skip to main content

Pulmonary embolism after negative D-dimer issue — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Respiratory PresentationsPulmonary embolism after negative D-dimer issueSCE Acute Medicine

A 39-year-old woman is assessed on the acute medical unit. She has pleuritic pain, tachycardia and haemoptysis two weeks after caesarean section. Wells score indicates likely PE and D-dimer is modestly raised. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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

Reveal the answer and explanation

Correct answer: D — CT pulmonary angiography

CT pulmonary angiography is the best answer because a likely clinical probability requires diagnostic imaging rather than relying on D-dimer to exclude PE. Urgent transthoracic echocardiography 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: D-dimer is most useful when pre-test probability is low or unlikely.

Reference: NICE NG158