Pulmonary Embolism USMLE Step 1 Practice Question
A 38-year-old woman with unprovoked DVT (diagnosed off oral contraceptives) presents with acute dyspnea and pleuritic chest pain. Vital signs: BP 128/82, HR 102, RR 22, SpO2 92% on room air. D-dimer elevated at 2.8 μg/mL; CTPA confirms segmental pulmonary embolism. She denies leg swelling currently. She takes no anticoagulants. Which recommendation best guides her anticoagulation duration?
Answer choices
- A3 months of anticoagulation followed by discontinuation and close surveillance
- BIndefinite anticoagulation due to unprovoked VTE recurrence risk exceeding 4% per yearCorrect answer
- CIndefinite anticoagulation only if she has a thrombophilia detected on testing
- D12 months of anticoagulation with subsequent conversion to aspirin monotherapy
- E6 months of anticoagulation with reassessment for provoked versus unprovoked status
- F3 months of anticoagulation followed by indefinite aspirin therapy to prevent recurrent thromboembolism
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