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 ben take immediately to the operating room for surgical repair without further diagnostic tests.

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

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)

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

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

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"

Tardive dyskinesia is a side effect of which of the following medications? A. Antipsychotics B. Monoamine oxidase inhibitors (MAOIs) C. Tricyclic antidepressants (TCAs) D. Selective serotonin reuptake inhibitors (SSRI)

=Neuroleptics

y Antipsychotics, also known as neuroleptics, are a class of medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia and bipolar disorder.

FIRST GENERATION SECOND GENERATION 1st gen (low potency) 1st gen (high potency) 2nd gen y Chlorpromazine y Fluphenazine y Aripiprazole (Abilify) y Prochlorperazine (Compro) y Haloperidol (Haldol) y Clozapine (Clozaril) y Olanzapine (Zyprexa) y Quetiapine (Seroquel) y Risperidone (Risperdal)

y A condition affecting the nervous system, often caused by longͲterm use of some psychiatric drugs. y Tardive dyskinesia is caused by longͲterm use of neuroleptic drugs, which are used to treat psychiatric conditions. y Tardive dyskinesia causes repetitive, involuntary movements, such as grimacing and eye blinking. y Stopping or tapering drugs ythat ma be contributing to involuntary repetitive movements can help. In rare cases, botulinum toxin, deep brain stimulation, or medications can help.

Vitamin D is a group of fatͲsoluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and multiple other biological effects. What is the side effect of Vitamin D when it is overdosed? A. considered nonͲtoxic B. rough skin, hair loss C. burning flush on face and hands D. nausea, vomiting, loss of, appetite diarrhea, constipation

VITAMINS

WATERͲSOLUBLE FATͲSOLUBLE

BIG DECK OF (“DEKA”) CARDS

MEGALOBLASTIC ANEMIA is an anemia that results from inhibition of DNA synthesis during red blood cell production and is characterized by red blood cells that are larger than normal. It's known that ______ or FOLATE deficiency causes MEGALOBLASTIC ANEMIA. A. Alcohol abuse B. Vitamin B12 C. Vitamin C D. Vitamin D

ANEMIA Microcytic Normocytic Macrocytic MCV <80 fL MCV 80Ͳ100 fL MCV >100 fL y IronͲdeficiency anemia y Anemia of chronic disease y MEGLOBLASTIC y Sideroblastic anemia y Paroxysmal nocturnal hemoglobinuria Vitamin B12 / Folate deficiency y Thalassemia y G6PD deficiency y NONͲMEGALOBLASTIC y Anemia of chronic disease y Hereditary spherocytosis Alcohol abuse, Liver disease Ð

Secondary hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. Which organ disease is a well known cause of secondary hypertensions? A. Pulmonary disease B. Hepatic disease C. Renal disease D. Gastrointestinal disease

HYPERTENSION

PRIMARY HYPERTENSION (95%) SECONDARY HYPERTENSION (5%)

A.K.A. Essential Hypertension, No established cause of known Secondary to other potentially rectifiable causes

Ð y Cushing’s syndrome y Hyperaldosteronism CHAPS y Aortic coarctation y Pheochromocytoma y Stenosis of Renal Arteries

A 63ͲyearͲold male who was diagnosed with large central disc herniation last year complains of lumbar and buttock pain, lower limb weakness, and perianal discomfort. Patient also reports bowel retention, urinary incontinence, and sexual dysfunction. Physical exam reveals saddle anesthesia including the back of the leg, buttocks, and soles of the feet. Which of the following is the most appropriate management? A. Needle UB40, DU3, UB23 B. Cupping on the lower back and buttock region C. Send patient home with Du Huo Ji Sheng Tang (Angelica Pubescens and Sangjisheng Decoction) D. Refer the patient to neuro surgery

y Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. y Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Onset may be rapid or gradual. y The cause is usually a disc herniation in the lower region of the back. Other causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma. The diagnosis is suspected based on symptoms and confirmed by medical imaging such as MRI or CT scan. y The management of true cauda equina syndrome frequently involves ______. When cauda equina syndrome is caused by a herniated disk early surgical decompression is recommended.