Medicine

Davidson 23rd; P-1082

Reference: Practical Manual in Clinical Medicine by Professor ABM Abdullah; P-251

Bowen’s disease Clinical features
Bowen’s disease (BD) is the name given to an intra-epidermal carcinoma that usually presents as a slowly enlarging, erythematous, scaly plaque on the lower legs of fair-skinned older women  but other sites can also be involved. It can be confused with eczema or psoriasis, but is usually asymptomatic and does not respond to topical glucocorticoids. It may also be hard to distinguish from superficial BCC. Transformation into SCC occurs in 3% or less

Reference: Davidson 23rd; P-509

The hypothalamus normally maintains core temperature at 37°C, but this set-point is altered in fever and may be lost in hypothalamic disease.

Answer: A
Explanation: Diabetic ketoacidosis (DKA) is most common in type 1 diabetes due to the absolute insulin deficiency. Davidson explains that without insulin, the body shifts to fat metabolism, producing ketones and leading to metabolic acidosis. Harrison adds that DKA can occur in type 2 diabetes under extreme stress, but it is far less common.

Reference: Davidson 23rd; P-799

Crohn’s shows skip lesions, cobblestoning, and non-caseating granulomas.

Spirometry measures two main components: Forced vital capacity (FVC). FVC is the highest amount of air you can forcefully and completely blow out after taking a deep breath in. Forced expiratory volume (FEV1)

Explanation:

Reference: Davidson 23rd; P-556
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

CSF is obtained from lumber puncture.

Asymptomatic bacteriuria in pregnancy should be treated with antibiotics to reduce the risk of symptomatic UTI, pyelonephritis, and potential adverse pregnancy outcomes like preterm labor.

(Ref : Davidson 23rd ,p -296 )

Reference: Davidson 23rd; P-825

Reference: Davidson 23rd; P-428

Ref: Davidson 23rd; P-1047

Reference: Davidson 23rd; P-500
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

An arterial blood gas (ABG) is a test that measures the oxygen tension (PaO2), carbon dioxide tension (PaCO2), acidity (pH), oxyhemoglobin saturation (SaO2), and bicarbonate (HCO3) concentration in arterial blood. Some blood gas analyzers also measure the methemoglobin, carboxyhemoglobin, and hemoglobin levels.

A sudden, severe “thunderclap” headache is the hallmark symptom of subarachnoid hemorrhage.

Myoglobin rises within 1–3 hours but is less specific. Troponin is gold standard but peaks later

Reference: Davidson 23rd Fig. 21.9

Reference: Davidson 23rd; P-590

Reference: Davidson 23rd, Box-22.5

Drugs- NSAIDs, retinoids, tetracyclines, furosemide

Coarctation of aorta: radio-femoral delay

Abdominal bruits are associated with renal artery stenosis, enlarged kidneys with polycystic kidney disease, and characteristic facies & habitus with Cushing's syndrome.

Explanation: Neisseria gonorrhoeae is the most common cause of septic arthritis in young adults, particularly women. Davidson explains that gonococcal arthritis typically presents with migratory polyarthritis and tenosynovitis. Harrison adds that early recognition and treatment with antibiotics are crucial to prevent joint destruction.

Cervical spondylosis (degenerative osteoarthritis) causes osteophytes and spinal cord compression (myelopathy). RA affects synovial joints (not osteophytes), and ankylosing spondylitis causes bamboo spine.

Serotonin (5-HT), along with norepinephrine and dopamine, is strongly implicated in the pathophysiology of depression. Most antidepressants target these systems.

Encephalitis is the inflammation of brain parenchyma.

Reference: Davidson 23rd; P-147

Reference: Davidson 23rd; P-430

Explanation: Night blindness occurs due to Vitamin A deficiency

ABM 477

Reference: Davidson 23rd , Page : 542
Explanation : Specific indicator of acute pericarditis in ECG is PR interval depression .

Explanation: The major symptoms are abdominal pain, diarrhoea and weight loss. Ddiarrhea, which is usually watery and does not contain blood or mucus.

An increased discharge without any itch or irritation accompanied by an unpleasant or fishy odour, worse after sexual intercourse and during menstruation, indicates the possibility of BV

Drugs causing hypothyroidism
Carbimazole, methimazole, popylthiouracil
Amiodarone
Lithium

Reference: Davidson 23rd; P-868

Reference: Davidson 23rd; P-584

Reference: Davidson 23rd; P-814

Anti-dsDNA antibodies are highly specific (100%) for diagnosis of SLE. Its level correlates with lupus activity.

Stem Breakdown:

Chronic non-productive cough and exertional dyspnoea: These are common symptoms of interstitial lung diseases, such as idiopathic pulmonary fibrosis (IPF).
Bilateral inspiratory crackles and digital clubbing: Inspiratory crackles ("Velcro crackles") are a hallmark of IPF, and clubbing is a common associated finding.
Reticular opacities on chest X-ray, especially in the lower lobes: This is characteristic of interstitial lung diseases like IPF.
Option Analysis:

A) Idiopathic pulmonary fibrosis: This is the correct diagnosis. Davidson and Harrison describe idiopathic pulmonary fibrosis (IPF) as a chronic progressive fibrosing interstitial lung disease. It primarily affects the lower lobes of the lungs and presents with exertional dyspnoea, a non-productive cough, and bilateral inspiratory crackles. Clubbing is also commonly seen in these patients.
B) Chronic obstructive pulmonary disease (COPD): COPD is characterised by airflow limitation due to chronic bronchitis or emphysema. It usually presents with a productive cough, wheezing, and hyperinflation on chest X-ray, not the reticular opacities seen in IPF.
C) Congestive heart failure: While heart failure can cause dyspnoea and bilateral crackles due to pulmonary ooedema, it usually presents with signs of fluid overload (e.g., leg ooedema, elevated jugular venous pressure). Additionally, the chest X-ray would show pulmonary congestion rather than reticular opacities.
D) Bronchiectasis: Bronchiectasis causes a chronic productive cough with copious sputum production and recurrent infections. It would show airway dilation (bronchial thickening) on imaging rather than reticular interstitial opacities.

Explanation: The World Health Organisation (WHO) guideline value for arsenic content in tube well water is 10 μg/L

Reference: Davidson 23rd; P-793

Severe dengue is characterized by plasma leakage, leading to hemoconcentration, pleural effusions, or ascites. This is the hallmark of dengue hemorrhagic fever and dengue shock syndrome. Warning signs include persistent vomiting, abdominal pain, mucosal bleeding, and evidence of plasma leakage (e.g., rising hematocrit). Early recognition is critical for fluid management to prevent shock.

Reference: Davidson 23rd; P-857
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Ref: Davidson 23rd; P- 938

Reference: Davidson 23rd; P-825

Explanation: Malar rash in SLE: Fixed erythema, flat or raised, sparing the nasolabial folds

Explanation: