Chapter 9. Complementary and Alternative Medicine

Question 1

743. Acupuncture needles used in current practice
(A) are under same marketing rules as
syringes
(B) are under same standard control like
medical needles
(C) have same quality control as surgical
scalpels
(D) are used once only
(E) all of the above

Answer 1

743. (E) In 1996, the US Food and Drug Administration
     (FDA) changed the classification of acupuncture
     needles from experimental to medical equipment.
     So acupuncture needles are under the same strict
     quality control standards demanded for medical
     needles, syringes, or surgical scalpels. It includes
     manufacture, marketing, and use.

Question 2

744. Which of the following statements is incorrect?
     (A) Acupuncture was widely practiced by
     thousands of physicians, dentists,
     acupuncturists, and other practitioners
     (B) Acupuncture can be used to relive pain
     and in various other health conditions
     (C) The National Institutes of Health (NIH)
     have funded many research projects
     relating to acupuncture
     (D) In a national survey, the number of visits
     to alternative medicine was nearly twice
     of the visits to primary care physician
     (E) Few medical schools in the United
     States have included subjects on integrated
     medicine

Answer 2

744. (E) Acupuncture is being “widely” practiced by
     thousands of physicians, dentists, acupuncturists,
     and other practitioners for relief or prevention of
     pain and for various other health conditions. The
     majority of medical schools in the United States
     have already added courses on integrated medicine.
     In a 1998 survey, the number of visits to
     alternative medicine was almost twice that of
     visits to primary care physician.

Question 3

745. Which of the following statements is correct?
(A) There are 600 to 2000 acupuncture
points on the human body
(B) Acupuncture points are mostly located
along the meridians
(C) Acupuncturist could use points on the
ears, scalp, hands, and feet to treat
diseases
(D) Each treatment may use different
acupuncture points even with the same
disease
(E) All of the above

Answer 3

745. (E) There are between 600 and 2000 acupuncture
     points on the human body in 12 major meridians
     named after organ systems, and 8 minor meridians.
     There are also points on the ears, hands,
     feet, and scalp corresponding to organs throughout
     the body, and extra points outside the traditional
     meridians. Acupuncture points are usually
     chosen based on the practitioner’s assessment
     of the particular imbalance that needs to be
     restored. Even with the same patient and medical
     condition, acupuncture points used in each
     acupuncture treatment may be different.

Question 4

746. In the acupuncture theory
     (A) “qi” is the life force or energy that flows
     through the body
     (B) “qi” influences our health at physical,
     mental, emotional, and spiritual levels
     (C) any excess or deficiency of “qi” will
     contribute to our health problems
     (D) blockage of “qi” may cause pain
     (E) all of the above

Answer 4

746. (E) According to traditional Chinese medicine,
     “qi” (pronounced “chee”) is the life force or
     energy that flows through all living things.
     “Qi” affects our body at physical, mental, emotional,
     and spiritual levels. Any imbalance
     (deficiency or excess) or blockage of “qi” may
     result in disease or pain. Acupuncture treats
     disorders by influencing the flow of “qi,” thus
     restoring the normal balance of organ systems.

Question 5

747. Which of the following statements is incorrect?
     (A) Electroacupuncture (EA) can be used
     through needles to enhance the stimulation
     of acupuncture points
     (B) Percutaneous electric nerve stimulation
     (PENS) is a modified form of acupuncture
     treatment
     (C) “Deqi” sensation is a side effect of
     acupuncture
     (D) Moxibustion can be used with or without
     insertion of acupuncture needles
     (E) Acupressure and cupping are also helpful
     in treating different diseases

Answer 5

747. (C) EA uses electrical impulses conducted
     through needles for enhanced stimulation of
     acupuncture points. Different frequencies of
     electrical stimulation have showed distinctive
     effects and mechanisms of action. PENS is an
     adapted form of acupuncture that is widely
     practiced. Other techniques include moxibustion
     (burning of herbs to apply heat near
     acupuncture points), acupressure and reflexology
     (stimulation of points without penetration
     of the skin with needles), and cupping
     (heat creates a partial vacuum in small jars,
     which are used to stimulate points with suction).
     The sensations of “deqi” at the insertion site
     noted by the patient include aching, tingling,
     numbness, warmness, or heavy pressure feeling.
     It usually corresponds to the acupuncturist’s
     feeling of the needle “catching” in the muscle.
     deqi is thought to be necessary for achieving the
     acupuncture therapeutic effect

Question 6

748. Which one of the following complications associated
with acupuncture is mostly reported?
(A) Infection
(B) Bruising or bleeding
(C) Transient vasovagal response
(D) Pneumothorax
(E) Intra-abdominal abscess

Answer 6

748. (B) In the hands of a skilled practitioner, complications
     associated with acupuncture are
     actually quite rare, and usually very mild. The
     most commonly reported complication is bruising
     or bleeding. A second, less common side
     effect is a transient vasovagal response. Severe
     complications and fatal reactions such as pneumothorax,
     abdominal abscess, or pericardial
     effusion associated with acupuncture are rare.

Question 7

749. With regard to the scientific basis of acupuncture’s
     effects, which of the following statements
     is incorrect?
     (A) Electric acupuncture can activate the
     central nervous system (CNS) to release
     endogenous opioids into blood or cerebrospinal
     fluid (CSF)
     (B) The analgesic effects of acupuncture
     may occur after 20 to 30 minutes of
     treatment
     (C) Naloxone and other opioid antagonists
     can inhibit the acupuncture analgesia
     (D) Acupuncture analgesia can not be
     passed from one animal to another animal
     via CSF transfer or blood transfer
     (E) Substances that inhibit endorphin enzymatic
     degradation enhance the analgesic
     effects of acupuncture treatment

Answer 7

749. (D) In the most widely accepted acupuncture
     model, needling of nerve fibers in the muscle
     sends impulses that activate the spinal cord,
     midbrain, and hypothalamus-pituitary system. Subsequently, it releases β-endorphin into the
     blood and CSF to cause analgesia at a distance.
     The effects of acupuncture are not immediate;
     rather analgesia occurs after a 20- to 30-minute
     induction period. Analgesia persists for 1 to
     2 hours after cessation of acupuncture. Naloxone
     and other opiate antagonists inhibit acupuncture
     analgesia. Substances that inhibit endorphin
     enzymatic degradation enhance acupuncture
     effects. Acupuncture analgesia can be passed
     from one animal to another via CSF transfer or
     via cross-circulation of blood between two
     animals.

Question 8

750. Which of the following is not involved in the
analgesic effect of acupuncture?
(A) Nicotine
(B) Serotonin
(C) Norepinephrine
(D) Nitric oxide
(E) β-Endorphin

Answer 8

750. (A) EAinduces upregulation of neuronal nitric
     oxide/nicotinamide adenine diphosphate
     (NADPH) diaphorase expression in the gracile
     nucleus in rats, and then mediates acupuncture
     signals through dorsal medulla-thalamic pathways.
     This may play a significant role in central
     autonomic regulation of somatosympathetic
     reflexes that contribute to acupuncture effects in
     somatic and visceral pain processing, and cardiovascular
     regulation. Other evidence also
     supports the notion that those neurotransmitters
     (eg, serotonin and norepinephrine) as well
     as β-endorphin all act as mediators.

Question 9

751. Which of the following is the condition/disease
that acupuncture has not shown to be an effective
treatment modality?
(A) Allergies
(B) Dysmenorrhea
(C) Leukemia
(D) Biliary colic
(E) Leukopenia

Answer 9

751. (C) In 2002, the World Health Organization
     (WHO) published a summary and review of all
     clinical trials through the year 1999, and determined
     four categories of disorders treated by
     acupuncture. Allergies, dysmenorrhea, biliary
     colic, and leukopenia are disorders among
     many others in the category of proven efficacy
     of acupuncture through controlled trials.

Question 10

752. Complementary and alternative medicine
includes all of the following EXCEPT
(A) herbs
(B) mind-body therapy
(C) massage
(D) aspirin
(E) homeopathic therapy

Answer 10

752. (D) Complementary and alternative medicine
     include following practices: mind-body medicine,
     biologically based practices, manipulative
     and body-based practices, energy medicine, and
     whole medical systems. Whole medical systems
     include homeopathic medicine, naturopathic
     medicine, traditional Chinese medicine (herb,
     acupuncture, massage, meditation, etc), and
     ayurveda (herb, massage, and yoga).

Question 11

753. Mind-body interventions have been used in all
the following conditions EXCEPT
(A) headache
(B) low back pain
(C) arthritis
(D) chemotherapy-induced nausea and
vomiting
(E) none of the above

Answer 11

753. (E) Mind-body interventions have also been
     applied to various types of pain. Clinical trials
     indicate that these interventions may be a
     particularly effective adjunct in the management
     of arthritis, with reductions in chronic pain
     for up to 4 years and reductions in the number of
     physician visits. When applied to more general
     acute and chronic pain management, headache,
     and low back pain, mind-body interventions
     show some evidence of effects, although results
     vary based on the patient population and type of
     intervention involved. Evidence from multiple
     studies with various populations of cancer
     patients suggests that mind-body interventions
     can improve mood, quality of life, and coping as
     well as ameliorate disease- and treatmentrelated
     symptoms, such as chemotherapyinduced
     nausea, vomiting, and pain.

Question 12

754. The following statements regarding Ginkgo
     biloba are true EXCEPT
     (A) Ginkgo biloba has been used to treat multiple
     conditions such as asthma, bronchitis,
     fatigue and tinnitus
     (B) Ginkgo biloba has also been tried to
     improve Alzheimer disease and dementia
     (C) patients with intermittent claudicating,
     multiple sclerosis have tried Ginkgo
     biloba supplement
     (D) Ginkgo biloba has side effects including
     headache, nausea, diarrhea, dizziness,
     and allergic skin reactions
     (E) Ginkgo biloba does not increase bleeding
     risk so it can be safely taken with other
     anticoagulant drugs

Answer 12

754. (E) Recently, Ginkgo biloba has been used to treat
     a variety of health conditions, including asthma,
     bronchitis, fatigue, and tinnitus. Some encouraging
     results have been seen from the studies of
     Alzheimer disease/dementia, intermittent claudication,
     and tinnitus. But a trial of more than 200
     healthy adults older than 60 years found that
     Ginkgo biloba taken for 6 weeks did not improve
     memory. Side effects of Ginkgo biloba include
     headache, nausea, GI upset, diarrhea, dizziness,
     or allergic skin reactions. More severe allergic
     reactions have occasionally been reported. There
     are some data to suggest that Ginkgo biloba can
     increase bleeding risk, so people who take anticoagulant
     drugs, have bleeding disorders, or
     have scheduled surgery or dental procedures
     should use caution.

Question 13

755. The evidence from research supports the following
     effects of ginseng EXCEPT
     (A) ginseng supports overall health and
     boost immune system
     (B) ginseng does not cause allergic reactions
     (C) ginseng can increase both mental and
     physical performance
     (D) some studies have shown that ginseng
     lowers the blood glucose level
     (E) most common side effects of ginseng are
     headache, sleep disturbances, and gastrointestinal
     (GI) problems

Answer 13

755. (B) Ginseng has numerous potential benefits
     which include: supporting overall health and
     boosting the immune system; improving recovery
     from illness; increasing a sense of well-being
     and stamina; improving both mental and physical
     performance; treating erectile dysfunction,
     hepatitis C; reducing symptoms related to
     menopause; lowering blood glucose; and controlling
     blood pressure. The most common side
     effects are headaches and sleep disturbance and
     GI problems. Ginseng can cause allergic reactions.
     There have been reports of breast tenderness,
     menstrual irregularities, and high blood
     pressure associated with ginseng products.
     Ginseng may lower the level of blood glucose;
     this effect may be seen more often in patients with diabetes. Therefore, diabetic patients
     should use extra caution with Asian ginseng,
     especially if they are taking medicines to lower
     blood sugar or taking other herbs.

Question 14

756. The biologically based practice is a domain of
     complementary and alternative medicine. It
     includes
     (1) vitamins
     (2) fatty acids
     (3) proteins
     (4) prebiotics

Answer 14

756. (E) The biologically based practice is a branch of
     complementary and alternative medicine.
     It includes, but is not limited to, botanicals,
     animal-derived extracts, vitamins, minerals,
     fatty acids, amino acids, proteins, prebiotics and

Question 15

757. Naturopathy is a system of healing. Its principles
     include the following:
     (1) The healing power of nature
     (2) Identification and treatment of the cause
     of disease
     (3) Treatment of the whole person
     (4) The doctor as a teacher

Answer 15

757. (E) Naturopathy is a system originating from
     Europe. It considers that a disease is a manifestation
     of alterations in the processes by which the
     body naturally heals itself. It emphasizes health
     restoration as well as disease treatment. There are
     six principles that form the basis of naturopathic
     practice in North America: (1) the healing power
     of nature; (2) identification and treatment of the
     cause of disease; (3) the concept of “first do no
     harm”; (4) the doctor as teacher; (5) treatment of
     the whole person; and (6) prevention.

Question 16

758. Which of the following statement(s) is (are) correct
     for homeopathy?
     (1) It stimulates the body’s ability to heal
     by itself
     (2) Remedy contains giving small doses of
     highly diluted substance that can cause
     similar symptoms
     (3) Same substance if given in a larger dose
     would produce illness or symptoms
     (4) “Principle of similar” is not the theory
     of homeopathy

Answer 16

758. (A) Homeopathy is a complete system of medical
     theory and practice that is founded by the German
     physician Samuel Christian Hahnemann. He
     hypothesized that one can select therapies on the
     basis of how closely symptoms produced by a
     remedy match the symptoms of the patient’s
     disease. He called this the “Principle of similar.”
     Hahnemann proceeded to give repeated
     doses of many common remedies to healthy
     volunteers and carefully record the symptoms
     they produced. As a result of this experience,
     Hahnemann developed his treatments for sick
     patients by matching the symptoms produced
     by a drug to symptoms in sick patients.

Question 17

759. Glucosamine and chondroitin are used to treat
     knee osteoarthritis, which of the following
     statements is (are) correct?
     (1) In the United States, glucosamine and
     chondroitin are considered dietary supplements
     (2) It may cause serious adverse events
     such as congestive heart failure and
     chest pain
     (3) It may have more substantial treatment
     effects in a subgroup of patients with
     moderate to severe pain
     (4) Overall, glucosamine and chondroitin
     sulfate alone or in combination reduces
     the pain effectively in patients with knee
     osteoarthritis

Answer 17

759. (A) In the United States, glucosamine and chondroitin
     sulfate are considered dietary supplements
     and are not held to the stringent standards
     of pharmaceutical manufacture. Treatment effects
     were more substantial in the subgroup of
     patients with moderate to severe pain. Overall,
     glucosamine and chondroitin sulfate were not
     significantly better than placebo in reducing
     knee pain by only 20%. Adverse events were
     generally mild, but some serious adverse events
     were judged by the investigator to be related to the study treatment: congestive heart failure
     (ina patient receiving combined treatment) and
     chest pain (in a patient receivingglucosamine).

Question 18

760. Which of the following is (are) true about
     mind-body interventions?
     (1) May have impact on health by the
     mechanism of the brain and CNS influencing
     immune, endocrine, and autonomic
     function
     (2) Multicomponent mind-body interventions
     may be useful adjunctive treatment
     for coronary artery disease and
     certain pain-related disorders
     (3) Cognitive behavioral therapy, combined
     with educational/informational component
     can be effectively used as adjuncts
     in the management of variety of chronic
     conditions
     (4) When applied presurgically, a group of
     mind-body therapies (imaginary, hypnosis,
     relaxation) may improve recovery
     time and reduce pain following surgical
     procedures

Answer 18

760. (E) Recent evidence from randomized controlled
     trials, case reports, and systematic reviews of
     the literature suggest that the mechanism of
     mind-body therapy may rely on the brain and
     CNS influence immune, endocrine, and autonomic
     functioning, which is known to have an
     impact on health. Mind-body interventions can
     be effective in the treatment of coronary artery
     disease. In a study, mind-body intervention
     enhanced the effect of standard cardiac rehabilitation
     in reducing all-cause mortality and
     cardiac event recurrences for up to 2 years. This
     treatment modality has also been used to treat
     various types of pain. Clinical trials indicate
     that these interventions may be a particularly
     effective adjunct in the management of arthritis,
     with reductions in chronic pain for up to 4 years
     and reductions in the number of physician
     visits. When applied to more general acute and
     chronic pain management, headache, and low
     back pain, mind-body interventions show some
     evidence of effects, although results vary based
     on the patient population and type of intervention
     involved.In multiple studies with different
     types of cancer patients, it is suggested that
     mind-body interventions can improve mood,
     quality of life, and coping, as well as ameliorate
     disease- and treatment-related symptoms, such
     as cancer-related pain, nausea, or vomiting from
     chemotherapy. Other studies have shown that
     this behavioral therapy has effects of reducing
     discomfort and adverse effects during percutaneous
     vascular and renal procedures, reducing
     self-administration of analgesic drugs and
     improving hemodynamic stability in the perioperative
     period.

Question 19

761. Which of the following is (are) true about
     Echinacea?
     (1) Studies indicate that Echinacea does not
     prevent colds or other infections
     (2) Studies have not proven that Echinacea
     shortens the course of colds or flu
     (3) Echinacea can cause allergic reactions
     including rash, asthma, and anaphylaxis
     (4) GI side effects are most common

Answer 19

761. (E) Echinacea has been used to treat or prevent
     colds, flu, and other infections that are believed
     to stimulate the immune system to help fight
     infections. Less commonly, Echinacea has been
     used for wounds and skin problems, such as
     acne or boils. With recent evidence, it is indicated
     that Echinacea does not appear to prevent
     colds or other infections, shortens the course of
     colds or flu. For example, two studies did not find any benefit from Echinacea, either as
     Echinacea purpurea fresh-pressed juice for treating
     colds in children, or as an unrefined mixture of
     Echinacea angustifolia root and E purpurea root
     and herb in adults. Other studies have shown
     that Echinacea may be beneficial in treating
     upper respiratory infections. When taken by
     mouth, Echinacea usually does not cause side
     effects other than mild GI side effects. However,
     some people have experienced allergic reactions,
     including rashes, worsening asthma, and life
     threatening anaphylaxis. People are more likely
     to experience allergic reactions to Echinacea if
     they are allergic to related plants in the daisy
     family, which includes ragweed, chrysanthemums,
     marigolds, and daisies. Also, people with
     asthma or atopy may be more likely to have an
     allergic reaction when taking Echinacea.

Question 20

762. Which of the following is (are) true about chiropractic
     practice?
     (1) It is an alternative medical system and
     takes a different approach from conventional
     medicine in diagnosing, classifying,
     and treating medical problems
     (2) The chiropractic theories consider that
     the body has a powerful self-healing
     ability and the body structure and its
     function are closely related and this
     relation affects our health
     (3) The goal of this therapy is to normalize
     the relation of structure and function
     (4) There have been serious reported
     adverse effects such as stroke, caudal
     equine syndrome associated with chiropractic
     therapy

Answer 20

762. (E) Chiropractic focuses on the relationship
     between the body’s structure, primarily of the
     spine, and its functions. The basic concepts of
     chiropractic can be summarized as follows: the
     body has a powerful self-healing ability; the
     body’s structure, essentially the spine, and its
     function are closely related and this relationship
     affects health. Chiropractic therapy practices
     with the goals of normalizing the
     relationship between spine and its function, and
     assisting the body as it heals. Conditions commonly
     treated by chiropractors include neck
     pain, back pain, sports injuries, repetitive
     strains, and headaches. Patients with pain associated
     with other conditions, such as arthritis,
     also seek this treatment. In the United States,
     chiropractors perform more than 90% of manipulative
     treatments. With current data, the risk
     appears to be very low. The serious complication
     appears to be more associated with neck
     manipulation. Stroke has been reported with
     cervical spine manipulation and rarely, cauda
     equina syndrome with low back adjustment.
     Such risk was estimated to be one in one million
     treatments.