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Cairo University – Faculty of Medicine
Master Degree
In
Cardiovascular Diseases
November, 2005.
Part II
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Paper II.
Answer all questions
Time: 3 hours
(1)
A 74 year old female was admitted to CCU, 3 hours after the onset of chest pain.
She was
dyspnic and drowsy with profuse sweating. The extremities were cold with mild
cyanosis. The pulse was variable from 32 to 56 bpm, BP 80/50 mm Hg.
Abdomen
was lax and normal and the chest was relatively clear.
Auscultation of the heart revealed a soft apical pan systolic murmur and
ejection systolic murmur of grade 2-3/6 over left sternal edge and lower neck.
The first
set of cardiac enzymes (CK-MB and troponin) were normal.
She was
not diabetic and had a history of mild hypertension with occasional bouts of
dyspnea and severe osteoarthritis of her knees.
She was
receiving a small dose of diuretic and diltiazem for the last 2 years.
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ECG showed:
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Echocardiography revealed;
LVED = 5.6 cm, LVES = 4.6 cm, FS = 18%. IVS = 1.5 cm, LVPW = 1.3 cm, LA =
4.3 cm, RV = 2.1 cm. Aortic root = 4.4 cm. The LV wall motion could not be
assessed.
The aortic
valve was sclerotic thickened with moderate calcification and restricted
mobility.
The mitral
valve appeared normal with small excursion. No pericardial effusion.
Doppler
study showed mitral incompetence of 3.2 cm2, and a mean systolic gradient across
the aortic valve of 38 mm Hg.
Discuss each of the
following:
a)
ECG and echocardiographic findings.
(10 Marks)
b)
Differential diagnosis.
(10 Marks)
c)
Management of the case.
(10 Marks)
(2)
a.
How to monitor the response of treatment for end-stage
cardiomyopathy.
(15 Marks)
b. Write a brief comment on the diagnosis and management of suspected
Fabry’s disease.
(15 Marks)
(3)
a.
Discuss the diagnosis and therapeutic options for dilutional hyponatremia.
(15 Marks)
b. Discuss the clinical presentation, diagnosis and management of double
outlet right
ventricle.
(15 Marks)
Good Luck.
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