Test Bank For Essentials of Cardiopulmonary
Physical Therapy Fourth Edition.
,Section 1: Anatomy and Physiology
● Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems
● Chapter 2: Physiology of the Cardiovascular and Pulmonary Systems
Section 2: Pathophysiology
● Chapter 3: Ischemic Cardiovascular Conditions and Other Vascular Pathologies
● Chapter 4: Cardiac Muscle Dysfunction and Failure
● Chapter 5: Restrictive Lung Dysfunction
● Chapter 6: Chronic Obstructive Pulmonary Diseases
● Chapter 7: Cardiopulmonary Implications of Specific Diseases
Section 3: Diagnostic Tests and Procedures
● Chapter 8: Cardiovascular Diagnostic Tests and Procedures
● Chapter 9: Electrocardiography
● Chapter 10: Pulmonary Diagnostic Tests and Procedures
Section 4: Surgical Interventions, Monitoring, and Support
● Chapter 11: Cardiovascular and Thoracic Interventions
● Chapter 12: Thoracic Organ Transplantation: Heart and Lung
● Chapter 13: Monitoring and Life Support
Section 5: Pharmacology
● Chapter 14: Cardiovascular Medications
● Chapter 15: Pulmonary Medications
Section 6: Cardiopulmonary Assessment and Intervention
● Chapter 16: Examination and Assessment Procedures
● Chapter 17: Interventions for Acute Cardiopulmonary Conditions
● Chapter 18: Interventions and Prevention Measures for Individuals with
Cardiovascular Disease, or Risk of Disease
● Chapter 19: Pulmonary Rehabilitation
● Chapter 20: Pediatric Cardiopulmonary Physical Therapy
● Chapter 21: The Lymphatic System
● Chapter 22: Outcome Measures: A Guide for the Evidence-Based Practice of
Cardiopulmonary Physical Therapy
,Chapter 1: Anatomy of the Cardiovascular and Pulmonary
Systems
1. A patient presents with a palpable deformity at the junction of the manubrium and
the body of the sternum. Which anatomical landmark is located at this level and
what is its clinical significance during a pulmonary examination?
A. The suprasternal notch; it indicates the level of the clavicular articulation.
B. The sternal angle; it marks the level of the tracheal bifurcation.
C. The xiphoid process; it is the site for attachment of the central tendon.
D. The second costal cartilage; it represents the superior boundary of the mediastinum.
Correct Answer: B. The sternal angle; it marks the level of the tracheal bifurcation.
Rationale: The sternal angle, or "angle of Louis," is formed by the junction of the
manubrium and the body of the sternum. It is a key landmark that marks the level where
the trachea bifurcates into the right and left mainstem bronchi and corresponds to the
second costal cartilage anteriorly and the T4–T5 vertebrae posteriorly.
2. A physical therapist is evaluating a patient in the acute care setting with multiple
rib fractures in the area where the shaft of the ribs bend. Which of the following
breathing patterns should the therapist be most concerned about identifying?
A. Pursed-lip breathing to reduce air trapping.
B. Lateral costal expansion during deep inspiration.
C. Paradoxical breathing indicative of a flail chest.
D. Increased "pump-handle" motion of the upper ribs.
Correct Answer: C. Paradoxical breathing indicative of a flail chest.
Rationale: Rib fractures are most common just anterior to the angle where the shaft bends.
In cases of multiple fractures in adjacent ribs, a flail chest may occur, which is
characterized by paradoxical breathing patterns where the affected chest wall moves
inward during inspiration.
3. During the surgical placement of a chest tube to drain a large pleural effusion, the
surgeon must avoid trauma to the neurovascular bundle. Based on anatomical
principles, where is the most appropriate location for the tube insertion?
A. Directly inferior to the rib to utilize the costal groove.
, B. In the mid-axillary line, directly superior to the rib.
C. Medial to the sternal border in the second intercostal space.
D. Posteriorly at the level of the T10 vertebral body.
Correct Answer: B. In the mid-axillary line, directly superior to the rib.
Rationale: The costal groove, which contains the intercostal vein, artery, and nerve (VAN),
extends along the inferior border of the rib. To avoid trauma to these structures, chest
tubes are surgically inserted above the ribs (superior border).
4. A patient has sustained a spinal cord injury at the C4 level. Which of the following
best describes the expected effect on the primary muscle of inspiration?
A. Complete paralysis of the diaphragm due to loss of the phrenic nerve.
B. Preserved but weakened diaphragmatic contraction.
C. Loss of internal intercostal function while the diaphragm remains fully intact.
D. Over-reliance on the sternocleidomastoid as the phrenic nerve is spared.
Correct Answer: B. Preserved but weakened diaphragmatic contraction.
Rationale: The phrenic nerve, which innervates the diaphragm, arises from the C3, C4, and
C5 cervical spinal nerves. A lesion at C4 would disrupt some but not all of the roots
contributing to the phrenic nerve, potentially leading to weakened but not necessarily
absent diaphragmatic function depending on the completeness of the injury.
5. A patient with severe chronic obstructive pulmonary disease (COPD) presents
with hyperinflated lungs and a "barrel chest." What is the anatomical consequence
for the diaphragm in this state?
A. It sits in a high, arched position, increasing its excursion capacity.
B. It becomes flattened and rigid, placing it at a mechanical disadvantage.
C. Its zone of apposition increases, allowing for improved caudal movement.
D. It remains unaffected as the accessory muscles take over all work of breathing.
Correct Answer: B. It becomes flattened and rigid, placing it at a mechanical
disadvantage.
Rationale: Hyperinflation in COPD results in a flattening of the diaphragm. A flat and rigid
diaphragm cannot be effectively strengthened and loses its mechanical efficiency, which
triggers the automatic firing of accessory muscles to facilitate inspiration.
Physical Therapy Fourth Edition.
,Section 1: Anatomy and Physiology
● Chapter 1: Anatomy of the Cardiovascular and Pulmonary Systems
● Chapter 2: Physiology of the Cardiovascular and Pulmonary Systems
Section 2: Pathophysiology
● Chapter 3: Ischemic Cardiovascular Conditions and Other Vascular Pathologies
● Chapter 4: Cardiac Muscle Dysfunction and Failure
● Chapter 5: Restrictive Lung Dysfunction
● Chapter 6: Chronic Obstructive Pulmonary Diseases
● Chapter 7: Cardiopulmonary Implications of Specific Diseases
Section 3: Diagnostic Tests and Procedures
● Chapter 8: Cardiovascular Diagnostic Tests and Procedures
● Chapter 9: Electrocardiography
● Chapter 10: Pulmonary Diagnostic Tests and Procedures
Section 4: Surgical Interventions, Monitoring, and Support
● Chapter 11: Cardiovascular and Thoracic Interventions
● Chapter 12: Thoracic Organ Transplantation: Heart and Lung
● Chapter 13: Monitoring and Life Support
Section 5: Pharmacology
● Chapter 14: Cardiovascular Medications
● Chapter 15: Pulmonary Medications
Section 6: Cardiopulmonary Assessment and Intervention
● Chapter 16: Examination and Assessment Procedures
● Chapter 17: Interventions for Acute Cardiopulmonary Conditions
● Chapter 18: Interventions and Prevention Measures for Individuals with
Cardiovascular Disease, or Risk of Disease
● Chapter 19: Pulmonary Rehabilitation
● Chapter 20: Pediatric Cardiopulmonary Physical Therapy
● Chapter 21: The Lymphatic System
● Chapter 22: Outcome Measures: A Guide for the Evidence-Based Practice of
Cardiopulmonary Physical Therapy
,Chapter 1: Anatomy of the Cardiovascular and Pulmonary
Systems
1. A patient presents with a palpable deformity at the junction of the manubrium and
the body of the sternum. Which anatomical landmark is located at this level and
what is its clinical significance during a pulmonary examination?
A. The suprasternal notch; it indicates the level of the clavicular articulation.
B. The sternal angle; it marks the level of the tracheal bifurcation.
C. The xiphoid process; it is the site for attachment of the central tendon.
D. The second costal cartilage; it represents the superior boundary of the mediastinum.
Correct Answer: B. The sternal angle; it marks the level of the tracheal bifurcation.
Rationale: The sternal angle, or "angle of Louis," is formed by the junction of the
manubrium and the body of the sternum. It is a key landmark that marks the level where
the trachea bifurcates into the right and left mainstem bronchi and corresponds to the
second costal cartilage anteriorly and the T4–T5 vertebrae posteriorly.
2. A physical therapist is evaluating a patient in the acute care setting with multiple
rib fractures in the area where the shaft of the ribs bend. Which of the following
breathing patterns should the therapist be most concerned about identifying?
A. Pursed-lip breathing to reduce air trapping.
B. Lateral costal expansion during deep inspiration.
C. Paradoxical breathing indicative of a flail chest.
D. Increased "pump-handle" motion of the upper ribs.
Correct Answer: C. Paradoxical breathing indicative of a flail chest.
Rationale: Rib fractures are most common just anterior to the angle where the shaft bends.
In cases of multiple fractures in adjacent ribs, a flail chest may occur, which is
characterized by paradoxical breathing patterns where the affected chest wall moves
inward during inspiration.
3. During the surgical placement of a chest tube to drain a large pleural effusion, the
surgeon must avoid trauma to the neurovascular bundle. Based on anatomical
principles, where is the most appropriate location for the tube insertion?
A. Directly inferior to the rib to utilize the costal groove.
, B. In the mid-axillary line, directly superior to the rib.
C. Medial to the sternal border in the second intercostal space.
D. Posteriorly at the level of the T10 vertebral body.
Correct Answer: B. In the mid-axillary line, directly superior to the rib.
Rationale: The costal groove, which contains the intercostal vein, artery, and nerve (VAN),
extends along the inferior border of the rib. To avoid trauma to these structures, chest
tubes are surgically inserted above the ribs (superior border).
4. A patient has sustained a spinal cord injury at the C4 level. Which of the following
best describes the expected effect on the primary muscle of inspiration?
A. Complete paralysis of the diaphragm due to loss of the phrenic nerve.
B. Preserved but weakened diaphragmatic contraction.
C. Loss of internal intercostal function while the diaphragm remains fully intact.
D. Over-reliance on the sternocleidomastoid as the phrenic nerve is spared.
Correct Answer: B. Preserved but weakened diaphragmatic contraction.
Rationale: The phrenic nerve, which innervates the diaphragm, arises from the C3, C4, and
C5 cervical spinal nerves. A lesion at C4 would disrupt some but not all of the roots
contributing to the phrenic nerve, potentially leading to weakened but not necessarily
absent diaphragmatic function depending on the completeness of the injury.
5. A patient with severe chronic obstructive pulmonary disease (COPD) presents
with hyperinflated lungs and a "barrel chest." What is the anatomical consequence
for the diaphragm in this state?
A. It sits in a high, arched position, increasing its excursion capacity.
B. It becomes flattened and rigid, placing it at a mechanical disadvantage.
C. Its zone of apposition increases, allowing for improved caudal movement.
D. It remains unaffected as the accessory muscles take over all work of breathing.
Correct Answer: B. It becomes flattened and rigid, placing it at a mechanical
disadvantage.
Rationale: Hyperinflation in COPD results in a flattening of the diaphragm. A flat and rigid
diaphragm cannot be effectively strengthened and loses its mechanical efficiency, which
triggers the automatic firing of accessory muscles to facilitate inspiration.
