FOURTH BHMS Winter 2023 PRACTICE OF MEDICINE / MEDICINE / HOMOEOPATHIC THERAPEUTICS -I [Solved Paper]

 

2. Short Answer Questions 

a) Write causes and clinical features ofAscitis

b) Write acute gastritis

c) Write clinical features of COPD

d) Write clinical features of Down syndrome

e) Write Irritable Bowel Disease.

f) Write Dehydration.

3. Short Answer Questions 

a) Write indications of ledum pal in punctured wound.

b) Write indication of Rhus tox in ankylosing spondilitis.

c) Write indications of Robinia in Gastritis.

d) Write indications ofglonine in sunstroke.

e) Write indication of Hepar sulph in Pulmonary tuberculosis.

f) Write indication of chelidinium in liver abscess.

 

4. Long Answer Questions (Solve any 2 Out of 4) :- [2 x 10 = 20J

a) Describe aetilogy of splenomegaly with indication of Ceanothus.

b) Write types and clinical features of asthma with indications of Wdorrinum.

c) Describe clinical features of Hepatitis B and role of suseptibility for the same.

d) Write causes of Vomiting with indications of Phosphorus for same.                   Long Answer Questions  

5. Describe Portal HypertensiOn under following headings Causes Clinical features Differential diagnosis and indications of 2 homoeopathic drugs Scope & limitation of homeopathy with Miasmatic understanding

6. Describe Pneumonia under following headings Aetiological classification of pneumonia clinical features investigations and indications of 2 homoeopathic drugs scope & limitations of homoeopathy & acute prescribing

7. Describe ulcerative colitis under the following headings Aetiology clinical features investigations and indications of 2 Homoeopathic drugs Miasmatic understanding and Chronic prescribing

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

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a) Causes and Clinical Features of Ascites

Causes:

1. Liver cirrhosis (most common)

2. Nephrotic syndrome

3. Congestive heart failure

4. Malignancy

5. Tuberculosis peritonitis

Clinical Features:

• Abdominal distension

• Shifting dullness

• Fluid thrill

• Dyspnea due to diaphragm pressure

• Ankle edema

• Early satiety

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b) Acute Gastritis

Definition: Acute inflammation of the gastric mucosa.

Causes:

• Alcohol

• NSAIDs

• Spicy food

• Helicobacter pylori

• Stress

Symptoms:

• Epigastric pain

• Nausea, vomiting

• Loss of appetite

• Hematemesis (in severe cases)

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c) Clinical Features of COPD

1. Chronic productive cough

2. Progressive breathlessness

3. Wheezing

4. Cyanosis in advanced stages

5. Barrel-shaped chest (in emphysema)

6. Use of accessory muscles for breathing

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d) Clinical Features of Down Syndrome

1. Flat facial profile

2. Upward slanting palpebral fissures

3. Single palmar crease

4. Mental retardation

5. Hypotonia

6. Short stature

7. Congenital heart defects (AV canal defect)

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e) Irritable Bowel Disease (IBD)

IBD includes:

• Ulcerative colitis

• Crohn’s disease

Features:

• Chronic diarrhea with blood/mucus

• Abdominal pain

• Weight loss

• Tenesmus

• Periodic remissions and relapses

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f) Dehydration

Definition: Excess loss of body fluids resulting in water and electrolyte imbalance.

Symptoms:

• Thirst

• Dry mucous membranes

• Decreased skin turgor

• Oliguria

• Tachycardia

• Sunken eyes

• In infants: depressed fontanelle

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

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a) Indications of Ledum Palustre in Punctured Wounds

1. Punctured wounds from nails, stings, and bites

2. Wound is cold to touch, yet patient feels warmth

3. Purple, puffy swelling around wound

4. Tetanus prophylaxis remedy after deep bites

5. Wounds that are painful but not bleeding, worsen with heat

💊 Complementary to Hypericum in nerve-rich injuries

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b) Indication of Rhus tox in Ankylosing Spondylitis

1. Stiffness of spine, worse on rest and initial motion

2. Relief from continuous movement

3. Pain in ligaments and tendons, especially lower back

4. Better by warmth and stretching

5. Suited to chronic inflammatory joint disease

💊 Important remedy in autoimmune spondyloarthropathy with restlessness

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c) Indications of Robinia in Gastritis

1. Intense acidity with sour vomiting

2. Heartburn worsens at night, lying down

3. Acidity affects teeth enamel

4. Burning pain in stomach and throat

5. Gastritis with very sour eructations and stools

💊 Useful when acidity coexists with headaches

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d) Indications of Glonoinum in Sunstroke

1. Congestive headache due to heat or sun exposure

2. Throbbing sensation in head with flushing of face

3. Palpitation, dizziness, and faintness

4. Head feels as if it will burst; worse from heat

5. Confusion and heatstroke symptoms

💊 Also used in hypertension with pulsating sensation

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e) Indication of Hepar Sulph in Pulmonary Tuberculosis

1. Purulent expectoration with offensive odor

2. Intense chilliness, slightest draft worsens

3. Irritable, oversensitive to pain and touch

4. Cough worse cold air, exposure

5. Used in suppurative phase of TB, lung abscess tendency

💊 Helpful after cavitation and pus formation begins

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f) Indications of Chelidonium in Liver Abscess

1. Right hypochondriac pain, radiating to inferior angle of scapula

2. Icterus with bitter taste in mouth

3. Liver enlarged, tender to pressure

4. Clay-colored stools, dark urine

5. Associated gastric disturbance and lethargy

💊 Remedy for congested liver with abscess tendency

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✅ Q.4 (a) – Etiology of Splenomegaly with Indication of Ceanothus

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Definition:

Splenomegaly refers to enlargement of the spleen beyond its normal size (usually >12 cm).

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Etiology (Causes):

🔹 Infectious Causes:

• Malaria

• Typhoid

• Infective endocarditis

• Kala-azar (Leishmaniasis)

🔹 Hematological Disorders:

• Hemolytic anemias

• Thalassemia

• Chronic myeloid leukemia

• Lymphoma

🔹 Portal Hypertension:

• Cirrhosis leading to congestive splenomegaly

🔹 Storage Disorders:

• Gaucher’s disease

• Niemann-Pick disease

🔹 Autoimmune Disorders:

• Systemic lupus erythematosus (SLE)

• Rheumatoid arthritis (Felty’s syndrome)

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Symptoms:

• Fullness in LUQ (left upper quadrant)

• Early satiety

• Pain radiating to left shoulder

• Weight loss

• Anemia-related fatigue

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Homeopathic Indication: Ceanothus Americanus

1. Acts deeply on spleen and liver

2. Indicated in chronic malarial splenomegaly

3. Spleen is enlarged and very painful

4. Left-sided abdominal pain with fullness and dyspnea

5. Worse on lying on left side; better by pressure

6. Acts well in patients with post-typhoid or post-kala-azar spleen

💊 Complementary remedy: China officinalis

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✅ Q.4 (b) – Types and Clinical Features of Asthma with Indication of Medorrhinum

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Definition:

Asthma is a chronic inflammatory disease of the airways, characterized by reversible bronchoconstriction, leading to episodic wheezing and breathlessness.

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Types:

1. Allergic (Extrinsic):

   • Common in children

   • IgE mediated, history of eczema/allergy

2. Non-Allergic (Intrinsic):

   • Triggered by infections, cold air, stress

   • More common in adults

3. Occupational Asthma:

   • Due to exposure to workplace allergens

4. Exercise-Induced Asthma:

   • Occurs after physical activity

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Clinical Features:

• Wheezing (esp. on expiration)

• Breathlessness

• Cough (especially at night)

• Chest tightness

• Use of accessory muscles during severe attack

• Relief on use of bronchodilators or sitting upright

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Indication of Medorrhinum in Asthma:

1. Sycotic constitution; suited to children with asthma and repeated colds

2. Asthma worse at night; must sit up

3. Sleepy in day, restless at night

4. Sensation as if lungs were full of mucus

5. Child suffocates in sleep, gasps for air

6. Family history of asthma or gonorrhea

💊 Often used as an intercurrent remedy in deep-seated chronic asthma

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✅ Q.4 (c) – Clinical Features of Hepatitis B and Role of Susceptibility

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Hepatitis B – Overview

Definition:
Hepatitis B is a viral infection caused by HBV (Hepatitis B Virus) that affects the liver, leading to inflammation, and can be acute or chronic.

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Clinical Features

🔹 Acute Phase:

1. Fever, fatigue, and malaise

2. Loss of appetite

3. Nausea and vomiting

4. Dark-colored urine, pale stools

5. Jaundice (yellowing of skin and eyes)

6. Right upper quadrant pain

🔹 Chronic Phase:

1. Persistent fatigue

2. Intermittent jaundice

3. Enlarged liver and spleen

4. Progressive liver damage → Cirrhosis

5. Risk of Hepatocellular carcinoma

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Modes of Transmission

• Blood transfusion

• Unprotected sexual contact

• Vertical transmission (mother to child)

• IV drug use

• Contaminated needles

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Diagnosis

• HBsAg (Hepatitis B surface antigen): active infection

• Anti-HBs: recovery or immunity

• HBV DNA: viral load

• Liver function tests: ↑ ALT/AST, bilirubin

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Role of Susceptibility in Hepatitis B

1. Individual Variation:

   • Not everyone exposed to HBV gets infected — susceptibility determines outcome

2. Genetic Factors:

   • Certain HLA types predispose to chronicity

3. Miasmatic Background:

   • Psoric constitution: slow, chronic course

   • Syphilitic taint: degeneration, fibrosis, cancer

   • Sycotic background: chronic inflammatory response

4. Environmental & Constitutional Factors:

   • Poor hygiene, alcoholism, stress weaken resistance

   • Over-medication suppresses acute symptoms, deepens miasm

5. Therapeutic Role:

   • Homeopathic remedy must match individual susceptibility

   • Constitutional and anti-miasmatic approach prevents complications

🧬 Hahnemann emphasized that “a similar force alone can extinguish a dynamic disease”—thus susceptibility and miasmatic matching are vital.

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✅ Q.4 (d) – Causes of Vomiting with Indications of Phosphorus

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Definition of Vomiting

Vomiting is the forceful expulsion of gastric contents through the mouth, coordinated by the vomiting center in the medulla.

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Causes of Vomiting

🔹 Gastrointestinal Causes:

1. Gastritis, peptic ulcer disease

2. Gastroenteritis (viral/bacterial)

3. Obstruction (e.g., pyloric stenosis, intestinal blockage)

4. Hepatitis, pancreatitis

🔹 Central Nervous System Causes:

1. Raised intracranial pressure (e.g., tumor, hemorrhage)

2. Migraine

3. Motion sickness

4. Psychogenic vomiting

🔹 Metabolic Causes:

1. Diabetic ketoacidosis

2. Uremia (renal failure)

3. Addison’s disease

4. Electrolyte imbalance

🔹 Toxic/Drug-Induced Causes:

1. Chemotherapy

2. Alcohol, poisoning

3. Antibiotics, opioids

🔹 Pregnancy-Related:

• Morning sickness in 1st trimester

• Hyperemesis gravidarum

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Indications of Phosphorus in Vomiting

General Profile:
Phosphorus is a tall, lean, sensitive, and anxious individual, often chilly and thirsty.

🔹 Key Vomiting Symptoms:

1. Vomits everything as soon as it gets warm in the stomach

2. Vomiting of water, bile, food, sometimes blood

3. Craving for cold drinks, which are vomited soon after

4. Nausea from smell of cooking food

5. Vomiting during gastritis, liver disease, and typhoid

🔹 Modalities:

• Better: Cold food and drinks (though not retained)

• Worse: Warm food, lying on left side, evening

🔹 Clinical Use Cases:

• Vomiting in hepatitis

• Post-operative vomiting

• Chronic gastritis with nausea and anxiety

• Vomiting in tuberculosis or hemorrhagic conditions

💊 Phosphorus is especially suited to vomiting with exhaustion, restlessness, and burning sensations.

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✅ Q.5 – Portal Hypertension (20 Marks)

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Definition

Portal Hypertension is defined as an elevation of blood pressure in the portal venous system, typically >12 mmHg, due to obstruction of portal blood flow.

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Causes

🔹 Pre-hepatic Causes:

• Portal vein thrombosis

• Splenic vein thrombosis

• Congenital atresia

🔹 Intra-hepatic Causes:

• Cirrhosis of liver (most common)

• Schistosomiasis

• Hepatic fibrosis

🔹 Post-hepatic Causes:

• Budd-Chiari syndrome

• Right heart failure

• Constrictive pericarditis

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Clinical Features

1. Splenomegaly

2. Ascites

3. Esophageal varices → Hematemesis

4. Caput medusae (dilated veins on abdomen)

5. Anorexia, fatigue

6. Jaundice (if associated with cirrhosis)

7. Hypersplenism: pancytopenia (low RBC, WBC, platelets)

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Differential Diagnosis

Condition	Key Differentiating Features
Cirrhosis	Liver hard, shrunken; altered LFTs
CHF	Raised JVP, pedal edema, enlarged heart
Budd-Chiari syndrome	Sudden ascites, tender hepatomegaly
Peritoneal TB	History of TB, SAAG < 1.1 g/dL

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Homeopathic Remedies

🔹 1. Ceanothus Americanus

• Splenomegaly with pain in left hypochondrium

• Useful in congestive spleen in portal hypertension

• Deep left-sided remedy; worse lying on left

🔹 2. Carduus Marianus

• Liver and portal vein congested

• Jaundice with dull pain in liver region

• Ascites, varicose veins, hemorrhoids

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Scope and Limitations of Homoeopathy

Scope:

• Helpful in early cases

• Controls bleeding tendencies (e.g., variceal bleeds)

• Reduces portal pressure via constitutional remedies

Limitations:

• In advanced liver failure, surgical or allopathic interventions required

• Endoscopic banding or TIPS may be lifesaving

• Homoeopathy cannot reverse cirrhosis but may slow progression

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Miasmatic Understanding

• Psora: Functional liver sluggishness, slow venous return

• Sycosis: Venous engorgement, varices, thickening

• Syphilis: Bleeding varices, degeneration, fibrosis

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✅ Q.6 – Pneumonia (20 Marks)

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Definition

Pneumonia is an acute inflammation of the lung parenchyma, usually due to infection, resulting in alveolar exudation and consolidation.

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Etiological Classification

🔹 By Pathogen:

• Bacterial: Streptococcus pneumoniae, Klebsiella, Staph aureus

• Viral: Influenza, RSV

• Fungal: Histoplasma

• Atypical: Mycoplasma, Chlamydia

🔹 By Setting:

• Community-acquired

• Hospital-acquired (nosocomial)

• Aspiration pneumonia

• Immunocompromised host pneumonia

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Clinical Features

1. Sudden high-grade fever with chills

2. Productive cough with rust-colored sputum

3. Pleuritic chest pain

4. Dyspnea, tachypnea

5. Crepitations or bronchial breathing on auscultation

6. Dullness on percussion (consolidation)

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Investigations

• Chest X-ray: Lobar or patchy opacity

• CBC: Leukocytosis

• Sputum culture and Gram stain

• Blood cultures

• CRP, ESR raised

• Pulse oximetry and ABG if severe

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Homeopathic Remedies

🔹 1. Bryonia alba

• Dry, hard, painful cough; worse motion

• Stitching pain in chest; wants to lie still

• Tongue white, thirst for large quantities

🔹 2. Antimonium tartaricum

• Rattling of mucus with little expectoration

• Cyanosis, cold sweat, rapid collapse

• Drowsiness and lethargy

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Scope and Limitations

Scope:

• Effective in early and moderate cases

• Reduces need for antibiotics if well selected

• Useful in recovery and convalescence

Limitations:

• Cannot replace oxygen, antibiotics, or hospitalization in severe pneumonia

• In ARDS or septicemia, urgent ICU care is essential

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Acute Prescribing

• Focus on sudden, clear totality

• Short-acting remedies

• Repetition guided by response

• Frequent monitoring necessary

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✅ Q.7 – Ulcerative Colitis (20 Marks)

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Etiology

• Autoimmune factors

• Genetic predisposition (family history)

• Abnormal immune response to gut flora

• Environmental triggers (stress, diet)

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Clinical Features

1. Chronic diarrhea with blood and mucus

2. Crampy lower abdominal pain

3. Urgency and tenesmus

4. Weight loss

5. Fever in flare-up

6. Anemia due to chronic bleeding

7. Extraintestinal: arthritis, uveitis, skin lesions

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Investigations

• CBC: Anemia, raised ESR

• Colonoscopy: Continuous inflammation starting from rectum

• Biopsy: Mucosal ulceration, crypt abscess

• Stool exam: Rule out infection

• Fecal calprotectin: Marker for intestinal inflammation

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Homeopathic Remedies

🔹 1. Mercurius corrosivus

• Tenesmus of both rectum and bladder

• Bloody, slimy, offensive stools

• Severe burning pain, worse at night

🔹 2. Aloe socotrina

• Sudden urge to stool, cannot control

• Gurgling, gas, mucous-filled diarrhea

• Relief after passing stool

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Miasmatic Understanding

• Psora: Chronicity, relapsing-remitting nature

• Sycosis: Mucous membrane involvement, tenesmus

• Syphilis: Ulceration, degeneration, hemorrhage

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Chronic Prescribing

• Identify constitutional type

• Intercurrent anti-miasmatic remedies

• Long-acting, deep remedies like Sulphur, Nux vomica, Nat mur

• Lifestyle and stress management crucial

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