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PTRS 825 Final Exam > Exercise Testing and Prescription in Peds > Flashcards

Exercise Testing and Prescription in Peds Flashcards

1
Q

CV Responses for Children

A

CO increases 3-4 times above resting level (due to HR)
Low SV compared to adults; therefore, higher HR
Boys: HR is lower and SV slightly higher

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2
Q

Submax HR

A

Declines with age

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3
Q

Max HR

A

Ranges from 195-210

Declines in late teens or early 20s

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4
Q

Boys

A

Faster post-exercise decline in HR than girls

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5
Q

Obese Children

A

Higher submax HR than lean -> reduces HR reserve

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6
Q

Environment

A

High temp and humidity increase HR 10-20 bpm

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7
Q

Fear or Apprehension

A

HR may increase due to being scared

See if they can relax more after test, than take a resting HR

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8
Q

Mode of Testing

A

Affect HR

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9
Q

Pharmacologic agents

A

May increase or decrease HR

Rely on 1-20 scale instead

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10
Q

BP

A

Rhythmic exercise will cause rise in systolic proportion to exercise intensity
African americans have higher BP due to stiffer arterial surfaces

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11
Q

Normal Responses to Exercise

A

SBP increases
>220 = concern
DBP varies +/- 6-10

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12
Q

Unique Responses to Exercise

A

VO2 - higher at submax, higher/equal at max
HR - higer at both max/submax
All other variables are lower

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13
Q

Voluntary Hypohydration

A

Even forced to drink, most children are underhydrated

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14
Q

Perpetual Response Difference to Exercise

A

Children tend to be slower/weaker BUT perceive intensities to be lower, recover faster

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15
Q

Considering Exercise Testing a Child

A

Begin around 6-8 yo

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16
Q

Testing Protocols

A

Bruce/Modified Bruce
Balke
CMH Max
Manual

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17
Q

Bruce/Modified Bruce

A

Most traditional
3 min stages at 10% grade and increase grade 2% each stage
Steep grades/large MET increases/long stages difficult for young pts

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18
Q

Balke

A

3.0-3.5 mph with 2% increase every min or 2.5% increase every 2 min

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19
Q

CMH Max

A

Used with athletes

No longer than 12 minutes

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20
Q

Tilt Table Indications

A

Presyncope
Dizziness
Tachycardia
Extreme fatigue

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21
Q

Tilt Table Monitoring

A

HR
BP
O2 Sat

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22
Q

Passive Tilt

A

20 min supine
20 min with HOB @ 80 deg
Assess patients whose symptoms occur with change of position/non-exercise related
Most common in slender, rapidly growing adolescents w/limited fluid intake

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23
Q

Active Tilt

A

Exercise test followed by 20 min with HOB @ 80 deg
Assess patients whose symptoms are related to exercise
Most common in competitive athletes

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24
Q

Tilt Table Positive Findings

A

LOC
Symptomatic hypotension/bradycardia/asystole
Persistent tachycardia w/o dec BP (POTS)
Inappropriate hypotension (HR gives out before BP)

25
Q

Ped Chest Pain and SOB

A

More likely in chronic/recurring issues

26
Q

Ped Chest Pain and SOB Acute Causes

A

Pericarditis
Trauma
Arrhythmias

27
Q

Ped Chest Pain and SOB Non-cardiac Causes

A

Pneumothorax
Pleurodynia
Acute esophagitis
Foreign body

28
Q

Ped Chest Pain and SOB Chronic Causes

A 
MI
Coronary artery anomalies
Pericarditis
Esophagitis
Costochondritis
Asthma
Sickle cell
Vocal cord dysfunction
29
Q

Asthma

A

Spirometry changes on expiration
Most common serious chronic childhood disease
Don’t have to have a wheeze

30
Q

Exercise Induced Asthma Symptoms

A

Coughing
Wheezing
Tightness
Typically begin 5-20 min after exercise on dry/cold days

31
Q

EIA Management

A

Use Rx 10-20 min prior to exercise
Quick acting: beta agonists, albuterol, anticholinergics, atrovent
Long acting: anti-inflammatories, leukotriene modifiers corticosteroids

32
Q

Treatment with Short Acting Beta Agonist

A

2/3 must be positive to ddx reversible airway obstruction:

  1. FEV1 - 200 mL or 12% increase after abutter dose
  2. FVC - 10+% increase
  3. FEF 25-75% - 20% increase
33
Q

Vocal Cord Dysfunction

A

Spirometry changes on inspiration, normal expiration
Paradoxical closure or adduction of vocal cords during inspiration
Mimics EIA but symptoms don’t respond to asthma meds
Occur with high intensities, but not sport specific

34
Q

VCD Triggers

A 
Bronchitis/pneumonia
Fumes/odors
Smoke
Post nasal drip
Emotions
Singing
35
Q

VCD Symptoms

A

Stridor (noise on inhale)
Tightness
Abrupt onset/resolution
Feeling faint

36
Q

VCD Treatment

A

Education
Belly breathing
Throat relaxation
Swallow-breath technique

37
Q

GERD

A

Treating can improve both EIA and VCD
Dehydration believe to increase incidence
Can lead to tracheal malacia

38
Q

Spirometry Purpose

A

Classify lung function

39
Q

Spirometry Contraindications

A

Pneumothorax
Thoracic aneurysms
Eye/ab/thoracic symptoms
MI/unstable angina

40
Q

FVC

A

Max volume of air forcefully exhaled after deepest inhale
Decreased with restrictive
Decrease or normal with obstructive

41
Q

FEV1

A

Forced expiratory volume in 1 sec
Indicator of large airway obstruction
>80% predicted

42
Q

FEV1/FVC

A

Ratio to classify lung function

Obstructive =

43
Q

FEF 25-75%

A

Mean forced expiratory flow during middle half of FVC
Indicator of SMALL airway function
Norm = >60-70%
Obstructive = decreased

44
Q

EISOB Evaluation Protocol

A

Get HR to 160-180 bpm for 6-8 min

Perform flow-volume loops pre-exercise and 5/10/15 min post-exercise

45
Q

Airway Obstruction

A

Any disease affecting diameter of airways

Low flow rate relative to lung volume

46
Q

Obstruction Classification

A

Mild - 65-80%
Moderate - 50-60%
Severe -

47
Q

Restricted Lung Disease

A

Restriction of lung tissue or capacity of lungs to expand and hold predicted volumes of air
Low volumes with normal flow rates

48
Q

RLD Causes

A

Fibrosis
Scarring
Physical deformity

49
Q

Combined Lung Disease

A

CF

Excessive mucous production and damage to lung tissue

50
Q

Bethesda Guidelines

A

For which activities/sports can be participated in

Conservative, probably lower PA level than needed

51
Q

Aortic Stenosis

A

Valves don’t open/close properly allowing back flow into ventricles

52
Q

Aortic Coarctation

A

“Kink in hose”
Elevated S/DPB
Better assessed with right arm BP
Typically treated with stent

53
Q

Hypertrophic Cardiomyopathy

A

Strong, thick muscle that doesn’t pump effectively, smaller ventricles, altered conduction

54
Q

HTCM Evaluation

A

For ischemic changes, ventricular ectopy and abnormal BP response
ST depression
Decrease in SPB

55
Q

Coronary Conditions

A

Kawasaki’s
Anomalous origin/course of coronary artery
Transposition of great vessels

56
Q

Single Ventricle

A

Blunted HR response
EKG abnormalities
Decrease O2

57
Q

Dysrhythmia

A

Lack of sleep
Stress
Caffeine

58
Q

Dysrhythmia Types

A

Ectopic: PVC, PAC
Sick Sinus Syndrome
Long QT Syndrome
Tachyarrhythmias

PTRS 825 Final Exam (13 decks)

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