NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma need to rule out what? - correct answer chronic subdural hematoma
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma and it is neurologically severe and progressing, who do you refer out to? -
correct answer refer to emergency department (ED)
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma, when do you call 911? - correct answer cardiopulmonary concerns -
changes in BP, changes in pulse, S.O.B. or chest pain
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma but neurological changes are not severe or less severe and no
cardiopulmonary concerns, who do you refer out to? - correct answer refer to PCP semi-urgent
basis
Chronic Subdural Hematoma in Elderly (S/S) - correct answer slow onset of symptoms/signs
over days, weeks, or months and may be after minor head trauma
confusion
slurred speech
difficulty balancing and walking
headache
lethargy
What can chronic subdural hematoma be mistaken for, that an elderly patient may already be
diagnosed with? - correct answer dementia
What is a key sign that a chronic subdural hematoma is present and it is not just the patient's
dementia? - correct answer a faster than normal decline in mental function
What physical exam(s) may be used for an elderly patient with increasing confusion for days,
weeks or months after minor head trauma? - correct answer mental status exam or mini-
mental health screening exam (MMSE)
MMSE - correct answer mini-mental health screening exam
Risk factors for chronic subdural hematoma - correct answer anticoagulant medication (blood
thinners, aspirin)'
long term alcohol abuse
recurrent falls
repeated head injuries
,NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
elderly age
If a patient presents with severe dizziness immediately after standing up, what condition do you
want to rule out? - correct answer severe orthostatic hypotension
Consequences that may occur if a patient has severe dizziness immediately after standing up -
correct answer possible syncope and falling, especially in elderly, causing fractures and possibly
death
If a patient presents with severe dizziness immediately after standing up, who should you refer
out to? (orthostatic dizziness) - correct answer refer to PCP for possible adjustment of
medications and/or diagnostic workup to determine cause of the condition
Physical exam(s) for orthostatic hypotension - correct answer repeated blood pressure readings
Potential causes of orthostatic hypotension - correct answer simple dehydration
overmedication with antihypertensive medicine
more complex dysfunctions of the cardiovascular, neurological, endocrine, or renal systems
Additional sign(s)/symptom(s) that may point to orthostatic hypotension - correct answer
varying dizziness (not just from rising) with underlying cause of hypotension
Risk factors for orthostatic hypotension - correct answer age 65 years or older
medications
cardiovascular, neurological, renal, and/or endocrine problems
heat exposure & dehydration
bed rest
crossing legs at the knees for prolonged periods of time
pregnancy
malnutrition
debilitation
Medications that can be risk factors for orthostatic hypotension - correct answer diuretics
(Furosemide - Lasix)
beta-blockers
anti-Parkinson's drugs
tricyclic antidepressants
,NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
sildenafil (Viagra)
If a patient has orthostatic hypotension, how should acupuncture treatment be performed? -
correct answer patient lying down in a stable position plus careful monitoring for syncope upon
arising after treatment
If an elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity, what condition do you want to rule
out? - correct answer sick sinus syndrome (SSS)
Consequences of sick sinus syndrome (SSS) in elderly if untreated - correct answer debility,
falling (resulting in fractures, head/brain injuries, etc.), possible death
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They are not presenting with S.O.B.
You suspect SSS and refer them out to their PCP. What can you not let the patient do? - correct
answer patient cannot drive themselves to their PCP
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They do not present with S.O.B. What
do you do? - correct answer refer out to PCP on timely basis
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They also present with S.O.B. What
do you do? - correct answer refer out on a semi-urgent basis (urgent care or immediate referral
to PCP aka same day)
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They also present with severe S.O.B.
while resting, chest pain, falling blood pressure, and/or syncope. What do you do? - correct
answer call 911
Sick Sinus Syndrome (SSS) (S/S) - correct answer fatigue, weakness, dizziness especially with
exertion
S.O.B.
chest pain
near-syncope or syncope
Physical Exam for sick sinus syndrome (SSS) - correct answer check pulse rate (below 60 bpm)
An adult or child patient presents with inattention and/or hyperactivity that is severely
interfering with daily functions. What condition needs to be ruled out? - correct answer
attention deficit hyperactivity disorder (ADHD)
, NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
Consequences of ADHD being left untreated - correct answer increased risk of:
bipolar
conduct disorders
oppositional-defiance disorders
impaired self-esteem & self-confidence
decreased performance at school and/or work
social isolation & dysfunction
depression
possible death from substance abuse & risk-taking behaviors
A patient presents with inattention and/or hyperactivity that is severely interfering with daily
functions. Who should you do? - correct answer refer out on a timely basis to expert or group
of experts in ADHD (skilled acupuncturist, family physician, psychologist, psychiatrist, dietician
and/or neurologist)
ADHD (S/S) - correct answer difficulty focusing on and finishing projects at school or work
struggling with academic and/or occupational performance
patient may appear dreamy/unfocused
patient may bounce their leg, fidget, shift positions frequently
Physical Exam for ADHD - correct answer self-scoring ADHD questionnaire
A previously healthy adult presents with sudden unconsciousness followed by severe
drowsiness. What condition should be ruled out? - correct answer seizures
Consequences of seizures being left untreated - correct answer disability and possible death
A previously healthy adult presents with sudden unconsciousness in your clinic followed by
severe drowsiness. The patient seems fully recovered from the lack of consciousness and is
stable. What should you do? - correct answer refer to PCP on semi-urgent basis but if no PCP is
available then refer to urgent care
Patients with the new onset of a seizure disorder will often present with - correct answer
unawareness of seizure acitivity but will report "postictal" or post-seizure state
Symptoms of post-seizure ("postictal") state - correct answer extreme fatigue
drowsiness
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma need to rule out what? - correct answer chronic subdural hematoma
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma and it is neurologically severe and progressing, who do you refer out to? -
correct answer refer to emergency department (ED)
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma, when do you call 911? - correct answer cardiopulmonary concerns -
changes in BP, changes in pulse, S.O.B. or chest pain
If an elderly patient walks in with increasing confusion after days, weeks, or even months after
a minor head trauma but neurological changes are not severe or less severe and no
cardiopulmonary concerns, who do you refer out to? - correct answer refer to PCP semi-urgent
basis
Chronic Subdural Hematoma in Elderly (S/S) - correct answer slow onset of symptoms/signs
over days, weeks, or months and may be after minor head trauma
confusion
slurred speech
difficulty balancing and walking
headache
lethargy
What can chronic subdural hematoma be mistaken for, that an elderly patient may already be
diagnosed with? - correct answer dementia
What is a key sign that a chronic subdural hematoma is present and it is not just the patient's
dementia? - correct answer a faster than normal decline in mental function
What physical exam(s) may be used for an elderly patient with increasing confusion for days,
weeks or months after minor head trauma? - correct answer mental status exam or mini-
mental health screening exam (MMSE)
MMSE - correct answer mini-mental health screening exam
Risk factors for chronic subdural hematoma - correct answer anticoagulant medication (blood
thinners, aspirin)'
long term alcohol abuse
recurrent falls
repeated head injuries
,NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
elderly age
If a patient presents with severe dizziness immediately after standing up, what condition do you
want to rule out? - correct answer severe orthostatic hypotension
Consequences that may occur if a patient has severe dizziness immediately after standing up -
correct answer possible syncope and falling, especially in elderly, causing fractures and possibly
death
If a patient presents with severe dizziness immediately after standing up, who should you refer
out to? (orthostatic dizziness) - correct answer refer to PCP for possible adjustment of
medications and/or diagnostic workup to determine cause of the condition
Physical exam(s) for orthostatic hypotension - correct answer repeated blood pressure readings
Potential causes of orthostatic hypotension - correct answer simple dehydration
overmedication with antihypertensive medicine
more complex dysfunctions of the cardiovascular, neurological, endocrine, or renal systems
Additional sign(s)/symptom(s) that may point to orthostatic hypotension - correct answer
varying dizziness (not just from rising) with underlying cause of hypotension
Risk factors for orthostatic hypotension - correct answer age 65 years or older
medications
cardiovascular, neurological, renal, and/or endocrine problems
heat exposure & dehydration
bed rest
crossing legs at the knees for prolonged periods of time
pregnancy
malnutrition
debilitation
Medications that can be risk factors for orthostatic hypotension - correct answer diuretics
(Furosemide - Lasix)
beta-blockers
anti-Parkinson's drugs
tricyclic antidepressants
,NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
sildenafil (Viagra)
If a patient has orthostatic hypotension, how should acupuncture treatment be performed? -
correct answer patient lying down in a stable position plus careful monitoring for syncope upon
arising after treatment
If an elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity, what condition do you want to rule
out? - correct answer sick sinus syndrome (SSS)
Consequences of sick sinus syndrome (SSS) in elderly if untreated - correct answer debility,
falling (resulting in fractures, head/brain injuries, etc.), possible death
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They are not presenting with S.O.B.
You suspect SSS and refer them out to their PCP. What can you not let the patient do? - correct
answer patient cannot drive themselves to their PCP
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They do not present with S.O.B. What
do you do? - correct answer refer out to PCP on timely basis
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They also present with S.O.B. What
do you do? - correct answer refer out on a semi-urgent basis (urgent care or immediate referral
to PCP aka same day)
An elderly patient presents with dizziness and a slow heartbeat, less than (<) 60 beats per
minute and the heart rate does not increase with activity. They also present with severe S.O.B.
while resting, chest pain, falling blood pressure, and/or syncope. What do you do? - correct
answer call 911
Sick Sinus Syndrome (SSS) (S/S) - correct answer fatigue, weakness, dizziness especially with
exertion
S.O.B.
chest pain
near-syncope or syncope
Physical Exam for sick sinus syndrome (SSS) - correct answer check pulse rate (below 60 bpm)
An adult or child patient presents with inattention and/or hyperactivity that is severely
interfering with daily functions. What condition needs to be ruled out? - correct answer
attention deficit hyperactivity disorder (ADHD)
, NCCAOM Biomedicine – Medical Red Flags – TCM Review Guide for Exam Preparation
Consequences of ADHD being left untreated - correct answer increased risk of:
bipolar
conduct disorders
oppositional-defiance disorders
impaired self-esteem & self-confidence
decreased performance at school and/or work
social isolation & dysfunction
depression
possible death from substance abuse & risk-taking behaviors
A patient presents with inattention and/or hyperactivity that is severely interfering with daily
functions. Who should you do? - correct answer refer out on a timely basis to expert or group
of experts in ADHD (skilled acupuncturist, family physician, psychologist, psychiatrist, dietician
and/or neurologist)
ADHD (S/S) - correct answer difficulty focusing on and finishing projects at school or work
struggling with academic and/or occupational performance
patient may appear dreamy/unfocused
patient may bounce their leg, fidget, shift positions frequently
Physical Exam for ADHD - correct answer self-scoring ADHD questionnaire
A previously healthy adult presents with sudden unconsciousness followed by severe
drowsiness. What condition should be ruled out? - correct answer seizures
Consequences of seizures being left untreated - correct answer disability and possible death
A previously healthy adult presents with sudden unconsciousness in your clinic followed by
severe drowsiness. The patient seems fully recovered from the lack of consciousness and is
stable. What should you do? - correct answer refer to PCP on semi-urgent basis but if no PCP is
available then refer to urgent care
Patients with the new onset of a seizure disorder will often present with - correct answer
unawareness of seizure acitivity but will report "postictal" or post-seizure state
Symptoms of post-seizure ("postictal") state - correct answer extreme fatigue
drowsiness
