Day 4
Diagnose the case, Give the investigations, suggest the management and select the rubrics
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1. A 63-year-old woman develops exertional angina and has had two episodes of syncope. Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2. Which of the following is the most likely diagnosis and why?
 (A)  mitral stenosis 
(B) mitral insufficiency 
(C)  aortic stenosis 
(D)  aortic insufficiency 
(E)  tricuspid stenosis
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2. A 19-year-old man develops typical angina pectoris. There is no family history of premature CAD. Which of the following is the most likely diagnosis?
 (A)  mitral stenosis 
(B)  coronary artery aneurysm 
(C)  coarctation 
(D)  atrial septal defect 
(E)  Werner’s syndrome
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3.  A 47-year-old man is found to have edema, ascites, and hepatosplenomegaly. The examination of his neck veins reveals elevated venous pressure with a deep y descent. Heart size on x-ray is normal. Which of the following etiologies is not a possible explanation for this syndrome? Why? 
(A) rheumatic fever 
(B) TB 
(C) unknown cause
(D) previous acute pericarditis 
(E) neoplastic involvement of the pericardium 

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4.  A 60-year-old woman presents with symptoms of weight loss, anxiety, and palpitations. On examination, she has a goiter. Which of the following is the most likely cardiac finding? Justify (A) prolonged circulation time (B) decreased cardiac output 
(C) paroxysmal atrial fibrillation (D) pericardial effusion  (E) aortic insufficiency

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5.  A 16-year-old boy is found to have hypertension on routine evaluation. On examination, the blood pressure in his arms is higher than in his legs by more than 10 mm Hg. Which of the following is the most likely diagnosis? Why? (A)  aortic insufficiency 
(B)  coarctation of the aorta 
(C)  normal variant 
(D)  ventricular aneurysm 
(E)  severe juvenile diabetes 

0 points
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