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Pulmonary embolism — MCCQE Part 1 MCQ

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HardDyspneaPulmonary embolismMCCQE Part 1

A 34-year-old woman presents with sudden pleuritic chest pain and dyspnea 10 days after a long-haul flight. Heart rate is 118/min, oxygen saturation is 92%, and the chest x-ray is normal. She takes a combined oral contraceptive pill and has no leg swelling. D-dimer is positive after a high pre-test probability assessment. What is the most appropriate investigation?

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

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Correct answer: E — CT pulmonary angiography

Her symptoms, tachycardia, risk factor and positive D-dimer after high pre-test probability assessment make pulmonary embolism likely, and CT pulmonary angiography is the usual diagnostic investigation in a stable non-pregnant adult. Repeating D-dimer is inappropriate once the probability is high and the result is positive. Echocardiography helps in haemodynamic compromise but does not exclude PE in stable patients.

Reference: Thrombosis Canada VTE Clinical Guides; MCC Objectives—Dyspnea