Fourth B.H.M.S. Winter - 2021 PRACTICE OF MEDICINE - II

2. Short answer questions 

a) Psoriatic arthritis.

b) Ichthyosis. |

c) Define and differentiate Marasmus and K washiorkar.

_d)  Cardiogenic shock. |

e) Clinical features of parkinson’s disease.

f) Mania.

3. Short answer questions 

a) Belladona in measles.

_b)  Barytacarb in senile dementia.

c) Muratic acid in scurvy.

d) Lithium carb in Gout.

e) Cantharis in Urinary tract infection.

f) Ignatia in Hyperthyroidism. 

4. Long answer questions (Slove any two out of four) : 

a) Give classification of leprosy with clinical features of each.

OR

‘b) Describe aplastic anaemia with its miasmatic background and auxillary

mode of treatment. :

c) Describe clinical features of secondary syphilis with its miasmatic

understanding.

OR

d) Discuss causes of Nephrotic syndrome with indications of 

homoeopathic drugs.

Long answer questions 

5. Discuss in detail epilepsy with respect to: classification, diagnosis, acute

precription and auxillary mode of treatment.

6. Discuss in detail angina pectoris with respect to :Types investigations, Acute

prescription and miasmatic understanding. |

7. Describe Addison’s diesease with respect to clinical features, Addisonian

crisis, investigations, acute prescription and chronic prescription.

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

[6 × 5 = 30 Marks]

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a) Psoriatic Arthritis

• Chronic inflammatory arthritis associated with psoriasis.

• Clinical Features:

  • Joint pain, stiffness (especially fingers, toes – “sausage digits”)

  • Nail changes (pitting, onycholysis)

  • Asymmetrical oligoarthritis or symmetrical polyarthritis

  • Morning stiffness

  • Associated skin lesions: silvery plaques on extensor surfaces

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b) Ichthyosis

• A group of hereditary disorders characterized by dry, scaly skin, due to abnormal epidermal keratinization.

• Types:

  • Ichthyosis vulgaris (commonest)

  • Lamellar ichthyosis

  • X-linked ichthyosis

• Symptoms:

  • Dry, fish-scale-like skin

  • Worse in cold, dry climate

  • May be associated with eczema or atopic dermatitis

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c) Marasmus vs. Kwashiorkor

Feature	Marasmus	Kwashiorkor
Cause	Calorie deficiency	Protein deficiency
Age group	<1 year	1–3 years
Appearance	Severe wasting, old-man face	Edema, moon face
Subcutaneous fat	Absent	Present
Skin/hair changes	Less prominent	More prominent (depigmented hair, flaky skin)
Edema	Absent	Present

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d) Cardiogenic Shock

• Condition where heart fails to pump effectively → decreased tissue perfusion.

• Causes:

  • Acute myocardial infarction

  • Severe arrhythmias

  • Cardiomyopathy

• Features:

  • Hypotension

  • Cold, clammy skin

  • Dyspnea

  • Cyanosis

  • Raised jugular venous pressure

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e) Clinical Features of Parkinson’s Disease

• Chronic neurodegenerative disorder due to dopamine deficiency in basal ganglia.

• Triad:

  • Bradykinesia (slow movement)

  • Rigidity (cogwheel)

  • Tremors (resting, pill-rolling)

• Other features:

  • Shuffling gait

  • Mask-like facies

  • Postural instability

  • Micrographia (small handwriting)

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f) Mania

• A psychiatric disorder characterized by abnormally elevated mood.

• Symptoms:

  • Euphoria or irritability

  • Increased activity and energy

  • Reduced need for sleep

  • Rapid speech, flight of ideas

  • Risky behavior, grandiosity

  • Seen in bipolar disorder

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

[6 × 5 = 30 Marks]

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a) Belladonna in Measles

• Sudden onset of fever, dry heat

• Red, flushed face, throbbing headache

• Photophobia, sore throat

• Skin hot and burning

• Convulsions in high fever

• Useful in early stage before rash fully develops

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b) Baryta Carb in Senile Dementia

• Memory weak, forgets recent events

• Mental and physical sluggishness

• Childish behavior in elderly

• Suspicious, shy, timid

• Useful in dementia and arteriosclerotic changes

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c) Muriatic Acid in Scurvy

• Bleeding gums, ulcerated mouth

• Weakness, prostration

• Tongue red, dry, and cracked

• Severe hemorrhagic tendency

• Worsens from least exertion

• Restlessness but too weak to move

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d) Lithium Carb in Gout

• Chronic gout with nodosities in joints

• Pain and swelling in finger and toe joints

• Renal involvement – albuminuria, uric acid deposits

• Tearing, shifting pain

• Stiffness and cracking of joints

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e) Cantharis in UTI

• Constant urge to urinate

• Burning pain before, during, and after urination

• Blood-stained urine

• Sharp, cutting pains in bladder

• Intolerable tenesmus of bladder

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f) Ignatia in Hyperthyroidism

• Rapid emotional changes

• Trembling, palpitations due to grief or suppressed emotions

• Hysteria-like symptoms

• Contradictory symptoms

• Anxiety with lump in throat sensation

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

[2 × 10 = 20 Marks]

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🔷 a) Classification of Leprosy with Clinical Features

Leprosy (Hansen’s disease) is a chronic infectious disease caused by Mycobacterium leprae, primarily affecting skin, peripheral nerves, and mucous membranes.

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Classification (WHO Clinical Classification)

1. Paucibacillary (PB) Leprosy:

   • 1–5 skin lesions

   • No bacilli on slit skin smear

   🔹 Types:

   • Tuberculoid Leprosy:

     • Few well-defined hypopigmented patches

     • Severe nerve involvement

     • Anesthesia present

2. Multibacillary (MB) Leprosy:

   • 5 skin lesions

   • Bacilli present in smears

   🔹 Types:

   • Borderline Leprosy:

     • Variable features between TT and LL

     • Lesions of mixed nature

   • Lepromatous Leprosy:

     • Numerous lesions (nodules, plaques)

     • Symmetrical nerve involvement

     • No sensation loss in early stage

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Other Forms:

• Indeterminate Leprosy: Early, vague hypopigmented macules

• Pure Neuritic Leprosy: Only nerve involvement, no skin lesions

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🔷 b) Aplastic Anemia – Miasmatic Background & Auxiliary Treatment

Definition:
Bone marrow failure disorder causing pancytopenia (↓ RBC, WBC, platelets)

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Causes:

• Idiopathic (70%)

• Drugs (chemotherapy, chloramphenicol)

• Radiation

• Viral infections (Hepatitis)

• Autoimmune disorders

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Clinical Features:

• Anemia: pallor, fatigue

• Infections: due to leukopenia

• Bleeding: petechiae, bruising due to thrombocytopenia

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Miasmatic Background:

• Syphilitic: Destruction and degeneration of marrow

• Psoric: Weak vitality, susceptibility to infection

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Auxiliary Mode of Treatment:

• Avoid infection exposure

• Nutritious diet

• Iron, folic acid supplements

• Avoid offending drugs

• Bone marrow transplant in severe cases

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🔷 c) Secondary Syphilis – Clinical Features & Miasmatic Understanding

Definition:
Second stage of syphilis occurring 6–12 weeks after primary chancre heals.

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Clinical Features:

• Flu-like symptoms: fever, malaise, sore throat

• Skin rashes (palms, soles)

• Mucous patches in mouth

• Condylomata lata (moist lesions in groin, anus)

• Generalized lymphadenopathy

• Alopecia (patchy hair loss)

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Miasmatic Understanding:

• Syphilitic:

  • Tendency to ulceration, degeneration

  • Destructive pathology

  • Nightly bone pains

• Deep-acting miasm; requires anti-syphilitic remedy like Merc. sol.

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🔷 d) Nephrotic Syndrome – Causes & Homoeopathic Drugs

Definition:
A renal condition characterized by:

• Heavy proteinuria (>3.5g/day)

• Hypoalbuminemia

• Edema

• Hyperlipidemia

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Causes:

• Primary:

  • Minimal change disease

  • Focal segmental glomerulosclerosis

  • Membranous nephropathy

• Secondary:

  • Diabetes mellitus

  • SLE

  • Infections (Hepatitis B/C)

  • Drugs (NSAIDs)

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Indications of Homoeopathic Drugs:

• Apis mellifica:

  • Puffy face, eyelid edema

  • Scanty urine, thirstless

  • Worse from heat

• Arsenicum album:

  • Edema with burning pain

  • Restlessness, anxiety

  • Thirst for small sips

• Digitalis:

  • Dropsy with weak heart

  • Slow, intermittent pulse

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✅ Q.5 – Epilepsy

[20 Marks]

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🔷 Definition:

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures due to abnormal electrical activity in the brain.

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🔷 Classification:

1. Generalized Seizures:

• Involve both cerebral hemispheres.

• Types:

  • Tonic-Clonic (Grand mal): Loss of consciousness, stiffening (tonic) followed by jerking (clonic)

  • Absence (Petit mal): Brief loss of awareness, staring spells (common in children)

  • Myoclonic: Sudden jerks

  • Atonic: Sudden loss of muscle tone → falls

2. Focal (Partial) Seizures:

• Involve localized area of brain.

• May or may not affect consciousness.

  • Simple partial: No loss of consciousness

  • Complex partial: Altered awareness

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🔷 Diagnosis:

• History: Eye-witness accounts of episodes

• EEG: Confirms abnormal electrical discharges

• MRI/CT scan: Rule out structural lesions

• Blood tests: Rule out metabolic causes

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🔷 Acute Prescription (Homoeopathy):

• Cicuta virosa:

  • Violent convulsions with rigidity

  • Head bent backward

  • Useful in post-traumatic seizures

• Bufo rana:

  • Sexual aura before seizures

  • Suited for mental dullness and epilepsy

• Cuprum metallicum:

  • Violent tonic-clonic convulsions

  • Cramps in fingers/toes

  • Blue face, clenched thumbs

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🔷 Auxiliary Mode of Treatment:

• Avoid sleep deprivation and alcohol

• Reduce stress

• Use helmets to prevent head injury

• Regular follow-up and lifestyle changes

• Antiepileptic drugs in conventional therapy

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✅ Q.6 – Angina Pectoris

[20 Marks]

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🔷 Definition:

Angina pectoris is chest pain or discomfort due to transient myocardial ischemia without infarction.

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🔷 Types:

1. Stable Angina:

   • Predictable pain with exertion, relieved by rest/nitroglycerin

2. Unstable Angina:

   • Occurs at rest or with minimal effort

   • Precursor to myocardial infarction

3. Variant (Prinzmetal’s) Angina:

   • Due to coronary artery spasm

   • Occurs at rest, often nocturnal

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🔷 Investigations:

• ECG: ST depression or T wave inversion during pain

• Troponin: Normal in angina, raised in MI

• Stress test: Exercise ECG

• Coronary angiography: Gold standard

• Lipid profile, blood sugar: Assess risk factors

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🔷 Acute Prescription (Homoeopathy):

• Cactus grandiflorus:

  • Constriction sensation “as if heart is gripped by iron band”

  • Palpitation and anxiety

  • Worse lying on left side

• Latrodectus mactans:

  • Violent precordial pain radiating to axilla and arm

  • Gasping respiration

  • Suited in acute cardiac crises

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🔷 Miasmatic Understanding:

• Psora: Functional spasms, initial stage

• Sycosis: Endothelial dysfunction, risk factors (HTN, hyperlipidemia)

• Syphilis: Arterial narrowing, atherosclerosis, destruction

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✅ Q.7 – Addison’s Disease

[20 Marks]

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🔷 Definition:

A chronic adrenal insufficiency caused by destruction or dysfunction of adrenal cortex → ↓ cortisol & aldosterone.

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🔷 Clinical Features:

• General fatigue, weight loss

• Hyperpigmentation (palms, mucosa)

• Hypotension (postural)

• Anorexia, nausea, vomiting

• Craving for salt

• Hypoglycemia

• Electrolyte imbalance (↓Na+, ↑K+)

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🔷 Addisonian Crisis:

• Acute adrenal failure

• Triggered by stress, infection, injury

• Sudden hypotension, hypoglycemia, shock

• Requires emergency hydrocortisone and fluids

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🔷 Investigations:

• ACTH stimulation test: No rise in cortisol confirms diagnosis

• Serum cortisol: Low

• Serum sodium/potassium: Hyponatremia, hyperkalemia

• CT scan: May show adrenal atrophy

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🔷 Acute Prescription (Homoeopathy):

• Camphora:

  • Sudden collapse, cold skin

  • Useful in adrenal crisis with prostration

• Veratrum album:

  • Cold perspiration, vomiting, weakness

  • Rapid loss of fluid and electrolytes

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🔷 Chronic Prescription:

• Natrum mur:

  • Weakness, craving for salt, emaciation

  • Reserved, emotionally closed off

• Sepia:

  • Apathy, hormonal imbalance

  • Hypopituitarism or chronic glandular dysfunction

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