pulmonary embolism

Question 1

Which of the following is the most common source of pulmonary embolism?
A) Right atrium
B) Pelvic veins
C) Deep veins of the lower limbs
D) Superficial veins of the legs

Answer 1

C) Deep veins of the lower limbs

Question 2

Which of the following best describes the pathophysiology of PE?
A) Arterial obstruction leading to systemic hypertension
B) Venous thrombus embolization leading to increased pulmonary vascular resistance
C) Atherosclerotic plaque rupture in the pulmonary arteries
D) Bronchial artery thrombosis causing alveolar collapse

Answer 2

B) Venous thrombus embolization leading to increased pulmonary vascular resistance

Question 3

Which of the following is NOT a risk factor for venous thromboembolism?
A) Immobility
B) Pregnancy
C) Hyperthyroidism
D) Malignancy

Answer 3

C) Hyperthyroidism

Question 4

Which inherited thrombophilia is most commonly associated with recurrent venous thromboembolism?
A) Protein S deficiency
B) Antithrombin III deficiency
C) Factor V Leiden mutation
D) Prothrombin gene mutation

Answer 4

C) Factor V Leiden mutation

Question 5

A 50-year-old male presents with sudden onset dyspnea, pleuritic chest pain, and hemoptysis. What is the most likely diagnosis?
A) Pulmonary embolism
B) Myocardial infarction
C) Pneumothorax
D) Pneumonia

Answer 5

A) Pulmonary embolism

Question 6

Which of the following clinical signs is most suggestive of a massive pulmonary embolism?
A) Bradycardia
B) Hypertension
C) Jugular venous distension
D) Unilateral leg swelling

Answer 6

C) Jugular venous distension

Question 7

Which scoring system is commonly used to assess the probability of PE before ordering investigations?
A) CHA₂DS₂-VASc score
B) Well’s score
C) APACHE II score
D) Glasgow Coma Scale

Answer 7

B) Well’s score

Question 8

Which of the following is the most appropriate next step in a hemodynamically stable patient with moderate Wells score for PE?
A) Pulmonary angiography
B) CT pulmonary angiography (CTPA)
C) D-dimer test
D) Echocardiography

Answer 8

C) D-dimer test

Question 9

What is the gold standard diagnostic test for pulmonary embolism?
A) D-dimer test
B) CT pulmonary angiography (CTPA)
C) Pulmonary angiography
D) Ventilation-perfusion (V/Q) scan

Answer 9

B) CT pulmonary angiography (CTPA)

Question 10

Which anticoagulant is preferred for the initial treatment of hemodynamically stable PE?
A) Unfractionated heparin
B) Warfarin
C) Low molecular weight heparin (LMWH)
D) Aspirin

Answer 10

C) Low molecular weight heparin (LMWH)

Question 11

Which of the following is an indication for thrombolytic therapy in PE?
A) A patient with mild dyspnea and a positive D-dimer
B) A hemodynamically stable patient with a high Wells score
C) A patient with massive PE and signs of shock
D) A patient with a previous history of PE

Answer 11

C) A patient with massive PE and signs of shock

Question 12

A patient with recurrent unprovoked PE despite appropriate anticoagulation is best managed with:
A) Long-term aspirin
B) Inferior vena cava (IVC) filter
C) Increased warfarin dose
D) Pulmonary embolectomy

Answer 12

B) Inferior vena cava (IVC) filter

Question 13

Which imaging modality is preferred in a pregnant woman or a patient with AKI with suspected PE?
A) CT pulmonary angiography
B) Pulmonary angiography
C) Ventilation-perfusion (V/Q) scan
D) Chest X-ray

Answer 13

C) Ventilation-perfusion (V/Q) scan

because of radiation to fetus
because of contrast use

Question 14

Which ECG finding is most suggestive of PE?
A) ST elevation in leads II, III, aVF
B) S1Q3T3 pattern
C) Widespread ST depression
D) Left bundle branch block

Answer 14

B) S1Q3T3 pattern

Question 15

what is virchow’s triad

Answer 15

1. venous stasis
2. endothelial injury
3. hypercoagulability