Cardiology: chronic thromboembolic pulmonary hypertension: 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 · Cardiology: chronic thromboembolic pulmonary hypertension

Sample item

A 52-year-old woman had an acute pulmonary embolism eight months ago and has taken warfarin since. She has progressive exertional breathlessness and her echocardiogram suggests pulmonary hypertension with a dilated right ventricle. Which investigation is the best screening test for a potentially curable cause?

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

The answer and the reasoning

B. Ventilation-perfusion scintigraphy

Persistent dyspnoea with pulmonary hypertension after pulmonary embolism suggests chronic thromboembolic pulmonary hypertension. Ventilation-perfusion scanning is the preferred screening test because it is more sensitive than CT angiography; a normal scan effectively excludes the diagnosis. Confirmation needs right heart catheterisation and pulmonary angiography, and pulmonary endarterectomy can be curative.

Option by option

  • A. High-resolution CT chest for interstitial disease

    HRCT looks for parenchymal lung disease and would not detect organised thromboembolic obstruction.

  • B. Ventilation-perfusion scintigraphy (correct)

    A V/Q scan showing unmatched segmental perfusion defects supports chronic thromboembolic disease and is the screening test of choice.

  • C. Repeat serum D-dimer

    D-dimer is not useful for chronic organised thrombus and does not guide the diagnosis.

  • D. Coronary angiography

    Coronary angiography assesses epicardial coronary disease, which does not explain right ventricular overload after embolism.

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, Ventilation-perfusion scintigraphy. Persistent dyspnoea with pulmonary hypertension after pulmonary embolism suggests chronic thromboembolic pulmonary hypertension.

Why is "High-resolution CT chest for interstitial disease" not the answer?

HRCT looks for parenchymal lung disease and would not detect organised thromboembolic obstruction.

Why is "Repeat serum D-dimer" not the answer?

D-dimer is not useful for chronic organised thrombus and does not guide the diagnosis.

Why is "Coronary angiography" not the answer?

Coronary angiography assesses epicardial coronary disease, which does not explain right ventricular overload after embolism.

What concept does this question test?

It tests Cardiology: chronic thromboembolic pulmonary hypertension in General Medicine. Ventilation-perfusion scanning is the preferred screening test because it is more sensitive than CT angiography; a normal scan effectively excludes the diagnosis. Confirmation needs right heart catheterisation and pulmonary angiography, and pulmonary endarterectomy can be curative.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Cardiology: chronic thromboembolic pulmonary hypertension?

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.