— 降低風險 · HARD · MCQ —
護理師照護一位疑似肺栓塞的病人，預期醫師會開立何種黃金標準檢查以進行確診？
A nurse is caring for a client with a suspected pulmonary embolism. Which diagnostic test should the nurse anticipate as the gold standard for confirmation?
- AElectrocardiogram (ECG)心電圖 (ECG)
- BComputed tomography pulmonary angiography (CTPA)✓ 正解電腦斷層肺血管攝影 (CTPA)
- CD-dimer testD-二聚體檢測
- DChest X-ray胸部 X 光
— Explanation · 中文詳解 —
CTPA 是診斷肺栓塞的黃金標準，其能清楚呈現肺血管內的填充缺損。雖然 D-dimer 可作為篩檢工具，但其特異性低；胸部 X 光僅能排除其他原因；心電圖則用於評估右心受壓表現，皆無法作為診斷確診的首選。
CTPA is the gold standard for diagnosing pulmonary embolism, as it can clearly visualize filling defects within the pulmonary vessels. Although the D-dimer test can serve as a screening tool, it has low specificity; chest X-ray can only rule out other causes; and ECG is used to assess findings of right heart strain, none of which can serve as the first-line diagnostic confirmation.
✦ 台美臨床差異
兩地皆以 CTPA 為主，但台灣病人若腎功能不佳，替代檢查（如 V/Q scan）的臨床思維流程相似。