Sudden onset dyspnea and pleuritic chest pain in a postoperative patient with tachypnea and clear lung fields are classic features of a pulmonary embolism (PE). Recent orthopedic surgery significantly increases VTE risk. Clear lungs on auscultation support this over pneumonia or CHF.

Toronto Notes 2023 – Respiratory, “Pulmonary Embolism”:

“Presentation includes sudden dyspnea, pleuritic chest pain, and tachypnea. Risk factors include recent surgery and immobilization. Examination often reveals clear chest auscultation.”

MCCQE1 Objectives (Internal Medicine > Cardiopulmonary > 44-1):

“Candidates must recognize PE in patients with risk factors (e.g., surgery) and classic features and initiate appropriate diagnosis and management.”

Fat embolism (B) usually presents with petechiae, neurologic symptoms, and occurs within 24–72 hours post-op. Cholesterol emboli (E) are more chronic and systemic.

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