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Student Questions for Cardiac Unit

Terms in this set (83)

When looking at a patient's EKG you notice a pause in their normal heart beat pattern followed by a beat that does not include a P wave. What would you call this dysrhythmia?
a. atrial escape beat
b. nodal escape beat
c. ventricular escape beat
d. AV node block
b. nodal escape beat
What difference could be detected on an EKG that would determine whether the AV block was 1st or 2nd degree?
a. 1st degree block has a PR interval longer than .2 seconds whereas a 2nd degree has a QRS interval that lasts longer than .12 seconds

b. 1st degree block there would be an inverted P wave whereas a 2nd degree block would show multiple inverted P waves for every QRS segment

c. 1st degree block has a PR interval longer than .2 seconds whereas a 2nd degree has multiple P waves for every QRS segment

d. 1st degree block has a QRS interval
longer than .12 seconds whereas a 2nd degree has a PR interval longer than .2 seconds
c. 1st degree block has a PR interval longer than .2 seconds whereas a 2nd degree has multiple P waves for every QRS segment
Which artery is MOST responsible for supplying blood to the heart tissue which pumps oxygenated blood into circulation?
A. Left anterior descending
B. Circumflex artery
C. Right coronary artery
D. Posterior descending artery
A. Left anterior descending
What area of the heart is MOST vulnerable to ischemia as a result of coronary artery disease?

A. epicardial surface
B. endocardial surface
C. the epicardial surface is only slightly more vulnerable
D. both are equally vulnerable
b. endocardial surface
Which of the following is correctly paired?

A. Subendocardial MI - STEMI

B. Transmural MI - NSTEMI

C. Subendocardial MI - Q Wave infarction

D. Transmural MI - Q Wave infarction
d. transmural MI- Q wave infarction
What is the correct matching of the following?

a. Atrial depolarization: Q wave

b. Septal Depolarization: T wave

c. Ventricular Depolarization: R wave

d. Ventricular Repolarization: P wave
c. Ventricular Depolarization: R wave
What would be the best plan of action after signs of myocardial ischemia (assuming it's the first time for the patient and you're in an acute setting)?

Continue with treatment

Call a code

Notify medical personnel

Cancel treatment for the day
notify medical personnel
What is the inherent rate of the AV Node?

60 bpm

75 bpm

100 bpm

40 bpm
60 bpm
ST segment depression is indicative of?

Myocardial infarction

Myocardial ischemia

Sinus Bradycardia

Sinus Tachycardia
myocardial ischemia
How many electrodes are required for a 12-lead standard arrangement?

a. 6

b. 10

c. 12

d. 16
b. 10
Irregular patterns observed in leads I, aVL, V5, and V6 would be indicative of abnormal activity in which portion of the heart?

a. Septum

b. Anterior Wall

c. Lateral Wall

d. Inferior Wall
c. lateral wall
True or false: Observing ST segment depression is indicative of a myocardial infarction pattern.

a. True

b. False
False - ST segment depression is indicative of transient ischemic changes.
Which of the following is true regarding gap junctions.

a. They are found in both cardiac muscle cells and skeletal muscle cells.

b. They block the electrical wave of depolarization from pacemaker cells in the heart.

c. Because the cells of the myocardium are connected by gap junctions, a problem with one cell will not cause problems with other cells.

d. Gap junctions form what is called a functional syncytium- they allow the cells of the myocardium to work together.
d. Gap junctions form what is called a functional syncytium- they allow the cells of the myocardium to work together.
Which of the following statements are correct?

a. The QRS wave will precede the actual contraction of ventricles.

b. The QRS wave will occur simultaneously with the contraction of ventricles.

c. The QRS wave will occur after the contraction of ventricles.

d. The QRS wave has nothing to do with ventricular contraction.
a. The QRS wave will precede the actual contraction of ventricles.
How would you identify an EKG as a PAC (premature atrial contraction)

a. There would be no p wave before the QRS wave

b. There would be an abnormal/wild looking QRS wave

c. There would be a p-wave however it would look abnormal

d. it would be a flat line
c. There would be a p-wave however it would look abnormal
Premature Nodal (Junctional) Contractions (PNC) lack which wave?

Q-wave

T-wave

P-wave

R-wave
P-wave
Atrial Fibrillation is considered "uncontrolled" when the heart rate is above what value?

>150 bpm

>120 bpm

>100 bpm

>80 bpm
> 100 bpm
The heart rhythm described as a "saw tooth pattern" that commonly has an atrial to ventricular rate of 3:1 is most likely:

Supraventricular Tachycardia

Paroxysmal Atrial Tachycardia

Ventricular Flutter

Atrial Flutter
atrial flutter
You are creating an exercise program for a 70 year old individual who was diagnosed with lower extremity PAD (peripheral arterial disease). Which of the following would least likely be an adaptation to exercise you would expect to see in your patient after 6 months of following your exercise prescription?

Increased blood supply to the muscle

Decreased pain in the lower extremity

Increased type 2 muscle fibers

Increased nitric oxide
Increased type 2 muscle fibers
You are the PT who is treating a 40 year old woman with hyperlipidemia, diabetes, and obesity who at risk for peripheral arterial disease. Which of the following is correct regarding the effect of cholesterol on atherosclerosis, and therefore peripheral arterial disease?

A total cholesterol: HDL ratio of 4.44 is desirable to reduce her risk of PAD.

Statins work by stimulating and enzyme that breaks down cholesterol in the liver.

Diabetes increases elasticity of blood vessels which increases risk for atherosclerosis.

Limiting her alcohol consumption to 2 drinks a day will reduce her risk of atherosclerosis.
A total cholesterol: HDL ratio of 4.44 is desirable to reduce her risk of PAD.
You are having your final session with a patient who has peripheral arterial disease and is taking Lovastatin. He will return home following this visit. Which of the following reflects your at home exercise prescription you would most likely have given this patient?

Exercise at most 2x per week.

Exercise between 1000-1200 kcal/week.

Exercise for 30 minutes at medium intensity.

Continue to exercise even if you feel pain in the LE.
Continue to exercise even if you feel pain in the LE.
Your patient comes in with a resting blood pressure of 180/110 and an elevated LDL measurement of 170. How would these two measurements together affect the risk of developing atherosclerosis?


Elevated blood pressure and elevated LDL have no correlation to the risk of developing atherosclerosis

The hypertension would lead to damage to the endothelial lining and the LDL would carry cholesterol to the damaged lining leading to hardening of the blood vessels leading to an increased risk of developing atherosclerosis

LDL elevation would offset the damage done by hypertension by carrying cholesterol away from damaged blood vessels decreasing the risk of atherosclerosis.

180/110 is not a blood pressure high enough for concern, therefore would not affect the risk of developing atherosclerosis.
The hypertension would lead to damage to the endothelial lining and the LDL would carry cholesterol to the damaged lining leading to hardening of the blood vessels leading to an increased risk of developing atherosclerosis
Your patient is looking to decrease their risk of developing atherosclerosis. They claim that they smoke 1 pack of cigarettes a day. They also express that they have not been to the gym in 2 months and also admit that they just have too much on their plate to exercise, make healthy meals (they eat a lot of fast food) and just say they are just feeling overwhelmed lately. What activities would you recommend they modify to decrease their risk?


Decrease (ideally stop) smoking

Make time to reduce stress

Help find ways to eat healthier options.

All of the above.
all of the above
Which of the following is not a chief cause of coronary heart failure (CHF)?

Past myocardial infarction(s)

Pulmonary Crackles

Chronic hypertension

Diabetes mellitus
Pulmonary Crackles
What is the cause of PURE right-sided heart failure?

Left-sided heart failure

Jugular venous distention

Pitting edema

Lung disease
lung disease
Which of the following is NOT a sign of uncontrolled coronary heart failure?

Swan-Ganz Catheter Value <8-12mmHg

Fluid retention

Lack of endurance

Dyspnea with mild exertion
Swan-Ganz Catheter Value <8-12mmHg
A score on the Pitting Edema Scale of 3+ indicates

Skin rebounds in <15 seconds seconds

Skin rebounds 15-30 seconds

Skin rebounds in >30 seconds

Skin does not rebound
Skin rebounds 15-30 seconds
What is a normal ejection fraction in a healthy individual?

0-10%

15-25%

30-40%

>50%
>50%
Which of the following measures increases after reaching 55% of one's VO2?

a. O2 Saturation

b. Ventilation

c. PaCO2

d. pH
b. ventilation
Where can cilia not be found?

a. Trachea

b. Secondary Bronchi

c. Primary Bronchi

d. Alveolar Sacs
d. alveolar sacs
In a perfectly healthy young adult, how is blood pressure affected during exercise?

a. Systolic blood pressure goes up; Diastolic blood pressure goes up

b. Systolic blood pressure goes up; Diastolic blood pressure goes down

c. Systolic blood pressure goes down; Diastolic blood pressure goes up

d. Systolic blood pressure goes down; Diastolic blood pressure goes down
b. Systolic blood pressure goes up; Diastolic blood pressure goes down
Which of the following statements is INCORRECT regarding conditions that affect the heart?

a. With coronary artery disease, ischemia occurs because blood supply < blood demand

b. Sitting a patient down who presents symptoms of angina pectoris will decrease their heart rate and systolic blood pressure

c. If a patient is having a myocardial infarction, sitting them down and giving them nitroglycerine will make their anginal symptoms go away

d. Cardiac output in a patient who is in ventricular fibrillation is zero
c. If a patient is having a myocardial infarction, sitting them down and giving them nitroglycerine will make their anginal symptoms go away
Which of the following statements is CORRECT regarding lung function?

a. Shortness of breath, lightheadedness, dyspnea, and FVC/FEV values are all good
forms of differential tests for assessing lack of lung function

b. If a patient has an FEV1 > 1 L, they will usually desaturate with exercise

c. Parasympathetic drive is what drives us to breathe faster and deeper during activity

d. Pulmonary capillary wedge pressure becomes elevated during heart failure
d. Pulmonary capillary wedge pressure becomes elevated during heart failure
What is the BMI of a 5'4 individual who weighs 154 lbs?

28.3 kg/in2

28.3 kg/m2

26.5 lbs/in2

26.5 kg/m2
26.5 kg/m2
What is the best treatment for obesity?

Behavior therapy

Dietary therapy

Surgery

Altering physical activity

A, B, and D combined
A, B, and D combined
Being overweight or obese increases the risk of all of the following except:

Sleep Apnea

Type 2 Diabetes

Cancer

Osteoarthritis

None of the above
None of the above
What is most correlated with increased health risk?

Waist to Hip Ratio

BMI

Height

% Body Fat
BMI
How many Kcal are expended by a 200 lbs individual who does 30 minutes of a 4 MET activity?

421.1 Kcal

194.8 Kcal

191.1 Kcal

182.4 Kcal
191.1 Kcal
2,3-biphosophglycerate; also known as BPG or DPG decreases the affinity of oxygen molecules to the Fe heme group found in hemoglobin. When traveling from the east coast of the US to the west coast you initially experience an increase in BPG. Select the answer that describes why this happens the WORST and then the BEST

a) Mama said when I get on a plane, I get high so everything in my body gets high too

b) The atmospheric pressure on the west coast is less then that of the east coast. Decreasing the affinity of O2 allows for hemoglobin to quickly release O2 into the system and quickly retrieve more O2 from the environment to compensate

c) Hemoglobin favors retrieving CO rather than O2 when shifting to higher climates so BPG is released to make room for incoming CO2

d) Hemoglobin prefers to release as many O2 molecules as it can each cycle throughout the body and requires BPG to release the molecule. The excitement from traveling stimulates the body to release more BPG to bring more O2 to the body as a form of sympathetic response
b) The atmospheric pressure on the west coast is less then that of the east coast. Decreasing the affinity of O2 allows for hemoglobin to quickly release O2 into the system and quickly retrieve more O2 from the environment to compensate
1 g of Hemoglobin carries how many mL's of O2?

a) 2.12

b) 13.4

c) 1.34

d) 21.2
c) 1.34
When taking an ankle measurement using the Ankle/Brachial Index what is the most distal artery that you can place the probe to get a pressure reading?

a) Posterior Tibial Artery

b) Dorsalis Pedis

c) Popliteal Artery

d) Radial artery
b) Dorsalis Pedis
During an Isometric contraction at what percent of maximal contraction would you see the MOST blood flow to the exercising muscles?

a) 10%

b) 30%

c) 70%

d) 100%
b) 30%
Which is least likely to contribute to the sensation of muscular fatigue?

a) Peripheral Nervous System

b) Lactic acid at the muscle fiber

c) Central Nervous System

d) Limited Neurotransmitter at Neuromuscular Junction
d) Limited Neurotransmitter at Neuromuscular Junction
Which coronary event is irreversible?
a. Myocardial ischemia
b. Myocardial infarction
c. Angina pectoris
d. Prinzmetal's vasospasm
b. Myocardial infarction
Which area of the heart is most vulnerable to myocardial ischemia and subsequent angina pectoris?
a. Epicardium
b. Myocardium
c. Endocardium
d. Pericardium
c. Endocardium
In which of these cases would you have a greater change of heart attack?
a. higher total cholesterol, lower HDL
b. higher total cholesterol, higher HDL
c. lower total cholesterol, lower HDL
d. lower total cholesterol, higher HDL
a. higher total cholesterol, lower HDL
Your patient presents with acute ST segment depression during exercise. As the physical therapist, what is your first step?
a. Call a code
b. Have the patient sit down and take nitroglycerin
c. Have the patient sit down and alert medical staff
d. Continue exercising and monitor future symptoms
b. Have the patient sit down and take nitroglycerin
Which myocardial infarction symptom can be different in women compared to men?
a. pallor
b. nausea
c. shortness of breath
d. chest discomfort
d. chest discomfort
Your patient complains of lower leg pain. They had a THR the prior day. Which of the following is the BEST test to diagnose a DVT?

a. Venogram

b. Color Duplex Ultrasonography

c. Homan's Sign

d. X-ray
b. Color Duplex Ultrasonography
Which of the following answers matches the term to the definition.

a. Lysis is when there is the phagocytosis of the thrombus with invasion of connective tissue components (scar tissue)

b. Extension is when the bodies natural fibrinolytic enzymes may dissolve the thrombus

c. Organization re-canalization is when the phagocytic cell removes sections of the thrombus, release growth factors, and stimulates endothelial cells to form new channels

d. Embolization is when there is growth from the original site, either proximally or distally
c. Organization re-canalization is when the phagocytic cell removes sections of the thrombus, release growth factors, and stimulates endothelial cells to form new channels
Your patient is on a Coumadin therapy after a first episode of proximal limb deep vein thrombosis. They begin to crave kale, broccoli, brussels sprouts, etc. Which of the following is the most CORRECT reason why?

a. The anti-coagulant they are on is a vitamin D antagonist

b. They are an avid health enthusiast

c. The Coumadin therapy involves eating leafy greens

d. The anti-coagulant they are on is vitamin K antagonist
d. The anti-coagulant they are on is vitamin K antagonist
Thigh length stockings are far more superior in preventing DVTs than compared to knee length stockings.

a. True

b. False
b. false
How often does re-canalization happen in patients with DVTs?

a. 50% of patients

b. 15% of patients

c. 3-5% of patients

d. Never
c. 3-5% of patients
How does deoxygenated blood get back to the heart from the lower extremities?
a. Skeletal muscle pumping
b. Valves
c. Do a headstand for 5 minutes
d. Sympathetic control of venous diameter
e. Thoraco-abdominal pumping
f. All of the above
g. Answers A,B,D,E
g. Answers A,B,D,E
T/F: A positive D-dimer test means that you are at low risk for having a DVT.
false
Which type of venous thrombosis' are most likely to lead to a pulmonary embolism?
a. Superficial Venous thrombosis
b. Deep Calf thrombosis
c. Proximal deep vein thrombosis
c. proximal deep vein thrombosis
You are testing a patient with a low pretest probability for a DVT using doppler ultrasound on their popliteal vein, you find that when the patient inhales their venous blood flow decreases, you should:

a. Consider other diagnoses

b. Refer to their physician for a D-Dimer test

c. Call an ambulance
a. consider other diagnoses
T/F: A woman has a higher risk of developing a DVT postpartum than late stage pregnancy?
true
Which of the following pairings is INCORRECT?

A) Aerobic metabolism requires oxygen; anaerobic metabolism does not

B) Aerobic metabolism utilizes all macronutrients; anaerobic metabolism only uses carbs

C) Aerobic metabolism occurs in the mitochondria; anaerobic metabolism occurs in the mitochondria

D) Aerobic metabolism yields ~ 38 ATP / Anaerobic metabolism yields ~ 2 ATP
C) Aerobic metabolism occurs in the mitochondria; anaerobic metabolism occurs in the mitochondria
Each of the following statement relate to age, as a factor affecting oxygen consumption. Which one is FALSE?

A) There is a linear relationship between age and a decline in VO2

B) Aerobic training has little to no effect on VO2 in the elderly

C) As much as 50% of the age-related decline in VO2 for both men and women is due to reduced physical activity and increased fat mass.

D) Maximal oxygen intake required for independence is ~15-18 mLO2/kg/min.
B) Aerobic training has little to no effect on VO2 in the elderly
If your patient has a peak VO2 of 25 ml O2/kg/min with an anaerobic threshold at 45% is 11.25 ml O2/kg/min, what is the LEAST amount of intensity that would require them to hit their anaerobic threshold?
a. 3 METS
b. 4 METS
c. 5 METS
d. 6 METS
b. 4 METS
All of the following are reasons that exercise decreases mortality rate EXCEPT:

a) Improves insulin sensitivity

b) Improves blood lipid profile

c) Maintains better body composition

d) Reduces inflammatory mediators in the blood

e) Increases blood pressure
e) Increases blood pressure
Erythrocytes produce energy in which of the following ways:

a) Metabolizes all macronutrients into ATP

b) Mitochondria produce ~38 ATP per glucose molecule broken down in RBCs

c) RBC's can only use glucose in ATP production

d) RBC's cannot generate ATP without oxygen
c) RBC's can only use glucose in ATP production
Which of the following are signs and or symptoms of uncontrolled CHF?

a. Weight gain of 2-3 lbs in one day

b. Increasing in lung crackling

c. Progressively worse shortness of breath

d. All of the above
d. all of the above
A physical therapist is testing edema on a patient. They pull out their watch and notice that it takes 25 seconds for the skin to rebound. Which score would the therapist give for the edema?

a. 4+

b. 2+

c. 3+

d. 1+
c. 3+
Which of the following components can lead to an ectopic site(s) in the heart?

a. Potassium

b. Calcium

c. Sodium

d. Lactic acid

e. A, B, C

f. A, C, D

g. B, C, D

None of the above

All of the above
g. B, C, D
You are working with a 55 year old female patient s/p two days after an acute MI. Her lab values show troponin levels are trending down. Her blood pressure is within normal limits and she is exhibiting no problematic symptoms. You begin ambulating with the patient down the hall and notice PVCs (more than 6 in a minute) beginning to appear on her EKG. The patient feels fine. What do you do?

a. continue ambulating the patient as planned

b. stop ambulation and call for assistance

c. call a code

d. none of the above
b. stop ambulation and call for assistance
Which of the following statements is true regarding absolute contraindications for activity or exercise testing?

a. They are universal across all patient populations and pathologies

b. They are standardized throughout the U.S. healthcare system

c. Their use should be informed and guided by clinical judgement

d. All of the above are true

e. None of the above are true
c. Their use should be informed and guided by clinical judgement
Which of the following is NOT a relative contraindication for both exercise testing AND exercise:

a. Tachyarrhythmias or bradyarrhythmias

b. Hypertrophic cardiomyopathy and other forms of outflow tract obstruction

c. Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise

d. High degree of AV block

e. A and B

f. B and C

g. A and D

All of the above
A and D
Which of the following blood glucose levels is/are ideal to exercise a diabetic patient?

90 mg/dl

185 mg/dl

350 mg/dl

All of the above

None of the above
185 mg/dl
anywhere between 100-250 is fine
At what range of platelet count should a patient not be doing activity

150,000/mm^3

60,000/mm^3

20,000/mm^3

10,000/mm^3

5,000/mm^3
answer: 5,000
150,000 = normal; 60,000 = no resistive exercises; 20,000 = AROM, maybe walking; 5,000 = no activity
Which of the following is NOT a reason to terminate exercise based on the ACSM guidelines for exercise testing and prescription?

Wheezing or leg cramps

Noticeable change in heart rhythm

Excessive blood pressure rise with SBP >115mmHg or DBP > 250mmHg

Failure of heart rate to increase with activity
Excessive blood pressure rise with SBP >115mmHg or DBP > 250mmHg
Which is NOT an acceptable reason to terminate exercise?

a. Patient asks to stop

b. Patient experiences cyanosis

c. Patient becomes confused

d. Patient expresses severe fatigue

e. All of the above

f. None of the above
e. all of the above
If your patient was able to count to 15 in an 8 second period but required three breaths, what level of dyspnea would they be at?

Level 0

Level 1

Level 2

Level 3

Level 4
answer: level 2- patient needs 3 breaths
For which of the following patients would you recommend the MOST calorie expenditure at about 2,000-2,200 kcal/week?

type II diabetic patient

a patient whose primary goal is to lose weight

a patient who has atherosclerosis and is at high risk for cardiovascular disease

a patient who has been diagnosed with breast cancer
a patient who has atherosclerosis and is at high risk for cardiovascular disease
According to the studies presented by Dr. Tepper, which of the following is a true statement regarding exercise vs. pharmacological intervention on the incidence of diabetes type II?

a. Metformin reduced the incidence of DM2, while lifestyle change increased the incidence of DM2.

b. Both Metformin and lifestyle change reduced the incidence of DM2, but lifestyle change reduced it by more.

c. Both Metformin and lifestyle change reduced the incidence of DM2, but Metformin reduced it by more.

d. Lifestyle change only reduced the incidence of DM2 in conjunction with Metformin.
Both Metformin and lifestyle change reduced the incidence of DM2, but lifestyle change reduced it by more.
Which of the following is true regarding exercise and disease risk?

Walking at 3-4 mph x 5 days/wk, reduces the risk for cardiovascular disease by 30%.

Jogging has been shown to be more effective than walking in the reduction of CV disease in women.

Obesity is responsible for more deaths than physical inactivity.

Walking 30 min/day at 3-5 mph is beneficial in the prevention of breast cancer, but has no benefits after a patient has already been diagnosed.
Walking at 3-4 mph x 5 days/wk, reduces the risk for cardiovascular disease by 30%.
Which caloric threshold is matched incorrectly?

Maximal cardiovascular prevention: 2,000-2,200 kcal/week

Optimal weight loss: 1,500-2,000 kcal/week

Diabetes: 700 kcal/week

Regression of atherosclerosis: 1,600-2,200 kcal/week
Diabetes: 700 kcal/week
All are reasons for doing cardiac rehab EXCEPT:
A. Improve sense of well-being
B. Assess effectiveness of surgical intervention
C. Develop an exercise routine
D. To improve the known deficits in their heart
D. To improve the known deficits in their heart
What phase(s) are PTs most involved in cardiac rehab?
A. Phase 1 - stabilization
B. Phase 2 - immediate outpatient
C. Phase 3 - intense outpatient
D. PTs are very involved in all phases
phase 1: stabilization
How long do sternal precautions last for after a CABG and/or heart transplant?
A. 4 weeks
B. 6-8 weeks
C. 10 weeks
B. 6-8 weeks
All are sternal precautions EXCEPT:
A. Avoid bilateral arm movement
B. Avoid lifting > 10lbs
C. Log roll to side and use elbow to push up
D. Hug a pillow when coughing to provide counter pressure
A. avoid bilateral arm movement
you want to avoid unilateral; bilateral is preferred
Which is a sign/symptom of infection?
A. Clicking/cracking along sternum
B. Coolness along incision
C. Bloody secretion
D. Bruising
A. clicking/cracking along sternum
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