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

 2. Write short answer 

a) Myasthenia gravis.

b) Tetralogy of Fallot.

c) Dermatitis.

d) Marasmus.

e) Schizophrenia.

f) Immunization Schedule.

3. Write short answer 

a) Indications of Nitric acid in UT]

b) Indications of Ferrum Met in Anaemia.

c) Indications of Urtica urens in Urticaria.

d) Indications of Graphitis in Psoriasis.

e) Indications of Chamomilla in Infantile Diarrhoea.

f) Indications Aconite in anxiety disorder.

4. Long answer question 

a) Write in detail about Renal calculus and its Homoeopathic management.

b) White in detail about Hemolytic Anemia and indication of 2 Homoeopathic

drugs.

c) Write in detail about Cellulitis and Homoeopathic management of the

same.

d) Write in detail about Filariasis and Homoeopathic management of the

same.

Long answer question 

5. Write in detail about Migraine and discuss its miasmatic heading with acute

and chronic prescribing. 

6. Write in detail about Rheumatic heart disease with scope and limitations of

homoeopathy and its Auxillary mode of treatment. 

7. - Write in detail about Diabetes and write 1ts homoeopathic scope and limitations

and miasmatic heading.

  a) Define Scurvy.

b) Calcarea Phos in Rickets.

c) Define Sickle cel] anemia.

d) Jodium in Thyroid disorders.

e) Define Addison’s disease.

f) Define Anuna.

g) Define unstable angina.

h) Helleborus in Neurological complaints.

i) Two indications of Belladona in Headache.

1) Two cardiac causes of chest pain.

k) Two indications of Bryonia in Osteoarthritis.

I) | Two indications of Amica in sprain.

m) Define Gonorrhoea.

n) Causative organism and incubation period of AIDS.

0) Two indications of Sulphur in Skin complaints. 

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2. Short Answer Questions (6 x 5 = 30 Marks)

a) Myasthenia Gravis
A chronic autoimmune neuromuscular disorder causing fluctuating muscle weakness and fatigue.

• Cause: Autoantibodies block acetylcholine receptors at neuromuscular junctions.

• Features: Ptosis, diplopia, difficulty swallowing, generalized weakness.

• Diagnosis: Edrophonium test, anti-ACh receptor antibody test, EMG.

• Management: Anticholinesterases (e.g., pyridostigmine), immunosuppressants, thymectomy.

b) Tetralogy of Fallot
A congenital heart defect with 4 features:

1. Pulmonary stenosis

2. Right ventricular hypertrophy

3. Overriding aorta

4. Ventricular septal defect (VSD)

• Features: Cyanosis, clubbing, squatting, "Tet spells".

• Diagnosis: Echo, chest X-ray (boot-shaped heart)

• Management: Surgical correction (Blalock-Taussig shunt, complete repair)

c) Dermatitis
Inflammation of skin characterized by erythema, itching, and rash.

• Types: Atopic, contact, seborrheic, nummular.

• Causes: Allergens, irritants, genetic factors.

• Management: Emollients, topical steroids, antihistamines.

d) Marasmus
A severe form of protein-energy malnutrition (PEM) due to caloric deficiency.

• Features: Wasting, severe weight loss, dry skin, thin limbs, alert but irritable child.

• Management: Gradual refeeding, electrolyte correction, treating infections.

e) Schizophrenia
A chronic psychiatric disorder with disturbances in thought, perception, and behavior.

• Symptoms: Delusions, hallucinations, disorganized speech, social withdrawal.

• Types: Paranoid, catatonic, disorganized.

• Treatment: Antipsychotics (e.g., risperidone), psychotherapy, rehabilitation.

f) Immunization Schedule (India, per National Immunization Program)

• Birth: BCG, OPV-0, Hep B-1

• 6, 10, 14 weeks: Pentavalent, OPV, Rotavirus, PCV

• 9 months: Measles-Rubella

• 16–24 months: DPT booster, MR-2

• 5–6 years: DPT booster

• 10, 16 years: Tetanus-diphtheria (Td)

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Q.3 Short Answer Questions

a) Indications of Nitric Acid in UTI (Urinary Tract Infection)
Nitric Acid is suited to patients with highly offensive urine and sharp, splinter-like pains.

• Key Indications:

  • Urine is dark, scanty, and offensive.

  • Cutting or burning pain while urinating.

  • Tenesmus after urination.

  • Suited for chronic cystitis.

• Modalities: Worse at night, after urination.

• Miasm: Syphilitic.

b) Indications of Ferrum Metallicum in Anaemia
Ferrum Met is indicated for patients with pale face, flushing easily, and fatigue.

• Key Indications:

  • Weakness with flushes of heat and palpitation.

  • Pale mucous membranes, dizziness, headaches.

  • Diarrhoea alternating with constipation.

  • Appetite increased despite anaemia.

• Modalities: Worse at rest, better walking slowly.

• Miasm: Psoric-syphilitic.

c) Indications of Urtica Urens in Urticaria

• Key Indications:

  • Burning, stinging, and itching eruptions.

  • Urticaria with rheumatism or after shellfish intake.

  • Useful in chronic urticaria and allergic skin conditions.

• Modalities: Worse from exposure to cold air or touch.

• Miasm: Psoric.

d) Indications of Graphites in Psoriasis

• Key Indications:

  • Thick, dry, rough skin with cracks and bleeding.

  • Itching aggravated by warmth and at night.

  • Dry scales, especially on the scalp, behind ears.

  • Oozing of sticky, honey-like discharge.

• Modalities: Worse from warmth, at night; better in open air.

• Miasm: Psoro-sycotic.

e) Indications of Chamomilla in Infantile Diarrhoea

• Key Indications:

  • Green, offensive stools like chopped eggs and spinach.

  • Restlessness and irritability during teething.

  • One cheek red, the other pale.

  • Cries unless carried.

• Modalities: Worse at night, with dentition.

• Miasm: Psoric.

f) Indications of Aconite in Anxiety Disorder

• Key Indications:

  • Sudden intense anxiety, fear of death.

  • Panic attacks following shock or exposure to cold.

  • Restlessness with palpitation and dry skin.

  • Fear predicts death or illness.

• Modalities: Worse at night, with cold dry winds.

• Miasm: Psoric.

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Q.4 Long Answer Questions (Solve Any Two – Full Paper Solved)

(2 × 10 = 20 Marks)

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a) Write in detail about Renal Calculus and its Homoeopathic Management

Definition

Renal calculus, also called nephrolithiasis, is the formation of stone-like concretions in the kidneys due to crystallization of minerals and salts.

Etiology (Causes)

• Dehydration (low water intake)

• High intake of oxalate-rich foods (e.g., spinach)

• Hypercalciuria

• Hyperparathyroidism

• Chronic urinary tract infections (UTIs)

• Family history

Types of Renal Stones

• Calcium oxalate (most common)

• Calcium phosphate

• Uric acid

• Cystine stones

• Struvite (infection-related)

Clinical Features

• Severe colicky pain radiating from flank to groin (renal colic)

• Hematuria (blood in urine)

• Dysuria, urgency, or frequency

• Nausea and vomiting

• Fever and chills (if infection is present)

Investigations

• Urinalysis

• X-ray KUB (Kidney-Ureter-Bladder)

• Ultrasonography

• CT Scan (most sensitive)

• Serum calcium and uric acid levels

Homoeopathic Management

1. Berberis Vulgaris

• Radiating pain in kidney extending to thighs.

• Pain worse from motion, pressure, and jarring.

• Bubbling sensation in the region of the kidneys.

2. Lycopodium Clavatum

• Right-sided renal colic.

• Red sand or brick-dust sediment in urine.

• Symptoms aggravated between 4–8 PM.

Miasmatic Understanding

• Sycotic for the tendency to form concretions.

• Psoric for functional symptoms.

• Syphilitic for destructive changes.

Auxiliary Management

• Increase fluid intake

• Reduce oxalate- and purine-rich foods

• Avoid excessive calcium supplements

• Medical management or surgical options in recurrent or obstructive cases

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b) Write in detail about Hemolytic Anemia and indication of 2 Homoeopathic Drugs

Definition

Hemolytic anemia refers to the premature destruction of red blood cells (RBCs), which exceeds their production rate by the bone marrow.

Types

• Intrinsic: Membrane defects, enzyme deficiencies (e.g., G6PD), hemoglobinopathies (e.g., Sickle cell)

• Extrinsic: Autoimmune disorders, infections, drugs, mechanical heart valves

Causes

• Autoimmune hemolytic anemia (AIHA)

• Infections (e.g., malaria)

• Hemoglobinopathies (e.g., thalassemia)

• Drug-induced (e.g., penicillin)

• Mechanical destruction (prosthetic valves)

Clinical Features

• Pallor, fatigue, weakness

• Jaundice (from hemolysis)

• Splenomegaly

• Dark urine (due to hemoglobinuria)

• Elevated reticulocyte count

Investigations

• CBC with peripheral smear

• Reticulocyte count

• Coombs test (direct and indirect)

• Bilirubin (unconjugated)

• LDH elevated, haptoglobin decreased

Homoeopathic Management

1. Ferrum Phosphoricum

• Early stages of anemia.

• Pale, flabby, fatigue with shortness of breath.

• Mild haemorrhagic tendencies.

2. China Officinalis

• Useful after blood loss (hemorrhagic or hemolytic).

• Debility, ringing in ears, and thirst for large quantities of water.

• Flatulence, palpitations.

Auxiliary Management

• Treat underlying cause

• Iron and folic acid supplementation if required

• Blood transfusions in severe cases

Miasmatic Understanding

• Predominantly syphilitic (destructive pathology)

• Psoro-syphilitic background

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c) Write in detail about Cellulitis and Homoeopathic management of the same

Definition

Cellulitis is an acute bacterial infection of the skin and subcutaneous tissues, usually caused by Streptococcus pyogenes or Staphylococcus aureus.

Etiology

• Breaks in the skin (cuts, wounds, insect bites)

• Skin conditions (eczema, athlete’s foot)

• Weakened immune system

• Diabetes mellitus

• Post-surgical wounds

Clinical Features

• Red, swollen, warm, and painful area on the skin

• Fever and chills

• Swollen lymph nodes

• Possible abscess formation

Common Sites

• Lower legs

• Face (especially in children)

• Arms

Investigations

• Clinical diagnosis is primary

• CBC (raised WBC)

• Culture of pus (if any)

• CRP and ESR elevated

• Ultrasound (if abscess is suspected)

Complications

• Abscess formation

• Sepsis

• Lymphangitis

• Necrotizing fasciitis (in severe cases)

Homoeopathic Management

1. Belladonna

• Sudden onset with redness, swelling, and throbbing pain.

• Skin hot and dry.

• Symptoms aggravated by touch and motion.

2. Apis Mellifica

• Edematous, puffy, rosy skin with stinging pain.

• Better by cold applications.

• Urticarial appearance.

Other indicated remedies:

• Rhus tox: Vesicular eruptions with itching.

• Hepar sulph: Abscess formation, sensitive skin, pus formation.

Miasmatic Understanding

• Psoric in early functional phase (inflammation)

• Syphilitic if suppuration, ulceration, or gangrene sets in

Auxiliary Management

• Elevate affected part

• Maintain hygiene

• Avoid scratching

• Antibiotics if severe or systemic symptoms are present

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d) Write in detail about Filariasis and Homoeopathic management of the same

Definition

Filariasis is a parasitic disease caused by nematodes (filarial worms) transmitted by mosquitoes. Commonly caused by Wuchereria bancrofti and Brugia malayi.

Mode of Transmission

• Bite of infected female Culex or Anopheles mosquitoes

Life Cycle

• Mosquito injects larvae → migrate to lymphatics → mature into adult worms → cause lymphatic obstruction

Clinical Features

• Asymptomatic phase: Microfilariae in blood

• Acute phase:

  • Fever with lymphangitis

  • Tender, inflamed lymph nodes

  • Chills and rigors

• Chronic phase:

  • Elephantiasis (gross swelling of limbs/genitals)

  • Hydrocele

  • Chyluria (milky urine)

Diagnosis

• Peripheral blood smear (night sample)

• Circulating filarial antigen (CFA) test

• Ultrasonography (filarial dance sign)

• Eosinophilia

Homoeopathic Management

1. Thuja Occidentalis

• Chronic lymphatic stagnation

• Warts, tumors, glandular swellings

• Indicated in chronic filarial infections with tissue induration

2. Hydrocotyle Asiatica

• Elephantiasis and thickened, indurated skin

• Acts on connective tissue

• Useful in lymphatic obstruction

Miasmatic Understanding

• Sycotic (growths, swellings, indurations)

• Syphilitic (tissue destruction, ulceration)

Auxiliary and Ancillary Treatment

• Prevention of mosquito bites (nets, repellents)

• Diethylcarbamazine (DEC) in modern medicine for microfilaria

• Hygiene and limb elevation

• Management of secondary bacterial infections

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Here are the complete answers for:

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Question 5: Migraine with Miasmatic Understanding, Acute and Chronic Prescribing (20 Marks)

Definition:

Migraine is a recurrent, throbbing headache often affecting one side of the head, typically accompanied by nausea, vomiting, and sensitivity to light and sound.

Types of Migraine:

1. Migraine without aura (Common migraine)

2. Migraine with aura (Classic migraine)

3. Chronic migraine (15+ days/month for >3 months)

4. Menstrual migraine

Etiology:

• Genetic predisposition

• Hormonal changes

• Stress, anxiety, lack of sleep

• Certain foods (chocolate, cheese, MSG)

• Environmental triggers

Clinical Features:

• Prodromal symptoms: fatigue, irritability, mood changes

• Aura: visual disturbances (zig-zag lines, scotoma)

• Headache phase: unilateral, throbbing pain lasting 4–72 hrs

• Associated symptoms: photophobia, phonophobia, nausea

• Postdrome: fatigue, difficulty concentrating

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Miasmatic Understanding:

Miasm	Characteristics
Psora	Functional headaches, better by rest; hypersensitivity to noise, light.
Sycosis	Periodic recurrence, worse from weather changes, stubborn attacks.
Syphilis	Intense pain, destructive in nature, often worse at night.

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Acute Prescribing in Migraine:

1. Belladonna:

   • Sudden onset, throbbing headache

   • Red face, hot skin, photophobia

   • Better by pressure and rest, worse by noise and light

2. Glonoinum:

   • Congestive headache with pulsations

   • Sunstroke or heat exposure triggers

   • Sensation as if head will explode

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Chronic Prescribing in Migraine:

1. Sanguinaria Canadensis:

   • Right-sided headache

   • Begins in the morning, increases during the day

   • Better by vomiting and sleep

2. Natrum Muriaticum:

   • Periodic migraines linked to grief or emotional suppression

   • Worse from sun, better in dark rooms

   • Aura symptoms common

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Scope and Limitation of Homoeopathy:

• Scope: Offers individualised, long-term relief, particularly effective in chronic migraine management with fewer side effects.

• Limitations: In acute severe migraines with vomiting and dehydration, allopathic intervention may be needed initially.

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Question 6: Rheumatic Heart Disease (RHD) (20 Marks)

Definition:

RHD is a chronic valvular disease resulting from acute rheumatic fever, an autoimmune response to Group A Streptococcus.

Etiology:

• Sequelae of rheumatic fever

• Poorly treated strep throat

• Autoimmune cross-reactivity (molecular mimicry)

Clinical Features:

• Dyspnea on exertion

• Palpitations, fatigue

• Chest pain, syncope (in severe valvular stenosis)

• Murmurs (typically mitral stenosis or regurgitation)

• Features of heart failure in advanced cases

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Miasmatic Background:

Miasm	Clinical Reflection
Psora	Functional palpitations, early fatigue
Sycosis	Inflammatory and fibrotic valve changes
Syphilis	Destructive valve lesions, heart failure

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Scope of Homoeopathy:

• Controls recurrence of rheumatic fever

• Reduces further valvular damage

• Improves quality of life in mild to moderate RHD

Limitations:

• Irreversible structural damage (e.g., valve replacement required)

• Severe heart failure requiring ICU support

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Auxiliary Mode of Treatment:

• Prophylactic penicillin (to prevent streptococcal infection)

• Salt-restricted diet

• Avoid strenuous activity

• Echocardiography monitoring

• Interventional/surgical treatment when needed

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Homoeopathic Remedies:

1. Spigelia:

   • Violent palpitation, precordial pain

   • Worse from slightest motion

2. Digitalis:

   • Weak, slow pulse; heart feels too weak to beat

   • Cyanosis, cold limbs

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Question 7: Diabetes Mellitus (20 Marks)

Definition:

A metabolic disorder characterized by hyperglycemia due to insulin deficiency or resistance.

Types:

1. Type 1 DM – Autoimmune destruction of pancreatic β-cells

2. Type 2 DM – Insulin resistance, lifestyle related

3. Gestational DM

4. Secondary DM (due to endocrinopathies, steroids, etc.)

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Etiology:

• Genetic predisposition

• Sedentary lifestyle, obesity

• High-carb diet

• Pancreatic diseases

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Clinical Features:

• Polyuria, polydipsia, polyphagia

• Fatigue, weight loss

• Delayed wound healing

• Recurrent infections

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Miasmatic Understanding:

Miasm	Characteristics
Psora	Functional disturbances, fatigue, cravings
Sycosis	Obesity, insulin resistance, recurrent boils
Syphilis	Gangrene, retinopathy, nephropathy, neuropathy

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Scope of Homoeopathy:

• Early cases (functional stage) can be well managed

• Improves insulin sensitivity and pancreatic function

• Individualized remedies help control complications

Limitations:

• Severe insulin-dependent cases may need allopathic co-management

• Cannot reverse established organ damage

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Acute Prescribing:

1. Phosphoric Acid:

   • Diabetes from grief and exhaustion

   • Profuse urination with debility

2. Syzygium Jambolanum:

   • Marked glycosuria

   • Known to reduce sugar levels (supportive role)

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Chronic Prescribing:

1. Uranium Nitricum:

   • Sugar and albumin in urine

   • Polyuria, dry tongue, extreme debility

2. Lactic Acid:

   • Gastric symptoms with diabetes

   • Dryness of skin, itching

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Short Definitions & Drug Indications (1–2 Marks Each)

Q	Answer
a) Scurvy	A disease caused by Vitamin C deficiency. Symptoms: bleeding gums, joint pain.
b) Calcarea Phos	For delayed dentition, soft bones in rickets.
c) Sickle Cell Anemia	Genetic hemolytic anemia with sickled RBCs.
d) Jodium in Thyroid	Indicated in hyperthyroidism with emaciation, anxiety.
e) Addison’s Disease	Adrenal insufficiency with hyperpigmentation, hypotension.
f) Anemia	Condition with reduced hemoglobin or RBC count.
g) Unstable Angina	Chest pain at rest or minimal exertion, high MI risk.
h) Helleborus	Used for dullness, brain fog, neurological slowness.
i) Belladonna in Headache	Sudden, throbbing, congestive headache. Worse light, noise.
j) Cardiac chest pain	MI, Angina are two major causes.
k) Bryonia in OA	Pain worse by motion, better by rest.
l) Arnica in Sprain	Bruised pain, soreness, after injury.
m) Gonorrhea	STD caused by Neisseria gonorrhoeae.
n) AIDS Pathogen	HIV (Human Immunodeficiency Virus); Incubation: 2–15 years.
o) Sulphur in Skin	Unhealthy, dirty-looking skin, itching worse by heat.

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