Question 1

A patient presents with complaints of shortness of breath and coughing.On auscultation there is extensive wheeze throughout.The chest x-ray the patient had taken yesterday shows mild hyperinflation.What would be the BEST test to aid in diagnosing this patient?

A)Pre-bronchodilator spirometry
B)Post-bronchodilator spirometry
C)Arterial blood gas
D)Pre- and post-bronchodilator spirometry

D

Accepted Answer

Pre- and post-bronchodilator spirometry is the best test to aid in diagnosing this patient as it can help determine if the patient has reversible airway obstruction, which is characteristic of asthma. It can also help assess the severity of the obstruction and guide treatment. Arterial blood gas may be useful in severe cases, but spirometry is the initial test of choice. Pre-bronchodilator spirometry may miss reversible obstruction while post-bronchodilator spirometry will capture it.

Question 2

By week two of a 3-day-per-week pulmonary rehabilitation program,a patient with moderate chronic obstructive pulmonary dysfunction is performing 15 minutes of cycling exercise with a 1-minute rest period at the 7-minute time-point.The patient's perceived dyspnea rating during cycling exercise was 2.What is the BEST way to progress this patient's exercise program for week three?

A)Increase cycle duration to 20 minutes with elimination of the rest period.
B)Increase cycle duration to 40 minutes with elimination of the rest period.
C)Increase training frequency to five times per week.
D)Increase training intensity to a dyspnea rating of 5.

A

Accepted Answer

Based on the patient's current level of exercise tolerance and perceived dyspnea rating, it would be appropriate to progress the program by increasing the duration of cycling exercise to 20 minutes while eliminating the rest period. This represents a gradual and appropriate progression in volume of exercise, while allowing the patient to continue to exercise at a moderate intensity without experiencing excessive dyspnea. Increasing the training frequency to 5 times per week or increasing the training intensity to a dyspnea rating of 5 may be too aggressive at this stage and could potentially lead to injury or exacerbation of symptoms. Increasing cycle duration to 40 minutes is also too aggressive and may be overwhelming for the patient at this point in the program.

Question 3

What is the MOST likely presentation of lung hyperinflation on physical examination of a person with chronic obstructive pulmonary disease?&#10;A)Increased anterior-posterior diameter of the chest with decreased thoracic excursion during breathing&#10;B)Increased anterior-posterior diameter of the chest with increased thoracic excursion during breathing&#10;C)Decreased anterior-posterior diameter of the chest with decreased thoracic excursion during breathing&#10;D)Decreased anterior-posterior diameter of the chest with increased thoracic excursion during breathing

Accepted Answer

Lung hyperinflation in chronic obstructive pulmonary disease results in air trapping, which leads to increased residual volume and increased total lung capacity. This causes an increase in the anterior-posterior diameter of the chest due to the overinflated lungs pressing against the rib cage. However, decreased thoracic excursion during breathing occurs due to reduced lung compliance and airflow obstruction.

Question 4

If a patient with severe cystic fibrosis performs a 10-meter shuttle test before a pulmonary rehabilitation program,what information collected during this test is MOST useful for exercise prescription?

A)Submaximal exercise capacity data
B)Peak exercise capacity data
C)Rating of perceived exertion at peak exercise
D)Resting oxygen saturation

Accepted Answer

Peak exercise capacity data is the most useful information for exercise prescription because it provides insight into the patient's maximal aerobic capacity and can be used to set appropriate exercise intensity levels for the rehabilitation program. Submaximal exercise capacity data and rating of perceived exertion at peak exercise can provide additional information but may not be as important for determining exercise prescription as peak exercise capacity. Resting oxygen saturation may be important for monitoring the patient's overall health status but is not directly related to exercise prescription.

Question 5

What smoking cessation program is MOST appropriate for a 56-year-old female with asthma whose subjective assessment reveals that she is suffering from depression and started smoking 5 years ago following the death of her husband?

A)Exercise training
B)Education and support
C)Counseling with pharmacological therapy
D)Acupuncture

Accepted Answer

Counseling with pharmacological therapy is the most appropriate program for a 56-year-old female with asthma who is suffering from depression and started smoking 5 years ago following the death of her husband. This approach addresses both the psychological and physical dependence components of smoking addiction. The counseling aspect can help address the underlying depression and grief, while pharmacological therapy (such as nicotine replacement therapy or prescription medication) can help manage nicotine withdrawal symptoms and cravings.

Question 6

What is the MOST appropriate classification of lung disease for a patient whose spirometry results are FEV₁/FVC ratio = 52,FEV₁ = 39% predicted,and FVC = 67% predicted? A)Very severe B)Severe C)Moderate D)Mild

Accepted Answer

The patient's spirometry results indicate a FEV1/FVC ratio of 52% and a FEV1 of 39% predicted, which falls into the severe classification of lung disease according to the GOLD criteria for the diagnosis and management of chronic obstructive pulmonary disease (COPD).

Deck 12: Chronic Pulmonary Dysfunction