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Pulmonary Embolism — UKMLA MCQ

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HardRespiratory MedicinePulmonary EmbolismUKMLAMRCEM SBAMRCP Part 1PARAPSA

A patient has cognitive fluctuations, recurrent visual hallucinations and parkinsonism, but specialist assessment remains uncertain between dementia with Lewy bodies and Alzheimer disease. Which investigation should be used?

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Correct answer: E — Use iodine-123 FP-CIT SPECT and interpret normal scans cautiously

The best answer is “Use iodine-123 FP-CIT SPECT and interpret normal scans cautiously”. NICE uses iodine-123 FP-CIT SPECT when DLB is suspected but the diagnosis remains uncertain; iodine-123 MIBG cardiac scintigraphy is considered if FP-CIT is unavailable. A normal result on either test does not by itself exclude DLB, hence the interpretation qualifier. Structural imaging helps exclude reversible or alternative pathology but is not the specified dopaminergic discriminator, and neither oligoclonal bands nor mandatory amyloid PET answers this clinical uncertainty.

Reference: NICE NG97, Dementia: assessment, management and support: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations