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Mr. Y is a 59 yo man brought to the hospital via ambulance with acute dyspnea. He complains of progressive SOB with exertion, dry cough, weight gain, and stiffness in hands and feet. He denies any chest pain. Jugular vein distention noted. 2+ LE pitting edema noted. He was diagnosed with CHF. PMH: HTN, appendectomy. He denies cardiac history and does not smoke. He states he drinks a few beers per week. SH: He lives with his wife in a 2 story house. He is retired from an auto assembly plant. He reports heavy yardwork and housework are getting difficult. He takes daily walks with his wife but has cut back the distance this past month due to fatigue. Vital signs: BP 151/95, HR 105, RR 26, and on 4L O2 nc to maintain SpO2> 93% Lab values: RBC normal, WBC normal, Troponin I 0.1 (↑), HGB 10 g/dL Prior to treatment, the physical therapist assistant sees the following ECG on the telemetry monitor:   The heart rate of the 6 second ECG strip is:  

Which of the following interventions would be the MOST appropriate for the patient based on their ejection fraction?

42. Which of the following describes a motor unit?

29. Which of the following proteins is involved in regulating muscle contraction by blocking the active sites on actin?

33. What happens to the Z discs during muscle contraction?

31. What is the smallest functional contractile unit of a muscle fiber?

30. Which protein directly binds calcium during muscle contraction?

Gretchen is a 25-year-old female taken to the emergency room with tachypnea, tachycardia, wheezing on expiration, and a tight non-productive cough. Her CXR shows translucent lung fields, a flattened diaphragm, and an increased A-P diameter of chest.  Gretchen’s signs and symptoms are most consistent with:

Robert is a 72 yr old man admitted to the hospital diagnosed with Congestive Heart Failure presenting with increased SOB, productive cough, 10# weight gain in past  2 weeks, 3+ pitting edema in LEs, fatigue and weakness.  PMH includes: L LE transtibial amputation, obesity, HTN, hyperlipidemia, MI x 2 (2008, 2011), PTCA with stent 2011.  Home meds include: metoprolol (Beta Blocker), lisinopril (ACE inhibitor), Lasix (diuretic), and aspirin (antiplatelet/anticoagulant). SH:  Married, lives in 2 story home with 2 STE without railing, bed/bath up 14 steps with railing on R side as you go up.  Has half bath on first floor.  Pt is retired.  Pt is independent with his prosthesis. Hobbies include golf, computer, reading, and going to grandchildren’s’ sporting events.  He wears glasses all the time and wears hearing aids bilaterally PT Evaluation:  UE/LE ROM WNL in available joints.  Strength = 4+/5 in available musculature except bilateral hip extension= 4-/5.  Pt presents with 3+ pitting edema in B LEs.  Sensation—pt with increased sensitivity to light touch and pressure in bilateral LE’s.  Functional Mobility:  Supine to sit with minimal assist, sit to stand with rolling walker with min assist, NWB L LE.  Pt is unable to wear his prosthesis due to edema.  Gait training with RW x 10’ with min A, NWB L LE.  Pt had 2 standing rest breaks x 20 seconds each due to fatigue and SOB.  Stairs not assessed due to SOB and fatigue. Vital signs: Pre-activity (sitting)                            BP  136/80 mmHg         HR 90 bpm                SpO2 on 2L  99% During activity (gait)                           BP  120/75 mmHg        HR  105 bpm            SpO2 on 2L  91%            RPE  5/10      Post-activity (sitting)                          BP  125/76 mmHg         HR  100 bpm            SpO2 on 2L  95% Line management: Foley catheter, oxygen 2 L per nasal cannula, IV R forearm   The primary barrier to Robert’s success at home is:

10. What is the defining characteristic of a direct (fleshy) attachment to bone?