1
Q
What will the exam include questions about?
A
- Equipment
- Procedures
- Methods involved in exercise testing
- Interpretation of results
The exam covers various aspects of exercise testing.
2
Q
List the primary indications for exercise testing.
A
- Dyspnea on exertion
- Pain, especially angina
- Fatigue
These indications help determine when exercise testing is necessary.
3
Q
What are the additional indications for exercise testing?
A
- Exercise-induced bronchospasm
- Assessing functional capacity
- Arterial desaturation
These indications provide further context for the need for exercise testing.
4
Q
Exercise testing can detect which cardiovascular limitations?
A
- Cardiovascular limitations to work
- Ventilatory limitations to work
- Degree of conditioning or deconditioning
- Maximum tolerable workload
- Safe levels of exercise
- Degree of disability for rehabilitation purposes
- Degree of oxygen desaturation
- Appropriate levels of O2 therapy
- Outcome measures following treatment
These detections are crucial for assessing a patient’s health and rehabilitation needs.
5
Q
What are the absolute contraindications for exercise testing?
A
- Acute MI within 2 days
- Ongoing unstable angina
- Uncontrolled cardiac arrhythmias
- Active endocarditis
- Severe aortic stenosis
- Decompensated heart failure
- Acute aortic dissection
- Acute myocarditis or pericarditis
- PaO2 < 40 mm Hg on room air
- PaCO2 > 70 mm Hg
- Physical disability that precludes safe testing
- Left main coronary artery stenosis
- Moderate aortic stenosis
- Complete heart block
- Hypertrophic cardiomyopathy
- Recent stroke or TIA
- Mental impairment
- Resting blood pressure > 200/110 mm Hg
- Uncorrected medical conditions
- Tachyarrhythmias
These contraindications indicate situations where exercise testing should not be performed.
6
Q
What are the relative contraindications for exercise testing?
A
Any issue with the heart at all
Relative contraindications suggest caution but do not outright prohibit testing.
7
Q
What is the first step in ensuring electrode signal stability prior to performing an ECG procedure?
A
Clean and shave electrode site
This step is crucial for optimal skin contact and signal quality.
8
Q
What should be used to enhance skin contact when setting up ECG monitors?
A
Conductive jelly
This helps improve the quality of the electrode signal.
9
Q
How should electrodes be secured during an ECG procedure?
A
Wrap with elastic bandages
This ensures that the electrodes remain in place during the procedure.
10
Q
What type of electrodes should be chosen for ECG monitoring?
A
- Low impedance
- High stickiness
These characteristics help maintain a stable signal during testing.
11
Q
What type of ECG machines should be utilized for exercise testing?
A
Machines that incorporate filters to eliminate movement artifact
This is important for accurate readings during physical activity.
12
Q
Where should limb leads be moved during an ECG exercise test?
A
To the torso
This adjustment helps in obtaining a clearer signal during exercise.
13
Q
What is the primary benefit of using an arm ergometer?
A
Beneficial for patients who are unable to walk or pedal a cycle
It provides an alternative method for exercise testing.
14
Q
In what position should the patient be seated when using an arm ergometer?
A
Upright position
This position is necessary for effective use of the ergometer.
15
Q
How should the fulcrum of the handle be adjusted on an arm ergometer?
A
To shoulder height
Proper adjustment is essential for comfort and effectiveness during exercise.
16
Q
What is the recommended elbow position during the furthest extension on an arm ergometer?
A
Slightly bent at the elbow
This position helps prevent strain during exercise.
17
Q
What is the target revolutions per minute for an arm ergometer?
A
60 - 75 revolutions per minute
This range is optimal for effective exercise testing.
18
Q
How does oxygen consumption during arm ergometer testing compare to cycle or treadmill testing?
A
20 - 30% lower
This difference is important to consider when interpreting exercise test results.
19
Q
What is a cycle ergometer beneficial for?
A
- Patients who have difficulty walking
- Obese patients
- COPD patients
The cycle ergometer can adjust pedaling frequency and resistance to increase or decrease workload.
20
Q
What must a patient maintain while using a cycle ergometer?
A
Rhythmic pedaling
A metronome can be used to assure the patient maintains pace.
21
Q
True or false: The workload on a cycle ergometer is dependent on the weight of the patient.
A
FALSE
The workload is independent of the weight of the patient.
22
Q
How does a cycle ergometer compare to a treadmill in terms of workload dependability?
A
Provides more dependable workloads
Compared to a treadmill.
23
Q
What is the most common equipment used for exercising patients?
A
Treadmill
Workload can be varied by adjusting the speed and grade of the treadmill.
24
Q
What features does a treadmill include for patient support?
A
- Handrails for support
- Handrails for balance
These features help patients during exercise.
25
How do you calculate the **speed** of a treadmill?
Speed = Belt Length X Cycles/minute (RPM)
## Footnote
This formula helps in calibrating the treadmill.
26
What is the formula for calculating the **grade** (slope, incline) of a treadmill?
Grade = Rise/Run
## Footnote
Example: If one end of a 30 inch carpenter level is 3 inches above the other end, Grade = 3 / 30 = 0.10 = 10%.
27
What factor must be considered when utilizing a **treadmill**?
Patient's body weight
## Footnote
This is important for accurate workload assessment.
28
List the **patient instructions** for using a treadmill during exercise testing.
* Take long strides
* Do not lean on or hold tightly to the handrails
* Do not talk during the test
## Footnote
Failure to follow these instructions may result in lower than expected values for heart rate and ventilatory response.
29
What is the purpose of a **Douglas bag**?
Collecting expired gas samples
## Footnote
The Douglas bag is specifically utilized for this purpose.
30
What are the components of the **emergency equipment** that should be available in the laboratory?
* Cardiac monitor
* Defibrillator
* Manual resuscitation bag and mask
## Footnote
These items are essential for emergency situations.
31
True or false: A **cardiac monitor** and **defibrillator** should be available when performing a stress test on a patient with heart disease.
TRUE
## Footnote
These devices are crucial for monitoring and responding to potential emergencies during the test.
32
What type of device is capable of plotting **volume, flow, and time**?
Recording device
## Footnote
This device is essential for accurate monitoring during tests.
33
What is used for **sampling** in blood gas analysis?
* Blood gas syringes
* Arterial line
## Footnote
These tools are critical for obtaining accurate blood gas samples.
34
What is the **maximum heart rate** formula?
Maximum Heart Rate = 220 - age (years)
## Footnote
This formula is used to determine the appropriate exercise intensity for patients.
35
In **steady state testing**, how long does the patient exercise at a sub-maximal level?
5 - 8 minutes
## Footnote
This testing method maintains workload at 50 - 75% of maximum load.
36
During **steady state testing**, when does timing begin?
Once target workload is reached (steady state)
## Footnote
Measurements are taken during the final 1 - 2 minutes of the test.
37
What is the purpose of **multistage (incremental) testing**?
To determine maximum tolerable workload
## Footnote
Workloads are increased at predetermined levels and measurements are taken at the end of each stage.
38
In multistage testing, how much is the workload increased at each stage?
15 watts/min
## Footnote
Workloads are varied by changing speed, grade, or resistance.
39
What are the workload categories in multistage testing?
* < 50 watts: Low
* 50 - 100 watts: Medium
* > 100 watts: High
* 200 watts: Too high for stress testing
## Footnote
These categories help assess the patient's exercise capacity.
40
What is the **Bruce Protocol**?
A testing protocol where workload is increased every 3 minutes
## Footnote
It begins at 1.7 mph and 10% grade.
41
What is the starting speed and grade for the **Modified Bruce Protocol**?
1.7 mph and zero % grade
## Footnote
This protocol is designed for less fit individuals and patients with chronic airway disease.
42
In the **Modified Bruce Protocol**, what is the grade increase in the second stage?
5%
## Footnote
The protocol continues to increase the grade in subsequent stages.
43
What is the duration of each stage in multistage testing?
1 - 6 minute intervals
## Footnote
Standard duration is typically 3 minutes.
44
True or false: A steady state of ventilation and gas exchange is achieved in multistage testing.
FALSE
## Footnote
This method does not achieve a steady state of ventilation and gas exchange.
45
What is the **Bruce Protocol** used for?
A standardized exercise testing protocol
## Footnote
It is commonly used for assessing cardiovascular fitness.
46
List the **stages of the Bruce Protocol**.
* Stage I
* Stage II
* Stage III
* Stage IV
* Stage V
* Stage VI
* Stage VII
* Stage VIII
## Footnote
Each stage increases in intensity and grade.
47
What is the **grade and speed** for **Stage I** of the Bruce Protocol?
0% grade and 1.7 mph
## Footnote
This is the starting point of the exercise test.
48
What is the **grade and speed** for **Stage II** of the Bruce Protocol?
5% grade and 1.7 mph
## Footnote
This stage introduces a slight incline.
49
What is the **grade and speed** for **Stage III** of the Bruce Protocol?
10% grade and 2.5 mph
## Footnote
This stage further increases the workload.
50
What does the **E. Borg Scale** measure?
Rating of perceived exertion (RPE)
## Footnote
It ranges from 1 to 20, with 20 being the highest level of dyspnea.
51
What is a **MET**?
A unit that measures oxygen consumption (VO₂) per kilogram of body weight
## Footnote
1 MET = 3.5 mL O₂/min/kg (normal value at rest).
52
What happens at the **anaerobic threshold (AT)**?
* Anaerobic metabolism begins
* Blood lactate levels increase
* Metabolic acidosis occurs
## Footnote
This is the exercise level where the body shifts from aerobic to anaerobic energy production.
53
True or false: **O₂ max** is the point where work continues to increase but VO₂ does not.
TRUE
## Footnote
This indicates a plateau in oxygen consumption despite increased exercise intensity.
54
What is the **normal RER** at the anaerobic threshold?
0.8
## Footnote
An increase to 1.0 or higher indicates lactic acid production.
55
What is the **significance of VCO₂** rising above VO₂?
Indicates anaerobic metabolism is occurring
## Footnote
This is a key marker of reaching the anaerobic threshold.
56
What are the **parameters monitored** during stress testing?
* Oxygen saturation (SpO2)
* Blood pressure
* Ventilation
* Heart rate and rhythm (ECG)
## Footnote
These parameters are crucial for assessing the patient's response to exercise.
57
Oxygen saturation (SpO2) should remain above _______ during the test.
> 90%
## Footnote
A decrease of 4 - 5% during testing may indicate a pulmonary disorder.
58
How is **Oxygen Saturation (SpO2)** measured?
By a pulse oximeter using a probe on the patient's finger, ear, or forehead
## Footnote
SpO2 may increase after several minutes of exercise due to increased oxygen delivery to tissues.
59
What should be monitored during low and moderate workloads to establish a normal response to exercise?
Systemic arterial blood pressure
## Footnote
Both manual and automatic devices are acceptable for monitoring.
60
What is important regarding the **size of the BP cuff**?
It should be appropriate for the size of the patient's arm
## Footnote
An indwelling arterial catheter can also be used for continuous BP monitoring.
61
What should be monitored in terms of **ventilation** during exercise?
* Minute ventilation
* Respiratory rate
* Oxygen consumption (VO2)
* Carbon dioxide production (VCO2)
## Footnote
Mixing chamber system or breath-to-breath technique may be used to collect data.
62
What is the **normal voltage setting** for ECG measurement?
1 millivolt = 10mm vertical movement
## Footnote
This setting is used to standardize the ECG readings.
63
What happens to the voltage setting when it is **halved**?
1 millivolt = 5 mm vertical movement
## Footnote
Halving the normal voltage reduces the vertical movement on the ECG.
64
What happens to the voltage setting when it is **doubled**?
1 millivolt = 20 mm vertical movement
## Footnote
Doubling the normal voltage increases the vertical movement on the ECG.
65
Where are the **electrodes** placed for ECG?
* On the arms and legs (limb leads)
* On the chest around the heart (precordial leads)
## Footnote
Proper placement is crucial for accurate ECG readings.
66
What does **Lead II** reflect in ECG monitoring?
The normal direction of electrical activity through the heart (axis)
## Footnote
Lead II is the most common lead used during exercise ECG monitoring.
67
What is the placement for the **Right Arm (RA)** electrode in Lead II?
Right subclavian fossa, usually at middle of right clavicle (Negative electrode)
## Footnote
Correct placement is essential for accurate ECG readings.
68
What is the placement for the **Left Leg (LL)** electrode in Lead II?
Lateral of the rectus abdominus muscle, superior to the iliac crest, inferior to bottom rib, usually along the umbilical line on left side of the torso (Positive electrode)
## Footnote
This placement helps capture the heart's electrical activity accurately.
69
What is the placement for the **Left Arm (LA)** electrode in Lead II?
Left subclavian fossa, usually at middle of left clavicle (Ground electrode)
## Footnote
The ground electrode helps reduce electrical noise in the ECG signal.
70
What is the interpretation for a heart rate of **< 60 beats per minute**?
Bradycardia
## Footnote
Bradycardia indicates a slower than normal heart rate.
71
What is the interpretation for a heart rate of **60 - 100 beats per minute**?
Normal
## Footnote
This range is considered a normal resting heart rate for adults.
72
What is the interpretation for a heart rate of **> 100 beats per minute**?
Tachycardia
## Footnote
Tachycardia indicates a faster than normal heart rate.
73
What does a heart rate of **> 200 beats per minute** indicate?
Flutter
## Footnote
Flutter is a rapid heart rhythm that can be dangerous.
74
What does the term **Fibrillation** refer to in heart rate interpretation?
Too fast to count
## Footnote
Fibrillation indicates chaotic heart activity that is not effective.
75
How can the heart rate be estimated on an ECG?
By measuring the distance between two adjacent R waves
## Footnote
This method helps determine the heart rate based on the spacing of R waves.
76
If the two R waves are between **3 and 5 large boxes apart**, what is the heart rate?
Normal (60 - 100/min)
## Footnote
This indicates a normal heart rate range.
77
If the two R waves are **closer than 3 large boxes**, what does this indicate?
Rate is greater than 100/min (tachycardia)
## Footnote
This suggests a rapid heart rate.
78
If the two R waves are **wider than 5 large boxes**, what does this indicate?
Rate is less than 60/min (bradycardia)
## Footnote
This suggests a slower heart rate.
79
What is the formula to calculate heart rate using large boxes between R waves?
Heart rate = 300 ÷ # of large boxes between R waves
## Footnote
This formula provides a quick estimate of heart rate.
80
What is the formula to calculate heart rate using small boxes between R waves?
Heart rate = 1500 ÷ # of small boxes between R waves
## Footnote
This formula allows for a more precise heart rate calculation.
81
What is the **normal heart rate** range in beats per minute (BPM)?
60-100 BPM
## Footnote
This range indicates a normal sinus rhythm.
82
Define **normal sinus rhythm (NS)**.
* Positive P wave
* Regular
* Normal rate
* No skipped beats
* No extra beats
## Footnote
NS indicates a healthy heart rhythm.
83
What does **sinus arrhythmia** refer to?
Sinus rhythm with irregular rate
## Footnote
Treatment involves addressing any other symptoms present.
84
Fill in the blank: The **normal heart rate** can be calculated as _______.
300 + 4 = 75/min
## Footnote
This calculation is based on the number of large boxes on an ECG.
85
True or false: A **sinus arrhythmia** indicates a healthy heart rhythm.
FALSE
## Footnote
Sinus arrhythmia is characterized by an irregular rate, which may require further evaluation.
86
What is the significance of the **P wave** in normal sinus rhythm?
Indicates atrial depolarization
## Footnote
A positive P wave is a key feature of normal sinus rhythm.
87
What is the **treatment** for sinus arrhythmia?
Treat any other symptoms
## Footnote
Sinus arrhythmia itself may not require treatment unless symptomatic.
88
What does the term **regular rhythm** imply in heart rate assessment?
Consistent intervals between beats
## Footnote
Regular rhythm is a characteristic of normal sinus rhythm.
89
How many boxes on an ECG correspond to a heart rate of **60-100 BPM**?
3-5 boxes
## Footnote
This is based on the standard ECG interpretation.
90
What is the **normal heart rate** range in beats per minute (BPM)?
60-100 BPM
## Footnote
This range indicates a normal sinus rhythm.
91
Define **normal sinus rhythm (NS)**.
* Positive P wave
* Regular
* Normal rate
* No skipped beats
* No extra beats
## Footnote
NS indicates a healthy heart rhythm.
92
What does **sinus arrhythmia** refer to?
Sinus rhythm with irregular rate
## Footnote
Treatment involves addressing any other symptoms present.
93
Fill in the blank: The **normal heart rate** can be calculated as _______.
300 + 4 = 75/min
## Footnote
This calculation is based on the number of large boxes on an ECG.
94
True or false: A **sinus arrhythmia** indicates a healthy heart rhythm.
FALSE
## Footnote
Sinus arrhythmia is characterized by an irregular rate, which may require further evaluation.
95
What is the significance of the **P wave** in normal sinus rhythm?
Indicates atrial depolarization
## Footnote
A positive P wave is a key feature of normal sinus rhythm.
96
What is the **treatment** for sinus arrhythmia?
Treat any other symptoms
## Footnote
Sinus arrhythmia itself may not require treatment unless symptomatic.
97
What does the term **regular rhythm** imply in heart rate assessment?
Consistent intervals between beats
## Footnote
Regular rhythm is a characteristic of normal sinus rhythm.
98
How many boxes on an ECG correspond to a heart rate of **60-100 BPM**?
3-5 boxes
## Footnote
This is based on the standard ECG interpretation.
99
What is **sinus tachycardia**?
Sinus rhythm with rate > 100/min
## Footnote
Treatment includes oxygen.
100
What is **sinus bradycardia**?
Sinus rhythm with rate < 60/min
## Footnote
Treatment includes oxygen and atropine.
101
What is the treatment for **sinus bradycardia**?
* Oxygen
* Atropine
* Consider other causes
## Footnote
Oxygen is a primary treatment.
102
What are **premature ventricular contractions (PVC)**?
A type of arrhythmia
## Footnote
Further details on treatment are not provided.
103
What are **multifocal premature ventricular contractions (PVC)**?
A type of arrhythmia
## Footnote
Multifocal PVCs occur when multiple ectopic foci in the ventricles cause premature heartbeats.
104
Define **ventricular tachycardia (V-tach)**.
Ventricular rhythm with rate > 100/min
## Footnote
V-tach can lead to decreased cardiac output and may require immediate treatment.
105
What is **ventricular fibrillation (V-fib)**?
Completely irregular ventricular rhythm
## Footnote
V-fib is a life-threatening condition that requires immediate medical intervention.
106
List the **treatment options** for arrhythmias.
* Oxygen
* Consider other causes
* Cardiovert (if pulse present)
* CPR, Defibrillate, Epinephrine, Amiodarone (if pulse absent)
## Footnote
Treatment varies based on the presence of a pulse and the specific arrhythmia.
107
What is the treatment for **Asystole**?
* Confirm in 2 Leads first
* CPR
* Epinephrine
## Footnote
Asystole is a state of no electrical activity in the heart, requiring immediate intervention.
108
What should be checked to address **Motion artifact** in ECG readings?
* Lead placement
* Deep inspiration
* Breathing movement
* Electrode movement (walking)
## Footnote
Motion artifact can interfere with accurate ECG readings and must be minimized.
109
What is the PR interval duration for a **1st degree AV block**?
> 0.20
## Footnote
Measured from the beginning of P wave to the beginning of the QRS complex. May also be caused by ischemia or digitalis.
110
Describe the rhythm characteristic of a **2nd degree AV block**.
Irregular rhythm with normal P waves, but missing QRS complex
## Footnote
This indicates a disruption in the conduction from the atria to the ventricles.
111
In a **3rd degree AV block**, what are the rates for atrial and ventricular contractions?
Atrial rate > 60, Ventricular rate < 40/minute
## Footnote
PR interval cannot be determined and the QRS complex will be widened.
112
What is the treatment for a **1st degree AV block**?
Atropine
## Footnote
Atropine is used to increase heart rate in cases of bradycardia.
113
What is the treatment for a **2nd degree AV block**?
Atropine
## Footnote
Atropine may be used to manage symptoms associated with this block.
114
What is the treatment for a **3rd degree AV block**?
Electrical pacemaker
## Footnote
A pacemaker is necessary to maintain an adequate heart rate and rhythm.
115
What is a **Bundle Branch Block**?
A condition where the right or left Bundle Branch delays the impulse to their respective side
## Footnote
Normally, both bundle branches send impulses to both ventricles simultaneously.
116
In a **Bundle Branch Block**, how does the depolarization of the ventricles occur?
One ventricle depolarizes later than the other
## Footnote
This delay causes a difference in timing between the two ventricles.
117
What effect does a **Bundle Branch Block** have on the QRS complex?
The QRS complex appears wider than normal
## Footnote
A QRS complex wider than three small squares (0.12 sec.) indicates a Bundle Branch Block.
118
What is the significance of a QRS complex wider than **three small squares**?
Indicates a **Bundle Branch Block**
## Footnote
This measurement is used to assess the width of the QRS complex in ECG readings.
119
Which ECG chest leads indicate a **right Bundle Branch Block (RBBB)**?
V1 and V2
## Footnote
These leads show a double R wave (R,R*) characteristic of RBBB.
120
Which ECG chest leads indicate a **left Bundle Branch Block (LBBB)**?
V5 and V6
## Footnote
These leads show a double R wave (R,R*) characteristic of LBBB.
121
Define **ischemia**.
Reduced blood flow to tissue
## Footnote
Ischemia can lead to tissue damage if not resolved.
122
What does **injury** refer to in the context of tissue?
Acute damage to tissue (often from ischemia)
## Footnote
Injury can result from various causes, including ischemic events.
123
What is **infarction**?
Necrosis or death of tissue (end result of ischemia and injury)
## Footnote
Infarction may be acute or old.
124
What does the ECG reveal in sequence from ischemia to injury to acute myocardial infarction?
Conditions occur in sequence: ischemia, injury, acute myocardial infarction
## Footnote
The ECG is a critical tool for diagnosing these conditions.
125
How is **ischemia** indicated on an ECG?
Depressed or inverted T wave
## Footnote
This change in the T wave is a key indicator of ischemia.
126
What ECG change indicates **injury**?
Elevated S-T segment
## Footnote
An elevated S-T segment is a sign of acute injury to the heart.
127
How is **infarction** diagnosed on an ECG?
Significant (large) Q waves
## Footnote
Q waves can indicate previous myocardial infarction.
128
What are the criteria for **significant Q waves**?
* Q waves ½ the height of the R wave
* Q waves one small square wide (0.04 mm)
## Footnote
These criteria help in diagnosing myocardial infarction.
129
What happens to the **heart rate** during exercise testing?
Increases linearly with workload (from about 70/min to about 200/min)
## Footnote
Elevated heart rates without ECG changes are commonly seen in patients who are not well.
130
What do **ST segment changes** indicate during exercise testing?
Depressions greater than 1 mm for 0.08 seconds or longer indicate ischemia
## Footnote
ST segment changes should be closely monitored.
131
True or false: **Premature ventricular contractions (PVC)** are common during exercise testing.
TRUE
## Footnote
PVCs are associated with ischemia, especially if there are more than 10 per minute.
132
What should be done if the **systolic pressure** does not rise during exercise testing?
The test should be terminated and the physician informed
## Footnote
This indicates that the patient's cardiac output is not increasing appropriately.
133
What are the normal changes in **systolic and diastolic pressure** during exercise testing?
* Systolic pressure: from 120 mm Hg to 200 - 250 mm Hg
* Diastolic pressure: from 80 mm Hg to 90 - 95 mm Hg
## Footnote
Changes in blood pressure are common in normal patients.
134
What happens to **respiratory rate**, **tidal volume**, and **minute volume** as workload increases?
All increase
## Footnote
This is a normal response during exercise testing.
135
What happens to **carbon dioxide production (VCO2)** and **oxygen consumption (VO2)** during exercise testing?
Both rise together to keep the respiratory exchange ratio (RER) near normal (0.8)
## Footnote
VCO2 is linear at 3 L/min/mm Hg.
136
What happens to **pH** during exercise testing?
May rise initially due to hyperventilation; will fall when the anaerobic threshold is reached
## Footnote
This reflects changes in metabolic activity.
137
What happens to **deadspace (VD)** during stress testing?
Normally decreases due to increased pulmonary perfusion
## Footnote
This is a physiological response to exercise.
138
What remains constant in normal patients during **stress testing**?
Pulmonary artery pressure (PAP)
## Footnote
Increases in PAP indicate ventilatory limitations due to lung disease or vascular impairment.
139
What is the formula for **Minute Ventilation (V)**?
V = tidal volume (V,) x respiratory rate (f)
## Footnote
Alternatively, V can be calculated as Volume expired × 60 × BTPS factor divided by Collection time (sec).
140
What is the normal value for **Minute Ventilation** at rest?
5 - 10 L/min
## Footnote
During exercise, normal values can reach 100 - 200 L/min.
141
How is the **maximum minute ventilation** during exercise estimated?
risest flow x 40
## Footnote
This can also be calculated using the formula: FEV, x 40.
142
What percentage of maximum minute ventilation should normal subjects be able to reach?
At least 70%
## Footnote
This is assessed during stress testing.
143
If maximum minute ventilation is reached during stress testing, what does this indicate?
Primary ventilatory limitation to exercise
## Footnote
This is determined using the formula FEV, × 40.
144
What is the formula to calculate **Frequency of Breathing (f)** using a spirometer?
number of accumulated breaths / testing period (minutes)
## Footnote
This gives the respiratory rate in breaths per minute.
145
If an exercise test is performed for 1.5 minutes with 30 accumulated breaths, what is the **breathing frequency**?
20 breaths/minute
## Footnote
Calculation: 30 accumulated breaths / 1.5 minutes.
146
What is the normal value for **respiratory rate** at rest?
10 - 20 breaths per minute
## Footnote
This indicates a typical resting respiratory rate.
147
How is **Alveolar Minute Volume (V)** calculated?
Subtracting the deadspace volume from the tidal volume and multiplying by the frequency (respiratory rate)
## Footnote
Formula: V Alveolar = (V - Vo) x f or V Alveolar = Ve - (Vo x t)
148
What is the formula for calculating **deadspace volume**?
Deadspace can be estimated as 1 mL/b of body weight
## Footnote
This estimation helps in calculating alveolar minute volume.
149
In breath-by-breath systems, how is **Tidal Volume (Vt)** reported?
As an average over a short time period
## Footnote
This provides a more accurate representation of tidal volume during breathing.
150
What is the normal value for **Tidal Volume (Vt)**?
5 mL/kg of body weight
## Footnote
This value is used to assess normal respiratory function.
151
At higher workloads, how is an increase in **minute ventilation** achieved?
By increases in respiratory rate
## Footnote
This contrasts with low and moderate workloads, where tidal volume increases contribute more.
152
Define **Oxygen Consumption (VO2)**.
Amount of oxygen consumed in liters per minute at STPD
## Footnote
Normal value is 0.25 L/min at rest, up to 4 L/min during exercise.
153
What is the best indication of **workload performed**?
Oxygen consumption must rise with increased workloads
## Footnote
This reflects the body's metabolic demands during physical activity.
154
What equipment is required to measure **oxygen uptake**?
* Inline gas analyzers for oxygen percentages (F,O/F.O,)
* F, CO, analyzer
* Spirometer (V)
## Footnote
These tools are essential for accurate measurement of oxygen consumption.
155
Define **Carbon Dioxide Production (VCO2)**.
Amount of carbon dioxide produced in liters per minute at STPD
## Footnote
Normal value is 0.2 L/min at rest, up to 4 L/min during exercise.
156
What does **VCO2** indicate?
A patient's metabolic status
## Footnote
This measurement helps assess how well the body is metabolizing nutrients.
157
What is the formula to calculate **VCO2**?
FaCO, x minute volume = VCO2
## Footnote
This formula uses the concentration of CO2 and the total volume of air exhaled.
158
What is the **definition** of the **Respiratory Exchange Ratio (RER)**?
The relationship of O₂ consumption and CO₂ production at the mouth, which represents gas exchange in the lung.
## Footnote
This ratio is crucial for understanding respiratory function.
159
What is the **formula** for calculating the **Respiratory Exchange Ratio (RER)**?
RER = VCO₂ (STPD) / VO₂ (STPD)
## Footnote
This formula helps quantify gas exchange efficiency.
160
What is the **normal value** of RER at rest?
0.85
## Footnote
This value indicates a balanced metabolic state.
161
What happens to RER during a **stress test**?
RER remains constant and increases to 1.0 or greater at anaerobic threshold (AT)
## Footnote
This increase indicates a shift to anaerobic metabolism.
162
In steady state testing, RER equals the **respiratory quotient (RQ)**. True or False?
TRUE
## Footnote
This relationship is important for metabolic assessments.
163
What does an **increased RER** at rest usually indicate?
Resting hyperventilation (increased respiratory rate and/or increased tidal volume)
## Footnote
This can affect overall respiratory efficiency.
164
What is the difference between **SaO₂** and **SpO₂**?
SaO₂ is directly measured arterial oxygen saturation; SpO₂ is measured by pulse oximetry
## Footnote
Both are important for assessing oxygen levels in the blood.
165
What is required for a **direct measurement** of arterial oxygen saturation (SaO₂)?
Obtaining a sample of arterial blood, usually from peripheral arterial puncture or an indwelling arterial catheter
## Footnote
This method provides accurate oxygen saturation levels.
166
What are the **advantages** of pulse oximetry (SpO₂)?
* Continuous readings
* Noninvasive estimate of arterial saturation
## Footnote
These features make pulse oximetry a preferred method in many clinical settings.
167
What are the **disadvantages** of pulse oximetry (SpO₂)?
* Inaccurate readings with poor peripheral perfusion
* Motion artifact
## Footnote
These limitations can affect the reliability of SpO₂ readings.
168
What is the **normal range** for SpO₂?
93 - 97%
## Footnote
Values outside this range may indicate respiratory issues.
169
What can cause pulse oximeters to read **falsely high**?
Exposure to carbon monoxide
## Footnote
This can lead to misinterpretation of oxygen saturation levels.
170
During **exercise**, what should happen to oxygen saturation?
It should remain fairly constant
## Footnote
A decrease indicates potential ventilatory limitations.
171
What should be done if oxygen saturation is **< 85%** during stress testing?
Terminate the stress testing
## Footnote
This threshold is critical for patient safety.
172
What is the **definition** of O, pulse?
Volume of oxygen consumed per heartbeat
## Footnote
O, pulse is a measure of oxygen utilization efficiency.
173
What is the **formula** for calculating O, pulse?
VO, (STPD) X 1000 / heart rate
## Footnote
Reported in mL O,/beat.
174
If a patient has an oxygen consumption of 0.731 L (STPD) with a heart rate of 100 beats per minute, what is the **O, pulse**?
7.31 mL O,/beat
## Footnote
Calculation: O, pulse = 0.731 L / 100 HR X 1000 = 7.31 mL O,/beat.
175
What is the **normal range** for O, pulse at rest?
2.5 - 4.0 mL O,/beat
## Footnote
During exercise, the normal range is 10 - 15 mL O,/beat.
176
A low O, pulse at rest that does not increase appropriately with high heart rates is consistent with **what condition**?
Cardiac disease and low stroke volume
## Footnote
Conditions include coronary artery disease, valve disease, and cardiac myopathies.
177
True or false: **Tachycardia at rest** will decrease O, pulse.
TRUE
## Footnote
Tachycardia can affect the efficiency of oxygen utilization.
178
What effect does **beta-blocker therapy** have on O, pulse?
Increases O, pulse
## Footnote
Beta-blockers can improve heart rate response.
179
Why do **athletes** have an increased O, pulse?
Result of their lower resting heart rate
## Footnote
Athletes' cardiovascular efficiency contributes to this increase.
180
Any cardiac arrhythmia with a low resting heart rate will result in an increased O, pulse in conditions such as **________**.
Bradycardia, A-V block
## Footnote
These conditions affect heart rate and oxygen utilization.
181
What happens to O, pulse when oxygen consumption plateaus at the end of a **stress test**?
O, pulse will drop as the heart rate increases
## Footnote
This reflects the body's response to exertion.
182
What does **PaO2** remain constant at during high workloads in healthy persons?
PaO2
## Footnote
PaO2 is the partial pressure of oxygen in arterial blood.
183
PaO2 less than _______ torr is criteria for terminating the test.
55
## Footnote
This threshold indicates significant hypoxemia.
184
What is the normal **P(A-a)O2** at rest while breathing room air (21% O2)?
10 - 20 torr
## Footnote
P(A-a)O2 indicates the difference between alveolar and arterial oxygen tension.
185
What is the expected **P(A-a)O2** during exercise in healthy persons?
20 - 30 torr
## Footnote
This reflects the increased demand for oxygen during physical activity.
186
Increases in **P(A-a)O2** accompanied by decreases in **PaO2** may indicate what?
* Increased right-to-left shunt
* Increased V/Q mismatching
* Diffusion defects
## Footnote
These conditions can impair gas exchange in the lungs.
187
An increase in **PaO2** may occur in the presence of what conditions?
* Pulmonary disease
* Increased pulmonary vascular resistance
## Footnote
This can be due to increased cardiac output and/or improved distribution of ventilation.
188
Use of supplementary **O2** during testing may be indicated if _______ is present at rest.
hypoxemia
## Footnote
Hypoxemia refers to low levels of oxygen in the blood.
189
What is the definition of **PaCO2**?
Partial pressure of carbon dioxide in arterial blood
## Footnote
It is a key indicator of respiratory function.
190
What does **ETCO2** stand for?
End Tidal Carbon Dioxide
## Footnote
It measures the amount of carbon dioxide in exhaled gas.
191
Normal **Vd/Vt** ratio at rest is between _______.
0.20-0.40
## Footnote
This ratio reflects the amount of wasted ventilation.
192
At moderate workloads, **PaCO2** remains constant while _______ increases.
PCO2
## Footnote
This occurs due to increases in ventilation.
193
At high workloads, what occurs as a result of lactic acid production?
Metabolic acidosis
## Footnote
This leads to increased ventilation and a decrease in **PaCO2**.
194
With severe pulmonary disease, the anaerobic threshold may not be reached, leading to what?
Respiratory acidosis
## Footnote
This can cause the **Vd/Vt** to remain constant or increase.
195
The **pH** will decrease as a result of increased **PaCO2** and/or _______ production.
lactic acid
## Footnote
This reflects the body's response to increased metabolic activity.
196
In normal subjects, the **pH** will not decrease until what is reached?
Anaerobic threshold
## Footnote
This indicates the point at which the body shifts to anaerobic metabolism.
197
What are the **limitations to exercise testing**?
* Ventilatory limitation
* Cardiac limitation
* Poor physical condition
* Poor effort
## Footnote
These limitations can affect the outcomes and interpretations of exercise tests.
198
What indicates a **ventilatory limitation** to stress during exercise testing?
* Maximum Minute Ventilation (FEV, × 40)
* Decrease in O₂ saturation
* Respiratory acidosis (low pH, high PaCO₂)
* Increased Respiratory Exchange Ratio (RER)
* Normal ECG and heart rate
## Footnote
These indicators suggest that the pulmonary system is reaching its maximum workload.
199
What indicates a **cardiac limitation** to stress during exercise testing?
* Significant ECG changes (S-T segment depression or elevation, T wave inversion, Large Q waves, frequent PVC, bradycardia)
* Systolic pressure does not rise
* Diastolic pressure decreases
* O₂ pulse decreases
* Minute ventilation V̇E less than 70% of MVV
## Footnote
These indicators suggest that the cardiovascular system is reaching its maximum workload.
200
What is indicated by **poor conditioning** during exercise testing?
Increased heart rate at low-moderate watts with normal ECG and V̇E less than 70% of MVV
## Footnote
This suggests that the individual may not be physically fit enough to handle the exercise workload.
201
What characterizes **poor effort** during exercise testing?
* ECG, SpO₂, and heart rate are normal
* Anaerobic threshold is not achieved
* V̇E is < 70% of the MVV
## Footnote
This indicates that the individual may not be exerting themselves adequately during the test.
202
What is a specific reason for ending an exercise evaluation related to **myocardial ischemia**?
2mm elevation or depression in the ST segment
## Footnote
Indicates potential myocardial ischemia during testing.
203
What does the presence of **inverted T waves** indicate in an exercise evaluation?
Termination of testing
## Footnote
Inverted T waves can signify underlying cardiac issues.
204
What is a reason for terminating an exercise test involving **Q waves**?
Presence of large Q waves
## Footnote
Large Q waves may indicate previous myocardial infarction.
205
What arrhythmia is a reason for ending an exercise evaluation?
Ventricular tachycardia or sustained supraventricular tachycardia (SVT)
## Footnote
These arrhythmias can be life-threatening during exercise.
206
What does **multifocal PVC** indicate in the context of exercise testing?
Termination of testing
## Footnote
Multifocal PVCs can suggest significant cardiac stress.
207
What heart block changes warrant the termination of an exercise evaluation?
Second or third degree heart block changes
## Footnote
These changes can indicate serious conduction issues.
208
What is an example of an exercise-induced condition that requires test termination?
Right or left bundle branch block
## Footnote
Bundle branch blocks can affect cardiac function during stress testing.
209
What symptom related to **angina** indicates the need to end an exercise test?
Angina that progresses with testing
## Footnote
Worsening angina can indicate increased cardiac risk.
210
What physical signs indicate the termination of an exercise evaluation?
* Sweating (diaphoresis)
* Pallor
## Footnote
These signs can indicate distress during exercise.
211
What systolic pressure reading indicates the need to terminate an exercise test?
Greater than 250mm Hg
## Footnote
High systolic pressure can indicate excessive cardiac strain.
212
What diastolic pressure reading indicates the need to terminate an exercise test?
Greater than 100mm Hg
## Footnote
Elevated diastolic pressure can signify cardiovascular risk.
213
What systolic pressure change during exercise indicates test termination?
Does not increase or falls 10mm Hg
## Footnote
A drop in systolic pressure during exercise is concerning.
214
What is an example of a blood pressure change that requires termination of a stress test?
From 120/80 mm Hg to 110/70 mm Hg
## Footnote
This example shows a significant drop in blood pressure during exercise.
215
What symptoms indicate the need to terminate an exercise evaluation?
* Lightheadedness
* Headache
* Mental changes
## Footnote
These symptoms can indicate inadequate cerebral perfusion.
216
What does **cyanosis** indicate during an exercise evaluation?
Termination of testing
## Footnote
Cyanosis suggests inadequate oxygenation of the blood.
217
What gastrointestinal symptoms indicate the need to end an exercise test?
* Nausea
* Vomiting
## Footnote
These symptoms can indicate distress during exercise.
218
What physical symptom related to muscles indicates the need to terminate an exercise evaluation?
Muscle cramping
## Footnote
Muscle cramping can indicate overexertion or electrolyte imbalance.
219
What respiratory symptom indicates the need to terminate an exercise evaluation?
Hyperventilation
## Footnote
Hyperventilation can indicate distress and inadequate oxygenation.
220
What can the **tidal breathing flow-volume loop** identify during stress testing?
Pulmonary disorders that only occur during exercise
## Footnote
The loop is monitored to assess changes in lung function under stress.
221
How is the **exercise tidal breathing Fv Loop** positioned on the resting loop?
Using the inspiratory capacity (IC) during exercise
## Footnote
This helps to compare the exercise response with the resting state.
222
What is a **normal response** to exercise regarding inspiratory and expiratory reserve volume?
* Decrease in inspiratory reserve volume (IRV)
* Decrease in expiratory reserve volume (ERV)
* Increase in tidal volume
* Increase in minute volume
## Footnote
This indicates effective lung function during exercise.
223
Patients with **chronic lung disease** will only be able to decrease which reserve to increase tidal volume and minute volume?
Inspiratory reserve volume (IRV)
## Footnote
This limitation affects their ability to respond to exercise effectively.
224
What can a **computer** measure during the exercise tidal breathing flow-volume loop?
% time the patient is breathing at or above the maximal flow
## Footnote
This measurement helps assess the patient's respiratory performance.
225
What does a **decreased inspiratory flow** during exercise indicate?
* Variable extra thoracic obstruction
* Vocal cord dysfunction
## Footnote
These conditions can affect airflow and breathing efficiency.
226
An **abnormal shift to the right** in the flow-volume loop can mimic which condition?
Asthma (dyspnea, wheezing)
## Footnote
This shift may also occur with morbid obesity, affecting respiratory function.
227
What can the **tidal breathing flow-volume loop** identify during stress testing?
Pulmonary disorders that only occur during exercise
## Footnote
The loop is monitored to assess changes in lung function under stress.
228
How is the **exercise tidal breathing Fv Loop** positioned on the resting loop?
Using the inspiratory capacity (IC) during exercise
## Footnote
This helps to compare the exercise response with the resting state.
229
What is a **normal response** to exercise regarding inspiratory and expiratory reserve volume?
* Decrease in inspiratory reserve volume (IRV)
* Decrease in expiratory reserve volume (ERV)
* Increase in tidal volume
* Increase in minute volume
## Footnote
This indicates effective lung function during exercise.
230
Patients with **chronic lung disease** will only be able to decrease which reserve to increase tidal volume and minute volume?
Inspiratory reserve volume (IRV)
## Footnote
This limitation affects their ability to respond to exercise effectively.
231
What can a **computer** measure during the exercise tidal breathing flow-volume loop?
% time the patient is breathing at or above the maximal flow
## Footnote
This measurement helps assess the patient's respiratory performance.
232
What does a **decreased inspiratory flow** during exercise indicate?
* Variable extra thoracic obstruction
* Vocal cord dysfunction
## Footnote
These conditions can affect airflow and breathing efficiency.
233
An **abnormal shift to the right** in the flow-volume loop can mimic which condition?
Asthma (dyspnea, wheezing)
## Footnote
This shift may also occur with morbid obesity, affecting respiratory function.
234
What does an **abnormal shift to the left (TLC)** indicate?
* No flow limitation is demonstrated
* Inappropriate breathing strategy
* May cause dyspnea during testing
## Footnote
This pattern is observed in certain pulmonary function tests.
235
What characterizes an **obstructive pattern with abnormal shift to the left (TLC)**?
* Flow limitation
* Significant expansion of tidal breathing
## Footnote
This indicates a more severe respiratory condition, such as COPD.
236
During **oxygen titration at rest**, what should be done for patients with hypoxemia?
* Test with oxygen administered via nasal cannula
* Adjust oxygen levels as workload increases
* Monitor SpO2 at different workloads
## Footnote
This ensures that arterial saturation remains acceptable during testing.
237
If resting **SpO2** is low, what should be performed prior to exercise titration?
Oxygen titration at rest
## Footnote
This step is crucial for ensuring patient safety before engaging in exercise testing.
238
What is the purpose of **Field Walking Tests**?
* Evaluate exercise capacity
* Identify factors limiting exercise performance
* Assess prognosis
* Evaluate treatment response
## Footnote
These tests are used to gather important information about a patient's physical capabilities and health status.
239
Name one **absolute contraindication** for conducting Field Walking Tests.
* Acute myocardial infarction (within 3-5 days)
## Footnote
Other contraindications include unstable angina, uncontrolled arrhythmias, and active endocarditis.
240
True or false: **Uncontrolled heart failure** is an absolute contraindication for Field Walking Tests.
TRUE
## Footnote
This condition poses significant risks during exercise testing.
241
List three **absolute contraindications** for Field Walking Tests.
* Unstable angina
* Active endocarditis
* Acute myocarditis or pericarditis
## Footnote
These conditions can lead to serious complications if exercise is performed.
242
Fill in the blank: **Room air SpO2 < _______** is an absolute contraindication for Field Walking Tests.
85%
## Footnote
Low oxygen saturation indicates a risk for respiratory complications during testing.
243
What does **mental impairment** leading to inability to cooperate indicate in the context of Field Walking Tests?
It is an absolute contraindication
## Footnote
Patients must be able to understand and follow instructions for the tests to be safely conducted.
244
What **equipment** is required for exercise testing?
* Countdown timer/stopwatch
* Mechanical lap counter
* Method to mark endpoints (small traffic cones)
* Chair (positioned at one end)
* Sphygmomanometer and appropriately sized cuff
* Rating of perceived exertion scale (Borg Scale)
* List of standard statement of timing and encouragement
* Pulse oximeter
* Access to emergency response team
* Oxygen delivery devices (O, cylinder and nasal cannula)
* Patient's rescue medications (albuterol, nitroglycerin, etc.)
* Clipboard with reporting sheet and pen
## Footnote
These items are essential for conducting a proper exercise test.
245
What should a **patient** wear during exercise testing?
Comfortable clothing and appropriate shoes for walking
## Footnote
Proper attire is important for safety and performance during the test.
246
True or false: Patients should use their usual **walking aids** during testing.
TRUE
## Footnote
This includes aids such as cane or walker to ensure safety and accuracy.
247
Patients should not have exercised within _______ of the beginning of the test.
2 hours
## Footnote
This ensures that the patient is adequately rested for accurate testing results.
248
If a patient is on long-term oxygen therapy, what should be administered at the standard flowrate?
Oxygen
## Footnote
This is crucial for patients who require supplemental oxygen during exercise.
249
What are the **initial measurements** to take before starting the exercise test?
* Heart rate
* SpO2
* Blood pressure
* Baseline dyspnea
## Footnote
These measurements provide a baseline for monitoring during the test.
250
What should be provided to the patient before starting the test?
Standardized instructions
## Footnote
Clear instructions help ensure that the test is conducted properly.
251
Where should the patient be positioned before starting the exercise test?
At the starting line
## Footnote
Proper positioning is essential for the test to begin accurately.
252
What should the instructor do to the patient at the end of the test?
Monitor the patient for at least 5 minutes following the test
## Footnote
This monitoring is important to ensure the patient's safety post-exercise.
253
What is the **first step** in the procedure for field walking tests?
Utilize standard statements of encouragement
## Footnote
This helps to motivate and support the patient during the test.
254
During the field walking tests, what two measurements should be recorded continuously?
* Heart rate
* SpO2
## Footnote
Continuous monitoring is essential for assessing the patient's response during the test.
255
Terminate the test if SpO2 is below _______.
< 80%
## Footnote
This threshold indicates a significant drop in oxygen saturation, necessitating test termination.
256
List three patient complaints that would require termination of the test.
* Chest pain
* Intolerable dyspnea
* Leg cramps
## Footnote
Other symptoms like staggering, diaphoresis, or pale appearance also warrant test termination.
257
What should be done to validate the results of the walking test?
Repeat the test
## Footnote
The repeat test can be performed on the same day with a minimum of 30-minute rest between tests.
258
What is the **greatest recorded distance** referred to in the walking tests?
* 6MWD (Six Minute Walk Distance)
* ISWD (Incremental Shuttle Walk Distance)
* ESWD (Endurance Shuttle Walk Distance)
## Footnote
These metrics help evaluate the patient's walking capacity.
259
In the Six Minute Walking Test (6MWT), what is the **minimum length** of the walking course?
100 ft (30 m)
## Footnote
A properly measured course is critical for accurate distance recording.
260
What type of environment is recommended for conducting the Six Minute Walking Test?
Quiet corridor, gym, or dedicated exercise testing room/area
## Footnote
A controlled environment helps minimize distractions and ensures comfort.
261
What should be announced to the patient during the Six Minute Walking Test?
Remaining time each minute
## Footnote
This helps the patient manage their pacing without being paced by the tester.
262
True or false: The Six Minute Walking Test is a **self-paced test**.
TRUE
## Footnote
Patients are encouraged to walk as far as possible at their own pace.
263
What should be recorded at the end of the **test**?
* Number of laps
* Additional distance covered
* Total distance walked (6MWD)
## Footnote
The total distance should be rounded to the nearest foot or meter.
264
What are the **reported mean distances** for men and women in the 6MWD?
* Men: 1889 ft.
* Women: 1620 ft.
## Footnote
Reference: Enright & Sherrill, Am J Respir Crit Care Med, 1998.
265
What should be noted regarding **walking aids** during the test?
Walking aids used during test
## Footnote
This includes any devices that assist the patient while walking.
266
What information about **oxygen administration** should be recorded during the test?
* Delivery device
* O2 transport method
## Footnote
This includes whether oxygen was pulled in a cart or carried in a unit.
267
True or false: If a patient **stopped** during the test, this should be recorded.
TRUE
## Footnote
Stopping during the test may indicate issues with exertion or endurance.
268
What is the **lowest SpO2** that should be recorded during the test?
Lowest SpO2 (nadir)
## Footnote
This indicates the lowest oxygen saturation level reached during the test.
269
What should be recorded regarding the **end-of-test heart rate**?
End-of-test heart rate
## Footnote
This provides insight into the cardiovascular response to the exercise.
270
What scale is used to measure **dyspnea** at the end of the test?
Borg Scale
## Footnote
This scale assesses the level of breathlessness experienced by the patient.
271
What are the ratings on the **Modified Perceived Exertion Scale**?
* 0.5: Very, very light
* 1: Very light
* 2: Light
* 3: Moderate
* 4: Somewhat hard
* 5: Hard
* 6: Very hard
* 7: Very, very hard
* 8: Maximal
## Footnote
This scale helps gauge the perceived exertion level during the test.
272
What is the **Incremental Shuttle Walk Test (ISWT)**?
Externally paced test of maximal walking exercise capacity
## Footnote
The test controls walking speed with pre-recorded signals.
273
How is the **speed of walking** controlled during the ISWT?
By a series of pre-recorded signals
## Footnote
The speed increases until the patient can no longer continue.
274
What is the **maximum duration** of the ISWT?
20 minutes
## Footnote
The test measures the patient's maximal walking capacity.
275
What is the **course length** for the ISWT?
33 feet (10 mm)
## Footnote
The course should be flat and straight with a hard surface.
276
What should be done to **mark the end of the course** in the ISWT?
Set cones 2 feet from the end
## Footnote
This avoids abrupt changes in direction.
277
What happens to the **speed** during the ISWT?
Increases each minute
## Footnote
Patients are encouraged to match their pace to the audio signal.
278
When is the ISWT **terminated**?
* Patient is unable to continue
* Evaluator determines patient is not fit to continue
* Patient cannot maintain appropriate speed
* SpO2 < 80%
## Footnote
These criteria ensure patient safety during the test.
279
At the end of the ISWT, what should be **recorded**?
* Distance walked (feet or meters)
* Walking aids used
* Oxygen administered
* Number of stops
* Lowest SpO2 (nadir)
* End-of-test heart rate
* End-of-test dyspnea scale (Borg Scale)
## Footnote
These records help assess the patient's performance and safety.
280
What is the **maximum test duration** for the Endurance Shuttle Walk (ESWT)?
20 minutes
## Footnote
This is the maximum time a patient can walk during the test.
281
In the ESWT, speed is based on a predetermined percentage of maximum walking performance from which test?
ISWT
## Footnote
ISWT stands for Incremental Shuttle Walk Test.
282
True or false: The ESWT elicits similar end-of-test heart rate and dyspnea responses compared to a treadmill at the same intensity.
TRUE
## Footnote
This indicates that the ESWT can be a reliable measure of endurance.
283
What is the **initial portion** of the ESWT procedure?
Warm-up period
## Footnote
This prepares the patient for the subsequent test.
284
During the ESWT, the speed is increased to what percentage of maximum performance from ISWT?
70 - 85%
## Footnote
This range is used to determine the testing intensity.
285
The ESWT ends when which of the following occurs? (Select all that apply)
1. Patient is unable to continue
2. Evaluator determines that the patient is not fit to continue
3. Patient is unable to maintain the appropriate speed
4. SpO2 < 80%
* Patient is unable to continue
* Evaluator determines that the patient is not fit to continue
* Patient is unable to maintain the appropriate speed
* SpO2 < 80%
## Footnote
These criteria ensure patient safety during the test.
286
At the end of the ESWT, which of the following should be recorded? (Select all that apply)
1. Time of test
2. Walking aids used
3. Oxygen administered
4. If patient stopped during the test
5. Lowest SpO2
6. End-of-test heart rate
7. End-of-test dyspnea scale
* Time of test
* Walking aids used
* Oxygen administered
* If patient stopped during the test
* Lowest SpO2
* End-of-test heart rate
* End-of-test dyspnea scale
## Footnote
Recording these details is crucial for evaluating the test results.
287
Who should be familiar with the test procedures and certified in BLS for the ESWT?
Evaluator
## Footnote
This ensures that the evaluator can safely conduct the test.
288
For ISWT and EST, the evaluator must be able to walk at exactly what speed?
First speed of walking
## Footnote
This is necessary to pace the patient correctly.
289
What should be functioning according to manufacturer's specifications during the ESWT?
Pulse oximeters
## Footnote
This is important for accurate monitoring of SpO2 levels.
290
The course for the ESWT should be measured how?
Accurately
## Footnote
Accurate measurement ensures the reliability of the test.
291
What is the **primary outcome** measured in the G-Minute Walk Test?
Distance (6MWD)
## Footnote
Measures how far a person can walk in 6 minutes.
292
What does the **Incremental Shuttle Walk Test** measure?
Distance
## Footnote
Assesses how far a person can walk at faster and faster speeds.
293
What is measured in the **Endurance Shuttle Walk Test**?
Time
## Footnote
Evaluates how long a person can walk.
294
True or false: All three tests demonstrate **good construct validity**.
TRUE
## Footnote
They show strong relationships with other measures of exercise performance.
295
Lower **6-minute walking distance (6MWD)** is associated with what risks in chronic respiratory disease?
* Increased risk of hospitalization
* Increased risk of mortality
## Footnote
Indicates the importance of walking distance as a health indicator.
296
The tests are responsive to what effects in people with chronic respiratory disease?
Treatment effects
## Footnote
Indicates their utility in monitoring patient progress.
297
What are the **safety protocols** for conducting field walking tests?
* Pre-test assessments
* Risks explained to the patient
* Consent forms signed
* Skilled physician present
* Trained personnel for emergencies
* Adequate testing room size
* Appropriate temperature, humidity, and lighting
* Emergency equipment checked daily
## Footnote
Ensures the safety of patients during testing.
298
What should be included in **emergency equipment** for testing?
* Oxygen equipment
* Airways
* Suction
* Defibrillator
* Resuscitation bag and mask
* Emergency drugs
## Footnote
Essential for managing emergencies during tests.
