American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the significant systolic blood pressure drop associated with massive PE?

Drop less than 30 mmHg
Drop equal to or greater than 40 mmHg
Drop greater than 50 mmHg
No specific drop mentioned

The correct answer is: Drop equal to or greater than 40 mmHg

A significant systolic blood pressure drop associated with a massive pulmonary embolism (PE) is recognized as a drop equal to or greater than 40 mmHg. This level of hypotension is indicative of severe cardiovascular compromise due to a substantial obstruction in the pulmonary arterial circulation, leading to increased right ventricular strain and decreased cardiac output. In cases of massive PE, the abrupt decrease in blood flow to the lungs can precipitate a critical reduction in systemic perfusion, ultimately resulting in shock. The hemodynamic changes can be profound, causing the heart to struggle to maintain adequate blood pressure and perfusion to vital organs. Hence, a drop of 40 mmHg or more is considered a threshold that signals a severe and potentially life-threatening situation. This information holds clinical significance as prompt recognition and intervention are crucial in managing acute PE, and understanding the extent of hypotension can guide treatment decisions, including the consideration of thrombolytic therapy or surgical intervention.