2023

Q-1

👀 a. What is anesthesia? What is anesthesia?

Anesthesia is a group of chemical agents that cause partial or complete loss of sensation.

👀 b. List the types of anesthesia
List the types of anesthesia.

There are three types of anesthesia.

1) Local Anesthesia:-

It affects a limited area of ​​the body (local part). This usually affects the area of ​​the body where the surgery is to be performed or the area that needs to be numbed.

• The following chemicals are used in local anesthesia.
• Xylocaine hydrochloride
• Lignocaine hydrochloride
• Amethocaine Hydrochloride
• Procaine hydrochloride

2) Spinal Anesthesia (Spinal Anesthesia) :-

It is of two types-

1) Epidural Anesthesia:-

• When anesthesia is injected into the epidural part of the spinal cord, it is called epidural anesthesia.

2) Spinal Anesthesia:-

• When anesthesia is injected into the subarachnoid space of the spinal cord, it is called spinal anesthesia.

3) General Anesthesia:-

• When the sensation is to be loosed in the whole body, the person is rendered unconscious. It is called general anesthesia. General anesthesia can be given as follows-

• Through Intravenous
• Through Inhalation

c. Describe any one type of anesthesia in detail.
Discuss one type of anesthesia area

General Anesthesia:-

• When sensation is to be loosed in the whole body, the person is rendered unconscious. It is called general anesthesia. General anesthesia can be given as follows-

• by intravenous
• by inhalation

Through Intravenous:-

• I.V. The following drugs are used in general anesthesia by injection
• Thiopental sodium 2.5%
• Hexabarbitone 10%
• Methohexital Sodium 1%
• Propofol
• Midazolam
• Fentanyl
• Ketamine hydrochloride

• Droperidol

Inhalation Anesthetics:-

• This anesthesia is given through inhalation which renders the patient unconscious.
• Before this anesthesia is administered, the patient is given some sedative, then an endotracheal tube is inserted into the airway and this is administered.
• The following drugs are used in this.
• Sevoflurane-Sevoflurane
• Nitrous oxide-Nitrous oxide
• Ether-Ether
• Cyclopropane-Cyclopropane
• Methoxyflurane-Methoxyflurane
• Enflurane-Enflurane
• Panthrene-Panthrene

Responsibility of Nurse:-

• Administering anesthesia is done by the anesthesia doctor or anesthetist but the nurse helps in it and the responsibilities of the nurse are as follows.
• First of all, ask the name of the patient to be given anesthesia
• Obtain written consent
• Questions asked by the patient about anesthesia should be answered appropriately by the nurse so as to reduce the patient’s anxiety.
• Prepare the necessary equipment
• The nurse prepares the patient for anesthesia by donning a gown, shoe cover, cap, etc
• Clean the anesthesia site with aseptic technique
• Keep the medicine required for anesthesia in proper place
• Continuous observation of the patient during anesthesia
• To check patient’s vital signs
• To check the conscious level of the patient
• The nurse observes for complications due to anesthesia
• Preparing for surgery after giving anesthesia
• Maintaining records and reports
• Clean the anesthesia machine after giving anesthesia.

👀 Q-2 A . Define following (ANY Three) :-Give the following definition. (any weed)

👀 a. Ascites

• Fluid accumulation greater than 25 ml in the peritoneal cavity is called ascites.
• S I T S Also Non S Peritoneal CVT Fluid, Peritoneal Fluid Access, Hydroperitoneum, Abdominal Dropsy.
• Essay teas is seen in conditions like cirrhosis of liver, metastatic cancer.

Classification:

Grade 1:
Mild ascites is seen in this stage which can be detected by USG and CT scan.

Grade 2:
Moderate fluid accumulation occurs in this stage which can be detected by flake bulging and shifting dullness.

Grade 3:
Civil fluid accumulation occurs in this stage which can be directly detected by visible.

👀 b.Homen’s Sign-Oman’s sign

• The Homan sign is a clinical test to detect deep vein thrombosis.
• In which pain is present in the calf muscles by dosi flexion of the foot or not.
• If there is pain on dosifection of the foot, it is called a positive Homan’s sign.

c. Cholecystites–Cholecystitis

• Gallbladder infection and inflammation is called cholecystitis. Due to which pain, tenderness, regurgitation of upper right abdomen, nosia, vomiting are seen.
• Colic cystitis is caused by round bladder stones which are of two types.

Aculeate coli cystitis:
Any major surgery or injury that leads to obstruction and infection is called aqueous cholecystitis.

Calculus coli cystitis:

Bile obstruction due to stones and infection is called calculous cholecystitis.

👀 d. Crohn’s Disease – Cohen’s disease

• It is an inflammatory bowel disease in which infection occurs in parts of the entire gastrointestinal tract that can range from the mouth to the anus. But commonly found in small intestine.
• Crohn’s disease is also called regional enteritis granulomatous colitis, transmural colitis, ileocolitis.

B. Write the action and side effects of the following drugs :-(ANY THREE)
Write the action and side effect of the following drugs. (any question)

👀 a. Asprin-aspirin

Mode of Action:

• Aspirin inhibits platelet thromboxin A2 synthase and inhibits platelet aggregation. Which reduces the formation of thrombus on the arterial wall.
• Cyclic oxygen inhibits this enzyme formation of prostaglandins that start the inflammatory process.

Side Effects:-

• Drowsiness
• Head one
• Upset Stomach
• Fever
• Heart bun
• Nozia
• Race
• Caesar
• Chest pain
• Constipation
• Dry mouth
• Bleedig
• Terry Stull
• Post urine

👀 b.Morphine – -morphine

2) Morphine-Morphine

Mode of Action:
Morphine binds to mu-opiod receptors in the central nervous system and peripheral nervous system, affecting the central nervous system and causing its sedative effect.

Side Effects:

• Dry mouth-Dry mouth
• nervousness
• Mood changes-mood change
• Small pupil-small pupil
• Drowsiness
• Stomach pain-stomach pain
• Dysuria-Dysuria.

c. Diuretic Drugs: Diuretics

Mode of Action:
Le Sixx reduces the reabsorption of sodium and chloride in the loop of Hanel in the kidney, which reduces the entry of sodium and chloride into the cell, thereby reducing the accumulation of fluid in the body.

Side Effect:

• Feeling Trusty
• Dry mouth-Dry mouth
• Headache
• Dizziness
• Nausea
• Vomiting.

👀 d.Dobutamine -—Dobutamine

Mode of Action:

• Dr. Butamine stimulates the beta one receptor in the heart which increases myocardial contraction leading to an increase in cardiac output.

Side Effect:

• Increase heart rate-Increase heart rate
• Increase blood pressure-Increase blood pressure
• Nozia
• Head one
• Palpitation
• Dyspnoea
• Chest pain.-Chest pain.

Q-3. A.Mr. Kanubhai 35 years old is diagnosed as pulmonary tuberculosis. Answer the following :-
35 years old Kanubhai is diagnosed with pulmonary tuberculosis.

👀 a. Define pulmonary tuberculosis
Define pulmonary tuberculosis.

• Pulmonary tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis and affects the lungs.
• Bacteria are spread through the air when an infected person coughs and sneezes.
• Infected persons experience persistent cough, chest pain, weight loss, breathing difficulties, and seizures.

👀 b. What health education will you give to this patient?
What health education would you provide to this patient?

Effective health education helps the patient in early recovery.

(1) Medication Adherence-Adher Medication

• For the recovery of the patient, it is necessary to take the medicine prescribed by the health care provider, so the patient should make sure to take the full course without missing the dose, and the NT TB drug along with the antibiotic to prevent drug resistance.

(2) Isolation & Respiratory Hygiene

• Educating the patient to cover the mouth and nose with a tissue or elbow while sneezing and coughing can reduce the spread of disease.
• Isolate active pulmonary tuberculosis patients and maintain proper respiratory hygiene to allow for proper breathing.

(3) Ventilation & Airflow

• Pulmonary tuberculosis can cause breathing difficulties, so advise the patient to stay in a well-ventilated area. Good airflow will ensure adequate oxygenation and reduce the risk of transmission.

(4) Nutritional & Hydration
Promote a healthy and balanced diet so that the immune system becomes strong. Asking for adequate intake so that the body remains hydrated, we can prevent dehydration.

(5) Follow-up & Monitoring

• Side effects are seen due to anti-TB drug, so we can know the effect of ND TV medicine through proper follow-up.
• We can know the progress of the decision through proper follow up and monitor.

(6) Prevention of Transmission
Educating patients to avoid close contact, especially those with compromised immune systems, can minimize transmission.

(7) Support & Counseling

• Pulmonary Tuberculosis patients need support and counseling to help them cope with this disease through counseling services.

(8) Economic Support

• Economic support is provided to patients under the Revised National Tuberculosis Control Program launched by the government. So educate the patient about all the programs that benefit him.
• Health education is provided keeping in mind the need of the patient.
• Emotional support is an important factor for success against TB.

👀 B. Write the nursing care of patient with colostomy.
Write the nursing treatment of a colostomy patient.

• To assess the patient’s knowledge about self-care.
• Ask the patient to express his feelings about the colostomy.
• Demonstrating colostomy care as well as explaining daily care.
• Appliance change
• The appliance should be changed every 3 days depending on the type of stoma. If leakage is found in it, the appliance should be changed as soon as possible to prevent peri-stomatal skin irritation.
• Place a skin barrier over the stoma to prevent stool from coming into contact with the skin.
• A drainable pouch is used for 8 weeks after surgery.
• Daily Care and Hygiene
• The patient can take a bath with the appliance but check the shell before the bath, change if loose.
• Install the patient or MT when the pouch swells to one-third.
• Dietary Considerations
• Proper chewing of food can prevent stone side blockage.
• Make the patient aware of the food that produces odor and gas and intake of fluid in adequate amount.
• The patient should know which food can control diarrhea and which food should be consumed in constipation.
• All foods that cause blockages should be avoided eg spinach, green leafy vegetables, porn, apples, grapes, potatoes, mushrooms, coconut, nuts.
• Colostomy irrigation
• Colestomy irrigation is rarely performed regularly. Irrigation is performed similar to enema.
• Fluid is instilled from the bowel through the stroma through special equipment.
• Disturbed body image
• All patients are afraid of disturbing their body image.
• The patient feels abnormal and dirty and the most common fear is gas and no order.
• Therefore, the patient should carry an extra appliance as soon as he is admitted so that leakage can be prevented.
• Sexual dish function
• Disturbed body image results in sexual dysfunction.
• Teach the patient to live with the appliance.

Q-4 Write the short notes on ANY THREE of the following
Write a note on any three of the following.

👀 a. Management in pain – pain management

• Pain can be controlled through a variety of approaches. Which is cute and chronic.

• The main goal is to improve the person’s quality of life by reducing or relieving pain. How many common methods and strategies can be used to manage pain?

(1) Medication

Over the counter medication
Non-prescription drugs such as acetaminophen, a non-steroidal anti-inflammatory drug, are used for mild to moderate pain.

Prescription meditation

• Stronger medicine prescribed by the doctor like oppo id, muscle relaxant, anti-seizure drug used for more severe pain.

• But when using opoid drugs, care should be taken because there is a risk of addiction or side effects.

(2) Physical therapy

Exercise
Taylor exercises help improve flexibility, strength and overall body function. A physical therapist provides guidance to a patient about specific exercises.

Manual therapy
It reduces pain and improves mobility through hands on techniques like manipulation, massage, mobilization.

(3) Interventional Procedures

injection
Procedures like Nav Blocks, Epidural Injections, Joint Injections target specific areas of pain to relieve pain.

Radio frequency ablation

This therapy uses heat to disturb the function of the temporary nerve so that the pain is reduced.

(4) Cognitive Behavior Therapy

Psychological technique
Cognitive behavioral therapy helps in reducing his pain by changing his thought patterns and behavior towards pain. Which is very effective in chronic pain.

(5) Alternative Therapies

A u puncture
Pain is relieved by inserting needles into specific points on the body where pain is experienced.

Massage therapy

Massaging the body’s soft tissues reduces muscle tension and improves relaxation.

(6) Life style modification

Maintain a healthy lifestyle through nutrition and exercise. Intervening well points to reduce certain types of pain.

Sleep management

Due to sleep, there is a positive effect in the body which helps in relieving the pain.

(7) Medical devices

• Transcutaneous Electrical Nav Stimulation
• This therapy uses a device that delivers a low voltage electrical current that reduces pain.
• Implant table device
• Devices such as spinal cord stimulators that are surgically implanted reduce pain by altering neural signals.

(8) Multidisciplinary Pain

Colla brative care

• Collaborative care is provided by a team of health care professionals including physicians, physical therapists, psychologists, and pain specialists. The team works together to relieve pain.

• Work closely with a health care provider experienced in pain management to manage pain through a suitable method based on the patient’s condition and needs.

👀 b. Importance of therapeutic diet in illness

Therapeutic diets have an important role in treating various medical conditions. A therapeutic diet supports the treatment of BCC, promotes recovery and improves overall health. Here are some reasons why a therapeutic diet is important.

(1) Disease Management
Control of Simatom
A therapeutic diet helps in controlling the symptoms of various illnesses, e.g.
Low sodium diet beneficial in hypertension or heart failure. It maintains blood pressure and fluid retention.

(2) Nutrient optimization

Meeting Nutritional Needs
A right balance diet helps in healing, maintains energy levels, and prevents mal-nutrition as the body’s nutritional levels change due to illness.

(3) Medication Effectiveness

Inhaling medication response

Some medications are taken along with a specific diet to increase their effectiveness. A well-designed therapeutic diet can improve the effectiveness of treatment by supporting the action of the medicine.

(4) Weight management

Promoting health weight

Therapy diet promotes weight loss or weight maintenance in conditions like OBCD, Diabetes, Cardio Vascular. This helps in managing risk factors and improves overall health.

(5) Blood sugar control
Diabetes Management
In a condition like diabetes, it is necessary to maintain the blood sugar level, so a therapeutic diet is given for the diabetic patient, which focuses on providing carbohydrates according to the body’s requirement and low glycemic food, which promotes stable blood glucose level.

(6) Digestive health
Managing Gastrointestinal Disorders

Conditions like irritable bowel syndrome, inflammatory bowel disease, celiac disease are managed by avoiding trigger foods that promote gut health.

(7) Reducing Information

Anti-inflammatory diseases
In inflammatory diseases such as arthritis, inflammation can be reduced through a therapeutic diet. This diet contains anti-inflammatory foods and omega-3 fatty acids.

(8) Supporting Organ Functions

Kidney or liver disorders

In conditions like kidney and liver disease, a therapeutic diet is prescribed which reduces the work load of the organ.E.g.
A low protein diet is commonly prescribed in conditions such as kidney disease.

(9) Enhancing immune function

• A nutritionally rich diet
• An adequate nutritional diet supports the immune system, especially during illness.
• The diet is rich in vitamins, minerals, antioxidants and helps the body fight infection and recover.

(10) Preventing complications

RADIUS RISK FACTOR

• A therapeutic diet reduces the factors of chronic disease as well as prevents complications and improves long term outcomes.
• A therapeutic diet plan by a health care professional as per the person and needs, preferences and medical requirements.

c. Metabolic Acidosis – Metabolic acidosis

Metabolic acidosis

• Metabolic acidosis is a medical condition in which there is an imbalance of acids and bases. So the amount of acid in the body increases and the base is lost from the body.
• This condition occurs when acid accumulation occurs in the body and bicarbonate and base levels decrease.

1. Cause

Acid production increases.
__Diabetic ketoacidosis, lactic acidosis and many other types of poisoning occur.

Decreased acid secretion.
__Due to altered kidney function, acid retention occurs in the body, resulting in metabolic acidosis.

Loss of bicarbonate.
__Diarrhea causes loss of bicarbonate from the body which causes an imbalance. 2.. Some common conditions associated with metabolic acidosis…

Diabetic keto acidosis Lactic acidosis
Renal failure Diarrhea
_Poisoning (eg Methanol Ethylene Glycol.)

3.Symptoms
_ Rapid breathing (Kusumal Respiration) Tiredness Confusion seen _ Head united
_ Nozia and Vo meeting _Wickness

4. Diagnostic test

• __Blood Gas Analysis: Measuring blood carbon dioxide pressure, bicarbonate levels, and blood pH.
• __Blood test: To assess electrolyte level, kidney function and other related parameters.
• __Urinalysis: Evaluation of acid excreted in urine.

5. Treatment
   To treat the underlying cause. Administer intravenous fluids to treat dehydration.
   If blood pH is high then give sodium bicarbonate. Managing factors like diabetes and kidney dysfunction.
6. Prognosis

• Prognosis depends on how the condition is treated and the severity of the condition.
• This can be life threatening if not titrated.
• Metabolic acidosis is a medical emergency. It needs to be noted. And to give medical attention immediately when that individual experiences symptoms.
• Correct the acid base im balance by giving it direct treatment according to the cause and prevent complications.
• Always consult with a health care professional for accurate diagnosis and appropriate management.

👀 d. Pre-operative nursing management – Pre-operative nursing management

• Preoperative nursing management is a critical aspect of patient care. It extends from the immediate pre-operative period with the decision for surgery. The goal is to prepare the patient physically and emotionally for the surgical procedure.

Steps of pre-operative nursing management:

1. Assessment
   A comprehensive nursing assessment that includes the patient’s medical history, current medications, allergies, and any other health conditions.
   Assessing the patient’s psychological and physiological status. Which includes vital sign laboratory results and emotional well being.
2. Education
   Providing information to the patient in detail about the purpose, procedure, potential risks, benefits and alternatives etc. of the surgery.
   Explain the pre-operative and post-operative process. including any necessary lifestyle modification or restriction.
   Understanding the patient and obtaining consent for the procedure.
3. Informing Consent
   After providing the information, verify that the patient has understood and signed the valid information. Inform the patient if he has any questions about the surgery.
4. Pre-operative testing
   Coordinating that necessary pre-operative diagnostic tests are completed such as blood work, imaging, and electrocardiogram.
   Communicating test results with the surgical team.
5. Management of medication
   Reviewing the patient’s current medication and discontinuing or managing it by the surgeon or anesthesiologist.
   Administer pre-operative medications as prescribed, such as prophylactic antibiotics or anxiety-reducing medications.

6.NPO (Nile on Oral) Guidelines
Instruct the patient not to eat or drink as per pre-operative fasting guidelines for prevention of aspirate during anesthesia.

7.Hygiene and skin preparation
Informing the patient of antimicrobial shop prior to surgery helps to reduce the risk of surgical site infection.
Noting that proper skin preparation has been done at the surgical site as per hospital protocol.

8. Patient comfort and safety
   See that the patient is comfortable and dressed in a hospital gown. Move the patient evenly with mobility and ability to prevent the patient from falling down.
9. Pre operative check list
   This includes seeing that the necessary preparations are complete.
   Availability and required equipment are ready and verifying the supply.
10. Emotional support
    Acknowledge the patient’s anxiety and provide emotional support and reassurance.
    To anchor the patient to express his worries and fears.
11. Communication
    Maintaining effective communication with the surgical team. This includes surgeons, anesthesiologists and other health care professionals who care for the patient.
    Note that the patient and family are aware and included in the process.
12. Documentation
    Document all pre-operative assessments, interventions and patient education in the medical record.

• Communicate clearly with the Post Anesthesia Care Unit (PACU) team as per the patient’s status and any specific needs.

• Remembering that individual patients have different needs and preoperative nursing management also depends on the specific surgical procedure and patient’s health status.
• Coordination with health care providers is essential for effective care and safety.

Q-5 Answer the following:- Answer the following.

👀 a. Write the sources of drugs. Write the places of origin of medicines.

Drugs are obtained from various sources. Which are biological, mineral and synthetic sources.

Biological Sources

(1) Plant:

• Drugs are made from plants naturally and by synthetic procedures. Medicine is made from the particular part of the plant
• A bella donna drug is made from the root.
• A digital drug is made from the leaves.
• Drugs like senna are made from the fruit and drugs like digoxin, morphine and quinone are made from plants.

(2) Animal products:

• Animal products are used as human chemicals such as insulin, thyroid growth hormone, hyporing, cold liver oil, which are made from animal products.
• Also, certain antibiotics are obtained from different types of micro-organisms.
• Penicillin drug is made from Penicillium notatum.
• BCG vaccine is made from M. bovis source.

(3) Mineral and Oil:

• Drug manufacturing is done from different minerals.
• Drugs are made from several minerals like albumin, iron, fluoride, magnesium, copper iodine. Which cures many diseases.
• Oils such as liquid paraffin are used as purgatives.

(4) Human:
Some drugs are obtained from men including immunoglobulin from blood, growth hormone from interior pituitary, chronic gonadotrophin from urine of pregnant women etc.

(5) Product of genetic engineering

• Many drugs are made from cell cultures through DNA technology, such as human insulin.
• Hybridoma antibiotic is obtained by hybridoma technique.

Synthetic
Most of the drugs are synthetically prepared including sulfonamides, aspirin and mepacrine.

👀 b. What are the possible causes of epilepsy
Write the causes of epilepsy (seizures).

• AP Lepsy stands for Recurrent-Siezure.
• Genetic Influence-Genetic Influence
• Brain asepsis
• Brain tumor
• Dementia
• Imbalance of neuro transmitter.-Imbalance of neurotransmitters.
• stroke
• Brain Damage from Illness and Injury.
• Congenital ab normality.
• Infection of green search age meningitis
• Certain genetic syndromes.
• Auto immune epilepsy.
• Metabolic cos
• Lake of Oxygen During Birth.
• Low level of blood sugar, blood calcium, blood magnesium.
• Bleeding in the brain.
• Maternal drug use.
• Cortical dysplasia.
• Brain tissue.
• Overdose of NT depression.
• Exposure to lead
• Drug Withdrawal Stat.

c. Explain the role of a nurse in organ donation of brain dead person.
Explain the role of nurse in organ donation of brain dead person

• Nurses have an essential role in organ donation.
• Organ donation is a process in which an organ is transmitted from a donor to another living person through a surgical process.
• One donor can save eight lives.
• A nurse should have deep knowledge of what organ donation is, why it is necessary, how an organ helps your patient, what is its process, and what is the role of a nurse in the procedure.

Identification and Assessment

• The nurse identifies a suitable organ donor and assesses his medical history and clinical criteria.
• Provides counseling about organ donation to family members of brain death person.

Communication

• The nurse facilitates communication and provides information between the donor’s family member and the organ procurement team.
• Provides emotional support by communicating with family members.
• The donor takes the signature of his guardian in the card.

Collaboration

Nurses collaborate with other health care teams such as physicians and other health care professionals to ensure proper management of the organ donation procedure.

Documentation

Nurses do accurate documentation of clinical details and all processes so that legal and ethical problems can be avoided.

Organ Preservation

The nurse helps maintain the physiological stability of the donor so that organ function can be preserved until transplantation.

Support for Families

This is a difficult time for the donor’s family, so the nurse provides psychological support and clears all doubts by explaining the process of organ donation.

Coordination

The nurse is in coordination with the other team from donor identification to transplant.

Post donation care

Post donation proper documentation and care and emotional support to relieve the family from this grief.

Reserving in transplanted cold storage helps transfer to recipe end.

👀 Q-6 A. Fill in the blanks:-

Normal potassium level in blood serum is __ The normal level of potassium in the blood is . (3.5-5.0mEq/L)

Tidal volume & vital capacity of lungs are measured by___instrument
Tidal volume and vital capacity are measured using instruments (spirometry).

Presence of blood in stool is known as __
The presence of blood in the stool (diarrhea) is known as Hematochezia.

Enlargement of liver is called___
Enlargement of the liver is called (hepatomegaly).

Removal of one lobe in the lungs is called __
Removing a lobe (part) of the lung is called (Lobectomy-Lobectomy)

👀 B. State whether the following statements are True or False.
Write whether the following statements are true or false.

1.Inflammation of vein wall is called phlebitis,
Inflammation of the vein wall is called phlebitis -(True)

2.Glass glow coma scale is used to check level of unconsciousness.
Glasg Go Coma Scale is used to check the level of consciousness. -(True)

3.Injection atropine increases bronchial secretion.
Injected atropine increases bronchial congestion. (False)

4.Projectile vomiting is occurring in pyloric stenosis.
Projectile vomiting occurs in pyloric stenosis.-(True)

5.Antibiotic drugs decrease infection and inflammation.
Antibiotic drugs reduce infection and inflammation. (True)

👀 C Match the following:-

A, B

Injection Heparin 1 Coughing in the morning
Injection heparin morning cough

Lithotomy 2 Rectum Examination
Examination of the lithotomy rectum

Emphysema 3 Auto immune disorder
Emphysema ota immune disorder

Proctoscope 4 Anti Coagulant
Proctiscope Anticoagulant

Hypothyroidism 5 Surgery in perineal area
Hypothyroidism perineal surgery

Answer-Answer

(1) Injection Heparin- 4. Anti coagulant

(2) Litho tomy- 5.Surgery in perineal area

(3) Amphi sema- 1.Cuffing in the morning

(4) Proctoscope- 2.rectum examination

(5) Hypo thyroidism- 3.Auto immune disorder

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