4th BHMS Winter 2022 PRACTICE OF MEDICINE / MEDICINE / HOMOEOPATHIC THERAPEUTICS -2 [Solved Paper]

 Short Answer Questions (Solve any 4 Out of 6) 

a) Glasgow Coma Scale 

b) Pernphigas 

c) Asphyxia Neonatorum 

d) Incontinence of Urine - Causes and clinical features 

e) Clinical features of Schizophrenia 

f) Beriberi 

3. Short Answer Questions  

Mezerium in Eczema 

Chininum Ars. in Malaria 

Platina in Hysteria

 Calc.Phos in Rickets

 Abrotanurn in Marastnus

 Causticurn in Urinary Retention 

 4. Long Answer Questions (solve any 2 Out or 4) 

 a) Give causes and clinical features A-cute Renal failure with indications of Cantharis and Apis mel. 

b) Describe Lichen lanus with indications of Sulphur and Natrum mur for it 

c) Poliomyelitis - Clinical features and clinical types \ treatment indications of Gelsemium and Hypericum for it.

 d) Aetiology and clinical features of icliopatifte thrombocytic purpura and indications or Lachesis and Phosphorus for it 

Long Answer Questions (Any one from Q.No. 5, 6 and 7) 

5. Discuss Subarachnoid Haemorrhage with respect to clinical features, complications acute prescription and miasmatic understanding. 

6. Discuss in detail Diabetes Mellitus with respect to classification, acute and chronic complications, miasmatic understanding , auxilliary mode of treatment. 

7. Discuss Nilitral Stenosis with respect to causes , clinical features miasmatic understanding and auxilliary management 

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✅ Q.2 – Short Answer Questions (All 6 Solved)

[6 × 5 = 30 Marks]

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🔹 a) Glasgow Coma Scale (GCS)

Used to assess level of consciousness in head injury.

Component	Response	Score
Eye Opening	Spontaneous, verbal, pain, none	4–1
Verbal Response	Oriented to no response	5–1
Motor Response	Obeys to decerebrate posture	6–1

• Total Score: 3 (deep coma) to 15 (normal)

• <8 = severe; 9–12 = moderate; >13 = mild head injury

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🔹 b) Pemphigus

• Rare, autoimmune bullous skin disease

• Involves desmoglein antibodies attacking skin adhesion

Clinical Features:

• Flaccid blisters that rupture easily

• Painful erosions in mouth and skin

• Positive Nikolsky’s sign

• Common variant: Pemphigus vulgaris

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🔹 c) Asphyxia Neonatorum

• Failure to initiate/maintain respiration after birth.

Causes:

• Birth trauma

• Prematurity

• Cord prolapse

• Meconium aspiration

Signs:

• Cyanosis

• Apnea or gasping

• Floppy muscles

• HR < 100 bpm

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🔹 d) Incontinence of Urine – Causes & Clinical Features

Causes:

• Neurogenic bladder

• UTI

• Spinal cord injury

• BPH in males

Types:

• Urge, stress, overflow, functional

Symptoms:

• Involuntary leakage

• Frequency, urgency

• Nocturnal enuresis

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🔹 e) Clinical Features of Schizophrenia

1. Positive symptoms:

   • Hallucinations (esp. auditory)

   • Delusions (paranoia)

2. Negative symptoms:

   • Apathy, flat affect

   • Social withdrawal

3. Disorganized thinking:

   • Incoherent speech

   • Catatonia in some cases

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🔹 f) Beriberi

• Caused by Vitamin B1 (Thiamine) deficiency.

Types:

1. Dry: Peripheral neuropathy, foot drop

2. Wet: High-output heart failure, edema

3. Infantile: Hoarseness, vomiting, cardiac failure

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✅ Q.3 – Short Answer Questions (All 6 Solved)

[6 × 5 = 30 Marks]

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🔹 a) Mezereum in Eczema

• Thick crusts with pus oozing beneath

• Itching < warmth of bed

• Intolerable itching, worse scratching

• Raw, excoriated skin

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🔹 b) Chininum Arsenicosum in Malaria

• Exhaustion, chills at regular intervals

• Marked periodicity

• Profuse sweating, burning

• Palpitations, restlessness

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🔹 c) Platina in Hysteria

• Proud, haughty behavior

• Hypersensitivity to touch

• Convulsive sobbing, exaggerated sexuality

• Suited to women with nervous temperament

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🔹 d) Calcarea Phosphorica in Rickets

• Late closure of fontanelles

• Curved bones, delayed dentition

• Emaciated, pot-bellied

• Craves salt/smoked meats

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🔹 e) Abrotanum in Marasmus

• Emaciation of lower limbs

• Good appetite but wasting continues

• Irritable child

• Useful after suppression of diarrhea

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🔹 f) Causticum in Urinary Retention

• Retention from nerve injury or surgery

• Paralysis of bladder

• Passes urine slowly, drop by drop

• Better in rainy weather

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✅ Q.4 – Long Answer Questions (All 4 Solved)

[4 × 10 = 40 Marks]

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🔷 a) Acute Renal Failure (ARF)

Definition:
Sudden, reversible decline in kidney function resulting in retention of nitrogenous waste and disturbances in fluid, electrolyte, and acid-base balance.

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Causes:

1. Pre-renal:

   • Hypovolemia, shock, dehydration

   • CHF, liver failure

2. Renal (intrinsic):

   • Acute tubular necrosis

   • Glomerulonephritis

   • Drugs (NSAIDs, aminoglycosides)

3. Post-renal:

   • Ureteral or bladder obstruction

   • BPH, stones, tumors

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Clinical Features:

• Oliguria/anuria

• Edema

• Hypertension

• Nausea, vomiting

• Uremic symptoms: confusion, fatigue

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Homoeopathic Remedies:

1. Cantharis

• Constant urge to urinate

• Burning pain before, during, after micturition

• Hematuria

• Suited in nephritis with painful retention

2. Apis Mellifica

• Scanty or suppressed urine

• Edema (face, eyelids)

• Burning urination with stinging pain

• Aggravated by heat, better cold

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🔷 b) Lichen Planus

Definition:
Chronic autoimmune skin condition affecting skin, mucous membranes, nails.

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Clinical Features:

• Purple, polygonal, flat-topped papules

• Wickham's striae (lacy white lines)

• Itching

• Involvement of buccal mucosa and genitalia

• Nail changes: ridging, thinning

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Homoeopathic Remedies:

1. Sulphur

• Dry, scaly, itchy eruptions

• Worse from heat and bathing

• Burning and scratching desire

• Unclean patients, philosophical

2. Natrum Muriaticum

• Itching after sweating

• Eruptions in flexures

• Grief, reserved nature

• < Sun, consolation

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🔷 c) Poliomyelitis

Definition:
Viral infection by Poliovirus affecting anterior horn cells causing flaccid paralysis.

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Clinical Types:

• Abortive

• Non-paralytic

• Paralytic (most severe)

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Clinical Features:

• Fever, headache

• Neck stiffness

• Muscle pain

• Flaccid asymmetrical paralysis

• No sensory loss

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Homoeopathic Remedies:

1. Gelsemium

• Muscular weakness

• Drooping eyelids, trembling

• Anticipatory anxiety

• Suitable in early stages

2. Hypericum

• Nerve injuries and spinal trauma

• Violent, shooting pain

• Prevents or treats nerve degeneration

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🔷 d) Idiopathic Thrombocytic Purpura (ITP)

Definition:
Autoimmune destruction of platelets causing thrombocytopenia and bleeding.

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Etiology:

• Autoimmune (unknown trigger)

• Post-viral in children

• Drug-induced

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Clinical Features:

• Petechiae, ecchymoses

• Gum bleeding

• Menorrhagia

• Hematuria

• Rarely, intracranial hemorrhage

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Homoeopathic Remedies:

1. Lachesis

• Dark purplish hemorrhages

• Worse from touch, heat, sleep

• Left-sided complaints

• Intense loquacity

2. Phosphorus

• Bright red bleeding from any orifice

• Hematemesis, epistaxis

• Craving for cold food and drinks

• Tall, lean, gentle personalities

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✅ Q.5 – Subarachnoid Hemorrhage

[20 Marks]

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Definition:

Bleeding into the subarachnoid space, often due to ruptured berry aneurysm.

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Clinical Features:

• Sudden, severe “worst headache of life”

• Neck stiffness

• Photophobia

• Vomiting

• Loss of consciousness or seizures

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Complications:

• Re-bleed

• Vasospasm → ischemia

• Hydrocephalus

• Death

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Acute Prescribing:

• Control BP, prevent seizures

• Homoeopathy: early stages with symptoms of shock, pain, vascular fragility

1. Belladonna – throbbing headache, flushed face
2. Glonoinum – bursting headache, better pressure

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Miasmatic Understanding:

• Syphilitic miasm: destructive pathology

• Psoric state: functional phase before rupture

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✅ Q.6 – Diabetes Mellitus

[20 Marks]

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Definition:

Group of metabolic disorders characterized by hyperglycemia due to insulin deficiency or resistance.

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Classification:

• Type 1 (IDDM) – autoimmune

• Type 2 (NIDDM) – insulin resistance

• Gestational DM

• Secondary DM

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Acute Complications:

• Diabetic ketoacidosis

• Hypoglycemia

• Hyperosmolar coma

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Chronic Complications:

• Neuropathy

• Retinopathy

• Nephropathy

• CAD, stroke

• Diabetic foot

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Miasmatic Understanding:

• Psora: functional (initial stage)

• Sycosis: metabolic derangement

• Syphilis: tissue destruction

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Auxiliary Mode of Treatment:

• Diet and exercise

• Glucose monitoring

• Stress control

• Foot care

• Regular eye and kidney screening

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✅ Q.7 – Mitral Stenosis

[20 Marks]

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Definition:

Narrowing of mitral valve orifice → impaired LV filling.

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Causes:

• Rheumatic fever (most common)

• Congenital

• Calcification in elderly

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Clinical Features:

• Dyspnea, especially on exertion

• Orthopnea, PND

• Palpitations (AFib)

• Hemoptysis

• Malar flush

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Miasmatic Understanding:

• Psora: functional dyspnea

• Sycosis: valvular thickening

• Syphilis: end-stage fibrosis

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Auxiliary Management:

• Avoid strenuous activity

• Diuretics for fluid overload

• Anticoagulation for AFib

• Surgery: valvotomy or valve replacement in severe cases

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