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Biomed Prep 12.Hwp BIOMED PREP 12 Page 1 A 77ͲyearͲold man with a history of hypertension, hypercholesterolemia, COPD, and a 90ͲpackͲyear smoking history presents to your clinic for acupuncture treatment. His temperature is 36.9°C (98.5°F), BP is 82/54 mm Hg, pulse is 125/min, and RR is 16/min. A pulsatile abdominal mass is palpable just superior to the umbilicus. There is diffuse abdominal tenderness, although rebound tenderness and guarding are absent. There is also slight skin discoloration noted in the left lower back. What is your next course of action? A. Needle PC6 + SP4 combination B. Needle Four Doors: RN12, ST25, RN6 C. Cupping therapy on local region D. Send the patient to emergency department Triad for Ruptured AAA ++ y This patient presents with the classic triad of symptoms for the diagnosis of a ruptured abdominal aortic aneurysm (AAA): abdominal pain, pulsatile abdominal mass, and hypotension. y In addition, this patient has several risk factors for an AAA rupture including HTN and COPD. y The skin discoloration along the left lower backy ma be due to a retroperitoneal hematoma that is associated with a ruptured AAA. A patient complains of abdominal pain with a pulsatile abdominal mass is palpable just superior to the umbilicus. What is the diagnosis? A. Thoracic aortic aneurysms B. Abdominal aneurysm C. Pancreatitis D. Bowel obstruction y The USPSTF recommends 1Ͳtime screening for abdominal aortic aneurysm (AAA) with ______________ in men aged 65 to 75 years who have ever smoked. y Repair is indicated when the aneurysm becomes greater than ______ cm in diameter or grows more than 0.6 to 0.8 cm per year. Asymptomatic patients with an AAA should be medically optimized before repair, including institution of beta blockade. y Patients with AAA diameters between 5–7 cm have a 5Ͳyear risk of rupture of about 33%. A ruptured AAA can be lethal and demands immediate surgical attention. When ruptured AAA is highly suspected, he patient should bentake immediately to the operating room for surgical repair without further diagnostic tests. (c) HB Kim, www.AcupunctureMedia.com BIOMED PREP 12 Page 2 A 62ͲyearͲold woman presents to the acupuncture clinic complaining of severe abdominal pain for the past 12 hours, first beginning as dull pain near the umbilicus but now localized to the right lower quadrant. She initially thought she was suffering from heartburn, but decided to come to the hospital because of the unrelenting pain. On examination the patient appears in distress secondary to pain, tachycardic, slightly hypotensive, and febrile at 39°C (102°F). She has a diffusely tender abdomen with point tenderness over her right lower quadrant, accompanied by guarding and rebound. Which of the following is the most appropriate management? A. Call 911 for emergent appendectomy B. Needle Lan Wei Xue C. Prescribe Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) D. Needle Lan Wei Xue and prescribe Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) APPENDICITIS SIGNS MCBURNEY POINT TENDERNESS Rebound pain or tenderness at McBurney’s Point (RLQ) ILIOPSOAS SIGN Extending the RIGHT hip causes pain along posterolateral back and hip R_______________________ Palpating in the LEFT lower quadrant causes pain in the RIGHT lower quadrant O_______________________ Passively flex the RIGHT hip and knee and internally rotate the hip causes pain HAMBURGER SIGN If a patient wants to eat his/her favorite food, rule out appendicitis Which of the following group of medications helps block excess acid production and provide longest relief? A. H2 blockers B. Proton Pump Inhibitor C. OTC Antiacids D. Beta 2 agonist Which of the following does NOT belong to Proton Pump Inhibitors? A. Omeprazole (Prilosec) B. Esomeprazole (Nexium) C. Pantoprazole (Protonix) D. Ranitidine (Zantac) HEARTBURN MEDICATION ANTIACIDS H2 BLOCKERS ᵊ PPI (Proton Pump Inhibitors) ᵊ y Aluminum hydroxide gel (Alternagel, Amphojel) y Ranitidine (Zantac) y Omeprazole (Prilosec) y Calcium carbonate (AlkaͲSeltzer, Tums) y Famotidine (Pepcid) y Esomeprazole (Nexium) y Magnesium hydroxide (Milk of Magnesia) y Cimetidine (Tagamet) y Pantoprazole (Protonix) y Gaviscon, Gelusil, Maalox, Mylanta, Rolaids y PeptoͲBismol Neutralize stomach acid to relieve Reduce stomach acidity to lessen Hep block excess acid production to shortͲacting heartburn frequency and severity of heartburn relieve severe heartburn pain Acid control lasts 30Ͳ60 minutes Acid control lasts up to 12 hours Acid control lasts up to 3 days (c) HB Kim, www.AcupunctureMedia.com BIOMED PREP 12 Page 3 Which one of the following does NOT belong to H2 blockers? A. Ranitidine (Zantac) B. Famotidine (Pepcid) C. Esomeprazole (Nexium) D. Cimetidine (Tagamet) Which one of the following belongs to Proton Pump Inhibitors (PPI)? A. Famotidine B. Pantoprazole C. Tums D. PeptoͲBismol y Antacids reduce the effects of acid in the stomach. y They do this by neutralizing the acid. Antiacids y Antacids can provide fast, shortͲterm relief. y There are many different brands of antacids. y They come in the forms of chewable tablets, dissolving tablets, and liquid. y H2 blockers reduce the amount of acid the stomach makes. y While they don’t relieve symptoms as quick as antacids, they do last longer. H2 Blockers y H2 blockers usually start to work within an hour. y OTC examples are ranitidine (Zantacᰌ) or famotidine (Pepcidᰌ). y PPIs reduce the body’s production of acid. y They work well for heartburn that isn’t resolved by antacids or H2 blockers. Proton Pump y It may take a little longer for a PPI to help the symptoms, but relief will last longer. Inhibitors (PPIs) y Most forms start working in a few days. y PPIs are most helpful for people who have chronic heartburn (more than 2 days a week). y Omeprazole (Prilosecᰌ) and lansoprazole (Prevacid 24HRᰌ) are examples of OTC PPIs. H1 receptor H2 receptor y Located in blood vessels and respiratory mucous y Located in the stomach lining membranes y Binding with histamine causes: blood vessel dilation, y Binding with histamine causes: increased narrow airways, increased mucus production and ________________ production formation of hives on the skin Which group of medicines reduces the amount of acid produced by the cells in the lining of the stomach? A. H1 blockers B. H2 blockers C. H3 blockers D. H4 blockers Which of the following is a competitive H1 anatagonist and is used for allergic reactions? A. Ranitidine (Zantac) B. Famotidine (Pepcid) C. Cimetidine (Tagamet) D. Loratadine (Claritin) (c) HB Kim, www.AcupunctureMedia.com BIOMED PREP 12 Page 4 Creatine kinase (CK), also known as creatine phosphokinase (CPK), is an enzyme expressed by various tissues and cell types. Clinically, creatine kinase is assayed in blood tests as a marker of damage of CKͲrich tissue such as in myocardial infarction, rhabdomyolysis, muscular dystrophy, autoimmune myositides, and acute kidney injury. In a case of acute myocardial infarction, __________ levels begin to rise begin to rise 5 to 6 hours after the onset of chest pain. A. CKͲMM B. CKͲMB C. CKͲBB D. CKͲHB CK = Three major isoenzyme of CK CKͲMM CKͲMB CKͲBB found mostly in the found mostly in the found mostly in the __________ muscles __________ muscle __________ tissue Assessing the active and passive range of motion are an important part of musculoskeletal physical exam. Which range of motion is attained by the examiner without the patient’s assistance? A. Active range of motion B. Assisted Active range of motion C. Passive range of motion D. A and B Normally, __________ is slightly greater than __________ because joints have a small amount of motion at the end range that is not under voluntary control. A. AROM, PROM B. PROM, AROM Assessing and treating loss of knee extension range of motion is an important component for rehabilitation following any knee surgery. What is the normal range of motion of knee in full extension? A. 0 degree B. 90 degree C. 140 degree D. 180 dgree RANGE OF MOTION (ROM) Active ROM (AROM) Passive ROM (PROM) Unassisted voluntary movement of a joint Attained by the examiner without the patient's assistance (c) HB Kim, www.AcupunctureMedia.com BIOMED PREP 12 Page 5 Degenerative joint diseases also known as ______________, this type of arthritis is caused by breakdown and eventual loss of the cartilage of the joints. ______________ is the most common type of arthritis and it usually affects the hands, feet, spine, and large weightͲbearing joints, such as the hips and knees. A. Osteoarthritis B. Rheumatoid arthritis C. Crystal arthritis DJD = D. Ankylosing spondylitis A 75ͲyearͲold males complains of right knee pain for the last 3 months. He states that he has trouble going up stairs due to pain. Physical exam revels decreased range of motion, crepitus, effusion, and tenderness on palpation at the joint line. There is no sign of redness and the joint is cool to touch. What is the diagnosis? A. Rheumatoid arthritis B. Septic arthritis C. Gout D. Degenerative Joint disease MORNING STIFFNESS Arthritis Type Joints involved Morning Stiffness Duration OA (Osteoarthritis) DIP, knees, hips < RA (Rheumatoid Arthritis) MCP, PIP, MTP joints > AS (Ankylosing spondylitis) Lumbosacral spine Approximately 3 hours Cerebrospinal fluid (CSF) is a clear, colorless body fluid found in the brain and spinal cord. There is about 125 mL of CSF at any one time, and about 500 mL is generated every day. CSF occupies the ______________ and the ventricular system and inside the brain and spinal cord. A. Epidural space B. Subdural space C. Subarachnoid space D. Subpia space D A P i Which of the following is caused by bleeding into the area between the arachnoid membrane and the pia mater and causes thunderclap headache? A. Epidural hematoma B. Subdural hemorrhage C. Subarachnoid hemorrhage D. Intracerebral hemorrhage “thunderclap headache” or "worst headache of my life“ or "like being kicked in the head" (c) HB Kim, www.AcupunctureMedia.com BIOMED PREP 12 Page 6 Tardive dyskinesia is a side effect of which of the following medications? A.
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