Sunday, January 14, 2018
Repeated USMLE Questions Step 1- 218
A 59 year old man visits his physician for his yearly routine examination. He mentions that his exercise tolerance had been reduced over the last year. He also notes that he experiences shortness of breath and chest pain when he is ascending his home stairs although he lives on the second floor. He smokes 1-2 packs of cigarettes every day for 35 years. He drinks socially and uses recreational drugs occasionally. On examination, his vital signs are as follows: pulse 86/min, blood pressure 140/90 and his BMI is 30. His cardiac examination is unremarkable. He has family history of hypercholesterolemia and coronary disease. His laboratory tests show abnormal lipid profile (LDL: 230 mg/dL and HDL: 32 mg/dL).
What is the most likely vascular pathology in this patient?
B-Deep venous thrombosis
D-Medial calcific sclerosis
This patient has hypercholesterolemia and most probably coronary artery disease revealed by exertional dyspnea and chest pain. At his age and due to other factors such as smoking and familial hypercholesterolemia, coronary artery disease is mostly precipitated by atherosclerosis. Deep venous thrombosis is suspected if the patient complains of pain, tenderness and swelling of one or both of his legs and/or shortness of breath and pleuritic pain. Hyperplastic arteriosclerosis and medial calcific sclerosis usually occur in smaller arteries and arterioles in patients with diabetes and/or hypertension which is not the case in this patient.
The correct answer is A