The Rosh Reveal: EPISODE 13

Do You Know Wells Criteria & the Pulmonary Embolism Rule-out Criteria?

May 7, 2019
Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let’s get started.

A 49-year-old woman presents with chest pain and shortness of breath. Her pain is constant, non-exertional and does not radiate into the back. She denies hemoptysis, history of previous venous thromboembolism, trauma or surgery within the last four weeks or unilateral leg swelling. She takes no medications. She smokes a half pack of cigarettes per day. Her vital signs at triage are temperature 98.6°F, blood pressure 120/80 mm Hg, and heart rate 108 bpm. Her heart rate improves to 97 bpm upon reevaluation. Her physician decides to evaluate her for a pulmonary embolism. In addition to an ECG and a chest X-ray, which of the following is the most appropriate next step in the diagnosis of pulmonary embolism?

A) CT pulmonary angiogram

B) D-dimer followed by a CT pulmonary angiogram if positive

C) Use the pulmonary embolism rule-out criteria to exclude pulmonary embolism

D) V/Q scan

Check out all of the episodes of “The Reveal” on the Rosh Review YouTube Channel.

By Adam Rosh

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