|Test Bank For Essentials of Cardiopulmonary Physical Therapy 3rd Edition by Hillegass – Test Bank|
Sample Questions Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition Chapter 3: Ischemic Cardiovascular Conditions and Other Vascular Pathologies Test Bank MULTIPLE CHOICE
- The presence of an obstruction that causes permanent damage to heart muscle fibers downstream, thus inhibiting heart muscle function, is BEST termed which of the following:
|B.||Coronary artery disease|
|C.||Coronary heart disease|
ANS: CAs a direct result of the work of Enos and co-workers, the medical community now distinguishes coronary artery disease (CAD––the presence of an obstruction that limits coronary blood flow but does not significantly inhibit heart muscle function) from coronary heart disease (CHD––the presence of an obstruction that causes permanent damage to heart muscle fibers downstream, thus inhibiting heart muscle function). PTS: 1
- Which of the following layers of the coronary arteries is responsible for making adjustments to the luminal diameter?
|D.||All of the above|
ANS: BIn the middle layer (media), through alterations in vasomotor tome, as demands for changes in blood flow to the myocardium are perceived, this muscular layer (multiple layers of smooth muscle cells) is responsible for making adjustments to the luminal diameter. PTS: 1
- Which of the following layers of the coronary arteries is selectively permeable to low-density lipoprotein (LDL) leading to the possible development of myocardial ischemia?
|D.||None of the above|
ANS: CThe arterial endothelium is selectively permeable to macromolecules of the size of a low-density lipoprotein (LDL). This permeability may lead to the development of processes associated with myocardial ischemia. PTS: 1
- Which of the following statements BEST explains how myocardium tissue perfusion occurs primarily during periods of muscle relaxation (diastole)?
|A.||All fluids follow the path of least resistance and flow from higher to lower pressure.|
|B.||The right ventricle has a lower pressure than the left ventricle during systole resulting in less difference in blood flow in the right coronary artery between systole and diastole.|
|C.||During diastole, full coronary arteries create high pressures, driving blood into the myocardium when intramyocardial pressure drops.|
|D.||When the aortic valve closes, pressure is transmitted through dilated Valsalva sinuses to openings of coronary arteries.|
ANS: CStatements A, B, and D all relate to preliminary processes that lead to coronary artery filling, but statement C discusses specifically how a high- to low-pressure gradient is created during diastole leading to enhanced blood flow into the myocardium tissue. PTS: 1
- In a patient with coronary artery disease, beta-blocking medications may be prescribed. Which of the following statements BEST describes the reasoning?
|A.||Beta-blockers lower resting heart rate, increasing diastolic filling time|
|B.||Beta-blockers lower the intramyocardial pressures, increasing muscle relaxation|
|C.||Beta-blockers lower the vasomotor tone in the media, increasing the diameter of the artery|
|D.||Beta-blockers lower the aortic pressure during systole, increasing blood flow to coronary arteries|
ANS: ABeta-blocking medications may optimize the filling of the coronary arteries in individuals with disease by lowering the resting and exercise heart rates, therefore increasing diastolic filling time. PTS: 1
- Which of the following determinants of myocardial blood flow will cause occlusive forces on the capillary beds of the endocardium if elevated?
|A.||Diastolic blood pressure|
|C.||Resistance to flow|
|D.||Left ventricular end-diastolic pressure|
ANS: DLVEDP is the pressure within the ventricle at the end of diastole; it causes an occlusive force on the capillary beds of the muscle closest to the pumping chamber, the endocardium. PTS: 1
- Which of the following determinants of myocardial blood flow will inhibit flow of blood to the myocardium?
|A.||Increased diastolic blood pressure|
|B.||Increased vasomotor tone|
|C.||Decreased vasomotor tone|
|D.||Lower left ventricular end-diastolic pressure|
ANS: BIncreased vasomotor tone will cause constriction, which will inhibit blood flow. Increased diastolic blood pressure, decreased vasomotor tone, and lower left-ventricular end-diastolic pressure all enhance blood flow. PTS: 1
- The processes of atherosclerosis development occur in which of the following arterial layers?
|D.||All of the above|
ANS: CAtherosclerosis consists of two processes, atherosis and sclerosis, that occur within the intima and endothelium of arterial walls. PTS: 1
- The accumulation of lipids by monocytes between endothelial cells is termed:
ANS: AClusters of monocytes have been found in junctional areas, between endothelial cells, where they accumulate lipid and are known as foam cells. PTS: 1
- Which of the following is characteristic of the “sclerotic” phase of atherosclerosis?
|A.||Fatty streaks in the artery|
|B.||Accumulation of lipid by monocytes|
|C.||Stretched endothelium by enlarging foam cells|
|D.||Aggregation of platelets forming a thrombus|
ANS: DWhen the endothelium is overstretched enough to cause an intima-based lesion, exposing the underlying connective tissue to the circulation, platelets aggregate forming a thrombus. The formation of a thrombus is characteristic of the “sclerotic” phase. Answers A, B, and C describe processes occurring in the “atherosis” phase. PTS: 1
- Which of the following risk factors is considered nonmodifiable?
|B.||High blood pressure|
ANS: CModifiable risk factors include cigarette/tobacco smoking, high blood pressure, high blood cholesterol levels, and physical inactivity. Nonmodifiable risk factors include heredity, male sex, and increased age. PTS: 1
- Which of the following risk factors has been shown to be associated with leukocytosis, lower serum high-density lipoprotein, elevated fibrinogen and plasma catecholamine levels, and increased blood pressure?
ANS: DIn comparison to nonsmokers, smokers have been shown to manifest leukocytosis, lower serum high-density lipoprotein levels, elevated fibrinogen and plasma catecholamine levels, and increased blood pressure. PTS: 1
- Which of the following blood pressure recordings would be considered hypertensive?
ANS: BHypertension, both systolic (over 140 mm Hg) and diastolic (over 90 mm Hg), is believed to be an independent risk factor for development of CAD and peripheral and cerebral vascular disease. Some new standards report systolic pressure of 120 or higher and diastolic of 80 or higher as prehypertension, but this question asked about hypertension. PTS: 1
- Which of the following ratios is the BEST predictor for developing cholesterol-related blockages in an artery?
|A.||Total cholesterol/high-density lipoproteins|
|B.||Total cholesterol/low-density lipoproteins|
|D.||Gram level of saturated fat/mg level of cholesterol|
ANS: AThe best predictor of risk for developing cholesterol-related blockages in an artery is the ration of total cholesterol to HDL; a ratio of greater than 4.5 increases an individual’s risk of developing atherosclerosis. PTS: 1
- In a patient with diabetes, which of the following physiological changes is a result of increased glycosylation?
|A.||Increase sensitivity to enzymes|
|B.||Elevated high-density lipoprotein|
|C.||Enhanced fibrin degrading by fibrinogen|
|D.||Enhanced thrombus formation|
ANS: DNonenzymatic glycosylation, or the chemical attachment of glucose to proteins without the involvement of enzymes, is known to affect fibrogen, collagen, antithrombin III, HDL, and LDL, all of which are involved in the evolution of CAD. The attachment of glucose to these molecules renders them less sensitive to the enzymes and other substances with which they interact. Thrombus formation enhanced via antithrombin III activity is decreased and fibrinogen is less likely to perform it function of degrading fibrin. PTS: 1
- In an older adult aged 70 years without known disease, which of the following interventions would have the HIGHEST impact on reducing the risk for coronary heart disease similar to younger subjects?
|A.||Age is too strong of a risk factor; therefore overall risk could not be altered.|
|B.||Have the older adult follow a low carbohydrate diet|
|C.||Encourage the older adult to walk daily for a minimum of 30 minutes|
|D.||Have the older adult consume a low dose of aspirin daily|
ANS: CStudies have shown that interventions on other risk factors have proved to be beneficial in older subsets of patients and have resulted in the reduction of clinical end points, for example, myocardial infarction and symptoms. Age is not a strong enough factor to be an independent predictor of heart disease risk. A low carbohydrate diet potentially will increase saturated fats. Increasing physical activity would have a greater impact on risk factors than taking a low dose of aspirin. PTS: 1
- Which of the following factors is defined as a type of amino acid found in blood that when elevated has been linked to increased risk for development of cardiovascular diseases?
|D.||Lipoprotein a (Lpa)|
ANS: BHomocysteine, which is a type of amino acid found in the blood, has been linked to an increased risk for the development of cardiovascular diseases when the levels in the blood are elevated. PTS: 1
- Which of the following interventions would result in the highest survival rate from ventricular fibrillation sudden cardiac arrest?
|A.||Entry into emergency medical system within 15 minutes|
|B.||Administration of CPR within 10 minutes|
|C.||Immediate CPR and AED shock within 3–5 minutes|
|D.||AED shock within 15 minutes|
ANS: CEarly CPR and rapid defibrillation combined with early advanced care can produce high long-term survival rates for witnessed cardiac arrest. If bystanders provide immediate CPR and the first shock is delivered within 3–5 minutes, the reported survival rates from ventricular fibrillation cardiac arrest are as high as 48–74 percent. PTS: 1
- Which of the following monitoring tools is MOST useful to the clinician when attempting to correlate functional activities and myocardial capabilities in a patient diagnosed with chronic stable angina?
|A.||Product of exercise HR and systolic BP|
|B.||Maximum heart rate during specific activity|
|C.||Systolic blood pressure at end of activity|
|D.||Highest rating of perceived exertion (RPE)|
ANS: AThe double product or rate pressure product (HR × Systolic BP) is an index that is useful in correlating functional activities with myocardial capabilities. Rate pressure product is closely related to myocardial oxygen demand and chronic stable angina results from an imbalance in supply and demand of myocardial oxygen. PTS: 1
- Which of the following clinical cues exhibited by a patient with stable angina should alert the healthcare provider to notify the patient’s physician?
|A.||Reports chest discomfort in morning that was relieved with minor activity|
|B.||Reports chest discomfort several times a week|
|C.||Reports chest discomfort at a lower level of activity than usual|
|D.||Reports chest discomfort resolution with rest or decrease of activity intensity|
ANS: CClinical clues to the development of unstable angina that should alert the health professional to notify the patient’s physician include angina at rest, occurrence of typical angina at lower level of activity than usual, angina several times a day versus a week, evidence of loss of previously present myocardial reserve, or angina that occurs in the morning that is worse with minor activity. PTS: 1
- Which of the following clinical signs/symptoms is MOST characteristic of ST segment elevation myocardial injury (STEMI)?
|A.||Q wave infarction occurring distal to a totally occluded coronary artery|
|B.||Non-Q wave infarction affecting subendocardial region|
|C.||Blood flow interruption is less than 30 minutes|
|D.||Coronary arteries are not completely blocked|
ANS: ASTEMI will have ST elevation that develops a Q wave on ECG in the subsequent 24–48 hours. Typically a STEMI with transmural injury occurs distal to a totally occluded coronary artery. PTS: 1
- Which of the following pathological myocardium changes results in an exaggerated and early peak value of substances such as CK-MD and cardiac-specific troponin T and I?
|A.||Development of coagulative necrosis with contraction bands in myocardial tissue|
|B.||Occurrence of hemorrhage within zones of irreversibly injured myocytes|
|C.||Mitochondria in necrotic areas developing calcium phosphate deposits|
|D.||Reperfusion of myocardium promotes removal of intracellular proteins|
ANS: DIf reperfusion of myocardium undergoing pathological changes from ischemia to infarction occurs sufficiently early (15–20 minutes), it can successfully prevent necrosis from developing. After reperfusion, when areas have become necrotic, mitochondria may develop deposits of calcium phosphate. Reperfusion of infracted myocardium also promotes removal of intracellular proteins, resulting in an exaggerated and early peak value of substances such as CK-MB and cardiac-specific troponin T and I. PTS: 1
- Which of the following medical interventions targets prophylaxis for arrhythmias?
|A.||Use of nitrates|
|B.||Use of fibrinolysis|
|C.||Use of lidocaine|
|D.||Use of morphine|
ANS: CFibrinolysis is used to provide early reperfusion. Cardiac pain is controlled with nitrates, morphine, and beta-blockers. Prophylaxis for arrhythmias is accomplished with the use of lidocaine or amiodorone. PTS: 1
- Which of the following factors would be MOST associated with a good prognosis
|A.||Development of atrial fibrillation|
|B.||Persistent systolic hypotension (<90 mm Hg)|
|C.||Elevation of left ventricular end-diastolic pressure|
|D.||Small infarction size with increase in scar formation|
ANS: DAn individual’s prognosis post-MI is related to the complications, infarction size, presence of disease in other coronary arteries, and most importantly left ventricular function. Answers A, B, and C reflect complications and left ventricular failure and therefore are associated with poorer prognosis. Answer D is associated with a better prognosis due to the small size of the infarction and improved remodeling indicated by increased scar formation. PTS: 1
- Which of the following pathological changes is MOST associated with diastolic dysfunction in hypertensive heart disease?
|A.||Impairment of left ventricular relaxation leading to stiffer left ventricle|
|B.||Subnormal left ventricular functional reserve during exercise|
|C.||Impairment of ventricular contraction|
|D.||Increase in end-systolic volume|
ANS: ADiastolic dysfunction refers to changes in ventricular diastolic properties that lead to an impairment in ventricular filling (reduction in ventricular compliance) and an impairment in ventricular relaxation. A consequence of diastolic dysfunction is the rise in end-diastolic pressure. Systolic dysfunction refers to an impairment in ventricular contraction, resulting in a decrease in stroke volume and decrease in ejection fraction. An increase inend-systolic volume will also occur. PTS: 1
- A 56-year-old male with a history of obesity, type II diabetes, and a high stress management occupation is scheduled for a physical therapy evaluation for treatment of low back pain. As a physical therapist which of the following guidelines is MOST appropriate to follow during the initial and subsequent physical therapy sessions?
|A.||Monitor BP at rest and during exercise for at least the first three to four sessions.|
|B.||If BP is normal or unremarkable at rest during the evaluation, there is no need to continue monitoring.|
|C.||It is recommended the patient stop his medication for blood pressure that results in unpleasant side effects.|
|D.||It is recommended the PT only provide manual therapy to the patient if his resting BP is 200/100.|
ANS: ADue to BP values varying considerably during the day, it is recommended the PT monitor BP for two to three different treatment sessions both at rest and during activity. Answers B, C, and D are incorrect due to the need to monitor BP regularly. A patient should be encouraged to visit with the physician before stopping any prescribed medication, and no intervention should be provided if the patient has an excessively high resting BP. PTS: 1
- Which of the following medical interventions is the MOST optimal regimen for primary and secondary prevention of a stroke?
|D.||A combination of all the above|
ANS: DA combination of aspirin, lipid-lowering, and antihypertensive medications may be the optimal regimen for primary and secondary prevention of stroke in addition to risk factor modification. PTS: 1
- Which of the following peripheral muscular adaptations that occur with aerobic exercise would benefit the patient with intermittent claudication the MOST?
|A.||Increased collateral circulation or capillary density|
|B.||Increased blood viscosity|
|C.||Reduced pain threshold|
|D.||Improvements in anaerobic metabolism|
ANS: AMechanisms that have been postulated to account for improvements in rest pain with patients diagnosed with intermittent claudication include increased peripheral blood flow through changes in collateral circulation, reduced blood viscosity, regression of atherosclerotic disease, raising of pain threshold, and improvements in skeletal muscle metabolism. PTS: 1
- A pathological permanent dilation of an artery wall that is usually uniform in shape, but can resemble a sac or outpouching, is termed:
ANS: BAn aneurysm such as aortic is a pathological permanent dilation of the aortic wall involving any number of segments of the aorta of at least 1.5 times the expected normal diameter. The aneurysm is usually uniform in shape, although some aneurysms form a sac or outpouching of a portion of the artery. PTS: 1
- A 72-year-old male arrives for a physical therapy evaluation for treatment of his low back pain. The patient has a history of peripheral vascular disease, diabetes, and hypercholesteremia. He reports leg pain and fatigue with walking. The physical therapist feels it is appropriate to include a vascular screen and testing in the evaluation. Which of the following signs/symptoms would be MOST indicative of an abdominal aortic aneurysm?
|A.||Fatigue with walking|
|B.||Numbness in the lower extremities|
|C.||Pulsating mass in the abdominal area|
|D.||High blood pressure at rest|
ANS: CThe most common signs/symptoms for aortic aneurysm include a pulsating mass in the abdominal area, a bruit heard over a swollen area, pressure on surrounding parts such as low back, leg pain, numbness in Les, excessive fatigue with walking, poor distal pulses, and low back pain. The pulsating mass in the abdominal area would be more indicative or suspicious of aortic aneurysm whereas fatigue, numbness in LEs, and high BP could be associated with aortic aneurysm, but also with low back pathology. C is the most correct answer. PTS: 1Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition Chapter 5: Restrictive Lung Dysfunction Test Bank MULTIPLE CHOICE
- Which of the following aspects of pulmonary ventilation lead to the requirement of increased transpulmonary pressure for a given volume of air in patients with restrictive lung disease?
|A.||Decreased lung compliance|
|B.||Low chest wall compliance|
|C.||Decreased inspiratory reserve volume (IRV)|
|D.||Increased work of breathing|
ANS: AAs lung tissue compliance diminishes or become stiffer, a greater transpulmonary pressure is required to expand the lung for a given volume of air. Low chest wall compliance limits thoracic expansion. Decreased IRV and increased work of breathing are a result of the higher pressures. PTS: 1
- In a patient with restrictive lung disease energy expenditure is increased due to the increase in work of breathing and accessory muscle use. Which of the following exercise prescriptions would be MOST appropriate?
|A.||Upper extremity ergometer at low intensity for 5 continuous minutes|
|B.||Upper extremity resistance training at moderate intensity, three sets of 8|
|C.||Low-intensity walking in intervals with walking time equal to rest time|
|D.||Moderate-intensity walking in intervals with rest time greater than walk time|
ANS: CLower extremity interval training such as walking is beneficial to the patient if the rest period is at least equal to exercise time as determined by patient tolerance. Any exercise requiring upper extremity use would exacerbate the muscle fatigue due to accessory muscle overuse for breathing. If a patient has an increase in energy expenditure due to increased work of breathing, low-intensity exercise would be more appropriate than moderate-intensity exercise. PTS: 1
- A patient with restrictive lung disease develops a rise in pulmonary circulation pressure subsequently increasing the work of the right ventricle. This is BEST described as:
|D.||Low lung volume|
ANS: CPulmonary hypertension due to hypoxemia, fibrosis, and compression of the pulmonary capillaries leads to a type of right-sided heart failure termed cor pulmonale. The increase in pulmonary circulation pressure leads to pulmonary hypertension. PTS: 1
- Ventilation-perfusion mismatching in restrictive lung disease leads to which of the following classic signs?
|C.||Low lung volume|
ANS: BVentilation-perfusion mismatching in restrictive lung disease (RLD) leads to the classic sign of hypoxemia. Mismatching may be due to changes in the collagenous framework of the lung, scarring of capillary channels, distortion or narrowing of the small airways, compression from tumors within the lung, or bony abnormalities of the chest wall. PTS: 1
- Hallmark symptoms of restrictive lung disease include dyspnea, an emaciated appearance, and which of the following?
|A.||Chest wall pain|
|B.||Wet, productive cough|
|C.||Dry, nonproductive cough|
ANS: CThree hallmark symptoms typically experienced with RLD include dyspnea, a wasted and emaciated appearance, and an irritating, dry, and nonproductive cough. PTS: 1
- Which of the following pathological occurrences associated with respiratory distress syndrome (RDS) in premature infants causes the overall retractive forces of the lung to be greater than normal?
|A.||Inadequate surfactant production|
|B.||Alveolar septal thickening|
|C.||Abnormal alveolar epithelial permeability|
ANS: ARDS is caused primarily by abnormalities in the surfactant system and inadequate surfactant production. The surfactant dysfunction causes overall retractive forces of the lung to be greater than normal, which decreases lung compliance, increases the work of breathing, and leads to progressive diffuse microatelectasis, alveolar collapse, increased ventilation-perfusion mismatching, and impaired gas exchange. PTS: 1
- The distribution of inspired air and pulmonary blood flow becomes less homogeneous with increasing age. This age-related change contributes MOST to which of the following clinical manifestations?
|A.||Left shift of lung compliance curve|
|B.||Sleep ventilation is altered|
|C.||Decreased maximal ventilatory effort|
|D.||Reduced diffusing capacity|
ANS: DThe alveolar walls become thinner and the capillary bed incurs considerable loss, with an increase in ventilation-perfusion mismatching. The distribution of inspired air and pulmonary blood flow becomes less homogeneous with age. Diffusing capacity is therefore reduced and the physiological space is increased. PTS: 1
- Which of the following causes of restrictive lung disease is characterized by necrosis of the respiratory epithelium in the affected bronchioles?
|C.||Idiopathic pulmonary fibrosis|
ANS: ABronchiolitis obliterans is characterized by necrosis of the respiratory epithelium in the affected bronchioles. This necrosis allows fluid and debris to enter the bronchioles and alveoli, causing alveolar pulmonary edema and partial or complete obstruction of these small airways. PTS: 1
- Survivors of respiratory distress syndrome who have been ventilated mechanically and received high concentrations of oxygen over a prolonged period of time may develop which of the following pulmonary restrictive lung diseases?
|A.||Idiopathic pulmonary fibrosis|
ANS: BBronchopulmonary dysplasia is a chronic pulmonary syndrome in neonates that occurs in some survivors of RDS who have been ventilated mechanically and have received high concentrations of oxygen over a prolonged period of time. PTS: 1
- Which of the following statements BEST describes a cause of compression atelectasis?
|A.||Extrabronchial compression from a tumor or enlarged lymph node|
|B.||Complication of either a lobar or segmental pneumonia|
|C.||Unwillingness by the patient to deep breath or cough|
|D.||Expanding volume outside of the alveoli|
ANS: DAtelectasis (compression) occurs as a result of expanding volume outside of the alveoli (in pleural space, interstitial space, etc.), which presses on the alveoli and prevents complete expansion. PTS: 1
- A patient is 1 day post-lumbar fusion surgery. Upon initial evaluation by the physical therapist, the patient was recorded to have an SpO2 of 92% on 2 liters of O2 via a nasal cannula. The physical therapist suspects acute atelectasis due to postoperative pain. Of the following, which is the BEST immediate intervention to improve oxygenation in this patient?
|A.||Use of an incentive spirometry|
|B.||Teach the patient pursed lip breathing|
|C.||Encourage the patient to sit in a chair|
|D.||Use of a lumbar corset|
ANS: AAcute atelectasis such as in postoperative or in other hospitalized patients can respond to deep breathing or incentive spirometry exercises as well as coughing. PTS: 1
- The key to medical treatment of pneumonia is which of the following:
|A.||Determining if it is community acquired or nosocomial|
|B.||Identifying the microbe (virus vs. bacteria)|
|C.||Identifying specific risk factors|
|D.||Determining the area of lung affected|
ANS: BThe key to treatment of pneumonia is to first identify the microbe (virus vs. gram-positive or gram-negative bacteria). Specific medical treatment (specific antibiotic) is based on the identification of the microbe. PTS: 1
- Which of the following specific types of pneumonia consists of a water-borne organism that can be emanated from an air conditioning unit?
- pneumophila can occur in epidemic proportions because the organism is water borne and can emanate from air conditioning equipment, drinking water, lakes, river banks, water faucets, and shower heads.
- Which of the following specific types of pneumonia is considered a fungal pneumonia and is closely associated with AIDS?
- carinii, originally described as a protozoan, is now thought to be a fungal organism. Pneumocystis carinii pneumonia (PCP) is closely associated with AIDS because nearly 75% of AIDS patients have at least one episode of PCP during their lifetime.
- In a patient with adult respiratory distress syndrome (ARDS), fat emboli would be categorized as which of the following types of causes for ARDS?
ANS: BSeveral categories exist to describe the varied primary causes of ARDS and fat emboli are categorized as trauma. PTS: 1
- The primary causative factor of lung cancer is which of the following?
ANS: CIt has been well established through numerous studies that the primary causative factor of lung cancer is tobacco use. Approximately 80% to 90% of lung cancers are caused by tobacco. The average cigarette smoker has 10 times the risk of developing lung cancer as the nonsmoker. PTS: 1
- Which of the following types of bronchogenic carcinoma arises from the bronchial mucosa after repeated inflammation or irritation such as cigarette smoking?
|A.||Small cell carcinoma|
|B.||Squamous cell carcinoma|
|D.||Large cell carcinoma|
ANS: BSquamous cell carcinoma arises from the bronchial mucosa after repeated inflammation or irritation caused by cancer stimuli. It is therefore the type of lung cancer most closely associated with cigarette smoking. PTS: 1
- Which of the following types of bronchogenic carcinoma rapidly involves the vascular channels, lymph nodes, and soft tissue and is known to metastasize widely and early typically before the lung cancer diagnosis is made?
|A.||Small cell carcinoma|
|B.||Squamous cell carcinoma|
|D.||Large cell carcinoma|
ANS: ASmall cell carcinoma tumors do not extend into the bronchial lumen, but spread through the submucosa and can cause obstructive and restrictive dysfunction. This type of lung cancer rapidly involves the vascular channels, lymph nodes, and soft tissue. It is known to metastasize widely and early, often before the lung cancer diagnosis is made. PTS: 1
- The MOST common body organ involved in direct metastasis from small cell carcinoma is which of the following?
|D.||Central nervous system|
ANS: DSeventy-five percent of small cell carcinoma metastasizes to the central nervous system, 65% to the liver, 58% to the adrenal gland, 30% to the pancreas, 285 to bone, 20% to the genitourinary system, 10% to the thyroid, and 10% to the spleen. PTS: 1
- Which of the following types of bronchogenic carcinoma is the least responsive to radiation?
|A.||Small cell carcinoma|
|B.||Squamous cell carcinoma|
|D.||Large cell carcinoma|
ANS: DLarge cell carcinoma is the least responsive to radiation. Small cell lung carcinoma is the most radiosensitive, followed by squamous cell carcinoma and adenocarcinoma. PTS: 1
- Exudative pleural effusion is characterized by high protein content and accumulates due to changes in permeability of the pleural surfaces. Which of the following is a cause of exudative pleural effusion?
|A.||Congestive heart failure|
ANS: BTransudative pleural effusions (low protein) can be caused by congestive heart failure, left ventricular failure, cirrhosis, nephritic syndrome, pericardial disease, myxedema, pulmonary emboli, peritoneal dialysis, or atelectasis. Exudative pleural effusions can be caused by bacterial or viral pneumonias, parasitic or fungal infections, tuberculosis, mesotheliomas, bronchogenic carcinoma, systemic lupus erythematosus, rheumatoid arthritis, acute pancreatitis, esophageal perforations, intraabdominal abscess, asbestos exposure, uremia, sarcoidosis, or drug hypersensitivity. PTS: 1
- Pulmonary edema is an increase in the amount of fluid within the lung. Which of the following BEST describes the results of a chest x-ray indicating pulmonary edema?
|A.||Diffuse scattered fluffy shadows|
|B.||Diffuse haze/lung white out|
|C.||Homogeneous opacity of fluid density|
|D.||Increased vascular markings in the hilar region|
ANS: DClinical manifestations of pulmonary edema on a chest radiograph include increased vascular markings in the hilar region, which is indicative of a fluid back-up from the left atrium to the pulmonary vein. PTS: 1
- Which of the following statements BEST defines congestive atelectasis resulting from a pulmonary emoboli?
|A.||Lack of blood flow to the alveolar wall|
|B.||Decrease in alveolar surfactant|
|C.||Edema and hemorrhage into the surrounding lung|
|D.||Increase in alveolar dead space|
ANS: CPulmonary emboli lead to occlusion of one or more pulmonary arterial branches causing edema and hemorrhage into the surrounding lung parenchyma, which is known as congestive atelectasis. PTS: 1
- A patient who is status postsurgical repair of a right hip fracture is at risk for thrombus formation and potentially pulmonary emboli. Which of the following interventions would be BEST recommended to this patient following discharge home to prevent a deep vein thrombus?
|A.||Pneumatic calf compression|
|B.||Regular ambulation throughout the day|
|C.||Passive stretch of the calf on the surgical limb|
|D.||Elevation of the lower extremities|
ANS: BFor a patient who has been discharged home from the hospital, encouraging regular ambulation should be feasible and is the best type of activity to promote muscle pumping and thus venous return. Pneumatic calf compression is typically not available to a patient at home. Passive stretch will not enhance venous blood mobility and elevation of lower extremities will decrease edema, but does not provide an active muscle pump. PTS: 1
- Which of the following spinal cord levels if injured would result in diaphragmatic dysfunction?
ANS: AC3, C4, and C5 (phrenic nerve) if injured would result in diaphragmatic dysfunction. PTS: 1
- On a chest radiograph, the classic finding of an elevated hemidiaphragm indicates which of the following musculoskeletal causes of restrictive lung dysfunction?
ANS: CDiaphragmatic paralysis or paresis is the loss or impairment of motor function of the diaphragm because of a lesion in the neurological or muscular system. In this condition, the negative pleural space pressure moves the diaphragm in a cephalad direction so that the diaphragm’s resting position is elevated. Elevated hemidiaphragm is a classic finding on chest radiograph. PTS: 1
- In patients with rheumatoid arthritis, an inflammatory reaction in the lung may occur, including patchy infiltrates, which can resolve or progress to fibrotic changes. This inflammatory reaction in the lungs is termed:
ANS: APneumonitis causes an inflammatory reaction in the lung, including patchy infiltrates, which can resolve spontaneously or can progress to fibrotic changes. PTS: 1
- Of the following connective tissue disorders, which one is associated with the highest incidence of pulmonary involvement?
|B.||Systemic lupus erythematosus|
ANS: BSystemic lupus erythematosus can involve the skin, joints, kidneys, lung, nervous tissue, and heart. In 50% to 90% of the cases it does involve the lungs or pleura; this incidence of pulmonary involvement is higher than that of any other connective tissue disorder. PTS: 1
- Which of the following is the MOST common lung problem in patients with polymyositis?
|C.||Diffuse pulmonary infiltrates|
ANS: DDysphagia and aspiration problems are common. As a result, aspiration pneumonia is most common pulmonary abnormality and is seen in 15% to 20% of patients. PTS: 1
- Which of the following pathological changes in lung function is a result of excess soft tissue in the abdominal wall, forcing the diaphragm upward at rest?
|A.||Decreases the compliance of the thorax|
|B.||Forces early closure of the small airways and alveoli|
|C.||Decreases carbon dioxide production from the lungs|
|D.||Increases ventilator drive|
ANS: BExcess soft tissue in the abdominal wall exerts pressure on the abdominal contents, forcing the diaphragm up to a higher resting position. This shift results in decreased lung expansion and early closure of the small airways and alveoli, especially at the bases or the dependent regions of the lung. PTS: 1
- A free-floating segment of ribs that can be identified by its paradoxical movement is termed:
ANS: CFlail chest refers to a free-floating segment of ribs due to multiple rib fractures both anteriorly and posteriorly that leave this part of the thoracic wall disconnected to the rest of the thoracic cage. This segment can usually be identified by its paradoxical movement during the respiratory cycle. PTS: 1
- A 59-year-old male has fallen off a ladder at his home and hit a retaining wall on the way down fracturing several ribs on the right side. He was admitted to the hospital for pain control, close observation, and physical therapy. The primary goal for physical therapy is which of the following?
|A.||The patient will demonstrate appropriate splinting using a small pillow to reduce pain.|
|B.||The patient will demonstrate log roll to the left side with contact guard assist to improve bed mobility.|
|C.||The patient will ambulate in the hall 150 feet with supervision.|
|D.||The patient will perform deep breathing using incentive spirometry to reestablish a normal breathing pattern.|
ANS: DPain control is the primary treatment and can be accomplished by oral analgesics, intercostals nerve block, or epidural anesthesia depending on the extent of the injury. The goal is to allow the patient to reestablish a normal breathing pattern. PTS: 1
- Penetrating wounds to the thorax are commonly caused by shooting or stabbing. An injury described as air entering the pleural space that cannot escape into the external environment is termed:
ANS: AA tension pneumothorax means air can enter the pleural space but cannot escape into the external environment. PTS: 1
- Which of the following lung pathologies may result in a condition known as fibrothorax if the pleural space is not evacuated effectively?
ANS: CHemothorax can have serious sequelae if all the blood is not evacuated from the pleural space. The residual blood becomes organized into nonelastic fibrous tissue, which can form a restrictive pleural rind. This condition is known as fibrothorax and can limit lung expansion markedly. PTS: 1
- The inhalation of carbon monoxide, a gas present in smoke, leads to which of the following pathological conditions?
|A.||Edema of the laryngeal and tracheal mucosa|
|B.||Damage to the mucociliary clearance mechanism|
|C.||Inactivation of surfactant and pneumonitis|
|D.||Decreases in the oxygen-carrying capacity of the blood|
ANS: DCarbon monoxide has more than 200 times the affinity for hemoglobin when compared to oxygen. This means that when CO is taken into the lungs it diffuses quickly into the pulmonary capillaries, enters the red blood cells, and binds with hemoglobin to form carboxyhemoglobin. This abnormal process decreases the available hemoglobin binding sites for oxygen and significantly decreases the oxygen-carrying capacity of the blood. PTS: 1
- Which of the following factors related to surgery contributes MOST to decreases in ventilator response to hypercapnia and hypoxia?
|C.||Placement of the endotracheal tube|
ANS: DThe anesthetic agent causes a decrease in the pulmonary arterial vasoconstrictive response to hypoxia. Anesthesia also depresses the respiratory control centers so that ventilator response to hypercapnia and hypoxia is decreased. PTS: 1
- Common techniques such as deep breathing exercises, early patient mobilization, and incentive spirometry are MOST likely implemented to treat which of the following conditions:
ANS: BCommon techniques used to treat postoperative atelectasis include deep breathing exercises, early mobilization of the patient out of bed, incentive spirometry, and CPAP. Pulmonary embolus is initially treated with low-dose heparin, venous thromboembolism with leg exercises or low-dose heparin, and aspiration pneumonia with preventive methods such as NPO 12 hours before surgery and initially antibiotics. PTS: 1
- Which of the following drugs is given for ventricular dysrhythmias and may lead to pulmonary complications if prescribed in a high dose?
ANS: DAmiodarone is an antiarrhythmic drug that is given for ventricular dysrhythmias. The pulmonary complications seem to be dose related. Nitrofurantoin is an antiseptic agent used to fight UTIs. suflatalazine is used to treat inflammatory bowel disease and rheumatologic disorders. penicillamine is used to treat Wilson’s disease, cystinuria, primary biliary cirrhosis, scleroderma, and severe RA. PTS: 1
- Which of the following oncology diagnosis tends to be the highest risk for developing radiation pneumonitis or fibrosis?
|C.||Bone marrow transplant|
ANS: COne group of patients seems to be at higher risk for developing radiation pneumonitis or fibrosis. Bone marrow transplant patients receive whole lung irradiation; they are also on cytotoxic chemotherapeutic agents that can intensify the pneumonitis. PTS: 1
- Which of the following chemotherapeutic drugs is used as an antiinflammatory agent to treat rheumatoid arthritis and may lead to interstitial lung disease?
ANS: BMethotrexate is an antimetabolite taken for acute lymphatic leukemia and osteogenic sarcoma, but is now also being used as an antiinflammatory agent to treat RA, psoriasis, and asthma. PTS: 1Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition Chapter 9: Electrocardiography Test Bank MULTIPLE CHOICE
- Which of the following types of myocytes have the highest rate of rhythmicity?
ANS: BNodal myocytes have the highest rate of rhythmicity but slow impulse-conduction rates. PTS: 1
- The ability of cardiac muscle cells to spread impulses to adjoining cells very quickly BEST describes which of the following properties?
ANS: CThe property of conductivity is one of three properties of cardiac muscle cells and describes the ability of the cardiac muscle cells to spread impulses to adjoining cells very quickly. PTS: 1
- Increased sympathetic activity through the release of norepinephrine and epinephrine from the adrenal gland results in which of the following changes in the heart?
|A.||Reduces conduction velocity throughout the atrioventricular node|
|B.||Decreases the irritability of the heart|
|C.||Increases the contractility of the heart muscle|
|D.||Depresses the automaticity of the heart|
ANS: CIncreased sympathetic activity through the release of norepinephrine and epinephrine increases the heart rate, increases conduction velocity throughout the AV node, increases the contractility of the heart muscle, and increases the irritability of the heart. PTS: 1
- Which of the following components of the ECG impulse represents the atrial kick or the delayed conduction of the electrical impulse by the AV node one-tenth of a second?
ANS: BThe P-R segment is considered the isoelectric line or the atrial kick. The AV node delays conduction of the electrical impulse from the atria allowing for the mechanical contraction of the atria to eject blood into the ventricles. PTS: 1
- Which of the following components of the ECG impulse represents the ventricular depolarization?
ANS: CThe QRS complex is the electrical stimulus of ventricular depolarization and is normally followed closely by ventricular contraction. PTS: 1
- A single-lead tracing or rhythm strip can be used to determine all of the following EXCEPT?
|C.||Presence of arrhythmia|
|D.||Presence of ischemia|
ANS: DThe single-lead tracing or rhythm strip can be used only to determine heart rate, rhythm, or the presence of arrhythmia. If hypertrophy, ischemia, or infarction is suspected, then a 12-lead ECG should be obtained. PTS: 1
- When a therapist is assessing the cardiac cycle for rhythm and rate disturbances, which of the following assessment approaches is used to evaluate the P-R interval?
|A.||Is the duration between 0.12 and 0.20 second?|
|B.||Is the duration between 0.06 and 0.10 second?|
|C.||Is it regular?|
|D.||Does one occur before every QRS?|
ANS: AWhen evaluating the P-R interval, the therapist determines whether it has a normal duration of 0.12 to 0.20 second. PTS: 1
- The rhythm strip reveals the following findings: all P waves are upright and normal in appearance and occur before every QRS complex, the P-R interval is between 0.12 and 0.20 second, the QRS complexes are identical, the QRS complex is between 0.04 and 0.10 second, the R-R interval is regular, and the HR is between 60 and 100 bpm. These findings BEST describe which of the following?
|C.||Normal sinus rhythm|
ANS: CAll the findings describe a normal rhythm strip. PTS: 1
- The rhythm strip reveals the following findings: all P waves are upright, normal in appearance, and exist before every QRS complex, the P-R interval is between 0.12 and 0.20 second, the QRS complexes are identical and are between 0.04 and 0.10 second, the R-R interval is regular, and the HR is greater than 100 bpm. These findings BEST describe which of the following?
|C.||Normal sinus rhythm|
ANS: BAll of the findings are normal except the heart rate was greater than 100 bpm indicating sinus tachycardia. PTS: 1
- Which of the following heart arrhythmias is commonly found in young females who have a mitral valve prolapse?
|B.||Paroxysmal atrial tachycardia|
|D.||Premature atrial complexes|
ANS: BParoxysmal atrial tachycardia is often diagnosed on ECG when a patient reports that “all of a sudden my heart was racing away.” It is often found in young females who may have mitral valve prolapse. PTS: 1
- The rhythm strip reveals the following findings: P waves are absent, leaving a flat or wavy baseline, the QRS complexes are between 0.04 and 0.10 second, the R-R interval is characteristically defined as irregularly irregular, and the rate varies, but is called “ventricular response”. These findings BEST describe which of the following?
ANS: BThe findings describe atrial fibrillation. The absence of P waves is one of the classic signs. None of the ectopic foci actually depolarizes the atria, so no true P waves are found in atrial fibrillation. PTS: 1
- The rhythm strip reveals the following findings: absence of P waves before QRS complex, but a retrograde P wave may be identified, the QRS complex is normal and its duration is between 0.04 and 0.10 second, the R-R intervals are regular, and the ventricular rate is between 40 and 60 bpm. These findings BEST describe which of the following?
|A.||Nodal or junctional arrhythmia|
|B.||Junctional (or nodal) rhythm|
|C.||Nodal (junctional) tachycardia|
|D.||Wandering atrial pacemaker|
ANS: BJunctional rhythm occurs when the AV junction takes over as the pacemaker of the heart. The AV node has an inherent firing rate of 40 to 60 bpm and will act as the pacemaker if the SA node is not functioning properly. PTS: 1
- The rhythm strip reveals the following findings: initially a P wave precedes each QRS complex, but eventually a P wave may stand alone, progressive lengthening of the P-R interval occurs, as the P-R interval increases, a QRS complex is dropped, the progressive lengthening of P-R interval and drop of QRS complex is repetitive, the QRS complex is normal with a duration between 0.04 and 0.10 second, the R-R interval is irregular, and heart rate varies. These findings BEST describe which of the following?
|A.||First-degree AV block|
|B.||Wenchekbach’s heart block|
|C.||Second-degree AV block type II|
|D.||Third-degree AV block|
ANS: BSecond-degree AV block or Wenchekbach’s heart block is characterized by the progressive nature of the P-R interval lengthening until finally one impulse is not conducted through to the ventricles. PTS: 1
- Which of the following heart blocks is characterized by no communication between the atria and the ventricles, thus resulting in no coordination between the firing of the atria and the firing of the ventricles, creating a complete independence of the two systems?
|A.||First-degree AV block|
|B.||Second-degree AV block, type I|
|C.||Second-degree AV block, type II|
|D.||Third-degree AV block|
ANS: DIn third-degree (complete) AV block all impulses that are initiated above the ventricle are not conducted to the ventricle. In complete heart block, the atria fire at their own inherent rate and a separate pacemaker in the ventricles initiates all impulses. PTS: 1
- A QRS complex that is described as being wide and bizarre looking without a P wave and followed by a complete compensatory pause BEST indicates which of the following arrhythmias?
|A.||Premature ventricular complex (PVC)|
|B.||Premature atrial contraction|
ANS: APVCs occur when an ectopic focus originates an impulse from somewhere in one of the ventricles. The ventricular ectopic depolarization occurs early in the cycle before the SA node actually fires. The myocardial cells conduct impulses very slowly compared with specialized conductive tissues resulting in a wide and bizarre looking QRS complex. PTS: 1
- Which of the following changes on an ECG BEST indicate ischemia?
|A.||ST segment elevation|
|B.||ST segment depression|
|C.||Enlarged QRS complex|
|D.||Presence of a significant Q wave|
ANS: BIschemia is classically demonstrated on the 12-lead ECG with T wave inversion or ST segment depression. PTS: 1
- Which of the following changes on an ECG BEST indicates the presence of acute infarction?
|A.||ST segment elevation|
|B.||ST segment depression|
|C.||Enlarged QRS complex|
|D.||Absence of P wave|
ANS: AIn the presence of acute infarction, the ST segment elevates and then later returns to the level of the baseline (within 24–48 hours). PTS: 1
- The presence of a significant Q wave (one-third the size of the QRS complex) on an ECG indicates which of the following?
ANS: DA significant Q wave is considered to be significant and indicative of a pathological condition (it persists as a permanent electrocardiographic “scar” from a previous infarction). Any ECG should include a scan for the presence of significant Q waves to identify previous infarctions. PTS: 1
- The presence of T wave inversion, ST segment changes, or Q waves in ECG chest leads V1, V2, V3, and V4 indicates an infarction in which of the following regions of the heart?
ANS: DThe presence of T wave inversion, ST segment changes, or Q waves in chest leads V1, V2, V3, and V4 indicates an infarction in the anterior portion of the left ventricle. PTS: 1
- Identification of significant Q waves in leads II, III, and aVF indicates an infarction in which of the following regions of the heart?
ANS: AAn inferior infarction is identified by significant Q waves in leads II, III, and aVF. PTS: 1
- A 21-year-old female college student was sitting in class listening to a lecture and reported that her heart was racing away and that she felt lightheaded. This episode of symptoms occurred a second time in the same class. Her past medical history is unremarkable. Which of the following arrhythmias is MOST likely occurring in this case?
|C.||Paroxysmal atrial tachycardia|
|D.||Premature atrial complex|
ANS: CParoxysmal atrial tachycardia is a very common, usually benign arrhythmia associated with mitral valve prolapse. PTS: 1
- Repolarization of the ventricular is BEST described as which of the following?
|A.||T wave on ECG|
|B.||Return of potassium ions into the cell|
|C.||Movement of sodium ions out of the cell|
|D.||All of the above|
ANS: DRepolarization is complete with the ending of the T wave. The T wave represents the ventricular repolarization. No mechanical contraction is occurring, so the T wave is indicating an electrical phenomenon that records the return of potassium inward and sodium outward changing the polarization of the cell. PTS: 1
- A trained athlete with an increased resting and exercise stroke volume may exhibit which of the following heart arrhythmias?
ANS: ASinus bradycardia is normal in well-trained athletes because of their enhanced stroke volume. PTS: 1
- Which of the following BEST defines atrial tachycardia?
|A.||R-R intervals are irregular|
|B.||Heart rate is greater than 200 bpm|
|C.||Three or more premature atrial complexes in a row|
|D.||P-R intervals are irregular with a duration of 0.25 second|
ANS: CThe definition of atrial tachycardia is three or more premature atrial complexes in a row. PTS: 1
- The development of mural thrombi secondary to the coagulation of blood in the heart chamber subsequently leading to a potential stroke occurs in which of the following heart arrhythmias?
|D.||Sinus pause or block|
ANS: BAtrial fibrillation has the potential for developing mural thrombi because of the coagulation of blood with fibrillating atria. Mural thrombi may lead to emboli. PTS: 1
- Which of the following sites is associated with a second-degree AV block, type II?
|A.||High in the AV junction|
|B.||Impulse delayed between the SA and AV nodes|
|C.||Above the ventricles|
|D.||Below the bundle of His|
ANS: DSecond-degree AV block, type II is defined as nonconduction of an impulse to the ventricles without a change in the P-R interval. The site of the block is usually below the bundle of His. PTS: 1
- A 68-year-old male collapses in his yard while mowing. The EMTs immediately obtain an ECG strip that reveals grossly irregular up and down fluctuations of the baseline in an irregular zigzag pattern. Which of the following arrhythmias is potentially occurring?
ANS: BAn ECG of a ventricular fibrillation results in a picture of grossly irregular up and down fluctuations of the baseline in an irregular zigzag pattern. PTS: 1
- Both an ST segment depression or elevation and significant Q wave are indicative of an acute infarction.
ANS: BST segment depression or elevation is indicative of an acute infarction, but the presence of a significant Q wave indicates an infarction, but the date cannot be determined by studying the ECG. PTS: 1
- On an ECG, a large R wave in V1 and V2 and ST segment depression BEST indicate an infarction in which of the following regions of the heart
ANS: DA large R wave in V1 and V2 and ST segment depression are mirror images of an anterior wall infarction in V1 and V2 indirectly indicating a posterior wall infarction. PTS: 1
- Which of the following ECG leads should be scanned to look for the presence of ventricular hypertrophy?
|A.||V1, V2, V3|
|B.||V4, V5, V6|
|C.||V1, V5, V6|
|D.||I, II, aVR|
ANS: CScan leads V1, V5, and V6 to look for ventricular hypertrophy. A large R in V1 indicates right ventricular hypertrophy and a deep S in V1 and a large R in V5 indicate left ventricular hypertrophy. PTS: 1