robin082006
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D ) Exercise stress test
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| fongch
Forum Elite
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E looks most likely to me.
This patient does have risk factors for CHD, but he is asymptomatic. So I believe E is more reasonable.
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| usmle12
Forum Senior
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patient has no shest pain why do stress test to se if he gets pain ...echo wont tell u much as he is not in failure n wont do any thing for risk stratification...rest is too confusing...well any one with better explanations
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| dncosta
Licensed, finally
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One can't establish the diagnosis of hypertension based on an isolated measurement. I would pick option B (first, to confirm that he has arterial hypertension)
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| nadiabarati
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D
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| doc_clotaire
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HTA DX :
High BP minimun 2 times repeats
B
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| eckimazuro
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Yes, answer B, get BP readings.
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| dermatology
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i wud go for D exercise stress test....
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| mjl1717
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Good q!
1)Id stress him answer-d
a) means you're good for nothing..
b)I know you need BP times 3 to dx HTN but this guy has HTN!! ambulatory? BP-what for? the BP readings do not have to be ambulatory.. Also ambulatory doesnt mean you stressed his heart. He needs RX..
c) since when do we use term ambulatory ECG.
d)as usmle12 said echo wont tell you much..
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| dr_arc
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so whats the final verdict on this one
by elimination looks like A to me
a single reading of 150/88= call for fu after 2 mnths. ambulatory bp monitoring seems a little radical here
ambulatory ekg is out cos baseline ekg was normal and pt has no complaints
exercise stress test is part of an angina workup. this pt has no complains of that
echo to look for an anatomical problem in the heart , no indication for that here.
what this pt has working against him is his age, smoking and a high cholesterol and now a sudden urge to exercise after a long sedentary lifestyle. which means you cannot allow him to go out and exercise on his own. he is definitely at risk for CAD. so better to have him exercise under some sort of supervision.
someone shed some light on this.
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| dr in trouble
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i am with A too after excluding all other choices.
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| elitoki
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answer should be B.
This is first time measure of BP. any situation can cause increase of BP (stress, smoking, sedentary life style with cholest...)and it should be confirmed before initiate with any management.
EKG is normal and pt is asymptomatic, it is unnecesary to go Echocardio, neither stress test.
I agree with doc_clotaire and eckimazuro
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| dr_arc
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agree definitely need to confirm the hypertension, but wouldnt ambulatory bp monitoring be a bit too radical here.
i think to make a diagnosis of hypertension , you usually call the ptt for a followup and recheck bp. meanwhile start nonpharmac intervention, such as exercise itself!!!
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| msyamp
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pt. here has multiple risk factors for CAD (age, smoking, high cholesterol. ? HTN).
An exercise stress test would be more beneficial to him than an ambulatory BP (not reqd. pt can be followed up for a repeat measurement).
A supervised exercise program is a must. However, at present, an exercise stress test would be more valuable.
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| nagi_step1
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Supervised Exercise Therapy (S.E.T.) is a monitored exercise and education program for people who want to exercise but also have special needs, risk factors or desire personal attention.You may want to consider S.E.T. is you have:
Diabetes
Cardiovascular disease (or are a graduate of the CVPT Program)
Pulmonary disease (or are a graduate of the Pulmonary Program)
Hypertension
Obesity
High cholesterol
Two or more primary illnesses or risks identified by the American College of Sports Medicine (to be determined by our professional staff)
You want to learn the correct way to exercise
so answer is a
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| MAGY17
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finally the ans is????????????????
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| drfax
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I'll go for A
this patient has Isolated systolic hypertension , and the treatment is beginning with exercise then give medications like dihydroperidine calcium channel blockers (felodipine, nitrondipine..) plus ACE Inhibitors
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| neuroblastoma
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D stress ecg for CAD.. cuz hypertension, hypercholeterlemia->200, 2packs daily smoking
so, do better screening for heart CAD.
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| arlete
Intern in 2009!!!!!
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D
Even to refer to A you need to be sure he doesn't have CAD, and he has too many risk factors.
Ambulatory ECG and ambulatory blood pressure tests are the holters. Not indicated right now.
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| RX 135
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d routine for 50 years and above
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| radonc
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I think the answer is D. exercise stress test.
Check this out http://www.postgradmed.com/issues/2004/06_04/tak....
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| guangyu
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I think the answer is B. It is tha matter of diagnosis HTN. You can not go to D or E without give him a ECG. I think it is the same reason i did not pick up A.
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