Adult Critical Care Specialty (ACCS) Practice Exam

For a pregnant woman with acute shortness of breath and chest pain, which procedure should be recommended to rule out complications?

1. Chest X-ray

2. Ventilation-perfusion scan

3. Echocardiogram

4. Electrocardiogram

The correct answer is: Ventilation-perfusion scan

In the context of a pregnant woman presenting with acute shortness of breath and chest pain, the recommendation to perform a ventilation-perfusion (V/Q) scan is grounded in its ability to specifically evaluate for the risk of pulmonary embolism (PE), a serious condition that can manifest with such symptoms. The V/Q scan is particularly effective in this scenario as it assesses both the ventilation (airflow) and perfusion (blood flow) within the lungs. In pregnant patients, the risk of venous thromboembolism increases, making the evaluation for PE critical. The V/Q scan provides detailed images that help determine the probability of a PE and is regarded as safe during pregnancy, avoiding the more extensive radiation exposure associated with a CT pulmonary angiogram, which is typically the preferred imaging modality outside of pregnancy. While a chest X-ray or electrocardiogram could provide adjunctive information, they do not specifically target the diagnosis of a pulmonary embolism as effectively as a V/Q scan. Similarly, an echocardiogram is more suited for evaluating cardiac function and structure but does not focus directly on pulmonary vasculature, limiting its utility in this acute scenario involving suspected PE. Thus, the V/Q scan stands out as the most appropriate procedure in this