MKSAP: 70-year-old man with a transient ischemic attack

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications are metformin and lisinopril.

On physical examination, the patient is afebrile, and blood pressure is 148/88 mm Hg. The remainder of the examination is unremarkable.

Laboratory studies show alanine aminotransferase 28 U/L, total cholesterol 239 mg/dL (6.19 mmol/L), LDL cholesterol 140 mg/dL (3.63 mmol/L), HDL cholesterol 38 mg/dL (0.98 mmol/L), serum creatinine 0.8 mg/dL (70.7 µmol/L), and triglycerides 302 mg/dL (3.41 mmol/L).

In addition to aspirin, which of the following is the most appropriate treatment?

A. Atorvastatin, high-intensity dosage
B. Atorvastatin, moderate-intensity dosage
C. Fenofibrate
D. Fenofibrate and atorvastatin, high-intensity dosage

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