Cardiovascular and Pulmonary PT Flashcards

A patient with COPD demonstrates pursed-lip breathing during exertion. What is the PRIMARY physiological benefit of this technique?

Answer: Creates back-pressure to prevent early airway collapse

Pursed-lip breathing creates positive back-pressure during exhalation, preventing dynamic airway collapse and promoting more complete emptying of air trapping.

Which ECG finding is MOST consistent with left ventricular hypertrophy?

Answer: Tall R waves in V5-V6 with deep S waves in V1-V2

Left ventricular hypertrophy produces tall R waves in lateral leads (V5-V6) and deep S waves in right precordial leads (V1-V2) due to the enlarged left ventricular mass.

A PT is treating a post-MI patient who suddenly develops a respiratory rate of 32 breaths/min, crackles bilaterally, and frothy pink sputum. Which condition does this BEST represent?

Answer: Acute pulmonary edema

Frothy pink sputum, bilateral crackles, and tachypnea following MI indicate acute pulmonary edema due to left heart failure and fluid extravasation into alveoli.

During a 6-minute walk test, a patient's SpO2 drops from 96% to 87%. What is the MOST appropriate PT action?

Answer: Stop the test and administer supplemental oxygen if available

A drop in SpO2 below 88% is a standard criterion to stop the 6MWT and apply supplemental oxygen per established safety guidelines.

Which breathing exercise is MOST appropriate for a patient with a flail chest to improve ventilatory mechanics?

Answer: Diaphragmatic breathing with manual stabilization

Manual stabilization of the paradoxical segment during diaphragmatic breathing reduces the inefficiency caused by the floating chest wall segment in flail chest.

A patient status post-coronary artery bypass graft (CABG) has sternal precautions. Which activity is CONTRAINDICATED in early rehabilitation?

Answer: Pushing up from a chair using both arms simultaneously

Pushing up with both arms simultaneously creates bilateral sternal stress and risks sternal dehiscence, which is contraindicated with sternal precautions after CABG.

Which pulmonary function test pattern is characteristic of restrictive lung disease?

Answer: Decreased FVC with normal or increased FEV1/FVC ratio

Restrictive disease reduces lung volumes including FVC, but since both FEV1 and FVC are proportionally reduced, the FEV1/FVC ratio remains normal or elevated.

A physical therapist auscultates a patient's chest and hears a high-pitched, musical wheeze during expiration. Which condition is this finding MOST consistent with?

Answer: Asthma or bronchospasm

High-pitched expiratory wheezing (sibilant rhonchi) results from narrowed lower airways during expiration, which is characteristic of bronchospasm in conditions like asthma.

At what heart rate threshold should a PT terminate exercise in a patient on a beta-blocker, given the Karvonen formula cannot be used reliably?

Answer: Rate of perceived exertion of 13-15 on the Borg scale

Beta-blockers blunt the heart rate response, making HR-based targets unreliable; RPE (Borg scale 13-15) is the preferred exercise intensity guide in these patients.

Which chest drainage position is MOST appropriate for draining the right middle lobe in postural drainage?

Answer: Left side-lying with the head of bed down 15 degrees

The right middle lobe drains optimally in the left side-lying position with slight head-down tilt (Trendelenburg), directing secretions toward the right mainstem bronchus.

A patient with heart failure has a New York Heart Association (NYHA) Class III classification. What does this indicate about their functional capacity?

Answer: Symptoms with ordinary activity; marked limitation

NYHA Class III denotes marked limitation of physical activity, with symptoms occurring during ordinary activity such as walking short distances, though comfortable at rest.

A patient presents with tracheal deviation toward the right, absent breath sounds on the right, and hemodynamic instability. Which emergency condition is MOST likely?

Answer: Tension pneumothorax on the left side

Tension pneumothorax on the left shifts the trachea and mediastinum away from the affected side (toward the right) and is a life-threatening emergency requiring immediate intervention.

Which outcome measure is MOST appropriate to assess functional exercise capacity in a patient with chronic heart failure?

Answer: 6-Minute Walk Test (6MWT)

The 6MWT is a validated, submaximal functional exercise test that correlates with peak VO2 and clinical outcomes in heart failure populations.

Which of the following is an absolute contraindication to initiating cardiopulmonary physical therapy?

Answer: Unstable angina with recent pain at rest

Unstable angina with rest pain indicates critical myocardial ischemia and is an absolute contraindication to exercise or physical therapy until medically stabilized.

A patient with chronic bronchitis has copious, thick secretions. Which airway clearance technique uses high-frequency chest wall oscillation to mobilize secretions?

Answer: The Vest airway clearance system

The Vest (high-frequency chest wall oscillation device) uses an inflatable vest to deliver rapid chest wall compressions that loosen and mobilize secretions toward central airways.

During cardiac rehabilitation, a patient's blood pressure drops 20 mmHg systolic during low-intensity exercise. What is the MOST appropriate response?

Answer: Stop exercise immediately and assess the patient

A systolic BP drop of ≥10 mmHg during exercise (especially with symptoms) is an indication to stop exercise immediately and evaluate for hemodynamic compromise.

Which of the following is the CORRECT interpretation of a PaO2 of 55 mmHg and PaCO2 of 55 mmHg on arterial blood gas?

Answer: Hypoxemia with hypercapnic respiratory failure

PaO2 of 55 mmHg indicates hypoxemia and PaCO2 of 55 mmHg indicates CO2 retention (hypercapnia), together consistent with type II (hypercapnic/ventilatory) respiratory failure.

A physical therapist notes that a patient's peripheral edema worsens in the afternoon and improves after overnight rest. This pattern is MOST consistent with which condition?

Answer: Chronic venous insufficiency

Gravity-dependent edema that worsens with prolonged standing and resolves with elevation overnight is the classic presentation of chronic venous insufficiency.

Which heart sound is associated with a stiff, noncompliant left ventricle and is heard early in diastole?

Answer: S4 gallop

S4 is a late diastolic sound produced when atrial contraction forces blood into a stiff, noncompliant ventricle; it is associated with hypertensive heart disease and hypertrophy.

A patient with cystic fibrosis performs the active cycle of breathing technique (ACBT). What is the CORRECT order of components?

Answer: Breathing control → thoracic expansion exercises → forced expiration technique

ACBT follows the sequence: breathing control (relaxed tidal breathing) → thoracic expansion exercises (deep breaths) → forced expiration technique (huffing), repeated cyclically.