MEDICINEnotes

Q1188. A 58-year-old man is reviewed three days after successful primary PCI with drug-eluting stent implantation for an anterior STEMI. He has no history of major bleeding, his haemoglobin concentration is normal and there is no evidence of active gastrointestinal bleeding. He is receiving aspirin 75 mg daily and ticagrelor 90 mg twice daily. He asks how long he should continue both antiplatelet medications before transitioning to long-term single-antiplatelet therapy.

Q1187. A 61-year-old man undergoes PCI with stent implantation for significant coronary artery disease. Ten days after the procedure, he develops new prolonged central chest pain accompanied by diaphoresis and breathlessness. ECG demonstrates new ischaemic changes that were absent immediately after the intervention. Serial high-sensitivity troponin measurements demonstrate a significant rise and fall above the 99th-percentile upper reference limit. The clinical team considers this event to be related to the recent coronary intervention rather than an unrelated chronic myocardial injury.

Q1186. A 64-year-old man has experienced occasional chest discomfort during brisk walking for several years. These episodes have been predictable and have consistently resolved with rest. During the last 48 hours, however, he has developed new episodes of central chest pain while sitting and watching television, each lasting approximately 15 minutes. ECG demonstrates transient horizontal ST-segment depression, but serial high-sensitivity troponin measurements remain below the 99th-percentile upper reference limit without a significant rise or fall. He is haemodynamically stable and has no persistent ST-segment elevation. Which diagnosis best explains the current presentation? A. Stable angina caused by an unchanged fixed coronary stenosis. B. NSTEMI caused by acute myocardial injury with elevated troponin. C. Unstable angina caused by new or worsening ischaemic symptoms without biochemical myocardial necrosis. D. STEMI caused by an occlusive coronary thrombus with persistent ST elevation. E. Variant angina caused by isolated nocturnal coronary vasospasm.

Q1185. A 48-year-old woman presents with recurrent discomfort localised mainly to the epigastric region. The sensation is described as pressure rather than sharp pain and occurs consistently during brisk walking. It usually resolves within five minutes of stopping exercise. She does not describe constricting discomfort in the chest, neck, jaw, shoulder or arm. Her resting ECG is normal, and there is no evidence of acute myocardial injury.

Q1184. A 53-year-old man with longstanding hypertension, diabetes mellitus, hypercholesterolaemia and cigarette smoking undergoes investigation for coronary artery disease. The cardiologist explains that these factors contribute to the earliest vascular changes that initiate atherosclerotic plaque formation. Which structure is primarily affected during the initial pathological stage? A. The myocardial endocardium, producing progressive ventricular fibrosis. B. The vascular endothelium, through injury associated with smoking, hypertension, LDL and high glucose. C. The coronary venous system, producing impaired myocardial drainage. D. The ventricular myocardium, producing direct lipid deposition within muscle fibres. E. The pericardium, producing inflammatory thickening around the heart.

Q1183. A 70-year-old man with severe aortic regurgitation develops recurrent episodes of exertional chest discomfort despite having no significant obstructive coronary stenosis on previous imaging. His blood pressure is 154/48 mmHg, pulse rate is 116 beats/min and haemoglobin concentration is 11 g/dL. The cardiologist explains that myocardial ischaemia may occur because coronary oxygen delivery is impaired even when a fixed coronary obstruction is absent.

Q1182. A 62-year-old woman with established coronary artery disease attends a cardiovascular risk assessment clinic. Her medical history includes chronic kidney disease, hypertension, type 2 diabetes mellitus and a family history of premature coronary disease. She also has a sedentary lifestyle and elevated LDL cholesterol. The physician reviews the risk-factor classification used in the clinical assessment, distinguishing characteristics that cannot be changed from those requiring active risk-factor management.

Q1174. A 34-year-old man attends a cardiovascular prevention clinic because of markedly elevated LDL cholesterol. He has no history of smoking, diabetes or hypertension. His father sustained a myocardial infarction at the age of 54, while his mother developed coronary artery disease at 67. His paternal uncle underwent coronary bypass surgery at 43. The patient asks whether his family history should be considered a premature cardiovascular risk factor.

من الناحية النفسية، المشكلة مش إن الإنسان يكون واثق من روحه أو مقدّر إنجازاته، المشكلة تبدا لما الثقة هذي تتحوّل لشعور إنه أفضل من غيره أو أعلى منهم. لما يلقى روحه ديما محتاج يثبت إنه دار أكثر، ويعرف أكثر، وإنه أحسن من غيره، هني تبدأ المشكلة. لأن علاقاته بالناس تولّي مبنية على المقارنة وإثبات الذات، بدل الاحترام والتقدير المتبادل. في فرق كبير بين إنك تعرف قيمة روحك، وبين إنك تشوف روحك أعلى من غيرك. والتواضع مش معناه إنك تنقص من قيمة روحك، التواضع إنك تعرف قيمتك من غير ما تحتاج تنقص من قيمة حد تاني.

Ego is lacking the capacity to appreciate, glorify and admire others in public. If you struggle to hear good things about someone else and to join in and to be a part of that and to celebrate that, that's ego. If you struggle to acknowledge, you may say I'm the best in the world. You can say you're the best in the world, sure. But even the best in the world, if you really sat down with them, they would happily talk about someone else that inspires them to be the best in the world. They'll never say they're self-made. قد تقول: أنا الأفضل في العالم، ولا بأس أن تقول ذلك. لكن حتى أفضل شخص في العالم، لو جلست معه فعلًا، ستجده يتحدث بكل سرور عن شخص آخر يُلهمه ويدفعه ليكون الأفضل في العالم. لن يقول أبدًا إنه صنع نفسه بنفسه (Self-made).

يعني طالب نقرا من بداية السنة وعندي مصدر تجي تشتتني في شهر قبل الامتحان وتقعد تزن وتحن على راسي واقرا مني واقرا مني وتركب فيا اللي مايتركبش وبعدها لا يطلع الامتحان منه ولا الوهم اللي تسوق بيه لنفسك صحيح..... والا اللي ينزلوا اقروا كيسس كيسس كيسس، شن تديروا مستحيل مازال ع الامتحان اسبوع وماسكين الشيتات وكلام فارغ وفي طلبة قرت منهج وبدون كيسس ولا اسئلة وصفتها بتقدير لإن قروا المادة بفهم مش حفظ يعني مثلا الـ Meningitis كلهم حافظين Neck stiffness, Photophobia, Headache وكأنه هذا البرينزتشين الوحيد بينما Absence of the classic triad does not exclude meningitis

ونزيدك من الشعر بيت أغلبية اللي طالعين توا، مجرد يغلط في سؤال وتصلحه له مش حيعترف انه غالط وان شخص صلحها ليا حيحذف ويقولك بعد تفكير وهو كذب ووهم