20 Multiple Choice Questions on Pulmonary Embolism Management
Question 1
Which of the following is the recommended first-line anticoagulant treatment for patients with pulmonary embolism who are eligible for oral anticoagulation? A) Warfarin B) Unfractionated heparin C) Low molecular weight heparin D) Non-vitamin K antagonist oral anticoagulants (NOACs)
Answer: D) Non-vitamin K antagonist oral anticoagulants (NOACs) According to the 2019 ESC guidelines, when oral anticoagulation is initiated in a patient with PE who is eligible for a NOAC (apixaban, dabigatran, edoxaban, or rivaroxaban), a NOAC is the recommended form of anticoagulant treatment (Class I recommendation) 1.
Question 2
Which of the following is indicated for patients with high-risk pulmonary embolism presenting with hemodynamic instability? A) Systemic thrombolysis B) Observation only C) Anticoagulation with NOACs only D) Inferior vena cava filter placement
Answer: A) Systemic thrombolysis Systemic thrombolytic therapy is recommended for patients with high-risk PE presenting with hemodynamic instability (Class I recommendation) 1, 2.
Question 3
What is the recommended duration of anticoagulation therapy for a patient with first PE secondary to a major transient/reversible risk factor? A) 1 month B) 3 months C) 6 months D) Indefinitely
Answer: B) 3 months According to the ESC guidelines, therapeutic oral anticoagulation should be discontinued after 3 months in patients with first PE secondary to a major transient/reversible risk factor 1, 2.
Question 4
Which of the following is NOT recommended during pregnancy for the treatment of pulmonary embolism? A) Low molecular weight heparin B) Unfractionated heparin C) Non-vitamin K antagonist oral anticoagulants (NOACs) D) Thrombolysis in high-risk PE
Answer: C) Non-vitamin K antagonist oral anticoagulants (NOACs) NOACs are not recommended during pregnancy or lactation (Class III recommendation) 1.
Question 5
Which diagnostic test should be considered as the first-line imaging test for suspected pulmonary embolism? A) Ventilation/perfusion scan B) CT pulmonary angiography (CTPA) C) Pulmonary angiography D) Echocardiography
Answer: B) CT pulmonary angiography (CTPA) CTPA is recommended as the first-line imaging test for suspected PE according to the ESC guidelines and Praxis Medical Insights 1, 2.
Question 6
Which of the following should be considered for patients who deteriorate hemodynamically while on anticoagulation treatment for PE? A) Increasing the dose of anticoagulant B) Adding an antiplatelet agent C) Rescue thrombolytic therapy D) Immediate discontinuation of anticoagulation
Answer: C) Rescue thrombolytic therapy Rescue thrombolytic therapy is recommended for patients who deteriorate hemodynamically while on anticoagulation treatment (Class I recommendation) 1.
Question 7
In which of the following situations should indefinite anticoagulation be considered? A) First PE with major transient risk factor B) Recurrent VTE not related to a major transient risk factor C) PE in a patient with active bleeding D) PE in a patient with planned major surgery
Answer: B) Recurrent VTE not related to a major transient risk factor Indefinite anticoagulation is recommended for patients with recurrent VTE not related to a major transient or reversible risk factor 1, 2.
Question 8
Which of the following is recommended for patients with antiphospholipid antibody syndrome who experience PE? A) Indefinite treatment with a vitamin K antagonist B) 6 months of NOAC therapy C) 3 months of low molecular weight heparin D) Aspirin therapy alone
Answer: A) Indefinite treatment with a vitamin K antagonist Indefinite treatment with a vitamin K antagonist is recommended for patients with antiphospholipid antibody syndrome (Class I recommendation) 1.
Question 9
What is the recommended follow-up timing after acute pulmonary embolism? A) 1 month B) 3-6 months C) 12 months D) No routine follow-up needed
Answer: B) 3-6 months Routine clinical evaluation is recommended 3-6 months after acute PE (Class I recommendation) 1, 2.
Question 10
Which of the following is NOT a common symptom of pulmonary embolism? A) Dyspnea B) Chest pain C) Hemoptysis D) Fever above 39°C
Answer: D) Fever above 39°C While low-grade fever may occur, high fever above 39°C is not a common symptom of PE. The most common symptoms are dyspnea, chest pain, and syncope/presyncope 2.
Question 11
Which of the following NOACs is FDA-approved for the treatment of pulmonary embolism? A) Dabigatran only B) Rivaroxaban only C) Apixaban only D) Both rivaroxaban and apixaban
Answer: D) Both rivaroxaban and apixaban Both rivaroxaban and apixaban are FDA-approved for the treatment of pulmonary embolism as indicated in their drug labels 3, 4.
Question 12
What is the recommended approach for a patient with mismatched perfusion defects on a V/Q scan beyond 3 months after acute PE who remains symptomatic? A) Repeat anticoagulation at therapeutic doses B) Referral to a pulmonary hypertension/CTEPH expert center C) Discontinuation of all therapy D) Antiplatelet therapy only
Answer: B) Referral to a pulmonary hypertension/CTEPH expert center It is recommended that symptomatic patients with mismatched perfusion defects on a V/Q scan beyond 3 months after acute PE are referred to a pulmonary hypertension/CTEPH expert center (Class I recommendation) 1.
Question 13
Which of the following is considered a high-risk PE? A) PE with right ventricular dysfunction but normal blood pressure B) PE with elevated troponin but normal hemodynamics C) PE with shock or hypotension D) PE with D-dimer elevation only
Answer: C) PE with shock or hypotension High-risk PE is defined by the presence of shock or hypotension 1, 2.
Question 14
What is the recommended alternative to thrombolysis for patients with high-risk PE when thrombolysis is contraindicated or has failed? A) Doubling the dose of anticoagulant B) Surgical pulmonary embolectomy C) Aspirin therapy D) Placement of IVC filter
Answer: B) Surgical pulmonary embolectomy Surgical pulmonary embolectomy is recommended for patients with high-risk PE when thrombolysis is contraindicated or has failed 1, 2.
Question 15
After the first 6 months of extended anticoagulation for PE, what dose adjustment should be considered? A) Discontinuation of therapy B) Increase in dose C) Reduced dose of apixaban or rivaroxaban D) Switch to aspirin
Answer: C) Reduced dose of apixaban or rivaroxaban A reduced dose of apixaban or rivaroxaban should be considered after the first 6 months of extended anticoagulation (Class IIa recommendation) 1.
Question 16
Which of the following is NOT recommended as a routine practice in PE management? A) Risk stratification of all PE patients B) Routine use of inferior vena cava filters C) Assessment of right ventricular function D) D-dimer testing in appropriate patients
Answer: B) Routine use of inferior vena cava filters The ESC guidelines specifically state not to routinely use inferior vena cava filters 1.
Question 17
Which of the following is recommended for pregnant women with high-risk PE? A) NOACs B) Thrombolysis or surgical embolectomy C) Observation only D) Aspirin therapy
Answer: B) Thrombolysis or surgical embolectomy Thrombolysis or surgical embolectomy should be considered for pregnant women with high-risk PE (Class IIa recommendation) 1.
Question 18
What is the recommended management approach for patients with intermediate-risk PE? A) Routine systemic thrombolysis B) Anticoagulation with close monitoring C) Immediate surgical embolectomy D) Placement of IVC filter
Answer: B) Anticoagulation with close monitoring For intermediate-risk PE, anticoagulation with close monitoring is recommended, as routine systemic thrombolysis is not recommended for these patients 1, 2.
Question 19
Which of the following is a recommended alternative to LMWH for cancer patients with PE, except for those with gastrointestinal cancer? A) Warfarin B) Edoxaban or rivaroxaban C) Aspirin D) Unfractionated heparin
Answer: B) Edoxaban or rivaroxaban Edoxaban or rivaroxaban should be considered as an alternative to LMWH for cancer patients, with the exception of patients with gastrointestinal cancer (Class IIa recommendation) 1.
Question 20
What is the recommended approach for management of high-risk and selected cases of intermediate-risk PE? A) Individual physician management only B) Consultation with hematology only C) Multidisciplinary teams D) Transfer to another facility
Answer: C) Multidisciplinary teams Set-up of multidisciplinary teams for management of high-risk and selected cases of intermediate-risk PE should be considered, depending on the resources and expertise available in each hospital (Class IIa recommendation) 1, 2.