skip to main content

Suspected pulmonary embolism with symptoms and signs of deep vein thrombosis in pregnancy — MRCEM SBA MCQ

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

HardRespiratory emergenciesSuspected pulmonary embolism with symptoms and signs of deep vein thrombosis in pregnancyMRCEM SBA

A 31-year-old woman at 29 weeks’ gestation presents with sudden pleuritic chest pain and breathlessness. Her left calf has been painful and swollen for two days. She is alert; pulse 112/min, blood pressure 118/72 mmHg and SpO₂ 96% on air. ECG shows sinus tachycardia and chest radiography is normal. Blood has been taken for a full blood count, coagulation screen, urea and electrolytes, and liver function tests. She has no contraindication to anticoagulation, and bilateral leg compression duplex ultrasonography is promptly available. Which investigation and treatment plan is most appropriate?

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

Reveal the answer and explanation

Correct answer: B — Start therapeutic LMWH, then perform leg compression ultrasonography; omit chest imaging if DVT is confirmed.

The acute pleuritic symptoms raise suspicion of pulmonary embolism (PE), while unilateral calf pain and swelling suggest concurrent deep vein thrombosis (DVT). Pregnancy makes the sequence important: following baseline blood sampling, therapeutic low-molecular-weight heparin (LMWH) should begin immediately while suspected venous thromboembolism is investigated, unless strongly contraindicated. Her symptomatic leg should be investigated with bilateral compression duplex ultrasonography. If DVT is confirmed, treatment continues without further investigation for PE; ongoing care should be coordinated through the local obstetric and medical pathway. ([rcog.org.uk](https://www.rcog.org.uk/media/wj2lpco5/gtg-37b-1.pdf?utm_source=openai)) A chooses the right first imaging test but incorrectly waits for its result before starting LMWH. C starts treatment and investigates the leg appropriately, but adds CTPA when a positive scan already establishes the need for venous thromboembolism treatment. D and E use recognised chest investigations but place them ahead of assessment of a symptomatic leg that could establish the diagnosis without chest imaging. If leg ultrasonography does not confirm DVT and PE remains suspected, chest imaging is required; an abnormal chest radiograph would favour CTPA over V/Q imaging. Her normal blood pressure supports this investigation pathway rather than the pathway for PE with cardiovascular compromise. ([rcog.org.uk](https://www.rcog.org.uk/media/wj2lpco5/gtg-37b-1.pdf?utm_source=openai))

Reference: RCOG Green-top Guideline No. 37b: Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management (April 2015) — https://www.rcog.org.uk/media/wj2lpco5/gtg-37b-1.pdf RCOG Green-top Guideline No. 37b: Baseline blood investigations (April 2015) — https://www.rcog.org.uk/media/wj2lpco5/gtg-37b-1.pdf RCOG Green-top Guideline No. 37b: Investigations for suspected PE (April 2015) — https://www.rcog.org.uk/media/wj2lpco5/gtg-37b-1.pdf