Answer:USMLE step 2 Mcq 198:A 55 year old complains of pain on the inner part of the left arm




Correct Answer: C

Angina may radiate to the throat or to the arms, particularly to the left arm and usually on the inner aspect of the left arm. Occasionally, exertional pain in the left ear lobe or the left wrist has been the only manifestation of angina. It has been said that pain below the navel or above the eyelids can be discounted as not representing angina. Once the patient has been tutored in the use of sublingual nitroglycerin, the response to using nitroglycerin is most helpful. In the office setting, a precise estimate of the interval between taking the sublingual nitroglycerin and the relief of the chest discomfort is necessary. Many patients will say that relief is prompt and when further questioned, their prompt means after 20 minutes. The relief produced by nitroglycerin should be within 2 minutes (and most often within 1 minute). Since estimates of time are often inaccurate, it is occasionally helpful to clock a 30-second interval during the interview with the patient. Patients will often be astounded as to how slowly a half-minute goes by, but the clarification of this detail of the history may be critical in defining angina.


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