Clinical Chemistry

250 Short Cases in Clinical Medicine by Ragavendra R. Baliga MD MBA

By Ragavendra R. Baliga MD MBA

A set of brief circumstances prepared through scientific region, emphasising the major diagnostic beneficial properties of scientific stipulations as as a rule offered within the brief case a part of the ultimate MB and MRCP examinations. additionally integrated are most probably directions or instructions anticipated from the examiner for every situation, and the most important issues which the candidate needs to inform the examiner. In June 2001 the MRCP brief instances examination is being changed with a brand new OSCE-style examination referred to as PACES (Practice evaluation of medical exam abilities) and this booklet will take complete account of this transformation.

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Manifestations of a systemic infection: fever, weight loss, pallor, splenomegaly. · Manifestations of a vasculitic phenomenon: cardiac failure, changing murmurs, petechia , Roth's spots , Osler nodes , Janway lesions , splinter hemorrhages, stroke, infarction of viscera, mycotic aneurysm. · Manifestations of immunological reactions: arthralgia, finger clubbing, uraemia. Name the common organisms found in infective endocarditis. faecahs, fungi. What precautions would you take to prevent bacterial endocarditis?

Revascularization may then be carried out if the coronary anatomy is appropriate. · Patients without these clinical indicators of high risk should undergo an assess-ment of left ventricular function (echocardiogram or radionuclide angiogram and submaximal stress) before hospital discharge. If the test is negative the patient may return for a symptom-limited exercise test at 3-6 weeks. If that too is negative he or she can remain on medical therapy and risk factor reduction. If the resting ejection fraction is <40% or if the stress is markedly abnormal (>2 nlm ST segment depression, hypotension at peak exercise or low working capacity) then coronary angiography should be carried out if there are no contraindications to revascularization.

How would you treat a patient with atrial fibrillation? Attempt to restore slow ventricular rate: · In the hypertensive patient use calcium antagonists (verapamil, diltiazem). g. propranolol). · In ischaemic heart disease use a beta-blocker or diltiazem, verapamil. · In heart failure use digoxin or verapamil. · In hypertrophic cardiomyopathy use a beta-blocker or calcium antagonists. · In those who are intolerant of or do not respond to drugs, radiofrequency catheter ablation of the atrioventricular node (with a cardiac pacemaker) may provide symptomatic relief; however, it does not change the risk of systemic emboli or the need for anticoagulation (N Engl J Med 1999; 340: 534).

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