EXPH Lab Exam 2

TPR =

(MAP / Q) x 80

VO2 =

(Q x a-vO2 difference) / 100

Match the following with the appropriate parts of this figure:

* A -- percent saturation in arterial blood * B -- 75% * G -- 100 * F -- PO2 in systemic tissues * I -- position of curve with low temperature * h -- position of curve with high temperature

Match the following with the appropriate parts of this figure:

* E: venous O2 content * D: 20 Vols% * G: PO2 in systemic arteries * F: 40 mmHg * I: position of curve at rest * H: position of curve during exercise (high pO2)

Which of the following would be most suggestive of v-fib?

- RR interval indeterminable - PR interval indeterminable - QRS interval indeterminable - no P waves identifiable - no QRS complexes identifiable

SV =

EDV - ESV

If graph v depicts the changes in venous O2 content (y axis) between rest and maximal intensity cycling exercise, what would be appropriate values for a and b on the Y axis in an untrained healthy adult male?

a = 5.8 b = 14.9

If graph ii 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 subject?

a = 65 b = 119

If graph ii 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 an elite male endurance athlete?

a = 72 b = 220

Which of the following is NOT a sign/symptom suggestive of cardiac, pulmonary, or metabolic disease? a) all of these ARE signs/symptoms suggestive of cardiac, pulmonary, or metabolic disease b) chest pain on exertion c) unexplained severe pain in the calves during mild activity d) mitral regurgitation (lub-swish-dup) e) unexplained loss of consciousness f) sudden shortness of breath when lying down

a) all of these ARE signs/symptoms suggestive of cardiac, pulmonary, or metabolic disease

If graph vi depicts the changes in DBP (y axis) between rest and maximal cycing exercise, what other cardiovascular response(s) to exercise contribute to this change? a) an increase in stroke volume during this type of activity b) a decrease in TPR during this type of activity c) two of these answers d) none of these answers e) an increase in TPR during thist type of activity

b) a decrease in TPR during this type of activity

MAP 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) dynamic knee extensions at 90% of maximum d) two of these would be tied e) arm crank at 60 Watts (90% of max)

b) isometric knee extension at 90% of maximum

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

c) none of these; this graph is wrong and does not reflect the blood pressure response to these exercises

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 a highly trained healthy adult male? a) a = 13.2 b = 18.2 b) a = 4.5 b = 15.8 c) a = 20 b = 35 d) a = 5.2 b = 17.9 e) none of these answers

d) a = 5.2 b = 17.9

On an EKG, the P wave represents the _

depolarization of the atria

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) two of these answers b) a decrease in pCO2 in the systemic capillaries c) none of these answers d) a decrease in pulmonary capillary pO2 e) a decrease in active muscle pO2

e) a decrease in active muscle pO2

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

e) fasting plasma glucose = 131 mg/dL

Bilateral ankle edema could suggest that the patient has:

heart failure

On an EKG, the T wave represents the _

repolarization of the ventricles

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 (low line, slight decrease)

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

126

Average VO2 Difference

5

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

60

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

60

A systolic blood pressure of __________ mmHg increases the possibility of the subject experiencing syncope

90

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

90

Based on pre-2017 guidelines hypertension could be diagnosed based on a diastolic blood pressure __________ mmHg

90

If your subject's PR interval is longer than normal, select the part of the conduction system that is most likely to be causing this problem?

AV Node

Which of the following letters identifies the segment/interval that would be most influenced by AV node dysfunction?

F (P-R interval)

Which of the following interval/s are expected to change as heart rate increases during exercise?

RR-Interval and QT-Interval

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 who recently started experiencing angina when they exercise c) patient with severe anemia d) Patient had myocardial infarction 36 hours ago 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 who experiences extreme pain in calves when walking (even very slow speeds) due to peripheral vascular disease

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

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 why this variable plateaus in most subjects during acute exercise? a) ventricular filling time decreases at high intensities b) decreases in afterload c) a failure to keep increasing venous return (muscle pump effect maxed out) d) three of these answers e) ventricular ejection time decreases at high intensities

a) ventricular filling time decreases at high intensities

venous O2 content

a-vO2 diff - arterial O2 content

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

b) HDL = 34 mg/dL

When we use a stethoscope and blood pressure cuff to determine blood pressure, we place the diaphragm of the stethoscope over which blood vessel?

brachial artery

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) none of these answers b) sympathetic nervous system constriction of arterioles c) an increase in blood volume d) an increase in muscle pump activity e) two of these answers

d) an increase in muscle pump activity

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

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

MAP =

diastolic pressure + 1/3 pulse pressure

If graph i depicts the changes in DBP (y axis) between rest and maximal isometric knee extensions, what other cardiovascular response(s) to exercise contribute to this change? a) none of these answers b) an increase in stroke volume during this type of activity c) a decrease in TPR during this type of activity d) two of these answers e) an increase in TPR during thist type of activity

e) an increase in TPR during thist type of activity

Orthopnea could suggest that the patient has:

heart failure

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 linear, (starting at point a vs axis)

downsloping ST segment

most indicative of CAD.

The first Korotkoff sound is associated with:

systolic blood pressure

Which of the following is/are true about the electrode indicated by the green square (collarbone)

this electrode would be the positive electrode in limb lead I

Which of the following would be most suggestive of NSR?

- RR interval 0.85 seconds every beat - PR interval 0.16 seconds every beat - QRS interval 0.10 seconds every beat - P before each QRS - QRS after each P wave

left ventricular hypertrophy

- they have left axis deviation - The S in V1 and the R in V5 adds up to 35mm - There is an inverted T wave in V5 and/or V6

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-.12seconds, a bundle branch block

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 AV node

Based on current (after 2017) guidelines a systolic blood pressure of __________ mmHg would be classified as elevated (more than one acceptable answer)

120-130

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

130

LDL concentration greater than ____is associated with increased CAD risk (no units required)

130

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

1393 - 1593

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

Based on pre-2017 guidelines hypertension could be diagnosed based on a systolic blood pressure __________ mmHg

140

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

164-200

When you are using the auscultatory method for determining blood pressure, how high do y ou pump up the pressure in the cuff?

20-30 mmHg above the expected systolic blood pressure

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

200

total cholesterol concentration greater than ____is associated with increased CAD risk (no units required)

200

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

25

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

28-42

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

30

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

What is a typical value for cardiac output in a healthy adult human (in L)?

4-6

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

40

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

45

What is a typical resting a-vO2difference in an untrained subject?

5

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

5

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)

55

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

6.5

mother (or other fmale first degree relative; e.g. 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)

65

What is a typical value for stroke volume in a healthy adult human (in mL)?

75

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

80

RPP =

HR x SBP

Q =

HR x SV

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

LL electrode

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

LL electrode

The figure below depicts an action potential from an atrial muscle cell. Phase X of this figure would likely occur during what part of the EKG? (vertical slope)

P wave

Corrected QT interval

QT / (square root) RR

ischemia

ST depression

acute infarction

ST elevation

ef% =

SV/EDV x 100

The electrode at the blue triangle would be _______.

V6

O2 content (vols%) =

[Hb] in g/100ml x 1.39 ml O2 /gHb x Sa O2%

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) an increase in venous return b) none of these answers c) an increase in TPR d) two of these answers e) an increase in ventricular filling time

a) an increase in venous return

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

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

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

a) patient with severe anemia f) patient who comes to your office with a resting blood pressure of 220/92 g) patient who had a stroke 10 days ago

Which of the following findings in a patient would be associated with an increased risk of developing a cardiovascular disease? a) quit smoking 4 months ago b) exercising three days per week for thirty to fourty minutes over the past half year c) 2 hour plasma glucose during glucose tolerance test = 174 mg/dL d) fasting plasma glucose = 102 mg/dL e) mother having a myocardial infarction at the age of 67

a) quit smoking 4 months ago

____________________________________ is a symptom suggestive of coronary artery disease. It is when the subject feels chest pain during exertion.

angina pectoris

Palpitations would most likely be associated with which of the following:

arrhythmias

Which of the following is/are NOT a possible sign that a patient may have heart failure? a) bilateral ankle edema b) intermittent claudicaiton c) shortness of breath when lying down d) orthopnea e) paroxysmal nocturnal dyspnea f) three of these answers

b) intermittent claudicaiton

Which of the following is/are NOT absolute 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 with a third degree AV blockand low blood pressure d) patient who recently started experiencing angina when they exercise e) patient with severe anemia 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

b) patient who comes to your office with a resting blood pressure of 220/92 d) patient who recently started experiencing angina when they exercise e) patient with severe anemia 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

PR Interval

beginning of P wave to beginning of QRS complex

QT interval

beginning of QRS complex to end of T wave

QRS Interval

beginning of QRS to end of QRS

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

d) patient who feels lightheaded every time they stand up f) patient who can feel their heart racing sometimes when tehy are at rest g)

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

e) Patient with a a clot in one of their pulmonary blood vessels f) Patient with inflamed pericardium

This image 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 DBP?

f (6/6)

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 DBP? Note: bicep curls would typically be considered relatively small muscle mass exercise except in extraordinary cases (such as in the case of your professor's huge biceps).

f (6/6)

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.

indirect-auscultatory

__________________ ____________________ 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

intermittent claudication

Normal ST segment

isoelectric line

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

left side -- V1/2??

Horizontal ST segment depression

likely associated with ischemia

When we use a stethoscope and blood pressure cuff to determine blood pressure, we place the diaphragm of the stethoscope where?

medial antecubital fossa

What does the 5th Korotkoff sound sound like?

no sound

____________________________________ 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).

palpitations

Pain in the lower extremities due to low blood flow during exercise would most likely be associated with which of the following:

peripheral vascular disease

intermittent claudication would most likely be associated with which of the following:

peripheral vascular disease

right arm electrode

right collarbone

ground electrode

right leg

____________________________________ is a symptom suggested of cardiovascular or pulmonary disease associated with loss of conciousness due to reduced blood flow to the brain

syncope

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.

top 2: SBP middle 2: MAP bottom 2: DBP (isometric always higher; 2 isometric > large muscle group)

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 (downward & decreasing, exponential slope to the right)

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 would be most suggestive of a 2 AV block?

- RR interval variable ranging from 0.84 to 1.24 seconds - PR interval progressively lengthening from 0.16 to 0.32 seconds - QRS interval 0.10 seconds every beat - P before each QRS QRS after most P waves - some P waves not followed by QRS

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

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

bruce protocol (female)

3(time) + 4 = VO2max

bruce protocol (male)

3(time) = 8 = VO2 max

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

LR electrode

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 dynamic knee extensions? a) it would increase instead of decrease 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 be about the same

a) it would increase instead of decrease

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

a) two of these * an increase in bolld volume would increase EDV 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.

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

b) cycling at 200 Watts (90% of max)

There are many possible causes of chest pain. Which of the following chest pain examples would be most suggestive coronary artery disease?

burning sensation below the sternum during exercise

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 (3/6)

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

stable angina pectoris would most likely be associated with which of the following:

coronary artery disease

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

Sudden shortness of breath at night could suggest that the patient has:

heart failure

If your subject had left ventricular hypertrophy, we would expect to see a tall R wave in which of these leads?

V6 (blue triangle)

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) none of these answers b) it is why DBP decreases slightly in young healthy subjects during this type of activity c) it is why SBP increases in young healthy subjects during this type of activity d) it is why MAP increases a little in young healthy subjects during this type of activity e) two of these answers

b) it is why DBP decreases slightly in young healthy subjects during this type of activity

One of your patients has hypertension and you 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?

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

a-vO2 difference =

Vo2 / Q x 100

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 untrained female subject?

a = 4.8 b = 21.3

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) none of these answers b) an increase in hemoglobin concentration during this type of activity c) a left shift in the O2 dissociation curve d) two of these answers e) a decrease in arterial pO2

b) an increase in hemoglobin concentration during this type of activity

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 left shift in the O2 dissociation curve b) two of these answers c) redistribution of blood flow away from inactive tissues and towards active tissues (especially muscle) d) none of these answers e) a decrease in arterial pO2

c) redistribution of blood flow away from inactive tissues and towards active tissues (especially muscle)

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

d) 2 hour plasma glucose during glucose tolerance test = 212 mg/dL

A 35-yr-old business consultant is in town for 2 wk and seeking a temporary membership at a fitness club. She and her friends have been training for a long-distance charity bike ride for the past 16 wk; she is unable to travel with her bike and she does not want to lose her fitness. She reports no current symptoms of CV or metabolic disease and has no medical history except hyperlipidemia, for which she takes a HMG-CoA reductase inhibitor (statin) daily. Select all that apply

- Does NOT need to be medically cleared before performing desired activity - currently participates in regular exercise - desired exercise intensity = vigorous - Does not have signs or symptoms suggestive of disease - does not have known cardiovascular, metabolic, or renal disease

Which of the following would be most suggestive of some type of SVT (supraventricular tachycardia)?

- RR interval 0.44 seconds every beat - PR interval 0.12 seconds every beat - QRS interval 0.08 seconds every beat - P before each QRS complexe - QRS after each P wave

Which of the following would be most suggestive of a bundle branch block?

- RR interval 0.75 seconds every beat - PR interval 0.16 seconds every beat - QRS interval 0.14 seconds every beat - P before each QRS - QRS after each P wave

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

- 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

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

- RR interval 0.80 seconds every beat - PR interval 0.24 seconds every beat - QRS interval 0.10 seconds every beat - P before each QRS QRS after each P wave

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 75x/min

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

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

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

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

b) 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 left shift in the O2 dissociation curve b) a right shift in the O2 dissociation curve c) two of these answers d) none of these answers e) a decrease in pulmonary capillary pO2

b) a right shift in the O2 dissociation curve

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) none of these answers b) an increase in body temperature c) a decrease in 2,3-BPG d) an increase in pH e) two of these answers

b) an increase in body temperature

A 60-yr-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 afterr 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

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

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

c) Based on new guidelines they have hypertension

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) an increase in ventricular filling time b) none of these answers c) an increase in venous return d) two of these answers e) an increase in TPR

c) an increase in venous return

Which of the following is/are NOT a sign/symptom suggestive of cardiovascular, pulmonary, or metabolic disease? a) feeling one's heart racing at rest b) intermittent claudicaiton c) breathing very deep after sprinting up three flights of stairs d) orthopnea e) aortic stenosis f) three of these answers

c) breathing very deep after sprinting up three flights of stairs

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) a = 5 b = 42.1 b) none of these answers c) a = 4.8 b = 21.3 d) a = 5.1 b = 31.9 e) a = 72 b = 141

d) a = 5.1 b = 31.9

If graph i depicts the changes in DBP (y axis) between rest and maximal isometric knee extensions, what other cardiovascular response(s) to exercise contribute to this change? a) an increase in stroke volume during this type of activity b) two of these answers c) none of these answers d) an increase in TPR during thist type of activity e) a decrease in TPR during this type of activity

d) an increase in TPR during thist type of activity

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

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

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 (2/6)

This image 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 cyclilng SBP?

b (2nd line out of 6; below a)

21 year old female who smokes socially on weekends (~10-20 cigarettes). Drinks alcohol one or two nights a week, usually on weekends. Height = 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 -l (5.33 mmol ·1 -l)_ 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?

zero

45 year old nonsmoking male. Height = 72 in (182.9 cm), weight= 168 lb (76.4 kg), BMI = 22.8 kg· m-2_ RHR = 64 beats· min-1, resting BP= 124/78 mm Hg. Total cholesterol= 187 mg· dL-1 (4.84 mmol · L-1), LDL-C = 103 mg· L-1 (2.67 mmol · L-1), HDL-C = 39 mg .. dL-1 (1.01 mmol · L-1), FBG = 88 mg· dL -l (4.84 mmol · 1 -l)_ Recreationally competitive runner, runs 4-7 cl· wk-1, completes one to two marathons and numerous other road races every year. No medications other than over-the-counter ibuprofen as needed. Father died at age 51 yr of a heart attack mother died at age 81 yr of cancer. How many risk factors does this subject have?

3

Man, age 44 yr,. nonsmoker. Height = 70 in (177 .8 cm), weight= 216 lb (98.2 kg), BMI = 31.0 kg · m -2 _ RHR = 62 beats·min-1, resting BP= 128/84 mm Hg. Total serum cholesterol= 184 mg· dL-1 (4.77 mmol · 1-1), 1DL-C = 106 mg·· dL-1 (2.75 mmol · L-1), HDL-C = 44 mg· dL-1 (1.14 mmol · L-1), FBG = 130 mg· d.L-1 (7.22 mmol · L -l)_ Reports that he does not have time to exercise. Father had Type 2 diabetes and died at age 67 yr of a heart attack mother living, no CVD. No medications.

3

This image 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 (top line out of 6)

Which of the following is/are absolute reasons for terminating a maximal GXT? a) 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 b) patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. c) patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused e) patient's SaO2% drops to 79% f) 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) Your patient asks to stop but you are sure they can last a little longer h) 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina

a) 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 b) patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. d) patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused g) Your patient asks to stop but you are sure they can last a little longer

A 22-yr-old recent college graduate is joining a gym. Since becoming an accountant 6 mo ago, she no longer walks across campus or plays intramural soccer and has concerns about her now sedentary lifestyle. Although her body mass index (BMI) is slightly above normal, she reports no significant medical history and no symptoms of any diseases, even when walking up three flights of stairs to her apartment. She would like to begin playing golf. Select all that apply

a) desired exercise intensity = moderate b) Does not have signs or symptoms suggestive of disease e) does not currently participate in regular exercise h) Does NOT need to be medically cleared before performing desired activity j) does not have known cardiovascular, metabolic, or renal disease

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) hypertension increases the risk of having a stroke b) a blood pressure of 80 over 40 could cause syncope c) 40-50% of all US adults have hypertension d) pre-eclamplsia is a complication of pregnancy associated with low blood pressure e) severe hypotension may be a more immediate threat to a pateint's life than hypertension f) hypotension increases the risk of coronary artery disease g) essential hypertension is when a patient needs to have high blood pressure to promote blood flow to critical organs h) orthostatic hypotension is when blood pressure drops due to an injury

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

Which of the following is/are relative reasons for terminating a maximal GXT? a) patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea 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) 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's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol 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 mmHg after increasing from stage 1 to stage 2 of the Bruce protocol. h) Angia increasing from 3 to 4 on a 4 point angina scale

a) patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea c) 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina 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'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 absolute reasons for terminating a maximal GXT? a) 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 b) Your patient asks to stop but you are sure they can last a little longer c) patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused d) patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. e) patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol f) 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 g) patient's SaO2% 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

a) 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 e) patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol g) patient's SaO2% 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 relative reasons for terminating a maximal GXT? a) patient's SaO2% drops to 79% b) patient's SaO2% drops to 79% c) 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina d) patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused e) patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol f) patient's EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. 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) 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

a) patient's SaO2% drops to 79% 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's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol h) 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

Which of the following is/are relative 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) 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 EKG now has 1.2-1.6 mm of ST elevation in three of the precordial leads. d) 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 e) patient is starting to loose coordination. Their speach is slurred and they seem lightheaded and confused f) patient's SaO2% drops to 79% g) Your patient asks to stop but you are sure they can last a little longer h) 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

a) patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol b) 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina f) patient's SaO2% drops to 79% h) 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

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

b) All of these ARE contraindications to stress testing

Which of the following is/are 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 who feels lightheaded/dizzy and SOB with mild activity, has chest pain, and when you listened to their heart sounds you hear lub-whistle-dup c) Patient who regularly has spontaneous angina at rest d) 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

b) Patient who feels lightheaded/dizzy and SOB with mild activity, has chest pain, and when you listened to their heart sounds you hear lub-whistle-dup c) Patient who regularly has

If graph vi depicts the changes in DBP (y axis) between rest and maximal cycing exercise, what other cardiovascular response(s) to exercise contribute to this change? a) none of these answers b) a decrease in TPR during this type of activity c) two of these answers d) an increase in stroke volume during this type of activity e) an increase in TPR during thist type of activity

b) a decrease in TPR during this type of activity

Which of the following is/are absolute 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) you are unable to hear the patient's korotkoff sounds and cannot get their blood pressure c) 2.0 mm of ST depresion 0.08 seconds after the J point in a patient who has history of stable angina d) Patient feels dizzy and their EKG has sawtooth like appearance with no p waves and heart rate of 150bpm e) patient's blood pressure just increased to 260/110 at the end of the second stage of the Bruce Protocol f) patient who is experiencing shortness of breath and who's SBP drops by 16 mmHg after increasing from stage 1 to stage 2 of the Bruce protocol. g) Angia increasing from 3 to 4 on a 4 point angina scale h) patient has severe pain in their calves due to peripheral vascular disease and they are also wheezing and experiencing dyspnea

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

SBP would likely be highest for which of the following exercises? a) two of these would be tied b) isometric knee extensions at 60% of maximum c) isometric knee extension at 90% of maximum d) cycling at 100 Watts (~50% of max) e) cycling at 200 Watts (90% of max)

c) isometric knee extension at 90% of maximum

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) none of these answers b) it would be about the same c) it would increase instead of decrease d) it would still decrease, but not as much e) it would remain relatively steady (neither increase or decrease)

c) it would increase instead of decrease

If graph ii depicts the changes in stroke volume (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 remain relatively steady (neither increase or decrease) c) it would still increase, but not as much d) none of these answers e) it would decrease instead of increase

c) it would still increase, but not as much

Which of the following findings in a patient would be associated with reduced risk of developing a cardiovascular disease? a) father having a myocardial infarction at the age of 54 b) exercising three days per week for fifteen to twenty minutes over the past half year c) quit smoking almost 100 days ago d) HDL = 74 mg/dL e) LDL = 144 mg/dL

d) HDL = 74 mg/dL

Which of the following is/are NOT true about changes in stroke volume during exercise? a) it increases, in part, due to increases in contractility, which increases ejection fraction b) all of these ARE true c) It increases, in part, due to increases in end diastolic volume d) It increases, in part. due to increases in end systolic volume e) it increases, in part, due to increases in venous return

d) It increases, in part. due to increases in end systolic volume

If graph i depicts the changes in TPR (y axis) between rest and maximal isometric knee extensions, how would this change influence the blood pressure response to exercise? a) none of these answers b) two of these answers c) it is why MAP does not increase as much during this type of activity d) it is why DBP increases during this type of activity e) it is why SBP does not increase as much during this type of activity

d) it is why DBP increases during this type of 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) an increase in sympathetic stimulation of the SA node b) a decrease in acetylcholine release at the SA node c) more neurotransmitter binding with beta-1-adrenergic receptors d) three of these answers e) none of these answers, the heart rate should never be zero for a living subject

d) three 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) secretion of nitric oxide in blood vessels of active muscles b) an increase in acetylcholine released near arteriolar smooth muscle c) an increase in acetylcholine released near arteriolar smooth muscle d) two of these answers e) a decrease in body fluid pH

d) two of these answers

which of the following would NOT be expected to increase a-vO2 difference during an exercise bout? a) a redistribution of blood flow away from inactive tissues and towards active tissues b) a decrease in active muscle pO2 c) all of these WOULD incresae a-vO2difference during exercise d) a decrease in plasma volume e) a decrease in pulmonary capillary pO2 f) a rightward shift in the O2 dissociation curve (which is caused by an increase in temperature, pCO2, and H+)

e) a decrease in pulmonary capillary pO2

If graph ii depicts the changes in stroke volume (y axis) between rest and maximal intensity cycling exercise in a healthy untrained subject, how would this figure look different if we obtained the same data from an elite endurance athlete? a) it would still increase, but not as much b) none of these answers c) it would start higher, but plateau at about the same intensity d) it would remain relatively steady (neither increase or decrease) e) it start at a higher value and may continuously increase

e) it start at a higher value and may continuously increase

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) two of these answers b) norepinephrine binding with alpha adrenergic receptors on the arteriolar smooth muscle in the active muscles c) the parasympathetic nervous system acting on the arteriolar smooth muscle in the active muscles d) the sympathetic nervous system acting on the arteriolar smooth muscle in the active muscles e) local metabolic factors acting on arteriolar smooth muscle in the active muscles

e) local metabolic factors acting on arteriolar smooth muscle in the active muscles

If graph iii 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) three of these answers c) an increase in sympathetic stimulation of the SA node d) more neurotransmitter binding with beta-1-adrenergic receptors 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

When we use the auscultatory method for determining blood pressure:

we are listening for Korotkoff sounds