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Q96) A 65 year old man with history of DM type II presents to your office with complaints of chest pain that he has been having lately. He denies any pain now. He says his chest pain is more left sided and about 5/10 in intensity and it appears after walking about 2 blocks. The pain disappears after resting for a while. He has been having these chest pain episodes for the past 3 months. He also reports severe crampy leg pain that occurs in his both legs which is also relieved by rest. He denies any shortness of breath. He has smoked about 1 pack per day for the past 40 years. He denies any cough. His only medications are Glyburide and Metformin. An EKG is obtained in the office and it reveals non-specific ST segment changes. Next important step in managing this patient:
A) CT angiogram of Chest
B) Exercise Treadmill Stress test
C) Obtain Cardiac Enzymes
D) Dipyridamole Stress test
E) Start Calcium Channel Blocker

B) Exercise Treadmill Stress test

@lascrusesdoc you are getting everyone of these wrong.

He has PVD. D. even though most beneficial in this case would have been a stress echo but that is not an option.

@misshyd what about his H/O smoking but no cough. Does this point towards a h/o copd? It is not categorically given so my answer would be D.

On second thought, I get the point of this question. Final answer C.

may be ur correct,l am glad for u.

I hope to learn from my mistakes.

Sorry, I didn't mean it in a bad way. I was just getting a conversation going, again sorry if I caused any offence. We don't know everything and this is how we learn by committing mistakes.

Since he has stable angina, and we need to reproduce the pain which leads to angina..so, would go with B..exercise treadmill..but as he also has severe crampy pain in legs, which means he might not be a candidate for an exercise stress test, will go with D..Dipyridamole testing.
Answer : d

I would say D..

cc

D) Dipyridamole Stress test
He is not a candidate for exercise stress test since he will not be able to exercise because of atherosclerotic PVD