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Pulmonary embolism — MCCQE Part 1 MCQ

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HardDyspneaPulmonary embolismMCCQE Part 1

A 36-year-old postpartum woman presents 9 days after caesarean delivery with pleuritic chest pain, dyspnoea and haemoptysis. Heart rate is 122/min, oxygen saturation is 90% on room air, and the right calf is swollen. Which of the following is the most appropriate next step?

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Correct answer: B — Start therapeutic anticoagulation while arranging urgent diagnostic imaging if there is no contraindication

This patient has a high pretest probability of pulmonary embolism and is hypoxaemic, so anticoagulation should be started while urgent imaging is arranged if bleeding risk is acceptable. D-dimer is not useful to exclude PE in a high-probability postpartum patient and is often elevated after delivery. Pneumonia, asthma and coronary testing do not address the immediate thromboembolic risk.

Reference: Thrombosis Canada venous thromboembolism guidance; SOGC pregnancy-related VTE resources