Exercise Testing - Flash Cards

Question 1

What is the primary indication for stress testing?

Bonus: name 2 others

Answer 1

Chief complaint of dyspnea on exertion

determine ventilatory limitations to work
determine cardiac limitations to work

*page E-5

Question 2

There are many contraindications to stress testing. Name as many as you can.

Answer 2

*page E-5

PaO2 < 45
PCO2 > 70
FEV1 < 30% of predicted
Recent MI
Unstable angina
2nd or 3rd degree heart block
Rapid ventricular or atrial arrhythmias
Orthopedic problems that impair activity
Severe aortic stenosis
CHF
Uncontrolled hypertension
Neurological disorders that limit ability to perform
Dissecting aneurysms
Severe pulmonary hypertension

Question 3

How do you adjust workload on a cycle ergometer (stationary bicycle)?

Answer 3

*page E-6

pedal frequency
pedal resistance

Question 4

How do you adjust workload on a treadmill?

Answer 4

*page E-7

treadmill speed
treadmill grade (incline)

note: you cannot adjust the resistance of a treadmill.

Question 5

True or False:

Handrails on a treadmill should only be used for balance.

Answer 5

*page E-7

True. The patient should never lean on the handrails in any way or try to support their weight with them.

Question 6

How do you calculate % incline on a treadmill.

For example you have a 100 inch ruler, and the high end is 5 inches higher.

Answer 6

*page E-8

You measure the difference in height, in this case 5 inches. Now you find the percentage of the height relative to the total length of the ruler, in this case 100 inches.

5 out of 100 is 5%

The treadmill is at an incline (grade) of 5%

Question 7

How many watts would the following workloads show on a stress test?

Low workload
Medium workload
High workload
Too high for stress testing

Answer 7

*page E-8

Low workload is less than 50 watts
Medium workload is 50-100 watts
High workload is greater than 100 watts
Too high for stress testing is greater than 200 watts

Question 8

Define METS (metabolic equivalents)

What is 1 MET at rest?

Answer 8

*page E-9

a unit that measures oxygen consumption per kg of body weight

1 MET = 3.5 ml of oxygen consumption, per minute, per kg.

Question 9

True or False:

If a patient reaches anaerobic threshold, you should stop the stress test

Answer 9

True

*page E-9

Question 10

True or False:

Ve will continue to increase at anaerobic threshold (AT) primarily by increasing respiratory rate instead of volume.

VCO2 (CO2 production) will rise above VO2 (oxygen consumption) and the RER (respiratory exchange ratio) will rise from a normal of about 0.8 to 1.

Answer 10

True

*page E-9

Question 11

True or False:

If BP doesn’t rise during a stress test, or rises dramatically, you should stop the test.

Answer 11

True

*page E-10

Question 12

1. What is the ventilatory equivalent for O2 (Ve/VO2)?

2. What is the ventilatory equivalent for CO2 (Ve/VCO2)?

Answer 12

1. The ratio of oxygen consumed per minute of ventilation

2. The ratio of CO2 produced per minute of ventilation.

Question 13

What is the Borg scale? What is the modified Borg scale?

Answer 13

*page E-12

“It’s the patient’s own evaluation of their level of dyspnea”

Borg scale is 1-20
Modified Borg scale is 1-10

Question 14

What 4 vitals should always be measured in a stress test?

Answer 14

*page E-13

SpO2
Blood Pressure
Ventilation
Heart rate and rhythm (ECG)

Question 15

Steady State or Multi-stage/Incremental?

Which type of test would involve gas analysis?

Answer 15

Steady state

*page E-11

gases measured will include O2, CO2, temperature of gases, volume of gases, respiratory rate, and collection time.

Question 16

SpO2 should remain above what level during a stress test?

Answer 16

90%

*page E-13

Note: You should terminate a test at below 85%, but that is not what this question specifically asked.

Question 17

Common exam question:

The exam implies your patient is obese (high BMI, high body weight, etc) and says when measuring a resting BP, that the pressures were incredibly high. What would you suspect?

Answer 17

The BP cuff is too small for the patient.

Question 18

1. What questions should you ask when interpreting an ECG rhythm strip?
2. A normal HR (60-100) should have 2 R waves between __ to ___ large boxes on the rhythm strip.

Answer 18

*page E-15

1.
Is there a p wave?
Is is positive?
Is it regular?
What is the rate?

2.
A normal HR should have 2 R waves between 3-5 large boxes.

Question 19

What drug would you give for any cardiac arrhythmia?

What drug would you give for bradycardia?

What drug would you give for pulseless Vtach, Vfib, or asystole?

Answer 19

Always give oxygen

Atropine for bradycardia

Epinephrine (if pulseless)

*page E-15 to E-17

Question 20

How would you identify a PVC on a rhythm strip?

Can a strip with a PVC be considered a normal sinus rhythm?

Answer 20

*page E-15

A wide QRS.

A strip with a PVC can be considered NSR if it has a positive p wave with regular rhythm.

Question 21

How would you identify a motion artifact on a rhythm strip?

Answer 21

*page E-17

There is a baseline shift on the strip.

Question 22

Heart Blocks:

How would you generally identify the following heart blocks?

1st degree
2nd degree
3rd degree

Answer 22

1st degree - elongated PR interval. there should never be more than 1 big box between the start of the P wave and the QRS

2nd degree - normal P waves, but there’s a missing QRS on the strip

3rd degree - No relationship between p wave rate and QRS rate. (2 different rates seen)

*page E-18

Question 23

1. Define:

Ischemia
Injury
Infarction

2. What indicates

Ischemia
Injury
Infarction

on an ECG rhythm strip?

Answer 23

1. Ischemia - reduced blood flow to tissue
   Injury - acute damage to tissue
   Infarction - necrosis or death of tissue. may be recent or old.
2. Ischemia - depressed or inverted T wave
   Injury - elevated ST segment
   Infarction - “significant Q waves”

See images on *page E-19

Question 24

What would indicate that a patient has a primary ventilatory limitation to exercise?

Answer 24

The patient hits their MVV during testing.

FEV1 x 35

*page E-21

Question 25

Define RER (respiratory exchange ratio)

Answer 25

The ratio of CO2 produced over O2 consumed. Normally 0.8 VCO2 ______ VO2 *page E-23

Question 26

Stress testing should be terminated if SpO2 is < ___?

Answer 26

85% Careful with this value. Testing should stop at 85%. SpO2 should remain above 90% during a stress test. Below 90% indicates cardiac disease. *pge E-25

Question 27

Common exam question: How would you monitor ___? ``` right atrial pressure right atrial filling pressure right side pre-load right ventricular filling pressure right ventricular end-diastolic pressure ``` aka anything "right".

Answer 27

CVP (central venous pressure) any question asking how to monitor hemodynamic values the "right" of the heart should be answered with CVP. * page E-29 note: normal is 2-6. Hemodynamics are not commonly on the current exam.

Question 28

Hemodynamics: "mixed venous blood samples must be drawn from the ___"

Answer 28

Pulmonary artery. note: you should have the balloon deflated so that you do not draw oxygenated blood from the capillaries. * page E-30

Question 29

PCWP monitors blood moving into the ___ ___.

Answer 29

Left heart. *page E-31

Question 30

How would you monitor ___? ``` left atrial pressure left atrial filling pressure left side pre-load left ventricular filling pressure left ventricular end diastolic pressure ``` aka anything "left".

Answer 30

PCWP. any questions asking for hemodynamic monitoring on the "left" should be answered with PCWP.

Question 31

If your CI (cardiac index) looks like a Qt (cardiac output) what should you suspect?

Answer 31

That the cardiac output was not divided by BSA. To get CI, you must divide Qt by BSA.

Question 32

A decreasing O2 pulse (HR increases but O2 consumption stays the same) suggests what?

Answer 32

Cardiac limitation to stress testing. note: any negative cardiac change without pulmonary change should be considered a cardiac limitation. * page E-35

Question 33

___ is present with increased HR at low watts with a normal ECG

Answer 33

Poor conditioning *page E-35 this may be important on the exam

Question 34

___ is present when the ECG, SaO2, and HR are normal, the anaerobic threshold is not achieved, and the Ve is less than 70% of MVV.

Answer 34

Poor effort *page E-35 this may be important on the exam