python3 -c " from docx import Document doc = Document('/tmp/workspace/attachments/0553093a-e0f0-4b2d-8648-a954ecc47676/SECOND TERMINAL PAPER.docx') for p in doc.paragraphs: style = p.style.name if p.style else 'None' if p.text.strip(): print(f'[{style}] {p.text}') "

ls -la /tmp/workspace/ 2>/dev/null || echo "workspace empty or does not exist"

mkdir -p /tmp/workspace/solved-paper && python3 << 'PYEOF' from docx import Document from docx.shared import Pt, Inches, RGBColor from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.oxml.ns import qn from docx.oxml import OxmlElement import docx doc = Document() # Page margins from docx.shared import Inches sections = doc.sections for section in sections: section.top_margin = Inches(0.8) section.bottom_margin = Inches(0.8) section.left_margin = Inches(1.0) section.right_margin = Inches(1.0) # Styles normal_style = doc.styles['Normal'] normal_style.font.name = 'Times New Roman' normal_style.font.size = Pt(12) def add_heading(doc, text, level=1, bold=True, color=None, size=13, center=False): p = doc.add_paragraph() if center: p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run(text) run.bold = bold run.font.size = Pt(size) run.font.name = 'Times New Roman' if color: run.font.color.rgb = color return p def add_body(doc, text, bold=False, italic=False, indent=False): p = doc.add_paragraph() if indent: p.paragraph_format.left_indent = Inches(0.3) run = p.add_run(text) run.bold = bold run.italic = italic run.font.size = Pt(12) run.font.name = 'Times New Roman' return p def add_marks_note(doc, text): p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.RIGHT run = p.add_run(text) run.bold = True run.font.size = Pt(11) run.font.color.rgb = RGBColor(0x00, 0x00, 0x80) run.font.name = 'Times New Roman' # ====== HEADER ====== p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run("DEPARTMENT OF PHYSIOLOGY") run.bold = True run.font.size = Pt(14) run.font.name = 'Times New Roman' p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run("Second Terminal Examination – MBBS Batch 2025-26") run.bold = True run.font.size = Pt(13) run.font.name = 'Times New Roman' p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run("Time: 2:40 Hrs Max. Marks: 80") run.font.size = Pt(12) run.font.name = 'Times New Roman' p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run("Note: Attempt all questions. Illustrate your answers with suitable diagrams wherever necessary.") run.italic = True run.font.size = Pt(11) run.font.name = 'Times New Roman' doc.add_paragraph() # ===================================================================== # Q.1 Essay Type Question (5+4+3+3=15 marks) # ===================================================================== add_heading(doc, "Q.1 ESSAY TYPE QUESTION [5+4+3+3 = 15 Marks]", level=1, size=13, bold=True) add_body(doc, "Draw well-labelled diagrams showing different types of ascending tracts and differentiate between them. Mention the sensations carried by them. What is Brown-Séquard Syndrome?", italic=True) doc.add_paragraph() add_heading(doc, "PART A: Types of Ascending Tracts – Diagrams & Differentiation [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run("The ascending (sensory) tracts of the spinal cord carry sensory information from receptors in the periphery to higher brain centres. The three major ascending tracts are:\n\n" "1. Posterior (Dorsal) Column – Medial Lemniscal Pathway\n" "2. Anterior Spinothalamic Tract\n" "3. Lateral Spinothalamic Tract\n") run.font.size = Pt(12) run.font.name = 'Times New Roman' # ASCII diagram for ascending tracts p = doc.add_paragraph() p.paragraph_format.left_indent = Inches(0.2) run = p.add_run( "CROSS-SECTION OF SPINAL CORD SHOWING ASCENDING TRACTS:\n\n" " ┌─────────────────────────────────────────┐\n" " │ POSTERIOR (DORSAL) │\n" " │ ┌──────────────────────┐ │\n" " │ │ Fasciculus Gracilis │ │\n" " │ │ Fasciculus Cuneatus │ │\n" " │ │ (Dorsal Columns) │ │\n" " │ └──────────────────────┘ │\n" " │ ┌───────────────┐ ┌──────────────────┐ │\n" " │ │ Lateral │ │ Anterior │ │\n" " │ │ Spinothalamic │ │ Spinothalamic │ │\n" " │ │ Tract │ │ Tract │ │\n" " │ └───────────────┘ └──────────────────┘ │\n" " │ ANTERIOR │\n" " └─────────────────────────────────────────┘\n" ) run.font.size = Pt(10) run.font.name = 'Courier New' add_heading(doc, "DIAGRAM 1: Dorsal Column – Medial Lemniscal Pathway", bold=True, size=11) p = doc.add_paragraph() run = p.add_run( " PERIPHERY → Dorsal Root Ganglion → Dorsal Column (SAME SIDE)\n" " → Nucleus Gracilis (leg) / Nucleus Cuneatus (arm) [Medulla]\n" " → Decussates → Medial Lemniscus → Thalamus (VPL nucleus)\n" " → Primary Somatosensory Cortex (Postcentral Gyrus)\n\n" " [Crosses at: Medulla]\n" ) run.font.size = Pt(11) run.font.name = 'Courier New' add_heading(doc, "DIAGRAM 2: Lateral Spinothalamic Tract", bold=True, size=11) p = doc.add_paragraph() run = p.add_run( " PERIPHERY → Dorsal Root Ganglion → Dorsal Horn synapse\n" " → Crosses via Anterior White Commissure (OPPOSITE SIDE)\n" " → Lateral Spinothalamic Tract → Thalamus (VPL nucleus)\n" " → Primary Somatosensory Cortex\n\n" " [Crosses at: Spinal cord level of entry]\n" ) run.font.size = Pt(11) run.font.name = 'Courier New' add_heading(doc, "DIAGRAM 3: Anterior Spinothalamic Tract", bold=True, size=11) p = doc.add_paragraph() run = p.add_run( " PERIPHERY → Dorsal Root Ganglion → Dorsal Horn synapse\n" " → Crosses via Anterior White Commissure (OPPOSITE SIDE)\n" " → Anterior Spinothalamic Tract → Thalamus (VPL nucleus)\n" " → Primary Somatosensory Cortex\n\n" " [Crosses at: Spinal cord level of entry]\n" ) run.font.size = Pt(11) run.font.name = 'Courier New' add_heading(doc, "PART B: Differentiation Table [4 Marks]", bold=True, size=12) # Table table = doc.add_table(rows=1, cols=5) table.style = 'Table Grid' hdr_cells = table.rows[0].cells headers = ['Feature', 'Dorsal Column', 'Lateral Spinothalamic', 'Anterior Spinothalamic', 'Spinocerebellar'] for i, h in enumerate(headers): hdr_cells[i].text = h hdr_cells[i].paragraphs[0].runs[0].bold = True hdr_cells[i].paragraphs[0].runs[0].font.size = Pt(10) rows_data = [ ['Sensations', 'Fine touch, proprioception, vibration, 2-pt discrimination', 'Pain, Temperature', 'Crude touch, pressure', 'Proprioception to cerebellum'], ['1st Neuron', 'Dorsal root ganglion → dorsal column', 'Dorsal root ganglion → dorsal horn', 'Dorsal root ganglion → dorsal horn', 'Dorsal root ganglion → dorsal horn'], ['Where crosses', 'Medulla (nucleus gracilis/cuneatus)', 'Spinal cord (same level)', 'Spinal cord (same level)', 'Mostly uncrossed'], ['2nd Neuron', 'Nucleus gracilis/cuneatus → Medial Lemniscus', 'Anterolateral column → Thalamus', 'Anterolateral column → Thalamus', 'Posterior spinocerebel. tract → cerebellum'], ['Location in cord', 'Posterior funiculus', 'Lateral funiculus', 'Anterior funiculus', 'Lateral funiculus'], ['Fiber type', 'Aα, Aβ (large myelinated)', 'Aδ, C (small, slow)', 'Aβ (medium)', 'Aα (large myelinated)'], ] for row_data in rows_data: row_cells = table.add_row().cells for i, val in enumerate(row_data): row_cells[i].text = val row_cells[i].paragraphs[0].runs[0].font.size = Pt(9) doc.add_paragraph() add_heading(doc, "PART C: Sensations Carried by Ascending Tracts [3 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "1. DORSAL COLUMNS (Fasciculus Gracilis + Fasciculus Cuneatus):\n" " • Fine/discriminative touch\n" " • Vibration sense\n" " • Proprioception (conscious awareness of joint position)\n" " • Two-point discrimination\n" " • Pressure sense\n" " • Stereognosis\n\n" "2. LATERAL SPINOTHALAMIC TRACT:\n" " • Pain (sharp/slow)\n" " • Temperature (hot and cold)\n\n" "3. ANTERIOR SPINOTHALAMIC TRACT:\n" " • Crude (light) touch\n" " • Pressure\n" " • Tickle and itch\n\n" "4. SPINOCEREBELLAR TRACTS (Posterior & Anterior):\n" " • Unconscious proprioception\n" " • Muscle and joint position sense → to cerebellum for coordination\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' add_heading(doc, "PART D: Brown-Séquard Syndrome [3 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nBrown-Séquard Syndrome results from hemisection (half-cut) of the spinal cord, " "affecting one side only. It was described by Charles-Édouard Brown-Séquard in 1850.\n\n" "CAUSES:\n" "• Penetrating trauma (stab wounds, bullet injuries) – most common\n" "• Tumors (meningioma, ependymoma)\n" "• Multiple sclerosis\n" "• Disc herniation\n" "• Ischemia\n\n" "CLINICAL FEATURES (below the level of lesion):\n\n" "IPSILATERAL (same side as lesion):\n" "• Upper Motor Neuron (UMN) paralysis – due to damage to corticospinal tract\n" "• Loss of fine touch, vibration, and proprioception – dorsal column damage\n" "• LMN paralysis AT the level of lesion (anterior horn cell damage)\n\n" "CONTRALATERAL (opposite side to lesion):\n" "• Loss of pain and temperature – lateral spinothalamic tract fibres that have already crossed\n" "• This sensory loss starts 2-3 segments below the actual lesion level\n\n" "MNEMONIC: IPSILATERAL – Power & Position lost; CONTRALATERAL – Pain & Temperature lost\n\n" "DIAGRAM:\n" " Level of lesion: e.g., T6 Right hemisection\n" " RIGHT side below T6: UMN paralysis + loss of vibration/proprioception\n" " LEFT side below T8: Loss of pain + temperature\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' doc.add_page_break() # ===================================================================== # Q.2 Clinical Case Scenario (1+3+6+3+2=15 marks) # ===================================================================== add_heading(doc, "Q.2 CLINICAL CASE SCENARIO [1+3+6+3+2 = 15 Marks]", bold=True, size=13) p = doc.add_paragraph() run = p.add_run( "CASE: A 50-year-old obese male with weakness, polydipsia, polyuria, polyphagia, weight loss, " "delayed wound healing. Investigations: FBG = 170 mg/dL; HbA1c = 7.9%; LDL = 140 mg/dL.\n" ) run.italic = True run.font.size = Pt(12) run.font.name = 'Times New Roman' add_heading(doc, "(a) Probable Diagnosis [1 Mark]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DIAGNOSIS: TYPE 2 DIABETES MELLITUS (T2DM)\n\n" "Justification:\n" "• Fasting Blood Glucose = 170 mg/dL (Normal < 100 mg/dL; Diabetic ≥ 126 mg/dL) ✓\n" "• HbA1c = 7.9% (Normal < 5.7%; Diabetic ≥ 6.5%) ✓\n" "• Classic symptoms: Polydipsia, Polyuria, Polyphagia, Weight loss ✓\n" "• Age 50, Obesity – typical for T2DM ✓\n" "• LDL 140 mg/dL – dyslipidemia associated with T2DM ✓\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' add_heading(doc, "(b) Physiological Basis of Symptoms [3 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "1. POLYURIA (Increased urination):\n" " Hyperglycemia → glucose exceeds renal threshold (~180 mg/dL) → glycosuria → osmotic diuresis\n" " → large volumes of water lost in urine → polyuria.\n\n" "2. POLYDIPSIA (Increased thirst):\n" " Osmotic diuresis causes dehydration + hyperosmolality of blood → stimulates osmoreceptors\n" " in hypothalamus → activates thirst center → polydipsia.\n\n" "3. POLYPHAGIA (Increased appetite):\n" " Despite high blood glucose, insulin deficiency/resistance → glucose cannot enter cells\n" " → cells 'starve' in midst of plenty → hunger signals activated → polyphagia.\n\n" "4. WEAKNESS (Fatigue):\n" " Glucose cannot be utilized by cells (insulin deficiency) → reduced ATP production\n" " → muscle weakness and fatigue.\n\n" "5. WEIGHT LOSS:\n" " Insulin deficiency → increased lipolysis (fat breakdown) → increased proteolysis\n" " (protein catabolism) → loss of fat and muscle mass → weight loss.\n\n" "6. DELAYED WOUND HEALING:\n" " Hyperglycemia → impaired neutrophil and macrophage function → reduced angiogenesis\n" " → impaired collagen synthesis + reduced growth factor activity → delayed healing.\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' add_heading(doc, "(c) Functions of Insulin [6 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "Insulin is a polypeptide hormone secreted by beta cells (β-cells) of the Islets of Langerhans in the pancreas.\n\n" "I. EFFECTS ON CARBOHYDRATE METABOLISM:\n" " (a) Increases glucose transport into cells (via GLUT-4 transporters) in muscle and adipose tissue\n" " (b) Promotes glycogenesis (glucose → glycogen) in liver and muscle\n" " (c) Inhibits glycogenolysis (breakdown of glycogen)\n" " (d) Inhibits gluconeogenesis (glucose production from non-carbohydrate sources)\n" " (e) Increases glucose oxidation (glycolysis)\n" " Net effect: LOWERS blood glucose\n\n" "II. EFFECTS ON FAT METABOLISM:\n" " (a) Promotes lipogenesis – excess glucose converted to fat in adipose tissue\n" " (b) Inhibits lipolysis – prevents breakdown of stored triglycerides\n" " (c) Inhibits ketogenesis – reduces formation of ketone bodies\n" " (d) Activates lipoprotein lipase → facilitates fat storage\n\n" "III. EFFECTS ON PROTEIN METABOLISM:\n" " (a) Stimulates amino acid uptake into cells\n" " (b) Promotes protein synthesis (anabolic effect)\n" " (c) Inhibits protein catabolism (anti-catabolic)\n" " → Net effect: POSITIVE NITROGEN BALANCE\n\n" "IV. EFFECTS ON POTASSIUM:\n" " • Stimulates Na⁺-K⁺-ATPase → drives K⁺ into cells\n" " → Used in treatment of hyperkalemia\n\n" "V. GROWTH-PROMOTING EFFECTS:\n" " • Acts with growth hormone and IGF-1 to promote cell growth\n" " • Stimulates DNA synthesis\n\n" "VI. VASCULAR EFFECTS:\n" " • Stimulates nitric oxide production → vasodilation\n" " • Counterbalances sympathomimetic vasoconstrictive effects\n\n" "SUMMARY TABLE:\n" " ┌──────────────────┬─────────────────────────────────────────────┐\n" " │ Substrate │ Effect of Insulin │\n" " ├──────────────────┼─────────────────────────────────────────────┤\n" " │ Glucose │ ↓ Blood glucose; ↑ uptake by cells │\n" " │ Glycogen │ ↑ Synthesis; ↓ Breakdown │\n" " │ Fat │ ↑ Lipogenesis; ↓ Lipolysis; ↓ Ketones │\n" " │ Protein │ ↑ Synthesis; ↓ Breakdown │\n" " │ Potassium │ ↑ Cellular uptake (↓ serum K⁺) │\n" " └──────────────────┴─────────────────────────────────────────────┘\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' add_heading(doc, "(d) Oral Glucose Tolerance Test (OGTT) [3 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nThe OGTT assesses the body's ability to metabolize a standard glucose load; it is the GOLD STANDARD for diagnosing diabetes and gestational diabetes.\n\n" "PREPARATION:\n" "• 3 days prior: Normal diet (≥150g carbohydrates/day)\n" "• 8-14 hours overnight fast\n" "• No smoking, strenuous exercise, or medication on test day\n\n" "PROCEDURE:\n" "Step 1: Collect fasting blood sample (0 min)\n" "Step 2: Patient drinks 75 g anhydrous glucose dissolved in 250-300 mL water\n" "Step 3: Blood glucose measured at 2 hours (120 min)\n" "(In pregnancy: additional measurements at 1 hr)\n\n" "INTERPRETATION (WHO/ADA 2024 criteria):\n" " ┌────────────────────┬───────────────────┬──────────────────┐\n" " │ Category │ Fasting (mg/dL) │ 2-hr (mg/dL) │\n" " ├────────────────────┼───────────────────┼──────────────────┤\n" " │ Normal │ < 100 │ < 140 │\n" " │ Impaired Fasting │ 100-125 │ < 140 │\n" " │ Impaired Glucose │ < 126 │ 140-199 │\n" " │ Tolerance (IGT) │ │ │\n" " │ DIABETES │ ≥ 126 │ ≥ 200 │\n" " └────────────────────┴───────────────────┴──────────────────┘\n\n" "CLINICAL USES:\n" "• Diagnosis of T2DM when FBG is borderline\n" "• Diagnosis of Gestational Diabetes Mellitus (GDM)\n" "• Detection of pre-diabetes (IGT)\n" "• Reactive hypoglycemia evaluation\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' add_heading(doc, "(e) Metabolic Syndrome [2 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nMetabolic syndrome (also called Syndrome X or Insulin Resistance Syndrome) is a cluster of " "cardiometabolic risk factors that occur together due to insulin resistance and excess visceral adiposity.\n\n" "DIAGNOSTIC CRITERIA (ATP III / IDF – any 3 of the following 5):\n" " 1. Waist circumference: Men > 102 cm (40\"); Women > 88 cm (35\")\n" " 2. Fasting blood glucose: ≥ 100 mg/dL (or on treatment)\n" " 3. Blood pressure: ≥ 130/85 mmHg (or on antihypertensives)\n" " 4. Triglycerides: ≥ 150 mg/dL (or on treatment)\n" " 5. HDL cholesterol: Men < 40 mg/dL; Women < 50 mg/dL\n\n" "IN THIS PATIENT:\n" "• Obesity (waist likely elevated) ✓\n" "• FBG 170 mg/dL ✓\n" "• LDL 140 mg/dL (dyslipidemia) – suggests associated lipid abnormality ✓\n" "→ This patient likely has Metabolic Syndrome along with T2DM.\n\n" "PATHOGENESIS:\nInsulin resistance → hyperinsulinemia → hypertension, dyslipidemia, central obesity, impaired glucose tolerance → CVD risk.\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' doc.add_page_break() # ===================================================================== # Q.3 Short Notes (6x5 = 30 marks) # ===================================================================== add_heading(doc, "Q.3 SHORT NOTES QUESTIONS (Max 300 words each) [6 × 5 = 30 Marks]", bold=True, size=13) # (a) Types of Hypoxia add_heading(doc, "(a) Types of Hypoxia [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nHypoxia is a state of inadequate oxygen supply to tissues despite adequate blood flow.\n\n" "CLASSIFICATION (Barcroft's Classification – 4 types):\n\n" "1. HYPOXIC HYPOXIA (Arterial Hypoxia):\n" " • PO₂ of arterial blood is reduced\n" " • O₂ saturation and O₂ content are also reduced\n" " • CAUSES: High altitude, hypoventilation, pneumonia, ARDS, asthma, airway obstruction\n" " • Low inspired PO₂ or impaired alveolar gas exchange\n\n" "2. ANEMIC HYPOXIA:\n" " • PO₂ of arterial blood is NORMAL\n" " • But O₂-carrying capacity is reduced (less hemoglobin)\n" " • CAUSES: Anemia, CO poisoning (carboxyhemoglobin), methemoglobinemia, hemorrhage\n" " • Blood has less Hb to carry O₂ even though lungs work fine\n\n" "3. STAGNANT (CIRCULATORY / ISCHEMIC) HYPOXIA:\n" " • PO₂ and O₂ content of arterial blood are NORMAL\n" " • But blood flow is too slow → more O₂ extracted per unit → venous PO₂ falls\n" " • CAUSES: Heart failure, shock, local ischemia, venous thrombosis\n\n" "4. HISTOTOXIC HYPOXIA:\n" " • PO₂, O₂ content, and blood flow are ALL NORMAL\n" " • But cells CANNOT utilize O₂ due to enzyme poisoning\n" " • CAUSES: Cyanide poisoning (blocks cytochrome oxidase), alcohol, hydrogen sulfide\n\n" "COMPARISON TABLE:\n" " ┌──────────────┬────────┬──────────┬──────────┬───────────┐\n" " │ Type │ Art PO₂│ Hb & O₂ │ Blood │ Venous │\n" " │ │ │ content │ Flow │ PO₂ │\n" " ├──────────────┼────────┼──────────┼──────────┼───────────┤\n" " │ Hypoxic │ LOW │ Low │ Normal │ Low │\n" " │ Anemic │ NORMAL │ LOW │ Normal │ Low │\n" " │ Stagnant │ NORMAL │ Normal │ LOW │ Very low │\n" " │ Histotoxic │ NORMAL │ Normal │ Normal │ HIGH │\n" " └──────────────┴────────┴──────────┴──────────┴───────────┘\n\n" "NOTE: In histotoxic hypoxia, venous PO₂ is HIGH because cells cannot extract O₂.\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (b) Visual Pathway and Lesions add_heading(doc, "(b) Visual Pathway with Lesions [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "The visual pathway carries visual information from the retina to the visual cortex.\n\n" "PATHWAY:\n" "Retina (photoreceptors: rods & cones)\n" " → Bipolar cells → Ganglion cells → Optic Nerve (CN II)\n" " → OPTIC CHIASMA (nasal fibers cross, temporal fibers stay ipsilateral)\n" " → Optic Tract → Lateral Geniculate Body (LGB) of Thalamus\n" " → Optic Radiation (Geniculocalcarine tract)\n" " → Primary Visual Cortex (Area 17, Calcarine sulcus, Occipital lobe)\n\n" "DIAGRAM OF VISUAL PATHWAY AND LESIONS:\n\n" " Left Eye Right Eye\n" " [Temporal][Nasal | Nasal][Temporal]\n" " | \\ / |\n" " | OPTIC CHIASMA |\n" " | / \\ |\n" " Left Optic Tract Right Optic Tract\n" " | |\n" " Left LGB Right LGB\n" " | |\n" " Left Optic Rad. Right Optic Rad.\n" " | |\n" " Left Visual Cortex Right Visual Cortex\n\n" "LESIONS AND VISUAL FIELD DEFECTS:\n" " 1. Optic Nerve lesion (A) → Total blindness in THAT eye (monocular blindness)\n" " 2. Optic Chiasma – central (B) → Bitemporal hemianopia (loss of both temporal fields)\n" " (pituitary tumor compresses crossing nasal fibers)\n" " 3. Optic Chiasma – lateral (C) → Binasal hemianopia (rare; carotid aneurysm)\n" " 4. Optic Tract lesion (D) → Contralateral homonymous hemianopia\n" " 5. Meyer's loop – temporal lobe → 'Pie in the sky' – upper contralateral quadrantanopia\n" " 6. Parietal lobe (E) → 'Pie on the floor' – lower contralateral quadrantanopia\n" " 7. Optic Radiation / Cortex (F) → Contralateral homonymous hemianopia WITH macular sparing\n" " (dual blood supply to macular area)\n\n" "KEY POINTS:\n" "• Macular sparing occurs in cortical lesions because macula has dual blood supply\n" "• Pituitary tumors cause bitemporal hemianopia (compress optic chiasma from below)\n" "• Craniopharyngioma also causes chiasmal compression\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (c) Gastrin, CCK, Secretin add_heading(doc, "(c) Functions of Gastrin, Cholecystokinin (CCK), and Secretin [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "These are GI hormones (peptide hormones) secreted by enteroendocrine cells of the GI tract.\n\n" "1. GASTRIN:\n" " Source: G cells of the Antrum of stomach; also in duodenum\n" " Stimulus for secretion: Protein digestion products, stomach distension, vagal stimulation\n" " Functions:\n" " (a) Stimulates gastric acid (HCl) secretion by parietal cells ← MAJOR FUNCTION\n" " (b) Stimulates pepsinogen secretion by chief cells\n" " (c) Promotes gastric motility\n" " (d) Stimulates growth of gastric mucosa (trophic effect)\n" " (e) Stimulates insulin secretion\n" " Inhibition: Low gastric pH (negative feedback), somatostatin, secretin\n" " Clinical: Zollinger-Ellison Syndrome = gastrinoma → excess gastrin → peptic ulcers\n\n" "2. CHOLECYSTOKININ (CCK):\n" " Source: I cells of duodenum and upper jejunum\n" " Stimulus: Fat and protein digestion products entering duodenum\n" " Functions:\n" " (a) CHOLECYSTO-KININ = stimulates GALLBLADDER CONTRACTION → bile release ← KEY\n" " (b) Relaxes Sphincter of Oddi → allows bile and pancreatic juice into duodenum\n" " (c) Stimulates pancreatic enzyme secretion (lipase, amylase, protease)\n" " (d) Enhances effect of secretin on pancreatic bicarbonate secretion\n" " (e) Inhibits gastric emptying (slows gastric motility)\n" " (f) Satiety signal – acts on hypothalamus to reduce appetite\n" " (g) Trophic effect on pancreas and gallbladder\n\n" "3. SECRETIN:\n" " Source: S cells of duodenum\n" " Stimulus: Acid (H⁺) in the duodenum (most potent stimulus)\n" " Functions:\n" " (a) Stimulates PANCREATIC BICARBONATE (HCO₃⁻) secretion ← MAJOR FUNCTION\n" " → Neutralizes acid entering duodenum\n" " (b) Stimulates bicarbonate secretion from liver (bile)\n" " (c) Inhibits gastrin secretion and gastric acid production\n" " (d) Inhibits gastric motility and emptying\n" " (e) Stimulates growth of exocrine pancreas\n" " Clinical Use: Secretin stimulation test – used to diagnose Zollinger-Ellison syndrome\n\n" "SUMMARY:\n" " Gastrin → More acid in stomach\n" " CCK → More enzymes + bile; less gastric emptying\n" " Secretin → More bicarbonate to neutralize acid\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (d) Properties of Synapse add_heading(doc, "(d) Properties of Synapse [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "A synapse is a specialized junction for transmission of nerve impulses from one neuron (presynaptic) " "to another neuron or effector organ (postsynaptic). The main properties are:\n\n" "1. UNIDIRECTIONAL CONDUCTION:\n" " • Transmission occurs ONLY in one direction: presynaptic → postsynaptic\n" " • This is because neurotransmitters are stored in vesicles at the presynaptic terminal\n" " and receptors are on the postsynaptic membrane\n" " • Ensures orderly flow of information through neural circuits\n\n" "2. SYNAPTIC DELAY:\n" " • There is a delay of ~0.5 ms at each synapse\n" " • Due to time for: AP arrival → Ca²⁺ influx → vesicle fusion → NT diffusion → receptor binding\n" " • Number of synapses in a reflex arc determines its total reflex time\n" " • Longer reflex latency = more synapses in the pathway\n\n" "3. SUMMATION:\n" " Two types:\n" " (a) SPATIAL SUMMATION: Multiple presynaptic neurons fire simultaneously\n" " → their EPSPs add together to reach threshold\n" " (b) TEMPORAL SUMMATION: Repeated stimuli from ONE neuron in rapid succession\n" " → successive EPSPs summate before decaying → reach threshold\n\n" "4. FATIGUE:\n" " • With repeated stimulation, synaptic transmission becomes less effective\n" " • Due to: Depletion of neurotransmitter vesicles, ATP deficiency, receptor desensitization\n" " • Acts as a protective mechanism to prevent overstimulation\n\n" "5. FACILITATION & POST-TETANIC POTENTIATION:\n" " • After repetitive stimulation, subsequent stimuli produce greater-than-normal response\n" " • Residual Ca²⁺ in presynaptic terminal → more NT released with next stimulus\n" " • Basis for learning and memory\n\n" "6. AFTER-DISCHARGE:\n" " • A single stimulus can produce a prolonged response\n" " • Due to reverberating circuits (re-entrant loops) keeping neurons firing\n\n" "7. CONVERGENCE AND DIVERGENCE:\n" " • Convergence: Many presynaptic neurons synapse on ONE postsynaptic neuron\n" " • Divergence: ONE presynaptic neuron synapses on MANY postsynaptic neurons\n" " • Allows integration and amplification of signals\n\n" "8. SUSCEPTIBILITY TO HYPOXIA AND DRUGS:\n" " • Synapses are very sensitive to anesthetics, analgesics, and poisons\n" " • Hypoxia, pH changes affect NT release and receptor sensitivity\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (e) Disorders of Glucocorticoids add_heading(doc, "(e) Disorders of Glucocorticoids – Hypersecretion and Hyposecretion [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "Glucocorticoids (primarily Cortisol) are secreted by the Zona Fasciculata of the adrenal cortex " "under control of ACTH from the anterior pituitary.\n\n" "A. HYPERSECRETION – CUSHING'S SYNDROME:\n\n" "DEFINITION: Syndrome resulting from excess glucocorticoid activity\n\n" "CAUSES:\n" " (1) Cushing's DISEASE: Pituitary adenoma → excess ACTH → bilateral adrenal hyperplasia\n" " (2) Ectopic ACTH syndrome: Small cell lung cancer producing ACTH\n" " (3) Adrenal adenoma/carcinoma: Autonomous cortisol production\n" " (4) Exogenous: Iatrogenic (long-term steroid therapy) – most common overall\n\n" "CLINICAL FEATURES:\n" " • Central obesity with moon face, buffalo hump, truncal obesity, thin limbs\n" " • Striae (purple striae over abdomen and thighs)\n" " • Hypertension\n" " • Hyperglycemia (steroid diabetes)\n" " • Osteoporosis and pathological fractures\n" " • Muscle wasting and proximal myopathy\n" " • Amenorrhea, hirsutism\n" " • Easy bruising, poor wound healing\n" " • Hypokalemic alkalosis\n" " • Neuropsychiatric changes (depression, psychosis)\n\n" "DIAGNOSIS:\n" " • 24-hr urinary free cortisol (elevated)\n" " • Overnight Dexamethasone suppression test (failure to suppress)\n" " • Plasma ACTH levels (high = pituitary/ectopic; low = adrenal)\n\n" "B. HYPOSECRETION – ADDISON'S DISEASE:\n\n" "DEFINITION: Primary adrenal cortex insufficiency → deficiency of cortisol AND aldosterone\n\n" "CAUSES:\n" " (1) Autoimmune adrenalitis (most common in developed world)\n" " (2) Tuberculosis (most common worldwide)\n" " (3) Metastatic carcinoma, HIV, fungal infections\n" " (4) Bilateral adrenalectomy\n\n" "CLINICAL FEATURES:\n" " • Hypotension (loss of aldosterone → Na⁺ loss → volume depletion)\n" " • Weakness, fatigue, weight loss, anorexia\n" " • Hyperpigmentation of skin (↑ ACTH/MSH due to loss of negative feedback)\n" " • Hyponatremia, Hyperkalemia, Hypoglycemia\n" " • GI symptoms: Nausea, vomiting, diarrhea\n" " • Amenorrhea in women\n\n" "ADDISONIAN CRISIS (Acute):\n" " • Severe shock, fever, acute abdominal pain\n" " • Precipitated by infection, surgery, or trauma\n" " • EMERGENCY: IV hydrocortisone + saline + glucose\n\n" "DIAGNOSIS:\n" " • Low serum cortisol (< 3 µg/dL confirms)\n" " • High ACTH (primary); Low ACTH (secondary/pituitary)\n" " • ACTH (Synacthen) stimulation test: Failure of cortisol to rise\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' doc.add_page_break() # ===================================================================== # Q.4 Short Answer Type Questions (4x5 = 20 marks) # ===================================================================== add_heading(doc, "Q.4 SHORT ANSWER TYPE QUESTIONS (Max 100 words each) [4 × 5 = 20 Marks]", bold=True, size=13) # (a) Cardiac Output Measurement add_heading(doc, "(a) Methods of Measurement of Cardiac Output [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "Cardiac Output (CO) = Heart Rate × Stroke Volume. Normal = 5 L/min (at rest).\n\n" "METHODS OF MEASUREMENT:\n\n" "1. FICK'S PRINCIPLE (Gold Standard):\n" " CO = O₂ consumed per min / (Arterial O₂ content – Venous O₂ content)\n" " CO = VO₂ / (CaO₂ – CvO₂)\n" " • Direct method; invasive (catheterization)\n" " • Normal O₂ consumption at rest ~250 mL/min\n\n" "2. DYE DILUTION METHOD (Stewart-Hamilton):\n" " • Indicator dye (Indocyanine green) injected IV\n" " CO = Amount of dye injected / (Mean concentration × Time)\n" " • Repeated use limited by dye accumulation\n\n" "3. THERMODILUTION METHOD:\n" " • Cold saline injected into right atrium\n" " • Temperature change measured downstream by thermistor in pulmonary artery\n" " • Most widely used clinically via Swan-Ganz catheter\n" " • CO inversely proportional to temperature change curve area\n\n" "4. ECHOCARDIOGRAPHY (Doppler Echo):\n" " • Non-invasive\n" " CO = Stroke volume × Heart rate\n" " • SV = Aortic cross-sectional area × Velocity-time integral\n" " • Most commonly used in clinical practice (safe, repeatable)\n\n" "5. BIOIMPEDANCE METHOD:\n" " • Measures changes in thoracic electrical impedance during cardiac cycle\n" " • Non-invasive but less accurate\n\n" "6. MRI / CT METHODS:\n" " • Phase-contrast MRI can directly measure aortic blood flow velocity\n" " • High accuracy but expensive and less practical\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (b) Referred Pain add_heading(doc, "(b) Referred Pain and Theories [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nReferred pain is pain that is perceived at a site remote from the actual site of the pathological stimulus.\n\n" "EXAMPLES:\n" " • Cardiac ischemia → pain in left arm, jaw, epigastrium\n" " • Diaphragmatic irritation → shoulder tip pain (C3, C4, C5 dermatome)\n" " • Appendicitis → begins as periumbilical pain\n" " • Renal colic → groin and inner thigh pain\n" " • Gallbladder disease → right shoulder pain\n\n" "THEORIES:\n\n" "1. CONVERGENCE-PROJECTION THEORY (Most accepted – Ruch, 1946):\n" " • Afferent fibers from BOTH visceral AND somatic structures converge\n" " on the SAME second-order neuron in the dorsal horn\n" " • Brain cannot distinguish the true source → projects pain to the somatic site\n" " (because somatic stimulation is more common and the brain has learned to\n" " associate that neuron with skin/muscle)\n\n" "2. CONVERGENCE-FACILITATION THEORY (MacKenzie):\n" " • Visceral pain impulses create a state of irritability (facilitation)\n" " in the dorsal horn neurons\n" " • Normal somatic afferent impulses that would otherwise be sub-threshold\n" " now cause pain perception in the somatic area\n\n" "3. AXON REFLEX THEORY:\n" " • Branching of sensory axons: one branch to viscus, another to skin\n" " • Impulse travels antidromically (backward) along the skin branch\n" " • Releases substance P and other mediators → local hyperalgesia\n" " (Less widely accepted)\n\n" "CLINICAL SIGNIFICANCE:\n" " • Understanding referred pain helps in diagnosis of visceral pathology\n" " • Head's zones: Dermatomes that become hyperalgesic with visceral disease\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (c) Pituitary vs Thyroid Dwarfism add_heading(doc, "(c) Difference Between Pituitary and Thyroid Dwarfism [5 Marks]", bold=True, size=12) table2 = doc.add_table(rows=1, cols=3) table2.style = 'Table Grid' hdr2 = table2.rows[0].cells hdr2[0].text = 'Feature' hdr2[1].text = 'Pituitary Dwarfism' hdr2[2].text = 'Thyroid Dwarfism (Cretinism)' for cell in hdr2: cell.paragraphs[0].runs[0].bold = True cell.paragraphs[0].runs[0].font.size = Pt(11) rows3 = [ ['Cause', 'Deficiency of Growth Hormone (GH) due to pituitary insufficiency', 'Deficiency of Thyroid Hormone (T3/T4) during fetal/neonatal life'], ['Also called', 'Lorain-Levi syndrome; GH deficiency dwarfism', 'Cretinism (congenital hypothyroidism)'], ['Body proportions', 'Normal – proportionate short stature', 'Disproportionate – stocky, large head, short limbs'], ['Intelligence', 'NORMAL', 'SEVERELY IMPAIRED (mental retardation)'], ['Puberty & sexual maturation', 'Delayed or absent without GH therapy', 'Absent; sexual infantilism'], ['Bone age', 'Delayed but proportionate', 'Severely delayed; epiphyseal dysgenesis'], ['Facial features', 'Normal but childlike (doll face)', 'Coarse, myxedematous; depressed nasal bridge; macroglossia'], ['Metabolic rate (BMR)', 'Normal', 'Very LOW'], ['Muscle tone', 'Normal', 'Hypotonic (floppy baby)'], ['Skin', 'Normal', 'Dry, coarse, myxedematous'], ['Abdomen', 'Normal', 'Pot-belly, umbilical hernia'], ['Treatment', 'Recombinant GH injections', 'Thyroxine (T4) supplementation – must start EARLY (neonatal screening)'], ['Critical period', 'GH needed throughout childhood', 'T4 critical in first 2 years for brain development'], ['Lab findings', 'Low IGF-1; Low GH on stimulation test', 'Low T4, High TSH; low bone age on X-ray'], ] for row in rows3: r = table2.add_row().cells for i, val in enumerate(row): r[i].text = val r[i].paragraphs[0].runs[0].font.size = Pt(9) doc.add_paragraph() # (d) Phantom Limb add_heading(doc, "(d) Phantom Limb [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nPhantom limb is the sensation that an amputated or absent limb is still present and may even feel painful. " "It occurs in up to 80% of amputees.\n\n" "TYPES:\n" " 1. Phantom limb SENSATION: Non-painful awareness of the absent limb\n" " 2. Phantom limb PAIN: Painful perception in the absent limb (burning, cramping, shooting pain)\n\n" "MECHANISM / THEORIES:\n\n" "1. PERIPHERAL THEORY:\n" " • Neuromas (cut nerve endings) at stump discharge spontaneously\n" " • These ectopic discharges are interpreted by brain as coming from original limb\n\n" "2. SPINAL CORD THEORY:\n" " • Loss of normal afferent input → dorsal horn becomes hyperexcitable (central sensitization)\n" " • Spontaneous firing of spinal interneurons generates pain signals\n\n" "3. CORTICAL REORGANIZATION (MOST IMPORTANT – Ramachandran):\n" " • After amputation, the cortical map in somatosensory cortex reorganizes\n" " • Neighboring cortical areas (e.g., face area) invade the deafferented hand area\n" " • Stimulating the face may trigger sensations perceived as coming from the phantom hand\n" " • Basis of mirror therapy for phantom limb pain treatment\n\n" "4. GATE CONTROL THEORY:\n" " • Loss of large-fiber (Aβ) input → uninhibited firing of small-fiber (C fiber) pain signals\n\n" "TREATMENT:\n" " • Mirror box therapy (Ramachandran's mirror visual feedback)\n" " • Pharmacological: Amitriptyline, Gabapentin, Opioids, Ketamine\n" " • TENS (Transcutaneous Electrical Nerve Stimulation)\n" " • Spinal cord stimulation\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # (e) Impedance Matching add_heading(doc, "(e) Impedance Matching [5 Marks]", bold=True, size=12) p = doc.add_paragraph() run = p.add_run( "DEFINITION:\nImpedance matching is the mechanism in the middle ear by which sound energy is efficiently " "transferred from the low-impedance air medium to the high-impedance fluid medium of the inner ear (cochlea).\n\n" "THE PROBLEM:\n" " • Sound travels in AIR (low impedance) → must enter fluid of inner ear (HIGH impedance)\n" " • Without impedance matching, ~99.9% (30 dB) of sound energy would be REFLECTED\n" " • Only 0.1% would be transmitted to inner ear fluid\n\n" "HOW THE MIDDLE EAR SOLVES THIS (Transformer Mechanism):\n\n" "The middle ear acts as an impedance-matching transformer by TWO mechanisms:\n\n" "1. AREA RATIO (Main mechanism – 17:1 amplification):\n" " • Area of tympanic membrane ≈ 55-60 mm²\n" " • Area of stapes footplate (oval window) ≈ 3.2 mm²\n" " • Ratio ≈ 17:1\n" " • Same force concentrated on smaller area → pressure amplified 17-fold\n" " • Pressure gain = Force/Area → 17× increase in pressure\n\n" "2. LEVER ACTION OF OSSICLES:\n" " • The malleus arm is longer than the incus arm (ratio ≈ 1.3:1)\n" " • Provides an additional mechanical advantage of 1.3×\n\n" "TOTAL PRESSURE GAIN:\n" " = 17 × 1.3 = ~22-fold increase in pressure\n" " = ~25-27 dB amplification\n" " (Compensates for the 30 dB that would otherwise be lost)\n\n" "ADDITIONAL PROTECTIVE MECHANISMS:\n" " • Acoustic (stapedius) reflex: Loud sounds → stapedius and tensor tympani contract\n" " → stiffen ossicular chain → reduce transmission of very loud sounds\n" " • Protects cochlea from damage (though too slow for sudden sounds)\n\n" "CLINICAL SIGNIFICANCE:\n" " • Damage to ossicles or tympanic membrane → conductive hearing loss\n" " • Otosclerosis (stapes fixation) → loss of impedance matching → conductive deafness\n" ) run.font.size = Pt(12) run.font.name = 'Times New Roman' # Save document output_path = '/tmp/workspace/solved-paper/SECOND_TERMINAL_PAPER_SOLVED.docx' doc.save(output_path) print(f"Document saved to: {output_path}") print("Done!") PYEOF

python3 -c " from docx import Document doc = Document('/tmp/workspace/solved-paper/SECOND_TERMINAL_PAPER_SOLVED.docx') count = sum(1 for p in doc.paragraphs if p.text.strip()) tables = len(doc.tables) print(f'Paragraphs with text: {count}') print(f'Tables: {tables}') import os size = os.path.getsize('/tmp/workspace/solved-paper/SECOND_TERMINAL_PAPER_SOLVED.docx') print(f'File size: {size/1024:.1f} KB') "