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Pulmonary embolism — USMLE Step 3 MCQ

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HardEmergency MedicinePulmonary embolismUSMLE Step 3

Five ambulatory adults have a confidently diagnosed single isolated subsegmental pulmonary embolus and negative bilateral leg ultrasonography. Which patient is the best candidate for structured surveillance without anticoagulation?

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

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Correct answer: A — A patient with mild symptoms, normal cardiopulmonary reserve, no cancer or prior VTE, and reliable follow-up

The best answer is “A patient with mild symptoms, normal cardiopulmonary reserve, no cancer or prior VTE, and reliable follow-up”. Structured surveillance is reserved for carefully selected low-risk patients after proximal DVT is excluded. Active cancer, pregnancy, impaired cardiopulmonary reserve, or prior VTE increases recurrence or deterioration risk and favors anticoagulation.

Reference: CHEST Guideline and Expert Panel Report: Antithrombotic Therapy for VTE Disease: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext