Essentials of Cardiopulmonary Physical Therapy 3rd Edition by Hillegass – Test Bank
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Hillegass: Essentials of Cardiopulmonary Physical Therapy, 3rd Edition
Chapter 3: Ischemic Cardiovascular Conditions and Other Vascular
Pathologies
Test Bank
MULTIPLE CHOICE
1. The
presence of an obstruction that causes permanent damage to heart muscle fibers
downstream, thus inhibiting heart muscle function, is BEST termed which of the
following:
|
A. |
Angina pectoris |
|
B. |
Coronary artery disease |
|
C. |
Coronary heart disease |
|
D. |
Atherosclerosis |
ANS: C
As a direct result of the work of Enos and co-workers, the
medical community now distinguishes coronary artery disease (CAD––the presence
of an obstruction that limits coronary blood flow but does not significantly
inhibit heart muscle function) from coronary heart disease (CHD––the presence
of an obstruction that causes permanent damage to heart muscle fibers
downstream, thus inhibiting heart muscle function).
PTS: 1
2. Which
of the following layers of the coronary arteries is responsible for making
adjustments to the luminal diameter?
|
A. |
Adventitia |
|
B. |
Media |
|
C. |
Intima |
|
D. |
All of the above |
ANS: B
In the middle layer (media), through alterations in vasomotor
tome, as demands for changes in blood flow to the myocardium are perceived,
this muscular layer (multiple layers of smooth muscle cells) is responsible for
making adjustments to the luminal diameter.
PTS: 1
3. Which
of the following layers of the coronary arteries is selectively permeable to
low-density lipoprotein (LDL) leading to the possible development of myocardial
ischemia?
|
A. |
Adventitia |
|
B. |
Media |
|
C. |
Intima |
|
D. |
None of the above |
ANS: C
The arterial endothelium is selectively permeable to
macromolecules of the size of a low-density lipoprotein (LDL). This
permeability may lead to the development of processes associated with
myocardial ischemia.
PTS: 1
4. Which
of the following statements BEST explains how myocardium tissue perfusion
occurs primarily during periods of muscle relaxation (diastole)?
|
A. |
All fluids follow the path
of least resistance and flow from higher to lower pressure. |
|
B. |
The right ventricle has a
lower pressure than the left ventricle during systole resulting in less
difference in blood flow in the right coronary artery between systole and
diastole. |
|
C. |
During diastole, full
coronary arteries create high pressures, driving blood into the myocardium
when intramyocardial pressure drops. |
|
D. |
When the aortic valve
closes, pressure is transmitted through dilated Valsalva sinuses to openings
of coronary arteries. |
ANS: C
Statements A, B, and D all relate to preliminary processes that
lead to coronary artery filling, but statement C discusses specifically how a
high- to low-pressure gradient is created during diastole leading to enhanced
blood flow into the myocardium tissue.
PTS: 1
5. In a
patient with coronary artery disease, beta-blocking medications may be
prescribed. Which of the following statements BEST describes the reasoning?
|
A. |
Beta-blockers lower resting
heart rate, increasing diastolic filling time |
|
B. |
Beta-blockers lower the
intramyocardial pressures, increasing muscle relaxation |
|
C. |
Beta-blockers lower the vasomotor
tone in the media, increasing the diameter of the artery |
|
D. |
Beta-blockers lower the
aortic pressure during systole, increasing blood flow to coronary arteries |
ANS: A
Beta-blocking medications may optimize the filling of the coronary
arteries in individuals with disease by lowering the resting and exercise heart
rates, therefore increasing diastolic filling time.
PTS: 1
6. Which
of the following determinants of myocardial blood flow will cause occlusive
forces on the capillary beds of the endocardium if elevated?
|
A. |
Diastolic blood pressure |
|
B. |
Vasomotor tone |
|
C. |
Resistance to flow |
|
D. |
Left ventricular
end-diastolic pressure |
ANS: D
LVEDP is the pressure within the ventricle at the end of
diastole; it causes an occlusive force on the capillary beds of the muscle
closest to the pumping chamber, the endocardium.
PTS: 1
7. Which
of the following determinants of myocardial blood flow will inhibit flow of
blood to the myocardium?
|
A. |
Increased diastolic blood
pressure |
|
B. |
Increased vasomotor tone |
|
C. |
Decreased vasomotor tone |
|
D. |
Lower left ventricular
end-diastolic pressure |
ANS: B
Increased vasomotor tone will cause constriction, which will
inhibit blood flow. Increased diastolic blood pressure, decreased vasomotor
tone, and lower left-ventricular end-diastolic pressure all enhance blood flow.
PTS: 1
8. The
processes of atherosclerosis development occur in which of the following
arterial layers?
|
A. |
Adventitia |
|
B. |
Media |
|
C. |
Intima |
|
D. |
All of the above |
ANS: C
Atherosclerosis consists of two processes, atherosis and
sclerosis, that occur within the intima and endothelium of arterial walls.
PTS: 1
9. The
accumulation of lipids by monocytes between endothelial cells is termed:
|
A. |
Foam cells |
|
B. |
Fibrous cap |
|
C. |
Thrombus |
|
D. |
Sclerosis |
ANS: A
Clusters of monocytes have been found in junctional areas,
between endothelial cells, where they accumulate lipid and are known as foam
cells.
PTS: 1
10. Which
of the following is characteristic of the “sclerotic” phase of atherosclerosis?
|
A. |
Fatty streaks in the artery |
|
B. |
Accumulation of lipid by
monocytes |
|
C. |
Stretched endothelium by
enlarging foam cells |
|
D. |
Aggregation of platelets
forming a thrombus |
ANS: D
When the endothelium is overstretched enough to cause an
intima-based lesion, exposing the underlying connective tissue to the
circulation, platelets aggregate forming a thrombus. The formation of a thrombus
is characteristic of the “sclerotic” phase. Answers A, B, and C describe
processes occurring in the “atherosis” phase.
PTS: 1
11. Which
of the following risk factors is considered nonmodifiable?
|
A. |
Cigarette smoking |
|
B. |
High blood pressure |
|
C. |
Increased age |
|
D. |
Physical inactivity |
ANS: C
Modifiable risk factors include cigarette/tobacco smoking, high
blood pressure, high blood cholesterol levels, and physical inactivity.
Nonmodifiable risk factors include heredity, male sex, and increased age.
PTS: 1
12. Which
of the following risk factors has been shown to be associated with
leukocytosis, lower serum high-density lipoprotein, elevated fibrinogen and
plasma catecholamine levels, and increased blood pressure?
|
A. |
Elevated cholesterol |
|
B. |
Physical inactivity |
|
C. |
Diabetes |
|
D. |
Cigarette smoking |
ANS: D
In comparison to nonsmokers, smokers have been shown to manifest
leukocytosis, lower serum high-density lipoprotein levels, elevated fibrinogen
and plasma catecholamine levels, and increased blood pressure.
PTS: 1
13. Which
of the following blood pressure recordings would be considered hypertensive?
|
A. |
132/85 |
|
B. |
142/95 |
|
C. |
119/78 |
|
D. |
128/88 |
ANS: B
Hypertension, both systolic (over 140 mm Hg) and diastolic (over
90 mm Hg), is believed to be an independent risk factor for development of CAD
and peripheral and cerebral vascular disease. Some new standards report
systolic pressure of 120 or higher and diastolic of 80 or higher as
prehypertension, but this question asked about hypertension.
PTS: 1
14. Which
of the following ratios is the BEST predictor for developing
cholesterol-related blockages in an artery?
|
A. |
Total
cholesterol/high-density lipoproteins |
|
B. |
Total cholesterol/low-density
lipoproteins |
|
C. |
Triglycerides/high-density
lipoproteins |
|
D. |
Gram level of saturated
fat/mg level of cholesterol |
ANS: A
The best predictor of risk for developing cholesterol-related
blockages in an artery is the ration of total cholesterol to HDL; a ratio of
greater than 4.5 increases an individual’s risk of developing atherosclerosis.
PTS: 1
15. In a
patient with diabetes, which of the following physiological changes is a result
of increased glycosylation?
|
A. |
Increase sensitivity to
enzymes |
|
B. |
Elevated high-density
lipoprotein |
|
C. |
Enhanced fibrin degrading
by fibrinogen |
|
D. |
Enhanced thrombus formation |
ANS: D
Nonenzymatic glycosylation, or the chemical attachment of
glucose to proteins without the involvement of enzymes, is known to affect
fibrogen, collagen, antithrombin III, HDL, and LDL, all of which are involved
in the evolution of CAD. The attachment of glucose to these molecules renders
them less sensitive to the enzymes and other substances with which they
interact. Thrombus formation enhanced via antithrombin III activity is
decreased and fibrinogen is less likely to perform it function of degrading
fibrin.
PTS: 1
16. In an
older adult aged 70 years without known disease, which of the following
interventions would have the HIGHEST impact on reducing the risk for coronary
heart disease similar to younger subjects?
|
A. |
Age is too strong of a risk
factor; therefore overall risk could not be altered. |
|
B. |
Have the older adult follow
a low carbohydrate diet |
|
C. |
Encourage the older adult
to walk daily for a minimum of 30 minutes |
|
D. |
Have the older adult
consume a low dose of aspirin daily |
ANS: C
Studies have shown that interventions on other risk factors have
proved to be beneficial in older subsets of patients and have resulted in the
reduction of clinical end points, for example, myocardial infarction and
symptoms. Age is not a strong enough factor to be an independent predictor of
heart disease risk. A low carbohydrate diet potentially will increase saturated
fats. Increasing physical activity would have a greater impact on risk factors
than taking a low dose of aspirin.
PTS: 1
17. Which
of the following factors is defined as a type of amino acid found in blood that
when elevated has been linked to increased risk for development of
cardiovascular diseases?
|
A. |
C-reactive protein |
|
B. |
Homocysteine |
|
C. |
Factor VII |
|
D. |
Lipoprotein a (Lpa) |
ANS: B
Homocysteine, which is a type of amino acid found in the blood,
has been linked to an increased risk for the development of cardiovascular
diseases when the levels in the blood are elevated.
PTS: 1
18. Which
of the following interventions would result in the highest survival rate from
ventricular fibrillation sudden cardiac arrest?
|
A. |
Entry into emergency
medical system within 15 minutes |
|
B. |
Administration of CPR
within 10 minutes |
|
C. |
Immediate CPR and AED shock
within 3–5 minutes |
|
D. |
AED shock within 15 minutes |
ANS: C
Early CPR and rapid defibrillation combined with early advanced
care can produce high long-term survival rates for witnessed cardiac arrest. If
bystanders provide immediate CPR and the first shock is delivered within 3–5
minutes, the reported survival rates from ventricular fibrillation cardiac
arrest are as high as 48–74 percent.
PTS: 1
19. Which
of the following monitoring tools is MOST useful to the clinician when
attempting to correlate functional activities and myocardial capabilities in a
patient diagnosed with chronic stable angina?
|
A. |
Product of exercise HR and
systolic BP |
|
B. |
Maximum heart rate during
specific activity |
|
C. |
Systolic blood pressure at
end of activity |
|
D. |
Highest rating of perceived
exertion (RPE) |
ANS: A
The double product or rate pressure product (HR × Systolic BP)
is an index that is useful in correlating functional activities with myocardial
capabilities. Rate pressure product is closely related to myocardial oxygen
demand and chronic stable angina results from an imbalance in supply and demand
of myocardial oxygen.
PTS: 1
20. Which
of the following clinical cues exhibited by a patient with stable angina should
alert the healthcare provider to notify the patient’s physician?
|
A. |
Reports chest discomfort in
morning that was relieved with minor activity |
|
B. |
Reports chest discomfort
several times a week |
|
C. |
Reports chest discomfort at
a lower level of activity than usual |
|
D. |
Reports chest discomfort
resolution with rest or decrease of activity intensity |
ANS: C
Clinical clues to the development of unstable angina that should
alert the health professional to notify the patient’s physician include angina
at rest, occurrence of typical angina at lower level of activity than usual,
angina several times a day versus a week, evidence of loss of previously
present myocardial reserve, or angina that occurs in the morning that is worse
with minor activity.
PTS: 1
21. Which
of the following clinical signs/symptoms is MOST characteristic of ST segment
elevation myocardial injury (STEMI)?
|
A. |
Q wave infarction occurring
distal to a totally occluded coronary artery |
|
B. |
Non-Q wave infarction
affecting subendocardial region |
|
C. |
Blood flow interruption is
less than 30 minutes |
|
D. |
Coronary arteries are not
completely blocked |
ANS: A
STEMI will have ST elevation that develops a Q wave on ECG in
the subsequent 24–48 hours. Typically a STEMI with transmural injury occurs
distal to a totally occluded coronary artery.
PTS: 1
22. Which
of the following pathological myocardium changes results in an exaggerated and
early peak value of substances such as CK-MD and cardiac-specific troponin T
and I?
|
A. |
Development of coagulative
necrosis with contraction bands in myocardial tissue |
|
B. |
Occurrence of hemorrhage
within zones of irreversibly injured myocytes |
|
C. |
Mitochondria in necrotic
areas developing calcium phosphate deposits |
|
D. |
Reperfusion of myocardium
promotes removal of intracellular proteins |
ANS: D
If reperfusion of myocardium undergoing pathological changes
from ischemia to infarction occurs sufficiently early (15–20 minutes), it can
successfully prevent necrosis from developing. After reperfusion, when areas
have become necrotic, mitochondria may develop deposits of calcium phosphate.
Reperfusion of infracted myocardium also promotes removal of intracellular
proteins, resulting in an exaggerated and early peak value of substances such
as CK-MB and cardiac-specific troponin T and I.
PTS: 1
23. Which
of the following medical interventions targets prophylaxis for arrhythmias?
|
A. |
Use of nitrates |
|
B. |
Use of fibrinolysis |
|
C. |
Use of lidocaine |
|
D. |
Use of morphine |
ANS: C
Fibrinolysis is used to provide early reperfusion. Cardiac pain
is controlled with nitrates, morphine, and beta-blockers. Prophylaxis for
arrhythmias is accomplished with the use of lidocaine or amiodorone.
PTS: 1
24. Which
of the following factors would be MOST associated with a good prognosis
post-myocardial infarction?
|
A. |
Development of atrial
fibrillation |
|
B. |
Persistent systolic
hypotension (<90 mm Hg) |
|
C. |
Elevation of left
ventricular end-diastolic pressure |
|
D. |
Small infarction size with
increase in scar formation |
ANS: D
An individual’s prognosis post-MI is related to the
complications, infarction size, presence of disease in other coronary arteries,
and most importantly left ventricular function. Answers A, B, and C reflect
complications and left ventricular failure and therefore are associated with
poorer prognosis. Answer D is associated with a better prognosis due to the
small size of the infarction and improved remodeling indicated by increased
scar formation.
PTS: 1
25. Which
of the following pathological changes is MOST associated with diastolic dysfunction
in hypertensive heart disease?
|
A. |
Impairment of left
ventricular relaxation leading to stiffer left ventricle |
|
B. |
Subnormal left ventricular
functional reserve during exercise |
|
C. |
Impairment of ventricular
contraction |
|
D. |
Increase in end-systolic
volume |
ANS: A
Diastolic dysfunction refers to changes in ventricular diastolic
properties that lead to an impairment in ventricular filling (reduction in
ventricular compliance) and an impairment in ventricular relaxation. A
consequence of diastolic dysfunction is the rise in end-diastolic pressure.
Systolic dysfunction refers to an impairment in ventricular contraction,
resulting in a decrease in stroke volume and decrease in ejection fraction. An
increase in
end-systolic volume will also occur.
PTS: 1
26. A
56-year-old male with a history of obesity, type II diabetes, and a high stress
management occupation is scheduled for a physical therapy evaluation for
treatment of low back pain. As a physical therapist which of the following
guidelines is MOST appropriate to follow during the initial and subsequent
physical therapy sessions?
|
A. |
Monitor BP at rest and
during exercise for at least the first three to four sessions. |
|
B. |
If BP is normal or
unremarkable at rest during the evaluation, there is no need to continue
monitoring. |
|
C. |
It is recommended the
patient stop his medication for blood pressure that results in unpleasant
side effects. |
|
D. |
It is recommended the PT
only provide manual therapy to the patient if his resting BP is 200/100. |
ANS: A
Due to BP values varying considerably during the day, it is
recommended the PT monitor BP for two to three different treatment sessions
both at rest and during activity. Answers B, C, and D are incorrect due to the
need to monitor BP regularly. A patient should be encouraged to visit with the
physician before stopping any prescribed medication, and no intervention should
be provided if the patient has an excessively high resting BP.
PTS: 1
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