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Postoperative pulmonary embolism risk — SCE Acute Medicine MCQ

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HardPerioperative, Safety and End-of-Life CarePostoperative pulmonary embolism riskSCE Acute Medicine

A 67-year-old man presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show postoperative hypoxaemia, pleuritic pain and clear CXR. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Start interim anticoagulation if imaging is delayed and arrange CTPA

The key discriminator is that postoperative hypoxaemia, pleuritic pain and clear CXR, which makes Start interim anticoagulation if imaging is delayed and arrange CTPA the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Optimise chronic medication and discharge are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG158