Clinical scenario - as promised!

Today's question is courtesy of Dr Ramachandra, senior SpR Cardiology, Leeds.

A 60 year old Asian man with a history of type 2 diabetes on insulin and hypertension presents with deteriorating renal function and is referred by his GP to the renal clinic. In the renal clinic, he is found to have leg oedema, elevated JVP with rapid x-descent, ascites, mild jaundice and bi-basal dullness. Chest X-ray shows cardiomegaly. ECG shows left ventricular hypertrophy with strain.  Resting heart rate was 100 bpm and BP of 90/70. The definitive cardiac diagnosis can be obtained by -

a. Cardiac MRI
b. CT pulmonary angiography
c. Ventilation-perfusion scan
d. Transthoracic echocardiography
e. Right and left heart catheterisation

In the patient above, which of the following observation is likely to be true?

a. Absent contrast reflux into the hepatic vein on CTPA
b. Pulsus paradoxus of 30 mmHg on clinical examination
c. Paradoxical septal motion on transthoracic echocardiography
d. Myocardial speckling on CMR
e. Pulmonary capillary wedge pressure of 15mmHg on cardiac catheter

Put your thinking caps on! Answer in a week!

Cardio4mrcp team.

Launch of Echo4exams - visit now!

Hey there readers!

We are pleased to announce the launch of our site Echo4exams, the online site for questions for basic echocardiography exams. The questions are in true/false format, and cover everything from ultrasound physics to complex congenital heart disease and valvular heart disease. Included is a *FREE* quick revision document which you can download (as pdf) which contains a snippet of the content on the site. We have had a large number of people already register, so check it out at

www.echo4exams.co.uk

Try our question of the day as well on the site! Look forward to seeing you there!

Warm wishes

E-Medilearn.org Limited

Answer to clinical scenario 27.03.2012

Hey everyone,

You may remember the clinical scenario that was posted on the 27th of last month. Well, for those of you who were wondering what the actor was asked to do - if the candidate apologised for the accident with the lignocaine and stated that it was contraindicated in her father, the actor would stand up and shout 'you killed my father' and leave the room! Imagine that.

The correct way to handle that situation is to explain the situation in its totality, and explain that at the local anaesthetic concentration, lignocaine pretty much has no effect on the heart, so would play no role in contributing toward the patient's death. Of course, you would also get a senior to discuss the situation with you and the family together.

MRCP clinical scenarios only appear scary on paper. They are no more than regular scenarios encountered in clinical practice. Keep a cool head, and they are all a walk in the park.

More scenarios soon!

Cardio4mrcp team.

Book Review - Anatomy!

Hello readers, hope all of you are well. Sorry it has been a while since my last post, but not only have I been travelling a bit but have been attending numerous meetings - been hectic! Its good to be back and see that the blog has had over 1000 views so far!! Thank you to all who have visited the blog.

Later today, I will be posting a clinical scenario for you all to discuss - something that is relevant to the MRCP exam. But for now, I will be quickly reviewing a book that got me (and many others) started in medical college. I do this as it brings back great memories - one of excitement of starting medical school, confusion as to what the difference between a tendon and aponeurosis is, and of course the beginning of a long career of healing.

So yes, the book I am referring to in the title is not Greys anatomy, but what we considered to be our Greys anatomy text book - 'Human anatomy' by BD Chaurasia. Best thing about the book - the simple, reproducible diagrams. Of course, anatomy is tedious and difficult, and memorising what nerve goes through what canal under what bone and over what muscle is hard, but the simple figure in this textbook just make memorising such facts easy. And as a first year medical student at the tender age of 16, I don't think I could have handled a huge textbook with complicated 3D figures - don't you agree?!!

I submit this post is probably not relevant to my readers as most of you are way past medical school and probably practising in you area of expertise, but a trip down memory lane never hurt anyone! Feels kinda nice :-)

Well, I am sure that myself and my 300 classmates, and everyone from most universities who have used this book would recommend it - we pretty much considered it the 'bible' of human anatomy. You can purchase your copy from Amazon, and I have attached a link below that should avoid the hassle of searching for the book and take you directly to the page -

It is definitely worth it, especially if you are preparing for entrance exams - the diagrams (though may appear redundant) are packed with information and are great to memorise facts. A lot of them I still remember, 12 years post graduation!

Clinical scenario coming up next!

Warm wishes

Vik.

Back after easter!

Sorry folks, away at the moment, hope you are all enjoying your Easter holidays! See you all soon! Later...

Ticagrelor

Those of you who are keeping up to date will have no doubt heard about Ticagrelor, a new antiplatelet drug. Below are key points regarding this revolutionary drug

Mechanism of action - Reversible platelet ADP receptor blocker (P2Y12)

Unlike Clopidogrel, it is not a thienopyridine drug.

Advantages over Clopidogrel include a more rapid onset of action and its platelet inhibition is more pronounced.  Bleeding risks are not different from Clopidogrel either.

From the MRCP point of view

1. Its a reversible P2Y12 inhibitor
2. More rapid onset of action compared with clopidogrel
3. More potent platelet inhibition.

There are recent studies looking at the role of Ticagrelor in ACS. The NEJM published the PLATO study that compared Ticagrelor and Clopidogrel in patients with ACS. The primary end points were significantly reduced. Interestingly, dyspnoea was a side effect seen more often with Ticagrelor.

It is a good idea to know what this study involved. Read the study here.

Pharmacology is a big part of the MRCP part 1 exam. Read a good book and thou shalt pass! Here are a few

Enjoy!