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

By Ragavendra R. Baliga MD MBA

A set of brief instances prepared via scientific zone, emphasising the major diagnostic positive aspects of scientific stipulations as mostly offered within the brief case a part of the ultimate MB and MRCP examinations. additionally incorporated are most likely directions or instructions anticipated from the examiner for every situation, and the foremost issues which the candidate needs to inform the examiner. In June 2001 the MRCP brief situations examination is being changed with a brand new OSCE-style examination known as PACES (Practice review of scientific exam talents) and this booklet will take complete account of this modification.

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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'? 5. Has the patient developed any new comorbid illnesses or has the severity or treatment of known comorbid illnesses worsened the patient's angina'?

G. g. 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.

Several large trials (SAVE, AIRE, SMILE, TRACE, GISSi-lll and IS1S-IV) have shown both short- and long-term improvement in survival with ACE inhibitor therapy. The benefits are greatest in patients with low ejection fractions, large iufa, ction~ tn ulinical evidence of heart failure. · · · The AIRE (Acute Infarction Ramipril Efficacy) and the AIREX (AIRE Extension) trials assessed the long-term (mean follow-up 59 months) efficacy of ramipril compared with placebo in 603 patients with heart failure after myo-cardial infarction.

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