Pulmonary embolism, pulmonary hypertension, pneumothorax, and pleural effusion concepts tested on USMLE Step 1, beyond the general pathology and lung volume overview.
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- What is the most common source of emboli causing pulmonary embolism?
- Deep vein thrombosis of the proximal lower extremities (femoral/iliac veins)
- What are the three components of Virchow's triad?
- Stasis, hypercoagulability, and endothelial injury
- What is the most common presenting symptom of pulmonary embolism?
- Dyspnea
- What is the most common physical exam sign of pulmonary embolism?
- Tachypnea
- What classic ECG pattern is associated with pulmonary embolism (right heart strain)?
- S1Q3T3 (S wave in lead I, Q wave and inverted T wave in lead III)
- What is the gold standard imaging test for diagnosing pulmonary embolism?
- CT pulmonary angiography (CTPA)
- What imaging study is preferred for suspected PE in pregnancy to limit breast radiation exposure?
- V/Q (ventilation-perfusion) scan
- What are the sensitivity and specificity characteristics of the D-dimer test for PE?
- High sensitivity, low specificity
- What clinical tool estimates the pretest probability of pulmonary embolism?
- Wells score
- What is a saddle embolus?
- A large embolus lodged at the bifurcation of the main pulmonary artery
- What is the first-line treatment for a hemodynamically stable pulmonary embolism?
- Anticoagulation
- What is the treatment for a massive PE causing hemodynamic instability (hypotension or shock)?
- Thrombolytic therapy (tPA)
- When is an IVC filter indicated in the management of PE or DVT?
- When anticoagulation is contraindicated or PE recurs despite adequate anticoagulation
- What clinical setting classically precedes fat embolism syndrome?
- Long bone fracture (e.g., femur)
- What is the classic triad of fat embolism syndrome?
- Respiratory distress, neurologic symptoms, and petechial rash