Medicine

Explanation: among Asians, BMI > 23.0 is overweight and > 25.0 is obese.

Reference: Davidson 23rd; P-137

Rose spots (blanching pink macules on the trunk) are classic but rare.

Koplik’s spots - Measles

Osler’s nodes & Janeway lesions - Infective endocarditis

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

ACEi/ARB are teratogenic and avoided in pregnancy

Reference: Davidson 23rd; P-642

Reference: Davidson 23rd; P-542

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

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

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

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

Reference: Davidson 23rd; P-801

Reference: Davidson 23rd; P-634

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

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

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

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

( 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: 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:

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

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.

Minimal change disease is the most common cause of nephrotic syndrome in children, characterized by normal glomeruli on light microscopy but podocyte effacement on electron microscopy.

Reference: Davidson 23rd; P-133

Reference: Davidson 23rd , Page : 447
Explanation : Neprilysin breaks down ANP , BNP & other proteins.

Before doing lumbar puncture, fundoscopy should be done to see papilloedema to exclude raised intracranial pressure.

Reference: Davidson 23rd; P-801

Reference: Davidson 23rd; P-612
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young athletes. Davidson explains that in HCM, abnormal thickening of the heart muscle, particularly the interventricular septum, can obstruct blood flow and predispose to fatal arrhythmias. Harrison emphasises the importance of screening athletes with family histories of sudden cardiac death or unexplained syncope for HCM.

Explanation: phagocytic cell includes neutrophils, monocytes and macrophages

Davidson 23rd; P-1152

Inconsistency in symptoms and improvement with distraction are hallmarks of conversion disorder. There are no objective findings or lab abnormalities.

"Pink puffers" have emphysema — they maintain oxygenation but breathe rapidly (puffing) due to reduced alveolar surface area.

Explanation:

Reference: Davidson 23rd; P-666

Stem Breakdown:

Abdominal pain and jaundice: These symptoms indicate liver dysfunction, which can be seen in several liver conditions.
Elevated liver enzymes: suggests hepatocellular injury, as seen in liver diseases that cause inflammation or damage to hepatocytes.
Low serum ceruloplasmin: This is the key finding pointing towards Wilson’s disease, a disorder of copper metabolism where ceruloplasmin (the copper-carrying protein in blood) is deficient.
Option Analysis:

A) Wilson’s disease: This is the correct diagnosis. Davidson explains that Wilson’s disease is caused by a genetic defect in copper excretion, leading to copper accumulation in various tissues, including the liver and brain. Harrison adds that low ceruloplasmin levels and liver involvement are key diagnostic features, often presenting in young adults with hepatic or neuropsychiatric symptoms.
B) Hemochromatosis: This is a disorder of iron overload, not copper. It leads to increased serum iron and ferritin, not ceruloplasmin. While hemochromatosis can cause liver disease, it does not present with low ceruloplasmin levels.
C) Autoimmune hepatitis: Autoimmune hepatitis presents with elevated liver enzymes and positive autoantibodies (e.g., ANA, SMA), but ceruloplasmin levels are not affected.
D) Primary biliary cholangitis (PBC): PBC is an autoimmune condition affecting the bile ducts, leading to cholestasis and jaundice. It is associated with elevated alkaline phosphatase and antimitochondrial antibodies (AMA), but not low ceruloplasmin.

If CT is negative but clinical suspicion remains, lumbar puncture to detect xanthochromia is essential for diagnosing SAH

Indications of Colloid in Dengue
• Patients with massive plasma leakage
• Patients with shock with rising Hct.
• Those not responding to the maximum volume of crystalloid
• Those with pulse pressure < 10 mm Hg, who need urgent restore BP

Reference: Davidson 23rd; P-563
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]