MKSAP: 62-year-old man is evaluated during a routine visit

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin. On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. BMI is 29. Cardiac examination reveals a grade 2/6 early-peaking systolic murmur at the cardiac base. Carotid upstrokes are normal. The remainder of the examination is unremarkable. Laboratory studies demonstrate a total serum cholesterol level of 150 mg/dL (3.89 mmol/L). Electrocardiogram is within normal limits. Echocardiogram from 1 year ago shows a peak velocity of 2.0 m/s, mean transaortic gradient of 13 mm Hg, aortic valve area of 1.5 cm2, and preserved ejection fraction. Which of the following is the most appropriate management? A. Echocardiogram B. Exercise perfusion study C. Exercise stress test D. No additional testing Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Cardiology Diabetes Source Type: blogs