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Cairo University
Faculty of Medicine |
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Department of Cardiovascular Medicine
November, 2003 |
M.D.
Degree in
Cardiovascular
Diseases
Paper I
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Answer all questions |
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Time: 3
hours
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1) a- Discuss the pathophysiologic mechanisms of
cardiovascular injury in patients with chronic kidney disease.
(20 marks)
b- Outline the prognostic implications of chronic renal dysfunction
in patients with coronary artery disease.
(10 marks)
2) Write a critical appraisal of each of the following:
a- Risk stratification of generally determined ventricular
tachycardia.
(20 marks)
b- The role of CD40 ligand in acute coronary syndromes.
(10 marks)
c- Indications, clinical application and hazards of
artificial ventilation in the critically ill cardiac patient.
(10 marks)
d- The risk/benefit ratio of PCI in the management of left
main trunk disease.
(10 marks)
3) Discuss the aetiology, clinical presentation and diagnosis of
congenital anomalies of the left ventricular inflow tract.
(20 marks)
GOOD LUCK
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Cairo University
Faculty of Medicine |
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Department of Cardiovascular Medicine
November, 2003 |
M.D.
Degree in
Cardiovascular
Diseases
Paper II
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Answer all questions |
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Time: 3
hours
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1) Figure: Bradykinin mediated microvascular (top) and epicardial
(bottom) vasomotion before (control solid circles with solid lines) and after
L-NMMA (open circles with dashed lines). **p = 0.003, ***p < 0.001 comparing
control with L-NMMA( L-NG monometly arginine).
a- The figure shows the results of a study of coronary
vascular endothelial function using increasing doses of bradykinin infusion, in
patients with mild angiographic coronary atherosclerosis.
Explain the results illustrated in the figure.
(10 marks)
b- Outline the actions of bradykinin as a mediator of
normal endothelial function.
(10 marks)
c- Describe the various methods for investigation of
endothelial dysfunction.
(10 marks)
d- Discuss the management of endothelial dysfunction.
(10 marks)
2) Write a short account of each of the following:
a- Cardiovascular actions and interactions of
antidiabetic drug.
(20 marks)
b- Cardiovascular actions and clinical applications of
natriuretic peptides.
(20 marks)
3) A 42 year old heavy smoker male patient presented to the ER
complaining of abdominal pan, fever, vomiting and constipation alternating with
bouts of watery diarrhea. The condition started rather suddenly 5 days prior to
admission, fever developed 2 days after the onset.
On examination the patient looked toxic and was short of breath. The pulse was
small in volume, heart rate 110 beats/min, temperature 38ºc, blood pressure
104/72 mmHg, jugular venous pressure was normal. The chest showed diffuse S4
gallop over the apex and no significant murmurs. The abdomen was distended and
immobile with respiration. The patient had generalized dull aching abdominal
pain. A mass was felt in the right iliac fossa measuring 2.5 × 3 cm. Bowel
sounds were infrequent and sluggish.
The ECG showed Q waves in V1-V5. Chest x-ray was unremarkable. Blood picture
showed haemoglobin 14.2 Gm/dl, white blood count 28000/mm3, polymorphs 61%,
lymphocytes 8%, staff 15%, eosinophils 4%, basophils 4% monocytes 8%. Serum
creatinine 1.3 mg/dl, total serum bilirubin 1.0 mg/dl, AST 28 u/l, ALT 32 u/l
and serum amylase 232 u/l (normal up to 110). Total serum cholesterol 190 mg/dl,
triglycerides 320 u/l, HDL 38 mg/dl and LDL 110 mg/dl. Urine analysis was
normal.
a- Discuss the diagnosis, investigations and
differential diagnosis of this case.
(10 marks)
b- Outline the management of this patient.
(10 marks)
GOOD LUCK
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Cairo University
Faculty of Medicine |
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Department of Cardiovascular Medicine
November, 2003 |
M.D.
Degree in
Cardiovascular
Diseases
Commentary
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Answer all questions |
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Time: 3
hours
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- A 36 year old female patient presented with shortness of breath,
orthopnea and oedema of lower limbs present for the past 3 months. She also
complained of extreme weakness, dizziness, easy fatigue and amenorrhea in the
past 2 years. Past history was remarkable for postpartum haemorrhage following
each of her 3 pregnancies. The heamorrhage was severe necessitating blood
transfusion after the second pregnancy and the patient received treatment for
anaemia for several months.
- On examination there was pallor, grossly distended neck veins showing
minimal pulsations, heart rate 80/min regular, and blood pressure 90/60 mmHg.
Cardiac examination showed normal S1, accentuated P2 and no significant murmurs.
The chest was clear. The liver was enlarged. There was no ascites. Peripheral
pulses were intact.
The ECG showed low voltage, flat T waves and poor r wave progression in the
right precordial leads. Chest radiograph showed cardiomegaly, normal pulmonary
vasculature and clear lung fields. The echocardiogram showed in (cm): LVEDD 6.4,
LVESD 5.2, septum 0.8, posterior wall 0.7, LA 4.6, aorta 2.4, RV 0.8, FS 22%, EF
0.44. Global hypokinesia of the left ventricle, normal mitral leaflets, moderate
mitral regurgitation, and a large pericardial effusion.
Following pericardiocentesis, the jugular venous pressure was reduced and showed
a distinct a wave. An S3 gallop was heard over the apex.
Laboratory investigations showed: haemoglobin 11 gm/dl, white blood count
6500/mm3, ESR 50 mm 1st hour, total serum bilirubin 1.1 mg/dl, AST 129 u/l, ALT
104 u/l, total serum proteins 8.1 gm/dl, serum albumin 4.0 gm/dl, INR 1.4. Total
CK 1239 u/l, CK-MB 24 u/l, LDH 850 u/l. Fasting blood sugar 80 mg/dl and serum
creatinine 1.0 mg/dl.
The pericardial fluid was clear yellowish and showed a protein content 3.0
gm/dl, LDH 320 u/l, and glucose 79 mg/dl. There was no bacterial growth and
cellular elements consisted of a few lymphocytes and mesothelial cells.
1) Discuss the investigations, diagnosis and differential diagnosis of
this case.
(70 marks)
2) Outline the management of this patient.
(30 marks)
GOOD LUCK
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