স্পেশাল বিসিএস (স্বাস্থ্য)

The function of the parasympathetic system is to conserve and restore energy. The heart rate is slowed, pupils are constricted, peristalsis and glandular activity is increased, and the bladder walls are contracted.

• Diagnosis rests on microscopic examination of blood, using both thick and thin Giemsa-stained smears.
• The thick smear is used to screen for the presence of organisms, and the thin smear is used for species identification.

During the relative ascent of the kidneys in fetal development, the kidneys rotate 90 degrees medially so that the renal hilus is normally orientated in a medial direction.

The Chief Justice and Supreme Court of Bangladesh do indeed hold administrative control over subordinate courts, including the appointment of judicial officers like Sessions Judges. 
Administrative Control:
The Supreme Court, through its High Court Division, exercises superintendence and control over all courts and tribunals subordinate to it. This includes overseeing the administration, functioning, and discipline of these courts. 
Appointments and Transfers:
The President of Bangladesh, while making appointments, consults the Chief Justice and the Supreme Court. This ensures that judicial appointments are made in accordance with the judicial system's requirements and recommendations. 
Supreme Judicial Council:
The Supreme Judicial Council (SJC) is responsible for maintaining ethical and professional standards among judges, including those in subordinate courts. It plays a crucial role in maintaining judicial integrity and accountability. 
Judicial Independence:
The judiciary, including the Supreme Court, plays a vital role in upholding the rule of law and ensuring judicial independence, which is essential for a fair and effective justice system.

Explanation: Hypothermia exists when the body’s normal thermal regulatory mechanisms are unable to maintain heat in a cold environment and core temperature falls below 35°C

Explanation: CT is is the first line investigation of stroke

Explanation: Streptococcus pneumoniae or pneumococcus is the most common cause of acute community-acquired pneumonia.

[Robbins 9th 90]

Reference: Guyton 14th; P- 501

Hypertrophy usually occurs in non-dividing cell

Explanation: Confidentiality and chain of custody must be maintained; thus only legal routes are permitted. (Ref: Reddy, Medical Law Practice)

Hyperkalaemia is a life-threatening complication of AKI due to impaired potassium excretion.

The “no-reflow” phenomenon refers to the inability to reperfuse myocardial tissue despite the reopening of the infarct-related artery. No-reflow often happens in acute myocardial infarction patients during primary percutaneous coronary intervention (PCI), which has a strong negative impact on clinical outcome, negating the potential benefit of primary PCI. No-reflow is associated with a higher rate of mortality and early postinfarction complications.

Reference: Davidson 23rd; P-800

Explanation-
★ Growth hormone is secreted in pulsatile fashion, with a large burst occurring during deep sleep (sleep stage 3 or 4). Growth hormone secretion is increased by sleep, stress, puberty, starvation, and hypoglycemia. Somatomedins are generated when growth hormone acts on its target tissues; they inhibit growth hormone secretion by the anterior pituitary, both directly and indirectly (by stimulating somatostatin release).
Reference-Guyton & Hall/13rd/P-927 & BRS physiology/6th/P-234

Autosomal Recessive Disorders
• They make up the largest group of Mendelian disorders.
• Manifested in the homozygous state. They occur when both of the alleles at a given gene locus are mutants
• The trait does not usually affect the parents
• Both the parents are carriers
• Siblings have one chance in four of being affected (i.e., the recurrence risk is 25% for each birth);
• May be result of a consanguineous marriage.
•The expression of the defect tends to be more uniform than in autosomal dominant disorders.
• Complete penetrance is common
• Onset is frequently early in life.
• In many cases, enzymes are affected by the mutation (Metabolic abnormalities).

Autosomal Dominant Disorders
• Disorders of autosomal dominant inheritance are manifested in the heterozygous state, so at least one parent in an index case usually is affected.
• Both males and females can be affected
• Both sexes can transmit the condition.
• When an affected person marries an unaffected one, each child has one chance in two of having the disease (50%).
• New mutation can occur
• Variable expressivity
• The age of onset is delayed
• Vertical transmission (consecutive generations are affected)
• No carrier state
• Father-son transmission possible
• Condition usually less severe than autosomal recessive
• Usually associated with structural abnormalities

Cyst of E. Histolytica is found in stool

“Selective” loss of albumin is seen in minimal change disease. Diabetes & FSGS lead to “nonselective” loss of all plasma proteins. Hypertension, CRF cause increased tubular protein loss.

Interstitial fluid volume is measured indirectly by determining the difference between extracellular fluid (ECF) volume and plasma volume. Inulin, a large fructose polymer that is restricted to the extracellular space, is a marker for ECF volume. Radioactive albumin is a marker for plasma volume.

[Ref. BD Chaurasia Vol.3] 

Left gastric artery lies in lesser omentum.

Collections of neuronal cell bodies (somata) outside the central nervous system is Ganglia & inside CNS is Nuclei.

Flagella formation is not a part of spermiogenesis.

Hazards in mismatched blood transfusion / ABO/Rh incompatibility
 
A. Immediate effects:
1. Acute hemolytic reaction 
2. Shivering and restlessness
3. Nausea and vomiting 
4. Chest pain and back pain
5. Heart/respiratory rate- increased
6. Blood pressure- decreased
7. Shock

Explanation -
Common metabolic causes of coma :
Hypoglycemia 
Hyperosmolar nonketotic coma
Diabetic ketoacidosis
Hyponatremia
Uremic coma
Hepatic encephalopathy 

Stem Breakdown:

Chronic diarrhoea, weight loss, and iron deficiency anaemia: These symptoms are indicative of malabsorption, which is a hallmark of coeliac disease.
Pruritic, blistering rash on elbows and knees: This describes dermatitis herpetiformis, a skin manifestation of coeliac disease.
Option Analysis:

A) Coeliac disease: This is the correct diagnosis. Davidson and Harrison explain that coeliac disease is an autoimmune disorder triggered by gluten ingestion, leading to small intestinal damage and malabsorption. Chronic diarrhoea, weight loss, and iron deficiency anaemia are common presentations. Dermatitis herpetiformis, a pruritic vesicular rash, is pathognomonic for coeliac disease.
B) Crohn’s disease: Crohn's disease can cause chronic diarrhoea and weight loss, but it typically presents with other features such as abdominal pain, perianal disease, or fistulas. Additionally, dermatitis herpetiformis is not associated with Crohn’s disease.
C) Ulcerative colitis: Ulcerative colitis primarily affects the colon, causing bloody diarrhoea and abdominal pain. It does not cause malabsorption or dermatitis herpetiformis.
D) Irritable bowel syndrome (IBS): IBS is a functional gastrointestinal disorder characterised by abdominal pain and altered bowel habits, but it does not cause malabsorption, weight loss, or iron deficiency anaemia.

Total body water (TBW) is approximately 60% of body weight. Body water is inversely proportional to body fat. The percentage of TBW is highest in newborns then in adult males and lowest in adult females and in adults with a large amount of adipose tissue.

In Addison’s disease there is hyposecretion of cortisol.

Cells that form the three primitive germ layers are derived from the – Epiblast

GI bleeding (e.g., ulcers, colon cancer) or menstrual loss are primary causes.

Reference: Davidson 23rd, Page: 644, Box : 18.14

The adherence and attachment of blastocyst to the endometrium is referred to as implantation.
• Site: Normal site is posterior wall of the uterus close to the fundus
• Time: The process begins 6 7 days after ovulation and completed by 11 12 th day when the blastocyst is completely embedded in the stroma of the compact layer of endometrium.

Chagas disease is caused by T. cruzi

2 equations
1.Hendersson  Hasslebach equation
2.Anion  Gap

Microtubule provides structural support to astrocytes

Explanation: ‘comedone’ is a Hallmark of Acne

Explanation: Ancylostomiasis is caused by Ancylostoma duodenale or Necator americanus

Explanation -
Symptoms
Skin reactions, including hives and itching and flushed or pale skin.
Low blood pressure (hypotension)
Constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing.
A weak and rapid pulse.
Nausea, vomiting or diarrhea.
Dizziness or fainting.

The inferior vena cava is formed at right side of the body of Vertebra L5

Weight loss with low grade evening fever, cough and night sweats indicates tuberculosis.
Weight loss in spite of good appetite or high food intake—thyrotoxicosis, diabetes mellitus, malabsorption syndrome.
Weight loss with pigmentation and hypotension—Addison’s disease.

Infection is cardinal symptom of immunodeficiency

• When the vertebrae are affected, the disease is referred to as Pott disease.

Increased condensation and finally pyknosis of the nucleus

Explanation: Hepatitis (A,B,C,D,E), Cytomegalovirus, Epstein–Barr virus, Herpes simplex and Yellow fever virus causes viral hepatitis.

Stem Breakdown:

Exertional dyspnoea, chest pain, and syncope: These are classic symptoms of aortic stenosis, indicating reduced cardiac output due to a narrowed aortic valve.
Harsh systolic murmur at the right upper sternal border, radiating to the carotids: This is the hallmark murmur of aortic stenosis, which is best heard at the aortic valve area and radiates to the carotids.
Option Analysis:

A) Aortic stenosis: This is the correct diagnosis. Davidson and Harrison explain that aortic stenosis is a common ventricular heart disease, particularly in older adults. It presents with exertional symptoms due to restricted blood flow through the stenotic aortic valve. The characteristic, harsh systolic murmur radiating to the carotids is diagnostic.
B) Mitral regurgitation: Mitral regurgitation causes a holosystolic murmur best heard at the apex and radiating to the axilla. It is associated with symptoms of heart failure but does not present with aortic murmur characteristics.
C) Aortic regurgitation: Aortic regurgitation causes a diastolic murmur best heard at the left sternal border. It is associated with wide pulse pressure and a "water hammer" pulse, but the systolic murmur described here points to aortic stenosis.
D) Hypertrophic cardiomyopathy: Hypertrophic cardiomyopathy causes a systolic murmur, but it is typically best heard at the left sternal border and increases with manoeuvres like Valsalva. It is associated with a thickened interventricular septum, leading to outflow obstruction.

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 

Reference: Davidson 23rd; P-862
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Normal Flora of vagina maintained by Oestrogen

Fertilization occurs at ampulla of uterine tube.

Ref: Davidson 23rd; P-949 (Box-23.38)