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Cairo University – Faculty of Medicine
Master Degree
In
Cardiovascular Diseases
May, 2005.
Paper II.
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Answer all questions |
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Time: 3 hours
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(1)
A 76-year-old women in excellent health, developed severe dyspnea and profound
diaphoresis two hours prior to being evaluated in the Emergency Department.
During the days prior to this episode, she has been fully active, and denies all
symptoms. She has no important chronic illnesses, although she takes
hydrochlorothiazide 25mg daily for systolic hypertension. She is not a smoker.
On evaluation, she is moderately uncomfortable, sweating, moderately dyspneic
with minimal wheezing. Temperature is 37.2. Her blood pressure is 180/105; heart
rate 105 (regular). Her mucous membranes are of good color. She has no jugular
venous hypertension. Peripheral vessels are moderately tortuous and sclerotic to
palpation. There is moderate wheezing but no rales on pulmonary exam. Heart
sounds are somewhat distant with a Grade I to II systolic ejection murmur at the
base and a possible fourth heart sound. The remainder of her general examination
is normal including good leg pulses and no edema or tenderness in the legs.
Electrocardiogram shows left bundle branch block and chest x-ray shows no
cardiomegaly and minimal cephalization in reference to pulmonary vasculature.
She was given an injection of furosemide 20 mg intravenously.
Discuss the possible diagnosis and the preferred management strategy?
(20 marks)
(2)
Discuss the management of resistant hypertension.
(20 marks)
(3)
Compare and contrast the different imaging modalities for the diagnosis of
pulmonary
embolism.
(15 marks)
(4)
Discuss the possible causes and management of cardiogenic shock on the second
day
after mitral valve replacement.
(15 marks)
(5)
Give a detailed account on the mechanism of action, indications,
contraindications and drug interaction of the following:
a- Clopidogrel.
(10 marks)
b- Adenosine.
(10 marks)
c- Carvidolol.
(10 marks)
Good Luck.
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