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Diseases Of The Nervous System Important Notes

1. Bell’s palsy
   • It is idiopathic paralysis of facial nerve
   • Etiology
     • Rheumatic – Cold
     • Ischaemia
     • Immunological
     • Viral
   • Clinical features
     • Pain in post auricular region
     • Sudden onset
     • Unilateral loss of function
     • Loss of facial expression
     • Absence of wrinkling
     • Inability to close eye
     • Watering of eye
     • Inability to blow
     • Obliteration of nasolabial fold
     • Loss of taste sensation
     • Hyperacusis
     • Slurring of speech
2. Grand mal epilepsy
   • Phases
     • Prodromal phase
     • Aura
     • Tonic and clonic phase
     • Postictal phase
3. Nerve lesion
4. lower motor neuron v/s upper motor neuron
5. Types of seizures
6. Pyogenic meningitis
   • Etiology
     • Cram negative bacteria
     • Croup B streptococci
     • Listeria monocytogenes
     • H. influenza
     • N. meningitides
     • M. tuberculosis
     • Drug of choice – ceftriaxone
7. Features of Horner’s syndrome
   • Miosis
   • Ptosis
   • Anhydrosis
   • Enophthalmos
8. Drug of choice in different seizures
9. Disorders of basal ganglia
   • Parkinson’s disease
   • Wilson’s degeneration
   • Chorea
   • Athetosis
10. Parkinsonism
    • It is syndrome consisting of akinesia and bradykinesia, rigidity, and tremors
    • Anticholinergics are used for it
11. Migraine
    • It is characterised by an episodic hemicranial or unilateral throbbing headache and is often associated with nausea, vomiting, and visual disturbances. It is most common vascular headache
    • Causes pain of face and jaws
    • Occurs due to vasoconstriction of intracranial vessels followed by vasodilation
12. Status epilepticus
    • It is a condition in which a series of seizures occur in the patient without regaining consciousness in between successive attacks
    • Precipitating factors
      • Sudden withdrawal of drugs
      • Irregular use of anticonvulsants
      • Following major intracranial pathology
    • Treatment
      • Immediate treatment
        • Rest the patient on the bed
        • Loosen the clothes
        • Maintain airway
        • Administration of high concentration of 02
        • Administration of 20-25 ml dextrose
        • Transfer the patient to ICU
    • Late treatment
      • Diazepam 10 mg IV repeat once only after 15 min
      • Lorazepam 4 mg IV repeated after 10 min
        • If the patient does not respond then drip of phenytoin 15 mg/kg at the rate of 50 mg/min
        • If still not controlled then 4 drip of thiopentone sodium 20 mg/kg at 50-100 mg/min.

Read And Learn More: General Medicine Question and Answers

1. Trigeminal neuralgia
   • Occurs due to paralysis of the trigeminal nerve
   • Clinical features
     • Site: right lower portion of the face, usually unilateral
     • Duration: a few seconds to a few minutes
     • As time passes duration between the cycles decreases
     • Nature: stabbing or lancinating
     • Aggravating factors: activation of TRIGGER ZONES
     • These are the Vermillion border of the lip, around the eyes, ala of nose
     • Interference with other activities:
     • The patient avoids shaving, washing face, chewing, and brushing, as these may aggravate pain
     • These lead to a poor lifestyle
     • Extreme cases: leads to “FROZEN OR MASK-LIKE FACE”
2. Syncope
   • It refers to generalized weakness of muscles, loss of postural tone, inability to maintain an erect posture, and loss of consciousness
   • Syncope Causes
     • Decreases cerebral perfusion
       • Inadequate vasoconstrictor mechanism
       • Hypovolemia
       • Reduction of venous return
       • Reduced cardiac output
       • Arrhythmias
       • Cerebrovascular disturbances
     • Noncirculatory causes
       • Hypoxia
       • Prolonged bed rest
       • Hypoglycaemia
       • Anaemia
       • Anxiety neurosis
       • Hyperventilation
   • Syncope Types
     • Vasovagal syncope
     • Postural hypotension with syncope
     • Micturition syncope
     • Cardiac syncope
     • Carotid sinus syncope
     • Cough syncope
     • Syncope of cerebrovascular disease
3. Petit mal epilepsy
   • Typically seen in children
   • It is brief, and lasts only for seconds
   • They may left unnoticed by the people
   • Later it may develop into tonic-clonic seizures in adulthood

Occurs due to developmental abnormality of neuronal control

1. Babinski’ sign
   • Extension of the great toe with fanning of other toes is called Babinski’s sign
2. Headache
   • Classification
     • Migraine headache
     • Tension type of headache
     • Cluster headache
     • Miscellaneous headache
     • Traumatic headache
     • Headache due to vascular causes- hematoma
     • Headache due to nonvascular causes- due to increased pressure
     • Headache due to substance abuse- alcohol
     • Headache due to systemic infection
     • Headache due to metabolic disorders
     • Headache due to referred pain- from the ear, etc.
     • Cranial neuralgia- trigeminal neuralgia
     • Unclassified headache

Diseases Of The Respiratory System Long Essays

Question 1. Describe the causes of bronchitis and chronic bronchitis and their clinical features, complications, and management.

Answer:

Bronchitis:

• It is an inflammation of the bronchi leading to increased bronchial secretions and airway obstruction

Bronchitis Causes:

1. Smoke, atmospheric, and industrial pollutants
   • These are atmospheric pollutants
   • They damage the protective mucosal barrier of the nose
   • Results in hypertrophy of mucus-secreting glands
2. Infection
   • It acts as a precipitating factor
3. Physical factors
   • Sudden change in temperature and exposure to fog leads to acute attacks of bronchitis
4. Genetic and familial
   • Alpha 1 antitrypsin deficiency leads to bronchitis

Bronchitis Management:

1. Removal of etiological factors
   • Avoid smoking
   • Avoid exposure to pollutants
2. Treatment of infection
   • Antibiotics used are:
     • Oxytetracycline or ampicillin 250-500 mg after every 6 hours for 5-7 days
     • Cotrimoxazole- 960 mg tablets for 5-7 days
3. Bronchodilators
   • Oral theophylline- 150 mg BID is used
   • Inhaled beta-2 adrenoreceptor stimulants- salbutamol 200 mg every 6 hours is used
   • In severe cases, ipratropium bromide- 40-80 meg every 6 hours is used
4. Mucolytic agents
   • These include bromhexine and carbocystein
5. Corticosteroids
   • Prednisolone 30 mg/day for 2 weeks is used
6. Oxygen therapy

Chronic Bronchitis:

• It is defined as a cough with expectoration on most days at least three consecutive months in a year for more than two consecutive years

Bronchitis Clinical Features:

• Productive cough
• Dyspnoea
• Wheezing
• Occasionally chest pain, fever, and fatigue
• Hemoptysis- the presence of blood streaks in sputum
• Complications:
• Type 1 and 2 respiratory failure
• Pulmonary arterial hypertension and corpulmonale
• Secondary infections
• Secondary polycythemia

Question 2. Describe clinical features and management of bronchial asthma.
(or)
Discuss the etiology, clinical features, investigations, and management of bronchial asthma.

Answer:

Bronchial Asthma:

• It is a disease of the airway in which there is chronic inflammation and increased responsiveness to a variety of stimuli leading to reversible airway obstruction.

Etiology:

• It is caused by various allergens, which are

1. Most common
   • Pollens, house dust, feathers, animal dander, insect web, fungal spores, etc.
2. Less common
   • Ingestion in predisposed individuals like fish, meat, milk, yeast, and wheat

Bronchial Asthma Clinical Features:

• Symptoms may be episodic or persistent

1. Episodic asthma
   • Sudden in onset
   • Triggered by allergens, exercise
   • Attacks may be spontaneous
   • Duration varies from a few hours to days and even two weeks
   • Characterized by wheezing, cough, and dyspnoea
   • Between attacks, the patients are usually asymptomatic
2. Acute severe asthma
   • It is a severe life-threatening attack of asthma
   • The patient may have tachycardia, cyanosis, and active accessory respiratory muscles
3. Chronic asthma

• Triad of symptoms- chest tightness, wheeze or cough, and exertional dyspnoea occurs
• Cough is productive
• A prominent wheeze is audible
• Breath sound is harsh vesicular with prolonged expiration

Read And Learn More: General Medicine Question and Answers

Bronchial Asthma Investigations:

Bronchial Asthma Management:

1. Management of acute asthma
   • Avoidance of allergens
     • Avoid allergens that may aggravate asthmatic attack
2. Hyposensitisation
3. Prevention of mediators of bronchoconstriction
   • Sodium cromoglycate is administered by inhalation
   • Useful in some cases of non-atopic asthma
4. Drug treatment
   • Use of salbutamol or terbutaline 100-200 meg is used
   • Use of beclomethasoneupto 800 meg twice a day is used along with it
   • A high dose of corticosteroids is used along with bronchodilators.

Question 3. Describe the etiology, clinical features, and management of ARDS.

Answer:

Acute Respiratory Distress Syndrome- ARDS:

• It describes the acute, diffuse pulmonary inflammatory response to either direct or indirect blood-borne insults.

Etiology:

1. Direct-Inhalation
   • Aspiration of gastric contents
   • Toxic gases/ bum injury
   • Pneumonia
   • Blunt chest trauma
2. Indirect-Blood Borne
   • Necrotic tissue
   • Multiple trauma
   • Pancreatitis
   • Severe bums
   • Drugs
   • Major blood transfusion reacion
   • Anaphylaxis
   • Fat embolism

Acute Respiratory Distress Syndrome Clinical Features:

• Neutrophil sequestration in pulmonary capillaries
• Increased capillary permeability
• Protein-rich pulmonary edema
• Alveolar collapse
• Progressive pulmonary fibrosis
• Multiple organ failure

Acute Respiratory Distress Syndrome Management:

1. General
   • Mechanical ventilation through
     • Oro-tracheal intubation
     • Tracheostomy
       • Antibiotic therapy to treat infection
2. Mechanical ventilation
   • For it, three parameters are used
     • Positive end-expiratory pressure- to maintain maximal recruitment of alveolar units
     • Mean airway pressure- to promote recruitment and predictor of hemodynamic effects
     • Plateau pressure- predictor of alveolar overdistention
3. Fluid management
   • By diuresis or fluid restriction
4. Corticosteroids
   • Methylprednisolone 2 mg/kg daily is used for 3-5 days
   • The dose is then tapered to 0.5-1 mg daily

Question 4. What is pneumothorax? What are the causes of pneumothorax? How do you manage tension pneumothorax?

Answer:

Pneumothorax:

• The presence of air in the pleural cavity is known as pneumothorax

Pneumothorax Causes:

• Rupture of subpleural blebs at the lung apices
• Rupture of emphysematous bullae
• Rupture of a subpleural tuberculous focus
• Rupture of lung abscess
• Pulmonary infarction
• Bronchial asthma
• Acute respiratory distress syndrome
• Sarcoidosis

Pneumothorax Management:

• Introduction of a wide-bore plastic cannula, one end is attached to a long rubber tubing, and the other is placed underwater in a bottle
• Another method is the introduction of an intercostal catheter connected to a water seal drainage system

Question 5. Describe pneumonia, Bacterial Pneumonia, complications, clinical features, and treatment of community-acquired pneumococcal pneumonia.

Answer:

Pneumonia:

• It is defined as an inflammation of the parenchyma of the lung.

Pneumococcal Pneumonia

• It is characterized by the homogeneous consolidation of one or more lobes or segments

Bacterfial Pneumonia:

• Etiology:
  • Streptococcal pneumonia Staphylococcal Aureus
  • Mycoplasma
  • Streptococcus pyrogens

Bacterial Pneumonia Complications:

• Para pneumonic pleural effusion or Empyema
• Lpbar collapse
• Pneumothorax
• Lung abscess
• Hepatitis, meningitis
• Pericarditis
• Myocarditis
• Septicaemia

Bacterial Pneumonia Clinical Features:

• It is sudden in onset
• Fever with chills and rigors occurs
• Vomiting
• Convulsions
• Loss of appetite
• Headache
• Breathlessness
• Chest pain
• Central cyanosis
• Haemoptysis
• Weakness
• Tachycardia, tachypnoea
• Productive cough
• Rust-colored sputum
• Rapid and shallow breathing

Bacterial Pneumonia Management:

1. Oxygen therapy
   • Delivered in high concentration through masks
2. Analgesics
   • Pethidine-50-100 mg or morphine 10-15 mg is given intramuscularly
3. Antibiotics
   • Oral amoxicillin 500 mg 8 hourly or
   • Erythromycin 500 mg 6 hourly or
   • Oral cephalosporin 250 mg 8 hourly
   • Cotrimoxazole 960 mg 2 times daily orally
4. Physiotherapy
   • The patient is encouraged to cough and take a deep breath

Question 6. Describe etiopathology, clinical features, complications, diagnosis, and treatment of lobar pneumonia

Answer:

Lobar Pneumonia:

• Lobar pneumonia is a radiological and pathological condition referring to the homogenous consolidation of one or more lung lobes associated with pleural inflammation

Etiopathology:

• It is caused by viruses, bacteria, fungi and parasites

Lobar Pneumonia Clinical Features:

• Sudden or insidious onset
• Fever with chills and rigors
• Headache
• Productive cough
• Breathlessness
• Chest pain
• Nausea, vomiting, diarrhea
• Myalgia, arthralgia

Lobar Pneumonia Complications:

• Para pneumonic pleural effusion
• Emphysema
• Lung abscess
• Acute Respiratory
• Distress Syndrome
• Pneumothorax
• Hepatitis
• Multiorgan failure
• Formation of ectopic abscess

Lobar Pneumonia Diagnosis:

Lobar Pneumonia Treatment:

1. Oxygen therapy
   • High-concentration oxygen is delivered through masks
2. Intravenous fluid administration
3. Antibiotic therapy
   • Duration of treatment-10-14 days
   • Drugs used are:
   • Ceftriaxone 1-2 g/day plus macrolide or fluoroquinolone

Question 7. Define and classify pneumonias. Describe the investigations, complications, and treatment of community-acquired pneumonia.

Answer:

Definition: It is defined as an inflammation of the parenchyma of the lung.

Community-Acquired Pneumonia Classification:

• Pneumonia is classified into four types

1. Lobar pneumonia
   • Generally, the entire lobe of the lung is involved
2. Bronchopneumonia
   • There is neutrophilic exudate in the bronchi and bronchiole with the peripheral spread of infection to alveoli
3. Interstitial pneumonia
   • There is predominant involvement of the in-interstitium, alveolar wall, and connective tissue around the broncho-vascular tree
4. Military pneumonia
   • Occurs due to the homogenous spread of pathogens to the lungs

Community-Acquired Pneumonia:

• It is acquired by inhalation of infected oropharyngeal secretions
• Caused specifically by highly virulent organisms

Community-Acquired Pneumonias Classification Investigations:

Community-Acquired Pneumonia Classification Complication:

• Persistent fever
• Emphysema
• Proximal bronchial obstruction
• Recurrent aspiration

Question 8. Describe the clinical features of pulmonary tuberculosis, and write short-term chemotherapy.

Answer:

Pulmonary Tuberculosis:

• Tuberculosis is a chronic infective disorder produced by mycobacterium tuberculosis characterised by the formation of granulomas and the development of cell-mediated hypersensitivity
• The involvement of the lungs by tuberculosis is called pulmonary tuberculosis

Pulmonary Tuberculosis Clinical Features:

• Loss of weight
• Loss of appetite
• Fever with night sweats
• Tiredness, malaise
• Amenorrhoea
• Cough with purulent sputum
• Haemoptysis
• Chest pain
• Breathlessness
• Finger clubbing
• Distended neck and chest veins
• Pleural effusion

Chemotherapy of Tuberculosis

Question 9. Describe the diagnosis, complications, and management of post-primary tuberculosis

Answer:

Post-primary tuberculosis:

Post-primary tuberculosis Complications:

• Haemoptysis
• Pneumothorax
• Secondary infection of the cavity
• Pleural effusion
• Emphysema
• Pulmonary fibrosis
• Scar carcinoma
• Respiratory failure
• Amyloidosis
• Anaemia

Post-primary Tuberculosis Investigations:

Question 10. Describe the etiology, clinical features, and treatment of bronchial obstruction.

Answer:

Bronchial Obstruction:

• It is called bronchiectasis
• It is defined as an abnormal and irreversible dilatation of bronchi

Etiology:

1. Infective causes
   • Bacterial- H. influenzae, staphylococcus aureus, E. coli, Tuberculosis, mycoplasma
   • Viral- measles, adenovirus, influenza virus
   • Fungal
2. Obstructive causes
   • Endobronchial benign neoplasm
   • Foreign body aspiration
   • Chronic bronchitis
   • Enlarged lymph nodes
3. Noninfective causes
   • Allergic
   • Cystic fibrosis

Bronchial Obstruction Clinical Features:

• Chronic cough with massive expectations
• Haemoptysis
• Recurrent pulmonary infection
• Dyspnoea
• Fever, weight loss, anemia, and weakness
• Oedema
• Sepsis

Bronchial Obstruction Treatment:

1. Physiotherapy
   • To keep bronchi dilated
2. Antibiotic therapy
   • Ampicillin- 500 mg 8 hourly or
   • Amoxycillin 500 mg 8 hourly or
   • Oral cefaclor 250 mg 8 hourly
3. Bronchodilators and nuicolytics
   • Bronchodilators used are theophylline or terbutaline
   • Mucolytics used arc bromhexine, carboys- teenie
4. Surgery- indications
   • Those who do not respond to medical therapy
   • Those who have repeated massive hemoptysis
   • Young patients
   • Unilateral bronchiectasis

Question 11. Describe the pathogenesis, clinical features, and diagnosis of lung abscess.
(or)
Write etiopathogenesis, clinical features, and treatment of lung abscesses.

Answer:

Bronchial Obstruction Lung Abscess:

• It is a collection of purulent material ilocalizedised necrotic area of lung parenchyma

Etiopathogenesis:

1. Infection without obstruction
   • Aspiration of nasopharyngeal contents
   • Involvement of various organisms like staphylococcus, Kleibsella, gram-negative and anaerobic organisms
   • Formation of abscess
   • Metastatic spread of infection
2. Obstruction with or without infection
   • Bronchus obstruction due to tumor, foreign body, lymph node
   • Bronchial collapse
   • Abscess formation

Bronchial Obstruction Clinical Features:

• High-grade fever with chills and rigors
• Pleuritic chest pain
• Dry cough
• The presence of copious purulent discharge
• Haemoptysis
• Weight loss, anorexia
• Emphysema

Bronchial Obstruction Investigations:

Bronchial Obstruction Management:

1. Postural drainage and chest physiotherapy
2. Antibiotic therapy
   • Oral amoxicillin 50 mg 8 hourly for 5-7 days
   • Cotrimoxazole 960 mg twice daily
   • Oral metronidazole 400 mg 8 hourly
3. Surgery
   • Resection of part of the lung is done
   • Indications:
     • Massive hemoptysis
     • Localized malignancy
     • Associated symptomatic bronchiectasis
     • Persistent abscess cavity

Question 12. Describe the etiology, clinical features, investigations, and management of pulmonary eosinophilia.

Answer:

Pulmonary Eosinophilia:

• It is a lesion in the lungs associated with blood eosinophilia

Etiology:

• Parasitic infections- hookworm disease, ascariasis, strongyloidiasis
• Allergic conditions- Hay fever, asthma, drugs like aspirin, aspergillosis
• Skin disorders- eczema, dermatitis herpetiform
• Tumors- lymphoma
• Collagen vascular disorders- rheumatoid arthritis, polyarteritisnodosa
• Hypereosinophilic syndromes- Loeffler’s syndrome, idiopathic
• Miscellaneous- Sarcoidosis, Addison’s disease

Pulmonary Eosinophilia Clinical Features:

• Dyspnoea or orthopnoea
• Wheezing
• Cough with mucoid expectoration
• Haemoptysis
• Types
  • Cryptogenic eosinophilic pneumonia
  • Idiopathic eosinophilic syndromes- includes
    • Loeffler’s syndrome
    • Hypereosinophilic syndrome
    • Churg Strauss syndrome
  • Tropical pulmonary eosinophilia

Pulmonary Eosinophilia Diagnosis:

• Blood examination- High blood eosinophils count
• Sputum shows eosinophilia
• X-ray of the chest shows diffuse miliary mottling of the lungs

Pulmonary Eosinophilia Treatment:

• Diethylcarbamazine- 2 mg/kg three times a day is used
• Allergic reactions are controlled by the use of antichrist-mimics and steroids