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A 52-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 20 years and does not drink alcohol. He has a sedentary lifestyle and requests advice about beginning a regular exercise program. His father died of a myocardial infarction at the age of 62 years. His 77-year-old mother and 51-year-old sister are healthy. He is 178 cm (5 ft 10 in) tall and weighs 80 kg (176 lb); BMI is 25 kg/m2. His pulse is 80/min, respirations are 12/min, and blood pressure is 140/90 mm Hg. Examination shows no other abnormalities. In addition to measurement of serum cholesterol concentration, which of the following is the most appropriate next step prior to starting this patient on an exercise program?
A.Complete blood count
B.Measurement of serum homocysteine concentration
C.Exercise stress test
D. Spirometry
E. Cardiac catheterization
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As examination is normal so respiratory exam would not be a priority. I would choose exercise test
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Wouldnt it be kind of excessive to do stress test for a couple of risk factors? I always thought you do stress test when you have symptoms of CHD.
oh btw i choose A and it was wrong do to that logic
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i mean symptoms suspecting CHD
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37 year old primigravid woman at 9 weeks' gestation is admitted to the hospital because of progressive nausea and vomiting. Her symptoms began at 6 weeks' gestation but havce worsened so that she can no longer keep food or fluids down. Her temperature is 36.9C, pulse is 105/min, respiration are 16/min, and blood pressure is 110/60 mm Hg. Examination shows a uterus consistent in size with a 9-week gestation. Serum electrolyte concentrations are within the reference range. Urinalysis shows 3+ ketones. In addition to beginning intravenous hydration, which of the following is the most appropriate initial step in management?
A) High-protein diet
B) Total parenteral nutrition
C) Antiemetic therapy
D) Insertion of a nasogastric tube
E) Therapeutic abortion
whats your 2cent on this one? does she have gestation diabetes? but electrolytes pretty normal
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A is wrong. High protein diet is ketogenic
B is not correct. There is no reason to jump on TPN when there r other available options
D neither releive symptoms nor does it treat anything.
E is obviously not correct.
So i think the only reasonable choice is to give antiemetics
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a 52 year old man....
Uptodate:
In contrast, cardiac stress testing as a screening test for CHD in asymptomatic patients is rarely indicated.
But...uptodate also says:Special populations
Pre-participation testing — Pre-participation evaluation of asymptomatic patients differs slightly depending on whether the goal of the athlete is recreation or competition:
●Recreational athletes – For asymptomatic patients who have been fairly sedentary and who plan to begin a recreational exercise program, no pre-participation testing is mandatory prior to beginning an exercise program [7-9]. Some patients, however, may require reassurance that they will be able to actively exercise; in such cases, we proceed with exercise electrocardiography (ECG) testing [8,9].
As an example of the utility of exercise ECG testing prior to beginning an exercise program, only 2 percent of 3617 asymptomatic, hypercholesterolemic men who underwent exercise ECG testing at baseline experienced an activity-related acute cardiac event during follow-up (average of 7.4 years) [10]. Although the risk of a cardiac event was increased 2.6-fold in patients with clinically silent, exercised-induced ST-segment changes during submaximal exercise treadmill test (ETT) at study entry, only 11 of the 62 men who experienced an activity-related event had a positive ETT at entry (sensitivity 18 percent).
so i guess if the patient needs reassurance you should do it??
