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1. A 45-year-old man presents with a history of recurrent episodes of chest pain that are
relieved by rest. He has a family history of coronary artery disease and smokes half a
pack of cigarettes per day. His blood pressure is 150/90 mmHg and his pulse is 80 beats
per minute. What is the most appropriate diagnostic test to confirm or rule out angina
pectoris?
A) Electrocardiogram (ECG)
B) Exercise stress test
C) Coronary angiography
D) Cardiac enzyme levels
Answer: B) Exercise stress test
Rationale: An exercise stress test is the most commonly used noninvasive test to evaluate
the presence and severity of coronary artery disease (CAD). It can detect ischemic
changes in the ECG, blood pressure, and symptoms during physical exertion. An ECG at
rest may be normal or nonspecific in patients with angina. Coronary angiography is an
invasive procedure that requires catheterization and contrast injection, and is usually
reserved for patients who have positive stress tests or who are candidates for
revascularization. Cardiac enzyme levels are elevated in myocardial infarction, not
angina.
2. A 60-year-old woman with type 2 diabetes mellitus and hypertension is prescribed
metformin, lisinopril, and hydrochlorothiazide. She reports that she has been
experiencing frequent episodes of nocturia, polyuria, and polydipsia. Her fasting blood
glucose level is 250 mg/dL and her hemoglobin A1c is 9%. What is the most likely
cause of her symptoms?
A) Diabetic nephropathy
B) Diabetic ketoacidosis
C) Hyperosmolar hyperglycemic state
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