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Pulmonary embolism in pregnancy — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsPulmonary embolism in pregnancySCE Acute Medicine

A 69-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 pregnancy with persistent PE suspicion after negative leg Doppler and normal CXR. What is the most appropriate investigation?

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Correct answer: C — Ventilation-perfusion scan or CTPA after shared discussion of risks

The key discriminator is that pregnancy with persistent PE suspicion after negative leg Doppler and normal CXR, which makes Ventilation-perfusion scan or CTPA after shared discussion of risks the single best answer. Arterial blood gas analysis is less appropriate because it does not address the dominant acute risk in the vignette; Bedside echocardiography would fit a different presentation or later stage of care. Formal swallowing assessment and Lumbar puncture after safety assessment 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: RCOG Green-top 37b; NICE NG158