Consider the following statements with regard to pulmonary embolism : 1. Unexplained breathlessness is the most common symptom. 2. When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should be considered. 3. Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without obligatory imaging tests. Which of the statements given above are correct?
Pulmonary Embolism Statement Analysis
This section evaluates the correctness of statements regarding pulmonary embolism (PE).
Statement 1: Breathlessness Symptom
Unexplained breathlessness is indeed recognized as the most frequent symptom of pulmonary embolism. The obstruction of blood flow in the lungs causes sudden shortness of breath, making this statement correct.
Statement 2: Persistent Symptoms Consideration
The statement suggests considering occult pulmonary embolism when conditions like congestive heart failure or pneumonia do not improve with standard treatment. This is clinically relevant, as PE can mimic or complicate these respiratory conditions. Persistent, unexplained symptoms warrant further investigation for PE, thus this statement is correct.
Statement 3: Testing Strategy
This statement proposes starting with D-dimer testing alone for patients with a high clinical likelihood of venous thromboembolism (VTE), bypassing initial imaging. Current guidelines typically reserve D-dimer testing primarily for patients with a low or intermediate clinical probability of VTE. For patients deemed at high clinical likelihood, diagnostic imaging (like CT pulmonary angiography) is often the preferred next step, as D-dimer sensitivity may decrease, and a positive result in high-risk individuals still necessitates imaging. Therefore, this statement is generally considered incorrect as it deviates from standard diagnostic pathways for high-risk patients.
Conclusion
Based on the analysis:
- Statement 1 is correct.
- Statement 2 is correct.
- Statement 3 is incorrect.
Therefore, the correct statements are 1 and 2 only.
Important Questions from General Clinical Conditions
- The height of the Jugular Venous Pulse is determined by :
- The SA node is situated at the junction of:
- Reverse splitting of second heart sound is most commonly seen in :
- A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud diamond-shaped, rough quality systolic murmur best heard at the right $2^{nd}$ intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis ?
Consider the following criteria:
1. Pleural fluid protein : Serum protein ratio > 0.5
2. Pleural fluid LDH : Serum LDH ratio > 0.6
3. Pleural fluid LDH > Two-thirds of the upper limit of normal serum LDH
Which of the above criteria, if present in pleural fluid, will indicate an exudate ?
