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a 60 year old male who has lead a relatively sedentary lifestyle has decided to jog for half an hour everyday. he mentions this to his friend who in response says that a check up should be done prior to any new physical exercise at his age. the pt's BP is 150/100. he has a 28 year smoking history. physical exam revelas nothing but serum cholestrol is 260 mg/dl.

what is the next step in management?

a] echo

b]working out with a CPR licensed trainer

c] ambulatory BP monitoring

d]ambulatory EKG monitoring

e] exercise stress test


e) exercise stress test.






I would rather go for the Ambulatory ECG monitoring. Why you all think exercise test is mandatory. Since he is old, it is better to do ambulatory test. Please correct me.


E-it is exercise stress test. its the cheapest to start off with and we would want to rule out any sort of angina on exertion before we send him off to a moderate level form of workout. esp since he has a sedentary lifestyle and high cholesterol levels with a sky rocketing BP.

starting with ambulatory EKG wont yield if this pt can handle exercise. if it gives a normal reading, and we send off jogging, it could precipitate an anginal attack in the middle of his run.

nice u guys...i found this and was torn between E and A... but goljan says that if u're torn between two answers, choose the cheaper one. and he was right wink


would u still go for exercise stress testing if this patient did not have hypertension and a high cholesterol?


Guys, you only go to a stress test if there is a history of angina. An old guy who wants to start working out doesnt need an extensive workup. You MIGHT want to get an EKG to establish a baseline. If he starts exercising and gets exertional angina THEN you would get a stress test.

This isnt "either he stays sedentary or he starts running 15 miles a day." You do the exercise he can tolerate.

A - he has no evidence of symptomatology of heart failure, valvular disease, or history of myocardial ischemia / infarction.

B - Rediculous. People should exercise, not worry about dying while they do it.

C - In order to diagnose hypertension he will need 2 consectutively elevated BPs on two separate visits. I would probably start treating him for hypercholesteremia and hypertension regardless, but this answer is only for diagnosis of hypertension

D - Get an EKG to establish baseline. He doesnt need to wear a halter around the house, nor while he exercises. We DONT need to do a stress test. Just get him an EKG right now

E - No indication for stress test. He has RISK FACTORS for disease, there is no recomendation for stress test screening in asymptomatic patients.


I was wondering what if this 60 yr guy already started to jog half an hr a day without any chest pain. Would we still do stress test

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