{"id":6022,"date":"2025-05-28T00:01:00","date_gmt":"2025-05-28T08:01:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=6022"},"modified":"2025-10-01T11:38:25","modified_gmt":"2025-10-01T19:38:25","slug":"usmle-step-2-ck-question-of-the-day-hypertension-smoker","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Hypertension smoker"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-hypertension-smoker\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today, we\u2019re examining a clinical case of a 42-year-old woman who&#8217;s a smoker with hypertension. What&#8217;s the next step in her care?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 42-year-old woman comes to her primary care physician for a routine visit. She is asymptomatic. Her past medical history is significant for hypertension, which is controlled by losartan. She has been smoking 2-3 cigarettes daily for the past 10 years. Family history is noncontributory. Temperature is 37 \u00baC (98.6 \u00b0F), heart rate is 66\/min, blood pressure is 115\/75 mmHg, and respiratory rate is 14\/min. Cardiopulmonary examination is unremarkable. Laboratory studies are shown below. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the <strong>most appropriate<\/strong> next step in management?<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td colspan=\"2\"><strong>Lipid panel<\/strong>&nbsp;<\/td><\/tr><tr><td>Total cholesterol&nbsp;<\/td><td>236 mg\/dL (6.24 mmol\/L)&nbsp;<\/td><\/tr><tr><td>HDL cholesterol&nbsp;<\/td><td>92 mg\/dL (2.56 mmol\/L)&nbsp;<\/td><\/tr><tr><td>LDL cholesterol&nbsp;<\/td><td>122 mg\/dL (3.00 mmol\/L)&nbsp;<\/td><\/tr><tr><td>Triglycerides&nbsp;&nbsp;<\/td><td>124 mg\/dL (1.45 mmol\/L)&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Initiate high-intensity statin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Repeat lipid panel while fasting<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Initiate low-dose aspirin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Calculate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Obtain an electrocardiogram (ECG)<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Calculate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Initiate high-intensity statin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> According to the ACC\/AHA guidelines, high-intensity statin therapy is indicated for primary prevention of ASCVD in patients with an LDL cholesterol level \u2265 190 mg\/dL and for patients with diabetes and multiple atherosclerotic cardiovascular disease (ASCVD) risk factors. This patient\u2019s ASCVD score should be calculated before determining the necessary intervention, but this patient would likely not require high-intensity statin therapy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Repeat lipid panel while fasting<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Fasting and nonfasting total cholesterol and HDL cholesterol levels have fairly similar prognostic value and association with cardiovascular outcomes. LDL levels vary slightly with and without fasting. Fasting is not generally required. It may be required with elevated triglyceride levels.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Initiate low-dose aspirin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The U.S. Preventive Services Task Force advises individualized decision-making regarding low-dose aspirin therapy for adults aged 40 to 59 years with a 10-year ASCVD risk of \u2265 10% and no elevated risk of bleeding, provided they have a life expectancy of \u2265 10 years and are willing to commit to daily aspirin for a decade. Conversely, the American College of Cardiology\/American Heart Association guidelines suggest limited use of aspirin in routine primary ASCVD prevention, citing a lack of overall benefit. This patient\u2019s ASCVD score should be calculated first before deciding on treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Obtain an electrocardiogram (ECG)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The USPSTF does not recommend screening for coronary artery disease with a resting ECG in asymptomatic patients at low risk, defined by the USPSTF as a 10-year cardiovascular event risk of &lt;10%. This patient\u2019s ASCVD score should be calculated first.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"580\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_8c2f49.png\" alt=\"Assess risk factors &gt; Risk factors &gt; Assess age &gt; 40-75 years old\n\nASCVD Risk Estimator\nRisk of major CV event in the next ten years\" class=\"wp-image-6024\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_8c2f49.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_8c2f49.png?resize=300,178 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_8c2f49.png?resize=768,457 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">While a general estimate of the relative risk for ASCVD in patients can be approximated by counting the number of traditional risk factors present, a more precise estimation of the absolute risk for a first ASCVD event is necessary when making treatment recommendations in patients aged 40-75 years who have no prior ASCVD and are asymptomatic. For this patient with a history of hypertension and smoking, the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) should be calculated, and based on the level of risk, prevention strategies and decisions regarding the lipid panel results can be made.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For all asymptomatic patients without a history of ASVD who are being screened for cardiovascular disease, the initial step in management involves determining the presence of one or more of the traditional risk factors (hypertension, cigarette smoking, diabetes mellitus [DM], premature family history of ASCVD, chronic kidney disease, obesity) for ASCVD. If a risk factor is present, then the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) should be calculated to classify patients into various risk categories: low risk (&lt; 5%), borderline risk (5%\u2012 7.4%), and intermediate risk (7.5%\u201219.9%) and high risk (&gt;20%). Based on this classification, optimal risk factor modification and primary prevention strategies, including statin therapy can be determined. All patients \u2265 20 years of age should have a baseline lipid profile, and treatment decisions for prevention of ASCVD should be based on the results of the lipid panel, patient age, and the patient\u2019s calculated 10-year risk for ASCVD.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">When screening patients for cardiovascular disease and making decisions regarding prevention of atherosclerotic cardiovascular disease (ASCVD) in patients without prior ASCVD who are asymptomatic, the presence of traditional risk factors for cardiovascular events should be determined. If risk factors are present, then the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) should be calculated to guide all prevention and treatment decisions, including statin therapy.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Cardiovascular_disease_screening:_Clinical_sciences\"><strong>Cardiovascular disease screening: Clinical sciences<\/strong><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC\/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11). doi:https:\/\/doi.org\/10.1161\/cir.0000000000000678<\/li>\n\n\n\n<li>Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 2: Preparticipation Screening for Cardiovascular Disease in Competitive Athletes: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2356-2361. doi:10.1016\/j.jacc.2015.09.034<\/li>\n\n\n\n<li>US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(22):2308-2314. doi:10.1001\/jama.2018.6848<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png\" alt=\"\" class=\"wp-image-4633\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dive into today&#8217;s USMLE\u00ae Step 2 CK question about a hypertensive smoker and learn the vital next steps in the patient&#8217;s care.<\/p>\n","protected":false},"author":202,"featured_media":6026,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,45],"tags":[740,736,733,265,739,84,731,742,741,185],"class_list":["post-6022","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-2","tag-ascvd","tag-cardiovascular-disease","tag-clinical-case","tag-healthcare-training","tag-hypertension","tag-medical-education","tag-patient-management","tag-preventive-medicine","tag-smoking","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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