NCCAOM Biomed Exam: Body &
Disease-Graded A
Cancer alert "C": - ANS-Changes in bowel or bladder
Cancer alert "A": - ANS-A sore throat that fails to heal in 6 weeks
Cancer alert "U": - ANS-Unusual bleeding or discharge
Cancer alert "T": - ANS-Thickening/lump (breast or elsewhere)
Cancer alert "I": - ANS-Indigestion or difficulty swallowing
Cancer alert "O": - ANS-Obvious change in wart or mole
Cancer alert "N": - ANS-Nagging cough or hoarseness (rust colored sputum)
Obvious change in wart or mole ABCD: - ANS-Asymmetric shape; Border irregularities;
Color pigmentation not uniform; Diameter > 6mm
More cancer alerts: - ANS-Change in DTRs (deep tendon reflexes), Proximal muscle
weakness, Night pain, Pathologic Fracture, 45+ years old
Most Common Primary Sites of Metastatic Tumors: - ANS-Lung: Prostate: Renal:
Breast: Colon:
Cancer Lung: - ANS-> 60 YO= smoker, shoulder chest & C-spine pain, TOS (Thoracic
Outlet Syndrome) symptoms, chronic cough, bloody sputum, weight loss, malaise,
fever, dyspnea, wheezing
Cancer Prostate: - ANS-> 50 YO= Lumbar/Sacral pain, frequent urination, weak urine
stream, difficulty starting urination
Thoracic Outlet Syndrome signs & symptoms: - ANS-kyphotic posture & forward head,
awakes @ night w/pins & needles in hand, poorly localized ache, pain w/lifting heavy
objects, (+) tests = Upper Limb Neurodynamic, Adson's, Wright's, military brace, Allen's,
DBP > 20mm Hg difference between arms, AP x-ray to r/o cervical rib (rare), EMG
results r controversial, need to r/o CTS, radiculopathy, pronator syndrome
Carpal Tunnel Syndrome pathology: - ANS-overuse injury related to repetitive trauma,
occurs in women > men, may occur during pregnancy
, Carpal Tunnel Syndrome signs & symptoms: - ANS-thenar atrophy w/out swelling or
trophic change, nighttime numbness of hand (median nerve pattern), thumb weakness,
loss of opposition abduction specific to APB (beware substitution of APL innervated by
radial nerve), (+) tests = Phalen's, reverse Phalen's, ULNT & Tinel's sign, (-) tests =
TOS, normal pulses (medial & ulnar arteries do not pass thru tunnel) sensation of palm
is spared, need to r/o C-spine problem, confirm w/CT or MRI
Central Nervous System: - ANS-Brain, Spinal cord
Peripheral Nervous System: - ANS-cranial nerves, spinal nerves, & autonomic nerves
(sympathetic, parasympathetic)
CN mnemonic (feel free to add more): - ANS-On Old Olympus' Towering Top, A Finn
And German Vaulted And Hopped
Sensory, Motor, or Both Mnemonic: - ANS-Some Say Marry Money, But My Brother
Says Bad Business Marrying Money
Cranial Nerve I: - ANS-olfactory =S smell :test, identify odors w/ eyes closed
Cranial Nerve II: - ANS-optic =S vision :test, peripheral vision w/ 1 eye covered
Cranial Nerve III: - ANS-oculomotor =M eye movement, pupillary reaction :test,
peripheral vision, eye chart, reaction to light
Cranial Nerve IV: - ANS-trochlear =M eye movement :test, ability to depress & adduct
eye
Cranial Nerve V: - ANS-trigeminal =S,M face sensation, mastication :test, face
sensation & clench teeth
Cranial Nerve VI: - ANS-abducens =M eye movement :test, ability to abduct eye past
midline
Cranial Nerve VII: - ANS-facial =S,M facial muscles, taste :test, close eyes & smile,
detect various flavors
Cranial Nerve VIII: - ANS-vestibulocochlear =S hearing & balance :test, hearing,
balance feet-together w/ eyes open-closed x 5 sec, past-pointing
Cranial Nerve IX: - ANS-glossopharyngeal =S,M swallow, voice, gag reflex :test,
swallow & say Ahh, tongue depressor to elicit gag
Cranial Nerve X: - ANS-vagus =S,M swallow, voice, gag reflex :test, swallow & say Ahh,
tongue depressor to elicit gag
Disease-Graded A
Cancer alert "C": - ANS-Changes in bowel or bladder
Cancer alert "A": - ANS-A sore throat that fails to heal in 6 weeks
Cancer alert "U": - ANS-Unusual bleeding or discharge
Cancer alert "T": - ANS-Thickening/lump (breast or elsewhere)
Cancer alert "I": - ANS-Indigestion or difficulty swallowing
Cancer alert "O": - ANS-Obvious change in wart or mole
Cancer alert "N": - ANS-Nagging cough or hoarseness (rust colored sputum)
Obvious change in wart or mole ABCD: - ANS-Asymmetric shape; Border irregularities;
Color pigmentation not uniform; Diameter > 6mm
More cancer alerts: - ANS-Change in DTRs (deep tendon reflexes), Proximal muscle
weakness, Night pain, Pathologic Fracture, 45+ years old
Most Common Primary Sites of Metastatic Tumors: - ANS-Lung: Prostate: Renal:
Breast: Colon:
Cancer Lung: - ANS-> 60 YO= smoker, shoulder chest & C-spine pain, TOS (Thoracic
Outlet Syndrome) symptoms, chronic cough, bloody sputum, weight loss, malaise,
fever, dyspnea, wheezing
Cancer Prostate: - ANS-> 50 YO= Lumbar/Sacral pain, frequent urination, weak urine
stream, difficulty starting urination
Thoracic Outlet Syndrome signs & symptoms: - ANS-kyphotic posture & forward head,
awakes @ night w/pins & needles in hand, poorly localized ache, pain w/lifting heavy
objects, (+) tests = Upper Limb Neurodynamic, Adson's, Wright's, military brace, Allen's,
DBP > 20mm Hg difference between arms, AP x-ray to r/o cervical rib (rare), EMG
results r controversial, need to r/o CTS, radiculopathy, pronator syndrome
Carpal Tunnel Syndrome pathology: - ANS-overuse injury related to repetitive trauma,
occurs in women > men, may occur during pregnancy
, Carpal Tunnel Syndrome signs & symptoms: - ANS-thenar atrophy w/out swelling or
trophic change, nighttime numbness of hand (median nerve pattern), thumb weakness,
loss of opposition abduction specific to APB (beware substitution of APL innervated by
radial nerve), (+) tests = Phalen's, reverse Phalen's, ULNT & Tinel's sign, (-) tests =
TOS, normal pulses (medial & ulnar arteries do not pass thru tunnel) sensation of palm
is spared, need to r/o C-spine problem, confirm w/CT or MRI
Central Nervous System: - ANS-Brain, Spinal cord
Peripheral Nervous System: - ANS-cranial nerves, spinal nerves, & autonomic nerves
(sympathetic, parasympathetic)
CN mnemonic (feel free to add more): - ANS-On Old Olympus' Towering Top, A Finn
And German Vaulted And Hopped
Sensory, Motor, or Both Mnemonic: - ANS-Some Say Marry Money, But My Brother
Says Bad Business Marrying Money
Cranial Nerve I: - ANS-olfactory =S smell :test, identify odors w/ eyes closed
Cranial Nerve II: - ANS-optic =S vision :test, peripheral vision w/ 1 eye covered
Cranial Nerve III: - ANS-oculomotor =M eye movement, pupillary reaction :test,
peripheral vision, eye chart, reaction to light
Cranial Nerve IV: - ANS-trochlear =M eye movement :test, ability to depress & adduct
eye
Cranial Nerve V: - ANS-trigeminal =S,M face sensation, mastication :test, face
sensation & clench teeth
Cranial Nerve VI: - ANS-abducens =M eye movement :test, ability to abduct eye past
midline
Cranial Nerve VII: - ANS-facial =S,M facial muscles, taste :test, close eyes & smile,
detect various flavors
Cranial Nerve VIII: - ANS-vestibulocochlear =S hearing & balance :test, hearing,
balance feet-together w/ eyes open-closed x 5 sec, past-pointing
Cranial Nerve IX: - ANS-glossopharyngeal =S,M swallow, voice, gag reflex :test,
swallow & say Ahh, tongue depressor to elicit gag
Cranial Nerve X: - ANS-vagus =S,M swallow, voice, gag reflex :test, swallow & say Ahh,
tongue depressor to elicit gag
