Pulmonary embolism - Quiz
Pulmonary embolism
  • 1. What is the defined systolic blood pressure threshold for hemodynamic instability in a PE patient?
A) <110 mmHg
B) <80 mmHg
C) <90 mmHg
D) <100 mmHg
  • 2. What is the three-month risk of a thromboembolic event following a normal D-dimer result in patients with low or moderate suspicion of PE?
A) 0.14%
B) 0.01%
C) 0.50%
D) 1.4%
  • 3. What is the approximate specificity of the D-dimer test?
A) 50%
B) 69%
C) 96%
D) 16%
  • 4. What is the typical cut-off value for a D-dimer test?
A) 1000 μg/L
B) 50 μg/L
C) 100 μg/L
D) 500 μg/L
  • 5. For patients over 50 years old, what is the recommended adjustment for the D-dimer cut-off value?
A) Age multiplied by 5 μg/L
B) Age multiplied by 10 μg/L
C) Age plus 500 μg/L
D) Age divided by 10 μg/L
  • 6. What percentage of patients with pulmonary embolism exhibit increased troponin levels?
A) 5% to 15%
B) 16% to 47%
C) 69% to 84%
D) 50% to 60%
  • 7. Which imaging test is recommended as the first-line diagnostic tool for most people suspected of having a PE?
A) CT pulmonary angiography
B) Leg ultrasound
C) Erythrocyte sedimentation rate
D) Right heart catheterization
  • 8. What is a limitation of using an ultrasound of the legs in the context of pulmonary embolism?
A) It is less accurate than a blood count
B) It cannot rule out PE
C) It is rarely available
D) It is highly invasive
  • 9. Compared to VQ scanning, how does CTPA perform?
A) It is much more expensive
B) It is less sensitive
C) It is non-inferior
D) It is significantly inferior
  • 10. Which of the following is an advantage of CTPA mentioned in the text?
A) It may identify other lung disorders
B) It has 100% specificity
C) It is always done before D-dimer
D) It requires right heart catheterization
  • 11. According to the study on single-slice spiral CT, what was the sensitivity of the test?
A) 69%
B) 83%
C) 96%
D) 50%
  • 12. Why is the use of a negative single-slice CT scan considered insufficient on its own?
A) It has 0% specificity
B) It has limited sensitivity
C) It is too expensive
D) It requires contrast agent
  • 13. What is the primary role of the D-dimer test in clinical practice?
A) To provide evidence for the need for imaging
B) To definitively confirm PE
C) To replace the need for CTPA entirely
D) To measure lung function
  • 14. Which blood tests are done to exclude secondary causes of PE?
A) D-dimer only
B) Full blood count and clotting status
C) Troponin only
D) Blood pressure only
  • 15. What is a potential bias identified in the study of single-slice spiral CT?
A) Incorporation bias
B) Selection bias
C) Age bias
D) Measurement bias
  • 16. What was the specificity reported in the study involving 4-slice and 16-slice scanners?
A) 69%
B) 50%
C) 96%
D) 83%
  • 17. Which of the following is tested during a 'thrombophilia screen'?
A) Factor V Leiden mutation
B) Red blood cell count
C) Vitamin D levels
D) Blood glucose levels
  • 18. What heart rate is considered a low-risk criterion for avoiding further PE testing?
A) Between 100 and 110 beats per minute
B) Less than 100 beats per minute
C) Greater than 120 beats per minute
D) Exactly 150 beats per minute
  • 19. What oxygen saturation level is associated with the low-risk criteria for PE?
A) Exactly 90%
B) More than 94%
C) Less than 80%
D) Between 85% and 90%
  • 20. Which of the following would trigger a need for further PE testing?
A) No history of surgery
B) Estrogen use
C) No leg swelling
D) No coughing up blood
  • 21. What is the primary use of a proximal lower limb compression ultrasound (CUS) in PE diagnosis?
A) As a confirmatory test
B) To replace the need for clinical history
C) To diagnose lung cancer
D) As a screening test for everyone
  • 22. What is the sensitivity of a CUS test according to the cross-sectional study mentioned?
A) 96%
B) 41%
C) 80%
D) 10%
  • 23. What is the main factor in the decision to perform medical imaging for PE?
A) Hospital policy only
B) Clinical reasoning
C) Patient preference alone
D) The time of day
  • 24. Which of the following is NOT included in the low-risk criteria mentioned in the text?
A) No leg swelling
B) A history of trauma in the last year
C) Age less than 50
D) No previous blood clots
  • 25. Which specific type of DVT is mentioned as a source of emboli?
A) Iliofemoral DVT
B) Distal calf DVT
C) Superficial venous thrombosis
D) Portal vein thrombosis
  • 26. Venous thoracic outlet syndrome is an especially notable cause of DVT in which population?
A) Young men without significant risk factors
B) Children with genetic disorders
C) Elderly women with cancer
D) Athletes with chronic dehydration
  • 27. What is the term for the continuum encompassing both DVT and pulmonary embolism?
A) Arterial thrombosis
B) Pulmonary hypertension syndrome
C) Chronic venous insufficiency
D) Venous thromboembolism
  • 28. What is the name of the group of causes that classically explains the development of thrombosis?
A) The hypercoagulable model
B) Virchow's triad
C) The clotting cascade
D) The VTE framework
  • 29. What type of surgery significantly increases VTE risk if performed without prophylaxis?
A) Dental surgery
B) Ocular surgery
C) Orthopedic surgery at or below the hip
D) Tonsillectomy
  • 30. Which of the following is considered an acquired thrombophilia?
A) Protein C deficiency
B) Factor V Leiden
C) Antiphospholipid syndrome
D) Protein S deficiency
  • 31. Which of the following is a genetic thrombophilia?
A) Paroxysmal nocturnal hemoglobinuria
B) Nephrotic syndrome
C) Protein C deficiency
D) Antiphospholipid syndrome
  • 32. How do catheterizations contribute to the risk of thrombosis?
A) They stimulate procoagulant secretion
B) They decrease the blood viscosity
C) They cause systemic dehydration
D) They cause endothelial injury
  • 33. Which of the following is an identified risk factor for pulmonary embolism?
A) Prolonged bed rest
B) Frequent exercise
C) Low altitude living
D) High-fiber diet
  • 34. Which test is used to rule out a PE in low-risk patients?
A) D-dimer
B) Liver function test
C) White blood cell count
D) Troponin test
  • 35. Which of these is a recommended anticoagulant medication for PE treatment?
A) Acetaminophen
B) Warfarin
C) Ibuprofen
D) Aspirin
  • 36. What procedure may be used if blood thinners are unsafe for a patient?
A) Lung transplant
B) Blood transfusion
C) Temporary vena cava filter
D) Chest tube insertion
  • 37. What is the term for coughing up blood?
A) Cyanosis
B) Hemoptysis
C) Dyspnea
D) Tachypnea
  • 38. Which medication is mentioned for thrombolysis in severe PE cases?
A) Direct-acting oral anticoagulants
B) Warfarin
C) Heparin
D) Tissue plasminogen activator
  • 39. What percentage of sudden deaths are estimated to be attributable to PE?
A) Nearly 90%
B) About 15%
C) 50%
D) Less than 1%
  • 40. Who initially developed a prediction rule for DVT based on clinical criteria in 1995?
A) Philip Steven Wells
B) The PIOPED investigators
C) The Geneva rule group
D) The 64-slice MDCT researchers
  • 41. What does a Wells score of >6.0 indicate in the traditional interpretation?
A) Low probability
B) Moderate probability
C) High probability
D) Confirmed PE
  • 42. According to the Wells score, how many points are assigned for tachycardia?
A) 2.0 points
B) 3.0 points
C) 1.0 points
D) 1.5 points
  • 43. What is the sensitivity of the PERC rule?
A) 97.4%
B) 21.9%
C) 1.0%
D) 5.0%
  • 44. Which scoring system is identified as being complicated by multiple available versions?
A) PIOPED recommendation
B) Geneva rule
C) Wells score
D) PERC rule
  • 45. For which patient group is a V/Q scan particularly useful due to lower radiation exposure?
A) Patients with high blood pressure
B) Patients with chronic obstructive pulmonary disease
C) Elderly patients
D) Pregnant patients
  • 46. Which technology enables three-dimensional imaging during a V/Q scan?
A) Chest X-ray
B) Fluoroscopy
C) SPECT
D) Planar two-dimensional imaging
  • 47. Which ECG pattern is considered a classic sign of large pulmonary emboli?
A) Left bundle branch block
B) ST elevation in V5-V6
C) S1Q3T3
D) Prolonged PR interval
  • 48. What is the most common ECG sign seen in patients with pulmonary embolism?
A) Complete heart block
B) Inverted T waves in V1-V4
C) Sinus tachycardia
D) Atrial fibrillation
  • 49. Which of these is identified as a sign of RV strain on an ECG associated with a worse prognosis in PE?
A) Sinus bradycardia
B) QRS narrowing
C) Atrial fibrillation
D) Normal sinus rhythm
  • 50. What potential treatment might be indicated by right heart dysfunction seen on an echocardiogram?
A) Antibiotic therapy
B) Beta-blocker administration
C) Diuretic monotherapy
D) Thrombolysis
  • 51. Which biomarker elevation warrants an echocardiogram in suspected PE?
A) Creatinine
B) Brain natriuretic peptide
C) C-reactive protein
D) White blood cell count
  • 52. Besides heart strain detection, what is another reason to perform an echocardiogram in PE?
A) Determining lung volume
B) Diagnosing pneumonia
C) Checking for pleurisy
D) Prognosis assessment
  • 53. What is the name of the specific right ventricular appearance on echocardiography for PE?
A) Homan's sign
B) McConnell's sign
C) Virchow's sign
D) Trousseau's sign
  • 54. What is the sensitivity of McConnell's sign for acute PE with right ventricular dysfunction?
A) 50%
B) 77%
C) 94%
D) 25%
  • 55. Does every patient with a suspected pulmonary embolism require an echocardiogram?
A) Yes
B) Only if they are asymptomatic
C) Only if they are under 18 years old
D) No
  • 56. Which cardiac biomarker, when elevated, suggests heart strain in PE patients?
A) Hemoglobin
B) Troponins
C) Albumin
D) Glucose
  • 57. What is considered the mainstay of treatment for pulmonary embolism?
A) Bed rest and elevation
B) Surgical removal of the embolus
C) Anticoagulant therapy
D) Long-term aspirin therapy
  • 58. Which medication is suggested to prevent recurrence after anticoagulation is completed in those with prior PE?
A) Heparin
B) Aspirin
C) Warfarin
D) Fondaparinux
  • 59. What is the preferred treatment for patients with cancer who develop pulmonary embolism?
A) LMWH
B) Warfarin
C) Aspirin
D) Dabigatran
  • 60. How long is anticoagulation therapy usually continued?
A) 10–12 months
B) 1 month
C) 1 week
D) 3–6 months
  • 61. What is the recommended treatment duration for patients without a known reversible cause for PE?
A) 2 years
B) 10 years
C) 6 months
D) 1 month
  • 62. Which of the following is an independent predictor of adverse outcomes in pulmonary embolism?
A) Increased appetite
B) Itching
C) Mild headache
D) Hypotension
  • 63. In the 1960 Barritt and Jordan trial, what was the reported mortality rate for the placebo group?
A) 5%
B) 26%
C) 10%
D) 50%
  • 64. Where was the 1957 study by Barritt and Jordan performed?
A) Bristol Royal Infirmary
B) London General Hospital
C) Cambridge Medical Center
D) Oxford University Hospital
  • 65. Which patient-related condition is thought to play a role in PE prognosis?
A) Allergies
B) COPD
C) Type 1 diabetes
D) Thyroid disease
  • 66. What is a major reason why the 26% mortality rate from the 1960 trial is considered an overstatement?
A) The patients were all children
B) The sample size was too large
C) Old technology detected only severe PEs
D) The data was fabricated
  • 67. Which of these is identified as a marker for risk stratification in PE?
A) High blood glucose
B) Low hemoglobin
C) Elevated cardiac enzymes
D) Increased white blood cell count
  • 68. Besides organization and recanalization, how else may a blood clot be broken down?
A) Fibrinolysis
B) Surgery
C) Osmosis
D) Radiation
  • 69. How many clinical variables are used in the PESI algorithm?
A) 10
B) 15
C) 5
D) 11
  • 70. What is the approximate annual death count in Europe attributed to pulmonary embolism as a primary cause (2013-2015)?
A) 40,000
B) 10,000
C) 250,000
D) 100,000
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