Medicine

Explanation: Option B,C, D Causes pitting oedema.

Mild falciparum malaria
Preferred therapy
• Co-artemether (CoArtem or Riamet); contains artemether and lumefantrine (4 tablets orally at 0, 8, 24, 36, 48 and 60 hrs)
Alternative therapy
• Quinine (600 mg of quinine salt 3 times daily orally for 5-7 days), together with or followed by doxycycline (200 mg once daily orally for 7 days)
Use clindamycin not doxycycline if the patient is a pregnant woman or young child
or
• Atovaquone-proguanil (Malarone, 4 tablets orally once daily for 3 days)
Pregnancy
• Co-artemether but avoid in early pregnancy
• If not using co-artemether, use quinine plus clindamycin (450 mg 3 times daily orally for 7 days)
Other regimens
• Artesunate (200 mg orally daily for 3 days) and mefloquine (1 g orally on day 2 and 500 mg orally on day 3)

Breast implant infection
Staphylococcus aureus
Coagulase-negative staphylococci
Peritoneal dialysis-related peritoniti
Staphylococcus aureus
Coagulase-negative staphylococci Coliforms
Pseudomonas spp.

Reference: Practical Manual in Clinical Medicine by Professor ABM Abdullah; P-162

Bulimia nervosa
 Recurrent bouts of binge eating 
Lack of self-control over eating during binges 
Self-induced vomiting, purgation or dieting after binges 
Weight maintained within normal limits

Anti-dsDNA (double-stranded DNA) antibodies are highly specific for SLE (present in ~60-80% of patients) and their titers often fluctuate with disease activity, particularly in lupus nephritis. Anti-Sm antibodies are also highly specific but less sensitive. Anti-Ro/SSA and Anti-La/SSB are associated with SLE but also Sjogren's syndrome.

Explanation: The area most commonly affected is the ileocaecal region

Reference: Davidson 23rd, Page: 760
Explanation: Median nerve compression is more common in diabetes causing carpal tunnel syndrome.

Explanation: The presence of leucocytes and nitrites in urine is indicative of renal tract infection

Explanation: Diarrhoea and weight loss in patients with a normal diet are likely to be caused by malabsorption.

Parathyroid glands are derived from the epithelial lining of the third and fourth pharyngeal pouches, with the superior glands arising from the fourth pouch and the inferior glands arising from the higher third pouch.

Reference: Davidson 23rd; P-800

:Chronic pancreatitis is most commonly caused by long-term alcohol abuse. Davidson explains that alcohol leads to repeated inflammation and fibrosis of the pancreas, resulting in exocrine and endocrine dysfunction. Harrison highlights that chronic pancreatitis presents with abdominal pain, malabsorption, and diabetes.

Immune-related adverse events should be considered in all patients who present acutely unwell following immunotherapy treatments for cancer. Although the other options are on the differential diagnosis list, severe IRAEs are oncological emergencies, and prompt recognition and management are vital. This is a grade 3 colitis and should be treated with IV methylprednisolone in the first instance. Investigations such as bloods, stool samples, radiological imaging and flexible sigmoidoscopy or colonoscopy are also appropriate.

Explanation: Iron deficiency anaemia is the most common type of anaemia worldwide.

Explanation: Main side effects of ACE inhibitors are: Renal impairment and Hyperkalemia

Davidson 23rd, Box-19.28

Reference: Davidson 23rd; P-568

Reference: Davidson 23rd, Box-23.17

Reference: Davidson 23rd, Box-16.72

Reference: Davidson 23rd, Page: 746 , Box : 20.26

Reference: Davidson 23rd; P-637

Explanation: Chest pain on effort is the hallmark of angina pectoris

CCBs (e.g., amlodipine) or thiazide diuretics as first-line for isolated systolic hypertension, particularly in the elderly, due to their efficacy in reducing systolic BP and improving arterial compliance.

Explanation: The area most commonly affected is the Ileal or ileocolonic region

Explanation: SAH typically presents with a sudden, severe, ‘thunderclap’ headache (often occipital), which lasts for hours or even days, often accompanied by vomiting, raised blood pressure and neck stiffness or pain. It commonly occurs on physical exertion, straining and sexual excitement.

Explanation: Dry (or neurological) beri-beri manifests with chronic peripheral neuropathy and with wrist and/or foot drop, and may cause Korsakoff’s psychosis and Wernicke’s encephalopathy

Reference: Davidson 23rd; P-393

Reference: Davidson 23rd; P-838

Explanation: Oliguria is defined as being present when less than 400 mL of urine is passed per day, whereas anuria is deemed to exist when less than 100 mL of urine is passed per day

In polycystic kidney disease erythropoietin production isn’t hampered, even there is increased production.

Crescent formation in glomeruli is a hallmark of rapidly progressive glomerulonephritis, a severe form of nephritic syndrome. Podocyte effacement is seen in nephrotic syndrome.

 Polysomnography (sleep study) is the gold standard for diagnosing obstructive sleep apnea (OSA). Davidson explains that polysomnography monitors various physiological parameters, including airflow, respiratory effort, oxygen saturation, and brain activity, to assess for apneic events during sleep. Harrison adds that the severity of OSA is determined by the apnea-hypopnea index (AHI), which is the number of apneas and hypopneas per hour of sleep.

MUS refer to physical symptoms for which a comprehensive medical evaluation has failed to reveal an underlying organic disease process that adequately explains the symptoms. This doesn't mean they are "all in their head" or fabricated, but rather that current medical knowledge or diagnostic tools cannot pinpoint a clear physical cause.

Reference: Davidson 23rd, Box-15.10

Lindsay’s nails
White/brown ‘half-and-half’ nails
Found in-  Chronic kidney disease

Macleod 14/box 3.4

Reference: Davidson 23rd Fig. 21.52

Sensory: 1, 2, 8
Motor: 3, 4, 6, 11, 12
Mixed: 5, 7, 9, 10

Explanation: Culture is gold standard investigation for Tuberculosis

Keshan disease is a severe form of dilated cardiomyopathy that occurs in areas with extremely low soil selenium content, where populations consume predominantly locally grown foods. Selenium deficiency leads to impaired antioxidant defense in the heart, making it vulnerable to oxidative stress and viral infections.

The presence of both nitrites (from bacterial reduction of nitrate) and leukocyte esterase (indicating pyuria) is highly suggestive of UTI.

Reference: Davidson 23rd; P-841

Bacterial meningitis typically shows-
neutrophilic pleocytosis, elevated protein, and low glucose

1.
Massive proteinuria, with the daily loss of 3.5 gm or more of protein (less in children)
2.
Hypoalbuminemia, with plasma albumin levels  less than 3 gm/dL
3.
Generalized edema
4.
Hyperlipidemia and lipiduria

Targets for antiphospholipid antibodies
 β2 -glycoprotein 1
 Protein C  Annexin V  Prothrombin (may result in haemorrhagic presentation)

Explanation: Humoral immunity is mediated by B lymphocytes, which differentiate from haematopoietic stem cells in the bone marrow.

Post-bariatric surgery, malabsorption of B12, iron, calcium, and vitamin D is common due to reduced gastric acid/intrinsic factor.

Explanation:

Reference: Davidson 23rd; P-411

Explanation: Red cell folate levels are a more accurate indicator of folate stores and tissue folate deficiency.

In the immediate aftermath of a significant trauma, the main aim is to provide support, direct advice and the opportunity for emotional catharsis (routine debriefing may actually be harmful).
In established PTSD, structured psychological approaches (CBT, eye movement desensitisation and reprocessing (EMDR) and stress management) are effective. Antidepressant drugs are moderately effective.

Labetalol, a combined alpha- and beta-blocker, is commonly used in hypertensive emergencies to rapidly lower blood pressure. Davidson explains that hypertensive emergencies require immediate reduction of blood pressure to prevent organ damage, and labetalol is effective due to its rapid onset and short half-life. Harrison emphasizes that intravenous administration is preferred in emergencies, and care must be taken to avoid an excessive drop in blood pressure.

CTPA is the gold standard for diagnosing pulmonary embolism, directly visualizing thrombus in pulmonary arteries. D-dimer is sensitive but not specific, and chest X-ray and arterial blood gas are non-specific

Acute cellular rejection is the most common form of graft rejection.

Chronic liver disease reduces hepatic clearance of estrogen, leading to features like spider naevi, gynecomastia, and palmar erythema.