Medicine

Reference: Davidson 23rd; P-574
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-758 , fig : 20.22

Reference: Davidson 23rd; P-798

Reference: Davidson 23rd; P-133

Untreated gonorrhoea in men can lead to epididymitis, presenting as painful swelling of the epididymis. Urethral stricture is a late complication, and prostatitis or orchitis is less common

Reference: Davidson 23rd , Page : 1233
Explanation : Niacin deficiency ( Vitamin B3 ) - pellagra can also seem in carcinoid syndrome.

Pulmonary hypertension is the leading cause of death in patients with systemic sclerosis, according to Davidson. It results from vascular damage and fibrosis within the lungs. Harrison explains that early detection and treatment of pulmonary hypertension are essential to improving survival in systemic sclerosis patients.

Reference: Davidson 23rd; P-583
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-836(Box-21.75)

Reference: Davidson 23rd; P-640

Persistent mild jaundice indicates Gilbert’s syndrome.
Jaundice with high fever and urinary complain indicates leptospirosis.
Recurrent jaundice with neurological abnormality—Wilson’s disease.

Explanation: Loss of acidic gastric contents leads to alkalosis and dehydration with low serum chloride and potassium and raised serum bicarbonate and urea concentrations (hypochloraemic metabolic alkalosis).

Reference: Davidson 23rd , Page : 716
Explanation : Too much calcium can lead to constipation , and toxicity has been observed in ‘milk-alkali syndrome’.

Reactive arthritis (a seronegative spondyloarthropathy) commonly follows genitourinary (Chlamydia) or gastrointestinal infections (Salmonella, Shigella). It presents with asymmetric oligoarthritis, often involving lower limbs, and may include conjunctivitis and urethritis.

Megaloblastic anemia is primarily caused by impaired DNA synthesis, most commonly due to vitamin B12 or folate deficiency. This leads to ineffective erythropoiesis and the presence of abnormally large red blood cell precursors (megaloblasts) in the bone marrow. A key peripheral blood smear finding is hypersegmented neutrophils (five or more lobes), which are characteristic of defective nuclear maturation in granulocytes.

Reference: Davidson 23rd, Box-29.1

Explanation: Chronic lymphocytic leukaemia (CLL) is the most common variety of leukaemia

Explanation: Ependymal cells line the cerebral ventricles. Oligodendrocytes are responsible for the formation and maintenance of the myelin sheath. Astrocytes form the structural framework for neurons

Reference: Davidson 23rd; P-858

Reference: Davidson 23rd; P-556

Reference: Davidson 23rd; P-599

Explanation: Leptospirainterrogans persist indefinitely in the convoluted tubules of the kidney.

Reference: Davidson 23rd; P-875
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Stem Breakdown:

Polyuria, polydipsia, and weight loss: These symptoms indicate uncontrolled hyperglycemia, suggesting diabetes mellitus.
Fasting blood glucose of 230 mg/dL and HbA1c of 10.5%: These levels confirm the diagnosis of diabetes, with an HbA1c >6.5% indicating poorly controlled blood glucose.
Option Analysis:

A) Insulin: Insulin is used in type 1 diabetes and in type 2 diabetes when oral agents fail to achieve glycaemic control. However, for most newly diagnosed type 2 diabetes patients, oral hypoglycemic agents are first-line unless there are signs of diabetic ketoacidosis or severe hyperglycemia.
B) Metformin: This is the correct answer. Davidson and Harrison both recommend metformin as the first-line therapy for type 2 diabetes, as it effectively lowers blood glucose by improving insulin sensitivity and reducing hepatic glucose production without causing significant hypoglycemia. It is typically used in patients who are overweight, as it does not promote weight gain.
C) Sulfonylureas: Sulfonylureas (e.g., glipizide, glyburide) are effective in lowering blood glucose but are associated with weight gain and a higher risk of hypoglycemia compared to metformin. They are often used as second-line agents if metformin alone is insufficient.
D) DPP-4 inhibitors: DPP-4 inhibitors (e.g., sitagliptin) help increase insulin secretion and reduce glucagon secretion but are generally used as add-on therapy to metformin. They are not as effective as first-line treatment for most patients with type 2 diabetes.

Reference: Davidson 23rd , Page : 712 , Box : 29.32

Reference: Davidson 23rd; P-746

Reference: Davidson 23rd; P-565

Ref: Davidson 23rd; P-982

Reference: Davidson 23rd; P-133

In obstructive (post-hepatic) jaundice, conjugated bilirubin cannot reach the intestine, leading to pale stools and is excreted in urine, causing dark discoloration.

Explanation: Metformin is used as first-line therapy for type 2 diabetes, irrespective of body weight

Reference: Davidson 23rd; P-644

Reference: Davidson 23rd; P-825

Reference: Davidson 23rd; P-617

Explanation: Metformin- is an oral anti diabetic drug

Explanation: Night sweats is common in TB & infective endocarditis

Investigations
1 to 5 days of fever : CBC, NS1 antigen, SGOT and SGPT (Not mandatory but helpful)
• After day7: IgM and IgG Antibodies (Day 5-7 window period)
• Follow up testing may be done on 1st afebrile day, but should be done daily when DHF is suspected
Haematocrit:
-A regular haematocrit is more important for management than the thrombocytopenia
-In severe dengue especially with shock hourly haematocrit is crucial for management

Soft-tissue swelling that most frequently affects the face (Fig. 4.15) but can also affect the extremities and genitalia characterizes angioedema. Involvement of the larynx or tongue may cause life-threatening respiratory tract obstruction, and oedema of the intestinal mucosa may cause abdominal pain and distension.

Foul smelling dark colored sputum: lung abscess
Rusty sputum: pneumococcal pneumonia.
Productive cough with frothy sputum occurs in pulmonary edema.
Barking cough: acute epiglottitis.

Reference: Davidson 23rd; P-818

Davidson P852

Ultrasound scanning can confirm the diagnosis, although in the earlier stages the gland may not be grossly swollen. An ultrasound scan is also useful because it may show gallstones, biliary obstruction or pseudocyst formation.

Contrast-enhanced pancreatic CT performed at least 3 days after
admission can be useful in assessing viability of the pancreas if persisting organ failure, sepsis or clinical deterioration is present, since these features may indicate that pancreatic necrosis has occurred.

Transposition of the great arteries (TGA) causes severe cyanosis at birth due to parallel pulmonary and systemic circulations. Mixing of blood (e.g., via a patent ductus arteriosus) is required for survival until corrective surgery.

Reference: Davidson 23rd; P-547

Reference: Davidson 23rd; P-816

Reference: Davidson 23rd, Page: 733 Box : 20.9

Dilated bronchi parallel to adjacent vessels create tram-tracks signs