Integrative Medicine

Chapter 19 Integrative Medicine




Clinical Case Problem 1: “Are Those All the Medications You Take?”


A 35-year-old white female schoolteacher presents to your office to establish care. She completes a medical history survey that states she has fibromyalgia and hypoglycemia. The only medication listed on her form is an oral contraceptive agent, but when interviewed, she adds that she also takes multiple dietary supplements. She requests that you perform a general well-woman examination and renew her birth control pills.



Select the best answer to the following questions




1. Which of the following aspects of this case does not match the typical user of complementary and alternative medicine (CAM) therapies?


a. a higher percentage of users are female

b. after prayer, use of “natural products” is the most common form of CAM therapy

c. the majority of users have at least some college education

d. despite the use of CAM, the majority of users continue to see conventional practitioners

e. the majority of CAM users inform their physicians

2. Which of the following statements is true regarding CAM in general?


a. CAM therapies are rarely covered by health insurance

b. use of CAM peaked in the 1990s and has steadily declined

c. the U.S. government funds several hundred million dollars of CAM-related research annually

d. the majority of U.S. medical schools do not have curriculum regarding CAM

e. most CAM users turn to these therapies because of their dissatisfaction with conventional biomedical care

3. In this case, which of the following options would be the least appropriate?


a. ask the patient to provide you with a complete list of her supplements

b. obtain additional information about her diagnoses of fibromyalgia and hypoglycemia

c. inquire into other CAM therapies that the patient may be using

d. when dictating this encounter, simply state that she is taking dietary supplements because it is not necessary to list each one in the record

e. perform a complete examination that is appropriate for her age and medical condition

4. Which of the following is not true about dietary supplements?


a. the Food and Drug Administration (FDA) does not regulate these products

b. they are not considered drugs and therefore do not have to prove their efficacy or safety

c. supplements are not allowed to make any claims of curing or mitigating disease

d. they must state on their labels: “this statement has not been evaluated by the Food and Drug Administration”

e. the most common reason people take these products is a belief that doing so promotes good health

5. Which of the following is not true about herbal products?


a. St. John’s wort has been shown in studies to be effective in the treatment of mild to moderately severe depression

b. St. John’s wort has been shown to elevate the levels of some drugs, such as cyclosporine and digoxin, by inhibition of the cytochrome P-450 (CYP3A4) pathway in the liver

c. some herbal products have been found to have contaminants, such as heavy metals or prescription drugs

d. ginkgo biloba, commonly taken for dementia-related concerns, can interfere with platelet function

e. studies have shown that some herbal products may not contain the dosage that is stated on the package label

6. Match the following supplements with the condition most associated with its use:



















a.saw palmetto A.respiratory infections
b.milk thistle B.menopausal symptoms
c.black cohosh C.prostate enlargement
d.echinacea D.anxiety
e.kava kava E.liver disease

7. In the current case, which would be the least appropriate option?


a. ask the patient to describe the reason that she is taking each of the herbals

b. discuss any potential harm, such as drug-herb interactions, that may occur with the specific supplements being used

c. try to convince the patient to stop taking all of the supplements because they do not have the same level of evidence as drugs do

d. provide the patient with a list of reliable resources for CAM therapies, including appropriate websites

e. invite the patient to be an active participant in decisions about her health care, such as treatment options and any laboratory testing

8. During the office visit, the patient states that she is interested in a “holistic” approach to her health care. Which of the following would be your least appropriate response?


a. respectfully explain that you are a family physician and holistic care is not part of your scope of practice

b. discuss the use of low-impact cardiovascular exercise for the treatment of her fibromyalgia

c. explain the importance of small, frequent, nutritious meals to help alleviate her hypoglycemic reactions

d. discuss the benefits of relaxation techniques, such as meditation and guided imagery, to reduce pain

e. offer to set up appropriate referrals as needed and help coordinate her care


Clinical Case Problem 2: When Traditional Medicine Fails …


Mr. Smith is a 72-year-old man who has been in your practice for several years. He has a history of prostate cancer that was successfully treated with radical prostatectomy 2   years ago. His only other known medical problems are hyperlipidemia and moderate osteoarthritis, that tends to limit his daily activities. He has tried several nonsteroidal anti-inflammatory agents but did not tolerate them for various reasons. He presents to your office for a routine follow-up visit, but his main objective is to ask your opinion about several CAM therapies that he is considering.



9. Regarding CAM in general, which of the following is true?


a. patients diagnosed with cancer rarely use CAM therapies because of the serious nature of this diagnosis

b. CAM treatments have not been shown to be effective in reducing pain

c. patients using prescription drugs rarely use dietary supplements

d. when taken according to the package label by relatively healthy adults, dietary supplements tend to have fewer side effects than do prescription drugs

e. most CAM users are older, retired individuals

10. Which of the following would be the least appropriate advice to offer this patient?


a. it is best to use either conventional treatments alone or only CAM therapies because of the potential for significant adverse interaction between them

b. some studies have demonstrated benefit with the use of glucosamine products for the treatment and prevention of osteoarthritis of the knee

c. there are data to support the use of acupuncture to treat knee arthritis

d. lifestyle modifications, such as maintaining ideal body weight, can have a positive effect on arthritis

e. tai chi, an oriental movement therapy, has been shown to have a favorable impact on strength and balance in elderly patients

11. Regarding acupuncture in the United States, which of the following is not true?


a. the majority of acupuncture is provided by licensed practitioners

b. it can legally be administered only by a person specifically licensed in acupuncture

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Integrative Medicine

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