Picture Challenge 08

Category : Picture Challenge

This young man is a case of Mumps of Right Parotid gland  where angle of the jaw is obliterated.

Register FREE  in FORUM for FURTHER QUERY, DISCUSSION AND COMMENT- CLICK HERE Mumps FB OK


Cardiomyopathy , HOCM In MRCP Part 1

Cardiomyopathies

Introduction

Myocardium is the main functional part of the heart. Heart failure is synonymous with failure of cardiac muscle. Myocardium may be affected by disease of muscle itself ( Primary) or due to effect of other disease process ( Secondary) or by coronary artery disease. Interestingly, as cardiac muscle is anatomically related with skeletal muscle ( striated muscle) , primary disease of skeletal muscle involves cardiac muscle also.

 Clinical types of Cardiomyopathy

Mainly as below:

  • Dilated cardiomyopathy ( Systolic heart failure)
  • Hypertrophic cardiomyopathy of multiple varieties ( Diastolic heart failure)
  • Restrictive cardiomyopathy ( Diastolic heart failure)

Of them, HOCM ( Hypertrophic Obstructive Cardiomyopathy) is the most common.

Clinical Presentation

Patient presents with symptoms of dyspnoea, angina and syncope due to outflow obstruction. Moreover there would be other-

  • Clinical features of Heart failure
  • Clinical features of Arrhythmia
  • Clinical features of primary disease / cause

 Bad prognostic feature ( risk factors of sudden cardiac death) of HOCM

Exercise induced hypotension is the most important

Investigation ( ECG, Echo, Electrophysiological Study, BNP, Electrolyte etc)

  • To diagnose heart failure ( eg Echo or cardiac MRI)
  • To identify causes of heart failure eg IHD
  • To identify complications eg renal function
  • To identify prognostic factor or co morbidities

Management

  • Management of heart failure
  • Management of Arrhythmia ( eg ICD)
  • Management of primary disease / cause

 


Picture Challenge 3

Category : Picture Challenge

This is Graves Disease. Examining hand  (for Warm sweaty hand- Tachycardia- Tremor) gives Thyroid status.

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Picture Challenge 2

Category : Picture Challenge

Coarse face and big hands cling the diagnosis of Acromegaly. Patient was anemic with H/O per rectal bleeding possibly due to unfortunate development of colorectal cancer. For further discussion Register FREE in the FORUM

 

Acromegaly FB OK


Picture Challenge 1

Category : Picture Challenge

Here is faint scar mark at the wrist for Carpal Tunnel ReleCTS surgery FB OKase operation  as conservative treatment failed.

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Ischemic Heart Disease in MRCP Part 1

IHD in MRCP-2

Causes :
Main cause of ischemia to heart muscle is Coronary Artery Disease ( Atherosclerotic or Non Atherosclerotic eg: cocaine abuse, Prinzmetal`s angina, Syndrome X).
Other (non coronary artery) causes are Aortic valve disease, Hypertrophic left ventricle ( eg- HOCM), Anemia etc.

Clinical Presentation and Diagnosis:
Central chest pain is the cardinal symptom but may be atypically breathless (angina equivalent in diabetes or old patient). Moreover there may be additive features of complications (Heart failure/cardiogenic shock, Myocardial rupture/left ventricular aneurysm, DVT and pulmonary embolism, Pericarditis, Dysrhythmias, Mitral regurgitation, Severe depression) of IHD or other cardiac risk factors , comorbidities.

Differential diagnosis of chest pain of IHD is challenging.

Acute MI is defined by several criteria. The commonest is an increase and then a
decrease in cardiac biomarkers (eg troponin) and either: symptoms of ischaemia OR ECG changes of new ischaemia OR development of pathological Q waves OR loss of myocardium on imaging.

Investigations:
ECG, Biomarkers, CXR, Echocardiogram, Coronary angiogram, CBC, Sugar, U/E, Lipids etc

Aims (basic principles) of Investigations in Hypertension
1) To diagnose ischemia
2) To identify causes of ischemia
3) To identify complication
4) To identify associated other cardiac risk factors or co morbidities

Management:
A) Management of Stable angina
B) Management of Acute coronary syndrome (ACS)

                       Immediate management of ACS
Drug
PCI ( if possible)
Thrombolysis (if PCI not is possible and NO contraindication of thrombolysis )

                       Long term management of ACS
Management of causes of IHD
Management of complication of IHD / co morbidities
Education of the patient ( eg: driving- DVLA guideline , sexual activity etc)

Download DOAMSmrcp Suggestion Part 1 – IHD

FOR FURTHER QUERY AND COMMENT PLEASE CLICK HERE

 


DOAMSmrcp Class Routine This Week (29-31 October) 2015

Category : Notice Board

Part 1 Thursday
(3:30pm- 6:30pm) 29 October

Venue: 5/Ka (Ground Floor) P C culture housing society, Ring road, Shamoly, Dhaka ( Little west from Shamoly cinema hall, Opposite Prince Bazar, Adjacent Samsung show room)

 

Part 1 Friday
(9am-12noon) 30 October

Venue: House – 33 (3rd Floor), Road- 4, Dhanmondi, Dhaka (Opposite Bangladesh Indian Int`l School)

 

Part 2 Written Examinee Friday

(2:30pm-8:30pm) 30 October

Venue: House – 33 (3rd Floor), Road- 4, Dhanmondi, Dhaka (Opposite Bangladesh Indian Int`l School)

 

PACES Saturday
(3:30pm- 6:30pm) 31 October

Venue: 5/Ka (Ground Floor) P C culture housing society, Ring road, Shamoly, Dhaka ( Little west from Shamoly cinema hall, Opposite Prince Bazar, Adjacent Samsung show room)


Hypertension In MRCP Part 1

Category : MRCP Part 1

Clinical Presentation
Mostly asymptomatic as the majority of cases are primary hypertension. Patient with secondary hypertension presents with the clinical features of causes of hypertension. Additionally, longstanding hypertensive patient can present with complications (Target Organ Damage) of hypertension. Few patients present with occipital headache.

Aims (basic principles) of Investigations in Hypertension
1) To diagnose: ( No Investigation is required as Hypertension is diagnosed by measuring blood pressure)
2) To identify causes of secondary hypertension
3) To identify Target Organ Damage/ complication
4) To identify associated other cardiac risk factors or co morbidities

HTN IN MRCP

Management of Hypertension
All the categories of antihypertensive medications are NOT suitable for each patient. Choosing the appropriate antihypertensive drug depends upon following factors-
a) Age
b) Race
c) Causes ( etiology) of hypertension
d) Existing Target Organ Damage / complication
e) Associated co morbidities ( eg – pregnancy etc)
f) Adverse effect of drugs

Target Blood Pressure by Treatment
In general—- less than 140/90 mm Hg
If age more than 80 years—— less than 150/90 mm Hg
If pregnant——– less than150/100 mm Hg, but if any associated Target Organ Damage- less than 140/90 mm Hg

For further information go through  NICE Guideline of Hypertension

Download DOAMSmrcp Suggestion – Hypertension Click Here

FOR FURTHER QUERY AND COMMENT PLEASE CLICK HERE

 


PACES course new batch from November 2015. Book Your Seat

Category : Notice Board

8 Month (Regular) course, 4 Block 2 Mock Exam, 66 Session. Every Saturday 3:30 pm – 6:30 pm, Limited 5 seat

1 Month (Short) Course, 4 Block, 1 Mock Exam, 33 Session. Sunday- Wednesday Every Week, 3:30-6:30 pm. Limited 5 seat



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