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* nbme 3-one question to ask
 #854347  
  anther0 - 09/09/18 09:13
 
  Over the past 2 weeks, a 60-year-old man has had shortness of breath on exertion. He also has paroxysmal nocturnal dyspnea with two-pillow orthopnea. He has taken aspirin daily since a myocardial infarction 3 years ago. He has a history of atrial fibrillation well controlled with digoxin and type 2 diabetes mellitus treated with diet. His blood pressure is 136188 mm Hg, pulse is 98/min and irregular, and respirations are 20/min. Jugular-venous pressure is increased. Breath sounds are decreased over the right lung base.. there is dullness to percussion. Cardiac examination shows an S. gallop. There is 2+ edema of the lower extremities. Pulse oximetry shows an oxygen saturation of 90%. Which of the following is the most appropriate next step in diagnosis?
O A) X-ray film of the chest
O B) Ambulatory ECG monitoring
O C) Thallium stress test
O D) Echocardiography
O E) Ventilation-perfusion lung scans

How to choose between A and D? I thought D is more accurate than A since sometimes chest X-ray won't show the cardiomegaly.
 
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