Repeated USMLE Questions Step 2 CK- 419

A 62-year-old woman visits her physician for a routine physical examination. She has a long history of lower back pain and she takes ibuprofen as needed. She also takes levothyroxine for hypothyroidism. She exercises daily for 30 minutes and follows a regular diet. On examination, her pulse is 45/min. Holter monitor reveals a regular pulse ranging from 40-80 pulse/min. Her thyroid-stimulating hormone is within normal limits.

What is the best management for this patient at this point?

A- Reassurance and follow up visits

B- Repeat Holter monitor examination

C- Perform exercise stress test

D- Pacemaker implantation

E- Refer to a cardiologist


This patient has sinus bradycardia with no symptoms. She exercises daily with no complaints. The best management at this point is reassurance and follow up visits to recheck for any new symptoms. Pacemaker is only implanted in case of symptomatic bradycardia.

The correct answer is A

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