স্পেশাল বিসিএস (স্বাস্থ্য)

Transplacental transmission occurs in Syphilis

Acute gout is treated with colchicine, NSAIDs, or steroids. Allopurinol (xanthine oxidase inhibitor) is for chronic prophylaxis, not acute attacks.

Answer: D
Explanation: Nephritic syndrome is characterised by hematuria, hypertension, oliguria, and azotemia. Davidson emphasises that hyperlipidemia is a feature of nephrotic syndrome, not nephritic syndrome. Nephritic syndrome results from glomerular inflammation, leading to red blood cell leakage into the urine. Harrison explains the differences between nephritic and nephrotic syndromes, noting that nephritic syndrome also causes renal insufficiency and fluid retention.

ALL peaks between ages 2–5 and presents with anemia, thrombocytopenia, and lymphadenopathy.

Primary hyperparathyroidism (PHP)

 Definition: It is the hypercalcemic disorder due to excessive secretion of PTH.

Causes:
1. Parathyroid adenoma (80 %).

2. Primary hyperplasia of parathyroid gland (15 %). 3.Parathyroid carcinoma.

Reference: Davidson 23rd, Box-3.4

Ref: Guyton 14th; P-482

Ref. Robbins 9th p-93

Explanation -
In the early nonprogressive phase of shock, various neurohumoral mechanisms help maintain cardiac output and blood pressure. These mechanisms include baroreceptor reflexes, release of catecholamines and antidiuretic hormone, activation of the renin-angiotensin-aldosterone axis, and generalized sympathetic stimulation. The net effect is tachycardia, peripheral vasoconstriction, and renal fluid conservation; cutaneous vasoconstriction causes the characteristic “shocky” skin coolness and pallor (notably, septic shock can initially cause cutaneous vasodilation, so the patient may present with warm, flushed skin). Coronary and cerebral vessels are less sensitive to sympathetic signals and maintain relatively normal caliber, blood flow, and oxygen delivery. Thus, blood is shunted away from the skin to the vital organs such as the heart and the brain.

Reference: Davidson 23rd; P-837

Ref: Davidson 23rd; P-971

Burrows + nocturnal pruritus are pathognomonic for scabies (caused by Sarcoptes scabiei mite).

Explanation:

Although the high circulating levels of estrogen stimulate prolactin secretion during pregnancy, the action of prolactin on the breast is inhibited by progesterone and estrogen. After parturition, progesterone and estrogen levels decrease dramatically. Prolactin can then interact with its receptors in the breast, and lactation proceeds if initiated by suckling.

The obligate intracellular bacteria Rickettsia prowazekii

Explanation: Headache, drowsiness, fever and neck stiffness are the usual presenting features. In severe bacterial meningitis the patient may be comatose, later developing focal neurological signs

In ancylostoma major damage is due to the loss of blood at the site of attachment in the small intestine. Weakness and pallor accompany the microcytic anemia caused by blood loss.

Explanation :
Approximately 40% of the patients have congenital heart disease. The most frequent forms of congenital heart diseases in Down syndrome are atrioventricular septal defects constituting 43% of cases, whereas ventricular septal defects, atrial septal defects, and tetralogy of Fallot also involved.
Children with trisomy 21 have a high risk of developing leukemia; there is 20-fold increased risk of developing acute B lymphoblastic leukemias and 500-fold increased risk of acute myeloid leukemias. The latter, most commonly, is acute megakaryoblastic leukemia.
• Virtually all patients with trisomy 21 older than age 40 develop neuropathologic changes characteristic of Alzheimer disease, a degenerative disorder of the brain.
• Patients with Down syndrome have abnormal immune responses that predispose them to serious infections, particularly of the lungs, and to thyroid autoimmunity, causing hypothyroidism .

Schwannoma is a peripheral nerve sheath tumour

TP is characterised by a pentad of findndings, although few patients have all five components:
 thrombocytopenia  microangiopathic haemolytic anaemia  neurological sequelae  fever  renal impairmen

Reference: Davidson 23rd; P-813

Except rich blood supply all are the criteria of white fibers

Reference: Davidson 23rd; P-514

In acute stroke, the priority is to differentiate ischemic stroke from hemorrhagic stroke is the main concern & it is done by Non-contrast CT brain.

Explanation :
Effects of complement in acute inflammation :
Vasodilation 
Increased vascular permeability 
Phagocytosis
MAC
Chemotaxis
Leucocyte adhesion

Explanation -
Tophaceous gout occurs when uric acid crystals form masses of white growths that develop around the joints and tissues that gout has affected. These masses, called tophi, are often visible under the skin and tend to look like swollen nodules. The material may be in a liquid, pasty, or chalky state.

Explanation -
B cell immunodeficiency -
X linked hypogummaglobulinaemia 
Selective immunoglobulin deficiencies. 

Reference: Davidson 23rd, Page: 1133
Explanation: The diagnosis may be confirmed by lumbar puncture, which shows raised normal CSF constituents at increased pressure ( usually > 30 cmH2O CSF )

• Bronchiectasis is a disorder in which destruction of smooth muscle and elastic tissue by chronic necrotizing infections leads to permanent dilation of bronchi and bronchioles
• Bronchiectasis usually affects the lower lobes bilaterally
• The airways are dilated, sometimes up to four times normal size.

Leucopenia occurs in kala-azar

Reference: Davidson 23rd; P-802
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-482

Explanation: Schwannoma is a peripheral nerve sheath tumour

Absorption of amino acids is faster in duodenum and jejunum and slower in ileum.

Carcinoma in situ includes CIN

Positron emission tomography (PET) scans in REM sleep show increased activity in the pontine area, amygdala, and anterior cingulate gyrus, but decreased activity in the prefrontal and parietal cortex. Activity in visual association areas is increased, but activity is decreased in the primary visual cortex. This is consistent with increased emotion and operation of a closed neural system cut off from the areas that relate brain activity to the external world.

Fat embolism is common in fracture

Explanation :
Systemic fungal infection -
Coccidiodes 
Paracoccidiodes
Histoplasma
Blastomyces

Sporotrichosis is subcutaneous fungal infection. 

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.

• Heparin is a highly sulfated glycosaminoglycan with the highest negative charge density of any known biological molecule. It is a naturally occurring anticoagulant produced by mast cells and basophils that plays an important role in vivo in the fine balance of anticoagulant and procoagulant processes. Although it does not break down preformed clots like tissue plasminogen activator, it instead potentiates the progression of the body’s natural clot lysis mechanisms to prevent the formation of clots.

• Heparin is administered parenterally because it is not absorbed in the gut due to its high negative charge and size; intramuscular injections are avoided because of the risk of developing hematomas. Subcutaneous administration is predominantly given for deep vein thrombosis prophylaxis. In order to maintain its antithrombotic effect throughout the duration of percutaneous coronary intervention (PCI), heparin must be rebolused or continually infused because of its short half-life.

• Heparin is the most commonly used anticoagulant in the world administered to minimize thrombotic complications during PCI; its onset of action is immediate after intravenous administration. In addition to avoiding thrombotic complications, anticoagulation strategies must be designed to avoid major bleeding complications, as they are associated with increased morbidity, mortality, and cost.

• The combination of heparin and glycoprotein (GP) IIb/IIIa inhibitors has a potent anti-ischemic effect, but also has an increased risk of serious bleeding complications that must be balanced carefully. Although randomized trials have demonstrated the reduction of ischemic events with GP IIb/IIIa inhibitors in patients who undergo PCI for non-ST elevation acute coronary syndromes and ST-elevation myocardial infarction, bleeding complications are also increased.

Reference: Davidson 23rd; P-813
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

AFP is elevated in up to 70% of patients with HCC and used as a screening and diagnostic tool.

Explanation: Ulcerative colitis is associated with PSC

Reference: Davidson 23rd; P-637, box: 18.8

Guyton 13 th page 522

Vitamin C is essential for the hydroxylation of proline and lysine during collagen synthesis. This hydroxylation is critical for forming stable collagen triple helices, which are fundamental to the structural integrity of skin, blood vessels, bones, cartilage, and gums.

Complications
 Laryngeal obstruction or paralysis
 Myocarditis  Peripheral neuropathy

IgM anti-HBc indicates acute or recent infection. HBsAg shows current infection but doesn’t differentiate acute from chronic.