Fourth B.H.M.S. Winter - 2020 PRACTICE OF MEDICINE-|

1. Write short answer 

a) Write two investigations for Asthama.

b) Define haemoptysis and write two causes of it.

c) Define constipation and give two causes.

d) Define Pseudomyxoma peritonei.

e) Define Malena and give its two causes.

f) Mention four common causes of acute diarrhoeal disease.

g) Mention four laboratory investigations for hepatic diseases.

h) Write down types of Gall stones.

1!) Mention two homoeopathic remedies for Hepatitis.

j) | Write four clinical features of Acute Pancreatitis.

k) Four causes of Hyperkalemia.

1!) Four oral manifestations of HIV.

m) Name four agents causing Environmental Hazards.

n) Define epidemic dropsy with two clinical features.

0) Four common infections occuring due to AIDS. 

2. Write short answer 

a) Heat stroke.

b) Dhatura Poisoning.

c) Indications of Arsenic Album in Gastric ulcers.

d) Indications of Merc sol in Ulcerative colitis.

e) Pulmonary Embolism.

f) Causes of Hepatomegaly.

3. Write short answer 

a) Hepatitis C.

b) Indications of Podophylum in Diarrhoea.

c) Indications of Aesculus Hip in Lower gastrointestinal bleeding.

d) Kaposi’s Sarcoma.

€) Indications of Arnica mont in Pulmonary embolism.

f) Indications of Tuberculinum in Abdominal tuberculosis.

4. Long answer question 

a) Write in detail about COPD and give indications of Lobelia and stanum

met in the same.

b) Write indications of Cardus mar and Belladonna in Acute pancreatitis.

c) Indications of Silicea and Hepar Sulph in Amoebic Liver Abcess

d) Indications of Sulphur and Calcarea Carb in Candidiasis. -

Long answer question 

5. Explain in detail Bronchial asthama and elaborate Scope and limitations of

homoeopathy and Chronic Prescribing in it. 

6. Explain in detail Gastroesophagial Reflux Disease with Acute prescribing and

Chronic prescribing.

 7. Describe Cirrhotie ascities with scope and limitation of homoeopahty and

Auxillary and ancillary measures for it.

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Question 1. Write short answers

a) Write two investigations for Asthma.

• Pulmonary Function Test (PFT) including Spirometry

• Peak Expiratory Flow Rate (PEFR)

b) Define Haemoptysis and write two causes of it.

• Definition: Expectoration of blood from the respiratory tract.

• Causes:

  • Pulmonary tuberculosis

  • Bronchogenic carcinoma

c) Define constipation and give two causes.

• Definition: Infrequent, hard or difficult passage of stool.

• Causes:

  • Low fiber diet

  • Hypothyroidism

d) Define Pseudomyxoma peritonei.

• A rare condition involving gelatinous ascitic fluid in the peritoneum due to mucin-secreting tumor cells, often from appendiceal or ovarian origin.

e) Define Malena and give its two causes.

• Definition: Passage of black, tarry stools due to upper GI bleeding.

• Causes:

  • Peptic ulcer

  • Esophageal varices

f) Mention four common causes of acute diarrhoeal disease.

• Rotavirus infection

• Escherichia coli (ETEC)

• Giardia lamblia

• Contaminated water

g) Mention four laboratory investigations for hepatic diseases.

• Serum bilirubin

• ALT and AST

• Alkaline phosphatase

• Prothrombin time

h) Write down types of gallstones.

• Cholesterol stones

• Pigment stones (Black and Brown)

i) Mention two homoeopathic remedies for Hepatitis.

• Chelidonium majus

• Carduus marianus

j) Write four clinical features of Acute Pancreatitis.

• Severe epigastric pain radiating to back

• Nausea and vomiting

• Fever

• Elevated serum amylase/lipase

k) Four causes of Hyperkalemia.

• Renal failure

• Addison's disease

• Potassium-sparing diuretics

• Hemolysis

l) Four oral manifestations of HIV.

• Oral candidiasis

• Hairy leukoplakia

• Aphthous ulcers

• Kaposi’s sarcoma

m) Name four agents causing environmental hazards.

• Lead

• Mercury

• Asbestos

• Pesticides

n) Define epidemic dropsy with two clinical features.

• Definition: Epidemic edema due to consumption of adulterated mustard oil (with Argemone oil).

• Clinical features:

  • Bilateral pedal edema

  • Glaucoma

o) Four common infections occurring due to AIDS.

• Tuberculosis

• Pneumocystis jirovecii pneumonia

• Cytomegalovirus

• Candidiasis

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Q.2 Short Answer Questions (6 questions × 5 marks = 30 marks)

a) Heat Stroke

Definition:
Heat stroke is a medical emergency marked by failure of the thermoregulatory mechanism due to prolonged exposure to high temperatures, typically above 40°C, with CNS dysfunction.

Causes:

• High environmental temperature

• Prolonged physical activity in hot climate

• Dehydration

Clinical features:

• Hyperthermia (>104°F or 40°C)

• Dry, hot skin (anhidrosis)

• CNS symptoms: confusion, seizures, coma

• Hypotension

• Tachycardia

Management:

• Immediate cooling (ice packs, cool water immersion)

• IV fluids

• Hospitalization for monitoring organ functions

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b) Datura Poisoning

Cause: Ingestion of seeds or leaves of Datura stramonium (contains atropine, hyoscyamine, scopolamine).

Symptoms:

• Dry mouth, dilated pupils (mydriasis)

• Flushed, hot skin

• Hallucinations, delirium, confusion

• Urinary retention

• Tachycardia

• "Blind as a bat, mad as a hatter, red as a beet, dry as a bone" (classic mnemonic)

Treatment:

• Gastric lavage

• Activated charcoal

• Physostigmine (antidote)

• Supportive care

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c) Indications of Arsenic Album in Gastric Ulcers

• Burning pain in stomach relieved by warm drinks

• Anxiety, restlessness, prostration

• Thirst for small sips at short intervals

• Worse at midnight

• Offensive vomiting after food intake

• Diarrhoea with weakness

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d) Indications of Mercurius Solubilis in Ulcerative Colitis

• Bloody, slimy stools with tenesmus

• Offensive odor of stool

• Constant desire to pass stool with little result

• Sweat with offensive odor

• Worse at night and from cold drinks

• Tongue flabby with imprints of teeth

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e) Pulmonary Embolism

Definition: Obstruction of pulmonary arteries by thrombus from deep veins (DVT).

Causes:

• Prolonged immobility

• Postoperative state

• Pregnancy

• Malignancy

• Oral contraceptives

Symptoms:

• Sudden onset dyspnea

• Chest pain (pleuritic)

• Hemoptysis

• Cyanosis

• Tachycardia

• Hypotension (in massive PE)

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f) Causes of Hepatomegaly

1. Infective causes: Hepatitis (viral A–E), malaria, leptospirosis

2. Congestive: Right heart failure, Budd-Chiari syndrome

3. Infiltrative: Fatty liver, amyloidosis, lymphoma

4. Neoplastic: Hepatocellular carcinoma, metastasis

5. Storage diseases: Gaucher's disease, hemochromatosis

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Great! Let's now continue with:

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Q.3 Short Answer Questions (6 questions × 5 marks = 30 marks)

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a) Hepatitis C

Definition:
Hepatitis C is a liver infection caused by the Hepatitis C Virus (HCV), primarily transmitted through blood.

Causes/Risk Factors:

• Blood transfusion (before 1992)

• IV drug use

• Unprotected sex

• Unsafe medical injections

• Needle-stick injuries

Clinical Features:

• Often asymptomatic in early stages

• Fatigue, anorexia, nausea

• Jaundice (in few cases)

• Chronic infection may lead to cirrhosis or hepatocellular carcinoma

Diagnosis:

• Anti-HCV antibodies (ELISA)

• HCV RNA (PCR)

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b) Indications of Podophyllum in Diarrhoea

• Profuse, offensive, painless, gushing stool

• Worse in early morning

• Prolapse of rectum with diarrhoea

• Watery stool with weakness

• Diarrhoea alternates with constipation

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c) Indications of Aesculus Hippocastanum in Lower GI Bleeding

• Painful haemorrhoids without bleeding

• Feeling of a stick in rectum

• Dry, hard stool with burning

• Backache and fullness in liver region

• Rectal pain lasts long after stool

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d) Kaposi’s Sarcoma

Definition:
A vascular tumor associated with Human Herpesvirus 8 (HHV-8), commonly seen in AIDS patients.

Features:

• Purplish-red to brown macules, nodules on skin

• Can involve oral mucosa, GI tract, and lungs

• Non-blanching and painless

• Diagnostic in advanced HIV infection

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e) Indications of Arnica Montana in Pulmonary Embolism

• Sudden dyspnea after exertion or trauma

• Fear of being touched, bruised feeling

• Hemorrhagic tendencies

• Useful after trauma/surgery leading to embolism

• Thirst with aversion to liquids

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f) Indications of Tuberculinum in Abdominal Tuberculosis

• Emaciation despite good appetite

• Chronic abdominal pain with distention

• Night sweats and fever

• Restlessness and constant change

• Desire for cold drinks and change

• Family history of TB

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Now, I’ll proceed to Question 4: Long Answer Questions.

Q.4 Long Answer Questions (Solve All: 4 × 10 = 40 marks)

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a) Write in detail about COPD and give indications of Lobelia and Stannum Met in the same.

COPD (Chronic Obstructive Pulmonary Disease)
A progressive lung disease characterized by airflow limitation that is not fully reversible. Includes chronic bronchitis and emphysema.

Etiology:

• Smoking (primary cause)

• Air pollution

• Occupational exposure

• Alpha-1 antitrypsin deficiency (genetic)

Clinical Features:

• Chronic cough with sputum

• Dyspnea on exertion

• Wheezing

• Barrel-shaped chest

• Use of accessory muscles

• Cyanosis (in later stages)

Diagnosis:

• Spirometry (↓FEV1/FVC ratio)

• Chest X-ray (hyperinflation)

• ABG (hypoxia, hypercapnia)

Miasmatic Background: Syphilitic with tubercular tendencies

Chronic Prescribing in Homoeopathy:

• Based on totality of symptoms

• Antimiasmatic treatment if indicated

• Use of constitutional remedies

Indications of:

1. Lobelia Inflata:

   • Dyspnea with oppression of chest

   • Asthmatic attacks with nausea

   • Sensation of weight or lump in the chest

   • Worse from exertion

   • Trembling with breathlessness

2. Stannum Metallicum:

   • Great weakness of chest, cannot talk or read aloud

   • Expectoration thick, yellow-green

   • Coughing leads to weakness

   • Worse from talking or laughing

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b) Write indications of Cardus Marianus and Belladonna in Acute Pancreatitis.

Acute Pancreatitis: Sudden inflammation of the pancreas with abdominal pain and systemic manifestations.

Symptoms:

• Epigastric pain radiating to back

• Vomiting

• Fever

• Elevated amylase/lipase

Indications:

1. Cardus Marianus:

   • Liver and pancreatic congestion

   • Nausea, vomiting with stitching pain

   • Jaundiced skin

   • Bitter taste in mouth

   • Great weakness with burning pain in region of liver and pancreas

2. Belladonna:

   • Sudden, violent pain

   • High fever with flushed face

   • Dry mouth, thirst, and delirium

   • Pains come and go suddenly

   • Extreme sensitiveness to touch and jarring

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c) Indications of Silicea and Hepar Sulph in Amoebic Liver Abscess

Amoebic Liver Abscess:
Caused by Entamoeba histolytica, presenting with fever, right upper abdominal pain, hepatomegaly.

Indications:

1. Silicea:

   • Chronic abscess tendency

   • Hepatic abscess with chilliness

   • Purulent, offensive discharges

   • Patient chilly, wants to be wrapped up

2. Hepar Sulphuris:

   • Suppurative liver abscess with throbbing pain

   • Marked sensitivity to touch

   • Pain worsens at night

   • Desire for sour and pungent things

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d) Indications of Sulphur and Calcarea Carb in Candidiasis

Candidiasis: A fungal infection caused by Candida albicans, often involving oral cavity, skin folds, genitals.

Indications:

1. Sulphur:

   • Burning, itching, aggravated by warmth

   • Offensive discharges, excoriating skin

   • Redness of mucous membranes

   • Worse from washing, warmth in bed

2. Calcarea Carbonica:

   • White, milky discharges

   • Candidiasis in overweight, chilly patients

   • Craving for eggs, indigestible things

   • Profuse sweating on head

Q.5 Long Answer: Bronchial Asthma

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Definition

Bronchial asthma is a chronic inflammatory disorder of the airways characterized by reversible airflow obstruction, bronchial hyperresponsiveness, and inflammation.

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Types of Asthma

1. Allergic (Extrinsic) Asthma – Triggered by allergens (dust, pollen).

2. Non-Allergic (Intrinsic) Asthma – Triggered by infections, stress.

3. Exercise-induced Asthma

4. Occupational Asthma

5. Drug-induced Asthma (e.g., aspirin)

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Clinical Features

• Recurrent episodes of wheezing

• Cough (often nocturnal)

• Dyspnea (shortness of breath)

• Chest tightness

• Symptoms are worse at night or early morning

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Investigations

• Spirometry: ↓ FEV1, ↓ FEV1/FVC ratio (reversible after bronchodilator)

• Peak Expiratory Flow Rate (PEFR)

• Chest X-ray (hyperinflation)

• Allergy tests (IgE levels, skin prick tests)

• Sputum eosinophilia

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Miasmatic Understanding

• Psora: Allergic, constitutional tendency, functional disturbances

• Sycosis: Overgrowths, excessive secretions, inflammation

• Tubercular: Periodic recurrence, hereditary weakness, changeability

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Scope and Limitations of Homoeopathy

Scope:

• Useful in controlling acute attacks

• Can reduce frequency and severity

• Helpful in managing allergic tendencies

• Strengthens immunity and constitution

Limitations:

• Emergency situations (status asthmaticus) need conventional intervention

• Not a substitute for oxygen therapy or bronchodilators in acute life-threatening episodes

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Chronic Prescribing in Asthma

• Based on totality of symptoms

• Miasmatic remedy selection

• Chronic constitutional remedy

• Avoid suppressive measures

Important Remedies:

1. Lobelia Inflata – Spasmodic asthma with nausea, dyspnea, anxiety.

2. Ipecacuanha – Constant cough with gagging/vomiting.

3. Arsenicum Album – Great restlessness, worse at night, cold drinks.

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Now moving to:

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Q.6 Long Answer: Gastroesophageal Reflux Disease (GERD)

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Definition

GERD is a condition in which stomach contents reflux into the esophagus causing symptoms and/or complications.

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Causes

• Lower esophageal sphincter dysfunction

• Hiatal hernia

• Obesity

• Smoking, alcohol

• Certain drugs (NSAIDs, theophylline)

• Pregnancy

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Clinical Features

• Heartburn (retrosternal burning)

• Regurgitation

• Dysphagia

• Chest pain

• Chronic cough or hoarseness (due to laryngopharyngeal reflux)

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Investigations

• Upper GI endoscopy

• 24-hour pH monitoring

• Barium swallow

• Esophageal manometry

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Acute Prescribing

• Nux Vomica – Heartburn, regurgitation, worsened by rich food/alcohol.

• Iris Versicolor – Burning along GI tract, sour vomiting, worse at night.

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Chronic Prescribing

• Based on:

  • Constitution

  • Miasmatic history

  • Generalities

  • Mentals

• Lycopodium – Flatulence, regurgitation, worse 4-8 PM, craving sweets.

• Robinia – Intense heartburn, sour eructations, especially during pregnancy.

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Q.7 Long Answer: Cirrhotic Ascites

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Definition

Accumulation of fluid in the peritoneal cavity due to liver cirrhosis, secondary to portal hypertension and hypoalbuminemia.

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Causes

• Alcoholic liver disease

• Hepatitis B/C

• Autoimmune hepatitis

• Non-alcoholic fatty liver disease

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Clinical Features

• Abdominal distention

• Shifting dullness, fluid thrill

• Peripheral edema

• Fatigue, weight loss

• Jaundice (in advanced stages)

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Investigations

• USG abdomen

• Serum-ascites albumin gradient (SAAG)

• Liver function tests (LFTs)

• Ascitic fluid analysis

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Scope and Limitations of Homoeopathy

Scope:

• Early ascites can be managed

• Can prevent progression

• Improves liver function

• Better control over constitutional complaints

Limitations:

• Not effective in advanced ascites with hepatic coma

• Supportive conventional therapy often needed

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Auxiliary and Ancillary Measures

• Salt restriction

• Diuretics (in conventional medicine)

• Avoid alcohol and hepatotoxic drugs

• Nutritional support

• Regular monitoring of LFT and ascitic fluid

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Homoeopathic Remedies:

1. Carduus Marianus – Liver affections with ascites, jaundice, pain under ribs.

2. Apis Mellifica – Edema, ascites, worse from heat, better in open air.

3. Digitalis – Weak heart, slow pulse, associated ascites.

4. Chelidonium – Liver enlargement, pain radiating to back, yellow tongue.

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