স্পেশাল বিসিএস (স্বাস্থ্য)

Epithelial cell tumour is not urinary bladder tumour

Glycine has both excitatory and inhibitory effects in the CNS. When it binds to NMDA receptors, it makes them more sensitive to the actions of glutamate. Glycine may spill over from synaptic junctions into the interstitial fluid and in the spinal cord; for example, it may facilitate pain transmission by NMDA receptors in the dorsal horn. However, glycine mediates direct inhibition in the brainstem and spinal cord.

Explanation: A diurnal variation in PEF of more than 20% is considered diagnostic for Bronchial asthma

ACEi/ARB are teratogenic and avoided in pregnancy

• Hyperuricemia (plasma urate level above 6.8 mg/dL) is necessary, but not sufficient, for the development of gout.

কোন ব্যাখ্যা যোগ হয় নি।

Reference: Davidson 23rd; P-642

[Robbins 9th 48]

Reference: Davidson 23rd; P-542

Definite cyanosis appears whenever the arterial blood contains more than 5 grams of deoxygenated hemoglobin in each 100 ml of blood. A person with anemia almost never becomes cyanotic. Conversely, in a person with Polycythemia vera frequently has cyanosis, even under otherwise normal conditions.

Explanation -
Causes of acute monoarthritis :
Septic arthritis 
Gout
Pseudogout
Haemathroses
Trauma
Monoarticular presentation of polyarthritis

Explanation: Vertical transmission (90%)

Dengue virus, which has 4 distinct  serotypes, i.e. DENV-1, DENV-2, DENV-3,  DENV-4 is transmitted by Aedes aegypti  and Aedes albopictus to human

Reference: Davidson 23rd; P-359

Explanation :
In progressive phase of shock -
Persistent oxygen deficit leads to intracellular aerobic respiration is replaced by anaerobic glycolysis with excessive production of lactic acid. The resultant metabolic lactic acidosis lowers the tissue pH, which blunts the vasomotor response; arterioles dilate, and blood begins to pool in the microcirculation.
Peripheral pooling not only worsens the cardiac output but also puts endothelial cells at risk for the development of anoxic injury with subsequent DIC.
With widespread tissue hypoxia, vital organs are affected and begin to fail.

Reference: Practical Manual in Clinical Medicine by Professor ABM Abdullah; P-339

Glucose is completely reabsorbed by kidney unless any abnormality.

Explanation: Gout is marked by transient attacks of acute arthritis initiated by crystallization of monosodium urate within and around joints.

Explanation: The vector and definitive host for plasmodia is the female Anopheles mosquito

  Signs
ØCoated tongue
ØRelative bradycardia
ØSplenomegaly ( Just Palpable)
ØCaecal gurgling

Aphthous oral lesions, genital ulcers and hypopyon suggest Behçet’s syndrome.

Thyroid hormone, an amine, acts on its target tissues by a steroid hormone mechanism, inducing the synthesis of new proteins. The action of antidiuretic hormone (ADH) on the collecting duct (V2 receptors) is mediated by cyclic adenosine monophosphate (cAMP), although the other action of ADH (vascular smooth muscle, V1 receptors) is mediated by inositol 1,4,5-triphosphate (IP3). Parathyroid hormone (PTH), β1-agonists, and glucagon all act through cAMP mechanisms of action.

Ligamentum venosum is the true Ligament of liver.

• ২০২৬ সালের বর্ষপণ্য : 
- পেপার ও প্যাকেজিংকে চলতি বছরের বর্ষপণ্য ঘোষণা করে ৩০তম ঢাকা আন্তর্জাতিক বাণিজ্য মেলার (ডিআইটিএফ) উদ্বোধন করা হয়েছে।
- 'পেপার ও প্যাকেজিং প্রডাক্টকে ২০২৬ সালের বর্ষপণ্য হিসেবে ঘোষণা করেন বাণিজ্য উপদেষ্টা শেখ বশিরউদ্দীন।
- বর্ষপণ্য ঘোষণার ফলে পেপার প্যাকেজিং শিল্পে নতুন বিনিয়োগ, আধুনিক প্রযুক্তির ব্যবহার, কর্মসংস্থান বৃদ্ধি এবং রফতানি আয় উল্লেখযোগ্যভাবে বাড়বে। 

উল্লেখ্য, 
- ২০২৫ সালের 'বর্ষপণ্য' ছিলো আসবাবপত্র বা ফার্নিচার। 

তথ্যসূত্র: বনিক বার্তা ও বাসস। (Link1) (Link2)

Reference: Davidson 23rd; P-801

Explanation -
Lower urinary tract symptoms :
Dysuria,Frequency, Urgency 
Impaired urinary flow,Hesitency,Dribbling of urine,Incomplete emptying of bladder
Urinary retention
Incontinence

RBC has no mitochondria

Hypertrophy + Hyperplasia simultaneously occurs in five organs; Thyroid, Breast, Kidney, Uterus Prostate

Reference: Davidson 23rd; P-634

Plasma Membrane: 

Thickness: 7.5 to 10nm 

Composition: It is composed of 
a.Protein -55% 
b. Lipids: 42% 
  ✓ Phospholipids -25% 
  ✓ Cholesterol - 13% 
  ✓ Other lipids- 4% 
c. Oligosaccharides -3%

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

Explanation:
Internal intercostal muscle is primary expiratory muscle

Haemophilia A (factor VIII deficiency) typically causes deep bleeds into joints and muscles.

Toxoplasma is a part of TORCH infection

A pansystolic murmur at the apex, radiating to the axilla, is characteristic of mitral regurgitation. This occurs due to retrograde flow from the left ventricle to the left atrium during systole.

Reference: Davidson 23rd; P-646

Reference: Davidson 23rd; P-649

Features of epithelium:
- Epithelial tissues are composed of closely aggregated polyhedral cells adhering strongly to one another and to a thin layer of extracellular matrix (ECM).
- The forms and dimensions of epithelial cells range from high columnar to cuboidal to low squamous cells. Epithelial cell nuclei vary in shape corresponding roughly to the cell shape.
- Epithelium is an avascular structure. It receives nutrition by diffusion.
- The epithelia have got nerve supply
- Epithelial cells rest on basement membrane. 
- Epithelial cells show various types of junctions with adjacent cells and basement membrane.
- Epithelial cells isolate deeper structures from surface environment.
- Epithelial cells show surface modifications as per functional need. 
- Epithelial cells undergo mitosis and can regenerate damaged portion.
- Epithelium is derived from all three germ layers.
- Epithelial cells generally show polarity. 

Rusty sputum, herpes labialis and lobar consolidation are classic for pneumococcal pneumonia, the most common community-acquired pneumonia.

False-negative reactions may occur in the setting of certain viral infections, sarcoidosis, malnutrition, Hodgkin lymphoma, immunosuppression,

Gastric ulcer occurs typically along Lesser curvature

( Ref : Davidson 23rd ,p –693 )

Explanation:

Stem Breakdown:

Progressive dysphagia to both solids and liquids: This suggests a motility disorder of the oesophagus. In achalasia, there is difficulty with both solids and liquids due to impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax.
Unintentional weight loss: Weight loss is often seen in achalasia due to reduced caloric intake from dysphagia.
Bird-beak appearance on barium swallow: This classic radiological finding is specific for achalasia.
Option Analysis:

A) Achalasia: This is the correct diagnosis. Davidson and Harrison describe achalasia as a motility disorder characterised by the loss of peristalsis in the distal oesophagus and failure of the lower esophageal sphincter to relax. The bird-beak appearance on barium swallow, progressive dysphagia, and weight loss are classic findings.
B) Esophageal cancer: Esophageal cancer often presents with dysphagia and weight loss, but it typically causes dysphagia that starts with solids and progresses to liquids. Additionally, the bird-beak appearance is not associated with cancer.
C) Gastro-oesophageal reflux disease (GERD): GERD causes heartburn, regurgitation, and sometimes dysphagia, but it does not cause a bird-beak appearance or progressive dysphagia to both solids and liquids.
D) Diffuse esophageal spasm: Diffuse esophageal spasm causes intermittent dysphagia and chest pain but does not lead to the bird-beak appearance seen in achalasia.

Reference: Ganong 26^th; Table-2.1

Reference: Davidson 23rd, Page: 1141
Explanation: The most evident symptom is fatigable muscle weakness. Worsening of symptoms towards the end of the day or following exercise is characteristic.

Explanation: Blood culture is the pivotal investigation to identify the organism that is the cause of the infection and to guide antibiotic therapy.

Explanation:

Explanation: According to Reddy and Nandy, patient confidentiality is paramount but can be breached when public health is at risk. In this case, counseling the patient and obtaining consent to disclose is the most ethical option.

Explanation : Mesencephalon is also known as midbrain. Rhombencephalon or hindbrain is subdivided into two portions:
i. Metencephalon, formed by pons and cerebellum
ii. Myelencephalon or medulla oblongata.
Midbrain, pons and medulla oblongata are together called the brainstem.
Ref : Sembullingam 6th edition (Page- 758)

Human placenta is - Hemochoreal

Answer: C. “My opinion is based on scientific methods and evidence available.”
Justification:

Medico-legal opinions are expert opinions, not certainties.
Confidence must be scientifically grounded.
(Reddy Ch. 3; Role of Medical Expert in Court)

When red cells become older(120days) and fragile, they are destroyed in reticulo-endothelial system. The main destruction occurs in the capillaries of red pulp of spleen because the splenic capillaries diameter is very small. So, spleen is called ‘graveyard of RBCs’.    

Explanation: Hepatitis D is a defective virus.

[Robbins 9th 123]

Reference: Davidson 23rd; P-801
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

 Aspiration of any fluid from the pleural cavity is called paracentesis thoracis
 It is usually done in the eighth intercostal space in the midaxillary line
 The needle is passed through the lower part of the space to avoid injury to the principal neurovascular bundle, i e vein, artery and nerve

Explanation -
Asthma is a chronic disorder of the conducting airways,usually caused by immunological reaction,is marked by episodic bronchoconstriction. 
Menifested by recurrent episodes of wheezing,breathlessness,chest tightness,Cough

Epicardium is another name of Visceral pericardium

** Vitamin-D resistant rickets: X-linked dominant
** Thalassaemia & Homocystinuria: Autosomal recessive

X linked Recessive Disorders

Blood:
 Hemophilia A & B
 Glucose-6-P dehydrogenase deficiency
 Chronic granulomatous disease

Musculoskeletal:
 Duchene muscular dystrophy

Immune:
 Agammaglobinemia

Metabolic:
 Nephrogenic diabetes insipidus

Nervous:
 Fragile X syndrome

Explanation : Anterior hypothalamus & mamillary body regulate sleep & wakefulness.
Ref : Sembulingam 6th edition (Table- 149.2)

Stem Breakdown:

Fatigue, easy bruising, and frequent nosebleeds: These symptoms suggest bone marrow failure, leading to anaemia (fatigue), thrombocytopenia (bruising, nosebleeds), and possibly leukopenia.
Pancytopenia and hypocellular bone marrow: Pancytopenia (low red cells, white cells, and platelets) with a hypocellular bone marrow is characteristic of aplastic anaemia.
Option Analysis:

A) Aplastic anaemia: This is the correct diagnosis. Davidson and Harrison describe aplastic anaemia as a condition in which the bone marrow fails to produce sufficient blood cells, leading to pancytopenia. The bone marrow is hypocellular (decreased cell production), and the condition can be caused by autoimmune factors, infections, or exposure to toxins.
B) Acute myeloid leukaemia (AML): AML presents with pancytopenia and blasts in the blood or bone marrow, but it is associated with hypercellular bone marrow filled with malignant cells, not hypocellularity.
C) Immune thrombocytopenic purpura (ITP): ITP causes isolated thrombocytopenia (low platelet count), leading to easy bruising and bleeding. However, it does not cause anaemia or leukopenia, and the bone marrow is typically normal or shows increased megakaryocytes.
D) Myelodysplastic syndrome (MDS): MDS can cause pancytopenia, but the bone marrow in MDS is usually hypercellular with abnormal maturation of blood cells, not hypocellular.