ACSM EP-C Certification Review Questions With Correct Answers

Signs/Symptoms suggestive of CV, metabolic, or renal disease: - Answer - Pain - Intermittent claudication - Ankle edema - Dizziness or syncope - SOB (at rest or w/ mild exertion) - Unusual fatigue or SOB w/ usual activities - Orthopnea or paroxysmal nocturnal dyspnea - Palpations or tachycardia - Known heart murmur Orthopnea: - Answer Dyspnea occurring at rest in the recumbent (laying down) position that is relieved promptly by sitting upright or standing Paroxysmal Nocturnal Dyspnea: - Answer Begins usually 2-5 hours after onset of sleep & may be relieved by sitting on side of bed or getting out of bed Intermittent Claudication: - Answer - Pain that occurs in lower extremities w/ an inadequate blood supply (usually result of atherosclerosis) that is brought on by exercise - Pain does not occur w/ standing or sitting, is reproducible day-to-day, is more severe when walking upstairs or up-hill, & is often described has a cramp that disappears 1-2 min after stopping exercise Snycope - Answer Loss of consciousness General Indications for Stopping an Exercise Test: - Answer - Onset of angina-like symptoms - Drop in SBP /= 10 w/ an increase in WR or if SBP decreases below value obtained in same position prior to testing - Excessive rise in BP = SBP /=250 &/or DBP /= 115 - SOB, wheezing, leg cramps, or claudication - Signs of poor perfusion = light-headedness, confusion, ataxia (loss of control of body movements), pallor (paleness), cyanosis, nausea, or cold & clammy skin - Failure of HR to increase w/ increased exercise intensity - Noticeable change in heart rhythm by palpation or auscultation - Subject requests to stop - Physical or verbal manifestations of severe fatigue - Failure of test equipment Contraindications to Symptom-Limited Maximal Exercise Testing: Absolute Contraindications - - Answer - Acute MI w/in 2d - Ongoing unstable angina - Uncontrolled cardiac arrhythmia w/ hemodynamic compromise - Active endocarditis - Symptomatic severe aortic stenosis - Decompensated heart failure - Acute pulmonary embolism, pulmonary infarction, or deep venous thrombosis - Acute myocarditis or pericarditis - Acute aortic dissection - Physical disability that precludes safe & adequate training Contraindications to Symptom-Limited Maximal Exercise Testing: Relative Contraindications - - Answer - Known obstructive left main coronary artery stenosis - Moderate to severe aortic stenosis w/ uncertain relationship to symptoms - Tachyarrhythmias w/ uncontrolled ventricular rates - Acquired advanced or complete heart block - Recent stroke or transient (short) ischemia (inadequate blood supply) attack - Resting HTN w/ SBP 200 or DBP 110 - Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, & hyperthyroidism Stenosis - Answer Narrowing of a passage in the body Causes of False NEGATIVES Symptom-Limited Maximal Exercise Test Results - Answer - Failure to reach an ischemic threshold - Monitoring an insufficient # of leads to detect ECG changes - Failure to recognize non-ECG signs & symptoms that may be associate w/ underlying CVD (exertional hypotension) - Angiographically significant CVD compensated by collateral circulation - Musculoskeletal limitations to exercise preceding cardiac abnormalities - Technical or observer error Sensitivity: - Answer The % of patients w/ IHD who have a positive test . Influenced by differences in disease prevalence of the cohort studied, test protocols, ECG criteria for a positive test, & angiographic definition of IHD. Specificity: - Answer The % of patients w/o IHD who have a negative test. Influenced by differences in disease prevalence of the cohort studied, test protocols, ECG criteria for a positive test, & angiographic definition of IHD. Overweight/Obese FITT Aerobic - - Answer /= 5 d/wk Initially, more moderate (40-59% VO2R or HRR) Progress to vigorous (/= 60%) -- for greater health benefits 30 min/d (150 min/wk) Increase to 60+ min/d (250-300 min/wk) - RT & flexibility FITT is same as for healthy adults Children FITT: Aerobic - - Answer Daily Most should be moderate (noticeable increase in HR & breathing) & vigorous (at least 3 d/wk) As part of min/d exercise Children FITT: RT - - Answer /= 3 d/wk Use of body weight as resistance or 8-15 submaximal reps to point of moderate fatigue As part of /= 60 min/d exercise Children FITT: Bone Strengthening - - Answer /= 3 d/wk As part of /= 60 min/d exercise Older Adult FITT: Aerobic - - Answer RPE: Moderate = 5-6 Vigorous = 7-8 Can accumulate in bouts of at least 10 min each Older Adult FITT: RT - - Answer /= 2 d/wk Light (40-50% 1RM) for beginners. Progress to moderate to vigorous (60-80% 1RM) Or, moderate (5-6) to vigorous (7-8) 8-10 exercises 1-3 sets of 8-12 reps 10-15 reps to improve strength Older Adult FITT: Flexibility - - Answer /= 2 d/wk Hold stretch for 30-60s Avoid ballistic movements Healthy Adult FITT: Neuromotor - - Answer /= 2-3 d/wk /= 20-30 min/d Involve motor skills (balance, agility, coordination, gait), proprioceptive exercise training, & multifaceted activities (tai chi, toga) Contraindications for Exercising during Pregnancy: Relative - - Answer - Severe anemia - Unevaluated maternal cardiac dysrhythmia - Chronic bronchitis - Poorly controlled T1DM - Extreme morbid obesity - Extreme underweight - History of extremely sedentary lifestyle - Intrauterine growth restriction in current pregnancy - Poorly controlled HTN - Orthopedic limitations - Poorly controlled seizure disorder - Poorly controlled hyperthyroidism - Heavy smoker Contraindications for Exercising during Pregnancy: Absolute - - Answer - Hemodynamically significant heart disease - Restrictive lung disease - Incompetent cervix/cerclage - Multiple gestation at risk for premature labor - Persistent 2nd or 3rd trimester bleeding - Placenta previa after 26 wk gestation - Premature labor during current pregnancy - Ruptured membranes - Preeclampsia/pregnancy-induced HTN Circumference Measurements: - Answer - Abdomen - Arm - Buttocks/hips - Calf - Forearm - Hips/thigh - Mid-thigh - Waist