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For practice exam – Clinical Case Study #1, Case 2, question 11:
“please place the pathogenesis in the correct order of appearance: Kidney & Heart Yang Deficiency with water overflowing into Upper Jiao; Lung Qi Deficiency; Spleen Yang Deficiency; Liver Qi Stagnation.
I put Liver Qi Stag, Spleen Yang Def, Lung Qi Def, then KD & HT Yang Def, and it was marked wrong, but for this same case in the acu practice test it was correct. Just wondering which one to go by 🙂
Case info:
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 back ache 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