Potential Finals Case Studies

Question 1

A 43-year-old female patient was diagnosed with carcinoma of the pancreas two months ago. She has since begun radiation and chemotherapy. Currently, she suffers from the side effects of the chemotherapy which include fatigue, nausea, vomiting, and anorexia. The vomitus is frequent though only in small amounts. The vomitus contains undigested food and does not have a strong odor. Which of the following pathogeneses is most likely to have caused her current condition?

a. Damp heat in the middle burner
b. Stomach and Spleen yang deficiency with cold
c. Food stagnation
d. Liver attacking Stomach

Answer 1

b. Stomach and Spleen yang deficiency with cold

Question 2

Cherie is a 68-year-old female who was diagnosed with emphysema five years ago with symptoms aggravated during the winter. She complains of shortness of breath, wheezing, coughing with copious watery sputum, and a heavy, tight feeling in the chest. She also complains of weakness in the legs and low back. What is the pathogenesis?

a. Lung qi deficiency (deficiency)
b. Lung qi obstruction
c. Cold phlegm retention in lung (excess)
d. Yin deficiency with heat

Answer 2

c. Cold phlegm retention in chest / (excess)…
or kidney yang deficiency with phlegm

Question 3

A 50-year-old male patient complains of a dry and sore throat with hoarseness for over two months. Last week he also found a small hard nodule in the throat area and his hoarseness is still getting worse. He has a dry, purple tongue, and a choppy pulse. What is the pathogenesis that is causing his hoarseness?

a. Heat phlegm obstructing throat
b. Exterior dryness attack
c. Blood stagnation
d. Lung and Kidney yin deficiency

Answer 3

c. Blood stagnation

Question 4

Linda told you that her 76-year-old father is always murmuring to himself with repetitions and interruptions. The content is incoherent, but it stops when he meets with people. His consciousness is clear, but his thinking and reactions are slow. What is the pathogenesis?

a. Heart qi and/or blood deficiency
b. Heat disturbing the Heart
c. Kidney yin deficiency
d. Blood stagnation

Answer 4

a. Heart qi and/or blood deficiency

Question 5

A 56-year-old male patient was diagnosed with asthma over the past 15 years. Symptoms and signs include shallow and difficult breathing, or shortness of breath, inhalation more difficult than exhalation, and symptoms worsen with exertion. Which of the following patterns apply to him?

a. Lung qi deficiency
b. Heat phlegm accumulation in the Lung
c. Kidney deficiency
d. Spleen yang deficiency

Answer 5

c. Kidney deficiency

Question 6

A patient suffers from palpitations, dream-disturbed sleep, forgetfulness and anorexia. The abdomen is distended and the stools are loose. The patient appears listless and has a sallow complexion. There are numerous subcutaneous hemorrhages on the arms and legs. She has not had her period in three months. The pulse is thin and forceless. Which pattern applies?

a. Spleen & Kidney Yang Deficiency
b. Blood Stagnation
c. Kidney Deficiency
d. Heat Phelgm Accumulation

Answer 6

a. Spleen & Kidney Yang Deficiency

Question 7

A male patient suffers from bronchial asthma for over 15 years, usually worse during the wintertime. The symptoms include difficulty exhaling, a heavy and full sensation in the chest, and cough with profuse thick white phlegm. He has a light pale tongue covered by a thick white coating, and a slippery pulse. Which of the following patterns apply to him?

a. Wind cold attacking the Lung
b. Kidney yang deficiency
c. Cold phlegm obstructing the Lung
d. Lung qi deficiency

Answer 7

c. Cold phlegm obstructing the Lung

Question 8

A 67-year-old male patient currently under chemotherapy for his lung cancer seeks out your help. He suffers from severe nausea and violent vomiting, especially after eating. The vomiting has a sharp and crisp sound. The vomitus is made up of food followed by clear fluids or green mucus. What is the pathogenesis for his condition?

a. Food stagnation
b. Cold dampness attacking the Stomach
c. Spleen and Stomach qi deficiency
d. Stomach yin deficiency

Answer 8

d. Stomach yin deficiency

Question 9

A 65-year-old female patient has been hiccoughing for over three months. The hiccoughs are intermittent and sound slow and forceless. It is induced or aggravated by eating or drinking something cold. Her appetite is very poor. Her tongue is flabby and pale with a moist white coating, and her pulse is submerged, slow, and forceless. What is the pathogenesis of this condition?

a. Pathogenic cold attacking the Stomach
b. Spleen and Kidney yang deficiency
c. Stomach yin deficiency
d. Liver attacking Stomach

Answer 9

b. Spleen and Kidney yang deficiency
(chronic + intermittent)

Pathogenic cold attack would have a superficial pulse!

Question 10

A 35-year-old male patient complains of loose stools over the last two months; the stools look like “duck droppings.” He also has dull abdominal pain, frequent loud borborygmi, pale urine, and cold limbs. His tongue is pale and his pulse is submerged and thin. What is the zàng fu diagnosis for this patient?

a. Interior cold in the Large Intestine
b. Damp heat in the lower burner
c. Liver attacking Spleen
d. Exterior cold invading the Large Intestine

Answer 10

a. Interior cold in the Large Intestine

Question 11

What do the following symptoms indicate: depression, sighing, poor appetite, belching, plum-pit sensation, irritability, distending pain in the hypochondriac and costal regions, chest stuffiness, irregular menses, dysmenorrhea, thin, white tongue coating with a wiry pulse?

a. Liver yang rising
b. Liver qi stagnation
c. Kidney and Liver yin deficiency
d. Damp phlegm obstructing the Lung

Answer 11

b. Liver qi stagnation

Question 12

A 38-year-old man with a five-year history of diabetes mellitus presents with anorexia, nausea, and vomiting. His urine output has increased significantly over the past 24 hours and he is now starting to experience a vague abdominal discomfort. His breathing is deep and rapid and his breath has a rotten fruity odor. Random blood glucose level is high. What is the diagnosis?

a. Acute hypoglycemic episode
b. Diabetic ketoacidosis
c. Acute renal failure from diabetic nephropathy
d. Insulin overdose

Answer 12

b. Diabetic ketoacidosis

Question 13

A 43-year-old female complains of excessive vaginal discharge. A thin and transparent white liquid is profuse and continuous. She also reports frequent and copious urinary output, loose stools, and a cold feeling in the abdomen. Her tongue is pale with a thin white coating and her pulse is submerged. What is her diagnosis?

a. Leukorrhea due to damp cold in the lower burner
b. Leukorrhea due to deficiency of the Kidney
c. Leukorrhea due to deficiency of the Spleen
d. Leukorrhea due to damp heat in the lower burner

Answer 13

b. Leukorrhea due to deficiency of the Kidney

Question 14

A 40-year-old female has had a low grade fever for three months. It usually occurs in the morning or is induced by exertion. Other symptoms included emaciation, shortness of breath, general weakness and lack of spirit, dryness in the mouth without desire to drink, sweating on exertion, poor appetite, and 2-3 daily soft bowel movements. Her body temperature is 99.5-100.4° F and she has a pale face and tongue. What is the pathogenesis?
a. Damp heat in middle burner
b. Kidney yin deficiency with empty heat
c. Spleen qi deficiency
d. Blood stagnation

Answer 14

c. Spleen qi deficiency

Question 15

A 67-year-old female patient’s hearing has declined rather suddenly and she has a constant ringing in her ears that cannot be alleviated by pressing her hand over her ears. She has a bad temper and often has headaches. Her face is flushed and her pulse is forceful and wiry. What is the pathogenesis?

a. Kidney yin deficiency with deficiency heat
b. Liver fire flaring up
c. Liver blood deficiency wind
d. Phlegm heat in the Gallbladder channel

Answer 15

b. Liver fire flaring up

Question 16

A 34-year-old female patient suffers from chronic fatigue pattern for three years. Her tongue is slightly pale with teeth marks and there is a thin white coating. Her pulse is deficient. TCM diagnosis is qi deficiency. Which of the following symptoms might she also have?

a. Irregular menstruation
b. Thirst
c. Spontaneous sweating
d. Dream-disturbed sleep

Answer 16

c. Spontaneous sweating

Question 17

A 43-year-old woman complains of a low-grade fever that persists throughout the day. She also experiences a heavy sensation in her head, limbs, and trunk; the stifling sensation in her chest especially bothers her. Her appetite is poor, associated with abdominal distention and lethargy after meals. Her pulse is soggy and slippery, and her tongue has a sticky slightly yellow coating. What is the diagnosis?

a. Kidney yin deficiency
b. Damp heat in the upper burner
c. Spleen qi deficiency with dampness
d. Spleen qi deficiency

Answer 17

b. Damp heat in the upper burner (Excess and interior pattern)

Question 18

A patient experiences upper stifling breath sounds that are harsh, rapid respiration, has difficulty breathing with rattling sound in throat. They have a stifling sensation in their chest that is relieved with exhalation or sitting, it worsens when lying down. What is the diagnosis?

a. Yang deficiency with phlegm
b. Phlegm accumulation in Lung
c. Yin deficiency with heat
d. Exopathogenic attack on the Lung

Answer 18

b. Phlegm accumulation in Lung (excess!)

Question 19

A female patient has a history of acute nephritis and duodenal ulcer. For five years she has had no kidney or ulcer symptoms, but she does have weakness in the limbs, a pale and yellowish complexion, abdominal bloating, poor appetite, shortness of breath, loose stools, and sweating after slight physical exertion. What is the pathogenesis?

a. Kidney essence insufficiency
b. Kidney qi deficiency
c. Spleen qi deficiency
d. Spleen yang deficiency

Answer 19

c. Spleen qi deficiency

Question 20

A 38-year-old man has been suffering from headaches for the past five years. The headaches occur over the whole head and are dull but intense in character. They improve when lying down, and worsen with stress or exposure to light. The headaches are accompanied by nausea, vomiting, and a feeling of cold. He also has hypochondriac pain and is prone to constipation. The tongue is slightly dusky and swollen, with a dirty coating. What is the correct diagnosis for this patient?

a. Liver yang rising due to Liver yin deficiency
b. Liver yang rising due to Liver blood deficiency
c. Liver yang rising due to Liver and Kidney yin deficiency
d. Liver fire

Answer 20

b. Liver yang rising due to Liver blood deficiency

Question 21

A 21-year-old male suffered from palpitations with anxiety for two years. He has palpitations 5-8 times a day. He also complains of poor memory, dizziness when studying hard. and insomnia with dream-disturbed sleep. He has a pale face, a pale tongue with a thin white coating, and a frail pulse. What is the diagnosis?

a. Heart qi deficiency
b. Heart blood deficiency
c. Fire disturbing the Heart spirit
d. Phlegm obstructing the orifices

Answer 21

b. Heart blood deficiency

Question 22

The patient complains of a headache with a heavey sensation and diarrhea. What channel is affected?

Answer 22

Tai Yin

Question 23

Your client complains of a headache on the lateral aspect of the head. What channel is affected?

Answer 23

Shao Yang

Question 24

Your client complains of a headache on the occipital aspect of the head, radiating to the neck. What channel is affected?

Answer 24

Tai Yang

Question 25

Your client complains of a headache on the forehead and periocular region of the head. What channel is affected?

Answer 25

Yang Ming

Question 26

Your client complains of a headache on the vetex of the head. What channel is affected?

Answer 26

Jue Yin

Question 27

Your client complains of a headache on the side of the head which radiates to the teeth and throat. What channel is affected?

Answer 27

Shao Yin

Question 28

Ralph is a timid person who gets palpitations when he is surprised. He is easily frightened, especially by strange noises. He suffers from restlessness, dream-disturbed sleep, irritability, and anorexia. His tongue coating is thin and white. What is the most appropriate diagnosis for this patient?

a. Gallbladder qi deficiency
b. Hyperactivity of fire due to yin deficiency
c. Heart and Spleen qi deficiency
d. Liver qi stagnation

Answer 28

a. Gallbladder qi deficiency

Question 29

Linda, a 48-year-old female, has complained of palpitations and insomnia for about a month. She also feels dizzy and nauseated. She has a bitter taste in her mouth and likes drinking cold water. Her menstrual cycle has been irregular for one year. Her tongue has a yellow greasy coating. The pulse is wiry and slippery. What is the correct diagnosis for her?

a. Lack of coordination between the Gallbladder and Stomach, with stirring up of phlegm heat
b. Heart qi and blood deficiency
c. Hyperactivity of the Liver yang and Spleen qi deficiency
d. Pathogenic cold in the Stomach

Answer 29

a. Lack of coordination between the Gallbladder and Stomach, with stirring up of phlegm heat

Question 30

A 32-year-old female suffers from persistent, severe headaches with repeated attacks and a fixed location. Her symptoms are caused by which of the following?

a. Blood stagnation
b. Wind cold attack
c. Qi stagnation
d. Yin deficiency

Answer 30

a. Blood stagnation

Question 31

An 18-year-old female complains of chest pain, insomnia, palpitations, migraine head-aches, lower abdominal pain and distention before and during her period, and an excessive menstrual flow with a dark red color and clots. There is a mass on her neck. The Western medical diagnosis is thyroiditis. What is the pathogenesis?

a. Heart blood stagnation
b. Kidney yin deficiency
c. Liver blood stagnation
d. Liver qi stagnation

Answer 31

c. Liver blood stagnation

Question 32

A 32-year-old male has excruciating pain in his left first metatarsophalangeal joint. It is red, warm, shiny, and extremely tender. He also has chills, fever, malaise, and tachycardia. His laboratory test results shows uric acid above 70 mg/di. His tongue is red with a greasy yellow coating, and his pulse is rapid and slippery. What is the TCM diagnosis?

a. Wind heat bi pattern
b. Damp heat bi pattern
c. Blood stagnation
d. Qi stagnation

Answer 32

b. Damp heat bi pattern

Question 34

A 50-year-old female patient has had pain in her left elbow for six months. The pain is severe and worsens with movement or when trying to grip an object with her hand. She is unable to work or carry out her daily household chores. A surgeon diagnosed the condition as lateral humeral epicondylitis. Heat therapy provides temporary relief from the pain. Examination shows local tenderness over the left lateral humeral epicondyle. Pain is also elicited by resisting dorsiflexion of the patient’s left hand. What is the pathogenesis?

a. Wind cold
b. Damp heat with blood stagnation
c. Cold dampness with blood stagnation
d. Blood stagnation

Answer 34

c. Cold dampness with blood stagnation

Question 35

A 25-year-old male patient complains of a headache lasting two days. He says that two days ago he started to feel the headache in the occipital region. The pain is violent, boring, and tight. It extends to the nape of the neck and upper back. His headache gets worse when exposed to wind or cold. He has had chills for the past two days and his body temperature is 100.4° F. Which of the following symptoms might this patient also have?

a. Sore throat
b. Red eyes
c. Constipation
d. Nasal discharge

Answer 35

d. Nasal discharge

Question 36

A 30-year-old woman comes to your office with a chief complaint of dizziness. When she stands up from her chair she feels dizzy and sometimes blacks out. She also has numbness of the limbs and muscle twitching. Her menstrual cycle is delayed and her sleep is very light. Sunlight makes her eyes hurt. Her face and tongue are pale, and her pulse is force-less. Which of the following signs and symptoms are consistent with her condition?

a. Lack of appetite
b. Lumbar and knee pain
c. Emotional instability
d. Brittle and pale nails

Answer 36

d. Brittle and pale nails

Question 37

A 43-year-old female complains of dizziness, fatigue, loose stools, loss of appetite, blurred vision, and a numb, tingling sensation in the limbs. Her face looks sallow and she has a pale tongue and a choppy pulse. According to zang fü diagnosis, what do these indications suggest?

a. Kidney and Spleen yang deficiency
b. Spleen and Liver blood deficiency
c. Lung and Heart qi deficiency
d. Kidney and Liver yin deficiency

Answer 37

b. Spleen and Liver blood deficiency

Question 38

A 43-year-old male patient complains of constipation over four weeks. The stools are not dry, but small, like a goat’s stools, and difficult to evacuate. He was diagnosed with IBS two years ago and suffers from alternating constipation and diarrhea. His symptoms indicate which of the following?

a. Heart fire
b. Spleen qi deficiency
c. Kidney yin deficiency
d. Liver qi stagnation

Answer 38

d. Liver qi stagnation

Question 39

A 45-year-old female omartains: f cinstipation and fatigue after bowel movements. Her stools are soft. She also perspires easily and has a pale tongue. What is the diagnosis?

a. Heat in the intestines
b. Qi stagnation
c. Qi blocked by cold
d. Qi deficiency

Answer 39

d. Qi deficiency

Question 40

A 32-year-old male presents with burning epigastric pain. He also has an empty and uncomfortable sensation in the stomach with hunger but no desire to eat, hiccoughs, thirst, and constipation. His tongue is red and dry with little coating and he has a thin, rapid pulse. What is the most appropriate TCM diagnosis for him?

a. Stomach yin deficiency
b. Stomach fire
c. Stomach qi deficiency
d. Food stagnation

Answer 40

a. Stomach yin deficiency

Question 41

A 40-year-old female has had dull epigastric pain for over 20 years. Two years ago she was diagnosed with an ulcer in the duodenal bulb with chronic superficial gastritis. The pain radiates to her back and is accompanied by nausea and regurgitation of clear fluids. She has a poor appetite, a dulled sense of taste, and a preference for hot beverages. The pain is alleviated with local pressure. Her stools are sticky and loose. She has a pale tongue with a thin, white coating and a deficient pulse. What is the pathogenesis?

a. Exogenous cold attack on the Stomach
b. Stomach and Spleen yang deficiency with cold
c. Stomach yin deficiency
d. Damp and cold accumulation in the middle burner

Answer 41

b. Stomach and Spleen yang deficiency with cold

Question 42

A patient has had diarhea and fever for two days. The symptoms include abdominal pain, tenesmus, blood and mucus in the stools, and a burning sensation in the anus. He IS thirsty and passes seanty, deep-yellow urine. His tongue has a yellow sticky coating and his pulse is slippery and rapid. What is the diagnosis for this patient?

a. Spleen damp heat
b. Large Intestine damp heat
c. Bladder damp heat
d. Heart fire transferring to the Small Intestine

Answer 42

b. Large Intestine damp heat

Question 43

A 30-year-old male patient has not had a bowel movement for four days. Before that, he also had constipation with dry stools. He tells you that he is passing dark and scanty urine. You also witness restlessness, a red face, dry mouth, foul breath, and abdominal fullness. His tongue is red with a yellow dry coating, and the pulse is slippery and rapid. What is the diagnosis for this patient?

a. Excess heat in the Stomach and Large Intestine
b. Lung heat transmitting to the Large Intestine
c. Dryness of the Large Intestine
d. Spleen qi deficiency

Answer 43

a. Excess heat in the Stomach and Large Intestine

Question 44

A 54-year-old male patient has suffered from insomnia for six months, accompanied by dizziness, tinnitus, irritability, low back pain, and seminal emission. His pulse is rapid and frail. What is the diagnosis?

a. Spleen qi deficiency with blood deficiency
b. Upward disturbance of Liver fire
c. Disharmony of Heart and Kidney
d. Liver and Kidney yin deficiency

Answer 44

c. Disharmony of Heart and Kidney

Question 45

A 32-year-old male complains of insomnia for three weeks, waking during the night, with nightmares and dreams of flying. He has a bitter taste in his mouth, thirst, mental restlessness, and palpitations. He also has facial acne, canker sores, and is constipated. What is the TCM diagnosis?

a. Liver qi stagnation with heat
b. Kidney and Heart disharmony
c. Heart fire blazing
d. Heart blood and Spleen qi deficiency

Answer 45

c. Heart fire blazing

Question 46

A 17-year-old girl was at the scene of a terrorist attack half a year ago. Since then, she has become highly sensitive to any noise around her. She gets palpitations and anxiety from any sudden noise. Other symptoms include tinnitus, nightmares, and difficulty making decisions. She has a slightly pale tongue with a thin white coating, and a wiry and thin pulse. What other symptom(s) may she have?

a. Shortness of breath
b. Extremely cold limbs
c. Sensations of heat in the palms and soles
d. Insomnia

Answer 46

d. Insomnia

Question 47

A 32-year-old female patient comes to your office because she suffers from irregular menstruation. She states that her menstrual cycle has gradually become more irregular over the past four years since she divorced her husband. She has a wiry pulse. Which of the following symptoms might she also have?

a. Sweating
b. Chills and fever
c. Frequent sighing
d. Cough

Answer 47

c. Frequent sighing

Question 48

Barbara, age 34, compains of infertility and has had three miscarriages during the past eight years. Since her first miscarriage, she has had an irregular menstrual cycle and lower abdominal pain during menstruation, which is aggravated by pressure and relieved by warmth. Her tongue is pale purple with a dry thin coating, and her pulse is thin, submerged, and frail. What is her diagnosis?

a. Deficiency cold of the Penetrating Vessel (chông mäl) and Conception Vessel (ren mä), with blood stagnation
b. Kidney essence insufficiency
c. Spleen yang deficiency
d. Blood stagnation with heat

Answer 48

a. Deficiency cold of the Penetrating Vessel (chông mäl) and Conception Vessel (ren mä), with blood stagnation

Question 49

A 16-year-old girl comes in because of menstrual problems. Her period started when she was 14 and has a 21-day cycle. The blood is bright red and she bleeds heavily. She has cramps during the first two days of the flow. She drinks a lot of cold water and likes to eat ice cream. What other symptom(s) would you expect?

a. Constipation
b. Thirst
c. Scanty urination
d. All of the above

Answer 49

d. All of the above

Question 50

A 37-year-old woman complains of mild, persistent uterine bleeding, irregular menstruation (either early or late), extended or continuous menstrual flow, spotting between periods, abdominal pain and distention, and coldness in the lower abdomen. Her lips and mouth are dry, and she has a low-grade fever in the evenings along with warm palms and soles. What is the best diagnosis for this patient?

a. Deficiency heat of the Penetrating Vessel (chöng mäi) and Conception Vessel (rên mäi) with blood stagnation
b. Deficiency cold of the Penetrating Vessel (chong mät) and Conception Vessel (rên mäi) with blood stagnation
c. Kidney yin deficiency with Liver yang rising with blood stagnation
d. Downward flow of damp heat with blood stagnation

Answer 50

b. Deficiency cold of the Penetrating Vessel (chong mät) and Conception Vessel (rên mäi) with blood stagnation

Question 51

A patient complains that he has thirst, drinks a lot of water, has excessive appetite, bad breath, swollen and painful gums, and a burning sensation in the epigastrium. What is the diagnosis?

a. Stomach fire blazing
b. Stagnation of the Stomach qi
c. Deficiency of Spleen qi
d. Liver fire invading Stomach

Answer 51

a. Stomach fire blazing