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Pulmonary embolism with right ventricular strain — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsPulmonary embolism with right ventricular strainSCE Acute Medicine

A 54-year-old woman is assessed on the acute medical unit. She has sudden pleuritic chest pain after hip surgery and oxygen saturations of 90% on air. ECG shows sinus tachycardia and bedside echo suggests right ventricular dilatation while CTPA is delayed. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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

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Correct answer: B — Start therapeutic anticoagulation while awaiting imaging

Start therapeutic anticoagulation while awaiting imaging is the best answer because the clinical probability is high and NICE supports interim anticoagulation when imaging is not immediately available and bleeding risk is acceptable. Refer for urgent endoscopy after resuscitation 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: In high-probability PE, diagnostic delay should not leave the patient untreated.

Reference: NICE NG158