OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is pulmonary embolism. While this may seem a odd practice, it is useful to see multiple examples of how pulmonary embolism will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 38 year old woman is at 36 weeks gestation when she comes to the emergency department. She complains of pain in the right hemithorax that began about 3 hours ago. She explains that the pain worsens when she is breathing. Her temperature is 100.7°F, pulse is 115/min, blood pressure is 115/70 mm Hg, and respirations are 25/min. Fetal heart rate is 174/min. A physical exam is conducted and is unremarkable. An chest X-ray is ordered and shows no abnormalities. A ECG shows nonspecific changes. Arterial blood gases are collected and are reported below:
- pH: 7.44
- PCO2: 36 mm Hg
- PO2: 69 mm Hg
What is the likely diagnosis in this patient?
Question # 2
55-year-old woman has brought to the emergency department after she collapsed while standing and lost consciousness for about five minutes. She recovered on her own but was very weak and short of breath. She also complains of left sided chest pain. There was no tonic clonic activity and she did not lose control of her bowels or urine. The patient has been recently diagnosed with colon cancer and is scheduled to undergo surgical resection next week. The patient’s past medical history is only notable for hypertension however she’s not been compliant with her medications. Her blood pressure is 90/50 mmHg, her pulse is 130/min and regular. Pulse oximetry shows 82% saturation on room air. She is diaphoretic and tachypneic. Physical exam is remarkable for JVP of 13 cm. The rest of the physical exam is noncontributory. What is a possible diagnosis in this patient?
Explanation: acute onset of shortness of breath + chest pain + malignancy + unstable vitals + decreased O2 saturation + elevated JVP = pulmonary embolism
Question # 3
50-year-old woman comes to the hospital because of a 3 hour history of shortness of breath and acute chest pain. She does not have any fever and denies any history of these types of symptoms. The patient is being evaluated as an outpatient for excessive abnormal uterine bleeding, and is scheduled to undergo an endometrial biopsy and ultrasound. Her past medical history is notable for carpal tunnel syndrome, hypertension, hypercholesterolemia, and hypothyroidism. Her temperature is 98.7°F, her blood pressure is 90/55 mmHg, her heart rate is 115/min, and respirations are 28/min. The patient’s BMI is 37 kg/m². Physical exam reveals normal heart sounds. Bilateral wheezing is heard upon auscultation and the patient’s right leg is swollen. What is the likely diagnosis in this patient?
Explanation: acute onset of shortness of breath + chest pain + (suspected) malignancy + unstable vitals + lower leg swelling (suspected DVT) = pulmonary embolism
Question # 4
A 35-year-old postpartum female is brought to the ER with a sudden onset of severe shortness of breath and a left-sided chest pain that began about two hours ago when she was breast-feeding her child. The patient was recently discharged from the hospital three days ago after and uneventful elective C-section. She denies using any tobacco, alcohol, or illicit drugs. Her temperature is 98°F, blood pressure is 105/70 mm Hg, pulse is 130 ppm, and respirations are 33/min. Pulse oximetry shows a saturation of 85% on room air. The patient’s BMI is 35 kg/m². Physical exam shows a female in moderate respiratory distress that is using accessory muscles for respiration. She appears to be alert and cooperative and does not have any signs of cyanosis or jaundice. The chest is clear to auscultation and the rest of the physical exam is not contributory. A chest x-ray is ordered and reveals no infiltrates. And EKG is ordered and only demonstrate sinus tachycardia. What is the likely diagnosis in this patient?
Explanation: acute onset of shortness of breath + chest pain + tachycardia + recent surgery = pulmonary embolism
Page Updated: 10.24.2016