PCE PCE Cardiopulmonary and Special Populations 2 — Questions and Answers
Question 1: During a cardiac rehabilitation session, a patient's heart rate increases from 70 bpm at rest to 145 bpm during moderate exercise. Using the Karvonen formula with a maximum heart rate of 170 bpm, what is the approximate exercise intensity as a percentage of heart rate reserve?
- 55%
- 65%
- 75% (Correct answer)
- 85%
Correct answer: 75%
Heart rate reserve = 170 − 70 = 100 bpm; target HR above rest = 145 − 70 = 75 bpm; intensity = 75/100 = 75% of HRR.
Question 2: A physiotherapist assesses a patient with lymphedema of the left arm following breast cancer treatment. Which treatment approach is considered the gold standard?
- High-intensity resistive arm exercises only
- Complete Decongestive Therapy (CDT) including manual lymphatic drainage and compression bandaging (Correct answer)
- Diuretic medication as primary intervention
- Surgical lymph node transplant as first-line therapy
Correct answer: Complete Decongestive Therapy (CDT) including manual lymphatic drainage and compression bandaging
Complete Decongestive Therapy (CDT), comprising manual lymphatic drainage, multilayer compression bandaging, exercise, and skin care, is the evidence-based gold standard for lymphedema management.
Question 3: When treating a geriatric patient with osteoporosis, which type of exercise is most important to include for both bone density maintenance and fall prevention?
- Non-weight-bearing aquatic exercise exclusively
- Sedentary activities only to reduce fracture risk
- Weight-bearing and progressive resistance exercises (Correct answer)
- Stretching in bed without ambulation
Correct answer: Weight-bearing and progressive resistance exercises
Weight-bearing and progressive resistance exercises stimulate bone remodeling, improve muscle strength, and enhance balance, addressing both bone density and fall risk in osteoporotic patients.
Question 4: A physiotherapist assesses a stroke patient with left hemiplegia using the Brunnstrom Stages of Recovery. The patient can perform voluntary movements only in synergy patterns. Which stage does this represent?
- Stage 1 — Flaccidity
- Stage 2 — Spasticity begins
- Stage 3 — Voluntary movement in synergy (Correct answer)
- Stage 4 — Movement out of synergy begins
Correct answer: Stage 3 — Voluntary movement in synergy
Brunnstrom Stage 3 is characterized by the ability to perform voluntary movement, but only within stereotyped flexion or extension synergy patterns, with spasticity at its peak.
Question 5: Which precaution is most critical when performing chest physiotherapy in a patient who has recently undergone coronary artery bypass graft (CABG) surgery?
- Avoid all positioning changes for 12 weeks
- Support the sternal incision site during coughing and breathing exercises (Correct answer)
- Perform vigorous percussion over the sternum to clear secretions
- Restrict respiratory exercises until 6 months post-surgery
Correct answer: Support the sternal incision site during coughing and breathing exercises
Following CABG, the sternotomy incision requires support (e.g., a pillow held against the chest) during coughing or deep breathing to reduce pain and protect the healing sternal closure.
Question 6: In the management of Type 2 diabetes, which physiotherapy-relevant effect of aerobic exercise is most significant for glycemic control?
- Increased hepatic glucose production during exercise
- Enhanced insulin-independent glucose uptake via GLUT-4 translocation in muscle (Correct answer)
- Decreased peripheral insulin sensitivity post-exercise
- Reduced pancreatic beta-cell function with regular training
Correct answer: Enhanced insulin-independent glucose uptake via GLUT-4 translocation in muscle
Aerobic exercise promotes GLUT-4 translocation to the muscle cell membrane, enabling insulin-independent glucose uptake, which directly improves glycemic control in Type 2 diabetes.
PCE PCE Cardiopulmonary and Special Populations 2
During a cardiac rehabilitation session, a patient's heart rate increases from 70 bpm at rest to 145 bpm during moderate exercise.
Using the Karvonen formula with a maximum heart rate of 170 bpm, what is the approximate exercise intensity as a percentage of heart rate reserve?