Medicine

Viruses are the most common cause of meningitis, usually resulting in a benign and self-limiting illness requiring no specific therapy. It is much less serious than bacterial meningitis unless there is associated encephalitis. A number of viruses can cause meningitis (see Box 28.59), the most common being enteroviruses. Where specific immunisation is not employed, the mumps virus is a common cause.

Appendicitis as the most common cause of acute right lower quadrant pain in young adults, often with tenderness at McBurney’s point, fever, and nausea. Diverticulitis typically affects the left side in older patients, cholecystitis causes right upper pain, and pancreatitis is epigastric, making appendicitis the best fit.

Painless lymphadenopathy, especially in the cervical or supraclavicular regions, is the most common presenting symptom of Hodgkin lymphoma. Davidson describes that patients may also experience systemic "B symptoms" such as fever, night sweats, and weight loss. Harrison adds that Hodgkin lymphoma often spreads in a predictable pattern from one lymph node group to another, and the presence of Reed-Sternberg cells on biopsy is diagnostic.

An ataxic gait can result from lesions in the cerebellum, vestibular apparatus or peripheral nerves

Explanation: Monocyte & Lymphocytes are agranulocytic white blood cell.

Explanation: M. leprae has tropism for Schwann cells and skin macrophages.

The diagnosis of Kala-azar will be based on the  following criteria in a symptomatic case.

History of fever for more than 2 weeks
Residing/ traveling in endemic areas
Any one of the following symptoms and signs:
1.Splenomegaly
2.Weight loss
3.Anemia
And ‘rk39’ test (+) positive.

While elevated uric acid, podagra, and radiographic changes are suggestive, the definitive diagnosis of gout is made by aspirating synovial fluid from the affected joint and visualizing characteristic negatively birefringent, needle-shaped monosodium urate (MSU) crystals under a polarized light microscope.

Pel-Ebstein fever describes cyclical fever (1–2 weeks of fever alternating with afebrile periods), classic for Hodgkin’s

GAD is defined by excessive, persistent worry lasting ≥6 months about various life domains, along with physical symptoms (e.g., fatigue, muscle tension).

Osteoporosis is a well-known side effect of long-term corticosteroid therapy. Davidson explains that corticosteroids reduce bone formation and increase bone resorption, leading to decreased bone density and an increased risk of fractures. Harrison adds that patients on long-term corticosteroids should be monitored for bone loss and may require prophylactic treatment with calcium, vitamin D, and bisphosphonates to reduce the risk of osteoporosis.

Red cells infected with malaria undergo haemolysis  which is most severe with P. falciparum that  invades red cells of all ages.
P. vivax and P. ovale preferentially invade younger  cells, and P. malariae normoblasts

Explanation: Antidepressants are the drugs of first choice. The therapeutic dose is usually higher for anxiety disorders than for depression

Explanation: An elevated blood urea with normal creatinine concentration implies severe bleeding

Explanation: Turner’s syndrome (45,X) is an example of Numerical chromosomal abnormalities

Extension of pituitary tumor into avernous sinus with subsequent compression of the 3rd, 4th or 6th  cranial nerve may cause diplopia and strabismus, but in anterior pituitary  tumours this is an unusual presentation.

Davidson 24th-695

Reference: Davidson 23rd; P-593

Explanation: histological features of Ulcerative colitis are: Inflammation limited to mucosa, crypt distortion, cryptitis, crypt abscesses, loss of goblet cells,

Reference: Davidson 23rd; P-389

Explanation: The specific benzodiazepine antagonist flumazenil (0.5 mg IV, repeated if needed) increases conscious level in patients with benzodiazepine overdose

Reference: Davidson 23rd; P-581

( Ref : Davidson 23rd ,p - 712 , box : 19.32 )

Reference: Davidson 23rd; P-841

These are the classic radiographic hallmarks of osteoarthritis. Joint space narrowing indicates cartilage loss, osteophytes are bony outgrowths at joint margins, and subchondral sclerosis refers to increased bone density beneath the cartilage.

Reference: Davidson 23rd; P-524

Explanation: Factor VIII deficiency resulting in haemophilia A affects 1/10 000 individuals. It is the most common congenital coagulation factor deficiency

Astrocytes form the structural framework for neurons and control their biochemical environment, their foot processes adjoining small blood vessels and forming the blood–brain barrier (Fig.28.1).

Oligodendrocytes are responsible for the formation and maintenance of the myelin sheath, which surrounds axons and is essential for maintaining the speed and consistency of action potential propagation along axons. Peripheral nerves have axons invested in myelin made by oligodendrocytes (Schwann cells).

Microglial cells derive from monocytes/macrophages and play a role in fighting infection and removing damaged cells.

Ependymal cells line the cerebral ventricles.

ABM 474

Reference: Davidson 23rd; P-812

Explanation: Vitamins are organic substances with key roles in certain metabolic pathways, and are categorised into those that are fat-soluble (vitamins A, D, E and K) and those that are water-soluble (vitamins of the B complex group and vitamin C).

VT shows broad QRS (>140 ms) and AV dissociation

Stem Breakdown:

Back pain, fatigue, and recurrent infections: These symptoms suggest multiple myeloma, a plasma cell malignancy that causes bone pain, anemia, and immunodeficiency.
Hypercalcemia and anemia: Hypercalcemia is due to bone destruction (osteolytic lesions), and anemia results from bone marrow infiltration by malignant plasma cells.
Elevated serum protein levels and rouleaux formation: These findings suggest excess monoclonal proteins (M-protein) in the blood, which is characteristic of multiple myeloma.
Option Analysis:

A) Multiple myeloma: This is the correct diagnosis. Davidson and Harrison describe multiple myeloma as a malignancy of plasma cells, leading to bone destruction, anemia, hypercalcemia, renal dysfunction, and immunodeficiency. Rouleaux formation on a blood smear is due to high levels of circulating monoclonal proteins, which interfere with red blood cell separation.
B) Chronic lymphocytic leukemia (CLL): CLL is a malignancy of B lymphocytes and causes lymphadenopathy, fatigue, and increased susceptibility to infections. However, it does not cause hypercalcemia or rouleaux formation.
C) Waldenström’s macroglobulinemia: This condition is associated with the production of IgM monoclonal protein, which can cause hyperviscosity symptoms but does not typically cause bone pain, hypercalcemia, or rouleaux formation.
D) Hyperparathyroidism: Hyperparathyroidism causes hypercalcemia due to overproduction of parathyroid hormone, but it does not cause anemia, rouleaux formation, or elevated serum protein levels.

Reference: Davidson 23rd, Box-25.87

Explanation: Option A,B,D causes obstructive jaundice

Horner’s syndrome results from disruption of the sympathetic pathway, commonly due to a Pancoast tumor (apical lung cancer). This tumor can invade the brachial plexus and cervical sympathetic chain, causing the classic triad: ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating). Its presence points to locally advanced disease, often requiring chemoradiotherapy.

Reference: Davidson 23rd; P-783
Explanation : The most common cause is irritable bowel syndrome which can present with increased frequency of defecation and loose , watery or pellety stools.

NSAIDs are the first-line treatment for acute joint pain and inflammation in reactive arthritis. While antibiotics are given for the initial infection, they generally do not affect the course of the arthritis itself. Systemic corticosteroids may be used for severe, refractory cases but are not first-line.

Reference: Davidson 23rd; P-8(Fig-1.7).

Ref: Davidson 23rd; Box- 24.55

Reference: Davidson 23rd; P-137

Extreme cachexia in young female with history of diet control, heavy exercise and amenorrhea – anorexia nervosa.

Multiple doses of activated charcoal is effective against other substances.