Podcast
Questions and Answers
Which of the following is NOT a typical benefit of MID-CAB surgery compared to traditional bypass surgery?
Which of the following is NOT a typical benefit of MID-CAB surgery compared to traditional bypass surgery?
A physical therapist is reviewing a patient's chart prior to seeing them for the first time post-operatively. Which of the following details should the therapist look for?
A physical therapist is reviewing a patient's chart prior to seeing them for the first time post-operatively. Which of the following details should the therapist look for?
Which of the following is not a key area to assess during a physical therapy examination, post cardiac surgery?
Which of the following is not a key area to assess during a physical therapy examination, post cardiac surgery?
Which of the following is a risk factor for sternal dehiscence?
Which of the following is a risk factor for sternal dehiscence?
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Which special test is not part of the cardiovascular examination?
Which special test is not part of the cardiovascular examination?
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Which of the following is NOT a primary focus of medical management for patients with Coronary Artery Disease (CAD) or Myocardial Infarction (MI)?
Which of the following is NOT a primary focus of medical management for patients with Coronary Artery Disease (CAD) or Myocardial Infarction (MI)?
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A percutaneous transluminal coronary angioplasty (PTCA) uses a balloon tipped catheter for what purpose?
A percutaneous transluminal coronary angioplasty (PTCA) uses a balloon tipped catheter for what purpose?
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What is the primary purpose of a stent in the context of treating CAD after a PTCA?
What is the primary purpose of a stent in the context of treating CAD after a PTCA?
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In a Coronary Artery Bypass Graft (CABG) surgery, which of the following is used to create a bypass around the occlusion?
In a Coronary Artery Bypass Graft (CABG) surgery, which of the following is used to create a bypass around the occlusion?
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Which of the following vessels might be used in a CABG procedure to route blood flow around the occluded area?
Which of the following vessels might be used in a CABG procedure to route blood flow around the occluded area?
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For how long should patients generally keep their upper arms close to their body post-surgery?
For how long should patients generally keep their upper arms close to their body post-surgery?
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Which of the following is NOT a recommended sternal precaution after surgery?
Which of the following is NOT a recommended sternal precaution after surgery?
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What is the primary purpose of having patients hug a pillow over their surgical incision while coughing or sneezing?
What is the primary purpose of having patients hug a pillow over their surgical incision while coughing or sneezing?
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Which of the following factors are typically evaluated during a movement system assessment?
Which of the following factors are typically evaluated during a movement system assessment?
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What should patients with large breasts use?
What should patients with large breasts use?
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During an assessment for sternal instability, which digits are used to palpate between the sternal halves?
During an assessment for sternal instability, which digits are used to palpate between the sternal halves?
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Which movement is LEAST appropriate when palpating for sternal stability?
Which movement is LEAST appropriate when palpating for sternal stability?
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According to the sternal instability scale, a 'moderately separated sternum' corresponds to which grade?
According to the sternal instability scale, a 'moderately separated sternum' corresponds to which grade?
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What is the maximum weight, in pounds, that a patient should lift or carry during the first 8 weeks following sternotomy under standard sternal precautions?
What is the maximum weight, in pounds, that a patient should lift or carry during the first 8 weeks following sternotomy under standard sternal precautions?
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Under standard sternal precautions, what is the restriction for bilateral shoulder elevation in the initial 8 weeks following a sternotomy?
Under standard sternal precautions, what is the restriction for bilateral shoulder elevation in the initial 8 weeks following a sternotomy?
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Under standard sternal precautions, which shoulder movement is generally allowed within pain limits?
Under standard sternal precautions, which shoulder movement is generally allowed within pain limits?
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According to the 'Move in the Tube' modified sternal precautions, backward movements of the arms at or above shoulder level should be performed:
According to the 'Move in the Tube' modified sternal precautions, backward movements of the arms at or above shoulder level should be performed:
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Which motion would be acceptable under the 'move in the tube' modified sternal precautions, but restricted under standard sternal precautions?
Which motion would be acceptable under the 'move in the tube' modified sternal precautions, but restricted under standard sternal precautions?
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A patient who requires the therapist to provide a light touch for balance during a transfer is classified as what level of assist?
A patient who requires the therapist to provide a light touch for balance during a transfer is classified as what level of assist?
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A patient is able to complete 80% of a sit-to-stand transfer on their own but requires minor physical help from the therapist to finish the movement. This would be documented as what level of assist?
A patient is able to complete 80% of a sit-to-stand transfer on their own but requires minor physical help from the therapist to finish the movement. This would be documented as what level of assist?
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If a patient performs $50%$ of a transfer and the therapist performs the remaining $50%$, what level of assistance is required?
If a patient performs $50%$ of a transfer and the therapist performs the remaining $50%$, what level of assistance is required?
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Which of the following is NOT a primary use of functional measures?
Which of the following is NOT a primary use of functional measures?
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What is the name of the test that helps determine an individual's aerobic capacity by measuring the distance they can cover in a set amount of time?
What is the name of the test that helps determine an individual's aerobic capacity by measuring the distance they can cover in a set amount of time?
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Which of the following sit-to-stand tests measures how quickly someone is able to stand up from a seated position five times?
Which of the following sit-to-stand tests measures how quickly someone is able to stand up from a seated position five times?
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During the 'Ready, Set, Go!' procedure for a sit to stand test, where should the mark be placed on the wall to measure the starting point?
During the 'Ready, Set, Go!' procedure for a sit to stand test, where should the mark be placed on the wall to measure the starting point?
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According to the provided information, what outcome is associated with the 6-minute walk test?
According to the provided information, what outcome is associated with the 6-minute walk test?
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What is the primary measurement taken during the 2-minute step test?
What is the primary measurement taken during the 2-minute step test?
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According to the provided data, what is the minimum number of steps considered 'average' for a 72-year-old woman in the 2-minute step test?
According to the provided data, what is the minimum number of steps considered 'average' for a 72-year-old woman in the 2-minute step test?
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Which of the following is a noted limitation of the 2-minute step test?
Which of the following is a noted limitation of the 2-minute step test?
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In the context of the provided information, what is the primary purpose of the Functional Assessment (Function) tool mentioned?
In the context of the provided information, what is the primary purpose of the Functional Assessment (Function) tool mentioned?
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Which of the following is NOT assessed by the SF-36 Quality of Life (QOL) assessment?
Which of the following is NOT assessed by the SF-36 Quality of Life (QOL) assessment?
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What is a primary benefit of using the 2-minute step test, as compared to the 6-minute walk test?
What is a primary benefit of using the 2-minute step test, as compared to the 6-minute walk test?
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According to the provided tables, a man between 80 and 84 years old would be considered to have a below average score on the 2-minute step test if he completes less than how many steps?
According to the provided tables, a man between 80 and 84 years old would be considered to have a below average score on the 2-minute step test if he completes less than how many steps?
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What is the primary focus of the Seattle Angina Questionnaire?
What is the primary focus of the Seattle Angina Questionnaire?
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Study Notes
Sternal Precautions
- Avoid pushing, pulling, lifting, or carrying anything heavier than 5-10 pounds for 8 weeks after surgery
- Avoid bilateral shoulder elevation past 90 degrees for 8 weeks; unilateral, unweighted elevation is permitted within pain limits
- Avoid reaching behind back
- Splint coughs
- Avoid driving for 8 weeks
Modified Sternal Precautions ("Move in the Tube")
- An alternative to traditional sternal precautions, being piloted in several institutions
- Patients keep movements within a designated "tube" or green area
- Allowed to move outside the green area for open-chain activities like ADLs
Documentation of Level of Assist
- Independent (I): Patient transfers independently and safely
- Supervision (S): Patient may need environmental set-up and/or supervision, but no hands-on assistance
- Contact Guard Assist (CGA): Therapist applies contact to assist with mobility and balance
- Minimal Assist (Min A): Patient performs 75% of the movement, with clinician providing 25%
- Moderate Assist (Mod A): Patient performs 50% of the movement, with clinician providing 50%
- Maximum Assist (Max A): Patient performs 25% of the movement, with clinician providing 75%
- Dependent (D): Clinician performs the entire transfer
Functional Measures
- Determine functional status
- Assess the impact of medications and/or surgery on function
- Stratify risk for mortality, re-admissions, and falls
- Establish baseline data for home exercise programs
Aerobic Capacity
- Six-Minute Walk Test (6MWT)
- Two-Minute Marching/Step Test (time to move)
- Functional Activities:
- 5 times sit-to-stand
- 30-second sit-to-stand
PT Examination
- Cardiovascular screen (heart auscultation, color/perfusion observation)
- Sternal stability and precautions
- Cardiorespiratory fitness tests
- Education on risk factor reduction
- Referral to cardiac rehabilitation
- Vital sign and cardiorespiratory response to activity monitoring
- ECG/telemetry (ongoing assessment)
Examination Continued: Special Tests CV
- Heart auscultation
- Capillary refill
- Peripheral pulse strength
- Lung auscultation
- Blood pressure (orthostatic hypotension)
- Sternal stability
Examination - Sternal Incision
- Wound Evaluation (color, odor, discharge)
- Sternal Stability
- Risk factors for dehiscence (older age, smoking, diabetes, overweight/obese, malnutrition)
Movement System
- Determine contributing systems (using ICF model)
- Identify activities and participation factors
- Develop an initial clinical hypothesis
- Evaluate specific areas of the movement system
Basic Mobility Inpatient Short Form (“6 clicks”)
- Assesses difficulty in daily tasks for patients (turning in bed, sitting/standing, moving between positions)
- Can measure help needed from another person during these activities
- Standardized assessment instrument for documenting activity level
QOL (SF-36)
- Physical functioning
- Role physical
- Bodily pain
- General health
- Vitality
- Social functioning
- Role emotional
- Mental health
Seattle Angina Questionnaire
- Assesses frequency, intensity, and impact of chest pain, tightness or angina on daily activities
2-Minute Step Test
- Alternative to 6-minute walk test
- Minimal equipment needed (tape measure, timer)
- Limited correlation to VO2, and limited data on reliability and responsiveness
Chart Review: Surgery
- Type of surgery
- Method of surgery
- Vein harvesting site
- Perioperative/operative period for unusual events
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Description
This quiz tests your knowledge on the benefits of MID-CAB surgery compared to traditional bypass surgery, important post-operative details for physical therapists, risk factors for sternal dehiscence, and the roles of various procedures in treating Coronary Artery Disease. Understand the nuances of cardiac care and rehabilitation techniques.
