CASE 1: A 54 year old male experienced sudden onset of crushing chest pain whilst gardening. His wife immediately called an ambulance. On arrival the paramedics did a clinical evaluation. The patient was cold and clammy and showing laboured shallow breathing (19 breaths per minute). The electrocardiogram was unremarkable apart from a slight tachycardia (93 beats per minute). The patient was immediately transferred to the emergency department. A second ECG demonstrated cardiac ischemia. His blood test results at admission and 3 hours are given below. The patient underwent a surgical cardiac procedure. 5 days from admission the patient experienced another sudden onset of chest pain and went into cardiac arrest. After an hour’s resuscitation attempt the patient was pronounced dead. A post-mortem was carried out at the request of the coroner. Admission blood results: Normal range SODIUM 144 mmol/L 133 to 146 POTASSIUM 4.5 mmol/L 3.5 to 5.3 UREA 16.0 mmol/L 2.5 to 7.8 CREATININE 179 µmol/L 62 to 106 eGFR 34 mL/min/1.73m2 GLUCOSE 6.0 mmol/L 3.0 to 6.0 CREATINE KINASE 226 U/L 40 to 320 CRP 23 mg/L 0 to 8 Troponin T 86 ng/L ˂14 3-hour blood results: Normal range SODIUM 143 mmol/L 133 to 146 POTASSIUM 4.6 mmol/L 3.5 to 5.3 UREA 35.9 mmol/L 2.5 to 7.8 CREATININE 419 µmol/L 62 to 106 eGFR 13 mL/min/1.73m2 GLUCOSE 6.7 mmol/L 3.0 to 6.0 CREATINE KINASE 154 U/L 40 to 320 CRP 96 mg/L 0 to 8 Troponin T 236 ng/L ˂14 Comment on the blood results and relate these to the presenting condition. (50%) What surgical cardiac procedure is the patient likely to have undergone and how would this be useful in treating the condition? (20%) What note of caution should be advised when carrying out this procedure? (5%) At post mortem, what pathological changes would be evident to the pathologist? (25%) CASE 2: A 82 year old female visits the GP with her partner who is getting increasingly concerned about her loss of memory and decline in cognition. Furthermore she is having increasing difficulty recognizing many family members, difficulties eating and occasional incontinence. The GP requests an APOE test and the patient is found to have one copy of the ε4 allele. Given the patient symptoms, provide a provisional diagnosis for the patient and discuss and explain which can be the underlying molecular mechanisms for this type of disease. (50%) Explain the relevance of the APOE test, and the relevance for ApoE in relation to dementia. (25%) Discuss how the suspected type of dementia would be characterised by histological analysis and how such histopathological features can be associated with cognitive status. (25%)