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频道帖子
Histological findings associated with diabetic nephropathy include Kimmelstiel-Wilson lesions and nodular glomerulosclerosis.
| 2 | 🧨Narcolepsy is associated with low orexin (hypocretn) levels | 178 |
| 3 | Always replace vitamin B12 before folate - giving folate to a patient defcient in B12 can
precipitate subacute combined degeneraton of the cord | 190 |
| 4 |  没有文字... | 258 |
| 5 |  Atypical info of Cardiology series 1 | 853 |
| 6 | obesity can cause decreased BNP level
leading to a false negative for heart failure screening..
🫵আবার কারো eGFR <60 হলেও serum natriuretic peptide বাড়তে পারে। | 296 |
| 7 | Ecg changes of ACUTE PERICARDITIS? | 313 |
| 8 | epsilon wave found in? | 315 |
| 9 | A 42-year-old man develops renal infarction, pulmonary embolism and cerebral ischemia over several days. He has known APS and rapidly develops multiorgan failure. What is the most likely diagnosis?
A. TTP
B. HUS
C. Catastrophic APS
D. DIC
E. HIT | 344 |
| 10 | Atrial Fibrillation এ Rhythm control এর ক্ষেত্রে :
🫵Davidsons principles and practice of medicine 25th edition : পেশেন্ট ২৪ ঘন্টার মধ্যে আসলে rhythm control করতে বলেছে।
যদি ২৪ ঘন্টার পর আসে কিংবা duration uncertain হয়,তাহলে ৩ সপ্তাহ anticoagulant নিবে,তারপর cardioversion করা হবে।
cardioversion করার পর মিনিমাম ৪ সপ্তাহ পর্যন্ত anticoagulant maintain করবে।
তাহলে,AF >24 h → delay cardioversion → ≥3 weeks OAC OR imaging-guided cardioversion → cardioversion → ≥4 weeks OAC → thereafter according to stroke risk.
(24th edition থেকে এই চেন্জটা অনেক আপডেট হয়েছে।) | 505 |
| 11 |  没有文字... | 610 |
| 12 | ⭕ Current Treatment of choice for primary prevention for variceal bleeding: Carvedilol (Davidson 25th) | 587 |
| 13 | * DIP + psoriasis → Psoriatic arthritis
* 1st MTP + needle/negative → Gout
* Knee + rhomboid/positive → CPPD
* Back pain + sacroiliitis → AS
* Dry eyes + dry mouth → Sjögren
* Malar + kidney → SLE
* CREST → limited scleroderma
* Renal crisis → diffuse scleroderma
* Gottron + heliotrope → Dermatomyositis
* Asthma + eosinophilia → EGPA
* Sinus + lung + kidney → GPA
* Pulseless young woman → Takayasu
* Old + headache + jaw claudication → GCA
* Shoulder/hip stiffness >50 → PMR
* Microaneurysms + HBV → PAN
* Purpura + abdominal pain + hematuria → IgA vasculitis
* Oral + genital ulcers + uveitis → Behçet
dr ali | 752 |
| 14 | Rheumatology: Buzzword Questions 🔥
1. Young woman with malar rash, photosensitivity, painless oral ulcers, and proteinuria. Anti-dsDNA is positive.
→ SLE
2. Woman with symmetric MCP/PIP pain and morning stiffness lasting >1 hour. Anti-CCP is positive.
→ Rheumatoid arthritis
3. Older woman with Heberden nodes and knee pain that worsens with activity; morning stiffness lasts 10 minutes.
→ Osteoarthritis
4. Young man with chronic low back pain that improves with exercise and bilateral sacroiliitis.
→ Ankylosing spondylitis
5. Patient with psoriasis develops DIP arthritis, nail pitting, and sausage-like fingers.
→ Psoriatic arthritis
6. Man develops acute, exquisitely painful first MTP swelling. Synovial fluid shows needle-shaped, negatively birefringent crystals.
→ Gout
7. Elderly patient with acute knee arthritis. Synovial fluid shows rhomboid-shaped, weakly positively birefringent crystals.
→ CPPD/pseudogout
8. Woman with dry eyes, dry mouth, dental caries, and bilateral parotid enlargement. Anti-Ro is positive.
→ Sjögren syndrome
9. Woman has Raynaud phenomenon, sclerodactyly, telangiectasias, esophageal dysmotility, and calcinosis.
→ Limited systemic sclerosis (CREST)
10. Patient with diffuse skin thickening develops
sudden severe hypertension and acute kidney injury.
→ Scleroderma renal crisis
11. Young woman with proximal muscle weakness, heliotrope rash, and Gottron papules. CK is elevated.
→ Dermatomyositis
12. Patient has proximal muscle weakness and elevated CK but no characteristic skin findings. Muscle biopsy shows endomysial inflammation.
→ Polymyositis
13. Patient with asthma, eosinophilia, sinusitis, pulmonary infiltrates, and peripheral neuropathy develops vasculitis.
→ EGPA
14. Patient has chronic sinusitis, hemoptysis, cavitary lung lesions, and rapidly progressive glomerulonephritis. c-ANCA is positive.
→ GPA
15. Patient has pulmonary hemorrhage and rapidly progressive glomerulonephritis. p-ANCA/MPO is positive, without granulomas.
→ Microscopic polyangiitis
16. Young woman has arm claudication, absent radial pulses, carotid bruits, and unequal blood pressures between arms.
→ Takayasu arteritis
17. 70-year-old woman develops new temporal headache, jaw claudication, elevated ESR, and transient visual loss.
→ Giant cell arteritis
18. 70-year-old patient has bilateral shoulder and hip stiffness with markedly elevated ESR and normal CK.
→ Polymyalgia rheumatica
19. Patient has abdominal pain, mononeuritis multiplex, hypertension, and renal ischemia. Angiography shows microaneurysms.
→ Polyarteritis nodosa
20. Child develops palpable purpura on the legs, abdominal pain, arthralgia, and hematuria after an upper respiratory infection.
→ IgA vasculitis
21. Young adult has recurrent oral and genital ulcers with uveitis and a positive pathergy test.
→ Behçet disease
22. Patient develops arthritis, conjunctivitis, and urethritis several weeks after a genitourinary infection.
→ Reactive arthritis
23. Young woman has recurrent miscarriages and DVTs. PTT is prolonged despite a hypercoagulable state.
→ Antiphospholipid syndrome
24. Woman with SLE has recurrent fetal loss and positive anticardiolipin antibodies.
→ Antiphospholipid syndrome
25. Patient has bilateral hilar lymphadenopathy, erythema nodosum, uveitis, and noncaseating granulomas.
→ Sarcoidosis
26. Patient has chronic widespread pain, fatigue, and poor sleep but normal ESR, CK, and physical examination.
→ Fibromyalgia
27. Patient develops migratory polyarthritis and carditis several weeks after untreated pharyngitis.
→ Acute rheumatic fever
28. Young patient has urethritis followed by asymmetric oligoarthritis and heel pain.
→ Reactive arthritis
29. RA patient develops splenomegaly and neutropenia.
→ Felty syndrome
30. RA patient who works in coal mining develops pulmonary nodules.
→ Caplan syndrome
The shortest possible recognition rules
* MCP/PIP + prolonged morning stiffness → RA | 679 |
| 15 | A 66-year-old woman came with a history of bilateral wrist and hand pain, which is worse in the mornings. You make a diagnosis of rheumatoid arthritis. Following unsuccessful treatment with a number of different medications, she is commenced on a trial of anakinra.
Which cell type is the main source of the cytokine that this drug blocks?
Options:
A. B cells
B. Macrophages
C. Natural killer cells
D. T helper cells
E. T killer cells | 541 |
| 16 |  all hypersensitivity reaction | 742 |
| 17 | ITP = Isolated ↓ platelets
HSP = Normal platelets + palpable purpura + PAIN
TTP = MAHA + ↓platelets + NEURO
HUS = MAHA + ↓platelets + KIDNEY + bloody diarrhea
DIC = MAHA + ↓platelets + PT/aPTT BOTH ↑ | 981 |
| 18 | * TNF-α → granuloma maintenance
High-Yield Healing
* Healing by first intention → clean surgical wound
* Healing by second intention → large wound/tissue loss
* Granulation tissue → new vessels + fibroblasts
* Granulation tissue ≠ granuloma
* VEGF → Angiogenesis
* FGF → fibroblast proliferation
* TGF-β → collagen synthesis + fibrosis
* Type III collagen → early wound
* Type I collagen → mature scar
* Vitamin C deficiency → impaired collagen hydroxylation
* Zinc deficiency → impaired wound healing
* Keloid → scar extends beyond original wound
* Hypertrophic scar → remains within original wound boundaries
© | 1 006 |
| 19 | General Pathology —Buzzwords 🔥
Cellular Adaptation
* ↑ cell size → Hypertrophy
* ↑ cell number → Hyperplasia
* ↓ cell size → Atrophy
* One mature cell type replaced by another → Metaplasia
* Smoking → bronchial squamous metaplasia
* Barrett esophagus → intestinal-type columnar metaplasia
* Exercise → skeletal muscle hypertrophy
* Pregnancy → uterine hypertrophy + hyperplasia
Cell Injury
* ATP depletion → Na⁺/K⁺ pump failure
* Na⁺/K⁺ pump failure → cellular swelling
* Ribosomal detachment → ↓ protein synthesis
* ER dilation → reversible cell injury
* Fat accumulation in liver → steatosis
* Severe mitochondrial damage → irreversible injury
* Ca²⁺ influx → activation of phospholipases/proteases/endonucleases
* ROS → lipid peroxidation + protein/DNA damage
* Reversible injury → cellular swelling + fatty change
Nuclear Changes
* Nuclear shrinkage → Pyknosis
* Nuclear fragmentation → Karyorrhexis
* Nuclear dissolution → Karyolysis
* Pyknosis → karyorrhexis → karyolysis
Necrosis
* Ischemia in most solid organs → Coagulative necrosis
* Myocardial infarction → coagulative necrosis
* Renal infarction → coagulative necrosis
* Splenic infarction → coagulative necrosis
* Brain infarction → Liquefactive necrosis
* Bacterial abscess → liquefactive necrosis
* TB granuloma → Caseous necrosis
* Cheese-like necrosis → caseous necrosis
* Acute pancreatitis → Fat necrosis
* Chalky white deposits → fat necrosis
* Saponification → fat necrosis
* Vasculitis → Fibrinoid necrosis
* Malignant hypertension → fibrinoid necrosis
* Dry gangrene → coagulative necrosis
* Wet gangrene → liquefactive component
* Gas gangrene → Clostridium perfringens
Apoptosis
* Programmed cell death → Apoptosis
* Cell shrinkage → apoptosis
* Chromatin condensation → apoptosis
* Apoptotic bodies → apoptosis
* No significant inflammation → apoptosis
* Intrinsic pathway → Mitochondria
* Cytochrome c release → Caspase-9
* Extrinsic pathway → Fas/TNF receptor
* Fas → Caspase-8
* Executioner caspases → 3, 6, 7
* p53 activation → apoptosis after severe DNA damage
* BCL-2 → inhibits apoptosis
* BAX/BAK → promote apoptosis
Free Radicals
* Superoxide → O₂⁻
* Hydrogen peroxide → H₂O₂
* Hydroxyl radical → OH•
* Superoxide dismutase → O₂⁻ → H₂O₂
* Catalase → H₂O₂ → H₂O + O₂
* Glutathione peroxidase → H₂O₂ → H₂O
* Iron + H₂O₂ → hydroxyl radicals → Fenton reaction
* Reperfusion after ischemia → ROS injury
Acute Inflammation
* Acute inflammation → Neutrophils
* Chronic inflammation → Macrophages + lymphocytes
* First vascular response → Vasodilation
* Increased vascular permeability → Exudation
* Protein-rich fluid → Exudate
* Low-protein fluid → Transudate
* Slow blood flow → Stasis
* Stasis → leukocyte margination
Leukocyte Recruitment
* Rolling → Selectins
* E-selectin → endothelial cells
* P-selectin → endothelial cells/platelets
* L-selectin → leukocytes
* Firm adhesion → Integrins
* Integrins bind ICAM-1/VCAM-1
* Diapedesis → PECAM-1/CD31
* Chemotaxis → movement toward inflammatory signal
* C5a → neutrophil chemotaxis
* LTB4 → neutrophil chemotaxis
* IL-8 → neutrophil chemotaxis
Complement
* C3b → Opsonization
* C3a → Anaphylatoxin
* C5a → Chemotaxis
* C5a → neutrophil activation
* C5b-9 → MAC
* MAC → cell lysis
* C3a + C5a → mast-cell degranulation
Inflammatory Mediators
* Histamine → vasodilation + ↑ vascular permeability
* Bradykinin → Pain
* Bradykinin → vasodilation + ↑ permeability
* PGE₂ → Fever + pain
* TXA₂ → platelet aggregation + vasoconstriction
* PGI₂ → vasodilation + ↓ platelet aggregation
* LTB4 → neutrophil chemotaxis
* LTC4/LTD4/LTE4 → Bronchoconstriction
* IL-1 → Fever
* TNF-α → endothelial activation + fever
* IL-6 → Acute-phase response
* IL-8 → neutrophil chemotaxis
* IFN-γ → Macrophage activation
* TGF-β → Fibrosis
Chronic Inflammation
* Chronic inflammation → macrophages + lymphocytes
* Chronic inflammation → tissue destruction
* Chronic inflammation → fibrosis
* Granuloma → activated macrophages surrounded by lymphocytes
* Epithelioid macrophages → granuloma
* Giant cells → fused macrophages
* IFN-γ → macrophage activation | 872 |
| 20 | Cherry-red spot → Tay-Sachs / Niemann-Pick / central retinal artery occlusion 🏥
🍀 Context is essential!
🍒 Cherry-red skin + severe hypertension → Carbon monoxide (CO) poisoning?
⚠️ No. CO → Cherry-red skin is a classic teaching association, but it is clinically unreliable. ⚠️ | 576 |
