Medicine

HAV and HEV are transmitted via the faeco-oral route, especially in areas with poor sanitation.

Ref: Davidson 23rd; P- 921(Box-23.2)

Explanation: ACE inhibitors & ARB are contraindicated in pregnancy

Explanation:

Type B: Impaired Lactic acid  metabolism
•Severe sepsis
•Hepatic & Renal failure
•Drugs- Metformin, Ethanol
•Diabetes mellitus
Type A: Increased production, due to:
Hypotension – Shock, Cardiac failure
Tissue hypoxia:
Mitochondrial  dysfunction (CO, Cyanide) Severe anemia

Explanation: Insulin causes hypokalaemia, option A,B,D Drugs causes hyperkalaemia

Mild
 Hydrocortisone 0.5%, 1%, 2.5%
 Hydrocortisone 1% and fusidic acid 2% (Fucidin H)
Potent
 Betamethasone valerate 0.1% (Betnovate)  Betamethasone valerate 0.1% and clioquinol 3% (Betnovate-C)  Fluocinolone acetonide 0.025% (Synalar)  Hydrocortisone butyrate 0.1% (Locoid)  Mometasone furoate 0.1% (Elocon)

Explanation: Blood culture is the specific investigation for thyphoid fever

Major criterias are:

Arthritis
Carditis 
Chorea
Erythema marginatum
Subcutaneous nodule

Vomiting without nausea–raised intracranial pressure (ICP)
Projectile vomiting–gastric outlet obstruction
Pain abdomen relieved by vomiting–gastric ulcer
Vomiting with absolute constipation–intestinal obstruction

Central obesity (truncal fat, moon face, buffalo hump) is a classic feature of Cushing’s syndrome due to excess cortisol. Weight loss is seen in adrenal insufficiency, and hypertension (not hypotension) and tachycardia (not bradycardia) are common

The major unmeasured cations are calcium,  magnesium, gamma globulins.

Explanation:
Stem Breakdown:

Sudden-onset weakness and difficulty speaking: These are classic signs of a stroke.
CT showing ischaemia in the left middle cerebral artery (MCA): This confirms that the stroke is ischaemic in nature.
Option Analysis:

A) Transient ischaemic attack (TIA): A TIA involves brief episodes of neurological dysfunction caused by temporary ischaemia without infarction. In this case, the CT scan shows ischaemia, indicating tissue damage, which rules out TIA.
B) Ischaemic stroke: This is the correct diagnosis. Davidson and Harrison explain that ischaemic strokes are caused by obstruction of a cerebral artery, leading to tissue infarction. Sudden-onset weakness (hemiparesis) and difficulty speaking (aphasia) are typical of a left MCA stroke.
C) Hemorrhagic stroke: Hemorrhagic stroke involves bleeding into the brain tissue, often presenting with a more severe clinical picture, including altered consciousness, headache, and vomiting. In this case, the CT shows ischaemia rather than haemorrhage.
D) Subdural haematoma: Subdural haematoma results from venous bleeding, typically following head trauma, and presents with a gradual onset of symptoms like confusion and headache. It does not present with acute ischaemic findings on CT.

Explanation: HIV-associated neurocognitive disorder (HAND) is the most common neurological complication in HIV-infected individuals, as described by Davidson. Cognitive deterioration, motor impairment, and behavioural abnormalities are all possible signs of HAND. Harrison emphasises that although antiretroviral therapy (ART) has reduced the incidence of severe forms, mild cognitive impairment remains common.

Wernicke’s encephalopathy (ataxia, confusion, nystagmus) is caused by thiamine deficiency. Niacin deficiency causes pellagra (dermatitis, diarrhea, dementia).

Reference: Davidson 23rd; P-563

Stem Breakdown:

Heat intolerance, weight loss, palpitations: These symptoms suggest hyperthyroidism.
Diffuse thyroid enlargement and exophthalmos: These signs strongly indicate Graves’ disease, an autoimmune form of hyperthyroidism where antibodies stimulate the thyroid to overproduce thyroid hormone.
Option Analysis:

A) Propylthiouracil (PTU): PTU is an antithyroid medication used to inhibit thyroid hormone synthesis. While it is an important treatment for Graves’ disease, it is not the first-line treatment in an acute setting. Beta-blockers are initially used to control symptoms such as palpitations and tachycardia.
B) Radioactive iodine: Radioactive iodine is a definitive treatment for Graves’ disease, as it destroys overactive thyroid tissue. However, it is not used as an initial treatment to control acute symptoms.
C) Beta-blockers: This is the correct answer. Davidson and Harrison explain that beta-blockers (e.g., propranolol) are used to manage the adrenergic symptoms of hyperthyroidism (palpitations, tremors, anxiety) while more definitive treatments (e.g., antithyroid medications or radioactive iodine) are initiated.
D) Thyroidectomy: Thyroidectomy is reserved for patients who fail medical therapy or cannot tolerate other treatments. It is not used as initial treatment for hyperthyroidism.

Reference: Davidson 23rd; P-544
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-363

Reference: Davidson 23rd; P-563

Reference: Davidson 23rd Box 21.2

Explanation: Chronic hepatitis B infection increases the risk of HCC 100-fold and is the major risk factor worldwide

Reference: Davidson 23rd , Page : 1239

Reference: Davidson 23rd; P-868
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd , Page : 543
Explanation : chronic constrictive pericarditis is sometimes overlooked but should be suspected in any patient with unexplained right heart failure and a small heart.
Differential diagnosis of small heart : Chronic constrictive pericarditis,Addison’s disease, Starvation.

Reference: Davidson 23rd; P-674

Reference: Davidson 23rd; P-762

Pulsus paradoxus, a decrease in systolic blood pressure of more than 10 mmHg during inspiration, is a classic finding in cardiac tamponade. Davidson explains that in tamponade, fluid accumulation in the pericardium compresses the heart, reducing ventricular filling during inspiration and leading to a drop in blood pressure. Harrison adds that pulsus paradoxus can be detected by palpating the pulse or measuring blood pressure during the respiratory cycle.

Reference: Davidson 23rd; P-783
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-649

A ruptured aneurysm is the most common cause of non-traumatic subarachnoid hemorrhage. Davidson explains that aneurysms, particularly berry aneurysms in the circle of Willis, are prone to rupture, causing bleeding into the subarachnoid space. Harrison highlights that patients typically present with a sudden, severe "thunderclap" headache, and diagnosis is confirmed with CT or lumbar puncture showing blood in the cerebrospinal fluid.

Reference: Davidson 23rd; P-863
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-514
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-812

Explanation: Liver imaging is the most revealing investigation

X-rays: used for fractures or foreign bodie
CT: Firrst line for stroke

Explanation: Ticagrelor is an antiplatelet drug. Warfarin, Rivaroxaban, Heparin are anticoagulants

Strict anaerobes
Bacteroides spp.
Clostridioides difficile Clostridium spp.
Fusobacterium spp.

Stem Breakdown:

Fever, pleuritic chest pain, and haemoptysis: These are common symptoms of pulmonary embolism (PE), particularly when there is pulmonary infarction.
History of recurrent deep vein thrombosis (DVT): DVT is the most common source of emboli in PE, making this history highly suggestive of PE as the cause.
Option Analysis:

A) Pulmonary embolism: This is the correct diagnosis. Davidson and Harrison explain that pulmonary embolism occurs when a thrombus from the venous system (often from the leg veins) embolises to the pulmonary arteries. The combination of pleuritic chest pain, haemoptysis, and a history of DVT strongly suggests PE.
B) Pneumonia: Pneumonia causes fever, cough, and pleuritic chest pain, but it usually presents with productive sputum, not haemoptysis. Additionally, a history of recurrent DVT is not typically associated with pneumonia.
C) Lung cancer: Lung cancer can cause haemoptysis and chest pain, but it is usually a chronic process associated with weight loss and a mass on imaging. This patient's history of recurrent DVT and acute presentation make PE more likely.
D) Tuberculosis: Tuberculosis can cause fever, haemoptysis, and pleuritic chest pain, but it typically presents with chronic symptoms and is associated with a history of exposure or travel to endemic areas. The acute onset and history of DVT make PE more likely.

Reference: Davidson 23rd , Page : 473 , Box : 16.24

Explanation: IgG distributed equally between blood and extracellular fluid and transported across placenta.

It will be cold intolerance , Reference: Davidson 23rd, Box-18.7

E E Explanation: The most important steps are to make a positive diagnosis and reassure the patient

Chronic inflammation leads to fibrosis and calcification. Pain is chronic and may lead to exocrine and endocrine insufficiency

Reference: Davidson 23rd, Page : 646

HAP is defined as pneumonia occurring ≥48 hours after admission, not incubating at admission. It is commonly caused by Gram-negative organisms like Pseudomonas, Klebsiella, and MRSA. These infections are often more resistant to antibiotics and carry higher morbidity. Management requires empiric broad-spectrum antibiotics, adjusted based on culture results.

Answer: A
Explanation: Radioactive iodine therapy is the most common treatment for Graves’ disease. Davidson explains that radioactive iodine selectively destroys thyroid tissue, leading to reduced thyroid hormone production. Harrison notes that this therapy is particularly effective in older patients and those with contraindications to surgery. Methimazole and beta-blockers are often used as adjunctive therapies but are not definitive treatments.

Neutropenia leaves patients vulnerable to severe bacterial and fungal infections.

Reference: Davidson 23rd , Page : 1200
Explanation : Lithium carbonate is the drug of first choice for bipolar disorder.

HOCM is the most common cause of sudden cardiac death in the young. 
Always consider HOCM in sudden death & unusual collapse in young person

p24 antigen appears earlier than antibodies and is used in fourth-generation HIV tests

Reference: Davidson 23rd; P-861
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-581