TCMTEST - Biomedicine Flashcards
A 40 year-old female presented with a one-month history of progressively worsening cough with occasional bright-red blood in the sputum. The morning before the appointment she coughed up about 1/4 teaspoon of blood. She denies having fever or an upper respiratory infection. Physical examination revealed a wheeze on the left side. Which action would you take?
- semi-urgent (next day) referral to primary care physician
- call 911for emergency transport
- provide acupuncture treatment for the cough and wheezing
- timely (1-2 weeks) referral to primary care physician
- semi-urgent (next day) referral to primary care physician
The red flag is cough with bloody sputum and no upper respiratory infection. Lung cancer is assumed present until proven otherwise. Coughing up a significant amount of blood (>, 1/4 tsp) in a patient without a fever or purulent sputum is a red flag. Another red flag for lung cancer is the presence of a unilateral wheeze in person without an upper respiratory tract infection.As the cancer metastasizes there can be unintentional weight loss, jaundiced skin (liver metastasis), bone pain (bone metastasis), and neurological signs
Electroacupuncture (EA) can be applied on patients with
pacemakers
seizure disorders
electronic implants
diabetes
diabetes
Which of the following should not be concurrently taken with Dramamine (dimenhydrinate) and Transderm-Scop (scopolamine),
alcoholic drinks
Vitamin A
aspirin
Tyramine foods
alcoholic drinks
In September 2009, Vioxx was voluntarily recalled after 5 years because
it was not an effective treatment for arthritis
it was not as popular as Celebrex
it had a higher incidence of gastrointestinal bleeding
it was associated with an increased risk of heart attack and strokes
it was associated with an increased risk of heart attack and strokes
Glomerulonephritis shows itself as
no body hair
peripheral edema
a paleface with red nodules
eye protrusion
peripheral edema
A 45 year-old female patient complains of chest discomfort for the past two weeks. The discomfort has recently changed to pain which is centered in her heart She reports that two weeks ago she had the flu for 2-3 days. She has no history of heart disease or known murmurs. The examination reveals a low-grade fever of at 100.4 degrees. Auscultation of the heart reveals a scraping sound superimposed owr the normal heart beat. Palpation of the her ankles and pre-sacral areas do not show the presence of edema. Her pulses are normal. What is the presumptive diagnosis?
viral flu
myocardial infarction
angina pectoris
myocarditis
myocarditis
Methamphetamine, cocaine, and MDMA are associated with which of the following neurotransmitters,
GABA, serotonin, dopamine
GABA, serotonin, norepinephrine, dopamine
serotonin, dopamine
serotonin, norepinephrine, dopamine
serotonin, norepinephrine, dopamine
What are the prime movers for wrist extension,
Extensor Carpi Radialis Longus, Extensor Carpi Ulnaris
Extensor Carpi Ulnaris Longus, Extensor Carpi Ulnaris Brevis
Extensor Carpi Radialis longus, Extensor Carpi Radialis Brevis and Extensor Carpi Ulnaris
Extensor Carpi Radialis Longus and Brevis
Extensor Carpi Radialis longus, Extensor Carpi Radialis Brevis and Extensor Carpi Ulnaris
The Urine Glucose test is used to assess the presence of diabetes. Diabetes mellitus
Is a defect in hypothalamic thirst regulation
Is the least common form of diabetes
Has only two forms
Has urine with abnormal glucose levels
Has urine with abnormal glucose levels
44- year-old female patient has a three-week history of sinus congestion. She has yellow nasal discharge and mild facial pain of the eyes. Her last episode lasted for six months. In the past she used antibiotics but is now using herbs, anti-histamines, and sinus rinses for this episode. Her temperature was 100.8 degrees F. The maxillary and frontal sinuses were tender to percussion. The nasal mucosa was hyperemic (an increase in the quantity of blood flow).What action would you next take with this patient?
call 911for emergency transport
urgent (same hour) referral to ENT
semi-urgent (one or two days) referral to primary care physician
have friend transport patient to emergency department (ED)
semi-urgent (one or two days) referral to primary care physician
Which of the following knee exams has the correct pairing between the test and what is tested .11
Valgus Test / Lateral Collateral Ligament (LCL)
Lachman Test / Anterior cruciate ligament (ACL)
Varus Test / Medial Collateral Ligament (MCL)
Anterior Drawer Test/ Lateral Collateral Ligament (LCL)
Lachman Test / Anterior cruciate ligament (ACL)
A pelvic ultrasonography can be used to detect extrauterine pregnancies.What is accurate about extrauterine pregnancies?
9O percent occur in the fallopian tubes, Mostly occur in women 35-94-years old, Bleeding is a major concern,
8O percent occur on the ovary 70 percent occur in the cervix, Mostly occur in women 20-30 years old.
Emergency situation when associated with abdominal pain with vaginal light bleeding, 60 percent occur in the abdominal cavity
9O percent occur in the fallopian tubes, Mostly occur in women 35-94-years old, Bleeding is a major concern
A 22 year-old female was prescribed an oral contraceptive.What is the generic drug prescription?
desogestrel
captopril
amantadine
lansoprazole
desogestrel
The optimal level of LDL cholesterol is
less then 50 mg/dL
less then 100 mg/dL
greater then 200 mg/dL
greater then 150 mg/dL
less then 100 mg/dL
Urinary pregnanediol is measured evaluate
Melatonin
ACTH (adrenocorticotropic hormone)
DHEA (dehydroepiandrosterone)
progesterone
progesterone
Pregnanediol is an inactive metabolic byproduct of progesterone. The measurement of pregnanediol in the urine is an indirect way of measuring progesterone levels. The hormone progesterone is vital for normal menstruation and fertility. The release of the egg by the ovaries is associated with high levels of pregnanediol.
Which of the following symptoms is not part of a heart attack,
High fever
pain in jaw, back, or left arm
pain in middle of chest
lips, hands, or feet may turn slightly blue
High fever
The body will likely send one or more waming signals of a heart attack: 1) uncomfortable pressure,fullness, squeezing o pain in the center of the chest lasting more than a few minutes. 2) pain spreading to the shoulders, neck, arms, jaw or inside the arms.The pain, mild or intense, may feel like pressure, tightness, burning,or heavy weight. 3) chest discomfort with lightheadedness,fainting, sweating, nausea or shortness of breath. 4) anxiety, nervousness. 5) paleness or pallor, and/or cold, sweaty skind5) increased or irregular heart rate. 7) feeling a sense of impending doom. Not all of these signs occur in every attack.
Which Tcells are the only cells that can directly attack and kill other cells?
helper cells
cytotoxic cells
plasma cells
regulatory cells
cytotoxic cells
cytotoxic is a type°, immune system white blood cell that reacts to infection and injury. These cells go by different names) CID8 cells, killer cells, cytolytic cells, cytotoxic lymphocytes. The main function of cytotoxic cells is to kill host cells that are infected by viruses and intracellular parasites or bacteria. They are also capable of killing tumor cells. Cytotoxicl) cells are activated by cytokines. Cytokines are cell signalling molecules (chemical messengers) involved in cell to cell communication in an immune response.
45 year-old male is prescribed Prevacid (lansopraxole). Which “PCNI disharmony would most likely apply?
common cold due to wind-cold
epigastric pain due to stagnant liver qi attacking the stomach
asthma due to phlegm heat
dizziness due to deficient gi and blood
epigastric pain due to stagnant liver qi attacking the stomach
Prevacid, a proton pump inhibitor, is used to treat and prevent stomach and intestinal ulcers, erosive esophagitis, and other conditions involving excessive stomach acid.
In using the ammonia blood test you are assessing which organ?
heart
liver
adrenals
stomach
liver
Urea is produced in the liver as an end product. protein digestion-metabolism. Protein breaks down into amino acids, which in the liver are catabolized resulting in the formation of free ammonia.Ammonia cannot be broken down when there is severe liver dysfunction resulting in increased blood levels of ammonia. Also, decreased kidney function diminishes the excretion of ammonia which results in increased blood levels
19 year-old recently married female requested acupuncture treatment for a two-day old episodes of aching and burning sensation when she urinated.She did not want to take antibiotics because they resulted in a yeast infection later. The patient also reported having chills and feeling slightly feverish. During the interview she complained of right flank pain. Her temperature was 99.5 degrees EAU other vital signs (pulse, breathing, heart rate) are stable. There was tenderness upon palpation at the right costovertebral angle and mild suprapubic tenderness. Which action would you take?
provide acupuncture treatment for bladder damp-heat
timely, (1 week) referral to PCP
call 911for emergency transport
same day referral to PCP
same day referral to PCP
The red flag is dysuria with high fever, chills,frequent urination, back pain, and malaise.A kidney infection is assumed present until proven otherwise. Patients with a kidney infection have symptoms not shared with simple cystitis. Patients with a kidney infection have pain in the flank or over the kidney as well as significant fever while patients with simple cystitis do not. Chills, nausea, and vomiting combined with dysuria and Sank pain greatly increases the possibi lity of acute pyelonephritis (kidney infection). The patient should be encouraged to drink liquids until the referral A made. The type of referral depends on the severity. Patients with mild fever, dysuria, and stable vital signs should get a same day referral to the PCP or to an urgent care center. If the patient has high fever, shaking chills, and appears septic the patient should be sent directly to the ED.. a friend of family member driving. 911 would be called if the patient had cardiopulmonary complaints (low BP, SOB, chest pain).
Anew 36 year-old male patient has a complaint of diarrhea. Fle said that he goes too many times to count He denied vomiting. His temperature was 101.5 degrees F the night before and also the day of the interview. There was blood in the stool. He denies any history of hemorrhoids. Which action would you take?
call 911for emergency assistance
same day or next day referral to his physician
non-urgent situation can see primary care physician next week
treat with acupuncture, no need to refer
same day or next day referral to his physician
A 26 year-old female volleyball athlete complained of right shoulder pain. She thought she had a rotator cuff injury.She did a course°, remedial exercises which did not improve the shoulder pain. She said that she recently noticed mild swelling in the hand and arm. The physical exam showed mild swelling of the right hand and arm. The ROM of the right shoulder was normal. The right radial pulse was normal.Which action would you take next for this patient?
have a family member drive patient to ED
treat with acupuncture lx per week for S weeks
semi-urgent referral to primary care physician
call R11 for emergency assist
semi-urgent referral to primary care physician
Sinus headaches are considered
rebound headaches
tertiary headaches
primary headaches
secondary headaches
secondary headaches
Primary headaches are due to the headache condition itself and not another cause. Secondary headaches are mused by another condition such as a sinus headache from sinusitis. The three types of primary headache are migraine, tension, and cluster. blon-emergency secondary headaches can be caused, for example, by a substance or its withdrawal (alcohol, medication overuse, carbon monoxide, etc.), a mild trauma, a disorder in Me head (sinusitis,glaucoma, Mc.), or a psychiatric problem. Emergency secondary headaches include subarachnord bleeding, meningitis, temporal arteritis, and raised intracranial pressure.
In CPR, what is the technique to clear a victim’s airway?
Lift chin up, tilt head back
Lift chin up, turn head sideways
Push chin down, tilt head forward
Gently turn head from side to side
Lift chin up, tilt head back
Diuril (hydnxhicirothiazide) is a
Loop diuretics
Thiazide diuretic
Thiazide-like diuretics
Potassium sparing diuretics
Thiazide diuretic
Thiazide diuretics cause the kidney to excrete water by blocking sodium, potassium, and water from being reabsorbed back into the blood. They work on the distal convoluted tubules in the kidneys. Thiazides are the only type of diuretic that dilate the blood vessels, which also helps to lower blood pressure
21year-old female patient complains of of severe, lower abdominal cramping for the past week.She also reports a foul smelling yellow-green vaginal discharge. She acknowledges that she is sexually active. Her partner does not use condoms but she is on oral contraceptives. She complains of painful urination and painful intercourse. Palpation of the lower abdomen has tenderness. She has just tested negative for pregnancy. For the past month, she has been having pain and bleeding during intercourse. Physical examination shows right lower quadrant tenderness. Ultrasound does not show any masses or any changes in the ovaries.What is the most likely diagnosis?
ovarian cysts
endometriosis
PID
ectopic pregnancy
PID
Pelvic Inflammatory Disease (PID) is a bacterial disease that causes an infection of the reproductive organs (uterus, fallopian tubes, ovaries). It is often a complication caused by STD. like chlamydia or gonorrhea. Endometriosis may also cause similar symptoms that occur in patients with PID. However, this patient has a purulent vaginal discharge which is indicative of PIO.An ectopic pregnancy is unlikely because the pregnancy test was negative.
Which sign are you looking for with a cholecystitis patient?
Psoas sign
Murphy’s sign
Roberts sign
Rovsing’s sign
Murphy’s sign
This is a test for gallbladder disease in which the patient is asked to inhale while the doctors fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain lithe gallbladder is inflamed.
tcmtests.com, July 2020
A 48 year old female complains of anxiety about being in places or situations where she cannot escape and feeling embarrassed. She constantly requires a companion at her side to reassure her Her symptoms come suddenly and seem unavoidable. Your patient probably has
Acrophobia
Anthrophobia
Panic attack
Agoraphobia
Agoraphobia
Agoraphobia means ‘a fear of wide, open spaces.” It is an anxiety disorder involving an intense fear of being in a situation where escape can be difficult. It includes fear of spending time alone, fear of being in crowds, fear of open spaces, fear not being able to escape (eg elevators), fear of losing control in public. Acrophobia is an extreme or irrational fear of heights. Anthrophobia is a fear of people. It is an extreme, pathological form of shyness. Panic attacks include sudden attacks of fear and anxiety, as well as physical symptoms (sweating and a racing heart). A panic attack is having intense fear that comes on suddenly without waming and without any obvious reason. Anthropophobia is extreme shyness and timidity. Acrophobia is an extreme Of irrational fear of heights. Bale’s Guide to Physical Examination, 13th Edition, page 247-253; Bates Guide to Physical Examination, 10th Edition, page 161
You are practidng in California. A patient you have been treating for five years confesses to you that her husband has been physically abusing her for the past year She says that the problem has gotten worse. She shows you the bruises on her body. She says that she is telling you this because she trusts you. She insists that you do not report it to the authorities. Which action do you take?
file a domestic abuse report
filing domestic abuse reports vary from state to state
do not report It to maintain her trust in you
advise that she and her husband have psychological counseling
file a domestic abuse report
What is true about pelvic ultrasonography?
Determines fetal but not placental size, Evaluates pregnancy and the fetus, Diagnoses of uterine, ovarian and pelvic disorders in pregnant women
Evaluates pregnancy and the fetus, Uses sound waves to examine the colon
Diagnoses of uterine, ovarian and pelvic disorders in both pregnant and non-pregnant women.
Determines placental but not fetal size Determines fetal and placental size, Evaluates pregnancy and the fetus. Diagnoses of uterine, ovarian and pelvic disorders in non-pregnant women
Determines placental but not fetal size Determines fetal and placental size, Evaluates pregnancy and the fetus. Diagnoses of uterine, ovarian and pelvic disorders in non-pregnant women
Which of the following indicate hypoglycemia as a possible side effect of Glucotrol (glipizide) prescribed for type 2 diabetes mellitus?
Fast and deep breathing
frequent urination
Cool and clammy skin
Thirst
cool and clammy skin
The term hypoglycemia literally means ‘under-sweet blood’. The most common forms of hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Hypoglycemia is treated by restoring the blood glucose level to normal by the eating or administering of glucose or carbohydrate foods. Symptoms of hypoglycemia include shakiness, anxiety, sweating, pallor, coldness, clamminess.
tcmtests.com, April 2020
A 45 year-old female has a three-week history of sinus congestion. She has yellow nasal discharge and mild facial pain of the eyes. Her last episode lasted for six months. In the past she used antibiotics but is now using herbs, anti-histamines, and sinus rinses for this episode. Her temperature was 100.8 degrees F. The maxillary and frontal sinuses were tender to percussion. The nasal mucosa was hyperemic (an increase in the quantity of blood flow). Which action would you take?
have friend transport patient to emergency department (ED)
urgent (same hour) referral to ENT
call 911 for emergency transport
semi-urgent (one or two days) referral to primary care physician
semi-urgent (one or two days) referral to primary care physician
The red flag is facial pain over sinuses, fever, purulent discharge from nose continuously for 3 or more months or recurrentiy fee 0 6 months. Chronic bacterial sinusitis is assumed present until proven otherwise. For acupuncturist the key is to determine if the sinusitis is improving, independent of what therapy is being used. Patients which are worsening Of the situation is becoming chronic should be referred before the infection spreads beyond the sinuses. Patients with weak immune systems (chronic prednisone, AIDS, etc) can quickly worsen with an ordinary infection.
An Acupuncturist’s Guide to Medical Red Flags and Referrals, 2012, Anzaldua, pages 112-113
What is the most common complaint of Cranial Nerve XII dysfunction?
Difficulty spitting
Garbled or slurred speech
Loss of taste
Spastic muscles
Garbled or slurred speech
The most common complaint of Cranial Nerve XII (hypoglossal) is garbled or slurred speech, speaking with “marNes in the mouth”, difficulty chewing, complaints that “my tongue gets in the war and difficulty swallowing. Dysphonia is associated with paralyzed or dysfunctional vocal cords.
Textbook of Clinical Neurology, Christopher G. Goetz, MD and Eric J. Pappert, 1999, W.B., Saunders Company, page 214
A 55 year-old female patient has a four day history of a swollen and painful left leg. The patient recently had a total hip arthroplasty due to severe arthritis. She is currently on estrogen-only replacement therapy (HRT) for perimenopausal symptoms. Her BMI is 24. Physical examination shows an edematous left leg below the knee with mild erythema. The right leg appears normal. Flomans’s sign is positive. The Thomas test is positive. Which of the following answers contain the strongest aspect of the clinical picture warranting a referral?
hip arthroplasty, HRT, Homan’s sign, edema and erythema
postive Homan’s sign, BMI 24, perimenopause with HRT
BMI 24, hip arthroplasty, HRT, Homan’s sign, Thomas Test
Homan’s sign, Thomas Test, edema and erythema
hip arthroplasty, HRT, Homan’s sign, edema and erythema
This is the best and strongest answer. This patient likely has a deep vein thrombosis (DVT). The BMI is not a factor in this patient. Normal BMI is 18.5 to 24.9. The Thomas test is done with the patient supine with full hip flexion. If the opposite hip lifts oft the table, there is likely a fixed flexion deformity. This test is not relevant. This patient has DVT should be referred. DVT classically presents itself as unilateral, swollen, and a painful lower extremity. In the Homan’s Sign the foot is dorsiflexed (bend toward shin). If it causes pain it is positive. This sign is often unreliable for DVT. The Virchow’s triad refers to the types of conditions that can predispose a patient to the formation of an abnormal thrombus (blood clot). Virchow’s triad can be remembered with the acronym SHE. These are Stasis (S), Hypercoagulability (H), and Epithelial Injury (E). S STASIS: The most common conditions that can cause blood flow stasis are surgery (hip or knee), prolonged immobilization, tong travel, varicose veins atrial tibrillatbn. or obesity (normal BMI is 18.5 to 24.9). In these conditions, the blood can pool or stagnate, increasing the risk of platelet coagulation. H HYPERCOAGULMILITY: This means an increased (hyper) risk of coagulation. The most common conditions for hypercoagulability risk are surgery (hip or knee), hormone replacement therapy, birth control pills, pregnancy, or obesity (normal BMI is 18.5 to 24.9). E EPITHELIAL INJURY: The endothelial is the cell layer of cells that lines veins. Damage to this layer can be from a direct or indirect cause stimulates platelets and the coagulation process. Damage to this layer can be due to IV drug abuse, trauma, or surgery (hip or knee). In patients who have a total hip or knee replacement surgery there is venous stasis (S) due to pedoperative immobilization, hypercoagulability (H) due to postoperative fibdnolytic shutdown, and epithelial injury (E) caused by the surgery. DVT can lead to blood dots traveling to the lungs (pulmonary embolism). There can be a sudden onset of non-infectuous pleurisy (central chest pain worse with breathing, bloody sputum), breathessness, cyanosis. This would be high-priority emergency referral.
With the patient supine, active isometric contraction of the quadratus quadriceps muscle by the patient with posterior directed tome placed upon the patellar by you causes reproduction of the patients pain. What is the name of this test?
Patella Twist
Patellar Grind/Compression Test
J Sign
Patellar Apprehension Test
Patellar Grind/Compression Test
The Patellar Apprehension Test is exactly where the patient is supine and the examiner provides lateral distraction to the patella and a positive test is the apprehension that the patient shows fearing that the patella will dislocate. With the Patellar Grind/Compression Test, the patient is supine with active isometric contraction of the quadriceps muscle by the patient and posterior directed force placed upon the patella by the examiner causes a positive test when it reproduces the patients pain with this maneuver. The J sign is where the patient is seated and slowly extends the knee to 0 degrees. Normally the examiner observes the patella gliding proximally with exMnsion and a positive J sign is observed when the knee approaches full extension of the patella. It will not only glide proximally but will lateralize in the final degree of extension, inverting a J, so an upside down J, movement of the patella occurs. Patients with malalignment or poor biomechanics will demonstrate a positi■ie J sign and indicate patella instability. The CI Angle is the quadriceps angle that is measured at the genu valgus, where the angle created by two lines, one drawn from the middle patella and the tibial tubercle and the other line from the middle of the patella to the anterior superior iliac spine of the iliac crest It is normal in males to be less than 10 degrees and in females less than 15 degrees. Patients with high Dangles have increased risk for patellofemoral conditbns and pain. Rotation Handout Family Medicine Residence Orthopedic Rotation Monteleone Jr. Dept. of Family Medicine West Virginia School of Medicine with further references to Magee’s Orthopedic Physical Assessment and Hoppenfeld’s Examination of the Spine and Extremities; Medicinehsc.wvu.edu
WhIch lab test can help confirm a possible peptc ulcer?
a urine test
a BUN test
a stool blood test
a blood glucose test
a stool blood test
A peptic ulcer is a defect in the lining of the stomach or the first pad of the small intestine which is called the duodenum. A peptic ulcer in the stomach is celled a gastric ulcer. Most ulcers occur in the first layer of the mucosa! lining. A hole that goes all the way through the stomach or duodenum is called a perforation which is a medical emergency. A fecal occult blood test may be done to detect blood in the stool, which may he caused by the peptic ulcer. By itself, a fecal occult blood test cannot diagnose peptic ulcer disease, but it may show if an ulcer is bleeding.
tcmtests.com, July 2020
A 7 year-old child has a sore throat, fever, difficulty breathing, and swollen lymph glands on the neck What sign would point to diphtheria?
skin vesicles
thick-gray membrane over throat and tonsils
white pimples in the gums surrounded by a red circle
macular skin eruption
thick-gray membrane over throat and tonsils
Diphtheria is a bacterial infection affecting the mucous membranes of the nose and throat. The classic sign is a sheet of thick-gray material covering the back of the throat. This can block the airway, causing a struggle for breathing. Because of the DTaP (diphtheria, tetanus pertussis) vaccine, diphtheria rarely occurs in the US and in Europe but is still common in developing countries with low immunization rates. Children (and adults) who have not been immunized or living in crowded-unsanitary situations or traveling to third-world countries are at dsk.
The Merck Manual, 18th Edition, page 1451
A 69 year-old male patient with Parkinson’s disease has been prescribed L-dopa. He should be careful taking the medication with meals that have too much
carbohydrates
sugar
fat
protein
protein
The amount of L-dopa or levodopa that reaches the brain can vary depending on how much protein is eaten when taking the drug. In order for L-dopa to work, it needs to be absorbed in the small intestine, where proteins can interact with the drug. L-dopa is an amino acid. Proteins are composed of amino acids. L-dopa depends on the same mechanism as the other amino acids togs from the small intestine into the blood stream. If a meal has too much protein while taking L-dopa, the drug will tend to stay in the small intestine with less of drug reaching the brain. The patient should consult with their primary care provider for specific instructions on protein intake and overall diet, particularly if the symptoms of Parkinson’s disease worsen.
webmd.com
A 10 year-old child is taking Flovent (fiuticasone). What is the presenting problem?
ear infection
bronchial asthma
diarrhea
Attention Deficit Disorder
bronchial asthma
A 57 year-old male is taking Flomax (tamsulosin). What is the chief complaint?
OCD
GERD
ADHD
BPH
BPH
Flomax (tamsulosin), an alpha-adrenergic blacker, treats Benign Prostatic Hyperplasia. tcmtests.com, July 2019
For women who do breast self-examination, the examination is best done
1 -3 days before onset of period
5 - 7 days before onset of period
1 - 3 days after onset of period
5 - 7 days after onset of period
5 - 7 days after onset of period
Self-examination done is best done when estrogen stimulation is lowest which is about 5-7 days after onset of menstruation. Breast self-exams allow the patient to alert the healthcare professional if there are any changes. Johns Hopkins Medical notes that forty percent of diagnosed breast cancers are detected by women who feel a lump
The American Cancer Society no longer recommends breast self-examination. Mammograms are the primary screening tool to help detect cancer Salem a lump is present Bate’s Guide to Physical Examination, 13th Edition, page 606-607; Bate’s Guide to Physical Examination, 10th Edition, page 392, 399; cancer.org
A 45 year-old African-American male has the chief complaint of morning headaches for the past week that have occurred three times. He complains of a pulsing pain in the temple area with a pain level of 3 on scale of 1-10. He complains of lightheadedness and chest tightness which resolve themselves after taking a warm shower. Yesterday he had a slight nosebleed. He complains of facial flushing during the evening. His oldest son was killed in a car accident two months ago. He also has had his work hours and pay reduced this past week. Physical exam has body temperature at 98.2 F, respiratory rate of 20, heart rate of 94, and BP was 185/90. The ECG test shows nonspecific T wave changes. Total cholesterol: 240, HDL: 58, LDL: 166; Triglycerides: 196. What is the most likely diagnosis for the headaches?
stage 2 hypertension
cardiovascular disease
stress headache
hypertensive crisis
hypertensive crisis
This patient is having an hypertensive crisis. The American Heart Association guidelines for hypertension are: Normal Less than 120/80. Elevated: Systolic between 120-129 and diastolic less than 80. Stage 1: Systolic between 130-139 or diastolic between 80.89. Stage 2: Systolic at least 140 or diastolic at least 90. Hypertensive crisis: Systolic over 180 and/or diastolic over 120. A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. A hypertensive crisis has two categories: urgent and emergency. In an urgent hypertensive crisis, blood pressure is extremely high but the physician does not suspect any internal organ damage. This patient has an urgent hypertensive crisis. In an emergency hypertensive crisis, the blood pressure is extremely high and has caused damage to internal organs which can be life-threatening. Signs and symptoms of an emergency life-threatening hypertensive crisis include severe chest pain, severe headache with confusion and blurred vision, nausea or vomiting, SOB, seizures, and unresponsiveness
What is an accurate statement in comparing otitis media and otitis extema?
an otitis media infection or an extern infection can spread to the mastoid bone
with an otoscope, only otitis media has a bulging tympanic membrane
otitis media is caused by a bacteria Mille otitis extema is caused by a virus
in otitis extema pulling the pinna elicits pain while in otitis media pressing on the tragus elicits pain
with an otoscope, only otitis media has a bulging tympanic membrane
The most indicative signs of otitis media through an otoscopic examination of the middle ear includes erythema, bulging, a cloudy appearance, and an immobility of the tympanic membrane. Otitis media can have fluid accumulation (effusion) which is indicative of a subtype (otitis media with effusion). In otitis externa the external ear canal can be red and puffy. In otitis externa, which affects the outer ear and canal, either pulling on the pinna or pressing on the tragus elicits pain. Tenderness with movement of the tragus or pinna is a classic sign of otitis externa.
An infection of the mastoid bone (mastoiditis) can be complication of otitis media but not otitis externa. Both otitis media and externa can be caused by a bacteria or a virus. However, most often otitis externa is due to ‘swimmers ear, ear psoriasis or eczema, or an irritation of the ear canal (ear buds, cotton swabs).
OTITIS MEDIA: is an inflammation of the middle ear. It can be acute or chronic. It can be caused by a bacteria or a virus. If there is no fever, mild or no pain, the ear drum moves, and the patient has cold symptoms it is likely a viral infection. Decongestant allergy treatment with an antihistamine and a nasal steroid can be prescdbed. If there is fever, pain, lack of movement of a very red and bulging eardrum, it is likely bacterial and antibiotics can be prescribed. Children with acute otitis media can have fever, irritability, acute pain and have fluid draining from the ear.
OTITIS EXTERNA: is an inflammation of the ear canal. It can be due to a water being trapped in ear canal (swimmers ear), a bacteria, a virus, an irritation of the ear canal or due to ear psoriasis or eczema. Symptoms include ear pain that worsens when the outer ear is tugged or pressed on, itchy ear canal, a blocked ear, and temporary hearing loss If severe, there can be a foul-smelling yellow discharge from the ear. Mild otitis extema can be treated by keeping the ear dry and with OTC medications such as Swim Ear (isopropyl alcohol) to help dry the ear. Antibiotic ear drops can be prescribed for more severe otitis externa. If there is a lot of drainage then the ear can be suctioned out.
What two muscles are involved in supination of the forearm?
Biceps and Supinator
Brachialis and Biceps
Triceps and Supinator
Biceps and Pronator
Biceps and Supinator
Biceps, C5-6, musculocutaneous nerve and supinator, C6, radial nerve are the prime movers for supination. Rotation Handout Family Medicine Residence Orthopedic Rotation Monteleone Jr. Dept. of Family Medicine West Virginia School of Medicine with further references to Magee’s Orthopedic Physical Assessment and Hoppenfeld’s Examination of the Spine and Extremities; Medicinehsc.wvu.edu
Which hormone stimulates development of oocyles in women and stimulates production of sperm in men?
LH
OT
PRL
FSH
FSH
In women, FSH (follicle stimulating horrnone ) helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout a woman’s menstrual cycle. It is highest just before ovulation. In men, FSH helps control the production of sperm. The amount of FSH in men normally remains constant OT (oxytocin) is produced by the hypothalamus and secreted by the pituitary gland and plays role in childbirth process and also helps with male reproduction. LH Outeinizing horrnone) is produced and released in the anterior pituitary and has a role in controlling the function of ovaries in females and testes in mM es. PRL (prolactin) is made by the pituitary gland. Pregnant women have high levels of prolactin, which helps make breast milk.
tcmtests.com, May 2020
Your acupuncture treatment requires the needling of REN-1 to a patient of the opposite sex. You explain to the patient the procedure. Which is most risky in a potential future lawsuit?
Put an latex gloves first
Proceed as though you received consent
Consider alternate points
Have your assistant present
Proceed as though you received consent
Excess ammonia blood levels have an effect on the
bladder
liver
lungs
heart
liver
A47 year-old female has Chronic Bronchitis. What are the symptoms and signs?
pursed lip breathing, prolonged expiratory period with grunting, dyspnea, barrel-shaped chest
malaise, fever, exertional dyspnea, productive cough, rales, dullness to permission over lung areas
productive cough for at least 3 months per year for 2. years, cyanosis, Dyspnea, wheezing
hemoptysis, chest pain, dyspnea, cough, weight loss, hoarseness
productive cough for at least 3 months per year for 2. years, cyanosis, Dyspnea, wheezing
Bronchitis is caused by inflamed bronchioles (air tubes in the lungs) producing too much mucous. There are two types of bronchitis: acute bronchitis is short-terrn and more common and is caused by a viral infection and the symptoms can be made worse with smoking. Chronic bronchitis is a cough that persists for two to three months each year for at least two years. The cough and inflammation can be due to an infection, an illness, or exposure to an irritating substance (tobacco smoke, air pollution). Symptoms include: cough with mucous, wheezing, and SOB.
Professional Guide to Diseases, 9th Edition, page 148
Your patient complains of loss of sensation at tip of the index finger, which peripheral nerve is most likely involved?
ulnar nerve
axillary nerve
radial nerve
median nerve
median nerve
HIPAA considers acupuncturists as a covered entIty because of
sending emails to patients and physicians, faxing health information, using electronic health insurance billing
the use of sterile single-use needles
faxing health information, using electronic health insurance billing, the use of sterile single-use needles
faxing health information, using electronic health insurance billing
sending emails to patients and physicians, faxing health information, using electronic health insurance billing
HIPAA are the rules governing the condition under which patient personal and health information and details can be communicated (verbally, in writing) with and without the consent of the patient. Acupuncturists can talk to other health care practitioners as long as there is no identifying information. Under HIPAA, protected health information (PHI) covers information on medical records, conversations about patient care, health insurer information, personal billing information.
Clean Needle Technique, 7th Ed/bon, page 219, 220
A 38 year old female presents to you with joint eliciting on the right side of the jaw. Upon palpation, you are able to palpate crepitus as well as hear the clicking. This may be due to
Meniscal displacement, Synovial swelling, Poor occlusion
Meniscal displacement
Meniscal displacement, Sinusitis. Poor occlusion
Synovial swelling, Poor occlusion
Meniscal displacement, Synovial swelling, Poor occlusion
This is the most complete and accurate answer. Sinusitis is not associated with crepitus. Crepitus occurs when rough cartilage and bones rub together in a joint, making a clicking or popping sound. In the temporomandibular joint (TMJ), crepitus can indicate poor occlusion (how the top and bottom teeth fit together), a meniscus injury (fibrous tissue that separates the TMJ joint, condyle and the temporal bone). Synovial swelling is an inflammation of the joint-lining (synovial) of the TMJ.
Bale’s Guide to Physical Examination, 13th Edition, page 757-759; Bate’s Guide to Physical Examination, 10th Edition, page 587
If an acupuncturist wants to terminate the patient/prectifioner relationship. how much notice should be given to the patient?
30 days
15 days
10 days
45 days
30 days
Patients should be netted via a certified letter. The letter should state a termination date. Termination date should be at least thirty (30) days from date of notice. The time period may vary depending on the circumstances of a particular patient Health care providers cannot abruptly dismiss a patient without first giving the patient notice and an opportunity to make other arrangements for health care. When discontinuing a patient, health care providers must be cautious not to abandon the patient Patient abandonment occurs when a health care provider ends a health care relationship and fails to provide the patient with adequate notice in time to allow the patient to find another health care provider. Health care providers who abandon patients can have disciplinary action by the state medical board. Health care providers can also be vulnerable to a medical liability suit if the patient suffers any injuries from the abandonment
Acupuncture Risk Management, CMS Press, Kailin, 1997 page 129
A 27 year-old female has chronic Ulcerative Colitis. What are her symptoms?
colicky abdominal pain relieved by BM, dear or white mucous in stool, bloating, flatulence
black tarry stools, anemia, abdominal ache and cramps, weight loss
lassitude, weakness, anorexia, intermittent diarrhea, steatorrhea, weight loss, rash
tenesmus, chronic diarrhea with blood and mucous, lower abdominal cramps
tenesmus, chronic diarrhea with blood and mucous, lower abdominal cramps
Ulcerative colitis is a subtype of inflammatory bowel disease (1130). Ulcers or sores form on the inner lining of the colon and cause bleeding and inflammation. Ulcerative colitis is similar to Grohn’s disease except that Crohn’s can affect the whole GI tract while ulcerative colitis only affects the large intestine. Patients with ulcerative colts normally present with diarrhea mixed with blood and mucus There are lower abdominal cramps and tenesmus (recurrent urge to evacuate the bowels). Ulcerative colitis can be classified in regards as to which part of the large intestine is affected: 1) there is ulcerative proctitis which affects mostly the rectum/anus and has rectal bleedng. 2) there is proctosigmoiditis which affects the sigmoid colon (lower end of the colon) and has bloody diarrhea, abdominal cramps and pain as symptoms. 3) Mere is left-sided colitis which affects the rectum up through the sigmoid and descending colon (all are located in the upper left part of the abdomen) with symptoms of bloody diarrhea, abdominal cramping and pain on the left side. Ulcerative colts can alternate between periods of flare ups alternating with periods of remission. It is no longer believed that stress is the main cause of ulcerative colitis (stress can worsen symptoms). The exact cause of ulcerative colitis is unknown but there is speculation that it might involve bacterial infection of the large intestine which triggers an inflammatory immune response. As ulcerative colitis runs in families it has been speculated that it is hereditary. Long-term yak of colon cancer is high.
Which of the followIng Is an accurate statement about shoulder pain?
rotator cuff tears most often affect the infraspinatus tendon
the Neers test can be used to diagnose shoulder impingement
biceps tendinitis mostly affects the short head of the biceps tendon
the Tine’s test can be used to diagnose adhesive capsulitis
the Neers test can be used to diagnose shoulder impingement
One of the tests use to diagnose shoulder impingement is the Neers test In this test patient sits or stands with arm relaxed at side. The examiner stabilizes the scapula with a downward tome while passively flexing the patients internally rotated humerus into full elevatbn. Pain is positive. The liners test helps to diagnose carpal tunnel syndrome. Biceps tendinitis most often affects the long head of the biceps tendon. Rotator cuff tears most often affect the supraspinatus tendon.
BICEPS TENDINITIS: Occurs most commonly in the long head of the biceps tendon. Inflammation is caused by micro tears in the tendon due to repetitive motion (throwing, swimming, serving, swinging a golf dub, etc). Also, arthritis can cause bone spurs that can impact the biceps tendon.Biceps tendonitis affects the anterior part of the shoulder. As tendinitis develops, the tendon sheath (covering) can thicken. Then the tendon itself can thicken. Pain or tendemess in the front of the shoulder worsens with overhead lifting or actNity. There can also be an occasional snapping sound when moving the shoulder. TEST: In the Speeds test the ann is raised parallel to the floor with palm facing up. The examiner pushes the arm down while the patient resists. Pain in front of shoulder during test is positive.
ROTATOR CUFF TEAR: The rotator cuff is a group of muscles and tendons (supraspinatus, infraspinatus, teras minor, subscapularis) that stabilize the shoulder joint. An injury or degeneration due to age can cause a tear to one of the rotator cuff tendons. The tear can be partial or a complete tear (full thickness) separating the tendon from the bone. With a complete tear there is significant weakness with an inability to raise the arm against gravity. The most common is a supraspinatus tendon tear. The supraspinatus is located at the top of the shoulder Na de and inserts at the top humerus bone. The main action of the supraspinatus is to abduct the shoulder joint. There is weakness and pain (deep dull ache) making it difficult to comb one’s hair or reaching behind the back. Common symptoms include pain during rest and at night pain lying on affected shoulder, pain or weakness liffing and lowering arm, and crepitus (crackling sensation when moving shoulder). TEST: The drop ann test is used to assess for full thickness rotator cuff
A medical practice can refuse a patients request to amend thew medical record
If unrelated to patient care
Only if insurance coverage is not affected
Under specific circumstances
Under no circumstances
Under specific circumstances
The patient has the right to request changes to (or amend) their information in a medical record. The health care provider is responsible for responding to the amendment request. The health care provider may require that the request be in writing and provide a reason for the amendment. When the health care provider agrees to an amendment request, the patient is first notified of the acceptance. The health care provider must act on requests no later than 60 days after receiving the request. If unable to act on the request within that time frame, the health care provider can give themselves a 30-day extension. If the extension is take, a letter should be sent to the patent explaining the delay and the date that the request will be completed. The health care practitioner might reject the request to amend under the grounds that the record is accurate. The patient can appeal that decision.
www.hhs.gov/hipaa/
A patent receiving chemotherapy should avoid gua sha treatment for
24 hours before and 48 hours after chemotherapy treatment
3 days before and 2 days after chemotherapy treatment
48 hours before and 24 hours after chemotherapy treatment
2 days before and 3 days after chemotherapy treatment
48 hours before and 24 hours after chemotherapy treatment
The therapeutic goal of chemotherapy foe cancer is apoptosis (cancer cell death) and because both gua sha and cupping are anti-apoptotic it is recommended to avoid applying gua sha or cupping for 48 hours before and 24 hours after chemotherapy treatment.
You are examining the internal nose with a speculum. You can see ridges of cartilage covered by mucous membrane. What are they?
turbinates
pterygoid processes
uvula
vomer
turbinates
Turbinates, ridges of cartilages that are covered by mucous membranes, line the inside of the nasal cavity. These cartilages warrn and moisten the air that is breathed in through the nose. A speculum is a medical instrument that is used to widen body cavity or passage openings, such as the vagina, anus, ear, or nostrils.
Which of the following are drug classes or drugs that reat angina?
Calcium channel blockers, Beta agonists, Beta Blockers, Nitrates
Beta agonists, Beta blockers, Nitrates, Ranolazine
Beta blockers, Nitrates, Ranolazine
Calcium channel blockers. Beta blockers, Nitrates, Ranolazine
Calcium channel blockers. Beta blockers, Nitrates, Ranolazine
This is the most complete and accurate answer. Beta agonists are prescribed for the treatment and control of ash and COPO. Angina pain is caused by insufficient oxygen blood flow (ischemia) to the heart muscle caused by an plaques. The four main categories of antiangina drugs are nitrates, beta blockers, calcium channel blockers, and ranolazine.
NITRATES improve blood flow by relaxing and dilating veins and arteries through the release of nitric oxyde (a vasodilator). Nitrates reduce the amount of blood returning to the heart. Nitrates come in different forms of nitroglycedn (NTG): 1) sublingual or spray form nitroglycerin is effective within 2-5 minutes and the effect can last 30 minutes, 2) oral or transdermal nitrates take about 15 minutes to take effect and can last up to 24 hours, if timc release. Continuous nitrate treatment can lead to tolerance of the drug within 24 to 48 hours. Nitrate tolerance do, not usually develop with sublingual NTG. Side effects of nitrates are headache, lightheadedness (especially the elderly), flushing, and an increased heart rate. Imdur (timed release pill), Nitro-Dur (patch), and Nitro-Bid (cream). BETA BLOCKERS reduce the heart rate and reduce the force of heart contractions thereby decreasing heart oxy requirement. Beta blockers work through the blocking epinephrine (another term far adrenalin) receptors. Example of beta blockers include Cardura (doxasosin) and Minipress (prazasin), Caves (donidine) and Aldomet (methyl& Beta blockers should not be used on asthmatic patients (block the effect of adrenalin on the lungs), certain heart conditions such as heart failure, and patients with a slow heart rate. Side effects of beta blockers include dry mou drowsiness, constipation, insomnia, palpitations, and a high risk of hypotension. CALCIUM CHANNEL BLOCKERS cause smooth muscle relaxation by blocking calcium receptors in the blood vessels preventing vasoconstriction, thereby improving blood flow to the heart. Examples of calcium channel bloc include Cardizem (diltiazem), Calan (reapamil), Vasoc, (berpdil), Procardia (nifedipine). Side effects include
Which of the following are drug classes or drugs that treat angina?
Bill recently returned from a trip to Guatemala. While there he was treated for bloody diarrhea which was identified as Salmonella typhosa (typhoid fever). He responded well to treatment Now, back in the US he has developed bloody diarrhea again with fever, cramping, and abdominal pain. Stool culture is negative. CBC blood lest indicates low-grade anemia with a hemoglobin of 10.0 gms and a leukocytosis with WBC of 15,000. He is having fi-B bowel movements per day. Physical exam reveals a mild tenderness on abdominal palpation of all quadrants, slightly increased in the left lower quadrant. During the exam he is afebrile. Possible drug treatments could include
Antibiotics, TNF drugs, Steroids, Aminosalicylates
Steroids, Aminosalicylates
Aspirin, Antibiotics, Steroids
Aspirin, Antibiotics, Steroids, Arninosalicylates
Antibiotics, TNF drugs, Steroids, Aminosalicylates
This is the most complete and accurate answer. He has ulcerative colitis and aspirin may make his ulcerative colitis worse. Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen can worsen the symptoms of ulcerative colitis. A better choice for pain relief is Tylenol (acetaminophen). Ulcerative colitis is an inflammatory bowel disease (IBD) which causes long-lasting digestive tract inflammation and ulcers which can produce pus and mucous. Ulcerative colitis symptoms include abdominal pain, diarrhea, rectal bleeding, tenesmus, poor appetite, fever, and fatigue. The key symptoms for ulcerative colitis are abdominal pain, diarrhea, and bloody bowel movements. TNF inhibitors are drugs that help stop inflammation. They treat diseases like rheumatoid arthritis (RA), juvenile arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, ulcerative colitis (UC), and Crohn’s disease.
A 50 year-old male has had a cough for the past 5 days. The cough is productive and the sputum purulent. The cough worsens with exertion and does not improve with rest. The cough is not time specific. There is shortness of breath and chest pain. There is loss of appetite and no weight loss. He chews tobacco and drinks 3 beers per night. His mother died of breast cancer. PHYSICAL EXAM: BP 132183 mm Hg; HR 105 bpm and regular; respiratory rate 28 breaths/min; temperature 101.7 F. Neck is supple with no lymphadenopathy or thyromegaly; Thorax is symmetric with good respiratory excursion; percussion notes are dull over the left base; breath sounds broncho-vesicular in left base with egophony and E-to-A changes and is diminished; no wheezes, rates, or rhonchi; tactile fremitus decreased on left side; diaphragm descends 5 cm bilaterally. Based on the preceding history and limited physical examination prior to lab tests what is the most likely disease state?
Lobar pneumonia
Lung Cancer
bronchitis
COPD
Lobar pneumonia
The clinical picture points to lobar pneumonia as there is fever, he is tachypneic and tachycardic, has diminished breath sounds with dullness to percussion over affected lobe, has positive egophony. In bronchitis the patient usually has normal or low-grade fever. Sputum usually clear or white. He does not have lung cancer as he lacks hemoptysis, has chest pain, does not have lymphadenopathy, hepatomegaly, ascites. It is possible due to history and chewing tobacco but further tests indicated for this dx. He lacks asymmetric thorax for COPD.
The Thyroid-Stimulating Hormone (TSH) test helps to
Differentiate between types of hypothyroidism
Exclude thyroid cancer
Confirm thyroid cancer
Evaluate iodine uptake by the thyroid
Differentiate between types of hypothyroidism
The TSH concentration test helps in diagnosing primary (thyroid), secondary (pituitary), and tertiary (hypothalamus) hypothyroidism. The hypothalamus releases TRH. When the anterior pituitary receives the TRH from the hypothalamus, the pituitary starts releasing TSH which then tells the thyroid to start producing thyroid hormones (T4, T3). Patients who have primary hypothyroidism where there is a dysfunctional thyroid unable to produce T4 and T3, the levels of TRH and TSH in the blood are high because the hypothalamus and pituitary are reacting to low thyroid hormone levels in the blood. In secondary hypothyroidism, there is a malfunction of the pituitary gland and in tertiary hypothyroidism there is a malfunction of the hypothalamus. The TSH test is also used to monitor the effect of treatment The TSH test is also used in the diagnosis of hyperthyrodism.
WhIch of the following are stimulant laxatives?
magnesium hydroxide, senna
bisacodyl, docusate
docusate, bisacodyl, magnesium hydroxide
senna, bisacodyl
senna, bisacodyl
This is the most accurate answer. Oral stimulants such as bisacodyl (Dulcolax) and senna (Senokot) trigger rhythmic contractions of intestinal muscles to eliminate stool. Oral osmolics such as magnesium hydroxide (Phillips Milk of Magnesia) and polyethylene glycol (Miralax) draw water into the colon to allow easier passage of stool. Oral stool softeners such as docusate (Colace, Surfak) add moisture to stool to allow strain-free bowel movements. Bulk formers such as wheat dextrin (Benetiber), psyllium husk powder (Metamucil), and methylcellulose fiber (Citrucel) absorb water to form soft, bulky stool, prompting normal contraction of intestinal muscles.
tcmtests.com, February 2019
Which of the following movements describes the Hawkins Impingement Test for the shoulder?
press on the patient’s scapula with one hand, place the other hand on the elbow, and then forward flex the arm
flex the patient’s shoulder and elbow at 90 degrees with the palm facing dorm; then with one hand on the elbow v and the other on the forearm, rotate the arm internally
press on the patient’s scapula with one hand, place the other hand on the elbow, and then pull the arm back
flex the patient’s shoulder and elbow at 90 degrees with the palm facing dorm; then with one hand on the elbow and the other on the forearm, rotate the arm externally
flex the patient’s shoulder and elbow at 90 degrees with the palm facing dorm; then with one hand on the elbow v and the other on the forearm, rotate the arm internally
Pain during this test is positive for a possible rotator cuff tear. Shoulder pain or apprehension are indicative of a shoulder impingement, especially the supraspinalus tendon. The Hawkins Impingement Test identifies impingement of the greater tuberosity against the coraco-humeral ligament.
Lanoxin (digoxin) treats
hypertension, heart failure
dysrhythmias, heart failure
cardiogenic shock, hypertension
dysrhythmias, hypertension
tcmtests.com, April 2020
dysrhythmias, heart failure
This is the most accurate answer. Digoxin beats dysrhythmias, heart failure, and cardiogenic shock. the most common indications for digoxin are atrial fibrillation and atrial flutter, but beta-blockers or calcium channel-blackens are often the first choice. Digoxin is no longer the first choice for congestive head failure, but can still be useful in patients who remain symptomatic despite proper diuretic and ACE inhibitor treatment. Cardiogenic shock is a condition in which a suddenly weakened head is no longer able to pump enough blood to meet the body’s needs. The condition is a medical emergency and is fatal if not treated immediately. Signs of inadequate blood flow include low urine production, cool arms and legs, and altered level of consciousness.
How would you describe the lymph nodes of a patient with Hodgkin’s disease?
swollen and tender
immovable and had
soft and panful
enlarged and painless
enlarged and painless
Hodgkin’s lymphoma is a cancer originating from white blood cells called lymphocytes. The most common symptom of Hodgkin’s is the painless enlargement of one or more lymph nodes, or lymphadenopathy. The nodes may also fee rubbery and swollen when examined. The nodes of the neck and shoulders (cervical and supradavicular) are most frequently involved (80- 90% of the time, on average).
A 32 year-old male has a mild hotly skin rash on the scalp. The rash is red, thick, and scaly Physical examination also reveals plaques on the right elbow and pitted discolored nails. What is the most likely diagnosis?
scabies
psoriasis
eczema
Tinea versicolor
psoriasis
Psoriasis consists of plagues of red skin (often with silver scales) that can be itchy and painful. The plaques can also crack and bleed. There can also be pitting discolored nails that can detach from the nail bed. The common sites for psoriasis are knees, elbows, scalp, torso, palms, and soles. With psoriasis the immune system is overactive causing skin inflammation. New skin cells are pushed to the surface h 3-4 days (28-30 days is normal) and accumulate causing dead skin to pile up and forming plaques. Diagnosis of psoriasis is usually done through medical history and physical exam that looks at the skin, nails, and scalp. A skin biopsy is rarely done unless to rule out other diseases.There is one eczema type but there are multiple types of psoriasis. The most common fOIM of psoriasis is plaque psoriasis which most clearly resembles eczema. Itching is a significant differences between the two. Psoriasis has mild itching while eczema causes intense itching to the point of scratching until bleeding. In eczema scratched skin become swollen and raw. With eczema the itching is usually worse at night. Eczema does not typically have joint swelling nor nail dsorders while psoriasis can Thee is a ringworm infection. Tinea versicolor changes the color pigmentation of the skin. Scabies is a contagious skin caused by microscopic burrowing mites. Scabies have intense uncontrollable itching (especially at night) but the rash consists of pimple like bumps where the mite has penetrated the skin.
medlineplus.gov
Which of the following combinations of CPT codes is not allowed?
acupuncture (97810) with additional 15 minutes of acupuncture (97811)
acupuncture with estim (97813) with adcbtonal 15 minutes of acupuncture with estim (97814)
acupuncture (97810) with additional 15 minutes of acupuncture with estim (97814)
acupuncture (97810) with additional 15 minutes of acupuncture with estim (97814)
The CPT book does not allow you to bill for a .mix-and-match” of acupuncture and electroacupuncture on the same visit. This is to prevent acupuncturists from charging for inserting the needles (acupuncture) and then attaching electrodes to those some needles (electroacupuncture).
Flaccidity is commonly associated with
Hypothyroidism
Parkinsonism
Guillain-Barre syndrome
dementia
Guillain-Barre syndrome
In Guillain-Barre syndrome (a rare disorder) the immune system attacks the nerves. Weakness, muscle flaccidity, and tingling in the extremities are usually the first symptoms. These symptoms can spread quickly and in severe cases lead to a paralysis of the entire body. Guillain-Barre syndrome is a medical emergency and the patient needs to be hospitalized for treatment. Guillain-Barre syndrome is a lower motor neuron disorder.
Your patient Is not aware of a particular mood, thought, or perception that Is abnormal or part of an Illness. One would consider this patent as having?
Disoriented
Good insight
Lack of insight
Lack of judgment
Lack of insight
Insight is a deep understanding of a person or thing. Insight is usually assessed during the interview. Asking questions such as ‘What do you think is wrong?”, “What brings you for treatment?” are ways to evaluate self-insight. Patients who am psychotic may lack insight into their condition. Also, some patients with neurological disorders can deny that they have any impairment. In evaluating judgment, notice whether the patient’s decisions are based on impulse, wish fulfillment, disordered thought, or reality. The judgement of a patient can be assessed by how the patient responds to family situations, use of money, their job, and relationship conflicts. Questions such as “How will you manage things if you lose your job?”, “Who will take care of your affairs if you go to a nursing home?’ Disorientation occurs when memory or attention is impaired.
A27 year old male came to the clinic wanting help for his knee pain. He works as a window washer. Three weeks earlier while stepping down from a ladder he missed a rung and landed on his left foot very hard. He felt the left knee twist and pop. From that point he was wobbly when standing. After the incident his knee was significantly swollen. Physical exam showed a limp when walking. The affected knee was swollen about 1.5 inches more than the right. The swelling was soft. There was a positive anterior drawer sign of 1/2 inch. There was a medial joint space tenderness upon palpation. The McMurray’s test was positive. Which action would you take?
call an orthopedist surgeon to schedule surgery
a timely (1-2 weeks) or a semi-urgent (same or next day) referral to primary care physician
treat with acupuncture and cupping 2x per week for three weeks
advise rest and ice every four hours until swelling and pain resolves
a timely (1-2 weeks) or a semi-urgent (same or next day) referral to primary care physician
The red flag is knee trauma with pain and immediate and severe knee swelling. An internal knee derangement is assumed until proven otherwise. Knee derangement is a general term referring to one or more tearing of the knee ligaments. This particular red flag will often show up in the history as a swollen knee after trauma to the knee. The patient should be driven by someone else to the referral if the knee is painful and unstable. The orthopedist will most likely be the final consultant because this can be a surgical problem in many cases. In chronic cases the patient has learned to live with the problem with recurrent swelling, pain, and dysfunction but, if there is enough discomfort, a referral is required. In acute cases ice, elevation, and crutches are advised if there is swelling.
What symptoms would indicate that a middle ear infection has spread to the inner ear?
sensitivity to light and headache
slurred speech and epistaxis
a sore throat with nasal congestion
dizziness, nausea, vomiting and nystagmus
dizziness, nausea, vomiting and nystagmus
Otitis media is a middle ear infection. It can cause a change in the normal eardrum. In otitis media the infection can be caused by a virus or by bacteria. It can be associated with allergies, enlarged adenoids, or a cold that could result in the blockage of the eustachian tube which connects the throat and middle ear. Otitis media symptoms include ear pain, fever, hearing loss, or a sense of fullness in the ear. Some cases have loss of appetite, vomiting, tinnitus, ear drainage, or v
Which condition requires cautious use of aspirin?
headache
strong appetite, extreme fatigue, flu-like symptoms
tinnitus
impaired renal functioning
impaired renal functioning
Aspirin is exacted by the kidneys. Aspirin should be used cautiously where hepatic failure or impaired renal function are present.
What’s the sensation for C6?
Medial forearm, ring and small finger
Medial arm
Middle finger
Lateral forearm, thumb
Lateral forearm, thumb
C5 innervates the lateral arrn. C6 innervates the lateral forearrn and thumb. C7 innervates the middle and index finger. C8 innervates the medial forearm, ring and small finger. T1 innervates the medial arm.
Which of the following demonstrates continuity of patient care?
Keeping the same acupuncture assistant in the office; Follow up phone call to no-show patients; Designate a substitute provider when on vacation; Follow up phone call to a patient-initiated closure of the relationship
Designate a substitute provider when on vacation; Follow up phone call to a patient-initiated closure of the
relationship
Follow up phone call to no-show patients; Follow up phone call to a patient-initiated dosure of the relationship
Follow up phone call to no-show patients; Designate a substitute provider when on vacation; Follow up phone
call to a patient-initiated closure of the relationship
Follow up phone call to no-show patients; Designate a substitute provider when on vacation; Follow up phone
call to a patient-initiated closure of the relationship
What can back pain with nerve root radiculopathy cause?
bilateral neurological signs and symptoms
radicular pain below the knee
unilateral neurological signs and symptoms
achy buttock pain only
unilateral neurological signs and symptoms
Red flags for back pain are serious back pain with neurological complications. Compression on the cord causes bilateral signs and symptoms while compression on the nerve roots where they exit the neuroforamina cause bilateral signs and symptoms while compression on the nerve roots where they exit the neuroforamina cause unilateral symptoms and signs. Simultaneous bilateral radiculopathy is rare.
