WBR0897

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Primary Care Office
Sub Category	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	Angiography
Answer A Explanation	Incorrect Angiography is done when the stress test is abnormal.
Answer B	Repeat Ck-MB
Answer B Explanation	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	Aspirin
Answer C Explanation	Incorrect Aspirin comes in the management of the case, but the diagnosis of CAD should be confirmed using stress test
Answer D	Stress test
Answer D Explanation	Correct Stress test is the answer when the case is not acute, and EKG or enzymes don’t establish the diagnosis
Answer E	Lipid profile
Answer E Explanation	Incorrect Lipid profile will not establish the diagnosis of CAD
Right Answer	D
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: References:
Approved	No
Keyword	[[WBRKeyword::Coronary artery disease]]
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