Basic resuscitation: thrombolysis in suspected pulmonary embolism arrest: practice question

A Anaesthesia 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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Anaesthesia · Basic resuscitation: thrombolysis in suspected pulmonary embolism arrest

Sample item

A 38-year-old woman collapses six days after a long-haul flight, with a swollen painful calf. She is in pulseless electrical activity, and bedside echocardiography shows a dilated right ventricle with an underfilled left ventricle. Besides high-quality CPR, which specific intervention should be considered?

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

The answer and the reasoning

C. Systemic thrombolytic therapy

Massive pulmonary embolism is a reversible cause of cardiac arrest, the thrombotic arm of the Hs and Ts. When it is confirmed or strongly suspected, systemic thrombolysis can be given during CPR, and resuscitation is continued for an extended period afterwards to allow the clot to lyse.

Option by option

  • A. Intravenous sodium bicarbonate

    Bicarbonate is not a routine drug in arrest and does not treat a clot.

  • B. Pericardiocentesis for tamponade

    Pericardiocentesis treats tamponade, which shows a pericardial effusion rather than right ventricular dilatation.

  • C. Systemic thrombolytic therapy (correct)

    Correct. Thrombolysis treats the obstructing clot in a suspected massive pulmonary embolism that has caused arrest.

  • D. Needle decompression of the chest

    Needle decompression treats tension pneumothorax, which would show a hyperinflated chest, not a dilated right ventricle with an empty left.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Systemic thrombolytic therapy. Massive pulmonary embolism is a reversible cause of cardiac arrest, the thrombotic arm of the Hs and Ts.

Why is "Intravenous sodium bicarbonate" not the answer?

Bicarbonate is not a routine drug in arrest and does not treat a clot.

Why is "Pericardiocentesis for tamponade" not the answer?

Pericardiocentesis treats tamponade, which shows a pericardial effusion rather than right ventricular dilatation.

Why is "Needle decompression of the chest" not the answer?

Needle decompression treats tension pneumothorax, which would show a hyperinflated chest, not a dilated right ventricle with an empty left.

What concept does this question test?

It tests Basic resuscitation: thrombolysis in suspected pulmonary embolism arrest in Anaesthesia. When it is confirmed or strongly suspected, systemic thrombolysis can be given during CPR, and resuscitation is continued for an extended period afterwards to allow the clot to lyse.

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 Basic resuscitation: thrombolysis in suspected pulmonary embolism arrest?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.