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Massive pulmonary embolism — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsMassive pulmonary embolismSCE Acute Medicine

A 76-year-old woman presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show shock, acute right ventricular dilatation and high PE probability indicate massive PE. 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 — Give immediate systemic thrombolysis after senior review

The key discriminator is that shock, acute right ventricular dilatation and high PE probability indicate massive PE, which makes Give immediate systemic thrombolysis after senior review the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Call critical care for escalation would fit a different presentation or later stage of care. Arrange urgent specialist referral and Give analgesia and antiemetic therapy 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; ESC PE guideline