American Board of Internal Medicine (ABIM) Certification Practice Exam

What Duke treadmill score indicates a high risk for further cardiac evaluation?

1. Above −11

2. At least 0

3. Below −11

4. Between −5 and −11

The correct answer is: Below −11

The Duke treadmill score is a clinical tool used to assess a patient's risk of cardiac events based on their performance on a treadmill stress test. The score takes into account the duration of exercise, the patient's heart rate response, and the occurrence of exercise-induced angina. A score below -11 indicates a high risk for adverse cardiac events, necessitating further cardiac evaluation. This level suggests that the patient has significantly impaired exercise capacity or experiences considerable symptoms during exertion, which correlates with a higher likelihood of underlying coronary artery disease or other serious cardiac conditions. In contrast, scores at least 0 are generally considered to indicate a lower risk, as they reflect better functional capacity and less symptom-related issues during exercise. Similarly, scores between -5 and -11 also imply increased but not the highest risk, while a score above -11 suggests an even lower risk and frequently does not warrant further invasive testing. Therefore, a Duke treadmill score below -11 is a clear marker that emphasizes the need for additional cardiac assessment.