স্পেশাল বিসিএস (স্বাস্থ্য)

Reference: Davidson 23rd , Page : 505

Explanations:
Platelet has no nucleus.

P. vivax and P. ovale may persist in liver cells as  dormant form hypnozoites capable of developing  into merozoites months or years later
Thus the first attack of clinical malaria may occur  long after the patient has left the endemic area, and  the disease may relapse after treatment with drugs  that only kill the erythrocytic stage of the parasite
P. falciparum, P. knowlesi and P. malariae have no  persistent exoerythrocytic phase but recrudescence  of fever may result from multiplication of parasites  in red cells that have not been eliminated by  treatment and immune processes

Hypoparathyroidism leads to hypocalcemia, by decreasing the resorption of calcium from bones. Hypocalcemia causes neuromuscular hyperexcitability, resulting in hypocalcemic tetany. Normally, tetany occurs when plasma calcium level falls below 6 mg/dL from its normal value of 9.4 mg/dL.

Hypokalemia occurs in Conn's syndrome

Loss of ankle jerk with extensor planter response
•       Subacute combined degeneration of spinal cord
•        Friedreich’s ataxia
•       Taboparesis
•       Multiple sclerosis
•       DM with cervical myelopathy.

Aldosterone is produced in the zona glomerulosa of the adrenal cortex because that layer contains the enzyme for conversion of corticosterone to aldosterone (aldosterone synthase). Cortisol is produced in the zona fasciculata. Androstenedione and dehydroepiandrosterone are produced in the zona reticularis. Testosterone is produced in the testes, not in the adrenal cortex.

Insulin is major anabolic hormone of the body

Explanation -
Bilateral planter extension found in- structural lesions such as hemorrhage, brain and spinal cord tumors, and multiple sclerosis, and in abnormal metabolic states such as hypoglycemia, hypoxia, and anesthesia,infection - meningitis,encephalitis.

Mode of Transmission-Sexually from partner, Neonate  exposed to infected secretions in birth canal

Nocturia is often the earliest symptom, due to impaired urine concentrating ability.

Explanation : NGF plays an important role in treating many nervous disorders such as Alzheimer disease, neuron degeneration in aging and neuron regeneration in spinal cord injury. Commercial preparation of Brain-derived Neurotrophic Growth Factor is used to treat motor neuron diseases.
GDNF is found in neuroglial cells. It has a potent protective action on dopaminergic neurons. It is used for the treatment of Parkinson disease.
CNTF is secreted in peripheral nerves, ocular muscles and cardiac muscle. It protects neurons of ciliary ganglion and motor neurons.
Ref : Sembulingam 6th edition (Page- 763)

Composition
FFP contains labile as well as stable components of the coagulation, fibrinolytic and complement systems, the protiens that maintain oncotic pressure and modulate immunity.
In addition fats, carbohydrates and minerals are present in concentrations similar to circulation.
The analysis of 35 samples of FFP show mean concentrations of of 535mg/dl Glucose, 172mEq/L. Na+, 73mEq/L Cl-, Cl-, 3.5mEq/Lk 3.5mEq/L. K+, 15mEq/L HCO3-and  protien with 60% albumin. 5-5g/dl
Thus FFP is a hyperosmolal, hyperglycemic, hypernatremic and hypochloremic solution.
It is a less effective volume expander than other albumin containing solutions, due to its lower albumin content.

Indications
Multiple coagulation factor deficiencies e.g.
DIC
Massive blood transfusion
Liver disease
Active or ongoing bleeding with abnormal coagulation tests
"Thrombotic thrombocytopaenic purpura
Vitamin K deficiency associated with active bleeding

Thiazide diuretics have a unique effect on the distal tubule; they increase Ca2+ reabsorption, thereby decreasing Ca2+ excretion and clearance. Because parathyroid hormone (PTH) increases Ca2+ reabsorption, the lack of PTH will cause an increase in Ca2+ clearance. Furosemide inhibits Na+ reabsorption in the thick ascending limb, and extracellular fluid (ECF) volume expansion inhibits Na+ reabsorption in the proximal tubule. At these sites, Ca2+ reabsorption is linked to Na+ reabsorption, and Ca2+ clearance would be increased. Because Mg2+ competes with Ca2+ for reabsorption in the thick ascending limb, hypermagnesemia will cause increased Ca2+ clearance.

Testes in male & ovary in female

The term basal nucleus is applied to a collection of masses of Gray matter situated within each cerebral hemisphere. They are the corpus striatum, the amygdaloid nucleus, and the claustrum.

Aquaporin-1 is localized to both the basolateral and apical membrane of the proximal tubules and its presence allows water to move rapidly out of the tubule along the osmotic gradients set up by active transport of solutes, and isotonicity is maintained. 60-70% of filtered water is reabsorbed in PCT.

The acetylcholine-gated channel has a diameter of about 0.65 nanometer, which is large enough to allow the important positive ions-sodium (Na+), potassium (K+), and calcium (Ca2+)-to move easily through the opening. Patch clamp studies have shown that one of these channels, when opened by acetylcholine, can transmit 15,000 to 30,000 sodium ions in 1 millisecond. Conversely, negative ions, such as chloride ions, do not pass through because of strong negative charges in the mouth of the channel that repel these negative ions.

Human papilloma virus is responsible for carcinoma of cervix

Reference: Davidson 23rd , Page : 516
Explanation : The most common major manifestation of rheumatic fever is arthritis.

Explanation -
 A mnemonic to remember some of the cerebellar signs is DANISH.
Dysdiadokinesia / dysmetria.
Ataxia.
Nystagmus.
Intention tremor.
Speech - slurred or scanning.
Hypotonia.

Explanations:
The time required for coagulation to take place is known as the prothrombin time. The shortness of the time is determined mainly by the prothrombin concentration. The normal prothrombin time is about 12 seconds.

Explanation: Escherichia coli and various streptococci, particularly Strep. milleri, are the most common organisms

Ref. Robbins 9th p-34

Explanation: Fever with Severe headache and photophobia, neck stiffnss usually suggestive of meningitis

Headache indicates pituitary cause of weight gain.

Hepatic acini distributes nutrients and act as metabolic unit of liver.

Reference: Davidson 23rd; P-801

Explanation:
Pulses bigeminy: This is due to premature ectopic beats following every sinus beat. The pulse rhythm is not regular because every weak pulse is premature.

o   Explanation: A witness declared hostile may be cross-examined by the party who called them. (Ref: Legal Glossary)

Feature of anaplastic tumour is pleomorphism

Visceral striated muscles:
These are microscopically identical to the skeletal muscles, but they are confined to the viscera such as tongue, pharynx, peripheral part of the  diaphragm, and upper two third of esophagus.

The first meiotic division reduces the chromosome number (Reductional division), but the DNA amount is unchanged (2n)

The second meiotic division reduces the DNA amount (n), but the chromosome number is unchanged (Equatorial division)

Myeloma kidney results from light chain deposition, hypercalcemia, and hyperuricemia.

Explanation: Chronic kidney disease (CKD) refers to an irreversible deterioration in renal function that usually develops over a period of years Initially, it manifests only as a biochemical abnormality but, eventually, loss of the excretory, metabolic and endocrine functions of the kidney leads to the clinical symptoms and signs of renal failure, collectively referred to as uraemia

Effects of low ionized Ca2+
1.  Increased excitability of nerve & muscles.
2.  Increased membrane permeability
3.  Impaired blood clotting
4.  Tetany
5.  Rickets (in children)
6.  Osteomalacia (In adult)

[Ganong 24th p-524]

Ankylosing spondylitis is an inflammatory spondyloarthropathy affecting young males, presenting with back pain that improves with activity, and is associated with HLA-B27.

Explanations: Agglutinogens are present on RBC membrane & agglutinins are present on serum.

Whipple’s triad confirmed
Patient had symptoms of hypoglycaemia
Low blood glucose measured at the time of symptoms
Symptoms resolved on correction of hypoglycaemia

Posttranslational modifications of proteins take place in Golgi complex

Presbycusis is age related hearing impairment.

Explanation: Tests for ACPA are positive in about 70% of cases and are highly specific for RA, occurring in many patients before clinical onset of the disease

The clinical features here are of fever in a patient at high risk of neutropenia. This is an oncological emergency. Patients are at risk of neutropenia at any point during their systemic anti-cancer therapy treatment cycle, with the highest risk typically 10–14 days after a treatment. In patients with potential neutropenic sepsis high-dose broad spectrum intravenous antibiotics should be commenced, ideally within 1 hour of admission, without awaiting test results. In this  should not delay the first dose of antibiotic therapy. Test results may later inform changes to antimicrobial therapy and its duration.

Reference: Davidson 23rd; P-676

According to Davidson, diabetic nephropathy is the most typical cause of nephrotic syndrome in adults. Diabetic nephropathy leads to glomerular damage resulting in proteinuria, hypoalbuminemia, and edoema. Harrison emphasises that strict control of blood sugar and blood pressure can help slow the progression of diabetic nephropathy and reduce the risk of end-stage renal disease.

Explanation: Prolactin is the hormone that stimulates milk production in the mammary glands. Davidson explains that prolactin levels rise during pregnancy and after childbirth, promoting lactation. Harrison adds that oxytocin is responsible for milk ejection, but prolactin is key to maintaining milk production.

Explanation: among Asians, BMI > 23.0 is overweight and > 25.0 is obese.

Xerostomia means dry mouth. It is also called pasties or cottonmouth. It is due to hyposalivation or absence of salivary secretion (aptyalism).

Complement acting as opsonin is C3b

Reference: Davidson 23rd; P-137

The H+/monocarboxylate cotransporter (MCT) recognizes monocarboxylates such as lactate, pyruvate, acetoacetate, and β-hydroxybutyrate. It is a proton-driven transporter with a coupling stoichiometry of 1 H+ : 1 monocarboxylate and, thus, MCT is an electroneutral transporter (Fig. 4). The direction of transport is governed by the prevailing proton gradient.

Rose spots (blanching pink macules on the trunk) are classic but rare.

Koplik’s spots - Measles

Osler’s nodes & Janeway lesions - Infective endocarditis

Explanation :
IgM -
Immunoglobulin of primary immune response 
Responsible for type II & Type III hypersensitivity
Acts a antigen receptor on B cell
Its a polymeric / pentameric form containing J chain
Highest molecular weight

Pain Initiators
• Glutamate - Central
• Substance P - Central
• Brandykinin - Peripheral
• Prostaglandins - Peripheral
• Aspartate
Pain Inhibitors
• Serotonin
• Endorphins
• Enkephalins
• Dynorphin
• GABA
• Glycine

With renin high and aldosterone high (secondary hyperaldosteronism)
• Inadequate renal perfusion, e.g. diuretic therapy, cardiac failure, liver failure, nephrotic syndrome, renal artery stenosis.
• Renin-secreting renal tumor (very rare)

Hypoxia (decreased level of oxygen in blood) stimulates kidney to secrete EPO.