Pulmonary embolism — MCCQE Part 1 MCQ

Correct answer: C — Begin urgent PE work-up with CT pulmonary angiography if stable and anticoagulate when clinically appropriate

Begin urgent PE work-up with CT pulmonary angiography if stable and anticoagulate when clinically appropriate is best because postpartum status, pleuritic pain, hypoxaemia and unilateral leg swelling make PE high probability. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. Pregnancy and postpartum status are major venous thromboembolism risk periods.

Reference: Thrombosis Canada Pulmonary Embolism Clinical Guide