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