Pulmonary Embolism USMLE Step 1 Practice Question
A 55-year-old woman with a history of unprovoked pulmonary embolism presents with acute dyspnea and chest pain. Vital signs: BP 128/82 mmHg, HR 102/min, RR 22/min, SpO2 92% on room air. She has been on therapeutic rivaroxaban for 3 months with confirmed anti-Xa levels in therapeutic range. CT pulmonary angiography reveals new emboli in the left pulmonary artery. D-dimer remains elevated. Bilateral lower extremity ultrasound shows no deep vein thrombosis. Which of the following is the most appropriate next step in management?
Answer choices
- AAdd aspirin to the current regimen
- BPlace an inferior vena cava filterCorrect answer
- CIncrease the rivaroxaban dose
- DInitiate systemic thrombolysis
- ESwitch to a different direct oral anticoagulant
- FPerform pulmonary angiography with catheter-directed thrombolysis
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.