Deck 8: Cardiovascular Diagnostic Tests and Procedures

Question 1

Which of the following biochemical markers is considered to be the gold standard indicator of myocardial damage because it is more conclusive to cardiac tissue?

A)Creatine phosphokinase (CK-MB)
B)Lactic dehydrogenase (LDH isoenzyme)
C)Aspartate aminotransferase (AST)
D)Troponin (cTnl,cTnT)

Answer 1

D
Blood levels of the troponins have been assessed to determine myocardial damage and are now considered the gold standard.Elevated levels of troponin occur earlier and may last for up to 5 to 7 days in plasma.

Question 2

An exercise test that is terminated on achievement of a predetermined end point (less than maximal)is termed which of the following?

A)Low-level testing
B)Maximal stress test
C)Submaximal test
D)Pulse recovery test

Answer 2

C
Submaximal tests are terminated on achievement of a predetermined end point (unless symptoms otherwise limit completion of the test).The predetermined end point may be either the achievement of a certain percentage of the patient's predicted maximal heart rate or the attainment of a certain workload.

Question 3

Which of the following variables identified in a maximal exercise test would BEST reflect low risk for developing coronary artery disease (CAD)?

A)Exercise time of more than 6 minutes
B)The presence of angina
C)Achieved maximal heart rate considerably below predicted
D)Maximal systolic blood pressure <130 mm Hg

Answer 3

A
Variables associated with a low risk for CAD,including an exercise time of >6 minutes,maximum heart rate of more than 150 beats/min,and an ST recovery time of <1 minute,were identified in women.Variables that suggested a greater risk for subsequent cardiac event included ST-segment depression,bradycardiac heart rate response,presence of angina,and maximal systolic blood pressure attained.

Question 4

Which of the following factors from the results of a low-level exercise test was determined to be the MOST significant factor for identifying high-risk patients?

A)Exercise-induced arrhythmias
B)Exercise-induced angina
C)Inappropriate blood pressure response
D)Exercise-induced ST-segment depression of ³2.0 mm

Question 5

Which of the following imaging modalities is often the diagnostic tool of choice over the PET imaging for measuring myocardial perfusion?

A)Computed tomography
B)Single-photon emission computed tomography (SPECT)
C)Electron beam compute tomography
D)Magnetic resonance imaging

Question 6

Which of the following components of complete blood cell count would be indicative of impeded blood flow secondary to increase blood viscosity?

A)Low hemoglobin levels
B)Elevated hematocrit levels
C)Small RBCs
D)Elevated WBCs

Question 7

Sensitivity of a diagnostic test is one method of determining the accuracy of a test.Which of the following statements BEST defines sensitivity?

A)The proportion of those individuals without the disease with a true negative test
B)The proportion of those individuals with the disease who have a true positive test
C)The proportion of individuals who had a positive test and actually have the disease
D)The proportion of individuals who had a negative test and truly do not have the disease

Question 8

Which of the following factors enhance the safety of exercise testing?

A)Knowledge of when to exclude a patient
B)Knowledge of when to terminate an exercise test
C)Knowledge and skills to react to an abnormal response
D)All of the above

Question 9

The physical therapist during an evaluation learns that his patient has recently worn a Holter monitor to investigate a report of shortness of breath during activity.Which of the following actions is MOST appropriate for the physical therapist to take next?

A)Continue with the evaluation and proceed with an exercise stress test to determine if shortness of breath occurs.
B)Hold any activity component of the evaluation and contact the physician and request a copy of the Holter monitoring report.
C)Stop the evaluation and refer the patient back to the physician for clearance to participate in physical therapy.
D)Call the physician to request a copy of the Holter monitoring report and continue treating the patient until the report is received stating otherwise.

Question 10

Which of the following reasons are considered indications for a Holter monitor?

A)Identifying symptoms caused by arrhythmias
B)Describing the arrhythmias noted with activity
C)Evaluating antiarrhythmic therapy or pacemaker functioning
D)All of the above

Question 11

An imaging modality that detects calcium in the coronary arteries and is a noninvasive method to detect and quantify coronary atherosclerosis BEST describes which of the following?

A)Computed tomography
B)Single-photon emission computed tomography
C)Electron beam computed tomography
D)Magnetic resonance imaging

Question 12

Which of the following imaging modalities is considered the gold standard for blood flow measurement and metabolic assessment of the heart but requires high cost and specially trained personnel?

A)Computed tomography
B)Multigated acquisition imaging
C)Magnetic resonance imaging
D)Positron emission tomography (PET)

Question 13

Which of the following tests is MOST useful for identifying the high-risk patient?

A)Low-level testing
B)Maximal stress test
C)Submaximal test
D)Pulse recovery test

Question 14

Specificity of a diagnostic test is one method of determining the accuracy of a test.Which of the following statements BEST defines specificity?

A)The proportion of those individuals without the disease with a true negative test
B)The proportion of those individuals with the disease who have a true positive test
C)The proportion of individuals who had a positive test and actually have the disease
D)The proportion of individuals who had a negative test and truly do not have the disease

Question 15

Which of the following biomarkers is MOST conclusive for myocardial injury?

A)CK-MB
B)CK-MM
C)CK-BB
D)All of the above

Question 16

Which of the following statements is FALSE regarding elevated troponin levels?

A)Elevated troponin levels assist the clinician in identifying the specific cause.
B)The higher the troponin levels,the greater the damage to cardiac tissue.
C)Critically ill patients with sepsis may have increased troponin levels.
D)Troponin levels remain elevated for 10 days after injury.

Question 17

Which of the following statements conveys the LEAST important rationale for using transesophageal echocardiography (TEE)instead of a standard echocardiogram?

A)The transesophageal echocardiography is invasive.
B)Confounding factors such as pulmonary disease,obesity,or chest deformity may exist.
C)Useful in detection of those at risk for embolic stroke.
D)Gauge the severity of certain valve problems.

Question 18

An elevated international normalized ratio (INR)should alert the therapist to consider which of the following?

A)Avoid having the patient walk a long distance due to low endurance.
B)Avoid out-of-bed physical activity due to low oxygen-carrying capacity.
C)Be cautious about moving the patient from supine to stand quickly.
D)Be cautious about bumping extremities with all movements.

Question 19

Which of the following laboratory values is indicative of the possible occurrence of life-threatening arrhythmias?

A)Low levels of CO₂
B)Low levels of potassium
C)High levels of sodium
D)High creatinine levels

Question 20

Which of the following laboratory values measure how well a patient with diabetes controls serum glucose over the most recent 90 days?

A)Serum glucose
B)Hemoglobin A1c
C)Albumin
D)BNP

Question 21

Which of the following values is considered a high-risk factor for coronary artery disease?

A)Homocysteine level of 10.0 μmol/L
B)C-reactive protein level of 3.2 mg/L
C)Glucose level of 92 mg/dL
D)Hb A1c of 5.5%

Question 22

A patient is undergoing a maximal exercise test in the laboratory.During the third stage of the treadmill maximal exercise test,the therapist notes the patient appears to be mildly confused and is less coordinated walking on the treadmill.Which of the following should be the next action of the therapist?

A)The therapist should straddle the treadmill and provide close contact guard of the patient to prevent a fall.
B)The therapist should immediately obtain a heart rate and blood pressure reading.
C)The therapist should terminate the test.
D)The therapist should ask the patient if he can continue the test.

Question 23

The results of a cardiac catheterization indicate the left ventricle is normal in size with anteroapical hypokinesis.Which of the following statements BEST defines hypokinesis of a cardiac region?

A)The anteroapical region is demonstrating low electrical activity.
B)The anteroapical region is demonstrating sluggish movement.
C)The anteroapical region is demonstrating muscle fatigue.
D)The anteroapical region is demonstrating a slow rhythm.

Question 24

Which of the following diagnostic tests would be indicated to evaluate vascular dysfunction?

A)Arterial duplex ultrasonography
B)Echocardiography
C)Pharmacological stress testing
D)Exercise ECG

Question 25

Which of the following pharmacological cardiac testing procedures is BEST for confirming coronary artery spasm?

A)Administration of adenosine
B)Administration of dobutamine
C)Administration of regadenoson
D)Administration of ergonovine

Question 26

Elevated CK-MB levels in a patient after a hip surgery confirms the patient experienced some level of myocardial injury.

Question 27

Which of the following variables would contribute to a less valid maximal exercise test?

A)Consistent adherence to a protocol
B)Competent examiners with previously demonstrated proficiency
C)Provision of encouragement to the patient
D)Instructing the patient to use a handrail only when ready to terminate the test

Question 28

A patient is positioned in supine and her legs are elevated to 45 degrees.In this position the therapist assesses the color of the legs,then places the leg in a dependent position to again assess the color.This procedure describes which of the following tests?

A)Venous filling time test
B)Rubor dependency test
C)Trendelenburg test
D)Homan's sign

Question 29

Which of the following target international normalized ratio (INR)values for anticoagulative therapy is MOST appropriate for patients with prosthetic heart valves?

A)1.8 (1.5-2.0)
B)2.5 (2.0-3.0)
C)3 (2.5-3.5)
D)3.5 (3.0-4.0)

Question 30

Which of the following ankle brachial index (ABI)values indicates severe arterial occlusive disease and high cardiovascular risk?

A)1.1
B)0.9
C)0.8
D)0.5