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"Palestinian child Habeeba Al-Askari" 💔

📌Tomorrow her foot and both hands will be amputated
Because the Zionist occupation prevented her from traveling and receiving treatment outside the Gaza Strip 🇵🇸

অথচ জীবনে আমাদের কত না পাওয়ার অভিযোগ.... 😥😥😥

https://www.facebook.com/share/p/15fiZpFmTa/

Latest update....

আজ ক্লাসের শেষের দিকে নেটওয়ার্ক সমস্যার কারণে লাইভ স্ট্রিমিং ডিসকানেকটেড হয়ে গেছিল।
ক্লাস নিয়ে কারো কোন পরামর্শ / অপিনিয়ন থাকলে জানাবেন।।।🙂

Live stream finished (1 hour)

Live stream started

📢📢📢

Davidson discussion for post-graduation

Gastroenterology 1

Tomorrow at 9.30 pm in Sha Allah

⬆️⬆️⬆️⬆️⬆️

Past test MRCP part 1

MRCP 2

Dx?

MRCP 2

Dx?

MRCP 2

Pictorial Dx?

MCA dot sign

+ An early marker of thromboembolic occlusion of distal MCA branches seen in Sylvian fissure (M2 segment).

Hyperdense MCA sign

+ appearance of increased attenuation of proximal middle cerebral artery (MCA) that is often associated with thrombosis of M1 MCA segment

+ May be the only diagnostic feature on CT early after ischaemic stroke.

MRCP 2

Joint fluid aspiration under florescence microscopy

H/O recurrent joint pain...

Dx?

MRCP 2

Clue : Smoking + Hemoptysis + Muscle weakness

Dx?

MRCP 2

Clue : CKD + Recurrent joint pain & swelling

Dx?

MRCP 2

Clue : DM + HTN + Recurrent pain in great toe

Dx?
Investigation?
Treatment?

MRCP 2

Clue : Fever + Ankle Joint pain + Erythematous tender skin lesions on shin

Dx?

MRCP 2

Clue : Joint pain + Morning stiffness

Confirmatory investigation?

MRCP 2

Clue : Difficulty in raising hands & climbing upstairs

Dx?
Confirmatory investigation?
Treatment?

MRCP 2

Clue : Joint pain + Red eye + Recurrent DVT

MRCP 2

Clue : Joint pain + Skin rash

Dx?

Pictorial Dx?

MRCP 2

Dx?

MRCP 2

Clue : Long duration of joint pain + Morning stiffness + Skin rash

Dx?

Multiphasic CT contrast showing early enhancement & washout of HCC

💎 Shock + Reduced / muffled heart sounds >>> Cardiac tamponade

💎 Shock + Absent / Reduced breath sound + ⬆️ Resonance on percussion >>> Tension pneumothorax

💎 Shock + Early diastolic murmur + Tearing chest pain + Pulse / BP difference between limbs >>> Aortic dissection

💎 Shock + Normal heart & breath sound >>> Massive pulmonary embolism

💎 Shock + H/O upper GI endoscopy >>> Esophageal rupture / Boerhaave syndrome

https://t.me/mquranilkareem?livestream

For those who are interested....🙂

PTH এর normal physiological effects হলো : ⬆️ Ca & ⬇️ PO4

PTH এর main regulator : Ca2+

বডিতে Ca2+ বেড়ে গেলে parathyroid gland থেকে PTH secretion inhibit করে/ কমায় & কমে গেলে PTH secretion stimulate করে / বাড়ায়

In primary hyperparathyroidism
: Parathyroid gland এ (Adenoma, carcinoma hyperplasia etc) বিভিন্ন কারণে parathyroid gland excessive PTH secretion করে।
⬆️ PTH >>>> ⬆️Ca & ⬇️ PO4

In secondary hyperparathyroidism : parathyroid gland এ কোন সমস্যা থাকেনা.
Vit D deficiency, malabsorption or CKD এ জাতীয় কোন কারণে শরীরে Ca2+ কমে যায়।আগেই বলেছি Ca2+ কমে গেলে সেটা Parathyroid gland এ feedback দেয় & PTH secretion stimulate করে।সো PTH বেড়ে যায়।মানে এখানে PTH বেড়ে যাওয়াটা
⬇️ Ca এর secondary effect on parathyroid gland.
এ কারণে এটাকে Secondary hyperparathyroidism বলে।এক্ষেত্রে
Main pathology : ⬇️ Ca2+ leading to >>>> ⬆️ PTH

Tertiary hyperparathyroidism :
Secondary hyperparathyroidism যখন long time persists করে (Ex : CKD without treatment) তখন parathyroid gland hyperplasia / adenoma develop করে ( Due to increased demand / hyperfunction)
এরপর Ca2+ বেড়ে গেলেও parathyroid gland autonomously excessive PTH release করতে থাকে।
⬆️ Ca তখন PTH কে আর suppress করতে পারেনা।
এটা যেহেতু Secondary hyperparathyroidism এর ব্যাকগ্রাউন্ডে develop করে এজন্য এটাকে Tertiary hyperparathyroidism বলে।

এটা যেহেতু advanced CKD তে হয়, এক্ষেত্রে kidney PO4 excrete করতে পারেনা।
Advanced CKD এর জন্য Po4 & Creatinine বেশি থাকবে।এই দুইটা দেখে primary hyperparathyroidism থেকে Tertiary আলাদা করা যায়।

In Pseudohypoparathyroidism : Main pathology হলো resistant to PTH hormone
So due to resistance PTH can't ⬆️Ca & ⬇️ PO4
So net effect : ⬇️ Ca & ⬆️ PO4

এখন Ca কমে যাওয়ায় parathyroid gland থেকে PTH secretion বেড়ে যাবে (Feedback mechanism)

এখানে Ca & PO4 level দেখলে মনে হবে Hypoparathyroidism কিন্তু PTH ত আসলে বেশি আছে।
এজন্য একে বলা Pseudohypoparathyroidism

Vision related problem থেকে প্রায়ই প্রশ্ন আসে।+ Neurology তে আসতে পারে আবার Endocrinology তেও আসতে পারে।
+ SBA & Scenario based question এর জন্য খুবই গুরুত্বপূর্ণ।

*******
Box 25.2
Fig 25.7
Box 25.19

Site of lesion & feature

Optic nerve - Monocular blindness

Optic chiasm - Bitemporal hemianopia

Optic chiasm (due to Craniopharyngioma) - Bitemporal inferior quadrantanopia

Optic chiasm (due to Pituitary macroadenoma) - Bitemporal superior quadrantanopia

Optic tract - Incongruous contralateral homonymous hemianopia

Parietal lobe - Contralateral homonymous lower quadrantanopia

Temporal lobe - Contralateral homonymous upper quadrantanopia

Occipital lobe - Congruous homonymous hemianopia (Often macular sparing)

(উপরের কথা গুলো আপনাকে অবশ্যই মনে রাখতে হবে।সেটা মুখস্থ হোক কিংবা বুঝে।নিচে আমি কিছুটা জগা খিচুড়ি explanation করেছি😐😐)

Vision related problem solve এর জন্য আমি কিছু gross anatomy মনে রাখতাম।
N.B. এখানে শুধুমাত্র Gross discussion করা হবে যেটা দিয়ে পরীক্ষায় উত্তর দেওয়া যায়।

নং ১
+ Pathway
Retina -> Optic nerve -> Optic chiasm -> Optic tract -> Parietal / Temporal lobe -> Occipital cortex

নং ২
+ Visual field এর Sensation carry হয় opposite fibre দিয়ে i.e Nasal fibres carry temporal field of vision,Upper fibres carry lower part of vision ( just like a mirror)

নং ৩
+ Nasal fibres midline cross করে কিন্তু Temporal fibres করে না।

নং ৪
+ Pituitary gland উপরে Hypothalamus এর সাথে pituitary stalk দিয়ে connected থাকে।আর সামনে optic chiasm থাকে।

Most important :

LESION IN OPTIC CHIASM

Nasal fibres are mostly affected.
Nasal fibres carry sensation from temporal field. যেহেতু দুই পাশের nasal fibres affected হচ্ছে সেহেতু দুই পাশের Temporal field লস হবে। Feature হবে bitemporal hemianopia.

এর Main cause হচ্ছে Pituitary tumor. যখন tumor টা stalk থেকে আসে তখন এটাকে বলে Craniopharyngioma. এটা উপর থেকে আসায় upper nasal fibres affected হবে। নং ২ অনুযায়ী inferior vision loss হবে। Feature হবে Bitemporal inferior quadrantanopia.

একইভাবে Pituitary macroadenoma তে affected হবে Lower nasal fibres. Feature হবে Bitemporal superior quadrantanopia.

LESION AT SITES BEHIND CHIASM

Nasal fibres midline cross করায় optic chiasm এর পরের pathway তে যেকোন পাশে Contralateral nasal fibres & ipsilateral temporal fibres থাকবে

If a lesion in left side
Affected fibres - Left temporal & right nasal
। নং ২ অনুযায়ী left এর nasal field & right এর temporal field lossহবে। আমরা যদি Visual field দেখি তাহলে দেখা যাবে দুই চোখের Rt. half side vision loss হচ্ছে।( Fig 25.7 Davidson). So feature হবে Rt. homonymous hemianopia
একইভাবে right side lesion এ feature পাব left homonymous hemianopia

So lesion at site behind optic chiasm,feature wiil be
Contralateral homonymous hemianopia

Upper fibres of optic tract pass through parietal lobe. So a lesion in parietal lobe will damage upper fbers. So নং ২ অনুযায়ী lower vision field loss হবে। Frature হবে
Contralateral homonymous lower quadrantanopia ( Half of hemianopia -> quadrantanopia)

একইভাবে lesion in temporal lobe --> Loss of lower fibers -> Loss of superior viual field - > Contralateral homonyms upper quadrantanopia

Lesion যত পেছনে হবে দুই পাশের field of vision loss তত similar হবে।
so optic tract lesion - Incongruous homonymous hemianopia
Lesion in occipital lobe - Congruous homonymous hemianopia

Why macular sparing in Visual cortex lesion :
Visual cortex supplied only by posterior cerbral artery. But macula has collateral circulation from middle cerebral artery. So occlusion of PCA leads to cortical blindness but spare macula

Interpretation of lab findings

⬆️ PTH plus

💎 ⬆️ Ca ⬇️ PO4 : Primary hyperparathyroidism

💎 ⬇️ Ca : Secondary hyperparathyroidism

💎⬆️ Ca ⬆️ PO4 ⬆️ Serum creatinine: Tertiary hyperparathyroidism

💎 ⬇️ Ca ⬆️ PO4 : Pseudohypoparathyroidism

https://www.facebook.com/groups/284419755592266/permalink/480013816032858/

Pigmentation of mucus membrane, lips & tongue + Bloody diarrhea / intestinal obstruction

Dx?
Investigation?

Skin & mucus membrane pigmentation + Weight loss + Dizziness + ⬇️ Na ⬆️ K

Dx?
Investigation?
Rx?

Skin pigmentation + Joint pain + Lymphadenopathy + Chronic diarrhea
Dx?
Investigation of choice?
Rx?

Skin pigmentation + Headache + Visual disturbances + H/O adrenal surgery

Dx?

Skin pigmentation + Proximal muscle weakness + DM + HTN + ⬇️ K

Dx?
Investigation?

Skin pigmentation + Polyuria + Joint pain + infertility + Abnormal LFTs

Dx?

BLISTERS

💎 Old age (Usually > 60 yr) + Tense blisters + No mucosal involvement >>> Bullous pemphigoid >>> Ab against hemidesmosomal BP antigen

💎 Middle age (Usually 40-60 yr) + Flaccid, Fragile blisters + Mucosal involvement >>> Pemphigus vulgaris >>> Ab against Desmoglein-1 and 3

💎 Intensly itchy blisters on extensor surfaces & buttocks + excoriation marks (Blisters are usually not seen due to excoriation) +/- GIT symptoms >>> Dermatitis herpetiformis >>> Granular IgA in papillary dermis

💎 Photosensitivity + Fragile skin + Hypertrichosis + Hyperpigmentation + Scarring >>> Porphyria cutanea tarda >>> Uroporphyrinogen decarboxylase deficiency

💎 Painful blisters limited to dermatome >>> Herpes zoster

💎 Worsening eczema + Small punched out lesions >>> Eczema herpeticum

💎 2nd trimester of pregnancy + Periumbilical blisters >>> Gestational pemphigoid

Credit : Tazkia Nur apu

Essential for thyroid hormone synthesis :

Iodine
Selenium
Thyroid peroxidase enzymes (TPO)

Iodine or selenium deficiency & anti TPO ab lead to hypothyroidism

⬇️ TSH + ⬆️ T3. T4
>>> Primary hyperthyroidism
>>> Do thyroid antibodies

⬆️ TSH + ⬇️ T3. T4
>>> Primary hypothyroidism
>>> Do thyroid antibodies >>> Radiodine uptake

⬇️ TSH + ⬇️ T3. T4
>>> Secondary hypothyroidism
>>> Do pituitary imaging

⬆️ TSH + ⬆️ T3. T4
>>> Secondary hyperthyroidism
>>> Do pituitary imaging

.

Which pituitary hormone is under constant inhibition by hypothalamus?

❤️ LOVE MEDICINE ❤️ pinned «পরীক্ষা তো সন্নিকটে।১ মাস এর মত আছে আর।
প্রিপারেশন কেমন সবার?»

MRCP

Associated conditions with aortic stenosis
💎 Heyde's syndrome : GI bleeding due to angiodysplasia of colon
💎 Von Willebrand disease : By breaking down its associated coagulation factor due to increased turbulence around stenotic valve
💎 Coarctation of aorta : With bicuspid aortic valve

💎 Murmur of Aortic stenosis may be transmitted downward & to apex, where it may be confused with systolic murmur of MR : Gallavardin effect 

💎 Murmur of MR involving posterior leaflet may radiate to neck & confused with AS

Ref : Harrison 21th

An interesting X-ray.....Can you find the abnormalities????
Clue :Patient has LBP & catheter in situ....

প্রথমেই দু:খিত গ্রুপে এ ধরনের পোস্ট করার জন্য।😞

একটা MacBook air M1 (8gb/256 gb)
সেল করা হবে।
Battery health Information :
Maximum capacity : 99%
Cycle count : 22

MacBook টা বাইরে থেকে আনা।সাথে অরিজিনাল চার্জার & বক্স আছে।ডেন্ট/স্ক্র‍্যচ বা অন্য কোন সমস্যা নাই।বেশিরভাগ সময় ট্যাব ব্যবহার করায় এইটা তেমন একটা ব্যবহার করা হয় নাই।বর্তমানে কিছুটা আর্থিক সমস্যা থাকায় বিক্রি করে দিতে হচ্ছে।

Price : 65 K (Fixed)

Interesting ECG....

Salmonella can be cultured from punched biopsy of rose spot

💎 Chronic carriage of salmonella typhi is associated with an increased risk of gallbladder cancer

Purtscher's retinopathy is associated with which GI disease?

MRCP

Choice of pacemaker in atrial fibrillation or atrial flutter?

MRCP

Contraindications of DDD pacemaker?

Wonderful book for ECG.....♥️♥️♥️

Some important ECG for OSPE / MRCP 2 from practical life...Text me if you can't understand... Though I'm not an expert, I'll try to explain In Sha Allah

Pericardial effusion

❤️ LOVE MEDICINE ❤️ pinned «Some helpful YouTube channels https://youtu.be/hjavYW6jiFw?si=62MeF2mE_xU95wMg https://youtu.be/vyR-Xxw_Whc?si=4d7YAPqH2G-lwr04 https://youtu.be/-G3k0jHZLWM?si=zMxTG58YnvJyLPtR https://youtube.com/@goubd?si=zb2BhDAdejP8UNXt https://youtube.com/@ninja…»

💎 Asymptomatic patients with ocular sarcoidosis can eventually develop blindness.

💎💎💎 It's recommended that all patients with sarcoidosis receive a dedicated ophthalmologic examination.

Ref : Harrison 21 st

💎 Lupus pernio is diagnostic for a chronic
form of sarcoidosis

Ref : Harrison 21st

Some helpful YouTube channels

https://youtu.be/hjavYW6jiFw?si=62MeF2mE_xU95wMg

https://youtu.be/vyR-Xxw_Whc?si=4d7YAPqH2G-lwr04

https://youtu.be/-G3k0jHZLWM?si=zMxTG58YnvJyLPtR

https://youtube.com/@goubd?si=zb2BhDAdejP8UNXt

https://youtube.com/@ninjanerdofficial?si=kLFUQ8oyPO2-meE0

https://youtube.com/@strongmed?si=e21ARqm0LLULOiyv

https://youtube.com/@armandohasudungan?si=olNbwxw5s530q25Z

https://youtube.com/@zerotofinals?si=wQ74bVGtRiJ4ZFQn

💎 Avoid medicinal iron supplementation in polycythemia vera as this can thwart the goals of a phlebotomy program

Ref : CMDT

Iron level in polycythemia vera & reason?

Auer rod if present is diagnostic of acute myeloid leukemia...

Sometimes PBF pictorials are given in MRCP 2 & this one is important

💎 Protein induced by vitamin K absence (PIVKA-II), also known as des-gamma-carboxyprothrombin >>>> A new biomarker for hepatocellular carcinoma


This test is available in BSMMU

Extensively itchy lesion...Dx?

MRCP 2

H/O sore throat.... Pictorial Dx?

MRCP 2

H/O hiking....
Pictorial Dx?

MRCP 2

Most important differentiating point between primary & secondary adrenal insufficiency?

Pigmentation & ACTH level

Pigmentation - Primary
High ACTH - Primary