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৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]

পরীক্ষা৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]তারিখতারিখ অনির্ধারিতসময়20 minutes
মোট প্রশ্ন৩৯
সিলেবাস
Exam - 2 Medicine-02 1. Diseases of the Respiratory System Upper respiratory tract infections Pneumonias Tuberculosis Lung abscess and bronchiectasis Diseases of the pleura: Pleurisy, Pleural effusion & empyema, Pneumothorax Chronic Obstructive Lung Disease (COPD) and cor pulmonale Bronchial asthma & Pulmonary eosinophilia Acute and chronic respiratory failure Neoplasm of the lung 2. Skin Diseases Scabies Superficial fungal infections Dermatitis Psoriasis Drug reactions, etc. 3. Nephrology & Urinary System Nephritic & Nephrotic Illness UTI / Pyelonephritis ARF (Acute Renal Failure) CRF (Chronic Renal Failure) 4. Endocrine and Metabolic Diseases Diabetes mellitus Thyrotoxicosis Hypothyroidism and iodine deficiency state Cushing’s syndrome and Addison’s disease
প্রশ্ন দেখুনঅনুশীলন
ঘনত্ব
উত্তর
উত্তরিতবর্তমানপুনরায় দেখুনঅসম্পূর্ণ

৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]

৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived] · তারিখ অনির্ধারিত · ৩৯ প্রশ্ন

১.
A 65-year-old smoker presents with fever, cold sore, rusty sputum and lobar consolidation on CXR. The most likely causative organism is:
  1. ক
    Mycoplasma pneumoniae
  2. খ
    Staphylococcus aureus
  3. গ
    Streptococcus pneumoniae
  4. ঘ
    Klebsiella pneumoniae
ব্যাখ্যা
Rusty sputum, herpes labialis and lobar consolidation are classic for pneumococcal pneumonia, the most common community-acquired pneumonia.
২.
Which finding is pathognomonic for bronchiectasis on HRCT?
  1. ক
    Ground-glass opacities
  2. খ
    "Tree-in-bud" pattern
  3. গ
    Cavitary lesions
  4. ঘ
    "Tram-track" sign
ব্যাখ্যা
Dilated bronchi parallel to adjacent vessels create tram-tracks signs
৩.
Type II respiratory failure is characterized by:
  1. ক
    PaO2 <60 mmHg with normal/low PaCO2
  2. খ
    PaO2 <60 mmHg + PaCO2 >45 mmHg
  3. গ
    Isolated hypercapnia
  4. ঘ
    Metabolic acidosis
ব্যাখ্যা
Type II involves hypoxemia with hypercapnia (e.g., COPD, neuromuscular disease)
৪.
Which test is most rapid for diagnosing TB?
  1. ক
    Sputum AFB microscopy
  2. খ
    GeneXpert MTB/RIF assay
  3. গ
    Tuberculin skin test
  4. ঘ
    Interferon-gamma release assay
ব্যাখ্যা
GeneXpert detects M. tuberculosis DNA and rifampicin resistance within 2 hours
৫.
60-year-old smoker with COPD develops pedal edema and elevated JVP. ECG shows right axis deviation. What is the diagnosis?
  1. ক
    Left heart failure
  2. খ
    Pulmonary embolism
  3. গ
    Constrictive pericarditis
  4. ঘ
    Cor pulmonale
ব্যাখ্যা
Features of right heart failure in COPD patient indicates Cor pulmonale
৬.
A pregnant lady with bronchial asthma is on maintenance dose of prednisolone >7.5mg/day. What should advice for her during labour?
  1. ক
    No corticosteroid
  2. খ
    Administer Dexamethasone 5mg 3-4 times daily
  3. গ
    Administer Hydrocortisone 100mg 3-4 times daily
  4. ঘ
    Increase dose of Prednisolone by 20-30%
৭.
What is a common cause of chronic type 2 respiratory failure?
  1. ক
    Pulmonary embolism
  2. খ
    Pneumothorax
  3. গ
    Myopathies
  4. ঘ
    Interstitial lung disease
ব্যাখ্যা
chronic type 2 respiratory failure, marked by hypoxemia (PaO2 <60 mmHg) and hypercapnia (PaCO2 >45 mmHg), commonly results from COPD, ankylosing spondylitis, sleep apnoea, myopathies, muscular dystrophies. 
৮.
What diagnostic test is most useful to differentiate transudative from exudative pleural effusion?
  1. ক
    Chest X-ray
  2. খ
    Pleural fluid analysis with Light’s criteria
  3. গ
    Pleural fluid analysis with microscopy
  4. ঘ
    Pleural fluid analysis with cytological study
ব্যাখ্যা
Pleural fluid analysis using Light’s criteria is the gold standard to differentiate transudative from exudative effusions. Criteria include pleural fluid/serum protein ratio >0.5, pleural fluid/serum LDH ratio >0.6, or pleural fluid LDH >2/3 the upper limit of normal serum LDH, indicating an exudate.
৯.
Which antibiotic is recommended as first-line empirical treatment for severe community-acquired pneumonia?
  1. ক
    Amoxicillin
  2. খ
    Azithromycin
  3. গ
    Co-amoxiclav + clarithromycin
  4. ঘ
    Ciprofloxacin
ব্যাখ্যা
Combination of co-amoxiclav (amoxicillin + clavulanic acid) and a macrolide like clarithromycin for severe community-acquired pneumonia. This regimen covers Streptococcus pneumoniae, atypical organisms (e.g., Mycoplasma pneumoniae, Chlamydia pneumoniae), and other common pathogens.
১০.
What is the first-line drug for managing type 2 diabetes mellitus?
  1. ক
    Insulin
  2. খ
    Metformin
  3. গ
    Sulfonylureas
  4. ঘ
    SGLT2 inhibitors
ব্যাখ্যা
Metformin is the first-line therapy for type 2 diabetes mellitus, as it reduces hepatic glucose production, improves insulin sensitivity, and is effective and well-tolerated. Insulin is used in type 1.
১১.
What is the most serious acute complication of type 1 diabetes mellitus?
  1. ক
    Hyperosmolar hyperglycemic state
  2. খ
    Hypoglycemia
  3. গ
    Lactic acidosis
  4. ঘ
    Diabetic ketoacidosis
ব্যাখ্যা
DKA is the most serious acute complication of type 1 diabetes, marked by hyperglycemia, ketosis, and acidosis due to insulin deficiency. Hyperosmolar hyperglycemic state is more common in type 2, hypoglycemia is a treatment complication, and lactic acidosis is rare and linked to metformin.
১২.
What test is used to monitor long-term glycemic control in diabetes mellitus?
  1. ক
    Fasting plasma glucose
  2. খ
    Oral glucose tolerance test
  3. গ
    HbA1c
  4. ঘ
    Random blood glucose
ব্যাখ্যা
HbA1c reflects average blood glucose over 2–3 months, making it the standard for monitoring long-term glycemic control in diabetes. Fasting and random glucose tests assess acute levels, and the oral glucose tolerance test is for diagnosis, not monitoring.
১৩.
Which lab finding is diagnostic of primary hypothyroidism?
  1. ক
    High TSH and low free T4
  2. খ
    Low TSH and low free T4
  3. গ
    High TSH and high free T4
  4. ঘ
    Low TSH and high free T4
ব্যাখ্যা
Primary hypothyroidism is diagnosed by a high TSH (from pituitary stimulation) and low free T4 (due to thyroid failure). Low TSH and low T4 suggest secondary hypothyroidism, while high TSH and high T4 or low TSH and high T4 are seen in hyperthyroid states.
১৪.
Which antibody is most specific for Graves’ disease?
  1. ক
    Anti-thyroid peroxidase (TPO) antibody
  2. খ
    Anti-thyroglobulin antibody
  3. গ
    TSH receptor antibody (TRAb)
  4. ঘ
    Anti-nuclear antibody (ANA)
ব্যাখ্যা
TSH receptor antibodies (TRAb), especially thyroid-stimulating immunoglobulins, are highly specific for Graves’ disease, driving hyperthyroidism. Anti-TPO and anti-thyroglobulin antibodies are more common in Hashimoto’s
১৫.
What is a classic clinical feature of Cushing’s syndrome?
  1. ক
    Weight loss
  2. খ
    Central obesity
  3. গ
    Hypotension
  4. ঘ
    Bradycardia
ব্যাখ্যা
Central obesity (truncal fat, moon face, buffalo hump) is a classic feature of Cushing’s syndrome due to excess cortisol. Weight loss is seen in adrenal insufficiency, and hypertension (not hypotension) and tachycardia (not bradycardia) are common
১৬.
What is a hallmark clinical feature of Addison’s disease?
  1. ক
    Hyperpigmentation
  2. খ
    Weight gain
  3. গ
    Tachycardia
  4. ঘ
    Moon face
ব্যাখ্যা
Hyperpigmentation (skin and mucous membranes) is a hallmark of Addison’s disease, caused by elevated ACTH stimulating melanocytes. Weight loss (not gain), weakness, and hypotension (not tachycardia) are typical; moon face is seen in Cushing’s.
১৭.
What is a hallmark clinical feature of nephritic syndrome?
  1. ক
    Massive proteinuria (>3.5 g/day)
  2. খ
    Haematuria with dysmorphic red blood cells
  3. গ
    Hyperlipidaemia
  4. ঘ
    Peripheral oedema
ব্যাখ্যা
Nephritic syndrome is characterized by haematuria (often with dysmorphic RBCs), hypertension, and oliguria due to glomerular inflammation. Massive proteinuria and hyperlipidaemia are features of nephrotic syndrome.
১৮.
Which histological pattern is most commonly associated with nephritic syndrome?
  1. ক
    Podocyte effacement
  2. খ
    Crescent formation
  3. গ
    Thickened glomerular basement membrane
  4. ঘ
    Mesangial proliferation
ব্যাখ্যা
Crescent formation in glomeruli is a hallmark of rapidly progressive glomerulonephritis, a severe form of nephritic syndrome. Podocyte effacement is seen in nephrotic syndrome.
১৯.
Which condition is a common cause of nephrotic syndrome in children?
  1. ক
    Membranous nephropathy
  2. খ
    Minimal change disease
  3. গ
    Post-streptococcal glomerulonephritis
  4. ঘ
    Lupus nephritis
ব্যাখ্যা
Minimal change disease is the most common cause of nephrotic syndrome in children, characterized by normal glomeruli on light microscopy but podocyte effacement on electron microscopy.
২০.
Which of the following is intermediate acting insulin?
  1. ক
    Asparte
  2. খ
    Lispro
  3. গ
    Isophane
  4. ঘ
    Detemir
২১.
Which of the following is a common cause of pre-renal AKI?
  1. ক
    Acute tubular necrosis
  2. খ
    Rhabdomyolysis
  3. গ
    Glomerulonephritis
  4. ঘ
    Hypovolaemia
ব্যাখ্যা
Hypovolaemia (e.g., from dehydration or haemorrhage) is a classic cause of pre-renal AKI due to reduced renal perfusion. The others are intrinsic or post-renal causes.
২২.
What is a common complication of severe AKI?
  1. ক
    Hyperkalaemia
  2. খ
    Hypoglycaemia
  3. গ
    Hypercalcaemia
  4. ঘ
    Thrombocytopenia
ব্যাখ্যা
Hyperkalaemia is a life-threatening complication of AKI due to impaired potassium excretion.
২৩.
Which condition is the most common cause of CKD worldwide?
  1. ক
    Polycystic kidney disease
  2. খ
    IgA nephropathy
  3. গ
    Diabetic nephropathy
  4. ঘ
    Lupus nephritis
ব্যাখ্যা
Diabetic nephropathy is the leading cause of CKD globally, driven by the high prevalence of diabetes. The others are less common causes.
২৪.
Which of the following is a potential serious complication of nephrotic syndrome due to the loss of antithrombin III?
  1. ক
    Anemia
  2. খ
    Hyperkalemia
  3. গ
    Thromboembolism
  4. ঘ
    Hypoglycemia
ব্যাখ্যা
Thromboembolism is a significant complication of nephrotic syndrome, largely due to the urinary loss of anticoagulant proteins, particularly antithrombin III, increasing the risk of clots.
২৫.
A pregnant woman in her second trimester presents with asymptomatic bacteriuria. What is the recommended management?
  1. ক
    No treatment, as she is asymptomatic
  2. খ
    Reassurance and follow-up in the third trimester
  3. গ
    Antibiotic treatment
  4. ঘ
    Referral for cystoscopy
ব্যাখ্যা
Asymptomatic bacteriuria in pregnancy should be treated with antibiotics to reduce the risk of symptomatic UTI, pyelonephritis, and potential adverse pregnancy outcomes like preterm labor.
২৬.
Which finding in a urine dipstick is most suggestive of a urinary tract infection?
  1. ক
    Nitrites and leukocyte esterase
  2. খ
    Proteinuria alone
  3. গ
    Hematuria alone
  4. ঘ
    Glucosuria
ব্যাখ্যা
The presence of both nitrites (from bacterial reduction of nitrate) and leukocyte esterase (indicating pyuria) is highly suggestive of UTI.
২৭.
Which is the earliest clinical manifestation of chronic kidney disease?
  1. ক
    Nocturia
  2. খ
    Uremic frost
  3. গ
    Pericarditis
  4. ঘ
    Oliguria
ব্যাখ্যা
Nocturia is often the earliest symptom, due to impaired urine concentrating ability.
২৮.
A 25-year-old man presents with intense nocturnal itching and linear burrows between his fingers. What is the most likely diagnosis?
  1. ক
    Atopic dermatitis
  2. খ
    Psoriasis
  3. গ
    Scabies
  4. ঘ
    Contact dermatitis
ব্যাখ্যা
Burrows + nocturnal pruritus are pathognomonic for scabies (caused by Sarcoptes scabiei mite).
২৯.
A patient with well-demarcated, erythematous plaques with silvery scales on the palm & sole likely has:
  1. ক
    Lichen planus
  2. খ
    Plaque psoriasis
  3. গ
    Pastular psoriasis
  4. ঘ
    Eczema
ব্যাখ্যা

  • Silvery scales on extensor surfaces are classic for psoriasis. Pastular psoriasis occurs in palm & sole.

৩০.
Which of the following is a systemic treatment for severe psoriasis?
  1. ক
    Corticosteroid
  2. খ
    Sulfasalazine
  3. গ
    Hydroxychloroquine
  4. ঘ
    Methotrexate
ব্যাখ্যা

  • Methotrexate is an immunosuppressant for severe psoriasis. It also improves psoriatic arthritis. 

৩১.
A patient develops targetoid lesions on the palms and mucosal erosions after starting sulfonamides. What is the diagnosis?
  1. ক
    Urticaria
  2. খ
    Stevens-Johnson syndrome
  3. গ
    Fixed drug eruption
  4. ঘ
    DRESS syndrome
ব্যাখ্যা

  • Target lesions + mucosal involvement suggest SJS (severe T-cell-mediated hypersensitivity).

  • Urticaria (A) causes wheals, not erosions. Fixed drug eruption (C) recurs at the same site. DRESS (D) has eosinophilia/organ involvement.

৩২.
Which diagnostic test is most specific for confirming pulmonary embolism?
  1. ক
    Chest X-ray
  2. খ
    D-dimer assay
  3. গ
    CT pulmonary angiography (CTPA)
  4. ঘ
    Arterial blood gas
ব্যাখ্যা
CTPA is the gold standard for diagnosing pulmonary embolism, directly visualizing thrombus in pulmonary arteries. D-dimer is sensitive but not specific, and chest X-ray and arterial blood gas are non-specific
৩৩.
What is the most common endogenous cause of Cushing’s syndrome?
  1. ক
    Adrenal adenoma
  2. খ
    Pituitary adenoma
  3. গ
    Ectopic ACTH production
  4. ঘ
    Exogenous steroid use
ব্যাখ্যা
Cushing’s disease (a pituitary ACTH-secreting adenoma) is the most common endogenous cause. However, overall, iatrogenic (exogenous steroids) is most common.
৩৪.
What nail finding is often associated with psoriasis?
  1. ক
    Onychomycosis
  2. খ
    Pitting
  3. গ
    Clubbing
  4. ঘ
    Beau’s lines
ব্যাখ্যা
Nail pitting is a common finding in psoriasis, resulting from defective keratinization in the nail matrix. Other nail changes include onycholysis (nail plate separation), subungual hyperkeratosis, and ridging. Nail involvement is more frequent in patients with psoriatic arthritis.
৩৫.
A patient with lung cancer presents with ptosis, miosis, and anhidrosis. Which syndrome is this?
  1. ক
    Superior vena cava syndrome
  2. খ
    Lambert-Eaton syndrome
  3. গ
    Carcinoid syndrome
  4. ঘ
    Horner’s syndrome
ব্যাখ্যা
Horner’s syndrome results from disruption of the sympathetic pathway, commonly due to a Pancoast tumor (apical lung cancer). This tumor can invade the brachial plexus and cervical sympathetic chain, causing the classic triad: ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating). Its presence points to locally advanced disease, often requiring chemoradiotherapy.
৩৬.
Which of the following findings supports a diagnosis of hospital-acquired pneumonia (HAP)?
  1. ক
    Symptoms onset <24 hours after admission
  2. খ
    Onset ≥48 hours after hospital admission
  3. গ
    Exposure to cold air
  4. ঘ
    Prior tuberculosis infection
ব্যাখ্যা
HAP is defined as pneumonia occurring ≥48 hours after admission, not incubating at admission. It is commonly caused by Gram-negative organisms like Pseudomonas, Klebsiella, and MRSA. These infections are often more resistant to antibiotics and carry higher morbidity. Management requires empiric broad-spectrum antibiotics, adjusted based on culture results.
৩৭.
Addisonian crisis is a medical emergency. Which of the following is part of its immediate management?
  1. ক
    Insulin
  2. খ
    Calcium gluconate
  3. গ
    IV hydrocortisone and fluids
  4. ঘ
    Beta-blockers
ব্যাখ্যা
Acute adrenal crisis presents with hypotension, shock, and electrolyte imbalances. Immediate IV hydrocortisone and isotonic fluids are lifesaving.
৩৮.
A "pink puffer" is typically seen in which condition?
  1. ক
    Bronchiectasis
  2. খ
    Pulmonary fibrosis
  3. গ
    Chronic bronchitis
  4. ঘ
    Emphysema
ব্যাখ্যা
"Pink puffers" have emphysema — they maintain oxygenation but breathe rapidly (puffing) due to reduced alveolar surface area.
৩৯.
Which of the following is the most sensitive test for detecting early diabetic nephropathy?
  1. ক
    Urine microalbumin
  2. খ
    Serum creatinine
  3. গ
    Urine protein dipstick
  4. ঘ
    Renal ultrasound
ব্যাখ্যা

Microalbuminuria is the earliest marker of diabetic nephropathy before overt proteinuria develops.