By Ragavendra R. Baliga MD MBA

ISBN-10: 0702026247

ISBN-13: 9780702026249

A suite of brief instances prepared through scientific sector, emphasising the most important diagnostic positive aspects of medical stipulations as usually provided 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 , and the main issues which the candidate needs to inform the examiner. In June 2001 the MRCP brief circumstances examination is being changed with a brand new OSCE-style examination referred to as PACES (Practice review of medical exam abilities) and this publication will take complete account of this transformation.

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Look for the underlying cause: -Examine the heart for mitral valvular lesion. -Check the blood pressure for hypertension. - Ask the patient for history of ischaemic heart disease. -Check the patient's thyroid status for thyrotoxicosis. DIAGNOSIS This patient has fast atrial fibrillation (lesion) which is commonly caused by ischaemic heart disease (aetiology). The patient is short of breath, indicating that he may be in cardiac failure (functional status). Read this recent review: N Engl J Med 2001; 344: 1067.

Amyloidosis). Treatment is directed towards the underlying cause. What are the indications for heart transplantation? When patients are refractory to treatment, both medical and surgical (such as valve replacement), and are in New York Heart Association class IV, then they are unlikely to survive for I year and should be considered for heart transplantation. The survival rate is about 69c)~ at 5 years, although most patients have one episode of rejection and 25% have multiple episodes. They are also prone to accelerated coronary atherosclerosis.

Listen to the heart for murmurs and look for signs of cardiac failure. · Examine the fundus for Roth's spots (vasculitic phenomena). " · Examine the abdomen for splenomegaly. · Look for embolic phenomena: stroke, viscera or occlusion of peripheral arteries · Test urine for microscopic haematuria (vasculitic phenomena). Remember that ostium secundum atrial septal defects almost never have infective endocarditis. DIAGNOSIS This patient has Janeway lesions and Roth's spots (lesions) confirming infective endocarditis and is in severe heart failure (functional status).

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