Biomedicine Flashcards
Man with acute chest pain, resulted in myocardial infarction, which drug for initial treatment?
NTG - Nitroglycerin
CAB in CPR
Compression, Airway, Breathing
CPR in Adult: Compression to breaths
30:2
Pericarditis-
Where’s the pain?
How can you alleviate it?
When does it get worse?
may travel to left shoulder and neck.
Sitting up and leaning forward can ease the pain
Often intensifies when you cough, lie down or inhale deeply.
CPK levels indicate?
Creatine Kinase (CPK)
Heart damage
Beta blockers are used for what?
Hyperthyroidism
Hypertension
Cardiovascular disease, prevent migraine headache
What pharmaceuticals treats migraines?
Beta Blocker
Beta blockers prevents
Headache
Beta-adrenergic Blockers treat what?
Thyroid Storm
Hyperthyroidism
Which drug can relax smooth muscle and lower vessel resistance
Alpha blocker cause vessel dilation: ACEI/ARB, CCB, direct vasodilator, nitrates
Calcium channel blockers
- Purpose
- Side effect
Relax vessels
- for hypertension, arrthmia, angina
- side effect: hypotension, AV block
Calcium Channel Blockers CCH) Toxicity
Rapid progression of hypotension, Brady dysrhythmia, cardiac arrest
Diuretics can cause a loss of
Potassium
Complication of ACE inhibitors?
early: cough
late: renal damage
Si Eff: dry cough, hyperkalemia (high Potassium)
ACE inhibitors risk and uses
Hypertension, dry cough
Renin-Angiotensin System (RAS)
regulates blood pressure and fluid balance
Medicine for hypertension:
Beta Blockers, Thiazide, Diuretics, ACE In or CCB (Calcium Channel blockers)
What is the primary cause for Hypertension?
too much salt intake
Primary cause of secondary hypertension?
Renal and endocrine disease
Which drug can treat high cholesterol?
HMG-CoA reductase inhibitor (-statin) & Niacin (B3)
- inhibits enzyme responsible for cholesterol biosynthesis
Which category of drugs has muscle aches (myalgia) as a side effect?
HMG-CoA reductase inhibitor (-statin)
- lipitor
- may cause renal failure, muscle pain (most common) & fever & heart failure
The generic name of medications that lower the cholesterol level often end in:
-statin
What are the Fat Soluble vitamins?
D A K E
What are the water soluble vitamins?
B C H (Biotin)
Q10 (Coenzyme Co10) function
Reduce Blood Pressure
- Congestive Heart Failure
- Parkinson’s disease
- Statin- induce myopathy
- Migraines
- Raise energy
Which vitamins should Old people with rickets (osteomalacia) take?
Vitamin D
- bone fragility
- muscle weakening
- Dental problems
- Growth retardation
- Enlargement of LV/SP
When improving diet and increasing exercise, which LDL or HDL improves?
HDL
Which vitamin is used to raise HDL?
Niacin (B3)
Which vitamin deficiency will cause dementia, diarrhea, dermatitis and death (pallagra)
Niacin (B3)
Overdose: liver damage
Si Eff: flushing
A patient comes to you complaining of night blindness, which vitamin deficiency could she have:
vitamin A
Which vitamin is antioxidant?
A, C, E & Selenium
Which mineral is antioxidant?
Calcium
Iron
Magnesium
Selenium
Selenium
What are the side effects of overdosing on Vitamin E?
Nausea & Diarrhea
What causes elevated ketone bodies?
High fat/low carb diet (Atkins diet)
If a patient has Renal Failure, what diet should they have
Low protein, Low salt
Long term use of laxatives & mineral oil will cause a deficiency in which vitamins?
K, A, D, E
Orange colored palms indicateL
Carotenemia
The most common allergy
Peanut
Patients comes in for abdominal pain, diarrhea, abdominal bloating after eating Pizza. What is the cause?
Lactose
Celiac sprue or disease is hereditary digestive disorder that involves intolerance to?
Gluten - celiac disease : Vit B12 def -> RBC formation, Anemia
Elevated PSA (Prostate Specific Antigen), which supplement is bad?
American ginseng, siberian ginseng, gui zhi, ma huang, cordyceps
Mc. Burney’s Sign
Tender point in Right Lower Abdomen of a patient with appendicitis
Patient with lower right quadrant abdominal pain
Appendicitis
Murphy’s sign
Inspiratory arrest due to pain in right hypochondriac region, suggesting acute cholecystitis
Women with right upper quadrant pain, worse with eating greasy food.
cholecystitis
How to palpate splenomegaly
Start RLQ to LUQ
34 years old female complaints lower left quadrant pain, diarrhea, fever, fatigue, after you examination what is the possible disease?
Diverticulitis - LLQ (Answer)
Cholecystitis - RUQ
Appendicitis - RLQ
Pancreatitis - LUQ
Diverticulitis case study: which tests would you use to diagnose this?
CT Scan
Laparoscopy used to visualize what?
Abdominal and pelvic organs when a pathologic condition is suspected.
Exam for lower GI Tract (colon, rectum and small bowel - Entire colon from rectum to cecum and often portion of the terminal ileum
Colonoscopy
Barium enema visualizes (characteristics)
of the colon
Which lab exam to check patient who has abdominal pain?
Xray
Patient has abdominal pain (or low back pain) and is aggravated when defecating
Cystitis (Answer)
Urethritis
Aortic Aneurysm
Herniated Lumbar Disc
18 years old college student has acute onset of severe watery diarrhea, vomiting, nausea, abdominal cramping pain for 2 days after her camping trip. What pathogen possibly caused these symptoms?
Giardia (answer)
Borrelia
Rhinovirus
Trichomonas
Symptoms of abdominal pain, diarrhea - relieved with defecation
IBS (answer)
Crohn’s disease
Ulcerative colitis
What are the symptoms of IBS
Colicky abdominal pain relieved by bowel movement, clear or white mucus and blood in stool.
Patient has diarrhea and constipation, stool shows mucus and blood. What is the diagnosis?
Ulcerative Colitis
Pus and blood w diarrhea for 6 months. What is the Diagnosis?
Ulcerative colitis`
Patient has lower left abdomen pain and has diarrhea with pus
Ulcerative colitis
Polyps removed from colon, what other signs would indicate colon cancer?
Painless bleeding
High level of Alpha-fetaprotein suggests
Liver cancer
Abdominal pain, worse by spicy food and alcohol, nausea, loose stool, no blood in sthool, anemia, amenorrhea, weight loss, no mention of stress or emotional problems.
Crohn’s Disease (answer)
IBS (stress)
Gastritis
Patient long term use drug for pain, and has anemia symptoms. Which one is the reason that caused this problem?
Bleeding intestine (NSAID) (answer)
Hematemesis
Hematochezia
Side effects of ibuprofen (NSAID -non steroidal anti-inflammatory drug)
GI (peptic ulcer, stomach upset, GI track bleeding)
Which drug category will you select if you want to reduce gastric acid in the stomach?
Histamine blocker (answer)
Proton pump activator
antacids
What drug is used for acid reflux?
Antacid, proton pump inhibitors, anti-H2 receptors
What drug for peptic ulcer is used to decrease secretion of gastric acid
PPI, H2 blocker
If the patient has been taking antacids and there is no relief of heart burn. Which drug category:
Proton Pump Inhibitor
If the patient has GERD, which procedure would you use to evaluate the condition?
Endoscopy
What are the symptoms for GERD?
burning sensation in chest (HT burn)usually after eating, might be worse at night
Chest pain
Difficult swallowing
Regurgitationi of food or sour liquid
Sensation of a lump in your throat
Postmenopausal woman with uterine bleeding, soft abdomen not tender, what is the diagnosis?
Endometrial carcinoma
Ovarian carcinoma
chocolate cyst
Endometriosis
Right lower abdomen limited tender, female, young, regular period, abdomen pain
Ovary Cyst (answer)
Pancreatitis
Cholecystitis
PCOS
Female patient has symptoms of fatigue, dimpled skin (look like orange peel) in the breast area, no galactorrhea or other symptoms, also her skn near breast area is
Breast cancer
Unilateral/bilateral lactation in non lactating woman, lump changes size 5-7 days after menstruation. Upper outer quadrant pain.
Fibrocystic changes (Fibrocystic breast disease)
Endometrial polyps found by?
A. Transvaginal Ultrasound
B. Hysteroscopy
C. Curettage
D. Laparoscopy
Hysteroscopy
Endometrial Polyps
Grow in response to circulating estrogen
Primary dysmenorrhea is caused by?
Prostaglandin
What structure can be viewed with hysteroscopy to visualize the endometrial cavity, with an abnormal Pap smear dysfunctional uterine bleeding, or postmenopausal bleeding
Uterine Cavity (Endometrium)
What test is used to confirm diagnosis of endometriosis?
Laparoscopy
What test is performed after an abnormal pap smear
Colposcopy (for cervix & vagina)
Colposcopy is applied to visualize which structure(s)?
Vagina & Cervix
Pregnancy confirmed by
hCG hormone (human chorionic gonadotropin)
Ectopic Pregnancy Symptoms:
Abdominal pain, the absence of menstrual periods (amenorrhea) and vaginal bleeding or intermittent bleeding (spotting)
Pregnant women with hypertension and preeclampsia, what test should be done regularly?
Urine Protein
Leukemia may have an issue with what?
A. Hemophilia
B. Hemorrhage
C. Thrombus/Clot
D. Leukocytosis
Leukocytosis
Hodgkin’s Lymphoma is
Cancer of the lymph nodes
Fatigue, night sweats, weight loss
Need R/O cancer
67 years old man with cachexia, what does it suggest?
Probably Cancer
Polycythemia
Increased RBCs
Abnormally increased large number of Red Blood Cells
Polycythemia
Reasons for EPO increase
A. Anemia
B. Diminished # of RBCs
C. Lower Oxygen levels
Lower Oxygen levels
Which hormone increases red blood cells production?
Erythopointin
14 year old girl with blood deficiency sign, what tests should be done?
CBC - Complete Blood Count
What is Pernicious Anemia?
A. Malabsorption of B12
B. Iron Deficiency
C. Folic acid deficiency
D. Deficiency of B12 from diet
Malabsorption of B12
Alcoholic need to be supplemented with
A. Vitamin C
B. Calcium
C. Vitamin B12
D. Potassium
C.Vitamin B12, excessive alcohol more than 2 weeks decrease vitamin B12 absorption from the gastrointestinal tract.
What is the problem with chronic Alcoholism?
A. Ketoacidosis
B. Macrocytic Anemia
C. Inflammatory Bowel Disease
B. Macrocytic Anemia (B12 def)
CAGE questions are:
Diagnose alcoholism
Cut down, Annoyed by criticism, Guilty feeling, Eye opener
Characteristics of Iron deficiency anemia:
A. Hct (low Hematocrit test)
B. Hg levels (low Hyperemesis gravidarum)
C. MCV small (mean corpuscular volume)
MCV small
Iron defiency Anemia (IDA)
Which vitamin helps Iron to be absorbed?
Vitamin C
S&S (Serious and Sudden) Iron overdose effects
A. GI upset, constipation/nausea
B. GI upset, constipation, weakness
C. GI upset, diarrhea, nausea/vomiting
GI upset, diarrhea, nausea, vomiting
Ingestion of Iron will cause?
A. Diarrhea
B. Acid Reflux
C. Vomiting/nausea
D. Constipation
Vomiting/nausea
Which tests are used to monitor the effects of iron therapy
Hemoglobin and reticulocyte levels
Which of the following iron related blood test is the most accurate indicator of iron deficiency?
Ferritin - blood cell protein that contains iron, and shows the amount of iron stored in body
Sickle cell anemia causes:
A. Nutrition deficiency
B. Vitamin B12 deficiency
C. Hemolytic Anemia
D. Aplastic anemia
Hemolytic Anemia - sickle cell disease causes a chronic hemolytic anemia, caused by homozygous inheritance of HBs
Which one of these is a risk factor blood clots?
A. Alcoholism
B. Pregnancy
C. Renal Failure
D. Hemophilia
E. Leukemia
B. Pregnancy
Taking Coumadin (blood thinner) and B12 is bad because
might increase risk of clotting
Vitamin D deficiency can result in what?
A. Anemia
B. Hemorrhage
C. Hemophilia
B. Hemorrhage
Coumadin (Warfarin) with B12 & K (deficiency bleeding) may cause?
Clotting
Coumadin (Warfarin) with Vitamin E (deficiency: Anemia)
Bleeding
If taking anticoagulant, avoid which supplement?
Vitamin K
Vitamin K is produced by
Large Intestinal Bacteria (& Liver)
A patient has blood clotting problem, the disease?
Thrombopenia or thrombocytopenia
Cephalosporins are antibiotics that
Inhibit bacterial cell wall synthesis
One of the most common first signs of infectious mononucleosis is
Severe sore throat
A young teen with swollen lymph nodes, fever, sore throat and fatigue, what is the disease?
A. Infectious mononucleosis
B. Leukemia
Infectious mononucleosis
20 yo college student presents with fever, sore throat, and faitgue. Upon examination enlarged lymph nodes are found in the poster lateral neck. What is the most likely medical diagnosis?
A. Palatine tonsillitis
B. Cervical tuberculosis
C. Infectious mononucleosis
D. Streptococcal pharyngitis
C. Infectious mononucleosis
Mononucleosis presents with what?
Spleanomegally - Anorexia - Fever
Most common STD in the US:
Chlamydia
Case: 17 yo girl with fever, amenorrhea, clear discharge, burning sensation during urination. probably:
A. Chlamydia
B. Bacteria Virginitis
Chlamydia
Most common pathogen for PID (Pelvic inflammatory Disease)
Chlamydia and Gonorrhea
Chlamydia/gonorrhea co infected rate is
50%
- 50% of People with gonorrhea have chlamydia
Case: woman with infertility issues and blocked fallopian tubes:
Post chlamydia infection
Patient comes in with cryptosporidiosis and esophageal candida. What is most likely cause?
A. Immune deficiency (HIV and AIDS)
B. Syphilis
C. Herpes
D. Thrush
A. Immune deficiency
How is HIV/AIDS diagnosed?
Gum Swab (& Blood test)
What is the risk of getting HIV from needle stick with contaminated blood?
0.3%
What is the % that an infected hypodermic needle stick will transmit HIV?
0.3%
Which are the primary mode of transmission for hepatitis B
Blood, sex and syringes
What is the risk of getting Hepatitis B from needle stick with contaminated blood?
30%
What is higher % transfer of infected needle?
A. HIV
B. HAV (Hep A)
C. HBV (Hep B)
D. HCV (Hep C)
HBV
Which of these statements about Hep is true?
A. Hep A is blood borne
B. Hep B Oral-Fecal
C. Hep C is the most common cause of Liver Cancer
Hep C - most common liver Cancer
Wearing a mask in the waiting room prevents
HAV, Chicken pox, Polio
Exposure to HBV will show what symptoms?
A. 2-6 months, fatigue, fever, flu-like symptoms
B. 4-6 months, flu like symptoms
C. 1 month flu-like symptoms
D. Within 2-3 months, flu-like symptoms
A. 2-6 months, fatigue, fever, flu-like symptoms
A patient has just returned from Mexico and has nausea and vomit. What should you ask?
Does he have a Hep A vaccine?
Which vaccination is highly recommended for acupuncturists?
Flu shots
OSHA - Hep B shot should be offered after the worker has received the required bloodborne pathogen training and within how many days of initial assignment to a job with occupational exposure.
10 days
CNT main focus on what?
A. Clean field
B. Hand washing
C. Disposable needles
D. Sharps container
all are correct, however the most important is hand washing to prevent cross-infection
CNT procedure: hand washing time?
15-20 seconds
CDC: 20sec
What best defines CNT?
A. Sterile procedure
B. Aseptic procedure
C. Clean procedures
C. Clean procedures
How full can sharpts container be?
3/4 full
The regulation for sharps container:
A. Big enough to put the long needles
B. Has to be labeled with the universal biohazard symbol and the word “biohazard” or be color-coded red
C. Made from a variety of products from cardboard to plastic
A. Big enough to put the long needles.
doesn’t have to be red
made from plastic, not cardboard
Catching disease from contaminated object in environment, ex: treatment table is
A. Indirect contact transmission
B. Direct contact transmission
Indirect contact transmission
Who must be given bloodborne pathogen training and universal precaution training?
A. All emplyees with occupational exposure to bloodborne pathogens
CNT: Universal Precautions should be taught to:
All emplyees with occupational exposure, including part-time and temporary employees
During treatment, you accidentally cut your finger, what should you do next?
A. Wear gloves
B. Wash and dress the cut with bandage
C. Cancel treatment
B. Wash and dress the cut with bandage
A single cotton swab can be used to clean more than one point on the same patient if:
A. A single cotton swab can only be used to prepare a single point
B. The points are in the same general area
C. The points are in different areas and there are no signs of inflammation, disease or broken skin
D. 90% isopropyl alcohol is used to prepare the patient’s skin
B. The points are in the same general area
All of the following tatments about the use of needle guide tubes are true EXCEPT:
A. Guide tubes should be sterile at the beginning of each treatment on each patient
B. When using bundled needles, it is considered acceptable to use the guide tube more than once on the same patient as long as it’s unsoiled and uncontaminated.
C. If a guide tube is used for more than one needle, it’s better to drop the needle into the tub handle-end first rather than point-end first
D. If guide tube are used, they should not be placed on the clean field between uses, since they are no longer sterile.
D. If guide tube are used, they should not be placed on the clean field between uses, since they are no longer sterile.
Needles can be used on the same patient from different parts of the body if
A. It is kept in the clean field
B. Immediately put into cotton swab
C. No because bacteria transfer/different areas with different immunities.
C. No because bacteria transfer/different areas with different immunities.
Change bed sheets between patient’s treatment. How should they be washed?
Launder with hot water & detergent. Add hypochlorite (bleach) solution to the wash provides an extra margin of safety
Excessive production of growth hormone
is caused by which gland? Which hormones?
Caused by pituitary adenoma
GH up: child - gigantism, adult -acromegaly
ACTH: Cushing disease
Patient comes in with Type1 Diabetes (side effect) for 10 years. What is a reasonable expectation of reatment?
A. Reduce dependency on insulin
B. treat diabetic circulatory problems
B. treat diabetic circulatory problems
Diabetes mellitus 20 years, mot serious complication?
Peripheral neuropathy (B12)
Chronic diabetic patient testing to check blood sugar level
A. HbA1C hemoglobin
B. FBS (fasting sugar)
C. Oral glucose tolerance test
A. HbA1C hemoglobin
Which hormone when high can cause hypercalcenia?
A. Calcitonin
B. Parathyroid hormone
C. Thyroid stimulating
D. Pitocin
B. Parathyroid hormone
What hormone helps absorb calcium in intestines?
PTH
Calcitonin is a hormone involved in the regulation of calcium metabolism, is secreted by the?
A. Pineal Gland
B. Thymus Gland
C. Thyroid Gland
D. Parathyroid Gland
C. Thyroid Gland
Goiter is caused by
A. Iodine deficiency
Older women 60s, fatigue, pale and puffy, dry skin and hair. What disease?
A. Grave’s
B. Myxedema (hypothyroidism)
C. Hashimoto’s
B. Myxedema (hypothyroidism)
Potassium deficiencies with high BP
Aldosterone is too high because of Adrenal cortex tumor (Adenoma)
Conn’s Syndrome
What and where does Aldosterone come from?
Raises blood pressure, released by adrenal cortex
DHEA - natural steroid hormonoe produced from cholesterol in which organs?
Adrenal glands, gonads and brain
What medicine is a risk for osteoporosis?
Steroids
What is Addison’s disease?
Adrenal insufficiency
Aldosterone: hypotension, metabolic acidosis
Cortisol fatigue, low blood sugar
A young female patient, who has suffered from an autoimmune disease, and is being treated with a glucocorticoid, shows the appearance of a moon shape face, buffalo hump, truncal obesity.
A. Graves Disease
B. Addison’s Disease
C. Turner’s Syndrome
D. Cushing’s Syndrome
D. Cushing’s Syndrome
Oral contraceptive Pills (OCP) feeback
Inhibition on LH and FSH
- regulates production of estrogen and progesterone
- release in the anterior pituitary
- FSH: stimulates follicle development in ovaries, stimulates sperm formation
LH: triggers ovulation in females, stimulates testosterone production in males
What hormone spikes during ovulation?
LH
What hormone is elevated in menopause?
FSH
50 yo woman present with irregular menstrual period, hot flashes, night sweats, mood swings and insomnia. A preliminary diagnosis of perimenopausal syndrome is made. Which hormones are expected to have an elevated level?
LH and FSH
(estrogen and progesterone decreased)
Progesterone is released from where after ovulation?
Corpus Luteum
What should you look for in a women taking estrogen therapy?
Shortness of breath
Patient has PCOS, infertility, she is overweight, w/irregular periods what other symptoms
A. Dysmenorrhea
B. Dyspareunia
C. PID
D. Insulin Resistance
D. Insulin Resistance
Which hormone level is high in PCOS?
Testosterone
Female patient 28, hysteria pain, increased testosterone. Probably has:
A. PCOS
B. Pituitary lesion
C. Adrenal lesion
A. PCOS
43 years old female patient has symptoms of high level of adrogen, irregular menses and ovarian polyps, what test should be done to confirm the diagnosis (PCOS)
A. hysteroscopy
B. Ultrasound
C. X-Ray
B. Ultrasound
Patient injured his calf, it’s red, swollen. What do you do?
Apply ice, let it rest
Which disorder is most likely to cause sleep disturbances?
A. MS
B. Lupus
C. Amyloidosis
D. Fibromyalgia
D. Fibromyalgia
Motor part enters muscle fiber, most electrically excitable part of muscle?
A. Trigger point
B. Reflect Point
C. Motor Point
D. Sensory Point
C. Motor Point
Ankylosing spondylitis is linked to which specific HLA Antigen
HLA-B27 (Human Leukocyte Antigen)
Restless leg syndrome symptoms
A. Pain, sting and worsen after long time standing
B. Cramping, needling pain worsen in the evening
C. Tingling, numbness and worsen after long time standing
D. Anxiety, shaking leg and worsen in the evening.
D. Anxiety, shaking leg and worsen in the evening.
U - Urge to move
R - rest induced
G - get better with activity
E - Evening and night gets worse
Willis-Ekbom Disease (WED)
Urge to move, usually due to uncomfortable sensation, worsening of symptoms by relaxation, worse in evening
MRI can confirm
A. Avascular Necrosis
B. Soft Tissue injury
A. Avascular Necrosis
B. Soft Tissue injury
Soft tissue, spinal cord, cancer, muscle, ligament
What does DEXA (Dual Energy Xray)
Bone scan, bone density osteoporosis
What is the cause for avascular necrosis at the head of the femoral?
Trauma, blood clots, inflammation, alcohol or steroid use
What does CT scan do?
Brain bleeding, organ bleeding, rupture, tumor
What does Xray confirm?
bone fracture, penumonia, initial survey
A patient has a skate board accident, possible skull fracture and subarachnoid hemorrhage: Diagnostic test used:
A Head CT (efficienty)
or MRI (slower bu accurate and costly)
Patient has abdominal pain (my test said low back pain) and is aggravated when defecating?
A. Cystitis
B. Urethritis
C. Aortic aneurysm (pulsating sensation near umbilicus)
D. Herniated Lumbar Disc
D. Herniated Lumbar Disc
Patient felt pain when doing straight leg test. What is the diagnosis?
Intervertebral disc herniation
What is Lasegue’s sign?
low back pain wht underlying herniated disc (L5)
Patient has lower back pain, positive raising leg sign. What would be the ‘initial’ imaging test to do?
A. CT
B. MRI
C. Xray
D. PET
C. Xray
Patient with pain in his back but all the tests for nerve damage are negative. What do you do?
Refer for MRI
Patient is referred to you for lower back pain, abduction and lateral rotation, recreate/irritate pain, flex hip to 45 degrees and gets pain. What does it mean?
A. herniated disc
B. Referred pain
C. Radiculopathy
D. Sacroiliac Joint Dysfunction
Patrick’s Test (FABER test)
D. Sacroiliac Joint Dysfunction
Positive Trendelenburg’s sign (seen in patients with weak or paralyzed hip abductor muscles) indicates what muscles are affected?
Hip abductors - gluteus medius and gluteus minimus
20 years old boy played some game, stand a lot and rotated his food a lot yesterday. He showed up symptoms like can’t bear his weight, fatigue, fever, pain on legs. What problem does he have?
A. Collateral ligament injury
B. Anterior cruciate ligament Injury
C. Medial Meniscus Tear
D. Patella Muscle rupture
C. Medial Meniscus Tear
The abduction (Valgus) stress test checks for:
Medial collateral ligament injury
Adduction (Varus) stress test checks for:
Lateral Collateral Ligament Injury
The Apley’s test checks for:
Meniscus Tear (similar to McMurray’s)
What are the McMurray and Apley tests for?
Check meniscus injury (medial & lateral)
What knee joint exams check meniscus (medial and lateral) injury?
Mc Murray & Apley’s test
Case: Patient has ski week and complains of knee pain, positive Apley test.
Meniscus injury
What are the 3 ACL test?
Lachman’s Test
Anterior Drawer Test
Lateral Pivot Shift Test
What are the Meniscus Test?
Apley Compression Test
McMurray Test
Lady went on vacation and hiked 40 miles. Pain in the lateral forefoot, swelling, no bruising
A. Morton’s neuroma
B. Stress Fracture
C. Plantar Fasciitis
B. Stress Fracture
Hairline fracture, fatigue-induced fracture of the bone caused by repeated stress over time
Painful arc 60-120 deg abducting arm, painful when washing hair, which muscle or tendon is most affected?
Supraspinatus, the most common muscle affected in Rotator Cuff Syndrome
An acute supraspinatus tendinitis (rotator cuff) movement are usually not limited but there is painful arc between.
60-120degree of abduction of the arm
Shoulder joint pain palpated on Deltoid, Teres minor area and subscapularis, supraspinatus, infraspinatus area and patient did repetitive motion of a sports activity, What is the diagnosis?
A. Rotator cuff syndrome
B. Frozen Shoulder (adhesive capulitis)
A. Rotator cuff syndrome
SITS: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
Winged Scapula, which muscles are injured?
A. Serratus anterior (boxer’s muscle)
B. Teres major
C. Supraspinatus
A. Serratus anterior (boxer’s muscle)
Long Thoracic nerve innervates the serratus anterior
Winged scapula is a condition in which the shoulder blade protrudes from a person’s back in an abnormal position. The most common cause is the serratus anterior muscle paralysis due to an injury to the?
A. Axillary nerve
B. Long Thoracic nerve
C. Dorsal scapular nerve
D. Spinal accessory nerve
B. Long Thoracic nerve
Case: Practitioner raised patient’s arm and can’t feel the radial pulse, and patient has neck, shoulder and arm pain, numbness or impaired circulation to the affected areas, what is the problem?
A. Thoracic outlet syndrome
B. Angina
A. Thoracic outlet syndrome
- wright’s test- hyperabducting the arms over the head with some extension
loss or radial pulse
- pain does not happen or increase when walking while the pain of angina
woman who is 7 months pregnant comes into clinic with a left side headache and right arm paresthesia and neck pain. What is the condition?
A. Heart attack
B. Preclampsia
C. Gestational Diabetes
D. Cervical Radiculopathy (pinched nerve)
D. Cervical Radiculopathy (pinched nerve)
cause: repetitive & excessive load on the spine
- incluce heavy manual labor requiring lifting of more than 25 lbs, smoking and driving
Bony nodules called Bouchard’s nodes (middle joint) or Heberden’s nodes (fingertip)
Osteoarthritis
Bouchard - PIP
Heberden’s (DIP)
A patient has both hand pain when constantly typing on the keyboard, what is the disorder?
A. Osteoporosis
B. Osteoarthritis
C. Rheumatoid Arthritis
D. Osteomyelitis
B. Osteoarthritis
How to differentiate between rheumatoid arthritis and osteoarthritis?
RA - Joints are painful, swollen and stiff
- Morning stiffness, lasts longer than 1 hour
Frequent fatigue
- Relatively rapid over weeks to month
OS
- Slow progression
- Joints ache and may be tender but have little or no swelling
- Stiffness returns at end of day, or period of activity
- not whole body
To evaluate joint range or motion, what’s the correct order?
Active ROM -> passive ROM -> resistant isometrics
The initial step in joint examination is to evaluate
A. Isotonic muscle contraction
B. Isometric muscle contraction
C. Active range of motion (ROM)
D. Passive range of motion
C. Active range of motion (ROM)
Passive ROM is used for what:
A. Muscles
B. Joints
C. Bursa
D. Nerves
B. Joints
Difference between Isotonic and Isometric muscles?
Isotonic: same tension; changing length
Isometric: Same length, changing tension
Parasympathetic response?
A. Pupil constriction (miosis)
B. Bronchioles dilates
C. Heart rate increases
A. Pupil constriction (miosis)
- heartbeat slows
- Constricts bronchi
- contracts bladder
Sympathetic nervous system B receptors cause all of the following except the following physiological response
Pupil constriction
Accelerate heartbeat
Convert glycogen to glucose
Inhibits peristalsis and secretion in digestion
Inhibits saliva flow
Early Signs of Opiate withdrawal
- Anxiety
- Dehydration
- Fatigue
- Hot/cold flashes
- Sweating
- muscle aches
Late signs of Opiate withdrawal
Late symptoms
- Dilated pupils
- Goosebumps
- Nausea
- Vomiting
A young man has anxiety, nausea/vomiting, “goose bump” with dilated pupils. What substanes(s) did the patient use?
A. Alcohol
B. Opiates
C. Cocaine
B. Opiates
Patient came to the clinic, agitated with dilated pupils what substanes did the patient use?
A. Cocaine
B. Alcohol
C. Opioid
D. Heroin
E. Amphetamine
A. Cocaine
E. Amphetamine
Beta Endorphins, enkephalins, dynorphins, which drug binds to these receptors?
A. Opioids
B. Antidepressants
A. Opioids
26 yo mad with headache, nausea and PHOTOSENSITIVITY. Most likely type of headache:
Migraine (vascular)
A patient comes in with a headache that is very painful and has lacrimation and runny nose, what type of headache is this?
A. Classic migraine
B. Common migraine
C. Cluster headache
D. Neuromyalgia headache
C. Cluster headache
What is cachexia?
weakness and wasting of the body due to chronic illness
Complete blood count include?
platelet count, RBC count, WBC count, hemoglobin, hematocrit
What is the Phalen test?
Putting top of hands together in opposite prayer hands. Testing the carpal tunnel syndrome, median nerve.
What is Leukopenia and what is associated with it?
Decreased WBC count associated with bone marrow failure, radiation therapy, drug toxicity, autoimmune, steroids, chemotherapy
What are the worse cancer in terms of death, top 4
pancreatic, breast, colon and finally worse: lungs
How is HIV/AIDS diagnosed?
Gum Swab
What is the risk of getting HIV from needle stick with contamincated blood?
0.3%
What is % that an infected hypodermic needle stick wtill transmit HIV?
0.3%
Which are the primary mode of transmission for hepatitis B?
Blood, sex, Syringe
What is risk of getting Hep B from needle stick with contaminated blood?
30%
What is higher % transfer of infected needle?
HBV
Which of these statements about Hep is true?
Hep A is bloodborne
Hep B Oral-Fecal
Hep C is the most common cause of Liver cancer
Hep C is the most common cause of Liver cancer
Expsosure to HBV will show what symptoms?
2-6 months, fatigue, fever, flu-like symptoms
4-6 months, flu-like symptoms
1 month, flu-like symptoms
within 2-3 months, flu-like symptoms
2-6 months, fatigue, fever, flu-like symptoms
A patient has just returned from Mexico and has nausea and vomit what should you ask?
Does he have a Hep A vaccine?
Which vaccination is highly recommended for acupuncturist?
Flu Shot (HBV shot was NOT an option)
OSHA - Hep B shot should be offered after the worker has received the required bloodborne pathogens raining and within XX days of initial assignment to a job with occupational exposure.
10 days
CNT main focus on waht?
Clean Field
Hand Washing
Disposable needles
Sharps container
Hand Washing
CNT procedure: hand washing time?
15-20 sec to prevent cross infection
What best defines CNT?
Sterile procedure
Aseptic procedure
Clean procedure
Clean procedure - Aseptic technique
How full can sharps container be?
3/4 full
The regulation for sharps container
-Big enough to put the long needles
-Has to be labeled with the universal biohazard symbol and the word “biohazard” or be color-coded red
- Made from a variety of products from cardboard to plastic
Big enough to put the long needles
Catching disease from contaminated object in environemnt, ex.treatment table is:
- Indirect contact transmission
- Direct cotnact transmission
- Indirect contact transmission
Who must be given bloodborne pathogen training and universal precaution training?
ALL employees
CNT: Universal Precautions should be taught to:
All employees
During treatment, you accidentally cut your finger, what should you do next?
- Wear gloves
- Wash and dress the cut with a bandage
- Cancel treatment
Wash and dress the cut with a bandage
Single cotton swab can be used to clean more than one point onthe same patient if:
- A single cotton swab can only be used to prepare a single point
- The points are in the same general area
- The points are in different areas and there are no signs of inflammation, disease or broken skin
- 90% isopropryl alcohol is used to preapare the patient’s skin
- The points are in the same general area
All of the following statements about the use of needle guide tubes are true EXCEPT:
- Guide tubes should be sterile at the begining of each treatment on each patient
- When using bundled needles, it is considered acceptable to use the guide tube more than once on the same patient, as long as it’s unsoiled and uncontaminated
- If a guide tube is used for more than one needle, it’s better to drop the needle into the tube handle-end first rather than point-end first.
- If guide tube are used, they should not be placed on the clean field between uses, since they are no longer sterile
If guide tube are used, they should not be placed on the clean field between uses, since they are no longer sterile
Needles can be used on the same patient from different parts of the body if
- it is kept in the clean field
- Immediately put into cotton swab
- No because bacteria transfer/different areas with different immunities
No because bacteria transfer/different areas with different immunities
Change bed sheets between patient’s reatment. How should they be washed?
Launder with hot water and detergent, add hypochlorite(bleach) solution to the wash provides an extra margin of safety.
What is hyperpituitarism?
Excessive production of growth hormone (acromegaly or gigantism)
GH up (acromegaly)
PRL up (infertility)
ACTH up (cushing)
Patient comes in with Type 1 Diabetes (side effect) for 10 years. What is a reasonable expectation of treatment?
- Reduce dependency on sinsulin
- Treat diabetic circulatory problems
- Treat diabetic circulatory problems
Diabetes mellitus 20 years, most serious complication?
Peripheral neuropathy (B12)
Chronic diabetic patient testing to check blood sugar level:
- HbA1C hemoglobin
- FBS (fasting sugar)
- long term monitor blood sugar
- Oral glucose tolerance test
- HbA1C hemoglobin
Which hormone when high can cause hypercalcemia
- calcitonin
- parathyroid hormone
- thyroid stimulating
- pitocin
- parathyroid hormone
What hormone helps absorb calcium in intestines?
PTH
Calcitonin, a hormone involved in the regulation of calcium metabolism, is secreted by the?
- Pineal gland
- Thymus gland
- Thyroid Gland
- Parathyroid Gland
- Thyroid Gland
If Ca2+ levels are too HIGH, which gland releases hormone to manage Ca2+?
Thyroid releases calcitonin, which increases Ca2+ deposits in bones, decrease uptake in intestines, decrease reabsorption from urine
If Ca2+ levels are too LOW, which gland releases hormone to manage Ca2+?
Parathyroid releases PTH, which decreases Ca2+ deposits in bones, increase uptake in intestines, increase reabsorption from urine
Goiter is caused by?
Iodine deficiency
(hyper - graves), hypo - hashimoto
Older woman 60’s, fatigue, pale and puffy, dry skin and hair. What disease?
- Grave’s
- Myxedema (hypothyroidism)
- Hashimoto’s
- Myxedema (hypothyroidism)
Potassium deficiencies with high BP
Aldosterone is too high because of adrenal cortex tumor (adenoma)
What does aldosterone and where does it come from?
Raises blood pressure; released by adrenal cortex
DHEA - natural steroid hormone produced from cholesterol in which organs?
Adrenal glands, gonads and brain
What medicine is a risk for osteoporosis?
Steroids
What id Addison’s disease
Adrenal insufficiency
aldosterone (down) hypotension
Cortosol (down) fatigue
ACTH (up)-hyperpigmentation
Young female patient, who has suffered from an autoimmune disease, and is being treated with a glucocorticoid, shows the appearance of a moon shape face, buffalo hump, and truncal obesity. This is typical case of?
-Graves disease
-Addison’s Disease
-Turners Syndrome
-Cushing’s syndrome
-Cushing’s syndrome
Oral contraceptive Pills (OCP) feedback
Inhibition on LH and FSH
What hormone spikes during ovulation
LH - basal body temp up
What hormone is elevated in monopause?
FSH
50 year old woman present with irregular menstrual period, hot flashes, night sweats, mood swings, and insomnia. A preliminary diagnosis of perimenopausal syndrome is made. Which hormones are expected to have an elevated level?
LH and FSH (estrogen and progesterone decrease)
Progesterone is released from where after ovulation?
Corpus Luteum
What should you look for in a women taking estrogen therapy?
Headache, Nausea, breast tenderness
Patient has PCOS, infertility, she is overweight, w/ irregular periods what other symptoms
- Dysmenorrhea
-Dyspareunia
-PID
-Insulin Resistance
-Insulin Resistance
Which hormone level is high in PCOS?
Testosterone
patient 28, hysteria, pain, increased testosterone. Probably has:
- PCOS
-Pituitary lesion
-Adrenal lesion
- PCOS
43 years old female patient has symptoms of high level of androgen, irregular menses, and ovarian polyps, what test should be done to confirm the diagnosis (PCOS)?
- hysteroscopy
-ultrasound
-Xray
-ultrasound
Patient thinks he injured his calf, theyare red, swollen. What do you do?
Let it rest
Apply Ice
Which disorder is most likely to cause sleep disturbances?
MS
Lupus
Amuloidosis
Fibromyalgia
Fibromyalgia
Motor part enters muscle fiber, most electrically excitable part of muscle?
Trigger point
Reflex point
Motor point
Sensory point
Motor point
Ankylosing spondylitis is linked to which specific HLA (human leukocyte antigen)
HLA - B27
Restless leg syndrome symptoms:
pain, sting & worsen after long time standing
cramping, needling pain worsen in he evening
Tingling, numbness and worsen in the evening.
MRI is used to confirm
Soft Tissue injury
Avascular necrosis
DEXA (DUal Energy Xray Absorptionmetry)
Osteoporosis
A patient has skate board accident, possible skull fracture & subarachnoid hemorrhage: diagnostic test used:
Head CT (efficient) or MRI (slower but accurate and costly)
Patient has abdominal pain and is aggravated when defecating?
Herniated Lumbar Disc
Patient felt pain when doing straight leg test. What is the diagnosis?
Intervertebral disc herniation
Patient has lower back pain, positive raising leg sign. What would be the initial imaging test to do?
Xray
Patient with pain in his back but all the tests for nerve damage are negative, what do you do?
Refer for MRI
Patient is referred to you for lower back pain, abduction and lateral rotation, recreate/irritate, flex hip to 45 def and gets pain what does this mean? (FABER test)
Sacroiliac Joint Dysfunction
Positive Trendelenburg’s sign indicates what muscles affected?
Hip abductors - gluteus medius and gluteus minimus
20 yrs old played some game, stand a lot and rotated his foot alot yesterday, he showed up with symptoms like can’t bear his weight, fatigue, fever, pain on legs. what problem does he have?
Collateral ligament injury
The abduction (Valgus) stress test test for
Medial Collateral Ligament Injury (MCL)
The Adduction (Varus) Stress Test test for :
Lateral Collateral Ligament Injury (LCL)
The Apley’s Test test for:
Meniscus Tear (MCL)
What are McMurray and Apley tests used for?
Meniscus injury, (medial and lateral)
What knee joint exams check meniscus injury?
McMurray & Apley’s test
Patient has ski week and complains of knee pain, positive Apley test. Your diagnosis:
Meniscus injury
Lady went on vacation and hiked 40miles. Pain in the lateral forefoot, swelling, no bruising
Stress Fracture (hairline fracture)
Painful arc 60-120deg abducting arm, painful when washing hair, which muscle or tendon is most affected?
Supraspinatus - most common muscle affected in Rotator Cuff Syndrome
An acute supraspinatus tendinitis, movement are usually not limited but there is painful arc between?
60-120 deg of abduction of the arm
Shoulder joint pain palpated on Deltoid, Teres minor area and supraspinatus, infraspinatus area, and patient did repetitive motion of a sports activity what is the diagnosis?
Rotator Cuff Syndrome
Winged scapula - which muscle has injury
Serratus anterior (boxer’s muscle)
Winged scapula is a condition in which the shoulder blade protrudes from a person’s back in an abnormal position. The most common cause is the serratus anterior muscle paralysis due to an injury to the?
Long Thoracic Nerve
Case STudy: Practitioner raised patient’s arm and can’t feel the radial pulse, and patient has neck, shoulder, and arm pain, numbness or impaired circulation to the affected area, what is the problem?
Thoracic Outlet Syndrome (wright’s test)
A woman who is 7 months pregnant comes into clinic with a left side headache and right arm paresthesia and neck pain, what is the condition?
Cervical Radiculopathy
Swan neck in fingers, boutonniere deformity
Rheumatoid Arthritis
Bony nodules called Bouchard’s nodes (middle joint) or Heberden’s nodes (fingertip) seen in:
Osteoarthritis
A patient has both hand pain when constantly typing on the keyboard, what is the disorder?
Osteoarthritis
How to differentiate between rheumatoid arthritis and osteoarthritis?
RA - joint are painful, swollen and stiff. Symmetrical on both joints, morning stiffness > 1hr
Osteo - Joints may ache, but no swelling, morning stiffness lasts less than 1 hour
To evaluate joint range of motion, what’s the correct order”
Active ROM -> passive ROM -> resistant isometrics
The initial step in the joint examination is to evaluate
Active range of Motion
Passive ROM is used for what?
Joints
Parasympathetic response?
Pupil constriction (miosis)
Sympathetic nervous system B receptors?
Opiod
Signs of Opiate withdrawal:
Early :
Anxiety, Dehydration, Fatigue, Sweating
Late:
Dilated pupils, goosebumps
A young man has anxiety, nausea/vomiting “goosebump” with “dilated pupils”, what substances did the patient used?
Opiates
Patient came to the clinic, agitated, with dilated pupils, what substances did the patient use?
Amphetamine, Cocaine
Beta Endorphin, enkephalins, dynorphins, which drug binds to these receptors?
Opiods
26 year old man with headache, drunk, nausea, and photosensitivity. Most likely type of headache:
Migraine
A patient comes in with a headache that is very painful and has lacrimation and runny nose, what type of headache is thi?
Cluster Headache
What are differences with the following headaches:
Migraine
Tension-type headache
Cluster headache
Migraine - Duration: hours. Nausea, photophobia, phonophobia + eye redness/tearing runny nose
Tension Type HA - Location - top of head - Duration for weeks
Clsuter HA - Side of face and eyes. ONly eye redness, sharp pain, last a few mins
Patient who is 78 years old has a hitory of hypertension and comes in today complaining of excruciating headache, he has never had a headache of this type. Which type of headache does this patient have?
- Cluster
- Sinus
- Migraine
- Hormonoal
- Thunderclap
Thunderclap HA - grabbing your attention like a clap of thunder.
On one side limbs are weak with slurred speech. Where is the stroke?
On opposite side and in cerebral cortex (not cerebellum)
Patient got stroke 2 weeks ago, what should you closely pat attention?
Blood pressure
Patient has right hemisphere cerebral vascular accident (CVA), which area is affected?
- Right face / right body
- Right face / left body
- Left Face / Left body
Left Face / Right Body
Left face /left body
Discriminative nerve findings: Left arm 1 + right 2+ left arm muscle weakness (during discrimination point find 2 better discrimination points on R arm) which side is lesion on:
- Right cerebral cortex
- Left cerebral cortex
- Right Cerebellum
- Left Cerebellum
Right Cerebral cortex
Restless LEg Syndrome (RLS) is associated with:
- Iron deficiency
- Vitamin D
- Magnesium deficiency
Iron Deficiency
A pap smear is recommenede at what age?
21
Dr may recommend a colposcopy if this test is abnormal
- urinalysis
- pap smear
- IQ test
- Testicular test
Pap smear
Describe symptoms and the positive signs to Bakody’s sign.
Patient abduct the artm and place on the head. A positive sign gives relief of symptoms.
Cervical radiculopathy at the C4-C6
What are the antioxidant vitamins and their corresponding minerals?
A - Lutein
C - Lycopene
E - Selenium
What is HbA1c used for?
Hemoglobin that carries oxygen. This one is specifically reflective of Blood Sugar (Diabetes)
How often should a patient be tested with an HbA1C?
about once every 3 months
What is the pre-diabetic range for A1C?
5.7 - 6.4 (6 is the middle +- 0.4)
Name the SSRI drugs?
E(ffective) : Escitalo-pram
F(or) : Fluoxetin
S(adness) : Sertraline
P(anic) : Paroxetine
C(ompulsion) : Citalo-pram
What are the adverse effects of SSRI?
Stomach Upset
Sexual Dysfunction
Serotonin Syndrome
Causes for Serotonin Syndrome?
Commonly placed with other pharmaceuticals:
SSRI + SSRI
SSRI + MAOI
SSRI + SNRI (venlafaxine)
What are the symptoms of Serotonin Syndrome?
delirium, agitation, tachycardia, diaphoresis, diarrhea, seizures
Treatment for Serotonin Syndrome?
STop the offending medications, IV fluids, Cyproheptadine (serotonin production down)
Benzodiazepine (muscle rigidity down)
What foods should you avoid with the following drugs:
- MAOI
- Gout
MAOI - Tyraminie-rich (cheese, pickled foods, wine)
Gout: Purine-rich foods (anchovies, sardines, alcohold)
What are the overdose symptoms for the following psychotics?
- LIthium
- Antipsychotics
- SSRI
- MAOI
Litium - Lithium Toxicity
Antipsychotics - Neuroleptic Malignant Syndrome (NMS)
SSRI - Serotonin Syndrome
MAOI -induced Hypertensive Crisis
Causes of high ESR
N (eoplasia)
A (nemia, autoimmune)
P regnancy
K idney disease
I infection, inflammation
N eoplasm
