Medicine

Artemether-lumefantrine, an artemisinin-based combination therapy (ACT), is the first-line treatment for uncomplicated P. falciparum malaria due to its rapid action and high efficacy. Chloroquine is ineffective against resistant strains, and quinine is reserved for severe cases

Reference: Davidson 23rd; P-137
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: In endemic regions, a highly sensitive direct agglutination test using stained promastigotes and an equally efficient rapid immunochromatographic k39 strip test have become popular for the Diagnosis of Visceral Leishmaniasis

Diuretics, particularly loop diuretics like furosemide, are the first-line treatment for acute decompensated heart failure (ADHF) to relieve fluid overload. Davidson notes that diuretics reduce pulmonary congestion and improve symptoms of breathlessness and edema. Harrison emphasizes that while ACE inhibitors and beta-blockers are important in chronic heart failure, diuretics are crucial for acute management to quickly reduce volume overload.

Explanation: Niacin Deficiency – pellagra, Thiamin Deficiency – beri-beri

DKA is the most serious acute complication of type 1 diabetes, marked by hyperglycemia, ketosis, and acidosis due to insulin deficiency. Hyperosmolar hyperglycemic state is more common in type 2, hypoglycemia is a treatment complication, and lactic acidosis is rare and linked to metformin.

Reference: Davidson 23rd; P-889
Explanation: On liver biopsy, the characteristics early features of PSC are periductal ‘onion skin’ fibrosis and inflammation.

Reference: Davidson 23rd; P-588
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Saline/ Chloride responsive:  Associated with hypovolemia and  responds to N/S infusion

•Ingestion of Alkaline Drugs
•GIT Cause
•Diuretic administration

Amoebiasis, caused by Entamoeba histolytica, most commonly leads to amoebic liver abscess as an extraintestinal complication. This occurs when trophozoites invade the portal vein, causing abscesses in the liver, typically presenting with fever, right upper quadrant pain, and hepatomegaly. Other extraintestinal sites like the brain or lung are rare

Reference: Davidson 23rd; P-862
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-620

Reference: Davidson 23rd; P-419

Reference: Davidson 23rd , Page : 718
Explanation : keshan’s disease ( cardiomyopathy in children ) occurs due to selenium deficiency .

Mitral stenosis is the most common long-term cardiac complication of rheumatic fever. Davidson describes that rheumatic fever causes inflammation and scarring of the heart valves, particularly the mitral valve, leading to progressive narrowing. Harrison adds that untreated or recurrent rheumatic fever increases the risk of chronic rheumatic heart disease, often manifesting years after the initial infection.

Ref: Davidson 23rd; P- 941

Ref: Davidson 23rd; P-1004 , box : 24.34

Rheumatic heart disease as the most common cause of mitral stenosis, particularly in developing countries, due to post-streptococcal inflammation leading to valve scarring. Congenital malformation (b) is rare, infective endocarditis (c) may cause regurgitation rather than stenosis, and degenerative calcification (d) is more associated with aortic stenosis in the elderly.

Reference: Davidson 23rd; P-859
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-429

Reference: Davidson 23rd; P-546

Explanation: The combination of absent breath sounds and a resonant percussion note is diagnostic of pneumothorax

Explanation: Treatment duration of abdominal Tuberculosis- 6 months

Reference: Davidson 23rd; P-518
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-429

Faecal elastase is a sensitive non-invasive test for pancreatic enzyme output. Low values indicate exocrine insufficiency.

Reference: Davidson 23rd; P-593

•Pancytopenia is common.
•Moderate to severe anaemia develops  rapidly and can cause cardiac failure.
•Thrombocytopenia, often compounded by  hepatic dysfunction, may result in bleeding  from the retina, gastrointestinal tract and  nose.
•In advanced illness, hypoalbuminemia may  manifest as pedal oedema, ascites and  anasarca (gross generalized oedema and  swelling).

Explanation:

Malignant disease
 Breast cancer  Bronchogenic cancer
 Leukaemia  Lymphoma

An ECG is the most critical initial investigation in suspected ACS to identify ST-elevation myocardial infarction (STEMI) or ischemic changes (e.g., ST depression, T-wave inversion) that guide urgent management (e.g., percutaneous coronary intervention).

Phase III RCTs are often used to determine whether a treatment should be licenced for clinical use. Patients are randomised to each arm, sometimes with stratification to ensure equal allocation of patient subgroups. RCTs may be double-blinded, as is the case here, single-blinded or ‘open-label’. The control arm should be the current clinical standard treatment. In this example, a placebo is used in place of observation only to ensure blinding and avoid potential bias of results. Patients may be divided in alternative ratios. This is sometimes the case when earlier studies suggest large differences between the investigational and current treatment.

Myasthenia gravis is an autoimmune disease, most commonly (80% of cases) caused by antibodies to acetylcholine receptors in the post-junctional membrane of the neuromuscular junction. The resultant blockage of neuromuscular transmission and complement-mediated inflammatory response reduces the number of acetylcholine receptors and damages the end plate (Fig. 28.50). Other antibodies can produce a similar clinical picture, most notably autoantibodies to muscle-specific kinase (MuSK), which is involved in the regulation and maintenance of acetylcholine receptors.

Hyperpigmentation (skin and mucous membranes) is a hallmark of Addison’s disease, caused by elevated ACTH stimulating melanocytes. Weight loss (not gain), weakness, and hypotension (not tachycardia) are typical; moon face is seen in Cushing’s.

Reference: Davidson 23rd; P-608
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-428

Reference: Davidson 23rd; P-358

Reference: Davidson 23rd; P-588

Individual hepatocytes are separated from the leaky sinusoids by the space of Disse, which contains stellate cells that store vitamin A and play an important part in regulating liver blood flow.

Reference: Davidson 23rd; P-464
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: A delusion is a false belief, Illusions are misperceptions of real stimuli. Hallucinations are sensory perceptions that occur in the absence of external stimuli

Reference: Davidson 23rd; P-133

Explanation: Microalbuminuria is the most sensitive test for detecting early diabetic nephropathy. Davidson explains that albumin excretion increases in the early stages of kidney damage, even before significant declines in GFR or rises in serum creatinine are seen. Harrison emphasises that early detection through microalbuminuria allows for timely interventions to slow disease progression.