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Pulmonary embolism — MCCQE Part 1 MCQ

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HardDyspneaPulmonary embolismMCCQE Part 1

A 32-year-old woman who is 4 weeks postpartum presents with pleuritic chest pain and dyspnea. Her pulse is 118/min, BP 112/70 mmHg, oxygen saturation is 93% on room air, and the chest radiograph is normal. Her ECG shows sinus tachycardia and D-dimer is elevated. What is the most appropriate investigation?

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

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Correct answer: D — CT pulmonary angiography

Postpartum status, tachycardia, pleuritic pain, and hypoxaemia create a high clinical suspicion for pulmonary embolism; definitive thoracic imaging is required. Repeating D-dimer is not useful after a high-risk presentation because pregnancy and postpartum states can elevate it. Echocardiography may help if unstable or massive PE is suspected, but it is not the first diagnostic test in this stable patient. Canadian practice follows structured PE assessment with appropriate imaging rather than exclusion by D-dimer in higher-risk cases.

Reference: Thrombosis Canada VTE guidance; SOGC VTE in pregnancy guidance