THE UNIVERSITY OF FAISALABAD

Department of Rehabilitation Sciences

Final Semester Examination Fall 2022

Degree Program: DPT Semester 9

Course Title: Cardiopulmonary Physical Therapy Total Marks 40
Date of Examination 16-01-2023 Time: 1 hr. 45 min

Subjective
Note: Attempt all the questions. Draw Diagrams where required.

Question 1 Being a cardiopulmonary physical therapist, you are appointed for the 8
Cardiovascular conditioning of a patient. The patient is elderly adult and has
recently recovered from cardiovascular surgery.

 Which CV training approach is recommended for that patient?

 Why you discourage to perform exercises in recumbent position in
that patient?
 Write down the class management for CV conditioning?
 Tabulate an example of circuit design for that patient?
 What are the contraindication of resistance training?
ANSWER:

 Interval training
 Exercises performed in the recumbent position should be avoided
during the CV conditioning phase because some older adults may
experience difficulty in getting up and down. Immediately after
vigorous activity, venous return will increase on lying down and will
increase myocardial workload. There is also an increased risk of
orthostatic hypotension.
 • Beginner: 1 minute CV and 1 minute active recovery (AR).
 • Intermediate: 1 minute CV, 30 seconds AR and 30 seconds CV
alternative.
 • Advanced: 1 minute CV and 1 minute CV alternative. In this circuit,
patients go round the circuit twice. The instructor calls at 30 seconds.
The beginner achieves 10 minutes of work, patients at intermediate
level achieve 15 minutes of CV work and the advanced-level patients
achieve 20 minutes of CV work (continuous training).
 
 Contraindications to resistance training are:
 • abnormal haemodynamic responses to exercise;
 • ischaemic changes during graded exercise testing;
 • poor left ventricular function;
 • uncontrolled hypertension or arrhythmias;
 • exercise capacity of less than six METs.

Question 2 a) What are the indications for mechanical ventilation? 4

ANSWER:

The indications for ventilation vary for different disorders and are rarely
absolute. In practical (and somewhat simplistic) terms they include the
following:

 Adult respiratory distress syndrome.

 Pneumonia.
 Asthma.
 Chronic obstructive airways disease.
 Respiratory muscle weakness.
 Blunt chest trauma.
 Pulmonary edema.
 Multiple trauma or septic shock.
 Elective postoperative ventilation.

b) What are the Conventional weaning criteria (clinical, mechanical, and

biochemical parameters?)

Conventional weaning criteria involve clinical, mechanical, and

biochemical parameters:

Clinical
 • The clinical condition of the patient is improving.

• The patient is cooperative and alert and able to clear secretions.

• There is no abdominal distension, cardiovascular instability, or likelihood

of prolonged immobility.

• The respiratory rate is less than 30 breaths/min.

Mechanical

• Vital capacity is more than 15 ml/kg.

• Maximal inspiratory mouth pressure is more than 20 cmH2 0.

• Minute volume is less than 10 1/min.

Biochemical
4
• Normal pH and PaC02

• PaO2 more than 8 kPa (60 mmHg) on no more than 40% oxygen and 5
cm PEEP.

Question 3 a) A patient presents with a constant level of hypocapnia which drops 4

further as a result of running. The voluntary hyperventilation provocation
test was performed. Using end-tidal PaC02 recordings the patient is
requested to hyperventilate for 3 minutes. The PaC02 falls by 1.33 kPa
(10mmHg) and the rate of recovery is less than two-thirds of the former
resting level after 3 minutes.

 What is your diagnosis?

 What are the effects of altered breathing patterns and fluctuations in
PaC02 on autonomic system, urinary excretion, calcium ions and
musculoskeletal system?
 What are the factors contributing to the hyperventilation-anxiety
spiral?
ANSWER:

 Hyperventilation syndrome.
 Fluctuations in PaC02 can have a destabilizing effect on the autonomic
system resulting in a sympathetic dominance. The patients are often in
a state of arousal. It has been shown that the mean urinary excretion
of adrenaline in a group of hyperventilators was three times as high as
in a group of normals. The respiratory alkalosis associated with
hyperventilation causes a lowering of calcium ions in the plasma which
precipitates hyperirritability of motor and sensory axons. Altered
patterns of breathing can cause musculoskeletal dysfunction with
 subsequent chest pain, which may be due to intercostal muscle
tension, spasm or fatigue, costochondritis, costosternal, or
costovertebral joint pain.

b) A boy of age 5 years presents with a history of recurrent infections in the

nose, ears, sinuses and lungs. Chest x-ray reveals dextrocardia and situs
inversus. The boy has history of Pneumonia and has hearing problems
associated with secretory otitis media (glue ear). A sweat test was perform
and it exclude the diagnosis of cystic fibrosis.

 What is your diagnosis?

 What are the specific tests for this disease? 4
 What is the physical therapy management for this disease?
ANSWER:

 Primary ciliary dyskinesia (PCD)

 Specific investigations which would clarify the diagnosis of PCD
include: the nasal mucociliary clearance test, photometric
determination of ciliary beat frequency and electron micrographic
analysis. A sweat test will exclude the diagnosis of cystic fibrosis.
 The treatment should be to assist clearance of secretions from the
dependent parts of the lungs using gravity-assisted positions and the
active cycle of breaming techniques.
Drainage daily. A child should be encouraged to blow his nose
regularly.
Huffing games for child.
Sports and other active exercises should be encouraged. Even with
grommets in place children can enjoy swimming.
Very occasionally, nasopharyngeal suction may be indicated in the
 infant when it is impossible to clear nasal and bronchial secretions by
any other means.

a) What are the aims of pulmonary rehabilitation?

ANSWER:

The aims of pulmonary rehabilitation are:

• To maximize independent functioning in activities of daily living and

minimize dependence on significant others and community agencies

• To evaluate and initiate, as appropriate, physical training to increase exercise

4
tolerance and encourage efficient energy expenditure

• To provide educational sessions for patients, families and significant others

regarding disease processes, medication and therapeutic techniques (Harris
1985).

In essence, the patient with chronic lung disease enters the vicious circle of
inactivity and the aim of pulmonary rehabilitation is to reverse that trend.

b) What is the role of aerobic training, strength training and ventilator

muscle training in exercise prescription of pulmonary rehabilitation
Question 4
program?

Aerobic training. Aerobic training provokes physiological and structural

changes that will improve endurance performance. These changes center
around the trained muscles (an increased capillary network, mitochondrial
density and concentration of oxidative enzymes) and the cardiovascular
system (increased stroke volume).

Strength training. The stepwise multiple regression, diffusing capacity,

quadriceps force and the forced expiratory volume in one second (FEY
appeared to be significant determinants of maximal oxygen consumption. This 4
training was able to report benefits measured as an increase in the strength of
the muscle groups trained, an improved endurance capacity (cycle ergometer)
and an improved quality of life.

Ventilatory muscle training. Respiratory muscles can be trained to improve

strength and /or endurance in a similar way to skeletal muscle in other parts of
the body for breathing, consequently reducing dyspnea. Respiratory muscle
training may enhance the benefits acquired from an aerobic training program.

Question 5 A 72-year-old female presents to clinic with complaints of her heart racing, 8
chest pain and dizziness. She has history of hypertension, hyperlipidemia and
coronary artery disease. Patient is comfortable at rest but have symptoms
with less than ordinary activity. The perceived exertion rate is very strong.

Vitals HR – 103 BP – 128/72 RR – 18 O2 – 98%

Meds: • Lisinopril 10 mg daily • Aspirin 81 mg daily • Atorvastatin 80 mg

daily • Metoprolol tartrate 50 mg bid

 According to NYHA criteria, in which class this patient is classified for

functional capacity?
 Write down NYHA criteria of functional capacity?
 In which category patient currently present on modified Borg scale?
 Write down the modified Borg scale?
ANSWER:

 Class III (moderate)


 7-9 (modified BORG CR-10 SCALE)