PAPER:CARDIO PULMONARY

5TH PROFESSIONAL YEAR

DR BUSHRA ABBASI
IIHS
1, Target patient group for cardiac rehab includes all of the following except
a) Following Myocardial Infarct
b) Post PTCA/CABG
c) Post appendectomy
d) Chronic Stable Angina
2, Goals of cardiac rehab includes
a) Emotional/Psychological adjustment
b) Diet/Exercise
c) Risk Factor Reduction
d) All of the above
3, In FITT principle F stands for
a) Force expiratory volume
b) Frequency
c) Fluency
d) Fluctuance
4, Secondary prevention in cardiac rehab includes
a) Cholesterol management
b) BP management
c) Blood sugar management
d) All of the above
5, Psychosocial care in cardiac rehab includes all except
a) Reduce fear and anxiety
b) Promote negative attitude
c) Facilitate behaviour change
d) Identify need for further support
6, A patient has developed congestive heart failure after experiencing his first
myocardial infarction. The pulmonary signs and symptoms the therapist
expect to find include:
a) Inspiratory wheezing and shortness of breath.
b) Crackles and cough.
c) Cough productive of thick yellow secretions.
d) Crackles and clubbing of the digits.
7, Which of the following clinical manifestations is NOT typical of early stage
cystic fibrosis?
a) Excessive appetite and weight gain.
b) Increased pulmonary secretions with airway obstruction.
c) Frequent recurrent respiratory infections.
d) Salty skin and sweat.
8, A patient is admitted to a coronary care unit with a mild myocardial
infarction, After 2 days the patient is referred to physical therapy for
exercise conditioning. During an initial exercise session on the unit, he
reports chest pain, appears anxious, and wants to go back to bed to rest. The
therapist's BEST course of action is to terminate the exercise and:
a) Have him sit down and continue to monitor his vital signs carefully.
b) Monitor his vital signs and contact his doctor immediately.
c) Assist the patient back to bed and contact the charge nurse on his
floor.
d) Assign the physical therapist assistant to assist him back to his bed
and monitor his vital signs carefully.
9, A therapist is examining a patient with a 12-year history of emphysema. The
clinical finding the therapist would NOT expect to find is:
a) Cor pulmonale.
b) Clubbing.
c) Cyanosis.
d) Decreased A-P to lateral chest ratio.
10, A patient recovering from surgery for triple coronary artery bypass grafts is
scheduled to begin a Phase III cardiac rehabilitation program. During the
resistance training portion of the circuit training program, the therapist
instructs the patient to AVOID the Valsalva maneuver because:
a) Heart rate and blood pressure are likely to be elevated.
b) Slowing of pulse and increased venous pressure are possible.
c) A cholinergic or vagal response can occur.
d) The decreased return of blood to the heart can lead to pitting edema.
11, Goals of chest physiotherapy includes all except
a) Reduse airway obstruction
b) Prevent the accumulation of secretions
c) Improve the mobilization of secretions
d) Decrease the distribution of ventilation
12, Which of the following is the goal of chest physiotherapy
a) Reduces gas exchange
 b) Promote more efficient breathing patterns
c) Increase the work of breathing
d) Decrease cardiopulmonary exercise tolerance
13, A 72 year-old patient is walking on a treadmill in the physical therapy
department while his vital signs are being monitored. It is noted that his
SaO2 drops from 97% to 95%. In this case, it would be BEST to:
a) Place a 100% O2 face mask on the patient for the remainder of the
exercise session.’
b) Place a 40% O2 face mask on the patient for the remainder of the
exercise session.
c) Place 2 liters of O2 by nasal cannula on the patient for the remainder
of the exercise session.
d) Not use supplemental O2.
14, Chest physiotherapy treatment hierarchy includes
a) Mobilisation & activity
b) Positioning
c) Breathing control
d) All of the above
15, diagnosis for the below mentioned ECG strip is

a) Ventricular Tachycardia
b) Ventricular Fibrillation
c) Atrial Flutter
d) Atrial Fibrillation
16, Which of the following statement is not true?
a) Arteries carry oxygen-rich blood away from heart
b) Veins carry oxygen-poor blood back to heart
c) Pulmonary artery that brings oxygen-poor blood into lungs and the
d) Pulmonary vein that brings oxygen-poor blood back to the heart
17, Diagnosis for the below mentioned ecg strip is
.

a) Anterior wall MI
b) Posterior Wall MI
c) Atrial fibrillation
d) Inferior wall MI
18, Positioning for relaxation, decreased dyspnea and improved ventilation and
oxygenation in icu management of the adult patient is
a) Head of the bed elevated to 60 degrees and lying on well aerated lung
b) Head of the bed elevated to 30 degrees and lying on well aerated lung.
c) Head of the bed in neutral positions lying on bad lung
d) None of the above
19, The valve that controls blood flow from the right ventricle into the
pulmonary arteries is
a) Aortic valve
b) Pulmonary valve
c) Mitral valve
d) None of the above
20, The valve that controls blood flow from the left ventricle into the aorta is
a) Aortic valve
b) Pulmonary valve
c) Mitral valve
d) None of the above
21, In the new born infant most breathing takes place via the nasal passages
because
a) Larynx is positioned high up
b) Pharynx descends with age
c) Tracheal diameter narrowed with age
d) New born infant are not nose breather
22, Percussion notes in pleural effusion will be
a. dull
b. hyper resonance
 c. none
d. both
23, Hearts "natural pacemaker is
a) SA NODE
b) AV NODE
c) RA NODE
d) None of the above
24, "Natural pacemaker’’ of the heart is located in
a) top of the right atrium
b) middle of the left atrium
c) in between right atrium and right ventricle
d) none of the above
25, Closing capacity is the sum of
a) Closing volume and residual volume
b) Closing volume and functional residual capacity
c) Residual volume and functional residual capacity
d) Vital capacity and residual volume
26, During Rapid Eye Movement sleep there is reduce efficiency of respiration and
increase work of breathing which predisposes the infant to apnoeic episodes due to
a) Diaphragm is at mechanical advantage
b) Tonic inhibition of intercostals muscles
c) Poorly developed bronchial smooth muscles
d) None of the above
27, Diaphragm of new born infant fatigue easily because they have more
a) Type I muscle fiber
b) Type II muscle fiber
c) Cartilaginous tissue
d) Spongy tissue
28, Prone positions is contraindicated in
a) ARDS
b) Haemodynamically unstable
c) Both
d) None
29, Precautions in pursed lip breathing are
a) avoid sudden expiration
b) avoid slow expiration
c) avoid forced expiration
d) both a and c
30, Decreased actions of cilia in the bronchial tree secondary to
a) COPD
b) ARDS
c) Smoking
d) a and c
31, postural drainage is contraindicated in
a) congestive heart failure
b) arrythmias
c) severe hypotension
d) all
32, FiO2 stands for
a) Fragment of inspired oxygen
b) Fraction of inspired oxygen
c) Fraction of expired oxygen
d) None of the above
33, Normal range of oxygen saturation is
a) 98-100%
b) 95-100%
c) 90-95%
d) None
34, PEEP stands for
a) Positive End Expiratory Pressure
b) Positive expiratory efficiency position
c) Positional expiratory effort pressure
d) All of the above
35, The best physiotherapy technique in acute lobar or lung collapse due to
mucous plugging is
a) Postural drainage in prone position
b) Bronchoalveolar lavage
c) ACBT
d) None of the above
36, When there is delay in the impulse reaching the AV node from the SA node
and there is longer than normal PR interval on ecg it is a
a) 3rd Degree heart block
b) 2nd Degree heart block
c) 1st Degree Heart block
d) Atrial fibrillation
37, in pulomonary embolism , if the embolus is of sufficient size it will cause
a) Right sided heart strain
 b) Left sided heart strain
c) Mitral valve prolapsed
d) Aortic regurgitation
38, Which one is not the part of general appearance of a patient
a. Level of consciousness
b. Body type
c. Body posture and position
d. Lung auscultation
39, in left ventricular hypertrophy there are abnormally large R waves greater than
five large squares of the ECG in leads
a) V1 and V2
b) II, III and AvF
c) I and AvR
d) V4 and V6
40, which of the following is true for pulmonary rehabilitation
a) restoration of the individual to the fullest medical, mental, emotional, social,
and vocational potential
b) The overall goal is to maximize functional ability and minimize the impact
of the disability.
c) To control symptoms and improve the overall quality of life.
d) All of the above
41.Teaching pursed lip breathing as part of the treatment regimen would be most
appropriate for a patient with:
a) Circumferential thoracic burns
b) Asbestosis
c) Radiation pneumonitis
d) Emphysema

42.A 54 year old male with a long history of cigarette smoking, has been admitted
to the hospital and presents with signs of infection, tachycardia, abnormal breath
sounds in both lower lobes and dullness to percussion. The physical therapist’s
major concern and focus with this patient is:
a) Getting the patient to quit smoking
b) Breathing reeducation to increase efficiency of ventilation
c) Airway clearance and secretion removal
d) Graded inspiratory muscle training

43.which of the following statement is not true?

 e) Arteries carry oxygen-rich blood away from heart
f) Veins carry oxygen-poor blood back to heart
g) Pulmonary artery that brings oxygen-poor blood into lungs and the
h) Pulmonary vein that brings oxygen-poor blood back to the heart

44.A physical therapist is treating a patient with active hepatitis B infection.

Transmission of the disease is best minimized if the therapist:
a) washes hands before and after treatment.
b) has the patient wear a gown and mask during treatment.
c) wears gloves during any direct contact with blood or body fluids.
d) has the patient wear gloves to prevent direct contact with the therapist

45.diagnosis of the below mentioned ecg strip is

 a) Anterior wall MI
b) Inferior wall MI
c) Atrial fibrillation
d) Atrial Flutter

46.The valve that regulates blood flow between the right atrium and right ventricle
is
a) Bicuspid valve
b) Tricuspid valve
c) Semilunar valve
d) None of the above

47.The valve that controls blood flow from the right ventricle into the pulmonary
arteries is
e) Aortic valve
f) Pulmonary valve
g) Mitral valve
h) None of the above

48.The valve that controls blood flow from the left ventricle into the aorta is
e) Aortic valve
f) Pulmonary valve
g) Mitral valve
h) None of the above
49.Diagnosis of the below mentioined ECG strip is

a) Anterior wall MI
b) Inferior wall MI
c) Atrial fibrillation
d) Atrial Flutter

49.If the patient of cystic fibrosis in a stable condition, the daily weight or volume
of sputum expectorated should
a) approximately constant with effective physiotherapy and medical
management
b) reduce with effective physiotherapy and medical management
c) both
d) none
50.Percussion notes in pleural effusion will be
e. dull
f. hyper resonance
g. none
h. both
51.Hearts "natural pacemaker is
e) SA NODE
f) AV NODE
g) RA NODE
 h) None of the above

52."natural pacemaker’’ of the heart is located in

e) top of the right atrium
f) middle of the left atrium
g) in between right atrium and right ventricle
h) none of the above

53.Diagnosis of the below mentioned ECG strip is

a) Anterior wall MI
b) Inferior wall MI
c) Atrial fibrillation
d) Atrial Flutter
54.Diagnosis of the below mentioned ECG Strip is

a) Anterior wall MI
b) Inferior wall MI
c) Atrial fibrillation
d) Atrial Flutter

55.A physical therapist is treating a patient with active hepatitis B infection.

Transmission of the disease is best minimized if the therapist:
a) washes hands before and after treatment.
b) has the patient wear a gown and mask during treatment.
c) wears gloves during any direct contact with blood or body fluids.
d) has the patient wear gloves to prevent direct contact with the therapist.

56.contraindications to manual hyperinflation

a) bronchospasm
b) arrythmias
c) haemptysis
d) all of the above

57.Prone positions is contraindicated in

e) ARDS
f) Haemodynamically unstable
 g) Both
h) None

58.Precautions in pursed lip breathing are

e) avoid sudden expiration
f) avoid slow expiration
g) avoid forced expiration
h) both a and c

59.Decreased actions of cilia in the bronchial tree secondary to

e) COPD
f) ARDS
g) Smoking
h) a and c

60.Postural drainage is contraindicated in

e) congestive heart failure
f) arrythmias
g) severe hypotension
h) all
i) a and b

61.Criteria of discontinuing postural drainage includes

a) normal or near normal breath sounds
b) infection
c) excessive sputum
d) none
62.Normal range of oxygen saturation is
e) 98-100%
f) 95-100%
g) 90-95%
h) None
63.you are examining a patient with COPD. You would may not expect to find
a) Hypercapnea
b) Increased TLC
c) Increased VC
d) Abnormal ventilation
64.Diagnosis of the below mentioned ecg is

a) Left ventricular hyper trophy

b) Right ventricular hyper trophy
c) Ventricular tachycardia
d) Normal ECG

65.Diagnosis of the below mentioned ecg strip is Normal ECG

 a) Left ventricular hyper trophy
b) Right ventricular hyper trophy
c) Ventricular tachycardia

66.Which one is not the part of general appearance of a patient

e. Level of consciousness
f. Body type
g. Body posture and position
h. Lung auscultation
67.which one of the following is true for respiration
a) Respiration is the act of breathing:

b) inhaling (inspiration) - taking in oxygen

c) exhaling (expiration) - giving off carbon dioxide

d) all of the above

68.upper respiratory tract includes all except

a) nose

b) alveoli

c) larynx

d) trachea

69.which one of the following is included in lower respiratory tract

a) nose

b) alveoli

c) larynx

d) trachea

70.Mediastinum consist of all of the following except

a) heart and its large vessels

b) trachea (windpipe)

c) stomach

d) esophagus

71.Bronchioles end in tiny air sacs called

a) Smaller bronchi
b) Alveoli
c) Terminal bronchioles
d) None of the above
72.A 12 year old girl with cystic fibrosis has been readmitted to the hospital in
acute respiratory failure as a result of an infection. Physical therapy, in the form of
bronchial hygiene should
a) Not be given as it is contraindicated in acute respiratory failure
b) Given two times a day
c) Given vigorously three times a day
d) Given vigorously every 2 hours

73.Ideal systolic pressure in healthy adult is

a) 130mm/hg
b) 120 mm of Hg
c) 80 mm of Hg
d) None of the above

74.Ideal Diastolic pressure in healthy adult is

a) 130mm/hg
b) 120 mm of Hg
c) 80 mm of Hg
d) None of the above
75…….. Carry the impulse to the heart apex and ventricular walls
a) Bundle branches
b) Purkinje fibers
c) SA node
d) None of the above

76.Impulse passes from atria to ventricles via the atrioventricular bundle generally
known as
a) Bundle branches
b) Purkinje fibers
c) Bundle of His
d) None of the above

77.which of the following is true for AV node

a) Generates impulses
b) Delays impulses 0.1 second
c) Passes impulses to the apex of the heart
d) All of the above

78.Diagnosis of the below mentioned ecg is

 a) Ventricular fibrillation
b) Ventricular tachycardia
c) Atrial fibrillation
d) Normal ecg

79.Respiratory muscle training can be divided into

a. strength training
b. endurance training
c. power training
d. a and b

80.Types of sounds in percussion are

a) tympanic
b) resonance
c) dull
d) all
81. A chronic smoker presents with the hemoptysis. On bronchoscopy there is a
fungating mass in the right main bronchus. The most likely carcinoma in this case would
be:
A. Squamous cell carcinoma
B. Small cell lung carcinoma
C. Bronchio-alveolar
 D. Adenocarcinoma
E. Large cell carcinoma

82.A 50-year-old woman with alpha- 1 antitrypsin deficiency and no history of smoking
requires a double lung transplant for severe emphysema. One year later the same lung
transplant patient presents to the ER with acute shortness of breath. A chest x-ray shows
patchy infiltrates. Which of the following is the most likely cause of her symptoms:
F. Chronic rejection
G. Asthma
H. Bronchiectasis
I. Oat cell carcinoma
J. Recurrent emphysema

83.The malnournished 50-year-old man with alcoholism & severe dental caries has a 2-
week history of malaise & right – sided chest pain . He is febrile and has a cough
productive of foul smelling, purulent sputum X-ray film of the chest shows a fluid filled
cavity, 2 cm in diameter, in the upper lobe of the right lung the most likely diagnosis is:
K. Abscess
Bronchiectasis
Pulmonary infarct
Squamous cell carcinoma
Tubeculosis

84.All of the following are true regarding patient suffering from chronic respiratory
failure except :
A. Shows an inc. respiratory sensitivity to CO 2
B. Does not inc. his ventilation in response to O2 lack
C. Should be given low conc. O2 administration to hospital
D. Always have a low Pa O2
E. May have a low PaCO2

85.A diabetic adult female patient after 3rd postoperative day feel severe chest pain, & has
hemoptysis; the cause is:
F. Myocardial infarction
G. Pulmonary embolism
H. Pneumonia
I. Pericaritis
J. Pleuritic pin

86.In addition to intravenous fluid therapy, which of the following is the most
appropriate intital pharmacotherapy
K. Intravenous bisphosphonate
L. Intravenous corticosteroids
 M. Intravenous mannitol
N. Intravenous mithramycin

Oral hydrochlorothiazide

87.Which of the following is the most likely electroyte abnormality :

O. Hypercalcemia
P. Hpocalcemia
Q. Hyperkalemia
R. Hypokalemia
S. Hyperphosphatemia

87.A woman after 4 days of hysterectomy develop dyspnea and chest pain, with normal
ECG & CK level; the diagnosis is:
A. MI
B. Hypersensitivity reaction

C. Pulmonary embolism
D. Cardiac arres
E. Angina

88.Fibrosis in SILICOSIS is best explained by:

T. Primary effect of the silica particles.
U. Due to indigestion/destruction of silica present in the periphery
V. Undestructed silica in macrophage’s which then produce factor ending up in
fibrosis
W. Undestructed silica which produce non specific response form fibroblasts
X. Undestructed silica in neutrophils which produce factor which by stimulating
macrophages produces fibrosis

89.A47-year-old woman has had cough productive of scant amounts of yellow

phlegm & temperatures to 101 F for 3 months. On one occasion, the phlegm was
blood streaked. She has had 10-kg weight loss over the past 4 months. She does
not smoke. Coarse upper lobe crackles & rhonchi are heard bilaterally. An xl-ray
film of the chest shows multiple, bilateral, upper lobe civilities\ with surrounding
infiltrates of the lungs. Select the most likely:
A. Chronic obstructive pulmonary disease
B. Congestive herd failure
C. Metastatic cancer to the lungs
D. Pneumonia
E. Tuberculosis
90.A patient exposed to asbestos, now has developed some malignancy; what is the
diagnosis:
A. Bronchogenci carcinoma
B. Pleural mesothelioma
C. Peritoneal mesothelioma
D. Pleuritis
E . Tuberculosis