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Daily Free Practice Question
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Updated on: 9/19/2025
An 82-year-old male with a history of hypertension, chronic kidney disease, and osteoarthritis presents with increasing shortness of breath and swelling in his legs over the past week. Physical examination reveals bilateral pitting edema and jugular venous distention. His current medications include lisinopril, furosemide, and acetaminophen. Which diagnostic test is most appropriate to perform next?
Rationale
AANP Domain Level: Evaluate
ANCC Domain Level: Evaluation
Focus Area: Cardiovascular Health
The patient’s presentation of increasing shortness of breath, bilateral pitting edema, jugular venous distention, and known medical history including hypertension, chronic kidney disease, and osteoarthritis suggests the possibility of heart failure exacerbation as the most likely diagnosis. Heart failure can lead to fluid retention and subsequent symptoms of dyspnea and lower extremity edema. Considering the patient’s symptoms and medical history, an echocardiogram to assess cardiac function and evaluate for heart failure exacerbation would be the most appropriate next diagnostic test. While renal ultrasound may provide information about kidney function, the patient’s symptoms are more suggestive of a cardiac etiology, making an echocardiogram a higher priority. A D-dimer test rules out pulmonary embolism in patients with suspected thromboembolic events. Still, the patient’s presentation does not strongly suggest pulmonary embolism, making this test less relevant. Similarly, spirometry to assess for chronic obstructive pulmonary disease (COPD) is not indicated in this case as the patient’s symptoms are more consistent with cardiac decompensation rather than respiratory pathology.
Study Tip:
Remember the classic symptoms of heart failure: dyspnea, edema, JVD, and crackles. Additionally, patients may exhibit orthopnea (difficulty breathing while lying flat) and paroxysmal nocturnal dyspnea (sudden nighttime breathlessness). An echocardiogram is often the next step to assess cardiac function and confirm the diagnosis.