Case Vignettes for Discussion

Case 1

A 60-year old man has had no medical problems. He was made the president of a local corporation and is in your office for an “executive physical”.

1. What should be done on physical examination? Is there any evidence that a complete physical exam on a well patient is beneficial?
    
2. What screening tests and/or procedures will you recommend? Do you need additional history to determine which tests you should recommend? (Consult the above reading assignments to answer these questions. The consumer oriented site http://www.ahrq.gov/ppip/healthymen.htm may also help.)
    
3. You note that his blood pressure is elevated. He wants you to order a stress test because his 66-year old brother just had coronary artery bypass surgery done after an angina episode and a stress test. He does not have any chest pain but he is mildly obese and does not do much exercise. How would you respond? Are there other tests that you would suggest?
    
4. He would like a PSA (prostate specific antigen) test to check for prostate cancer. What will you tell him about the test? How will you proceed if the test result is elevated?