Vascular surgery: massive pulmonary embolism: practice question

A General Surgery 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 Surgery · Vascular surgery: massive pulmonary embolism

Sample item

A postoperative patient develops sudden dyspnoea, collapse and BP of 70/40 mmHg. Echo shows a dilated right ventricle and CT confirms a central pulmonary embolus. What is the treatment?

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

The answer and the reasoning

C. Systemic thrombolysis, if not contraindicated

Massive PE with haemodynamic compromise has high mortality and is treated with thrombolysis such as alteplase, or surgical or catheter embolectomy if thrombolysis is contraindicated, as with recent major surgery. Heparin is started alongside. Haemodynamically stable PE is treated with anticoagulation alone.

Option by option

  • A. Observation with oxygen alone

    Oxygen alone does not clear the thrombus.

  • B. Low-dose aspirin

    Aspirin is not adequate.

  • C. Systemic thrombolysis, if not contraindicated (correct)

    Correct. Shock from PE needs reperfusion therapy.

  • D. IVC filter without anticoagulation

    Filters do not treat the established embolus.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is C, Systemic thrombolysis, if not contraindicated. Massive PE with haemodynamic compromise has high mortality and is treated with thrombolysis such as alteplase, or surgical or catheter embolectomy if thrombolysis is contraindicated, as with recent major surgery.

Why is "Observation with oxygen alone" not the answer?

Oxygen alone does not clear the thrombus.

Why is "Low-dose aspirin" not the answer?

Aspirin is not adequate.

Why is "IVC filter without anticoagulation" not the answer?

Filters do not treat the established embolus.

What concept does this question test?

It tests Vascular surgery: massive pulmonary embolism in General Surgery. Heparin is started alongside. Haemodynamically stable PE is treated with anticoagulation alone.

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 Vascular surgery: massive pulmonary embolism?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.