patho exam 3

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patho exam 3
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2015-04-13 19:33:43
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patho exam 3
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  1. hormone naturally produced by the adrenal cortex?
    cortisol/hydrocortisone
  2. cortisol is primarily involved in?
    • control of glucose metabolism
    • bodys ability to deal with stress
  3. what are some other attributes of cortisol?
    • decrease inflammation 
    • suppress the immune system (immunosuppression is good for autoimmune)
  4. Normally, cortisol release occurs cyclically with plasma cortisol levels rising _________ throughout the early morning hours and peak at approx. ______.
    slowly; 8 AM
  5. T/F: cortisol is released in any situation you feel as stressful
    true
  6. medrol
    topicort
    dexasone/methasone
    lidex
    predinsone/prelone 

    what type of med are these?
    glucocorticoid
  7. allergic disorders
    collagen disorders
    neurological
    dematological disorders
    GI disorders
    hematological disorders 
    respiratory disorders 
    rheumatic disorders 

    what do all these have in common?
    non endocrine pathologies treated with glucocorticoids
  8. muscle spastity and muscle spasm are treated with what type of medication/
    muscle relaxers
  9. what are the primary side effects of muscle relaxers?
    • dizziness
    • drowsiness
  10. can muscle relaxers develop a physical dependence?
    yes
  11. nausea
    light headedness
    vertigo
    ataxia
    headaches

    these are all other reported side effects of what type of med?
    muscle relaxers
  12. soma
    diazepam/valium
    paraflex/parafon forte
    flexeril
    skelaxin
    robaxin

    what type of med's are these?
    muscle relaxers
  13. what is an over the counter, homeopathic supplement for joint health that there is still debate about its effects?
    glucosamine
  14. according to the new research, is there really an imporvement in pain while taking glucosamine?
    no, not really.
  15. what are the functions of the heart?
    • pump oxygenated blood to the arterial system 
    • and collect deoxygenated blood from the venous system
  16. what part of the heart receives the blood?
    right and left atria
  17. what part of the heart send the blood?
    right and left ventricles
  18. where does the right ventricle send the blood?
    pulmonary
  19. where does the left ventricle send the blood?
    systemic
  20. what are the three layers of the heart?
    • pericardium: outer layer 
    • myocardium: contracts the heart; middle layer
    • endocardium: inner layer
  21. blood vessels on the surface of the heart which supply heart muscle with blood?
    coronary arteries
  22. the coronary arteries arise from the ________.
    aorta
  23. the ______ aorta supplies inferior heart; medium infarct possible resulting in possible AV block and ventricle damage
    right
  24. the ______ aorta supplies anterior heart; major infarct possible resulting in sudden death or heart failure
    left
  25. which arteries fill on diastole?
    coronary arteries
  26. what maintains uni-directional blood flow through the heart?
    cardiac valves
  27. the __________ valve is between the r. atrium and r. ventricle and it is an _____________ type valve
    tricuspid; atrioventricular
  28. the _______ valve is between the l. atrium and l. ventricle and it is an ___________ type valve?
    bicuspid (mitral); atrioventricular
  29. the _______ valve is btw the l. ventricle and aorta and it is a ____________ type valve
    aortic; semilunar
  30. the ____________ valve is btw the right ventricle and pulmonary artery and it is a ___________ type valve
    pulmonary; semilunar
  31. arteries are __________________ due to musculoature
    cross sectionally thick
  32. smaller arteries that control the amount of blood flowing into specific areas
    arterioles
  33. very small vessels in networks; site of nutrient exchange btw blood and tissues
    capillaries
  34. where does gas exchange take place?
    capillary bed
  35. capacitance vessels (at any given time hold approx. 70% of total blood volume); poorly organized and less smooth muscle
    veins
  36. vein flow depends upon?
    • skeletal muscle action
    • respiratory motion
    • gravity
    • valves
  37. pacemaker of the heart ocatd at the junction of the superior vena cava and the right atrium
    sinoatrial node (SA)
  38. located in the lower aspect of the atrial septum, receives electrical impulses from the SA node
    atrioventricular (AV) node
  39. fused with AV node near the top of ventricles
    bundle of his
  40. right and left in septum inbtween ventricles
    bundle branches
  41. terminal network of fibers in the ventricles
    purkinje fibers
  42. what are some common conditions associated with these structures of the heart?

    1: heart muscle
    2: heart nervous system
    3: heart valves
    4: pericardium
    5: blood vessles
    • 1. myocardial infarction
    • 2. arrhythmias
    • 3. murmurs
    • 4. pericarditis
    • 5. atherosclerosis
  43. what are some of the most common cardiac diagnostic  tests/
    • ECG
    • auscultation
    • echocardiogram
    • exercise stress tests
  44. what nerve root level can cardiac pain be referred to?
    C3-T4
  45. what is the most common spinal nerve root level is it most common to see cardiac pain referred to and why?
    C5; it innervates the heart, respiratory diaphragm and shoulder
  46. what are some of the most common heart pathologies?
    • CAD
    • atherosclerosis
    • angina pectoris
    • MI
    • CHF
    • arrhythemias
    • congenital heart defects
  47. what is aka as ischemic heart disease?
    coronary artery disease
  48. general term of all types of arterial changes; degenerative changes in arteries in which elasticity is lost, walls thicken, harden and lumen narrows
    arteriosclerosis
  49. an inflammatory process whereby atheromas or plaques consisting of lipids, cells, fibrin and cell debris from insde the walls or medium sized arteries after injury is incurred to the wall
    atherosclerosis
  50. high cholestrol content, low triglyceride content; transports cholesterol from the liver to cells; binds to receptors on the membranes of smooth muscle cells and promotes atheroma formation
    LDL- low density lipoprotein
  51. high tiglyceride content and moderate cholesterol content; contributes to atheroma formation
    VLDL- very low density lipoprotein
  52. low cholesterole content, used to transport cholesterol from the periphery to the liver where it is catabolized and excreted
    high density lipoprotein
  53. physical activity
    cigarette smoking
    elevated serum cholesterol
    high blood pressure

    these are all what type of risk factors for CAD?
    modifiable
  54. age
    male
    family history
    race
    infections

    these are all what type of risk factors for CAD>
    non-modifiable
  55. obesity
    response to stress
    personality
    DM
    hormonal status

    the are all what for CAD?
    contributing factors
  56. what has been the gold standard for predicting CAD but now there are things that are better?
    cholesterol level
  57. Now what are the most common predictors for CAD?
    • elevated homocysteine
    • high sensititivty c-reactive protein (CRP)
    • fibrinogen levels
    • high level of lipoprotein
    • pulse pressure >60mmHg
    • ED
  58. what is the procedure where they put in a "balloon" that blows up the artery?
    angioplasty
  59. chest pain due to a deficit of oxygen for the heart muscle?
    angina pectoris
  60. imbalance btw cardiac workload and oxygen spply to myocardial tissue with the primary cause being CAD, but may also be a result of circulatory disorders
    angina pectoris
  61. sudden onset of temp. pain, pressure or "strangling" sensation during exertion that typically lasts 1-5 min
    felt sub-sternally or can radiate to jaw, neck, throat, back and arms
    may also be described as squeezing, buring, pressing, choking, aching, or as heartburn

    these are s/s of what?
    angina pectoris
  62. what type of angina is possible related to CHF and will wake one up from sleep demonstrating the same characteristics as exertional angina?
    nocturnal
  63. what type of angina is secondary to CAD and occurs at rest; possibly sever and not easliy relieved by nitro?
    prinzmetals
  64. what type of angina typically occurs at a predictable level of exertion and responds to rest or nitroglycerin
    stable
  65. what type of angina occurs with either rest or exertion and changes in freq., duration and intensity?
    unstable
  66. what is caused by obstruction of coronary artery leading to prolonged ischemia (over 20 min) cell death/necrosis
    MI
  67. what is the most common cause for MI?
    atherosclerosis
  68. what are the three ways in which a MI can develop?
    • thrombus formation
    • vasospasm in presence or partial occulusion
    • embolic (thrombus may break away producing an embolus that occuludes a smaller coronary artery)
  69. what are the classic s/s of a MI?
    • light headedness, dizziness
    • SOB
    • nausea
    • profuse perspiration
  70. left chest, stomach, or abdominal pain
    pain relieved by antacids but not nitro or rest
    continuous mid-scapular or thoracic pain
    isolated right biceps pain
    unexplained nausea or vomiting; flu like s/s w/o chest pain
    unexplained anxiety, weakness or fatigue

    these all have what in common?
    female considerations with MI
  71. alterations in cardiac rate or rhythm, manifested on ECG
    arrhythmia
  72. damage to hearts conduction system
    systemic causes: electrolyte abnormalities, fever, drug toxicity, infection, and stress
    produce inefficiency of hearts pumping so cardiac output may drop 

    these are all due to what?
    arrhythmia
  73. s/s for arrhythmia include?
    • depends on the part of the heart involved
    • heart palpitations, dizziness, chest pain
  74. a physiologic state in which the heart is unable to pump enough blood to meet the metabolic needs of the body at rest or during exercise
    CHF
  75. not a disease, denotes a group of manifestations related to inadequate pump performance
    CHF
  76. when __________ of heart fails to propel blood forward normally, congestion occurs in the pulmonary irulation as blood acculmulates in the lungs resulting in SOB
    left side
  77. T/F: failure of one side of the heart leads to failure on the other side of the heart
    true
  78. ____________ heart failure results in peripheral edema and organ enlargement
    right side
  79. decreased blood supply to tissues; general hypoxia
    fatigue and weakness, dyspnea, SOB, exercise intolerance, dizziness
    compensatory mechanisms; tachycardia, pallor, fluid retention

    these are s/s for what?
    CHF
  80. results in pulmonary related s/s
    left sided failure
  81. results in peripheral edema, ascites, distended neck veins, headach
    right sided failure
  82. peripheral edema is the hallmark for which side of the heart with CHF?
    right
  83. swelling associated with CHF is typically in what type of pattern?
    bilateral and dependent; dangling legs
  84. you want to watch for 3lbs or > weight gain or gradual continuous gain over several days accompanied by swelling in the ankles and feet, abdomen, SOB and fatigue with pt.'s with?
    CHF
  85. what are anomalies that arise during the first 8 weeks of embryonic life?
    congenital heart defects
  86. "hole in the heart", opening btw ventricles; blood flows from left to right ventricles due to pressure differential; less blood leaves left ventricle, reducing cardiac output
    ventricular septal defect
  87. narrowing of pulmonary artery reducing blood flow to lungs for oxygenation
    pulmonary stenosis
  88. most common congenital heart defect; pulmonary valve stenosis, ventricular septal defect, dextoposition of the aorta over VSD, right ventricular hypertrophy
    tetralogy of fallot
  89. what is the major sign for congenital heart defects?
    cyanosis
  90. pericarditis
    endocarditis
    rheumatic disease

    what do these have in common?
    causes of valvular issues
  91. inflammation of the parietal and viseral pericardium. may be acute or chronic and may be primary or secondary to other conditions
    pericarditis
  92. chest pain
    dyspenea
    increase pulse rate, fever

    these are s/s for what?
    pericarditis
  93. micro-organisms in the general circulation attach to the endocardium and invade the heart valves causing inflammation which interferes with valve function
    infective endocarditis
  94. congenital valve defects, rheumatic fever, mitral prolapse, artificial valves, IV drug users, immune system suppression, post surgical cardiac patients
    predisposing conditions for infective endocarditis
  95. may be sudden or onest or asymptomatic for mnths
    valvular dysfunction
    chest pain
    CHF
    clubbing of the fingernails
    arthralgia, arthritis, acidosis
    myalgia, LBP

    these are symptoms of what?
    infective endocarditis
  96. infection caused by streptococcal bacteria in children ages 5-15 which is acute then becomes chronic due to an abnormal immune reaction with connective tissue in skin, joints, brain and heart
    rhematic fever
  97. if strep is not fatal, _______________ occurs, caused by scarring and deformity at the heart valves
    chronic rheumatic heart disease
  98. carditis with chest pain
    acute onset of polyarthritis
    arthralgias and weakness
    chorea (jerky arms and legs)
    fever
    palpitations 

    these are symptoms of what?
    rheumatic heart disease
  99. persistent elevation of systolic blood pressure above 140mmHg and/or diastolic pressure above 90mmHg at least two or more separate occassions more than 2 weeks apart
    hypertension
  100. what is considered normal BP?
    120/80
  101. what BP is considered pre-hypertensive?
    120-139/80-89
  102. what is stage 1 HTN?
    140-159/90-99
  103. what is stage 2 HTN?
    >= 160/ >=100
  104. HTN is a powerful risk factor for?
    • stroke
    • strongly linked to heart attack
    • heart and kindey failure
    • damage to arterioles with secondary hardening further exacerbating HTN
  105. type of HTN that is idiopathic, most common (90-95%) increased arteriorlar vasoconstriction increases peripheral resistance and increases diastolic pressure; increased BP over a long period of time will damage blood vessel walls and atherosclerosis will occur, further increasing BP
    essential
  106. what type of HTN results from renal or endocrine disease
    secondary
  107. what type of HTN is intermittent elevation interspersed with normal readings
    labile HTN
  108. what type of HTN is uncontrollable, severeand rapidly progressive leads to target organ damage
    malignant
  109. what type of HTN does not have a diastolic change?
    isolated systolic HTN
  110. preggo
    alcohol abuse
    increase in ICP
    collagen disease
    endocrine disease
    renal disease
    acute stress
    nerological disorders 

    these all have what in common?
    possible causes of HTN
  111. why should you take caution with pt.'s with NSAIDS and CAD?
    more likely to suffer myocardial event during exercise
  112. are either confined to the heart or are part of generalized systemic disorders often lead to cardiovascular death or progressive heart failure- related disability.
    cardiomyopathy
  113. a heterogenous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and are due to a variety of causes that frequently are genetic
    cardiomyopathy
  114. in what decade does cardiomyopathy usually occur?
    2nd and 3rd generation
  115. what type of cardiomyopathy is 50% idopathic, the rest of the case result from myasthenia gravis, rheumatic fever, muscular dystrophy, sarcoidosis
    dilated
  116. what type of cardiomyopathy is genetically trasmitted; most common cause of death in young athletes
    hypertrophic
  117. what type of cardiomyopathy occurs as a result of myocardial fibrosis, hypertrophy, infiltration or defect in relaxation
    restrictive
  118. what type of intervention would you use with a pt. with cardiomyopathy?
    • breathing techniques; avoid valsalva
    • energy conservation techniques
    • teach how to monitor for s/s of cardiomyopathy
  119. relatively uncommon acute or chronic inflammation of the heart muscle, classified by the american heart association as an acqired inflammatory cardiomyopathy. most often caused by bacterial or viral infection
    myocarditis
  120. complications of myocarditis include?
    • heart failure
    • arrhythmias
    • congestive cardiomyopathy
    • sudden death
  121. mild, continuous low level chest pain
    epigastric soreness
    dyspnea
    fatigue
    palpitations
    s/s of viral upper respiratory infection 

    these are s/s of?
    myocarditis
  122. any abnormality in the arteries or veins excluding the heart?
    PVD
  123. increased fatigue and weakness, intermittent claudictation or leg pain associated with exercise due to muscle ischemia, sensory impairment, decreased peripheral pulses, pallor or cyanosis of skin, dry and hairless skin, thick toenails
    PAD
  124. pain in the region of a thrombus, swelling, redness or warmth of leg, dilated veins, positive homans sign if thrombus is in calf
    PVD
  125. what type of PVD is the leading cause of amputation?
    PAD
  126. vasospastic disorder in which periodic temporary but sever vasoconstricion occurs in arterioles and small arteries in the superficial tissues of the fingers and toes; idopathic or secondary to other conditions
    raynauds syndrome
  127. irregular dilated and tortuous areas of the superficial or deep veins. may develop from defect or weakness in vein walls or valves, familial tendency, lack of muscle support in superficial leg veins, trauma to valves, long periods of standing, crossing the legs, preggo
    varicose veins
  128. development of a thrombus in a vein in which inflammation is present
    caused by blood stasis due to immobility; endothelial injury from trauma, IV chemical injury, increased blood coagulability from dehydration, cancer, preggo . venous thrombophlebitis can lead to pulomnary embolism which is life threatening
    leg will be tender, burning, aching
    thrombophlebitis
  129. What parts of the body do PT's screen for pulmonary issues?
    • neck or Ut's pain
    • shoulder or scapular pain
    • upper back pain 
  130. abrupt dyspnea with fall in BP with weak and rapid pulse
    inadequate ventilation or CO2 return
    any red flag s/s with a Hx of previous CA

    these are __________ medical attention s/s
    immediate 
  131. shoulder pain aggr by resp movement
    shoulder pain aggr by supine postion
    shoulder or chest pain that subsides with autosplinting
    asthmatic pt. with s/s during exercise
    weak and rapid pulse with fall in BP
    persistent cought, dyspnea or constitutional s/s

    these are ___________ guidelines for physician referral 
    general 
  132. <2 points on the wells criteria =?
    low probability 
  133. 2-6 points on the wells criteria =? 
    moderate probablity 
  134. >6 points on the well criteria =?
    high probablity 
  135. dyspnea
    pleuritic chest pain provoked with deep respiration and/or cough
    tachypbea
    persistent cough
    apprehension, anxiety
    tachycardia
    palpitations

    what are these?
    clinical manifestations associated with PE 
  136. what are the 2 most common s/s of pulmonary disorders?
    • cough 
    • dyspnea
  137. chest pain
    abnormal sputum
    hemoptysis
    cyanosis
    digital clubbing 
    altered breathing patterns

    what are these?
    other s/s of pulmonary disorders 
  138. what can a dry cough mean?
    • tumor
    • congestion
    • hypersensitive airways 
  139. what could purlent sputum mean?
    infection 
  140. what could non-purulent sputum mean?
    airway irritation 
  141. what does rust colored sputum mean?
    pneumonia 
  142. what could coughing up blood mean?
    • infection
    • inflammation
    • abscess
    • tumor
    • MI 
  143. repeated cycles of deep breathing, followed by shallow and/or cessation
    cheyne-stoke 
  144. abnormally long and deep inspiration
    hyperventilation 
  145. decreased air entering alveoli
    hypoventilation
  146. distressing dyspnea with increased rate and depth, air hunger
    kussmauls 
  147. chest wall falls in during inspiration
    paradoxical 
  148. shrill, harsh sound during inspiration
    stridor 
  149. high pitched whisteling sound with experation 
    wheezing 
  150. discontinuous low pitched sounds predominatly during inspriation
    crackles 
  151. cyanosis
    pallor
    clubbing of the nails
    use of accessory muscles 
    nasal flaring
    retraction of intercostal, supraclavicular or suprasternal spaces
    cough
    sputum

    what are these?
    further clinical inspection for pulmonary disorders
  152. CF
    COPD
    lung CA
    bronchiectasis

    what do these 4 things have in common?
    pulmonary causes for clubbed nails 
  153. what can clubbed nails be due to other than pulm?
    • heart disease
    • PVD
    • disorders of the liver and GI 
  154. chronic bronchitis and emphysema are what?
    COPD 
  155. asthma and bronchiectasis can also be considered what?
    COPD 
  156. pneumonia
    adult RDS
    scoliosis
    atelectasis

    these are considered what type of pulm disease?
    restrictive 
  157. increased resistance to air movement in and out resulting in hyperinflation
    COPD 
  158. how does COPD typically present?
    • dyspnea
    • chronic productive cough
    • excessive mucus production 
  159. when do patients typically start to present with s/s of COPD?
    55-60 yoa 
  160. what type of exercise would you do with a pt. with COPD?
    • aerobic
    • postural
    • strength
    • flexibility
    • breathing 
  161. what is main goal with rehab with pt.'s with COPD?
    increase oxygen uptake into the tissues and maximizing status 
  162. how would you apply resisted inspiratory muscle training?
    ankle weight across the rib cage while taking deep breaths
  163. how do you do postural drainage?
    percussion and vibration to the congested segment of the lung
  164. in pt.'s with COPD is moderate exercise better than sustained intense work for 45 minutes, why?
    no; muscle oxidative capicity critical to function
  165. what oxygen level is unsafe to exercise a pt.?
    <90
  166. what is typical pt. education for COPD?
    • hydration to prevent secretion thickening
    • energy conservation
    • flu vaccine (immunosuppressed due to steroid use) 
  167. productive cough >3 months per year for 2 consecutive years accompanied by decreased FEV/FCV ratio <75%
    chronic bronchitis 
  168. inflammation and scarring of the bronchial lining
    hypersecretion and hypertrophy of mucus producing glands
    thick sputum and swelling obstruct airways

    these are characteristics of what? 
    chronic bronchitis 
  169. what is cor pulmonale and what is it associated with?
    right sided heart failure; chronic bronchitis 
  170. what is the inflammation and scarring of chronic bronchitis due to?
    heat from cigarette smoke 
  171. chronic productive cough that is worse in the AM and PM. This is a clinical indicator for what?
    chronic bronchitis 
  172. chronic bronchitis results in what?
    • SOB
    • prolonged expiration
    • persistent coughing with expectoration
    • recurrent infection 
  173. pathological retention of air in tissues, particularly the lungs?
    emphysema 
  174. with emphysema, destruction of the elastin leads to permanent, irreversible enlargement of the?
    alveoli 
  175. obstruction from emphysema is from changes in the actual _______________ versus from ___________________
    lung tissue; mucus production and swelling 
  176. reversible obstructive lung disease characterized by inflammation and smooth muscle contraction that has a hereditary componet
    asthma 
  177. interplay to varying degrees of biochemical, autonomic, infectious, immuologic, endocrine and psychologic factors
    asthma 
  178. non-allergic type asthma that  is typically over 40 yoa due to respiratory infection?
    intrinsic 
  179. what type of asthma is triggered by allergens?
    extrinsic 
  180. what are the 4 main catorgories for asthma?
    • adult onset
    • exercise induced 
    • aspirin-sensitive
    • occupational 
  181. what is the hygiene hypothesis?
    germ freaks over cleaning reducing their ability to build up immunity to germs 
  182. a hacking, paroxysmal, exhausting, irritative non productive cough is a clinical manifestation of what?
    asthma 
  183. if a pt. with asthma has not responded to initial treatment of med within 15-20 min, is hunched over and unable to straighten up or resume activity after dose of meds, and their lips and/or nail beds are turning blue/gray what you be your course of action?
    activate EMS 
  184. progressive form characterized by irreversible destruction and dilation of airways generally associated with chronic bacterial infections?
    bronchiectasis 
  185. inflammatory pulmonary response to the offending organism or agent
    pneumonia 
  186. bacterial, viral, fungal, mycoplasm
    inhalation of toxic or caustic chemicals, smoke, dust, or gases
    aspiration of food, fluids or vomit 

    these are causes of what?
    pneumonia 
  187. infectious agents
    cigarette smoking
    chronic bronchitis
    poorly controlled DM
    dehydration
    malnourished
    hospitalized
    elderly, very young
    profound disabilty
    bedridden
    altered consciousness

    these are risk factors for what?
    pneumonia 
  188. viral pneumonia can be due to or set the stage for what?
    chickenpox or measles 
  189. what type of pneumonia is more common in adults but is less common than viral pneumonia over all age ranges and that can turn in to sepsis if not treated properly?
    bacterial 
  190. sudden and sharp pleuritic chest pain, aggravated by movement and accompanied by hacking productive cough often with sputum rust colored or green
    pneumonia 
  191. how long does it typically take pneumonia to resolve?
    1-2 weeks; walking pneumonia last's longer 
  192. acute respiratory failure secondary to a systemic or pulmonary insult; often a fatal complication of serious illness such as sepsis, trauma, or major surgery 
    ARDS 
  193. diffuse alveolar damage, necrosis and apoptosis and inactivation of surfactant leads to pulmonary edema and atelectasis that can develop into multiple organ dysfunction syndrom -> multi system organ failure 
    ARDS 
  194. autosomal recessive inherited disorder of ion transport in the exocrine glands 
    cystic fibrosis 
  195. increased viscosity of secretions in multiple organ systems and patch atelectasis with hyperinflation of the lungs and predisposes  them to infection
    cystic fibrosis 
  196. if a mother said that when she kissed her child on the forehead and said they were really salty what you suspect?
    cystic fibrosis 
  197. secretion blocks release of enzymes into the duodenum is a clinical manifestation of the pancreas due to?
    Cystic fibrosis 
  198. most pt.'s with cystic fibrosis most often die from what?
    pneumonia 
  199. the goals of exercise for pts with cystic fibrosis are mainly what?
    • enhance fitness
    • increase sputum clearance 
    • delay decline in pulm function
    • prevent decrease in bone density 
  200. special considerations for athletes with cystic fibrosis include?
    • adequate caloric intake
    • proper hydration and electrolyte balance
    • maintenance of weight 
  201. cor pulmonale is due to what?
    pulmonary hypertension 
  202. cor pulmonale is right sided heart failure but it is also known as?
    pulmonary heart disease 

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