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Cairo University
Faculty of Medicine |
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Department of Cardiovascular Medicine
November, 2003 |
Master
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- Give a short
account on the following:
A- Controversy on postmenopausal hormone replacement.
(15 marks)
B- Adverse effects of Sildenafil.
(10 marks)
C- Predictors and management of in-stent restenosis.
(20 marks)
2- Discuss causes and management of:
A- Cryptogenic stroke.
(15 marks)
B-
Cardiogenic shock.
(15 marks)
3- A 17 years old female with history of rheumatic
fever. She is in functional class II/IV (NYHA). Her puls
was 105 bpm, AF.
Echo-Doppler measurements were:
LVED : 6.3 cm, LVES : 4.5 cm, FS = 29% LA: 6.1 cm.
The mitral valve echoscore was 6/16, valve area = 1.5 cm2,
the diastolic pressure gradient was; V-wave of 29 mmHg,
mean of 18 mmHg.
The regurgitation jet by color flow mapping was 10 cm2
Aortic valve cusps were mildly thickened with mild
incompetence and mean systolic gradient of 14 mmHg.
- Discuss the management of
this case.
(25 marks)
GOOD LUCK
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Cairo University
Faculty of Medicine |
|
Department of Cardiovascular Medicine
November, 2003 |
Master
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) A 66 year old male patient presented with
progressive shortness of breath and chest discomfort on
effort. The patient was dyslipidemic with a positive family
history of coronary heart disease. A stress test was
positive for myocardial ischemia, and coronary angiography
revealed multivessel disease with a normal left ventricular
systolic function.
He was subjected to CABG with LIMA to LAD, radial artery to
diagonal branch and saphenous vein grafts to RCA and LCX-OM
branches.
On the fifth post-operative day, the patient developed
swelling of the right calf and an episode of paroxysmal AF.
Duplex ultrasound revealed fresh thrombi in the right common
femoral vein and left superficial femoral vein of both lower
limbs. He was treated with a full dose of heparin.
On the next day he complained of lightheadedness and
increasing difficulty on walking. A multislice CT scan
showed filling defects in the right and left proximal
pulmonary arteries.
Echocardiography showed mild right ventricular dilatation.
The patient was hemodynamically stable and heparin was
continued with careful adjustment of APTT.
Two days later the patient was stable and the lower limb
swelling was improving.
Examination revealed; temp 37.5 C, normal jugular venous
pressure, sinus tachycardia (105 bpm), BP 120/80 mmHg, S-4
gallop over the apex, normal first and second heart sounds,
and bilateral diminution of breath sounds at the lung bases.
The ECG showed non-specific ST and T-wave changes. Chest
radiography showed small bilateral pleural effusion and
right basal atelectatic bands. The cardiac enzymes were
normal. Blood picture; HB 10.2 gm/dL, total leucocytic count
of 12,300/ml3, platelet count 60,000/ml3, serum bilirubin
1.0 mg/dL, AST 32 U/dL, ALT 26 U/dL, serum creatinine 0.9
mg/dL.
The patient felt weak with poor appetite but his condition
was slowly improving.
Two days later, however he developed right hemiplegia which
worsened over several hours and it was associated with motor
aphasia.
- Discuss the diagnosis and differential diagnosis.
(20 marks)
- Describe further investigations and management.
(10 marks)
(2) Discuss the mechanism of action of the following
in heart failure.
A- Beta-blockers.
(10 marks)
B- ACE inhibitors.
(10 marks)
C- Spironolactone.
(10 marks)
(3) Enumerate the guide lines and complications for:
A - Use of ICD.
(20 marks)
B - Alcohol septal
ablation in HOCM.
(20 marks)
GOOD LUCK
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Cairo University
Faculty of Medicine |
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Department of Cardiovascular Medicine
November, 2003 |
Master
Degree In
Cardiovascular Diseases
Basic Cardiology
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Answer all questions |
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Time: 3
hours
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1- Discuss the use of
pressure volume curve in the diagnosis of left ventricular
function abnormalities.
(10 Marks)
2- Outline the
embryology and surface anatomy of the aortic arch.
(10 Marks)
3- Discuss the
cardiovascular functions and clinical significance of each
of the following:
A) Endothelin.
(5 Marks)
B) Glycoprotein IIb and
IIIa receptors.
(5 Marks)
GOOD LUCK
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