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

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By Ragavendra R. Baliga MD MBA

A suite of brief instances prepared via medical quarter, emphasising the most important diagnostic positive aspects of medical stipulations as more often than not awarded within the brief case a part of the ultimate MB and MRCP examinations. additionally integrated are most likely 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 circumstances examination is being changed with a brand new OSCE-style examination known as PACES (Practice review of medical exam abilities) and this booklet will take complete account of this modification.

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250 Short Cases in Clinical Medicine

A suite of brief situations prepared by means of medical quarter, emphasising the main diagnostic positive aspects of scientific stipulations as in most cases provided within the brief case a part of the ultimate MB and MRCP examinations. additionally integrated are most likely directions or instructions anticipated from the examiner for every , and the most important issues which the candidate needs to inform the examiner.

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Premature ischaemic heart disease in migrants from the Indian subcontinent is associated with insulin resistance. The site of this defective insulin action has been localized to the skeletal muscle by means of positron emission tomography (Baliga RR et al. Positron emission tomography localizes insulin resistance to skeletal muscle in premature coronary heart disease. Circulation1995; 92: 1-16). What is the role of troponins in the diagnosis of myocardial infarction? Raised concentrations of the myocardial regulatory protein troponin I are highly specific for myocardial injury.

What do you understand by the term chronotropic incompetence? Failure to reach a heart rate that is 85% of the age-predicted maximum (220 - age in years) at peak exercise, the failure to achieve a heart rate of 100 beats per minute, or a maximal heart rate more than 2 SD below that in a control population (N Engl J Med 2000; 342:703 9). What do you know about Stokes-Adams syndrome? It refers to syncope or tits occurring during complete heart block. W. Stokes (1804-1878), Regius Professor of Medicine in Dublin, graduated from Edinburgh.

Drugs (see above). · Other: thyrotoxicosis, hypoglycaemia, unaccustomed exertion, phaeochromo-cytoma, fever. · Anxiety state (also known as da Costa's syndrome or cardiac neurosis). How would you investigate a patient suspected of having a disorder of cardiac rhythm ? · · · 12-lead ECG (look tk)r evidence of a rhythm disturbance and pre-excitation syndrome). Continuous ambulatory (Holter) echocardiography (many patients with pal-pitations may have stable sinus rhythm). Exercise ECG. M. da Costa (1833-1900) was Professor of Medicine at Jefferson Medical College, Philadelphia.

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