Electron Beam Computed Tomography for Evaluation of Coronary Artery Disease Amber M. Shah, MD, MPH Dr. Shah is chief resident, Department of Medicine, Reading Hospital and Medical Center, West Reading, PA. The questions below are based on the article “Electron Beam Computed Tomography for Evaluation of Coronary Artery Disease”. Choose the single best answer for each question.
	1. In which of the following patients would electron beam computed tomography (EBCT) be beneficial for diagnosis of coronary artery disease (CAD)? A 20-year-old man presenting for medical clearance prior to beginning sports A 30-year-old woman who is anxious and has atypical chest pain that occurs after anxiety A 55-year-old hypertensive man with atypical chest pain who presents to the emergency department (ED) A 65-year-old man with diabetes, a history of smoking, and typical anginal chest pain A 70-year-old man with known CAD presenting with typical anginal chest pain Click here to compare your answer. 2. A 60-year-old woman with diabetes mellitus presents to the ED with atypical chest pain. Her electrocardiogram is normal. EBCT for evaluation of CAD is performed and reveals a calcium score of 455. What is the most appropriate next step? Discharge patient home and ask her to follow-up with her primary care provider Discharge patient home with pain control medications; no follow-up necessary Observe the patient overnight and discharge her home the next day if asymptomatic Perform nonemergent further evaluation (stress test or coronary angiography), depending on the clinical scenario Arrange for immediate coronary angiography Click here to compare your answer. 3. What is the approximate charge for EBCT? $75 $350 $1000 $2000 $5000 Click here to compare your answer.		4. Which of the following statements comparing EBCT with multi-detector row computed tomography (MDCT) is true? Calcium scores obtained by EBCT and MDCT are comparable MDCT exposes the patient to a lower radiation dose than EBCT MDCT is much more widely available than EBCT Most clinical research on the value of calcium scoring has been done on MDCT EBCT and MDCT are technically similar Click here to compare your answer . 5. A 30-year-old woman with a history of smoking who has atypical chest pain undergoes EBCT. The calcium score is 0. What is the most appropriate next step? Reassurance and smoking cessation counseling Referral to cardiology for further work-up of chest pain Anti-anginal medications Stress test Repeat EBCT test Click here to compare your answer. 6.  Which of the following statements regarding the strengths and limitations of EBCT is the most accurate? EBCT is an excellent tool for evaluation of patients at low risk of disease EBCT is too expensive to be used in patients who may benefit from the test EBCT does not provide information on the physiologic significance of a coronary plaque Calcium scores are similar across different ethnicities and can be employed without racial considerations Third-party payer reimbursement has been very good for the EBCT test for coronary calcification screening Click here to compare your answer.
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