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4397 Medicine

An 18-year-old man is admitted to the hospital with acute onset of substernal chest pain that began abruptly 30 minutes ago. He repos the pain radiating to his neck and right arm. He has otherwise been in good health. On physical examination, he is diaphoretic and tachypnoeic. His BP is 102/48 mmHg and hea rate is 112 bpm, regular rhythm but is tachycardiac. A 2/6 holosystolic murmur is heard best at the apex and radiates to the axilla. His lungs have bilateral rales at the bases. The ECG demonstrates 4 mm of ST elevation in the anterior leads. In the past he was hospitalized for some problem with his hea when he was 4 years old. His mother, who accompanies him, repos that he received aspirin and g- globulin as treatment. Since that time, he has required intermittent follow-up with echocardiography. What is the most likely cause of this patient’s acute coronary syndrome?

ADissection of the aoic root and left coronary ostia
BPresence of a myocardial bridge overlying the left anterior descending aery
CThrombosis of a coronary aery aneurysm
DVasospasm following cocaine ingestion
Medicine
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4401 Medicine

A 14 year old male was presented to the casualty on a saturday night with left sided upper abdominal pain. Clinical examination revealed massive splenomegaly. He has history of massive hematemesis 2 year back, and was diagnosed to have Extrahepatic Poal Venous Obstruction (EHPVO) and bleeding was controlled by ligation of the esophageal varices. What is the likely diagnosis?

AAcute pancreatitis
BAoic dissection
CSplenic infarction
DIntussusception
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