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Pulmonary embolism risk stratification — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsPulmonary embolism risk stratificationSCE Acute Medicine

A 72-year-old woman is assessed on the acute medical unit. She has confirmed PE, syncope and persistent hypotension. CT shows a large central clot and lactate is 4.5 mmol/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: E — Urgent transthoracic echocardiography

Urgent transthoracic echocardiography is the best answer because echo rapidly assesses right ventricular failure in high-risk PE and informs escalation to reperfusion or critical care. Twelve-lead ECG and serial high-sensitivity troponin is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Shock in PE is a marker of high early mortality.

Reference: NICE NG158; ESC PE guideline