CONO Clinical Science Sample Questions

Sample Case #1

Patient: 62-year-old male, 175 cm (5'9"), 82 kg (181 lbs), BMI: 26.8
Presentation: The patient presents with increasing difficulty seeing in low light and a noticeable reduction in peripheral vision over the past year. He reports occasional eye pain and headaches, especially after reading or using a computer for extended periods. He is concerned about his vision and has been diagnosed with open-angle glaucoma by his ophthalmologist. The patient is seeking naturopathic treatments to complement his current medical regimen and manage intraocular pressure naturally.
Medical History: Diagnosed with open-angle glaucoma 2 years ago. Mild hypertension diagnosed at age 55, controlled with medication. No history of diabetes. Cataract surgery in the right eye at age 60. No other significant illnesses or surgeries.
Psychosocial: Retired engineer, currently works part-time as a consultant. Lives with his wife in a suburban home. Enjoys reading, gardening, and spending time with his grandchildren, though his vision problems have limited these activities.
Health Habits: Diet: Breakfast: Oatmeal with berries and a cup of coffee. Lunch: Salad with grilled chicken or fish. Dinner: Cooked at home; typically includes lean protein, vegetables, and whole grains. Snacks on nuts and occasionally dark chocolate.
Alcohol: Drinks a glass of red wine with dinner most evenings.
Tobacco: Non-smoker, quit smoking at age 45.
Exercise: Walks for 30 minutes daily and practices yoga twice a week.
Supplements: Current Regimen: Takes a daily multivitamin, omega-3 fish oil, and lutein supplements for eye health.
Medication: Prescriptions: Latanoprost eye drops for glaucoma, taken once daily at night. Lisinopril 10 mg daily for hypertension. Over-the-Counter: Occasionally uses ibuprofen for joint pain
Allergies: No known drug allergies.
Family History: Father: Hypertension, died of a stroke at age 70. Mother: Age-related macular degeneration, still living. Siblings: One brother with hypertension and glaucoma.
Vital Signs: T: 36.7°C (98.1°F), BP: 128/78 mmHg, PR: 70 bpm, RR: 14 bpm.
Physical Exam: General Appearance: Appears well-nourished, alert, and oriented but anxious about his vision. Ophthalmic Exam: Bilateral cupping of the optic discs noted. Visual field testing shows reduced peripheral vision. Pupils equal and reactive to light, no afferent pupillary defect.
Preliminary Lab Results: Blood Tests: CBC and metabolic panel within normal limits. Blood glucose: 5.2 mmol/L (normal).
Intraocular Pressure (IOP): Measured at 22 mmHg in the right eye and 21 mmHg in the left eye.
Diagnostic Imaging: OCT: Shows thinning of the retinal nerve fibre layer in both eyes, consistent with glaucoma.

What is the primary action of latanoprost in managing glaucoma?

Sample Case #1

Patient: 62-year-old male, 175 cm (5'9"), 82 kg (181 lbs), BMI: 26.8
Presentation: The patient presents with increasing difficulty seeing in low light and a noticeable reduction in peripheral vision over the past year. He reports occasional eye pain and headaches, especially after reading or using a computer for extended periods. He is concerned about his vision and has been diagnosed with open-angle glaucoma by his ophthalmologist. The patient is seeking naturopathic treatments to complement his current medical regimen and manage intraocular pressure naturally.
Medical History: Diagnosed with open-angle glaucoma 2 years ago. Mild hypertension diagnosed at age 55, controlled with medication. No history of diabetes. Cataract surgery in the right eye at age 60. No other significant illnesses or surgeries.
Psychosocial: Retired engineer, currently works part-time as a consultant. Lives with his wife in a suburban home. Enjoys reading, gardening, and spending time with his grandchildren, though his vision problems have limited these activities.
Health Habits: Diet: Breakfast: Oatmeal with berries and a cup of coffee. Lunch: Salad with grilled chicken or fish. Dinner: Cooked at home; typically includes lean protein, vegetables, and whole grains. Snacks on nuts and occasionally dark chocolate.
Alcohol: Drinks a glass of red wine with dinner most evenings.
Tobacco: Non-smoker, quit smoking at age 45.
Exercise: Walks for 30 minutes daily and practices yoga twice a week.
Supplements: Current Regimen: Takes a daily multivitamin, omega-3 fish oil, and lutein supplements for eye health.
Medication: Prescriptions: Latanoprost eye drops for glaucoma, taken once daily at night. Lisinopril 10 mg daily for hypertension. Over-the-Counter: Occasionally uses ibuprofen for joint pain
Allergies: No known drug allergies.
Family History: Father: Hypertension, died of a stroke at age 70. Mother: Age-related macular degeneration, still living. Siblings: One brother with hypertension and glaucoma.
Vital Signs: T: 36.7°C (98.1°F), BP: 128/78 mmHg, PR: 70 bpm, RR: 14 bpm.
Physical Exam: General Appearance: Appears well-nourished, alert, and oriented but anxious about his vision. Ophthalmic Exam: Bilateral cupping of the optic discs noted. Visual field testing shows reduced peripheral vision. Pupils equal and reactive to light, no afferent pupillary defect.
Preliminary Lab Results: Blood Tests: CBC and metabolic panel within normal limits. Blood glucose: 5.2 mmol/L (normal).
Intraocular Pressure (IOP): Measured at 22 mmHg in the right eye and 21 mmHg in the left eye.
Diagnostic Imaging: OCT: Shows thinning of the retinal nerve fibre layer in both eyes, consistent with glaucoma.

What risk factors for glaucoma does the patient exhibit?

Sample Case #1

Patient: 62-year-old male, 175 cm (5'9"), 82 kg (181 lbs), BMI: 26.8
Presentation: The patient presents with increasing difficulty seeing in low light and a noticeable reduction in peripheral vision over the past year. He reports occasional eye pain and headaches, especially after reading or using a computer for extended periods. He is concerned about his vision and has been diagnosed with open-angle glaucoma by his ophthalmologist. The patient is seeking naturopathic treatments to complement his current medical regimen and manage intraocular pressure naturally.
Medical History: Diagnosed with open-angle glaucoma 2 years ago. Mild hypertension diagnosed at age 55, controlled with medication. No history of diabetes. Cataract surgery in the right eye at age 60. No other significant illnesses or surgeries.
Psychosocial: Retired engineer, currently works part-time as a consultant. Lives with his wife in a suburban home. Enjoys reading, gardening, and spending time with his grandchildren, though his vision problems have limited these activities.
Health Habits: Diet: Breakfast: Oatmeal with berries and a cup of coffee. Lunch: Salad with grilled chicken or fish. Dinner: Cooked at home; typically includes lean protein, vegetables, and whole grains. Snacks on nuts and occasionally dark chocolate.
Alcohol: Drinks a glass of red wine with dinner most evenings.
Tobacco: Non-smoker, quit smoking at age 45.
Exercise: Walks for 30 minutes daily and practices yoga twice a week.
Supplements: Current Regimen: Takes a daily multivitamin, omega-3 fish oil, and lutein supplements for eye health.
Medication: Prescriptions: Latanoprost eye drops for glaucoma, taken once daily at night. Lisinopril 10 mg daily for hypertension. Over-the-Counter: Occasionally uses ibuprofen for joint pain
Allergies: No known drug allergies.
Family History: Father: Hypertension, died of a stroke at age 70. Mother: Age-related macular degeneration, still living. Siblings: One brother with hypertension and glaucoma.
Vital Signs: T: 36.7°C (98.1°F), BP: 128/78 mmHg, PR: 70 bpm, RR: 14 bpm.
Physical Exam: General Appearance: Appears well-nourished, alert, and oriented but anxious about his vision. Ophthalmic Exam: Bilateral cupping of the optic discs noted. Visual field testing shows reduced peripheral vision. Pupils equal and reactive to light, no afferent pupillary defect.
Preliminary Lab Results: Blood Tests: CBC and metabolic panel within normal limits. Blood glucose: 5.2 mmol/L (normal).
Intraocular Pressure (IOP): Measured at 22 mmHg in the right eye and 21 mmHg in the left eye.
Diagnostic Imaging: OCT: Shows thinning of the retinal nerve fibre layer in both eyes, consistent with glaucoma.

Which supplement is most appropriate to recommend for supporting eye health in this patient?

Sample Case #1

Patient: 62-year-old male, 175 cm (5'9"), 82 kg (181 lbs), BMI: 26.8
Presentation: The patient presents with increasing difficulty seeing in low light and a noticeable reduction in peripheral vision over the past year. He reports occasional eye pain and headaches, especially after reading or using a computer for extended periods. He is concerned about his vision and has been diagnosed with open-angle glaucoma by his ophthalmologist. The patient is seeking naturopathic treatments to complement his current medical regimen and manage intraocular pressure naturally.
Medical History: Diagnosed with open-angle glaucoma 2 years ago. Mild hypertension diagnosed at age 55, controlled with medication. No history of diabetes. Cataract surgery in the right eye at age 60. No other significant illnesses or surgeries.
Psychosocial: Retired engineer, currently works part-time as a consultant. Lives with his wife in a suburban home. Enjoys reading, gardening, and spending time with his grandchildren, though his vision problems have limited these activities.
Health Habits: Diet: Breakfast: Oatmeal with berries and a cup of coffee. Lunch: Salad with grilled chicken or fish. Dinner: Cooked at home; typically includes lean protein, vegetables, and whole grains. Snacks on nuts and occasionally dark chocolate.
Alcohol: Drinks a glass of red wine with dinner most evenings.
Tobacco: Non-smoker, quit smoking at age 45.
Exercise: Walks for 30 minutes daily and practices yoga twice a week.
Supplements: Current Regimen: Takes a daily multivitamin, omega-3 fish oil, and lutein supplements for eye health.
Medication: Prescriptions: Latanoprost eye drops for glaucoma, taken once daily at night. Lisinopril 10 mg daily for hypertension. Over-the-Counter: Occasionally uses ibuprofen for joint pain
Allergies: No known drug allergies.
Family History: Father: Hypertension, died of a stroke at age 70. Mother: Age-related macular degeneration, still living. Siblings: One brother with hypertension and glaucoma.
Vital Signs: T: 36.7°C (98.1°F), BP: 128/78 mmHg, PR: 70 bpm, RR: 14 bpm.
Physical Exam: General Appearance: Appears well-nourished, alert, and oriented but anxious about his vision. Ophthalmic Exam: Bilateral cupping of the optic discs noted. Visual field testing shows reduced peripheral vision. Pupils equal and reactive to light, no afferent pupillary defect.
Preliminary Lab Results: Blood Tests: CBC and metabolic panel within normal limits. Blood glucose: 5.2 mmol/L (normal).
Intraocular Pressure (IOP): Measured at 22 mmHg in the right eye and 21 mmHg in the left eye.
Diagnostic Imaging: OCT: Shows thinning of the retinal nerve fibre layer in both eyes, consistent with glaucoma.

How should the ND address the patient’s diet to help manage his glaucoma?

Sample Case #1

Patient: 62-year-old male, 175 cm (5'9"), 82 kg (181 lbs), BMI: 26.8
Presentation: The patient presents with increasing difficulty seeing in low light and a noticeable reduction in peripheral vision over the past year. He reports occasional eye pain and headaches, especially after reading or using a computer for extended periods. He is concerned about his vision and has been diagnosed with open-angle glaucoma by his ophthalmologist. The patient is seeking naturopathic treatments to complement his current medical regimen and manage intraocular pressure naturally.
Medical History: Diagnosed with open-angle glaucoma 2 years ago. Mild hypertension diagnosed at age 55, controlled with medication. No history of diabetes. Cataract surgery in the right eye at age 60. No other significant illnesses or surgeries.
Psychosocial: Retired engineer, currently works part-time as a consultant. Lives with his wife in a suburban home. Enjoys reading, gardening, and spending time with his grandchildren, though his vision problems have limited these activities.
Health Habits: Diet: Breakfast: Oatmeal with berries and a cup of coffee. Lunch: Salad with grilled chicken or fish. Dinner: Cooked at home; typically includes lean protein, vegetables, and whole grains. Snacks on nuts and occasionally dark chocolate.
Alcohol: Drinks a glass of red wine with dinner most evenings.
Tobacco: Non-smoker, quit smoking at age 45.
Exercise: Walks for 30 minutes daily and practices yoga twice a week.
Supplements: Current Regimen: Takes a daily multivitamin, omega-3 fish oil, and lutein supplements for eye health.
Medication: Prescriptions: Latanoprost eye drops for glaucoma, taken once daily at night. Lisinopril 10 mg daily for hypertension. Over-the-Counter: Occasionally uses ibuprofen for joint pain
Allergies: No known drug allergies.
Family History: Father: Hypertension, died of a stroke at age 70. Mother: Age-related macular degeneration, still living. Siblings: One brother with hypertension and glaucoma.
Vital Signs: T: 36.7°C (98.1°F), BP: 128/78 mmHg, PR: 70 bpm, RR: 14 bpm.
Physical Exam: General Appearance: Appears well-nourished, alert, and oriented but anxious about his vision. Ophthalmic Exam: Bilateral cupping of the optic discs noted. Visual field testing shows reduced peripheral vision. Pupils equal and reactive to light, no afferent pupillary defect.
Preliminary Lab Results: Blood Tests: CBC and metabolic panel within normal limits. Blood glucose: 5.2 mmol/L (normal).
Intraocular Pressure (IOP): Measured at 22 mmHg in the right eye and 21 mmHg in the left eye.
Diagnostic Imaging: OCT: Shows thinning of the retinal nerve fibre layer in both eyes, consistent with glaucoma.

What is the most likely Traditional Chinese Medicine (TCM) diagnosis for this patient’s condition?

Sample Case #1

Patient: 62-year-old male, 175 cm (5'9"), 82 kg (181 lbs), BMI: 26.8
Presentation: The patient presents with increasing difficulty seeing in low light and a noticeable reduction in peripheral vision over the past year. He reports occasional eye pain and headaches, especially after reading or using a computer for extended periods. He is concerned about his vision and has been diagnosed with open-angle glaucoma by his ophthalmologist. The patient is seeking naturopathic treatments to complement his current medical regimen and manage intraocular pressure naturally.
Medical History: Diagnosed with open-angle glaucoma 2 years ago. Mild hypertension diagnosed at age 55, controlled with medication. No history of diabetes. Cataract surgery in the right eye at age 60. No other significant illnesses or surgeries.
Psychosocial: Retired engineer, currently works part-time as a consultant. Lives with his wife in a suburban home. Enjoys reading, gardening, and spending time with his grandchildren, though his vision problems have limited these activities.
Health Habits: Diet: Breakfast: Oatmeal with berries and a cup of coffee. Lunch: Salad with grilled chicken or fish. Dinner: Cooked at home; typically includes lean protein, vegetables, and whole grains. Snacks on nuts and occasionally dark chocolate.
Alcohol: Drinks a glass of red wine with dinner most evenings.
Tobacco: Non-smoker, quit smoking at age 45.
Exercise: Walks for 30 minutes daily and practices yoga twice a week.
Supplements: Current Regimen: Takes a daily multivitamin, omega-3 fish oil, and lutein supplements for eye health.
Medication: Prescriptions: Latanoprost eye drops for glaucoma, taken once daily at night. Lisinopril 10 mg daily for hypertension. Over-the-Counter: Occasionally uses ibuprofen for joint pain
Allergies: No known drug allergies.
Family History: Father: Hypertension, died of a stroke at age 70. Mother: Age-related macular degeneration, still living. Siblings: One brother with hypertension and glaucoma.
Vital Signs: T: 36.7°C (98.1°F), BP: 128/78 mmHg, PR: 70 bpm, RR: 14 bpm.
Physical Exam: General Appearance: Appears well-nourished, alert, and oriented but anxious about his vision. Ophthalmic Exam: Bilateral cupping of the optic discs noted. Visual field testing shows reduced peripheral vision. Pupils equal and reactive to light, no afferent pupillary defect.
Preliminary Lab Results: Blood Tests: CBC and metabolic panel within normal limits. Blood glucose: 5.2 mmol/L (normal).
Intraocular Pressure (IOP): Measured at 22 mmHg in the right eye and 21 mmHg in the left eye.
Diagnostic Imaging: OCT: Shows thinning of the retinal nerve fibre layer in both eyes, consistent with glaucoma.

How should the ND adjust the patient’s omega-3 supplementation?

Sample Case #2

Patient: 40-year-old male, 180 cm (5'11"), 82 kg (180 lbs), BMI: 25.3
Presentation: The patient presents with a persistent feeling of extreme thirst and frequent urination, including waking up several times at night to urinate. He reports that these symptoms have gradually worsened over the past few months, and he has started to notice significant fatigue and an inability to concentrate during work. He is concerned about the impact of these symptoms on his quality of life and is seeking natural approaches to manage his condition.
Medical History: Diagnosed with hypertension at age 35, managed with medication. No surgeries or hospitalizations. No history of diabetes mellitus.
Psychosocial: Works as a project manager for a construction company. Married with two young children. Has a supportive family but feels overwhelmed by work stress and the demands of parenting.
Health Habits: Diet: Breakfast: Oatmeal with fruit and coffee. Lunch: Salad with grilled chicken or sandwich. Dinner: Varies but typically includes lean meats, vegetables, and whole grains. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks wine with dinner.
Tobacco: Non-smoker.
Exercise: Tries to go to the gym 3 times a week, focusing on cardio and strength training.
Supplements: Takes a daily multivitamin and omega-3 fish oil.
Medication: Lisinopril 10 mg daily for hypertension.
Allergies: No known drug allergies.
Family History: Father: Type 2 diabetes mellitus, managed with diet and oral medications. Mother: Hypothyroidism.
Grandfather: Died at age 70 from a myocardial infarction.
Vital Signs: T: 36.7°C (98°F), BP: 128/78 mmHg, PR: 72 bpm, RR: 14 bpm
Physical Exam: General appearance: Appears well-hydrated but slightly fatigued. No signs of edema. Skin is normal without any unusual pigmentation.
Preliminary Lab Results: Serum Sodium: 150 mEq/L [135-145 mEq/L], Serum Osmolality: 310 mOsm/kg [275-295 mOsm/kg], Urine Osmolality: 150 mOsm/kg [500-850 mOsm/kg], Glucose: 95 mg/dL [70-99 mg/dL]
Diagnostic Imaging: None performed at this stage, as the patient is under initial evaluation for his symptoms.

What is the primary function of antidiuretic hormone (ADH) in the body?

Sample Case #2

Patient: 40-year-old male, 180 cm (5'11"), 82 kg (180 lbs), BMI: 25.3
Presentation: The patient presents with a persistent feeling of extreme thirst and frequent urination, including waking up several times at night to urinate. He reports that these symptoms have gradually worsened over the past few months, and he has started to notice significant fatigue and an inability to concentrate during work. He is concerned about the impact of these symptoms on his quality of life and is seeking natural approaches to manage his condition.
Medical History: Diagnosed with hypertension at age 35, managed with medication. No surgeries or hospitalizations. No history of diabetes mellitus.
Psychosocial: Works as a project manager for a construction company. Married with two young children. Has a supportive family but feels overwhelmed by work stress and the demands of parenting.
Health Habits: Diet: Breakfast: Oatmeal with fruit and coffee. Lunch: Salad with grilled chicken or sandwich. Dinner: Varies but typically includes lean meats, vegetables, and whole grains. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks wine with dinner.
Tobacco: Non-smoker.
Exercise: Tries to go to the gym 3 times a week, focusing on cardio and strength training.
Supplements: Takes a daily multivitamin and omega-3 fish oil.
Medication: Lisinopril 10 mg daily for hypertension.
Allergies: No known drug allergies.
Family History: Father: Type 2 diabetes mellitus, managed with diet and oral medications. Mother: Hypothyroidism.
Grandfather: Died at age 70 from a myocardial infarction.
Vital Signs: T: 36.7°C (98°F), BP: 128/78 mmHg, PR: 72 bpm, RR: 14 bpm
Physical Exam: General appearance: Appears well-hydrated but slightly fatigued. No signs of edema. Skin is normal without any unusual pigmentation.
Preliminary Lab Results: Serum Sodium: 150 mEq/L [135-145 mEq/L], Serum Osmolality: 310 mOsm/kg [275-295 mOsm/kg], Urine Osmolality: 150 mOsm/kg [500-850 mOsm/kg], Glucose: 95 mg/dL [70-99 mg/dL]
Diagnostic Imaging: None performed at this stage, as the patient is under initial evaluation for his symptoms.

Which lab result is most indicative of diabetes insipidus in this patient?

Sample Case #2

Patient: 40-year-old male, 180 cm (5'11"), 82 kg (180 lbs), BMI: 25.3
Presentation: The patient presents with a persistent feeling of extreme thirst and frequent urination, including waking up several times at night to urinate. He reports that these symptoms have gradually worsened over the past few months, and he has started to notice significant fatigue and an inability to concentrate during work. He is concerned about the impact of these symptoms on his quality of life and is seeking natural approaches to manage his condition.
Medical History: Diagnosed with hypertension at age 35, managed with medication. No surgeries or hospitalizations. No history of diabetes mellitus.
Psychosocial: Works as a project manager for a construction company. Married with two young children. Has a supportive family but feels overwhelmed by work stress and the demands of parenting.
Health Habits: Diet: Breakfast: Oatmeal with fruit and coffee. Lunch: Salad with grilled chicken or sandwich. Dinner: Varies but typically includes lean meats, vegetables, and whole grains. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks wine with dinner.
Tobacco: Non-smoker.
Exercise: Tries to go to the gym 3 times a week, focusing on cardio and strength training.
Supplements: Takes a daily multivitamin and omega-3 fish oil.
Medication: Lisinopril 10 mg daily for hypertension.
Allergies: No known drug allergies.
Family History: Father: Type 2 diabetes mellitus, managed with diet and oral medications. Mother: Hypothyroidism.
Grandfather: Died at age 70 from a myocardial infarction.
Vital Signs: T: 36.7°C (98°F), BP: 128/78 mmHg, PR: 72 bpm, RR: 14 bpm
Physical Exam: General appearance: Appears well-hydrated but slightly fatigued. No signs of edema. Skin is normal without any unusual pigmentation.
Preliminary Lab Results: Serum Sodium: 150 mEq/L [135-145 mEq/L], Serum Osmolality: 310 mOsm/kg [275-295 mOsm/kg], Urine Osmolality: 150 mOsm/kg [500-850 mOsm/kg], Glucose: 95 mg/dL [70-99 mg/dL]
Diagnostic Imaging: None performed at this stage, as the patient is under initial evaluation for his symptoms.

Considering the patient's symptoms and lab results, which type of diabetes insipidus is most likely?

Sample Case #2

Patient: 40-year-old male, 180 cm (5'11"), 82 kg (180 lbs), BMI: 25.3
Presentation: The patient presents with a persistent feeling of extreme thirst and frequent urination, including waking up several times at night to urinate. He reports that these symptoms have gradually worsened over the past few months, and he has started to notice significant fatigue and an inability to concentrate during work. He is concerned about the impact of these symptoms on his quality of life and is seeking natural approaches to manage his condition.
Medical History: Diagnosed with hypertension at age 35, managed with medication. No surgeries or hospitalizations. No history of diabetes mellitus.
Psychosocial: Works as a project manager for a construction company. Married with two young children. Has a supportive family but feels overwhelmed by work stress and the demands of parenting.
Health Habits: Diet: Breakfast: Oatmeal with fruit and coffee. Lunch: Salad with grilled chicken or sandwich. Dinner: Varies but typically includes lean meats, vegetables, and whole grains. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks wine with dinner.
Tobacco: Non-smoker.
Exercise: Tries to go to the gym 3 times a week, focusing on cardio and strength training.
Supplements: Takes a daily multivitamin and omega-3 fish oil.
Medication: Lisinopril 10 mg daily for hypertension.
Allergies: No known drug allergies.
Family History: Father: Type 2 diabetes mellitus, managed with diet and oral medications. Mother: Hypothyroidism.
Grandfather: Died at age 70 from a myocardial infarction.
Vital Signs: T: 36.7°C (98°F), BP: 128/78 mmHg, PR: 72 bpm, RR: 14 bpm
Physical Exam: General appearance: Appears well-hydrated but slightly fatigued. No signs of edema. Skin is normal without any unusual pigmentation.
Preliminary Lab Results: Serum Sodium: 150 mEq/L [135-145 mEq/L], Serum Osmolality: 310 mOsm/kg [275-295 mOsm/kg], Urine Osmolality: 150 mOsm/kg [500-850 mOsm/kg], Glucose: 95 mg/dL [70-99 mg/dL]
Diagnostic Imaging: None performed at this stage, as the patient is under initial evaluation for his symptoms.

How should the ND interpret the patient's elevated serum sodium level in the context of his symptoms?

Sample Case #2

Patient: 40-year-old male, 180 cm (5'11"), 82 kg (180 lbs), BMI: 25.3
Presentation: The patient presents with a persistent feeling of extreme thirst and frequent urination, including waking up several times at night to urinate. He reports that these symptoms have gradually worsened over the past few months, and he has started to notice significant fatigue and an inability to concentrate during work. He is concerned about the impact of these symptoms on his quality of life and is seeking natural approaches to manage his condition.
Medical History: Diagnosed with hypertension at age 35, managed with medication. No surgeries or hospitalizations. No history of diabetes mellitus.
Psychosocial: Works as a project manager for a construction company. Married with two young children. Has a supportive family but feels overwhelmed by work stress and the demands of parenting.
Health Habits: Diet: Breakfast: Oatmeal with fruit and coffee. Lunch: Salad with grilled chicken or sandwich. Dinner: Varies but typically includes lean meats, vegetables, and whole grains. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks wine with dinner.
Tobacco: Non-smoker.
Exercise: Tries to go to the gym 3 times a week, focusing on cardio and strength training.
Supplements: Takes a daily multivitamin and omega-3 fish oil.
Medication: Lisinopril 10 mg daily for hypertension.
Allergies: No known drug allergies.
Family History: Father: Type 2 diabetes mellitus, managed with diet and oral medications. Mother: Hypothyroidism.
Grandfather: Died at age 70 from a myocardial infarction.
Vital Signs: T: 36.7°C (98°F), BP: 128/78 mmHg, PR: 72 bpm, RR: 14 bpm
Physical Exam: General appearance: Appears well-hydrated but slightly fatigued. No signs of edema. Skin is normal without any unusual pigmentation.
Preliminary Lab Results: Serum Sodium: 150 mEq/L [135-145 mEq/L], Serum Osmolality: 310 mOsm/kg [275-295 mOsm/kg], Urine Osmolality: 150 mOsm/kg [500-850 mOsm/kg], Glucose: 95 mg/dL [70-99 mg/dL]
Diagnostic Imaging: None performed at this stage, as the patient is under initial evaluation for his symptoms.

What would be an appropriate initial naturopathic approach to manage this patient's thirst and frequent urination?

Sample Case #2

Patient: 40-year-old male, 180 cm (5'11"), 82 kg (180 lbs), BMI: 25.3
Presentation: The patient presents with a persistent feeling of extreme thirst and frequent urination, including waking up several times at night to urinate. He reports that these symptoms have gradually worsened over the past few months, and he has started to notice significant fatigue and an inability to concentrate during work. He is concerned about the impact of these symptoms on his quality of life and is seeking natural approaches to manage his condition.
Medical History: Diagnosed with hypertension at age 35, managed with medication. No surgeries or hospitalizations. No history of diabetes mellitus.
Psychosocial: Works as a project manager for a construction company. Married with two young children. Has a supportive family but feels overwhelmed by work stress and the demands of parenting.
Health Habits: Diet: Breakfast: Oatmeal with fruit and coffee. Lunch: Salad with grilled chicken or sandwich. Dinner: Varies but typically includes lean meats, vegetables, and whole grains. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks wine with dinner.
Tobacco: Non-smoker.
Exercise: Tries to go to the gym 3 times a week, focusing on cardio and strength training.
Supplements: Takes a daily multivitamin and omega-3 fish oil.
Medication: Lisinopril 10 mg daily for hypertension.
Allergies: No known drug allergies.
Family History: Father: Type 2 diabetes mellitus, managed with diet and oral medications. Mother: Hypothyroidism.
Grandfather: Died at age 70 from a myocardial infarction.
Vital Signs: T: 36.7°C (98°F), BP: 128/78 mmHg, PR: 72 bpm, RR: 14 bpm
Physical Exam: General appearance: Appears well-hydrated but slightly fatigued. No signs of edema. Skin is normal without any unusual pigmentation.
Preliminary Lab Results: Serum Sodium: 150 mEq/L [135-145 mEq/L], Serum Osmolality: 310 mOsm/kg [275-295 mOsm/kg], Urine Osmolality: 150 mOsm/kg [500-850 mOsm/kg], Glucose: 95 mg/dL [70-99 mg/dL]
Diagnostic Imaging: None performed at this stage, as the patient is under initial evaluation for his symptoms.

Which botanical medicine could potentially support the management of this patient’s condition?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

What is the most likely physiological cause of the patient’s symptoms?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

Which electrolyte imbalance is most commonly associated with hyperventilation syndrome?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

What is the most appropriate initial approach for managing the patient’s acute symptoms?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

Considering the patient’s anxiety disorder, what therapeutic strategy should the ND prioritize to prevent hyperventilation episodes?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

What is the best dietary recommendation to support overall well-being and reduce anxiety for this patient?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

How should the ND address the patient’s use of alprazolam, considering her symptoms and history?

Sample Case #3

Patient: 35-year-old female, 166 cm (5'5"), 58 kg (128 lbs), BMI: 21.1
Presentation: The patient presents with recurrent episodes of rapid breathing, accompanied by lightheadedness, chest tightness, and tingling sensations in her hands and feet. These symptoms have been occurring more frequently over the past few months, often triggered by stress or crowded environments. The patient is concerned that these episodes may indicate a serious underlying health issue and is seeking natural ways to manage her symptoms and improve her overall well-being.
Medical History: Diagnosed with generalized anxiety disorder at age 28, managed with occasional use of anti-anxiety medications. No surgeries or hospitalizations. No history of asthma or other respiratory conditions.
Psychosocial: Works as an office manager for a busy law firm, often under significant stress. Married with one child. Enjoys spending time with family but finds it challenging to balance work and home life. Describes herself as a perfectionist, often feeling overwhelmed by responsibilities.
Health Habits: Diet: Breakfast: Smoothie with spinach, banana, and almond milk. Lunch: Salad with grilled chicken and avocado. Dinner: Salmon with quinoa and steamed vegetables. Snacks on nuts and fruit throughout the day.
Alcohol: Occasionally drinks a glass of wine in the evening.
Tobacco: Non-smoker.
Exercise: Practices yoga twice a week and takes a brisk walk during lunch breaks.
Supplements: Takes a daily multivitamin and magnesium supplement, as recommended by a previous healthcare provider.
Medication: Occasionally takes lorazepam (0.5 mg) during periods of intense anxiety.
Allergies: No known drug allergies.
Family History: Father: Hypertension, controlled with medication. Mother: Anxiety and panic disorder. Grandmother: Died at age 75 from a stroke.
Vital Signs: T: 36.6°C (97.9°F), BP: 125/80 mmHg, PR: 78 bpm, RR: 16 bpm
Physical Exam: General appearance: Appears anxious but cooperative. Respiratory: Breath sounds clear, no wheezing or crackles noted. Cardiovascular: Regular heart rate and rhythm, no murmurs. Neurological: No focal deficits, but patient reports mild paresthesia in the extremities during hyperventilation episodes.
Preliminary Lab Results: Complete Blood Count (CBC): Within normal limits. Electrolytes: Sodium: 140 mEq/L, Potassium: 4.0 mEq/L, Calcium: 9.0 mg/dL.
Arterial Blood Gas (ABG): pH 7.47 [7.35-7.45], PaCO2: 33 mmHg [35-45 mmHg], PaO2: 98 mmHg [80-100 mmHg], HCO3: 24 mEq/L [22-26 mEq/L].
Diagnostic Imaging: No imaging performed at this stage, as the patient is under initial evaluation for her symptoms.

What is the most appropriate lab test to monitor if the patient’s symptoms persist or worsen?

A 65-year-old patient with a history of hypertension presents with a suspected cerebral aneurysm. Which imaging modality is most appropriate for confirming the diagnosis?

A patient diagnosed with melanoma is seeking naturopathic support during conventional treatment. Which intervention should be prioritized to enhance overall treatment outcomes?

A patient presents with a history of repetitive running and reports lateral knee pain. Which condition should be considered, and what is the best initial management approach?

A patient presents with rapidly spreading redness, pain, and swelling in the lower leg, accompanied by fever. Which diagnosis should be ruled out immediately?

A woman with a BRCA1 gene mutation is seeking naturopathic advice for cancer prevention. Which intervention should be emphasized to support cellular health and reduce cancer risk?

A patient with suspected organochlorine pesticide toxicity presents with neurological symptoms, including tremors and dizziness. Which naturopathic intervention should be prioritized to enhance detoxification and reduce the body burden of organochlorines?