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