CARDIOVASCULAR BLOCK CASE 1 A 45 years old malay man presents to the clinic for annual checkup.

He has no complaints other than occasional headaches. History reveals that this patient is a smoker and has family history of heart disease. After you take BP which reveals reading of 160/100, you suggest lifestyle changes to this patient. 1. Classify hypertension based on primary and secondary, explain definition, epidemiology and causes 2. Explain briefly how blood pressure is determine and the compensatory mechanism if there is hypertension and hypotension 3. Describe 2 errors in taking blood pressure 4. List 3 complications of hypertension 5. Suggest what lifestyle change should the patient with hypertension practice

CASE 2 A 40 years old malay man presents with complaining of sharp chest pains radiating to his shoulder during strenuous physical activity. On physical examination, you find the yellow nodules under both eyelids. 1. State your provisional diagnosis 2. What is the medical term of yellow nodules under both eyelids? 3. List 3 relevant investigations 4. State 1 treatment based on your provisional diagnosis CASE 3 A 7 years old boy presents to A&E room complaining of shortness of breath. Upon further history, you discover that her mother suffered from Rubella from pregnancy. The boy was diagnosed to have Persistent Ductus Arteriosus secondary to congenital rubella disease and was brought to cardiac surgeon 1. With the aid of diagram, describe briefly Persistent Ductus Arteriosus 2. State 3 others complication of Congenital Rubella Disease 3. State 2 drugs that can help this patient if he do not consent the surgery

ONNAZLI0910

CASE 4 1. Name the instrument used to get this reading 2. With the aid of diagram, explain how this wave is formed 3. State 3 diseases that can be diagnosed using this instrument

CASE 5 A week after suffering from MI, a 55 years old man presents to hospital due to weakness and difficulties in breathing. On physical exam, his blood pressure was 90/55 and his heart sounds are distant and faint. You also note that he has increased JVP during inspiration. When ECG reveals QRS complex that varies from one heart beat to another, you prepped the patient for cardiothoracic surgery 1. State your diagnosis 2. State what is Triad of Beck 3. State the name of the sign increase JVP during inspiration 4. How do you measure for JVP, state briefly 5. State one treatment

CASE 6 A 10 years old girl presents to the clinic with fever, malaise, migratory polyarthritis and a blanching erythematous ring-shaped rash over her proximal extremities. On further questioning, you found out that she suffered from a severe sore throat 2-3 weeks ago. You worry that she may suffer from valvular heart disease during her adult years 1. State your diagnosis 2. State most probable organism that cause sore throat in this patient

ONNAZLI0910

3. What is the criteria used to diagnosed the disease, state the signs and symptoms stated in the criteria 4. What do you mean by she may suffer from valvular heart disease during her adult years

CASE 7 A 60 years old man presents to HUSM with crushing chest pain radiating to his left shoulder and jaw. He is fatigue, breathing heavily and sweating profusely. ECG reveals ST elevation and a Q wave and cardiac enzymes reveals elevated Creatinine Kinase 1. State your diagnosis 2. Based on time framed, state the pathological changes in the cardiac tissue 3. Explain the mechanism of elevated Creatinine Kinase in this patient

CASE 8 A 1. State line A, B and C B 2. Explain steps taken in reading ECG

CASE 9

ONNAZLI0910

A newborn boy, born to a diabetic mother is found to be blue. CXR reveals a boot shaped heart and he was diagnosed to suffer from Tetralogy of Fallot 1. With the aid of diagram, explain briefly the fetal circulation 2. Classify the congenital heart disease, give 2 disease that falls under each category 3. What do you mean by boot shaped heart, explain the underlying pathology 4. What do you mean by Tetralogy of Fallot? Explain using a diagram CASE 10 A 20 years old man presents with progressive increase work of breathing. His lung exam was normal, but is found to have significant weak femoral pulses bilaterally and blood pressure of 160/110 in both arms. CXR reveals notching of the ribs 1. State your diagnosis 2. State 1 genetic disease associated with the disease stated above 3. With the aid of diagram, explain your diagnosis and why this patient has weak femoral pulse

ONNAZLI0910