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Pulmonary embolism — USMLE Step 2 CK MCQ

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HardInternal MedicinePulmonary embolismUSMLE Step 2 CK

A 68-year-old woman has CT-confirmed bilateral pulmonary emboli. Blood pressure is 118/72 mm Hg, but troponin is elevated and echocardiography shows right-ventricular dilation. After starting unfractionated heparin, she remains stable with oxygen saturation 93% on 2 L/min. What is the best immediate strategy?

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Correct answer: E — Continue anticoagulation with monitored observation and reserve reperfusion for deterioration

The best answer is “Continue anticoagulation with monitored observation and reserve reperfusion for deterioration”. This is intermediate-high-risk pulmonary embolism: right-ventricular dysfunction and myocardial injury are present without hypotension. The appropriate initial course is therapeutic anticoagulation in a monitored setting, with rescue thrombolysis or another reperfusion strategy if decompensation occurs. Routine lysis increases major bleeding without established net benefit in a stable patient.

Reference: PERT Consortium Consensus on Acute Pulmonary Embolism: https://pmc.ncbi.nlm.nih.gov/articles/PMC6714903/