Postgraduate exams
5/2006

MASTER:

Paper I

1.    Coronary artery disease equivalents.

2.    Fever in a cardiac patient.

3.    Valve disease: to medicate, dilate or operate.

4.    Evaluation of a cardiac patient for non-cardiac surgery.

5.    Secondary pulmonary hypertension.

 

Paper 2

1.    Palpitation in pregnancy.

2.    Timing of surgery in left to right shunts.

3.    Hypertension in elderly.

4.    Management of non-ST segment elevation MI.

5.    Restrictive heart syndrome.

 

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5/2005

I-MD:

PAPER I:

1)    Chronic total occlusion: to open or not to

2)    Percutanous implantation of valve prosthesis: from hopes to reality

3)    Discuss the systemic right ventricle

4)    Challenges of modern therapies in CV practice

5)    Drug induced heart diseases

 

PAPER II:

1)    In-hospital complications after PCI.

2)    Prosthetic valve: thrombosis and thrombolysis.

3)    Invasive Vs medical treatment of elderly with chronic symptomatic CAD.

4)    Reconstructive surgery in intractable heart failure

5)    CRP and heart diseases

 

COMMENTARY: 

A 60 years old male was admitted to CCU 3 hours after the onset of severe chest pain that made him sweaty and anxious. He had never felt a similar pain before. 10weeks before he got an unexpected fall in the street that resulted in scalp lacerations and blood loss. After 24 hours he was discharged with no complications and no further investigations were done. By getting to CCU, no chest pain then with BP= 180/115 mmHg, HR= 90bpm, JVP= 3cm above sternal angle. Irregular retinal arteries on fundus examination.

Soft ejection systolic murmur is heard at A1 followed by a moderate intensity early diastolic murmur. ECG showed ST-segment elevation in II. III. aVf and PR-interval of 0.28 sec. Q- waves were developed in II. III. aVf in the following day. Initial Hb level=16.4 g/dl, Na= 141 mmol/l, K= 3.6 mmol/l. BP later falls to 140/90 on treatment over next 24 hours with rise of temperature to 38.5 C. one day after admission, he had no chest pain, but sudden deterioration occurred after 3 days in hospital. He became semicomatosed with flaccid right sided hemiplegia.

 

 

 II-MASTER:

Paper I:

1)    Impact of DM on management of IHDs

2)    Contrast induced nephropathy.

3)    Mitral regurge and left sternal edge systolic murmur.

4)    Hypertension and pregnancy

5)    Antiplatelets in cardiovascular practice

 

Paper II:

1)    Mild Hypertension

2)    Constrictive pericarditis Vs restrictive cardiomyopathy

3)    Culture negative endocarditis

4)    Recurrent atrial fibrillation

5)    Aortic dissection

Essentials:

1)    Atrial septum: development, anatomy and related anomalies

2)    Contrast echocardiography.

3)    Cardiac catheterization: indications, contraindications and complications.

4)    Stress tests in cardiovascular practice.

5)    Prolonged Q-T interval in ECG.

 

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11/2006

I-MD:

PAPER I:

1)      Identification of high risk atherosclerotic plaque.

2)      Sudden cardiac death in athletes.

3)      Usefulness of neurohormonal markers in the diagnosis and prognosis of heart failure.

4)      Life style modification in hypertensive: facts and fiction.

 

PAPER II:

1)    Very high lipid patients.

2)    Stem cell therapy: update.

3)    Patent foramen ovale: current pathology, pathophysiology and clinical status.

4)    Coronary artery patient with valvular heart disease.

 

PHYSIOLOGY AND ANATOMY:

1)    Sequence of events allover the different phases of cardiac cycle.

2)    Nervous and hormonal regulation of arterial blood pressure

3)    Sympathetic and parasympathetic plexus in the thoracic region

4)    Papillary muscles of the heart: development and anatomy.

 

 

COMMENTARY CASE:  

Initial presentation: 35 years old pregnant female presented at 37^th week with reterosternal chest heaviness radiating to the left arm associated with nausea and dyspnea.

Present history: constant pain with no alleviating or exacerbating factors began at rest, no similar attacks, started 2.5 hours before getting to ER.

Past history: sickle cell trait, 2 normal previous vaginal deliveries at term, no HTN, no DM, no hyperlipidemia.  Only on vitamins.

Family history: a mother with NIDDM, an 8 years child with sickle cell trait and a second 4 years child with sickle cell disease. No smoking, no alcohol and no illicit drugs.

Examination: BP= 150/85, symmetrical, HR= 74bpm, RR=24/m, Mild discomfort, JVP=10cm with clear lungs. Abdomen: fundal height at 38 cm, non tender. Bilateral LL edema up to knees with well palpable dorsal is pedis and posterior tibial arteries bilaterally.

Cardiac examination: grade II/VI ESM at right upper sternal border.

Lab: as tabulated

 

Na	135	HbA1c	5.4%	WBCs	8.2	CPK-MB	8.2
K	3.6	TC	194	Ht value	32.6	TpN 4 hours after chest pain onset	3.63
Hco3	25	TG	202	Platelets	356
Creat.	0.8	HDL-C	45	ABG	7.47/37/123
glucose	124	LDL-C	109	CPK	224

  

ECG: sinus rhythm with non-specific ST-T changes, no evident ST-segment elevation

CXR: Unremarkable

TTE: EF= 55%, moderate apicoseptal hypokinesis

CT chest with contrast: Unremarkable

Discuss the case: diagnosis, differential diagnosis & management…

 

II-MASTER:

Paper I:

1)    Exercise Induced Arrhythmia

2)    Primary PCI in cardiac patient.

3)    Natural history of congenital left to right shunts.

4)    Global risk stratification in hypertension.

 

Paper II:

1)    Infective endocarditis: to conserve or to operate.

2)    Cardiac tamponade: diagnosis and treatment.

3)    Diabetic coronary patient.

4)    Echo diagnostic pitfalls in:   a) HOCM      B) Aortic dissection.

 

Essentials:

1)    Pericardium: development, anatomy and related anomalies

2)    ECG: P-R interval abnormalities

3)    Echo Doppler derived measurements

4)      Pericatherterization patient care.

 

III- Diploma

PAPER I:

1)    Refractory Heart Failure Syndrome.

2)    Myocardial infarction in young age

3)    Hypertensive crisis

4)    Management of a patient with palpitation

 

PAPER II:

1)    Recurrent rheumatic activity

2)    Congenital cyanotic heart disease in adults

3)    Constrictive pericarditis

4)    Endocrinal- cardiovascular disease interrelationship.