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When used externally, the herb provides the same soothing effects on mucous membranes that will support the skin and connective tissues. It is thought that Marigold will support good heart health, as some recent studies indicate that the herb may reduce blood pressure. Dosages: Take two (2) to three (3) capsules, two (2) times each day with water at mealtimes. Precautions: Pregnant women should not take Marigold internally, as it may stimulate the uterus. When taken internally, Marigold/Calendula may increase the sedative effects of medications taken for anxiety and insomnia, and caution should be exercised if using the medications and the herb at the same time, particularly when driving or operating machinery. When using topically, some people may show an allergic reaction, and it is wise to test a patch of skin before widespread use. It eases colic, sour stomach, stomach pains and menstrual cramps and is an effective expectorant that loosens phlegm in the lungs and alleviates sinus headache, bronchitis, dry coughs and the symptoms of colds and flu. Marjoram is also a natural disinfectant, anti inflammatory, antifungal and antioxidant that effectively relieve pains and aches. Plant Description: Sweet Marjoram is a half-hardy annual that is native to southern Europe (probably Portugal) and can be found in North Africa, the Balkans and the Middle East, and has been introduced throughout Europe and into North America. Sweet Marjoram Leaf has a more delicate flavor than its close cousin, Origanum vulgare (oregano or wild marjoram), and possesses very similar medicinal properties, often being used in a similar manner. Marjoram Leaf is a bushy plant with small, dark green leaves and flowers that resemble little knots, hence, one of its common names, Knotted Marjoram, and the plant generally reaches about one foot in height, thriving in well drained-to-dry, and neutral-to-alkaline soil in full sun. History: the Greeks gave us its botanical name, Origanum, which is derived from oros and ganos, meaning "joy of the mountain," and those traveling through Greece will find it (and wild Marjoram) covering the hillsides and scenting the summer air. Legend tells us that sweet Marjoram was created by Aphrodite as a symbol of happiness, and bridal couples in Greece and Rome were crowned with its garlands to ensure a happy marriage. This highly fragrant herb was also placed on tombs to give peace to departed spirits. In ancient Greece Marjoram was used in oils to massage into the skin to relieve pain, and Aristotle recommended it as an antidote for poisoning, claiming that tortoises swallowing a snake would immediately eat wild Marjoram as an antidote to prevent death. The ancient Egyptians also knew of its power to heal, using it to disinfect, preserve and heal wounds, and it is used in that country for the same purposes to this day. In medieval times, herbalists prescribed Marjoram oil for toothache, and sixteenth and seventeenth-century herbalists recommended it as an internal aid to digestion and as a diuretic. Throughout history, Marjoram Leaf has been used in preserving food and in remedies for colds and sore throats, and dried Marjoram Leaf was popular as snuff. Sweet or Knotted Marjoram is considered by many cooks to be far better than wild Marjoram (oregano), and the leaves are highly popular in Italian and Greek cuisine and used to flavor oil and vinegar. It is often infused in healthful teas, and its fragrance is placed on pillows to promote sleep, in moth bags to deter moths, in potpourris for it fragrance, on hair and skin for its sweet scent and added to bathwater to relieve tension and rheumatic pains.

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The outer earis that part w hich ear passage can be seen on the outside of the head together w ith the passage w hich leads inw ard to the ear M astoid process drum. A narrow tube (the eustachian tube) runs betw een the m iddle ear and the back of the nose and throat to keep the cavity at atm ospheric pressure. Inner earis a com plicated, deep seated arrangem ent of tissues concerned w ith the senses of balance and hearing. Look for sw elling or redness of the pinna and the surrounding area, and for discharge from the ear passage. Feel for tender or enlarged lym ph nodes around the affected ear and com pare them w ith those of the other ear. In a good light pull the pinna gently backw ards and upw ards to enable inspection further inside the ear passage. Establish if hearing has been dim inished or if there are added noises in the ear and if the sense of balance has been im paired. W ax in the ear Accum ulated w ax m ay cause only slight discom fort in the ear passage but if it has hardened and is near the ear drum, pain m ay be felt w hen sw allow ing or blow ing the nose. It is often possible to see the w ax plug w hen the entrance to the ear passage is exam ined in good light. If treatm ent is felt to be necessary, the patient should lie dow n w ith the affected ear upperm ost. Slightly w arm ed vegetable oil should be put into the ear passage and left for five m inutes before w iping aw ay any drops w hich run out w hen the head is tipped sidew ays. If relief of sym ptom s is not satisfactory, advice should be sought at the next port. Infection of the outer ear (otitis externa) this is a com m on infection in hot w eather or after sw im m ing, especially in the tropics and sub-tropics. The condition frequently affects both ears w hilst boils and m iddle ear infection occur m ainly in one ear. Pain is not a feature of the disease but the ear m ay be uncom fortable and itch, w ith a discharge from the ear passage. The skin of the ear passage is liable to bleed slightly and appears red, shiny and abraded. Som etim es it is better for the patient to do this for him self under supervision. When dry, three drops of antibiotic ear drops should be put in one ear passage w hile the patient is lying on one side. After five m inutes in that position, the ear should be dried before the other ear is sim ilarly treated. The patient m ust not sw im or get w ater into his ears w hen w ashing until he has been seen by a doctor or his ears have been norm al for tw o w eeks. Boil in the ear A boil in the ear passage causes a throbbing pain w hich increases in severity over several days.

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A follow-up code may be used to explain multiple visits  True  False 2. If you are seeing a client for a confirmed or suspected condition or for a specific treatment, then codes under “Examination” should not be used  True  False 4. If a client comes in for a routine examination and a condition is discovered, the condition will be the primary diagnosis  True  False 5. Neoplasms are classified primarily by site  True  False 2. Only one Diabetes Mellitus code can be assigned for each encounter  True  False 3. Type 2 Diabetes Mellitus is the default if Type is not documented  True  False 4. Most codes in Chapter 7, Diseases of the Eye and Adnexa, include anatomic site and/or laterality. A diagnosis of “Otitis Media” will surely be paid by Medicaid, no questions asked. Hypertension is no longer classified by type such as benign, malignant or unspecified hypertension   True  False 4. Diagnosis: Uncontrolled essential hypertension  Code the scenario . Scenario 2: 33 year old male states he has had a bad cough and diarrhea for two days. Codes for signs and symptoms are not reported in addition to a related definitive diagnosis  True  False 2. When coding injuries, assign separate codes for each injury unless a combination code is provided   True  False 3. For adverse effects due to drugs or chemicals, always use the Table of Drugs and Chemicals   True  False 4. She states he fell out of a swing at the park and complained of his ankle hurting. Diagnosis: Sprained right ankle 2 Primary Care: 25 year old female complains of persistent, stubborn headache. The client reports she has been taking more than the recommended dose of Tylenol since her surgery 2 months ago. Client was on post-op opiates for one week following the surgery but when the opiates were discontinued, she has continued to experience pain so she has been taking additional doses of Tylenol. The clinician documents that the client has drug-induced, intractable headache due to Tylenol overuse with chronic post-op pain.

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History reveals that five people were arrested for awarding fake medical degrees in Kolkata. Indian Medical Association‘s ex president Subir Ganguly said that ‗‗these institutes should have stopped from venturing into modern medicine without necessary expertise and permission. They are deliberately trying to pass off such degrees to confuse people‘‘ [35] But such ventures could not be stopped as such institutions are still running with full vigour. One of them initially refused to utter a single word about his profession, but some informations could be obtained. He was highly annoyed when asked from where do you get approval and whether the institute has government recognition? He claimed that his organisations registered under the Society Act and other branches are operating successfully in various other districts. He reiterated that although there is no assurance that the passed out candidates will get jobs but at least they can eke out their livelihood through such training. Although he claimed that classes are being taken by experts in the field, one can raise doubts about the quality of such teaching as difficult areas are taught within a short span. The Institutes themselves provide certificates to the candidates after completion of their courses. The representative of this institute offered commission to the researcher in order to send candidates to the Institute. Another institute [39] functioning from 1984 offers similar courses like Anatomy, Physiology, Pathology. Lab Technician, Classes are taken by doctors who did their graduation in Homeopathy. Thirty lecturers are training students in various subjects as reported by the head of the institution. The course content, the duration of the courses, the expertise of the faculty is highly questionable. The presence and functioning of these institutes manifests, that there is a demand for such courses. The question is whether people are falling prey to such institutions consciously or unconsciously and whether they are getting quality teaching? Many of the quacks interviewed referred to such institutes from where they sought training. The unyielding presence of such institutes raises a question as to what is the reaction of the state towards them!

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Neurologists have encompassed this phenomenon under the term reduplicative paramnesia. Capgras syndrome may be envisaged as a Geschwindian disconnection syndrome, in which the visual recognition system is disconnected from the limbic system, hence faces can be recognized but no emotional significance ascribed to them. Cross References Cotard’s syndrome; Disconnection syndromes; Prosopagnosia; Reduplicative paramnesia Carphologia Carphologia, or floccillation, is an aimless plucking at clothing, as if picking off pieces of thread. Clearly, this term is cognate with or overlaps with waxy flexibility which is a feature of catatonic syn dromes. Rarely status cataplecticus may develop, particularly after withdrawal of tricyclic antidepressant medication. Cross References Areflexia; Hypersomnolence; Hypotonia, Hypotonus Catathrenia Catathrenia is expiratory groaning during sleep, especially its later stages. There are no associated neurological abnormalities and no identified neurological or otorhinolaryngological cause. Furthermore, although initially thought to be exclusively a feature of psychiatric disease, catatonia is now recognized as a feature of structural or metabolic brain disease (the original account contains descriptions suggestive of extrapyramidal disease): -75 C Cauda Equina Syndrome. Weakness of hip flexion (L1) does not occur, and -76 Central Scotoma, Centrocaecal Scotoma C this may be useful in differentiating a cauda equina syndrome from a conus lesion which may otherwise produce similar features. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Broadly speaking, a midline cerebellar syndrome (involving the ver mis) may be distinguished from a hemispheric cerebellar syndrome (involving the hemispheres). Midline cerebellar syndrome: Gait ataxia but with little or no limb ataxia, hypotonia, or nystag mus (because the vestibulocerebellum is spared), or dysarthria; causes include alcoholic cerebellar degeneration, tumour of the midline. Extension of the hallux (upgoing plantar response, Babinski’s sign) is pathological, indicating corticospinal tract (upper motor neurone) pathology. There is trophic change, with progressive destruction of articu lar surfaces with disintegration and reorganization of joint structure. Cross References Analgesia; Main succulente Charles Bonnet Syndrome Described by the Swiss naturalist and philosopher Charles Bonnet in 1760, this syndrome consists of well-formed (complex), elaborated, and often stereotyped visual hallucinations, of variable frequency and duration, in a partially sighted (usually elderly) individual who has insight into their unreality. There are no other features of psychosis or neurological disease such as dementia. Reduced stimula tion of the visual system leading to increased cortical hyperexcitability is one possible explanation (the deafferentation hypothesis), although the syndrome may occasionally occur in people with normal vision. Functional magnetic res onance imaging suggests ongoing cerebral activity in ventral extrastriate visual cortex. Complex visual hallucinations in the visually impaired: the Charles Bonnet syndrome. When, as is often the case, such movements are confined to one side of the body they are referred to as hemichorea–hemiballismus. There may be concurrent abnormal muscle tone, 80 Chorea, Choreoathetosis C either hypotonia or rigidity.

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