest and rises very little with exercise. These changes, therefore, invalidate the use of HR to monitor exercise responses. A more sensitive measure would be RPE. (B186 eval/ diagnosis)
300
A patient arrives for outpatient cardiac rehab 10 weeks after a coronary artery bypass graft. The postoperative course was complicated by atrial fibrillation, which has been controlled with medications prescribed by a cardiologist. The patient’s resting vital signs are HR= 90 in atrial fibrillation, BP = 116/74, RR= 14, SpO2= 99% on room air. Is a symptom limited exercise test appropriate for this patient at this time?
Yes, the patient is managed by a cardiologist and has no symptoms now
Yes, the heart rate is well controlled and the cardiologist is aware of the arrhythmia
No, the patient is tachycardic at rest and has an arrhythmia
No, a patient in atrial fibrillation should not complete and exercise test
B. it is appropriate to perform an exercise test on a patient who is on medication to control his/ her heart rate with atrial fibrillation. A normal heart rate is between 60-100 beats per minute, which is where this patient's heart rate falls.
300
What is the best way to monitor the intensity of exercise for a patient limited mostly by claudication?
Assessing ankle-brachial index (ABI) during exercise
Maintaining heart rate between 60% and 70% of age predicted HR max during exercise
Sustaining pain levels of at least 2 out of 4 on the claudication scale during exercise
Upholding rate of perceived exertion levels of 11 to 13 out of 20 during exercise
C. It has been established that in order to generate collateral circulation in patient's with ischemia (ie. claudication), patients need to exercise with at least moderate claudication pain. This level of blood and oxygen deprivation over time initiates the generation of collateral circulation. This correlates to 2 out of 4 om the claudication scale. (A108 exam)
300
A phase 2 outpatient cardiac rehabilitation program uses circuit training with different exercise stations for the 50 minute program. One station uses arm ergometry. For arm exercise as compared with leg exercise, at a given workload, what can the therapist expect?
Higher systolic and diastolic BP
Higher HR and systolic/diastolic BP
Higher HR and lower systolic BP
Reduced exercise capacity owing to higher stroke volumes
B. arm ergometry uses a smaller muscle mass than leg ergometry with resulting lower maximal oxygen uptake. In upper extremity exercise, both HR and BP will be higher than for the same level of work in the lower extremities (B164 interventions)
400
An elderly patient has a history of 2 myocardial infarctions and one episode of recent congestive heart failure. The patient also has claudication pain in the right calf during an exercise tolerance test. Which of the following is the best initial exercise prescription for this patient?
Daily walking, using interval training for 10 to 15 minutes periods
Walking 5 times a week using continuous training for 60 minutes
Walking 3 times a week using continuous training for 40 minutes sessions
Walking 3 times a week using interval training for 30 minutes periods.
A. an appropriate initial exercise prescription for a patient with a history of CHF and claudication pain in the right calf should include low intensity exercise (walking), low to moderate duration (10-15 minutes) and higher frequencies (daily). The exercise session should carefully balance activity with rest (interval or discontinuous training) (B132 eval/ diagnosis)
400
A home care PT receives are referral to evaluate the fall risk potential of an elderly community- dweller with chronic coronary artery disease. The patient has fallen 3 times in the past 4 months, with no history of fall injury except for minor bruising. The patient is currently taking a number of medications. What is the drug that is most likely to contribute to dizziness and increased fall risk?
Colace
Albuterol
Nitroglycerin
Coumadin sodium
C. of the medications listed, nitroglycerin has the greatest risk of causing dizziness or weakness due to postural hypotension. Fall risk is increased even with small doses of nitroglycerin. (B82 eval/ diagnosis)
400
What are the possible ECG changes with exercise that can occur in a patient with coronary artery disease and prior myocardial infarction?
Tachycardia at a relatively low intensity of exercise with ST segment depression
Bradycardia with ST segment elevation
Significant arrhythmias early on in exercise with a shortened QRS
Bradycardia with ST segment depression > 3 mm below baseline
A. the typical exercise ECG changes in the patient with CAD include tachycardia at low levels of exercise intensity. The ST segment becomes depressed (>1 mm is significant). In addition complex ventricular arrhythmias (multifocal or runs of PVCs) may appear, and are associated with significant CAD and/ or a poor prognosis (B174 exam)
400
What is the expected hemodynamic response for a patient on a beta-adrenergic blocking agent during exercise?
Heart rate to be low at rest and rise minimally with exercise
Heart rate to be low at rest and rise continuously to expected levels as exercise intensity increases
Systolic blood pressure to be low at rest and not rise with exercise
Systolic blood pressure to be within normal limits at rest and progressively fall as exercise intensity increases
A. A beta- blocker will decrease the sympathetic response to activity. This will decrease the heart rate at rest and will blunt the heart rate response to activity. (A48 exam)
400
A patient with coronary artery disease received inpatient cardiac rehabilitation after a mild myocardial infarction. The patient is now enrolled in an outpatient exercise class that utilizes intermittent training. What is the best initial spacing of exercise/ rest intervals to safely stress the aerobic system?
5:1
1:1
10:1
2:1
D. Presuming that the exercise goals for inpatient cardiac rehabilitation are met, an exercise/ rest ratio of 2:1 can be used with this patient to begin exercise in an outpatient setting in a safe manner. (C4 interventions)
500
A patient with coronary artery disease has been doing regular aerobic exercise on a treadmill. If the patient fails to comply in taking prescribed beta blocker medication and continues to exercise, what potential rebound effect could result?
A. Increased in blood pressure and decrease in heart rate during exercise.
B. Decrease in blood pressure and heart rate during exercise.
C. Increase in blood pressure and heart rate during exercise.
D. Decrease in blood pressure and increase in heart rate during exercise.
C. Beta- blockers affect the beta- 1 adrenergic receptors. Blocking these inhibits the sympathetic response. However, when abruptly terminated, they cause a reflexive opposite response. This patient will demonstrate increased contractility, blood pressure, and heart rate as a result. (A4 eval/diagnosis)
500
After a myocardial infarction a patient is a new admission to a phase 2 hospital- based cardiac rehabilitation program. During the initial exercise session, the patient's ECG responses are continuously monitored via radio telemetry. The therapist notices three PVC’s occurring in a run with no P wave. What action should the therapist take?
Modify the exercise prescription by decreasing the intensity
Stop the exercise and notify the physician immediately
Continue the exercise session, but monitor closely
Have the patient sit down and rest for a few minutes before resuming exercise
B. a run of 3 or more PVC’s occurring sequentially is ventricular tachycardia. The rate is very rapid, resulting in seriously compromised cardiac output. This is potentially an emergency situation that can deteriorate rapidly into ventricular fibrillation (no cardiac output) and cardiac arrest. (B80 eval/ diagnosis)
500
A patient is walking on a motorized treadmill and is undergoing ECG monitoring. Based on viewing this cardiac rhythm strip, what action should the physical therapist take?
Immediately call emergency medical services
Modify the exercise based on past cardiac disease
Modify the exercise based on current cardiac disease
Exercise the patient/ client without any cardiac restrictions
D. This is sinus bradycardia. There are no restrictions on proceeding with exercise in this patient. (A67 exam)
500
During auscultation of the heart, the therapist hears S1 and S2 heart sounds. During early diastole the therapist also hears a low frequency sound of turbulence. What suspected abnormal sound should the therapist record this as?
S4 sound
S 3 sound
Heart murmur
Pericardial friction rub
B. S3 is an abnormal third heart sound due to poor ventricular compliance and turbulence. It is heard as a low frequency sounds during early diastole. (A40 exam)
500
A patient who is 5 weeks post- myocardial infarction is participating in a cardiac rehabilitation program. The therapist is monitoring responses to increasing exercise intensity. Which finding is an indication that exercise should be immediately terminated?
1.5 mm of downsloping ST segment depression
Peak exercise HR > 140
Appearance of a PVC on the electrocardiogram (ECG)
Systolic BP >140 mm Hg or diastolic BP > 80 mm Hg
A. the upper limit for exercise intensity prescribed for patients post- MI is based on signs and symptoms. Of the choices, only ST segment depression (>1.0 mm of horizontal or downsloping depression) is a significant finding, representative of myocardial ischemia. (B62 interventions)