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488 Cards in this Set
- Front
- Back
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Exercise increase what pulmonary parameter by increasing oxygen extraction from arterial circulation?
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arterial venous oxygen difference
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What are two criteria for maximal benefit from pulmonary rehabiliation?
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*respiratory limitation of exercise at 75% of predicted max O2 consumption
*COPD: FEV1<2000ml *Restrictive lung disease with CO diffusion<80% |
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What is level 5 Functional Pulmonary Disability?
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dyspnea at rest
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What is the main feature of levels 1-4 of the Functional Pulmonary Disability rating?
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no dyspnea at rest
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Where in the CNS is the center of voluntary control of respiration?
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medulla
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Central pulmonary chemoreceptors are stimulated by the presence of what in the CSF?
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hypercarbia
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Peripheral chemoreceptors are stimulated by what 3 factors?
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CO2, O2, and pH
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The diaphragm is the the primary muscle of respiration during what part of breathing?
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inspiration
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Diaphragmatic contraction increases or decreases intra-thoracic pressure?
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decreases
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What muscle group is active during exhilation?
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abdominal muscles
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What is the primary muscle of inspiration? nerve?
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diaphragm/phrenic nerve
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What is the minute volume?
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tidal volume - rate of breathing per minute
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What is the residual volume?
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amount of air in lungs at the end of maximal expiration
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What is functional residual capacity?
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amount of air in lungs at the end of normal expiration
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What is tidal volume?
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amount of air move in normal inspiratory effort
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What is total lung capacity?
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amount of gas within lungs at the end of maximal inspiration
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What is forced vital capacity?
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vital capacity measured with the subject exhaling as rapidly as possible
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What is vital capacity?
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the greatest volume of air that can be exhaled from the lungs after maximum inspiration
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What is VO2 max?
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the amount of O2 that can be used in 1 minute during max exercise
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What is the Fick equation for VO2 max?
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VO2 max = (HRxSV) x AVO2 difference
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What characterizes COPD?
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increased airway resistance due to bronchospasm
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What is the maximum midexpiratory flow rate of COPD? high or low?
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low
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In COPD what is the cause of hypoxemia?
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prefusion/ventilation mismatch
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Are CO2 levels normal, low, or high in COPD?
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normal
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What is a xray hallmark of COPD?
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diaphragm flattening on xray
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What is the incidence of COPD?
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20% off all Americans
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What # cause of death in COPD in USA?
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4th leading cause of death
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What is the most common cause of COPD?
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cigarette smoke
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Cessation of smoking causes what to happen to the FEV1?
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decreased reduction in the rate of loss of FEV1
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All forms of COPD involve what phenomenon?
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air trapping
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List 4 types of COPD?
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chronic bronchitis
emphysema cystic fibrosis asthma |
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What is the diagnositic criteria of chronic bronchitis?
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>100ml sputum/day for >3 months for 2 years
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What is the molecular defect in emphysema?
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unimpeded action of neutrophil derived elastase destroys alveolar walls leading to distention of alveolar walls
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What is a vascular complication of emphysema?
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pulmonary artery hypertension
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What is a cardiac complication of emphysema?
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right ventricular heart failure
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What is the only proven therapy improving mortatlity in hypoxemic patients?
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O2
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What is the inheritence pattern of cystic fibrosis?
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autosomal recessive
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What is the molecular defect in CF?
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chloride ion channels
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How is respiratory involvement caused in CF?
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failure of secretion removal leads to bronchiolar obstruction
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Aerobic exercise in CF improves what lung function?
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improved ciliary beat promotes secretion removal
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What types of cells infiltrate in asthma?
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eosinophils
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What condition can result from asthma?
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chronic bronchitis
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What membrane is affected in asthma?
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basement membrane
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What muscle hypertrophies in asthma?
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bronchial muscle
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Respiratory impairment develops when FEV1 falls below what value?
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<3L second
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What is a normal FEV1?
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>4L second
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Severe exercise impairment occurs at what FEV1?
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<1L/second
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In restrictive pulmonary disease impaired lung ventilation is due to what phenomenon?
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loss of normal elastic recoil leading to loss of normal lung compliance
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In restrictive lung disease lung volumes are increased or decreased?
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decreased
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In restrictive lung disease flow rates are increased or decreased?
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increased
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Give 4 examples of restrictive lung disease?
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asbestosis
sarcoidosis silicosis idiopathic pulmonary fibrosis |
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Give 4 examples of neuromuscular diseases causing restrictive lung diseae.
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Duchenne's muscular dystrophy
ALS Guillan-Barre syndrome myasthenia gravis |
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What is the basic defect in neuromuscular disesases causing restrictive lung disease?
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respiratory muscle weakness
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What is the presenting symptom of patients with scoliosis >90?
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dyspnea
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What is the presenting symptom of patients with scoliosis>120?
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hypoventilation
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What type of lung disease may ankylosing spondylitis cause?
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restrictive lung disease (limited expansion of chest wall)
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What are two respiratory symtpoms of duchenne's muscular dystrophy?
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atelectasis
pneumonia |
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What spinal condition do DMD patients develop, leading to ventilatory failure?
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scoliosis
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What is the most common form of motor neuron disease that causes respiratory failure?
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ALS
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What is the most common cause of death in ALS?
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respiratory failure
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In kyphoscoliosis if the angle >120 what 2 conditions may develop?
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hypoventilation
cor pulmonale |
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What are the nerve root levels of the phrenic nerve?
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C3 C4 C5
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What complete SCI level results in loss of function of intercostal muscles?
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C2
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What PFT value increases in C-spine injury?
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residual volume
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Lesions above what level eliminate all but accessory muscles of breathing?
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C3
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A high thoracic SCI eliminates intercostal and abdonimal muscle function and impair what function?
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cough
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All PFTs decrease or stay the same with aging except for increases in what two values?
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residual volume and functional residual capacity increase with aging
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With aging, FEV1 decreases by how much per year (cc/yr)
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30 cc/yr
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What two conditions of restrictive lung disease result from a increase in the stiffness of lung tissue itself?
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pulmonary edema
interstitial lung disease |
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Residual volume increase in what two conditions?
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c-spine injury
COPD |
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In restrictive lung disease all volume values are increased or decreased?
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decreased
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What is the single PFT value in restrictive lung disease that is normal?
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FEV1
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Is FEV1 increased, decreased, or normal in restrictive lung disease?
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normal
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What is the basic etiology of COPD?
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air trapping
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What is the FEV1 decrease range in COPD (cc/year)?
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45-75 cc/year decrease in FEV1
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All PFT values in COPD are decreased except for what 3 values that are increased?
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residual volume
functional residual capacity total lung capacity |
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Residual volume increases or decreases in COPD?
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increases
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Functional residual capacity increases or decreases in COPD?
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increases
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Total lung capacity increases or decreases in COPD?
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increases
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What is the respiratory pattern of C-spine injuries, COPD or restrictive?
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restrictive
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What device improves VC in c-spine injuries?
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abdominal binder
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What is a primary goal of SCI pulmonary rehab?
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increase vital capacity
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In DMD, what is the range of loss of VC (cc/year)
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200-250 cc/year
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What are 4 indications for ventilatory support of DMD?
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*dyspnea at rest
*vital capacity 45% of predicted *max inspiratory pressure <30% of predicted *hypercapnia |
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What are the first two pulmonary changes noted in ALS?
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maximum inspiratory pressure
maximum expiratory pressure |
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In ALS the ability to cough is impaired at what vital capacity value (mL/kg)?
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25ml/kg
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In ALS what PFT is the best prognostic indicator for non-invasive ventilation?
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functional vital capacity
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Deficiencies of what 4 minerals are associated with respiratory muscle weakness?
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magnesium
calcium potassium phosphate |
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What single serum value is associated with spirometric values, severity and chronicity of disease, degree of hypoxemia, and predictor of rehab potential?
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serum albumin level
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Protein supplemenation equal or greater than what value is associated with physiological improvement?
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1.7g/kg body weight
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What bacteria commonly colonize a patient with poor nutrition?
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pseudomonas
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What cellular activity is decreased in the alveolar region in a patient with poor nurtrition?
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macrophage
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COPD patients are encouraged or discouraged to increase fluid intake?
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encouraged
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What receptors are blocked by inhaled anticholinergics such as atrovent or ipratropium?
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muscarinic receptors
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Name 1 inhaled anticholinergic.
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Atrovent
(Iprotroprium) |
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What chronic COPD med is not useful for acute exacerbations?
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steroids
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What type of drug is N-acetylcysteine?
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mucolytic
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What is an indication for theophylline use?
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young patients with resistent exercise induced asthma
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For a dx of exercise-induced asthma, how long must exercise last before sxs are apparent?
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at least 5 minutes
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What is the first-line tx for exercise-induced asthma?
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B-2 agonists
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What is a second-line med for exercise-induced asthma?
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inhaled steroids
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What is a third-line med for exercise-induced asthma?
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anticholinergics
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Name 2 inhaled B-2 agonists.
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Albuterol
Alupent |
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Below what SaO2 value (%)indicates O2 use during exercise?
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Exercise induced SaO2<90%
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Supplemental O2 use is recommended for patients with what PO2 value range (mm Hg)?
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55-60 mm Hg PO2
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What blood condition improves with home O2 use?
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polycythemia
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What circulatory condition improves with home O2 use?
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pulmonary hypertension
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Home O2 use is associated with increased or decreased life expectancy?
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increased life expectancy
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What generates more pressure in COPD, the diaphragm or rib cage inspiratory muscles?
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rib cage muscles generate more force
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What breathing technique is used to treat COPD patients?
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diaphragmatic breathing
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Diaphragmatic breathing is used to treat COPD or restrictive lung disease?
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COPD
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What 2 PFTs improve with diaphragmatic breathing techniques?
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*increased tidal volume
*decreased functional reserve capacity |
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What breathing technique reverses the altered pattern of respiratory muscle recruitment in COPD?
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diaphragmatic breathing
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What technique prevents air trapping due to small airway collapse during exhilation?
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pursed-lip breathing
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What PFT parameter does pursed-lip breathing improve?
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increases tidal volume
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What two respiratory measures improve with the combination of pursed-lip and diaphragmatic breathing?
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reduces respiratory rate
improve blood ABGs |
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Improvement in respiratory rate and improvement in blood ABGs can be accomplished in COPD using the combination of what 2 techniques?
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diaphragmatic breathing
pursed-lip breathing |
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What is the position for postural drainage?
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trendelenburg
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What is the usual patient position to drain the upper lobes?
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sitting
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What is the patient position to drain the right anterior segment?
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supine
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What is the patient position to drain the lingular lobe?
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lateral decubital trendelenburg
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What is the patient position to drain both posterior segments?
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prone
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What is the usual patient position to drain the right middle and lower lobes?
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lateral decubital trendelenburg
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What is patient position to drain the superior segment of the lower lobe?
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prone with buttocks elevated
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What is the patient position to drain the posterior lower segment?
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prone trendelenburg with buttocks elevated
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What is the patient position to drain the anterior segment?
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supine trendelenburg
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What is the max trendlenburg angle (degrees) a COPD patient can tolerate?
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25 degrees trendelenburg
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What are 4 primary contraindications to postural drainage?
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pulmonary edema
CHF HTN dyspnea |
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Going from sitting to trendelenburg increases or decreases the work of breathing?
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increases the diaphragmatic work of breathing through increased contractions
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Dependent alveoli expand or contract in size when changing from sitting to supine? thereby accomplishing what?
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expand, thereby increasing ventilation at the base of the lung
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What position increases ventilation at the base of the lung?
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supine
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Where in the lung is blood flow maximum?
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gravity dependent portions of lung
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Which lobes are preferentially ventilated?
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upper lobes
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Which lobes are preferentially perfused?
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lower lobes
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The difference in blood flow distribution is based on what circulatory pressure?
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pressure affecting the capillaries
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Blood flow depends on what 3 pressures?
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pulmonary artery pressure
alveolar pressure pulmonary venous pressure |
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Rank (highest to lowest) pulmonary venous pressure, pulmonary artery pressure, alveolor pressure in the lower lobes (zone 3)
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pulmonary artery pressure>pulmonary venous pressure>alveoloar pressure
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When changing from a sitting to supine position, venous pressure increases or decreases relative to pulmonary artery pressure? Where?
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increases in dependent areas of the lung
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What is the normal ventilation/perfusion ratio?
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0.8
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Lung areas where ventilation:perfusion ratio is low (<0.8) act as what?
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a shunt
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Lung areas where ventilation:perfusion is high (>0.8) as a what?
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dead space
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When supine blood flow increases to what segments?
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apical
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Rank pulmonary arterial pressure, alveoloar pressure, and pulmonary venous pressure in the apical lobes (zone 1)
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alveolar pressure>pulmonary arterial pressure>pulmonary venous pressure
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Rank pulmonary arterial pressure, alveoloar pressure, and pulmonary venous pressure in the middle lobes (zone 2)
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pulmonary arterial pressure>alveolar pressure>pulmonary venous pressure
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What determines blood flow in the middle lobes (zone 2)?
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arterial-alveolar pressure difference
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What determines blood flow in the lower lobes (zone 3)?
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arterial venous pressure difference
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What is the frequency of lung percussion?
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5 Hz
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What are 2 circulatory contraindications to percussion?
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CV failure
aortic aneursym |
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What is a complication of vibration and percussion in COPD?
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airway obstruction
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What is the preferred frequency range for chest vibration threapy?
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10-15 Hz
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Pre- and post-operative chest therapy reduce the incidence of what 2 complications?
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*decreased incidence of pneumonia
*decreased liklihood of atelectasis post-surgically |
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What chest treatment is preferred postoperatively?
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vibration
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Inspiratory muscle training devices are helpful in what 2 conditions?
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CF
asthma |
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What 2 PFTs are improved with an inspiratory muscle training device in CF?
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forced vital capacity
total lung capacity |
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In asthma, what 5 social parameters are improved with the use of an inspiratory muscle training device?
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*reduced hospitalizations
*reduced ER visits *reduced medication use *increased school attendance *increased work attendance |
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What type of reconditioning activities produce the most benefits in pulmonary rehab?
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unsupported UE activities
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Reconditioning exercises are suspended for SaO2 less than what value?
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<92%
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What are 3 aerobic exercises for CF patients?
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swimming
jogging sit-ups (i.e. exercises utilizing trunk muscles) |
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What 3 parameters are improved in CF patients involved in a structured running program?
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exercise capacity
respiratory muscle endurance reduction in airway resitance |
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An exercise program for children with CF has been found to show improvements in what 2 areas?
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increased sputum production
improvement in lung function |
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What parameter is an indicator for the need of a rest period?
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hypercapnia
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Ventilatory assistance in COPD can exacerbate what phenomenon?
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air trapping
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What is the most common method of noninvasive ventilatory support?
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intermittent positive pressure ventilation
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What ventilatory support is used to maintain a patent airway in obstructive sleep apnea?
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continuous postive airway pressure
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What airway does CPAP maintain in an open position?
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The pharangeal airway
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How does a bilevel positive airway pressure device function?
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permits independent adjustment of inspiratory and expiratory positive airway pressure
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What 2 metric does negative pressure body ventilators improve
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*improved 12-minute walking distance
*decrease in dyspnea |
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What device is an alternative to intubation and tracheostomy for patients with acute respiratory failure?
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negative pressure body ventilators
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What is the cause of fatal respiratory complication in patients with restrictive lung disease?
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failure to clear secretions
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What treatment can aggravate restrictive lung disease?
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O2 therapy
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How does excessive O2 therapy aggravate restrictive lung disease?
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suppression of central ventilatory drive, leading to hypercapnia
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What mineral disorder can aggravate restrictive lung disease?
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hypokalemia
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What neruomuscular junction disorder patients can develop hypokalemia during acute illnesses?
|
Duchenne muscular dystrophy
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What type of breathing technique can be used in the event of ventilator failure?
|
glossopharyngeal breathing
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What muscle strength must be intact to perform glossopharyneal breathing?
|
oropharyngeal muscles
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What are 5 uses of glossopharyngeal breathing?
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*breathing (4 hours) off vent
*improve voice volume *prevents micro-atelectasis *improves cough *improve pulmonary compliance |
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What technique other than glossopharyngeal breathing can help prevent atelectasis?
|
air stacking hyperinflations
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What is pressure applied to the pelvis or shoulder during inspiration followed by reversing the pressure direction to compress the thorax in all planes to facilitate expulsion?
|
counter rotation assist
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What is pressure applied at the naval with pushing up the diaphragm?
|
Abdominal thrust assist
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What is pressure applied applied to the costophrenic angles?
|
costophrenic assist
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What is pressure applied to the upper and low anterior chest?
|
anterior chest compression
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What are 10 possible complications of airway suctioning?
|
airway membrane irritation
bleeding airway edema wheezing hypoxemia bradycardia tachycardia hypertension hypotension increased intracranial pressure |
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True of False: Only suction as the catheter is being advanced?
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false
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What is the most effective method of mechanical assistance for secretion clearance in a paralyzed patient?
|
mechanical insufflator-exsufflator
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What is the desired decrease in pressure from insufflation to exsufflation (in cm H2O)?
|
80 mmH2O
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What are 4 conditions that are indications for insufflator-exsufflator treatment?
|
scoliosis
dysphagia impaired glottis severe URI |
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What is the air flow range (L/sec) generated by an insufflator/exsufflator device?
|
7-11 L/sec
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Use of an insufflator/exsufflator device can help prevent what surgical intervention?
|
tracheostomy
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A pneumobelt and an exsufflation belt are example of what type of body ventilator?
|
intermittent abdominal pressure ventilator
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What percentage of the cycle in an intermittent abdominal pressure ventilator is inspiration and what percentage expiration?
|
inspiration: 40%
expiration: 60% |
|
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What is the range (mL) of tidal volume that can be provided by an intermittent abdominal pressure ventilator?
|
250-1200 mL
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An intermittent abdominal pressure ventilator is effective only when the patient is in what position?
|
sitting
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Inspiration in an intermittent abdominal pressure ventilator device depends on what force?
|
gravity
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What is the most useful mode of ventilation for a wheelchair-bound patient with less than 1 hour of ventilator-free time during the day?
|
intermittent abdominal pressure ventilator
|
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What are two contraindications to the use of an intermittent abdominal pressure ventilator?
|
scoliosis
obesity |
|
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The intermittent abdominal pressure ventilator is not useful for patient with what two lung issues?
|
*decreased pulmonary compliance
*increased airway resistance |
|
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Is intermittent abdominal pressure ventilator most beneficial during the day or night?
|
day
|
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What is the optimal trunk angle for use of an intermittent abdominal pressure ventilator?
|
75 degrees
|
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What is the range (degrees) of rocking from horizontal of a rocker bed?
|
15-30 degrees
|
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What mechanical respiratory assist device is used for patients with paralyzed diaphragms?
|
rocking bed
|
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|
In addition to the respiratory benefits what are 4 other benefits of the the rocking bed?
|
improved secretion clearance
decreased pressure ulcers improved bowel motility prevents venous stasis |
|
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In an external oscillation ventilator what pressure is always negative?
|
inspiratory pressure
|
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What type of device is useful for patients with decreased lung compliance?
|
external oscillation ventilator
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What 2 devices are not beneficial to those with decreased pulmonary compliance or increased airway resistance?
|
*intermittent abdominal pressure ventilator
*rocking bed |
|
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How is secretion clearance performed with an external oscillation ventilator?
|
increasing the number of oscillations per minute
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What type of ventilator is mainly used at night?
|
negative pressure ventilator
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A negative pressure ventilator may prevent development of what circulatory/respiratory condition?
|
cor pulmonale
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What condition is a primary contraindication to the use of a negative pressure ventilator?
|
upper airway obstruction
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|
Emerson Iron Lung and LifeCare Porta-Lung are examples of what type of ventilator?
|
tank negative pressure ventilator
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What are 3 conditions that are indications for use of a tank negative pressure ventilator?
|
*decreased pulmonary compliance
*scoliosis *severe infections |
|
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What type of ventilator is a plastic grid that covers the abdomen and thorax?
|
wrap ventilator
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What are two indications for use of a wrap ventilator?
|
scoliosis
sensory deficits |
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What is a chamber that encloses a patient's entire body and produces intermittent subatmospheric pressure?
|
tank negative pressure ventilator (iron lung)
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What is a firm shell that covers the chest and abdomen attached to a negative pressure ventilator and generates a subatmospheric pressure under the shell?
|
cuirass or chest shell ventilator
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What is the only negative pressure body ventilator that can be used during the day for ventilatory support in the seated position?
|
cuirass or chest shell ventilator
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What is the great advantage of a chest shell ventilator?
|
the only negative pressure ventilator that can be used during the day for ventilatory support in the seated position
|
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A chest shell ventilator is not effective in what 6 conditions?
|
*complete respiratory paralysis
*impairment of pulmonary compliance *apnea *intrinsic lung disease *severe back deformity *morbid obesity |
|
|
In sleep apnea, what muscles relax and block the airway?
|
retropharyngeal
|
|
|
Greater than what neck circumference is an independent risk factor for obstructive sleep apnea?
|
neck cirumference>17cm
|
|
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What ethnic groups have a higher risk for sleep apnea?
|
black, hispanic, or pacific islander
|
|
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What gender is more of risk factor for sleep apnea?
|
male
|
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What endocrine disease is a risk factor for sleep apnea?
|
DM
|
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What subtances use are a risk factor for sleep apnea?
|
alcohol
smoking |
|
|
What CV condition is a risk factor for sleep apnea?
|
HTN
|
|
|
What weight condition is a risk factor for sleep apnea?
|
obesity
|
|
|
What is the preferred treatment for moderate to severe sleep apnea?
|
continuous positive airway pressure (CPAP)
|
|
|
What surgery for obstructive sleep apnea is effective in 50% of cases?
|
uvulopalatopharingoplasty
|
|
|
What is the name of the procedure that is an implant to keep the soft palate open?
|
Pillar procedure
|
|
|
What type of device is preferred for those patients with obstructive sleep apnea and hypercapnia?
|
BiPAP
|
|
|
What device is used for those with obstructive sleep apnea requiring high pressures?
|
BiPAP
|
|
|
In BiPAP how is greater inspiratory muscle assitance provided?
|
the greater the difference between inspiratory positive airway pressure and expiratory positive airway pressure
|
|
|
Below what ABG PaO2 (mmHg) is invasive ventilatory support required?
|
PaO2<55 mgHg
|
|
|
Above what ABG PCO2 (mmHg) is invasive ventilatory support required?
|
PCO2>50mmHg
|
|
|
Below what assisted peak cough flow (L/minute) is intubation required?
|
<160 L/min
|
|
|
What trach tube material helps keeps trach stoma open until it's not needed, and causes less local irritation?
|
metal
|
|
|
What tach tube material is always cuffless?
|
metal
|
|
|
Can a patient speak with an inflated cuffed trach?
|
no
|
|
|
What type of trach should not be used in patients with a risk of aspiration?
|
uncuffed
|
|
|
What are two indications for using an uncuffed trach tube?
|
*immediately after tracheostomy
*increased secretions |
|
|
Is it possible to speak on an uncuffed trach while on mechanical ventilation?
|
Yes
|
|
|
What type of tube is used for patients who are able to speak and require only intermittent ventilatory assistance?
|
fenestrated tube
|
|
|
An outer fenestrated cannula used with an continuous inner cannula should not come into conatct with what structure?
|
the tracheal wall
|
|
|
A fenestrated outer cannula used with an inner cannula can be used to speak when what is removed?
|
the inner cannula
|
|
|
What tube is used in patients who require continuous mechanical ventilation or are unable to protect the airway duiring swallowing?
|
nonfenestrated tube
|
|
|
What are two indications for the use of a nonfenestrated tube?
|
*continuous mechanical ventilation
*unable to protect airway during swallowing |
|
|
A talking valve attached to the trach opens during inspiration or exhilation?
|
inspiration
|
|
|
A talking valve is one-way or two-way?
|
one-way
|
|
|
A talking tube closes on exhilation to produce what?
|
phonation
|
|
|
A talk tube is appropriate for a patient who has intact vocal cords and can mouth words but requires type of cuff for ventilation?
|
inflated cuff
|
|
|
What is an example of a talk tube?
|
portex talk tube
|
|
|
With a talk tube, airflow is through what structure?
|
vocal cords
|
|
|
Talking trachs supply pressurized gas to the trachea through small holes above or below the inflated cuff tube?
|
above the inflated cuff
|
|
|
What activity is required by the patient using a talking trach?
|
occluding the external port
|
|
|
What is the only speaking valve brand that has a biased, closed position and opens only on inspiration?
|
passy-muir
|
|
|
All speaking valves except the passy-muir are open when?
|
open all the time until actively closed by adequate force
|
|
|
What condition is not appropriate for a speaking valve?
|
COPD
|
|
|
What are two reasons why speaking valves are not used for COPD patients?
|
*lack of lung compliance
*excessive secretions |
|
|
What are two indications for decannulation?
|
*no longer need mechanical ventilation
*adequately clear secretions |
|
|
When the outer diameter of the talking tube is what size (mm) the trach may be discontinued?
|
8mm
|
|
|
Tracheal buttons extend only to the inner surface of what structure?
|
inner surface of the anterior tracheal wall
|
|
|
An electrophrenic pacing is used in SCI in patients with what 2 intact structures?
|
diaphragm
phrenic nerve |
|
|
By what percentage does ASA reduce the incidence of subsequent MI, stroke, and death from CV causes?
|
25%
|
|
|
B-blockers reduce what parameter?
|
mortality
|
|
|
What percentage of deaths in US is caused by CV disease?
|
50%
|
|
|
How many MIs each year in US?
|
1.5 million
|
|
|
What percentage of MI is in those under 65?
|
50%
|
|
|
Men or women are referred more often to cardica rehab?
|
men
|
|
|
What is the 3-year survival rate of MI participants in cardiac rehab?
|
95%
|
|
|
What are three risk factors credited with reducing CAD mortality rate over the past 50 years?
|
lower cholesterol
improved HTN management reduced cigarette smoking |
|
|
By how much (%) has mortality from CV disease fallen since 1963?
|
47%
|
|
|
What layer of the artery is the first damaged in th Response to Injury Hypothesis?
|
endothelium
|
|
|
When is phase I cardiac rehab?
|
during acute hospitalization
|
|
|
What is the time frame (month span of cardiac rehab phase II?
|
from discharge up to 6 months
|
|
|
What phase of cardiac rehab is the most closely monitored phase of rehab?
|
phase II
|
|
|
How many phases of rehab oare there?
|
4
|
|
|
VO2 represents the O2 consumption of the peripheral skeletal muscles. It does NOT include the work of what muscle?
|
the heart
|
|
|
What is the unit of VO2 max?
|
mLO2/kg/min
|
|
|
With exercise VO2 max increases in what fashion?
|
linear, then it plateaus
|
|
|
What technique measures myocardial VO2?
|
cardiac catheterization
|
|
|
What value can estimate the myocardial VO2?
|
the rate pressure product
|
|
|
What two CV parameters correlate well with the rate pressure product?
|
heart rate
systolic blood pressure |
|
|
What is the formula for the estimated myocardial rate pressure product?
|
HR x SBP
|
|
|
What is the formula for cardiac output?
|
CO=HR x stroke volume
|
|
|
What is the Fick equation for VO2 max?
|
VO2 max = CO x AVO2 difference
|
|
|
1 MET = ? mLO2?
|
3.5mLO2
|
|
|
The Frank Starling relationship describes the ability of the myocardium to increase its force of contraction in response to increased what?
|
stretch - increased ventricular volume or increased preload
|
|
|
As a result of increased preload (ventricular volume) what will increase with the next contraction?
|
stroke volume
|
|
|
What is the vertical axis in the Frank Starling relationship?
|
stroke volume
|
|
|
What is horizontal axis in the Frank Starling relationship?
|
end diastolic volume
|
|
|
What does the end-diastolic volume represent?
|
the preload, which is the initial stretching of the cardiac myocyte prior to contraction
|
|
|
Myocyte stretching represents the increase of what structure's length?
|
sarcomere
|
|
|
Increasing the sarcomere length increases what?
|
force, thereby increasing stroke volume
|
|
|
What 2 elderly CV disease conditions are improved by cardiac rehab?
|
CHD
heart failure |
|
|
Cardiac rehab improves heart failure symptoms in patients with what cardiac dysfunction?
|
left ventricular systolic dysfunction
|
|
|
Exercise as a sole intervention improves lipid profiles. True or false
|
False
|
|
|
What systolic BP is a contraindication to cardiac training?
|
>200 mm Hg
|
|
|
What tachycardia rate (bpm) is a contraindication to cardiac exercise training?
|
>100 bpm
|
|
|
What drop (mg Hg) in resting systolic blood pressure is a contraindication to exercise training?
|
20 mg Hg
|
|
|
What degree heart block without pacemaker is a contraindication to cardiac rehab exercise training?
|
3rd degree
|
|
|
What resting ST displacement (mm) is a contraindication to cardiac rehab exercise training?
|
>3mm `
|
|
|
What is the MET range for and acute, coronary care unit cardiac rehab program?
|
1-2 METs
|
|
|
What type of exercise should be avoided in the acute setting?
|
isometric ativity
|
|
|
How many METs to use a bedpan?
|
4.7
|
|
|
How many METs to use a bedside commode?
|
3.6
|
|
|
What is the MET range for the subacute rehab?
|
3-4 METs
|
|
|
What is the MET range of propelling a WC?
|
2-3 METs
|
|
|
What is th MET range of a regular slow walk (2 mph)?
|
2-3 METs
|
|
|
Is graded exercise training a functional or diagnostic tool?
|
functional
|
|
|
What type of exercise testing allows the establishment of appropriate limits and guidelines for exercise therapy and the assessment of functional change over time?
|
graded exerce testing
|
|
|
What type of graded exercise testing is recommended for inpatients and prior to outpatient cardiac rehab?
|
submaximal graded exercise testing
|
|
|
Most ADLs in the home environment require less than how many METs?
|
4 METs
|
|
|
What Borg rating of perceived exertion range is an end point for low-level exercise testing?
|
13-15
|
|
|
What diagnostic imaging tool increases the sensitivty and specificity of stress testing?
|
exercise echocardiography
|
|
|
What development during an exercise echo stress test is considered positive?
|
wall motion abnormality in previously normal area or worsens in an already abnormal segment
|
|
|
What is the sensitivity of exercise echo stress?
|
97%
|
|
|
What is the specificity range of exercise echo stress?
|
64-94
|
|
|
Higher specificities of the exercise echo stress are obtained in patients with what condition?
|
multivessel disease
|
|
|
Exercise echo stress testing is highly accurate in what patient with a increased incidence of what?
|
increased incidence of false positive execise ECG (i.e. women)
|
|
|
In exercise nuclear imaging, perfusion defects present during exercise and persist at rest suggest what?
|
previous ME or scar
|
|
|
In exercise nuclear imaging perfusion defects present during exercise but not at rest suggest what condition?
|
ischemia
|
|
|
What 2 agents can be used for exercise nuclear imaging?
|
thallium
sestainibi |
|
|
What two agents are used for pharmacological stress testing?
|
dobutamine
sestainibi with dipyridamole or adenosine |
|
|
What exercise device is used for low extremity amputee?
|
arm ergometer
|
|
|
What two parameters of exercise testing are higher in treadmill testing than in arm ergometer testing?
|
VO2 max
peak heart rate |
|
|
What 2 CV monitoring parameters are more accurate with ergometers?
|
ECG and BP
|
|
|
What protocol is used for high risk patients with function capacity less than 7 METs?
|
Balke-Ware
|
|
|
Balke-Ware protocols increase metabolic demands by how many METs per stage?
|
1 MET per stage
|
|
|
How many METs per stage for the Bruce Protocol?
|
2-3 METs per stage
|
|
|
What is a systolic BP indication for stopping an exercise test?
|
drop in Systolic BP > 10 mm Hg despite increase in workload and evidence of ischemia
|
|
|
What is the ST elevation value (mm) that is an indication for stopping an exercise test?
|
>1mm
|
|
|
How many METs for sex?
|
3-4 METs
|
|
|
How many METs to shovel snow?
|
7 METS
|
|
|
What NYHA class is a patient who can do any activity >7 METs?
|
Class I NYHA
|
|
|
What is the NYHA classification for doing any activity between 5-7 METs to completion?
|
NYHA Class II
|
|
|
What is the NYHA classification for doing activity between 2-5 METs?
|
NYHA Class III
|
|
|
Less than ordinary activity causes fatigue, palpitation, dypnea, or anginal pain. What is the NYHA class?
|
NYHA Class III
|
|
|
Symptoms at rest or angina syndrome may be present at rest. What NYHA class is this?
|
NYHA Class IV
|
|
|
How many METS can a NYHA Class IV perform?
|
<2 METs
|
|
|
How long (week range) after an MI should a patient wait before starting a resistence training program?
|
3-6 weeks
|
|
|
Type I fibers have how many times the aerobic capacity as type II fibers?
|
5x
|
|
|
What are the 3 methods of determining the target heart rate?
|
clearance heart rate
age-predicated heart rate Karvonen method |
|
|
What is the targe heart rate range (as a % of the maximum HR)?
|
70-85% of maximum HR
|
|
|
What is the clearance HR (%)?
|
70% of maximum HR attained on stress test
|
|
|
What is the age predicted method method of maximum HR?
|
220-age=maximum HR
|
|
|
What is the target heart rate range as a percentage using the age predicted method of maximum HR?
|
70-85% of maxium HR
i.e. 0.7(220-age) to 0.85(220-age) |
|
|
What method has the potential for over and underestimating the actual exercise intensity?
|
age-predicted method
|
|
|
What method uses the subjet's potential heart-rate increase and assumes that the resting heart rate represents zero intensity?
|
Karvonen method
|
|
|
What method for target heart rate is used for those with chronic beta blockade or with abnormally high resting heart rate?
|
Karvonen method
|
|
|
What is the Karvonen formula?
|
target heart rate = 0.7 to 0.85(max HR - resting HR) + resting HR
|
|
|
What is the range for the Borg perceived exertion scale?
|
6-20
|
|
|
With what three parameters does the BORG scale linearly correlate?
|
heart rate, ventricular O2 consumption, and lactate levels
|
|
|
With what scale do heart rate, O2 ventricular consumption, and lactate levels correlate linearly?
|
BORG rating of perceived exertion
|
|
|
What the American Heart Association suggested heart rate limit range for patients not on beta blockers?
|
130-140 BPM
|
|
|
What Borg range is recommend for low level exercise testing?
|
13-15
|
|
|
What is the recommendation for conditioning in terms of time (minutes range) at what % of maximum HR?
|
20-30 minutes at 70% of max HR
|
|
|
In the Borg scale what value is no exertion?
|
6
|
|
|
In the Borg scale what value is maximal exertion?
|
20
|
|
|
Patients with CHD with reduced LV ejection fraction and ventricular tachycardia are more prone to develop what fatal arrythmia?
|
ventricular fibrillation
|
|
|
An implantable cardioverter-defibrillator decreases mortality by what percentage in patients with nonsustained Vtach after MI?
|
31%
|
|
|
What procedure and what device are used to treat Vtach?
|
ablative therapy
implantable cardioverter-defibrillator |
|
|
Who is more likely to experience Vtach or Vfib during cardiac rehab? A patient with very good exercise tolerance and a hx of a ventricular arrhythmia and minimally reduced EF or a patient with very limited exercise capacity?
|
The patient with the very good exercise tolerance and hx of malignant ventricular arrhythmia and minimally reduced EF
|
|
|
What are the 1 and 5 year survival rates for heart transplantation?
|
1 year- 85%
5 year -75% |
|
|
A transplanted heart lacks what innervation?
|
vagal innervation (parasympathetic tone)
|
|
|
A transplanted heart lacks input of what part of the autonomic nervous system?
|
parasympathetic
|
|
|
What heart node in transplant lacks vagal inhibition?
|
SA node
|
|
|
What is the resting heart rate of a transplanted heart compared to normal?
|
higher
|
|
|
What is the peak exercising heart rate of a transplanted heart compared to normal?
|
lower peak exercise heart rate
|
|
|
Renal effects of the anti-rejection medications causes what CV condition in the patient with a transplanted heart?
|
resting HTN
|
|
|
After exercise the transplanted heart returns to resting HR slower or faster than a normal person?
|
slower return to resting HR
|
|
|
What 4 CV parameters are lower in heart transplant at maximum effort than in normal?
|
work capacity
cardiac output systolic BP VO2 |
|
|
What arterial pathology progresses faster in heart tranplantation than in normal
|
arthrosclerosis
|
|
|
What scale is used in cardiac transplantation exercise prescription?
|
Borg
|
|
|
Are standard heart-rate guidelines used for exercise prescriptions in heart transplantation rehab?
|
No
|
|
|
What Borg range is used for exercise prescription post heart transplant?
|
11-14
|
|
|
Intensity of exercise post cardiac transplantation is based on what 3 parameters?
|
*Borg 11-14
*percentage of VO2 max on stress test *anaerobic threshold |
|
|
What 3 elements of the exercise prescription post-transplantation follow that as other cardiac problems?
|
*duration
*frequency *types of exercise |
|
|
Cardiac ischemia during post-transplantion exercise testing is followed using what method?
|
ECG changes
|
|
|
Does cardiac ischemia present with angina post cardiac transplantion?
|
no
|
|
|
What percentage of people over 70 have PVD?
|
20%
|
|
|
What is the ratio comparing systolic BP to the brachial systolic BP?
|
ankle-brachial index
|
|
|
An ankle-brachial index of <0.4 is normal, moderate or very severe?
|
very severe
|
|
|
What is a normal ankle brachial index value?
|
1.0
|
|
|
Exercise intensity in PVD is based on what parameter of treadmill walking?
|
provoking MODERATE claudication within 5 minutes of treadmill walking
|
|
|
What are the 4 elements of a cardiac rehab exercise prescrption?
|
type of exercise
intensity duration frequency |
|
|
PVD exercise therapy improves pain-free walking time by what percentage?
|
189%
|
|
|
With PVD exercise therapy when (months) is the maximum benefit?
|
12 months
|
|
|
With PVD exercise therapy what percentage improvement is there in ability to do ADLs?
|
31%
|
|
|
Exercise improves PAD and walking economy by increasing what two efficiencies?
|
biomechanical a
and metabolic efficiencies |
|
|
What is the coexistence (%) of CHD in those patients undergoing amputation?
|
75%
|
|
|
What is the most common cause of death in dysvascular amputees?
|
CHD
|
|
|
What is the percentage range of amputations caused by diabetes?
|
50-70%
|
|
|
For similar walking speeds how much more energy is required for a BKA with prosthesis (% range)?
|
9-28%
|
|
|
For similar walking speeds how much more energy is required for bilateral BKA with prosthesis?
|
41-100%
|
|
|
For similar walking speeds how much more energy is required for a AKA with prosthesis (% range)?
|
40-65%
|
|
|
For similar walking speeds how much more energy is required for a bilateral AKA with prosthesis?
|
280%
|
|
|
For similar walking speeds how much more energy is required for a hemipelvectomy with prosthesis (%)?
|
125%
|
|
|
For similar walking speeds how much more energy is required for a unilateral hip disarticulation with prosthesis?
|
82%
|
|
|
For similar walking speeds how much more energy is required for a BKA and AKA with prostheses (%)?
|
75%
|
|
|
For similar walking speeds how much more energy is required for no prosthesis with crutches?
|
50%
|
|
|
What percentage of stroke patients have some form of coexisting CHD?
|
77%
|
|
|
What is the increase (% range) in energy cost for hemiplegic ambulation compared to normal?
|
50-65%
|
|
|
What equipment is used for CV conditioning in a patient with lower extremity weakness?
|
air dyne-leg cycle ergonometer
|
|
|
Greater than what MET is suitable for return to any employment?
|
> = 7 METs
|
|
|
What MET range is suitable for return to a sedentary job?
|
5 to <7 METs
|
|
|
What MET range is not suitable for return to work?
|
3-4 METs
|
|
|
The energy cost of work is increased by how many time in a hot and humid environment?
|
2-3x
|
|
|
What percentage of total daily calories is from fat in an AHA Step 1 diet?
|
30%
|
|
|
What percentage range of total calories is from saturated fat in a Step 1 diet?
|
8-10%
|
|
|
How much dietary cholesterol (mg/day) is permitted in a Step 1 diet?
|
300mg/day
|
|
|
A step 2 diet is similar to step 1 except how much (mg/day) dietary cholesterol is permitted in a step 2 diet?
|
200 mg/day
|
|
|
Increased stroke volume at rest and submaximal is due to what 2 factors?
|
increased blood volume
prolonged diastolic filling time |
|
|
True or False: exercise training alone results in regression or limitation of progression of documented coronary atherosclerosis.
|
False. Only exercise and intensive dietary intervention
|
|
|
True or False: exercise training has no apparent effect on the development of coronary collateral circulation.
|
True
|
|
|
Patients undergoing cardiac rehab with heart failure and decreased ventricular systolic function improved in functional capacity due to adapation in what two systems rather than adaptation in cardiac musculature?
|
peripheral circulation
skeletal muscles |
|
|
Long term cardiac rehab has no apparent effect on the development of what circulation?
|
cardiac collateral circulation
|
|
|
What 2 interventions result in the regression or limitation of coronary atherosclerosis?
|
exercise training
intensive dietary intervention |
|
|
With exercise training Improved utilization of O2 by active muscles results from what 2 cellular changes?
|
*increased oxidative enzymes
*increased number of mitochondria in the muscles |
|
|
What is the rate pressure product formula?
|
RPP = HR x SBP
|
|
|
Rate pressure product is a good indicator for what parameter of oxygen demand?
|
myocardial oxygen demand (MVO2)
|
|
|
What type of tumor comprises 60% of all adult primary CNS tumors?
|
gliomas
|
|
|
What is the most common primary CNS solid tumor in young adults?
|
cerebellar astrocytoma
|
|
|
What is the most common malignancy in childhood?
|
leukemia
|
|
|
What is the second most common tumor in childhood
|
brain tumors
|
|
|
What is the most common posterior fossa tumor in childhood?
|
cerebellar astrocytoma
|
|
|
What childhood tumor has the best prognosis?
|
cerebellar astrocytoma
|
|
|
What is the second most common childhood posterior fossa malignancy?
|
medulloblastoma
|
|
|
What is the most common tumor in children less than 7 years old?
|
medulloblastoma
|
|
|
What percentage of patients suffer metastasis?
|
25%
|
|
|
What are the three most common primary tumor sites that metastasize to the brain in men?
|
lung, GI, uro
|
|
|
What are the 3 most common primary tumor sites (or types) that metastasize in women?
|
brain, GI, melanoma
|
|
|
What is the most common symptom of brain tumors?
|
headaches
|
|
|
What is the most common focal sign of brain tumors?
|
weakness
|
|
|
What is the most common first presenting sign of malignant CNS involvement?
|
seizures
|
|
|
What is the best diagnostic test for brain tumors?
|
contrast MRI
|
|
|
What med is used to decrease brain edema and symptoms?
|
dexamethasone
|
|
|
What is a common neurological deficit resulting from chemo and radiation?
|
impaired visual perceptual skills
|
|
|
What percentage of spinal cord tumors are extra-dural?
|
95%
|
|
|
If the majority of spinal tumors are extradural, from where do they arise?
|
vertebral body
|
|
|
What percentage of metastates are in the thoracic cord?
|
70%
|
|
|
What is the most common form of radiation damage to the spinal cord?
|
induced transient myelopathy
|
|
|
When (in months range post treatment) does induced transient myelopathy peak?
|
4-6 months
|
|
|
What neurons are afected in induced transient myelopathy?
|
sensory neurons
|
|
|
What is transient about induced transient myelopathy?
|
transient demyelination
|
|
|
What column is affected by induced transient myelopathy?
|
posterior columns
|
|
|
What cord tract is affected by induced transient myelopathy?
|
lateral spinothalamic tract
|
|
|
Is induced transient myelopathy assymetric or symmetric?
|
symmetric
|
|
|
Is the CT normal or abnormal in induced transient myelopathy?
|
normal
|
|
|
Over what time span (months range) does induced transient myelopathy resolve?
|
1-9 months
|
|
|
What form of radiation myelopathy is irreversible?
|
delayed radiation myelopathy
|
|
|
When do symptoms of delayed radiation therapy begin post-treatment (months range)?
|
9-18 months
|
|
|
What is the initial symptom in delayed radiation myelopathy?
|
lower extremity paresthesias
|
|
|
What two symptoms of delayed radiation myelopathy occur after lower extremity paresthesias?
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bowel dysfunction and weakness
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Where is the most common location for pain in delayed radiation myelopathy
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mid-back pain
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What four cancers are associated with peripheral polyneuropathy?
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lung, breast, and colon cancer
multiple myeloma |
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Polyneuropathy is associated with inflammation and degeneration of what spinal structure?
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dorsal root ganglia
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Inflammation and degeneration of the dorsal root ganglia is associated with what neurological complication of cancer?
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polyneuropathy
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What are two EMG findings in cancer polyneuropathy?
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fibs
polyphasics |
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What are 3 symptoms of cancer polyneuropathy?
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gait dysfunction
paresthesias sensory loss |
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What area is spared in cancer peripheral polyneuropathy?
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face
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What two functions are spared in cancer peripheral polyneuropathy?
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bowel and bladder
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What neuropathy can occur with lymphoma?
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subacute motor neuropathy
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What cells degenerate in lymphoma associated subacute motor neuropathy?
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anterior horn cells
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What is the main symptom in lymphoma associated subacute motor neuropathy?
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weakness
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Is the weakness of lymphoma associated subacute motor neuropathy permanent?
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no, gradual improvement does occur
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What are the two most common neuropathies of chemo?
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plexopathy
peripheral neuropathy |
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Are the plexopathies or peripheral neuropathy of chemo distal or proximal, symmetric or assymetric?
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distal and symmetric
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What is the typical neuropathy of vincristine?
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distal axonal degeneration
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What is a common complaint in the the distal axonal degeneration of vincristine?
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severe neuropathic pain
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Rarely vincristine can cause what neurological symptom?
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quadriparesis
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What 3 chemo agents can cause fluctuating BP or HR?
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cisplatin
vincristine bortezomid |
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Vincristine, cisplatin, and bortezomid can cause what 2 autonomic symptoms?
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fluctuating BP or HR
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Through what 3 ways does radiation cause peripheral nerve damage?
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*directly to the nerve itself
*damage to the connective tissue *damage to the vascular supply |
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What are 3 common symptoms of radiation damage?
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muscle atrophy
hyperesthesia paresthesias |
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What are 2 ways in which brachial plexopathy can occur?
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radiation treatment
tumor extension |
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In 90% of patients with direct tumor extension what is the most common symptom?
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severe pain
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Severe pain is the most common initial symptom in what type of brachial plexopathy etiology radiation or driect extension?
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brachial plexopathy by direct extension of tumor
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What are the initial 2 symptoms in a post-radiation plexopathy?
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numbness and parethesias
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What brachial plexus structure is most commonly invovled with radiation plexitis?
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upper trunk
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What brachial plexus structure is most commonly involved with direct tumor extension?
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lower trunk
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What syndrome is an example of brachial plexus tumor extension?
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Pancoast's syndrome
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Where is the lesion in Pancoast's syndrome?
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superior pulmonary sulcus
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What is the nerve root level range pain distribution in Pancoast's syndrome?
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C8-T1
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What is the facial syndrome in Pancoast's syndrome?
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Horner's syndrome
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In what two structures is pain intially reported in Pancoast's syndrome?
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shoulder and medial border of the scapula
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What are the 2 main treatments of Pancoast's syndrome?
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radiation and surgery
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What finding on EMG is pathognomonic of radiation plexitis?
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myokymia
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Myokymia on EMG is pathognomonic of what type of pelxitis?
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radiation plexitis
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A CT reveals focal lesions in plexopathy in what percentage of cases?
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90%
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