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

By Ragavendra R. Baliga MD MBA

A set of brief circumstances prepared via medical region, emphasising the most important diagnostic beneficial properties of scientific stipulations as usually awarded within the brief case a part of the ultimate MB and MRCP examinations. additionally incorporated are most probably directions or instructions anticipated from the examiner for every , and the major 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 known as PACES (Practice review of medical exam talents) and this publication will take complete account of this variation.

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2. Have the patient's anginal symptoms increased in frequency and become more severe since the last visit'? If the symptoms have worsened or the patient has decreased physical activity to avoid precipitating angina, then he or she should be evaluated and treated according to either the unstable angina or chronic stable angina guidelines, as appropriate. 3. How well is the patient tolerating therapy'? 4. How successful has the patient been in reducing modifiable risk factors and improving knowledge about ischaemic heart disease'?

Pathological: · Heart failure. · kelt ventricular dilatation without failure: mitral regurgitation, ventricular septal defect, patent ductus arteriosus. · Right ventricular S3 in right ventricular failure, tricuspid regurgitation. What are the implications of a third heart sound in patients with valvular heart disease? · in patients with mitral regurgitation, they are common but do not necessarily reflect ventricular systolic dysfunction or increased filling pressure (N Engl J Med 1992: 327: 458-62).

PVE is classified into two groups: · · Early:occurring within 2 months of surgery. It develops as a result of intra-operative contamination of the prosthetic valve or as a consequence of a post-operative nosocomial infection, such as sternotomy infection, postoperative pneumonia, urinary tract infection or intravenous cathether-related insertion. The clinical features may be masked by the ordinary events in the postoperative course or by another infection. Cutaneous signs are not common. Late PVE: develops more than 2 months after valve surgery.

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