Pulmonary arterial hypertension — MCCQE Part 1 MCQ

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ModerateDyspneaPulmonary arterial hypertensionMCCQE Part 1

A 35-year-old woman has progressive exertional dyspnoea, syncope, elevated pulmonary pressures on echocardiography and right ventricular enlargement. Which of the following is the most appropriate next step?

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Correct answer: B — Refer to a pulmonary hypertension centre for confirmatory right-heart catheterisation

Refer to a pulmonary hypertension centre for confirmatory right-heart catheterisation is the single best answer because the age, timing, examination findings and investigations in the vignette fit Pulmonary arterial hypertension better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Thoracic Society pulmonary hypertension guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Thoracic Society pulmonary hypertension guidance