স্পেশাল বিসিএস (স্বাস্থ্য)

Liquefactive necrosis is seen in abscess

Explanation: Chloroquine- Antimalarial drug, Isoniazid is anti-TB drug

Reference: Davidson 23rd; P-886, box: 22.50

Explanation: Gram-negative bacilli (Escherichia coli, Proteus) and Group B streptococci causes meningitis in neonate

Explanation: The most common cause of ulceration is genital herpes

Stem Breakdown:

Fever, arthritis, and a malar rash: These are classic symptoms of systemic lupus erythematosus (SLE), an autoimmune disease that can affect multiple organs.
Positive ANA and anti-dsDNA antibodies: These antibodies are highly specific for SLE, especially anti-dsDNA, which correlates with disease activity.
Option Analysis:

A) Rheumatoid arthritis: Rheumatoid arthritis primarily causes symmetric polyarthritis, particularly affecting the small joints of the hands and feet. It is not typically associated with a malar rash or positive anti-dsDNA antibodies.
B) Systemic lupus erythematosus (SLE): This is the correct diagnosis. Davidson and Harrison both emphasise that SLE is a systemic autoimmune disease characterised by a wide range of clinical features, including the malar (butterfly) rash, arthritis, renal involvement, and positive ANA and anti-dsDNA antibodies.
C) Dermatomyositis: Dermatomyositis is an inflammatory myopathy that causes muscle weakness and characteristic skin findings (e.g., heliotrope rash, Gottron’s papules), but it does not cause the malar rash or positive anti-dsDNA antibodies seen in SLE.
D) Sjögren’s syndrome: Sjögren’s syndrome is characterised by dry eyes and dry mouth due to autoimmune destruction of the salivary and lacrimal glands. It does not typically present with a malar rash or positive anti-dsDNA antibodies.

Reference: Langman’s 13th; P-42

Explanation: Some added sounds are physiological but may also occur in pathological conditions; for example, a third sound is common in young people and in pregnancy but is also a feature of heart failure
Davidson 23rd, Box-16.8

Explanation: Acute coronary syndrome is a term that encompasses both unstable angina and myocardial infarction

Explanation :
Non enveloped DNA virus :

Parbo virus B19
Papilloma virus
Adeno virus

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

Explanation: Lithium, Valproate, Lamotrigine are mood-stabilising drgus

Explanation: Osteoblasts are responsible for bone formation

Explanation: ANA is 100% sensitive for Systemic lupus erythematosus, Autoimmune hepatitis and Mixed connective tissue disease

Explanation: Gout is the most common inflammatory arthritis in men and in older women. It is caused by deposition of monosodium urate monohydrate crystals in and around synovial joints.

[Robbins 9th 98]

[Ganong 24th p-565]

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.

Explanation: Iron deficiency anaemia is the most common type of anaemia worldwide. A thorough gastrointestinal history is important, looking in particular for symptoms of blood loss. Menorrhagia is a common cause of anaemia in pre-menopausal females, so women should always be asked about their periods

কোন ব্যাখ্যা যোগ হয় নি।

Explanation: According to forensic guidelines in Reddy and standard protocols, teeth (pulp) are excellent sources of DNA in decomposed bodies.

Teeth are known for their high resistance to the most extreme temperature variations thanks to the presence of their external enamel, which protects the nucleic acids of the dental pulp, which is rich in cells and blood and is more stable and persistent than many other tissues of the organism

Explanation: Lumbar puncture is mandatory unless there are contraindications in a patient of meningitis

Haemorrhagic disease of the newborn: Haemorrhagic disease of the newborn: enzyme-inducing antiepileptic drugs increase risk. Give IM vitamin K (1 mg) to the infant at birth.

Explanation: Causes of Right iliac fossa mass are: Caecal carcinoma, Crohn’s disease & Appendix abscess

Interstitial fluid is three-fourths of the ECF. Thus, it is one-fourth of TBW. The composition of interstitial fluid is the same as that of plasma except that it has little protein. Thus, interstitial fluid is an ultrafiltrate of plasma.

Aplastic anaemia is characterized by pancytopenia and a hypocellular marrow. Often idiopathic or drug-induced.

Crista terminalis (an internal muscular ridge 3- to 6-mm thick), which marks the junction between the trabeculated part and smooth part of the right atrium

Explanation: Staph. aureus has now overtaken streptococci as the most common cause of acute endocarditis

Drug causing hepatitis -
Isoniazide
Rifampicin
NSAID
Co-amoxiclav
Chrorpromazine
Statins

Most of the cells contain single nucleus except-
– RBCs and platelets do not have nuclei
– Striated muscle cells are multinucleated
– Few hepatocytes and transitional epithelial cells are binucleated

*** Normoblasts have nucleus, after this stage, they loss their nuclei to become reticulocytes, and the mature RBCs. 

Reference: Davidson 23rd: Box-17.12

[Guyton 13th p-65]

Anaemia occurs in kala-azar due to hypersplenism

Explanation -
Localized edema is generally due to cellulitis, chronic venous insufficiency, deep vein thrombosis, lymphedema, or May-Thurner syndrome. 

Osteoarthritis is primarily a disease of articular cartilage, characterized by progressive cartilage degradation, loss, and fibrillation. This is accompanied by subchondral bone remodeling, osteophyte formation, and mild synovial inflammation.

Intercalated discs join the membrane of one cardiac cell with its neighbour and promote rapid conduction of depolarisation between cells.

Reference: Davidson 23rd; P-145
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-533
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Management
The aims of management are to relieve symptoms, induce healing and prevent recurrence. H. pylori eradication is the cornerstone of therapy for peptic ulcers, as this will successfully prevent relapse and eliminate the need for long-term therapy in the majority of patients.

Page-814

Anosmia refers to total loss of sensation of smell, i.e., inability to recognize or detect any odor.

Activation of complement in any pathways results in activation of C3.

With renin low and aldosterone high (primary hyperaldosteronism)
·         Adrenal adenoma secreting aldosterone (Conn's syndrome)
·         Idiopathic bilateral adrenal hyperplasia
·         Glucocorticoid-suppressible hyperaldosteronism (rare)

Blood culture establishes the diagnosis  and multiple cultures increase the yield
^{Stool cultures are often positive in  the  second and third weeks}
The Widal test detects antibodies to the O  and H antigens but is not specific

Reference: Practical Manual in Clinical Medicine by ABM Abdullah Sir; P-797

Explanation: A single dose of albendazole (400 mg) is the treatment of choice. Alternatively, mebendazole 100 mg twice daily for 3 days may be used.

Explanation -
Extraarticular features of reactive arthritis -
Circinate balanitis
Keratoderma blennorrhagica
Nail dystrophy
Buccal erosions

The fossa ovalis is the slight depression that remains when the foramen ovale closes.

Sertoli cells
1.       Inhibin
2.       Androgen-binding protein (ABP)
3.       Mullerian inhibiting substance (MIS)
4.       Estrogen

T

Anorexia, nausea, vomiting–acute viral hepatitis, may be drug induced hepatitis.
Itching with pale or dark pale stool–obstructive jaundice.
Long standing jaundice with itching, pigmentation of skin–primary biliary cirrhosis.

Acute tubular necrosis  is most commonly due to renal ischaemia, as in this case, though direct pharmacological toxicity can also be the cause among many others including haemorrhage, diuretics, contrast during radiological procedures and heart failure. The clinical course is dependent on the offending factor and degree of damage but most commonly early oliguria followed by recovery of renal function with an increase in renal output. GFR, however, may remain low due to tubular damage. Full renal capacity is usually regained within 6 weeks of the initial stressor. Haemolytic uraemic syndrome (HUS) (A) defines the acute injury to the kidney from RBC fragmentation which usually originates from thrombosis within arteries. HUS is therefore the triad of microangiopathic haemolysis, thrombocytopenia

Explanation :
Payhological cause of palpitation :
Atrial fibrillation
SVT
Ventricular extrasystole
Atrial extrasyatole
Dropped beats
Thyrotoxicosis

Anti HBs is positive in immunized people without infection?