Reply To: Acupuncture Bootcamp
I have a couple questions about Practice Exam – Clinical Case Study #1, Case 2, questions 9 & 16
Case info:
CASE 2
Use the following information to answer questions (9-17):
A 68-year old female comes to you with the complaint of difficulty breathing while lying down.
Patient Information:
breathing issue is worse at night when she is lying down for long periods
patient feels as though she is choking at times when lying down
frequent shortness of breath, palpitations, and wheezing with exertion
patient “always” fatigued, and has felt this way for a long period of time
lips are slightly bluish
hands are cold
patient has had all of the above symptoms for approximately 1 year
patient “doesn’t trust” allopathic medicine, and hasn’t been to see her PCP
her ankles are quite swollen, and pit when pressed
complexion is bright pale slightly waxy
patient is overweight, mostly around her abdomen and her lower body
patient is slow in her movements
patient history shows that she has a great amount of stress in her past
used to suffer from severe tension headaches, PMS and painful periods in her mid-twenties. These reduced in nature after her divorce from an abusive husband at 38 years old.
in her thirties, she started having issues with loose stool, fatigue, and ‘belly fat’
loose stool eventually turned into chronic diarrhea.
patient menopause was difficult as she would wake with a cold flash early in the morning and would have big sweats all day long. She stated that her cheeks would flush red, and her sweat would be profuse.
patient had a lot of low backache at this time and was diagnosed with osteopenia
since menopause, the patient has noticed issues with swelling in her abdomen and lower body, consistent loose stool/diarrhea, without smell and with undigested food, chronic fatigue, weight gain, and constant lumbago
patient started having spontaneous sweats about 5 years ago plus a weak cough
Pulse: Weak (Ruo), especially in proximal right position; Slippery (Hua) mostly in both distal positions
Tongue: puffy, pale, wet
Question 9: Select the TCM Illnesses that most apply to this case. (Select 2)
-Diarrhea (Xie Xie)
-Lumbago (Yao Tong)
-Menstrual Edema (Jing Xing Fu Zhong)
-Lung Distention (Fei Zhong)
-Perimenopausal Syndrome (Jue Jing Qian Hou Zhu Zheng)
Question 16: What is the most likely biomedical impression for this patient?
-cor pulmonale
-Pneumonia
-Emphysema
-Congestive Heart Failure
My questions are:
For question 9: If dyspnea was also an option, would the answer still be lung distention, or would it be dyspnea?
Since her chief complaint is orthopnea, I would have been inclined to call it dyspnea, not lung distention.
Because if it’s lung distention/COPD, wouldn’t we have seen more coughing with sputum?
For question 16: I definitely saw red flags for congestive heart failure which was the correct answer for #16 (fatigue, orthopnea, pitting edema of the ankles, cold signs), but since the TCM disease was Lung Distention/COPD it made me think that the answer should have been one of the other options/something that falls under COPD, like cor pulmonale or emphysema.
Thank you!