AIM • KMU Exam Reasoning
KMU Past Paper Practice
Venous Thromboembolism: Deep Vein Thrombosis & Pulmonary Embolism
Final Year MBBS • 20 A-Type Single Best Answer MCQs • Context-rich KMU professional examination practice
MCQ 1
A 69-year-old man is admitted after a hip fracture and remains largely immobile. Four days later he develops unilateral calf swelling. There is no convincing alternative cause for the swelling. Which factor most appropriately determines whether he should proceed directly to objective testing rather than be reassured?
Absence of pleuritic chest pain
Overall clinical probability of DVT
Presence of normal oxygen saturation
Normal chest radiograph
Absence of fever
Correct Answer: Overall clinical probability of DVT
Explanation: Diagnostic testing for suspected DVT is guided by pre-test probability derived from risk context, symptoms and examination findings rather than by pulmonary symptoms or unrelated investigations.
MCQ 2
A 55-year-old woman with active malignancy develops unilateral leg swelling. D-dimer is elevated, but no imaging has yet been performed. Which interpretation is most appropriate?
The result proves proximal DVT
The result excludes pulmonary embolism
The result establishes the site of thrombosis
The result indicates chronic venous insufficiency
The result increases suspicion but requires objective confirmation
Correct Answer: The result increases suspicion but requires objective confirmation
Explanation: D-dimer is nonspecific and may be elevated in malignancy. A positive value cannot confirm DVT and must be interpreted with clinical probability and imaging.
MCQ 3
A patient with suspected lower-limb DVT undergoes compression ultrasonography. The femoral vein does not collapse when pressure is applied with the probe. What is the best interpretation?
The finding supports venous thrombosis at that site
The finding excludes pulmonary embolism
The finding indicates arterial occlusion
The finding proves chronic lymphedema
The finding is expected in a normal vein
Correct Answer: The finding supports venous thrombosis at that site
Explanation: A normal deep vein is compressible. Loss of compressibility occurs when thrombus occupies the lumen and is a key ultrasound feature of DVT.
MCQ 4
A 47-year-old woman presents with calf swelling and pain. Examination also shows marked superficial erythema surrounding a skin wound with fever. What is the most appropriate diagnostic reasoning?
DVT is confirmed because swelling is unilateral
Pulmonary embolism is confirmed by the fever
Anticoagulation should replace further assessment
Cellulitis is a plausible alternative that lowers the clinical probability of DVT
Compression ultrasonography becomes contraindicated
Correct Answer: Cellulitis is a plausible alternative that lowers the clinical probability of DVT
Explanation: A convincing alternative diagnosis changes pre-test probability. Unilateral swelling alone is insufficient to diagnose DVT.
MCQ 5
A postoperative patient develops sudden dyspnea and pleuritic chest pain. The patient is tachycardic but blood pressure is maintained. Which feature would most strongly indicate progression to a more dangerous form of pulmonary embolism?
Mild pleuritic discomfort
Sinus tachycardia
Persistent hypotension with signs of shock
Isolated calf tenderness
Normal chest radiography
Correct Answer: Persistent hypotension with signs of shock
Explanation: Hypotension or shock indicates major hemodynamic compromise from severe pulmonary vascular obstruction and acute right ventricular failure.
MCQ 6
A patient with acute PE has a large embolic burden. Pulmonary vascular resistance rises rapidly. Which subsequent change most directly contributes to systemic hypotension?
Increased left ventricular preload
Reduced left ventricular filling due to right ventricular failure
Reduced systemic venous pressure
Increased pulmonary venous return
Primary systemic arterial vasodilatation
Correct Answer: Reduced left ventricular filling due to right ventricular failure
Explanation: Acute RV pressure overload reduces forward flow through the lungs, decreasing LV preload and cardiac output and thereby producing hypotension.
MCQ 7
A patient with suspected pulmonary embolism has hypoxemia. The embolized region of lung remains ventilated but receives markedly reduced blood flow. What is the physiological consequence?
Reduced anatomical dead space
Uniform reduction of ventilation
Increased diffusion capacity
Ventilation-perfusion mismatch
Primary alveolar collapse in every affected segment
Correct Answer: Ventilation-perfusion mismatch
Explanation: PE creates lung units that are ventilated but poorly perfused, producing V/Q mismatch and contributing to hypoxemia.
MCQ 8
A 61-year-old man has sudden dyspnea after prolonged immobilization. He is stable but PE is considered clinically likely. Which investigation should provide definitive anatomical assessment of the pulmonary arteries in this setting?
CT pulmonary angiography
Routine spirometry
Plain chest radiography
Resting ECG alone
Pulse oximetry alone
Correct Answer: CT pulmonary angiography
Explanation: CTPA directly visualizes the pulmonary arterial circulation and can demonstrate an intraluminal filling defect consistent with PE.
MCQ 9
A patient with sudden dyspnea has an ECG showing sinus tachycardia but no specific diagnostic pattern. What is the best conclusion regarding pulmonary embolism?
Sinus tachycardia confirms PE
PE is excluded because no specific pattern is present
The ECG localizes the embolus
The ECG determines the duration of anticoagulation
The ECG may support assessment but cannot confirm or exclude PE alone
Correct Answer: The ECG may support assessment but cannot confirm or exclude PE alone
Explanation: ECG findings in PE are supportive and may show tachycardia or right-heart strain, but they are neither sufficiently sensitive nor specific to establish the diagnosis.
MCQ 10
A patient with confirmed pulmonary embolism has echocardiographic evidence of right ventricular dilatation and impaired function. Which underlying process best explains this finding?
Reduced systemic arterial resistance
Chronic mitral valve obstruction
Acute rise in pulmonary vascular resistance
Primary left ventricular hypertrophy
Loss of systemic venous return
Correct Answer: Acute rise in pulmonary vascular resistance
Explanation: Pulmonary arterial obstruction acutely increases RV afterload, causing dilatation and dysfunction when the right ventricle cannot overcome the sudden pressure load.
MCQ 11
A patient with DVT is started on anticoagulant therapy. Several days later he develops gastrointestinal bleeding. Which principle best explains this complication?
Anticoagulants increase platelet production
Anticoagulants directly injure pulmonary arteries
Anticoagulants increase systemic blood pressure
Suppression of coagulation increases hemorrhagic risk
The thrombus has migrated to the gastrointestinal tract
Correct Answer: Suppression of coagulation increases hemorrhagic risk
Explanation: Anticoagulation reduces further clot formation but also impairs normal hemostasis, making clinically significant bleeding an important treatment complication.
MCQ 12
A patient with confirmed PE is normotensive, alert and has no evidence of shock. Which treatment principle best matches this presentation?
Immediate surgical embolectomy for every patient
Anticoagulation with monitoring for clinical deterioration
Routine systemic thrombolysis irrespective of bleeding risk
No treatment if oxygen saturation is normal
IVC filter as routine first-line treatment
Correct Answer: Anticoagulation with monitoring for clinical deterioration
Explanation: Stable PE is principally treated with anticoagulation. Reperfusion strategies are reserved for selected patients with severe hemodynamic compromise.
MCQ 13
A patient with massive PE remains in shock despite initial stabilization. There is no major contraindication to thrombolytic treatment. Which management step best addresses the obstructing thrombus urgently?
Systemic reperfusion with thrombolytic therapy
Oral antibiotics
Long-term bronchodilator therapy
Observation until blood pressure normalizes spontaneously
Routine pleural aspiration
Correct Answer: Systemic reperfusion with thrombolytic therapy
Explanation: Persistent shock from severe PE indicates threatened circulation; thrombolytic reperfusion may rapidly reduce thrombotic obstruction when appropriate.
MCQ 14
A patient has proximal DVT but develops an intracranial hemorrhage, making anticoagulation unsafe. Which intervention is most appropriate to consider for prevention of further embolization?
Routine thrombolysis
Coronary angiography
Pleural drainage
Long-term oxygen therapy
Inferior vena cava filter
Correct Answer: Inferior vena cava filter
Explanation: In selected patients with acute VTE and a major contraindication to anticoagulation, an IVC filter can reduce passage of further lower-limb emboli to the lungs.
MCQ 15
A 50-year-old man develops a first DVT after major surgery. Another patient develops a first DVT without any obvious transient trigger. Why is this distinction clinically important?
It determines whether the vein will be compressible
It determines whether pulmonary symptoms can occur
It helps estimate recurrence risk and guide longer-term anticoagulation decisions
It determines the location of a future pulmonary embolus
It eliminates the need for objective diagnosis
Correct Answer: It helps estimate recurrence risk and guide longer-term anticoagulation decisions
Explanation: VTE provoked by a temporary risk factor has a different recurrence context from unprovoked or persistent-risk VTE, affecting follow-up and treatment duration.
MCQ 16
A patient receiving anticoagulation for DVT asks whether the medicine removes the existing thrombus immediately. Which explanation is most accurate?
It mechanically extracts the clot from the vein
It rapidly fragments the clot into the circulation
It increases venous pressure until the clot is displaced
It prevents further thrombus formation while endogenous fibrinolysis acts
It permanently prevents all future thrombosis
Correct Answer: It prevents further thrombus formation while endogenous fibrinolysis acts
Explanation: Anticoagulants prevent clot extension and new thrombosis; the body’s fibrinolytic mechanisms gradually resolve the existing clot.
MCQ 17
A hospitalized patient is identified as being at high risk of VTE but currently has no symptoms of DVT or PE. Which approach best addresses the underlying preventable mechanism?
Daily CT pulmonary angiography
Appropriate mobilization and thromboprophylaxis when safe
Routine thrombolysis
Routine IVC filter insertion
Strict bed rest until discharge
Correct Answer: Appropriate mobilization and thromboprophylaxis when safe
Explanation: Prevention targets venous stasis and thrombotic risk through mobilization and appropriate mechanical or pharmacological prophylaxis.
MCQ 18
A patient with confirmed DVT develops sudden pleuritic pain and hemoptysis but remains hemodynamically stable. Which pulmonary complication best explains the hemoptysis?
Acute bronchial asthma
Left ventricular hypertrophy
Pleural fibrosis
Pulmonary edema from mitral stenosis
Peripheral pulmonary infarction caused by embolic obstruction
Correct Answer: Peripheral pulmonary infarction caused by embolic obstruction
Explanation: Peripheral embolic occlusion can produce pulmonary infarction, causing pleuritic pain and hemoptysis in some patients with PE.
MCQ 19
A patient with suspected PE has a normal chest radiograph but remains tachypneic and hypoxemic after recent surgery. Which conclusion best reflects correct diagnostic reasoning?
A normal chest radiograph does not exclude pulmonary embolism
A normal chest radiograph confirms PE
Pulmonary vascular imaging is unnecessary
Hypoxemia rules out VTE
The symptoms must represent pneumonia
Correct Answer: A normal chest radiograph does not exclude pulmonary embolism
Explanation: Chest radiography may help identify alternative causes of symptoms, but PE can occur despite a normal or nonspecific chest X-ray.
MCQ 20
A patient with known lower-limb DVT develops acute dyspnea. Compression ultrasonography confirms persistent thrombus in the leg, while CTPA demonstrates a pulmonary arterial filling defect. What is the most appropriate integrated interpretation?
Two unrelated vascular diseases are present
The pulmonary lesion caused the original leg swelling
DVT and PE represent different manifestations of the same venous thromboembolic process
The leg thrombus excludes pulmonary embolization
The pulmonary arterial defect represents chronic airway disease
Correct Answer: DVT and PE represent different manifestations of the same venous thromboembolic process
Explanation: DVT is commonly the source of embolic material that travels through the right heart to obstruct the pulmonary arteries, linking the two presentations as VTE.
Generated according to the supplied AIM KMU Past Paper Practice requirements: exactly 20 A-type SBA questions, context-rich clinical application, five options, one correct answer and concise explanations. :chatgpt-content-reference{index=”0″}