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Pulmonary arterial hypertension — USMLE Step 2 CK MCQ

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ModerateInternal MedicinePulmonary arterial hypertensionUSMLE Step 2 CK

A 50-year-old Native American man comes to the hospital because of chest discomfort or shortness of breath. History and focused examination are notable for exertional dyspnea, loud P2, right ventricular strain, and clear lungs. Temperature is 99.1°F (37.3°C), blood pressure is 118/74 mmHg, pulse is 116/min, respirations are 26/min, and oxygen saturation is 89% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Chest imaging and arterial blood gas testing show abnormalities matching the respiratory findings; serum electrolytes are within reference range. Which of the following is the most appropriate initial diagnostic study?

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

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Correct answer: D — Right heart catheterization

The vignette describes Pulmonary arterial hypertension, supported by exertional dyspnea, loud P2, right ventricular strain, and clear lungs. Right heart catheterization is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: ESC/ERS Pulmonary Hypertension Guideline