Medicine

Explanation: durug causes dyspepsia are NSAIDs, Glucocorticoids, Iron and potassium, supplements

Projectile vomiting suggests brainstem compression (e.g., tumor, hydrocephalus)

Explanation: Campylobacter species have been linked to GBS & post infectious reactive arthritis.

Explanation: history remains the most important part of the clinical decision-making process. Studies show that physicians make a diagnosis in 70–90% of cases from the history alone

An erect chest X-ray is highly diagnostic for a perforated peptic ulcer, showing free air under the diaphragm in ~70–90% of cases. CT is sensitive, ultrasound may detect fluid, and endoscopy confirms ulcers, but X-ray is the initial, rapid test for perforation.

Hyperreflexia is not a feature of myasthenia gravis. Davidson describes myasthenia gravis as an autoimmune disorder that causes muscle weakness and fatigue, particularly affecting the ocular, facial, and limb muscles. Diplopia (double vision) and ptosis (drooping eyelids) are common presenting symptoms. Harrison explains that reflexes are usually normal, and fatigue increases with activity, improving with rest.

Answer: C
Explanation: Chronic blood loss, particularly from the gastrointestinal tract or menstruation, is the most common cause of iron deficiency anaemia worldwide. Davidson highlights that iron deficiency leads to decreased haemoglobin synthesis and microcytic, hypochromic anaemia. Harrison further emphasises that iron deficiency is more prevalent in low-income countries due to dietary insufficiency and parasitic infections.

Reference: Davidson 23rd; P-601

(Ref : Davidson 23rd ,p – 692 )

Reference: Davidson 23rd; P- 1115

Reference: Davidson 23rd; P-800
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

The 5 classic lacunar syndromes, established by Fisher in the 1960s and 1970s, are pure motor hemiparesis, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and clumsy-hand dysarthria.

Reference: Davidson 23rd , Page : 528
Explanation : The most common cause of acute endocarditis is Staphylococcus aureus.

Reference: Davidson 23rd; P-429

Constrictive pericarditis is a possibility when ascites is out of proportion to peripheral edema.

Reference: Davidson 23rd Box 21.15

ECG abnormalities: T-wave inversion, ST depression and prolonged QTc interval

Chest pain with Breathlessness: IHD, pulmonary embolism, pleurisy, anxiety.
Chest pain with Nausea, vomiting or sweating: acute myocardial infarction.
Chest pain with Burning in chest or epigastrium: GERD

Reference: Davidson 23rd; P-772
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: CT is much more sensitive and shows thickened, dilated airways

Hemolytic anemia is characterized by premature destruction of red blood cells. Haptoglobin is a protein that binds to free hemoglobin released during red blood cell destruction.

Ref: Davidson 23rd; P-1038

Reference: Davidson 23rd; P-515

Reference: Davidson 23rd; P-749

Reference: Davidson 23rd; P-434

GROSS  HEMATURIA
•Trauma
•Tumor
•IgA nephropathy
•Alport syndrome

Reference: Davidson 23rd; P-565
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Explanation: Chloroquine- Antimalarial drug, Isoniazid is anti-TB drug

Reference: Davidson 23rd; P-886, box: 22.50

Explanation: The most common cause of ulceration is genital herpes

Stem Breakdown:

Fever, arthritis, and a malar rash: These are classic symptoms of systemic lupus erythematosus (SLE), an autoimmune disease that can affect multiple organs.
Positive ANA and anti-dsDNA antibodies: These antibodies are highly specific for SLE, especially anti-dsDNA, which correlates with disease activity.
Option Analysis:

A) Rheumatoid arthritis: Rheumatoid arthritis primarily causes symmetric polyarthritis, particularly affecting the small joints of the hands and feet. It is not typically associated with a malar rash or positive anti-dsDNA antibodies.
B) Systemic lupus erythematosus (SLE): This is the correct diagnosis. Davidson and Harrison both emphasise that SLE is a systemic autoimmune disease characterised by a wide range of clinical features, including the malar (butterfly) rash, arthritis, renal involvement, and positive ANA and anti-dsDNA antibodies.
C) Dermatomyositis: Dermatomyositis is an inflammatory myopathy that causes muscle weakness and characteristic skin findings (e.g., heliotrope rash, Gottron’s papules), but it does not cause the malar rash or positive anti-dsDNA antibodies seen in SLE.
D) Sjögren’s syndrome: Sjögren’s syndrome is characterised by dry eyes and dry mouth due to autoimmune destruction of the salivary and lacrimal glands. It does not typically present with a malar rash or positive anti-dsDNA antibodies.

Explanation: Some added sounds are physiological but may also occur in pathological conditions; for example, a third sound is common in young people and in pregnancy but is also a feature of heart failure
Davidson 23rd, Box-16.8

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

Explanation: Lithium, Valproate, Lamotrigine are mood-stabilising drgus

Explanation: Gout is the most common inflammatory arthritis in men and in older women. It is caused by deposition of monosodium urate monohydrate crystals in and around synovial joints.

While both vitamin B12 and folate deficiencies cause megaloblastic anemia, only vitamin B12 deficiency typically leads to neurological symptoms. These can include peripheral neuropathy, subacute combined degeneration of the spinal cord (affecting posterior and lateral columns), paresthesias, gait disturbances, and even cognitive impairment. Folate deficiency does not cause these specific neurological issues.

Explanation: Iron deficiency anaemia is the most common type of anaemia worldwide. A thorough gastrointestinal history is important, looking in particular for symptoms of blood loss. Menorrhagia is a common cause of anaemia in pre-menopausal females, so women should always be asked about their periods

Explanation: Lumbar puncture is mandatory unless there are contraindications in a patient of meningitis

Haemorrhagic disease of the newborn: Haemorrhagic disease of the newborn: enzyme-inducing antiepileptic drugs increase risk. Give IM vitamin K (1 mg) to the infant at birth.

Explanation: Causes of Right iliac fossa mass are: Caecal carcinoma, Crohn’s disease & Appendix abscess

Aplastic anaemia is characterized by pancytopenia and a hypocellular marrow. Often idiopathic or drug-induced.

Explanation: Staph. aureus has now overtaken streptococci as the most common cause of acute endocarditis

Reference: Davidson 23rd: Box-17.12

Osteoarthritis is primarily a disease of articular cartilage, characterized by progressive cartilage degradation, loss, and fibrillation. This is accompanied by subchondral bone remodeling, osteophyte formation, and mild synovial inflammation.

Reference: Davidson 23rd; P-145
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-533
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Management
The aims of management are to relieve symptoms, induce healing and prevent recurrence. H. pylori eradication is the cornerstone of therapy for peptic ulcers, as this will successfully prevent relapse and eliminate the need for long-term therapy in the majority of patients.

Page-814

Blood culture establishes the diagnosis  and multiple cultures increase the yield
^{Stool cultures are often positive in  the  second and third weeks}
The Widal test detects antibodies to the O  and H antigens but is not specific

Reference: Practical Manual in Clinical Medicine by ABM Abdullah Sir; P-797

T

Anorexia, nausea, vomiting–acute viral hepatitis, may be drug induced hepatitis.
Itching with pale or dark pale stool–obstructive jaundice.
Long standing jaundice with itching, pigmentation of skin–primary biliary cirrhosis.

Explanation: Organic mental disorders: Dementias, Delirium Other mental disorders due to brain damage or disease