HIV or AIDS? What’s the difference?

Often used interchangeably in layman language, HIV positivity and AIDS are not the same thing and that’s why the examiners want to know: are you a doctor or a layman?

So first things first. HIV is Human Immunodeficiency Virus and AIDS is Acquired Immunodeficiency Syndrome. Only an HIV-positive patient can develop AIDS but NOT all HIV-positive patients have AIDS. HIV-positivity doesn’t automatically mean that a patient has AIDS. Only when the HIV- virus attacks and weakens the immune system of an individual, he/she develops AIDS. There is a very specific criteria to diagnose a patient with AIDS while a simple PCR laboratory test can label a patient as HIV positive. Since patients with AIDS are Immunodeficient so they can easily get infected by organisms that otherwise do not cause infections in an immunocompetent person. So if a question states that a patient is HIV-positive but DOES NOT have AIDS then consider him/her as an average immunocompetent person.

Now we come to our question which is if a woman who is HIV positive but doesn’t have AIDS develops otitis media, what would be most likely organism? Since we already clarified that a person who doesn’t have AIDS, is not affected by opportunistic organisms. So please don’t jump to the conclusion that since she is HIV positive she will be affected by all the strange named opportunistic organisms. So we use our common sense here. In this case just recall the three most common organisms that cause otitis media in immunocompetent persons:

Streptococcus pneumoniae (most common)

Haemophilus influenzae

Moraxella (Branhamella) catarrhalis.

These three organisms are responsible for more than 95% of all Acute otitis media cases with a bacterial etiology.

Dear friends, I need help/Feedback!

Assalamoalaikum my dear brother and sisters in medicine. After a long hiatus I want to reinvest sometime in this blog of mine. Life changed, circumstances changes, I changed, everything changed. But this blog stayed the same and that’s not fair in my opinion. So lets start some work. First of all I noticed on my recent visit to a medical book store that they no longer sell MURAD FCPS-1 Mcq books, rather there are some new names in market such as SK Golden, FCPS prep Golden and what not. In today’s digital world copyright is a huge issue. Although all these books print MCQs recalled by past test takers, I still can’t copy the questions and paste them here in my blog despite the fact that I write my own original explanations. I tried to look for Facebook groups where I can find past papers without any copyright issue but I wasn’t very successful. So the running on this blog now depends on two things.

1. Reader provided MCQs or
2. Writing short explanations without the questions (this would cover a small topic that appeared in the past papers starting from the most recent July 2021

So I will start with the short explanations without posting the questions and also wait to get more input from readers. Lets see how it works out.

PS: It would be nice if some of you can guide me to some free resources where I can get some input of past papers.

Question 5 (Upper Limb)

Question: A person can’t abduct his arm after fall on the out-streched hand; however he is able to abduct it after the initial 90 degrees of passive abduction of his arm. The most likely muscle involved is?

a. Trapezius

b. Deltoid

c. Pectoralis major

d. Supraspinatus

e. Teres Major

Answer: b

Explanation:

Remember that in  normal subjects the supraspinatus initiates the first 15 degrees of abduction along the vertical plane. The deltoid functions from 15 to 90 degrees, while synergistic actions of the trapezius and serratus anterior abduct from 90 to 180 degrees by rotating the scapula laterally.

So our patient in this question is unable to abduct this arm till 90 degrees only (indicating a paralysed deltoid), and then from 90 degrees onwards his trapezius and serratus anterior muscles take over and perform the rest of abduction.

A little bit of more information about the Deltoid which is a favourite muscle in medical exams:

Deltoid is supplied by the Axillary Nerve (C5, C6)

I like to think of deltoid as the epaulet (the shoulder ornament you see on soldier uniforms, picture follows).

The deltoid muscles.

The epaulet that overlie the deltoids.

Question 4 (Histology)

Question: A medical student is examining a slide under the microscope but he is unable to differentiate the gallbladder different from the colon; the point which will help him in differentiating the gallbladder from colon histologically will be?

a. Muscular layer arranged in 3 layers in the gallbladder wall

b. Columnar epithelium in gallbladder wall

c. Peyer’s patches in the gallbladder wall

d. No submucosa in the gallbladder wall

e. No serosa in the gallbaldder wall

Answer: d

Explanation:

Of all the things, gallbladder does not have a well defined submucosa or muscularis mucosae.

Almost all the GI tract from stomach to large intestine is lined with columnar epithelium. So you will find columnar epithelium in the gallbaldder as well as the colon, can’t differentiate them using this feature.

Gall baldder’s muscular layer isn’t arranged into layers. The classic three layered muscular layer is the feature of stomach. 

Peyer’s patches are organised lymphoid tissue in the gut wall found only in the small intestine, mostly the ileum. So Peyer’s patches are neither the feature of the colon nor the gall bladder. 

Serosa is a distintive feature of both gallbaldder and the colon so you can’t use this feature for differentiation either. 

Then all we are left with is the submucosa which is absent in gallbaldder and present in colon.

Just Mucusa, Muscularis and Serosa in the gall baldder wall. NO submucosa.

Books for FCPS-1 Medicine & Allied

Books I used for FCPS-1 are:

Anatomy:

• Gross Anatomy: Kaplan Lecture Notes  + Snell’s Review
• Neuroanatomy: Kaplan Lecture Notes
• Embryology: High Yield Embryology, 3rd Edition
• Histology: Kaplan Lecture Notes + Laiq Hussain (just a few things)

Physiology:

• Kaplan Lecture Notes
• Kaplan Lecture Videos (2007 editon)

Biochemistry: (You can also use first aid only)

• Kaplan Lecture Notes
• Kaplan Lecture Videos

Pharmacology:

• Kaplan Lecture Notes + Videos

Bio statistics:

• Kaplan Lecture Notes (1st two chapters only)

Behavioral Sciences:

• First Aid 2009

Pathology:

• Immunology: Kaplan Lecture Notes +Videos
• Microbiology: Medical Microbiology Made Ridiculously Simple
• General & Special Pathology: Rapid Review Pathology by Goljan.

First Aid 2009: (or whatever the latest edition is)

Absolute Gold. Read it atleast a minimum of 3 times.

Murad MCQs:

Terrible to study but great for exam. I’ll add up explanations to Murad’s MCQs soon.

Hello world!

I’ve started this blog to help those who are taking the FCPS-1 Exam. I cleared my FCPS-1 exam in Medicine in June 2009. I’ve been through this and I know how it feels while preparing for it. There is no good MCQs book with proper explanations and all the MCQs scattered over the internet hardly have the correct answers marked. At the time of your prep you hardly have the time to wade through the questions and come up answers. So I’m trying to make your life easier by compiling the questions and writing proper explanations to it. I hope you will appreciate my effort. If you like this blog, please take a moment to spread the word. Thank you.