A 63-year-old man is evaluated during a follow-up appointmen

Discussion in 'USMLE STEP 2 CS' started by luke, Jan 6, 2011.

  1. luke

    luke Guest

    A 63-year-old man is evaluated during a follow-up appointment. One month ago, he had a transient ischemic attack. Carotid ultrasound revealed a 60% left internal carotid artery stenosis, and transthoracic echocardiogram revealed left ventricular hypertrophy. He is currently asymptomatic. He has hypertension and quit smoking 10 years ago. He has no history of coronary artery disease and no family history of premature coronary artery disease. Current medications are hydrochlorothiazide and aspirin. An LDL cholesterol level 6 months ago was 138 mg/dl (3.57 mmol/L), and he has been complian with recommended lifestyle modifications, including diet and exercise. On physical examination, blood pressure is 132/84 mmHg. There are no focal neurologic abnormalities. Fasting lipid levels are as follows: total cholesterol, 206 mg/dL (5.34 mm/L); HDL cholesterol, 50 mg/dL (1.3 mmol/L); LDL cholesterol, 128 mg/dL (3.32 mmol/L); triglycerides, 144 mg/dL (1.63 mmol/L). In addition to continuing therapeutic lifestyle changes, which of the following is the most appropriate management otion for this patient?

    a. change hydrochlorothiazide to amlodipine
    b. Add atorvastatin
    c. Change hydrochlorothiazide to carvedilol
    d. Add nicotinic acid

    Could anybody answer this please? take from MKSAP 3.
    thank you!

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