DPT Cardiovascular & Pulmonary PT 4 — Questions and Answers
Question 1: A patient with COPD is prescribed pursed-lip breathing. What is the primary physiological mechanism by which this technique improves oxygenation?
- It increases inspiratory muscle strength over time
- It creates back pressure that prevents dynamic airway collapse during expiration (Correct answer)
- It increases the rate of carbon dioxide elimination
- It recruits accessory muscles to augment tidal volume
Correct answer: It creates back pressure that prevents dynamic airway collapse during expiration
Pursed-lip breathing creates positive expiratory pressure that splints open collapsible airways, prolonging expiration and reducing air trapping.
Question 2: Which ECG finding during a graded exercise test is considered a significant positive finding for myocardial ischemia?
- Sinus tachycardia with HR exceeding 150 bpm
- Horizontal or downsloping ST depression of ≥1 mm (Correct answer)
- Premature atrial contractions increasing with exercise
- Increase in P wave amplitude in inferior leads
Correct answer: Horizontal or downsloping ST depression of ≥1 mm
Horizontal or downsloping ST depression ≥1 mm during exercise testing is the classic ECG criterion for exercise-induced myocardial ischemia.
Question 3: A patient with lymphedema of the left arm is being seen for cardiac rehab after left-sided breast cancer treatment. Which intervention is CONTRAINDICATED?
- Complete decongestive therapy with multilayer bandaging
- Compression garments during aerobic exercise
- Vigorous vigorous heat application to the affected limb (Correct answer)
- Progressive resistive exercise with compression garment
Correct answer: Vigorous vigorous heat application to the affected limb
Heat increases lymphatic production and vasodilation, exacerbating lymphedema; heat application to a lymphedematous limb is contraindicated.
Question 4: What is the primary purpose of the inspiratory-to-expiratory (I:E) ratio adjustment in mechanical ventilation weaning?
- Increase mean airway pressure to recruit atelectatic alveoli
- Allow adequate expiration time to prevent intrinsic PEEP in obstructive disease (Correct answer)
- Reduce patient discomfort by synchronizing with natural breathing pattern
- Decrease FiO2 requirements by improving alveolar ventilation
Correct answer: Allow adequate expiration time to prevent intrinsic PEEP in obstructive disease
In obstructive lung disease, prolonging expiration time (I:E ratio of 1:3 or greater) prevents air trapping and intrinsic PEEP formation.
Question 5: A patient with cor pulmonale demonstrates jugular venous distension, peripheral edema, and hepatomegaly. Which chamber is primarily affected?
- Left atrium due to mitral regurgitation
- Left ventricle due to systolic dysfunction
- Right ventricle due to chronic pulmonary hypertension (Correct answer)
- Both ventricles equally due to biventricular failure
Correct answer: Right ventricle due to chronic pulmonary hypertension
Cor pulmonale is right ventricular hypertrophy and failure resulting from chronic pulmonary hypertension secondary to lung disease.
Question 6: Which breath sound is described as a continuous, musical, high-pitched sound heard primarily during expiration and indicates airway narrowing?
- Crackles (rales)
- Rhonchi
- Wheeze (Correct answer)
- Stridor
Correct answer: Wheeze
Wheezes are continuous, high-pitched musical sounds caused by turbulent airflow through narrowed airways, heard primarily during expiration in asthma or COPD.
Question 7: During postural drainage for a patient with left lower lobe bronchiectasis, which position is most appropriate?
- Right side-lying with head elevated 30 degrees
- Right side-lying with foot of bed elevated 18 inches (Correct answer)
- Supine with pillow under the hips
- High Fowler's position with left arm elevated
Correct answer: Right side-lying with foot of bed elevated 18 inches
Left lower lobe drainage requires right side-lying with foot of bed elevated to use gravity to drain secretions from the left lower lobe toward the mainstem bronchus.
DPT Cardiovascular & Pulmonary PT 4
A patient with COPD is prescribed pursed-lip breathing.
What is the primary physiological mechanism by which this technique improves oxygenation?