Repeated USMLE Questions Step 2 CK- 430

A 75-year-old man develops sudden onset of shortness of breath at the orthopedic department. He was admitted for suspected pathological fracture of femur 3 days ago. On examination, his pulse is 122, blood pressure 90/60, respiratory rate 34/min and oxygen saturation is 92%. Lung sounds are clear bilaterally. Heart rhythm is regular with no murmurs or gallops.

What is the appropriate immediate step to improve this patient’s condition?

A-Intravenous injection of broad spectrum antibiotics

B-Intravenous injection of heparin

C-Subcutaneous injection of epinephrine

D-Electric cardioversion

E-Call the cardiology attendant


This is a case of pulmonary embolism characterized by dyspnea, hypotension and tachycardia. The age of the patient and the fracture are important risk factors. Immediate IV injection of heparin is mandatory on this situation and could be lifesaving.

The correct answer is B

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