NCCAOM Biomedicine Exam 2026/2027 – 200
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Section A: Clinical Application of Biomedical Sciences, Pharmacology, and
Nutrients/Supplements (25%)
1. A 40-year-old woman with an enlarged thyroid gland is most likely deficient in which of
the following?
(A) Iodine
(B) Iron
(C) Magnesium
(D) Zinc
Answer: A. Iodine is essential for the synthesis of thyroid hormones (T3 and T4). A
deficiency leads to decreased hormone production, which causes the thyroid gland to
enlarge (goiter) in an attempt to compensate.
2. A 55-year-old patient presents with chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which structure is most likely involved in the pain pathway?
(A) Vagus nerve
,(B) Phrenic nerve
(C) Sympathetic chain ganglia
(D) Intercostal nerves
Answer: C. Cardiac pain (angina/MI) is transmitted via visceral afferent fibers that travel
with sympathetic nerves. Pain from the heart is referred to the left arm and jaw because
these visceral afferents enter the same spinal cord segments (T1-T4) as somatic afferents
from those areas.
3. A 45-year-old woman presents with drooping of her left eyelid (ptosis), a constricted left
pupil (miosis), and lack of sweating on the left side of her face. This triad of symptoms is
known as:
(A) Bell's palsy
(B) Horner's syndrome
(C) Myasthenia gravis
(D) Trigeminal neuralgia
Answer: B. Horner's syndrome (ptosis, miosis, anhidrosis) results from disruption of the
sympathetic innervation to the head and neck. The sympathetic pathway originates in the
hypothalamus, descends through the brainstem and spinal cord, and synapses in the
superior cervical ganglion.
4. A 34-year-old female presents with numbness and tingling in the thumb, index, and
middle fingers that worsens at night. She works as a data entry clerk and reports frequent
wrist pain. Examination reveals a positive Tinel sign over the volar wrist. Which anatomical
structure is most likely compressed?
(A) The median nerve within the carpal tunnel
(B) The ulnar nerve at Guyon's canal
,(C) The radial nerve in the spiral groove
(D) The anterior interosseous nerve deep to the flexor digitorum superficialis
Answer: A. The median nerve passes through the carpal tunnel along with the flexor
tendons, and compression at this site produces the classic presentation of numbness in the
thumb, index, and middle fingers with nocturnal worsening. The ulnar nerve at Guyon's
canal would affect the ring and little fingers instead.
5. A 45-year-old male undergoes shoulder surgery and awakens with inability to abduct his
arm beyond 15 degrees and diminished sensation over the lateral deltoid. Which nerve was
most likely affected?
(A) Long thoracic nerve
(B) Axillary nerve
(C) Suprascapular nerve
(D) Musculocutaneous nerve
Answer: B. The axillary nerve innervates the deltoid muscle (primary shoulder abductor
beyond 15 degrees) and provides cutaneous sensation to the lateral deltoid region. The
long thoracic nerve innervates the serratus anterior and would produce winging of the
scapula.
6. A patient presents for acupuncture to treat memory issues. They mention taking Warfarin
for atrial fibrillation. They ask if they can take Ginkgo biloba to improve cognitive function.
What is the most appropriate response?
(A) "Ginkgo biloba is safe to take with Warfarin as it does not affect the liver."
(B) "You should consult your prescribing physician before adding Ginkgo, as it may increase
the risk of bleeding when combined with Warfarin."
(C) "Ginkgo biloba will enhance the effects of Warfarin, allowing you to lower your dosage."
(D) "It is safe as long as you stop taking the Ginkgo three days before blood work."
, Answer: B. Ginkgo biloba has antiplatelet effects and can inhibit platelet-activating factor.
When combined with anticoagulants like Warfarin, there is a significant increased risk of
bleeding and elevated INR.
7. A patient is currently taking Lithium for Bipolar Disorder. They request herbal treatment
for hot flashes. Which herb is contraindicated due to the risk of lithium toxicity?
(A) Black Cohosh
(B) Ginseng
(C) Raspberry Leaf
(D) Chamomile
Answer: A. Black Cohosh may have diuretic effects or alter renal clearance. If a patient is
taking Lithium, which has a narrow therapeutic index and is cleared renally, diuresis can
lead to increased reabsorption of Lithium and subsequent toxicity.
8. Which class of antidepressants requires strict dietary restrictions (tyramine-free diet) and
has a potentially dangerous interaction with Ephedra (Ma Huang)?
(A) Selective Serotonin Reuptake Inhibitors (SSRIs)
(B) Monoamine Oxidase Inhibitors (MAOIs)
(C) Tricyclic Antidepressants (TCAs)
(D) Benzodiazepines
Answer: B. MAOIs inhibit the breakdown of tyramine and catecholamines. Combining
MAOIs with sympathomimetic herbs like Ephedra can precipitate a hypertensive crisis.
9. A patient is taking Cyclosporine following a kidney transplant. They want to take
Echinacea to prevent colds. What is the concern?
(A) Echinacea may increase the risk of rejection by stimulating the immune system.
(B) Echinacea will suppress the immune system further, leading to infection.
Latest Questions & Answers with Rationales |
Complete Practice Test & Study Guide | Instant
Download
Section A: Clinical Application of Biomedical Sciences, Pharmacology, and
Nutrients/Supplements (25%)
1. A 40-year-old woman with an enlarged thyroid gland is most likely deficient in which of
the following?
(A) Iodine
(B) Iron
(C) Magnesium
(D) Zinc
Answer: A. Iodine is essential for the synthesis of thyroid hormones (T3 and T4). A
deficiency leads to decreased hormone production, which causes the thyroid gland to
enlarge (goiter) in an attempt to compensate.
2. A 55-year-old patient presents with chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which structure is most likely involved in the pain pathway?
(A) Vagus nerve
,(B) Phrenic nerve
(C) Sympathetic chain ganglia
(D) Intercostal nerves
Answer: C. Cardiac pain (angina/MI) is transmitted via visceral afferent fibers that travel
with sympathetic nerves. Pain from the heart is referred to the left arm and jaw because
these visceral afferents enter the same spinal cord segments (T1-T4) as somatic afferents
from those areas.
3. A 45-year-old woman presents with drooping of her left eyelid (ptosis), a constricted left
pupil (miosis), and lack of sweating on the left side of her face. This triad of symptoms is
known as:
(A) Bell's palsy
(B) Horner's syndrome
(C) Myasthenia gravis
(D) Trigeminal neuralgia
Answer: B. Horner's syndrome (ptosis, miosis, anhidrosis) results from disruption of the
sympathetic innervation to the head and neck. The sympathetic pathway originates in the
hypothalamus, descends through the brainstem and spinal cord, and synapses in the
superior cervical ganglion.
4. A 34-year-old female presents with numbness and tingling in the thumb, index, and
middle fingers that worsens at night. She works as a data entry clerk and reports frequent
wrist pain. Examination reveals a positive Tinel sign over the volar wrist. Which anatomical
structure is most likely compressed?
(A) The median nerve within the carpal tunnel
(B) The ulnar nerve at Guyon's canal
,(C) The radial nerve in the spiral groove
(D) The anterior interosseous nerve deep to the flexor digitorum superficialis
Answer: A. The median nerve passes through the carpal tunnel along with the flexor
tendons, and compression at this site produces the classic presentation of numbness in the
thumb, index, and middle fingers with nocturnal worsening. The ulnar nerve at Guyon's
canal would affect the ring and little fingers instead.
5. A 45-year-old male undergoes shoulder surgery and awakens with inability to abduct his
arm beyond 15 degrees and diminished sensation over the lateral deltoid. Which nerve was
most likely affected?
(A) Long thoracic nerve
(B) Axillary nerve
(C) Suprascapular nerve
(D) Musculocutaneous nerve
Answer: B. The axillary nerve innervates the deltoid muscle (primary shoulder abductor
beyond 15 degrees) and provides cutaneous sensation to the lateral deltoid region. The
long thoracic nerve innervates the serratus anterior and would produce winging of the
scapula.
6. A patient presents for acupuncture to treat memory issues. They mention taking Warfarin
for atrial fibrillation. They ask if they can take Ginkgo biloba to improve cognitive function.
What is the most appropriate response?
(A) "Ginkgo biloba is safe to take with Warfarin as it does not affect the liver."
(B) "You should consult your prescribing physician before adding Ginkgo, as it may increase
the risk of bleeding when combined with Warfarin."
(C) "Ginkgo biloba will enhance the effects of Warfarin, allowing you to lower your dosage."
(D) "It is safe as long as you stop taking the Ginkgo three days before blood work."
, Answer: B. Ginkgo biloba has antiplatelet effects and can inhibit platelet-activating factor.
When combined with anticoagulants like Warfarin, there is a significant increased risk of
bleeding and elevated INR.
7. A patient is currently taking Lithium for Bipolar Disorder. They request herbal treatment
for hot flashes. Which herb is contraindicated due to the risk of lithium toxicity?
(A) Black Cohosh
(B) Ginseng
(C) Raspberry Leaf
(D) Chamomile
Answer: A. Black Cohosh may have diuretic effects or alter renal clearance. If a patient is
taking Lithium, which has a narrow therapeutic index and is cleared renally, diuresis can
lead to increased reabsorption of Lithium and subsequent toxicity.
8. Which class of antidepressants requires strict dietary restrictions (tyramine-free diet) and
has a potentially dangerous interaction with Ephedra (Ma Huang)?
(A) Selective Serotonin Reuptake Inhibitors (SSRIs)
(B) Monoamine Oxidase Inhibitors (MAOIs)
(C) Tricyclic Antidepressants (TCAs)
(D) Benzodiazepines
Answer: B. MAOIs inhibit the breakdown of tyramine and catecholamines. Combining
MAOIs with sympathomimetic herbs like Ephedra can precipitate a hypertensive crisis.
9. A patient is taking Cyclosporine following a kidney transplant. They want to take
Echinacea to prevent colds. What is the concern?
(A) Echinacea may increase the risk of rejection by stimulating the immune system.
(B) Echinacea will suppress the immune system further, leading to infection.
