Representative picture of schizophrenia

Definition of Schizophrenia:

Schizophrenia is a chronic, severe psychiatric disorder characterized by disturbances in thought, perception, emotion, and behavior, with a significant decline in functioning. It is classified under psychotic disorders.

Etiology of Schizophrenia:

• Genetic: High heritability (~80%). Risk increases with genetic proximity.

• Neurodevelopmental factors: Prenatal infections, obstetric complications, hypoxia.

• Neurotransmitter hypothesis:

• Dopamine hypothesis: Hyperactivity of dopaminergic pathways, particularly mesolimbic (positive symptoms); hypoactivity in mesocortical pathway (negative symptoms).

• Other neurotransmitters: glutamate (hypofunction), serotonin (5-HT2A involvement).

• Psychosocial factors: Urban upbringing, childhood trauma, high expressed emotion in families.

Clinical Features of Schizophrenia:

Symptoms divided into positive, negative, and cognitive:

• Positive symptoms: Delusions, hallucinations (esp. auditory), disorganized speech and behavior.

• Negative symptoms: Avolition, alogia, anhedonia, affective flattening, asociality.

• Cognitive deficits: Impaired attention, working memory, and executive function.

Diagnostic Criteria (DSM-5) of Schizophrenia:

At least 2 of the following for ≥1 month (1 must be from 1–3):

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Grossly disorganized or catatonic behavior

5. Negative symptoms

Duration of illness ≥6 months including prodromal or residual symptoms.

Subtypes of Schizophrenia(no longer in DSM-5, but clinically relevant):

• Paranoid

• Disorganized

• Catatonic

• Undifferentiated

• Residual

Investigations of Schizophrenia:

• Clinical diagnosis

• Neuroimaging (enlarged ventricles, reduced cortical volume)

• Neuropsychological testing

• Rule out secondary causes (e.g., substance use, CNS pathology)

Management of Schizophrenia:

• Pharmacotherapy:

• First-generation antipsychotics (FGAs): e.g., haloperidol, chlorpromazine

• Second-generation antipsychotics (SGAs): e.g., risperidone, olanzapine, clozapine (treatment-resistant cases)

• Psychosocial interventions: CBT, social skills training, family therapy, supported employment

• Rehabilitation: Community support, psychoeducation

• ECT: In treatment-resistant catatonia or severe depression with psychosis

Prognosis of Schizophrenia:

• 1/3 improve significantly

• 1/3 show partial improvement

• 1/3 have chronic course

Poor prognostic factors: early onset, insidious onset, prominent negative symptoms, poor premorbid functioning

Why are fishes contaminated with mercury was my concern for long time and now i am telling answer of that to you so that you are also aware of it before consuming fished often.

Generally fishes are very safe in moderate amoun,large amount regular consumption of  fishes that are highy contaminated with mercury can actually turn unsafe for human consumption.

Many fish contain mercury to varying degrees, primarily in the form of methylmercury, which accumulates in their tissues over time. Here’s a general classification based on mercury content:

Fish High in Mercury (Limit or avoid, especially for pregnant women and children):

• Shark
• Swordfish
• King mackerel
• Tilefish (from the Gulf of Mexico)
• Bigeye tuna
• Marlin
• Orange roughy

Fish with Moderate Mercury Levels (Limit intake to a few times a month):

• Albacore (white) tuna
• Spanish mackerel
• Halibut
• Grouper
• Snapper
• Bluefish

Fish Low in Mercury (Generally safe to eat 2–3 times per week):

• Salmon
• Sardines
• Tilapia
• Catfish
• Anchovies
• Pollock
• Shrimp
• Scallops
• Canned light tuna
• Cod Continue reading Why are fish contaminated with mercury?

NHPC has published 13 licening examination result of PCL level just today

follow this link

See notice from NHPC here:

How to NHPC result easiy:

Check NHPC results now at abve website of nepal health profesional council

Cardiothoracic and Vascular Physiotherapy MCQs for NHPC Nepal – BPT License Exam 2025

Table of Contents(toc)

Here are 25 high-quality multiple-choice questions (MCQs) on Cardiothoracic and Vascular Physiotherapy for the BPT Physiotherapy License Examination (NHPC Nepal), with an answer key at the end.

1. Which of the following is the primary goal of pulmonary rehabilitation?

a) Improve lung volume
b) Strengthen upper limb muscles
c) Reduce breathlessness and improve functional capacity
d) Increase oxygen saturation at rest

2. Which breathing technique is most commonly used in obstructive lung diseases like COPD?

a) Apical breathing
b) Pursed-lip breathing
c) Paradoxical breathing
d) Glossopharyngeal breathing

3. Which of the following is the best position for postural drainage of the lower lobes?

a) Supine
b) Trendelenburg position
c) Prone
d) Sitting upright

4. Which is the most effective airway clearance technique for patients with cystic fibrosis?

a) Incentive spirometry
b) Postural drainage with percussion
c) Diaphragmatic breathing
d) Glossopharyngeal breathing

5. Which of the following devices is commonly used in inspiratory muscle training?

a) Incentive spirometer
b) Peak flow meter
c) Pulse oximeter
d) Manometer

6. Which of the following is a contraindication for chest physiotherapy?

a) Bronchiectasis
b) Rib fractures
c) Chronic obstructive pulmonary disease
d) Pulmonary fibrosis

7. The Borg scale is used to assess:

a) Lung volume
b) Dyspnea perception
c) Blood pressure
d) Heart rate variability

8. What is the primary focus of phase I cardiac rehabilitation?

a) Returning to competitive sports
b) Preventing deconditioning and early mobilization
c) Strength training
d) Running on a treadmill

9. Which of the following is a primary cause of restrictive lung disease?

a) Emphysema
b) Pulmonary fibrosis
c) Asthma
d) Chronic bronchitis

10. A six-minute walk test (6MWT) is commonly used to assess:

a) Muscle strength
b) Cardiopulmonary endurance
c) Joint mobility
d) Blood pressure changes

11. The most common symptom of deep vein thrombosis (DVT) is:

a) Shortness of breath
b) Pain and swelling in one leg
c) Chest pain
d) Cough with sputum

12. In pursed-lip breathing, the ratio of inspiration to expiration should be:

a) 1:1
b) 1:2
c) 2:1
d) 3:1

13. Which of the following is an absolute contraindication to exercise training in cardiac rehabilitation?

a) Controlled hypertension
b) Unstable angina
c) History of myocardial infarction
d) Mild mitral valve regurgitation

14. What is the primary effect of positive expiratory pressure (PEP) therapy?

a) Strengthen inspiratory muscles
b) Improve ventilation-perfusion ratio
c) Enhance mucus clearance
d) Reduce respiratory rate

15. Which of the following is the best indicator of cardiovascular fitness?

a) Resting heart rate
b) VO2 max
c) Blood pressure
d) Respiratory rate

16. Which phase of cardiac rehabilitation involves supervised exercise training?

a) Phase I
b) Phase II
c) Phase III
d) Phase IV

17. A patient with chronic bronchitis presents with excessive sputum production. Which physiotherapy technique is most beneficial?

a) Incentive spirometry
b) Active cycle of breathing technique (ACBT)
c) Glossopharyngeal breathing
d) Diaphragmatic breathing

18. What is the recommended duration of aerobic exercise in phase II cardiac rehabilitation?

a) 10 minutes
b) 20-60 minutes
c) 90 minutes
d) 5 minutes

19. The primary benefit of diaphragmatic breathing is:

a) Reducing lung compliance
b) Enhancing oxygen consumption
c) Strengthening accessory muscles
d) Promoting efficient breathing mechanics

20. Which of the following conditions can lead to cor pulmonale?

a) Asthma
b) COPD
c) Bronchiectasis
d) All of the above

21. The ankle-brachial index (ABI) is used to assess:

a) Peripheral arterial disease
b) Cardiac output
c) Respiratory function
d) Stroke volume

22. The normal forced expiratory volume in one second (FEV1) is approximately:

a) 10% of vital capacity
b) 50% of vital capacity
c) 75-80% of vital capacity
d) 90% of vital capacity

23. Which test is used to diagnose pulmonary embolism?

a) D-dimer test
b) Arterial blood gas analysis
c) Chest X-ray
d) Bronchoscopy

24. Which is the recommended target heart rate during moderate-intensity aerobic exercise?

a) 40-50% of max heart rate
b) 50-70% of max heart rate
c) 70-90% of max heart rate
d) Above 90% of max heart rate

25. The primary purpose of an incentive spirometer is to:

a) Measure expiratory pressure
b) Prevent lung atelectasis
c) Detect lung infections
d) Improve heart rate

Answer Key

1. c Reduce breathlessness and improve functional capacity
2. b Pursed-lip breathing
3. b Trendelenburg position
4. b Postural drainage with percussion
5. a Incentive spirometer
6. b Rib fractures
7. b Dyspnea perception
8. b Preventing deconditioning and early mobilization
9. b Pulmonary fibrosis
10. b Cardiopulmonary endurance
11. b Pain and swelling in one leg
12. b 1:2
13. b Unstable angina
14. c Enhance mucus clearance
15. b VO2 max
16. b Phase II
17. b Active cycle of breathing technique (ACBT)
18. b 20-60 minutes
19. d Promoting efficient breathing mechanics
20. d All of the above
21. a Peripheral arterial disease
22. c 75-80% of vital capacity
23. a D-dimer test
24. b 50-70% of max heart rate
25. b Prevent lung atelectasis

Summary

This 50-MCQ set covers key topics in cardiothoracic and vascular physiotherapy, including pulmonary rehabilitation, chest physiotherapy techniques, cardiac rehab phases, airway clearance techniques, and vascular conditions for the NHPC Nepal BPT licensing exam.

10 MCQs on Emergency Medicine (revised and updated)

The anatomy of a research paper (eazch section and its content explained)

1. Title Page

• Title of the paper

• Author(s) name(s)

• Affiliation(s)

• Contact information

• Date of submission

2. Abstract

• A concise summary of the research, including background, objectives, methods, results, and conclusion (usually 150-250 words).

3. Keywords

• A list of relevant terms to help in indexing and searching the paper.

4. Introduction

• Background information

• Research problem and significance

• Objectives and research questions

• Hypothesis (if applicable)

• Overview of the paper

5. Literature Review

• Summary of existing research

• Identification of gaps in knowledge

• Justification for the current study

6. Methodology (Materials and Methods)

• Study design

• Population/sample selection

• Data collection methods

• Tools, instruments, or techniques used

• Statistical analysis methods

7. Results

• Presentation of findings using text, tables, graphs, and figures

• Statistical analysis and interpretation

8. Discussion

• Interpretation of results

• Comparison with previous studies

• Implications of the findings

• Limitations of the study

9. Conclusion

• Summary of key findings

• Practical applications or recommendations

• Future research directions

10. References

• List of all cited sources following a specific citation style (e.g., APA, MLA, Vancouver).

11. Appendices (if needed)

• Supplementary materials such as questionnaires, raw data, additional tables, or figures.

Clinical features of Kawasaki disease: CREAM:

• C-Conjunctivitis (non-exudative); non purulent
  conjuncivits
• R-Rash (Polymorphous non-vesicular)
• E-Edema (or erythema of hands or feet)
• A-Adenopathy (cervical, often unilateral and non
  suppurative)
• M-Mucosal involvement (strawberry tongue

Important facts about Kawasaki disease

• 80% cases occur prior to age of 5 years with peak incidence < 2
  years. 
• Kawasaki diseaseis an Acute febrile multisystem disease of children. 
• Prolonged fever over 5 days that isunresponsive to antibiotics is
  seen. 
• Although the disease is generally benign & self limiting it is
  associated coronary artery aneurysm in 25% of cases. 
• Non suppurative cervical lymphadenopathy is characteristic.

Source: cleaveland clinic

Important People’s Names in Epidemilogy

MCQ: Epidemiological determinants are all except:

Types of Epidemiological studies

Table of Contents(toc)

Prolonged PT (extrinsic pathway factors):

• Inherited: Factor VII deficiency
• Acquired: mild vitamin K deficiency, Liver disease, warfarin

Prolonged aPTT (intrinsic pathway factors):

• Inherited: 

• factors VIII, IX, XI deficiency; 
• factor XII, 
• Prekallikrein or HMW kininogen deficiency
• Von Willebrand disease

• Acquired: 

• Heparin, 
• lupus anticoagulant, 
• acquired Von Willebrand disease

Prolonged PT and Prolonged aPTT (common pathway factors):

• Inherited: 

• Prothrombin (II), 
• Fibrinogen (I),
•  factor V and factor X deficiencies

• Acquired: 

• DIC, 
• severe liver disease, 
• severe vitamin K deficiency, 
• Direct thrombin inhibitor – agratroban, 
• dabigatran, 
• Direct factor Xa inhibitor – rivaroxaban, apixaban, edoxaban,  fondaparinaux Continue reading Bleeding Disorders Notes

Question

In an epidemic, the first case come to the notice of investigator is termed as:

a. index case

c. Secondary case

b. Primary case

d. Tertiary case

Ans: ‘a’

a germ

Important Points in Epidemiology

Index case in 1st case to come to attention to investigation.

Impoortant Definitions

• Primary case 1st case of a communicable d/s introduced into population unit which is studied (in an epidemic), which may or may not come to observer’s attention.
• Screening time – interval between 1st clinical detection & final critical point.
• Lead time time lag between 1st possible detection & usual time of diagnosis.
• Serial interval – Gap in time b/t primary & secondary case (measures incubation period)
• Generation time time interval between receipt of infection & maximum infectivity of host.
• Latent infection during which infectious agent is not shaded or not demonstrable in blood/ tissue.