WBR0897
| Author | [[PageAuthor::Mohamed Moubarak, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Primary Care Office |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 55 year- old male comes to your office after 2 days of experiencing a chest pain. He mentions the attack as a dull pain started 15 min before arriving to ED all over his chest that radiates to the left shoulder and arm, and he was released the next day. His CK-MB was 2ng/mL, and his EKG is shown below. Which of the following is the best next step in his further management?
|
| Answer A | AnswerA::Angiography |
| Answer A Explanation | [[AnswerAExp::Incorrect
Angiography is done when the stress test is abnormal.]] |
| Answer B | AnswerB::Repeat Ck-MB |
| Answer B Explanation | [[AnswerBExp::Incorrect
CK-MB only stays elevated for 1-2 days, and stress test is a way to increase the sensitivity of detection of CAD]] |
| Answer C | AnswerC::Aspirin |
| Answer C Explanation | [[AnswerCExp::Incorrect
Aspirin comes in the management of the case, but the diagnosis of CAD should be confirmed using stress test]] |
| Answer D | AnswerD::Stress test |
| Answer D Explanation | [[AnswerDExp::Correct
Stress test is the answer when the case is not acute, and EKG or enzymes don’t establish the diagnosis]] |
| Answer E | AnswerE::Lipid profile |
| Answer E Explanation | [[AnswerEExp::Incorrect
Lipid profile will not establish the diagnosis of CAD]] |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Coronary artery disease (CAD) present with chest pain that doesn’t change with body position and respiration. Stress test is done when the case is equivocal, and you are not certain of the diagnosis. Angiography is done when the stress test is abnormal. Educational Objective: |
| Approved | Approved::No |
| Keyword | [[WBRKeyword::Coronary artery disease]] |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
