Question of the Week # 384

384)  A 55  year old airline pilot presents for a follow-up visit for hypertension. He was diagnosed with hypertension a year ago and has been on treatment with hydrochlorthiazide and lisinopril.  He denies any chest pain, palpitations or shortness of breath on exertion. He has no other significant health issues. His Hemoglobin a1C about 6 months ago was 5.0% . A lipid profile obtained 3 months ago showed a total chlesterol of 270mg% with HDL cholesterol of 34mg%. He  smokes about 1 pack per day but denies any drug or alcohol abuse.  There is no family history of Diabetes or coronary artery disease or abdominal aorta aneurysm. On examination, his blood pressure is 138/74. Cardiac examination shows regular heart sound with no S3 gallop or S4. There are no audible murmurs. Abdominal examination is benign and there are no audible bruits. A complete blood count, comprehensive metabolic panel and urinalysis are unremarkable. A resting electrocardiogram shows changes consistent with left ventricular hypertrophy. He had a colonoscopy five years ago which was normal. Which of the following is indicated at this time?

A) No additional Tests

B) Exercise Stress Test

C) Cardiac catheterization

D) Abdominal Ultrasound for Aortic aneurysm

E) Fecal Occult Blood Testing

9 Responses

  1. d

  2. exercise tolerance test……

  3. B

  4. B) Exercise Stress Test -risk factors like abnormal lipid profile and smoking puts him at a high risk of an acute coronary event…so being in a high risk profession he needs to be screened.

  5. A) No additional tests
    Abdominal Ultrasound for Aortic aneurysm is indicated in male smoker >65yr. No screening indication for male nonsmoker and female, regardless of smoking history.

    Fecal occult blood is not required because the colonoscopy was done 5 yr ago.

    Exercise stress test is not required because he doesn’t have chest pain.

  6. A tan has the reason

    • What is the Framingham Risk score and what are ACC guidelines regarding patients with high risk profession? No one else need this but patients with high risk professions have little different recommendations many times because an event to them will cause a disaster to hundreds of people ( Bus Driver, Air Line Pilot)

      Key point: ACC recommends screening asymptomatic patients in high-risk occupations for CAD if they have intermediate probability of having CAD as assessed by Framingham Risk Score

      Framingham Score estimates the pre-test probability of having CAD based on some variables
      Variables in Framingham Risk SCore: Age, SBP ( Systolic Blood Pressure) , Total cholesterol, HDL-C, Current smoking, Diabetes, Anti-hypertensive therapy
      Recognize:
      20% – High risk for CAD
      More information http://www.framinghamheartstudy.org/risk/coronary.html
      Framingham Risk Score Calculator http://www.medcalc.com/heartrisk.html

      • Thank for good explanation.

  7. Thank u DR Red. learning a lot!
    thx for helping us.

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