Low-risk suspected pulmonary embolism — MCCQE Part 1 MCQ

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HardDyspneaLow-risk suspected pulmonary embolismMCCQE Part 1

A 33-year-old woman has mild pleuritic chest pain after a long flight, normal vital signs and low clinical pre-test probability. Which of the following is the most appropriate next step?

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Correct answer: E — Use a validated clinical decision rule and D-dimer testing rather than immediate CT pulmonary angiography

Use a validated clinical decision rule and D-dimer testing rather than immediate CT pulmonary angiography is the single best answer because the age, timing, examination findings and investigations in the vignette fit Low-risk suspected pulmonary embolism better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Thrombosis Canada VTE guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Thrombosis Canada VTE guidance