NBME 3 block 4

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NBME 3 block 4

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9 Posts

docdoc9
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Topics: 63
Posts: 513

08/24/08 - 06:47 PM

. An asymptomatic 57-year-old man comes to the physician before beginning a jogging program. He has a sedentary lifestyle and has smoked two packs of cigarettes daily for 30 years. His blood pressure is 150188 mm Hg. Examination shows no other abnormalities. An ECG shows normal findings. His serum cholesterol level is 250 mgfdL. Which of the following is the most appropriate next step in management?

O A) Referral to a supervised exercise program
O B) Ambulatory blood pressure monitoring
O C) Ambulatory ECG monitoring
O D) Exercise stress test
0 E) Echocardiography

nightflight1945
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Topics: 32
Posts: 920

08/24/08 - 10:21 PM

D) Exercise stress test

It is indicated to observe patient's response to exercise ,to see wether he developes sign of ischemia or arythmia during exercise.

ngaybinhyen
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08/25/08 - 12:26 AM

Do we need to make sure pt has HT by either second measurement or ambulatory BP?

nightflight1945
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08/25/08 - 12:56 AM

yes , maybe secondary blood pressure measurement is a good option or even the best next step , but ambulatory BP monitoring, I dont know!

nightflight1945
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08/25/08 - 01:05 AM

Exercise stress test is not indicated in asymptomatic patients other than two occasions:

1-pilots or those with critical jobs

2-elderly patients who wish to start a heavy exercise activity

docdoc9
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Topics: 63
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08/25/08 - 01:25 AM

Thank you

ngaybinhyen
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08/25/08 - 01:27 AM

It's just a thought as many times i don't know how to respond to tricky Q's
Anyway, thanks for the post

-t. smiling face

ngaybinhyen
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Topics: 23
Posts: 657

08/25/08 - 01:40 AM

1. Evaluation of persons with multiple risk factors as a guide to risk reduction therapy

2. Evaluation of asymptomatic men > 45 yr and women > 55 yr:
- plan to start vigorous exercise (especially if sedentary or DM) or
- involved in occupations in which impairment might impact public safety (pilots) or
- at high risk for CAD because of other diseases (peripheral vascular disease and chronic renal failure)

not indicated for other asymptomatic people as for no supportive evidence

good post nightflight

nightflight1945
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08/25/08 - 06:30 AM

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