A student’s ability to answer this question correctly will be solely based on their familiarity with the Wells Score and the associated scoring system which determines the level of risk for pulmonary embolism.

Let’s explore each of the options:

Option 1 - Wheezing during physical activity 

Wheezing during physical activity is more suggestive of reactive airway disease or exercise-induced bronchospasm, not pulmonary embolism. 

While pulmonary embolism can cause shortness of breath, it typically does not present with audible wheezing, which is more characteristic of conditions like asthma or COPD. This symptom is not included in the Wells Score and would therefore not increase the clinical suspicion for pulmonary embolism.

Option 2 – Bilateral lower extremity swelling

While unilateral leg swelling with pain is associated with deep vein thrombosis, a major source of pulmonary embolism, bilateral swelling is not specific and is more often due to systemic causes like heart failure or fluid retention.

The Wells Score specifically includes clinical signs and symptoms of deep vein thrombosis as one of its criteria, which implies unilateral, not bilateral, findings.

Option 3 – Heart rate of 115 beats per minute

A heart rate over 100 beats per minute is one of the criteria considered with the Wells Score, contributing 1.5 points to the total score.

Tachycardia is a common physiological response to pulmonary embolism due to hypoxia and increased pulmonary vascular resistance. This finding, especially when combined with other clinical features, increases suspicion for pulmonary embolism and should prompt further investigation.

Option 4 – Productive cough with green sputum

Productive cough with green sputum is more typical of a respiratory infection, such as bronchitis or pneumonia, rather than pulmonary embolism.

While pulmonary embolism can cause coughing, it is typically dry or hemoptysis (bloody sputum), not productive with green sputum.

Wells Score Interpretation

< 2 points = Low Risk for PE
2-6 points = Moderate Risk for PE
> 6 points  = High Risk for PE

The scoring presented is representative of the original scoring system. There are several alternate versions of this tool that assign risk as likely or unlikely as well as an additional variation that assigns all predictive factors as only 1 point. 

The correct answer is Option 3.

Let’s explore the all student data:

5% of students selected Option 1 - Wheezing during physical activity
30% of students selected Option 2 - Bilateral lower extremity swelling
45% of students selected Option 3 - Heart rate of 115 beats per minute - the correct response
20% of students selected Option 4 - Productive cough with green sputum

System Classification
This question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content? Check out page 418 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!