৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মডেল টেস্ট [Archived]

• মধ্য স্বরাগম, বিপ্রকর্ষ বা স্বরভক্তি (Anaptyxis):
সময় সময় উচ্চারণের সুবিধার জন্য সংযুক্ত ব্যঞ্জনধ্বনির মাঝখানে স্বরধ্বনি আসে। একে বলা হয় মধ্য স্বরাগম বা বিপ্রকর্ষ বা স্বরভক্তি।
যেমন:
অ: রত্ন > রতন, ধর্ম ধরম, স্বপ্ন স্বপন, হর্ষ > হরষ ইত্যাদি।
ই: প্রীতি > পিরীতি, ক্লিপ> কিলিপ, ফিল্ম > ফিলিম ইত্যাদি।
উ: মুক্তা > মুকুতা, তুর্ক > তুরুক ইত্যাদি।
এ: গ্রাম > গেরাম, প্রেক> পেরেক, স্রেফ > সেরেফ ইত্যাদি।
ও: শ্লোক > শোলোক, মুরগ> মুরোগ > মোরগ ইত্যাদি। 

উৎস: বাংলা ভাষার ব্যাকরণ- নবম ও দশম শ্রেণি (২০১৯ সংস্করণ)।

• বৈষ্ণব পদাবলি:
- বৈষ্ণব পদাবলি মধ্যযুগের বাংলা সাহিত্যের শ্রেষ্ঠ ফসল।
- বাঙালি কবি জয়দেবকে বৈষ্ণব পদাবলির প্রথম পদকর্তা বা পদাবলির আদিকবি বলা হয়। তাঁর রচিত রাধাকৃষ্ণের প্রেমলীলা অবলম্বনে রচিত 'গীতগোবিন্দম্' কাব্যটি আদি বৈষ্ণব পদাবলির নিদর্শন। তবে গ্রন্থটি বাংলা ভাষায় নয়, সংস্কৃত ভাষায় রচিত।
- পরবর্তীতে বিদ্যাপতি ব্রজবুলি ভাষায় প্রথম বৈষ্ণব পদ রচনা করেন।
- অবাঙালি কবি বিদ্যাপতিকে ব্রজবুলি ভাষায় বৈষ্ণব পদাবলির আদি কবি বলা হয়। উনি অভিনব জয়দেব নামেও পরিচিত।
- বাংলা ভাষায় প্রথম বৈষ্ণব পদাবলি রচনা করেন চণ্ডীদাস।

এই কাব্যে পাঁচটি রস রয়েছে। যথা:
১. শান্তরস,
২. দাস্যরস,
৩. সখ্যরস,
৪. বাৎসল্যরস ও
৫. মধুররস।
['শৃঙ্গার রস'কে মধুররস বলে।]

এতে ৮ প্রকার অভিসারের কথা বলা হয়েছে। যথা:
- জ্যোৎস্নাভিসার,
- তামসীভিসার,
- বর্ষাভিসার,
- দিবাভিসার,
- কুঞ্ঝাটিকাভিসার,
- তীর্থযাত্রাভিসার,
- উন্মত্তাভিসার,
- সঞ্চরাভিসার।

উৎস: বাংলা ভাষা ও সাহিত্য জিজ্ঞাসা, ড. সৌমিত্র শেখর এবং বাংলা সাহিত্যের ইতিহাস, ড. মাহবুবুল আলম।

জনশুমারি ও গৃহগণনা ২০২২:
- বাংলাদেশ পরিসংখ্যান ব্যুরো (BBS) জনশুমারি পরিচালনা করে।
- জনশুমারি ও গৃহগণনা ২০২২ এর তথ্য সংগ্রহে যে পদ্ধতি অনুসরণ করা হয়েছে - CAPI.
- CAPI এর পূর্ণরূপ - Computer Assisted Personal Interviewing.
- গণনায় যে পদ্ধতি অনুসরণ করা হয়েছে- মোডিফাইড ডি-ফ্যাক্টো (Modified De-facto) পদ্ধতি।
- মোট জনসংখ্যা: ১৬ কোটি ৯৮ লাখ ২৮ হাজার ৯১১ জন।
- সবচেয়ে ঘনবসতিপূর্ণ জেলা- ঢাকা (১০০৬৭ জন)।
- সবচেয়ে কম ঘনবসতিপূর্ণ জেলা- রাঙ্গামাটি (১০৬ জন)।
- সবচেয়ে বেশি মানুষ বাস করে - ঢাকা বিভাগে (৪৫৬৪৪৫৮৬ জন)।
- সবচেয়ে কম মানুষ বাস করে - বরিশাল বিভাগে (৯৩২৫৮২০ জন)।
- জনসংখ্যার ঘনত্ব সবচেয়ে বেশি ঢাকা বিভাগে। (২১৫৬ জন)।
- জনসংখ্যার ঘনত্ব সবচেয়ে কম বরিশাল বিভাগে। (৬৮৮ জন)।
- সবচেয়ে বেশি জনসংখ্যা বাস করে ঢাকা উত্তর সিটি কর্পোরেশনে (৫৯,৯০,৭২৩ জন)।
- সবচেয়ে কম জনসংখ্যা বাস করে বরিশাল সিটি কর্পোরেশনে (৭,০৮,৫৭০ জন)।
- জনসংখ্যার ঘনত্ব সবচেয়ে বেশি ঢাকা দক্ষিণ সিটি কর্পোরেশনে (প্রতি বর্গ কিলোমিটারে ৩৯,৪০৬ জন)।
- জনসংখ্যার ঘনত্ব সবচেয়ে কম রংপুর সিটি কর্পোরেশনে (প্রতি বর্গ কিলোমিটারে ৩,৪৪৫ জন)।
- ভাসমান জনসংখ্যার দিক দিয়ে শীর্ষে রয়েছে - ঢাকা বিভাগ।
- ভাসমান জনসংখ্যার দিক দিয়ে সর্বনিম্ন অবস্থানে আছে - ময়মনসিংহ বিভাগ।

তথ্যসূত্র - পরিসংখ্যান ব্যুরোর ওয়েবসাইট।

The basic structural unit of chromatin is the nucleosome.

A nucleosome consists of DNA wrapped around a core of histone proteins. This "beads-on-a-string" structure is the fundamental building block of chromatin, which is the material that makes up chromosomes in eukaryotic cells.

Nucleotide is the basic structural unit of DNA. 

Gene is the functional unit of DNA. 

Pyramidal cells and spinal cord are derived from neural tube. 

Microglia are derived from blood monocytes. 

Posterior cerebral artery is a branch of basilar artery. 

A negative inotropic effect is one that decreases myocardial contractility. Contractility is the ability to develop tension at a fixed muscle length. Factors that decrease contractility are those that decrease the intracellular [Ca2+]. Increasing heart rate increases intracellular [Ca2+] because more Ca2+ ions enter the cell during the plateau of each action potential. Sympathetic stimulation and norepinephrine increase intracellular [Ca2+] by increasing entry during the plateau and increasing the storage of Ca2+ by the sarcoplasmic reticulum (SR) [for later release]. Cardiac glycosides increase intracellular [Ca2+] by inhibiting the Na+–K+ pump, thereby inhibiting Na+–Ca2+ exchange (a mechanism that pumps Ca2+ out of the cell). Acetylcholine (ACh) has a negative inotropic effect on the atria.

Blood flow (or cardiac output) in the systemic and pulmonary circulations is nearly equal; pulmonary flow is slightly less than systemic flow because about 2% of the systemic cardiac output bypasses the lungs. The pulmonary circulation is characterized by both lower pressure and lower resistance than the systemic circulation, so flows through the two circulations are approximately equal (flow = pressure/resistance).

Adrenocortical excess—Cushing’s syndrome

■ is most commonly caused by the administration of pharmacologic doses of glucocorticoids.
■ is also caused by primary hyperplasia of the adrenal glands.
■ is called Cushing’s disease when it is caused by overproduction of ACTH.
■ is characterized by the following:
(1) increased cortisol and androgen levels
(2) decrased ACTH (if caused by primary adrenal hyperplasia or pharmacologic doses of
glucocorticosteroids); ↑ ACTH (if caused by overproduction of ACTH, as in
Cushing’s disease)
(3) Hyperglycemia (caused by elevated cortisol levels)
(4) Increased protein catabolism and muscle wasting
(5) Central obesity (round face, supraclavicular fat, buffalo hump)
(6) Poor wound healing
(7) Virilization of women (caused by elevated levels of adrenal androgens)
(8) Hypertension (caused by elevated levels of cortisol and aldosterone)
(9) Osteoporosis (elevated cortisol levels cause increased bone resorption)
(10) Striae
■ Ketoconazole, an inhibitor of steroid hormone synthesis, can be used to treat Cushing’s disease.

3. Optic pathways and lesions (Figure 2-4)
■ Axons of the ganglion cells form the optic nerve and optic tract, ending in the lateral geniculate body of the thalamus.
■ The fibers from each nasal hemiretina cross at the optic chiasm, whereas the fibers from each temporal hemiretina remain ipsilateral. Therefore, fibers from the left nasal hemiretina and fibers from the right temporal hemiretina form the right optic tract and synapse on the right lateral geniculate body.
■ Fibers from the lateral geniculate body form the geniculocalcarine tract and pass to the occipital lobe of the cortex.
a. Cutting the optic nerve causes blindness in the ipsilateral eye.
b. Cutting the optic chiasm causes heteronymous bitemporal hemianopia.
c. Cutting the optic tract causes homonymous contralateral hemianopia.
d. Cutting the geniculocalcarine tract causes homonymous hemianopia with macular sparing. 

Tripathi 8e, P9

Semisolid forms of drugs are
Ointments,
Pastes,
Gels etc

Triapthi 7e, P39,40

Following drugs act by blocking or opening ion channels

• Quinidine blocks myocardial Na+ channels.
• Dofetilide and amiodarone block myocardial
delayed rectifier K+ channel.
• Nifedipine blocks L-type of voltage sensitive
Ca2+ channel.
• Nicorandil opens ATP-sensitive K+ channels.
• Sulfonylurea hypoglycaemics inhibit pancreatic ATP-sensitive K+ channels.
• Amiloride inhibits renal epithelial Na+
channels.
• Phenytoin modulates (prolongs the inactivated
state of) voltage sensitive neuronal Na+
channel.
• Ethosuximide inhibits T-type of Ca2+ channels
in thalamic neurones

Tripathi 8e, P578

Adverse effects of Amiodarone:

These are dose-related and increase with duration of therapy. Fall in BP, bradycardia and myocardial depression occurs on i.v. injection and after drug cumulation. Nausea, gastrointestinal upset may attend oral medication, especially during the loading phase. Photosensitization and sun burn like skin pigmentation occurs in about 10% patients. Corneal microdeposits are common with longterm use, may cause headlight dazzle, but are
reversible on discontinuation.

Pulmonary alveolitis and fibrosis is the most serious toxicity of prolonged use, but is infrequent if daily dose is kept below 200 mg.

Peripheral neuropathy generally manifests as weakness of shoulder and pelvic muscles. Liver damage is rare. Amiodarone interferes with thyroid function in many ways including inhibition of peripheral conversion of T4
to T3 and interaction with thyroid hormone receptor. It is a source of iodine as well. Goiter, hypothyroidism and rarely hyperthyroidism may develop on chronic use.

Amomg the following, appropriate dosing and duration (especially course completion) is the most important steps in ensuring rational use of antibiotics. 

Answer: B) Not a conclusive sign

Explanation:
Hymenal rupture can occur due to reasons other than intercourse. Its presence or absence is not conclusive of rape.

Answer: B) Buccal epithelial cell

Explanation:
Barr body is the inactivated X chromosome seen in females, visible in buccal smear in ~30-40% of cells.

A) Neurons are not practical for such smear tests.
C) RBCs are anucleate, so no Barr body.
D) Fibroblasts may contain Barr body but are not routinely used.

Answer: C) Medico-legal autopsy

Explanation:
Medico-legal autopsies are performed on behalf of legal authority in unnatural or suspicious deaths and require police requisition.

A) Virtual autopsy uses imaging techniques.
B) Psychological autopsy is used in suicides.
D) Clinical autopsy is done for academic/diagnostic purposes with consent.

Answer: B) Opinion based on specialized knowledge

Explanation:
An expert witness is not an eyewitness. Their role is to interpret medical/legal findings using expertise.

Answer: C) The declarant is mentally fit

Explanation:
The person must be conscious, oriented, and mentally sound. The doctor must certify mental fitness before recording.

Answer: D) Combined oral pills taken after 5 days

Explanation:
Emergency contraception is effective if used within 72–120 hours, depending on the method. Combined pills (Yuzpe method) lose effectiveness after 72 hours.

Answer: C) Relative risk is calculated

Explanation:
Cohort studies follow exposed/unexposed individuals over time to determine disease occurrence, allowing direct computation of relative risk. Case-control studies calculate odds ratio.

Answer: C) Assessing community needs

Explanation:
Health education planning begins with assessing the needs of the target group, identifying problems and gaps, then setting measurable goals.

Answer: B) Endemic

Explanation:
Endemic means a disease occurs regularly in a population or area (e.g., malaria in hilly areas), with stable transmission over time.

Answer: C) Behavioral intention

Explanation:
This theory suggests that behavioral intention (determined by attitude, subjective norms, and perceived control) best predicts whether someone will engage in a behavior.

Explanation:
Macrophages are central to chronic inflammation and contribute to tissue destruction and fibrosis by releasing enzymes, cytokines, and reactive oxygen species.

Explanation:
Type IV hypersensitivity is cell-mediated (T-cell mediated) and delayed. The tuberculin test (Mantoux test) is a classic example where T-cells mediate a response to previously encountered antigens.

Explanation:
Blood culture is the gold standard, especially during the first week of illness, when the bacteria are most likely to be present in the bloodstream.

Explanation:
Hepatitis D is a defective virus that requires hepatitis B surface antigen (HBsAg) to replicate. It can occur as a coinfection or superinfection with HBV.

Explanation:
Non-bacterial verrucous vegetations, often on mitral or aortic valve.

Answer: B) Chronic myeloid leukemia (CML)

Explanation:
The Philadelphia chromosome is pathognomonic for CML, involving BCR-ABL fusion.

Answer: C) Hypersegmented neutrophils

Explanation:
Megaloblastic anemia due to B12/folate deficiency shows macrocytosis and hypersegmented neutrophils.

Answer: C) Asterixis

Explanation:
Asterixis, or flapping tremor, is a hallmark of hepatic encephalopathy, indicating metabolic encephalopathy.

Answer: B) Urea breath test

Explanation:
Urea breath test is highly sensitive and specific for active infection, and best to confirm eradication, unlike serology, which may remain positive.

Answer: A) Aspirin 75 mg daily

Explanation:
Long-term secondary prevention of ischaemic stroke includes antiplatelet therapy, with low-dose aspirin being first-line unless contraindicated. Warfarin is used in cardioembolic strokes (e.g. due to AF).

Answer: A) Functional bowel disorder

Explanation:
IBS is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and altered bowel habits without structural or biochemical abnormality.

Answer: C) Microalbuminuria

Explanation:
Microalbuminuria (30–300 mg/day) is the earliest detectable change in diabetic nephropathy. Early detection is crucial for timely intervention to slow CKD progression.

Answer: B) Proteinuria >3.5 g/day

Explanation:
Nephrotic syndrome is defined by:
• Proteinuria >3.5 g/day
• Hypoalbuminemia
• Edema
• Hyperlipidemia

Answer: C) Adenocarcinoma

Explanation:
Adenocarcinoma is the most frequent type in non-smokers and women. It arises in peripheral lung fields.

Answer: C) Collapsed lung with visible pleural line

Explanation:
On chest X-ray, pneumothorax appears as a clear space with no lung markings, and a sharp pleural line outlining the collapsed lung is seen.

Answer: C) 1st metatarsophalangeal joint

Explanation:
The 1st MTP joint (podagra) is the classic site for acute gout, due to lower temperature and urate deposition tendency in distal joints.

Answer: A) Multiple physical complaints with no organic cause

Explanation:
Somatisation disorder involves recurrent, multiple somatic symptoms not fully explained by medical conditions, often associated with psychological distress.

Answer: A) Boutonnière deformity

Explanation:
RA commonly causes deformities like Boutonnière (PIP flexion + DIP hyperextension) and swan-neck deformity due to chronic synovitis.

Answer: D) Plasmodium falciparum

Explanation:
P. falciparum causes severe complications, including cerebral malaria, due to sequestration of parasitized RBCs in microvasculature.

Answer: C) Leishman–Donovan (LD) bodies

Explanation:
LD bodies are amastigote forms of Leishmania inside macrophages—seen in marrow, spleen or lymph node aspirates.

Answer: B) Stimulating pancreatic β-cells

Explanation:
Sulfonylureas (e.g. gliclazide) increase insulin secretion from β-cells. Risk of hypoglycemia is a major side effect.

Answer: B) Trichophyton rubrum

Explanation:
Trichophyton rubrum is the leading cause of tinea corporis, a superficial dermatophyte infection of the skin.

Massive transfusion protocol includes: provide blood and blood products in a ratio of 1 packed red cells : 1 fresh-frozen plasma : 1 platelets.

Explanation:
A mediolateral episiotomy (usually at a 45–60° angle from the midline) is the most commonly used type because it avoids the anal sphincter and reduces the risk of third- and fourth-degree perineal tears. A median (midline) episiotomy has a higher risk of extending into the anal sphincter.

Explanation:
Primordial germ cells are derived from the endoderm of the yolk sac, then migrate to the gonadal ridge where they initiate gametogenesis.

Explannation :
Placenta previa (major/central type)
Advanced carcinoma of cervix
Obstruction caused by pelvic mass ( cervical or broad ligament fibroid)
Cephalopelvic disproportion (CPD)Severe degree
Vaginal obstruction ( Atresia,Stenosis)

Explanation:
The ureter descends on the anterior surface of the psoas major muscle, posterior to the peritoneum

Explanation:
Seizures indicate eclampsia, a complication of severe preeclampsia, but not necessary for the diagnosis of preeclampsia.

Explanation:
Mature teratomas (dermoid cysts) often contain ectodermal structures like hair, teeth, and skin appendages.

Explanation:
Copper ions are toxic to sperm, impairing their motility and viability, thus preventing fertilization. It does not reliably inhibit ovulation.

Explanation:
Systemic symptoms like fever, malaise, lymphadenopathy occur in secondary syphilis, not tertiary.
Option a,b,c are feature of tertiary syphilis

Explannation : 
Oxytocin is the first line uterotonic drug, because-
It stimulates uterine contractions by acting on oxytocin receptors in the myometrium.
Fast-acting with fewer side effects compared to other uterotonics.

Explanation:
Painful menstruation (dysmenorrhea) is a hallmark symptom of endometriosis due to ectopic endometrial tissue responding to hormonal changes.
HMV and dysperonea is also present in endometriosis.

Explannation :
A Pfannenstiel incision is a transverse (horizontal) skin incision made about 2–3 cm above the pubic symphysis, commonly used in cesarean sections

Explannation : 
Chlamydia trachomatis ( D-k serotype ) is the most common cause of non gonococcal urethritis.

Explanation:
Total serum bilirubin measurement is the key test to assess the degree of hyperbilirubinemia and guide treatment decisions (e.g., phototherapy, exchange transfusion).

Explanation:
PCOS is characterized by oligo- or amenorrhea due to anovulation.

Explanation:
Tetracyclines cross the placenta and deposit in developing bones and teeth, leading to yellow-brown discoloration of teeth and bone growth retardation. They are contraindicated especially after the first trimester.

Explanation:
Women with an intact uterus require combined estrogen and progesterone to prevent endometrial hyperplasia.
In hysterectomized patient Estrogen only HRT is used.