Typical exam stem
A postoperative patient develops sudden dyspnoea, pleuritic chest pain and tachycardia. How would you investigate and manage suspected pulmonary embolism?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
When is D-dimer useful?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Begin with probability and stability
Pulmonary embolism ranges from small, haemodynamically tolerated emboli to obstructive shock. The first examination decision is whether the patient is unstable. Hypotension or shock shifts the case into an emergency pathway where bedside echocardiography and urgent reperfusion decisions may be required.
In a stable patient, estimate pre-test probability before ordering a D-dimer. A D-dimer is most useful when clinical probability is low or intermediate; it is not a sensible screening test in every breathless hospital patient.
Investigation pathway
- ECG, chest radiograph and routine blood tests help evaluate alternatives but do not reliably rule PE in or out.
- D-dimer can exclude PE in appropriately selected low-probability patients when below the validated threshold.
- CT pulmonary angiography is the usual definitive imaging test when PE remains likely.
- Ventilation-perfusion imaging can be useful when CTPA is unsuitable in selected patients.
- Compression ultrasound may establish venous thromboembolism when leg symptoms are present or chest imaging is difficult.
Treatment and risk stratification
Start anticoagulation promptly when PE is sufficiently likely and bleeding risk is acceptable, according to local protocol. After diagnosis, distinguish high-risk PE with haemodynamic instability from lower-risk disease. Systemic reperfusion is principally considered for high-risk PE or rescue treatment when a patient deteriorates despite anticoagulation. Stable patients require assessment of right-ventricular strain, biomarkers, comorbidity and clinical risk before deciding the level of care.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.