LSD -NOV-DEC 2024 AU QP ANS

NOV-DEC 2024
LIFESTYLE DISEASES
AU QP ANS
1. Risk Factors of Lifestyle Diseases
The primary risk factors include:
Unhealthy diet: Consuming high amounts of saturated fats, sugar, and salt.
Physical inactivity: Lack of regular exercise or leading a sedentary lifestyle.
Tobacco use: Smoking or chewing tobacco products.
Harmful alcohol use: Excessive and frequent consumption of alcohol.
2. Definition of Illicit Drug
An illicit drug is a substance that is highly illegal to produce, possess, sell, or use. It also refers to prescription medications that are obtained or used illegally without a medical prescription.
3. Types of Cancer
Cancer is broadly categorized into these major types:
Carcinomas: Cancers originating in the skin or tissues lining internal organs (e.g., lung, breast, colon cancer).
Sarcomas: Cancers developing in bone, cartilage, fat, muscle, or blood vessels.
Leukaemias: Cancers of the bone marrow and blood-forming tissues.
Lymphomas and Myelomas: Cancers that begin in the cells of the immune system.
4. Causes of Mouth Cancer
The leading causes of mouth (oral) cancer include:
Tobacco consumption: Smoking cigarettes, cigars, pipes, or chewing tobacco.
Heavy alcohol use: Frequent and excessive drinking (the risk increases significantly when combined with tobacco use).
Human Papillomavirus (HPV): Infection with certain strains of the sexually transmitted virus, particularly HPV-16.
Chronic irritation: Long-term irritation in the mouth caused by sharp, broken teeth or ill-fitting dentures.

5. Define Coronary Atherosclerosis.

Coronary atherosclerosis is a condition in which fatty deposits, cholesterol and other substances accumulate inside the walls of the coronary arteries, forming plaques and narrowing the arteries. This reduces blood flow to the heart muscle and may lead to coronary artery disease.

6. What are the causes of Coronary Artery Disease?

Major causes/risk factors include:

· High blood cholesterol

· High blood pressure

· Smoking and tobacco use

· Diabetes mellitus

· Obesity

· Lack of physical activity

· Unhealthy diet

· Stress

· Family history and increasing age

7. What is Type II Diabetes?

Type II diabetes mellitus is a chronic metabolic disorder in which the body becomes resistant to insulin and/or does not produce sufficient insulin. This results in increased blood glucose levels. It is commonly associated with obesity, physical inactivity and unhealthy lifestyle.

8. What is Body Mass Index?

Body Mass Index (BMI) is a measure used to assess body weight in relation to height.

BMI= Weight in kg / (Height in metres)²
For adults, a BMI of 18.5–24.9 is generally considered normal.

9. List out the causes of Asthma.

Common causes/triggers of asthma include:

· Dust and dust mites

· Pollen

· Smoke and air pollution

· Pet allergens

· Respiratory infections

· Exercise

· Cold air

· Chemical fumes

· Certain medicines

· Stress and emotional factors

10. Write a note on Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease that causes persistent airflow limitation and difficulty in breathing. The major forms are chronic bronchitis and emphysema. Smoking is the major risk factor. Symptoms include chronic cough, sputum production, wheezing and breathlessness. Treatment includes smoking cessation, inhaled medicines, pulmonary rehabilitation, oxygen therapy when required, vaccination and regular medical care.

PART B-(5x13=65 marks)

PART B – 13-Mark Answers

11(a). Explain how diet and exercise avoid the risk factors of lifestyle diseases.

Lifestyle diseases such as obesity, diabetes, cardiovascular diseases and hypertension are strongly influenced by diet and physical inactivity.

Role of a healthy diet

1. Balanced nutrition: Provides carbohydrates, proteins, healthy fats, vitamins and minerals.

2. Weight management: Appropriate calorie intake prevents obesity.

3. High-fibre foods: Fruits, vegetables and whole grains help control blood glucose and cholesterol.

4. Reduced saturated fat: Helps reduce LDL cholesterol and cardiovascular risk.

5. Reduced salt: Helps control blood pressure.

6. Limited sugar: Reduces the risk of obesity and Type II diabetes.

7. Adequate water: Maintains proper hydration and supports metabolism.

8. Avoid processed foods: Reduces excess salt, sugar and unhealthy fats.

Role of regular exercise

1. Helps maintain healthy body weight.

2. Improves insulin sensitivity.

3. Reduces blood pressure.

4. Improves HDL cholesterol and lipid profile.

5. Strengthens the heart and lungs.

6. Improves muscle strength and endurance.

7. Reduces stress and improves mental health.

8. Improves sleep quality.

Conclusion: A balanced diet combined with regular physical activity helps prevent obesity, diabetes, hypertension and cardiovascular diseases and promotes a healthy lifestyle.

11(b). Illustrate various risk factors of lifestyle diseases with suitable examples.

Lifestyle disease risk factors can be classified as follows:

1. Unhealthy diet

Excess consumption of sugar, salt, saturated fat and processed foods increases disease risk.
Example: Excess fast-food consumption may lead to obesity and hypertension.

2. Physical inactivity

Lack of exercise increases obesity and cardiovascular risk.

3. Smoking

Smoking damages blood vessels and lungs and increases the risk of heart disease, COPD and cancer.

4. Alcohol consumption

Excess alcohol can cause liver disease, hypertension and cardiovascular problems.

5. Obesity

Excess body fat increases the risk of Type II diabetes, hypertension and heart disease.

6. Stress

Chronic stress may contribute to hypertension, anxiety and cardiovascular problems.

7. Poor sleep

Insufficient sleep is associated with obesity, diabetes and cardiovascular disorders.

8. Genetic factors

Family history can increase susceptibility to diabetes, hypertension and certain cancers.

9. Age

The risk of many chronic diseases increases with age.

10. Environmental factors

Air pollution and exposure to harmful chemicals may contribute to respiratory diseases and cancer.

12(a). Write a detailed note on Skin cancer and its types.

Detailed note on Skin Cancer and its Types

Skin cancer is the abnormal and uncontrolled growth of skin cells. Excessive exposure to ultraviolet (UV) radiation from sunlight is a major risk factor.

Risk factors

· Excessive UV exposure

· Frequent sunburn

· Fair skin

· Family history

· Use of tanning beds

· Exposure to certain chemicals

· Weakened immune system

Major types

1. Basal Cell Carcinoma (BCC)
It develops from basal cells of the epidermis. It usually grows slowly and rarely spreads to other organs.

2. Squamous Cell Carcinoma (SCC)
It develops from squamous cells. It can grow more rapidly and may spread if untreated.

3. Melanoma
It develops from melanocytes, the cells that produce melanin. It is less common but more dangerous because it can spread rapidly.

Prevention

· Avoid excessive sunlight.

· Use sunscreen.

· Wear protective clothing.

· Avoid tanning beds.

· Examine unusual skin changes.

· Seek medical advice for suspicious lesions.

Treatment

Treatment may include surgical removal, cryotherapy, radiation therapy, immunotherapy, targeted therapy or other treatments depending on the type and stage.

12(b). Describe the causes and treatment of Lung cancer

Causes and Treatment of Lung Cancer

Lung cancer is the uncontrolled growth of abnormal cells in the lungs.

Causes and risk factors

1. Smoking – the most important risk factor.

2. Passive smoking.

3. Exposure to radon gas.

4. Occupational exposure to asbestos and other chemicals.

5. Air pollution.

6. Family history.

7. Previous radiation exposure.

Symptoms

· Persistent cough

· Coughing up blood

· Chest pain

· Breathlessness

· Unexplained weight loss

· Fatigue

· Recurrent respiratory infections

Diagnosis

Diagnosis may involve chest X-ray, CT scan, bronchoscopy and biopsy.

Treatment

Treatment depends on the type and stage and may include:

· Surgery

· Chemotherapy

· Radiation therapy

· Targeted therapy

· Immunotherapy

Prevention: Avoid smoking and tobacco, reduce occupational exposure to harmful substances and maintain a healthy lifestyle.

13(a). Explain the recent advancement in the diagnosis of Coronary Artery Disease.

Recent Advancements in the Diagnosis of Coronary Artery Disease

Modern diagnosis of Coronary Artery Disease (CAD) uses both non-invasive and invasive techniques.

Major advancements

1. High-sensitivity cardiac troponin tests – help detect heart muscle injury more accurately.

2. Coronary CT angiography (CCTA) – provides detailed images of coronary arteries without conventional catheterization.

3. CT calcium scoring – detects calcium deposits and helps estimate coronary risk.

4. Stress echocardiography – evaluates heart function during stress.

5. Cardiac MRI – provides detailed information about heart structure, function and tissue damage.

6. Nuclear cardiac imaging – assesses myocardial blood flow and ischemia.

7. Intravascular ultrasound (IVUS) – provides images from inside coronary arteries.

8. Optical coherence tomography (OCT) – provides high-resolution images of coronary plaques.

9. Fractional Flow Reserve (FFR) – helps determine whether a coronary blockage significantly affects blood flow.

10. Artificial intelligence-assisted imaging – supports image analysis and cardiovascular risk assessment.

Conclusion: These technologies allow earlier, more accurate and less invasive detection of coronary artery disease.

13(b). Explain how the fat, lipids and alcohol increase the risk of cardio vascular diseases.

How Fat, Lipids and Alcohol Increase the Risk of Cardiovascular Diseases

Fat

Excess consumption of saturated and trans fats can increase LDL cholesterol. High LDL promotes plaque formation in arteries and increases the risk of coronary artery disease.

Lipids

Abnormal blood lipid levels, particularly:

· High LDL cholesterol

· High triglycerides

· Low HDL cholesterol

can contribute to atherosclerosis, narrowing and hardening of arteries.

Alcohol

Excessive alcohol consumption can:

· Increase blood pressure

· Increase triglyceride levels

· Contribute to obesity

· Cause heart rhythm abnormalities

· Increase the risk of cardiomyopathy and stroke

Prevention

A healthy diet, regular exercise, weight control and limiting alcohol consumption can reduce cardiovascular risk.

14(a). Elaborate on blood glucose regulation and the mechanism behind the regression of diabetes.

Blood Glucose Regulation and Mechanism Behind the Progression of Diabetes

Blood glucose is mainly regulated by the hormones insulin and glucagon, produced by the pancreas.

After a meal

1. Blood glucose increases.

2. Pancreatic β-cells release insulin.

3. Insulin promotes glucose uptake by muscle and fat cells.

4. It promotes conversion of glucose into glycogen in the liver and muscles.

5. Blood glucose therefore decreases toward normal.

During fasting

1. Blood glucose decreases.

2. Pancreatic α-cells release glucagon.

3. Glucagon stimulates breakdown of liver glycogen.

4. It also promotes glucose production by the liver.

5. Blood glucose increases toward normal.

Progression of Type II Diabetes

Insulin resistance → increased insulin production → pancreatic β-cell dysfunction → inadequate insulin → persistent hyperglycaemia → diabetes complications

Long-term high blood glucose may damage the:

· Eyes

· Kidneys

· Nerves

· Heart and blood vessels

14(b). Explain the different ways of weight control in paediatric and adolescent obesity.

Weight Control in Paediatric and Adolescent Obesity

Weight management in children and adolescents should focus on healthy growth rather than rapid weight loss.

Important approaches

1. Provide a balanced diet with fruits and vegetables.

2. Reduce sugary drinks and processed foods.

3. Control portion sizes.

4. Encourage regular physical activity.

5. Limit excessive screen time.

6. Maintain adequate sleep.

7. Involve parents and family members.

8. Encourage healthy eating habits at home.

9. Monitor growth, BMI and overall health regularly.

10. Provide behavioural counselling when required.

11. Manage underlying medical conditions.

12. Specialist treatment may be considered for severe obesity.

Conclusion: Early lifestyle modification and family support are important for preventing long-term complications.

15(a). a) Write a detailed note on chronic lung diseases and its types

Chronic Lung Diseases and Their Types

Chronic lung diseases are long-term disorders that affect the lungs and respiratory system. They may cause persistent breathing difficulties and reduced lung function.

Major types

1. Chronic Obstructive Pulmonary Disease (COPD)
Includes chronic bronchitis and emphysema. Smoking is the major risk factor.

2. Asthma
A chronic inflammatory disease characterized by variable airway narrowing, wheezing and breathlessness.

3. Bronchiectasis
Permanent widening and damage of the airways, often associated with recurrent respiratory infections.

4. Interstitial Lung Diseases
A group of disorders causing inflammation and/or scarring of lung tissue, leading to reduced oxygen transfer.

5. Pulmonary Hypertension
Increased pressure in the blood vessels of the lungs.

Common symptoms

· Breathlessness

· Chronic cough

· Wheezing

· Sputum production

· Fatigue

· Reduced exercise tolerance

Prevention and management

Smoking cessation, avoiding pollutants, vaccination, regular exercise, appropriate medication and medical follow-up help manage chronic lung diseases.

15(b). Explain the importance and procedure involved in the pulmonary function teat.

Importance and Procedure of Pulmonary Function Test

Pulmonary Function Tests (PFTs) are tests used to evaluate how well the lungs work.

Importance

PFTs help to:

· Diagnose respiratory diseases.

· Differentiate obstructive and restrictive disorders.

· Assess severity of lung disease.

· Monitor disease progression.

· Evaluate response to treatment.

· Assess lung function before certain surgeries.

Common measurements

· FVC: Forced Vital Capacity

· FEV₁: Forced Expiratory Volume in one second

· FEV₁/FVC ratio

· PEF: Peak Expiratory Flow

Procedure

1. The patient is seated and instructed about the test.

2. A nose clip is usually applied.

3. The patient breathes through a mouthpiece connected to a spirometer.

4. The patient takes a deep breath.

5. The patient exhales forcefully and completely into the device.

6. The manoeuvre is repeated to obtain reliable measurements.

7. In some cases, the test is repeated after giving a bronchodilator.

8. The results are compared with predicted values based on factors such as age, height and sex.

PART - C (1 x 15 = 15)

16. (a) Risk Factors of Illicit Drugs, Tobacco, and Smoking & Cardiac Rehabilitation

PART I: Risk Factors Associated with Illicit Drugs, Tobacco, and Smoking

The use of tobacco, smoking, and illicit drugs poses severe risks to physical, mental, and social health. Below is a detailed breakdown of these risks.

1. Health Risks of Smoking and Tobacco Use

Tobacco contains nicotine (an addictive substance) and over 7,000 chemicals, many of which are toxic and carcinogenic. [1, 2]

Cardiovascular System: Smoking accelerates atherosclerosis (narrowing of arteries), increases blood pressure, and promotes blood clots. This directly leads to coronary heart disease, stroke, and peripheral artery disease. [3, 4, 5]
Respiratory System: Chronic inhalation of smoke destroys lung tissue. It causes Chronic Obstructive Pulmonary Disease (COPD), chronic bronchitis, emphysema, and triggers severe asthma attacks. [6]
Oncological Risks: Tobacco use is the leading cause of lung cancer. It also causes cancers of the mouth, throat, oesophagus, pancreas, cervix, and bladder. [7, 8]
Reproductive Health: Smoking during pregnancy increases the risk of miscarriage, premature birth, low birth weight, and Sudden Infant Death Syndrome (SIDS). In men, it can cause erectile dysfunction. [9, 10]

2. Health Risks of Illicit Drugs

Illicit drugs (such as opioids, cocaine, amphetamines, and cannabis) alter brain chemistry and systemic physiology.

Acute Toxicity and Overdose: Central nervous system depressants (like heroin/opioids) can cause respiratory depression and death. Stimulants (like cocaine) can cause sudden cardiac arrest, stroke, or hyperthermia.
Infectious Diseases: Intravenous drug use sharing needles significantly increases the transmission of blood-borne pathogens, primarily HIV and Hepatitis B and C.
Mental Health Disorders: Chronic drug use alters dopamine pathways, leading to severe addiction (substance use disorder). It can trigger or worsen paranoia, schizophrenia, depression, and anxiety.
Cognitive Decline: Prolonged use damages brain structure, impairing memory, decision-making, and emotional regulation.

3. Socio-Economic and Behavioural Risks

Financial Strain: The cost of maintaining an addiction leads to financial instability, debt, and poverty.
Legal Consequences: Possession or distribution of illicit substances carries heavy legal penalties, including imprisonment and a permanent criminal record.
Relationship Breakdown: Substance abuse often leads to domestic conflict, isolation, loss of employment, and societal stigma.

PART II: Cardiac Rehabilitation (CR)

Cardiac rehabilitation is a comprehensive, long-term program involving medical evaluation, prescribed exercise, cardiac risk factor modification, education, and counselling. It is designed to limit the physiologic and psychological effects of cardiac illness.

1. Core Components of Cardiac Rehabilitation

Medical Evaluation: Assessing the patient’s physical capabilities, medical history, and specific risks to tailor a safe program.
Physical Activity: Supervised, structured exercise training (mostly aerobic activities like walking, cycling, or rowing) to safely strengthen the heart.
Lifestyle Education: Guidance on heart-healthy nutrition, weight management, and strictly quitting smoking or tobacco.
Psychosocial Support: Counselling to help patients cope with depression, anxiety, and the stress of recovering from a major cardiac event.

2. Phases of Cardiac Rehabilitation

Phase I (Inpatient Phase): Begins in the hospital shortly after a cardiac event (e.g., heart attack, bypass surgery). It focuses on early mobilization, basic self-care education, and discharge planning.
Phase II (Outpatient Supervised Phase): Starts 2 to 6 weeks post-discharge. It involves continuous ECG-monitored exercise sessions and intensive lifestyle counselling, typically lasting 3 to 4 months.
Phase III (Maintenance Phase): A lifetime, self-directed program. Patients transition to unmonitored exercise at home or a community gym to maintain the cardiovascular benefits achieved.

3. Benefits of Cardiac Rehabilitation

Reduces the risk of a subsequent heart attack or cardiac death.
Improves functional capacity, physical strength, and quality of life.
Helps manage risk factors like high blood pressure, high cholesterol, and obesity.

16. (b) Summary of Cervical Cancer and Oesophagus Cancer

Feature	Cervical Cancer	Oesophagus Cancer
Description	Cancer originating in the cells of the cervix (the lower part of the uterus connecting to the vagina).	Cancer originating in the oesophagus (the muscular tube connecting the throat to the stomach).
Primary Types	• Squamous cell carcinoma (most common) • Adenocarcinoma	• Squamous cell carcinoma (upper/middle part) • Adenocarcinoma (lower part near stomach)

1. Causes and Risk Factors

Cervical Cancer

Human Papillomavirus (HPV): Persistent infection with high-risk HPV strains (primarily HPV 16 and 18) is the cause of over 95% of cervical cancers.
Smoking: Tobacco by-products damage the DNA of cervix cells and weaken the local immune response against HPV.
Early Sexual Activity & Multiple Partners: Increases the likelihood of exposure to high-risk HPV.
Immunosuppression: Individuals with HIV or those using immunosuppressive drugs are at a much higher risk.
Prolonged Oral Contraceptive Use: Using birth control pills for 5 or more years slightly increases the risk. [11]

Oesophagus Cancer

Tobacco and Alcohol: Heavy smoking and chronic alcohol consumption act synergistically to severely damage the oesophageal lining.
Gastroesophageal Reflux Disease (GERD): Chronic acid reflux irritates the lower oesophagus, which can lead to a precancerous condition called Barrett’s Oesophagus.
Obesity: Increases the risk of GERD and subsequent adenocarcinoma of the oesophagus.
Dietary Factors: Consuming very hot beverages regularly, eating diets low in fruits and vegetables, or eating foods high in nitrosamines (pickled foods).
Achalasia: A condition where the lower oesophageal sphincter fails to relax, causing food to stagnate and irritate the lining.

2. Diagnosis

Cervical Cancer

Pap Smear (Cytology): A screening test to collect cells from the cervix to look for precancerous changes.
HPV DNA Testing: Checks cervical cells specifically for the presence of high-risk HPV strains.
Colposcopy and Biopsy: If screening is abnormal, a magnifying instrument (colposcope) is used to guide a tissue biopsy for definitive diagnosis.
Imaging (CT, MRI, PET): Used to determine the stage and spread of the cancer.

Oesophagus Cancer

Upper Endoscopy (EGD): A flexible tube with a camera is passed down the throat to visually examine the oesophageal lining.
Biopsy: Tissue samples are taken during an endoscopy to confirm malignancy under a microscope.
Barium Swallow: The patient drinks a barium liquid, and X-rays are taken to visualize blockages or narrowing in the oesophagus.
Endoscopic Ultrasound (EUS) & CT Scan: Used to determine how deeply the tumor has penetrated the wall and if it has spread to lymph nodes.

3. Treatment

Cervical Cancer

Surgery: Includes conization (removing a cone-shaped piece of tissue) for early stages, or a hysterectomy (removal of the uterus and cervix) for advanced localized cases.
Radiation Therapy: High-energy rays used to kill cancer cells, often combined with chemotherapy (Chemoradiation).
Chemotherapy: Medications (e.g., Cisplatin) used systemically to destroy cancer cells that have spread.
Targeted Therapy & Immunotherapy: Advanced drugs that block specific pathways in cancer cells or help the immune system fight the disease.

Oesophagus Cancer

Surgery (Oesophagectomy): Surgical removal of the cancerous section of the oesophagus and reconnecting the remaining part to the stomach.
Chemotherapy and Radiation: Often given together before surgery (neoadjuvant therapy) to shrink the tumor, or after surgery (adjuvant therapy).
Endoscopic Therapies: For very early stage or superficial cancers, techniques like Endoscopic Mucosal Resection (EMR) or photodynamic therapy can destroy the tumor.
Palliative Care: If the cancer is advanced, stents may be placed inside the oesophagus to keep it open so the patient can swallow food.

4. Preventive Measures

Cervical Cancer

HPV Vaccination: Routine vaccination of adolescents before sexual exposure highly prevents infection from cancer-causing HPV strains.
Regular Screening: Routine Pap smears and HPV tests allow for the detection and treatment of precancerous lesions before they turn into cancer.
Safe Sexual Practices: Using barrier methods like condoms reduces the risk of HPV transmission.
Smoking Cessation: Stopping smoking helps the body eliminate natural HPV infections more effectively.

Oesophagus Cancer

Abstaining from Tobacco and Alcohol: Eliminating smoking and reducing alcohol intake drastically cuts down the risk of squamous cell carcinoma.
Managing GERD: Treating chronic acid reflux with medications (like antacids or proton pump inhibitors) and lifestyle changes protects the oesophageal lining.
Healthy Weight Management: Maintaining a healthy body mass index reduces the abdominal pressure that causes acid reflux.
Dietary Adjustments: Eating a balanced diet rich in fresh fruits, vegetables, and whole grains, while avoiding excessively boiling hot foods and liquids.