Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for a patient experiencing dyspnea, nonproductive cough, and chest pain after recent knee surgery?

1. Pneumonia

2. Pulmonary embolism

3. Acute bronchitis

4. Congestive heart failure

The correct answer is: Pulmonary embolism

The presentation of dyspnea, nonproductive cough, and chest pain in the context of recent knee surgery raises a strong suspicion for pulmonary embolism. This condition is often seen in patients who have undergone surgical procedures, especially orthopedic surgeries like knee surgery, where there is a higher risk of venous thromboembolism due to immobility and potential for deep vein thrombosis (DVT). Pulmonary embolism typically presents with sudden onset of dyspnea and pleuritic chest pain, which occurs as clot fragments travel to the pulmonary arteries and obstruct blood flow. The nonproductive cough may also be related to the irritation of the airways or the lung parenchyma secondary to the embolus. Additionally, risk factors such as recent surgery, particularly involving the lower extremities, significantly increase the likelihood of this diagnosis. In contrast, pneumonia usually presents with productive cough, fever, and chills, while acute bronchitis is characterized by cough that typically is productive and lasts less than three weeks. Congestive heart failure could lead to similar symptoms, but it generally manifests over a longer time frame and often includes signs of fluid overload, such as edema and orthopnea. Given the acute nature and context of this patient’s symptoms, pulmonary embol