Respiratory medicine: high-risk pulmonary embolism: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: high-risk pulmonary embolism

Sample item

A 55-year-old man develops sudden breathlessness and syncope on day 5 after hip surgery. Blood pressure is 80/50 mmHg, heart rate 125 per minute, SpO2 86%, the JVP is raised and bedside echocardiography shows a dilated right ventricle. What is the most appropriate immediate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous alteplase (systemic thrombolysis)

Pulmonary embolism with sustained hypotension (systolic below 90 mmHg) is high-risk, and the right ventricle is failing from acute pressure overload. Systemic thrombolysis with unfractionated heparin is the treatment of choice unless contraindicated. Surgical embolectomy or catheter therapy is used when thrombolysis fails or is contraindicated.

Option by option

  • A. Low-molecular-weight heparin alone with observation

    Anticoagulation alone prevents extension but does not quickly remove the clot in a patient in shock.

  • B. Intravenous alteplase (systemic thrombolysis) (correct)

    Correct. Rapid clot lysis relieves the obstruction and reverses right ventricular failure.

  • C. Inferior vena cava filter as the only initial measure

    A filter prevents new emboli but does not treat the existing obstruction, and is reserved for contraindication to anticoagulation.

  • D. Oral rivaroxaban and early discharge

    Oral anticoagulation is for haemodynamically stable low-risk patients and is too slow here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Intravenous alteplase (systemic thrombolysis). Pulmonary embolism with sustained hypotension (systolic below 90 mmHg) is high-risk, and the right ventricle is failing from acute pressure overload.

Why is "Low-molecular-weight heparin alone with observation" not the answer?

Anticoagulation alone prevents extension but does not quickly remove the clot in a patient in shock.

Why is "Inferior vena cava filter as the only initial measure" not the answer?

A filter prevents new emboli but does not treat the existing obstruction, and is reserved for contraindication to anticoagulation.

Why is "Oral rivaroxaban and early discharge" not the answer?

Oral anticoagulation is for haemodynamically stable low-risk patients and is too slow here.

What concept does this question test?

It tests Respiratory medicine: high-risk pulmonary embolism in General Medicine. Systemic thrombolysis with unfractionated heparin is the treatment of choice unless contraindicated. Surgical embolectomy or catheter therapy is used when thrombolysis fails or is contraindicated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: high-risk pulmonary embolism?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.