DPT Cardiovascular & Pulmonary PT 2 — Questions and Answers
Question 1: A patient with COPD has a resting SpO2 of 88%. During ambulation, SpO2 drops to 82%. What is the most appropriate immediate action?
- Continue ambulation and reassess in 2 minutes
- Stop activity and apply supplemental oxygen (Correct answer)
- Reduce walking speed by 50% and monitor
- Discontinue PT services for the day
Correct answer: Stop activity and apply supplemental oxygen
SpO2 below 88% during exercise warrants stopping activity and applying supplemental oxygen to prevent hypoxic complications.
Question 2: Which auscultation finding is most consistent with a left ventricular S3 heart sound in a patient with heart failure?
- A high-pitched sound best heard at the aortic area
- A low-pitched early diastolic sound best heard at the apex (Correct answer)
- A mid-systolic click at the left sternal border
- A late diastolic sound heard with the bell at the base
Correct answer: A low-pitched early diastolic sound best heard at the apex
An S3 is a low-pitched early diastolic sound (ventricular gallop) best heard at the cardiac apex with the bell of the stethoscope.
Question 3: A patient post-CABG is 4 days post-op. Which sternal precaution is MOST critical during upper extremity exercises?
- Avoid shoulder flexion beyond 90 degrees bilaterally
- Limit bilateral shoulder abduction to 45 degrees
- Avoid resisted bilateral upper extremity pushing or pulling (Correct answer)
- Restrict cervical rotation to prevent sternal stress
Correct answer: Avoid resisted bilateral upper extremity pushing or pulling
Resisted bilateral UE activities (pushing/pulling) create the greatest sternal stress and risk sternal dehiscence in early post-CABG recovery.
Question 4: When using the Borg Rating of Perceived Exertion (RPE) scale during cardiac rehab, which RPE range corresponds to moderate intensity exercise?
- 6-9
- 10-11
- 12-14 (Correct answer)
- 15-17
Correct answer: 12-14
An RPE of 12-14 ('somewhat hard') on the 6-20 Borg scale corresponds to moderate intensity exercise, roughly 60-70% of HRmax.
Question 5: A patient with pulmonary fibrosis demonstrates a restrictive ventilatory pattern. Which PFT findings are expected?
- Decreased FVC, normal FEV1/FVC ratio, decreased TLC (Correct answer)
- Decreased FEV1, decreased FEV1/FVC ratio, normal TLC
- Normal FVC, decreased FEV1, decreased FEV1/FVC ratio
- Increased RV, decreased FVC, normal FEV1/FVC ratio
Correct answer: Decreased FVC, normal FEV1/FVC ratio, decreased TLC
Restrictive lung disease shows decreased FVC and TLC with a preserved or elevated FEV1/FVC ratio, unlike the obstructive pattern.
Question 6: Which positioning strategy best reduces work of breathing for a patient with acute decompensated heart failure and orthopnea?
- Supine with legs elevated 30 degrees
- High Fowler's position (60-90 degrees) (Correct answer)
- Left lateral decubitus with head flat
- Prone positioning with pillow support
Correct answer: High Fowler's position (60-90 degrees)
High Fowler's position reduces venous return, decreases preload, and lowers the diaphragm to improve breathing mechanics in heart failure.
Question 7: A 65-year-old cardiac patient is on a beta-blocker. How should the physical therapist modify exercise intensity prescription?
- Use target heart rate based on age-predicted HRmax without modification
- Add 20 bpm to the calculated target heart rate to compensate
- Use RPE scale rather than heart rate as the primary intensity guide (Correct answer)
- Reduce exercise duration by 50% to account for blunted HR response
Correct answer: Use RPE scale rather than heart rate as the primary intensity guide
Beta-blockers blunt the heart rate response to exercise, making RPE a more reliable intensity indicator than heart rate targets.
DPT Cardiovascular & Pulmonary PT 2
A patient with COPD has a resting SpO2 of 88%.
During ambulation, SpO2 drops to 82%.
What is the most appropriate immediate action?