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Exam 3 Labs 11-14

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LAB XII starts here

21 year old female who smokes socially on weekends (~10-20 cigarettes). Drinks alcohol one or two nights a week, usually on weekends. Height vE 63 in (160 cm), weight = 124 lb (56.4 kg). BMI = 22.0 kg/m2 RHR = 76 beats- min-1, resting BP= 118/72 mm Hg. Total cholesterol = 178 mg/dL (4.61 mmol • L-1), 1DL-C = 98 mg • dL-1 (2.54 mmol • L-1), HDL-C = 62 mg • dL-1 (1.60 mmol • L-1), FBG = 96 mg. d.1 -I (5.33 mmol • 1 -I)_ Currently taking oral contraceptives. Attends group exercise class two to three times a week. Both parents living and in good healih. How many risk factors does this subject have?

The normal duration of the PR interval is ----to ---- seconds and if it is longer than usual it could suggest the person has -... 0.12-.20 seconds, a disruption in the SA node 0.08-.12 seconds, a disruption in the AV Node 0.12-.20 seconds, a irregular event from the ventricles 0.08-.12 seconds, a disruption in the SA node 0.12-20 seconds, a disruption in the AV node

0.12-20 seconds, a disruption in the AV node

How many millimeters of ST segment depression are there on the EKG tracing below? Select the best answer and be sure to take measurements at the right location

1.5mm (1.5 boxes ?)

Your subject has an a-vO2difference of 9.7 vols%, an R interval of 0.43 sec, and an end diastolic volume of 174.5 ml and an end systolic volume of 68 ml. What is this subject's stroke volume in mi? calculate to 2 decimal places, no units required

106.5 SV = EDV - ESV

fasting plasma glucose concentration greater than ____ is associated with increased CAD risk (no units required)

126

Current guidelines in the United States use an SBP cutoff value of greater than or equal to ___ to diagnose hypertension. (no units required)

130

What is a typical maximal exercise stroke volume in an untrained subject? (use ml)

130 (110-150)

What is a typical maximal exercise SBP for an adult female subject?

137-173

What is a typical maximal exercise SBP for an adult male subject?

164-200

2 hour plasma glucose concentration during a glucose tolerance test (GTT) greater than ___ is associated with increased CAD risk (no units

200

Your subject has a cardiac output of 12, a heart rate of 126, and a blood pressure of 174/89. Estimate their heart's oxygen demand. (do not need units)

21,924 HR x SBP

What is a typical maximal exercise cardiac output in an untrained subject? (use L)

Your subject is a 42 year old female who lasted 8 minutes on the Bruce protocol during her stress test. What is her approximate relative VO2max?

28 3x(time) + 4`

Your subject has a cardiac output of 12, a heart rate of 170, and a blood pressure of 165/85. Estimate their heart's oxygen demand. (do not need units)

28,050 HR x SBP

A BMI over __ is associated with increased CAD risk (no units required)

Which of the following is an appropriate value for maximal exercise TPR in (dyn/s.cm5) a young, untrained, healthy subject with a normal blood pressure response to exercise?

300

How many millimeters of ST segment depression are there on the EKG tracing below? Select the best answer and be sure to take measurements at the right location

3mm (5ish boxes)

Your subiect is a 42 ear old female who lasted 14 minutes on the Bruce protocol during her stress test. What is her approximate relative VO2max?

46 3 x (time) + 4

How many millimeters of ST segment depression are there on the EKG tracing below? Select the best answer and be sure to take measurements at the right location

4mm (4 boxes ?)

What is a typical resting venous return (in L/min) in an untrained subject?

Women over the age of ___ are at increased risk of developing coronary artery disease. (no units required)

A diastolic blood pressure of ____ mmHg would be suggestive of hypotension

HDL concentration greater than is associated with decreased CAD risk (no units required)

mother (or other fmale first degree relative; eg. sister) having a myocardial infarction, revascularization surgery, or sudden death priort to the age of ___ are at increased risk of developing coronary artery disease. (no units required)

What is a typical resting stroke volume in an untrained subject? (use ml)

75 (59-91)

Based on current (after 2017) guidelines hypertension could be diagnosed based on a diastolic blood pressure ______

A systolic blood pressure of < ___ mmH would be suggestive of hypotension

A systolic blood pressure of <__ mmH increases the possibility of the subject experiencing syncope

a-vO2diff

= (VO2/Q) x 100

A=4.5, B = 15.8

Click on the location exercise electrode placement for the positive electrode in limb lead III:

Bottom right rib (left for them)

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f): cycling and isometric knee extensions. Which line is likely the cycling MAP?

D 4th line

Which of the following is/are true about the electrode indicated by the green square A this electrode would be the positive electrode in limb lead I B. this electrode would be the negative electrode in limb lead I c. this electrode would be the positive electrode in limb lead I D. this electrode would be the positive electrode in limb lead I E. Two of the above

D. this electrode would be the positive electrode in limb lead I

Click on the location exercise electrode placement for V2:

Edge of 4th rib space, on their left my right

Which of the following would be most suggestive of sinus bradycardia?

RR interval 1.25 seconds every beat PR interval 0.18 seconds every beat QRS interval 0.10 seconds every beat P before each QRS complexe QRS after each P wave

Which of the following would be most suggestive of afib?

RR interval highly variable ranging from 0.34 to 0.60 seconds PR interval indeterminable QRS interval 0.10 seconds every beat no p waves before QRS complexes

Which of the following interval/s are expected to change as heart rate increases during exercise? PR- Interval QRS -Interval QT-Interval RR-Interval RR-Interval and QT-Interval PR- Interval and RR-Interval

RR-Interval and QT-Interval

Hearts estimated Oxygen demand/rate pressure product

Rate Pressure Product = HR x SBP

Click on the location exercise electrode placement for the positive electrode in AVF:

Their left bottom rib my right

Match the labels on the figure with the correct part of the heart's electrical conduction system

Top left blob - SA node 2nd lower blob - AV node Pathway between nodes - internodal pathway

One of the following graphs depicts the most common changes in total peripheral resistance (Y axis) from rest to maximal intensity cycing exercise (on the X axis) in a young healthy subject with an appropriate vasodilatory response to exercise. Which graph best illustrates the trend for this variable?

V Decrease curve

In this figure, the electrode that would be at the red circle would be

on EKG 23 is there any evidence of myocardial ischemia? if so, in what leads do you see significant evidence of ischemia? select all that apply

V3, V4, V5

Venous oxygen content

Venous oxygen content = arterial oxygen content - a-vO2difference

One of the following graphs depicts the most common changes in diastolic blood pressure (Y axis) from rest to maximal intensity cycing exercise (on the X axis) in a young healthy subject with an appropriate vasodilatory response to exercise. Which graph best illustrates the trend for this variable?

Vi Slight decrease

Vi (straight line graph that slightly decreases

Which of the following findings in a patient would be associated with dyslipidemia and an increased risk of developing a cardiovascular disease? a. HDL = 34 mg/dL b. total cholesterol = 181 mg/dL c. HDL = 64 mg/dL d LDL = 127 mg/dL e. LDL = 99 mg/dL

a. HDL = 34 mg/dL

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what factors could be causing this change? a. a decrease in active muscle P02 b. a decrease in pCO2 in the systemic capillaries c. two of these answers d. none of these answers e a decrease in pulmonary capillar p02

a. a decrease in active muscle P02

MAP would likely be highest for which of the following exercises? a. isometric knee extension at 90% of maximum b. cycling at 200 Watts (90% of max) c. arm crank at 60 Watts (90% of max) d. two of these would be tied e. dynamic knee extensions at 90% of maximum

a. isometric knee extension at 90% of maximum

When we use a stethoscope and blood pressure cuff to determine blood pressure, what is true of the first sound we hear? a. it is called the first Korotkoff sound b. it is often described as muffled c. it is called the first heart sound d. two of these answers e. it indicates the diastolic blood pressure

a. it is called the first Korotkoff sound

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, how would this change influence the blood pressure response to exercise? a. it is why DBP decreases slightly in young healthy subjects during this type of activity b. two of these answers c. none of these answers D. it is why SP increases in young healthy subjects during this type of activity

a. it is why DBP decreases slightly in young healthy subjects during this type of activity

A 60-vr-old woman i beginning a professionally led walking program. Two years ago she had a drug-eluting stent placed in her left anterior descending coronary artery after a routine exercise stress test revealed significant ST segment depression. Sh completed a brief cardiac rehabilitation program in the 2 mo following the procedure but has been inactive since. She reports no signs or symptom and take a cholesterol lowering statin and antiplatelet medications as directed by her cardiologist. Select all that apply a. desired exercise intensity = vigorous b. Does not have signs or symptoms suggestive of disease c. Does NOT need to be medically cleared before performing desired activity d. does not have known cardiovascular, metabolic, or renal disease e. Needs to be medically cleared before performing desired activity f currently participates in regular exercise g. does not currently participate in regular exercise h. has known cardiovascular, metabolic, or renal disease i.Has signs or symptoms suggestive of disease j. desired exercise intensity = moderate

b. Does not have signs or symptoms suggestive of disease e. Needs to be medically cleared before performing desired activity g. does not currently participate in regular exercise h. has known cardiovascular, metabolic, or renal disease J. desired exercise intensity = moderate

Orthopnea could suggest that the patient has: a. mitral regurgitation b. heart failure c. syncope d. anemia e. three of these answers f peripheral vascular disease

b. heart failure

______ is a symptom suggested of cardiovascular or pulmonary disease associated with loss of conciousness due to reduced blood flow to the brain a. bilateral ankle edema b. syncope c. shortness of breath when lying down d. three of these answers e. intermittent claudicaiton f. orthopnea

b. syncope

Which of the following findings in a patient would be associated with diabetes and an increased risk of developing a cardiovascular disease? a. HbA1c = 6.1 % b. 2 hour plasma glucose during glucose tolerance test = 189 mg/dL c. 2 hour plasma glucose during glucose tolerance test = 212 mg/dL d. fasting plasma glucose = 118 mg/dL e. fasting plasma glucose 98 mg/dL

c. 2 hour plasma glucose during glucose tolerance test = 212 mg/dL

Which of the following is an appropriate value for maximal exercise TPR in (dyn/s.cm5) a young, untrained, healthy subject with a normal blood pressure response to exercise? a. 30 b. 3 c. 300 d. 15,000 е. 15 f. 1,500 g. 3,000

c. 300

Which of the following is NOT an absolute contraindication for exercise testing (you should not start an exercise test)? a. inflammation of the pericardium b. 3rd degree AV block accompanied by low blood pressure c. All of these ARE contraindications to stress testing d. patient with heart failure who presents with severe bilateral ankle edema and shortness of breath at rest and when lying down e. chest pain that occurs at random times

c. All of these ARE contraindications to stress testing

Which of the following is are NOT true about cardiac output? a. During maximal exercise ins untrained subjects, 20-30 L/min would be typical b. In elite endurance athletes it may reach 40-50 L/min at maximal excercise c. At rest it is approximately 70 ml/beat d. All answers are true

c. At rest it is approximately 70 ml/beat

In the image below, the green square would be the ______ electrode. A. V6 B. V2 c. Left Arm D. Right Arm E. V1

c. Left Arm

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what factors could be causing this change? a. a decrease in 2,3-BPG b. none of these answers c. an increase in body temperature d. two of these answers e. an increase in pH

c. an increase in body temperature

Which sound do we associate with systolic blood pressure? Selected Answer: d. The first Korotkoff sound Answers: a. The second heart sound, S2 b. the fifth Korotkoff sound c. none of these answers d. The first Korotkoff sound e. The first heart sound, S1

d. The first Korotkoff sound

When we use the auscultatory method for determining blood pressure during exercise, what do we need to do differently? a. pump the pressure in the cuff higher than we would under resting conditions b. isolate the arm C. if sounds are heard very low (e.g. down to zero), the 4th Korotkoff sound may be a better indicator of DBP than the disappearance of the sounds (5th Korotkoff sound) d. all of these ARE modifications of the auscultatory technique that we would use during exercise E. none of these ARE modifications of the auscultatory technique that we would use during exercise

d. all of these ARE modifications of the auscultatory technique that we would use during exercise

When we use the auscultatory method for determining blood pressure during exercise, what do we need to do differently? а. if sounds are heard very low (e.g. down to zero), the 4th Korotkoff sound may be a better indicator of DBP than the disappearance of the sounds (5th Korotkoff sound) b. isolate the arm c. pump the pressure in the cuff higher than we would under resting conditions d. all of these ARE modifications of the auscultatory technique that we would use during exercise e. none of these ARE modifications of the auscultatory technique that we would use during exercise

d. all of these ARE modifications of the auscultatory technique that we would use during exercise

DBP would likely be lowest for which of the following exercises? a. isometric knee extension at 90% of maximum b. two of these would be tied c. dynamic knee extensions at 90% of maximum d. cycling at 200 Watts (90% of max) e. arm crank at 60 Watts (90% of max)

d. cycling at 200 Watts (90% of max)

During ACUTE exercise, which of the following would NOT be assciated with an increase in EDV? a. sympathetically mediated venoconstriction b. an increase in muscle pump activity can increase in afterload d. two of these answers e. an increase in preload an increase in activity of the respiratory pump (ventilation) g. an increase in blood volume h. all of these WOULD increase EDV

d. two of these answers

If your patient's blood pressure was 132/78, which of the following is/are true a. Based on new guidelines they have elevated blood pressure b. Based on new guidelines they have normal blood pressure c. Two of these d. Based on old guidelines (pre-Nov 2017) they have hypertension e. Based on new guidelines they have hypertension

e. Based on new guidelines they have hypertension

Bilateral ankle edema could suggest that the patient has: a. syncope b. three of these answers c. mitral regurgitation d. coronary artery disease e. heart failure f. peripheral vascular disease

e. heart failure

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, what factors could be contributing to this change? a. an increase in acetylcholine released near arteriolar smooth muscle b. the sympathetic nervous system c. secretion of nitric oxide in blood vessels of active muscles d. a decrease in body fluid pH e. two of these answers

e. two of these answers

______ is a symptom suggestive of cardiovascular disease where one has an unpleasant feeling that their heart is racing. This can be due to a variety of arrhythmias (tachycardia, bradycardia, or PVCs). a. bilateral ankle edema b. intermittent claudicaiton c. orthopnea d. three of these answers e. syncope f. palpitations

f. palpitations

One of the following graphs depicts the changes in systolic blood pressure (Y axis) from rest to maximal intensity cycing exercise (on the X axis) in a young healthy subject. Which graph best illustrates the trend for this variable?

i Stead increase from partway up

i Steady increase from partway up

In some arrhythmias we may not observe all EKG waveforms in their normal order of PQRST. Which of the following is/are NOT true? In atrial flutter some P waves are not followed by QRS complexes In Atrial fibrillation there are QRS complexes that are not preceded by P waves In PVCs there are QRS complexes with no P wave before them in a bundle branch block there may be QRS complexes with no P wave before them three of the above

in a bundle branch block there may be QRS complexes with no P wave before them

On an EKG, the T wave represents the _ depolarization of the atria depolarization of the ventricles repolarization of the atria repolarization of the ventricles repolarization of the purkinje fibers

repolarization of the ventricles

Your subject has a cardiac output of 12.5, a heart rate of 133, and a blood pressure of 166/77. What is their mean arterial pressure? (no units required)

106.7 MAP = 1/3 PP + DBP

considering EKGs 16-19, which of these EKGs has evidence of infarction? If so, what evidence? (select two answers)

18 There was ST depression

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f: cycling and arm cranking. Which line is likely the arm crank SBP?

A 1st line on graph`

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f: isometric bicep curls and × sometric knee extensions. Which line is likely the isometric bicep curl SBP?

B 2nd line

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f): cycling and arm cranking. Which line is likely the arm crank MAP?

E 5th line on graph

Pulse pressure would likely be highest for which of the following exercises? a. cycling at 200 Watts (90% of max) b. isometric knee extension at 90% of maximum c. arm crank at 60 Watts (90% of max) d. dynamic knee extensions at 90% of maximum e. two of these would be tied

a. cycling at 200 Watts (90% of max)

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what factors could be causing this change? a. an increase in pH b. an increase in body temperature c. none of these answers d two of these answers e. a decrease in 2.3-BPG

b. an increase in body temperature

Your subject has a cardiac output of 13.4, a heart rate of 130, and a blood pressure of 157/82. What is their mean arterial pressure? (no units required)

107.2 1/3PP + DBP

What is a typical value for mean arterial pressure in a healthy adult human?

90.3 (86.6-100.0)

looking at EKGs 19-22, do any of these EKGs have evidence of left ventricular hypertrophy? If so, what evidence? (select two answers) A. EKG 19 B. EKG 20 c. EKG 21 D. EKG 22 E. they have left axis deviation F. The R in lead II is greater than 35 mm g. The S in V1 and the R in V5 adds up to 35mm H. There is an inverted T wave in AVF

A. EKG 19 E. they have left axis deviation g. The S in V1 and the R in V5 adds up to 35mm

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f: cycling and isometric knee extensions. Which line is likely the cycling SBP?

B 2nd line on graph

Click on the location exercise electrode placement for the positive electrode in AVF:

Bottom right rib (my right, their left)

C 3rd line on graph

Click on the location exercise electrode placement for V5:

Middle of 5th rib space on their left my right

Click on the location exercise electrode placement for V3:

On the edge of the 5th rib space on their left my right

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what would be appropriate values for a and b on the Y axis in an trained healthy adult female? a. b = 15.8, a = 4.5 b. b = 15.4, a = 9.9 c. none of these answers d. b = 20.8, a = 15.2 e. b = 35, a = 20

a. b = 15.8, a = 4.5

This likely depicts the SBP, DBP, and MAP response to which type of exercise? a. none of these; this graph is wrong and does not reflect the blood pressure response to these exercises b. isometric exercise with small muscle mass (e.g. handgrip exercise) c. arm crank exercise d. isometric exercise with large muscle mass (e.g. leg press)

a. none of these; this graph is wrong and does not reflect the blood pressure response to these exercises All lines on graph start from same point, a&b slightly increase, and c slightly decreases

Sudden shortness of breath at night could suggest that the patient has: a. Syncope b. three of these answers c. mitral regurgitation d. heart failure e. peripheral vascular disease f. anemia

d. heart failure

which of the following would NOT be expected to increase a-vO2 difference during an exercise bout? a. a decrease in active muscle pO2 b. a redistribution of blood flow away from inactive tissues and towards active tissues c. all of these WOULD incresae a-vo2difference during exercise d. a rightward shift in the 02 dissociation curve (which is caused by an increase in temperature, pCO2, and H+) e. a decrease in pulmonary capillary p02 f. a decrease in plasma volume

e. a decrease in pulmonary capillary p02

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, what factors could be contributing to this change? a. the sympathetic nervous system b. two of these answers c. the parasympathetic nervous system d. high pCO2 and low pO2 in the systemic capillaries e. low pO2 and high pCO2 in the systemic capilarles

e. low pO2 and high pCO2 in the systemic capilarles

What does the 4th Korotkoff sound sound like? a. no sound b. somewhat loud tapping c. somewhat loud clicking d. hone of these answers e. muffled

e. muffled

Your subject has a cardiac output of 14.7, a heart rate of 134, and a blood pressure of 150/81. What is their stroke volume in ml/beat? (no units required)

109.7 Cardiac output x 1000/heart rate

What is a typical value for systolic blood pressure in a healthy adult human?

120

Arterial oxygen content

Arterial oxygen content = [g hemoglobin / 100ml blood] x 1.39ml/gHb x SaO2

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, how would this figure look different if the subject were performing arm crank exercise? a. it would remain relatively steady (neither increase or decrease) b. it would still decrease, but not as much c. none of these answers d. it would increase instead of decrease e. it would be about the same

b. it would still decrease, but not as much

Which of the following is/are relative contraindications to maximal exercise testing? Select all that apply a. Patient had myocardial infarction 36 hours ago b. patient who comes to your office with a resting blood pressure of 220/92 c. patient who had a stroke 10 days ago d. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease e. patient who recently started experiencing angina when they exercise F. Patient with a third degree AV blockand low blood pressure g. Patient with severe anemia

b. patient who comes to your office with a resting blood pressure of 220/92 c. patient who had a stroke 10 days ago g. Patient with severe anemia

If graph iv depicts the changes in cardiac output (y axis) during prolonged cylcling exercise (time on the x axis), what factors explain this lack of change? a. threre of these answers b. two of these answers c. heart rate is increasing d. stroke volume is decreasing e. blood pressure is levelling off

b. two of these answers

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, what factors could be contributing to this change? a. an increase in acetylcholine released near arteriolar smooth muscle b. two of these answers C. the sympathetic nervous system D. secretion of nitric oxide in blood vessels of active muscles E. a decrease in body fluid pH

b. two of these answers

intermittent claudication would most likely be associated with which of the following: a. three of these answers b. heart failure c. peripheral vascular disease d. arrhythmias e. COPD f. coronary artery disease

c. peripheral vascular disease

Based on pre-2017 guidelines hypertension could be diagnosed based on a systolic blood pressure ≥ ___

140

Your subject has a cardiac output of 12.0, a heart rate of 147, and a blood pressure of 170/92. What is their stroke volume in ml/beat? (no units required)

81.6 Cardiac output x 1000/HR

Click on the location exercise electrode placement for the left arm electrode:

Middle of collarbone on their left side my right

stable angina pectoris would most likely be associated with which of the following: a. coronary artery disease b. arrhythmias c. heart failure d. aortic stenosis e. three of these answers f. peripheral vascular disease

a. coronary artery disease

P waves may be absent in which of the following? atrial fibrilation multifocal PVCs unifocal PVCs ventricular tachycardia all of the above

all of the above

Which of the following is/are absolute contraindications to maximal exercise testing? Select all that apply a. patient with severe anemia b. Patient with a third degree AV blockand low blood pressure c. Patient had myocardial infarction 36 hours ago d. patient who had a stroke 10 days ago e. patient who recently started experiencing angina when they exercise f. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease g. patient who comes to your office with a resting blood pressure of 220/92

b. Patient with a third degree AV blockand low blood pressure c. Patient had myocardial infarction 36 hours ago

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, what factors could be contributing to this change? a. norepinephrine binding with alpha adrenergic receptors on the arteriolar smooth muscle in the active muscles b. two of these answers c. local metabolic factors acting on arteriolar smooth muscle in the active muscles D. the parasympathetic nervous system acting on the arteriolar smooth muscle in the active muscles e. the sympathetic nervous system acting on the arteriolar smooth muscle in the active muscles

c. local metabolic factors acting on arteriolar smooth muscle in the active muscles

The first Korotkoff sound is associated with: a. closing of the AV valves b. occluded blood flow c. turbulent blood flow d. laminar blood flow e. two of these answers

c. turbulent blood flow

When we use the auscultatory method for determining blood pressure: a. We are watching the needle to determine when it starts to bounce b. two of these answers c. we are listening to heart sounds d. we are listening for Korotkoff sounds e. we are feeling the subject's pulse to see when it resumes

d. we are listening for Korotkoff sounds

What does the 5th Korotkoff sound sound like? a. somewhat loud tapping b. somewhat loud clicking c. none of these answers d. muffled tapping e. no sound

e. no sound

Your subject has a stroke volume of 110 ml/beat, a heart rate of 129, and a blood pressure of 163/90. What is their cardiac output in L/min? (no units required)

14.2 HR x SV Divide by 1000

According to the current American College of Sports Medicine (ACSM) Guidelines for Exercise Testing and Prescription (i.g. the handout we used), systolic blood pressure greater than ____ is associated with decreased CAD risk (no units required)

140

What is a typical resting TPR (in dyn/s.cm5) for an adult human with an average cardiac output and average blood pressure?

1500 (1393-1593)

looking at EKGs 3-6, do any of these EKGs have evidence of left ventricular hypertrophy? If so, what evidence? (select two answers) A. EKG 3 B. EKG4 C. EKG 5 D. EKG 6 E. The S in V1 and R in V5 add up to more than 35 mm F. The R in lead Il is greater than 35 mm g. they have left axis deviation H. the QRS in AVR is mostly downwards

B. EKG4 D. EKG 6 E. The S in V1 and R in V5 add up to more than 35 mm Response Feedback: EKG 6 meets some criteria of LVH, there is actually a different issue

Which of the following would be most suggestive of a 3° AV block?

RR interval 1.2 seconds and pretty consistent PR interval hypervariable QRS interval 0. 10 seconds every beat P before some QRS complexes P waves have a very regular rhythm at around 75/min

Our body is a little like Goldilocks; it wants everything just right. Which of the following is/are true about hypertension, normotension, and hypotension? a. 40-50% of all US adults have hypertension b. severe hypotension may be a more immediate threat to a pateint's life than hypertension c. hypotension increases the risk of coronary artery disease d. orthostatic hypotension is when blood pressure drops due to an injury e. hypertension increases the risk of having a stroke F. pre-eclamplsia is a complication of pregnancy associated with low blood pressure g. a blood pressure of 80 over 40 could cause syncope h. essential hypertension is when a patient needs to have high blood pressure to promote blood flow to critical organs

a. 40-50% of all US adults have hypertension b. severe hypotension may be a more immediate threat to a pateint's life than hypertension e. hypertension increases the risk of having a stroke g. a blood pressure of 80 over 40 could cause syncope

When we use a stethoscope and blood pressure cuff to determine blood pressure, we place the diaphragm of the stethoscope over which blood vessel? a. brachial artery b. median antebrachial vein c. radial artery d. none of these answers e. ulnar artery

a. brachial artery

________ is a common symptom in subjects with peripheral vascular disease and it is associated with pain in their muscles (often in the calves) when they exercise a. intermittent claudicaiton b. three of these answers c. shortness of breath when lying down d. bilateral ankle edema e. paroxysmal nocturnal dyspnea f. orthopnea

a. intermittent claudicaiton

Which of the following is/are NOT absolute contraindications to maximal exercise testing? Select all that apply a. patient who can feel their heart racing sometimes when thy are at rest b. Patient who has evidence of recent aortic dissection c. patient with severe anemia d. patient who feels lightheaded every time they stand up E. patient who regularly experiences chest pain at random times when they are at rest f. patient who feels short of breath when lying down at night and has bilateral anKle edema g. Patient who has recently developed mycarditis secondary to COVID

a. patient who can feel their heart racing sometimes when thy are at rest c. patient with severe anemia d. patient who feels lightheaded every time they stand up

Which of the following is/are NOT absolute contraindications to maximal exercise testing? Select all that apply a. patient who comes to your office with a resting blood pressure of 220/92 b. patient with severe anemia c. Patient had myocardial infarction 36 hours ago d. Patient with a third degree AV blockand low blood pressure e. patient who recently started experiencing angina when they exercise f. patient who had a stroke 10 days ago g. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease

a. patient who comes to your office with a resting blood pressure of 220/92 b. patient with severe anemia e. patient who recently started experiencing angina when they exercise f. patient who had a stroke 10 days ago g. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease

If graph v depicts the changes in end systolic volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what factors could be contributing to this change? a. two of these answers b. three of these answers c. the Frank-Starling law d. an increase in inotropy due to sympathetic stimulation of the ventricles e. a decrease in parasympathetic stimulation of the ventricles

a. two of these answers

Which of the following is/are absolute contraindications to maximal exercise testing? Select all that apply a. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease b. Patient with a third degree AV blockand low blood pressure c. patient who recently started experiencing angina when they exercise d. patient who had a stroke 10 days ago e. Patient had myocardial infarction 36 hours ago f. patient with severe anemia g. patient who comes to your office with a resting blood pressure of 220/92

b. Patient with a third degree AV blockand low blood pressure e. Patient had myocardial infarction 36 hours ago

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what factors could be causing this change? a. a decrease in pulmonary capillary p02 b. a right shift in the 02 dissociation curve c. none of these answers d. two of these answers e. a left shift in the 02 dissociation curve

b. a right shift in the 02 dissociation curve

If graph ii depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what factors could be contributing to this change? a. the Frank-Starling law b. an increase in venous return c. three of these answers d. an increase in inotropy due to sympathetic stimulation e. none of these answers

b. an increase in venous return

Which of the following findings in a patient would be associated with an increased risk of developing a cardiovascular disease? a. HDL = 63 mg/dL b. fasting plasma glucose = 131 mg/dL c. BMI = 25.7 kg/m2 d. 2 hour plasma glucose during glucose tolerance test = 189 mg/dL e. LDL = 128 mg/dL

b. fasting plasma glucose = 131 mg/dL

Palpitations would most likely be associated with which of the following: a. peripheral vascular disease b. COPD c. arrhythmias d. heart failure e. coronary artery disease f. three of these answers

c. arrhythmias

DBP would likely be lowest for which of the following exercises? a. dynamic knee extensions at 90% of maximum b. arm crank at 60 Watts (90% of max) c. cycling at 200 Watts (90% of max) d. two of these would be tied e. isometric knee extension at 90% of maximum

c. cycling at 200 Watts (90% of max)

If graph i depicts the changes in heart rate (y axis) between rest and maximal intensity cycling exercise, what is causing this change? a. more neurotransmitter binding with beta-1-adrenergic receptors b. a decrease in acetylcholine release at the SA node c. three of these answers d. none of these answers, the heart rate should never be zero for a living subject e. an increase in sympathetic stimulation of the SA node

c. three of these answers

If graph ii depicts the changes in end diastolic volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what factors could be contributing to this change? a. two of these answers b. none of these answers c. an increase in blood volume d. an increase in muscle pump activity e. sympathetic nervous system constriction of arterioles

d. an increase in muscle pump activity

If graph i depicts the changes in heart rate (y axis) between rest and maximal intensity cycling exercise, what is causing this change? a. a decrease in acetylcholine release at the SA node b. none of these answers, the heart rate should never be zero for a living subject c. an increase in sympathetic stimulation of the SA node d. three of these answers e. more neurotransmitter binding with beta-1-adrenergic receptors

d. three of these answers

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, how would this figure look different if the subject were performing isometric knee extensions? a. it would still decrease, but not as much b. it would remain relatively steady (neither increase or decrease) c. none of these answers d. it would be about the same e. it would increase instead of decrease

e. it would increase instead of decrease

The normal duration of the QRS interval is ----to ---- seconds and if it is longer than usual it could suggest the person has -... 0.08-.12 seconds, a disruption in the SA node 0.08-.12 seconds, a bundle branch block 0.12-20 seconds, a irregular event from the ventricles 0.12-20 seconds, a disruption in the AV node 0.08-12 seconds, a disruption in the AV Node

0.08-.12 seconds, a bundle branch block

Your subject has an arterial O2 content of 19.3 vols%, a venous 02 of 7.4 vols%, an RR interval of 0.36 sec, and a stroke & volume of 96 ml/beat. What is this subject's absolute VO2? calculate to 2 decimal places, no units required

1.9 Absolute VO2 = VE STPD(NF x 0.2093 - FEO2)

Your subject has a hemoglobin concentration of 15.4 g/dL, an Sa02 of 97%, a VO2 of 1.5 cardiac output of 13.4, a heart rate of 151, and a blood pressure of 175/76. What is their a-vO2difference? (no units required)

11.2 (VO2/Q) x 100

Your subject has a cardiac output of 14.5, a heart rate of 138, and a blood pressure of 162/88. What is their mean arterial pressure? (no units required)

112.7 1/3 PP + DBP PP = SBP - DBP

Your subject has a hemoglobin concentration of 15.9, an Sa02 of 96 VO2 of 1.2 cardiac output of 13.4, a heart rate of 138, and a blood pressure of 161/70. What is their venous 02 content? (must include units )

12.3 Venous oxygen content = arterial oxygen content - a-vO2difference a-vO2diff = (VO2/Q) x 100 Arterial oxygen content = [g hemoglobin / 100ml blood] x 1.39ml/gHb x SaO2

What is a typical resting venous 02 content of an adult female human with average hemoglobin concentrations, arterial 02 saturation, and average resting a-vO2 difference (e.g. [Hb] of 13.5 g/dL, Sa02 of 98%)? No units required

13.4 (11.9-14.9)

You are taking a subject's blood pressure by the auscultatory method. When you have worked with this patient before, their blood pressure is usually around 132/84. You pump the cuff up until the pressure is 161 mmH. You then release the pressure from the cuff, while listening for changes in sound as the pressure in the cuff gradually becomes lower. The needle on the sphygmomanometer is moving down and is at 133 Hg when you hear a relatively loud sound, then it becomes a little softer at around 122, then a little louder again around 111, becomes muffled around 101, and then disappears at 83 mmH. Based on this information what is their systolic blood pressure?

133

You are taking a subject's blood pressure by the auscultatory method. When you have worked with this patient before, their blood pressure is usually around 132/84. You pump the cuff up until the pressure is 157 mmHg. You then release the pressure from the cutt, while listening for changes in sound as the pressure in the cutt gradualy becomes lower. The needle on the sphygmomanometer is moving down and is at 142 mmH when you hear a relatively loud sound, then it becomes a little softer at around 120, then a little louder again around 117, becomes muffled around 94, and then disappears at 92 mmH. Based on this information what is their systolic blood pressure?

142

Your subject has a cardiac output of 13, a heart rate of 114, and a blood pressure of 142/71. Estimate their heart's oxygen demand. (do not need units)

16,188 HR x SBP

Your subject has a hemoglobin concentration of 14.3, an Sa02 of 98 VO2 of 1.6 cardiac output of 13.7, a heart rate of 131, an end ejection fraction of 64 and a blood pressure of 158/70. What is their end diastolic volume in ml? (must include units of ml)

163 SV = Q x100/HR EDV = SV/EF%

Your subject has a stroke volume of 136 ml/beat, a heart rate of 146, and a blood pressure of 173/82. What is their cardiac output in L/min? (no units required)

19.9 HR x SV divide by 1000

considering EKGs 19-22, which of these EKGs has evidence of ischemia? If so, what evidence? (select two answers) Note: one of these EKGS has evidence of left ventricular hypertrophy, which can mimic certain aspects of ischemia on an EKG. You can rule this one out.

20 ST depression

HDL concentration less than is associated with increased CAD risk (no units required)

father (or other male first degree relative; e.g. brother) having a myocardial infarction, revascularization surgery, or sudden death priort to the age of __ are at increased risk of developing coronary artery disease. (no units required)

hemoglobin A1c greater than __is associated with increased CAD risk (no units required)

6.5

A diastolic blood pressure of < ______ mmHg would be suggestive of hypotension

You are taking a subject's blood pressure by the auscultatory method on a hot day outside and they just finished exercising in the heat. When you have worked with this patient before, their blood pressure is usually around 116/82. You pump the cuff up until the pressure is 139 mmH. You then release the pressure from the cuff, while listening for changes in sound as the pressure in the cuff gradually becomes lower. The needle on the sphygmomanometer is moving down and is at 121 mmg when you hear a relatively loud sound, then it becomes a little softer at around 104, then a little louder again around 92, becomes muffled around 67, and then disappears at 0 mmH. Based on this information what is their diastolic blood pressure?

Your subject has a hemoglobin concentration of 13.9 g/dL, an Sa02 of 99%, a VO2 of 1.6 cardiac output of 12.0, a heart rate of 136, and a blood pressure of 172/93. What is their total peripheral resistance? (no units required)

795.6 TPR = (MAP/Q) x 80 MAP = 1/3 PP + DBP (PP = SBP - DBP) Q = HR x SV

Your subject has a hemoglobin concentration of 15.5, an Sa02 of 97 VO2 of 1.5 cardiac output of 12.1, a heart rate of 149, and a blood pressure of 166/80. What is their venous 02 content? (must include units )

8.5 Arterial oxygen content - A-VO2 dif = ([g hemoglobin / 100ml blood] x 1.39ml/gHb x SaO2) - ((VO2/Q) x 100)

Based on current (after 2017) guidelines hypertension could be diagnosed based on a diastolic blood pressure ≥

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f): cycling and isometric Knee extensions. Which line is likely the isometric knee extension SBP?

A (1st highest line)

If graph i depicts the changes in cardiac output (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what would be appropriate values for points a and b on the y axis in a healthy trained female subject?

A = 5.1 B = 31.9

Which of the following is/are relative reasons for terminating a maximal GXT? A. patient has had several beats that had no P wave and long, unusual QRS complexes; these complexes do not all look the same. These unusual beats are increasing in frequency and, at one point you observed three in a row. b. Patient feels dizzy and their EKG has sawtooth like appearance with no p waves and heart rate of 150bpm c. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina d. Angia increasing from 3 to 4 on a 4 point angina scale e. patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea f. you are unable to hear the patient's korotkoff sounds and cannot get their blood pressure g. patient who is experiencing shortness of breath and who's SBP drops by 16 mmg after increasing from stage 1 to stage 2 of the Bruce protocol. h. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol

A. patient has had several beats that had no P wave and long, unusual QRS complexes; these complexes do not all look the same. These unusual beats are increasing in frequency and, at one point you observed three in a row. c. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina e. patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea h. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol

Which of the following is/are NOT true about limb lead II? A. we would expect the QRS to be mostly negative if the subject had left ventricular hypertophy B. the positive electrode is on the left leg c. the negative electrode is on the right arm D. It is usually mostly upright in subjects with a normal mean electrical axis E. Three of the above

A. we would expect the QRS to be mostly negative if the subject had left ventricular hypertophy

A=5,b=42.1

If graph i depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what would be appropriate values for points a and b on the y axis in a healthy untrained female subiect?

A=65,b=119

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f: isometric bicep curls and sometric knee extensions. Which line is likely the isometric bicep curl SBP?

B 2nd line on graph

considering EKGs 19-22, which of these EKGs has evidence of ischemia? If so, what evidence? (select two answers) * Note: one of these EKGS has evidence of left ventricular hypertrophy, which can mimic certain aspects of ischemia on an EKG. You can rule this one out. a. 19 b. 20 c. 21 d. 22 e. there was a high heart rate f. there was a low heart rate g. there was ST segment depression h. There was ST segment elevation

B. 20 G. There was ST segment depression

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f): cycling and arm cranking. Which line is likely the arm crank MAP?

C 3rd line down

This immage depicts the SP, DBP, and MAP response to exercise for the same subject during two different exercises (lines af): cycling and isometric knee extensions. Which line is likely the isometric knee extension MAP?

C 3rd line down

Which of the following is/are relative reasons for terminating a maximal GXT? a. Your patient asks to stop but you are sure they can last a little longer b. patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused C. patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else d. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina e. patient's Sa02% drops to 79% f. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol g. patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads h. Patient's P waves and QRS complexes no longer seem to correspond to one another and are following different rates (P waves about 115 bpm and QRS about 50 bpm) and their blood pressure is dropping and they report feeling lightheaded

C. patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else d. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina e. patient's Sa02% drops to 79% f. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol

This immage depicts the SBP, DBP, and MAP response to exercise for the same subject during two different exercises (lines a-f: cycling and arm cranking.Which line is likely the arm crank DBP?

E 5th line

Match the following with the appropriate parts of this figure: 15 vols% arterial 02 content 100 PO2 in systemic tissues position of curve with high concentration of H+ position of curve with low concentration of H+

E 2nd dotted line going across on right D 1st dotted line going across on right G far right dotted line on bottom going up F middle ish dotted line on bottom going up H curve moved slightly to right I original curve

Which of the following would be most suggestive of a subject having occasional PVCs?

E. RR interval 0.80 seconds every beat PR interval 0.18 seconds every beat QRS interval 0.10 seconds most beats 2 QRS complexes are 0.18 seconds P before all but 2 QRS complexes QRS after each P wave

F Bottom line

Which of the following is/are possible sign(s) that a patient may have heart failure? A. bilateral ankle edema B. intermittent claudicaiton c. shortness of breath when lying down D. orthopnea E. palpitations F. three of these answers

F. three of these answers

Which of the following would be most suggestive of a 1° AV block?

H. RR interval 0.80 seconds every beat PR interval 0.24 seconds ever beat QRS interval 0.10 seconds every beat P before each QRS QRS after each P wave

One of the following graphs depicts the changes in a-vO2 difference (Y axis) from rest to maximal intensity exercise (on the X axis). Which graph best illustrates the trend for this variable?

I Straight increasing line from partway up

One of the following graphs depicts the changes in heart rate (Y axis) from rest to maximal intensity cycling exercise (on the X axis). Which graph best illustrates the trend for this variable?

I Straight line increase starting from part way up

As stroke volume increases, it would be expected that Venous Return would: Neither increase or decrease Increase Decrease Stay the same

Increase

Click on the location exercise electrode placement for the negative electrode in limb lead III:

Middle of their left collarbone my right

Which of the following is/are absolute contraindications to maximal exercise testing? Select all that apply a. Patient with a a clot in one of their pulmonary blood vessels b. Patient with inflamed pericardium c. patient who had a stroke 10 days ago d. patient who recently started experiencing angina when they exercise e. patient with severe anemia F. patient who comes to your office with a resting blood pressure of 220/92 g. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease

a. Patient with a a clot in one of their pulmonary blood vessels b. Patient with inflamed pericardium

Which of the following is/are absolute contraindications to maximal exercise testing? Select all that apply a. Patient with a third degree AV blockand low blood pressure b. patient with severe anemia C. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease d. patient who recently started experiencing angina when they exercise e. patient who comes to your office with a resting blood pressure of 220/92 f. patient who had a stroke 10 days ago g. Patient had myocardial infarction 36 hours ago

a. Patient with a third degree AV blockand low blood pressure g. Patient had myocardial infarction 36 hours ago

a constricting sensation in the chest during exercise would most likely be associated with which of the following: a. coronary artery disease b. aortic stenosis c. peripheral vascular disease d. heart failure e. arrhythmias f. three of these answers

a. coronary artery disease

A 45-yr-old former collegiate swimmer turned lifelong triathlete requests assistance with run training. His only significant medical history is a series of overuse injuries to his shoulders and Achilles tendon. In recent weeks, he notes his workouts are unusually difficult and reports feeling constriction in his chest with exertion - something he attributes to deficiencies in core strength. Upon further questioning, he explains that the chest constriction is improved with rest and that he often feels dizzy during recovery. Select all that apply a. desired exercise intensity = vigorous b. does not have known cardiovascular, metabolic, or renal disease c. desired exercise intensity = moderate d. currently participates in regular exercise e. Has signs or symptoms suggestive of disease f. Does NOT need to be medically cleared before performing desired activity g. does not currently participate in regular exercise h. Needs to be medically cleared before performing desired activity I. Does not have signs or symptoms suggestive of disease j. has known cardiovascular, metabolic, or renal disease

a. desired exercise intensity = vigorous b. does not have known cardiovascular, metabolic, or renal disease d. currently participates in regular exercise e. Has signs or symptoms suggestive of disease h. Needs to be medically cleared before performing desired activity

If graph v depicts the changes in TPR (y axis) between rest and maximal intensity cycling exercise, how would this figure look different if the subject were performing arm crank exercise? a. it would still decrease, but not as much b. it would remain relatively steady (neither increase or decrease) c. it would be about the same d. none of these answers it would increase instead of decrease

a. it would still decrease, but not as much

One of our patients has hypertension and vou usually determine that their blood pressure is around 154/90. However, one of your interns usually determines that they have a blood pressure of around 128/90. What might they be doing wrong to get this answer? a. they might not be pumping the pressure in the cuff high enough to be able to observe the first Korotkoff sound b. they might be pumping up the pressure in the cuff too high C. none of these answers D. they might be letting the pressure out of the cuff too slowly

a. they might not be pumping the pressure in the cuff high enough to be able to observe the first Korotkoff sound

Which of the following conditions would be least likely to cause the mean electrical axis to shift to the left? pregnancy lying down left ventricular hypertrophy inferior wall or right ventricular infarction all of the above could potentially cause mean electrical axis to shift to the left

all of the above could potentially cause mean electrical axis to shift to the left

If graph v depicts the changes in TPR (y axis between rest and maximal intensity cycling exercise, how would this figure look different if the subject were performing arm crank exercise? A. it would be about the same b. it would still decrease, but not as much c. none of these answers D. it would remain relatively steady (neither increase or decrease) E. It would increase instead of decrease

b. it would still decrease, but not as much

Which of the following is/are relative reasons for terminating a maximal GXT? A. patient who is experiencing shortness of breath and who's SP drops by 16 mmHg after increasing from stage 1 to stage 2 of the Bruce protocol. b. patient has had several beats that had no P wave and long, unusual QRS complexes; these complexes do not all look the same. These unusual beats are increasing in frequency and, at one point you observed three in a row. c. you are unable to hear the patient's korotkoff sounds and cannot get their blood pressure d. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina e. Patient feels dizzy and their EKG has sawtooth like appearance with no p waves and heart rate of 150bpm f. Angia increasing from 3 to 4 on a 4 point angina scale g. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol h. patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea

b. patient has had several beats that had no P wave and long, unusual QRS complexes; these complexes do not all look the same. These unusual beats are increasing in frequency and, at one point you observed three in a row. d. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina g. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol h. patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea

Which of the following is/are absolute reasons for terminating a maximal GXT? a. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol b. patient who is experiencing shortness of breath and who's SBP drops by 16 mHg after increasing from stage 1 to stage 2 of the Bruce protocol. c. you are unable to hear the patient's korotkoff sounds and cannot get their blood pressure d. patient has had several beats that had no P wave and long, unusual QRS complexes; these complexes do not all look the same These unusual beats are increasing in frequency and, at one point you observed three in a row. e. Patient feels dizzy and their EKG has sawtooth like appearance with no p waves and heart rate of 150bpm f. Angia increasing from 3 to 4 on a 4 point angina scale g. patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea h. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina

b. patient who is experiencing shortness of breath and who's SBP drops by 16 mHg after increasing from stage 1 to stage 2 of the Bruce protocol. c. you are unable to hear the patient's korotkoff sounds and cannot get their blood pressure e. Patient feels dizzy and their EKG has sawtooth like appearance with no p waves and heart rate of 150bpm f. Angia increasing from 3 to 4 on a 4 point angina scale

Which of the following is/are relative reasons for terminating a maximal GXT? a. patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. b. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol C. Patient's P waves and QRS complexes no longer seem to correspond to one another and are following different rates (P waves about 115 bpm and QRS about 50 bpm) and their blood pressure is dropping and they report feeling lightheaded d. Your patient asks to stop but you are sure they can last a little longer e. patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else f. patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused g. patient's Sa02% drops to 79% h. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina

b. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol e. patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else g. patient's Sa02% drops to 79% h. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina

Which of the following is/are NOT absolute reasons for terminating a maximal GXT? a. patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused b. patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. c. patient's Sa02% drops to 79% d. Your patient asks to stop but you are sure they can last a little longer e. patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else f. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol g. Patient's P waves and QRS complexes no longer seem to correspond to one another and are following different rates (P waves about 115 bpm and QRS about 50 bpm) and their blood pressure is dropping and they report feeling lightheaded h. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina

c. patient's Sa02% drops to 79% e. patient is at a high heart rate and their QRS complexes are now very wide; it is hard to tell if they have a bundle branch block or something else f. patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol h. 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina

If graph iii depicts the changes in heart rate (y axis) between rest and maximal intensity cycling exercise, what is causing this change? a. more neurotransmitter binding with beta-1-adrenergic receptors b. an increase in sympathetic stimulation of the SA node c. a decrease in acetylcholine release at the SA node d. none of these answers, the heart rate should never be zero for a living subject e. three of these answers

d. none of these answers, the heart rate should never be zero for a living subject

Which of the following is/are absolute contraindications to maximal exercise testing? Select all that apply a. patient who recently started experiencing angina when they exercise b. patient who comes to your office with a resting blood pressure of 220/92 c. patient who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease d. patient who had a stroke 10 days ago e. Patient who regularly has spontaneous angina at rest f. patient with severe anemia g. Patient who feels lightheaded/dizzy and SOB with mild activity, has chest pain, and when you listened to their heart sounds vou hear lub-whistle-dup

e. Patient who regularly has spontaneous angina at rest g. Patient who feels lightheaded/dizzy and SOB with mild activity, has chest pain, and when you listened to their heart sounds vou hear lub-whistle-dup

If graph i depicts the changes in a-vO2 difference (y axis) between rest and maximal intensity cycling exercise, what factors could be causing this change? a, a decrease in pulmonary capility p02 b. a left shift in the 02 dissociation curve c. two of these answers d. none of these answers e. a right shift in the 02 dissociation curve

e. a right shift in the 02 dissociation curve

If graph ii depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what factors could be contributing to this change? a. none of these answers b. two of these answers c. an increase in TPR d. an increase in ventricular filling time e. an increase in venous return

e. an increase in venous return

If graph ii depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, what factors could be contributing to this change? a. two of these answers b. an increase in ventricular filling time C. an increase in TPR d none of these answers e. an increase in venous return

e. an increase in venous return

We demonstrated a couple different methods for determining blood pressure in lab X. Taking a subject's blood pressure using a stethoscope, blood pressure cuff and sphygmomanometer and noting when the Korotkoff sounds occur is a part of the _____ for determining blood pressure. a. none of these answers b. direct Korotkoff method C. indirect-oscillometric d. direct method e. indirect-auscultatory F. indirect-palpatory

e. indirect-auscultatory

If graph iii depicts the changes in heart rate (y axis) between rest and maximal intensity cycling exercise, what is causing this change? a. three of these answers b. a decrease in acetylcholine release at the SA node c. more neurotransmitter binding with beta-1-adrenergic receptors d. an increase in sympathetic stimulation of the SA node e. none of these answers, the heart rate should never be zero for a living subject

e. none of these answers, the heart rate should never be zero for a living subject

During ACUTE exercise, which of the following would NOT be associated with an increase in EDV? a. an increase in preload b. all of these WOULD increase EDV c. an increase in muscle pump activity d. an increase in blood volume e. two of these f. an increase in activity of the respiratory pump (ventilation) g. an increase in afterload h. sympathetically mediated venoconstriction

e. two of these • an increase in boll volume would increase DV with chronic exercise (training), ut blood volume decreases during an acute bout of exercise, so this would NOT contribute to increaaes in EDV during exercise. • an in increase in preload, not afterload, is associated with an increased EDV.

i Increasing graph from 1/4 up

One of the following graphs depicts the changes in mean arterial blood pressure (Y axis) from rest to maximal intensity cycing exercise (on the X axis) in a young healthy subject. Which graph best illustrates the trend for this variable?

i Steady increase starting from partway up

One of the following graphs depicts the changes in stroke volume (Y axis) from rest to maximal intensity exercise (on the X axis) in an untrained subject. Which graph best illustrates the trend for this variable?

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