TCMTEST - Biomedicine Flashcards

Question

Diuril (hydnxhicirothiazide) is a Loop diuretics Thiazide diuretic Thiazide-like diuretics Potassium sparing diuretics

Answer 1

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

Answer 2

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.

Answer 3

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

Answer 4

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

Answer 5

file a domestic abuse report

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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.

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

bronchial asthma

Answer 16

BPH Flomax (tamsulosin), an alpha-adrenergic blacker, treats Benign Prostatic Hyperplasia. tcmtests.com, July 2019

Answer 17

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

Answer 18

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

Answer 19

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.

Answer 20

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

Answer 21

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

Answer 22

Proceed as though you received consent

Answer 23

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

Answer 24

median nerve

Answer 25

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

Answer 26

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

Answer 27

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

Answer 28

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.

Answer 29

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

Answer 30

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/

Answer 31

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.

Answer 32

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.

Answer 33

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?

Answer 34

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.

Answer 35

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.

Answer 36

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.

Answer 37

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

Answer 38

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.

Answer 39

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.

Answer 40

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).

Answer 41

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

Answer 42

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).

Answer 43

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.

Answer 44

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.

Answer 45

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.

Answer 46

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

Answer 47

impaired renal functioning Aspirin is exacted by the kidneys. Aspirin should be used cautiously where hepatic failure or impaired renal function are present.

Answer 48

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.

Answer 49

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

Answer 50

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.

Answer 51

Records the electrical activity of a skeletal muscle EMG (electromyography) is used to evaluate patients with diffused or local muscle weakness. It measures the electrical activity of the skeletal muscles. EMG evaluates the health of the muscles and the motor neurons or nerve cells that control the muscles. EMG can show a nerve dysfunction, a muscle dysfunction or a dysfunction in the cells that control the muscles. EMG can show a nerve dysfunction, a muscle dysfunction or a dysfunction in the nerve-to-muscle signal transmission. This test is usually done to evaluate tingling, numbness, muscle weakness, and muscle pain/cramping. When combined with the electroneurography (ENG), the EMG can differentiate between muscle pain/cramping. When combined with the electroneurography (ENG), the EMG can differentiate between primary muscle disease and primary neurological disorders.

Answer 52

One of the cruciate ligaments Deep knee pain is always associated with cruciate ligaments, either anterior or posterior, whereas generalized pain to the knee region is characteristic of referred pain, or pain from a contusion or partial tear of a muscle or ligament. the knee region is characteristic of referred pain, or pain from a contusion or partial tear of a muscle or ligament.

Answer 53

Hemoptysis, Productive cough with negative routine cultures, Suspicious x-ray findings This is the most complete and accurate answer. The Mantoux tuberculin skin test (TST) is the standard method used in determining infection with Mycobacterium tuberculosis. It is performed on patients suspected to have TB (productive cough, hemoptysis, unexplained weight loss, x-ray findings, etc.). The test is performed by injecting a small amount of tuberculin into the forearrn. The skin reaction is evaluated between 48 and 72 hours after the test. The examiner looks fora palpable, raised, hardened area or swelling (not just redness). The examiner looks fora palpable, raised, hardened area or swelling (not just redness).

Answer 54

rebellious stomach due to qi stagnation Nexium (esomeprazole), a proton pump inhibitor, treats gastrcesophageal reflux disease (GERO).

Answer 55

large and fragile erythrocytes Anemias caused by a vitamin B12 Of folic add deficiency are called mega anemias. Ina blood smear a thin layer of blood is smeared on a microscope slide. The blood is then stained to allow various blood cells to be examined. Pernicious anemia (PA) can be suspected if the peripheral blood test shows large, fragile, erythrocytes (megMoblasts). A blood count is also done. If uncertain, a blood marrow exam can be performed.

Answer 56

Severe degenerative arthritis Degenerative arthritis is when arthritis evolves to a chronic breakdown of cartilage in the joints resulting in very painful joint inflammation. The lack of cartilage between the joints results in severe pain and limits motion. The protective joint inflammation. The lack of cartilage between the joints results in severe pain and limits motion. The protective cartilage, covers the bones in an affected joint, degenerates causing the body to start forming new bone (osteophytes) as a response. The cartilage loss with the osteophytes contribute to the pain. She might need knee replacement surgery. If she continues. Without surgical care, she can become crippled and unable to move.

Answer 57

apply cool wet cloth on skin, give a sports drink, encourage person to rest Heat exhaustion occurs when body fluids are lost through sweating and are not replaced. The body cools itself through sweating. If the person fails to take in enough fluids the body fails to have fluids to produce sweat. This results in heat exhaustion which is often associated with dehydration to have fluids to produce sweat. This results in heat exhaustion which is often associated with dehydration. Dehydration occurs as the body produces an excess amount of sweat to cool the body and this results in depleted fluid body levels. Signs and symptoms include cool and moist skin, ashen or flushed skin, headache, nausea, dizziness, and weakness. The first aid strategy is to apply cool-wet cloths to the skin or spray the person with cool water. Fanning can also help. If the person is responsive and can swallow provide a sports drink with electrolyte or coconut water or milk. Just give water if a sports drink, coconut water or milk are not available. Prevent the person from drinking the liquids too fast. Encourage the person to rest and carefully watch for any worsening of the condition. If after several hours the symptoms and signs subside the person can resume normal activity. On the other hand if the If after several hours the symptoms and signs subside the person can resume normal activity. On the other hand if the condition develops into heat stroke (confusion, loss of consciousness, seizure, vomiting, rapid-shallow breathing, weak-rapid heartbeat) place person in the recovery position and call 911 as this is a life threatening event.

Answer 58

the heart enlarges Myocardial hypertrophy is enlargement of the heart. It is an increase in size of myocardial muscle due to increase in size of individual myocardial cells. Cardiac hypertrophy is frequent in chronic hypertension.

Answer 59

past neutral position, slightly past neutral position, neutral position

Answer 60

Absence of plantar flexion The Achilles tendon originates from the tendons of two muscles, gastrocnemius and soleus. Plantar flexion is powered by gastrocnemius muscle. The Achilles tendon, the largest tendon in the body, is a band of fibrous tissue that connects the calf muscles to the calcaneous (heel bane). If the Achilles tendon is torn (partial or complete), this is called an Achilles tendon rupture. In a partial tear, the tendon is partly torn but it is still joined to the calf muscle. With a complete tear, the tendon is so torn that the connection between the calf muscles and the heel bone (calcaneous) is a complete tear, the tendon is so torn that the connection between the calf muscles and the heel bone (calcaneous) is lost. Symptoms of a ruptured Achilles tendon include a flat-footed type of walk, inability to push off the ground on affected foot, and an inability to stand on tiptoe. Them can be a difficulty M dorsi flexion (bringing toes toward leg). If the tendon is completely tom, the patient can feel a gap just above the back of the heel.

Answer 61

dizziness, drowsiness, diarrhea This is the most complete and accurate answer. Zolpidem (Ambien, Stilnox, Sublinox) is a prescription medication for the treatment of insomnia. Zolpidem does not have an adequately demonstrated effectiveness in maintaining sleep unless delivered in a controlled-release form. It is effective in initiating sleep. Its hypnotic effects are similar to benzodiazepine class of drugs. Rashes area rare side-effect with Ambien.

Answer 62

type 2 diabetes Novolog (insulin aspart) is an injectable insulin. It can be used for both type 1 (children and adults) and type 2 (adults ) diabetes.

Answer 63

crackles CRACKLES, previously termed rates, are abnormal lung sounds characterized by discontinuous clicking or rattling sounds. There are two types of cracIdes, fine and coarse. Fine crackles sound like cellophane being crumpled or like velcro being torn open. Compared to fine crackles, coarse crackles are louder, lower in pitch and they last longer and they sound more a like a bubbling sound. Crackles can be heard in both phases of respiration. Early inspiratory and they sound more a like a bubbling sound. Crackles can be heard in both phases of respiration. Early inspiratory and expiratory crackles are the hallmark of chronic bronchitis. Late inspiratory crackles may indicate pneumonia or congestive heart failure. PLEURAL RUBS are creaking or grating sounds similar to walking on fresh snow. Coughing will not change the sound because pleural rubs are produced by two inflamed surfaces are sliding by one another as can occur with pleurisy RHONCHI are low pitched continuous wheezes that occur in both inspiratory and expiratory. They often have a snoring, gurgling or rattle-like sound quality that is usually caused by secretions In bronchial airways. Rhonchi usually clear after coughing. WHEEZES are a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree needs to be narrowed. Wheezes can be high or low pitched. High pitched wheezes are similar to squeaking or whistling while lower pitched wheezes are similar to snoring or moaning. Wheezing commonly occurs in patients with lung disorders such as the wheezing in asthma attacks. Wheezing can also occur in lung cancer or congestive heart failure. STRIDOR is a gasping sound during inhalation that is produced by a partial blockage of the pharynx (throat), larynx (voice box), trachea (windpipe). Stridor is caused by turbulent airflow through a narrowed upper airway. In children it can be caused by croup or an inhaled foreign object. In adults it can be caused by a turner, edema of the upper airways, vocal paralysis, or an inhaled foreign object. Strider that causes shortness of breath when the person is at rest is a medical emergency medical emergency.

Answer 64

alcohol dependence MCV, an index of red blood cell size, increases with excessive alcohol intake. Although MCV has a high correlation with alcohol consumption, the index, alone, is not a useful screening marker. The liver enzyme aspartate with alcohol consumption, the index, alone, is not a useful screening marker. The liver enzyme aspartate aminotransferase (AST) can be a useful marker for alcohol abuse: The ratio of levels of mitochondria! AST to total AST has been found effective in differentiating alcoholics from other patients and in detecting chronic excessive AST has been found effective in differentiating alcoholics from other patients and in detecting chronic excessive drinking.

Answer 65

ANA The ANA (Antinuclear Antibody) test identifies the presence of antinuclear antibodies (ANA) in the blood. ANA is a group of special antibodies produced by a person's immune system when it fails to adequately distinguish between "self" and "nonself". These autoantibodies attack the body's own cells, causing signs and symptoms such as tissue group of special antibodies produced by a person's immune system when it fails to adequately distinguish between "self" and "nonself". These autoantibodies attack the body's own cells, causing signs and symptoms such as tissue "self" and "nonself". These autoantibodies attack the body's own cells, causing signs and symptoms such as tissue and organ inflammation, joint and muscle pain, and fatigue.

Answer 66

Imodium AD The FDA has a warning that taking higher than recommended doses of the OTC and prescription diarrhea drugs loperamide (Imodium AD, Lamotil) can cause serous heart problems leading to death. The cardiovascular risk includes abnormal head rhythms. The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide. Loperamide is classified as an opioid. Opioids are pain relievers that act directly on opioid receptors in the brain. Loperamide, however, targets opioid receptors in the digestive tract to slow down digestive activity to beat diarrhea. Loperamide does not get past the blood-brain barrier which is needed to achieve the painkilling, sedative and euphoric effects of other opioids. However, individuals with which is needed to achieve the painkilling, sedative and euphoric effects of other opioids. However, individuals with opioid addiction have been using loperamide to either get high or to manage the withdrawal symptoms experienced when abstaining from opioid drugs. To get the desired results, they are taking extremely high doses (hundreds of pills). Taking high amounts of loperamide can lead to dangerous changes in heart rate and can lead to fatal overdoses. Some patients get professional help to recover from an opioid addiction by using some form of opioid replacement therapy. Others attempt to beat the symptoms on their own, using over-the-counter medications like Imodium (loperamide) or herbal drugs like kratom. Kaopectate and Pepto-Bismol have the active ingredient bismuth subsalicylate.

Answer 67

Alcoholism, Amenorrhea from excess exercise, Galactorrhea from hyperprolactinemia This is the most complete and accounts answer. She shows no indication of a breast tumor. It would have been worrisome if the discharge was bloody or dear. On the other hand, breast discharge that is green, milky, or other colors is almost always not a concern. Galactorrhea is excessive or inappropriate production of milk. Hyperprolactinemia occurs when person has higher-than-normal levels of the hormone prolactin whose main function is to stimulate breast milk production after childbirth. High prolactin levels are normal during pregnancy. Exercise induced amenorrhea is the absence of monthly periods caused primarily by intense exercise which alters induced amenorrhea is the absence of monthly periods caused primarily by intense exercise which alters gonadotropin releasing hormone (GnRH) production from the hypothalamus. GnRH stimulates the synthesis and secretion of the gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

Answer 68

weight gain, depression, hypervigilance This is the most complete and accurate answer. Stimulants such as methylphenidate (Ritalin, Concede), dextroamphetamine and amphetamine (Adderall XR) and dextroamphetamine (Dexedrine) are used to teat attention. deficit/hyperactivity disorder (ADHD) and also certain sleep disorders such as narcolepsy. Stimulants speed up the body, making one feel awake, full of motWation, and very energized. Weight loss is a major warning sign of abuse. body, making one feel awake, full of motWation, and very energized. Weight loss is a major warning sign of abuse. The patient may spend days awake and adios without eating. They than may sleep for days to recover. Other signs of stimulant abuse include reduced appetite, agitation, high body temperature, insomnia, high blood pressure, irregular head beat, anxiety, and paranoia.

Answer 69

corticosteroids, anti-inflammatories, immune system suppressors This is the most complete and accurate answer. Anticholinergics are prescribed for chronic obstructive pulmonary disease (COPD). Currently, there is no cure for Cmhn's Disease Moreover, there is no single treatment that helps every patient Anti-inflammatories such as Azulfidine can be prescribed, especially if Crohn's affects the colon. Cot costeroids (prednisone) can also help decrease the inflammatory response. Immune system suppressors (eg disease (COPD). Currently, there is no cure for Cmhn's Disease Moreover, there is no single treatment that helps every patient Anti-inflammatories such as Azulfidine can be prescribed, especially if Crohn's affects the colon. Cot costeroids (prednisone) can also help decrease the inflammatory response. Immune system suppressors (eg every patient Anti-inflammatories such as Azulfidine can be prescribed, especially if Crohn's affects the colon. Cot costeroids (prednisone) can also help decrease the inflammatory response. Immune system suppressors (eg Cot costeroids (prednisone) can also help decrease the inflammatory response. Immune system suppressors (eg Humira) can be used to target the immune system rather than the inflammation.

Answer 70

Dysphagia Dysphagia (difficulty in swallowing) and choking are the most common identifying clinical symptom of Cranial Nerve IX (Glossopharyngeal nerve) dysfunction. Cranial Nerve IX (Glossopharyngeal nerve) disorders produce difficulty in swallowing, an impairment of taste over the back one-third of the tongue. The back one-third of the tongue can also have an impaired sensation . There can also be an absence of the gag reflex.

Answer 71

intestinal tract The X-ray obstruction series is a group of x-rays which help evaluate the abdominal area (diaphragm, stomach, intestines, kidneys, ureters, bladder). It is usually ordered to discover the possible cause for abdominal sense of fullness, abdominal pain/cramping, vomiting, diarrhea, and constipation. This series of tests help in the diagnosis of abdominal aortic aneurysms, kidney stones, intestinal obstruction, ascites, soft tissue masses, and to help detect the presence of a foreign body.

Answer 72

State privacy laws supersede HIPAA if state laws are stricter Generally, when a state and federal law conflict, the federal law is the one that reigns supreme. HIPAA sets a federal floor for privacy protections for individuals. No state has the right to provide weaker protection for an individual than what is available at the federal level.This is covered under a concept known as preemption. The exception is that when the state law is more stringent than the law at the federal level, then the state law will prevail. For example, HIPAA medical record retention is for six years but California medical retention of records is for seven years. The California regulation takes precedence over the HIPAA regulation.

Answer 73

Psychiatric symptoms and specific organ symptoms

Answer 74

Psychiatric symptoms and specific organ symptoms

Answer 75

Medial meniscal tear A medial meniscal tear is usually associated with torsional force Mat combines compression, rotation and activities that require cutting maneuvers. These cutting maneuvers put undue stress upon the medial meniscus and can cause require cutting maneuvers. These cutting maneuvers put undue stress upon the medial meniscus and can cause additional strain of the ACL and oftentimes with twisting injuries in which the tibia moves forward with respect to the femur when accompanied by valgus stress in a cutting maneuver.

Answer 76

Speed's Test Speed's,. is best for bicep tendonitis and it is performed with the elbow extended, the forearm supinated and forearm elevation of the humerus to approximately 60 degrees with manual resistance. Pain is recreated in bicipital groove that constitutes a positive test for bicipital tendonitis constitutes a positive test for bicipital tendonitis.

Answer 77

Valgus Stress Test This test is also called the Abduction Stress Test. Pain or a gap in the medial joint line indicates that the medial ligaments are las and there can possibly be a tear in the medial collateral ligament (MCL). The MCL is a band of tissue on the media side of the knee connecting the Mmur with the tibia. The MCL prevents the knee from bending inward. In an MCL injury or Mar to the medial collateral ligament, there can be pain, stiffness, swelling,tenderness along the inside of the knee, and feeling that the knee may give away, lock, or catch when the knee is under stress. Most knee injuries involve the MCI (medial collateral ligament).

Answer 78

Gonorrhea Gonorrhea is caused by the neisseria gonorrhowe bacteria.The NAAT (nucleic acid amplification test) is a direct DNA probe which can look for the presence of neisseria gonorrhoeae bacteria for gonorrhea, chlamydia trachomatic bacteria for chlamydia, and trichomonasvaginalis bacteria for trichomonitis. In gonorrhea,women usually have no symptoms but can have painful intercourse, a purulent vaginal discharge, painful urination, and lower abdominal pain. Men may have no symptoms or may have a purulent discharge from the penis, a discharge from the anus, testicular pain, painful urination. Chlamydia symptoms are slow to manifest often taking months. The discharge tends to be watery and cloudy. Patients often have both gonorrhea and chlamydia. 3rd generation cephalosporin (eg ceftriaxone) treats the neisseria bacteria. Chlarnydia can be treated with either a macrolide (azithromycin) or a tetracycline. Often, a patient is treated with both antibiotics because a co-infection of gonorrhea and chlamydia is very common.Syphilis has painless ulcer (chancre) antibiotics because a co-infection of gonorrhea and chlamydia is very common.Syphilis has painless ulcer (chancre) usually on genitals and is diagnosed via blood, body fluid, or tissue samples.

Answer 79

20-30 degrees

Answer 80

Children with Fragile X Syndrome have a higher risk of Autism Spectrum Disorder (ASD) Sex: boys are about four times more likely to develop autism spectrum disorder than girls are. Family History: families that have one child with ASO have an increased risk of having another child with the disorder. Other disorders: children with certain medical conditions such as Fragile X Syndrome or Rett syndrome have a higher than normal risk of ASO. Fragile X Syndrome is an inherited disorder that causes intellectual problems and is more common in girls than boys. Rett syndrome, a genetic disorder occurring almost always in girls, causes slowing of head growth and intellectual disability. Extremely preterm babies born before 26 weeks may have a greater risk of ASD. Despite extensive research, no reliable study has yet to show a link between autism spectrum disorder (ASD) and any vaccines. The original study that ignited We debate years ago has been retracted due to poor design and questionable research methods.

Answer 81

around 5 to 30 sounds per minute Auscultation of the abdomen is performed after the visual inspection of the abdomen. The diaphragm of the stethoscope is place on the right lower quadrant which is generally the best place to listen. The other quadrants have solid organs. Listen to the bowel sounds for up to one minute. The normal frequency°, bowel sounds is around 5 to 30 per minute. Occasionally there will also be borborygmi caused by noisy fluid movement. The bowel sounds are caused by the peristaltic movement of the bowels.Various conditions can increase or decrease bowel sounds. A patient who is hung, or has diarrhea will have increased bowel sounds. There is also an increase of bow. sounds when there is a bowel obstruction or if the patient has Groh!. disease. Decreased bowel sounds due to slowed bowel activity can occur after abdominal surgery peritonitis f rom a ruptured appendix, a ruptured gallbladder, pancreatitis, or as a side effect of medications. When there is abdominal pain with a total absence of bowel sounds after listening up to two minutes, it is an emergency situation.

Answer 82

chest pain worse with deep inhaling

Answer 83

stop the mitotic process, block the synthesis of new DNA strands, damage the DNA in the nucleus

Answer 84

SNOOP S ystemic Symptoms N eurological signs symptoms O nset (new or sudden) O ther associated conditions P rior headache history

Answer 85

Juvenile Rheumatoid Arthritis Juvenile rheumatoid arthritis ORAL also called juvenile idiopathic arthritis (11A), is a type of arthritis (joint inflammation and stiffness/ far more than six weeks in a patient that is younger than 16 years-old.112A is an auto-immune disorder in and stiffness/ far more than six weeks in a patient that is younger than 16 years-old.112A is an auto-immune disorder in which the immune system attacks healthy tissue. Symptoms include joint pain, swelling, and stiffness. The joint pain is on both sides of the same joint in contrast to osteoarthritis. JRA can affect one joint or many In some cases, JRA affects the whole body causing rashes, fever, and swollen lymph nodes. The inflammation can affect the liver, heart, and spleen as well as the eyes (uveitis, iritis). This is a red flag case requiring immediate referral.

Answer 86

trouble breathing In this situation the trouble breathing with the swollen lips indicate an allergic reaction and anaphylaxis. Symptoms and signs of shock include excessive thirst, skin feels cool or moist and looks pale or bluish with a possible altered level of consciousness, and rapid-weak heartbeat. There are three situations to consider in assessing an allergic reaction and consciousness, and rapid-weak heartbeat. There are three situations to consider in assessing an allergic reaction and anaphylaxis depending on whether you know or do not know that the patient has been exposed to an allergen or you suspect that they have. In this situation neither you or the patient knows if they have been exposed to an allergen.YOU DO NOT KNOW IF PATIENT EXPOSED TO ALLERGEN: Any skin reaction (hiv, itching, flushing) OR swollen face, neck, tongue or lips PLUS trouble breathing OR symptoms and signs of shock indicates an allergic reaction and anaphylaxis. YOU SUSPECT PATIENT !EXPOSED TO ALLERGEN: any two of the following indicates an allergic reaction and anaphylaxis: 1) skin reaction, 2) swelling of face, neck,tongue, or lips, 3) trouble breathing, 4) signs and symptoms of shock, 5) nausea,vomiting, cramping, or diarrhea. YOU KNOW THAT PATIENT EXPOSED TO ALLERGEN: Trouble shock, 5) nausea, vomiting, cramping, or diarrhea. YOU KNOW THAT PATIENT EXPOSED TO ALLERGEN: Trouble breathing OR signs and symptoms of shock are an indication for an allergic reaction and anaphylaxis.

Answer 87

muscle strength testing Tensilon test, EMG This is the most complete and accurate answer. Visual examination is not part of the diagnostic criteria. Electromyography (EMS) can help to detect impaired nerved muscle transmission. The Tensilon test helps to diagnose myasthenia gravis. A drug (Edrophonium) is injected and if the patient has myasthenia gravis they will show an improvement in muscular strength. Edrophonium is a short acting anticholinesterase which increases the amount of acetylcholine at the neuromuscular junction. Muscle testing can evaluate the strength of muscle groups

Answer 88

Muscle strain Symptoms of a muscle strain may include one or more of the following: 1) bruised skin or bleeding under the skin on the area of your injured muscle. 2) little or stiff muscle movement, or loss of muscle strength. 3) muscle soreness, cramps, or spasms. Muscle pain worse with activity. 4) crepitus or a crackling or grating feeling when moving the muscle.

Answer 89

Middle finger, index finger C7 innervates the middle and index finger. C6 innervates the lateral forearm and thumb. C5 innervates the lateral arm. C8 innervates the medial forearm, ring and small finger. T1 innervates the medial arm.

Answer 90

formoterol

Answer 91

history of injection drug use

Answer 92

oppositional defiant behavior Sometimes it is difficult to recognize the difference between a strong-willed child or teen and one with oppositional defiant disorder. It is normal to exhibit oppositional behavior at certain stages of development. Oppositional defiance disorder (ODD) is defined as a recurrent pattern of negative, defiant, disobedient, and hostile behavior towards figures of authority. ODD is the commonest psychiatric disorders in children and early teens.Any of the following four oppositional behaviors during at least 6 months: often loses temper, often argues with adults, often refuses to comply with rules, deliberately annoys people.. angry and resentful, and can often be spiteful. Conduct disorder (CD) is a persistent pattern of antisocial behavior where the individual repeatedly breaks social rules and carries out aggressive acts.

Answer 93

The cerebrum The carotid arteries on the side of the neck supply the brain. The internal carotid arteries arise from the common carotid arteries where these branch into the internal and external carotid arteries. The internal carotid artery supplies the brain. The external carotid nourishes the head (face, scalp, skull, meninges). The cerebellum is supplied by other arteries (the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (RCM. The bronchial arteries supply blood to lungs. The coronary artery supplies blood to the heart

Answer 94

Rheumatoid factor sedimentation rate, Lupus erythematosus test, anti-nuclear antibody, X-rays This is the most complete and accurate answer. Blood gases test for how much oxygen and carbon dioxide is in your blood. This patient might have scleroderma, rheumatoid arthritis, or lupus which are all auto-immune disea ses. The antinuclear antibody (ANA) test to help evaluate autoimmune disorders that affect many tissues and organs throughout the body.X-rays are done to evaluate the status of joints. The Rheumatoid factor sedimentation rate is a common blood test that is used to detect and monitor inflammation in the body. A negative finding on the LE (lupus erythematosus) cell testing excludes a diagnosis of systemic lupus erythematosus (SLE).

Answer 95

Unilateral rash with vesicles on an erythematous base, severe pain Herpes roster is a viral disease. Chicken pox and herpes zoster are caused by the varicel la-zoster virus. Patients with a history of chicken pox are at risk for developing shingles (herpes zoster) as the virus remains inactive in nerve cells. Sympeoms include itching and pai which is of a stabbing or shooting nature. In the affected dermatome there is a rash (fluid filled blisters that break and crust) over red skin. The blisters occur in a band on one side of the body. The painful rash usually manifests on the torso (usually one side), but can also appear on the face, around the eyes or other areas. The initial symptoms of herpes zoster can include fever, chills, and headache. A patient with herpes zoster (shingles) can pass on the virus (varicella-zoster) to anyone who is not immune to chicken pox through direct contact with the open blisters. Once the other person becomes infected, he/she will develop chickenpox but not shingles. Risk factors for shingles include a weakened immune system pregnancy, newborns, and anyone over the age of SO. Fewer than 498 of patients have another shingles outbreak. However, many, especially the old, can have recurring uostherpetic nerve pain.

Answer 96

bowel obstruction The red flag is mid to lower abdominal colicky pain, vomiting, constipation, and abdominal distention. Bowel obstruction is assumed present until proven otherwise. This situation is an emergency and the patient should be sent to the nearest ED. If the patient is in shod, or is in cardiopulmonary compromise, 911 should be called. Otherwise, a private transport with non-patient driver is.< In small bowel obstruction pain comes first followed by vomiting, distention, and constipation. In large bowel obstruction, constipation is followed by distention, pain, and vomiting. In either case, persistent vomiting is a key feature of true bowel obstruction as opposed to bowel slowdown.

Answer 97

pin prick The trigeminal nerve, cranial nerve V, has both sensory and motor fibers. The trigeminal nerve as the name indicates is composed of three large branches. They are the ophthalmic (sensory), maxillary (sensory) and mandibular (motor and sensory) branches. It is responsible for sensations in the face and certain motor functions such as biting, chewing, and swallowing. Damage to the trigeminal nerve mainly manifests as loss of facial sensation, facial pain and mastication dysfunction.Assessment procedures include a cold tuning fork, light touch with a cotton wisp, or a pin prick.

Answer 98

hypertension Avopro (Irbesartan) angiotensin II receptor antagonist. It works by preventing the hormone angiotensin II from narrowing the blood vessels.

Answer 99

the pulmonary circulation The pulmonary circuit is the half portion of the cardiovascular system which carries oxygen-depleted blood away from the heart to the lungs, and returns oxygenated (oxygen-rich) blood back to the heart. Systemic circulation is the circuit of vessels supplying oxygen and blood to and returning deoxygenated blood from the tissues of the body, as distinguished from the pulmonary circulation. The closed circulatory system is the type of system that human beings have. Unlike an open circulatory system, a closed circulatory system is more structured and controlled. The blood of a closed system always flows inside vessels.

Answer 100

timely (1-2 weeks) referral to a pediatrician The red flag is a child with poor language skills, self-isolating behavior, and repetitive non-useful motions. Autism is presumed present until proven otherwise. By 3-4 years children should be speaking several words to several sentences, eager. interact with parents and siblings instead of isolation with non-useful motions (rocking, head banging). The preliminary diagnosis is based on the report f rom the mother that the child lacked normal language and social skills. The referral should be made to the PCP or pediatrician on a timely basis (1-2 weeks). Further referrals will be made to autism specialists.

Answer 101

monitoring blood pressure In Addison, disease, the adrenal glands fail to produce enough of the hormone called cortisol, or less often, a related hormone called aldosterone. This disease is also called chronic adrenal insufficiency or hypecortisol ism.The most important function of cortisol is to help the body respond to stress. It also helps maintain blood pressure and cardiovascular function and controls inflammation. Aldosterone regulates the amount of salt and water in the body which is the main way to maintain blood pressure control. When aldosterone levels drop too low, the kidneys cannot keep salt and water levels in balance. This makes your blood pressure drop.

Answer 102

Papillary reactions to light In a healthy patient, when 1,,ht is directed into one eye, the pupil of that eye will constrict. The opposite eye in a consensual response will also constrict. The pupillary light response consists of both the optic nerve (CN II) and the oculomotor nerve (CN III) pathways. CN II transmits all visual information (brightness perception, color perception and contrast). It also conducts the visual impulses responsible for two neurological reflexes: the light reflex and the accommodation reflex (ability to focus on near objects as in reading). Together CN II and CN III control the pupillary reaction.A normal pupil response to light is dependent on the function of both the optic nerves and oculomotor nerves.

Answer 103

pain in a muscle – this may feel like a burning pain or a deep ache (moving the body part can make the pain even worse) swelling or bulging of the muscle. numbness, weakness or pins and needles. tightness or difficulty moving the affected body part.

Answer 104

Swelling of your leg or arm Pain or tenderness in your leg or arm (may only happen when standing or walking). The area of your leg or arm that’s swollen or hurts may be warmer than usual. Skin that’s red or discolored. The veins near your skin’s surface may be larger than normal. Abdominal pain or flank pain (when blood clots affect the veins deep inside your abdomen). Severe headache (usually of sudden onset) and/or seizures (when blood clots affect the veins of your brain).

Answer 105

DVT is a cause from blood clot, while compartment is pressure from within the muscle.

Answer 106

Blood test for testosterone and male hormones.

Answer 107

administer second dose of EpiPen medium q

Answer 108

call 911 for patient

Answer 109

acid reflux due to stomach yin xu with empty heat Aciphex (rabeprazole), a proton pump inhibitor, treats erosive esophagus caused by gastroesophageal reflux disease (GERD). It may be used for short-term treatment of ulcers of the small intestine.

Answer 110

fasting lipid profile, HbA1c level, homocysteine level This is the most complete and accurate answer. A liver profile is not a first line test for ischemic atherosclerosis. Ischemia is an insufficient supply of blood to an organ or body part, particularly the heart muscle. Signs of ischemia can include chest pressure, pain, neck/jaw pain, or shoulder/arm pain. A fasting lipid profile measures cholesterol and triglycerides levels. This profile measures total cholesterol levels, high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL). The lipid profile is part of assessing cardiac disease risk. Glycated hemoglobin (HbA 1c) can be predictive of possible ischemic stroke in non-diabetic patients. Elevated homocysteine levels can promote atherosclerosis. Imaging studies can be used to identify plaque location.

Answer 111

down regulates CB1 receptors Regular THC use decreases the body's natural anandamine (the body's "natural marijuana") production and down regulates the CB1 receptors. Down regulation means that when receptors are overstimulated they make themselves unavailable. This produces drug tolerance which requires more THC to produce its effect. Additionally, marijuana contains another important non-psychoactive, non-high compound called CBD (cannabidiol) that has anti-inflammatory, anticonvulsant, anti-emetic, and analgesic effects. The effects of marijuana usually last from 1 to 3 hours, but marijuana can stay in the body for days or even weeks after use. Organs in the body have fatty tissues that absorb the THC in marijuana. In general, standard urine tests can detect THC several days after use. In people who use heavily, however, urine tests can sometimes detect THC for several weeks.

Answer 112

Pupils pinpointed Under the influence of opiates such as heroin, codeine, methadone, morphine and oxycodone, the patient will seem far too relaxed and often oblivious to their surroundings even in a trance-like state. Contrary to stimulant abuse, in opiate abuse the pupils appear to be extremely constricted to pin points in the eye. This effect is often used to describe people high on opiates as "pinned". Even when using a very bright light, normal eyes do not constrict like they do in persons abusing opiates.

Answer 113

Medial meniscus The clinician rotates the tibia into external rotation while he slowly extends the knee to test the medial meniscus. To test the lateral meniscus, the clinician flexes the knee again, but now internally rotates the patient's tibia and then slowly extends the knee.

Answer 114

Midbrain The midbrain contains a portion called the substantia nigra, which is involved in voluntary movements. The result of a dysfunction (death of dopaminergic neurons) in the substantia nigra is the tremors associated with Parkinson's disease.

Answer 115

Anemia Folic acid, a B vitamin, is essential for the normal functioning of RBCs and WBCs. If blood levels of folic acid are low, it indicates that the recent intake of folate is below normal or that the patient has a vitamin B12 deficiency which blocks the cells from taking in folic acid. If the reason for the low level of blood folate is due to a B12 deficiency then it would require a supplementation of B12 and not folic acid. Folic acid blood levels are down during pregnancy, to evaluate blood disorders, and to determine anemia due to folic acid deficiency. The main causes that lead to a folate deficiency are: 1) dietary, usually in alcoholic patients. 2) malabsorption syndrome. 3) pregnancy. 4) due to anti-convulsant drugs.

Answer 116

/ three times per day “ter in die" is Latin for three times daily.

Answer 117

C7 The triceps reflex is associated with C7, wrist flexion and the triceps muscle. It is sensory to the middle finger.

Answer 118

make a timely (a week or two) referral to primary care physician The red flag no history of trauma and progressive hip pain on movement and decreased hip ROM. Avascular necrosis of the hip is assumed present until proven otherwise. Avascular hip necrosis is also called Perthes disease which is the death of a portion of the ball of the femur due to poor blood supply. Pain is the primary complaint in avascular necrosis. The pain usually starts hours after activity and lasts for one hour or two afterwards. Rest pain is present in 75% of cases. Night pain is present in 45% of cases. The peak incidence of Perthes disease is in children 4-10 years old with a median age of 6. There is another peak incidence period between 24-25 years old. The clue in this case was the hip pain plus the age. In this situation you may make a semi-urgent (same day or next day) or a timely referral. The ultimate consultant will be an orthopedic surgeon.

Answer 119

Third party vendors who have access to PHI A Business Associate Agreement is a contractual document required between a Covered Entity and its service entities that have access to protected health information (PHI). This agreement sets forth the requirements the Business Associates must follow in regard to confidentiality, security, use and disclosure of protected health information (PHI) in providing services to help the covered entity with its health care operations.

Answer 120

Determines if a thyroid nodule is solid or fluid filled, Monitors medical treatment of a thyroid nodule This is the most accurate and complete answer. A thyroid ultrasound measures the size and shape of the thyroid gland. However, this test does not evaluate thyroid functioning nor can it confirm-diagnose that a tumor is cancerous. Thyroid ultrasonography helps to determine if a thyroid nodule is solid or fluid filled (cyst) and monitors the medical treatment of a thyroid nodule.

Answer 121

Trapezius and Levator Scapulae Trapezius Cranial Nerve XI and levator scapulae C3-4 are the prime movers of scapular elevation, whereas the rhomboids are the secondary movers of scapular elevation.

Answer 122

Medial epicondylitis Medial epicondylitis is what is commonly known as golfer's elbow but can occur with other baseball pitchers, bowlers, archers, and weight lifters. The medial epicondyle is the common origin of the forearm flexor and pronator muscles. This disorder occurs after repetitive wrist flexion. There is tenderness at the medial epicondyle. When the wrist is flexed against resistance there is pain produced. If a person has medial epicondylitis, the pain usually is felt in the inner aspect of the elbow. The most common symptom of medial epicondylitis is pain along the palm side of the forearm, from the elbow to the wrist (same side as little finger). Treatment consists of ice, strengthening exercises, NSAIDs, bracing,

Answer 123

Drug effects are still active 2 weeks after drug is discontinued Antabuse (disulfiram) was the first drug approved for the treatment of alcohol abuse and alcohol dependence. Alcohol is broken down in the liver by the enzyme alcohol dehydrogenase. Disulfiram blocks this enzyme. Antabuse acts as a physical and psychological deterrent to stopping drinking. It does not reduce the craving for alcohol. The effects of disulfiram may occur up to two weeks after disulfiram has been discontinued.

Answer 124

migraine headaches Imitrex (sumatriptan) is selective serotonin receptor agonist.

Answer 125

Streptococcal pharyngitis What points to streptococcal pharyngitis is the history of fever, anterior cervicaladenopathy, tonsillar exudates, no cough. Rapid strep test needed to confirm. Viral pharyngitis has no prominent rhinorrhea, cough, hoarseness, conjunctivitis, or diarrhea. A rapid strep test needed to confirm. Mononucleosis is most common in adolescent and young adults. The lymphadenopathy is anterior and not posterior and lacks palatal petechia. She does not have sinusitis as the sinuses are not tender.

Answer 126

cannabinol Cannabinols have three different forms. The first form is marijuana which is the smoked dried plant. The second is hashish which is the dried cannabis plant resin. The third is hash oil which is the liquid form. Some states in the US have legalized its use for both recreational and medical purposes. Prescription drugs containing synthetic cannabinoids are readily available. Marijuana is used to reduce nausea/vomiting during chemotherapy and helps HIV/AIDS patient increase appetite. It is also used to treat chronic pain. Cannabidiol (CBD) is a cannabis compound with medical benefits that does not have the THC which is what gets people "stoned". CBD is used to treat inflammation, pain, fibromyalgia, anxiety, and seizures.

Answer 127

TB status, HIV status, HBV status This is the best and most complete answer. Exposure-prone procedures (EPP) are those procedures where the hands may be in contact with sharp instruments, needles tips or sharp tissues (eg bone or teeth) or wound where the hands or finger tips may not be completely visible at all times. In addition to a yearly physical, an acupuncturist needs to know their status for TB, HIV, HCV, and HBV if the practitioner works in a inner city clinics for AIDS or drug addicts, prisons, homeless shelters. The HDV status is not required. Mandatory testing for HIV, HBV, and HCV is not recommended.

Answer 128

Cranial nerves I, II, VIII | = olfactory, Il = optic, VIII = auditory. There are three cranial nerves with primarily sensory function. Cranial nerve I, | = olfactory, Il = optic, VIII = auditory. There are three cranial nerves with primarily sensory function. Cranial nerve I,

Answer 129

use a sunscreen and take iron 2 hours before This is the most accurate answer. Photosensitivity is a common side effect of tetracyclines and the patient should be advised to use a sunscreen. Iron may interfere with the absorption of many different medications. It is best to take iron supplements at least 2 hours before or 2 hours after taking medications.

Answer 130

no pointing by age one, no response to name, no smiling, no eye contact This is the most complete and accurate answer. Difficulty swallowing or deafness are not intrinsically part of ASD. Early indicators of ASD can include no babbling or pointing by age 1, no single words or two word-phrases by age 2, no response to their name, loss of language or social skills previously learned, poor eye contact, excessive lining up of toys, lack of spontaneous or make-believe play, no social responsiveness or smiling, repetitive movements (rocking, spinning or hand flapping). Children should be screened specifically for ASD at 18-24-months during well-child visits. ASD is diagnosed by clinicians based on symptoms, signs, and testing according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-V). If a young child is deaf it can be misdiagnosed for ASD due to poor social response arising from impaired hearing.

Answer 131

no pointing by age one, no response to name, no smiling, no eye contact This is the most complete and accurate answer. Difficulty swallowing or deafness are not intrinsically part of ASD. Early indicators of ASD can include no babbling or pointing by age 1, no single words or two word-phrases by age 2, no response to their name, loss of language or social skills previously learned, poor eye contact, excessive lining up of toys, lack of spontaneous or make-believe play, no social responsiveness or smiling, repetitive movements (rocking, spinning or hand flapping). Children should be screened specifically for ASD at 18-24-months during well-child visits. ASD is diagnosed by clinicians based on symptoms, signs, and testing according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-V). If a young child is deaf it can be misdiagnosed for ASD due to poor social response arising from impaired hearing.

Answer 132

McMurray test Placing your hand against the lateral knee and pushing medially against the knee and pulling laterally at the ankle to open the knee joint on the medial side (valgus) tests for the medial collateral ligament (MCL). Placing your hand against the medial surface of the knee and pushing medially against the knee and pulling laterally at the ankle (varus) tests for the lateral collateral ligament (LCL). The McMurray Test tests for meniscus damage. A popping sound during the test makes a meniscus tear 8.2 times more likely. The symptoms of a meniscal tear include a popping sensation in the knee, swelling, stiffness, pain (particularly when rotating the knee), difficulty straightening the knee fully, feeling that knee is locked in place. Any move that forcefully twists the knee (forceful pivoting or sudden stops and turns) can tear a meniscus. Sometimes even a deep squat or lifting a heavy object can tear a meniscus. In older adults, there can be degenerative knee joint that can play a part in a torn meniscus.

Answer 133

high triglyceride levels Tricor (fenofibrate), in the fibrate class, treats high total blood cholesterol along with a low-fat diet.

Answer 134

Autoantibodies are directed against contents of the cell nucleus. They are present in higher than normal numbers in autoimmune diseases.

Answer 135

Hypertension, Senile tremor, Intention tremor Intention or action tremor is a trembling a body part when attempting a precise movement. It is associated especially with disease of the cerebellum. The cerebellum is located in the occipital area and its function is to coordinate and regulate muscular activity. Parkinson's disease is associated with rest tremors, when the body part is at rest, and typically stops with voluntary movement of the body part. Senile tremor or essential tremor often runs in the family and in this patient it is being made worse with caffeine addiction (coke). Both intention and essential tremor are activated with movement. Essential tremors get worse with purposeful movement and consist of an uncontrollable shaking that occurs for brief periods of time. Intention tremors appear with movement, then get worse the closer it comes to an object or task, then disappear at rest. Her BP reading indicates that she has hypertension. Normal BP should normally be less than 120/80 mm Hg for an adult age 20 or over.

Answer 136

amyotrophic lateral sclerosis (ALS) MNDs are classified by whether only the upper motor neurons, lower motor neurons, or both are affected. Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's Disease is the most common MND in adults. ALS affects both upper and lower motor neurons. The muscle of the arms, legs, facial muscles as well as muscles that control speech, swallowing, and chewing are affected. Primary lateral sclerosis is a disorder that affects the upper motor neurons (stiffness, weakness and spasticity in the legs). Progressive bulbar palsy primarily affects the lower motor neurons (difficulty swallowing, speaking, chewing). Primary lateral sclerosis (PLS) affects the upper motor neurons of the arms, legs, and face. Upper motor neuron disorders occur in conditions that affect the motor neurons in the brain or spinal cord such as stroke, traumatic brain injury and cerebral palsy. Polio, Guillain-Barre, peripheral neuropathy, and muscular dystrophy are examples of lower motor neuron disorders. Multiple sclerosis can affect the upper and/or lower neurons. Progressive muscular atrophy only affects the lower motor neurons.

Answer 137

Dermatome S5 is associated with the anus The correct answers are: Dermatome S5 is associated with the anus. Dermatome L5 is associated with the anterior ankle. Dermatome L4 is associated with the medial malleolus. Dermatome S2 is associated with the inner part of the heel bone. A dermatome is a skin area that is mainly supplied by branches of a single spinal sensory nerve root. Dermatome $11 is the lateral malleolus. S3 dermatome is associated with the middle part of the buttocks, perianal area, penis, and scrotum. Because distribution pattern of the dermatomes are defined, the dermatomes can be used to detect which spinal nerve is affected. For example, if a patient has numbness and tingling down the right arm to the thumb, index and middle finger. These fingers involved dermatome Cé (thumb), C7 (middle finger), and C8 (little finger) dermatome spinal nerves. The doctor can then consider abnormalities that affect the spinal nerves from the C6,7, and & nerve roots.

Answer 138

97811 97810 is "Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient”. For insurance coding purposes, a practitioner cannot combine non-estim acupuncture with estim acupuncture. If you start with a 97810 and do a reinsertion, even if it involves estim, you must bill 97811 which is “Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles". The reverse is also true. If you bill 97813, you must bill 97814 upon reinsertion regardless if there is estim or no

Answer 139

rizatriptan The suffix for this class of drugs is -triptan. Examples are almotriptan. Eletriptan. Rizatriptan. Sumatriptan. Zolmitriptan.

Answer 140

ACTH ACTH (adrenocorticotropic hormone) stimulates the adrenal cortex. It stimulates secretion of glucocorticoids such as cortisol, and also has some control over the secretion of aldosterone, the other major steroid hormone from the adrenal cortex. ACTH is secreted from the anterior pituitary in response to corticotropin-releasing hormone from the hypothalamus. The corticotropin-releasing hormone is secreted in response to many types of stress. The corticotropin- releasing hormone itself is inhibited by glucocorticoids, making it part of a classical negative feedback loop. ADH (antidiuretic hormone) assists the kidneys to regulate the amount of water in the body. FSH (follicle-stimulating hormone) is important for the reproductive system. It is responsible for the growth of ovarian follicles which produce estrogen and progesterone. GH (growth hormone) is secreted by the anterior pituitary and stimulates the growth of all tissues of the body, including bone.

Answer 141

dry mouth, urinary retention, dizziness This is the most complete and accurate answer. OTC sleep aids that contain antihistamines (diphenhydramine, doxylamine) can lead to the side-effects of dry mouth and throat, increased heart rate, urinary retention, constipation, motor impairment, dizziness, irritability. Some side effects can be serious: vision problems and difficulty urinating. Patients with the following conditions should also consult with their doctor before taking antihistamines for sleep: asthma, emphysema, chronic bronchitis, or other breathing problems. Patients with glaucoma, ulcers, difficulty urinating. heart disease, hypertension, seizures, or an overactive thyroid gland. Antihistamines should not be used when drinking alcohol.

Answer 142

Gonorrhea (neisseria gonorrhoea) is a bacterial infection that often co-exists with chlamydia. Chlamydia and gonorrhea are transmitted through vaginal, anal or oral sexual contact. Both types of infections can cause symptoms in some patients while other patients have no symptoms at all. When someone is diagnosed with chlamydia or gonorrhea, any sexual partners in the preceding 60 days should be contacted, evaluated, tested, and, if needed, treated. Infected patients are to abstain from all sexual contact for seven days after completion of treatment.

Answer 143

L4 corresponds to the knee There are five lumbar dermatomes (L1-L5) that supply sensation from these spinal nerves in the lower limb (leg, foot, hip knee, etc). L1 corresponds to the lower back, hips, groin. L2 corresponds to the the lower back, hips, and tops of the inner thighs. L3 corresponds to the the lower back, inner thighs, and inner legs just below the knees. L4 corresponds to the knees, inner sections of the lower legs, and the heels. L5 corresponds to the lower back, front and outside of calf, top and bottom of foot, first four toes.

Answer 144

Uterine fibroids Uterine fibroids are benign and are the most common tumors affecting women. They originate in the smooth muscle of the uterus. Uterine fibroids are estrogen-dependent and estrogen-responsive. Uterine fibroids can vary in size and shape, generally grow very slowly, and can be asymptomatic. Abnormal menstrual bleeding is the most common symptom with uterine fibroids. Menstruation can be abnormal, heavy, irregular, painful, or with spotting. Symptoms related to tumor size include constipation, frequent and urgent urination, pelvic pain/cramping, and back pain. A laparoscope is inserted through a small cut just below or through the navel. The doctor can then observe abnormal growth tissue on the outside of the uterus with the laparoscope. The hysteroscope is inserted through the vagina and cervix (opening of the uterus) to see abnormal growth tissue inside the uterine cavity. Uterine fibroid tumors are located within the uterine wall while in endometriosis abnormal endometrial growth is located outside of the uterus (ovaries, fallopian tube, large intestine, bladder). Ultrasound can also be used in diagnosis.

Answer 145

20 minutes The rapid HIV test is an immunoassay. An immunoassay detects and measures specific proteins through their properties as antigens or antibodies. The rapid HIV test is used for screening blood or oral fluid to look for antibodies to HIV. If the immunoassay rapid test is performed during the window period, the test may not find antibodies and may give a false- negative result. The window period is the period after HIV exposure but before the test can find antibodies). All immunoassays with a positive result need a follow-up test for confirmation. Anyone in high-risk categories should be tested as part of routine medical care.

Answer 146

Immunoglobulin E

Answer 147

delay treatment until a western assessment This is to identify possible MRSA (Methicillin-Resistant Staphylococcous Aureus). Do not start acupuncture treatment until appropriate antibiotics are given to the patient.

Answer 148

Dopamine agonists: activate and enhance dopamine receptors in the brain The correct answers are: Dopamine agonists: activate and enhance dopamine receptors in the brain. Levodopa: is a precursor to the dopamine neurotransmitter. MAO-B inhibitors: block an enzyme that breaksdown dopamine in the brain. COMT inhibitors: block an enzyme that degrades the drug levadopa. Levadopa does not directly provide the body with dopamine. It is a precursor to dopamine. Most symptoms of Parkinson's disease (PD) are due to aa lack of dopamine in the brain. Dopamine is a neurotransmitter involved with fine motor control (as well as motivation, pleasure, and learning). When there is a depredation of dopamine-producing brain cells, there can be resting tremors, postural instability, and rigidity of the limbs and trunk. Many PD drugs focus at either replenishing dopamine or mimicking the action of dopamine. LEVODOPA is a chemical precursor of dopamine that is transported to the brain where it is transformed into dopamine. It is the gold standard for treating PD. Levadopa is most often combined with another drug carbidopa. The drug Sinemet or Rytary are a mix of levodopa and carbidopa. Carbidopa increases levadopa availability by blocking the breakdown of levadopa. The addition of carbidopa allows a lower dosage of levadopa to be effective and thus reduce the side effects (nausea, vomiting) of only using levadopa by itself. Common side effects of carbidopa-levodopa combination include nausea, dizziness, headache, insomnia, abnormal dreams, dry mouth, anxiety, and constipation. DOPAMINE AGONISTS activate and enhance dopamine receptors (D2, D3, D4) in the brain. While levodopa is converted into dopamine, dopamine agonists mimic the effects of dopamine without having to be converted. Dopamine agonists are often used instead of levodopa or in combination with levodopa. The most prescribed dopamine agonists are Mirapex (peramipexol), Requip (ropinirole), and Neupro patch (rotigotine).

Answer 149

Atrophic vaginitis: can have thin discharge with little odor, vaginal dryness, pale and thin labia, itchy vulva The correct answers are: Atrophic vaginitis: can have thin discharge with little odor, vaginal dryness, pale and thin labia, itchy vulva. Bacterial vaginitis: white, gray or yellow discharge with a fishy odor with itching, burning, swelling, and redness of the vulva or vagina. Candidal vaginitis: white, cheesy discharge, no odor, pain with intercourse around vulva, and with itching, burning and vulvar swelling. Trichomonas vaginitis: frothy yellow or greenish discharge with a foul odor, pain on urination, with itching and burning. Atrophic vaginitis has a thin discharge with little odor unless there is a secondary infection. Bacterial vaginitis, candidiasis and atrophic vaginitis can be associated with dyspareunia (painful intercourse). Trichomoniasis is not associated with dyspareunia but there can be pain on urination. The vaginal discharges for bacterial vaginitis have a fishy odor. Trichomoniasis has a foul odor. Candida has no odor or a yeast smell. Atrophic vaginitis has no odor (unless there is a secondary infection). The vaginal discharge for trichomoniasis are frothy yellow or green, for candidiasis they are white and cheesy, for bacterial vaginitis they are white, gray or yellow, and for atrophic vaginitis they can be white. All four disorders can have itching and burning.

Answer 150

anxiety disorders Benzodiazepines enhance the effect of the neurotransmitter GABA (gamma-aminobutyric acid). Benzodiazepines have a sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant, and amnesic actions. Benzodiazepines are useful in the treatment of alcohol dependence, seizures, anxiety, panic, agitation and insomnia. The most common side-effects of benzodiazepines are related to their sedating and muscle-relaxing action which can cause drowsiness, dizziness, decreased alertness, and lack of coordination.

Answer 151

knee jerk reflex Sciatica is pain that affects the back, hip, and the leg. The pain can be burning or stabbing. Sciatica can occur with or without lumbar pain. Sciatica is caused by a spinal nerve root compression in the lower back which is often due to an intervertebral disk degeneration. Reflex testing is used to determine the intervertebral level of the nerve root compression. A weak or non-existent knee jerk reflex test points to a L3-L4 involvement. Straight leg raising can result in radiating pain down the leg when the leg is raised above 60 degrees (sometimes less). An MRI and/or electrodiagnostic studies can be ordered.

Answer 152

bacterial conjunctivitis Bacterial conjunctivitis manifests acutely with red eyes, usually both, a mild discomfort with pruritis, and with a purulent drainage. It is the most common form of conjunctivitis and called “pink eyes". Diagnosis is usually based on the patient history and physical symptoms. Patients often report purulent discharges as “sleep crusts" or "glue" on waking up. This is very predictive of bacterial conjunctivitis. Diagnostic tests are usually not needed and should only be done in severe cases or in patients who have a compromised immune system. Topical antibiotics is indicated to reduce the symptoms, shorten the duration of the disorder to prevent further contagion. Without treatment, bacterial conjunctivitis can last three or more weeks. Viral conjunctivitis is very contagious and caused by the adenovirus. It is usually accompanied with upper respiratory symptoms (cough, nasal congestion). Allergic conjunctivitis is usually associated with atopic disorders such as allergic rhinitis, eczema, or asthma. Iritis can be due to trauma, an infection, or be associated with other diseases (ankylosing spondylitis, Reiter syndrome, inflammatory bowel disease, psoriasis) Iritis has eye pain which is worse when exposed to light, red eyes, irregular shaped pupils, blurred vision, and headache.

Answer 153

snoring is more common with Obstructive Sleep Apnea than with Central sleep apnea Sleep apnea is a disorder that occurs when breathing is interrupted during sleep. Obstructive Sleep Apnea (OSA) is more common than Central Sleep Apnea (CSA). OSA occurs when breathing becomes locally obstructed. In OSA the blocked airway can be due to a deviated septum, the back of the tongue falling backward, the palate and the uvula becoming floppy, and the walls of throat narrowing or closing the airway. In adults, the most common cause of OSA is excess weight and obesity. The blocking of the throat airways leads to diminished air intake that causes blood oxygen levels to drop. The brain then signals to the body to wake up to start breathing. This sequence can be repeated dozens, if not hundred of times per night. CSA occurs when the brainstem fails to send signals to the muscles that control breathing. CSA occurs not because the patient cannot breathe as with OSA. Instead, the body does not try to breathe at all because the brain stem fails to signal the body to breathe. If the brainstem is dysfunctional and fails to monitor the sensitivity of oxygen in the blood, the signals sent to the respiratory system can be weak, resulting in shorter breaths or no breaths at all. This sequence can be repeated dozens, if not hundred of times per night. Unlike OSA, CSA is typically not linked to obesity. Since CSA is directly caused by a miscommunication in the brain, weight does not play a role in CSA like it does with OSA. CSA is usually associated with serious disorders (congestive heart failure, hypothyroidism, kidney failure, Parkinson's, Lou Gehrig's disease, or a stroke affecting the lower brainstem). Snoring is not as prominent in CSA as it is with OSA. Snoring is not prevalent in CSA because the brain fails to send the signal to breathe as opposed to a physical obstruction in airflow with OSA. Both types of sleep apnea are treated with continuous positive airway pressure (CPAP), a machine that uses a hose and mask or nosepiece. CPAP works by passing a stream of compressed air to the air passageway to allow for easy breathing.

Answer 154

painless, fixed, hard breast lump, palpable axillary lymph nodes, thickening of one breast The majority of breast cancer lumps are discovered either by the patient, during a physical examination, or during a mammography. Breast cancer is less commonly discovered by the symptom of breast pain or enlargement or thickening of the breast. Disease of the nipple (Paget's disease) which has breast skin changes such as erythema, crusting, scaling and nipple discharge occurs in about 50% of patients who have a palpable tumor. However, to the patient, the symptoms of Paget's disease are viewed as benign and ignored, thereby delaying diagnosis. A lump in the upper-outer quadrant of the breast is most characteristic of benign disorder (fibrocystic breast disease). One breast that is firmer and with a thick skin while the other breast is normal can be a cancer sign. As breast cancer progresses there is a fixed lump attached to the skin or chest wall, a satellite of nodules or skin ulcers, orange peel skin, and enlarged lymph nodes.

Answer 155

increased urination Furosemide is the generic name for Lasix. Most patients who are prescribed Lasix note increased urination for the several hours after taking Lasix. This often occurs when significant edema is present and renal function is normal.

Answer 156

use eye protection Eye protection is a recommendation for bleeding techniques but wearing gloves is critical. Wash hands right away after removing gloves (critical). Patients should be screened for bleeding disorders and anti-coagulant drugs and supplements. Lancing devices should be single-use to a single patient. They should not be reinserted in another body area or used on another patient. Retractable devices must only be used on a single patient. Do not bleed over active skin lesions. In terms of depth, the point is bled superficially about 0.05 - 0.1 cun deep.

Answer 157

Acute myocardial infarction A heart attack is associated with chest pressure with radiating pain, risk factors of hypertension and family history. It is not aortic dissection as he has pain and has BP equal in both arms. Peptic ulcer pain is unlikely to arise from exertion. He does not have rib pain and costal cartilage tenderness of Tietze's syndrome.

Answer 158

Meningococci, Streptococci, Neisseria gonorrhoeae A throat culture is a laboratory diagnostic test that evaluates the presence of a bacterial or fungal infection in the throat. Streptococci, meningococci, neisseria gonorrhoeae, and mycobacterium tuberculosis are bacterial infections. Throat cultures are not done for viral infections even though viruses are the most common cause of a sore throat. However, a throat culture is not done for a viral infection because viruses do not grow in the culture. A culture helps to differentiate between a bacterial infection and a viral infection as only bacterias will grow in the culture. Moreover, a throat culture can help identify the type of bacteria causing the infection which then gives treatment guidance. A COVID-19 is a virus which is not detected with a throat culture. Instead, in COVID-19 a throat swab can be used with the help of a PCR test Polymerase chain reaction) to help detect the virus.

Answer 159

Two weeks This is in case something more serious is occuring, such as a stomach ulcer or even stomach cancer. If symptoms are not relieved after two weeks of use, the patient should see their doctor.

Answer 160

Candida vaginitis The three main types of vaginitis are bacterial vaginosis, vaginal candidiasis, and trichomoniasis. A woman may have any combination of vaginal infections at one time. Vaginal candidiasis or yeast infection is caused by a fungus called Candida which is normally present in the rectum and vagina. In candidiasis there is an overgrowth of the fungus. Not all candida vaginitis is odorless.

Answer 161

Stroke, Endometrial cancer, Breast cancer This is the most complete and accurate answer. In osteoporosis the bones become brittle and fragile from loss of tissue,typically as a result of hormonal changes or a deficiency of calcium and/or vitamin D. In menopause, estrogen levels drop with associated physical signs (hot flashes) and psychological signs (mood swings). A drop in estrogen also affects bonedensity. When estrogen levels drop, the osteoblasts (cell that secrete the matrix for bone formation) are not able to effectively produce bone. Estrogen therapy slows down bone loss. Estrogen replacement therapy should not be usedwith patients who have breast/uterine cancer, liver disease, and history of blood clots. Estrogen therapy has been associated with increased risks of uterine cancer, breast cancer, stroke, heart attacks, and blood clots. At one point,estrogen replacement therapy was the only FDA-approved treatment to prevent osteoporosis. There are now manyother drugs for osteoporosis (eg Fosamax), but estrogen is still a fairly common treatment. Bate's Guide to Physical Examination, 13th Edition, page 819-820 ; Bate's Guide to Physical Examination, 10th Edition, page 582

TCMTEST - Biomedicine Flashcards

(188 cards)