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Pulmonary Embolism — RACP Adult Medicine MCQ

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HardRespiratoryPulmonary EmbolismRACP Adult Medicine

A 35-year-old taking a combined oral contraceptive develops sudden dyspnoea and pleuritic pain five days after a long-haul flight. Heart rate is 120/min, oxygen saturation 92%, chest radiograph is normal and clinical probability of pulmonary embolism is high. What is the next diagnostic test?

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Correct answer: C — Obtain CT pulmonary angiography now, using V/Q imaging when contrast or radiation considerations favour it

The best answer is “Obtain CT pulmonary angiography now, using V/Q imaging when contrast or radiation considerations favour it”. High clinical probability requires definitive pulmonary vascular imaging rather than relying on D-dimer. CTPA is usual; V/Q scanning is selected for contrast allergy, kidney considerations, pregnancy and a suitable chest radiograph. A normal radiograph is common in PE and does not exclude it.

Reference: Medical Journal of Australia: Australasian venous thromboembolism guideline: https://www.mja.com.au/journal/2019/new-guidelines-venous-thromboembolism