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Cervical cancer screening — USMLE Step 2 CK MCQ

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HardPreventive Medicine & BiostatisticsCervical cancer screeningUSMLE Step 2 CK

A 59-year-old with acute pulmonary embolism is normotensive but has RV dilation, elevated troponin and increasing oxygen requirement. He has no bleeding contraindication and remains perfused. Which initial strategy is recommended?

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Correct answer: D — Begin therapeutic anticoagulation with monitored reassessment

This normotensive patient has intermediate-high-risk pulmonary embolism and should receive therapeutic anticoagulation with close monitored reassessment, reserving reperfusion for hemodynamic deterioration. Routine full-dose systemic thrombolysis causes excess major bleeding without a net benefit while perfusion is preserved. Half-dose thrombolysis is not a guideline-standard substitute. Catheter-directed thrombolysis and surgical embolectomy are reperfusion strategies for selected deteriorating or high-risk patients, not the initial approach in a stable patient.

Reference: CHEST guideline and expert panel report on antithrombotic therapy for VTE: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext