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

Rifampicin induces red-orange discoloration of body fluids due to its chromophore structure. Patients should be informed this is harmless.

Anti-HBs indicates immunity to hepatitis B, either from past infection or vaccination.

Over 90% of duodenal ulcers are associated with H. pylori infection.

SGLT2 inhibitors (e.g., Dapagliflozin) increase urinary glucose excretion, predisposing to genital mycotic infections.

The CURB-65 score helps guide decisions about hospital admission and management in pneumonia.

Lactulose acidifies gut content, trapping ammonia in the colon and promoting its excretion.

E. coli is responsible for ~75–95% of uncomplicated community-acquired UTIs.

Ethosuximide is highly effective in typical absence seizures, especially in children.

HLA-B27 is strongly associated with spondyloarthropathies, including reactive arthritis.

Methotrexate is the anchor drug in RA and is usually started early to prevent joint destruction.

ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria, thereby slowing CKD progression.

Seizures, altered consciousness, or focal neurological signs raise concern for raised intracranial pressure — LP is delayed pending neuroimaging.

IV alteplase is approved for use within 4.5 hours of symptom onset in eligible patients with ischemic stroke.

Hydroxychloroquine is beneficial for skin and joint symptoms, reduces flares, and improves survival in SLE.

Oral ferrous sulfate is the first-line therapy unless there is intolerance, non-compliance, or malabsorption.

Scabies causes severe itching that worsens at night, particularly in web spaces and skin folds.

CBT is the most effective psychological intervention for anxiety, targeting thought patterns and behavior.

Auer rods are seen in myeloblasts and are characteristic of AML, especially the M3 (APL) subtype.

Auspitz sign is pinpoint bleeding seen when psoriatic scales are scraped off.

Early morning awakening, weight loss, and loss of appetite are typical somatic symptoms in severe depression.

Mitral regurgitation classically presents with a pansystolic murmur at the apex, which radiates to the left axilla.

The ileocecal region is the most frequent site of involvement in abdominal TB due to lymphoid abundance and stasis.

Nerve conduction studies (with EMG if needed) help classify neuropathies as axonal or demyelinating.

Allopurinol (a xanthine oxidase inhibitor) is used for chronic urate control, not during acute attacks.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma, and the first-line treatment is R-CHOP:
 • Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone.
Radiotherapy may be added for bulky disease, but not as monotherapy. Transplant is reserved for relapsed/refractory cases.

Though both TTP and DIC present with thrombocytopenia and MAHA, coagulation parameters help differentiate:
 • In TTP, PT and APTT are normal, because the coagulation cascade is not activated.
 • In DIC, PT and APTT are prolonged, and D-dimer is markedly raised.
This distinction is critical for correct management.

Perianal complications such as fistulas, abscesses, and strictures are much more common in Crohn’s disease, due to its transmural inflammation.
 • PSC is more linked with UC.
 • Toxic megacolon and CRC are also more often complications of extensive UC.

Post-TB bronchiectasis often presents with unilateral or lobar involvement, unlike diffuse disease in CF or Kartagener’s.
 • CF and PCD usually cause bilateral, widespread bronchiectasis.
 • ABPA typically affects central bronchi.

VF leads to immediate cessation of cardiac output, and is the most common arrhythmia in sudden cardiac arrest.
 • Sinus tachycardia and 1st degree block are benign.
 • Atrial flutter is rarely fatal without other pathology.

In lepromatous leprosy, poor CMI allows bacilli proliferation.
 • Lepromin test is negative, bacillary load is high, and immune response is Th2-dominant

Severe falciparum malaria is a medical emergency requiring IV artesunate.
 • Oral therapy is inadequate for high parasitemia or complications like cerebral malaria.

Mitral stenosis presents with:
 • Loud S1
 • Opening snap
 • Mid-diastolic murmur at the apex (best heard in the left lateral position)
 • Often due to rheumatic heart disease
Dyspnea results from pulmonary congestion due to raised left atrial pressure.

Pancreatic insufficiency leads to fat malabsorption, which affects absorption of fat-soluble vitamins (A, D, E, K).
 • Vitamin K deficiency causes coagulopathy due to impaired synthesis of clotting factors.

Dengue fever typically presents with:
 • Sudden high fever
 • Severe headache, retro-orbital pain
 • Generalized myalgia and arthralgia (“breakbone fever”)
 • Maculopapular rash
 • Positive tourniquet test (suggests capillary fragility)

This constellation of symptoms is classic for dengue, especially in endemic areas.

Blood culture is considered the gold standard for diagnosing enteric fever, especially in the first week of illness, as the bacteria (typically Salmonella Typhi or Paratyphi) are present in the bloodstream during this phase. While stool and urine cultures can be positive later in the disease, they are less reliable for initial diagnosis. The Widal test, which detects antibodies, is often positive but has low sensitivity and specificity and is not recommended for definitive diagnosis due to high rates of false positives and negatives.

ACE inhibitors (e.g., ramipril, enalapril, lisinopril) are fundamental to the management of HFrEF. They block the renin-angiotensin-aldosterone system, leading to vasodilation, reduced preload and afterload, and favorable cardiac remodeling. Numerous clinical trials have demonstrated their ability to improve symptoms, reduce hospitalizations, and significantly decrease mortality in patients with HFrEF. Beta-blockers, MRAs, and SGLT2 inhibitors are also key mortality-reducing agents in HFrEF.

"Alarm symptoms" or "red flags" in patients with suspected IBS are signs that suggest an underlying organic pathology rather than functional bowel disorder and warrant further investigation (e.g., endoscopy, imaging). Rectal bleeding is a significant alarm symptom that could indicate inflammatory bowel disease, colorectal cancer, or other serious conditions. Bloating, abdominal pain relieved by defecation, and alternating bowel habits are all common features of IBS itself.

Lisinopril is an ACE inhibitor, and drugs that block the renin-angiotensin-aldosterone system (RAAS) are well-known causes of hyperkalemia. ACE inhibitors reduce aldosterone secretion, which in turn impairs potassium excretion by the kidneys. Hydrochlorothiazide (a thiazide diuretic) typically causes hypokalemia. Amlodipine (a calcium channel blocker) and Metformin (an oral hypoglycemic) are generally not associated with hyperkalemia.

Multiple myeloma cells produce factors that activate osteoclasts and suppress osteoblasts, leading to increased bone resorption and the formation of lytic lesions. This increased bone breakdown releases calcium into the bloodstream, resulting in hypercalcemia. Hypercalcemia is a common and potentially severe complication that can lead to renal dysfunction, confusion, and cardiac arrhythmias.

Most drugs are entered into the body tissues by passive diffusion.

Oxidation, Epoxidation, Reduction, Hydrolysis etc are the Phase-I drug biotransformation reaction

As most drugs are absorbed in the small intestine, villous atrophy can largely affect the absorption

Albumin is the main binding protein for many natural substances and drug (Lawrence, 12th, P93)

Here efficacy of the both drugs are same. So Diclofenac is about 10 times potent than Naproxen. Safety information has not been explained through the statement. And half life is not related to dose

Lipid solubility is the property of a drug to cross the biological membranes and enter to the tissues. So if a drug has higher lipid solubility it would likely have a higher volume of distribution.

SGLT2 inhibitors (Canaglilozin, Dapagliflozin, Empagliflozin) can cause UTI or Fungul infections, more in female.

THe hypertensive drugs safe in pregnancy are - Methyldopa, Labetalol, Nifedipine, Amlodipine, Doxazosin (Davidson 24th)

Using more than one group of drug definitely increase the therapeutic expenditure. Other options are not obvious.

Diarrhea can be of bacterial origin. But before confirmation, the primary therapy will be volume replacement by ORS/ IV Saline.