QuestionSBA
QuestionChoice
D-dimer is a highly sensitive but non-specific marker of clotting. This test is useful for ruling out DVTs and PEs, but not confirming the diagnosis. According to the Wells' Score, this patient has a high risk of having a pulmonary embolism, and as such a d-dimer test is not recommended. Furthermore, d-dimer is elevated in pregnancy, and would not provide a meaningful result in this patient.
10003982
b
D-Dimer
QuestionChoice
As this patient has signs and symptoms of a DVT as well as a PE, compression duplex ultrasound is the next best investigation. If the compression duplex ultrasound was negative or the woman did not have features of DVT, then a CT pulmonary angiogram or V/Q scan could be considered. A V/Q scan is a ventilation-perfusion scan, and it looks at the blood and air supply to the lungs. In pregnant women, V/Q scanning is associated with a mildly increased risk of childhood cancer, and a lower risk of maternal breast cancer compared to CT pulmonary angiogram. This is why it is not used first line for diagnosis of PE in pregnant women who also show features of DVT. However, the absolute risk for both these scans is very low.
10003983
c
V/Q scan
QuestionChoice
As this patient has signs and symptoms of a DVT as well as a PE, compression duplex ultrasound is the next best investigation. If the compression duplex ultrasound was negative, then a CT pulmonary angiogram or VQ scan could be considered. A CT pulmonary angiogram looks at the blood vessels from the heart to the lungs and can identify any blockages. As CT scans use radiation, this poses risks to the foetus, however, the absolute risks are very small.
10003984
d
CT pulmonary angiogram
QuestionChoice
As this patient has signs and symptoms of a DVT as well as a PE, compression duplex ultrasound is the next best investigation. Fibrinogen is a protein that is essential for clot formation. It is most often requested after a patient has prolonged or unexplained bleeding, not clots. However, it can also be used to help diagnose disseminated intravascular coagulation (DIC).
10003985
e
Fibrinogen levels
QuestionChoice
In pregnant women with suspected pulmonary embolism (PE) who also have symptoms and signs of deep vein thrombosis (DVT), compression duplex ultrasound should be performed. This is due to the risks of radiation exposure to the foetus in CTPA and VQ scans. The management would also be the same for both DVT and PE.
10003981
a
Compression duplex ultrasound
Concept
Chapter
2693
4223
Virchow's Triad
Topic
193
Haematological Science
13343
A 32-year-old pregnant female attends the Emergency Department with shortness of breath, pleuritic chest pain and haemoptysis. She is also complaining of a swollen left leg that is warm to touch. Pitting oedema is present. A chest x-ray and ECG have been performed.

Considering the most likely diagnosis, what is the next best investigation to carry out?
a