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Moderate Depression — UKMLA MCQ

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MediumPsychiatryModerate DepressionUKMLAMRCGP AKTPARAMRCP Part 1

A 48-year-old woman has pleuritic chest pain, mild haemoptysis and unilateral calf swelling 2 weeks after knee surgery. Pulse is 104/min, blood pressure 126/78 mmHg and oxygen saturation 96% on air. Her PE Wells score is 7. CTPA cannot be performed until tomorrow. She has no active bleeding, severe renal impairment or other anticoagulation contraindication. What is the best immediate plan?

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Correct answer: D — Start interim therapeutic anticoagulation while arranging definitive imaging without delay

A Wells score above 4 makes pulmonary embolism likely, so the diagnostic step is immediate CTPA rather than D-dimer triage. When CTPA or an appropriate ventilation-perfusion scan cannot be performed immediately, NICE advises interim therapeutic anticoagulation, assuming no contraindication, while definitive imaging is arranged. Baseline full blood count, renal and hepatic function, PT and APTT should be taken, but treatment should not wait for those results; they must be reviewed within 24 hours. Prophylactic dosing under-treats suspected PE, while withholding treatment solely because the patient is currently stable leaves preventable progression risk.

Reference: NICE. NG158 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing, recommendations 1.1.18 to 1.1.19 and 1.3.4. https://www.nice.org.uk/guidance/ng158/chapter/Recommendations