Rosh Internal Medicine Boost Practice Exam

Which exam finding is most indicative of angina pectoris?

1. Left-sided chest pain with dermatomal rash

2. Reproducible chest pain on palpation

3. Substernal chest pain with a new third heart sound

4. Substernal chest pain with jugular venous distention

The correct answer is: Substernal chest pain with a new third heart sound

The most indicative exam finding for angina pectoris is substernal chest pain accompanied by a new third heart sound. Angina pectoris typically manifests as a sensation of tightness or pressure in the chest, often described as discomfort rather than sharp pain. When chest pain is substernal and related to myocardial ischemia, it aligns with the typical presentation of angina. The presence of a new third heart sound is significant because it may indicate heart failure or elevated left atrial pressure, which can be associated with ischemia or compromised cardiac function. This finding can suggest underlying coronary artery disease, which is directly related to angina pectoris. In contrast, the other options do not align with the classic presentation of angina. A left-sided chest pain with a dermatomal rash suggests a different diagnosis, potentially related to shingles or herpes zoster. Reproducible chest pain on palpation is indicative of a musculoskeletal origin rather than angina, as musculoskeletal pain typically does not correlate with myocardial ischemia. Lastly, substernal chest pain accompanied by jugular venous distention suggests heart failure or right-sided heart strain, which would not be characteristic of angina, as angina primarily involves ischemic events rather than congest