The Correct Answer is C!

 

A 38-year-old fitness instructor comes to you with complaints of mild pleuritic chest pain. He just got off a 4-hour flight from home and comes to you worried about a pulmonary embolism. His BP is 119/80 and HR 55, and exam is otherwise normal. D-Dimer assessment is within normal limits.

What is the next appropriate step in DVT/PE evaluation?

A. V/Q scan
B. CT angio
C. Evaluate for alternate causes of chest pain
D. Duplex ultrasound

Rationale:

The optimal testing for DVT/PE should be based upon the pre-test likelihood of having venous thromboembolic disease. This person has a low likelihood of disease. Plane flights <8 hours duration are not associated with venous thrombosis.

 

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