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