Medicine

Reference: Davidson 23rd, Box-15.11

Ref: Davidson 23rd; P-946, box: 23.36

Metformin is the first-line therapy for type 2 diabetes mellitus, as it reduces hepatic glucose production, improves insulin sensitivity, and is effective and well-tolerated. Insulin is used in type 1.

Stem Breakdown:

Abdominal pain, bloating, and altered bowel habits: These symptoms suggest a gastrointestinal disorder, possibly involving the colon.
Multiple polyps throughout the colon on colonoscopy: This finding is characteristic of familial adenomatous polyposis (FAP), a hereditary condition associated with numerous adenomatous polyps and a high risk of colorectal cancer.
Option Analysis:

A) Familial adenomatous polyposis (FAP): This is the correct diagnosis. Davidson and Harrison explain that FAP is an autosomal dominant disorder caused by mutations in the APC gene, leading to the development of hundreds to thousands of adenomatous polyps in the colon. If left untreated, FAP almost inevitably leads to colorectal cancer.
B) Peptic ulcer disease: Peptic ulcer disease causes epigastric pain, often related to meals, but it affects the stomach and duodenum, not the colon, and does not cause polyps.
Crohn’s disease: Crohn’s disease is an inflammatory bowel disease that can affect any part of the gastrointestinal tract, but it does not cause multiple polyps throughout the colon. It typically presents with skip lesions and transmural inflammation.
D) Diverticulosis: Diverticulosis involves the formation of small pouches (diverticula) in the colon, usually in the sigmoid colon, but it does not cause multiple polyps. It is often asymptomatic but can lead to diverticulitis (inflammation of diverticula).

Marasmus is a form of severe protein-energy malnutrition characterized by extreme wasting of muscle and fat, leading to a "skin and bones" appearance. It results from severe caloric deficiency. Unlike kwashiorkor, edema is absent or minimal, and appetite may be relatively preserved.

Kayser-Fleischer rings are brown or green deposits of copper seen around the cornea in patients with Wilson’s disease. Davidson explains that Wilson’s disease is a genetic disorder characterised by the accumulation of copper in the liver, brain, and other tissues due to a defect in copper excretion. Harrison emphasises that Kayser-Fleischer rings are pathognomonic for Wilson’s disease, and treatment involves copper chelation therapy.

Reference: Davidson 23rd, Box-4.4

Toxoplasma gondii is an intracellular parasite. The sexual phase of the parasite’s life cycle (Fig. 13.40) occurs in the small intestinal epithelium of the domestic cat. Oöcysts in cat faeces are spread to intermediate hosts (pigs, sheep and also humans) via soil contamination. Oöcysts may survive in moist conditions for weeks or months.

Reference: Davidson 23rd; P-634

Interstitial lung disease (ILD) is a significant pulmonary complication of RA, leading to progressive fibrosis and impaired lung function, often presenting as restrictive lung disease. While pericarditis, rheumatoid nodules, and amyloidosis (secondary) are also extra-articular features, ILD directly causes restrictive lung disease.

Reference: Davidson 23rd; P-777
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Gallstones and alcohol account for the majority of acute pancreatitis cases. Gallstones are more common in females.

Hyperkalemia
Drug causes
β-blockers
·Angiotensin-converting enzyme (ACE) inhibitors
·Angiotensin-receptor blockers (ARBs)
·Spironolactone
·Eplerenone
·Calcineurin inhibitors: Cyclosporin, Tacrolimus

First Heart Sound: 
Loud: hyperdynamic circulation (anaemia, pregnancy, thyrotoxicosis); mitral stenosis
Soft: heart failure; mitral regurgitation

Warning Signs
• No clinical improvement or worsening of the situation just before or during the transition to afebrile phase or as the disease progresses.
• Persistent vomiting.
• Severe abdominal pain.
Lethargy and/or restlessness, sudden behavioural changes.
• Bleeding: Epistaxis , black stool, haematemesis, excessive menstrual bleeding, dark colored urine (haemoglobinuria) or haematuria.
Giddiness.
• Pale, cold and clammy hands and feet.
• Less/no urine output for 4-6 hours
• Liver enlargement > 2cm • Haematocrit >20%

Reference: Davidson 23rd; P-746

Explanation: Gastrin stimulates gastric acid secretion. Somatostatin, Secretin and GIP inhibits gastric acid secretion.

Ref: Davidson 23rd; P- 924 (Fig-23.10)

Reference: Davidson 23rd, Page: 644 , Box : 18.14

Reference: Davidson 23rd, Box-11.35

Explanation: Loud first heart sound, opening snap Mid-diastolic murmur. These are the Auscultation finding of MS

Explanation: Features of an acute adrenal crisis include circulatory shock with severe hypotension, hyponatraemia, hyperkalaemia and, in some instances, hypoglycaemia and hypercalcaemia.

Explanation

Reference: Davidson 23rd; P-564
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-856
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-644

Ref : Davidson 23rd ,p - 291

Reference: Davidson 23rd; P-599

Explanation: persistent daily vomiting suggests gastric outlet obstruction

Explanation: heaving apex beat found in: Pressure overload, such as aortic stenosis, hypertension

Explanation: HIV mainly transmits through Blood transfusion (90%)

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

Reference: Davidson 23rd; P-860
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Fever with chill and rigor, Pleuritic chest pain & Cough: Pneumonia

Explanation: Acute coryza is the most common URTI and is usually the result of rhinovirus infection

Adverse effects  Gastrointestinal side-effects in 1%–5%.
 Rare skin reactions (phototoxicity).  Tendinitis and Achilles tendon rupture, especially in older people.  Central nervous system effects (delirium, tremor, dizziness and occasional seizures in 5%–12%), especially in older people.
 Reduces clearance of xanthines and theophyllines, potentially inducing insomnia and increased seizure potential.
 Prolongation of QT interval on ECG, cardiac arrhythmias.  Ciprooxacin use is associated with acquisition of MRSA and strains of C. difcile

Reference: Davidson 23rd; P-365

Reference: Davidson 23rd; P- 1112 (Box-25.55)

The main test for COPD is spirometry. Spirometry can detect COPD before symptoms are recognized. Your provider may also use the test results to find out how severe your COPD is and help set your treatment goals. Spirometry is a type of lung function test that measures how much air you breathe out.

Stem Breakdown:

Sudden-onset severe headache ("thunderclap" headache), nausea, and vomiting: These are classic symptoms of a subarachnoid hemorrhage (SAH), a life-threatening condition often described as the "worst headache of my life."
Neck stiffness and photophobia: These symptoms suggest meningeal irritation, which occurs when blood irritates the meninges in SAH.
Blood in the subarachnoid space on CT: This confirms the diagnosis of SAH.
Option Analysis:

A) Subarachnoid hemorrhage: This is the correct diagnosis. Davidson and Harrison explain that subarachnoid hemorrhage (SAH) is most commonly caused by the rupture of a cerebral aneurysm, leading to bleeding into the subarachnoid space. The sudden onset of a severe headache, often described as "thunderclap," and the presence of blood on CT are diagnostic of SAH.
B) Migraine headache: Migraine can cause severe headache with nausea and photophobia, but it typically has a gradual onset and is often preceded by an aura. It is not associated with neck stiffness or blood in the subarachnoid space.
C) Meningitis: Meningitis can cause headache, neck stiffness, and photophobia, but it would not cause blood in the subarachnoid space on CT. Lumbar puncture would show infection (e.g., elevated white blood cells in the cerebrospinal fluid).
D) Tension headache: Tension headaches are usually mild to moderate, with a band-like distribution of pain around the head. They are not associated with sudden onset, nausea, vomiting, or blood in the subarachnoid space.

Reference: Davidson 23rd; P-746

Reference: Davidson 23rd; P-440

Reference: Davidson 23rd; P-607

Ref: Davidson 23rd; P-954, box - 23.40

Malingering = intentional exaggeration for external gain (e.g., workers’ compensation). Factitious disorder lacks obvious external incentives.

Stem Breakdown:

Polyuria, polydipsia, and nocturia: These are classic symptoms of diabetes mellitus, indicating hyperglycemia leading to osmotic diuresis.
Fasting blood glucose of 170 mg/dL and haemoglobin A1c of 8.2%: These results confirm persistent hyperglycemia and meet the diagnostic criteria for diabetes mellitus (fasting blood glucose ≥126 mg/dL, A1c ≥6.5%).
Option Analysis:

A) Type 1 diabetes mellitus: Type 1 diabetes usually presents in younger individuals with an acute onset of symptoms (polyuria, weight loss) and often requires insulin from the onset. This patient’s presentation, age, and gradual development of symptoms are more consistent with type 2 diabetes.
B) Type 2 diabetes mellitus: This is the correct diagnosis. Davidson and Harrison explain that type 2 diabetes is the most common form of diabetes, typically occurring in middle-aged or older adults, often with a gradual onset. It is characterised by insulin resistance and relative insulin deficiency, leading to elevated fasting blood glucose and A1c levels.
C) Diabetes insipidus: Diabetes insipidus is characterised by polyuria and polydipsia, but it results from a deficiency of antidiuretic hormone (ADH) or renal insensitivity to ADH. Blood glucose levels would be normal, not elevated.
D) Hyperosmolar hyperglycaemic state (HHS): HHS is a life-threatening complication of type 2 diabetes, characterised by extreme hyperglycemia (>600 mg/dL), dehydration, and altered mental status. The patient in this case has elevated glucose but is not in HHS.

Comedone is a characteristic lesion in acne.

Reference: Davidson 23rd; P-813

Ref: Davidson 23rd; P-1003 , box : 24.31

Reference: Davidson 23rd; P-774