Rosh Emergency Medicine Practice Test

What is the best next step in the management of a patient suspected to have a pulmonary embolism presenting with chest pain and dyspnea?

1. Discharge with albuterol

2. Obtain CT angiography

3. Obtain D-dimer

4. Obtain ventilation-perfusion scan

The correct answer is: Obtain CT angiography

In the scenario of a patient presenting with chest pain and dyspnea, who is suspected of having a pulmonary embolism (PE), obtaining a CT angiography is the best next step in management. CT angiography is highly sensitive and specific for detecting pulmonary embolisms and is the preferred imaging modality in emergency settings. It allows for rapid visualization of the blood vessels in the lungs and can confirm the presence of clots in the pulmonary arteries. The urgency of diagnosing a pulmonary embolism cannot be overstated, as untreated PEs can lead to significant morbidity and potential mortality. By choosing CT angiography, healthcare providers can quickly address the diagnosis and potentially initiate appropriate treatment measures, such as anticoagulation, without unnecessary delay. While other options like D-dimer testing can have value in the diagnostic workup for pulmonary embolism, they are not definitive. A positive D-dimer can indicate PE but is not specific, and a negative D-dimer can only reliably rule out PE in low-risk patients. Ventilation-perfusion scans can be useful in certain scenarios, particularly for patients who cannot undergo CT due to contrast allergies or kidney issues, but they are not as readily available or as definitive as CT angiography. Discharging a patient with bronchodil