স্পেশাল বিসিএস (স্বাস্থ্য) - লং কোর্স

Explanation -
Immediately after an injury the narrow incisional space is filled with clotted blood containing fibrin and blood cells. 

Within 24 hours, Neutrophil appear at the margin of the incision moving towards the fibrin clot.

Explanation :
DNA -
a polymer composed of two polynucleotide chains that coil around each other to form a double helix.
The polymer carries genetic instructions for the development, functioning and growth.
Each nucleotide is composed of one of four nitrogen-containing nucleobases (cytosine [C], guanine [G], adenine [A] or thymine [T]), a sugar called deoxyribose, and a phosphate group.
Purin base - Adenine and guanine
Pyrimidine base - Cytosine,Thymine,Uracil

Explanation :
The ultrastructural changes of reversible cell injury, visible by
electron microscopy,  include the following:
1. Plasma membrane alterations, such as blebbing, blunting, and loss of microvilli
2. Mitochondrial changes, including swelling and the appearance of small amorphous densities
3. Accumulation of “myelin figures” in the cytosol composed of phospholipids derived from damaged cellular membranes
4. Dilation of the ER, with detachment of polysomes 5. Nuclear alterations, with disaggregation of granular and fibrilar elements.

Explanation :
Contraction of endothelial cells resulting in opening of interendothelial gaps is the most common mechanism of vascular leakage. It is elicited by histamine, bradykinin, leukotrienes, and other chemical mediators. 

Explanation :
Causes of CKD -
Diabetes malitus (20-40%)
Interstitial disease (20-30%)
Glomerular disease
Hypertension 
SLE
PCOD
Renal artery stenosis
Unknown (5-20%)

Explanation -
Immediate investigation of stroke :
CT scan of brain
ECG
RBS

Explanation -
Transplacental transmission  :
Treponema pallidum
Listeria monocytogens
Cytomegalovirus 
Parbovirus B19
Rubella virus
Measles virus
HIV
Toxoplasma gondii 

Through birth canal :
Streptococcus agalactiae

Explanation :
Local factor influence wound healing -
Local blood supply
Denervation
Local infection
Foreign body
Haematoma
Necrotic tissue
Mechanical stress
Protection ( dressing)
Surgical techniques
Types of tissues

Explanation :
Autosomal dominant inheritance -
At least one parent of a case is affected
Both male and female canbe equally affected.
Consecutive generations are affected
Presents in heterozygous state

Explanation :
Ischemia reperfusion injury causes cell injury by :
Reactive oxygen species
IgM complement 
Intracellular calcium deposition
Cytokine 

Explanation :
Features of innocent or benign murmur -
Soft
Mid- systolic
Heard at left sternal edge
No radiation 
No other cardiac abnormalities 
Present in anaemia,Thyrotoxicosis,Pregnancy. 

Explanation :
Live bacterial vaccine -
BCG,Live cholera vaccine,Typhoid vaccine
Live viral vaccine -
MMR,Varicella,Influenza,Rota virus,OPV,Small pox, Adeno virus,Yellow fever vaccine.

Explanation :
Purulent inflammation is characterized by the production of pus, an exudate consisting of neutrophils, the liquefied debris of necrotic cells, and edema fluid. The most frequent cause of purulent (also called suppurative) inflammation is infection with bacteria that cause liquefactive tissue necrosis, such as staphylococci; these pathogens are referred to as pyogenic (pus-producing) bacteria.
A common example of an acute suppurative inflammation is acute appendicitis.

Explanation -
Causes of flaccid paraplegia :
Guillain Barre Syndrome ( GBS) 
Peripheral neuropathy 
Hypokalemic or hyperkalemic periodic paralysis
Myopathy
Poliomyelitis 
Rediculopathy
Tabes dorsalis
Cauda equina syndrome 
Myesthenia gravis & Lambert -eaton syndrome 

Explanation -
Benign childhood tumor -
Haemangioma
Lymphangioma
Benign fibrous tumor
Mature teratoma

Explanation :
Cardinal signs of right heart failure  -
Raised JVP
Ascities
Pitting oedema
Hepatomegaly

Cardinal signs of left heart failure :
Bilateral basal crepitation
Gallop rhythm
Pulsus alternans
Orthopnea

Explanation -
Causes of transudative oedema :
Protein energy malnutrition 
Liver cirrhosis
Malnutrition 
Protein losing gastroenteropathy

Causes of exudative ascities :
Heart failure
Cirrhosis
Portal vein thrombosis
Tuberculosis
Peritoneal tumor.

Explanation :
Site of traumatic fat necrosis -
Mostly breast
Then- salivary gland 
Pancreas
Neonates after delivery. 

Explanation :
Causes of fine tremor :
Hyperthyroidism
Heavy metal poisoning
Drugs ( Beta agonist,Theophylline,Caffine,Sodium valproate,TCA,Amphetamine) 

Resting tremor :
Parkinson's syndrome

Explanation :
Cytokines are the biologically active molecules, have low molecular weight
Protein or polypertides
Distinct from hormones
Usually not present in serum because they act locally near the producing cell.

Explanation -
Preformed chemical mediators :
Histamine 
Serotonin
Lysosomal enzyme 

Causes of Bell's palsy :
Idiopathic
Herpes zoster infection
Brainstem infraction
Tumor in the cerebello pontine angle
Acoustic neuroma
Parotid tumor
Fracture of petrous part of temporal bone

Explanation :
Signs of consolidation -
Inspection - Increased respiratory rate
Palpation- Reduced chest expansion,increased vocal fremitus
Percussion - Dull over affected area
Auscultation - Bronchial bredth sound,Increased vocal resonance 

Explanation :
Disposable syringe is sterilized by -
Ethylene oxide
Ionizing radiation. 

Explanation -
Hyperemia is an active process in which arteriolar dilation (e.g., at sites of inflammation or in skeletal muscle during exercise) leads to increased blood flow. Affected tissues turn red (erythema) because of increased delivery of oxygenated blood. 
Sympathetic activation play a role.

Explanation :
Approximately 40% of the patients have congenital heart disease. The most frequent forms of congenital heart diseases in Down syndrome are atrioventricular septal defects constituting 43% of cases, whereas ventricular septal defects, atrial septal defects, and tetralogy of Fallot also involved.
Children with trisomy 21 have a high risk of developing leukemia; there is 20-fold increased risk of developing acute B lymphoblastic leukemias and 500-fold increased risk of acute myeloid leukemias. The latter, most commonly, is acute megakaryoblastic leukemia.
• Virtually all patients with trisomy 21 older than age 40 develop neuropathologic changes characteristic of Alzheimer disease, a degenerative disorder of the brain.
• Patients with Down syndrome have abnormal immune responses that predispose them to serious infections, particularly of the lungs, and to thyroid autoimmunity, causing hypothyroidism .

Explanation :
Sites of moist gangrene -
Intestine is the commonest sites
Mouth
Pressure area
Vulva
Scrotum
Anterior abdominal wall
Thigh

Explanation -
Antibody raised in SLE :
ANA
Anti Ds DNA
Anti phospholipid antibody
Anti Sm antibody 

ACPA is anti citrullinated peptide antibodies raised in rheumatoid arthritis. 

Explanation :
Superantigen -
Enterotoxin of staphylococcus
Toxic shock syndrome toxin of s.aureus
All toxin of steptococcus
Enterotoxin of bacillus
Enterotoxin of clostridium.

Explanation :
Common cause of haemoptysis -
Tuberculosis
Bronchogenic carcinoma
Lung abscess
Bronchiactasis
Pulmonary embolism
LVF
MS
Bleeding disorder

Explanation -
Arsenic - Lung carcinoma,Squamous cell carcinoma,Basal cell carcinoma
Asbestos - lung carcinoma,Esophageal carcinoma,Gastric carcinoma
Benzene - Acute myeloid leukemia
Vinyl chloride - Hepatic angiosarcoma

Explanation :
Pathogenesis of osteoporosis -
Postmenopausal due to low peak bone mass
Genetic cause
Hypogonadism
Inflammatory bowel disease
Hyperparathyroidism
Cushing syndrome 
Corticosteroid 
GnRH agonist therapy
Alcohol excess
Heparin therapy

Explanation -
Arterial thrombi :
are frequently occlusive; the most common sites in decreasing order of frequency are the coronary, cerebral, and femoral arteries. They typically consist of a friable meshwork of platelets, fibrin, red cells, and degenerating leukocytes. Although these are usually superimposed on a ruptured atherosclerotic plaque, other vascular injuries (vasculitis, trauma) may be the underlying cause.

Venous thrombosis (phlebothrombosis)- is almost invariably occlusive, with the thrombus forming a long luminal cast. Because these thrombi form in the sluggish venous circulation, they tend to contain more enmeshed red cells (and relatively few platelets) and are therefore known as red thrombi or stasis thrombi. Venous thrombi are firm, are focally attached to the vessel wall. 

Explanation :
Sex chromosomal aneuploidy :
Turners syndrome : 45,XO
Klinfelters syndrome : 47,XXY
Super female : 47,XXX

Explanation :
Coagulative necrosis is a form of necrosis in which the architecture of dead tissue is preserved for a span of at least some days .
The affected tissue has a firm texture. Presumably, the injury denatures not only structural proteins but also enzymes and so blocks the proteolysis of the dead cells; as a result, intensely eosinophilic cells with indistinct or reddish nuclei may persist for days or weeks.
Ultimately, the necrotic cells are broken down by the action of lysosomal enzymes derived from infiltrating leukocytes, which also remove the debris of the dead cells by phagocytosis. Ischemia caused by obstruction in a vessel may lead to coagulative necrosis of the supplied tissue in all organs except the brain (see next paragraph for explanation).
A localized area of coagulative necrosis is called an infarct.

Explanation :
Seropositive arthritis -
Rheumatoid arthritis 
Systemic lupus erythromatosus ( SLE) 

Explanation :
IgM is the only immunoglobulin can become monomer or pentamer.

Explanation :
Effects of complement in acute inflammation :
Vasodilation 
Increased vascular permeability 
Phagocytosis
MAC
Chemotaxis
Leucocyte adhesion

Explanation :
Clinical features of type 2 respiratory failure :
Hypoxia
Hypercapnia
Airway obsteuction
Cor pulmonale
Signs of precipitating factors

Explanation -
Premalignant condition of female genital tract :
Cervical dysplasia including CIN
LSIL,HSIL
Endometrial hyperplasia 
Leucoplakia
Dysplasia
Lichen sclerosus of vulva

Explanation :
Bacterial spores are small oval or spherical structures that are very resistant to high temperatures, radiation, desiccation, and chemical agents.
When they are formed intracellularly, they are called endospore.
The bacterial cell producing spore is called vegetative cell.

Explanation :
Acute phase proteins :
CRP,Ceruloplasmin,Cryoglobulin
Serum amyloid A protein 
Fibrinogen
Ceruloplasmin
Heptoglobin
Ferritin
Lactoferrin

Explanation -
Most pulmonary emboli (60% to 80%) are clinically silent because they are small. With time they become organized and are incorporated into the vascular wall; in some cases organization of the thromboembolus leaves behind a delicate, bridging fibrous web.

• Sudden death, acute right heart failure (cor pulmonale), or cardiovascular collapse occurs when emboli obstruct 60% or more of the pulmonary circulation( Large emboli). 

• Embolic obstruction of medium-sized arteries with subsequent vascular rupture can result in pulmonary hemorrhage but usually does not cause pulmonary infarction.
• Embolic obstruction of small end-arteriolar pulmonary branches often does produce hemorrhage or infarction.
• Multiple emboli over time may cause pulmonary hypertension and right ventricular failure.

Explanation :
Multifactorial ( polygenic)  inheritance disorders -
Cleft lip and or palate
Congenital dialocation of hip
Congenital heart defects
Gout
Hypertension 
Diabetes
Neural tube defects

Explanation :
The removal of supernumerary cells (in excess of the required number) during development. 
• Involution of hormone-dependent tissues on hormone withdrawal, such as endometrial cell breakdown during the menstrual cycle, ovarian follicular atresia in menopause, and regression of the lactating breast after weaning.
• Cell turnover in proliferating cell populations, such as immature lymphocytes in the bone marrow and thymus, B lymphocytes in germinal centers that fail to express useful antigen receptors and epithelial cells in intestinal crypts, to maintain a constant cell number (homeostasis).
• Elimination of potentially harmful self-reactive lymphocytes to prevent immune reactions against one’s own tissues.
• Death of host cells that have served their useful purpose, such as neutrophils in an acute inflammatory response, and lymphocytes at the end of an immune response.

Explanation :
Signs of portal hypertension -
Ascites
Yellowing of the skin
Easy bruising 
Enlarged spleen
Varices
Arterial hypotension
Caput medusae
Edema of the legs

Explanation :
Chronic inflammation is characterized by the
following:
• Infiltration with mononuclear cells, which include macrophages, lymphocytes, and plasma cells.
• Tissue destruction, induced by the persistent offending agent or by the inflammatory cells.
• Attempts at healing by connective tissue replacement of damaged tissue, accomplished by angiogenesis (proliferation of small blood vessels) and, in particular, fibrosis.

Explanation :
Examples of illnesses resulting from type IV hypersensitivity reactions include contact dermatitis
drug hypersensitivity
GVHD
Tuberculin test
Lepromin test
Tumor immunity
Type I DM
Hashimoto thyroiditis
Erythema multiforme

Explanation :
Causes of -
Osteoblastic metastasis following carcinoma :
Prostate 
Breast ( Mixed)
Osteolytic metastasis following carcinoma :
Kidney
Thyroid
Lung
Breast

Explanation :
Liver failure -
Hyperacute : <7  days
Acute : 8-28 days
Subacute : 29 days - 12 weeks.

Explanation :
Mycobacterium -
Rigid cell wall contain mycolic acid
M.fortuitum is rapid growing
Causes growth primarily in lungs

Explanation -
Amniotic fluid embolism is the fifth most common cause of maternal mortality worldwide; it accounts for roughly 10% of maternal deaths in the United States and results in permanent neurologic deficit in as many as 85% of survivors.
Amniotic fluid embolism is an ominous complication of labor and the immediate postpartum period.Mortality rate is up to 80%.
The onset is characterized by sudden severe dyspnea, cyanosis, and shock, followed by neurologic impairment ranging from headache to seizures and coma, and by DIC. 

Explanation :
Morphology of apoptotic cell -
Cell shrinkage
Chromatin condensation
Formation of cytoplasmic blebs and apoptotic body
Phagocytosis 

Explanation :
Fungi -
Eukaryotes 
Mitochondria and endoplasmic reticulum present
Sterol present in cell membrane 
Chitin present in cell wall
Sexual and asexual spores are present

Explanation -
Class I - Present in all nucleated cell and platelet
Class II - Present in antigen presenting cell ( Macrophage,B- cell,Dendritic cell) 
Class III - Remains free in plasma.

Explanation :
Granulomatous inflammation is a form of chronic inflammation characterized by collections of activated macrophages, often with T lymphocytes, and sometimes associated with necrosis.
Granuloma formation is a cellular attempt to contain an offending agent that is difficult to eradicate. In this attempt there is often strong activation of T lymphocytes leading to macrophage activation, which can cause injury to normal tissues.
Epitheloid cell predominant.

Explanation :
Causes of bloody diarrhoea -

Hemorrhoids
IBD
Anal fissure
Colorectal cancer
Diverticulitis
Colon polyps
Angiodysplasia
Colititis
Gastroenteritis
Infections ( Entamoeba histolytica, E.coli,Shigella, Camphylobacter) 
Dysentery
Medications
Unsafe water 
Esophageal problems

Explanation :
Avuscular necrosis seen in :
Head of femur
Talas
Scaphoid
Radiation therapy
Sickle cell crisis
Trauma 
Tumor

Explanation :
Organism causes UTI :
E.coli (most common) 
Proteus
Staphylococcus saphrophyticus ( Young women)
Staph.epidermidis
Enterococcus
Klebsiella
Pseudomonas

Explanation :
Toxin production by S.aureus -
Enterotoxin
Toxic shock syndrome toxin
Exfoliatin
Leukocidins

Explanation -
Fate of an infraction -
Absorption ( Regeneration /organisation)
Dystrophic calcification 
Hyalinization 
Suppuration and abscess
Liquifactive necrosis

Explanation :
Diabetic ketoacidosis presents as -
excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion.

Explanation :
Hyperacute rejection:
Occurs within minutes to hours 
Due to preformed antibody and complement activation (type II hypersensitivity) 

Explanation :
C-reactive protein (CRP) is a protein made by the liver.
The level of CRP increases when there's inflammation in the body.
Synthesis upregulated by TNF.

Explanation :
Clinical triad of Grave's disease :
Goiter
Exophthalmos
Pretibial myxoedema

Explanation :
Respiratory emergency -
Tension pneumothorax
Acute severe bronchial asthma
Acutr exacervation of COPD

Endocrine emergency :
DKA
Hypoglycemia
Thyrotoxic coma

Explanation -
Trichomonas vaginalis :
Is sexually transmitted 
Metronidazole is effective drug
May cause urethritis,vaginal discharge
Found in trophozoite form

Explanation :
Causes of distributive shock -
Septic shock
Anaphylaxis 
Spinal cord injury

Ehlers danlos syndrome is a condition where there is poorly developed collagen,easy to hurt,poor healers,cigarette paper like skin known as rubber man or human pretzels. 

Explanation :
Decreased workload or disuse atrophy is seen in skeletal muscle in a patient with restricted to bed rest,or when immobilised in plaster cast.

Explanation :
Direct coombs test - Haemolytic autoantibody 
Indirect coombs test -
Rh antibody.

Explanation -
B cell immunodeficiency -
X linked hypogummaglobulinaemia 
Selective immunoglobulin deficiencies. 

Explanation :
Congenital cyanotic heart disease :
Fallot's tetralogy
Transposition of the great vessels
Severe ebstain anomaly
Tricuspid atresia
Pulmonary atresia
Severe pumonary stenosis

Congenital acyanotic heart disease -
ASD
VSD
PDA
Coarctation of aorta
Congenital aoryuc stenosis

Explanation :
Exfoliative cytology have diagnostic role in -
Lung carcinoma
Bladder carcinoma
Prostate carcinoma
Gastric carcinoma
Cervical carcinoma
Bronchial carcinoma
Endometrial carcinoma

Explanation :
Non enveloped DNA virus :

Parbo virus B19
Papilloma virus
Adeno virus

Enveloped DNA virus :
Herpes virus family
Pox virus family
Hepadna virus.

Explanation -
Metastatic calcification :
Metastatic calcification may occur in normal tissues whenever there is hypercalcemia. Hypercalcemia also accentuates dystrophic calcification. There are four principal causes of hypercalcemia: (1) increased secretion of parathyroid hormone (PTH) with subsequent bone resorption, as in hyperparathyroidism due to parathyroid tumors, and ectopic secretion of PTH-related protein by malignant tumors  (2) resorption of bone tissue, secondary to primary tumors of bone marrow (e.g., multiple myeloma, leukemia) or diffuse skeletal metastasis (e.g., breast cancer), accelerated bone turnover (e.g., Paget disease), or immobilization; (3) vitamin D–related disorders, including vitamin D intoxication, sarcoidosis (in which macrophages activate a vitamin D precursor), and idiopathic hypercalcemia of infancy (Williams syndrome), characterized by abnormal sensitivity to vitamin D; and (4) renal failure, which causes retention of phosphate, leading to secondary hyperparathyroidism. Less common causes include aluminum intoxication, which occurs in patients on chronic renal dialysis, and milk-alkali syndrome, which is due to excessive ingestion of calcium and absorbable antacids such as milk or calcium carbonate.

Explanation :
In progressive phase of shock -
Persistent oxygen deficit leads to intracellular aerobic respiration is replaced by anaerobic glycolysis with excessive production of lactic acid. The resultant metabolic lactic acidosis lowers the tissue pH, which blunts the vasomotor response; arterioles dilate, and blood begins to pool in the microcirculation.
Peripheral pooling not only worsens the cardiac output but also puts endothelial cells at risk for the development of anoxic injury with subsequent DIC.
With widespread tissue hypoxia, vital organs are affected and begin to fail.

Explanation :
Mostly all autosomal recessive disorders are related to enzyme.

Explanation :
Most effective cardiac biomarker in acute MI is serum trophonin I, which rise in 4-6 hours, peak at 12 hours and fall after 48-72 hours.

Explanation :
Typical feature of nephrotic syndrome -
Generilized oedema
Pitting oedema
Blood pressure : Normal
Proteinuria : 3+/4+ 

Explanation -
Components of acquired immunity :
B & T lymphocyte
Eosinophil
Macrophage 
NK cell
Cytokine
Complement
CD4 and CD8 T cell

Explanation :
Acute inflammatory exudates :
Contains neutrophil
Rich in Fibrinogen 
Have protective function
Due to change in blood vessels

Explanation :
Rabies virus can grow in nerve cell
And transmitted through nerve.

Explanation :
Fixative in tissue biopsy is used for fixation of tissue
It prevents autolysis
Most frequently, the routine fixative will be neutral buffered formalin.

Explanation :
Female pseudohermaphrodite -
Gonads : Ovary
Karyotype : 46,XX
Secondary sexual organ incomplete or ambiguous 
Cliteromegaly found
Excessive androgen found.

Explanation :
In chronic passive hepatic congestion-
The centrilobular regions are grossly redbrown and slightly depressed (because of cell death) and are accentuated against the surrounding zones of uncongested tan liver (nutmeg liver). 
Microscopically, there is centrilobular congestion and hemorrhage, hemosiderin-laden macrophages, and variable degrees of hepatocyte dropout and necrosis.