1 AMREF INTERNATIONAL UNIVERSITY SCHOOL OF MEDICAL SCIENCES DEPARTMENT OF REHABILIATIVE MEDICINE BACHELOR OF SCIENCE IN PHYSIOTHERAPY END OF TRIMESTER EXAMINATIONS SEPTEMBER TO DECEMBER 2022 UNIT NAME: PHT 322: CARDIOPULMONARY IN PHYSIOTHERAPY INSTRUCTIONS 1. All students will have two (2) hours to complete the examination 2. Attempt all questions as per the instruction 3. It is the student’s responsibility to report any page and number missing in this paper. 4. Check that the paper is complete 5. Total number of pages is 13 including the cover. 6. Read through the paper quickly before you start. 7. The exam is worth a total of 70 points or 1 point for each correct answer. 2 1. Fine crackles are ..... A. heard during inspiration and indicate alveolar opening. B. heard during expiration and indicate alveolar opening. C. heard during inspiration and indicate air moving through secretions. D. heard during expiration and indicate air moving through secretions. ANSWER: A 2. Using the diagnostic procedure called egophony (asking the client to say "ee". The sound you hear when auscultating the left lower lobe sounds like a distant "ee", your assumption is that the underlaying lung is... A. atelectatic. B. hyper-inflated. C. consolidated. D. absent. ANSWER: A 3. An effective cough is able to move secretions ________________. A. from about the 5th generation of the bronchial tree. B. from about the 9th generation of the bronchial tree. C. from about the 7th generation of the bronchial tree. D. from the carina. ANSWER: C 4. In questioning the patient about his symptoms, he remarks he has been experiencing intermittent right arm discomfort for the past day; a dull ache that seems to be associated with getting up and moving around the room. He has no chest discomfort, however, and the arm ache seems to go away pretty quickly. Since he doesn't think this is a big deal and it just started, he's only told you about this because you're the PT and arm pain is more likely to be a muscle strain. Your plan for the day was to get him out of bed and perform a 6-minute walk test. Does your plan change? Pick the best option: A. The symptoms are atypical - proceed with the test and monitor his symptoms. B. Walking him will help you decide if this is arm strain or something else, perhaps cardiac, so you'll make sure you check his ECG during exercise - defer the test but bring a bedside pedal unit or a bike for activity. C. Excuse yourself and immediately discuss his symptoms with the nurse or physician, if available. D. Defer the 6-minute walk test, substitute with bed mobility exercise and determine to check back in later. ANSWER: C 5. You are examining a 63-year-old patient recently admitted for chest discomfort and shortness of breath. He has a history of an anterior wall myocardial infarction and hypertension. Upon exam, you observe bilateral jugular venous distension. This is most likely associated with: A. Another myocardial infarction B. Pulmonary embolism C. Heart failure D. Cor Pulmonale 3 E. Stroke ANSWER: D 6. Which of the following is a singular sign of central cyanosis? A. Blue tinged fingers or toes. B. Blue tinged tip of the nose. C. Blue tinged mucous membranes. D. Blue tinged nail beds. E. Blue tinged ear lobes. ANSWER: C 7. Eupnea defined. A. Normal rate, normal depth, regular rhythm B. Fast rate, shallow depth, regular rhythm C. Slow rate, normal depth, regular rhythm D. Rapid rate, shallow depth, regular rhythm ANSWER: A 8. Atrial fibrillation is common, especially among older adults, and is considered benign if the patient is asymptomatic. A) True B) False ANSWER: B 9. Bronchovesicular breath sounds are .......... A. soft, medium pitched sounds that are heard longer on the expiratory phase then the inspiratory phase. B. soft, medium pitched sounds that are heard equally on inspiration and expiration. C. soft, medium pitched sounds that are heard longer on the inspiratory phase then the expiratory phase. ANSWER. B 10. The Professorial position adopted by individuals with significant pulmonary disease/dysfunction is an adaptation to help facilitate the recruitment of the accessory muscle of respiration. A) True B) False ANSWER: A 11. Polyphonic or musical wheezes indicate diffuse airway obstructions. A) True B) False ANSWER: A 12. When using mediate percussion, you find that the left upper lobe is hyper-resonant. This finding confirms that there is a mucous plug present in a proximal airway(s). A) True 4 B) False ANSWER: B 13. When assessing the chest mobility of the upper anterior chest wall, for the most part, you are seeing/feeling "pump handle" motion. A. True B. False ANSWER. A 14. Unilateral jugular vein distention is associated with an exacerbation of Cor Pulmonale. A) True B) False ANSWER: B 15. During a full inspiration the lower lobe on the posterior aspect can be identified using mediate percussion down to the T12 level. A) True B) False ANSWER: A 16. On the anterior aspect of the chest, bronchovesicular breath sounds are heard over the carina and the L/R main stem bronchi. A) True B) False ANSWER: A 17. A fast and irregularly, irregular pulse suggests? A. Frequent Premature Atrial Contractions B. Atrial fibrillation C. Ventricular fibrillation D. Frequent Premature Ventricular Contractions E. Bradycardia ANSWER: B 18. Which of the following statements regarding ejection fraction is incorrect? A. Normal ejection fractions range from 55% to 75%. B. Ejection fraction is used as a measure to understand how the heart is functioning. C. Ejection fraction refers to the amount of blood pumped out of the left ventricle. D. A low ejection fraction could be a sign of ventricular muscle weakness or valvular leakage. E. A high ejection fraction could be a sign of hypertrophic conditions such as hypertrophic cardiomyopathy. ANSWER: C 19. Which of the following statements about Rheumatic Fever is incorrect? A. Rheumatic fever is most prevalent in children. 5 B. Damage to the heart from rheumatic fever can ultimately result in heart failure. C. A cardinal sign of rheumatic fever is joint pain that can migrate from joint to joint during the course of the infection. D. Rheumatic fever is currently more common in the developing world. E. Cardiac muscle is at risk for damage in 50% of rheumatic fever cases. ANSWER: E 20. Which of the following has the greatest odds ratio for the development of peripheral artery disease? A. Being male. B. Being Hispanic. C. Smoking. D. Hypertension. E. Renal insufficiency. ANSWER: C 21. Heart failure is a clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of a ventricle to fill with or eject blood. A) True B) False ANSWER: A 22. Persons with peripheral artery disease are at an increased risk for stroke. A) True B) False ANSWER: A 23. Cor Pulmonale can refer to either left or right heart failure, as long as it is affection the lungs. A) True B) False ANSWER: B 24. Although a conservative approach to the management of a patent ductus arteriosus or patent foramen ovale is the preferred choice if, necessary both can be well managed through cardiac catheterization or a surgery. A) True B) False ANSWER: B 25. After a pace maker is placed, overhead movements of the left arm are typically restricted for 2 weeks. A) True B) False ANSWER: B 6 26. With prolonged bed rest there is a change in where the bulk of the plasma volume resides, this is called a ___________. A. Central fluid shift B. Peripheral fluid shift C. Central fluid shunt D. Peripheral fluid shunt ANSWER: A 27. The long-term consequence of prolonged bed rest is a/an _________________ in plasma volume. A. Decrease B. Increase C. No change ANSWER: A 28. The consequence of this change in plasma volume is a/an ________________ in resting heart rate. A. Decrease B. Increase C. No change ANSWER: B 29. With prolonged bed rest what happens to pulmonary residual volume? A. Decrease B. Increase C. No change ANSWER: B 30. With prolonged bed rest what happens to pulmonary forced expiratory volume? A. Decrease B. Increase C. No change ANSWER: A 31. With prolonged bed rest what happens to the spontaneous cough? A. Decrease B. Increase C. No change ANSWER: A 32. Left heart failure is the most common form of heart failure. Which of the following does not result directly in left heart failure? A. Myocardial infarction B. Hypertension C. Valve disease D. Pulmonary hypotension E. Cardiomyopathy 7 ANSWER: D 33. Your patient reports that they frequently suffer from severe afternoon headaches, given this information you would consider screening them for Sleep Apnea. A) True B) False ANSWER: B 34. Critical limb ischemia is characterized by a number of symptoms, which of the following is not correct? A. High risk for arterial wounds B. Nocturnal pain C. Pain at rest D. Relieved by cessation of activity E. Relieved by elevation ANSWER: D 35. Treatment for Peripheral Arterial Disease with claudication can consists of: A. Exercise training B. Revascularization C. Pharmacological therapy D. Education E. All of the above ANSWER: E 36. Rheumatic Fever is a complication of untreated Strep throat or Scarlet Fever. A) True B) False ANSWER: A 37. Which of the following statements are incorrect regarding a Patent Foramen Ovale? A. In utero the PFO allows the fetal blood to bypass the lungs B. Full closure normal occurs in the first few days after birth C. Failure to close results in an increased risk for clot formation and stroke D. In most cases a defect (failure to close) is small and asymptomatic ANSWER: B 38. In the case of clinical suspicion based on symptoms and clinical findings, the Ankle Brachial Index should be used as the first-line noninvasive test for the screening of Peripheral Arterial Disease. A) True B) False ANSWER: A 39. Undiagnosed atrial fibrillation is particularly worrisome due to the increased risk. A. Diabetes B. Hypertension 8 C. Myocardial infarction D. Stroke ANSWER: D 40. The most common cause of Diastolic Heart Failure is Systolic Heart Failure. A) True B) False ANSWER: A 41. Which of the following best describes Paroxysmal Nocturnal Dyspnea? A. An attack of severe shortness of breath and coughing, that is common sequela of Cor Pulmonale that can be relieved in whole or in part by sitting up with the legs dependent. B. An attack of severe shortness of breath and coughing, that is common sequela of systolic heart failure that can be relieved in whole or in part by sitting up with the legs dependent. C. An attack of severe shortness of breath and coughing, that is common sequela of diastolic heart failure that can be relieved in whole or in part by sitting up with the legs dependent. ANSWER: A 42. Which of the following facilitated cough techniques would be most useful in treating the client who has difficulties with taking in an adequate inspiration? A. Forced expiratory technique B. Huffing C. "k" sound D. Sniffing E. Splinting ANSWER: D 43. In the acute care setting an Incentive Spirometer can be used to help treat atelectasis. A) True B) False ANSWER: A 44. The literature demonstrates a number of clear benefits that people with COPD can expect from a well-prescribed exercise program, except? A. Improved exercise capacity B. Reduction in the perceived intensity of breathlessness C. Reduction in hospitalizations D. Improved survival E. Reduction in the number of hospitalization days for a give stay ANSWER: D 45. Which one of the following does not represent a sign or symptom of decreased strength/endurance of the muscles of respiration? A. Decreased chest expansion 9 B. Shortness of breath C. Increased tidal volume D. Decreased breath sounds E. Uncoordinated breathing pattern ANSWER: C 46. The cardiopulmonary treatment of Vibration is equally effective at decreasing localized atelectasis and retained secretions. A) True B) False ANSWER: B 47. Hemoptysis is considered a clinical feature of Bronchiectasis. A) True B) False ANSWER: A 48. Obesity, cigarette smoking and alcohol abuse are all factors that put the ventilated patient at risk for developing Adult Respiratory Distress Syndrome. A) True B) False ANSWER: A 49. All of the following are considered precautions for postural drainage positioning, except? A. Hemoptysis B. Increased intracranial pressure C. Large pleural effusions D. Morbid obesity E. Pulmonary edema ANSWER. B 50. With auscultation, you note that there are tracheal breath sounds heard about 2 inches to the right of midline. On further examination, you find that the breath sounds for the entire right middle and lower lobes are absent and there is little if any lateral coastal chest wall movement on the right. What is the most likely cause for these findings? A. Atelectasis B. Consolidation C. Pneumothorax D. Tension pneumothorax E. Secretion retention ANSWER: A 51. During the initial phase of a lobar viral pneumonia a persistent productive cough is a typical patient complaint. A) True B) False 10 ANSWER: B 52. The increased work of breathing experienced by those with significant pulmonary disease may be observed by the clinician via; A. Increased accessory muscle use B. Intercostal retractions C. Nasal flaring D. Use of short word phrases E. All of the above ANSWER: E 53. Which pulmonary function test has been adapted for simple home use to help prevent an asthma attack? A. Forced vital capacity B. Forced expiratory capacity in 1 second C. Functional residual capacity D. Maximum ventilatory volume E. Peak expiratory flow ANSWER: E 54. Which of the conditions listed below best fit the following description? Repeated pulmonary infections and bronchial obstructions result in airway dilations. The chronic cough and copious foul-smelling expectoration are common clinical clues with this condition. A. Asthma B. Chronic bronchitis C. Bronchiectasis D. Emphysema E. Congestive Heart Failure ANSWER:C 55. Which of the following is not an associated trigger for asthma? A. Cigarette smoke B. Emotional stress and/or excitement C. Humid environments D. Physical exertion E. Respiratory infections ANSWER. C 56. Is it reasonable that patients with a metabolically compensated long-standing chronic obstructive disorder could experience an acute bout of hypoxia, develop Cor Pulmonale and die from respiratory failure? A) True B) False ANSWER: A 11 57. Cor Pulmonale is the enlargement of the right ventricle secondary to pulmonary hypertension. A) True B) False ANSWER: A 58. Cardiogenic pulmonary edema is typically associated with Right Heart Failure. A) True B) False ANSWER: B 59. While palpating the anterior chest wall just above where the diaphragm attaches, you ask your patient to speak, so you can assess tactile fremitus. You note that what you feel is absent tactile fremitus under your right hand versus the left. What is indicated by the absence of tactile fremitus that you are experiencing? A. The area is consolidated B. The area is atelectatic C. The area has a pneumothorax ANSWER: A 60. Which of the following pulmonary diseases are not typically associated with bronchiectasis? A. Cystic fibrosis B. Measles C. Tuberculosis D. Acute Bronchitis E. Solid body aspiration ANSWER: D 61. The right lower lobe has a significant amount of accumulated secretions, with mediate percussion you would expect a ___________ sound. A. Dull B. Hyper-resonant C. Hypo-resonant D. Normal E. Resonant ANSWER: A 62. The left lower lobe is significantly collapsed, with mediate percussion you would expect a _____________ sound. A. Dull B. Hyper-resonant C. Hypo-resonant D. Normal E. Resonant ANSWER: A 12 63. The lingula has a large mucus plug with trapped air, with mediate percussion you would expect a _____________ sound. A. Dull B. Hyper-resonant C. Hypo-resonant D. Normal E. Resonant ANSWER: E 64. The right lower lobe is significantly collapsed, with auscultation you would expect the air entry to be _____________ . A. Absent B. Decreased C. Loud D. Increased E. Soft ANSWER: A 65. The left upper lobe has a significant amount of accumulated secretions, with auscultation you would expect the air entry to be _____________. A. Absent B. Decreased C. Loud D. Increased E. Soft ANSWER: A 66. The lingula has a large mucous plug with trapped air, with auscultation you would expect the air entry to be _____________. A. Absent B. Decreased C. Loud D. Increased E. Soft ANSWER: A 67. The right lower lobe is significantly collapsed, with egophony you would expect hear _____________. A. “aaa” B. “eee” C. Loud “aaa” D. Loud “eee” E. No sound ANSWER: E 13 68. The left upper lobe has a significant amount of accumulated secretions, with egophony you would expect to hear _____________ . A. “aaa” B. “eee” C. Loud “aaa” D. Loud “eee” E. No sound ANSWER: B 69. The right lower lobe is significantly collapsed, with auscultation what adventitious sounds might you hear _____________. A. Course crackles B. Fine crackles C. Monophonic wheezes D. None E. Polyphonic wheezes ANSWER: B 70. The left upper lobe has a significant amount of accumulated secretions, with auscultation what adventitious sounds might you hear _____________. A. Course crackles B. Fine crackles C. Monophonic wheezes D. None E. Polyphonic wheezes ANSWER: A