Test Prep Workbook for the NCCAOM Bio-medicine Module 1891845349, 9781891845345, 9781423779476

Citation preview

Test Prep Workbook for the NCCAOM

Biomedicine Module Exam Preparation & Study Guide

By Zhong Bai-song

• Blue Poppy Press •

Published by: BLUE POPPY PRESS A Division of Blue Poppy Enterprises, Inc. 5441 Western Ave., Suite 2 BOULDER, CO 80301 First Edition, February, 2006 ISBN 978-1-891845-34-9 COPYRIGHT © BLUE POPPY PRESS, 2006 All Rights Reserved. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, transcribed in any form or by any means, electronic, mechanical, photocopy, recording, or any other means, or translated into any language without the prior written permission of the publisher. DISCLAIMER: The information in this book is given in good faith. However, the author and the publishers cannot be held responsible for any error or omission. The publishers will not accept liabilities for any injuries or damages caused to the reader that may result from the reader’s acting upon or using the content contained in this book. The publishers make this information available to English language readers for research and scholarly purposes only. The publishers do not advocate nor endorse self-medication by laypersons. Chinese medicine is a professional medicine. Laypersons interested in availing themselves of the treatments described in this book should seek out a qualified professional practitioner of Chinese medicine. COMP Designation: Original work using a standard translational terminology. 10 9 8 7 6 5 4 3 2 1 Printed at National Hirshfeld, LLC, Denver, Colorado. Cover & page design by Eric J. Brearton

Table Of Contents Foreword ……………………………………………………………………………………… Introduction …………………………………………………………………………………… Section 1 ………………………………………………………………………………………… Section 2 ………………………………………………………………………………………… Section 3 ………………………………………………………………………………………… Section 4 ………………………………………………………………………………………… Section 5 …………………………………………………………………………………………

v vii 3 27 49 73 97

Foreword In my 20 years of teaching I have had to treat many students for headaches caused by the stress of taking exams. One day I decided to take a different approach in my treatment strategy. In the spirit of traditional Chinese medicine, I wanted to do something that would prevent the students from getting headaches in the first place. This is when I coauthored my first study guide, A Study Guide in Chinese Medical Pediatrics (1993). Then, in 2001 I participated in the writing of A Collection of Multiple Choice Questions for TCM Pediatrics. These books became very popular in China and were used by many students in order to prepare for their exams during their course of study. My goal in writing this book remains the same. This is a preparatory guide for the biomedicine portion of the NCCAOM exam. I believe this book will also serve its readers in providing useful information that can be utilized in clinic. The book consists of five sections of questions, each containing 50 questions. The format of the questions are written as they would appear on the NCCAOM test with four choices. (A few have more than four choices.) Each question is also accompanied by a concise explanation of the correct answer. My purpose here is that students can learn the necessary informa-

tion without becoming confused by some of the more complex subject matter. It is my goal that students should be able to learn this information efficiently and quickly. Several people worked very hard to make this book possible. I would like to offer my most sincere thanks to Thomas Wang, Ph.D., O.M.D., a longtime colleague and excellent teacher; Alexandra Ramirez, Ph.D., O.M.D. whose advice was invaluable to this project; Edward Block IV, Ph.D., whose excellent editing skill really brought things together; Angela Lakes who worked tirelessly to gather huge amounts of information for this book; and Michael Johnston, L.Ac., who helped with the process of getting the book published. I really appreciate everyone's efforts. Finally, to my audience, you can pass the NCCAOM exam easily with hard work and effective studying. I believe this book is a useful tool that will help assure success in this endeavor. Through the successful realization of your goals, TCM will continue to thrive as a necessary component in the modern health medical system. — Zhong Bai-song

v

Introduction This book is intended to help prepare you to pass the NCCAOM biomedicine module. The biomedicine module is made up of 50 questions divided into three sections. Approximately 20% of the questions pertain to questioning and collecting relevant information from the patient; approximately 60% of the questions pertain to Western medical assessment and therefore a basic knowledge of anatomy, physiology and pathology; and, approximately 20% of the questions pertain to legal, professional and safety issues. This book is modeled after this biomedicine module and contains questions from each of the three categories for which the NCCAOM tests. This book is divided into five sections containing 50 questions each. Preceding each test is an

answer sheet for you to mark the answers that you think are correct. Following each section is an answer key for you to check your answers. Since the time to complete the NCCAOM biomedicine module is 1.5 hours we suggest, as you move from section #1 to section #5, you attempt to come closer to the actual time limit provided for this exam. After checking your answers against the key, calculate your score on the test (% correct) at the bottom of the page. The section after the answer key gives you a detailed explanation of the correct answer for each question. Read all of the answers carefully before you move on to the next test. If you take this preparation manual and your studies seriously, we think you will be well prepared for taking the biomedicine module. Good luck!

vii

Test #1 – Place your answers on the appropriate line. The answer key appears at the end of the 50 questions in this test. After the answer key there is a section with the explanation for each correct answer.

1 ______

18 ______

35 ______

2 ______

19 ______

36 ______

3 ______

20 ______

37 ______

4 ______

21 ______

38 ______

5 ______

22 ______

39 ______

6 ______

23 ______

40 ______

7 ______

24 ______

41 ______

8 ______

25 ______

42 ______

9 ______

26 ______

43 ______

10 ______

27 ______

44 ______

11 ______

28 ______

45 ______

12 ______

29 ______

46 ______

13 ______

30 ______

47 ______

14 ______

31 ______

48 ______

15 ______

32 ______

49 ______

16 ______

33 ______

50 ______

17 ______

34 ______

✃

TEST #1 SCORE - ___________ / 50 = ________% correct # of correct answers

Section 1 1. The main symptoms of hepatitis B are: A. renal colic, tinnitus, and dyspnea B. chills, fever, nausea, vomiting, and malaise C. edema, weight lost, distended abdomen, and constipation D. severe cough, sore throat, and swollen lymph glands

2. In regard to the definition of antisepsis, which one of the following is the best description? A. The use of chemicals and procedures designed to destroy or reduce the number of pathogens on inanimate objects. B. The use of procedures that destroy all microbial life, including viruses. C. Products designed to reduce microbial life on living tissue, particularly on the skin of the patient or practitioner. D. The introduction of disease-causing organisms into or onto previously clean or sterile objects, making them impure.

3. Which of the following is NOT an action of cortisone? A. Reduce inflammation. B. Decrease edema of inflammation. C. Reduce pain by inhibiting some pain-causing molecules called prostaglandins. D. Treatment of Cushing’s syndrome.

4. Absorption of nutrients mainly occurs in: A. stomach B. small intestine C. large intestine D. rectum

3

4

Biomedicine Module Test Prep Workbook

5. Which of the following organs is influenced by the sympathetic nervous system? A. urinary bladder B. gastrointestinal tract C. pupils of the eyes D. heart E. All of the above

6. All of the following substances or cell components cannot usually be found in a mature red blood cell EXCEPT: A. mitochondria B. hemoglobin C. nucleus D. lysosome

7. Which of the following is among the highest risk factor for breast cancer in women? A. early menopause B. low-fat, high-fiber diet C. history of ovarian cancer D. history of using birth control pills

8. Which one of the following is a true statement about treatment of cancer pain? A. Identifying the cause of the pain is not included in palliative care. B. The confusion and drowsiness of a narcotic analgesic can be treated by switching to another narcotic analgesic. C. Intractable, chemotherapy-caused nausea and vomiting can be managed by a serotonin antagonist. D. Fear and anxiety modify pain threshold without affecting its management.

9. All of the following organisms causes diarrhea EXCEPT: A. neisseria gonorrhoeae B. clostridium perfringens C. escherichia coli D. vibrio cholerae E. giardia lambria

Section 1

10. Which of the following most likely causes diarrhea to a patient on antibiotics? A. escherichia coli B. streptococcus faecalis C. bacteroides fragilis D. clostridium difficile

11. Cushing’s syndrome is characterized by all of the following signs EXCEPT: A. hyperpigmentation of the skin B. acne C. weight gain D. hypertension

12. As part of the routine in your practice, you measure the blood pressure of each patient. In regard to blood pressure measurement, which of the following is true? A. A cuff that is too narrow will measure an artificially low reading. B. Blood pressure readings from both arms are always equal. C. The measurement can be done any moment during the visit. D. The width of the bladder should cover entirely the circumference of the arms. E. It is necessary to fully deflate the cuff before repeating a measurement.

13. A 45-year-old female patient, 5 ft tall, weighing 140 lbs, presents to you acute, steady right upper quadrant pain of the abdomen. This pain aggravates with fatty food, and is accompanied by pain and nausea. She looks a little jaundiced. On further examination, she is slightly febrile, and her right costal margin is tender on deep palpation. Her pulse feels slippery and strong, and her tongue looks red with greasy yellow coating. The most possible diagnosis is: A. acute pancreatitis B. peptic ulcer disease C. acute appendicitis D. acute cholecystitis

5

6

Biomedicine Module Test Prep Workbook

14. This maneuver elicits pain in the right lower quadrant during left-sided pressure; it suggests appendicitis. This sign is: A. Rovsing’s sign B. Thumb sign C. Tinel’s sign D. Wright’s maneuver

15. All of the following complications occur with type 2 diabetes EXCEPT: A. retinopathy B. nephropathy C. polydipsia D. neuropathy

16. The one or more symptoms or concerns causing a patient to seek care is: A. chief complaint B. past history C. family history D. review of history

17. Red, swollen pimple-like lesion on the eyelid is most likely: A. scleroderma B. malignant melanoma C. stye D. conjunctivitis

18. A patient complains about abdominal gas problems. At physical examination you would find: A. Decreased gurgles at ascultation of the abdomen. B. Presence of bruits. C. Increased tympany. D. Painful palpation at right costal margin.

Section 1

7

19. Elevated creatine may be a disorder of: A. liver B. lung C. kidney D. spleen

20. A positive _______ occurs when a patient, lying supine lifts their head and shoulder blade off the table causing previous abdominal pain to persist or become worse. A. Blumberg sign B. Brudzinski sign C. Boas sign D. Carnett sign

21. ATP is associated with all of the following EXCEPT: A. a basic nucleotide structure B. high-energy phosphate bonds C. reversible reaction D. deoxyribose E. inorganic phosphate

22. The urine osmalality test is used to evaluate: A. urine glucose levels B. 5-HIAA C. urine cortisol levels D. fluid and electrolytes abnormalities

23. The acupunture point GB 21 can be more safely punctured by inserting the needle posteriorly into this muscle. What is this muscle? A. sternocleidomastoid muscle B. trapezius muscle C. brachial muscle D. infraspinatus muscle

8

Biomedicine Module Test Prep Workbook

24. The ammonia blood test is useful to diagnose: A. lung failure B. heart failure C. liver disease D. pancreatic disease

25. Deep perpendicular puncturing on left GB 25 with a 1.5 cun needle would most likely damage which of the following organs? A. liver B. pancreas C. kidney D. stomach

26. A 35-year-old patient comes to see you for the first time. As an acupuncturist your inquiry should include all of the following EXCEPT: A. vital signs B. chief complaint C. past medical history and family history D. allergies E. None of the above

27. Which of the following findings in a deep tendon reflex would suggest peripheral nerve injury: A. normal B. absent C. decreased D. hyperactive

28. All of the following are true about type 2 diabetes EXCEPT: A. Tends to occur in people over 40 who are overweight and inactive. B. Pancreas cannot produce enough insulin. C. Most common type of diabetes. D. Can be controlled with diet and exercise.

Section 1

29. All of the following are tests that assess the sacroiliac joint EXCEPT: A. Gaenslen’s sign procedure B. Patrick’s test C. Sacroiliac distraction test D. Fabere test E. Valsalva’s maneuver

30. Which of the following is an indication of the carcinoembryonic antigen (CEA) blood test? A. to diagnose allergic sinus B. to diagnose hepatitis B C. to evaluate cancers D. to evaluate renal function

31. All of the following about cortisol are true EXCEPT: A. affects blood levels of glucose B. stimulates the effects of insulin C. affects metabolism of carbohydrates, protein, and fats D. production is stimulated by ACTH

32. The foramen magnum is located in which of the cranial bones? A. Parietal B. Temporal C. Sphenoid D. Occipital

33. If a patient has fever, nausea, vomiting, and rigidity on the low right side of the abdomen, which of the following is possibly positive? A. Abdominal reflexes B. McBurney’s sign C. McMurray’s sign D. McMurphey’s sign

9

10

Biomedicine Module Test Prep Workbook

34. An athlete has a pain near the lateral epicondyle that radiates along the forearm to the dorsum of the wrist. The pain appears after recreational activities involving repeated rotation of the fore arm. Which of the following tests is most helpful to diagnose this disease? A. Phalen’s sign B. Tennis elbow test C. Tinel’s sign D. Thumb abduction test

35. If a patient has endometriosis, before surgery, which of the following can be used to confirm it? A. Laparoscopy B. Ultrasound C. CT D. MRI

36. Which one of the following cranial nerves innervates sensation of the face? A. accessory B. glossopharyngeal C. trigeminal D. vagus

37. Mr. Z is a muscle builder who works out diligently every day. His muscles are huge. From a pathological perspective, his muscle cells have undergone which process to make him look beefy? A. hypertrophy B. hyperplasia C. atrophy D. hypoplasia E. aplasia

38. A person with an XXY karyotype would demonstrate all of the following characteristics EXCEPT: A. atrophic testes B. female phenotype C. one Barr body on buccal smear D. tall stature

Section 1

11

39. John is a homeless person who lives on soliciting from storeowners of several close by shopping centers. Whenever he gets money, he buys alcoholic beverage. One day a shopping center security guard found John unconscious, lying in vomit, smelling of alcohol, and running a high fever. It was Christmas season, so security took John to a local emergency room, and left him there. John’s x-ray shows consolidation of the right lower lobe of the lung. He most likely had contracted: A. fungal pneumonia B. viral pneumonia C. protozoa pneumonia D. bacterial pneumonia

40. Characteristics of pyogenic osteomyelitis include all of the following EXCEPT: A. In children, it most often is caused by blood-borne spread from infection elsewhere. B. In adults, it often is a complication of trauma or surgery. C. It can lead to bone necrosis. D. It can lead to draining sinuses. E. It is almost never amenable to antibiotic therapy.

41. Sterilization is the use of a procedure which: A. Reduces adhesive properties of microbial life. B. Destroys all microbial life. C. Stops reproduction and growth of all microbial life. D. Reduces the number of all types of microbial life.

42. A 60 year-old male smoker comes to the clinic suddenly with complaints of blood tinged productive sputum on coughing and weight loss. His temperature is 100˚F and has significant weight loss. There is a family history of cancer. What would be the next step in establishing the diagnosis? A. branchoscopy B. chest X-ray C. culture of the sputum of acid-fast bacteria D. PPD

12

Biomedicine Module Test Prep Workbook

43. How often should a man over 40 years old have a rectal exam? A. weekly B. monthly C. yearly D. every two years

44. Which of the following signs is indicative of excessive glucocorticoids? A. exophthalmos B. moon face C. striae on skin D. hirsutism

45. CRH (corticotropin-releasing hormone) is produced in the: A. pituitary B. hypothalamus C. adrenal D. testes

46. Rotator cuff manifests with all of the following signs EXCEPT: A. positive drop arm test B. positive empty can test C. painful external rotation D. painful internal rotation E. positive speed’s test

47. Reduced bile production will result in the appearance of what matter in the feces? A. blood B. very small stones C. mucous strands D. fat

Section 1

48. What is the main function of DNA? A. To transfer amino acids to ribosomes. B. To form part of the ribosomes. C. To construct single nucleotide strands. D. To control inheritance of characteristics.

49. Which one of the following conditions is a characteristic of cirrhosis of the liver? A. degeneration of the cerebral cortex B. gastric ulcer C. hemolytic anemia D. ascites E. pulmonary edema

50. Which of the following vitamins can be synthesized by intestinal bacteria? A. vitamin A B. vitamin C C. vitamin E D. vitamin K E. niacin

13

Test #1 – Answers

1. B

18. C

35. C

2. A

19. C

36. C

3. D

20. D

37. A

4. B

21. C

38. B

5. E

22. D

39. D

6. B

23. B

40. E

7. A

24. C

41. B

8. C

25. C

42. B

9. A

26. E

43. C

10. D

27. D

44. B

11. A

28. B

45. B

12. E

29. E

46. E

13. D

30. C

47. D

14. A

31. B

48. D

15. C

32. D

49. D

16. A

33. A

50. D

17. C

34. B

Answers & Explanations 1. B. The symptoms of hepatitis B include chills, fever, nausea, vomiting, malaise, symptoms of flu-like syndrome. Jaundice, enlarged tender liver also may be present. (Tierney, Lawrence. Essentials of Diagnosis & Treatment. Connecticut: Appleton & Lange, 1997. 94.) 2. A. The use of chemicals and procedures designed to destroy or reduce the number of pathogens on inanimate objects is called antisepsis. The use of procedures that destroy all microbial life, including viruses is called sterilization. Products designed to reduce microbial life on living tissue, particularly on the skin of the patient or practitioner is called antiseptic. The introduction of disease-causing organisms into or onto previously clean or sterile objects, making them impure is called contamination. 3. D. Cortisone has anti-inflammatory effects. It decreases edema of inflammation, and reduces pain by inhibiting some pain-causing molecules called prostaglandins. Cortisone causes Cushing’s syndrome instead of treating Cushing’s syndrome. (Mycek, Mary. Lippincott’s Illustrated Reviews: Pharmacology. Ed. Richard Harvey. Philadelphia: Lippincott Williams & Wilkins, 2000. 272-73.) 4. B. Absorption of water mainly occurs in the large intestine. The stomach acts as a temporary “storage tank” for food as well as a site for food breakdown. Nearly all food absorption occurs in the small intestine. (Tortora, Gerard. Principles of Anatomy and Physiology. John Wiley & Sons, Inc., 10th ed.) 5. E. The sympathetic and parasympathetic nervous systems have opposite effects on the pupils of the eyes. The sympathetic nervous system dilates pupils, constricts sphincters of urinary bladder and digestive system, and increases rate and force of heartbeat. The parasympathetic nervous system relaxes sphincters of urinary bladder and gastrointestinal tract, constricts pupils and decreases the rate of the heart. (Tortora, Gerard. Principles of Anatomy and Physiology. John Wiley & Sons, Inc., 10th ed.) 6. B. The mature red blood cells (erythrocytes) are anucleate cells devoid of typical organelles. These cells are literally sacs of hemoglobin molecules (Hb). Hb, an iron-containing protein, transports the bulk of the oxygen that is carried in the blood. Moreover, because erythrocytes lack mitochondria and nucleus, and make ATP by anaerobic mechanisms, they do not use up any of the oxygen they are transporting, making them very efficient oxygen transporters indeed. (Ross, Michael. Histology: A Text and Atlas. Baltimore, MD: Lippincot Williams & Wilkins, 2003. 217-20.) 7. A. Breast cancer is the most common cancer in adult women. It occurs in approximately one in nine women in the United States. Predisposing factors of breast cancer are: (1) a family history of a first-degree relative with breast cancer, (2) previous history of contralateral breast cancer, (3) early menarche and late menopause, (4) a high-fat, low-fiber diet, (5) a history of endometrial carcinoma, (6) increasing age (over 40-50 years of age).

18

Biomedicine Module Test Prep Workbook

8. C. Ondansertron, a recently developed serotonin antagonist, is the recommended antiemetic agent of choice in identifying the cause of the pain, preventing it from recurring, and maintaining a clear sensorium. Narcotic-produced confusion and drowsiness should be treated by adding methylphenidate to the treatment plan. Fear and anxiety are among factors that lower pain threshold. 9. A. Neisseria gonorrhoeae, also called gonococcus, is a gram-negative coccus that causes urethritis in men, and endocervicitis, salpingitis, and PID in women. Clostridium perfringens is a grampositive rod that causes food poisoning when contaminating the food. Escherichia coli is a gramnegative rod that causes UTI, meningitis, “traveler’s diarrhea”, etc. “Traveler’s” diarrhea is characterized by a watery, non-bloody, self-limited diarrhea of short duration. Vibrio cholerae is a gramnegative rod that causes cholera, which is characterized by profuse watery diarrhea, vomiting, muscular cramps, dehydration, oliguria, and collapse. Giardia lambria is a flagellated protozoan that causes giardiasis, which manifests from absence of symptoms to intermittent flatulence, watery malodorous diarrhea, to chronic malabsorption. (Medical Microbiology & Immunology. Appleton & Lange. The Merck Manual, 17th ed.) 10. D. Clostridium difficile is part of the normal flora in 3% of the population. Up to one-third of hospitalized patients can be colonized by this bacterium. The transmission route is fecal-oral. Antibiotics can suppress drug-sensitive normal flora, allowing clostridium difficile to multiply and produce toxins that cause pseudomembranous colitis. In this disease marked by diarrhea, pseudomembranes (yellow-white plaques) are formed, and can be visualized by sigmoidoscopy. (Medical Microbiology & Immunology. Appleton & Lange.) 11. A. Hyperpigmentation of the skin at crease, pressure areas, and nipples; weakness, hypotension, and easy fatigability are all signs and symptoms of chronic adrenocortical insufficiency (Addison’s disease). 12. E. The cuff should have the appropriate size for the limb, with the bladder encircling approximately 80% of the limb. A cuff that is too narrow generates a falsely high reading. The opposite happens with a cuff that is too wide. For accuracy of reading, the patient should have rested in a sitting or supine position, with the back supported, for at least 5 minutes, and at least 30 minutes after smoking or coffee ingestion. The cuff should always be fully deflated before a second reading. One should wait at least 15 seconds between measurements. In a normal person, readings between two arms can be different, but rarely vary by more than 10mmHg. (Mosby’s Guide to Physical Examination. 2004, CMDT.) 13. D. This clinical picture strongly suggests acute cholecystitis. Acute pancreatitis manifests as an abrupt epigastric pain, which often radiates to the back, accompanied by nausea, vomiting, and fever. There is frequently a history of previous episode, or alcoholism. Peptic ulcer disease causes an epigastric pain, which can be described as burning, gnawing, or hunger. Gastric ulcer pain may be exacerbated by eating, while duodenal ulcer pain can awaken the patient at night, tends to be relieved by food, but may recur 2 to 3 hours after eating. Acute appendicitis presents with

Section 1

19

abdominal pain that is initially poorly localized or periumbilical, later migrating to the right lower quadrant. It is not directly associated with fatty food. 14. A. Rovsing’s sign: Pain in the right lower quadrant during left-sided pressure suggests appendicitis; so does right lower quadrant pain on quick withdrawal. Thumb sign: In Marfan’s disease, Ehlers-Danlos syndrome, and similar syndromes, thumb protrudes from clenched fist. Tinel’s sign: A sensation of tingling or pins and needles felt in distal extremity when percussion is made over the site of an injured nerve; it indicates a partial lesion or early regeneration of the nerve; 60% sens, 67% spec. Wright’s maneuver: Looking for thoracic outlet obstruction: evaluating the radial pulse at the wrist with the shoulder in external rotation and abduction, positive sign if it reproduces shoulder and arm symptoms and obliterates radial pulse. 15. C. Polydipsia is the primary symptom of type 1 diabetes mellitus. Diabetes mellitus is a chronic disease of absolute or relative insulin deficiency or resistance, and characterized by disturbances in carbohydrate, protein, and fat metabolism. This condition occurs in two forms: type 1, characterized by absolute insulin insufficiency, and type 2, characterized by insulin resistance with varying degrees of insulin secretory defects. Many patients with type 2 diabetes may be asymptomatic. The complications of type 2 diabetes are retinopathy (up to 63%), nephropathy (up to 54%), and neuropathy (up to 60%). 16. A. Chief complaint refers to the one or more symptoms or concerns causing the patient to seek care. Past history amplifies the chief complaint, describes how each symptom developed, and so on. Family history outlines age and health, or age and cause of death, of siblings and or parents, and documents presence or absence of specific illnesses in the family, such as hypertension, cancers, and coronary artery diseases. Review of history documents presence or absence of common symptoms related to each major body system. 17. C. Stye is an ophthalmic disease caused by staphylococci, and marked by an abscess in the follicle of an eyelash that leads to redness, swelling, and pain. Scleroderma is a diffuse connective tissue disease characterized by inflammatory and then degenerative and fibrotic changes in skin, blood vessles, synovial membranes, skeletal muscles and internal organs. This disease occurs in distinctive forms: limited systemic sclerosis, benign subtype called CREST syndrome; diffuse systemic sclerosis, localized scleroderma; and linear scleroderma. The cause is unknown. Malignant melanoma is a cancer of the skin. Common sites of melanoma are the head and neck in men, the legs in women, and the backs of people exposed to excessive sunlight. Hyperemia of the conjunctiva from infection, allergy, or chemical reactions characterizes conjunctivitis. Bacterial and viral conjunctivitis are highly contagious, but also self-limiting after two weeks’ duration. Conjunctivitis commonly produces hyperemia of the conjunctiva, sometimes accompanied by discharge and tearing. 18. C. Patient with increased gas in lower gastrointestinal tract will present with increased gurgling (borborygmus), with accentuated tympany during percussion over the abdomen. Presence of bruit over arterial area will be compatible with aneurysm. A painful palpation at right costal margin would raise suspicion to disorder such cholecystitis, trauma to ribs, etc.

20

Biomedicine Module Test Prep Workbook

19. C. Elevated creatine may be a disorder of the kidney. Creatinine clearance is used to measure the glomerular filtration rate (GFR). Creatinine is a catabolic product of creatine phosphate, which is used in skeletal muscle contraction. Creatine is excreted entirely by the kidneys and therefore is directly proportional to the GFR. 20. D. Carnett’s sign: Head raise, tenderness persists in abdominal wall condition (rectus hematoma) whereas pain due to intraperitoneal disease lessens. Brudzinski’s sign: Flex the neck, watch the hips and knees in reaction to the maneuver. A positive sign shows flexion of hips and knees, suggests meningeal inflammation. Boas’s sign: Right subscapular pain due to cholelithiasis, 3.0ng/mL. 31. B. The cortisol is released from the adrenal cortex in response to rising blood levels of ACTH. When the level of cortisol is high, fats and proteins are broken down by cells and converted to glucose, which is released into blood and leads to the metabolic disorder of carbohydrates, protein, and fats. It leads to insulin resistant and eventually development of diabetes. 32. D 33. A. The patient is supposedly diagnosed with appendicitis according to his symptoms. Rebound tenderness at the McBurney point is a positive McBurney’s sign; indicating appendicitis. The common symptoms and signs of cholecystitis are RUQ tenderness and frigidity, positive McMurphy sign, palpable gallbladder, anorexia, fever, vomiting, possible jaundice. If a click felt or heard at the joint line during flexion and extension of knee, or if tenderness is noted along the joint line, it is McMurray’s sign positive, which indicates a need to assess the meniscus for a posterior tear. Abdominal reflexes may be absent in both central and peripheral nervous system disorders. 34. B. The cause of the athlete’s pain is likely tennis elbow (lateral epicondylitis). Tennis elbow test: First stabilize the patient’s forearm and instruct him to make a fist and to extend his wrist. When the patient has done so, the doctor applies pressure with his other hand on the dorsum of the patient’s fist in an attempt to force his wrist into flexion. If he has tennis elbow, the patient will have a sudden severe pain on the site of the wrist extensors’ common origin, the lateral epicondyle. This indicates the patient has tennis elbow. Phalen’s sign: Let the patient hold both wrists in a fully palmar-flexed position with the dorsal surfaces pressed together for one minute. Paresthesia and

22

Biomedicine Module Test Prep Workbook

numbness in the distribution of the median nerve indicates carpal tunnel syndrome. Tinel’s sign: The sign is elicited by tapping with a finger over the carpal tunnel, this produces paresthesia in the hand and traveling up the arm, this indicates carpal tunnel syndrome. Thumb abduction test: Ask patient to place the palm up and raise the thumb perpendicular to it. Apply downward pressure on the thumb to test muscle strength. Weakness indicates carpal tunnel syndrome. 35. C. CT is an important part of staging and monitoring of many tumors before and after therapy. Treatment of tumors of the colon, rectum, hepatic system, breast, lung, prostate gland, ovaries, uterus, kidneys, lymph glands and adrenal gland commonly fails, and this can be detected early with CT. Laparoscopy is used to evaluate the pelvic and abdominal organs if they are suspected with masses. The indications of laparoscopy are pelvic or abdominal pain, suspected cancer, abdominal masses. Ultrasound is used to determine a lump or a fluid-filled cyst, or a solid tumor. Because it is painless and noninvasive, it is also used to evaluate pregnancy and placental status, to detect fetal status, size, and growth. The MRI is mostly used to diagnose the CNS, liver, bony spine, joints, and extremities, however, it is not used to diagnose the abdominal masses, because a contrast agent is needed for good visualization of abdominal organs. 36. C 37. A. Hypertrophy is a response to trophic signals or increased functional demands and is commonly a normal process. It is an increase in the size of a cell accompanied by an augmented functional capacity. For example, exercise or increased sex hormones can often lead to hypertrophy. Hyperplasia is increased number of cells in a tissue or an organ. Atrophy is decreased size and function of an organ or cell. Hypoplasia is reduced size due to the incomplete development of part or all of an organ. For example, microcephaly. Aplasia is a rudiment that never developed completely, or absence of an organ coupled with persistence of the organ anlage. 38. B. Testicular dysgenesis or Klinefelter syndrome, is a genetic abnormality of XXY karyotype that affects males resulting from an extra X chromosome. It becomes apparent at puberty with testes failing to mature and degenerative testicular changes. The individual tends to be tall and thin, with long legs, one Barr body on buccal smear, and is infertile. 39. D. Pneumonia is an infection of pulmonary parenchyma, which is caused by various viruses, bacterial species, mycoplasmas, fungi, rickettsiae, chlamydiae, and parasites. The patient, John has some characteristics of bacterial pneumonia. Example (1) susceptible factors: exposure to ill patients, season of the year, smoking status; (2) common symptoms of bacterial pneumonia acute onset, with fever and chills, dyspnea, productive cough, and chest pain. (3) X-ray shows consolidation of whole lobe of the lung, WBC count elevated. (4) Physical examination of most of the disease also shows that dull to percussion, egophony, rhonchi. The viral pneumonia also has (1) cough, dyspnea, fever, chills. (2) chest X-ray shows diffuse bilateral bronchopneumonia; WBC count normal to slightly elevated. (3) Weak persons and children easily suffer. 40. E. Pyogenic osteomyelitis is a pyogenic bone infection. It may be acute or chronic. Acute

Section 1

23

pyogenic osteomyelitis is caused by blood-borne spread from infection elsewhere, and often affecting children. But it may be a common complication of trauma or surgery in adults. Chronic pyogenic osteomyelitis is characterized by multiple draining sinus tracts and metastatic lesions. 41.B. Sterilization is the use of procedure which destroys all microbial life. 42. B. The patient could have lung cancer, pneumonia, pulmonary tuberculosis. In order to initially work his patient up, a chest X-ray has to be performed to see if there are infiltrates, effusions, mass lesions, or bronchiectasis. If the chest X-ray shows lung cancer, then a CT scan of the lung and bronchoscopy can be performed. If the chest X-ray shows bilateral upper lobe of tuberculosis, the sputum for acid-fast bacilli can be sent. A PPD skin test should be performed on all individuals suspected of having been exposed to tuberculosis. This test doesn’t inform us if it is active. A chest X-ray has to be performed first. Bronchoscopy with biopsy or culture is the gold standard for obtaining tissue samples in the lung to make the diagnosis of cancer, pneumonia, or tuberculosis. This test can be performed only after an initial chest X-ray is done to guide the bronchoscopist to the tissue sample site. 43. C. Prostate cancer is the most common male cancer in U.S.A. The incidence of prostate cancer is age-related. The American Cancer Society recommends that every man 40 years of age and older should have a rectal exam as part of his annual physical exam. Prostate cancer is diagnosed by biopsy. 44. B. The signs of excessive glucocorticoids are a moon face and the appearance of a buffalo hump of fat on the upper back. Other common and undesirable effects of excessive glucocorticoids include high blood pressure, hyperglycemia and possible diabetes, weakening of the bone, and severe depression of the immune system. In addition to the exophthalmos, enlargement of the thyroid gland are common signs of hyperthyroidism, the extreme overproduction of thyroxine results in a high basal metabolic rate, intolerance of heat, rapid heartbeat, weight loss, nervous and agitated behavior. Hirsutism is excessive growth of hair in women and children. Typically the adult male distribution pattern, possibly stem from a hereditary trait or endocrine abnormalities. 45. B. Hypothalamus produces CRH to stimulate anterior pituitary secrete ACTH. The posterior lobe of pituitary releases oxytoxin and antidiuretic hormone (ADH). The anterior lobe of pituitary produces growth hormone (GH), prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH). 46. E. Rotator cuff consists of four muscles that hold the head of humerus in the glenoid cavity: supraspinatus, infraspinatus, teres minor, and subscapularis. Drop arm test: patient standing, fully abducting the arm then slowly lower the arm. Positive test: arm suddenly drops to side at about 90° abduction or inability to hold the arm at 90° abduction with minimal downward force applied by the examiner. Empty can test evaluates the supraspinatus muscle: abducting the arm to 90°, and flexing forward 30°, and internally rotating so that the thumb points downward. Patient resists downward direct force. Internal rotation of the shoulder evaluates subscapularis, pectoralis

24

Biomedicine Module Test Prep Workbook

major, latissimus dorsi, and teres major muscles: shoulder neutral, and elbow flexed to 90°. Patient is asked to resist outward directed force. External rotation of the shoulder evaluates teres minor and infraspinatus. Patient is asked to resist inward directed force. Speed’s test examines the biceps tendonitis. This disorder is caused by inflammation or subluxation of the biceps tendon out of the intertubercular groove. Speed’s test is performed with the patient flexing the arm to 60° with elbow extended, and forearm in neutral position (thumbs up), and the examiner applies a downward force while the patient resists. The test is positive when pain is provoked or patient gives way. (Primary Care Essentials: Sports Medicine. Thomas Howard, et al.) 47. D. Bile salts emulsify fats by physically breaking large fat globules into smaller ones, thus providing more surface area for the fat-digesting enzymes to work on. 48. D. DNA, double-nucleotide stranded, is the genetic material found within the cell nucleus. It provides the instructions for building every protein in the body and replicates itself exactly before a cell divides, thus the genetic information in every body cell is identical. RNA is single nucleotide strand, three varieties of RNA exist: messenger, ribosomal, and transfer RNA. Messenger RNA carries the information for building the protein from DNA genes to the ribosomes, the protein-synthesizing sites. Ribosomal RNA forms part of the ribosomes. Transfer RNA ferries amino acids to the ribosomes. 49. D. Cirrhosis of the liver is a chronic liver disease, characterized by diffuse destruction and fibrotic regeneration of hepatic cells. Ascites, a common manifestation of cirrhosis of the liver, is caused by portal hypertension, renal retention of sodium and water. Other features of cirrhosis are pathologic development of collateral circulation, leading to caput medusae, esophageal varices, and hemorrhoids; splenomagaly; hepatic encephalopathy; impaired liver synthesis of albumin and clotting factors; decreased estrogen metabolism with concomitant gonadal atrophy, gynecomastia, and amenorrhea. There are no signs of degeneration of the cerebral cortex and gastric ulcers. Hemolytic anemia is not associated with cirrhosis. Dependent edema is related to insufficient albumin and general sodium retention in cirrhosis, but pulmonary edema is not characteristic. 50. D. Vitamin K can be synthesized by intestinal bacteria. Green leafy vegetables is a main dietary source of vitamin K. Vitamin A, vitamin C, vitamin E, niacin cannot be synthesized by intestine bacteria. Vitamin A is mainly in liver, eggs, whole milk and fish oils. Vitamin C mainly comes from fresh vegetables and fruits. Vitamin E from vegetable oils. Niacin from meat and nuts.

Test #2 – Place your answers on the appropriate line. The answer key appears at the end of the 50 questions in this test. After the answer key there is a section with the explanation for each correct answer.

1 ______

18 ______

35 ______

2 ______

19 ______

36 ______

3 ______

20 ______

37 ______

4 ______

21 ______

38 ______

5 ______

22 ______

39 ______

6 ______

23 ______

40 ______

7 ______

24 ______

41 ______

8 ______

25 ______

42 ______

9 ______

26 ______

43 ______

10 ______

27 ______

44 ______

11 ______

28 ______

45 ______

12 ______

29 ______

46 ______

13 ______

30 ______

47 ______

14 ______

31 ______

48 ______

15 ______

32 ______

49 ______

16 ______

33 ______

50 ______

17 ______

34 ______

✃

TEST #2 SCORE - ___________ / 50 = ________% correct # of correct answers

Section 2 1. The incubation period of hepatitis B is: A. From 3 days to 6 weeks B. From 3 hours to 6 days C. From 3 months to 6 years D. From 3 weeks to 6 months

2. What is an autogenous infection? A. Autogenous infection is caused by pathogens that the patient is already carrying. B. Autogenous infection is caused by eating unclean food. C. Autogenous infection is acquired from another person. D. Autogenous infection is caused by eating unclear food.

3. What is the name of the gap between the muscle cells’ membrane and the nerve ending? A. postsynapsis membrane B. synaptic cleft C. synaptic membrane D. axon

4. Which of the following is NOT a characteristic result of sympathetic stimulation? A. dry mouth B. profuse sweating C. hypertension D. slowing of the heart

27

28

Biomedicine Module Test Prep Workbook

5. Which of the following is NOT the manifestation or laboratory finding for Graves’ disease? A. weight loss B. increased sweating C. increased metabolic rate D. increased TSH

6. Which hormone acts on a receptor in the nucleus to form hormone-receptor complex, and then changes the function of DNA and RNA that leads to a new protein production? A. glucocorticoids B. insulin C. epinephrine D. thyroxin

7. The main causes of death in the United States across age groups in descending order are: A. heart disease, COPD, cancer B. cancer, heart disease, stroke C. heart disease, cancer, stroke D. AIDS, cancer, heart disease

8. If a physician is HIV-positive, he must: A. practice universal precautions B. tell all his coworkers C. tell his patients D. quit his job

9. All of the following organisms are involved in urinary tract infections EXCEPT: A. escherichia coli B. proteus mirabilis C. klebsiella pneumoniae D. mycoplasma pneumoniae

Section 2

29

10. Three organisms: Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitides cause in common which of the following disorders? A. meningitis B. diarrhea C. urinary tract infection D. skin infection

11. A patient with a history of hyperthyroidism would most likely present with which of the following laboratory test results? A. increased thyroxin B. increased TSH C. increased ACTH D. decreased FSH

12. Ms. Randy suddenly fell on the floor in the waiting room. She has a pulse but no respiration. You should first: A. open her mouth B. give the patient rescue breaths C. call 911 D. sweep the oral cavity

13. A 46-year-old patient complains about a pressure-like episodic precordial chest pain, which is precipitated by exertion and/or stress, relieved by rest or a sublingual medication that he forgot the name of. He has smoked 1 pack of cigarettes per day for the past 20 years, but rarely does physical exercise. He enjoys eating fried food and grilled beef, and hates fruits and vegetables. His father died in his forties of a “heart problem”, while his mother is still alive but has “high blood sugar”. What is the most likely diagnosis? A. myocardial infarction B. peptic ulcer disease C. pneumothorax D. gastroesophageal reflux disease E. angina Pectoris

30

Biomedicine Module Test Prep Workbook

14. A 23-year-old female patient has drooping of the corner of the mouth, with loss of skin creases and folds, her eye can’t close and attempts to close it results in it rolling upwards. This is likely a disorder of the: A. trigeminal nerve B. oculomotor nerve C. facial nerve D. hypoglossal nerve

15. If a patient has a Babinski’s sign, it indicates: A. sciatica B. pyramidal tract disease C. meningeal irritation D. hernia

16. Flex the patient’s leg at both hip and knee, and then straighten the knee; positive sign shows increased resistance to extending knee with pain and suggest meningeal irritation. This sign is: A. Carvallo’s sign B. Chvostek’s sign C. Cullen’s sign D. Kernig’s sign

17. A 35-year-old woman, with a new pregnancy complains of headache. Her blood pressure is 146/94 mmHg. Proteinuria 500mg/24 hours. She has no history of hypertension before pregnancy. Her disease is mostly: A. essential hypertension B. pre-eclampsia C. nephrotic syndrome D. acute renal failure

Section 2

31

18. This maneuver exhibits pain upon internal rotation of the leg with the hip and knee flexed; seen in appendicitis, pelvic abscess. This sign is: A. Obturator sign B. Ortolani’s sign C. Patrick sign D. Phalen’s maneuver

19. A postmenopausal woman that has mentrorrhagia for a long time most likely has a deficiency of: A. calcium B. zinc C. magnesium D. iron

20. Smoking is known to be a risk factor for the increased incidence of all the following EXCEPT: A. peptic ulcer B. emphysema C. ectopic pregnancy D. cervical cancer E. carcinoma of the bladder

21. Which of the following is NOT the side effect of aluminum containing antacids? A. muscle weakness B. obstruction urination C. loss of appetite D. softened bones

22. Angiography is used for all of the following EXCEPT: A. Helping to visualize blood-flow dynamics and determine vascular anomalies. B. Helping to evaluate occlusions in the brain. C. Helping to evaluate suspected neoplasms. D. Helping to visualize the muscles.

32

Biomedicine Module Test Prep Workbook

23. You are treating a patient with disharmony between the liver and stomach. A point two cun proximal to the wrist crease between the tendons of muscle palmaris longus and muscle flexor radialis was chosen. Your quick and deep puncturing caused sharp pain that spread to the second and third fingers. Which structure can be damaged? A. radial nerve B. axillary nerve C. ulnar nerve D. median nerve

24. If a patient complains of acute abdominal pain, which of the following Lab test should you first choose? A. creatine B. X-ray of lung C. blood urea nitrogen D. amylase test

25. In regard to the sternocleidomastoid muscle (SCM), all of the following are correct EXCEPT: A. The right SCM muscle rotates the head to the right side. B. When SCM muscles on both sides contract simultaneously, the neck flexes. C. Acupuncture point GB 12 is located posterior and inferior to the insertion point of this muscle. D.This muscle has two origins.

26. You are seeing a 30-year-old female college student for the first time. She presented to you with a cough of 2 weeks. Which of the following is the LEAST useful question to ask? A. History of hypertension and the type of medication she is taking. B. History of similar cough in the past. C. Classmate or close friend with similar problem. D. History of substance abuse or promiscuity. E. History of diabetes.

Section 2

33

27. Which of the following has the purpose of assessing a chronic alcoholic patient by performing heel-to-shin test, and evaluating gait and balance? A. cerebellar function B. sensory system C. muscle tone D. muscle strength

28. A patient has chronic obstructive pulmonary disease (COPD) with increased level of CO2 content, which mostly indicates: A. respiratory acidosis B. metabolic acidosis C. respiratory alkalosis D. diabetic ketoacidosis

29. When assessing the range-of-motion of the shoulder joint, one expects to find all of the following as normal EXCEPT: A. Shrug shoulders—symmetric rising on both sides B. Forward flexion—180 degrees C. Hyperextension—50 degrees D.Abduction—90 degrees E. Adduction—50 degrees F. Internal rotation—90 degrees G.External rotation—90 degrees

30. The ESR (erythrocyte sedimentation rate) can be elevated in all of the following EXCEPT: A. all collagen diseases B. erythrocytosis C. rheumatoid arthritis D. tuberculosis

34

Biomedicine Module Test Prep Workbook

31. In the Urinaylis test which urine constituent is associated with gallstone? A. urobilinogen B. bilirubin C. nitrites D. ketones

32. This bone is located above the Adam’s apple (thyroid cartilage). It does not articulate with any other bone. This bone is suspended by muscles, and moves with speech and swallowing. This bone is the: A. nasal bone B. clavicle C. hyoid bone D. mandible

33. If a patient’s PSA levels are elevated, it suggests the disorder of the: A. prostate B. breasts C. kidneys D. lungs

34. The inferior angle of the scapula correspond to the level of: A. T7 B. T8 C. T9 D. T10

35. Which of the following is the best test to diagnose a disease of the rectum? A. endoscopy B. hysterscopy C. cystoscopy D. sigmoidscopy

Section 2

35

36. This is the longest vein of the body, often used as surgical bypass for coronary artery obstructions. This vein is: A. vena saphena magnus B. inferior vena cava C. renal D. superior vena cava

37. Which of the following is LEAST LIKELY to be associated with delayed repair after acute inflammation? A. advanced age B. ascorbic acid deficiency C. diabetes mellitus D. protein deficiency

38. An increased incidence of atherosclerosis has been correlated with all of the following associations EXCEPT: A. hypotension B. diabetes mellitus C. hyperuricemia D. decreased serum high-density lipoprotein (HDL) concentration E. use of oral contraceptives

39. Predisposing or aggravating factors that may lead to gastroesophageal reflux include all of the following EXCEPT: A. hiatal hernia B. pernicious anemia C. pregnancy D. fatty food E. lying down soon after eating

36

Biomedicine Module Test Prep Workbook

40. All of the following characteristics are associated with rheumatoid arthritis EXCEPT: A. serum anti-IgG antibodies B. subcutaneuous rheumatoid nodules C. fatigue, malaise, anorexia, weight loss, fever, and myalgia D. symmetric polyarthritis E. formation of osteophyte

41. The Center for Disease Control Prevention recommends that practitioners who work in an inner city clinic with AIDS and drug addicts should have a PPD test for tuberculosis every: A. three months B. six months C. one year D. two years

42. CPR for infants is: A. 1 breath and 5 compressions B. 2 breaths and 5 compressions C. 3 breaths and 5 compressions D. 4 breaths and 5 compressions

43. Which of the following cells in AIDS should be low? A. red blood cell B. eosinophil C. CD4 D. CD8

44. A patient presents with macrocytic anemia, and a known history of peripheral neuropathy, he may have deficiency of: A. folic acid B. B1 (thiamine) C. B12 D. iron

Section 2

37

45. On washing hands, all of the following are correct EXCEPT: A. Washing hands should be performed before and after each patient contact. B. Wash hands when gloves are removed as soon as possible after contact with blood or other potentially infectious materials. C. Wash hands for at least ten seconds with soap running under water prior to patient contact. D. Adequate hand washing will sterilize the skin.

46. All of the following can be expected when you are assessing the straight-leg raise test on a patient with possible sciatica EXCEPT: A. Worsening of the lower-extremity pain or paresthesia on the side being examined. B. Ameliorating of the lower-extremity pain or paresthesia on the side being examined. C. Pain occurs down the opposite leg. D. Pain in the posterior part of the thigh.

47. This pair of cranial nerves control the sternocleidomastoid and trapezius muscles. What are these cranial nerves? A. oculomotor B. glossopharyngeal C. abducens D. accessory

48. This nerve is the largest in the body. It splits to common peroneal and tibial nerves. It is: A. sciatic nerve B. femoral nerve C. obturator nerve D. median nerve

49. All of the following clinical manifestations are characteristic of patients with SLE EXCEPT: A. scarring B. arthralgias and myalgias C. butterfly rash D. proteinuria E. headache

38

Biomedicine Module Test Prep Workbook

50. Which of the following is an organelle of bacteria? A. Golgi’s apparatus B. endoplasmic reticulum C. mitochondrion D. ribosome

Test #2 – Answers

1. D

18. A

35. D

2. A

19. D

36. A

3. B

20. C

37. A

4. D

21. B

38. A

5. D

22. D

39. B

6. A

23. D

40. E

7. C

24. D

41. B

8. A

25. A

42. A

9. D

26. E

43. C

10. A

27. A

44. C

11. B

28. A

45. D

12. C

29. D

46. B

13. E

30. B

47. D

14. C

31. B

48. A

15. B

32. C

49. A

16. D

33. D

50. D

17. B

34. A

Answers & Explanations 1. D. The incubation period of hepatitis B is 50 to 180 days. The incubation period of hepatitis A is 15 to 45 days. The incubation period of hepatitis C is 20 to 90 days. The incubation period of hepatitis E is 30 to 40 days. 2. A. Autogenous infections are caused by pathogens that the patient is already carrying. Crossinfection is acquired from another person. 3. B. The gap between the muscle cells’ membrane and the nerve ending is called the synaptic cleft. Neuron processes that generate nerve impulses and typically conduct them away from the cell body are axons. Each neuron has only one axon, although a neuron may have hundreds of the branching tree. 4. D. A characteristic result of parasympathetic stimulation is decrease of heart rate, no effect on the sweat glands of the skin and most blood vessels, and increased secretion by the digestive system glands. 5. D. Graves’ disease is due to extreme overproduction of thyroxine and results in a high basal metabolic rate, intolerance of heat, rapid heart rate, weight loss, nervous and agitated behavior. Graves’ disease is one form of hyperthyroidism. Hyposecretion of thyroxine may reflect problems other than iodine deficiency, such as lack of TH stimulation. 6. A. The steroid hormones can diffuse through the plasma membranes of their target cells. Inside of the cells, the hormone enters the nucleus, and binds to a specific protein there. Then, the hormone receptor binds to specific sites on the cell’s DNA, and activates certain genes to transcribe messenger RNA (mRNA). The mRNA is translated in the cytoplasm, which causes the synthesis of new proteins. 7. C. The leading causes of death in the United States across age-groups in descending order are heart disease, cancer, stroke. 8. A. A physician or other health care worker is not obligated to tell everyone about his condition, but he is under obligation to protect others from exposure by using universal precautions, as should all health care workers. 9. D. Mycoplasma pneumoniae causes “atypical” pneumonia. Escherichia coli causes UTI (urinary tract infection), “traveler’s diarrhea”, and meningitis. Proteus are gram-negative rods that cause urinary tract infections, both community- and hospital-acquired. Klebsiella are gramnegative rods that cause urinary tract infections and pneumonia. (Medical Microbiology & Immunology. Appleton & Lange.) 10. A. These three organisms cause the vast majority of cases of bacterial meningitis. (Medical Microbiology & Immunology. Appleton & Lange.)

42

Biomedicine Module Test Prep Workbook

11. B. Thyroxin levels would be increased, while TSH decreases or becomes absent due to negative feedback inhibition on pituitary gland by increased thyroxin. Increased ACTH is associated with Cushing’s disease. Underproduction of FSH by any cause would cause gonadal insufficiency. 12. C 13. E. Angina pectoris results from a deficiency of oxygen and nutrients to myocardial tissue due to the decreased coronary blood flow. The disease commonly occurs in middle-aged and elderly people. The risk factors of the disease are family history, hypertension, stress, a sedentary lifestyle, obesity, smoking, high serum cholesterol and triglyceride level. The patient has frequent and lasting angina. During angina, ECG of the patient may show ischemia. Because of the risks and manifestations of the patient, the most likely diagnosis is angina pectoris. Myocardial infarction (MI) is reduced blood flow through one of the coronary arteries leading to myocardial ischemia and necrosis. The risk factors of MI are similar to angina pectoris. The major signs and symptoms are persistent, crushing substernal pain that may radiate to the left arm, jam neck or shoulder blades. ST-segment changes on the EKG, elevated levels of total creatine kinase (CK) and CKMB isoenzyme over a 72-hour period usually confirm MI. Ausculatation may show diminished heart sounds, gallops and, in papillary dysfunction, the apical systolic murmur of mitral insufficiency over the mitral valve area. Peptic ulcer disease is the normal defense mechanism of gastric or duodenal mucosa overwhelmed or impaired by pepsin or acid, which is manifested by burning epigastric pain exacerbated by fasting and improved with meals. Barium meal and endoscopy studies are used as tests for documenting the ulcer or H. pylori. Pneumothorax is air that enters the chest but can’t be ejected during exhaling, which is manifested by acute pain of the chest, shortness of breath, cough, cyanosis, and X-ray documents the lung collapse. Gastroesophageal reflux disease is the backflow or reflux of gastric and duodenal contents into the esophagus and past the lower esophageal sphincter. Manifestations are major heartburn, which may become more severe 30 to 60 minutes after meals. Endoscopy and a biopsy allow visualization and confirmation of pathologic changes in the mucosa. 14. C. The patient has drooping of the corner of the mouth, with loss of skin creases and folds, her eye can’t close and attempts to close it result in it rolling upwards. All of these symptoms are called Bell’s phenomenon. It indicates she has Bell’s palsy, that is the most common cause of infranuclear paralysis of the facial nerve. Lesions of the trigeminal nerve lead to loss of sensation in the skin of the face and crown of the head, the conjunctivae and the nasopharynx. Trigeminal neuralgia is a disease of unknown origin that manifested with excruciating paroxysms of stabbing pain over the distribution of the trigeminal nerve. The manifestations of oculomotor nerve lesions are ptosis, eyeball is rotated downwards and outwards, and the pupil is dilated and fixed. The hypoglossal nerve is wholly motor, supplying the tongue and the depressors of the hyoid bone. Lesions of this nerve result in unilateral paralysis, wasting and fasciculation of the tongue, which is pushed over to the paralyzed side when protruded. 15. B. Babinski’s sign is present when there is dorsiflexion of the great toe with or without fanning of the other toes. This is an expected response in children under 2 years of age, but it indi-

Section 2

43

cates a central nervous system lesion in the corticospinal tract. The ticklish patient may respond with some degree of Babinski sign, but this can be avoided with a firm touch. The Brudzinski sign and Kernig sign indicate meningeal irritation. Lasegue sign is positive when a patient is unable to raise the leg more than 30˚ without pain and indicates sciatica. 16. D. Kernig sign: Flex patient’s leg at both hip and knee, and then straighten the knee; positive sign is pain and increased resistance to extending knee and suggests meningeal irritation. Carvallo’s sign: In tricuspid regurgitation, murmur increases with inspiration. Chvostek’s sign: Hypocalcemia, in latent tetany, tapping the facial nerve against the bone just anterior to the ear producing ipsilateral contraction of facial muscles. Cullen’s sign: A faintly blue coloration particularly of the umbilicus as the result of retroperitoneal bleeding from any cause, but especially in ruptured ectopic pregnancy; also seen in acute pancreatitis (1-2%). 17. B. Toxemia of pregnancy, or pregnancy-induced hypertension (PIH), usually develops late in the second trimester or in the third trimester. Preeclampsia, the nonconvulsive form of toxemia, develops in about 7% of pregnancies. The mild pre-eclampsia generally produces hypertension, proteinuria, generalized edema. An intermittent or a sustained elevation in diastolic or systolic blood pressure, hypertension occurs as two major types: essential hypertension, the most common, and secondary hypertension, which results from kidney disease or another identifiable cause. Essential hypertension is a major cause of cerebrovascular accident (CVA), heart disease, and renal failure. Nephrotic syndrome (NS) is characterized by marked proteinuria, hypoalbuminemia, hyperlipemia, and edema. It results from a specific glomerular defect and indicates renal damage. Obstruction, reduced circulation, and renal parechymal disease can all cause the sudden interruption of kidney function. Acute renal failure is usually reversible with medical treatment. Its early signs are oliguria, azotemia and, rarely anuria. 18. A. Obturator sign: Pain upon internal rotation of the leg with the hip and knee flexed; seen in appendicitis, pelvic abscess. Ortolani’s sign: In congenital hip dislocation, rotate hip with patient in supine position and hip abducted; a “clunk” or “click” represents congenitally dislocated hip. Patrick’s sign: Hip pain on external rotation of the hip in hip joint disease that may refer pain to the back and thighs. Phalen’s maneuver: Median nerve compression, palmar flexion of the wrist for 1 minute exacerbates or reproduces symptoms; 75% sens, 47% spec. Rovsing’s sign: Pain in the right lower quadrant during left-sided pressure suggests appendicitis; so does right lower quadrant pain on quick withdrawal. 19. D. Mentrorrhagia for a long time easily causes anemia, which leads to iron deficiency anemia. 20. C. Besides causing lung cancer and COPD (chronic bronchitis and emphysema), cigarette smoking also increases risks of atherosclerosis, myocardial infarction, cervical cancer, peptic ulcer and cancers of the larynx, esophagus, kidney, pancreas and bladder. 21. B. The side effects of aluminum containing antacids are muscle weakness, loss of appetite and softened bones.

44

Biomedicine Module Test Prep Workbook

22. D. It is used to evaluate and visualize arterial blood-flow dynamics, determine vascular anomalies, evaluate occlusions in the brain and evaluate suspected neoplasms. 23. D 24. D. Acute abdominal pain is the main symptom of pancreatitis. Amylase is formed in the pancreas and salivary glands. When there is a inflammation of the pancreas or salivary glands, much amylase enters the blood. The amylase test is used to diagnose acute pancreatitis. The creatine and blood urea nitrogen tests are used to evaluate kidney function. 25. A. 26. E. ACE inhibitors such as captopril may cause cough as a side effect. Similar cough in the past can help in diagnosis of diseases like asthma. In a closed environment, upper respiratory infection may easily transmit. A history of substance abuse or promiscuity, in the presence of signs and symptoms such as wasting and monilia, may suggest HIV infection. Opportunistic infections of the lung may happen in this scenario. 27. A. Alcoholism can cause cerebellar degeneration. Ataxia of stance and gait evolves over weeks or months, but can appear acutely. The tests mentioned in the question evaluate cerebellar function. There are some other tests for this purpose: finger-to-finger test, finger-to-nose test, Romberg test, walking, straight-line walking, etc. (Mosby’s Physical Examination Handbook. Merck Manual, 17th ed.) 28. A. The increased levels of CO2 content suggests severe vomiting, high volume gastric suction, aldosteronism, use of mercurial diuretics, metabolic alkalosis, and COPD with respiratory acidosis. The decreased level of CO2 content indicates chronic diarrhea, chronic use of loop diuretics, persistent loss of base ions, renal failure, diabetic ketoacidosis, starvation. 29. D. Abduction can reach 180 degrees. (Mosby’s Physical Examination Handbook.) 30. B. ESR is used to monitor the progression of inflammatory diseases. The level of ESR in the conditions, such as all collagen diseases, rheumatoid arthritis, and tuberculosis is increased. 31. B. The elevated urine bilirubin concentration can indicate unsuspected liver injury due to disease, gallstones, or drug toxicity. 32. C 33. D. Prostate specific antigen (PSA) is a method for early detection of prostate cancer. 34. A

Section 2

45

35. D. Sigmoidscopy is used to evaluate the pathologic conditions of rectum and sigmoid. Endoscopy is a general term referring to the inspection of the internal organs and cavities by using endoscopy. Cystoscopy is used to evaluate pathologic conditions of lower ureters, urethra, bladder. Hysterscopy is used to evaluate women with an abnormal Papanicolaou smear, dysfunctional uterine bleeding, or postmenopausal bleeding. 36. A. Vena saphena magnus is a superficial and the longest vein in the body that runs a medial course ascending the legs and thighs. 37. A. Advanced age, ascorbic acid deficiency, diabetes mellitus, and protein deficiency effect the repair after acute inflammation. But the advanced age is the least likely one. 38. A. There are four major acquired risk factors that are correlative with atherosclerosis: (1) hyperlipidemia, (2) hypertension, (3) cigarette smoking, and (4) diabetes mellitus. There are also soft risk factors, such as insufficient physical activity, stress, obesity, the use of oral contraceptives, hyperuicemia, high carbohydrate intake and hyperhomocysteimia. 39. B. The gastroesophageal reflux refers to backflow or reflux of gastric and duodenal contents into the esophagus and past the lower esophageal sphincter (LES), without associated belching or vomiting with any agent that lowers LES pressure, such as fatty food, cigarettes, alcohol, hiatal hernia, pregnancy, lying down soon after eating. 40. E. Rheumatoid arthritis is a chronic, systemic inflammatory polyarthritis. RA primarily damages peripheral joints, surrounding muscles, tendons, ligaments, and blood vessels. The causes of RA isn’t known. It possibly belongs to a heterogeneous group of disorders. One theory states that abnormal immune activation results in inflammation, cell proliferation and complement activation within synovium, where they produce immunoglobulins, mainly of IgG. The prognosis worsens with the development of subcutaneuous rheumatoid nodules. The clinical manifestations and signs are: symmetric polyarthritis, fatigue, malaise, anorexia, weight loss, fever, and myalgia, positive of rheumatoid factor. 41. B. The Center for Disease Control Prevention recommends that practitioners who work in an inner city clinic with AIDS and drug addicts should have a PPD test for tuberculosis every six months. 42. A. CPR for infants is 1 breath and 5 compressions. CPR for adult is 2 breaths and 15 compressions. 43. C. After HIV infection, the HIV targets the CD4 (T4) lymphocytes reproductive system that eventually destroys the cell. Once the immune deficit reaches a certain stage, the body can’t recover. Since the CD4 lymphocyte plays a crucial role in regulation of all parts of the immune system, its depletion due to HIV infection impacts all aspects of the immune response. So CD4 should be low in AIDS. Eosinophils respond to allergic and parasitic diseases. When patients suffer from allergic and parasitic diseases, eosinophils will be increased.

46

Biomedicine Module Test Prep Workbook

44. C. Vitamin B12 serves as a cofactor for several essential biochemical reactions in humans. Deficiency of vitamin B12 leads to macrocytic anemia, gastrointestinal symptoms, and peripheral neuropathy. Deficiency of folic acid leads to megaloblastic anemia but no peripheral neuropathy. Deficiency of vitamin B1 leads to beriberi. Deficiency of iron leads to microcytic hypochromic anemia. 45. D. Adequate hand washing will not sterilize the skin, but it can remove surface germs from the epidermal layer of the skin. 46. B. Symptoms of sciatica aggravate with straight-leg raise test. When pain occurs down the opposite leg (crossed response), sciatica is highly suggested. Pain in the posterior part of the thigh can be caused by tightness of the hamstrings. 47. D 48. A 49. A. SLE is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. SLE may involve multi-organs or only one organ. The musculoskeletal manifestations are arthralgias and myalgias. The malar (butterfly) rash is common cutaneous manifestations, scarring is absent. Most patients with SLE have immunoglobulins deposited in glomeruli. The urinalysis shows proteinuria, hematuria, and cylindruria. The SLE also results in damage to the vascular, cardiopulmonary, gastrointestinal systems. 50. D. Bacteria only has ribosome, it doesn’t have Golgi’s body, endoplasmic reticulum, mitochondrion.

Test #3 – Place your answers on the appropriate line. The answer key appears at the end of the 50 questions in this test. After the answer key there is a section with the explanation for each correct answer.

1 ______

18 ______

35 ______

2 ______

19 ______

36 ______

3 ______

20 ______

37 ______

4 ______

21 ______

38 ______

5 ______

22 ______

39 ______

6 ______

23 ______

40 ______

7 ______

24 ______

41 ______

8 ______

25 ______

42 ______

9 ______

26 ______

43 ______

10 ______

27 ______

44 ______

11 ______

28 ______

45 ______

12 ______

29 ______

46 ______

13 ______

30 ______

47 ______

14 ______

31 ______

48 ______

15 ______

32 ______

49 ______

16 ______

33 ______

50 ______

17 ______

34 ______

✃

TEST #3 SCORE - ___________ / 50 = ________% correct # of correct answers

Section 3 1. The primary means of transmission of AIDS is by the blood of AIDS carrierS or: A. a toilet seat used by AIDS carrier B. the hands of an AIDS carrier C. sexual contact D. saliva from an AIDS carrier

2. Infection is the entry into the body of: A. large T cells B. antibodies and phagocytes C. environmental poisons D. foreign micro-organisms

3. The total volume of urine of a normal adult per day is about A. 150ml B. 1,500ml C. 15,000ml D. 3 liters

4. The stroke volume means: A. The volume of blood pumped out by a ventricle with each heartbeat. B. The volume of blood pumped out by a ventricle in 1 minute. C. The volume of blood pumped out by both ventricles with each heartbeat. D. The volume of blood pumped out by both ventricles in 1 minute.

49

50

Biomedicine Module Test Prep Workbook

5. A 33-year-old female patient with a rapid heart rate, weight loss, high basal metabolic rate, intolerance of heat, nervous and agitated behavior. The female patient most likely has: A. Addison’s disease B. Graves’ disease C. Cushing’s disease D. cretinism

6. If patient has lobar pneumonia, you expect that his total white blood cell count would be closest to: A. 500/mm3 B. 20,000/mm3 C. 100,000/mm3 D. 200,000/mm3

7. Headache associated with a brain tumor is most common in which clinical setting? A. after eating breakfast B. after eating lunch C. after eating dinner D. upon awakening in the morning

8. Which of the following examination results is a criterion for fasting glucose? A. symptoms of diabetes plus casual plasma glucose ≥200mg/dL B. fasting plasma glucose ≥126mg/dL C. fasting plasma glucose