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Pulmonary embolism — USMLE Step 3 MCQ

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HardEmergency MedicinePulmonary embolismUSMLE Step 3

A normotensive patient with acute PE has RV dilation and elevated troponin but no worsening hypoxemia or shock. Which initial strategy is most appropriate?

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

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Correct answer: A — Start therapeutic anticoagulation with monitored reassessment

The best answer is “Start therapeutic anticoagulation with monitored reassessment”. Stable intermediate-risk PE is treated first with anticoagulation and monitoring; reperfusion is reserved for deterioration or greater severity. Anticoagulation is primary therapy for acute PE; advanced reperfusion therapies are reserved for patients with the greatest severity or clinical deterioration rather than stable intermediate-risk disease. The alternatives use a different threshold, timing, population, or intervention and therefore do not match the clinical facts presented.

Reference: ACC: 2026 Acute Pulmonary Embolism Guideline: https://www.acc.org/about-acc/press-releases/2026/02/19/19/27/first-ahaacc-acute-pulmonary-embolism-guideline-prompt-diagnosis-and-treatment-are-key