Cardiovascular and Pulmonary PT Flashcards

A physical therapist is monitoring a patient during a Phase II cardiac rehabilitation session. The patient, who is 3 weeks post-myocardial infarction, is walking on a treadmill. According to ACSM guidelines, which of the following findings is an absolute indication to terminate the exercise session immediately?

Answer: ST-segment depression of 3.0 mm on the ECG monitor.

According to the American College of Sports Medicine (ACSM), ST-segment depression greater than 2 mm is an indication of myocardial ischemia and is a relative contraindication to continuing exercise. Horizontal or downsloping ST depression ≥ 3.0 mm is considered a severe sign and an absolute indication to stop the test. A rise in SBP and HR are normal responses, and an RPE of 13 is expected during moderate exercise.

While auscultating the lungs of a patient with an acute exacerbation of congestive heart failure (CHF), a physical therapist hears discontinuous, high-pitched, popping sounds primarily during the end of inspiration over the lower lung bases. These sounds are BEST described as which of the following?

Answer: Fine crackles (rales)

Fine crackles (rales) are discontinuous, high-pitched sounds caused by the sudden opening of closed small airways and alveoli, commonly heard in conditions involving fluid in the lungs, such as the pulmonary edema seen in CHF. Wheezes are continuous and musical, rhonchi are low-pitched and snoring-like, and a pleural friction rub is a grating sound.

A physical therapist is teaching a patient with severe chronic obstructive pulmonary disease (COPD) a breathing technique to help relieve dyspnea by maintaining positive airway pressure during exhalation and preventing premature airway collapse. Which of the following techniques BEST accomplishes this goal?

Answer: Pursed-lip breathing

Pursed-lip breathing is the most effective technique for patients with obstructive lung disease like COPD to manage dyspnea. By exhaling slowly through pursed lips, it creates a back-pressure (positive end-expiratory pressure or PEEP) that helps keep the smaller airways from collapsing, allowing for more complete emptying of trapped air.

A physical therapist calculates the Ankle-Brachial Index (ABI) for a patient complaining of intermittent claudication. The highest systolic pressure in the right arm is 150 mmHg, and the highest systolic pressure in the left arm is 144 mmHg. The highest systolic pressure in the right ankle (dorsalis pedis) is 90 mmHg. What is the patient's right ABI, and how is it classified?

Answer: 0.60, classified as moderate peripheral artery disease.

The ABI is calculated by dividing the highest ankle systolic pressure by the highest brachial systolic pressure from either arm. In this case, Right ABI = 90 mmHg / 150 mmHg = 0.60. An ABI value between 0.41 and 0.70 is typically classified as moderate peripheral artery disease (PAD).

A patient is admitted to the hospital with a suspected acute myocardial infarction (MI). The physical therapist reviews the patient's lab values in the electronic medical record. Which of the following cardiac biomarkers is the most sensitive and specific for myocardial cell death, making it the gold standard for diagnosing an MI?

Answer: Cardiac Troponin (cTnI or cTnT)

Cardiac troponins (I and T) are regulatory proteins that are highly specific to cardiac muscle. When myocardial necrosis occurs, troponins are released into the bloodstream and remain elevated for several days. Their high sensitivity and specificity make them the preferred and gold-standard biomarker for diagnosing acute MI. While CK-MB was previously used, it is less specific, and myoglobin is not specific to cardiac muscle.

A physical therapist plans to perform postural drainage on a patient to clear secretions from the posterior basal segments of the lower lobes. Which is the MOST appropriate patient position to target these specific lung segments?

Answer: Prone with the foot of the bed elevated 18 inches.

To drain the posterior basal segments of the lower lobes using gravity, the patient should be positioned prone (on their stomach) in a Trendelenburg position, with the foot of the bed or table elevated approximately 18-20 inches (about 30 degrees). This orients the target segments vertically to allow secretions to move towards the larger airways.