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Ectopic pregnancy — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Ectopic pregnancyUSMLE Step 3

A 62-year-old man 5 days after a transcontinental flight has sudden dyspnea and syncope. CT angiography shows bilateral main pulmonary emboli. Blood pressure remains 76/48 mm Hg despite initial fluids, bedside echocardiography shows severe right-ventricular dilation, and there is no recent surgery, stroke, or active bleeding. Which reperfusion strategy is most appropriate?

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Correct answer: A — Administer systemic thrombolysis now while continuing vasopressor and respiratory support

The best answer is “Administer systemic thrombolysis now while continuing vasopressor and respiratory support”. Persistent hypotension from acute pulmonary embolism defines high-risk massive PE. In the absence of a major bleeding contraindication, systemic thrombolysis offers the fastest widely available reperfusion while vasopressor and respiratory support continue. Anticoagulation alone is insufficient in shock, a filter prevents future emboli but does not reperfuse, and biomarkers need not delay treatment.

Reference: AHA Scientific Statement: Massive and Submassive Pulmonary Embolism: https://www.ahajournals.org/doi/10.1161/CIR.0b013e318214914f