American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended initial step in the workup for pulmonary arterial hypertension (PAH)?

1. Right heart catheterization

2. Electrocardiogram

3. Echocardiography

4. Pulmonary function tests

The correct answer is: Echocardiography

The recommended initial step in the workup for pulmonary arterial hypertension (PAH) is echocardiography. Echocardiography plays a crucial role in the assessment of PAH as it is a non-invasive imaging technique that helps in estimating pulmonary artery pressures and evaluating right ventricular function. In cases of suspected PAH, echocardiography can provide vital information such as signs of right heart strain, enlargement of the right ventricle, and changes in the interatrial septum. These findings can raise suspicion for PAH, guiding further diagnostic evaluation. Additionally, echocardiography may help identify potential causes of pulmonary hypertension, such as left heart disease, which must be considered in the differential diagnosis. While right heart catheterization is the gold standard for definitive diagnosis of PAH, it is usually performed after echocardiography has indicated the potential presence of the condition. In contrast, electrocardiograms and pulmonary function tests, while helpful in assessing overall cardiovascular and respiratory health, do not specifically provide the initial diagnostic information regarding PAH. Therefore, starting with echocardiography is in line with current guidelines, facilitating early detection and management of this complex condition.