স্পেশাল বিসিএস (স্বাস্থ্য)

Explanation: It is during the third week that the notochordal process and it's associated mesoderm induce the neural plate. The hollow notochordal process eventually becomes the solid notochord, the forerunner of the axial skeleton.

Ancylostoma duodenale larva causes ground itch.

The Permissive action of cortisol is on glucagon

Reference: Langman’s 13th; P-43

Reference-BD Chourasia’s/7th/vol-4/p-101

Reference: Guyton 14th; P- 528

Reference: Davidson 23rd; P-775
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Clinical features

The typical presentation is for a reduced eGFR to be found incidentally during routine blood tests, often during screening of high-risk patients, such as those with diabetes or hypertension. Most patients with slowly progressive disease are asymptomatic until GFR falls below 30 mL/ min/1.73 m 2 and some can remain asymptomatic with much lower GFR values than this. An early symptom is nocturia, due to the loss of concentrating ability, but this is non-specific. When GFR falls below 15–20 mL/ min/1.73 m2 , symptoms and signs are common and can affect almost all body systems, but are often non-specific and may not immediately raise suspicion of kidney disease (Fig. 18.22). They typically include tiredness or breathlessness, which may, in part, be related to renal anaemia or fluid overload. With further deterioration in renal function, patients may suffer pruritus, anorexia, weight loss, nausea, vomiting and hiccups. In very advanced renal failure, respiration may be particularly deep (Kussmaul breathing) due to profound metabolic acidosis, and patients may develop muscular twitching, fits, drowsiness and coma.

Reference: Davidson 23rd; P-530

[Ref. Junqueira 15th, 89]

Explanation: persistent daily vomiting suggests gastric outlet obstruction.

Explanation -
• The reduction-oxidation reactions that occur during normal metabolic processes. 
• Absorption of radiant energy (e.g., ultraviolet light, x-rays). 
• Rapid bursts of ROS are produced in activated leukocytes during inflammation. 
•. Defects in leukocytic
superoxide production lead to chronic granulomatous disease.
• Enzymatic metabolism of exogenous chemicals or drugs can generate free radicals
• Transition metals such as iron and copper donate or accept free electrons during intracellular reactions and catalyze free radical formation

Explanation :
Organism causes UTI :
E.coli (most common) 
Proteus
Staphylococcus saphrophyticus ( Young women)
Staph.epidermidis
Enterococcus
Klebsiella
Pseudomonas

Finger clubbing is due to overgrowth of soft tissue in the terminal phalanx, which increases the lateral and longitudinal curvature of the nail (see Fig. 3.8), raising the nail bed off the underlying bone. It is palpable as a boggy fluctuation of the nail when pressure is applied just proximal to the nail 

The most common respiratory causes of clubbing are chronic suppurative lung disease (such as bronchiectasis), lung cancer and pulmonary fibrosis. An additional rare complication of lung cancer is hypertrophic pulmonary osteoarthropathy, in which painful, tender swelling of
the wrists and ankles accompanies pronounced finger clubbing. X-rays of the distal forearm and lower legs show subperiosteal
new bone formation overlying the cortex of the long bones.
Other important signs of respiratory disease in the hands include:
•     cyanosis
•     tar staining of fingers from tobacco use (Fig. 5.8)
•     small-muscle wasting (see Fig. 13.22), which may indicate
T1 root damage by an apical lung tumour
•     rarely, yellow–brown discoloration of nails in yellow nail
syndrome

Specific gravity of urine is the measure of dissolved solutes (particles) in urine. It is low in diabetes insipidus and high in diabetes mellitus, acute renal failure and excess medications.

Explanation: In Pregnancy, old age and multiple myeloma, isolated elevation of ESR not CRP.

Explanation :
Oncogenic RNA Viruses:

1. Human T-cell leukemia virus type 1 (HTLV-1)
– Causes adult T-cell leukemia/lymphoma.


2. Hepatitis C virus (HCV)
– Associated with hepatocellular carcinoma (liver cancer).

Reference: Davidson 23rd; P-576
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: Initial flushing faint macular rash in first 1–2 days. Maculopapular, scarlet morbilliform blanching rash from days 3–5 on trunk, spreading centrifugally and sparing palms and soles; onset often with fever defervescence. May desquamate on resolution or give rise to petechiae on extensor surfaces

Reference: Davidson 23rd, Fig-23.17

Reference: Davidson 23rd; P-800

Explanation: LPS &teichoic acid are septic shock inducer.

[Robbins 9th 71]

In tuberculoid leprosy, ulnar and common peroneal nerves are typically affected.

• The term atypical organisms is used for Mycoplasma pneumoniae, Chlamydophila pneumoniae, Coxiella burnetii, and viruses (influenza viruses types A and B, human metapneumovirus)

Drugs causes gout are: Thiazide and loop diuretics, Low-dose aspirin, Ciclosporin & Pyrazinamide

The barriers of an oocyte are
1. First barrier is formed by cells of corona radiata
2. Second barrier is formed by zona pellucida made of
glycoproteins, ZP1, ZP2, and ZP3.
3. Third barrier is formed by vitelline membrane of oocyte itself

This ability of barrier penetration is achieved by two processes:
(a) capacitation and
(b) acrosome reaction

Prevention of polyspermy:
- Rapid depolarization of the oocyte
- Cortical reaction
- Zona reaction
- Destruction of ZP3 receptor

Explanation : Accommodation is a reflex action. When a person looks at a near object after seeing a far object, three adjustments are made in the eyeballs:
1. Convergence of the eyeballs due to contraction of the medial recti
2. Constriction of the pupil due to the contraction of constrictor pupillae of iris
3. Increase in the anterior curvature of the lens due to contraction of the ciliary muscle.
Ref : Sembulingam 6th edition (Page- 997)

• The treatment of choice is either tinidazole or metronidazole.
• Tinidazole is better tolerated.

Explantion : Purkinje cells are termed as ‘final common path’ of cerebellar cortex. It is because the impulses from different parts of cerebellar cortex are transmitted to other parts of brain only through Purkinje cells.
Ref : Sembulingam 6th edition (Page- 866)

Explanation :
Multifactorial ( polygenic)  inheritance disorders -
Cleft lip and or palate
Congenital dialocation of hip
Congenital heart defects
Gout
Hypertension 
Diabetes
Neural tube defects

Adrenal insufficiency & hypothyroidism may cause hyponatremia. Hypothyroidism decreases cardiac output and GFR and thus increased AVP secretion leading to hyponatremia.

Explanation: Acne usually affects the face and often the trunk. Greasiness of the skin may be obvious (seborrhoea). The hallmark is the comedone

Explanation: The most common cause of acute pancreatitis is Gallstones disease

Explanation: About 65% of the filtered sodium load is reabsorbed in the proximal renal tubule

Mucous glands of duodenum lies in submucosa.

Explanation :
Common D/D in acute upper abdominal pain :
Peptic ulcer disease ( most common)
Acute pancreatitis 
Acute cholecystitis 
Acute inferior MI
Diabetic ketoacidosis . 

Aldosterone is life saving hormone

Explanation :
Hyperacute rejection:
Occurs within minutes to hours 
Due to preformed antibody and complement activation (type II hypersensitivity) 

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

Explanation:

• Most gastric adenocarcinomas involve the gastric antrum; the lesser curvature is involved more often than the greater curvature.

By the beginning of 4th month,cytotrophoblastic cells and some connective tissue cells disappear.the syncytium and endothelial wall of the blood vessels are then the only layers that separate the maternal and fetal circulation.

The structures representing all three components of embryonic disc is Tympanic membrane

In PDA, severe pulmonary vascular disease results in reversal of flow through ductus thereby unoxygenated blood is shunted to descending aorta leading to cyanosis and clubbing of the toes, but not fingers. This is called differential cyanosis.

Explanation -
Causes of transudative oedema :
Protein energy malnutrition 
Liver cirrhosis
Malnutrition 
Protein losing gastroenteropathy

Causes of exudative ascities :
Heart failure
Cirrhosis
Portal vein thrombosis
Tuberculosis
Peritoneal tumor.

[Ganong 24th p-115]

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

Ribosome lies outside nucleus in the cytoplasm.

Reference: Davidson 23rd; P-572