DPT Cardiovascular & Pulmonary PT 5 — Questions and Answers
Question 1: A patient's arterial blood gas shows: pH 7.28, PaCO2 55 mmHg, HCO3 26 mEq/L, PaO2 58 mmHg. How is this interpreted?
- Metabolic acidosis with respiratory compensation
- Respiratory acidosis without metabolic compensation (Correct answer)
- Mixed respiratory and metabolic acidosis
- Respiratory alkalosis with metabolic acidosis
Correct answer: Respiratory acidosis without metabolic compensation
Low pH with elevated PaCO2 and normal bicarbonate indicates acute respiratory acidosis without renal compensation, consistent with acute ventilatory failure.
Question 2: Which exercise training modality has the strongest evidence for improving peak VO2 in patients with stable chronic heart failure (EF <40%)?
- High-intensity interval training (HIIT) exclusively
- Moderate-intensity continuous aerobic training (Correct answer)
- Resistance training alone without aerobic component
- Inspiratory muscle training as the sole intervention
Correct answer: Moderate-intensity continuous aerobic training
Moderate-intensity continuous aerobic training has the most robust evidence base for improving peak VO2 and quality of life in stable HFrEF patients.
Question 3: A physical therapist is using the talk test to monitor exercise intensity. At which intensity level does the talk test become positive (inability to speak in full sentences)?
- At the ventilatory threshold (anaerobic threshold) (Correct answer)
- At 50% of maximal heart rate
- At a Borg RPE of 8-9 on the 6-20 scale
- At resting metabolic rate with slight exertion
Correct answer: At the ventilatory threshold (anaerobic threshold)
The talk test becomes positive (patient cannot comfortably speak in full sentences) at approximately the ventilatory threshold, marking the transition to higher-intensity exercise.
Question 4: Which complication is the primary reason physical therapists monitor for signs of deep vein thrombosis (DVT) in post-surgical cardiac patients?
- DVT causes direct cardiac arrhythmias through vagal stimulation
- Pulmonary embolism from DVT can be immediately life-threatening (Correct answer)
- DVT causes systemic hypertension requiring medication adjustment
- DVT leads to lymphedema that complicates cardiac rehabilitation
Correct answer: Pulmonary embolism from DVT can be immediately life-threatening
DVT poses the risk of embolization to the pulmonary vasculature, causing pulmonary embolism which can be rapidly fatal if large enough to cause right heart failure.
Question 5: A patient with pulmonary arterial hypertension (PAH) is referred to cardiac rehab. Which exercise parameter requires the MOST careful monitoring due to the pathophysiology of PAH?
- Blood glucose levels due to corticosteroid medications
- SpO2 and symptoms of right heart failure with exertion (Correct answer)
- Skin integrity at compression garment sites
- Bone density due to inactivity-related osteoporosis
Correct answer: SpO2 and symptoms of right heart failure with exertion
PAH patients have fixed pulmonary vascular resistance; exercise-induced increases in cardiac output can precipitate acute right heart failure and dangerous drops in SpO2.
Question 6: Which manual airway clearance technique involves the clinician applying rhythmic clapping over the chest wall during postural drainage?
- Autogenic drainage
- Active cycle of breathing technique (ACBT)
- Chest percussion (clapping) (Correct answer)
- High-frequency chest wall oscillation (HFCWO)
Correct answer: Chest percussion (clapping)
Chest percussion involves rhythmic clapping with a cupped hand over the chest to loosen secretions adherent to airway walls during postural drainage.
Question 7: A patient with chronic heart failure reports gaining 4 lbs overnight and increasing ankle edema. According to standard self-monitoring guidelines, what should the patient do first?
- Increase daily walking distance to mobilize excess fluid
- Contact their physician or nurse immediately (Correct answer)
- Double their diuretic dose without consulting the provider
- Restrict fluid intake to 500 mL per day independently
Correct answer: Contact their physician or nurse immediately
A weight gain of ≥2 lbs in 24 hours or ≥5 lbs in a week is a standard alert threshold for decompensation, requiring immediate medical notification.
DPT Cardiovascular & Pulmonary PT 5
A patient's arterial blood gas shows: pH 7.28, PaCO2 55 mmHg, HCO3 26 mEq/L, PaO2 58 mmHg.
How is this interpreted?