skip to main content

Pulmonary hypertension screen — SCE Rheumatology MCQ

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

ModerateMusculoskeletal investigationsPulmonary hypertension screenSCE Rheumatology

A 61-year-old woman with limited cutaneous systemic sclerosis reports progressive exertional breathlessness. Oxygen saturation is 96% while breathing room air at rest. Examination reveals a loud pulmonary component of the second heart sound but no basal crackles. Pulmonary function tests show an FVC of 88% predicted and a TLCO of 42% predicted. Which investigation is the most appropriate next test to assess the probability of pulmonary hypertension?

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

Reveal the answer and explanation

Correct answer: E — Transthoracic echocardiography

E. Transthoracic echocardiography is the appropriate next investigation. Progressive exertional dyspnoea, a loud P2 and a markedly reduced TLCO disproportionate to preserved FVC are characteristic warning features for systemic-sclerosis-associated pulmonary arterial hypertension, particularly without crackles suggesting significant interstitial lung disease. Echocardiography estimates pulmonary hypertension probability from tricuspid regurgitation velocity and other right-heart findings and guides referral for definitive right heart catheterisation. NT-proBNP is a useful component of multimodal screening but does not replace cardiac imaging in this symptomatic patient. High-resolution CT assesses interstitial lung disease, while ventilation–perfusion scanning is used principally to exclude chronic thromboembolic disease during the subsequent pulmonary hypertension work-up. Chest radiography is insufficiently sensitive or specific.

Reference: Royal Papworth Hospital NHS Foundation Trust, Pulmonary Vascular Diseases Unit, Information for healthcare professionals—suspected pulmonary hypertension, current page accessed 2026. https://royalpapworth.nhs.uk/our-services/respiratory-services/pvdu/information-healthcare-professionals