APK Past Book 3 (Cardio-Pulmo and Physiology) PDF

APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW APK CARDIO-PULMO 1. This blood vessel does not originate from the aortic arch: a. Right common carotid artery b. Left subclavian artery c. Innominate artery d. Left common carotid artery Answer: A 2. Bradycardia is heart beats less than: a. 60 per minute c. 65 per minute b. 80 per minute d. 72 per minute Answer: A BRADYCARDIA= 100 3. The biggest volume that can be expired by a person is called: a. Total lung capacity c. vital capacity b. Tidal volume d. inspiratory capacity Answer: C 4. Given a blood pressure of 130/95, the pulse pressure is: a. 115 mm Hg c. 35 mm Hg b. 95 mg Hg d. 130 mm Hg Answer C (Formula for Pulse pressure) PP= Systolic-Diastolic Average:40 mmHg Other fomulas: Stroke volume : EDV-ESV CARDIAC OUTPUT:SV X HR Mean arterial pressure= DBP + 1/3 (PP) 5. Which part of the upright lung has the greatest perfusion? a. base c. uniform throughout b. middle lobe d. apex Answer: A Due to the pull of the gravity ,the blood goes down to zone 3/base of the lungs 6. Inspiration requires: a. Decrease in intrathoracic volume c. increase in intrathoracic volume b. Increase in extrathoracic volume d. no change in intrathoracic volume 2 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Answer: C During the process of inhalation,the lung volume expands as result of the contraction of the diaphragm and intercostals, thus expanding the thoracic cavity. 7. The external intercostals: a. When present with the internal intercostals, the external intercostals will act in expiration only b. Assist in forced expiration c. Has fibers that are slanted downward and backward d. Does not show any activity during normal, quite breathing e. None of the above Answer: E a. When present with the internal intercostals, the external intercostals will act in expiration only(the statement is consisted with relaxed inspiration) b. Assist in forced expiration(the statement is for internal intercostals) c. Has fibers that are slanted downward and backward(FORWARD) d. Does not show any activity during normal, quite breathing(External intercostals is responsible for quiet breathing) e. None of the above 8. Given a blood pressure of 130/95, the mean arterial pressure is around: a. 102 mm Hg c. 107 mm Hg b. 115 mm Hg d. 110 mm Hg Answer: C 1. SBP + 2(DBP)/3 130+2(95)/3 130 + 190/3= 106.66 OR 2.DBP + 1/3(PP) PP= 130-95= 35 95+ 1/3(35)=106.66 9. If the heart rate is 60 beats per minute and the stroke volume is 90 ml, then cardiac output is: a. 5.4 L c. 6.2 L b. 5.2 L d. 5.6 L Answer: A FORMULA FOR CARDIAC OUTPUT= SV X HR NORMAL: 4-6 L 10. The first heart sound is associated with the closure of: a. Aortic and pulmonic valves c. tricuspid and mitral valves b. Pulmonic and tricuspid valves d. aortic and mitral valves Answer: C 1st sound: CLOSURE: AV-INLET(Tricuspid & mitral) 2ND sound: CLOSURE: SL-OUTLET(Pulmonic & aortic 11. The union of the brachiocephalic vein of both sides form the: a. Superior vena cava c. subclavian vein b. Internal jugular vein d. inferior vena cava Answer: A Brachiocephalic vein- Formed by: Union of subclavian vein & Internal jugular veins. Superior Vena cava Formed by: Union of brachiocephalic veins 3 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 12. Voluntary breathing control resides in the: a. Cerebellar cortex c. cerebral motor cortex b. Medulla d. pons Answer: C MEDULLA and Pons “RESPIRATORY CENTER” CEREBRAL CORTEX “VOLUNTARY” CENTER: 13. The lung volume that is involved in gas exchange with the capillary blood at the end of a normal expiration is: a. Functional residual capacity c. vital capacity b. Tidal volume d. expiratory reserve volume Answer: B PULMONARY VOLUME: TIDAL VOLUME:Volume of air inspired or expired with each normal breath. EXPIRATORY RESERVE VOLUME:Maximum extra volume that can be expired after forceful expiration. PULMONARY CAPACITY: FUNCTIONAL RESIDUAL CAPACITY:Amount of air remains in the lungs at the end normal expiration VITAL CAPACITY:Maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the max extent. 14. Determinant of heart rate: a. Changes in HCO3 c. changes in K b. Changes in CO2 d. changes in Na Answer: C Changes in potassium is considere one of the most important for determinant of heart rate. The predicted maximum heart rate for a 50 year old male is 15. The predicted maximum heart rate for a 50 year old male is: a. 140-160 c. 160-180 b. 120-140 d. 100-120 Answer: C Formula: Mhr= 220-age of the patient 16. Stroke volume is lowest in: a. Muscular activity c. recumbent position b. Erect position d. slow walking Answer: B During the erect position there is a low work load of the heart. 17. The bodies of the fifth to the ninth thoracic vertebral are usually asymmetric because of: a. None of these c. presence of thoracic aorta b. Presence of pericardium and heart d. asymmetric ribs Answer: B Pericardium and heart is at level of T5-T9 18. Will lead to edema formation, EXCEPT: a. Increase in venous pressure c. lymphatic obstruction b. Decrease in permeability of the capillaries d. increase in arteriolar hydrostatic pressure Answer: B OTHER CAUSES OF EDEMA: ï DECREASED PLASMA PROTEINS ï INCREASED CAPILLIARY PRESSURE ï INCREASED CAPILLIARY PERMIABILITY 4 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW ï BLOCKAGE OF LYMPH RETURN 19. Hyperventilation in the absence of increased CO2 production results in: a. Hypoxemia c. acidosis b. Alkalosis d. hypercapnea Answer: B ACIDOSIS:Increased CO2 ALKALOSIS:Increased O2 or decreased CO2 20. Inspiratory reserve volume plus tidal volume plus expiratory reserve volume: a. Vital capacity c. Inspiratory capacity b. Total lung capacity d. Functional residual capacity Answer: A 21. The following statements are true of the right atrium, EXCEPT: a. It receives the venous blood returning from all parts of the body except the lungs b. The superior vena cava enters it vertically from above c. The inferior vena cava enters it vertically from below d. It receives blood from the lungs via the pulmonary veins Answer: D Right atrium receives blood from the Superior vena cava and inferior vena cava. 22. Pulmonary edema may be caused by: a. None of these c. Damage to the pulmonary capillary membrane due to infections b. Both of these d, Mitral valve disease or left heart failure Answer: B All of the statement is considered primary caused for pulmonary edema 23. Expiration in normal quiet breathing is due to: a. Recoil of the chest wall lung system c. Contraction of the internal intercostals b. Downward movement of the diaphragm d. None of these Answer: A Relaxed Inspiration: Diaphragm External intercostals Force Inspiration: SCM Upper trapz Pecs major and minor Anterior,middle and posterior scalene Serratus anterior &posterior(superior fibers) 5 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Relaxed expiration (+)Elastic/passive recoil of the lungs ForcedExpiration expiration Abdominals Serratus posterior Internal intercostals 24. Following statements apply to venous pump, EXCEPT: a. Tightening of the muscles result to vein compression, squeezing the blood out of the veins b. Efficient enough to maintain less than 25 mmHg venous pressure in the feet of a walking adult c. If the subject stands motionless, venous pump does not work, and could increase lower extremity venous pressure to 90 mm Hg in about 30 seconds. d. Valves in veins allow bi-directional flow to and from the heart Answer: D Valve in veins allow uni-directional(one way)flow to and from the heart. To avoid the back flow of the blood. 25. The following statements are true of the lungs, EXCEPT: a. The right lung is longer and less voluminous b. The wall of each alveolar duct and air sac is made up of a number of ultimate unit known as alveoli c. The left lung resembles, in general appearance the right except that it possesses no horizontal fissure, and therefore no middle lose d. The lungs are supplied with branches of the sympathetic nervous system and of the vagus which is parasympathetic Answer: A 26. Air volume remaining in the lungs after maximum expiratory effort: a. Vital capacity c. Functional residual capacity b. Residual volume d. Expiratory reserve volume Answer: B VC=Amount of air that can be maximally expired after a maximal inspiration. RV=Amount of air left/remained inside the lungs after MAX expiration FRC=Amount of air left/remained inside the lungs after NORMAL expiration ERV=Amount of air that can still be expired after normal expiration 27. Way by which lung can be expanded: a. Diaphragmatic up and down motion which lengthens or shortens chest cavity b. All of these c. None of these d. Increase in anteroposterior diameter of the chest cavity by elevating and depressing the ribs Answer: B All statements are responsible for the expansion of the lungs. 28. The pulmonary artery leaves the heart via: a. Right Ventricle c. Right Ventricle b. Left Auricle d. Left ventricle Answer: A 6 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 29. Which of the following determines fluid movement through the capillary membrane? a. Interstitial fluid pressure c. Capillary pressure b. Plasma colloid osmotic pressure d. All of these Answer: D All of the statements are correct. Hydrostatic pressure is also considered as determinants for the fluid movement. 30. The pressure at the height of each pulse, which is about 120 mm Hg in young adults: a. Stroke volume output c. Pulse pressure b. Diastolic pressure d. Systolic pressure Answer: D Systolic pressure is considered as the highest arterial pressure Ave:120mmHg 31. The statements apply to inspiratory capacity, EXCEPT: a. Equals residual volume plus the inspiratory reserve volume b. Amount of air one can breath at normal expiratory level and distending the lungs to the maximum c. Equals tidal volume plus the inspiratory reserve level d. Amount of air is about 3500 ml Answer: A 32. Amount of air remaining in the lungs at the end of normal expiration: a. Vital capacity c. Inspiratory capacity b. Functional residual capacity d. Total lung capacity Answer: B VC=Amount of air that can be maximally expired after a maximal inspiration. RV=Amount of air left/remained inside the lungs after MAX expiration FRC=Amount of air left/remained inside the lungs after NORMAL expiration ERV=Amount of air that can still be expired after normal expiration 33. The sinu-atrial node, which regulates the strength and rate of the heart beat is located in the wall of: a. Right Auricle c. Right Ventricle b. Left Ventricle d. Left Auricle Answer: A Right auricle is also known as Right atrium. 34. The extra volume of air that can be inspired over and beyond the normal tidal volume: a. None of these c. Inspiratory reserve volume b. Expiratory reserve volume d. Residual volume Answer: C Amount of air that can still be inspired in after a normal inspiration 35. The aorta is the great artery leaving this chamber of the heart: a. Left Auricle c. Left Ventricle b. Right Auricle d. Right Ventricle Answer: C 7 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 36. On of the following true of coronary circulation: a. A rapidly boating heart prolongs diastole and promotes filing of the coronary arteries b. Studies show that smoking has nothing to do with the coronary arteries c. A low cardiac output may give rise to angina pectoris as when the aortic valve does not close properly d. It physiologic importance lies in the fact that the total anaerobic conditions are adequate in sustaining ventricular contraction Answer: C Cardiac output: Cardiac output is the term that describes the amount of blood your heart pumps each minute. Angina pectoris is the result of myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand. 37. Functions of veins include: a. Stores large quantities of blood and making it available when required b. Propels blood through venous pump c. All of these d. Regulate cardiac output Answer: C Low cardiac output means low blood supply to the heart- leads to angina pectoris 38. In the central part of the mediastinal part of the medial surface is large area where bronchi and pulmonary vessels plunge into the lung. Name this part: a. Hilus c. Mediastinum b. Apex d. Root Answer: A Complicated anatomical structures containing the pulmonary vessels and the major bronchi, arranged asymmetrically. 39. This is the largest blood vessel in the body and runs up the right sides of the lumbar vertebral bodies and behind the peritoneum of the posterior abdominal wall. It enters the right atrium at the lower right corner of the heart: a. Great Saphenous Vein c. Superior Vena Cava b. Inferior Vena Cava d. Femoral Vein Answer: B Receives blood from the lower half of the body. 40. The following statements apply to the auscultatory method for measuring systolic and diastolic pressure, EXCEPT: a. The auscultatory method is very accurate, values are within 11 percent compared to direct arterial measurements b. When the Korotkoff sounds become muffled, the pressure on the manometer is approximately equal to the diastolic pressure. c. Tapping sounds are heard after cuff pressure falls below systolic pressure in the antecubital artery synchronizing with the heartbeat. d. Korotkoff sound is heard with each pulsation cycle as the cuff pressure closes the artery during the arterial pressure cycle. Answer: A Direct arterial measurement is more accurate compaed to auscultatory method. Korotkoff sound “tapping" sounds heard with a stethoscope as the cuff is gradually deflated. 8 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 41. The most serious cardiac arrhythmia resulting from cardiac impulses re-exciting the same ventricular muscles over and over: a. Premature ventricular contractions c. Stokes-Adams syndrome b. Ventricular Paroxysmal tachycardia d. Ventricular fibrillation Answer: D Ventricular fibrillation: Can be fatal(if not stopped with 1-3mins) One portion of ventricles contracts another portion contracts despite of the continuous contraction of the ventricles there is no pumping of blood happening during the contraction of the heart. After ventricular fibrillation,patient may become unconscious due to lack of blood supply n the brain. 42. The following statements characterize vibration syndrome, EXCEPT: a. Common symptoms include intermittent numbness and tingling in the fingers b. Exposure to cold will not trigger vasospasm in the fingers c. There is recurrent episode of finger blanching due to complete closure of digital arteries d. Condition is caused in part by forceful gripping prolonged use of vibrating tools e. Also referred to as white finger or Reynaud’s phenomenon Answer: B Exposure to cold will trigger vasospasm in the fingers. Symptoms of vibration syndrome: Tingling sensation Permanent numbness(severe) 43. The following statements apply to alveolar dead space, EXCEPT: a. All of these b. A condition that occurs when blood flow is blocked by a pulmonary embolus c. Selected alveoli are replaced with scar tissue, decreasing ventilation to areas with normal perfusion d. A result of vascular abnormalities e. The volume of gas in alveoli that is ventilated but poorly perfused or underperfused. Answer: C Selected alveoli are replaced with scar tissue, decreasing ventilation to areas with ABNORMAL PERFUSION 44. The following describe the 6-minute walk test (6MW), EXCEPT: a. The patient is encourage to cover as much as possible le over a flat, measure coursed in 6 minutes b. Used to assess exercise tolerance in patients with pulmonary disease c. Supplemental oxygen is administered as needed to maintain oxygen saturation above a prescribed level (usually 88%-90%) d. The patient is allowed to stop and rest as needed, but the clock is not stopped e. It is essential not to repeat the 6MW and report the better effort Answer: E The test can be performee twice with 30 mins break. 45. The following statements apply to Percussion and Vibration, EXCEPT: a. Recommended for patients with impaired cognition or poor coughing ability b. Recommended for the patient who is intubated and mechanically ventilated c. Used to enhance mucociliary clearance from both central and peripheral airways d. The exact mechanism of action of chest percussion is unknown, but there is some evidence that physical stimulation alters airflow and is associated with the release of pulmonary chemical mediators e. Alterations in airway diameter and airflow may increase the viscosity of mucus, making percussion more effective in mobilizing secretions that are adherent to the bronchial walls Answer: E The Alteration in airway diameter and airflow may DECREASE the viscosity of mucus. 46. Arterial blood pressure increases with: a. Decreased angiotensin b. Increased bradykinin c. Decreased Aldosterone d. Increased carbon dioxide Answer: D 9 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Option A-C will result in decrease arterial blood pressure. 47. Cardiopulmonary manifestation of spinal cord injury include the following, EXCEPT: a. Dysrhythmias can be precipitated by hypoxemia in the absence of primary heart disease b. Normal position-included changed in respiratory functional can be accentuated with changes in body position c. Hemodynamically unstable initially due to the effects of spinal shock and hypotension d. Inspiratory and expiratory capacities are decreased e. Residual volume and ventilation of the lung bases are diminished Answer: E Residual volume and ventilation of the lung bases are not diminished Spinal cord injury Most common respiratory problem n SCI patient is ATELECTASIS ATELECTASIS Decreased IRV,VC AND TLC. 48. In cardiac transplantation, postoperative cardiovascular physiology is dramatically affected by the following, EXCEPT: a. None of these d. Denervation b. Immunosuppression e. Rejection c. Donor-recipient size mismatch Answer: A Immunosupression Patient who underwent cardiac transplantion needs to take steroids to avoid rejection Steroids-Immunosuppressive drug. Denervation The heart is not responding to parasympathetic--- The heart will remain vasoconstriction (+)Increase HR(90-100) Rejection Cellular rejection:When T-cells(responsible for immune system) attacks the cells of the new heart. 49. The major modifiable risk factors for the development and progression of coronary artery disease include the following, EXCEPT: a. Habitual smoking b. Hypertension c. Physical activity d. Habitual smoking e. Hypercholesterolemia Answer: C Physical activity is not considered as modifiable risk factor for CAD 50. In a normal electrocardiogram, this wave is caused by potentials generated as the ventricles depolarize: a. T wave c. Q wave b. QRS complex d. P wave Answer: B QRS COMPLEX:Ventricular depo T Ventricular repolarization P atrial depolarization 51. If the cardiac output is 7.2 L/min and the heart rate is 80 bpm, then the stroke volume is: a. 70 ml d. 80 ml b. 100 ml e. 60 ml c. 90 ml Answer: C 52. A cardiac cycle is from the beginning of one heartbeat to the beginning of the next. Each cycle is initiated by: 10 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW a. Atrioventricular node b. Purkinje fibers c. Sinoatrial node d. Atrioventricular bundle Answer: C SA is the primary pacemaker of the heart. 2 CONTROLLING SYSTEM ï AUTONOMIC NERVOUS SYSTEM: SYMPATHETIC & PARASYMPATHETIC ï CONDUCTING SYSTEMT SINO ATRIAL NODE->AV NODE->BUNDLE OF HIS ->PURKINJE FIBERS 53. Decreases vascular resistance by decreasing catecholamine mediated vasoconstriction of peripheral vasculature: a. Alpha-adrenergic blockers b. Diuretics c. Angiotensin- converting (ACE) enzyme inhibitors d. Calcium channel blockers e. Beta-adrenergic blockers Answer: A Calcium channel blockers: Decreases vascular resistance by inhibiting calcium mediated contraction of vascular smooth muscle. Alpha adrenergic blockers: Decreases vascular resistance by decreasing catecholamine mediated vasoconstriction of peripheral vasculature. 54. Atrial depolarization is represented in the ECG as the: a. ST interval d. QRS complex b. P wave e. T wave c. PR interval Answer: B QRS COMPLEX:Ventricular depo T Ventricular repolarization P atrial depolarization 55. When the patient is able to make two breaths in order to complete counting aloud to 15, the Ventilatory Index Scale is: a. 0 d. 4 b. 1 e. 3 c. 2 Answer: C 56. Normal cardiac rhythm is: a. 40-70 bpm d. 60-90 bpm b. 30-60 bpm e. 100-130 bpm c. 120-150 bpm Answer: D The normal HR 60-90bpm. 57. Cardiac dysfunction results in the following, EXCEPT: a. Excessive fatigue b. Chest pain c. Changes in electrocardiographic activity or heart sounds d. Dyspnea e. decreased or absent peripheral pulses 11 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Answer: E Peripheral pulses are not directly affected n patients with cardiac dysfunction. 58. During isovolumentric contraction phase: a. The aortic and tricuspid valves are closed b. The aortic valve is open while the pulmonic valve is closed c. The mitral valve is open but the tricuspid valve is closed d. The mitral valve is open while the aortic valve is closed e. The mitral and aortic valves are closed Answer: E CARDIAC CYCLE: 1. Period of rapid filling 2. Period of isovolumetric contraction 3. Period of ejection 4. Period of relaxation 59. The following steps describe increased cardiopulmonary activity in response to various levels of physical activity, EXCEPT: a. During exercise, CO is increase because of increase in both stroke volume and heart rate, with stroke volume reaching its maximal level at approximately 40% of maximal oxygen consumption. b. When ventilation occurs, the muscles contract creating a negative pressure within the thorax allowing air to move inward from the mouth to various lung parts. c. Because of regional differences in the distribution of both ventilation and perfusion, the possibility exists to have areas of the lungs that are well ventilated but underperfused, but not vice versa. d. In myocardial ischemia, the ability to adequately fill the left ventricle may be impaired and patients may experience dyspnea or signs and symptoms of decreased CO. e. At rest, the primary muscles of respiration are the diaphragm, scalene and parasternal intercostals. Answer: C Perfusion: Perfusion refers to the blood flow to tissues and organs Ventilation: It is the process of air flowing into the lungs during inspiration (inhalation) and out of the lungs during expiration (exhalation). Air flows because of pressure differences between the atmosphere and the gases inside the lungs because of regional differences in the distribution of both ventilation and perfusion, the possibility exists to have areas of the lungs that are well ventilated and WITH GOOD PERFUSION, but not vice versa. 60. The following statements are true of the heart, EXCEPT: a. It lies behind the body of the sternum and in front of the middle four thoracic vertebrae (T5, T6, T7 and T8). b. During development, the heart undergoes rotation so that its right side is carried backwards and its left side forwards c. It is about the size of a clenched fist and occupies a central position in the thoracic cavity d. The right ventricle occupies most of the anterior surfaces and forms all but the extremities of the inferior border Answer: B During development, the heart undergoes rotation so that its right side is carried FORWARDS and its left side BACKWARDS. Patient should wear the compression stockings during day and take them off before going to bed. 61. Thrombus formation in the legs, particularly in patients following surgery may be prevented in the following manner, EXCEPT: a. Gentle mobilization and modified exercises after thrombi have resolved b. Increase movement and activity to negate sequelae of restricted mobility and recumbency on oxygen transport c. Specially designed stockings in conjunction with pneumatic compression devices to stimulate the normal action of the muscle pump in the leg d. Stockings that are applied with uniform pressure along the leg, and removed frequently for 10 minute periods and reapplied. e. Compression stockings to prevent peripheral blood pooling and augment venous return Answer: B Therapists need to consider the relative risk of movement and activity with respect to increasing bleeding versus the negative sequelae of restricted mobility and recumbency on oxygen transport. 12 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 62. The product of heart rate and stroke volume: a. Cardiac output (in liters per minute) b. Ventilation c. breathing d. tidal volume e. metabolic rate Answer: A Formula for CO= SV X HR 63. The following statements are true of breathing exercises, EXCEPT: a. Indicated during mechanical ventilation b. Indicated in the ICU setting for patients with neuromuscular disease c. Benefit includes increased tidal volume, improved thoracic cage mobility and increased inspiratory capacity d. Used when thoracic excursion is decreased as a result of retained secretions or pain e. May be used during weaning from mechanical ventilation Answer: A Not indicated during mechanical ventilation CHEST PHYSICAL THERAPY Postural drainage -Percussion -Vibration -Breathing exercise -Cough stimulation -Airway suctioning 64. The following are effects of cardiac transplantation on cardiovascular and pulmonary variables, EXCEPT: a. The peak heart rate achieved during maximal exercise is markedly lower in cardiac transplant patients than in age-matched subjects thereby limiting the usefulness of exercise prescriptions based on target heart rate b. Peak systolic blood pressure of cardiac transplant recipient is less than that of individuals without, but diastolic blood pressure is not much different c. Resting stroke volume of patients following cardiac transplantation is less than that of individuals without, but diastolic blood pressure is not much different d. At rest, cardiac recipients exhibit lower heart rates than do individuals without cardiac transplants due to the loss of vagal tone associated with the surgical procedure e. Oxygen consumption at anaerobic threshold is markedly lower than that of individuals without cardiac transplants, partially due to skeletal muscle weakness Answer: D Vagal stimulation will result in decreased HR. Patient who loss vagal tone will manifest increased HR 65. The following are true of the types of breathing exercises, EXCEPT: a. Use of a flutter valve, the forced-expiration technique and autogenic drainage are beneficial in patients with cystic fibrosis, although efficacy has not been determined. b. Following coronary artery bypass of gall-bladder surgery, breathing exercises offer no advantage over early patient mobilization c. Incentive spirometry is no more advantageous or cost-effective than instruction in deep breathing and coughing d. Diaphragmatic breathing and lateral costal and segmental costal and segmental costal expansion exercises are used most often post-operatively e. Inspiratory muscle training and resistive diaphragmatic breathing exercises are not beneficial in weaning the patient with chronic obstructive pulmonary disease 13 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Answer: E Inspiratory muscle training and resistive diaphragmatic breathing exercises are BENEFICIAL in weaning the patient with chronic obstructive pulmonary disease. 66. Stroke volume is expected to increase if: a. After load increases b. Myocardial contractility decreases c. Myocardial elasticity decreases d. pre-load increases e. none of these Answer: D SV Is directly proportional to preload FRANK STARLING LAW Represents the relationship between stroke volume and EDV. Law states that the SV of heart increases in response to an increase in volume of blood in the ventricles before ctxn. (EDV) “PRELOAD” “EDV” (INITIAL STRETCH OF HEART 67. If the blood pressure reading is 150/90 the mean blood pressure is: a. 100 mm Hg d. 110 mm Hg b. 135 mm Hg e. 115 mm Hg c. 120 mm Hg Answer: D MAP=DBP +1/3(pp) PP=SBP- DBP PP= 150- 90=60 MAP=90 + 1/3(60) MAP= 90+20= 110 OR MAP 1(SBP) +2 (DBP)/3 MAP=150 + 2(90)/3 MAP=150 +180/3 MAP=110 68. Main determinant of cardiac output: a. Left ventricle and diastolic pressure b. Blood present in the aorta c. Efficiency of systolic contraction d. Venous pressure Answer: C Cardiac output is determined by heart and stroke volume. This means that the force from systolic contraction should be efficient to pump our blood to systemic circulation 69. The following statements characterize percussion in chest PT, EXCEPT: a. For patients with rib and sterna fracture, controlled mechanical ventilation may even stabilize the fracture site by minimizing negative intrathoracic pressure b. Used during both the inspiratory and expiratory phases or respiration c. Pneumathorax and hemothorax that develop as a result of the initial injury is considered a contraindicated to percussion d. Not indicated for the spontaneously breathing with rib fractures who is responding to breathing exercises and assistive coughing techniques e. Fast percussion (240 cycles/min) demonstrated the greatest sputum production, although slow percussion (6-12 cycles/min) was more effective than no percussion f. None of the above 14 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Answer: C Extrapleural pathology, pneumothorax, and hemothorax that develop as a result of the initial injury should not be considered a contraindication to percussion. Reference: Ciesla, N. D. (1996). Chest physical therapy for patients in the intensive care unit. Physical Therapy, 76(6), 609-625. 70. Postoperative complications in cardiac transplantation include the following, EXCEPT: a. Weight loss b. Transplant Vasculopathy c. Cyclosporine related hypertension d. Rejection e. Infection Answer: A Weight gain is more common complication in cardiac transplantation. 71. The following are causes of cardiac muscle dysfunction, EXCEPT: a. Pulmonary embolus d. Spinal cord injury b. Hypotension e. Cardiomyopathy c. Renal insufficiency Answer: B *Renal insufficiency Renal system :Contains the renin ezymes which controls the blood pressure *Spinal cord injury SCI patients are common to have cardiac dysrhythmias *Cardiomyopathya disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Cardiomyopathy can lead to heart failure. 72. The sinu-atrial node is the normal pacemaker in the human heart because: a. It has the highest intrinsic rate of automaticity b. It receives both sympathetic and parasympathetic innervations c. It is far from the ventricles d. It is located near the entry to the right atrium e. It is located near the entry to the right ventricle Answer: A Sinu atrial node Self-excited Controls the HR of the entire heart 73. Venous return to the heart may be aided by the following, EXCEPT: a. Tight elastic stockings c. A sedentary job b. Massage d. Venous valves Answer: C Sedentary job will not assist venous return. 74. Administration of any of the following may be expected to result in elevation of mean blood pressure, EXCEPT: a. Bradykinin d. Angiotensin b. All of these e. Vasopressin (ADH) c. Norepinephrine Answer: A Bradykinin Vasodilator Mild diuretics 75. Main venous drainage of the neck: a. Maxillary vein c. Internal jugular vein b. Anterior jugular vein d. Retromandibular vein Answer: C Internal Jugular Vein: Collects blood from the brain & superior parts of the face and neck. 76. In the venous system: a. Blood vessels have smaller diameters than their corresponding arteries b. Mean pressures are higher than in the arterial system 15 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW c. Blood vessels have greater compliance d. All of these are true e. None of these are true Answer: C Although the veins have thinner walls (particularly tunica media) than the arteries, they have larger diameters in order to carry a higher blood volume. Because the veins have thinner tunica media than the arteries, their mean pressures are lower than those of the arteries. Reference: Guyton, p. 169 77. Mean arterial pressure is expected to increase if: a. None of these b. Stroke volume increases c. Calcium-channel blockers are administered d. Cardiac output decreases e. There is generalized vasodilatation Answer: B INCRASED MAP, INCREASED CO, AND INCREASED SV. 78. Which of the following statements is true of individuals without cardiopulmonary abnormalities? a. The increases in ventilation (VE) and CO are inversely proportional to the increase in metabolic rate, allowing venous blood gas and pH levels to remain close to baseline values during exercise b. The decrease in ventilation (VE) and CO are closely matched to the decrease in metabolic rate allowing venous blood gas and pH levels to remain close to baseline values during exercise c. The decrease in ventilation (VE) and CO are closely matched to the increase in metabolic rate, allowing venous blood gas and pH levels to remain close to baseline values during exercise d. The increases in ventilation (VE), and CO are closely matched to the increase in metabolic rate, allowing arterial blood gas and pH levels to remain close to baseline values during exercise Answer: D During exercise, skeletal muscle activity results in an increase in cellullar 02, requirements and ill the amount of CO2, that must be carried to the lungs for removal from the body. To meet the increased 02 needs, both ventilation (VE) and cardiac output (CO) must increase in propor-tion to the increased metabolic rate. \'entilation (in liters per minute) is the product of breathing frequency and tidal volume (VT). Cardiac output (in liters per minute) is the product of heart rate (HR) and stroke volume (SV). In individuals with cardiopulmonary abnormalities, the increases in (VE) and CO are closely matched to the increase in metabolic rate, allowing arterial blood gas and pH levels to remain close to baseline values during exercise.The precision of thesystem is demonstrated by all appropriate increase in both (VE) and CO as the exercise intensity level ranges from light to very heavy. 79. Signs of cardiac dysfunction include the following, EXCEPT: a. A heart rate that is either excessively high of exceptionally low during exercise b. An increase in diastolic blood pressure during exercise that is greater than 15 to 20 mm Hg c. Electrocardiographic changes such as dysrythmias or ST-segment depression d. A diastolic blood pressure that does not rise progressively as work level increases e. A systolic blood pressure that falls during exercise Answer: D In patients with cardiac dysfunction diastolic blood pressure RISE progressively as work level increases. 80. Mean arterial pressure is expected to increase if a. Stroke volume increases d. cardiac output decreases b. There is maintained exertion e. there is generalized vasodilatation c. Calcium channel blockers are administered Answer: A Increased MAP - increased SV. 81. Decreases vascular resistance by inhibiting calcium mediated contraction of vascular smooth muscle: a. Calcium channel blockers d. Calcium channel blockers b. Beta adrenergic blockers e. Angiotensin-converting (ACE) enzyme inhibitors c. Diuretics Answer: A 16 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Reference: Ciccone, C. D. (1996). Current trends in cardiovascular pharmacology. Physical therapy, 76(5), 481-497. 82. The aorta leaves this chamber of the heart. a. Right ventricle d. Left ventricle b. It bypasses the heart e. Left auricle c. Right auricle Answer: D 83. In the revised category-ratio rating of perceived exertion (RPE), a rating of 7 is described as a. Very strong d. Weak b. Very, very strong e. Moderate c. Somewhat strong Answer: A 0 Nothing at all.5 Very, very weak 1 very weak 2 weak 3 moderate 4 somewhat strong 5 strong 7 very strong 10 very very strong 84. Normal spread of excitation in the heart is: a. SAN → AVN → Bundle of his → Purkinje Fibers → Ventricles b. AVN → Bundle of His → Atrium → Purkinje Fibers → Ventricles c. SAN → AVN → Purkinje Fibers → Bundle of His → Ventricles d. SAN → Bundle of His → AVN → Purkinje Fibers → Ventricles e. AVN → SAN → Purkinje Fibers → Ventricles → Atria Answer: A CONDUCTING SYSTEM: SAN → AVN → Bundle of his → Purkinje Fibers → Ventricles 17 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 85. Supplying the lower limb, this artery enters the thigh in the midline in front then descends vertically. a. Tibial Artery d. Sciatic Artery b. Left Femoral Circumflex Artery e. Popliteal Artery c. Femoral Artery Answer: C Anterior Tibial artery-Supplies the anterior leg compartment Posterior Tibial artery-supplies the posterior leg Left femoral circumflex artery-supplies the femoral head Popliteal Artery-Supplies also the leg 86. Immediate postoperative care following cardiac transplantation include the following EXCEPT: a. Oral diet is begun as soon as patient can tolerate it b. Most patients are weaned from mechanical ventilator assistance within 24 to 36 hours c. Typically, heart rate is maintained at about 80 beats per minute for the first 72 hours and then tapered off d. First endomyocardial biopsy is performed 7 to 10 days after transplantation e. Endotracheal and orogastric tubes are removed within 24 to 36 hours Answer: C Typically, heart rate is maintained at about 110 beats per minute for the first 72 hours and then tapered off. 87. The following statements apply to myocardial ischemia and infarction, EXCEPT: a. Characteristic symptoms of pain associated with angina pectoris is caused by an imbalance between myocardial oxygen supply and demand b. Resolving thrombus formation in the coronary arteries cannot control factors leading to coronary occlusion c. Caused primarily by coronary artery atherosclerosis that decreases the ability of the coronary arteries to supply adequate oxygen to meet the demands of the myocardium d. Progressive atherosclerosis also leads to the development of coronary artery thrombosis resulting in vessel before occlusion and MI e. Drugs are often used to treat the symptoms of ischemic heart disease and restore myocardial oxygen balance before additional damage occurs to the heart Answer: B Resolving thrombus formation in the coronary arteries can control factors leading to coronary occlusion. 88. The product of breathing frequency and tidal volume (Vt): a. Ventilation (in liters per minute) d. heart rate b. Stroke volume e. cardiac output c. Metabolic rate Answer: A Ventilation:Breathing x tidal volume Stroke volume: (EDV-ESV) Cardiac output:SV X HR 89. According to the original Borg scale for rating of Perceived on a rating of 15 is described as: a. Hard d. Fairly light b. Very, Very hard e. light c. Very, Very light Answer: A 18 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 90. Decreases catecholamine stimulation of the heart; may also cause a general decrease in systemic sympathetic activity: a. Calcium channel blockers d. Angiotensin-converting (ACE) enzyme inhibitors b. Diuretics e. Alpha-adrenergic blockers c. Beta-adrenergic blockers Answer: C Reference: Ciccone, C. D. (1996). Current trends in cardiovascular pharmacology. Physical therapy, 76(5), 481-497. 91. When one shifts to an upright from supine position: a. The lungs receive a greater portion of the cardiac output b. More blood shifts to the venous portion of the circulation c. The heart receives a lesser portion of the cardiac throughout d. The heart receives a greater portion of the cardiac output e. More blood shifts to the arterial portion of the circulation Answer: B When the person suddenly stands upright, gravity acts on the vascular volume causing blood to accumulate in the lower extremities. (Compare the size of veins in the top of your feet while lying down and standing.) Because venous compliance is high and the veins readily expand with blood, most of the blood volume shift occurs in the veins. Therefore, venous volume (Vol) and pressure (VP) become very high in the feet and lower limbs when standing. This shift in blood volume decreases thoracic venous blood volume (CV Vol) and therefore central venous pressure (CVP) decreases. 92. In the normal upright adult lung, blood flow is greatest at this part of the lung: b. Both at the base and apex d. equally distributed throughout c. At the base e. near the middle d. At the apex 19 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Answer: B Greatest perfusion/blood flow is at the base due to the pull of gravity. 93. This artery enters the thigh in the midline in front, descends vertically and supplies the lower limb: a. Left femoral circumflex artery c. Femoral artery b. Tibial artery d. Popliteal artery Answer: C The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the femoral triangle 94. Acute postoperative rehabilitation of lung transplant cases include the following, EXCEPT: a. ROM exercises progressing to transfer out of bed b. Adequate pain control, optimal positioning, and modification in coughing techniques c. Huff coughing with closure of the glottis d. Postural drainage with shaking or vibration provided the patient is stable e. Body positioning and mobilization Answer: C During coughing OPENING of the glottis will promote less pain and easier to move the mucus out of the lungs. 95. The following statements describe congestive heart failure, EXCEPT: a. Some type of injury to the myocardium of ten initiates a progressive decline in myocardial function b. Characterized by decrease in cardiac pumping ability that leads to inadequate tissue perfusion and accumulation of fluid in the lungs and other organs c. Prognosis for patients with heart failure is often poor, with 5 year mortality rates d. Compensatory neurohumoral mechanism changes may actually exacerbate myocardial dysfunction by increasing cardiac work load e. Decreased sympathetic nervous system activation and increased activation of the rennin angiotensin system occurs as the heart fails Answer: E INCREASED SYMPATHETIC NERVOUS SYSTEM ACTIVATION and increased activation of the renin angiotensin system occurs as the heart fails Reference: Ciccone, C. D. (1996). Current trends in cardiovascular pharmacology. Physical therapy, 76(5), 481-497. 96. Inhibits synthesis of angiotensin II in the bloodstream and various tissues, and decreases angiotensin II mediated vasoconstriction and vascular structural changes: a. Alpha-adrenergic blockers d. Calcium channel blockers b. Angiotensin-converting (ACE) enzyme inhibitors e. Beta-adrenergic blockers c. Diuretics Answer: B Angiotensin-converting enzyme (ACE) inhibitors help relax your veins and arteries to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder. Angiotensin II also releases hormones that raise your blood pressure. 97. In the neuropathic extremity, a poor indicator of inflammation is: a. Edema or loss of function b. Heat and redness 20 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW c. Pain and disturbance of function d. Redness and edema e. Edema or pain Answer: C The four cardinal signs of inflammation are : redness (Latin rubor) heat (calor), swelling (tumor) pain (dolor) 98. The pulmonary artery leaves the heart via a. Left aoristic d. Right ventricle b. It enters the heart e. right auricle c. Left ventricle Answer: D 99. Which of the following statement describe the heart? I. During development, the heart undergoes rotation so that its right side is carried backwards and its left side forwards. II. It is about the size of a clenched fist and occupies central position in the thoracic cavity. III. It lies behind the body of the sternum and in front of the middle four thoracic vertebra (T. 5,6,7 and 8) IV. The left ventricle forms the posterior surface and occupies most of the superior border. V. The right ventricle occupies most of the anterior surface and forms all but the extremities of the inferior border. a. II and V only d. II, III and V b. I, II and IV e. II, III and IV c. I and IV only Answer: D STATEMENT I : During development, the heart undergoes rotation so that its LEFT side is carried backwards and its RIGHT side forwards. STATEMENT IV: The left ATRIUM forms the posterior surface and occupies most of the superior border 100. A therapist observes a patient in the rehab waiting room that appears to be experiencing a heart attack. The most Significant sign of a heart attack is a. Dizziness d. chest pain b. Sweating e. shortness of breath c. Nausea Answer: D LEVINE SIGN 101. This structure is in the central part of the mediastinal part of the medial surface and is a large area where bronchi and pulmonary vessels plunge into the lung. a. Root d. Mediastinum b. Upper Sternal Angle e. Hilus c. Apex Answer: E Complicated anatomical structures containing the pulmonary vessels and the major bronchi, arranged 21 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW asymmetrically. 102. The following statements characterized postural drainage, EXCEPT: a. Refers to placing the body in a position that allows gravity to assist drainage of mucus from the lung periphery to the segmental bronchus and upper airway. b. The duration of postural drainage may range from 15 to 20 minutes, depending on the patient’s tolerance to changes in position and the amount of sputum production c. Cooperative, spontaneously breathing patients who can cough effectively may not need postural drainage d. Fourteen positions are commonly used to drain 14 lung segments Answer: D ELEVEN POSITIONS are commonly used to drain 14 LUNG SEGMENTS. Reference: Ciesla, N. D. (1996). Chest physical therapy for patients in the intensive care unit. Physical Therapy, 76(6), 609-625. 103. A therapist attempts to clear a patient’s secretions after performing postural drainage techniques. What position would allow the patient to produce the most forceful cough? a. Supine d. upright sitting b. Prone e. side lying c. Half sitting Answer: D Side lying. 104. During phase O of the cardiac action potential, there is rapid influx of these ions: a. Sodium b. Oxygen c. Hydrogen d. Potassium e. Calcium Answer: A CARDIAC ACTION POTENTIAL Phase 22 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 0(DEPOLARIZATION) INWARD:CA PHASE 1(INITIAL REPO) DECREASE INFLUX NA OUTWARD CURRENT OF K PHASE 2 PLATEU INWARD: Ca PHASE 3: DEC INFLUX OF Ca OUTWARD CURRENT OF K PHASE 4 RESTING MEMBRANE POTENTIAL 105. For a stroke volume of 70 ml and a heart rate of 70 beats per minute, the cardiac output is equal to a. 2, 450 ml d. 4,700 ml b. 140 ml e. 1,225 ml c. 1,633 ml Answer: D CO= SV X HR 106. Decreases fluid volume in the vascular system by increasing fluid and electrolyte excretion: a. Calcium channel blockers d. Beta-adrenergic blockers b. Alpha-adrenergic blockers e. Angiotensin-converting (ACE) enzyme inhibitors c. Diuretics Answer: C Diuretics ,sometimes called water pills, help rid your body of salt (sodium) and water. Most of them help your kidneys release more sodium into your urine. 107. Compared to the actions potential in ventricular muscle, the action potential of the Sinu-atrial Node shows I. No plateau III. A high velocity down stroke V. the T wave II. A slow velocity of upstroke IV. Rapid influx of sodium ions a. III and V d. I and III b. II and III e. I and II c. IV and V Answer: E The Action Potential in SA node is different from the Action Potential of the Cardiac Muscle.If you’ll compare the graphs, they’re totally different. The cardiac action potential exhibits 5 phases: Phase 0, 1, 2, 3 and 4. Whereas, SA Node Action Potential only has 3 phases. Phase 4, 0 and 3.The difference between two graphs is very apparent. In Cardiac Action Potential (right figure), we have 5 phases. Phase 4 is RMP. Phase 0 is Rapid upstroke/ rapid depolarization due to Sodium influx. Phase 1 is Initial repolarization due to potassium efflux. Phase 2 is Plateau due to Calcium influx. Plateau happens because nagcocounteract ang electrochemical gradient created by potassium efflux and calcium influx (this is the phase not exhibited by SA node action potential. Phase 3 is rapid repolarization due to Potassium efflux (which makes choice "C" wrong because there is rapid downstroke n Cardiac AP than SA node AP. In SA Node AP, we only have 3 phases. Phase 4 RMP. Phase 0 Slow Depolarization due to Calcium influx and Phase 3 which is repolarization due to potassium efflux. SA node shows "NO PLATEAU or NO PHASE 2" and "SLOW VELOCITY OF UPSTROKE". Option V - T-wave, it means Ventricular repolarization ( part of cardia AP) Choice III and IV are both part of the AP exhibited by the ventricles. 23 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 108. The act of inspiration increases the capacity of the thoracic cage in which principal direction: a. Increase in the transverse diameter due to the ribs swinging outwards b. Increase in the anteroposterior diameter by the sternal body which is hinged at the sternal angle, swinging forwards c. Increase in vertical diameter due to the descent and flattening of the dome of the diaphragm d. All of these movements Answer: D Increase in the transverse diameter due to the ribs swinging outwards- the diaphragm and external intercostal muscles contract, causing the rib cage to expand and move outward, and expanding the thoracic cavity and lung volume. 109. What structure releases the substance that lessens surface tension in the alveoli? a. Type I pneumocyte b. Alveoli c. Type II pneumocyte d. Trachea Answer: C Type II pneumocytes are identified as the synthesizing cells of the alveolar surfactant, which has important properties in maintaining alveolar and airway stability. Lung surfactant can reduce the surface tension and prevent alveolar collapse and the airway walls collapse. Reference: Zhao, C. Z., Fang, X. C., Wang, D., & Wang, X. D. (2010). Involvement of type II pneumocytes in the pathogenesis of chronic obstructive pulmonary disease. Respiratory medicine, 104(10), 1391-1395. 110. Air left in lungs after maximal expiration a. Residual Volume b. Functional Residual Capacity c. Expiratory Reserve Volume d. Functional Vital Capacity Answer: A Residual volume (RV) is the volume of air remaining in the lungs after maximum forceful expiration. In other words, it is the volume of air that cannot be expelled from the lungs, thus causing the alveoli to remain open at all times. Reference: Lofrese, J. J., Tupper, C., & Lappin, S. L. (2018). Physiology, residual volume. 111. Which of the following correctly describes tidal volume? a. the amount of air that enters the lungs but does not participate in gas exchange b. the amount of air that normally moves into (or out of) the lungs with each respiration c. the amount of air expired after maximal expiratory effort d. the amount of gas that can be moved into and out of the lungs in 1 min Answer: B Tidal volume (TV) - is the amount of air breathed in and out during normal, restful breathing. Reference: Beatty, P. (2012). Measurement of pressure and gas flow. Ward’s anaesthestic equipment. 6th ed. Saunders Elsevier, 27-39. 112. What is the maximal volume inspired after normal inspiration? a. Functional residual capacity b. Vital capacity c. Tidal capacity d. Inspiratory reserve volume Answer: D 24 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Inspiratory reserve volume (IRV) - is the additional volume of air that can be inspired at the end of a normal or tidal inspiration. Reference: Beatty, P. (2012). Measurement of pressure and gas flow. Ward’s anaesthestic equipment. 6th ed. Saunders Elsevier, 27-39. 113. Tidal volume plus inspiratory reserve volume a. Vital capacity b. Total lung capacity c. Inspiratory capacity d. Functional residual capacity Answer: C Inspiratory Capacity - The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration. It is the sum of the TIDAL VOLUME and the INSPIRATORY RESERVE VOLUME. Reference: Lutfi, M. F. (2017). The physiological basis and clinical significance of lung volume measurements. Multidisciplinary respiratory medicine, 12(1), 1-12. 114. Air volume remaining in the lungs after maximum expiratory effort a. VC b. FRC c. RV d. ERV Answer: C Residual volume (RV) is the volume of air remaining in the lungs after maximum forceful expiration. In other words, it is the volume of air that cannot be expelled from the lungs, thus causing the alveoli to remain open at all times. Reference: Lofrese, J. J., Tupper, C., & Lappin, S. L. (2018). Physiology, residual volume. 115. Patient has normal vital capacity, inspiratory capacity of 2500 mL, and residual volume of 900 mL. What is their functional residual capacity? a. 1950 b. 2300 c. 2900 d. 1890 Answer: C Normal VC = 4500 IC = 2500 RV = 900 Normal ERV = 1000 1st step: VC - IC = ERV 4500 - 2500 = 2000 2nd step: ERV + RV = FRC 2000 + 900 = 2900 116. Which heart sound represents the closing of the tricuspid and mitral valve? a. S1 b. S2 c. S3 d. S4 Answer: A S1 - is produced as the mitral and tricuspid valves (atrioventricular valves) close in systole S2 - is produced with the closing of the aortic and pulmonic valves (semilunar valves) in diastole Reference: Dornbush, S., & Turnquest, A. E. (2019). Physiology, heart sounds. 117. Which of the following branches out from the brachiocephalic trunk? a. Left subclavian artery b. Left common carotid artery c. Right subclavian artery d. Right coronary artery Answer: C The brachiocephalic trunk, also called the brachiocephalic or innominate artery, is one of the major branch of the aorta. The brachiocephalic trunk gives off the right subclavian artery, supplying the right upper limb; and the right common carotid artery, supplying the right side of the brain, head and neck. 25 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Singh, V. (2014). Anatomy of upper limb and thorax; Volume III. London: Elsevier Health Sciences APAC. 118. Decreased level of CO2 in blood a. Hypercapnia b. Hypocapnia c. Hypoxemia d. Hyperoxemia Answer: B Hypercapnia - increased level of CO2 in blood Hypocapnia - decreased level of CO2 in blood Hypoxemia - decreased level of O2 in blood Hyperoxemia - increased level of O2 in blood 119. Dyspnea, a symptom of cardiac dysfunction may be described as follows, except it a. is often caused by hypertension or aortic valve disease resulting in impaired ventricular relaxation b. can occur in patients with left ventricular hypertrophy c. often occurs with myocardial ischemia and heart failure d. is associated with heart failure or myocardial ischemia, and also with hypotension Answer: D Ratio: is associated with heart failure or myocardial ischemia, and also with HYPERtension 120. Atrial depolarization is seen in the ECG as the a. U wave b. T wave c. QRS complex d. P wave Answer: D U wave - represents the recovery period of the Purkinje or ventricular conduction fibers. It isn’t present on every rhythm strip. T wave - represents ventricular recovery or repolarization QRS complex - follows the P wave and represents depolarization of the ventricles. P wave - is the first component of a normal ECG waveform. It represents atrial depolarization—conduction of an electrical impulse through the atria Reference: Coviello, J. S. (2020). ECG interpretation made incredibly easy!. Lippincott Williams & Wilkins. 121. A patient recently admitted to an acute care hospital is referred to physical therapy. The therapist documents the following clinical signs: pallor, cyanosis, and cool skin. These clinical signs are most consistent with a. Hypertension b. Anemia c. Diaphoresis d. Cor pulmonale Answer: B A decrease in the number of red blood cells that carry oxygen in the blood results in a variety of symptoms including, pallor, cyanosis, cool skin, vertigo, weakness, headache, and malaise. Reference: PT Book Review 3 122. A patient with left sided CHF class II, is referred for physical therapy. During exercises, the patient can be expected to exhibit a. Anorexia, nausea with abdominal pain and distension b. Dyspnea with fatigue and muscular weakness c. Severe, uncomfortable chest pain with shortness of breath d. Weight gain with dependent edema Answer: B Left-sided heart failure is the result of the left ventricle failing to pump enough blood through the arterial system to meet the body's demands. It produces pulmonary edema and disturbed respiratory control mechanisms. Pa«ents can be expected to demonstrate progressive dyspnea (exertional at first, then paroxysmal noctumal dyspnea), fatigue and muscular weakness, pulmonary edema, cerebral hypoxia and renal changes. Reference: PT Book Review 4 123. A PT is treating a 39 year old female diagnosed with thoracic outlet syndrome. During exercise, the patient begins to complain of lightheadedness and dizziness. PT immediately takes the patient to a chair and monitors her vital signs. 26 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Her respiration rate is 11 breaths per minute, pulse rate is 60 beats per minute, and BP 120/85 mmHg. Which value is below normal levels? a. HR b. BP c. RR d. BP and RR Answer: C RR 11 cpm - below normal level (normal: 12-20 cpm) BP 120/85 mmHg - above normal level (normal: Slow concentric > Fast concentric Fast eccentric has highest microtrauma 19. The main source of ATP immediately after exercising for 10 seconds: a. Glycogen breakdown c. glycolytic processes b. Phosphocreatine d. oxidative processes Answer: B 8 – 10 seconds in Guyton, 18% The “rule of nines” is commonly utilized to assess the percentage of the body surface affected by a burn. Each area of the body has a specific percentage allocated to it in order to approximate the total percentage of the body surface affected. The values are as follows: head (9%), each upper extremity (9%), the trunk (36%), each lower extremity (18%), and the genital area (1%). 193. You are working in the rehab department with a patient with burns on his entire face, half of the anterior trunk, half of posterior trunk, genital area, and B LEs. Using the rule of nines, which of the following values listed below would correctly describe the percentage of the body burned? a. 60% b. 62% c. 55% d. 46.5% Answer: A Face -> 4.5% Half of anterior trunk -> 9% Half of posterior trunk -> 9% Genital area -> 1% (B) LE -> 36% The “rule of nines” is commonly utilized to assess the percentage of the body surface affected by a burn. Each area of the body has a specific percentage allocated to it in order to approximate the total percentage of the body surface affected. The values are as follows: head (9%), each upper extremity (9%), the trunk (36%), each lower extremity (18%), and the genital area (1%). 194. Which does not correctly describe Hoffman’s disease? a. Affects the first dorsal compartment of the wrist b. Pain is located in the radial styloid area c. Affected tendons include the extensor pollicis brevis and adductor pollicis longus d. Also called Washerwoman’s thumb Answer: C The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons comprise the first extensor compartment, and in de Quervain’s tensynovitis they are affected at the point where they pass through a fibro-osseous tunnel from the forearm into the hand Reference: Katechia, D., & Gujral, S. (2017). De Quervain’s tenosynovitis. InnovAiT: Education and Inspiration for General Practice, 10(9), 505–509. doi:10.1177/1755738017713515 195. Which blood cell is responsible for long term immunity? a. Eosinophil b. Macrophage c. Neutrophils d. Leukocytes Answer: D (formerly B) A lymphocyte is a type of white blood cell that is part of the immune system. There are two main types of lymphocytes: B cells and T cells. In contrast, activation and differentiation of B cells within germinal centers allow the generation of plasma cells of high affinity that will then migrate to the bone marrow, where they can survive for decades and provide long-term humoral protection. Such long-lived plasma cells are key to maintaining long-term humoral immunity after infection or vaccination. Reference: Palm, A. K. E., & Henry, C. (2019). Remembrance of things past: long-term B cell memory after infection and vaccination. Frontiers in immunology, 10, 1787. 196. Functions of protein except? a. Helps build and repair cells and body tissues including skin, hair, and muscle b. Important for blood clotting c. Helps maintain proper pH and fluid balance d. Stores energy Answer: D Proteins are necessary for tissue repair and function, growth, fluid balance, clotting, and the production of white blood cells. 63 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Reference: Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 14 Nutrition. Available from: https://www.ncbi.nlm.nih.gov/books/NBK591829/ 197. Function of mitochondria except? a. Oxidative phosphorylation b. Release cytochrome C which activates an enzyme involved in apoptosis c. Stores calcium d. Site of protein synthesis Answer: D Cytochrome c, an essential component of the electron transport chain initiates apoptosis when released from mitochondria. Mitochondria are in constant communication with the cytosol to coordinate the balance between the energy demands of the cell and energy production by oxidative phosphorylation. Mitochondria have evolved to control a diverse number of processes including cellular energy production, calcium signalling and apoptosis. Reference: Osellame, L. D., Blacker, T. S., & Duchen, M. R. (2012). Cellular and molecular mechanisms of mitochondrial function. Best practice & research Clinical endocrinology & metabolism, 26(6), 711-723. Protein synthesis occurs in the cytoplasm on ribonucleoprotein particles, the ribosomes. Reference: Oleinick, N. L., & Rustad, R. C. (1976). Interrelationships between ionizing radiation, protein synthesis, and the physiological expressions of radiation damage. In Advances in Radiation Biology (Vol. 6, pp. 107-160). Elsevier. 198. A patient presents with a tumor in his posterior pituitary gland. Which of the following is a possible manifestation? a. Hyponatremia, weight gain, restlessness b. Polydipsia and polyuria c. Fatigue, mental retardation, weakness d. Hyperhidrosis, exophthalmos, heat intolerance Answer: A Local pituitary tumor may cause exaggerated secretion of arginine vasopressin (AVP), resulting in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). One of the effects of SIADH is hyponatremia, and can present with headache, muscular cramps, weakness, lethargy, restlessness, disorientation, depressed reflexes, seizures, coma, or respiratory arrest. Reference: Giuliani, C., & Peri, A. (2014). Effects of hyponatremia on the brain. Journal of clinical medicine, 3(4), 1163- 1177. 199. The endocrine system mostly uses the negative feedback mechanism but there are some instances where it uses positive feedback. Which of the choices illustrates this? a. An increase in blood sugar levels triggers release of insulin from the pancreas which increases sugar uptake in cells thus making the blood sugar level drop b. An decrease in blood calcium level is sensed by the parathyroid gland and it secretes more parathormone which then stimulates calcium release from bones and increases calcium in the blood c. An increase in oxytocin stimulates muscle contractions that push an infant through the birth canal. The stronger contractions activate the uterine stretch receptors thus further increasing levels of oxytocin d. An increase in systemic blood pressure activates receptors in the carotid sinus which send signals to the brain, the final response being bringing blood pressure back to normal Answer: C In negative feedback, the response will reverse or cause the opposite effect of the original stimulus. Negative feedback can be explained with the process of insulin production and release. After a meal the blood sugar level will be elevated. This triggers the release of insulin from pancreas. Insulin converts sugar into cells and hence the blood sugar level drops. Another example of negative feedback is the regulation of the blood calcium level. The release of oxytocin from the posterior pituitary gland during labor is an example of positive feedback mechanism. Oxytocin stimulates the muscle contractions that push the baby through the birth canal. The release of oxytocin result in stronger or augmented contractions during labor. The contractions intensify and increase until the baby is outside the birth canal. Reference: Casas, R. (2022, March 28). Negative and Positive Feedback Mechanisms. Cerritos Colleges. Retrieved January 12, 2024, from https://www.cerritos.edu/rpcasas/positive-and-negative-feedback.htm 200. Who is more susceptible for hypertrophic scarring? a. A 2 year old male caucasian baby b. A 34 year old pregnant woman of African descent c. A 65 year old Japanese male d. A 15 year old female with albinism Answer: B Keloid formation is seen in individuals of all races, except albinos, but dark-skinned individuals have been found to be more susceptible to keloid formation, with an incidence of 6% to 16% in African populations. Excessive scar growth may also be 64 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW stimulated by various hormones, as indicated by some studies in which results have suggested a higher incidence of keloid formation during puberty and pregnancy, with a decrease in size after menopause Reference: Gauglitz, G.G., Korting, H.C., Pavicic, T. et al. Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies. Mol Med 17, 113–125 (2011). https://doi.org/10.2119/molmed.2009.00153 201. Gastroduodenal reflex a. Gastric emptying b. Prevents release of chyme c. Inhibits small intestine d. Decreases peristalsis in GI tract Answer: C Gastric distension inhibited duodenal motility via a nerve reflex which was abolished by section of the nerves connecting the coeliac plexus to the viscera. Reference: Mazet, B., Miolan, J. P., Niel, J. P., & Roman, C. (1994). New insights into the organization of a gastroduodenal inhibitory reflex by the coeliac plexus. Journal of the autonomic nervous system, 46(1-2), 135-146. 202. Which of the following correctly describe the process of voice production? a. Glottis closure → exhalation facilitates increase in subglottic pressure → air passes through vocal folds → mucosal wave begins infraglottically and is propagated superolaterally b. Exhalation facilitates increase in subglottic pressure → glottis closure → air passes through vocal folds → mucosal wave begins infraglottically and is propagated superolaterally c. Air passes through vocal folds → mucosal wave begins infraglottically and is propagated superolaterally → Exhalation facilitates increase in subglottic pressure → glottis closure d. Mucosal wave begins infraglottically and is propagated superolaterally → Air passes through vocal folds → Exhalation facilitates increase in subglottic pressure → glottis closure Answer: A The process of voice production is outlined below: Glottic closure → during exhalation facilitates increase in subglottic pressure → once subglottic pressure exceeds glottic closure force → air passes through the vocal folds → mucosal wave begins infraglottically and is propagated superolaterally → glottic pressure drops due to open phase + elastic recoil of tissues leads to glottal closure → which facilitates increase in subglottic pressure & glottal cycle repeats Reference: https://alahns.org/wp-content/uploads/CLC/5-Mechanisms-of-Voice-Production.pdf 203. You are assessing a patient with a pressure ulcer. The ulcer demonstrates a partial thickness skin loss that involves the epidermis and/or dermis. In addition, the ulcer is superficial and presents clinically as an abrasion, a blister, or shallow crater. Using the national pressure ulcer advisory panel (NPUAP) pressure ulcer stages, how would you grade this ulcer? a. Stage I b. Stage II c. Stage III d. Stage IV Answer: B These findings are indicative of a stage II ulcer under the NPUAP classifications. Stage I will present with superficial skin loss only and non-blanchable erythema. Stage III will present with full thickness skin loss and presence of a deep crater. Stage IV will present with full thickness skin loss extending to fascia, muscles and bones and with presence of undermining/tunneling,rimming/sinus tracts. Reference: O'Sullivan O. S. & Siegelman R. P. (2018). National physical therapy examination : review & study guide 2018 (21st ed.). TherapyEd 204. Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. a. Stage I b. Stage II c. Stage III d. Stage IV Answer: D Reference: O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2019). Physical rehabilitation. FA Davis. 205. You are treating a 24 year old female patient who suffered a scald burn. After inspection, you noticed that the burn wound is bright pink with intact blisters. There is blanching observed when pressed and has quick capillary refill. The patient reported a pain of 7/10 on the area that increases with changes in temperature and light touch. What kind of burn wound does she have? a. Epidermal 65 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW b. Deep partial c. Superficial partial d. Full thickness Answer: C (Reference: Schmitz, T. J., Fulk, G. D., & O'Sullivan, S. B. (2014). Physical rehabilitation. Philadelphia: F.A. Davis Co.) 206. If your patient cannot support full weight on either of his legs, which crutch‐walking gait would you choose? a. Four‐point gait b. Two‐point gait c. Swing‐through three‐point gait d. Three‐point‐gait (non‐weight‐bearing) e. Three‐point‐and‐one‐gait (partial‐weight‐bearing) Answer: A Choose a four-point gait if your patient can’t support his full weight on either of his legs; for example, a patient with leg muscle weakness or spasticity, poor muscular coordination or balance, degenerative leg joint disease, or bilateral leg prosthesis 207. Which of the following is NOT an intrinsic risk factor which predispose to the development of pressure ulcers? a. anemia b. muscle atrophy c. smoking and substance abuse d. impaired nutritional status Answer: C Smoking and substance abuse are not risk factors for development of pressure ulcers. Reference: DeLisa, J. A., & Frontera, W. R. (2010). Physical medicine & rehabilitation: Principles and practice. Philadelphia: Lippincott Williams & Wilkins Health. 208. A therapist is asked to estimate the percentage of a patient’s body that has been burned. The patient is a 32- year-old man of normal size. Burns are located along the entire anterior surface of the face. The patient also burned the entire anterior portion of the right upper extremity in an attempt to guard himself from flames. Using the rule of nines, what percentage of the patient’s body is burned? a. 9% b. 18% c. 4.50% d. 27% Answer: A Face → 4.5% ® Anterior UE → 4.5% The “rule of nines” is commonly utilized to assess the percentage of the body surface affected by a burn. Each area of the body has a specific percentage allocated to it in order to approximate the total percentage of the body surface affected. The values are as follows: head (9%), each upper extremity (9%), the trunk (36%), each lower extremity (18%), and the genital area (1%) 209. Fast twitch fibers differ from slow twitch fibers, EXCEPT: a. Number of capillaries per mass of fibers in greater in slow twitch fibers b. Fast twitch fibers are for strength and mobility c. Fast twitch fibers can achieve double the maximal power d. Fast twitch fibers are twice in diameter e. None of the above Answer: E 210. A 55 y/o patient is being assessed for his complaint of upper abdominal pain. Results show that the lower esophagus seems to have been burned. What could be the cause of this? a. Gastroesophageal reflux disease b. Cigarette smoking c. Alcohol consumption d. All of the above Answer: A Gastroesophageal reflux is primarily a disorder of the lower esophageal sphincter (LES). The most common cause is transient lower esophageal sphincter relaxations (TLESRs). Reference: Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri medicine, 115(3), 214. 66 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW 211. The digestive enzyme that breaks down starch a. Lipase b. Amylase c. Protease d. Ligase Answer: B Ratio: Amylase breaks down starch or carbohydrates. Lipase digests fats. Proteases mix with proteins to break it down into amino acids. Ligase is not a digestive enzyme. Past Book 3 212. Muscle fibers that fatigue slowly a. Type I b. Type IIa c. Type IIb d. AOTA e. NOTA Answer: A 213. Failure of the lower esophageal sphincter to relax a. Achalasia b. GERD c. Esophagitis d. Heartburn ANSWER: A Ratio: Achalasia is a motility disorder characterized by esophageal aperistalsis and nonrelaxation of the lower esophageal sphincter (LES). Gastroesophageal reflux disease (GERD) is a condition that develops when reflux of gastric contents causes symptoms and complications. Generally, achalasia and GERD are thought to be at opposite ends of the spectrum of LES dysfunction. In achalasia, the LES may be hypertensive and show impaired relaxation in response to swallowing. In GERD, the LES can either be hypotensive or display frequent relaxations. Reference: Park, H. (2017). Is gastroesophageal reflux disease and achalasia coincident or not?. Journal of neurogastroenterology and motility, 23(1), 5. 214. A physical therapist is treating a 40‐year‐old business executive who lives a sedentary lifestyle. The patient tires quickly and complains of quadriceps fatigue and "burning" after 2 minutes on the stair stepper. The therapist explains to the patient that the "burning" is probably due to lactic acid build‐up in muscles. Which of the following statements is incorrect? a. Lactic acid build‐up is due to the aerobic system not keeping up with the energy demands of the muscles. b. Lactic acid builds up is more quickly in an unconditioned person than in a conditioned person exercising at the same intensity level c. A small amount of lactic acid is produced at low to moderate intensity levels of exercise d. Only the anaerobic system is active during rest Answer: D Both anaerobic and aerobic systems are active during rest. The anaerobic system is working at least at a cellular level during rest. The level of lactic acid produced at rest is not enough to cause any build‐up. The aerobic system is also working at least at a cellular level during high‐intensity activity. 215. A fall in the glomerular filtration rate is seen in the following situations, EXCEPT: a. Fall in blood pressure. b. Efferent arteriolar contraction c. Increase in plasma protein concentration d. Tetanic venous contraction Answer: B Ratio: Contraction of arterioles increase BP. An increase in BP would synonymously increase your GFR. 216. Summation of Action Potentials a. Relative Summation b. Absolute Summation c. Spatial Summation d. Temporal Summation e. Both C and D Answer: E Ratio: In the summation of Action Potentials, remember: (Guyton 13th ed, p.590) 67 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission. APK PAST BOOK 3 (Cardio-Pulmo and Physiology) PLP PT BOARD REVIEW Inhibitory Postsynaptic Potential: IPSP Excitatory Postsynaptic Potential: EPSP If: EPSP1 + EPSP2 = greater than IPSP = activation of the neuron EPSP1 + EPSP2 = lesser than IPSP = turning off the activity of the neuron 2 Types: Spatial Summation = many presynaptic neurons stimulating the postsynaptic neuron allowing firing at the threshold Temporal Summation = one presynaptic neuron stimulating the postsynaptic neuron in a rapid succession can allow firing at the threshold 217. Rh factor incompatibility occurs in this setting: a. Rh (-) mother, Rh (+) fetus, Rh (+) father b. Rh (+) mother, Rh (-) fetus, Rh (+) father c. Rh (-) mother, Rh (+) fetus, Rh (-) father d. Rh (+) mother, Rh (+) fetus, Rh (+) father e. Rh (-) mother, Rh (-) fetus, Rh (+) father Answer: A Rh factor incompatibility occurs when an Rh-negative mother is pregnant with an Rh-positive fetus. The Rh factor refers to the presence or absence of the Rh antigen on red blood cells. 218. Stimulation of mass movements after ingestion of a normal meal is called: a. Ileal break d. ga

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