PAEA Surgery End Of Rotation (EOR) Practice Exam

In a surgical patient presenting with dyspnea on exertion, what condition should most urgently be ruled out?

1. Pneumonia

2. Pulmonary embolism

3. Asthma attack

4. Pneumothorax

The correct answer is: Pulmonary embolism

In a surgical patient presenting with dyspnea on exertion, pulmonary embolism should be ruled out as a priority due to its potential to rapidly produce serious complications or even be life-threatening. Pulmonary embolism occurs when a blood clot travels to the lungs, blocking a pulmonary artery. This condition can present acutely with symptoms such as dyspnea, chest pain, and sometimes hemoptysis, and it is particularly critical to assess in the surgical population because they often have risk factors such as immobility and hypercoagulability. The urgency lies in the fact that untreated pulmonary embolism can lead to reduced oxygenation and can cause hemodynamic instability, resulting in shock or cardiac arrest. Immediate diagnosis and management are crucial through imaging, typically with a CT pulmonary angiogram, and prompt initiation of anticoagulation if a DVT has been confirmed. While pneumonia, asthma attacks, and pneumothorax are also significant conditions to consider in a patient with dyspnea, they generally present less acutely in the context of surgery unless there are additional clear clinical indicators pointing toward these conditions. Pneumonia may develop post-operatively due to factors such as aspiration or limited mobility but is usually less urgent than a suspected pulmonary embolism.