Medicine

Nucleic acid vaccines
 COVID-19 (RNA vaccines)  Ebola virus (DNA in clinical trials)

Reference: Davidson 23rd; P-357

This is a sign of meningitis.

The pivotal investigation is echocardiography, which can confirm the diagnosis and also helps to identify the optimum site for aspiration of the fluid.

Dyspnea but chest is clear—pulmonary embolism, metabolic acidosis (diabeti ketoacidosis, renal failure, lactic acidosis salicylate poisoning), severe anemia, shock, pneumocystis jiroveci pneumonia, psychogenic.

Dyspnea with stridor (indicates upper airway obstruction)—foreign body or tumor, acute epiglottitis, anaphylactic reaction, laryngeal trauma, laryngeal fracture.

Mood disorders Mood or affective disorders include:
 unipolar depression: one or more episodes of low mood and associated symptoms
 bipolar disorder: episodes of elevated mood interspersed with episodes of depression
 dysthymia: chronic low-grade depressed mood without sufcient other symptoms to count as ‘clinically signicant’ or ‘major’ depression.

Reed–Sternberg cells (giant binucleate cells) are pathognomonic for Hodgkin lymphoma.

• Patient feeling feverish with excessive sweating—Thyrotoxicosis.

Explanation: Infarct (85%), Haemorrhage (15%), venous (1%)

Stem Breakdown:

Fever, weight loss, and a new systolic murmur: These symptoms are concerning for a systemic infection affecting the heart valves, raising suspicion for infective endocarditis. Murmurs are common in endocarditis due to the vegetation forming on heart valves.
Blood cultures grow gramme-positive cocci. This is typical for organisms like Streptococcus viridans and Staphylococcus aureus, both of which commonly cause infective endocarditis.
Option Analysis:

A) Infective endocarditis: This is the correct diagnosis. Endocarditis is characterised by infection of the heart valves or endocardium, often due to gramme-positive organisms. Davidson and Harrison explain that fever, new murmurs, and positive blood cultures are hallmarks of the disease. Risk factors include valve disease, intravenous drug use, or recent dental procedures.
B) Rheumatic heart disease: While this condition can cause valvular damage, it usually arises as a sequela of untreated streptococcal pharyngitis and does not typically present with acute infection or gramme-positive bacteremia. Rheumatic disease causes chronic changes in valve function, not an acute systemic infection.
C) Pericarditis: Pericarditis often presents with sharp chest pain that improves when sitting up and has different auscultatory findings (pericardial friction rub) compared to a systolic murmur. Blood cultures in pericarditis are typically sterile unless there is a coexisting infection.
D) Myocarditis: Myocarditis primarily involves inflammation of the heart muscle, often due to viral infections. It may cause heart failure symptoms or arrhythmias but typically does not cause systolic murmurs or gramme-positive bacteremia.

Reference: Davidson 23rd; P-556

Explanation: pleural fluid accumulates as a result of either increased hydrostatic pressure or decreased osmotic pressure (‘transudative’ effusion, as seen in cardiac, liver or renal failure), or from increased microvascular pressure due to disease of the pleura or injury in the adjacent lung (‘exudative’ effusion).

Reference: Davidson 23rd, Box-18.11

Staphylococcus aureus is the most common cause of septic arthritis in all age groups, especially in those with joint prostheses or IV drug use.

Nail pitting is a common finding in psoriasis, resulting from defective keratinization in the nail matrix. Other nail changes include onycholysis (nail plate separation), subungual hyperkeratosis, and ridging. Nail involvement is more frequent in patients with psoriatic arthritis.

Reference: Davidson 23rd; P-575
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

The BCR-ABL fusion gene (t(9;22)) is diagnostic of CML and is the target of tyrosine kinase inhibitors like imatinib.

CT pulmonary angiography is the best initial diagnostic test for suspected pulmonary embolism. Davidson explains that CT angiography provides direct visualization of thrombi in the pulmonary arteries and is the gold standard for diagnosis. Harrison adds that while the D-dimer test is highly sensitive for detecting clot formation, it lacks specificity, and CT pulmonary angiography should be performed for definitive diagnosis.

Urethritis + arthritis + conjunctivitis = reactive arthritis
Reactive arthritis >>>> the Pt. can’t see, can’t pee, can’t bend the knee

Explanation: Ultrasound scanning can confirm the diagnosis of acute pancreatitis

Explanation: Aschoff nodules is pathognomonic for rheumatic fever and occur only in the heart

( Ref : Davidson 23rd ,p - 281 )

Reference: Davidson 23rd; P-665

Reference: Davidson 23rd; P-351

Reference: Davidson 23rd, Page: 1066 , Box : 25.2

Explanation: Paracetamol (1 g up to 4 times daily) is the oral analgesic of first choice for mild to moderate pain

Each kidney is approximately 10–13 cm in length in healthy adults;they are located retroperitoneally on either side of the aorta and inferior vena cava between the 12th thoracic and 3rd lumbar vertebrae (Fig. 18.1A). The right kidney is usually a few centimetres lower because the liver lies above it. Both kidneys rise and descend several centimetres with respiration.

Stem Breakdown:

Heat intolerance, palpitations, weight loss, and diarrhoea: These symptoms are classic for hyperthyroidism, indicating increased metabolism.
Diffusely enlarged thyroid: A diffusely enlarged thyroid without nodularity is characteristic of Graves’ disease.
Low TSH and elevated free T4: These lab findings confirm hyperthyroidism, with low TSH due to feedback inhibition and high free T4 indicating excessive thyroid hormone production.
Option Analysis:

A) Graves’ disease: This is the correct diagnosis. Davidson and Harrison describe Graves’ disease as the most common cause of hyperthyroidism, characterised by a diffusely enlarged thyroid gland, low TSH, and elevated free T4. Graves' disease is caused by autoantibodies that stimulate the TSH receptor, leading to increased thyroid hormone production.
B) Subacute thyroiditis: Subacute thyroiditis can cause transient hyperthyroidism due to the release of preformed thyroid hormone, but it is usually associated with neck pain and tenderness, not a diffusely enlarged thyroid.
C) Toxic multinodular goitre: Toxic multinodular goitre causes hyperthyroidism due to the presence of multiple autonomous thyroid nodules. The thyroid gland is typically irregular and nodular, not diffusely enlarged.
D) Hashimoto’s thyroiditis: Hashimoto's thyroiditis is a common cause of hypothyroidism, not hyperthyroidism. It causes a firm, enlarged thyroid and is associated with high TSH and low T4 levels.

Reference: Davidson 23rd; P-872
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-748

Reference: Davidson 23rd; P-758

Explanation: ACE inhibitors causes angioedema

Explanation: Obesity is regarded as a pandemic, with potentially disastrous consequences for human health.

Reference: Davidson 23rd; P-638

Reference: Davidson 23rd; P-357

Scurvy
Vitamin C deciency affects the normal synthesis of collagen and results in a bleeding disorder characterised by perifollicular and petechial haemorrhage, bruising and subperiosteal bleeding. The key to diagnosis is the dietary history

Reference: Davidson 23rd; P-637

Due to volume and duration of right ventricular ejection remaining the same during inspiration and expiration, there is little inspiratory exaggeration of the splitting of S2 in ASD.

Reference: Davidson 23rd; P-547

Hyperkalaemia is a common finding in adrenal insufficiency due to decreased aldosterone secretion. Davidson explains that oestrogen normally promotes sodium reabsorption and potassium excretion in the kidneys. In Addison’s disease, low aldosterone levels lead to sodium loss and potassium retention. Harrison adds that adrenal insufficiency also leads to hyponatremia and volume depletion due to salt wasting.

Reference: Davidson 23rd; P-1088(Fig-25.19)

Reference: Davidson 23rd; P-868

Stem Breakdown:

Epigastric pain, nausea, and vomiting: These are common symptoms of peptic ulcer disease (PUD).
Pain worsens after meals and improves with antacids: This suggests acid-related irritation, consistent with PUD. Antacids neutralise stomach acid, providing relief.
History of NSAID use: NSAIDs are a known risk factor for PUD because they inhibit prostaglandin synthesis, reducing the protective mucus layer in the stomach.
Option Analysis:

A) Peptic ulcer disease: This is the correct diagnosis. Davidson and Harrison explain that peptic ulcer disease is characterised by the formation of ulcers in the stomach or duodenum, often caused by NSAID use or Helicobacter pylori infection. NSAIDs disrupt the stomach’s protective mechanisms, leading to ulceration. Epigastric pain that worsens after eating and improves with antacids is typical of PUD.
B) Acute pancreatitis: Pancreatitis causes severe epigastric pain that radiates to the back, along with nausea and vomiting. The pain is typically worse after eating, but antacids do not relieve it. Pancreatitis is more often associated with elevated amylase and lipase levels.
C) Gallstones: Gallstones cause biliary colic, a sharp right upper quadrant pain that may radiate to the shoulder. The pain is not typically relieved by antacids, and gallstones are more common in women and those with risk factors like obesity and pregnancy.
D) Gastro-oesophageal reflux disease (GERD): GERD can cause epigastric pain and heartburn, but the pain is more likely to be retrosternal (behind the breastbone) and related to reflux of stomach acid into the oesophagus. GERD is associated with regurgitation and burning sensation rather than pain that improves with antacids.