NPTE-PT Cardiovascular and Pulmonary PT 5 — Questions and Answers
Question 1: A patient's chest X-ray shows a mediastinal shift toward the affected side with ipsilateral hemidiaphragm elevation. Which condition is MOST consistent with these findings?
- Tension pneumothorax
- Large pleural effusion
- Lobar atelectasis (Correct answer)
- Emphysema
Correct answer: Lobar atelectasis
Lobar atelectasis (lung collapse) pulls the mediastinum toward the collapsed lobe due to volume loss, unlike pneumothorax or effusion which push it away.
Question 2: Which exercise intensity zone is RECOMMENDED for most patients in Phase II cardiac rehabilitation according to American Heart Association guidelines?
- 40-50% of heart rate reserve
- 50-80% of heart rate reserve (Correct answer)
- 80-90% of heart rate reserve
- Less than 40% of heart rate reserve
Correct answer: 50-80% of heart rate reserve
Phase II cardiac rehabilitation targets 50-80% of heart rate reserve (or VO2 reserve) to provide a safe and effective cardiovascular training stimulus.
Question 3: A patient with pulmonary hypertension is MOST at risk for which complication during vigorous exercise?
- Bronchospasm and wheezing
- Right heart failure and syncope (Correct answer)
- Spontaneous pneumothorax
- Ventricular tachycardia from ischemia
Correct answer: Right heart failure and syncope
Pulmonary hypertension imposes severe afterload on the right ventricle; vigorous exercise can precipitate acute right heart failure and syncope due to inability to augment cardiac output.
Question 4: Which diaphragm position finding on chest X-ray is MOST characteristic of severe emphysema?
- Elevated hemidiaphragms bilaterally
- Flattened hemidiaphragms bilaterally (Correct answer)
- Right hemidiaphragm 2 cm higher than left
- Scalloped diaphragm contour
Correct answer: Flattened hemidiaphragms bilaterally
Severe emphysema causes air trapping and hyperinflation, which pushes the diaphragms inferiorly and flattens their domes bilaterally on chest X-ray.
Question 5: A therapist observes paradoxical inward movement of the abdomen during inspiration in a supine patient. This sign indicates dysfunction of which muscle?
- External intercostals
- Serratus anterior
- Diaphragm (Correct answer)
- Scalenes
Correct answer: Diaphragm
When the diaphragm is weak or paralyzed, it is drawn upward during inspiration by negative intrathoracic pressure, causing paradoxical inward abdominal movement.
Question 6: Which of the following is the CORRECT interpretation of SpO2 = 88% in a patient with COPD on room air?
- Normal finding acceptable for COPD patients requiring no intervention
- Mild hypoxemia; supplemental oxygen is beneficial but not urgently required
- Significant hypoxemia meeting threshold criteria for supplemental oxygen therapy (Correct answer)
- Severe hypoxemia indicating imminent respiratory failure requiring mechanical ventilation
Correct answer: Significant hypoxemia meeting threshold criteria for supplemental oxygen therapy
SpO2 ≤88% (corresponding to PaO2 ≤55 mmHg) meets the threshold for long-term supplemental oxygen therapy in COPD per established guidelines.
Question 7: During percussion of a patient's chest, the PT notes a dull sound over the right lower lobe base. This finding is MOST consistent with which condition?
- Pneumothorax
- Emphysema
- Pleural effusion or consolidation (Correct answer)
- Normal lung parenchyma
Correct answer: Pleural effusion or consolidation
Dull percussion notes replace the normal resonance when fluid (pleural effusion) or solid tissue (consolidation, atelectasis) replaces air-filled lung tissue.
NPTE-PT Cardiovascular and Pulmonary PT 5
A patient's chest X-ray shows a mediastinal shift toward the affected side with ipsilateral hemidiaphragm elevation.
Which condition is MOST consistent with these findings?