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A 62-year-old woman presents with progressive dyspnea on exertion, fatigue, and occasional lightheadedness over the past year. She denies cough or wheezing. Past medical history includes systemic sclerosis. Vital signs: BP 110/68, HR 96, SpO2 95% on room air. Cardiac exam reveals a loud P2 and a right ventricular heave. Lung exam is clear.   Which diagnosis should be most strongly suspected?

A 70-year-old man walks into your primary care clinic with sudden severe shortness of breath and near-syncope that started 30 minutes ago. He had a hip fracture repair 10 days ago and has been mostly sedentary at home. Vital signs: BP 78/44, HR 128, RR 30, SpO2 84% on room air. He is pale, diaphoretic, and speaking in single words. Lung exam is clear. You suspect a massive pulmonary embolism.   What is the most appropriate next step in evaluation and management in the primary care setting?

A 71-year-old man with severe COPD presents with increased dyspnea, purulent sputum, and wheezing over the past 2 days. He uses home oxygen at 2 L/min. Vital signs: RR 30, HR 108, SpO2 88% on his usual oxygen. He is using accessory muscles and speaks in short phrases.   What is the most appropriate next step?

A 61-year-old presents with progressive fatigue and spontaneous gum bleeding. CBC shows anemia and thrombocytopenia. Peripheral smear shows blast cells containing rod-shaped cytoplasmic inclusions. Which diagnosis is most strongly supported by this finding?

A 45-year-old woman presents with small-volume hemoptysis occurring intermittently for 2 days following a recent upper respiratory infection. She is afebrile and hemodynamically stable. Lung exam is normal.   What is the most appropriate initial diagnostic test?

A 38-year-old woman presents with sharp chest pain that worsens with deep inspiration and coughing. She reports a recent viral upper respiratory infection. Lung exam is normal. Vitals are stable. Which diagnosis is most likely?

A 72-year-old former smoker presents with hemoptysis and unexplained weight loss. Chest X-ray reveals a right upper-lobe mass.   What is the most appropriate next step to confirm the diagnosis?

A 71-year-old man with severe COPD presents with increased dyspnea, purulent sputum, and wheezing over the past 2 days. He uses home oxygen at 2 L/min. Vital signs: RR 30, HR 108, SpO2 88% on his usual oxygen. He is using accessory muscles and speaks in short phrases.   What is the most appropriate next step?

A 35-year-old woman presents with intermittent burning chest discomfort that occurs after eating large meals, when bending over, and at night when lying flat. She denies shortness of breath, diaphoresis, or exertional symptoms. Cardiac exam and vital signs are normal.   What is the most appropriate initial management step?

A 35-year-old woman presents with intermittent burning chest discomfort that occurs after eating large meals, when bending over, and at night when lying flat. She denies shortness of breath, diaphoresis, or exertional symptoms. Cardiac exam and vital signs are normal.   What is the most appropriate initial management step?