Knowledge Base Cardiopulmonary I understand that 100mL of sputum production is normal according to Hillgrass text book, but does time of day affect sputum production? Lung compliance increases with age and emphysema, is it because of the destructive enlargement of the alveoli in emphysema that the compliance increases? How about with age? I understand that with patients that have a complete spinal cord injury we should not use the age predicted HR formula to calculate their max HR (220-age) due to their inability to achieve that number as their injury makes the results variable; what I do not understand is how I would calculate their max HR? What formula would be appropriate for someone with a thoracic spinal cord injury (as in T3), for example? What are the major differences between Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and International Normalized Ratio (INR)? They all seem to be associated with clotting time and or with association with “blood thinning” meds. Is there an easier way to understand pulmonary function tests (FVC, RV, TLC, etc.)? The NPTE always seems to cover questions on this topic and I always seem to get them wrong. What is the direction of lymphatic drainage? Initially its proximal to distal or distal to proximal? What is the step wise direction of drainage for lymphatic drainage? What is the normal sound of posterior upper, middle and lower Rt lung lobes? What is the effect of high blood pressure on cardiac output, heart rate, respiratory rate, vasodilation/constriction, and ect. What’s the mechanism of action of nitroglycerin for angina control? 1) Inhibit vasospasm of coronary arteries. OR 2) Dilating peripheral arteries and veins. Could you please clarify to me the EMG potentials, when occur the polyphasic potentials, positive sharp waves, electrical silence, fibrillation, fasciculations? Thank you! I understand that modifiable risk factors are important to educate PT with preventing or controlling Coronary artery disease, but how do you know which is more important (could you please list it from most important to least important)? Which Korotkoff sound is associated with diastolic blood pressure? Phase IV or Phase V? (I’ve seen mixed answers) If Chronic Bronchitis is an obstructive disorder, that means they are able to get air in, but not out. Why then are they a “Blue Bloater” and cyanotic? While someone with Emphysema, another obstructive disorder, for different reasons, is a “Pink Puffer”? What is the proper progression of Kegel exercises? I’m seeing different things in different texts. Starting Supine vs. Sitting? Starting with just contractions or with holding urine flow while sitting on toilet? What is the difference between O2Sat and SaO2? Both appear to indicate oxygen saturation levels. Why supine with head of the bed flat is an optimal position for breathing in a patient with C5 SCI, ASIA-A? The book says that supine holds the abdominal contents under diaphragm to improve zone of apposition and height of diaphragm dome. I think, this position hinders diaphragm to contract and thus decrease efficiency during inspiration. Whereas, I feel the Semi-Fowler’s position should be better for this patient, as it helps in inspiration better, while expiration is passive. Please explain. What is the difference between a spirometer and an incentive spirometer. Can we use it for obstructive or restrictive diseases? For diaphragmatic breathing is it better to be in the Semi-Fowler’s position or sitting, if the diaphragm is weak? Is there a level on the Borg scale that corresponds to therapeutic activity? How do we know what a specific patient should be at for a given condition? In the O’Sullivan NPTE study tool, it says that for contrast baths, arterial insufficiency is a contraindication and peripheral vascular disease is an indication. I thought these were very similar conditions, so I am very confused. Please help! Thank you. I’m confused about blood volume and bed rest. Blood volume and viscosity supposedly decrease with prolonged bedrest. But then how is bed rest a risk factor for DVT (which I thought included increased viscosity and clot formation)? Is there a difference between signs/symptoms to terminating a cardiac exercise stress test and terminating exercise during cardiac rehab? It seems to me there is, at least w/regards the ST depression or elevation. For both, I have seen there needs to be >2mm AND >1mm. Which one is it? Even within the answer explanations in one test alone, it seems as though I see conflicting answers. I want to know what is the difference between a Coronary artery disease and the NSTEM of Myocardial Infarction because it looks both are detected in ECG as ST elevated. A patient is found to have a DVT in LE and is given anticoag, how long will PT be on hold? Is there a certain amount of time to wait to make sure the anticoag will have therapeutic effect? At what phase of cardiac rehab is best to teach the patient monitor their Vital signs? Is it at Phase II or Phase III? I saw the APTA normal lab values as guideline for exercise and now I am confused especially in platelet count, does that mean that less than 100k platelet count still have categories for allowable exercise or stretching is contraindicated in less than 100K? Is there any way to easily remember the pulmonary function tests of the lungs? How do you correlate HRmax to VO2 max? Is there a formula for this? For example, I came across a rationale that said 60-90% HRmax correlates to 50-85% VO2 max. How would I know this? I understand that the parasympathetic system is generally inhibitory and its primary function is to decrease HR, decrease the force of contraction and cause vasoconstriction. The sympathetic system, on the other hand, does the opposite and is generally acceleratory with its primary function to increase HR (fight-or-flight) and cause vasodilation. Where I get confused is when baroreceptors and BP are involved. I have read that an increased BP will result in the stimulation of the PARASYMPATHETIC system and, therefore, cause VASODILATION in order to decrease BP. I get the vasodilation part but wouldn’t that be coming from the SYMPATHETIC system rather than the Parasympathetic system? As we are all aware, there are 4 locations to which we auscultate the heart – aortic, pulmonary, tricuspid, mitral. When compared to the specific heart sounds, at what location would each be heard best? For instance – S2 represents the closure of the semilunar valves – aortic & pulmonary. Would we auscultate at the aortic location or the pulmonary location? Same goes for S1 – would we listen for it at the tricuspid or the bicuspid location? I am looking for help with decreased or absent breath sounds versus increased breath sounds. I have conflicting information and wanted a more clear list. Thanks. During CPR in ICU will we be using manual resuscitator bag (AMBU) instead of giving rescue breaths, then what will be the ratio of compression: breaths, Alo, if we bag the AMBu from one hand how much 0xygen is delivered and if we use 2 hands how much oxygen is delivered? For the patients with orthostatic hypotension or prolonged bed ridden cases, if we use tilt table to make them come in standing position, BP should be taken every 5 mins or all the time? Also, will the same method be applied for multiple sclerosis patients on tilt table? I’m kind of confused but had come across a question like this before. In a cardiac transplant patient, will there be any abnormality in heart rate and BP seen while exercising, if yes then why please explain also will we be using Borg RPE for them as well. Can you please explain further about the difference of pneumothorax and hemothorax in terms with the tracheal and mediastinal shift? For resistance training in a patient who had a cardiac transplant and CABG, how much should a patient wait to start resistance training and what should they start with? Q. I’m not able to understand, in exercise prescription for cardiac patients, how to determine the exercise/rest ratio for inpatient, outpatient cardiac patients.
I understand that 100mL of sputum production is normal according to Hillgrass text book, but does time of day affect sputum production?
Lung compliance increases with age and emphysema, is it because of the destructive enlargement of the alveoli in emphysema that the compliance increases? How about with age?
I understand that with patients that have a complete spinal cord injury we should not use the age predicted HR formula to calculate their max HR (220-age) due to their inability to achieve that number as their injury makes the results variable; what I do not understand is how I would calculate their max HR? What formula would be appropriate for someone with a thoracic spinal cord injury (as in T3), for example?
What are the major differences between Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and International Normalized Ratio (INR)? They all seem to be associated with clotting time and or with association with “blood thinning” meds.
Is there an easier way to understand pulmonary function tests (FVC, RV, TLC, etc.)? The NPTE always seems to cover questions on this topic and I always seem to get them wrong.
What is the direction of lymphatic drainage? Initially its proximal to distal or distal to proximal? What is the step wise direction of drainage for lymphatic drainage?
What is the effect of high blood pressure on cardiac output, heart rate, respiratory rate, vasodilation/constriction, and ect.
What’s the mechanism of action of nitroglycerin for angina control? 1) Inhibit vasospasm of coronary arteries. OR 2) Dilating peripheral arteries and veins.
Could you please clarify to me the EMG potentials, when occur the polyphasic potentials, positive sharp waves, electrical silence, fibrillation, fasciculations? Thank you!
I understand that modifiable risk factors are important to educate PT with preventing or controlling Coronary artery disease, but how do you know which is more important (could you please list it from most important to least important)?
Which Korotkoff sound is associated with diastolic blood pressure? Phase IV or Phase V? (I’ve seen mixed answers)
If Chronic Bronchitis is an obstructive disorder, that means they are able to get air in, but not out. Why then are they a “Blue Bloater” and cyanotic? While someone with Emphysema, another obstructive disorder, for different reasons, is a “Pink Puffer”?
What is the proper progression of Kegel exercises? I’m seeing different things in different texts. Starting Supine vs. Sitting? Starting with just contractions or with holding urine flow while sitting on toilet?
Why supine with head of the bed flat is an optimal position for breathing in a patient with C5 SCI, ASIA-A? The book says that supine holds the abdominal contents under diaphragm to improve zone of apposition and height of diaphragm dome. I think, this position hinders diaphragm to contract and thus decrease efficiency during inspiration. Whereas, I feel the Semi-Fowler’s position should be better for this patient, as it helps in inspiration better, while expiration is passive. Please explain.
What is the difference between a spirometer and an incentive spirometer. Can we use it for obstructive or restrictive diseases?
For diaphragmatic breathing is it better to be in the Semi-Fowler’s position or sitting, if the diaphragm is weak?
Is there a level on the Borg scale that corresponds to therapeutic activity? How do we know what a specific patient should be at for a given condition?
In the O’Sullivan NPTE study tool, it says that for contrast baths, arterial insufficiency is a contraindication and peripheral vascular disease is an indication. I thought these were very similar conditions, so I am very confused. Please help! Thank you.
I’m confused about blood volume and bed rest. Blood volume and viscosity supposedly decrease with prolonged bedrest. But then how is bed rest a risk factor for DVT (which I thought included increased viscosity and clot formation)?
Is there a difference between signs/symptoms to terminating a cardiac exercise stress test and terminating exercise during cardiac rehab? It seems to me there is, at least w/regards the ST depression or elevation. For both, I have seen there needs to be >2mm AND >1mm. Which one is it? Even within the answer explanations in one test alone, it seems as though I see conflicting answers.
I want to know what is the difference between a Coronary artery disease and the NSTEM of Myocardial Infarction because it looks both are detected in ECG as ST elevated.
A patient is found to have a DVT in LE and is given anticoag, how long will PT be on hold? Is there a certain amount of time to wait to make sure the anticoag will have therapeutic effect?
At what phase of cardiac rehab is best to teach the patient monitor their Vital signs? Is it at Phase II or Phase III?
I saw the APTA normal lab values as guideline for exercise and now I am confused especially in platelet count, does that mean that less than 100k platelet count still have categories for allowable exercise or stretching is contraindicated in less than 100K?
How do you correlate HRmax to VO2 max? Is there a formula for this? For example, I came across a rationale that said 60-90% HRmax correlates to 50-85% VO2 max. How would I know this?
I understand that the parasympathetic system is generally inhibitory and its primary function is to decrease HR, decrease the force of contraction and cause vasoconstriction. The sympathetic system, on the other hand, does the opposite and is generally acceleratory with its primary function to increase HR (fight-or-flight) and cause vasodilation. Where I get confused is when baroreceptors and BP are involved. I have read that an increased BP will result in the stimulation of the PARASYMPATHETIC system and, therefore, cause VASODILATION in order to decrease BP. I get the vasodilation part but wouldn’t that be coming from the SYMPATHETIC system rather than the Parasympathetic system?
As we are all aware, there are 4 locations to which we auscultate the heart – aortic, pulmonary, tricuspid, mitral. When compared to the specific heart sounds, at what location would each be heard best? For instance – S2 represents the closure of the semilunar valves – aortic & pulmonary. Would we auscultate at the aortic location or the pulmonary location? Same goes for S1 – would we listen for it at the tricuspid or the bicuspid location?
I am looking for help with decreased or absent breath sounds versus increased breath sounds. I have conflicting information and wanted a more clear list. Thanks.
During CPR in ICU will we be using manual resuscitator bag (AMBU) instead of giving rescue breaths, then what will be the ratio of compression: breaths, Alo, if we bag the AMBu from one hand how much 0xygen is delivered and if we use 2 hands how much oxygen is delivered?
For the patients with orthostatic hypotension or prolonged bed ridden cases, if we use tilt table to make them come in standing position, BP should be taken every 5 mins or all the time? Also, will the same method be applied for multiple sclerosis patients on tilt table? I’m kind of confused but had come across a question like this before.
In a cardiac transplant patient, will there be any abnormality in heart rate and BP seen while exercising, if yes then why please explain also will we be using Borg RPE for them as well.
Can you please explain further about the difference of pneumothorax and hemothorax in terms with the tracheal and mediastinal shift?
For resistance training in a patient who had a cardiac transplant and CABG, how much should a patient wait to start resistance training and what should they start with?
Q. I’m not able to understand, in exercise prescription for cardiac patients, how to determine the exercise/rest ratio for inpatient, outpatient cardiac patients.