American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common initial step in the management of patients presenting with suspected pulmonary embolism?

1. Ct angiography

2. D-dimer testing

3. Randomized clinical trial

4. Lung function test

The correct answer is: D-dimer testing

D-dimer testing is often a common initial step in the management of patients suspected to have a pulmonary embolism (PE). D-dimer is a fibrin degradation product that is typically elevated in the presence of a thrombus, including pulmonary emboli. When a patient presents with symptoms suggestive of PE, such as shortness of breath, chest pain, or hemoptysis, D-dimer testing is usually performed to help rule out the presence of a clot. A low D-dimer level can help exclude PE in patients with a low to moderate pre-test probability, thereby reducing the need for more invasive and expensive testing like CT angiography. This approach aligns with diagnostic algorithms designed to efficiently evaluate and manage suspected PE cases, minimizing patient risk and healthcare costs. In contrast, while CT angiography is a key diagnostic tool for confirming PE, it is typically utilized after D-dimer results indicate a potential need for further investigation. Randomized clinical trials and lung function tests are not primary steps in the initial evaluation of a suspected pulmonary embolism. Thus, D-dimer testing serves as an important and commonly employed initial strategy in the clinical management of these patients.