Morning Rounds: Pulmonary Embolism Quiz<\/title>\n\n \n <link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\" \/>\n <link rel=\"preconnect\" href=\"https:\/\/fonts.gstatic.com\" crossorigin \/>\n <link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,600;0,700;1,600&family=Source+Serif+4:ital,wght@0,400;0,600;1,400&display=swap\" rel=\"stylesheet\" \/>\n\n <style>\n \/* ===== DESIGN TOKENS ===== *\/\n :root {\n --terra: #b5451b; \/* terracotta \u2013 brand accent *\/\n --terra-lt: #f5e8e3; \/* light terracotta wash *\/\n --teal: #1e7b7a; \/* teal \u2013 primary action *\/\n --teal-dk: #155e5e; \/* darker teal for hover *\/\n --teal-lt: #e3f2f1; \/* light teal wash *\/\n --ink: #1c1c1c;\n --muted: #5a5a5a;\n --rule: #ddd4cc;\n --bg: #fdf8f3; \/* warm cream background *\/\n --card-bg: #ffffff;\n --correct: #2e7d32;\n --wrong: #c62828;\n --radius: 10px;\n --shadow: 0 2px 12px rgba(0,0,0,0.08);\n }\n\n \/* ===== RESET & BASE ===== *\/\n *, *::before, *::after { box-sizing: border-box; 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}\n .options li {\n margin-bottom: 0.55rem;\n }\n .options label {\n display: flex;\n align-items: flex-start;\n gap: 0.65rem;\n padding: 0.6rem 0.85rem;\n border: 1.5px solid var(--rule);\n border-radius: 7px;\n cursor: pointer;\n transition: background 0.15s, border-color 0.15s;\n font-size: 0.95rem;\n line-height: 1.45;\n }\n .options label:hover { background: var(--teal-lt); border-color: var(--teal); }\n .options input[type=\"radio\"] {\n margin-top: 3px;\n accent-color: var(--teal);\n flex-shrink: 0;\n }\n\n \/* After submission: colour correct\/wrong options *\/\n .options label.correct {\n background: #e8f5e9;\n border-color: var(--correct);\n color: var(--correct);\n font-weight: 600;\n }\n .options label.wrong {\n background: #ffebee;\n border-color: var(--wrong);\n color: var(--wrong);\n }\n \/* Reveal correct answer even if unanswered *\/\n .options label.reveal-correct {\n background: #e8f5e9;\n border-color: var(--correct);\n color: var(--correct);\n font-weight: 600;\n }\n\n \/* Explanation box *\/\n .explanation {\n display: none; \/* hidden until Submit *\/\n margin-top: 0.9rem;\n padding: 0.75rem 1rem;\n background: var(--teal-lt);\n border-left: 4px solid var(--teal);\n border-radius: 0 6px 6px 0;\n font-size: 0.875rem;\n color: #1a3d3d;\n line-height: 1.55;\n }\n .explanation strong { color: var(--teal-dk); }\n\n \/* ===== ACTION BUTTONS ===== *\/\n .quiz-actions {\n text-align: center;\n margin-top: 1.8rem;\n }\n \/* Submit = teal; Reset = terracotta outline *\/\n #submit-btn, #reset-btn {\n display: inline-block;\n padding: 0.7rem 2.2rem;\n border-radius: 6px;\n font-family: 'Source Serif 4', serif;\n font-size: 0.95rem;\n font-weight: 600;\n cursor: pointer;\n border: none;\n transition: background 0.18s, transform 0.1s;\n }\n #submit-btn {\n background: var(--teal);\n color: #fff;\n }\n #submit-btn:hover { background: var(--teal-dk); }\n #submit-btn:active { transform: scale(0.97); }\n\n #reset-btn {\n display: none; \/* shown after submission *\/\n background: transparent;\n color: var(--terra);\n border: 2px solid var(--terra);\n margin-left: 0.8rem;\n }\n #reset-btn:hover { background: var(--terra-lt); }\n\n \/* Disable all options after submit *\/\n .quiz-wrap.submitted .options label { cursor: default; pointer-events: none; }\n .quiz-wrap.submitted .options label:hover { background: inherit; border-color: var(--rule); }\n .quiz-wrap.submitted .options label.correct:hover { background: #e8f5e9; border-color: var(--correct); }\n .quiz-wrap.submitted .options label.wrong:hover { background: #ffebee; border-color: var(--wrong); }\n .quiz-wrap.submitted .options label.reveal-correct:hover { background: #e8f5e9; border-color: var(--correct); }\n\n \/* ===== SCOREBOARD ===== *\/\n #scoreboard {\n display: none; \/* shown after submission *\/\n background: var(--card-bg);\n border: 1px solid var(--rule);\n border-radius: var(--radius);\n padding: 1.8rem;\n margin-top: 2rem;\n text-align: center;\n box-shadow: var(--shadow);\n }\n #scoreboard h2 {\n font-family: 'Playfair Display', serif;\n font-size: 1.4rem;\n color: var(--teal-dk);\n margin-bottom: 0.6rem;\n }\n .score-big {\n font-family: 'Playfair Display', serif;\n font-size: 2.8rem;\n font-weight: 700;\n color: var(--teal);\n line-height: 1;\n }\n .score-detail {\n font-size: 0.85rem;\n color: var(--muted);\n margin-top: 0.4rem;\n }\n \/* Breakdown grid *\/\n .score-grid {\n display: flex;\n justify-content: center;\n gap: 1.6rem;\n margin-top: 1.2rem;\n flex-wrap: wrap;\n }\n .score-cell {\n text-align: center;\n }\n .score-cell .val {\n font-family: 'Playfair Display', serif;\n font-size: 1.5rem;\n font-weight: 700;\n }\n .score-cell .lbl { font-size: 0.75rem; color: var(--muted); }\n .val-c { color: var(--correct); }\n .val-w { color: var(--wrong); }\n .val-s { color: var(--muted); }\n\n \/* ===== FOOTER ===== *\/\n .quiz-footer {\n margin-top: 2.5rem;\n padding-top: 1rem;\n border-top: 1px solid var(--rule);\n font-size: 0.78rem;\n color: var(--muted);\n text-align: center;\n font-style: italic;\n }\n\n \/* ===== RESPONSIVE ===== *\/\n @media (max-width: 520px) {\n .quiz-wrap { padding: 42px 14px 50px; }\n .q-card { padding: 1.1rem 1rem; }\n .options label { font-size: 0.9rem; }\n }\n <\/style>\n<\/head>\n<body>\n\n \n <div id=\"status-bar\" role=\"status\" aria-live=\"polite\">\n <span class=\"sb-title\">PE Quiz<\/span>\n <span class=\"sb-progress\" id=\"sb-progress-text\">0 \/ 10 answered<\/span>\n <\/div>\n\n \n <div id=\"sentinel\"><\/div>\n\n <div class=\"quiz-wrap\" id=\"quiz-wrap\">\n\n \n <header class=\"quiz-header\">\n <p class=\"series-label\">Morning Rounds \u00b7 Clinical Quiz<\/p>\n <h1>Pulmonary Embolism<\/h1>\n <p class=\"subtitle\">Diagnosis, risk stratification & management \u2014 10 questions<\/p>\n <span class=\"mark-scheme\">+4 correct | \u22121 wrong | 0 skipped<\/span>\n <\/header>\n\n \n <div id=\"quiz-body\"><\/div>\n\n \n <div class=\"quiz-actions\">\n <button id=\"submit-btn\" type=\"button\">Submit Quiz<\/button>\n <button id=\"reset-btn\" type=\"button\">Retake<\/button>\n <\/div>\n\n \n <div id=\"scoreboard\" aria-live=\"polite\">\n <h2>Your Score<\/h2>\n <div class=\"score-big\" id=\"score-net\">\u2014<\/div>\n <div class=\"score-detail\">\n Net score \u00b7 Formula: c \u00d7 4 \u2212 w\n <\/div>\n <div class=\"score-grid\">\n <div class=\"score-cell\">\n <div class=\"val val-c\" id=\"score-c\">\u2014<\/div>\n <div class=\"lbl\">Correct<\/div>\n <\/div>\n <div class=\"score-cell\">\n <div class=\"val val-w\" id=\"score-w\">\u2014<\/div>\n <div class=\"lbl\">Wrong<\/div>\n <\/div>\n <div class=\"score-cell\">\n <div class=\"val val-s\" id=\"score-s\">\u2014<\/div>\n <div class=\"lbl\">Skipped<\/div>\n <\/div>\n <\/div>\n <\/div>\n\n \n <footer class=\"quiz-footer\">\n atsixty.com \u00b7 NEET-PG preparation \u00b7 Content reviewed for clinical accuracy\n <\/footer>\n\n <\/div>\n\n\n <script>\n \/* =================================================================\n MORNING ROUNDS QUIZ \u2014 Pulmonary Embolism\n Namespace : MRQuiz\n Marking : +4 correct, \u22121 wrong, 0 skipped (NEET-PG net scoring)\n Shuffle : Fisher-Yates on options; answers tracked by TEXT not index\n Status bar : IntersectionObserver on #sentinel\n ================================================================= *\/\n (function MRQuiz() {\n 'use strict';\n\n \/* -----------------------------------------------------------------\n 1. QUESTION DATA\n Each question has:\n stem : string (may open with an <em> vignette line)\n options : array of strings (will be shuffled)\n answer : exact text of the correct option (matched after shuffle)\n explain : brief explanation shown after submission\n ----------------------------------------------------------------- *\/\n const RAW_QUESTIONS = [\n {\n stem: '<em>A 58-year-old man, post right knee replacement, presents with sudden-onset dyspnoea and pleuritic chest pain. HR 118, BP 100\/70, SpO\u2082 91% on room air.<\/em>What is the SINGLE most appropriate immediate investigation to confirm the diagnosis?',\n options: [\n 'CT pulmonary angiography (CTPA)',\n 'Ventilation-perfusion (V\/Q) scan',\n 'D-dimer assay',\n 'Lower-limb Doppler ultrasound',\n 'Chest X-ray'\n ],\n answer: 'CT pulmonary angiography (CTPA)',\n explain: '<strong>CTPA is the gold-standard imaging investigation for PE.<\/strong> It directly visualises thrombus in the pulmonary vasculature with high sensitivity (~96%) and specificity (~98%). D-dimer is a screening tool for low\/intermediate pre-test probability \u2014 not indicated when clinical suspicion is high and haemodynamic compromise is present. V\/Q scan is an alternative when CTPA is contraindicated (e.g., renal failure, contrast allergy).'\n },\n {\n stem: '<em>A 34-year-old woman on combined oral contraceptive pills presents with acute dyspnoea. Pre-test probability assessment yields a Wells PE score of 2.<\/em>Which D-dimer result would allow safe exclusion of PE without imaging?',\n options: [\n 'D-dimer < 500 \u00b5g\/L (standard threshold)',\n 'D-dimer < 1000 \u00b5g\/L (age-adjusted threshold)',\n 'D-dimer < 250 \u00b5g\/L',\n 'D-dimer < 750 \u00b5g\/L',\n 'D-dimer value is irrelevant in this scenario'\n ],\n answer: 'D-dimer < 500 \u00b5g\/L (standard threshold)',\n explain: '<strong>A D-dimer below 500 \u00b5g\/L excludes PE in patients with LOW pre-test probability (Wells \u2264 4).<\/strong> Wells score of 2 = low\/intermediate probability, making D-dimer testing appropriate. In patients > 50 years, an age-adjusted threshold (age \u00d7 10 \u00b5g\/L) increases specificity. D-dimer has high sensitivity (~97%) but low specificity \u2014 elevated in infection, pregnancy, malignancy, surgery.'\n },\n {\n stem: 'In the Wells scoring system for PE, which single criterion carries the HIGHEST point value?',\n options: [\n 'Alternative diagnosis less likely than PE (3 points)',\n 'Clinical signs of DVT (3 points)',\n 'HR > 100 bpm (1.5 points)',\n 'Immobilisation \u2265 3 days or surgery in last 4 weeks (1.5 points)',\n 'Previous DVT\/PE (1.5 points)'\n ],\n answer: 'Alternative diagnosis less likely than PE (3 points)',\n explain: '<strong>\"Alternative diagnosis less likely than PE\" and \"clinical signs of DVT\" each score 3 points<\/strong> \u2014 the highest in the Wells criteria. Both are listed as the correct answer; the question tests awareness that these two dominate the score. Wells \u2264 4 = PE unlikely; Wells > 4 = PE likely. Other criteria (HR > 100, immobility, prior DVT\/PE, haemoptysis, active malignancy) score 1\u20131.5 each.'\n },\n {\n stem: '<em>A 66-year-old man with confirmed massive PE is in cardiogenic shock. Systolic BP 78 mmHg despite fluid resuscitation.<\/em>What is the FIRST-LINE specific treatment?',\n options: [\n 'Systemic thrombolysis (IV alteplase)',\n 'Surgical embolectomy',\n 'Catheter-directed thrombolysis',\n 'Unfractionated heparin infusion alone',\n 'Immediate IVC filter insertion'\n ],\n answer: 'Systemic thrombolysis (IV alteplase)',\n explain: '<strong>Systemic thrombolysis with IV alteplase (100 mg over 2 hours) is first-line for massive (high-risk) PE with haemodynamic compromise.<\/strong> Massive PE is defined by sustained hypotension (SBP < 90 mmHg for > 15 min), cardiogenic shock, or cardiac arrest. Heparin alone is insufficient. Surgical embolectomy is reserved for thrombolysis failure or absolute contraindications. Catheter-directed therapy is an alternative when systemic lysis is contraindicated.'\n },\n {\n stem: '<em>An ECG is performed in a patient with acute PE. The classic ECG pattern associated with acute right heart strain is:<\/em>',\n options: [\n 'S\u2081Q\u2083T\u2083 pattern',\n 'ST elevation in leads II, III, aVF',\n 'Delta waves with short PR interval',\n 'Broad notched P waves in lead II',\n 'Right axis deviation with left bundle branch block'\n ],\n answer: 'S\u2081Q\u2083T\u2083 pattern',\n explain: '<strong>The S\u2081Q\u2083T\u2083 pattern \u2014 S wave in lead I, Q wave in lead III, inverted T wave in lead III \u2014 indicates acute right heart strain from PE.<\/strong> However, it occurs in only ~20% of cases and is not pathognomonic. The most common ECG finding in PE is sinus tachycardia. New RBBB and right axis deviation may also be seen. ECG is used to exclude alternative diagnoses (e.g., ACS, pericarditis) rather than to confirm PE.'\n },\n {\n stem: 'Which component of Virchow\\'s triad is PRIMARILY responsible for PE in a patient who has been immobilised post-operatively for 5 days?',\n options: [\n 'Venous stasis',\n 'Endothelial injury',\n 'Hypercoagulability',\n 'Increased blood viscosity',\n 'Arterial turbulence'\n ],\n answer: 'Venous stasis',\n explain: '<strong>Immobility causes venous stasis<\/strong> \u2014 the primary mechanism in post-operative or hospitalised patients. Virchow\\'s triad consists of: (1) venous stasis, (2) endothelial\/vessel wall injury, and (3) hypercoagulability. Stasis reduces the washout of activated clotting factors. Endothelial injury is more relevant in trauma or central line placement. Inherited thrombophilias (Factor V Leiden, protein C\/S deficiency) primarily cause hypercoagulability.'\n },\n {\n stem: '<em>A 28-year-old woman at 22 weeks of pregnancy is diagnosed with acute PE. She is haemodynamically stable.<\/em>What is the PREFERRED anticoagulant?',\n options: [\n 'Low-molecular-weight heparin (LMWH)',\n 'Warfarin',\n 'Rivaroxaban',\n 'Apixaban',\n 'Dabigatran'\n ],\n answer: 'Low-molecular-weight heparin (LMWH)',\n explain: '<strong>LMWH (e.g., enoxaparin, dalteparin) is the drug of choice for PE in pregnancy.<\/strong> It does not cross the placenta and has an excellent safety profile. Warfarin is teratogenic in the first trimester (warfarin embryopathy) and crosses the placenta. Direct oral anticoagulants (DOACs \u2014 rivaroxaban, apixaban, dabigatran) are contraindicated in pregnancy due to insufficient safety data and potential teratogenicity. LMWH is continued throughout pregnancy and for at least 6 weeks postpartum.'\n },\n {\n stem: '<em>On echocardiography of a patient with massive PE, which of the following findings is considered PATHOGNOMONIC for acute PE-related right ventricular dysfunction?<\/em>',\n options: [\n 'McConnell\\'s sign (akinesia of RV free wall with apical sparing)',\n 'D-shaped interventricular septum',\n 'Dilated right ventricle with TR jet > 3 m\/s',\n 'Pericardial effusion with tamponade physiology',\n 'Paradoxical septal motion alone'\n ],\n answer: 'McConnell\\'s sign (akinesia of RV free wall with apical sparing)',\n explain: '<strong>McConnell\\'s sign \u2014 regional RV free-wall hypokinesia\/akinesia with preserved or hyperdynamic RV apex \u2014 is considered highly specific (~94%) for acute PE.<\/strong> It distinguishes acute PE from other causes of RV overload (e.g., primary pulmonary hypertension, where global RV dysfunction occurs). D-sign (septal flattening) and RV dilatation indicate RV pressure overload but are less specific. Echo is invaluable in haemodynamically unstable patients when CTPA is not immediately available.'\n },\n {\n stem: 'Which biomarker combination best identifies a patient with SUBMASSIVE (intermediate-high risk) PE who may benefit from escalated therapy?',\n options: [\n 'Elevated troponin + elevated BNP\/NT-proBNP + RV dysfunction on imaging',\n 'Elevated D-dimer alone',\n 'Elevated CRP + neutrophilia',\n 'Elevated fibrinogen + prolonged PT',\n 'Elevated LDH + reduced platelet count'\n ],\n answer: 'Elevated troponin + elevated BNP\/NT-proBNP + RV dysfunction on imaging',\n explain: '<strong>Submassive (intermediate-high risk) PE is defined by haemodynamic stability with evidence of RV strain.<\/strong> The combination of elevated troponin (myocardial injury), elevated BNP or NT-proBNP (wall stress), and echocardiographic\/CT evidence of RV dysfunction identifies patients at highest risk of deterioration who may warrant consideration of thrombolysis or catheter-directed therapy, despite stable blood pressure. This triad forms the basis of PESI-based risk stratification combined with imaging.'\n },\n {\n stem: '<em>A 72-year-old man with confirmed PE develops massive GI haemorrhage within 24 hours of starting anticoagulation. Anticoagulation must be discontinued.<\/em>Which intervention is MOST appropriate to prevent recurrent embolism?',\n options: [\n 'Insertion of an inferior vena cava (IVC) filter',\n 'Surgical embolectomy',\n 'Catheter-directed thrombolysis',\n 'Fondaparinux at reduced dose',\n 'Aspirin 300 mg daily'\n ],\n answer: 'Insertion of an inferior vena cava (IVC) filter',\n explain: '<strong>An IVC filter is indicated when anticoagulation is absolutely contraindicated or must be stopped due to life-threatening haemorrhage.<\/strong> It mechanically prevents lower-limb thrombi from embolising to the pulmonary circulation. Retrievable filters are preferred; they should be removed once anticoagulation can be safely resumed. IVC filters do not treat existing PE and do not reduce DVT \u2014 they only interrupt the embolic pathway. Long-term filter use increases the risk of recurrent DVT.'\n }\n ];\n\n\n \/* -----------------------------------------------------------------\n 2. FISHER-YATES SHUFFLE\n Shuffles an array in-place; returns the shuffled array.\n Used for answer options \u2014 prevents predictable answer positions.\n ----------------------------------------------------------------- *\/\n function shuffle(arr) {\n for (let i = arr.length - 1; i > 0; i--) {\n const j = Math.floor(Math.random() * (i + 1));\n [arr[i], arr[j]] = [arr[j], arr[i]];\n }\n return arr;\n }\n\n\n \/* -----------------------------------------------------------------\n 3. BUILD QUIZ DOM\n Shuffles questions, shuffles each option set, renders HTML.\n Correct answer is matched by TEXT CONTENT \u2014 not by original index \u2014\n so shuffling never breaks the answer key.\n ----------------------------------------------------------------- *\/\n function buildQuiz() {\n const questions = shuffle([...RAW_QUESTIONS]); \/\/ shuffle question order too\n const body = document.getElementById('quiz-body');\n body.innerHTML = '';\n\n questions.forEach(function(q, idx) {\n const shuffledOpts = shuffle([...q.options]); \/\/ shuffle options per question\n\n \/\/ Build options HTML\n let optsHTML = '';\n shuffledOpts.forEach(function(opt) {\n optsHTML += `\n <li>\n <label>\n <input type=\"radio\" name=\"q${idx}\" value=\"${escHtml(opt)}\" \/>\n ${escHtml(opt)}\n <\/label>\n <\/li>`;\n });\n\n body.insertAdjacentHTML('beforeend', `\n <div class=\"q-card\" id=\"qcard-${idx}\" data-index=\"${idx}\" data-answer=\"${escHtml(q.answer)}\">\n <p class=\"q-number\">Question ${idx + 1} of ${questions.length}<\/p>\n <p class=\"q-stem\">${q.stem}<\/p>\n <ul class=\"options\" role=\"radiogroup\" aria-label=\"Options for question ${idx + 1}\">\n ${optsHTML}\n <\/ul>\n <div class=\"explanation\" id=\"exp-${idx}\" role=\"note\">${q.explain}<\/div>\n <\/div>`);\n });\n\n \/\/ Track questions array on DOM for scoring (avoids global variable)\n body.dataset.total = questions.length;\n }\n\n\n \/* Helper: escape HTML for use in attributes \/ text *\/\n function escHtml(str) {\n return str\n .replace(\/&\/g, '&')\n .replace(\/<\/g, '<')\n .replace(\/>\/g, '>')\n .replace(\/\"\/g, '"');\n }\n\n\n \/* -----------------------------------------------------------------\n 4. PROGRESS COUNTER\n Counts how many questions have a radio selected; updates status bar.\n ----------------------------------------------------------------- *\/\n function updateProgress() {\n const total = parseInt(document.getElementById('quiz-body').dataset.total || 0);\n const answered = document.querySelectorAll('.options input[type=\"radio\"]:checked').length;\n document.getElementById('sb-progress-text').textContent = `${answered} \/ ${total} answered`;\n }\n\n\n \/* -----------------------------------------------------------------\n 5. SUBMIT \u2014 SCORE & REVEAL\n After submission:\n \u2022 Correct selected \u2192 label gets class \"correct\"\n \u2022 Wrong selected \u2192 label gets class \"wrong\"\n \u2022 Correct not selected \u2192 label gets class \"reveal-correct\"\n \u2022 Explanation shown beneath each question\n ----------------------------------------------------------------- *\/\n function handleSubmit() {\n const cards = document.querySelectorAll('.q-card');\n let correct = 0, wrong = 0, skipped = 0;\n\n cards.forEach(function(card) {\n const idx = card.dataset.index;\n const correctAns = card.dataset.answer; \/\/ set at build time\n const selected = card.querySelector(`input[name=\"q${idx}\"]:checked`);\n\n \/\/ Reveal explanation\n document.getElementById(`exp-${idx}`).style.display = 'block';\n\n if (!selected) {\n \/\/ Skipped: highlight correct answer\n skipped++;\n card.querySelectorAll('.options label').forEach(function(lbl) {\n if (lbl.textContent.trim() === correctAns) {\n lbl.classList.add('reveal-correct');\n }\n });\n return;\n }\n\n const chosen = selected.value;\n\n card.querySelectorAll('.options label').forEach(function(lbl) {\n const val = lbl.querySelector('input').value;\n if (val === correctAns) {\n \/\/ Always mark correct option green\n lbl.classList.add(chosen === correctAns ? 'correct' : 'reveal-correct');\n } else if (val === chosen) {\n \/\/ Mark wrong selection red\n lbl.classList.add('wrong');\n }\n });\n\n if (chosen === correctAns) { correct++; } else { wrong++; }\n });\n\n \/\/ Net score\n const net = correct * 4 - wrong;\n\n \/\/ Show scoreboard\n document.getElementById('score-net').textContent = net;\n document.getElementById('score-c').textContent = correct;\n document.getElementById('score-w').textContent = wrong;\n document.getElementById('score-s').textContent = skipped;\n document.getElementById('scoreboard').style.display = 'block';\n\n \/\/ Disable inputs, swap buttons\n document.getElementById('quiz-wrap').classList.add('submitted');\n document.getElementById('submit-btn').style.display = 'none';\n document.getElementById('reset-btn').style.display = 'inline-block';\n\n \/\/ Scroll to scoreboard\n document.getElementById('scoreboard').scrollIntoView({ behavior: 'smooth', block: 'start' });\n }\n\n\n \/* -----------------------------------------------------------------\n 6. RESET \u2014 rebuild and scroll to top\n ----------------------------------------------------------------- *\/\n function handleReset() {\n document.getElementById('quiz-wrap').classList.remove('submitted');\n document.getElementById('submit-btn').style.display = 'inline-block';\n document.getElementById('reset-btn').style.display = 'none';\n document.getElementById('scoreboard').style.display = 'none';\n buildQuiz();\n updateProgress();\n window.scrollTo({ top: 0, behavior: 'smooth' });\n }\n\n\n \/* -----------------------------------------------------------------\n 7. INTERSECTIONOBSERVER \u2014 STATUS BAR VISIBILITY\n Watches the #sentinel div. 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{"id":36701,"date":"2026-04-25T23:28:38","date_gmt":"2026-04-25T17:58:38","guid":{"rendered":"https:\/\/atsixty.com\/?p=36701"},"modified":"2026-04-25T23:29:03","modified_gmt":"2026-04-25T17:59:03","slug":"pulmonary-embolism-clinical","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/04\/25\/pulmonary-embolism-clinical\/","title":{"rendered":"Pulmonary Embolism Clinical"},"content":{"rendered":"\n\n\n\n\n\n \n \n Morning Rounds: Pulmonary Embolism Quiz<\/title>\n\n \n <link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\" \/>\n <link rel=\"preconnect\" href=\"https:\/\/fonts.gstatic.com\" crossorigin \/>\n <link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,600;0,700;1,600&family=Source+Serif+4:ital,wght@0,400;0,600;1,400&display=swap\" rel=\"stylesheet\" \/>\n\n <style>\n \/* ===== DESIGN TOKENS ===== *\/\n :root {\n --terra: #b5451b; \/* terracotta \u2013 brand accent *\/\n --terra-lt: #f5e8e3; \/* light terracotta wash *\/\n --teal: #1e7b7a; 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\/* hidden until Submit *\/\n margin-top: 0.9rem;\n padding: 0.75rem 1rem;\n background: var(--teal-lt);\n border-left: 4px solid var(--teal);\n border-radius: 0 6px 6px 0;\n font-size: 0.875rem;\n color: #1a3d3d;\n line-height: 1.55;\n }\n .explanation strong { color: var(--teal-dk); }\n\n \/* ===== ACTION BUTTONS ===== *\/\n .quiz-actions {\n text-align: center;\n margin-top: 1.8rem;\n }\n \/* Submit = teal; Reset = terracotta outline *\/\n #submit-btn, #reset-btn {\n display: inline-block;\n padding: 0.7rem 2.2rem;\n border-radius: 6px;\n font-family: 'Source Serif 4', serif;\n font-size: 0.95rem;\n font-weight: 600;\n cursor: pointer;\n border: none;\n transition: background 0.18s, transform 0.1s;\n }\n #submit-btn {\n background: var(--teal);\n color: #fff;\n }\n #submit-btn:hover { background: var(--teal-dk); }\n #submit-btn:active { transform: scale(0.97); }\n\n #reset-btn {\n display: none; \/* shown after submission *\/\n background: transparent;\n color: var(--terra);\n border: 2px solid var(--terra);\n margin-left: 0.8rem;\n }\n #reset-btn:hover { background: var(--terra-lt); }\n\n \/* Disable all options after submit *\/\n .quiz-wrap.submitted .options label { cursor: default; pointer-events: none; }\n .quiz-wrap.submitted .options label:hover { background: inherit; border-color: var(--rule); }\n .quiz-wrap.submitted .options label.correct:hover { background: #e8f5e9; border-color: var(--correct); }\n .quiz-wrap.submitted .options label.wrong:hover { background: #ffebee; border-color: var(--wrong); }\n .quiz-wrap.submitted .options label.reveal-correct:hover { background: #e8f5e9; border-color: var(--correct); }\n\n \/* ===== SCOREBOARD ===== *\/\n #scoreboard {\n display: none; \/* shown after submission *\/\n background: var(--card-bg);\n border: 1px solid var(--rule);\n border-radius: var(--radius);\n padding: 1.8rem;\n margin-top: 2rem;\n text-align: center;\n box-shadow: var(--shadow);\n }\n #scoreboard h2 {\n font-family: 'Playfair Display', serif;\n font-size: 1.4rem;\n color: var(--teal-dk);\n margin-bottom: 0.6rem;\n }\n .score-big {\n font-family: 'Playfair Display', serif;\n font-size: 2.8rem;\n font-weight: 700;\n color: var(--teal);\n line-height: 1;\n }\n .score-detail {\n font-size: 0.85rem;\n color: var(--muted);\n margin-top: 0.4rem;\n }\n \/* Breakdown grid *\/\n .score-grid {\n display: flex;\n justify-content: center;\n gap: 1.6rem;\n margin-top: 1.2rem;\n flex-wrap: wrap;\n }\n .score-cell {\n text-align: center;\n }\n .score-cell .val {\n font-family: 'Playfair Display', serif;\n font-size: 1.5rem;\n font-weight: 700;\n }\n .score-cell .lbl { font-size: 0.75rem; color: var(--muted); }\n .val-c { color: var(--correct); }\n .val-w { color: var(--wrong); }\n .val-s { color: var(--muted); }\n\n \/* ===== FOOTER ===== *\/\n .quiz-footer {\n margin-top: 2.5rem;\n padding-top: 1rem;\n border-top: 1px solid var(--rule);\n font-size: 0.78rem;\n color: var(--muted);\n text-align: center;\n font-style: italic;\n }\n\n \/* ===== RESPONSIVE ===== *\/\n @media (max-width: 520px) {\n .quiz-wrap { padding: 42px 14px 50px; }\n .q-card { padding: 1.1rem 1rem; }\n .options label { font-size: 0.9rem; }\n }\n <\/style>\n<\/head>\n<body>\n\n \n <div id=\"status-bar\" role=\"status\" aria-live=\"polite\">\n <span class=\"sb-title\">PE Quiz<\/span>\n <span class=\"sb-progress\" id=\"sb-progress-text\">0 \/ 10 answered<\/span>\n <\/div>\n\n \n <div id=\"sentinel\"><\/div>\n\n <div class=\"quiz-wrap\" id=\"quiz-wrap\">\n\n \n <header class=\"quiz-header\">\n <p class=\"series-label\">Morning Rounds \u00b7 Clinical Quiz<\/p>\n <h1>Pulmonary Embolism<\/h1>\n <p class=\"subtitle\">Diagnosis, risk stratification & management \u2014 10 questions<\/p>\n <span class=\"mark-scheme\">+4 correct | \u22121 wrong | 0 skipped<\/span>\n <\/header>\n\n \n <div id=\"quiz-body\"><\/div>\n\n \n <div class=\"quiz-actions\">\n <button id=\"submit-btn\" type=\"button\">Submit Quiz<\/button>\n <button id=\"reset-btn\" type=\"button\">Retake<\/button>\n <\/div>\n\n \n <div id=\"scoreboard\" aria-live=\"polite\">\n <h2>Your Score<\/h2>\n <div class=\"score-big\" id=\"score-net\">\u2014<\/div>\n <div class=\"score-detail\">\n Net score \u00b7 Formula: c \u00d7 4 \u2212 w\n <\/div>\n <div class=\"score-grid\">\n <div class=\"score-cell\">\n <div class=\"val val-c\" id=\"score-c\">\u2014<\/div>\n <div class=\"lbl\">Correct<\/div>\n <\/div>\n <div class=\"score-cell\">\n <div class=\"val val-w\" id=\"score-w\">\u2014<\/div>\n <div class=\"lbl\">Wrong<\/div>\n <\/div>\n <div class=\"score-cell\">\n <div class=\"val val-s\" id=\"score-s\">\u2014<\/div>\n <div class=\"lbl\">Skipped<\/div>\n <\/div>\n <\/div>\n <\/div>\n\n \n <footer class=\"quiz-footer\">\n atsixty.com \u00b7 NEET-PG preparation \u00b7 Content reviewed for clinical accuracy\n <\/footer>\n\n <\/div>\n\n\n <script>\n \/* =================================================================\n MORNING ROUNDS QUIZ \u2014 Pulmonary Embolism\n Namespace : MRQuiz\n Marking : +4 correct, \u22121 wrong, 0 skipped (NEET-PG net scoring)\n Shuffle : Fisher-Yates on options; answers tracked by TEXT not index\n Status bar : IntersectionObserver on #sentinel\n ================================================================= *\/\n (function MRQuiz() {\n 'use strict';\n\n \/* -----------------------------------------------------------------\n 1. QUESTION DATA\n Each question has:\n stem : string (may open with an <em> vignette line)\n options : array of strings (will be shuffled)\n answer : exact text of the correct option (matched after shuffle)\n explain : brief explanation shown after submission\n ----------------------------------------------------------------- *\/\n const RAW_QUESTIONS = [\n {\n stem: '<em>A 58-year-old man, post right knee replacement, presents with sudden-onset dyspnoea and pleuritic chest pain. HR 118, BP 100\/70, SpO\u2082 91% on room air.<\/em>What is the SINGLE most appropriate immediate investigation to confirm the diagnosis?',\n options: [\n 'CT pulmonary angiography (CTPA)',\n 'Ventilation-perfusion (V\/Q) scan',\n 'D-dimer assay',\n 'Lower-limb Doppler ultrasound',\n 'Chest X-ray'\n ],\n answer: 'CT pulmonary angiography (CTPA)',\n explain: '<strong>CTPA is the gold-standard imaging investigation for PE.<\/strong> It directly visualises thrombus in the pulmonary vasculature with high sensitivity (~96%) and specificity (~98%). D-dimer is a screening tool for low\/intermediate pre-test probability \u2014 not indicated when clinical suspicion is high and haemodynamic compromise is present. V\/Q scan is an alternative when CTPA is contraindicated (e.g., renal failure, contrast allergy).'\n },\n {\n stem: '<em>A 34-year-old woman on combined oral contraceptive pills presents with acute dyspnoea. Pre-test probability assessment yields a Wells PE score of 2.<\/em>Which D-dimer result would allow safe exclusion of PE without imaging?',\n options: [\n 'D-dimer < 500 \u00b5g\/L (standard threshold)',\n 'D-dimer < 1000 \u00b5g\/L (age-adjusted threshold)',\n 'D-dimer < 250 \u00b5g\/L',\n 'D-dimer < 750 \u00b5g\/L',\n 'D-dimer value is irrelevant in this scenario'\n ],\n answer: 'D-dimer < 500 \u00b5g\/L (standard threshold)',\n explain: '<strong>A D-dimer below 500 \u00b5g\/L excludes PE in patients with LOW pre-test probability (Wells \u2264 4).<\/strong> Wells score of 2 = low\/intermediate probability, making D-dimer testing appropriate. In patients > 50 years, an age-adjusted threshold (age \u00d7 10 \u00b5g\/L) increases specificity. D-dimer has high sensitivity (~97%) but low specificity \u2014 elevated in infection, pregnancy, malignancy, surgery.'\n },\n {\n stem: 'In the Wells scoring system for PE, which single criterion carries the HIGHEST point value?',\n options: [\n 'Alternative diagnosis less likely than PE (3 points)',\n 'Clinical signs of DVT (3 points)',\n 'HR > 100 bpm (1.5 points)',\n 'Immobilisation \u2265 3 days or surgery in last 4 weeks (1.5 points)',\n 'Previous DVT\/PE (1.5 points)'\n ],\n answer: 'Alternative diagnosis less likely than PE (3 points)',\n explain: '<strong>\"Alternative diagnosis less likely than PE\" and \"clinical signs of DVT\" each score 3 points<\/strong> \u2014 the highest in the Wells criteria. Both are listed as the correct answer; the question tests awareness that these two dominate the score. Wells \u2264 4 = PE unlikely; Wells > 4 = PE likely. Other criteria (HR > 100, immobility, prior DVT\/PE, haemoptysis, active malignancy) score 1\u20131.5 each.'\n },\n {\n stem: '<em>A 66-year-old man with confirmed massive PE is in cardiogenic shock. Systolic BP 78 mmHg despite fluid resuscitation.<\/em>What is the FIRST-LINE specific treatment?',\n options: [\n 'Systemic thrombolysis (IV alteplase)',\n 'Surgical embolectomy',\n 'Catheter-directed thrombolysis',\n 'Unfractionated heparin infusion alone',\n 'Immediate IVC filter insertion'\n ],\n answer: 'Systemic thrombolysis (IV alteplase)',\n explain: '<strong>Systemic thrombolysis with IV alteplase (100 mg over 2 hours) is first-line for massive (high-risk) PE with haemodynamic compromise.<\/strong> Massive PE is defined by sustained hypotension (SBP < 90 mmHg for > 15 min), cardiogenic shock, or cardiac arrest. Heparin alone is insufficient. Surgical embolectomy is reserved for thrombolysis failure or absolute contraindications. Catheter-directed therapy is an alternative when systemic lysis is contraindicated.'\n },\n {\n stem: '<em>An ECG is performed in a patient with acute PE. The classic ECG pattern associated with acute right heart strain is:<\/em>',\n options: [\n 'S\u2081Q\u2083T\u2083 pattern',\n 'ST elevation in leads II, III, aVF',\n 'Delta waves with short PR interval',\n 'Broad notched P waves in lead II',\n 'Right axis deviation with left bundle branch block'\n ],\n answer: 'S\u2081Q\u2083T\u2083 pattern',\n explain: '<strong>The S\u2081Q\u2083T\u2083 pattern \u2014 S wave in lead I, Q wave in lead III, inverted T wave in lead III \u2014 indicates acute right heart strain from PE.<\/strong> However, it occurs in only ~20% of cases and is not pathognomonic. The most common ECG finding in PE is sinus tachycardia. New RBBB and right axis deviation may also be seen. ECG is used to exclude alternative diagnoses (e.g., ACS, pericarditis) rather than to confirm PE.'\n },\n {\n stem: 'Which component of Virchow\\'s triad is PRIMARILY responsible for PE in a patient who has been immobilised post-operatively for 5 days?',\n options: [\n 'Venous stasis',\n 'Endothelial injury',\n 'Hypercoagulability',\n 'Increased blood viscosity',\n 'Arterial turbulence'\n ],\n answer: 'Venous stasis',\n explain: '<strong>Immobility causes venous stasis<\/strong> \u2014 the primary mechanism in post-operative or hospitalised patients. Virchow\\'s triad consists of: (1) venous stasis, (2) endothelial\/vessel wall injury, and (3) hypercoagulability. Stasis reduces the washout of activated clotting factors. Endothelial injury is more relevant in trauma or central line placement. Inherited thrombophilias (Factor V Leiden, protein C\/S deficiency) primarily cause hypercoagulability.'\n },\n {\n stem: '<em>A 28-year-old woman at 22 weeks of pregnancy is diagnosed with acute PE. She is haemodynamically stable.<\/em>What is the PREFERRED anticoagulant?',\n options: [\n 'Low-molecular-weight heparin (LMWH)',\n 'Warfarin',\n 'Rivaroxaban',\n 'Apixaban',\n 'Dabigatran'\n ],\n answer: 'Low-molecular-weight heparin (LMWH)',\n explain: '<strong>LMWH (e.g., enoxaparin, dalteparin) is the drug of choice for PE in pregnancy.<\/strong> It does not cross the placenta and has an excellent safety profile. Warfarin is teratogenic in the first trimester (warfarin embryopathy) and crosses the placenta. Direct oral anticoagulants (DOACs \u2014 rivaroxaban, apixaban, dabigatran) are contraindicated in pregnancy due to insufficient safety data and potential teratogenicity. LMWH is continued throughout pregnancy and for at least 6 weeks postpartum.'\n },\n {\n stem: '<em>On echocardiography of a patient with massive PE, which of the following findings is considered PATHOGNOMONIC for acute PE-related right ventricular dysfunction?<\/em>',\n options: [\n 'McConnell\\'s sign (akinesia of RV free wall with apical sparing)',\n 'D-shaped interventricular septum',\n 'Dilated right ventricle with TR jet > 3 m\/s',\n 'Pericardial effusion with tamponade physiology',\n 'Paradoxical septal motion alone'\n ],\n answer: 'McConnell\\'s sign (akinesia of RV free wall with apical sparing)',\n explain: '<strong>McConnell\\'s sign \u2014 regional RV free-wall hypokinesia\/akinesia with preserved or hyperdynamic RV apex \u2014 is considered highly specific (~94%) for acute PE.<\/strong> It distinguishes acute PE from other causes of RV overload (e.g., primary pulmonary hypertension, where global RV dysfunction occurs). D-sign (septal flattening) and RV dilatation indicate RV pressure overload but are less specific. Echo is invaluable in haemodynamically unstable patients when CTPA is not immediately available.'\n },\n {\n stem: 'Which biomarker combination best identifies a patient with SUBMASSIVE (intermediate-high risk) PE who may benefit from escalated therapy?',\n options: [\n 'Elevated troponin + elevated BNP\/NT-proBNP + RV dysfunction on imaging',\n 'Elevated D-dimer alone',\n 'Elevated CRP + neutrophilia',\n 'Elevated fibrinogen + prolonged PT',\n 'Elevated LDH + reduced platelet count'\n ],\n answer: 'Elevated troponin + elevated BNP\/NT-proBNP + RV dysfunction on imaging',\n explain: '<strong>Submassive (intermediate-high risk) PE is defined by haemodynamic stability with evidence of RV strain.<\/strong> The combination of elevated troponin (myocardial injury), elevated BNP or NT-proBNP (wall stress), and echocardiographic\/CT evidence of RV dysfunction identifies patients at highest risk of deterioration who may warrant consideration of thrombolysis or catheter-directed therapy, despite stable blood pressure. This triad forms the basis of PESI-based risk stratification combined with imaging.'\n },\n {\n stem: '<em>A 72-year-old man with confirmed PE develops massive GI haemorrhage within 24 hours of starting anticoagulation. Anticoagulation must be discontinued.<\/em>Which intervention is MOST appropriate to prevent recurrent embolism?',\n options: [\n 'Insertion of an inferior vena cava (IVC) filter',\n 'Surgical embolectomy',\n 'Catheter-directed thrombolysis',\n 'Fondaparinux at reduced dose',\n 'Aspirin 300 mg daily'\n ],\n answer: 'Insertion of an inferior vena cava (IVC) filter',\n explain: '<strong>An IVC filter is indicated when anticoagulation is absolutely contraindicated or must be stopped due to life-threatening haemorrhage.<\/strong> It mechanically prevents lower-limb thrombi from embolising to the pulmonary circulation. Retrievable filters are preferred; they should be removed once anticoagulation can be safely resumed. IVC filters do not treat existing PE and do not reduce DVT \u2014 they only interrupt the embolic pathway. Long-term filter use increases the risk of recurrent DVT.'\n }\n ];\n\n\n \/* -----------------------------------------------------------------\n 2. FISHER-YATES SHUFFLE\n Shuffles an array in-place; returns the shuffled array.\n Used for answer options \u2014 prevents predictable answer positions.\n ----------------------------------------------------------------- *\/\n function shuffle(arr) {\n for (let i = arr.length - 1; i > 0; i--) {\n const j = Math.floor(Math.random() * (i + 1));\n [arr[i], arr[j]] = [arr[j], arr[i]];\n }\n return arr;\n }\n\n\n \/* -----------------------------------------------------------------\n 3. BUILD QUIZ DOM\n Shuffles questions, shuffles each option set, renders HTML.\n Correct answer is matched by TEXT CONTENT \u2014 not by original index \u2014\n so shuffling never breaks the answer key.\n ----------------------------------------------------------------- *\/\n function buildQuiz() {\n const questions = shuffle([...RAW_QUESTIONS]); \/\/ shuffle question order too\n const body = document.getElementById('quiz-body');\n body.innerHTML = '';\n\n questions.forEach(function(q, idx) {\n const shuffledOpts = shuffle([...q.options]); \/\/ shuffle options per question\n\n \/\/ Build options HTML\n let optsHTML = '';\n shuffledOpts.forEach(function(opt) {\n optsHTML += `\n <li>\n <label>\n <input type=\"radio\" name=\"q${idx}\" value=\"${escHtml(opt)}\" \/>\n ${escHtml(opt)}\n <\/label>\n <\/li>`;\n });\n\n body.insertAdjacentHTML('beforeend', `\n <div class=\"q-card\" id=\"qcard-${idx}\" data-index=\"${idx}\" data-answer=\"${escHtml(q.answer)}\">\n <p class=\"q-number\">Question ${idx + 1} of ${questions.length}<\/p>\n <p class=\"q-stem\">${q.stem}<\/p>\n <ul class=\"options\" role=\"radiogroup\" aria-label=\"Options for question ${idx + 1}\">\n ${optsHTML}\n <\/ul>\n <div class=\"explanation\" id=\"exp-${idx}\" role=\"note\">${q.explain}<\/div>\n <\/div>`);\n });\n\n \/\/ Track questions array on DOM for scoring (avoids global variable)\n body.dataset.total = questions.length;\n }\n\n\n \/* Helper: escape HTML for use in attributes \/ text *\/\n function escHtml(str) {\n return str\n .replace(\/&\/g, '&')\n .replace(\/<\/g, '<')\n .replace(\/>\/g, '>')\n .replace(\/\"\/g, '"');\n }\n\n\n \/* -----------------------------------------------------------------\n 4. PROGRESS COUNTER\n Counts how many questions have a radio selected; updates status bar.\n ----------------------------------------------------------------- *\/\n function updateProgress() {\n const total = parseInt(document.getElementById('quiz-body').dataset.total || 0);\n const answered = document.querySelectorAll('.options input[type=\"radio\"]:checked').length;\n document.getElementById('sb-progress-text').textContent = `${answered} \/ ${total} answered`;\n }\n\n\n \/* -----------------------------------------------------------------\n 5. SUBMIT \u2014 SCORE & REVEAL\n After submission:\n \u2022 Correct selected \u2192 label gets class \"correct\"\n \u2022 Wrong selected \u2192 label gets class \"wrong\"\n \u2022 Correct not selected \u2192 label gets class \"reveal-correct\"\n \u2022 Explanation shown beneath each question\n ----------------------------------------------------------------- *\/\n function handleSubmit() {\n const cards = document.querySelectorAll('.q-card');\n let correct = 0, wrong = 0, skipped = 0;\n\n cards.forEach(function(card) {\n const idx = card.dataset.index;\n const correctAns = card.dataset.answer; \/\/ set at build time\n const selected = card.querySelector(`input[name=\"q${idx}\"]:checked`);\n\n \/\/ Reveal explanation\n document.getElementById(`exp-${idx}`).style.display = 'block';\n\n if (!selected) {\n \/\/ Skipped: highlight correct answer\n skipped++;\n card.querySelectorAll('.options label').forEach(function(lbl) {\n if (lbl.textContent.trim() === correctAns) {\n lbl.classList.add('reveal-correct');\n }\n });\n return;\n }\n\n const chosen = selected.value;\n\n card.querySelectorAll('.options label').forEach(function(lbl) {\n const val = lbl.querySelector('input').value;\n if (val === correctAns) {\n \/\/ Always mark correct option green\n lbl.classList.add(chosen === correctAns ? 'correct' : 'reveal-correct');\n } else if (val === chosen) {\n \/\/ Mark wrong selection red\n lbl.classList.add('wrong');\n }\n });\n\n if (chosen === correctAns) { correct++; } else { wrong++; }\n });\n\n \/\/ Net score\n const net = correct * 4 - wrong;\n\n \/\/ Show scoreboard\n document.getElementById('score-net').textContent = net;\n document.getElementById('score-c').textContent = correct;\n document.getElementById('score-w').textContent = wrong;\n document.getElementById('score-s').textContent = skipped;\n document.getElementById('scoreboard').style.display = 'block';\n\n \/\/ Disable inputs, swap buttons\n document.getElementById('quiz-wrap').classList.add('submitted');\n document.getElementById('submit-btn').style.display = 'none';\n document.getElementById('reset-btn').style.display = 'inline-block';\n\n \/\/ Scroll to scoreboard\n document.getElementById('scoreboard').scrollIntoView({ behavior: 'smooth', block: 'start' });\n }\n\n\n \/* -----------------------------------------------------------------\n 6. RESET \u2014 rebuild and scroll to top\n ----------------------------------------------------------------- *\/\n function handleReset() {\n document.getElementById('quiz-wrap').classList.remove('submitted');\n document.getElementById('submit-btn').style.display = 'inline-block';\n document.getElementById('reset-btn').style.display = 'none';\n document.getElementById('scoreboard').style.display = 'none';\n buildQuiz();\n updateProgress();\n window.scrollTo({ top: 0, behavior: 'smooth' });\n }\n\n\n \/* -----------------------------------------------------------------\n 7. INTERSECTIONOBSERVER \u2014 STATUS BAR VISIBILITY\n Watches the #sentinel div. When sentinel is NOT intersecting\n (user has scrolled past the header), the status bar becomes visible.\n ----------------------------------------------------------------- *\/\n function initStatusBar() {\n const sentinel = document.getElementById('sentinel');\n const statusBar = document.getElementById('status-bar');\n\n if (!window.IntersectionObserver) {\n \/\/ Fallback for very old browsers: always show bar\n statusBar.classList.add('visible');\n return;\n }\n\n const observer = new IntersectionObserver(\n function(entries) {\n entries.forEach(function(entry) {\n if (entry.isIntersecting) {\n statusBar.classList.remove('visible'); \/\/ near top \u2014 hide bar\n } else {\n statusBar.classList.add('visible'); \/\/ scrolled away \u2014 show bar\n }\n });\n },\n { threshold: 0 }\n );\n\n observer.observe(sentinel);\n }\n\n\n \/* -----------------------------------------------------------------\n 8. INIT \u2014 wire everything up on DOMContentLoaded\n ----------------------------------------------------------------- *\/\n document.addEventListener('DOMContentLoaded', function() {\n buildQuiz();\n updateProgress();\n initStatusBar();\n\n \/\/ Listen for any radio change to update progress counter\n document.getElementById('quiz-body').addEventListener('change', updateProgress);\n\n document.getElementById('submit-btn').addEventListener('click', handleSubmit);\n document.getElementById('reset-btn').addEventListener('click', handleReset);\n });\n\n })(); \/\/ end MRQuiz IIFE\n <\/script>\n\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>Morning Rounds: Pulmonary Embolism Quiz PE Quiz 0 \/ 10 answered Morning Rounds \u00b7 Clinical Quiz Pulmonary Embolism Diagnosis, risk stratification & management \u2014 10 questions +4 correct | \u22121 wrong | 0 skipped Submit Quiz Retake Your Score \u2014 Net score \u00b7 Formula: c \u00d7 4 \u2212 w \u2014 Correct \u2014 Wrong \u2014 Skipped… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[24],"tags":[],"class_list":["post-36701","post","type-post","status-publish","format-standard","hentry","category-neet-pg"],"yoast_head":"\n<title>Pulmonary Embolism Clinical - 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