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economics 1 modul

 

Subgect Propedeutics of internal medicine
Modul ¹
Enclosure module ¹
Topic Clinical, laboratory and instrumental examinations of patients with aortic valve disease.
Course
Faculty Medical ¹ 1

 

Methodical recommendations are made in accordance with educationally-qualifying descriptions and educationally-professional programs of preparation of the specialists ratified by Order MES of Ukraine from 16.05 2003 years ¹ 239 and experimentally - curriculum, that is developed on principles of the European credit-transfer system (ECTS) and Ukraine ratified by the order of MPH of Ukraine from 31.01.2005 year ¹ 52.

 

 

Vinnytsya – 2007


 

  1. Importance of the topic

Valve aortic diseases are important structural pathology of the heart. They can be formed due to different pathological process and usually could not be resolved without surgery. Knowledge about causes, hemodynamics, symptoms and signs of the aortic valve diseases has a great role in the study of the cardiovascular diseases.

  1. Concrete aims:

To learn and understand hemodynamics, symptoms, signs, laboratory and instrumental data at patients with the aortic valve diseases.

Basic training level

 

Previous subject Obtained skill
Normal anatomy Anatomy of the heart, its conduction systems
Normal physiology Principles of the heart automaticity, conductivity
Histology histological structure of the heart
Propedeutics to internal diseases Symptoms of the cardiovascular diseases, data of general and local visual inspection, palpation, percussion, auscultation of the heart, main ECG-signs, Echo-CG signs of the aortic valve diseases

 

4. Task for self-depending preparation to practical training

4.1. List of the main terms that should know student preparing practical training

 

“Cat purring” Capillary pulse cardiac asthma
Systolic murmur syncope ‘parvus and tardus’ pulse
Diastolic murmur carotid pulsation (‘pulsus celer, altus, magnus’
Pulmonary edema Traube’s sign Flint murmur

 

4.2. Theoretical questions:

  1. Causes and hemodynamics of aortic stenosis.
  2. Symptoms and signs of aortic stenosis.
  3. Data of additional methods of investigation at patients with aortic stenosis.
  4. Causes and hemodynamics of aortic regurgitation.
  5. Symptoms and signs of aortic regurgitation.
  6. Data of additional methods of investigation at patients with aortic regurgitation.

4.3. Practical task that should be performed during practical training

1. Collecting symptoms at patient with aortic valve diseases

2. Revealing signs of the aortic valve diseases

3. Assessing data of ECG, Echocardiography and X-ray examination of the aortic valve diseases patient



 

Topic content

Causes of aortic stenosis:

Senile calcification is the commonest

rheumatic fever,

congenital aortic bicuspid valve (associated with coarctation of the aorta),

congenital stenosis of valve cusps,

septic endocarditis.

Hemodynamics of the aortic stenosis is impaired if the aortic opening is decreased from normal 3 sm2 until 1,00 -0,75 sm2 and less. During systole blood doesn’t go to the aorta completely. Increased left ventricular pressure tries to overcome the resistance of the narrowed valvular opening. The massive hypertrophy of the left ventricle has being developed. The added workload increases the demand for oxygen, and diminished cardiac output causes poor coronary artery perfusion, ischemia of the left ventricle, and left ventricular failure.

Later compensatory ability of the left ventricle has been diminished and its cavity has been enlarged. It is developed diastolic dysfunction of the left ventricle. Relative mitral regurgitation is formed and results in increased pulmonary artery pressure, eventually leading to left and right ventricular failure.

Symptoms and signs of aortic stenosis: Symptoms appear if aortic stenosis has decompensated. There is dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, palpitations, angina pectoris, headache, dizziness, and syncope.

Dizziness and syncope can be due to insufficiency of the cerebral circulation. The angina occurs when hypertrophy myocardium of the left ventricle needs more oxygen than coronary arteries can get because cardiac output is low than normal.

Dyspnoea appears at blood congestion in the pulmonary veins resulting in reduction of the pulmonary tissue elasticity. At first, dyspnoea appears only on physical effort, later at rest when the patient is lying and it is relieved if patient sits (orthopnea). At last dyspnea does not disappear even in an upright position of the patient. Dyspnoea is frequently mixed with difficulty in inspiration and expiration as well as involvement of the auxiliary respiratory muscles in the act of respiration.

Paroxysmal dyspnea sometimes appears suddenly at night as attack of cardiac asthma with dry cough or heamoptysis. The most severe complication of this disease is pulmonary oedema.

At the visual examination a pale skin due to low blood filling of peripheral arterioles is observed.

Pulse is low-volume, slow rising with narrow pulse pressure (‘parvus and tardus’). Systolic blood pressure is decreased and diastolic blood pressure is normal.

Apex beat is heaving, displaced to the left, and resistant. You can obtain systolic trembling of chest at the base region named “cat purring”. It is palpation sensation of murmur which appears during going flow blood through narrowing aortic opening.

The left border of relative heart dullness shifts left due to hypertrophy left ventricle.

On auscultation diminished S1 (muscle component) on the apex, a quiet S2 on the aorta (sometimes inaudible due to calcified and unmoving valve) are heard. There is rough ejection systolic murmur heard at the base, left sternal edge and the aortic area, radiates to the carotids and interscapular region.

Chest X-ray examination: Aortic configuration of the heart at the front position: accentuated waist of heart and left ventricle enlargement, valvular calcification, post-stenotic dilatation of ascending aorta, and pulmonary vein congestion are recognized.

ECG: There is left ventricle hypertrophy, chronic coronary insufficiency (depressed ST segment and negative T-wave in I, II, AVL, V4-6). Sometimes p-mitrale can be if relative mitral regurgitation has been developed.

Echocardiography: There is thickened calcified aortic valve and thickened left ventricular wall, interventricular septum. Reduction of aortic opening square (normal – 3 cm2) are revealed.

Causes of aortic regurgitation:

Rheumatic fever,

infective endocarditis,

syphilitic aortitis

hypertension,

connective tissue disorders (rheumatoid arthritis, systemic lupus erythematosus, Marfan syndrome),

congenital (may be associated with other defects, such as ventricular septal defect),

trauma with aortic dissection.

Hemodynamics of the aortic regurgitation: Blood flows back into the left ventricle during diastole, causing fluid overload in the ventricle, which dilates and hypertrophies. The excess volume causes fluid overload in the left atrium and, finally, the pulmonary system. Left ventricular failure and pulmonary edema eventually result.

Pulmonary hypertension augments loading of right ventricle and causes its hypertrophy and failure.

Symptoms and signs of the aortic regurgitation: Symptoms appear if aortic regurgitation has decompensated and congestive changes in pulmonary circulation are developed.

The first complains are fatigue, palpitation and heaviness in the heart region which increase in the reclining position. The characteristic complain is an angina which is caused by worsened coronary circulation of the hypertrophied left ventricle and low diastolic blood pressure in the aorta.

Dizziness, pulsating headache and syncope can be due to insufficiency of the cerebral circulation.

Dyspnea, cough, cardiac asthma attack occur when cardiac decompensation have been developed. Finally, heaviness in the right under rib and leg edemas appear as symptoms of the right ventricle failure.

At the visual examination a pale skin due to low blood filling of peripheral arterioles during diastole and their reflex spasm is observed. There is carotid pulsation (Corrigan’s sign), head nodding (de Musset’s sign), capillary pulsation in nail beds (Quincke’s sign), pulsatile narrowing and widening pupils, pulsatile dermography spot. All this signs occur because of quick fluctuation of blood pressure.

Pulse is rapidly rising, collapsing (water-hammer), large, high and frequent (‘pulsus celer, altus, magnus’). Systolic blood pressure is decreased and diastolic blood pressure is normal.

Apex beat is heaving, wide, undisplaced to the left and downward, and resistant.

The left border of relative heart dullness drifts left and downward due to enlarged left ventricle.

On auscultation the weakened S1on the apex (due to hypertrophy and overfilling of the left ventricle), and weakened S2 at the 2nd intercostals space near right edge of the sternum (due to absence of closing the aortic valve) are heard. If the aortic valve has broken significantly S2 over aorta couldn’t be heard.

There is high-pitched soft blowing early diastolic murmur at the right 2nd intercostals space near sternum. It is heard best in expiration, with patient sitting forward and radiates to the 5th point of auscultation.

In severe aortic regurgitation an Austin Flint murmur (due to the fluttering of the anterior mitral valve cusp caused by regurgitation stream) may be heard.

If relative mitral regurgitation has developed the systolic murmur can be heard on the apex.

There are associated auscultation phenomena: ‘pistol shot’ sound over femoral arteries (Traube’s sign) and femoral diastolic murmur as blood flows backwards in diastole (Duroziez’s sign).

Arterial blood pressure always is changed: systolic is high and diastolic is low → wide pulse pressure.

Chest X-ray examination: Aortic configuration of the heart at the front position: accentuated waist of heart and left ventricle enlargement dilated ascending, and pulmonary vein congestion are recognized.

ECG: There is left ventricle hypertrophy, chronic coronary insufficiency (depressed ST segment and negative T-wave in I, II, AVL, V4-6). Sometimes p-mitrale can be if relative mitral regurgitation has been developed.

Echocardiography: aortic valvular insufficiency, left ventricular enlargement, alteration in mitral valve movement (indirect indication of aortic valve disease) and mitral enlargement and thickening, pulmonary hypertension signs are revealed. Doppler echo allow assessing size and sites of regurgitation. Cardiac catheterization confirms diagnosis (aortic regurgitation, anatomy of aortic root reduction in arterial diastolic pressures, and increased left ventricular end-diastolic pressure), excludes other valve disease, assesses coronary artery disease.

 

Reference source

o Handbook of diseases.-.2nd ed.- Springhouse Corporation, 2000 – P.892-895


Materials for self-control (added)

1. How is the systolic murmur conducted at patient with aortic stenosis?

A. along the right edge of breastbone;

B. to the Botkin-Erb point;

C. to the vessels of neck;

D. to the lift axillary area;

E. not conducted.

 

2. How is the first sound changed at the patient with aortic stenosis?

A. Amplified;

B. Diminished;

Ñ. Split;

D. not changed;

E. Depend on clinical situation.

 

3. How is the second sound changed at the patient with aortic stenosis?

A. increased above the aorta

B. increased above the pulmonary artery;

C. diminished above the aorta;

D. diminished above the pulmonary artery;

E. not changed.

 

4. What are ECG changes at the patients with aortic stenosis?

A. hypertrophy left atrium

B. hypertrophy of right atrium;

C. hypertrophy of right ventricle;

D. hypertrophy of left ventricle;

E. all mentioned above.

5. What border of the relative heart dullness is shift at the patient with aortic stenosis?

A. right is shift right

B. left is shift left and downward;

C. upper is shift upward;

D. upper is shift upward and right is shift right;

E. left is shift left.

 

6. How is the first sound changed at the patient with aortic regurgitation?

A. Amplified;

B. Diminished;

Ñ. Split;

D. not changed;

E. Depend on clinical situation.

7. What border of the relative heart dullness is shift at the patient with aortic regurgitation?

A. right is shift right

B. left is shift left and downward;

C. upper is shift upward;

D. right answers A, B, and C;

E. borders of the relative heart dullness are not changed.

8. What murmur at the aorta point can be heard at the patient with aortic regurgitation?

A. systolic

B. diastolic;

C. systolic and diastolic;

D. murmur is absent;

E. depend on clinical situation

9. Which area is the murmur at the patient with aortic regurgitation conducted to?

A. neck vessels

B. axillary region

C. interscapular region

D. Botkin-Erb point

E. is not conducted.

10. What are the symptoms of decompensated aortic stenosis?

A. Dyspnea and fatigue,

B. Palpitation,

C. Chest pain,

D. Faintness

E. All mentioned above

11. What are the symptoms of decompensated aortic regurgitation?

A. Dyspnea and cough,

B. Palpitation, heaviness in the heart region

C. Cardiac asthma attack,

D. Faintness, dizziness

E. All mentioned above

12. What are the main causes of aortic regurgitation?

A. Rheumatic fever,

B. infective endocarditis, syphilitic aortitis

C. connective tissue disorders (rheumatoid arthritis, systemic lupus erythematosus, Marfan syndrome),

D. congenital (may be associated with other defects, such as ventricular septal defect),

E. all mentioned above

13. What are the main causes of aortic stenosis?

  1. Senile calcification is the commonest
  2. rheumatic fever,
  3. congenital valve diseases

D. septic endocarditis.

E. all mentioned above

14. How is color of skin changed at patients with aortic valve diseases?

A. Became bluish

B. Become reddish

C. Become yellowish

D. Became pale

E. Nothing from above.

15. Capillary pulse is a sign of…

A. Aortic stenosis

B. Mitral stenosis

C. Mitral regurgitation

D. Pulmonary hypertension

E. Aortic regurgitation

16. ‘Carotid dance’ (carotid pulsation) is a sign of …

A. Mitral stenosis

B. Pulmonary hypertension

C. Aortic regurgitation

D. Aortic stenosis

E. Mitral regurgitation

17. How is blood pressure changed at patient with aortic stenosis?

A. Systolic increased, diastolic normal

B. Systolic decreased, diastolic normal

C. Systolic normal, diastolic increased

D. Systolic normal, diastolic decreased

E. Systolic increased, diastolic decreased

18. What murmur at the aorta point can be heard at the patient with aortic stenosis?

A. systolic

B. diastolic;

C. systolic and diastolic;

D. murmur is absent;

E. depend on clinical situation

19. How is the second sound changed at the patient with aortic regurgitation?

A. increased above the aorta

B. increased above the pulmonary artery;

C. diminished above the aorta;

D. diminished above the pulmonary artery;

E. not changed.

20. Systolic ‘cat purring’ is a sign of…

A. aortic regurgitation

B. mitral regurgitation

C. arterial hypertension

D. aortic stenosis

E. mitral stenosis

economics 1 modul

* When people want to set up or start a company, they need money, called ...

* Companies can borrow this money, called a …, from banks.

* The loan must be paid back with ...: the amount paid to borrow the money.

* Capital can also come from issuing shares or ... - certificates representing units of ownership of a company.

* The people who invest money in shares are called shareholders and they own part of the company. The money they provide is known as ... .

* Individuals and financial institutions, called investors, can also lend money to companies by buying … - loans that pay interest and are repaid at a fixed future date.

* Money that is owed - that will have to be paid - to other people or businesses is a …

* In accounting, companies’ debts are usually called ….

* Long-term liabilities include bonds; short-term liabilities include … to suppliers who provide goods or services on credit - that will be paid for later.

* The money that a business uses for everyday expenses or has available for spending is called working capital or funds.

* All the money coming into a company during a given period is ….

* Revenue minus the cost of sales and operating expenses, such as rent and salaries, is known as profit, earnings or net income.

* The part of its profit that a company pays to its shareholders is a ….

* Companies pay a proportion of their profits to the government as …, to finance government spending. They also retain, or keep, some of their earnings for future use.

* Companies give information about their financial situation in financial ….

* The balance sheet shows the company’s … - the things it owns; its liabilities - the money it owes; and its capital.

* The profit and loss account shows the company’s revenues and … during a particular period, such as three months or a year.

* For most of the 20th century, most banks operated in one country only (in the US, in one state only).

* Different kinds of … did specialized kinds of financial business.

* Retail banks or commercial banks worked with individuals and small companies: received deposits and ….

* Investment banks worked with big companies: gave financial advice, raised capital - increased the amount of money companies had by issuing … or shares and bonds and organized mergers and takeover bids.

*Insurance companies provided life insurance and …..

* Building societies specialized in …. Many have now become normal commercial banks.

* Debts that pay interest and are repaid at a fixed future date are

* The financial industry changed radically in 1980s and 90s when it was ….

* Before deregulation: rules and regulations in the US, Britain and Japan prevented commercial banks doing … banking business.

* Some other countries (Germany, Switzerland) already had universal banks doing all kinds of financial ….

* Today: many large international conglomerates offer a complete…of financial services.

* Individuals and … can use a single financial institution for all their financial needs.

* Central banks issue currency and carry out the government's financial ….

* Private banks manage the … of rich people or high net worth individuals.

* Clearing banks pass … and other payments through the banking system.

* Non-bank financial intermediaries such as car manufacturers, food retailers and department stores now offer products like …, credit cards and insurance.

* Unlike commercial banks, investment banks like ours don’t lend ….

* Instead we act as intermediaries between companies and investors.

* We help companies and governments raise capital by issuing securities such as stocks and bonds - that is, we offer them for sale.

* We often underwrite securities issues: in other words, we guarantee to buy the securities ourselves if we can’t find other purchasers.

* As well as initial public offerings (IPOs), when companies offer stock for sale for the first time, there are other occasions when they … funds.

* For example, they might want to expand their operations, or to acquire another company, or to reduce their amount of debt, or to finance a specific project.

* They don’t only raise capital from the public: they can sell stocks or shares to institutional investors like … companies, investment funds - companies that invest the money of lots of small investors, and pension funds - companies that invest money that will later be paid to retired workers.

* We also have a stockbroking and … department.

* Stockbroking and dealing department executes orders - buys and sells stocks for clients - which is broking, and trades with our own money, which is ….

* The stockbroking department also … advice to investors.

* Investment banks often …. firms in mergers and acquisitions, and divestitures.

* A divestiture is when a company … a subsidiary - another company that it owns.

* Large corporations have their own … and corporate development departments.

* But they often use an investment bank like ours because, like a consulting firm, we can offer independent advice, and we have a lot of … in financial transactions.

* We also have a large network of …, and relationships with investors and companies that could be interested in a merger or acquisition.

* If we’ve worked on a … with a company, we know a lot about its business. This means we can give advice about strategic planning - deciding what do to in the future - or financial restructuring - changing the way the business is financed.

* Large investment banks also have extensive research departments with analysts and forecasters who specialize in the valuation of different …, industries, companies, securities and currencies.

* Analysts try to work out how much things are worth now, and … study the prospects for the future.

* a company of experts providing professional advice to businesses for a fee

* a financial institution that invests money to provide retirement income for employees

* deciding what a company is going to do in the future

* people who try to predict what will happen in the future

* a company that is partly or wholly owned by another one

* a financial institution that purchases securities

* making changes to how a company is financed

* establishing how much something is worth

* Financial planning involves … whether new projects would be profitable.

* We have to calculate the probable rate of return: the amount of income we’d receive each year from the investment, expressed as a … of the total amount invested.

* If we’re going to finance a project with our own money, the rate of return must be at least as high as we could get by depositing the money in a bank instead, or by making another risk-free investment, like buying government bonds.

* If we need to borrow money to finance a new investment, its projected rate of return has to be higher than the cost of capital - the … we have to pay to borrow the money.

* We usually calculate the discounted cash flow value of an investment. This means …. or reducing future cash flows to get their present values - in other words, calculating the present value of money to be received in the future.

* This is because the value of … decreases over time.

* Firstly, there’s nearly always inflation, so … will have lower purchasing power in the future: you’ll be able to buy less with the same amount of money.

* And secondly, if you had the money now, you could get … by using or investing it.

* The return we could get by investing the money in other ways is the opportunity cost of capital. So waiting for money is also a ….

* This is the time … of money: how much more it is worth to receive money now rather than in the future.

* If we have to choose among possible investments in new projects, we work out the … (NPV) of each project by adding up all the expected cash flows, discounted to their present value, minus the initial investment.

* To do this, we have to select a discount … or capitalization rate. This is usually the interest rate we pay for borrowing the capital, but we could increase it if there’s a lot of uncertainty or risk.

* Discounting sounds complicated, but it isn’t. It’s the … of compounding interest.

* For example, if you invest $1,000 at 10% for five years, it will yield 1.61 times its original value. So you get back $1,610, including $610 compound …..

* When we’re comparing alternative investments, we also calculate the … (IRR).

* That’s the interest rate or discount rate that gives a net present value of zero in today’s money values.

* The present value of the cash that we’re going to receive from an investment is the same as the present value of …. that cash. We normally choose the investment with the highest IRR.

* Mei Lee is the compliance officer at a large US bank with subsidiaries in major financial centres: she has to make sure that everybody obeys government …. and follows internal procedures.

* The financial … industry was deregulated in the 1980s: lots of government controls were removed to make the market freer and more efficient. But a lot of regulations still exist.

* We’re still regulated and supervised by government …. For example, in Britain there’s the Financial Services Authority (FSA), and here in the States there’s the Federal Reserve (or the Fed) and the Securities and Exchange Commission (SEC).

* The Fed supervises banks, and the SEC tries to protect investors by requiring full disclosure: it makes sure that public … make all significant financial information available.

* When people want to set up or start a company, they need money, called ...

(choose the wrong answers, 3 choices)

* Companies can borrow this money, called a …, from banks.

(choose the wrong answers, 3 choices)

* The loan must be paid back with ...: the amount paid to borrow the money.

(choose the wrong answers, 3 choices)

* Capital can also come from issuing shares or ... - certificates representing units of ownership of a company. (choose the wrong answers, 3 choices)

* The people who invest money in shares are called shareholders and they own part of the company. The money they provide is known as ... . (choose the wrong answers, 3 choices)

* Individuals and financial institutions, called investors, can also lend money to companies by buying … - loans that pay interest and are repaid at a fixed future date.

(choose the wrong answers, 3 choices)

* Money that is owed - that will have to be paid - to other people or businesses is a …

(choose the wrong answers, 3 choices)

* In accounting, companies’ debts are usually called ….(choose the wrong answers, 3 choices)

* Long-term liabilities include bonds; short-term liabilities include … to suppliers who provide goods or services on credit - that will be paid for later.

(choose the wrong answers, 3 choices)

* The money that a business uses for everyday expenses or has available for spending is called working capital or funds.

(choose the wrong answers, 3 choices)

* All the money coming into a company during a given period is ….

(choose the wrong answers, 3 choices)

* Revenue minus the cost of sales and operating expenses, such as rent and salaries, is known as profit, earnings or net income.

(choose the wrong answers, 3 choices)

* The part of its profit that a company pays to its shareholders is a ….

(choose the wrong answers, 3 choices)

* Companies pay a proportion of their profits to the government as …, to finance government spending. They also retain, or keep, some of their earnings for future use. (choose the wrong answers, 3 choices)

* Companies give information about their financial situation in financial ….

(choose the wrong answers, 3 choices)

* The balance sheet shows the company’s … - the things it owns; its liabilities - the money it owes; and its capital. (choose the wrong answers, 3 choices)

* The profit and loss account shows the company’s revenues and … during a particular period, such as three months or a year. (choose the wrong answers, 3 choices)

* For most of the 20th century, most banks operated in one country only (in the US, in one state only). (choose the wrong answers, 3 choices)

* Different kinds of … did specialized kinds of financial business. (choose the wrong answers, 3 choices)

* Retail banks or commercial banks worked with individuals and small companies: received deposits and ….

(choose the wrong answers, 3 choices)

* Investment banks worked with big companies: gave financial advice, raised capital - increased the amount of money companies had by issuing … or shares and bonds and organized mergers and takeover bids. (choose the wrong answers, 3 choices)

*Insurance companies provided life insurance and …..

(choose the wrong answers, 3 choices)

* Building societies specialized in …. Many have now become normal commercial banks.

(choose the wrong answers, 3 choices)

* Debts that pay interest and are repaid at a fixed future date are

(choose the wrong answers, 3 choices)

* The financial industry changed radically in 1980s and 90s when it was ….

(choose the wrong answers, 3 choices)

* Before deregulation: rules and regulations in the US, Britain and Japan prevented commercial banks doing … banking business.

(choose the wrong answers, 3 choices)

* Some other countries (Germany, Switzerland) already had universal banks doing all kinds of financial ….(choose the wrong answers, 3 choices)

* Today: many large international conglomerates offer a complete…of financial services.

(choose the wrong answers, 3 choices)

* Individuals and … can use a single financial institution for all their financial needs.

(choose the wrong answers, 3 choices)

* Central banks issue currency and carry out the government's financial ….

(choose the wrong answers, 3 choices)

* Private banks manage the … of rich people or high net worth individuals.

(choose the wrong answers, 3 choices)

* Clearing banks pass … and other payments through the banking system.

(choose the wrong answers, 3 choices)

* Non-bank financial intermediaries such as car manufacturers, food retailers and department stores now offer products like …, credit cards and insurance.

(choose the wrong answers, 3 choices)

* Unlike commercial banks, investment banks like ours don’t lend ….

(choose the wrong answers, 3 choices)

* Instead we act as intermediaries between companies and investors. (choose the wrong answers, 3 choices)

* We help companies and governments raise capital by issuing securities such as stocks and bonds - that is, we offer them for sale. (choose the wrong answers, 3 choices)

* We often underwrite securities issues: in other words, we guarantee to buy the securities ourselves if we can’t find other purchasers. (choose the wrong answers, 3 choices)

* As well as initial public offerings (IPOs), when companies offer stock for sale for the first time, there are other occasions when they … funds. (choose the wrong answers, 3 choices)

* For example, they might want to expand their operations, or to acquire another company, or to reduce their amount of debt, or to finance a specific project. (choose the wrong answers, 3 choices)

* They don’t only raise capital from the public: they can sell stocks or shares to institutional investors like … companies, investment funds - companies that invest the money of lots of small investors, and pension funds - companies that invest money that will later be paid to retired workers. (choose the wrong answers, 3 choices)

* We also have a stockbroking and … department.

(choose the wrong answers, 3 choices)

* Stockbroking and dealing department executes orders - buys and sells stocks for clients - which is broking, and trades with our own money, which is ….

(choose the wrong answers, 3 choices)

* The stockbroking department also … advice to investors. (choose the wrong answers, 3 choices)

* Investment banks often …. firms in mergers and acquisitions, and divestitures. (choose the wrong answers, 3 choices)

* A divestiture is when a company … a subsidiary - another company that it owns. (choose the wrong answers, 3 choices)

* Large corporations have their own … and corporate development departments.

(choose the wrong answers, 3 choices)

* But they often use an investment bank like ours because, like a consulting firm, we can offer independent advice, and we have a lot of … in financial transactions. (choose the wrong answers, 3 choices)

* We also have a large network of …, and relationships with investors and companies that could be interested in a merger or acquisition. (choose the wrong answers, 3 choices)

* If we’ve worked on a … with a company, we know a lot about its business. This means we can give advice about strategic planning - deciding what do to in the future - or financial restructuring - changing the way the business is financed.

(choose the wrong answers, 3 choices)

* Large investment banks also have extensive research departments with analysts and forecasters who specialize in the valuation of different …, industries, companies, securities and currencies.

(choose the wrong answers, 3 choices)

* Analysts try to work out how much things are worth now, and … study the prospects for the future. (choose the wrong answers, 3 choices)

* a company of experts providing professional advice to businesses for a fee

(choose the wrong answers, 3 choices)

* a financial institution that invests money to provide retirement income for employees

(choose the wrong answers, 3 choices)

* deciding what a company is going to do in the future (choose the wrong answers, 3 choices)

* people who try to predict what will happen in the future

(choose the wrong answers, 3 choices)

* a company that is partly or wholly owned by another one

(choose the wrong answers, 3 choices)

* a financial institution that purchases securities

(choose the wrong answers, 3 choices)

* making changes to how a company is financed

(choose the wrong answers, 3 choices)

* establishing how much something is worth

(choose the wrong answers, 3 choices)

* Financial … involves … whether new projects would be profitable. (2 choices)

* We have to calculate the probable …. of return: the amount of income we’d receive each year from the investment, expressed as a … of the total amount invested.(2 choices)

* If we’re going to finance a project with our own …, the rate of return must be at least as high as we could get by depositing the money in a bank instead, or by making another risk-free investment, like buying government bonds.(2 chioces)

* If we need to borrow … to finance a new investment, its projected rate of return has to be higher than the cost of capital - the … we have to pay to borrow the money.(2 choices)

* We usually calculate the discounted … flow value of an investment. This means …. or reducing future cash flows to get their present values - in other words, calculating the present value of money to be received in the future. (2 choices)

* This is because the … of … decreases over time. (2 choices)

* Firstly, there’s nearly always inflation, so … will have lower purchasing power in the future: you’ll be able to buy less with the same amount of …. (2 choices)

* And secondly, if you had the … now, you could get … by using or investing it.( 2 choices)

* The return we could get by investing the … in other ways is the opportunity cost of capital. So waiting for money is also a …. (2 choices)

* This is the time … of money: how much more it is worth to receive … now rather than in the future. (2 choices)

* If we have to choose among possible … in new projects, we work out the … (NPV) of each project by adding up all the expected cash flows, discounted to their present value, minus the initial investment. (2 choices)

* To do this, we have to select a discount … or capitalization rate. This is usually the interest rate we pay for borrowing the …, but we could increase it if there’s a lot of uncertainty or risk.

(2 choices)

* Discounting sounds complicated, but it isn’t. It’s the … of compounding …. (2 choices)

* For example, if you … $1,000 at 10% for five years, it will yield 1.61 times its original value. So you get back $1,610, including $610 compound ….. (2 choices)

* When we’re comparing alternative …, we also calculate the … (IRR).

(2 choices)

* That’s the … or discount rate that gives a net present value of zero in today’s … values. (2 choices)

* The present … of the cash that we’re going to receive from an investment is the same as the present value of …. that cash. We normally choose the investment with the highest IRR. (2 choices)

* Mei Lee is the compliance officer at a large US bank with subsidiaries in major financial centres: she has to make sure that everybody obeys government …. and follows internal ….(2 choices)

* The financial … industry was deregulated in the 1980s: lots of government controls were removed to make the … freer and more efficient. But a lot of regulations still exist.

(2 choices)

* We’re still regulated and supervised by government …. For example, in Britain there’s the … (FSA), and here in the States there’s the Federal Reserve (or the Fed) and the Securities and Exchange Commission (SEC).(2 choices)

* The Fed supervises banks, and the SEC tries to protect investors by requiring full disclosure: it makes sure that public … make all significant financial … available. (2 choices)

 

 


Date: 2014-12-21; view: 1030


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Guidelines for Third-year Students of the Medical Department | Topic: Diseases of the alimentary tract, urinary tract, hematologic disorders, sexually transmitted diseases. HIV
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