Q437) A 65 year old man with HTN presents to your office for evaluation of right leg pain that increases on walking about one block. The pain seems to disappear when he sits and takes rest for about 10 minutes. He is concerned because it is interfering with his exercise activity that his cardiologist has recommended him. His medications include hydrochlorthiazide and enalapril. The patient has a history of heavy smoking but he quit 2 years ago. Physical exam was normal except for diminished dorsalis pedis pulses bilaterally. An arterial doppler is performed and ankle brachial index obtained which is 0.70 . The next best step in the management of his leg pain?
A) Start Cilostozol
B) Start Pentoxyfilline
C) Supervised exercise therapy
D) Recommend unsupervised exercise for 30 minutes everyday.
E) Add clopidogrel.
F) Obtain Magnetic Resonance Angiography.
G) Arterial bypass surgery
438) For the patient in Q437, which of the following is most effective in reducing the combined risk of ischemic stroke, myocardial infarction, or vascular death ?
A) Aspirin
B) Clopidogrel
C) Cilostozol
D) Pentoxifilline
E) Abciximab
439) The patient was appropriately treated and a follow up visit was scheduled one month later. The patients symptoms have moderately improved. During this visit, his fasting lipid panel revealed an LDL of 126mg%, HgbA1c of 5.5 and a blood pressure of 128/82. Next important step:
A) Advise dietary modification to treat his high LDL cholesterol
B) Start Atorvastatin and Dietary changes
C) Start Metformin
D) Start Metoprolol
440) Three months after he was diagnosed with Peripheral arterial disease, the patient suffered a massive myocardial infarction and hospitalized. He underwent Coronary artery bypass grafting and his symptoms are now well controlled. While in the hospital, the patient was started on Aspirin and Clopidogrel. He was continued on Hydrochlorthiazide and Enalapril. His Ejection fraction after the MI was 35%. One month after discharge, during a regular follow up with his cardiologist, he was started on metoprolol. Two weeks after this the patient comes back to your office with worsening leg pain on walking. On physical examination, the legs are normal in color with diminished dorsalis pedis pulses bilaterally.
Next best step in management:
A) Stop metoprolol
B) Change metoprolol to carvedilol
C) Start Cilostozol
D) Obtain angiogram and schedule arterial bypass surgery
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