১.
Which of the following is most typical of irritable bowel syndrome?
ব্যাখ্যা
IBS is a functional disorder with abdominal discomfort that improves post-defecation. No alarm features like bleeding or weight loss.
৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]
মোট প্রশ্ন৪০
সিলেবাস
Exam - 3
Medicine-03
1. Diseases of the gastrointestinal tract:
· Peptic ulcer disease and non-ulcer dyspepsia
· Malabsorption syndrome
· Irritable bowel syndrome and inflammatory bowel disease
· Acute viral hepatitis and chronic hepatitis
· Abdominal tuberculosis
2. Pancreatic Disease
Acute pancreatitis
Chronic pancreatitis
3. Liver and Biliary Tract Disease
Viral hepatitis
Chronic liver disease
Cirrhosis of liver
Carcinoma liver
Liver abscess
4. Diseases of the Blood
Anaemia: iron deficiency
Common haemolytic anaemia (Thalassemia and acquired haemolytic anaemia)
Common bleeding disorders (Thrombocytopenia and haemophilia)
Agranulocytosis and aplastic anaemia
Leukaemias: Acute and chronic
Lymphomas
Multiple myelomas
Blood transfusion
৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]
৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived] · তারিখ অনির্ধারিত · ৪০ প্রশ্ন
২.
Which of the following is most specific to ulcerative colitis?
ব্যাখ্যা
UC typically involves continuous inflammation starting from the rectum, unlike Crohn’s disease which has skip lesions and can affect any GI segment.
৩.
Best indicator of acute Hepatitis B infection?
ব্যাখ্যা
IgM anti-HBc indicates acute or recent infection. HBsAg shows current infection but doesn’t differentiate acute from chronic.
৪.
Most common cause of acute pancreatitis-
ব্যাখ্যা
Gallstones and alcohol account for the majority of acute pancreatitis cases. Gallstones are more common in females.
৫.
A key feature of chronic pancreatitis is:
ব্যাখ্যা
Chronic inflammation leads to fibrosis and calcification. Pain is chronic and may lead to exocrine and endocrine insufficiency
৬.
Most accurate test for exocrine pancreatic insufficiency:
ব্যাখ্যা
Faecal elastase is a sensitive non-invasive test for pancreatic enzyme output. Low values indicate exocrine insufficiency.
৭.
Which of the following is a hallmark sign of obstructive jaundice?
ব্যাখ্যা
In obstructive (post-hepatic) jaundice, conjugated bilirubin cannot reach the intestine, leading to pale stools and is excreted in urine, causing dark discoloration.
৮.
Which type of hepatitis virus is most commonly transmitted through contaminated food or water?
ব্যাখ্যা
HAV and HEV are transmitted via the faeco-oral route, especially in areas with poor sanitation.
৯.
Which marker indicates immunity due to past HBV infection?
ব্যাখ্যা
Anti-HBs indicates recovery and immunity. HBsAg indicates current infection, and anti-HBc IgM suggests acute infection.
১০.
Which vitamin deficiency is commonly seen in chronic liver disease due to fat malabsorption?
ব্যাখ্যা
Chronic liver disease can lead to impaired bile production and fat-soluble vitamin (A, D, E, K) malabsorption. Vitamin K deficiency can cause coagulopathy.
১১.
Spider naevi in chronic liver disease are due to:
ব্যাখ্যা
Chronic liver disease reduces hepatic clearance of estrogen, leading to features like spider naevi, gynecomastia, and palmar erythema.
১২.
Which is a major complication of portal hypertension in cirrhosis?
ব্যাখ্যা
Portal hypertension leads to collateral formation, especially esophageal varices, which can bleed massively
১৩.
Most important risk factor for hepatocellular carcinoma (HCC) worldwide
ব্যাখ্যা
HBV is a major cause of HCC, especially in endemic regions. Cirrhosis of any cause increases HCC risk.
১৪.
Tumor marker most commonly associated with hepatocellular carcinoma:
ব্যাখ্যা
AFP is elevated in up to 70% of patients with HCC and used as a screening and diagnostic tool.
১৫.
Most common organism in pyogenic liver abscess:
ব্যাখ্যা
Pyogenic liver abscesses are often polymicrobial, with E. coli and Klebsiella among the most common.
১৬.
Which lab finding best confirms iron deficiency?
ব্যাখ্যা
Ferritin reflects iron stores; low levels confirm iron deficiency. Note: ferritin is also an acute phase reactant and may be falsely elevated in inflammation.
১৭.
Which test confirms autoimmune haemolytic anaemia?
ব্যাখ্যা
The direct antiglobulin (Coombs) test detects antibodies attached to RBCs, confirming autoimmune hemolysis.
১৮.
A child presents with hemarthrosis. What is the most likely diagnosis?
ব্যাখ্যা
Haemophilia A (factor VIII deficiency) typically causes deep bleeds into joints and muscles.
১৯.
Most serious complication of agranulocytosis:
ব্যাখ্যা
Neutropenia leaves patients vulnerable to severe bacterial and fungal infections.
২০.
Pancytopenia with hypocellular bone marrow suggests:
ব্যাখ্যা
Aplastic anaemia is characterized by pancytopenia and a hypocellular marrow. Often idiopathic or drug-induced.
২১.
The most common childhood leukemia is:
ব্যাখ্যা
ALL peaks between ages 2–5 and presents with anemia, thrombocytopenia, and lymphadenopathy.
২২.
Which marker is typically positive in chronic myeloid leukemia (CML)?
ব্যাখ্যা
The BCR-ABL fusion gene (t(9;22)) is diagnostic of CML and is the target of tyrosine kinase inhibitors like imatinib.
২৩.
Reed–Sternberg cells are characteristic of:
ব্যাখ্যা
Reed–Sternberg cells (giant binucleate cells) are pathognomonic for Hodgkin lymphoma.
২৪.
Which is a common complication of multiple myeloma?
ব্যাখ্যা
Myeloma kidney results from light chain deposition, hypercalcemia, and hyperuricemia.
২৫.
A pathognomonic feature of Crohn’s disease is:
ব্যাখ্যা
Crohn’s shows skip lesions, cobblestoning, and non-caseating granulomas.
২৬.
The most common cause of IDA in adults is:
ব্যাখ্যা
GI bleeding (e.g., ulcers, colon cancer) or menstrual loss are primary causes.
২৭.
First-line treatment for hepatic encephalopathy includes:
ব্যাখ্যা
Lactulose reduces ammonia absorption via colonic acidification.
২৮.
Which lab finding best supports a diagnosis of Idiopathic Thrombocytopenic Purpura (ITP) in a patient presenting with petechiae and bruising?
ব্যাখ্যা
: ITP is an autoimmune disorder characterized by isolated thrombocytopenia due to increased platelet destruction and/or impaired platelet production. The hallmark lab finding is a significantly low platelet count (often below 100,000/µL, and sometimes below 20,000/µL), while other cell lines (red blood cells and white blood cells) remain normal. Options a, c, and d are more indicative of other conditions: elevated PT/PTT suggests coagulation factor deficiencies, schistocytes suggest microangiopathic hemolytic anemia, and a positive direct Coombs test indicates autoimmune hemolytic anemia.
২৯.
Which lab finding would provide the strongest evidence for a hemolytic anemia?
ব্যাখ্যা
Hemolytic anemia is characterized by premature destruction of red blood cells. Haptoglobin is a protein that binds to free hemoglobin released during red blood cell destruction.
৩০.
Which laboratory finding is most indicative of hemolytic anemia?
ব্যাখ্যা
Hemolytic anemia is characterized by increased red blood cell destruction, leading to low hemoglobin (anemia) and a compensatory increase in reticulocytes (immature red blood cells) due to bone marrow response.
৩১.
A hallmark characteristic of megaloblastic anemia is:
ব্যাখ্যা
Megaloblastic anemia is primarily caused by impaired DNA synthesis, most commonly due to vitamin B12 or folate deficiency. This leads to ineffective erythropoiesis and the presence of abnormally large red blood cell precursors (megaloblasts) in the bone marrow. A key peripheral blood smear finding is hypersegmented neutrophils (five or more lobes), which are characteristic of defective nuclear maturation in granulocytes.
৩২.
Which of the following is a common neurological manifestation of vitamin B12 deficiency in megaloblastic anemia?
ব্যাখ্যা
While both vitamin B12 and folate deficiencies cause megaloblastic anemia, only vitamin B12 deficiency typically leads to neurological symptoms. These can include peripheral neuropathy, subacute combined degeneration of the spinal cord (affecting posterior and lateral columns), paresthesias, gait disturbances, and even cognitive impairment. Folate deficiency does not cause these specific neurological issues.
৩৩.
Which of the following is a common clinical presentation in a patient with severe aplastic anemia?
ব্যাখ্যা
Due to severe neutropenia (a component of pancytopenia), patients with aplastic anemia are highly susceptible to infections, which can be life-threatening. Anemia leads to fatigue and pallor, while thrombocytopenia causes bleeding tendencies (e.g., petechiae, ecchymoses, mucosal bleeding).
৩৪.
A key feature often observed in abdominal tuberculosis is:
ব্যাখ্যা
Abdominal tuberculosis (TB) can affect any part of the gastrointestinal tract, peritoneum, mesentery, or abdominal lymph nodes. A "doughy" abdomen on palpation, often with tenderness, is a classical but not always present sign, particularly in peritoneal TB due to thickened omentum and adhesions. Other common features include chronic abdominal pain, weight loss, fever, and ascites.
৩৫.
A common manifestation indicating the progression of chronic liver disease to decompensation is:
ব্যাখ্যা
Chronic liver disease (CLD) is a broad term encompassing various conditions leading to progressive liver damage. Decompensation signifies the failure of the liver to perform its essential functions, often leading to complications like ascites, hepatic encephalopathy, variceal bleeding, and spontaneous bacterial peritonitis (SBP). SBP is an infection of the ascitic fluid and is a serious complication of advanced CLD with ascites.
৩৬.
অনির্ধারিতWhich of the following laboratory findings is most indicative of synthetic dysfunction in chronic liver disease?
ব্যাখ্যা
সঠিক উত্তর: Increased prothrombin time
অপশন খ) - এর Decreased-এর পরিবর্তে Increased হলে এটা সঠিক উত্তর হতো।
লাইভ পরীক্ষায় সঠিক উত্তর না থাকায় উত্তর বাতিল করা হয়েছে।
⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯
The liver synthesizes various proteins, including clotting factors (prothrombin). In CLD, impaired synthesis of clotting factors leads to a prolonged prothrombin time (PT) or elevated international normalized ratio (INR), indicating synthetic dysfunction and an increased risk of bleeding.
Albumin synthesis is also impaired, leading to hypoalbuminemia, but PT/INR is a more sensitive and earlier indicator of acute synthetic impairment.
অপশন খ) - এর Decreased-এর পরিবর্তে Increased হলে এটা সঠিক উত্তর হতো।
লাইভ পরীক্ষায় সঠিক উত্তর না থাকায় উত্তর বাতিল করা হয়েছে।
⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯
The liver synthesizes various proteins, including clotting factors (prothrombin). In CLD, impaired synthesis of clotting factors leads to a prolonged prothrombin time (PT) or elevated international normalized ratio (INR), indicating synthetic dysfunction and an increased risk of bleeding.
Albumin synthesis is also impaired, leading to hypoalbuminemia, but PT/INR is a more sensitive and earlier indicator of acute synthetic impairment.
৩৭.
The primary characteristic of leukemia is:
ব্যাখ্যা
Leukemia is a group of cancers affecting the blood-forming tissues, primarily the bone marrow. It is characterized by the uncontrolled proliferation of abnormal, immature white blood cells (blasts) that accumulate in the bone marrow, peripheral blood, and sometimes other organs, impairing the production of normal blood cells.
৩৮.
Which of the following is a frequent cause of pyogenic liver abscesses?
ব্যাখ্যা
Pyogenic liver abscesses are most commonly caused by ascending infection from the biliary tract (e.g., cholangitis, gallstones obstructing bile ducts), portal vein pylephlebitis from intra-abdominal infections (e.g., appendicitis, diverticulitis), or hematogenous spread from systemic infections. Amoebic liver abscesses are caused by Entamoeba histolytica but are less common than pyogenic abscesses in many parts of the world.
৩৯.
Which of the following clinical pentad components is characteristic of TTP, although not always fully present?
ব্যাখ্যা
The classic pentad of TTP includes: 1) microangiopathic hemolytic anemia (MAHA), 2) thrombocytopenia, 3) neurological abnormalities (e.g., headache, confusion, seizures, stroke), 4) renal impairment, and 5) fever. While the full pentad is not always observed, MAHA and thrombocytopenia are almost universally present.
৪০.
A central pathophysiological event in Disseminated Intravascular Coagulation is:
ব্যাখ্যা
DIC is a complex, acquired disorder characterized by systemic activation of blood coagulation, leading to widespread fibrin formation in the microvasculature. This results in both consumptive coagulopathy (depletion of clotting factors and platelets) and secondary fibrinolysis, manifesting clinically as both thrombosis and bleeding.