skip to main content

Stable angina — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardAmbulatory Medicine / Primary CareStable anginaUSMLE Step 3

A 72-year-old woman has stable exertional chest pressure and an intermediate pretest probability of obstructive coronary disease. She cannot exercise because of severe knee arthritis, ECG shows left bundle-branch block, and kidney function is normal. Which noninvasive test is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Obtain pharmacologic stress imaging because exercise ECG would be uninterpretable

The best answer is “Obtain pharmacologic stress imaging because exercise ECG would be uninterpretable”. Exercise ECG alone is uninterpretable with left bundle-branch block, and she cannot exercise adequately. An imaging-based test using pharmacologic stress is appropriate; test selection can be individualized between nuclear, echocardiographic, PET, or anatomic approaches based on local expertise and patient factors.

Reference: 2021 AHA/ACC Guideline for Evaluation and Diagnosis of Chest Pain: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029