Pulmonary Embolism USMLE Step 1 Practice Question
A 63-year-old woman with confirmed submassive PE (stable hemodynamics, RV strain on echo, elevated troponin) is being monitored in the ICU. Six hours after admission, her systolic blood pressure drops to 78 mmHg and does not respond to a 1-liter normal saline bolus. Her heart rate is 128 bpm and oxygen saturation is 85% on 15 L/min oxygen. Which of the following is the most appropriate next step?
Answer choices
- APerform emergent CT angiography to reassess clot burden
- BAdminister systemic thrombolysis with alteplaseCorrect answer
- CIncrease the heparin infusion rate
- DStart a norepinephrine infusion
- EPlace an IVC filter
- FUrgent catheter-based aspiration embolectomy to physically remove the thrombus
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.