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MKSAP 19 Q & A
A 57-year-old woman is evaluated for a 4-month history of progressive exertional dyspnea and occasional chest pain and palpitations. She has limited cutaneous systemic sclerosis with Raynaud phenomenon and gastroesophageal reflux disease. Medications are omeprazole and diltiazem.
On physical examination, blood pressure is 107/74 mm Hg and pulse rate is 90/min. Oxygen saturation is normal at rest. Characteristic skin findings of limited cutaneous systemic sclerosis are present. New cardiac findings include jugular venous distention, persistent splitting of S2, and 2/6 systolic murmur at the left lower sternal border that increases with inspiration. Lungs are clear.
ECG shows a heart rate of 95/min and is otherwise normal. Chest radiograph is normal. Echocardiography performed 12 months ago was normal.
Which of the following is the most appropriate diagnostic test?
A: CT angiography of the chest
B: Echocardiography
C: Exercise stress test
D: Pulmonary function testing
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