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What After MBBS? All Courses and Careers options


After this blog, you will never ask the same questions again! Are you an aspiring MBBS student who is worried about career option after MBBS? Or have you considered questions like “pg courses after mbbs”, “options after mbbs” or even “jobs after mbbs”? There are a lot of approaches and ways one you may go after mbbs in India, but what is best, that comes with wisdom.

Important Update: Check your NEET PG 2019 Result here!

We will guide you through very basics of choices after MBBS you can opt and where, when and how. We will help you at our best towards all courses and career options after MBBS :

The first question, is of course, what after MBBS? Following are choices of courses that will make career after mbbs:

  • Post-graduation
  • Research
  • Hospital management
  • Foreign studies
  • Clinical practice

With these keeping as key points, we will get answers of all our questions regarding after MBBS.

Post-Graduation after MBBS

There are 3 main Post Graduation courses you can opt after MBBS. PG career after MBBS is indeed what everyone’s parents ask for. These are as follows:

  • PG- Specialty
  • PG- Diploma
  • DNB

PG- Specialty

Post graduation courses after mbbs in India are the most pronounced MD (Doctor of Medicine) and MS (Master of Surgery). These are some of the toughest PG exams in India and even after a lot of tries, many mbbs graduates fail to get success.

The simple reason behind this is very limited number of seats. Even after you get the college of your choice, you may not get the course of choice or vice-versa. Although many private colleges provide pg seats, but the price of private institutions outweighs that of merit quota.

Nevertheless, you will be having great career options after MBBS after completing Post graduation.

Duration of course: 3 years

Complete list of PG degree courses after MBBS in India include 78 recognized courses:

  • DM – Infectious Diseases
  • DM – Organ Transplant Anesthesia & Critical Care
  • DM – Critical Care Medicine
  • MD – Thoracic Medicine
  • MD – Sports Medicine
  • MD – Family Medicine
  • MD – Radio Diagnosis/Radiology
  • MD – Aviation Medicine/Aerospace Medicine
  • MD – Tuberculosis & Respiratory Diseases / Pulmonary Medicine
  • Anesthesia. & Critical Care Med.
  • MD – Medical Genetics
  • MD – Rheumatology
  • Master of Family Medicine
  • MD – Palliative Medicine
  • Master of Public Health (Epidemiology)
  • MD – Blood Banking & Immuno. Haem./Imm. Haem. & Blood Trans.
  • MD – Tropical Medicine
  • MD – Maternity & Child Health
  • MD – Pulmonary Medicine
  • MD – CCM
  • MD – P.S.M
  • MD – TB & Chest
  • MD – Skin & VD & Lepxsy
  • MD – MD- Skin & VD
  • MD-Transfusion Medicine
  • MD – Immuno Hematology & Blood Transfusion
  • MD – Medicine
  • Doctor of Medicine
  • M.D.
  • Master’s of Physician
  • MD – Pharmacology and Therapeutics
  • MD – Pathology & Microbiology
  • MD – Emergency Medicine
  • MD – R & D
  • MD – Anesthesiology
  • MD – Anatomy
  • MD – Aviation Medicine
  • MD – Bio-Chemistry
  • MD – Bio-Physics
  • MD – Community Medicine
  • MD – Dermatology
  • MD – Forensic Medicine/Forensic Medicine & Toxicology
  • MD – General Medicine
  • MD – Community Health Administration
  • MD – Geriatrics
  • MD – Hospital Administration
  • MD – Health Administration
  • MD – Lab Medicine
  • MD – Microbiology
  • MD – Nuclear Medicine
  • MD – Obstetrics & Gynecology
  • MD – Ophthalmology
  • MD – Pediatrics
  • MD – Pathology
  • MD – Dermatology , Venereology & Leprosy
  • MD – Pharmacology
  • MD – Physiology
  • MD – Physical Medicine & Rehabilitation
  • MD – Psychiatry
  • MD – Radio Diagnosis
  • MD – Radiology
  • MD – Radiotherapy
  • MD – Social & Preventive Medicine / Community Medicine
  • MD – Tuberculosis & Respiratory Diseases/Medicine
  • MD – Venereology
  • MS – Obstetrics and Gynecology
  • MS – Orthopedics
  • MS – Anatomy
  • MS – ENT
  • MS – General Surgery
  • MS – Ophthalmology
  • MS – Anesthesia
  • MS. – MS. Medicine
  • MS – Neuro Surgery
  • MS – Traumatology and Surgery
  • MD/MS – Anatomy
  • MD/MS – Ophthalmology
  • MD/MS – Obstetrics & Gynecology

MD or MS? This is another tricky question, however, the choice mainly depends on one’s skills and wish. We will soon write a blog for this topic too.

PG- Diploma

Pg diploma courses after mbbs include total of 61 courses according to MCI in India. These are as follows:

Duration of course: 2 year

Following is the list of Diploma Courses after MBBS:

  • Diploma in Anesthesia
  • Diploma in Child Health
  • Diploma in Community Medicine
  • Diploma in Clinical Pathology
  • Diploma in Dermatology
  • Diploma in Diabetology
  • Diploma in Forensic Medicine
  • Diploma in Health Administration
  • Diploma in Hospital Administration
  • Diploma in Health Education
  • Diploma in Bacteriology
  • Diploma in Obstetrics & Gynaecology
  • Diploma in Industrial Hygiene
  • Diploma in Immuno-Haematology and Blood Transfusion
  • Diploma in Leprosy
  • Diploma in Oto-Rhino-Laryngology
  • Diploma in Radio-Diagnosis
  • Diploma in Radio Therapy
  • Diploma in Medical Virology
  • Diploma in Occupational Health
  • Diploma in Ophthalmology
  • Diploma in Orthopaedics
  • Diploma in Public Health
  • Diploma in Physical Medicine & Rehabilitation
  • Diploma in Psychological Medicine
  • Diploma in Radiation Medicine
  • Diploma in Sports Medicine
  • Diploma in Tuberculosis & Chest Diseases
  • Diploma in Tropical Medicine Health
  • Diploma in Dermatology, Venereology and Leprosy
  • Diploma in Venereology
  • Diploma in Paediatrics
  • Diploma – Aviation Medicine
  • Diploma in Cardiology
  • Diploma in Basic Medical Sciences (Anatomy)
  • Diploma in Basic Medical Sciences (Physiology)
  • Diploma in Basic Medical Sciences (Pharmacology)
  • Diploma in Maternity & Child Welfare
  • DGO
  • FMT
  • PSM
  • Diplom -Diploma V & D
  • Diploma – Diploma – OLO – Rhino-Laryngology
  • Diploma – Diploma in Medical Radio-Diagnosis
  • Diploma in Medicine Radiology and Electrology
  • Diploma – Diploma in Pathology & Bacteriology
  • Diploma- Plastic Surgery
  • Diploma- Urology
  • Diploma-Diplomate N.B.(Gen.Surg.)
  • Diploma in Microbiology
  • Dip. in Path.& Bact.
  • Diploma in Industrial Health
  • Diploma in Medical Radio Electrology
  • Diploma (Marine Medicine)
  • Diploma in Nutrition
  • Diploma in ENT
  • Diploma in Psychiatry
  • Diploma in Radiological Physics
  • Diploma in Neuro-pathology
  • Diploma in Allergy & Clinical Immunology

DNB (Diplomate of National Board) after MBBS

DNB stands for Diplomate of National board and is another diploma equivalent to MD. You can find more about DNB in the link given below.

This is another perfect career option after MBBS apart from Post-graduation.

Duration of course: – 3 years

Link to DNB CET

Research after MBBS

Clinical research options for MBBS students rely on your will to learn and to invent. The most renowned research institute in India is the ICMR (Indian council for medical research) which is also renowned for its studentship to graduating mbbs students, though the 5000 INR is too low for 2 months, but the experience adds wonders to your resume.

Duration of course: – 3 years

Following 45 PhD courses after MBBS have been recognized by MCI in India:

  • Ph. D – Bio- Chemistry
  • Ph. D – Microbiology
  • Ph. D – Pathology
  • Ph. D – Forensic Medicine
  • Ph. D – Anaesthesia
  • Ph. D – Bio-Statistics
  • Ph. D – Bio-Technology
  • Ph. D – Cardiology
  • Ph. D – Community Medicine
  • Ph. D – Cardio Thoracic & Vascular Surgery
  • Ph. D – Dermatology & Venereology
  • Ph. D – Endocrinology & Metabolism
  • Ph. D – ENT
  • Ph. D – Gastro & Human Nutrition Unit
  • Ph. D – Gastrointestinal Surgery
  • Ph. D – Hospital Administration
  • Ph. D – Haematology
  • Ph. D – Histo Compatibility & Immunogenetics
  • Ph. D – Lab Medicine
  • Ph. D – Medical Oncology
  • Ph. D – Medical Physics
  • Ph. D – Medicine
  • Ph. D – Nephrology
  • Ph. D – Neurology
  • Ph. D – Neuro Surgery
  • Ph. D – Neuro Magnetic Resonance
  • Ph. D – Nuclear Medicine
  • Ph. D – Obst. & Gynae
  • Ph. D – Ocular Bio Chemistry
  • Ph. D – Ocular Microbiology
  • Ph. D – Ocular Phramacology
  • Ph. D – Orthopaedics
  • Ph. D – Paediatric Surgery
  • Ph. D – Paediatric
  • Ph. D – Physical Medicine & Rehabilitation
  • Ph. D – Psychiatry
  • Ph. D – Radiotherapy
  • Ph. D – Radio Diagnosis
  • Ph. D – Surgery
  • Ph. D – Urology
  • Ph. D – Medical Biochemistry
  • Doctor of Phylosophy
  • Ph. D-Pharmacology
  • Ph. D – Anatomy
  • Ph. D – Physiology

Hospital Management after MBBS

Hospital management is another very fast developing sector which is one trending career option available for MBBS students. IIM (Indian institute of Management) is one worthy but toughest choice. But you should be prepared to face the competition for this course.

MBA or MHA? Where MBA stands for Masters of Business Administration, MHA stands for Masters in Hospital Administration. Both are choices for getting into the hospital management, but which to go for? You can read our review on MBA vs MHA.

Duration of course: 2 years

Foreign Studies after MBBS

And then you wanted to study abroad, but here we will discuss education after MBBS in USA and UK. USMLE is for US while PLAB is for UK.

USMLE stands for United States Medical Licensing Examination and is one of most fortunes giving choice. Yet many Indians fail to achieve a success even after appropriate tries. This is because USMLE is a 3 step procedure. Further, the costs are too high and even after you complete these three steps, it still doesn’t guarantee until you have secured US residency. But if you get it, you will make fortunes after MBBS.

You can find more info on USMLE here or apply to USMLE.

PLAB is an alternative to USMLE who want to study in UK after MBBS. PLAB stands for Professional and Linguistic Assessments Board. It is an option after MBBS in UK.

You can find more info on PLAB here.

Please note, there are other master degrees and PhD course in other countries like US too, but we have missed them since we are focusing on more appropriate choices for an Indian MBBS student.

Clinical Practice after MBBS

While some believe practicing at clinic refreshes what you study and hence help in preparing for PG exams, some give preference to getting as much time for books.

An MBBS graduate student may plan to study while going for job after mbbs, or start clinical practice immediately after completing MBBS. It can be done in following ways:

  • Government hospitals: You can either go for Full time job or even do contract basis part time job.
  • Private Hospitals- Corporate sectors always welcome worthy students.
  • Owned clinic- Owned clinic, nursing home or hospitals are always the best choice for some.

MCI (Medical Council of India)

So, we hope we delivered you the best of courses and career options that you can go for after MBBS. If you still have doubts, let us know in the comments.

Online Histology Made Easy Slides Atlas


We have prepared an online atlas of histology that has following histology slides terming it as Histology made easy. These histology slides can be used for practical exams in First Year MBBS while others may find it useful in their ways. Hope the following slides help you in exams and learning it better, though you will have to refer a histology atlas book.

Appendix Histology slide

Also check out our K Sembulingam PDF Book here!

Appendix Histology slide
Appendix Histology slide

Bone Histology slide

Bone Histology slide
Bone Histology slide

Cardiac muscle Histology slide

Cardiac muscle Histology slide
Cardiac muscle Histology slide

Cerebellum Histology slide

Cerbellum Histology slide
Cerbellum Histology slide

Cerebrum Histology slide

Cerebrum Histology slide
Cerebrum Histology slide

Cornea Histology slide

Cornea Histology slide
Cornea Histology slide

Dorsal root ganglia Histology slide

Dorsal root ganglia Histology slide
Dorsal root ganglia Histology slide

Duodenum Histology slide

Duodenum Histology slide
Duodenum Histology slide

Elastic artery Histology slide

Elastic artery Histology slide
Elastic artery Histology slide

Epididymis Histology slide

Epididymis Histology slide
Epididymis Histology slide

Fallopian tube Histology slide

Fallopian tube Histology slide
Fallopian tube Histology slide

Fundus stomach Histology slide

Fundus stomach Histology slide
Fundus stomach Histology slide

Gall bladder Histology slide

Gall blader Histology slide
Gall blader Histology slide

Hyaline Cartilage Histology slide

Hyaline Histology slide
Hyaline Histology slide

Ileum Histology slide

Ileum Histology slide
Ileum Histology slide

IVC Histology slide

IVC Histology slide
IVC Histology slide

Jejunum Histology slide

Jejunum Histology slide
Jejunum Histology slide

Large intestine colon Histology slide

Large Intestine colon Histology slide
Large Intestine colon Histology slide

Large intestine Histology slide

Large Intestine Histology slide
Large Intestine Histology slide

Liver Histology slide

Liver Histology slide
Liver Histology slide

LS of thin skin Histology slide

Ls of thin skin Histology slide
Ls of thin skin Histology slide

Lungs Histology slide

Lungs Histology slide
Lungs Histology slide

Lymph node Histology slide

Lymph Node Histology slide
Lymph Node Histology slide

Mixed gland Histology slide

Mixed Gland Histology slide
Mixed Gland Histology slide

Mucus glands Histology slide

Mucus Glands Histology slide
Mucus Glands Histology slide

Muscular artery Histology slide

Muscular Artery Histology slide
Muscular Artery Histology slide

Esophagus Histology slide

Esophagus Histology slide
Esophagus Histology slide

Ovary Histology slide

Ovary Histology slide
Ovary Histology slide

Palatine tonsil Histology slide

Palatine tonsil Histology slide
Palatine tonsil Histology slide

Pituitary gland Histology slide

Pituitary gland Histology slide
Pituitary gland Histology slide

Prostate Histology slide

Prostate Histology slide
Prostate Histology slide

Pylorus Histology slide

Pylorus Histology slide
Pylorus Histology slide

Retina Histology slide

Retina Histology slide
Retina Histology slide

Serous gland Histology slide

Serous gland histology slide
Serous gland histology slide

Simple Columnar Histology slide

Simple Columnar Histology slide
Simple Columnar Histology slide

Skeletal muscle Histology slide

Skeletal muscle Histolog slide
Skeletal muscle Histolog slide

Smooth muscle Histology slide

Smooth muscle Histology slide
Smooth muscle Histology slide

Spleen Histology slide

Spleen Histology slide
Spleen Histology slide

Sub-mandibular gland Histology slide

Submandibular gland Histology slide
Submandibular gland Histology slide

Supra-renal gland Histology slide

Suprarenal gland Histology slide
Suprarenal gland Histology slide

Sympathetic ganglia Histology slide

Sympathetic ganglia Histology slide
Sympathetic ganglia Histology slide

Testis Histology slide

Testis Histology slide
Testis Histology slide

Thick skin Histology slide

Thick skin Histology slide
Thick skin Histology slide

Thymus Histology slide

Thymus Histology slide
Thymus Histology slide

Thyroid Histology slide

Thyroid Histology slide
Thyroid Histology slide

Tongue Histology slide

Tongue Histology slide
Tongue Histology slide

Trachea Histology slide

Trachea Histology slide
Trachea Histology slide

TS of skin Histology slide

TS of skin Histology slide
TS of skin Histology slide

Ureter Histology slide

Ureter Histology slide
Ureter Histology slide

Urinary bladder Histology slide

Urinary bladder Histology slide
Urinary bladder Histology slide

Uterus Histology slide

Uterus Histology slide
Uterus Histology slide

Vas Deferens Histology slide

Vas Deferens Histology slide
Vas Deferens Histology slide

This was our online atlas of histology for first year mbbs students. If you want to download the atlas in PDF format or if you want these histology slides in High Image Quality, then please contact us through Facebook page or through mailing us at given address.

Intravenous Cannula Insertion | IV Cannulation: Common Veins Sites


Intravenous Cannula Insertion is one important clinical procedure that requires skills and practice. But you can always get some tips and info from sources. With the below guide, you will learn what is Intravenous (IV) Cannula Insertion, Indications, Procedure, Common vein sites for cannula insertion, When to avoid it, Complications and some bonus tips.


Intravenous Cannula Insertion is a procedure of inserting intravenous cannula or IV cannula into the vein to provide easy access to vein and hence reduce IV injection repetitions.


  1. Repeated blood sampling
  2. Intravenous fluid administration
  3. Intravenous medications administration
  4. Intravenous chemotherapy administration
  5. Intravenous nutritional support
  6. Intravenous blood or blood products administration
  7. Intravenous administration of radiological contrast agents for computed tomography, magnetic resonance imaging, or nuclear imaging


The procedure involves the following steps:

A. Introduce yourself to the patient and ask for his consent to perform the Intravenous Cannula Insertion. Usually this is avoided in hospitals but it is an important step.

B. Prepare the equipment

The equipment required for IV Cannulation should be ready. The equipment required for iv cannula insertion include:

  1. Hand sanitizer
  2. Gloves
  3. Cotton
  4. Disposable tourniquet
  5. IV cannula
  6. Suitable plaster
  7. Syringe
  8. Saline

C. Wash your hands with a hand sanitizer.

D. Identify the vein in which venous cannula is to be inserted. The preferable site includes median vein in arm.

E. Click Sites of Intravenous Cannula Insertion to know more about sites of choice for IV cannula insertion.

F. Apply the tourniquet above the insertion point and make sure it is tight but make sure it is comfortable for patient.

G. Wear the gloves and clean the patient’s skin.

H. Prepare the cannula for insertion and avoid touching it.

I. Stretch the skin distally and tell the patient to expect a sharp scratch.

J. Insert the needle, bevel upwards at about 30 degrees. Advance the needle until you observe blood at the back of the cannula.

K. Once bloods appear, progress the entire cannula a further 2mm, and then fix the needle, advancing the rest of the cannula into the vein.

L. Release the tourniquet, apply pressure to the vein at the tip of the cannula and remove the needle fully. Remove the cap from the needle and put this on the end of the cannula.

M. Dispose off the needle used to ensure clinical safety.

N. Apply the dressing to the cannula to fix it in place.

O. Fill the syringe with saline and flush it through the cannula to check for patency. If there is any resistance, if it causes any pain, or you notice any localized tissue swelling; immediately stop flushing, remove the cannula and start again.

P. Dispose off your gloves and equipment in the clinical waste bin.

Common Veins Sites

Sites for Intravenous cannula insertion include common veins for IV cannula- Cephalic vein, Basilica vein, Median vein and Metacarpal veins.

Common sites of veins for Intravenous Cannulation
Common sites of veins for Intravenous Cannulation

While Median vein remains the choice of vein, each vein has its own advantages and disadvantages.

These are as follows:

1. Cephalic vein


  • Readily receives a large cannula and is therefore a  good site for blood administration.
  • Splinted by the forearm bones
  • Cannula is easily secured


  • Can be more difficult to cannulate than the metacarpal veins.
  • May be confused with an aberrant radial artery.

2. Basilic vein


  • A large vein that is frequently overlooked while searching for other veins.


  • Requires awkward positioning of the limb to gain access to the vein.
  • The vein tends to roll away when you attempt to cannulate  it.
  • Site prone to phlebitis.
  • Cannula port gets caught on sheets.

3. Median vein


  • Large veins and so they will readily accept a large cannula.
  • Do not “shut down” as quickly as the more peripheral veins.
  • First choice in emergency situation.


  • Can be very positional due to elbow flexion/extension.
  • Can be very uncomfortable for the patient due to elbow flexion/extension.
  • Care must be taken not to cannulate the brachial artery.

4. Metacarpal veins


  • Easy to see and palpate veins.
  • Splinted by metacarpal bones
  • Allows use of more proximal veins in the same limb should the cannula need to be re-sited.
  • Cannula is easily accessible in the theater environment.


  • Active patients may dislodge easily.
  • Dressing may be compromised by hand-washing.
  • May be more difficult if the skin is thin and friable.
  • Flow can be affected by wrist flexion or extension i.e. A POSITIONAL VENFLON.


There is no absolute contraindication for Intravenous cannula insertion, but some key points may always be recalled:

  1. When peripheral venous access is an injured, infected, or burned extremity, Cannulation should be avoided if possible.
  2. Some vesicant and irritant solutions (pH < 5, pH >9, or osmolarity >600m Osm/L) can cause blistering and tissue necrosis if they leak into the tissue, including sclerosing solutions, some chemotherapeutic agents, and vasopressors. These solutions are more safely infused into a central vein. They should only be given through a peripheral vein in emergency situations or when a central venous access is not readily available.


  1. Hematoma: a collection of blood, which can result from failure to puncture the vein when the cannula is inserted or when the cannula is removed. Selection of an appropriate vein and gently applying pressure slightly above the insertion point on removal of the cannula may prevent this.
  2. Infiltration: when infusate enters the subcutaneous tissue instead of the vein. To prevent this, a cannula with accurate trim distances may be used. It is essential to fix the cannula in place firmly.
  3. Embolism: this can be caused by air, a thrombus, or fragment of a catheter breaking off and entering the venous system. It can cause a pulmonary embolism. Air emboli can be avoided by making sure that there is no air in the system. A thromboembolism can be avoided by using a smaller cannula.
  4. Phelebitis: an inflammation of the vein resulting from mechanical or chemical irritation or from an infection. Phlebitis can be avoided by carefully choosing the site for cannulation and by checking the type of infusate used.

Bonus tips

  1. Always apply tourniquet first. This makes the vein show up easily.
  2. With patient having cold arms or arms at room temperature, veins do not tend to show up easily.
  3. Wrist sites are highly prone to infiltration, pain, and positional flowing of the IV solution. Select something mid-arm or in the hand for the best results, and always start distal and work your way proximal unless there is a clinical reason for a larger vein.

But the best learning comes with practice, so go and try it out.

What is Endotracheal Intubation: Procedure, Steps, Complications


Endotracheal Intubation is an emergency procedure of introducing ET or Endotracheal Tube Insertion. It is one of the widely performed medical procedure in casualty to establish respiration to those who are unable to breath. Our guide below will help you with its indications, procedure, complications and a video of course.

What is Endotracheal Tube Insertion?

Endotracheal Tube Insertion or Endotracheal Intubation (EI) is an emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own. EI helps to prevent suffocation or obstruction of the passage of air.

In a typical EI, a patient is first given a heavy anesthetic. Then, a flexible plastic tube is placed into the trachea (windpipe) through the mouth or sometimes the nose to help the patient with breathing.

The trachea, also known as the windpipe, is a cylindrical tube that is about four inches long and one inch in diameter. It begins just under the voice box, descends behind the breastbone, and then divides into two smaller tubes. Each tube connects to one of your lungs.

The windpipe is made from discs of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, the windpipe gets slightly longer and wider—then returns to its normal size as you breathe out.


Basically, Endotracheal Tube Insertion is used for:

  • Provide airway for mechanical ventilatory support.Administration of surfactants or other medications directly into the lungs.
  • Relieve critical upper airway obstruction.
  • Provide route for selective bronchial ventilation.
  • Assist in pulmonary hygiene when secretions cannot be otherwise cleared.
  • Obtain direct tracheal cultures.

Specifically, endotracheal tube insertion is used for the following conditions:

  • Respiratory arrest
  • Respiratory failure
  • Airway obstruction
  • Need for prolonged ventilatory support
  • Class III or IV hemorrhage with poor perfusion
  • Severe flail chest or pulmonary contusion
  • Multiple trauma, head injury and abnormal mental status
  • Inhalation injury with erythema/edema of the vocal cords
  • Protection from aspiration


Endotracheal Intubation is an invasive procedure and can cause considerable discomfort. For this reason, general anesthesia and a muscle relaxing medication are usually administered so that you do not feel anything. However, if necessary, the procedure can be performed while the patient is awake, with local anesthesia or with no anesthesia at all.

Procedure Steps

To begin the procedure steps, an anesthesiologist opens the patient’s mouth by separating the lips and pulling on the upper jaw with the index finger. Holding a laryngoscope in the left hand, he or she inserts it into the mouth of the patient with the blade directed to the right tonsil. Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view.

The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis. Next, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view. Often during endotracheal intubation, an assistant has to press on the trachea to provide a direct view of the larynx. The anesthesiologist then takes the endotracheal tube, made of flexible plastic, in the right hand and starts inserting it through the mouth opening.

The tube is inserted through the cords to the point that the cuff rests just below the cords. Finally, the cuff is inflated to provide a minimal leak when the bag is squeezed. Using a stethoscope, the anesthesiologist listens for breathing sounds to ensure correct placement of the tube.


Waking Up While Under Anesthesia

According to the Mayo Clinic, about one or two people in every 1,000 wake up briefly while under the effects of general anesthesia. If this happens, usually you will be aware of your surroundings but will feel no pain. On rare occasions of endotracheal intubation, people feel severe pain. This can lead to long-term psychological problems. Factors that may increase the risk of this happening include:

  • Emergency surgery
  • Heart or lung problems
  • Long-term use of opiates, tranquilizers, or cocaine
  • Daily alcohol use


There are some risks related to endotracheal intubation. To prevent these from occurring, you will be evaluated by the anesthesiologist (or ambulance personnel in an emergency situation) before the procedure and will be monitored throughout for potential complications such as:

  • Buildup of excess water in your tissues
  • Bleeding
  • Collapsed lung

Sleep Paralysis: Demon vs Medical | Sleep Apnoea


Have you ever wake up to find you cannot move or speak but you can feel everything and hear everything near you? Have you ever felt that a ghost or something is trying to stop you from getting up? The phenomenon you just suffered is called Sleep Paralysis or Sleep Apnoea. This guide will explain the medical causes as well as uncover what are the mythological creatures supposed for Sleep Apnoea in different countries and culture.

Then certainly you are reading the right blog. We will be explaining what just happened with you. Read throughout what just caught you!

Two way approach

The two-way approach says either you will take it as medical condition or stick to the old theory-“A ghost struck me!” So, we are gonna explain everything according to the two-way approach for sleep apnoea or the sleep paralysis.

Where the medical approach defines parameters for sleep apnoea, the spiritual theory says you will call demons to this world if you recite the prayers backwards!

Sleep Paralysis: A Medical Approach

Sleep paralysis or Sleep Apnoea is a feeling of being conscious but unable to move. It occurs when a person passes between stages of wakefulness and sleep. During these transitions, you may be unable to move or speak for a few seconds up to a few minutes.

Some people may also feel pressure or a sense of choking. Sleep paralysis may accompany other sleep disorders such as narcolepsy. Narcolepsy is an overpowering need to sleep caused by a problem with the brain’s ability to regulate sleep.

When it occurs?

Sleep paralysis can occur either when you are asleep or when you are awake.

When asleep: If it occurs while you are falling asleep, it’s called hypnagogic or predormital sleep apnoea.

Mechanism: As you fall asleep, your body slowly relaxes. Usually you become less aware, so you do not notice the change. However, if you remain or become aware while falling asleep, you may notice that you cannot move or speak.

When awake: If it happens as you are waking up, it’s called hypnopompic or postdormital sleep paralysis.

Mechanism: During sleep, your body alternates between REM (rapid eye movement) and NREM (non-rapid eye movement) sleep. One cycle of REM and NREM sleep lasts about 90 minutes. NREM sleep occurs first and takes up to 75% of your overall sleep time. During NREM sleep, your body relaxes and restores itself. At the end of NREM, your sleep shifts to REM. Your eyes move quickly and dreams occur, but the rest of your body remains very relaxed. Your muscles are “turned off” during REM sleep. If you become aware before the REM cycle has finished, you may notice that you cannot move or speak.


Many theories have been put up for the causes like hormones or neurological, but the more casual approach just defines the simple causes:

  1. Teenage
  2. Lack of sleep
  3. Changing sleep schedule
  4. Sleeping on the back
  5. Other sleep problems like narcolepsy or nighttime leg cramps
  6. Use of meds like for ADHD
  7. Substance abuse


If you find yourself unable to move or speak for a few seconds or minutes when falling asleep or waking up, then it is likely you have isolated recurrent sleep paralysis. Often, there is no need to treat this condition.

More symptoms include:

  1. Anxiety
  2. Tiredness
  3. Insomnia or sleepless at nights


Most people need no treatment for sleep apnoea. Treating any underlying conditions such as narcolepsy may help if you are anxious or unable to sleep well. These treatments may include the following:

  • Improving sleep habits — such as making sure you get six to eight hours of sleep each night
  • Using antidepressant medication if it is prescribed to help regulate sleep cycles
  • Treating any mental health problems that may contribute to sleep paralysis
  • Treating any other sleep disorders, such as narcolepsy or leg cramps

The Demon- Paranormal Theories

Some people deny the fact of medical thing, because the feeling of demon is so strong, that they can actually feel like a ghost is sitting on the chest! They may also report like someone or something was preventing them from moving while they were trying to move from the bed.

In such a case, we have got a collection of cultural beliefs of different countries which define sleep paralysis with supernatural powers in their own languages. These are Cultural beliefs of sleep apnoea.

Scandinavian folklore

Mare, a supernatural creature which is related to incubi and succubi, is a cursed woman and her body is carried mysteriously during sleep and without her noticing. In this state, she visits villagers to sit on their rib cages while they are asleep, causing them to experience nightmares. Watch the movie Marianne for epic fun.


Pinyin: guǐ yā shēn is translated as “ghost pressing on body” or “ghost pressing on bed.”


Kanashibari, meaning Bound in metal (Kana: Metal, Shibari: To bind)


The term sleep paralysis is called gawi nulim, literally meaning “being pressed down by something scary in a dream.” It is often associated with a belief that a ghost or spirit is lying on top of or pressing down on the sufferer.


Nightmares in general as well as sleep apnoea is referred to by the verb-phrase khar darakh meaning “to be pressed by the Black” or “when the Dark presses.”


Sleep paralysis is often known as dip-non or dip-phok which translates roughly as “oppressed/struck by dip”; dip, literally meaning shadow, refers to a kind of spiritual pollution.


Sleep paralysis is called phǐǐ am and khmout sukkhot. It is described as an event in which the person is sleeping and dreams that one or more ghostly figures are nearby or even holding him or her down. The sufferer is unable to move or make any noises. This is not to be confused with pee khao and khmout jool, ghost possession.


Sleep paralysis is called phǐǐ am and khmout sukkhot. It is described as an event in which the person is sleeping and dreams that one or more ghostly figures are nearby or even holding him or her down. The sufferer is unable to move or make any noises.


Sleep paralysis is called ma đè, meaning “held down by a ghost,” or bóng đè, meaning “held down by a shadow.”


Bangungut has traditionally been attributed to nightmares.

New Guinea

People refer to this phenomenon as Suk Ninmyo, believed to originate from sacred trees that use human essence to sustain its life. The trees are said to feed on human essence during night as to not disturb the human’s daily life, but sometimes people wake unnaturally during the feeding, resulting in the paralysis.

Malay Peninsula

Sleep paralysis is known as kena tindih (or ketindihan in Indonesia), which means “being pressed.” Incidents are commonly considered the work of a malign agency; occurring in what are explained as blind spots in the field of vision, they are reported as demonic figures.

India Kashmir

In Kashmiri mythology, sleep apnoea is caused by an invisible creature called a pasikdhar or a saayaa. Some people believe that a pasikdhar lives in every house and attacks somebody if the house has not been cleaned or if god is not being worshiped in the house. One also experiences this if one has been doing something evil or derives pleasure from the misfortunes of others.

India Tamil Nadu

The sleep paralysis phenomenon is referred to as Amuku Be or Amuku Pei meaning “the ghost that forces one down.”


Sleep paralysis is considered an encounter with Shaitan (Satan), evil jinns or demons who have taken over one’s body. Like Iran, this ghoul is known as bakhtak or ‘ifrit’. It is also assumed that it is caused by the black magic performed by enemies and jealous persons. People, especially children and young girls, wear Ta’wiz (Amulet) to ward off evil eye. Spells, incantations and curses could also result in ghouls haunting a person. Some homes and places are also believed to be haunted by evil ghosts, satanic or other supernatural beings and they could haunt people living there especially during the night. Muslim holy persons (Imams, Maulvis, Sufis, Mullahs, Faqirs) perform exorcism on individuals who are believed to be possessed. The homes, houses, buildings and grounds are blessed and consecrated by Mullahs or Imams by reciting Qur’an and Adhan, the Islamic call to prayer, recited by the muezzin.


The phenomenon of sleep apnoea is referred to as boba (“speechless”).

Sri Lanka

This particular phenomenon is referred to as Amuku Be or Amuku Pei meaning “the ghost that forces one down.”


Especially Newari culture,it is also known as Khyaak, after a ghost-like figure believed to reside in the darkness under the staircases of a house.


Sleep paralysis is often referred to as Ja-thoom, literally “What sits heavily on something”. In folklore across Arab countries, the Ja-thoom is believed to be a shayṭān or a ‘ifrīt sitting on top of the person or is also choking him. It is said that it can be prevented by sleeping on your right side and reading the Throne Verse of the Quran.


Sleep apnoea is often referred to as karabasan (“the dark presser/assailer”). It is believed to be a creature that attacks people in their sleep, pressing on their chest and stealing their breath. However, folk legends do not provide a reason why the devil or ifrit does that.


It is known as bakhtak, which is a ghost-like creature that sits on the dreamer’s chest, making breathing hard for him/her.


Ogun Oru is a traditional explanation for nocturnal disturbances among the Yoruba of Southwest Nigeria; ogun oru (“nocturnal warfare”) involves an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming.

Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer’s earthly spouse and a “spiritual” spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements.


The word Madzikirira is used to refer something strongly pressing one down. This mostly refers to the spiritual world in which some spirit—especially an evil one—tries to use its victim for some evil purpose. The people believe that witches can only be people of close relations to be effective, and hence a witches often try to use one’s spirit to bewitch one’s relatives.


The word dukak (“depression”) is used, which is believed to be an evil spirit that possesses people during their sleep. Some people believe this experience is a symptom of withdrawal from the stimulant khat. The evil spirit dukak is an anthropomorphic personification of the depression that often results from the act of quitting chewing khat. ‘Dukak’ often appears in hallucinations of the quitters and metes out punishments to its victims for offending him by quitting. The punishments are often in the form of implausible physical punishments (e.g., the dukak puts the victim in a bottle and shakes the bottle vigorously) or outrageous tasks the victim must perform (e.g., swallow a bag of gravel).


Sleep paralysis is called unihalvaus (dream paralysis), but the Finnish word for nightmare, painajainen, is believed to originally have meant sleep apnoea, as it’s formed from the word painaja, which translates to pusher or presser, and the diminutive suffix -nen.


Sleep paralysis is called lidércnyomás (lidérc pressing) and can be attributed to a number of supernatural entities like lidérc (wraith), boszorkány (witch), tündér (fairy) or ördögszerető (demon lover).[17] The word boszorkány itself stems from the Turkish root bas-, meaning “to press.”


Sleep apnoea is generally called having a Mara. A goblin or a succubus (since it is generally female) believed to cause nightmares (the origin of the word ‘Nightmare’ itself is derived from an English cognate of her name). Other European cultures share variants of the same folklore, calling her under different names; Proto-Germanic: marōn; Old English: mære; German: Mahr; Dutch: nachtmerrie; Icelandic, Old Norse, Faroese, and Swedish: mara; Danish: mare; Norwegian: mare; Old Irish: morrigain; Croatian, Bosnian, Serbian, Slovene: môra; Bulgarian, Polish: mara; French: cauchemar; Romanian: moroi; Czech: můra; Slovak: mora. The origin of the belief itself is much older, back to the reconstructed Proto Indo-European root mora-, an incubus, from the root mer- “to rub away” or “to harm.”


Sleep apnoea attributes a sleep paralysis incident to an attack by the Haddiela, who is the wife of the Hares, an entity in Maltese folk culture that haunts the individual in ways similar to a poltergeist. As believed in folk culture, to get rid of the Haddiela, one must place a piece of silverware or a knife under the pillow prior to sleep.


It is believed that sleep paralysis occurs when a ghost-like creature or Demon named Mora, Vrahnas or Varypnas (Greek: Μόρα, Βραχνάς, Βαρυπνάς) tries to steal the victim’s speech or sits on the victim’s chest causing asphyxiation.


Salem witch trials

During the Salem witch trials several people reported night-time attacks by various alleged witches, including Bridget Bishop, that may have been caused by sleep paralysis.


It is believed that this is caused by the spirit of a dead person. This ghost lies down upon the body of the sleeper, rendering him unable to move. People refer to this as “subirse el muerto” (dead person on you).


Sleep apnoea is known as the ‘Old Hag’. In island folklore, the Hag can be summoned to attack a third party, like a curse.


There is a legend about a mythological being called the pisadeira (“she who steps”). She is described as a tall, skinny old woman, with long dirty nails in dried toes, white tangled hair, a long nose, staring red eyes, and greenish teeth on her evil laugh. She lives over the roofs, waiting to step on the chest of those who sleep with a full stomach.

Alien abduction

Some people also report that alien took them away and did experiments on them and returned them back.

This was all about Sleep Apnoea- The way you think is the one which will decide what it does to you. The best solution to get rid of it is SLEEP!

Goosebumps Medical Term Meaning


Ever had your hairs on skin suddenly stand up? Of course you had. But all you know about it is either “Oh I’m getting chills” or “OMG that’s hilarious”. Walk through our blog that explains the minutes of Goosebumps or the Piloerection. Featuring Trivia also that will really answer some weird question of yours.


Definition What are Goose bumps
Having Violin in your hair?

Goose bumps (Goosebumps) or medical term “Cutis anserine” is a physiological process of human body in response to cold (hypothermia) or strong emotions which causes involuntary erection of hairs. Goosebumps are also referred as Goose flesh or Goose pimples.

Origin of word

Origin of word “Goose bumps”
Goose + Bumps, simple, isn’t it?

It’s not like someone plucked feathers from the goose, and the goose skin got protrusions exactly where the feathers were, but hey, it’s exactly is! The word “Goose bumps” originates from the goose protrusions on goose skin after a feather had been plucked from it. Human skin is just like that goose who faced the feather plucking, and hence the term “Goose bumps” for the humans too.


The reflex of producing goose bumps is known as horripilation, piloerection, or the pilomotor reflex. This reflex can be initiated by stimuli like Cold (hypothermia) or strong emotions like fear, nostalgia, pleasure, euphoria, awe, admiration, and sexual arousal.

Causes of Goose bumps
Maybe the Goose did bump?

Apart from this, weird causes involve when hearing plastic or metal being scratched. Indeed weird! But hey, we got explanation for that too

An important point to add is that Goose bumps can occur only in mammals, since other animals do not have hair. The term “goose bumps” is therefore misleading: the bumps on the skin of a plucked goose technically do not qualify as piloerection. Birds do however have a similar reflex of raising their feathers in order to keep warm.


Diseases in which Goose bumps can occur
As a Doctor, you should know everything

Rarely, Goose bumps may be included as symptom of some diseases, such as temporal lobe epilepsy, some brain tumors, and autonomic hyper-reflexia. Goose bumps can also be caused by heroin withdrawal. A skin condition that mimics goose bumps in appearance is keratosis pilaris.


Mechanism of Goose bumps
Arrector Pili causes erection of hairs

In response to the stimuli explained in the section Causes of Goose bumps, the basics of piloerection can be better understood by the following:

Somatomotor and Sympathetic Nervous System
Somatomotor and Sympathetic Nervous System

Stimulus initiates pilomotor reflex through sympathetic nervous system and hence causing tiny muscles at the base of each hair, known as arrector pili muscles, to contract and pull the hair erect.

Detailed Diagram of Goosbumps cause
Detailed Diagram of Goosbumps Cause


Where goose bumps occur
Goosbumps occuring on thigh and legs

In humans, goose bumps are strongest on the forearms, but also occur on the legs, back, and other areas of the skin that have hair. In some people, they even occur in the face or on the head.

In animals, these can occur throughout parts of skin covered by hair. Most important example may include Porcupines! Have a look what they look after goose bumps-

porcupine goosebumps
Exaggerated response perhaps


Piloerection as a response to cold or fear is vestigial in humans; as humans retain only very little body hair, the reflex (in humans) now serves no known purpose.

In animals, this may serve as heat preservation (more hairs=more insulation) or for defense as in porcupine or maybe some else.

Goosebumps on kitties can definitely be scary sometimes


Q1- Why not on face?

Ans- Piloerection (the muscular reflex that causes goosebumps) is found throughout the animal kingdom and is usually put to use by angry or scared animals. The piloerection causes hair to stand on its end making animals appear larger to predators and rivals.

goose bumps human body
You don’t get goosebumps on beard, do you?

Humans, through the course of evolution have retained comparatively very little body hair, so piloerection no longer serves much of a purpose. As such, it functions to varying degrees among people; a genetic variation similar to hair color or nose length. That’s the long way of saying, while most people do not get goosebumps on their face as it has not assisted in human evolutionary survival for quite some time, some people still do.

Q2- Why Goosebumps in scratching sounds?

Ans- The mechanism of piloerection (Goosebumps) has to do with your natural reflexes to external stimuli.

Fear and temperature both have strong effects on piloerection (Goosebumps) through autonomic nervous systems feedback systems. These are mediated like other emotion-linked autonomic reflexes by routing through the limbic system. These other emotion-linked autonomic reflexes include blushing, blanching, butterflies in the stomach.

The limbic system is the site of primitive drives: sex, fear, rage, aggression and hunger. Anatomical sites for the limbic system include amygdala, parahippocampal gyrus, uncus, subcallosal gyrus, cingulate gyrus, fornix, dentate gyrus, hypothalamus and hippocampus. These are found around a major structure called the thalamus which receives virtually all sensory input. The medial forebrain bundle is a bidirectional communication with the brainstem which then directly mediates autonomic reflexes. A second method of invoking the autonomic reflexes is through the hypothalamus which also sends nerve projections to the brainstem.

Specifically, direct stimulation of the amygdala and hypothalamus evokes the piloerection pathway. It’s in these physical structures that emotional stimulation by music or the reading of poetry, etc. can result in piloerection. So also non-pleasant and/or unexpected sounds may elicit a fight or flight reaction, which may include piloerection (goosebumps).

Q3- Can it be controlled?

Ans- Medical term clearly says- “Involuntary action”, so indeed no. But news has been that some people do control it!

Indian Penal Code 233 IPC


Indian Penal Code 233 or IPC 233 became viral as news messages started to spread across social media. According to news, the new law passed will grant women the right to kill or injure the sex organs of attacker. However, the truth about it is totally different.

A latest news went viral on social media about a new Anti-rape law being passed named Indian penal code 233 or IPC 233 which stated as the following :-

“A new law has been passed and under section Indian penal code 233, if a girl is suspected to be raped or getting raped, she has a right to kill the man, injure his sexual organ or harm the person within ipc 233. In such a situation, the girl would not be charged with murder.”

And the original message was:-

“If a girl is suspected to be raped or gettin raped , then she has the supreme ryt to kill the man, injure his sexual part or harm that person as dangerously under ipc 233 by modi govt.. that girl wont be blamed fr murder ……..tell as many as u can .. its your power .. create awareness …. Finally…”

This clearly doesn’t sound like a statement from Supreme Court, right? To add, one of the Supreme Court lawyer stated the following about Indian Penal Code 233:

“The act of rape is punishable under the IPC section 376, not under IPC 233 and punishment starts from 10 years to life imprisonment. There is no bill in the parliament about any amendments to the laws relating to rape currently. However, in certain cases judges have increased life imprisonment and have ordered that the accused will live and die in jail.”

There is no word of IPC 233! Adding to the following, he also said-

“The existing laws in the country are good enough if the prosecution can establish that there was a case of rape. We just need an active and efficient investigation agency, a brilliant prosecution and a dispassionate judge to decide based on facts presented. Further, under the current judicial system and based on the various statutes of the IPC, judges have the power to order that the sentence cannot be reduced and there will be no commutation of imprisonment.”

Answer to Hoax or Truth about Indian Penal Code 233

So this has been declared a False statement being viral all around on social media like WhatsApp and Facebook. So far, the real accused of the false statement is out of reach, but the main question is, “What is IPC 233 or Indian Penal Code 233” and “What is the anti-rape law then?”

We have got all answers as you go through this article. Just make sure you spread to your friends that this is indeed a hoax. But before that, have a look at something really interesting!

Gun For Indian Women

Nirbheek (Nirbhaya) – A 500gm Gun worth 1.22 lakhs for Women is out now! India has launched a new handgun for women, named after a student who was gang-raped in Delhi in December 2012 and later died of her injuries. Officials say it will help women defend themselves, but critics say it’s an insult to the victim’s memory. Let’s see how far it can beat IPC 233 then?

Coming back to the original topic, let’s have a look at the answers-

What is IPC 233 or the Indian penal code 233?

Central Government Act,
Section 233 in the Indian Penal Code

Real Indian Penal Code 233 states as:

“Making or selling instrument for counterfeiting coin.—Whoever makes or mends, or performs any part of the process of making or mending, or buys, sells or disposes of, any die or instrument, for the purpose of being used, or knowing or having reason to believe that it is intended to be used, for the purpose of counterfeiting coin, shall be punished with imprisonment of either description for a term which may extend to three years, and shall also be liable to fine.”

So now you know what exactly is Indian Penal Code 233. If IPC 233 is not anti-rape, then what is? Let’s have a look at it.

The Real Anti-Rape laws

IPC Section 375

It states definition of Rape and IPC Section 376 states the Punishment of rape. IPC 233 is completely irrelevant.

IPC Section 375

It states definition of Rape. The new definition of rape was amended on Jan 1, 2013.

Old Rape Definition

“Sexual intercourse with a woman against her will is called rape.”

New definition as per January 1, 2013

“Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.”

IPC Section 376

It states punishment for rape as follows

The punishment for committing rape is generally decided under rape laws – IPC section 376, punishing with a maximum sentence of life imprisonment and a minimum of seven years, where the rape accused is also liable to fine unless the woman raped is his wife and is not under twelve years of age. So, you see, no IPC 233 yet!

Additional Laws of Self defense

There are other laws as well which explains the Private Defense. But an important requirement goes as follows for the laws below:

“The right of private defense is only available when there is a reasonable apprehension of receiving injury/sexual assault. Also, the victim needs to provide the necessary evidence of sexual assault/rape either by herself or from the witnesses.”

IPC Section 79

Nothing is an offense which is done by any person who is justified by law, or who by reason of a mistake of fact and not by reason of a mistake of law in good faith, believes himself to be justified by law, in doing it.

IPC Section 96

Things done in private defense.—Nothing is an offense which is done in the exercise of the right of private defense.

IPC Section 97

Right of private defense of the body and of property.—Every person has a right, subject to the restrictions contained in section 99.

IPC Section 100

When the right of private defense of the body extends to causing death.

But wait, there’s another law that explains when the Right of self defense is not applicable!

IPC Section 99

There is no right of private defense against an act which does not reasonably cause the apprehension of death or of grievous hurt.

Summary of Additional laws applicable to Woman

According to the IPC section 100, about Private Defense, a person/woman has a right to defend his/her body when there is a physical assault, with the intention of committing rape or gratifying unnatural lust. And according to section 96, nothing is an offense which is done in the exercise of the right of private defense. In cases of sexual assault, the right of private defense of one’s body can extend to the voluntary causing of death or of any other harm to the assailant. But it is important to note that:

The right of private defence is only available when there is a reasonable apprehension of receiving injury/sexual assault. Also, the victim needs to provide the necessary evidence of sexual assault/rape either by herself or from the witnesses.

The conclusion is that when a woman is attacked and physically assaulted by a man with an intention of rape or lust, the woman has every right to defend herself (not under IPC 233 ofcourse). She can go to any extent to protect herself from the danger, she won’t be blamed or accused for murder – she will only need to prove the sexual assault. Moreover, according to IPC section 97, during the assault, any person associated with the woman also has the legal right to defend her body and fight/kill the assailant.

So next time someone passes the message of new anti-rape law IPC 233 , or says Indian Penal Code 233 has arrived as the savior, slap him with all the LAWS! Share the info now to let everyone know.

Snakes: Difference between Poisonous and Non-Poisonous


Have you seen in movies the sucking of venom by mouth? And you wonder that’s suicide, right? Well, medically, that’s POSSIBLE! Let us find out what this blog has got about snakes. This blog will explain you everything about snakes, that is, Types of snakes, Common snakes in India, How to find if snake is poisonous, General management for snake bite and the Treatment.

Almost everyone faces a snake, at least once in the lifetime, so why not just get some basics of snakes in short? A simple read can save someone’s life someday, and worth value for the doctors.

Snakes – An overview

Snakes are cylindrical, long, limbless, cold-blooded reptiles. There are about 3500 species of snakes known among which about 350 species are venomous. In India, about 216 species are found and among them, about 52 are poisonous.

The body of snake is divided into:

  1. Head
  2. Trunk
  3. Tail

Types of Poisonous snakes

Poisonous snakes are divided into 5 families:

Types of Poisonous snakes
Fig: Fangs in different snake families
  1. Colubridae: e.g. African boomslanag snake, twig snakes.
  2. Alractaspididae: e.g. mole vipers or adders.
  3. Elapidae: e.g. cobra, krait, coral snake.
  4. Viperidae: e.g. Russell’s viper, saw-scaled viper.
  5. Hydrophidae: e.g. Sea snakes.

Difference between Poisonous and Non-Poisonous Snakes

The following image will just clear out all doubts as to how you are going to quickly find out if the snake is venomous:

Difference between Poisonous and Non-Poisonous Snakes
Figure- A to H: Important features of poisonous and non-poisonous snakes: (A) Poison apparatus and fangs (canalised and grooved), (B) Ventral shields (belly scales) and vertebrals, (C) Head scales, (D) Cobra (note the hood and spectacle mark) (E) Cobra – Third supralabial touching eye and nasal shield, (F) Krait — four infralabials (note the large fourth one), (G) Krait — enlarged vertebrals on the back, and (H) Pit viper — a pit between eye and nostril

Common Non-Poisonous Snakes in India

  1. Rat snake (Dhaman Snake)
  2. Vine snake
  3. Bronze back tree snake
  4. Banded kukri
  5. Sand boa

Dhaman Snake is the most common non-poisonous snake found in India and also known as Rat Snake. Non-poisonous snakes, at times, may resemble poisonous snakes and create confusion.

Features of Common Poisonous Snakes in India

Common cobra

Common cobra
Fig: Common cobra

Zoological name: Naja naja
Common names: Common cobra, nag


Common cobra features
Fig: Dorsal aspect of cobra with marks
  • Common cobras are usually brown or black in color
  • Head is covered with shields. The third supra-labial shield touches the eye and nose
  • A small wedge shaped scale called as cuneate is present between 4th and 5th infra-labials
  • Pupils are round
  • Hood is present. Dorsal aspect of hood may have monocellate (monocele) or binocellate (spectacle) mark. Ventral surface of hood have two dark spots
  • Fangs are short, grooved and situated anteriorly
  • Tail is cylindrical. Caudal scales (scales on undersurface of tail) are divided and double
  • Venom — neurotoxic

Common Krait

Common Krait
Fig: Common krait

Zoological name: Bungarus caeruleus
Common name: Indian krait, common krait, Maniyar, Kawadya


Common Krait features
Fig: Common krait head
  • Usually steel blue or black in color with single or paired white bands on back. The bands are more distinct towards the tail
  • Pupils are round
  • Large hexagonal scale presents over back
  • The 4th infra-labial scale is the largest scale of other infra-labial scales
  • The subcaudal (ventral scales distal to vent) are undivided and entire
  • Fangs are short, grooved and situated anteriorly
  • Venom — neurotoxic

Banded Krait

Banded Krait
Fig: Banded krait

Zoological name: Bungarus fasciatus
Common name: Banded krait


  • Inverted “V” shaped mark on head
  • Broad black and yellow glistening bands encircle the body. On cross-section, the bands are triangular in shape
  • As per habitat, the snake is shy in nature often seen basking near water bodies usually in morning hours
  • Venom — neurotoxic

Saw Scaled Viper

Saw Scaled Viper
Fig: Saw scaled viper

Zoological name: Echis carinatus
Common name: Carpet viper, phoorsa, afai


  • Aggressive snake
  • Viviparous
  • Usually brown in color and grows up to 1.5 to 2 feet
  • Head triangular with small scale. White “arrow mark” or “spear mark” may present on head
  • Pupils are vertical
  • Wavy white line (zig-zag pattern) may present on each flank
  • Diamond shaped markings over back
  • Belly scales are broad and cover entire width
  • The scales of viper are serrated, saw like thus name sawscale viper
  • Fangs are long, curved, hollow, channelised and hinged
  • Venom — vasculotoxic and hemotoxic
  •  (Can also be remembered as 5 V’s; V= viper, V=viviparous, V=vertical pupil, V=v shaped head (triangular), V=vasculotoxic venom)

Russell’s Viper

Russell’s Viper
Fig: Russell’s viper

Zoological name: Vipera russelli
Common name: Kander, ghonas


  • Head is large, flat and triangular with small scales. White V shaped mark present on head
  • Pupils are vertical
  • Large nostrils
  • Body is stout and fatty with brown or yellowish color
  • Body scales are semi-elliptical
  • Three rows of chained dark spots present on back
  • Tail is narrow and short. Scales are divided into two rows
  • Fang are long, curved, hollow, channelized and hinged
  • When disturbed, makes a loud and hissing sound
  • Venom — Vasculotoxic and hemotoxic

Sea Snakes

  • Sea snakes are usually bluish, grayish or greenish in color. They have prominent nostrils and are situated on the top of snout
  • Body is flat and belly scales are not broad
  • Tail is flattened and paddle shaped
  • Venom — myotoxic


Basically snake venom are of three types, namely neurotoxic, haemotoxic and myotoxic venom.

Types of venom are:

Neurotoxic Venom

  • Origin—Common in Elapidae snakes, e.g. krait, cobra, etc.
  • Action—Acts like Curare, mainly on the motor nerve cells and results in muscular paralysis, the muscles are affected in following order:
  • >Firstly—Muscles of the mouth
  • >Secondly—Muscles of the throat
  • >Finally—Muscles of respiration
  • Symptoms at bite site—Local manifestations are least with neurotoxic venom snake bite
  • Other symptoms—Convulsions may be seen with Cobra venom (Krait venom produces only paralysis)

Haemotoxic Venom

  • Origin—Common in Viperidae snakes, e.g. Pit viper (Crotalidae); Pit-less viper (Russell’s viper, Saw scaled viper/Phoorsa/Echis/Echis Carinata), and Bamboo snake (Common green pit viper)
  • Action—Acts by cytolysis of endothelium of blood vessels, lysis of red cells and other tissue cells and coagulation disorders. All these can lead to:
  • >Severe swelling with oozing of blood and spreading cellulitis at bite site. Blood from such patients fails to clot even on adding thrombin, because of very low level of fibrin.
  • >Necrosis of renal tubules, and
  • >Functional disturbances like convulsions, due to intracerebral haemorrhage.

Myotoxic Venom

  • Origin—Common in hydrophidae or sea snakes
  • Action—Produces generalized muscular pain, followed by:
  • >Myoglobinuria within 3 to 5 hours
  • >Death usually occurs due to respiratory failure

Fatal Dosage for Venom?

Depending upon snake type, some common snake venoms with dosage toxicity are:-

Clinical Features

The signs and symptoms of snake bite vary depending on the snake that bites:

Non-Poisonous Snake

  1. Fear and apprehension
  2. Sweating
  3. Patient may be in state of shock with feeble pulse, hypotension, syncope, rapid and shallow breathing
  4. Bite area — may show multiple teeth marks

Poisonous snake

Elapid Bite

Local Features:

Elapid Bite Local Features
Fig: Bite area in elapid bite
  • Fang marks
  • Burning pain
  • Swelling and discoloration sometimes associated with some blisters
  • Serosanguinous discharge from bite site
  • In comparison with viper bite, local manifestations are milder in elapid bite

Systemic features:

Elapid Bite Systemic Features
Fig: Flow chart showing clinical features in elapid bite
  • Pre-paralytic stage — characterized by vomiting, headache, giddiness, weakness, lethargy
  • Paralytic stage — characterized by spreading paralytic features with ptosis, ophthalmoplegia, drowsiness, dysartheria, convulsions, bulbar paralysis, respiratory failure and death

Viperid bite

Local features:

Local features in Viperid bite
Fig: Local features in Viperid bite
Local features in Viperid bite 2
Fig: Local features in Viperid bite
  • Rapid swelling of the bite site
  • Discoloration
  • Blister formation — may extend to entire limb and even spread to trunk
  • Bleeding from bite site
  • Pain

Systemic features:

  • Generalized bleeding—epistaxis, hemoptysis, hemetemesis, bleeding gums, hematuria, melaena, hemorrhagic areas over skin and mucosa
  • Shock
  • Renal failure

Hydrophid bite

Local features:

  • Local swelling
  • Pain

Systemic features:

  • Myalgia
  • Muscle stiffness
  • Myoglobinuria
  • Renal failure


Diagnosis depends on:

  1. Identification of fang marks
  2. Identification of snake—vide supra
  3. Laboratory methods

Fang marks

Multiple Bite mark in poisonous snake
Fig: Multiple bite marks in poisonous snake
Multiple Fang mark in poisonous snake
Fig: Fang marks in poisonous snake

Usually, two fang marks in form of puncture wound can be noticed. The puncture wounds are usually separated from each other by a distance varying from 8 mm to 4 cm depending up on the type of poisonous snake. At times, due to sideswipe, a single mark may be produced or if the area is bitten at multiple times, it may result in more fang marks.

Laboratory methods

  • Complete blood count—leucocytosis may be evident with thrombocytopenia
  • Smear — hemolysed and fragmented RBCs
  • Increased prothrombin time and increased partial thromboplastin time
  • Immunodiagnosis — consists of:
  1. Immunodiffusion
  2. Counter-current immunoelectrophoresis
  3. ELISA
  4. Radioimmunoassay


General Measures

Non-poisonous snakebite:

  • Allay the anxiety and fear
  • Reassure the patients that all snakes are not poisonous
  • Avoid alcohol or morphine, for these can increase the rate of absorption of venom

First aid and field management

First aid in snakebite
Fig: First aid in snakebite
  • Reassurance
  • Limit systemic spread of venom by immobilizing the affected part (e.g. limb)
  • For Viperid bites, the bitten limb should be splinted if possible and kept at approximately heart level
  • For elapid or sea snakebites, the Australian pressure immobilization technique is beneficial. In this method, the entire bitten limb is wrapped with an elastic or crepe bandage and then splinted
  • Tourniquet—a proximal lymphatic-occlusion constriction band or torniquet may limit the spread of venom if applied within 30 minutes. The tourniquet should be applied such that it does not prevent arterial flow of blood and the distal pulsation should be appreciated

Hospital Management

  • Monitor vital signs, cardiac rhythm, oxygen saturation and urine output
  • The level of local edema/swelling/erythema in the bitten limb should be marked and the circumference should be measured every 15 minutes until swelling has stabilized
  • Intravenous access with fluid resuscitation. If needed, vasopressors (e.g. dopamine) should be administered
  • Blood and urine should be collected for laboratory evaluation
  • Care of bite site — apply dry sterile dressings. Splint may be applied
  • Tetanus immunization should be updated as appropriate
  • If the swelling in the affected limb continues and impending tissue perfusion causing muscle compartment syndrome, intracompartmental pressure should be checked. If pressure is elevated prompt surgical consultation should be obtained while antivenin continues
  • Antivenin therapy—antivenin should be administered only when indicated. Antivenins are available as monovalent (i.e. species specific) or polyvalent. In India, polyvalent antivenin is available that is effective against common cobra, common krait, Russell’s viper and sawscaled viper. The antivenin should be administered with caution. Usually the antivenins are of equine origin and carry risk of anaphylaxis or delayed-hypersensitivity type of reactions. Prior to administration of antivenin infusion, the patient should receive appropriate loading doses of intravenous antihistamines. The antivenin should be administered as intravenous infusion. It should be dissolved in 500 ml of normal saline or Ringer’s lactate or 5% dextrose for adults and 20 ml/kg for children
  • Severe hemorrhage or bleeding may require blood or fresh frozen plasma
  • If there are features of neurotoxicity, neostigmine may be required. Every injection of neostigmine should be preceded with atropine
  • Oxygen, ventilatory support
  • Management of renal failure on usual line

Adverse reactions to antivenin

  • Anaphylaxis
  • Delayed type of hypersensitivity reaction

Chronic Kidney Disease – An Occasion of CKD Day


On the very special day for the beany kidneys, we are going to stir you up about the disease of kidney, especially the chronic kidney disease, with our latest blog.


Kidney, being one the most vital organ (of course all organs are vital but Kidney is close to topping the chart) most often gets neglected by common people. By the time patients realize the complications it can yield, the disease would have reached an advanced stage. March 12th -World Kidney Day did not get the attention it most certainly requires among the masses. So let’s get to know more about Chronic Kidney Diseases (CKD).

What is CKD?

Chronic Kidney Disease PathologyChronic Kidney Disease is defined as persistent kidney damage accompanied by a reduction in the glomerular filtration rate (GFR) and the presence of albuminuria.

Statistics and Etiology

According to World Health Organization (WHO) Global Burden of Disease Project, disease of the kidney and urinary tract contribute to approximately 8,50,000 deaths every year of which Chronic Kidney Disease (CKD) is the 12th leading cause of death and 17th leading cause of disability in the world.

The global increase in CKD is due to diabetes mellitus, hypertension, obesity, and aging. The two most common causes of kidney disease are diabetes and high blood pressure. People with a family history of any kind of kidney disease are also at high risk.

Diabetic Nephropathy

It is a progressive disease characterized by nephrotic syndrome and diffuse glomerulosclerosis. Initially it causes glomerular hyperfiltration which progresses to BM (Basement membrane)thickening which leads to microalbuminuria .This is the earliest detectable change in the course of diabetic nephropathy.

Proliferation of mesangium follows and finally nodular sclerosis occurs. The Armanni-Ebstein change or Armanni-Ebstein cells which are deposits of glycogen in the tubular epithelial cells are seen in the end stages of this disease.

Hypertension and CKD

The relationship between HTN and CKD is cyclic in nature. Uncontrolled HTN is a risk factor for developing CKD and is also associated with a more rapid progression of CKD. Primarily, there is impairment in the glomerular filtration causing microalbuminuria.

Other Causes

Autoimmune diseases (such as systemic lupus erythematosus and scleroderma),infection-related diseases, and sclerotic diseases may also cause CKD. Irrational use of NSAID’s can also lead to CKD by causing interstitial nephritis.

Signs and Symptoms

The patient usually presents with the following symptoms:-

  • Edema
  • Persistent fatigue or shortness of breath
  • Loss of appetite
  • Increasing blood pressure
  • Pale, itchy, dry skin
  • Odoor in breath


  • Staging can be done by the following investigations:
  • Glomerular filtration rate (GFR)
  • Urine albumin:

Staging of Chronic Kidney Disease

  • Blood Urea Nitrogen (BUN)
  • Kidney imaging
  • Kidney Biopsy


The kidneys make and release hormones and balance the minerals in the blood. When the kidneys stop working, most people develop conditions that affect the blood, bones, nerves, and skin. These complications can range from uncomfortable to damaging and potentially even life-threatening. Managing these complications may help prevent or slow further damage to your kidneys and help you stay as healthy as possible.

The following image may shortly explain the complications of chronic kidney disease:-
Complications of Chronic Kidney Disease


For stages I- IV, the first line therapy is to not only lower BP, but also to reduce proteinuria. Such drugs are:

  • ACE Inhibitors
  • ARB’s
  • Thiazide/Loop diuretics
  • Aldosterone antagonists
  • Renin inhibitors
  • Calcium Channel Blockers
  • Beta blocker

Lifestyle modifications are also suggested:

Increase physical activity, weight loss, and dietary modifications. Patient should be advised not to smoke/consume alcohol, explaining his situation.

For Vth stage of the disease, RTT (Renal Replacement Therapy) is advised.
Renal replacement therapy includes kidney transplant, peritoneal dialysis & Hemodialysis. Renal replacement therapy is usually indicated in end stage renal disease.

MBBS Third Year Books and Syllabus


Third year MBBS consists of one year which includes the Subjects– Ophthalmology, ENT and Community medicine. Ophthalmology refers to Eye, ENT is based on Ear Nose and Throat while Community Medicine is somewhat branch of Medicine but with detailed Epidemiology. Following are the best MBBS Books for Third Year and the syllabus for each subject. Don’t forget to check our Downloads Section to get the books in PDF Format.

If you are in other year, you can jump to the below sections:


Ophthalmology in Third Year MBBS deals with primary eye care and study of related diseases.


The Syllabus for Ophthalmology for Third Year MBBS has been listed below:


A) Conjunctiva

  • Symptomatic conditions: – Hyperemia, Sub conjunctival Haemorrhage
  • Diseases: – Classification of Conjunctivitis
  • > Mucopurulant Conjunctivitis
  • > Membranous Conjunctivitis Spring Catarrh
  • > Degenerations :- Pinguecula and Pterigium

B) Cornea

  • Corneal Ulcers: Bacterial, Fungal, Viral, Hypopyon
  • Interstitial Keratitis
  • Keratoconus
  • Pannus
  • Corneal Opacities
  • Keratoplasty

C) Sclera

  • Episcleritis
  • Scleritis
  • Staphyloma

D) Uvea

  • Classification of Uveitis
  • Gen. Etiology, Investigation and Principles Management of Uveitis
  • Acute & Chronic Iridocyclitis
  • Panophthalmitis
  • End Ophthalmitis
  • Choriditis

E) Lens

  • Cataract – Classification & surgical management of cataract
  • Including Preoperative Investigation
  • Aphakia
  • IOL Implant

F) Glaucoma

  • Aqueous Humor Dynamics
  • Tonometry
  • Factors controlling Normal I.O.P
  • Provocative Tests
  • Classifications of Glaucoma
  • Congenital Glaucoma
  • Angle closure Glaucoma
  • Open Angle Glaucoma
  • Secondary Glaucoma

G) Vitreous

  • Vitreous. Opacities
  • Vitreous. Haemorrhage

H) Intraocular Tumours

  • Retinoblastoma
  • Malignant Melanoma

I) Retina

  • Retinopathies : Diabetic, Hypertensive Toxaemia of Pregnancy
  • Retinal Detachment
  • Retinitis Pigmentosa, Retinoblastoma

J) Optic nerve

  • Optic Neuritis
  • Papilloedema
  • Optic Atrophy

K) Optics

  • Principles : V.A. testing Retinoscopy, Ophthalmoscopy
  • Refraction Errors
  • Refractive Keratoplasty
  • Contact lens, Spectacles

L) Orbit

  • Proptosis – Aetiology, Clinical Evaluation, Investigations & Principles of Management
  • Endocrinal Exophthalmos
  • Orbital Haemorrhage

M) Lids

  • Inflammations of Glands
  • Blepharitis
  • Trichiasis, Entropion
  • Ectropion
  • Symblepharon
  • Ptosis

N) Lacrimal System

  • Wet Eye
  • Dry Eye
  • Naso Lacrimal Duct Obstruction
  • Dacryocystitis

O) Ocular Mobility

  • Extrinsic Muscles
  • Movements of Eye Ball
  • Squint : Gen. Aetiology, Diagnosis and principles of Management
  • Paralytic and Non Paralytic Squint
  • Heterophoria
  • Diplopia

P) Miscellaneous

  • Color Blindness
  • Lasers in Ophthalmology – Principles

Q) Ocular Trauma

  • Blunt Trauma
  • Perforating Trauma
  • Chemical Burns
  • Sympathetic Ophthalmitis

2) Principles of Management of Major Opthalmic Emergencies

  • Acute Congestive Glaucoma
  • C. Ulcer
  • Intraocular Trauma
  • Chemical Burns
  • Sudden Loss of vision
  • Acute Iridocyclitis
  • Secondary Glaucomas

3) Main Systemic Diseases Affecting the Eye

  • Tuberculosis
  • Syphilis
  • Leprosy
  • Aids
  • Diabetes
  • Hypertension

4) Drugs

  • Antibiotics
  • Steroids
  • Glaucoma Drugs
  • Mydriatics
  • Visco elastics
  • Fluoresceue

5) Community Ophthalmology

  • Blindness : Definition Causes & Magnitude
  • N.P.C.B. – Integration of N.P.C.B. with other health
  • Preventable Blindness
  • Eye care
  • Role of PHC’s in Eye Camps
  • Eye Banking

6) Nutritional

  • Vitamin A Deficiency

Best Books

Following MBBS Books are recommended for Ophthalmology in Third year MBBS:


ENT (Ear Nose Throat)

ENT in Third Year MBBS deals with common disorders, emergencies in ENT, and basic principles of impaired hearing and rehabilitation.


The Syllabus for ENT for Third Year MBBS has been listed below:


  • Anatomy/physiology
  • Diseases of buccal cavity
  • Diseases of pharynx
  • Tonsils and adenoids
  • Pharyngeal tumours and related topics (trismus, Plummer .Vinson Syndrome etc.)
  • Anatomy /physiology/examination
  • Methods/symptomatology of larynx
  • Stridor /tracheostomy
  • Laryngitis /laryngeal trauma/ Laryngeal paralysis/ foreign body larynx/Bronchus, etc.
  • Laryngeal tumours

Nose and Paranasal sinuses

  • Anatomy /physiology/ exam.
  • Methods /symptomatology
  • Diseases of ext. nose/cong.
  • Conditions
  • • Trauma to nose/p.n.s/Foreign Body. / Rhinolith
  • • Epistaxis
  • • Diseases of nasal septum
  • • Rhinitis
  • • Nasal polyps/nasal allergy
  • • Sinusitis and its complications
  • • Tumours of nose and Para nasal sinuses


Study of Ear, including the basic anatomy, physiology and diseases related to ear.

  • Anatomy / Physiology
  • Methods / methods of examination
  • Congenital diseases / ext.ear /middle ear
  • Acute/chronic supp. otitis media – Aetiology, clinical features and its management/complications
  • Serous/adhesive otitis media
  • Mastoid/middle ear surgery
  • Otosclerosis/tumours of ear
  • Facial paralysis/Meniere’s disease
  • Tinnitus /ototoxicity
  • Deafness/hearing aids/rehabilitation
  • Audiometry

Best Books

Following MBBS Books are recommended for ENT in Third Year MBBS:


Community Medicine

Community Medicine in Third Year MBBS deals with Teachings of the community and general understanding.


The Syllabus for Community Medicine for Third Year MBBS has been listed below:

  • Basic concept of Health and disease
  • Sociology and health
  • Epidemiology
  • Communicable disease epidemiology
  • Non-communicable disease epidemiology
  • National Health Programmes of India
  • Environment and impact on health
  • Entomology
  • Occupational Medicine / occupational health
  • Genetics and health
  • Nutrition and health
  • Health care management India and International
  • Primary Health care
  • International Health and travelers health

Best Books

Following MBBS Books are recommended for Community Medicine in Third year MBBS:

  1. Text book of Community Medicine, Kulkarni A.P. and Baride J.P
  2. Park’s Textbook of Preventive and Social Medicine, Park
  3. Principles of Preventive and Social Medicine, K. Mahajan
  4. Textbook of Community Medicine, B. Shridhar Rao
  5. Essentials of Community Medicine, Suresh Chandra
  6. Textbook of Biostatistics, B. K. Mahajan
  7. Review in Community Medicine, V.R. Sheshu Babu
  8. Sociology and Health Niraj Pandit
  9. National Health Programme, J Kishor

Further Reading

  1. Epidemiology and Management for health care for all P.V. Sathe and A.P. Sathe
  2. Essentials of Preventive Medicine O.P. Ghai and Piyush Gupta

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