Pulmonary Embolism Practice Questions

30 multiple-choice questions on Pulmonary embolism for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A patient with possible PE has a swollen, tender left calf, a heart rate of 112, and active cancer on chemotherapy. PE is not judged the most likely diagnosis, and no other Wells criteria apply. What is the Wells score?

   1. A. 4.0, so PE is unlikely
   2. B. 3.5, so PE is unlikely
   3. C. 5.5, so PE is likely
   4. D. 7.0, so PE is likely
   Show answer

   Answer: C. 5.5, so PE is likely

   Wells assigns 3 points for clinical signs of DVT, 1.5 for a heart rate over 100, and 1 for active cancer: 3 + 1.5 + 1 = 5.5. A score above 4 means PE is likely. 4.0 and 3.5 leave out one of the criteria. 7.0 adds points for criteria that are not present.

2. A 35-year-old with pleuritic chest pain meets every PERC criterion except one. Which finding is the one that fails PERC?

   1. A. A heart rate of 108
   2. B. An SpO2 of 97% on room air
   3. C. Her age of 35 years
   4. D. No swelling in either leg
   Show answer

   Answer: A. A heart rate of 108

   PERC can rule out PE in a low-risk patient only if all eight criteria are met: age under 50, heart rate under 100, SpO2 of 95% or more, no hemoptysis, no estrogen use, no prior VTE, no unilateral leg swelling, and no recent surgery or trauma. A heart rate of 108 fails. An SpO2 of 97%, age 35, and no leg swelling all pass.

3. A patient with a suspected massive PE is hypotensive and tiring, and your partner wants to perform RSI. What is the main danger?

   1. A. Sedation and positive pressure can cause collapse
   2. B. The tube will push the clot deeper
   3. C. Intubation causes a pneumothorax in most PE patients
   4. D. Paralytics make the clot grow faster
   Show answer

   Answer: A. Sedation and positive pressure can cause collapse

   A failing right ventricle depends on sympathetic tone and venous return; induction drugs blunt that tone and positive pressure cuts venous return, so cardiac arrest can follow intubation. If it is unavoidable, prepare pressors and use minimal pressures. The tube does not reach the clot. Pneumothorax is not a specific risk of PE. Paralytics do not affect clot growth.

4. What is the most common sign of pulmonary embolism?

   1. A. Leg swelling
   2. B. Tachypnea
   3. C. Cyanosis
   4. D. Hemoptysis
   Show answer

   Answer: B. Tachypnea

   Tachypnea and tachycardia are the most common findings. Hemoptysis and cyanosis are less frequent.

5. Which factor is a well-known risk for pulmonary embolism?

   1. A. Prolonged immobility
   2. B. Regular aerobic exercise
   3. C. Daily low-dose aspirin use
   4. D. A recent influenza vaccine
   Show answer

   Answer: A. Prolonged immobility

   Prolonged immobility, such as long flights, bed rest, or recent surgery, causes venous stasis that promotes DVT. Exercise, aspirin and influenza vaccination do not raise the risk; aspirin, if anything, lowers it slightly.

6. Which medication history increases a woman's risk of venous thromboembolism?

   1. A. Estrogen-based birth control
   2. B. Inhaled albuterol as needed
   3. C. Antacids taken after meals
   4. D. Daily low-dose aspirin
   Show answer

   Answer: A. Estrogen-based birth control

   Estrogen increases clotting factor production, and the risk is higher in smokers and women over 35.

7. A 28-year-old who injects drugs has fever, a new heart murmur, pleuritic chest pain, and dyspnea. What best explains his lung symptoms?

   1. A. A spontaneous pneumothorax from ruptured bullae
   2. B. Asthma triggered by drug fumes
   3. C. Septic emboli from right-sided endocarditis
   4. D. Viral bronchitis from a cold
   Show answer

   Answer: C. Septic emboli from right-sided endocarditis

   Injection drug use can cause tricuspid valve endocarditis, which throws infected clots into the lungs, causing fever, pleuritic pain, dyspnea, and multiple lung lesions. Pneumothorax does not cause fever and a murmur. Asthma causes wheezing, not fever and a new murmur. Bronchitis does not cause a murmur or septic embolism.

8. Which ECG finding is most commonly seen with pulmonary embolism?

   1. A. Atrial flutter
   2. B. Sinus bradycardia
   3. C. Sinus tachycardia
   4. D. Third-degree block
   Show answer

   Answer: C. Sinus tachycardia

   Sinus tachycardia is the most common ECG finding. The classic S1Q3T3 pattern is uncommon and not specific.

9. The S1Q3T3 ECG pattern associated with PE reflects:

   1. A. Right heart strain
   2. B. Digoxin toxicity
   3. C. Left atrial enlargement
   4. D. Inferior wall infarction
   Show answer

   Answer: A. Right heart strain

   A large S wave in lead I, Q wave in lead III, and inverted T wave in lead III suggest acute right ventricular strain.

10. Ten days after hip surgery, a 70-year-old briefly fainted. She is now dyspneic with a BP of 84/50, a heart rate of 126, distended neck veins, and clear lungs. What does this presentation suggest?

    1. A. A simple vasovagal faint after standing up quickly
    2. B. Dehydration from poor oral intake
    3. C. A high-risk PE straining the right heart
    4. D. A urinary infection with mild sepsis
    Show answer

    Answer: C. A high-risk PE straining the right heart

    Syncope, hypotension, distended neck veins, and clear lungs after surgery point to a large PE causing right ventricular failure (high-risk PE). Handle her gently, give oxygen, use small fluid boluses or pressors per protocol, and transport to a center that can give lytics. A vasovagal faint resolves fully. Dehydration causes flat, not distended, neck veins. Mild sepsis would not cause distended neck veins.

11. A 58-year-old man has sudden dyspnea, hypotension, JVD, and clear lungs after a long car trip. Which other cause of obstructive shock must you consider?

    1. A. Cardiac tamponade
    2. B. Septic shock from pneumonia
    3. C. Hypovolemic shock
    4. D. Anaphylactic shock
    Show answer

    Answer: A. Cardiac tamponade

    A long car trip points to pulmonary embolism, but clear lungs with JVD and hypotension also fit cardiac tamponade, the other obstructive cause that keeps the lungs clear. Tension pneumothorax is also obstructive but usually causes diminished or absent breath sounds on one side, which this patient does not have. Septic shock from pneumonia would bring fever and abnormal lung sounds, and hypovolemic and anaphylactic shock cause flat neck veins rather than JVD.

12. Which finding on physical exam may support DVT as the source of a PE?

    1. A. Bilateral ankle swelling at day's end
    2. B. A cool, pale foot with no pulse
    3. C. Calf pain on walking that eases at rest
    4. D. One swollen, tender calf
    Show answer

    Answer: D. One swollen, tender calf

    One-sided leg swelling, warmth, and tenderness suggest DVT. Bilateral dependent edema is more typical of heart failure. A cool, pulseless foot points to arterial occlusion, and calf pain with walking that eases at rest is claudication from arterial disease.

13. What is the prehospital management focus for a patient with suspected PE?

    1. A. Supportive care and transport
    2. B. Nebulized albuterol and observe
    3. C. Aspirin and nitroglycerin
    4. D. Large fluid boluses to raise BP
    Show answer

    Answer: A. Supportive care and transport

    Prehospital care is supportive: oxygen to target SpO2, cardiac monitoring, IV access, careful fluid use for hypotension per protocol, and rapid transport. Aspirin and nitroglycerin are ACS treatments, and nitroglycerin can drop the BP of a preload-dependent right ventricle; large boluses can overstretch a failing right ventricle, and albuterol does not treat PE.

14. What does current AHA guidance say about fibrinolytics for cardiac arrest thought to be caused by a pulmonary embolism?

    1. A. They may be considered when PE is suspected
    2. B. They are no longer used during cardiac arrest
    3. C. They must wait until a pulse returns
    4. D. They replace the need for continued CPR
    Show answer

    Answer: A. They may be considered when PE is suspected

    AHA guidance supports fibrinolysis for arrest from confirmed PE and allows it to be considered when PE is suspected, so early notification of the receiving team matters. They are still used in this setting. They are given during CPR, not only after a pulse returns, and CPR continues afterward while the drug works.

15. A 28-year-old woman who is 6 weeks postpartum has sudden dyspnea and tachycardia. How does her recent pregnancy affect her PE risk?

    1. A. It only matters before birth
    2. B. It decreases her risk
    3. C. It increases her risk
    4. D. It has no effect
    Show answer

    Answer: C. It increases her risk

    Pregnancy and the postpartum period are hypercoagulable states that raise VTE risk for weeks after delivery.

16. A stable patient with a suspected PE offers to walk to the ambulance to save time. What is the best response?

    1. A. Let him walk; exercise helps dissolve clots
    2. B. Move him on the stretcher to limit exertion
    3. C. Let him walk if his SpO2 is over 90%
    4. D. Have him jog to see whether his pain worsens
    Show answer

    Answer: B. Move him on the stretcher to limit exertion

    Exertion increases oxygen demand on a strained right ventricle and can trigger collapse in PE, so move him without effort. Exercise does not dissolve clots. A reassuring SpO2 does not make exertion safe. Provocative exertion adds risk without useful information.

17. Which of the H's and T's in ACLS refers to pulmonary embolism?

    1. A. Thrombosis, pulmonary
    2. B. Thrombosis, coronary
    3. C. Tension pneumothorax
    4. D. Tamponade, cardiac
    Show answer

    Answer: A. Thrombosis, pulmonary

    The ACLS reversible causes include thrombosis, both pulmonary (PE) and coronary (MI).

18. Which patient has the highest risk of PE?

    1. A. A smoker with mild asthma
    2. B. A healthy runner after a 5K race
    3. C. A patient on chemotherapy
    4. D. A patient after a 2-hour flight
    Show answer

    Answer: C. A patient on chemotherapy

    Active cancer and chemotherapy promote a hypercoagulable state, significantly raising VTE risk. Smoking, mild asthma and a short flight add little risk, and a 5K race does not cause PE.

19. A fat embolism causing respiratory distress is most commonly associated with:

    1. A. Femur fractures
    2. B. Deep vein thrombosis
    3. C. Rib fractures
    4. D. Pleural effusions
    Show answer

    Answer: A. Femur fractures

    Fat from fractured long bones such as the femur can enter the circulation and lodge in the lungs, usually 24 to 72 hours after injury. A DVT causes a thromboembolism rather than a fat embolism, and rib fractures and pleural effusions are not the usual source.

20. A patient on an anticoagulant for prior DVT is short of breath. Which question is most important?

    1. A. "When did you last eat?"
    2. B. "Who prescribed the medicine?"
    3. C. "Have you missed any doses?"
    4. D. "Do you take it with food?"
    Show answer

    Answer: C. "Have you missed any doses?"

    Missed anticoagulant doses increase the risk of recurrent thrombosis and PE. Who prescribed the drug, whether it is taken with food and when he last ate do not tell you whether he is protected against a new clot.

21. Why is hemoptysis seen in some patients with PE?

    1. A. Clot material coughed up
    2. B. Lung infarction
    3. C. Ruptured esophagus
    4. D. Bronchospasm from the clot
    Show answer

    Answer: B. Lung infarction

    Obstruction of a pulmonary artery branch can cause pulmonary infarction, which may produce blood-tinged sputum. The clot sits in the pulmonary artery and is not coughed up, bronchospasm does not cause bleeding, and the esophagus is not involved.

22. A hypotensive patient with suspected massive PE has clear lungs. Which fluid approach is most appropriate per many protocols?

    1. A. Fluids only after vasopressors fail
    2. B. Small, cautious fluid boluses
    3. C. No fluids under any circumstances
    4. D. Several liters as fast as possible
    Show answer

    Answer: B. Small, cautious fluid boluses

    A failing right ventricle may benefit from modest preload but can be overloaded by large volumes. Small boluses with reassessment are reasonable per protocol.

23. Air embolism causing respiratory distress can occur during:

    1. A. Routine blood pressure checks
    2. B. Intramuscular injections
    3. C. Central line placement
    4. D. Nasogastric tube placement
    Show answer

    Answer: C. Central line placement

    Air can enter the venous system through central lines, especially with the patient upright or during inspiration. Positioning and occluding the site are key. IM injections, nasogastric tubes and blood pressure cuffs do not open a vein to the air.

24. Which statement about pulse oximetry in PE is most accurate?

    1. A. It is the best screening test
    2. B. It rules out PE if over 94%
    3. C. It may be normal
    4. D. It falls before the heart rate rises
    Show answer

    Answer: C. It may be normal

    Small emboli may not cause hypoxemia, so a normal SpO2 does not exclude PE. Pulse oximetry is not a screening test for PE, tachypnea and tachycardia often appear before any fall in SpO2, and a reading over 94% does not rule it out.

25. A patient with calf pain has pain behind the knee when you flex his foot upward (Homans sign). How useful is this finding for DVT?

    1. A. Too unreliable to confirm or rule out a DVT
    2. B. It confirms a DVT and rules out other causes
    3. C. Its absence rules out DVT in most patients
    4. D. It is the best bedside test for PE as well
    Show answer

    Answer: A. Too unreliable to confirm or rule out a DVT

    Homans sign is present in many patients without DVT and absent in many with it, so it neither confirms nor excludes the diagnosis; ultrasound is needed. Its presence does not confirm DVT, and its absence does not rule it out. It is not a test for PE.

26. Which treatment for PE is given in the hospital to break up a large clot?

    1. A. Corticosteroids
    2. B. Diuretics
    3. C. Fibrinolytics
    4. D. Beta-blockers
    Show answer

    Answer: C. Fibrinolytics

    Fibrinolytic therapy may be used for massive PE with shock. Anticoagulation prevents clot growth in less severe cases.

27. Which vital sign pattern is most consistent with a massive pulmonary embolism?

    1. A. Hypotension with tachycardia
    2. B. Hypertension with bradycardia
    3. C. Hypertension with a fever
    4. D. Normal BP with a slow rate
    Show answer

    Answer: A. Hypotension with tachycardia

    Massive PE reduces cardiac output, causing hypotension and compensatory tachycardia.

28. A 70-year-old bedbound patient has a sudden onset of anxiety, dyspnea, and tachycardia. A family member says, 'She just suddenly felt like something was wrong.' This feeling of impending doom is:

    1. A. Proof of a cardiac cause
    2. B. Specific to panic attacks
    3. C. Common with pulmonary embolism
    4. D. Rare in any respiratory emergency
    Show answer

    Answer: C. Common with pulmonary embolism

    Many patients with PE report a sense of impending doom along with sudden dyspnea. Do not dismiss it as anxiety.

29. Why might a patient with PE complain of sharp chest pain worse on inspiration?

    1. A. Spasm of the esophagus
    2. B. Swelling of the larynx
    3. C. Stretching of the trachea
    4. D. Pleural irritation
    Show answer

    Answer: D. Pleural irritation

    Clots near the lung periphery can cause infarction and pleural inflammation, producing pleuritic pain.

30. A 67-year-old man has sudden dyspnea. Which item in his recent history most increases his risk of PE?

    1. A. Inhaled steroid use
    2. B. Hip replacement 2 weeks ago
    3. C. Daily insulin injections
    4. D. A flu shot last month
    Show answer

    Answer: B. Hip replacement 2 weeks ago

    Major orthopedic surgery of the hip or knee combines vessel injury, immobility, and hypercoagulability and is one of the highest-risk settings for VTE.