Biomedicine
You are not diagnosing; you are screening
Biomedicine items test whether you recognize a presentation that must leave your office. Know normal adult vitals: heart rate 60-100, respiratory rate 12-20, blood pressure under 120/80, temperature roughly 36.5-37.5 C. Know that HbA1c below 5.7 percent is normal and 6.5 or above suggests diabetes, and that INR of 2-3 is typical therapeutic anticoagulation.
Red flags to refer emergently
Chest pain or pressure, sudden severe headache, focal neurologic deficits or new slurred speech, fever with neck stiffness, unexplained weight loss, night pain that wakes the patient, new GI bleeding or black stools, and any suspected fracture. These are transferable to urgent care or the emergency department, not treatable in a session.
Medications and interactions
Anticoagulants (warfarin, DOACs) and antiplatelets raise bleeding risk; avoid deep or highly vascular needling and consider deferring. Corticosteroids, poorly controlled diabetes, and immunosuppression raise infection risk. Pacemakers and implanted devices rule out electrical stimulation over the chest. Insulin timing matters for fainting risk.
Traps
The exam rewards knowing limits. Stems describing clear biomedical pathology expect referral plus continued supportive care, not a reclassification into an Oriental pattern. Watch for questions where an incidental abnormal vital sign, such as a blood pressure of 190/110, should change your plan.
Worked example
A patient on warfarin reports an INR of 4.0 today. Rule of thumb: an INR above the therapeutic range plus a bleeding-risk intervention means defer needling, document, and communicate with the prescriber rather than proceeding with shallow needles and hoping.